Daily Health Policy Report

Friday, December 14, 2012

Last updated: Fri, Dec 14

KHN Original Reporting & Guest Opinion

Fiscal Cliff

Health Reform

Capitol Hill Watch

Quality

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

More ACA Lawsuits: The 'Contraceptive Mandate' Versus Religious Freedom (Analysis)

In this Kaiser Health News analysis, Stuart Taylor writes: "The Supreme Court famously upheld most of the Affordable Care Act in June. But in a year or two we may see another riveting Supreme Court drama growing out of the health law, this one driven by the passionate objections of many religious employers to the so-called contraceptive mandate. … While the legal challenges pose no threat to the law as a whole, they have all the ingredients of a legal donnybrook that might well end up before the high court" (Taylor, 12/13). Read the story.

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Capsules: Facing Deadline, Most States Say No To Running Their Own Insurance Exchanges; Obama Administration Grilled About Insurance Markets In House Hearing; Health Law Could Help Low-Income Mothers With Depression

Now on Kaiser Health News'' blog, Phil Galewitz offers an update regarding today's health exchange deadline: "With today's deadline hours away, only 17 states and the District of Columbia have proposed running their own insurance markets, also known as exchanges, a key vehicle under the law to expand health coverage to an estimated 23 million people over next four years" (Galewitz, 12/14).

In addition, Galewitz reports on yesterday's House subcommittee hearing regarding the health law: "Top Obama administration officials were called before a House subcommittee Thursday to answer questions about the implementation of the president’s landmark health law, and what Republicans say is a lack of clarity over how online insurance markets and a massive expansion of Medicaid will work" (Galewitz, 12/13).

Also on Capsules, Ankita Rao reports on how the health law could help low-income mothers with depression: "But states choosing to participate in the expansion of Medicaid could improve access to the prevention and treatment women need, said Larke Huang, a psychologist and senior adviser at the federal Substance Abuse and Mental Health Services Administration, who was also part of the forum. Medicaid currently covers pregnant women considered 'medically needy,' who might not meet income requirements. The coverage continues until six months after they give birth. In states that expand the program, many of those women will now qualify for the program after the six-month period, she said" (Rao, 12/14). Check out what else is on the blog.

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Political Cartoon: 'Dive Trying?'

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

Meanwhile, here is today's health policy haiku:

OPTIONS ON CONTROLLING MEDICARE COSTS

Editors left out 
The most effective option
Medicare for All!
-Don McCanne, MD, Senior Health Policy Fellow Physicians for a National Health Program

 

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

Partisan Differences Persist On Taxes And Medicare, Other Entitlement Programs

Meanwhile, news outlets report that some Senate Republicans are working on a back-up plan that would cancel certain tax increases scheduled to take effect next year for most Americans.

The New York Times: With Gap Wide And Time Short, Obama And Boehner Meet
With time running short to work out a deal to avert a year-end fiscal crisis, President Obama called Speaker John A. Boehner to the White House on Thursday evening to try to move talks forward even as pessimism mounted that a broad deal could be struck that bridges the substantial gap between the parties on taxes and entitlements like Medicare (Weisman and Calmes, 12/13).

Los Angeles Times: Signs Of Drift In 'Fiscal Talks'
Earlier in the day, a top Senate Democrat said increasing the Medicare eligibility age was off the table — an important stance to liberal Democrats. Publicly, the two sides appear to be drifting apart as Boehner, in a feisty moment during a morning news conference at the Capitol, insisted that spending cuts deeper than the president has proposed must be part of the deal. … But recent polls on how to deal with the "fiscal cliff," the automatic year-end tax increases and spending cuts, have emboldened Democrats, who see no reason to budge. The results show Americans favor the president's position that taxes should go up on the top 2% of Americans (Mascaro and Mason, 12/13).

The Washington Post: Obama, Boehner Meet On 'Fiscal Cliff,' But No Deal Is Reached
After the 50-minute session in the Oval Office, aides to both men described the meeting as a frank exchange and said the lines of communication remained open. But Boehner prepared to return to Ohio for the weekend, with no further negotiations on his schedule. … Senior Senate Republicans, meanwhile, were at work on a fallback plan that would not significantly restrain the national debt but would at least avert widespread economic damage by canceling tax increases scheduled to take effect next year for the vast majority of Americans (Montgomery and Kane, 12/13).

NPR: Obama And Boehner Meet At White House; Session Ends Without Deal
The president has called for $1.4 trillion in revenue over the next decade, which would include higher taxes for the wealthiest taxpayers as well as $400 billion in spending cuts. The speaker has put forth a plan that includes $1.2 trillion in spending cuts over the same period, as well as $800 billion in new revenue — much of it derived from restructuring the existing tax code. This afternoon meeting between President Obama and Speaker Boehner came on the same day the Pew Research Center released a new national poll that gauged Americans' views on the fiscal cliff and the efforts to avoid it (Chappell, 12/13).

The Associated Press/Washington Post: 'Fiscal Cliff’ Talks Eye Narrow Bargain To Raise Some Tax Rates, Other Issues Would Be Put Off
Hopes dimming for a wide-ranging bargain, the White House and many congressional Republicans are setting their sights on a more modest deal that would extend current tax rates for most Americans, raise rates for top earners and leave other, vexing issues for the new year (12/13).

National Journal: Will Health Coverage For Older, Sicker Patients Become A Target For Cuts?
As lawmakers search for ways to rein in chronic budget deficits, health coverage for people who are both old enough to qualify for Medicare and poor enough to receive Medicaid might end up as a target for cuts. These patients, who are known as dual eligibles, are costly to cover and their care is often poorly coordinated. Because of that, many budget cutters are convinced there are ways to make their coverage more efficient, which would save the government money (Mershon, 12/14).

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Raising Medicare's Eligibility Age Is Tough Issue For Democrats

Though one leading Senate Democrat has signaled that the idea of raising Medicare's eligibility is off the negotiating table, it's not clear where this bargaining chit stands.

Politico: Fiscal Cliff: Medicare Eligibility Age Off The Table For White House, Dick Durbin Says
Senate Majority Whip Dick Durbin told reporters Thursday that the White House is no longer considering raising the Medicare eligibility age as part of fiscal cliff talks. ... Democrats and liberal groups have put heavy pressure on the White House in recent days not to support an increase in the Medicare eligibility age from 65 to 67 (Gibson, 12/13).

The Associated Press/Detroit News: Durbin: White House Won't Yield On GOP Demands To Increase Medicare Eligibility Age
But Illinois Democratic Sen. Dick Durbin said he didn't get it directly from the president or the White House. However, he is regularly updated on the negotiations. ... Durbin's comments on the Medicare eligibility age were surprising, since top Senate Democrats like Majority Leader Harry Reid of Nevada, have been careful to not preclude the possibility of agreeing to such an increase — perhaps as a late-stage concession in a potential deal between Obama and Boehner (Taylor, 12/13).

Politico: Dem Split On Medicare Concessions In Cliff Talks
A growing number of Democrats in the Senate are ready to offer up a key concession on Medicare to try to reach a deal on the fiscal cliff: higher premium payments for wealthy seniors. But that might not get them very far. Means testing won’t reduce Medicare costs enough for Republicans who want a big deal on entitlements and the idea still outrages some liberal Democrats (Haberkorn and Raju, 12/13).

NPR: Making The Rich Pay More For Medicare
Besides, making the rich pay more would hardly be breaking new ground. Medicare already charges wealthy people more and poor people less. "We already don't have a common standard social insurance system where everybody gets the same benefits," [Heritage Foundation's Robert] Moffit says. "We already have means testing" (Rovner, 12/14).

Attention is also focused on Medicaid spending -

The Wall Street Journal: Cantor: Democrats Back Off Medicaid Cuts
Republicans said Thursday that the Obama administration was backing away from proposals that would trim federal contributions to the Medicaid program, making it harder to reach a budget deal (Radnofsky and Hughes, 12/13).

The New York Times: In The Fiscal Debate, An Unvarnished Voice For Shielding Benefits
Today the issue of tax cuts for the wealthy is once again front and center in Washington, as part of the debate over how to reduce the federal deficit. And [Sen. Bernie Sanders, I-Vt.,] is once again talking, carving out a place for himself as the antithesis of the Tea Party and becoming a thorn in the side to some Democrats and Mr. Obama, who he fears will cut Social Security, Medicare and Medicaid benefits as part of a deficit reduction deal (Stolberg,12/12).

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Health Reform

Today Is Deciding Time For States On Health Exchanges

The Associated Press reports that 19 states have turned down the idea of running health insurance exchanges, creating a daunting task for the federal government.

The Associated Press: Time For States To Decide On Health Care Exchanges
Nineteen states have turned down the Obama administration's invitation to run the new health insurance markets that will begin serving millions of uninsured Americans less than a year from now. That puts a huge task on the feds, a defining challenge for President Barack Obama's second term. ... On the other side of the ledger, 17 states and Washington, D.C., say they want to set up and run their own markets. The administration has already started granting approvals. Eight other states have indicated they want to pursue a partnership with Washington, and more may do so. Only six remain undecided (Alonso-Zaldivar, 12/13).

Kaiser Health News: Capsules: Facing Deadline, Most States Say No To Running Their Own Insurance Exchanges
The Obama administration will have to build and operate online health insurance markets for more than 30 states, something few expected when the federal health law was approved in 2010. With today’s deadline hours away, only 17 states and the District of Columbia have proposed running their own insurance markets, also known as exchanges, a key vehicle under the law to expand health coverage to an estimated 23 million people over next four years (Galewitz, 12/14).

Reuters: U.S. Faces Task Of Running Dozens Of Health Exchanges
On the eve of a federal deadline for states to say whether they will run their own exchanges, a top U.S. healthcare policy official told lawmakers that the exchanges will start enrolling eligible families starting on October 1, 2013 (Morgan, 12/13).

NBC News: Vitals: Feds Look Set To Run Most State Health Insurance Changes
Two-thirds of Americans who sign on to buy health insurance using new state marketplaces will actually be getting a federally administered plan, a health consultancy firm projected Thursday. ... Friday is the deadline for states to say for sure what they plan to do and just three states – Florida, North Dakota and Indiana – have failed to give an answer so far. But all three have governors who have indicated they won’t be setting up exchanges (Fox, 12/13).

The Hill: Analysis: Feds Will Have Outsize Role In Health Exchanges
Most people buying coverage on the Affordable Care Act's exchanges will be working through a system run by the federal government, according to a new analysis. Consulting firm Avalere Health estimated Thursday that two-thirds of people likely to purchase coverage on the marketplaces will buy through a federally administered or "partnership" exchange. This trend means that "key federal decisions about plan participation, the consumer interface and outreach activities, eligibility and enrollment, and options for small businesses will have a crucial impact on individuals’ experiences with the exchanges," Avalere wrote (Viebeck, 12/13).

Politico Pro: Avalere: Two-Thirds Of Exchange Enrollment Will Be Federally Administered
Almost two-thirds of those who buy insurance via an exchange in 2014 will do so in one that has significant federal involvement, Avalere Health predicted Thursday. On the eve of the latest exchange decision deadline for states, Avalere's estimates find that federally run exchanges and partnership exchanges will end up dominating the landscape. Of the 8.2 million people who are expected to buy insurance through an exchange in 2014, the health consulting firm estimates that just 2.8 million will buy it through a state-based exchange. Avalere said that as of Thursday, 17 states plus the District of Columbia have committed to a state-based exchange, and Utah is still waiting to see if the Obama administration will approve its state-based model (Smith, 12/13).

The Washington Post: GOP State Leaders Fumble By Ceding Control Of Health Exchanges To Federal Officials, Critics Say
Republicans frequently denounce the health-care law as a dangerous overreach of federal power. But now Washington's role is expanding, and some conservatives charge that Republicans have only themselves to blame. The vast majority of Republican-led states, faced with a Friday deadline to submit plans for running the insurance exchanges at the heart of the law, have opted instead to relinquish much or all of their control to the federal government (Aizenman, 12/13).

National Journal: Health Exchanges A Tough Sell With Many States
In hopes of encouraging reluctant states to embrace the new health care law, the Obama administration has extended their deadlines to commit to running new insurance marketplaces and published answers to states' biggest questions. But most states will probably still decide to sit on the sidelines. President Obama's signature health law was designed around the notion that new access to health insurance for individuals and small businesses would be crafted in partnership with state governments, which have traditionally regulated their own insurance products. The federal government would perform some functions, but leave many details to the states. The idea is to have the new online marketplaces, known as exchanges, up and running by late 2013 to allow the new insurance coverage to begin in 2014. Friday is the final deadline for states that wish to run their own exchanges to submit their plans (Sanger-Katz, 12/13).

Bloomberg: Republicans Seek Delay Of Obama Rules On U.S. Health Law
Senator Orrin Hatch and nine other Republicans asked for a delay of new U.S. rules for health-insurance exchanges and other parts of the Affordable Care Act, saying the public isn't being given enough time to comment. The 30-day comment period on the regulations makes it "extremely burdensome, if not nearly impossible, to formulate an accurate and instructive response," the senators said in a letter today to the U.S. health, treasury and labor secretaries. The period should be extended to at least 60 days, they said (Wayne, 12/13).

Modern Healthcare: CMS Won't Delay On Insurance Exchange Rules
A senior CMS official rejected a call by Republican senators to extend the comment period for rules governing coming health insurance exchanges. Gary Cohen, director of the Center for Consumer Information and Insurance Oversight at the CMS, told reporters Thursday that he would not consider extending the comments period for various exchange rules and delaying their finalization. "There's not a lot of time between now and October, and people are saying that we need to get these rules; the industry in particular is saying 'We need to get these rules finalized in order to know how to develop plans and get them into states,'" Cohen said. … The senators requested extensions of the comment periods for an essential health benefits rule; health insurance market rules; and the HHS notice of benefit and payment parameters for 2014. The comment periods for the rules end later in this month (Daly, 12/13).

And on the Medicaid expansion front -

The Associated Press/Washington Post: After Campaigning Against Federal Health Care Law, Ark. Republicans Weigh Medicaid Expansion
Like their counterparts in other southern states, Arkansas Republicans denounced "Obamacare" during this year's election campaign and called for its repeal. But now that they've won control of the Legislature for the first time in 138 years, GOP lawmakers are considering something that would be anathema to conservatives elsewhere -- expanding government health care in the state (12/13).

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Challenges, Questions Loom Over Health Law Implementation

Health law implementation faces tough scrutiny as the "fiscal cliff" looms, even as it remains the law of the land. Republicans are leading a charge to change the law and are calling for greater specifics about its implementation.

National Journal: 'Obamacare' Is The Law Of The Land, But 3 Enormous Challenges Loom
How quickly the politics of health care has changed. Just over a month ago, the country was debating whether President Obama’s health reform law, aka "Obamacare," should be saved or scrapped. Now, with the president's re-election, that’s all settled, and regulators, states, employers, and health care providers are rushing to get ready for a transformed system that is coming in 2014. This involves several challenging tasks. Industry is readying itself for hundreds of pages of regulations, insurance companies for new products and some 7 million new customers in the first year, states for an IT infrastructure unlike anything they have seen. Employers are facing a raft of new requirements, including an obligation to cover all of their workers or pay fines for not doing so (Sanger-Katz, 12/14).

CBS News: As 'Fiscal Cliff' Looms, Health Reform Questions Linger
Washington lawmakers this month are squarely focused on deficit reduction as they attempt to scramble off the so-called "fiscal cliff." All the while, however, the government is proceeding with the costly and ambitious rollout of the Affordable Care Act. Key components of President Obama's health care law won't go into effect for about another year, but federal and state lawmakers are obligated to start building up those health care systems now. Many Republicans, however, argue the Obama administration hasn't said with certainty what the programs will ultimately cost or how they'll be governed. Democrats largely chalk up the complaints to the latest chapter in Republican-led obstruction against the Affordable Care Act, pointing to Democratic-led states that are making progress implementing the law (Condon, 12/14).

Politico: Tom Price: Time To Move On Obamacare Alternatives
A Republican doctor on the House Ways and Means Committee encouraged his colleagues Thursday to produce meaningful legislation to replace the Affordable Care Act in the next session of Congress. … Asked for specifics, Price said the exchange subsidies could "easily be morphed into a defined contribution model to allow for true flexibility," enabling patients to choose high-deductible catastrophic plans, for example. "Those kinds of things would be available where the current law doesn't allow them," he said (Cheney, 12/13).

The law could also affect access to care for illegal immigrants --

The Associated Press/Washington Post: Health Care Overhaul Could Reduce Treatment Options For Nation's 11 Million Illegal Immigrants
But in states with large illegal immigrant populations, the math may not work, especially if lawmakers don't expand Medicaid, the joint state-federal health program for the poor and disabled. When the reform has been fully implemented, illegal immigrants will make up the nation’s second-largest population of uninsured, or about 25 percent (12/14).

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Capitol Hill Watch

House Republicans Assail Administration On Health Law Implementation

Members of the Energy and Commerce subcommittee on health assert administration officials have not been helpful to states.

Kaiser Health News: Capsules: Obama Administration Grilled About Insurance Markets In House Hearing
Top Obama administration officials were called before a House subcommittee Thursday to answer questions about the implementation of the president's landmark health law, and what Republicans say is a lack of clarity over how online insurance markets and a massive expansion of Medicaid will work (Galewitz, 12/13).

CQ HealthBeat: House Panel Continues Sniping Over Health Care Law
Continuing the partisan divide permeating debate on the health care law, House Republicans and Democrats painted two conflicting pictures of the state of the overhaul's implementation at a hearing Thursday. GOP lawmakers on the Energy and Commerce Subcommittee on Health maintained that the Obama administration has not provided states with the information necessary to move forward, leaving them with uncertainty about how to proceed. But Democrats argued that the federal agencies have done their jobs and accused the other party of continuing to play politics with the law after it survived repeal votes, a Supreme Court ruling and the election (Attias, 12/13).

Meanwhile, in other Capitol Hill news --

The Hill: Rep. Graves: Essential-Benefits Policy Too Hard On Small Businesses
The "essential benefit" mandates in President Obama's healthcare law will drive up costs for small businesses, House Small Business Committee Chairman Sam Graves (R-Mo.) said Thursday. Graves, in a letter to Health and Human Services Secretary Kathleen Sebelius, said the administration should revise the essential-benefits rule to better reflect the needs of small employers — including small insurance companies. "Although the Department claims that the health care law and its rules provide 'flexibility,' any flexibility is provided within expensive and mandatory categories of benefits, which will increase the cost of premiums for small businesses," Graves said in his letter Thursday (Baker, 12/13).

CQ HealthBeat: Medicaid Ruling On Rates Challenged By Republicans
Two top Republicans questioned the administration on reversing its support of a single federal blended rate for the Medicaid program, saying it results in a "bait and switch" for states. Orrin G. Hatch, ranking Republican on the Senate Finance Committee, and Fred Upton, chairman of the House Energy and Commerce Committee, said the decision could confuse states as they weigh expanding their Medicaid populations under the 2010 health care overhaul. "Many worry that the administration's policy shift simply represents a 'bait and switch' in order to get states to agree to PPACA expansions,” said Hatch, R-Utah, and Upton, R-Mich., in a Dec. 13 letter to Department of Health and Human Services Secretary Kathleen Sebelius (Ethridge, 12/13).

CQ HealthBeat: Senate Finance Committee Members Question Director Of Duals Office
Sen. Jay Rockefeller on Thursday grilled the director of the office that the health care law created to oversee the care of those eligible for both Medicare and Medicaid about an initiative the administration is pursuing to shift recipients into managed or coordinated care plans. The West Virginia Democrat was a key backer of establishing such an office but has questioned the scope of its initiative, which would be undertaken in about half the country. Announced in July 2011, the effort would shift people who are dually eligible for the programs into either managed or coordinated care. The goal is to improve patient care and save federal and state funds. The governments spend more than $300 billion every year to care for the more than 9 million dually eligible patients (Adams, 12/13).

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Quality

New Finding Likely To Fuel Cost-Benefit Debate Over Cancer Care

A study published Thursday in the Journal of the National Cancer Institute concluded that proton-beam therapy provided no long-term benefit over traditional radiation despite far higher costs.

The Wall Street Journal: Costly Cancer Care Dinged
In a finding likely to add fuel to the debate over treatments for prostate cancer, proton-beam therapy provided no long-term benefit over traditional radiation despite far higher costs, according to a study of 30,000 Medicare beneficiaries published Thursday in the Journal of the National Cancer Institute (Beck, 12/13).

Reuters: More Pressure To Justify Cost Of Cancer Drugs Versus Benefits
Medical providers have begun to think more about cost, as well as safety and effectiveness, when they decide on cancer treatments. In the past, pharmaceutical companies could launch a high-priced drug with little push back (Beasley, 12/14).

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State Watch

Reports: State Budgets Looking Grim, Medicaid Particularly Problematic

Medicaid costs continue to rise as state revenues are not recovering fast enough from the recession.

The New York Times: As State Budgets Rebound, Federal Cuts Could Pose Danger
Adjusted for inflation, this year's revenues are still expected to be 7.9 percent below the 2008 levels. And with Medicaid costs continuing to rise — states now spend more on Medicaid than on elementary and high school education — states find themselves hard-pressed to restore many of the deep cuts they have made to other services. Now many governors are bracing for the prospect of cuts in federal aid, which provided states with roughly a third of their revenue last year (Cooper, 12/14).

The Washington Post: States Face Double Fiscal Whammy: Federal Aid Cuts And Spiraling Health-Care Costs
The Fiscal Survey of States, a report released Friday by NASBO and the National Governors Association, found that state revenues for the current fiscal year surpassed pre-recession levels for the first time. The problem for states is that the revenue is increasing slowly while health-care costs are going through the roof. The result is that many other state government priorities — including higher education, infrastructure development and law enforcement — are being forced to take a back seat (Fletcher, 12/14).

Stateline: Medicaid Trumps ‘Fiscal Cliff’ As Top State Budget Concern
The so-called fiscal cliff talks in Washington, D.C., might be getting all the attention, but for states, Medicaid is still the biggest budget worry for the coming year, according to a new survey of state legislative directors to be released soon. Nowhere is the problem larger than in Texas, which faces a $4.3 billion Medicaid deficit. Nine other states likewise are reporting spending overruns for Medicaid and other health care programs for the current 2013 fiscal year, compared with six at this time last year, says the National Conference of State Legislatures (Prah, 12/14).

The Wall Street Journal: Fiscal Threats Are Forecast For New Jersey
New Jersey faces "major fiscal threats in years ahead" despite having made strides in reining in costs and resorting to fewer budgetary tricks than other states according to a report released Thursday ... The privately financed report from former Federal Reserve Chairman Paul Volcker and former New York Lt. Gov. Richard Ravitch found that it will cost New Jersey an additional $9 billion over the next five years to keep up with four major expenses: Medicaid, school aid, health benefits and pensions. That amount represents 29% of the state's current $31.7 billion budget (Haddon, 12/13).

The New York Times: New Jersey's Pension Plan Is Said To Be In Trouble Despite Overhaul By Christie
Mr. Volcker and Mr. Ravitch formed the task force out of a concern that the fiscal debate in Washington was overlooking parallel fiscal problems at the state level, and that the coming measures to shore up the federal government’s finances were likely to make the states’ troubles worse. Federal proposals to raise the Medicare age to 67 would blow back onto the states, for example, because many have promised to cover retiree health care in the years before Medicare kicks in (Walsh, 12/13).

The Associated Press: Report: Retiree, Health Costs Draining NJ Budget
The report describes spiraling retiree and health care costs draining all state budgets. ... "It became very clear to many of us that for a lot of reasons most states were on the verge of being on unsustainable paths for true fiscal balance. The reasons for this, which are almost uniformly true, are that the cost of pensions and other retiree payments and the costs of health care and Medicaid in particular are rising at rates far greater than the rates at which taxes are being collected," Ravitch said (Delli Santi, 12/13).

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Appeals Court: Calif. Can Cut Medicaid Reimbursement Rates

A federal appeals court panel ruled Thursday that Medi-Cal payments to providers may be reduced by 10 percent -- a move that HHS had previously approved.

Los Angeles Times: Court Ruling Could Cut California Spending On Medi-Cal
In a potential windfall for the state, a federal appeals court decided unanimously Thursday that California may cut reimbursements to doctors, pharmacies and others who serve the poor under Medi-Cal. A three-judge panel of the 9th Circuit U.S. Court of Appeals overturned injunctions blocking the state from implementing a 2011 law that slashed Medi-Cal reimbursements by 10 percent. Medi-Cal, a version of Medicaid, serves low-income Californians (Dolan and Megerian, 12/13).

Los Angeles Times: California Medical Group Warns Against Medi-Cal Reimbursement Cuts
Despite a federal appeals court ruling Thursday allowing California to cut Medi-Cal reimbursement payments, a spokeswoman for the California Medical Assn. said the group hoped the state would decide against doing so. Earlier this year, U.S. District Court Judge Christina Snyder granted injunctions blocking a 10 percent cut to Medi-Cal reimbursement rates to health care providers. State officials had said the court's injunctions were costing the state more than $50 million a month (Dolan, 12/13).

San Francisco Chronicle: Medi-Cal Cuts Upheld By Appellate Court
[The court] said it was required to defer to the U.S. Department of Health and Human Services, which decided in October 2011 that lowering the Medi-Cal rates was unlikely to reduce access to health care. The federal government, which provides at least half the cost of Medi-Cal services, must approve all rate cuts. The appeals court noted that federal department also reached its conclusion without studying the costs of providing care. Considering such costs before reducing providers' rates "seems at first blush to be logical," ... But "the executive branch has been giving careful consideration to the ins and outs of the program since its inception, and the (federal) agency is the expert," said Judge Stephen Trott in the 3-0 ruling (Egelko, 12/13).

Reuters: California May Cut State Medicaid Reimbursement Rates: Court
Attorney Lynn Carman, who represents the Medicaid Defense Fund, said the court's decision was "totally without merit." A spokesman for Brown welcomed the ruling. "Today's decision allows California to continue providing quality care for people on Medi-Cal while saving the state millions of dollars in unnecessary costs," spokesman Gareth Lacy said in a statement. Carman said his non-profit group would ask for a review of the decision by the full 9th Circuit. If a review is denied, he said he expects to file an appeal to the U.S. Supreme Court (Christie, 12/13).

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States Getting Arms Around Medicaid Expansion, Program Challenges

The health law's treatment of using Medicaid to expand coverage to more Americans is examined in Georgia -- where a doctor pay raise in the program has stirred discontent -- and in Oregon, where 200,000 stand to qualify under the program's expansion.

Georgia Health News: Doctor Pay Raise Encounters Controversy
Reimbursing underpaid doctors more for treating Medicaid patients, with the additional money coming from the federal government instead of state coffers, might appear to be an easy thing for a health agency board to approve. But the idea was not greeted enthusiastically by the state Department of Community Health board. There were expressions of dissatisfaction and a dissenting vote at Thursday’s board meeting. The discontent appeared to stem from the pay raise's link to the Affordable Care Act, a federal law that has survived legal and political challenges but remains highly unpopular with many Georgians (Miller, 12/13).

The Lund Report: Medicaid Expansion Offers Richer Benefits To 200,000 Oregonians
The 200,000 Oregonians expected to qualify for Medicaid coverage in 2014 will receive more robust benefits if the Oregon Health Policy Board approves a recommendation from the Medicaid Advisory Committee. Now many low-income adults lack the dental, rehabilitative and optical care required by the Affordable Care Act, which expands Medicaid coverage to 133 percent of the poverty line. Those newcomers would receive care in the Oregon Health Plan Plus that’s already offered to children, pregnant women and people with certain disabilities. "The Oregon Health Plan Plus is slightly richer than the average commercial plan," said Rhonda Busek, who chairs the advisory committee, adding that people wouldn't have to pay deductibles or co-payments to access care. Up until 2017, the federal government will absorb 100 percent of the cost for the expansion (Gray, 12/13).

In other state Medicaid news --

The Seattle Times: Two Health Plans Sue State Over Allocation Of Medicaid Patients
Two health plans that have contracted with the state to administer managed-care health services to Medicaid enrollees have sued the state, saying its allocation formula will penalize them by assigning too many new patients to other plans. In a lawsuit filed in Thurston County Superior Court, Molina and Community Health Plan of Washington (CHPW) contend that the state has breached its contract with them, penalizing the plans that have served the state's Medicaid patients for many years. The two plans maintain that three new plans have been given an unfair advantage by a reworked formula the state wants to use to assign patients (Ostrom, 12/13).

North Carolina Health News: Alzheimer's Patients Caught Up In State Medicaid Service Changes
Several thousand seniors with Alzheimer's disease are at risk of losing their housing due to changes in the state Medicaid program that will result in deep cuts in payment. The changes mean that 416 people in "special care units" designed to house people with Alzheimer's and dementia will completely lose reimbursement for personal care services on Jan 1. The Medicaid dollars cover so-called activities of daily living: bathing, dressing, feeding, toileting and getting around safely (12/14).

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State News: Calif. Health Care Special Session Priorities; Nurse Practitioner Role Debated In Minn.

A selection of health policy stories from Michigan, California, Kansas and Minnesota.

Detroit Free Press: Abortion Bill Heads To Snyder's Desk After House Vote
An omnibus abortion bill, approved by the Senate on Wednesday, passed the House early this morning by a 72-35 vote, after a controversial requirement that an aborted fetus be buried, cremated or interred was removed earlier this week. Democrats offered a handful of amendments, some referred to as "what’s good for the goose is good for the gander," to require men to undergo physical exams before being prescribed Viagra or to get a vasectomy. But all the amendments were shot down. Gov. Rick Snyder is expected to sign the bill into law. … A separate bill that would have allowed health care providers to opt out of procedures to which they had moral or religious objections did not come up for a vote, meaning it effectively dies for the year (Erb and Gray, 12/14).

California Healthline: Setting Priorities In Health Care Special Session And Beyond
California's march toward health care reform may be picking up speed after clearing several hurdles over the past year coupled with the election of a supermajority of Democrats in the state Legislature. … As a precursor to shifting into a higher gear, the Democrat-dominated Legislature will convene a special session next month on health care. We asked legislators and stakeholders to use post-election perspective to tell us what priorities should be in the special session. And looking ahead to the legislative year, we asked what health care issues they see on the horizon for 2013 (12/13).

Minneapolis Star Tribune: More Independence Sought For 5,000 Nurse Practitioners
For years, nurse practitioners in Minnesota have been able to see patients only in association with a licensed doctor. But a governor's task force says it's time to let those nurses work independently -- in part, because of a coming shortage of primary care physicians. The proposal, which has been opposed by physician groups, was endorsed Thursday in the final report of the state Task Force on Health Reform, headed by Human Services Commissioner Lucinda Jesson. The report is expected to set the stage for a debate in the Legislature, which must approve any changes (Lerner, 12/13).

California Healthline: Sonoma Center Facing State Sanctions
The California Department of Public Health took a major step this week toward decertifying and revoking the license of the intermediate care facility at Sonoma Developmental Center. The Sonoma facility, which serves 290 people with intellectual disabilities, is expected to appeal the state action. The original survey in July by the Department of Public Health found 57 deficiencies, and four instances of immediate jeopardy to residents. The facility had two three-month periods to correct those problems. According to CDPH officials, time is up (Gorn, 12/14).

Detroit Free Press: Tax Cuts, Fiscal Cliff Could Push Michigan Back Into Deficit Territory
The State of Michigan, widely credited with righting its financial ship since 2011 after years of crisis, is again facing potential deficits that could be aggravated by a raft of bills passed in the lame duck session that ended Thursday, officials warned. … The document also identifies about $2.1 billion in other revenue issues unrelated to the lame-duck session, including $1.4 billion in additional money needed to fix roads and a $145-million shortfall in the Health Insurance Claims Assessment tax, a 1 percent tax on certain health insurance claims that took effect this year, replacing an earlier health tax that was eliminated (Egan and Gray, 12/14).

Kansas Health Institute News: KHIE Board Members Get Cold Feet On Legal Changes
A recently approved plan to move the duties of the Kansas Health Information Exchange to the state health department is getting a second look from the KHIE board members because they're uncertain how the 2013 Legislature might deal with it. "There's nervousness about whether this Legislature would accept the changes and pass it on through," KHIE, Inc. board chair Dr. Joe Davison told KHI News Service after the board met Wednesday. "We want to make sure it passes. The way it stands now, (current law is) better than nothing." KHIE was the public-private entity created to oversee the digital exchange of Kansans' health records (Cauthon, 12/13).

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Health Policy Research

Research Roundup: Workers' Insurance Costs Vary Depending On Employers' Size

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

Kaiser Family Foundation: A Comparison Of The Availability And Cost Of Coverage For Workers In Small Firms And Large Firms: A View from the 2012 Employer Health Benefits Survey -- The authors of this analysis provide a detailed look at the availability of health coverage at small and large employers, as well as the variations in plan costs and cost-sharing requirements. Covered workers at small firms – those with 3-199 employees -- on average have lower annual premiums for family coverage ($15,253) than those in large firms ($15,980), yet they contribute "significantly more" for this coverage ($5,134 vs. $3,926) (Panchal, Rae, and Claxton, 12/11).

Health Affairs: Reducing Waste in Health Care -- The author of this brief writes: "[R]esearchers at the Dartmouth Institute for Health Policy and Clinical Practice have estimated that 30 percent of all Medicare clinical care spending could be avoided without worsening health outcomes. ... Efforts to extract waste from the health care system will in all likelihood continue along a range of federal government initiatives, including information technology adoption, pay-for-performance, payment and delivery reforms, comparative effectiveness research, and competitive bidding. Similar programs are also being initiated by state Medicaid agencies and by private payers. In the view of many experts, even more vigorous efforts to pursue the reduction of waste in health care are clearly warranted" (Lallemand, 12/13).

John A. Hartford Foundation: Public Poll: "Silver And Blue – The Unfinished Business Of Mental Health Care For Older Adults" – Lake Research Partners surveyed more than 1,300 adults ages 65 and older and found that many older adults "may not be receiving evidence-based standards of care, such as being informed about the side effects of treatment and receiving timely follow-up care." According to the survey, “One in five respondents (20%) reports having been diagnosed with a mental health issue. Fourteen percent have been diagnosed with depression and 11% have been told by a doctor they have anxiety.” Yet the majority of those polled did not know that depression can can affect physical health and nearly half of those getting treatment said their doctors had not followed up with them to see how they were doing. The poll had a margin of error of 3.9 percentage points (12/10).

American Journal Of Public Health: Relationship Between Medical Well Baby Visits And First Dental Examinations For Young Children In Medicaid – Researchers examined the relationship between preventive well-baby visits and the time of first dental examinations among children enrolled in the Iowa Medicaid Program. After analyzing Medicaid enrollment and claims data of more than 6,000 children, the researchers found that "more well baby visits between ages 1 to 2 and 2 to 3 years were significantly associated with early first dental examinations." They add: "Few children see a dentist by age 12 months, however, which motivates efforts to identify the factors related to earlier first dental examinations" (Chi et al., 12/13).

Kaiser Family Foundation: Medicaid Eligibility, Enrollment Simplification, And Coordination Under The Affordable Care Act: A Summary Of CMS’s March 23, 2012 Final Rule -- The authors write: "This brief provides a summary of the Centers for Medicare and Medicaid Services' (CMS) March 23, 2012 final rule to implement the ACA provisions relating to Medicaid eligibility, enrollment simplification and coordination. The rule, which is effective Jan. 1, 2014, lays out procedures for states to implement the Medicaid expansion and the streamlined and integrated eligibility and enrollment system created under the ACA. Achieving this goal will require substantial process and system changes among state Medicaid agencies and close coordination between Medicaid, the new health insurance Exchanges and other insurance affordability programs" (Artiga, Musumeci, and Rudowitz, 12/13).

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

Medscape: After-Hours Access to Clinicians Tied to Fewer ED Visits
Patients who have an easier time reaching their primary care clinician after regular office hours visit the hospital emergency department (ED) less often, according to a new study published online December 12 in Health Affairs. The study, by Ann O'Malley, MD, MPH, also reveals that patients enjoyed better after-hours access if they belonged to a practice with extended office hours. Roughly 40% of patients with a usual source of primary care reported going to a practice that was open in the evening or on weekends (Lowes, 12/13). 

Reuters: A Sick World: We Live Longer, With More Pain And Illness
The world has made huge progress fighting killer infectious diseases, but as a result we now lead longer and sicker lives, with health problems that cause us years of pain, disability and mental distress. This "devastating irony", as researchers describe it, is the main conclusion of a five-year study that forms the most comprehensive assessment of global health in the history of medicine, according to the journal publishing the research. The Global Burden of Disease study, led by the Institute for Health Metrics and Evaluation (IHME) at Washington University, finds that countries face a wave of financial and social costs from rising numbers of people living with disease and injury (Kelland, 12/13).

MedPage Today: Crowded EDs May Be Serious Health Hazard
The busiest days in Emergency Departments are linked to higher inpatient mortality risk and higher costs, a population-based study affirmed. Patients seen on days when EDs were so full they turned away ambulances had a 5% greater risk of death before discharge than those admitted at other times, Benjamin Sun, MD, MPP, of Oregon Health and Science University in Portland, and colleagues found. These patients also faced slightly but significantly longer stays and higher costs for their admission in the analysis of statewide hospital discharge and ambulance diversion data for California, reported online in the Annals of Emergency Medicine (Phend, 12/12). 

Reuters: Fewer Cancer Patients Pick CPR After Video Demo
Dying cancer patients are less likely to want aggressive end-of-life care if they watch a short video about CPR than if they simply hear about it, according to a new study. "These are huge differences. You will die very differently if you watch the video than if you don't," said Dr. Angelo Volandes, the study's lead author from Boston's Massachusetts General Hospital. ... The researchers found in a group of 150 cancer patients, who were thought to have less than a year to live, 48 percent wanted CPR after being told about it, compared to 20 percent in the group who also watched a video showing compressions on a dummy and the inserting of a breathing tube (Seaman, 12/12). 

MedPage Today: Patients' Health IT Savvy Judged Lacking
As hospitals and physicians move to wider use of electronic health records (EHRs), patients need to become more engaged and be made aware that their records are accessible, health technology experts said. And as providers work on the next stage of becoming "meaningful users" of EHRs, they must remember that higher patient engagement is related to higher quality, better outcomes, and lower costs, several speakers said at a press conference here Monday sponsored by the Bipartisan Policy Center (Pittman, 12/12).

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Editorials and Opinions

Viewpoints: Krugman Says GOP's Attacks On Big Government Don't Translate To Medicare; Democrats Must Overcome Hesitancy To Bargain

The New York Times: The GOP's Existential Crisis
By all accounts, Republicans have, so far, offered almost no specifics. They claim that they're willing to raise $800 billion in revenue by closing loopholes, but they refuse to specify which loopholes they would close; they are demanding large cuts in spending, but the specific cuts they have been willing to lay out wouldn't come close to delivering the savings they demand. It's a very peculiar situation. ... Since the 1970s, the Republican Party has fallen increasingly under the influence of radical ideologues, whose goal is nothing less than the elimination of the welfare state — that is, the whole legacy of the New Deal and the Great Society. From the beginning, however, these ideologues have had a big problem: The programs they want to kill are very popular (Paul Krugman, 12/13).

The Washington Post: Democrats Losing Their 'Balance' On Entitlement Reform
The cartoon version of the fight is that Democrats want to soak the rich, and Republicans want to slash the poor. But here's the problem: There's no way for either of them to solve this problem without affecting the middle class, which in the end will have to pay more and accept something less than what has been promised. Neither party likes either side of that equation. ... But there's no way to fix America's problem without doing something on entitlements. If the Democrats — and Mr. Obama, in particular — don't get more seriously into that discussion, they have no standing to complain about the Republicans' lack of balance (12/13).  

Los Angeles Times: Sofia's Choice
When I told Sofia her diagnosis, she looked down. She told me how she had been forced to choose between buying health insurance and paying for food and housing for herself and her three children. She was a healthy 40-year-old with no medical problems, and was hoping to get insurance through a permanent job in the future. Cancer had not been a part of her calculation (Dr. Palav Babaria, 12/14).

The Wall Street Journal: It's A Mad, Mad, Mad, Mad ObamaCare
For sheer political farce, not much can compete with ObamaCare's passage, which included slipping the bill through the Senate before dawn three Christmas eves ago. But the madcap dash to get ready for the entitlement's October 2013 start-up date is a pretty close second. The size and complexity of the Affordable Care Act meant that its implementation was never going to easy. But behind the scenes, even states that support or might support the Affordable Care Act are frustrated about the Health and Human Services Department's special combination of rigidity and ineptitude (12/13). 

The Wall Street Journal: The End Of Birth-Control Politics
As a conservative Republican, I believe that we have been stupid to let the Democrats demagogue the contraceptives issue and pretend, during debates about health-care insurance, that Republicans are somehow against birth control. It's a disingenuous political argument they make (La. Gov. Bobby Jindal, 12/13).

Los Angeles Times: Getting The Runaround On Long-Term Care Insurance
As the baby boomers enter their sunset years, long-term care coverage represents an increasingly costly gamble for insurers. That's why Prudential stopped selling individual policies in March. MetLife exited the business in 2010. About 70% of people over age 65 will require long-term care services during their lifetime, and more than 40% will need care in a nursing home, according to the U.S. Department of Health and Human Services (David Lazarus, 12/13).

Des Moines Register: Branstad's Concerns About Iowa's Mental Health Treatment Are On The Mark
Gov. Terry Branstad is raising questions about Iowa's four state-run mental health institutes. The facilities in Cherokee, Clarinda, Independence and Mount Pleasant were built in the era of so-called insane asylums, when the state locked up and looked after thousands of people. ... The Des Moines Register's editorial board has argued for closing at least one of these facilities, and perhaps more, if they can be consolidated into a single location. Iowa's health care infrastructure should reflect the fact that we are living in the 21st century, not in 1902, when the last of the four institutes was built (12/14).

Kansas City Star: Why Kansans Should Worry About 'Like-Minded' State
As a deadline for partnering with the federal government in a health insurance exchange drew near, (Gov. Sam) Brownback's office put out a statement saying that "we are discussing options and alternatives with like-minded states and with our legislative partners in Kansas." The next day, Kansas participation in an insurance exchange was off the table. Brownback hasn't said yet whether he'll recommend that Kansas expand its Medicaid eligibility threshold to the limits called for in the Affordable Care Act, but a statement from his office provides a clue. "We continue to discuss options and alternatives with like-minded states" (Barbara Shelly, 12/13).

The Palm Beach Post: Is Obama Right To Rule Out Raising Medicare Eligibility Age?
Many budget hawks have insisted that raising the Medicare eligibility age is the only sure way to rein in rapidly rising health care costs. The eligibility age for Social Security already has risen to 66 for Americans born from 1943 to 1954. It goes up to age 67 for people born in 1960 or later. Medicare, unlike Social Security, is a major factor in the U.S. deficit. But many politicians, and Democrats in particular, have been reluctant to make cuts in Medicare benefits (12/13).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
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.