Daily Health Policy Report

Thursday, November 29, 2012

Last updated: Thu, Nov 29

KHN Original Reporting & Guest Opinion

Fiscal Cliff

Health Reform

Capitol Hill Watch

Health Care Marketplace


Health Information Technology


State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Options For Parents To Cover Sick Children (Video)

Kaiser Health News consumer columnist Michelle Andrews answers a reader question about how to find affordable coverage for a child with a preexisting medical condition (11/28). Watch the video.

This Story: Print | Link to | Top

Capsules: More Workers Covered By Bosses' Self-Insured Plans

Now on Kaiser Health News' blog, Ankita Rao writes: "The number of U.S. workers covered by self-insured health plans—in which their employer assumes the financial risk for health costs rather than paying insurance companies to do that—has grown steadily in recent years. But such plans are still primarily used by large companies, not small employers, a new study finds" (Rao, 11/28). Check out what else is on the blog.

This Story: Print | Link to | Top

Political Cartoon: 'Be Careful What You Wish For'

Kaiser Health News provides a fresh take on health policy developments with "Be Careful What You Wish For" by Chris Weyant.

Meanwhile, here is today's health policy haiku:


No sequestration! 
Balanced approach "consensus"
But not high tax rates?
- Paul Hughes-Cromwick 

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.

This Story: Print | Link to | Top

Fiscal Cliff

Medicare, Other Entitlement Programs Key To 'Fiscal Cliff' Deal

Politico reports that "inside the talks," a framework for addressing the "fiscal cliff" is taking shape that includes both tax increases and entitlement cuts. Other news outlets note that publicly, President Barack Obama is playing down spending cuts, while GOP leaders demand entitlement reductions but without offering specifics.

Politico: Inside The Talks: Fiscal Framework Emerges
Cut through the fog, and here's what to expect: Taxes will go up just shy of $1.2 trillion — the middle ground of what President Barack Obama wants and what Republicans say they could stomach. Entitlement programs, mainly Medicare, will be cut by no less than $400 billion - and perhaps a lot more, to get Republicans to swallow those tax hikes. There will be at least $1.2 trillion in spending cuts and "war savings." And any final deal will come not by a group effort but in a private deal between two men: Obama and House Speaker John Boehner (Vandehei and Allen, 11/29).

The New York Times: Obama Tilts Tax Debate Away From Spending Cuts
Mr. Obama has embraced specific cuts to the federal budget in the past and has committed to an agreement with Congress that will include deep reductions in spending. But it would be easy for those who listen to his public pronouncements lately to miss it. In public statements since his re-election, he has barely discussed how he would pare back federal spending, focusing instead on the aspect of his plan that plays to his liberal base and involves all gain and no pain for 98 percent of taxpayers. … Republican leaders were more scathing, saying the president was more interested in campaigning than sitting down to resolve difficult issues. They said they were willing to raise tax revenue by closing loopholes and limiting deductions, but Mr. Obama has not reciprocated with more restraint of entitlement programs (Baker, 11/28).

Los Angeles Times: Obama Takes 'Fiscal Cliff' Battle To Social Media
Democrats welcomed Obama's effort to mobilize public opinion as the divided Congress struggles to strike a budget deal before Jan. 1, when a series of automatic tax hikes and sharp spending cuts are scheduled to kick in. … Obama urged Americans to tweet members of Congress using hashtag #My2k, a reference to the $2,200 he said an average family would pay in additional taxes if Congress failed to act. He mentioned the Twitter hashtag four times, and it later appeared on a screen behind Jay Carney, the White House press secretary, at his televised afternoon briefing. House Speaker John A. Boehner (R-Ohio) indicated that he had little patience for the continued focus on taxes, and that he wanted the administration to put spending cuts to Medicare, Medicaid and other government programs on the table (Parsons and Mascaro, 11/28).

The Associated Press/Washington Post: White House, Congress To Talk As Fears Increase That Government Heading Toward 'Fiscal Cliff'
Amid increasing anxiety that the White House and top Republicans are wasting time as the government slides toward an economy-rattling "fiscal cliff," administration officials are heading to Capitol Hill for talks with congressional leaders. Treasury Secretary Tim Geithner and senior White House aide Rob Nabors were to visit separately Thursday with the four leaders of the House and Senate to discuss how to avert a series of tax increases and spending cuts due to begin in January. Republicans complain that the White House is slow-walking the talks and has yet to provide specifics on how President Barack Obama would curb the rapid growth of benefit programs like Medicare and Medicaid (11/29).

The Washington Post: 'Fiscal Cliff' Talks Bogged Down By Dispute Over Cost Of Retirement Programs
Negotiations to avert the year-end "fiscal cliff" advanced at a glacial pace Wednesday, with a dispute over how to tackle the soaring cost of federal retirement programs emerging as the latest roadblock to progress. … Republicans, meanwhile, insisted that it is up to President Obama to offer a plan to restrain the cost of Medicare, Medicaid and Social Security — the government's biggest and fastest-growing programs — in exchange for GOP concessions on taxes (Montgomery and Helderman, 11/28).

Roll Call: Liberals Start To See Entitlement Trim As Inevitable
When the Center for American Progress recently pointed to some potential savings from entitlement programs, the political implications were more important than the numbers. The left-of-center group’s entry into the battle over entitlement spending provided some political cover that could allow more Democratic lawmakers to support a deficit reduction compromise including savings from programs they have long defended with their political lives — Medicare, Medicaid and perhaps Social Security. The report said Congress could reduce the cost of health care for seniors by $385 billion over 10 years by picking up some proposals that were either discussed during the 2011 debt limit standoff or included in President Barack Obama’s fiscal 2013 budget proposal — things such as higher premiums for upper-income Medicare beneficiaries and cuts in Medicare payments to hospitals and nursing facilities (Krawzak, 11/28).

National Journal: Dems To GOP: Stop Stalling And Name Your Entitlement Cuts
Senate Democrats are blaming Republicans for the slow pace of the fiscal cliff negotiations, arguing that Republicans have failed to lay out the entitlement spending cuts they want to see as part of a deal. Instead, Republicans are trying to force Democrats into negotiating with themselves and in the process take on the political burden of proposing both tax increases on the wealthy and spending cuts that could hit the middle class, a Senate Democratic leadership aide said. ... Even Democratic Sen. Tom Harkin, who has publicly opposed including Medicare or Medicaid cuts in a deal, refrained from saying that Democrats would reject an Obama-Boehner crafted deal that includes spending cuts. Instead, he urged the president to keep Senate Democrats in the loop so they can work something out (Frates, 11/28).

Reports also explore what Medicare proposals could be in play -

NPR: The Hidden Costs Of Raising The Medicare Age
Whenever the discussion turns to saving money in Medicare, the idea of raising the eligibility age often comes up. … It's hardly surprising that the idea keeps finding its way into the conversation. That same increase is already being phased in for Social Security. Even President Obama reportedly had the idea on the table during his informal negotiations with House Speaker John Boehner during the summer of 2011 (Rovner, 11/29).

NPR: A Huge Pay Cut For Doctors Is Hiding In The Fiscal Cliff
On Jan. 1, Medicare is set to cut payments to doctors by nearly 30 percent. Both Republicans and Democrats in Congress want to prevent this from happening. But a very different Congress 15 years ago decided the cut was necessary to contain health-care costs (Joffe-Walt, 11/29).

The Medicare NewsGroup: AMA’s New Leader Embraces Medicare Policy
For Dr. Ardis Hoven and other veteran policymakers within the American Medical Association (AMA), the nation’s largest medical organization’s move to support transitioning Medicare away from a defined-benefit to a defined-contribution system has been a long time coming. Hoven, an internist and infectious disease specialist based in Lexington, KY, served countless hours over the last two decades on the AMA’s Council on Medical Service, debating how the physicians’ organization could best advise Congress and the White House to preserve Medicare, the federal health insurance program for seniors and the disabled. Meanwhile, doctors became increasingly unsure what they would be paid by Medicare from one year to the next (Japsen, 11/27).

This Story: Print | Link to | Top

Health Reform

Several Health Law Provisions Take Effect In New Year

While health exchanges and the Medicaid expansion grab most of the headlines, media outlets explore other, lesser-known provisions soon to take effect.

CQ HealthBeat: Health Law In The New Year: It's Not Just Exchanges And Medicaid
There's a lot happening in coming weeks to implement the health care law that has nothing to do with what everyone has been talking about in recent days — standing up health insurance exchanges, expanding Medicaid and establishing a new regulatory structure for the insurance market. Just consider the changes that occur starting Jan. 1. That day marks the start of the Medicare bundled payment pilot. It's a form of reimbursement that policy analysts hope will help bend down the upward curve in health care spending, together with other strategies. Hospitals, doctors and nursing facilities taking part in the Bundled Payments for Care Improvement Initiative will get one payment for multiple services a patient receives during an episode of care (Reichard, 11/28).

Politico: ACA Boosts 'Shared Decision-Making'
What can they do when everyone seems to be trying to push aggressive, expensive treatments on them? One solution — or a partial solution — is known as shared decision making, in which patients are given specific tools, such as easy-to-understand videos laying out the pros and cons of treatment choices, to help them make decisions along with their doctors (Kenen, 11/29).

Bloomberg: Unaffordable Costs Seen For Some Under Affordable Care Act
To Megan Hildebrandt, President Barack Obama's Affordable Care Act means she can no longer be denied health insurance because of her lymphatic cancer. There's a big catch: Coverage for the 28-year-old artist and many other Americans without insurance will come at a potentially unaffordable cost. ... The landmark health-care law, which survived the threats of repeal and a Supreme Court review, now confronts another hurdle: living up to expectations. As the administration spells out the details, many uninsured will be surprised at how much they will have to pay (Faler, 11/28).

Bloomberg: Insurers Join Former Adversaries To Publicize Health Law
Aetna Inc. and other insurers that initially fought President Barack Obama's health-care overhaul are reversing course and supporting the effort by funding a group planning to spend $100 million to help the uninsured get coverage. Enroll America, a nonprofit created two years ago, has gathered support from the insurers that opposed the law and consumer organizations such as Washington-based Families USA that supported it. The new organization plans a broad-based educational campaign to make uninsured people aware of the health-care law's benefits and help them sign up, said Ron Pollack, Enroll America's chairman (Wayne, 11/29).

Meanwhile, a Gallup survey measures public thoughts on the government and health coverage -

Politico: Poll: Health Coverage Not Federal Government's Job
For the first time in 12 years, a majority say it is not the federal government’s responsibility to ensure that health care coverage is provided to all Americans, according to a poll on Wednesday. Only 44 percent believe the government should guarantee health care coverage, and 54 percent believe it has no such responsibility, according to a Gallup survey (Robillard, 11/28).

This Story: Print | Link to | Top

Capitol Hill Watch

Republican Top Docs Take Helm Of House Energy And Commerce Oversight Panel

In other news from the Hill, lawmakers called for stepping up the fight against Medicare fraud during a Wednesday Capitol Hill hearing.

CQ HealthBeat: GOP Docs Take Helm Of Energy And Commerce Oversight Panel
Two top members of the House GOP Doctors Caucus will take control of the investigatory panel of the House Energy and Commerce Committee, a move that should help House Speaker John A. Boehner fulfill his goal of conducting hard-hitting oversight of the health care overhaul law. With Republicans lacking the votes to repeal the law because of their failure to sufficient gains at the ballot box, Boehner, R-Ohio, is now depicting oversight as the route to repealing the law. Joining Murphy, a strong critic of the health care law, will be an energetic and sometimes aggressive questioner, Rep. Michael C. Burgess. Burgess, R-Texas, will serve as the panel’s vice chairman, a role he also will continue to play next year on the Energy and Commerce Health Subcommittee (Reichard, 11/28).

The Hill: GOP Lawmaker Calls For Tougher Fight Against Medicare Fraud
Republican Rep. Joe Pitts (Pa.) called Wednesday for more sophisticated techniques to fight fraud in Medicare, a problem he said costs taxpayers $60 billion every year. "Our nation's seniors are counting on us to ensure that Medicare fulfills its promises," Pitts said Wednesday at a hearing on the issue. "We can do that in part by making sure their premium dollars are managed wisely and not lost to con artists." Pitts leads the House Energy and Commerce Subcommittee on Health, which held the hearing (Viebeck, 11/28).

This Story: Print | Link to | Top

Health Care Marketplace

Survey: More Workers Gaining Coverage Through Employers' Self-Insured Plans

Based on 2011 data, the share of workers in self-insured company health plans increased for the fourth straight year, according to the Employee Benefit Research Institute

Kaiser Health News: Capsules: More Workers Covered By Bosses' Self-Insured Plans
The number of U.S. workers covered by self-insured health plans—in which their employer assumes the financial risk for health costs rather than paying insurance companies to do that—has grown steadily in recent years. But such plans are still primarily used by large companies, not small employers, a new study finds (Rao, 11/28).

Modern Healthcare: Survey Finds More Workers In Self-Insured Company Health Plans
The share of workers in self-insured company health plans increased for the fourth straight year in 2011 to 58.5% of all private-sector employees, according to an employment research group. The Employee Benefit Research Institute analyzed data collected by the Agency for Healthcare Research and Quality and found a 1 percentage point increase last year in the share of private-sector employees in health plans operated by their employers (PDF), instead of commercially available plans. Ten years earlier, 48.8% of private-sector employees were in such plans. Much of the increase has been driven by larger firms. For instance, the share of workers in firms with at least 1,000 employees enrolled in self-insured plans rose from 55.4% in 1998 to 86.3% in 2011 (Daly, 11/28).

CQ HealthBeat: Self-Insurance On The Rise And Health Care Law May Spur The Trend
A new analysis by the Employee Benefit Research Institute says self-insurance is a huge trend in employer-sponsored coverage that could become more pronounced in the wake of the health care law. "In 2011, 58.5 percent of workers with health coverage were in self-insured plans, up from 40.9 percent in 1998," an EBRI summary of the study says. For the most part, employers with 1,000 or more workers have driven the trend. Only 12 percent of firms with fewer than 50 employees were self-insured in most of the years examined in the study (Reichard, 11/28).

In related news -

Modern Healthcare: AMA Report Sees Monopolies In Insurance Markets
The American Medical Association's annual report on the health insurance marketplace suggests that 70% of metropolitan markets lack competition among insurers, prompting a quick critical response from a payers trade group. The Chicago-based AMA, in its "Competition in Health Insurance: A Comprehensive Study of U.S. Markets" 2012 report, states, "It appears that consolidation has resulted in the possession and exercise of health insurer monopoly power." This is the first year that the study analyzed insurer competition among markets. The research covered 385 metro areas across the country and compiled three lists that ranked the states with the least competitive HMO (PDF), PPO (PDF) and commercial health insurance markets (Selvam, 11/28).

This Story: Print | Link to | Top


Sharp Criticism For Medicare's Conversion To Electronic Medical Records

A federal report scheduled for release today details specific vulnerabilities of Medicare's EMR system.

The New York Times: Medicare Is Faulted On Shift To Electronic Records
The conversion to electronic medical records — a critical piece of the Obama administration's plan for health care reform — is "vulnerable" to fraud and abuse because of the failure of Medicare officials to develop appropriate safeguards, according to a sharply critical report to be issued Thursday by federal investigators (Abelson, 11/29).

Modern Healthcare: HHS Inspector General: EHR Programs Need Better Oversight
The CMS and the Office of the National Coordinator for Health Information Technology at HHS need to tighten up their oversight of the Medicare EHR incentive payment program, according to HHS' inspector general's office. The watchdog office, headed by Inspector General Daniel Levinson, offered a couple of recommendations for the agencies in its report, "Early Assessment Finds That CMS Faces Obstacles in Overseeing the Medicare EHR Incentive Program" (PDF). The report is based on audits of EHR incentive payment attestations, reviews of internal CMS and ONC documents about the program and interviews with CMS personnel (Conn, 11/29).

This Story: Print | Link to | Top

Health Information Technology

How Technology Is Introducing New Twists Into Health Privacy Protections

The Wall Street Journal: Heart Gadgets Test Privacy-Law Limits
The U.S. has strict privacy laws guaranteeing people access to traditional health files. But implants and other new technologies—including smartphone apps and over-the-counter monitors—are testing the very definition of medical records. Medtronic says federal rules prohibit giving Ms. Hubbard's data to anyone but her doctor and hospital (Marcus and Weaver, 11/28).

This Story: Print | Link to | Top


Project Shows Simple Steps Reduce Hospital Infections

Seven health care institutions participated in a quality-improvement project advanced by the Joint Commission and the American College of Surgeons to reduce colorectal surgical-site infection rates. During a two and a half year period, those facilities saved more than $3.7 million by avoiding 135 infections.

The Associated Press/Wall Street Journal: Simple Measures Cut Infections Caught In Hospitals
A project at seven big hospitals reduced infections after colorectal surgeries by nearly one-third. It prevented an estimated 135 infections, saving almost $4 million, the Joint Commission hospital regulating group and the American College of Surgeons announced Wednesday. The two groups directed the 2 1/2-year project (11/28).

Medscape: Hospitals Cut Colorectal Surgical-Site Infections By A Third
Seven academic medical centers reduced their rate of colorectal surgical site infections (SSIs) by 32 percent with interventions that included hand sanitizer, new sets of instruments for closure, and postoperative telephone calls to patients about wound care, leaders of the quality improvement campaign announced at a press conference today. The hospitals scored an even bigger success by lowering the rate for a type of colorectal SSI called superficial incisional by 45 percent. In all, they avoided an estimated 135 colorectal SSIs, thereby saving more than $3.7 million. They also lowered the average length of stay for patients with these infections from 15 days to 13 days (Lowes, 11/28).

Modern Healthcare: Project Seen Cutting Colorectal Surgical-Site Infections
Seven institutions participating in a Joint Commission and American College of Surgeons quality-improvement project to reduce colorectal surgical-site infection rates saved more than $3.7 million by avoiding 135 infections over a 2½-year period. This included superficial incisional infections, affecting skin and underlying tissue, which were lowered 45 percent; and all types of colorectal surgical-site infections by 32 percent. The average length of stay for surgical-site infection patients was reduced to 13 days from 15. Joint Commission President Dr. Mark Chassin said during a news conference that "there is no simple, one-size-fits-all solution," but he explained that the key to reducing these infections lies in pinpointing causes and then using and testing targeted solutions to solve those problems (Robeznieks, 11/28).

Also in the headlines --

USA Today: Deadly 'Superbugs' Invade U.S. Health Care Facilities
The doctors tried one antibiotic after another, racing to stop the infection as it tore through the man's body, but nothing worked. In a matter of days after the middle-aged patient arrived at University of Virginia Medical Center, the stubborn bacteria in his blood had fought off even what doctors consider "drugs of last resort" (Eisler, 11/29).

This Story: Print | Link to | Top

State Watch

Health Exchange News: Ariz. Looks To Feds, Conn. And Co. Move Ahead

Arizona's Gov. Jan Brewer has decided Arizona will not implement a key part of the health law.

Reuters: Arizona Declines To Set Up State-Based Health Insurance Exchange
Arizona Governor Jan Brewer said on Wednesday she was rejecting a major provision of President Barack Obama's health care reform law that calls for creating state-based health insurance markets where consumers can purchase private, federally subsidized coverage. Citing lingering questions about the plan and operating costs she said would be passed on to families and small businesses, Brewer, a Republican, said Arizona would join at least 16 other states in opting instead for a federally run health insurance exchange (Schwartz, 11/28).

Politico Pro: Arizona Nixes State-Run Exchange
"[T]hough I am a steady advocate of local control, I have come to the conclusion that the state of Arizona would wield little actual authority over its 'state' exchange," Brewer said in a statement. "The federal government would maintain oversight and control over virtually every aspect of our exchange, limiting our ability to meet the unique needs of Arizonans and the Arizona insurance market" (Millman, 11/28).

The Associated Press/MSN: Arizona's Governor Chooses Not To Form State-Run Health Care Exchange Under Federal Law
Her announcement preceded a Dec. 14 deadline for states to declare whether they'd run their own exchanges. A decision to create an exchange would have been subject to approval by the Republican-led state Legislature. ... a Brewer push to create a state-run exchange would have faced a fight from GOP lawmakers who oppose the law. An alliance of hospitals, insurance companies and business groups wanted Arizona to have a state-run exchange, arguing that it would increase coverage while giving the state flexibility (Davenport, 11/28).

The Hill: Arizona Governor Rejects State-Based Insurance Exchange
Republican governors are under pressure from conservatives to reject state-based exchanges. They hope pushing the task to HHS will strain federal resources, a potential avenue to chip away at the Affordable Care Act without repealing it outright. But that strategy comes with practical risks. It gives the federal government more control over states' healthcare marketplaces (Baker, 11/28).

Other states are already busy considering what the new exchange will look like and how it will pay for itself by 2015, a stipulation of the health law --

CT Mirror: What Exactly Will The New Insurance Exchange Offer?
A year from now, state residents will have a new marketplace for buying health insurance -- think of it like a virtual store for health plans. And the policymakers at work developing the rules for the market are facing a key question about how much discretion to use in determining which health plans it will sell. Put another way: How selective should the shopkeeper be about what products stock its shelves? (Becker, 11/28).

Health Policy Solutions (a Colo. news service): Colorado Health Exchange Must Pay For Itself By 2015
Now a reality across the country as the Affordable Care Act steams toward full implementation, health exchanges are supposed to make it easier for individuals and small business owners to choose and buy health insurance plans. ... Colorado's exchange — which will soon have a new name — is slated to open for enrollment in October of next year with coverage that will start on Jan. 1, 2014. By Jan. 1, 2015, Colorado's health exchange must be financially self-sustaining (Kerwin McCrimmon, 11/28).

This Story: Print | Link to | Top

Uncertainty Reigns As Some States Mull Medicaid Expansion

With key details left to be sorted out, including estimates of coming tax revenue to cover the cost, Colorado, Missouri and South Carolina are confronting whether to expand Medicaid to millions -- a vital part of the health law's coverage provisions.

The Associated Press: Medicaid Expansion Still Uncertain For Colorado
Colorado health officials won't commit to increasing Medicaid coverage as called for by President Barack Obama's federal health care law, saying it's too soon to know whether the state can afford to expand health care for the needy. Speaking to a group of health care activists, Roxane White, chief of staff to Democratic Gov. John Hickenlooper, said Wednesday the administration is waiting until after a December tax estimate before deciding how to proceed (Wyatt, 11/28).

The Associated Press: Mo. Medical Groups Pushing For Medicaid Expansion
Missouri medical groups launched a campaign Wednesday to expand Medicaid coverage to thousands of working adults, citing a study estimating that the expansion largely funded by federal money could lead to 24,000 new jobs across the state. The push to expand Missouri's Medicaid program could also get a boost from Gov. Jay Nixon, who before his re-election this month had been noncommittal  (Lieb, 11/28).

St. Louis Beacon: Expanding Medicaid Called A ‘Win-Win’ For Jobs, Tax Revenue In Missouri 
The Republican legislative leadership in Jefferson City has generally opposed expanding the program for philosophical and fiscal reasons. While acknowledging such opposing views as legitimate arguments, those [medical groups] releasing the report this morning said their study represented a conservative estimate of cost and would put Missouri in what one described as a win-win economic situation if it chooses to expand Medicaid (Joiner, 11/28).

The Associated Press: SC Senators Warned About Rising Medicaid Costs
The director of South Carolina's Medicaid agency told state senators Wednesday that whether they support or oppose federal health care reform, they need to get ready for costs associated with the government health insurance program to increase rapidly. Department of Health and Human Services Director Tony Keck said his agency estimates the changes mean about 200,000 more people will join the 1 million adults and children in the state already using Medicaid (Collins, 11/28).

Politico Pro: Experts: Governors Won't Resist Medicaid Expansion For Long
Governors will eventually succumb to pressure to expand their Medicaid programs, a pair of health care experts predicted Thursday, arguing that the prospect of medical practices going out of business will force their hands. “The governor gets to decide whether these providers are going to go out of business,” Dan Mendelson, president of Avalere Health, said at a POLITICO Pro health policy breakfast. ... Gail Wilensky, who headed Medicaid for President George H.W. Bush, predicted that states resisting Medicaid expansion would reverse themselves within a few years (Cheney, 11/29).

Hispanics stand to gain if the expansion takes hold --

The Hill: Medicaid Expansion Would Benefit Hispanics
Hispanics -- one of Democrats' key voting blocs -- will be the biggest beneficiaries if President Obama's health care law is fully implemented, the law's supporters said Wednesday. Jennifer Ng'andu, director of the Health and Civil Rights Policy Project at the National Council of La Raza, said Hispanics would see the biggest gains in health care coverage if the law is fully implemented, meaning every state opts in to the optional Medicaid expansion. ... [Medicaid] would cover roughly 15 million people if every state took part (Baker, 11/28).

This Story: Print | Link to | Top

Hospital Developments: Calif. Hospital Chain Fined In Privacy Case

Details on how hospitals around the nation are making deals, and getting fined, graded or taxed in this roundup.

Los Angeles Times: Prime Healthcare Services Is Fined $95,000 In Privacy Case
State officials have fined hospital chain Prime Healthcare Services Inc. $95,000 for violating patient confidentiality by sharing a woman's medical files with journalists and sending an email about her treatment to 785 hospital employees. The California Department of Public Health levied the fine this month after determining in May that Shasta Regional Medical Center in Redding had five deficiencies related to the unauthorized disclosure of medical information on a diabetes patient treated there in 2010 (Terhune, 11/29).

The Lund Report: State Officials Insist Hospitals Not Overpaid Under Provider Tax
Poor Oregonians will receive an extra $2.033 billion in health care from mid-2011 through mid-2013, according to the latest estimates of the impact of a state tax on hospitals. Yet even many within the industry still don't understand the state’s so-called provider tax, according to Judy Mohr-Peterson, director of medical assistance programs with the Oregon Health Authority. Hospitals will pay $685 million by the end of the current two-year fiscal biennium, Mohr-Peterson said. The Oregon Health Plan must use that money to pay for medical care at those hospitals, and to qualify for roughly $1.4 billion in federal reimbursement for OHP care. But there's no guarantee that any specific hospital will get back as much in reimbursements as it pays in taxes (Sherwood, 11/29).

Georgia Health News: 'A' Through 'F': Group Rates Georgia Hospitals
Eleven Georgia hospitals rated an "A"’ grade on patient safety in an updated report card released Wednesday by the Leapfrog Group. The Washington-based nonprofit organization’s ratings come five months after its first scorecard, and reflect more current data and some adjustments in methodology. The new Leapfrog list gave 27 hospitals in Georgia a "B" and 32 a "C."’ Four received a "D" and one, Phoebe Putney Memorial Hospital in Albany, got an "F" (Miller, 11/28).

Modern Healthcare: Vanguard Plans Another Deal In Conn.
Vanguard Health Systems, Nashville, has made further inroads into Connecticut, signing a second deal in the state with a letter of intent to acquire Bristol (Conn.) Hospital and Health Care Group. The for-profit system this month signed a deal to form a joint venture that would operate Waterbury (Conn.) Hospital. Financial terms for the Bristol deal were not disclosed. In a news release, Marie O'Brien, chairman of the Bristol Hospital board of directors, said the deal would allow the medical center to complete extensive renovations to its main campus and expand its outpatient services (Kutscher, 11/28).

This Story: Print | Link to | Top

State Roundup: Conn. Health Care Programs Face $70M

A selection of health policy stories from Connecticut, Mississippi, Florida, Illinois, California, Minnesota and Kansas.

CT Mirror: Malloy Shrinks Deficit With Cuts To Social Services, Colleges
Connecticut's social services safety net and its public colleges and universities took the brunt Wednesday of Gov. Dannel P. Malloy's first effort to whittle down a $363 million state budget deficit. The administration released $123 million worth of emergency cuts ordered by the governor, including nearly $70 million aimed at health care and social service agencies and $25 million more at public colleges and universities. Technically, the governor used his emergency authority to slice $170 million off the books. But because about $47 million of the cuts announced Wednesday involved spending the administration had planned to cancel to meet miscellaneous savings targets built into the budget, the overall deficit shrank to about $240 million (Phaneuf, Becker and Thomas, 11/28).

The New York Times: Connecticut Aims To Cut $170 Million In Spending
The cuts include nearly $70 million to health care programs and social service agencies, along with $25 million to public colleges and universities. Programs facing reductions included AIDS services, children's health programs, food stamps, funds for magnet schools, housing and homeless services, and services for elderly and disabled residents (Applebome, 11/28).

The Associated Press/Washington Post: Mississippi's Only Abortion Clinic Again Asks U.S. Judge To Block State Law That Could Close It
Attorneys for Mississippi's only abortion clinic are again asking a federal judge to block a state law that could close the facility. In court papers Wednesday, attorneys say despite repeated attempts, Jackson Women's Health Organization has been unable to obtain privileges for most of its physicians to admit patients to a local hospital (11/28).

Reuters: Mississippi's Last Abortion Clinic Faces Closure
Mississippi's sole abortion clinic will have to close unless a federal judge halts a new state law requiring its physicians to obtain admitting privileges to local hospitals, according to a court motion filed on Wednesday. The Jackson Women's Health Organization renewed its request for a federal judge to prevent state officials from enforcing the law, which the clinic said was an unconstitutional attempt to ban abortion in Mississippi (Le Coz, 11/28).

The Palm Beach Post: Advocates Ask Feds To Kick State Out Of Health Care Law Decisions
Advocates who once begged Florida lawmakers to embrace President Barack Obama’s health care law are now lobbying federal officials to leave out Florida decision-makers. With little more than a year left to plan major provisions and Florida politicians on record against the law – chief among them Gov. Rick Scott – health care reform advocates argue that programs they fought for may fail in the hands of state leaders. An alliance of state organizations is sending a letter today to the Department of Health and Human Services, asking federal officials to set up an online insurance marketplace, set to go live Jan. 2014, without state input (Elmore and Green, 11/28). 

Chicago Sun-Times: City Won't Abandon Retirees On Health Care, Emanuel Says
Mayor Rahm Emanuel said Wednesday he's not about to walk away and leave thousands of retired city employees without city-subsidized health care, but changes must be made to control skyrocketing health care costs. Active city employees will see their monthly health insurance premiums rise by $50 unless they participate in a "wellness program" to manage chronic health problems such as obesity, diabetes and high-blood pressure. That has led to overwhelming levels of participation and what Emanuel has claimed as "north of $100 million" in savings for the city (Spielman, 11/28).

HealthyCal: Salinas Safety Nets Catch Immigrants Dropped By ACA
The Affordable Care Act excludes undocumented immigrants from buying health insurance on state health benefit exchanges. But health care providers in the Salinas Valley are weaving safety nets of their own for medically vulnerable farm and migrant workers who are part of the community and essential to the country's food production (Graebner, 11/28).

California Watch: Health Plans Air Concerns Amid Changes To Kids' Coverage
Under a budget-paring plan crafted by Gov. Jerry Brown and approved by lawmakers, 870,000 children who were covered by the Healthy Families program will be moved to Medi-Cal in phases starting Jan. 1. But it remains unclear whether a health plan serving Sacramento, Fresno, San Diego and Los Angeles counties will have enough doctors to accept the children (Jewett, 11/29).

California Healthline: Uninsured Eligible For Mental Health Services
When major portions of the Affordable Care Act are implemented in 2014, almost all of the 500,000 uninsured Californians who were previously identified as being in need of mental health services will be eligible for those services, either through Medi-Cal expansion or the exchange, according to a study released yesterday by the UCLA Center for Health Policy Research. "Last year we did a mental health report, and what we found is there are 500,000 or so people in California who are uninsured and in need of mental health services, so this year we wanted to see who among them would be eligible for coverage under the Affordable Care Act," said Imelda Padilla-Frausto, lead author of the report released yesterday (Gorn, 11/29).

Associated Press/Minneapolis Star Tribune: Lawsuit Alleges Minnesota Improperly Paid For 37,000 Elective Abortions For Poor Women
A conservative legal group claims in a lawsuit filed Tuesday, Nov. 27, that Minnesota taxpayers have been wrongfully charged for more than 37,000 elective abortions for indigent women since 1999. The Alliance Defending Freedom argues that state government is allowed to pay for abortions for indigent women only for "therapeutic reasons," including when the life or health of the woman is in danger or in cases of rape or incest, under state laws and a 1995 Minnesota Supreme Court decision. But the group, citing state Health Department data it reviewed, said the state paid for thousands of abortions that it believes did not meet that standard (Karnowski, 11/28).

Kansas Health Institute News: Federal Officials Say They Hope To Act Soon On KanCare Waiver Request
The federal official in charge of reviewing 1115 Medicaid waiver requests sat in on an hour-long conference call today to hear Kansans' views on Gov. Sam Brownback's proposed Medicaid makeover plan. Only about 20 people had time to comment but none of them expressed support for KanCare, which would move virtually all the state's 380,000 Medicaid beneficiaries into managed care plans run by three insurance companies. Most people who called in questioned the need for KanCare and expressed concern that they or family members would lose services or their case managers (Shields, 11/28).

This Story: Print | Link to | Top

Weekend Reading

Longer Looks: Are 'Pods' The Solution To Our Long-Term Care Crisis?

Every week Shefali S. Kulkarni selects interesting reading from around the Web.

The New York Times: After Dozens Of Deaths, Inquiry Into Bed Rails
In November 2006, when Clara Marshall began suffering from the effects of dementia, her family moved her into ... an assisted living home in Vancouver, Wash. ... just five months into her stay, Ms. Marshall, 81, was found dead in her room apparently strangled after getting her neck caught in side rails used to prevent her from rolling out of bed. ... [from 2003 through May 2012] 150 mostly older adults died after they became trapped in bed rails. Over nearly the same time period, 36,000 mostly older adults — about 4,000 a year — were treated in emergency rooms with bed rail injuries. ... Experts who have studied the deaths say they are avoidable. ...  but there is a technical question over which regulator is responsible for some bed rails. Are they medical devices under the purview of the F.D.A., or are they consumer products regulated by the [Consumer Product Safety Commission]? (Ron Nixon, 11/25).

Los Angeles Times: An Ethics Debate Over Embryos On The Cheap
Dr. Ernest Zeringue was looking for a niche in the cutthroat industry of fertility treatments. He seized on price, a huge obstacle for many patients, and in late 2010 began advertising a deal at his Davis, Calif., clinic unheard of anywhere else: Pregnancy for $9,800 or your money back. That's about half the price for in vitro fertilization at many other clinics, ... Zeringue sharply cuts costs by creating a single batch of embryos from one egg donor and one sperm donor, then divvying it up among several patients. The clinic, not the customer, controls the embryos, typically making babies for three or four patients while paying just once for the donors and the laboratory work (Alan Zarembo, 11/19).

The Washington Post: Pioneering The Granny Pod: Fairfax County Family Adapts To High-Tech Dwelling That Could Change Elder Care
Viola Baez wouldn't budge. Her daughter's family had just invested about $125,000 in a new kind of home for her, a high-tech cottage that might revolutionize the way Americans care for their aging relatives. But Viola wouldn't even step inside. She told her family she would rather continue living in the family’s dining room than move into the shed-size dwelling that had been lowered by crane into the backyard of their Fairfax County home. ...  As the first private inhabitant of a MedCottage, Viola is a reluctant pioneer in the search for alternatives to nursing homes for aging Americans. Her relatives agonized over the best way to care for Viola only after her ability to care for herself became questionable. ... The family is strikingly candid about the stress that comes with Viola’s daily care (Fredrick Kunkle, 11/25).

The New Republic: Pro-Life Activists Conveniently Ignore the Abortion Drop 
[A] new report from the Centers for Disease Control and Prevention has some encouraging news: the U.S. abortion rate fell 5 percent in 2009, the largest single-year drop in a decade. While abortion rights supporters may worry that the declining abortion rate is partly a result of increased abortion restrictions and access at the state level, the trend matches a similar decline in pregnancies overall. ... But many [anti-abortion activists] are shoving that headline aside to focus on what they say is the real story in the CDC report—the fact that deaths from abortions have doubled. ... That sounds alarming, and certainly even one death would be tragic. But abortion-related deaths rose from six to twelve between 2007 and 2009. ... In 2006-2007—the last period for which data are available—the CDC found 1,294 pregnancy-related deaths in the U.S. (Amy Sullivan, 11/27).

American Specatator: A New Republican Agenda for the Future 
The traditional Republican issue triad of fiscal responsibility, national defense, and social regulation is broken. The electoral coalition which delivered the White House to Ronald Reagan three decades ago is headed toward civil war. The GOP should rethink what it stands for. Fiscal responsibility certainly, but in practice as well as in theory. ... As for the "entitlements" that threaten to swamp the budget, Republicans must point out that recipients have not paid for Social Security and Medicare, which is why the nation's fiscal future is so bleak. On average the latter alone pays out nearly four times as much in benefits as it collects in taxes from recipients. The starting point of reform should be to means-test, that is, kick the rich off the dole (Doug Bandow, 11/27).

The New York Times: Beating The Odds, And A Storm, To Get A Transplant
It was the best possible news, at the worst possible time. The phone call from the hospital brought the message that Dolores and Vin Dreeland had long hoped for, ever since their daughter Natalia, 4, had been put on the waiting list for a liver transplant. The time had come. They bundled her into the car for the 50-mile trip from their home in Long Valley, N.J., to New York-Presbyterian Morgan Stanley Children's Hospital in Manhattan. ... [But] Hurricane Sandy, the worst storm to hit the East Coast in decades, was bearing down on New York. Airports and bridges would soon close, but the donated organ was in Nevada, five hours away (Denise Grady, 11/26).

This Story: Print | Link to | Top

Editorials and Opinions

Viewpoints: GOP Attack On Medicare, Medicaid Could Hurt Critical Programs; Will Says Obama Is Repeating His Overreach On Health Care

The New York Times: Health Care Entitlements
Congressional Republicans are insisting that big cuts to Medicare and Medicaid be on the table in the negotiations over the so-called fiscal cliff and deficit reduction. That stance is largely a political move against two programs, which have been critical to the public welfare for the past half-century (11/28).

The Washington Post: A Cliff Of Their Own Choosing
With a chip on his shoulder larger than his margin of victory, Barack Obama is approaching his second term by replicating the mistake of his first. Then his overreaching involved health care -- expanding the entitlement state at the expense of economic growth. Now he seeks another surge of statism, enlarging the portion of gross domestic product grasped by government and dispensed by politics. The occasion is the misnamed "fiscal cliff," the proper name for which is: the Democratic Party's agenda (George F. Will, 11/28).

The Wall Street Journal: The Outlines Of A Budget Deal Are Obvious
Will a second term feature a new, fiscally responsible Barack Obama? We'll know soon enough. Real spending restraint must involve changes to entitlements and other mandatory programs, which (along with interest payments) comprise 64 percent of this year's budget. But the White House says it's not considering any Social Security reforms, has offered little in the way of fixes for Medicare, and now finds that its union and liberal pressure-group allies vociferously oppose any entitlement changes (Karl Rove, 11/28).

JAMA: Key Decisions Loom For States About The Health Care Law
Health insurance exchanges have, in many ways, become synonymous with "Obamacare" in state-level debates. The judgments of governors and state legislatures about whether to go ahead with them are indeed significant ones, in both practical and political terms. The option of federally run exchanges in states that refuse to create them on their own, however, provides a fallback for individuals and small businesses. But without such a fallback for the Medicaid expansion, the consequences for consumers, hospitals, and health professionals in states that decide not to participate are in fact far greater (Larry Levitt, 11/28).

The Denver Post: Sticker Shock On Medicaid Costs
If you know anything about the state budget, it's probably that there's not a bunch of extra money lying around. You might even remember the University of Denver report last year that said lagging revenues meant Colorado would be unable to pay for Medicaid, public schools and prisons by 2025. Which is why a recent Kaiser Family Foundation estimate that expanding Medicaid in Colorado under Obamacare could cost the state as much as $858 million over the next 10 years should give all of us pause (11/29).

The Arizona Republic: Governor Chooses Fear Over Affordable Health Care
The politicians opposed to the Affordable Care Act, "Obamacare," understand that fear is a powerful political medicine, a cure-all for a lack of sound arguments. Unfortunately, scare tactics are bad for your health. Gov. Jan Brewer proved it Wednesday with her decision not to establish a state health exchange, letting the federal government do so instead (E.J. Montini, 11/29).

WBUR: Cognoscenti: The Little-Known Provision Of Obamacare That Could Have A Big, Bad Impact
Passing through Kendall Square one might never get a sense of the medical research and innovation going on here. But when my business partner and I founded Semprus BioSciences, a medical device company, we had an inkling it was the place to be. It turned out to be one of our best decisions. In Kendall, our neighbors are some of the smartest people in the world -- innovative companies that create better disease detection and whose therapies and products help treat cystic fibrosis, cancer, diabetes and many other life threatening diseases. … But (the) labs and companies ... those that are tackling many of today's toughest medical problems, face a daunting threat that may well stifle that innovation and technology transfer -- the true lifeblood of our industry (David Lucchino, 11/29).

Politico: Help Medicare To Thrive Under ACA
Here are the facts. Medicare spending per beneficiary, for the past two decades before 2008, rose much more than inflation, in general, year in and year out. The growth was as much as 7 percent in 2006 and stayed above 5 percent through 2008. That rate, combined with a growing elderly population, eroded the program’s long-term financial prospects. But beginning in 2010 after passage of the Affordable Care Act, the trend changed dramatically. Per capita spending inched below 4 percent in 2010 and has been below 3 percent ever since. Today, Medicare is defying predictions by the nonpartisan Congressional Budget Office (Rep. Joe Courtney, D-Conn., 11/28).

The New England Journal of Medicine: Implications of the 2012 Election for Health Care -- The Voters' Perspective
Now that the election is over, we have analyzed a range of pre-election and post-election polls as part of a Robert Wood Johnson Foundation project. ... As expected, health care was not the top issue but was an important one in this close election. ... Voters saw President Obama as better than Governor Mitt Romney, the Republican candidate, at handling key issues in health care and Medicare. However, the President's lead in handling health care was not as large as those held by Democratic presidential candidates in the previous three elections (Robert J. Blendon, John M. Benson and Amanda Brulé, 11/29).

USA Today: Birth Control Pill Proposal Not Easy To Take
In a country where nearly half of pregnancies are unintended and an alarming 7 percent of teens get pregnant, it's useful to look for ways to make birth control more accessible. That's what the nation's leading group of obstetricians and gynecologists is doing with its recommendation this month to put birth control pills on drugstore shelves, eliminating the need for prescriptions. ... But beyond the science lie several thorny issues that make this decision more complex (11/28).

USA Today: Opposing View: Make The Pill More Accessible
Contraception is essential to women's health, and improved access is critical. The U.S. continues to have one of the highest unintended pregnancy rates among developed countries. ... There are many reasons for our high unintended pregnancy rate. Access and cost are two common reasons why women do not use contraception or use it sporadically. Trying to get a prescription renewal -- or getting to the doctor or pharmacy at all -- can be difficult for many women. Fifty years after its debut, the birth control pill is the most widely used contraceptive in America. It is also one of the most studied drugs in the world. No drug, prescription or over-the-counter, is without risk. However, the data clearly show that oral contraceptives are safe for the majority of women (Dr. James T. Breeden, 11/28).

Los Angeles Times: Keep The State Off My Plate
We have entered the eating season, a time when fresh-baked goods appear on counters at work and families and friends get together to raise a glass and enjoy good food and good company. But this year, our indulgence is likely to be more fraught, as the government continues its intrusion into what we choose to eat and drink (Julie Gunlock, 11/29).

This Story: Print | Link to | Top

Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

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