Daily Health Policy Report

Tuesday, November 27, 2012

Last updated: Tue, Nov 27

KHN Original Reporting & Guest Opinion

Fiscal Cliff

Health Reform

Capitol Hill Watch

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

New Prenatal Blood Tests Come With High Hopes And Some Questions

Reporting for Kaiser Health News, in collaboration with The Washington Post, Rita Rubin writes: "When Ramona Burton became pregnant with her second child this year, the 37-year-old Upper Marlboro woman knew that her age put her baby at an elevated risk for Down syndrome, even though screening with ultrasound and standard blood tests raised no warning flags" (Rubin, 11/26). Read the story.

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Effort To Curb Medicare Spending Begins With Crackdown On Hospital Readmissions

Kaiser Health News staff writer Jordan Rau, working in collaboration with The New York Times, reports: "After years of gently prodding hospitals to make sure discharged patients do not need to return, the federal government is now using its financial muscle to discourage readmissions. Medicare last month began levying financial penalties against 2,217 hospitals it says have had too many readmissions. Of those hospitals, 307 will receive the maximum punishment, a 1 percent reduction in Medicare's regular payments for every patient over the next year, federal records show" (Rau, 11/26). Read the story or a related New York Times blog post.

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Insuring Your Health: Medical Questions About Gun Ownership Come Under Scrutiny

In her latest Kaiser Health News consumer column, Michelle Andrews writes: "Should doctors be able to ask patients or patients' parents whether they own a gun? What about health insurers, employers or health-care officials implementing the federal health law? Can they ask about gun ownership? The issue is playing out in Florida, where a federal judge in July issued a permanent injunction against enforcement of a law that would have prohibited doctors from asking patients about gun ownership in many instances, saying the prohibition impinged on doctors' First Amendment right to speak with their patients about gun safety" (Andrews, 11/26). Read the column.

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In Juvenile Detention, Girls Face Health Care Designed For Boys

Kaiser Health News staff writer Jenny Gold, working in collaboration with NPR, reports: "Incarcerated girls like Jessica are 'one of the most vulnerable and unfortunately invisible populations in the country,' and up to 90 percent have experienced physical, sexual, or emotional abuse, according to Catherine Pierce, a senior advisor at the federal government's Office of Juvenile Justice and Delinquency Prevention. The health statistics are particularly grim: 41 percent of girls in detention have signs of vaginal injury consistent with sexual assault, up to a third have been or are currently pregnant, eight percent have had positive skin tests for tuberculosis and 30 percent need glasses but do not have them, according to research from the National Girls Health and Justice Institute" (Gold, 11/26). Read the story.

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The Best Medicine For Fixing The Modern Hospital

Reporting for Kaiser Health News, in collaboration with Fast Company, Russ Mitchell writes: "Now, health care reform is fundamentally changing the way hospitals are run, and with it the way they look. A combination of crushing costs, government edicts, and fierce competition for the millions of newly insured patients that will result from federal health-care legislation has put the patient front and center" (Mitchell, 11/26). Read the story.

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Capsules: Study: States Face Increased Medicaid Costs Even If They Don't Expand Program; Report: Coverage Of Smoking Cessation Treatments Is Spotty Despite Health Law

Now on Kaiser Health News' blog, Phil Galewitz reports on a new study regarding states and Medicaid costs: "If state officials think they can escape a fiscal quagmire by refusing to expand Medicaid under the federal health law, they might want to reconsider" (Galewitz, 11/26).

Also on the blog, Ankita Rao reports on insurance coverage trends regarding smoking cessation: "In 2010, the Affordable Care Act required that all new private health insurance plans completely cover preventive services deemed effective by the United States Preventive Services Task Force. Several methods of halting tobacco use, the country's leading cause of preventable death, made the cut. Despite effective treatments, a report from the Georgetown University's Health Policy Institute found that confusing language and inconsistent coverage stood in the way of those trying to use such treatments to kick their habits" (Rao, 11/26). Check out what else is on the blog.

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Political Cartoon: 'Fat Chance?'

Kaiser Health News provides a fresh take on health policy developments with "Fat Chance?" by Lee Judge.

Meanwhile, here is today's health policy haiku:

WORTH A SHOT?

Patients packing heat?
Should doctors ask that question?
A dicey notion...
-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

Democrats Resist Significant Changes To Medicare, Other Entitlement Programs

Efforts to avert the looming "fiscal cliff" have revived talk of raising Medicare's eligibility age. Some Republicans also suggest that spending to carry out the health law should be viewed as a source for savings. Meanwhile, an important meeting is scheduled for Wednesday.

The Wall Street Journal: 'Cliff' Wranglers Weigh Medicare Age
The fiscal cliff has revived an old idea that long seemed unfeasible: gradually raising the Medicare eligibility age to 67 from 65. Proponents of the idea point out that the health-overhaul law makes it easier, beginning in 2014, for seniors to buy private insurance, by banning insurance denials based on pre-existing conditions. Opponents caution that the change could raise premiums for younger people who buy private plans alongside these seniors in the law's new marketplaces, and on large employers who would be required to cover seniors in company plans (Radnofsky, 11/26).

The New York Times: Efforts To Curb Social Spending Face Resistance
President Obama's re-election and Democratic gains in Congress were supposed to make it easier for the party to strike a deal with Republicans to resolve the year-end fiscal crisis by providing new leverage. But they could also make it harder as empowered Democrats, including some elected on liberal platforms, resist significant changes in entitlement programs like Social Security and Medicare (Pear, 11/26).

The Washington Post: On 'Fiscal Cliff,' Both Sides Lay Groundwork For Debate's Next Phase
Ahead of the Wednesday meeting, GOP aides noted that Bowles offered a debt-reduction plan last fall in line with Republican principles. That plan called for $800 billion in fresh revenue through an overhaul of the tax code and significant spending cuts, including major changes to Medicare and other federal health programs (Goldfarb and Montgomery, 11/26).

Los Angeles Times: Much Talk, Little Action On 'Fiscal Cliff' As Congress Returns
Congress returned to a lame-duck session with no signs of quick compromise to ease the nation's budget deadlock, and the White House rolled out a strategy Monday to marshal popular support for raising taxes on the wealthiest tier of income earners. … In the days since, however, talks have become "slow," according to one congressional aide. Republicans insist that new revenue must come from economic growth, which they believe would be produced by revamping the tax code to lower all tax brackets — an approach Democrats reject as "fairy tale" economics. Democrats are unwilling to discuss cuts to Medicare, Medicaid or other government programs unless Republicans put upfront revenue on the table, aides said (Mascaro and Parsons, 11/27).

The Associated Press/Washington Post: GOP Senator Offers Plan To Avert 'Fiscal Cliff': Spending Cuts, Entitlement Curbs, Tax Hikes
A freshman GOP senator is jumping into the debate on how to avoid a "fiscal cliff" of tax hikes and automatic spending cuts, advocating a mix of tax increases with curbs on Social Security and Medicare benefits. Tennessee Sen. Bob Corker is circulating a 10-year, $4.5 trillion plan loaded with controversial proposals, including a less generous inflation adjustment for Social Security, and a gradual increase in the regular Social Security retirement age to 68 and the Medicare eligibility age to 67 (11/27).

CQ HealthBeat: A House Of Cards In Deficit Talks
Talk of finding health care savings in the federal budget inevitably involves making changes to Medicare. But some lawmakers are starting to suggest that President Barack Obama's signature health care overhaul also imposes costs that must be borne by taxpayers and that could be pared back. In its entirety, the law is expected to reduce the deficit over time, according to the Congressional Budget Office. At the same time, it contains individual provisions that, by themselves, cost money. Some observers, especially Republicans on the lookout for ways to constrain the 2010 law, say negotiators trying to avoid upcoming tax increases and spending cuts — known collectively as the fiscal cliff — should take a hard look at those provisions. The problem is, the two most costly parts of the law — setting up subsidies to help people buy insurance and expanding Medicaid to provide care to more uninsured Americans — are also two of the pillars upon which the law is built. If lawmakers start scraping money away from either, they risk weakening the law (Attias, 11/26).

Minnesota Post (Video): Cantor: Put Health Care Law, Device Tax On Fiscal Cliff Negotiating Table
House Republican leaders are now calling for President Obama to put the Affordable Care Act — "Obamacare," the legislative highlight of the president's first term — on the fiscal cliff negotiating table, including, according to Majority Leader Eric Cantor, a provision hiking taxes on medical device companies. Cantor told Fox News on Monday that the Affordable Care Act, "the largest expansion of government programs we've ever seen," should be subject to the same fiscal cliff negotiations as other areas of the government if lawmakers are to avoid the year-end cocktail of spending cuts and tax increases. Specifically, he said lawmakers should look at the law's Independent Payment Advisory Board and averting a tax increase on the medical device industry (Henry, 11/26).

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Health Reform

High Court OKs Liberty University's Push To Argue Claims Against The Health Law

The arguments, which were not considered in the earlier Supreme Court review of the overhaul, maintain that it is unconstitutional for the government to require large employers to provide health insurance to their full-time workers or pay a tax and that the law violates the school's religious freedoms.

The Wall Street Journal: Court Orders New Review Of Health Law
The Supreme Court told a federal-appeals court Monday to consider several lesser-known legal arguments against the national health-care law, in an order backed by the White House. The move came in a case brought by Liberty University, a Lynchburg, Va., college founded by the late Rev. Jerry Falwell, and observers said the challenge was unlikely to succeed (Bravin, 11/26).

The Associated Press: Court Orders New Look At Health Care Challenge
The court on Monday ordered the federal appeals court in Richmond, Va., to consider the claim by Liberty University in Lynchburg, Va., that Obama's health care law violates the school's religious freedoms. ... Liberty is challenging both the requirement that most individuals obtain health insurance or pay a penalty, and a separate provision requiring many employers to offer health insurance to their workers. ... Liberty's case joins dozens of other pending lawsuits over health reform (Sherman, 11/26).

Los Angeles Times: Liberty University Allowed To Argue Claims Against Healthcare Law
No one has seriously disputed that the federal government has broad power to regulate employers, and the justices did not even consider this claim earlier this year. ... Last month, the Obama administration told the justices it had no objection to such an order (Savage, 11/26).

Politico: SCOTUS Orders Appeals Court To Hear Liberty University Health Care Lawsuit
The Justice Department declined to comment on the Supreme Court order Monday, but it told the court last month that it wouldn’t object to the 4th Circuit taking up the case. In that brief, Solicitor General Donald Verrilli wrote that Liberty University’s arguments “lack merit” but that the Obama administration wouldn’t oppose a hearing because the issues weren’t fully aired the first time around. Some legal experts are skeptical that Liberty would get anywhere with its arguments against the employer mandate if the case does get to the Supreme Court (Haberkorn and Smith, 11/27).

The Hill: Supreme Court Revives Challenge To President Obama's Health Care Law
The court's decision Monday is purely procedural and does not indicate that the justices believe Liberty is likely to win on the merits. The lower court will still be bound by the Supreme Court's decision upholding the healthcare law as constitutional (Baker, 11/26).

Medpage Today: Supreme Court Remands ACA Mandate Case
After the case was dismissed by a district court, the plaintiffs appealed to the U.S. Court of Appeals for the Fourth Circuit, in Richmond, Va., which decided in September 2011 that it could not rule on it because of the Anti-Injunction Act, a federal law that states that a person cannot sue over a tax until they are actually forced to pay it. The Supreme Court disagreed with that thinking (Frieden, 11/26).

Reuters: Obama Health Law To Face Religion-Based Challenge
Ilya Somin, a law professor at George Mason University in Virginia, said the challenge to the employer mandate would be a "tough sell" based on the June decision, which let Congress require people to buy health insurance under its power to tax. "If you look at the way Chief Justice John Roberts upheld the individual mandate, and made it a tax, there is considerable reluctance on his part to strike down a major portion of this law," Somin said (Baynes and Stempel, 11/26).

In other news from the Supreme Court -

Modern Healthcare: High Court Justices Skeptical Of Phoebe Putney’s Arguments In Antitrust Case
The Supreme Court has long allowed state governments to disregard federal antitrust law and establish monopolies to meet public goals. But a lawyer for the Federal Trade Commission told the justices Monday that the same power does not flow to public hospital authorities unless the legislature explicitly says so in a law. The FTC has been waging a legal battle against the public hospital authority in Dougherty County, Ga., which federal lawyers say was used as a front to protect an anticompetitive transaction between two private corporations that consolidated the acute-care services within a six-county area under the control of Phoebe Putney Health System, Albany, Ga (Carlson, 11/26).

CQ HealthBeat: Supreme Court Considers Whether Georgia Hospital Merger Creates Monopoly
The justices didn't seem to reveal their opinions one way or the other. At one point, Justice Stephen G. Breyer declared: "I'm not at all decided." Justice Ruth Bader Ginsburg pressed a Department of Justice lawyer to explain how a Georgia state law should have been worded to allow a hospital to acquire other properties. ... The FTC says such a sale creates a monopoly that will drive up prices for consumers since they are the only two hospitals in a wide geographic area (Norman, 11/26).

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Impact Of Medicaid Expansion Would Vary By State, According To Study

The analysis released Monday explored how some states would experience savings while others would see cost increases as a result of the health law's plan to expand Medicaid.

Kaiser Health News: Capsules: Study: States Face Increased Medicaid Costs Even If They Don't Expand Program
If state officials think they can escape a fiscal quagmire by refusing to expand Medicaid under the federal health law, they might want to reconsider. State Medicaid costs will jump $76 billion, or nearly 3 percent, over the next decade if all 50 states decide to expand Medicaid eligibility in 2014 under the federal health law. But state spending on the program would still increase to the tune of $68 billion even if not a single one opts for the expansion, according to a study released Monday by the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.) (Galewitz, 11/26).

Modern Healthcare: For States, Impact Of Medicaid Expansion Would Vary: Study
Some states would see savings while others would experience cost increases as a result of the health reform law's provision to expand Medicaid, according to a report from the Kaiser Family Foundation (PDF). As states consider whether to expand their Medicaid programs—based on the Supreme Court's ruling this past summer that gives them this option—the new analysis shows Medicaid spending would increase by about $1.03 trillion between 2013 and 2022, with federal spending rising by $952 billion, or about 26%, and state spending increasing by $76 billion, or less than 3%, over that period (Zigmond, 11/26).

CQ HealthBeat: States Face Higher Medicaid Costs Even If They Don't Expand Program, Kaiser Report Finds
State officials who are hoping to avoid high Medicaid costs from the health care law by not expanding the program might be in for an unpleasant discovery: Other Medicaid-related mandates in the overhaul will mean higher state spending regardless of whether a state expands, according to a state-by-state analysis the nonpartisan Kaiser Family Foundation released Monday. The report shows that if all states expand coverage, as allowed under the 2010 health care law, they would collectively spend $76 billion more from 2013 to 2022 on Medicaid than if the measure had never been enacted. That's only about $8 billion more than states would pay under the law if none of them expand (Adams, 11/26).

The Hill: Study: Medicaid Expansion Is Cheap For States
Republican governors are under enormous pressure not to expand their Medicaid programs, as conservatives look for any way to undermine the Affordable Care Act now that it has survived the Supreme Court as well as the 2012 election. Nearly every Republican governor has rejected the expansion, citing the additional costs to state governments that are still recovering from the recession. But according to the new Kaiser analysis, states' additional costs would be small (Baker, 11/26).

The Associated Press/Washington Post: Report Says States Can Get More Than $9 From Feds For Every $1 They Spend To Expand Medicaid
States will receive more than $9 in federal money for every $1 they spend to cover low-income residents under President Barack Obama's health care law, according to a nonpartisan analysis released Monday. Expanding Medicaid to cover about 20 million more low-income people will cost over $1 trillion nationally from 2013 to 2022, said the joint report from the Kaiser Family Foundation and the Urban Institute (11/26).

CNN: Medicaid: States Turning Down Free Money, Group Says
Since the Supreme Court ruled that states cannot be forced to participate, eight states have said they won't expand their current Medicaid programs, and several others say they may follow suit. But the KFF report says those states may be making life unnecessarily hard for their poorest citizens. Why? Let's start with the basics: The cost of Medicaid is currently shared by states and the federal government, with Washington picking up a little more than half the bill. Under Obamacare, the feds would carry a much heavier load: 100% of new costs for the first three years, 95% starting in 2017 and 90% in 2020 and beyond (Hellerman, 11/26).

News outlets also report on how specific states fare in the calculations.

The Denver Post: Medicaid Expansion Could Cost Colorado $858 Million Over 10 Years
The state's share of costs for expanding Medicaid rolls under federal health-care reform could be $858 million over 10 years, according to new estimates from the Kaiser Family Foundation. The analysts still consider the price a bargain for Colorado and other states that want to bring health insurance to hundreds of thousands of low-income residents (Booth, 11/26).

The Atlanta Journal-Constitution: Study: Medicaid Expansion Would Bring Georgia $33B
Expanding Georgia's massive Medicaid health care program would cost the state roughly $2.5 billion over a decade, while providing half a million poor, uninsured Georgians with coverage, a new study estimates. Under a Medicaid expansion — a pillar of the Affordable Care Act — the federal government would pay 100 percent of the costs for newly eligible enrollees the first few years, though that would later fall to 90 percent. The result: more than $33 billion in new federal money would flood into Georgia over a 10-year period, according to the study released Monday by the nonprofit Kaiser Family Foundation (Williams, 11/27).

Georgia Health News: Report Takes New Look At Medicaid Expansion Costs
A new study has estimated that Georgia's 10-year cost of expanding Medicaid under the health reform law would be $1.8 billion. Only five states – California, Texas, Ohio, Pennsylvania and Florida – would face a higher cost, the report said. The Georgia increase would represent a 4.1 percent hike in Medicaid spending through the year 2022, according to the analysis, conducted by the Urban Institute and released Monday by the Kaiser Family Foundation (Miller, 11/26).

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Progress Check On States And Health Insurance Exchanges

With Democrats regaining control of the New Hampshire House, lawmakers could revisit a GOP decision not to build a health insurance exchange. In the meantime, Oregon, California and Missouri officials seek to clarify their options.

The Associated Press: N.H., Feds Could Partner On Health Exchange
New Hampshire could revisit a state law requiring the federal government to run a health insurance exchange and take on a bigger role through a partnership. 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 (Love, 11/26).

The Oregonian: Public Comment Sought On Rules For Oregon Health Insurance Exchange
State officials are holding a hearing Wednesday to receive public comment on rules for the state's health insurance exchange -- essentially an online marketplace for consumers called for by federal health reforms. Starting October 2013, the state's exchange, called Cover Oregon, will offer standardized plans to help consumers choose between carriers; the plans will be rated bronze, silver, gold and platinum. Some consumers will qualify for tax credits to offset premiums (Budnick, 11/26).

California Healthline: Exchange Official: Multistate Plans Not Same As Public Option
How and when federally overseen multistate plans develop in California's health insurance exchange is still anybody's guess, but no matter what shape they take and when they arrive, they won't serve as a surrogate public option, according to a California exchange official. "This is not a public option," said Andrea Rosen, interim health plan management director for Covered California. "These are private carriers contracting with the federal government. In a true public option, the government would be the insurer. That's not the case here," Rosen said. The Affordable Care Act calls for the federal government to offer two multistate health insurance plans through state exchanges. To be eligible, insurers must be licensed in all 50 states. At least one of the insurers must be not-for-profit, according to the ACA (Lauer, 11/26).

St. Louis Beacon: Legislative Divides May Sink State-Based Health Insurance Exchanges
On the surface, President Barack Obama’s re-election seemed to be a death knell to opponents of the Affordable Care Act, and the measure's mandates for health-insurance exchanges. In some other states, some prominent GOP officials -- such as Florida Gov. Rick Scott -- seem to see the writing on the wall and have been softening their opposition to certain provisions of the ACA, more commonly known as "Obamacare." But so far, not in Missouri. In fact, some Missouri Republicans -- notably state House Speaker Tim Jones, R-Eureka, and others in the state Senate -- are firming up their resistance when it comes to the state setting up a health-insurance exchange, an internet portal aimed at helping uninsured Americans purchase health insurance at lower rates (Rosenbaum, 11/26).

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Capitol Hill Watch

Critics Look To House Panels To Restrain Health Law; Big Policy Issues Remain

Questions remain on implementing the health law -- both politically and in settling policy matters -- as opponents look to House committees to police the Obama administration's activities to get the law up and running.

Politico Pro: ACA Opponents Pin Hopes On House Panels
Republicans' attempts to ditch the health care law through Congress and the Supreme Court have failed, so they're funneling their energy into the one remaining venue through which they can still influence the law: committees in the House of Representatives. The GOP-led committees have the power to oversee the health overhaul as it's put into place -- and keep a sharp eye on the Obama administration as it works toward that end. Various committees are looking at a host of issues -- the software contracts for insurance exchanges, how quality bonuses might temporarily hide the sting of Medicare cuts and the administration’s approach to selling a skeptical public on the benefits, to name a few (Cunningham, 11/26).

Medpage Today: Big Questions About ACA Still To Be Answered
But just because efforts by conservatives in Congress to repeal the law may be gone doesn't mean there aren't major questions left unanswered, according to Jonathan Oberlander, PhD, professor of health policy and management at the University of North Carolina School of Medicine. The Obama administration faces several challenges in the coming months in implementing the law, Oberlander wrote online in a New England Journal of Medicine perspective piece. … Politically vulnerable provisions of the law such as the Independent Payment Advisory Board also are left in question, he said (Pittman, 11/26).

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Health Care Marketplace

Earnings Outlook Weaker Than Expected For UnitedHealth

Los Angeles Times: UnitedHealth's Earnings Outlook Is Below Expectations
UnitedHealth Group Inc., the nation's largest health insurer, issued a weaker-than-expected 2013 profit outlook amid worries about economic growth and negotiations over federal spending. Ahead of its annual investor conference Tuesday, UnitedHealth said it expects earnings next year to be $5.25 to $5.50 a share. That's slightly below the average analyst estimate of $5.58 a share (Terhune, 11/27).

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State Watch

State Roundup: Conn. Official Says Bulk Buying Prescription Drugs Could Help Budget

A selection of health policy stories from Connecticut, Mississippi, California, Wisconsin, Florida and North Carolina.

CT Mirror: Bulk Purchasing Of Medication Can Reduce State Budget Deficit, Comptroller Says
The state's chief fiscal watchdog is asking legislators and Gov. Dannel P. Malloy's administration to take a second look at how government purchases prescription medication -- and a proposal he believes could save more than $65 million over the next fiscal year. Comptroller Kevin P. Lembo said purchasing of medications in bulk for social service recipients as well as for state employees and retirees is a cost-cutting move that might be implemented as early as this spring, mitigating both the current budget deficit and the projected shortfall for 2013-14 (Phaneuf, 11/26).

Milwaukee Journal Sentinel: Clarke Lacks Authority To Privatize Inmate Health, Lawyer Says
Sheriff David A. Clarke Jr. does not have the power he claims to unilaterally privatize inmate health care at the county jail, according to lawyers for Milwaukee County. Clarke has mistakenly relied on an earlier case on a sheriff's constitutional authority for inmate transport to claim he has similar say-so over inmate health care, Ronald Stadler, a lawyer representing the county, wrote in a legal brief. "He has failed to show that the provision of jail health services is constitutionally protected," Stadler wrote. "Just because Sheriff Clarke says it, does not make it so” (Schultze, 11/26).

Health News Florida: Patients Are Pawns In Contract Fight
Carol White of St. Petersburg and some of her friends spent Monday looking for a new Medicare Advantage plan after BayCare Health System ended its contracts with UnitedHealthcare. … It's not only seniors who got squeezed at midnight Monday when the contract ended between one of the nation's largest health insurers and BayCare, Tampa Bay's dominant non-profit hospital chain. The break-up also affects Medicaid and employer-sponsored coverage -- a total of 400,000 United customers, said Elizabeth Calzadilla-Fiallo, spokeswoman for the Florida division of the Minnesota-based insurer (Gentry, 11/27).

The Associated Press: NC Report Analyzes Child Health In 15 Areas
North Carolina's 2.3 million children are falling behind in some important benchmarks for health, such as the poverty rate, but they're improving in other areas, including the number who have insurance, according to a report issued Monday. The North Carolina Institute of Medicine and Action for Children released the 18th annual Child Health Report Card on Monday, analyzing data in 15 areas. North Carolina got two A's and three D's, compared to three A's and one D in last year's report. The reports compare health indicators from 2010 and 2011 with the same figures from years dating back to 2004 (11/26).

North Carolina Health News: Annual Report Card Shows Poor Economy Hinders Child Health
Even as North Carolina's infant mortality rates improved and rates of childhood death dropped, the health of the state's children is still poor, with high levels of obesity and childhood poverty, according to a report released Monday. The annual report from Action for Children North Carolina and the North Carolina Institute of Medicine details how some traditional measures of childhood health improved over the past five years: immunization rates are up, tobacco use among teens is down and more kids have access to dental care. But as North Carolina slowly climbs out of the worst economic downturn since the Great Depression, the report details how poverty still impedes the health of North Carolina’s children (Hoban, 11/26).

California Healthline: Advocates' Challenge To Adult Day Process Denied
A federal judge ruled last week to deny a motion that would have forced the Department of Health Care Services to alter the way it is handling enrollment in the new Community Based Adult Services program. The ruling means CBAS enrollment will continue without changes unless Disability Rights California, the health advocacy group that filed the motion, appeals the ruling. Deadline for appeal is Friday (Gorn, 11/27).

The Associated Press: Corrections, Medicaid Deficit Hurdles For Mississippi Legislators
Mississippi legislators head into the 2013 session knowing they have deficits to address in corrections and Medicaid. Any others? That's all rather tentative right now about six weeks out from the Jan. 8 start. One thing is certain: the money handlers must be convinced there is a clear need. ... "There's not going to be a significant number of deficits. We know there's going to be one in corrections and one in Medicaid. We've got the money in reserve accounts to cover it," said House Appropriations Committee chairman Herb Frierson, R-Poplarville (11/26).

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Editorials and Opinions

Viewpoints: WSJ Suggests Norquist 'Give Some Ground' On Fiscal Cliff Talks; Voters Aren't Buying GOP Obstruction On Health Law

The Wall Street Journal: Republicans And The Tax Pledge
The fact is that Republicans and (Grover) Norquist both face a new political reality on taxes. President Obama's re-election means that taxes for upper-income earners are going up one way or another. The Bush rates expire on December 31 unless Mr. Obama signs an extension, and he shows no inclination to do so. ... This is where Mr. Norquist can give some ground. If taxes are going up anyway because the Bush rates expire, and Republicans can stop them from going up as much as they otherwise would, then pledge-takers deserve some credit for that. ... Speaker John Boehner deserves some leeway to try to mitigate the damage by negotiating a larger tax reform. All the more so if Mr. Boehner can also get Mr. Obama to agree to significant spending and entitlement reform. This means more than the usual suspects of cuts to doctors and hospitals and means-testing benefits for the affluent (11/26).

The Washington Post: Breaking Grover Norquist's Anti-Tax Pledge
Republicans who signed the pledge — and who now find themselves in a box — have only themselves to blame. To boost their own political fortunes, they lied to the voters. They pretended it was possible to provide the services that Americans need and want without collecting sufficient revenue. They sold the bogus promise of not just a free lunch, but a free breakfast and supper, too. This is a big, complicated country that faces big, complicated challenges. There are no simple, one-sentence solutions (Eugene Robinson, 11/26).

The Hill: In Denial On Health Reform
Four weeks after a decisive election victory for President Obama, Speaker John Boehner (R-Ohio) and much of the GOP are still suffering from a severe case of Romnesia. The symptoms initially seemed to subside when Boehner admitted to ABC news that the Affordable Care Act is the "law of the land" in a post-election interview, only to return shortly thereafter as a spokesman "corrected" the Speaker’s comments by restating support for repealing the healthcare reform law. Boehner followed up with an op-ed in The Cincinnati Enquirer with new GOP talking points renaming obstructive efforts as "oversight of the executive branch." …The inability to accept the validity of certain polls has been a key symptom of Romnesia. Yet the GOP does seem to recognize its obstruction effort is in a race against the clock; recent polls show the more Americans learn about the Affordable Care Act, the more they like it, and support for repeal is declining (Karen Finney, 11/26).

The Washington Post: Santorum's New Cause: Oposing The Disabled
(Former Republican Sen. Rick) Santorum, joined by Sen. Mike Lee (R-Utah), declared his wish that the Senate reject the U.N. Convention on the Rights of Persons With Disabilities — a human rights treaty negotiated during George W. Bush's administration and ratified by 126 nations, including China, Russia, Iran, Cuba, Syria and Saudi Arabia. The former presidential candidate pronounced his "grave concerns" about the treaty, which forbids discrimination against people with AIDS, who are blind, who use wheelchairs and the like. "This is a direct assault on us," he declared at a news conference (Dana Milbank, 11/26). 

WBUR: CommonHealth: When The Full Sticker Shock Of Health Coverage Hits Our Family
I have always carried the health insurance — a very robust PPO (“paid provider option”) family plan that was largely subsidized by my employer. The direct cost to me (paid bi-weekly on a pre-tax basis) was roughly $400 a month. In discussing my career departure with my husband, we knew that the monthly cost for a similar plan purchased through the Health Connector (the Massachusetts state agency that acts as a vehicle to allow uninsured residents to purchase health insurance through local health insurance companies) would likely be higher. Much higher (Sara Cushing, 11/26).

The Lund Report: We Can Improve Healthcare By Exchanging Ideas
If you had five minutes with the Governor to talk healthcare, what would you say? That’s the question we asked 17 healthcare, business, civic and legal executives from across four states: Washington, Oregon, Idaho and Alaska The response, collected in a new book titled "Dear Governor: About The State Of Reform," offers readers perhaps the most sophisticated level of discussion and analysis of state healthcare policy in the northwest (DJ Wilson, 11/26).

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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.