Daily Health Policy Report

Wednesday, December 19, 2012

Last updated: Wed, Dec 19

KHN Original Reporting & Guest Opinion

Fiscal Cliff

Coverage & Access

Health Reform

Capitol Hill Watch

Health Care Marketplace

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Health On The Hill: Spending, Taxing Remain Sticking Points As 'Fiscal Cliff' Looms (Audio)

Kaiser Health News' Mary Agnes Carey speaks with Jackie Judd about negotiations on Capitol Hill to avoid the "fiscal cliff" and just how close -- or far apart -- Democrats, Republicans and the White House seem to be on cutting spending and letting some tax cuts for the rich expire (12/18). Listen to the audio or read the transcript.

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'If I'd Had To Wait Until 67 For Medicare, I'd Be Dead'

Writing for Kaiser Health News, Russ Mitchell reports: "Sam Lewis turned 65 in the nick of time. For a year, he'd been broke. His Brentwood, Calif., general contracting business had gone bust. He couldn't make payments on his home, and lost it. He couldn't make payments on his health insurance, so he let it lapse. The day after his birthday in October, when he qualified for Medicare, Lewis got a checkup. Days later, he went under the knife: open-heart surgery, a triple-bypass, three arteries blocked with plaque, one of them, 99 percent. 'If I'd had to wait until 67 for Medicare,' Lewis said, 'I'd be dead'" (Mitchell, 12/18). Read the story.

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Capsules: Colorado Gov Pitches Plan To Mend Mental Health Safety Net

Now on Kaiser Health News' blog, Colorado Public Radio's Eric Whitney, working in partnership with Kaiser Health News and NPR, reports on a proposal advanced by the governor: "In a grim coincidence, just days after the mass killing in Newtown, Conn., Colorado Gov. John Hickenlooper is proposing an $18.5 million plan to strengthen the state’s mental health system. The proposal is the result of five months of work by a group of advisors convened by Hickenlooper in the wake of a mass shooting in July at an Aurora, Colo., movie theater that left 12 dead. The governor’s announcement had been set well before Friday’s massacre" (Whitney, 12/19). Check out what else is on the blog.


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Political Cartoon: 'Unmanaged Care?'

Kaiser Health News provides a fresh take on health policy developments with 'Unmanaged Care?' by Bob Staake.

Meanwhile, here is today's health policy haiku:


We will kick the can
Until it's off the table
For the Grand Bargain
- 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

Maneuvering Toward A 'Fiscal Cliff' Deal

House Republicans moved Tuesday toward a "Plan B" if budget talks fail. Some media outlets suggested that both President Barack Obama and Speaker John Boehner, R-Ohio, are attempting to quell backlash within their own parties.

The New York Times: Boehner Plan Addresses Taxes But Delays Fight Over Spending Cuts
House Republican leaders struggled on Tuesday night to rally their colleagues around a backup measure to ease the sting of a looming fiscal crisis by allowing tax rates to rise only on incomes over $1 million. The plan would leave in place across-the-board spending cuts to military and domestic programs that Republicans have been warning could have dire consequences, especially to national defense. ... Republicans would resume the fight for broad spending cuts, especially to entitlement programs like Medicare, in late January or February, when the government will face raising its borrowing limit and when, many Republicans believe, they will have much more leverage than they do now (Weisman, 12/18).

The Wall Street Journal: GOP Unveils A 'Plan B' If Budget Talks Fail
Despite progress toward agreement on a budget deal with the White House, House Republican leaders on Tuesday proposed a backup plan to prevent most Americans from facing an income-tax increase if negotiations collapse. ... Both leaders face perils as they enter what could be the final stages of high-stakes negotiations to avoid the "fiscal cliff" of higher taxes and spending cuts in early January. Mr. Obama will have to deal with liberals unhappy about entitlement cuts. Mr. Boehner faces a potential backlash from Republicans for contemplating tax-rate increases—both in his talks with the White House and in Plan B (Hook, Lee and Boles, 12/19).

Kaiser Health News: Health On The Hill: Spending, Taxing Remain Sticking Points As 'Fiscal Cliff' Looms (Audio)
KHN's Mary Agnes Carey speaks with Jackie Judd about negotiations on Capitol Hill to avoid the "fiscal cliff" and just how close -- or far apart -- Democrats, Republicans and the White House seem to be on cutting spending and letting some tax cuts for the rich expire (12/18).

The Washington Post: Boehner's Backup Tax Plan Shakes Up ‘Fiscal Cliff’ Negotiations
House Speaker John A. Boehner (R-Ohio) veered off the bipartisan course he had been charting toward a broad tax-and-entitlement deal with President Obama and instead Tuesday pushed a GOP package to extend tax cuts for income up to $1 million. The move shook the Capitol after several days of significant progress between Obama and Boehner, who had moved closer to a pact raising taxes on the wealthy and curbing government spending, including on Social Security (Kane and Montgomery, 12/18).

Los Angeles Times: Boehner Changes Gears In 'Fiscal Cliff' Talks With Obama
The speaker made clear that he is not cutting off talks with Obama, but Democrats characterized Boehner as walking away just as compromise appeared within reach. This week, Obama made what White House aides saw as a substantial concession by telling Boehner that he would accept an agreement raising taxes on household income above $400,000, rather than the $250,000 threshold he had previously insisted on. He also proposed changes to reduce the long-term cost of government benefit programs, including Social Security (Mascaro, Parsons, and Memoli, 12/18).

The Associated Press: House GOP Focusing On Fiscal Cliff Backup Plan
Still short of a "fiscal cliff" deal with the White House, top House Republicans are laboring to rally their rank-and-file behind an alternative plan that would prevent looming tax increases for everyone but those earning over $1 million a year. House Speaker John Boehner's so-called Plan B, which is aimed at letting GOP lawmakers vote to prevent New Year's Day tax boosts on more than 99 percent of taxpayers, was getting a cool reception from conservatives reluctant to boost anyone's taxes, raising questions about whether it could pass the GOP-run House (Fram, 12/19).

Politico: Cliff Talks Turn Into Public Posturing
House Speaker John Boehner’s decision to pursue a fiscal cliff backup plan looked like an attempt to go his own way. But it was really about bolstering his position in the one-on-one talks with President Barack Obama (Sherman, Bresnahan and Budoff Brown, 12/18).

Politico: Many Democrats Unhappy With CPI Offer
After weeks of gleefully watching Republicans struggle to find their footing in fiscal cliff talks, it’s time for the Democrats to do some painful soul-searching of their own. President Barack Obama’s latest offer to congressional Republicans crosses lines that Democrats have long portrayed as untouchable. The provision causing the most heartburn for Democrats on Capitol Hill is one that would change the way inflation is measured to ultimately reduce payments to Social Security beneficiaries (Sloan and Kim, 12/18).

The Wall Street Journal: Budget Hawk Is Now Quiet As A Mouse
What will Paul Ryan do? ... With talks at a crucial phase, Republicans are keeping close tabs on their recent vice-presidential nominee. His support for a compromise could stem conservative defections. His opposition could sink the deal entirely (O'Connor, 12/18).

The Washington Post: Eric Cantor Plays Loyal Lieutenant To Boehner
In the “fiscal cliff” drama, Cantor has been casting himself as a supportive bit player to Boehner, a contrast from the debt-ceiling showdown of 2011. At that time, Cantor had a starring role as a lead negotiator in high-level talks with Vice President Biden and as a chief antagonist to Obama, tangling with the president in one tense White House exchange. But that role did not go well for Cantor. It neither strengthened the GOP’s hand in the fiscal crisis nor served the lawmaker’s image. He emerged with a taint of disloyalty toward Boehner and a new reputation, carefully stoked by Democrats, as the leader of hard-liners unwilling to compromise (Helderman, 12/18).

The Hill: Advocates: Shield Medicaid From ‘Fiscal Cliff’ Cuts
A coalition of health and social justice groups is urging Congress not to allow Medicaid cuts in a deal to reduce the deficit and avoid the so-called "fiscal cliff." The 165 national groups sent a letter to lawmakers Tuesday asking them to shield Medicaid, which provides health insurance to low-income people, including millions of children. Liberal lawmakers have made the same case in recent weeks. Tuesday's letter also argued against proposals to block-grant the program, like House Budget Committee Chairman Paul Ryan's (R-Wis.) (Vibeck, 12/18).

Politico: The Toxic Medicare Payment Panel
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. Some Democrats aren’t exactly crazy about it, either. So far, nobody on the Hill is talking about any kind of bipartisan revamp to make the Independent Payment Advisory Board work in a way both parties could tolerate. The talk of rationing, death panels and unelected bureaucrats has made IPAB far too toxic. But health care experts say there are fixes that could be considered if or when Congress finds itself so inclined. The Simpson-Bowles deficit-cutting commission wanted to give it more punch. Foundations and think tanks have published dozens of suggestions to make it stronger, weaker, faster, slower, broader or narrower. Right now, though, those ideas are going nowhere (Kenen, 12/18).

Also on Capitol Hill, doctors are appealing to members of Congress to stop funding cuts at NIH.

Medpage Today: Physicians Groups Work To Boost NIH Budget
Concerned that erosion of the National Institutes of Health's budget may be undercutting future health care advances, physician groups are aggressively lobbying Congress to restore the agency's funding. Even if negotiations between the White House and congressional Republicans succeed in averting the "fiscal cliff," these groups point out that NIH's budget has failed to keep pace with inflation over the past decade, putting an increasing squeeze on the biomedical research community. Moreover, they worry that longer-term efforts to reduce the federal deficit will take a further toll on NIH -- in essence, draining the well of knowledge from which new treatments and diagnostics must be drawn. One of the most aggressive medical societies in this regard has been the American Society of Hematology (ASH), which has been conducting a multifaceted campaign on behalf of NIH (Gever, 12/18).

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Workers, Employers, Elderly And Hospitals All Worried About Effects Of Fiscal Cuts

As negotiations drag on to cut federal debt, many groups are concerned about how potential changes in spending will affect them.

Kaiser Health News: 'If I'd Had To Wait Until 67 For Medicare, I'd Be Dead'
Sam Lewis turned 65 in the nick of time. For a year, he'd been broke. His Brentwood, Calif., general contracting business had gone bust. He couldn't make payments on his home, and lost it. He couldn't make payments on his health insurance, so he let it lapse. The day after his birthday in October, when he qualified for Medicare, Lewis got a checkup. Days later, he went under the knife: open-heart surgery, a triple-bypass, three arteries blocked with plaque, one of them, 99 percent. "If I'd had to wait until 67 for Medicare," Lewis said, "I'd be dead" (Mitchell, 12/18).

The New York Times: Hospitals Fear They'll Bear Brunt Of Medicare Cuts
As President Obama and Congress try to thrash out a budget deal, the question is not whether they will squeeze money out of Medicare, but how much and who will bear the brunt of the cuts. ... But any significant tinkering with the benefits for older Americans comes with significant political risks, and most Democrats in Congress strenuously oppose raising the age when Medicare coverage begins. With growing pressure to reach an agreement on deficit reduction by the end of the year, some consensus is building around the idea that the largest Medicare savings should come from hospitals and other institutional providers of care (Pear and Abelson, 12/18).

Politico: Chained CPI Foes: Seniors Get Raw Deal
Progressives say the latest deficit-cutting proposal in the fiscal cliff negotiations would unfairly put the squeeze on seniors — largely because a new formula for calculating Social Security payments would fail to account for how much more money they have to spend on health care than the rest of the population. And that unless the proposed Social Security payment cuts are offset for older, low-income seniors, they're worried that this vulnerable group could be forced into choosing between necessities — between housing, for instance, and medical care. "If we don't do this right, we could be asking old, poor elderly people to make some pretty terrible choices," said Jared Bernstein, former economic adviser to Vice President Joe Biden and now a senior fellow at the Center on Budget and Policy Priorities (Norman, 12/19).

CQ HealthBeat: What's In Obama's Offer Of $400 Billion In Health Care Cuts?
President Barack Obama’s latest proposed fiscal cliff remedy includes $400 billion in health care cuts, according to sources familiar with the fiscal cliff negotiations. What are they? The White House hasn’t offered specifics, but according to a House aide, "most of it can be found by looking at the Center for American Progress report and the president’s budget." Those proposals would hit drug and medical devices hard, among other health sectors. The CAP report is better known as the "Senior Protection Plan." It cuts providers and product makers and charges affluent Americans more for Medicare Part B doctor care and the Medicare Part D prescription drug benefit, among other things (Reichard, 12/18).

Los Angeles Times: Most Americans Benefit From Entitlements
Forget the 47%. A new study finds that 71% of Americans live in a household in which at least one member has benefited from one of the federal government’s major entitlement programs. The new data, based on a survey by the Pew Research center, underscore the wide reach of the spending programs that make up the lion's share of the federal budget. More than half of Americans (55%) have personally benefited from one of the government's six best-known entitlement programs, including 53% of people who voted for Mitt Romney in November’s election and 59% of those who voted for President Obama (Lauter, 12/18).

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Speaker Doesn't Foresee Increase In Medicare Eligibility Age This Year

The Hill: Boehner: Raising Medicare Age Can Wait Until Next Year
Congress doesn't need to raise the Medicare eligibility age this year, House Speaker John Boehner (R-Ohio) said Tuesday. Raising the eligibility age from 65 to 67 was on the table in earlier debt talks, and has been floated again as Boehner and President Obama look for a way to avoid the looming fiscal cliff. Republicans have insisted that increases in tax rates must be accompanied by cuts to entitlement programs, including Medicare. But Boehner's most recent proposal calls for higher rates on taxpayers making more than $1 million per year, and he said Tuesday that raising the Medicare age can wait for a broader package of tax and entitlement reform next year (Baker. 12/18).

CQ HealthBeat: Boehner Says Medicare Eligibility Age Issue Can Wait Until Next Year
House Speaker John A. Boehner indicated Tuesday that he would not insist on raising the Medicare eligibility age as part of a fiscal cliff package and that the issue could be addressed next year as part of a larger overhaul of entitlement programs. At a morning news conference, the Ohio Republican was asked how strongly he feels that the Medicare eligibility age needs to be part of a deal. Although President Barack Obama entertained the idea during debt limit negotiations in 2011, Democrats in both chambers have expressed strong opposition to the change over the past few weeks. “That issue has been on the table, off the table, back on the table. It’s an issue for discussion. But I don’t believe it’s an issue that has to be dealt with between now and the end of the year,” Boehner said. “It is an issue, I think, if Congress were to do entitlement reform next year and tax reform, as we envision, if there’s an agreement that issue will certainly be open to debate in that context” (Attias, 12/18).


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Negotiators Eye Short-Term and Long-Term 'Doc Fix' Options

Single-year and two-year fixes to the "sustainable growth rate" formula -- or even a permanent fix -- are floated as the White House and congressional Republicans continue negotiations over taxes and spending.

Politico Pro: House GOP Looking At Two-Year 'Doc Fix'
House Republicans are looking at a two-year reprieve from the Medicare physician payment cuts as House Speaker John Boehner puts together a plan B in the fiscal cliff negotiations, according to sources familiar with the leadership efforts. The “doc fix” would be paid for by recapturing more tax subsidies from the health law’s insurance exchanges, according to a GOP aide familiar with the discussions. Boehner told Republicans on Tuesday that he plans to move a bill that would hike tax rates on incomes of more than $1 million. It would keep the Bush-era tax rates for people making less than $1 million. But Senate Majority Leader Harry Reid has already said the plan won’t pass the Senate (Haberkorn, 12/18).

Modern Healthcare: White House Calls For Healthcare Cuts, Permanent SGR Fix
The White House has called for a permanent—not temporary—fix to Medicare's sustainable growth-rate formula and about $400 billion in healthcare cuts, according to a source familiar with the fiscal-cliff negotiations. House Speaker John Boehner (R-Ohio), however, was generally dismissive of the president's new proposal, signaling that a permanent fix to the physician payment system is still not within reach. During a news conference in the Capitol, Boehner said the GOP leadership plans to introduce a bill this week that would extend current tax rates for Americans who make $1 million or less, but Boehner stopped short of saying whether that legislation would include a temporary fix to Medicare's physician payment formula (Zigmond, 12/18).

CQ HealthBeat: Full Repeal Of 'Doc Fix' Formula May Be Part Of Long-Term Plan
President Barack Obama’s latest offer in the fiscal cliff negotiations includes a path to permanently repeal the formula that dictates cuts to Medicare payments to physicians, but that change — as well as others to the federal health care program — probably will wait until next year. Until then, according to a House aide, Obama would provide physicians with a one-year payment patch to stave off the 27 percent cuts that are scheduled to take effect Jan. 1. In addition, other major changes to Medicare, including a move to increase the program’s eligibility age, also probably will not be considered until next year, when lawmakers take a broader look at entitlement programs, House Speaker John A. Boehner said Tuesday (Ethridge, 12/18).

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Coverage & Access

Newtown Shooting Spotlights Gaps In Mental Health Care

The elementary school massacre prompts an examination of mental health care policies and access to guns by the mentally ill.

Wall Street Journal: Lawmakers Focus Early Gun-Curb Efforts On Mentally Ill
The debate over gun rights in the wake of the mass shooting in Newtown, Conn., has yielded one point of agreement among Republican and Democratic political leaders in Washington: laws on access to firearms among the mentally ill must be reviewed. But any effort to expand limits on gun rights based on mental health is bound to collide with privacy protections for patients and a variety of other considerations when addressing mental health (Fields and Jones, 12/18).

MPR: Funding For Mental Health Lacking
Another mass shooting, this one involving little children, has the country talking about the availability of guns and gun violence. But some experts and law makers say that discussion should also include a serious look at mental health care in this country. Families with a mentally ill family member say it's difficult to get them adequate care. In the Twin Cities, for example, the shortage of beds in local hospitals for the mentally ill is so bad patients Twin Cities patients are often sent to Duluth or other places for acute care. To look at the situation, MPR's Cathy Wurzer called longtime state Representative Mindy Greiling. The soon-to-retire lawmaker also has firsthand knowledge of the mental health system, her son has been diagnosed with schizophrenia (12/18).

ABC: Newtown Shooting Put Spotlight On U.S. Mental Health Care -- Again
It has not yet been confirmed whether Adam Lanza had been diagnosed with mental illness, but the 20-year-old who murdered his mother, then drove to a Newtown, Conn., elementary school and gunned down 20 first-graders and six adults has again shined the spotlight on care for the mentally ill in the United States, and has many asking whether yet another mass shooting could have been prevented. Despite four shooting rampages since President Obama took office in 2009, mental health care continues to be hampered by budget cuts, closures, battles with insurers and stigma, doctors said. "We have very good treatments for mental illness that are highly effective," said Dr. Jeffrey Lieberman, president-elect of the American Psychiatric Association. "But they're not widely available. People don't have ready access to them" (Lupkin, 12/19).

Kaiser Health News: Colorado Gov Pitches Plan To Mend Mental Health Safety Net
In a grim coincidence, just days after the mass killing in Newtown, Conn., Colorado Gov. John Hickenlooper is proposing an $18.5 million plan to strengthen the state’s mental health system. The proposal is the result of five months of work by a group of advisors convened by Hickenlooper in the wake of a mass shooting in July at an Aurora, Colo., movie theater that left 12 dead. The governor’s announcement had been set well before Friday’s massacre (Whitney, 12/19).

The Associated Press: Hickenlooper Wants Expansion Of Mental Care
Colorado Gov. John Hickenlooper wants to expand mental health services and make mental health records readily available for background checks on firearm purchases -- initiatives that are a response to the Aurora theater shooting this summer. The governor’s office and health officials began working on the proposals days after the theater shooting in July and had planned the announcement for weeks (Moreno, 12/18).

Meanwhile, news outlets look at some other mental health care issues.

MPR: 'Make It OK' Campaign Aims At Mental Illness Stigma
A new campaign called "Make It OK" is encouraging Minnesotans to talk more openly about mental illness. The campaign aims to de-stigmatize mental health conditions so people will be more willing to seek out the care that they need. The project was launched by the Minnesota chapter of the National Alliance on Mental Illness, HealthPartners and Regions Hospital in St. Paul. HealthPartners President and CEO Mary Brainerd, who appeared on The Daily Circuit Tuesday, said both society and the health care system need to treat people with mental illness with greater understanding. "Small things that start to indicate whatever illness you're experiencing, we support you, we want you to get better," Brainerd said. "Doing just the same kinds of things for people with mental illness as we do for those experiencing other kinds of illness" (Benson, 12/18).

WBUR: Worried Group Home Workers Seek Protections As Mass. Aims To Improve Safety
With light streaming in through windows overlooking a glittering Dorchester Bay, hundreds of Massachusetts mental-health workers and advocates gathered earlier this month in a cavernous room at the John F. Kennedy Library in Boston to honor a slain colleague — and looked for reassurance from state and industry leaders they’ll be kept safe on the job. Stephanie Moulton was 25 and working alone at a Revere group home when she was slain in 2011, allegedly by a client with a history of violence (Becker, Mulvihill, Stine, 12/19).

Finally, a study finds unmet health care needs among adults with autism.

The Philadelphia Inquirer: Many Adults With Autism Unhappy With Their Health Care
U.S. adults with autism are more likely to report poor health care experiences than those without autism, a new study reveals. Researchers conducted an online survey of 209 adults with autism and 228 adults without the disorder and found that those with autism reported more unmet health care needs, greater use of emergency departments, and lower rates of preventive services such as Pap smears (a cervical cancer screening test) (Preidt, 12/18).

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Health Reform

Clock Is Ticking For Insurance Exchange Implementation

Roll Call: Health Exchanges: Can They Be Ready By 2014?
The idea of a health insurance exchange as laid out in President Barack Obama’s signature law seems straightforward: an online marketplace where people will shop for private health insurance, like buying an airline ticket or a hotel room. But making sure exchanges in every state are ready for business by the law’s deadline of 2014 has been anything but easy given the legal, technical and political questions surrounding them (Norman, 12/18).

Politico Pro: Utah Exchange The Next ACA Test
Utah says it wants to run its own health insurance exchange. HHS says it wants Utah to run its own exchange. If it were only that simple. Utah says it doesn’t want to do much to alter its existing exchange, which it started for small businesses before President Barack Obama’s health care law was enacted in 2010. Gov. Gary Herbert’s administration says it’s ready to add individual coverage, but not much else. So, Utah has become a test of just how much flexibility the Obama administration is willing to give to states (Millman, 12/19).

CQ HealthBeat: Patients Groups Lobby HHS To Allow Coverage Of More Than One Drug Per Class
With a week left to go before the comment deadline on three major rules, a coalition of 151 groups sent a letter Tuesday urging the administration to improve protections for patients in the health benefit exchanges due to open in 2014. The essential health benefits rule is one of three proposed regulations, along with proposals on insurance market rules and wellness, that was released on Nov. 26 with a 30-day comment period. The essential health benefits rule outlines the kinds of coverage that plans will have to offer in order to be sold in the exchanges (Adams, 12/18).

Other aspects of the health law were also in the news --

The Wall Street Journal: Cleveland Clinic Diagnoses Health-Care Act
Just over a year from now, the Affordable Care Act is set to unleash enormous change in the health-care sector, and Cleveland Clinic Chief Executive Delos "Toby" Cosgrove is preparing his institution by expanding its reach and striving to make caregivers more cost-conscious. ...  Cleveland Clinic is also striking deals with employers such as Wal-Mart Stores Inc. to send workers to there for complex procedures, moves that lock in patients for high-end surgeries. The new federal provisions—which include cutbacks to Medicare payments and the creation of new health-insurance marketplaces for consumers—will test institutions like Cleveland Clinic (Mathews, 12/18).

Modern Healthcare: PCORI Awards Over $40 Million For Comparative Effectiveness Research
The Patient-Centered Outcomes Research Institute announced it is awarding more than $40 million over three years to its first round of comparative-effectiveness research projects. The 25 winning projects, chosen from among a field of more than 500 applicants, cover a broad range of topics, such as rehabilitation care for stroke patients, palliative care in nursing homes, dementia care and healthcare disparities among patients with depression. Winning institutions include the Portland-based Oregon Community Health Information Network, the University of Rochester (N.Y.), the University of Michigan at Ann Arbor, and Seattle-based Group Health Cooperative (McKinney, 12/18).

The Hill: GOP Rep. Says HHS May Be Trying To Evade Record-Keeping Laws
Whistleblowers have accused the Obama administration of using instant-messaging software to evade federal record-keeping rules, Rep. Charles Boustany (R-La.) said Tuesday. Boustany, who chairs the Ways and Means Subcommittee on Oversight, said the accusations pertain to officials in the Health and Human Services Department who are tasked with implementing parts of President Obama's signature healthcare law (Baker, 12/18).


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Capitol Hill Watch

Congressional Negotiators Agree To Some Abortion Coverage For Women In The Military

Lawmakers added a provision to the Defense Authorization Act that would allow abortions in the case of rape or incest.

Politico Pro: Bill Expands Abortion Coverage For Military Women
Women in the military will receive abortion coverage in cases of rape or incest, under a measure lawmakers included in the final version of the defense authorization bill on Tuesday. For more than a decade, all military funding for abortion has been banned except when the mother's life is at stake. The provision, sponsored by Sen. Jeanne Shaheen (D-N.H.), would allow the Department of Defense to pay for abortions in cases of rape or incest as well. Right now, women who are pregnant due to rape or incest can only get an abortion at military hospitals if they pay for it themselves. But for decades, the Hyde Amendment has limited taxpayer dollars to be used only for abortions in the cases of rape, incest or to save the life of the mother (Cunningham, 12/18).

CQ HealthBeat: Conferees Keep Senate's Abortion Provision In Final Defense Bill
House and Senate negotiators on the annual Pentagon policy bill have reached a compromise on highly charged social issues in the sprawling measure, agreeing to authorize Defense Department funds for abortions in cases of rape or incest while also letting military chaplains decide for themselves whether to officiate gay marriages. Social and domestic issues have, in the past, often tied up final negotiations on the sprawling measure, with the House and Senate regularly at odds over provisions ranging from immigration to abortion. But for this year’s bill, negotiators have navigated these often prickly social issues and reached compromise relatively swiftly (Scully, 12/18).

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Health Care Marketplace

Amgen To Pay $762 Million Fine For Improper Drug Marketing

Los Angeles Times: Amgen Pleads Guilty To Improper Marketing Of Anemia Drug Aranesp
Biotech giant Amgen Inc. pleaded guilty in federal court to improper marketing of its anemia drug Aranesp and has agreed to pay $762 million in criminal fines and civil settlements to resolve complaints from company whistle-blowers. Federal prosecutors in New York said the Thousand Oaks company was "pursuing profits at the risk of patient safety" by encouraging doctors to use its popular anemia drug for unapproved uses to boost sales and to take market share from a rival drug maker (Terhune, 12/18).

Medpage Today: Amgen Agrees To Pay $762 Million In Aranesp Case
The biotech drug giant Amgen pled guilty Tuesday to promoting its blockbuster anemia drug darbepoetin alfa (Aranesp) for off-label dosing regimens, agreeing to pay more than $760 million in fines. The drug, administered once weekly, was initially approved in September 2001 to treat anemia caused by chronic renal failure. Knowing it would have trouble competing with the well-established epoetin alfa (Procrit), which is used every other week, Thousand Oaks, Calif.-based Amgen used to its advantage a statement in the product's labeling that said darbepoetin had a longer serum half-life than epoetin alfa, which the company thought might suggest a less-frequent dosing regimen. Amgen sales representatives promoted darbepoetin for the off-label dose of once monthly, according to the complaint filed Tuesday by the U.S. Attorney's Office in the Eastern District of New York (Pittman, 12/18).

Meanwhile, the Milwaukee Journal Sentinel and MedPage Today look into the influence of drug companies on treatment guidelines.

MedPage Today: Guidelines: Guides To Profit?
Doctors with financial ties to drug companies have heavily influenced treatment guidelines, an analysis by the Milwaukee Journal Sentinel and MedPage Today has found. Critics say those financial relationships have corrupted the guideline process so that the end products, make dangerous or ineffective recommendations. Industry and some doctors counter that those with conflicts are often top experts in their field. The Journal Sentinel/MedPage Today examined 20 clinical practice guidelines for conditions treated by the 25 top-selling drugs in the U.S.  (Fauber and Gabler, 12/19).

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Public Health & Education

Study Finds No Clear Indication 9/11 Debris Causes Cancer

The study, published in the Journal of the American Medical Association, examined the health of nearly 56,000 people.

The New York Times: No Clear Link Between Cancer And 9/11 Debris, Study Finds
Six months after the federal government added cancer to the list of sicknesses covered by the $4.3 billion World Trade Center fund, a New York City health department study has found no clear link between cancer and the dust, debris and fumes released by the burning wreckage of the twin towers. The study was by far the largest to date. It examined 55,700 people, including rescue and recovery workers who were present at the World Trade Center site, on barges or at the Staten Island landfill where debris was taken in the nine months after Sept. 11, 2001, as well as residents of Lower Manhattan, students, workers and passers-by exposed on the day of the terrorist attacks (Hartocollis, 12/18).

The Wall Street Journal: Cancer Link Unclear
A new study of nearly 56,000 people exposed to rubble and fumes from the World Trade Center site found increased rates of some cancers among recovery workers, but researchers established no link between their illness and the toxic debris (Nahmias, 12/18).

Medscape: Increase In Some Cancers Among 9/11 Rescue Workers
A study of rescue and recovery workers involved in the World Trade Center (WTC) atrocity in September 2011 has found small increases in rates of prostate and thyroid cancers and multiple myeloma beginning six years after 9/11. There were no increases in cancer overall (all sites combined), the researchers report in their study, which was published in the December 19 issue of JAMA. It is not clear how medical screening and non-WTC risk factors contributed to the increases in prostate and thyroid cancers and multiple myeloma, they note (Brooks, 12/18).

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U.S. Preparedness For Drug-Resistant TB Strains Questioned

The Wall Street Journal: TB's Global Resurgence Amplifies U.S. Risk
Multidrug-resistant TB is at epidemic proportions in some parts of the world -- a growing problem the U.S. is surprisingly unprepared for. The U.S. beat back multidrug-resistant tuberculosis in the 1990s. Today, however, a new threat is emerging as drug resistance worsens abroad and far more dangerous strains develop and spread, including some that are all but untreatable with standard drugs (McKay, 12/18).

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Energy Drink Makers Blitz College Students Amid Calls For Regulation

The Washington Post: Energy Drink Popularity Booms At College, Despite Health Concerns
With finals season in full swing this month, weary students are looking for anything that can help them endure late-night study sessions. Energy drink companies, whose products are already popular on college campuses, are increasingly looking to replace coffee as a student's go-to answer for a stamina boost during finals -- and then for late nights after graduation. As one Red Bull advertisement states: "Nobody ever wishes they’d slept more during college." But this biannual marketing blitz comes amid renewed calls from lawmakers and health activists in recent months for the Food and Drug Administration to regulate such beverages more strictly, in the aftermath of several deaths that could be connected to energy drinks (Johnson, 12/18).

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State Watch

Roundup: States Facing Medicaid Woes; Colorado, N.C. Govs Extend Funding For Mental Health Care

Reuters: States Scramble To Cover Medicaid Costs, Some Face Overruns
Rising health care costs are pushing up the amounts states must spend on the Medicaid insurance program for the poor, sending some scrambling to find funds, according to a report released on Tuesday by the National Conference of State Legislatures. The report found that spending on Medicaid and other public health care programs is currently over budget in 10 states, compared to six states at the same point last year (Lambert, 12/18).

The New York Times: Experts Warn Of Budget Ills For The State, Lasting Years
The State Budget Crisis Task Force, a nonpartisan group, said that New York’s problems had been "papered over with gimmicks" for decades. ... [T]he report highlighted the state's enormous Medicaid budget, which is larger than those of Florida, Pennsylvania and Texas combined. The report said that while the Cuomo administration had put in place a cap on annual increases in health care spending, it was not certain the measure would drive down costs over the long run (Kaplan, 12/18).

Reuters: Medicaid, Other Costs Threaten New York State And Local Budgets: Report
"Health care costs and retirement costs are rising a lot faster than revenue. And unless one sees something on the horizon that will change that essential dynamic, then that means we're not on a sustainable path," said former New York Lieutenant Governor Richard Ravitch in an interview (Russ, 12/18).

Health Policy Solutions (a Colo. news service): 'Raw' From Tragedies, Governor Calls For Mental Health Overhaul
Acknowledging that emotions are still raw over the mass killing Friday of 20 first-graders and six educators in Connecticut, Hickenlooper said the mental health overhaul -- which will require legislative approval -- has been in the works since two days after the Aurora theater shootings last July (Kerwin McCrimmon, 12/18).

North Carolina Health News: Governor Temporarily Fixes Group Home Funding Problem
Outgoing Governor Bev Perdue announced Tuesday morning she had found a way to provide $1 million to help group homes pay for housing for people with mental health and developmental disabilities through the month of January. The move is a temporary patch for the homes until General Assembly returns to Raleigh and can construct a longer-term fix to the problem. For months, operators of group homes for people with mental health and developmental disabilities have been warning lawmakers that changes to the state’s Medicaid program put about 1400 people at risk of losing the money that pays for their housing and care (Hoban, 12/19).

Modern Healthcare: Partners Healthcare Marks $42 Million For Mass. Tax
One prominent Boston health system plans to pay $42 million under a tax in Massachusetts' health care cost-containment law. ... The Massachusetts law, an ambitious and widely watched attempt to contain rising health care costs, includes provisions to promote health information technology, accountable care and new payment models (Evans, 12/18).

The Lund Report: Oregon Gives CCOs Financial Incentives For Quality Care
The Oregon Health Authority wants to give financial bonuses to the new coordinated care organizations if they can show good health care access as well as emphasize preventive practices such as mental health screening and good maternal health care. But when the Metrics and Scoring Committee dug into the current statistics, it found paltry rates well below national standards. ... As part of Oregon’s experiment with CCOs, the state received a $1.9 billion increase in Medicaid funding over five years (Gray, 12/18).

The Lund Report: OHSU Intends To Track Effectiveness Of CCOs
The newly created Center for Health Systems Effectiveness at Oregon Health & Science University intends to measure the effectiveness of coordinated care organizations under the leadership of John McConnell ... McConnell said the five major drivers of spiraling costs in healthcare are: income, technological change (which can be tied to income -- higher-income populations demand state-of-the-art care), fee-for-service payment systems, fragmentation (contributing to poor communication and redundant care between providers) and productivity differentials (McCurdy, 12/19).

The Oregonian: Hundreds Of High-Prescribers Don't Check Oregon's Pharmacy-Monitoring Program
Doctor-shopping by people seeking opioid painkillers is not new, but for the first time, Oregon officials have an idea of how often it goes on. A report on the state's pharmacy monitoring program shows that in a recent six-month period, 1,746 Oregonians fit the definition of drug-seeker: filling prescriptions written by five or more providers at five or more pharmacies (Budnick, 12/18).

Modern Healthcare: Avera To Acquire Two CHI Hospitals In S.D.
The Avera Health system will acquire two South Dakota hospitals and four long-term-care centers from Catholic Health Initiatives in a deal announced this week. The deal includes 164-bed St. Mary's Healthcare Center, Pierre, and 60-bed Gettysburg (S.D.) Memorial Hospital. The agreement also includes long-term-care centers (Selvam, 12/18).

Detroit Free Press: Congress' Action Puts Nigerian Closer To Medical School Dream
He arrived in Michigan from Nigeria as a 15-year-old, alone, with large tumors spread over his head and threatening his life. A decade later, he is headed to medical school, the tumors removed and permanent U.S. residency coming his way, thanks to rare action by Congress on Tuesday. ... The House passed a special bill granting [Sopuruchi] Chukwueke legal status in the U.S. (Jesse and Spangler, 12/19).

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Editorials and Opinions

Viewpoints: Does 'Fiscal Cliff' End Justify The Means?; A Shrinking Government Under Any Plan

Journal of the AMA: Poised On Edge Of The Fiscal Cliff
It is the third week of December, and all of Washington is focused on whether the country will fall off the "fiscal cliff" it has built for itself. ... As of January 1, physicians’ fees for treating Medicare patients are scheduled for an across-the-board reduction of about 27% in addition to the 2% reduction for all services relating to Medicare under sequestration. ... At some point, the Congress is going to stop kicking the can down the road and decide how it is going to resolve the sustainable growth rate dilemma it has created for itself—but there is no indication that it is yet ready to do so. I have written so many times about my frustration with the failure of Congress to directly confront this issue, including several times in this forum, that I am beginning to feel like a broken record (Gail Wilensky, 12/18).

The New York Times: The Deal Dilemma
First things first: cutting Social Security benefits is a cruel, stupid policy -- just not nearly as cruel and stupid as raising the Medicare eligibility age. But sometimes you have to accept bad things in pursuit of a larger goal: health reform should have included a public option -- heck, it should have gone straight to single-payer -- but a flawed route to universal coverage was better than none at all. The question about this looming deal is whether the end justifies the means (Paul Krugman, 12/18).

The Wall Street Journal: A Bad Budget Deal
It's clear by now that the budget talks are drifting in a drearily familiar Washington direction: Tax and spending increases now, in return for the promise of spending cuts and tax and entitlement reform later. ... Even if Mr. Obama agrees to income-testing for affluent Medicare recipients, this means another tax increase if it comes in the form of premium increases. None of this is anywhere close to the reforms that might slow the pace of health-care spending, which everyone agrees is the biggest fiscal problem (12/18).

The New York Times: Goodbye, Government, Under Either Fiscal Plan
The truth is that both the president and House Republicans have agreed to shrink a critical part of the government to its smallest in at least half a century. ... Loath to raise taxes on the middle class yet unwilling to cut deeply into the budgets for Social Security or Medicare, the president and his advisers proposed cutting the discretionary part of the budget devoted to everything except defense and other security agencies to 1.7 percent of economic output by 2022, down from 3.1 percent last year (Eduardo Porter, 12/18).

The Washington Post: Confusing Asperger's With Mental Illness, And Mental Illness With Evil
Our still underinformed, over-anxious understanding of mental illness -- or of any cognitive or neurological difference, for that matter -- suggests that we haven’t come very far ... A well person doesn’t shoot a bunch of 6-year-olds, though, and while I believe in evil, from a Christian perspective, sin involves free will, which I’m just not sure someone who acted as Lanza did was in any shape to exercise. Saying so is seen as “excusing” such horrific acts, but calling illness by its modern name is important. We have so much hard work to do, and on multiple fronts (Melinda Henneberger, 12/18).

CNN: Get Serious About Mental Health Care
We should be careful not to blame the mentally ill for all crimes. But we should also be prepared to accept that we might be able to prevent some tragedies if we did a better job of caring for them. ... Studies show that more than 10 percent of children in the United States might benefit from some sort of mental health treatment. Most don't get it. ... There is a shortage of resources and services available to serve children. Furthermore, even when those resources exist, a lack of coordination often prevents they're being used effectively (Aaron E. Carroll, 12/18).

Reuters: Of States And Health Insurance Exchanges
Reuters reports [“No sign Congress meant to limit health exchange subsidy: CBO,” Dec. 6] that a recent Congressional Budget Office letter “could complicate” efforts to stop the Internal Revenue Service from imposing “Obamacare’s” employer mandate in states that refuse to implement a health insurance “exchange.” In fact, the CBO’s letter devastates the IRS’s already weak case (Michael F. Cannon, 12/18).

The New York Times Opinionator blog: Dietary Seat Belts
Forget the fiscal cliff: we've long since fallen off the public health cliff. We need consistent policies that benefit a majority of our citizens, even if it costs corporations money. And guns are just the bloodiest public health menace to go virtually unregulated. Preventable, chronic disease -- to a large extent brought about by diet -- is now the biggest killer on the planet. Soda kills more people than guns -- more people than car wrecks -- only less dramatically. What we need is the equivalent of a dietary seat belt (Mark Bittman, 12/18).

Kansas City Star: The Best Medicine For Healing KC’s Wellness Plan
The sickness that plagued Kansas City’s employee wellness program allegedly was spread not just by a few people but by hundreds of city workers. That appalling possibility indicates City Hall contains a large number of people who tried to game the Blue Cross and Blue Shield of Kansas City system to make some easy money for themselves -- without doing the work needed to get healthier and truly earn those rewards (12/18).

The Lund Report: Making Sense Out Of Drug Prices
I take a generic drug, a little yellow pill that’s been produced for decades, to control blood pressure. I started taking it long before the day I turned 65 that happened to coincide with the beginnings of the great recession that effectively reduced the value of our savings and our house. ... in all the upheaval, I still had my little yellow pill to quell the violence of a blood pressure that was simply responding in kind to the events of the day. Some stability existed after all in $4 a month yellow pills. Then one day last year I went as usual to pick up my 90 day supply and was told the pharmacy didn’t have it. Say what? How could you not? (Bertha Cooper, 12/18).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.