Daily Health Policy Report

Friday, February 1, 2013

Last updated: Fri, Feb 1

KHN Original Reporting & Guest Opinion

Health Reform

Administration News


Health Care Marketplace

Public Health & Education

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Post-Sandy, NYU Langone Has Reopened, But Can It Regain Market Share?

Kaiser Health News staff writer Jenny Gold, working in collaboration with NPR, reports: "As of mid-January, most of NYU is up and running again, including the labor and delivery unit. But the question still looms whether NYU will lose some of the patients and even doctors who sought refuge at NYU's biggest competitors after the storm. If that happens, the storm could end up having a long term impact on NYU's valuable share of the fiercely competitive health care market in New York City" (Gold, 2/1). Read the story.

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Tick, Tock: Administration Misses Some Health Law Deadlines

Kaiser Health News staff writer Phil Galewitz reports: "The programs, slated to take effect Jan. 1, were supposed to increase fees to primary care doctors who treat Medicaid patients, give states more federal funding if they eliminate Medicaid co-pays for preventive services and experiment with changes to how doctors and hospitals are paid by Medicare. The administration also has delayed giving states guidance on a new coverage option known as the 'basic health program,' designed to help low and moderate-income people who don't qualify for Medicaid" (Galewitz, 1/31). Read the story.

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Capsules: State Action Needed To Guarantee Health Law Protections, Says Report

Now on Kaiser Health News’ blog, Julie Appleby reports: "Lawmakers in most states better get busy if they want authority to enforce key provisions of the federal health law that go into effect next year. That's the takeaway message from a report by the Commonwealth Fund showing that only 11 states and the District of Columbia have passed rules needed to implement the law" (Appleby, 2/1). Check out what else is on the blog.

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Political Cartoon: 'Tight Shot?'

Kaiser Health News provides a fresh take on health policy developments with "Tight Shot?" by Joel Pett.

Meanwhile, here is today's health policy haiku:


Entitlement costs –
The super bowl of health care
policy contests?

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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Health Reform

Survey: Few States Have Laws To Enforce Consumer Protections

A report by the Commonwealth Fund finds that 39 states do not have measures to allow officials to enforce some key insurance regulations from the federal health law.

Los Angeles Times: Most States Lack Healthcare Consumer Protection Laws
Nearly 4 out of 5 states have not enacted laws essential to enforcing new consumer protections in President Obama's healthcare law, less than a year before it is supposed to be fully implemented, a new survey indicates. Millions of Americans still stand to benefit in 2014 from protections in the Affordable Care Act, such as a new guarantee that consumers with preexisting medical conditions cannot be denied coverage (Levey, 1/31).

Reuters: Report Warns Of U.S. State Consumer Health Reforms
Only 11 of the 50 U.S. states have moved to implement new consumer safeguards under President Barack Obama's healthcare law, raising questions about how major health insurance reforms will be enforced, a report released on Friday says. The report by the nonpartisan Commonwealth Fund found 39 states have yet to pass laws or issue regulations on seven reforms, including coverage for people with preexisting medical conditions, a ban on coverage waiting periods and limits for out-of-pocket consumer costs (Morgan, 2/1).

Modern Healthcare: Many States Lack Authority On New Insurance Rules: Report
Nearly half of state insurance departments lack the power to fully enforce new insurance regulations that take effect next year under healthcare reform, raising the possibility of federal oversight of the rules when a state fails to do so, according to a newly released report. Twenty-two states surveyed by the Commonwealth Fund have limited or no authority to uphold the new regulations, including a popular provision that prohibits insurers from denying coverage to individuals with existing medical conditions. The report did not list the states and researchers declined to release a list, saying respondents were promised confidentiality (Evans, 2/1).

Kaiser Health News: State Action Needed To Guarantee Health Law Protections, Says Report
Lawmakers in most states better get busy if they want authority to enforce key provisions of the federal health law that go into effect next year. That's the takeaway message from a report by the Commonwealth Fund showing that only 11 states and the District of Columbia have passed rules needed to implement the law (Appleby, 2/1).

Meanwhile, KHN also looks at efforts by the federal government --

Kaiser Health News: Tick, Tock: Administration Misses Some Health Law Deadlines
The programs, slated to take effect Jan. 1, were supposed to increase fees to primary care doctors who treat Medicaid patients, give states more federal funding if they eliminate Medicaid co-pays for preventive services and experiment with changes to how doctors and hospitals are paid by Medicare. The administration also has delayed giving states guidance on a new coverage option known as the 'basic health program,' designed to help low and moderate-income people who don't qualify for Medicaid" (Galewitz, 1/31).

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Debate About Health Law's Medicaid Expansion Is Hot Topic In State Capitols

Lawmakers, officials and health advocates continue to press their policy positions on the pros and cons of expanding the Medicaid program.

MedPage Today: Lawmakers Push For Medicaid Expansion
Senators on Thursday urged governors to expand their Medicaid programs under the Affordable Care Act (ACA) and pushed advocates to lobby states for the same. While many states have already said they will expand to cover individuals essentially up to 138 percent of the federal poverty level, others are still mulling the issue over. "Medicaid expansion is about protecting the most vulnerable Americans at the most vulnerable time of their lives," Sen. Tammy Baldwin (D-Wis.) said Thursday morning at a conference here sponsored by Families USA, a liberal health policy group (Pittman, 1/31).

The Associated Press: Possible Debate Later On Miss. Medicaid Expansion
Democrats in the Mississippi Legislature say they're trying to preserve the option of expanding Medicaid in the state, even though Gov. Phil Bryant and other Republican leaders oppose adding hundreds of thousands more people to the government health insurance for the poor. The Democrats' votes helped kill a bill Thursday that would keep the existing Medicaid program in business beyond July 1. Lawmakers say there are other bills to keep the program alive (Pettus, 1/31).

Related, earlier KHN story: Cracks Appearing In GOP Opposition To Health Law (Galewitz, 1/22).

The Washington Post: Republican Bolling Makes Case For Expanding Medicaid In Va.
Lt. Gov. Bill Bolling on Thursday came out in favor of expanding Virginia's Medicaid program, carving out another position that sets him apart from Gov. Robert F. McDonnell and a Republican rival for governor (Vozzella, 1/31).

The Texas Tribune: Health Advocates Make Case For Medicaid Expansion
Health care advocates flocked to the Capitol on Thursday to urge the Senate Finance Committee to consider the benefits of expanding Medicaid to impoverished adults, restoring funding for family planning services cut last session and encouraging a redesign of the state's health delivery system to help additional disabled and low-income Texans (Aaronson, 1/31).

North Carolina Health News: Legislators Reject State Implementation Of Obamacare
On their first day back in session, North Carolina Senate Republicans introduced a bill yesterday to opt out of several provisions of the federal Affordable Care Act, or Obamacare, scheduled to go into effect next year. Senate Bill 4, introduced by senators Tom Apodaca (R-Henderson), Harry Brown (R-Onslow) and Bob Rucho (R-Mecklenburg), would exempt the state from establishing a state-run health insurance exchange or a federal-state partnership exchange. The bill would also rule out expansion of the state’s Medicaid program (Sisk, 1/31).

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Health Law Counts New Allies, All-Time High Support In Calif.

The battle to win American hearts when it comes to supporting the health law continues as a new organization takes hold, a ranking lawmaker reiterates his intent to defend it and the law finds all-time high support in California.

Politico: The New Campaign: Obamacare For America
Several former White House staffers have found a new way to promote Obamacare: They're spending millions of dollars in secret corporate and union cash, and they're harnessing grass-roots tactics to some of the biggest names in the health care industry. Organizing for Action, the successor to President Barack Obama's presidential campaign, and Enroll America, a group led by two former Obama staffers that features several insurance company bigwigs on its board, are planning to unleash the same grass-roots mobilization and sophisticated micro-targeting tactics seen in the 2012 campaign (Haberkorn and Vogel, 2/1).

Politico: McDermott Won't Retreat On Health Care
In Jim McDermott's ideal world, health reform would have meant a single-payer health care system. But in Jim McDermott's real world, he’ll happily defend President Barack Obama's health care law -- and defend is precisely what he expects to do in his new post as the ranking Democrat on the House Ways and Means Health Subcommittee (Cunningham, 2/1).

Los Angeles Times: Support for Health Care Overhaul Reaches All-Time High In New Poll
Support for President Obama's health care overhaul is at an all-time high in California, according to a new poll from the Public Policy Institute of California. The survey, released Wednesday, found that 55 percent of Californians back the changes to the nation's health care system under the federal Affordable Care Act, up 8 percentage points since last March (Mishak, 1/31).

The fight over health care also continues in the states, where Virginia lawmakers are criticizing the state's attorney general --

The Associated Press/Washington Post: Democrats Criticize Cuccinelli For Comments In His Book On Medicare, Social Security
Democratic lawmakers on Thursday denounced Republican Attorney General Ken Cuccinelli’s remarks in his new book about government programs like Medicare and Social Security. The gubernatorial candidate’s book, "The Last Line of Defense: The New Fight for American Liberty," will be released Feb. 12. But according to media reports on excerpts from the book, Cuccinelli writes that politicians bolster their power by creating benefits that make people dependent on the government (1/31).

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Administration News

Sperling: Obama 2014 Budget Won't Cut Medicaid

White House economics adviser Gene Sperling also told a gathering at a conference sponsored by Families USA that GOP efforts to transform the program into a block grant would be an "attack."

CQ Healthbeat: Sperling Says Obama Budget Proposal Won't Cut Medicaid
White House economics adviser Gene Sperling told a gathering of left-leaning activists Thursday that President Barack Obama's fiscal 2014 budget proposal would not cut Medicaid even though the administration put as much as $100 billion in such reductions on the table during the recent deficit reduction negotiations. But that decision means "we're going to have to look harder for Medicare savings," he warned (Reichard, 1/31).

Medpage Today: Medicaid: Cut Cost Not Benefits
Reducing overall health care costs -- and not cutting benefits -- is the way to address rising spending on entitlement programs, a senior White House adviser said Thursday. Gene Sperling, director of the National Economic Council and assistant to the president for economic policy, slammed efforts to change Medicaid, addressing advocates at a conference here sponsored by Families USA, a liberal health policy group. "The right answer and the best answer for reducing entitlement savings is to reduce the cost of health care in a way that does not compromise quality," Sperling said. The economic adviser specifically mentioned Republican efforts to transform Medicaid into a block grant program -- a move the GOP says would cut Medicaid spending by about a third -- as one effort to attack Medicaid (Pittman, 1/31).

The Hill: White House Vow On Medicaid Wins Praise
President Obama's top economic adviser said that the White House will accept a fight on Medicare in order to protect Medicaid from cuts — a promise that is winning fast praise from advocates for the low-income health insurance program. Gene Sperling made the remark Thursday at a conference organized by Families USA, a liberal advocacy group, saying that even Medicaid cuts endorsed by the administration in the past will no longer be on the table as a series of fiscal deadlines approach (Viebeck, 1/31).

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CMS OKs Applications For Bundled Payment Initiative

The initiative is designed to test whether this payment model will lower costs without undermining the quality of care.

Modern Healthcare: More Than 450 Provider Organizations Joint Payment-Bundling Initiative
The CMS on Thursday announced that more than 450 health care organizations will participate in the Bundled Payments for Care Improvement initiative, a payment model program created in the health care reform law to test whether bundling payments for services in a single episode of care can improve quality and lower costs. Those selected organizations represent a wide range of healthcare providers -- including not-for-profit and for-profit hospitals, academic medical centers, physician-owned facilities and post-acute providers -- that were chosen by the CMS either as awardees for Model 1 starting in April, or as participants for the first phase of models 2, 3 and 4 that begins with Thursday's announcement (Zigmond, 1/31).

CQ Healthbeat: Federal Officials Approve Applications For Bundled Payment Initiative
More than 500 health care organizations will participate in the Department of Health and Human Services' bundled payments initiative, the agency announced Thursday. This effort will test whether paying groups of providers a lump sum for a patient's treatment will lower costs without undermining the quality of care (Adams, 1/31).

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Health Care Marketplace

Overbilling And Out-Of-Network Care Contribute To Marketplace Tension

News outlets examine what providers charge for surgical care.

The New York Times: Report Faults High Fees For Out-Of-Network Care
Though he was living on $18,000 a year as a graduate student, [Angel] Gonzalez had good insurance and the hospital, St. Charles in Port Jefferson, N.Y., was in his network. But the surgeon who came in to remove Mr. Gonzalez’s gallbladder that Sunday night was not. He billed Mr. Gonzalez $30,000, and an assistant billed an additional $30,000. ... A health insurance industry report to be released on Friday highlights the exorbitant fees charged by some doctors to out-of-network patients like Mr. Gonzalez. The report, by America's Health Insurance Plans, or AHIP, contrasts some of the highest bills charged by non-network providers in 30 states with Medicare rates for the same services. Some of the charges, the insurers assert, are 30, 40 or nearly 100 times greater than Medicare rates (Rabin, 1/31).

Meanwhile --

Los Angeles Times: Small Surgeries, Huge Markups
Nationwide, some insurers have begun to challenge these bills from outpatient centers. Last year, a unit of insurance giant Aetna Inc. sued several surgery centers in Northern California and accused them of overbilling the insurer more than $20 million. It has pursued similar actions against providers in New Jersey and Texas. Other insurers such as UnitedHealth Group Inc. have filed similar suits in California (Terhune, 1/31).

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Facing A 'Transition Year,' Aetna's Fourth-Quarter Profits Are Halved

The insurer's net income dropped 49 percent as higher medical costs squeezed the profit margin for the insurer.

The Wall Street Journal: Aetna's Profit Is Halved On Charges, Higher Costs
This will be something of a transition year for managed-care firms as they gear up for major changes under the health-care overhaul law that start in 2014, such as expanded coverage to millions of Americans through state-based exchanges and an extended Medicaid program. Aetna is also working toward closing on the purchase of Coventry Health Care Inc. through a cash-and-stock deal that was valued at $5.7 billion when it was announced in August (Kamp, 1/31).

The Associated Press: Aetna's 4thQ Profit Sinks 49 Pct, Medical Costs Climb
Aetna's fourth-quarter net income sank 49 percent as higher medical costs squeezed profitability for the insurer's commercial health coverage, and several one-time expenses chipped away at the bottom line. The Hartford, Conn., company said Thursday the amount it paid in medical claims grew more than 9 percent in the quarter to $6.12 billion as a rise in flu-related expenses countered a drop in use when Superstorm Sandy swept up the East Coast last fall. ... Aetna officials said their medical costs also climbed in the final quarter of 2012 because employer-sponsored health insurance coverage is changing (Murphy, 1/31).

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Health Sector Emerges As Major New Jobs Creator

National Journal: You Can Thank The Health Care Industry For The Economic Recovery
Since the recession hit in late 2007, a huge proportion of the new jobs have been in the health sector—hospitals, doctors’ offices and nursing homes. All along, those jobs have been rising at a steady clip, while jobs in all other sectors have seen more dismal performance. ... If health care jobs had just held steady, the unemployment rate would be a full point higher. If they had taken a dive with the rest of the economy, the current unemployment rate would be 10.8 percent, according to an analysis from the Altarum Institute, which track health employment trends (Sanger-Katz, 1/31).

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Experts Contemplate Whether Medicare Should Pay For Alzheimer's Test

Also in the news, AstraZeneca and Bristol-Myers Squibb step up their diabetes-drug partnership.

NPR: Should Medicare Pay For Alzheimer's Scans?
Researchers have embraced the drug as a tool to gauge these so-called amyloid plaques in the brain. They've already found that amyloid shows up years before people start having problems with memory or thinking. But is the test appropriate for widespread clinical use? A panel of advisers grappled with that question Wednesday at a public meeting to consider whether Medicare should pay for the test (Hensley, 1/31).

The Wall Street Journal: AstraZenaca, Bristol-Myers Deepen Diabetes Alliance
AstraZeneca PLC and Bristol-Myers Squibb Co. have deepened their diabetes-drug partnership by merging their diabetes marketing teams and moving them to a new U.S. headquarters separate from either company, AstraZeneca's new chief executive, Pascal Soriot, said in an interview (Whalen and Hodgson, 1/31).

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Public Health & Education

Mental Health Efforts In Gun Debate Are Raising Concerns

Some advocates worry that a new focus on mental health issues could lead to unfair assumptions about patients and could keep them from seeking help.

The New York Times: Focus On Mental Health Laws To Curb Violence Is Unfair, Some Say
Legislation to revise existing mental health laws is under consideration in at least a half-dozen states, ... President Obama has ordered "a national dialogue" on mental health, and a variety of bills addressing mental health issues are percolating on Capitol Hill. But critics say that this focus unfairly singles out people with serious mental illness, who studies indicate are involved in only about 4 percent of violent crimes and are 11 or more times as likely than the general population to be the victims of violent crime. And many proposals ... are rushed in execution and unlikely to repair a broken mental health system, some experts say (Goode and Healy, 1/31).

Los Angeles Times: Survey Finds Strong Support For Gun Control, More Mental Healthcare
New survey results published Thursday by the New England Journal of Medicine show that a majority of Americans -- gun owners and non-owners alike -- support stricter measures to keep handguns from people under 21 and to block ownership of any guns for 10 years by those who have perpetrated domestic violence ... But a murkier picture emerged when Americans were asked about keeping guns out of the hands of those with mental illness. Almost 70% of respondents supported greater government spending and insurance coverage for mental healthcare as a means of averting gun violence. But fear and suspicion of those with mental illness were also strongly evident (Healy, 1/31).

The Huffington Post: Mental Health Solutions Alone Can't Thwart Gun Violence, Experts Say
But public health and firearms experts assert that focusing on mental illness is unlikely to achieve a significant reduction in gun violence, because the vast majority of shootings are the handiwork of people who do not fit the profile of those deemed dangerous. Moreover, by shifting the debate away from gun control and toward mental health concerns, proponents run the risk of further stigmatizing mental illness, discouraging those who confront it from seeking professional help (Young, 2/1).

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State Watch

Ark., Ga. Latest To Ponder Medicaid Budget Shortfalls, Solutions

Arkansas and Georgia are the latest to debate the cost of Medicaid to their budget bottom lines -- and possible solutions.

The Associated Press: Arkansas Lowers Medicaid Shortfall Projection To $61M
Arkansas Medicaid officials said Thursday they're no longer proposing cuts to nursing home care and three other areas after lowering the projected shortfall the program faces next year to $61 million. The Department of Human Services, which last year had detailed $138 million in cuts Medicaid faced in the budget that begins July 1 because of a deficit, lowered the estimate after the program's costs came in $21 million under budget for the first half of the current fiscal year (1/31).

Atlanta Journal Constitution: Georgia House To Debate Hospital Tax Bill Friday
A bill extending a controversial fee on hospitals that props up the state's Medicaid program could receive final passage Friday. The House will consider Senate Bill 24, which would give the state's community health agency power to levy the fee, commonly called the "bed tax." The fee helps the state fill a nearly $700 million hole in the Medicaid budget. Not passing the bill, supporters say, would limit access to critical care for thousands of Georgians. Anti-tax activists see the fee as tantamount to a tax increase, but even lawmakers who loathe extending or creating taxes say ending the fee would deal a devastating blow to Georgia’s health care system (Sheinin, 1/31).

In the meantime, an audit of North Carolina's Medicaid program has the governor there calling the system "broken" --

North Carolina Health News: Medicaid Audit Finds Overruns, Governor Calls Program 'Broken'
North Carolina's Medicaid program has been plagued by cost overruns and poor budget projections, and the program needs to be fixed before the state can consider expanding it, Gov. Pat McCrory told reporters at a press conference Thursday morning. McCrory said that even before he took the oath of office, he had asked State Auditor Beth Wood to review expenditures in the program that provides health care for low-income children, seniors, people with disabilities and pregnant women (Hoban, 2/1).

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Battles Over Availability and Coverage Of Abortion Move To States

States are the arena for new abortion battles -- both the fight over their availability and coverage of them by state and private insurance. In the meantime, new legislation on the procedure is winding through the Washington state and Arkansas legislatures.

Politico: Abortion Coverage: The New Battleground For States
Conservative states may have lost their bid to kill Obamacare, but they're winning the battle on another front: abortion coverage. At least 20 states have banned or restricted the coverage of abortion procedures -- including coverage in private insurance plans -- revealing a new battleground in the arduous task of carrying out the controversial national health care law (Smith, 1/31).

The Associated Press/Washington Post: Arkansas Senate Passes Legislation That Would Ban Abortions As Early As 6 Weeks Into Pregnancy
The Arkansas Senate voted Thursday to prohibit most abortions if a heartbeat is detected, ignoring warnings from opponents that banning the procedure as early as six weeks into a pregnancy would invite lawsuits. If enacted, the ban would be the most stringent in the nation. The Ohio House passed a similar ban in 2011, but it was sidelined in the Senate last year over concerns that it might be found unconstitutional. Democratic Gov. Mike Beebe told reporters Thursday that’s the same concern that he’s researching (1/31).

The Associated Press: Abortion Insurance Bill Creates Wash. State Debate
Abortion rights supporters and opponents packed a Washington state House hearing Thursday and debated a measure that would require insurers to pay for the procedure. Supporters call the bill the Reproductive Parity Act and say it's intended to preserve existing abortion coverage once new health insurance rules come into effect under the federal health care law (Kaminsky, 1/31).

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State Highlights: Milwaukee County Board Considers Dropping Employee Coverage

A selection of health policy stories from California, New York, Texas, Minnesota, Florida and Wisconsin.

MPR News: Mayo Clinic Seeks State Help For Rochester Expansion (Audio)
The Mayo Clinic is proposing more than $5 billion in investments in and around Rochester as part of an ambitious expansion plan to create what the clinic calls a "Destination Medical Center." Included in that plan is a request for more than $500 million in state taxpayer money to help fund infrastructure as the Mayo grows. Mayo claims the plan would create between 35,000 and 45,000 new jobs. Mayo is already Minnesota's largest private employer with 32,000 employees in the state (1/31).

The Texas Tribune: Bill Would Clarify End-Of-Life Treatment
Sen. Robert Deuell, R-Greenville, filed legislation Thursday that provides clarification to Texas' Advanced Directives Act, which sets out the end-of-life care for patients. Deuell's bill adds language that specifically addresses patients "for whom life-sustaining treatment would be medically inappropriate and ineffective," Dr. Arlo Weltge said. It also sets out a longer timeline for notifications and an appeals process for families or surrogates of terminally ill patients who disagree with the patient or the doctor's wishes for treatment (Schneider, 1/31).

Milwaukee Journal Sentinel: Milwaukee County Board Panel Sidetracks Proposal To Consider Dropping Health Insurance
Milwaukee County supervisors Thursday sidetracked a request for a staff report on the potential for savings if the county dropped its employee health insurance and instead encouraged workers to obtain their own coverage under provisions of the new federal health care law. In calling for the study, Supervisor Deanna Alexander noted the county faces a long-term funding gap and a looming crisis in transportation funding. She said the county could save up to $103.5 million in health insurance costs if it stopped providing health insurance and paid the $2,000 per employee penalty that would be assessed under the Patient Protection and Affordable Care Act (Schultze, 1/31).

California Healthline: How Might Immgration Reform Influence Health Care Reform?
Immigrants -- both those who are documented and those who are not -- are less likely to have health insurance than their U.S.-born counterparts. Almost half the documented immigrants in the U.S. do not have health coverage, according to 2011 Employee Benefit Research Institute statistics. In California, which has one of the country's largest immigrant populations, immigration policies influence health care policies. Some contend that health care policies influence immigration. We asked policymakers, immigration experts and consumer advocates how immigration reform might influence health care reform in California (1/31).

Kaiser Health News: NYU Langone Has Reopened, But Can It Regain Market Share?
As of mid-January, most of NYU is up and running again, including the labor and delivery unit. But the question still looms whether NYU will lose some of the patients and even doctors who sought refuge at NYU's biggest competitors after the storm. If that happens, the storm could end up having a long term impact on NYU's valuable share of the fiercely competitive health care market in New York City (Gold, 2/1).

Los Angeles Times: Glendale Memorial Hospital Employees Protest Planned Layoffs
Nurses, technicians and other employees gathered outside Glendale Memorial Hospital on Thursday morning to protest planned layoffs. The hospital last week announced plans to lay off an undetermined number of employees, citing an increase in the number of uninsured patients caused by the lengthy economic recession and cuts in government insurance programs (Wells, 1/31).

San Francisco Chronicle: Dental Clinic Proves Importance Of Care
Jabari Kelly showed up at San Francisco General Hospital's dental clinic last Friday looking like he was hiding a golf ball in his left cheek. He had been in pain for three weeks. The 36-year-old San Francisco man had an infected wisdom tooth, and swelling had spread into his jaw and cheek. A few more days, he was told, and the infection could have advanced below his chin, possibly restricting his breathing. "You've got 32 teeth -- each one can kill you," said Dr. Newton Gordon, a dentist and UCSF School of Dentistry professor. Kelly lacks dental insurance and said he had not been to a dentist in two years. His dental problems were more extreme than most, but they illustrate the importance of preventive dental care and the larger ties between dental health and overall health (Joseph, 1/31).

MPR News: Webcam Connect Pharmacists To Immobile Minn. Seniors
Virtual visits with pharmacists may become more common under the federal health care overhaul. For some seniors, getting out to see a pharmacist can be difficult in good weather and treacherous during Minnesota winters. But it's an essential trip for many; prescription drugs can keep serious illnesses in check, if they're taken as prescribed and managed effectively. … Ensuring that patients take their medicine correctly can keep chronic health problems from spiraling out of control and into emergency rooms, intensive care units or worse. Reducing preventable hospital re-admissions is a key strategy to containing costs in the federal health care law (Stawicki, 1/31).

MPR News: Report: Minn. Medical Errors Hold Steady, But Some Improvements Seen
Minnesota hospitals and surgical centers had about as many serious medical errors in 2012 as they did the year before, but there's still some hard-won improvements among the mistakes. That's according to the 9th-annual "Adverse Health Events in Minnesota," a study published by the state's Department of Health, summarizing the mandatory reports of serious injuries and deaths suffered by patients in medical facilities. The state summary was released Thursday morning. Care providers reported 314 adverse events in 2012, down slightly from 316 the year before, and about the same as the 310 reported in 2010. The errors led to 89 serious injuries and 14 deaths last year, up from five deaths in 2011 (Nelson, 1/31).

Miami Herald: Report Shows Health Concerns In Broward's Black Communities
A swath of low-income communities wedged between Interstate 95 and the turnpike, and stretching from Fort Lauderdale to Lauderdale Lakes and Lauderhill, is home to the highest diabetes rates in Broward County. That's one of the most troubling findings from a "state of black Broward health report"’ released Thursday by the Urban League of Broward County (Burch, 1/31).

MinnPost: Dayton’s Human Services Budget Drawing General Enthusiasm From Health Care Legislators
Lawmakers across a broad political spectrum have praised Gov. Mark Dayton’s human services budget --  nearly a third of state expenditures -- even if they haven't had an opportunity to fully digest the dense spreadsheets yet. Health and Human Services committees in both chambers are plodding through the complicated budget proposal with the help of Dayton administration officials this week (Nord, 1/31).

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Health Policy Research

Research Roundup: Concerns About Ambulance Diversions

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

Annals Of Emergency Medicine: The Effect Of An Ambulance Diversion Ban On Emergency Department Length Of Stay And Ambulance Turnaround Time – Hospitals across the United States routinely turn away ambulances to relieve overcrowding, but the practice remains controversial. Researchers in this study aimed to identify the impact of Massachusetts' 2009 ambulance diversion ban. The authors found an overall increase of 3.6 percent in patient volume but no evidence suggesting an increase in the length of stay for admitted patients. They also reported a small decrease in ambulance turnaround time. They conclude: "Our findings support the anecdotal reports of the ban’s success and are consistent with existing literature that diversion is not an effective means to mitigate ED crowding" (Burke et al., 1/25). 

The Kaiser Commission On Medicaid and the Uninsured/Kaiser Family Foundation: Implementation of Affordable Care Act Provisions to Improve Nursing Home Transparency, Care Quality, and Abuse Prevention – According to the authors, the federal health overhaul is "the first comprehensive legislation" since the Nursing Home Reform Act of 1987 to expand Medicare and Medicaid quality measures for nursing homes and improve government oversight. "The ACA incorporates the Nursing Home Transparency and Improvement Act of 2009, introduced because complex ownership, management, and financing structures were inhibiting regulators' ability to hold providers accountable for compliance with federal requirements. The ACA also incorporates the Elder Justice Act and the Patient Safety and Abuse Prevention Act, which include provisions to protect long-term care recipients from abuse and other crimes," according to a synopsis of the issue paper (Wells and Harrington, 1/30). 

Health Affairs: Federally Facilitated Exchanges
The author writes: "As of the publication date of this brief, 25 states have decided not to establish and run their own exchanges. The result is that the federal government will now have a major role in expanding insurance coverage in the individual and small-business insurance markets in at least half the states. This policy brief explores the issues now arising as the federally facilitated exchanges are being shaped. ... much remains in flux. ... Clearly, HHS will continue to face challenges in planning and implementing federally facilitated exchanges ahead of the October 2013 open enrollment deadline. A separate set of challenges will arise in the creation of partnership exchanges, and there is also the possibility that a federal exchange will evolve, as authorized under the law (Goodell, 1/31).

Center On Budget And Policy Priorities: The Relationship Between SNAP And Work Among Low-Income Households – The Supplemental Nutrition Assistance Program (SNAP), formerly known as the Food Stamp Program, offers financial assistance to millions of eligible low-income individuals and families to lessen the burden of hunger and malnutrition. "The program's success in meeting this core goal has been well documented," the author writes. She adds that "[l]ess well understood is the fact that the program has become quite effective in supporting work and that its performance in this area has improved substantially in recent years," and notes: "Most SNAP participants are either not expected to work or are working.... almost 70 percent (68 percent) of SNAP recipients were not expected to work because they were children, elderly, disabled, or were caring for a disabled family member in their home or for a child under six where another household member was working" (Rosenbaum, 1/29).

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

The Washington Post: Surprise! We Don't Know If Half Our Medical Treatments Work
Clinical Evidence, a project of the British Medical Journal, recently combed through the 3,000 medical treatments that have been studied in controlled, randomized studies. They found, for half of those, we have no idea how well they work (h/t Austin Frakt) ... There are specific bodies dedicated to figuring out whether these 1,500 treatments actually work. That includes the Patient Centered Outcomes Research Institute, or PCORI, which was created by the health-care law to study comparative effectiveness research (Kliff, 1/24).

MedPage Today: Intervention Cut Use of Possibly Unsafe Drugs
Educating physicians on potentially inappropriate medications lowered prescription of such drugs to seniors by nearly a third in 3 years, a proof-of-concept study showed. Exposure to potentially inappropriate medications dropped in those 65 and older from 7.8% at baseline to 5.3% after general practitioners (GPs) in Italy received information on prescribing for older patients (P<0.001), according to the study, published in the December issue of the journal Drugs & Aging (Pittman, 1/24).

Politico Pro: Study: Few Switch Health Plans To Save Money
The majority of people getting coverage from work stuck with their plan — although many of them had no choice of plans at work. Just one in eight, or 12.8 percent, switched plans in 2010, and of those people, most switched because of a job change or changes in their employer’s benefit offerings. Fewer than 3 percent switched in search of lower costs or better care, research released Thursday by the National Institute for Health Care Reform finds. ... But employees have limited options. Only 15 percent of workers had three or more choices while more than half receive just one option from their employer, the study found (McIntyre, 1/31).

MedPage Today: Much Fiction Found In Obesity Reporting
Press reports and scientific writing on dieting, weight gain, and obesity are burdened by false or unproven claims, a literature review found. A search of popular media and scientific literature showed seven myths and six presumptions about obesity were prevalent in text, mostly related to false or unsupported claims about caloric intake or expenditure and dieting, as well as breast feeding, environment, and types of food eaten, according to David Allison, PhD, of the University of Alabama at Birmingham, and colleagues. ... Myths addressed related to weight loss included the idea that small sustained changes in energy intake or expenditure produce longer-term weight changes; that realistic goal setting leading to fewer frustrated attempted weight-losers; that rapid loss of great weight was associated with poorer long-term weight loss compared with gradual weight loss; and that diet readiness was an important element of weight-loss success. The authors also pointed out other myths, including the usefulness of play in physical-education classes in weight loss, breast feeding as protection against obesity, and sexual activity as a 100-to-300-calorie-burning activity (Petrochko, 1/30).

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Editorials and Opinions

Viewpoints: Health Law's 'Implausible' Foundations; 4 Needed Health Reforms; Sunlight On Drugmaker Payments To Doctors

The Wall Street Journal: ObamaCare's Broken Promises
As the federal government moves forward to implement President Obama's Affordable Care Act, the Department of Health and Human Services is slated to spend millions of dollars promoting the unpopular legislation. In the face of this publicity blitz, it is worth remembering that the law was originally sold largely on four grounds—all of which have become increasingly implausible (Daniel P. Kessler, 1/31).

Politico: Checking The Vitals Of Health Reform
Real reform means replacing the Sustainable Growth Rate payment formula and transitioning Medicare away from fee-for-service toward value-based payment. After all, if Medicare, the largest payer, continues to reimburse most providers for quantity not quality, there is little hope that federal accountable care initiatives or private-sector innovators can successfully tame cost growth. Real reform means harnessing competition to drive down prices for drugs, medical equipment and other services. ... Real reform means engaging consumers in their own health and health care choices. ... Finally, real reform looks beyond federal programs to scrutinize increasingly uncompetitive private-sector hospital markets (David Durenberger, 1/31).

Los Angeles Times: In The Dark On Doctor Perks
Though few patients realize it, many doctors receive thousands of dollars from pharmaceutical companies for each patient enrolled in an experimental drug trial. The medication might be the best thing for the patient's condition. The doctor's motives might be pure. But patients should be able to find out about such payments so they can discuss them with their doctors and decide for themselves whether the doctor's participation in an experiment might compromise his medical advice (2/1).

The New York Times' Economix Blog: Measuring The 'Quality' Of Health Care
It is, to be sure, challenging to measure the quality of any human-service sectors, be it health care, education, the administration of the law or even corporate management. That is why anecdotes and word of mouth remain important signals that attract or repel individuals from particular products or institutions (Uwe E.Reinhardt, 2/1). 

The Washington Post: The Sequester We Need
The Post reports that the odds are increasing — perhaps to the point of near certainty — that the so-called "sequester" will take effect March 1. ... With hindsight, the sequester's failure to compel consensus seems understandable. For Republicans, the sequester guarantees spending reductions — even if many abhor the defense cuts — and avoids tax increases. Democrats may dislike the domestic cuts, but they also know that the biggest social programs are off the table — Social Security, Medicaid and most of Medicare (Medicare is subject to a 2 percent cut, but all of that would come from lower payment rates to doctors, hospitals and other providers) (Robert J. Samuelson, 1/31).

Politico: Most Liberals Still Oppose Benefit Cuts
Reading POLITICO's recent coverage of the budget debate, you’d think that nearly all liberals support Social Security and Medicare benefit cuts. In reality, liberal groups that support benefit cuts, such as the chained Consumer Price Index, are in the minority (Nancy J. Altman and Eric Kingson, 1/31).

The New York Times: Treatment, Not Jail, For The Mentally Ill
Mayor Michael Bloomberg has started an important new corrections initiative focused on mentally ill offenders, who make up about a third of the city’s jail population and are more likely than other prisoners to resume criminal behavior once they are freed. The aim is to give the courts up-to-date information about a defendant’s record and mental health status so that a judge can decide whether the defendant should be sent to a treatment program instead of jail (1/31).

HealthyCal: Is The ACA The Road To Semi-Single Payer
The Wall Street Journal has an interesting, and important, story on how some unions that supported the Affordable Care Act are now wary about how it will affect them once it is fully implemented. At issue is whether workers who get their health care through unions will be eligible for the same subsidies that are available for lower-income people who will get their insurance through the new health exchanges, or Covered California here (Weintraub, 1/31).

Fox News: Plan B Vending Machines: Irresponsible And Just Crazy
I am shocked that a vending machine selling Plan B is available at Shippensburg University's health center.  And one of the main reasons of placing it there? Because a survey of the student body found that many of them thought it would be good to have. People tend to forget that this is a medication, and therefore, it should be treated with the same respect that all medications deserve.  With Plan B, there needs to be proper indication, timing and the ability by the consumer to ask a pharmacist any questions regarding its safety. Putting a couple of dollars into a machine and receiving this medication so easily is unethical and crazy to me (Dr. Manny Alvarez, 1/30).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.