Daily Health Policy Report

Thursday, December 13, 2012

Last updated: Thu, Dec 13

KHN Original Reporting & Guest Opinion

Fiscal Cliff

Health Reform

Capitol Hill Watch


State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Medicare Silver Bullets: What's The Best Way To Control Costs

Kaiser Health News asked a range of health policy experts the following question: If you could make only one change to Medicare to control costs, what would it be and why? (12/12). Read edited excerpts of their answers.

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Political Cartoon: 'Advent-tageous'


Kaiser Health News provides a fresh take on health policy developments with "Advent-tageous" by R.J. Matson.

Meanwhile, here is today's health policy haiku:


What's on your wish list?
A fiscal deal? An exchange?
It is the season...


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

'Fiscal Cliff' Deal: What Will The Compromise Look Like?

Right now, news reports indicate that neither side shows much inclination toward making concessions, but a new Wall Street Journal/NBC poll indicates that Americans want lawmakers and the White House to reach an agreement. Analysts predict a softening of positions as the deadline for automatic tax increases and spending cuts approaches.

The Associated Press/Washington Post: 'Fiscal Cliff' Vexing Official Washington As Both Sides Show Little Inclination To Compromise
Republicans still aren't budging on Obama's demands for higher tax rates on upper bracket earners, despite the president's convincing election victory and opinion polls showing support for the idea. Democrats in turn are now resisting steps, such as raising the eligibility age for Medicare, that they were willing to consider just a year and a half ago, when Obama’s chief Republican adversary, House Speaker John Boehner, was in a better tactical position (12/13).

Los Angeles Times: Boehner: Obama's 'Fiscal Cliff' Deal 'Mainly Tax Hikes'
Republican leaders kicked off Wednesday with a fierce critique of President Obama's handling of "fiscal cliff" negotiations, part of the political posturing on both sides that has characterized efforts to avoid across-the-board tax hikes and spending cuts before a January deadline (Little, 12/12).

The Wall Street Journal: Democrats Confident They Have 'Cliff' Leverage
The Democrats' buoyancy isn't limitless, and there are signs it will soften as talks enter a more intense phase. With the end of the year approaching, more Democrats are saying they recognize they will have to agree to safety-net cuts to get a deal, and some on the party's left worry that is what will happen (Bendavid, 12/12).

The New York Times: News Analysis: Income Malaise Of Middle Class Complicates Democrats' Stance In Talks
Many Democrats have derided the expiring tax cuts as irresponsible since President George W. Bush signed them a decade ago. Yet the party is united in pushing to make the vast majority of them permanent, even though President Obama could ensure their expiration at year’s end with a simple veto. That decision reflects concern over the wage and income trends of the last decade, when pay stagnated for middle-class families, net worth declined and economic mobility eroded. Democrats who generally would prefer more tax revenue to help pay the growing cost of Medicare and other programs are instead negotiating with Republicans to find a combination of spending cuts and targeted tax increases for higher incomes (Lowry, 12/12).

The Wall Street Journal's Washington Wire: Poll Finds Big Support For Compromise Deficit Deal
A large majority of Americans of all political persuasions says Congress should craft a compromise to reduce the federal budget deficit, even if that means making cuts to Social Security and Medicare and increasing some tax rates, a new Wall Street Journal/NBC News poll finds (King, 12/12).

Medpage Today: Docs A Powerful Voice In Nation’s Fiscal Future
Physicians must decide whether they will support changes in healthcare policy that will help reduce government spending but may also hit their pocketbooks, according to one analyst. They can let lawmakers enact policies to cut healthcare costs, or stand in the way in order to save physician incomes even as care continues to be rationed informally, Arnold Milstein, MD, of the Clinical Excellence Research Center at Stanford University, wrote online in a perspective piece in the New England Journal of Medicine (Pittman, 12/12).

Kaiser Health News: Medicare Silver Bullets: What's The Best Way To Control Costs
KHN asked a range of health policy experts the following question: If you could make only one change to Medicare to control costs, what would it be and why? (12/12). Read edited excerpts of their answers.

Politico: Getting Past Grudges To Fiscal Cliff Deal
That said, the Jan. 1 tax increase is already baked in the cake. And while Washington is paralyzed by the big stare down, other crises are also piling up in these last weeks before New Year’s. Milk prices will spike after Jan. 1 without a farm bill deal. Medicare payments to physicians will fall, affecting the elderly. And there is the very real threat of across-the-board cuts hitting the Pentagon and domestic appropriations. In each case, bipartisan deals seem possible while moving toward House Republicans on key points — small building blocks but a potential path to progress. For example, Speaker John Boehner has proposed $200 billion in 10-year savings from adjusting the cost-of-living index for entitlement benefits and federal tax brackets. That $200 billion would come down once adjustments are made to protect low-income Supplemental Security Income recipients. But Obama could accept this change and use the savings to give the elderly a permanent solution to the Medicare physician payment crisis (Rogers, 12/12).

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Liberal Dems Line Up Against Raising Medicare's Eligibility Age

Proposals to raise the eligibility age continue to get traction in the fiscal negotiations between the White House and Congress. But liberal Democrats oppose it and express concern that President Barack Obama has not ruled it out.

The Wall Street Journal: Spending-Cut Proposals Drawing Democratic Flak
One big question in Washington's budget talks is whether Republicans will make more concessions on taxes. This week, the counterpoint has started to come into play: What will Democrats swallow on spending cuts? The prospect of cuts to Medicare and other entitlement programs is making many Democrats anxious. Of particular concern is Republicans' call for increasing the eligibility age for Medicare from 65 to 67, an idea that could split Democrats (Hook and Lee, 12/12).

The Hill: Dems Line Up Behind Pelosi Against Changing Medicare Eligibility Age
House Democrats are lining up behind Minority Leader Nancy Pelosi (D-Calif.) against raising Medicare's eligibility age as part of a year-end tax-and-spending package. Pelosi rejected raising Medicare's eligibility age in an op-ed published Tuesday in USA Today, then doubled down on that position Wednesday. "We want what happens to be fair," she said in an interview on CBS's "This Morning" program. "And one of the things that we object to is raising the Medicare age" (Lillis, 12/12).

The Hill: Report: Liberal Senators United Against Raising Medicare Age
The Senate's liberal wing is upset that President Obama has declined to rule out raising Medicare's eligibility age as part of a deficit-reduction deal, according to a report. Sen. Jeff Merkley (D-Ore.) told the Washington Post that in a recent private caucus meeting there was an "overwhelming sense" that the raising the age would be "absolutely unacceptable" to progressive lawmakers (Viebeck, 12/12).

Politico Pro: Conrad: No Need To Raise Medicare Eligibility Age
Outgoing Senate Budget Committee Chairman Kent Conrad is advocating for a compromise of $500 billion savings in a health care deal, and doesn’t think the Medicare eligibility age needs to be raised to do it. In his farewell speech on the Senate floor Wednesday, the North Dakota Democrat — who has spent much of his career warning about the need for entitlement reform — insisted lawmakers could get all the money they need just by cutting waste in health care spending (Smith, 12/12).

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Health Reform

States Face Friday Deadline On Health Exchanges

States must decide by Dec. 14 if they are going to operate their own health care marketplaces, or if they will defer to the federal government. They have until mid-February to decide whether to partner with the federal government or let the feds do it all. Meanwhile, polls in Missouri and Tennessee show public support for state-run marketplaces.

Marketplace: States Must Make Health Care Decisions
It's decision time again in health care. No, not for you. States are making this one. Namely, whether they will operate their own health care exchanges or let the federal government do it. They've got til Friday to decide. Exchanges, you'll remember, are the online sites where small businesses and people who aren't insured at work, will be able to shop for health insurance starting in 2014. States? The fed? You may be wondering what difference it makes anyway. Well, here’s one difference, says Georgetown professor Sabrina Corlette: power. "A state that's going to run its own exchange has an opportunity to really change the entire health care landscape if it wants to do that," she says. So for example, says Corlette, say a state has a big obesity problem. The state can make sureall the insurance plans on the exchange cover programs aimed at reducing obesity (Gorenstein, 12/12).

Politico Pro: Pennsylvania Governor: No-State-Based Exchange
Add the Keystone State’s Republican governor to the list of those who have accepted federal funding to plan for a state-run insurance exchange, only to shut the door on it at the last minute. Pennsylvania Gov. Tom Corbett announced Wednesday that he will instead defer to the feds to establish an exchange for his state, arguing that the Obama administration hadn’t provided enough details about how much authority the state would have. "With regulations still to be finalized and with more forthcoming, too many unknowns remain for us to plan accordingly," he wrote in a letter to HHS Secretary Kathleen Sebelius (Cheney, 12/12).

CQ HealthBeat: Idaho GOP Governor Says Yes To State Exchange, Nevada To Expand Medicaid
Idaho's Republican governor is a staunch opponent of the health care law but despite that C.L. "Butch" Otter says he will ask his legislature to approve a state-based health benefits exchange. Otter made clear in a statement that his decision doesn’t mean he’s had a change of heart about the health overhaul law. "This is not a battle of my choosing, but no one has fought harder against the mandates and overreaching federal authority of the Affordable Care Act," Otter said. (Bunis, 12/12).

MPR: Does Minnesota Need A Basic Health Plan?
When Minnesota lawmakers return to the Capitol in 2013, several health care-related matters await them, as the state moves to implement the federal Affordable Care Act by its 2014 deadline. The fate of MinnesotaCare - - the state-run health care program for low-income individuals and families -- is one of those issues. Under the Affordable Care Act, enrollees in MinnesotaCare will be among those eligible for tax credits that will help them purchase private insurance through online marketplaces called health care exchanges. The very creation of those exchanges is also a matter lawmakers will have to tackle next year. The debate also includes a question about people enrolled in MinnesotaCare who might not be able to afford private insurance, even with the tax credits. The state has the option under the ACA of creating what's called a Basic Health Plan. But many details about such a plan, including its cost, are still unknown (Weber, 12/13).

St. Louis Beacon: Most Missourians Favor Health Insurance Exchange, Expanding Medicaid, Poll Says
More than half of Missourians favor Medicaid expansion and embrace the principles behind health insurance exchanges, according to a new poll, financed by the Missouri Foundation for Health and completed in October. It surveyed more than 1,400 Missourians and had a margin of error of plus or minus 2.6 percent. "Missouri voters want action to ensure access to affordable health care and believe state government should take a leading role in this endeavor -- even if this requires a tax increase," according to the introduction to the poll (Joiner, 12/12).

The Associated Press/San Francisco Chronicle: Vandy Poll Shows Support For State-Run Exchange
A majority of Tennesseans — including nearly three-quarters of those identifying themselves as Republicans — prefer a state-run health insurance exchange over one run by the federal government, according to a poll released by Vanderbilt University on Wednesday. The poll of 829 registered voters showed 53 percent favor the state-run marketplace, while 33 percent prefer the federal approach. Seventy-two percent of Republicans surveyed said they support the state-based approach to the exchanges required under the federal health care law, compared with 31 percent of Democrats and 59 percent of independents (Schelzig, 12/12).

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GOP Govs Seek White House Meeting To Discuss Medicaid Expansion

The governors hope to discuss ways to make the health law's Medicaid expansion -- as well as the challenge of setting up health exchanges -- more affordable.

The Associated Press/Washington Post: Fla. Gov. Scott, 10 Other Governors, Seek Meeting With Obama To Discuss New Health Care Law
Eleven Republican governors, including Florida's Rick Scott, Louisiana's Bobby Jindal and Arizona's Jan Brewer want to meet with President Barack Obama to discuss the federal health overhaul, including ways to make expanding the Medicaid rolls and setting up online health exchanges more affordable for states with tight budgets (12/12).

Meanwhile, officials in Wisconsin and Nevada were talking about the impact and implementation of the law.

Milwaukee Journal Sentinel: Federal Health Care Law Will Cost State, Secretary Says
The state health secretary will tell Congress on Thursday that Wisconsin will pay more for its health care programs for the needy under the looming federal health care law but doesn't have hard financial figures yet on his claim. Dennis Smith, the point man on health care for Gov. Scott Walker's administration, said Wednesday that he will argue that the federal law commonly called Obamacare will cost Wisconsin taxpayers more than it will save through an expansion of joint state and federal Medicaid health programs for the poor. That's because, according to Smith, it won't provide enough additional reimbursement to the state to cover the full number of people who will sign up for programs such as BadgerCare Plus in 2014 (Stein and Marley, 12/12).

The Associated Press: State Senate GOP Leaders Back Sandoval On Medicaid
State Senate Republican leaders lined up Wednesday to back Gov. Brian Sandoval's decision to expand Medicaid eligibility for Nevada's poorest residents, while Democrats and advocates for the needy expressed cautious support until more details emerge. Sandoval became the first Republican governor to accept expanding Medicaid eligibility as called for under the federal Patient Protection and Affordable Care Act (Chereb, 12/12).

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Aetna CEO Predicts Some 'Premium Rate Shock' Because Of Health Law Provisions

In news about the health law, Bloomberg reports that Aetna's Mark Bertolini says premiums for individuals and small businesses could as much as double in 2014, and Modern Healthcare examines what's ahead for the accountable care organizations next year.

Bloomberg: Aetna CEO Sees Obama Health Law Doubling Some Premiums
Health insurance premiums may as much as double for some small businesses and individual buyers in the U.S. when the Affordable Care Act's major provisions start in 2014, Aetna Inc.'s chief executive officer said. While subsidies in the law will shield some people, other consumers who make too much for assistance are in for "premium rate shock," Mark Bertolini, who runs the third-biggest U.S. health-insurance company, told analysts yesterday at a conference in New York. The prospect has spurred discussion of having Congress delay or phase in parts of the law, he said (Nussbaum, 12/13).

Modern Healthcare: More ACOs Coming In New Year
The number of accountable care organizations operating under Medicare's shared-savings program is expected to grow in the coming weeks. The initiative began roughly eight months ago with 27 accountable care organizations and expanded in July to include another 89. Created under the Patient Protection and Affordable Care Act, the program offers hospitals and doctors financial incentives that are tied to quality goals and targets for cost control. A CMS spokeswoman declined to say how many organizations applied for the upcoming round of ACOs or how many would be named, but confirmed the start date of Jan. 1. The Center for Medicare and Medicaid Innovation, also created by the health care reform law, also launched 32 accountable care organizations nearly a year ago (Evans, 12/12).

And in another look ahead --

California Healthline: Five Things To Watch In Health Care In 2013
In health care, the mix of ever-shifting technologies, laws and competitive landscape means that many patients' lives (and industry dollars) rest on whether providers and regulators can make the right bets. And some years, the industry's direction is relatively easy to predict. … What will be significant in 2013 is a bit murkier, though several major developments await in the months ahead. A slew of ACA-related provisions are slated to take effect, with new taxes and programs like the Bundled Payments for Care Improvement Initiative slated to come online. Both parties continue to discuss entitlement reforms, which could include raising the Medicare eligibility age. ... Here are five broader trends that industry observers are watching (Diamond, 12/12).

Meanwhile, the United Nations favors universal coverage --

The Washington Post: Obamacare Everywhere: U.N. Votes In Favor Of Universal Health Coverage
The United Nations General Assembly voted in favor of a draft resolution supporting universal health coverage, signaling the importance of universal health care to the international development agenda (Khazan, 12/12).

The Hill: U.S. Backs United Nations Measure In Favor Of Universal Health Coverage
The United States has backed a United Nations draft resolution favoring universal health care coverage. The nonbinding measure calls on U.N. member states to ensure citizens' access to health insurance, and was approved by the U.N. General Assembly on Wednesday. Supporters say the draft resolution paves the way for the post-2015 development agenda to include universal health coverage. Health insurance for all promotes "sustained, inclusive and equitable growth, social cohesion and well-being of the population," the U.N. said (Viebeck, 12/12).

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Capitol Hill Watch

In Shadow Of The 'Cliff,' Other Capitol Hill Health Care Activity Goes On

On Capitol Hill, various members and committees are writing letters to the administration or proposing legislation.

CQ HealthBeat: House Small Business Chairman Pushes Back On Essential Benefits Rule
Small businesses are concerned about the costs of the health care law’s essential health benefits provisions as more information emerges about how they will be implemented, according to a letter the chairman of the House Committee on Small Business will send Thursday to the Obama administration. ... said that in some cases, state benchmark plans may not cover all the essential benefits. “Virtually all small businesses will be forced to supplement state-selected policies that will not include coverage for mental health, substance abuse, pediatric dental and vision, habilitative care and additional prescription drugs,” wrote [Republican Sam Graves of Missouri] (Norman, 12/12).

CQ HealthBeat: Bill To Lift Ban On Asthma Inhalers Rejected By House
The House defeated a measure Thursday that would allow for the sale of existing stockpiles of a banned over-the-counter emergency asthma inhaler. The bill, sponsored by Texas Republican Michael C. Burgess, was rejected 229-182. ... In 2008, the Food and Drug Administration barred the sale of the inhalers after Dec. 31, 2011, because they contain chlorofluorocarbons (CFCs), a chemical believed to deplete the ozone layer (Phenicie, 12/12).

WBUR: Warren Named To Senate Banking, Health, Aging Committees
Sen.-elect Elizabeth Warren will once more be taking on Wall Street. On Wednesday the Democratic Steering Committee approved Warren’s assignment to the Senate Banking Committee. The assignments are subject to caucus and full Senate approval. ... Warren was also named to the Committee on Health, Education, Labor and Pensions (HELP), and the Aging Committee (12/12).

The Hill: Warren, Baldwin To Join HELP Panel
Incoming Sens. Elizabeth Warren (D-Mass.) and Tammy Baldwin (D-Wis.) were both given spots on the Health, Education, Labor and Pensions (HELP) Committee, along with the Special Committee on Aging. The new Senate Finance Committee, meanwhile, will include returning Sens. Sherrod Brown (D-Ohio) and Michael Bennet (D-Colo.). The announcements came after the Senate's Democratic Steering Committee approved new rosters Wednesday (Viebeck, 12/12).

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Question For Physicians, Politicians: Is 'Doc Fix' Part Of Capitol Hill Negotiations?

Medical providers are hoping that part of the fiscal cliff negotiations includes adjusting the sustainable growth rate (SGR) formula for Medicare.

Politico Pro: Hill Has No Backup Plan On Doc Fix—Yet
Lawmakers are betting the “doc fix” will be part of a potential fiscal cliff bargain — but if that doesn’t happen, they admit there’s currently no Plan B. They say they’re confident that if President Barack Obama and House Speaker John Boehner reach a deal before the end of the year, it will certainly include another patch to the Sustainable Growth Rate. ... Rep. Fred Upton (R-Mich.), chairman of the House Energy and Commerce Committee, ... insisted there’s still enough time to figure it out (Cunningham, 12/12).

CQ HealthBeat: Physicians Push For New Payment System
Doctors will be lobbying in full force on Capitol Hill on Thursday in hopes of convincing lawmakers to block the nearly 27 percent Medicare cut set to take effect in a couple of weeks. The American Medical Association, American Academy of Family Physicians, American College of Physicians, American College of Surgeons and the American Osteopathic Association will not only ask lawmakers to stop the cut scheduled for Jan. 1 but also will ask them to repeal the current payment structure known as the sustainable growth rate formula (Adams, 12/12).

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Study Examines Medicare Out-Of-Pocket Expenses In The Last 5 Years Of Life

CNN Money: Cutting The High Cost Of End-Of-Life Care
Should your 82-year-old dad, who has been declining after a stroke, get hip surgery after a fall? Would your 43-year-old sister, fighting late-stage cancer, benefit from an experimental drug that could have serious side effects? These are wrenching decisions. And while no one wants to think about money at such times, they are also expensive ones -- for families and for the country. One out of every four Medicare dollars, more than $125 billion, is spent on services for the 5% of beneficiaries in their last year of life. Yet even with Medicare or private insurance, you're likely to face a big bill: A recent Mount Sinai School of Medicine study found that out-of-pocket expenses for Medicare recipients during the five years before their death averaged about $39,000 for individuals, $51,000 for couples, and up to $66,000 for people with long-term illnesses like Alzheimer's (Wang, 12/12).

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State Watch

Sides Wage Fights Over New Or Proposed Abortion Laws In Wis., Mich.

Wisconsin Planned Parenthood is challenging a state law in court that could expose doctors who give medically induced abortions to criminal charges. In the meantime, Michigan bills limiting abortion move closer to becoming law.

The Associated Press/(St. Paul) Pioneer Press: Wisconsin Planned Parenthood Sues Over Abortion Medication
Planned Parenthood of Wisconsin has filed a legal challenge to the state law that subjects doctors who perform medication-induced abortions to possible criminal charges. Planned Parenthood stopped offering the medication abortions when the law took effect in April. The organization continues to offer surgical abortions at its clinics in Madison, Appleton and Milwaukee (12/12).

Detroit Free Press: Bills Limiting Abortion Options Step Closer To Becoming Law In Michigan
Two sweeping bills aimed at limiting abortion options moved closer to Gov. Rick Snyder's desk Wednesday, adding to two others already awaiting his signature. From a chaotic Lansing, where protests over right-to-work this week had overshadowed abortion concerns, Ed Rivet, spokesman for Michigan Right to Life, was thrilled. "Those three issues were our top issues: conscience, insurance, and regulation and reform," he said, referring to the issues addressed in the bills. "That we're doing them all simultaneously is pretty remarkable. ... This is a bit of rewards for 25 years of work." One bill passed the Senate 27-10 and calls for more stringent licensing of abortion clinics; the other passed out of the House Insurance Committee into the full House and would allow health care providers to refuse service based on moral objections, religious reasons or matters of conscience (Gray and Erb, 12/13).

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State Leaders Brace To Make Mental Health Program Changes

Officials and lawmakers in Wisconsin and North Carolina struggle to reform their mental health programs over delivering care and budgeting.

Milwaukee Journal Sentinel: County Panel Backs Timetable For Mental Health Complex Reforms
After a tense exchange, a Milwaukee County Board panel Wednesday narrowly backed requiring the county's Behavioral Health Division to produce a report with specific benchmarks for downsizing the troubled Mental Health Complex. The push for concrete goals and timelines is aimed at ending delays on shifting patients to community care, which has been repeatedly recommended over the past two years, said Supervisor Joe Sanfelippo. "Nobody's ever held people's feet to the fire; that's how we got to the point where we're at today," Sanfelippo said (Schultze, 12/12).

North Carolina Health News: Group Home Residents Remain In Limbo Over Personal Care Services
The clock is ticking until a Jan. 1 deadline when thousands with mental health problems are scheduled to lose the funding that helps them stay in their small group homes. But during legislative committee meetings Monday and Tuesday, lawmakers didn’t address the funding issue hanging over the state’s group homes for people with mental health and developmental disabilities. And no word came out of Governor Bev Perdue’s office about resolving the issue either, despite a call from House speaker Thom Tillis (R-Charlotte) for the governor to convene a special session of the legislature to fix the problem (Hoban, 12/12).

In the meantime, mental health care at a juvenile detention center in Illinois is scrutinized --

The Associated Press: Report: Mental Health Care At Ill. Center Lacking
Medical care for severe mental illness at a Kewanee juvenile detention center is so inadequate, the state should find another place for residents needing care "to prevent the violation of their constitutional right to treatment," a report released Thursday says. Only eight of 17 mental health positions were filled at the Illinois Youth Center-Kewanee, the state's designated facility for delinquent young people with the worst mental disturbances, when the John Howard Association visited in September (O’Connor, 12/13).

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State Roundup: Mass. A Template For Controlling Health Care Costs?

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

Los Angeles Times: A Shift In How Health Care Is Paid For
This simple shift in how health care is paid for -- long seen as key to taming costs -- has been occurring in pockets of the country. But nowhere is it happening more systematically than in Massachusetts, the state that blazed a trail in 2006 by guaranteeing its residents health insurance. Now Massachusetts, a model for President Obama's 2010 national health care law, may offer another template for national leaders looking to control health spending (Levey, 12/12).

The Associated Press: Fewer Than Expected Use Minn. Health Care Vouchers
A plan to shift thousands of Minnesota residents from a state-subsidized health care coverage program to vouchers for private insurance isn't getting the traction that officials planned on. About 1,200 of the 4,200 people who lost their MinnesotaCare coverage are getting the vouchers, which is well below what the state's projections (12/12).

Los Angeles Times: Blue Shield Of California Seeks Rate Hikes Up To 20%
Health insurer Blue Shield of California wants to raise rates as much as 20 percent for some individual policyholders, prompting calls for the nonprofit to use some of its record-high reserve of $3.9 billion to hold down premiums (Terhune, 12/13).

The New York Times: Nursing Homes Told To Reinstate Workers
A federal judge in Hartford has ordered a Connecticut nursing home chain to reinstate nearly 600 workers who have been on strike since July 3, and to rescind the pension and health care cuts it had imposed (Greenhouse, 12/12).

Modern Healthcare: Ga. Hospitals Team Up Seeking Quality Gains, Lower Costs
Nine Georgia hospitals are working together as part of a statewide collaborative that will compare surgical outcomes and ultimately attempt to reduce health care costs. The initiative follows similar efforts in Tennessee and Michigan with some early evidence suggesting that these groups can be successful in saving hospitals money. Similar groups are also working on a national level, such as a multihospital collaborative that was formed in 2010 with the Dartmouth Institute for Health Policy and Clinical Practice. The Georgia collaborative—which will grow to 14 hospitals next year—will be led by the state chapter of the American College of Surgeons. The ACS unveiled the program today at its Surgical Health Care Quality Forum Georgia, an event that is part of a series focused on improving quality of care (Kutscher, 12/12).

CT Mirror: Part Show Biz, This New Effort Will Promote The State's Health Care Industry
The reason we're here, Robert Patricelli told the room full of health care industry leaders, is "to beat Nashville at its own game." He wasn't talking about country music. The home of the Grand Ole Opry has emerged in recent years as a major hub of the health care industry, home to more than 250 health care companies -- including national hospital chains -- that employ more than 100,000 people in the area. Nashville now describes itself as "the Silicon Valley of health care." Learning that, said Patricelli, the chairman and CEO of Women's Health USA, he and other Connecticut business leaders "got a serious case of cluster envy." They learned that Nashville's health-care sector had grown in part because of a health care council that had been boosting the industry, providing networking opportunities, mentoring and support. And so, they decided to copy it. The result: The Connecticut Health Council, which launched Wednesday to support and promote the industry (Becker, 12/12).

California Healthline: State Plans Retroactive Payment Rate Hikes
The good news for primary care physicians is the federal program to raise Medicaid reimbursement rates starts Jan. 1. The bad news is Medi-Cal providers in California may have to wait several months to retroactively receive the higher payment. … The first phase of the Healthy Families transition to Medi-Cal also starts on Jan. 1, with roughly 415,000 California children making the switch. The promised higher primary care rate payment for Medicaid was one of the factors that could help ensure a smoother transition by helping to address access concerns (Gorn, 12/13).

Minneapolis Star Tribune: Mayo Puts Brakes On Its New Project At Megamall
Mayo Clinic said Wednesday it will not be part of the Mall of America's expansion scheduled to open next fall. Spokesman Bryan Anderson said the Rochester-based hospital system "is evaluating new ways to evolve our long-term presence" at the Bloomington megamall…. The economic downturn, implementation of the federal Affordable Care Act, an aging population and rising costs of care were among the factors driving the decision to slow capital growth plans and to assess hiring, Anderson said (Crosby and Moore, 12/12).

Minneapolis Star Tribune: Home Aides Seek Right To Join One Of Minn.'s Biggest Unions
One of the state's largest unions is seeking a change in the law that would allow it to bargain on behalf of thousands of people who provide home care to elderly or disabled Minnesotans, including their own family members. DFL Gov. Mark Dayton and incoming DFL House Speaker Paul Thissen say they are open to the idea of allowing an estimated 15,000-20,000 people the chance to join the Service Employees International Union. The move would put Minnesota's new DFL-run government in the position of helping strengthen the SEIU at a time when Republican-dominated governments in Michigan, Indiana and Wisconsin have been limiting union influence with right-to-work laws or public-employee bargaining limits (Ragsdale, 12/12).

Minnesota Post: Gov. Dayton's Mid-Term Checklist Continues With Health Achievements
Gov. Mark Dayton says that improvements have been made in state health care policies in his first two years in office. ... The governor's office says the goal is to improve health in the state, and by "increasing access to high quality, affordable health insurance and promoting strong community health programs, we can improve our quality of life and help lower the cost of health care for all Minnesotans." Things accomplished so far: Expanding Health Coverage for Children and Adults. Provided coverage for 86,000 low-income Minnesotans and 16,000 children. Providing Quality, Affordable Coverage. Secured $70 million in federal funds to design a new online marketplace for health insurance that will help 1.2 million Minnesotans save $1 billion on health insurance (Kimball, 12/12).

The Miami Herald: Florida Vows To Stick Fewer Kids In Nursing Homes
Florida's top healthcare administrator is vowing to keep as many medically fragile children as possible at home with their parents — and to improve the lives of those who remain in nursing homes — amid an outcry over hundreds of children living in institutions designed for frail elders. Liz Dudek, who heads the state Agency for Health Care Administration, outlined a series of new policies on Wednesday to help the parents of severely disabled children care for their kids at home. The new policies also are contained in a memo written Tuesday by Justin Senior, AHCA's deputy secretary for Medicaid, the insurance program for needy and disabled people (Miller, 12/12).

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Weekend Reading

Longer Looks: The Struggles To Reopen N.Y. Hospitals

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

Los Angeles Times: Reckless Prescribing Of Narcotics Endangers Patients, Eludes Regulators
Dr. Carlos Estiandan was up to no good, and the medical board of California was on to him. He prescribed powerful painkillers to addicts who had no medical need for them, conducted sham examinations and appeared to be a key supplier for drug dealers, according to court records. He wrote more prescriptions than the entire staffs of some hospitals and took in more than $1 million a year. ... By the time the medical board stopped Estiandan from prescribing, more than four years after it began investigating, eight of his patients had died of overdoses or related causes, according to coroners' records. It was not an isolated case of futility by California's medical regulators. The board has repeatedly failed to protect patients from reckless prescribing by doctors, a Los Angeles Times investigation found (Lisa Girion and Scott Glover, 12/9).

The New York World: Emergency At The Emergency Room
The sign at the entrance to Beth Israel Medical Center on First Avenue at 16th Street screams "EMERGENCY ROOM," but five hours into her wait to be seen for sharp pain in her ribs, it didn’t feel that way to Yamira Velazquez. Her regular hospital, Bellevue Hospital Center, shut down after Hurricane Sandy ripped through the northeast. So did NYU Langone Medical Center next door. Bellevue won't reopen its emergency room until at least February, and NYU has not yet announced a date. And so, like thousands of others seeking immediate medical care, she ended up in the emergency room at Beth Israel, the last standing hospital for two and a half miles in any direction. ... Before it closed, psychiatric patients and arrested criminals went to Bellevue. Now, they're showing up at Beth Israel (Curtis Skinner, 12/6).

Modern Healthcare: Recovery Mode
As superstorm Sandy made landfall, the water that surged toward Long Beach (N.Y.) Medical Center knocked through bricked-over windows and punched holes through walls, easily pouring over a 3-foot-high concrete barrier along the hospital's northern wall built 20 years earlier to keep out floodwaters from an adjacent channel. Until late October, the 142-bed hospital had withstood decades of hurricanes and nor'easters, largely without flooding. ... Now, as hospitals severely damaged by the storm race to rebuild and reopen their inpatient services, hospital executives are drafting plans to better defend against future forceful storms as experts convened by state and city officials work to devise recommendations in coming months that could force hospitals to meet new standards for storms (Melanie Evans, 12/8).

The New York Times: A Tense Compromise On Defining Disorders
This month, the American Psychiatric Association announced that its board of trustees had approved the fifth edition of the association’s influential diagnostic manual — the so-called bible of mental disorders — ending more than five years of sometimes acrimonious, and often very public, controversy. The committee of doctors appointed by the psychiatric association had attempted to execute a paradigm shift, changing how mental disorders are conceived and posting its proposals online for the public to comment. And comment it did: Patient advocacy groups sounded off, objecting to proposed changes in the definitions of depression and Asperger syndrome, among other diagnoses. Outside academic researchers did, too. ... But the deeper story is one of compromise (Benedict Carey, 12/10).

The Atlantic: A Social Network For People With Prediabetes
[D]iabetes is preventable -- through modest weight loss, it's possible to step back from the brink of disease. This suggests a unique opportunity for intervention. A solution that helps prediabetics make a few key lifestyle changes could save literally millions of lives -- not to mention billions of dollars. Fortunately, such a solution may already exist. The Diabetes Prevention Program, a landmark clinical research study led by the National Institutes of Health (NIH) and supported by the Centers for Disease Control and Prevention (CDC), demonstrated that intensive coaching in behavior modification reduces the risk of progression from prediabetes to diabetes by nearly 60 percent. Even more remarkably, 10 years after the trial ended, the benefits of the intervention persisted (Rena Xu, 12/12).

CQ HealthBeat: Remembering Alec Vachon
Many were the days when hunting for news and wary of being scooped, I picked up my phone, punched Alec Vachon's number and heard a clipped greeting at the other end of the line: "Vachon." Just like the sound of his name, Vachon, who died Dec. 5 after a long illness, was terse and to the point. He was razor-sharp, a focused thinker who had no patience for baloney. ... A consultant for many years and a GOP aide on the Senate Finance Committee before that, Alec was an important but not terribly well-known figure in the health policy community. His memory deserves to be honored ... Vachon worked on physician payment and other Medicare issues during his tenure on Senate Finance in the 1990s. ... But for me, what really makes Alec’s career notable is that it’s a reminder that the health policy world really is a community and of how rewarding it can be because of the relationships involved and the stimulating work that people do (John Reichard, 12/11).

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Editorials and Opinions

Viewpoints: Politicians Flirting With Danger On Medicare Eligibility Age; Maybe Doctors Should Be Paid Less

Bloomberg: To Cut Health-Care Costs, Pay Doctors Less
[T]he 2010 health- care law, which imposed immediate and heavy cuts on hospitals, drugmakers and insurers, left doctors relatively untouched. A 1997 law that reduces doctors' Medicare payments is consistently overridden by Congress. And none of the proposals for entitlement reform now circulating around Washington calls for significant sacrifices from physicians. It's worth asking whether doctors, who account for almost one-fifth of health spending, really need the special treatment (Christopher Flavelle, 12/12).

Los Angeles Times: Poll: Raising The Eligibility Age For Medicare
Medicare may not be the third rail of American politics -- that distinction belongs to Social Security -- but politicians who alter it put their careers at risk. ...  some advocates of the change insist that, like Social Security, Medicare needs to respond to the significant gains in longevity that have occurred since it was created in 1965. Seniors are living about eight years longer on average now than they were 45 years ago. They're working longer too, and the current system lets employers offload their oldest workers' healthcare costs onto the federal taxpayers. So where do you come down? Take our wildly unscientific poll, leave a comment below or do both (Jon Healey, 12/12).

The Wall Street Journal: Means Testing
What means testing in a general way means ... is that the very wealthy who do not need to receive a Social Security check or Medicare payments will no longer receive them, or no longer receive them in full. The object is to cut spending. You can argue that means testing would be unjust—people paid into the system throughout their work lives and have the right to receive the benefits in old age, even if the benefits make little difference in their lives and they can do without them (Peggy Noonan, 12/12).

The Medicare NewsGroup: Progressives Launch Medicare Defense Campaigns
It remains to be seen whether the White House will go beyond the above-stated "savings" and venture into the realm of even-more radical reform at this point in the fiscal-cliff battle. The next tier of savings may involve chipping away at the Medicare’s expensive, but-popular, "fee for service" model, which many progressives have suggested needs to be reexamined and possibly abandoned over time. Despite the pitched battle that has created this political equivalent of a World War I-style stalemate, radical reform—if it comes at all—will most likely be delayed ... It's far too complicated and politically toxic to undertake now as Congress faces a year-end deadline with no compromise in sight  (John F. Wasik, 12/12).

Los Angeles Times: Why Not Expand Medi-Cal In California?
California's Democratic-controlled Legislature has been an enthusiastic supporter of the 2010 federal healthcare reform law, but it has yet to take advantage of one of the most important provisions: the opportunity to offer Medi-Cal, the state's version of the Medicaid insurance program for the poor, to more Californians largely at the federal government's expense (12/12).

Georgia Health News: Medicaid Expansion Should Go Forward
The Georgia chapter of (the American College of Physicians) believes that it is imperative that our state accept the unique opportunity that is now available to use federal dollars to expand Medicaid to the working poor and near-poor in our state…. If Georgia turns down or delays accepting this unprecedented offer of federal money to extend Medicaid, we will be leaving our poorest citizens with no other way to get coverage (Dr. Jacqueline Fincher, 12/12).

The New England Journal of Medicine: Off-Label Marketing And The First Amendment
On December 3, 2012, a three-judge panel of a U.S. appeals court took a controversial leap toward what some fear will be license by the courts to invalidate a host of state and federal regulations, including some applicable to health care. ... At the heart of Sorrell was the question of whether governments are permitted to enact regulations, even those protecting the health of the public, that single out a particular industry (e.g., the pharmaceutical industry) and allow some messages (e.g., promoting brand-name drugs for off-label uses) but not others (Marcia M. Boumil, 12/13).

Politico Pro: Why Comparative Effectiveness Research Needs Guardrails
We must improve the quality of care provided and reduce costs. ... One way to reach this goal is through the increased use of comparative effectiveness research, which, in its simplest terms, is the comparison of one health treatment to another. While the hope for CER is that it will identify the best treatment to be used for specific diseases or conditions, and in turn provide improved information for patients and providers, medicine and science have proved that all people do not react the same way to the same treatment. This creates a big challenge: What can we do to help patients who do not respond to the most common treatment? (Dan Leonard, 12/13).

Health Policy Solutions (a Colo. news service): Just How Healthy Is Colorado?
As UnitedHealthcare's medical director for Colorado, I have witnessed efforts statewide on behalf of the public and private sectors to improve certain health trends, such as the prevalence of binge drinking and immunization coverage, and to improve our overall health outcomes, such as reducing infant mortality and geographic disparity. UnitedHealthcare Colorado has several programs in place for businesses that seek to address the health concerns underscored in this year's America's Health Rankings (Dr. Bill Mandell, 12/12).

Health Policy Solutions (a Colo. news service): Pediatric Dental Health Crucial To Long-Term Success
Research shows that good oral health is critical to a child's long-term success in life. Unfortunately, the data are not promising for Colorado kids. Tooth decay is almost entirely preventable, and yet around half of our Kindergartners suffer from it. ... If we care about a bright future for children, then we must care about the health of their teeth (Sarah Mapes, 12/12).

Kansas City Star: Challenges Come Fast For Johnson County Mental Health System
The colorful flier lies. "Change can be easy" is the leading quote in a flow chart to help guide people through Kansas' shift to managed care for those covered by Medicaid. But change is never easy. Not for humans. And this is a massive undertaking, set to begin next month (Mary Sanchez, 12/12).

Baltimore Sun: A Small Step Against Obesity In Howard Co.
Howard County's new ban on the sale of sugary drinks on government property won't solve the obesity epidemic. It won't prevent Howard Countians from slurping down empty calories by the Big Gulpful. ... But the ban, announced Tuesday by County Executive Ken Ulman, is a step toward aligning the wares available at libraries, parks and office buildings with what the county's health department recommends about a healthy lifestyle, and for that reason alone it is worthwhile (12/12).

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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.