Daily Health Policy Report

Wednesday, November 21, 2012

Last updated: Wed, Nov 21

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Information Technology

Health Care Marketplace

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Administration Releases New Health Law Rules For Insurers, Employers

Kaiser Health News staff writers Julie Appleby, Jay Hancock and Mary Agnes Carey report: "Long-awaited details on how insurers can structure health benefits and premiums for policies that will cover tens of millions of Americans starting in 2014 were released by the Obama administration Tuesday. The three proposed rules reaffirm key elements of the 2010 federal health law, including its requirement that insurers accept all applicants, even those with health conditions, and not charge higher rates based on health, gender or occupation" (Appleby, Hancock and Carey, 11/20). Read the story.

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Obama Administration Gives Smokers A Way Out Of Higher Insurance Premiums

Kaiser Health News staff writer Phil Galewitz reports: "The Obama administration on Tuesday effectively nullified a provision of the federal health law that would have allowed insurers in the small group market to charge smokers up to 50 percent more than nonsmokers. Under the proposed regulation, employees who use tobacco can avoid paying those higher premiums if they participate in a program to quit. The regulation also allows states to eliminate higher rates for smokers altogether" (Galewitz, 11/20). Read the story.

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Online Access To Docs Increases Office Visits, Study Finds

Colorado Public Radio's Eric Whitney, working in partnership with Kaiser Health News and NPR, reports: "Uncle Sam wants you to e-mail your doctor. A federal law passed in 2009 says that physicians have to start offering their patients online communication, or Medicare will start docking how much it pays them in the future. Some patients hope that having online access to their doctors will mean they can cut down on how often they have to go to the doctor's office. But new research suggests that patients with online access actually schedule more office visits" (Whitney, 11/21). Read the story.

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Political Cartoon: 'Pilgrims' Progress?'

Kaiser Health News provides a fresh take on health policy developments with "Pilgrims' Progress?" By Chris Weyant.

Meanwhile, here is today's health policy haiku:

INSURANCE COVERAGE FOR MEDICAL MARIJUANA

Pot as medicine?
Even after election,
some health plans have doubts.
-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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Health Reform

New Rules For 'Obamacare' Scrutinized By Insurers, Employers, States, Consumers

Long-awaited draft regulations offer new guidance to insurers, states and employers.

USA Today: Administration Unveils Health Care Regulations
The Obama administration released new health care regulations Tuesday that preclude insurers from adjusting premiums based on pre-existing or chronic health conditions, tell states what benefits must be included in health exchange plans, and allow employers to reward employees who work to remain healthy (Kennedy, 11/20).

The Washington Post: Obama Administration Officials Propose Altered Rules For Health Insurers
The Obama administration proposed new rules Tuesday that would loosen some of the 2010 health-care law’s mandates on insurers while tightening others. Certain health plans, for instance, would be able to charge customers higher deductibles than originally allowed under the legislation. But all plans would be required to cover a larger selection of drugs than under an earlier approach outlined by the administration (Aizenman, 11/20).

The New York Times: Administration Defines Benefits That Must Be Offered Under The Health Law
The proposed rules, issued more than two and a half years after President Obama signed the Affordable Care Act, had been delayed as the administration tried to avoid stirring criticism from lobbyists and interest groups in the final weeks of the presidential campaign (Pear, 11/20).

Los Angeles Times: Administration Affirms Key Mandates Of Healthcare Law
Consumer advocates, insurers and business groups were looking for signs the administration might try to modify some of the law's requirements as the federal government races to implement the legislation by the end of next year. But the proposed rules issued Tuesday hew closely to the Affordable Care Act (Levey, 11/20).

Kaiser Health News: Administration Releases New Health Law Rules For Insurers, Employers 
[A] quick review showed that no one group won everything it wanted. For example, insurers did not succeed in getting the government to phase-in a requirement that limits their ability to charge older applicants more than younger ones. And consumer groups, which wanted specific details on the benefits required in 10 broad categories, instead saw continued discretion given to state regulators to pick "benchmark" plans and benefits (Appleby, Hancock and Carey, 11/20).

The Wall Street Journal: States Get A Say In Health Law
The federal government also expanded requirements for prescription-drug coverage from previous proposals, but it left states with different options to choose from, as well as responsibility for enforcement. Some employer groups praised the rules for keeping new plan benefits in line with what is already offered by small businesses. But the insurance industry said the rules didn't go far enough to keep insurance costs down, particular for younger consumers (Radnofsky, 11/20).

Modern Healthcare: HHS Releases Proposed ACA Insurance Regulations
Starting in 2014, the Patient Protection and Affordable Care Act will make it illegal for health insurance companies to discriminate against people who have pre-existing conditions, which HHS estimates affect some 129 million nonelderly Americans. In the proposed rule, health insurance issuers would generally be barred from denying coverage for such conditions, and individuals would have new special enrollment opportunities in the individual market when they have certain losses of other coverage (Zigmond, 11/20).

NPR: Administration Lays Down Rules For Future Health Insurance
[T]he administration is laying out rules to govern the use of employer-provided "wellness programs." These popular programs encourage employees to meet certain health goals, such as losing weight, quitting smoking, or lowering cholesterol. The rules spell out that programs must not be "overly burdensome" and must provide a "reasonable alternative means of qualifying for the reward" for individuals whose medical conditions "make it unreasonably difficult, or for whom it is medically inadvisable, to meet the specified health-related standard" (Rovner, 11/20).

Kaiser Health News: Obama Administration Gives Smokers A Way Out Of Higher Insurance Premiums
[The rules] effectively nullified a provision of the federal health law that would have allowed insurers in the small group market to charge smokers up to 50 percent more than nonsmokers. Under the proposed regulation, employees who use tobacco can avoid paying those higher premiums if they participate in a program to quit (Galewitz, 11/20).

The Associated Press: HHS Details Overhaul Rules And Required Benefits
Having the federal government set minimum standards for what health insurance must cover is a departure from normal practice. Usually, insurance companies, their state regulators and employers play that role. But the Affordable Care Act requires that Washington establish a baseline for minimum coverage in areas that include inpatient and outpatient care, emergency services, maternity and childhood care, prescription drugs, preventive screenings and lab work  (Murphy, 11/20).

The Hill: HHS Releases Health Law Rules Requiring Pre-Existing Conditions Coverage
The regulations still leave key questions unanswered, including the structure of a federally run insurance exchange in the roughly 30 states that won’t set up their own. HHS officials said more information on the federal exchange will be coming soon. ... While the new rules don’t answer some questions for states, they do provide much-needed specifics for insurance companies that must prepare for new mandates set to take effect in 2014 (Baker, 11/20).

Medpage Today: HHS Proposes Rules On Key Parts Of ACA
The rules also mandate that insurers maintain separate statewide risk pools for the individual and small-employer markets, unless a state wants to combine the two. Premiums and rate changes would be based on the health risk of the entire pool (Pittman, 11/20).

McClatchy: Insurers' Duties Under Health Care Law Taking Shape
The rule’s final provision insures that young adults and people who can’t afford insurance will have access to catastrophic health coverage in the individual insurance market. Many of today’s proposed rules will help “ensure that consumers are protected from some of the worst insurance-industry practices,” [Gary Cohen, the director of the Center for Consumer Information and Insurance Oversight at the Department of Health and Human Services] said (Pugh, 11/20).

Politico Pro: Essential Benefits Rule: No Surprises, Some Gaps
The health care industry waited 11 months for the Obama administration's follow-up act to its essential health benefits bulletin. For many, Tuesday's EHB proposed rule felt like a repeat performance. Credit the administration's bulletin last year for spelling out what the proposed rule itself would look like. States will get to set benefits from a choice of certain plans, insurers will have some flexibility and HHS will be there watching over it all in some capacity (Millman, 11/20).

Politico Pro: HHS To States: Costs Of New Rules 'Minor'
In a section of its proposed rule titled "Costs to States," HHS estimates that although states "may need additional resources" to ensure that health plans in their exchange meet minimum coverage requirements, "these costs will be relatively minor." In the rule, HHS also notes that federal law prohibits Washington from imposing an "unfunded mandate" on states in excess of $139 million in a given year (Cheney, 11/20).

CQ HealthBeat: Lots Of Regs, But What About The Federal Exchange?
Missing from Tuesday’s massive release of hundreds of pages of proposed rules filling in the details of the sweeping redesign of the insurance market, set in motion 32 months ago by passage of the health care law, were details on an entity looming ever larger in delivering the fruits of that legislation: the federally facilitated exchange. By the end of the day, however, it appeared that officials had made considerable progress on the regulatory front, with insurers and states now having to scramble to conform to the new mandates (Reichard, 11/2).

CQ HealthBeat: Obama Administration Rolls Out Proposed Rule On Insurance Market Changes
The long-anticipated next steps in a complicated regulatory dance involving the federal government, states and health insurers were laid out by the Obama administration on Tuesday, and federal officials acknowledged that there is much more work ahead (Norman, 11/20)

CQ HealthBeat: Essential Health Benefits Proposal Gives States Flexibility, Expands Prescription Drug Requirements
The proposed rule also included standards on how the actuarial value of plans would be determined. Separately, the Centers for Medicare and Medicaid Services issued a guidance to states on the types of benefits that Medicaid programs must include if they expand coverage under the health care law. Under the essential benefits proposed rule, health plans in the individual and small-group markets — both in and outside of the new exchanges — would have to provide coverage in the 10 categories of services that the health care law requires (Adams, 11/20)

CQ HealthBeat: Proposed Rule Sets Standards For Wellness Programs 
[T]he maximum permissible rewards would increase in 2014 from the current ceiling of 20 percent of the cost of health coverage to 30 percent. However, the proposed regulation says that when it comes to programs designed to prevent or decrease tobacco use, the maximum reward could be increased to as much as 50 percent (Reichard, 11/20).

Reuters: U.S. Releases New Health Insurance Reform Rules
The proposed measures were likely to come under fire from healthcare reform opponents including a growing number of Republican governors who have rejected the provisions calling on states to operate their own healthcare exchanges beginning January 1, 2014. States have until December 14, under a newly extended deadline, to tell the Department of Health and Human Services whether they intend to pursue their own healthcare exchanges (Morgan, 11/20).

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Health Law Provisions Still Unknown To Lots Of Americans

Meanwhile, the administration continues to get ready to implement the law.

The Washington Post: Many Americans Unaware Of Health-Care Law Changes
After surviving a Supreme Court decision and a presidential election, the Obama administration's health-care law faces another challenge: a public largely unaware of major changes that will roll out in the coming months. States are rushing to decide whether to build their own health exchanges and the administration is readying final regulations, but a growing body of research suggests that most low-income Americans who will become eligible for subsidized insurance have no idea what is coming (Kliff, 11/20).

Politico: Next Up For Obamacare: Launching The Exchanges In 2014
[T]he Obama administration and its backers are turning their attention toward getting the law right — before the next elections come around in 2014. All eyes are on January 2014, when the health insurance exchanges — online portals where individuals and small businesses can get their health coverage — are slated to start covering millions of people. Consumers will have access to tax subsidies, if they qualify, to help them buy coverage, and almost everyone will be subject to the mandate to have insurance. Each step holds the potential to reinforce — or change — public perception (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).

Politico Pro: Schnatter On ACA: It's The Franchisees
Papa John's CEO John Schnatter says he had no plans to "close stores and cut jobs because of Obamacare." In a Huffington Post op-ed Tuesday, Schnatter — who supported Republican Mitt Romney’s presidential candidacy — insisted his company actually plans to expand, regardless of any Affordable Care Act costs, and that he's "cool" with all full-time workers getting health care coverage (Cheney, 11/20).

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Capitol Hill Watch

Fiscal Cliff: Lame Duck Budget Talks Begin

News sources report on the beginnings of negotiations among White House and congressional staff.

Politico: Rough Start For Fiscal Cliff Talks
The opening round of negotiations this week between White House and senior GOP congressional staffers left both sides pessimistic about their ability to reach a quick deal on averting the fiscal cliff, according to sources familiar with the talks. Hill Democrats say Republicans aren't serious about crafting a deal that President Barack Obama can accept. ... For their part, Republicans remain unconvinced that Obama and Senate Majority Leader Harry Reid (D-Nev.) will make the kind of significant concessions on entitlement programs like Medicare and Medicaid that would make them agree to tax rate hikes (Sherman, Bresnahan and Budoff Brown, 11/20).

CNN Money: Deficit Reduction? Not Without Entitlement Reform
The nation is staring into the fiscal cliff, which involves $7 trillion worth of spending increases and tax cuts over a decade. If no other action is taken, it will start to take effect in January, kicking off with $491 billion in deficit reduction in fiscal 2013, a large chunk of which will come from the expiration of the Bush tax cuts. Another $54 million in spending cuts are set to take place as a result of last year's debt-reduction deal. Empowered by his re-election victory, Obama is centering the conversation on increasing taxes on the wealthy. House Republicans, who lost seats on November 6, have said they are willing to talk about raising revenue if it is accompanied by spending cuts and entitlement reform. House Speaker John Boehner called on Democrats Monday to come forward with proposals (Luhby, 11/21).

Meanwhile, interest groups stake out their positions and brace for cuts.

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).

The Hill: Nursing Homes Tout Quality Improvement, Blast Sequester
The lead advocacy group for nursing homes touted high customer satisfaction in its annual survey, released Tuesday, and cautioned that automatic federal spending cuts could hamper the industry. The American Health Care Association (AHCA) found that short-stay patients' satisfaction reached 87 percent in 2012 as staff turnover decreased and individuals received more time with nurses. The group has been pushing Congress to stop the sequester's looming cuts to Medicare, which AHCA President Mark Parkinson said could "undo this progress" (Viebeck, 11/20).

Los Angeles Times: Union Ads Take New Tack: Praising GOP Members
Labor unions seeking a fiscal solution that protects entitlement programs and raises taxes on the rich are trying the carrot approach before taking the stick to lawmakers. A new six-figure ad campaign backed by three major unions includes radio spots praising four Republican House members as "leaders willing to put people ahead of partisan politics." ... The commercials call on the lawmakers "to stand up for us by investing in job creation, extending the middle class tax cuts, and protecting Medicare, Medicaid and education from cuts." (Gold, 11/20).

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'Doc Fix' Cost: $25 Billion For One Year, CBO Says

The Hill reports that delaying a scheduled pay cut for one year to doctors who treat Medicare patients would cost $25 billion.

The Hill: CBO: 'Doc Fix' Costs Rise To $25 Billion
A one-year "doc fix" has gotten nearly $7 billion more expensive, according to new estimates from the Congressional Budget Office, obtained by The Hill. Doctors are scheduled to see a 26.5 percent drop in their Medicare payments at the end of the year unless Congress steps in to delay the cut, as it does every year. Delaying the cut and freezing doctors' payments for one year would cost $25 billion, according to CBO's latest estimates -- up from $18.5 billion in its last projection (Baker, 11/20).

Meanwhile, the food stamp program is coming under some congressional scrutiny, Politico reports.

Politico: Food Stamp Eligibility At Issue In Congress
The share of food stamp benefits going to American households with gross incomes over 130 percent of poverty has more than doubled in the past four years, according to the most recent data compiled by the Agriculture Department and released Tuesday. The 130 percent cap -- about $28,680 for a family of four in recent years -- dates back to the early 1980s. But it has been increasingly ignored by cash-strapped governors trying to help working-class households in hard economic times. As the federal costs mount, there is more pushback from Republicans in Congress (Rogers, 11/20).

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Health Information Technology

Online Access To Colorado Docs Linked To More Office Visits

The assumption had always been that offering patients e-mail access to their doctors and records would reduce office visits, but a new study from Kaiser Permanente of Colorado showed the opposite. (Kaiser Health News is not affiliated with Kaiser Permanente.)

Kaiser Health News: Online Access To Docs Increases Office Visits, Study Finds
Uncle Sam wants you to e-mail your doctor. A federal law passed in 2009 says that physicians have to start offering their patients online communication, or Medicare will start docking how much it pays them in the future. Some patients hope that having online access to their doctors will mean they can cut down on how often they have to go to the doctor's office. But new research suggests that patients with online access actually schedule more office visits (Whitney, 11/21).

Medscape: Online Relationship Linked To More Office Visits
Health care futurists have viewed online communication between clinicians and patients as a welcome substitute for low-level office visits and telephone calls, lightening a clinician's load. In addition, some studies have found that virtual visits make a waiting room a little less crowded. However, a study published in the November 21 issue of JAMA showed that letting patients email their clinician and access their records online was associated with more, not fewer, telephone calls, office visits, and clinical services in general. In this case, the substitution theory did not hold (Lowes, 11/20).

Reuters: Online Medical Records May Not Improve Efficiency
People who had access to their medical records online also came into their doctor's office for more appointments and used the emergency room more often than those who didn't log on, in a new study from Colorado. One theory supporting online access to health records is that if patients can look up their test results and put in for prescription refills online, they'll make fewer unnecessary trips or calls to the office (Pittman, 11/20).

CNN: Online Access Associated With Uptick In Doctor Visits
Patient online access to doctors and medical records was associated with increased use of almost all in-person and telephone medical services, according to a study published Tuesday in the Journal of the American Medical Association. Those services included doctor appointments, telephone consults, after-hours clinic visits, emergency room visits and hospitalizations. Dr. Ted Palen and his team looked at members of Kaiser Permanente Colorado, an integrated health system with more 500,000 members that includes an online patient portal known as MyHealthManager (MHM). Palen and his team are all affiliated with Kaiser Permanente Colorado. They set out to learn more about the use of electronic medical records and their association to the amount of health care services patients use when they have online access to their health care (Hagan, 11/20).

Modern Healthcare: Patients' E-Records Access Tied With Increased Health Care Use: Study
Patient use of Web-based electronic health-record system portals has been linked to increased use of clinical services, including higher rates of office visits and telephone calls to providers, a study of patients at Kaiser Permanente in Colorado suggests. Results of the study are set to be published in an article, "Patients with Online Access to Clinicians, Medical Records Have Increased Use of Clinical Services," in the Nov. 21 issue of the Journal of the American Medical Association. The study looked at health care services by nearly 89,000 patients enrolled for at least 24 months with the integrated delivery network from March 2005 through June 2010 (Conn, 11/20).

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Health Care Marketplace

Study Predicts Shortage of Primary Care Doctors Will Worsen

A study details the depth of the shortage of new primary-care doctors by 2025.

The Hill: Study: US Faces Shortages Of 52,000 Doctors By 2025
The United States will need about 52,000 new primary-care doctors as the population grows and ages, according to a new study. Research published in the Annals of Family Medicine estimated that most of the doctor shortage will be caused by the rising U.S. population. Aging adults and the expansion of healthcare coverage under the Affordable Care Act will contribute to a lesser extent, the study found. Researchers predicted that the U.S. population will increase 15.2 percent by 2025, necessitating about 33,000 more physicians (Viebeck, 11/20).

San Jose Mercury-News: The Numbers: Shortage Of Physicians Expected To Worsen
Here is a look at the numbers: Two to 4 million Californians, and 32 million people nationally, will obtain insurance in 2014 under the national health reform law. ... Nearly one-third of all physicians are expected to retire in the next decade, just as more Americans seek care. Only about 20 percent of American medical students go into primary care, according to the Council on Graduate Medical Education (Kleffman, 11/20).

Other media outlets explore the role of doctors in the purchase of illegal foreign drugs as well as the merger of nurse practititioner groups -

The Wall Street Journal: U.S. Fake-Drug Probe Puts Spotlight On Role Of Doctors
A Tennessee cancer doctor has pleaded guilty to purchasing illegal foreign drugs, as part of a long-running investigation into overseas distributors that sold fake versions of the cancer drug Avastin and other unapproved medicines to U.S. clinics. The physician, William Kincaid of Johnson City, Tenn., who signed a plea agreement last week, is among the first to face charges in the probe. Dozens of doctors were warned by the U.S. Food and Drug Administration that they may have purchased the fake Avastin from distributors owned by Canada Drugs (Weaver, 11/20).

Modern Healthcare: Nurse Practitioner Associations To Merge
Two professional associations representing nurse practitioners have announced plans to merge, creating a newly formed organization of roughly 40,000 members. Effective Jan. 1, 2013, the American Academy of Nurse Practitioners and the American College of Nurse Practitioners will be known as the American Association of Nurse Practitioners, according to a news release (McKinney, 11/20).

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Study: 40% Of Surgery Complications Occur When Patients Are Home

Meanwhile, in other hospital news, Bloomberg looks at the increasing number of emergency departments that offer online reservations.

NPR: Many Surgical Complications Show Up After Patients Get Home
It's natural for patients returning home from the hospital after surgery to feel a sense of relief that the worst is over. But, research published this week suggests those patients and their doctors shouldn't let their guard down too soon. More than 40 percent of all patients who experience complications after surgery experience them at home, according to a study in the journal Archives of Surgery. Half of those complications occur within nine days of patients leaving the hospital (Schultz, 11/20).

Bloomberg: ER Concierge Services At Hospitals Boost Bottom Lines
Just before her wedding this year, Ashleigh Kondracki came down with bronchitis and went to the emergency room. ... Kondracki was able to breeze through the crowded waiting room because she went online and made a reservation from home, where she waited until her appointment. Hospital emergency departments eager to woo patients are borrowing an idea from the restaurant industry. ER online reservations are available at more than 100 hospitals, including facilities run by Tenet Healthcare Corp. (THC), the third-largest U.S. hospital company. Reservations and other concierge services, including mobile apps that provide wait times, are intended to make emergency room experiences more palatable (Armour, 11/21).

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Aetna CEO: Deficit Fix Rests On Slowing Health Care Wasteful Spending

NPR: Bertolini: Health Care Waste Fix Would Trim Deficit
Washington lawmakers are still working to avoid the fiscal cliff. That's the expiring of tax cuts at the end of the year and deep spending cuts that could throw the economy into recession. A group of top CEOs has been urging lawmakers to reach a deal. Renee Montagne talks to Aetna CEO Mark Bertolini about the fiscal cliff and health care (11/21).

The Washington Post also offers advice on open-enrollment season for the federal employee health plan --

The Washington Post: Advice On Choosing A Federal Employee Health Plan
It’s the time of year for football, turkey and FEHBP. Time for federal employees to choose health insurance plans from within the Federal Employees Health Benefits Program. The open season for making that choice runs through Dec. 12. Open season also means it's time to talk with Walton Francis, a health economist who is the guru on health insurance for federal workers. Francis is the primary author of Checkbook's 34th annual Guide to Health Plans for Federal Employees and has been writing it from the beginning (Davidson, 11/20).

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Public Health & Education

OB-GYN Group Calls For Over-The-Counter Birth Control Pills

Detroit Free Press: Ob-Gyn Group: Make The Pill Over The Counter, Cut Unintended Pregnancies
In an attempt to reduce unintended pregnancies that cost the nation an estimated $11.1 billion a year, the nation's largest group of obstetricians and gynecologists said Tuesday that oral contraceptives should be available without a prescription (Erb, 11/21).

USA Today: OB-GYN Group: Birth Control Pill Should Be On Shelves
Birth control pills are so safe and important to women that they should be sold on drugstore shelves, without a doctor's prescription, says a group representing many of the doctors who prescribe them. The American College of Obstetricians and Gynecologists (ACOG) takes the perhaps-surprising stance in an opinion released today and published in the December issue of Obstetrics & Gynecology (Painter, 11/20).

The Associated Press: OB/GYNS Back Over-The-Counter Birth Control Pills
But no one expects the pill to be sold without a prescription any time soon: A company would have to seek government permission first, and it's not clear if any are considering it. Plus there are big questions about what such a move would mean for many women's wallets if it were no longer covered by insurance. Still, momentum may be building (Neergaard, 11/20).

CBS (Video): OB/GYN Society Says Birth Control Pill Should Be Sold Over-The-Counter
[W]omen would not need a doctor's visit for a prescription. That raises concerns that some women who shouldn't take the pills, such as those at risk for blood clots or who have an unrecognized ailment like hypertension, may risk their health by taking them. ACOG said women should self-screen for most of these contraindications by using a checklist, such as the one from the World Health Organization. Skipping the doctor also raises concerns that women would miss out on other important women's health services like screening for sexually transmitted diseases and cervical cancer (Jaslow, 11/20).

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Meningitis Outbreak Could Prompt Call For Executive Jail Time

A tough prosecutor and high public scrutiny could mean jail time for executives of the New England Compounding Center -- the pharmacy at the center of the deadly meningitis outbreak. In the meantime, the pharmacy's lawyers counter that the executives had no direct hand in the illnesses.

The Boston Globe: Pharmacy Case May See Call For Jail Time
The top executives of New England Compounding Center are likely to be criminally prosecuted on federal charges that carry possible prison sentences, according to former prosecutors who cite the large number of people harmed, allegedly by contaminated steroids made by the Framingham pharmacy. U.S. Attorney Carmen M. ­Ortiz, whose Boston office is known for aggressive prosecution of health care companies, acknowledged in a statement last month that she is probing New England Compounding, but has declined further comment (Lazar, 11/21).

Reuters: Pharmacy Owners Had No Hand In Meningitis Outbreak: Lawyers
Lawyers for New England Compounding Center's owners told a federal judge on Tuesday there is no evidence that any of them directly participated in the events that led to a deadly U.S. meningitis outbreak. The defense lawyers also argued to block a motion by meningitis victims to freeze the assets of NECC and its owners (McLaughlin, 11/20).

Watchdog group Public Citizen, however, is blaming Medicare's reimbursement policies for the meningitis outbreak --

Medpage Today: Watchdog Blames Medicare For Meningitis Cases
Consumer watchdog Public Citizen is pointing toward flawed Medicare reimbursement practices for compounded drugs as a reason for the fungal meningitis outbreak that has killed 34 people. The group said the Centers for Medicare and Medicaid Services (CMS) is required by law to deny Medicare reimbursement for any drug that is not "reasonable and necessary" and that the agency generally considers drugs that haven't received FDA approval -- which would include many compounded formulations -- not to have met that standard. Yet despite those regulations, CMS nonetheless provided reimbursement to centers such as the New England Compounding Center (NECC), allowing large-scale compounding pharmacies to flourish (Pittman, 11/20).

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State Watch

State Roundup: Calif. Schedules Health Care Special Session; Fla. To Boost Medicaid Payment Rates

California Healthline: Health Care Special Session Slated For January
California's legislative special session on health care won't take place until January, according to officials at the California Health and Human Services agency. ... The session was expected to be convened in December. The special session will be held concurrently with the regular legislative session that begins Jan. 7 (Gorn, 11/21).

The Miami Herald: Florida Will Pay Medicaid Docs At New Obamacare Rate
Starting Jan. 1, Florida will start paying Medicaid primary care doctors at new, higher rates required by the federal Affordable Care Act, a state spokeswoman said Tuesday. Shelisha Coleman, spokeswoman for the state Agency for Health Care Administration, said some budgetary details need to be worked out with the Legislature and the governor's office, but there was no question that payments will be made. "We are still working with our partners to determine how to expand our budget authority for the current fiscal year," Coleman said in an email. "However, we will be implementing the increase per federal law" (Dorschner, 11/20).

Stateline: To Raise Revenue, Raise Tobacco Taxes, Kentucky Commission Says
Kentucky may soon tell its smokers to cough up some extra cash. The state's Blue Ribbon Commission on Tax Reform says the state should raise taxes on tobacco. The governor-appointed panel Monday (November 19) recommended the state increase its cigarette tax from 60 cents to $1 per pack, along with a proportional hike on other forms of tobacco, The Lexington Herald-Leader reports. The move would raise an estimated $120 million in revenue and presumably help the state address its high smoking rate, cutting down on long-run health care costs (Malewitz, 11/20).

Associated Press/Houston Chronicle: Texas Medicaid Recipients Call For Full Funding
A coalition of people who depend on Medicaid for their health care and jobs called on the Texas Legislature Tuesday to fully fund the program when they meet next year. People with disabilities, parents with ill children, the elderly poor and the health care providers who work with them held a pre-Thanksgiving meeting to demonstrate who depends on Medicaid and how important the program is for them.... Lawmakers cut Medicaid programs last year and underfunded the program by $4.8 billion (Tomlinson, 11/20).

The Texas Tribune: Bill Renews Debate Over Rural Access To Abortion
Before Texas' abortion sonogram law passed last legislative session, some women in rural communities seeking to end their pregnancies 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).

(St. Paul) Pioneer Press: Fairview Patients Getting Money From Accretive Billing Statement
Minnesota Attorney General Lori Swanson's investigation of collection tactics at Fairview Health Services reached a milestone Tuesday, Nov. 20, with the distribution of $364,000 in awards among 90 people who claimed they were wrongly pressured for payments while receiving care. The money comes from a July settlement in which a Fairview vendor called Accretive Health paid $2.49 million to resolve allegations that the company broke state debt collection and consumer protection laws. Swanson alleged that the Chicago-based firm instituted overly aggressive collection tactics at Fairview such as harassing patients on gurneys and a "baby prison" scenario in which a mother had to pay $800 to take her newborn home (Snowbeck, 11/20).

Minneapolis Star Tribune: Harassed Minnesota Hospital Patients Get Checks From Accretive
Minnesota hospital patients who endured abusive billing tactics linked to Accretive Health Inc. have begun receiving restitution payments averaging $4,000 apiece, Attorney General Lori Swanson said Tuesday. Some 90 patients will share $364,000 -- part of a $2.5 million pool funded by Accretive to settle a lawsuit filed by Swanson in January. The remainder of the restitution fund -- more than $2.1 million -- will go to the state's general fund under terms approved in July by a federal judge. The settlement also bars Accretive from operating in Minnesota for two to six years (Kennedy, 11/20).

WBUR: Report: High Priced Providers Get 80 Percent Of All Payments To Hospitals
As Massachusetts tries to become the first state to keep health care spending in line with the gross state product, a new report offers some startling insights about what it might take to do that. A report by the Center for Health Information and Analysis (CHIA) finds that higher priced hospitals and doctors take in 80 percent of all the money health insurers spend on hospitals and doctors. These hospitals and physicians are paid more, they see more patients, and they have more patients with complicated ailments. "That means that in order to save a lot of money, you really have to go after those high priced hospitals, because trying to squeeze dollars out of the low priced hospitals, there’s just not a lot of payments there," said Aron Boros, director of the CHIA (Bebinger, 11/20).

Denver Post: Suit Sets Up Clash Between Day-Surgery Centers and Hospitals, Insurers
Four Colorado day-surgery centers have filed a lawsuit alleging a conspiracy by the state's largest hospital chains and insurers to drive them out of business, while the defendants allege the surgery centers may violate insurance and kickback laws, bringing a battle of health titans into the open. Four Colorado day-surgery centers have filed a lawsuit alleging a conspiracy by the state's largest hospital chains and insurers to drive them out of business, while the defendants allege the surgery centers may violate insurance and kickback laws, bringing a battle of health titans into the open (Booth, 11/20).

Health Policy Solutions (a Colo. news service): Senator, Doctor, Champion For The Vulnerable
[State Sen. Irene] Aguilar enters the 2013 session as one of the legislature's most powerful voices on health issues, respected on both sides of the aisle and a leading Latina in the state. She plans to join Democratic colleagues in fighting to expand Medicaid to a greater share of the poor as planned in the Affordable Care Act, but undercut by the U.S. Supreme Court, which allowed states to opt out of expansion. Now governors and state lawmakers must decide how to handle Medicaid. Ultimately, Aguilar wants to ignite an even broader health revolution by bringing universal care to people throughout Colorado (Kerwin McCrimmon, 11/20).

The Lund Report: Salaries On The Rise Among Salem Hospital's Top Executives
President Norman Gruber made $877,502 in the hospital's 2011 fiscal year, up 10 percent from the previous year. Chief Medical (Officer) William Holloway’s compensation climbed 11.4 percent, to $576,945. Neither man has fully recovered from pay cuts experienced in 2010, when salaries of the hospital’s top paid employees fell 15 percent. But the trend is clear, with paid officers at the nonprofit hospital getting an average raise of 12.4 percent last year. Executives are not the only ones to see their checks bounce down then up in recent years, but a Lund Report review of tax filings suggests that rank-and-file employees of Salem Hospital saw deeper salary reductions than their bosses, and now have experienced more modest pay hikes (Sherwood, 11/21).

The Lund Report: Tension Mounts In Klamath County Over CCO
The movement to create coordinated care organizations throughout Oregon is riddled with tension in Klamath County where its commissioners are embroiled in a dispute with Cascade Health Alliance over who should be responsible for mental health services. "Right now we’re the only county in the state that doesn’t have a CCO fully functioning at this point," said Amanda Bunger, the county’s mental health director. Currently 14 CCOs are operational in the state. The Oregon Health Authority is attempting to resolve the dispute, by calling in another mediator, and intends to continue working with Cascade and the community "as they work through the process," said Kimberly Mounts, spokesperson (Lund-Muzikant, 11/21).

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Editorials and Opinions

Viewpoints: Protecting Us From Counterfeit Medicines; Simpson-Bowles And The Health Law

Bloomberg: Governors Have No Excuse Not To Build Insurance Exchanges
HHS has made it clear that after federally operated exchanges are up and running, states may eventually take over operations. This seems like wasted effort. States have the information they need to move on insurance exchanges. Governors who care about fiscal responsibility, strong state government and the basic welfare of their residents would do well to get with the program (11/20).

The Dallas Morning News: Terribly Costly Medicaid Expansion Buys Less Than Claimed
At first glance, expansion looks like a good deal for states: The federal government will initially pay for 100 percent of the cost of new enrollees and gradually roll back to 90 percent by 2020. But it’s unlikely the federal government will continue to subsidize Medicaid at 90 percent for very long after 2020. ... It is a classic “buy now and pay later” scheme. The long-term costs of Medicaid expansion will impose a huge fiscal burden that state budgets, already strained by a failing system, cannot bear (John Davidson, 11/20).

The Medicare NewsGroup: The Return Of Simpson-Bowles In The Medicare Debate
While mentioning "premium support" in passing, [Simpson-Bowles] never really endorsed the concept. The plan built upon some core principles in the Affordable Care Act (ACA) while pushing forward some controversial pieces, such as the Sustainable Growth Rate (SRG), or "doc fix." … By using the ACA as a foundation, Simpson-Bowles gives a nod to the fundamental approach of President Obama's strategy: reform the program internally, pass along more costs, and restructure payments and treatment modes (John F. Wasik, 11/20).  

Los Angeles Times: Avoiding The 'Fiscal Cliff' But Falling Anyway
[T]budget-cutting juggernaut rolls on, apparently on the principle that if you're going to extract higher taxes from the wealthy, you have to offer in return more "sacrifices" from retirees living on Social Security, less healthcare for seniors, more transfers of crucial programs from the federal government to already strapped states and municipalities (Michael Hiltzik, 11/21).

Los Angeles Times: Grover Norquist The Has-Been
Grover Norquist is losing his grip. It once seemed as if Washington's most powerful anti-tax crusader had the Republican Party firmly in hand. ... Even Senate GOP leader Mitch McConnell (R-Ky.), usually a hard-liner, said last week that he was "open to new revenue" as long as it was accompanied by cuts in Medicare and other entitlement programs (Doyle McManus, 11/21).

The New York Times: Deadly Fake Medicines 
The world’s medicine supply is under attack. ... It is estimated that at least 100,000 people die every year from substandard and falsified medicines for cancer, heart disease, infectious diseases and other ailments. This week delegates from about 100 member countries of the World Health Organization are meeting in Buenos Aires with the aim of strengthening defenses against substandard and fraudulent medicines. The meeting is extremely important, but to make progress a number of hurdles will have to be overcome (Amir Attaran and Roger Bate, 11/20).

Journal of the AMA: Emergency Preparedness and Public Health: The Lessons of Hurricane Sandy
It is a familiar story—a superstorm comes ashore, infrastructure is overwhelmed, and health care facilities evacuate patients, with major delays in returning to normal functioning. Afterwards, policy makers evaluate lessons learned for the next disaster, but similar missteps are often repeated. Why did some health care facilities with the same risk level evacuate while others did not? Although the 2 storms were different in many ways, it is instructive to compare Hurricane Katrina with the still-unfolding events of Sandy (Dr. Tia Powell, Dr. Dan Hanfling and Lawrence O. Gostin, 11/16).

Baltimore Sun: An Unhealthy Fear Of Fatty Foods 
Hostess is struggling to escape the Great Recession sandpit, or get bought out. Yet this octogenarian snack king is really just the victim of another movement sweeping the country over the past couple decades: "low-fat" and "health food" trends, and the current government-sponsored anti-obesity campaign. ... One unintended consequence of anti-obesity campaigns (which are filtering into our schools) is clear, according to health experts: an increasingly all-consuming fear of gaining weight and an unhealthy relationship with food (Joanne Cavanaugh Simpson, 11/20).

St. Louis Post-Dispatch: Time For A Bipartisan Solution To State Health Exchange
Speaking to a group of St. Louis business leaders last week, the new speaker of the Missouri House, Tim Jones, R-Eureka, suggested that lawmakers might eventually design a state health insurance exchange, rather than leaving the task to the federal government. This is great news. Feuding over health exchanges is a futile rear action in the political war against the Affordable Care Act (11/21).


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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Ankita Rao
Marissa Evans

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.