Daily Health Policy Report

Wednesday, December 9, 2009

Last updated: Wed, Dec 9

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Administration News

Medicaid

Medicare

Quality

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Democrats' Ideas To Expand Medicare Raise The Hackles Of Doctors, Hospitals, Insurers

Kaiser Health News staff writers Julie Appleby and Mary Agnes Carey write: "Hospitals, doctors and insurers lined up in opposition Tuesday to allowing people under 65 to join Medicare – an idea being debated as Senate negotiators struggle to put together the 60 votes needed to pass sprawling health care legislation" (12/9). Read entire story.

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Report: Recession Doesn't Keep Some States From Expanding Health Coverage

Kaiser Health News staff writer Phil Galewitz writes about the findings of a new report. "Despite the economic downturn that's busting state budgets from Sacramento to Tallahassee, 26 states this year made it easier for low-income children, parents or pregnant women to get health coverage, according to a report released Tuesday by the Kaiser Family Foundation" (12/8). Read entire article.

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Political Cartoon: 'A Christmas Carol?'

Kaiser Health News provides a fresh take on health policy developments with David Fitzsimmons' "A Christmas Carol?"

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Health Reform

Reid Says 'Broad Agreement' On Public Option, Senators Await Details

Coverage of the Senate's "broad agreement" to create a national health insurance plan continues, with Democratic leaders remaining mum on details while insisting the compromise leaves a "public" option in the bill. (See KHN's Tuesday night breaking news round-up). 

The Washington Post: "Democratic Senate negotiators struck a tentative agreement Tuesday night to drop the controversial government-run insurance plan from their overhaul of the health-care system, hoping to remove a last major roadblock preventing the bill from moving to a final vote in the chamber." The Post reports that the deal would allow the government's Office of Personnel Management to negotiate with insurers to create private, national plans much like those available to federal employees. It would also open Medicare to some people 55 to 64 years old (Murray and Montgomery, 12/9).

Kaiser Health News reports that lobbyists for insurers, doctors and hospitals object to the Medicare "buy-in" for some 55-64 year olds, saying that "Medicare already doesn't pay enough. Adding more people would compel hospitals, doctors and others to jack up charges to private insurers and employers to make up the difference, they warned" (Appleby and Carey, 12/9).

Meanwhile, House Majority Leader Steny Hoyer, D-Md., said he believes the plan is "an idea worth consideration," Roll Call reports. "The No. 2 House Democrat couched the assessment by stating he did not want to 'anticipate what is acceptable or not acceptable' in the Senate. But he also pointed to the difficulty of finding 60 Senate votes on a reform package, and he praised Senate Majority Leader Harry Reid's (D-Nev.) 'herculean' efforts to forge consensus" (Newmyer, 12/8).

Meanwhile, Majority Leader Harry Reid, D-Nev., "told reporters that news accounts that the government-run 'public option' had been dropped were 'not true,'" Chicago Tribune reports (Levey and Hook, 12/9).

But a version of the article appearing in the Tribune's sister paper, the Los Angeles Times, quotes a Reid aide as saying, "By and large, it's not a public option, but I think the liberals felt so strongly about getting a bill that allows for comprehensive coverage and meaningful reform, it was worth accepting this." Another concession to liberals in the compromise may be "a mechanism for triggering the creation of a more traditional government-run plan like the one now in the bill, if the nonprofit option does not materialize" (Hook and Levey, 12/9).

CNN: "[L]iberal Sen. Russ Feingold of Wisconsin, one of 10 Democratic senators working on the deal, said in a statement released after Reid's announcement that he would not 'support proposals that would replace the public option in the bill with a purely private approach. We need to have some competition for the insurance industry to keep rates down and save taxpayer dollars,' Feingold said. ... Two senators who oppose a public option, moderate Republican Sen. Olympia Snowe of Maine and independent Sen. Joe Lieberman of Connecticut, said they were open to the non-profit private alternative to a public option" (Bash, Barrett and Henry, 12/9).

The New York Times reports that Reid has not yet briefed colleagues outside of the ten-member negotiating group that came up with the deal. "Even senior members of the party said late Tuesday that they did not know if an agreement had been reached. 'I have no idea,' said Senator Richard J. Durbin of Illinois, the assistant Democratic leader" (Pear and Herszenhorn, 12/8).

One remaining hurdle, according to The Wall Street Journal, is that the plan must get a passing score from the Congressional Budget Office. "Although the public option generated significant dissension among Democrats, the CBO projected that a relatively small number of Americans would use it. It said total enrollment after a decade would be only three million to four million people, in part because the CBO predicted the public option would attract less-healthy employees and charge higher premiums" (Hitt and Adamy, 12/9).

 

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Senate Rejects Abortion Amendment, Sparking More Challenges

The Hill: "The Senate voted against strengthening restrictions for federal funding of abortion Tuesday evening, a development that could imperil Democrats' efforts to pass an underlying healthcare reform bill. Sen. Ben Nelson (D-Neb.), who offered the amendment, had indicated that he could support a Republican filibuster of the healthcare reform bill if the abortion language were not added to it." Senators voted 54-45 to table the measure. Six Democrats voted with Nelson to support the amendment, but they — perhaps unlike Nelson — "are not expected to oppose the healthcare bill as a result of the amendment's failing" (Young, 12/8).

NPR: "The amendment, offered by Sens. Ben Nelson (D-NE) and Orrin Hatch (R-UT), would have made the Senate bill's abortion language nearly identical to that adopted by the House last month. Nelson insisted there was nothing complicated about his plan. 'Our amendment only ensures that where taxpayer money enters the picture, people are not required to pay for other people's abortions,' he said. ... But opponents of Nelson's amendment said it would go much further ... 'What this amendment would do, as I read it, is to prohibit any health insurance plan that accepts a single government subsidy or dollar from providing coverage for any abortion, no matter how necessary that procedure might be for a woman's health, even if she pays for the coverage herself,' said Sen. Dianne Feinstein (D-CA)" (Rovner, 12/8).

The Associated Press reports that Reid urged Democrats to reject the amendment in a speech on the Senate floor, though he opposes abortion himself. Reid "recognized the threat Nelson's amendment posed to the overall bill to expand health coverage to some 30 million uninsured Americans. ... 'This is a health care bill. It's not an abortion bill,' Reid said, carefully reading a prepared speech on the Senate floor. 'We can't afford to miss the big picture'" (Kellman, 12/8).

Roll Call: "'It makes it harder to be supportive' of the health care bill, Nelson said after his amendment was defeated. He added, 'We'll have to see if they can make it easier.'" Nelson said that "losing his abortion amendment 'could' be the determinative factor" in terms of how he votes for the sweeping health bill (Pierce, 12/9).

The Christian Science Monitor: If Nelson now decides not to vote with the Democratic caucus, "Democrats will have to find a Republican to join them (perhaps one of Maine's pro-abortion-rights moderates), which is no small task. … But it's also possible that Nelson could sign on to a compromise over abortion. Earlier on Tuesday, Senate majority leader Harry Reid told reporters that he would work with Nelson on language the Nebraskan would find acceptable" (Feldman, 12/8).

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Reid Continues To Court Moderates For Health Bill Support

Some news organizations are watching how certain key swing senators are reacting to the negotiations on a public option in the health care legislation.

The Hill reports that Republican Sen. Olympia Snowe, of Maine, remains one of the only Republican votes Democrats are trying to secure for reform but that she herself remains skeptical of some plans in the proposal. "Snowe emerged from a meeting in Reid's office Tuesday, telling reporters that she is intrigued by the proposal to have the (Office of Personnel Management), which administers the Federal Employees Health Benefits Program, offer plans on the health insurance exchange that the bill would create. Snowe opposes a public option except a version she introduced, which would 'trigger' the program in states underserved by private insurance." Snowe "shot down" proposals to expand Medicare and Medicaid, however (Young, 12/8).

That hasn't stopped Senate Majority Leader Harry Reid from continuing his pursuit of Snowe, Roll Call reports. "'My deep concern is about the breadth and scale of this legislation — taking it in a more expansionistic approach for the government's role, rather than the reverse,' Snowe said after meeting with Reid. 'At a time in which people are questioning expanding the scale of government's involvement in health care, you can design incentives in this legislation to maximize the power of the marketplace and make sure the industry performs'" (Drucker, 12/9). 

MSNBC reports, in the meantime, that Sen. Joseph Lieberman, I-Conn., says he's "open-minded" about a compromise on the public option in the bill. "Lieberman said the idea of a national insurance plan that mirrors the one offered to members of Congress is 'an idea worth considering' as long as private companies run the program" (Strickland, 12/8).

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House Staffers Mull Strategies To Speed Health Bill Passage

CongressDaily: "Congressional Democrats are laying groundwork that would allow the House to pass the Senate's healthcare overhaul bill without a conference, a move that would avoid additional Senate filibusters and possibly send a bill to President Obama before the end of the year." After a meeting of top Democratic staffers, one aide said "[f]rom a strategic standpoint, the ideal situation is that we do something like [skip the conference]... We'd go into the new year with a major accomplishment. The decks would be cleared, and we can move on to other issues." But four policy differences -- abortion, immigration, the public option,and the Senate's excise tax on expensive insurance plans --  could determine whether the House could muster the votes necessary to pass the Senate bill without additional negotiations (Hunt, 12/8).

Meanwhile, Roll Call reports on how the congressional schedule is shaping up for the new year. "The Senate may be voting until Christmas on the $848 billion health care reform bill, but members won't have to return to until Jan. 19 to begin work in the new year." The official 2010 calendar notes that the Senate will meet Jan. 5 for a pro forma session. "The House is scheduled to return one week earlier than the Senate, with votes expected on Jan. 12"  (Brady, 12/8).

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Polls Show Stable Attitudes On Public Option, Abortion

A Bloomberg poll conducted Dec. 3-7 found, on health care, "about half of poll respondents saying they disapprove of the plans in Congress to overhaul the system. Sixty-two percent of Americans say they are mostly pessimistic they would benefit from [a health-care bill Congress may pass.] The youngest Americans are more optimistic, with 47 percent of those under 35 saying they would benefit." In addition, "Americans are almost evenly split -- 46 percent to 45 percent -- in their support for the proposed government-run health-insurance program known as the public option." The poll had a margin of error of +/- 3.1 percentage points (Przybyla and Johnston, 12/9).

CBS News reports that "Americans' views about the government funding abortions, and about abortion itself, have remained stable for many years." In a CBS News poll conducted last month, more than half of Americans said "that health care reform should not cover abortions, while just 34 percent thought it should. … In 1994, CBS and the New York Times found 53 percent of Americans thought abortion should not be part of any government health care plan. In CBS News Polls conducted in the late 1970s, about half felt the government should not 'help a poor woman with her medical bills if she wants an abortion'" (Dutton, 12/8).

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Fact Check On McConnell's Statement On Medicare Advantage

As part of the NPR series, "Is That So?, fact-checking the health care debate now on the Senate floor," NPR Congressional Correspondent David Welna examines a statement by Republican Minority Leader Mitch McConnell about the Medicare Advantage program (Welna, 12/9).

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'Hidden Nuggets' On Work Breaks And Calorie Counts Added To Health Reform Legislation

USA Today reports that the health care bills moving through Congress have dozens of "lesser-known provisions" that include ideas that failed to gain traction in the past but are benefiting by hitching their proposal to health care reform. Among the ideas: "Companies with 50 or more employees would have to set aside 'reasonable' break times for nursing mothers and create a private space for breastfeeding." Additionally, midwives would be paid the same as doctors for their services under Medicare, and restaurants — even vending machines — with more than 20 locations would have to post nutritional information (Fritze, 12/9).

KHN related coverage, Seven Things You Didn't Know Were In The Senate Health Bill (Carey, Galewitz and McGinley, 11/30).

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Capitol Hill Watch

Aetna Understated Profits, Overhead, Lawmakers Say

Insurers' profits are a lightning rod for reform advocates. Aetna's earnings have now attracted reprimand from Senate Democrats who say the major insurance company overstated it spending on patient care in regulatory filings, minimizing profits and overhead, The Wall Street Journal reports. "The Senate Committee on Commerce, Science and Transportation launched an investigation last summer into the percentage of premiums insurers spend on medical care versus profits and other administrative expenses. That percentage, known in the industry as 'the medical-loss ratio,' is watched closely by detractors who say insurers take too much money from the system in profits. In a statement Monday, the committee said Aetna overstated by $4.9 billion the amount of money it spent on patient care for small businesses. As a result, the insurer's medical-loss ratio for small businesses was 79%, not the 82% Aetna initially reported, it said, drawing attention to a correction that Aetna had made to its filings last week."

Aetna corrected its filings "proactively" in an amended report on Dec. 2. A spokesperson said staff had been alerted to the accounting "errors" and would not repeat the mistake (Johnson, 12/8).

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Drug Makers Attract Scrutiny Over Cost And Ads, But May Benefit From Overhaul

Drug makers came under scrutiny after the AARP published research recently showing their wholesale prices had increased by an average of 9.3 percent during the past year, offsetting the value of rebates the industry promised as part of a health care overhaul to help seniors pay for drugs. The New York Times reports that the study was exhibit A at a House hearing Tuesday, which disintegrated into "many people talking past one another." Republicans accused AARP, the retiree's lobby, of using the report to promote its own interests, while a leading Democrat said drug makers were "playing a shell game" (Wilson, 12/8).

Congress isn't the only branch of government scrutinizing the pharmaceutical companies. The Food and Drug Administration sent "about three dozen" warning letters to drug companies complaining about their advertising practices so far this year, more than a 50 percent increase compared with last year, the St. Louis Post Dispatch reports. One ad suggested an athlete's foot drug, Etaczo, may "Crush," "Kill" and "Destroy" fungus, but the FDA said that "greatly overstated" the drugs effectiveness. That scrutiny has led the companies to pursue laxer regulation for online ads, but Congress instead is considering new curbs to their ad practices (Lambrecht, 12/9).

That's not to say there are no bright patches for pharmaceutical companies in recent politics. Bloomberg reports, "Health-overhaul legislation, now being debated in Congress, would create the first U.S. regulatory process to copy biotech drugs, opening a market worth $10 billion in the next decade." Pfizer, the biggest drug maker, plans to begin capitalizing on that change within five years, a company official said (Pettypiece, 12/9).

Also, drug makers may have a surprise ally in their opposition to legislation that would allow the importation of lower-cost drugs, which could be considered in the Senate Wednesday as part of the overhaul debate, the Associated Press reports. "President Barack Obama's administration is raising safety concerns that could effectively scuttle it, even though Obama backed the plan as a senator. Some import supporters question whether the administration is acting to keep the powerful pharmaceutical industry's support for Obama's effort to overhaul the nation's health care system. An administration official denied that" (Fram, 12/9).

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Administration News

White House Announces $600 Million For Community Health Centers, Medical Records

The White House announced Wednesday it would spend $600 million to build and enhance community health centers and medical records.

The Associated Press: "The administration plans to give almost $509 million to repair, rebuild or replace federally designated community health centers. From coast to coast, the centers serve more than 17 million patients -- about 40 percent of whom have no health insurance. As much as $88 million more will go to health care facilities to transfer their medical records to electronic format and to upgrade technologies, according to figures provided ahead of a scheduled afternoon announcement. ... Obama also asked Health and Human Services Secretary Kathleen Sebelius to begin a three-year trial on how to improve care for Medicare patients at community health centers. The administration anticipates as many as 500 health centers would participate" (Elliott, 12/9).

Reuters/The Washington Post reports that the designated money came from "the $787 billion economic stimulus plan to help create jobs at 85 community health centers. Obama is under heavy pressure to generate job growth in the United States, with the November unemployment rate at 10 percent. ... The funds are expected not only to create new jobs in construction and health care, but also to help provide care for more than 500,000 additional patients in underserved communities, the White House said" (Holland, 12/9).

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Medicaid

Despite Recession, Some States Boosting Insurance Coverage

"Despite the economic downturn that's busting state budgets from Sacramento to Tallahassee, 26 states this year made it easier for low-income children, parents or pregnant women to get health coverage, according to a report released Tuesday by the Kaiser Family Foundation," Kaiser Health News and The Miami Herald report (KHN is a program of the foundation). "But the gains could be fleeting as most were made possible by new federal stimulus dollars, which run out at the end of 2010, along with a requirement that states maintain Medicaid eligibility levels" (Galewitz, 12/8).

Modern Healthcare: "Forty-seven states currently cover children in families with an annual income at or higher than 200% of the federal poverty level ($36,620 for a family of three), with half (24 states) covering children in families with incomes at or greater than 250% of poverty ($45,775 for a family of three), the commission report stated" (Lubell, 12/8).

Mobile, Ala., Press-Register: The report found that "the percentage of uninsured children in Alabama fell by almost half last year, despite rising unemployment and a slumping economy…. The rate dropped from 7.5 percent in 2007 to 4.4 percent in 2008 as two government programs — Medicaid and All Kids — helped compensate for people losing coverage from employer-provided insurance" (Reilly, 12/9).

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Medicare

Medicare To Pay For HIV Testing

Reuters: "Americans enrolled in the U.S. government-run Medicare health insurance program will now be covered for tests that screen for HIV, The Centers for Medicare and Medicaid Services (CMS), which oversees the program for the elderly and disabled, said on Tuesday. The tests to detect the virus that causes AIDS will be covered for Medicare beneficiaries who are at increased risk for the infection, including pregnant women, CMS said, but it added that Medicare participants of any age who voluntarily request the service will also be covered" (Berkrot, 12/8).


 

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Quality

Misuse Of Blood Thinners In Dialysis Patients Reported

Reuters/ABC News reports on research published in the Journal of the American Medical Association that examined the misuse of two blood thinners – Lovenox and Integrilin – in "about 20 percent of kidney dialysis patients who undergo a procedure to open a blocked artery [who] are given the wrong blood clot medicine, increasing the chances of significant bleeding, researchers said Tuesday. They said the findings suggest many doctors in the United States ignore warnings on drug labels, often putting patients at risk of serious harm or death."  The two drugs "are not recommended for use in kidney dialysis patients" (Wilson, 12/8).

U.S. News and World Report/HealthDay: "According to [study author Dr. Thomas] Tsai, this particular type of medicating error may stem from the simple fact that there are so many possible medications for physicians to choose from now. ... Ease of use and convenience may also play a role in doctors' turning to these particular drugs, Tsai said. Meanwhile, the population of people undergoing dialysis is also exploding, and is projected to pass the 2 million mark worldwide by 2010, according to the study" (Gardner, 12/8).

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Public Health & Education

Study Finds One Third Of American Adults Serves As A Caregiver

"A new study says almost one out of three adults in the U.S. currently serves as a caregiver," NPR reports. "The time and energy they put into caregiving becomes like an unpaid job. On average, they spend about 19 hours a week providing care, doing everything from bathing and dressing an elderly parent or loved one to balancing a checkbook or doing household chores."

The survey was sponsored by AARP and the National Alliance for Caregiving, with funding from the MetLife Foundation. Many results "are similar to those from earlier versions in 2004 and 1999. Two-thirds of caregivers are women. The average age is about 48. Almost all -- 86 percent -- care for a relative. Most often, 36 percent of the time, it's for a parent. On average, caregivers have been providing care for 4.6 years, and three in ten report doing so for five years or more" (Shapiro, 12/8).

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State Watch

New York Cuts Drug Reimbursements, States Trim Tobacco Prevention Funding

Crain's New York Business: "Independent New York pharmacies say new state budget cuts will drive more drugstores out of business. Albany's deficit reduction plan calls for $18.5 million in savings from Medicaid and Elderly Pharmaceutical Insurance Coverage (EPIC) pharmacy reimbursement rates. What made those cuts possible was a September federal rule that changed the definition of the Average Wholesale Price, the benchmark used to determine pharmacy reimbursement rates in New York. ... As a result, independent pharmacies will see an almost 4% cut in reimbursement for filling brand-name drug prescriptions for Medicaid, a collective $100 million annual hit, says the Pharmacists Society of the State of New York" (Benson, 12/8).

The Associated Press: "States cut funding for state tobacco prevention programs more than 15 percent this year, pushing it further than ever below federally recommended levels, according to a report that a coalition of public health groups is releasing Wednesday. The states will spend $567.5 million of their own money and $62 million in federal grants on programs to prevent tobacco use -- about 17 percent as much as the $3.7 billion the federal Centers for Disease Control recommends, the report says. Thirty-four states and the District of Columbia trimmed funding for such programs this year. New York cut the most at $25.2 million, or 31 percent, the report said" (Felberbaum, 12/9).

Chicago Tribune: "Skeptics in the mental health community are starting to wonder if the plan to close the Tinley Park Mental Health Center and replace it with a new psychiatric hospital may fall victim to the state's precarious economy. Private hospitals are being asked to sell beds to care for patients now housed at the 51-year-old center, stirring fears that the arrangement could become permanent if the new 100-bed facility is never built. Several hospitals say they aren't staffed or equipped to handle those needing long-term psychiatric care" (Schorsch, 12/9).

The Cleveland Plain Dealer: "In an effort to keep pace with a $1.2 billion expansion and growing number of patients, University Hospitals said Tuesday that it will add more than 550 jobs in the coming year and announced a new management structure. The region's second-largest system, which saw patient volumes increase even in a dismal economic year, is gaining market share and plans to use the staff to add more services for people downtown and in the suburbs. ... Since [UH Chief Executive Tom Zenty] began leading the system in 2003, UH has turned its finances around and is in the final stages of an aggressive growth plan called Vision 2010. The system reported $1.7 billion in total revenues last year and earned $103.7 million after expenses, according to its most recent federal tax filing. Fundraising increased from $50 million in 2007 to $69.7 million in 2008" (Tribble, 12/8).

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Editorials and Opinions

Today's Opinions And Editorials

What My Amendment Won't Do The New York Times
The language in our amendment is completely consistent with the Hyde Amendment, which in the 33 years since its passage has done nothing to inhibit private health insurers from offering abortion coverage. There is no reason to believe that a continuation of this policy would suddenly create undue hardship for the insurance industry — or for those who wish to use their private insurance to pay for an abortion (Rep. Bart Stupak, 12/8).

Will Abortion Derail Healthcare Reform? Los Angeles Times
Whatever the fallout from Nebraska Democrat Ben Nelson's failed attempt to insert new abortion restrictions into the Senate's healthcare package, it appears increasingly likely that reform will be made hostage to this most divisive of issues. In the process, it also appears that America's Catholic bishops, who have supported some form of government health insurance as a fundamental right for nearly a century, are determined to transform themselves into a single-issue constituency. If that occurs, it will constitute a transformation almost as historic as passage of universal healthcare reform (Tim Rutten, 12/9). 

South Florida Is Scam Capital The Miami Herald
Thanks to an aggressive federal push to catch the fraud in medical equipment sales, HIV infusion therapy and fake diabetes treatments, dozens of scammers have been prosecuted the past two years in South Florida. But more can be done, starting with a new Medicare policy in January that will cap payments to home-health agencies treating diabetics to 10 percent of the bill for such services (12/9).

Health Reform's Heavy Lifting The Washington Post
As the Senate weighed whether to proceed to debate on health-care reform, we hoped lawmakers would take up an imperfect measure and improve it. So far they've done one but not the other (12/9).

Cancer Death Rates Are Down, But Watch Out If Breast Cancer Screening Falls Off U.S. News & World Report
The breast-cancer screening saga points to the kind of struggles that will be rampant as comparative-effectiveness studies—whether of mammograms, testing for prostate cancer, or a new drug or procedure for heart failure—are translated into medical decisions by Uncle Sam, who will also be determining what everyone's health insurance will and won't cover. Most of these decisions will be clear, based on good science and a consensus of opinion, but some will struggle in the gray zone where legitimate disagreements can run hot (Bernadine Healy, 12/8).

The Medicaid Nuclear Option The National Review 
Buried amid the bill’s technical gobbledygook are several provisions that, acting in concert, could induce many, if not most, states to terminate their Medicaid programs and stick Uncle Sam with the full cost of providing health care to some 60 million low-income Americans.  (Michael G. Franc, 12/9). 

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Ankita Rao
Marissa Evans

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.