Daily Health Policy Report

Tuesday, December 18, 2012

Last updated: Tue, Dec 18

KHN Original Reporting & Guest Opinion

Fiscal Cliff

Health Reform

Capitol Hill Watch

Quality

Health Care Marketplace

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Seniors Need To Be Tenacious In Appeals To Medicare

Reporting for Kaiser Health News in collaboration with The Washington Post, Susan Jaffe writes: "Dan Driscoll used to be a smoker. During a regular doctor's visit, his primary-care physician suggested that Driscoll be tested to see if he was at risk for an abdominal aortic aneurysm, a life-threatening condition that can be linked to smoking. The doctor said Medicare would cover the procedure. So Driscoll, 68, who lives in Silver Spring, had the test done and was surprised when he got a bill from Medicare for $214" (Jaffe, 12/17). Read the story and the related sidebar.

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After Newtown Shootings, Questions About Mental Health Insurance Coverage

Kaiser Health News staff writer Jenny Gold reports: "Insurance coverage for mental health treatment has long been spotty. More than a quarter of U.S. adults have a diagnosable mental health problem in any given year, but fewer than half receive treatment. While the Affordable Care Act, along with the Mental Health Parity Act of 2008, go a long way toward assuring coverage for most Americans, some gaps persist. There are questions, for example, about just what counts as equivalent treatment under the parity law, and whether it's being fully enforced. Here are some answers to frequently asked questions about mental health coverage" (Gold, 12/18). Read the story.  

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Study Finds Coverage To Help Kick Smoking Can Be Tricky

In her latest Kaiser Health News consumer column, Michelle Andrews writes: "Most people who smoke want to quit, and the 2010 health-care law is supposed to make it easier for them by requiring many insurance plans to cover smoking-cessation treatments with no out-of-pocket cost to members. But a recent study found that details about what's covered and who pays for it remain confusing and inconsistent" (Andrews, 12/17). Read the column.

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Political Cartoon: 'Three Kings?'

Kaiser Health News provides a fresh take on health policy developments with "Three Kings?" by Chris Weyant.

Meanwhile, here is today's health policy haiku:

IN THE WAKE OF FRIDAY'S EXCHANGE DEADLINE...

Eighteen states will run
their own health marketplaces.
Is that a good sign?
-Anonymous 

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

Obama, Boehner Trade 'Fiscal Cliff' Offers, Express Optimism About Possible Deal

President Barack Obama's latest offer does not include a Republican proposal to increase the Medicare eligibility age from 65 to 67. Meanwhile, The Wall Street Journal reports on how health care spending is driving the nation's debt, while USA Today details a new poll showing the public favors the president in the fiscal talks.

The New York Times: Obama’s New Offer On Fiscal Crisis Could Lead To Deal
The offer is close to a plan proposed by the speaker on Friday, and both sides expressed confidence that they were closing in on a major deficit-reduction plan that could be passed well before January, when more than a half-trillion dollars in automatic tax increases and spending cuts would kick in (Weisman, 12/17).

The Washington Post: Obama, Boehner Move Closer To ‘Cliff’ Deal
Obama laid out a counteroffer that included significant concessions on taxes, reducing the amount of new revenue he is seeking to $1.2 trillion over the next decade and limiting the hike in tax rates to households earning more than $400,000 a year. … Obama also gave ground on a key Republican demand — applying a less-generous measure of inflation across the federal government. … In addition, Obama increased his overall offer on spending cuts. … Meanwhile, the possibility remains that the deal could get even more distasteful for Democrats, particularly if Republicans counter Obama's request for $1.2 trillion in new taxes with a demand for an additional concession on health care, such as raising the eligibility age for Medicare beneficiaries from 65 to 67 (Montgomery and Kane, 12/17).

Los Angeles Times: Boehner, Obama Meet Amid Optimism On 'Fiscal Cliff'
Boehner made a substantial shift over the weekend by offering to raise tax rates on those making more than $1 million a year, a significant change from Republican orthodoxy against higher tax rates. Aides described it as an optimistic overture, even though the White House did not accept the proposal. … By proposing the rate hike on the super wealthy, Boehner can be seen as offering a substantial compromise toward Obama, even though the offer falls short of the president’s preferred approach. … At the same time, the spending cuts Boehner would extract in exchange for the new tax revenue would likely be severe -- changes to Medicare, Medicaid and other social safety net reductions that Democrats would resist (Mascaro and Hennessey, 12/17).

The Wall Street Journal: With New Offers, Fiscal-Cliff Talks Narrow
The president's offer notably didn't include a Republican proposal to increase the Medicare eligibility age from 65 to 67, an idea opposed by many Democrats. And to blunt Democratic resistance to changing the formula for calculating Social Security benefits, his plan would include protections for beneficiaries of the program deemed "most vulnerable," people familiar with the talks said (Lee, Hook and Paletta, 12/17).

The Associated Press/Washington Post: Obama Softens Stance On Taxes As He And Boehner Seek A 'Fiscal Cliff' Compromise
And in a move sure to create heartburn among some congressional Democrats, Obama is proposing lower cost-of-living increases for Social Security beneficiaries, employing an inflation index that would have far-reaching consequences, including pushing more people into higher income tax brackets. … In making his offer, Obama stiff-armed Republican demands to increase the eligibility age for Medicare from 65 to 67, a goal Democrats strongly reject. He also sought to contain cuts in Medicare and other health care programs to about $400 billion over 10 years, less than what Republicans want (12/18).

Politico: Obama Makes New Offer To Narrow Gap On Cliff
But questions remained over whether Boehner could sell the key points to Republicans at a pivotal meeting Tuesday. The progress is fragile, and the next 24 hours are critical as lawmakers from both parties and interest groups on all sides weigh in (Budoff Brown and Bresnahan, 12/18).

CNN: Fiscal Cliff Talks Centered On GOP $2 Trillion Proposal
Democratic sources tell CNN part of the issue now is that the trillion in spending cuts comes from some changes to entitlement programs such as reforms to Medicare – along with a discussion of raising the eligibility age. These Democratic sources say it is unclear if those Medicare changes could pass the House or Senate, because they may be too deep for many Democrats. Pushing the talks to a new stage, Speaker Boehner relented over the weekend on his opposition to any tax rate increases, and proposed that tax rates be allowed to go up on those making a million or more per year. In addition to new revenue from the wealthy, Boehner is also proposing closing some tax loopholes and limiting some deductions. As he has in previous offers, the speaker is also pushing for the White House to agree to change the way inflation is adjusted for federal benefits like Social Security (Walsh and Bash, 12/17).

The Wall Street Journal: Beneath Budget Battle, A Health-Spending Juggernaut
Is all this talk of the "fiscal cliff" making you sick? Actually, it's the other way around: The biggest long-term driver of the federal budget and its eye-popping deficit is health care. The government dollars go out the door through a variety of programs: benefits for federal workers, the military and veterans; Medicaid coverage for the poor and disabled; and the biggest slice of all, Medicare, the health-care program serving the elderly (Meckler, 12/ 17).

USA Today: Poll: Public Favors Obama In 'Fiscal Cliff' Talks
According to the latest USA TODAY/Gallup Poll, 66% said the two negotiators should compromise "on their principles and beliefs" on taxes and spending to avert the year-end "fiscal cliff" … Boehner is also seeking deeper spending cuts, particularly to entitlement programs, such as Medicare and Social Security, in exchange for more revenue. … Possible entitlement reforms such as raising the eligibility age for Medicare benefits and changing the way the government calculates cost-of-living adjustments for Social Security beneficiaries have been presented by the GOP. Both proposals face strong opposition from Democrats, who have not included entitlement benefits in their spending cut proposals (Page, 12/17).

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Medicare Issues In Play: IPAB, The Doc-Fix And The Eligibility Age

News outlets report on how specific Medicare-related proposals and provisions are holding up in the continuing negotiations to avert the so-called fiscal cliff.

Politico: The Medicare Payment Panel Everyone Loves To Hate
Largely unspoken in the fiscal cliff Medicare fight is this fact: The Democrats' health law already includes a legally binding brake on Medicare spending. And the Republicans can't wait to get rid of it (Kenen, 12/18).

CQ HealthBeat: Panelists Say Increasing Medicare Eligibility Age Would Save Money But Shift Costs Widely
Raising the Medicare eligibility age to 67 would save the program money but would also drive up costs for employers and out-of-pocket charges for a vulnerable population, while increasing overall health care spending and causing hundreds of thousands of Americans to become uninsured, panelists said at a Capitol Hill forum on Monday. One of the speakers, former Medicare and Medicaid Administrator Gail Wilensky, didn't dispute those conclusions by her fellow panelists at the event sponsored by the Alliance for Health Reform. But she emphasized that it's important to begin moving to the higher age as part of a broader set of policies to change younger Americans' perceptions about what they can expect from entitlement programs (Reichard, 12/17).

The Hill: Doctor's Group Calls For 'Doc Fix' In Fiscal Cliff Bill
Congress should permanently repeal Medicare's flawed payment formula as part of a year-end deal to avoid the so-called fiscal cliff, the Alliance of Specialty Medicine said Monday. The Alliance said a deal to avoid the fiscal cliff should include a permanent "doc fix." Doctors will see their Medicare payments cut by nearly 30 percent at the end of this year if Congress does not act, although a permanent fix is unlikely. Some congressional Republicans have been angling for a one-year fix by the end of 2012, with or without a deal on the fiscal cliff. Congress routinely delays the automatic cuts built into Medicare's Sustainable Growth Rate formula (Baker, 12/17).

Medpage Today: AARP: Bumping-Up Medicare Age 'Bad Economics'
Policymakers are still considering raising Medicare's eligibility age to 67 as a way to solve the nation's fiscal woes, but that's not a good idea, several healthcare analysts said here Monday. Washington budget hawks are contemplating moving the eligibility age from 65 to 67 as a way to save more than $100 billion in federal spending in the next decade. However, moving the eligibility age wouldn't cure Medicare's spending woes and would only shift costs to seniors, speakers said at an event on the topic Monday hosted by the Alliance for Health Reform. … By the AARP's estimate, 5% of the 5 million beneficiaries (affected) by the policy change would be left uninsured (Pittman, 12/17).

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Health Reform

18 States Plan To Operate Their Own Health Exchanges

This total was announced in a Monday blog post by Health and Human Services Secretary Kathleen Sebelius. Meanwhile, Virginia Gov. Bob McDonnell announced Monday that his state will bow out of the another key aspect of the health law: Medicaid expansion.

Reuters: Health Insurance Exchanges Planned By 18 U.S. States: Sebelius
The deadline for states to inform the federal government if they would operate healthcare exchanges under President Barack Obama's healthcare reform law was December 14. The number of states participating was in line with expectations and leaves the government to create online marketplaces for the rest of the country. The exchanges are one of the key aspects of the U.S. Patient Protection and Affordable Care Act (Humerm, 12/17).

Modern Healthcare: 10 More State Exchange Plans Submitted
States have until mid-February to indicate if they want to operate an exchange in partnership with the federal government. HHS received blueprint applications from California, Hawaii, Idaho, Minnesota, Mississippi, Nevada, New Mexico, Rhode Island, Vermont and Utah by last Friday's midnight deadline. Last week, HHS announced that it had granted eight states—Colorado, Connecticut, Kentucky, Massachusetts, Maryland, New York Oregon and Washington—as well as Washington, D.C., conditional approval of the plans those states had submitted to run their exchanges (Zigmond, 12/17).

Politico Pro: Virginia Governor Says No Medicaid Expansion
Virginia Gov. Bob McDonnell bowed out of the Affordable Care Act’s Medicaid expansion Monday, warning of the program’s skyrocketing costs and other state investments needed to comply with the health law. “Medicaid is the second largest program in our general fund budget. It has grown exponentially at nearly 1,600 percent over the past 30 years to now consume nearly 21 percent of the state budget" (Cheney, 12/17).

CNN Money (Video): How Your Health Care Will Change In 2013
The piece by piece implementation of the Affordable Care Act of 2010 is bringing a few more changes to your health care in 2013 [includes details of flexible spending account changes and requirements about details of your health plan]  (Gengler, 12/17).

Also in the news, a report by the Government Accountability Office concludes that the Centers for Medicare & Medicaid Services Innovation Center needs to do better in one area --

Politico Pro: GAO: Innovation Center Not Avoiding Overlap
The top auditor for Congress says the new Innovation Center needs to work harder at making sure it’s not duplicating efforts with the rest of CMS. Innovation Center officials have tried to coordinate with CMS as both offices experiment with better, more efficient ways of paying providers — but they need to step up their endeavors, the Government Accountability Office said. “Our review … suggests that while the Innovation Center has taken steps to coordinate with other offices, it still has work to do in making this coordination more systematic,” GAO wrote in a report that’s expected to be made public Monday (Cunningham, 12/17).

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Capitol Hill Watch

House Republicans Seeking IRS Response On Health Law Subsidies

Prominent GOP committee chairmen are looking for documents that could affect the Internal Revenue Service rule about subsidies on the federal health insurance exchanges.

CQ HealthBeat: House Panels Seek More Information On Health Care Subsidies Rule
Republican leaders of two House committees are seeking unredacted versions of documents related to an IRS rule that they say is inconsistent with language of the 2010 health care law ... Ways and Means Chairman Dave Camp of Michigan, the panel’s Oversight Subcommittee Chairman Charles Boustany Jr. of Louisiana, and Oversight and Government Reform Chairman Darrell Issa of California said the Treasury Department agreed to a private review of internal documents after meetings between their staffs. Both committees had previously requested information related to the rule, which addresses the law’s subsidies to help eligible individuals buy insurance through exchanges beginning in 2014 (Attias, 12/17).

The Hill: House GOP Seeks More Documents In Probe Of Health Law’s Subsidies
The healthcare law provides subsidies for most people who buy insurance through a new insurance exchange. The law envisioned each state operating its own exchange, but authorized a federally-run fallback in states that don't act. The statute refers to subsidies flowing through a "state exchange" — which, to the law's critics, means subsidies shouldn't be available in the federal exchange. The IRS has said it determined that Congress intended for subsidies to be available in both state- and federally-run marketplaces, but Republicans have pressed the tax agency to back up that assertion (Baker, 12/17).

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Quality

Health Care Quality: Hospital Readmission Rates, Innovations In Patient Care

Modern Healthcare reports on new research that raises questions about the relationship between shorter hospital stays and higher hospital readmission rates.

Modern Healthcare: Shorter Hospital Stays Don't Necessarily Mean Higher Readmissions: Study
Hospitals that have grappled with how best to curb length of stay while also preventing readmissions may find comfort in a new study that suggests that a drop in the former does not necessarily mean a greater number of the latter. Using 14 years of data from 129 Veterans Affairs hospitals, researchers concluded that an overall reduction in risk-adjusted length of stay was not associated with a corresponding spike in 30-day readmission rates, according to the VA-funded study, published Monday in the Annals of Internal Medicine. From 1997-2010, overall length of stay for the five conditions examined fell nearly 27%, to 3.98 days from 5.44 days. Meanwhile, 30-day readmission rates for those conditions, including heart failure and heart attack, fell to 13.8% from 16.5% (McKinney, 12/17).

Meanwhile, The Wall Street Journal explores innovations that are improving patient care and outcomes, while also lowering costs -

The Wall Street Journal's The Informed Patient: Ten Ways Patients Get Treated Better
Even healthy people worry about the quality of care they can expect to receive when they become ill. Will a cancerous tumor be spotted early enough? Will hospital staff move fast enough to save my life? What is the worried-looking doctor scribbling in my chart? Health-care innovations aren't limited to drugs and devices. Experts increasingly are adopting new ways to treat patients that studies show are better at healing the sick, preventing disease, improving patients' quality of life and lowering costs (Landro, 12/17).

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Health Care Marketplace

Amgen Expected To Enter A Guilty Plea To Unspecified Charges

The biotech giant is expected to plead guilty in a New York federal court criminal case. Some reports suggest the charges relate to "misbranding" -- which refers to the promotion of drugs for uses that have not gained the Food and Drug Administration's approval.

The New York Times: Amgen Expected To Plead Guilty In U.S. Case
But one person close to the investigation said Amgen would plead guilty to misbranding, a charge that usually refers to promoting drugs for uses not approved by the Food and Drug Administration. Amgen announced 14 months ago that it had set aside $780 million for a settlement of federal and state investigations and 10 separate whistle-blower lawsuits. Much of the investigations are believed to involve its anemia drugs, Aranesp and Epogen. In more recent regulatory filings, Amgen said the settlement was likely to include an 11th whistle-blower suit, one regarding the marketing of Enbrel, its blockbuster drug for rheumatoid arthritis and psoriasis (Pollack, 12/17).

Los Angeles Times: Amgen Is Expected To Plead Guilty To Unspecified Charges
Biotech giant Amgen Inc. is expected to plead guilty Tuesday in a criminal case in New York federal court, according to prosecutors. The Thousand Oaks company is scheduled to enter a plea to unspecified charges, according to a notice from the U.S. attorney's office in Brooklyn. Federal prosecutors couldn't be reached for further comment. Amgen didn't respond to requests for comment late Monday (Terhune, 12/18).

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More Surgeons Opting For Hospital Jobs

Medscape: Surgeons Choose Hospitals Employment Over Private Practice
General surgeons and surgical subspecialists are opting for hospital employment over private practice, according to a database study published online December 17 in the Archives of Surgery. The researchers found that the trend was particularly strong among surgeons who are younger or female. Data from the American Hospital Association indicate that the number of US physicians employed by a hospital has increased by 32% since 2000, according to Anthony G. Charles, MD, MPH, from the Department of Surgery at the University of North Carolina School of Medicine in Chapel Hill, and coauthors (Barclay, 12/17).

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Public Health & Education

Conn. Shootings Spur Questions About Adequacy Of Mental Health Services

Some news organizations also covered the stigma faced by people with mental health problems.

CQ HealthBeat: After Shooting, Congress Ponders Mental Health Role
Lawmakers in both chambers are calling for Congress to start a conversation about mental health issues in the wake of last week’s deadly shooting at a Connecticut elementary school, with one goal of ensuring adequate funding for services for those who need treatment. Although much of the discussion since last week’s shooting has focused on gun policy, several members are also emphasizing the role that mental illness has played in many national tragedies. Congress has taken little action on the issue this year, and mental health leaders are hopeful that events in Newtown, Conn., could spur lawmakers to move forward (Attias, 12/17).

Politico Pro: Carney: Mental Health Part Of Newtown Response
White House spokesman Jay Carney invoked the Affordable Care Act on Monday when discussing the mental health implications of last week’s shooting massacre in Newtown, Conn. — namely, that the health law requires mental health services to be a part of the basic insurance package that millions of Americans are slated to get. “Obamacare, if you will, has ensured that mental health services are a part of the services that the 30 million additional Americans … will receive,” he said (Cheney, 12/17).

The New York Times: Fearing A Stigma For People With Autism
Amid reports from neighbors and classmates that the gunman in the shooting rampage in Newtown, Conn., had an autism variant known as Asperger syndrome, adults with the condition and parents of children with the diagnosis are fighting what they fear may be a growing impression that it is associated with premeditated violence. Individuals with autism spectrum disorders, who are often bullied in school and in the workplace, frequently do suffer from depression, anxiety and suicidal thoughts … But experts say there is no evidence that they are more likely than any other group to commit violent crimes (Harmon, 12/18).

St. Louis Beacon:  The Difficult Relationship Between Mental Health And Violence
Statistics show that the overall contribution to violence by mentally ill people in the United States is "exceptionally small," according to Jackie Lukitsch, director of advocacy at the National Alliance on Mental Illness in St. Louis. But the persistent belief that mental illness equals violence feeds a harmful stigma and may actually prevent people from getting help. "Stigma is the No. 1 reason people don’t seek mental-health care when they need it," Lukitsch said. "Getting it, I think, would reduce the possibility of these incidences" (Fowler, 12/18).

Kanas Health Institute: Mass Shootings Raise Concerns About Kansas Mental Health System
[Rick Cagan] runs the National Alliance on Mental Illness-Kansas Chapter office in Topeka. ... Mass shootings nearly always rekindle debates about gun control and the adequacy of the nation’s mental health system. Commenting on the latter, Cagan said many Kansans with mental illness are not getting the early treatment they need to avoid crises. … In Kansas, state-hospital admissions are reserved for adults who are seriously mentally ill and have been deemed a danger to themselves or others (McLean, 12/17).

WBUR: Former Commissioner Laments Weaknesses In Mass. Mental Health System
WBUR’s All Things Considered host Sacha Pfeiffer spoke with former state mental health Commissioner Marylou Sudders, who’s now on the faculty at Boston College, about the state of mental health services for children in Massachusetts (Pfeiffer, 12/17).

WBUR: Gaps Found In Care, Safety In Mass. Group Homes
Valerie Diaz’s worst fears were realized when ... [h]er 24-year-old daughter, an ambitious singer afflicted with debilitating mental illnesses, had been found by workers at the Somerville, Mass., group home where she lived, dangling from a pipe. Her family is now questioning how closely Holloway was supervised at the home, run by a private vendor hired by the Massachusetts Department of Mental Health. ... An ongoing state investigation into Holloway’s death comes as DMH strives to shore up its battered community mental health system, the subject of two critical oversight reports issued in the past 18 months that highlight deep fissures in client care and worker safety (Becker, Mulvihill, and Stine, 12/18).

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State Watch

State Roundup: Colo. Gov. Wants $18.5M For Expanded Mental Health Care

A selection of health policy news from Minnesota, Georgia, Colorado, Montana, Texas, Florida and Connecticut.

MPR: PCA Pay Disparity Unconstitutional, Rules Minn. Appeals Court
The state's effort to reduce pay for some personal care attendants has hit a snag. The Minnesota Appeals Court ruled Monday that the state's attempt to pay PCAs who care for relatives 20 percent less than other personal care attendants is unconstitutional. "They have the same training, they have the same experience, they're limited to the same number of maximum hours," said attorney David Bradley Olsen, who represents 11 agencies and several personal care assistants who sued over the matter. ... PCA's are often parents or grandparents who care for an adult child or relative for $10 an hour, Olsen said (Aslanian, 12/17).

The Associated Press: CO Gov. Wants $18.5M To Expand Mental Health Care
Gov. John Hickenlooper is asking Colorado lawmakers for $18.5 million to expand mental health services, including opening five urgent care mental health centers, as a response to this summer's mass shooting at an Aurora theater. The governor's office said Monday that the services Hickenlooper and state health officials are proposing are aimed at redesigning and strengthening Colorado's system for taking care of the mentally ill, an issue that has received more attention in the wake of the July's shootings (Moreno, 12/17).

Modern Healthcare: Seeking Data Access And Lower Costs, Ga. Health Systems To Launch Insurance Plan
Two Georgia health systems will enter the insurance market in a bid for greater control over patients' medical data and benefits design. Executives said the move is necessary to better coordinate care. Piedmont Healthcare in Atlanta and WellStar Health System in Marietta said they agreed to launch a health plan in about a year. The venture continues a string of deals pairing insurers with providers as the industry reacts to policy changes that are expected to payments to hospitals and physicians and increase financial incentives for lower-cost, higher-quality medical care. Insurers have recently acquired or announced deals for hospitals, medical groups and other providers. Humana acquired Concentra, an urgent-care and occupational-care provider; UnitedHealth Group bought Monarch HealthCare; and insurer Highmark bid to acquire West Penn Allegheny Health System in Pittsburgh (Evans, 12/17).

MPR: Blue Cross And Blue Shield MN Names New CEO
The state's largest commercial health insurer, Blue Cross and Blue Shield of Minnesota, has named a new CEO. Former Aetna executive Michael Guyette takes over the helm of Blue Cross and Blue Shield Jan. 7. The Eagan-based non-profit has had a quick succession of CEOs in the past year and a half. Guyette replaces Scott Lynch who filled in as interim president and CEO after the board of trustees ousted Ken Burdick after only six months on the job. Burdick had replaced Patrick Geraghty who took over as CEO of Blue Cross and Blue Shield of Florida (Stawicki, 12/17).

The Associated Press: Montana Supreme Court Upholds Lower Court, Rejects Request From Gay Couples For Equal Benefits
The Montana Supreme Court on Monday rejected an "overly broad" request that gay couples be guaranteed the same benefits as married couples, but left the door open for advocates to modify their case and try again. The plaintiffs promised to do so, declaring they are "on the right side of history" and will inevitably win (12/17).

California Watch: Report Estimates Health Plan Overbilled Medicare
Medicare may have overpaid an estimated $424 million to PacifiCare of California's Medicare Advantage plan based on risk assessments that in many cases made patients seem sicker than they were, according to a federal oversight agency. Medicare Advantage plans send patient diagnosis codes to Medicare, which boosts plan rates if clients are affected by serious medical conditions (Jewett, 12/17).

The Texas Tribune: State, Drug Company At Odds Over Pre-Term Birth Therapy
The distributor of a drug designed to prevent pregnant women from delivering premature babies has sued a number of states, and Texas could be next. The drug, Makena, which is marketed by St. Louis-based KV Pharmaceutical, is the only version of 17-alpha hydroxyprogesterone caproate, or "17P," FDA-approved to treat women at high risk of premature delivery. But its high cost — especially compared with an unbranded drug produced by “compounding pharmacies” that customize medications — has prompted some state Medicaid programs to refuse to offer it (Ramshaw, 12/18).

Also see related KHN story: Insurance Policies Favoring Compounded Drugs For High-Risk Pregnancies Draw Scrutiny

Health News Florida: FL Medicaid Doctors To Get 105% Raise
Florida is one of five states that pay primary-care doctors so little for treating Medicaid patients that those doctors will get a raise of more than 100 percent when a federal subsidy kicks in on Jan. 1, according to a new study. The raise, which brings Medicaid pay up to the level of Medicare for two years, is part of the Patient Protection and Affordable Care Act. The idea is to lure more doctors into primary care and make it worth their while to care for those insured by Medicaid, the joint state and federal program for the very poor. The federal government pays for Medicare, the program for the elderly and disabled, and determines the regional pay rates. But states determine the reimbursement rates for Medicaid by deciding how much to contribute (Gentry, 12/18).

Also see related KHN story: Questions Linger About Implementing Doctors' Medicaid Pay Raise

Stateline: Connecticut Health Agency Fights Desperation Among The Uninsured
At 68, Maureen Smith has short, blonde hair, fashionable dark-framed glasses, and a soft, measured way of speaking that is the aural equivalent of comfort food The last is a particularly valuable trait because Smith frequently finds herself on the opposite end of the telephone with someone at the edge of desperation, if not a good deal beyond it. It might be a mother distraught after her teenage son has been rushed to an emergency room following a suicide attempt and her insurance carrier balks at paying for his hospital admission. It might be an elderly man enraged over a $75,000 hospital bill for a hip procedure that his insurer says it will not cover because it regards the operation as "experimental." Or it might be a young woman in tears because her insurance company will not pay $8,000 for a "safety bed" for her five-year old son whose cerebral palsy causes him to thrash about at night, keeping his parents sleepless and watchful out of fear that he will hurt himself (Ollove, 12/18).

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Editorials and Opinions

Views On Conn. Shootings: Mental Illness Doesn't Generally Lead To Violence; Need For More Treatment Options; Helping The Survivors

The New York Times: In Gun Debate, a Misguided Focus on Mental Illness
It's possible that preventing people with schizophrenia, bipolar disorder and other serious mental illnesses from getting guns might decrease the risk of mass killings. Even the Supreme Court, which in 2008 strongly affirmed a broad right to bear arms, at the same time endorsed prohibitions on gun ownership "by felons and the mentally ill." But mass killings are very rare events, and because people with mentally illness contribute so little to overall violence, these measures would have little impact on everyday firearm-related killings (Dr. Richard A. Friedman, 12/17).

The Wall Street Journal: Guns, Mental Illness And Newtown
Since gun controls today are far stricter than at the time when "active shooters" were rare, what can account for the increase in these shootings? One plausible answer is the media. Cable TV in the 1990s, and the Internet today, greatly magnify the instant celebrity that a mass killer can achieve. … A second explanation is the deinstitutionalization of the violently mentally ill. A 2000 New York Times study of 100 rampage murderers found that 47 were mentally ill. In the Journal of the American Academy of Psychiatry Law (2008), Jason C. Matejkowski and his co-authors reported that 16% of state prisoners who had perpetrated murders were mentally ill (David Kopel, 12/17).

The Washington Post: We Are Not Helpless Against Gun Violence
It is sometimes argued that public policy is useless in this area because it would not have prevented this specific killing or that one. But this is not the threshold for government action. The relevant question is: What policies could reasonably be argued to reduce the likelihood and severity of such incidents over time? As in matters of public health, the goals are risk and harm reduction. This would involve better services for the severely mentally ill, who are now more likely to be found in a prison than a hospital — as well as more stringent requirements on mental-health professionals to report possible threats. It may impose increased security burdens on schools. And, yes, reasonable gun restrictions are needed (Michael Gerson, 12/17).

The New York Times: What Drives Suicidal Mass Killers
For years, the conventional wisdom has been that suicide terrorists are rational political actors, while suicidal rampage shooters are mentally disturbed loners. But the two groups have far more in common than has been recognized. ... In fact, we should think of many rampage shooters as nonideological suicide terrorists. In some cases, they claim to be fighting for a cause — neo-Nazism, eugenics, masculine supremacy or an antigovernment revolution — but, as with suicide terrorists, their actions usually stem from something much deeper and more personal. There appears to be a triad of factors that sets these killers apart. The first is that they are generally struggling with mental health problems that have produced their desire to die. ... The second factor is a deep sense of victimization and belief that the killer's life has been ruined by someone else, who has bullied, oppressed or persecuted him. Not surprisingly, the presence of mental illness can inflame these beliefs. ... The third factor is the desire to acquire fame and glory through killing (Adam Lankford, 12/17).

The New York Times: Don't Blame Autism For Newtown
Let me clear up a few misconceptions. For one thing, Asperger's and autism are not forms of mental illness; they are neurodevelopmental disorders or disabilities. Autism is a lifelong condition that manifests before the age of 3; most mental illnesses do not appear until the teen or young adult years. Medications rarely work to curb the symptoms of autism, but they can be indispensable in treating mental illness like obsessive-compulsive disorder, schizophrenia and bipolar disorder. Underlying much of this misreporting is the pernicious and outdated stereotype that people with autism lack empathy (Priscilla Gilman, 12/17).

USA Today: How To Best Care For Survivors
Hundreds of children successfully escaped Sandy Hook Elementary School in Newton, Conn., this past week, leaving behind 20 schoolmates who were not so fortunate. But the survivors have also been wounded. The initial lifesaving response, fight or flight, which involves an outpouring of stress hormones triggered by the brain's fear center, gives way over the succeeding weeks to Post Traumatic Stress Disorder (PTSD). According to the National Center for PTSD, 77% of children who witness a school shooting and 35% of the kids who see violence in the area are affected. These children are headed for a rocky course filled with anger and sadness at play, feelings of alienation and low self-esteem, repeating the tragedy, and feelings that they will see warning signs before future tragedies. Luckily, psychotherapy can help these children overcome their fears and anxieties and return to a normal life (Marc Siegel, 12/17).

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Viewpoints: Krugman Says Cuts In Social Security Better Than Medicare Option; Governors Refusing To Set Up Exchanges Are Not 'Federalist Hypocrites'

The Washington Post: A 'Fiscal Cliff' Deal Is Near: Here Are The Details
All at once, a "fiscal cliff" deal seems to be coming together. ... On the spending side, the Democrats' headline concession will be accepting chained-CPI, which is to say, accepting a cut to Social Security benefits. Beyond that, the negotiators will agree to targets for spending cuts. Expect the final number here, too, to be in the neighborhood of $1 trillion, but also expect it to lack many specifics. Whether the cuts come from Medicare or Medicaid, whether they include raising the Medicare age, and many of the other contentious issues in the talks will be left up to Congress (Ezra Klein, 12/17).

The New York Times: Rumors Of A Deal
Unlike what we'd heard from Republicans before, this contains stuff that Obama can't get just by letting us go over the cliff: more revenue than he could get just from tax-cut expiration, unemployment and infrastructure too. But it has a cost, those benefit cuts. Those cuts are a very bad thing, although there will supposedly be some protection for low-income seniors. But the cuts are not nearly as bad as raising the Medicare age, for two reasons: the structure of the program remains intact, and unlike the Medicare age thing, they wouldn't be totally devastating for hundreds of thousands of people, just somewhat painful for a much larger group. Oh, and raising the Medicare age would kill people; this benefit cut, not so much (Paul Krugman, 12/17).

Los Angeles Times: To Fix The Deficit, Tax And Cut
(House Speaker John) Boehner called for cutting projected spending by $1 trillion over 10 years while raising an equal amount in new tax revenue, in part by ending the Bush-era tax cuts for those making $1 million or more. Obama had sought $400 billion more in tax revenue, or $1.4 trillion over 10 years. Yet even if the GOP eventually comes closer to Obama's tax proposal, lawmakers will still have to reel in spending considerably to stabilize the growing debt. The biggest problems for the budget are Medicare and Medicaid, the healthcare benefits whose costs are growing rapidly. Unless Congress finds a way to shore up those programs, the federal budget gap will only get worse in later decades (12/18).

USA Today: Fixing The Debt Is A Progressive Cause
A lot of ink has been spilled about the looming "fiscal cliff," and rightly so. Going off the cliff won't just affect the wealthy or those interested in maintaining our current levels of military spending. Instead, the vast majority of American families -– including those in the lowest tax brackets –- will see their federal tax bills rise. And the so-called "sequestration" would cut funding from many critical state-run programs that protect the most vulnerable among us, including nutrition programs for low-income women and children, education and public housing. Unemployment insurance will be cut off from the people who need it most. In short, going off the cliff is bad for everyone. But so is simply putting off the cliff (Antonio Villaraigosa and Ed Rendell, 12/17).

The Wall Street Journal: ObamaCare's Faux Federalism
Having failed to persuade 26 states that participating in ObamaCare is a good deal, the liberals behind the law are denouncing these dissident Governors as federalist hypocrites. A few critics on the right are chiming in and arguing that the 26 are inviting worse results once the feds swoop in. So someone ought to say a word on behalf of the people who run state governments in the real world and have examined the health insurance "exchange" question in detail. They've seen enough to know that the choice to set up and run these insurance bureaucracies is not a choice at all (12/17).

New York Post: Fixing NY Medicaid
New York’s Medicaid program is now testing, on a small and limited scale, giving people financial incentives and requiring compliance in changing their behavior. The approach has promise — if done right; it’s important to keep in mind the lessons of welfare reform. When an individual insists on eating too much of the wrong food while not exercising at all, or smoking or never getting a physical checkup, he’s at serious risk of developing a chronic illness. His choice, his problem? Yes, but when that same person is enrolled in a taxpayer-funded health-insurance program like Medicaid, he also risks becoming a very expensive problem for the rest of us (Russell Sykes, 12/16).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
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.