Daily Health Policy Report

Monday, December 3, 2012

Last updated: Mon, Dec 3

KHN Original Reporting & Guest Opinion

Fiscal Cliff

Health Reform

Health Care Marketplace

Capitol Hill Watch


Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insurance Surcharges Will Fund Most Online Exchanges Created Under Health Law

Kaiser Health News staff writer Phil Galewitz reports: "Republican governors in Florida, Virginia, Texas and several other states say they’re reluctant to build the online insurance markets required by the federal health law because they’re worried about getting stuck with the bills" (Galewitz, 12/3). Read the story.

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Political Cartoon: 'No Pulling Punches?'

Kaiser Health News provides a fresh take on health policy developments with "No Pulling Punches?" by Gustavo Rodriguez.

Meanwhile, here is today's health policy haiku:


Taxes, taxes - when
Will negotiators talk
About Medicare?

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

'Fiscal Cliff' Talks Morph Into High-Stakes Game Of Political Chicken

White House negotiators and GOP lawmakers remain at odds over a deficit-reduction plan with only weeks to go before automatic spending cuts and tax increases are triggered. Policymakers seek a two-step deal with an initial round of spending cuts and changes to the tax code in January, followed by an overhaul of the tax code and entitlement programs next year.

The Wall Street Journal: Fiscal Cliff Talks At Stalemate
The White House and congressional Republicans remained at loggerheads—in both public and private—over how to design a deficit-reduction package, with just a few weeks remaining before the nation hits the fiscal cliff. … Policy makers are aiming to secure a two-step deal by year-end. The first would lock in an initial round of spending cuts and potentially make changes to the tax code that would take effect in January. The second would require policy makers to pursue an overhaul of the tax code and entitlement programs, with the White House setting August as its target date for the negotiations to end (Paletta and O'Connor, 12/3).

The Associated Press/Washington Post: White House, Republicans Play Game Of Political Chicken As Fiscal Cliff Nears
The White House says Republicans should come clean about how much they're willing to raise tax rates on the rich. Republicans counter that President Barack Obama's latest plan is a joke that avoids tough decisions on the nation's biggest entitlement programs, including Medicare (12/3).

The New York Times: Negotiators Leading Talks On Fiscal Crisis Defend Stands
The separate television appearances of the two men came after their private meeting on Capitol Hill on Thursday, when Mr. Geithner outlined the president's positions for about $4 trillion in deficit reduction over the first 10 years to Mr. Boehner and the No. 2 Republican in the House, Eric Cantor of Virginia. The specifics were the same as those proposed by Mr. Obama in his budget earlier this year, without any additional concessions. The proposal includes $1.6 trillion in new revenue from upper-income taxpayers; $600 billion in reduced spending for Medicare, Medicaid, farm subsidies and other programs; $1 trillion in other spending cuts that the president and Congress committed to last year for the coming decade; and an $800 billion reduction in projected war spending, reflecting the winding down of American combat operations overseas (Calmes, 12/2).

The New York Times' News Analysis: Criticized As Weak In Past Talks, Obama Takes Harder Line
His approach is born of painful experience. In his first four years in office, Mr. Obama has repeatedly offered what he considered compromises on stimulus spending, health care and deficit reduction to Republicans, who either rejected them as inadequate or pocketed them and insisted on more. Republicans argued that Mr. Obama never made serious efforts at compromise and instead lectured them about what they ought to want rather than listening to what they did want. Either way, the two sides were left at loggerheads over the weekend with less than a month until a series of painful tax increases and spending cuts automatically take effect, risking what economists say would be a new recession (Baker, 12/2).

The Wall Street Journal: GOP Takes Aim At Entitlements
Senate Minority Leader Mitch McConnell outlined potential changes to Medicare and Social Security in an interview Friday, providing fresh clarity on the concessions Republicans would like to see from Democrats ... Mr. McConnell (R., Ky.) said bipartisan agreement on higher Medicare premiums for the wealthy, an increase in the Medicare eligibility age and slowing cost-of-living increases for Social Security could move both parties closer to a budget deal ... Some Democrats have said they were open to more so-called means testing in Medicare, which would charge higher premiums to higher-income recipients (Bendavid and Hook, 11/30).

The Washington Post: Lindsay Graham: 'I Think We're Going Over The Cliff'
"I think we're going over the cliff. It's pretty clear to me they made a political calculation. This offer doesn't remotely deal with entitlement reform in a way to save Medicare, Medicaid and Social Security from imminent bankruptcy. It raises $1.6 trillion on job creators that will destroy the economy and there are no spending controls," Graham said on CBS's "Face The Nation." Graham had signaled a willingness to violate Grover Norquist's anti-tax pledge to avert the "fiscal cliff" if Democrats made an effort to reform entitlements. But he said Sunday the White House's plan for entitlement reform was laughable (Sullivan, 12/ 2).

The New York Times: Trusted Aide To Obama Faces Test in Budget Showdown
When President Obama was locked in painful spending negotiations with House Republicans last spring, his exceedingly meticulous budget director, Jacob J. Lew, went to the Oval Office to propose some complex budget changes. ... With his owlish glasses and low-key manner, Mr. Lew may come off as just a policy nerd. But he is a fierce negotiator. When defending social safety net programs, particularly those like Medicaid that help the poor, he morphs into a warrior, Republicans say, though he has proved willing to make concessions (Stolberg, 12/1).

Politico: The Cold, Hard Realities Behind Medicare Cuts
Democrats have said they can cut Medicare spending without touching seniors' benefits. But here's the reality: They can't get several hundred billion dollars out of Medicare without at least some beneficiaries taking a hit. And that could be a big problem if the framework for a fiscal cliff deal calls for $400 billion in entitlement savings — most of which would be likely to come from Medicare (Haberkorn and Cunningham, 12/2).

CQ HealthBeat: Republicans Point To Health Care, Social Security Changes In Fiscal Deal
Republicans may be sharply denouncing what they called an unrealistic fiscal proposal from President Obama, but beneath that heated rhetoric lawmakers and conservatives also pointed Friday toward areas of potential compromise and broad suggestions for the changes they want to see in entitlement programs. Those included calls for changes in Medicare, Medicaid and Social Security that stop well short of overhauling those programs, as GOP leaders have sought amid this year’s budget and electoral battles, but add up to the kinds of savings Republicans want in exchange for higher revenue. “I’m not dogmatic and ideological on fixing problems but this president is losing all ability to negotiate with Republicans who want to solve problems with the kind of offer he put on the table yesterday,” Rep. Pat Tiberi, R-Ohio, told reporters (Goldfarb and Weyl, 11/30).

CQ HealthBeat: Drugmakers Hardest Hit If Cliff Deal Includes Obama Cuts
Who are the biggest losers if a fiscal cliff deal includes the health care cuts put on the table by President Barack Obama in an initial offer this week? Well, the pharmaceutical industry, skilled nursing facilities, teaching hospitals and imaging suppliers would not be happy. Neither would future seniors. The drugmakers in particular would take a hit to their profits. And future seniors would see higher charges for Medigap policies that pick up charges Medicare doesn’t cover. In his opening cliff offer outlined this week, the president says he would save $400 billion over 10 years through changes to entitlements first outlined in his fiscal 2013 budget proposal (Reichard, 11/30).

The Denver Post: Fiscal Cliff: How Colorado Health Care Will Be Affected
The fiscal cliff is no ethereal metaphor in Colorado's health-care community — it would be a calamity for thousands of health and medical jobs because of Medicare cuts, in one of the few industries that remained a bright spot in the recession. Other federal budget cuts required by the cliff's "sequestration" provisions could severely hamper such public-health efforts as vaccinations, food safety and doctor training (Booth, 11/30).

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Health Reform

Political, Policy Issues Swirl Around State Plans For Exchanges, Medicaid Expansion

Even as the Department of Health and Human Services releases regulations offering guidance for the health law's online insurance marketplaces, these health exchanges -- as well as the overhaul's Medicaid expansion -- continue to be hot topics.

Politico: HHS Health Rules No Balm For States
Sure, the Obama administration is dumping piles of Affordable Care Act rules in everyone's laps now. The danger, though, is that the rules have been held up so long that the states' insurance commissioners -- even the ones that want to implement the law -- may have trouble making up for lost time. That's the word from the National Association of Insurance Commissioners meeting near Washington, D.C., last week, where commissioners from around the country told Politico that the Department of Health and Human Services has left large holes in its guidance for states building insurance exchanges -- online marketplaces for individuals to access subsidized insurance plans (Cheney and Millman, 12/3).

Kaiser Health News: Insurance Surcharges Will Fund Most Online Exchanges Created Under Health Law
Republican governors in Florida, Virginia, Texas and several other states say they're reluctant to build the online insurance markets required by the federal health law because they're worried about getting stuck with the bills (Galewitz, 12/3).

Bloomberg: Insurers To Pay Fees In States Rejecting U.S. Health Law
Health insurers who want to sell plans in states that refuse to create new U.S. health-care marketplaces will have to pay fees for the federal government to regulate them. Insurers will pay a fee of 3.5 percent of their premiums to sell plans in a federally run health exchange, the government said today in a regulatory filing. The exchanges are new marketplaces somewhat like online travel services where uninsured people will buy policies (Wayne, 11/30).

The Washington Post: State Lawmakers Gird For Battle Over Medicaid Expansion
As state legislatures prepare to meet in January, lawmakers across the country are girding for a battle over whether to sign on to the health care law's expansion of Medicaid (Aizenman, 12/2).

The Associated Press: States' Medicaid Decisions Scrutinized
Hundreds of billions of dollars and the well-being of millions of people will be at stake when more states consider in coming months whether to expand Medicaid under the federal health care overhaul. As legislatures look ahead to their 2013 sessions, the calculating and the lobbying have already begun. President Obama's law expands Medicaid, the federal-state health program for low-income people, but cost-wary states must decide whether to take the deal (12/3).

Medpage Today: State Docs Groups Hold Back On ACA Medicaid Changes
Most state physician groups have kept a low profile on their positions to expand Medicaid under the Affordable Care Act (ACA), even 6 months after the Supreme Court gave states an option to increase eligibility. … Unlike their hospital counterparts, professional doctor groups have been a bit slow to endorse the idea, even in states who have already said 'no' to the federal dollars. … Advocates of expansion have more ammunition as they approach state leaders in their decision to expand. A report released this week by the Urban Institute found states would save a combined $10 billion in the first 10 years of expansion. While spending would increase a modest $8 billion or 0.3 percent if all opted into the expansion, they would save $18 billion in uncompensated care, the analysis and state-by-state breakdown found (Pittman, 12/2).

The New York Times/Texas Tribune: Democrats Expect a Deal on Medicaid Despite Perry
Despite Gov. Rick Perry's firm opposition to a central tenet of federal health reform -- expanding the state's Medicaid program for those with low incomes -- Texas Democrats remain optimistic that the 2013 legislative session can yield a deal that brings in billions of additional federal dollars. It will be a tough sell: no Republican lawmaker has gone on record supporting the Medicaid expansion, which would add an estimated 1.8 million Texans to the joint state-federal health plan by 2022 (Aaronson, 12/1).

The Dallas Morning News: Dallas Interfaith Group Challenges Perry’s Decision To Opt Out Of Medicaid Expansion
Gov. Rick Perry might have been surprised to hear his name invoked repeatedly during a recent gathering at Christ’s Foundry United Methodist Mission. But the rollicking crowd that filled the northwest Dallas church was not praising the governor's leadership or even praying for his soul. Nearly 300 people crowded into the church to launch a petition drive challenging Perry's decision to opt out of a Medicaid expansion under President Barack Obama's Affordable Care Act (Jacobson, 12/2).

The Associated Press: State Health Plan Faces New Future
Considered by many as a prelude to today's federal health reform efforts, MinnesotaCare will celebrate its 20th anniversary this year -- and simultaneously see its demise, at least in its current form. Portions of the groundbreaking health care program don't comply with the Affordable Care Act. The future of MinnesotaCare will be one of several pressing health care issues facing legislators when they arrive at the Capitol in January (Crosby, 12/1).

Los Angeles Times: Health Care Law Will Have New California Legislature Scrambling
Facing a federal deadline, the Legislature must move quickly to pass measures to implement President Obama's health care law and revamp the state's insurance market. New legislation will help extend coverage to millions of uninsured Californians and solidify the state's reputation as a key laboratory for the federal law (Mishak, 12/2).

CQ HealthBeat: Fight Over The Health Care Law Spawns A Second Generation Of Lawsuits
The health care law is a gift that keeps on giving -- at least for lawyers. Despite a decision by the Supreme Court in June that upheld the law's individual mandate as a tax, opponents -- mostly led by conservative legal groups -- continue to mount challenges. Multiple lines of attack are represented in suits percolating in federal district and appellate courts, including one arguing that the law should be struck down because its language originated in the Senate rather than the House. "You can never get too much of the Affordable Care Act," said Randy Barnett, a professor at Georgetown University Law Center who also helped represent the National Federation of Independent Business in its challenge (Norman, 11/30).

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Health Care Marketplace

60 Minutes: HMA Pressures Doctors To Admit Patients, Defrauding Medicare

The CBS newsmagazine reported that it interviewed more than 100 current and former employees of Health Management Associates (HMA), who said they were pressured to admit patients, whether they needed hospital care or not, to increase revenues.

CBS 60 Minutes: Hospitals: The Cost Of Admissions
[I]t's estimated that $210 billion a year -- about 10 percent of all health expenditures -- goes towards unnecessary tests and treatments and a big chunk of that comes right out of the pockets of American taxpayers in the form of Medicare and Medicaid payments. For more than a year, we have been looking into the admission and billing practices of Health Management Associates. It's the fourth largest for-profit hospital chain in the country with revenues of $5.8 billion last year ... We talked to more than 100 current and former employees and we heard a similar story over and over: that HMA relentlessly pressured its doctors to admit more and more patients -- regardless of medical need -- in order to increase revenues (Kroft, 12/2).

Modern Healthcare: HMA Exec Says Physicians 'Grossly Mischaracterized' Admissions Management
Physicians interviewed for a "60 Minutes" investigation into Health Management Associates' admissions practices "grossly mischaracterized" what goes on at the for-profit hospital chain's facilities, a top executive for the company said after the segment aired Sunday. Alan Levine, senior vice president at HMA and president of its Florida group, said some of the doctors who spoke to reporter Steve Croft had reasons for doing so, including ongoing litigation with the company. ...[Levine said] the core issue is not about inpatient admission goals or quotas, but rather about the challenge hospitals face in managing patients between observation stays and inpatient admissions (Zigmond, 12/2).

Reuters: Health Management Shares Fall Ahead Of "60 Minutes" Segment
Shares in Health Management Associates Inc fell nearly 3 percent on Friday ahead of a "60 Minutes" television segment on the hospital chain's admissions practices ... The Naples, Florida-based hospital company, which operates 70 hospitals in 15 states, said in a statement on its website that it retained "third-party experts" to examine admissions data for individual hospitals and across the company. "The data simply do not support the allegations," it wrote (Humer, 11/30).

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Drug Makers Zero In On Diabetes Patients' Social Media Connections

NPR: Social Media Helps Diabetes Patients ( And Drugmakers) Connect
People living with diabetes have created a vibrant online community. Big drug companies are certainly taking notice — and some advocacy groups feel that the Food and Drug Administration should as well (Silverman, 12/3).

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Capitol Hill Watch

Roe, Gingrey To Lead GOP Doctors Caucus

Meanwhile, The Hill reports that House Republicans are likely to embrace the same Medicare cuts that GOP presidential nominee Mitt Romney had assailed President Barack Obama over, but which are likely to be included again in the House Republican budget. And Rep. Jack Kingston, R-Ga., is getting encouragement to head the House Appropriations Labor, Health and Human Services, Education and Related Agencies Subcommittee.

Modern Healthcare: Roe, Gingrey To Lead House GOP Doc Caucus
Two obstetricians who strongly oppose the Patient Protection and Affordable Care Act will lead the House's GOP Doctors Caucus after the new 113th Congress is sworn in early next month. Rep. Phil Roe (R-Tenn.), an obstetrician who currently serves as vice chairman of the group that includes 21 healthcare providers, will become the group's new co-chairman alongside current co-chairman Rep. Phil Gingrey (R-Ga.). Gingrey co-founded the caucus in 2009 with Rep. Tim Murphy (R-Pa.), a psychologist who currently serves as the other co-chairman. Roe will succeed Murphy, who announced he will step down from his role to focus on his responsibilities as the new chairman of the House Energy and Commerce Oversight and Investigations Subcommittee (Zigmond, 12/1).

Politico Pro: Kingston Eyed For Spending Panel Slot
Rep. Jack Kingston could be reunited next year with his Democratic pal Rep. Rosa DeLauro as chairman of the House panel that allocates most government health spending. Kingston (R-Ga.) is a contender to take the spot being vacated by outgoing Rep. Denny Rehberg as head of the House Appropriations Labor, Health and Human Services, Education and Related Agencies Subcommittee, which is responsible for distributing funding to HHS and other agencies. Kingston, who is currently chairman of the agriculture subcommittee, said Friday that he'll serve wherever Chairman Hal Rogers asks him to go. "It's up to Mr. Rogers," he told reporters. "I'm willing to go wherever I'm sent. You know, just to be considered a cardinal is a good honor, a great honor" (Haberkorn, 11/30).

The Hill: Republicans Ready To Forget Romney And Embrace Rep. Ryan On Medicare
Mitt Romney's Medicare budget might be fading away just as quickly as Romney himself. During the campaign, candidate Romney repeatedly hammered President Obama for cutting $716 billion from Medicare as part of his signature healthcare law. Romney pledged to repeal those cuts in a break from his running mate, Rep. Paul Ryan (R-Wis.). Ryan, the House Budget Committee Chairman, had preserved Obama’s Medicare cuts in two consecutive budget proposals that repealed the rest of the Affordable Care Act. Ryan is now back at work crafting his next budget, and Republicans on his committee say the $716 billion in Medicare cuts will likely survive (Baker and Viebeck, 12/2).

MPR: Walz Pushes Mental Health Bill For Vets
U.S. Rep. Tim Walz, D-Minn., said he will push for the lame-duck Congress to pass legislation restoring benefits to military veterans who were discharged because of personality disorders. Walz introduced the Service Members Mental Health Review Act of 2012 with Rep. Tom Rooney, R-Fla. The bill directs the military to review the cases of more than 30,000 service members who have been discharged since 2001 because of personality disorders. He said that many of those veterans actually suffer from post-traumatic stress disorder or traumatic brain injury. … He added that the bill would restore the records of soldiers discharged because of personality disorders (Shenoy, 12/2).


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Scheduled Medicare Doctor Pay Cut Could Be Just A Few Weeks Away

Medscape and The Connecticut Mirror covered the looming 26.5 percent cut, mandated by the SGR law.

Medscape: Scrapping Consultations Blew Medicare Budget
Next year primary care physicians will receive a Medicare pay hike, assuming that Congress postpones a scheduled 26.5% cut mandated by the program's sustainable growth rate formula. Instead of further bloating the budget deficit, the Centers for Medicare & Medicaid Services (CMS) will fund the pay hike by trimming Medicare rates for specialists. The plan is to achieve "budget neutrality," an accounting mantra in a time of fiscal anxiety (Lowes, 11/30).

CT Mirror: Doctors Look To Congress As Medicare Fee Decrease Looms
Unless Congress acts soon, the New Year will bring plenty of misery for Connecticut's doctors. On Dec. 31, a temporary measure known as the "doc fix" will expire, resulting in a 30 percent decrease in fees to all doctors who treat patients through Medicare, the government-run health program for the elderly, and active and retired members of the military who are covered under the government's TRICARE program (Radelat, 11/30).

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Public Health & Education

Psychiatrists' Group Approves New DSM

The American Psychiatric Association's new edition of the Diagnostic and Statistical Manual of Mental Disorders will place what was called Asperger's as part of the autism spectrum.

USA Today: Psychiatrists Approve Vast Changes To Diagnosis Manual
Asperger's is out, but binge eating and hoarding are in as official mental disorders in the latest version of the diagnostic bible published by the American Psychiatric Association, following a vote Saturday by that group's board. The Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, is often called the "bible" because it's used to identify and classify mental disorders (Jayson, 12/2).

The Associated Press: Asperger's Dropped From Revised Diagnosis Manual
Full details of all the revisions will come next May when the American Psychiatric Association's new diagnostic manual is published, but the impact will be huge ...The manual also is important for the insurance industry in deciding what treatment to pay for, and it helps schools decide how to allot special education. ... The aim is not to expand the number of people diagnosed with mental illness, but to ensure that affected children and adults are more accurately diagnosed so they can get the most appropriate treatment, said Dr. David Kupfer. He chaired the task force in charge of revising the manual (Tanner, 12/1).

Bloomberg Businessweek: Psychiatrists Redefine Disorders Including Autism After 7-Year Fight 
The move comes after a seven-year debate that has split the mental health community over whether the changes will spur over- diagnosis of some disorders, and limit treatment for others. The guide collapses several conditions into a broadened definition for autism. It also adds new maladies, including one called disruptive mood dysregulation disorder for children who have temper tantrums at least three times a week (Lopatto, 12/2).

The Wall Street Journal: Psychiatric Association's Diagnosis Revisions Seen Upending Evaluations
The changes—the first major revisions since 1994—could affect millions of adults and children and billions of health-care dollars, determining who qualifies for subsidized services, treatment programs and insurance reimbursements. An estimated 30% of Americans are diagnosed with at least one mental illness in their lifetimes, and several conditions face major revisions in the DMS-5 (Beck, 12/1).

CNN: Psychiatric Association Approves Changes To Diagnostic Manual 
[T]hese incremental revisions raised concerns among some researchers and advocacy groups who feared the new criteria would result in many children losing their autism diagnosis and much-needed services. For example, in March, a study presented by Yale autism expert Dr. Fred Volkmar suggested only 60% of those meeting current criteria for autism would still be diagnosed with the disorder under the proposed criteria. ... Kupfer agrees that some children might fall off the autism spectrum, but he believes maybe 5% to 10% of patients will no longer meet the criteria for autism (Falco, 12/2).

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State Watch

Hospital Mergers, Acquisitions And Delivery Of Care Make News

Hospitals in California, New York and across the nation deal with mergers, acquisitions, delivery of care and fines in the marketplace. In the meantime, doctors whose practices were purchased by hospital chains feel increasing pressure to meet financial goals.

The New York Times: A Hospital War Reflects A Bind For Doctors In The U.S.
For decades, doctors in picturesque Boise, Idaho, were part of a tight-knit community, freely referring patients to the specialists or hospitals of their choice and exchanging information about the latest medical treatments. But that began to change a few years ago, when the city’s largest hospital, St. Luke's Health System, began rapidly buying physician practices all over town. ... Across the country, doctors who sold their practices and signed on as employees ... describe growing pressure to meet the financial goals of their new employers -- often by performing unnecessary tests and procedures or by admitting patients who do not need a hospital stay (Creswell and Abelson, 11/30).

Los Angeles Times: South LA Frustrated By Delays In Building New King Hospital
For years, King/Drew provided emergency, trauma and inpatient care to residents from throughout South Los Angeles. After a series of medical errors resulted in patient deaths, Los Angeles County closed it in 2007. County officials promised the community a better, safer new medical center in a few years. But the opening has been repeatedly delayed, and the community is still waiting (Gorman, 12/1).

The New York Times: Leery Of A Merger, A Hospital In Brooklyn Plans To Declare Bankruptcy
A financially troubled hospital serving a largely African-American and Caribbean niche of central Brooklyn is planning to declare bankruptcy this week, hospital officials said on Sunday, raising concerns that New York State may force it to close or merge with another institution (Hartocollis, 11/2).

Los Angeles Times: Santa Monica Hospital Ousts Top Execs, Most Of Its Board
Saint John's Health Center abruptly ousted its top two executives and most of its governing board as the Santa Monica hospital tries to grapple with years of losses and increasing competition from bigger rivals (Terhune, 12/1).

Los Angeles Times: Atascadero Hospital Fined Over Worker Safety Lapses
California workplace safety officials have once again fined a state mental hospital for failing to keep staff members safe from patient assaults. The most serious of the citations issued by Cal/OSHA on Thursday against the Central Coast's Atascadero State Hospital carries a $27,000 fine (Romney, 12/3).

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State Roundup: Mental Health Care Fund Questioned In Calif.

A selection of health policy stories from Iowa, California, North Carolina, Kansas, Virginia, Michigan and Texas.

San Francisco Chronicle: Is Prop. 63 Missing Mental Health Goals?
Proposition 63, which voters approved in 2004, was touted as a way to address serious mental illnesses in California, but in the years since, critics -- including some of the original supporters -- have argued that it has gone off the rails in its implementation. They have questioned how the $7 billion the measure has generated -- from a 1 percent tax on income above $1 million -- has been spent, accusing state and county officials of squandering millions on public relations campaigns, consultants and programs loosely tied to mental illness (Joseph, 12/2).

North Carolina Health News: Three Mental Health Agencies Delay Transition
Three mental health agencies have gotten the green light from state officials to delay their transition to the new managed care model required by state law. Alliance Behavioral Healthcare, Partners Behavioral Health Management and Centerpoint all asked the state Department of Health and Human Services last week if they could move their "go-live" dates for the transition from Jan 1 to Feb 1. Al Delia, acting Secretary of Health and Human Services sent letters late Friday giving the agencies permission to delay (Hoban, 12/3).

California Healthline: Senate Leader Asks To Slow Healthy Families Transition
California Senate President Pro Tem Darrell Steinberg (D-Sacramento) sent a four-page letter late last week to state health officials urging the state to move more slowly in its transition of approximately 860,000 children from the Healthy Families program into Medi-Cal managed care. ... The transition is scheduled to begin Jan. 1 with the first phase moving 415,000 children to Medi-Cal plans (Gorn, 12/3).

The Associated Press: Branstad Administration Proposed Wage Freeze, Hike In Health Care Costs For State Workers
[Iowa] Gov. Terry Branstad's administration has proposed freezing wages and increasing health care costs for 20,000 state workers in negotiations with state employee unions. The talks are for new contracts slated to take effect next year (12/1).

Kansas Health Institute News: Douglas County Among Few Health Departments To Digitize Patient Records
The Lawrence-Douglas County Health Department will be closed for two days next week in order to finish implementation of an electronic health record system. …. Since 2009, use of electronic health records (EHRs) has been surging among hospitals and doctors, thanks to federal incentives to make the costly transition. But of Kansas' 100 health departments, only Shawnee and Lyon qualified for the incentives because they are also Federally Qualified Health Centers (Cauthon, 11/30).

Richmond Times-Dispatch: Home-Bases Care Tested In Medicare Initiative
Family nurse practitioner Susanna Payne typed on her laptop computer as she quizzed Maureen Peterson on the medications Peterson was taking. ... Typically such an exam would take place in a medical office, but Payne handled it in the living room of the Richmond home Peterson shares with her husband and caregiver, Harry Peterson. Mrs. Peterson, 57, who needs a wheelchair to get around, is thankful that Payne, a nurse practitioner who works for VCU Health System’s House Calls program, was able to come to her. … the federal Medicare program is testing whether home visits can provide care of select homebound patients on par with, or beyond, office visits (Smith, 12/3).

Detroit Free Press: 85 Doctors-In-Training Heading To Southeast Michigan Clinics
A $21-million federal grant will send 85 doctors-in-training into southeast Michigan health clinics over three years beginning in July -- an effort to encourage them to consider a career in underserved areas. "It puts doctors in the much-needed safety net provider sites," said Chris Allen, CEO of the Detroit Wayne County Health Authority, which is charged with bolstering health care in areas lacking sufficient health care providers. As they finish out their training, many new doctors face daunting student loans and are drawn to higher-paying specialties (Erb, 12/3).

Stateline: Texas Cancer Agency Fights Controversy
The new Texas agency that is leading the state’s 10-year, $3 billion push to cure cancer is fighting for its reputation and future in the face of doubts about its operations. Spurred on by Governor Rick Perry and cyclist Lance Armstrong, voters in 2007 overwhelmingly approved a ballot measure that makes Texas the largest state funder of cancer research and prevention, second only to the federal government. At issue is whether the Cancer Prevention Research Institute of Texas, commonly called CPRIT, is letting politics trump science in the way it doles out grant money (Prah, 12/3).

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Editorials and Opinions

Viewpoints: Disputing Obama's and GOP's Commitment To Cutting Spending And Avoiding Fiscal Cliff

The Wall Street Journal: An Entitlement Reform Guide
President Obama has said he wants to reform entitlements eventually, someday, after Republicans raise taxes. Republicans want the President to sign on to serious reform now as part of any deal, since AARP and the left will kill anything that isn't passed immediately. Given the political difficulty of reforming entitlements, Republicans are right to try to get Mr. Obama's fingerprints on such a deal this year (12/2).

The Washington Post: An Achievable Solution To Getting Off The 'Cliff'
It is legitimate for the president to hold out for as high a revenue target as possible. But that will also require him to proffer more in the way of entitlement reforms than many in his party will be happy to accept. ... During his negotiations with Mr. Boehner, the president also agreed to increase the eligibility age for Medicare beneficiaries from 65 to 67 and to change the way Social Security cost-of-living adjustments, as well as other programs, are calculated. If these offers are no longer on the table, Mr. Obama should explain why and come up with cost-saving alternatives (11/30).

The New York Times: The Full McConnell
In his interview with the Wall Street Journal, Mitch McConnell finally mentioned a few sort-of specifics about what spending cuts the GOP wants: raising the Medicare age, charging higher premiums to affluent Medicare recipients, and changing the price indexing of Social Security. But how much does all this amount to? ... So, if we take all of McConnell’s ideas together, we get a bit more than $300 billion. ... This is pathetic – and these people are definitely not serious (Paul Krugman, 12/2). 

The Washington Post: Who’s Not Bargaining In Good Faith? 
Supporting retirees is now the federal government’s main activity. There’s a huge redistribution from young to old — a redistribution that will be made worse if retiree programs are largely excluded from deficit reduction. ... [In fiscal 2012] $469 billion for Medicare (insurance for the 65 and over population) and $251 billion for Medicaid (insurance for the poor — two-thirds goes for long-term care for the aged and disabled) (Robert J. Samuelson, 12/2).

The Washington Post: Why Sane Bargaining Looks Strange
An entirely new political narrative is taking shape before our eyes, yet many in Washington are still stuck in the old one. President Obama’s victory blew up the framework created by the 2010 elections, which forced him to play defense. Now, he finally has room to move. … Republicans claim they are fighting for cuts in entitlement programs, particularly Medicare. ... So far, all we have are words. Obama has outlined $400 billion in savings from Medicare. If this isn’t enough, the GOP’s negotiators should tell us how to find more (E.J. Dionne Jr., 12/2).

Los Angeles Times: Cut Medicare and Social Security? What's the rush?
Because economic projections for a year or two from now, let alone 20 or 70 years, are useless, it's best to resist being pressured to act now on 'entitlements' (Michael Hiltzik, 12/1).

The Wall Street Journal: Time To Call The President’s Budget Bluff
Flush with the adrenaline rush of his election victory, President Obama insists that Congress must now agree not only to raise taxes on the "rich," but also to adopt his previously ignored full budget. ... He says that he will consider Medicare cuts and tax reform in the future, maybe. On the other hand, Mr. Obama says reductions in ObamaCare spending are out of the question, and Congress must now agree to at least $50 billion in new stimulus spending next year (Keith Hennessey, 12/2).

The Wall Street Journal: The Crisis of American Self-Government
Harvey Mansfield, Harvard's 'pet dissenter,' on the 2012 election, the real cost of entitlements, and why he sees reason for hope ... The welfare state's size isn't what makes it so stifling, Mr. Mansfield says. "What makes government dangerous to the common good is guaranteed entitlements, so that you can never question what expenses have been or will be incurred"  (Sohrab Amari, 11/30).

The Washington Post: Saving Taxpayer Money On Tricare
We refer to the Senate Armed Services Committee’s refusal to accept an administration proposal to trim Tricare, the military health-care program for which 9.7 million active and retired military personnel and family members are eligible. Obviously, those who serve or served their country deserve generous health benefits. But Tricare goes well beyond that (12/2).

The New York Times: Promises On AIDS Are Not Enough
Experts know how to control the global spread of the AIDS virus. What’s missing is enough money and political will to apply proven tactics widely enough to change the course of the epidemic (12/2). 

McClatchy: Don’t Cut HIV/AIDS Budget
Seven people — three women and four men — thought it was necessary to remove all their clothing and stand before cameras and strangers in U.S. House Speaker John Boehner's office Tuesday to bring attention to potential cuts to HIV/AIDS funding and other federal programs. They obviously thought their radical actions were needed to show Boehner and other politicians that when budgets are sliced, people are hurt (Marlene Davis, 12/2).

The Washington Post: In The VA System, The Future Of Primary Health Care
My first patient in medical school was a 25-year-old Iraq war vet from a small farming town in Idaho. ... I had 30 minutes with him, and my attending physician had just 15. We were already running late. But my attending calmly introduced our team’s social worker and psychologist. ... This multifaceted and coordinated approach to treatment — all of it at minimal or no cost for veterans at the VA — is rarely practiced in other American hospitals and clinics (Dr. Yogesh Khanal, 12/1).

Los Angeles Times: Keeping California's Kids Healthy
In a bid to cut the state's healthcare bills, the Brown administration will begin shuttering the Healthy Families insurance program for low-income children on Jan. 1. More than 850,000 kids will be shifted over the course of the year into HMOs that participate in Medi-Cal, California's version of the federally subsidized Medicaid program. It may be too late now for the Legislature to rescue Healthy Families from its untimely and potentially disruptive end, even though lawmakers are heading to Sacramento on Monday to begin a special session devoted to healthcare issues. But state lawmakers and federal Medicaid officials should do as much as they can to ensure that these children's parents won't be left scrambling (12/2).

The Arizona Republic: A Good Health-Care Idea
The recession and cuts in state health-care coverage for the poor have been hard on Arizona's hospitals. Unlike any other business, they are required to offer services even when there is no realistic expectation of being paid. They can't say no. And they shouldn't. ... Phoenix Mayor Greg Stanton has come up with an answer to this dilemma (12/1).

Roll Call: A Stark Perspective On 40-Year Career
Everyone in Washington has an opinion on Rep. Pete Stark. The California Democrat’s penchant for speaking his mind — at times when things were better left unsaid — has earned him quite a reputation. In the end, it may have been part of what led to his defeat, but it is also something that will be sorely missed on Capitol Hill. ... Serving as either chairman or ranking member of the Ways and Means Health Subcommittee since 1985, his mark on health policy — especially Medicare — can’t be overstated (Debbie Curtis, 12/2).

CNN: The $70 Childbirth Bill
According to a 2011 report from the American Congress of Obstetricians and Gynecologists (ACOG), the cost for a hospital stay, including physician fees, for a conventional birth with no complications was a little over $11,000 in 2008, the most recent year the report covered. ... So what exactly has happened, for costs to rise so astronomically? ... The technology available to keep mothers and babies safe is light years removed from what was available in 1947, [Dr. Gary Hankins of the University of Texas Medical Branch in Galveston] said, and "regrettably, the technology is expensive" (Bob Greene, 12/3).

Minneapolis Star Tribune: A Timely Proposal On Birth Control
But it's long past time to seriously consider how greater availability of this effective contraceptive might reduce the nation's high rate of unintended pregnancies -- a rate that hasn't budged in two decades, according to the college. The annual cost of unplanned pregnancies to taxpayers? About $11.1 billion annually (12/2).

Minneapolis Star Tribune: A Comprehensive Solution To Mental Illness Is Needed
It is clear that we need to do a better job when anyone who needs treatment in a mental-health facility is languishing in a jail cell. The answer is not, however, simply building more psychiatric hospital beds. We need to help move people effectively through the entire system of care -- a system currently fraught with potential obstacles (Lucinda Jesson, 12/2).

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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.