Daily Health Policy Report

Thursday, January 3, 2013

Last updated: Thu, Jan 3

KHN Original Reporting & Guest Opinion

Fiscal Cliff

Health Reform

Capitol Hill Watch

Coverage & Access

Health Care Marketplace

Public Health & Education

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Health On The Hill: Counting Health Care Changes In The 'Fiscal Cliff' Deal

Kaiser Health News' Mary Agnes Carey and Politico Pro's Jennifer Haberkorn detail the deal struck between President Obama and Congress to avert the so-called "fiscal cliff" and what the compromise means for hospitals and doctors who serve Medicare patients (1/2). Listen to the audio or read the transcript.

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Capsules: Fiscal Deal Kills Future Funding For Health Law's Co-Ops; Consumers May Draw Wrong Conclusions From Medical Prices

Now on Kaiser Health News' blog, Phil Galewitz reports on a 'fiscal cliff' development that will impact health insurance co-ops: "The fiscal cliff deal, approved by Congress on New Year's Day, eliminates most of the more than $1.4 billion in remaining funding from the federal health law for new nonprofit, customer-owned health plans designed to compete against the major for-profit insurers" (Galewitz, 1/2).

Also on the blog, Shefali S. Kulkarni reports on medical prices: "Some health policy experts and consumer advocates are pushing for greater transparency in the pricing of medical good and services. If consumers know the price of an item, so the thinking goes, they'll make smarter decisions about whether they need it" (Kulkarni, 1/3). Check out what else is on the blog.

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Political Cartoon: 'Anger Management?'

Kaiser Health News provides a fresh take on health policy developments with "Anger Management?" by Steve Kelley.

Meanwhile, here is today's health policy haiku:


Cliff was averted,
but risks are ahead. Break - or
brake for health spending?

 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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Fiscal Cliff

Fiscal Deal Political Fallout Will Likely Shape Future Medicare, Entitlement Spending Battles

News outlets continue to analyze how the fiscal deal will set the table for future deficit debates and when some of the difficult spending issues could again take center stage.

The Wall Street Journal: Deal Fails To Satisfy Liberal Democrats
A deal to avert the fiscal cliff and raise taxes on the wealthy left a sour aftertaste among some liberals who believe President Barack Obama wasted his political leverage by settling for a pared-down deal. … One of those showdowns is sure to include a debate over changes to entitlement programs, such as Medicare and Social Security. That has already bred tension in the Democratic ranks. Groups such as Health Care for America Now vow to oppose any cuts that would affect beneficiaries, whereas the president and other congressional Democrats have shown some willingness to make changes that would affect recipients (Murray, 1/2).

The Associated Press: 'Fiscal Cliff' Deal Leaves Lots Of Issues Dangling
As larger and larger numbers of baby boomers receive retirement benefits in coming years, the strain on the budget will be unsustainable. [President] Obama says Medicare's climbing costs must be addressed to fix this. Republicans want to rein in Medicare, Social Security and other entitlement programs more sharply. Many Democratic lawmakers object. And tampering with programs so popular with voters is never easy (Cass, 1/3).

The Wall Street Journal: Fresh Budget Fights Brewing
Republicans say any further deficit reduction or legislation to avoid across-the-board spending cuts should come from reducing spending. President Obama and many Democrats advocate a combination of tax increases and spending cuts. The most serious skirmish will arrive toward the end of February, when the U.S. Treasury is expected to be unable to pay all the government's bills unless Congress boosts the federal borrowing limit (Paletta, 1/3).

The New York Times: Lawmakers Gird For Next Fiscal Clash, On The Debt Ceiling
Smarting from the president's victory on taxes over the New Year's holiday, Republicans in Congress are betting that their refusal to raise the $16.4 trillion debt ceiling will force Mr. Obama to the bargaining table on spending cuts and issues like changes in Medicare and Social Security (Shear and Calmes, 1/2).

Reuters: Bigger Fights Loom After 'Fiscal Cliff' Deal
President Barack Obama and congressional Republicans face even bigger budget battles in the next two months after a hard-fought "fiscal cliff" deal narrowly averted devastating tax increases and spending cuts. The agreement, approved late on Tuesday by the Republican-led House of Representatives and signed by Obama on Wednesday, was a victory for the president, who had won re-election in November on a promise to address budget woes, partly by raising taxes on the wealthiest Americans. But it set up potentially bruising showdowns over the next two months on spending cuts and an increase in the nation's limit on borrowing. ... The debate over "entitlement" programs is also bound to be difficult. Republicans will be pushing for significant cuts in government healthcare programs like Medicare and Medicaid for retirees and the poor, which are the biggest drivers of federal debt (Ferraro and Whitesides, 1/3).

Politico: Mitch McConnell Defends 'Imperfect' Deal
Senate Minority Leader Mitch McConnell says he supported the fiscal cliff bill as an "imperfect solution" because he didn't want taxes increases on nearly every American — but now it's all about cutting spending. ... (In an op-ed on Yahoo, he) continued: "We simply cannot increase the nation’s borrowing limit without committing to long overdue reforms to spending programs that are the very cause of our debt."

CNN: McConnell: Debt Debate 'Starts Today'
Hours after Congress sent a bill for the president's signature to avoid the fiscal cliff, Senate Minority Leader Mitch McConnell is already gearing up for the next showdown. The Kentucky Republican wrote in an op-ed that President Barack Obama should be prepared to "have a fight" over government spending and the debt limit in the coming weeks, adding that the tax debate is now a thing of the past with the new legislation (Killough, 1/3).

The New York Times: Tax Deal Shows Possible Path Around House GOP In Fiscal Fights To Come
With the contentious 112th Congress coming to a close, the talks between the White House, Senate Republicans and Senate Democrats that secured a path around a looming fiscal crisis on Tuesday may point the way forward for President Obama as he tries to navigate his second term around House Republicans intent on blocking his agenda in the 113th. … A senior Democrat said that game plan would start in the coming weeks, when Mr. Obama addresses his agenda in his State of the Union address and lays out his budget for the 2014 fiscal year, due in early February. That opening bid should restart talks with Congress on an overarching agreement that would lock in deficit reduction through additional revenue, changes to entitlement programs and more spending cuts, to be worked out by the relevant committees in Congress (Weisman, 1/2).

Los Angeles Times: News Analysis: Parties' Role Reversal Complicates Spending Debates
At its core, the debate over the size of government and how to pay for it pits the interests of the huge baby boom generation, now mostly in their 50s and 60s, against the needs of the even larger cohort in their teens and 20s. With limited government money to spend, how much should go to paying medical bills for retirees versus subsidizing college loans, job training and healthcare for young families with children? As they grapple with that, the party of small government increasingly relies on the votes of people dependent on entitlement spending. And the party that created the massive government programs for retirees has more and more become the political home of the young (Lauter, 1/2).

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Some Health Law Funding Becomes 'Fiscal Cliff' Casualty

The agreement approved by Congress and signed by President Barack Obama would kill new funding for health insurance co-operatives. The fiscal deal also officially repealed the health law's CLASS Act, but establishes a new bipartisan commission to develop a plan for long-term care services for elderly and disabled people.

Kaiser Health News: Capsules: Fiscal Deal Kills New Funding For Health Law's Co-Ops
The fiscal cliff deal, approved by Congress on New Year's Day, eliminates most of the more than $1.4 billion in remaining funding from the federal health law for new nonprofit, customer-owned health plans designed to compete against the major for-profit insurers (Galewitz, 1/2).

The Washington Post's Wonkblog: The Fiscal Cliff Cuts $1.9 Billion From Obamacare. Here's How.
The fiscal cliff deal is, obviously, mostly about preventing the fiscal cliff and stopping a wave of huge spending cuts. At the same time, legislators did find ways to make some relatively important health policy changes too. They include everything from raising Medicare doctor's pay, repealing a part of the Obamacare and cutting over a billion from the law's funding (Kliff, 1/2).

CQ HealthBeat: New Bipartisan Commission To Kick Off Search For Answers On Long-Term Care
A new high-level commission created to develop a national plan for long-term services for the elderly and disabled will have six months to come up with recommendations on one of the most complex and difficult issues in health care. The fiscal cliff bill, approved by the Senate and House and sent to President Barack Obama late Tuesday, has nine pages devoted to establishment of the Commission on Long-Term Care, a 15-member temporary body modeled on other independent health care panels, such as the Medicare Payment Advisory Commission (Norman, 1/2).

The Boston Globe: Agreement Makes Social Programs More Vulnerable
The lack of spending cuts in legislation that averted the fiscal cliff will place enormous pressure on entitlement programs such as Social Security, Medicare, Medicaid, and even the president's new heath insurance plan when negotiations begin in coming weeks to reduce the deficit, analysts said Wednesday. The legislation passed this week delayed by two months the implementation of automatic across-the-board cuts in discretionary spending. Now President Obama and Republicans are hoping to use that breathing room to come up with specific cuts, which could affect an array of social programs that are vital to many lower and middle-income Americans (Bender, 1/3).

Kaiser Health News: Health On The Hill: Counting Health Care Changes In The 'Fiscal Cliff' Deal
Kaiser Health News' Mary Agnes Carey and Politico Pro's Jennifer Haberkorn detail the deal struck between President Obama and Congress to avert the so-called "fiscal cliff" and what the compromise means for hospitals and doctors who serve Medicare patients (1/2).

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A Closer Look At Latest 'Doc Fix'

As part of the fiscal deal, a scheduled cut in Medicare physician payment rates was postponed -- but its 10-year price tag is being borne by other health care players, especially hospitals.

CQ HealthBeat: Sectors Hit By 'Doc Fix' Offsets May Keep Taking Their Lumps
As anxious as their advocates might be to see the Medicare and Medicaid payments cut by the fiscal cliff measure now awaiting President Barack Obama's signature restored, health care sectors that felt the budget blade could be in for a few more whacks in the coming months. The cuts in the fiscal cliff measure the Senate and House cleared this week offset the $25 billion cost over 10 years of continuing current Medicare physician payment rates through the end of 2013. But other cuts may be coming as lawmakers move to reduce deficit spending. Hospitals, for example, took about $15 billion in cuts to Medicare inpatient payments stemming from bill coding practices and reduced Medicaid "disproportionate share" payments to treat poor patients (Reichard, 1/2).

The Medicare NewsGroup: Docs Have Lived Under SGR Since '97, And Threats Of Cuts For A Decade
The SGR worked okay in the late 90s and early 2000s, when the economy was growing fast. During this time, physicians received significant increases in their payment updates. In 2002, the economy slowed and the SGR began turning out negative numbers. Congress let the cuts go into effect the first year (a 4.8 percent cut), but since then, they've passed legislation to defer the cuts. The SGR is cumulative, so cuts have grown from year to year. Congress is now afraid to permanently repeal the SGR because without it, they fear there will be no control whatsoever on the volume and intensity of physician services, [Stuart Guterman, vice president and executive director of the Commission on a High Performance Health System at The Commonwealth Fund] said (Sjoerdsma, 1/2).

The Medicare NewsGroup: Docs Spared From Fee Cuts In Fiscal Cliff Deal, But Say Permanent Fix Needed
There's bi-partisan agreement that the SGR formula, passed into law with the Balanced Budget Act of 1997, is flawed. Congress has passed 12 short-term patches since 2003 to keep the formula from going into effect. The Medicare Payment Advisory Commission (MedPAC), the group of experts who advise Congress on Medicare payments, has said that Congress has two options for dealing with the problem. Option one: Repeal the SGR and accelerate adoption of new payment models that improve quality and lower costs. Option two: Tweak the SGR or replace it with a new spending target. In option two, Congress should still experiment with new payment models (Sjoerdsma, 1/2).

The Medicare NewsGroup: A Look At Medicare Costs And Cuts In The Fiscal Cliff Deal
The "doc fix" included in the American Taxpayer Relief Act of 2012 averts a 27 percent pay cut slated to hit doctors on Tuesday due to the sustainable growth rate. But the $30 billion price tag of that patch is offset in the bill by cuts in reimbursement to other Medicare providers over the next ten years. Hospitals will fare the worst, picking up nearly 50 percent of the tab. Below is a detailed breakdown of the bill's Medicare provisions, and how they impact spending compared to the CBO's "current law" baseline (Solana, 1/2).

Philadelphia Inquirer: Hospitals To Eat Medicare Budget's 'Doc Fix
The budget package that Congress passed Tuesday to avert widespread tax increases and spending cuts blocked a 26.5 percent cut in Medicare payments to doctors, but hospitals and other health-care providers are paying for it. Even so, the head of a local hospital group was glad that the new law prevented the reduction in doctor payments linked to a 1997 law. "That's becoming increasingly relevant for hospitals" as they employ more physicians, said Curt Schroder, regional executive for the Delaware Valley Healthcare Council. But Sean Hopkins, senior vice president of the New Jersey Hospital Association, was disappointed that money to pay for keeping doctor payments level came from hospitals, many of which are already struggling to break even. "Hospital Medicare payments continue to be viewed as a big bucket you can take a little bit out of with without making a difference," said Hopkins. "But you can die a death of a thousand cuts" (Brubaker, 1/3).

The Wall Street Journal's Washington Wire: Cliff Deal Irks Hospitals
Now that health-care providers have sifted through the fiscal-cliff package, one group is emerging as the most upset with the deal: hospitals. Several pieces of the bill, which is headed for President Barack Obama's desk, would reduce federal payments to hospitals in exchange for staving off cuts to doctor's pay. Hospitals are calling it a raid on their funding, which has already been subject to cuts in the health overhaul law (Radnofsky, 1/2).

The Miami Herald: Fiscal Cliff Compromise Will Cost Florida Billions
Congress may have kept the nation from going over the fiscal cliff, but it failed to avert a multi-billion dollar hit to Florida's struggling economy. ... Under the bill, Congress voted to halt a $30 billion cut in payments to physicians who treat Medicare patients that was scheduled to take effect this week. The solution calls for hospitals that treat those patients to pick up half the tab over the next 10 years. That worries Florida’s public and teaching hospitals, which serve a larger percentage of Medicare patients than hospitals in other states. These Florida hospitals are already facing $654 million in annual cuts thanks to the Affordable Care Act on top of $1 billion in cuts imposed on them by state lawmakers over the past decade (Klas, 1/2).

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Health Reform

Hobby Lobby Won't Offer Contraception Coverage, Defying Health Law And Rulings; States Face Implementation Battles

Hobby Lobby has said it faces penalties of $1.3 million per day.

Los Angeles Times: Hobby Lobby To Defy Law On Contraception Coverage
After losing a last-minute appeal to the Supreme Court, craft stores chain Hobby Lobby said it would defy a federal health care mandate requiring employers to provide their workers with insurance that covers emergency contraceptives. ... The Oklahoma City-based chain, which is owned by a conservative Christian family also with holdings in the religious bookseller Mardel Inc., had applied to the Supreme Court to block a part of the federal healthcare law ordering companies to offer insurance that covers contraceptive drugs including the morning-after pill (Li, 1/1).

CQ HealthBeat: Hobby Lobby Owners Say They Will Defy HHS Over Birth Control Rule
[T]here was no word by late Wednesday afternoon on whether the federal government might take any enforcement action against the company. The owners of the 514-store Hobby Lobby chain -- the biggest company that has filed suit challenging the rule -- have said in court filings that they face penalties of $1.3 million a day under the health care law if they don't comply as of Jan. 1 (Norman, 1/2).

A health law rule released last week also stipulates that large employers offer unsubsidized coverage to employees' dependent children --

Modern Healthcare: Rule Would Require Big Employers To Offer Unsubsidized Dependent Coverage
Those employers that are required by the Patient Protection and Affordable Care Act to offer qualified health insurance coverage or pay a penalty are also required to offer unsubsidized health insurance coverage to their employees' dependent children, under a proposed rule unveiled late Dec. 28. The National Business Group on Health argues that the law does not concern dependents and for that reason there should be no dependent requirements in the rule, said Steve Wojcik, vice president of public policy for the employers group (Barr, 1/2).

Politico, in the meantime, looks at states' health law implementation battles -- 

Politico: 5 States To Watch On The Implementation Of ACA
Though governors may have come out strongly one way or another on implementation, most of them will have to face their first legislative sessions since the Supreme Court upheld the ACA. And even if states aren’t expanding Medicaid or setting up their own exchanges, they’ll have to confront possible changes to state laws to align with ACA requirements — or risk having the feds step in to regulate their insurance markets like never before. Here are five of the more interesting states to watch on ACA implementation in 2013: [Florida, Idaho, Arizona, Arkansas, Maine] (Millman, 1/3).

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Capitol Hill Watch

Sen. Kirk's Stroke Offers Him New Medicaid Perspective

Sen. Mark Kirk's stroke has awakened him to what people on Medicaid experience in their rehabilitation efforts, he said.

The Hill: Sen. Kirk Says Stroke Changed Perspective On Medicaid
Sen. Mark Kirk (R-Ill.) said his debilitating stroke has sparked a new interest in the experience of people on Medicaid. In an interview published Wednesday, Kirk said that most Illinois residents insured through the low-income health program would be eligible for just 11 rehabilitation sessions following a stroke. "Had I been limited to that I would have had no chance to recover like I did. So unlike before suffering the stroke, I’m much more focused on Medicaid and what my fellow citizens face," Kirk told the Chicago Sun Times (Vibeck, 1/2).

And new health care leadership in Congress continues to take shape --

The Hill: Rep. Lankford To Lead New Oversight Health Panel
Rep. James Lankford (R-Okla.) will lead a new subpanel on health care, entitlements and energy policy in the 113th Congress, leaders announced Wednesday. The House Oversight appointment comes as leaders reduce the committee's seven subpanels to five. Health care was previously lumped in with the District of Columbia, the Census and the National Archives. The revamp gives health issues -- sure to include President Obama's health care law as implementation ramps up -- a more prominent position, related and equal to entitlement reform (Viebeck, 1/2).

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Coverage & Access

States Consider Licensing Dental Therapists To Fill Cavities -- And Care Gap

A shortage of dentists spurred Minnesota to license dental therapists, and several other states may follow suit, USA Today reports. Meanwhile, a health plan in rural South Dakota and Minnesota is hiring Native American healers as consultants.

USA Today: Dental Therapists Aim To Fill Dental-Care Gap
With a growing number of people on medical assistance or without insurance needing dental care and an insufficient number of dentists, "The need for dental therapists is huge," says (Megan) Meyer, among the first nine graduates of the University of Minnesota School of Dentistry's Dental Therapy program in 2011. The school's second graduating class of nine students received their degrees earlier this month. ... Although Minnesota is currently the only state to license dental therapists, a number of others, including California, Kansas, Maine and New Hampshire, are considering such midlevel providers (Healy, 1/2).

The Associated Press: Sanford To Hire 2 Native American Healers
The country's largest rural, nonprofit hospital system is hiring two traditional Native American healers to train medical staff in the Dakotas and Minnesota in an effort to better serve the American Indian patient population. Sanford Health is in the process of hiring a Lakota/Dakota and an Ojibwe to serve as consultants as part of a three-year $12 million Center for Medicare and Medicaid Services award, said Read Sulik, Sanford's senior vice president for Behavioral Health Services. "Being where we're located in South Dakota, North Dakota and Minnesota, we realized we serve perhaps the largest American Indian population in a health system outside of Indian Health Services of probably any other system in the country, given where we're located across the northern Plains," Sulik said, noting that Native Americans as a group have some of the biggest health disparities in the country (Eaton, 1/2).

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Health Care Marketplace

Consumers' Perceptions Of Medical Prices Can Be Faulty

Despite advocates' push for more transparency in medical pricing, consumers may draw the wrong message when they know what a health service or good costs.

Kaiser Health News: Consumers May Draw Wrong Conclusions From Medical Prices
Some health policy experts and consumer advocates are pushing for greater transparency in the pricing of medical good and services. If consumers know the price of an item, so the thinking goes, they'll make smarter decisions about whether they need it. But a new study in the Journal of Consumer Research suggests that consumers’ perceptions of prices could lead them to the wrong conclusions (Kulkarni, 1/3).

Meanwhile, another study looks at financial incentives for oncologists --

Medscape: A Call To Eliminate 'Chemotherapy Concession'
A new study confirms that financial incentives exist for some US oncologists in the prescribing of chemotherapy and growth factors for treatment-related anemia. These potential "inducements" are not widespread, existing for only about 25% of 480 medical oncologists surveyed, and who are mostly among fee-for-service clinicians or those with financial incentives in their salary structure, found the authors, who were led by Jennifer Malin, MD, PhD, of the University of California, Los Angeles. ... Such financial incentives need to be "decreased" because they may be contributing to rising cancer costs, Dr. Malin and colleagues explain (Mulcahy, 1/2).

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Despite Uncertainty, 2012 Was Good Year For Hospital Stocks

Modern Healthcare: Hospital Stocks Saw Hefty Gains In 2012 Despite ACA Jitters
Hospital stocks ended 2012 posting big gains despite a year that was filled with uncertainty regarding the Patient Protection and Affordable Care Act. When the closing bell rang Dec. 31, HCA, Nashville, the largest investor-owned chain, was trading 37% higher than it was on the last trading day of 2011. Community Health Systems, Brentwood, Tenn., added more than 77% to its market capitalization. And Tenet Healthcare Corp., Dallas, saw gains of 58% over the same period. The boost came despite a tumultuous—but ultimately fruitful—year that saw the U.S. Supreme Court uphold key provisions of the healthcare law, and the re-election of President Barack Obama to cement its future. And despite weak patient volume, investor-owned systems managed to cut costs, boost outpatient revenue and reap gains from strategic acquisitions to satisfy investors (Kutscher, 1/2).

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Public Health & Education

Confusion Surrounds Regulation Of Various Types Of Drug Makers

Stateline: Big Drug Companies Poorly Regulated
Far from triggering a quick fix, the deaths or illnesses of 620 people in 19 states that have been linked to a Massachusetts pharmacy have only underscored confusion over how to regulate the various types of drug-makers in the United States. All that's clear at the moment is that the present federal-state regulatory divide isn't working. "This is the time that we have to get this right," Cody C. Wiberg, executive director of the Minnesota Board of Pharmacy, said last month after attending a hearing convened by the U.S. Food and Drug Administration. One of the ideas the FDA floated at that hearing was a bigger role for states in the regulation of drug-making, a role for which some believe they are ill-equipped (Ollove, 1/3).

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State Watch

State Restrictions On Abortions Slow In 2012, But Still Second Most Ever

A new Guttmacher Institute report finds that the number of new abortion restrictions passed by states in 2012 was down from 2011, but that the year still saw the second most new rules on the procedure ever.

Politico Pro: Report: 2012 Near Top For Anti-Abortion Rules
Forty-three provisions of new laws in 19 states set out to restrict access to abortion, according to the report, out of 122 total provisions related to reproductive health enacted in 42 states and the District of Columbia during the year. And more than half of those restrictions came from just six states. Arizona topped the charts with a total of seven anti-abortion restrictions. The others were Kansas, Louisiana, Oklahoma, South Dakota and Wisconsin, which all had at least three (Smith, 1/2).

The Hill: Study: New Abortion Restrictions Dropped In 2012
The Guttmacher Institute, a research organization that supports abortion rights, found that states sought to restrict the practice with 43 new laws in 2012. That number is less than half of the restrictions passed at the state level in 2011. ... 2011 was considered a banner year for opponents of abortion rights after Republicans took control of statehouses across the country (Viebeck, 1/2).

And governors in Michigan and Virginia rang in 2013 by signing new abortion restrictions --

Politico Pro: Two Governors OK Anti-Abortion Measures Over Holidays
As the nation celebrated the holidays, governors in Michigan and Virginia approved sweeping abortion restrictions that could spell the end of many abortion clinics in both states. In Michigan, Gov. Rick Snyder signed H.B. 5711, an "omnibus" bill of many abortion measures rolled into one, the Friday before the New Year's holiday. On the same day in Virginia, Gov. Bob McDonnell signed off on strict construction regulations for abortion providers in his state (Smith, 1/2).

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State Roundup: Ill. To Scrutinize Medicaid Eligibility

A selection of health policy news from Florida, Illinois, Connecticut, Texas, California, Oregon and Georgia.

Health News Florida: 1/5 Of Nursing Homes On "State Watch List"
[Fort Pierce resident Cathi] Odom recently learned that her mother's nursing home is one of 140 on the state's "Watch List."  Families for Better Care, a citizen advocacy organization, found that one in five facilities in Florida are on that list for not meeting state standards, or for not making corrections quickly enough. Twelve of the homes have been on the watch list for more than 100 days. Brian Lee, executive director for Families for Better Care, says that is unacceptable (Pusateri, 1/2).

The Associated Press: Vendor Begins Checks Of Medicaid Eligibility
Illinois officials have announced the launch of an effort ... to verify annually the income levels and residency of the state's 2.7 million Medicaid clients...Illinois Department of Healthcare and Family Services Director Julie Hamos says annual verification can determine whether people's circumstances have changed and they're no longer eligible (1/3).

Texas Tribune (Video): Valley Physicians Push For Medicaid HMO Reforms
[W]e've traveled across the state to find out what voters hope their lawmakers will fight for on their behalf during the 83rd Legislature. ... Put in place 10 months ago to save the state $385 million, many doctors in the Rio Grande Valley say Health Maintenance Organizations, HMOs, are limiting patients' access to care. The Texas Medical Association is among those hoping the 83rd Legislature can find ways to streamline the current system (Rocha, 1/2).

The CT Mirror: Report: Mental Health Care System Fragmented, Inadequate
There are too few hospital beds and psychiatrists for people seeking mental health and substance abuse treatment in Connecticut. There are too many barriers to getting services that could prevent crises. There's too much pushback from insurers over covering inpatient care even after a patient attempts suicide. And people with private health insurance often face some of the biggest challenges to getting treatment, according to a report issued Wednesday by the state Office of the Healthcare Advocate (Levin Becker, 1/2). 

The CT Mirror: After Newtown: A Rethinking Of Connecticut Law On Outpatient Commitment
The first time Jeanne Maillet's family called the police on her mentally ill relative, they thought he would finally get to a doctor, get treatment and get better. "We were so naïve," she said. Instead, it was only one step in what Maillet calls five years of hell, trying to get him help in Connecticut's mental health system. ... He doesn't think he's ill. And Maillet wishes there was a way to require he get treatment -- something she thinks would be possible in nearly every other state (Levin Becker, 1/2). 

The Lund Report: Regence Regains Its Lead While Losing Individual Members
Regence BlueCross BlueShield took back its spot as Oregon's top provider of health insurance, though its ongoing battle for market dominance remains a near-tie with previous leader Kaiser Permanente. Oregon’s health reform efforts played a major role pulling Kaiser down from the top position. Coordinated care organizations began insuring the majority of the state’s Medicaid members in the third quarter, removing 13,503 people from Kaiser's official Oregon rolls. In all, 650,000 people on Medicaid are in CCOs (Sherwood, 1/2). 

San Francisco Chronicle: Retirees Can Sue Livermore Lab Over Health Care
A state appeals court has revived a lawsuit by retired employees of the University of California's Lawrence Livermore National Laboratory over UC's decision in 2008 to switch their health insurance to a private plan that covered less and cost more. The four retirees presented evidence that the university had promised them lifetime health coverage and can try to prove that the shift to a lesser plan was a breach of contract, the First District Court of San Francisco ruled Monday (Egelko, 1/2).

Medscape: Prompt-Pay Reform In Georgia Blocked By Judge Temporarily
In a case pitting physicians against health insurers, a federal judge on Monday temporarily blocked an amendment to Georgia's prompt-pay law that would require companies cutting checks on behalf of self-funded employer health plans to pay errorless electronic claims within 15 working days or suffer a 12 percent penalty. The law originally applied only to traditional health insurers, not third-party administrators (TPAs) of self-funded plans (Lowes, 1/2). 

Atlanta Journal-Constitution: DeKalb Doctor Indicted On Medicaid Fraud Charge Over Abortions
A DeKalb County physician has been indicted for alleged Medicaid fraud for taking federal funds to perform elective abortions. Andre Damian Williams was indicted on Dec. 20 on one count of Medicaid fraud for allegedly accepting $205,003 in Medicaid funds for services not rendered and for services associated with the performance of elective abortions, according to Lauren Kane, a spokeswoman for the Georgia Attorney General's office (Jeffries, 1/2).

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Weekend Reading

Longer Looks: Helping Other Parents Reach Out To Mentally Ill Children

Every week Shefali S. Kulkarni selects interesting reading from around the Web.

The New Republic: The Rise of DIY Abortions
(Jennie Linn) McCormack knew that an abortion would cost $400 to $2,000, depending on how far along she was. ... She couldn’t come up with that kind of money. So she called her older sister, who owned a computer, and asked her to order abortion pills for her on the Internet. ... By the time the medication arrived in an unmarked envelope on December 23, she was in her second trimester ... That night, she started having cramps. The next morning, Christmas Eve, she delivered a dead fetus alone in her bathroom, along with the placenta and a great deal of blood. ... Several months later, in May 2011, McCormack was charged by the Bannock County Prosecutors’ office under 1973’s Idaho Code 18-606, which makes it a felony for a woman to have an abortion in a manner not sanctioned by the state and carries a possible prison sentence of up to five years. McCormack isn’t the only woman in recent years to be prosecuted for ending her own pregnancy. But her case could change the trajectory of abortion law in the United States (Ada Calhoun, 12/21).

The New York Times: Hispanic Pregnancies Fall In U.S. As Women Choose Smaller Families
In 2010, birthrates among all Hispanics reached their lowest level in 20 years, the [Pew Research Center] found. The sudden drop-off, which coincided with the onset of the recession, suggests that attitudes have changed since the days when older generations of Latinos prized large families and more closely followed Roman Catholic teachings, which forbid artificial contraception. Interviews with young Latinas, as well as reproductive health experts, show that the reasons for deciding to have fewer children are many, involving greater access to information about contraceptives and women’s health, as well as higher education (Susan Saulny, 12/31).

Los Angeles Times: A Lifeline For Parents Concerned About A Child's Mental Health
Lynn Goodloe saw her son's grades begin to fall as he developed a knack for getting into mischief at a private Westside high school. Was it a phase, drugs or something more troubling? Harold Turner didn't know what to make of his daughter's disorganized thinking and erratic behavior at Loyola Marymount University. ... The eventual diagnosis for Goodloe's son and Turner's daughter was severe mental illness, and both are now in treatment. And for the past several years, Goodloe and Turner have devoted themselves to helping others identify mental health problems and begin the daunting task of figuring out how to get help. ... "It was (the National Alliance on Mental Illness, an education and advocacy group) that saved us. It wasn't a psychiatrist or a psychologist," said Goodloe, a medical doctor who was flummoxed by the byzantine and fragmented mental health system (Steve Lopez, 12/30).

NBC (Video): Rising Above The Violence, To Pursue A Career In Health Care
Pediatrician Tomás Magaña has treated it all -- gunshot wounds, drug overdoses and domestic abuse injuries. "I've seen too many kids die. I've lost 10 kids in my practice, five in the past year alone," he said. The doctor’s voice cracks when he talks about his patients. ... Magaña and a colleague started a program designed to inspire at-risk teens to stay in school.  And it's working. Their program, FACES for the Future, helps teens explore careers in health care. The students get academic credit for volunteering in local hospitals where they shadow medical professionals doing their jobs. The kids rotate through specialties like surgery, anesthesia, pediatrics and neo-natal care (Mary Murray, 1/2).

The American Spectator: MSM Gives Us the Mushroom Treatment on HHS Mandate
In December, there were five federal court decisions relating to Obamacare. Chances are, however, that you will have heard about only one of them. If you do a web search for recent news stories on Hobby Lobby, whose long-shot request for a Supreme Court injunction against the HHS contraception mandate was denied last week, you will get thousands of hits. ... Now, using precisely the same parameters, do a search for recent stories on Wheaton College. You will get fewer than a dozen results relating to the December 18 decision by the D.C. Circuit Court of Appeals to overrule a lower court dismissal of Wheaton’s lawsuit against the government pursuant to the HHS mandate. You will find a similar paucity of stories about December rulings against the government in suits brought by the Catholic Archdiocese of New York, Korte & Luitjohan Contractors, and American Pulverizer, Inc. (David Catron, 12/31). 

American Medical News: Adopted Children Greeted By Doctors Who Specialize In Their Needs
When Eleanor Rybicki first came to the office of Elaine Schulte, MD, MPH, in August, she was a frail and tiny baby — so small she didn’t register on U.S. growth charts for her age group. Joseph and Kimberly Rybicki, who adopted Eleanor from a Chinese orphanage, were nervous, but Dr. Schulte quickly put their fears to rest. ... As an adoption medicine specialist and medical director of the International Adoption Program at Cleveland Clinic Children’s Hospital, Dr. Schulte routinely sees children who come from challenging circumstances. She is one of about 65 physicians in 31 states who focus much of their practices on treating adopted children, according to the American Academy of Pediatrics' Council on Foster Care, Adoption and Kinship Care Carolyne Krupa, 12/17).

The Associated Press: Big Pharma Cashes In On HGH Abuse
A federal crackdown on illicit foreign supplies of human growth hormone has failed to stop rampant misuse, and instead has driven record sales of the drug by some of the world's biggest pharmaceutical companies, an Associated Press investigation shows. The crackdown, which began in 2006, reduced the illegal flow of unregulated supplies from China, India and Mexico. But since then, Big Pharma has been satisfying the steady desires of U.S. users and abusers, including many who take the drug in the false hope of delaying the effects of aging. From 2005 to 2011, inflation-adjusted sales of HGH were up 69 percent, according to an AP analysis of pharmaceutical company data collected by the research firm IMS Health. Sales of the average prescription drug rose just 12 percent in that same period (David B. Caruso and Jeff Donn, 12/31).

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Editorials and Opinions

Viewpoints: McConnell Says Spending Cuts Are Coming; Plea To Kan. Governor To Rethink Insurance Exchange

Yahoo: Fiscal Cliff Deal Not Great, But It Shields Americans From Tax Hike
Predictably, the President is already claiming that his tax hike on the “rich” isn’t enough. I have news for him: the moment that he and virtually every elected Democrat in Washington signed off on the terms of the current arrangement, it was the last word on taxes. That debate is over. Now the conversation turns to cutting spending on the government programs that are the real source of the nation’s fiscal imbalance. And the upcoming debate on the debt limit is the perfect time to have that discussion. ... While most Washington Democrats may want to deny it, the truth is, the only thing we can do to solve the nation’s fiscal problem is to tackle government spending head on — and particularly, spending on health care programs, which appear to take off like a fighter jet on every chart available that details current trends in federal spending (Sen. Mitch McConnell, R-Ky., 1/3).

Bloomberg: When Governing Means Lurching Between Phony Crises
The tax cuts passed under President George W. Bush show what happens when reforms lack broad support. They were pushed through in 2001 and 2003 against solid Democratic opposition. For more than a decade, the overriding aim of Democratic politics has been to (partially) reverse them. Mission accomplished -- for now. A similar fate might be in store for health-care reform. With uncertain support from the public, the Affordable Care Act faces the skepticism of Republican governors and the outright hostility of a Republican-controlled House of Representatives. The policy may be the law of the land, but without a firmer base of support it will remain in jeopardy. Expect the pattern to repeat during the next phase of budgetary dysfunction (Clive Crook, 1/2).

Baltimore Sun: Budget Deal Won't Fix Unemployment
Friday, forecasters expect the Labor Department to report the economy added 155,000 jobs in December — substantially less than is needed to pull unemployment down to acceptable levels. ... However, on the supply side, increased business regulations, rising health care costs and mandates imposed by Obamacare — and now higher taxes on small businesses — discourage investments that raise productivity and competitiveness and create jobs (Peter Morici, 1/2).

Kansas City Star: Political Posturing On Health Care Hurts The Uninsured
In my last year of medical school I was part of a surgical team and met Tom, a 54-year-old farmhand. ... After a thorough assessment and numerous tests the team found that Tom had a mass in his bladder. ... The advanced stage of his cancer meant that he needed surgery and radiation to even have a chance at cure. However, he was uninsured, and his medical bills were already in the tens of thousands of dollars from this admission alone. Tom was left with two options: bankruptcy or death. ... Tom, along with tens of millions of Americans, will benefit from the insurance expansions in the new health reform law, popularly known as "Obamacare," once it is enacted in 2014. However, with Kansas and many other states dragging their feet, millions will continue to die, suffer and be bankrupted (Branden Comfort, 1/2).

The New York Times: Our Absurd Fear Of Fat
The meta-analysis, published this week in The Journal of the American Medical Association, reviewed data from nearly a hundred large epidemiological studies to determine the correlation between body mass and mortality risk. The results ought to stun anyone who assumes the definition of "normal" or "healthy" weight used by our public health authorities is actually supported by the medical literature (Paul Campos, 1/2).

The New England Journal of Medicine: Shared Decision Making To Improve Care And Reduce Costs
For many health situations in which there's not one clearly superior course of treatment, shared decision making can ensure that medical care better aligns with patients' preferences and values. ... However, more than 2 years after enactment of the ACA, little has been done to promote shared decision making. We believe that the Centers for Medicare and Medicaid Services (CMS) should begin certifying and implementing patient decision aids, aiming to achieve three important goals: promote an ideal approach to clinician–patient decision making, improve the quality of medical decisions, and reduce costs (Emily Oshima Lee and Dr. Ezekiel J. Emanuel, 1/3).

The New England Journal of Medicine: Using Shared Savings To Foster Coordinated Care For Dual Eligibles
There are 9.2 million people who are eligible for both Medicare and Medicaid. ... New federal policy initiatives are promoting organizations that integrate and coordinate care to meet the complex needs of this vulnerable population. The hope is that if beneficiaries are encouraged to enter into such arrangements, costs will fall and quality of care will improve. ... It is important to advance program designs that have the potential to improve care and save money, but we need to do so in a way that promotes self-determination and the exercise of real options (Richard G. Frank, 1/2).

The New England Journal of Medicine: The Bystander Effect In Medical Care
When nine different specialty teams are called in to help diagnose a perplexing condition in an ICU patient, chaos and inaction result, with all participants assuming passive roles, expecting another physician to bear the burden of authority and responsibility. ... promoting the use of mechanisms that encourage healthy and collegial interactions between specialty and primary care teams may empower individual clinicians to participate more meaningfully in the care of shared patients. The recent TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) initiative developed by the U.S. Agency for Healthcare Research and Quality, which aims to improve communication and team-based skills among health care professionals, is an important step in this direction (Drs. Robert R. Stavert and Jason P. Lott, 1/3).

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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.