Daily Health Policy Report

Tuesday, November 13, 2012

Last updated: Tue, Nov 13

KHN Original Reporting & Guest Opinion

Administration News

Health Reform

Capitol Hill Watch

Health Care Marketplace

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Doctors' And Nurses' Licenses Snagged By New Immigration Law In Georgia

WABE's Jim Burress, working in collaboration with Kaiser Health News and NPR, reports: "Hundreds of health care workers in Georgia are losing their licenses to practice because of a problem created by a new immigration law in the state. The law requires everyone – no matter where they were born – to prove their citizenship or legal residency as they renew their professional licenses. But with too few staff to process the extra paperwork, licenses for doctors, nurses, pharmacists and other health workers are expiring" (Burress, 11/12). Read the story.

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Insuring Your Health: High Deductible Plans Offer Low Premiums But Steep Risks

Kaiser Health News consumer columnist Michelle Andrews writes: "Alison Mitisek was at a Denver pediatrician's office with her 15-month-old son last August when she passed out. The doctor's office staff called an ambulance, which rushed her to a nearby emergency department" (Andrews, 11/12). Read the column.

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Obama Administration Extends Deadline For State Exchanges

Kaiser Health News staff writer Phil Galewitz reports: "The Obama administration on Friday gave states more time to submit plans to set up state-based health insurance exchanges, a concession to the reality that many states had delayed planning until they saw who won the presidential election" (Galewitz, 11/9). Read the story.

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Capsules: FEMA Hurricane Sandy Workers Win Health Benefits; Hospital Shift Changes A Dangerous Time For Patients; Health System Touted By Obama Doesn't Back Medicaid Expansion

Now on Kaiser Health News' blog, Ankita Rao writes about the decision to give health benefits to FEMA Hurricane Sandy workers: "Just one week after an online petition made news by calling for the Federal Emergency Management Agency to give health benefits to part-time disaster workers responding to Hurricane Sandy, the United States government changed its policy" (Rao, 11/13).

In addition, Alvin Tran reports on the quality issues associated with hospital shift changes: "Before physicians at Massachusetts General Hospital finish their 13-hour shifts in the surgical intensive care unit, they hand off their patients to the crew taking over. The outgoing and incoming doctors carefully exchange important information about each patient to ensure that they are properly cared for through the next shift" (Tran, 11/13).

Also in Capsules, Phil Galewitz reports on Intermountain Healthcare and the health law's Medicaid expansion: "Intermountain Healthcare, the Salt Lake City-based hospital system praised by President Barack Obama as being a model for low-cost, high quality care, says it is not convinced Utah should expand Medicaid under the federal health care overhaul" (Galewitz, 11/9). Check out what else is on the blog.

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Political Cartoon: 'Cliff Hanger?'

Kaiser Health News provides a fresh take on health policy developments with "Cliff Hanger?" by John Darkow.

Meanwhile, here is today's health policy haiku:


Boehner backpedals
Sometimes backwards is forward
Now we can move on?
- Beau Carter

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

Labor, Business Groups Step Up Efforts To Shape 'Fiscal Cliff' Debate Over Medicare, Medicaid And Social Security

Some news outlets examine the impact of looming tax increases and spending cuts if a budget deal is not struck by the end of the year. Others examine the positions being staked out by powerful groups over issues such as Medicare and other entitlement programs. 

The Associated Press/Washington Post: Most Of America Would Be Hit By Tax Increases And Spending Cuts From 'Fiscal Cliff'
Everyone who pays income tax — and some who don't —will feel it. So will doctors who accept Medicare, people who get unemployment aid, defense contractors, air traffic controllers, national park rangers and companies that do research and development. The package of tax increases and spending cuts known as the "fiscal cliff" takes effect in January unless Congress passes a budget deal by then. The economy would be hit so hard that it would likely sink into recession in the first half of 2013, economists say (11/13).

The Wall Street Journal: White House Plans Public Appeal On Deficit
The White House plans an aggressive public campaign to build support for its approach to reduce the deficit through tax increases and spending cuts, a sharp contrast to its private talks with Republicans that faltered last year. … The strategy comes as many Republicans appear to have softened their antitax rhetoric in the wake of the election, with many openly acknowledging that higher taxes will likely be part of any plan to reduce the deficit (Paletta and Hook, 11/12).

The New York Times: Labor Leaders Have Obama's Back, And Are Ready To Help
Having helped President Obama win re-election, labor leaders will meet with him on Tuesday and intend to offer their robust support for what they view as his mandate: stand tough against cuts in Medicare, Medicaid and Social Security and keep pushing to raise taxes on the wealthy. … As the administration begins talks with Congressional Republicans to modify a range of tax increases and budget cuts scheduled to go into effect next year, the unions say they will rally their forces on a broader agenda, seeking to counter business and conservative groups that are pushing for cuts in social programs and tax breaks for corporations and wealthy individuals (Greenhouse, 11/12).

The Associated Press/Washington Post: Obama To Meet With Labor Leaders About Impeding 'Fiscal Cliff,' Prospect Of Taxes On Wealthy
The president views his re-election as an affirmation of his belief that raising taxes on families earning more than $250,000 a year is what voters want. Republican House Speaker John Boehner has expressed a willingness to raise revenues but remains opposed to boosting tax rates, pointing instead to closing tax loopholes, lowering rates and fixing entitlement programs. Both sides have voiced the potential for cooperation, but face a post-election confrontation over a series of expiring tax cuts approved during the George W. Bush presidency and tough, across-the-board spending cuts set to take place because lawmakers failed to reach a deal to reduce the federal debt (11/13).

The Wall Street Journal: Labor Pressures Obama On Budget
These groups held more than 100 events last week to trumpet their success at the polls and remind voters that many Democratic candidates pledged during the campaign to push for higher taxes on upper-income earners and oppose cuts to Social Security, Medicare, and Medicaid benefits (Paletta, 11/12).

The Washington Post: Liberal Groups Mobilize For 'Fiscal Cliff' Fight Over Social Security, Medicare
With President Obama seeking a deal to avoid the "fiscal cliff," liberal groups that campaigned aggressively for his reelection are mobilizing to oppose concessions they fear he could make on Medicare and Social Security. Leaders of the nation’s labor unions and other liberal groups are planning Tuesday to press Obama at the White House to reject the kind of cuts in Medicare and Social Security that he has previously offered to make. On Thursday, left-leaning lawmakers and seniors groups plan to rally on Capitol Hill against any changes to entitlements (Goldfarb, 11/12).

The Washington Post: As 'Fiscal Cliff' Nears, Business Groups Jostle For Ear Of White House, Congress
Tension among the country's leading business lobbies has become more pronounced this week as competing groups jostle for attention from Capitol Hill and the White House over their favored approaches to resolving the ongoing deadlock over tax and spending policy (Hamburger, 11/12).

The Wall Street Journal’s Washington Wire: Obama To Meet With 12 CEOs Wednesday
The outreach by Mr. Obama is part of his attempt to court corporate support for a bipartisan deficit-reduction plan that he hopes to advance before the end of the year. Many of the CEOs have said they will only accept higher taxes if policy makers also agree to major changes to Medicare and Social Security, something Democrats haven't embraced (Paletta, 11/12).

Los Angeles Times: Group Mobilizing Young People To Push For National Debt Plan
A new group, the Can Kicks Back, aims to give Americans 18 to 32 years old a voice in the debate over tax hikes and budget cuts that loom next year if Congress and President Obama cannot agree on a deficit-reduction plan. … Part of that effort will be sending a giant mascot character in the shape of a can to college campuses to generate support, and then to Congress to highlight the concerns of young people. The group is focusing on how the debt affects the ability of people to get a job, pay for their education and raise a family, Schoenike said. To drive home the point, the group is highlighting the share of the national debt being shouldered by every American. Although the U.S. national debt officially is about $16.25 trillion, the Can Kicks Back is using a much higher figure — $71 trillion — which includes unfunded liabilities such as Social Security, Medicare and government pensions (Puzzanthera, 11/13).

In related news -

The Washington Post: 5 Things (Other Than The 'Fiscal Cliff') To Watch During The Lame-Duck
Lawmakers are currently scheduled to meet for just 16 days between today and the end of the year, but leaders could add more time as they work to avoid the "fiscal cliff," or the series of automatic federal spending cuts and tax increases set to take effect in January. And let's face it: After more than a year of campaigning and partisan rancor, the "fiscal cliff" and all of its policy and economic implications is set to dominate the attention of Washington in the coming weeks. Despite that, there are several other political and policy developments worth tracking in the coming weeks (O'Keefe, 11/13).

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Health Reform

Obama Administration Gives States More Time To Decide On Health Exchanges

On Friday afternoon, the Department of Health and Human Services extended the deadline until Dec. 14 for states to submit plans to set up state-based health insurance exchanges under the health care law. Those states that want to partner with the federal government have until Feb. 15 to outline the duties the state government would handle in running the exchanges.

Kaiser Health News: Obama Administration Extends Deadline For State Exchanges
The Obama administration on Friday gave states more time to submit plans to set up state-based health insurance exchanges, a concession to the reality that many states had delayed planning until they saw who won the presidential election" (Galewitz, 11/9).

Reuters: States Given More Time To Work On Health Exchanges
The Obama administration gave states extra time to work toward setting up new health insurance exchanges on Friday, days after President Barack Obama's re-election ensured the survival of his healthcare reform law. The move is seen as a concession to dozens of states that delayed compliance with the Patient Protection and Affordable Care Act until after the November 6 election. Opponents of the plan had hoped a victory for Republican Mitt Romney would ultimately result in the law's repeal (Morgan and Selyukh, 11/9).

Bloomberg: States Given Extra Month For Health Exchange Blueprints
President Barack Obama's administration gave U.S. states one more month to decide how they plan to develop new health exchanges that will let people shop for insurance coverage. While the states still must say by Nov. 16 if they plan to build their own marketplaces, they can now wait until Dec. 14 to submit the actual blueprint, Health and Human Services Secretary Kathleen Sebelius said in a letter sent yesterday to state governors. States that want to create a partnership with the federal government to manage the exchanges have until Feb. 15 to outline the duties they'll handle (Wayne, 11/10).

CQ HealthBeat: Health Care Law's Insurance Market Rules Might Provoke More Battles In The States
The next big hurdle for implementation of the health care law: States must adopt the overhaul’s major changes to how consumers purchase health insurance, which are due to take effect in 2014. They are very guts of the measure's promise of better access to health care. But tough new standards on guaranteed issue, age rating and more might also provoke a new round of fights in Republican-controlled states where officials have been so resistant to implementing the overhaul that they've refused to set up state health insurance exchanges. Insurers, health policy experts, state regulators and others are watching to see if proposed rules are issued as soon as Tuesday dealing with insurance market regulations, as well as standards for qualified health plans and minimum standards for essential health benefits (Norman, 11/12).

Medpage Today: Feds' Health Exchange Plans Still Hazy
States wanting to run their own health exchanges under the Affordable Care Act (ACA) recently got a last-minute deadline reprieve, but little information is known about how exchanges would work in states that choose to let the federal government run them, insiders said. Details on which plans will be included in the federal online marketplace and what will be covered at what rates -- all questions states may like to know answers to before they decide if they will run their own exchanges -- are still unknown. Under the ACA, exchanges would operate in every state to allow individuals to buy health insurance. Exchanges can be run by individual states, by the federal government, or by a combination of the two under an arrangement known as a "state partnership exchange." The exchanges are scheduled to begin operating on Jan. 1, 2014 (Pittman, 11/12).

NPR: Health Insurance Exchanges Explained
Last week's election may have settled the fate of the federal Affordable Care Act, but its implementation after months of uncertainty has caught many of the players unprepared. Late last week, the federal government extended the deadline for states to decide what they want to do about health exchanges. Those are the new marketplaces where individuals and small businesses will be able to shop for health insurance (Rovner, 11/13).

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States Wrestle With Decisions Regarding How To Move Forward On Exchanges

News outlets report on how various states are responding to the implementation of the health law now that President Barack Obama has been re-elected.  

The Associated Press: Constituencies Bend Fallin's Ear On Health Care
Looming decisions for Gov. Mary Fallin on how Oklahoma will respond to the sweeping federal health care law are prompting an energetic, behind-the-scenes lobbying effort by hospitals, insurance companies, business and industry groups, and other constituencies that will be affected by provisions of the law. Fallin is expected to announce within the next week her position on whether the state will move ahead with setting up a state-based online health insurance marketplace, or exchange, required under the law (Murphy, 11/13).

The Associated Press: Arkansas Moves Forward On Health Overhaul
Arkansas officials say the state is moving forward with implementing parts of the federal health care law after an election that provided clarity on the federal level but uncertainty in the state Legislature about the political future of the controversial legislation. ... Officials with Gov. Mike Beebe's administration say the election at the national level provides some certainty on the future of the law as it takes effect in the state. Congress returns today and begins efforts to avoid the "fiscal cliff" of automatic spending cuts and tax increases (DeMillo, 11/12).

(St. Paul) Pioneer Press: Changes In Minnesota Health Care Look Likelier
The shift in control of the state Legislature from Republicans to Democrats should create a smoother path for Democratic Gov. Mark Dayton to implement his plans for a state health insurance exchange next year. What's more, there's now less chance of a fight over whether to expand the Medicaid health insurance program for low-income and disabled residents. Those are two of the clearest health care implications from election victories this week by the Democratic-Farmer-Labor Party in Minnesota (Snowbeck, 11/9).

Minneapolis Star Tribune: Federal Health Care Law: Now It's Full Speed Ahead
With President Obama's victory in hand, it's full steam ahead on implementing the federal health care law. States face a Friday deadline to say whether they'll build their own heath insurance exchanges in 2014, or else live with a version being designed by the federal government. In a month, they'll need detailed blueprints that show they'll be ready to flip the switch (Crosby, 11/11).

The Associated Press: Election Clears Path For Minn. Health Exchange
Republican lawmakers who refused to help Gov. Mark Dayton develop Minnesota's online health insurance marketplace while they hoped for a changing of the guard in Washington will now be on the sidelines while Democrats move ahead. Tuesday's results confirmed the federal health care law is here to stay (Lohn, 11/12).

The Associated Press: State-Run Health Exchange Faces GOP Roadblock
Republican Gov. Bill Haslam says Tennessee could design its own health insurance exchange required under Democratic President Barack Obama's health care law, but resistance in the GOP-controlled General Assembly may cause the state to hand that power off to the federal government. States have until Friday to inform the U.S. Department of Health and Human Services if they plan to set up their own health insurance markets, and Haslam's decision could come down to the wire. The governor opposes the new health care law but said he can see reasons for not deferring the exchange to federal government (Schelzig, 11/11).

The Dallas Morning News: Texas GOP Leaders Still Resist Federal Health Care Law; Others Try To Expand Coverage
President Barack Obama's federal health care law may be safe from repeal, but it’s drawing nothing close to a salute in Texas. Just as before last week's election, state leaders castigate President Barack Obama's signature legislative achievement, even after he won re-election and Democrats strengthened their grip on the U.S. Senate (Garrett, 11/11).

California Healthline: Budget, Special Session, Exchange Votes On Tap
November and December are supposed to be off-time for California lawmakers, but not this year. This week, the Legislative Analyst's Office is expected to release its budget forecast. Also this week, the Health Benefit Exchange board will vote on submission of its federal establishment grant. A number of health reform guidelines are expected to be released soon by federal health officials who are also dealing with a deadline this week for states to declare whether or not they will form their own exchanges (Gorn, 11/12).

Milwaukee Journal Sentinel: Obama Administration Extends Health Exchange Deadline
The Obama administration moved Friday to give states more time to submit plans for setting up insurance exchanges in 2013, a central pillar of the health care law…. Wisconsin is among the states in which officials are scrambling to decide on a response. State Rep. Jon Richards, a Democrat from Milwaukee, said the decision offers Gov. Scott Walker administration's a "reprieve," providing the state a chance to reach out to stakeholders and get a proposal for implementing the law (11/9).

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How The Election Factors Into States' Plans For The Health Law's Medicaid Expansion And Other Changes

News outlets report that the outcome of some states' gubernatorial races will likely change the outlook for the health overhaul's sweeping Medicaid expansion. In general, however, the future remains unsettled.

Politico: New Governors Might Change Medicaid Outlook
New faces in a pair of state capitols could alter the future of Medicaid expansion. In New Hampshire, expansion now looks virtually assured. Democrat Maggie Hassan, a vocal proponent of the Affordable Care Act's optional Medicaid expansion, will take the keys from Gov. John Lynch, a more moderate Democrat. And voters sent Hassan reinforcements, giving her more room than Lynch had to advance the health law. Democrats reclaimed control of the state House and took six seats from Republicans in the state Senate, leaving the GOP with a slim 13-11 majority. Lynch wouldn’t commit to Medicaid expansion and faced a hostile Legislature. In contrast, Hassan pledged her support for expansion during her campaign (Cheney and Smith, 11/12).

San Francisco Chronicle: States Now Must Make Call On Obamacare
President Obama's re-election solidified the future of national health care, and now it's up to the states to carry it out. … Gov. Jerry Brown plans to call a special session of the Legislature in December to focus on how to expand Medi-Cal, the state's Medicaid program, and work out details of the benefits to be offered (Colliver, 11/22).

The Oregonian: Health Watch: Despite Election Results, Health Care's Future Remains Unsettled, Including In Oregon
Democrats' retention of the White House and U.S. Senate last week meant the federal health reforms contained in the Patient Protection and Affordable Care Act will remain the law of the land. But that doesn't mean things are settled in the world of health care, including in Oregon. Next year Oregon lawmakers will decide whether to expand coverage under the Medicaid-funded Oregon Health Plan to about 200,000 people using federal subsidies that will ratchet back over time. Moreover, discussions of significant changes to Medicare programs that provide care to the elderly and disabled remain on the table as Congress takes up negotiations to avoid major cuts and tax increases scheduled for January, known as "the fiscal cliff"…The state remains on course to set up its health insurance exchange, required under federal health reform to provide an online marketplace for consumers and small businesses. But significant decisions remain (Budnick, 11/12).

Kansas Health Institute News: Group Urges Brownback To Expand Medicaid Eligibility
About 100 people rallied outside the Kansas Statehouse today, urging state officials to expand Medicaid eligiblity as provided for in the federal health reform law. … Earlier this week, the governor announced that he would block the state's participation in a state-federal insurance exchange, one of the hallmarks of the new law. But unlike some Republican governors, he hasn't ruled out the possibility he would support some sort of Medicaid expansion (Ranney, 11/9).

In addition, some health systems and providers offer their take on the Medicaid expansion --

Kaiser Health News: Capsules: Health System Touted By Obama Doesn't Back Medicaid Expansion 
Intermountain Healthcare, the Salt Lake City-based hospital system praised by President Barack Obama as being a model for low-cost, high quality care, says it is not convinced Utah should expand Medicaid under the federal health care overhaul (Galewitz, 11/9). 

The Atlanta Journal-Constitution/Associated Press: SD Health Care Providers Urge Medicaid Expansion
Now that President Barack Obama's re-election has cleared the way for the full implementation of his health care law, doctors and hospitals in South Dakota are urging the state to expand its Medicaid program so thousands of additional low-income residents can receive coverage. But Gov. Dennis Daugaard says any expansion of coverage is unlikely for at least several years while the potential costs are examined. The South Dakota Association of Health Care Organizations said about 48,000 uninsured residents will be left behind if South Dakota doesn't ease its eligibility requirements for Medicaid, the government health care program for the poor (Brokaw, 11/13).

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Despite Election, Health Overhaul Faces Changes And Legal Challenges

Lawsuits continue to go forward against the health law, and some politicians vow to continue repeal efforts.

Politico: The Legal Hurdles Obamacare Still Must Clear
The Supreme Court gave its definitive ruling upholding the Affordable Care Act in June. But that hasn't stopped three other legal challenges to core provisions of Obamacare — including the mandates and subsidies — that could unravel big parts of the law if they succeed. ... while the lawyers fight it out, the cases continue to be political irritants and a way to keep the antagonism to the law burning hot (Kenen, 11/13).

The Washington Post: After Election, Health Care Lobbyists Tweak Strategy
Ilisa Halpern Paul, a health care lobbyist and head of government relations at Drinker Biddle & Reath, is a native Californian. Her deputy, Jodie Curtis, is from Wisconsin, and fellow lobbyist Jeremy Scott is from Ohio. ... [Obama's re-election] is prompting the three of them to become self-taught experts on their home states’ politics and major policymaking players. That's because the federal health care law requires states to build online marketplaces, called health insurance exchanges ... many health care lobbyists are shifting their attention from federal agencies and Capitol Hill to the 50 state legislatures that will be calling the shots (Ho, 11/11).

Politico: Price Not Willing To Admit Defeat On Obamacare
Rep. Tom Price (R-Ga.) isn't ready to join House Speaker John Boehner in admitting President Barack Obama's health care reform law was the "law of the land." ... "I can tell you, as a physician, we're not opposed to the president's health care law because of this election, we're opposed because it's bad policy" (Robillard, 11/11).

USA Today: Improvements Sought For Health Insurance Law
Democrats and Republicans say now is the time for them to come together to fix [the health law]. ... "It's pretty clear to me that the [law] will not end up the way it is now," said Doug Holtz-Eakin, president of the American Action Forum ... The analysts do agree on one thing, even if they don't necessarily agree on how to go about it: Cutting costs through provider payments, rather than through the health care system itself, won't cause health care costs to stabilize (Kennedy, 11/10).

The Washington Post: Paul Ryan: We Didn't Lose On Medicare
In his first post-Election Day television interview, former GOP vice-presidential nominee Paul Ryan said Monday that he doesn't believe that the 2012 White House campaign was a referendum on his plan to cut the federal budget and overhaul entitlement programs such as Medicare. "I don’t think we lost it on those budget issues, especially on Medicare," Ryan told Jessica Arp, a reporter for Madison CBS affiliate WISC-TV (Sonmez, 11/12).

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Capitol Hill Watch

As Congress Ponders Spending Cuts, Health Care Industry, Advocates Urge Medicare Be Spared

Congress returns today and begins efforts to negotiate a budget deal that would avert the "fiscal cliff" of automatic spending cuts and tax increases, which are slated to take effect early next year.

Politico Pro: AHA To Hill: No Cuts Worse Than The Sequester
The hospital industry is worried it's going to be called upon again to withstand funding cuts as lawmakers try to prevent this winter's sequestration and the planned cut to physician payments. In an interview with POLITICO, top officials at the American Hospital Association say they're concerned that the decisions being made today aren't based on what's best for health care, but rather what's going to generate the most revenue savings (Haberkorn, 11/12).

The Hill: Nursing Homes To Congress: Stop Looming Medicare Cuts
Nursing homes are welcoming Congress back with a campaign against the sequester's looming cuts to Medicare. The American Health Care Association (AHCA) will run ads against the cuts in Beltway publications and on major cable networks starting Monday. ... "The end of the year marks the end of the line for sequestration. Something must be done to address these deep cuts to Medicare," said Mark Parkinson, AHCA president and CEO, in a statement. The AHCA represents nursing homes and other skilled nursing facilities, which rely heavily on Medicare and Medicaid (Viebeck, 11/12).

The Hill: Budget-Cutters Eye Health Care Law's Insurance Subsidies
As the election fades into the rearview mirror and attention turns more seriously toward the looming "fiscal cliff," lobbyists and advocates are once again wondering whether Congress might look to the healthcare law for spending cuts. Specifically, lawmakers might be tempted to tap the health law's insurance subsidies, by far its most expensive provision, and probably the most tangible benefit it will provide. Cutting into the subsidies has been discussed before, but it's gaining new urgency as the fiscal cliff, a combination of spending cuts and tax increases set to take effect at the end of the year, draws closer (Baker, 11/12).

CQ HealthBeat: Hill Pokes At Health Care Issues Before Returning For Heavy Helping Of Medicare
Congress will take a crack at a few health care issues this week before recessing Friday and returning after Thanksgiving for a month of legislating — which could include cuts to a wide range of Medicare providers. On tap late Tuesday is a House vote on a measure to allow the continuing sale of existing inventories of certain inhalers to treat asthma. These epinephrine inhalers contain aerosol propellants that violate chlorofluorocarbon limits put on the law books to reduce ozone that contributes to global warming. … The week also will include consideration of Medicare payments to foster the adoption of health information technology (Reichard, 11/12).

Medpage Today: Medicare Changes Likely Soon, Experts Say
As the dust continues to settle after Tuesday's election and policy wonks debate what it means for the future of healthcare, an increasing number of experts say Medicare will be the subject of likely reforms in the near future. In post-election Washington, lawmakers and the president face what is commonly called the "fiscal cliff" -- a series of expiring tax breaks, needed federal spending bills, and a periodic increase in the nation's debt ceiling all coming together at once (Pittman, 11/9).

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Health Care Marketplace

Marketplace News: U.S. Overpaying Nursing Homes

News outlets cover various aspects of the costs of coverage, including in Medicare, high-deductible plans and also in the average employee plan.

The Wall Street Journal: Nursing Homes Said To Overbill U.S.
Hundreds of nursing homes overcharge Medicare every year for so-called skilled services, adding $1.5 billion in annual costs to the program, according to a federal report to be released Tuesday. About one-fourth of Medicare bills from facilities examined in the report were incorrect. The majority of these claims involved so-called upcoding, where a nursing home or other provider inflates the cost of its bill to Medicare (Burton, 11/12).

USA Today: New Long-Term Care Insurance Policies Offer More Options
As Americans are living longer they are facing the staggering cost of nursing homes and assisted-living care. ... Long-term-care insurance is one way to prepare for the growing expenses, but the industry is undergoing changes and the products are confusing and costly. ... the industry is shrinking, prices are rising and carriers are limiting their coverage. Since 2010, five key insurance carriers have exited the market (Dugas, 11/12).

CQ HealthBeat: Employee Health Plan Deductibles On The Rise
As employers move to shift more and more health care costs to their workers, deductibles have been growing to the point that it is commonplace for an employee to be enrolled in a plan with a $1,000 or higher up front out-of-pocket payment, according to a new snapshot report issued Monday by the Kaiser Family Foundation. Based on the 2012 Kaiser/HRET Employer Health Benefit Survey, the percent of workers with health insurance who have a general deducible for single coverage has risen from 52 percent in 2006 to 72 percent in 2012 (11/12). (KHN is an editorially independent program of the foundation.)

Kaiser Health News: High Deductible Plans Offer Low Premiums But Steep Risks
In general, the higher a health plan's deductible, the lower the premium. ... "People get caught all the time," says Martin Rosen, co-founder of Health Advocate, a company that helps consumers resolve medical billing problems and provides support for health-care decisions. ... In a high-deductible plan, preventive care is typically not subject to the deductible. But all other care, including prescription drugs and emergency care, may be (Andrews, 11/12).

The Wall Street Journal: More Sticks, Carrots In Health Care Plans
Benefits-enrollment season is here, offering workers a glimpse of their health coverage for next year. For many, the picture will be familiar: higher costs and more incentives to improve their health. Underlying the details is a longer-term trend in health benefits. For many years, U.S. companies have been seeking to shift more responsibility onto employees. ... Next year, workers will see limited effects of the federal health care overhaul (Mathews, 11/11).

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Public Health & Education

L.A. Times Investigates Doctors' Connection To Prescription Drug Abuse

Also, a new study shows that most states are cutting back on antibiotic use.

Los Angeles Times: Legal Drugs, Deadline Outcomes
Prescription overdoses kill more people than heroin and cocaine. An L.A. Times review of coroners’ records finds that drugs prescribed by a small number of doctors caused or contributed to a disproportionate number of deaths (Glover and Girion, 11/11).

Los Angeles Times: Tighter Oversight Of Prescription Drug Deaths Sought
The chairman of a state Senate committee that oversees the Medical Board of California said Monday that he would introduce a bill requiring coroners to report all prescription drug deaths to the agency — a move aimed at helping authorities identify doctors whose prescribing practices may be harming patients. Sen. Curren D. Price Jr. (D-Los Angeles), responding to a Times' report that authorities have failed to recognize how often people overdose on medications prescribed by their doctors, said the medical board needed coroners' reports to improve its oversight (Girion and Glover, 11/12).

In other pharmaceutical news -

USA Today: Southeast Paying Health Price For High Antibiotic Use
Antibiotic use in the United States is dropping, but it is dropping most slowly in states that use the drugs the most – widening regional gaps that may be putting people in some Southeastern states at heightened risk for infections that no longer respond to antibiotics, a new analysis shows. ... [Researchers] have new data showing that urinary tract infections have became more resistant to antibiotics and that the problem is worst in regions where use is highest (Painter, 11/13).

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State Watch

State Roundup: Cheers, Jeers For Mass. Assisted Suicide Defeat

A selection of health policy stories from Massachusetts, Georgia, California, Maryland, and New York.

The Washington Post: Sandy Triggers New Policies On Health Insurance, Leave-Sharing
The government is continuing to expand benefits policies in the wake of Hurricane Sandy, clearing the way for certain emergency relief employees to be eligible for federal health insurance and soliciting donations of leave for affected federal workers. The Office of Personnel Management plans to publish on Wednesday rules effective immediately making relief workers who are hired on an intermittent basis by agencies such as the Federal Emergency Management Agency eligible under the Federal Employees Health Benefits Program (Yoder, 11/12).

The Boston Globe: [Cardinal] O'Malley Lauds Defeat Of Doctor-Assisted Suicide Bill
Cardinal Sean P. O'Malley, the Roman Catholic archbishop of Boston, said Monday that the results of the Nov. 6 election do not reflect increased support for abortion rights in the United States, even though some of the candidates most staunchly opposed to abortion lost. ... [O'Malley] said a few prominent abortion opponents may have caused a backlash in their own races by talking about the issue in a way that alienated voters (Wangsness, 11/12).

ABC News: Advocates For Assisted Dying Deflated By Massachusetts Defeat
More than 1.5 million Massachusetts voters said "no" to a ballot measure last week that would have allowed doctor-assisted suicide for the terminally ill, clinching a 51 percent majority. … Assisted dying advocates argue data from Oregon, where the Death With Dignity Act was passed in 1994, refutes concerns about safeguards and plan to push for the ballot measure again in 2014 (Moisse, 11/12).

The Boston Globe: State Names Six Organizations To Oversee Health Care For Neediest Adults
The state has selected six organizations to oversee health care for some of the neediest adults in Massachusetts, as it works to streamline coverage for about 110,000 people who qualify for both Medicare and Medicaid. The program is aimed at saving money and lessening the confusion for doctors and patients caused by the two programs sharing responsibility for bills (Conaboy, 11/12).

The Boston Globe: Doubts Weaken Health Cost Data
Some health policy analysts and provider groups cheered last year when results from a 2010 national survey of employers showed that Massachusetts no longer had the most expensive health insurance coverage in the country. But the latest data show that the family plans offered through Massachusetts employers once again cost more, on average, than in any other state. "I’m not surprised,” said John McDonough, director of the Center for Public Health Leadership at the Harvard School of Public Health" (Conaboy, 11/12).

Kaiser Health News: Doctors' And Nurses' Licenses Snagged By New Immigration Law In Georgia
Hundreds of health care workers in Georgia are losing their licenses to practice because of a problem created by a new immigration law in the state. The law requires everyone -- no matter where they were born -- to prove their citizenship or legal residency as they renew their professional licenses. But with too few staff to process the extra paperwork, licenses for doctors, nurses, pharmacists and other health workers are expiring (Burress, 11/12).

Georgia Health News: Piedmont-WellStar Alliance Shakes Up Marketplace
Two metro Atlanta hospital systems announced Monday that they are forming a partnership, and they predict it will improve medical quality and reduce costs in a health care marketplace remodeled by the Affordable Care Act. Piedmont Healthcare and WellStar Health System will create the Georgia Health Collaborative, combining 2,393 hospital beds, 10 hospitals, seven urgent care centers and more than 700 physicians (Milller, 11/12).

The Associated Press/CBS News: San Francisco Health Care To Cover Sex Reassignment Surgery
A panel has voted to cover the cost and provide sexual reassignment surgery for transgendered people as part of San Francisco's universal health care plan. The city's Health Commission approved on Tuesday the creation a comprehensive program for treating transgender people experiencing mental distress because of the mismatch between their bodies and their gender identities (11/12).

The Baltimore Sun: Paid Sick Leave Urged In Maryland
Forty percent of Maryland's private-sector workers — nearly 820,000 people — have no option to take time off with pay if they're ill, according to estimates from the Institute for Women's Policy Research. Now three Baltimore groups that advocate for workers are launching a campaign to require paid leave in the state, calling it a public-health issue as well as a matter of basic fairness (Hopkins, 11/12).

ABC News: Applebee's N.Y. Franchise Owner Says Obamacare Could Lead To Hiring Freeze
Applebee's is making clear that it is not on a firing rampage because of the Affordable Care Act (ACA) after one franchisee [of 40 restaurants] was quoted saying that Obamacare is leading to a hiring and building freeze. Zane Tankel, chairman and CEO of Apple-Metro, an Applebee franchisee for the New York metropolitan area, told Fox Business last week, "We've calculated it will [cost] some millions of dollars across our system. So what does that say -- that says we won't build more restaurants. We won't hire more people." Apple-Metro did not immediately return requests for comment (Kim, 11/12).

HealthyCal: Children's Health Hangs In Balance
The health of nearly 1 million California children hangs in the balance this month as the state prepares to shift responsibility for their care to the troubled, cash-strapped Medi-Cal program from a popular service that subsidizes private insurance coverage, known as Healthy Families. The administration of Gov. Jerry Brown says the change will save the taxpayers’ money while also improving care for the children. But advocates for kids are not so sure (Weintraub, 11/12).

California Healthline: Rural Health Care At A Crossroads
How to handle and benefit from changes affecting health care will be the central topic of conversation at the annual conference of the California State Rural Health Association, according to Steve Barrow, its executive director. The rural health conference takes place today and tomorrow in Anaheim. Rural communities, with higher percentages of Medi-Cal beneficiaries and seniors, feel the effects of change more than other parts of California -- and those percentages are increasing, according to Barrow (Gorn, 11/13).

California Healthline: Diana Dooley On 2 Years Of Budget Cuts, Controversy And Reform
It's hard to believe Diana Dooley has been on the job only two years, given the number of large and historic health care changes under way in California. Appointed secretary of California's Health and Human Services Agency by Gov. Jerry Brown (D), Dooley has overseen billions of dollars in budget cuts, realignment of county and state responsibilities and the building of a foundation for comprehensive reform that includes creating a statewide insurance exchange and launching multiple conversions from fee-for-service to managed care in Medi-Cal, California's Medicaid program (Gorn, 11/12).

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Editorials and Opinions

Viewpoints: Starting Point For Fiscal Cliff Puts Entitlements At Risk; Cancer Center's Actions Provide Leadership On Reducing Drug Prices

The New York Times: The Cliff Is A Hard Place To Compromise
[T]he closest thing to a framework for a big deficit agreement has more for Republicans to like than for Democrats. Mr. Obama was so eager to reach a deal with Congressional Republicans in 2011 that he agreed to the outline of a plan that made many Democrats cringe. It was well to the political right -- with fewer tax increases, fewer military cuts and more cuts to Medicare and Social Security -- of the bipartisan plan released by the Bowles-Simpson commission in 2010 (David Leonhardt, 11/10).

The New York Times: Budget Showdown Offers An Opportunity For Progress
Republicans in Congress will likely insist that reforms to Medicare, Medicaid and Social Security be part of any budget deal. Democrats should meet them partway. It will be impossible to get our long-run deficit under control without slowing entitlement spending. Rather than fighting all changes to these programs, Democrats should work to preserve their core functions and protect the most vulnerable (Christina D. Romer, 11/10).

The New York Times: The Fiscal Delusion
Now that the election is over, Washington's attention is consumed by the looming combination of automatic spending cuts and tax increases known as "the fiscal cliff." That combination poses risks, including economic contraction and erosion of confidence in government. But it also offers a chance to address our unsustainable and dangerous fiscal trajectory. ... We should let the Bush high-end tax cuts expire, with an achievable, progressive reduction in tax expenditures. And we should have spending cuts, including entitlement reforms, equally matched by revenue increases (Robert E. Rubin, 11/12).

Fox News: Off The Fiscal Cliff And Into The Great Abyss
The federal deficit exceeds $1 trillion dollars -- up from $161 billion in 2007, the last year before the financial collapse. Spending is up some $1 trillion, as outlays for Social Security, Medicare, Medicaid and other entitlements have increased by an amount equal to the entire 2013 defense budget. By the end of the decade, runaway entitlement spending will require shutting down the military or crippling many other domestic spending programs to head off ballooning deficits. With Americans living longer, the only reasonable solution is to raise the Social Security retirement age to 70, and pattern U.S. health care reforms after other national systems that better contain costs (Peter Morici, 11/12).

The New York Times: The Choice Confronting Republican Governors
Republican governors and legislators routinely rail against federal intrusion in activities that they think would be better managed by the states. This week they will have a chance to show they really mean it. ... [P]ragmatic Republican legislators, insurers and advocacy groups for patients and health care providers ought to press their governors to move ahead [with health exchanges] (11/10).

Milwaukee Journal Sentinel: Create Insurance Exchange To Meet Wisconsin's Needs
An unlikely collection of business groups and liberal Democrats is urging [Gov. Scott] Walker to have the state do its own work, and we agree that's probably the best approach. A Wisconsin exchange should acknowledge the state's unique strengths and be tailored as much as possible to the state's health care landscape. The Affordable Care Act requires certain baseline standards, and federal officials will have to sign off on any state-designed exchange. That's why that other option -- the blended approach of close cooperation with federal health care officials -- also might make sense (11/12).

The Baltimore Sun: Maryland's Obamacare Gamble Pays Off
The outcome of last week's presidential election has vindicated the wisdom of Maryland's early decision to begin setting up a state health exchange where consumers can shop for affordable health insurance coverage. President Barack Obama's victory virtually assures that the Patient Protection and Affordable Care Act he signed in 2010 will go into effect as planned in 2014 (11/12).

The New York Times: Incredible Prices For Cancer Drugs
An unusually bold stand by doctors at the Memorial Sloan-Kettering Cancer Center in New York has forced a big drug company to reduce the cost of an overpriced drug for treating colorectal cancer that was no better than a cheaper competitor and did almost nothing to extend a patient's life. It is a heartening sign that alert and aggressive physicians can potentially play a major role in helping to reduce the escalating costs of health care for treatments of marginal value (11/12).

The Wall Street Journal: Not Enough Cancer Drugs, Too Many Price Controls
Cancer patients face daunting challenges, including side effects of treatment, impact on family life and work disruptions. They now face another problem: shortages of vital drugs. Imagine an oncologist talking to his patient: Everything is going well with your treatment, he says, but one of the drugs you've been receiving is unavailable. There's a substitute -- sort of. Your Medicare copayment for the drug we've been using is $9. Now it will cost you $520 each time the substitute is given (Bill Cassidy and Patrick W. Cobb, 11/11).

Los Angeles Times: Patient Trapped In Health Insurance Rate Hike
It's understandable that car insurance rates can change when you move. One neighborhood might have more accidents or burglaries than another. But health insurance? (David Lazarus, 11/13).

Kansas City Star: Condom Requirement For Porn Actors Gets A Bad Wrap
A condom is not a crime against humanity. It's a form of protection. But to hear James Deen, one of the porn industry's biggest stars tell it, a new Los Angles County law requiring adult film actors to wear condoms is no different than laws banning gay marriage. The Safer Sex in the Adult Film Industry Act, known as Measure B, passed Tuesday in Los Angeles County. Proposed by the AIDS Healthcare Foundation, the legislation mandates performers wear condoms and also requires porn producers to apply for a permit from the L.A. County Department of Public Health. The Free Speech Coalition, a trade group representing the adult film industry, is planning to challenge the rule (Jeneé Osterheldt, 11/11).

Richmond Times-Dispatch: Tobacco: Money to Burn
The catechism recited by every advocate for a government program includes a line to the effect that spending money now will save money later. If that were true, then at some point one would expect government spending to shrink. Absent outside forces -- such as a recession -- it never does. But just because the argument is not true in all cases does not make it false in every case. Some spending probably does save money down the line. Spending for smoking-cessation treatments likely falls into that category. Yet as a recent Times-Dispatch news story pointed out, Virginia spends only a small fraction of what it should on smoking prevention and cessation (11/13).

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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.