Daily Health Policy Report

Monday, December 10, 2012

Last updated: Mon, Dec 10

KHN Original Reporting & Guest Opinion

Fiscal Cliff

Health Reform

Capitol Hill Watch

Health Care Marketplace

Health Care Fraud & Abuse


Coverage & Access

Health Information Technology

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

How Much For An MRI? $500 Or $5,000? A Reporter Struggles To Find Out

WBUR's Martha Bebinger, working in partnership with Kaiser Health News and NPR, tries to solve the mystery of her migraines with a doctor-recommended imaging test, but trying to find out the real cost of that test induces headaches of its own (Bebinger, 12/9). Read the story.

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Capsules: What Sea World, Universal Studios And The Zoo Can Teach Health Care Executives; Report: Payment Reform Leaves Docs Uneasy

Now on Kaiser Health News' blog, Phil Galewitz reports on key lessons for health care executives about making the health system more safe and efficient: "Thousands of health care administrators, policy experts and practitioners will gather in Orlando this week for the 24th annual Institute for Healthcare Improvement’s national forum – akin to a pilgrimmage to Mecca for those passionate about making health care safer and more efficient" (Galewitz, 12/10).

Also on Capsules, Shefali S. Kulkarni writes about physicians' reactions to payment reform: "A new report from insurer UnitedHealth Group shows that doctors have mixed views on the new pay-for-performance model promoted in the 2010 health care law as a means of controlling health care costs and improving quality" (Kulkarni, 12/7). Check out what else is on the blog.

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Political Cartoon: 'Gator Aid?'

Kaiser Health News provides a fresh take on health policy developments with "Gator Aid?" By Jeff Parker.

Meanwhile, here is today's health policy haiku:


Patient safety and 
crowd control... Such insights can
be found at Sea World.

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

As Clock Ticks Toward Fiscal Deadline, Obama, Boehner Meet At The White House

Action this week is critical if a deal is to be reached this year, The Washington Post reports. Most analysts appear to agree that the contours of such an agreement are clear, but the specifics -- which include raising taxes as well as spending reductions for Medicare and Medicaid -- remain challenging and politically divisive. 

The Washington Post: Time Running Out On 'Fiscal Cliff' Deal
The contours of a deal to avert the year-end fiscal cliff are becoming increasingly clear. But progress has been slow, and time is running out for leaders to seal an agreement and sell it to restless lawmakers who so far have been given little information. … Lawmakers say action this week is vital if (President Barack) Obama and (House Speaker John) Boehner hope to win approval by the end of the year for complex, bipartisan legislation that would raise taxes, push down social-safety-net spending and lift the federal debt limit (Montgomery and Kane, 12/9).

Los Angeles Times: Boehner, Obama Talk 'Fiscal Cliff' At White House
After days of theatrics and threats from both sides, President Obama met privately with House Speaker John A. Boehner at the White House on Sunday afternoon as the two principal negotiators stepped up discussions aimed at crafting an agreement to thwart a looming budget showdown. … Obama and his allies on Capitol Hill increasingly believe they have the stronger hand over congressional Republicans in their effort to push up marginal tax rates for high-income earners. … Boehner, of Ohio, continues to press for deep spending reductions, including cuts to Medicare, Social Security and other widely popular programs, and he has said he is prepared to increase revenue by changing the tax code to lower deductions, not by raising taxes (Mascaro and Hennessey, 12/9).

The Associated Press: Obama, Boehner Discuss 'Fiscal Cliff'
President Barack Obama and House Speaker John Boehner met at the White House to discuss the "fiscal cliff," while rank-and-file Republicans stepped forward with what they called pragmatic ideas to break the stalemate. The Obama-Boehner meeting Sunday was the first between just the two leaders since Election Day (Flaherty, 12/9).

Politico: Fiscal Cliff: Barack Obama, John Boehner Meet At White House
Before the meeting, top aides said there was little progress made over the weekend. But the meeting between Boehner and Obama signals a new stage in the process to resolve tax hikes and spending reductions that take hold at the beginning of 2013 (Sherman and Budoff Brown, 12/9).

The Wall Street Journal: Both Parties Divided Over GOP 'Cliff' Idea
Republican leaders are pushing what looks like a relatively painless method of slowing federal spending, one that alters how the government calculates annual cost-of-living increases for an array of programs. ... In all, budget experts figure a switch to the chain-weighted CPI would reduce the projected deficit by about $200 billion over the next decade. Of that, about $72 billion would come from increased tax revenue. It's not a huge number, but if the new index were approved, Republicans would see that as proof of Democrats' willingness to countenance changes to entitlement programs (McKinnon, 12/9).

Politico: What Medicaid Cuts Might Look Like
In the ongoing battle over the fiscal cliff, Democrats and Republicans have exchanged plenty of words about what they would or wouldn't do to Medicare. The same can't be said about Medicaid. But behind the scenes, they're going to have to work that out to give Republicans enough entitlement savings — because Republicans have been demanding big changes in the low-income health program for years, and the Democrats are nowhere close to ready for the same level of savings (Millman, 12/9).

The Hill: Democrats Warm To Medicare Change That Late Sen. Edward Kennedy Opposed
Democrats in Congress are changing their tune on means testing in Medicare, an idea the late Sen. Edward Kennedy (D-Mass.) resisted for decades. Leading Democratic lawmakers have suggested that raising premiums for wealthy Medicare beneficiaries could be a matter of common ground with Republicans in the ongoing deficit-reduction talks. "I think that is reasonable and certainly consistent with the Democratic message that those who are better off in our country should be willing to pay a little more," Senate Majority Whip Dick Durbin (D-Ill.) said Thursday. The idea of affluence testing is not new — wealthy Medicare recipients already pay higher premiums for doctor visits and prescription drug coverage (Viebeck, 12/8).

Politico: On Entitlements, Republicans Are Ready To Take Any Victory They Can Get
The script for a fiscal cliff deal was always supposed to be simple: Democrats would win on taxes. Republicans would win on entitlements. But what kind of victory can Republicans really hope to win? They’re going to have to lower their sights — by a lot — from the big ideas they pushed in the presidential campaign. Mitt Romney and Paul Ryan wanted to turn Medicare into a competition between private plans. They wanted to scale back Medicaid, and turn it into block grants for states. Nothing like that is remotely likely now. With Obama in the White House for another four years, Republicans are looking for something much smaller, even a down payment on Medicare, that they can still call a victory (Nather, 12/9).

CBS (Video): Bowles Sees "Progress" On "Fiscal Cliff"
On CBS News' "Face the Nation," two deficit reduction experts discussed the stalled talks in Washington over the "fiscal cliff." Despite the logjam and lack of progress between President Obama and House Speaker John Boehner about how to avert end of the year spending cuts and tax hikes that could throw the economy back into recession, former President Clinton chief of staff Erskine Bowles said he is "more encouraged" than he had previously been. … Bowles said movement is apparent because both sides have taken positions that differ from previously hardened stances. He noted Boehner's willingness to increase taxes and the president's openness to cut entitlements. Although Bowles expressed some optimism, he said the president has to go further. He said the president's proposal to cut around $350 billion to Medicare is "not enough." "We simply made promises we can't keep. We've got to face up to it," Bowles said of the health care program for seniors. "We're going to have to do more" (Caldwell, 12/9).

Politico: Corker: Obama's Offer May Be 'Best Route' For GOP
Republicans may need to concede the current tax fight to President Barack Obama, who holds the "upper hand" in that battle, Sen. Bob Corker said Sunday. "There is a growing group of folks looking at this and realizing that we don't have a lot of cards as it relates to the tax issue," the Tennessee Republican told "Fox News Sunday." "I think [that notion] has merit.... I actually am beginning to believe that is the best route for us to take." Corker said ceding to Obama and preserving current tax rates for 98 percent of Americans while allowing rates to rise to Clinton-era levels on the top 2 percent would allow Republicans to pick up the fight over spending and entitlements next year (Gerstein, 12/9).

The Washington Post's The Fact Checker: Lindsey Graham's 'Bankruptcy' Trifecta
In dismissing the administration's offer to resolve the so-called "fiscal cliff," Sen. Graham referred to the "imminent bankruptcy" of Medicare, Medicaid and Social Security. We have warned before that politicians in both parties are guilty of misusing such phrases as "bankruptcy" or "broke" when talking about Medicare. But Graham hits the trifecta here—Medicare, Social Security and Medicaid. We take no position on whether the White House's proposals are adequate but what’s he talking about? (Kessler, 12/10).

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Health Reform

New Taxes, Medicaid Expansion Requests and Health Insurance Portability Make Health Law News

News outlets examine a host of health law issues including new taxes on the rich -- set to soon take effect -- meant to pay for parts of the health law, governors' latest requests on expanding Medicaid, health insurance portability for older workers and dealing with chronic care.

The New York Times: New Taxes To Take Effect To Fund Health Care Law
For more than a year, politicians have been fighting over whether to raise taxes on high-income people. They rarely mention that affluent Americans will soon be hit with new taxes adopted as part of the 2010 health care law. The new levies, which take effect in January, include an increase in the payroll tax on wages and a tax on investment income, including interest, dividends and capital gains. The Obama administration proposed rules to enforce both last week (Pear, 12/8).

The Washington Post: GOP Governors Seek Leeway On Medicaid Expansion
Republican governors are ratcheting up pressure on President Obama to scale back a key provision of his health care law. In a letter to Obama last week, 11 governors asked for a meeting "as soon as possible" to negotiate for greater control over their Medicaid programs. Among other things, the governors want the option of expanding Medicaid -- the state-federal program for the poor and disabled — in a much more modest way than envisioned in the law (Aizenman, 12/8).

The Wall Street Journal: Health Care Law May Free Some Workers To Switch Jobs
The health-care overhaul, whatever its larger merits, might offer some relief for individuals in their 50s and early 60s in the grips of "job lock." That's a term used to describe workers who are unable or reluctant to leave their current jobs for fear they won't be able to find health insurance. Older employees in particular -- who are likelier than younger workers to have health problems and who don't qualify for Medicare until age 65 -- see that uncertainty as a "major barrier" to changing jobs or retiring, says Michael Thompson, New York-based principal of human-resource services at consulting firm PwC (Coombes, 12/10).

California Healthline: Forum Explores Dealing With Chronic Care Under ACA
Chronic health conditions will remain one of the contributing factors to financial and utilization strain on the health care system, but there are a number of steps that can be taken to address them, according to a panel of experts that met recently in San Jose. ... The moderator, physician and health care author Travis Stork, said dealing with chronic conditions may be the most important health care concern of our time. ... Now that health care reform is becoming reality nationally, Stork said, it's time to shift from pilot programs to implementation of the pilots that work (Gorn, 12/10).

The Boston Globe: Will National Health Reform Close Ethnic And Racial Disparities?
One-third of Hispanics and more than 20 percent of African-Americans nationwide lack health insurance. But the law's provisions -- most of which take effect in January 2014 -- will effectively cut by half the number of African-Americans who are uninsured, and significantly improve coverage rates for Hispanics (Weintraub, 12/9).

Additionally, a former Congressional Budget Office director says GOP governors may be inadvertently enabling a "single-payer" system --

The Hill: Holtz-Eakin: GOP Governors Enabling Single-Payer Health Care
Republican governors are going down a slippery slope toward single-payer healthcare by resisting the key feature of President Obama's health care law, according to conservative economist Douglas Holtz-Eakin. Republican governors have taken a hard line against setting up their own exchanges, which conservatives see as the best chance to undermine President Obama's signature health care law. But as Holtz-Eakin noted in the National Review, that choice gives more power to the federal government. "Conservatives must recognize that establishing a state health-insurance exchange is not acquiescing to ObamaCare," Holtz-Eakin wrote. "It is instead one of the best means available to fight it and to ensure that control remains where it belongs -- in the states and with citizens" (Baker, 12/7).

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Capitol Hill Watch

Medical Device Tax Repeal Advocates Feel Momentum

And, in other news from Capitol Hill, lawmakers from the House Energy and Commerce Committee grill compounding pharmacies' trade group.

CQ HealthBeat: Opponents Of Tax On Medical Devices See Hope In Fiscal Cliff Debate
Opponents of the health care law's tax on medical devices say they are making headway in their push to repeal the provision before it takes effect next year. But some also see delaying the implementation of the tax as a way to get around concerns about the cost of eliminating it if they’re unable to fully repeal it before the end of the session. Rep. Erik Paulsen, [R-Minn.,] the sponsor of the House repeal measure, said he thinks there is a real possibility of wrapping repeal into the end-of-the-year budget negotiations (Attias, 12/7).

CQ HealthBeat: Energy And Commerce Leaders Query Compounding Pharmacies' Trade Group
As part of a continuing investigation into a deadly fungal meningitis outbreak, bipartisan leaders of the House Energy and Commerce Committee on Friday asked the trade association that represents compounding pharmacies to explain advice it’s given to members about Food and Drug Administration investigations. Chairman Fred Upton, R-Mich., and ranking Democrat Henry A. Waxman of California wrote to the International Academy of Compounding Pharmacists asking for copies of internal academy communications and communications with members about how to handle FDA requests or inspections (Norman, 12/7).


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Health Care Marketplace

SCOTUS Agrees To Hear 'Pay-For-Delay' Drug Case

The Supreme Court will hear arguments on the legality of drug companies paying their generic-making counterparts to keep generic drugs -- in this case, a testosterone gel -- off the market.

Politico: Supreme Court Takes Up Case On Generic Drugs
The Supreme Court will take up "pay for delay" -- the multibillion-dollar dispute over whether brand-name drug makers should be able to pay generic drug companies for agreeing to delay putting cheaper versions on the market (Norman, 12/10).

Modern Healthcare: Supreme Court Slates Generic Drug 'Pay-For-Delay' Case
The U.S. Supreme Court has agreed to hear arguments in a "pay-for-delay" case that has the Federal Trade Commission accusing generic drugmakers of violating competition laws by agreeing to accept $42 million in annual payments in exchange for not selling generic versions of a more-expensive brand-name testosterone gel. The FTC says the companies -- lead respondent Watson Pharmaceuticals, along with Paddock Laboratories, Par Pharmaceutical Cos. and Abbott Laboratories subsidiary Solvay Pharmaceuticals -- conspired illegally to keep cheaper drugs off the market, to the detriment of consumers of the brand-name drug. The companies, meanwhile, say their actions were legal and immune from FTC scrutiny. However, they did not oppose a hearing before the U.S. Supreme Court, because they said differing interpretations of federal law had led to split legal reasoning in various U.S. circuits on a controversy of national significance (Carlson, 12/8).

Reuters: Supreme Court To Hear "Pay-For-Delay" Drug Case
The Supreme Court agreed on Friday to decide whether brand-name drug companies may pay money to generic drug rivals to keep their lower-priced products off the market, a practice estimated to cost consumers and the government billions of dollars each year. The arrangements, known as "pay-for-delay" or "reverse payments," have for more than a decade vexed antitrust enforcers, including the Federal Trade Commission (FTC), which have been stung until recently by a series of court decisions allowing such practices (Stempel, 12/7).

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Health Care Fraud & Abuse

GAO Takes Hard Look At Anti-Fraud Effort Inefficiencies In Medicare, Medicaid

Politico Pro: GAO: Medicare Wastes Money In Fraud Work
The Medicaid program has government employees and contractors doing some of the exact same work, which is wasting government time and money, according to a new Government Accountability Office report to be released Monday. Medicare, meanwhile, could do more to use data programmed into claims processing systems to stop fraud, GAO said in a separate report. GAO made the recommendations in reports requested by Sens. Tom Carper (D-Del.), Tom Coburn (R-Okla.) and others. The reports come as lawmakers are likely to look to both programs for potential savings in the fiscal cliff negotiations and are part of the constant effort on Capitol Hill to reduce waste in both programs (Haberkorn, 12/10).

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Communication And Checklists May Lead To Fewer Surgical Complications

An article published in the December issue of the Journal of the American College of Surgery found decreases in some postoperative complications when surgical teams were trained in communication and to use a procedure check list.

Medscape: Checklists, Communication May Reduce Surgical Complications
Training surgical teams in communication and using a procedure checklist before, during, and after surgery may significantly decrease 30-day postoperative complications such as surgical site infections and bleeding requiring transfusions, according to a study conducted at 2 Connecticut medical centers. Lindsay A. Bliss, MD, general surgery resident at the University of Connecticut Health Center, Farmington, and colleagues report their results in an article, published in the December issue of the Journal of the American College of Surgery. The investigators compared the outcomes for 3 sets of surgeries: 73 in which the surgical team had participated in communications training and used a surgical checklist, 246 in which the team had not received the training but used a checklist, and 2079 that were drawn from the American College of Surgeons National Surgical Quality Improvement Program database for use as a baseline comparator (Hand, 12/7).

Meanwhile, a news report from the Los Angeles Times details how a heart surgeon caused five patients to contract infections during valve-replacement surgeries -

Los Angeles Times: Surgeon Infected Patients During Heart Procedure, Cedars-Sinai Admits
A heart surgeon at Cedars-Sinai Medical Center unwittingly infected five patients during valve replacement surgeries earlier this year, causing four of the patients to need a second operation. The infections occurred after tiny tears in the latex surgical gloves routinely worn by the doctor allowed bacteria from a skin inflammation on his hand to pass into the patients' hearts, according to the hospital. The patients survived the second operation and are still recovering, hospital officials said (Gorman, 12/8).

Also in the news, a new study finds survival chances increase when patients enter the hospital via the emergency room during slower periods --

Medscape: Crowded EDs Associated With Higher Risk For Inpatient Death
Patients admitted to hospitals via crowded emergency departments (EDs) may be more likely to die in the hospital than similar patients admitted during slow periods, according to a study published online December 5 in the Annals of Emergency Medicine. Findings also suggest that ED crowding is associated with a slight increase in length of stay and a 1 percent cost increase. Benjamin C. Sun, MD, MPP, associate professor of emergency medicine, Oregon Health & Science University, Portland, and colleagues studied the admission records from 995,379 ED visits by adults to 187 California acute-care hospitals in 2007, focusing on periods of ED crowding, distinguished by the need to divert ambulances from the hospital. The data were adjusted for case mix, patient demographics, comorbidities, and primary discharge diagnosis (Laidman, 12/7).

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Coverage & Access

Ex-Con Gets Arrested On Purpose In Order To Get Health Care

The Associated Press/Wall Street Journal: NY Ex-Con Says He Shoplifted To Get Health Care
A 56-year-old ex-convict says he purposely got arrested for shoplifting to get prison health care for his leukemia. Frank Morrocco of Amherst tells The Buffalo News that he stole shoelaces and other items from Wegman's as "an act of desperation" because he can't afford health care. He was released from federal prison a year ago after serving 20 years on drug charges. He was getting cancer treatment as an inmate (12/9).

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Health Information Technology

Many Docs Apply For 'Meaningful Use' Electronic Health Record Payments, But Few Will Pass Muster

Medpage Today: Most Docs Won't Qualify For EHR 'Meaningful Use'
Two-thirds of office-based physicians plan to apply or have already applied for meaningful use incentives for using electronic health records (EHRs), a government survey found. However, only about a quarter have computer systems that support Stage 1 meaningful use objectives -- a prerequisite for receiving the incentives. Physicians must meet all 15 of the Stage 1 core objectives to qualify for meaningful use incentives as of 2012, along with a few other requirements. "Among physicians who had already applied or intended to apply for incentives, 27 percent had EHR systems capable of supporting 13 of the Stage 1 core objectives for meaningful use, which is an overestimate of the percentage meeting the 2012 requirements," according to a report released this week from the CDC's National Center for Health Statistics (Pittman, 12/7).

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State Watch

State Roundup: Texas Medicaid Funding Fight Looms; Minn. Facing Federal Medicaid Scrutiny; Health Care Jobs 'Boom'

A roundup of health policy news from Michigan, Texas, Minnesota, Nebraska, Florida and Massachusetts.

The Associated Press/Beaumont (Texas) Enterprise: Drugs, Fraud, Mental Health Top Legislative Issues
If the Texas Legislature is in session, there must be a fight about Medicaid going on. The health care program for the disabled, the elderly poor and the impoverished raises hackles every two years, mostly because the number in need keeps rising alongside health care costs. ... The 2013 legislative session, however, adds a new wrinkle: President Barack Obama's Affordable Care Act and its provision to dramatically expand Medicaid (Tomlinson, 12/8).

MPR: Federal HHS Probing Minn. Medicaid Program
Another federal agency is looking into whether the state of Minnesota improperly set rates for its Medicaid program. The Office of Inspector General for the Department of Health and Human Services has sent a letter to state officials. ... The letter asks for documents and records to determine how Minnesota set its payment rates for HMOs that administered the Medicaid program [during the Pawlenty administration] from Jan 1, 2008 to Dec. 31, 2009 (Stawicki, 12/7).

(St. Paul) Pioneer Press: Minnesota Human Services Department Target Of Federal Review; Health Insurance Funding At Issue
Questions started swirling at the state Capitol in February about whether Minnesota officials had been manipulating the rate-certification process in Medicaid to wrongly gain excess federal funds. Both the state and federal governments fund the health insurance program. ... In a statement released Friday, Dec. 7, the Department of Human Services said it would cooperate with the review (Snowbeck, 12/7).

The Associated Press: Nebraska Confronting Rural Doctor Shortage
Dr. Michelle Seller starts her mornings with inpatient rounds at the local hospital in Central City, then visits a health clinic. ... Seller is among a declining number of Nebraska doctors who work full-time in rural areas, a key point of debate for Nebraska lawmakers when they address the federal health care law next year (Schulte, 12/9).

Minneapolis Star Tribune: Health Care Creates A New State Jobs Boom
Minnesota's hospitals and clinics are on a hiring spree, and they're not just looking for the usual MDs and RNs. New demand for data analysts and specialists who steer patients through the system has helped make health care the strongest engine driving Minnesota's jobs recovery. That's on top of a growing need for doctors and nurses as baby boomers hit their retirement years (Belz, 12/10).

Medpage Today: States Spend Anti-Smoking $ On Other Things
Only 1.8 percent of the $25.7 billion states will collect from both taxes on cigarettes and the 1998 tobacco settlement -- about $460 million -- will go to tobacco prevention and treatment programs in 2013, according to an annual report from several public health organizations, including the American Heart Association, the American Lung Association, the American Cancer Society, and the Campaign for Tobacco-Free Kids. ... Health care costs relating to tobacco use total about $96 billion annually (Fiore, 12/7).

Kansas Health Institute News: Mental Health Center Braces For Spending Cuts
The head of a community mental health center that serves 20 counties in northwest Kansas said today that his agency will need to significantly cut its budget for children's services because of the anticipated decrease in state tobacco settlement dollars it receives. ... [Walt] Hill said the agency's planned spending cuts were driven by a Kansas Children's Cabinet decision Monday to include programs for mentally ill children and their families on a list of services that Gov. Sam Brownback could consider defunding (Ranney, 12/7).

Detroit Free Press: Bill Would Require Abortion To Be An Optional Rider In Health Exchange
Michigan women who buy their insurance from state health care exchanges would have to buy separate riders to pay for elective abortions under a controversial measure passed by the Michigan Senate on Thursday. Under the national health care overhaul, often called Obamacare, the state health exchanges are to begin operating next year. But the Senate provision would not allow the exchanges to offer elective abortions as part of their core plans (Meyer, 12/7).

Detroit Free Press: 'Moral Objection' Bill Would Allow Health Care Providers To Refuse Service
[The bill] also would allow employers to refuse to pay for services for their employees that "violated the payer's conscience." The state already has a conscientious objection clause for abortion services, but the new law also could give the green light to doctors to refuse to write birth control prescriptions and opens the door to a refusal of service for all sorts of ailments, said state Sen. Roger Kahn, R-Saginaw (Gray and Erb, 12/7).

The Miami Herald: VA, Jewish System Reach Deal To Keep Vets At Home
The Veterans and Miami Jewish health systems announced a partnership Friday to lower government costs. ... The arrangement by the Miami Veterans Healthcare System is intended to keep aging vets out of expensive nursing homes and keep them living at home with the support of a coordinated care network provided by Miami Jewish Health Systems. The cost difference: Instead of $80,000 a year for a nursing home, the Jewish system will provide care that will keep the vets living at home for not more than $30,000 a year (Dorschner, 12/7).

The Boston Globe: Little Scrutiny As Drug Compounder Expanded
In February 2003, 11 federal and state health regulators gathered around a conference table in Boston, joined by three colleagues patched in on telemonitors from Washington, to decide the fate of New England Compounding ­Center. ... Massachusetts ultimately would take no significant ­action against New England Compounding, the company that a decade later is blamed for a national meningitis outbreak (Kowalczyk and Wallack, 12/9).

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Editorials and Opinions

Viewpoints: Girding For A 'Beloved' Medicare Fight; Two Views About Health Law's Employer Mandate; Doctors Fear 'SGR Cliff'

The Wall Street Journal: The Republican Tax Panic
(I)t's a shame that Republicans are playing into Mr. Obama's hands, negotiating in public among themselves, ... Tennessee Senator Bob Corker made the case for this strategic retreat on "Fox News Sunday," arguing that if Republicans raise tax rates as Mr. Obama wants, "the focus then shifts to entitlements and maybe it puts us in a place where we actually can do something that really saves the nation." But what is the evidence in the last four years, or even since the election, that Mr. Obama won't pocket that victory and then refuse to offer any but token changes on entitlements? (12/9).

Los Angeles Times: Medicare, The Beloved Budget Buster
While President Obama spars with congressional Republicans over whether to raise taxes, advocates for the elderly have been girding for a fight that promises to be at least as intense: what to do about the rising cost of Medicare, the federal health insurance program for the elderly and disabled. ... In fact, it is the single biggest factor in the deficit over the long run. And with multiple forces driving up costs, there's no easy way to solve the budget problems it presents (12/9).

The New York Times: How Medicare Is Misrepresented
[Doctors] generally believe they can manage their patients’ care properly without outside interference into their clinical decisions. ... This can explain why critics of traditional Medicare delicately but nonsensically prefer to decry it as being fee for service rather than as free-choice-of-providers insurance or unmanaged-care insurance (Uwe E. Reinhardt, 12/7).

Los Angeles Times: Lift The Debt Ceiling, Permanently
To anyone with little or no faith in Washington's willingness to tame the growth in Medicare, the debt ceiling might seem like a badly needed fail-safe against runaway entitlements. That would be true if refusing to lift the debt ceiling caused less damage than letting benefit programs continue to grow on autopilot. And as significant a problem as Medicare (and to a lesser extent, Medicaid) may prove to be eventually, defaulting on U.S. debts would inflict a much larger and more immediate toll on the economy (Jon Healey, 12/8).

The Wall Street Journal: Obama's Historic Budget Opportunity 
Unless the president pushes to slow the growth of spending, he will fail to strike a deal, undermine U.S. growth prospects and ultimately erode America's safety-net programs. ... A deal should also match Medicare's eligibility age with Social Security's, so these programs retain their principal purpose of assisting retirees, instead of slipping into general subsidies (Robert B. Zoellick, 12/9). 

USA Today: 'Employer Mandate' Attacks Leave Sour Taste 
Let's cool the coffee before it scalds. Yes, the employer mandate will add to some companies' costs of doing business, and those costs no doubt will be passed along to customers. Papa John's says the price of a pizza could increase 11 cents to 14 cents per pie. But is that such a terrible price to pay to ensure that some of the nation's hardest working, lowest paid employees will get health coverage they've never had? (12/9). 

USA Today: Opposing View: Businesses Face Wrenching Choice 
[M]oney that must go toward increased benefits or non-tax deductible penalties will crowd out wage increases and business investment. The realities that smaller employers, in particular, face under this mandate are both economical and emotional, with the consequences of their choices impacting both their employees' well-being and their ability to stay in business (Dan Danner, 12/9).

Roll Call: Doctors: We Gave At The Office, And Then Some
At least once a year, I am taken to a precipice known as the SGR cliff, which mandates that reimbursement rates are reduced by significant levels unless Congress steps in with its "doc fix" and staves off the cut. This year is no different. The SGR rate will be cut by nearly 27 percent on Jan. 1 unless Congress acts. ... For more and more physicians, these multiple and repeated cliffs give us no choice but to limit the number of Medicare patients we see. Like it or not, this is rationing of care (Dr. Alex Valadka, 12/9).

The Medicare NewsGroup: Medicare Doctor Reimbursement Battle Heats Up In Earnest
Doctors have been arguing for years that their payments from Medicare have been too low, particularly in high-cost urban areas. Even the "geographic adjustments" that Medicare has come up with ... have come under fire from the AMA as being outdated. Medicare must tread carefully on this issue, however, because if it pegs reimbursement rates too low in rural areas, it runs a greater risk of losing doctors where they are in short supply (John Wasik, 10/7).

Health Policy Solutions (a Colo. news service): Informed Patients Essential For Better Health Care
You would think that in areas of the country where high-tech services are provided to more people, that health would be better than in areas where they are provided less frequently. Surprisingly, that is not the case. In fact, areas that use more high-end medical technology often have worse health outcomes. How can this be? (Dr. David Downs, 12/8).

The Philadelphia Inquirer: Electronic Records Can Streamline Patient Care
The patient says he has been suffering from more asthma attacks, so a natural question is: Has he been faithfully taking his daily medicine? In another era, physicians would have to rely solely on the patient or the parent for that kind of information. Increasingly, these days they also can see on a computer screen if the pharmacy has provided a refill (Tom Avril, 12/10).

WBUR: Cognoscenti: Do Screening Mammograms Do More Harm Than Good? 
Although experts agree that diagnostic mammograms are beneficial (cases where there is a breast lump or other symptoms), there is much controversy about screening mammograms, which are performed on women with no signs of cancer. Mammograms detect breast cancer, although many people believe mistakenly that they prevent breast cancer. We now know that the mortality benefits remain quite small (Judy Norsigian, 12/10).

Detroit Free Press: In The Making In Lansing, A Disaster For Women's Health Care Choices
In the pile of poorly planned, badly executed ideas the Legislature seems determined to make law during its lame-duck session are two with the potential for devastating consequences for Michigan women: One bill would allow physicians and other health care providers to refuse to provide services to patients when there's a "moral" or "conscientious" objection, and allow employers to refuse to pay for services on the same grounds; another three-bill package would require women seeking insurance through Michigan’s soon-to-exist health care exchange — part of federal health care reform — to purchase an optional abortion insurance rider to have such services covered (12/7).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

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