Daily Health Policy Report

Monday, January 28, 2013

Last updated: Mon, Jan 28

KHN Original Reporting & Guest Opinion

Health Spending And Fiscal Battles

Health Reform

Health Care Marketplace

Capitol Hill Watch

Coverage & Access

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Independence Of Long-Term Care Ombudsman Challenged In Some States

Reporting for Kaiser Health News, in collaboration with USA Today, Jenni Bergal writes: "The 2.3 million elderly or disabled people living in nursing homes or assisted living centers might not know it, but they've got an advocate – someone who's supposed to be looking out for their health, safety and rights" (Bergal, 1/27). Read the story.

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Retiring Medicare Actuary Reflects On The Politics Of Spending And Why He Almost Quit

Kaiser Health News staff writer Mary Agnes Carey, working in collaboration with Politico Pro, reports: "Richard S. Foster is retiring this week after 18 years as the chief actuary for the Centers for Medicare and Medicaid Services. His duties included projecting Medicare and Medicaid spending and the cost of health care legislation to help policymakers weigh the impact on the federal budget. Some of those estimates got him into hot water with members of both parties" (Carey, 1/28). Read the story.

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Political Cartoon: 'Cautious Pessimism?'

Kaiser Health News provides a fresh take on health policy developments with "Cautious Pessimism?" By Chris Weyant.

Meanwhile, here is today's health policy haiku:


Birth control mandate
still creating legal stir.
So many cases...

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 Spending And Fiscal Battles

Democrats Defend Safety Net, Propose Modest Adjustments

Meanwhile, House Budget Committee Chairman Paul Ryan, R-Wis., portrays spending cuts to those programs as a path to growth.

The New York Times' Political Memo: Obama Focuses On Status Quo, Not Left, In Battle With GOP
That partisan gibe was telling. He defended two programs, Medicare and Medicaid, begun nearly a half-century ago, and a third, Social Security, that dates from the Great Depression. The federal welfare commitments that Mr. Obama praised in observing that "a great nation must care for the vulnerable" also date back to President Franklin D. Roosevelt's time. Yet all those benefits are in the cross-fire of the president's continuing fiscal battle with Republicans in Congress. That is not because of a shift in philosophy by Mr. Obama or his party, but rather because of the looming cost of the retirements of baby boomers and of the persistent ideological boldness of partisan foes (Harwood, 1/27).

Politico: The Quiet Liberal Plans For Entitlement Reform
Ask liberals about GOP demands to rein in Social Security and Medicare spending, and many say this: no way. But the truth is, there are a number of ideas to do just that already sitting on the shelves of influential liberal think tanks around Washington (Nather, 1/27).

Roll Call: Ryan Defends GOP Views On Spending Cuts
"I think the sequester is going to happen," [Rep. Paul] Ryan said of the roughly $85 billion in fiscal 2013 spending cuts scheduled to occur in March throughout government operations, especially those linked to the Defense Department. "We think these sequesters will happen because the Democrats have rejected our efforts to replace those cuts with others and have offered no alternatives" (Dumain, 1/27).

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Health Reform

Building Health Insurance Exchanges

News outlets report on small business concerns, the potential impact of immigration reform and how some medical device makers are passing on new fees to their customers.

Stateline: Future Of Health Law Is Largely In State Hands
After running a gauntlet of legal and political opposition, the Affordable Care Act is poised to bring the United States closer than it has ever been to universal health insurance. But just how close it gets will be up to individual states. To reach its goal of covering 30 million low-income Americans in 2014, the Obama administration wants states to take two crucial steps: create an online health insurance exchange where people can sign up for coverage; and expand state Medicaid programs to cover 17 million more low-income adults. Each state will have an exchange whether it wants one or not, because the federal government will create them in states that fail to do it on their own. But the administration is asking states to take the initiative (Vestal, 1/28).

The Associated Press/Washington Post: Health Insurance Exchanges: A New Way For Individuals And Small Business To Buy Coverage
Health insurance exchanges will change the way people buy coverage and will help millions of uninsured people get a private plan. Nearly 49 million people are uninsured in the United States, but the numbers vary dramatically by state. Exchanges will be the most visible part of President Barack Obama's health care overhaul law in everyday life. Open enrollment starts Oct. 1, less than 10 months away (1/27).

The Associated Press: Consumer Alert: New Health Care Markets On The Way
Buying your own health insurance will never be the same. ... remember that nothing in life is free and change isn't easy. ... Starting Jan. 1, 2014, when coverage takes effect in the exchanges, virtually everyone in the country will be required by law to have health insurance or face fines (Alonso-Zaldivar, 1/27).

Medpage Today: Employers Get More Time On Health Exchange Notices
The March 1 deadline for employers to notify workers about health insurance exchanges available under the Affordable Care Act (ACA) is being pushed back, the government said this week. Under a provision of the ACA, businesses need to provide to each employee a written notice informing them about the existence of exchanges and the employer's cost-sharing plans. The original deadline for providing the notice was March 1, 2013. However, the Labor Department delayed the deadline, saying it was "committed to a smooth implementation process including providing employers with sufficient time to comply” (Pittman, 1/27).

Also in the news, some states take action on exchanges --

The Associated Press/CBS Local: Minn. Building New Health Insurance Marketplace
Big changes are coming in how a fourth of all Minnesotans get health insurance as the state rushes to build a new kind of marketplace that will help about 1.3 million people choose their best coverage options. It’s called a health care exchange, a centerpiece of the Obama administration’s health care overhaul. If it lives up to advance billing, consumers will go to a web site similar to Expedia or Travelocity where they can get the information they need to choose a plan, learn if they qualify for financial assistance and sign up — all in less than an hour. Leading this construction project is April Todd-Malmlov, a 35-year-old mother of two who grew up in the small northwestern Minnesota town of Halstad and shows a knack for rattling off facts and figures without notes. For the past two years, she’s been grappling with them as executive director of Minnesota’s health care exchange (1/27).

California Healthline: Exchange Outreach Grants Worth $43 Million
Community groups are eligible for a total of $43 million in outreach grants, according to a plan released Friday by officials at Covered California, the new state's new insurance exchange. The goal of the outreach effort is for community groups to help get the word out about Covered California and the exchange is willing to pay for that help. About $40 million has been slated for individual coverage outreach, and another $3 million will go to help raise awareness of the Small-business Health Options Program, said Oscar Hidalgo, director of communication and public affairs at the exchange (Gorn, 1/28).

In related news --

The Associated Press/Washington Post: New Lingo For Consumers: Health Care Overhaul Glossary
President Barack Obama's health care overhaul law has spawned its own jargon. With the law finally about to take full effect, consumers might want to get familiar with some of the terms (1/27).

Los Angeles Times: Under Healthcare Overhaul, Will Small Businesses Benefit?
In a perfect world, Irvine businessman Scott Griffiths says, he hopes to continue offering health insurance to the 42 employees at his chain of high-end men's hair salons. But with the full effect of President Obama's Affordable Care Act approaching, small businesses like his are facing numerous questions and concerns about the future of employee health insurance in California and what it will mean for them (Zamosky, 1/26).

The Hill: Immigration Reform Could Add Millions Of People Under Obama Health Law
Comprehensive immigration reform could make millions of people suddenly eligible for assistance under President Obama's healthcare law, assuming a final deal paves the way for undocumented immigrants to receive papers. Illegal aliens are now prohibited from purchasing coverage through the Affordable Care Act's insurance exchanges, which will launch next year. They are also ineligible for Medicaid under most circumstances (Viebeck, 1/26).

The Wall Street Journal: Device Makers Add Fees To Cover Health Tax
Some medical-device companies faced with a new tax meant to help finance the health law are hoping someone else will pick up the tab: their hospital customers. Companies including feeding-tube supplier Applied Medical Technology Inc. and respiratory-valve maker Hans Rudolph Inc. quietly added new surcharges or warned hospitals of price increases to cover the new 2.3% tax on device sales that went into effect Jan. 1, according to letters and invoices from nine manufacturers sent to hospitals that were reviewed by The Wall Street Journal (Weaver, 1/25).

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How The Medicaid Expansion Is Playing In Certain States

In New Jersey, advocates are making a case for the state to pursue this part of the health law, but  Wisconsin's governor is pointing to its complexity as an argument against it. The Washington state legislature is also giving an expansion a long look.

The Wall Street Journal: Questions Remain On Expanded Medicaid
Advocates for the poor are making their case that New Jersey should expand the ranks of people eligible for Medicaid in what could be the next big decision on how the federal health insurance overhaul plays out in New Jersey. They say it will save state taxpayers money and give far more low-income people health coverage. But doctors are apprehensive, and hospitals aren't pushing hard for the change, which some anti-big-government groups oppose deeply (1/28).

Milwaukee Journal Sentinel: State Could Save Money By Not Expanding Medicaid Program
The complexity of the Affordable Care Act could give Gov. Scott Walker a strong incentive to not expand the state's Medicaid program. Under one scenario, not expanding the program would save the state money immediately and even more money in future years. But it would leave tens of thousands of people in the state ineligible for coverage. And because of a quirk in the law, it could increase costs for some Wisconsin businesses. Not expanding the Medicaid program would give the state the option of not covering adults with household incomes above 100% of the federal poverty threshold - $23,050 for a family of four this year. Instead, they would be eligible for federal subsidies to buy commercial health insurance through online marketplaces known as exchanges. In contrast, only adults with incomes above 138% of the federal poverty level would be eligible for federal subsidies to buy insurance if the state expands its Medicaid program (Boulton, 1/26).

Seattle Times: State Legislators Study Expanding Medicaid
Washington state officials are moving ahead quickly to set up a new health-insurance marketplace where the uninsured can start buying health plans later this year. But one other major element of Obamacare — the expansion of Medicaid to cover more of the state’s poorest people — is getting a close look in the Legislature (Shannon, 1/27).

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Birth Control Coverage Mandate Triggers Numerous Legal Challenges

Lawsuits have been filed by Catholic dioceses as well as private employers who say this provision of the health law conflicts with their religious beliefs.

The New York Times: A Flood of Suits Fights Coverage of Birth Control
In recent months, federal courts have seen dozens of lawsuits brought not only by religious institutions like Catholic dioceses but also by private employers ranging from a pizza mogul to produce transporters who say the government is forcing them to violate core tenets of their faith. Some have been turned away by judges convinced that access to contraception is a vital health need and a compelling state interest. Others have been told that their beliefs appear to outweigh any state interest and that they may hold off complying with the law until their cases have been judged. New suits are filed nearly weekly (Bronner, 1/26).

The Associated Press: Obama Birth Control Mandates Loosen Lawsuits
The legal challenges over religious freedom and the birth control coverage requirement in President Barack Obama's health care overhaul appear to be moving toward the U.S. Supreme Court. Faith-affiliated charities, hospitals and universities have filed dozens of lawsuits against the mandate, which requires employers to provide insurance that covers contraception for free. However, many for-profit business owners are also suing, claiming a violation of their religious beliefs (Zoll, 1/26).

KHN earlier, related coverage: More ACA Lawsuits: The 'Contraceptive Mandate' Versus Religious Freedom (Taylor, 12/13/2012).

Bloomberg: Catholic Church Birth Control Suit Thrown Out By Judge
A Catholic Church challenge to the birth-control mandate in the Obama administration’s health-care overhaul was thrown out by a federal judge who said it’s too early to hear the lawsuit. Regulations governing the provision of birth control in the law are likely to be supplanted by new rules, making it premature to decide the case now, U.S. District Judge Amy Berman Jackson in Washington decided today in a case filed by the Archdiocese of Washington and four other Catholic nonprofit groups. “If after the new regulations are issued, plaintiffs are still not satisfied, any challenges that they choose to bring will be substantially different from the challenges in the current complaint,” Jackson wrote (Zajac, 1/25).

In related news --

The Hill: Coburn Bill Would Restrict Abortion In Plans Created By Healthcare Law
Sen. Tom Coburn (R-Okla.) introduced a bill Friday to ban abortion coverage in new healthcare plans created by President Obama's reform law. ... The healthcare law states that one multi-state plan must not cover abortion, but others can. Under Cobrun's bill, abortion coverage would be prohibited in all multi-state plans, with exceptions for cases of rape, incest or when the life of the pregnant woman is at stake (Baker, 1/25).

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Oklahoma Pushes Back Against Feds' Rebuttal In State's Health Law Challenge

The Oklahoma attorney general argued that the Internal Revenue Service does not have the power to implement the health overhaul.  

Bloomberg: Oklahoma Rebuts U.S. In State's Challenge To Health Care Act
Oklahoma opposed a request by the U.S. that a judge dismiss the state's lawsuit challenging President Barack Obama's 2010 health-care reform legislation. The U.S. District Court in Muskogee, Oklahoma, has the authority to determine whether the state is "injured" by the federal government's disregard for a 2010 amendment to the state’s constitution barring bar any rule or law that compels a person, an employer or health-care provider to participate in a health care system, Attorney General Scott Pruitt said in a filing with the court today (Rosenblatt, 1/25).

The Associated Press: Oklahoma AG Challenges Federal Health Care Claims
Lawyers for the federal government have asked that the lawsuit be dismissed. Pruitt's main argument centers on health insurance exchanges. ... States were told they could create their own exchanges or defer to a federally created program. Pruitt argues that the IRS created a rule that allows it to levy millions of dollars in tax penalties on “large employers,” which include state or local governments, in states using the federal exchange. That power was never given to the IRS as part of the law and allows the government to punish states that didn’t create their own exchanges, he argued (Talley, 1/27).

Earlier, related KHN analysis: Health Exchanges And The Litigation Landscape (Taylor, 11/29).

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Health Care Marketplace

Health Industry Shows Stock Market Muscle

Despite various concerns and challenges, health care stocks, including shares of for-profit hospitals, have fared well in the opening weeks of 2013.

The Associated Press: Health Care Among Early Leaders In The S&P 500
Health care stocks have started off the year on a tear. The industry group that includes health care providers, drugmakers and biotechnology companies has advanced 7.3 percent this year, making it the second-best in the Standard and Poor's 500 index, trailing only energy companies. Even drugmakers, traditionally considered a safe-haven play, are outperforming the market (Rothwell, 1/28).

Modern Healthcare: Reform Brightens For-Profit Outlook; Chains See Share Prices Surge
Despite worries about a storm of reimbursement cuts expected to rain on all sectors of the health care industry, shares of for-profit hospital operators remained buoyant in the early weeks of 2013. The acute-care chains continued what was already a strong run last year as investors calculated that the benefit of having more insured patients would ultimately outweigh any payment squeeze. As the closing bell sounded on Jan. 25, shares of hospital operators showed sizable gains over their performance four weeks earlier, during the last full week of 2012. HCA, Nashville, and Tenet Health Corp., Dallas, have gained about 25 percent over the period, while Community Health Systems, Franklin, Tenn., is up nearly 29 percent (Kutscher, 1/27).

In other health industry news --

The Associated Press/Washington Post: Analysis: Is It Fair To Penalize Smokers And Overeaters? Yes, Say Experts. Here's Why.
Faced with the high cost of caring for smokers and overeaters, experts say society must grapple with a blunt question: Instead of trying to penalize them and change their ways, why not just let these health sinners die prematurely from their unhealthy habits? Annual health care costs are roughly $96 billion for smokers and $147 billion for the obese, the government says. These costs accompany sometimes heroic attempts to prolong lives, including surgery, chemotherapy and other measures (1/26).

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Capitol Hill Watch

Harkin's Retirement Leaves Hole In Senate Health Care Leadership -- And Parties Are Scrambling

The retirement of Sen. Tom Harkin -- a key health care figure in the Senate -- has both parties scrambling to field someone to fill the seat.

The Wall Street Journal: Harkin's Exit Heralds Scramble For Senate Seat
Mr. Harkin has endured major political upheavals through the decades, arriving in the Senate during the conservative Reagan era and more recently helping to advance the 2010 health-care overhaul, the Affordable Care Act, a cornerstone of President Barack Obama's presidency that is widely embraced by liberals (Hughes, 1/26).

Also in the news, a retirement from the Centers for Medicare & Medicaid Services --

Kaiser Health News: Retiring Medicare Actuary Reflects On The Politics Of Spending And Why He Almost Quit
Richard S. Foster is retiring this week after 18 years as the chief actuary for the Centers for Medicare and Medicaid Services. His duties included projecting Medicare and Medicaid spending and the cost of health care legislation to help policymakers weigh the impact on the federal budget. Some of those estimates got him into hot water with members of both parties (Carey, 1/28).

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Coverage & Access

Shelters For Abused Elderly Take Hold, Long-Term Care Ombudsmen Questioned

The Associated Press examines the rising use of shelters for the elderly who have been abused, and Kaiser Health News reports that long-term care ombudsmen face questions about their independence.

The Associated Press: Aging America: Elder Abuse, Use Of Shelters Rising
The woman, in her 70s, is trying to explain how she wound up in a shelter that could well be where she spends the rest of her life. While the woman was living with a close family member, officials at the Shalom Center say, her money was being drained away by people overcharging for her grocery shopping, while her body and spirit were sapped by physical neglect and emotional torment. ... The Shalom Center offers shelter, along with medical, psychological and legal help, to elderly abuse victims in this northern Cincinnati suburb. It is among a handful in the country that provide sanctuary from such treatment, a problem experts say is growing along with the age of the nation's population (Sewell, 1/27).

Kaiser Health News: Independence Of Long-Term Care Ombudsman Challenged In Some States
The 2.3 million elderly or disabled people living in nursing homes or assisted living centers might not know it, but they've got an advocate -- someone who's supposed to be looking out for their health, safety and rights (Bergal, 1/27).

Meanwhile, a story about access to care at the other end of the age spectrum --

The Wall Street Journal: Get Developmental Care
Many kids struggle with developmental problems at some point in their childhoods, and getting care for them can be costly and confusing. If your child isn't babbling or sitting at nine months, for instance, struggles with stairs or speaks unclearly at age three, you might be worried about a developmental delay. Help is available to enable your child to catch up, but parents will need to navigate a complicated zone where health care rubs up against education—and kids sometimes fall through the cracks (Johnson, 1/27).

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State Watch

State Leaders Seeking Cash, Legislation To Improve Mental Health Care

Minnesota, Florida, Illinois are directing money to provide more mental health care as Massachusetts is taking another look at background checks for gun sales. 

MPR: Dayton Budget Would Boost School-Based Mental Health Funding
State lawmakers will begin debate on DFL Gov. Mark Dayton's budget this week. ... The governor wants to double state funding for mental health programs in schools ... [to] pay for independent mental health professionals to support existing school programs. Schools cannot do everything for students, and they should not have to, said Sue Abderholden of the National Alliance on Mental Health. But schools are an ideal place for children to get mental health treatment, she said (Shenoy, 1/28).

The Miami Herald: Miami-Dade Teachers To Receive Mental Illness Training
Starting in March, the school district will begin training each of its middle school and high school teachers to identify early-warning signs of mental illness through a program called "Typical or Troubled?" ... Catching those symptoms becomes even more important in Florida, where state officials recently testified at a state House committee hearing that two-thirds of mentally ill people go untreated (Smiley, 1/27).

The Associated Press: Advocates Warn Of 'Broken' Mental Health System
Illinois mental health advocates say more attention -- and money -- must be directed to a system they describe as overwhelmed and ill-equipped to identify or care for the mentally ill, including someone intent on carrying out a violent act. Between 2009 and 2012, Illinois slashed funding for community mental health programs by more than 30 percent -- more than all but three other states, according to the National Alliance on Mental Illness. Even before those cuts, Illinois’ per capita spending on mental health was about $85 -- well below the national average of about $123 per person, the group found (Burnett, 1/27).

Boston Globe: Mass. Keeps Mental Health Data From FBI Gun Checks
Massachusetts for more than a decade has not provided mental health records to an FBI database for gun background checks, the result of a 43-year-old state law prohibiting such sharing. ... The situation has sparked concerns that firearms could fall into the hands of the mentally ill. Governor Deval Patrick has twice tried unsuccessfully to get legislative approval for the sharing of mental health data. Both attempts failed to gain traction in the state Legislature amid opposition from gun-rights activists. The governor renewed the effort earlier this month when he proposed universal background checks that include mental health information (Uberti, 1/28).

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State Roundup: Feds Say Ariz. Overbilled Them $12M On Medicaid

A selection of health policy stories from Arizona, Maryland, North Dakota, California, Massachusetts, Minnesota, North Carolina and Texas.

Arizona Republic: Feds: Ariz. Overbilled Medicaid Program
Arizona failed to properly document efforts to enroll children in its Medicaid program for years and overcharged the federal government nearly $12 million, auditors found in a report expected to be released today. In addition to recommending that Arizona repay the federal government $11.7 million, the report by the inspector general for the U.S. Department of Health and Human Services suggests the review of an additional $18.8 million as questionable billing. In a written response to the findings, state officials with the Arizona Health Care Cost Containment System acknowledged that they need to update the way work is documented, but they challenged the recommendation to have the state repay millions (Hansen, 1/27).

Bloomberg: Obama Law Pits Insurance Giants Against Maryland Co-Op
UnitedHealth Group Inc. and other U.S. health insurers will soon have company in Maryland: a nonprofit started by a county government that plans to sell coverage at rates as much as 30 percent lower than competitors. Backed by $65 million in federal loans, Howard County, a suburban area south of Baltimore, Maryland, will become the first municipality to establish a nonprofit, member-run health co-op to compete with commercial insurers under a provision in the 2010 Affordable Care Act. The Howard County co-op will sell individual and small group plans through the insurance marketplaces, or exchanges, created by the law to help extend medical coverage to 30 million uninsured Americans. It is among two dozen nonprofits to roll out coverage in 23 states starting in October, though the only one run by a local government (Wayne, 1/27).

The New York Times: North Dakota Oil Boom Takes A Toll On Health Care
The patients come with burns from hot water, with hands and fingers crushed by steel tongs, with injuries from chains that have whipsawed them off their feet. Ambulances carry mangled, bloodied bodies from accidents on roads packed with trucks and heavy-footed drivers. The furious pace of oil exploration that has made North Dakota one of the healthiest economies in the country has had the opposite effect on the region’s health care providers.  (Eligon, 1/27).

Los Angeles Times: St. John's In Court Fight Over Failed Nurse Recruitment Effort
Now the hospital is pursuing a court fight over this costly failure, saying it was the victim of fraud, bribery and unfair business practices. But the legal battle may also yield unflattering details about the inner workings of one of the area's best-known hospitals, which recently saw a high-profile management shake-up (Terhune, 1/25).

Boston Globe: Program Brings Dental Care To Children Without Dentists
Kyara Fortes hadn’t been to a dentist for about a year. So, when the 3-year-old and her mother stopped in to the offices of Brockton Area Multi-Services Inc. recently, she visited a tiny back office just big enough for a desk, a filing cabinet, and a collapsible dental chair. "Do all your teeth feel good? Can you eat all the foods that you like?" dental hygienist Carol Gilmore of Halifax asked, and the bright-eyed girl in pink nodded. "Go, 'Ahhhh.'" … Gilmore is a public health hygienist, one of the first licensed under a program created in 2010 to improve access to dental care among low-income children and adults by giving experienced hygienists more authority to deliver preventive care without direct supervision from a dentist. The state Medicaid program covers dental care for children. Yet, each year, about 200,000 children enrolled in the program do not receive any care from a dentist, said Dr. Brent Martin, dental director for MassHealth (Conaboy, 1/28).

MPR: Minneapolis VA Receives Grants For Woman's Health
The Minneapolis VA has received $217,000 in women's health grants from the Department of Veterans Affairs. VA officials say they will use the money to establish a new women's health telepharmacy for women veterans in rural Minnesota. "With women veterans who are receiving care at one of our outlying community-based clinics ... they would rather get care closer to home rather than drive all the way into Minneapolis," said Erin Krebs, the women's health medical director. The VA also plans to offer specialized nurse training and women's health outpatient services (Mador, 1/27).

N.C. Health News: New HHS Secretary Meets with Public Health Leaders
Dr. Aldona Wos, the newly appointed state secretary of health and human services, addressed hundreds of North Carolina's public health leaders yesterday, with a message to emphasize customer service. ... "She gave us some charges, she gave us some things that we really do need to work on," said state health director Dr. Laura Gerald. ... "In these challenging economic times, we have to make sure that every dollar is spent on things that are going well" (Hoban, 1/25).

The Texas Tribune: Legislators Can Carry Bills That Benefit Them
Sen. Leticia Van de Putte, a pharmacist and San Antonio Democrat, said she has no qualms about filing pharmacy-related bills. She has paid her dues, she said ... she files pharmacy bills with the knowledge that she knows more about the industry than her colleagues, and the comfort that there is nothing she could pass that would recoup her state-induced losses (Ramshaw, 1/27).

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Editorials and Opinions

Viewpoints: Debating P4P; 'Tactical Retreat' By GOP; The Virtues Of Across-The-Board Spending Cuts

The New York Times: Paying For Performance
Instead of granting automatic pay increases, [N.Y. City's public hospital system] will pay them based on how well they reduce costs, increase patient satisfaction and improve the quality of care. The Health and Hospitals Corporation, which runs the city’s 11 public hospitals, deserves praise for an ambitious proposal that will need to be refined as it is put into practice. ... The doctor’s union is still seeking a wage increase or at least a guarantee of part of the bonus. ... Such issues must not be allowed to disrupt this important move to pay doctors based on how well they perform (1/27).

The New York Times: Carrots For Doctors
Pay for performance, or P4P in the jargon, is embraced by right and left. It has long been the favorite egghead prescription for our absurdly overpriced, underperforming health care system. ... In practice, pay for performance does little to improve outcomes or to control costs. But if you look hard enough at why this common-sense approach doesn’t deliver, you find some clues to what might. ... The first problem with P4P is that it does not address the biggest problem (Bill Keller, 1/27).

The Wall Street Journal: The Case For Across-The-Board Spending Cuts
Targeted reductions would be welcome, but the current federal budget didn't drop from the sky. Every program in the budget—from defense to food stamps, agriculture, Medicare and beyond—is in place for a reason: It has advocates in Congress and a constituency in the country. ... Whatever carefully targeted budget cuts might animate our dreams, the actual world of divided government suggests only one realistic way to achieve real spending reductions. It is not a meat ax. A scalpel that shaves a bit off all programs equally would work just fine (Jeff Bergner, 1/27).

Los Angeles Times: The GOP’s Tactical Retreat
Polls also show that when voters are presented specific options for shrinking the deficit, they recoil from domestic spending cuts, especially in Medicare and Social Security. The most popular ways to cut the deficit turn out to be Democratic policies: higher taxes on the wealthy and cuts in military spending. And as the price for tea party support, Boehner promised conservatives a gift he may come to rue. He directed Ryan, the chairman of the House Budget Committee, to draw up a new federal budget that eliminates the deficit within 10 years through spending cuts alone — no new taxes allowed (Doyle McManus, 1/27).

The Washington Post: Obama’s Daring Liberal Agenda Is Neither Daring Nor Liberal. Discuss.
Opinion polls show that on almost all of the major positions Obama espoused in his speech — entitlements, immigration, climate change and same-sex marriage — a majority of Americans agree with him. ... the central mechanism of Obamacare — the individual mandate, which Republicans blasted as a massive liberal exercise of power — began as a conservative idea. ... Looking at this history and today’s opinion polls, it would seem pretty easy to find consensus in America on a lot of big issues — not just “liberal” or “conservative” solutions (Zachary A. Goldfarb, 1/25).

The Fiscal Times: Why Government Spending Is Not Out of Control
We are much closer to fiscal sustainability than even most economists realize. Relatively small adjustments to the growth path of federal revenues and Medicare would be sufficient to eliminate the primary deficit. Taking a meat ax to every federal program, as Republicans demand, is neither necessary nor desirable (Bruce Bartlett, 1/28).

The Hill: With State of the Union, Obama Will Take Case To The People
In this year’s State of the Union, scheduled for February 12, the President opens a prime-time window of about 100 days to make significant headway on his second term agenda. ... Top White House aides tell me the President now has “clear-eyes” about Congressional politics. ... on poverty programs, look for the President to shift the GOP focus on deficit reductions to discussions of how seniors and the poor will be hurt by big cuts to entitlement programs such as Medicare (Juan Williams, 1/28).

MinnPost: New Regulations Of Compounded Medicines Mean Fewer Options At Higher Prices
Today, there are three injectable medications available for the treatment of macular degeneration with enormous benefits for a patient’s vision. The three medicines are similar in safety, efficacy, and dosing; however, there is a shocking difference in cost: Avastin costs $50 per dose, while Lucentis and Eylea each cost $2,000. Unfortunately, the option to use Avastin has been restricted by the debate on how to regulate medicine from compounding pharmacies (Dr. Geoffrey Emerson, 1/28).

The Oregonian: Dentists’ Concerns Must Be Addressed To Hasten Health Care Overhaul
It was inevitable that one group of providers would feel Oregon's health care transformation was happening way too fast. It's the dentists. Not all of them, but a few significant players. ... it's time for collaboration and negotiation rather than legislation. An intervention by the Legislature at this point to protect one class of caregiver against the sheer forces of change would set the wrong precedent, if not be fatal to the overhaul effort (1/26).

Sacramento Bee: Amgen Uses Its Clout To Boost Costs Of Health Care For Millions
California's own biomedical giant, Amgen, appears to have received an especially sweet deal as Congress rushed to avoid the automatic tax hikes and spending cuts of the so-called "fiscal cliff." ... As detailed by the New York Times last Sunday, senators, Democrats and Republicans alike, approved obscure language that appears to benefit Amgen – although the company says patients with end-stage kidney disease are the ones who truly will be helped (1/27).

Kansas City Star: Keep The Health Care Promises
The 2003 sale of the former Health Midwest hospital network to the out-of-town Hospital Corp. of America was a drawn-out, contentious process. Thirteen hospitals in the Kansas City region were involved, and people understandably worried that the transfer of nonprofit community assets to a for-profit owner would result in weakened connections and diminished charity care. ... We are likely to see more mergers and sales in which large, out-of-town corporate entities gain control over what are intended to be community assets. Sound agreements, and the sort of vigilance that the Health Care Foundation has provided, are essential going forward (1/27).

Baltimore Sun: Safe, Legal Abortion For 40 Years
[A] majority of Americans still agree with the high court that personal health care decisions should be left up to a woman. ... the way people identify with the issue has shifted over the years. No longer do labels like "pro-choice" and "pro-life" reflect the way people think about abortion. The fact is, generations of Americans — across party lines — understand that it's just not that simple. The decision to obtain an abortion is deeply personal and complex. It's not something that can be put squarely in a "pro" or "anti" box (Jenny Black, 1/27).

WBUR: Cognoscenti: Your Personal Health Information Isn’t As Safe As You Think
Using a computer, an Internet connection and information available publicly online, researchers from the Whitehead Institute at MIT were able to figure out the identities of nearly 50 people who had submitted personal genetic information for a research study ... the National Institutes of Health has taken steps to make re-identifying research subjects harder to do. ... Will it work? Will these new protections be strong enough? I hope so. But frankly, I doubt it (Judy Foreman, 1/28).

Georgia Health News: Don’t Make Scapegoats Of People With Mental Illness What needs to be done to prevent violence should not, therefore, be linked to national databases of people with mental illnesses. ... There is no evidence that such a database would effectively control or limit violent behavior. ... The problem with our mental health system is not that we fail to hospitalize people with acute mental health conditions. Rather, it is that we fail to take reasonable steps to prevent those conditions from occurring (Ellyn Jeager, 1/26).

Boston Globe: Patients, Doctors, And The Power Of Religious Faith
Several surveys show that over 90 percent of Americans believe in God. It’s not surprising, then, that religion plays an important role in medical care. Just as there are no atheists in foxholes, a nonbeliever might reconsider while being rolled into the operating room or waiting for a biopsy result. The clinical efficacy of prayer is difficult to measure, though researchers have tried (Dr. Suzanne Koven, 1/28).

Health Policy Solutions (a Colo. news service): Colorado’s Health Insurance Exchange On Track For October Launch
Colorado’s exchange, like those in other states, will be funded with federal grants through 2015 as long as certain benchmarks are met along the way. ... Colorado is ahead of the game, however, because lawmakers passed a bipartisan bill in 2011 that created the exchange. That bill was supported by a broad-based coalition of business groups, health plans and consumer groups that favored creation of a state-based exchange (Bob Serno, 1/25).

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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.