Daily Health Policy Report

Monday, November 19, 2012

Last updated: Mon, Nov 19

KHN Original Reporting & Guest Opinion

Fiscal Cliff

Health Reform


Capitol Hill Watch

Health Care Marketplace

Coverage & Access

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Stuart Altman's Huge Challenge: Bring Down Mass. Health Costs

WBUR's Martha Bebinger, working in partnership with Kaiser Health News and NPR, spoke with Prof. Stuart Altman, a Brandeis economist who advised President Richard Nixon on health policy and President Bill Clinton on Medicare. He has responsibility for helping the state of Massachusetts control health care costs so that they stop increasing faster than that of most other goods and services (11/18). Read the interview.

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Four NYC Hospitals Still Closed By Hurricane Sandy

WNYC's Fred Mogul, working in partnership with Kaiser Health News and NPR, reports: "Three weeks after Hurricane Sandy, four New York City hospitals remain closed for inpatients, leaving thousands of patients scrambling to find other medical centers to treat everything from broken bones to brain cancer. The closures of NYU Langone Medical Center, Bellevue Hospital Center, the Manhattan VA Medical Center, and Coney Island Hospital have meant more business for some nearby hospitals and an unwelcome extra burden for others" (Mogul, 11/18). Read the story.

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Capsules: Florida Gov. Rick Scott Ready To Negotiate State Exchange; Gerontology Expert: Revive CLASS Act To Help Pay Long-Term Care Bills

Now on Kaiser Health News' blog, Phil Galewitz reports on developments in Florida related to health exchanges: "Florida Gov. Rick Scott said Friday that he's open to building a state-based health insurance exchange under the health care law — but only if he can find a way to pay for it that doesn’t increase health costs or state taxes" (Galewitz, 11/16).

Also on the blog, Liz Seegert writes about developments related to the CLASS Act and long-term care costs: "As policymakers in Washington struggled to avoid a year-end budget crisis affecting spending on the biggest health programs, gerontologists on the other side of the country were worrying about how to meet long-term care needs of the expanding senior population. At the Gerontological Society of America’s 65th annual scientific meeting in San Diego, Dr. Toni Miles, director of the Institute of Gerontology at the University of Georgia, called for a reinvigorated version of the CLASS Act" (Seegert, 11/19). Check out what else is on the blog.

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Political Cartoon: 'Grand Slammed?'

Kaiser Health News provides a fresh take on health policy developments with "Grand Slammed?" by Lisa Benson.

Meanwhile, here is today's health policy haiku:


Is it possible?
A deal to avert the cliff
the countdown is on.

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

Even As Leaders Appear 'Upbeat' After 'Fiscal Cliff' Meeting, Taxes, Benefit Programs Remain Flashpoints

President Barack Obama and House Speaker John Boehner, R-Ohio, appeared optimistic about a deal to avert automatic spending cuts and tax increases, but major issues must be tackled.

The Associated Press/Washington Post: Taxes, Benefit Programs Key Flashpoints In 'Fiscal Cliff' Negotiations
There are numerous hurdles, big and small, in front of President Barack Obama and lawmakers on Capitol Hill as they seek a budget and tax agreement to avoid economy-rattling tax increases and automatic spending cuts known as the "fiscal cliff" (11/19).

Los Angeles Times: Obama And Boehner Upbeat After 'Fiscal Cliff' Meeting
The outline of a compromise over impending tax hikes and spending cuts began to come into focus Friday after President Obama convened top congressional leaders at the White House. The first part of such a deal would be legislation this year that would commit Congress to specific revenue increases, favored by Democrats, and spending cuts, as advocated by Republicans. How those increases and cuts would be achieved would be worked out in the second stage next year by the new Congress (Mascaro, 11/16).

The New York Times: Back On Hill, Ryan Remains A Fiscal Force
Speaker John A. Boehner has tapped Mr. Ryan, who has returned to his post as the House Budget Committee chairman after an unsuccessful run for vice president, to help strike a deal to avoid big tax increases and spending cuts by the end of the year, and to bring along fellow Republicans. … The test will be whether Mr. Ryan … can make the transition from House budget philosopher to governing heavyweight who can help negotiate a bipartisan deal and sell it to his colleagues. While President Obama and the Democrats are expected to give ground on entitlements and discretionary spending, it is likely that Mr. Ryan will be the player under the most pressure to back away from his previous conservative positions in order to form a bipartisan agreement (Steinhauer, 11/18).

NPR: In Fiscal Cliff Talks, Higher Taxes Vs. Closing Loopholes
The White House and Congress continue to work on a deal that avoids the fiscal cliff and cuts deficits in the long run. One of the biggest hurdles is President Obama's proposal to raise tax rates for the wealthy (Ydstie, 11/19).

The Wall Street Journal: What A Deal Might Look Like
North Dakota Democrat Kent Conrad, retiring chairman of the Senate Budget Committee, spoke with The Wall Street Journal's John Bussey about why he's hopeful, and what he thinks a deal could look like (Bussey, 11/19).

The Associated Press: Democrats Toughen Stance On Trimming Benefits
President Barack Obama's re-election has stiffened Democrats' spine against cutting popular benefit programs such as Medicare and Social Security. Their new resolve could become as big a hurdle to a deal that would skirt crippling tax increases and spending cuts in January as Republicans' resistance to raising tax rates on the wealthy (Taylor, 11/17).

Meanwhile, news outlets offer advice for retirees about how to "survive the fiscal cliff," and warnings about how the automatic cuts could affect the health care system, including the health law's implementation -

The Fiscal Times: 4 Ways Retirees Can Survive The Fiscal Cliff
The past few years haven’t been great for those who have just retired or are nearing their golden years. And unfortunately with the fiscal cliff on the horizon — more than $600 billion in spending cuts and tax increases coming January 2 — things could get a lot worse. Lawyer and certified public accountant Leon LaBrecque predicts in a Bankrate analysis that retirees could face a 17 percent increase in their 2013 federal income taxes, in addition to increases in state, local and property taxes. And if the nation slips into another recession, they’ll see a significant dent in their portfolios. … As part of the spending cuts mandated by Congress last year, Medicare Part D would get a 2 percent cut, which could increase out-of-pocket costs for Medicare recipients. Physicians who take Medicare patients could also see a pay cut, which might prompt more to stop accepting Medicare (Johnson, 11/18).

CQ HealthBeat: Experts See Trouble For Health Care In The Fiscal Cliff And Beyond
Budget and health policy experts Friday painted a grim picture of the implications for health care should automatic scheduled cuts go into effect at the end of the year, including an 8.2 percent slash in administrative costs for the Department of Health and Human Services as it struggles to establish insurance exchanges. Members of the Alliance for Health Reform discussion panel also were skeptical, for the most part, that Congress and the White House will allow the cuts and tax increases that would prevent the fiscal cliff to take effect. They said they expect some kind of temporary solution followed by talks and legislative action through 2013 on long-term solutions that would have to involve health care costs. However, fiscal expert Stan Collender said he's heard increasingly in recent days from both Democrats and Republicans who think the fiscal cliff should go into effect — even if just for a few days — so that those who are affected will become angry and lawmakers will be forced into a decision (Norman, 11/16).

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Health Reform

What The Health Law's Future Holds

Even with the election in the rear view mirror, efforts to implement the health care law will continue to face challenges. Meanwhile, experts discuss what steps must be taken to control health care costs and to educate the public about the health overhaul.

The Hill: Five 'ObamaCare' Battles To Watch
Republicans aren't going to repeal "ObamaCare" in the next four years, but there's still plenty of room for both political fights and policy changes. Republicans have begun over the past two weeks to acknowledge — albeit grudgingly — that President Obama's reelection took repeal off the table for the next four years. Conservatives have responded by stepping up the pressure on Republican governors to stand in the law's way as much as possible at the state level, and governors do have considerable power over how the law is implemented. In Washington, deflated partisan rancor over the Affordable Care Act could be a blessing to industry groups with smaller, more targeted complaints about the law. Republican lawmakers and healthcare lobbyists say smaller fixes are more realistic if every minor issue doesn't blow up into a full-scale war over ObamaCare, and the appetite for that war is finally starting to wane (Baker, 11/18).

The Wall Street Journal: Remaking Health Care: Change The Way Providers Are Paid
In the debate over the nation's finances, health care is one of the biggest items on the agenda. How do we bring down soaring costs as more people get coverage and more baby boomers head into retirement? The Wall Street Journal's Laura Landro moderated the task-force discussion on remaking health care (Landro, 11/19).

Politico: McClellan: Public Needs Education On Obamacare
Mark McClellan, who helped implement the Medicare prescription drug benefit for President George W. Bush, says the two parties should separate their political battles over Obamacare from the need for broad public education about how the law will affect ordinary people. Now at The Brookings Institution, McClellan was the Centers for Medicare & Medicaid Services administrator when the largely GOP-designed drug benefit was rolled out from 2003 to 2006. He says the two parties had very strong differences over the prescription drug law but were able to have two parallel tracks — one fighting about the policy and one helping to explain what it would mean to a constituent (Kenen, 11/19).

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GOP Governors Welcome Extension On Health Exchange Decision

Last week was marked by a flurry of state-level activity related to the health law's insurance exchanges: News outlets run down which states have decided to develop their own marketplaces and which will defer to the federal government. A number of states, many with Republican state executives, are still seeking more information.

Politico Pro: States Take Advantage Of Extension
They asked for more time, and now they're going to use it. Most of the states that hadn't announced an exchange decision before HHS pushed extended the deadline said Friday that they're going to take the extra month to think things over. States originally had until Friday to indicate whether they’d build their own exchanges, but HHS pushed the deadline back to Dec. 14 after the Republican Governors Association requested more time -- and much more guidance from the feds. For the most part, governors were grateful for the bonus time, but also strongly suggested that HHS would be well-served to quickly clear up states' major exchange questions (Millman, 11/16).

Reuters: Five Republican Governors Reject State-Run Health Markets
Five Republican governors rejected on Friday a major provision of President Barack Obama's health care reform law that calls on states to set up online health insurance markets where consumers can purchase private coverage at federally subsidized rates. That makes it likely that the federal government will establish its own markets, known as health care exchanges, in those states and potentially supplant state control of private individual insurance markets (Morgan, 11/16).

The Associated Press: GOP Govs Of Iowa, Neb. Differ On Health Exchanges
Iowa and Nebraska are turning down different paths to comply with the federal health care overhaul, which reflects the broader struggle many Republican governors face now that they must submit to a law they feverishly oppose. Iowa Gov. Terry Branstad said Friday that his administration will continue to work on a state-based exchange, but he left open the possibility of defaulting to a federal exchange or some combination of the two (Schulte, 11/19).

Politico Pro: Iowa To Build Exchange, But Wants Details
Iowa will pursue a state-run health insurance exchange — even though it’s annoyed at the Department of Health and Human Services and might still change its mind. In a letter to HHS Friday, Gov. Terry Branstad, a Republican, swam against a tide of GOP governors refusing to proactively implement the Affordable Care Act, permitting the feds to set up an exchange in their backyard instead. “I write you today to inform you that Iowa will continue on its path to creating an Iowa-based exchange that is intended to protect the health of Iowans … I continue to have concerns that an intrusive federal exchange would raise costs on individuals and businesses, making it harder for them to create jobs and raise family incomes in Iowa,” he wrote in a letter to Sebelius (Cheney, 11/16).

Politico Pro: GOP Governors Open Doors To ACA
Bobby Jindal's got a funny way of showing how much he hates Obamacare and Washington bureaucracy: The Louisiana governor's about to invite the feds to set up a health insurance exchange right in his backyard. So is Rick Perry in Texas. Ditto for John Kasich in Ohio. And Scott Walker in Wisconsin. These Republican governors, and more than a dozen others in red states around the country, have decided it’s better to have Obamacare forced on them than to legitimize it by setting up their own exchanges, even if that means empowering the federal government at the expense of the states. It's a stick in the eye of a just reelected president whose health care plan is still opposed by about half the country -- and an indication that some Republican governors have no intention of backing down just because President Barack Obama won another four years (Allen, 11/16).

Los Angeles Times: California Works to Get Word Out On Health Insurance Exchange
With the presidential election over and the nation's health care overhaul moving forward, California officials have less than a year to clear up widespread uncertainty about future medical coverage options (Gorman and Terhune, 11/ 19).

California Healthline: Long Busy Day For The Exchange Board
The Health Benefit Exchange board issued a draft establishment grant proposal Wednesday, which is basically a blueprint of the exchange's business and operational plan through 2017, the year it is supposed to become self-sufficient. The board also took on a number of other issues on Wednesday, including imminent submission of its quality health plans proposal to the Office of Administrative Law. The eight-hour meeting had a get-down-to-business tone, partly in response to the reelection of President Obama, which ensures a smoother track for implementation of the Affordable Care Act (Gorn, 11/16).

The Hill: Health Law Author Calls On Christie To Set Up Exchange
An author of the health care law is calling on New Jersey Gov. Chris Christie (R) to set up his state's insurance exchange and not leave the task to the federal government. Christie has not announced his decision. The deadline for states to say if they will run their own exchanges was pushed back from Friday to Dec. 15 to accommodate Republican governors. Rep. Frank Pallone Jr. (D-N.J.) wrote to Christie on Thursday as the original deadline loomed, urging him to sign a bill passed by the State Legislature that authorizes a New Jersey-run exchange (Viebeck, 11/16).

The Associated Press: Walker's Health Care Decision Ripped By Democrats
Gov. Scott Walker's decision to hand off creation of an online marketplace to connect Wisconsin consumers with private health insurance providers riled Democrats and others who hoped he would support a state-run exchange despite his opposition to the federal law. But Walker stayed true to his longtime opposition to President Barack Obama's Affordable Care Act, derided by Republicans as "Obamacare," with his decision Friday to join with other Republican governors in ceding authority for creating the exchanges to the federal government (Bauer, 11/16).

Milwaukee Journal Sentinel: Many Decisions Remain On Wisconsin's Health Care Exchange
Judy Neary of Brookfield has mixed feelings about the Affordable Care Act and knows little about the online marketplaces, or exchanges, for health insurances that are to be in place by late next year under the law. But she knows the frustration of shopping for health insurance and the idea of an exchange intrigues her. "I would definitely use that," Neary said. The exchanges, a key component of the Affordable Care Act, have the broad goal of making it easier for people and small businesses to compare health plans, potentially increasing competition and helping to slow the rise in premiums and health care costs (Boulton, 11/17).

St. Louis Beacon: Missing Deadline Won't Prevent Missouri From Setting Up A Health Exchange
Today marked the first major deadline for states planning to set up their own health-insurance exchanges as mandated by the Affordable Care Act. And Missouri Gov. Jay Nixon followed through with a letter Friday to the federal government stipulating that the state will be unable to meet the deadline, and won't be setting up a state exchange. But missing the deadline, as Missouri is doing, doesn’t mean a state can’t create an exchange in a later year. Kathleen Sebelius, secretary of health and human services, made that point in a letter Thursday to some state lawmakers, saying "A state may apply at any time to run an exchange in future years." Observers say that's one of the overlooked issues surrounding the controversial health reform law (Joiner, 11/16).

The Associated Press: Deal: Ga. Won't Create Health Care Exchanges
Georgia will not create the health insurance exchanges required under President Barack Obama's health care overhaul and will leave that task to federal authorities, Gov. Nathan Deal said Friday. Deal, a Republican, outlined his stance in a letter to the U.S. Department of Health and Human Services in which he criticized the Democratic health care plan for what he called its "one-size-fits-all approach" and the financial burdens it places on state governments (Henry, 11/16).

Kaiser Health News: Capsules: Florida Gov. Rick Scott Ready To Negotiate State Exchange
Florida Gov. Rick Scott said Friday that he's open to building a state-based health insurance exchange under the health care law — but only if he can find a way to pay for it that doesn't increase health costs or state taxes (Galewitz, 11/16).

The Associated Press: Mead Says Feds Are Ducking Health Care Questions
Wyoming Gov. Matt Mead has expressed mounting frustration with the Obama administration, saying the secretary of Health and Human Services has not answered his requests for additional information regarding the federal health care law. Mead wrote to HHS Secretary Kathleen Sebelius on Friday stating that her department's failure to respond to a pair of earlier letters means the state will likely miss a key deadline next month (Neary, 11/16).

The Associated Press: Illinois Keeps Pace On Obama's Health Law
Illinois is ahead of some states but behind others on the path toward creating a health insurance exchange, a cornerstone of President Barack Obama's health care law. Obama's home state plans to partner with the federal government to run a health insurance exchange beginning in 2014, the first year for coverage. State officials submitted their blueprint for that partnership Friday (Johnson, 11/16).

The Associated Press: Scott Wants To Meet With Federal Health Officials
Gov. Rick Scott told federal health officials in a letter Friday that he isn't convinced a state health exchange will lower health care costs for Floridians, and that he's worried the actual costs could end up exceeding early estimates. The Republican governor, who has recently softened his staunch opposition to the federal health care law, requested a meeting with federal health officials in hopes of working together to set up a state health exchange to help the nearly 4 million uninsured in the state. But Scott said he needs more information before making a decision (Kennedy, 11/16).

Minnesota Post: Dayton Administration Commits To State-Run Health Exchange
The Dayton administration on Friday sent an early signal to the federal government that Minnesota will pursue a state-run health insurance exchange and apply for an additional $39 million in grant funding to develop the tool, a crucial component of the federal health care reform law. The U.S. Department of Health and Human Services postponed two key Friday deadlines till mid-December, but Minnesota pushed ahead anyway, emphasizing Gov. Mark Dayton's commitment to implementing the exchange. Federal funding for the project will top $100 million if the grant is approved. With DFL majorities in the Legislature, what once looked like a lonely project for the executive branch has become one of the most important issues for lawmakers this session (Nord, 11/16).

CQ HealthBeat: Insurers Could Face Fees To Help Pay Exchange Administration
One of the main rationales GOP governors gave this week for their decisions not to run their own exchanges is that it would cost their taxpayers less in administrative expenses if they let the federal government do it. That raises a question: How would the federal government pay for the costs of operating an exchange? One strong possibility is that federal officials would impose a fee on insurers in the exchange, said a former federal official Friday. Those costs for insurers would probably be passed on to consumers. A number of states that will run their own exchanges are also considering user fees. Already, the Massachusetts health insurance exchange market, which was a model for the federal framework, assesses fees on insurance plans in its exchange (Adams, 11/16).

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Medicare Part B Premiums Up $5 Per Month Next Year

The increase will eat about a quarter of a typical retiree's cost-of-living raise in Social Security payments.

The Associated Press/New York Times: Medicare Premiums To Rise By $5 A Month
Medicare premiums will rise by $5 a month next year, the government said Friday. That is less than expected, but enough to consume about a fourth of a typical retiree's cost-of-living raise in Social Security payments next year (11/16).

Modern Healthcare: HHS Announces Changes To Medicare Premiums, Deductibles
Medicare Part B premiums will rise in 2013 while Part A premiums will fall, HHS announced Friday. Published in the Federal Register, the notice said the standard premium for Medicare Part B -- which covers physician, outpatient hospital and certain home health services, as well as durable medical equipment -- will be $104.90, a 5 percent increase over the 2012 premium of $99.90. The deductible for Part B services next year will be $147, up from $140. Meanwhile, premiums for Part A will drop by $10 to $441 for 2013. Medicare Part A covers inpatient hospitals, skilled-nursing facilities and some home health care (Zigmond, 11/16).

CQ HealthBeat: Medicare Part B Premium Increase Modest For 2013
With health care inflation relatively stable, officials at the Centers for Medicare and Medicaid Services released rules Friday that include a $5-per-month increase in Medicare Part B premiums and a $28 hike in the hospital inpatient deductible. The Part B premium will reach a milestone, however, topping $100 a month. The monthly payment for Part B, which covers doctor visits, outpatient hospital services, home health care and other items, will be $104.90 next year, compared to the current $99.90. And the deductible for inpatient hospital stays will go to $1,184 in 2013 from $1,156 this year. One item will be decreasing: the Part A monthly premium, which pays for inpatient hospital stays, skilled nursing facilities and some home care for about 1 percent of Medicare beneficiaries who do not automatically qualify for the program. That premium will be $441 a month, down $10 a month from this year (11/16).

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Capitol Hill Watch

Appropriators Focus Quietly On Omnibus Spending Bill

Also in the news, the Senate approves legislation to reauthorize federal research and intervention activities to lower the rate of premature births.

Politico: Appropriations Panels Quietly Work On Omnibus
Talks on the giant labor, education and health chapter are lagging because the chief House Republican negotiator, Rep. Denny Rehberg, was preoccupied so long with his Senate campaign in Montana. But enough progress has been made overall that even a reluctant White House is beginning to take notice of the committees' persistence. Indeed, if the fiscal cliff debt talks end up requiring more cuts from discretionary spending, an updated omnibus would be a far better vehicle for implementing new savings than the six-month stopgap bill that is keeping the government funded (Rogers, 11/18).

The Hill: Senate Passes Bill To Help Prevent Premature Birth
The Senate reauthorized federal research and intervention activities on premature births in a voice vote Thursday night. The PREEMIE Reauthorization Act continues programs established by the 2006 bill, which made the study and prevention of premature births an explicit federal priority. "The PREEMIE Reauthorization Act will save infants’ lives," said Dr. Jennifer L. Howse, president of the March of Dimes, in a statement. "Preterm birth rates have now dropped for five consecutive years after rising steadily for three decades. The PREEMIE Reauthorization Act will continue to fuel our progress by supporting federal research and promoting known interventions and community initiatives" (Viebeck, 11/16).

CQ HealthBeat: Senate Backs Research Bill On Premature Birth
The Senate passed a measure Thursday to reauthorize research on pre-term labor and infant mortality. The bill, passed by voice vote, would authorize a four-year extension of a law authorizing programs to decrease the risk of pre-term labor, pregnancy-related deaths and infant mortality. The Health, Education, Labor and Pensions Committee advanced the measure by voice vote in September. Before passing the bill, the chamber gave unanimous consent approval to a Lamar Alexander, R-Tenn., substitute amendment that would strike provisions to allow the National Institutes of Health to expand, intensify and coordinate its research on the causes of pre-term labor and premature infants. Under the amended bill, the Department of Health and Human Service’s Centers for Disease Control and Prevention would be allowed, not required, to conduct studies on factors relating to premature births. The measure also would allow the department to establish an advisory committee on infant mortality to provide recommendations on programs and strategies that address the issue (Khatami, 11/16).

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Health Care Marketplace

Studies Suggest Doctors, Dentists Can't Keep Up With Health Law's Insurance Expansion

Two studies find that primary-care doctors will be in short supply in the future.

Modern Healthcare: Medicaid Providers Tough To Find For Many States, Report Says
More than half of U.S. states and territories surveyed earlier this year by the Government Accountability Office reported it was a challenge to find enough dentists, specialists, primary-care doctors or other providers to care for Medicaid patients, a newly released report said. The online survey of the District of Columbia, U.S. states and five territories, conducted between February and May, found dentists were the most problematic provider. ... Mental health and substance abuse provider participation was a challenge for 17 of the surveyed Medicaid officials, and the same was true for primary care (Evans, 11/18).

Reuters: U.S. Will Need 52,000 More Family Docs By 2025: Study
A growing and aging population, along with increased access to health insurance, will create the need for 52,000 more primary care doctors within the U.S. by the year 2025, according to a new study. ...  "A lot of the increase in utilization is going to be from population growth. That's going to be the largest driver. Then, a smaller percentage is actually going to be from [the health law's] insurance expansion," said [author Dr. Winston] Liaw, who was a fellow at Washington's Robert Graham Center when the study was written (Seaman, 11/16).

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When It Comes To Surgery, Businesses Increasingly Want Workers To Shop Around

Los Angeles Times: Companies Go Surgery Shopping
It's all part of a growing movement by employers fed up with wildly different price tags for routine operations. In response, businesses are showering workers with generous incentives — including waiving deductibles or handing out $2,500 bonuses — to steer them to these top-performing providers offering bargain prices (Terhune, 11/17).

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Coverage & Access

Aging Care: Hospices Seek Better Image; New Nursing Home Database Released

Several news organizations cover issues related to end-of-life and long-term care.

The Boston Globe: Hospices Trying To Sell The Public On Their Care
People often have one regret about hospice care: that they didn’t get it sooner. The hospice system has been caring for terminally ill patients and their families for decades; 42 percent of the 2.4 million Americans who died last year were under hospice care at the end. Now, hospices across the country are trying to rebrand and reposition themselves to reach patients earlier and erase the idea that turning to hospice is akin to "giving up" (Weintraub, 11/19)

ProPublica: The 10 Most Common Nursing Home Violations
[The Centers for Medicare and Medicaid Services] now releases narrative reports of these problems from a home’s last three inspection cycles -- or about three years. ProPublica created Nursing Home Inspect to allow users to easily search through the reams of reports, looking for trends or particular problems. ... Nursing homes are inspected annually, called a standard survey, and when there is a complaint. Inspectors typically work for state agencies paid by Medicare. If they find problems, known as deficiencies, they rank them on a scale of A to L, the most severe. The vast majority are either labeled D or E (Ornstein, 11/16).

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Public Health & Education

Drug Shortages A New Way Of Life In Providing Care; Lawmakers Call For Investigation

As health care facilities struggle to keep inventories of key medicines, some are resorting to risky practices. Meanwhile, six members of Congress seek a GAO probe of pharmaceutical contracting to see if it has hurt generic drugmakers and added to shortages.

The New York Times: Drug Shortages Persist In U.S., Harming Care
From rural ambulance squads to prestigious hospitals, health care workers are struggling to keep vital medicines in stock because of a drug shortage crisis that is proving to be stubbornly difficult to fix. Rationing is just one example of the extraordinary lengths being taken to address the shortage, which health care workers say has ceased to be a temporary emergency and is now a fact of life. In desperation, they are resorting to treating patients with less effective alternative medicines and using expired drugs. ... the shortage has prompted Congressional hearings, a presidential order and pledges by generic drug makers to communicate better with federal regulators (Thomas, 11/16).

Medpage Today: Buying Groups' Role In Drug Shortages Queried
Six members of the House of Representatives have called on the Government Accountability Office (GAO) to investigate whether contracting practices by hospital purchasing organizations are an underlying cause of ongoing shortages of generic drugs. Specifically, the six want to know whether group purchasing organizations (GPOs) have designed exclusive contracts for drugs and devices that have had detrimental effects on generic drugmakers -- potentially leading to drug shortages and an increased reliance on compounding pharmacies (Fiore, 11/16).

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A Closer Look Into The Meningitis Outbreak's Unwitting Enablers

The New York Times: How Back Pain Turned Deadly
Randall Kinnard's legal clients had steroids injected into their backs last summer for a wide range of reasons. ... Now the 25 -- or their survivors -- have engaged Mr. Kinnaird, one of Nashville’s leading lawyers, to sue the New England Compounding Center. ... But, experts say, the now notorious Compounding Center has a nationwide network of unwitting enablers and accomplices: There are the doctors who overprescribe an invasive back-pain therapy that, in studies, has not proved useful for many of the patients who get it. And there are the patients, living in an increasingly medicalized society, who want a quick fix for life's aches and pains (Rosenthal, 11/17).

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State Watch

State Roundup: Ill. Insurer To Buy Montana Blues; Calif. Nurses Plan Strike

News outlets report on health news from California, Florida, Massachusetts, Montana, New York, Washington and Wyoming.

The New York Times: In Wyoming, Conservatives Feeling Left Behind
But since the election, a blanket of baffled worry has descended on conservatives here like early snow across the plains, deepening a sense that traditional, rural and overwhelmingly white states in the center of the country are losing touch with an increasingly diverse and urban American electorate. ... People said their worries about the next four more years had little to do with Mr. Obama's race, or even Democratic policies on abortion, same-sex marriage and birth control. Wyoming's conservatism has some strong libertarian hues. What worries conservatives here is that an increasingly diverse and Democratic polity will embrace health care mandates, higher domestic spending and a bigger government role in people's economic lives (Healy, 11/18).

Kaiser Health News: Stuart Altman's Huge Challenge: Bring Down Mass. Health Costs
Massachusetts is the first state to say that health care costs must stop increasing faster than that of most other goods and services. Prof. Stuart Altman, a Brandeis economist who advised President Richard Nixon on health policy and President Bill Clinton on Medicare, has responsibility for helping the state achieve that goal. ... WBUR's Martha Bebinger spoke with Altman about the challenge (Bebinger, 11/18).

Kaiser Health News: Four NYC Hospitals Still Closed By Hurricane Sandy
Three weeks after Hurricane Sandy, four New York City hospitals remain closed for inpatients, leaving thousands of patients scrambling to find other medical centers to treat everything from broken bones to brain cancer. The closures of NYU Langone Medical Center, Bellevue Hospital Center, the Manhattan VA Medical Center, and Coney Island Hospital have meant more business for some nearby hospitals and an unwelcome extra burden for others (Mogul, 11/18). 

Modern Healthcare: Mont. Blues Seeks OK For HCSC Deal
Blue Cross and Blue Shield of Montana has filed for regulatory approval for its proposed deal with Health Care Service Corp., which operates Blue Cross and Blue Shield plans in four other states. The insurer said in a news release that it submitted paperwork to the Montana Commissioner of Securities and Insurance as well as the Montana attorney general. Under the transaction, the companies will contribute about $120 million to set up a charitable foundation focused on improving quality and access to healthcare programs in Montana. Health Care Service Corp. will spend about $18 million to acquire some of the assets of Montana Blues and will assume certain liabilities (Kutscher, 11/16).

(Helena, Mt.) Independent Record: Blue Cross Montana Files Documents On Merger, Will Create $100 Million-Plus Foundation
Blue Cross said Friday that merging with a large nonprofit will preserve Blue Cross’s longstanding mission and nonprofit status, while giving it access to capital and other services it will need to compete in a dramatically changing health insurance market. ... Blue Cross will be transferring the business of its 274,000 customers to HCSC, along with assets such as its provider network of 2,000 physicians, all Montana hospitals and 2,800 other health care providers. Blue Cross is calling the transaction an “alliance” with HCSC, and says it will maintain its name and operate locally with the same local management team, although its employees will become employees of HCSC (Dennison, 11/16).

The San Francisco Chronicle: Nurses To Strike Bay Area Hospitals Again
Registered nurses represented by the California Nurses Association have barely had time to put away their picket signs from the last strike, and they're preparing to walk off their jobs again over a long-standing contract dispute. Unionized nurses plan to strike Tuesday at a number of Bay Area hospitals operated by Sutter Health, the largest being Alta Bates Summit Medical Center in Oakland and Berkeley. This will be the seventh strike against Sutter since September 2011 and the second one this month (Colliver, 11/18).

The Seattle Times: Hospital Cuts Add To Oversupply Of Health-Care Workers
A dozen years ago, hospital leaders, state officials and political leaders were wringing their hands about a looming shortage of nurses and other health-care workers. Hospitals were expanding, and health-care workers — particularly the most highly trained nurses — could almost pick and choose their jobs. But a combination of events, including the recession, hospital cost-cutting and a sharp increase in the number of workers being trained, revised that equation (Ostrom, 11/18).

The Miami Herald: Fallout From Privatizing Prison Health Care: Layoffs
Nearly 2,000 state workers are being displaced from Florida Gov. Rick Scott's administration because of the nation's biggest outsourcing of prison health care. "Due to the outsourcing of this function, your position will be deleted," reads a dryly worded dismissal notice from the Department of Corrections, sent to 1,890 state employees in the past two weeks. ... The latest outsourcing is still not a sure thing. Labor unions representing many affected workers will be back in court Monday, challenging the state’s authority to outsource health care without specific legislative direction (Bousquet, 11/18).

Related KHN story: States Efforts To Outsource Prison Health Care Come Under Scrutiny

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Editorials and Opinions

Viewpoints: 'Bad Idea' About Repealing Medicare Cost Board; Conservatives Say Health Law Repeal Fight Is Not Over

The New York Times: A Bad Idea Resurfaces
House Republicans like to talk about the need to find common ground with President Obama to make progress on important national issues, especially after the election. Yet within days, they were setting an agenda to eliminate an important element of his signature domestic achievement, the Affordable Care Act. Representative Eric Cantor of Virginia, the majority leader, recently proposed that House Republicans set their sights on repealing the part of the law that creates an independent board that is supposed to help limit growth in Medicare spending (11/17).

USA Today: 'Another Federal Power Grab'
It's really far past time for us to call ObamaCare what it truly is: an unprecedented government overreach into every American's life, forcing higher costs on individuals, practitioners, employers and state governments in lieu of actually fixing our health care system (Texas Gov. Rick Perry, 11/8). 

USA Today: ObamaCare Resisters Get With The Program
[T]he Affordable Care Act has survived everything its opponents threw at it and is on track to take full effect starting in 2014. And that's a good thing: It means the USA can finally join the rest of the world's industrial democracies in guaranteeing that most of its citizens have health coverage. But some politicians, like Japanese soldiers who hid in the jungle for years after the end of World War II, are determined to battle on (11/18).

The Wall Street Journal: Why ObamaCare Is Still Not A Sure Thing
The Patient Protection and Affordable Care Act won't be fully repealed while Barack Obama is in office, but the administration is heavily dependent on the states for its implementation. ...states still have two key choices to make that together will put them in the driver's seat: whether to create state health-insurance exchanges, and whether to expand Medicaid. They should say "no" to both (James C. Capretta and Yuval Levin, 11/18).

HealthyCal: Health Is About More Than Health Care
But for all the hype and controversy over the Affordable Care Act, the law is really more about insurance than health. Insurance coverage is a good thing. But by itself it is not likely to make Californians much healthier. Chronic disease, which can often be prevented and can almost always be managed, accounts for 75 percent of all deaths in California and a similar percentage of health care costs (Daniel Weintraub, 11/18).

Kansas City Star: Needed: Honest Analysis Of Medicaid Expansion In Missouri, Kansas
The U.S. Supreme Court ruling upholding the constitutionality of the individual insurance mandate in President Barack Obama's health reform law also handed a huge decision to state governments [about Medicaid expansion]. ... Before leaders rule out expanding Medicaid eligibility, however, they owe it to constituents to obtain a thorough and honest analysis of the impact. Some preliminary studies indicate states may come out ahead financially (11/17).

The Washington Post: The 'Fiscal Cliff' Deal We Need
Liberal groups are already mobilizing against cuts in Social Security and Medicare. Republican hostility to tax increases runs deep. These objections are overblown. Millions of comfortable retirees can afford Social Security cuts or higher Medicare premiums and remain comfortable. Likewise, modest tax increases have "a small [economic] growth impact when tax rates are low or moderate," argue economists Nir Jaimovich of Duke University and Sergio Rebelo of Northwestern University (Robert J. Samuelson, 11/18).

The Boston Globe: Language Can Be Barrier Between Doctor, Patient
Studies have shown that patients who do not speak English generally fare worse in our health care system. They are often diagnosed with more advanced disease, have difficulty taking medications as prescribed, and spend more time in the hospital. Medical interpreters are essential in bridging this gap, lending meaning to our interactions with non-English-speaking patients (Dr. Kiran Gupta, 11/19).

The Philadelphia Inquirer: When New Drugs Cost Too Much, We Can Just Say No
In health care, we tend to assume that newer is always better. But sometimes it is not. It just runs up the bill. ... Last month, when confronted with an unpalatable price for a new drug, Memorial Sloan-Kettering Hospital in New York just said no and declined to purchase it. And their refusal worked. Faced with the loss of business from one of its largest and most prestigious customers, the manufacturer, Sanofi, agreed to grant a 50% discount (Robert I. Field, 11/16).

Minnesota Public Radio: State Strategy Places Substance Abuse Emphasis Where It Belongs
Substance abuse may be the greatest public health and safety issue facing our community, state and nation. It costs our nation more than $510 billion a year, ... Unfortunately, our emergency rooms, jails, homeless shelters and prisons have become an expensive alternative to treatment for so many suffering the chronic illness of substance abuse. This is particularly unfortunate when we have so many quality community-based prevention, treatment and recovery centers (Heidi Kammer, 11/19).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.