Daily Health Policy Report

Monday, January 7, 2013

Last updated: Mon, Jan 7

KHN Original Reporting & Guest Opinion

Fiscal Cliff

Health Reform

Administration News

Health Care Marketplace

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Triage System Helps Colleges Treat Mentally Ill Students

Kaiser Health News staff writer Jenny Gold, working in collaboration with NPR, reports: "Over the past decade, colleges and universities across the country have seen an influx of students like Dale with mental health needs. The stigma of mental illness has started to dissipate, and more students are comfortable seeking help. In addition, teenagers with serious conditions are getting treatment earlier, and so a population of students that previously didn't make it to college now arrives on campus each fall" (Gold, 1/7). Read the story.

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Political Cartoon: "Founding Faulters?" by John Deering

Kaiser Health News provides a fresh take on health policy developments with "Founding Faulters?" by John Deering.

Meanwhile, here is today's health policy haiku:

STRATEGY CHANGE FOR DEFENSE CONTRACTORS?

Health care not weapons...
A new way to combat cuts?
Ask defense vendors.
-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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Fiscal Cliff

Clear Battle Lines Emerge On Budget Issues

After last week's agreement to avert the "fiscal cliff," President Barack Obama and congressional GOP leaders are making clear their positions on tax increases and entitlement spending reductions -- including those to Medicare.

The Associated Press/Washington Post: White House, GOP Draw Red Lines In Debate On US Debt Limit, Vow Not To Budge
Republicans say they are willing to raise the debt ceiling but insist any increase must be paired with significant savings from Medicare, Medicaid and other government benefit programs. President Barack Obama has said he's willing to consider spending cuts separately but won’t bargain over the government's borrowing authority (1/7).

The Wall Street Journal: Battle Lines Drawn On Budget
Many conservative House Republicans opposed last week's fiscal-cliff measure, which raised income-tax rates for the first time in almost two decades and contained no long-term spending cuts of any significance. That bill would reduce the deficit by some $620 billion over 10 years, far short of the $4 trillion in deficit reduction that some leaders had hoped to negotiate. "Now, it's time to pivot and turn to the real issue, which is our spending addiction," Mr. McConnell said Sunday. He said any cuts should target entitlements such as Social Security, Medicare and Medicaid, which Democrats have been reluctant to cut (Gorman and Nicholas, 1/6).

Bloomberg News/The New York Times: Letter From Washington: U.S. Fiscal Talks Made No One Look Good
Tougher still is the substance. House Republicans are all for big spending cuts, though other than some easy ones, including going after programs for the poor, they duck specifics. They are fierce deficit hawks in principle, yet when specific cuts to Medicare, a health insurance program for the elderly, or Social Security, a retirement fund, are raised, they turn into pacifists. And the president, who wouldn't play for keeps when he had the leverage, vows this time will be different. He won't negotiate over the debt ceiling; that would be tantamount, he proclaims, to negotiating with terrorists. Mr. Obama demands that any spending cuts be accompanied by revenue increases (Hunt, 1/6).

The Hill: Sen. Sanders Says He's 'Not Confident' Obama Will Protect Social Security
Entitlement programs must stay off the table in the next round of budget negotiations, Sen. Bernie Sanders (I-Vt.) said. Sanders said he's "not confident" that President Obama will try to protect entitlements — particularly Social Security — during upcoming talks about raising the country's debt ceiling. "Well, we've got to make the president and Republicans and any Democrats that want to cut Social Security an offer they can`t refuse, and that is tens of millions of people have got to make it very clear to Congress -- Social Security has nothing to do with the deficit," Sanders said Friday night in an interview with MSNBC's Ed Schultz (Baker, 1/5).

In other news stemming from the fiscal agreement -

Politico: Hospitals Flex Lobbying Muscle To Bypass Some Cuts
For all the hits the hospital industry took in the final fiscal cliff deal, it managed to persuade Congress to avoid some of the biggest cuts that had been looming over it for years: cuts to outpatient payments, graduate medical education and "bad debt" payments. The hospitals aren't celebrating — Congress still cut the industry elsewhere, and hospital lobbyists insist those savings will be painful. But the fact that hospitals escaped the most widely expected cuts shows that the industry still holds real power with lawmakers (Haberkorn, 1/7).

And, in the background, the expected release of a White House health care expenditures report could highlight trends and cost control ideas -

Reuters: Analysis: Obama May Turn Medicare Reform Into Wider Health Debate
President Barack Obama could seek common ground with Republicans in the looming battle over Medicare spending by broadening the debate over entitlement reform to encompass the spiraling healthcare costs that confront a wide range of Americans. In recent public remarks the president has identified the U.S. healthcare system's sky-high price tag - by far the highest in the world - as a driving force for Medicare reform. The administration is expected to release a report on 2011 national healthcare expenditures on Monday that should further underline well-known trends. In 2010, health spending hovered at almost 18 percent of U.S. gross domestic product. Healthcare experts, including former Obama advisers, say the White House appears to be considering ideas for Medicare, the popular health insurance program for the elderly and disabled, that could become models for the overall health landscape (Morgan, 1/6).

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Health Reform

In Some States, Health Insurers Are Raising Rates Despite Health Law's Efforts To Restrain Increases

The New York Times details differences in states' ability to regulate rates as well as in premium costs. Meanwhile, the Associated Press reports on the savings that New Yorkers could experience.

The New York Times: Health Insurers Raise Some Rates By Double Digits
Health insurance companies across the country are seeking and winning double-digit increases in premiums for some customers, even though one of the biggest objectives of the Obama administration's health care law was to stem the rapid rise in insurance costs for consumers. ... Under the health care law, regulators are now required to review any request for a rate increase of 10 percent or more ... The review process not only reveals the sharp disparity in the rates themselves, it also demonstrates the striking difference between places like New York, one of the 37 states where legislatures have given regulators some authority to deny or roll back rates deemed excessive, and California, which is among the states that do not have that ability (Abelson, 1/5).

The Associated Press/Wall Street Journal: NYers To Save $500M On Health Insurance Premiums
Governor Andrew Cuomo says new state power to limit rate hikes will save New Yorkers more than $500 million on health insurance premiums in 2013. Cuomo announced Sunday that health insurers requested average increases of about 12.4 percent, but the state Department of Financial Services cut the average increase to 7.5 percent (1/6).

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Medicaid Expansion, Health Exchanges Continue To Draw Headlines

Meanwhile, Florida Gov. Rick Scott is coming to Washington to meet with Health and Human Services Secretary Kathleen Sebelius to discuss related health law implementation issues and concerns.

Politico Pro: Medicaid Expansion: What To Watch For In 2013
Millions of lives and billions of dollars have been heaped upon the doorsteps of state capitols, where officials must decide whether to expand their Medicaid programs under the Affordable Care Act in time for a 2014 launch. A handful of states, though, will play a bellwether role, their political dynamics and path to expansion likely instructive for others grappling with whether to grow their Medicaid rolls. The federal government will pick up most of the cost of expansion under the health law — but states are skeptical about that promise over the long haul, and are worried about creating new entitlements that would be hard to roll back. Some states may hold back for a year or more — they can opt to expand Medicaid later, although they’d lose some federal funds (Cheney and Smith, 1/7).

CNN: Obamacare: A Few Changes Coming In 2013
While the bulk of the law goes into place in 2014, you'll see a few changes this year. However, much of 2013 will be dedicated to health facilities and government offices getting ready for the larger changes coming down the road. On Thursday, the Department of Health and Human Services conditionally approved eight more states' plans to set up their own health insurance exchange programs. The conditional approvals mean a total of 19 states plus the District of Columbia have the initial thumbs-up on their plans. Two others, Arkansas and Delaware, have the go-ahead to run an exchange in partnership with the federal government (Christiansen, 1/4).

Associated Press/ Miami Herald: Scott, Sebelius To Meet In DC To Talk Health Care
Gov. Rick Scott will meet with Health and Human Services Secretary Kathleen Sebelius to discuss the Affordable Care Act. The Republican governor has been a vocal critic of so-called "Obamacare" but softened his stance after the election, saying he was willing to work with federal officials. He's repeatedly expressed concerns about potential costs to Florida taxpayers. The meeting is slated for Monday. Florida must decide whether to expand its Medicaid rolls, which could extend coverage to roughly 900,000 low-income residents (1/7).

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Administration News

Groups Urge HHS To Issue Rules On Medical Company-Doc Relationships

Medpage Today: Groups To HHS: Issue Sunshine Act Rules
The American Medical Student Association (AMSA) and the National Physicians Alliance (NPA) are urging the Obama Administration to issue past-due regulations for a database of payments made by pharmaceutical companies and device makers to physicians. … The law, part of the Affordable Care Act, requires drug, medical device, biologic, and medical equipment manufacturers to collect data on financial relationships with doctors and hospitals, and to report that data to the Centers for Medicare and Medicaid Services (CMS) (Frieden, 1/4).

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Health Care Marketplace

Study Finds School Debt Keeps Some Young Doctors From Specializing

The research suggests that financial concerns may keep some residents from going into medical specialties that don't offer high compensation.

Reuters: Debt May Influence Young Doctors' Careers Plans
Pediatricians-in-training are more likely to plan to go into primary care -- rather than a specialty field -- if they have lots of debt from college and medical school, according to a new study. Researchers also found the average pediatric resident's debt increased 34 percent between 2006 and 2010. That suggests financial considerations may keep young doctors out of medical specialties, they said, especially those fields that aren't known for paying big bucks but still require extra training (Pittman, 1/7).

Medpage Today: Med School Debt May Push Docs To Primary Care
Too much debt accrued during medical school appears to tip pediatric residents toward primary care or hospital employment rather than a subspecialty career, a national survey found. After adjustment for other factors, residents who owed $51,000 or more were about 50 percent more likely to be planning on a career that didn't require fellowship training, Mary Pat Frintner, MSPH, a researcher with the American Academy of Pediatrics (AAP) in Elk Grove Village, Ill., and colleagues reported in the February issue of Pediatrics. That could pose a problem for subspecialty care, as debt levels were on the rise (Phend, 1/7).

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As Pentagon Considers Cuts, Weapons Makers Look To Contracts On Health Issues

Bloomberg/The Washington Post: Weapons Makers Try Health Care Amid Defense Cuts
Top weapons makers Lockheed Martin and General Dynamics are pursuing and winning health-care projects as the Pentagon weighs hundreds of billions of dollars in cuts. Lockheed Martin, the top federal contractor, won $472 million in awards from the Department of Veterans Affairs and the Department of Health and Human Services in the fiscal year ended Sept. 30, about five times more than in 2002. General Dynamics, the No. 3 U.S. vendor, won almost nine times as much work, or $398 million, from the two health-focused agencies last year compared with fiscal 2002 (Miller, 1/6).

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Public Health & Education

Exercise And The Exam Room: Kaiser Permanente, Other Providers Record New Vital Sign

The Associated Press: Your Medical Chart Could Include Exercise Minutes
Kaiser Permanente, one of the nation's largest nonprofit health insurance plans, made a big push a few years ago to get its southern California doctors to ask patients about exercise. Since then, Kaiser has expanded the program across California and to several other states. Now almost 9 million patients are asked at every visit, and some other medical systems are doing it, too. Here's how it works: During any routine check of vital signs, a nurse or medical assistant asks how many days a week the patient exercises and for how long. The number of minutes per week is posted along with other vitals at the top the medical chart. So it's among the first things the doctor sees (Tanner, 1/6).

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State Watch

Mass. Governor Proposes New Compounding Pharmacy Oversights

Massachusetts Gov. Deval Patrick is proposing the state exercise stricter control over compounding pharmacies by -- in part -- establishing new licensing requirements for the labs and letting the state assess fines against them if they break rules.

The New York Times: Massachusetts Plans Stricter Control of Compounding Pharmacies
New laws to strengthen state control of compounding pharmacies were proposed on Friday by Gov. Deval Patrick, in hopes of preventing another public health disaster like the current outbreak of meningitis caused by a contaminated drug made in Massachusetts. ... The legislation would establish strict licensing requirements for compounding sterile drugs; let the state assess fines against pharmacies that break its rules; protect whistle-blowers who work in compounding pharmacies; and reorganize the state pharmacy board to include more members who are independent of the industry and fewer who are part of it (Goodnough and Grady, 1/4).

Stateline: Following Outbreak, Massachusetts Seeks Tougher Oversight Of Compounding Pharmacies
Massachusetts Governor Deval Patrick has unveiled legislation aiming to plug a regulatory gap that allows compounding pharmacies to operate with little oversight. The state's effort to crackdown on compounders, which traditionally alter drugs to meet specific patients' needs but have since expanded to produce medications in bulk, was sparked by a deadly outbreak of viral meningitis linked a now-shuttered pharmacy in Framingham, Massachusetts. The company distributed a tainted steroid suspected of sickening or killing as many as 620 people in 19 states. The governor's bill, announced Friday (January 4), would likely make Massachusetts the nation's toughest regulator of compounders, requiring them to apply for special licenses, while authorizing the state Board of Pharmacy to levy fines against wayward companies and granting whistleblower protections to pharmacy workers who report violations (Malewitz, 1/7).

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State Roundup: Mo. Lawmakers Look To Cap Malpractice Awards

A selection of health policy stories from California, Minnesota, Missouri, New York, Texas, Illinois and North Carolina.

The Associated Press/Kansas City-Star: Missouri GOP Looks To Impose Caps On Malpractice Cases
Missouri lawmakers have their eyes on reinstating liability limits for medical malpractice cases after the state Supreme Court struck down an existing cap on damages last summer. Republicans claim a supermajority when the General Assembly meets Wednesday to start the 2013 session, and GOP leaders say restoring the liability limits invalidated by the high court is needed to control health care costs and help keep doctors in Missouri (Blank, 1/6).

San Francisco Chronicle: Low-Income Kids Shuffled Onto Medi-Cal
On Tuesday, California started dismantling a popular health care program for low-income children by shifting nearly 200,000 young people into the massive Medi-Cal program, a move many health advocates fear will disrupt their care. And this is just the first phase of the transition away from the program called Healthy Families. By August, the nearly 900,000 people in the program will be shifted into Medi-Cal. The move is expected to save the state about $58 million in health care costs in 2013-14 and more than $70 million a year when Healthy Families is fully phased out (Colliver, 1/4).

Los Angeles Times: Vast Cache Of Kaiser Patient Details Was Kept In Private Home
Federal and state officials are investigating whether health care giant Kaiser Permanente violated patient privacy in its work with an Indio couple who stored nearly 300,000 confidential hospital records for the company (Terhune, 1/5).

Minneapolis Star Tribune: Woodbury Hospital Lawsuit Pits Privacy Rights Vs. Cover-Up Allegations
Three years ago, Barbara Peterson walked out of Woodwinds Hospital in Woodbury with more than 200 pages of confidential patient files. On that much, everyone agrees. Now those files are at the heart of a federal lawsuit, in which Peterson accuses the hospital of trying to cover up evidence of medical misconduct. Peterson, who was a patient advocate at Woodwinds, claims that she was ordered to destroy notes and e-mails about incidents that could damage the hospital's reputation -- including an allegation that a doctor was drunk while delivering a baby. She says she took the documents home to protect them. The hospital says that her version of events "simply did not happen." And it accuses Peterson of violating patient privacy by walking off with -- and refusing to return -- hospital records. Woodwinds fired her in 2010 before the missing documents came to light (Lerner, 1/6).

The New York Times: Pregnancy Centers Gain Influence in Anti-Abortion Arena
With free pregnancy tests and ultrasounds, along with diapers, parenting classes and even temporary housing, pregnancy centers are playing an increasingly influential role in the anti-abortion movement. While most attention has focused on scores of new state laws restricting abortion, the centers have been growing in numbers and gaining state financing and support. ... Abortion rights advocates have long called some of their approaches deceptive or manipulative. Medical and other experts say some dispense scientifically flawed information, exaggerating abortion's risks (Belluck, 1/4).

Texas Tribune (Video): The Fight To Restore Health Care Cuts
Doctors in the Rio Grande Valley are leading the charge to restore cuts made during the 2011 legislative session. They want lawmakers to once again make it so that Medicare and Medicaid benefits add up to 100-percent of dual eligible patients' bills. They're expecting a fight (Rocha, 1/7).

The Associated Press: Sandy Prompts Some Elderly To Seek Assisted Living
Although New York and New Jersey health care officials say it's too soon to confirm a spike, some senior care operators say they've seen a surge in older people relocating to assisted-living or retirement communities after Sandy. Prolonged power outages, wrecked homes and flooded streets have helped convince even the most stubborn seniors that they may not be capable of living independently (Eltman, 1/7).

Chicago Sun Times: Casinos, Health Care, And Education Concerns For Local Lawmakers
With the first super majority in both houses of the [Indiana] General Assembly since 1964, Republicans have the ability to pass a number of legislative measures, while Democrats are looking for ways to keep their voices heard during the process. For representatives of Northwest Indiana, concerns that may come up this year include protecting Indiana casino revenues from out-of-state competition, funding for both K-12 and vocational education, and how the state will handle requirements from the federal Affordable Care Act. Republicans stress the importance on keeping a balanced budget, helping to determine the priorities for the state (Mikus, 1/5).

North Carolina Health News: Community Health Center Leaders Eye Uncertain Future
Brian Toomey is worried. Toomey runs Piedmont Health Services, a network of community health clinics serving eight counties in the center of the state. More than half of the patients who visit Piedmont’s six clinics lack any form of health insurance, including Medicaid. So you might think that Toomey would be sleeping better now that it’s clear that, in the wake of President Obama’s reelection, the Affordable Care Act will proceed. Once the law goes into effect, many of Toomey’s patients could either gain Medicaid or some form of insurance coverage, making it easier for Piedmont to cover its costs. But Toomey said his relief at knowing the law will go forward is tempered by a multitude of questions still remaining about the implementation of health reform in North Carolina (Hoban, 1/7).

California Healthline: How Can Hospitals Thrive In Future?
The first step in dealing with complex financial and care issues faced by community hospitals is to get people engaged and talking about them, according to the organizers of tomorrow's online "Future of the Hospital" game. People will compete to present the most cogent and worthwhile ideas for improving hospitals in California and the nation. Starting tomorrow morning and running for 24 hours, the Institute for the Future is putting on an online forecasting competition to prompt possible solutions for community hospitals with a discussion involving as many people as possible (Gorn, 1/7).

California Healthline: State Delays Adult Day Center Not-For-Profit Requirement
The requirement that adult day health care centers become not-for-profit operations has been delayed at least a year, according to Department of Health Care Services officials. A Dec. 31 letter to centers caring for the frail and elderly population in the Community Based Adult Services program said "DHCS has decided to postpone until further notice and no sooner than January 1, 2014, the implementation of the requirement restricting CBAS providers to Non-Profit legal status." About two thirds of California's 250 adult day centers are for-profit entities, according to state officials. Putting as many as 186 centers through the complexity of a not-for-profit conversion was a little too much for the state and the centers, according to Jane Ogle, deputy director for DHCS (Gorn, 1/4).

CQ HealthBeat: Illinois Judge Grants Temporary Injunction On Birth Control Rule
A federal judge has granted an Illinois company a temporary injunction against an Obama administration birth control rule, making it yet another private business to succeed in staving off any enforcement while the court considers legal challenges to the policy. The Becket Fund for Religious Liberty, which represents plaintiffs in some of the cases filed against the rule, says 10 for-profit companies now have obtained injunctions against the requirement that contraceptives be provided as preventive health services in employee health plans. The mandate went into effect for many health plans on Jan. 1 (Norman, 1/4).

The Oregonian: Oregonians Who Buy Own Health Insurance Face Major Cost Changes
Insurers and state officials are bracing for major upheaval for more than 200,000 Oregonians who buy their own insurance. Insurers' rate requests for 2014 will be announced in less than four months. But the general outlines are clear: Under the new federal health law, the reasonably well-off can expect to pay higher premiums in the individual market, especially if they're 49 or younger. For many of the rest, there's good news: Costs of coverage will drop significantly thanks to tax credits. But important details remain to be worked out, including how big a role age plays and specific rate hikes (Budnick, 1/6).

The Miami Herald: State Appeals Order To Pay For Special Autism Treatment
Already facing sharp criticism over policies that have resulted in the rationing of care to severely disabled children, Florida health care regulators are challenging a federal judge’s order that the state provide a costly -- but potentially life-changing -- treatment to children with autism. Last spring, U.S. District Judge Joan Lenard struck down the state's refusal to pay for applied behavior analysis (ABA) for autistic children, calling the state’s policy "arbitrary, capricious and unreasonable." The court case involved three autistic youngsters -- then-5-year-old K.G., 2-year-old I.G. and 4-year-old C.C. -- whose efforts to obtain behavioral therapy had been denied by the state’s Medicaid insurance program for needy and disabled people. Lenard ordered that the three children be given the care they sought -- and that the state provide such care to other autistic children, as well (Miller, 1/6).

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Editorials and Opinions

Viewpoints: Fla. Gov. Fears Medicaid Expansion As Idaho, Missouri And Colorado Wrestle With Issue ; Few Acceptable Options For Improving Medicare

The New York Times: Scorecard On Health Insurance Exchanges
Twenty-three states, most led by Republican officials, have declared that they will not set up their own health insurance exchanges to help individuals and small businesses find affordable coverage. ... Residents of states where political leaders seem bent on frustrating or sabotaging the health care reforms might well be better off with a federally run exchange (1/6).

The Washington Post: Repairs To Medicare
Liberals would empower the Independent Payments Advisory Board (IPAB) to stop payment for treatments it deems not cost-effective. The idea hasn't gotten very far, partly because Republicans denounce it as "rationing." Conservatives favor "premium support," which would subsidize seniors to shop among competing insurance plans, but Democrats, the president included, have tarred that idea as a skimpy "voucher." It's unfortunate but not disastrous that no structural solution is, for the moment, politically possible (1/6).

Tampa Bay Times: Working For Affordable Health Care For Floridians
On Monday, I will meet with Health and Human Services Secretary Kathleen Sebelius in Washington. ... I believe that having a safety net health care system — like Medicaid — is absolutely critical for those who need it most. But we must understand if we can afford to nearly double (from 3.3 million to 6.1 million by 2022-23) the number of Floridians using Medicaid today under the new law. We must also be certain that nearly doubling the people in this program would improve health care services, not just for those in government-run programs but all Floridians who would be impacted by such a dramatic growth of government in the health care marketplace (Gov. Rick Scott, 1/6).

Tampa Bay Times: Florida Needs Medicaid Expansion 
Embracing the Medicaid expansion would be a humane step and a practical one. ... Scott has argued that Florida cannot afford to expand a program that has been eating an ever larger share of the state budget. Using new numbers from the state Agency for Health Care Administration, Scott claims the cost for taxpayers of the expansion is $63 billion over 10 years, with Florida's share at nearly $26 billion. This figure is just plain wrong (1/6).

Denver Post: Colorado's Medicaid Expansion Plan Must Cut Costs
To understand Democratic Gov. John Hickenlooper's decision to expand Medicaid coverage in Colorado, it helps to buy into the assessment that doing (so) makes financial sense. ... offering health care coverage to an additional 160,000 adults — who currently cost all of us money — and launching wide-ranging plans to contain costs and spur innovation are notable public policy goals that we'd like to see succeed. But given the state of the state treasury, it is imperative that cost savings are truly found and not just promised (1/7).

The Idaho Statesman: Expanding Health Care Coverage Benefits All Idahoans
As a member of Gov. Butch Otter’s task force, which voted 15-0 in favor of this [Medicaid] expansion, here are eight reasons why: 1. It saves Idaho money. The expansion of Medicaid to 150,000 people will cost Idaho $284 million over the next 10 years. However, the federal government’s payment program for this expansion will bring in $290 million to the state over that time. Idaho stands to gain $6 million by expanding Medicaid. Conversely, there are 70,000 Idahoans who already meet the expanded eligibility requirements and their coverage will cost the state hundreds of millions of additional dollars without the benefit of enhanced federal payment if we don’t do this (Dr. Ted Epperly, 1/6).

Kansas City Star: Bid To Renew KC’s Extra Health Levy Merits Scrutiny
Almost eight years ago, Kansas Citians narrowly approved a property tax increase to provide more public funds for indigent health care. It was a compassionate decision by voters. But the world of health care has changed a great deal since then. ... Truman Medical Centers and a few other medical care providers in Kansas City still want to keep receiving the extra health levy. ... If Missouri does not adopt Medicaid expansion or progress on the exchanges is delayed, the squeeze will be on hospitals in earnest to keep their doors open to serve indigent patients in Kansas City and the state. Still, the City Council and local health care providers must use this week’s hearing to start providing clear evidence they need a $135 million tax renewal over nine years (1/6).

Los Angeles Times: Another Surgery – While Knee-Deep In The Insurance Swamp
The other thing I dread is the stream of medical mail that is guaranteed to land in my mailbox every few days, every last bit of it entirely indecipherable. BlueCross BlueShield of Illinois keeps sending me things that say, "This is not a bill." Then don't send it to me. ... I can honestly tell you that I have no idea whether I've paid what I owe, or if that's even been determined (Steve Lopez, 1/5).

Baltimore Sun: CIA Deception Threatens Global Effort To Eradicate Polio
The news that the Central Intelligence Agency had been running a fake vaccination program in Pakistan first surfaced in 2011 and quickly ignited fears that the covert operation could compromise the global campaign to eradicate polio. ... many worry that the violence will continue unless the U.S. government takes steps to rebuild trust in Pakistan and ensure that the CIA can never again infiltrate efforts to fight global health problems that affect all of us, from residents of Karachi to people living here in Baltimore (Drs. Lynn Goldman and Michael Klag, 1/7).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Marissa Evans

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.