Daily Health Policy Report

Tuesday, December 4, 2012

Last updated: Tue, Dec 4

KHN Original Reporting & Guest Opinion

Fiscal Cliff

Health Reform

Medicare

Capitol Hill Watch

Quality

Health Care Marketplace

Health Care Fraud & Abuse

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Health Plans Gear Up To Sell Directly To Consumers

Kaiser Health News staff writer Julie Appleby, working in collaboration with USA Today, reports: "All this is happening in anticipation that an estimated 9 million people will buy their own insurance in 2014 -- about 50 percent more than do so now. That's when the law goes into full effect and virtually all Americans will be required to have health insurance. Those not covered through their jobs will be able to buy policies online, through so-called exchanges that will be run by the states or the federal government" (Appleby, 12/3). Read the story.

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Specialists Work To Reduce Kids' Fears In The Hospital

Kaiser Health News staff writer Jenny Gold, working in collaboration with The Washington Post, reports: "There are more than 4,000 child life specialists across the country. Every pediatric hospital in the country has a child life program, according the Children's Hospital Association, as do many general hospitals with large pediatrics units. The specialists must have a college degree, with classes in child development, psychology and similar subjects. They must also complete an internship of at least 12 weeks" (Gold, 12/3). Read the story and watch the related video.

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Insuring Your Health: Weighing A State Mini-COBRA Plan; Premiums Must Be Based On Pay

In her latest Kaiser Health News consumer column, Michelle Andrews answers readers' questions about picking an insurance plan when leaving a job, small-business health insurance coverage requirements under the Affordable Care Act and salary-based premiums (Andrews/12/3). Read the column.

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Capsules: Patients Often Don't Realize Preventive Care Is Free; Hospice Rules May Keep Patients Away; State Insurance Officials Raise Concerns About 'Rate Shock' For Young People

Now on Kaiser Health News' blog, Jay Hancock reports on a study examining what patients realize about the costs of preventive care: "A survey of hundreds of Californians enrolled in health savings accounts, one type of high deductible plan, showed that fewer than one member in five understood that preventive care was free or almost free. A fifth of those surveyed said they had avoided preventive examination or treatment because of cost" (Hancock. 12/3).

Also on Capsules, Jordan Rau reports on new findings related to hospice enrollment policies: "Hospice is one of the fastest growing segments of Medicare, and many health policy experts laud it as a humane and cheaper way to care for people in the last half-year of life. But in surveying hospices, the new study warns Medicare's method of paying a fixed daily fee to hospices may be discouraging many from taking on patients with expensive needs" (Rau, 12/3).

In addition, Susan Jaffe writes about the idea of insurance "rate shock" for young people: "If young adults can't afford health insurance policies available in 2014 under the health care law, state insurance officials are worried they won't buy them. And that could drive up the cost of insurance for the mostly older, sicker people who do purchase it. That's a potential problem even in states like California and Rhode Island, which are moving ahead to carry out the law, state officials told representatives of the Obama administration Friday at a meeting of the National Association of Insurance Commissioners" (Jaffe, 12/4). Check out what else is on the blog.

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Political Cartoon: 'Life Of Entitlements'

Kaiser Health News provides a fresh take on health policy developments with "Life Of Entitlements" by David Fitzsimmons.

Meanwhile, here is today's health policy haiku:

BUNDLE OF JOY

Deliv'ry system
reform… Pay for performance…
Slow and as you go.
-Keally Cieslik

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

GOP Counteroffer Would Raise Medicare's Eligibility Age To 67

The Republican marker, which was almost immediately rebuffed by the White House, includes cuts to federal safety net programs, but does not meet the president's "test of balance" because it rejects tax increases for the wealthy.

The New York Times: Republicans Make Counteroffer In Fiscal Talks
The counteroffer represented an acknowledgment by Republicans that they had to issue their own proposal to head off around $600 billion in automatic tax increases and spending cuts next year, a fiscal combination that could send the economy back into recession. They said that their approach was a move toward the center rather than sticking to a position established last year with the passage of the House Republican budget, which included contentious changes to Medicare and Medicaid and deep domestic spending reductions (Weisman, 12/3).

Los Angeles Times: Republicans Counter With Their Own 'Fiscal Cliff' Plan
Under pressure from the White House to make a specific deficit reduction proposal, House Speaker John A. Boehner on Monday countered with one that rejects higher tax rates for the wealthy and deeply cuts Medicare, Social Security and other safety net programs. The offer from the Republican leader was swiftly dismissed by the White House as not meeting the "test of balance." President Obama, seemingly confident that the public is on his side, has insisted that the nation can no longer afford to continue tax breaks for the wealthy (Mascaro and Memoli, 12/3).

The Washington Post: Boehner, House GOP Leaders Offer 'Fiscal Cliff' Counterproposal
That framework aims to raise new revenue through an overhaul of the tax code. It also calls for slicing $600 billion from federal health programs, in part by increasing the Medicare eligibility age from 65 to 67, and saving $200 billion by applying a less generous measure of inflation to all federal programs, including Social Security benefits, according to GOP aides. For the first time, Boehner managed to get his entire leadership team … to publicly sign on to a plan that explicitly calls for new tax revenue. … But Democrats said the proposed cuts to social safety-net programs would outweigh higher taxes. And they said Republicans have not made clear how they would raise the additional tax revenue without imposing new burdens on the middle class (Montgomery, 12/3).

The Wall Street Journal: GOP Makes Counteroffer In Cliff Talks
The GOP offer was immediately rejected by the White House, but it provides the most detailed statement to date of what Republicans are willing to concede for now. It comes days after the White House put forward its opening bid in the high-stakes deficit talks. With both sides now having made preliminary offers, the parameters for future negotiations between Republicans and the White House are becoming clearer (Hook, Lee and Paletta, 12/4).

Politico: GOP Cliff Offer Is No Deal-Maker
Boehner didn't pitch the plan with a personal phone call to the president or even with much advance warning to the White House. In a sign of how distant the parties remain, White House aides received the offer via email shortly before 2 p.m. — just as Boehner's staff began briefing reporters, a senior administration official said. House Republicans touted their offer as a middle-ground option outlined during a congressional hearing last year by Erskine Bowles, a Democrat who led the president's debt-reduction committee. But Bowles himself disavowed the GOP characterization (Sherman and Budoff Brown, 12/4).

The Associated Press/Washington Post: GOP Plan Would Raise Medicare Age, Lower Social Security COLAs, While Raising $800B In Revenue
Republicans are proposing a "fiscal cliff" plan that revives ideas from failed budget talks with President Barack Obama last year, calling for raising the eligibility age for Medicare, lowering cost-of-living hikes for Social Security benefits and bringing in $800 billion in higher tax revenue. The counter to a White House plan last week relies more on politically sensitive spending cuts and would raise half the $1.6 trillion in revenue proposed by Obama over the coming decade (12/4).

Politico Pro: GOP Offer Suggests Higher Medicare Eligibility Age
House Republicans on Monday embraced the idea of raising the Medicare eligibility age as part of a $2.2 trillion fiscal cliff counteroffer to President Barack Obama. The plan, based on ideas in November 2011 testimony from Erskine Bowles, calls for coming up with $600 billion in health savings — the same target Bowles proposed to the deficit supercommittee that year. But the GOP offer doesn't break down the health care numbers, and Bowles's testimony to the supercommittee — which Republican leadership aides circulated with the counteroffer Monday — didn’t cite any specifics other than the eligibility age (Haberkorn, 12/3).

Los Angeles Times: White House Spurns Republican Offer On 'Fiscal Cliff' Negotiations
The White House on Monday dismissed a Republican counteroffer to avert the so-called fiscal cliff as failing to "meet the test of balance" by resisting higher tax rates for the wealthy, a point that remains a key hurdle in the impasse over spending and revenues. … Republicans greeted the White House response as a demonstration of "how unreasonable it has become" (Memoli, 12/3).

USA Today: GOP's $4.6T 'Fiscal Cliff' Counterproposal Rebuffed
The Republicans' proposal is based on a framework outlined last year by former Clinton White House chief of staff Erskine Bowles, who co-chaired Obama's debt commission, and included an increase in the eligibility age for Medicare benefits. Republicans did not offer specific language on raising the age in their proposal, but Bowles has supported raising the age to 67. Boehner called it a "la-la land offer" on Monday (Page, 12/3).

McClatchy: GOP Fiscal-Cliff Counter: Cut Tax Rates, Limit Deductions To Increase Revenue
A Republican proposal Monday to shave $2.2 trillion off projected budget deficits sets up a fiscal-cliff showdown with the White House because the plan includes reductions in the very tax rates that Democrats seek to raise. The Obama administration’s opening offer sought to raise $1.6 trillion in taxes over 10 years, much of it from higher income-tax rates on the wealthy. Republican leaders in the House of Representatives countered Monday with their own offer, saying their plan would raise $800 billion in new tax revenues but basing that on cuts in tax rates coupled with limits on deductions that would make more income taxable. …The other $900 billion would come from so-called mandatory programs and health care, presumably Medicare, Medicaid and other programs in which spending is often subject to automatic formulas (Lightman and Hall, 12/3).

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Trouble Spot In Fiscal Talks: The Down Payment

Although there appears to be general agreement about tax code and entitlement changes that would begin next year and tally more than $1 trillion over 10 years, the initial installment of deficit reduction has become a sticking point between the White House and GOP leaders. Meanwhile, the Washington Post checks the facts on entitlement "spending cuts."

The New York Times: Initial Deficit Cuts Are Sticking Point In Negotiations
For all the growing angst over the state of negotiations to head off a fiscal crisis in January, the parties are farthest apart on a relatively small part of the overall deficit reduction program — the down payment. President Obama and the House speaker, John A. Boehner, are in general agreement that the relevant Congressional committees must sit down next year and work out changes to the tax code and entitlement programs to save well more than $1 trillion over the next decade. But before that work begins, both men want Congress to approve a first installment on deficit reduction in the coming weeks (Weisman, 12/3).

The Washington Post's The Fact Checker: Geithner's Fuzzy Math On Entitlement 'Spending Cuts'
Eager to rebut Republican claims that the administration was not serious about reining in entitlement programs such as Medicare and Medicaid, Geithner insisted the administration did have "a detailed plan of spending cuts," totaling $600 billion, in what he described as "mandatory programs" or "entitlement programs." But his language is a bit slippery. Let's explore what's going on (Kessler, 12/4).

Another report explores how changes to Medicare might affect AARP's revenues  -

The Washington Post: AARP Lobbies Against Medicare Changes That Could Hurt Its Bottom Line
As Washington debates whether to cut federal retirement programs as part of a deal to tackle the nation's debt, one of the most powerful advocates for preserving them could have millions of dollars riding on the outcome. AARP, the highly influential lobby for older Americans, is fiercely opposing any Medicare or Social Security cuts and emphasizes that it is fighting for the good of its members. But the proposals for changing Medicare also could affect AARP's bottom line (Markon, 12/3).

News outlets also offer state and local takes on the impact of going over the "cliff" -

The Associated Press/Wall Street Journal: AARP: Benefit Changes Could Harm New Yorkers
With the "fiscal cliff" looming, AARP is warning that changes being considered for Social Security and Medicare could harm older New Yorkers. The clock is ticking closer to the end-of-year deadline to avert the fiscal cliff, which is a combination of the expiration of Bush-era tax cuts and automatic, across-the-board spending cuts. Some economists say the combination could send the economy back into recession (12/4).

WBUR: Citing Hospital Stay, Menino Weighs In On Fiscal Cliff
Boston Mayor Thomas Menino is weighing in on federal budget negotiations. The mayor has sent a letter (PDF) to President Obama and House Speaker John Boehner urging that federal health research funding be spared any cuts. Menino says his recent hospitalization demonstrates the "importance of funding for health research, training and care": I know a little bit about the importance of funding for health research, training, and care. Boston is home to the #1 medical school in the country and the #1 hospital in the country. Researchers in Boston earn more NIH support than in any other city. Health care companies and institutions employ more people than any other sector. Oh, and there's this: I just spent a month in one of our world-class health care institutions and am writing you from another (WBUR, 12/3).

MPR: The Future Of Social Security And Medicare
Two economists discuss the future of Social Security and Medicare at a forum held November 28, 2012 at the University of Minnesota's Humphrey School (MPR, 12/3).

And what about health insurance's role in the tax code? -

NPR: The (Huge And Rarely Discussed) Health Insurance Tax Break
What's the largest tax break in the federal tax code? If you said the mortgage interest deduction, you'd be wrong. The break for charitable giving? Nope. How about capital gains, or state and local taxes? No, and no. Believe it or not, dollar for dollar, the most tax revenue the federal government forgoes every year is from not taxing the value of health insurance that employers provide their workers (Rovner, 12/4).

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Health Reform

Health Plans Welcome Some HHS Health Law Regs, Gear Up For Changes

Insurers are preparing for new approaches to selling plans directly to consumers and how some state exchanges will operate. They are also girding for additional guidance from the Department of Health and Human Services that could help stabilize the insurance market.

Kaiser Health News: Health Plans Gear Up To Sell Directly To Consumers
All this is happening in anticipation that an estimated 9 million people will buy their own insurance in 2014 -- about 50 percent more than do so now. That's when the law goes into full effect and virtually all Americans will be required to have health insurance. Those not covered through their jobs will be able to buy policies online, through so-called exchanges that will be run by the states or the federal government (Appleby, 12/3).

The Washington Post: Some Health Exchange Plans To Mirror FEHBP
Health care offerings to be available in multiple states through the Affordable Care Act's insurance exchange system would parallel those of the Federal Employees Health Benefits Program in many ways, although the two programs would not affect each other directly, under rules to be proposed on Wednesday (Yoder, 12/4).

Politico Pro: Insurers Generally Welcome '3-R' Regs
The regulations HHS has proposed to stabilize premiums during the first three years of the health exchanges were generally welcomed by insurers, who said they would be needed to help calm a potentially volatile market. But the complexity of the so-called 3-Rs programs outlined Friday -- reinsurance, risk-adjustment and risk corridors -- as well as HHS's claim that it won't correct errors in risk adjustment payments made in the first two years, raised some concerns about gaming the system (Norman, 12/3).

Kaiser Health News: Capsules: State Insurance Officials Raise Concerns About 'Rate Shock' For Young People
If young adults can't afford health insurance policies available in 2014 under the health care law, state insurance officials are worried they won't buy them. And that could drive up the cost of insurance for the mostly older, sicker people who do purchase it. That's a potential problem even in states like California and Rhode Island, which are moving ahead to carry out the law, state officials told representatives of the Obama administration Friday at a meeting of the National Association of Insurance Commissioners (Jaffe, 12/4).

CQ HealthBeat: Conservatives Pressure Christie To Rely On Federal Exchange
The conservative group Americans for Prosperity is running 60-second radio ads pressuring New Jersey Gov. Chris Christie to reject a state-passed bill that would allow New Jersey to run its own health care exchange. Christie must decide by Thursday whether he will sign the measure, which passed in October (Adams, 12/3).

California Healthline: How Will Consumers Choose Exchange Coverage?
The Pacific Business Group on Health yesterday released the third and final installment of its comprehensive report on how to ensure that the people joining a health benefit exchange end up with the plan that works best for them. … That's one of the points of yesterday's report, that health officials need to make sure that the choice of a health plan for consumers in the exchange becomes both a simple and well-informed decision. The report, done in three installments, is based on a series of 2,100 interviews overall, conducted in 2012 with low-income participants chosen to mirror the demographic makeup of expected enrollees in the exchange in 2014. Outside of premium cost, one of the most important factors to increase enrollment among participants is to make the process a simple one (Gorn, 12/4).

Meanwhile, on the state level, opponents of the Affordable Care Act pack a Florida hearing -

The Associated Press: 'Obamacare' Foes Vent To Senate Panel
Dozens of Tea Party activists flooded a [Florida] state Senate meeting on the Affordable Care Act on Monday, calling the law a gross overreach by the federal government. The first meeting of the Senate Select Committee on Patient Protection and Affordable Care Act, chaired by Republican Sen. Joe Negron, was a fiery one as lawmakers discussed what will be one of the most critical and contentious issues of the upcoming legislative session (Kennedy, 12/3).

And, an update regarding the Oklahoma challenge to the health law --

Politico Pro: DOJ Asks Court To Dismiss Oklahoma ACA Lawsuit
The Obama administration on Monday asked an Oklahoma court to toss a lawsuit challenging whether Americans can get tax subsidies through federally run health insurance exchanges. Oklahoma Attorney General Scott Pruitt filed suit in September, arguing that the Obama administration is violating the letter of the health care reform law by writing rules that allow consumers to get tax subsidies through exchanges that will be fully or partially run by the federal government in 2014. The Justice Department wrote Monday that Oklahoma "seeks to take federal tax credits from its own residents" (Haberkorn, 12/3).

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Medicare

Stakeholders Focus On Addressing Medicare Physician Payment Issues

Stakeholders worry that, although a "doc fix" is likely to be included in a broad deficit-reduction deal, steps also need to be taken immediately to prevent scheduled Medicare physician payment cuts from kicking in.

CQ HealthBeat: Details Emerging On Possible Physician Payment Patches
Health care stakeholders are urging Congress to prevent scheduled cuts in payments to Medicare physicians, as details on another annual patch are getting caught up in the deficit-reduction negotiations. Lobbyists and provider groups are meeting with congressional staffers to try to discuss details of how to avert the payment reductions, although aides say details may not be ironed out between the parties until a broader deficit agreement is reached. A payment patch for Medicare physicians, also known as a "doc fix," is likely to be included as part of a larger deal. With much still unresolved on a deficit-reduction agreement, lawmakers have been mostly quiet on how to avoid the expiring Medicare physician payment rates. But lobbyists say some details are being discussed -- particularly the tricky issue of how to offset the cost of a payment patch (Ethridge, 12/3).

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HHS: Health Law Changes To Medicare Drug Program Saved Seniors $5B

The administration announces that almost 2.8 million people have saved an average $677, because the law is closing the prescription drug doughnut hole.

USA Today: Medicare Beneficiaries Reach $5 Billion In Drug Savings
Since passage of the health care overhaul two years ago, 5.8 million Medicare patients have saved $5 billion from prescription drug discounts, and the government can now predict lower health care costs based on increased use of these cheaper drugs (Kennedy, 12/3).

The Hill: HHS: Obama Health Law Saved Seniors $5B On Prescription Drug Costs
The Obama administration on Monday touted the healthcare law for saving people on Medicare $5.1 billion on prescription drugs. The Health and Human Services (HHS) Department said almost 2.8 million people have saved an average of $677 on their medications so far this year. The release coincided with the final week of Medicare Open Enrollment — a period that ends Friday (Viebeck, 12/3).

Meanwhile, the nonpartisan CBO has released a study looking at the link between prescription costs and other medical services.

Medpage Today: More Rx Drug Use Tied To Lower Health Costs
A 1 percent increase in the number of prescriptions filled causes Medicare spending to drop by roughly 0.2 percent, the Congressional Budget Office (CBO) has estimated. ... a growing body of published evidence shows a link between changes in prescription drug use and spending for medical services, the CBO said in the report, which was published late last week. The new calculation may have a slight impact on negotiations now going on in Washington to avert the "fiscal cliff" -- the combination of tax increases and spending cuts due to become effective Jan. 1 if nothing is done. The CBO's mission is to calculate the potential savings generated by proposed legislation, including the bills now being discussed by Washington budget hawks (Pittman, 12/3).

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Capitol Hill Watch

Lawmakers Consider Health Coverage For Illegal Immigrants' Children

Members of Congress spotlight the health risks associated with bed rails and demand that federal health care programs cover the children of illegal immigrants who are able to stay in the U.S. under the administration's deferred-action immigration policy.

CQ HealthBeat: Markey Highlights Gap In Oversight Of Lethal Bed Rail Risks
Federal officials will coordinate more closely to strengthen oversight of such products as hospital bed rails that blur the line between medical devices and consumer items, if Rep. Edward J. Markey has his way. The Massachusetts Democrat is calling on the Food and Drug Administration, the Federal Trade Commission and the Consumer Product Safety Commission to create a task force to better address risks associated with bed rails. Bed rails are commonly used in nursing homes, assisted living facilities and patients’ homes to keep people from falling out of bed or to help them get up. A recent New York Times investigation linked bed rails to 550 deaths since 1995, including 27 in the last year alone (Reichard, 12/3).

The Hill: Dems: Federal Health Programs Should Cover DREAMers
Federal health care programs should cover the children of illegal immigrants, a group of House Democrats says. Democrats are asking the Obama administration to make health care available to children who are able to stay in the U.S. under the deferred-action immigration policy that President Obama announced earlier this year. The policy -- similar to the DREAM Act -- allows many children of illegal immigrants to remain in the U.S. without fear of deportation, as long as they meet certain criteria. A group of House Democrats, led by Rep. Barbara Lee (D-Calif.), is now pressing the Obama administration to open federal health care programs to children who receive deferred action under Obama's plan (Baker, 12/3).

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Quality

Study: Hospices And The Enrollment Of High-Cost Patients

Many hospices may be discouraging enrollment for the highest cost treatments, and Medicare's way of paying them may be part of the problem, a new study finds.

Politico Pro: Hospices May Deter High-Cost Patients
For years, hospices have grappled with why many dying people don’t seek out hospice care -- or why they get it for only the last days or weeks of their lives when they might have been helped by an earlier referral. But it turns out that hospices' own enrollment policies may be at least partly responsible, creating barriers to dying people with high-cost conditions. A study in Health Affairs on Monday, by Mt. Sinai School of Medicine's Melissa Carlson and colleagues at Yale and Johns Hopkins University, found that nearly eight in 10 hospices had at least one restrictive enrollment policy. Many had two or three such policies. These exclude people with particularly high cost treatment -- treatments like palliative radiation or transfusions that "may be prohibitively expensive for hospices to provide" (Kenen, 12/3).

Kaiser Health News: Capsules: Study: Hospice Rules May Keep Patients Away
Hospice is one of the fastest growing segments of Medicare, and many health policy experts laud it as a humane and cheaper way to care for people in the last half-year of life. But in surveying hospices, the new study warns Medicare's method of paying a fixed daily fee to hospices may be discouraging many from taking on patients with expensive needs (Rau, 12/3).

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Software To Curb Hospital Readmissions?

The Wall Street Journal: UMass Memorial Tests Software To Curb Hospital Readmissions
Stung by a multimillion-dollar penalty for failing to meet new patient readmissions standards set by Medicare, UMass Memorial Health Care is using transaction analytics software to reduce frequent and costly readmissions for patients with heart attacks, heart failure and pneumonia (Boulton, 12/3).

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Health Care Marketplace

Appeals Court Reverses Conviction Of Drug Sales Rep Who Talked About Off-Label Uses

The federal judges said the conviction violates the salesman's right to free speech.

The New York Times: Ruling Is Victory For Drug Companies In Promoting Medicine For Other Uses
In a case that could have broad ramifications for the pharmaceutical industry, a federal appeals court on Monday threw out the conviction of a sales representative who sold a drug for uses not approved by the Food and Drug Administration. The judges said that the ban on so-called off-label marketing violated the representative's freedom of speech (Thomas, 12/3).

Reuters: U.S. Court Voids Drug Rep's Conviction, Cites Free Speech
A divided federal appeals court on Monday threw out the conviction of a sales representative for promoting off-label use of a prescription drug, a ruling that could make it harder for the government to police how drugs are marketed and sold. The 2nd U.S. Circuit Court of Appeals in New York found that the sales representative's free speech rights under the First Amendment had been violated (Stempel, 12/3).

Meanwhile, the FDA promised to help fund the new effort to evaluate medical devices.

Modern Healthcare: Consortium Aims To Speed Device Reviews
The Food and Drug Administration has joined a public-private partnership to fund new evaluation tools and methods for assessing medical devices, according to a news release. The agency will provide an indeterminate amount of funding to the not-for-profit Medical Device Innovation Consortium, which was created by a biomedical science trade association. The group of industry, government and other not-for-profit organizations aims to fund projects that simplify the medical device design and approval process. The funded projects would include new "tools, standards and approaches to assess the safety, efficacy, quality and performance of FDA-regulated products." … The FDA's support for the initiative may extend to its staff collaborating on partnership-supported research (Daly, 12/3).

Medscape: First-Ever Group Aims To Speed Medical Devices To Market
The US Food and Drug Administration (FDA) today unveiled a new, nonprofit, public-private partnership that aims to speed safe medical devices to market, in part by encouraging otherwise competing manufacturers to pool their knowledge about product testing. … The new partnership, called the Medical Device Innovation Consortium (MDIC), was created by LifeScience Alley, a biomedical science trade association. Founding MDIC members include the FDA, the Centers for Medicare & Medicaid Services, LifeScience Alley, Medtronic, Boston Scientific, the Pew Charitable Trust, and the National Organization for Rare Disorders. Organizers envision bringing aboard leaders of academia as well as industry and government. (Lowes, 12/3).

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Health Care Fraud & Abuse

Tennessee Nursing-Care Company Charged With Medicare Fraud

The Wall Street Journal: Medicare Fraud Is Charged
A Tennessee-based nursing-care company systematically defrauded Medicare of millions of dollars by pressuring therapists to perform expensive, unnecessary treatments, according to a recently unsealed federal complaint. The filing against Life Care Centers of America Inc. is part of an investigation by the Office of Inspector General of the U.S. Department of Health and Human Services into high-priced nursing care. The inspector general reported last month that Medicare loses about $1.5 billion annually from overbilling by skilled-nursing facilities (Burton, 12/3).

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State Watch

State Roundup: Building More Texas Medical Schools

A selection of health policy stories from Texas, California, Illinois, Georgia, North Carolina, Kansas and Massachusetts.

The Texas Tribune: Report Cautions Against Rush To Build Medical Schools
Recommendations in a new draft report on Texas undergraduate medical education caution against rushing to build any new medical schools, which may irk those that are pushing to do exactly that. The report was prepared by the staff of the Texas Higher Education Coordinating Board and posted on the agency's website on Monday in preparation for an upcoming meeting of their Task Force on Graduate Health Professions (Hamilton, 12/3).

HealthyCal: Better Mental Health Care Predicted For Healthy Families Kids With Serious Needs
Santa Cruz County mental health staff and patient advocates in California predict that many children enrolled in the state's Healthy Families Program, an insurance program for low-income families that will be phased out in 2013, should actually have better access to mental health services once they start transitioning to Medi-Cal in January. This summer the state legislature approved Governor Jerry Brown's plan to cut the Healthy Families Program, saving the state $129 million in the next two years and $71 million annually after that (Graebner, 12/4).

Modern Healthcare: Heartburn For Chicago's Northwestern Memorial
Northwestern Memorial HealthCare has suffered its first quarterly operating loss in at least four years, a nearly $24 million setback that reflects the dual challenge of flattening revenue and rising expenses faced by even the largest hospitals. Anchored by an 894-bed medical center in Streeterville, the two-hospital system lost $23.6 million in the fourth quarter of fiscal 2012, compared with operating income of $6.4 million a year earlier, according to new financial statements. Quarterly operating losses are rare for healthcare networks the size of Northwestern, with revenue of $1.70 billion in the year ended Aug. 3 (Barr, 12/3).

California Healthline: High Desert Hospitals Fighting For Financial Solvency
Three rural, stand-alone hospitals in the Inland Empire are in various stages of addressing daunting financial challenges. Victor Valley Community Hospital in Victorville, Colorado River Medical Center in Needles and Hi-Desert Medical Center in Joshua Tree are all attempting to emerge from financial distress, but in different ways. … These hospitals play a critical role in providing care in a region that is nearly the size of Vermont and New Hampshire combined, where long stretches of desert separate small, remote towns and communities. But they are grappling with high numbers of uninsured or underinsured patients, as well as economies of scale that larger hospital systems are not subject to (McSherry, 12/3).

Georgia Health News: Rate Review Targets Double-Digit Premium Hikes
Call it more transparency and accountability -- or simply more publicity. For the past year, health insurers' requests for premium increases of 10 percent or more have received more attention from the public and regulators. That's due to a provision in the health reform law called "rate review," wherein any insurer proposing a double-digit hike in an individual or small-group plan must submit more documentation to justify it. And ultimately, those requests are receiving more public scrutiny. Over the past year, with the new rate review rules in effect, Georgia insurance regulators say they have seen insurers' requests for premium increases becoming more moderate (Miller, 12/3).

North Carolina Health News: New UNC Program Will Turn Army Medics Into Local Practitioners
Sergeant Eric Strand spent more than a decade in the US Army Special forces as a combat medic; he completed a year's intensive training in medicine; he served three tours in Iraq where he treated wounded comrades and provided the rest of his company with primary care. But there's no way for him to use those skills in civilian life. ... For Strand, that means applying to medical school at UNC-Chapel Hill for next fall. But many of his older, married comrades don't have the resources or time to spend years in medical school and residency. So, a new program to train army medics as physician assistants at the UNC School of Medicine may just be the ticket (Hoban, 12/4).

Kansas Health Institute News: More KanCare Implementation Details Outlined
After prodding from local consumer advocates and federal overseers, Kansas officials have made public more details about how they would implement KanCare and say they plan to release more information as quickly as it becomes available. A federal decision on the state’s plan to remake its Medicaid program is expected any day and the new information is evidence of the back-and-forth in the discussion between the federal Centers for Medicare and Medicaid Services as the administration of Gov. Sam Brownback continues its push for a Jan. 1 launch of the new program. Brownback officials so far have posted six section 1915c waiver amendments on the KanCare website and also within the last several days have posted six "implementation activities" reports that outline previously undisclosed details about how they expect KanCare to work (Shields, 12/3).

WBUR: Tool Helps Mass. Patients Find Best Hospital Care
There's a new push in health care to get patients to choose where they get their care based on cost and quality. But it's difficult to find out which hospitals and doctors provide the best and most economical care, whether a test or surgery or other procedure. With that dilemma in mind, WBUR's Martha Bebinger has created a new tool to help patients find the best hospital care. Martha spoke about the tool with All Things Considered host Sacha Pfeiffer (Bebinger, 12/3).

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Editorials and Opinions

Viewpoints: David Brooks' Formula To Avoid Cliff; Krugman Says Control Costs, Don't Cut Coverage

The New York Times: The Truly Grand Bargain
Republicans should go to the White House and say they are willing to see top tax rates go up to 36 percent or 37 percent and they are willing to forgo a debt-ceiling fight for this year. This is a big political concession, but it's not much of an economic one. … In return, Republicans should also ask for some medium-size entitlement cuts as part of the fiscal cliff down payment. ... But the big demand would be this: That on March 15, 2013, both parties would introduce leader-endorsed tax and entitlement reform bills in Congress that would bring the debt down to 60 percent of G.D.P. by 2024 and 40 percent by 2037, as scored by the Congressional Budget Office (David Brooks, 12/3).

The New York Times: The House Makes An Offer
The proposal ... purports to raise $800 billion in revenue over a decade by ending deductions and loopholes, while allowing the Bush-era tax cuts for the rich to continue. It would cut $1.2 trillion in spending, half of which would come from Medicare, Medicaid, and other health programs, including an increase in the Medicare eligibility age to 67. Another $600 billion would be cut from other unspecified spending (12/3).

The New York Times: It's Health Care Costs, Stupid 
The point is that if you want to control Medicare costs, you can't do it by kicking a small number of relatively young seniors off the program; to control costs, you have to, you know, control costs. And the truth is that we know a lot about how to do that — after all, every other advanced country has much lower health costs than we do, and even within the U.S., the VHA and even Medicaid are much better at controlling costs than Medicare, and even more so relative to private insurance. The key is having a health insurance system that can say no — no, we won't pay premium prices for drugs that are little if any better, we won't pay for medical procedures that yield little or no benefit (Paul Krugman, 12/3). 

The New York Times' Opinionator: From All Sides, Fiscal Plans Fall Far Short Of What's Needed
We don't yet know whether our economy will take the icy plunge off the fiscal cliff, but do we know this: At present course and speed, any budget deal that emerges from the intense brinkmanship now under way would fall short of every sensible ambition for fiscal reform (Steven Rattner, 12/3).

The Washington Post: In 'Cliff Talks,' Obama On Brink Of Disaster
While Obama was inviting Republicans to capitulate aboard the USS Missouri, Senate Majority Leader Harry Reid and 32 other Senate Democrats signed a letter declaring, "We will oppose including Social Security cuts for future or current beneficiaries in any deficit reduction package." Not in a year-end package, mind you, but in any package. 14 Senate Democrats wrote a letter opposing any changes to Medicare or Medicaid as well. It will be hard for Obama and the Democrats to blame the GOP for taking us over the fiscal cliff when they are the ones cheering for going over the edge (Marc A. Thiessen, 12/3).

Kansas City Star: Why Medicare And Medicaid Remain Popular Programs
They say Social Security is the third rail of American politics: Touch it and you die. That extends to Medicare and even Medicaid as well. I'd like to take this opportunity to remind President Barack Obama and members of both parties in Congress of why that is. If you are an ordinary American worker, you might be unlucky enough to learn a new buzzword in the health care industry: memory care. It refers to the health care assistance some older people need to do basic things like take the correct pills at the right time or remember whether they already ate lunch. This care is incredibly expensive — several thousand dollars a month in a live-in facility (Mary Sanchez, 12/3)

The Washington Post: Extending Leadership On Disability Issues
Today, the United States has an opportunity to show leadership and reduce the challenges that millions of disabled people around the world face every day: The Senate can vote to join the U.N. treaty on rights for people with disabilities. By encouraging other nations to strengthen their own accessibility laws, we can improve the lives of our 56.7 million disabled U.S. citizens, including 5.5 million disabled veterans like me, when we travel and work abroad. Many of those opposing this treaty claim to support military veterans, but a vote against ratifying this treaty undercuts that support (Dan Berschinski, 12/3).

The Wall Street Journal: Doctor Dissident
At 20 minutes after-hours, a handful of patients sit in the front office of Vladimir Gressel's multi-specialty practice. A few seniors, a young man and a mother and daughter are still waiting to see one of the clinic's two GPs or its cardiologist, podiatrist or orthopedic surgeon. They will not, however, be seeing Dr. Gressel, the physiatrist who co-owns and manages East Shore Medical. The Belarus-born doctor took a hiatus five months ago from treating patients. Now, facing four more years of President Obama, he's considering a permanent end to his doctoring days, at least in this country (Anne Jolis, 12/3).

The Dallas Morning News: Parkland Must Prove Reforms Are Effective In Practice
Today is an important day for Parkland Health & Hospital System officials. They will tell their Board of Managers that 91 percent of the action items in their Corrective Action Plan have been completed and 95 percent are on schedule to make deadline…. The question now for Parkland officials is whether they can turn their reforms from checklists to reality. In effect, they are most of the way through the written portion of their exam. What follows is more critical: proving that those plans actually work in practice and are hard-wired throughout their organization (12/3).

The Seattle Times: Physicians Group's Compelling Case For Over-The-Counter Birth Control
In recent news reports, the FDA has signaled a willingness to explore the issue, even if no drugmakers have publicly expressed interest. They must consider cost, whether the insured would still be covered and the role of pharmacists. The bottom line is that access to family planning is essential to ensure children in Washington are born when their parents are ready (12/3).

WBUR: Cognoscenti: The Pill Without A Prescription: It's Time
Contraception, as everybody knows by now, was a hot button political issue this fall. (Haven’t we fought this fight already?) But perhaps, given the election results, the time is finally nigh to come to our collective senses and do as the ob/gyns recommend – make birth control pills available to women of any age, any time, at any pharmacy, no doctor visit or prescription needed (Judy Foreman, 12/3).

The Arizona Central: Brewer Move OK For Now
Citing high anticipated costs and other reservations, Gov. Jan Brewer declined the option to create an Arizona-based online health-care exchange under the new Affordable Care Act. By doing so, Brewer is ceding control over Arizona's health-care marketplace to the federal government -- not a good idea, overall. Still, the governor's reasons for declining to set up the exchange are defensible. Should it prove to be in Arizona's better interests in the years to come to establish its own exchange, the decision is not irrevocable (12/4).

Medpage Today: The Medical Home
But in my mind, the single most important factor is the absence of good information readily available in the settings of what is often labeled today as "the medical home." Notice there are two ingredients in that formula. When I started my television career 40 years ago, there was a paucity of good health information readily available to the public. Today there is a lot of good information but, unfortunately, it is often lost in the tsunami of information pouring over the public. So a key factor in controlling healthcare costs and avoiding unnecessary care is helping people find – and trust – good information (Dr. Timothy Johnson, 12/3).

San Jose Mercury News: Chronically Ill Californians In Danger Of Going Over Cliff
As Americans turn their focus from the recent elections to the talks over federal deficit reduction and the "fiscal cliff," millions of chronically ill California patients face a very real threat. If Congress does not act now, more than $1 trillion in automatic federal budget cuts will begin Jan. 2, and access to care for California patients living with arthritis, mental illness, autoimmune disorders and countless other conditions will be imperiled (Monica L. Johnson, 12/3). 

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