Daily Health Policy Report

Wednesday, November 14, 2012

Last updated: Wed, Nov 14

KHN Original Reporting & Guest Opinion

Administration News

Health Reform


Capitol Hill Watch

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Avoiding The 'Fiscal Cliff' Likely Means Changes In Medicare

Kaiser Health News staff writer Mary Agnes Carey reports: "Expectations are high. President Barack Obama and House Speaker John Boehner, R-Ohio, say they want to avert the fiscal cliff, that toxic mix of expiring tax breaks and automatic spending reductions set to begin in January.  If Republicans make concessions on taxes, Democrats and the president say, they'll move on entitlements, such as Medicare and Medicaid, as part of a larger deal to reduce the federal deficit" (Carey, 11/13). Read the story.

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Missouri, Kansas Reject State-Run Health Insurance Exchanges

KCUR's Elana Gordon, working in partnership with Kaiser Health News and NPR, reports: "Immediately after the presidential election, and more than a week ahead of the Nov. 16 deadline, Missouri Gov. Jay Nixon, a Democrat, announced he had made up his mind. The state would not be setting up its own health insurance exchange. Next door in Kansas, Gov. Sam Brownback, a Republican, made a similar announcement. These governors' moves open the door for increased federal involvement in health care in both states" (Gordon, 11/13). Read the story.

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Nevada Quietly Moves Ahead On Health Law

Capital Public Radio's Pauline Bartolone, working in partnership with Kaiser Health News and NPR, reports: "Nevada has one of the highest rates of uninsured people in the nation – more than one in five Nevadans lack coverage. The state voted to reelect President Barack Obama by a margin of almost 7 points, but the president’s health law has been as controversial in Nevada as it has been in most states led by a Republican governor. Nevada was one of the 27 states that challenged the constitutionality of the Affordable Care Act in court. But now Gov. Brian Sandoval is moving forward on a key part of the law" (Bartolone, 11/13). Read the story.

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Colorado's New Element In Exchange Plan: Certainty

Colorado Public Radio's Eric Whitney, working in partnership with Kaiser Health News and NPR, reports: "Most states - especially those with Republican governors and legislatures - have opted to have the federal government create and run their exchanges, which are supposed to start enrolling customers in October 2013 for policies that kick in January 2014. Steven Summer, head of the Colorado Hospital Association, is also pleased that the election outcome means Colorado's exchange is green-lighted" (Whitney, 11/14). Read the story

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Capsules: Health Law Was A Wash In The Election, Poll Finds; U.S. Lowering Rate Of Premature Births, But Slowly

Now on Kaiser Health News' blog, Jordan Rau reports on a new poll: "Both President Barack Obama and Republican Mitt Romney ended up getting equal support among voters who said the law was a 'major factor' in their vote for president, according to the poll from the Kaiser Family Foundation conducted shortly after last Tuesday's election. (KHN is an editorially independent program of the foundation.) This shouldn't come as a surprise since the public remained consistently split about the law throughout the election season (Rau, 11/13).

Also on Capsules, Shefali S. Kulkarni reports on new premature birth rate figures from March of Dimes: "The United States is slowly reducing its rate of premature births, bringing the rate to 11.7 percent in 2011, but the figure is still higher than public health advocates believe it should be" (Kulkarni, 11/13). Check out what else is on the blog.

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Political Cartoon: 'The Healthy Wait?'

Kaiser Health News provides a fresh take on health policy developments with "The Healthy Wait?" by Joe Heller.

Meanwhile, here is today's health policy haiku:


Nixon and Brownback
Hickenlooper, Sandoval
Each takes his own path

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

Obama, GOP Leaders Stake Out Positions In 'Fiscal Cliff' Face-Off

President Barack Obama and GOP congressional leaders signal what they're looking for in a budget deal to avert the looming "fiscal cliff," offering their respective takes on tax increases, spending cuts and changes to entitlement programs.

The New York Times: Obama Vows Firm Stance On Deficit-Reduction Plan
President Obama reassured leaders of labor and progressive groups on Tuesday that he will not yield to Congressional Republicans and extend Bush-era tax cuts for the wealthiest Americans as he negotiates for a deficit-reduction plan to avoid looming tax increases and spending cuts. … The $4 trillion, 10-year plan includes the commitment to $1.1 trillion in spending cuts that Mr. Obama and Congress have already agreed to, he added, as well as additional spending cuts that include $340 billion in savings from Medicare and Medicaid. And, Mr. Carney said, Mr. Obama "insists as the essence of balance that revenue be included — $1.6 trillion in revenue" (Calmes and Greenhouse, 11/14).

NPR: Facing Cliff, Obama Tries Again For 'Grand Bargain'
Compromise is suddenly the watchword in Washington, as negotiations over taxes, spending and entitlements begin in advance of another self-imposed deadline, popularly known as the "fiscal cliff." Automatic tax increases and deep spending cuts are slated for the first of the year, unless the president and Congress take action. Leaders on both sides say they are willing to meet in the middle, but that makes their constituents worry about what any compromise will cost them. … Republicans, while offering an olive branch to the president in the form of greater tax revenues, are still adamant that income tax rates should not go up, even on the richest Americans. Liberal groups are just as adamant that no changes be made to Social Security or Medicare — something the president has been open to in the past (Liasson, 11/13).

The Wall Street Journal: Obama Sets Steep Tax Target
President Barack Obama will begin budget negotiations with congressional leaders Friday by calling for $1.6 trillion in additional tax revenue over the next decade, far more than Republicans are likely to accept and double the $800 billion discussed in talks with GOP leaders during the summer of 2011. Mr. Obama, in a meeting Tuesday with union leaders and other liberal activists, also pledged to hang tough in seeking tax increases on wealthy Americans. In one sign of conciliation, he made no specific commitment to leave unscathed domestic programs such as Medicare, leaving the door open to spending cuts many fellow Democrats oppose (Hook and Lee, 11/14).

The Washington Post: Obama To Open Talks With $1.6 Trillion Plan To Raise Taxes On Corporations, Wealthy
President Obama is taking a hard line with congressional Republicans heading into negotiations over the year-end fiscal cliff, making no opening concessions and calling for far more in new taxes than Republicans have so far been willing to consider (Goldfarb and Montgomery, 11/13).

Los Angeles Times: Speaker John Boehner Still Faces A GOP House Divided
In both the House and Senate, key Republicans have shown a willingness to compromise on taxes as part of a broader deal to cut spending on entitlements, such as Medicare — especially after an election when high-profile tea party candidates lost their Senate races. That support could give Boehner a political safety net in negotiations (Mascaro, 11/13).

USA Today: Tea Party Senator Digs In Against Talk Of Compromise
The political action committee founded by Sen. Jim DeMint, a darling of the Tea Party movement, was three-for-nine in picking conservative Senate candidates this year — after spending more than $8.7 million. … Boehner, in post-election remarks on Capitol Hill and in a national television interview, said House Republicans would be open to a deficit-reduction plan that includes new revenue through tax reform. He also said that comprehensive immigration reform was overdue and that the 2010 health care reform law — abhorred by conservatives — is the "law of the land." The Tea Party wing of the Republican Party opposes tax increases and a path to citizenship for illegal immigrants already in the country, and favors repealing of "Obamacare" (Troyan, 11/13).

The Associated Press/Washington Post: Senate GOP Leader: Up To Obama To Present Deficit Plan That's Not A Campaign Slogan
The Kentucky Republican said that like House Speaker John Boehner, he is ready to support new revenue as part of a deal that reins in government benefit programs like Medicare and Medicaid. But like the speaker, McConnell also says it’s a non-starter to talk about raising tax rates as the president has proposed for the wealthiest taxpayers (11/13).

Politico: Boehner And McConnell Play Good Cop, Bad Cop
Here's how different things are for House Speaker John Boehner and Senate Minority Leader Mitch McConnell in the upcoming fiscal cliff negotiations. McConnell warned President Barack Obama on the floor Tuesday against "thumbing his nose" at the GOP and insisting that "if Republicans aren't willing to do things his way, he won’t do anything at all." On the same day, Boehner's chief aide, Mike Sommers, quietly headed down Pennsylvania Avenue to the White House to discuss negotiations with Rob Nabors, Obama's top legislative hand (Sherman and Raju, 11/13).

News outlets also focus on how Medicare and health care spending factor into the 'fiscal cliff' calculus -  

Kaiser Health News: Avoiding The 'Fiscal Cliff' Likely Means Changes In Medicare
Expectations are high.  President Barack Obama and House Speaker John Boehner, R-Ohio, say they want to avert the fiscal cliff, that toxic mix of expiring tax breaks and automatic spending reductions set to begin in January.  If Republicans make concessions on taxes, Democrats and the president say, they'll move on entitlements, such as Medicare and Medicaid, as part of a larger deal to reduce the federal deficit (Carey, 11/13).

The Associated Press/Washington Post: Budget Negotiators Get Options For $385B In Health Care Savings, Mostly From Medicare
Hoping to head off wider health care cuts in upcoming budget talks, a think tank close to the White House is unveiling a plan for how to save $385 billion, mostly from Medicare. Medicaid and the new health care law are largely spared from cuts in the blueprint being released Wednesday by the liberal-leaning Center for American Progress. Instead, it targets Medicare service providers, from the pharmaceutical industry to hospitals and nursing homes. And higher-income Medicare recipients would face increased monthly premiums for outpatient and prescription coverage (11/14).

CQ HealthBeat: Providers Mobilize Amid Fears About Fiscal Cliff, Grand Bargain
Provider groups Tuesday appeared increasingly on edge about possible cutbacks in health care spending as Congress returned to work for a lame-duck session and moved toward negotiations on how to avoid the combination of tax hikes and spending cuts commonly called the fiscal cliff. Automatic spending cuts in the debt ceiling law spare Medicaid from cuts — but the groups made clear Tuesday that they don’t see the program as immune in talks to develop deficit reduction alternatives to avoid such sequestration. Nursing home owners, doctors who treat HIV/AIDS patients and cancer doctors separately warned of the harm that would be done by reductions to Medicaid reimbursements. In letters to Congress and statements, they also urged that Congress avoid cuts in federal spending on health research and the drug review process (Norman, 11/13).

USA Today: The Fiscal Cliff: Will Obama, Congress Cut Budget Deal?
Promise or peril, some Americans are going to feel the pinch. Should Obama get his way, those with annual incomes above $250,000 will face higher tax bills. If Republicans come out on top, tax rates and defense spending will remain the same, but social programs will face budget cuts. A compromise portends discomfort, most likely in the form of reduced paychecks, jobless benefits and business tax breaks. And a stalemate means higher taxes and reduced federal spending across the board, including at the Pentagon (Wolf, Mullaney and Davis, 11/13).

The Wall Street Journal: Companies Warn About Cutbacks
Some big American companies are making plans to slow investments, lay off workers and pay less-generous dividends if Congress and the Obama administration don't find a way to avert the so-called fiscal cliff. A range of businesses, including defense contractors and hospitals, will be directly affected by the $600 billion in cuts to government spending and end of tax breaks if Washington doesn't otherwise lower the deficit. Other employers worry the reduced spending will hurt them indirectly by slowing economic growth (Linebaugh and Hughes, 11/13).

The Wall Street Journal: Business Leaders Spooked By 'Fiscal Cliff'
Democrats and Republicans said they want to enact a package of long-term measures to reduce the federal budget deficit, which has exceeded $1 trillion for four straight years, but they are divided over issues related to taxes and big entitlement programs like Medicare. Mr. Obama and House Speaker John Boehner (R., Ohio) have suggested they are open to compromise and don't want to replay the brinkmanship that occurred last year during a fight over raising the government's borrowing limit. But negotiations are almost certain to spill into mid-December, and perhaps even beyond (Paletta and Reddy, 11/13).

The Wall Street Journal’s Washington Wire: Companies Eye Cliff Layoffs, Aetna Chief Says
Aetna Inc. Chief Executive Mark Bertolini, who is among a dozen chief executives meeting with U.S. President Barack Obama later this week, on Monday warned that companies are preparing backup plans that include layoffs if the White House and congressional leaders are unable to reach a deal to avoid the combination of tax increases and spending cuts known as the "fiscal cliff" (Hughes, 11/13).

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Health Reform

States Wrestle With Health Exchange Decisions

Even as state officials decide whether they will set up online insurance markets or allow the Obama administration to do it for them, some wonder if the federal government is up to the task. Decisions about the health law's Medicaid expansion are also on governors' minds.

The Washington Post: Some Question Administration's Ability To Set Up State Insurance Exchanges
With a growing number of state leaders saying they will leave it to the federal government to handle a crucial element of President Obama's health-care law, even supporters of the statute are wondering if the administration is up to the job (Aizenman and Kliff, 11/13).

Los Angeles Times: California Works To Get Word Out On Health Insurance Exchange
Under the federal law, the state-run exchange aims to fundamentally reshape the health insurance market by negotiating with insurers for the best rates and assisting consumers in choosing a plan. The exchange must also help millions of Californians figure out whether they qualify for an expansion of Medicaid, the government insurance for the poor, or federally subsidized private coverage (Gorman and Terhune, 11/14).

Kaiser Health News: Nevada Quietly Moves Ahead On Health Law
Nevada has one of the highest rates of uninsured people in the nation – more than one in five Nevadans lack coverage. The state voted to reelect President Barack Obama by a margin of almost 7 points, but the president’s health law has been as controversial in Nevada as it has been in most states led by a Republican governor. Nevada was one of the 27 states that challenged the constitutionality of the Affordable Care Act in court. But now Gov. Brian Sandoval is moving forward on a key part of the law (Bartolone, 11/13).

Kaiser Health News: Missouri, Kansas Reject State-Run Health Insurance Exchanges
Immediately after the presidential election, and more than a week ahead of the Nov. 16 deadline, Missouri Gov. Jay Nixon, a Democrat, announced he had made up his mind. The state would not be setting up its own health insurance exchange. Next door in Kansas, Gov. Sam Brownback, a Republican, made a similar announcement. These governors' moves open the door for increased federal involvement in health care in both states (Gordon, 11/13).

Kaiser Health News: Colorado's New Element In Exchange Plan: Certainty
More people with health insurance means fewer unpaid hospital bills, so it’s no surprise hospitals like anything that makes it easier for people to get coverage. But in Colorado, even some Republicans who hate what they call Obamacare, support that the state is setting up its own health insurance exchange (Whitney, 11/14).

The Hill: Rick Scott Opens Door To Working With HHS On Insurance Exchange
Florida Gov. Rick Scott — one of the most ardent Republican critics of President Obama's healthcare law — might be backing down. Scott told the Associated Press on Tuesday that with the election over and the fate of "ObamaCare" secured, he's willing to at least consider taking some role in designing the state's insurance exchange. "The election is over and President Obama won," Scott said. "I'm responsible for the families of Florida ... If I can get to yes, I want to get to yes." That doesn't necessarily mean he'll end up at "yes" — Scott, like other high-profile Republican governors, has been outspoken about what he sees as a law with excessive federal regulations. But even entertaining the idea of a state role in Florida's exchange is a sharp change in tone for the governor whose state led the legal challenge that ended up at the Supreme Court earlier this year (Baker, 11/14).

The Associated Press: Snyder, Lawmakers Discussing Health Care Exchange
Gov. Rick Snyder and legislative leaders are still discussing whether to establish a state market where people without health insurance could shop for private policies, officials said Tuesday. Under President Barack Obama’s health care law, states have the option of running their own programs, letting the federal government do it or creating a partnership (Flesher, 11/13). 

The Associated Press: Choice Looms For Ariz Governor On Health Exchange
Gov. Jan Brewer is being pulled one way by major business groups and another by fellow conservatives as she faces a fast-approaching deadline to decide whether to implement a key part of the federal health care law. The decision, due Friday, will determine if Arizona creates a state-run, online marketplace for consumers to use when choosing health plans, or lets the federal government create and run a so-called "exchange" for the state (Davenport, 11/13).

The Associated Press: Haslam Remains Undecided On Insurance Exchange
Gov. Bill Haslam said Tuesday that part of the delay in deciding whether Tennessee will design its own health insurance exchange required under the new federal health care law is finding out how much flexibility the state would have. 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 (Johnson, 11/13).

The Associated Press: NJ Must Decide Soon On Health Insurance Exchange
The administration of Gov. Chris Christie is refusing to tip its hand on how New Jersey will respond to Friday's deadline to declare whether it will run its own health insurance exchange, let the federal government do it, or work together. The decision is the first major one states must make under the health insurance overhaul adopted in 2010 by Congress and signed by President Barack Obama (Santi, 11/13).

Politico Pro: Alabama: We Won't Build Exchange After All
After more than a year of planning for a state-based health insurance exchange, Alabama won't build its own after all, Gov. Robert Bentley announced Tuesday. Bentley also declared that Alabama won't expand Medicaid "under the current structure that exists because we simply cannot afford it." Though Bentley had put off a formal decision until the Supreme Court ruling and then last week's election, it's a sharp turnaround from June 2011, when he set up an exchange office and appointed an executive director to lead it (Millman, 11/13).

The Hill:  Ala. Governor Rejects State Exchange, Medicaid Expansion
Another Republican governor on Tuesday formally refused to set up an insurance exchange under President Obama's healthcare law. Alabama Gov. Robert Bentley said the state will not establish an exchange and also will not participate in the law's Medicaid expansion. National conservatives are pressuring GOP governors to reject both exchanges and the Medicaid expansion, hoping to cause problems for "ObamaCare" by complicating the implementation process now that repeal is off the table. Bentley joins a handful of other GOP stalwarts who have said they won't proceed with either policy. Their approach comes with risks, though, namely by ensuring a far greater federal role in their states' healthcare systems (Baker, 11/13).

Minnesota Post: Minnesota's Health Exchange Path Gets Easier, But Still Lots To Do In A Little Time
Gov. Mark Dayton, who was using federal money and his executive authority to inch the exchange along — as federal deadlines bear down — now has friendly partners in the state to complete the exchange planning process. ... Exchange supporters say the service will affect about 1 million Minnesotans and will provide a competitive marketplace for individuals and small businesses to purchase insurance with a setup similar to travel websites like Travelocity. But much beyond the basics of what the exchange will look like and how it will function remain unknown. The federal government announced last week that it would extend a key Friday deadline to mid-December for states to submit blueprint proposals. By all indications, Minnesota will still signal to the feds this week that it intends to move forward with a state-based exchange and instead of a federally produced model. But the questions remain: Will Minnesota meet the ambitious deadlines outlined in the Affordable Care Act, and if it doesn't, how will the federal government react (Nord, 11/13)?

Milwaukee Journal Sentinel: 9 Lawmakers Want To Charge U.S. Officials Who Implement Obamacare
As Gov. Scott Walker contemplates whether to create a state health care exchange under Obamacare, he will have to contend in the coming legislative session with nine lawmakers who have said they back a bill to arrest any federal officials who try to implement the health care law. Rep. Chris Kapenga (R-Delafield) is one of the nine from Wisconsin who told the Campaign for Liberty he would back legislation to declare Obamacare illegal and allow police to arrest federal officials who take steps to implement it in Wisconsin. He said he believes the health care law is unconstitutional, despite the U.S. Supreme Court's ruling that it passes constitutional muster (Marley, 11/13).

Politico: Medicaid Expansion Decision Looms For Many States
Clues about governors' intentions for Medicaid expansion are beginning to seep out of tight-lipped state capitals, and it may be the start of a deluge. Most have kept silent until now, waiting for the presidential election to determine whether the Affordable Care Act — and its optional Medicaid expansion — would survive. But President Barack Obama's reelection, combined with looming budget deadlines in all of the indecisive states, could force their hands (Cheney and Smith, 11/14).

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U.S. Bishops Promise To Continue Fight Against Birth Control Mandate

Cardinal Dolan, the nation's top bishop, made clear that the Roman Catholic church will not comply with the Obama administration requirement regarding contraception coverage and will continue to fight it.  

The Associated Press/ABC News: Top Bishop: We Won't Give In On Birth Control Rule 
New York Cardinal Timothy Dolan, president of the U.S. Conference of Catholic Bishops, said church leaders are open to working toward a resolution with federal officials, but will meanwhile press ahead with challenges to the mandate in legislatures and in court. ... The bishops have made the issue the centerpiece of a national campaign on preserving religious freedom, which they consider under assault on several fronts from an increasingly secular broader culture. The Department of Health and Human Services adopted the rule as a preventive service meant to protect women’s health by allowing them to space their pregnancies (Zoll, 11/13).

The Hill: Catholic Bishop Vows To Keep Fighting Birth-Control Mandate
Churches and houses of worship are exempt from the administration's policy requiring employers to include contraception in their employees' healthcare plans. The White House has also made a more nuanced "accommodation" for religious-affiliated employers, such as Catholic hospitals and universities. In a series of lawsuits challenging the contraception policy, critics argue that any employer should be able to opt out of the mandate based on their religious beliefs, even if their business isn't at all connected to a religious organization (Baker, 11/13).

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Poll: Health Care Not Main Motivation For Voters Choosing President

Voters cited the health law as the third most important topic they considered last week -- behind the economy and the candidates' personal characteristics -- according to a new poll.

Kaiser Health News: Capsules blog: Health Law Was A Wash In The Election, Poll Finds
President Barack Obama and Republican Mitt Romney ended up getting equal support among voters who said the law was a 'major factor' in their vote for president, according to the poll from the Kaiser Family Foundation conducted shortly after last Tuesday's election. (KHN is an editorially independent program of the foundation.) This shouldn't come as a surprise since the public remained consistently split about the law throughout the election season (Rau, 11/13).

Modern Healthcare: Health Care Ranked Third As Top Ballot Issue
Conducted from Nov. 7-10, the survey of 1,223 respondents asked voters to identify the top two factors in their decision, without providing choices. The results showed that 55 percent of those who voted to re-elect President Barack Obama and 48 percent of those who voted for former Massachusetts Gov. Mitt Romney cited candidate characteristics and candidate record as the top factor. ... The survey results also showed that voters considered more than the 2010 Patient Protection and Affordable Care Act when asked about healthcare (Zigmond, 11/13).

CQ HealthBeat: Kaiser: Health Care Didn't Motivate Voters, Repeal Fervor Fades
Lawmakers debating health policy in the lame duck and next year in the new session of Congress will do so knowing that the issue didn’t carry as much weight with voters as it might have appeared during the election campaign, a new survey released Tuesday suggests. The Kaiser Family Foundation poll also found, though, that the share of those surveyed who want to see the health care law repealed dropped to a new low of 33 percent (Norman, 11/13).

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As Health Law's Fate Becomes More Clear, Insurers, Medical Device Makers Try To Stem New Taxes

Insurers and medical device makers are planning ad campaigns and intense lobbying to try to stop taxes in the health law from cutting at their bottom lines.

Bloomberg: Humana Says Trade Groups Plan Ad Campaign Against Insurer Tax
Humana Inc. (HUM), the second-biggest provider of Medicare health plans, said business groups plan an advertising campaign to get lawmakers to ease new taxes in President Barack Obama's health-care overhaul. Stop the HIT, a Washington-based coalition of trade groups, will start the effort during the lame-duck congressional session this year, Heidi Margulis, Humana's senior vice president for public affairs, told analysts during an investor conference today. Changes to the taxes will be "on the table" as part of talks to cut the U.S. budget deficit, she said (Nussbaum, 11/13).

CQ HealthBeat: Medical Device Manufacturers Lobby To Repeal Tax
The medical device industry is organizing a lobbying fly-in Thursday to urge lawmakers to repeal the medical device tax that is set to take effect in January. Dozens of CEOs and other executives plan to urge Congress to repeal the 2.3 percent tax. The effort is part of a broad campaign to kill the tax. The Advanced Medical Technology Association (AdvaMed) also plans to release a paper Wednesday that will show how much the new tax will add to the tax burden on manufacturers (Adams, 11/13).

Politico Pro: Medical Device-Makers Push Back Against Tax
Executives from medical device firms are planning to blitz the Hill on Thursday to urge Congress to stave off a 2.3 percent medical device tax set to take effect at the beginning of next year. AdvaMed's top lobbyist, JC Scott, told Politico Influence that a group of more than 50 executives had scheduled about 60 meetings with congressional offices and will meet directly with Sen. Amy Klobuchar (D-Minn.). The medical device tax, intended as that sector’s contribution under the health law for the extra business it will gain through expanded insurance, is among the top targets of ongoing anti-Obamacare efforts (Norman, 11/13).

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Alliance Of Medicare Providers Urge Link Between Payment Changes, Quality

The Premier healthcare alliance is urging that, if scheduled 2 percent cuts take effect, they not apply to hospitals that have already reduced costs.

Modern Healthcare: Providers Want Medicare Payment Changes Tied To Quality
Health Care providers are pushing for Medicare payment changes based on quality during the recently started post-election lame duck session of Congress. Premier healthcare alliance is urging Congress to ensure that if a scheduled 2 percent cut to Medicare providers does go into effect next year, it will not apply to hospitals that have enacted demonstrable cost reductions. Blair Childs, Premier's senior vice president for government affairs, said in an interview that the alliance of more than 2,700 hospitals is urging a requirement that the CMS calculate the extent to which hospitals have reduced their Medicare costs recently when applying the deficit-related across-the-board cut (Daly, 11/13).

Meanwhile, coverage continues regarding improper therapy claims submitted by skilled nursing facilities --

Los Angeles Times: Medicare Paid $1.5 Billion In Improper Therapy Claims In 2009
Medicare paid $1.5 billion in improper claims for skilled nursing care in 2009, federal investigators found. The inspector general of the Department of Health and Human Services said Tuesday that 25 percent of all Medicare claims submitted by skilled nursing facilities had errors and the majority of those bills were "upcoded" for ultra-high therapy that wasn't necessary (Terhune, 11/13).

In other news related to health care billing and payment --

Modern Healthcare: AMA Continues Fight Against ICD-10 Mandate
The American Medical Association reaffirmed its commitment "to vigorously work" against the nationwide adoption of ICD-10 diagnostic and procedural codes while evaluating the feasibility of skipping directly to ICD-11 codes, which are expected to be introduced in 2015. The AMA House of Delegates adopted a resolution at its annual meeting in Chicago this summer to weigh skipping ICD-10 and debated the issue again Monday during its interim meeting in Honolulu after two related resolutions were put on the meeting's agenda. A resolution introduced by the Florida delegation cited an $80,000-per-physician implementation cost for ICD-10 and noted that -- for all its complexity -- ICD-10 does not include codes for genomic information (Robeznieks, 11/13).

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ACO Tally Could Double By January, Says CMS Official

CQ HealthBeat: CMS Official: Number Of Medicare ACOs Could Reach 300 In January
The total number of accountable care organizations contracting with Medicare might double in January, the head of the federal Center for Medicare and Medicaid Innovation predicted Tuesday. Currently, 153 ACOs contract with Medicare to provide team-based care that meets certain savings and quality requirements under a so-called shared-savings model. When a third round of such contracts is announced in January, as many as 300 ACOs will have inked agreements, said the Centers for Medicare and Medicaid Services official, Richard Gilfillan (Adams, 11/13).

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Capitol Hill Watch

Subcommittee Chair Presses For Answers About Health IT-Related Injury

Rep. Renee Ellmers, R-N.C., says she has been waiting for the Department of Health and Human Services to respond to her questions for five months.

CQ HealthBeat: After Five Months And No Reply From Sebelius On IT-Related Injury, Small Business Panel Complains
The head of the House Small Business Subcommittee on Technology says it's been five months since she asked HHS Secretary Kathleen Sebelius about federal efforts to protect against injuries from faulty health information technology, and she still has not received a response. In a letter to Sebelius obtained by CQ HealthBeat, the chairwoman, North Carolina Republican Renee Ellmers, complained about the lack of a reply to her June 12, 2012, letter to Sebelius. That letter asked, among other things, what the department is doing to minimize patient safety risks associated with health IT, following an Institute of Medicine report issued a year ago calling for greater public and private oversight of technology. An HHS official forwarded a copy of the letter but had no immediate comment (Reichard, 11/13).

The Hill: Rep. Ellmers Pushes HHS On Safety Of Health Technology
Rep. Renee Ellmers (R-N.C.) is still looking for answers from the Health and Human Services Department about the safety risks associated with electronic health records. … Ellmers is interested in an Institute of Medicine (IOM) report that said health IT could pose safety risks and called for greater federal oversight. "Almost five months ago … I wrote to you to request a copy of your plan to minimize health IT patient safety risks and a number of related documents, or the status of those documents if not yet complete, with the documents to follow," Ellmers wrote Wednesday. "Now, just five weeks before the one year anniversary of IOM's report, we have heard nothing from the Department about the status of any of my requests" (Baker, 11/14).

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Public Health & Education

Pharmaceutical Compounding Problems Spread Under Lax Regulation

News outlets report that congressional oversight was lacking and the Boston Globe uncovers documents about the company that started the meningitis outbreak.

The New York Times: Friends In Congress Have Helped Drug Compounders Avoid Tighter Rules
[B]y positioning itself as a more affordable, community-based alternative to huge drug manufacturers, compounders have attracted broad support from politicians. They have become popular among proponents of hormone therapy to slow aging and advocates for the autistic, who often distrust the traditional pharmaceutical industry, and rely on compounders’ tailor-made blends (Lichtblau and Tavernise, 11/13).

The Boston Globe: State Was Lax On Framingham Drug Maker
State pharmacy regulators on at least two occasions in the past decade displayed indifference in their oversight of a troubled Framingham specialty pharmacy that has now been blamed for a national fungal meningitis outbreak, ­according to documents ­obtained by the Globe Tuesday. At the same time state and federal regulators were investigating New England Compounding Center for problems with sterile drug preparation, the company’s lead pharmacist, Barry Cadden, was chosen to serve on a state pharmacy board task force to write new rules for compounding pharmacies (Lazar and Kowalczyk, 11/14).

USA Today: FDA Finds Contamination Issues At Ameridose
Federal drug inspectors found a range of problems, including ineffective drugs given to children and pregnant women, leaky ceilings, insects, non-sterile conditions and at least one bird flying around, at a sister company to the Massachusetts compounding pharmacy linked to a national outbreak of fungal meningitis (Weise, 11/13).

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Despite Modest Improvement, Premature Birth Rates Cause Concern

A new report from the March of Dimes gives the U.S. a 'C' in preterm birth rate reductions.

Kaiser Health News Capsules blog: U.S. Lowering Rate Of Premature Births, But Slowly
The United States is slowly reducing its rate of premature births, bringing the rate to 11.7 percent in 2011, but the figure is still higher than public health advocates believe it should be. The updated figures come from The March of Dimes, ...  It gives the U.S. a ‘C’ in overall preterm birth rate reductions. ... In a report released earlier this year, the March of Dimes noted that the U.S. ranks 131 out of 184 countries — putting it close to countries such as Somalia, Thailand and Turkey (Kulkarni, 11/13).

Georgia Health News: Ga. Improved On Preterm Births, Still Gets Low Grade
Georgia lowered its preterm birth rate last year, but the state still received a "D"’ grade on the annual preterm birth report card released Tuesday by the March of Dimes. The reduction of Georgia's preterm birth rate – from 13.8 percent to 13.2 percent – is part of a national trend. Forty states saw improvement in their rates between 2010 and 2011 (Miller, 11/13).

MPR: Minn. Launches Effort To Prevent Early Birth
A new Minnesota birth campaign seeks to dispel the notion that it's safe to schedule an elective delivery before 39 weeks of pregnancy. Approximately one in 10 babies born in Minnesota is premature. Some of those preterm births are unavoidable, but health officials believe many mothers are giving birth through Caesarean sections or induced labor earlier than they should, causing unnecessary health problems for some newborns (Benson, 11/13).

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Hospitals Directed To Step Up Protections For Kidney Donors

The New York Times: Hospitals Ordered To Do More To Protect Kidney Donors
Addressing long-held concerns about whether organ donors have adequate protections, the country's transplant regulators acted late Monday to require that hospitals thoroughly inform living kidney donors of the risks they face, fully evaluate their medical and psychological suitability, and then track their health for two years after donation (Sack, 11/13).

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State Watch

State Roundup: Disparity In States' Fiscal Health; Ark. Medicaid Shortfall Threatens Care

A selection of health policy news from Michigan, Arkansas, Massachusetts, Oklahoma, Oregon, Kansas and California.

The Wall Street Journal: Fiscal Health Of States Shows Growing Divergence
Factors such as growing unfunded pension liabilities and burgeoning fixed costs related to programs like Medicaid are weighing down weaker states, while stronger states are benefiting from improved business conditions and strong employment growth, he said. A closer look at some specific metrics shows this fiscal disparity (Nolan, 11/13).

The Associated Press/The Atlanta Journal-Constitution: Blue Cross Official Stresses Urgency Of Overhaul
Blue Cross Blue Shield of Michigan officials argued Tuesday that they will face "serious challenges" selling health insurance next year if state lawmakers don't quickly approve legislation that would transform the organization from a charitable trust to a customer-owned nonprofit. Meanwhile, critics of overhauling the state's largest insurer countered that the urgency is overblown and that moving too rapidly might be more harmful to Blue Cross' 4.4 million customers. Mark Cook, Blue Cross' vice president of governmental operations, told the House Insurance Committee that changes being ushered in by the federal Affordable Care Act make it necessary to level the playing field for the insurer and its rivals (Karoub, 11/13).

The Associated Press: Ark. Medicaid Faces Significant Cuts In Services
Arkansas would stop paying for thousands of seniors in nursing homes, eliminate an insurance program for low-income workers and cut rates for providers to fill a $138 million shortfall in the state's Medicaid program, even if lawmakers support a proposal to boost funding, an official said Tuesday. Department of Human Services Director John Selig told members of the Joint Budget Committee that the cuts are needed to make up for a deficit in the state share of its Medicaid program, which serves nearly 800,000 Arkansans (DeMillo, 11/13).

The Associated Press: Health Report: Mass. Struggling With Illicit Drugs
Massachusetts continues to struggle with the use of illegal drugs including heroin, while tobacco remains the leading cause of preventable death and disease in the commonwealth, according to a new report by the nonprofit Massachusetts Health Council. Eastern Massachusetts appears to have been particularly hard hit by the use of illicit drugs, according to the report released Wednesday, which brings together findings from recent studies by state and federal agencies (LeBlanc, 11/13).

Reuters: Planned Parenthood Seeks Injunction Over Oklahoma Health Program
Planned Parenthood asked a federal judge on Tuesday to stop Oklahoma from blocking it from participating in a federally funded nutrition program that helps poor women and children at three clinics in the Tulsa area. The request, filed in federal court in Oklahoma City, appeared aimed at combating a move similar to those taken by conservative Republicans in more than a dozen states over the past two years to eliminate funding for health services provided by Planned Parenthood (Olafson, 11/13).

The Lund Report: Kaiser Becomes First Health Insurer To Cover Autism Treatment
Advocates scored a major victory when Kaiser Permanente announced it would provide coverage of Applied Behavioral Analysis (ABA) therapy for autism and neurodevelopmental disorders. … Kaiser intends to work with its medical and clinical staff to provide ABA services for members who have such a medical need, said David Northfield, spokesman. "This behavioral health treatment will complement the existing health care services we already provide to children with autism spectrum disorders, such as speech, occupational and physical therapy," he told The Lund Report. Kaiser is the first health insurer in Oregon to voluntarily cover autism but Terdal isn’t giving up the fight. He’s drafting legislation for the 2013 session that would mandate coverage of ABA therapy, and provide a licensing and credentialing process for such providers (Jorgensen, 11/13).

Kansas Health Institute News: VA Poised To Expand Telemedicine For Kansas Vets
After a successful, two-year pilot project, Veterans Administration officials today said their telemedicine partnership with the University of Kansas Medical Center is poised to expand across the state with the goal of putting mental health services within easier reach of Kansas veterans. They also said the program -- the first of its kind -- could serve as a national model, if all goes as expected. "This is the initial one. This is the trailblazer," said Dr. William Patterson, director of the VA Heartland Network, which is in Kansas and Missouri (Shields, 11/13).

California Healthline: Health Task Force Releases Draft Report
The first task has been checked off the list. Yesterday the Let's Get Healthy California task force met to go over the release of its draft report, the culmination of six months' work. The final report is slated for completion by Dec. 19. "When you look at where we are today in California, there are so many challenges we're facing [in health care]," said Pat Powers, director of the task force. "The population is aging, there are unprecedented levels of chronic disease across the state, and alarming high rates of obesity and diabetes. For the first time in a long time, the children born in this generation may not live as long as their parents." That creates a moral imperative to do something to meet all of those needs, Powers said. At the same time, the task force hopes to propose changes that not only improve care but save the state money, as well, she said (Gorn, 11/14).

The Oregonian: Oregon Health Plan Dental Clash Will Get Hearing Wednesday
A political tug of war could affect dental care for more than 600,000 members of the Oregon Health Plan, as well as about 200,000 people who could soon be joining it. Legislators adopted health reform earlier this year intended to save money by making physical, mental and dental care providers work together in networks for the health plan's low-income members. Now, however, the new coordinated care organizations are clashing with the dental plans already providing dental care to OHP members. Both sides say the good of patients and their teeth is at stake. So is a lot of money. Much like the recent flap over naturopathic doctors who felt excluded from the reforms, the dental clash points to the inherent tension in reforming how the Oregon Health Plan spends more than $3 billion a year. Of that figure, more than $100 million goes to dental care (Budnick, 11/13).

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Editorials and Opinions

Viewpoints: Voters Want Medicare Protected In 'Grand Bargain;' Increases In Taxes Can't Cover The 'Fiscal Cliff'; Kids' Health Needs More Attention

Roll Call: Clay: Adult Moment Needed On Fiscal Cliff 
As the ranking member on the House Financial Services Subcommittee on Domestic Monetary Policy and Technology, let me simply state the hard truth. To avoid the fiscal cliff and to get our budget deficit and the national debt under control, we need to do three things simultaneously: cut spending, increase revenue and have the courage to put everything on the table in a responsible, bipartisan manner. ... The Simpson-Bowles commission laid out a road map containing some common-sense parameters to guide us toward a realistic compromise that can actually become law (Rep. William Lacy Clay, 11/13).

The Wall Street Journal: Obama's Left Flank
This week's pressing question is which Barack Obama will show up for his Friday fiscal-cliff talks with Congressional leaders. The president who has hinted he's open to a bipartisan deal? Or the President who on Tuesday threw open the White House to his no-compromise-ever brigades? ... The deficit last fiscal year was $1.1 trillion, and that's before ObamaCare kicks in and the baby boom cohort keeps retiring. Everyone talks about Republicans and taxes as an obstacle to bipartisanship, but the liberal delusion that entitlements can be financed by taxes alone is something Mr. Obama needs to address (11/13).

The Washington Post: Grand Bargain Is The Wrong Solution
In the election eve poll done by the Democracy Corps for the Campaign for America's Future (disclosure: I serve on the board of the Campaign's sister institution, the Institute for America's Future), voters were asked what would be unacceptable in a large deal to reduce deficits. Seventy-nine percent found cuts to Medicare benefits unacceptable;  ... Republicans are arguing yet again for cutting Social Security and Medicare in exchange for lowering tax rates on the wealthy ... Voters just rejected Mitt Romney when he tried to peddle a version of this junk arithmetic (Katrina vanden Heuvel, 11/13).

The New York Post: Beware: ObamaCare's Now Reality
President Obama's re-election and Democratic gains in the US Senate end any possibility of repealing the Obama health law. It will roll out as written, imposing major changes soon on you and your family. If you are uninsured because you can't afford it, help may be on the way. But if you are one of the 250 million Americans with coverage, there are big problems ahead (Betsy McCaughey, 11/12).

The Philadelphia Inquirer: Election 2012 And Women's Health 
[E]ven as they celebrate their victories, Democratic Party stalwarts and lovers of the 21st century everywhere can agree that one of the biggest winners in this year's election was public health. From Obama's victory ensuring the life of the Affordable Care Act to the rejection of candidates around the country who attacked women’s health, public health was front and center (Michael Yudell, 11/13).

The New York Times: Women Make History, For Now
On Election Day, American women really did make their mark. Their ascendance can be laid at least in part at the door of right-wing Republicans who mounted what feminists — but not just them — saw as a "war on women," with their opposition to unfettered abortion rights, required insurance coverage for contraceptives and aid to women's health organizations like Planned Parenthood (Luisita Lopez Torregrosa, 11/13). 

Los Angeles Times: Democratic Party's 'New Majority' Far From A Sure Thing
But the most perceptive of these commentators realize that the demographic changes that helped Obama to victory are not cemented in favor of any one party. ... [Alan Draper, a professor of government at St. Lawrence University] believes Democrats need to lock in their electoral majority by delivering on a few key promises: implementing Obamacare, thus bringing health insurance to millions and the promise of their future votes (James Rainey, 11/13).

The Wall Street Journal: A Compounding Fracture At The FDA
The recent deadly outbreak of meningitis caused by spinal injections of a contaminated steroid has cast a spotlight on the practice of pharmacy compounding—when pharmacists mix or adapt medicines to make a specific prescribed treatment. The House and Senate are holding oversight hearings this week on the tragedy that has sickened at least 438 people and is believed to have killed more than 30. ... The FDA will likely say that it doesn't have enough authority to regulate the pharmacies that compound drugs. But the FDA does have enough authority (Scott Gottlieb and Sheldon Bradshaw, 11/13).

San Jose Mercury News: Invest In Kids Like We Do In Seniors And The Military
Budgets reflect choices. ... We talk a good game, but at the federal and state level, we have systematically chosen to invest in support for seniors, the military, "too big to fail" institutions, prisons -- but we have consistently chosen not to protect and support children. … Our level of chronic health problems, such as obesity or asthma, has doubled since 1991, with more than a quarter of our kids now facing these health challenges. That means increased health care costs and lower productivity later in life. In a nutshell, our next generation is sicker, out of shape, in debt, lacking proper education and less socially mobile than those in the recent past (Tom Steyer and Jim Steyer, 11/14).

Houston Chronicle: Uninsured Kids Aren't Only An Urban Problem
Children's Medical Center released a report Monday showing that five booming counties in North Texas are home to twice the national average for children without health insurance. ... We say shocking because some of those counties, such as Collin and Denton, are associated with prosperity and stability. But, as the accompanying chart shows, 16 percent or more of their kids lacked health insurance in 2010. ... Private-sector responses ... will spread health care to more suburban children. But they alone won’t answer the problem. Legislators also should revisit the rates the state pays doctors for treating Medicaid and CHIP patients (11/13).

Houston Chronicle: It's Not Too Late To Avoid America's Looming Diabetes Crisis
Simply put, America's diabetes epidemic is a community problem that demands a community-based solution. It's not too late to stop the crisis and improve the quality of life for millions of Americans. Expanding proven diabetes prevention programs in our communities will promote prevention, provide access to quality care and services, control costs, encourage healthier lifestyles choices and loosen the grip that diabetes has on our citizens, our health care system and our future (Dr. Deneen Vojta, 11/13). 

The New York Times: Saving A Program That Saves Lives 
[In 2010] the Global Fund to Fight AIDS, Tuberculosis and Malaria began a pilot program in which it provided a “co-payment” to the manufacturers of A.C.T.’s, thereby allowing commercial wholesalers and private or government health services to purchase the drugs at a fraction of the already low negotiated price. ... Strikingly, it has worked. ... Still, it may not end well ... The Global Fund is to meet on Wednesday, with American representatives in attendance, to consider what comes next. The recommendations on the table are to cut back, not expand, the subsidy program (Kenneth J. Arrow, 11/13).

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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.