Daily Health Policy Report

Thursday, December 20, 2012

Last updated: Thu, Dec 20

KHN Original Reporting & Guest Opinion

Fiscal Cliff

Health Reform

Coverage & Access

Public Health & Education


Capitol Hill Watch


State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Health Insurance Executive: 'Incorporating All The New Regulations' Will Be Challenge In 2013

Kaiser Health News reporters Alvin Tran and Sarah Barr write: "As chairman and CEO, Bruce Bodaken led Blue Shield of California to become one of the fastest growing health plans in the state – it currently has more than 3 million members. But after 12 years of service, the 61-year-old recently announced his plans to retire at the end of 2012. ... Bodaken's views on the health law and the current state of the insurance industry were among the many topics during a recent interview with Kaiser Health News" (Tran and Barr, 12/19). Read the story.

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Capsules: The Gun Lobby's Favorite Part Of The Health Law

Now on Kaiser Health News' blog, Jay Hancock writes about a provision of the health law that bans doctors from requiring patients to answer questions about guns in the home: "The 'Protection of Second Amendment Gun Rights' section says the health law's wellness programs can't require participants to give information about guns in the house. It also keeps the Department of Health and Human Services from collecting data on gun use and stops insurance companies from denying coverage or raising premiums on members because of gun use" (Hancock, 12/20).  Read what else is in the blog.

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Political Cartoon: 'A Mile In Her Shoes?' By Edgar Argo

Kaiser Health News provides a fresh take on health policy developments with 'A Mile In Her Shoes?' by Edgar Argo.

Meanwhile, here is today's health policy haiku:


Oh my how things change:
Now the speaker likes 'Plan B'
Without prescription
- 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

As Clock Runs Down, 'Fiscal Cliff' Negotiations Stall

Speaker John Boehner pledged to bring his alternative option to a House vote as early as today. Meanwhile, the issue of savings in the Medicare program continue to be examined.

The New York Times: Obama And Boehner Diverge Sharply On Fiscal Plan
Hopes for a broad deficit-reduction agreement faded on Wednesday as President Obama insisted he had offered Republicans "a fair deal" while Speaker John A. Boehner moved for a House vote as early as Thursday on a scaled-down plan to limit tax increases to yearly incomes of $1 million and up, despite Senate opposition and Mr. Obama's veto threat (Calmes and Weisman, 12/19).

The Washington Post: 'Cliff' Standoff: Boehner Works To Wrangle Votes For 'Plan B'; Obama Threatens Veto
House GOP leaders scrambled to rally their members Wednesday behind a plan to extend tax cuts on income up to $1 million, defying President Obama’s veto threat and setting up a showdown that could send Washington over the year-end "fiscal cliff." ... If Boehner's limited proposal were to be enacted, the economy would still take a hit: Jobless benefits would begin to expire for the long-term unemployed; physicians with elderly patients would see a sharp drop in Medicare reimbursements; and $100 billion in across-the-board cuts to federal agencies would begin (Kane and Helderman, 12/19).

The Wall Street Journal: Boehner's 'Plan B' Gets Pushback
House Republicans hustled Wednesday to build support for a fallback proposal that would eliminate most of the tax impact of the "fiscal cliff," providing a test of Speaker John Boehner's leadership as the year-end deadline approached. ... Some lawmakers suggested the Obama-Boehner budget negotiations—currently stalled—could resume if Plan B passes the House. Messrs. Boehner and Obama still appear to want a broader deal than Plan B, which doesn't address across-the-board spending cuts set to take effect next year and does little for the budget's long-term problems, such as health-care costs (Favole and Paletta, 12/19).

Los Angeles Times: Boehner Seeks Support For Tax Increase On The Wealthiest
As President Obama and House Speaker John A. Boehner took turns blaming each other for the sudden lull in the budget talks, the action continued off-camera Wednesday as the Ohio Republican focused on building support from his conservative majority to increase tax rates on the wealthy. ... Conservatives railed against Boehner's proposal, which he calls Plan B, as an affront to the party's core values, but Boehner received a crucial lifeline Wednesday from Grover Norquist. The influential anti-tax activist's Americans for Tax Reform said voting for the measure would not violate the pledge most GOP lawmakers had taken not to raise taxes (Mascaro, Parsons and Memoli, 12/19).

Politico Pro: House GOP Spending Cuts Target Obamacare, Medicaid
The House is about to recycle Paul Ryan's sequester replacement bill — most of it, anyway — and put it up for a vote so Republicans can vote for spending cuts along with the "Plan B" tax bill that they’ll be asked to pass Thursday. The spending-cuts bill is almost identical to Ryan's sequester replacement bill, which the House passed this spring, when it comes to the extra health savings it would achieve to prevent the sequester’s defense cuts. Like Ryan's previous bill, the new one would take several bites out of Obamacare, although not out of its major provisions. It would repeal unlimited funding for exchange-planning grants under the Affordable Care Act, get rid of the Prevention and Public Health Fund and defund the CO-OP program (Nather, 12/19).

The Associated Press: Medicare Premiums Could Rise For Many Retirees
It's a health care change that President Barack Obama and Republicans both embrace: Expand a current, little-known law so more retirees the government considers well-off are required to pay higher Medicare premiums. That plan is likely to be part of any budget deal to reduce the overhang of federal debt, raising $20 billion or more over 10 years. It could come as a shock to many seniors who will have to pay the higher premiums even though they consider themselves solidly middle-class, and by no means wealthy (Alonso-Zaldivar, 12/20).

Fiscal Times: Medicare May Be Silent Killer In Budget Battles
Taxes may be taking the lion's share of the spotlight right now in the fervor to negotiate a fiscal cliff deal, but Medicare looks more and more like the major obstacle to putting the federal budget on a stable course. ... Structural changes to Medicare – the spending bomb set to detonate as the grand bargain's 10-year window closes – have mostly been offstage in this D.C. drama. Boehner has proposed gradually raising the Medicare eligibility age from 65 to 67, a change Obama has resisted while calling for savings on prescription drugs (Boak, 12/20).

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Medicare 'Doc Fix' Hostage To Fiscal Cliff Negotiations

The Obama administration notified more than 1 million physicians Wednesday that their Medicare payment rate would be cut by 27 percent next month if Congress doesn't act to stop it. But proposals for a one-year patch and even a repeal of the flawed payment formula are now caught up in the "fiscal cliff" talks.

Forbes: 27% Medicare Pay Cut For Doctors Real Danger In Fiscal Cliff
Unlike past years when Congress has headed off the Medicare fee cut, inaction in Washington lately on the fiscal cliff and for an entire year on the "doc fix" has the American Medical Association, the nation's largest doctor group, and physicians across the country worried there will not even be a stopgap measure this time around. "The threat is real," AMA president Dr. Jeremy Lazarus said in an interview. ... The Obama administration's latest offer to avoid the fiscal cliff to U.S. House Speaker John Boehner and Republicans in Congress includes a repeal of the SGR, which could cost more than $240 billion (Japsen, 12/20).

CQ HealthBeat: HHS Mails Doctors Medicare Payment Cut Notice
Just in case the nation's doctors weren't aware, the Obama administration on Wednesday sent out a notice to more than 1 million physicians telling them that their Medicare payment rate will be cut by 27 percent if Congress does not act to stop it. It's estimated that the reimbursement cut would mean $14 billion less in Medicare payments to doctors in 2013. But while the notice chastises lawmakers for not acting, it also lets doctors know that, practically, they won't see the payment cut as long as Congress finds a solution, a so-called "doc fix," by mid-January (Bunis, 12/19).

CQ HealthBeat: Medicare 'Doc Fix' Still High On House GOP Priority List
Although the issue is not addressed in the speaker's "Plan B" tax proposal, House Republicans are continuing to work on a measure to block upcoming payment cuts for Medicare physicians. The Obama administration released an analysis criticizing Speaker John A. Boehner's plan, noting that it did nothing to avert the 27 percent payment cut to doctors that is slated to take effect on Jan. 1, and House Minority Leader Nancy Pelosi of California also highlighted the omission at a Wednesday press conference. But Republicans said a temporary patch, known as a "doc fix," is being discussed, and they emphasized the importance of moving legislation through Congress that addresses the issue  (Attias and Ethridge, 12/19).

Modern Healthcare: CMS Notice Spurs AMA To Stress Doc-Pay Fix
The American Medical Association on Wednesday called on Congress to act immediately to avert a looming 27% Medicare payment cut to physicians after a notice from the CMS indicated there will be no delay in the processing of claims payments under the Medicare physician fee schedule. "The threat is real and a cut of 26.5 percent is simply unsustainable," AMA President Dr. Jeremy Lazarus said in a statement (Zigmond, 12/19).

Medscape: Obama's Fiscal-Cliff Plan Said To Repeal SGR
President Barack Obama's latest plan to save the nation from the fiscal cliff includes a repeal of Medicare's sustainable growth rate (SGR) formula that otherwise will trigger a 26.5% cut in physician reimbursement on January 1, according to a source familiar with negotiations between Congress and the White House. The Medicare rate reduction is part of the automatic spending cuts and tax increases dubbed the "fiscal cliff" that take effect in January. ... The SGR crisis, a yearly event for physicians over the past decade, is a fiscal-cliff sideshow. Most of the jawboning between Obama, Senate Democrats who rule that chamber, and House Speaker John Boehner (R-OH), has been over the expiration of the Bush-era tax cuts, which will raise everyone's rates (Lowes, 12/19).

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Health Reform

Many Uninsured Still Don't Understand Health Law's Benefits While Employers Remain Concerned About Costs

The New York Times examines efforts by a nonprofit group to explain the overhaul's provisions to the uninsured. And the Wall Street Journal looks at an employer's efforts to keep the number of workers low so he can avoid the law.

The New York Times: Next Challenge For The Health Law: Getting The Public To Buy In
On its face, the low-key discussion around a conference table in Miami last month did not appear to have national implications. Eight men and women, including a diner owner, a chef and a real estate agent, answered questions about why they had no health insurance and what might persuade them to buy it. ... The sessions confirmed a daunting reality: Many of those the law is supposed to help have no idea what it could do for them. In the Miami focus group, a few participants knew only that they could face a fine if they did not buy coverage. ... There lies the challenge for Enroll America, a nonprofit group formed last year to get the word out to the uninsured and encourage them get coverage, providing help along the way (Goodnough, 12/19).

The Wall Street Journal: Health Costs On His Mind
Owner Carl Schanstra ... is worried that as Automation Systems continues to expand, it will be subject to a provision in the health-care overhaul that could damage its bottom line. ... That is because his plant, with sales of about $1.6 million for 2012, currently employs 40 full-time workers, mostly low-paid employees who monitor the factory equipment. If sales were to continue to rise, the plant could, conceivably, employ 50 full-time workers in 2014. Under the new health-care law, the Affordable Care Act, businesses with 50 or more full-time equivalent employees will be required, starting in that year, to offer workers health insurance or potentially pay a penalty. The expense, he says, would drive up the cost of his labor. So he doesn't want to let employment at the factory reach that number (Maltby and Needleman, 12/19).

Meanwhile, in other health law news --

Kaiser Health News: Health Insurance Executive: 'Incorporating All The New Regulations' Will Be Challenge In 2013
As chairman and CEO, Bruce Bodaken led Blue Shield of California to become one of the fastest growing health plans in the state – it currently has more than 3 million members. But after 12 years of service, the 61-year-old recently announced his plans to retire at the end of 2012. ... Bodaken's views on the health law and the current state of the insurance industry were among the many topics during a recent interview with Kaiser Health News (Tran and Barr, 12/19).

Politico Pro: States Can't Get Guidance To Launch Basic Health Plans
Some of the states that hope to go the extra mile on Obamacare say they've been confounded by a lack of guidance — from the Obama administration. While most of the attention around the law's implementation has focused on states refusing to cooperate at all, the most eager states — seeking to unwrap all the law has to offer — have hit a wall on one of the most advanced features: building a Basic Health Plan. The optional program is intended to cover low-income people whose earnings routinely fluctuate, often leaving them eligible for Medicaid one day and more likely to end up on a subsidized insurance exchange the next. But in a handful of states that are eyeing the option, officials say the absence of guidance from Washington means states can't set up a Basic Health Plan until at least 2015 (Millman and Cheney, 12/19).

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Court Challenge To Contraception Coverage Mandate Paused As Administration Writes Rules

The D.C. Circuit Court of Appeals will allow a suit by religious school to continue but says it will hold the government to its deadlines for revising rules for religiously affiliated employers.

McClatchy: Religious Challenge To Health Care Law Can Continue
North Carolina's Belmont Abbey College can keep on challenging the Obama administration's signature health care law under an appellate court ruling that leaves the challenge on hold. In a decision closely watched by many other religious schools and institutions, the U.S. Court of Appeals for the District of Columbia Circuit has ruled that the legal challenge by Belmont Abbey and Illinois' Wheaton College may remain "in abeyance" while the administration revises rules for a contraception coverage mandate. Pointedly, the court also set firm deadlines for administration officials to make the revisions protecting those with religious objections. The ruling is a compromise victory for the schools and a definite defeat for the administration, which wanted the religious liberty lawsuit dismissed outright (Doyle, 12/19).

CQ HealthBeat: Appeals Court Orders Obama Administration To Submit Reports On Progress Of Birth Control Rule
A federal appeals panel Tuesday ordered the Obama administration to update the court every 60 days on progress on a rule governing how religious colleges, hospitals and other entities are to provide birth control coverage in their workers' health insurance policies. The unsigned ruling by the three-court panel of the U.S. Court of Appeals for the District of Columbia said that during recent arguments before the court, government lawyers said the long-awaited proposed contraception rule will be published during the first quarter of 2013 and the final rule before August. "We take the government at its word and will hold it to it," the appeals court said (Norman, 12/19).

Earlier from KHN: The 'Contraceptive Mandate' Versus Religious Freedom

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Coverage & Access

Access To Mental Health Care, Increased Funding Key In Emerging Strategies To Curb Gun Violence

As President Barack Obama vowed to restart the "national conversation" on gun issues, he included the need to improve access to mental health services among the central elements of this discussion. Meanwhile, a new Gallup poll concluded that Americans believe that increasing federal spending on mental health screenings and services is among the steps more likely to deter mass shootings than banning the sale of assault weapons.

The New York Times: Obama Vows Fast Action In New Push For Gun Control
President Obama declared on Wednesday that he would make gun control a "central issue" as he opens his second term, promising to submit broad new firearm proposals to Congress no later than January and to employ the full power of his office to overcome deep-seated political resistance. ... Having avoided a politically difficult debate over guns for four years, Mr. Obama vowed to restart a national conversation about their role in American society, the need for better access to mental health services and the impact of exceedingly violent images in the nation's culture (Shear, 12/19).

Los Angeles Times: White House Task Force To Tackle Gun Violence
Announcing his first steps in response to the Newtown, Conn., school massacre, President Obama on Wednesday charged a task force with drawing up a list of proposals to reduce gun violence across the nation and urged Congress to hold votes on gun control legislation early in the new year. ... Obama acknowledged the challenging politics of gun control. He emphasized that the task force would look beyond stiffer gun laws for solutions, including measures that address cultural influences and mental health services (Hennessey, 12/19).

The Hill: Poll: Americans See Police, Mental Health Care More Effective Than Assault Weapons Ban
Americans believe that increasing the police presence at schools and upping federal spending on mental health screenings and services are more likely to deter mass shootings than banning the sale of assault weapons, according to a poll from Gallup released Wednesday. More than half of those surveyed said more police and mental health services would be "very effective," with nearly nine in 10 saying doing so would be at least "somewhat effective" in preventing gun crime. Some 78 percent also said decreasing the depictions of violence on TV and in movies and video games would help to prevent mass shootings (Sink, 12/19).

The Hill: Advocates For Mental Health Have Momentum After Conn. Massacre
The mental-health community has begun a major lobbying effort for federal action in response to last Friday's school shooting in Newtown, Conn. Major advocacy groups are already meeting with Capitol Hill offices and formulating an agenda that they say has forward momentum as a result of the new public dialogue on mental illness. "The field as a whole has agreed. There is a lot of interest among other national organizations in getting something done," said Rebecca Farley with the National Council for Community Behavioral Healthcare (Viebeck and Baker, 12/20).

CT Mirror: Welcome, And Wary Of, A Focus On Mental Health
The calls to improve the mental health care system in the wake of last week's elementary-school shooting are welcome, and worrisome, for people like Kate Mattias. "The good news is there's attention being paid," said Mattias, executive director of the National Alliance on Mental Illness Connecticut. "On the other hand, it's attention wrought by a terrible, terrible incident." She and other advocates have spent years trying to counter the perception that people with mental illness are violent and dangerous; in fact, research suggests that they're more likely than the general public to be victims of violent crime. And people who work in the mental health system are wary of potential policy changes that are based on the notion that people with mental illness are violent (Becker, 12/19).

Meanwhile, KHN looks at a section of the health law that deals with gun violence.

Kaiser Health News: The Gun Lobby's Favorite Part Of The Health Law
Did you know the Affordable Care Act stands up for gun rights? The "Protection of Second Amendment Gun Rights" section (page 19 in this PDF) says the health law’s wellness programs can't require participants to give information about guns in the house. It also keeps the Department of Health and Human Services from collecting data on gun use and stops insurance companies from denying coverage or raising premiums on members because of gun use (Hancock, 12/20).

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Public Health & Education

FDA Seeks Input From States On Drug Compounders

FDA Commissioner Margaret Hamburg convened a meeting that included federal officials and representatives from state boards of pharmacy and governors' offices. Meanwhile, the Los Angeles Times reports on "rogue pharmacists."

The New York Times: F.D.A. And States Discuss Regulation Of Drug Compounders
The Food and Drug Administration conferred with public health officials from 50 states on Wednesday about how best to strengthen rules governing compounding pharmacies in the wake of a national meningitis outbreak caused by a tainted pain medication produced by a Massachusetts pharmacy. It was the first public discussion of what should be done about the practice of compounding, or tailor-making medicine for individual patients, since the F.D.A. commissioner, Dr. Margaret Hamburg, testified in Congress last month about the need for greater federal oversight of large compounding pharmacies. So far, 620 people in 19 states have been sickened in the outbreak, and 39 of them have died (Tavernise, 12/19).

The Wall Street Journal: FDA Lagged On Specialized Pharmacy Regulations
The Food and Drug Administration under President Barack Obama didn't push for a law to regulate drug-mixing pharmacies before a recent outbreak of more than 600 meningitis cases tied to such a pharmacy, the head of the agency said Wednesday. FDA Commissioner Margaret A. Hamburg said her agency didn't press for such a law despite numerous deaths and illnesses over several years linked to compounding pharmacies. She made the remark at a summit meeting the FDA held Wednesday with officials of all 50 states who regulate compounding pharmacies (Burton, 12/19).

CQ HealthBeat: State And Federal Officials Explore Details Of Additional Regulations On Compounding Pharmacies
Some state officials seemed open to more uniform definitions and standards for overseeing compounding pharmacies, at a meeting Wednesday between officials from all 50 states and the Food and Drug Administration. However, FDA Commissioner Margaret Hamburg called the daylong meeting the beginning of a long conversation among state boards of pharmacy, governors’ staffs and federal officials. The focus on compounding pharmacies emerged after a company, the New England Compounding Center in Massachusetts, released contaminated products that sparked a widespread national outbreak of deadly fungal meningitis that resulted in 620 illnesses and 39 deaths as of Dec. 17 (Adams, 12/19).

Medpage Today: Compounding Pharmacies Focus Of All Day Hearing
The FDA and health officials from all 50 states came together Wednesday for a one-day workshop to help identify and close the gaps in overseeing compounding pharmacies including the ones like the Massachusetts one linked to 39 deaths from fungal meningitis. Heads of state boards of pharmacy -- who oversee compounding pharmacies -- told the FDA they need better communication with the federal agency and greater clarity in certain areas to understand what aspects they're responsible for and what the FDA controls. In the nearly 3 months since the outbreak started, the FDA has claimed gaps in regulating compounding pharmacies helped facilitate lax oversight of Framingham, Mass.-based New England Compound Pharmacy (NECC), found to have shipped tainted steroids that later infected more than 600 patients in 19 states (Pittman, 12/19).

Meanwhile, the impact of the meningitis outbreak continues to reverberate -

Reuters: U.S. Fungal Meningitis Outbreak Could Have Been Much Worse: CDC
As bad as the 2012 fungal meningitis outbreak has been, so far infecting 620 people in 19 states and killing 39 of them, it could have been a lot worse, U.S. health officials said on Wednesday. Prior and much smaller fungal outbreaks involving tainted spinal injections were far more deadly, killing as many as 40 to 50 percent of those who had become infected, said Dr. Rachel Smith, an epidemic intelligence service officer at the Centers for Disease Control and Prevention (Steenhuysen, 12/19).

Also, the Los Angeles Times continues its look at misuse of prescriptions.

Los Angeles Times: Rogue Pharmacists Fuel Addiction
Pharmacists are supposed to be a last line of defense against misuse of prescription medications. By law, they are required to scrutinize prescriptions, size up customers and refuse to dispense a drug when they suspect the patient has no medical need for it. Some, however, provide massive amounts of painkillers and anti-anxiety drugs to addicts and dealers with no questions asked, according to state records, regulators and law enforcement officials. Rogue pharmacists are key enablers of drug abuse and an important source of supply for the illegal market (Glover, Girion and Branson-Potts, 12/20).

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Report: States Underprepared To Meet Public Health Needs During A Crisis

The report by Trust for America's Health and the Robert Wood Johnson Foundation found that although some states have improved their preparedness, gaps persist largely because of state budget cuts.

Medscape: Public Health Emergencies: Most Of Nation Unprepared
More than a decade after the September 11, 2001, domestic terrorism attacks, most of the nation remains woefully unprepared to respond to pressing public health needs during such emergencies, largely because of budget cuts, according to a report released this morning. The annual report, "Ready or Not?" released by the Trust for America's Health and the Robert Wood Johnson Foundation, ranked states' preparedness to handle public health emergencies resulting from natural disasters, such as Superstorm Sandy; disease outbreaks, such as Escherichia coli; and bioterrorism attacks. Pointing to the aftermath of the mass shooting last week in Newtown, Connecticut, Jeffrey Levi, PhD, executive director, Trust for America's Health, told reporters it was "a heartbreaking reminder about the importance of ensuring we invest in this as a society" (Henderson, 12/19).

ABC: Most States Underprepared For Public Health Emergencies
There are persistent gaps in the nation's ability to respond to public health emergencies, according to a new study from the Robert Wood Johnson Foundation and Trust for America's Health, despite a series of recent tragic events like 9-11, anthrax threats and Hurricane Katrina. One of the most notable findings is that 20 U.S. states do not currently mandate written evacuation plans for all licensed child care facilities, should the need arise. "Most school systems have plans in place, but we also need to recognize that child care facilities need plans as well," said Dr. Jeffrey Levi, executive director of Trust for America's Health (Austin, 12/19).

CQ HealthBeat: Report Finds Budget Cuts Put Preparedness at Risk
The nation has made progress in preparing for disasters in the past decade but those accomplishments "are now being undermined due to severe budget cuts and lack of prioritization," according to a report released Wednesday by the Trust for America’s Health and Robert Wood Johnson Foundation…The 80-page report included a state-by-state analysis of the country's readiness, which determined that Kansas and Montana were the least prepared based on 10 measures. The report found that 29 states reduced public health spending from fiscal 2011 to fiscal 2012, and 23 of them did so for the second consecutive year. State and local health departments have cut more than 45,700 jobs nationwide since 2008, the report said (Adams, 12/19).

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Teen Smoking Falls To Record Low, Study Finds

Cigarette smoking among U.S. teenagers dropped to a record low in 2012, a decline that may have been partly driven by an increase in the federal tobacco tax, researchers said.

The Wall Street Journal: Teen Smoking Keeps Falling
Cigarette use among U.S. teenagers fell to historic lows and a four-year rise in marijuana use appears to have leveled off, according to a national study released Wednesday. The annual report, funded by the National Institute on Drug Abuse and conducted by the University of Michigan, found the number of teenagers who reported smoking cigarettes in the prior 30 days fell to 10.6% this year from 11.7% in 2011, the lowest level recorded since the survey began in 1975 (Dooren, 12/19).

USA Today: Survey: 1 In 15 High School Seniors Smoking Pot
As states increasingly adopt laws allowing medical marijuana, fewer teens see occasional marijuana use as harmful, the largest national survey of youth drug use has found. Nearly 80% of high school seniors don't consider occasional marijuana use harmful — the highest rate since 1983 — and one in 15 smoke nearly every day, according to the annual survey of eighth-, 10th- and 12th-graders made public Wednesday (Leger, 12/19).

Reuters: U.S. Teen Smoking Declines To Record Low In 2012: Study
Cigarette smoking among American teenagers dropped to a record low in 2012, a decline that may have been partly driven by a sharp hike in the federal tobacco tax, researchers said on Wednesday. An annual survey of about 45,000 students in the eighth, 10th and 12th grades found that the overall proportion of those saying they had smoked in the prior 30 days fell by just over a percentage point to 10.6 percent (Gorman, 12/19).


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Surgeons Make Thousands Of Errors Every Year

So-called 'never events' happen more than 4,000 times a year, according to a study by Johns Hopkins researchers. Another report finds health care workers just as likely as people they treat to be overweight, avoid the dentist, get sunburned and not wear seatbelts.

The Wall Street Journal: Surgeons Make Thousands Of Errors
They are known as "never events"—the kind of mistake that should never happen in medicine, like operating on the wrong patient or sewing someone up with a sponge still inside—yet new research suggests that they happen with alarming frequency. Surgeons make such mistakes more than 4,000 times a year in the U.S., according to a study led by Johns Hopkins University School of Medicine, published online in the journal Surgery (Landro, 12/19).

Reuters: Do Health Care Workers Practice What They Preach?
Health care workers may not always "practice what they preach" when it comes to keeping up to date with cancer screenings, maintaining a healthy weight and not smoking, a new study suggests. Researchers found people surveyed by phone who said their job involved direct patient care were just as likely to be overweight, avoid the dentist, get sunburned and not wear their seatbelt as those in other fields (Pittman, 12/19).

Medscape: Healthcare Workers Often Fail To Practice What They Preach
When it comes to healthy living, healthcare workers (HCWs) may not always be the best role models for their patients, the authors of a new study say. In a survey of 260,558 participants including 21,380 HCWs, the HCWs did not differ significantly from the general population in the likelihood of "having a recent Papanicolaou test or dental visit, ever having a sigmoidoscopy or colonoscopy, being overweight or obese, drinking and driving, failing to wear a seatbelt, smoking, using smokeless tobacco, engaging in [HIV] risk behaviors, getting sunburned, or being dissatisfied with life. Most surprisingly, female HCWs were significantly more likely to report not having a mammogram within the past 2 years," Benjamin K.I. Helfand, MSc, and Kenneth J. Mukamal, MD, MPH, from the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, write in a research letter published online December 17 in the Archives of Internal Medicine (MacReady, 12/19).

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Capitol Hill Watch

House Passes Bio-Threat Vaccines, Medicare Coverage Bills

The House passed several health measures Wednesday including bills on developing vaccines to thwart bio-threats and on Medicare coverage for immune deficiency care.

The Hill: House Reauthorizes Bio-Threat Readiness Program, Other Health Laws
The House voted Wednesday to extend a program aimed at developing vaccines and other responses to bio-threats, along with other health-related bills, including one that could lead to Medicare coverage for home IVIG treatments. In a 383-16 vote, members approved the Pandemic and All Hazards Preparedness Reauthorization Act, H.R. 6672, which reauthorizes programs that help prepare for bio-threats. These programs are now carried out under the Public Health Service Act and other laws dealing with public health (Kasperowicz, 12/19).

CQ HealthBeat: Medicare Coverage For Immune Deficiency Care At Home Advanced By House
The House passed a bill Wednesday that would establish a demonstration project to evaluate the benefits of allowing Medicare to cover in-home intravenous treatments for patients with primary immune deficiency disease. The disease leaves patients unable to produce protective antibodies or develop immunity, requiring infusions of intravenous immunoglobulin to help them fight infections. Changes in Medicare reimbursement policy have had the unintended consequence of limiting the access of many beneficiaries to this lifesaving treatment (McGeehan, 12/19).

And Sen. Barbara Mikulski will likely be the next head of the Senate Appropriations Committee --

CQ HealthBeat: Mikulski, A Passionate NIH Booster, Will Lead Senate Appropriations Panel
The expectation that Sen. Barbara A. Mikulski will be the new chairwoman of the Senate Appropriations Committee places a passionate advocate of the National Institutes of Health and the Food and Drug Administration in a powerful position to protect the agencies' funding amid deficit reduction pressures. Mikulski is likely to be officially named as the head of the panel by her Democratic colleagues at Thursday's caucus meeting. She would become the first woman to chair that committee. The Maryland Democrat also has been a fierce advocate for federal employees and for funding of Johns Hopkins University in Baltimore and its health system, regarded by many as one of the finest hospitals in the world (Reichard, 12/19).

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CMS Awards $306M To States For Enrolling More Kids In Medicaid

The Centers For Medicare & Medicaid Services on Wednesday awarded $306 million in bonuses to 23 states for enrolling more children in Medicaid. The move is meant to help offset the expense of covering more kids in the state-federal health care program.

CQ HealthBeat: Take A Bow: 23 States Get Bonuses For CHIP, Medicaid Programs
The Department of Health and Human Services on Wednesday announced that 23 states qualified for $306 million in performance bonuses for their gains in signing up low-income children for health coverage, including Utah for the first time. The bonuses come as states and the federal government work on setting up health insurance exchanges that will begin operation in 2014 and are intended to make enrollment in public programs even smoother. According to an Urban Institute study published earlier this month, 86 percent of eligible children were signed up for CHIP and Medicaid in 2010, an increase from 81.7 percent in 2008 (Norman, 12/19).

The Denver Post: Colorado Wins $43 Million Medicaid Bonus For Its Kids Programs
Colorado won a $43 million bonus from federal Medicaid officials Wednesday as reward for enrolling more children in the insurance program, the largest of awards to 23 states. The bonuses are meant to help offset the added expenses states incur when they increase the number of children with state insurance. Medicaid costs are split evenly between federal and state governments (Booth, 12/19).

The Lund Report: Oregon Receives $25.8 Million In Performance Bonus From CMS
Lawmakers will have $25.8 million at their disposal when the legislature convenes next February -- with no strings attached. Yesterday, the Centers for Medicare & Medicaid Services made the announcement, saying Oregon is among 23 states receiving performance bonuses for enrolling children in its Medicaid program, known as the Children’s Health Insurance Program. In Oregon, that meant 289,802 children participated in that program during fiscal 2012. “No decisions have been made about how this money will be spent,” said Alissa Robbins, spokesperson for the Oregon Health Authority (Lund-Muzikant, 12/20).

Georgia Health News: State Gets (Smaller) Bonus For Kids' Enrollment
Georgia is one of 23 states that will receive a performance bonus for enrolling eligible children in government health insurance programs, but the amount is far less than last year’s award. The Centers for Medicare & Medicaid Services said Wednesday that Georgia will receive a bonus of $1.9 million. The state’s bonus last year was almost $5 million. 2011 was the first year that Georgia got this performance bonus, funded under legislation that reauthorized the Children’s Health Insurance Program (CHIP). A state qualifies for a federal bonus by implementing procedures to simplify enrollment and renewal to ensure that all eligible children have easier access to coverage under Medicaid and CHIP, which in Georgia is known as PeachCare (Miller, 12/19).

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State Watch

Roundup: Calif. Report Sets 10-Year Health Goals; Conn. Hospitals Plead To Stop Cuts; Colo. Lawmaker Wants State Universal Health Care On Ballot

A selection of health policy stories from California, Colorado, Connecticut, Virginia, Massachusetts, Michigan, Florida and North Carolina.

Los Angeles Times: California Leaders Set State Health Goals To Be Met By 2022
With the state facing rising medical costs and increasing rates of chronic disease, California health leaders issued a report Wednesday setting specific health targets to meet by 2022. The state's goals include reducing smoking rates, increasing vaccinations among children and improving depression screening and treatment. The report also describes ways to improve end-of-life care, by expanding palliative care at hospitals and hospice programs at home (12/19).

HealthyCal: A Road Map To A Healthier State
A task force appointed by Gov. Jerry Brown has laid out a road map for California to become the healthiest state in the nation by 2022. The ten-year plan establishes 39 specific, measurable goals from cradle to grave. They range from infant mortality and childhood obesity to the management of chronic disease, preventable hospitalizations and the number of terminally ill people using hospice care (Weintraub, 12/19).

Los Angeles Times: New Report Embraces Medi-Cal Expansion
Gov. Jerry Brown's top healthcare official appeared to embrace an expansion of the state's Medi-Cal system as California moves to implement the healthcare overhaul signed by President Obama in 2010. A new report from the Let's Get Healthy Taskforce, co-chaired by Diana Dooley, Brown's secretary for Health and Human Services, says "expansion of coverage through the Health Benefit Exchange and Medi-Cal will be an important step" that can particularly help African American and Latino populations, who together comprise nearly half of the state's estimated 8 million residents without health coverage (York, 12/19).

CT Mirror: Hospitals Say Budget Cuts Look Far Worse In Historical Context
Hospitals face the single-largest cut in the tentative plan crafted over the past week by the administration of Gov. Dannel P. Malloy and legislative leaders from both parties. But they are hoping that some historical perspective will persuade officials to spare them from deep cuts. The chief lobbying agency for the state's 29 acute care hospitals also warned Tuesday that the anticipated $103 million mid-fiscal-year cut in state funding would eliminate jobs and "critical community programs" and services (Phaneuf and Becker, 12/19).

The Denver Post: Colorado Sen. Irene Aguilar To Push For Universal Health Care
Obamacare got the Supreme Court's stamp of approval, and the state health insurance exchange is well on its way, but universal coverage for all Coloradans is still a better goal, state Sen. Irene Aguilar is willing to argue all over again. Aguilar said Wednesday she will introduce a bill in the 2013 legislature seeking a referendum to the people on creating state-run, universal health insurance (Booth, 12/20).

CQ HealthBeat: HHS Awards More Money To School Health Centers
Federal health officials on Wednesday awarded more than $80 million to 197 school-based health centers as part of funding the health care law provides in an effort to continue expanding preventive and primary care. Health and Human Services Secretary Kathleen Sebelius said in a statement that the grants will serve an additional 384,000 students across the country. This funding will allow school-based health centers to serve an additional 384,000 students. The award list shows grants going to schools and health systems in 38 states (12/19).

The Denver Post: Colorado School-Based Health Centers Receive $1 Million In Grants
Three Colorado school-based health centers received more than $1 million in competitive grant funds from the U.S. Department of Health and Human Services on Wednesday. Sen. Mark Udall congratulated the Durango School District 9-R, Denver Health Medical Center and Commerce City Community Health Services for receiving the funds (12/19).

California Watch: Prime Hospital Abruptly Stops Billing Medicare For Rare Ailment
After billing Medicare for treating more than 1,100 cases of a rare affliction, a Prime Healthcare Services hospital in Redding abruptly stopped last year, state health records show. The change occurred soon after California Watch published a story about aggressive billing practices at the hospital (Williams and Doig, 12/20).

Richmond Times-Dispatch: Va. Makes Push On Health Innovation Plan
The road to Medicaid expansion could go through the Virginia Center for Health Innovation. The center, established last spring with help from private and nonprofit health care organizations and housed at the Virginia Chamber of Commerce, launched an intensive effort on Wednesday to produce the Virginia Health Innovation Plan by the end of May. The plan would be the foundation for projects that test new ways of delivering and paying for health care — at a lower cost to those who pay the bills, both public and private. And those kinds of reforms are what some state and health care industry officials say are necessary before Virginia agrees to expand its Medicaid program under the Affordable Care Act (Martz, 12/19).

Richmond Times-Dispatch: Patient-Centered Medical Homes Touted For Free Clinics And Other Safety-Net Providers
As part of an initiative to improve patient care, Fan Free Clinic three years ago started a diabetes wellness program that included an hour each week of one-on-one time with patients to go over their blood sugar numbers, nutrition and other issues. "I was very excited because we were going to call those patients. We were going to get them on the phone. They didn't have to come in, and we were going to call them anytime they wanted us to," said Cathy Wheeler, a registered nurse and director of clinical operations for the Richmond clinic (Smith, 12/20).

WBUR (Audio): Is The Mass. Mental Health Care System Doing Enough?
Malissie Holloway was only 24 when she was found dead, hanging from a pipe in her closet. Holloway suffered from debilitating mental illness and was living in a Somerville community based mental health facility. Her family began asking questions. The group home was supposed to a safe place, one with support and ongoing supervision, yet the staff was admonished for not seeing her for two days before her body was discovered. The Somerville group home is part of Massachusetts' Community Health System -- specifically, a relatively new program called Community Based Flexible Supports, or CBFS. As part of a special investigative report, WBUR and the New England Center for Investigative Reporting looked into CBFS, which provides treatment and support to over 29,000 individuals (12/19).

Detroit Free Press: Henry Ford, Beaumont Health Systems Announce Task Force To Oversee Merger
Henry Ford Health System and Beaumont Health System have created a task force to oversee the merger of the two hospital systems, they announced today. The various panels will include administrators, doctors, nurses and other staffers, according to a press release. Among the topics to be explored are academics and research, branding, safety and quality, supply chain, insurance, nursing and facilities. "The Merger Integration Task Force will launch our due diligence process, during which we will address how to smoothly and efficiently bring our two organizations together," said Henry Ford CEO Nancy Schlichting, who’s co-chairing it with Beaumont CEO Gene Michalski (Meyer, 12/19).

The Miami Herald: Accelerator Planned For Health Care-Tech Start-Ups
Project Lift Miami, designed to help develop young companies and prepare them for investment opportunities, is a partnership between Lift1428, an innovation design, strategy and communications firm; the Miami Innovation Center at the University of Miami Life Science & Technology Park and its developer, Wexford Science + Technology; and the UM Miller School of Medicine, said Robert Chavez, the project's executive director. "We're being proactive and trying to support innovative ideas and companies. … We'd like to keep them here and really help to transform the area into a healthcare innovation hub." The accelerator will offer entrepreneurial teams a structured 100-day program of classes, workshops and training directed by national and local healthcare experts as well as mentoring and strategic support that will continue well beyond the program, said David McDonald, CEO of Lift1428 and co-founder of Project Lift Miami (Dahlberg, 12/19).

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. But the legislature is in recess, and state law limits the governor's options, so a solution has been elusive (Hoban, 12/19).

Los Angeles Times: Battle Over Nation's Largest Pot Dispensary Heads To U.S. Court
A showdown over the fate of the country's largest medical marijuana dispensary heads to federal court here Thursday, and the outcome could hint at what lies ahead as a growing number of states opt for legalization. This fall, Oakland became the first municipality to sue federal prosecutors in an attempt to block them from shuttering a medical cannabis facility. Harborside Health Center, with facilities in Oakland and San Jose, has more than 108,000 members in its patient collective (Romney, 12/19).

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Weekend Reading

Longer Looks: Disparities In Nursing Home Penalties; Understanding Dying With Dignity

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

Los Angeles Times: Chorus Of Voices Grows Stronger For 'Death With Dignity'
My mortality wake-up call came in a hospital after knee surgery, when I flat-lined because of a heart arrhythmia and was resuscitated by a nurse. In response to columns about those events, stories have streamed in from people who are running out of time themselves, or enduring the pain of watching loved ones fade. The deaths they face are as different as the lives they've lived, but a steady refrain runs through their emails and letters. People want more control in the end. They want to be in charge of one last thing. These people speak a common language, linked by a desire to have lethal, doctor-prescribed medication as a legal option, as do residents of Oregon and Washington (Steve Lopez, 12/18).

ProPublica: Two Deaths, Wildly Different Penalties: The Big Disparities In Nursing Home Oversight
At a nursing home in the East Texas town of Hughes Springs earlier this year, a resident approached the nurses’ station gagging on a cookie. ... he died. Government inspectors determined that staff at the home were not trained for emergencies ... Months earlier, in North Augusta, S.C., a resident pulled out her breathing tube and died. Inspectors faulted the home for failing to take appropriate steps to keep the resident from harming herself ... Both homes posed an “immediate jeopardy” to residents’ health and safety, inspectors [working on behalf of the U.S. Centers for Medicare and Medicaid Services] determined. But the consequences were starkly different. ... The average fine paid by a South Carolina nursing home in the past three years was $40,507. The average fine in Texas: $6,933 (Charles Ornstein and Lena Groeger, 12/17).

The New York Times: In Gun Debate, A Misguided Focus On Mental Illness
[T]here is overwhelming epidemiological evidence that the vast majority of people with psychiatric disorders do not commit violent acts. Only about 4 percent of violence in the United States can be attributed to people with mental illness. ... Alcohol and drug abuse are far more likely to result in violent behavior than mental illness by itself. ... 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. ... But mass killings are very rare events, and because people with mental illness contribute so little to overall violence, these measures would have little impact on everyday firearm-related killings. ... Perhaps more significant, we are not very good at predicting who is likely to be dangerous in the future (Dr. Richard A. Friedman, 12/17).

The Economist: Obesity: Fat Chance
In 2008 obesity rates were nearly double those of 1980. One in three adults was overweight, with a body-mass index (BMI) of 25 or more (at least 77kg for a man 175cm tall); 12% were obese, with a BMI of at least 30. ... in most countries the state covers some or most of the costs of health care, so fat people raise costs for everyone. ... Obesity is, at its heart, the result of many personal decisions. But the rise of obesity—across many countries and disproportionately among the poor—suggests that becoming fat cannot just be blamed on individual frailty. ... In the absence of a single big solution to obesity, the state must try many small measures (12/15).

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Editorials and Opinions

Viewpoints: Could Expanding Mental Health Services Curb Gun Violence?; Opinions On Other Aspects Of Health Law

USA Today: 6 Ways To Stop Gun Madness
President Obama said he would use whatever powers his office holds to address this violence. ... Currently, nearly half of all gun sales in the U.S. are conducted without a background check. Criminals, the mentally ill, minors and domestic abusers are all prohibited from purchasing guns, but they all can do so as easily as attending a gun show or going online. ... Fixing the background check system also requires the federal government to compel states to submit all necessary records on felons, domestic abusers, the seriously mentally ill and others to the background check system (New York Mayor Michael Bloomberg, 12/19). 

The Wall Street Journal: Reflecting On Mental Illness After Newtown
Four years ago, my colleague, Nathan Koppel, and I wrote a front-page article about William Bruce, a young man with paranoid schizophrenia who bludgeoned his mother to death with a hatchet. ... Bruce’s sad tale illustrates why it’s so hard to get help for someone who is so sick: People who are mentally ill often suffer from agnosia, or a lack of insight into the illness; they don’t believe they are sick. Family members or parents may not comprehend the extent of the illness or may not be able to control their loved one and get him help. Resources for people with mental illness are scarce and hard to access (Elizabeth Bernstein, 12/19).

The Houston Chronicle: Take The Wiser Approach To Mental Health Funding
As Texans, we can act right away to try to prevent the next tragedy. We can convince state lawmakers to stop cutting the funding for mental health treatment for those who must rely on public services. I have always said that an investment in mental health services, especially out-patient care, is an investment in public safety (Adrian Garcia, 12/19).

Politico: Affordable Care Act Fills Need In Mental Health Care
A provision [in the health law] that passed with unanimous support requires that starting in 2014, health insurance plans cover mental health and addiction services as part of the essential benefits. As a result of these historic changes, approximately 68 million Americans will have access to lifesaving mental health and addiction treatment services. Furthermore, these services, which have been misunderstood and marginalized for so long, will finally be fully integrated as part of a comprehensive approach to health care. That is, if the law is implemented as intended. The far-reaching impact of this change cannot be overestimated (Former Reps. Patrick Kennedy and Jim Ramstad, 12/19).

The Boston Globe: Expansion Of Medicaid May Prevent Future Tragedies
Limiting the availability of assault weapons is an obvious and necessary step to reducing the future likelihood of mass shootings like the one in Connecticut. But so is maintaining and improving mental health care services, which have been severely strained in recent years (and in some areas reduced) and are further threatened by the fallout from a recent Supreme Court decision and the incipient deal to avert the fiscal cliff. The linchpin is Medicaid. Though mainly thought of as a safety-net program for the poor, Medicaid provides about half of state mental-health budgets (Joshua Green, 12/19).

The New England Journal of Medicine: Medicaid Expansion Opt-Outs and Uncompensated Care 
With the number of uninsured people projected to drop by half, policymakers anticipated a substantial decrease in the uncompensated care provided at acute care hospitals. Consequently, beginning in 2014 the ACA initiates a series of payment reductions under the Medicare and Medicaid Disproportionate Share Hospital (DSH) programs. ... without either federal changes to DSH formulas or a full expansion of affordable coverage to the uninsured with incomes below the poverty line, states forgoing the Medicaid expansion are likely to leave a substantial uncompensated-care burden on hospitals (John A. Graves, 12/20).

The New England Journal of Medicine: Religious Freedom And Women's Health — The Litigation On Contraception
Perhaps the most interesting question, however, is whether the [health law's contraception coverage] requirement substantially burdens the religious beliefs of employers. Two courts have observed that the rule does not require employers to use contraceptives or even to approve of their use. ... Employers object, however, that they should not have to pay for services that they consider to be morally wrong. The question of whose interests and beliefs — those of the employer or those of the employee — ought to determine access to contraception benefits is one that the courts, and no doubt ultimately the Supreme Court, will have to decide (Timothy Stoltzfus Jost, 12/19).

The Wall Street Journal: 'Obamacare' Rollout: What Companies Need To Know
Two questions come up every time I speak to companies about President Obama's health care law, now called "Obamacare" by detractors and supporters alike. First, "Will it be repealed?" And second, "Can't I just drop coverage and plan to pay the penalty?" Many executives have not tackled the question they need to focus on very soon, "What will it take to comply with the new law?" (Kate Barton, 12/19).

News outlets also offered editorials and columns exploring elements of the health care system -

Bloomberg: Lure More Doctors Into Primary Care With 'Medical Homes'
By 2025, the U.S. will require 52,000 more nonspecialist physicians than it has now. This is mainly because there will be more Americans, especially older ones. The increased number of insured people will only worsen the problem. … No simple solution is possible because this predicament is knitted into American health care -- an insurance-driven, government-subsidized system in which general practitioners’ time and attention isn’t priced as high as specialists’ surgeries and procedures. … What’s needed are clerkships in community primary care that give students a strong team experience, and that last as long as a year, so they can learn the rewards of getting to know their patients (12/18).

The Philadelphia Inquirer: Community Health Workers: A New Healthcare Workforce For The Era Of Health Reform
The current American health-care system, with its focus on delivering expensive treatments to well-insured individuals, is ripe for a [revolution]. There is a largely untapped workforce with the potential to lead such a revolution in the health-care market — the too-often unheralded community health workers. Community health workers are lay people trained by medical and public health professionals to provide a range of health-related services in their communities, and who help patients live better by supporting behaviors that impact their health (Matt O'Brien, 12/19).

The Lund Report: A Healthcare Odyssey Without Electronic Health Records
In a pre-health reform world without interoperable electronic health records (EHR), or a patient-centered provider collaborative model, my healthcare experiences over the last year or so are all too common.  As a biomedical informatician and healthcare attorney, I will ... offer some initial thoughts on how interoperable EHRs, and a patient-centered provider collaborative model can afford a greater quality of care, in a more cost-effective manner, with less angst and less time on the part of a patient  (Paul DeMuro, 12/20).

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Viewpoints On The Fiscal Cliff: Boehner As 'Adult In Charge'?; Sorting Through Entitlement Program Spending

The Wall Street Journal: Boehner Plays A Weak Hand Well
Since the election, House Speaker John Boehner has emerged as that Washington rarity, the adult in charge. ... Shortly after the election, Mr. Boehner made the first move by acknowledging that Washington could draw additional revenue if it also cut spending (Karl Rove, 12/19).

USA Today: Taxes Debate Avoids The Hard Truths
[T]he simple truth is, if deficits are to be brought under control, the middle class is going to have to contribute in the form of higher taxes and reduced benefits. ... As Baby Boomers retire, the cost of major benefit programs such Medicare and Social Security is rising faster than the government's ability to pay for them. And tax receipts have sunk to levels not seen since the Truman administration (12/19).

USA Today: Opposing View: Spare The Middle Class From Tax Hike
Middle- and lower-income Americans have been bearing the brunt of our nation's economic malaise, and fiscal condition, for years. No one is suggesting that dealing with the deficit won't require contributions from all Americans. ... But it is essential that ... we keep in mind the challenges confronted by the American middle class in recent decades and the unprecedented prosperity enjoyed by a very small minority at the top (Rep. Sandy Levin, D-Mich., 12/19).

The New York Times: A Tale Of Two Welfare States
In the United States, the welfare system includes dozens of federal programs ... Beginning in 2014, more programs will be added and expanded by the Patient Protection and Affordable Care Act: new health-insurance premium-support programs, new cost-sharing subsidies for out-of-pocket health expenditures, financial hardship relief from the new individual mandate penalties, new subsidies for small businesses employing low-income people and expansion of Medicaid. ... the United States intends to move in the direction of more assistance programs and higher marginal tax rates, while Britain intends to move in the direction of fewer programs and lower marginal tax rates (Casey B. Mulligan, 12/19).

The Wall Street Journal: America's Dangerous Powerball Economy 
[M]ore than half of American households receive government transfer benefits. And this isn't just a case of senior citizens taking the Social Security they have paid for. Unearned transfers are exploding. Consider that the number of Americans receiving disability benefits has increased almost 20-fold since 1960, to 8.6 million today from 455,000. The Tax Foundation notes that nearly 70% of Americans now take more out of the tax system than they pay into it. It is a simple fact that the United States is becoming an entitlement state (Arthur C. Brooks, 12/19).

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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.