Daily Health Policy Report

Monday, February 11, 2013

Last updated: Mon, Feb 11

KHN Original Reporting & Guest Opinion

Health Reform

Health Spending And Fiscal Battles

Capitol Hill Watch


Health Information Technology

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

FAQ On Medicare Doctor Pay: Why Is It So Hard To Fix?

Kaiser Health News staff writer Mary Agnes Carey reports: "While physicians have sidestepped drastic Medicare payment cuts for 2013, doctors' groups and lawmakers are gearing up for yet another battle to scrap the formula that forces Congress to consider the 'doc fix' on a yearly basis. For doctors, the nail-biter has become a familiar but frustrating rite. Lawmakers invariably defer the cuts prescribed by a 1997 reimbursement formula, which everyone agrees is broken beyond repair. But the deferrals are always temporary due to the difficulty of finding offsetting cuts to pay for a permanent fix. In 2010, Congress delayed scheduled cuts five times, with the longest patch lasting one year" (Carey, 2/10). Read the story.

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Medicaid Transformation Watched Closely In Florida

WFSU's Lynn Hatter, working in partnership with Kaiser Health News and NPR, reports: "This week the federal government signed off on the first part of a plan that could eventually steer more than 3 million low-income Floridians on Medicaid into a managed care, or HMO system. The decision comes two years after Florida lawmakers approved the conversion in an attempt to control costs in the $21 billion program" (Hatter, 2/8). Read the story.

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Capsules: Feds Blame Mississippi Governor For Exchange Denial

Now on Kaiser Health News' blog, Phil Galewitz reports: "One, Mississippi has become No, Mississippi. The Obama administration on Friday offered an explanation for why it rejected Mississippi's bid to establish a state-based online health insurance marketplace, called One, Mississippi. In a letter, the federal government's top exchange official said they had no choice because Gov. Phil Bryant would not allow the exchange to work with Medicaid and other agencies under his control" (Galewitz, 2/8). Check out what else is on the blog.

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Letters To The Editor: Readers' Thoughts On Issues Related To Hospice Care, Mental Health Provisions Of The President's Gun Plan

Here's a selection of reader responses to Kaiser Health News' stories, including one about a federal investigation into San Diego Hospice as well as another detailing the mental health provisions included in President Barack Obama's gun plan (2/8).

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Political Cartoon: 'Bedside Manner?'

Kaiser Health News provides a fresh take on health policy developments with "Bedside Manner?" by Jeff Parker.

Meanwhile, here is today's health policy haiku:


Mississippi's hope
to run its own exchange dashed.
Will state, feds partner?

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

In Some States, Opposition To Medicaid Expansion Leading Employers To Brace For Higher Health Care Costs

The Wall Street Journal reports on this trend. Meanwhile, other news outlets report on state-specific developments regarding the debates over expanding the health program for low-income people.

The Wall Street Journal: In Medicaid, A New Health-Care Fight
Employers in several states are bracing for higher health-care costs as some governors, worried about the impact on state budgets from the federal overhaul, resist a planned Medicaid expansion (Radnofsky, 2/10).

Kaiser Health News: Medicaid Transformation Watched Closely In Florida
This week the federal government signed off on the first part of a plan that could eventually steer more than 3 million low-income Floridians on Medicaid into a managed care, or HMO system. The decision comes two years after Florida lawmakers approved the conversion in an attempt to control costs in the $21 billion program (Hatter, 2/8).

Stateline: Seizing Medicaid Expansion As A Means to Reform
Just two states have governors who are physicians. Democrat John Kitzhaber of Oregon is an emergency room doctor. Republican Robert Bentley of Alabama is a dermatologist. Their states may have little in common, but the medically trained governors have embraced similar Medicaid reforms (Vestal, 2/11).

The Associated Press: NY Hopes To Add 500,000 Residents To Medicaid
With New York's Medicaid coverage already broader than federal law requires, the state expects to add about 75,000 more people to the program next year under the health care overhaul, plus another 425,000 who are already eligible but don't know it. Medicaid, the government health insurance program for the poor, currently covers 5.1 million New Yorkers, more than one-fourth of the state's residents (Virtanen, 2/10).

San Francisco Chronicle: Health Care Topic Of CA Special Session
California leaders are getting ready to consider legislation to expand health insurance coverage to millions of uninsured state residents as the start date of the federal Affordable Care Act moves closer. The act was signed into law by President Obama in 2010, but California must still pass bills to expand its Medicaid program, known as Medi-Cal, for more than 1 million new people and set the rules that the insurance industry must follow when individuals begin to purchase medical insurance through an open market exchange. Starting next week, lawmakers at the Capitol will hold hearings on bills that will help California set the stage for Obamacare (Buchanan, 2/10).

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Feds Encourage Mississippi To Pursue Health Exchange Partnership

Also, cost issues spark disagreement in Minnesota as the state Senate continues to weigh action related to these health insurance marketplaces.

The Associated Press: Mississippi Can Try For Fed-State Health Exchange
After blocking Mississippi's proposal for a state-run health insurance exchange because of divisions among state leaders on the plan, federal officials said Friday that they're encouraging the state to seek approval for a partnership — an exchange jointly run by the state and federal governments (Pettus, 2/9).

Kaiser Health News: Capsules: Feds Blame Mississippi Governor For Exchange Denial
One, Mississippi has become No, Mississippi. The Obama administration on Friday offered an explanation for why it rejected Mississippi's bid to establish a state-based online health insurance marketplace, called One, Mississippi. In a letter, the federal government's top exchange official said they had no choice because Gov. Phil Bryant would not allow the exchange to work with Medicaid and other agencies under his control (Galewitz, 2/8).

Pioneer Press: Minnesota Health Insurance Exchange Funding Sparks Disagreement Among DFL
If the state creates a health insurance exchange later this year, should smokers pay for it? The question is in play at the Capitol following a Senate Tax Committee hearing last week that amended legislation for the health exchange, a new marketplace for buying insurance that's set to start operating in October (Snowbeck, 2/10).

In other news related to the health law's implementation -

Los Angeles Times: Judges Split Over Birth Control Coverage And Religious Liberty
Judges across the country are increasingly split over whether private employers and their companies can cite their religious beliefs as a valid reason for denying birth control coverage to their employees (Savage, 2/8).

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Health Spending And Fiscal Battles

White House Details Impact Of March 1 Sequester On Health Programs

As these scheduled budget cuts get closer, a poll by the Pew Research Center concluded that young voters are supportive of Medicare and Social Security and hope to see these programs overhauled so they live on into the future.  

Modern Healthcare: White House Warns Of Sequester's Healthcare Impact
The Obama administration is warning that budget cuts scheduled for March 1 would hit especially hard in mental healthcare, medical research and the drug approval process. On Friday, the administration released details of some of the nonmilitary cuts under the Budget Control Act of 2011, which required $1.2 trillion in across-the-board spending cuts from most federal programs over 10 years. The White House paper said the cuts would mean the loss of 12,000 research positions funded by grants from the National Institutes of Health and the end of treatment for 373,000 people with mental illness due to reductions in the Mental Health Block Grant (Daly, 2/8).

The New York Times: A Growing Trend: Young, Liberal And Open To Big Government
Under-30 voters are "the only age group in which a majority said the government should do more to fix problems," the nonpartisan Pew Research Center reported in November. In a Pew survey a year earlier, more than 8 in 10 said they believed that Social Security and Medicare had been good for the country, and they were especially supportive of seeing the programs overhauled so they would be intact when they retire. (Young people were also more open than their elders to privatizing the programs.) (Stolberg, 2/10).

In the background, Medpage today reports on how the health care sector fits into the overall economy -

Medpage Today: Health Care Jobs Grow, Spending Growth Still Slow
The healthcare sector continues to add jobs, despite the continued slow growth in overall healthcare spending, according to a healthcare research and consulting firm report. Employment in ambulatory care settings grew by 28,000 jobs in January, higher than the average of the last 24 months, the Altarum Institute said in its February Health Sector Economic Indicators briefs released Thursday. … In the last year, private sector health employment grew by 2.3 percent compared with 1.4 percent for non-health jobs, the report said. Since the recession in December 2007, health sector employment has grown by 10.5 percent while non-health employment has fallen by 3.7 percent (Pittman, 2/10).

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Capitol Hill Watch

GOP Lawmakers Focus On Tavenner Nomination, Doc Fix, Medicaid Costs

News outlets covered a variety of Medicare and Medicaid news, including prospects for Marilyn Tavenner to be confirmed as head of CMS.

Roll Call: Medicare Agency Nominee Likely To Face Health Care Law Questioning
Marilyn Tavenner has another shot to be confirmed as leader of the Centers for Medicare and Medicaid Services, but getting there will require defending the 2010 health care law to Senate Republicans. Tavenner is the acting administrator of the agency, which has not had a confirmed leader in seven years (Ethridge, 2/8). 

The Hill: Wyden Says He Has No Plans To Again Take Up Medicare Reform With Paul Ryan
Sen. Ron Wyden (D-Ore.) has no plans to partner with Rep. Paul Ryan on a new Medicare reform bill, the senator has told The Hill. The two lawmakers made waves in 2011 with a bipartisan proposal that infuriated Democrats and later inspired Mitt Romney's healthcare plan (Viebeck, 2/10).

Kaiser Health News: FAQ On Medicare Doctor Pay: Why Is It So Hard To Fix?
While physicians have sidestepped drastic Medicare payment cuts for 2013, doctors' groups and lawmakers are gearing up for yet another battle to scrap the formula that forces Congress to consider the 'doc fix' on a yearly basis. For doctors, the nail-biter has become a familiar but frustrating rite. Lawmakers invariably defer the cuts prescribed by a 1997 reimbursement formula, which everyone agrees is broken beyond repair. ... Here are some answers to frequently-asked questions about the doc fix (Carey, 2/10).

Kaiser Health News also tracked weekend health policy news headlines, including reports about what Democratic and Republican congressional leaders said on the Sunday talk shows about Medicare and the nation's spending (2/10).

The Hill: Advocates Say GOP Proposal Would Ration Medicaid For Kids
A Republican proposal to reform Medicaid would ration care for one-third of U.S. kids, advocates said Friday.  First Focus, a bipartisan group, responded to the idea of per-capita Medicaid caps floated by Senate Finance Ranking Member Orrin Hatch (R-Utah) and Rep. Bill Cassidy (R-La.) (Viebeck, 2/8).

CQ Healthbeat: Advocacy Group Argues Against Medicaid Per-Capita Limits
The report contains no new statistics but lays out the group’s reasons for opposing a change. Advocates may use the analysis as a lobbying tool. The group said such a system would shift costs from the federal government to the states and patients. ... A per-capita grant program also would probably require more investments to create stronger oversight to make sure that states did not game the new system, said the analysis (Adams, 2/8).

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Roadblocks Continue Despite Efforts To Address Causes of Hospital Readmissions

News outlets also report on how Medicare's efforts to curb readmissions have led to innovations.

The Associated Press/Washington Post: Medicare Crackdown Spurs Innovative Fixes To Slow Hospital Readmissions Epidemic
Hospital readmissions are miserable for patients, and a huge cost -- more than $17 billion a year in avoidable Medicare bills alone -- for a nation struggling with the price of health care. Now, with Medicare fining facilities that don't reduce readmissions enough, the nation is at a crossroads as hospitals begin to take action (2/11).

The Associated Press/Washington Post: Aging America: Myriad Roadblocks To Recovery Fuel Hospital Readmissions, Geography A Factor
More than 1 million Americans wind up back in the hospital only weeks after they left for reasons that could have been prevented -- a revolving door that for years has seemed impossible to slow (2/10).

Bloomberg: Boomerang Patients To Penalize Hospitals Under U.S. Law
Tenet Healthcare Corp., the third-largest U.S. hospital chain, keeps an eye on Medicare patients after they're released. This isn't just about professional integrity. Tenet has a financial stake in their well-being. Fines are being levied against hospitals with high rates of patient readmissions under a provision of the Affordable Care Act targeting $8 billion in Medicare cost savings within six years (Armour, 2/11).

In related news --

Los Angeles Times: A Delicate New Balancing Act In Senior Health Care
Frail seniors like Gordon account for a disproportionate share of health care expenditures because they are frequently hospitalized and often land in intensive care units or are readmitted soon after being released. Now the federal health reform law is driving sweeping changes in how hospitals treat a rapidly growing number of elderly patients (Gorman, 2/9).

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Health Information Technology

As Feds Encourage Health IT, Analysts Forecast Big Increase In Telehealth

Politico and The Hill covered various aspects of electronic health records and health care.

Politico: Feds; 'E-Health' Initiative Reaches Out To Patients
In an age of the Web, Wi-Fi and ever-present social media, so-called e-health lags far behind. But federal officials leading the multibillion effort to get doctors and hospitals to use health information technology are now reaching out to patients and families to help them become e-patients. Farzad Mostashari, national coordinator for health information technology at Department of Health and Human Services, and other top health IT officials outlined plans in the February’s Health Affairs journal to expand access, promote innovation and ensure privacy while giving patients and families a bigger role in their care (Kenen, 2/11).

The Hill: Analysis Predicts Spike In Telehealth
Efforts to curb rising healthcare costs will cause the use of telehealth technology to spike, a new analysis predicted.  IMS Research, which studies the electronics industry, forecast a nearly sixfold rise in the number of telehealth patients over the next five years. About 1.3 million U.S. patients will use communications technology to interact with doctors by 2017, the firm said (Viebeck, 2/8).

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State Watch

State Roundup: Calif. Doc Supply Strains Under Health Law

The Associated Press/Washington Post: In Health Secretary Bill Hazel, Lawmakers Find An Honest Broker In Medicaid Expansion Struggle
The compelling facts and figures he provided the Senate Finance Committee gave feuding Democrats and Republicans the confidence to unite behind an expedited but cautious roadmap toward a federally prescribed expansion of Medicaid in Virginia (2/10).

Los Angeles Times: State Lacks Doctors To Meet Demand Of National Health Care Law
As the state moves to expand health care coverage to millions of Californians under President Obama's health care law, it faces a major obstacle: There aren't enough doctors to treat a crush of newly insured patients (Mishak, 2/9).

The Associated Press: Los Angeles School Health Clinics Expand
When Maria Barrales' children got sick, she would drive two hours south from her East Los Angeles home to the Mexican border and spend two more hours waiting to cross so she could go to an affordable doctor in Tijuana. … While a smattering of school clinics across the nation have long been open to the public, more are looking to expand their patient base to reap revenue that can subsidize the care often given for free to youngsters as well as fill a dire larger need for community health care access. (2/10).

Los Angeles Times: HealthCare Partners Seeks License To Operate As Managed-Care Plan
HealthCare Partners, the medical-group giant acquired last year by dialysis chain DaVita Inc. for $4.4 billion, is seeking a state license to operate as a managed-care plan after questions were raised about its compliance with California law (Terhune, 2/9).

The New York Times: Montefiore's President, Influential In Albany, Is Unknown By Design
The man behind the largest hospital system in the Bronx -- one that delivers nearly a third of the babies born in the borough -- remains largely unknown, by choice. But behind the scenes, where he holds court with political and business leaders while speaking in the language of a community activist, Dr. Safyer has become one of the most powerful figures in a borough of 1.4 million residents facing a growing health crisis from obesity, diabetes, asthma and chronic diseases (Hu, 2/10).

The Associated Press/Washington Post: Virginia Struggles With Federal Health Insurance Requirement Regarding Part-Time Workers
State agencies are trying to figure out how to comply with federal health insurance requirements regarding part-time workers. The health care reform law requires providing health insurance coverage to employees who work at least 30 hours a week or more on average (2/11).

MPR News: Training Helps Workers Defuse Incidents With Mentally Ill Inmates
In what was to be a routine trip to St. Joseph's Hospital in St. Paul, correctional officer Shane Warnke Jr. suddenly found himself confronted by the kind of danger he was trained to face while overseeing inmates in prison. As he escorted an inmate scheduled for surgery, a frantic nurse appeared. A patient had taken a staff member hostage. When the nurse led Warnke to a room with the door propped open, he could see a staff member lying on the ground. As he stepped inside, Warnke saw a man holding a pair of scissors to a nurse's throat. The patient lunged at Warnke twice, but the officer did not respond with force (Shenoy, 2/11).

Baltimore Sun: Solving The State's Health Disparities
Nearly 10,000 people in West Baltimore are diagnosed each year with new cases of diabetes, hypertension and other treatable, chronic health conditions -- enough to fill 24 jumbo jets. These illnesses will kill many of them and complications will disable others who may end up in wheelchairs or have limbs amputated because they didn't get the proper medical care. This is the evidence the West Baltimore Primary Care Access Collaborative, a coalition of 16 hospitals and nonprofit organizations, gave state health officials as they sought to join a state program that provides financial incentives in an effort to curb health disparities in the state through the creation of special zones. The argument was convincing. The coalition, made up of organizations that encompass some of the city's most impoverished neighborhoods, was one of five groups chosen by the state last month to create a health enterprise zone (Walker, 2/10).

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Editorials and Opinions

Viewpoints: Contraceptive Debate May Hinge On 'Conscience Of A Corporation;' Rep. Cantor's Insights On Medicare; Sebelius And Holder On Fraud

Houston Chronicle: Fighting Health Care Fraud Pays Dividends
Today, our departments released a report showing that the Obama Administration's historic efforts to go after criminals who steal from Medicare and Medicaid are paying off, especially in hotspots like Houston. The report shows that last year, we recovered a record $4.2 billion from those who prey on our health care system. In total, our efforts returned $14.9 billion over the last four years, more than double what was returned in the previous four years (U.S. Attorney General Eric Holder Jr. and HHS Secretary Kathleen Sebelius, 2/11).

The New York Times: The Conscience Of A Corporation
David Green, who built a family picture-framing business into a 42-state chain of arts and crafts stores, prides himself on being the model of a conscientious Christian capitalist. His 525 Hobby Lobby stores forsake Sunday profits to give employees their biblical day of rest. … And the company’s in-house health insurance does not cover morning-after contraceptives ... This has put Hobby Lobby at the leading edge of a legal battle that poses the intriguing question: Can a corporation have a conscience? And if so, is it protected by the First Amendment (Bill Keller, 2/10).

Los Angeles Times: Catholic Bishops Won't Take 'Mostly Yes' For An Answer 
[Cardinal] Dolan's statement reiterated that the Roman Catholic Church is equally adamant that nonreligious employers should be free to ignore the mandate. ... But do the bishops really believe that owners of hardware stores and coffee shops have a right to opt out of Obamacare -- or other laws -- because of their personal religious convictions? (Michael McGough, 2/8).

The Washington Post: Mr. Cantor Looks For Middle Ground 
[Medicare's] structure, [House Majority Leader Eric Cantor] noted, is still rooted in the standard Blue Cross and Blue Shield plan of 1965, with an "arbitrary division" between insurance for hospital services and for doctor services. Each side has its own premium, deductible and co-pay rules, which creates expensive complexity, sometimes inadequate protection against catastrophic costs and powerful incentives to seek supplemental "Medigap" insurance. Mr. Cantor suggested unifying the program and revising the cost-sharing rules to create "reasonable and predictable" out-of-pocket expenses (2/8).

The New York Times: The Ignorance Caucus 
Mr. Cantor's support for medical research is curiously limited. He's all for developing new treatments, but he and his colleagues have adamantly opposed "comparative effectiveness research," which seeks to determine how well such treatments work. What they fear, of course, is that the people running Medicare and other government programs might use the results of such research to determine what they're willing to pay for. Instead, they want to turn Medicare into a voucher system and let individuals make decisions about treatment (Paul Krugman, 2/10).

Philadelphia Inquirer: A Costly Rebuff To Medicaid
One in six Pennsylvanians lacks health insurance. ... The Affordable Care Act would make 631,000 more Pennsylvanians eligible for Medicaid coverage next year. ... Last week, Gov. Corbett called it "financially unsustainable for the taxpayers," and strongly suggested he was saying no to Medicaid expansion. He is the first governor of a blue state to reject the coverage for now. He is brutally wrong to do so (Karen Heller, 2/10).

The Washington Post: Virginia Can't Afford Not To Embrace Obamacare
Gov. Bob McDonnell and some fellow Republicans in the legislature are considering blocking one of the (health overhaul's) key reforms: extending Medicaid, the federal health insurance program for the working poor. That would be a costly mistake, for two reasons. First, it would mean a missed opportunity to help hundreds of thousands of Virginians struggling to make ends meet (Robert McCartney, 2/9). 

Milwaukee Journal Sentinel: Medicaid Expansion Is A Wise Investment For Wisconsin
Many people think of Medicaid or BadgerCare as programs that provide health care coverage to the poor, but few know that Wisconsin is home to an estimated 170,000 uninsured, many of whom are working adults who do not qualify for Medicaid even though they have little income. These include people ages 50 to 64 who have lost their jobs or are struggling to find work. They are not yet eligible for Medicare and have paid into the system all their lives. As aging adults they are facing the onset of health conditions that, if left untreated, will inevitably increase their need for and use of health and long-term care (Lisa Pugh and Helen Marks Dicks, 2/10).

Milwaukee Journal Sentinel: Obamacare's 'Giveaway' Is Anything But Free
If a deal sounds too good to be true it usually is. That's a maxim that Gov. Scott Walker and Wisconsin legislators should keep in mind as they wrestle with the question of whether to expand the state's Medicaid program in conjunction with the Patient Protection and Affordable Care Act, a.k.a. Obamacare. ... The expansion would also make childless single men, a notoriously high-cost group, eligible for Medicaid for the first time in every state. ... there is little evidence to suggest that expanding Medicaid will significantly reduce the cost of uncompensated care (Michael Tanner, 2/10).

The Wall Street Journal: Ben Carson For President
(M)ake time to watch the video of Dr. Ben Carson speaking to the White House prayer breakfast this week. ... Not surprisingly, a practicing physician has un-PC thoughts on health care: "Here's my solution: When a person is born, give him a birth certificate, an electronic medical record, and a health savings account to which money can be contributed—pretax—from the time you're born 'til the time you die. ... Instead of sending all this money to some bureaucracy, let's put it in their HSAs. Now they have some control over their own health care. And very quickly they're going to learn how to be responsible" (2/8).

The New York Times: What A Company Knew About Its Metal Hips
All-metal hip replacements have failed at a high rate and harmed many patients in recent years. Now there is evidence that a major manufacturer was aware of a serious problem with one of its models yet failed to alert patients or doctors and continued to market it aggressively (2/10). 

Milwaukee Journal Sentinel: What We Need To Do To Fight HIV
The latest statistics show the incidence of HIV among gay men in Wisconsin was higher in 2011 than when the disease peaked in 1987. The category with the highest infection rate: young black men who have sex with men who may not identify themselves as gay. Of the 400 new cases of HIV reported in the state every year, nearly 31% fall within that vulnerable and very hard-to-reach category. We need action -- now -- to deal with this growing problem (James E. Causey, 2/8).

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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.