Daily Health Policy Report

Thursday, December 6, 2012

Last updated: Thu, Dec 6

KHN Original Reporting & Guest Opinion

Fiscal Cliff

Health Reform


Capitol Hill Watch

Public Health & Education

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Huge Experiment Aims To Save On Care For Poorest, Sickest Patients

Kaiser Health News staff writers Mary Agnes Carey and Sarah Varney, working in collaboration with USA Today, report: "Patient advocates around the country, and some lawmakers in Congress, warn that managed care plans – some run by for-profit, publicly traded companies – are ill-equipped to deal with the complex health needs of those who are elderly, mentally ill or disabled. Advocates are looking closely at the experiences of patients like Saavedra in California to see what the pitfalls of the national program may be" (Carey and Varney, 12/6). Read the story or watch the video.

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Health On the Hill: Medicare Changes Loom As 'Fiscal Cliff' Negotiations Pick Up (Video)

Kaiser Health News staff writer Mary Agnes Carey talks with Jackie Judd about the "fiscal cliff" negotiations in Congress and possible cuts in federal spending on health care programs (12/5). Watch the interview or read the transcript.

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Capsules: Advocates Sue To Change The 'Nursing Cliff' In California; KHN Changes How It Describes Medicaid Eligibility Level Under Health Law

Now on Kaiser Health News' blog, Sarah Varney writes about a California lawsuit brought by advocates to change the "nursing cliff": "It was some 21st birthday present. When Pablo Carranza turned 21 in September, California's Medicaid agency notified him that the around-the-clock nursing care he receives at the Chula Vista, Calif., home he shares with his mother would be sharply cut back" (Varney, 12/6).

Also on Capsules, Phil Galewitz writes about a KHN stylebook change: "Since President Barack Obama signed the Affordable Care Act in March 2010, most news organizations including Kaiser Health News have reported that in 2014 the law would expand Medicaid coverage to nearly everyone with a household income below 133 percent of the federal poverty level, which this year is nearly $31,000 for a family of four. But that doesn’t describe the full picture for those newly eligible for Medicaid, the state-federal health insurance program for the poor" (Galewitz, 12/5). Check out what else is on the blog.

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Political Cartoon: '3-2-1 Liftoff?'

Kaiser Health News provides a fresh take on health policy developments with '3-2-1 Liftoff?' By Lisa Benson.

Meanwhile, here is today's health policy haiku:


In the fiscal talks
Medicare's a target. But
what to change, and how?

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

Medicare Changes Central As 'Fiscal Cliff' Countdown Continues

The Washington Post reports that some Republicans are urging House leaders to back higher tax rates for the wealthy in exchange for a deal to rein in spending on safety-net programs. Other news outlets report that AARP and other groups are warning lawmakers about the hazards of cutting benefits as part of a deficit reduction package.

The Washington Post: Some In GOP Urge Lawmakers To Back Tax Hikes For Changes In Safety-Net Programs
A growing chorus of Republicans is urging House leaders to abandon their staunch opposition to higher tax rates for the wealthy with the aim of clearing the way for a broad deal that would also rein in the cost of federal health and retirement programs (Montgomery and Helderman, 12/5).

Kaiser Health News: Medicare Changes Loom As 'Fiscal Cliff' Negotiations Pick Up
Kaiser Health News staff writer Mary Agnes Carey talks with Jackie Judd about the deficit talks and possible cuts in federal spending on health care programs (12/5).

Reuters: Medicare Emerging As Prime Target In U.S. "Fiscal Cliff" Talks
With rival Democratic and Republican deficit plans increasingly focused on Medicare, experts say the two sides could be edging toward common ground on important changes to the popular health insurance program for seniors and the disabled. None of the changes are assured and any specific decisions would come only after resolution of the "fiscal cliff," the combination of tax hikes and spending cuts that's driving the discussion (Morgan, 12/5).

Bloomberg: Raising Medicare Age May Save U.S. More Than $100 Billion
A Republican proposal to raise the eligibility age for Medicare may save the federal government more than $100 billion while increasing health-care costs to senior citizens, states and employers. People age 65 and older could pay an extra $2,000 for health insurance if they’re excluded from Medicare, the federal health-care program for the elderly, according to the nonpartisan Kaiser Family Foundation. Other government and private health plans would see costs rise as would-be Medicare recipients seek care elsewhere (Faler and Wayne, 12/6).

MPR: Fiscal Cliff: It Isn't Just Taxes And Spending On The Table
The threat of big tax increases and spending cuts has meant great business for the airlines. All kinds of people have been visiting Washington recently to lobby about the "fiscal cliff" — the automatic spending cuts and tax increases that will occur next year if Congress does not agree on a financial plan. They include Gov. Mark Dayton, who had a chance to tell President Barack Obama this week what areas he thought should be spared if big spending cuts happen. "Health care would be my number one and education number two but that's where the money is so realistically, something's going to happen," Dayton said. But there are many other policy issues that are important to Minnesota that could get wrapped into any agreement that comes out of the talks. That explains why many of the visitors to the nation's capitol have narrower interests (Neely, 12/6).

The Hill: AARP Hits Capitol Hill To Warn Against Benefit Cuts In Deficit Deal
Staff and volunteers with AARP met with lawmakers Wednesday to warn against cuts to Social Security and Medicare in a year-end deficit-reduction package. The nation's largest senior lobby has been vocal in its opposition to benefit cuts as lawmakers negotiate with the White House to avoid the so-called "fiscal cliff," a combination of tax increases and spending cuts set to hit Jan. 1. "Americans have spoken and they don’t want Congress or the president to make changes to Social Security or Medicare in any last minute deficit deal," said AARP's volunteer President Rob Romasco in a statement (Viebeck, 12/5).

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Polls Show Public Reluctance For Trimming Medicare To Curb The Deficit

A new AP-GfK poll found most Americans favor letting tax cuts expire for top wage earners and a Quinnipiac poll found that voters oppose cutting Medicaid spending and increasing the Medicare eligibility age.

The Associated Press: Poll Shows Support For Raising Taxes On The Rich
Americans prefer letting tax cuts expire for the country's top earners, as President Barack Obama insists, while support has declined for cutting government services to curb budget deficits, an Associated Press-GfK poll shows. Fewer than half the Republicans polled favor continuing the Bush-era tax cuts for the wealthy. There's also a reluctance to trim Social Security, Medicare or defense programs, three of the biggest drivers of federal spending, the survey released Wednesday found (Fram and Agiesta, 12/6).

Politico: Poll Shows Support For Raising Taxes On The Rich
[A new Quinnipiac] poll also showed that voters overwhelmingly oppose cutting Medicaid spending, 70-25 percent. Voters surveyed also oppose gradually raising the Medicare eligibility age, 51-44 percent, and don't support cuts to military spending by a margin of 55-41 percent. Those surveyed also said a "no-taxes" pledge isn't a good idea, 85-10 percent (Glueck, 12/6).

Meanwhile, an American Hospital Association poll found more public wariness about cuts --

Los Angeles Times: Public Wary Of Cutting Hospital Payments To Reduce Deficit
Nearly seven in 10 registered voters said they oppose reductions in what the government Medicare and Medicaid health insurance programs pay hospitals, the survey found. Two-thirds believe that such cuts would harm access to healthcare. “This is simply not a direction that is popular with the public,” said Public Opinion Strategies co-founder Bill McInturff, a veteran Washington pollster who conducted the survey for the American Hospital Assn. (Levey, 12/5).

Modern Healthcare: Voters Oppose Medicare Cuts to Hospitals: AHA Poll
The poll also illustrated the challenge that hospital advocates face in convincing members of Congress to oppose specific cuts to them. About half of the poll respondents had no opinion about a proposed $1 billion in cuts from reducing payments for evaluation and management in hospital settings to the level provided for office-based physicians—even after the voters were provided descriptions of the issue (Daly, 12/5).

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Health Reform

Benefits Under Health Law Will Vary By State; Restaurant Chain Backs Off Plan To Move To Part-Time Workers To Avoid Insurance Costs

The New York Times looks at the wide variations in essential health benefits defined by states, while The Associated Press reports that Darden Restaurants, which owns Olive Garden and Red Lobster, has decided not to try to avoid health law requirements and will not switch full-time employees to part-time status.

The New York Times: Interest Groups Push To Fill Margins Of Health Coverage
The main goal of the health care law has always been to guarantee medical coverage to nearly all Americans, but as states finalize their benefits packages, it is becoming clear that what is received will depend partly on location. According to proposals that the states have submitted to the Department of Health and Human Services, insurance plans will have to cover weight-loss surgery in New York and California, for example, but not in Minnesota or Connecticut. Infertility treatment will be a required benefit in New Hampshire, but not in Arizona. Over all, the law requires that essential health benefits cover 10 broad categories, including emergency services, maternity and newborn care, hospitalization, preventive care and prescription drugs. But there is room for variation in those categories. Whether insurance will pay for hearing aids, foot care, speech therapy and various medications will vary significantly by state (Goodnough, 12/5). 

The Associated Press/Washington Post: Olive Garden Owner Darden Restaurants To Hold Off Worker Changes Tied To Health Care Reform
The owner of Olive Garden and Red Lobster says it won’t bump any full-time workers down to part-time status, after its tests aimed at limiting health care costs resulted in a publicity backlash that took a bite out of sales. ... The company, based in Orlando, Fla., is set to announce Thursday that none of its current full-time employees will have their status changed as a result of the new regulations. The move will come just two days after the company lowered its profit outlook for the year, citing failed promotions and negative publicity from its tests that used more part-time employees. The tests were aimed at keeping down costs tied to new health care regulations, which will require large companies to provide insurance to full-time workers starting in 2014 (12/5).

Meanwhile, a federal judge in New York allows a lawsuit to go forward on the administration's contraception policy -

Politico Pro: Judge Dismisses Contraception Rule Challenge For Two Plaintiffs
A district court dismissed claims brought by two Catholic organizations in New York against the Obama administration's employer contraception coverage rule but will let challenges from three other Catholic plaintiffs proceed. Judge Brian M. Cogan of the U.S. District Court of the Eastern District of New York said in a ruling released Wednesday that the claims brought by Roman Catholic Diocese of Rockville Centre, N.Y., and Catholic Charities do not have standing, as they may be "grandfathered" plans that do not have to immediately comply with the rule (Smith, 12/5).

Bloomberg: Catholic Groups' Can Pursue Contraceptive Coverage Suit
The Roman Catholic Archdiocese of New York and two other Catholic entities can proceed with a lawsuit seeking to invalidate a provision of the Obama administration's health-care law requiring group health insurers to cover contraceptives. U.S. District Judge Brian Cogan in Brooklyn, New York, refused the U.S. Department of Health and Human Service's request to dismiss the case, ruling that the archdiocese, which includes 370 parishes and insures 9,000 people, is facing impending injuries from the rule, even though it doesn't take effect until January 2014, according to a court filing today. The government said the case should be dismissed because the coverage mandate isn't causing imminent injury and there will be changes to the requirements to accommodate the interests of religious organizations, according to the filing (Gullo, 12/5).

And the health insurance industry reports on a new study -

The Hill: Study: Health Care Law's Insurance Tax Will Raise Premium Costs
Insurance premiums could increase by thousands of dollars because of a new tax in President Obama's healthcare law, according to a study commissioned by the insurance industry. The healthcare law imposes several new taxes, including a tax on the insurance industry. The amount the government will collect will rise each year, and is expected to raise $100 billion over 10 years. The health insurance tax will raise families' insurance costs by as much as $7,000 over a decade, according to a study conducted by the firm Oliver Wyman on behalf of America's Health Insurance Plans (AHIP), the insurance industry's leading trade group (Baker, 12/5).

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IRS Releases Final Rules For Health Law's Medical Device Tax

The 2.3 percent tax is expected to raise $29 billion over 10 years.

Politico: Medical Device Tax Set But Industry Still Fighting
The IRS has finalized details on the new medical device tax -- as the medical device industry has redoubled its efforts to get it repealed. The 2.3 percent excise tax on many medical devices, which is part of the 2010 health care law, takes effect Jan. 1. On Wednesday, an Internal Revenue Service final rule detailed plans to levy the tax (Millman, 12/6).

Reuters: IRS Finalizes New Tax From Medical Devices In Health Care law
The U.S. Internal Revenue Service on Wednesday released final rules for a new tax on medical devices, products ranging from surgical sutures to knee replacement implants, that starts next year as part of President Barack Obama's 2010 health care law. The 2.3-percent tax must be paid, effective after December 31, by device-makers on their gross sales. The tax is expected to raise $29 billion in government revenues through 2022 (Temple-West, 12/6).

Modern Healthcare: Industry Rips Device Tax As Regs Arrive
The Internal Revenue Service issued its final regulations on the medical device excise tax, prompting renewed calls by manufacturers to repeal or delay implementation of the tax. A provision of the Patient Protection and Affordable Care Act mandates manufacturers pay a 2.3 percent tax on the sales of certain medical devices starting next month. The tax is considered the industry's contribution to financing the 2010 health care law. Providers and group purchasing organizations have previously raised concerns that manufacturers will pass through the cost of the tax to purchasers of medical devices, while trade groups representing device manufacturers have said the tax will lead to job losses and more broadly will have a negative impact on innovation in the medical technology sector. In a statement today, the Advanced Medical Technology Association again called for a repeal of the excise tax (Lee, 12/5).

CQ HealthBeat: IRS Issues Final Rule On Medical Device Tax
The IRS released a 58-page final rule Tuesday explaining how medical device manufacturers will have to comply with a new 2.3 percent tax on their products starting in January. The action unleashed fresh criticism of the tax from the industry and calls for Congress to repeal it. "With a mere 27 days until the device tax goes into effect, medical imaging and radiation therapy manufacturers do not have sufficient time to implement or adjust to these job-killing regulations," said Gail Rodriguez, executive director of the Medical Imaging and Technology Alliance, an industry trade group. The industry is pushing for a complete repeal, which would cost about $30 billion over a decade (Adams, 12/5).

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States Trying Managed Care For 'Dual Eligibles' - Medicare/Medicaid Recipients

People who qualify for Medicare and Medicaid - many of whom are elderly and in nursing homes - need lots of often-expensive care.

Kaiser Health News: Huge Experiment Aims To Save On Care For Poorest, Sickest Patients
Twenty-five states have applied to be part of the managed care experiment for so-called "dual-eligibles," people who qualify for both Medicare and Medicaid. All dual-eligibles are poor ... Patient advocates around the country, and some lawmakers in Congress, warn that managed care plans – some run by for-profit, publicly traded companies – are ill-equipped to deal with the complex health needs of those who are elderly, mentally ill or disabled (Carey and Varney, 12/6).

California Healthline: Duals Project Edges Closer To Completion
More than 300 people attended a Department of Health Care Services seminar yesterday offering details of the duals demonstration project, also known as the Coordinated Care Initiative. The department recently released several reports, including a draft of the care coordination and long-term services and supports readiness standards. … The number of dual-eligibles in the demonstration project is now estimated to be 525,000 -- significantly fewer than the original estimate of about 700,000 (Gorn, 12/6).

CQ HealthBeat: Groups Forming Consortium Of Plans That Cover Dually Eligible Beneficiaries
States that are testing out ways to shift dually eligible patients into managed care could get some guidance from a new consortium of health plans being put together by the Visiting Nurse Service of New York with support from The Commonwealth Fund. The project, known as Promoting Integrated Care for Dual Eligibles, was mentioned in a presentation at a conference in Washington sponsored by the National Committee for Quality Assurance on Tuesday (Adams, 12/5).

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Capitol Hill Watch

Bill Would Give FDA Clearer Authority Over Drug Compounders

The bill, introduced in Congress, would also direct the Food and Drug Administration to train state regulators -- who may have contributed to the meningitis outbreak that sickened more than 500 and killed at least 36.

Modern Healthcare: Bill Would Make Drug Compounders Register With FDA
A bill that would require compounding pharmacies to register with the Food and Drug Administration was introduced in the House, according to a news release from the two sponsors of the bill, Reps. Rosa DeLauro (D-Conn.) and Nita Lowey (D-N.Y.). The bill, called the Supporting Access to Formulated and Effective Compounded Drugs Act, or SAFE Compounded Drugs Act, would establish an FDA database on the pharmacies for use by the FDA and states in oversight of drug compounders, according to the news release. In addition, it would require the FDA to set minimum production standards and direct the FDA to offer training to state regulators. A compounding pharmacy in Massachusetts is blamed for a meningitis outbreak that sickened more than 500 people and caused at least 36 deaths (Barr, 12/5).

CQ HealthBeat: DeLauro, Lowey Bill Would Give FDA Authority Over Compounding Pharmacies
Two House Democrats introduced a bill to give the Food and Drug Administration clearer authority over compounding pharmacies, although any action on the issue probably will have to wait until the next Congress. The bill, from Democrats Rosa DeLauro of Connecticut and Nita M. Lowey of New York, would give the FDA more authority and also try to build more collaboration between state and federal regulators (Ethridge, 12/5).

In other Capitol Hill news --

Medscape: Proposal Nixes Medicaid Raise To Fund Doc Fix
Organized medicine is protesting a nascent Congressional proposal to eliminate a Medicaid raise for primary care physicians that would either fund a 1-year postponement of a 26.5 percent Medicare pay cut set for January 1 or reduce the federal deficit in general. The American Medical Association and 260 other national and state medical societies registered their "strong opposition" to the idea in a letter today to Republican and Democratic leaders in both the House and Senate. … In 2013 and 2014, the Affordable Care Act (ACA) raises Medicaid rates to Medicare levels for evaluation and management (E/M) services and vaccine administration. Family physicians, general internists, pediatricians, and subspecialists related to these fields (eg, pediatric cardiologists) are eligible for the increase. Congress wrote the raise into the ACA to entice more physicians to accept Medicaid patients, who will grow dramatically in number as a result of the law (Lowes, 12/5).

The Associated Press/Washington Post: Proponents For Abortion Coverage For Military Women Press To End Restrictions
Proponents of ending the ban on women in the military using their health insurance to pay for abortions in cases of rape and incest stepped up the political pressure on Wednesday, insisting that this year's defense bill be used to finally lift the prohibition (12/5).

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Public Health & Education

Study Finds Longer Course Of Tamoxifen Treatment Cuts Breast Cancer Deaths

The finding that women should be taking the drug for twice as long as is now customary came out of a study of nearly 7,000 women from 36 countries.

The New York Times: Bigger Role Seen For Breast Cancer Drug
The widely prescribed drug tamoxifen already plays a major role in reducing the risk of death from breast cancer. But a new study suggests that women should be taking the drug for twice as long as is now customary, a finding that could upend the standard that has been in place for about 15 years (Pollack, 12/5).

USA Today: Long-Term Treatment Cuts Breast Cancer Deaths
Tamoxifen, which has been used for decades, is far cheaper than most new chemotherapies and biological drugs, which cost thousands of dollars a month. A generic version costs about $100 a month in the USA, according to Susan G. Komen for the Cure (Szabo, 12/5).

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State Watch

State Roundup: Fla. Judge Rules Legislature Must Decide On Prison Care Privatization

A selection of health policy stories from Florida, Pennsylvania, Colorado, Texas and Oregon.

The Associated Press: Judge Rules On Scott’s Prison Health Care Privatization Plan, Sends To Legislature
A Tallahassee judge ruled Tuesday that a legislative committee did not have the authority to approve a contract regarding prison health care services. According to Businessweek, the plan would privatize health care services in three of Florida's four prison system regions. Circuit Judge John Cooper, who made the decision, said the policy changes must be approved by the full Legislature, rather than just a panel of 14 select legislators (Meany and Harding, 12/5).

The Oregonian: Kitzhaber Medical Liability Proposal Gets Negative Portrayal In Small Survey: Taste Of 2013 Debate?
A new survey put out by a Georgia-based health care staffing company shows how changing Oregon's medical liability system -- on tap for the Legislature next year -- inspires criticism from advocates of more radical change. In February, Gov. John Kitzhaber promised lawmakers he would tackle the issue of medical negligence lawsuits and doctors practicing what's called "defensive medicine" to avoid those lawsuits. The resulting compromise effort negotiated between doctors and trial lawyers would require early disclosure of medical errors, allow apologies and mediation before any litigation, and is headed for the 2013 Legislature. The survey released Tuesday by Jackson Healthcare asked doctors it has placed around the country their opinions on reforming the medical negligence legal system -- including a "disclosure and offer" concept similar to Kitzhaber's proposal (Budnick, 12/5).

Healthy Policy Solutions (a Colo. news service): Insurance Companies Block Nurse Care
Two of Colorado’s largest insurance companies refuse to pay for their clients to see independent advanced practice nurses in urban areas even though some patients want to see them and the care would cost less. Advanced practice nurses say the insurance companies, Anthem Blue Cross and Blue Shield of Colorado and Rocky Mountain Health Plans, are protecting doctors in a "turf war" instead of focusing on what’s best for patients and allowing free market choice. … Joyzelle Davis, a spokeswoman at Anthem Blue Cross and Blue Shield of Colorado, which provides health insurance to nearly 1 million Coloradans, says there is no need for additional providers in urban areas. Managers at Anthem Blue Cross were not willing to answer questions regarding advanced practice nurses. At Rocky Mountain Health Plans, a spokeswoman said that the company's "standard of care is to provide the best possible access to physicians" (Kerwin McCrimmon, 12/5).

The Dallas Morning News: Many Dallas-Area Patients Could Lose Care If Clinics In Texas Women’s Health Program Are Overwhelmed
Texas says it's ready to take over a women's health program from the federal government, but an analysis indicates the state may not have enough doctors lined up to serve the low-income patients who depend on it. A study by The Dallas Morning News of the state's plan in Dallas, Tarrant, Collin and Denton counties shows 222 health care providers had been approved as of October to treat about 13,000 women. But more than half of those providers, including clinics and private practices, didn’t see any program clients in 2011 (Cardona, 12/5).

The Dallas Morning News: Dallas County Medical Society To End Program Providing Low-Cost Care For Uninsured Patients
The Dallas County Medical Society will pull the plug early next year on its Project Access Dallas, a popular program that matches uninsured county residents with doctors willing to provide them low-cost medical care. The 10-year-old effort, which employed 30 people, will end as early as March, after more than 3,000 current patients have found a "new medical home," said Dr. Rick Snyder, president of the medical society. More than 2,200 local doctors, many of them specialists, had voluntarily provided low-cost care to uninsured patients, including surgery, chemotherapy and chronic-disease management (Jacobson, 12/5).

The Associated Press: Pa. Gov Working To Avoid More Deep Spending Cuts
A top aide to Gov. Tom Corbett would not say Wednesday whether the governor will ask the Legislature for deep spending cuts when he presents a budget plan in February, but suggested that layoffs could be necessary to help offset rising costs for public employee pensions and Medicaid. Budget secretary Charles Zogby said his office is trying to produce a plan that avoids deep spending cuts, but he said it is too early to say if that's achievable (Levy, 12/5).

Florida Health News: FL Law, Health Agency Lax On Compounding Pharmacies
When the nationwide fungal meningitis outbreak exploded into headlines two months ago, Florida health officials responded quickly, tracking the contaminated drug lots and finding potential victims. On Wednesday, they announced the 25th case, including three who died. While the response was swift, Florida health officials concede the state failed to foresee the danger and take steps to reduce the risk. New England Compounding Center, identified as the source of the tainted drugs, had a Florida non-resident license that allowed it to send drugs into the state (Gentry, 12/6).

The Lund Report: Klamath County Still At Odds Over Mental Health
A last-ditch effort is under way in Klamath County to mediate the dispute over mental health services for the nearly 13,000 people on the Oregon Health Plan. State officials have intervened once again, sending in another mediator, while residents continue circulating petitions, asking the Oregon Health Authority to re-open the bidding process and allow a new coordinated care organization to emerge. But that won’t happen while the mediation process continues, according to Patty Wentz, spokesperson. Two issues still separate county officials and Cascade Health Alliance, the physician-hospital owned group that’s attempting to become the CCO – the control of mental health services and representation on Cascade's for-profit board of directors. As the local mental health authority, the county is responsible for such services and has the ultimate contracting authority, but Cascade prefers to establish its own provider network (Lund-Muzikant, 12/5).

North Carolina Health News: Mental Health Court Offers An Alternative Path
"I'm not a jail kind of guy," said Kurt O'Briant. "I'm really not. I can't take jail." ... It took a little shove, and some intestinal fortitude, to take that first step in the right direction. The Community Resource Court (CRC) was his portal. … Launched in April 2000 as a collaborative effort of the OPC Area Program -- the agency that provided mental health services in Orange, Person and Chatham counties at the time – and the court system, the CRC is designed to address the needs of people living with mental health problems who’ve gotten into trouble with the law. The court offers treatment as an alternative to jail -- that might mean psychiatric services, one-on-one or group mental health therapy, substance-abuse therapy, medication management, case management or some combination of these (Sisk, 12/6).

St. Louis Beacon: Health-Care Backers Of Medicaid Expansion Must Woo Skeptical Lawmakers
For the Missouri Hospital Association, the key to getting legislators on board with a push to expand Medicaid is making a pitch about the move’s economic opportunity -- and the practical consequences of inaction. "It isn't the matter that 'we should expand Medicaid because it’s the right thing to do,' although that is certainly still a strong argument," said MHA spokesman Dave Dillion. "Not only could we accomplish that, but we could create an economic engine by doing that." But state Sen. Rob Schaaf, for one, is unmoved so far by what he's heard from proponents of the expansion (Rosenbaum, 12/5).

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Weekend Reading

Longer Looks: The Frustrations Of Academic Medicine

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

The New York Times: Small Employers Weigh Impact Of Providing Health Insurance
Like many franchisees, Robert U. Mayfield, who owns five Dairy Queens in and around Austin, Tex., is always eager to expand and — no surprise — has had his eyes on opening a sixth DQ. But he said concerns about the new federal health care law had persuaded him to hold off. ... Mr. Mayfield, who has 99 employees, said he was worried he would face penalties of $40,000 or more because he did not offer health insurance to many of his full-time workers ... Most employers, even small businesses, already offer health insurance, and the federal law is not expected to have a significant impact on what they do over the next year or so. But businesses that rely heavily on low-income workers, many of whom do not make enough to afford their share of the cost of the insurance premiums, are being forced to rethink their business models (Reed Abelson and Steven Greenhouse, 11/30).

The Weekly Standard: The Sebelius Coverup
Many states are wisely signaling that they aren’t interested in doing the Obama administration’s bidding on Obamacare. As a result, many if not most of Obamacare’s insurance exchanges — the heart of the beast — will have to be set up and run by the Obama administration at the federal level. ... The Obama administration’s congressional allies botched the drafting of this aspect of the health care overhaul, as the plain language of Obamacare doesn’t empower federal exchanges to distribute taxpayer-funded subsidies to individuals; it empowers only state-based exchanges to distribute the subsidies. ... Moreover, the Department of Health and Human Services (HHS) is lagging behind in developing the federal exchanges (Jeffrey H. Anderson, 12/5).

The New Republic: The Legal Crusade to Undermine Obamacare—and Rewrite History
Can one very determined libertarian and one very distorted version of history keep millions of people from getting health insurance? We’re about to find out. The determined libertarian is Michael Cannon of the Cato Institute. He was among the most vocal opponents of the Affordable Care Act, ... Cannon and [Jonathan] Adler, along with the state of Oklahoma and others embracing this cause, argue that the federal government lacks authority to offer those subsidies. ... Not too many legal experts seem to think the lawsuit has merit. ... [Samuel Bagenstos, a professor at the University of Michigan and a widely respected expert on constitutional law]  says Cannon and Adler are reading the statute in an unusually pinched way. ... Clearly, Bagenstos says, the Senate bill’s architects wanted these substitute exchanges to be fully functional, complete with subsidies (Jonathan Cohn, 12/5).

Health Affairs: As She Lay Dying: How I Fought To Stop Medical Errors From Killing My Mom
Back when I was training to become an emergency physician, I'd worry about the day I'd be involved in a medical error. It seemed inevitable. With land mines everywhere—the possibilities of missed diagnoses, delayed treatments, miscommunication—it felt like almost anything could lead to catastrophe. I imagined attending the in-house case review afterward, chastened as my hospital colleagues dissected my decisions. Yet I also thought—and hoped—that something positive would come from the process, that lessons from an error would sharpen my clinical skills and improve care in the hospital. But when I was entangled in my first medical error, I played an unexpected role: I was a thirty-three-year-old son trying to save my mom's life (Johnathan R. Welch, December 2012).

The New York Times: Sharing The Pain Of Women In Medicine
I recently learned that a doctor friend had seriously considered quitting her job at her medical school to go into private practice. As long as I have known her, she has talked about her love for teaching new doctors and conducting research while still caring for patients. Nonetheless, I wasn't surprised to hear the reason she wanted to leave. "I got tired of being a woman in academic medicine," she said. ... What surprised me, however, was what finally persuaded her to stay. When she described her situation to some male colleagues, they listened attentively, then began relaying their frustrations with how little support they got from superiors. "It's hard being a woman here, but I concluded it's not that great for anyone else either," she said. Sadly, her assessment seems to be correct (Dr. Pauline W. Chen, 11/29).

American Medical News: The South Responds To Its Surging HIV Epidemic
Laurie Dill, MD, has HIV-positive patients who were forced to eat off paper plates because their families feared they would spread the disease. Some were kicked out of their homes when they disclosed their status. ... The attitudes toward HIV/AIDS that she sees now in Alabama were what many physicians saw in the early days of the epidemic. In many places, fears of contracting AIDS have lessened due to education about the disease and how it’s transmitted. But in parts of the South, the stigma remains a serious problem. It prohibits people from getting tested, receiving timely medical care, and getting emotional and mental support. ... The South is in the grips of an epidemic, which few people paid attention to until recently (Christine S. Moyer, 12/3). 

The Oregonian: With Seniors' Help, OHSU Researchers Use Technology To Track The Aging Process
Every time Trudy Rice or her husband comes in the front door, it's recorded. ... The data captured by motion detectors installed at the retired couple's Northeast home flows to electronic charts at Oregon Health & Science University, allowing researchers to discern their patterns. ... In the future, a doctor or family member with access to the data may be able to notice changes before they become problems. A falter in Trudy Rice's walking speed, as measured by four sensors mounted on the ceiling from the front door to the living room wall, may indicate the onset of Alzheimer's disease. ... Research at the Oregon Center for Aging and Technology, or ORCATECH, a program at OHSU, indicates sensors, smartphones, computer links and other technology hold great promise for maintaining older adults' quality of life (Eric Mortenson, 12/1).

Men's Journal: The Military's Billion-Dollar Pill Problem
Suffering under the unfathomable strain caused by two extended wars and some of the most intense fighting in our nation's history, the suicide rate among active duty soldiers and veterans is at an all-time high – prompting Secretary of Defense Leon Panetta to dub it "an epidemic." The U.S. military has spent more than a billion dollars on psychiatric drugs as part of the effort to help combat the problem. The most commonly prescribed drugs to treat Post Traumatic Stress Disorder (and also as sleep aids) are anti-depressants and a class of anti-psychotics that includes Seroqel. The tragically ironic issue, however, is that with many of these drugs, some of the possible side effects include suicidal urges (December 2012).

The World/The Pulitzer Center: Cancer’s New Battleground — the Developing World
America has waged war on cancer for more than forty years, but in developing countries the fight has barely begun. In this radio and online series, we meet patients, doctors, and public health advocates on the front lines. What political, cultural, and logistical obstacles make tackling cancer so difficult across most of the globe? (Joanne Silberner, 12/3).

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Editorials and Opinions

Viewpoints: Lame Duck Congress Shouldn't Take On Entitlement Changes; New Legal Challenge To Health Law; 'Irrational Vote' On Disability Pact

Politico: Fiscal Cliff Deal: What We Need
What we need in order to address this fiscal abyss is a Grand Bargain that addresses the two main drivers of our structural deficits: unsustainable social insurance programs, especially health care programs, and a complex, unfair, uncompetitive and inadequate tax system. But a lame duck Congress cannot and should not tackle comprehensive tax and social insurance reforms. It will take dedicated effort in 2013 from the new Congress and its responsible committees, as well as a non-partisan public education initiative sanctioned by the White House, and private discussions with key bipartisan leaders to forge such a bargain (David Walker, 12/6).

The Wall Street Journal: Obama's Ruinous Course
The only issue on the cliff negotiation table held true by every serious person is that the entitlement crisis is going to crush the country. But nothing is dearer to this president than higher taxes on people defined by him as the wealthiest. If the president's DNA prevents him from a compromise that also includes a sequester-strength commitment to disarming the entitlement bombs, much less discretionary spending, take the sequester. Better the fiscal cliff than pitching the American people over the bottomless entitlement cliff (Daniel Henninger, 12/5).

The Washington Post: Bewitched By Obama
In 1965, the year [Medicare] was created, the average life expectancies of men and women at age 65 were another 13.5 and 18 years respectively. Today they are 19 and 21, and rising. Given modern medical — especially pharmacological — marvels, longevity often involves living with several chronic ailments that might have been fatal a generation ago. For liberals, however, no demographic or scientific changes need be accommodated (George F. Will, 12/5).

The Wall Street Journal: The Opening For A Fresh ObamaCare Challenge
ObamaCare is being implemented, having been upheld as constitutional by the Supreme Court in June in a series of cases now known as National Federation of Independent Business v. HHS. It is becoming increasingly clear, however, that the court took a law that was flawed but potentially workable and transformed it into one that is almost certainly unworkable. More important, the justices also may have created new and fatal constitutional problems (David B. Rivkin Jr. and Lee A. Casey, 12/5).

New England Journal of Medicine: Threading the Needle — Medicaid And The 113th Congress
[Medicaid] now plays a vital role in the U.S. health care system and a foundational role in health care reform. The central question, as we approach a major debate over U.S. spending and federal deficits, is how to preserve this role and shield Medicaid from crippling spending reductions. ... Of particular importance is a heightened focus, begun under the ACA, on reforms that emphasize community care for millions of severely disabled children and adults, including patients who are dually enrolled in Medicare and Medicaid and who rely heavily on long-term institutional care. This is the time for delicate and careful strategies (Sara Rosenbaum, 12/5).

Austin American Statesman: Why Medicaid Matters 
The face of Medicaid is changing. Medicaid covers 1 out of 3 children in our state and country. The majority of these children come from working families whose income cannot keep pace with normal living expenses. ... It is imperative that everyone across the state and nation understand the purpose of Medicaid — that it is not for people who do not want to work or are simply looking for a handout. Medicaid is a safety net for everyone because we are all one medical crisis or catastrophic event away from financial ruin (Mark A. Wallace, 12/5). 

Kansas City Star: An Irrational Vote Against Disability Treaty 
The Senate needed 66 votes to ratify a United Nations treaty that calls upon countries to ensure disabled citizens receive the same rights and freedoms as their able-bodied peers. Despite a visit in the Senate chamber from an ailing former Senate Majority Leader Bob Dole, it received only 61 votes. The treaty, already ratified by 126 countries, calls on nations to live up to the standards of the Americans with Disabilities Act. ... Opposition to the treaty was drummed up by far-right denizens like Rick Santorum and Glenn Beck, who claimed it would empower governments to tell parents how to care for disabled children. Other groups said it was really a call for more abortions. None of that is true (12/5).

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Stephanie Stapleton

Andrew Villegas

Sarah Barr
Shefali S. Kulkarni
Ankita Rao
Alvin Tran

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.