Daily Health Policy Report

Tuesday, November 20, 2012

Last updated: Tue, Nov 20

KHN Original Reporting & Guest Opinion

Fiscal Cliff

Health Reform


Public Health & Education

Coverage & Access

Health Care Fraud & Abuse

Health Information Technology

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insuring Your Health: Advocates Of Medical Marijuana Face Another Hurdle: Insurance Coverage

In her latest Kaiser Health News consumer column, Michelle Andrews writes: "With the passage of a ballot initiative this month, Massachusetts became the latest state to allow the use of marijuana for medical purposes, joining 17 others and the District of Columbia. But for patients who use marijuana to help alleviate chronic pain and nausea and stimulate appetite, legalization is only part of the battle. Health insurance rarely if ever covers its use; some patients spend hundreds of dollars a month or more on the drug. The situation may not change anytime soon, some experts say" (Andrews, 11/19). Read the column.

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Capsules: Uninsured Die At Higher Rate After Brain Surgery, Study Finds; States Detail Questions About Their Exchange Options; Survey: Maryland Voters Know Little About Federal Health Law; NFL Records Go High-Tech

Now on Kaiser Health News' blog, Alvin Tran reports on a study involving mortality rates, brain surgery and people without insurance: "According to the findings of a new study by Johns Hopkins University researchers, uninsured patients died at a higher rate after receiving brain surgery to remove cancerous tumors than those with private insurance. Uninsured patients had a death rate of 2.6 percent, compared to 1.3 percent among the privately insured, a statistically significant difference" (Tran, 11/20).

Also on Capsules, Ankita Rao reports on some states' questions about health insurance exchanges: "Iowa Gov. Terry Branstad said Friday that he will build a health exchange in his state – as soon as the Obama administration can explain exactly what that means. The Republican governor submitted 50 questions to Health and Human Services Secretary Kathleen Sebelius about how the state-built online insurance markets are supposed to be set up. … Branstad and New Jersey Gov. Chris Christie, also a Republican, are more public than some other state leaders in their criticism of the health law, but they are not the only ones demanding answers on how the exchanges must be set up. A National Association of Insurance Commissioners committee is compiling a working document of state queries about exchange regulations, which had 40 questions as of Monday afternoon" (Rao, 11/19).

In another post, Tran reports on a survey exploring how much Maryland voters know about the health law: "Although Maryland is a leader in implementing major provisions of the federal health law, many of its voters are still unsure of what changes are actually in store for them. The results of a new poll, released Monday, found that while the majority of Maryland voters support the measure, only 30 percent of survey respondents know a lot about its specific provisions" (Tran, 11/19).

And Shefali S. Kulkarni reports on how NFL medical records are going high tech: "Given the increased interest in providing better care for players, including more emphasis on concussions, National Football League officials announced Monday a new way to track and treat injuries. The NFL said it is implementing an electronic health records system that will eventually be adopted by all 32 teams" (Kulkarni, 11/19). Check out what else is on the blog.

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Political Cartoon: 'An Ax To Grind?'

Kaiser Health News provides a fresh take on health policy developments with "An Ax To Grind?" by Nate Beeler.

Meanwhile, here is today's health policy haiku:


Turkey carcasses
Fuse legislative sausage
In lame duck caucus.
-Michael Reinemer

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

Dems Face Internal Divide On Medicare, Safety Net Questions

A split is evident on proposals to raise Medicare's eligibility age and increase premium costs for wealthier beneficiaries as part of a 'grand bargain' on the deficit, according to media reports.

The Wall Street Journal: Entitlements Split Democrats
With deficit talks kicking off in earnest, Democrats are divided on the magnitude of changes they would accept when it comes to overhauling Medicare and other safety-net programs. The party is split between those who would agree to major adjustments, including increasing premiums for wealthier beneficiaries and raising Medicare's eligibility age, and those who rule out such moves altogether. In the middle is a group that would tolerate some cuts as long as they didn't hit beneficiaries directly (Bendavid and Hook, 11/19).

Politico: Democrats Have Own Fiscal Cliff Issues
Senate Majority Leader Harry Reid (D-Nev.) will have to find 60 votes to extend just the middle-income tax rates — far from a given when a swath of the Senate's moderate Democrats are up for reelection in 2014. Reid and the White House will also need to navigate a hardening Democratic divide on entitlements. Progressives don't want any deep cuts that Republicans will insist on for a deal. But a Third Way poll of 800 Obama voters set for release Tuesday found that efforts to fix Medicare and Social Security enjoy broader support than liberals suggest (Sherman, Budoff Brown and Bresnahan, 11/19).

National Journal: Bold Medicare Reform May Require Going Beyond The CBO Score
Liberal Democrats would rather not see any cuts to entitlement programs — period. Instead, they argue, the U.S. government needs to put policies in place that will bring down the costs of health care overall. Make care cheaper to administer, the argument goes, and Medicare and Medicaid won't cost the federal government so much. It's a beguiling idea with one big flaw: The Congressional Budget Office isn't always able to put a dollar figure on how much money Democrats' ideas would save. As Washington negotiators work toward a debt-reduction deal, Democrats want reducing the cost of care to be part of the conversation. But budget negotiators want to be able to talk in dollars. CBO's scoring rules "much too much embed the status quo. They require levels of certainty about the costs and benefits that defy many forms of innovation," said Donald Berwick, a Center for American Progress senior fellow and former administrator of the Centers for Medicare and Medicaid Services (Quinton, 11/20).

Meanwhile, the prospect of cuts unnerves providers and others within the health industry  -

Medpage Today: 'Fiscal Cliff' Bad For Health $$$ Either Way
If the country falls off the dreaded "fiscal cliff" -- a series of mandatory federal spending cuts and tax increases -- at the end of next month, Medicare will see nearly $12 billion in spending cuts and the National Institutes of Health will lose money for about 700 grants. And that's just in one year. But as dire as that outlook sounds, long-term support of federal health programs could be even worse as lawmakers try to avert the cliff, health policy experts said here last week at a briefing on the topic sponsored by the Alliance for Health Reform (Pittman, 11/19).

Politico: Medicare Cuts Give Health Providers Jitters
The $716 billion in Medicare "cuts" that got so much attention in the presidential election have already begun sinking their teeth into health care providers. And there are widespread jitters that any further cuts as part of a year-end deal to stave off sequestration or strike a "grand bargain" for a long-term fiscal deal would deeply gouge some providers, if not put them out of business (Norman, 11/20).

Kansas Health Institute News: Rural Hospitals Bracing For Change On Multiple Fronts
In small towns like this across Kansas, hospital administrators are paying close attention to federal deficit-reduction talks in Washington, D.C. that could lead to a 2 percent cut in Medicare spending, starting Jan. 1."Two percent may not sound like much," said Vicki Hahn, who runs the Wichita County Health Center in Leoti. "But we're a 'critical access hospital,' which means we're reimbursed for 101 percent of our Medicare costs. If 2 percent gets taken away, it would put us in the red on our Medicare patients. That wouldn't be good"… A cut in Medicare reimbursement, Hahn said, would force the hospital to ask the Wichita County Commission for help in offsetting the loss of federal support (Ranney, 11/19).

And Alice Rivlin offers her insights regarding prospects for success -

The Wall Street Journal's Washington Wire: Rivlin Sees A Two-Step Plan To Avoid The Fiscal Cliff
Alice Rivlin, who once led both the congressional and White House budget offices, says a two-step solution can get Washington past the so-called fiscal cliff at year's end and set the table for a long-term budget solution. … She also said she continues to favor finding ways to introduce more competition into the Medicare program. Under "premium support," the approach House Budget Committee chairman and Republican vice presidential nominee Rep. Paul Ryan has advocated, the government helps senior citizens pay the premiums on health policies they acquire on their own (Seib, 11/19).

Meanwhile, the man behind the GOP tax pledge is facing pressure too -

The New York Times: For Tax Pledge And Its Author, A Test Of Time
Next to the oath of office, it has been perhaps the most important commitment that Republicans in Congress can make. It is called simply "the Pledge," and its enforcer is such a fixture in the party that he is known simply by his first name, Grover. … But the pledge and its creator, Grover Norquist, a 56-year-old conservative lobbyist, have never before faced a test as they do now. The federal deficit stands at $1 trillion. The social safety net continues to grow — and, in the case of Medicare and Social Security, remains hugely popular. And unless the two parties can agree on a fiscal plan before Jan. 1, hundreds of billions of dollars of tax increases will go into effect automatically, meaning that Congress does not even need to act for taxes to rise (Peters, 11/19).

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Health Reform

As HHS Gears Up For Health Exchanges, States Wrestle With Policy Choice

Oklahoma has opted not to proceed with a state-based exchange or with the Medicaid expansion, while Republican governors from Tennessee, Utah and Iowa continue to press the Department of Health and Human Services for more guidance.

Politico: Next Up For Obamacare: Launching The Exchanges In 2014
Now that the elections saved the health care law from the threat of repeal, the Obama administration and its backers are turning their attention toward getting the law right — before the next elections come around in 2014 (Haberkorn, 11/20).

Politico: HHS Looks To Step Up Role In Health Exchanges
The last thing the Obama administration wanted to do was come into a bunch of states and start running health insurance exchanges. But when the new insurance marketplaces open for business late next year, it's clear that the Department of Health and Human Services will have a much bigger job than it wanted (Millman, 11/20).

The Associated Press: State-Run Health Care Exchange Nixed
Oklahoma will not establish a state-run health insurance exchange under the federal health care law or expand its Medicaid eligibility to provide coverage to thousands of low-income, uninsured citizens, Gov. Mary Fallin announced Monday. The Republican governor's move puts Oklahoma's insurance exchange, required under the health care reform law, in the hands of the federal government (Murphy, 11/19).

Tulsa World (Oklahoma): Fallin Rejects Health-Care Exchange
The decision means Oklahoma will not do anything to accommodate the federal health-care law known as "Obamacare." It also means the state will skip an opportunity to help some 693,000 uninsured Oklahomans, 18.7 percent of the state population, get coverage through the federal government (Greene, 11/20).

Politico Pro: Utah Asks HHS About ACA Exchanges
Almost three years after President Barack Obama's health care law passed, Utah still doesn't know how its small-business exchange fits into the picture. On Monday, Utah Gov. Gary Herbert sent HHS Secretary Kathleen Sebelius a list of 10 "critical questions" about federal exchanges — and he says he needs answers before making any decision about the future of Utah's exchange. Herbert asked Sebelius a variety of questions about a federal exchange's regulatory powers, costs and consumer relations. He asked what a federal exchange would cost the state, taxpayers and the private sector, and how the federal exchange would handle existing state laws. Herbert also wanted know how Utah's existing systems would "link" to the federal exchange (Millman, 11/19).

The Associated Press: Haslam Blames Feds For Delay In Health Care Choice
Republican Gov. Bill Haslam (of Tennessee) said Monday that a lack of information from the White House is delaying a decision about whether the state should run its own health insurance exchange under the new federal health care law. Haslam told reporters that President Barack Obama's administration has refused to address a series of questions about the health insurance marketplaces raised by Republican governors, including whether states would be able to create wellness-based incentives to encourage healthy behavior (Schelzig, 11/19).

Kaiser Health News: Capsules: States Detail Questions About Their Exchange Options
Iowa Gov. Terry Branstad said Friday that he will build a health exchange in his state – as soon as the Obama administration can explain exactly what that means. The Republican governor submitted 50 questions to Health and Human Services Secretary Kathleen Sebelius about how the state-built online insurance markets are supposed to be set up. … Branstad and New Jersey Gov. Chris Christie, also a Republican, are more public than some other state leaders in their criticism of the health law, but they are not the only ones demanding answers on how the exchanges must be set up. A National Association of Insurance Commissioners committee is compiling a working document of state queries about exchange regulations, which had 40 questions as of Monday afternoon (Rao, 11/19).

The Hill: Bipartisan Bill Would Widen Exemption From Health Insurance Mandate
New legislation would allow people an exemption from the healthcare mandate by filing an affidavit with the IRS. Those seeking the exemption would be required to tell the IRS that they don't have insurance because of their religious beliefs. If those seeking the exemption later used healthcare services under the law, they would lose their eligibility for the exemption from buying insurance and would have to pay a penalty. The bill, H.R. 6597, has drawn the support of more than two dozen Democrats, including Reps. Carolyn Maloney (N.Y.) and Barney Frank (Mass.). It is also supported by more conservative Republicans, including libertarian Rep. Ron Paul (R-Texas) (Kasperowicz, 11/19).

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The IRS Gears Up For Health Law Tasks; Fine-Tuning Health Law Messages

News outlets report on the moving parts involved in the next phase of the health law's implementation. Meanwhile, legislators consider what the sweeping measure might mean for their states.

Politico: Can The IRS Handle Obamacare?
Now that the health care law's future is finally secure, it's up to the Internal Revenue Service to make sure the money flows. ... The agency is charged with shouldering some of the law’s most nitty-gritty technical details, from making sure Americans receive the insurance premium tax credits they’re eligible for, to incorporating more than 40 changes to the Tax Code, to collecting penalties from individuals and businesses that fail to meet the law’s insurance requirements (Cunningham, 11/20).

CQ HealthBeat: Enroll America Gears Up For Coverage Expansion Effort
Those spearheading a broad-based, privately funded educational campaign to enroll the uninsured in health plans as part of the health care overhaul are in the closing stages of pinpointing what messages they will use and which audiences the effort will target. The campaign's goal is to fully develop its strategy by year's end and to launch in mid-2013, in time for the Oct. 1 start of the open enrollment period in the new state insurance exchanges (Reichard, 11/19).

The Associated Press: Indiana Legislative Leaders Ponder Health Costs
Indiana's top lawmakers said Monday they're not sure what to expect from the federal health care law other than greater costs at a time the state's budget is already stretched thin. Republican Senate President Pro Tem David Long said the state no doubt would have to absorb some hidden expenses, even if the federal government sets up Indiana's online exchange allowing consumers and businesses to shop for insurance. That coupled with a potential Medicaid expansion could make the law a long-term burden on Indiana taxpayers, he said (LoBianco, 11/19).

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Federal Judge Grants Temporary Injunction In Bible Publisher's Contraception Rule Challenge

In separate action, another judge ruled against Hobby Lobby's effort to be exempted from the contraception mandate.

The Washington Post: Judge Grants Company Injunction Against Health Care Law Contraception Efforts
A federal judge on Friday temporarily prevented the Obama administration from forcing a Christian publishing company to provide its employees with certain contraceptives under the new health care law. U.S. District Judge Reggie Walton granted a preliminary injunction sought by Tyndale House Publishers, which does not want to provide employees with contraceptives that it equates with abortion (Frommer, 11/19).

CQ HealthBeat: Bible Publisher Wins Temporary Injunction Against Birth Control Rule
A third private company has won a temporary injunction against a Department of Health and Human Services rule that requires employers to provide workers with no-cost birth control in their health insurance policies. Judge Reggie B. Walton issued a ruling Friday in U.S. District Court for the District of Columbia in favor of Tyndale House Publishers, a publishing company that produces Bibles and biblical commentaries, books about family issues and other Christian-oriented material. The for-profit company, based in Carol Stream, Ill., employs 260 workers and is owned primarily by a nonprofit religious foundation. The injunction applies only to Tyndale and not any other employers. Private companies owned by individuals with religious objections to the rule have gotten the most legal traction so far in more than 30 legal challenges filed to the HHS rule, rather than religious-affiliated colleges or charities that also object to the requirement (Norman, 11/19).

Reuters: Court Rejects Hobby Lobby's Challenge To Contraceptive Mandate
A federal judge on Monday denied a legal challenge to President Barack Obama's signature health reforms, ruling that the owners of a $3 billion arts and crafts chain must provide emergency contraceptives in their group health care plan. The owners of Hobby Lobby asked to be exempted from providing the "morning after" and "week after" pills on religious grounds, arguing this would violate their Christian belief that abortion is wrong (Olafson, 11/19).

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Unjustified Repeat Tests Common Among Medicare Patients

Dartmouth researchers found that up to half of older adults who had a heart, lung, stomach or bladder test had the same procedure repeated within three years despite guidelines against routine testing, leading to unnecessary costs.

Reuters: Repeat Testing Common Among Medicare Patients
In a new study, up to half - or more - of older adults on Medicare who had a heart, lung, stomach or bladder test had the same procedure repeated within three years. Those tests typically aren't supposed to be routinely repeated, researchers said. For some of them, such as echocardiography and stress tests for heart function, there are recommendations specifically against routine testing (Pittman, 11/19).

Modern Healthcare: Repeat Testing Common With Medicare Patients: Study
The study [in the Archives of Internal Medicine], which was led by Dr. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Research, analyzed testing patterns for a random sample of 5% of Medicare patients, and also looked at the proportion of repeated tests in the 50 largest metropolitan areas (Kutscher, 11/19). 

Medpage Today: Repeat Testing Common In Older Patients
[T]he rate of repeat testing varied widely from place to place, suggesting doctors in some regions are more likely to order repeat exams ... The finding has "important implications not only for the capacity to serve new patients and the ability to contain costs but also for the health of the population," they argued. Although the risks of the tests themselves are not great, they could substantially increase rates of incidental detection and overdiagnosis, Welch and colleagues concluded (Smith, 11/19).

Medscape: Medicare Patients Often Receive Unjustified Repeat Tests
In an accompanying commentary, Jerome P. Kassirer, MD, from Tufts University School of Medicine, Boston, Massachusetts, and Arnold Milstein, MD, MPH, from Stanford University School of Medicine, Palo Alto, California, write: "After decades of attention to unsustainable growth in health spending and its degradation of worker wages, employer economic vitality, state educational funding, and fiscal integrity, it is discouraging to contemplate the fresh evidence by Welch et al of our failure to curb waste of health care resources"  (Kelly, 11/19).

In other Medicare news --

Bloomberg:  Hospital Medicare Cash Lures Doctors As Costs Increase
Thomas Lewandowski, a Wisconsin heart doctor, was faced with a dilemma after his Medicare payments were cut and his overhead costs soared: Fire half his staff to keep his practice open, or sell it to a local hospital. He decided to sell, becoming one of more than 6,000 employees at Thedacare, which runs five hospitals and numerous clinics in northeast Wisconsin. It’s a decision being made increasingly in the U.S., creating a new dynamic that threatens to raise the price of health care (Pettypiece, 11/19).

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Public Health & Education

Panel Backs Routine HIV Screenings For Teens, Adults

The U.S. Preventive Services Task Force advises that nearly everyone ages 15 to 64 should be screened for the HIV virus, a recommendation which, if adopted, would require Medicare and most private health insurers to pay for the tests.

USA Today: Panel Recommends Routine HIV Tests For Teens, Adults
In a broad new expansion of HIV screening, an influential government panel now says everyone ages 15 to 65 should be tested for the virus that causes AIDS. The draft recommendation, issued Monday by the U.S. Preventive Services Task Force, is far broader than its last recommendation in 2005, which called for screening only those at high risk (Szabo, 11/19).

Los Angeles Times: U.S. Panel Advises HIV Tests For Everyone Ages 15 to 64
Nearly everyone ages 15 to 64 should be screened for HIV even if they're not at great risk for contracting the virus, according to new guidelines proposed by an influential panel of medical experts. If the panel ultimately adopts those recommendations, Medicare and most private health insurers will be required to pay for the tests (Mestel, 11/19).

The Wall Street Journal: Health Panel Backs Broad HIV Tests
[I]f finalized, private insurers would have to pay for the test. Past recommendations haven't always been embraced by doctors. But in this instance, the weight of medical evidence has already been trending in favor of screening and earlier treatment of people with HIV (Burton and McKay, 11/19).

The Associated Press: New Push For Most In US To Get At Least 1 HIV Test
And if finalized, the task force guidelines could extend the number of people eligible for an HIV screening without a copay in their doctor's office, as part of free preventive care under the Obama administration's health care law. Under the task force's previous guidelines, only people at increased risk for HIV—which includes gay and bisexual men and injecting drug users—were eligible for that no-copay screening (Neergaard, 11/20).

CNN: New Draft Recommendations Issued For HIV Testing
The USPSTF says screening after 64 is usually unnecessary unless there is a continuing risk of infection. The group says the new draft recommendations will allow for early detection and treatment. Early treatment with antiretroviral therapy reduces the risk of AIDS-related complications and the likelihood of transmission (Young, 11/19).

Bloomberg: HIV Screening Recommended For All Americans Older Than 15
Those with the highest risk, which includes gay men and those who use injection drugs, should be tested every year. The task force, based in Rockville, Maryland, is a panel of medical professionals, composed mostly of primary care providers. The draft guidelines on HIV have been posted for public comment on the group’s website. Comments may be submitted from Nov. 20 to Dec. 17 (Lopatto and Langreth, 11/20).

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Questions Continue Over State, FDA Oversight Of Specialty Pharmacies

Several news outlets analyze the hearings last week into the meningitis outbreak resulting from a New England compounding pharmacy.

The Associated Press/Boston Globe: Senate Questions Pharmacy Boards After Outbreak
A Senate committee investigating the deadly outbreak of meningitis wants to know how regulators in all 50 states oversee specialty pharmacies like the one that triggered the illness. The Senate Committee on Health, Education, Labor and Pensions sent letters Monday to all 50 state boards of pharmacy, seeking details about their oversight of compounding pharmacies (Perrone, 11/19).

The New York Times: Deaths Stir A Dispute On Powers Of FDA
The issue is that New England Compounding identified itself as a compounding pharmacy, a practice that is supposed to involve making unusual drug formulations to fill prescriptions for individual patients with special needs. Compounding is legal on a small scale, and does not have to follow the strict rules that apply to mass-produced drugs. It is generally regulated by states rather than the federal government, which has jurisdiction over manufacturers (Grady, 11/19).

Reuters: Amid Meningitis Crisis, Critics Say Medicare May Promote Risky Drug Compounding
As long as a physician has prescribed a compounded drug, Medicare as well as some private insurers cover it even if the Food and Drug Administration has approved a version of the drug from a pharmaceutical manufacturer. ... HHS spokesman told Reuters that if the FDA finds that a company is producing compounded drugs in violation of the law, "Medicare will not reimburse for drugs produced in that facility." But because the FDA's authority over compounding pharmacies is severely limited, "we urge Congress to strengthen FDA's authority" (Begley, 11/19).

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Coverage & Access

40 Percent Of Vets Have Little Understanding Of Benefits Due Them

McClatchy: VA Outreach Lags As Many Veterans Unaware Of Benefits
More than half of America's veterans say they have little or no understanding of the benefits due them, despite efforts over recent years to match returning soldiers with the help and services they need. An analysis of Department of Veterans Affairs survey data found that younger veterans – those who served in the post-9/11 war period – are better versed in their benefits. But even among those veterans, 40 percent say they have little or no understanding of their benefits, a figure that climbs to two-thirds for those unfamiliar with life insurance benefits available. The VA said it's working hard to boost benefits awareness and has taken steps in recent years to do so (Adams, 11/19).

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Health Care Fraud & Abuse

Health Care Executives Accused Of Insider-Trading Scheme

The Wall Street Journal: Health Care Executives At Center Of Alleged Insider-Trading Scheme
Secrets passed at recreational basketball games, code words and calls on a pay phone outside a Virginia K-Mart marked what prosecutors say was a five-year insider-trading scheme fueled by corporate secrets leaked by health care executives. Federal prosecutors in New Jersey have accused six men -- including former executives at pharmaceutical company Celgene Corp. and medical-technology firm Stryker Corp. and some of their high-school friends -- of passing corporate secrets about their companies and using that information to make profitable trades. The scheme allegedly began in 2007, involved 11 corporate announcements and resulted in more than $1.4 million in illicit profits (Bray, 11/19).

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Health Information Technology

NFL To Track Player Health With Electronic Medical Records

The goals are to give better medical treatment to players and an easier way to track health issues such as concussions and dementia.

WBUR: NFL, EClinicalWorks Team Up On Electronic Health Records
The NFL is teaming up with Westborough medical technology company eClinicalWorks to improve the way it monitors players' health and safety. The deal with eClinicalWorks will last 10 years and is worth as much as $10 million. The company will create an online database of players’ health records which will help with treatment. It will also help researchers studying long-term health issues such as concussions and dementia. "Relationships like ones we've done with the NFL should obviously help us further grow and add more to the jobs and growth in Westborough and across the country," said eClinicalWorks CEO Girish Kumar Navani (WBUR Newsroom, 11/19).

Kaiser Health News: Capsules: NFL Records Go High-Tech
Given the increased interest in providing better care for players, including more emphasis on concussions, National Football League officials announced Monday a new way to track and treat injuries. The NFL said it is implementing an electronic health records system that will eventually be adopted by all 32 teams (Kulkarni, 11/19).

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State Watch

State Roundup: Larger-Than-Expected Medicaid Enrollment In Conn.

A selection of health policy stories from Connecticut, Colorado, Texas, California, Maryland and Florida.

CT Mirror: Medicaid Mystery: Who Are All The News Members?
Ron Harney is still looking for work after being laid off from his marketing firm job three years ago. He's used up nearly all of his savings and says he's grateful for the state's Medicaid program, which covers the medical care he needs to manage his HIV. … Harney is part of a group that took state officials by surprise, one of more than 37,000 people who joined a new portion of the Medicaid program since it was created in 2010 to replace a state-funded form of coverage. Enrollment in the program, Medicaid for Low-Income Adults, or LIA, now tops 83,000, including 46,156 who were in the predecessor program. That's far higher than had been anticipated or budgeted for by the state, which didn't expect that many enrollees until next August (Becker, 11/20).

The Texas Tribune: Bill Renews Debate Over Rural Access To Abortion
Before Texas' abortion sonogram law passed last legislative session, some women seeking to end pregnancies in rural communities relied on telemedicine, with physicians -- working in partnership with medical technicians or nurses -- administering prescription drugs via videoconference to induce early-stage abortions. If new legislation filed by Sen. Dan Patrick, R-Houston, passes in 2013, women in remote corners of the state may have even fewer options to get the procedure (Aaronson, 11/20).

California Healthline: Covered California's Plans To Become Self-Sufficient
California's health benefit exchange, now also known as Covered California, eventually is supposed to run by itself without state or federal money. The exchange board took a couple of steps toward that end at Wednesday's board meeting. It released its draft Level II establishment grant proposal, which now will be forwarded to federal officials. The proposal is a blueprint for how the exchange will operate in California. As part of the proposal, exchange officials laid out plans for the exchange to be self-sufficient by 2017 (Gorn, 11/20).

Modern Healthcare: Four Colo. ASCs File Antitrust Lawsuit
Four Colorado ambulatory surgery centers have filed an antitrust lawsuit in U.S. District Court in Denver against HCA, HCA-HealthOne, Centura Health, the Colorado Ambulatory Surgery Center Association and Kaiser Foundation Health Plan of Colorado charging them with anti-competitive activities and restraint of trade agreements. The ASC plaintiffs accuse the defendant hospital systems of abusing their market share power to convince Kaiser not to sign a contract that it had negotiated with one of the ASCs and attempting to further use their market power to influence other health insurance companies that do business in Colorado from putting the ASCs in their provider networks (Robeznieks, 11/19).

California Healthline: Saving Money, Lives With Mental Health Program
A new study by the UCLA Center for Healthier Children, Families and Communities suggests an intensive and integrated mental health program called Full Service Partnerships is likely to save the state money at a return rate of $1.27 for every dollar spent. The FSP program is designed to care for individuals with serious mental illness by taking a holistic approach to their care, according to Renay Bradley, chief of research and evaluation at the UCLA center (Gorn, 11/20).

Baltimore Sun: Insurer To Pay $3 Million To Avoid Prosecution In Medicare Case
A Bethesda-based insurance company that gained advantage over competitors by allowing its employees to inappropriately access a federal Medicare database has agreed to pay the federal government $3 million to avoid criminal prosecution, according to the Maryland U.S. attorney's office. According to an agreement with prosecutors, top officials at Coventry Health Care Inc., which is incorporated in Delaware but headquartered in Bethesda and provides group and individual health insurance to some five million members nationally, knew of the inappropriate use of the database and did nothing to stop it until a federal agency raised concerns (Rector, 11/19).

San Jose Mercury News: Nurses To Strike At 10 Bay Area Hospitals Beginning Tuesday
For the second time in three weeks, hundreds of registered nurses will walk off the job at Bay Area hospitals beginning at 7 a.m. Tuesday in their lengthy dispute over a new contract. This will mark the seventh time since September 2011 that the California Nurses Association/National Nurses United has gone on strike at Sutter Health facilities in the East Bay. Their last walkout was Nov. 1 (Kleffman, 11/19).

Kaiser Health News: Capsules: Survey: Maryland Voters Know Little About Federal Health Law 
Although Maryland is a leader in implementing major provisions of the federal health law, many of its voters are still unsure of what changes are actually in store for them. The results of a new poll, released Monday, found that while the majority of Maryland voters support the measure, only 30 percent of survey respondents know a lot about its specific provisions (Tran, 11/19).

The Miami Herald: Legislature Doesn't Need To Approve Increase In Doctors' Pay, Says Spokeswoman
A spokeswoman for incoming Senate President Don Gaetz said Monday that the Legislature does not have to take any action in order for Florida's primary care doctors to start receiving increased Medicaid payments starting Jan. 1 -- the first time that providers will received direct financial benefits from Obamacare. That position directly contradicts statements last week from the office of Gov. Rick Scott and from the Agency for Healthcare Administration, which said the Legislature or the Legislative Budget Commission needed to approve the increased payments (Dorschner, 11/19).

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Editorials and Opinions

Viewpoints: Papa John's Complaint; Renewed Criticism Of Justice Roberts; Calif. Voters Rout Food Police

The Wall Street Journal: Picking On Papa John's
If ObamaCare negatively impacts your business, you better not complain about it. That's what Papa John's CEO John Schnatter found out when he announced the health-care law would increase the price of a pizza by up to 14 cents. ... But Papa John's isn't the only restaurant chain to complain that the Affordable Care Act is bad for business (Matthew Payne, 11/19).

Health Policy Solutions (a Colo. news service): With Health Reform Moving Forward, Costs Remain An Issue
Here we are, billions of political ads later, facing the same challenges from before the election.  In health care, now that the Supreme Court ruled the Affordable Care Act constitutional and it is unlikely to be repealed, the work starts on implementation and discussion about health insurance exchanges. … So it again comes down to the basic problem: we pay too much for the quality we receive in health care.  In your business, Colorado, the state, and the country, the same problem exists.  That solution is a debate yet to come politically, but it is inevitable. (Dr. Ted Norman, 11/19).

Politico: President Obama Won, But Obamacare Didn't
During the campaign, President Barack Obama minimized discussion of his first term's most consequential new law: the Patient Protection and Affordable Care Act, or what's commonly referred to as Obamacare. That was no accident. Undoubtedly, the campaign knew that Obamacare is, as it always has been, deeply unpopular with the American people. In fact, Obamacare epitomizes the public's greatest concerns about this administration: the massive expansion of government and failure to deliver a new era of post-partisanship to Washington, since the law was jammed through using a party line vote and every available legislative trick (Carrie Lukas, 11/20).

The Wall Street Journal: Liberal Man Of The Year
But none of his colleagues can compete with the media acclaim cascading over Chief Justice John Roberts after his solo decision upholding the Affordable Care Act this June. The editors of Esquire have included Chief Justice Roberts in their December "Americans of the Year" issue, praising his "nimbleness." ... Such is the strange new respect a conservative receives for sustaining liberal priorities. Our own view is less effusive (11/19).

Myrtle Beach Sun News/McClatchy: No More Health Care Russian Roulette
Officials in Washington, D.C., Columbia and elsewhere are scrambling to figure out just how to embrace the Affordable Care Act now that President Barack Obama has been re-elected. ... They also need to keep in mind stories such as Shannon Sherman’s. Sherman and her husband Jeff spent the past couple of decades doing what we all are encouraged to do, paying down debt, living within their means and being responsible citizens. … They had been making it without (health insurance) until one day several weeks ago when a brain aneurysm blew them off course, instantly thrusting them into the debt they had so meticulously avoided. The bills, so far, amount to at least $80,000, and that includes a 60 percent discount from one of the hospitals that treated her (Issac J. Bailey, 11/19).

The Spokesman-Review: (Medicaid) Expansion Right Course For State
The U.S. Supreme Court has upheld the underpinnings of Obamacare. President Barack Obama has won re-election, and by a comfortable margin in Washington. So it might seem like a fait accompli to accept the additional Medicaid funding that would expand coverage for the poor. But some health care observers are worried, because Medicaid expansion still requires legislative authority to proceed. ... Conservative Idaho formed a commission to look at this issue, and panelists came back with a unanimous decision to take the money. We think a close examination in Washington would arrive at the same conclusion (11/20).

The (Eugene, Ore.) Register-Guard: Executing Exchanges
While 20 of the nation's governors continue to rant and rail about the alleged expense and intrusiveness of the Obama administration's new health insurance exchange program, and another 11 continue to dither and scratch their heads about whether to participate, the remaining 19 governors are proceeding with plans to set up exchanges, which will allow households and small businesses without insurance to shop online for plans that suit their needs. … Oregon, which has been in the forefront of health care reform since setting up its Oregon Health Plan two decades ago, was among the first to join in the insurance exchange effort(11/20).

Medpage Today: The Medical Cost 'Fiscal Cliff'
I do expect that healthcare costs will be back on the radar fairly soon as discussions about the fiscal cliff intensify – and Medicare and Medicaid costs become critical to any long-term solution of "debt and deficit." And over the next year, as health care premiums for private insurance start to rise again, the subject will become part of hallway and water-cooler conversations. So do I think the provisions in the Affordable Care Act (ACA) will succeed in reeling in the rising costs of healthcare? Honest answer: Not really (Dr. Timothy Johnson, 11/19).

The Philadelphia Inquirer: Health Care And The Fiscal Cliff
Health care is part of the debate and discussion regarding the fiscal cliff and how the federal government might solve its near and long-term economic problems. Wharton Health Care Management Professor Jonathan Kolstad said that while there are health-care issues in resolving the immediate problem of the fiscal cliff, the long-term problem of deciding how the nation pays for health care extends beyond the Nov. 6 election and the Jan. 2 deadline (David Sell, 11/19).

The Wall Street Journal: The Food Police Are Routed At The Ballot Box
As Americans tuck into their turkey and dressing on Thursday, they might add one little item to the list of things for which they give thanks: the defeat of California's Proposition 37 on Election Day. That initiative would have made the Golden State the first and only to require the labeling of genetically modified foods. And its demise marks the death throes of a self-proclaimed "food movement" that urges ever-greater government intrusion into the nation's grocery stores and kitchens (Jayson Lusk, 11/19). 

The Washington Post: Time To End The War On Drugs
With his final election behind him, and the final attack ads safely off the air, President Obama now returns to his regularly scheduled programming — governing. Yet, the chatter about his second term agenda, from deficit reduction to immigration reform, ignores one critical issue: ending our nation's inhumane, irrational — and ineffective — war on drugs. Since its launch in 1971, when President Nixon successfully branded drug addicts as criminals, the war on drugs has resulted in 45 million arrests and destroyed countless families. The result of this trillion dollar crusade? Americans aren't drug free — we're just the world's most incarcerated population (Katrina vanden Heuvel, 11/19). 

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Alvin Tran

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2012 Kaiser Health News. All rights reserved.