Daily Health Policy Report

Tuesday, January 8, 2013

Last updated: Tue, Jan 8

KHN Original Reporting & Guest Opinion

Administration News

Health Reform

Coverage & Access

Capitol Hill Watch

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insuring Your Health: When An Employer Drops Coverage, Workers Lose Their Tax Advantage

With just a year to go before the most significant changes under the Affordable Care Act take effect, Kaiser Health News consumer columnist Michelle Andrews answers readers' questions about how the law will affect them (Andrews, 1/7). Read the column.

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Capsules: Under Tight Budgets, Public Health Spending Falls For First Time; Conn., Insurance Capital, Moves Ahead With Exchange Plans; Study: Doctors Give In To Patient Demands For Brand-Name Drugs

Now on Kaiser Health News' blog, Jay Hancock reports on the diminishing level of public health spending: "But one aspect of moderating health expenditures — and the only category showing outright decline — could cost more than it saves. Hit by recession and tight budgets, spending on public health by federal, state and local governments fell in 2011 for the first time since analysts started tracking the numbers in 1960" (Hancock, 1/7).

Also on the blog, Phil Galewitz reports on Connecticut's plans to proceed with health exchange plans: "Five health plans — including all the major insurers in the state's individual and small group markets — have told Connecticut's health insurance exchange that they plan to offer policies in the state's new online marketplace this fall. Exchange officials said Monday that Aetna, United Healthcare, Anthem, ConnectiCare and a new nonprofit co-op owned by the Connecticut State Medical Society have filed letters of intent to sell coverage, exchange officials said Monday" (Galewitz, 1/8).

In addition, Alvin Tran writes about a new study about how physicians handle patients’ requests for brand-name drugs: "Doctors are more likely to prescribe brand-name drugs over lower-cost generics when patients request them and when physicians have contacts with drugmakers, a study published in JAMA Internal Medicine Monday shows" (Tran, 1/7). Check out what else is on the blog.

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Political Cartoon: 'Pleasantly Plump?'

Kaiser Health News provides a fresh take on health policy developments with "Pleasantly Plump?" by Joe Heller.

Meanwhile, here is today's health policy haiku:


take heart... if you break your pledge
science supports you.


 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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Administration News

Report: U.S. Health Spending Grew At Record Slow Pace For Third Consecutive Year

The country's health care bill tallied $2.7 trillion, according to the Department of Health and Human Services. Some indicators, though, suggest the slowed growth may not last.

The New York Times: Growth Of Health Spending Stays Low
National health spending climbed to $2.7 trillion in 2011, or an average of $8,700 for every person in the country, but as a share of the economy, it remained stable for the third consecutive year, the Obama administration said Monday (Pear, 1/7).

The Associated Press: Unusual Respite From Surging Health Care Costs
Americans kept health care spending in check for three years in a row, the government reported Monday, an unusual respite that could linger if the economy stays soft or fade like a mirage if job growth comes roaring back. The nation's health care tab stood at $2.7 trillion in 2011, the latest year available, said nonpartisan number crunchers with the Department of Health and Human Services. That's 17.9 percent of the economy, which averages out to $8,680 for every man, woman and child, far more than any other economically advanced country spends (Alonso-Zaldivar, 1/7).

The Wall Street Journal: Health-Cost Pause Nears End
U.S. health-care spending grew at a record low pace for a third consecutive year in 2011, according to federal figures released Monday, but signs are emerging that the slow growth may not last….But data published Monday also showed that the amount spent to treat individuals, as opposed to spending on administration and insurance premiums, began to rise in 2011, signaling that cutbacks in health spending hadn't become permanent (Radnofsky, 1/7).

Politico: What's With Slow Rise In Health Spending?
Health care spending continued to grow at one of the slowest rates in history last year even as signs emerged that the downward pressures applied by the recession were beginning to lift, according to an annual government report published Monday. And experts say that if the recent slowing of health spending is due to changes other than the lost insurance and general belt-tightening of the severe economic downturn, it could have major implications for the country's fiscal prospects (Norman, 1/8).

McClatchy: Growth In Health Care Spending Remains At Record Low In 2011
Total U.S. health care spending hit $2.7 trillion in 2011, making for a three-year run of record-low annual spending growth after the onset of the Great Recession. The roughly 3.9 percent increase in public and private health expenditures for 2011 was nearly identical to the rates of growth in 2009 and 2010. They represent the three lowest annual growth rates in the 52 years the data has been kept, according to a report Monday by the U.S. Department of Health and Human Services. The slower growth resulted from a mix of trends, including a decline in federal public-health spending and slower growth in private health insurance premiums – 3.8 percent. These trends offset an increase in 2011 in the use of personal health-care goods and services as the economy continued to rebound and private health-insurance enrollment stabilized after three years of major declines, said Micah Hartman, a federal statistician who co-authored the report (Pugh, 1/7).

Bloomberg: Health Spending Grows At Half Pre-Recession Level In 2011
Health-care spending in the U.S. grew at less than half the pre-recession level for the third straight year, as employers shifted more costs to strapped workers and state governments limited payouts for the poor. Spending on hospital visits, medications and other care grew 3.9 percent to $2.7 trillion in 2011, matching the slowest growth in 52 years of record keeping, the Centers for Medicare and Medicaid Services said in a report yesterday in the journal Health Affairs. Growth was close to 8 percent before the U.S. entered an 18-month recession in December 2007. Joseph Antos, who researches the economics of health policy at the Washington-based American Enterprise Institute, said changes in employer-sponsored insurance coverage has been a key factor in putting a damper on health-care costs (Edney, 1/8).

The Hill: Health Care Costs Grew At Near-Record Lows In 2011
Healthcare spending grew at near-record lows in 2011, according to data released Monday by the Health and Human Services Department. HHS Secretary Kathleen Sebelius credited parts of President Obama's signature healthcare law with the smaller increase. "A number of provisions in the health care law that will help control costs and spending are still being implemented, but the statistics show how the Affordable Care Act is already making a difference," Sebelius said in a statement. Healthcare spending grew by 3.9 percent last year, according to the latest report on national health expenditures. The rate matches increases in 2009 and 2010, and it's the lowest rate of growth in the 52 years the report has been issued (Baker, 1/7).

NewsHour (Video): Health Care Spending Increases But Rate Slows With Recession And Economy
While health care spending rose in 2012, it did so only slightly due to the recession and slow overall economic growth. Ray Suarez talks to Health Affairs' Susan Dentzer about the dichotomies of health care spending, including why there has been a slowdown in health care spending when personal out-of-pocket costs have increased (1/7).

Some coverage focused on spending for public health, as well as physician services --

Kaiser Health News: Capsules: Under Tight Budgets, Public Health Spending Falls For First Time
But one aspect of moderating health expenditures — and the only category showing outright decline — could cost more than it saves. Hit by recession and tight budgets, spending on public health by federal, state and local governments fell in 2011 for the first time since analysts started tracking the numbers in 1960 (Hancock, 1/7).

Medscape: Spending On Physician Services Crawls Out Of Recession
A slowly improving economy drove a 3.6% increase in spending on physician services in 2011, a noticeable improvement over 2.8% growth the year before, the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS) reports. Total healthcare spending in the public and private sectors rose 3.9% to reach $2.7 trillion in 2011, according to a study by CMS economists and statisticians published online today in the journal Health Affairs. That total healthcare spending growth rate, a repeat of 2010 and 2009, is the lowest in the last 52 years and represents the fallout of a recession that officially ended in June 2009. In 2010 and 2011, total healthcare-spending growth closely mirrored the rise in the gross domestic product (GDP), 3.8% and 4%, respectively, according to the CMS Office of the Actuary (Lowes, 1/7).

Medpage Today: Spending On MD Services Up More Than Other Costs
U.S. spending on health care remained flat overall in 2011, the latest year available, but spending on doctors and other clinician services continued to rise, a government report showed. While the U.S.'s health care spending grew 3.9 percent for the third consecutive year in 2011 -- a modest growth compared with years past -- physician and clinical services grew at 4.3 percent, outpacing overall spending for the first time in 3 years, the Centers for Medicare and Medicaid Services (CMS) Office of the Actuary said Monday in its annual health spending report. Physician and clinical services grew at a slower 3.1 percent and 3.5 percent rate in 2010 and 2009, being outpaced each year by the overall 3.9 percent increase. The 2010 growth in physician spending was the slowest in the 52-year history of the National Health Expenditure Accounts study, CMS said last year (Pittman, 1/7).

In other spending news -

Los Angeles Times: Great Recession Forced All Americans To Cut Back On Health Care
Though the Great Recession took a much larger toll on African Americans and Latinos than on whites, members of all three groups were forced to cut back on medical services as a result of the economic downturn, research shows (Kaplan, 1/7).

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Health Reform

Sebelius, Fla. Gov. Scott Have Health Care Chat With No Immediate Results

A meeting Monday between HHS Secretary Kathleen Sebelius and Florida Gov. Rick Scott on the health care law didn't seem to yield any immediate results on whether the GOP governor will implement parts of the law, but his willingness to meet may signal he is willing to do just that.

Politico: Scott, Sebelius Have 'Productive' Obamacare Chat
A long-awaited sit-down Monday between Florida Gov. Rick Scott and Health and Human Services Secretary Kathleen Sebelius didn't provide any answers on whether one of Obamacare's biggest critics will suddenly embrace the law. But the fact that the meeting happened at all -- and that Scott is keeping up the newly pragmatic tone he's had since the election -- raises the intriguing possibility that one of the nation's most high-profile Republican governors might actually agree to implement some of the law (Millman and Cheney, 1/7).

The Wall Street Journal's Washington Wire: Florida's Scott Talks Health Overhaul With Sebelius
Florida Republican Gov. Rick Scott is no fan of the health overhaul law, with his state having led the Supreme Court fight against it. But on Monday, he sat down in Washington with Health and Human Services Secretary Kathleen Sebelius to talk about whether the Sunshine State will work with federal officials to implement it (Dooren, 1/7).

CQ HealthBeat: Sebelius And Scott Pow-Wow Produces No Immediate Results
Health and Human Services Secretary Kathleen Sebelius met with Florida Gov. Rick Scott in Washington on Monday to discuss how the health care law will be implemented in his state, but afterward there didn't appear to be any agreement forged between the two. In November, Scott, a longtime Republican opponent of the law, had requested the meeting to discuss the cost to Florida of expanding the state's Medicaid program to uninsured adults as well as the cost of establishing a state-run health insurance exchange. In a statement following the Sebelius meeting, Scott said it was a "great conversation" but repeated his concerns that he doesn't have enough information on what implementation would cost the state (Norman, 1/7).

Reuters: Florida Governor Meets Sebelius On Healthcare, Bridles At Cost
Florida Governor Rick Scott kept up his attacks on Obamacare on Monday even after meeting U.S. Health and Human Services Secretary Kathleen Sebelius, complaining that federal health care reforms could cost Florida $26 billion over the next decade. Scott, a vocal critic of the Affordable Care Act also known as Obamacare, told reporters following the meeting in Washington that Medicaid program costs, which state officials say could mushroom over the next 10 years, continue to be his major concern. Scott was among a group of Republican governors who fought hard against the federal mandate and waited until the outcome of the November election before proceeding in earnest to comply with the law. "I understand the need to have a quality health care safety net for every Florida family that can't afford their own health care," Scott told reporters. "But we have to do it at a price that Floridians can afford" (Peltier, 1/7).

Health News Florida: Scott Keeps Using Wrong Medicaid Numbers, Records Show
Gov. Rick Scott says he opposes expanding Florida Medicaid because it would cost too much: $63 billion over 10 years, he says, with the state paying $26 billion of that. But those numbers are based on a flawed report, state budget analysts say. A series of e-mails obtained by Health News Florida shows the analysts warned Scott’s office the numbers were wrong weeks ago, but he is still using them. He cited them in a Tampa Bay Times op-ed on Sunday and at at a Washington press conference on Monday. The flawed report, "Estimates Related to the Affordable Care Act," was sent to members of the Legislative Budget Commission on Dec. 17. Three days later, two of the recipients pointed out the faulty assumptions and sent it back to AHCA for a do-over. They said it would violate Florida law to proceed with the estimate (Gentry, 1/8).

In other states, decisions loom on whether and how states will implement health insurance exchanges and the Medicaid expansion --

Kaiser Health News: Capsules: Conn., Insurance Capital, Moves Ahead With Exchange Plans
Five health plans -- including all the major insurers in the state's individual and small group markets -- have told Connecticut's health insurance exchange that they plan to offer policies in the state's new online marketplace this fall. Exchange officials said Monday that Aetna, United Healthcare, Anthem, ConnectiCare and a new nonprofit co-op owned by the Connecticut State Medical Society have filed letters of intent to sell coverage, exchange officials said Monday (Galewitz, 1/8).

MPR: Health Insurance Exchange, MinnesotaCare, Medicaid Decisions Due At Legislature
State lawmakers are under a tight deadline as they tackle a number of issues related to the federal health care overhaul, including passing legislation to set up a health insurance exchange, the fate of MinnesotaCare and an expansion of Medicaid. The exchange will serve as the online gateway for more than a million Minnesotans to comparison shop for health insurance policies and enroll in government programs such as Medicaid. Health insurance exchange legislation has faced a difficult couple of years at the state Capital, opposed by a Republican majority hostile to President Barack Obama's health care law. With Democrats now in power, such legislation should move along a smoother path (Stawicki, 1/8).

State Of Health: Analysis: Medicaid Expansion Brings 'Minimal' State Costs
A new report finds California could see a significant increase in Medi-Cal coverage at “minimal” cost to the state. Medi-Cal is the state’s version of Medicaid, health insurance largely for the poor. In the new study from researchers at UC Berkeley and UCLA, analysts report that 1.4 million California adults under 65 will be newly eligible for Medi-Cal. The Affordable Care Act says the federal government will pay 100 percent of the costs of these new enrollees from 2014 to 2016 and no less than 90 percent of the cost after that. In addition, the implementation of the ACA is expected to bring many people already eligible for Medi-Cal into the fold. The state will pay a greater share of the costs for those people. Altogether, analysts project that from 2014 to 2016, California will incur additional annual costs between $188 million and $471 million. But at the same time, billions of dollars will flow into the state, paying the overwhelming majority of total costs for the newly enrolled and those already eligible (Aliferis, 1/7).

And Sebelius is telling states they should review insurance rate increases more carefully --

CQ HealthBeat: HHS Secretary Pushes States To Do More On Rate Review
Health and Human Services Secretary Kathleen Sebelius Monday called on states to beef up their reviews of proposed insurance rate increases. As part of a statement on national health expenditures, Sebelius said states should "continue the work to hold insurance companies accountable by reviewing and building the capacity to deny unreasonable health insurance rate increases." On Sunday, The New York Times highlighted some proposed double-digit increases in premiums for individual and small-group market customers in states such as California, Florida and Ohio (Adams, 1/7).

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Coverage & Access

High Court Turns Away Challenge To Obama Administration Stem Cell Policy

Meanwhile, the Supreme Court heard arguments in a case involving Medicaid and malpractice awards. In addition, the justices rejected an appeal from Social Security recipients who don't want Medicare benefits.

Los Angeles Times: Supreme Court Rejects Challenge To Obama Stem Cell Policy
The Supreme Court has turned away a challenge to President Obama's policy of expanding government-funded research using embryonic stem cells that scientists say may offer hope for new treatments for spinal injuries and Parkinson's disease (Savage, 1/7).

McClatchy: Supreme Court Case Involves Medical Malpractice Awards, Medicaid
Sandra and William E. Armstrong's 12-year-old daughter will never learn of the Supreme Court's deliberations Tuesday, though the results could change her life. The young Taylorsville, N.C., resident is deaf and blind. She cannot sit, crawl, walk or converse. She's the victim, her parents say, of negligence by the troubled doctor who delivered her. She's at the center of a high-level legal case that pits state governments against the Obama administration and afflicted families. What the high court ultimately decides, after the hourlong oral argument Tuesday, could shape how states stake claims on medical malpractice awards that Medicaid beneficiaries win (Doyle, 1/7).

The Associated Press/Washington Post: Supreme Court Turns Down Appeal From Social Security Recipients Who Don't Want Medicare
The Supreme Court has turned away a challenge from former House Majority Leader Dick Armey and other Social Security recipients who say they have the right to reject Medicare in favor of continuing health coverage from private insurers (1/7).

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Capitol Hill Watch

Sandy Hook Shooting Changes Lobbying Dynamics For Guns And Mental Health

The Washington Post reports on how the recent Sandy Hook shooting has altered the lobbying landscape regarding gun rights and mental health issues.

The Washington Post: Sandy Hook Shooting Reshapes The Lobbying Landscape On Gun Laws, Mental Health Services
The classic lobbying nemeses over gun laws have been the National Rifle Association and the Washington gun control group, the Brady Campaign to Prevent Gun Violence. But the Newtown tragedy is prompting some locally based advocacy groups that have previously been silent on gun control to consider stepping in (Ho, 1/6).

In other news from Capitol Hill --

Modern Healthcare: Better Data Needed On Preventative Health Spending: GAO
HHS and the Veterans Affairs and Defense departments could improve their reporting on estimated cost savings and cost-effectiveness of federal spending on preventive health activities, according to a report from the Government Accountability Office. The authors of the 45-page report, requested by Sens. Max Baucus (D-Mont.), Tom Harkin (D-Iowa) and Carl Levin (D-Mich.), wrote that additional information on the cost savings and effectiveness of preventive health spending would be useful for policymakers to have given the increased attention such programs have received. Preventive services include such things as immunizations provided in clinical settings and health education media campaigns (Barr, 1/7).

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Health Care Marketplace

Patient Requests, Drug Company Ties Likely To Influence Doctors' Decision To Prescribe Name-Brand Drugs

About 40 percent of physicians are likely to comply at least sometimes with patients' requests for branded drugs.

Medpage Today: Rx Ads, Promos To Docs Still Work
When patients ask for a brand-name drug, many physicians give in rather than prescribe a generic, according to a nationwide survey, and in-office promotions to doctors increase the likelihood. About four in every 10 physicians said they at least sometimes comply with requests for the branded version of a drug when a generic is available, Eric Campbell, PhD, of the Mongan Institute for Health Policy at Massachusetts General Hospital in Boston, and colleagues found. Drug samples and meetings with pharmaceutical company representatives appeared to boost that rate, the group reported in a research letter online in JAMA Internal Medicine (Phend, 1/7).

Kaiser Health News: Study: Doctors Give In To Patient Demands For Brand-Name Drugs
Doctors are more likely to prescribe brand-name drugs over lower-cost generics when patients request them and when physicians have contacts with drugmakers, a study published in JAMA Internal Medicine Monday shows (Tran, 1/7).

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State Watch

Judge Orders Trial On Kan. Law Restricting Insurance Coverage For Abortions

A federal judge turned down the ACLU's request to summarily invalidate the measure, but said the issues must be adjudicated at trial.

The Associated Press: Judge Orders Trial In Kan. Abortion Insurance Case
Kansas' law that restricts private health insurance coverage for abortions will go to trial to resolve whether it poses a substantial obstacle to women seeking to end pregnancies, a federal judge ruled Monday. U.S. District Judge Julie Robinson rejected an argument by the American Civil Liberties Union of Kansas and Western Missouri that the 2011 law should be summarily invalidated because the Legislature's predominant purpose in passing the act was to impede access to abortion. Instead, Robinson sided with the state in finding that the ACLU failed to provide any evidence about lawmakers' motivation. But, the judge said, a trial is necessary to determine the larger question of whether the significant costs for abortions many women must now pay for themselves create a substantial burden on the federal right to an abortion (Hegman, 1/7).

Meanwhile, in other state news on the issue of abortion --

The Associated Press: Texas: New Women's Health Program Can Meet Demand
The Texas Health and Human Services Commission has signed up more than enough doctors to treat the poor women who depended on Planned Parenthood for family planning services and check-ups, the commissioner said Monday. Planned Parenthood's family planning programs for poor women was cut from the state program after Texas decided to eliminate funding to groups that support abortion rights starting Jan. 1. Commissioner Kyle Janek said Monday that his staff surveyed newly recruited doctors and clinics in the Texas Women's Health Program and found that they can pick up Planned Parenthood's caseload. "This gives us great confidence that we can continue to provide women with family planning and preventive care and fully comply with state law," Janek said (Tomlinson, 1/7).

NPR: New Regulations Could Treat Virginia Abortion Clinics Like Hospitals
This month marks the 40th anniversary of Roe v. Wade, the famed and widely cited case that legalized abortion. Yet across the country, states are continuing to approve restrictions. With little fanfare, Virginia and Michigan Republican governors recently signed new abortion bills into law. Virginia's Bob McDonnell, in particular, quietly approved clinic regulations adopted by the state's Board of Health three months ago that hold abortion clinics to the same building standards as hospitals (Lohr, 1/7).

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State Roundup: Medicaid Costs Could Affect State Surpluses; Calif. Gets 'C' For Dental Care

A selection of health policy stories from states across the country, including New York, California, Oregon, Florida and Massachusetts.

Stateline: Surpluses Await Some States In 2013 Sessions
In Tennessee, Republican governor Bill Haslam has said that much of the state’s $580 million surplus is already spent. Obamacare is expected to increase enrollment in TennCare, the state's Medicaid program, by more than 60,000 Tennesseans. ... At the same time, Texas has a $8.8 billion surplus and more than $8 billion in its rainy day fund, but faces a staggering $4.3 billion hole in its Medicaid budget (Prah, 1/8).

California Healthline: More California Kids Need Sealant, Study Says
A national study released today by the Pew Center on the States, part of the Pew Charitable Trusts, grades every state's level of adherence to a basic preventive dental procedure for children -- the application of dental sealant. California earned a "C." Dental sealant is vital for children, particularly for youngsters who don't get regular dental care, according to Bill Maas, policy advisor to the Pew Children's Dental Campaign (Gorn, 1/8). 

The New York Times: Cuomo Plans New Rules In Fight Against Sepsis
Gov. Andrew M. Cuomo will announce in his State of the State Message this week that every hospital in New York must adopt aggressive procedures for identifying sepsis in patients, including the use of a countdown clock to begin treatment within an hour of spotting it, a state official said. The new steps could save 5,000 to 8,000 lives annually, state health officials say, and reduce the long-term costs of the condition (Dwyer, 1/7).

The Oregonian: Health Benefit Changes On Tap For State Meeting Tuesday In Portland
Under the federal Affordable Care Act, health insurance policies for small businesses and individuals buying their own coverage will be sold through exchanges that amount to online marketplaces. The policies must meet new minimum standards such as offering maternity and mental health coverage. On Tuesday members of the Oregon Health Policy Board are poised to adopt recommendations concerning these standards, called essential health benefits. The beefed-up standards are among changes expected in the individual market, including premium hikes for some (Budnick, 1/7).

California Healthline: Dave Jones Reflects On 2nd Year, Stresses Need For Rate Regulation
After his second year as California Insurance Commissioner, Dave Jones sat down with California Healthline to talk about health insurance rate regulation, successes of the Department of Insurance over the past couple years and the department's role in the implementation of the Affordable Care Act. ... "I'm very concerned there's a lot of magical thinking going on. Look at the evidence. Look at what happened in Massachusetts. It's very clear the Affordable Care Act, in and of itself, is not going to magically reduce rates" (Gorn, 1/7).

The Miami Herald: Parents Of Disabled Kids Blast Florida Care
Twice in the past year, state health administrators cut the number of hours caregivers assisted Alex Perez’s severely disabled son at his Westchester home. Both times, the child’s pediatrician was left wondering why the state had reduced the care he had prescribed for the boy. ... Perez, whose 13-year-old son, Christian, suffers from cerebral palsy and failure to thrive, was one of a dozen parents and advocates who spoke to several lawmakers and other community leaders Monday night at the meeting called to address the needs of Florida children with severe disabilities and life-threatening medical conditions (Marbin Miller, 1/7).

Boston Globe: Meals For Medical Clients Back On The Table
Bill Brady said he lost 20 percent of his restaurant sales four years ago after Massachusetts put in place stringent new rules preventing drug companies from taking doctors out for meals. ... Last fall, however, the state relaxed the restrictions, and Brady, along with other restaurateurs, is counting on a return of the lucrative drug company business (Shemkus, 1/8).

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Editorials and Opinions

Viewpoints: Health Care And The 'Crushing Federal Debt;' Optimism About 'Grand Bargain;' Iowa's Premium Increase Request

Fortune: 2013: The Year We Become The Health Care Nation
The largest issue America will face in 2013 is health care. And it will only get larger. As the national conversation changes, we'll find that by year-end we're talking about it all the time, whether the ostensible topic is politics, government, the economy, our jobs, or our families. Health care will be the unavoidable topic. Medicare and Medicaid are the biggest element of our most serious national problem: crushing federal debt (Geoff Colvin, 1/5).

Los Angeles Times: The Coming Fight Over The Debt Ceiling: An Optimistic Take 
The Obama-Boehner argument over defining our fiscal problem obscures a basic issue on which both parties agree: spending on healthcare, including Medicare and Medicaid, must come down. Obama has already taken modest steps toward cutting spending on Medicare, and even entertained the idea of raising the health plan's eligibility age from 65 to 67 until he was shouted down by members of his own party. Is a bargain -- grand or otherwise -- possible? (Doyle McManus, 1/7).

Journal of the American Medical Association: Curbing Gun Violence
Gun violence arises from sociocultural, educational, behavioral, and product safety issues that transcend gun ownership alone. Addressing this crisis will require a comprehensive, multidimensional strategy. Toward that end, much can be learned from prior public health successes in changing the prevalence, social norms, and cultures of harmful behaviors. These major achievements—in the realms of tobacco, unintentional poisoning, and motor vehicle safety—provide a set of evidence-based, successful tactics for immediate application to gun violence (Dr. Dariush Mozaffarian, David Hemenway and Dr. David S. Ludwig, 1/7).

Forbes: If Insurance Companies Can't Utilize Pre-Existing Conditions, Then They're Not In The Insurance Business
When both Republicans and Democrats agree on something, it is not a cause for celebration but a reason to heighten scrutiny over the measure in question. One such initiative that has garnered a bipartisan seal of approval is the Affordable Care Act’s provision that forbids insurance companies from utilizing pre-existing conditions to determine who they wish to insure. This position—which is pure populist demagoguery—is designed not to improve the functioning of the health care industry but to destroy it. The health insurance industry, by allowing individuals to purchase security against serious incident health conditions, provides a crucial and heroic role as evidenced by its continued success and profitability (Amesh Adalja, 1/8).

Des Moines Register: Voss Needs To Reduce Wellmark Increase
It seems not long ago that Wellmark Blue Cross and Blue Shield increased its premiums. Now, the insurer is asking Iowa Insurance Commissioner Susan Voss to again allow it to begin collecting another increase. The company wants approval for a 12 to 13 percent increase on policies for about 150,000 Iowans. ... These Iowans are at the mercy of Wellmark, which sells 89 percent of the individual policies in Iowa. ... Voss should stand up for these desperate Iowans who have seen their premiums rise at least 8.5 percent each year since 2008 (1/7). 

Los Angeles Times: Addressing An Epidemic Of Rx Deaths
Prescription drug overdoses killed more than 37,000 Americans in 2009, according to the U.S. Centers for Disease Control; that death rate has tripled since 1990. The increase is not surprising, considering these additional CDC statistics: The number of prescriptions for painkillers has more than quadrupled since 1999 ... It's a terrible and hideously expensive toll, made even sadder in California by the fact that the state has the data in its hands to help stave off some of the injury and death but isn't using the information effectively (1/7).

Kansas City Star: War On Abortion Targets Reproductive Health Care For Poor Women
For those who believe that the "war on women" amounts to nothing more than a campaign slogan, behold Texas. ... Gov. Perry’s cloaks his crusade against Planned Parenthood in Christian concern for unborn babies. Yet he actually might be increasing abortions by limiting access to family planning. His patriarchal attitude is also more than a little offensive. It tells women, we know what is best for you, which doctors are morally fit to provide healthcare. Never mind that we’re also making it more difficult for you to find that care. Holier than thou, and wholly unconcerned about your welfare. That’s Rick Perry and the faith-n-values party (Mary Sanchez, 1/4).

Boston Globe: Medical Promised Land
From the moment their son was born, Mohammad and Alia Alhazmi knew something was wrong. ... Doctors in Saudi Arabia, the Alhazmis’ native land, suspected that the infant had Diamond Blackfan Anemia, a rare genetic condition that prevents the body from making red blood cells. ... Mohammad and Alia vowed to do whatever it took to cure their son. They learned that Diamond Blackfan Anemia was discovered in 1938, at Boston Children’s Hospital, one of the world’s premier research centers on the disease. ... Why were they so optimistic that America could save their son? “Everything is possible for the American people,” Mohammad told me (Farah Stockman, 1/8).

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Stephanie Stapleton

Andrew Villegas

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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.