Daily Health Policy Report

Tuesday, January 29, 2013

Last updated: Tue, Jan 29

KHN Original Reporting & Guest Opinion

Health Reform


Health Care Marketplace

Capitol Hill Watch

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Kidney Donation Over Age 70? Desperate Patients Saying, 'Yes, Please'

Reporting for Kaiser Health News, in collaboration with The Washington Post, Judith Graham writes: "But physicians are conservative about living kidney donors: Nearly three-quarters of transplant centers have not accepted organs from people older than 70, according to Johns Hopkins research" (Graham, 1/28). Read the story and related sidebar.

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Insuring Your Health: Long Waits For Consumers When Medicare Is 'Secondary Payer'

In her latest Kaiser Health News consumer column, Michelle Andrews writes: "Anyone who sues for personal injury probably knows that the process may take time. But for Medicare beneficiaries, too often it's not only the legal system that grinds slowly. Lawyers and policy experts say bureaucratic inefficiency at the federal Centers for Medicare & Medicaid Services (CMS) can add months or even years to the process. During that period, a beneficiary often must wait until Medicare is reimbursed for its costs before he or she can receive any payment" (Andrews, 1/28). Read the column.

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Capsules: Patient Loads Often At Unsafe Levels, Hospitalist Survey Finds

Now on Kaiser Health News' blog, Alvin Tran reports: "Nearly forty percent of hospital-based general practitioners who are responsible for overseeing patients' care say they juggle unsafe patient workloads at least once a week, according to a study published Monday as a research letter in JAMA Internal Medicine" (Tran, 1/28). Check out what else is on the blog.

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Political Cartoon: 'Small Game Hunting?'

Kaiser Health News provides a fresh take on health policy developments with "Small Game Hunting?" by Eric Allie.

Meanwhile, here is today's health policy haiku:


Having physicians
you know helps prevent errors.
Ask Dr. Clarkson.

  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

States And The Medicaid Expansion: This Year's Big Choice

One of the biggest decisions governors and legislatures will wrestle with in 2013 is whether to pursue the health law's Medicaid expansion.

The Associated Press: Money Fears Vs. Real Benefits In Medicaid Choice
President Barack Obama thinks his health care law makes states an offer they can't refuse. Whether to expand Medicaid, the federal-state program for the poor and disabled, could be the most important decision facing governors and legislatures this year. The repercussions go beyond their budgets, directly affecting the well-being of residents and the finances of critical hospitals (Alonso-Zaldivar, 1/29).

Los Angeles Times: Legislation Proposed To Help California Launch Healthcare Overhaul
The state Legislature gaveled in a special session on healthcare Monday, pushing forward with sweeping proposals to help California implement President Obama's healthcare overhaul. The measures, including a major expansion of Medi-Cal, the state's public insurance program for the poor, would cement the state's status as the nation's earliest and most aggressive adopter of the federal Affordable Care Act. ... State lawmakers are racing to pass rules for enrollment in a new state-run insurance market in October (Mishak, 1/29).

Sacramento Bee: California Lawmakers Move To Expand Medi-Cal Eligibility
More than 1 million low-income Californians would become eligible for health care coverage through Medi-Cal under legislation proposed Monday by Assembly Speaker John A. Pérez. ... Pérez's proposal, Assembly Bill 1X-1, would provide coverage to single adults whose income is less than $15,400 per year, representing roughly 133 percent of the federal poverty level. ... If Pérez's bill is signed into law, the federal government would pay the tab for Medi-Cal's expansion for three years (Sanders, 1/29).

The Associated Press: Calif. Speaker Seeks To Expand Medi-Cal For Poor
At the same time, health care providers escalated their legal fight against the state's planned cuts to Medicaid reimbursement rates, saying any further reductions to the state's payments could keep patients from accessing vital care at a time when the state seeks to expand quality coverage for uninsured Californians (Williams and Burke, 1/28).

St. Louis Beacon: Nixon Uses State Of The State To Press For Medicaid Expansion, More Education Spending
Missouri Gov. Jay Nixon sought to confront Republican resistance to his proposed Medicaid expansion by promising in his State of the State address Monday night that he would support rolling back the expansion if the federal government cuts off the financial spigot to cover most of the costs. ... Nixon and his budget team say the expansion actually would save the state about $47 million in the coming fiscal year because of related provisions in the Affordable Care Act tied to the expansion (Mannies, 1/28).

The Associated Press: Mo. Gov. Backs Medicaid Expansion, Bonding Plan
The governor argued that the Medicaid expansion was a sound financial decision embraced by many of Missouri's leading business organizations, whom who he asked to stand. Again, Democratic lawmakers responded with an ovation while Republicans sat silently. "Friends, let's put the politics of health care aside for just a moment," Nixon said as some Republicans chuckled, "and look at this as a business decision for the state of Missouri" (Lieb, 1/28).

St. Louis Beacon: In GOP Response, Jones Rejects Medicaid Expansion, Calls On Nixon To Engage With Legislators
Claiming that Gov. Jay Nixon "articulated grand concepts" with "little detail" in his annual State of the State speech, House Speaker Tim Jones challenged the Missouri chief executive to work with the GOP-legislature "to find solutions" on the vexing issues of the day. ... Jones portrayed the Medicaid expansion as "a call that has come courtesy of Obamacare and Washington, D.C." and "a call the Republican-led legislature will not answer" (Rosenbaum, 1/28).

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States Look To Speed Shift Of High-Risk Pool Enrollees Into Exchanges

Meanwhile, the Associated Press checks on the status of the online insurance markets in the District of Columbia, New York, New Mexico and South Carolina.

Politico: States Rethink High-Risk Pools, Exchanges
When the health exchanges open next year, they will cover some of the sickest and costliest patients, people who cannot easily get insurance precisely because they are so likely to run up bills that no insurer would want to be on the hook for. The federal health law contains several measures designed to spread the risk and tamp down some of the expected turbulence in the market. But a recent change in how the Department of Health and Human Services plans to run a three-year, $20 billion fund — known as reinsurance — to cushion health plans that end up with lots of high-cost customers is forcing states to rethink their own timetable for shifting some of their highest-risk people into the exchanges (Norman, 1/29).

The Associated Press/Washington Post: Questions And Answers About DC's Health Insurance Exchange
This fall, new insurance markets called exchanges will open in each state and the District of Columbia. A major component of President Barack Obama's health care overhaul, exchanges are online markets where consumers can choose between private health plans similar to what workers at large corporations already get. The government will help many middle-class households pay their premiums. Here are some facts about the district's exchange (1/28).

The Associated Press/Wall Street Journal: NY Health Exchange Expects To Insure 1.1 Million
President Barack Obama's federal health care overhaul, known as the Affordable Care Act, requires every state to have a new health insurance marketplace called an exchange. The exchange will be an online shopping center for small business and for people who don't get health coverage from their employer. Users will be able to compare the costs and benefits of various insurance plans, and they'll be able to find out whether they qualify for federal subsidies to help pay their premiums (1/28).

The Associated Press: A Look At New Mexico's Planned Insurance Exchange
New Mexico plans to establish a state-run health insurance exchange and Republican Gov. Susana Martinez's administration is taking steps to implement it this year (Massey, 1/28).

The Associated Press: A Look At The Federal Health Care Law In SC
New insurance markets called exchanges are set to open in each state this fall as part of the new federal health care law. They are meant to function as one-stop online marketplaces of private health policies offering consumers side-by-side comparisons (1/28).

In other health law implementation news -

The New York Times' Bucks Blog: Breast Pump Coverage Under New Law Varies In Practice
As part of its coverage of preventive health-care services for women, the Affordable Care Act requires many insurance plans to provide equipment and services to promote breast-feeding, like breast pumps and lactation counseling, at no extra cost. The requirement took effect last summer but kicked in for many plans on Jan. 1, the start of new insurance plan years for many employers (Carrns, 1/28).

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When Hospitalists Feel Overburdened By Workload, Patient Care Suffers

A survey finds that hospital-based general practitioners feel overburdened by patient loads to the point where it has a negative impact on patient assessments, satisfaction and possibly safety outcomes.

Medpage Today: Patients Suffer If Hospitalists Overworked
Many attending physicians said they feel overburdened to the point where it has a negative impact on patient assessments, satisfaction, and possibly safety outcomes, researchers found. In a survey on workloads, 40 percent of hospitalists said their typical inpatient load exceeded safe levels at least once a month, and 36 percent reported having an unsafe workload at least weekly, according to Henry Michtalik, MD, of Johns Hopkins University, and colleagues. Excessive workloads caused nearly a quarter of hospitalists surveyed to say they'd ordered potentially unnecessary tests, procedures, or consultations due to inadequate time with a patient, while similar numbers said overwork "likely contributed" to patient transfers, morbidity, or mortality, they wrote online in a research letter in JAMA Internal Medicine (Petrochko, 1/28).

Kaiser Health News: Capsules: Patient Loads Often At Unsafe Levels, Hospitalist Survey Finds
Nearly forty percent of hospital-based general practitioners who are responsible for overseeing patients' care say they juggle unsafe patient workloads at least once a week, according to a study published Monday as a research letter in JAMA Internal Medicine (Tran, 1/28).

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Health Care Marketplace

Coal Company Seeks To Set Up Trust To Limit Costs of Retiree Health Benefits

The Wall Street Journal: Patriot Coal Seeks Trust To Limit Retiree Health Costs
Patriot Coal Corp., currently under Chapter 11 bankruptcy protection, is seeking to limit its obligation to provide retiree health benefits to 22,000 active miners, retirees and their spouses and set up an outside trust to fund future benefits, according to documents filed in federal court Monday (Maher, 1/28).

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Capitol Hill Watch

House Lawmaker Explores New Ways To Fill Veteran Mental Health Care Gap

The Associated Press: Lawmaker Looks Outside VA To Fill Mental Care Gap
Veterans who have trouble getting timely mental health care from Veterans Affairs hospitals and clinics should also have access to thousands of health care providers who care for military personnel and their families, says the Republican chairman of the House Committee on Veterans Affairs. The proposal by Rep. Jeff Miller, R-Fla., borrows from the playbook of Republican Mitt Romney, who raised the idea of tapping into the military's Tricare network of doctors during the course of the presidential campaign (Freking, 1/29).

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Public Health & Education

Report Calls For Greater Emphasis On Preventive Care

A report issued by the Trust for America's Health is urging a revamp of state and local public health efforts to better integrate and focus prevention strategies.

Modern Healthcare: Report Urges Coordinated Approach On Preventive Care
The not-for-profit Trust for America's Health is calling for a revamp of public health management at the federal, state and local levels in a report that urges a greater focus on preventive care. The report, called "A Healthier America 2013: Strategies to Move From Sick Care to Health Care in the Next Four Years," argues that the different agencies in HHS involved with preventive healthcare should work more closely together to coordinate efforts, and existing attempts to become more coordinated have been too slow in creation. Even within parts of HHS, programs are too separated, the authors of the 98-page report wrote (Barr, 1/29).

And on the topic of prevention and obesity --

NPR: What's Wrong With Calling Obesity A Medical Problem?
Americans have gotten heavier since 1980 — this we know. And most doctors would say that the extra weight has made us more prone to heart disease, diabetes, arthritis, hypertension and even cancer. It's become a source of major national anxiety. The Robert Wood Johnson Foundation predicts that every state in the nation will have an obesity rate greater than 44 percent by 2030, and will be sicker for it (Barclay, 1/28).

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State Watch

Calif. Medicaid Providers Appeal Court Decision That Would Allow Cut In Pay

California is also preparing for a boom of children who will soon qualify for dental care in the Medicaid program. In the meantime, transitions in the Kansas' Medicaid program encounter problems.

Los Angeles Times: Health Care Providers Appeal To Block Medi-Cal Cut
California health care providers are appealing a December court decision that would allow the state to cut spending on medical care for poor residents. The case revolves around the state's 2011 attempt to reduce by 10 percent reimbursements to doctors, pharmacies and others who provide health care through the Medi-Cal program. The cut has been continuously blocked by judges worried about how it would affect access to medical care (Megerian, 1/28).

Kansas Health Institute: Lawmakers And Providers Assess KanCare Transition
There have been plenty of problems and frustrations. No one denies it. But as Gov. Sam Brownback's Medicaid makeover entered its fourth week, administration officials, some legislators and a variety of others involved with KanCare said they thought the massive changes underway in the $3.2 billion program so far have gone smoother than many expected (Shields, 1/28).

California Healthline: Half of California's Kids May Get Medi-Cal Dental Care
By this time next year, about half of California's children -- roughly five million -- will get dental care through Medi-Cal, California's Medicaid program. Or maybe they won't. A new issue brief from The Children's Partnership suggests California's Medicaid system may not be up to the task. "California's Medi-Cal dental system is already struggling to serve children and is unprepared for what's to come," said Wendy Lazarus, founder and co-president of The Children's Partnership (Lauer, 1/28).

And Kansas gets a new Medicaid inspector --

Kansas Health Institute: After A Year's Vacancy, A New Medicaid Inspector General
After a year without one, Kansas once again has an official Medicaid inspector general. The Kansas Senate last week with no objections confirmed the appointment of Bill Gale (Cauthon, 1/28).

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Officials Consider Suicide's Place In Mental Health Gun Control Debate

Officials are looking at suicides as a major cause of gun death in America. In Maryland, a mental health gun control task force is considering recommending that medical personnel report suicide threats to authorities while suicides also take center stage in Massachusetts.

Baltimore Sun: Psychiatrists, Mental Health Advocates Uneasy With Gun Policy Prescriptions
Sitting around a broad table in a nondescript office in Reisterstown last week, more than a dozen mental health advocates, medical professionals and law enforcement officials stared tensely at one another. Nearly a month after the state-created task force issued a report outlining its findings on psychiatric patients' access to firearms, several members were questioning a key recommendation -- that mental health professionals should be required to report to law enforcement all patients who threaten suicide. "Some people say they would be reporting every single person who walked through their door," said Dan Martin, a panel member representing the Mental Health Association of Maryland (Rector, 1/28).

WBUR: Guns, Suicide, Mental Health (Audio)
Along with the rest of the nation, Massachusetts is engaged in a loud debate about guns, gun rights and how to reduce gun violence. Over the weekend, some 200 supporters of tighter gun control rallied at the State House. It came just one week after 700 2nd amendment advocates protested gun control legislation being proposed on Beacon Hill. At the heart of the debate: how to keep guns out of the hands of people like Adam Lanza, who massacred 26 people, including 20 children, at the Sandy Hook elementary school in Newtown, Connecticut. The debate has focused on assault weapons, high capacity magazines and how to stop potential killers. But relatively little is being said about the biggest cause of gun deaths in America: suicides (1/28).

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State Roundup: Fla. Leaders Pay Less For Coverage Than Workers

A selection of health policy stories from New York, Kansas, Nebraska, Florida and California.

The New York Times: Biotech Firms, Billions At Risk, Lobby States To Limit Generics
In statehouses around the country, some of the nation's biggest biotechnology companies are lobbying intensively to limit generic competition to their blockbuster drugs, potentially cutting into the billions of dollars in savings on drug costs contemplated in the federal health care overhaul law (Pollack, 1/28).

The New York Times: Rescue Plan Is Emerging For Hospital In Manhattan
Manhattan's only remaining hospital south of 14th Street, New York Downtown, has found a white knight willing to take over its debt and return it to good health, hospital officials said Monday (Hartocollis, 1/28).

The Associated Press: State Leaders Pay Less Than Workers For Insurance
Gov. Rick Scott and state legislators will soon decide whether Florida should extend health insurance coverage to nearly 1 million residents, and those officials all get their plans from the state, many paying less than state workers. Scott, as well as the three other Republican members of the Cabinet, and nearly all state lawmakers are enrolled in Florida's health insurance plan (Fineout, 1/28).

Kansas City Star: Health Care Law Means Free Clinics Have To Accept Payment
Free health clinics around the Kansas City area, like many across the country, are shedding their "free" designation and preparing to accept payment from most patients as they adapt to the federal health care law. The shift will be a big one, especially for the bustling Kansas City Free Health Clinic in midtown. It's one of the largest free clinics in the country, treating upward of 15,000 patients a year with more than 100 staff members and 1,000 volunteers. In its 42 years, "KC Free," as it's commonly called, hasn't charged fees or billed patients for care. And it has seen only the uninsured. Soon, all that will change (Gordon, 1/28).

Stateline: As Legislatures Become More Partisan, Nebraska Holds Out
If Brad Ashford were a state senator almost anywhere, the step he took in the waning days of 2011 might have foreclosed any hope for future legislative accomplishments. Saying the Republican Party here was no longer the place for moderates, Ashford announced he was becoming an Independent -- in a legislature that was heavily Republican. … Earlier this month, Ashford was reelected the chairman of the Judiciary Committee. No one even opposed him. … But the same traditions that have produced bipartisan comity within the legislature are a source of partisan frustration outside of it. The state Republican Party's official platform calls for making the legislature partisan and, from what’s transpired in Nebraska over the last year, it’s easy to see why. The legislature has thwarted the plans of Dave Heineman, the state’s popular conservative Republican governor, and has even overridden some of his vetoes on prominent legislation. Now, the relationship between the Heineman and the legislature is about to be tested again. This month, Heineman proposed making Nebraska the first state in more than 30 years to abolish its income tax. Heineman also is an opponent of the Medicaid expansion under the federal health care law, but some key Republican legislators favor expanding anyway (Goodman, 1/29).

HealthyCal: Special Needs Children Struggle To Obtain Quality Health Care
California children with special needs often receive less-than-adequate health care services, regardless of whether they are covered by private or public health insurance, a new analysis has found. California was among the bottom six states in offering coordinated and family-oriented care to some of the state’s most vulnerable populations (Ramirez, 1/29).

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Editorials and Opinions

Viewpoints: Gov. Jindal Calls Medicaid An 'Outdated Model;' GOP's Opposition To 'Big Government' Hurts Effort To Revamp Entitlements

The Washington Post: Let's Meet On Medicaid, Mr. President
As the implementation of Obamacare unfortunately nears, every governor must decide whether to expand Medicaid. This is not a simple question. Expanding Medicaid will significantly burden state budgets across the country. ... The Obama administration heralds this as a tremendous bargain for states. That's simply not the case. The administration overlooks that Medicaid is largely failing current enrollees with its outdated model that costs billions of taxpayer dollars and produces poor outcomes (Gov. Bobby Jindal, 1/28).

The New York Times: A Second G.O.P.
The core American conflict, in (the Republican narrative), is between Big Government and Personal Freedom. While losing the popular vote in five of the last six presidential elections, the flaws of this mentality have become apparent. First, if opposing government is your primary objective, it's hard to have a positive governing program. ... Moreover, given all the antigovernment rhetoric, (the public) will never trust these Republicans to reform cherished programs like Social Security and Medicare. You can't be for entitlement reform and today's G.O.P., because politically the two will never go together (David Brooks, 1/29).

The Wall Street Journal: To Outsmart ObamaCare, Go Protean
How big can a company get with just 50 employees? We're about to find out. Thousands of small businesses across the U.S. are desperately looking for a way to escape their own fiscal cliff. That's because ObamaCare is forcing them to cover their employees' health care or pay a fine—either of which will cut into profits and stymie future investment and growth (Paul Christiansen, 1/28). 

Arizona Republic: Arizona's Medicaid System Is Effective
The suggestion that our state’s Medicaid patients are shuttered off to a "low-quality, government-managed health insurance system with limited medical options" is preposterous. States across America are now trying to emulate Arizona's model for patient-centered managed care, provided through an innovative public-private partnership where private health plans -- not the government -- coordinate the health care for their members (Deb Gullett, 1/28).

Reuters: Insight: Think Preventive Medicine Will Save Money? Think Again
In a report released on Tuesday, the non-profit Trust for America's Health outlined a plan "to move from sick care to health care" by putting more resources into preventing chronic disease rather than treating it, as the current system does.  But the report also makes an economic argument for preventive care, highlighting the possibility of reducing healthcare spending -- which in 2011 reached $2.7 trillion, just shy of 18 percent of gross domestic product -- by billions of dollars. And that has health economists shaking their heads (Sharon Begley, 1/29).

MinnPost: New Regulations Of Compounded Medicines Mean Fewer Options At Higher Prices
Compounding pharmacies can offer a wider variety of mixtures and doses than are available at most pharmacies. ... Doctors, state boards of pharmacy and legislators all share a strong desire to improve safety for patients treated with compounded medications. Compounding is an important source of medication for our health-care system. We should focus on oversight of sterile processing at compounding pharmacies, rather than limit the choices available to patients and doctors (Geoffrey Emerson, 1/28).

The New York Times: A Brief History Of Panic
The fright and flight experience of panic that characterized yellow fever and cholera outbreaks began to change around the turn of the century as scientists identified the microbes that caused disease. Permanent health departments sprouted in cities and towns. The confidence that came with the new germ theory seemed to provide shelter from the panicky days of old. ... Governments increasingly saw it as their duty to prevent both disease and disease-related panic (Amy L. Fairchild, David Merritt Johns and Kavita Sivaramakrishan, 1/28). 

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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.