Daily Health Policy Report

Friday, November 30, 2012

Last updated: Fri, Nov 30

KHN Original Reporting & Guest Opinion

Fiscal Cliff

Health Reform



Health Care Marketplace

Coverage & Access

Public Health & Education

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Analysis: Health Exchanges And The Litigation Landscape

In this Kaiser Health News analysis, Stuart Taylor, Jr. writes: "If you think that the Affordable Care Act has surmounted all of the major legal attacks its opponents could come up with, think again. Critics of the federal health law have only begun to fight, although most of their battles are decidedly uphill" (Taylor, 11/29). Read the story.

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Key Group Rejects Calls To Charge Seniors More For Medigap Policies

Reporting for Kaiser Health News, Susan Jaffe writes: "A key group of state insurance commissioners dealt a blow Friday to a proposal to shrink Medicare spending by asking seniors to pay more for Medicare supplemental coverage" (Jaffe, 11/30). Read the story.

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Capsules: Missouri Governor Backs Medicaid Expansion

Now on Kaiser Health News' blog, KCUR's Elana Gordon, working in collaboration with KHN and NPR, reports: "Missouri Gov. Jay Nixon wants the state to expand its Medicaid program, marking the strongest stance the Democratic governor has taken to date on the state's pending decision. Nixon previously said he was evaluating the issue to see what’s best for Missouri" (Gordon, 11/29). Check out what else is on the blog.

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Political Cartoon: 'Tipping The Scales'

Kaiser Health News provides a fresh take on health policy developments with 'Tipping The Scales' by Eric Allie.

Meanwhile, here is today's health policy haiku:


"It's always something,"
Roseanne Rosannadana
would say of this news.

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

White House Fiscal Plan Draws Cool GOP Response

The proposal reflects Democratic priorities, focusing on stimulus spending and unspecified spending cuts this year, and legislation in 2013 that would cut as much as $400 billion from Medicare and other government entitlement programs over the next decade in exchange for $1.6 trillion in tax increases.

The New York Times: GOP Balks At White House Plan On Fiscal Crisis
The proposal, loaded with Democratic priorities and short on detailed spending cuts, met strong Republican resistance. In exchange for locking in the $1.6 trillion in added revenues, President Obama embraced the goal of finding $400 billion in savings from Medicare and other social programs to be worked out next year, with no guarantees (Weisman, 11/29).

Los Angeles Times: Obama And Boehner Seem To Hit Wall As 'Fiscal Cliff' Looms
As Obama prepares to take his proposal on the road Friday, Democrats are increasingly buoyed, believing they hold a stronger hand. "Look, we don't expect the Republicans to be enthusiastic and start cheerleading about a deal that includes higher rates on the wealthiest Americans," said New York's Sen. Charles E. Schumer, the No. 3 Democrat. "But they see the handwriting on the wall." … Republicans are increasingly frustrated that Democrats have declined to outline specific cuts to Medicare, Medicaid and other government programs in exchange for Boehner's willingness to consider new revenue sources (Mascaro and Parsons, 11/29).

The Washington Post: Obama Makes Fresh Demands On 'Fiscal Cliff'
The offer lacks any concessions to Republicans, most notably on the core issue of where to set tax rates for the wealthiest Americans. … Democratic leaders, meanwhile, were triumphant after receiving similar briefings from Geithner and White House legislative liaison Rob Nabors. Top Democrats have for months insisted that an Obama victory would entitle them to demand far more in new taxes than Republicans have been willing to consider, to seek new measures to boost economic growth, and to avoid major cuts to entitlement programs, such as Social Security and Medicare (Montgomery and Kane, 11/29).

The Associated Press/Washington Post: White House 'Fiscal Cliff' Offer Gets Withering GOP Response As Accusations Fly
The White House is seeking $1.6 trillion in higher taxes over a decade and an immediate infusion of funds to aid the jobless, help hard-pressed homeowners and perhaps extend the expiring payroll tax cut, officials said Thursday as talks aimed at averting an economy-rattling "fiscal cliff" turned testy. In exchange, the officials said, President Barack Obama will support an unspecified amount of spending cuts this year, to be followed by legislation in 2013 producing savings of as much as $400 billion from Medicare and other benefit programs over a decade (11/29).

The Wall Street Journal: Obama's Cliff Offer Spurned
The proposal marked an opening salvo in negotiations over the fiscal cliff and represented a particularly expansive version of the White House's wish list, with a heavy focus on tax increases and spending proposals—including keeping in place a payroll-tax cut and extended unemployment benefits. Republicans haven't put any comparable offer on the table. They have indicated willingness to accept $800 billion in revenues over 10 years, half the amount Mr. Obama proposed. And they have sought far more in spending cuts in exchange for their concessions on taxes (Hook, Paletta and Lee, 11/29).

Politico: GOP Rejects White House Fiscal Cliff Offer
The back-and-forth exchanges underscored how the November election results have failed to clarify how Washington should resolve intractable policy disputes threatening to shake the economy if Congress and the White House cannot reach a deal by New Year’s Day. And it left open the real possibility that the country could fall off the fiscal cliff when all the Bush-era tax rates expire, payroll taxes will increase, Medicare payments to physicians will drop and deep across-the-board spending cuts will go into effect (Sherman and Raju, 11/30).

USA Today: GOP Calls White House Cliff Offer A Non-Starter
The $4 trillion package includes a number of requests that stand little or no chance of passing the GOP-controlled House, because Republicans continue to oppose raising individual tax rates. The package also includes spending cuts that are considered insignificant to Republicans, who want more concessions on spending for entitlement programs such as Medicare and Medicaid (Davis and Madhani, 11/29).

CNN: 10 Ways Falling Off The Fiscal Cliff Could Hurt Your Health
If President Barack Obama and Congress cannot reach an agreement on the fiscal cliff, economic experts agree it would be devastating. It would likely send the country back into recession, according to the Congressional Budget Office, and some 3.4 million jobs would be lost. And ultimately, it could hurt your physical and emotional health. That's because the part of the government that handles health-related programs -- Medicare, veterans' medical benefits, food safety inspectors -- all would be automatically cut starting January 2 if there is no agreement on the Budget Control Act. If not amended in time, the move would abruptly remove $1.2 trillion from the federal budget (Christensen, 11/30).

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Fiscal Crisis, Threats Of Sequestration Cause Provider Angst

If the "fiscal cliff's" scheduled cuts take effect, physicians will face a 2 percent reduction in Medicare reimbursements. Separately, however, they also are confronting a 27 percent pay cut as a result of the failure to fix the Medicare physician payment formula.

Politico: Providers: Doctors Face 'Worse' Fiscal Cliff
As the nation hurtles toward the fiscal cliff, doctors are staring down a much more daunting abyss, a panel of experts said Thursday at Politico Pro's health care breakfast briefing. Not only do doctors face a 2 percent cut in Medicare reimbursements because of the failure -- thus far -- to avoid sequestration, but they're also looking at a 27 percent reduction in pay in the absence of a deal to fix the Medicare payment formula (Cheney, 11/29).

Modern Healthcare: Fiscal Cliff For-Profit Providers: Fitch
For-profit providers face the greatest risk from slashed spending and tax hikes known as the fiscal cliff, one major credit rating agency said in a newly released outlook for the health care industry. For-profit providers could see lost revenue under a scheduled 2 percent Medicare pay cut and a slump in business "should elements of the fiscal cliff reduce economic activity and increase unemployment," Fitch Ratings said in its 2013 outlook for for-profit health care, which includes acute-care hospital operators, drug and device manufacturers, diagnostic and life science companies and the health care service sector. Overall, the weak economy and fiscal cliff will drag on health care growth despite an aging population, the chronically ill and demand from emerging markets, the report said. The sector's outlook is stable, Fitch said (Evans, 11/29).

Modern Healthcare: AHA Warns On Impact Of Rate Cuts For Hospital-Based Docs
Congress is focused on using a $7 billion reduction in Medicare evaluation and management payments for hospitals as a way to help pay for delaying a looming physician pay cut, according to hospital officials and advocates. The long-discussed reduction in evaluation and management rates for hospital-based clinicians to the level paid to office-based physicians has gained traction with members of Congress as a way to help offset the estimated $25.2 billion cost of a one-year patch for the sustainable growth-rate formula. …The country's largest hospital group brought about 150 executives to Capitol Hill on Thursday to warn lawmakers about the impact on hospitals of the proposed evaluation and management cuts, among other cuts (Daly, 11/29).

Politico Pro: AHA: Don't Trade Hospital Cuts For Doc Fix
Hospital officials complain that Medicare already underpays them, and they're worried that an idea that was proposed by the Medicare Payment Advisory Commission -- and could be adopted by Congress -- would further reduce what they pocket for nonemergency doctors' visits. Representatives from hospitals in Mississippi, Maine, Pennsylvania and Oregon spoke at the Rayburn House Office Building about how the proposed cuts would affect their services. ... The recommendation would cut hospital reimbursements by 68 percent to 80 percent, the hospitals say (Cunningham, 11/29).

CNN Money: Medicare Patients At Risk Without Doctors' Fiscal Cliff Fix
As lawmakers head into talks to avoid the fiscal cliff, doctors are watching closely. Thanks to bad timing, the Medicare fees that doctors are paid for treating seniors has gotten tangled up in the same high-stakes deal-making to avert the fiscal cliff -- across the board tax hikes and spending cuts that kick in January. If Congress does nothing, doctors will be reimbursed 27 percent less than current rates, starting Jan. 1. That could spur thousands of doctors to stop seeing Medicare patients. It's not a situation any politician wants to see. So, Congress will likely find a way to keep rates from going up in 2013, experts from both political parties say. The question is when and how (Liberto, 11/30).

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Health Reform

States, Courts, Employers Contend With Health Law's Requirements

News outlets follow developments on health insurance exchanges, requirements for mental health parity and employer coverage and assess still-pending lawsuits

Politico: Republicans Feud Over Obamacare
At issue are the state-based health care exchanges, set to start in 2014, which will create new marketplaces for people who can’t get insurance elsewhere. If states don’t declare their plans to set one up by Dec. 14, the Department of Health and Human Services will begin doing it for them. So Republicans face a choice: Create their own and appear to endorse a federal government health care takeover, or allow Washington to take control (Epstein and Cheney, 11/30).

Kaiser Health News: Analysis: Health Exchanges And The Litigation Landscape
If you think that the Affordable Care Act has surmounted all of the major legal attacks its opponents could come up with, think again. Critics of the federal health law have only begun to fight, although most of their battles are decidedly uphill (Taylor, 11/29).

The Associated Press: Pay A Penalty? Biz Owners Face Health Care Dilemma
Rose Wang looks at her staff of 70 employees and wonders if she’ll have to lay off some of them to comply with the health care law. The owner of Binary Group Inc., an information technology firm based in Alexandria, Va., is one of many small business owners who will be required to provide health insurance for her staffers under a provision of the law that goes into effect on Jan. 1, 2014. ... Right now, no one knows how much the insurance will cost, and owners aren't sure if they'd be better off not buying it and paying a government penalty of $2,000 per worker (Rosenberg, 11/29).

Medscape: Dentistry Could Be Shaped By New Affordable Care Act Rules
Eleven million adults may drop their dental insurance as a result of a requirement in the affordable care act that they buy dental benefits for their children, the National Association of Dental Plans (NADP) is warning. The changes could come about as a result of rules published online November 26 by the US Department of Health and Human Services to define what "essential benefits" health insurance plans must include when sold to individuals or small groups, such as companies with fewer than 50 employees (Harrison, 11/29).

Stateline: Parity For Behavioral Health Coverage Delayed By Lack Of Federal Rules
[The 2008 Mental Health Parity and Addiction Act] requires insurers to cover mental illness and substance abuse treatment on an equal basis with physical ailments. The law, which passed with substantial bipartisan support, was supposed to eliminate two-tiered systems for co-pays, deductibles or treatment limitations. The Obama administration's Affordable Care Act will vastly extend the reach of the 2008 law. The older law does not require health insurance plans to offer behavioral health coverage, although if they do it must be on par with benefits provided for medical and surgical care. But the ACA does require that all health plans sold on the soon-to-be-created state health insurance exchanges eventually offer mental health coverage (Ollove, 11/30).

ABC: Voters Come Clean on Health Care
Voters who backed President Obama and those who supported Mitt Romney just can’t seem to agree on key health care issues, a new study suggests. But they’ll have to compromise if they want change in Washington. The study, which drew on the combined data of three pre-election and exit polls, found that Obama supporters were three times more likely to say that health care was the most important problem facing the country (Nathan, 11/29).

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Appeals Court Temporarily Blocks Contraception Rule

A three-judge panel of the 8th U.S. Circuit Court of Appeals granted a preliminary injunction from the rule for Frank O'Brien and his company -- which is the fourth private business to secure such a temporary order.

The Associated Press: Ruling Temporarily Blocks Contraception Mandate
A federal appeals court has issued an order temporarily blocking implementation of the contraception mandate of the federal health care law for a Missouri business owner. A three-judge panel of the 8th U.S. Circuit Court of Appeals granted a preliminary injunction Wednesday on behalf of Frank O'Brien and his company, O'Brien Industrial Holdings LLC of St. Louis (Salter, 11/29).

CQ HealthBeat: Fourth Private Business Obtains Injunction Against Birth Control Rule
A federal appeals court has issued a temporary injunction to a Missouri company blocking enforcement of a rule requiring contraceptive coverage in workers' health insurance policies. This makes the fourth private business to secure a temporary order against the Department of Health and Human Services rule, and lawyers for the company said it was the first decision from an appeals court. Other injunctions have been obtained by a Bible publisher in Illinois, a supply company in Michigan and a heating and cooling company in Colorado. But the largest concern to challenge the rule -- the Hobby Lobby chain of craft stores -- was turned down in its attempt to obtain an injunction in an Oklahoma federal court. Hobby Lobby has since appealed (Norman, 11/29).

St. Louis Beacon: Federal Appeals Court Here Resurrects Battle Against ACA Mandate On Contraceptive Coverage
U.S. Sen. Roy Blunt, R-Mo., is lauding a decision by the federal 8th Circuit Court of Appeals, based in St. Louis, that is temporarily blocking enforcement of a provision of the Affordable Care Act requiring employer-provided insurance to cover contraception. The 8th Circuit voted to delay the provision while St. Louis businessman Frank R. O'Brien continues his court fight against the requirement. O'Brien, a Catholic, contends that it would violate his religious beliefs to provide such coverage for his 87 employees (Mannies, 11/29).

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GAO: Medicaid Payment Information Late, Inconsistent

The Government Accountability Office's report examined two Medicaid databases.

CQ HealthBeat: GAO Finds That Two Medicaid Data Sets Should Be Better Aligned
Two methods federal officials use to report Medicaid expenditures don't match up, according to a Government Accountability Office report released Thursday. And GOP Sen. Orrin G. Hatch says that such discrepancies call into question whether expanding Medicaid in 2014 is a good idea. The 56-page GAO report did not include specific recommendations for Medicaid officials, but noted that it has previously put the health program for the poor on its list of programs that are vulnerable to waste and fraud (Adams, 11/29).

Bloomberg: Mismatched Data Hamper U.S. Accounting Of Medicaid Costs 
Delays in reporting the data and inconsistencies between the two databases “limit their usefulness as oversight tools,” auditors said in the report. States are supposed to report one set of Medicaid spending to the federal government within 45 days of the expenditures. The statistics can be as many as three years late, GAO said. Hospitals are under increasing scrutiny for their use of computer systems to increase their billings to Medicare, the $591 billion U.S. health program for the elderly and disabled (Wayne, 11/29).

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Decoding Part D Marketing And Other News

The Medicare NewsGroup examines the complexity of Part D plans.

The Medicare NewsGroup: Figuring Out The Part D Market
Choosing a Medicare Prescription Drug (Part D) plan is a tricky business. Most beneficiaries go for the cheapest monthly premium, but this can be a big mistake, especially for those with unusual or expensive medications. Over the years, the marketers of Part D plans have made them increasingly complex, adding tiers of varying prices and using "medication management" techniques, which can make patients and doctors jump through veritable hoops to get a prescription filled (Rosenblatt, 11/29).

Also in the news about Medicare, various stories about Medicare's vulnerability to fraud, and lawmakers' interest in finding new ways to fight the abuse.

The Washington Post: Audit Finds Billions In Unverified Medicare Spending
Medicare has paid doctors and hospitals billions of dollars to switch from paper to electronic health records without verifying that the new systems meet required quality standards, according to a federal audit released Thursday (Aizenman, 11/29).

Medpage Today: Medicare Fraud Efforts Queried
Lawmakers are exploring ways to fight Medicare fraud and abuse as part of the effort to trim the federal budget and they're looking to the private sector for suggestions. For instance, investigators at the health insurer WellPoint recently contracted with a company to mine data on practice patterns and spot spikes in payment or identify emerging areas of fraud potential, Alanna Lavelle, Wellpoint's director of special investigations, told members of the House Energy and Commerce Health Subcommittee on Wednesday. The most egregious billers are flagged and investigated for potential waste, fraud, and abuse, Lavelle said (Pittman, 11/29).

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Health Care Marketplace

Major Maker Of Generic Lipitor Halts Production

The New York Times: Maker Of Generic Lipitor Halts Production
Ranbaxy Pharmaceuticals, the largest producer of the generic version of Lipitor, has halted production of the drug until it can figure out why glass particles may have ended up in pills that were distributed to the public, the Food and Drug Administration announced Thursday. The agency said it had not received any reports of patients being harmed by the particles, which are about the size of a grain of sand. Earlier this month, Ranbaxy recalled more than 40 lots of the drug because of the glass contamination (Thomas, 11/29).

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Coverage & Access

Supreme Court May Decide Gay Health Benefits Issues

The justices could consider same-sex marriage, which would affect health benefits for federal employees and possibly Medicaid.

The Associated Press/San Francisco Chronicle: Gay Marriage Before Supreme Court? Cases Weighed
Three weeks after voters backed same-sex marriage in three states and defeated a ban in a fourth, the justices are meeting Friday to decide whether they should deal sooner rather than later with the claim that the Constitution gives people the right to marry regardless of sexual orientation. The court also could duck the ultimate question for now and instead focus on a narrower but still important issue: whether Congress can prevent legally married gay Americans from receiving federal benefits otherwise available to married couples (Sherman, 11/30).

The Hill: Supreme Court Poised To Enter Battle Over Same-Sex Marriage
Observers predict the justices will take up at least one of [the cases] — most likely a challenge to the Defense of Marriage Act (DOMA). ... Another DOMA case before the Supreme Court comes from Massachusetts, where the state complained that the law prohibits it from combining the incomes of a same-sex couple when determining whether they are eligible for Medicaid. The state has had to give benefits to people who shouldn’t have been eligible because of DOMA, Massachusetts says (Baker, 11/29).

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Public Health & Education

Clinton's Blueprint For 'AIDS-Free Generation' Focuses On Preventing New Infections, Stopping HIV-Infection Progression

NPR: Clinton Reveals Blueprint For An 'AIDS-Free Generation'
Before Secretary of State Hilary Rodham Clinton passes the reins to her successor, she's got a few loose ends to tie up. One of them is mapping out the U.S.'s continuing efforts to combat AIDS around the world. So today she unveiled a blueprint for what she called an "AIDS-free generation." Now Clinton isn't talking about ending the HIV pandemic altogether. Rather, she hopes to prevent most new infections from occurring in the first place and to stop HIV-positive people from developing AIDS (Knox, 11/29).

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Traveling Med Tech Indicted On New Charges Related To Hepatitis C Outbreak

The technician was indicated Wednesday in New Hampshire on 14 new charges. The outbreak involved more than 30 patients in New Hampshire while people in a number of other states also were exposed.

The New York Times: Medical Technician Accused In Hepatitis C Infections Is Indicted On New Charges
A traveling medical technician who is believed to have infected at least 39 people with hepatitis C through his use of stolen hospital drugs and syringes was indicted late Wednesday in New Hampshire on 14 new charges (Seelye, 11/29).

Los Angeles Times: Ex-Medical Technician Indicted In Hepatitis C Outbreak
A nomadic medical technician who held hospital jobs from Arizona to New England has been indicted in connection with a hepatitis C outbreak that infected more than 30 patients at a New Hampshire hospital and exposed thousands of others in Pennsylvania, Maryland and other states (Serrano, 11/29).

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State Watch

Mo. Governor Wants Medicaid Expansion; Other States Consider Health Exchanges

After mulling the controversial decision, Missouri Gov. Jay Nixon said Thursday he wants the state to expand Medicaid, a key part of the health law, but he faces substantial opposition from Republicans who control the legislature. Meanwhile, some states continue to wrestle with issues related to health exchanges.

Kaiser Health News: Capsules: Missouri Governor Backs Medicaid Expansion
Missouri Gov. Jay Nixon wants the state to expand its Medicaid program, marking the strongest stance the Democratic governor has taken to date on the state's pending decision. Nixon previously said he was evaluating the issue to see what's best for Missouri (Gordon, 11/29).

The Kansas City Star: Gov. Nixon Calls For Expansion Of Medicaid In Missouri
Gov. Jay Nixon announced [Thursday] morning that he plans to push lawmakers to expand the public health insurance program for the poor to include an estimated 300,000 uninsured Missourians. The expansion of Medicaid is part of the federal health care law, known as the Affordable Care Act. Missouri Republicans, who hold super majorities in both legislative chambers, have steadfastly opposed the idea. But Nixon, a Democrat, said he's come to the conclusion that the expansion is "the smart thing to do, and it is the right thing to do." … The federal government would pay the additional cost of expansion initially, with states picking up 5 percent beginning in 2017 and 10 percent by 2020. Nixon said his office estimates an additional 300,000 people would be eligible for coverage. Other estimates have ranged from 160,000 to 380,000 newly insured (Hancock, 11/29).

The Associated Press: Mo. Gov. Nixon Backs Expanded Medicaid; GOPs Don't
Breaking months of silence on the subject, Democratic Gov. Jay Nixon on Thursday embraced a broad expansion of Medicaid health care coverage for working adults, but his support was met with immediate criticism by Republican legislative leaders. Nixon had remained noncommittal during his recent re-election campaign about the multi-billion-dollar Medicaid expansion called for under President Barack Obama's health care law. But Nixon said Thursday that he had analyzed the plan since the Nov. 6 election and concluded that expanding Medicaid to an estimated 300,000 additional people was both "the smart thing" and "the right thing to do" (Lieb, 11/29).

Politico Pro: Missouri Governor Says Yes To Medicaid Expansion
Missouri Gov. Jay Nixon announced Thursday he will expand Medicaid in his state, a move that could provide health coverage to approximately 300,000 people. At a news conference at a Kansas City, Mo., medical center, Nixon, a Democrat, said, “My consistent position on expanding Medicaid has been to carefully study the options and then determine what is the best fit for Missouri.” Nixon said his budget proposal to the state legislature, which is due in January, will include federal funding for an expansion. But a fight may lie ahead, as he faces Republican majorities in both houses (Smith, 11/29).

St. Louis Beacon: Nixon Makes Strong Push For Medicaid Expansion, Faces Stiff Challenge In GOP-Controlled Legislature
Gov. Jay Nixon announced his full support for expanding the state’s Medicaid program, a key provision of the Affordable Care Act that he contends will bolster the state's economic fortunes and help an estimated 300,000 poor Missourians get access to health care. But the Democratic governor’s advocacy could face a steep challenge in the Republican-led Missouri General Assembly, unless GOP legislators make an about face from their decision in 2005 to cut eligibility for the health-care program for the poor. When Nixon first campaigned for governor in 2008, he said he would make restoring Medicaid cuts one of his major priorities. But then, after he was elected, he did little -- aside from a failed 2009 effort -- until today (Rosenbaum, 11/29).

In Connecticut, officials are deciding how a health insurance exchange will negotiate with insurers --

CT Mirror: Health Insurance Exchange Won't Negotiate Insurance Rates To Start
Health insurance carriers won't have to negotiate rates to sell their products in the state's new virtual coverage "store." But those running the market -- known as the health insurance exchange -- will develop a plan for ways to drive down costs and promote affordability, which could include negotiation, members of the exchange's board determined Thursday. "This is a huge compromise," said state Healthcare Advocate Victoria Veltri, who had wanted the exchange to have the ability to negotiate rates with insurance carriers from the start. Exchange CEO Kevin Counihan, who had warned that negotiating rates could interfere with the new market's viability, was more pleased. "I think we're very comfortable with it," he said (Becker, 11/29).

Elsewhere, a House legislative committee in Michigan rejects the exchange altogether, and Iowa officials consider if the state should partner with the feds on an exchange --

The Associated Press: House Panel Rejects Michigan-Run Health Exchange
A Michigan House panel on Thursday rejected a proposal to create a state-run online market where people can compare and buy health insurance plans, leaving Michigan to continue down the road of teaming up with the federal government on the mandated health exchange. The House Health Policy Committee defeated the health exchange legislation by a 9-5 vote, with two members abstaining. The state Senate approved a bill, but the House delayed action because its Republican majority had opposed President Barack Obama's federal health care act (Karoub, 11/29).

Politico Pro: Iowa May Opt For Partnership Exchange
Though Iowa Gov. Terry Branstad recently said he wants his state to run its own health insurance exchange, the state’s top insurance official predicted that Iowa will start out in a partnership exchange with the feds in 2014. Branstad, in a Nov. 16 letter to HHS, said Iowa preferred to keep the feds away from its exchange, but he also warned he would opt for a federal exchange if he didn’t get answers to a list of about 50 question (Millman, 11/29).

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Mass. Republicans Want Top State Health Official To Resign

The state's Republicans are challenging the handling of the recent meningitis outbreak and drug test tampering allegations.

WBUR: Mass. GOP Lawmakers Call For Health Secretary's Resignation
Republicans in the Massachusetts House are calling for the departure of JudyAnn Bigby, the state's health and human services secretary. In a letter sent on Thursday to Gov. Deval Patrick, House Republicans cited "poor management" in the aftermath of two recent crises: The alleged tampering with drug tests at a former Department of Public Health lab, and a deadly outbreak of fungal meningitis linked to a Framingham compounding pharmacy that was regulated by the state. Minority Leader Brad Jones said at a news conference on Thursday that the agency "desperately" needs new leadership (11/29).

The Boston Globe: State House Republicans Call For Ouster Of Patrick's HHS Chief In Wake Of State Drug Lab Crisis
Though Republicans hold scant power on Beacon Hill, their call to replace Bigby is a reminder that the allegedly tainted samples of thousands of drug samples remains a significant political liability for Patrick, a Democrat. Patrick and other officials have blamed the problems on former state chemist Annie Dookhan, whom they have called a rogue employee at the former Department of Public Health lab where workers once tested contraband seized during drug investigations. But defense attorneys, the Massachusetts Bar Association, and the Committee for Public Counsel Services have insisted the problems were not limited to Dookhan (Bierman, 11/29).

A different group is asking the FDA to expand its probe of compounding pharmacies --

CQ HealthBeat: Public Citizen Asks FDA For Wider Compounding Probe
The advocacy group Public Citizen on Thursday called on the Food and Drug Administration to go back to the more than 16 pharmacy compounding companies it has warned about unsafe practices in the past decade and see if the problems at those facilities have been corrected. The group's 11-page letter comes as the FDA is preparing to hold a public meeting Dec. 19 to hear from state and federal representatives about the best way to oversee compounding agencies in the future  (Bunis, 11/29).

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State Highlights: Ruling On Privatizing Fla. Prison Care Expected Soon

A selection of health policy stories from Florida, California, Illinois and Georgia.

The Associated Press: Privatized Prison Health Care Disputed
A Florida judge quoted from Sherlock Holmes and conservative U.S. Supreme Court Justice Antonin Scalia on Thursday as he questioned the state's plan to privatize prison health care services. Circuit Judge John Cooper did not immediately rule but promised a quick decision after the second of two hearings in the case. The $58 million outsourcing plan is being challenged by two unions representing many of some 3,000 prison health care employees who stand to lose their jobs (11/30).

Modern Healthcare: Health First, Fla. Foundation Reach Settlement Ending Antitrust Lawsuit
After seven years of litigation, integrated delivery network Health First and a local charitable foundation have reached a settlement to end an antitrust lawsuit that was started by the central Florida foundation's corporate forerunner, Wuesthoff Health System. A Health First spokeswoman declined to elaborate on the terms of the settlement or the exact nature of the dispute, but a joint release from the two organizations said Health First is offering two seats on its board to members of the foundation, the Space Coast Health Foundation, as part of the deal. … Wuesthoff Health System, formerly a three-hospital system based in Rockledge, Fla., sued Health First, alleging antitrust violations in 2005, according to a spokeswoman. Health First is a three-hospital system based in Rockledge that also operates a multispecialty medical group and offers commercial and Medicare health plans. Both systems were not-for-profits at the time (Carlson, 11/29).

San Francisco Chronicle: Health Insurance Rates Could Shoot Up
California health insurers are proposing double-digit rate increases for hundreds of thousands of policyholders, drawing criticism that health insurers are padding their profits as the nation prepares to carry out the federal health care law. Anthem Blue Cross, the state's largest for-profit health insurer, wants to raise rates an average of 17.5 percent for 744,000 members in February, with some Anthem policyholders seeing increases as high as 25 percent. … Other insurers are also proposing hikes (Colliver, 11/29).

The Associated Press: Uninsured Patients Sue Chicago Nonprofit Hospital
A lawsuit filed Thursday claims a nonprofit hospital in northwest Chicago failed to provide charity care to two low-income, uninsured patients, reopening a longstanding controversy in Illinois over whether hospitals are doing enough charitable work to qualify for lucrative tax exemptions. Swedish Covenant Hospital repeatedly lost one patient's financial assistance application and threatened to send her bill to a collection agency, according to the lawsuit. The hospital incorrectly told another patient she was ineligible for assistance and demanded cash from her, the complaint alleges (11/29).

California Healthline: Higher Primary Care Rate Welcome News For California
Earlier this month, CMS made it official: The federal government will pay Medi-Cal primary care physicians in California at the same rate as Medicare in 2013 and 2014. The higher rate, confirmed by CMS officials on Nov. 2, means more than just paying more to family practice, pediatrics and internal medicine physicians, said Kevin Prindiville, deputy director of the National Senior Citizens Law Center, a national legal advocacy group with an office in Oakland. … The new rate has the added benefit of saving California money, he said, since the federal government is paying for the rate change, but the state will reap the savings from lighter use of public services, from emergency departments to 911 calls, because more people will have access to preventive care (Gorn, 11/30).

Health News Florida: BayCare-United Fight Spurs Call For Less Secrecy
The contract dispute between BayCare Health System and UnitedHealthcare forced 74-year-old Mike Dellmore to choose between his doctors and his insurance plan. … It all started when BayCare Health System, a network of 10 major non-profit hospitals, notified United that it was ending their contract early because, according to the hospital system, United had failed to pay bills totaling $11 million. United denies this and says BayCare is demanding unreasonable rate increases -- more than 20 percent for employer-based plans. … Some health care experts view this as a debacle that could have been avoided (Pusateri and Gentry, 11/29).

Georgia Health News: In Georgia Medical Field, Spanish Speakers Wanted (And Needed)
Joey Krakowiak has always known he wanted to be a doctor. … While a childhood interest in the human body may commonly lead to pursuing a career in medicine, Krakowiak didn’t initially realize just how valuable his familiarity with the Spanish language would be in his chosen profession. … As Georgia's Hispanic population grows, so does the need for Spanish-speaking physicians who understand the culture. According to the 2009 and 2010 U.S. Census Bureau, 35 percent of Hispanics reported that they were not fluent in English. Yet few Hispanics, or Spanish-speakers like Krakowiak, attend medical school (Avery, 11/27).

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Health Policy Research

Research Roundup: High Rates Of Postdischarge Complications

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

Archives Of Surgery: Association Of Postdischarge Complications With Reoperation And Mortality In General Surgery – The authors note that hospitals need detailed data about postdischarge (PD) complications among surgical patients in order to develop "appropriate quality improvement interventions and potentially avoid reimbursement penalties." In attempt to bridge this knowledge gap, researchers from Yale and Stanford Universities evaluated procedure types, rates and risk factors for PD complications occurring within 30 days after 21 groups of inpatient general surgery procedures for more than 500,000 patients. "We found that more than 40% of all postoperative complications occurred PD; approximately 1 in 14 general surgery patients who underwent an inpatient procedure experienced a PD complication," the authors state. They conclude: "Fastidious, procedure-specific patient triage at discharge as well as expedited patient follow-up could improve PD outcomes" (Kazaure, Roman, and Sosa, 11/2012).

Annals Of Internal Medicine: Pharmacy Dispensing Of Electronically Discontinued Medications – "Most physician offices do not transmit orders for medication discontinuation to the pharmacy, creating the potential for errors in dispensing of previously prescribed medications," write the authors. They analyzed five common prescription medicines and found that, of 83,902 medications that were electronically discontinued, 1.5 percent continue to be refilled by the pharmacy. The authors conclude: "The dispensing of discontinued medications represents an important ambulatory patient safety concern. Electronic health records should be used to facilitate better communication between providers and pharmacies and improve medication safety" (Allen and Sequist, 11/20).  

Journal of Neurosurgery: Association Of A Higher Density Of Specialist Neuroscience Providers With Fewer Deaths From Stroke In The United States Population – Researchers at the Dartmouth-Hitchcock Medical Center sought to identify a relationship between the availability of specialist neuroscience providers and reduction in stroke-related deaths. With a retrospective analysis of data from more than 3,000 counties, the researchers found a link between a higher density of neurologists and neurosurgeons and a decreased risk of death from stroke and concluded that "availability of local neurologists and neurosurgeons may be an important factor in the overall likelihood of survival after stroke, and therefore underlines an importance of promotion specialist clinical neuroscience education and practice throughout the country" (Desai et al., 11/30).  

Kaiser Family Foundation: Premiums, Cost-Sharing And Coverage At Public, Private And Non-Profit Employers: A View From The 2012 Employer Health Benefit Survey – Workers at private firms on average pay more toward their health premiums and face greater cost sharing than those working for public or private non-profit employers, a new Kaiser Family Foundation analysis finds. Workers covered by an employer plan at private firms contribute 30 percent of the premium for family coverage compared to public employees who contribute 23 percent for family coverage, according to data from the annual Kaiser/HRET Employer Health Benefits Survey. The analysis is the second in a series of "snapshots" taking a closer look at data from the benchmark annual study that examines national trends in employer-sponsored coverage (Rae, Panchal, Claxton, 11/2012).

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Editorials and Opinions

Viewpoints: Fighting To A Draw On Medicare; A Coming Era Of Austerity

The Wall Street Journal: The Death Of 'Mediscare'
Since Nov. 6, Republicans have, for perfectly understandable reasons, expressed their deep disappointment with the election results. But even in defeat something significant and positive occurred: Republicans fought Democrats to a draw on the issue of Medicare (Dan Senor and Peter Wehner, 11/29).

The New York Times' Taking Note: Medicare Off The Menu
But the charge has everything to do with the other conversation going on in Washington today as the two parties try to avert a fiscal deadline of spending cuts and tax hikes. Republicans have demanded that Democrats put painful Medicare cuts on the table in exchange for tax hikes on the rich, yet they ran an entire presidential campaign on the misleading notion that Mr. Obama was cutting Medicare too much. Now they sit mute across the table from White House negotiators, refusing to expose themselves by saying what Medicare cuts they actually want to make, and demanding that Democrats go first (David Firestone, 11/29).

Chicago Sun-Times: Democrats Should Pay Heed To Dick Durbin On Medicare, Medicaid
Progressives in this country would be wise to listen to Dick Durbin, Illinois’ senior senator. The No. 2 Democrat in the U.S. Senate this week essentially pleaded with his fellow progressives to give up the false notion that raising taxes on the wealthiest will alone solve the nation’s crippling debt problem. This comes as talks on averting the Jan. 1 fiscal cliff of tax hikes and crippling spending cuts near a crescendo. Durbin is right -- and the sooner progressives and Democrats get that, the sooner they can get to work on shaping the cost-cutting to Medicaid and Medicare that must be part of any realistic long-term deficit-reduction plan (11/29).

The Washington Post: Austerity And Morality
America is entering a period of prolonged austerity. The entitlement commitments made by past generations have been rendered untenable by demographics and health cost inflation. The problem is no one's particular fault, but it is very, very large. Failing to get our borrowing under control would deny our children the lives we have had in this country (Michael Gerson, 11/29).

The Washington Post: Cliff-Jumping With Barack
Why are Republicans playing the Democrats' game that the "fiscal cliff" is all about taxation? … Where is the other part of President Obama's vaunted "balanced approach?" Where are the spending cuts, both discretionary and entitlement: Medicare, Medicaid and now Obamacare (the health care trio) and Social Security? (Charles Krauthammer, 11/29).

The New York Times: Class Wars Of 2012
Consider, as a prime example, the push to raise the retirement age, the age of eligibility for Medicare, or both. This is only reasonable, we’re told -- after all, life expectancy has risen, so shouldn't we all retire later? In reality, however, it would be a hugely regressive policy change, imposing severe burdens on lower- and middle-income Americans while barely affecting the wealthy. Why? First of all, the increase in life expectancy is concentrated among the affluent; why should janitors have to retire later because lawyers are living longer? Second, both Social Security and Medicare are much more important, relative to income, to less-affluent Americans, so delaying their availability would be a far more severe hit to ordinary families than to the top 1 percent (Paul Krugman, 11/29).

Los Angeles Times: Dislodging Obamacare
Democrats are likewise deluding themselves if they think the law is safe because Obama wields the veto pen. The greatest threat to Obamacare was never a Romney presidency but Obamacare itself. The law remains vulnerable because of its unpopularity, the compromises that unpopularity forced on its authors and the Supreme Court's ruling that part of it is unconstitutional. These factors guarantee repeal will remain a viable issue, and -- I predict -- that the president will ultimately sign a bill making major changes, at the very least (Michael F. Cannon, 11/30).

The Washington Post: A Much-Needed Medicaid Reform
Medicaid has grown dramatically since its inception in 1965. It now accounts for 8.5 percent of all federal spending, and just under a quarter of all state spending. Between 1970 and 2010, the program quintupled from half a percent of gross domestic product to 2.7 percent. Federal forecasters expect Medicaid to reach 3.7 percent of GDP by 2020 -- due in large part to increased enrollment under health-care reform. Any serious plan to reduce the federal debt has to deal with spending, and, given the foregoing numbers, any serious plan to deal with spending has to address Medicaid. The question is how (11/29).

Baltimore Sun: Facing The Fiscal Cliff, Obama Can't Back Down Again
As official Washington nervously ponders the approaching fiscal cliff and the potential economic chaos it entails, President Barack Obama faces a precipice of his own in the challenge of making use of his re-election victory. Unless he emerges from this, the last major crisis of his first term, with the appearance of political strength and skill in navigating it, he risks losing public confidence that he has the stuff to take the country where he wants it to go in his second term. More than the specific details of any deal with House Speaker John Boehner and his resistant Republican cohorts on taxes and spending, Mr. Obama needs to demonstrate more steel in confronting GOP obstructionism than he showed in the previous showdown over deficit reduction (Jules Witcover, 11/30).

Minnesota Post: REAL ID, No Child Left Behind, And The Future Of The Affordable Care Act
The ACA's health care exchanges appear to be the next in a series of ambitious federal programs that share the following lineage: The establishment of sweeping goals without clear funding mechanisms, followed by implementation during a period of economic crisis. While Congress may be able to muster the political will to enact such programs, the federal government increasingly seems to be unable to whipsaw states into complying with the vast complexities and costs of their mandates. ... It is almost certain that the ACA's directive to run millions of uninsured Americans through (largely) non-existent state exchanges will face similar hurdles (Matt Ehling, 11/29).

Detroit Free Press: GOP Continues Health Care Tantrum
If you thought the Detroit City Council was the main attraction at the Museum of Governance by Self-Delusion, perhaps you've not met the members of the Michigan House of Representatives. The House's GOP majority failed this week (for at least the third time) to pass legislation that would set up a Michigan-based nonprofit to manage the health care exchanges required under the Affordable Care Act. This, after the Supreme Court decreed this summer that health reform is here to stay. And after the Nov. 6 election handed a second term to President Barack Obama and two more U.S. Senate seats to the Democratic majority (11/30).

Kansas City Star: Struggle Over Medicaid Is Shaping Up In Missouri
As you may have heard, some sore losers who didn't like the way the national election turned out have petitioned for Missouri to secede from the union. That prompted a more fun-loving group to ask that the rest of the nation be treated to a gigantic pizza party in the event of Missouri’s departure. It's probably a bit early for the partiers to be firing up the ovens, however. Before it takes on the rest of the union, Missouri must resolve the war within itself. Democratic Gov. Jay Nixon threw down the gauntlet Thursday when he announced his 2014 budget would include federal money to vastly expand the state’s Medicaid program (Barbara Shelly, 11/29).

Los Angeles Times: Patients' Choices Narrower, Yet Cost Of Insurance Rises
It's hard enough having a serious condition like cancer or kidney failure. It's even worse, some might think, when your health insurer says you have to buy your medicine from the pharmacy of its choice -- or pay the full amount for expensive life-saving drugs elsewhere. Yet that's precisely what Anthem Blue Cross is telling people who require so-called specialty medicines, which are used for complex conditions and can cost thousands of dollars a month (David Lazarus, 11/30).

Los Angeles Times: Safe Peanut Butter, And Beyond
Citing the conditions at Sunland as well as its history of health violations, the U.S. Food and Drug Administration put at least a temporary hold on those plans Monday, suspending operations at the plant and exercising for the first time its new authority to shut down potentially dangerous food facilities. Luckily for consumers, this was made possible by the Food Safety Modernization Act, signed into law nearly two years ago -- and long overdue even then. But other, much more sweeping changes required by the law haven't yet been implemented (11/29).

The Seattle Times: Dental Therapists Are Not The Right Fit For Washington State
Some believe dental therapists could be used to provide care to additional Medicaid patients and extend hours for community health centers. We can achieve the same result by employing more young, unemployed dentists looking for work in this struggling economy, or by increasing the number of dental residents who are already expanding capacity in community health centers. The problem is not due to a shortage of dentists but a shortage of dental funding (Danny Warner, 11/28).

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Andrew Villegas

Sarah Barr
Shefali S. Kulkarni
Ankita Rao
Alvin Trann

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