Daily Health Policy Report

Friday, January 25, 2013

Last updated: Fri, Jan 25

KHN Original Reporting & Guest Opinion

Health Reform

Health Spending And Fiscal Battles

Capitol Hill Watch


Women's Health

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

TurboTax, Not Travelocity, May Be Better Analogy For Health Exchanges

Colorado Public Radio's Eric Whitney, working in collaboration with Kaiser Health News and NPR, reports: "For years, we've been hearing that health insurance exchanges created by the Affordable Care Act are going to be 'online marketplaces, like Travelocity' where people will buy health policies like plane tickets. But a consumer focus group in Colorado suggests people are going to want something more like TurboTax" (Whitney, 1/25). Read the story.

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Q&A: Picking Health Insurance For Your Newborn (Video)

Kaiser Health News consumer columnist Michelle Andrews answers a reader question about how expectant parents can figure out which of their health insurance plans will best cover their child (1/25). Watch the video.

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Capsules: Americans Want Deficit Addressed Without Medicare Cuts, Poll Finds

Now on Kaiser Health News' blog, Mary Agnes Carey reports: "Most Americans want quick action to reduce the deficit, but almost six in 10 oppose cutting Medicare spending to achieve that goal, according to a new poll released today. Lawmakers should examine other alternatives, including requiring drug makers to give the government 'a better deal' on medications for low-income seniors (85 percent) and making higher-income seniors pay more for coverage (59 percent), according to the survey conducted by the Kaiser Family Foundation, the Robert Wood Johnson Foundation and the Harvard School of Public Health" (Carey, 1/24). Check out what else is on the blog.

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Political Cartoon: 'You Won't Feel A Thing'

Kaiser Health News provides a fresh take on health policy developments with "You Won't Feel A Thing" by Chris Wildt.

Meanwhile, here is today's health policy haiku:


It is amazing
how the word marketplace changed
thoughts on an exchange.

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Health Reform

Medicaid Expansion Raises Possibilities, Problems For States

California Gov. Jerry Brown describes implementing the expansion as "incredibly complex," while Michigan Gov. Rick Snyder sees it an opportunity to address gaps in the mental health system. In Arizona, meanwhile, the expansion is framed as an immigration issue.

Los Angeles Times: Gov. Jerry Brown Calls For Special Session Of Legislature On Healthcare
Healthcare and education reform were key themes of Gov. Jerry Brown's State of the State address Thursday in which he called for the Legislature to convene a special session to work out issues involving the state's compliance with the federal Affordable Care Act. "Our health benefit exchange, called Covered California, will begin next year providing insurance to nearly one million Californians," Brown said. "Over the rest of this decade, California will steadily reduce the number of uninsured." But he said it will be "incredibly complex" to implement a broader expansion of Medi-Cal called for by the federal law (McGreevy, 1/24).

State Of Health: Gov. Brown's State Of The State – On The Health Care Overhaul
In his State of the State speech Thursday morning, Gov. Brown spent about 60 seconds addressing health and human services — and all those seconds were devoted to the rollout of the Affordable Care Act. Early in his speech, Brown reiterated his theme of fiscal discipline and seemed to urge caution in implementing the Affordable Care Act, stating, "The ultimate costs of expanding our health care system under the Affordable Care Act are unknown. Ignoring such known unknowns would be folly." … Let’s take these two items one at a time, starting with the health benefit exchange. Brown is calling for a special legislative session so that new laws necessary to implement the exchange can take effect more quickly. That speed is necessary since the exchange must open for people to enroll on October 1. Health insurance purchased in the exchange will start on January 1, 2014 (Aliferis, 1/24).

The Associated Press: Snyder Eyes Mental Health Makeover, GOP Skeptical
Gov. Rick Snyder's plan to fill the gaps of Michigan's mental health care system might lie in his ability to convince lawmakers on both sides of the aisle to expand Medicaid to provide 500,000 Michigan residents with coverage under the federal Affordable Health Care Act. Snyder, a Republican, told the Associated Press on Wednesday that it would "actually expand mental health coverage significantly" and that it is "one of the factors" he is "taking into account." Snyder said he will "make that call" during his budget presentation Feb. 7 (Durkin, 1/25).

The Washington Post's Wonk Blog: Arizona Could Make The Medicaid Expansion An Immigration Fight
Arizona Gov. Jan Brewer's decision to participate in the Medicaid expansion was a puzzling one: Why would one of the nation's most conservative governors opt into an Obamacare program that most of her Republican colleagues have rejected? New budget memos from the state provide some insight: Opting out of the Medicaid expansion had the potential to give immigrants better access to health care than American citizens. This small quirk in the Affordable Care Act that Arizona stumbled on could significantly reshape the politics for governors weighing whether to sign up for the health law's Medicaid expansion (Kliff, 1/24).

Dallas Morning News: Quirk In Health Care Law Could Set Up Tough Choice For Rick Perry On Medicaid
A glitch in the federal health care law could put Gov. Rick Perry over a political barrel. Under President Barack Obama's signature measure, some legal immigrants will receive subsidies to help buy private insurance next year. But thanks to a legal quirk and an unexpected twist from the Supreme Court, hundreds of thousands of poor Texans who are U.S. citizens stand to get nothing if Perry and state GOP leaders follow through in refusing a mostly federally paid expansion of Medicaid. The prospect that immigrants, even legal ones, possibly could receive better treatment under the law than native Texans may not faze Perry, especially as he guards his right flank against a possible challenge by Attorney General Greg Abbott in the 2014 governor’s race, said Rice University political scientist Mark Jones (Garrett, 1/24).

Also in the news related to state action and the health law --

Kaiser Health News: TurboTax, Not Travelocity, May Be Better Analogy For Health Exchanges
For years, we've been hearing that health insurance exchanges created by the Affordable Care Act are going to be 'online marketplaces, like Travelocity' where people will buy health policies like plane tickets. But a consumer focus group in Colorado suggests people are going to want something more like TurboTax (Whitney, 1/25).

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Health Spending And Fiscal Battles

Poll: 6 in 10 Oppose Cutting Medicare To Lower Deficit

A new poll from the Kaiser Family Foundation has found that most of the public wants deficit reduction, but they want it without cutting major social programs like Medicare and Medicaid. On health care, the public favors requiring drug makers to give the government 'a better deal' on medications for low-income seniors and making higher-income seniors pay more for coverage to reduce the deficit. Kaiser Health News is an editorially independent program of the Foundation.

Reuters: Public Wants Deficit Reduction But Not Programs Cuts: Polling Data
Most Americans want President Barack Obama and Congress to reduce the federal deficit without cutting Medicare, Social Security and education, according to polling data released Thursday. A joint survey by the Robert Wood Johnson Foundation, the Harvard School of Public Health and the Kaiser Family Foundation also showed majorities support President Barack Obama's plan to expand Medicaid and provide subsidized private health insurance to working families through new online state exchanges (Morgan, 1/24).

The Wall Street Journal's Washington Wire: Whose Budget Fix Is More Popular?
Democracy has its merits, lots of them. But trying to find a popular fix to the budget deficit by parsing public-opinion polls is, well, a challenge. … But 58 percent oppose any spending cuts to Medicare or Social Security, and 46% oppose cuts to Medicaid. Three quarters said the deficit can be cut without major reductions in Medicare. That takes a lot of federal spending off the table (Wessel, 1/24).

Kaiser Health News: Capsules: Americans Want Deficit Addressed Without Medicare Cuts, Poll Finds
Most Americans want quick action to reduce the deficit, but almost six in 10 oppose cutting Medicare spending to achieve that goal, according to a new poll released today. Lawmakers should examine other alternatives, including requiring drug makers to give the government 'a better deal' on medications for low-income seniors (85 percent) and making higher-income seniors pay more for coverage (59 percent), according to the survey conducted by the Kaiser Family Foundation, the Robert Wood Johnson Foundation and the Harvard School of Public Health" (Carey, 1/24). 

Politico: Public Not Keen On D.C.'s Medicare Ideas
Americans want Washington to keep its hands off their Medicare. That’s the gist of a poll released Thursday showing that the public isn’t ready for the dramatic changes in Medicare that are under discussion to help control the nation’s finances (Haberkorn, 1/24).

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Capitol Hill Watch

Lawmakers Target Fiscal Cliff's Provision Aiding Amgen For Elimination

The fiscal cliff legislation approved earlier this month excluded Amgen's Sensipar, which is used by kidney dialysis patients, from Medicare price controls for an additional two years.

Los Angeles Times: Lawmakers Seek To Repeal 'Fiscal-Cliff' Provision Aiding Amgen
A bipartisan group of U.S. lawmakers is seeking to repeal a Medicare-pricing provision in the recent "fiscal-cliff" deal in Congress that benefits Thousand Oaks biotech giant Amgen Inc. Legislation to eliminate the exemption for a class of drugs, including Amgen's Sensipar, that are used by kidney dialysis patients, was filed this week by U.S. Rep. Peter Welch (D-Vt.). The fiscal cliff legislation approved this month excluded these oral medications from Medicare price controls for an additional two years (Terhune, 1/25).

Meanwhile, Sen. Orrin Hatch, R-Utah, issues a list of five Medicare and Medicaid changes that he predicts would draw bipartisan support --  

The Hill: Hatch Outlines 5 Entitlement Reforms He Says Could Pass
Sen. Orrin Hatch (R-Utah) said Thursday that a package of five changes to Medicare and Medicaid should be able to gain bipartisan support in Congress, casting the proposals as a way to reform entitlements without the dramatic changes Republicans have also supported. Probably the most controversial measure in Hatch's proposals is a per-person cap on Medicaid spending (Baker, 1/24).

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Senate Hearing Urges Action On Obama Mental Health Care Agenda

Democrats and Republicans expressed concerns about gaps in the system at the Senate Health, Education, Labor and Pensions Committee.

Politico: Newtown Renews Panel's Focus On Mental Health
At a hearing Thursday, Democrats and Republicans on the Health, Education, Labor and Pensions Committee urged the Obama administration to hurry up aspects of its mental health agenda. The lawmakers didn't specifically talk much about gun violence or President Barack Obama's sweeping proposals to combat it after the school shooting in Newtown, Conn. But there was a fair amount of bipartisan concern about gaps in access to mental health care, and about unfinished pieces of the mental health system (Cunningham, 1/25).

Reuters: U.S. Mental Health Experts Urge Focus On Early Treatment
The U.S. mental health system has huge gaps that prevent millions of people with psychological problems, including children and teens, from receiving effective treatment that could prevent tragic consequences, experts told U.S. lawmakers on Thursday. ... experts told a Senate hearing that three-quarters of mental illnesses emerge by age 24, but fewer than one in five youths with diagnosable problems receive treatment that could avoid later problems including violence and suicide (Morgan, 1/24).

Related, earlier KHN story: Children, Teens, Young Adults Focus Of Mental Health Provisions In Obama's Gun Plan (Varney, 1/17).

The Hill: US Mental Health Chief Says Treatment Cuts The Risk Of Violence
The risk of violent behavior drops 15-fold for people who receive treatment for psychosis as opposed to those who do not, the U.S. mental health chief said Thursday. Thomas Insel, director of the National Institute of Mental Health (NIMH), spoke at a Senate hearing ... He argued for "closing that gap" between the onset of symptoms, diagnosis and treatment (Viebeck, 1/24).

Also --

The Associated Press: Begich Proposed Bill To Improve Mental Health Care
Sen. Mark Begich is co-sponsoring legislation aimed at improving mental health care in this country. The proposal is an expansion on a measure that Begich proposed last year to improve mental health services on college campuses but that died with the last Congress. The new plan has drawn bipartisan support, which Begich said should help the measure gain traction (Bohrer, 1/24).

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Medicare Foots $120 Million Bill For Ineligible Patient Groups

According to two government reports, the Medicare program was billed for more than $33 million in inmate care and more than $91 million for illegal immigrant care between 2009 and 2011. Medicare generally does not pay for services for either of these patient groups.

The Associated Press: Reports: Medicare Paid $120M In Illegal Care
The taxpayer-funded Medicare program paid more than $120 million from 2009 to 2011 in violation of federal law for medical services for inmates and illegal immigrants, according to two reports issued Thursday by federal health officials. Under federal law, Medicare generally does not pay for services for either group of patients (Kennedy, 1/24).

Meanwhile --

Bloomberg: Drugmakers Prep For U.S. Rules On Disclosing Payments
Drug companies and medical-device makers would be forced to publicly disclose any money paid to doctors under new U.S. regulations designed to make patients aware of conflicts of interest that may affect their health. The final rule, a provision in President Barack Obama’s health law that is more than a year overdue, is set to be released soon, said Brian Cook, a spokesman for the Centers for Medicare and Medicaid Services. Companies would have to publish payments to doctors for research and consulting services (Edney and Wayne, 1/24).

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Women's Health

Anti-Abortion Protestors Marking Roe V. Wade Anniversary With D.C. March

Meanwhile, a coalition including business interests, state officials and educational institutions is gelling around efforts to fight the health law's contraception mandate.

USA Today: Anti-Abortion March To Draw Thousands To Washington
Hundreds of thousands of people are expected to fill the National Mall on Friday to protest the 40-year-old landmark Roe v. Wade Supreme Court decision that legalized abortion in the first trimester. Buses are shuttling in anti-abortion protesters from all over the country for the annual March for Life. Organizers predict many of them will be young people (1/25).

Roll Call: Unlikely Coalition Fights Contraception Mandate
Abortion opponents rallying by the thousands Friday in Washington at the annual March for Life have lost some political battles lately but won a string of court victories, thanks in part to a diverse coalition challenging a contraception mandate in the health care overhaul. For-profit businesses, state attorneys general and educational institutions are among more than 100 plaintiffs who have mounted some 40 lawsuits challenging the mandate, according to the Becket Fund for Religious Liberty, a nonprofit legal institute that has played a leading role in the suits (Carney, 1/24).


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State Watch

Some States Reconsider Funding For Mental Health Care

In the wake of the Sandy Hook Elementary School killings in Connecticut, state lawmakers and governors talk about boosting mental health care.

The Miami Herald: Florida Legislature Now Rethinking Mental Health Spending
In light of the tragic shootings in Connecticut and Colorado, Florida legislators are taking a hard look at the state’s mental health system, which ranks 49th among states and the District of Columbia when it comes to funding. ... Legislators need to look at the continuum of care “from prevention to identification to intervention to treatment,” [Rep. Gayle] Harrell said, if any improvements can occur in a system where issues range from school safety to finding places for mentally impaired nursing home patients (Koff, 1/24).

Kansas Health Institute: Mental Health Advocates Urge Evidence-Based Approach To Curbing Violence
Advocates for mentally ill Kansans said today that policies aimed at preventing mass shootings and other acts of violence should be based on evidence not inaccurate generalizations and stereotypes. ... Often what goes wrong, [Rick] Cagan said, is that people with serious mental illnesses fall through the cracks of an inadequate mental health system. He said one-third of people who need help don’t get it in time to avert a crisis (McLean, 1/24).

MPR News: [Minn. Gov.] Dayton: Counties Should Pay More For Mental Health Treatment At 2 Facilities
The governor's budget proposal, released Tuesday, calls for counties to pay a greater share of the cost for patients at the troubled Minnesota Security Hospital and the Anoka Metro Regional Treatment Center. ... By requiring counties to pay more, counties will have a financial incentive to work more quickly to move patients back into the community, said Anne Barry, deputy commissioner of the state Department of Human Services. The state would use the extra money to pay for mental health services for former patients who need assistance with housing, in-home medical care and other issues, Barry said (Baran, 1/25).

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State Highlights: N.Y. Plans For Big Budget Hole After Medicaid Cuts

A selection of health policy news from New York, Texas, Vermont, New Mexico, California and Puerto Rico.

The Wall Street Journal: Budget Hole Seen After Loss Of Aid
New York state is drawing up plans for a budget shortfall almost twice as large as the $1.35 billion gap described by Gov. Andrew Cuomo on Tuesday, as the federal government seeks to reduce how much it pays for health care to some of the state's most severely disabled people. Health care officials in Washington and New York are negotiating a plan that would squeeze between $800 million and $1.1 billion out of federal Medicaid spending, potentially blowing a new hole in the annual budget Mr. Cuomo proposed on Tuesday (Nahimias, 1/24).

The Texas Tribune: Bill Proposing Tax Break Targets Contraception Rule
A bill filed Thursday in the Texas House would give religiously based businesses, such as Hobby Lobby, a state tax break if the businesses were forced to comply with the federal government's mandate that employers provide contraception coverage. The contraception rule, part of federal health care reform, requires employment-based health insurance plans to cover contraception (Aaronson, 1/24).

The Associated Press: Vermont Gov Wants More Time On $1.6B Health Plan
After two years of pressure to say how it was going to pay for its single-payer health care plan, Gov. Peter Shumlin's administration on Thursday released a new accounting of what Vermont's universal health care system might cost, but left for later how it would be paid for. Reports released by the governor's office say Vermonters would have to pay $1.6 billion in new taxes to pay for their share of a single-payer system that can't be implemented until 2017 (Gram, 1/25).

ABC News: N.M. State Rep Takes Heat For Bill That Criminalizes Abortion In Cases Of Rape
New Mexico State Rep. Cathrynn Brown has come under attack for a bill she recently introduced that would brand survivors of rape and incest who become pregnant and chose to have abortions as felons. On Wednesday, Brown, a Republican from Carlsbad, submitted House bill 206, which equates a pregnancy resulting from rape or incest as evidence, meaning that terminating the pregnancy would constitute destruction of evidence."Tampering with evidence shall include procuring or facilitating an abortion, or compelling or coercing another to obtain an abortion of a fetus that is the result of criminal sexual penetration or incest with the intent to destroy evidence of the crime," the bill reads (Parnass, 1/24).

The Texas Tribune/New York Times: Despite Counsel, Victim Is Hindered By Tort Laws
When Connie Spears arrived at a Christus Santa Rosa hospital emergency room in 2010 with severe leg pain, she told medical staff members about her history of blood clots. Doctors sent her home with a far less serious diagnosis. Days later, swollen and delusional, Ms. Spears was taken by ambulance to another hospital where doctors found a severe clot and extensive tissue damage. With her life on the line, they amputated both of her legs above the knee. Nearly three years later, Ms. Spears contends that she is a victim not only of a medical mistake but also of Texas' tort reform laws (Aaronson, 1/24).

The New York Times: Judge Orders HCA To Pay $162 Million To Foundation
HCA, the nation's largest profit-making hospital chain, was ordered on Thursday to pay $162 million after a judge in Missouri ruled that it had failed to abide by an agreement to make improvements to dilapidated hospitals that it bought in the Kansas City area several years ago (Creswell, 1/24).

California Healthline: So Far, Healthy Families Transition Going Smoothly
Given the immense amount of worry and concern over the planned shift of 860,000 kids out of the Healthy Families program and into Medi-Cal managed care plans, there has been surprisingly little turmoil throughout the start of the first phase of that transition. Healthy Families is California's Children's Health Insurance Program, and Medi-Cal is the state's Medicaid program. "Phase 1 has gone extremely smoothly," said Jane Ogle, deputy director for the Department of Health Care Services. … The transition started Jan. 1, moving 197,000 children to Medi-Cal managed care plans. So far, according to DHCS officials, the telephone complaint hotline has been pretty quiet (Gorn, 1/24).

MPR News: Puerto Rican Provider Joins Mayo Network
A Puerto Rican medical and dental provider has joined the Mayo Clinic as the newest member of its care network. San Juan-based Clinica Salus is the first health system in the Caribbean to join Mayo's care network. It provides services to patients at locations in San Juan and around the island. Bob Brigham, chief administrative officer for Mayo Clinic's Florida campus, said under the new partnership, Salus physicians will have access to Mayo Clinic specialists and medical information closer to home. "Our physicians have networked with their physicians, historically. And we've referred patients back and forth, between the organizations for a number of years," Brigham said. "This is a chance to build and formalize on that relationship" (Baier, 1/24).

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Health Policy Research

Research Roundup: Does Higher Rx Drug Spending Lower Medicare Costs?

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs. 

Health Affairs: Regions With Higher Medicare Part D Spending Show Better Drug Adherence, But Not Lower Medicare Costs For Two Diseases – Researchers aimed to find a relationship between geographic variation in Medicare Part D spending and medication-taking behavior among patients with diabetes or heart failure. “If systematic regional differences do exist, then policy makers can use this information to better target interventions designed to improve the quality and efficiency of Medicare service delivery,” they write. After analyzing 2006 and 2007 data, they concluded: "We found that beneficiaries residing in areas characterized by higher adjusted drug spending had significantly more 'therapy days'—days with recommended medications on hand—than did beneficiaries in lower-spending areas. However, we did not find that this factor translated into short-term savings in Medicare treatment costs for these two diseases (Stuart, Shoemaker, Dai and Davidoff, 1/2013).

Journal of the American College of Radiology: Provider Cost Transparency Alone Has No Impact on Inpatient Imaging Utilization
The researchers write: "Using data from fiscal year 2007, the 10 most frequently ordered imaging tests [at Johns Hopkins Hospital] were identified." From Nov. 2009 to May 2010, they showed the prices of five of the tests and did not show them for the other five to the radiologists ordering the tests. They found that "the mean utilization change was +2.8 ± 4.4% for the active group and −3.0 ± 5.5% for the control group, with no significant difference between the two groups. There was also no significant difference in the correlation between test cost and utilization change ... Provider cost transparency alone does not significantly influence inpatient imaging utilization" (Durand, Feldman, Lewin and Brotman, 1/2).

Journal Of Nursing Care Quality: Early-Career Registered Nurses’ Participation In Hospital Quality Improvement Activities – According to the authors, health care leaders and experts agree that engaging registered nurses (RNs) in quality improvement (QI) efforts is essential to improving the nation’s health care system. Researchers compared the participation levels in QI activities between early-career registered nurses from 15 states – one cohort licensed to practice 2004-2005 and the other 2007-2008. “We found no statistically significant differences in QI participation between the 2 cohorts, with the exception of their reported use of appropriate strategies to improve hand-washing compliance to reduce nosocomial infection rates,” the authors write. “We believe that these findings are significant because they highlight the need to increase mobilization of RNs for QI,” they conclude (Djukic, Kovner, Brewer and Bernstein, 1/2013).

JAMA Surgery: Residential Segregation And Lung Cancer Mortality In The United States – "This is the first study, to our knowledge, to examine the specific effect of residential segregation on lung cancer morality using data inclusive of the entire US population," the authors write. After analyzing data from the 2009 Area Resource File and Surveillance, Epidemiology and End Results program, they found that the overall lung cancer death rate between 2003 and 2007 was higher among blacks than for whites and "[b]lacks living in counties with the highest levels of segregation had a 10% higher mortality rate than those residing in counties with the lowest level of segregation." They conclude: “Our data confirm that blacks have been disproportionately affected by segregation and that the greater the segregation, the worse the lung cancer outcomes for this community” (Hayanga, Zeliadt, and Backhus, 1/2013).  

Kaiser Commission on Medicaid and the Uninsured/Kaiser Family Foundation: Faces of the Medicaid Expansion: How Obtaining Medicaid Coverage Impacts Low-Income Adults – The authors write that "the Affordable Care Act (ACA) seeks to fill the longstanding gap in Medicaid coverage for low-income adults by expanding eligibility to a minimum floor of 138% of the federal poverty level (FPL), or $24,344 for a family of 3 in 2012. ... To provide insight into the potential impacts of expanding Medicaid, this report highlights the experiences of adults in California, Connecticut, Minnesota, and the District of Columbia, which all have already expanded Medicaid to adults. Based on focus groups and interviews with previously uninsured adults who recently gained Medicaid coverage in these states, it examines the personal impacts gaining coverage had on individuals’ health, finances, employment, and overall well-being" (1/23).  

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Editorials and Opinions

Viewpoints: Medicare Obligation Is Heavy Future Obligation; Mental Health's 'Elephant In The Room'

The Wall Street Journal: Yes, Mr. President, We Are A Nation Of Takers 
A growing body of empirical evidence points to increasing dependency on state largess. The evidence documents as well a number of perverse and disturbing changes that this entitlement state is imposing on society. ... Social Security and Medicare have already made tens of trillions of dollars in future promises that are not covered by their expected funding streams. If and when outside resources are required to honor their promises, these entitlements become transfer programs, not insurance programs (Nicholas Eberstadt, 1/24).

The Washington Post: Health Care Threatens To Crush U.S. Growth
The 2012 annual report for the federal government, released last week, continues to use dubious accounting standards to avoid putting the cost of government retirement promises into the headline deficit of $1.1 trillion. ... One example is the cost, in today’s dollars, to make Social Security and Medicare solvent for the next 75 years ... Every other developed country delivers universal health care with better results and lower costs. The U.S. government’s own annual report shows that our finances are unsustainable unless we do the same (Bryan R. Lawrence, 1/24).

The New York Times: Deficit Hawks Down
President Obama’s second Inaugural Address offered a lot for progressives to like. There was the spirited defense of gay rights; there was the equally spirited defense of the role of government, and, in particular, of the safety net provided by Medicare, Medicaid and Social Security. But arguably the most encouraging thing of all was what he didn’t say: He barely mentioned the budget deficit (Paul Krugman, 1/24).

National Journal: We Need To Talk About Mental Health Even If It’s Only A Sideshow To The Gun Control Debate
The federal law governing mental-health allocations to states hasn’t been reauthorized since 2000. Over the past three years, budget cuts have cost state mental-health systems $4.3 billion, according to the research institute connected with the National Association of State Mental Health Program Directors. Sandy Hook offers an opportunity to address the mental-health components of violence. If the conversation is a sideshow to gun control, so be it (Fawn Johnson, 1/24).

National Journal: Why Improving Mental Health Would Do Little To End Gun Violence 
[A]lthough people with serious mental illness have committed a large percentage of high-profile crimes, the mentally ill represent a very small percentage of the perpetrators of violent crime overall. Researchers estimate that if mental illness could be eliminated as a factor in violent crime, the overall rate would be reduced by only 4 percent. ... Better screening and treatment could, however, make a significant difference in preventing one type of violence. Those who suffer from mental illness are much more likely to harm themselves than other people (Margot Sanger-Katz, 1/25).

Boston Globe: All Americans Are At Risk
Statistics show the United States ranking below other rich countries on health measures are often broadly attributed to the lack of public health resources and dangerous environments confronting Americans who are poor or members of minority groups. But while unequal access to health care remains a problem, a new report by the National Institutes of Health has a sobering message: Unhealthy and unsafe practices are leaving even well-off Americans with lower life-expectancies than their peers in other countries (1/25).

Health Policy Solutions (a Colo. news service): Colorado Medicaid Expansion Would Make 86,000 College Students Eligible
Gov. John Hickenlooper wants yet another expansion of Colorado Medicaid. This one will cover the more than 86,000 college students in Colorado that the Census Bureau estimates have incomes below the federal poverty level. ... Many Colorado colleges already require students to buy health coverage. But Medicaid enrollment is free and it covers everything from unnecessary emergency room visits and major surgery to over-the-counter drugs with $5 copays and no deductible. Students and their parents know a good deal when they see one (Linda Gorman, 1/24).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.