Daily Health Policy Report

Monday, November 26, 2012

Last updated: Mon, Nov 26

KHN Original Reporting & Guest Opinion

Fiscal Cliff

Health Reform

Medicare

Health Care Marketplace

Coverage & Access

Health Disparities

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Minnesota Facing Bigger Bill For State's Health Insurance Exchange

Minnesota Public Radio News' Elizabeth Stawicki, working in partnership with Kaiser Health News and NPR, reports: "Minnesota's state health insurance exchange will cost $54 million in 2015 to operate, according to the Gov. Mark Dayton administration. The cost comes in at greater than earlier estimates of $30 to $40 million. The state would not have to find the money until 2015, when the state exchanges are required to be financially self-sustaining" (Stawicki, 11/25). Read the story.

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How To Handle Extra Costs Not Covered By Medicare (Video)

Kaiser Health News consumer columnist Michelle Andrews answers a question about an unexpected bill a reader received after paying out-of-pocket for medical services not covered by Medicare (11/15). Watch the video.

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Political Cartoon: "ObamaScare"

Kaiser Health News provides a fresh take on health policy developments with "ObamaScare" by Joel Pett.

Meanwhile, here is today's health policy haiku:

ASKING AGAIN 

Hamlet had it wrong:
For, to test or not to test
THAT is the question.
-Anonymous 

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

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Fiscal Cliff

Lawmakers Return To Washington To Face The 'Fiscal Cliff'

As interest groups ranging from business lobbies to AARP mobilize to protect their constituencies, some Democrats acknowledge that Medicare and Medicaid need to be part of the conversation.

The Wall Street Journal: Talks Over Fiscal Cliff Stay Stuck In Low Gear
Congressional leaders return to Washington this week facing the prospect that talks with the White House over the country's budget impasse have barely progressed, a reminder of the philosophical divisions that remain despite both sides' early professions of optimism. … Inconclusive talks among high-level aides have done more to define the differences between the two parties than bridge them, according to people in both parties. Republican leaders have agreed to boost tax revenue by capping deductions rather than raising rates. And senior Democrats have agreed to modest changes to programs such as Medicare. Each side has resisted ceding too much ground and views their adversaries' concessions as inadequate (Hook and Paletta, 11/25).

The Associated Press/Washington Post: Influence Game: Fiscal Compromise Is Fine, Groups Say, Provided Members Don't Share The Pain
A big coalition of business groups says there must be give-and-take in the negotiations to avoid the "fiscal cliff" of massive tax increases and spending cuts. But raising tax rates — a White House priority — is out of the question, the group adds. … And there's no ambiguity in the views of the top lobbying arm for retirees. "AARP to Washington: No cuts to Medicare and Social Security in last-minute budget deal" the group's Web site declares. … So much for the notion of shared sacrifice as Congress and the White House face a Dec. 31 deadline to craft a far-reaching deficit-reduction plan (11/26).

McClatchy: At Edge Of Fiscal Cliff, Everyone Fights To Protect His Bit Of Budget
As Washington debates how to trim runaway federal budget deficits without going over a "fiscal cliff" of immediate tax increases and automatic spending cuts, special interest groups are mounting aggressive campaigns to make sure that they’re not the ones who have to pay the price. Defense companies, health care providers, public broadcasting and even national parks enthusiasts are warning that cuts to their interests would cost jobs and hurt consumers. Some say that all entitlements such as Medicare and Social Security should be off limits. So, too, should be federal aid to education. And tax breaks for contributions to charity (Recio and Lightman, 11/26).

The New York Times: Trying To Turn Obama Voters Into Tax Allies
When Tea Party activists swamped town hall-style meetings about health care in the summer of 2009, President Obama's army of campaign volunteers largely stayed away, seemingly less interested in fighting for legislation than they had been in electing the nation's first African-American president. Now, Mr. Obama is seizing a second chance to keep his election-year supporters animated (Shear, 11/25).

ABC (Video): Sen. Dick Durbin: Medicare, Medicaid Fair Game In Talks To Avoid Fiscal Cliff
Sen. Dick Durbin said today that his Democratic colleagues in the House and Senate should be willing to address entitlement programs like Medicare and Medicaid in deficit reduction negotiations. "From my side of the table, bring entitlement reform into the conversation," Durbin said on "This Week with George Stephanopoulos." "Social Security — set aside … doesn't add to the deficit. But when it comes to Medicare and Medicaid, protect the integrity of the program, but give it solvency for more and more years." But Durbin ruled out raising the age of Medicare eligibility as a potential reform (Stephanopoulos, 11/25).

National Journal: Medicare Competition Makes Bipartisan Comeback
After President Obama's reelection win, you might think that talk of competition in Medicare—a cornerstone of Mitt Romney's campaign—would fall by the wayside. But introducing greater competition into the health program for older Americans is an idea that could prove ripe for a bipartisan compromise in any "Grand Bargain" on the budget. The future of Medicare was a potent issue during the campaign, with Democrats and Republicans offering sharply different views. Romney and other Republicans pushed to have Medicare compete with private plans in an open marketplace, betting that consumers’ power of the purse would drive down the ever-growing costs of the program. Democrats strongly opposed that plan, saying it would not actually reduce spending and would instead end up costing seniors thousands more than the traditional Medicare coverage they have today (McCarthy, 11/25).

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Health Reform

Health Law Implementation Proceeds -- With Fits And Starts

Even as the election has altered the landscape for lawmakers who hoped to repeal the 2010 health law, some opponents are pressing on with legal challenges. Specific elements of the law, such as its health exchanges, also present logistical and financial issues for the Obama administration.

Politico: Back To The Drawing Board For Obamacare Foes
[Republican] support for full repeal isn’t going anywhere. But they also realize the short-term strategy has to change. The opposition plan is now centered on three main pieces, according to conversations with House and Senate Republicans: Focus on piecemeal repeal where it might be possible to pick up a few Democratic votes; use the House majority to conduct investigations into the implementation of the law; and be ready to act when the law crumbles, as they argue that it will (Haberkorn, 11/26).

Politico: Time's Short, But Obamacare Foes Press On In Court
The window is closing for those who want to bulldoze President Barack Obama's health law in court. "It's going to become increasingly difficult because courts are much less willing to overturn something that's already entrenched," said Randy Barnett, the Georgetown University law professor who helped construct the Supreme Court argument against the law earlier this year. ... But the right-leaning critics of the law aren’t waving the white flag yet. And even if they can’t get rid of the whole law, they are taking legal aim at parts of it (Cheney, 11/26).

Medpage Today: Exceptions To Birth Control Mandate Grow
An Illinois Christian book publisher is the third organization to get a reprieve from a federal court and be told it doesn't have to comply with the Affordable Care Act's (ACA's) contraception mandate. A federal judge here agreed with Tyndale House Publishers that adhering to the law by supplying coverage for certain contraceptives would infringe on its religious freedom. … Tyndale House Publishers, a self-insured company employing 260 full-time workers here, objected and sued the Department of Health and Human Services (Pittman, 11/23).

The Hill: Obama Faces Huge Challenge In Setting Up Health Insurance Exchanges
The Obama administration faces major logistical and financial challenges in creating health insurance exchanges for states that have declined to set up their own systems. ... Sixteen states — most of them governed by Republicans — have said they will not set up their own systems, forcing the federal government to come up with one instead (Viebeck, 11/25).

Meanwhile, state leaders continue to wrestle with health exchange decisions -

Kaiser Health News: Minnesota Facing Bigger Bill For State's Health Insurance Exchange
Minnesota's state health insurance exchange will cost $54 million in 2015 to operate, according to the Gov. Mark Dayton administration. The cost comes in at greater than earlier estimates of $30 to $40 million. The state would not have to find the money until 2015, when the state exchanges are required to be financially self-sustaining (Stawicki, 11/25).

The Associated Press: New Hampshire Could Partner With Feds On Health Exchange
New Hampshire could revisit a state law requiring the federal government to run a health insurance exchange ... State Republicans opposed implementing the federal health care overhaul law. They helped turn back $1 million in federal money to be used for planning and passed a law banning the state from establishing an exchange to serve as a marketplace for consumers to find insurance. That could change with the shift in power after the election. Democrats regained control of the House (Love, 11/26).

In other implementation news, a report measures the reach of ACOs -

Politico Pro: Report: ACOs Already Cover 10 Percent Of The Country
An estimated 25 million to 31 million people are treated by organizations already participating in ACOs of some kind, according to a report to be released Monday by the management consulting group Oliver Wyman. By no means are they all receiving truly "accountable care" yet, authors Richard Weil and Niyum Gandhi write, but the rapid growth of ACOs suggests that success in some of the experiments could spread relatively quickly to change the way health care is delivered and paid for in the country. They don't have high expectations for broad savings immediately (Norman, 11/26).

And, the health law is expected to exacerbate a physician shortage -

The Dallas Morning News: Thinly Spread Primary-Care Doctors Face Surge Of Patients From Health Law
Angie Wang arrived at UT Southwestern Medical School in Dallas after two years of working in a New York laboratory trying to unlock the mysteries of Alzheimer’s disease ... By selecting family practice, Wang will join an inadequate number of primary-care doctors, the kind who are supposed to care for the millions of newly insured Americans flowing into the U.S. health care system in 2014. Their ranks include family practitioners, pediatricians, obstetrician-gynecologists and general internists (Jacobson, 11/24).

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Medicare

Plan To Pay Less For Certain Diagnostic Tests Draws Fire

The Boston Globe: Medicare Payment Changes Draw Fire
Neurologists in Boston and nationwide are objecting to a plan that would pay them less for certain diagnostic tests, a change meant to cut Medicare costs and direct more money to primary care physicians whose pay is widely seen as inadequate even before they take on more work under the national health care overhaul. The neurologists are asking federal regulators to reconsider the plan and argue that the cuts, made under a provision of the Affordable Care Act, could undermine patient care and limit access to neurology services (Conaboy, 11/26).

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Health Care Marketplace

Changes In Health Care Deductions Soon To Kick In

The Wall Street Journal examines key changes in the health insurance marketplace for which consumers should be prepared.

The Wall Street Journal: New, Higher Hurdle To Deduct Care
Starting next year, taxpayers will only be able to deduct medical expenses that exceed 10% percent of their adjusted gross income. For years that threshold has stood at an already formidable 7.5 percent of income. (People age 65 and older can keep using the old threshold through 2016.) The change affects taxpayers who itemize deductions on Schedule A of the 1040 form instead of taking the standard deduction (Geer, 11/25).

The Wall Street Journal: Women Face Higher Costs
Shopping for long-term-care insurance is about to get even trickier for families -- and potentially costlier. Until now, insurers have charged the same premiums regardless of gender for the policies, which help pay for future nursing-home, assisted-living and home care. But beginning early next year, Genworth Financial, the country's largest long-term-care insurer, plans to start charging women applying for coverage as much as 40 percent more than men (Greene, 11/23).

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Two New Studies Explore How Laws, Advertising Impact Cancer Costs

Reuters reports on two new studies regarding cancer treatment costs, including findings that laws don't curb the use of pricey prostate cancer treatments and that ads don't increase the use of aromatase inhibitors for breast cancer.

Reuters: Laws Don't Curb Pricey Prostate Cancer Treatments
Laws meant to prevent the overuse of expensive health care services don't stop doctors from using pricey prostate cancer treatments, according to two new studies. Researchers found doctors used robots and special radiation to treat prostate cancer regardless of whether their area had laws requiring government approval before money is spent on health care facilities and new equipment (Seaman, 11/23).

Reuters: Cancer Drug Ads Don't Boost Inappropriate Prescribing
A new study ties advertising for breast cancer drugs known as aromatase inhibitors to a slight increase in the total number of prescriptions for those medications. But the extra prescriptions were limited to women with a medical reason for taking those drugs. The ads didn't seem to increase the inappropriate use of aromatase inhibitors, which include letrozole (marketed as Femara) and anastrozole (Arimidex) (Pittman, 11/22).

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Coverage & Access

Supreme Court Could Consider Family Health Coverage For Lesbian Couple

The Associated Press/Washington Post: Four-Year Fight For Family Health Coverage Leads Lesbian Couple To Supreme Court's Door
Like a lot of newlyweds, Karen Golinski was eager to enjoy the financial fruits of marriage. Within weeks of her wedding, she applied to add her spouse to her employer-sponsored health care plan, a move that would save the couple thousands of dollars a year. Her ordinarily routine request still is being debated more than four years later, and by the likes of former attorneys general, a slew of senators, the Obama administration and possibly this week, the U.S. Supreme Court (11/26).

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Health Disparities

Parents With Disabilities Face Challenges Gaining Custody Of Children

The Associated Press/Wall Street Journal: Disabled Parents Face Bias, Loss Of Kids: Report
Millions of Americans with disabilities have gained innumerable rights and opportunities since Congress passed landmark legislation on their behalf in 1990. And yet advocates say barriers and bias still abound when it comes to one basic human right: To be a parent. A Kansas City, Mo., couple had their daughter taken into custody by the state two days after her birth because both parents were blind. A Chicago mother, because she is quadriplegic, endured an 18-month legal battle to keep custody of her young son. A California woman paid an advance fee to an adoption agency, then was told she might be unfit to adopt because she has cerebral palsy (11/26).

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Public Health & Education

Pediatricians Called To Prescribe 'Morning-After' Pills In Advance

Reuters: Prescribe Morning-After Pills In Advance, Say Pediatricians
Wading into the incendiary subject of birth control for young teenagers, the American Academy of Pediatrics (AAP) on Monday called on the nation's pediatricians to counsel all of their adolescent patients about emergency contraception and make advance prescriptions for it available to girls under 17. Because current federal policy bans over-the-counter sales of the pills to girls under 17, having a prescription on hand could help younger teens obtain emergency contraception more quickly than if they have to contact a physician only after they need it (Begley, 11/26).

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Drug Development Pipeline Sometimes Involves Intersection Of Influence, Research And Profits

The Washington Post: As Drug Industry's Influence Over Research Grows, So Does The Potential For Bias
[S]ince about the mid-1980s, research funding by pharmaceutical firms has exceeded what the National Institutes of Health spends. ... The billions that the drug companies invest in such experiments help fund the world's quest for cures. But their aim is not just public health. That money is also part of a high-risk quest for profits, and over the past decade corporate interference has repeatedly muddled the nation's drug science, sometimes with potentially lethal consequences (Whoriskey, 11/24).

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State Watch

Medicaid Budget Issues Mean Tough Choices Across Nation

Medicaid programs in Connecticut, Texas, New Jersey and California deal with swelling rolls, tight budgets and reimbursement decisions.

The Associated Press/Wall Street Journal: Medicaid Hits Budget
The larger-than-expected demand for Medicaid health coverage for needy adults, a contributor to Connecticut's latest budget shortfall, is being felt across the state, according to a review of Department of Social Services statistical reports. Average monthly caseloads in cities and towns during the last three years show the state's three largest cities have the greatest jump in numbers of residents seeking coverage under Medicaid for Low Income Adults or LIA (11/23).

The Dallas Morning News: Texas Health Care Facing Big Changes, Tough Spending Decisions
Gov. Rick Perry has promised to fight tooth and nail against implementing the Affordable Care Act. But that doesn't mean big changes aren't coming to Texas health care, and it won't save lawmakers from facing tough spending decisions. … Signs of conflict are already showing. For the 2014-2015 budget cycle, the Texas Health and Human Services Commission that runs the Medicaid program has asked the Legislature for an additional $6.7 billion. Republican leaders, meanwhile, have already pledged to increase the entire state budget by only $7 billion. If they plan to maintain their spending cap, they will need to pare down spending on health care (11/24).

The Record (New Jersey): N.J. Bill Seeks To Limit Cuts By Insurers
One of the four private insurance companies that manage the state's Medicaid program is seeking to cut reimbursement rates for home care to the elderly and the sick, but some lawmakers want to limit their authority to do so. State Sen. Loretta Weinberg, D-Teaneck, said she hopes that the Senate will pass legislation next week to require that managed-care companies get written approval from the Department of Human Services to lower homecare reimbursement rates and that a public hearing be held first. Weinberg introduced the legislation in response to pleas from home-health agencies, which expressed concern in September when Horizon NJ Health -- the largest of the four managed-care companies that administer the state’s Medicaid system -- said it would decrease the hourly reimbursement rate for home care from $15.50, to $13.95, a 10 percent drop (Diskin, 11/24).

California Healthline: Letter From Congress Focuses On Healthy Families Transition
California's effort to move approximately 860,000 children from the Healthy Families program has drawn national attention. Twenty-two members of the House of Representatives, including House Speaker Nancy Pelosi (D-San Francisco), last week sent a letter to state health officials, urging caution in the Healthy Families transition to Medi-Cal managed care. The transition is slated to begin Jan. 1 when almost half the Health Families kids -- about 415,000 -- make the switch. The state still needs CMS approval for the plan (Gorn, 11/26).

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Roundup: Abortion Opponents See Openings In Ark., Wis.; Dems Look To Upend Maine GOP Health Law; Rural Health Care Issues In Texas, Kansas

A selection of health policy stories from Arkansas, Wisconsin, Maine, Texas, Kansas, California and Minnesota.

The Associated Press: Abortion Opponents See New Opportunity In Arkansas
Abortion opponents in Arkansas see an opportunity to enact new restrictions, including a ban on the use of telemedicine to make the abortion pill available, with Republicans controlling both sides of the Legislature in next year's session. Fresh off an election where Republicans won control of the state House and Senate for the first time in 138 years, GOP lawmakers and anti-abortion groups are now focusing on a handful of bills they believe have a better chance (DeMillo, 11/25).

Milwaukee Journal Sentinel: Wisconsin Right To Life Aims For Further Abortion Regulations
The state's largest anti-abortion group sees opportunities to place further regulations on abortion, including requiring women seeking the procedure to view an ultrasound of her fetus. Wisconsin Right to Life is also proposing banning abortions that would cause pain to the fetus, … Wisconsin Right to Life noted in an email to supporters that the election also put all of Wisconsin's state government in the hands of Republicans. ... Walker has yet to weigh in on the specific proposals (Marley, 11/24). 

The Associated Press: Democrats May Reverse Maine Health Insurance Law
Democrats who've wrested control of the Legislature back from Republicans are poised to reverse a GOP health insurance overhaul when the 2013 session gets going. The law, passed in 2011 after Republicans pushed for years for the changes, seeks to lower health insurance costs and cover more Maine residents through a series of market changes (Adams, 11/24).

The Texas Tribune: For South Texas, No Easy Road To Medical School
When Travis County voters approved a ballot measure this month that paved the way for a new University of Texas medical school in Austin, many South Texans had to stifle the emotions that came most naturally: frustration and resentment. They had been trying for decades to secure financing for a medical school in the Rio Grande Valley, only to watch the deal get sealed first for their wealthier northern neighbor (Ramshaw, 11/25).

Kansas Health Institute News: Rural Kansas Towns Cope With Aging Hospital Facilities
Construction on a new $8.2 million hospital is scheduled to begin early next year in this small, south-central Kansas community. The project is in response to conditions common in many parts of rural Kansas where an increasingly aging population often is treated in outdated hospital facilities. ... 80 percent of the critical access hospital's business is from Medicare patients, said Alden Vandeveer, chief executive of the Kiowa District Hospital (Cauthon, 11/26).

Los Angeles Times: Health Insurer Sued Over Disclosure Of Exclusions
A health insurer owned by two Wall Street giants is headed to trial next week over claims it misled a San Bernardino County couple into buying a policy that left them with more than $140,000 in unpaid medical bills from cancer treatment. Norman and Kathleen Carter of Yucaipa are battling their insurance company, even as Kathleen continues to fight abdominal cancer (Terhune, 11/24).

The Associated Press: Minn. Health Incentives Raise Privacy Concerns
More Minnesota workers are considering financial incentives to participate in wellness programs that monitor their health, but those programs come at the sacrifice of some privacy. It's not uncommon for an employer to offer basic incentives, such as a discount for gym membership (11/24).

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Editorials and Opinions

Views On Health Law: 'Hyperactive Regulators' Shift Into Gear; States Need To Stop 'Foot-Dragging'

The Wall Street Journal: Here Comes The Regulatory Flood
President Obama's hyperactive regulators went on hiatus in 2011 to get through Election Day. Now with his second term secure, they're about to make up for lost time and then some. … It begins with the Affordable Care Act, which has been in hibernation because it was the largest campaign liability. … Hiding the details paid off politically but also undermined ObamaCare's already slim prospects for success. Ahead of the law's go-live date of October 2013, states and industries will have less than a year to prepare to meet the new mandates. Three of the rules were released right before Thanksgiving, so insurers are only now about to learn how they'll design and price coverage, since one new rule defines "essential benefits" they must include. Another deals with limits on how premiums can vary from person to person based on risk (11/23).

San Francisco Chronicle: Anti-Obamacare Foot-Dragging Must Stop
Obamacare survived a Supreme Court showdown and the presidential election. Now the historic law faces a new test: putting it into operation where red-state governors are uncertain or outright hostile. … The Obama administration is loosening the deadlines, giving wavering states more time to decide. But this forbearance shouldn't be misunderstood. Health coverage for the uninsured won in the courts and on the presidential ballot. It's time to put it in practice and not delay it any longer (11/25).

The New York Times: Care At The End Of Life
Three years ago, at the height of the debate over health care reform, there was an uproar over a voluntary provision that encouraged doctors to discuss with Medicare patients the kinds of treatments they would want as they neared the end of life. That thoughtful provision was left out of the final bill. ... No matter what the death-panel fearmongers say, end-of-life conversations and medical orders detailing what care to provide increase the confidence of patients that they will get the care they really want. In some cases, that could well mean the request to be spared costly tests, procedures and heroic measures that provide no real medical benefit (11/24).

The New York Times: Health Insurance Exchanges May Be Too Small To Succeed
Certainly, it is hard to be against competition. Economic theory is clear about its indispensable benefits. But not all health care markets are composed of rational, well-informed buyers and sellers engaged in commerce. Some have a limited number of service providers; in others, patients are not well informed about the services they are buying; and in still others, the quality of the service offerings vary from provider to provider. So the question is: What effect does insurer competition have in a marketplace with so many imperfections? The evidence is mixed, but some of it points to a counterintuitive result: more competition among insurers may lead to higher reimbursements and health care spending, particularly when the provider market -- physicians, hospitals, pharmaceuticals and medical device suppliers -- is not very competitive. In imperfect health care markets, competition can be counterproductive (Dana P. Goldman, Micheal Chernew and Anupam Jena, 11/23).

The Washington Post: How Fighting Income Inequality Became Obama's Driving Force
Obama's actions as president provide a glimpse of how he views legislation as a means to his end. His health-care reform law, aimed at covering as many of the uninsured as possible, takes a shot at addressing income inequality by imposing new taxes on the wealthiest Americans. ... The money will help finance insurance subsidies and other coverage in 2014 for people in the lower middle class and below. A recent study by Cornell University's Richard Burkhauser estimates that "Obamacare" will add $400 to $800 in disposable income annually for these Americans (Zachary A. Goldfarb, 11/23).

Los Angeles Times: Giving Thanks For Our Health Care System -- Which Needs Reform
We have two systems -- a medical system and an insurance system. They're intertwined, and any decision affecting one inevitably affects the other. The reality is that our medical system is extraordinary, and extraordinarily expensive. Our insurance system, meanwhile, is a model of inefficiency and misplaced priorities (profits over patients). Reform on both fronts is necessary (David Lazarus, 11/23).

The New York Times: A Shortcut To Wasted Time
The advent of electronic medical records has been a boon to patient safety and physician efficiency in many ways. But it has also brought with it a slew of "timesaving" tricks that have had some unintended consequences. These tricks make it so easy for doctors to document the results of standard exams and conversations with patients that it appears more and more of them are being documented without ever having happened in the first place (Dr. Leora Horwitz, 11/22).

The Washington Post: It's Time To Accept Obamacare, Virginia
The election is finally behind us, and the Affordable Care Act (ACA) won. It's time for Virginia's elected leaders -- whether or not they supported the law -- to take steps to fully implement it. This is not just about providing health care to more than 1 million uninsured Virginians; this is about Virginia's economic interests (Patrick Hope, 11/23).

Richmond Times-Dispatch: Health Care: Already Sailed
Only two things could explain state Democrats' laughable demand for a special legislative session to set up an insurance exchange only a few weeks before the regular General Assembly session convenes: ignorance or partisan mischief. Under Obamacare, every state must have an insurance exchange where consumers can shop for policies. States can set up their own exchanges, or they can let the federal government set one up for them. There is no reason whatsoever to set up a state exchange. The federal government has imposed so many rules and restrictions that it has left states with little latitude beyond picking what kind of font to use on the exchange's stationery (11/26).

Journal of the AMA: Women's Health, Contraception, And The Freedom Of Religion
Although the 2012 Presidential election settled many issues related to the health care law, there is one that will linger well into President Obama's second term: contraception and religious freedom. The Affordable Care Act (ACA) requires employers to provide women with cost-free coverage for preventive care and screenings (Lawrence O. Gostin, 11/21).

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Viewpoints: Sen. Corker's Plan To Avoid The 'Fiscal Cliff'; Romney's Brave Attempt To Deal With Health Entitlements; Fixing The Drug Shortage

The Washington Post: A Plan To Dodge The 'Fiscal Cliff'
I have shared with House and Senate leaders as well as the White House a 242-page bill that, along with other agreed-upon cuts that are to be enacted, would produce $4.5 trillion in fiscal reforms and replace sequestration. ... The proposal includes pro-growth federal tax reform, which generates more static revenue — mostly from very high-income Americans — by capping federal deductions at $50,000 without raising tax rates. It mandates common-sense reforms to the federal workforce. … It also includes comprehensive Medicare reform that keeps in place fee-for-service Medicare without capping growth, competing side by side with private options that seniors can choose instead if they wish. Coupled with gradual age increases within Medicare and Social Security; the introduction of means testing; increasing premiums ever so slightly for those making more than $50,000 a year in retirement; and ending a massive "bed tax" gimmick the states use in Medicaid to bilk the federal government of billions, this reform would put our country on firmer financial footing and begin to vanquish our long-term deficit (Sen. Bob Corker, R-Tenn., 11/25).

Forbes: Thanks, Mitt Romney, For Campaigning On Big Ideas
Mitt Romney isn't going to be the next President of the United States. But the familiar spectacle of the post-election circular firing squad shouldn't blind us to the many good things that Mitt Romney brought to the 2012 election. First and foremost, he had the courage to campaign on the most pressing domestic policy problem we face: the explosion of deficit spending caused by our health-care entitlements. No modern Republican presidential nominee—not even Ronald Reagan—has ever attempted anything like it (Avik Roy, 11/24).

The New York Times: Fighting Fiscal Phantoms
But the deficit scolds aren't giving up. Now yet another organization, Fix the Debt, is campaigning for cuts to Social Security and Medicare, even while making lower tax rates a "core principle." That last part makes no sense in terms of the group's ostensible mission, but makes perfect sense if you look at the array of big corporations, from Goldman Sachs to the UnitedHealth Group, that are involved in the effort and would benefit from tax cuts. Hey, sacrifice is for the little people (Paul Krugman, 11/25).

Los Angeles Times: HIV Testing For All
The U.S. Centers for Disease Control and Prevention reports that 1.2 million people in the United States are infected with HIV but that close to 1 in 5 don't know it. Even before there was any effective treatment for HIV, large-scale testing as a preventive measure could have kept a tremendous amount of suffering and death at bay. It should have begun years ago. Decades ago (11/23). 

The Baltimore Sun: The High Price Of Health Disparities
Why do some people get sicker and die sooner than others? The answer involves more than our genes, behaviors and medical care, according to a new study by the Joint Center for Political and Economic Studies and the advocacy group Equity Inc. It turns out that where we live is often the strongest predictor of our well-being, and that disparities along racial and class lines in health outcomes and access to care mirror the inequities in every other aspect of people's lives (11/23).

The New York Times: A Stubborn Drug Shortage
The drug shortages that have disrupted care for critically ill patients show no signs of going away anytime soon. As Katie Thomas reported in The Times this month, a rural ambulance squad in Ohio withheld its last vial of morphine from a patient in pain with a broken leg in case someone else needed it more (11/25). 

The New York Times: Dealing With Doctors Who Take Only Cash
A few weeks ago, my wife and I were at our wits' end: our 4-month-old daughter wouldn't sleep for more than an hour at a time at night. ... So my wife called a pediatrician who specializes in babies who struggle with sleep problems. The next day, he drove an hour from Brooklyn to our house. ... The only catch was this pediatrician did not accept insurance. He had taken our credit card information before his visit and given us a form to submit to our insurance company as he left, saying insurance usually paid a portion of his fee, which was $650 (Paul Sullivan, 11/23).

The Wall Street Journal: Round Up The Usual Social Conservative Suspects
According to Gallup, a majority of Americans now consider themselves pro-life, including one-third of Democrats. ... A 2012 survey of voters 30 years or younger by Naral Pro-Choice America found that pro-life voters were twice as likely as their pro-choice peers to say abortion is an important issue in determining their vote. Despite the Obama campaign's accusation of a Republican "war on women," Mr. Obama actually won women by a narrower margin than he did in 2008; he lost married women by seven points. ... If the GOP is serious about reaching out to minorities, social issues are rich soil for finding common ground (Ralph Reed, 11/25).

Detroit Free Press: The Free Press' Agenda For Improving Mental Health In Michigan
Michigan's 32 prisons hold thousands of mentally ill inmates, including as many as 200 isolated in segregation cells, where they are locked up for 23 hours a day or more, cut off from treatment programs, and often denied needed medications. ... Michigan should generally ban the segregation of severely mentally ill prisoners. For exceptions made for security reasons, MDOC should ensure that mentally ill inmates placed in isolation are treated as soon as possible at one of its inpatient or residential treatment centers. Any mentally ill inmate in segregation should be checked daily by a mental health professional. Mentally ill prisoners should not be removed from brand-name drugs with no generic equivalents, if the brand drugs work for them (11/25). 

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
Lisa Gillespie
Shefali Luthra

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