Daily Health Policy Report

Friday, January 4, 2013

Last updated: Fri, Jan 4

KHN Original Reporting & Guest Opinion

Health Reform

Fiscal Cliff

Capitol Hill Watch

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Behind The Fiscal Cliff Deal, A Prolonged Hospital Finance Fight

Kaiser Health News staff writer Jordan Rau reports: "After Congress' fiscal cliff deal this week dug into hospitals' pockets to avert a drop in Medicare payments to physicians, industry associations screamed. The president of the American Hospital Association said the reductions — nearly $15 billion over a decade — 'will make it harder for patients to access the care they need.' The president of the Federation of American Hospitals also said patients would suffer because lawmakers had decided to 'rob hospital Peter to pay for fiscal cliff Paul'" (Rau, 1/3). Read the story.

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Rural Hospitals Get Relief In Fiscal Cliff Deal

Kaiser Health News staff writer Phil Galewitz reports: "While much of the hospital industry has lamented the deal reached between Congress and the White House because it will pay about half the $30 billion bill to avert a 27 percent Medicare fee cut for physicians, the agreement was cause for celebration for about 200 small, rural hospitals. That's because it also extended for one year a program that pays hospitals such as Jones Memorial up to several millions of dollars each year because they have fewer than 100 beds, are located in rural areas and treat a high proportion of Medicare patients" (Galewitz, 1/4). Read the story.

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Capsules: Colorado Will Expand Medicaid, Governor Announces; Exchange Surprise: GOP-Led Utah Gets Thumbs Up From HHS

Now on Kaiser Health News' blog, Colorado Public Radio's Eric Whitney, working in partnership with KHN and NPR, reports on Colorado's plans to expand Medicaid: "Gov. John Hickenlooper said Colorado will expand its Medicaid program as much as the federal health care law calls for, and he said the state won’t have to spend any extra money to make it happen. The federal health overhaul law requires states to significantly expand the health care program for the poor, but when the U. S. Supreme Court ruled on the Affordable Care Act last June, it said states couldn’t be forced to take the new Medicaid money, essentially making that expansion optional" (Whitney, 1/3).

Also on the blog, Phil Galewitz reports on the Obama administration's approval of Utah's health exchange: "The Obama administration's announcement Thursday that it has given Utah a conditional okay to run its own state health insurance marketplace came as a surprise to many exchange watchers. Utah Gov. Gary Herbert, a Republican, had resisted making major changes to the state's existing market, which was built before passage of the health care law and is geared to small business" (Galewitz, 1/3). Check out what else is on the blog.

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Political Cartoon: 'No Returns Policy?'

Kaiser Health News provides a fresh take on health policy developments with "No Returns Policy?" by Gary Varvel.

Meanwhile, here is today's health policy haiku:


HHS says yes
to seven state exchange plans --
including Utah!

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

HHS Gives 7 States The Go-Ahead To Create Health Exchanges

So far, the Obama administration has approved the health exchange blueprints submitted by 17 states and the District of Columbia. And, the most recent set includes both red states, including Utah, and blue states.

Los Angeles Times: More States Cleared To Run Own Health Insurance Exchanges
The Obama administration Thursday cleared what could be the final group of states to open their own health insurance exchanges this fall, advancing a key goal of the 2010 health care law to provide Americans with new options to shop for coverage (Levey, 1/3).

The Washington Post: Plans For Health Insurance Exchanges Approved By White House For Seven More States
The Obama administration on Thursday approved plans by seven states to create health insurance exchanges, the new marketplaces at the heart of the Affordable Care Act. With this final round of approvals, the White House has signed off on blueprints by 17 states and the District to operate their own exchanges in 2014, as long as they continue to meet certain benchmarks over the course of the next year (Kliff, 1/3).

The Wall Street Journal: Seven States Clear Health-Exchange Hurdle
The Obama administration on Thursday gave conditional approval to plans by seven states that want to run their own health-insurance exchanges under the health-overhaul law. Among them was Utah, which already runs its own insurance exchange but would have to make significant changes to comply fully with the law, raising questions over whether the state will end up operating its exchange in October when open enrollment begins (Radnofsky, 1/3).

The Associated Press: Red States, Too, Get Health Care Nod From Obama
Injecting a rare shot of bipartisanship in the nation's contentious health care overhaul, the Obama administration Thursday cleared four Republican-led states to build their own consumer-friendly insurance markets. With open enrollment for millions of uninsured Americans just nine months away -- Oct. 1, 2013 -- the four GOP-led states became part of a group totaling 17 states plus Washington, D.C., that have gotten an initial go-ahead to build and run insurance exchanges. Another two states have gotten clearance to run their markets in partnership with the federal government. Seven were approved Thursday (Alonso-Zaldivar, 1/3).

Reuters: U.S. Approves Health Exchanges In Four Republican-Governed States
U.S. officials on Thursday gave four states currently governed by Republicans the green light to set up their own health insurance exchanges under President Barack Obama's health care reform law, an initiative largely opposed by Republicans. The U.S. Department of Health and Human Services said Idaho, Nevada, New Mexico and Utah joined a list totaling 17 states and the District of Columbia that have all won conditional approval to establish their own state exchanges, with operations set to begin on January 1, 2014. A fifth Republican-governed state, Mississippi, applied to operate a state exchange, but has not received approval because of a dispute about how much authority state officials should exercise over the operations of its prospective online marketplace, officials said (1/3).

CQ HealthBeat: HHS Conditionally Approves Seven State, One Partnership Exchange
Federal officials gave conditional approval on Thursday to Utah's health benefits exchange, even though state officials have sent mixed signals about whether they are willing to modify their current small business-only marketplace to meet all of the health law standards. Centers for Medicare and Medicaid Services officials also conditionally okayed six other state exchange plans and Arkansas' proposal to partner with the federal government on an exchange when the new marketplaces are set to begin operating in 2014 (Adams, 1/3).

USA Today: Feds Approve Eight State Health Insurance Exchanges
The newly approved states that will run their own exchanges are California, Hawaii, Idaho, Nevada, New Mexico, Vermont and Utah. Arkansas will partner with the federal government for its exchange. Although states with Republican governors have fought the law, such as Texas, four of them -- Idaho, Nevada, New Mexico and Utah -- have created the exchanges (Kennedy, 1/3).

Kaiser Health News: Capsules: GOP-Led Utah Gets Thumbs Up From HHS
The Obama administration's announcement Thursday that it has given Utah a conditional okay to run its own state health insurance marketplace came as a surprise to many exchange watchers. Utah Gov. Gary Herbert, a Republican, had resisted making major changes to the state's existing market, which was built before passage of the health care law and is geared to small business (Galewitz, 1/3).

Politico Pro: HHS Says Utah Can Keep Its Exchange
HHS gave Utah conditional approval to run its own exchange Thursday afternoon, arguably marking the first major health care surprise of 2013. But Utah has some work to do before it receives final approval. The state’s existing small business exchange -- known as Avenue H -- will have to add individual coverage and make other adjustments to satisfy Affordable Care Act requirements. "The state has given us a plan to do that, so like all of the states that we’re conditionally approving, there's more work to be done and we look forward to working with Utah," said CCIIO Director Gary Cohen on a Thursday afternoon conference call (Millman, 1/3).

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Colorado Will Expand Medicaid, Claims Cost Savings Are In Progress

The state plans to expand its Medicaid program as much as the federal health law envisions, without spending any extra money to make it happen.

Kaiser Health News: Capsules: Colorado Will Expand Medicaid, Governor Announces
Gov. John Hickenlooper said Colorado will expand its Medicaid program as much as the federal health care law calls for, and he said the state won’t have to spend any extra money to make it happen. The federal health overhaul law requires states to significantly expand the health care program for the poor, but when the U.S. Supreme Court ruled on the Affordable Care Act last June, it said states couldn't be forced to take the new Medicaid money, essentially making that expansion optional (Whitney, 1/3).

Denver Post: Colorado Plans Medicaid Expansion, Claims Cost Savings In Process
Colorado plans to expand Medicaid coverage next year to cover more than 160,000 additional low-income adults, aided by cost-control savings of more than $280 million over the next 10 years, Gov. John Hickenlooper announced Thursday. "This is a step toward what we have talked about for a couple of years: How can we make sure we're making Colorado the single healthiest state in America?" Hickenlooper said. Through 2016, the federal government covers the entire cost of the expansion, which comes under provisions of the Affordable Care Act. The governor said he anticipates that even when federal funding for the expansion is reduced, "not one dollar of general-fund money will be used to replace it" (Simpson, 1/3).

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States Confront Myriad Of Health Law Implementation Issues

States face fallout from decisions on whether to implement key parts of the health law, including exchanges in California and Washington -- where dental insurance will be mandated in plans offered in the marketplaces -- and Florida, which missed out on co-ops and faces a decision on expanding Medicaid in 2013.

Health News Florida: Florida Missed Out On Consumer Co-ops
One of the most innovative parts of the Patient Protection and Affordable Care Act -- a loan program to start consumer health-care cooperatives -- died this week, a victim of the fiscal cliff deal. Of the two dozen co-ops in as many states that got funding, none was in Florida. PPACA's Consumer Oriented and Operated Plans (CO-OPs) are non-profit member-owned insurers or managed-care plans that were created to expand competition and try out new ideas in health care (Gentry, 1/4).

Medscape: Dental Insurance For Some Children Mandated In 2 States
The states of California and Washington will require people who buy medical insurance through new health plan exchanges to also buy pediatric dental benefits regardless of whether they have children, according to official documents and interviews. The new requirements will kick in on January 1, 2014, as part of the states' implementation of the federal Affordable Care Act. Together the 2 states are offering some of the first responses to a conundrum embedded in the new law: Although the law requires everyone to have health insurance or pay a penalty, it exempts dental benefits from this "individual mandate" (Harrison, 1/3).

Medscape: Florida Facing Huge Medicaid, 'Obamacare' Decisions In 2013
Dealing with issues that affect the health care of millions of poor and uninsured residents, Florida leaders in 2013 could move forward with a long-awaited overhaul of the Medicaid system and likely will decide how to carry out the federal Affordable Care Act. Both issues are highly complex and politically controversial. Gov. Rick Scott and Republican legislative leaders want to require almost all Medicaid beneficiaries statewide to enroll in managed-care plans, an effort that has drawn opposition from Democratic lawmakers and some patient advocates. Meanwhile, after waging a legal and political battle, Scott and his GOP colleagues face the reality that the Affordable Care Act --- better known as Obamacare --- is here to stay (Saunders, 1/3).

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Fiscal Cliff

Health Care And The Shakeout From The Fiscal Cliff

News outlets parse the particulars of how the fiscal deal will impact the health care system, and how the health industry is bracing for the next rounds in the budget battles.

Kaiser Health News: Behind The Fiscal Cliff Deal, A Prolonged Hospital Finance Fight
After Congress' fiscal cliff deal this week dug into hospitals' pockets to avert a drop in Medicare payments to physicians, industry associations screamed. The president of the American Hospital Association said the reductions — nearly $15 billion over a decade — "will make it harder for patients to access the care they need." The president of the Federation of American Hospitals also said patients would suffer because lawmakers had decided to "rob hospital Peter to pay for fiscal cliff Paul" (Rau, 1/3).

The Hill: Public Hospitals Seek To Ward Off Cuts
The lead advocate for public hospitals is already making the case that safety-net providers cannot sustain cuts as part of a deficit-reduction deal this spring. Bruce Siegel, who leads the National Association of Public Hospitals and Health Systems, congratulated lawmakers and the White House for avoiding the worst effects of the "fiscal cliff" (Viebeck, 1/3).

Kaiser Health News: Rural Hospitals Get Relief In Fiscal Cliff Deal
While much of the hospital industry has lamented the deal reached between Congress and the White House because it will pay about half the $30 billion bill to avert a 27 percent Medicare fee cut for physicians, the agreement was cause for celebration for about 200 small, rural hospitals. That’s because it also extended for one year a program that pays hospitals such as Jones Memorial up to several millions of dollars each year because they have fewer than 100 beds, are located in rural areas and treat a high proportion of Medicare patients (Galewitz, 1/4).

NPR: Bargain Over Fiscal Cliff Brings Changes To Health Care
The bill that prevented the nation from plunging over the fiscal cliff did more than just stop income tax increases and delay across-the-board spending cuts. It also included several provisions that tweaked Medicare and brought bigger changes to other health care programs (Rovner, 1/4).

Politico: Health Care Guide To Debt Limit Battle
Congress's most recent spending battle left the health industry with some nicks and scratches, but it's leery of having to hand over even bigger savings in the next battle looming two months from now. From hospitals to doctors to insurers to drug makers, industry players are expecting they'll come up in the mix as lawmakers search for ways to pay for another deal to avert sequestration and increase the debt limit (Haberkorn and Cunningham, 1/3).

In the background, controversial ways to find savings continue to percolate -

Minneapolis Star Tribune: Health Beat: In Health Care, An Rx For Deficits?
Relief over the new federal budget deal has turned to cynicism almost overnight, with many saying that Washington has merely kicked its problem down the road. But Jonathan Gruber, a respected health economist from MIT, suggests there's a solution down that road -- if Congress is willing to tackle health policy for the second time in three years. His suggestion: Change the tax deduction that employers get for offering their workers health insurance. Lawmakers have long considered it untouchable, for fear they would jeopardize a system that provides 60 percent of Americans with their health insurance. Along with the mortgage-interest deduction, it's one of the biggest and most popular federal tax breaks (Hage, 1/3).

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Capitol Hill Watch

New Congress Brings Changes In Leadership, Expertise

Politico offers insights regarding the leadership style and health law attitudes of Rep. Jack Kingston, R-Ga., who will chair the House Labor, HHS appropriations subcommittee. Meanwhile, The Wall Street Journal reports that two physicians were sworn in yesterday -- doubling the number of doctors in the Democratic caucus.

Politico: Jack Kingston Has Bipartisan Goals For ACA Funding
Rep. Jack Kingston wants to repeal Obamacare, and his ascension to the top of an Appropriations subcommittee with jurisdiction over health funding puts him in a powerful position to leave an imprint. But the affable Georgia Republican -- set to chair the Subcommittee on Labor, Health and Human Services in the new Congress -- wants it known he's not a saber-rattling, repeal-at-any-cost zealot (Cheney, 1/4).

The Wall Street Journal's Washington Wire: House Call: Democratic Caucus Adds Two Doctors
House Democrats doubled the number of doctors in their caucus with the swearing-in of California freshmen Raul Ruiz and Ami Bera, both of whom have signaled their eagerness to weigh in on health care issues (Radnofsky, 1/3).

The Hill: Isakson, Portman, Toomey To Join Finance Panel
Republican leaders in the Senate Thursday announced three new appointments to the chamber's elite Finance Committee, which governs Medicare and Medicaid. GOP Sens. Johnny Isakson (Ga.), Rob Portman (Ohio) and Pat Toomey (Pa.) received Finance positions for the 113th Congress. Sen. Tom Coburn (R-Okla.) will leave the panel. Leaders also announced that newly appointed Sen. Tim Scott (R-S.C.) will join the Senate Health, Education, Labor and Pensions Committee starting Thursday (Viebeck, 1/3).

Republicans in the new Congress too are taking aim at the health care law --

The Hill: House Rules Aim To Block Controversial Health Care Board's Medicare Cuts
House Republicans signaled Thursday they will not follow rules in President Obama's health care law that were designed to speed Medicare cuts through Congress. The House is set to vote Thursday afternoon on rules for the 113th Congress. The rules package says the House won't comply with fast-track procedures for the Independent Payment Advisory Board (IPAB) -- a controversial cost-cutting board Republicans have long resisted (Baker, 1/3).

In other news from Capitol Hill --

CQ HealthBeat: Lawmakers Urge Implementation Of 2008 Mental Health Law
A group of House Democrats called on three Cabinet secretaries Thursday to release a delayed final rule to provide equal insurance coverage for mental health services. The 32 Democrats, led by Ted Deutch of Florida and Tim Ryan of Ohio, said that last month's deadly shootings at a Newtown, Conn., elementary school bring "newfound urgency" to ensuring access to mental health care. They requested the issuance of final rules set in a 2008 mental health law that would require insurers to offer mental health benefits coverage comparable to other medical benefits (Ethridge, 1/3).

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State Watch

California Nurses Association, National Union of Healthcare Workers Join Forces

The move could change the scope of labor battles statewide and renew a rivalry between the nurses organization and the Service Employees International Union, according to media reports.

The Associated Press: Health Union Alliance Could Threaten Larger Rival
Two health care unions are joining forces in a move that could threaten a powerful rival's dominance and fuel a new round of labor tensions. The 85,000-member California Nurses Association is forging an alliance with the 10,000-member National Union of Healthcare Workers to form a new union made up entirely of health sector workers. The alliance announced Thursday renews a bitter rivalry between the nurses' union and the powerful 2 million-member Service Employees International Union, the nation's dominant health care union and a major force in Democratic politics (Hananel, 1/3).

San Jose Mercury News: National Union Of Healthcare Workers Affiliates With Powerful California Nurses Association
In a move expected to shake up health care labor battles statewide, the powerful California Nurses Association announced Thursday that it will affiliate with the National Union of Healthcare Workers in fights with major health systems over wages, benefits and patient care issues. CNA also agreed to use its 85,000 members and considerable resources to help NUHW in its campaign to defeat a large rival, the Service Employees International Union-United Healthcare Workers West, in an upcoming election for the right to represent 43,500 Kaiser Permanente service and technical workers. That election, which may happen this spring, will be a repeat of a 2010 election, which was the largest union election in the private sector in nearly 70 years. At that time, Kaiser workers voted to remain in SEIU (Kleffman, 1/3).

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State Highlights: Texas Begins New Women's Health Program

News outlets offer health articles in California, Minnesota, Texas, New Jersey and Wisconsin.

The Texas Tribune: Amid Legal Drama, Texas Takes Over Women's Health Program
Texas is funding the [Women's Health Program] on its own because the federal government pulled funding after the state blocked Planned Parenthood from participating. The Texas version still serves low-income women who would qualify for Medicaid if they became pregnant. It will cover about 110,000 women between 18 and 44 years old with free well-woman exams, basic health care and certain family planning services. ... The big change is where women can go for those services. Women using the plan may not receive any health care from Planned Parenthood or any medical provider "affiliated" with abortion providers (Philpott, 1/3).

Stateline: Uncertainty From Washington Continues For States
[D]eficit reduction and spending cuts will continue to be front and center in Washington in the coming weeks, particularly as the country once again edges closer to the federal debt ceiling. This has state officials bracing for the possibility of more comprehensive tax reform and changes in entitlements such as Medicaid. The largest single component of total state spending, edging out K-12 education, Medicaid had been exempt from the sequestration cuts. But that could change in broader deficit reduction talks (Prah, 1/4).

NJ Spotlight (New Jersey): Higher Payments May Prompt More NJ Doctors To Accept Medicaid Patients
The federal government will cover the difference between Medicare and Medicaid reimbursements for 146 primary-care services from Jan. 1 through the end of 2014. The increased payments will be made to family physicians, pediatricians and internal medicine doctors who specialize in primary care. ... The state hasn’t announced when doctors will begin receiving the higher Medicaid rate, which will be paid retroactively for services provided beginning on Jan. 1 (Kitchenman, 1/4).

MPR: 'Medi-Scare:' Behind The Sinister Fundraising Mailers Sent To Minn. Seniors
Tax-exempt political groups pledging to protect Medicare and Social Security send out sinister, sometimes false, missives asking elderly people to send a donation to fight, for instance, an effort to raise "Medicare Premiums at a rate that is far faster and greater than the Cost of Living Increase allotted," as one letter from a group called the Federation of Responsible Citizens requests. ... Even in the digital age, it remains an effective way to reach older people who are at the center of a debate in Washington over whether to cut entitlement spending (Richert, 1/3).

California Healthline: CMS Meets Deadline For Approving Healthy Families Transition
Tight up against the end-of-year deadline, CMS officials on Dec. 31 granted approval of California's plan to move 860,000 Healthy Families children into Medi-Cal managed care programs. Federal officials asked for changes to the transition plan, including more frequent monitoring and evaluation of the transition to better ensure children are able to access primary care physicians under the new plan (Gorn, 1/3).

California Healthline: San Diego Diabetes Program Working, Gaining Attention
Over the past 15 years, more than 18,000 San Diegans with diabetes have been involved in a focused care management program that has proven to be both clinically and cost effective, according to recent findings. A study published in the fall issue of the journal Clinical Diabetes compiles research that was conducted over the course of 15 years  (Zamosky, 1/3).

Milwaukee Journal Sentinel: Contract Proposal For Patient Rides Allows Leeway
After Wisconsin selects a new medical transportation provider to replace the embattled LogistiCare, patients may spend more time on the phone when they call to make reservations or complaints. And their service complaints will still be processed by the same company that messed up, rather than a third party. On the upside, the state will be able to provide better oversight and beef up enforcement (Laasby, 1/3). 

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Health Policy Research

Research Roundup: Gearing Children's Hospitals For Future Patients

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

JAMA Pediatrics: Inpatient Growth And Resource Use In 28 Children's Hospitals – Researchers in this study examined the use of children’s hospitals by relatively healthy children and those "with chronic conditions of varying medical complexity" from 2004 to 2009. They found an increase in the number of individual hospitalizations for both groups. But, the rise was more significant for children with the greatest chronic conditions (conditions affecting two or more body systems or the most complex conditions), a trend that, if continues, "these hospitals may ultimately find themselves structurally and financially stressed to meet the inpatient needs of both types of children," the researchers wrote. "If fewer patients with medical complexity are ultimately diverted to other hospitals, then children's hospitals may predominately care for a patient population that, by nature, is expensive, has a major risk for experiencing suboptimal health outcomes, and tends to draw inadequate reimbursement from payers to cover inpatient care costs" (Berry et al., 12/24).  

JAMA Internal Medicine: Trends In The Overuse Of Ambulatory Health Care Services In The United States – Using 1998, 1999, 2008, and 2009 data from the Centers for Disease Control and Prevention, the authors aimed to determine whether the use and misuse of health care services in the ambulatory setting has decreased. They found an improvement in 6 of 9 "underuse" measures, such as administering aspirin to patients with heart disease or the use of the statins for patients with diabetes.  But only 3 of 13 measures of inappropriate care, which included both overuse and misuse such as prescribing ineffective drugs for urinary tract infections, improved, according to the authors: "We found significant improvement in the delivery of underused care but more limited changes in the reduction of inappropriate care. With the high cost of health care, these results are concerning" (Kale, Bishop, Federman and Keyhani, 12/24).

New England Journal Of Medicine: Ensuring Physicians’ Competence – Is Maintenance Of Certification The Answer? – This "Health Policy Report" focuses on physician Maintenance of Certification or MOC, sponsored by the American Board of Medical Specialties. This is one of many initiatives by national accrediting organizations, state medical licensing boards, and the federal government and others "designed to link more closely the goals of learning with the delivery of better care and measures of greater accountability." But it is the most contentious, the authors write: "MOC requires most certified specialists to seek recertification on a periodic basis – typically every 10 years – by successfully completing a four-part assessment designed to test their medical knowledge, clinical competence, and skills in communicating with patients, ... Although the number of specialists engaged in the process grows by about 50,000 diplomates a year, the exercise also draws strong criticism from physicians who assert that MOC is too expensive and the process is too time-consuming" (Iglehart and Baron, 12/27). 

PLOS ONE: 'The Ultimate Decision Is Yours': Exploring Patients' Attitudes About The Overuse Of Medical Interventions – Columbia College of Physicians and Surgeons' researchers conducted focus groups with privately-insured, healthy, middle-aged Americans. "We considered whether attitudes towards testing and screening differ from attitudes toward pharmaceutical use," the authors write. "We also sought to understand how problems of overuse and non-adherence could be related to patients' efforts to take responsibility for their health." While participants were "suspicious of overmedication," they "placed enormous value on testing and screening [but] reacted with hostility to messages recommending fewer procedures." The authors conclude: "Given patients' concerns about overuse of pharmaceuticals, we maintain that they can learn to understand the connections between over-testing and over-treatment, and can actively choose to do less" (Schleifer and Rothman, 12/26). 

Here is a selection of news coverage of other recent research:

Reuters: Annual Pap Tests? For Some In U.S., Old Habits Die Hard
An increasing number of younger women in the United States are delaying their first Pap test for cervical cancer until after they reach 21, reflecting new U.S. guidelines, health officials said on Thursday. But 60 percent of U.S. women who have had a total hysterectomy and no longer have a cervix are still getting the tests, a sign that old habits may die hard, experts said. ... two teams at the U.S. Centers for Disease Control and Prevention analyzed Pap test data from 2000 to 2010 to see how well doctors were adjusting to the call for less frequent screening. ... while Pap testing fell among women who had a hysterectomy, dropping to 60 percent in 2010 from 73 percent in 2000, the number still reflects significant overtreatment (Steenhuysen, 1/3). 

MedPage Today: Drug Adherence Linked To Communication
Diabetic patients treated by healthcare professionals who had poor communication skills were less likely to refill their cardiometabolic medications than those whose doctors were good communicators, researchers found. Among a cohort of more than 9,000 patients with diabetes, a 10-point decrease in scores for healthcare provider communication quality increased rates of poor adherence by a significant 0.9%, according to Neda Ratanawongsa, MD, of the University of California San Francisco, and colleagues (Petrochko, 1/2). 

Medscape: Pill Shape, Color Linked To Adherence With Anti-Epileptics
Shape and color differences between branded and generic drugs may be associated with medication discontinuation ... Aaron S. Kesselheim, MD, JD, MPH, from Brigham and Women's Hospital and Harvard Medical School in Boston, Massachusetts, and colleagues published their findings online December 31, 2012, in the Archives of Internal Medicine. ... "Changes between generic products with different physical characteristics may cause confusion and result in reduced adherence or prescription error," the authors write (Barber, 12/31).

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Editorials and Opinions

Viewpoints: 'Class War' Over Medicare Funding; GOP Needs Courage To Cut Entitlements In Debt Fight

CNN: Fiscal Cliff Deal Bad For Future Generations 
Failure to curb our deficits and reform unsustainable entitlement spending means passing greater debt burdens on to future generations. Democrats and Republicans have the opportunity to reverse this trend and claim credit. ... Sadly, the deal struck this week in Congress maintains the trend of $1 trillion deficits for at least another year while continuing to ensure that federal health care spending a generation from now will be untenable (Alex Brill, 1/4).

The New York Times: Battles Of The Budget
For the reality is that our two major political parties are engaged in a fierce struggle over the future shape of American society. Democrats want to preserve the legacy of the New Deal and the Great Society — Social Security, Medicare and Medicaid — and add to them what every other advanced country has: a more or less universal guarantee of essential health care. Republicans want to roll all of that back, making room for drastically lower taxes on the wealthy. Yes, it's essentially a class war (Paul Krugman, 1/3). 

Fortune Magazine: 2013: The Year We Became The Health Care Nation
Medicare and Medicaid are the biggest element of our most serious national problem: crushing federal debt. ... Without changes, health care alone will consume more of the federal budget than all discretionary spending does now -- defense, law enforcement, courts, and all regulatory agencies. Every time we have to reconcile taxes and spending or approve a federal budget or raise the debt limit, we'll face the inescapable need to cut Medicare's and Medicaid's growth. And every time an elected official whispers such a thing, large groups of citizens will scream (Geoff Colvin, 1/4).

Los Angeles Times: More Cliffs To Come 
Obama insists he won't negotiate over the debt ceiling this time around, and Democrats seem to believe that they can extract more tax hikes in return for agreeing to curb spending on entitlements. This week's deal, however, appears to have drained their leverage. ... The compromise that McConnell worked out with Biden wasn't a complete washout. ... It avoided a steep cut in fees that could have driven many doctors out of the Medicare program while continuing a tax break that improves the work incentives for low-income families (1/3).

The Washington Post: Making Future Cliffs Count 
[I]f the president and Republicans want to restrain entitlement growth, but neither wants to offer specifics, let them come together around a new aggregate annual cap on entitlement spending. If Social Security, Medicare and Medicaid are together slated to grow by 6.7 percent a year for the next decade, enact a law saying they can only grow by, say, 5 percent ... And an entitlement cap embraced by both sides could put fresh energy into bipartisan efforts to make the health-care system more efficient (Matt Miller, 1/3).

The Wall Street Journal: The Debt-Ceiling Fight Will Be Dirty
Throughout the fiscal-cliff negotiations, the Republicans kept thinking Mr. Obama would sign on to entitlement reform, giving both parties political cover. In this vain hope, the GOP shrunk from laying out its specific demands on Medicare, Social Security and Medicaid. ... The GOP must know by now that the president's only goal is to water down any reform proposals. So their only chance of making a dent in the debt is to begin bold. Do House Republicans have the courage to lay out big demands (say, premium support for Medicare or block grants for Medicaid), send a bill to the Senate, and sell entitlement reform to the public? (Kimberley A. Strassel, 1/3).

The Wall Street Journal: Boehner's Second Chance 
During the Reagan years when the GOP held the Senate, John Dingell used the Energy and Commerce Committee to highlight executive branch sins (real and imagined), while Henry Waxman used every lever of power to expand entitlement benefits. Republicans should do a reverse Waxman, reforming the likes of Medicaid quietly and at the margin until they can do it wholesale (1/3).


Des Moines Register: Congress Again Just Delayed Its Day Of Reckoning 
[T]he cost of federal entitlements — namely Medicare, Medicaid and Social Security — will rise dramatically in future years. So, we will still need that "grand bargain" on higher tax revenues and entitlement spending cuts that Obama and House Speaker John Boehner, R-Ohio, came close to reaching last year (1/3).

The New York Times' Opinionator: Better, If Not Cheaper, Care 
While end-of-life care has improved considerably over the last 30 years, many Americans still die in hospitals when they would rather die at home. Nearly 20 percent of deaths occur in an intensive care unit or immediately after discharge, and too many patients experience symptoms like pain that are controllable with appropriate palliative care (Dr. Ezekiel J. Emanuel, 1/3). 

The New York Times' Economix: The Complexities Of Comparing Medicare Choices
A fundamental question that has engaged health-policy researchers and commentators for some time is whether coverage of Medicare’s standard benefit package under Medicare Advantage plans is cheaper or more expensive than it is under traditional fee-for-service Medicare. The answer is yes (Uwe E. Reinhardt, 1/4). 

The Medicare NewsGroup: Can Medicare Fraud Be Curbed?
As Congress batted around higher eligibility ages and reduced Medicare spending last year, two topics that have not garnered much public discussion are fraud and overbilling. If Medicare is to clean up its fiscal act, it will need to be much more aggressive in these areas (John Wasik, 1/3).

WBUR: Beating Obesity By Any Means Necessary 
Obesity remains a serious and costly epidemic. If the country is ever going to get its health care costs under control, these are the people government has to reach. We ban unsafe cribs and scrutinize toys for safety. Why not help children and their parents make better choices about food? (Ed Fouhy, 1/3).

Minneapolis Star Tribune: We've Lost Our Balance On Mental Illness
I once knew someone, many years ago, who was sent to a "rest home" by her aggravated husband. Today, you and I would call that "involuntary commitment,"  ... It was a time when horrific places like Pennhurst were still operating, and anyone who grew up in the Philadelphia area knows what I'm talking about. Dante himself couldn't have conjured up something as infernal as this "hospital" where the patients were chained to their beds and starved for days on end (Christine Flowers, 1/4).

The Washington Post: Virginia's Phony Concern
Twenty clinics in Virginia performed slightly more than 25,000 first-trimester abortions in 2011. In carrying out that legal, safe and relatively simple procedure, there were very few reports of mishaps or complications. ... Nonetheless, in that same year Republicans in Richmond enacted legislation requiring stringent and unnecessary rules that would reclassify abortion clinics as the regulatory equivalent of hospitals (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.