Daily Health Policy Report

Friday, November 16, 2012

Last updated: Fri, Nov 16

KHN Original Reporting & Guest Opinion

Fiscal Cliff

Health Reform

Capitol Hill Watch

Health Information Technology

Health Care Marketplace

Public Health & Education

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Administration Expected to Release Many New Rules For Health Law Shortly

Kaiser Health News staff writer Jordan Rau reports: "With the national health law's political future now entrenched, a deluge of new rules is expected in the coming days and weeks as the Obama administration fleshes out the law's complex components" (Rau, 11/15). Read the story.

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Obama Administration Extends Deadline For State Exchanges – Again

Kaiser Health News staff writer Phil Galewitz reports: "Bowing to a request from Republican governors, the Obama administration announced late Thursday that it would give states more time to decide whether to build online health insurance markets that will help millions of people buy coverage starting next fall. Health and Human Services Secretary Kathleen Sebelius pushed back the deadline until Dec. 14 for states to submit letters of intent to build the state-based markets, called exchanges. The original deadline had been Friday, Nov. 16" (Galewitz, 11/15). Read the story.

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Fiscal Cliff: What Is At Stake For Medicare And Medicaid? (Health On The Hill Video)

In this Kaiser Health News video, Jackie Judd talks to KHN's Mary Agnes Carey about the budget negotiation scenarios for Medicare, where the "doc fix" fits into the budget picture, and whether Medicaid cuts are possible (11/15). Watch the video or read the transcript.

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Feds Say Nursing Home Overbilled Medicare By $1.5 Billion

Reporting for Kaiser Health News, Jenni Bergal writes: "At a time when the nursing home industry is lobbying Congress to avoid cuts in Medicare payments, a federal watchdog agency is reporting that taxpayers overpaid nursing homes $1.5 billion. The study released this week by the inspector general's office of the Department of Health and Human Services concluded that nursing homes billed about a quarter of claims incorrectly in 2009 – the year it studied. Most of those claims were 'upcoded,' which means Medicare was billed for services that were more extensive than what was provided or needed. Many of the claims were for intensive physical, speech or occupational therapy" (Bergal, 11/15). Read the story.

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Capsules: Survey: Most U.S. Primary Care Docs Using EMRs; Miss. Builds Exchange Despite Objections Of Gov, Tea Party; Divorce Often Means Women Lose Health Coverage

Now on Kaiser Health News' blog, Ankita Rao reports on primary care physicians and electronic medical records: "U.S. doctors are no longer the laggards when it comes to using health information technology in their practices. But they are still more weighed down by paperwork and health care costs than many of their Western counterparts" (Rao, 11/15).

In addition, Mississippi Public Radio's Jeffrey Hess, working in collaboration with Kaiser Health News and NPR, reports on Mississippi's exchange: "The Mississippi Insurance Department officially told the federal government that it will run its own health insurance exchange and plans to file the exchange blueprint Friday. If the state had not set up an insurance exchange, which is an online marketplace for comparison shopping for health insurance called for by the health overhaul law, the federal government would have set one up in Mississippi instead" (Hess, 11/16).

Also on Capsules, Shefali S. Kulkarni writes about the link for women between divorce and losing health insurance: "A study released this week from the University of Michigan reveals that roughly 115,000 American women lose their private health insurance annually after a divorce and about half of them do not get replacement coverage" (Kulkarni, 11/15). Check out what else is on the blog.

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Political Cartoon: 'Walking Wounded?' By Jimmy Margulies

Kaiser Health News provides a fresh take on health policy developments with "Walking Wounded?" by Jimmy Margulies.

Meanwhile, here is today's health policy haiku:

HEALTH EXCHANGE DECISION - NOW DEC. 14

Kick that can farther...
States sought more decision time.
HHS complied.
-Anonymous

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Fiscal Cliff

White House Meeting Kicks Off 'Fiscal Cliff' Negotiations

News outlets set the scene for President Barack Obama's meeting today with lawmakers. Both sides say they want a deal, but privately, some Democrats acknowledge they would rather go over the cliff than accept a deal that raised too few taxes while cutting Medicare and Medicaid. Some Republicans feel that way about tax increases.

Politico: Opening Gambit On Fiscal Cliff Negotiations
After months of talking about the fiscal cliff publicly, President Barack Obama and congressional Republicans finally expect to get down to business privately on Friday. Sort of (Budoff Brown and Sherman, 11/15).

The Associated Press/Washington Post: Analysis: Both Sides Talk Compromise On Fiscal Cliff, Without Significant New Concessions Yet
When President Barack Obama greets congressional leaders at the White House on Friday, an elaborate set of postelection rituals will be complete. Yet divided government's ability to attack the nation's economic woes is no clearer now than it has been for months. In talks that came close to a deal in 2011, Obama said he was willing to make significant cuts in the growth of benefit programs like Medicare and Medicaid, infuriating liberals. Boehner spoke of as much as $800 billion in new revenue, angering conservatives. The talks eventually collapsed (11/15).

The Associated Press/Washington Post: Obama On Tricky Path In Fiscal Cliff Negotiations With Congressional Leaders
President Barack Obama is kicking off budget dealings with congressional leaders with new leverage from last week's big win, but he confronts a decidedly tricky path to avoiding a market-rattling "fiscal cliff" that could imperil a still-fragile economy. Obama's GOP rivals promise greater flexibility on new tax revenues, but Democrats face pressure from liberal interest groups urging the president to take a hard line and avoid cutting big benefit programs like Medicare and food stamps. It's up to Obama to navigate the course toward an agreement (11/16).

The New York Times: Demystifying The Fiscal Impasse That Is Vexing Washington
Well, it's complicated — the so-called cliff, that is. And most solutions are politically painful. … Q. What spending would be cut? A. An emergency unemployment-compensation program is expiring, which would save $26 billion but end payments to millions of Americans who remain jobless and have exhausted state benefits. Medicare payments to doctors would be reduced 27 percent, or $11 billion, because this year Congress has not passed the usual so-called "doc fix" to block the cuts, which otherwise are required by a 1990s cost-control law (Calmes, 11/15).

The New York Times: Senate 'Gang Of 8' Says This Isn't Its Moment In Deficit Talks
After years of wrangling, members of the bipartisan group of senators known as the Gang of Eight are ratcheting back expectations for a deficit reduction breakthrough and now say the best they can probably do is offer ideas for the one fiscal negotiation that will truly matter: talks between President Obama and Speaker John A. Boehner that begin in earnest on Friday. … Both sides insist they want a deal before January, but a rising chorus of voices, especially Democrats, say they would rather go over the cliff than accept a deal that raised too few taxes while extracting too many cuts, especially to Medicare and Medicaid. The search for a deal before January is off to a slow start. Rob Nabors, the president's chief liaison to Congress, came to the Capitol early this week to meet with Mr. Boehner's chief of staff, Mike Sommers. But little groundwork was done ahead of Friday's meeting (Weisman, 11/15).

A California poll offers a snapshot of public opinion related to the deficit negotiations -

Los Angeles Times: California Backs A 'Fiscal Cliff' Compromise – Sort Of, Poll Says
But things foundered on the details. When Democrats were asked whether cuts in Medicare and Social Security benefits should be offered to get Republican agreement on some tax hikes, or whether all reductions were off the table, they strongly opposed any benefit cuts. When Republicans were asked whether some revenue hikes should be accepted to get Democrats to agree to benefit cuts, they just as firmly opposed any tax increases (Decker, 11/15).

California Healthline: Fiscal Cliff, Deals To Avoid It Worry Health Advocates
While they're concerned about what might happen if the country goes off a fiscal cliff, some California health care advocates worry more about bargains that might be struck to prevent the plunge. … The potential effects of sequestration on California's health care system are hard to measure as a whole, but according to a few predictions about specific parts, the effects could be significant. According to an analysis from the American Hospital Association, 500,000 health care jobs would be eliminated nationwide within a year and another 266,000 would be gone by 2021 if sequestration takes effect. Job losses would hit hardest in California, Florida and Texas, according to AHA. Most of the jobs would disappear from hospitals, followed by nursing facilities, physician offices and medical laboratories. According to a study from George Mason University, California will lose more than 225,000 jobs in the first year -- about 135,000 of them related to the defense industry and about 90,000 unrelated to defense, including health care (Lauer, 11/15).

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Approaching The Cliff: What's At Stake For Medicare And Medicaid?

Medicare and other entitlement programs are in the mix as deficit deal-making takes center stage. If no deal is reached and automatic spending cuts take effect, Medicare providers will face a 2 percent across-the-board cut in January 2013.

The Medicare NewsGroup: Fiscal Cliff Discussions, Looming Cuts Have Medicare Providers Facing Double Whammy
Doctors, hospitals, other clinical care providers and insurance companies all face looming pay cuts. President Obama and Congress are in negotiations starting this week to avert the fiscal cliff. Medicare and other entitlement programs are on the table as lawmakers seek to bring down the deficit. If a deal is not struck, Medicare providers will be hit with a 2 percent across-the-board cut in January 2013 as part of sequestration. The sequestration cuts, scheduled to hit clinical care providers and insurers that operate Medicare Advantage Plans (Part C) and Medicare Prescription Drug Plans (Part D), resulted from Congress’ failure to reach a deficit agreement in 2011. The cuts total nearly $10.7 billion in 2013 alone. And for physicians, the fiscal cliff includes a 27 percent pay cut caused by the Sustainable Growth Rate (SGR) (Sjoerdsma, 11/15).

The Medicare NewsGroup: Primer On The Fiscal Cliff And Its Impact On Medicare
If Democrats and Republicans don't reach a grand bargain ahead of the new year, Medicare providers will be hit with a 2 percent across-the-board cut as part of mandated expense reductions. These could hit providers especially hard, as most are struggling to adapt to reimbursement cuts under the Affordable Care Act (Szot, 11/15).

Kaiser Health News: Fiscal Cliff: What Is At Stake For Medicare And Medicaid? (Health On The Hill Video)
In this Kaiser Health News video, Jackie Judd talks to KHN's Mary Agnes Carey about the budget negotiation scenarios for Medicare, where the "doc fix" fits into the budget picture, and whether Medicaid cuts are possible (11/15).

CQ HealthBeat: Liberals And Advocates Pledge To Fight Medicare Cuts To Beneficiaries In Deficit Talks
Defenders of Medicare, Medicaid and Social Security rallying at the Capitol on Thursday vowed they’ll oppose any attempt to cut benefits as Congress and the Obama administration seek a deal on taxes and spending in the lame duck session and possibly a larger safety net overhaul in 2013…Leaders of the National Committee to Preserve Social Security and Medicare were joined at a Thursday morning news conference by a parade of House Democrats, including Xavier Becerra of California and Rosa DeLauro of Connecticut, who said they’ll fight any budget proposals that would affect benefits for Medicare enrollees (Norman, 11/15).

The Hill: Hospitals: Protect Our Payments In Deficit Deal
A major hospital group warned lawmakers Thursday that its members "cannot absorb" further cuts that could come as part of a deficit-reduction deal. The Federation of American Hospitals (FAH), which represents for-profit hospitals, is the latest stakeholder group to raise concerns about possible cuts. The healthcare world faces the expiration of Medicare's latest doc fix and the sequester, which would slash $11 billion as a result of an across-the-board 2 percent cut to Medicare providers. Like hospitals, doctors and nursing homes have urged lawmakers to avoid the so-called "fiscal cliff" of automatic spending cuts and tax increases set to hit in January, and preserve their payments in any final deal (Viebeck, 11/15).

The Hill: Harkin: Leave Medicare, Medicaid Out Of Fiscal-Cliff Talks
Senate Health Committee Chairman Tom Harkin (D-Iowa) said Thursday that Medicare and Medicaid should be off the table during talks on the fiscal cliff. Harkin spoke alongside other liberal lawmakers at an event to highlight opposition to cutting social programs for deficit reduction. He touted the results of the Nov. 6 election as evidence that Americans support raising taxes instead of cutting spending. "When it comes to Social Security, Medicare and Medicaid, the American people told us to protect and strengthen these programs, not cut them," Harkin said (Viebeck, 11/15).

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Health Reform

HHS Delays Health Exchange Decision Deadline To Dec. 14

The Obama administration announced late Thursday that it was extending the deadline for states to decide whether they would establish and operate these online insurance markets. A number of Republican governors had complained about the initial Nov. 16 deadline.

The New York Times: U.S. Extends Deadline For States On Health Insurance Exchanges
For the second time in a week, the Obama administration said on Thursday that it was extending the deadline for states to decide whether they will establish and operate online markets where consumers can shop for health insurance under the new health care law (Pear, 11/15).

NPR: Health Exchange Activity Heats Up As Deadline Is Extended
There's nothing quite like a deadline to focus the mind. Even a deadline that's not quite real. Friday was originally the day that states were supposed to not only tell the federal government whether they planned to run their own health exchanges but also how they planned to do it (Rovner, 11/15).

The Wall Street Journal: Deadline Delayed For A Month On Health Exchanges
Hours ahead of a Friday deadline, the administration told states that they could take another month to declare if they will set up their own insurance exchanges, where people can shop for approved plans and apply for tax subsidies toward the cost of health-insurance premiums. The exchanges are one of the main ways the law tries to extend coverage to up to 30 million Americans (Radnofsky and Nelson, 11/15).

Politico: HHS Pushes Back Health Exchange Deadline To Dec. 14
HHS is moving the exchange goalposts yet again. With one day to go before states were supposed to declare whether they plan to run their own exchanges, HHS gave them a last-minute reprieve Thursday night — although all but about 10 states had already made their intentions clear by then (Millman, 11/15).

Kaiser Health News: Obama Administration Extends Deadline For State Exchanges – Again
Bowing to a request from Republican governors, the Obama administration announced late Thursday that it would give states more time to decide whether to build online health insurance markets that will help millions of people buy coverage starting next fall. Health and Human Services Secretary Kathleen Sebelius pushed back the deadline until Dec. 14 for states to submit letters of intent to build the state-based markets, called exchanges. The original deadline had been Friday, Nov. 16 (Galewitz, 11/15).

The Hill: HHS Extends Health Care Deadline For States
States now have until Dec. 14 to decide whether they want to run their exchanges entirely on their own (though using billions of dollars in federal grant money). Those that don't will have until Feb. 15 to decide whether they want to work in partnership with the federal government or cede the task entirely to Washington. "States have and will continue to be partners in implementing the health care law and we are committed to providing states with the flexibility, resources and time they need to deliver the benefits of the health care law to the American people," HHS said in a letter to Republican governors. "We will continue to work directly with individual states to address their particular questions and concerns" (Baker, 11/15).

Bloomberg: States Given More Time To Decide On Health Exchange Plan
States received an extra month from the Obama administration to decide whether to build online marketplaces for medical insurance after Republican governors pressed their resistant to the president’s health-care law. Extending a deadline set for today, U.S. Secretary of Health and Human Services Kathleen Sebelius said states can wait until Dec. 14 to declare whether they’ll build their own insurance exchanges. States that opt out can join a partnership with the federal government or let the U.S. run the markets (Wayne and Nussbaum, 11/16).

Reuters: U.S. Gives States More Time To Make Obama Health Law Decision
The federal government on Thursday gave states another month to decide if they will operate insurance exchanges under the new U.S. healthcare law, after some Republican governors stalled in the hope President Barack Obama would lose last week's election. The delay was the second time in a week that Health and Human Services Secretary Kathleen Sebelius showed flexibility on deadlines as a way to entice states to cooperate in implementing Obama's signature domestic achievement (Charles and Kelleher, 11/16).

Stateline: States Get More Time To Decide If They Will Run Their Own Health Insurance Exchanges
With one day left before states were required to notify Washington if they wanted to form their own health insurance "exchanges," the insurance marketplaces authorized by the Affordable Care Act, U.S. Health and Human Services Secretary Kathleen Sebelius granted a one month extension yesterday. She said states will also have to submit detailed exchange "blueprints" at that time. Since postponement of the deadline came at the last minute, this week was marked by a flurry of announcements from governors about how they intended to run their exchanges. The deadline for states to commit to partnering with the federal government is still set for February 15, 2013, according to a letter from Sebelius to the Republican Governors Association (Vestal and Ollove, 11/16).

NBC: Feds Give States A Last-Minute Break On Insurance Marketplaces
States got a last-minute extension late Thursday of a deadline to decide whether they'll build their own health insurance marketplaces, or let the federal government do it for them. Republican governors had been complaining about the Nov. 16 deadline to file their formal decision with the Health and Human Services Department, mostly because HHS has not yet told them what a federal exchange would look like. HHS secretary Kathleen Sebelius gave in at almost the last moment, extending the deadline to Dec. 14 (Fox, 11/15). 

CBS: HHS Pushes Back States Health Reform Deadline
Responding to Republican criticism, the Obama administration is giving states an extra month to make a key decision about how to implement the Affordable Care Act. The move comes in response to a letter sent yesterday by Virginia Gov. Bob McDonnell, chair of the Republican Governors Association, and Louisiana Gov. Bobby Jindal, asking President Obama to step in and extend the deadline. "As has been stated many times, before making any final policy decisions, governors must carefully consider the short and long-term implications of an expanded entitlement program and the consequences of significantly increasing the size of government to manage these programs," they wrote (Condon, 11/15).

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States Declare Their Health Exchange Intentions

A number of states notified the Department of Health and Human Services how they plan to proceed on the question of setting up an insurance exchange. News reports offer insights into the role political views and policy positions have played so far in the decision making.  

The Associated Press/Washington Post: States Deciding If They'll Help Carry Out A Key Component Of Obama's Health Care Overhaul
At issue is the creation of new health insurance markets, where millions of middle-class households and small businesses will shop for private coverage. The so-called exchanges will open for business Jan. 1, 2014, and most of their customers will be eligible for government subsidies to help pay premiums. The exchanges will also steer low-income people into expanded Medicaid programs, if states choose to broaden their safety net coverage (11/16).

The Associated Press/Washington Post: Grudging Acceptance Of 'Obamacare' Spreads As GOP-Led States Confront Implementation Choices
Associated Press reporters interviewed governors and state officials around the country, finding surprising openness to the changes in some cases. Opposition persists in others, and there is a widespread, urgent desire for answers on key unresolved details. Thursday evening, the Obama administration granted states a month's extension, until Dec. 14. A check by the AP found that 16 states remain in the undecided column (11/15).

National Journal: Republican Governors Happy With Sebelius Decision
Republican governors have spent two days bemoaning the Obama administration's deadline of Friday to decide whether to set up state-run health care exchanges or to allow the federal government to do it for them. But Health and Human Services Secretary Kathleen Sebelius's decision to push that deadline back to Dec. 14 gives governors more time to decide—and a lot to celebrate. Sebelius pushed the deadline back after receiving a letter sent by Virginia Gov. Bob McDonnell, the outgoing chairman of the Republican Governors Association, and Louisiana Gov. Bobby Jindal, who was formally elected as McDonnell's successor on Thursday. The letter included 30 questions dealing with specific regulations to which the governors said they had not been provided answers. "There are many unanswered questions from HHS, from the administration, about the operation" about the Affordable Care Act, Jindal said on Wednesday. "We have not gotten meaningful answers. I think governors deserve those actions" (Wilson, 11/15).

CQ HealthBeat: More States Reach Decisions On Exchange Options
Leaders in Nebraska, North Carolina, South Carolina and Indiana on Thursday afternoon announced their decisions on what kind of health benefits exchanges they want in their states. Federal officials set Friday as the deadline for states to tell them if they plan to run their own marketplace. Nebraska Republican Gov. Dave Heineman said in a news conference that while he had first thought it would be better for Nebraska officials to control the exchange, he felt that the 2010 health care overhaul contained so many mandates that it left the state with little discretion about the details of the coverage in the exchange and the operational costs could be too costly. Heineman also confirmed that he would not expand Medicaid (Adams, 11/15).

Kaiser Health News: Capsules: Mississippi Builds Exchange Despite Objections Of Governor, Tea Party
The Mississippi Insurance Department officially told the federal government that it will run its own health insurance exchange and plans to file the exchange blueprint Friday. If the state had not set up an insurance exchange, which is an online marketplace for comparison shopping for health insurance called for by the health overhaul law, the federal government would have set one up in Mississippi instead (Hess, 11/16).

Houston Chronicle: Perry Says Texas Will Not Set Up Health-Insurance Exchange
A day before a Friday deadline, Gov. Rick Perry announced Texas would not set up a key component of the Affordable Care Act, a health-insurance exchange that would allow individuals and small businesses to find coverage online at the most favorable price. The governor reiterated his opposition in a letter released Thursday to U.S. Health and Human Services Secretary Kathleen Sebelius. "As long as the federal government has the ability to force unknown mandates and costs upon our citizens, while retaining the sole power in approving what an exchange looks like, the notion of a state exchange is merely an illusion," Perry said in the letter (Holley, 11/15).

The Associated Press/The Dallas Morning News: Gov. Rick Perry Officially Refuses To Set Up Affordable Care Act Insurance Exchange For Texas
Texas Gov. Rick Perry officially notified the federal government on Thursday that the state will not set up an exchange to help people buy health insurance. Perry sent the letter to Health and Human Services Secretary Kathleen Sebelius a day before the deadline to let Washington know that the state will not set up its own exchange. President Barack Obama's administration gave states the option of setting up their own exchanges, partnering with the federal government or letting Washington do it (Tomlinson, 11/15).

The Associated Press: Arizona Governor Jan Brewer Postpones Health Care Act Decision
Arizona Gov. Jan Brewer is postponing when she'll declare whether Arizona will create a state-run insurance exchange as part of implementing the federal health law that she opposes. Brewer's office disclosed the postponement on the hot-potato issue late Thursday after the federal Department of Health and Human Services extended until mid-December a deadline for states to make exchange declarations (11/15).

The Associated Press: ND GOP Leader Rethinking Options On Health Care Law, Administration Possible
North Dakota's House Republican majority leader says the Legislature may revisit whether the state should take part in running a new health insurance marketplace that is a key part of the new federal health care law. Lawmakers rebuffed a proposal for a state-run "health exchange" a year ago, when many Republicans hoped the U.S. Supreme Court would throw out the law — or that this year's elections would lend momentum to efforts to repeal it (Wetzel, 11/15).

The Associated Press: Alaska Gov Again Rejects State-Run Health Exchange
Alaska is not one of the states that will be setting up a state-run health insurance exchange under the federal health care law. Gov. Sean Parnell made his intention clear in July, saying "federally mandated programs should be paid for by federal dollars" (Bohrer, 11/15).

Anchorage Daily News/McClatchy: Alaska Rejects State-Run Health Insurance Exchange
Gov. Sean Parnell announced in July that Alaska would not create a state-run health insurance exchange, and he is sticking by that, Parnell spokeswoman Sharon Leighow said Tuesday (Shinohara, 11/15).

The Associated Press: Haley Reaffirms No To Health Exchange
Gov. Nikki Haley told the federal government Thursday that South Carolina won't set up a state health exchange, saying President Barack Obama's re-election did not change her stance. In a letter to Health and Human Services Secretary Kathleen Sebelius, Haley says the exchanges called for under the federal health care law known as Obamacare are state-based in name only (Adcox, 11/16).

The Associated Press: NC Officials Opt For Online Health Insurance Market As State-Federal Hybrid, Seek Fed Funds
North Carolina and the federal government will jointly run a new one-stop shop to help people buy affordable health insurance, Gov. Beverly Perdue said Thursday. Perdue, a Democrat, said she consulted with Gov.-elect Pat McCrory, a Republican, and chose a state-federal partnership to operate the health insurance exchange required by the Affordable Care Act (Dalesio, 11/15). 

Milwaukee Journal Sentinel: Wisconsin Unlikely To Create Health Care Exchange
Gov. Scott Walker signaled Wednesday that Wisconsin likely won't move forward with creating its own online insurance marketplace as called for under President Barack Obama's health care overhaul, leaving that to the federal government. The Republican governor's decision on the insurance exchange, scheduled to be announced Friday morning, has big potential implications for the state's patients, the health care sector and Walker's own political career. An odd coalition of business groups, health insurers and Democrats has pressed Walker, an opponent of the Affordable Care Act that is often called Obamacare, to set up state exchanges where small businesses and individuals could buy health insurance (Stein and Boulton, 11/15).

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Tidal Wave Of Health Law Rules Expected In Days And Weeks Ahead

Also in the news, reports estimate state-specific costs and savings related to the overhaul's Medicaid expansion.   

Kaiser Health News: Administration Expected to Release Many New Rules For Health Law
With the national health law's political future now entrenched, a deluge of new rules is expected in the coming days and weeks as the Obama administration fleshes out the law's complex components (Rau, 11/15). 

The Associated Press: HHS Releases Report On Cost To Expand Medicaid In NH Under New Federal Health Care Law
New Hampshire could save up to $114 million if it decides not to expand Medicaid under the new federal health care law, but it would lose $2.5 billion in federal aid toward health care for the state's uninsured. The state Health and Human Services Department on Thursday released the first part of a study on the impact of expanding Medicaid that examines the cost to the state from 2014 to 2020 (Love, 11/15). 

The Associated Press: Report: Fla. Could Save Money Expanding Medicaid
A health report released Thursday estimates the state could expand its Medicaid coverage to more than 1 million residents without spending additional money by offsetting costs in state-funded hospital programs and other safety nets. The study by Georgetown University Health Policy Institute comes days after Gov. Rick Scott softened his staunch opposition to the federal health care law, signaling he wants to explore setting up a state health exchange and expanding the Medicaid rolls (Kennedy, 11/15).

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Capitol Hill Watch

Senators Pledge Regulation Of Compounding Pharmacies

At a Capitol Hill hearing, senators from both parties promised to take action following a meningitis outbreak that killed 32 people.

Politico: Senators Grill FDA Commissioner On Outbreak
Food and Drug Administration Commissioner Margaret Hamburg acknowledged Thursday that the FDA could have acted more decisively against the company implicated in the meningitis outbreak but asked lawmakers to clarify and strengthen the agency's powers to regulate compounding pharmacies. Given more than a decade of documented safety and other violations at the New England Compounding Center, "I wish that [FDA's] responses had been more timely … that they had been better coordinated with the states," Hamburg said at a hearing of the Senate Health, Education, Labor and Pensions Committee (Norman, 11/16).

The Associated Press/Washington Post: Senate Health Chairman Promises New Drug Compounding Laws In Wake Of Meningitis Outbreak
The chairman of the Senate's health committee pledged Thursday to move ahead with legislation to tighten oversight of compounding pharmacies, amid a deadly outbreak caused by tainted specialty medications. But a top lobbyist for the compounding industry, and some fellow senators, argued that existing state and federal laws could have prevented the wave of fungal meningitis that has killed 32 people (11/15).

Reuters: U.S. Lawmakers Pledge Action After Meningitis Outbreak
Democratic and Republican lawmakers said on Thursday they would alter the regulation of drug compounding pharmacies in hopes of preventing more crises like the rare fungal meningitis outbreak that has now cost 32 lives. ... "Our first order of business (is) to answer these questions: not just whose job was it to prevent this tragedy, but whose job will it be to make sure it doesn't happen again," said Republican Senator Lamar Alexander of Tennessee, the state that has become the outbreak's epicenter with 83 cases and 13 deaths. Alexander suggested the FDA could be given powers to certify individual states as the primary regulators of large-scale compounders and withdraw certification from those that fall short. ... "In the face of such a tragedy, it is natural to want to take action. And we will," said Senator Tom Harkin, the Iowa Democrat who chairs the Senate committee (Morgan, 11/15).

The Wall Street Journal: Regulators Faulted For 'Inertia' Over Meningitis Concerns
A congressional report on Thursday released details of how federal and state regulators knew nearly a decade ago of serious safety concerns with the pharmacy tied to hundreds of meningitis cases, but failed to act decisively. Bipartisan staff of the Senate Health, Education, Labor and Pensions Committee concluded in a report that "bureaucratic inertia appears to be what allowed a bad actor to repeatedly risk public health" (Burton, 11/15).

Medpage Today: Senators Want FDA To Regulate Compounders
Senators from both political parties said Thursday they plan to craft legislation to give the FDA authority over compounding pharmacies the agency says is needed in light of the ongoing fungal meningitis outbreak that has killed 32 people. But what that legislation will look like and if it will even gain enough support to pass remains to be seen. "Hopefully, we'll have something soon next year to help put this sad chapter behind us," Senate Health, Education, Labor and Pensions Committee Chair Tom Harkin (D-Iowa) said at the close of a Senate hearing examining the meningitis outbreak (Pittman, 11/15).

Modern Healthcare: Experts Urge Clearer Policies On Compounding Pharmacies
As lawmakers sought clarity on whether the FDA or the states have regulatory jurisdiction over pharmacy compounding companies, Hamburg outlined her agency's proposal for a risk-based framework in which traditional compounding would remain under state purview, while "nontraditional compounding" -- which she said poses higher risks -- would be subject to federal standards. Hamburg's testimony laid out what might fall under nontraditional compounding, including the type of product or activity, such as sterile compounding; the amount of product that is being made; and whether the drug is being shipped within a state (Zigmond, 11/15).

States themselves are acting to strengthen rules on these pharmacies as well --

The Boston Globe: States Try To Strengthen Rules On Drug Compounders
State pharmacy regulators across the country are moving to strengthen their oversight of compounding pharmacies like the one in Framingham that has been blamed for a deadly outbreak of fungal meningitis in 19 states. The Massachusetts pharmacy board, whose failure to ensure safe practices at New England Compounding Center was highlighted in two days of legislative hearings this week, has enacted emergency regulations and begun surprise inspections (Wallack, 11/16).

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Health Information Technology

U.S. Docs Adopt Digital Records But Find Sharing Information Difficult

More than two-thirds of U.S. doctors now use electronic medical records -- a substantial increase from years past -- but are finding that information is still not easily shared among medical professionals, a new study says.

Kaiser Health News: Survey: Most U.S. Primary Care Docs Using EMRs
U.S. doctors are no longer the laggards when it comes to using health information technology in their practices. But they are still more weighed down by paperwork and health care costs than many of their Western counterparts" (Rao, 11/15).

CQ HealthBeat: Despite Recent Progress, U.S. Use Of Health IT Lags Behind Some Other Countries, Commonwealth Fund Says
While more primary care doctors are adapting to health information technology to track medical records, they’re still having trouble syncing with specialists or hospital personnel to get the full picture of their patients’ care, according to a Commonwealth Fund survey released early Thursday. The survey compared 10 countries’ health systems in terms of patient access, health information technology use, communication, performance and satisfaction with the medical system. Published in the December edition of Health Affairs, the survey asked about 8,500 primary care doctors about their perceptions and experiences (McGlade, 11/15).

Medpage Today: More Docs Use EHRs, But Info Still Not Shared
The number of U.S. primary care physicians using electronic medical records increased by 50 percent in the last 3 years, but most doctors still do not receive timely information from specialists or hospitals, an international survey found. Roughly 69 percent of U.S. primary care doctors reported using EHRs in 2012 compared with 46 percent in 2009, the survey published in the journal Health Affairs found. The 2012 number put the U.S. in the middle among the 10 nations surveyed -- only 41 percent of Swiss physicians used EHRs, compared with 98 percent of Norwegian physicians. But despite the increase in their use of EHRs, only 11 percent of U.S. doctors said information they receive about their patients from specialists is timely, and only 26 percent are told by a hospital that their patient has been discharged (Pittman, 11/15).

Kansas Health Institute News: Use Of Electronic Health Records Surges In U.S., Survey Finds
More than two-thirds of U.S. primary care physicians were using electronic health records last year, a substantial increase from three years ago, when less than half had adopted the technology, according to a Commonwealth Fund survey published today. In 2012, 69 percent of primary care physicians reported using an electronic health record (EHR) system, compared to 46 percent in 2009. Among the 10 developed countries surveyed, the U.S. still lags six of them. In those six countries, including the United Kingdom and Australia, EHR use is near universal (11/15).

Additionally, a survey has found that 59 percent of U.S. doctors say their patients often go without needed care because of costs --

Medscape: Primary Care Docs: Only 15% Happy With U.S. Health Care System
Among U.S. primary care physicians, 59 percent said that their patients often went without care because of costs, according a new survey released this week. In contrast, only small minorities of physicians in other developed countries reported affordability problems. The findings from the 2012 Commonwealth Fund International Health Policy Survey were published online November 16 in Health Affairs. The survey gathered responses from 8,462 primary care physicians surveyed in Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Switzerland, the United Kingdom, and the United States. In the United States, 1,012 respondents were reported (Hitt, 11/15).

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Health Care Marketplace

Some Employers Are Telling Employees To Shop Around For Health Insurance

The Associated Press/Washington Post: Employers Are Giving Employees The Option Of Choosing Their Own Health Insurance Plan
For some American workers, picking the right health insurance is becoming more like hunting for the perfect business suit: It takes some shopping around to find a good fit and avoid sticker shock. In a major shift in employer-sponsored health insurance coverage, companies such as Sears Holdings Corp. and Darden Restaurants Inc. are giving employees a fixed amount of money and allowing them to choose their own coverage based on their individual needs (11/15).

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Public Health & Education

For Alzheimer's, Detection Advances Move Faster Than Treatment Options

The New York Times: For Alzheimer's, Detection Advances Outpace Treatment Options
The new brain scan technology, which went on the market in June, is spreading fast. There are already more than 300 hospitals and imaging centers, located in most major metropolitan areas, that are ready to perform the scans, according to Eli Lilly, which sells the tracer used to mark plaque for the scan. The scans show plaques in the brain -- barnaclelike clumps of protein, beta amyloid -- that, together with dementia, are the defining feature of Alzheimer's disease. Those who have dementia but do not have excessive plaques do not have Alzheimer's. It is no longer necessary to wait until the person dies and has an autopsy to learn if the brain was studded with plaques (Kolata, 11/15).

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State Watch

State Highlights: Texas Pursues Some Medicaid Providers

Health policy news from Oregon, Florida, Texas, North Carolina, Ohio and California.

The Texas Tribune/New York Times: Providers Push Back On Medicaid Inquiries
It has been nearly a year since Texas officials accused Dr. Glenn Wood of overbilling the state's Medicaid system by $17.9 million through his business, Carousel Pediatrics. Dr. Wood denies the accusations ... The Texas Health and Human Services Commission's Office of Inspector General is trying to reclaim hundreds of millions in misspent Medicaid money. But after months of investigations, more medical providers are saying publicly that they have been wrongly targeted. (Aaronson, 11/15).

North Carolina Health News: Thousands In Group Homes Face Losing Their Homes As January Deadline Looms
Robert Bullock has lived in his group home in Cary ... Bullock and thousands of other people with mental health problems who live in small group homes face possible eviction on Jan. 1, 2013 if state lawmakers don’t find money to make up what for the homes will lose as the result of a change those same lawmakers made to the state’s Medicaid program earlier this year. Dozens of group home residents and their advocates sat in on a legislative committee Wednesday and then rallied outside (Hoban, 11/15).

The Oregonian: With Bulge Of Aging Boomers Approaching, Oregon Reconsiders How It Provides Long-Term Care
Oregon pioneered the notion of assisted living and other means of helping people stay out of nursing homes, but state officials believe that's old school when it comes to publicly-funded long-term care for the elderly and disabled. A new planning process, which includes a bill for the 2013 Legislature to consider, is wrapping up after a statewide series of public meetings. ... Among other things, a draft bill directs the department to establish home- and community-based care, rather than nursing homes, as the new long-term care "entitlement" (Mortenson, 11/15).

Politico Pro: Ohio Proves Planned Parenthood Fight Isn't Over
A bill that would essentially defund Planned Parenthood in Ohio was approved in the Ohio House Health and Aging Committee on Wednesday, and is now on its way to the full state House. Republicans who support anti-abortion policies have majorities in both the state House and Senate, and look likely to approve the bill. ... The organizations' defunding battles aren't finished -- and Planned Parenthood says it's ready to keep on fighting (Smith, 11/15).

California Healthline: 'California's Budget Situation Has Improved Sharply'
Yesterday's long-term budget forecast for sunnier skies in California by the Legislative Analyst's Office could also mean good things for the state's health care programs, according to the LAO and health experts. ... The state still faces a $1.9 billion deficit for the fiscal year 2013-14. ... It is unlikely any previous cuts to health care programs would be restored, [Anthony Wright, executive director of Health Access California said] ... "The big risk with [implementation of] the Affordable Care Act was the state's fiscal uncertainty. So this should help that, as well" (Gorn, 11/15).

Health News Florida: Would Expanding Medicaid Pay Off For Florida?
Florida could gain a badly-needed economic boost and thousands of new jobs each year if state officials accept federal funds to expand Medicaid, three new studies say. One study calculates the payoff at 16-to-1. The studies -- two by university researchers, one by a hospital association -- all took a decade-long view of the fiscal impact of enlarging Florida's health program for the poor. All found a significant net gain (Gentry, 11/15).

The Lund Report (an Oregon health news service): Malpractice Legislation Nearly Ready To See Daylight
After months of negotiations between trial lawyers and physicians, legislators are optimistic about reaching a consensus on medical malpractice reform when they gather in Salem next month. All along the goal has been to find a way of reducing lawsuits while creating a safer patient environment (Lund-Muzikant, 11/15).

The Lund Report: Naturopaths Given Reprieve By Oregon Health Authority
Naturopathic doctors are "cautiously optimistic" that they will have a place within Oregon's coordinated care organizations (CCOs) after officials threatened to cut them out of the primary-care system and seemingly ignore non-discrimination language in Senate Bill 1509 (Rendleman, 11/16).

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Health Policy Research

Research Roundup: Talking To Patients About End-Of-Life Care

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

Annals Of Family Medicine: Projecting US Primary Care Physician Workforce Needs: 2010-2022 – With estimates of 30 million people in the US expected to gain health insurance under the federal health law, questions have been raised of whether there will be enough primary care physicians. Using Medical Expenditure Panel Survey data, researchers projected "that the total number of office visits to primary care physicians for the United States will increase from a base of 462 million in 2008 to 565 million in 2025. … By 2025, the United States would require nearly 260,687 practicing primary care physicians, an increase of 51,880 from the current workforce." They conclude that the "population growth will be the greatest driver" of that increase, accounting for about 33,000 of the new physicians (Petterson et al., Nov-Dec/2012).

Journal Of Clinical Oncology: Association Between End-Of-Life Discussion Characteristics And Care Received Near Death: A Prospective Cohort Study – According to the study, national guidelines recommend that conversations about end of life (EOL) care take place soon after patients are diagnosed with an incurable cancer. It is unclear, however, if such conversations lead to less aggressive care near death. "We sought to evaluate the extent to which EOL discussion characteristics, such as timing, involved providers, and location, are associated with the aggressiveness of care received near death," the authors write. After studying more than 1,200 patients with stage IV lung or colorectal cancer, the authors found that patients who had earlier discussions about EOL care were less likely to receive aggressive care before death. They conclude that earlier discussions with patients "have the potential to change the way EOL care is delivered for patients with advance cancer and help to assure that care is consistent with patients' preferences" (Mack et al., 11/13).

GAO: High-Expenditure Part B Drugs – The Medicare program and its beneficiaries spent about $19.5 billion on Part B drugs in 2010, according to this new report by the Government Accountability Office (GAO). Part B drugs are commonly administered by physicians or other health care providers under a physician's supervision. "The 55 highest-expenditure Part B drugs accounted for 85 percent of all Part B drug spending in 2010," the report states. In addition, "Spending on Medicare beneficiaries accounted for the majority of estimated total U.S. spending for 35 of the 55 highest-expenditure part B drugs in 2010. For 17 of the 35, Medicare spending accounted for more than two-thirds of total U.S. spending, defined as spending by the insured population in the United States" (10/12).

American Journal Of Public Health: Using The HIV Surveillance System To Monitor The National HIV/AIDS Strategy – Using surveillance data from HIV-positive adults and adolescents of 13 U.S. jurisdictions, researchers aimed to assess how successfully patients were linked to care after an HIV diagnosis and the proportion of HIV-infected patients who had suppressed virus levels. "In this analysis, we found that about 20% of people did not enter care within 3 months of diagnosis and about 30% of people living in HIV were not virally suppressed," the authors write. "We also observed disparities across race/ethnicity, age, sex, and risk groups among people who are linked to clinical care and virally suppressed." They conclude: "The findings highlight disparities in access to and success of care" (Gray et al., 11/15).

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

Medscape: Antibiotic Rx Highest In Southern States
Clinicians in 7 southern states lead the nation in prescribing antibiotics on an outpatient, per capita basis, and at roughly double the rate found in Pacific Coast states, where such rates are the lowest, according to the Center for Disease Dynamics, Economics & Policy (CDDEP). The think tank released these findings today as part of "Get Smart: Know When Antibiotics Work," a week-long publicity campaign organized by the Centers for Disease Control and Prevention (CDC). Now in its fifth year, Get Smart week aims at curbing the inappropriate use of antibiotics that leads to bacterial resistance and infections that defy treatment (Lowes, 11/13).

Medscape: Breast Cancer Deaths Higher In Black Women
In the United States, more black women than white women die from breast cancer, even though the incidence of breast cancer is slightly lower in black women. This racial disparity was highlighted in a press briefing held today by the Centers for Disease Control and Prevention (CDC), and is detailed in a report published online November 14 in the Morbidity and Mortality Weekly Report (Chustecka, 11/14). 

Medpage Today: Cost Control Key To Hospitals' Bundled Pay
Wide variation exists between hospitals in their average spending on post-acute care, researchers said, and providers that work best to coordinate that care stand to benefit the most under Medicare's bundled-payment models. The variation between the highest- and lowest-cost hospitals can exceed 100%, Robert Mechanic and Christopher Tompkins, PhD, of Brandeis University found. Hospitals spending more than the average spent almost 40% more than those below the average for various episodes (Pittman, 11/15).

Medpage Today: Physician Suicide Linked To Work Stress
Suicide among physicians appears to follow a different profile than in the general population, with a greater role played by job stress and mental health problems, a national analysis showed. Problems with work were three times more likely to have contributed to a physician's suicide than a nonphysician's, Katherine J. Gold, MD, MSW, of the University of Michigan in Ann Arbor, and colleagues found (Phend, 11/14).

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Editorials and Opinions

Viewpoints: 'Zombie' Plans For Medicare; James Baker's Grand Bargain Advice; Conservative Govs' Choices

The New York Times: Life, Death And Deficits
America's political landscape is infested with many zombie ideas — beliefs about policy that have been repeatedly refuted with evidence and analysis but refuse to die. ... the most dangerous zombie is probably the claim that rising life expectancy justifies a rise in both the Social Security retirement age and the age of eligibility for Medicare. ... What would happen if we raised the Medicare eligibility age? The federal government would save only a small amount of money, because younger seniors are relatively healthy and hence low-cost. Meanwhile, however, those seniors would face sharply higher out-of-pocket costs. How could this trade-off be considered good policy? (Paul Krugman, 11/15).

The Wall Street Journal: How To Get To A Grand Bargain
One way to generate the necessary political will for a deal would be to establish a mechanism guaranteeing that any agreed-upon spending cuts actually happen—and then remain in place after taxes are raised. ... If a part of any grand bargain is that the wealthy should pay more in taxes, why not means-test entitlements such as Medicare and Social Security, two of the biggest contributors to our deficits? This wouldn't hinder economic growth as much as raising marginal tax rates would (James A. Baker III, 11/15).

The Washington Post: Putting Obamacare Into Effect
Should conservatives help implement the Affordable Care Act, the health-care law they detest? For months, it seemed that Republican state leaders hoped they would not need to decide. ... Now conservative governors are facing their first deadline to decide how much they will cooperate with a federal government that will push forward. ... The more states that take an active role in this experimentation, the more likely that Congress’s bet on America’s laboratories of democracy will pay off (11/15).

The Arizona Republic: Exchange Must Stay Within State's Control
As of today, the [Obamacare] law is embracing us, one way or another. The choice before Gov. Jan Brewer today is whether to take some measure of state control of the sweeping health-care reforms by creating for Arizona one of the law's signature health-insurance "exchanges." ... The responsible choice going forward is to consider the state's best interest once the law is in effect. And that would be with a state-controlled exchange (11/16).

Los Angeles Times: Mitt Romney's Misperception Of President Obama's 'Gifts'
(Mitt Romney's) explanation is beyond simplistic, ahistorical and more than a little self-serving. Didn't polls show throughout the election year that most Americans opposed healthcare reform? Didn't Republicans think the policy would prove so problematic that they hung it around the president's neck, with the epithet "Obamacare?" How many candidates have won the White House just by delivering up pork? Romney couldn't be expected to acknowledge that he offered up "gifts" of his own (James Rainey, 11/15).

The New England Journal of Medicine: Lessons Learned Preparing for Medicare Bundled Payments 
The Bundled Payments for Care Improvement Initiative has great potential to engage hospitals in clinical redesign and care coordination that could improve both care and efficiency. ... The success of the initiative will depend on whether it protects participating hospitals against losses resulting from both random and systematic variation in illness severity. ... If hospitals are confident that the program will financially reward successful clinical performance, many more will be willing to pursue the opportunities for care improvement that this program seeks to encourage (Robert Mechanic and Christopher Tompkins, 11/15).

The New England Journal of Medicine: Reducing Administrative Costs and Improving the Health Care System
The average U.S. physician spends 43 minutes a day interacting with health plans about payment, dealing with formularies, and obtaining authorizations for procedures. In addition, physicians' offices must hire coders, who spend their days translating clinical records into billing forms and submitting and monitoring reimbursements. The amount of time and money spent on administrative tasks is one of the most frustrating aspects of modern medicine. ... it may be necessary to establish a senior-level office in the DHHS focused solely on implementation and innovation in the realm of administrative simplification (David Cutler, Elizabeth Wikler and Peter Basch, 11/15).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
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.