Daily Health Policy Report

Tuesday, December 11, 2012

Last updated: Tue, Dec 11

KHN Original Reporting & Guest Opinion

Health Reform

Fiscal Cliff

Coverage & Access

Public Health & Education


State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

HHS Tells States It Will Not Fund Partial Medicaid Expansion

Kaiser Health News staff writers Phil Galewitz and Mary Agnes Carey report: "The Obama administration answered a key question from governors on Monday with a clear 'no': States may not expand Medicaid only part of the way and still get the additional federal funding provided in the Affordable Care Act. The decision, announced by Health and Human Services Secretary Kathleen Sebelius in a letter sent to governors, is significant because after the Supreme Court ruling in June made the Medicaid expansion optional, several states have floated the idea of a less generous expansion than called for in the federal health law" (Galewitz and Carey, 12/10). Read the story.

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Aging Doctors Face Greater Scrutiny

Reporting for Kaiser Health News, in collaboration with The Washington Post, Sandra G. Boodman writes: "These real-life examples, provided by an expert who evaluates impaired physicians, exemplify an emotionally charged issue that is attracting the attention of patient safety experts and hospital administrators: how to ensure that older doctors are competent to treat patients" (Boodman, 12/10). Read the story.

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Insuring Your Health: When A Plan Overpays For A Service, Is A Patient Responsible For A Refund?

Kaiser Health News consumer columnist Michelle Andrews writes: "Experts say that overpayments can occur for a variety of reasons. An insurer may simply make a mistake and pay a provider more than the contracted amount for a service, for example. Or a provider may be paid for a service that's not covered under the patient's insurance plan. Whatever the reason, overpayments can create headaches for providers and patients alike" (Andrews, 12/10). Read the column.

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Capsules: A Day Of Stark State Differences On Health Exchanges; Eye Experts: States Should Make Vision Care An Exchange Benefit

Now on Kaiser Health News' blog, Colorado Public Radio's Eric Whitney and News Service of Florida's Jim Saunders, working in collaboration with KHN and NPR, offered updates regarding their respective state's action on health exchanges: "Friday is the deadline for states to decide if they want to build and operate their own exchanges or have the federal government do it. The online insurance marketplaces are supposed to start signing people up in October 2013 for policies that begin in January 2014. Here are two dispatches from reporters in the field" (12/11).  

Also on the blog, Alvin Tran writes that authors of a new study are pressing for the inclusion of adult vision benefits in the insurance coverage sold on the exchanges: "Athough the federal health law mandates vision coverage for children, the same requirement does not apply to adults. States themselves can require certain insurance benefits. And researchers from the Arnold School of Public Health at the University of South Carolina suggest strong reasons for doing so" (Tran, 12/11). Check out what else is on the blog.

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Political Cartoon: 'Fiscal Cliff Funnies'

Kaiser Health News provides a fresh take on health policy developments with 'Fiscal Cliff Funnies' by Jen Sorensen.

Meanwhile, here is today's health policy haiku:


Worthy of Dickens,
Pundits opine, plots thicken:
"A Cliff-mas Carol?" 
-Michael Reinemer

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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Health Reform

HHS To States: Partial Medicaid Expansion Won't Get Full Federal Funding

On Monday, the Department of Health and Human Services said it was all or nothing on the health care law's expansion of Medicaid eligibility, disappointing some Republican governors who were considering smaller growth in the state-federal program for the poor and elderly.

Kaiser Health News: HHS Tells States It Will Not Fund Partial Medicaid Expansion
The Obama administration answered a key question from governors on Monday with a clear 'no': States may not expand Medicaid only part of the way and still get the additional federal funding provided in the Affordable Care Act. The decision, announced by Health and Human Services Secretary Kathleen Sebelius in a letter sent to governors, is significant because after the Supreme Court ruling in June made the Medicaid expansion optional, several states have floated the idea of a less generous expansion than called for in the federal health law" (Galewitz and Carey, 12/10).

Los Angeles Times: States Pressed To Guarantee Medicaid Expansion
The Obama administration stepped up pressure on states Monday to guarantee insurance for all their low-income residents in 2014 under the new healthcare law, warning governors that the federal government would not pick up the total cost of partially expanding coverage. … But Sebelius indicated that governors who do not open their Medicaid programs to all eligible low-income residents would forfeit some of the federal aid promised by the Affordable Care Act (Levey, 12/11).

The Washington Post: Partial Medicaid Expansions Won't Get Full Federal Funding, Administration Tells States
The Obama administration told states Monday that they couldn't do a partial expansion of Medicaid under the health-care law and still receive full federal funding, disappointing many Republican governors on one of the most important questions surrounding the health-care law. In recent weeks, these governors, along with other state officials, had shown increasing interest in the idea of a partial expansion of the state-federal program for the poor and disabled. In ruling that option out, the administration has raised the stakes for states debating whether to participate in a part of the law that is crucial to its success (Aizenman, 12/10).

NPR: Feds Say 'No' To Partial Medicaid Expansion
After several months of consideration, the Obama Administration delivered its decision Monday, as part of a series of questions and answers for states about Medicaid expansions and setting up health care exchanges (Rovner, 12/10).

The Associated Press/Washington Post: Feds Say States Must Follow Health Care Law To Get Full Medicaid Funding For Low-Income People
The ruling affects a federal-state program that covers nearly 60 million low-income and severely disabled people, caught in a tug-of-war between Republican governors and the Democratic administration. President Barack Obama's health care law expanded Medicaid to cover people up to 138 percent of the federal poverty line, or about $15,400 for an individual. The change mainly affects low-income adults without children at home, as well as low-income parents who can't get coverage under current Medicaid rules (12/10).

The Wall Street Journal: Feds Nix Partial Medicaid Expansion
Around half of the 30 million people expected to gain coverage from the law as it was passed were to gain it through the growth of Medicaid. … This summer, the Supreme Court's decision on the health overhaul's constitutionality effectively gave states the chance to choose whether to expand eligibility criteria for the program. Many Republican governors, and some Democratic ones, had indicated they were worried they wouldn't be able to meet their share of the costs of the full expansion. But several of those states had suggested they might be open to enrolling some residents whose incomes put them below the federal poverty level if they could exclude residents who had incomes just above the level. … On Monday, federal health officials ruled out that option and said they were confident governors would still decide to participate in the expansion as it was set out in the law (Radnofsky, 12/10).

Politico Pro: Reaction To Medicaid Expansion Policy Splits
Supporters of the massive Medicaid expansion under health reform cheered HHS's Monday announcement that states have to do all or nothing — partial expansion isn't an option. But critics said the Republican governors may dig in more, seeing HHS offering a dagger, not an olive branch. "Rather than try to engage Republican governors, they decided to ramp up political pressure from provider groups and everyone else and make their lives miserable," said Michael Ramlet, director of health policy at the American Action Forum. "The Obama administration's refusal to grant states more flexibility on Medicaid is as disheartening as it is short-sighted," the new Republican Governors Association Chairman Bobby Jindal of Louisiana said in a statement (Norman and Cheney, 12/10).

The Associated Press: Branstad: High Medicaid Costs Complicate Expansion
Gov. Terry Branstad said Iowa's state budget is already being squeezed by health care costs, even before a federally mandated expansion of the state's program takes effect next year as part of the 2010 health care act signed by President Barack Obama. But if Branstad and other Republican governors hoped to exempt their states from that expansion, they also received that answer on Monday (12/10).

KQED California Report: Feds To States On Medicaid: Expand Fully Or No New Funding
The Obama Administration handed down a key rule Monday on its health care overhaul having to do with Medicaid, or Medi-Cal in California. States must expand to the federally mandated 138 percent of poverty in order to receive matching funds for those newly eligible for the program. Because the Supreme Court ruling in June had struck down the requirement that states participate or lose existing match funds, some states thought there might be flexibility in the expansion. But the answer to that question is a clear "no" as Secretary of Health and Human Services Kathleen Sebelius explained in a letter to governors. In a briefing last week, California's Health and Human Services Secretary Diana Dooley indicated she was waiting for guidance from the feds about the Medicaid expansion and might not expand to the full 138 percent limit (Aliferis, 12/10).

The Arizona Republic: Arizona AHCCCS Funding Could Stagnate
States will not receive more-generous funding to expand their Medicaid programs unless they agree to the fullest extent intended under federal health-care reform, the U.S. health secretary warned Monday. Partial expansion of Medicaid, as Gov. Jan Brewer and other governors have been considering, would bring no additional federal benefit beyond the traditional share already paid to states, Health and Human Services Secretary Kathleen Sebelius announced in a letter to governors (Reinhart, 12/10).

Medpage Today: No $ For Partial Medicaid Expansion
States must cover all adults with incomes up to 133 percent of the federal poverty level in order to have the federal government pay for their expanded Medicaid program, the government said Monday. While states can choose to set their coverage limits at less than 133 percent, if they do so, the federal government won't pay for 100 percent of the cost for those newly eligible enrollees as stipulated by the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services (CMS) announced. "Consistent with the law, there is not an option for enhanced match for a partial or phased-in Medicaid expansion," acting CMS administrator Marilyn Tavenner told reporters on a call (Pittman, 12/10).

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Six States Get An Early Greenlight From HHS On Health Exchanges

The Obama administration also gave conditional approval on Monday to six states -- all led by Democratic governors -- that were the first to meet the health law's rules for setting up health insurance marketplaces.

The New York Times: Obama Approves Health Insurance Marketplace In 6 States
The Obama administration gave conditional approval on Monday to health insurance marketplaces being set up by six states led by Democratic governors eager to carry out President Obama's health care overhaul. … At the same time, the administration rejected pleas from other states that want to carry out a partial expansion of Medicaid, to cover fewer people than the president and Congress originally intended. Some states want to expand Medicaid to cover childless adults with incomes up to the poverty level, $19,090 for a family of three (Pear, 12/10).

Bloomberg: First Six State Health Insurance Markets Approved By U.S.
Six U.S. states became the first to meet Affordable Care Act rules for the creation of marketplaces by 2014 where local residents can buy medical insurance. Colorado, Connecticut, Massachusetts, Maryland, Oregon and Washington, all states with Democratic governors, have made enough progress building their health-insurance exchanges to receive conditional approval to begin enrolling members in October 2013, the U.S. Department of Health and Human Services said yesterday in a statement. The six represent less than half of the 14 states that have told the U.S. they will set up the online exchanges (Wayne, 12/11).

The Hill: HHS Approves 6 State-Run Health Care Exchanges
The states approved Monday were the first six to apply, officials said. "This is not a reflection on whether any other state will be approved," said Gary Cohen, the director of HHS's Center for Consumer Information and Insurance Oversight, which is handling the bulk of the implementation effort for President Obama's signature healthcare law (Baker, 12/11).

The Associated Press/Washington Post: Maryland Gets Conditional Approval To Operate Health Insurance Exchange
Maryland has received conditional approval by the federal government to operate a state-based health insurance exchange in 2014, Lt. Gov. Anthony Brown announced Monday (12/10).

Baltimore Sun: Feds Approve MD Health Exchanges
Maryland and five other states received conditional federal approval Monday to operate a state exchange, or marketplace where individuals can buy insurance under health care reform. The approval by the Centers for Medicare & Medicaid Services means that Maryland is on track under federal guidelines to operate an exchange during open enrollment next October. Most aspects of health reform will be implemented in 2014. ... Maryland already has received $157 million in federal grants for its exchange. Maryland was one of the early supporters of health care reform and began building an exchange even as the law's constitutionality was challenged in the courts and its future faced uncertainty because of last month's election (Walker, 12/10).

HHS also provided more details about the operation and oversight of these exchanges -

CQ HealthBeat: HHS: States With Federal Exchanges Will Retain Oversight Of Their Insurance Markets
New details emerged Monday on how federal exchanges will operate in states that decline to establish their own exchanges, accompanied by a pledge from the Obama administration that it will strive to allow states to continue their traditional oversight of insurance plans. The question of control enters a sensitive political territory, since states that likely will be home to federal exchanges generally also have Republican governors who have been the most resistant to implementing the health care law (Norman, 12/11).

In other news regarding health exchanges -

The Associated Press: Haslam Says No To State Health Insurance Exchange
Gov. Bill Haslam announced Monday that Tennessee will not create a state-run health insurance exchange, but the Republican governor said he remains undecided about whether to expand Medicaid. Haslam said in a speech to the Nashville Rotary Club that he was unsettled by the lack of guidelines from the federal government about the insurance marketplaces that are required under President Barack Obama's health care overhaul (Schelzig, 12/10).

Health Policy Solutions (a Colo. news service): Annual Tab For Colorado Health Exchange About $25 Million
Colorado’s new health exchange will cost an estimated $22 million to $26 million a year starting in 2015, spurring managers to consider advertising, taxes on insurance companies or fees charged to employers and consumers using the exchange to pay for it. The U.S. Department of Health and Human Services formally approved Colorado’s exchange on Monday, making the state one of the first six in the country to be approved to open for enrollment next October. Other states that will use a federally-run health exchange will pay fees of about 3.5 percent on the premiums that each person pays per month. Colorado’s managers aren’t certain they’ll charge user fees because they don’t want health insurance costs to go up when people are already struggling to pay for insurance. Managers here pledged that they will keep costs lower than those the federal exchange will charge. Health exchange board members have not yet voted on how to pay for Colorado’s exchange and some funding proposals would require legislative approval (Kerwin McCrimmon, 12/10).

(St. Paul) Pioneer Press: Grassley Says UnitedHealth Acquisition Poses Possible Health Exchange Monopoly
Congressional Republicans are questioning whether a recent acquisition by Minnetonka-based UnitedHealth Group raises concerns about conflicts of interest in the development of health insurance exchanges. In a letter issued Monday, Dec. 10, Sen. Charles Grassley, R-Iowa, asks a series of questions related to a UnitedHealth acquisition of Quality Software Services Inc., or QSSI, a Maryland company that has a federal contract to build a database hub for health exchanges…."This contract creates a situation whereby the exchange's ultimate designer, QSSI, is in a position to tailor the system to favor the interests of its parent company, UnitedHealth Group, and further maintain a monopoly over information that is unavailable to competitors," Grassley wrote in a letter also signed by U.S. Rep. Fred Upton, R-Michigan (Snowbeck, 12/10).

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Employers Complain About Health Law's Costly 'Sleeper Fee'

The Associated Press reports on a new, $63-per-person charge, which will be levied for three years beginning in 2014 to "cushion" the cost of covering people with pre-existing conditions and to stabilize the insurance market. Large employers say it works out to tens of millions in added costs which are likely to be passed onto workers.

The Associated Press/Washington Post: Employers Grumble About 'Sleeper' Fee To Stabilize Insurance Market In Obama's Health Overhaul
Your medical plan is facing an unexpected expense, so you probably are, too. It's a new, $63-per-head fee to cushion the cost of covering people with pre-existing conditions under President Barack Obama's health care overhaul. The charge, buried in a recent regulation, works out to tens of millions of dollars for the largest companies, employers say. Most of that is likely to be passed on to workers (12/10).

Also in the news, 17 Senate Democrats are pushing to delay the implementation of the health law's medical-device tax -

The Wall Street Journal's Washington Wire: Senate Democrats Seek Delay In Medical-Device Tax
A group of 17 Democratic U.S. senators and senators-elect have signed a letter urging for a delay in implementing a tax on the medical-device industry that is scheduled to go into effect Jan. 1, said two people familiar with the matter (Walker, 12/10).

Minneapolis Star Tribune: Klobuchar And Franken Fight Planned Tax On Medical Devices
Minnesota's two senators sought Monday to delay a tax on medical devices that was expected to add $28 billion over the next decade to help pay for health care reform. Democratic Senators Amy Klobuchar and Al Franken pointed to thousands of high-paying jobs that device companies support in Minnesota, headquarters to such giant devicemakers as Medtronic and St. Jude Medical. The industry has painted the tax as a job killer that would hurt innovation (Spencer, 12/10).

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Fiscal Cliff

In 'Fiscal Cliff' Talks, Medicare And Medicaid Savings Ideas Draw Scrutiny

The Wall Street Journal asks when cuts to these programs will start affecting beneficiaries and causing access issues. Other savings ideas face a burden of proof. Also, The Hill reports that the White House is cooling to the idea of $100 billion in Medicaid cuts floated earlier this year. In the background, news outlets offer reports about progress or lack thereof in averting the looming cliff.

The Wall Street Journal: Health Providers Watch Cliff Talks
Deficit-reduction negotiations have revived a long-standing question: How much can the government cut what it pays Medicare and Medicaid providers without directly affecting beneficiaries? (Radnofsky, 12/10).

Politico Pro: Dems' Challenge: Proving Their Medicare Ideas Save Money
It's getting harder and harder for members of Congress to sell deficit-cutting ideas without proof that they’ll work — and that’s a big problem for Democrats who believe they can fix Medicare without making deep cuts in the program. Democrats want to focus on making Medicare more efficient. But it’s extremely difficult for the Congressional Budget Office, Congress's official scorekeeper, to predict exactly how much money innovations like bundled payments and accountable care organizations will end up saving. It’s a lot easier for the CBO to score the long list of ideas touted by Republicans, who want to cut costs by doing things like raising the eligibility age or requiring wealthy seniors to pay more (Cunningham, 12/11).

The Hill: White House Drops Support For Major Medicaid Cut
The Obama administration backed away Monday from roughly $100 billion in Medicaid savings it had proposed during deficit-reduction talks earlier this year. The move comes as liberals have pressed the White House to take Medicaid off the table in negotiations surrounding the "fiscal cliff" — and it will make any agreement on entitlement spending about $100 billion harder to reach. The Health and Human Services Department (HHS) said the Obama administration no longer supports a plan to combine the various calculations used to determine the federal government's share of Medicaid spending (Baker, 12/11).

Los Angeles Times: A Prayer As 'Fiscal Cliff' Talks Continue
Lawmakers returned to Washington as President Obama and House Speaker John A. Boehner continued negotiations to swerve around the so-called fiscal cliff of tax hikes and spending cuts in the new year. The president and congressional Republicans remain far apart, but the silence coming from the White House and the speaker's office after a meeting Sunday between the two principal negotiators was seen by many observers as a breakthrough of sorts. … Obama wants to extend existing tax rates for all but those at the top-2% income level, but Republicans are pushing to continue lower tax rates for all, including couples earning more than $250,000 a year, or singles bringing in $200,000 a year. Republicans also want spending reductions in popular safety-net programs, including Medicare, Medicaid and Social Security, in exchange for any new tax revenue (Mascaro, 12/10).

The Wall Street Journal: Obama-GOP Cliff Talks Take Positive Turn
Both sides still face sizable differences before any agreement might be reached by the end of the year, and talks could well falter again over such controversial issues as taxes and Medicare before any deal is reached. The people familiar with the matter say talks have taken a marked shift in recent days as staff and leaders have consulted, becoming more "serious" (Paletta and Lee, 12/11).

The Associated Press/Washington Post: Cliff Talks: No Progress Evident As Each Side Demands Specifics From The Other; Deadline Ahead
A year-end deadline approaching, quiet negotiations to avoid an economy-rattling "fiscal cliff" yielded no tangible signs of progress on Monday as Republicans pressed President Barack Obama to volunteer spending cuts he will support while the White House insisted the GOP endorse higher tax rates on upper incomes (12/10).

Los Angeles Times: Obama And Boehner Seem To Get Along, Politics Is The Problem
After weeks of private phone calls and public posturing, the Ohio Republican quietly ducked into the White House on Sunday for his first one-on-one meeting with the president since mid-2011. The goal this time: forging a deal to avoid $500 billion in tax increases and spending cuts set to take effect in early January (Hennessey and Mason, 12/10).

The New York Times: In Talks, House Majority Weighs Loyalty To Voters
As their leaders inch toward agreeing to higher tax rates, dozens of House Republicans find themselves caught between the will of a larger American public that favors higher taxes on the rich and the wishes of constituents who re-elected them overwhelmingly to oppose the Obama agenda at every turn (Weisman, 12/10).

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Coverage & Access

Low-Cost Concierge Care, Social Media Among Changes In Practice Of Medicine

News outlets examine trends such as doctors' use of social media to explore medical information and the growth of relatively low-cost concierge medicine, where patients may pay $50 a month for unlimited doctors' visits and calls.

Medscape: Oncologist, Primary Care Physicians Don't Tweet
One in 4 physicians uses social media either daily or multiple times a day to scan or explore medical information, and 14 percent contribute daily, according to a survey of 186 oncologists and 299 primary care physicians. However, the surveyed physicians selectively use social media. For example, only 33 of the 485 total respondents (6.8 percent) use Twitter, which was dwarfed by the 252 (52 percent) who use online physician-only communities such as Sermo, Ozmosis, medical society membership sites, and Medscape Connect (Mulcahy, 12/10).

WBUR: New Trend In Health Insurance: Low-Cost Concierge Medicine
A recent survey of physicians by the consulting firm Accenture found that one in three independent doctors is thinking about no longer accepting health insurance and going into what’s been called concierge care, where they cap the number of patients they see, and patients  -- who pay them as much as $30,000 a year -- get to see the doctor whenever they want. But Bloomberg Businessweek reports that a new trend is emerging: low-cost concierge care, such as Atlas MD, a family practice in Wichita, Kansas, which charges most of its adult patients just $50 dollars a month for unlimited visits, free medical tests, house calls … you even get the doctor’s cell phone number (WBUR, 12/10).

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Public Health & Education

Examining Americans' Health: Longer, But Sicker, Lives; Childhood Obesity Drops

A new report finds Americans may be living longer thanks to medical advances, but they may also be sicker. Meanwhile, childhood obesity may be dropping in several cities around the nation.

USA Today: Health Rankings: USA Is Living Longer, But Sicker
Americans are living longer, with fewer deaths from heart disease and cancer, but more chronic illnesses, an annual snapshot of the USA's health shows. The 2012 America's Health Rankings highlight troubling levels of obesity, diabetes, high blood pressure and sedentary behavior. Medical advances are allowing more people to live with those conditions (Healy, 12/11).

The New York Times: Obesity In Young Is Seen As Falling In Several Cities
The trend has emerged in big cities like New York and Los Angeles, as well as smaller places like Anchorage, Alaska, and Kearney, Neb. The state of Mississippi has also registered a drop, but only among white students. … The drops are small, just 5 percent here in Philadelphia and 3 percent in Los Angeles. But experts say they are significant because they offer the first indication that the obesity epidemic, one of the nation's most intractable health problems, may actually be reversing course (Tavernise, 12/10).

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Medicaid Contractors, Government Employees Doing The Same Work, GAO Says

Politico: GAO Hits Medicaid On Waste
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 released Monday. Medicare, meanwhile, could better use data programmed into claims processing systems to stop fraud, GAO said in a separate report (Haberkorn, 12/11).

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State Watch

State Roundup: Report Finds Racial Gap in Colo. Dental Coverage; Health Cuts Part Of Conn. Budget Plan

News outlets report on a variety of state health news developments.

The Associated Press: NH Hospital Hepatitis Problems, Fixes Detailed
Though Exeter Hospital has fixed problems discovered after a hepatitis C outbreak last spring, federal officials say the hospital initially failed to conduct an adequate investigation. The Centers for Medicare and Medicaid Services said last week it no longer plans to terminate the hospital's Medicare funding now that multiple issues raised by inspectors have been addressed (Ramer, 12/10).

The Denver Post: Huge Colorado Racial Gap In Dental Coverage As More Lose Access
The number of Coloradans without dental insurance jumped by 17 percent — 300,000 people — over two years and widened a troubling ethnic gap, with more than half of Latinos reporting no coverage, according to a broad study by the Colorado Trust. Those using dental care in a given year also fell, even among those who had insurance, because of high co-pays and a lack of dental providers willing to give low-cost care, the study showed (Booth, 12/10).

Health Policy Solutions (a Colo. news service): Access To Dental Care Declining In Colorado
The crisis in access to dental health care in Colorado is growing more severe even as the effort by the state Department of Health and Environment this year continues to highlight improved oral care as one of its 10 "winnable battles." A new analysis released Monday by The Colorado Trust found that the number of Coloradans without dental insurance grew 17 percent between 2009 and 2011, and that even people with dental insurance failed to receive care due to cost or a lack of available dental providers. "Coloradans need to speak up for the care they need to stay healthy, including oral health," said Ned Calonge, MD, who is president and CEO of The Colorado Trust, which funds the biannual surveys (Carman, 12/10).

CT Mirror: Malloy Defends His Plan To Collect More Revenue From Businesses
Gov. Dannel P. Malloy defended his plan Monday to seek an extra $22 million in revenue from businesses and power plants to help close the current budget deficit, arguing this doesn't break his pledge not to raise taxes. ... Though details were limited, the "road map" -- as referred to by the administration -- called for $220 million in spending cuts and $22.6 million in new revenue. … Malloy also acknowledged he could face a tough road with his fellow Democrats in the House and Senate majorities. The largest single-reduction proposed Friday involves $122 million aimed at the Department of Social Services, which administers a wide array of health care and other support services for the poor, aged and disabled, most of which are partially supported with federal aid. That proposed $122 million cut is expected to save the state just $63.5 million since the reduction would trigger a $58 million loss in federal assistance (Phaneuf, 12/10).

MPR: Program To Shift People From MinnesotaCare To Vouchers Off To A Slow Start
The Healthy Minnesota Contribution Program was supposed to shift 4,200 people from the MinnesotaCare program to a voucher system. But the program itself is having a hard time getting off the ground. Judie Nyholm has not had health insurance since July, when the 61-year-old Brooklyn Center resident was dropped from MinnesotaCare. "One month came up, and I had $52 a month too much for one month, so they dropped me and told me that I could go on the Healthy Minnesota Contribution Program," Nyholm said. She is the subject of an experiment being discussed on both the state and federal level. Instead of relying on state-subsidized, government-based health insurance, Nyholm became eligible to receive a state voucher of $395 monthly to buy health insurance on the private market (Scheck, 12/10).

Modern Healthcare: Maine System, Hospital Exploring Deal
Eastern Maine Healthcare Systems said it signed a nonbinding letter of intent to acquire Mercy Hospital, a 168-bed hospital in Portland, Maine, which was previously in talks to be purchased by Steward Health Care System. Eastern Maine Healthcare Systems, based in Brewer, is one of the largest systems in Maine and owns seven hospitals. Mercy Hospital is owned by Catholic Health East (Lee, 12/10).

The Boston Globe: Letter To Lawmakers: In Light Of Recent Scandals, Invest More In Public Health
As the Legislature begins planning for next year's budget, public health leaders are calling on the state to "reverse the trend of disinvestment" in programs meant to protect the public from infectious diseases, environmental contaminants, and medical errors. The Department of Public Health could see a small budget cut as Governor Deval Patrick looks to close a $540 million shortfall this year (Conaboy, 12/10).

HealthyCal: Program Cuts Health Costs By Housing The Homeless
Sixteen months after a coalition of San Diego nonprofit groups took the county's most costly homeless people – highest consumers of ambulance rides, emergency room and police resources – and put them into permanent housing, the cost savings are adding up. Early calculations suggest that costs are down by nearly $1 million (Graham, 12/10).

Kansas Health Institute News: KanCare Workforce Shift Hampering Local Agencies
Workforce shortages prompted by the overhaul of the Kansas Medicaid program are hampering operations at some social service agencies in Johnson County and elsewhere in the state, according to executives at the organizations. Human Services Director Debbie Collins said since September, her Johnson County agency had lost three of its nine case managers that assist frail elderly Medicaid clients through the Area Agency on Aging. Collins said the workers all left for similar positions at UnitedHealthcare, one of the three insurance companies hired by the state as part of the new Medicaid program, which the state has dubbed KanCare (Sherry, 12/10).

Kansas Health Institute News: Regents Take A Pass For Now On Mid-Level Dental Practitioner Issue
The Kansas Board of Regents will not consider a proposal from Fort Hays State University to create a new training program for mid-level dental practitioners until the Kansas Legislature decides whether it wants to authorize licensing for the new category of dental worker. Andy Tompkins, chief executive of the state's higher education governing board, today said the panel's governance committee had decided to wait and see what the Kansas Legislature would do before taking up the issue. A coalition of consumer and health advocates have been pushing for the new type of dental technician in each of the past two legislative sessions (Shields, 12/10).

California Healthline: Time Running Out To Opt Back In To Adult Day Program
About 4,400 frail and elderly Californians who qualified for Community Based Adult Services opted out of the managed care program to remain in traditional fee-for-service care. Less than three weeks remain for them to change their minds. On Dec. 31, the state Easy-Way-Back program will close, and those "opt-outs" who declined Medi-Cal managed care will officially forfeit their CBAS benefits, according to Norman Williams, director of public affairs for the Department of Health Care Services. The opt-outs -- or the providers who are advising them to opt out -- may be operating on false assumptions, Williams said in a written statement. "[They] may have a misunderstanding that entering Medi-Cal managed care would negatively affect their Medicare options, including which providers they may visit," Williams wrote (Gorn, 12/11).

California Healthline: Northern California Addresses Safety-Net Challenges
The California Health Policy Forum predicts that once the ACA is fully implemented, about four million previously uninsured Californians could obtain coverage. But it won't be everybody. The Public Policy Institute of California estimates that four million Californians still will be uninsured after 2014, and many of them will rely on safety-net providers for care. A report by the institute underscores the new role of safety-net providers -- treating both those not eligible for coverage under reform and low-income, newly insured Californians (Edlin, 12/10).

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Editorials and Opinions

Viewpoints: Sen. Portman's Rx For Deficit Talks; Gerson Says Obama Needs To Give Boehner Political Cover To Make A Deal

The Wall Street Journal: A Truly Balanced Approach To The Deficit
Washington needs to pursue structural reforms in the country's important but unsustainable entitlement programs and in an inefficient, outdated tax code. By doing so, lawmakers can responsibly avoid the immediate cliff while addressing the long-term fiscal crisis and spurring job creation (Sen. Rob Portman, R-Ohio, 12/10). 

The Washington Post: Obama Must Learn To Negotiate
There is a political problem at the heart of the budget debate. If Democrats get what they want — tax-rate increases on the wealthy — they can crow about it in public. If Republicans get what they want — structural reductions in entitlement spending — they are unable to crow. Their motivation is fiscal and ideological, not political. Despite Rep. Paul Ryan's best efforts, entitlement reform is not yet a popular, bottom-up political movement. It won't happen unless the president leads — providing cover for the political class to move together (Michael Gerson, 12/10). 

Politico Pro: Medicare Reform Should Focus On Quality, Sustainability
Sen. Sheldon Whitehouse’s recent op-ed presents an argument that deserves more attention in Washington: Health care budget savings can be achieved without making drastic, arbitrary cuts to Medicare. While the senator does not provide specifics, he accurately points out that simply cutting Medicare reimbursements will not address the larger issue of slowing the growth in spending. Instead, we must consider comprehensive reform measures. With the election over, policy makers need to broaden the debate about Medicare reform and consider ideas that both reduce costs and make structural changes that improve health outcomes for beneficiaries. Successful reform requires policymakers to embrace initiatives that help improve the overall quality of care but also ensure the sustainability of the Medicare program that millions of Americans rely on (Douglas Holtz-Eakin and Kenneth Thorpe, 12/10).

The Boston Globe: Cutting Health Care Costs: A Test Of Nerves
A new Medicare-cost-cutting effort that will pay neurologists less for some procedures has the whole profession up in arms, but that doesn't mean the new policy is wrong. Similar disagreements are likely to occur with some frequency over the next few years, as the Affordable Care Act goes forward and Medicare officials — necessarily — focus more and more on curbing health care costs (12/10).

Kansas City Star: Expand Medicaid, Save Lives
Officials in Missouri and Kansas and other states are busy crunching numbers to determine whether expanding Medicaid limits to comply with the Affordable Care Act makes sense. So far the answer is yes. The expenses states would incur by making Medicaid available to adults with incomes up to 133 percent of the poverty level would be offset by savings elsewhere in the budgets and by a hefty economic lift as millions of federal dollars pour in to build clinics, purchase equipment and hire medical workers. A study released earlier this year provides another compelling reason for states to bring more people under their Medicaid umbrellas: It would keep people alive (12/10).

Health Policy Solutions (a Colo. news service): Colorado Must Expand Access To Dental Care
It is becoming more difficult for Coloradans to get oral health care. Last Thursday, legislators who attended the Hot Issues in Health Care conference in Colorado Springs, sponsored by the Colorado Health Institute, got a sneak preview of new Colorado Trust report on oral health. Based on findings from the 2011 Colorado Health Access Survey (CHAS), the report, "A Growing Problem: Oral Health Coverage, Access and Usage in Colorado," said there are now more than 2 million Coloradans without dental insurance -- an increase of 17 percent since the 2009 baseline survey. The survey also found that having dental insurance makes a significant difference in whether Coloradans seek dental care, which means that fewer Coloradans are getting the dental care they need (Sara Schmitt, 12/10).

Medpage Today: The Tragedy That Is Medical Economics
Today, I come back to where I started 11 weeks ago – namely the tragedy of medical economics in this country. And I would apply that word "tragedy" in at least two ways. The first tragedy is that we are headed for fiscal disaster in this country because of health care costs. We now spend twice as much per person on health care as the average per person cost of all developed countries. ... But lost in this economic tragedy is the even more important human tragedy. Because healthcare costs are soaring (I believe last year's somewhat lower costs were primarily due to the recession) 40 to 50 million Americans have no health insurance largely because they or their employer can't afford it (Dr. Timothy Johnson, 12/10).

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Stephanie Stapleton

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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.