Daily Health Policy Report

Friday, December 7, 2012

Last updated: Fri, Dec 7

KHN Original Reporting & Guest Opinion

Fiscal Cliff

Health Reform

Public Health & Education


Veterans Health Care

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Governors Weigh Options On Health Insurance Exchanges

Kaiser Health News reporter Julie Appleby writes: "To partner with the federal government or not. That is the question facing many of the nation’s governors as crunch time approaches to carry out the 2010 health care law. Their decisions about whether to set up state-run online markets to offer health insurance will affect whether millions of individual consumers and small businesses shop for coverage on state or federally operated websites starting in 2014. Consumers are likely to see some differences – possibly around the number of insurers offering plans, the scope of coverage and the marketing campaigns to persuade people to enroll" (Appleby, 12/6). Read the story

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Kaiser Health News: Capsules: Advocates Sue To Change The ‘Nursing Cliff’ In California; Smoking Prevention Funds Run Short Despite Tobacco Settlement

Now on Kaiser Health News' blog, Sarah Varney writes about the differences in Medicaid coverage for children and adults: "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. Carranza has muscular dystrophy and can only move his left thumb and his eyes. The nurses, paid for by Medi-Cal, the joint federal-state program for low income people and those with disabilities in California, have long monitored Carranza’s ventilator and feeding tube. They also cleared fluids from his lungs and lifted him into his wheelchair. But like many other states, California's Medicaid benefits are much more generous for disabled children than for adults" (Varney, 12/6).

In addition, Ankita Rao reports on a study about state efforts to curb smoking: "In 1998, big tobacco companies settled a landmark lawsuit and agreed to pay states $246 billion over 25 years for smoking prevention efforts.  Fourteen years later – with smoking still the country’s leading cause of preventable death – most states use only a fraction of the money for its intended purpose. An annual report found that less than 2 percent of the $25.7 billion collected by states this year from the tobacco settlement and tobacco taxes will be spent on prevention and cessation programs" (Rao, 12/6).

Check out what else is on the blog.

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Political Cartoon: 'Hit The Ground Running?'

Kaiser Health News provides a fresh take on health policy developments with 'Hit The Ground Running?' By Gary Varvel, of The Indianapolis Star.

Meanwhile, here is today's health policy haiku:


Read about the cliff?
Or struggle with a bad cold?
Which is really worse?
-Anonymous KHN editor

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

Boehner, Obama Move To Direct Talks On Budget

As the negotiations shift to the president and House speaker, some Republicans appear to be encouraging their colleagues to abandon staunch opposition to any tax rate hike, The Washington Post reports. But several outlets note that little movement is apparent from either side.

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, 12/6).

The New York Times: Participants In Talks On A Budget Deal Shrink To Two
At House Speaker John A. Boehner's request, Senate leaders and Representative Nancy Pelosi have been excluded from talks to avert a fiscal crisis, leaving it to Mr. Boehner and President Obama alone to find a deal, Congressional aides say. All sides, even the parties excluded, say clearing the negotiating room improves the chance of success. It adds complexity as the two negotiators consult separately with the leaders not in the room. But it also minimizes the number of people who need to say yes to an initial agreement (Weisman and Baker, 12/6).

The Wall Street Journal: Some See Hope As Talks Resume Over 'Fiscal Cliff'
After days of public posturing, budget talks resumed Thursday between the staff of House Speaker John Boehner and the White House. The talks broke a nearly weeklong lull since administration officials had traveled to Capitol Hill for contentious, unproductive meetings with Republicans. Mr. Boehner (R., Ohio) and President Barack Obama spoke by phone Wednesday and committed to renewing negotiating efforts, according to people familiar with the call (Hook, 12/6).

Los Angeles Times: Little Movement On 'Fiscal Cliff' Budget Talks
Congress and the White House appear no closer to an agreement on the year-end budget crisis, although House Speaker John A. Boehner and President Obama have opened lines of communication that could produce a deal later this month. ... The president and his Democratic allies in Congress maintain that wealthier Americans should pay more, saying the country can no longer afford the estimated $900-billion cost of continuing the Bush-era tax rates for another decade. Several influential Republicans have suggested the GOP should accept the president's offer to extend the tax rates for most Americans while the broader budget battle continues. ... Top Republicans are seeking steep cuts to Medicare, Medicaid and Social Security in exchange for producing some new tax revenue (Parsons and Mascaro, 12/7).

Politico: W.H. To House GOP: We're Not Moving
If Wednesday's phone call between Speaker John Boehner and President Barack Obama seemed like a hopeful sign in the fiscal cliff standoff, think again. On Thursday, with the House out of session, White House congressional liaison Rob Nabors trekked to Capitol Hill and delivered a firm message: We aren't moving. In a meeting with leadership staff, Nabors reiterated the administration's hard line that tax rates on top earners must go up, according to Republican sources with knowledge of the meeting. The White House is also insisting that Congress give it power to raise the debt limit on its own. Furthermore, in a development that could signal a step closer to the fiscal cliff, Nabors said the White House's offer stands on mandatory spending on entitlement programs, the sources said (Sherman, Bresnahan and Budoff Brown, 12/6).

Politico Pro: Senate Dems To GOP: First, The Tax Cuts
Senate Democratic leaders complained Thursday that Republicans still haven't spelled out specifics about how they want to cut health care programs. But they also said they wouldn't talk entitlements — specifics or not — until the Republicans agreed to raise tax rates for the wealthy. "I've tried to make very clear until there is some movement in tax rates I’m not talking about any other proposals, whether there will be a cut here or a cut there," Majority Leader Harry Reid told reporters Thursday morning. In short, the health entitlement component of any fiscal cliff deal remains much where it's been all along: mired in a bog of tactical disagreements, and stuck there because of the disputes over taxes (Cunningham, 12/6).

Meanwhile, one news outlet looks to what may happen if a deal isn't reached.

McClatchy: Health Services Advocates Are Apprehensive About Federal Budget Debate
Health care providers and patient advocates are anxious over pending cuts to federal health programs next year if Democrats and Republicans can't strike a deal on budget cuts and taxes by Dec. 31. Unless Congress can agree on at least $1.2 trillion in program cuts, wide-ranging reductions in domestic and defense spending, known as "sequestration," will begin Jan. 2. Some services are exempt, such as veterans' health programs, Medicaid and the Children's Health Insurance Program. Funding for the main provisions of the 2010 health care law doesn’t begin until 2014, so it also wouldn't be affected by the 2013 sequester. But money for crucial services such as community health centers, HIV and AIDS programming, bio-medical research, disease control and prevention, and the regulation of food, drugs and medical devices would face reductions of 8.2 percent beginning next year if Congress and the White House fail to reach a compromise (Pugh, 12/6).

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Raising Medicare's Eligibility Age Would Bring Trade-Offs

The Los Angeles Times and The Associated Press examine the implications of one option being considered in the federal deficit talks and discover some surprising consequences, including higher premiums for those already covered by Medicare.

Los Angeles Times: Q&A: What Would It Mean To Raise Medicare's Eligibility Age?
As they debate ways to control the federal deficit, President Obama and congressional Republicans have both acknowledged the need to rein in federal spending on healthcare programs such as Medicare, which provides health insurance to about 50 million elderly and disabled Americans. Among the leading proposals to slow Medicare spending — a key ingredient of a budget deal — is to raise the eligibility age for the program, an option frequently championed by conservatives. Here are answers to some basic questions about the concept and its potential effects (Levey, 12/7).

The Associated Press: Fiscal Cliff: Trade-Offs In Raising Medicare Eligibility Age
Americans are living longer, and Republicans want to raise the Medicare eligibility age as part of any deal to reduce the government's huge deficits. But what sounds like a prudent sacrifice for an aging society that must watch its budget could have surprising consequences, including higher premiums for people on Medicare (Alonso-Zaldivar, 12/7).

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Health Reform

Christie Rejects State-Run Health Insurance Exchange

The New Jersey governor said he didn't have enough information about the alternatives.

The Wall Street Journal: Christie Rebuffs Health Exchange
New Jersey Gov. Chris Christie on Thursday joined a string of Republican state leaders in turning down a key component of the Obama health-care overhaul, a move freighted with political consequences for GOP governors eyeing potential presidential runs. Some Republican governors have made a show recently of rebuffing President Barack Obama's chief domestic initiative, but Mr. Christie struck a softer tone. He rejected a bill Thursday that was designed to establish a state-run health insurance exchange, while leaving open the possibility he might change his mind later (King and Radnofsky, 12/6).

Politico: Chris Christie Nixes State-Run Insurance Exchange
Christie — who was in Washington on Thursday pushing for Hurricane Sandy aid — rejected a bill passed by the Democratic state Legislature that would have built an exchange, a key part of the president’s health care law that makes available subsidies to help low- and middle-income individuals purchase coverage in new health insurance markets starting in 2014 (Millman, 12/7).

Modern Healthcare: N.J.'s Christie Rejects State-Run Health Insurance Exchange
Christie put his state among a growing number that will defer to the federal government to run the health insurance marketplaces that are a key provision of the Patient Protection and Affordable Care Act. The picture of which states would participate in providing tightly regulated individual and small-group coverage through the exchanges beginning in 2014 has rapidly clarified since the Nov. 6 election. Under a Dec. 14 deadline to notify the Obama administration of plans to establish a state-based exchange, 21 states have indicated they will not form their own exchange. In states that decline, HHS will operate an insurance marketplace on its own or in partnership with state officials (Blesch, 12/6).

CQ HealthBeat: Gov. Christie Vetoes State-Run Exchange Bill
“We will comply with the Affordable Care Act, but only in the most efficient and cost-effective way for New Jersey taxpayers,’’ Christie said in a statement. “Such an important decision as how to best move forward for New Jerseyans can only be understood and reasonably made when fairly and fully compared to the overall value of the other options. Until the federal government gives us all the necessary information, any other action than this would be fiscally irresponsible” (Adams, 12/6).

The Hill: NJ Rejects State-Based Health Exchange
In a technical sense, Christie vetoed a bill that would have begun to establish the exchange. At least 17 states are declining to create their own marketplaces, and most are governed by Republicans who continue to oppose the healthcare law. The decisions pose a huge challenge to the Department of Health and Human Services, which must step in and do the work itself (Viebeck, 12/6).

The Daily Show: Chris Christie Pt. 2 (video)
New Jersey Gov. Chris Christie explains why he vetoed a state-run health insurance exchange, but will accept federal disaster relief.

Other media outlets explore the exchange implications for state leaders and for consumers -

Kaiser Health News: Governors Weigh Options On Health Insurance Exchanges
[Governors'] decisions about whether to set up state-run online markets to offer health insurance will affect whether millions of individual consumers and small businesses shop for coverage on state or federally operated websites starting in 2014. Consumers are likely to see some differences – possibly around the number of insurers offering plans, the scope of coverage and the marketing campaigns to persuade people to enroll (Appleby, 12/6).

CQ HealthBeat: Federal Exchange Details Beginning To Emerge
Bottled up by the Obama administration for months before the election, details about how the federal government will operate insurance exchanges in states that don’t establish their own are beginning to emerge — to the great relief of the insurance industry. “They are opening the door,” is how Candy Gallaher, a senior insurance industry official, summed up the situation after hearing remarks Wednesday by Center for Consumer Information and Insurance Oversight Director Gary Cohen at an industry conference at the Renaissance Chicago hotel (Reichard, 12/6).

CT Mirror: So, What’s An Exchange?
It's a major piece of "Obamacare," and set to debut in just under 10 months. ... An exchange is a store for selling health insurance. Every state is supposed to have one as part of federal health reform. Connecticut's is expected to begin selling coverage in October; the plans will take effect Jan. 1, 2014. Connecticut Health Insurance Exchange CEO Kevin Counihan said it's intended to be a simpler, more transparent way to buy coverage than the market that exists now. Who will use it? If you buy coverage for yourself, you will have the option of buying it through the exchange. So will small businesses (Levin Becker, 12/6).

Related, earlier KHN story: A Guide To Health Insurance Exchanges (Appleby, 7/10/11)

CT Mirror: Exchange Chat Draws Questions, Chiding, On Health Insurance Reform
The audience at Thursday night's panel discussion on the state's health insurance exchange included those with questions about the basics of federal health reform and those with arguments about the nuances of policy decisions being made. The discussion was one of seven "Healthy Chats" being held around the state, part of an effort to raise awareness and answer questions about the exchange (Levin Becker, 12/6).

California Healthline: Report Urges Exchanges To Help Consumers Make Right Choices
Setting up a health benefit exchange is so complex that the simpler aspects sometimes can get lost, said Ted von Glahn, a senior director at Pacific Business Group on Health. … Von Glahn helped create a new PBGH report that looked at one basic and vital component of the enrollment process at health benefit exchanges: the moment when online participants choose a health plan. There are only a few yardsticks that can effectively measure enrollment success, he said, but online enrollment success is one of them (Gorn, 12/6).

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Conservative Lawyers Offer New Argument Against Health Law's Mandate

The lawyers who helped bring the first challenge against the health law's individual mandate think they've figured out another way to kill it using the Supreme Court's own argument that it's a tax. Meanwhile, President Barack Obama's Justice Department files to dismiss an Oklahoma lawsuit challenging the law's implementation.

Politico Pro: Lawyers Behind SCOTUS Challenge Find New Tax Argument Against Mandate
The lawyers who inspired the legal challenge to the health reform law's individual mandate think they've found a way to use the Supreme Court’s own logic to undo the mandate after all. In a Wall Street Journal op-ed Thursday, David B. Rivkin Jr. and Lee A. Casey, who were the first to publicly suggest challenging the mandate and represented the 26 states in the trial court, argue that there's a vulnerability in the reasoning of the Supreme Court decision that upheld the law. They say that if the mandate's penalty is a tax — as the court ruled — it has to be applied uniformly or it is unconstitutional. They write that low-income people can get out of the tax by enrolling in Medicaid — a choice that won't exist in states that refuse to expand the program (Haberkorn, 12/6)

The Associated Press: US Files To Dismiss Oklahoma Health Care Lawsuit
Oklahoma Attorney General Scott Pruitt's lawsuit challenging the federal health care overhaul amounts only to a "difference of opinion" and should be dismissed, lawyers for the federal government say. Pruitt is challenging the health care law's implementation. Lawyers for the federal government filed papers Monday urging U.S. District Judge Ronald White to throw out the case (Talley, 12/6).

Meanwhile, the high court may soon be looking at another health-related dispute that affects how fast lower-priced generic drugs come to market .

Bloomberg: Generic Drug Accords Face Review By U.S. Supreme Court
A multibillion-dollar fight between the drug industry and antitrust enforcers is poised to get U.S. Supreme Court review in a case that may determine how quickly low-price generic medicines reach the market. The justices will say as early as today whether they'll scrutinize "pay for delay" agreements that the Federal Trade Commission says cost customers $3.5 billion each year. Under the accords, brand-name drugmakers pay other companies to hold off selling generic versions. The pharmaceutical industry says the accords are legitimate settlements of patent disputes (Stohr, 12/7).

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Restaurant Chain Owner Backs Down, Won't Cut Employee Hours Over Health Law

The owner of Olive Garden and Red Lobster restaurants backed off threats to cut employee hours to part time, which would have allowed the company to avoid offering health insurance to workers.

The Hill: Restaurant Chains Ditch Plans to Cut Workers' Hours In Response To Health Law
The company that owns the Olive Garden and Red Lobster restaurants backed down Thursday from its plan to cut employees' hours in response to President Obama's health care law. Darden Restaurants -- one of several restaurant firms embroiled in political controversy over employees' health care benefits -- said Thursday it will not follow through with plans to cut workers' hours. The move is a big win for the Obama administration and supporters of the health care law, who have defended the employer mandate to provide health coverage against criticism from Darden, Papa John's Pizza and other companies that rely heavily on hourly workers (Baker, 12/6).

Politico Pro: Darden Says It Won't Cut Worker Hours Under Health Law
After taking heat for suggesting it would cut restaurant workers' hours to avoid having to give them health insurance under Obamacare, Darden restaurants announced a change of heart Thursday: It won't switch anyone's status to part time. The restaurant chain also said it will offer all full-time employees -- whether they're hourly workers or executives -- access to the same health plans. "None of Darden's current full-time employees, hourly or salaried, will have their full-time status changed as a result of health care reform," it said in a statement describing policy through 2014. "In 2014, all of Darden’s full-time employees, including hourly, salaried and executive employees, will have access to the same insurance plan coverage" (Kenen, 12/6).

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Public Health & Education

Women's Health: Advocates Seek New Plan B Consideration; Texas Lawmakers Find Planned Parenthood Decision Is Costly

NPR notes that some backers of the "morning after" pill hope to get HHS Secretary Sebelius to review age restrictions on the drug. And, The Texas Tribune examines the costs to the state because of the lack of subsidized birth control.

NPR: Post-Election, 'Morning After' Pill Advocates Want Age Rules Revisited
Friday marks a not-so-happy anniversary for some of President Obama's biggest supporters: It's exactly one year since Health and Human Services Secretary Kathleen Sebelius decided not to lift the age restrictions on availability of the so-called morning-after pill, Plan B. But now, with the election safely behind them, backers of the pill are hoping the administration may be willing to revisit the issue (Rovner, 12/7).

The Texas Tribune/The New York Times: Likely Increase In Births Has Some Lawmakers Revisiting Cuts
When state lawmakers passed a two-year budget in 2011 that moved $73 million from family planning services to other programs, the goal was largely political: halt the flow of taxpayer dollars to Planned Parenthood clinics. Now they are facing the policy implications — and, in some cases, reconsidering. The latest Health and Human Services Commission projections being circulated among Texas lawmakers indicate that during the 2014-15 biennium, poor women will deliver an estimated 23,760 more babies than they would have, as a result of their reduced access to state-subsidized birth control (Ramshaw, 12/6).

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States Cut Anti-Tobacco Efforts Despite Record Revenue From Taxes, National Settlement

States spend less than 2 percent of what they collect from tobacco taxes and a national tobacco settlement on smoking cessation and prevention efforts, a new report says.

The New York Times: States Cut Antismoking Outlays Despite Record Tobacco Revenue
Faced with tight budgets, states have spent less on tobacco prevention over the past two years than in any period since the national tobacco settlement in 1998, despite record high revenues from the settlement and tobacco taxes, according to a report to be released on Thursday (Tavernise, 12/6).

Kaiser Health News: Smoking Prevention Funds Run Short Despite Tobacco Settlement
In 1998, big tobacco companies settled a landmark lawsuit and agreed to pay states $246 billion over 25 years for smoking prevention efforts. Fourteen years later -- with smoking still the country's leading cause of preventable death -- most states use only a fraction of the money for its intended purpose. An annual report found that less than 2 percent of the $25.7 billion collected by states this year from the tobacco settlement and tobacco taxes will be spent on prevention and cessation programs (Rao, 12/6).

Marketplace: States Cut Anti-Smoking Efforts Despite Tobacco Money Windfall
A new report finds states are expected to collect record revenue this year from a 1998 settlement with the tobacco industry, taking in a total of almost $27 billion from the settlement and tobacco taxes. But only a tiny fraction of that money will be used to discourage people from smoking. The study by the Campaign for Tobacco-Free Kids finds states are spending less than two percent of the money on prevention -- only around $500 million a year. Spokesman Vince Willmore says that doesn't come close to the $8 billion that the industry still puts into marketing (Moon, 12/6).

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Marijuana Legalization In 2 States Comes Under Microscope

The New York Times reports the Justice Department and senior White House officials are debating legal action against Colorado and Washington, which could undermine voter-approved initiatives. Meanwhile, a USA Today/Gallup Poll shows Americans are divided on decriminalization efforts but believe the federal government should not intervene after states vote to take that step.

The New York Times: Administration Weighs Legal Action Against States That Legalized Marijuana Use
Senior White House and Justice Department officials are considering plans for legal action against Colorado and Washington that could undermine voter-approved initiatives to legalize the recreational use of marijuana in those states, according to several people familiar with the deliberations (Savage, 12/7).

USA Today: Poll: Feds Should Back Off When States Legalize Pot
Americans are divided over whether marijuana should be decriminalized — 50% say no, 48% say yes — but they overwhelmingly agree on this: When states vote to legalize pot, the feds should look the other way. In a USA TODAY/Gallup Poll, those surveyed say by almost 2-1, 63%-34%, that the federal government shouldn't take steps to enforce federal marijuana laws in states that legalize pot (Page, 12/6).

Reuters: Marijuana Goes Legal In Washington State Amid Mixed Messages
Hundreds of marijuana enthusiasts huddled near Seattle's famed Space Needle tower on Thursday night with pipes, bongs and hand-rolled joints to celebrate Washington's new status as the first state in the nation to legalize pot for adult recreational use. The public gathering at the downtown Seattle Center, like a smaller turnout at a nearby spot hours earlier, defied a key provision of the state's landmark marijuana law, which allows possession of small amounts of cannabis but forbids users from lighting up outside the privacy of their homes (Myers, 12/7).

The Associated Press: Wash. State Legalizes Marijuana – Questions And Answers
Marijuana became legal under Washington state law Thursday. So, bong hits and funny brownies for everybody? Not quite. Pot legalization in the Evergreen State has raised many questions, some that likely won't be answered for a while. Here's a quick primer (12/6)

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More Compounding Pharmacies Closed As New Infections Are Reported

Massachusetts orders the closing of three more pharmacies, while health officials in at least two states report additional infections from contaminated steroids, although the latest cases are not life-threatening.

The Boston Globe: State Orders Closing Of 3 More Drug Compounding Pharmacies
Three compounding pharmacies found to have problems in how they prepared or stored drugs have ­received cease-and-desist notices from the state Department of Public Health, as part of its ongoing surprise inspections of pharmacies that prepare sterile drugs used in injections. But none of their products has been recalled (Johnson, 12/6).

The Wall Street Journal: New Waves of Meningitis-Related Cases Emerge
Health officials in at least two states are reporting waves of new infections from contaminated steroids linked earlier this fall to a deadly outbreak of fungal meningitis, but say the latest cases aren't life-threatening. The new infections are mostly abscesses in the spines of patients who received steroids produced by a specialized Massachusetts pharmacy that were recalled this fall after they were found to be contaminated with fungal material, officials said. The infections haven't developed into fungal meningitis, but could if left untreated, they said (Martin, 12/6).

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Medicare Advisory Group Recommends 1% Increase In Hospital Rates

The head of the group that advises Congress on Medicare issued the draft recommendation, which will be voted on by the full board in January.

Modern Healthcare: MedPAC Mulls 1% Bump In Hospital Rates
Hospitals should receive a 1% increase in their inpatient and outpatient Medicare payment rates, according to draft recommendations released Thursday by the head of Congress' primary Medicare advisory group. Glenn Hackbarth, chairman of the Medicare Payment Advisory Commission, issued the draft increase based on his staff's conclusion that patients' access to care and the quality of care have generally improved, while the number of hospitals has continued to increase and costs have slowed. The rate increases, on which the full commission will vote in January, are based on current rates and do not account for the effect of a looming 2% cut to all Medicare providers from a separate deficit-reduction deal that is scheduled to begin in February (Daly, 12/6).

CQ HealthBeat: MedPAC Considers 1 Percent Payment Increase For Hospitals
The Medicare Payment Advisory Commission on Thursday in a draft recommendation called for a modest 1 percent increase in inpatient and outpatient hospital payments in 2014, at a time when providers are dreading the impact of possible Medicare cuts under sequestration or as a result of budget negotiations. A staff analysis used for the draft recommendation found that Medicare paid two percent more to hospitals in 2011 compared to 2010, as well as a continued shift to services provided in an outpatient setting rather than in hospital beds. The quality of care is generally improving as well, the analysis said. But commissioners continued to chafe at a fee-for-service system that they say too often rewards volume over quality and efficiency. "I believe $117 billion in spending on acute care is too much," said Scott Armstrong, president of Group Health Cooperative in Seattle, Wash., referring to total inpatient Medicare costs in 2011 (Norman, 12/6).

Also in Medicare news, senators are seeking more payments for rural hospitals.

CQ HealthBeat: Senators Want To Revive Medicare Programs For Rural Hospitals
Thirty-one senators are pushing to reinstate expired programs that increased Medicare payment for some rural hospitals as part of legislation that would block scheduled year-end cuts to Medicare physicians. The bipartisan group asked leaders of the Senate Finance Committee to continue the programs, which expired Sept. 30, through the end of fiscal 2013. “Rural hospitals face a wide array of financial difficulties and operational challenges under the current Medicare Prospective Payment System,” the group wrote in a letter to Senate Finance Chairman Max Baucus, D-Mont., and ranking Republican Orrin G. Hatch of Utah. “The network of health providers that serves rural Americans is fragile and more dependent on Medicare revenue because of the high percentage of Medicare beneficiaries who live in rural areas” (Ethridge, 12/6).

Meanwhile, MedPAC also urged Congress to repeal the rate formula used to figure doctors' payments.

Medpage Today: MedPAC To Congress: Repeal SGR
The Medicare Payment Advisory Commission (MedPAC) said once again that it supports repealing the sustainable growth rate formula that establishes physician pay under Medicare. Congress should also rebalance payment across specialties so that primary care providers are on equal footing with specialists, the commissioners said in their meeting Thursday. The body, which advises Congress on issues affecting Medicare, made the same proposal last year in an October letter to lawmakers. … The recommendation to repeal the SGR came in the form of a "chairman's proposal" presented during the meeting. A final vote on the recommendation will come during the commission's next scheduled meeting on Jan. 17-18 (Pittman, 12/6). 

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Veterans Health Care

VA To Offer New Rules For Veterans With Brain Injuries

The new regulations will make it easier for veterans with traumatic brain injuries to get health care. And, an agreement between the VA and the Indian Health Service will allow some vets to get care closer to home.

The New York Times: Rules Eased for Veterans' Brain Injury Benefits
The Department of Veterans Affairs will propose new regulations on Friday that will make it easier for thousands of veterans to receive health care and compensation for certain illnesses that have been linked to traumatic brain injury. The regulations, which will be published on Monday in the Federal Register, lists Parkinsonism, unprovoked seizures, certain dementias, depression and hormone deficiency diseases related to the hypothalamus, pituitary or adrenal glands as eligible for the expanded benefits (Dao, 12/7).

The Associated Press/Washington Post: Federal Agreement Aims To Increase Access To Health Care For Native American Veterans
The agreement allows for Veterans Affairs to reimburse [the Indian Health Service] for direct health care services provided to eligible American Indian and Alaska Native veterans. ... Veterans Affairs and IHS released more details Thursday, saying the agreement stemmed from much work among the agencies and tribal governments as they tried to find a more equitable solution for bolstering access to care for veterans, particularly those in rural areas (12/6).

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State Watch

Roundup: Ga. 'Provider Fee' Defeat Could Mean $430M Less For Medicaid; Calif. Stem Cell Board Criticized

Georgia Health News: Defeat On Provider Fee Could Gut Hospitals' Finances
Just weeks before the 2013 General Assembly convenes, the state's provider fee, called a "bed tax" by some, remains a high-profile wild card -- one that could deal Georgia's hospital industry a crippling blow. If the fee is not renewed -- and anti-tax forces will oppose it -- the Medicaid system may lose $430 million-plus that the assessment now generates. That loss would swell the state's Medicaid financial shortfall, which is already about $400 million (Miller, 12/6).

(St. Paul) Pioneer Press: Fiscal Cliff: Minnesota Health Programs Could See $37 Million In Cuts
If the federal government goes over the fiscal cliff early next year, the Minnesota Department of Health would suffer a big hit. That was the message Thursday, Dec. 6, from Health Department officials testifying at the Capitol before a joint meeting of two heath committees in the state House of Representatives. … The automatic cuts would result in a $33 million to $37 million reduction in federal support for health programs in Minnesota between July 2013 and June 2015 (Snowbeck, 12/6).

Minnesota Post: Minnesota's Budgeting Efforts Clouded By Nation's Fiscal Uncertainty
Minnesota’s projected $1.1 billion deficit for the 2014-15 biennium is a big improvement from chronic budget deficits in Minnesota for the past decade -- and particularly last year’s $5 billion-plus shortfall that Gov Mark Dayton and the Republican-controlled Legislature had to resolve for the current biennium. … The state also is waiting to see how federal officials will reimburse Minnesota for expanded coverage of low-income populations on government health-care programs that leaves $4.3 billion potentially hanging in the balance. Even if the fiscal cliff is resolved, entitlement cuts that come as part of a national compromise package also could affect Minnesota's bottom line (Nord, 12/6).

Los Angeles Times: Stem Cell Agency Board Criticized For Conflicts Of Interest
The board of California's stem cell funding agency is rife with conflicts of interest and should be restructured to improve the integrity of its grant-making process, according to a new report from independent experts convened by the national Institute of Medicine. The committee found that "far too many" of the board members are from organizations that stand to benefit from the $3 billion the California Institute for Regenerative Medicine is supposed to dole out to researchers over 10 years. Making matters worse, the panel said, the 29 board members are too closely involved in the agency's day-to-day decisions (Brown, 12/7).

Kaiser Health News: Advocates Sue To Change The 'Nursing Cliff' In California
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. Carranza has muscular dystrophy and can only move his left thumb and his eyes. The nurses, paid for by Medi-Cal, the joint federal-state program for low income people and those with disabilities in California, have long monitored Carranza’s ventilator and feeding tube. They also cleared fluids from his lungs and lifted him into his wheelchair. But like many other states, California’s Medicaid benefits are much more generous for disabled children than for adults (Varney, 12/6).

The Lund Report: Medicare Payments Favor Hospitals
Dr. Don Berwick believes the Triple Aim is critical to the success of health care reform over the next few years. That means better care for individuals, better health for populations and lower health care costs. "The fundamental flaw in American health care is fragmentation," said the former administrator of the Centers for Medicare and Medicaid Services, who appears in Portland next Thursday to keynote the 2012 State of Reform Conference. The health care delivery systems are facing an identity crisis, he told The Lund Report. "Are they going to continue raising prices and costs or redesign health care so costs start to fall. This isn’t about rationing or withholding care. It’s about getting costs down while improving care. If it doesn’t happen, we’ll go over the fiscal cliff. An extra dollar taken by health care that’s not needed is a dollar denied for a school or a road. This is not free money that health care is taking. It’s coming from somewhere else" (Lund-Muzkant, 12/6).

Modern Healthcare: U. Of Texas Launches Unique Health Info Exchange Lab
University of Texas at Austin officials are touting their first-in-the-country learning laboratory for health information exchange, the newest addition to the school's nine-week health IT certification program. The health information exchange laboratory, launching this week, gives students hands-on training with information exchange software and allows them to watch real-time transfers of patient records in a simulated environment, Leanne Field, the university's director of public health, medical laboratory science and information technology programs, said in an interview. ... Students in the program also take advantage of a Health IT Learning Center that allows them to work directly with six electronic health-record systems, as well as a telemedicine system (McKinney, 12/6).

The Denver Post: Colorado Approves One Sky-High Health Hike After Nixing Another. Why?
Colorado regulators approved a nearly 30 percent rate hike by a local health plan soon after rejecting a 24 percent boost by Cigna as too high, further muddying the waters over how to control medical insurance. The system works, despite the confusion of watching two high rate increases with opposite fates, said Matt Valeta, a health-insurance analyst for the consumer initiative (Booth, 12/7).

The Associated Press: Miss. Gov Tells Teens To Avoid Early Parenthood
To fight Mississippi's highest-in-the-nation teen birth rate, is it best to give young people detailed information about contraception or to just tell them to abstain from sex before marriage? Separate conferences Thursday at the Jackson Convention Complex offered competing views. Republican Gov. Phil Bryant's office sponsored a conference that was, at times, like a church service complete with emotional testimony from young adults who regret having been sexually active when they were teens (Pettus, 12/6).

The Boston Globe: State's Medical Panel Chief Steps Down
The staff director of the Board of Registration in Medicine resigned Tuesday, and the departure, combined with turnover among board members this year, indicates a probable shift in focus at the agency that oversees licensing and discipline for more than 34,000 physicians in the state. Every seat on the seven-member board has been filled with someone new in the past 18 months or left empty after resignations (Conaboy, 12/7).

Richmond Times Dispatch: Six Large Medical Groups Part Of Anthem Primary Care Initiative
Bon Secours Medical Group and Patient First have signed agreements with Anthem, [Virginia's] largest health insurer, in which Anthem pays primary care doctors more for taking care of patients and rewards them if patient outcomes improve. The focus is on what's called patient-centered medical homes in which a primary care provider oversees and coordinates a patent’s care, which is often fragmented if a patient has complex medical problems and sees multiple providers. … Anthem’s parent company, WellPoint, launched the patient-centered primary care program in January, describing it as a "fundamental change" in its relationship with primary care physicians (Smith, 12/7).

Stateline: Prescription Databases Weigh Public Health Against Patient Privacy
Kentucky's "pill problem" and the state’s plan to fix it unfolded before a national gathering of state lawmakers in Washington D.C. Thursday. As David Hopkins, director of Kentucky's prescription drug monitoring program, shared the state’s prescription numbers -- about 60 million prescriptions in August 2012 alone for a population of about 4.4 million -- legislators attending the National Conference of State Legislatures session shook their heads in disbelief. ... To tackle the problem, the Kentucky legislature passed a sweeping bill in April, beefing up enforcement and requiring all prescribers to enter each prescription they write for scheduled drugs, any drug identified by the U.S. Food and Drug Administration as potentially addictive, into the state's existing prescription monitoring database (Clark, 12/7).

The New York Times: Queens Doctor Is Charged in Two Deaths
A doctor accused of running a prescription pain medication mill out of a basement office in Queens was charged with manslaughter on Thursday in the deaths of two former patients. An indictment filed in State Supreme Court in Manhattan accused the doctor, Stan Xuhui Li, of prescribing pain medicine for medically unsound reasons to 20 patients, seven of whom died from overdoses (Buettner, 12/6).

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Minn. Review Finds HMOs Working In Medicaid And State Health Programs Are 'Generally Sound'

Minnesota Public Radio: State Review Finds HMO Finances Are 'Generally Sound' But Report Raises Questions
A state review finds Minnesota HMOs providing services to public programs such as Medicaid and MinnesotaCare have generally sound financial practices. But the report did raise concerns about the plans' charitable donations and other uses of public dollars. Last March, Gov. Mark Dayton called for a review of how the non-profit health plans were spending the taxpayer money they receive. The government health programs are designed to provide health care coverage for many of the state's poor, vulnerable residents and children. Dayton directed the auditors to look at whether the plans' administrative expenses were appropriate (Stawicki, 12/7).

Minneapolis Star Tribune: State Audits Of Insurance Plans Find Some Issues
Audits of the state's largest health insurance companies found the financial management of taxpayer-supported health plans for low-income Minnesotans is "generally sound," but revealed enough areas of concern to warrant further attention. The audits, released Thursday by the Department of Human Services, found examples where the state was inappropriately billed for lobbying expenses and advertising, and where certain plans donated millions to charitable organizations. Some of the managed care plans also set aside more money in reserves to pay for unpaid claims "than has been historically necessary," according to the state (Crosby, 12/6).

(St. Paul) Pioneer Press: UCare Pays Minnesota Additional $1.57 Million After Profit-Cap Error
Minneapolis-based UCare has paid another $1.57 million to the state to comply with a one-time cap on health plan profits during 2011, according to the state Department of Human Services. The payment was disclosed in an audit of UCare released Thursday, Dec. 6, along with audits of three other HMOs that manage care for patients in the state's public health insurance programs. Overall, the audits found "generally sound" financial management at the health plans, a state official said, but also identified "several issues" including the need for the UCare payment (Snowbeck, 12/6).

Meanwhile, the legislative auditor's office in Minnesota raises another concern.

Minnesota Public Radio: Report: Health Dept. Failed To Monitor Grants, Stop Possible Impropriety
The Minnesota Legislative Auditor's office will broadly review the state Department of Health's administration of grants, after health officials may have allowed thousands of dollars to be inappropriately used by one nonprofit over the last two years. The possible misuse of funds was detailed in a report released Thursday by the auditor's office. The case concerns grants to a St. Paul nonprofit called the Sierra Young Family Institute, Inc. The department of health paid the Sierra Young Family Institute $328,993 in state and federal funds beginning in July 2010 and ending June 30, 2012 to work on reducing health disparities in the black community. This summer, health department staff noticed inconsistencies in the Sierra Young Family Institute's reporting, and asked the Legislative Auditor to investigate (Shenoy, 12/7).

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Health Policy Research

Research Roundup: Medicare Advantage Plan Beneficiaries May Get More Appropriate Services; CHIP Participation Grows

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

Health Affairs: Analysis Of Medicare Advantage HMOs Compared With Traditional Medicare Shows Lower Use of Many Services During 2003-09 – Researchers compared the utilization rates of Medicare Advantage health maintenance organizations (HMOs) with those of traditional Medicare beneficiaries, 2003-09, "to ascertain whether the HMO enrollees demonstrated different levels of use of services, which can be a hallmark of more integrated care." They found that Medicare Advantage plans' "utilization rates in some major categories, including emergency departments and ambulatory surgery or procedures, were much lower." Some treatments, such as hip and knee replacement surgeries were also lower, "but coronary bypass surgery was more common." The authors concluded: "These findings suggest that overall, Medicare Advantage HMO enrollees might use fewer services and be experiencing more appropriate use of services than enrollees in traditional Medicare"  (Landon et al., 12/2012).

Health Affairs: Smoking Bans Linked To Lower Hospitalizations For Heart Attacks And Lung Disease Among Medicare Beneficiaries – Researchers at the University of Iowa analyzed the impact of smoking bans in workplaces, restaurants and bars on hospitalizations involving Medicare beneficiaries for conditions not expected to be linked to smoke exposure. They also studied heart attacks (acute myocardial infarctions) and chronic obstructive pulmonary disease, smoking-related conditions. "We found that smoke-free legislation was associated with a significant reduction in hospitalizations for acute myocardial infarction and that the rate of decline increased over time…" and also "with reductions in hospitalizations for chronic obstructive pulmonary disease." The authors found "very little effect" on admission rates for bleeding in the gastrointestinal tract and hip fractures, which are "largely unrelated" to smoking (Vander Weg, Rosenthal, Sarrazin, 12/2012).

Urban Institute/Robert Wood Johnson Foundation: Medicaid/CHIP Participation Among Children And Parents – "Despite the economic downturn, most states have maintained or expanded Medicaid and CHIP for children, by expanding eligibility to higher income and immigrant children, undertaking enrollment and retention simplifications, and implementing new policy options," the authors wrote about coverage rates between 2008 and 2010. The rate of eligible children participating in Medicaid or CHIP grew to 86 percent nationwide and the number of eligible children who were not insured fell by 500,000 in that time, the study found. Participation rates for eligible parents were lower, however. The authors conclude that the 2009 law designed to improve participation of children in the program "may have contributed to increased take-up for Medicaid/CHIP among children, but that additional efforts will be needed, particularly among parents, to achieve high levels of Medicaid enrollment under the Affordable Care Act ACA" (Kenney et al., 12/3).

Journal Of American College Health: 2009-2010 Seasonal Influenza Vaccination Coverage Among College Students From 8 Universities In North Carolina – Researchers at Wake Forest Baptist Medical Center set out to determine the 2009-2010 seasonal influenza vaccine coverage at eight universities in North Carolina. After surveying more than 4,000 college students between October and November 2009, the researchers found that 20 percent of college students reported receiving the 2009-2010 seasonal flu vaccine. "Self-reported seasonal influenza vaccine coverage among college students in 2009-2010 was one-quarter of the 2020 Healthy People objective of having 80% vaccine coverage for health persons 18 through 64 years of age," they concluded. "This study highlights the opportunity that college campuses have to implement effective strategies and increase influenza vaccine coverage among its diverse student populations" (Poehling, Blocker et al., 12/2012).

Here is a selection of news coverage of other recent research:

Medscape: Physician Burnout Decreases With Shorter Trainee Rotations
Shorter, 2-week clinical rotations appear to be similar to 4-week rotations with respect to patient revisits within 30 days (a measure of patient care) and may decrease burnout and stress among attending physicians on the internal medicine wards, who are training house staff and medical students, according to a new trial. Brian P. Lucas, MD, from the Department of Medicine, Cook County Health and Hospitals System and Rush Medical College, Chicago, Illinois, and colleagues report their findings in an article published in the December 5 issue of JAMA (Hitt, 12/5).

Medscape: ACA Offers 'Golden Opportunity' for Mental Illness Prevention
Implementation of the Affordable Care Act (ACA) will create increased opportunity for mental illness prevention and mental health promotion in the primary care setting. Writing in the December issue of Psychiatric Services, members of the Prevention Committee of the Group for the Advancement of Psychiatry, led by Ruth Shim, MD, MPH, note that provisions of the ACA will shift the US healthcare system to address achieving wellness rather than just treating illness by including improved coverage of preventive services and incentives to integrate and coordinate primary care, mental healthcare, and addiction services, and through the establishment of the National Prevention, Health Promotion, and Public Health Council (Harrison, 12/4).

Medpage Today: Preventive Care At Risk With High-Deductible Health Plans?
Nearly 20% of respondents with a high-deductible health insurance plan delayed or avoided a preventive office visit because of cost, even though preventive care was completely covered, a survey found. One possible reason: only 18.1% of respondents understood that their health plan exempted preventive office visits from deductibles and copays, according to a study published in the December issue of Health Affairs (Pittman, 12/6).

Medpage Today: Sentinel Node Surgery Still Less Likely For Black Women
The rate of sentinel lymph node dissection as the standard of care for node-negative breast cancer has persistently lagged for black women, with negative clinical consequences, a national study showed. Use remained roughly 12 to 14 percentage points lower than among white women throughout the period from 2002 through 2007 as the procedure became established as preferred over completion axillary node dissection, Dalliah M. Black MD, of the University of Texas MD Anderson Cancer Center in Houston, and colleagues found (Phend, 12/6).

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Editorials and Opinions

Viewpoints: Considering Baby Boomers' Future Burden On Medicare; Holtz-Eakin Endorses State Exchanges; The Value (Or Not) Of Mammograms

The New York Times: The Baby Boom Bump
The Congressional Budget Office projects that if current policies continue, total federal spending will rise to 24 percent of gross domestic product in 2022. [Republicans and Washington deficit hawks'] proposed solution is a cap on government spending. ... These plans ignore the simple fact that you cannot repeal the aging of the boomers. The main reason expenditures are rising this decade is that spending on Social Security, Medicare and Medicaid is increasing by a whopping 3.7 percent of G.D.P. as the baby boomers age and retire. This demographic fact also has been driving increases in disability insurance payments as more knees give way and backs give out (Kenneth S. Baer and Jeffrey B. Liebman, 12/6).

The Wall Street Journal: Beneath The Presidential Platitudes
Former Wyoming Sen. Alan Simpson has put fresh emphasis on a major and underlying aspect of our fiscal disputes: It's the yoots versus the coots. The young may not be aware of it, but they'll long bear the tax burden of the entitlement arrangements the old have instituted (Peggy Noonan, 12/6). 

The Washington Post: Health-Care Dominoes
Amid the entitlement mumbo jumbo, raising the eligibility age (for Medicare) is attractive to politicians casting about for savings because it is tangible. It is at the top of the Republican wish list. It was part of the never-consummated deal that House Speaker John Boehner and President Obama crafted last year — although House Minority Leader Nancy Pelosi has declared her opposition. Here’s the wrinkle: This no-brainer turns out to be exceedingly complicated. The savings aren’t as big as you might imagine (Ruth Marcus, 12/6).

The Washington Post: Pelosi: Dems Must Say No To Raising Medicre Eligibility Age
It’s a perennial fear among liberals: In the quest for a fiscal cliff deal, the White House and Democrats will ultimately acquiesce to GOP demands to raise the Medicare eligibility age. But one Democrat is drawing a line against this possibility: Nancy Pelosi. ... It’s unclear how much influence Pelosi will have over any final deal. ... But if tax hikes are in the compromise, there may be major Republican defections, meaning as many as 100 or more House Dems could be needed to pass it. Public statements like the above are meant to signal to the White House what her caucus can accept (Greg Sargent, 12/5).

National Review: Yes To State Exchanges
Already 18 states have decided to leave their exchanges to the federal government, choosing a slippery slope toward precisely what liberal Democrats want: a federally controlled health-care system that would be the first step toward European-style, single-payer health care. Conservatives have an obligation to keep this from happening. Setting up state-based exchanges is an important piece of defense (Douglas Holtz-Eakin, 12/6).

USA Today: Potential ObamaCare Privacy Nightmare
By mid-December, the federal government is planning to quietly enact what could be the largest consolidation of personal data in the history of the republic. ... ObamaCare's federal exchange, however, will be very different from these earlier efforts or emerging private exchanges such as eHealthInsurance.com. In order to determine eligibilty for health insurance subsidies, the new exchange has to bring together information about you and your family from the Treasury Department and IRS, the Department of Homeland Security, the Department of Justice, as well as your Social Security number -- all coordinated by the Department of Health and Human Services (Stephen T. Parente and Paul Howard, 12/6).

The New York Times: Two Important Steps For Women
The version of the National Defense Authorization Act approved this week by the Senate contains two important provisions promoting equitable treatment of women. ... The first provision would end an injustice to women who serve in America’s military. ... it would lift the statutory ban that denies female service members coverage for abortions in cases of rape and incest. Under current law, military health plans pay for abortions only when a pregnancy endangers a woman’s life. ... The other provision offers hope for the Afghan women (12/6).

Los Angeles Times: Appeals Court Puts 1st Amendment Over Public Health
The Food, Drug and Cosmetic Act makes it illegal to sell a prescription drug for any purpose other than what's listed on the label. Nevertheless, a divided federal appeals court this week tossed out the conviction of a former drug sales rep who was recorded pitching a doctor on other uses of a medicine approved by regulators solely to treat the sleep disorder narcolepsy. And here's the kicker: The court ruled that the sales rep had a free-speech right to promote the drug's unapproved uses (David Lazarus, 12/6). 

Kansas City Star: Mammogram Doubts Are Health Care’s Third Rail 
For more than a decade, multiple studies have advanced the argument that routine screening for some forms of cancer doesn’t prevent premature death and may do more harm than good. ... Similar mixed messages have been sounded to men about screenings for prostate cancer. Studies have found that early detection and aggressive treatment of that disease may be unnecessary, ineffective and risky. ... Is it time to rethink the value of preventive screenings, and cut back on the costly diagnosis and treatment options that come with early detection? (Barbara Shelly, 12/6).

The Philadelphia Inquirer: Maternal Mortality Is Getting Worse. We Can Do Better
The U.S. ranks a dismal 50th in maternal mortality – dead last in the developed world and behind numerous other countries, from Turkey and Saudi Arabia. About 1,000 women across the country die each year from pregnancy-related complications, a rate of 14.5 deaths per 100,000 live births in 2007, the most recent data available from the Centers for Disease Control and Prevention (Fischer and Begleiter, 12/7).

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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) 2014 Kaiser Health News. All rights reserved.