Daily Health Policy Report

Friday, November 9, 2012

Last updated: Fri, Nov 9

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Campaign 2012

Public Health & Education

Health Care Marketplace

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

After The Election: A Consumer’s Guide To The Health Law

Kaiser Health News staff writers Mary Agnes Carey and Jenny Gold write: "Now that President Barack Obama has won a second term, the Affordable Care Act is back on a fast track. ... Here's a primer on parts of the law already up and running, what's to come and ways that provisions could still be altered" (Carey and Gold, 11/9). Read the story.

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Capsules: Medicare Extends Enrollment Period For Those Affected By Sandy; Bloggers Parse What Happens Next On Health Law; Status Update: Medical Schools May Check Applicants On Facebook

Now on Kaiser Health News' blog, Susan Jaffe reports on Medicare's effort to help people caught in the path of the recent hurricane: "Medicare beneficiaries battered by Superstorm Sandy have one less problem to worry about: Federal officials have extended the Dec. 7 deadline to enroll in a private medical or drug plan for next year for those still coping with storm damage" (Jaffe, 11/8).

Also on Capsules, Andrew Villegas examines in his Blogwatch column what bloggers are saying about the health law following Tuesday's election: "The health policy world has moved on from what happens IF the health law survives to what happens NEXT now that its future appears secure" (Villegas, 11/8).

In addition, Alvin Tran writes about a new study looking at whether medical schools check out applicants' social media accounts: "While applying to medical school as a college student, Drew Lee did what many of his fellow 'premeds' were doing at the time – he gave himself an anonymous name on his Facebook account. ... a new study by researchers at the University of Miami’s Miller School of Medicine, suggests his concerns were well-founded" (Tran, 11/8). Check out what else is on the blog.

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Political Cartoon: 'Crowning Achievement?'

Kaiser Health News provides a fresh take on health policy developments with "Crowning Achievement?" By Nate Beeler, The Columbus Dispatch.

Meanwhile, here is today's health policy haiku:


Re-elected Prez
Health Reform and Fiscal Cliff
One down, one to go!
- 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.

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Capitol Hill Watch

Obama, Boehner Gird For Talks To Avert 'Fiscal Cliff'

The two men who failed to reach a "grand bargain" to tame the national debt last year face a year-end deadline to avert automatic budget cuts. Media outlets assess the likelihood of a deal that might curb Medicare spending in exchange for revenue increases.

The Washington Post: Obama, Boehner Again Prepare To Tackle National Debt
Tuesday’s election returned to power the same men who have battled for two years over the nation’s budget problems: President Obama and House Speaker John A. Boehner (Ohio). ... the political winds have shifted in Obama’s favor. ... In Boehner’s view, aides said, the starting point should be the deficit-reduction deal that he and Obama were close to sealing in secret talks during the summer of 2011. With Congress locked in a bitter battle over the federal debt limit, the two tentatively agreed to slice $2.4 trillion from future borrowing in part by trimming Medicare and Social Security benefits and generating $800 billion in new revenue by overhauling the tax code (Montgomery and Goldfarb, 11/8).

USA Today: Boehner Sees Short-Term Budget Fix
House Speaker John Boehner, R-Ohio, says he will resist any effort to make major tax or spending changes in the lame duck session of Congress beginning next week, seeking instead a short-term deal to delay the year-end "fiscal cliff." "I've never seen a lame duck Congress do big things. And as speaker I feel pretty strongly that a lame duck Congress shouldn't do big things," he said in an interview with USA TODAY. ... Boehner is proposing what he calls a short-term "bridge" that would extend all of the tax rates for one year and buy more time to overhaul the federal tax code (Davis, 11/8).

The New York Times: Congress Sees Rising Urgency On Fiscal Deal
The accelerated activity in Washington showed that members of Congress believed the election had amplified the imperative to strike a deal. Still, signs that the two sides are open to some compromise are no guarantee that they can reach an agreement after warring for two years. Many Republicans will continue to resist any proposal that can be read as increasing taxes, and many Democrats will balk at changes in entitlement programs and spending cuts (Weisman, 11/8).

The Wall Street Journal: Pressure Rises On Fiscal Crisis
The White House and Republican lawmakers faced pressure to reach a solution to the looming budget crisis after a nonpartisan agency detailed Thursday how inaction would push the U.S. economy back into recession next year, and skittish investors continued to drive stocks lower. ... Offering a framework rather than a detailed proposal could be attractive to the White House because of concerns that Republicans might reject a plan with too many details. The White House also was trying to decide whether any offer should include deficit-cutting proposals that Democrats might find unappealing, such as changes to Medicare and Social Security (Paletta, Lee and Bendavid, 11/8).

Politico: Behind Boehner's New Tone
After his secret debt negotiations last year with President Barack Obama sparked a sharp round of blowback from conservatives, his leadership and members of his House Republican Conference, Boehner has launched a carefully choreographed campaign on the high-stakes fiscal cliff talks. ... Boehner said he was prepared to raise new revenue for the government — but not increase tax rates — as long as the White House would agree to entitlement reform (Sherman, Budoff Brown and Bresnahan, 11/8).

The Associated Press: Obama Approaches 'Fiscal Cliff' Days After Victory
Obama is not expected to offer specifics immediately. His long-held position—repeatedly rejected by Republicans—is that tax rates on family income over $250,000 should jump back up to Clinton-era levels. Republicans say they're willing to consider new tax revenue but only through drafting a new tax code that lowers rates and eliminates some deductions and wasteful tax breaks. And they're insisting on cuts to Medicare, Medicaid and food stamps, known as entitlement programs in Washington-speak (Taylor, 11/9).

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Medicare Eyed As Part Of 'Grand Bargain'

Groups are planning how to fight cuts to Medicare and other health care programs which might be targeted as part of a debt deal.

The Associated Press: Highlights Of 'Fiscal Cliff' Taxes And Cuts
The so-called fiscal cliff is an economy-rattling combination of expiring Bush- and Obama-era tax cuts and major across-the-board spending cuts to the Pentagon and domestic programs. ... The fiscal cliff includes:
... A $55 billion, 9 percent cut in the defense budget next year and another $55 billion in cuts to domestic programs, including a 2 percent cut to Medicare providers (11/10).

Los Angeles Times: Coalition Pushes New Proposal To Avoid Medicare, Medicaid Cuts
With President Obama and congressional Republicans turning to address the looming budget crisis, a coalition of consumer groups, labor unions and major employers is pushing new approaches to control federal health spending without cutting benefits for seniors and others who rely on Medicare and Medicaid. The plan, released Thursday by the National Coalition on Health Care, includes several potentially controversial proposals such as a new penny-per-ounce federal tax on sweetened beverages and tougher penalties on under-performing hospitals (Levey, 11/8).

CQ HealthBeat: Health Care Coalition Offers Options For Health Savings And Revenue Raisers
The National Coalition on Health Care said its plan to save $220 billion in government health spending and raise $276 billion in revenue also included more general "game changers" with the potential to cut spending across the board in the private sector as well. Coalition leaders characterized their ideas as ones that could help improve performance, reduce waste and increase value rather than just bluntly cutting payments to providers or beneficiaries (Norman, 11/8).

The Hill: Groups To Launch Campaign To Keep Federal Research Funding
A coalition of groups is launching a campaign to emphasize federal funding for medical research ahead of negotiations on the "fiscal cliff." Research!America and several dozen patient, industry and other health organizations have planned a week of advocacy starting Monday to convince lawmakers to "champion medical innovation." ... The automatic cuts would reduce budgets at federal health agencies by $3.8 billion unless Congress to stop them, according to Research!America (Vieback, 11/9).

The Associated Press: Labor: Tax The Rich, Don't Touch Safety Nets
Labor's massive voter turnout effort played a major role in helping President Barack Obama win Ohio, Nevada and Wisconsin, according to exit polls, and its leaders are now looking for a more liberal, pro-union agenda from the White House. ... Topping labor's wish list — for now — is a push to raise taxes on wealthy Americans and discouraging Obama from agreeing to any deal with Republicans over the looming "fiscal cliff" that cuts into Social Security and Medicare (Hanahel, 11/10).

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CBO Emphasizes Need To Trim Medicare Spending

The Congressional Budget Office also found that GOP proposals to change a provision of the health law that requires insurers to spend 80 percent of premiums on medical care would increase the federal debt. Proposals to repeal coverage provisions would save billions, but also leave 29 million people uninsured, it found.

The Hill: CBO: Federal Health Care Costs Skyrocketing
After an election in which both parties demonized cuts in Medicare spending, the Congressional Budget Office issued a reminder Thursday of the need to cut Medicare spending. Healthcare programs are quickly outgrowing their historical share of the federal budget, CBO said, and the cost of those programs will only grow faster as more Baby Boomers reach retirement and underlying healthcare costs continue to soar. CBO's latest figures confirm what Republicans and Democrats acknowledge only selectively — that healthcare is a huge part of what's driving federal spending and debt. Healthcare programs are eating up an ever-increasing share of the economy, while tax revenues and other domestic spending are holding relatively steady, CBO said (Baker, 11/8).

Modern Healthcare: CBO Outlines Impact Of Keeping Current Doc-Pay Rates
Maintaining the Medicare program's current payment rates to physicians and eliminating the expected automatic cuts to nondefense spending early next year would increase federal spending by about $40 billion in 2013 and by $61 billion the following year, the nonpartisan Congressional Budget Office projected Thursday. As lawmakers prepare for intense deficit-reduction negotiations in Washington, the CBO released an analysis that details the consequences of not addressing the fiscal cliff, which describes a series of looming tax increases and spending cuts designed to reduce the nation's federal budget deficit (Zigmond, 11/8).

The Hill: CBO: GOP Bill Revising Health Law Ratio Will Add To Deficit
A Republican bill altering the healthcare law's medical loss ratio (MLR) will add about $1 billion to the budget deficit over the next decade, the Congressional Budget Office (CBO) said Thursday. The Obama administration frequently touts the MLR as a policy that helps consumers. It mandates that insurers spend no less than about 80 percent of their premium dollars on medical care rather than administrative costs or profits. The difference insurance companies must send back to policyholders, producing more than $1 billion in consumer rebates this year. Rep. Mike Rogers's bill (H.R. 1206) would exclude insurance brokers' fee from counting as administrative costs under the ratio. Agents say the MLR in its current state threatens their business by incentivizing insurers not to work with them (Viebeck, 11/8).

CQ HealthBeat: Change In Insurer Provision In Health Care Law Would Add To Deficit, CBO Says
Legislation that would change a consumer protection provision in the health care overhaul would increase the deficit by more than $1 billion over 10 years and reduce rebates for health plan enrollees, according to a Congressional Budget Office estimate. The bill, which was approved by the House Energy and Commerce Committee on Sept. 20, would amend the law’s medical loss ratio calculations to exempt agent and broker fees (Attias, 11/8).

Politico Pro: CBO: ACA Repeal Would Save Billions
Repealing the health care reform law’s insurance coverage expansion would generate the most deficit savings of any health initiative analyzed this year, according to the Congressional Budget Office's deficit reduction report released Thursday. Repeal of the coverage expansion — while keeping the rest of the law in place including various taxes and provider payment changes — would generate $150 billion annually in 2020. It would also increase the number of people without health insurance by about 29 million in the same year. Repealing other pieces of the law would generate between $5 billion and $50 billion each in 2020 (Haberkorn, 11/8).

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Boehner Backpedals After Calling Obamacare 'Law Of The Land'

House Speaker John Boehner reaffirmed his desire to repeal the health law Thursday, after earlier referring to it as the "law of the land."

Los Angeles Times: Boehner: Obamacare Is Law Of The Land, Ryan Not The GOP Leader
In a wide-ranging interview, House Speaker John A. Boehner (R-Ohio) said raising tax rates is "unacceptable," vice presidential nominee Paul D. Ryan is not the new leader of the GOP and the reelection of President Obama means the nation’s new health care law is "the law of the land." ... Boehner also suggested House Republicans would not entertain repeated votes to repeal the nation’s new health care law, as happened this past session of Congress. "The election changes that," Boehner said. "Obamacare is the law of the land." The speaker later tweeted that "our goal has been, and will remain, full repeal" of the health care law. Boehner's spokesman provided a transcript of the exchange in which the speaker also said, "There certainly may be parts of it that we believe -- need to be changed. We may do that. No decisions at this point" (Mascaro, 11/8).

National Journal: Boehner Backing Off Obamacare Repeal
After more than three dozen attempts to repeal all or part of President Obama's signature health care reform law, House Speaker John Boehner sounds like he'll be backing off the issue next year. Asked by ABC News if he still plans on repealing the law next year, Boehner said "the election changes that" and that "Obamacare is the law of the land." The Alley asked Boehner spokesman Kevin Smith if that meant there'd be no more repeal votes and Smith responded: While ObamaCare is the law of the land, it is costing us jobs and threatening our health care. Speaker Boehner and House Republicans remain committed to repealing the law, and he said in the interview it would be on the table. Of course, with a Democratic Senate and Obama in the White House, it hardly makes sense to continue to spend much time on an errand as quixotic as repealing Obamacare (Frates, 11/8).

The Hill: Boehner: 'ObamaCare Is The Law Of The Land'
Speaker John Boehner (R-Ohio) quickly reaffirmed his commitment to abolishing President Obama’s healthcare reform law after suggesting in an interview that repeal was no longer a priority for the House. "ObamaCare is law of the land, but it is raising costs & threatening jobs. Our goal has been, and will remain, full repeal," Boehner tweeted Thursday. The tweet was sent shortly after the release of an interview with ABC News in which Boehner indicated he has no firm plans to push for repeal of the Affordable Care Act, a law the GOP-led House has voted to abolish, dismantle or defund more than 30 times (Viebeck, 11/8).

Politico Pro: Boehner: 'Obamacare Is The Law Of The Land'
House Speaker John Boehner made it official Thursday: Obamacare isn’t going anywhere. In an interview with ABC News, Boehner seemed to suggest the election ended any efforts to wipe out the whole law. When "World News" anchor Diane Sawyer asked if there would be any more votes to repeal the law, Boehner said "the election changes that" and "Obamacare is the law of the land." … In a way, Boehner was just acknowledging the obvious: With President Barack Obama back in the White House for another four years, and the Senate still firmly in Democratic hands, a full repeal of the health care law is out of the question. Targeted repeal of unpopular parts of the law -- or efforts to scale back some parts -- might be a different story (Nather, 11/8).

Still, the health law is a target for some Republicans.

CQ HealthBeat: Cantor Targets Medicare Cost-Containment Board, Hopes To Enlist Senate Democrats In Effort
House Majority Leader Eric Cantor has set his sights on repealing the health care overhaul’s Medicare cost-cutting board in the 113th Congress, and says he can get Democrats to join him. In a Nov. 7 letter to GOP colleagues, Cantor includes repealing the Independent Payment Advisory Board on a short list of legislative priorities he says he believes can reach the president’s desk, with the support of Senate Democrats. Seven House Democrats joined Republicans in passing a bill to repeal the board earlier this year. But some Democrats who support repealing the board did not vote for the final bill after Republicans added language to restrict medical malpractice lawsuits. Cantor, R-Va., said if Republicans "successfully make the case publicly," Senate Democrats might sign on to a repeal measure as well (Ethridge, 11/8).

CQ HealthBeat: Health Care Law, Entitlements On House Panels' Agendas
Even with Republicans maintaining their majority, retirements and party term limits could lead to as many as a dozen full committee chairmanship and ranking member changes in the 113th Congress. And that doesn't include Republican and Democratic vacancies at the top of almost 30 subcommittees. Negotiating new party ratios on committees shouldn't be a big problem, given the slight Democratic gain in overall seats. Here's a look at the likely work plans for the two House committees with the most jurisdiction over health matters. Committee Republicans approved countless measures in the current Congress signaling their displeasure with the Obama administration’s energy and environment policies and health care overhaul. They’re expected to pick up where they left off in the next Congress (11/8).

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Health Reform

Raising - And Answering - Questions About Health Law's Future

Kaiser Health News: After The Election: A Consumer’s Guide To The Health Law
Now that President Barack Obama has won a second term, the Affordable Care Act is back on a fast track. ... Here's a primer on parts of the law already up and running, what's to come and ways that provisions could still be altered: ... I get my health coverage at work and want to keep my current plan. Will I be able to do that? How will my plan be affected by the health law? (Carey and Gold, 11/9).

The New York Times: With Obama Re-Elected, States Scramble Over Health Law
After nearly three years of legal and political threats that kept President Obama’s health care law in a constant state of uncertainty, his re-election on Tuesday all but guarantees that the historic legislation will survive. Now comes another big hurdle: making it work. ... Will the administration, for example, try to address the concerns of insurers, employers and some consumer groups who worry that the law’s requirements could increase premiums? (Goodnough and Pear, 11/8).

The Associated Press: Obama's Health Care Overhaul Turns Into A Sprint
[N]ot all hurdles have been cleared. Republican governors who opposed the law have to decide whether it's better for their states to now help carry it out. The administration could stumble carrying out the complex legislation, or get tripped up if budget talks with Congress lead to scaling back the plan (Alonso-Zaldivar, 11/9).

Kaiser Health News Bloggers Parse What Happens Next On Health Law
Bloggers are focusing on how the law will be implemented, what the role of states may be, how patient care will be affected and how the work left to be done will shake out. Here’s a sampling (Villegas, 11/8).

CQ HealthBeat: Berwick Pleased That Implementation Of Law Is Proceeding, But Worried About Funding
Former Centers for Medicare and Medicaid Services Administrator Donald M. Berwick said Thursday he fears that House Republicans might still try to deny funding for health care law implementation, particularly for the insurance exchanges. Berwick, who is now a senior fellow at the Center for American Progress and spends a good deal of his time visiting health systems around the country, said that just because the electoral results protect the health care law from repeal, “that doesn’t automatically mean it can be implemented" (Adams, 11/8).

Politico: ACA Opponents Scramble For A Plan B
What’s the plan for Obamacare’s opponents now? Judging from Republicans’ mixed messages Thursday, the plan is: disarray. ... The best hopes of resistance, for now, are coming from the states — where some governors are saying they may just not move ahead to set up the health exchanges. But even then, all that happens is that the feds would set up the exchanges for them (Norman and Millman, 11/8).

Politico Pro: U.S. Lawyers Defend Health Law In 'Blue Slip' Case
Once again, the Obama administration is defending the health reform law in court. And this time it’s arguing that there is no reason for a court to strike the individual mandate — which the Supreme Court in a separate lawsuit considered a tax — just because the bill originated in the Senate. This lawsuit alleges that the health law violates the Constitution’s requirement that all revenue-raising bills start in the House. It’s a technical claim that its backer — Iraq war veteran Matt Sissel — hopes will put a significant dent in the law (Haberkorn, 11/9).

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Governors Wrestling With Decision On Health Insurance Exchanges

As federal officials consider whether to let the Nov. 16 deadline slip, governors in places such as Kansas, Virginia and Colorado are deciding whether to have the federal government design their exchange.

CQ HealthBeat: HHS Expected To Give States More Time On Exchange Decisions
The federal government is likely to extend the Nov. 16 deadline for states to decide whether they will run their own health insurance exchanges, according to several state officials. ... Instead, HHS officials are expected to set a new deadline for states that want to operate the marketplaces alone but have a rolling deadline with ongoing discussions for states that are interested in a partnership (Adams, 11/8).

The Denver Post: National, Colorado Elections Push Five Key Health Reforms Down Road
Coloradans backing major expansions of insurance and other pivotal health reforms briefly rejoiced in this week's election results, then immediately resumed a 14-month sprint to key deadlines. ... Can the state health-insurance exchange, the focal point for many of the reform movement's ambitious goals, be up and running with a friendly interface to consumers within a year? ... Will Gov. John Hickenlooper's administration enthusiastically join the national Medicaid expansion, adding hundreds of thousands to Colorado insurance rolls? Or will it take the back exit opened by the Supreme Court? (Booth, 11/9).

The Associated Press: Gov. Jindal Asked To Rethink Medicaid Expansion
Republican Gov. Bobby Jindal is being urged by Louisiana Democratic leaders and advocacy groups to reconsider his opposition to expanding the state's Medicaid coverage, now that the presidential campaign is over. ... The head of the Louisiana Democratic Party, state Sen. Karen Carter Peterson, said families, businesses and health care providers can benefit from the law's provisions. ... Jindal hadn't responded Thursday to multiple requests for comment about whether he'd change his stance (Deslatte, 11/8).

The Associated Press: Mo. Won’t Run Health Insurance Exchange By 2014
Gov. Jay Nixon acknowledged Thursday that Missouri will not be able to set up an online marketplace for residents to shop for health insurance as envisioned under President Barack Obama's health care. That means federal officials will take over the task — at least for the near future (Lieb, 11/8)

The Richmond Times-Dispatch: Va. To Use Federal Health Exchange Option - For Now
Gov. Bob McDonnell acknowledges that with the re-election of President Barack Obama, federal health care reform no longer can be stopped in Virginia, but he remains unwilling to expand the state's Medicaid program or establish a state-based health insurance exchange without more certainty about the costs. ... "I don't want to buy a pig in a poke for the taxpayers of Virginia," he said at a postelection news briefing on Wednesday. "At this point, without further information, the only logical decision for us is to use the federal option" (Martz, 11/7).

Kansas City Star: No State-Run Health Insurance Exchanges In Missouri Or Kansas
Missouri will be unable to implement a key provision of federal health care law, Gov. Jay Nixon announced Thursday. Meantime, Kansas Gov. Sam Brownback says he won't support an application from Insurance Commissioner Sandy Praeger to establish a state-federal health insurance marketplace. That means it will be up to the federal government to establish health insurance exchanges in Missouri and Kansas. ... When states do not open their own, the federal government will step in and set up an exchange (Hancock, 11/9).

St. Louis Beacon: Feds Will Set Up Missouri’s Health-Care Exchange, Nixon Says 
Fresh off his decisive re-election victory, Nixon told reporters Thursday at his office in Jefferson City that Missouri had run out of options to implement a health-care exchange, one of the provisions of the federal Affordable Care Act (Rosenbaum, 11/8). 

Kansas Health Institute News: Brownback Says No Again To Health Insurance Exchange
Gov. Sam Brownback today squelched Insurance Commissioner Sandy Praeger’s efforts to partner with the federal government on a health insurance exchange. ... “Kansans feel Obamacare is an overreach by Washington and have rejected the state’s participation in this federal program," Brownback said in a prepared statement. ... Praeger earlier this week said the grant application to help develop a state-federal partnership on a Kansas exchange did not need explicit approval by the governor but could not go forward without his tacit support for it (11/8).

Kansas Health Institute News: Groups Call For KanCare Delay
With KanCare's scheduled launch only short weeks away, spokesmen for groups representing the elderly and developmentally disabled today urged legislators to delay Gov. Sam Brownback's Medicaid makeover plan for at least six months. "We believe such an aggressive timeline, with little oversight, for an untested system will place many of the state's frailest and most vulnerable residents into a long-term managed care program that we believe the state is not ready to operate," said David Wilson, testifying on behalf of AARP Kansas to the Joint Committee on Home and Community Based Services Oversight (Shields, 11/8). 

Health News Florida: Re-Engineer Health System, CEOs Urge
The U.S. health-care system has begun a huge transformation from a cottage industry noted for waste and inefficiency to one that rewards value, four Florida health executives said Thursday. The CEOs -- two from hospitals, two from physician networks --appeared on a panel before dozens of insurance specialists at the Tampa Bay Association of Health Underwriters. Far from objecting to the Affordable Care Act, the panelists said it doesn’t go far enough in restraining costs, given demographics of an aging population (Gentry, 11/8).

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Insurers, Other Industries React To Obama Victory, Health Law

AHIP's Karen Ignagni says insurers will shift focus to cost cutting, as survey finds other businesses continue to oppose the 2010 health care overhaul.

Bloomberg: Health Insurers Are Shifting Focus To Costs, Ignagni Says
The health-care industry will change its focus from expanding the insurance market to reining in medical costs now that the U.S. presidential election has been decided, said Karen Ignagni, chief executive officer of America’s Health Insurance Plans. The re-election of President Barack Obama, who campaigned to preserve his health-care system overhaul of 2010, gives the industry certainty that implementation of the Affordable Care Act will proceed, Ignagni said in an interview with Bloomberg Television’s Peter Cook for “Capitol Gains” airing Nov. 11. “When we look at health reform we look at it through the prism of affordability and disruption,” said Ignagni, whose organization is the main Washington-based lobbying group for health insurers (Armour, 11/9).

Modern Healthcare: Modern Healthcare Survey Finds Anger Over ACA
A Modern Healthcare Internet survey conducted after this week's presidential election tapped a deep vein of anger over the effects of the Patient Protection and Affordable Care Act, with a large group of respondents saying they had waited to see Tuesday's outcome before fully embracing the law. Of the 829 people who responded to the survey, 67% said the reform law would have a negative impact on the bottom lines of their healthcare business. Only 33% said the law would have a positive impact. A majority of respondents agreed that it would have been “better for your organization's bottom line” if Republican Mitt Romney had defeated President Barack Obama and raised the prospect of repealing the reform law. Nearly 57% agreed with that, while 31% disagreed and 12% were unsure (Modern Healthcare, 11/8).

The Wall Street Journal: What Obama's Victory Means For Business
After President Barack Obama's victory, CEOs say they are looking for a softening of the standoff between Congress and the president that characterized much of his first term in office. Here is a rundown of what a number of key industries may see during President Obama's second term: Health Care. President Obama's re-election means the complex health-care overhaul—with its coverage-expanding benefits and new costs for the industry—is here to stay. But questions remain on how the law would be implemented. That business in general performed better than the slumping broader market, helped by surging shares of hospital companies and insurers that manage Medicaid plans (Kamp and Mathews, 11/8).

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Campaign 2012

Will Sebelius Stay At HHS?

CQ HealthBeat says there is little talk of her moving on but even so, four years is a long tenure in the job.

CQ HealthBeat: Health Team May Stay Steady In Key Phase Of Overhaul Implementation
There's little or no talk thus far that Health and Human Services Secretary Kathleen Sebelius is on her way out, particularly with the possibility that her legacy would be burnished by seeing through the job of implementing the health law if she does stay. But four years as HHS secretary is a long time. Staying through a second term would be highly unusual. "Only one HHS secretary has stayed on that long, and the job was much easier then," said a former administration official, referring to the tenure of Donna Shalala as head of HHS during the eight years of the Clinton administration. "As for Sebelius, it's hard to say," the former official adds. "She's got a helluva lot of energy and wants to see things through, so I expect she'll stay for at least part of a second term" (Reichard, 11/8).

Meanwhile, some of President Barack Obama's political advisers say the health law played a role in his re-election.

The New York Times: Don't Credit Us, Obama's Tacticians Say
But less than 48 hours after Mr. Obama clinched re-election, his aides were becoming wary that the first draft of history on the campaign was turning into a story about how smart campaign tactics had delivered victory to an embattled president rather than one about how it was all due to the president himself and his policies. ... Jim Messina, the campaign manager who oversaw the creation of the system that surprised Republicans by getting more Obama supporters to the polls than Republicans had expected, argued that the results should be viewed as vindication for the president's call for higher taxes on the rich as part of any deal to reduce the deficit. And Mr. Obama's aides noted that exit polls showed that only a minority want to see the president's health care plan entirely repealed (Rutenberg, 11/8). 

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Public Health & Education

Sanofi To Cut Cost Of Colon Cancer Drug In Half After Cancer Center Denial

The New York Times: Sanofi Halves Price Of Cancer Drug Zaltrap After Sloan-Kettering Rejection
In an unusual move, a big drug company said on Thursday that it would effectively cut in half the price of a new cancer drug after a leading cancer center said it would not use the drug because it was too expensive. ... Zaltrap came to market in August at a price of about $11,000 a month. Soon after, Memorial Sloan-Kettering Cancer Center in New York decided not to use the drug, saying it was twice as expensive but no more effective than a similar medicine, Avastin from Genentech. Both drugs improved median survival by 1.4 months, doctors there said (Pollack, 11/8).

In other public health news, officials worry about a new form of West Nile Virus --

The Washington Post: Hints Of A More Virulent, Mutating West Nile Virus Emerge
The West Nile virus epidemic of 2012, the worst in a decade, may be notorious for yet another reason: The virus, in some cases, is attacking the brain more aggressively than in the past, raising the specter that it may have mutated into a nastier form, say two neurologists who have extensive experience dealing with the illness. ... So far this year, health authorities have reported more than 5,000 cases of West Nile illness and 228 deaths in 48 states, with Texas, California, Illinois and Michigan having the most cases (Vastag, 11/8).

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Health Care Marketplace

For Nurses, Long Shifts Equal Burn Out

Medpage Today: Nurses Burn Out On Long Shifts
Hospital nurses working longer hours were associated with higher levels of burnout, patient dissatisfaction, and safety issues, a study found. Having nurses work shifts of 13 or more hours was associated with increased patient dissatisfaction, a study published in the November issue of Health Affairs found. Also, nurses working shifts of 10 or more hours were two-and-a-half-times more likely than those working shorter shifts to experience job dissatisfaction and intention to leave the job (Pittman, 11/8).

The Associated Press: Dean: Need For Nebraska Nurses Expected To Grow
Nebraska already faces a shortage of nurses and primary care doctors, but a top dean at the University of Nebraska Medical Center said Thursday that the need will grow even more under the federal health care law. Juliann Sebastian, dean of the university's College of Nursing, said the increase in insured Nebraskans as a result of the law will prompt more to visit doctors' offices for preventative care (Schulte, 11/8).

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Temporary Pharmacy In D.C. Draws Attention To Cluttered Drug Market

The "help shop" is the brainchild of founders of a company that seeks to make over-the-counter drugs less complicated. In other news about the health care industry, the Minneapolis Star Tribune examines the growing number of primary health clinics.

The New York Times: Attacking Ailments With Small Doses
Disappointed voters, runners with blisters and headache sufferers alike are getting some unexpected relief from a pop-up pharmacy that opened this week in the nation's capital. The "help shop," which offers low-dose drugs for everyday woes, is the idea of Help Remedies, a start-up company that sells minimalist white packets directed at single medical issues like nausea, headache or insomnia (Olson, 11/8).

Minnesota Star Tribune: Clinics Are Going Where The Patients Are
The expanded role of primary health care clinics in the age of the Affordable Care Act is driving a healthy uptick in medical real estate as providers seek to fill gaps in the Twin Cities' medical map. A push by providers to connect with patients in a "neighborhood retail" way is being driven both by competitive necessities and reforms under the Affordable Care Act that aim to reward primary care providers for keeping overall health care costs down…. But the key for providers under the new primary care emphasis is "access," meaning more neighborhood/retail-style locations and higher public visibility, all aimed at creating long-term patient relationships (Jacobson, 11/8).

Meanwhile, for doctors, or at least people wanting to be doctors, it may be important to protect your social networking.

Kaiser Health News: Status Update: Medical Schools May Check Applicants On Facebook
While applying to medical school as a college student, Drew Lee did what many of his fellow “premeds” were doing at the time – he gave himself an anonymous name on his Facebook account. ... a new study by researchers at the University of Miami’s Miller School of Medicine, suggests his concerns were well-founded (Tran, 11/8).

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State Watch

Roundup: Federal Judge Extends Ban On Texas Cut To Planned Parenthood Funding; Hospital Tax Break Could Cost Ill. $10M Per Year

Bloomberg: Planned Parenthood Wins Extended Ban On Texas Funding Cuts
Planned Parenthood won an extension of an order blocking Texas from making cuts in funding to its clinics because the organization provides abortion services. Texas officials were stopped by an Oct. 26 temporary restraining order issued by Judge Amy Clark Meachum in Austin from eliminating public funds for the 49 Planned Parenthood clinics in the state that don’t provide abortions. After a hearing yesterday in Austin, U.S. District Judge Stephen Yelenosky said he is extending Meachum’s order (Shannon, 11/9).

The Dallas Morning News: Ruling Keeps Planned Parenthood In Women's Health Program
A state judge decided Thursday to extend an injunction that keeps Planned Parenthood in the federal women’s health program. The injunction from Judge Stephen Yelenosky lasts until mid-December, when the court will hear a case for a permanent injunction. "The state may claim that the effect on women is 'irrelevant' but today’s ruling is a small but critical victory for the approximately 50,000 Texas women who rely on Planned Parenthood," said Patricio Gonzales, CEO of the Planned Parenthood Association of Hidalgo County (Cardona, 11/8).

The Associated Press: Little-Known Hospital Tax Break To Cost Illinois $10M A Year
A little-noticed tax break for investor-owned hospitals that was tucked into a deal last spring aimed at saving the Illinois Medicaid program from collapse will cost the cash-strapped state at least $10 million a year in lost revenue, according to an analysis by The Associated Press. Hospital industry officials say the tax credit recognizes the free care they provide to the uninsured (Johnson, 11/8).

The Dallas Morning News: Expanded Medicaid Plan For Texas Expected To Improve Access To Care
Thousands of North Texans who have struggled to find adequate health care could see improved access to medical services under an expanded Medicaid plan expected to bring $4 billion to local doctors and hospitals over five years. So far, in the first phase, 95 new medical projects would target Medicaid recipients in Dallas, Denton and Kaufman counties. The projects range from expanded chronic care management at Parkland Memorial Hospital to improved diabetes treatment at Methodist Dallas Medical Center. For more than a year, health care officials from the three counties have been hunched over plans that would improve care for those insured under Medicaid, a state-federal program that provides care for low-income Texans (Jacobson, 11/8).

The Associated Press: San Francisco Plans To Provide Transgender Surgeries For Uninsured Residents
San Francisco is preparing to become the first U.S. city to provide and cover the cost of sex reassignment surgeries for uninsured transgender residents. The city's Health Commission voted Tuesday to create a comprehensive program for treating transgender people experiencing mental distress because of the mismatch between their bodies and their gender identities. San Francisco already provides transgender residents with hormones, counseling and routine health services, but has stopped short of offering surgical interventions, Public Health Director Barbara Garcia said Thursday after the vote was announced (Leff, 11/8).

Los Angeles Times: L.A. Councilwoman Offers Pension Overhaul Plan
Warning that Los Angeles is facing insolvency, mayoral candidate and City Councilwoman Jan Perry outlined her plan Thursday for reforming the city's employee pension and benefits system. ... Perry said she would press city employees to increase the amount they contribute to their healthcare and pension costs. About 70% of the city's workforce pays nothing toward their health insurance premiums, said City Administrative Officer Miguel Santana. The changes would save an estimated $44 million per year, Perry said. That savings would fill only a portion of next year's budget shortfall, which is projected to reach $216 million (Mai-Duc and Linthicum, 11/9).

The Boston Globe: Medical Marijuana Law Will Challenge Overseers
Voters' approval of medical use of marijuana on Tuesday is already prompting questions about the readiness of beleaguered state health regulators, local communities, and police to oversee the retail outlets where the drug will be sold. The law, which won majorities in all but two Massachusetts communities, takes effect Jan. 1. But some groups, including the Massachusetts Municipal Association, are calling on the Legislature to delay it. Town officials must draft zoning rules stipulating where the distribution centers may be located — or whether to allow them at all — and police departments are grappling with how to deal with a law that is in direct conflict with federal drug policy and their own training (Conaboy, 11/9).

California Healthline: Budget Expert Unfazed By Supermajority In Calif. Legislature
Fears that the Legislature might spend money faster than a speeding bullet are unfounded, despite the possibility that the Democrats in Sacramento could have a two-thirds supermajority in both houses, according to Chris Hoene, executive director of the California Budget Project. However, if election results in several key races too close to call go in Democrats' favor, the new supermajority could have an impact on health care policy, particularly cuts to health care, Hoene said (Gorn, 11/9).

California Healthline: Will Prop. 30 Move Government Away From 'Fee-For-Service'?
Characterizing passage of Proposition 30 as "a reinvestment in the broader common good," California Health and Human Services Secretary Diana Dooley said voters' willingness to tax themselves may signal a move away from "fee-for-service government." Prop. 30 proponents say the initiative's approval may indicate California's taxing pendulum has reached the other side of the arc started by Prop. 13 in 1978. That landmark property tax rollback pulled away much of the funding for the state education system and increased pressure on other parts of state government, including health care (Lauer. 11/8).

The Lund Report: Health Care Leaders Stress Need For Diversity In Oregon Coordinated Care
As the state's coordinated care organizations ramp up, health care experts agree that a major advance CCOs can bring to the table is the ability to custom-design health care priorities based on the needs of a specific community. But that won’t necessarily be easy, experts speaking at a conference last week agreed. “The challenge is getting adequate representation from the community,” Benton County Health Department Director Mitch Anderson told a CCO conference on November 1. The gathering was co-sponsored by Community Health Advocates of Oregon (CHAO) and the Oregon Primary Care Association (OPCA) and attended by more than 250 healthcare professionals. Diversity -- or the lack of it -- at the planning phase was a major topic of discussion. Each CCO is required to have an advisory committee that represents the community it serves (Widman, 11/8).

The Lund Report: People On Medicaid Struggle With Mental Health, Substance Abuse Problems
There’s a very high preponderance of people on the Oregon Health Plan who have a mental health or substance abuse problem, according to Mary Monnat, president and CEO of LifeWorks NW. In the Portland metropolitan area, such problems affect 70 percent of that population. Now that coordinated care organizations are under way, it’s not only important for people to receive better coverage, but mental health professionals also need to connect their patients with primary care physicians, said Monnat (McCurdy, 11/8).

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Health Policy Research

Research Roundup: Medicare Spending Grows During Recessions; Docs Discriminate Against Obese People; Too Much Hospital Smoking

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

Health Affairs: State Unemployment In Recessions During 1991-2009 Was Linked To Faster Growth In Medicare Spending –  Although overall health care spending fell during the 2007-2009 recession, Medicare spending growth increased. Using 1991-2009 data, researchers found that "Higher unemployment rates across states and over time [1991-2009] were associated not only with faster Medicare spending growth, but also with more Medicare spending per capita – more hospital spending and more hospital use by free-for-service Medicare beneficiaries.”  They conclude that "One of many possible explanations may be that health care providers have greater capacity, inclination, and financial incentive to treat Medicare patients during recessions as a result of slackening demand from the non-Medicare population (McInerney and Mellor, 11/2012).

PLOS ONE: Implicit And Explicit Anti-Fat Bias Among A Large Sample Of Medical Doctors By BMI, Race/Ethnicity And Gender – Findings from previous research suggests that weight discrimination exists among Americans. Many patients have also reported that they have been mistreated by health care providers. In this study, researchers aimed to determine if some medical doctors (MDs) possess any bias based on their patients’ weight. “We found that MDs’ implicit and explicit attitudes about weight follow the same general pattern seen in the very large public samples that hold strong implicit and explicit anti-fat bias,” the authors write, and conclude that "implicit and explicit anti-fat bias is as pervasive among MDs as it is among most people in society" (Sabin, Marini and Nosek, 11/2012).

JAMA: Association Of Race And Sex With Risk Of Incident Acute Coronary Heart Disease Events – Guided by previous findings that showed disparities in the incidence of heart disease (CHD) among white and black individuals, researchers aimed to determine if the disparities continued. They found that black men and women in the US were more likely to die from CHD than whites. They conclude that the “excess risk factor burden among black men and women continues to be a major public health challenge, along with their high risk for death as the presentation of CHD. Increase emphasizes on optimizing well-established risk factors among blacks could potentially reduce these disparities." Reuters quoted the lead author as saying the result is "distressingly similar" to racial differences seen in data from the 1990s, despite public health efforts to address them (Safford et al., 11/7).

Archives Of Internal Medicine: Prevalence And Predictions Of Smoking By Inpatients During A Hospital Stay – The authors write: "Accredited U.S. hospitals prohibit smoking inside hospital buildings," though some allow smoking outdoors. Researchers surveyed more than 5,000 patients from Massachusetts General Hospital during and 2 weeks after their hospitalization to assess the proportion of smoking. Between 2007 to 2010, “18.4% reporting having smoked during their hospital stay … Patients were more likely to report having smoked while hospitalized if they were young, had more severe cigarette cravings, did not report planning to quit, had longer hospital stays, and were not admitted to a cardiac unit.” The researchers write that “a clear policy prohibiting patients from leaving the hospital to smoke may be necessary to prevent smoking by inpatients” (Regan, Viana, Reyen and Rigotti, 11/5).

Here is a selection of news coverage of other recent research:

Inside Health Policy: Avalere Health: CMS Likely To Grant Flexibility On Medicaid Expansion
With the elections over, the consulting firm Avalere Health predicts that CMS will grant states the flexibility to expand Medicaid to people earning up to 100 percent -- rather than 138 percent -- of the federal poverty level, and that most states will end up at that threshold. ... States are under no strict deadline to decide whether to take up the reform law's voluntary Medicaid expansion (Lotven, 11/7).

USA Today: Diabetes: Effect Of Weight Loss Thrown Into Question
A recent study showed that obese people with diabetes who lost a modest amount of weight didn't lower their risk of having a heart attack or stroke, but the weight loss did help improve many other health factors. ... "[W]e did show the benefits of weight loss for improving depression, quality of life, sleep apnea, incontinence, fitness, physical function and blood sugar control," says Rena Wing, a professor of psychiatry and human behavior at Brown University and chairman of the Look AHEAD (Action for Health in Diabetes) study. The research was financed by the National Institutes of Health (Hellmich, 11/7).

Reuters: Hospital Guidelines Not Linked To Readmissions: Study
Procedural guidelines designed to ensure patients get quality care while in the hospital are also thought to reduce the chances a patient will need to be readmitted down the line, but a new study suggests there's little connection between the two.... Overall, they found that hospitals with the best scores for following guidelines did not have "meaningfully" lower readmissions than hospitals with the worst scores. "Even when the associations were statistically significant, the differences in the readmission rates of high and low-performing hospitals were small," the team writes in the Journal of General Internal Medicine (Seaman, 11/8).

Reuters: Values Exercise Improves Doctor-Patient Communication
A short waiting room exercise encouraging African American patients to reflect on their personal values helped improve communication between the patients and their white doctors, in a new study. However, those patients didn't rate their trust in their doctor or satisfaction with the appointment any higher, compared to those who didn't do the "values affirmation" exercise (Pittman, 11/7).

Reuters: Human Enhancements At Work Pose Ethical Dilemmas
Retinal implants to help pilots see at night, stimulant drugs to keep surgeons alert and steady handed, cognitive enhancers to focus the minds of executives for a big speech or presentation. Medical and scientific advances are bringing human enhancements into work but with them, according to a report by British experts, come not only the potential to help society and boost productivity, but also a range of ethical dilemmas (Kelland, 11/7).

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Editorials and Opinions

Viewpoints: Voters Voice Abortion Positions; Obama's 'Tough Road Ahead' On Health Reforms; Mass. Paves The Way On Cost Control?

The New York Times: Voters Speak on Abortion Rights
On Election Day, Florida voters wisely rejected a proposed amendment to the State Constitution that would prohibit abortion coverage as part of health plans for state workers and Medicaid recipients (such coverage is already severely limited by law). ... The measure received only 45 percent of the vote -- far short of the 60 percent required for a constitutional change. The defeat should send a strong message to politicians in Florida and elsewhere who might want to broadly attack women’s reproductive rights (11/8).

Los Angeles Times: The Tough Road Ahead
[Obama] earned reelection by keeping the country from falling into a depression and persuading Congress to enact vital reforms to healthcare and the financial industry. ... As hard fought as the campaign was, the task of governing this divided country will be even more difficult. ... The longer-term problem for the president will be coping with the dueling pressures of an economy that's growing too slowly and a federal debt that's growing too fast, largely because of the rising cost of Medicare and Medicaid (11/8).

Minnesota Star Tribune: Health Care Shopping
Teamwork still will be needed to build a Minnesota health exchange, even though the DFL now has the legislative votes and the governor's signature to unilaterally make the new online health insurance shopping site a reality. … The new DFL leadership can create the sorely needed buy-in by inviting the business community and Republicans back to the table. The main mission for Minnesota's exchange: getting consumers to use it. Gathering good ideas and forging a consensus among stakeholders will create the foundation to make that happen (11/8).

The Lund Report: A New Way Of Shopping For Health Insurance Gets A Trial Run
Earlier this week, I took part in a trial run of the user interface system for the website of the Oregon health insurance exchange -- now called Cover Oregon. Cover Oregon is a lot of things: a new marketplace for health insurance, a means to leverage the buying power of hundreds of thousands of Oregonians to drive a hard bargain with the insurance industry, and a new way to spark competition between insurers, to the benefit of consumers. But it’s also a website, and like all big IT projects, it faces some real challenge (Jesse Ellis O’Brien, 11/8).

WBUR’s Cognoscenti: Advice To The Next President: Health Care Cost Containment
As anyone following the 2012 election knows, Massachusetts has served as a model for the expansion of health care coverage nationally. ... Now, Massachusetts could become the standard bearer for how to get costs under control. In August of this year, state lawmakers passed landmark legislation aimed at containing rising health care costs. In a discussion held just days before Tuesday’s election, four veteran observers of and participants in Massachusetts’ ongoing efforts to provide universal health care access at affordable prices ... offered their advice to the next president (David Seltz, James Roosevelt, Regina Herzlinger, and Stephen D’Amato, 11/8).

Minnesota Post: Time For Minnesota To Move Forward On Health Care Reform
Thursday, the Access Work Group of the Minnesota Health Care Reform Task Force will vote on whether to recommend that the state cover nearly all non-elderly individuals with incomes up to 138 percent of the federal poverty line through Medicaid ... A "yes" vote from the Work Group will keep Minnesota moving forward on improving access to affordable health insurance. If Minnesota fails to expand Medicaid, it will not only increase costs for the state, for people with private insurance and for health care providers, it will also leave tens of thousands of Minnesotans struggling to get the health care they need (Christina Wessel, 11/8) .

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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.