Daily Health Policy Report

Monday, December 17, 2012

Last updated: Mon, Dec 17

KHN Original Reporting & Guest Opinion

Fiscal Cliff

Health Reform


Public Health & Education

Health Care Marketplace

Health Information Technology

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

FAQ: Grandfathered Health Plans

In this Kaiser Health News FAQ, Sarah Barr writes, "If you get your insurance from your employer, there’s a very good chance that you are in a 'grandfathered plan,' and that means some of the changes do not affect you — yet. ... Nonetheless consumers should know the status of their plans since that may determine whether they are eligible for certain protections and benefits created by the health law" (Barr, 12/16). Read the story.

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Capsules: Facing Deadline, Most States Say No To Running Their Own Insurance Exchanges; Med Students Switch Gears After Sandy KO's Training Hospitals; Tax Exclusion For Health Benefits Could Be Part Of 'Fiscal Cliff' Talks

Now on Kaiser Health News' blog, Phil Galewitz reports on the states' announcements of their plans to build or not build 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. ... Most experts thought only states with small populations such as Delaware or Montana would seek federal help. Instead, most will rely on the federal government — including two of the most populous states, Texas and Florida, which together account for nearly 20 percent of nation's uninsured" (Galewitz, 12/14).

Also on Capsules, Alvin Tran looks into the impact on medical students of the closure of two New York City hospitals: "After completing a medical rotation in pediatrics, Hannah Kirsch was looking forward to starting another one in psychiatry at New York City’s Bellevue Hospital – but then Hurricane Sandy hit. Kirsch is among about 170 third-year and fourth-year medical students at New York University who were required to change their plans after two of NYU's academic training hospitals, NYU Langone Medical Center and Bellevue, temporarily closed due to extensive flood damage" (Tran, 12/17).

Finally, Julie Appleby reports about how tax benefits for employee health insurance benefits factor into "fiscal cliff" negotiations: "As the deficit debate continues, some policy wonks think it’s inevitable that negotiators will address a loophole that allows workers to avoid paying taxes on the value of their job-based health insurance" (Appleby, 12/14). Check out what else is on the blog.

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Political Cartoon: 'Boxed In?'

Kaiser Health News provides a fresh take on health policy developments with 'Boxed In?' by Clay Bennett.

Meanwhile, here is today's health policy haiku:


If you're counting down
to Christmas and not the cliff
don't make travel plans.

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

Boehner Offers Tax Increases In Exchange For $1 Trillion in Cuts To Social Benefit Programs

The latest offer by House Speaker John Boehner, R-Ohio, is seen as progress in the negotiations between Congress and the White House, but in return Boehner is asking for significant cuts in Medicare and other programs.

The Associated Press/Washington Post: Movement Seen In 'Fiscal Cliff' Talks As Boehner Offers Revenue Boost
In return, Boehner is asking for $1 trillion in spending cuts from government benefit programs like Medicare. Those cuts would defer most of a painful set of across-the-board spending cuts set to slash many domestic programs and the Pentagon budget by 8-9 percent, starting in January (12/17).

Politico: Fiscal Cliff Deal Still Faces Many Hurdles
House Speaker John Boehner jump-started the budget talks by offering to raise tax rates, but major differences on entitlements and revenue could prove difficult to bridge with only two weeks until the fiscal cliff deadline. … But proposed cuts to Medicare are now the key to any fiscal cliff deal. Boehner needs robust changes to the hugely popular seniors health program to sell any kind of tax-rate increase to his conservative-dominated Republican Conference (Sherman and Bresnahan, 12/16).

USA Today: Signs Of A Thaw Emerge In 'Fiscal Cliff' Talks
In talks with President Obama, Republican House Speaker John Boehner offered to back raising the income tax rates for people making $1 million or more if Obama agreed to significant cuts in entitlement program spending, according to two sources close to the negotiations. They spoke on condition of anonymity because they were not authorized to speak publicly. Obama rejected that offer, the sources said, but it was the first sign that Boehner was willing to endorse raising tax rates for anyone (Jackson, 12/16).

Bloomberg News/The New York Times: U.S. Fiscal Deal Unlikely Without Compromise
As the political tension mounts over the current fiscal deadlock — which, unless a deal is reached by Dec. 31, would increase taxes for everyone and force some draconian spending cuts — there will have to be trade-offs for any ultimate deficit-reduction deal. Congressional Republicans insist this will only be palatable if there are major cuts to entitlement programs, especially Medicare. There are clear indications that the White House, despite the objections of some Democrats, would go along with significant changes, perhaps including a form of means testing for Medicare benefits, altering the cost-of-living adjustments for entitlements and taxes (Hunt, 12/16).

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Democrats Wary Of Medicare Benefits Cuts Being Discussed In Fiscal Talks

Talk of hiking costs for wealthier beneficiaries and increasing the program's eligibility age appear to make some Democrats nervous and may be causing difficulties in the Democratic caucus.

The Hill: Democrats Want GOP To Show Hand On Medicare In Deficit Negotiations
Democrats wary of accepting any entitlement benefits cuts are asking Republicans to show them their plans if they want to make Medicare means-testing a part of a lame-duck fiscal package. GOP leaders have floated the idea of hiking Medicare costs for wealthier beneficiaries – a proposal President Obama has repeatedly backed – as a condition of any deal to prevent a slew of tax hikes and spending cuts from taking hold Jan. 1. But Speaker John Boehner (R-Ohio), the GOP's point man in the negotiations, has declined to specify the Republicans' wish-list for entitlement reform – at least publicly. And it's unclear whether means-testing would be enough to win GOP support for a deal that would also hike tax rates on households with annual family income above $250,000 (Lillis, 12/16).

Los Angeles Times: Fault Lines Also Appearing On Democratic Side In Fiscal Debate
White House officials insist nothing is off the table, tacitly acknowledging that the president is weighing potential changes to Medicare, Medicaid and Social Security as he negotiates with House Speaker John A. Boehner (R-Ohio). Although both sides have been reluctant to put details in writing, any deficit reduction deal will almost certainly require significant alterations to these entitlement programs. … The Democratic fault lines were apparent last week. More than 80 Democrats signed a letter to Obama urging him not to agree to a deal that would raise the eligibility age for Medicare. Obama had moved in that direction last year in a failed attempt to craft a "grand bargain" with Boehner, considering an increase phased in over time (Parsons, Memoli and Hennessey, 12/16).

The Hill: House Democrats Say Obama's Medicare Board Should Be Put On The Table
The healthcare law's controversial Medicare board should be on the table in deficit-reduction talks, House Democrats said this week. Killing the Independent Payment Advisory Board (IPAB), which Sarah Palin decried as a "death panel" in June, could ease Republican concessions as part of a year-end deficit deal, Dems said. "I think everything has to be on the table," said Rep. Dan Boren (Okla.), one of healthcare reform's most consistent Democratic opponents. "Anything that could help along the way to get some agreement," said Rep. David Scott (D-Ga.) (Viebeck 12/15).

Roll Call: CBC Pans Medicare Age Increase
An increase in the Medicare eligibility age, perhaps more than any other proposal getting bandied about in the fiscal cliff talks, would split President Barack Obama from the heart of his political base. Rep. Emanuel Cleaver II, D-Mo., the chairman of the Congressional Black Caucus, told CQ Roll Call last week that his caucus has been supportive of the president, but he said raising the Medicare eligibility age from 65 to 67 would present a tough choice between backing the president and protecting African-American seniors from bearing the brunt of the change. As Cleaver noted, African-Americans have much lower life expectancy than whites, so later eligibility affects them far more (Dennis, 12/16).

In addition, KHN takes a look at how health insurance tax inclusions could be in play.

Kaiser Health News: Capsules: Tax Exclusion For Health Benefits Could Be Part Of 'Fiscal Cliff' Talks
As the deficit debate continues, some policy wonks think it's inevitable that negotiators will address a loophole that allows workers to avoid paying taxes on the value of their job-based health insurance (Appleby, 12/14).

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Health Reform

HHS Left With Key Task Of Setting Up Insurance Exchange For More Than Half The States

More than 30 states are opting to not build the insurance marketplaces that are at the center of the health overhaul, so the job will be left to the federal government.

Los Angeles Times: Many States Leaving Insurance Exchanges To Federal Government
Despite years of prodding and pleading by the Obama administration, close to half of the nation's governors will not take a critical step to implement the president's health care law next year, leaving the job of running new insurance markets for their residents to the federal government (Levey, 12/14).

The Washington Post: Setup For States' Health Insurance Exchanges Is Massive Job With Crucial Deadline
Oregon's health insurance exchange needs a 150-person call center. Maryland's wants a public relations agency. And the Colorado exchange seeks something even more basic: a name. ... Officials in the states that did receive approval this past week to run their own health insurance exchanges describe the effort as a huge undertaking, with much work still to be done (Kliff, 12/15).

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. ... Most experts thought only states with small populations such as Delaware or Montana would seek federal help. Instead, most will rely on the federal government -- including two of the most populous states, Texas and Florida, which together account for nearly 20 percent of nation's uninsured (Galewitz, 12/14).

CQ HealthBeat: As The Dust Settles, 18 States And The District Opt For A State Exchange
Iowa's Republican governor announced Friday that his state would pursue a partnership, though he said he also reserved the state's right to withdraw. In another development late Friday, Utah Gov. Gary Herbert said in a letter to HHS Secretary Kathleen Sebelius that he intends to ask her agency to certify Utah's existing state exchange as compliant with the health care law. While the exchange likely won't meet standards set in the law, and Herbert acknowledged it is "atypical," he also said it should serve as the minimum standard for all exchanges (Norman, 12/14).

CNN: Decision Day For States On Health Insurance Marketplaces
For most people, the decision won't mean much initially. Whatever states decide, consumers and small businesses in every state will have access to a health insurance exchange -- a place for people without work-based coverage to buy a policy. Analysts also say plans and costs will likely be fairly similar regardless of who runs the marketplaces, which are supposed to begin accepting enrollments in October (Pearson, 12/14).

Politico: GOP Governors Can Gum Up Health Care
Can the governors do what Congress, the Supreme Court and the election couldn't do -- drive out Obamacare? Some of the law's opponents certainly hope so. ... The reality is that the governors' rebellion won't deliver a knockout blow -- but it can throw a pretty large amount of sand in the gears. Supporters of the law and exchange experts say the Department of Health and Human Services has the capability to set up exchanges in as many states as it needs to. But the passive resistance of so many governors could gum up the works if the feds have to handle millions of enrollments, questions from confused customers and greater health plan oversight (Millman, 12/16).

The Hill: HHS Approves Three More State-Based Exchanges
The Department of Health and Human Services (HHS) issued conditional approvals for the District of Columbia, Kentucky and New York to run their own health insurance exchanges. HHS Secretary Kathleen Sebelius also approved six states on Monday: Colorado, Connecticut, Massachusetts, Maryland, Oregon and Washington (Viebeck, 12/14).

Politico Pro: Utah To HHS: We'll Stick With Our Exchange
Utah Gov. Gary Herbert asked the Obama administration late Friday to declare that the state's existing exchange meets Affordable Care Act standards, The Associated Press reports. The letter echoes Herbert's request from earlier this week, when he wrote to President Barack Obama asking him to order HHS to certify Utah's exchange and set it as the minimum standard for meeting the ACA. HHS Secretary Kathleen Sebelius responded on Friday, expressing the administration's desire to work with Utah to certify its existing exchange, the AP reported earlier (Millman, 12/14).

Minnesota Post: Minnesota Task Force Finalizes Plan For Implementing Federal Health Care Reform
A Dayton administration task force has finalized its recommendations for implementing federal health care reform and lowering Minnesota's increasing health care costs. The key goal, as Department of Human Services Commissioner Lucinda Jesson put it: "We just need more health for our dollar." Thursday's report, which will go to the Legislature and the governor, endorses work the Dayton administration already has undertaken to create a state-based health insurance exchange -- a key mechanism of the federal health care law -- and to expand Medicaid eligibility (Nord, 12/14).

MPR: Minn. Meets Deadline For Health Exchange
Minnesota is already ahead of the game. The insurance exchanges have been a politically charged topic around the country, as some Republican governors and legislatures have stalled or spurned the idea of building exchanges in their states. The exchanges will allow consumers to comparison shop for health insurance in online marketplaces. Minnesota submitted its plan to build an exchange last month. The next major task is to enact legislation authorizing an exchange in Minnesota. Lawmakers say they'll have a bill ready when the session begins in January (Stawicki, 12/14).

Meanwhile, states such as Arizona continue to weigh the decision about a Medicaid expansion --

The Associated Press: Options Fewer As Arizona Weighs Medicaid Decision
It's almost a case of starting over for Gov. Jan Brewer as she weighs whether to ask legislators to provide government-paid health coverage to hundreds of thousands of additional low-income Arizonans. A new Obama administration pronouncement eliminated a middle option that was seen as potentially palatable for Brewer and at least some cost-conscious majority Republican legislators (Davenport, 12/16).

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'Obamacare' Roundup: Contraception Mandate, 'Grandfathered Plans' Face Challenges In 2013

A roundup of news on some of the challenges the health law's provisions face in the new year.

Politico: Department Of Justice: Put A Hold On Contraception Suits
There's no reason to try legal challenges to the contraception mandate brought by religious employers who are now protected from it until HHS decides how it will try to accommodate them, government lawyers told federal appellate court judges Friday. Arguing in the U.S. District Court of Appeals for the District of Columbia, Department of Justice attorney Adam Jed said Health and Human Services will release a proposed rule on the contraception accommodation in the first three months of 2013 and finalize it by August (Norman, 12/17).

Kaiser Health News: FAQ: Grandfathered Health Plans
If you get your insurance from your employer, there’s a very good chance that you are in a 'grandfathered plan' and that means some of the changes do not affect you -- yet. ... consumers should know the status of their plans since that may determine whether they are eligible for certain protections and benefits created by the health law (Barr, 12/16).

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Legal Settlement Paves Way For Medicare To Cover More Home Care

The Wall Street Journal: Medicare To Cover More Home Care
For years, Medicare recipients with chronic conditions have had difficulty qualifying for home health services administered by nurses and therapists. Now, a legal settlement between consumer advocates and the federal government has paved the way for patients with chronic conditions to receive such services both at home and in skilled-nursing and outpatient facilities (Tergesen, 12/16).

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System To Curb Medicare Fraudulent Payments Saves $115 Million

The Associated Press: New Medicare Fraud Detection System Saves $115 Mil
A highly touted new technology system designed to stop fraudulent Medicare payments before they are paid has saved about $115 million and spurred more than 500 investigations since it was launched in the summer of 2011, according to a report released Friday. Federal health officials said the projected savings are much higher (Kennedy, 12/15).

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Public Health & Education

School Shootings Raise Questions About Adequacy, Availability of Mental Health Care

President Barack Obama said at a prayer service Sunday that he would engage in a dialogue with all Americans, including law enforcement and mental health professionals, about how to curb rising gun violence, but psychiatrists say it's difficult to identify who among the mentally ill is likely to be truly dangerous.

ABC News: Connecticut School Shooting Leaves Nation With ‘Some Hard Questions,’ Obama Says
President Barack Obama said at an interfaith prayer service in this mourning community this evening that the country is “left with some hard questions” if it is to curb a rising trend in gun violence, such as the shooting spree Friday at Newtown’s Sandy Hook Elementary School. After consoling victims’ families in classrooms at Newtown High School, the president said he would do everything in his power to “engage” a dialogue with Americans, including law enforcement and mental health professionals, because “we can’t tolerate this anymore" (Tapper, 11/17).

Buffalo News: Better Care For Mentally Ill Won't Be Enough, Experts Say
For a nation of millions of broken hearts grasping for something, anything, to prevent yet another schoolhouse slaughter, the solution sounds simple: If we could just get the mentally ill the proper care, then the nation would be spared the agony of one more Newtown. The trouble is, that’s too simple a solution, and one that’s unlikely to work on its own, psychiatrists say. ... [they] say it’s nearly impossible to identify who among the mentally ill is truly dangerous, and that any effort to do so will only further stigmatize a category of illness where many people already shun treatment out of embarrassment and fear. And there’s one last important fact: The vast majority of mentally ill people are not prone to violence (Zremski, 11/16).

St. Louis Beacon: Blunt Calls For More Focus On Mental-Health Issues, In Response To School Shootings
U.S. Sen. Roy Blunt, R-Mo., says there's no question that the Connecticut murders of 20 school children and six educators is "a huge tragedy." But Blunt, in St. Louis on Saturday, said the question of a response "is a lot more complicated" than calls to ban assault weapons or to put in place other gun-control measures. ... Blunt said a [more] productive discussion than gun control could center on how to better monitor people with mental or emotional problems, which investigators say appear to have been suffered by the shooter, 20-year-old Adam Lanza (Mannies and Koenig, 12/16).

NPR: Shooting Raises Issues Of Mental Health, Treatment
[P]eople have been carrying out mass murderers for centuries. And researchers have been studying those people for almost as long, trying to come up with some kind of a profile of mass murderers; some way to identify somebody who is likely to commit this sort of crime. And for the most part they failed. I mean, yes, mass murderers tend to be young and male and angry and troubled. But think about how many young people fit that description in this country (Hamilton, 12/16).

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Health Care Marketplace

Marketplace: Hospitals Work On Insurance Arms; Walgreen Eyes Hospice Business

News outlets covered developments in the hospital and hospice industries.  

The Wall Street Journal: Hospital Systems Branch Out As Insurers
A growing number of hospital systems are moving to start their own insurance plans, aiming to broaden their roles and prepare for the changes coming under the federal health-care overhaul. Piedmont Healthcare and WellStar Health System, both in the Atlanta area, are set to announce a jointly owned insurance arm, with the goal of marketing coverage to employers and Medicare recipients in 2014. They also will consider selling coverage on a health exchange, one of the online insurance marketplaces required in each state by the health-overhaul law (Mathews, 12/16).

Earlier, related KHN story: Hospitals Look To Become Insurers, As Well As Providers Of Care (Rabin, 8/26).

Modern Healthcare: Walgreen Returns To Hospice Care
Looking to bolster sagging revenue, Walgreen Co. plans to launch a national platform targeting hospice providers as soon as next year, an about-face after jettisoning its long-term care pharmacy business two years ago. Providing medications to dying patients is more lucrative than retail sales, where the Deerfield-based company faces mounting price competition. The hospice pharmacy industry is particularly fragmented, making it attractive to a company with the heft of Walgreen (Sweeney, 12/16).

And in insurer news -

Medscape: Physician Groups Rank UnitedHealthcare Last Again
For the fourth year in a row, Medicare Part B has received the highest overall satisfaction score from group practice professionals and UnitedHealthcare has received the lowest score, according to the latest survey on third-party payers conducted by the Medical Group Management Association (MGMA). Medicare Part B and UnitedHealthcare also took the top and bottom spots, respectively, with regard to other key indicators of a happy business relationship, such as timely and accurate responses to questions, the claims appeals process, and full disclosure of payment policies (Lowes, 12/14).

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Poll: Cost Of Care Causes 3 In 10 Americans To Skip Necessary Medical Treatment

CBS: Gallup Poll: 3 In 10 Americans Skip Medical Care Due To Cost
A record number of Americans are skipping necessary medical care because of cost, according to a new Gallup poll. The poll of more than 1,000 U.S. adults found that 32 percent of Americans say they had to put off medical care for themselves or a family member over the past year because of finances. Gallup said that's the highest percentage since Gallup began tracking this measure 12 years ago, when 19 percent of Americans said they put off medical care. "The cost of healthcare is a longstanding issue in the United States," wrote Elizabeth Mendes on Gallup's website. "The rising costs can put personal as well as public health at risk if Americans forgo treatment they need because they feel they cannot afford it" (Jaslow, 12/14).

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Health Information Technology

Turning Small Errors Into Bigger Ones: A Problem For EHRs

Medpage Today: EHRs May Turn Small Errors Into Big Ones
As electronic health record systems become more interconnected, errors may propagate much farther than under old paper-based systems, a recent study suggested. According to a review by the Pennsylvania Patient Safety Authority, mistakes and near misses involving electronic health records were analogous to those made with paper-based records with one caveat: those made with EHRs tend to be amplified and can affect a larger group of people. The Authority's study looked at 3,099 reports from Pennsylvania hospitals detailing 3,946 problems. More than 2,700 incidents involved near misses and 15 involved temporary harm to patients. … Wrong medication was the No. 1 source of mix-ups, just as with paper-based records (Baum, 12/16).

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State Watch

In Calif., Will Court-OK'd Pay Reductions Make It Harder For Poor To Get Care?

Some worry that a Medicaid expansion in California could be hampered by reduced payments to Medi-Cal providers that a court approved last week, making it more difficult for the poor to find specialists.

Los Angeles Times: Advocacy Groups Coming Hat In Hand To A Less-Strapped Sacramento
The California Medical Assn. also wants more funding as the state prepares to enlarge health care coverage. David Ford, the group's associate director of medical and regulatory policy, said administrators will need more staff to process an influx of newly covered Californians. "We have to be ramping up," he said. Advocates worry that the new health care law will be undermined in California because the state's Medi-Cal cuts could make it harder for the poor to get care. A federal appeals court ruled Thursday that the state can reduce payments to doctors and others who care for Medi-Cal patients; provider groups say they will appeal (Megerian, 12/17).

Los Angeles Times: Health Care Crisis: Not Enough Specialists For Poor
Many of the newly insured will receive Medi-Cal, the government plan for the needy as administered through the state of California. Clinics already struggle to get private specialists to see Medicaid patients because of the low payments to doctors. Last week, an appellate court decision that authorized the state to move forward with 10 percent cuts in Medi-Cal reimbursement, which could make finding doctors for those patients even more difficult (Gorman, 12/15).

The Associated Press: Providers: Medi-Cal Cuts Could Hurt Health Reform
Health providers and advocates for the poor say they are worried that California's cuts to Medi-Cal will hamper the state's ability to expand and improve health care under President Barack Obama's overhaul. A federal appeals court backed California's right to cut payments by 10 percent, saving the state more than $330 million a year. An attorney representing a group of pharmacies said they would appeal next week (Lin, 12/14).

CQ HealthBeat: Critics Say California Medicaid Cuts Upheld By Appeals Panel Bode Ill For Health Care Law
[E]ven if its impact is limited to California, it could have a big impact on [Medicaid] expansion under the health care law. "I can't speak to other states and whether this sets a precedent for them," said Molly Weedn of the California Medical Association in a brief interview. ... if the cuts take effect, the promise of health coverage for some 2.5 million to 3 million residents of the state amounts to a "false promise" because doctors won’t be able to treat them, she said. They already are being paid the lowest Medicaid rates in the nation, even before any cuts, and couldn’t keep their doors open if they accepted the state’s newly covered residents, she said (Reichard, 12/14).

Other states consider new programs to extend Medicaid coverage to some residents --

The Denver Post: New Colorado Medicaid Program Helps Middle Class With Long-Term Issues
The state of Colorado agreed, expanding Medicaid in July to allow middle-class families of children with severe, ongoing disabilities to "buy in" to the insurance traditionally for the low-income. The new benefit is being used by more than 160 children. It's being paid for with funds from the hospital provider fee created in 2009 to expand Medicaid eligibility in Colorado, and federal matching money. The state says no Colorado general funds are used for the Children's Buy-In (Booth, 12/16).

The Associated Press: NC Governor Still Working On Group Home Solutions
Gov. Beverly Perdue won't release her solution to ensure certain group home residents losing Medicaid coverage can keep a roof over their heads until probably next week. It may give her time to address another problem involving Alzheimer's disease and dementia patients. The outgoing Democratic governor said earlier this week she hoped to unveil by Friday a plan to address denied coverage for personal care services to about 2,000 residents in group homes starting Jan. 1 (Robertson, 12/14).

And many of Wisconsin's health care players sit on the fence over expanding Medicaid  --

Milwaukee Journal Sentinel: Nonprofit Health System Ducking Medicaid Issue
The nonprofit health systems in the Milwaukee area are quick to state their support for access to care and to note the costs they incur from people who don't have health insurance. But that doesn't mean they are urging Gov. Scott Walker to expand the Medicaid program under the Affordable Care Act, even with the federal government paying 100 percent of the cost through 2016, before declining to 90 percent in 2019. The governor's decision will determine whether 125,000 to 150,000 people in the state gain health insurance in 2014. So far, the five health systems that treat adults in the Milwaukee area are ducking the issue. The same holds true for community health centers, which provide primary care to many of the uninsured in Milwaukee. They, too, haven't taken a stand on whether the state should expand Medicaid to include low-income adults not eligible for coverage now. Nor has the Wisconsin Hospital Association or the Wisconsin Primary Health Care Association, which represents the state's community health centers. Only the state's largest medical societies have made their position clear (Boulton, 12/15).

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State Roundup: Some Medical Students Forced To Change Course After Sandy

A selection of health policy stories from New York, North Carolina, Connecticut, Wisconsin and Colorado.

Kaiser Health News: Capsules: Med Students Switch Gears After Sandy KO's Training Hospitals
After completing a medical rotation in pediatrics, Hannah Kirsch was looking forward to starting another one in psychiatry at New York City's Bellevue Hospital -- but then Hurricane Sandy hit. Kirsch is among about 170 third-year and fourth-year medical students at New York University who were required to change their plans after two of NYU's academic training hospitals, NYU Langone Medical Center and Bellevue, temporarily closed due to extensive flood damage (Tran, 12/17).

Raleigh News And Observer: Doctors Join Hospitals, And Prices Soar
North Carolina patients pay more for many tests and procedures if their physician is employed by a hospital, an investigation by The News & Observer and The Charlotte Observer has found. It’s true whether the health care offered is a heart stress test or a routine visit to a doctor's office. And it's part of a national shift that experts say is raising costs but not quality: Hospitals are increasingly buying doctors' practices, then sending bills for routine services that are significantly higher than those charged by independent doctors. By one count, the percentage of doctors nationally who are employed by hospitals has doubled over the past decade. No similar statistics are available in North Carolina, but it's clear that more and more doctors are affiliating with hospitals (Neff, Alexander, Garloch and Raynor, 12/16). 

CT Mirror: State Budget Talks Press On Though There Are No 'Easy Choices'
State officials who toiled behind closed doors last week trying to close a shortfall in the current budget described it as a task like no other in recent history. And while they took comfort Friday afternoon that bipartisan commitment to a solution remained strong, they also conceded that the challenge, at times, has been painstakingly slow. … State law gives the governor limited authority to reduce spending in most agencies by up to 5 percent without obtaining the approval of the legislature. Though the statute exempts municipal aid from the governor's rescissionary authority, other segments of the budget effectively are exempt as well because of contractual obligations or federal rules governing health care programs. Many of the governor's cuts last month affected social services and education. And the plan Malloy offered earlier this month to cover the rest of this year's deficit also included significant cuts in social services (Phaneuf, 12/17).

Milwaukee Journal Sentinel: Milwaukee County Seeks To Expand Family Care Program To 5 More Counties
Milwaukee County is poised to expand its role operating state Family Care services for older residents and those with disabilities into five additional counties. The expansion plan, which has won initial state approval, would put Milwaukee County's program into competition with a private firm already serving clients in Waukesha, Washington, Walworth, Ozaukee and Sheboygan counties. ... Growing to a regional provider of care services will help ensure the Milwaukee County program survives and thrives in a more competitive environment, said Maria Ledger, director of the Milwaukee County program (Schultze, 12/16).

Health Policy Solutions (a Colo. news service): 'Design Thinking' Offers New Approach To Tackling Childhood Obesity
For organizations and individuals working to address the epidemic of childhood obesity, the biggest challenge is to make it fun. Or at the very least to avoid making it humiliating, frustrating, boring and punitive. "We need to bring back creativity. Creativity is crucial to solving the obesity crisis," said Chris Waugh, director and co-founder of the design innovation consultancy IDEO. Waugh spoke Friday at an event called Symposium Unplugged, sponsored by the Colorado Health Foundation (Carman, 12/14).

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Editorials and Opinions

Viewpoints: Raising Medicare's Entitlement Age Doesn't Save Money; New Anti-Fraud Efforts

Los Angeles Times: Medicare: Is 67 The New 65?
Looking for ways to slow the growth of entitlement programs, budget negotiators in Washington are considering making seniors wait two years longer to qualify for Medicare — from age 65 to 67. Many Republicans have endorsed the idea, noting that Medicare beneficiaries now live far longer on average than they did when Congress created the program in 1965. The problem with the proposal is that it wouldn't save the federal government much money overall, even though it might cut Medicare's costs. Worse, it would probably cause total spending on healthcare to go up faster, which is the opposite of what Washington should be trying to achieve (12/14).

Los Angeles Times: Stem Cell Conflicts
The California Institute for Regenerative Medicine, the quasi-governmental agency authorized to spend $3 billion in taxpayer money on embryonic stem cell research, deserves praise for commissioning an independent study of its operations by a blue-ribbon committee of the Institute of Medicine, the health arm of the National Academy of Sciences. But the $700,000 spent on the study — funded by donations — will be wasted if the institute's oversight board fails to heed the committee's criticisms, which echo the findings of the Little Hoover Commission and other groups over the years (12/14).

Wall Street Journal: Haley's Dilemmas
South Carolina Gov. Nikki Haley faces two politically fraught decisions in the coming days that could help or hinder her re-election in 2014. The first is whom to appoint to retiring Sen. Jim DeMint's seat until a special election is held in 2014. ... Ms. Haley is also under considerable pressure to reverse her decision to reject the ObamaCare Medicaid expansion. Although Uncle Sam would initially pay for most of the expansion, Ms. Haley says the state would be on the hook for $1.7 billion in 2020. Provider groups and health non-profits—including the March of Dimes, United Way and the American Heart Association—have been urging legislators to ignore Ms. Haley and take the $3 billion in "free" federal cash (Allysia Finley, 12/14).

The Arizona Republic: Expansion Of AHCCCS Is Arizona's Best Option
On Monday, the Obama administration announced that Arizona must expand its Medicaid program, the Arizona Health Care Cost Containment System, to everyone who is below 138 percent of the federal poverty level to be eligible for the increased federal match provided for in the Affordable Care Act. Unfortunately, this move places Arizona's health-care system and the vulnerable people AHCCCS serves on the critical list (Robert Meyer and 10 other co-authors, 12/14).

Politico: Stopping Health Care Fraud Before The Bills Are Paid
Everyone agrees that one area where we can save billions of dollars for taxpayers is fighting health care fraud. The Obama administration has taken important steps to crack down on fraud that are already yielding record results. As a result of the Affordable Care Act, doctors, hospitals and other health care providers and suppliers seeking to bill Medicare, Medicaid and the Children's Health Insurance Program are now required to undergo an enhanced level of scrutiny if they pose a risk of fraud or abuse. ... One of the most exciting new steps we're taking is to use state-of-the-art technology, similar to the technology that credit card companies use to flag suspicious activity, to review medical claims before they are paid. ... Since the technology was first used in 2011, all Medicare claims — over 1 billion — have run through the system before they were paid (Peter Budetti, 12/14). 

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Stephanie Stapleton

Andrew Villegas

Shefali S. Kulkarni
Ankita Rao
Alvin Tran

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2012 Kaiser Health News. All rights reserved.