Daily Health Policy Report

Thursday, January 31, 2013

Last updated: Thu, Jan 31

KHN Original Reporting & Guest Opinion

Health Reform

Medicare

Health Care Marketplace

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Fed Economist Steps Into Dispute On Geographic Differences In Health Spending

Kaiser Health News staff writer Jordan Rau reports: "An economist at the Federal Reserve has restoked the debate over the causes of regional differences in Medicare spending, and her analysis disputes some of the thinking behind a number of policy changes in the 2010 health law" (Rau, 1/30). Read the story.

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Manhattan's Bellevue Hospital Is Back, But Changed, After Sandy

WNYC's Fred Mogul, working in partnership with Kaiser Health News and NPR, reports: "When a ferry crashed in lower Manhattan earlier this month, ambulances took dozens of people to hospitals around Manhattan. Bellevue Hospital took in 31 passengers who all had minor injuries. Despite their bruises and bandages, something was missing: the most seriously hurt patients from the crash. Dr. Suzi Vassallo said that's because Bellevue currently can't handle serious traumatic injuries. Hurricane Sandy closed Bellevue, and it re-opened in December, but doing only partial duty" (Mogul, 1/30). Read the story.

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Capsules: Some Families Will Be Ineligible For Insurance Subsidies Under Final Rule; A Wish List For Medicare

Now on Kaiser Health News' blog, Julie Appleby reports on a newly issued health law final rule: "But the rule defines the standard for affordability more narrowly than most consumer groups had hoped — as an amount less than 9.5 percent of household income to cover just that employee's share of premium costs, not on what he or she must pay to cover their entire family, which is generally more expensive" (Appleby, 1/30).

Also on Capsules, Mary Agnes Carey reports on what a group of Medicare experts consider to be their wish list: "The three experts want to see a permanent fix for the payment formula for doctors. That formula, called the sustainable growth rate, or SGR, has threatened large payment cuts nearly every year since being implemented and Congress has repeatedly stepped in to stop it. And all said it's high time Congress confirms a CMS administrator" (Carey, 1/30). Check out what else is on the blog.

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Political Cartoon: 'Risk Factor?'

Kaiser Health News provides a fresh take on health policy developments with "Risk Factor?" by Chris Weyant.

Meanwhile, here is today's health policy haiku:

Decisions... Decisions!

States cast about on
Medicaid expansion... It's
more than politics.
-Anonymous

 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

Eligibility For Health Insurance Subsidies Narrower Than Many Consumer Groups Had Hoped

A final rule, released Wednesday, set out a strict definition of affordable health insurance that will prevent many families with modest incomes from obtaining federal financial assistance.

The New York Times: Federal Rule Limits Aid To Families Who Can’t Afford Employers Health Coverage
The Obama administration adopted a strict definition of affordable health insurance on Wednesday that will deny federal financial assistance to millions of Americans with modest incomes who cannot afford family coverage offered by employers. In deciding whether an employer's health plan is affordable, the Internal Revenue Service said it would look at the cost of coverage only for an individual employee, not for a family (Pear, 1/30).

The Wall Street Journal: Workers' Children Won't Get Subsidies
The decision, announced by the Obama administration on Wednesday, means some low-income Americans whose employer-plan premiums are beyond their means won't be eligible for the main perk of the law. Several provisions are behind the wrinkle (Radnofsky, 1/30).

Kaiser Health News: Capsules: Some Families Will Be Ineligible For Insurance Subsidies Under Final Rule
But the rule defines the standard for affordability more narrowly than most consumer groups had hoped — as an amount less than 9.5 percent of household income to cover just that employee's share of premium costs, not on what he or she must pay to cover their entire family, which is generally more expensive" (Appleby, 1/30).

The Associated Press: Some Families To Be Priced Out Of Health Overhaul
The Obama administration says its hands were tied by the way Congress wrote the law. Officials said the administration tried to mitigate the impact. Families that can't get coverage because of the glitch will not face a tax penalty for remaining uninsured, the IRS rules said (Alonso-Zaldivar, 1/30).

In addition -- 

Modern Healthcare: No Penalty For Medicaid-Eligible Uninsured, Proposed Rule Says
Two proposed rules from HHS and the IRS issued Wednesday describe how the government intends to apply the law's individual insurance mandate effective in 2014. Tax filers will need to begin verifying in 2015 that all of their dependents have qualifying coverage or pay tax penalties for them. The regulations describe a number of exemptions from the mandate, which requires most Americans to obtain qualifying health insurance or face tax penalties. About 2% of the population is expected to face those tax penalties despite the exemptions, according to the Congressional Budget Office (Daly, 1/30).

The Hill: Obama Administration Takes Steps To Implement Individual Mandate
The Obama administration took new steps Wednesday toward implementing the individual mandate in its signature healthcare law, downplaying the scope of the unpopular provision by stressing rules that allow exemptions from the requirement to purchase insurance. The Internal Revenue Service and the Health and Human Services Department emphasized exceptions to the mandate, which were detailed in new regulations that also laid out the process by which the IRS will calculate penalties for going uninsured (Baker, 1/30).

Kansas Health Institute: Feds Post Proposed Regulations For Health Insurance Mandate
Persons who go without health insurance after Jan. 1, would be spared a tax penalty if they can't afford health insurance, if they spend less than three consecutive months without coverage or if they qualify for other exemptions ranging from hardship to religious beliefs. The regulations also would exempt from penalty people whose income would qualify them for Medicaid coverage but live in states that choose not to expand eligibility (1/30).

Finally --

The Fiscal Times: Obamacare May Bring Heavier Workloads – And More Mistakes
When the Affordable Care Act is fully implemented, 32 million formerly-uninsured patients are expected to enter the health system. The influx has many experts worried about a physician shortage as doctors are not being added to the system at the same rate. While this could translate into doctors accepting fewer patients in offices, it could also mean crowded hospitals and overworked staff (Briody, 1/30).

San Francisco Chronicle: W-2 Forms Now Listing Health Care Costs
Employees have some new information on their W-2 forms for 2012 - the cost of their employer-provided health insurance. This amount shows up in box 12 with the code DD. It includes what the employer and employee paid in premiums last year. To find out what your employer paid, subtract what you paid (look at your last pay stub for 2012) from the DD amount. The amount in this box is not taxable (Pender, 1/30).

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Ohio Might Join Ranks Of Red States Opting For Medicaid Expansion

John Kasich, the state's Republican governor, hints to The Cincinnati Enquirer that he might call for this step in his two-year budget plan, expected to be released in the next few days.

USA Today/The Cincinnati Enquirer: Ohio Governor Weighs Medicaid Expansion
Ohio could be among a growing contingent of Republican-led states leaning toward expanding Medicaid coverage for hundreds of thousands of low-income residents. In an interview with The Cincinnati Enquirer this week, Ohio Gov. John Kasich hinted he would call for expanding the joint federal-state health care program for poor and disabled in his pending two-year budget proposal, which is due Monday (Bernard-Kuhn, 1/30).

The Associated Press: Where Ohioans Stand On Medicaid Expansion In State
A look at where Ohio's political leaders, health industry organizations and others stand on expanding Medicaid benefits. Gov. John Kasich is to announce Feb. 4 whether he'll push for expansion (Seewer, 1/30).

MPR News: Expanded Medicaid Eligibility Could Cover Additional 145,000 Minnesotans
Gov. Mark Dayton's plan to expand eligibility for Medicaid in Minnesota would provide health coverage for an additional 145,000 Minnesotans, including 47,000 children, said Minnesota's Human Services Commissioner. Medicaid is a joint federal state safety net program that serves low-income, disabled and vulnerable residents. It's called Medical Assistance in Minnesota. The expansion plan would raise income limits and cover some childless adults. Last summer, the U.S. Supreme Court ruled that states could opt out of the expansion. But Commissioner Lucinda Jesson said the legislature should approve the plan because it covers more Minnesotans and is a good deal for taxpayers (Stawicki, 1/30).

The Hill: HHS Clarifies Exemptions From Individual Mandate In States That Buck Medicaid Expansion
As the Obama administration took new steps Wednesday to implement the healthcare law's individual mandate, it clarified an exemption for people whose governors don't take part in the expanded Medicaid program. The law's unpopular individual mandate requires most taxpayers to either buy health insurance or pay a penalty to the IRS. But there are several exceptions to the policy, and the Health and Human Services Department emphasized those carve-outs in newly issued regulations Wednesday (Baker, 1/30).

North Carolina Health News: Legislators Reject State Implementation Of Obamacare
On their first day back in session, North Carolina Senate Republicans introduced a bill yesterday to opt out of several provisions of the federal Affordable Care Act, or Obamacare, scheduled to go into effect next year. Senate Bill 4, introduced by senators Tom Apodaca (R-Henderson), Harry Brown (R-Onslow) and Bob Rucho (R-Mecklenburg), would exempt the state from establishing a state-run health insurance exchange or a federal-state partnership exchange. The bill would rule also out expansion of the state’s Medicaid program (Sisk, 1/31). 

The Associated Press: Update: N.C. Lawmakers Want To Stop Online Insurance Market
Republicans in control of the General Assembly introduced legislation today that would block the expansion of Medicaid under the health care overhaul and leave it to the federal government to build the state’s online marketplace for health insurance. Under the health overhaul championed by President Barack Obama, the federal government offered to pay the full cost for expanding Medicaid coverage the first three years and 90 percent thereafter (Dalesio, 1/30).

Meanwhile, on the topic of state-based health exchanges --

MPR News: Brokers Could Be Paid Directly By Insurance Carriers Under Exchange Amendment
A Minnesota Senate committee handed insurance brokers a victory today in a long-running skirmish over the state's new health insurance marketplace. Brokers who sell policies on the state's exchange could be paid directly by insurance carriers under an amendment the commerce committee approved Wednesday. But, brokers would have to disclose the payment arrangement to consumers. In the original bill, the exchange would withhold a portion of premiums paid and then decide how much to pay the brokers (Stawicki, 1/30).

Fox News: Administration Scrambling To Set Up ObamaCare Exchanges
The Obama administration continues to scramble in an effort to convince states to create their own so-called insurance exchanges, which were established under the health care overhaul. But so far, 25 states have rejected the idea -- forcing the federal government to do it instead. "They've essentially said to the federal government, 'we don't ... really want to be a part of trying to clean up this train wreck we see coming'," said Jim Capretta of the Ethics and Public Policy Center (Angle, 1/30).

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Health Law Drawing Concern From Unexpected Source

The Wall Street Journal: Some Unions Grow Wary Of Health Law They Backed
Labor unions enthusiastically backed the Obama administration's health-care overhaul when it was up for debate. Now that the law is rolling out, some are turning sour. Union leaders say many of the law's requirements will drive up the costs for their health-care plans and make unionized workers less competitive. Among other things, the law eliminates the caps on medical benefits and prescription drugs used as cost-containment measures in many health-care plans. It also allows children to stay on their parents' plans until they turn 26 (Adamy and Trottman, 1/30).

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Medicare

Medicare Expands Competitive Bidding Program

The new prices will kick in July 1 and are expected to save on average 45 percent for products such as walkers, wheelchairs, oxygen equipment and other medical products. 

The Associated Press/Washington Post: Medicare Expands Competitive Bids For Medical Equipment; Big Savings Seen For Some Seniors
Savings are also coming for many patients who rent home oxygen gear, hospital beds, wheelchairs and other equipment. Medicare deputy administrator Jonathan Blum said Wednesday its due to competitive bidding making inroads against wasteful spending (1/30).

Reuters: U.S. Expects Big Medicare Savings From Competitive Bid Program
Medicare and its beneficiaries in 100 metropolitan areas will pay less for durable equipment beginning July 1. The new prices, set by competitive bidding, are expected to save 45 percent on average, on products including walkers, wheelchairs, oxygen equipment, hospital beds and prosthetics (Morgan, 1/30).

CQ Healthbeat: Medicare Patients In 91 Cities May Face Supplier Switch, But Will Save Big On Gear
Medicare beneficiaries in 91 cities will save an average of 45 percent a month on wheelchairs and other medical equipment starting this summer thanks to the expansion of a competitive bidding program, federal officials announced Wednesday. Beneficiaries will also save an average of 72 percent on diabetic testing supplies under a national mail-order program starting at the same time, the Centers for Medicare and Medicaid Services said in a news release (Reichard, 1/30).

In related news --

The Washington Post: Medicare To Adjust Payment For Dialysis Drugs After Overspending Millions
The Medicare system is recalculating how much it will reimburse hospitals and clinics for the drugs used to treat dialysis patients after federal auditors found recently that the program could save as much as $880 million annually. An analysis by The Washington Post in August showed that the government was overspending by hundreds of millions for just one group of those drugs (Whoriskey, 1/30).

Additional Medicare headlines --

Kaiser Health News: Capsules: A Wish List For Medicare
The three (former Medicare administrators) want to see a permanent fix for the payment formula for doctors. That formula, called the sustainable growth rate, or SGR, has threatened large payment cuts nearly every year since being implemented and Congress has repeatedly stepped in to stop it. And all said it's high time Congress confirms a CMS administrator (Carey, 1/30).

Kaiser Health News: Fed Economist Steps Into Dispute On Geographic Differences In Health Spending
An economist at the Federal Reserve has restoked the debate over the causes of regional differences in Medicare spending, and her analysis disputes some of the thinking behind a number of policy changes in the 2010 health law (Rau, 1/30).

The Medicare NewsGroup: Fact/Fiction: Medicare Beneficiaries Pay The Same Amount For Medicare, Regardless Of How Much Money They Have
Premiums for Medicare Medical Insurance (Part B) and Medicare Prescription Drug Plans (Part D) are already tied to beneficiaries’ income levels. In a more indirect form, Medicare Hospital Insurance (Part A) is also tied to income. … Within the context of Medicare reform, some policymakers explain that what they are proposing as parts of proposals to either save the program money or as a deficit-reduction strategy is an expansion on means-testing for the program (Solana, 1/30).

Medpage Today: Medicare Panel Pans Alzheimer's Test
A Medicare advisory panel expressed little support Wednesday for the idea that an imaging technology for the beta-amyloid protein tied to Alzheimer's disease changes health outcomes. Using a scale of 1 for "low confidence" and 5 for "high confidence," the 12-member Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) responded with an average vote of 2.1667 on how confident they were that PET scans to detect beta-amyloid protein in the brain improved health outcomes in patients who show early signs of cognitive dysfunction. Panelists expressed their concerns that the benefits of a Medicare patient knowing they tested positive for beta amyloid were outweighed by the possible false positives and other issues that come with that knowledge (Pittman, 1/30).

And from Capitol Hill -

Politico: Brady To Take On Medicare Challenges
Congress has done little but bicker over Medicare for the past few years, but Rep. Kevin Brady still thinks he has a shot at fixing the program now that he's leading a powerful health panel. As newly installed Health Subcommittee chairman for the Ways and Means Committee, the Texas Republican is already working on two projects that lawmakers have pushed to the back burner for years because they were too contentious to solve (Cunningham, 1/31).

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Health Care Marketplace

Pharmacuetical Companies Eye Orphan Drugs As New Revenue Source

The New York Times: Making 'Every Patient Counts' A Business Imperative
Drug companies are fond of saying that every patient counts, but in the world of orphan diseases, entire business plans are built around the idea. ... Development of these drugs is increasingly attractive to pharmaceutical companies, which are searching for new sources of revenue as sales of more traditional, mass-market drugs have been lost to generic competition. The orphan drug market was worth more than $50 billion in 2011 and turns out blockbusters at the same rate as the broader industry, according to a recent Thomson Reuters analysis (Thomas, 1/30).

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Market Demands Spur More Options For Senior Care

The Associated Press: As America Ages, Senior Care Options Flourish
Millions of families are beginning to grapple with the one major health expense for which most Americans are not insured: long-term care. About 10 million seniors currently rely on others for daily care, such as help getting dressed, preparing meals or taking medication. That number will only increase as more of the nation's 78 million baby boomers enter old age (Perrone, 1/31).

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State Watch

Medicaid News: Minn. Effort To Expand Program Praised

Officials in Texas, Oregon, Minnesota and California consider a myriad of changes to their Medicaid programs -- including fitting maintenance or expansion of coverage for the poor into tightening budgets.

MinnPost: Effort To Expand Access To Minnesota's Medical Assistance Program Praised
Human Services Commissioner Lucinda Jesson praised lawmakers and the Dayton administration on Wednesday for working to enroll more low-income Minnesotans on public health programs available under the federal reform law. Democrats are moving forward quickly with legislation this session to expand eligibility for the state's Medical Assistance program to offer 145,000 Minnesotans improved health care, Jesson said during a conference call with reporters (Nord, 1/30).

CQ Healthbeat: Federal, California Officials Rushing To Prevent Expiration Of Duals Demonstration Authority
A California demonstration for people eligible for both Medicare and Medicaid is so far behind schedule that the state law authorizing it expires Friday. But state and federal officials hope to keep that from happening. California is one of 26 states that applied to participate in the Centers for Medicare and Medicaid Services federal demonstration for the dually eligible (Adams, 1/30).

The Associated Press: Texas Senate Chairman Seeks Health Budget Changes
Texas will use "all the money that there is available to spend" in the state budget just paying the health care costs of the growing number of poor, disabled and elderly unless dramatic changes are made to the Medicaid system, the chairman of the Senate Finance Committee said Wednesday. Tommy Williams, R-The Woodlands, called on fellow Texas lawmakers and state agency chiefs to prepare themselves to make tough choices but offered no details on how he would change Medicaid, the joint state-federal health program for 3.6 million Texans (Tomlinson, 1/30).

The Lund Report: Flares Still Brewing Over Integration Of Dental Care
Mike Shirtcliff insists he's not trying to derail the transformation process and says that he supports the integration of dental care into coordinated care organizations, better known as CCOs. He just wants to make certain patient care isn't sidelined by the process. Currently, 650,000 people on Medicaid receive physical and mental health services from the 15 CCOs throughout Oregon (Lund-Muzikant, 1/30).

California Healthline: Using Data To Simplify Medi-Cal Enrollment
A different approach to Medi-Cal eligibility renewal was floated yesterday at an informational seminar in Sacramento. The idea is to limit the amount of forms and paperwork in renewing Medi-Cal eligibility. That might be accomplished in part by using statistical analysis of eligibility data to determine which beneficiaries don't need to fill out new forms when their Medi-Cal benefits are up for renewal, said Stan Dorn, senior fellow at the Urban Institute, a Washington, D.C.-based think tank. "The traditional way to handle Medicaid enrollment is very paperwork-intensive," Dorn said (Gorn, 1/31).

California Healthline: Access Denied? Implications Of Medi-Cal Pay Cut
In 2014, about 1.5 million adults in California are expected to gain access to Medi-Cal under the Affordable Care Act. However, insurance coverage could be all they get, as some observers say there might not be enough doctors willing to treat them. The fiscal year 2013-2014 budget proposal that Gov. Jerry Brown (D) released this month could be read as contradictory. On one hand, he makes it clear that California will pursue a full expansion of Medi-Cal, offering coverage to individuals with incomes up to 138 percent of the federal poverty level. At the same time, however, the governor's budget plan also counts on $488.4 million in savings from a 10 percent cut to Medi-Cal reimbursements. Medi-Cal is California's Medicaid program. State officials maintain that the provider pay cut should not hurt access to care during the expansion, but others fear the reduction could be implemented at the worst possible time (Wayt, 1/30).

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State Roundup: Texas Lawmakers Ready Health Budget

A selection of health policy stories from Oregon, Texas, Colorado, Florida, New York, California, Kansas and Arizona.

The Texas Tribune: Senators Take On Health Care Costs, Medicaid Expansion
Texas budget writers got a briefing on the state's health care programs Wednesday, and many of the biggest questions focused on how the state can reduce fraud and what to do about ever-increasing health care costs. The state Senate's initial budget proposal spends more than $70 billion on health and human services, a 2 percent increase from the current budget (Philpott, 1/31).

Health Policy Solutions (a Colo. news service): Public Health Agencies Lose $4 Million In Vaccine Funds
Deep into a whooping cough epidemic and a long struggle with poor immunization rates, Colorado can no longer tap a $4 million pot of federal money to give vaccines to needy children. As of Jan. 1, the federal government barred local public health agencies from using so-called "317 funds" to give children vaccines if they have health insurance other than Medicaid (Kerwin McCrimmon, 1/30).

The New York Times: Federal Agents Raid Offices Of Donor Linked To Senator Menendez
The Federal Bureau of Investigation on Tuesday raided the offices of a prominent South Florida eye surgeon who is a wealthy Democratic Party donor with close ties to Senator Robert Menendez of New Jersey. ... At the West Palm Beach office, agents from the F.B.I. were joined by the Office of the Inspector General of the federal Department of Health and Human Services, which investigates fraud in Medicare, Medicaid and other agency programs (Robles, 1/30).

Kaiser Health News: Manhattan's Bellevue Hospital Is Back, But Changed, After Sandy
When a ferry crashed in lower Manhattan earlier this month, ambulances took dozens of people to hospitals around Manhattan. Bellevue Hospital took in 31 passengers who all had minor injuries. Despite their bruises and bandages, something was missing: the most seriously hurt patients from the crash. Dr. Suzi Vassallo said that's because Bellevue currently can't handle serious traumatic injuries. Hurricane Sandy closed Bellevue, and it re-opened in December, but doing only partial duty" (Mogul, 1/30).

Los Angeles Times: Beach Cities Are Getting Healthier, Data Show
A comprehensive effort to improve the health of residents living in the beach cities is doing just that, according to new data released Wednesday. Beginning in 2010, Redondo Beach, Manhattan Beach and Hermosa Beach started making changes in homes, workplaces and schools to improve the well-being of people living in the region. They revamped restaurant menus, started "walking school buses" for children and created neighborhood gardens. Hermosa Beach passed an anti-smoking ordinance and the beach cities began working on adding bike lanes (Gorman, 1/30).

Los Angeles Times: County Health Clinic To Open In Skid Row Apartment Building
Recognizing the high cost of treating homeless patients, Los Angeles County plans to open a health clinic inside a skid row apartment building. Residents of the 102-unit building, scheduled to open this summer on 6th Street, will be carefully chosen based on their health needs and their regular use of the emergency health care system (Gorman, 1/30).

The Associated Press: Students Call For End To UC Health Insurance Cap
Students have called on the University of California to end caps on health care coverage that could leave them to foot the bill for their medical treatment. Most UC campuses limit students' coverage to $400,000, the San Francisco Chronicle reported Tuesday (1/30).

The Lund Report: Gov. Kitzhaber Steps Into Debate Over Medical Liability Reform
A heated debate over medical liability reform pitted physicians against each other and came extremely close to the tipping point when the Oregon Medical Association's board of trustees met last Saturday. Legislators, defense attorneys and malpractice insurers even joined the fray. The governor had appointed a committee of physicians and trial attorneys last year, which reached agreement on an early disclosure process for medical errors, allowing physicians to apologize and enter into mediation before facing litigation. Shortly before the OMA met, that legislative proposal was altered -- making it voluntary in order to curry the favor of physicians. But there was still dissension in the ranks, particularly among physician specialists who feared the proposal would open them up to more lawsuits because of the lack of confidentiality (Lund-Muzikant, 1/30).

The Lund Report: Legislature Considers Evidence-Based Approach For Insurance Reform
Dr. John McAnulty, a cardiologist at Legacy Health System, knows all too well that medicine can't sort out every last detail -- particularly when it comes to evidence-based care. That’s why he supports a legislative proposal allowing the Oregon Insurance Division to initiate a pilot program using the protocols developed by the Health Evidence Review Commission. Created in 2011 after passage of House Bill 2100, that commission is charged with coming up with evidence-based findings -- known as guidances -- for providers, consumers and health care purchasers, including the state’s Medicaid plan (Lund-Muzikant, 1/30).

The Lund Report: Oregon Midwives Face New Regulation
Practitioners of one of medicine's oldest professions could face new regulation in Oregon after this coming legislative session. And implementation of the Affordable Care Act could bring even more changes – though that remains far from clear. What is certain is that many midwives across the state are worried. … The number of medical professionals affected is relatively small -- about 120 midwives -- and they deliver only about 3 percent of the state's roughly 50,000 births per year (Sherwood, 1/30).

Health News Florida: 950 FL Pharmacies Called High-Risk Compounders
Almost 950 Florida-licensed pharmacies engage in "sterile compounding," the type of high-risk drug-making that led to a deadly fungal meningitis epidemic last year, according to a Department of Health survey released last week. Sterile compounders are now given priority for state inspections, but it’s going to be a daunting task to check them all, judging from the survey report and interviews with pharmacists and health department officials (Gentry, 1/31).

Kansas Health Institute: Independent Pharmacies Pinched By Preferred Provider Networks
Preferred provider networks can help seniors save money on their prescription drugs. If a senior’s Medicare Part D plan includes a network of preferred providers and if they have their prescriptions filled at one of the participating pharmacies, they get a discount. ... But most of the participating pharmacies are large, corporate owned stores in towns large enough to have a Walmart, and owners of smaller, independent pharmacies say the chains' Medicare arrangements are hurting their businesses (Ranney, 1/31).

Health Policy Solutions (a Colo. news service): Governor, Lawmakers Support Help For The Disabled
Colorado's notorious and seemingly endless waiting list for services for people with developmental disabilities numbers at least 2,692 including 69 people who are in hospice care. Gov. John Hickenlooper wants lawmakers to spend at least $13 million to begin reversing the backlog. Colorado lags behind most states on funding for the disabled. Hickenlooper’s proposal calls for covering all children whose families care for them in their homes and would chip away at the adult waiting list. ... So far, lawmakers from key health committees on both sides of the aisle are indicating support to boost funding for the disabled after the economic downturn forced Colorado to cut spending on the disabled in recent years (Kerwin McCrimmon, 1/30).

Arizona Republic: Arizona Prisons' Health-Care Contractor Replaced
The Arizona Department of Corrections and Wexford Health Sources, Inc. have agreed to terminate the company's medical-services contract that provides health care for inmates statewide. Wednesday's abrupt announcement of the split came in the wake of accusations last year that the company improperly dispensed medicine to inmates and wasted state resources. The corrections department, in a joint statement with Wexford, said both parties encountered unforseeable challenges and decided to end the deal. The state has reached an agreement with Corizon, Inc. of Brentwood, Tenn., to become the health care provider for all state-run prisons, and it will take over March 4 (Harris, 1/30).

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Weekend Reading

Longer Looks: Dr. Oz, Deconstructed; Malpractice And Apology

Every week Ankita Rao selects interesting reading from around the Web.

The New Yorker: The Operator
Oprah Winfrey first referred to Mehmet Oz as "America's doctor" in 2004, during one of his earliest appearances on her television show. The label stuck. Oz was a rare find: so eloquent and telegenic that people are often surprised to learn that he is a highly credentialled member of the medical establishment. ... "The Dr. Oz Show" frequently focusses on essential health issues: the proper ways to eat, relax, exercise, and sleep, and how to maintain a healthy heart. Much of the advice Oz offers is sensible, and is rooted solidly in scientific literature. That is why the rest of what he does is so hard to understand. Oz is an experienced surgeon, yet almost daily he employs words that serious scientists shun, like "startling," "breakthrough," "radical," "revolutionary," and "miracle." There are miracle drinks and miracle meal plans and miracles to stop aging and miracles to fight fat. ... I asked Oz several times why he promotes that kind of product, and allows psychics, homeopaths, and purveyors of improbable diet plans and dietary supplements to appear on the show. He said that he takes his role as a medium between medicine and the people seriously, and he feels that such programs offer his audience a broader perspective on health (Michael Specter, 2/4).

The Boston Globe: Medical Malpractice: Why Is It So Hard For Doctors To Apologize?
The paradox of modern medicine is that the increasing specialization that has revolutionized care has also depersonalized it. When a mistake is suspected, it may be unclear who from a team must step in to take responsibility. For patients seeking information, the only obvious recourse is to call a malpractice lawyer, whose livelihood depends on replacing a patient’s desire for comfort and understanding with a need for vengeance. There is reason for hope that things can be done differently, even among doctors like myself who are conditioned to be suspicious of malpractice claims. Massachusetts recently enacted a law that, among other things, usually allows doctors to speak more openly to patients and families who were harmed, even apologize to them, without worry that their words will later be used against them in court (Dr. Darshak Sanghavi, 1/27).

The Atlantic: 'He Didn't Seem Crazy': Where Violence Meets Health Care
In 2008 Thomas Scantling, who at the time was not taking medication to treat his schizophrenia and who compounded his mental health problems by abusing PCP, attacked 20-year-old Dewayne Taylor ... Around the same time as Scantling's subway hammer attack, Philadelphia rolled out its criminal mental health court. Designed to steer low level offenders towards outpatient mental health treatment instead of county jail, ... Advocates of mental health courts say they can prevent terrifying high profile violence of the sort described here by catching mentally ill offenders early and providing them with supportive services. Critics claim that expanding the reach of the judicial system into the lives of people with severe mental illness will actually backfire, driving people away from therapists and doctors for fear of being reported to the police (Jeff Deeney, 1/23).

HealthyCal: The Difference Between Poverty And Mental Illness
Anxiety isn’t always necessarily mental illness. Sometimes it is a normal reaction to life’s challenges, such as the level of poverty [Judith] Baer experienced. In the 1960s, Baer and her children were living on $300 a month. Making the money stretch to cover their needs was no easy feat. She was stressed. But she wasn't mentally ill. "The last thing I needed, on top of everything else, was to be called disordered," she says. "I was very anxious—yes, but not disordered." Recently, Baer and colleagues at the Rutgers School of Social Work examined the relationship between poverty and generalized anxiety disorder (GAD), a psychological disorder characterized by "excessive anxiety and worry" that lasts for at least six months (Elise Craig, 1/28).

Time: Time to Curb Unintended Military Pregnancies
The U.S. military faces numerous challenges. Among these are the burgeoning costs of healthcare and persistently limited participation of women. Practical solutions exist which can tackle both of these problems simultaneously. ... Unwanted pregnancies are a significant contributor to healthcare expenditures. Indeed, according to the April 2012 issue of Medical Surveillance Monthly Report, ... about half of all pregnancies to military women were "mistimed or unwanted at the time of conception." ... there is no denying that fewer unwanted pregnancies will mean fewer abortions, improved health for women, greater participation (recruitment and retention) of women in the military, and a smaller healthcare bill for the nation's taxpayers (Dr. Artin Terhakopian, 1/31).

The New Republic: Why Do Grandmothers Exist?
The question is not as unfeeling as it sounds. From the point of view of the selfish gene, creatures are supposed to drop dead as soon as they lose the power to reproduce. ... [The "grandmother hypothesis"] holds that women past childbearing age helped not just their children, but their children's children, and lengthened the human lifespan in the process. Without babies of their own to lug around, grandmothers had both time and a very good reason to be useful (Judith Shulevitz, 1/29).

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Editorials and Opinions

Viewpoints: Congress Must Put Entitlements On 'More Sustainable Path;' Reading, Writing And Mental Health Screenings

Los Angeles Times: Playing With Fiscal Fire
What's needed now is a clear, achievable plan to bring the debt and deficit under control for the long term. A crucial part of any such plan is promoting a more vigorous economy, possibly by simplifying the federal tax code. Another important piece is putting entitlements on a more sustainable path, reducing the drain on the Treasury. That means expanding on the 2010 healthcare law's efforts to increase efficiency, quality and innovation in healthcare. But if Congress is determined to cut federal spending now at all costs, it may be chagrined to find how much it costs the economy (1/31).

The Washington Post: Obamacare: A Starting Point For GOP Revival
The Republicans, at least sentient ones, have figured out that talking in abstractions ("free-market capitalism") and slogans ("rule of law!") may be soothing for fellow conservatives but largely falls on deaf ears in a wider electorate. Likewise, opposing tax increases, opposing Obamacare and opposing compromise aren't going to capture the imagination or earn the respect of non-ideological voters. Any political hack can vote no on the "fiscal cliff," oppose immigration reform and demand a repeal of Obamacare; none of those actions, however, will advance conservatism nor earn the GOP more support (Jennifer Rubin, 1/30).

The New England Journal of Medicine: After Newtown — Public Opinion On Gun Policy And Mental Illness 
Gun policies with the highest support included those related to persons with mental illness. The majority of Americans apparently also support increasing government spending on mental health treatment as a strategy for reducing gun violence. Given the data on public attitudes about persons with mental illness, it is worth thinking carefully about how to implement effective gun-violence–prevention measures without exacerbating stigma or discouraging people from seeking treatment (Colleen L. Barry, Emma E. McGinty, Jon S. Vernick and Daniel W. Webster, 1/30).

USA Today: Mental Health Screening For Kids
Children can't enroll in school without a doctor's verification of good health, and many districts also require visits to dentists and eye doctors. The Newtown school massacre has focused attention on dealing with mental health. A key step should be adding mental health screenings to the list of required checkups. Such screening is rarely done and represents a huge unmet need: Best estimates suggest that fewer than 2% of schools have a systematic mental health screening program (Rahil Briggs, 1/30).

The Wall Street Journal: When Hospitals Become Killers
Last week, public-health researchers released alarming data in the journal Infection Control and Hospital Epidemiology showing that the same germ that swept through the NIH is invading hospitals across the country. Researchers writing this month in another medical journal, Emerging Infectious Diseases, warn that CRK poses "a major threat to public health" (Betsy McCaughey, 1/30).

The Medicare NewsGroup: Medical Equipment, Devices Still A Ripe Area For Abuse
Knee replacements. Coronary stents. Artificial hips. A veritable hardware store of human replacement parts. It's likely that Medicare is paying too much for these items, costing taxpayers tens of billions of dollars each year, but money can't be saved until the program overhauls its purchasing practices in this expensive expense category. The greatest source of expense for medical devices is in the area of implantable medical devices, or IMDs. As America's baby boomer generation ages, seniors are getting joint replacements and coronary stents at an increasingly higher rate (John Wasik, 1/30).

Politico: The Drug Patent's Real Challenge
"Reverse payment" or "pay for delay" patent settlements between brand and generic drug manufacturers are a classic example of how legislation enacted with good intentions can produce bad public policy (Alfred Engelberg, 1/30).

Health Policy Solutions (a Colo. news service): All Payer Claims Database Designed To Reduce Costs, Improve Health Care
Health care is full of acronyms. One of them is the APCD, or All Payer Claims Database. That’s a mouthful that describes a simple goal – creating a system that will allow Coloradans to compare prices and data on health care. Compiling and sharing this data is designed, in the long run, to reduce costs and improve the quality of care. Currently, this secure database has information on costs and health care usage for about 2 million Coloradans with private insurance and Medicaid coverage. When fully implemented, it will include data from almost 90 percent of all Coloradans that have insurance coverage (Bob Semro, 1/30). 

Kansas City Star: Catholic Church Tests Its Reach In Health Care Debate
Bystanders love a good brawl. Make it between people not normally viewed as combative and the crowd gathers, primed for the rumble. No surprise, then, when people jumped at the animosity between Bishop Robert Finn and the Kansas City-based National Catholic Reporter. ... Those tensions are the tip of this iceberg. Faith-based pushback to health care reform is where eyes and ears should focus. That's the building battle that will affect people far beyond the Catholic faith (Mary Sanchez, 1/30). 

The New England Journal of Medicine: Use of Health IT For Higher-Value Critical Care
With an aging population and ever-growing demand for critical care, some observers worry that the number of staffed ICU beds will become increasingly inadequate. ... Nevertheless, relatively little effort has been devoted to what could be the most promising approach to the problem: the application of advances in health information technology (HIT) to triage decisions (Lena M. Chen, Edward H. Kennedy, Anne Sales and Timothy P. Hofer, 1/30).

The Lund Report: What Interoperable EHRs Might Have Done To Improve The Patient Care Experience
You will recall in my article last December, about my healthcare experience outside of Oregon, that both the ear doctor and the neurosurgeon professed to have electronic health records (EHRs). The ear doctor advised that he was using the aircraft control type headset to dictate into my medical record, by pushing the button in his ear. When I corrected him, he would re-dictate the correction. The neurosurgeon was complaining about a most popular vendor's EHR, why it did not work for him and the inflexible nature of the product and the company. I mentioned that I had heard that the company thought it was preferable to make no or very little changes for clinicians because it could reduce errors. Neither I nor the clinician seemed to understand this concept, particularly if the physician had to design his or her own workaround or the EHR was not really useful to him (Paul DeMuro, 1/30).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
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.