Daily Health Policy Report

Wednesday, December 5, 2012

Last updated: Wed, Dec 5

KHN Original Reporting & Guest Opinion

Fiscal Cliff

Health Reform


Health Care Fraud & Abuse

Health Care Marketplace

Health Disparities

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

How The 'Fiscal Cliff' Affects Health Care: Six Questions

Kaiser Health News staff writer Mary Agnes Carey reports: "The impending 'fiscal cliff' is a package of automatic spending cuts and tax hikes set to kick in next month unless President Barack Obama and Capitol Hill agree on a way to stop them. … The president and congressional Democrats have said they will reduce spending on entitlements, including Medicare, if Republicans will agree to increase tax rates on the highest earners. While Republicans have agreed to more revenue they oppose increasing tax rates, preferring to focus on closing loopholes and eliminating some deductions. Here are a few questions – and answers – about what could happen in the weeks before the end-of-year deadline" (Carey, 12/4). Read the story.

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Electronic Health Records Breed Digital Discontent For Some Docs

Health Records Breed Digital Discontent For Some Docs
Colorado Public Radio's Eric Whitney, working in partnership with Kaiser Health News and NPR, reports: "Two years and $8.4 billion into the government's effort to get doctors to take their practices digital, some unintended consequences are starting to emerge. One is a lot of unhappy doctors. In a big survey by Medscape this summer 38 percent of the doctors polled said they were unhappy with their electronic medical records system" (Whitney, 12/4). Read the story.

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Political Cartoon: 'You Jump First'

Kaiser Health News provides a fresh take on health policy developments with 'You Jump First' by R.J. Matson.

Meanwhile, here is today's health policy haiku:


Providers, Patients:
Peer over the fiscal cliff.
Now – can all hold hands?
-Christopher Koller

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

Health Care Programs A Clear Target In Deficit Reduction Efforts

As negotiators debate proposals to trim entitlement programs such as Medicare and Medicaid, stakeholders ranging from public hospitals to physician groups lobby to protect their interests.

Kaiser Health News: How The 'Fiscal Cliff' Affects Health Care: Six Questions
The impending "fiscal cliff" is a package of automatic spending cuts and tax hikes set to kick in next month unless President Barack Obama and Capitol Hill agree on a way to stop them. … The president and congressional Democrats have said they will reduce spending on entitlements, including Medicare, if Republicans will agree to increase tax rates on the highest earners. While Republicans have agreed to more revenue, they oppose increasing tax rates, preferring to focus on closing loopholes and eliminating some deductions. Here are a few questions and answers about what could happen in the weeks before the end-of-year deadline (Carey, 12/4).

Modern Healthcare: Likely Healthcare Deficit Targets Come Into View
As federal lawmakers remain stuck in negotiations to avert the fiscal cliff, healthcare experts say they're hearing the Medicaid provider tax, evaluation and management services and graduate medical education are payment areas lawmakers could cut to achieve entitlement-program savings as part of a deficit-reduction deal. White House Communications Director Dan Pfeiffer said in a statement that a letter from House Republicans on Monday—intended as a counteroffer to an administration proposal last week—"includes nothing new and provides no details on which deductions they would eliminate, which loopholes they will close or which Medicare savings they would achieve" (Zigmond, 12/4).

CQ HealthBeat: Zandi Says Credible Cliff Deal Requires $600 Billion In Medicare, Medicaid Cuts
Economist Mark Zandi appeared to give the House Republican leadership's proposal for entitlement changes a boost Tuesday by saying that a deficit reduction plan that would get the economy back on track would generate $600 billion to $700 billion in Medicare and Medicaid savings over 10 years. The framework House Speaker John A. Boehner, R-Ohio, proposed Monday includes $600 billion in Medicare and Medicaid savings. Last year Democrats first said they are willing to find $500 billion and then said they would agree to $400 billion in savings from the programs, according to people familiar with the negotiations. In his initial fiscal cliff proposal, President Barack Obama called for health care program savings closer to $400 billion (Reichard, 12/4).

The Hill: Safety-Net Hospitals: Don't Cut Medicaid
A coalition of public hospitals has launched a new campaign against cuts to Medicaid that could come as part of a deficit-reduction deal. At ProtectMedicaid.org, the National Association of Public Hospitals and Health Systems (NAPH) argues the low-income health insurance program is essential for a healthy economy. "Medicaid ensures access to quality healthcare for more than 60 million people … all at a lower per-beneficiary cost than private insurance and Medicare," NAPH writes (Viebeck, 12/4).

The Hill: Hoyer: Entitlement Benefit Cuts On The Table In Talks With GOP On 'Fiscal Cliff'
Entitlement cuts should remain on the table as party leaders seek to hash out an end-of-the-year budget deal, Rep. Steny Hoyer (D-Md.) said Tuesday. A number of Democratic leaders — including Reps. Nancy Pelosi (Calif.), John Larson (Conn.) and Xavier Becerra (Calif.) — have said they would support some spending reductions in Medicare, but that cuts to direct benefits should not be a part of the negotiations. Along with Senate Majority Leader Harry Reid (D-Nev.), they also maintain that Social Security reform has no place at all in the "fiscal cliff" talks (Lillis, 12/4).

The Hill: Baucus: Don't Shift Health Costs To Seniors In 'Fiscal Cliff' Deal
A deal to avoid going over the "fiscal cliff" should include controlling healthcare spending but shouldn't shift costs to seniors, Sen. Max Baucus (D-Mont.) said Tuesday. Baucus acknowledged that rising healthcare costs are a burden on federal spending, and he said controlling those underlying costs is the way to tackle entitlements. "Shifting costs to seniors is not the solution," Baucus said. "We cannot break the promise of Medicare and Social Security." Baucus chairs the powerful Senate Finance Committee, which has jurisdiction over Medicare and other healthcare programs. He's also up for reelection in 2014, and has been angling for a key position in negotiating a deal to avoid the fiscal cliff of automatic spending cuts and tax increases set to hit next month (Baker, 12/4).

Roll Call: Health Care Professionals Descend On Washington
From now through the end of the year, lawmakers can look forward to hearing from physicians, family practitioners, nurses, home health workers and anyone else who provides care to patients. On Nov. 29, four hospital executives held a briefing in the Rayburn House Office Building, while members of the American Academy of Orthopaedic Surgeons visited Capitol Hill. More such events by a variety of medical professionals are planned in the coming weeks. The visits are part of separate, but equally intense, efforts by health care groups to protect their members from potential Medicare payment cuts, especially in the ongoing deficit-reduction negotiations (Ethridge, 12/4).

Politico Pro: Another Patch For 'Doc Fix' – If Fiscal Cliff Doesn't Interfere
The "doc fix" problem comes up almost every year, but this year the fiscal cliff talks could make a difference. The fiscal cliff negotiations could bog down even another temporary solution to the perennial Sustainable Growth Rate problem. But there’s also a long-shot chance that the cliff talks provide an opening to finally get full repeal of the outdated SGR formula. Still, the most likely outcome, according to several industry and K Street sources, is another patch: $25 billion for a yearlong fix. Physician groups, including the American Medical Association, are urging lawmakers to include the first steps toward SGR repeal in any grand bargain framework that would be filled in next year, according to Capitol Hill sources and health care lobbyists (Haberkorn, 12/4).

NPR: The Perilous Politics Of The Health Insurance Tax Break
There's not much in health care that economists agree on. But one of the few things that bring them together is the idea that excluding the value of health insurance from federal taxes is nuts. "It just doesn't make sense," says Jonathan Gruber, an MIT health economist and author of Health Care Reform. "And it's important to emphasize in this world where economists seem to agree about nothing, this is something where there's just broad and universal agreement" (Rovner, 12/4).

Meanwhile, polls suggest the public supports protecting Medicare and other entitlement programs -

National Journal: Poll Shows Public Wants Entitlements Left Untouched
As Democrats and Republicans in Washington remain at odds over how to reshape the nation's finances and prevent it from falling over the fiscal cliff, the public is supportive of cutting spending and at the same time more protective than ever of entitlement programs such as Medicare. Traditional cleavages of class and race, age and income, and even region are apparent in the latest edition of the United Technologies/National Journal Congressional Connection Poll, but they are far more muted than on issues such as President Obama's reelection or the fate of his signature health care law. When it comes to the tax and spending issues that are at the heart of negotiations in Washington, primarily between the president and House Speaker John Boehner, the public is eager to defend the entitlement programs that both leaders have acknowledged need to be reined in if the nation’s $16 billion debt is to stop growing, let alone shrink (Cooper, 12/4).

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Overlap In Competing Budget Proposals Points Way To Deal

The Associated Press reports the White House and House Republicans have identified areas of significant overlap that could form the basis for an agreement after posturing gives way to actual bargaining.

The Wall Street Journal: GOP Deficit Plan Irks Conservatives
The conservatives' attitude could nonetheless complicate Mr. Boehner's mission as he strives to negotiate with a re-elected Democratic president without losing so many Republican votes that his leadership would be in peril. GOP leaders said the criticism underscores how much Mr. Boehner's proposal was an attempt at compromise, while Mr. Obama's proposal, which would raise $1.6 trillion in new taxes, was not (Bendavid and Lee, 12/4).

The Associated Press/Washington Post: Hot Rhetoric Aside, There's Overlap In Competing Fiscal Offers That Could Form Basis Of A Deal
Both sides now concede that tax revenue and reductions in entitlement spending are essential elements of any deal. If the talks succeed, it probably will be because House Speaker John Boehner yields on raising tax rates for top earners and the White House bends on how to reduce spending on Medicare and accepts some changes in Social Security (12/4).

Los Angeles Times: Republicans Drop Ryan Budget Plan In 'Fiscal Cliff' Negotiations
The austere federal budget plan drafted by Rep. Paul D. Ryan and embraced by Republicans as a sweeping reimagining of government has hit a roadblock on the way to the so-called fiscal cliff. Top Republicans, including Ryan, insisted this was not the end of the plan and pledged to "support and advance" its principles. But by sidestepping the plan, the House leadership sidelined the push for a transformative overhaul of federal entitlements — a move that quickly sparked dissent from the party's conservative wing (Mason and Mascaro, 12/5).

The Washington Post: Governors Urge Obama, Lawmakers To Avoid 'Fiscal Cliff'
Although some federal programs especially key for states — notably Medicaid — are exempt, many other federal grants to states would be cut. The Pew report said 18 percent of federal grant money would be subjected to the automatic hit. That includes Title I funding, which covers education programs for the poor and the disabled, medical research money, and health and human resource programs (Fletcher and Helderman, 12/4).

Stateline: In Fiscal Cliff Talks, Governors Get White House Seat
A bipartisan group of governors has called on Washington to find a solution — any solution — to the nation's budget woes as the federal government nears its so-called 'fiscal cliff.' "It's not acceptable to have failure when it comes to the fiscal cliff," said Utah Republican Governor Gary Herbert, following a meeting Tuesday (December 4) with President Obama and five other governors. "We need the good people on both sides of the aisle to come together." The governors — three Republicans and three Democrats — said they left the White House meeting feeling "encouraged" that Obama would strike a deal with Congressional Republicans before December 31, the date that would trigger a series of spending cuts and tax hikes to deal with the federal deficit but that economists say would plunge the nation back into recession (Clark and Malewitz, 12/5).

CQ HealthBeat: Governors Want To Be Heard In Fiscal Cliff Fight
Democratic and Republican governors who met Tuesday with the president and congressional leaders said they want a seat at the table when negotiations occur on spending cuts and major changes in health programs that could upend their state budgets. The bipartisan National Governors Association gave few specifics in a conference call with reporters after their meeting with President Barack Obama. The governors were equally vague when they spoke to reporters at the White House after their meeting with the president. But the state leaders said they want to be sure they’re not shut out from the deal-making among the White House and congressional Republicans and Democrats (Norman, 12/4).

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Health Stocks Embraced Amid Market Uncertainty

The Wall Street Journal reports that following President Barack Obama's re-election, health stocks are viewed as a port in the storm. Other news outlets explore how the markets have remained stable during the 'fiscal cliff' negotiations as investors count on an eleventh-hour deal.

The Wall Street Journal: Health Stocks A Port In Market Storm
Some investors believe they have found a remedy for the volatile market: health-care stocks. Money managers are embracing the group following the Nov. 6 U.S. presidential election, which ensured that the health-care overhaul championed by President Barack Obama will survive. While the overhaul of the U.S. health-care system creates winners and losers within the industry, investors say the newfound certainty heightens health care's overall allure (Jarzemsky and Kiernan, 12/4).

The Associated Press/New York Times: As Budget Talks Continue, Markets Change Little
Stocks closed little changed Tuesday on Wall Street as budget talks continued in Washington. … Investors are waiting for developments on the budget talks, which are aimed at avoiding the government spending cuts and tax increases that would begin to arrive Jan. 1 and could eventually cause a recession. … Republicans, led by Mr. Boehner, have balked at Mr. Obama’s proposal of $1.6 trillion in additional taxes over a decade, and called on Monday for increasing the Medicare eligibility age and lowering cost-of-living increases for Social Security benefits (12/4).

The Washington Post: 'Fiscal Cliff' Warnings Yet To Faze Wall Street
The markets' sense of confidence — or, arguably, complacency — is rooted in two strains of thought. One is that all the tough talk from the negotiators is mere posturing, nothing more than a signal to their allies that they are taking a stand in advance of real dealmaking closer to the deadline. Investors and executives have repeatedly seen brinkmanship out of Washington — including over raising the cap on government borrowing in the summer of 2011 — conclude with an agreement at the last possible moment (Irwin, 12/4).

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Health Reform

Studies Gauge Health Law's Impact On Consumer Savings, Rx Drug Coverage

The Commonwealth Fund concluded that consumers saved $1.5 billion in 2011 as a result of a provision that limits how much insurers can spend on expenses not related to medical care. Meanwhile, Avalere Health found that drug coverage plans offered on health exchanges will vary by state.

Los Angeles Times: 'Obamacare' Saves Consumers Nearly $1.5 Billion
Consumers saved nearly $1.5 billion in 2011 as a result of rules in President Obama's healthcare law that limit what insurance companies can spend on expenses unrelated to medical care, including profit, a new analysis shows. Much of those savings — an estimated $1.1 billion — came in rebates to consumers required because insurers had exceeded the required limits. The study by the New York-based Commonwealth Fund also suggests that the Affordable Care Act forced insurers to become more efficient by limiting their administrative expenses, a key goal of the 2010 law (Levey, 12/5).

Modern Healthcare: Reform Law Aiding Insurance Consumers: Report
A new report estimated insurance consumers benefited from $1.5 billion in either rebates or reduced costs last year, due to requirements of the healthcare overhaul. But insurers warned that money could have funded anti-fraud and quality-improvement programs. Research supported by the Commonwealth Fund, which backed the Patient Protection and Affordable Care Act, concluded that the law's medical loss-ratio requirements implemented in 2011 provided big savings—mainly in the individual insurance market. Individual market policyholders had "substantially reduced premiums" due to the law's requirement that insurers spend at least 80% of premium dollars on direct healthcare or quality-improvement activities, or else pay a rebate to their customers, according to the report (Daly, 12/5).

The Associated Press/Washington Post: Study: Prescription Drug Coverage Under Obama Health Care Law Could Vary Markedly By State
A new study says basic prescription drug coverage could vary dramatically from state to state under President Barack Obama's health care overhaul. That's because states get to set benefits for private health plans that will be offered starting in 2014 through new insurance exchanges (12/4).

The Hill: Analysis Finds Big State-By-State Swings In Prescription Coverage
President Obama's signature healthcare law requires insurance plans to cover a range of prescription drugs, but the number of drugs covered will vary widely from state to state, according to a new analysis from Avalere Health. The Affordable Care Act requires plans to cover a set of "essential health benefits," including prescription drugs. To prevent benefit mandates from driving up premiums, the Health and Human Services Department has said it will let states fill in most of the details about their essential-benefits packages (Baker, 12/4).

In other coverage related to the health overhaul -

MPR: Federal Health Care Law
The federal health care overhaul is here to stay after surviving an epic legal battle at the United States Supreme Court and the contentious 2012 elections. But that does not mean the massive law will remain intact, as enacted. Congress may be tempted to raid some of the Affordable Care Act's funding as part of a deal to avert the collection of automatic tax hikes and spending cuts known as the "fiscal cliff." The court battles are hardly over; legal challenges involving issues the Supreme Court did not address when it upheld the law in June, 2012, are already underway. But for the most part, key provisions, such as the individual mandate requiring most Americans to obtain health insurance, will take effect January 1, 2014 (Stawicki, 12/4).

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States Continue Sorting Out Choices About Health Exchanges, Medicaid Expansion

Kansas, South Dakota and Texas are among the states still making decisions -- or reconsidering old ones -- about the health law's insurance exchanges and the Medicaid expansion.

Kansas Health Institute News: ACA Opponent Says Brownback Should Reconsider Stand On Insurance Exchange
Like Kansas Gov. Sam Brownback, Bob Laszewski is a staunch opponent of the Affordable Care Act. Despite that, the Washington, D.C. consultant said at a meeting here today that Brownback is making a mistake by refusing to partner with the federal government to run the Kansas health insurance purchasing exchange that the law requires to be operational by 2014. … Brownback last year blocked Kansas Insurance Commissioner Sandy Praeger's attempts to establish a state-operated exchange, returning a $31.5 million federal grant in the process. Last month, the governor told Praeger, who also is a Republican, that he would not support her efforts to partner with the federal government to operate and fund the Kansas exchange (McLean, 12/4).

Politico Pro: South Dakota Governor: 'No' On Expansion For Now
South Dakota Gov. Dennis Daugaard says the state won't expand Medicaid for now — but he's not ruling it out for the long term. Daugaard, a Republican, included no funding for the optional expansion in his proposed budget for fiscal year 2014, which he released Tuesday. But he said in an address to the state Legislature that expansion is not "a now-or-never decision" — and left the door open for an expansion or partial expansion in the future (Smith, 12/4).

The Texas Tribune: Interactive: Comparing State Medicaid Expansions
If Texas lawmakers decide to expand Medicaid, as called for in the federal Affordable Care Act, the spending, savings, enrollment growth and reduction in the number of uninsured residents are poised to be greater in Texas than in most other states. This interactive compares the expansion of Medicaid in each state using data from a report by the Kaiser Family Foundation, a nonpartisan health care think tank (Aaronson, 12/5).

In the meantime, Health and Human Services Secretary Kathleen Sebelius will meet with state lawmakers on health law implementation Wednesday --

Politico Pro: Sebelius To Meet With State Lawmakers On ACA
State legislators are scheduled to meet with HHS Secretary Kathleen Sebelius at the department headquarters Wednesday to discuss implementation of the health care law. Sebelius asked for the meeting with the members of the National Conference of State Legislatures' Federal Health Reform Implementation Task Force, who are in town for the group's fall forum. She is scheduled to meet with the legislators for 30 minutes Wednesday afternoon. Joy Johnson Wilson, who directs health policy for NCSL, said she wants to hear Sebelius talk about state flexibility. That’s a message that governors stressed during a White House meeting with President Barack Obama on Tuesday (Millman, 12/4).

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Supreme Court Hears Arguments In Hospitals' Medicare Claims Lawsuit

Politico: SCOTUS Asks Tough Questions On Hospitals' Medicare Claims Lawsuit
A majority of Supreme Court justices on Tuesday sounded skeptical of a suit brought by hospitals to reopen Medicare claims as much as 25 years old because of calculations that were found to have underpaid them. The justices heard oral arguments Tuesday in the case of Sebelius v. Auburn Regional Medical Center, a challenge brought by 18 hospitals that are seeking compensation from claims dating to 1987 (Norman, 12/5).

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Health Care Fraud & Abuse

Government Announces Fraud Collections Hit Record $5 Billion

A large portion of the money came from health care probes.

The Washington Post: Justice Dept. Recovers Record $5 Billion Under False Claims Act
The Justice Department's civil division recovered a record $5 billion in the past fiscal year from companies that defrauded taxpayers, with much of the abuse occurring in the health care and mortgage industries (Finn, 12/4).

Modern Healthcare: Feds Collect Record $4.9 Billion Under False Claims Act
Led by the record-breaking legal settlement with drugmaker GlaxoSmithKline, federal collections through the civil False Claims Act exceeded all previous years, topping $4.9 billion in the fiscal year ended Sept. 30. The one-year tally by the Justice Department included settlements with mortgage lenders and military contractors, but the biggest single chunk -- more than $3 billion -- came from health care companies accused of defrauding Medicare and other government health care programs. Fiscal 2012 marked the first time that health care tallies topped $3 billion (Carlson, 12/4).

Meanwhile, federal authorities are watching for a surge in pain drugs from Canada --

The Wall Street Journal: U.S. On Alert For Canadian Drugs
The White House has alerted police and border agents to prepare for a possible influx of addictive pain drugs from Canada, where cheaper, generic versions of OxyContin will soon become available. U.S. drug czar Gil Kerlikowske also called Canada's health minister last week to discuss the issue and offer assistance to address the wave of prescription-drug abuse sweeping both countries, Mr. Kerlikowske's office said (Barrett, Catan and Vieira, 12/4).

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Health Care Marketplace

Olive Garden's Parent Company Lowers Earnings Estimate After Health Law Comments

Restaurant officials say that earlier statements about the costly effects of the health overhaul have contributed to a reduction in revenues.

Politico: Obamacare Press Hits Olive Garden
Harsh press coverage of how the Olive Garden and Red Lobster are implementing Obamacare depressed earnings, the restaurants' owner says. The company offered a lower earnings estimate for fiscal year 2013 on Tuesday, citing in part the media's reporting on the company's handling of the new health care law. The chains' owner, Darden, has in the past been outspoken about what it viewed as adverse effects of the new health care law, taking steps like moving some employees to part-time status to reduce costs (Glueck, 12/5).

Los Angeles Times: Olive Garden Parent Darden Suffers From Bad Specials, 'Obamacare'
The Olive Garden, Red Lobster and LongHorn Steakhouse parent lowered its profit and revenue projections for the quarter ended Nov. 25, blaming sour promotions in its eateries, Superstorm Sandy, its purchase of the Yard House USA chain and even its efforts to mitigate the coming costs of health care reform, also known as "Obamacare" (Hsu, 12/4).

The Hill: Restaurant Chain Says Criticizing 'ObamaCare' May Hurt Its Earnings
Darden is one of several large employers to consider rolling back workers' hours in response to the Affordable Care Act. But the company said Tuesday that negative publicity surrounding that position might be bad for business. ... The company said it would figure out how to make the new health care requirements work. After saying Darden's brands are working to improve their products and marketing, (Darden CEO Clarence) Otis added that "we are also committed to accommodating health care reform in ways that work for our employees and guests" (Baker, 12/4).

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Few New Doctors Choose Primary Care

Less than a quarter of new doctors are choosing primary care as their specialty, even after finishing residency programs focused on internal medicine, a new study reports.

Reuters: Most Internists Don't Plan To Stay In Primary Care
Less than a quarter of new doctors finishing an internal medicine training program planned to become a primary care physician instead of a specialist, in a new study. That suggests fewer generalists will be entering the workforce, researchers said - possibly exacerbating the primary care doctor shortage in parts of the United States (Pittman, 12/4).

Medpage Today: Few IM Residents Headed For Primary Care
Even in residency programs focused on primary care training, most residents do not plan on pursuing a career in general internal medicine, opting instead to practice subspecialty medicine, a survey showed. Only 21.5 percent of third-year residents in categorical and primary care programs said they were going to go into general internal medicine, whereas 64.2 percent said they planned a subspecialty career, according to Colin West, MD, PhD, and Denise Dupras, MD, PhD, of the Mayo Clinic in Rochester, Minn. Although those in a primary care program were more likely than those in a categorical program to plan a career in general internal medicine (39.6 percent versus 19.9 percent; OR 2.76, 99 percent CI 2.35 to 3.23), the majority still opted for other career paths, the researchers reported in the Dec. 5 issue of the Journal of the American Medical Association (Neale, 12/4).

In the meantime, women and nurse practitioners are both becoming a larger part of the medical workforce --

The Wall Street Journal: Women Notch Progress
Women account for a third of the nation's lawyers and doctors, a major shift from a generation ago when those professions were occupied almost exclusively by men, new Census figures show. Women's share of jobs in the legal and medical fields climbed during the past decade even as their share of the overall workforce stalled at slightly less than half (Mitchell, 12/4).

Stateline: Nurse Practitioners Step In Where Doctors Are Scarce
Most people in this rural logging area have only one choice when they need medical care: the Central Virginia Community Health Center. On most days, at least 200 people show up at the center seeking treatment for maladies ranging from sore throats to depression to cavities. The health center typically has four doctors on duty, but the clinical director, Dr. Randall Bayshore, says his staff would never meet local demand if it weren't for the two nurse practitioners who provide the same care, to the same number of patients, as the doctors. Buckingham County is one of roughly 5,800 U.S. communities, with about 55 million residents, that have a shortage of primary care physicians. In these places, many residents are forced to forgo regular checkups and treatment for chronic diseases such as hypertension and diabetes -- harming their overall health (Vestal, 12/5).

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UnitedHealth Report Examines How Doctors Get Paid

Minneapolis Star Tribune: UnitedHealth Looks At Doctors' Pay For Medical Savings
A new report from UnitedHealth Group Inc. takes aim at the way U.S. doctors get paid, saying the nation could save up to $1 trillion over the next decade in health care costs if it were possible to "unleash the potential of payment reform initiatives." The report, which comes out Wednesday, analyzes the savings as well as likely pitfalls to adopting a number of different methods to move away from the current "fee-for-service" approach, which pays doctors based on the number of services they provide. The federal health care law is forcing some of the changes, while Minnetonka-based UnitedHealth and the bulk of the major hospital systems and health plans in Minnesota have taken the initiative on their own (Crosby, 12/5).

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Health Disparities

Poorer Cancer Patients Less Likely To Have Access To Experimental Drug Trials

Reuters: Fewer Poor Cancer Patients Referred For Drug Trials
Among people with advanced cancer, poorer patients are less likely to be referred for clinical trials of experimental drugs, a new study from the UK suggests. Because those early trials will eventually help regulators decide if drugs should be approved for a wider population, it's important that test patients be representative of people the medications are designed to treat, researchers said (Pittman, 12/4).

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State Watch

State Roundup: Florida Health Law Battles Take New Turn

A selection of health policy stories from California, Texas, Oklahoma, Florida, Maryland, North Carolina and Oregon.

NPR: For Tea Party Activists In Florida, The Health Care Battle Goes On
Even in Florida, where Republican leaders led the legal battle against Obamacare, there's recognition now that the state has to act fast to comply with the new law. ... After Nov. 6, [Gov. Rick] Scott had a change in tone. "Gov. [Mitt] Romney did not win the election. So, it's not an option to repeal Obamacare," he said. "So, my goal now is to focus on what's good for our citizens." But Republicans are having trouble convincing Tea Party activists that the fight is over (Allen, 12/4).

The Associated Press: 'Obamacare' Foes Vent Anger To Fla. Sen. Committee
Dozens of Tea Party activists and conservative religious leaders flooded a state Senate meeting on the Affordable Care Act on Monday, calling the law a gross overreach by the federal government and begging lawmakers not to implement it. 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 (Kennedy, 12/5).

The Associated Press: Oklahoma Court Rules Anti-Abortion Laws Pertaining to Ultrasound, Drugs Are Unconstitutional
Oklahoma laws requiring women seeking abortions to have an ultrasound image placed in front of them while they hear a description of the fetus and that ban off-label use of certain abortion-inducing drugs are unconstitutional, the state Supreme Court ruled Tuesday (Talley, 12/4).

The Miami Herald: DCF Wants Its Kids Out Of Nursing Homes
With Florida under heavy fire for funneling sick and disabled children into nursing homes designed for elders, child welfare administrators have quietly enacted a new policy aimed at keeping sick foster kids in community settings. The Department of Children & Families has distributed a new agency policy that requires high-level approval before any child in state care can be admitted to a nursing home, or move from one institution to another. DCF also will ramp up its efforts to recruit foster parents who are specially trained to care for children with significant special needs (Miller, 12/4).

California Healthline: Suit Seeks Changes In-Home Support Services Disability Rules
A lawsuit filed yesterday in U.S. District Court in Sacramento urges state health officials to alter California's limit on adult in-home supportive services. The limit doesn't make sense, the Disability Rights California lawsuit said, because a higher limit would allow some beneficiaries to remain home, which would cost the state less than the price of institutionalization.  DHCS officials said the department has a policy of not commenting on pending litigation (Gorn, 12/5).

Los Angeles Times: Changes To California Children's Healthcare Won't Be Delayed, Official Says
A top official in Gov. Jerry Brown's administration said Tuesday that California will begin transferring poor children into a cheaper healthcare plan on Jan. 1, despite concerns from some lawmakers and advocates that the state's plan is inadequate (Megerian, 12/4).

The Dallas Morning News: Texas Again Fines Parkland Memorial Hospital For Patient-Safety Breakdowns State regulators have again fined Parkland Memorial Hospital for patient-safety breakdowns. Dallas County's troubled public hospital failed to investigate two sudden, unexpected deaths this summer and a third case in which a patient "was suspected of having blood transfusion complications," the Texas Department of State Health Services said. Such internal investigations are legally required. None of these failures "put any patient at clinical risk," Parkland spokeswoman April Foran responded in an email Tuesday. She stressed the hospital had reported all the problems to the state (Egerton, 12/4).

The Oregonian: Gov. John Kitzhaber Wants To Add Roughly 200,000 To Oregon Health Plan
Not having health insurance was making Tamica Kent sick. ... Her lupus-related kidney disease is life-threatening, and three or four times she was forced to seek treatment in hospital emergency rooms. ... The waiting period for people like Kent could end if Gov. John Kitzhaber gets his way on a proposal to add at least 160,000 people to the Oregon Health Plan – but his budget has to get through the Legislature first (Budnick, 12/4).

The Lund Report: Future Of Tobacco Settlement Funds Faces Legislature
An advocacy coalition of healthcare and public health organizations is seeking legislative support next session on a proposal to spend Oregon's share of the Tobacco Master Settlement Agreement (MSA) funds on prevention and community based-health initiatives. ... settlement payments from tobacco companies cover only $0.07 of each $1.00 that Oregon spends treating smoking-related conditions (Scharer, 12/4).

Baltimore Sun: Legislators To Look At Drug Shortages
The staff at Anne Arundel Medical Center considered canceling some surgeries on a recent weekend because the hospital was running low on a common drug used to help bring people out from under anesthesia. It is the kind of problem hospitals and doctors around the country continue to face as drug shortages that began a few years ago threaten the way everyday medicine is practiced. ... Maryland lawmakers are jumping into the fray with plans to introduce legislation to tackle the issue (Walker, 12/4).

ABC: NC Hospitals Warn Employees To Get A Flu Shot Or Get Fired
With officials at the Centers for Disease Control saying it's gearing up to be a bad flu season, ... [t]his past summer, officials at First Health Moore Regional Hospital adopted a policy that requires all staff who routinely work in patient care areas to be vaccinated annually for influenza. Officials at the care facilities say the forward-thinking policy was put in place because the common flu may have not-so-common effects on people facing more serious illnesses (Schmitt, 12/4).

Milwaukee Journal Sentinel: Health Care Cost Increases Slow, But Still Higher Than Midwest, U.S.
Hospitals in southeastern Wisconsin are doing a better job controlling costs and keeping prices in check than their counterparts in the Midwest and throughout the country, according to a study released Tuesday. The result is that health care premiums continue to move closer to the Midwest and national averages. Those were the key findings of two studies released by the Greater Milwaukee Business Foundation on Health Inc., which has done a series of studies since 2003 on health care costs in southeastern Wisconsin (Boulton, 12/4).

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Editorials and Opinions

Viewpoints: Sen. Whitehouse Argues Deficit Fix Shouldn't Be About Medicare; Is A Plunge Over The Cliff So Bad?

Politico: Health Care Savings Without Medicare Cuts
As President Barack Obama and congressional leaders continue discussions to avert the so-called fiscal cliff — the mix of tax increases and spending cuts set to take effect automatically in January — we hear a troubling but familiar refrain in Washington: To fix our deficit, we must cut Medicare benefits. That is flat-out wrong. The fact is, we have a systemwide health care cost problem in America. Health care expenditures are nearly 18 percent of our gross domestic product. The next least-efficient developed country in the world spends 12 percent of its GDP on health care (Sen. Sheldon Whitehouse, D-R.I., 12/4).

Baltimore Sun: Why We Must Stop Obsessing About The Budget Deficit
America's wildly inefficient, balkanized health-care system is already taking a far larger share of the total economy than that of every other rich nation (18 percent), and yet our health outcomes are worse. ... So instead of fighting over how to cut the budget deficit, we should be having a constructive conversation about how to use government's bargaining power through Medicare and Medicaid to hold down health care costs. And then use the Affordable Care Act as a stepping stone toward a single-payer health-care system (Robert B. Reich, 12/5).

The Washington Post: Opening Bids On 'Fiscal Cliff' Talks Are Too Small
Mr. Boehner would cut $600 billion in medical entitlement spending, $300 billion in other entitlements and $300 billion in discretionary outlays — numbers that he suggested are based on ideas raised in congressional testimony a year ago by Erskine Bowles, a former co-chair of the national deficit reduction commission. The reference to Mr. Bowles’s recommendation also would imply applying a new inflation adjustment to federal taxes and benefits, yielding $200 billion in savings, and a gradual increase in the Medicare eligibility age (12/4).

The Wall Street Journal: The Budget Baseline Con
Both the White House and House Republicans are pretending that their goal is "reducing the deficit," which they suggest means making real spending choices. They are talking about a "$4 trillion plan," or something, regardless of how that number is reached. Here's the reality: Those numbers have no real meaning because they are conjured in the wilderness of mirrors that is the federal budget process (12/4).

Los Angeles Times: 'Fiscal Cliff’? Let's Take The Plunge 
Let's join hands and walk to the bottom of the cliff together. It's not very far down. The deficit and national debt will be reduced; Social Security, Medicaid and, for the most part, Medicare will go on unharmed; America will go back to tax rates that worked better than the cuts we've been living with; and Congress will actually be forced to do something for a change: Republicans and Democrats will have to work together to repair those programs damaged by sequestration (Jack Shakely, 12/5).

Los Angeles Times: Your Guide To The 'Fiscal Cliff' 
So far, Democrats have managed to duck tough decisions on how much to cut from Medicare, Medicaid and Social Security. Their day of reckoning will come, but probably not until next year (Doyle McManus, 12/5).

The Tennessean: State Should Run With Ball, Manage Own Health Care
State [health insurance] exchanges will have lots of authority. Though they will not be setting the insurance rates, they can bar an insurer from an exchange for raising its rates too high. ... We believe it is best for Tennessee to develop its own exchange, because exchanges are an innovative, market-driven strategy that foster competition, choice, cost-savings and quality among insurers. It leaves Tennessee in charge, and not the federal government (Drs. Manoj Jain, and William H. Frist, 12/4).

The Wall Street Journal: The FDA Vs. Free Speech
The dirty not-so-little secret of health-care regulation is how frequently it infringes on civil liberties. On Monday a three-judge panel of the Second Circuit Court of Appeals said that Food and Drug Administration rules on the promotion of drugs violate the First Amendment's guarantee of free speech. ... [The Second Circuit decision is] ...a reminder that health regulation is by nature health coercion. This is especially important to keep in mind now that the health-care system awaiting under ObamaCare depends very much on coercing people for "their own good" (12/4).

Bloomberg: Hospital Incentives Help Babies Determine Own Birth Dates
As hospitals and insurers struggle to contain expenses, a confluence of interests emerges. By reducing elective birth interventions, providers and insurers can cut costs while mothers and newborns achieve better health. A two-year effort in Washington state shows the possibilities of such an approach. ... A handful of other states are experimenting with measures to reduce optional early births (12/4).

Health Policy Solutions (a Colo. news service): Medicaid Expansion May Be More Costly Than Advertised
For the first time in decades, [the federal health law] makes it reasonable for Colorado to begin mending its structural fiscal imbalance by reversing the excessive growth in the state’s Medicaid and child health insurance programs. The act makes commercial insurance widely available for both working and nonworking people at all income levels (Linda Gorman, 12/4).

The Philadelphia Inquirer: Pharma's "Vision" For The Future Or Three Blind Mice?
Last month the pharma columnist at Forbes, Matthew Herper, wrote that after "talking to executives around the drug industry," most are pursuing one of the following three alternative scenarios: The blockbuster model, the expanded orphan strategy and the access model. Here, I offer up some insight into each of these "visions" of the future (Daniel R. Hoffman, 12/4).

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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.