Daily Health Policy Report

Wednesday, February 13, 2013

Last updated: Wed, Feb 13

KHN Original Reporting & Guest Opinion

Administration News

Health Reform



Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

$2 Billion Medicaid Program Helps Mostly Illegal Immigrants

Kaiser Health News staff writer Phil Galewitz reports: "During the debate over the 2010 federal health care overhaul, Democrats promised that illegal immigrants wouldn't be among the 27 million people who'd gain coverage. President Barack Obama repeated that pledge last month when he outlined his immigration plan" (Galewitz, 2/12). Read the story.

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Higher Hospital Readmissions Aren't Linked To Fewer Deaths, Study Finds

Kaiser Health News staff writer Jordan Rau reports: "Some hospitals with high readmission rates say they're saving lives by bringing patients back at the first hint of trouble. The evidence for this is that a handful of hospitals with high readmission rates also have extremely low death rates among Medicare patients. But a study published Tuesday finds that there's no major link between hospitals with high readmissions and those with low mortality rates" (Rau, 2/12). Read the story.

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Capsules: Health Figures Big In State Of The Union Guest List

Now on Kaiser Health News' blog, Phil Galewitz reports: "Five of the 24 people invited to sit near First Lady Michelle Obama at tonight’s State of the Union have strong health care connections. They include a governor, a business owner and a beneficiary of the health law provision that prevents health plans from denying coverage because of pre-existing conditions" (Galewitz, 2/12). Check out what else is on the blog.

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Twitter Topics: What's Next For The #DocFix?

Why is the way Medicare pays doctors so hard to fix? Our @MaryAgnesCarey ran down some questions and answers on the Medicare #DocFix

See what others are saying on KHN's Twitter Feed about what chance a permanent fix to the Medicare payment formula has of passing this year, and join the #DocFix conversation on Twitter. Be sure to follow @KHNews for the latest.

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Political Cartoon: '9-1-1, What Is Your Emergency?'

Kaiser Health News provides a fresh take on health policy developments with "9-1-1, What Is Your Emergency?" by Pat Bagley.

Meanwhile, here is today's health policy haiku:


Readmissions fact
or fiction: High return rates,
less mortality.

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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Administration News

As Part Of 'Expansive' Agenda, Obama Offers Support For 'Modest' Medicare Reforms

In last night's State of the Union address, President Barack Obama offered his take on how the U.S. budget could achieve "fiscal stability" through a mix of Medicare cuts and tax increases; however, he provided few details of what changes to Medicare he found acceptable.

The New York Times' News Analysis: In An Age Of Spending Cuts, Making The Case For Government
In setting out how government could reach what he considers an acceptable level of fiscal stability through Medicare cuts and tax increases, Mr. Obama was doing more than trying to set the terms for the next, fast-approaching rounds in his fiscal cage match with Congressional Republicans (Stevenson, 2/13).

The Wall Street Journal: Obama Urges Action On Expansive Agenda
Mr. Obama repeated his earlier calls for reducing the budget deficit through a mix of tax increases and spending cuts. He also said he would support "modest reforms" in programs including Medicare, as long as wealthy Americans contribute as well (Nicholas and Nelson, 2/12).

Modern Healthcare: Obama Address Light On Details For Reforming Medicare
In the first State of the Union address of his second term, President Barack Obama acknowledged the biggest driver of the nation's long-term debt is the rising cost of healthcare for an aging population, but proceeded to offer very few specifics on the type of Medicare reforms he's willing to make to sustain the decades-old federal program. Vowing to "reignite the true engine of economic growth—a rising, thriving middle class," the president said that task must start with making basic decisions about the nation's budget, which in turn will have a significant impact on the economy. He reiterated his earlier stance that broad-based economic growth needs a balanced approach to deficit reduction that includes both spending cuts and additional revenue (Zigmond, 2/13).

Medscape: State Of The Union Addresses Medicare Reform, Gun Control
In his fifth State of the Union address tonight, President Barack Obama spoke mostly as a Job Creator in Chief, Deficit Reducer in Chief, and Commander in Chief, but he took a few minutes to put healthcare policy on his second-term agenda, including the public health issue of gun violence. "What I’ve said tonight," said Obama, "matters little if we don’t come together to protect our most precious resource — our children." Shortly after the school massacre in Newtown, Connecticut, on December 14, Obama proposed a ban on military-style assault rifles and high-capacity magazines, universal background checks in gun sales, higher spending on mental health services, and other measures aimed at reducing gun violence (Lowes, 2/12).

The Washington Post: Obama: Limited Cost-Cutting For Medicare
When it came to Medicare, Obama reiterated his determination to accept only limited cost-cutting proposals. Among the ideas he appeared to reference was requiring pharmaceutical companies to charge Medicare the lower rates they currently receive from Medicaid, the federal-state health insurance program for the poor (Aizenman, 2/12).

The Washington Post: Fact Checker: Medicare Reform
Using Congressional Budget Office estimates of the president’s budget, we see that over 10 years, Obama's proposals would achieve $337 billion from 2013 to 2022, compared to $483 billion for Bowles-Simpson in the same time period. (Bowles-Simpson, or more accurately the National Commission on Fiscal Responsibility and Reform, is considered by many in Washington to be the model for a bipartisan approach for deficit reduction.) However, in 2022, both would achieve exactly the same amount of savings — $68 billion (Kessler, 2/12).

Medpage Today: State Of The Union: Health Savings Proposed
Having wealthier seniors pay higher Medicare premiums and reducing taxpayer subsidies to drug companies are just a few of the ways the federal government can lower its healthcare spending, President Obama said during his State of the Union address Tuesday evening. In a speech light on health care mentions, Obama also mentioned doing away with a fee-for-service Medicare reimbursement system and replacing it with one that rewards quality. The president said he was willing to enact reforms "that will achieve the same amount of health care savings by the beginning of the next decade as the reforms proposed by the bipartisan Simpson-Bowles commission." President Obama has already proposed reforms that will save $340 billion in healthcare spending over the next decade, the White House noted on its website (Pittman, 2/13).

Kaiser Health News: Capsules: Health Figures Big In State Of The Union Guest List
Five of the 24 people invited to sit near First Lady Michelle Obama at tonight’s State of the Union have strong health care connections. They include a governor, a business owner and a beneficiary of the health law provision that prevents health plans from denying coverage because of pre-existing conditions" (Galewitz, 2/12).

The Medicare NewsGroup: Why Democrats And Republicans Can't Agree On Medicare Reform
At the National Academy of Social Insurance’s annual meeting, a pair of influential Democratic and Republican strategists agreed that the presidential election failed to provide any clear mandate for changes or reforms to the Medicare and Social Security programs. They also shared a belief that neither party offered specific solutions during the campaign, so the bitter political struggles over these issues continue. NASI is a nonpartisan think tank dealing with Medicare and Social Security. … There seems scant chance for any bipartisan agreement on managing the future of Medicare and Social Security because the party differences are so great, the opposing party strategists concurred (Rosenblatt, 2/12).

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Rubio' Repeats GOP Calls For Overhauling Medicare, Other Entitlement Programs

During his televised speech responding to President Barack Obama's State of the Union address, Sen. Marco Rubio, R-Fla., also criticized the health law.

Los Angeles Times: Rubio Responds To President's Speech With Familiar GOP Themes
Rubio, speaking from the Capitol, repeated GOP calls for a constitutional balanced-budget amendment and an overhaul of the Medicare and Social Security programs, though he provided no specifics. "Anyone who is in favor of leaving Medicare exactly the way it is right now is in favor of bankrupting it," Rubio said (Barabak, 2/12).

The Hill: Rubio Plugs GOP Medicare Plan
Sen. Marco Rubio (R-Fla.) criticized President Obama's healthcare law and plugged Republicans' controversial Medicare plan during his response to the State of the Union on Tuesday. Rubio said current seniors should be held harmless from any Medicare overhaul, but said the program is on an unsustainable fiscal path (Baker, 2/12).

CNN: Rubio Says Obamacare Needs A Check Up
Sen. Marco Rubio took President Barack Obama to task on the issue of health care during the Republican response to the State of the Union. The Claim: "Obamacare was supposed to help middle-class Americans afford health insurance. But now, some people are losing the health insurance they were happy with. And because Obamacare created expensive requirements for companies with more than 50 employees, now many of these businesses aren't hiring. Not only that; they're being forced to lay people off and switch from full-time employees to part-time workers" (Hellerman, 2/13).

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Health Reform

State Policies, Positions On Medicaid Expansion Continue To Take Shape

Some state health exchange plans also appear to be moving forward as specifics emerge.

Reuters: North Carolina's Medicaid Program Too Troubled To Expand: Governor
North Carolina will not expand Medicaid coverage under President Barack Obama's signature health care reform law and will play no role in setting up the required health insurance exchange, Gov. Pat McCrory, a Republican, said on Tuesday (Lambert, 2/13).

The Hill: North Carolina Rejects Medicaid Expansion, Partnership Exchange
North Carolina Gov. Pat McCrory (R) made clear Tuesday that he doesn't want any part of the coverage expansion under President Obama's signature health care law. McCrory rejected the law's Medicaid expansion and said he doesn't want to work with the federal government to retain some control over his state's insurance exchange. He'll cede that power entirely to the Obama administration (Baker, 2/12).

The Associated Press: Medicaid Expansion Profitable For State
A study released Monday by the Indiana Hospital Association estimates that expanding Medicaid would generate billions of dollars in economic growth for the state, a stark contrast from the budget-busting projections cited by former Gov. Mitch Daniels. The hospital association's study estimates that using the federal expansion to cover an additional 406,000 residents would cost Indiana $503 million but pump several times that amount back into the economy over the next seven years (LoBianco, 2/13).

The Associated Press: Walker Hints At Middle Ground In Medicaid Growth
Wisconsin Gov. Scott Walker has watched quietly in recent days as a handful of other Republican governors decided to accept billions of dollars from the U.S. government to expand Medicaid as part of the federal health care overhaul. Walker planned to reveal Wednesday whether he will go along with those six GOP governors, stick with 11 others who have rejected the expansion, or chart his own course somewhere in the middle. He was to announce his plans in a speech about entitlement reform before the state's chamber of commerce (Bauer, 2/12).

Milwaukee Journal Sentinel: Scott Walker To Back Limited But Not Full Expansion Of BadgerCare
Gov. Scott Walker will not pursue a full expansion of the state's BadgerCare program as foreseen under the federal health care law, seeking instead a more limited expansion of coverage. A source familiar with the proposal confirmed some of the broad outlines of the proposal on Medicaid health programs that Walker is expected to make at an event Wednesday afternoon in Madison. The decision will have far-ranging effects on whether and how tens of thousands of Wisconsinites receive health coverage, whether state taxpayers will have to cover tens of millions of dollars of that cost, and how much the state will receive in the coming years out of the billions of dollars in possible federal money to assist the expansion (Stein and Marley, 2/12).

The Associated Press: Missouri Senators Cite Credit Rating As Reason Not To Expand Medicaid
Gov. Jay Nixon's plan to expand Medicaid health care coverage in Missouri has encountered a new wrinkle of opposition from some lawmakers. Members of the Senate Appropriations Committee raised concerns on Monday that the Medicaid expansion could hurt the state's credit rating (2/12).

The Associated Press: Ohio's Treasurer Bucks GOP Governor On Medicaid
A fellow Republican state official is bucking Gov. John Kasich's proposed expansion of Medicaid, urging GOP lawmakers to reject the plan for the sake of the state's bottom line. In a letter sent Monday, Treasurer Josh Mandel urged legislative leaders to oppose Kasich's decision, which was incorporated into the $63.2 billion, two-year budget the governor released last week (Smyth, 2/12).

The Associated Press/Washington Post: Brown to Testify On Measure To Expand Medicaid And Create Funding Stream For Maryland Exchange 
Lt. Gov. Anthony Brown will be outlining the latest steps in Maryland to implement federal health care reform. Brown is scheduled to testify Wednesday on legislation before a House panel and a Senate committee (2/13).

Health Policy Solutions (a Colo. news service): Health Exchange Will Tap Brokers But Won't Pay Them
Health insurance brokers will get referrals and be able to sell plans to individual and business clients of Colorado's new health exchange. But they won't earn money directly from the exchange and won't have to abide by a strict conflict of interest policy that Colorado’s exchange board passed Monday to govern new "health guides." Instead, insurance companies will continue to pay commissions to brokers as they currently do. And Colorado's Division of Insurance will continue to license and monitor brokers (Kerwin McCrimmon, 2/12).

The Associated Press: New Mexico House Panel Oks Health Exchange Plan
Democratic lawmakers pushed ahead Tuesday with a proposal to establish a state-run health insurance exchange, despite objections from the insurance industry and Republican Gov. Susana Martinez. The House Health, Government and Indian Affairs Committee approved the measure on a party-line vote, with Democrats in favor and Republicans opposed (Massey, 2/12).

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Implementation Issues Trigger Action, Analysis

News outlets examine health law issues ranging from how states are planning to market the health plans that will become available this fall to whether accountable care organizations will help control health care costs.

The Wall Street Journal: States Gear Up To Pitch Health Plans
Supporters of the 2010 health law are looking to draft sports teams, pharmacies and political ground operations for their biggest marketing campaign yet: persuading millions of uninsured, hard-to-reach and skeptical Americans to sign up for health plans this fall (Radnofsky and Dooren, 2/12).

HealthyCal: Can Accountable Care Organizations Reign In Health-Care Costs?
Coordination and effective use of existing resources can save money. That’s the idea behind the push for innovations built into the health care reform law, like electronic health records, pay for performance and accountable care organizations. But it's unlikely that any of these innovations will be a silver bullet in the battle against rising health care costs, including accountable care organizations (Shanafelt, 2/13).

Kaiser Health News: $2 Billion Medicaid Program Helps Mostly Illegal Immigrants
During the debate over the 2010 federal health care overhaul, Democrats promised that illegal immigrants wouldn't be among the 27 million people who'd gain coverage. President Barack Obama repeated that pledge last month when he outlined his immigration plan (Galewitz, 2/12).

Medpage Today: Docs Must Take Active Role In Reform, HHS Says
The ongoing debate about payment and delivery reforms is a chance for physicians to take a seat at the table to dictate their design, a Medicare official said Tuesday. Doctors shouldn't sit idly by and take what comes to them as public and private payers ramp up alternative care models like accountable care organizations and bundled payments for episodes of care, Nancy Nielsen, MD, PhD, senior adviser at the Center for Medicare and Medicaid Innovations in Baltimore, said here at the American Medical Association's (AMA) National Advocacy Conference. Nielsen, who was president of the AMA from 2008 to 2009, said the practice of medicine faces a tipping point as leaders look for ways to bend the rising cost of care (Pittman, 2/12).

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Study: No Link Between Hospital Readmissions And Saving Patient Lives

A Journal of the American Medical Association study released Tuesday has found that higher hospital readmissions don't lead to fewer patient deaths.

Reuters: Hospital Deaths And Readmissions Not Linked: Study
A measure used by Medicare to penalize hospitals for poor performance is not linked to how many patients die after being admitted, suggests a new study. The study, published in the Journal of the American Medical Association on Tuesday, suggests that hospitals can keep the number of patients who come back for more treatment low without having more of them die (Seaman, 2/12).

Kaiser Health News: Higher Hospital Readmissions Aren't Linked To Fewer Deaths, Study Finds
Kaiser Health News staff writer Jordan Rau reports: "Some hospitals with high readmission rates say they're saving lives by bringing patients back at the first hint of trouble. The evidence for this is that a handful of hospitals with high readmission rates also have extremely low death rates among Medicare patients. But a study published Tuesday finds that there's no major link between hospitals with high readmissions and those with low mortality rates" (Rau, 2/12). Read the story.

In other quality news -

Bloomberg: Hospitals In U.S. Cut Infection Rates In 2011, CDC Says
U.S. hospitals reduced some types of deadly and costly infections in 2011, three years after a government initiative to cut hospital-acquired illnesses. Infections stemming from catheters placed in a large vein in the neck, chest or groin to give medication or collect blood declined 41 percent from 2008, the Centers for Disease Control and Prevention said today in a report (Edney, 2/12).

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Will More Availability Of Some Medicare Therapies Spark A Budget Crisis?

Politico looks at how making some therapies more widely available to Medicare recipients -- as one lawsuit is asking for -- could strain the program's budget. In addition, The Associated Press examines Medicare records to find that monitoring some kidney cancer patients instead of operating could improve their chances to live.

Politico: Broader Therapies Could Further Strain Medicare
A lawsuit may have lit the fuse on a budgetary time bomb in Medicare, even though it simply reaffirms what should be a routine payment policy for services like physical therapy that the massive federal health care program has always had. People on Medicare are entitled to various kinds of rehab and therapeutic services -- occupational or speech therapy, for instance. But over the past 30 years or so, the coverage became spotty. Some people were able to get that care only if it could help them get better -- not if it was aimed at keeping them stable or slowing a predictable decline. That became known as the "improvement standard." The care was only for those who would improve (Norman, 2/13).

The Associated Press/Wall Street Journal: Study Questions Kidney Cancer Treatment In Elderly
In a stunning example of when treatment might be worse than the disease, a large review of Medicare records finds that older people with small kidney tumors were much less likely to die over the next five years if doctors monitored them instead of operating right away (2/12).

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Health Care Marketplace

WellPoint Names Hospital Industry Veteran As New Chief Executive

The insurer announced yesterday that Joseph R. Swedish, the chief executive of Trinity Health, will replace Angela Braly at the company's helm.

The New York Times: Big Insurer Hires A Hospital Executive As Chief
Joseph R. Swedish, the 61-year-old chief executive of a major nonprofit Catholic-owned health system, Trinity Health, will become WellPoint's chief executive on March 25. He will be responsible for leading the company, which operates profit-making Blue Cross plans in 14 states, into a future in which health insurers will sell insurance through state and federal exchanges and to work in new ways with hospitals and doctors (Abelson, 2/12).

The Wall Street Journal: WellPoint Names New Chief Executive
WellPoint Inc. named Joseph R. Swedish as its new chief executive, unexpectedly turning to a hospital-industry veteran to lead the second-largest U.S. health insurer through the challenging implementation of the health-care overhaul (Mathews and Kamp, 2/12).

The Associated Press/Los Angeles Times: Health Insurer WellPoint Picks Joseph Swedish As Its New CEO
Swedish's resume includes work with HCA, the nation's largest hospital chain. He also has served as a director for another insurer, Coventry Health Care. In his new job, Swedish's tasks will include helping WellPoint prepare for coverage expansions that start next year under the federal healthcare overhaul (2/13).

Modern Healthcare: Swedish Leaving Trinity Health To Become CEO Of WellPoint
Trinity Health President and CEO Joseph Swedish was named to replace Angela Braly at the helm of WellPoint, one of the nation's largest health insurers, effective March 25. The news comes months after Trinity Health announced a merger with Catholic Health East that would create a Roman Catholic system with national reach with Swedish, 61, as its CEO. Braly stepped down from her position as WellPoint's CEO last August after months of pressure from shareholders who were unhappy with the direction of the Indianapolis-based company. Trinity board member Larry Warren will serve as interim leader of the Livonia, Mich.-based system. Warren is the former CEO of Howard University Hospital in Washington (Selvam, 2/12).

Meanwhile, in pharmaceutical industry news -

The New York Times: Dispute Develops Over Discount Drug Program
The program, known as 340B, requires most drug companies to provide hefty discounts — typically 20 to 50 percent — to hospitals and clinics that treat low-income and uninsured patients. But despite the seemingly admirable goal, the program is now under siege, the focus of a fierce battle between powerful forces — the pharmaceutical industry, which wants to rein in the discounts, and the hospitals, which say they might have to cut services without them (Pollack, 2/12).

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College Health Plans Beginning To Accomodate Transgender Students

The New York Times: College Health Plans Respond As Transgender Students Gain Visibility
Over the last decade, as activists started pushing colleges to accommodate transgender students, they first raised only basic issues, like recognizing a name change or deciding who could use which bathrooms. But the front lines have shifted fast, particularly at the nation's elite colleges, and a growing number are now offering students health insurance plans with coverage for gender reassignment surgery (Perez-Pena, 2/12).

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State Watch

State Roundup: Ore. Considers Rural Doc Loan Repayment

A selection of health policy news from Oregon, Maryland and California.

The Lund Report: Oregon May Bring Back Rural Loan Repayment Program With $4 Million
Oregon would restore $4 million in the next biennium to fund a loan repayment program that assists primary health care providers willing to work in rural areas, under a bill being pushed by Sen. Elizabeth Steiner Hayward, D-Beaverton. The program ran for nearly two decades before it was cut in 2009 in the depths of the recession (Gray, 2/12).

The Lund Report: Pharmacists Want To Give Shots To Young Children
If a disease outbreak swept over Oregon like this winter's flu pandemic or the whooping cough epidemic declared in Washington last April, children under 11 could not get shots at pharmacies under current law without a prescription. Senate Bill 167, pushed by the Oregon State Pharmacists Association, would give the state public health director the right to lift that restriction in case of an epidemic (Gray, 2/12).

Baltimore Sun: St. Joseph Medical Center Not Certified By Medicare System
The University of Maryland St. Joseph Medical Center failed a critical federal inspection and has been unable to collect what is likely millions of dollars in Medicare reimbursements from the federal government since Dec. 1. As part of its takeover of the troubled St. Joseph that day, the University of Maryland voluntarily gave up a certification needed to bill Medicare and applied for a new one. The university health system wanted to disassociate itself from problems the hospital faced under its previous owner, Denver-based Catholic Health Initiatives. A federal inspection days after the acquisition turned up shortcomings at St. Joseph. As a result, the Centers for Medicare & Medicaid Services (CMS) could not issue what is known as a Medicare provider agreement to St. Joseph. As of Tuesday, it could not be determined why St. Joseph failed the inspection (Walker, 2/12).

California Healthline: New Health Care Bills Introduced
One source of funding for pediatric trauma care could get a boost from a new bill being introduced in the state Senate, according to the author of SB 191, Sen. Alex Padilla (D-Pacoima). "Pediatric trauma care is still not widely available in California," Padilla said, referring to the 14 pediatric trauma care centers in the state. "SB 191 would provide essential funding for emergency care and pediatric trauma care throughout California." The pediatric trauma care bill makes permanent a temporary penalty imposed by counties on vehicle code violations, at a rate of $2 for every $10 in fines. That penalty is due to expire at the end of 2013. Padilla wants to eliminate a sunset date and make it permanent (Gorn, 2/13).

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Editorials and Opinions

Viewpoints: Obama Prescription For Medicare Is 'Modest;' GOP Doubts Entitlement Plan Is Serious

The Washington Post: In State Of The Union Address, Obama Lays Out His Second-Term Agenda
Somewhat more substantively, he called for a larger deficit-reduction deal built around loophole-closing tax reform and what he called "modest" reforms to Medicare and entitlements. In an apparent effort to rally Democrats to this cause, he called on "those of us who care deeply about programs like Medicare" to "embrace" reform. Yet in promising the same amount of Medicare savings as the Simpson-Bowles commission proposed, Mr. Obama did not mention that this would be a mere $341 billion over 10 years (2/12).

Los Angeles Times: Obama's Less-Is-More Agenda
He exhorted Republicans (for the umpteenth time) to adopt his solution to the impending crisis over automatic spending cuts: closing tax loopholes that benefit "the well-off and well-connected." In return, he offered to support modest reforms in Medicare, an offer he has also made before. And, significantly, he contended that a modest amount of deficit reduction is all we need (Doyle McManus, 2/13).

The Wall Street Journal: The President's Plans 
He also spoke of "entitlement reform," but his only two concrete ideas were price controls on drug companies and more means-testing for affluent seniors. These won't come close to solving the health-care entitlement problem that even he admits is unsustainable, which is why Republicans don't think he's serious (2/13). 

The New York Times: Rubio's Rebuttal
In his speech, Mr. Rubio followed the Republican rebranding strategy by rephrasing the party’s grand old policies without offering any new ideas. ... Mr. Rubio declared that he was particularly concerned about seniors who depend on Medicare, like his mother, and that "anyone who is in favor of leaving Medicare exactly the way it is right now, is in favor of bankrupting it." Funny Mr. Rubio should say that, because on Tuesday night, Mr. Obama argued that we can't leave Medicare as is: "Those of us who care deeply about programs like Medicare must embrace the need for modest reforms." ... Mr. Rubio didn’t actually mention how he would fix Medicare. But we all know that he supported Paul Ryan's plan to turn it into a voucher system (Andrew Rosenthal, 2/12).

Bloomberg: The Medicare Change Obama Was Talking About
President Barack Obama promised to save as much money on Medicare in the next decade as was proposed by the Bowles-Simpson commission. That would include, he said, lowering tax subsidies for drug companies and asking more affluent beneficiaries to pay more. And he said it would also include making a fundamental change in the way the government pays for care -- by basing bills not on fee-for-service but on "the quality of care our seniors receive." This explains why John Kitzhaber, the governor of Oregon, was watching the State of the Union address from first lady Michelle Obama's box. Kitzhaber has made his state's Medicaid program a laboratory that will test a promising model for making that change (Mary Duenwald, 2/13).

The Washington Post: Obama's Message: 'We Can Fix This'
Obama even made the country's intractable fiscal mess sound soluble. He didn't offer new proposals, but he made clearer than in any speech I can recall that he's willing to make real changes in Medicare and other entitlement programs to begin to get the deficit under control. He said he was willing to offer savings on Medicare that would equivalent to those proposed by the Simpson-Bowles commission. Now he should show the way by proposing those cuts, rather than throwing this rhetorical pledge into the miasma of congressional budget politics (David Ignatius, 2/12).

Los Angeles Times: Obama's New Vision: Doable?
Yes, there are problems left over from his first four years: high unemployment and slow economic growth. He rightly called on Congress to close the nation's long-term budget gap by reforming entitlements and simplifying the tax code, rather than making across-the-board reductions that only chip away at the deficit. But it wasn't clear how he'd get his ideas, many of them recycled from his first term, through a polarized Congress (2/13). 

And a few opinions on topics other than the State of the Union address --

The New York Times: Calorie Detective
Diet programs revolve around a proven principle: if you burn more calories than you consume, you will lose weight. The calorie is the defining metric. And so, in the interest of public health, the Food and Drug Administration requires most packaged foods to list their calories, among other data, on labels. To help combat obesity in New York City, the Department of Health requires most chain restaurants to post calorie content on their menus and fines those who don't comply. Thanks to the Affordable Care Act, a national program will soon follow (Casey Neistat, 2/12).

Los Angeles Times: Susan Love, Doctor/Patient
And now, she is the patient. For decades, as a surgeon, researcher, professor and medical celebrity of sorts, Susan Love has led the charge against breast cancer and for women's health. She served on President Clinton's cancer advisory board. She set up a research foundation. Her book on breast cancer is on the short shelf for clinicians and counselors. And last June, when, like so many women, she was feeling and doing fine, the diagnosis came. Except it wasn't breast cancer but leukemia (Patt Morrison, 2/13).

Milwaukee Journal Sentinel: Walker Finds The Medicaid Middle Ground
Gov. Scott Walker has decided to decline federal funds that would have allowed the state to expand Medicaid coverage, sources in his administration say. Walker is right to do this. Last week, legislative Democrats urged the governor to participate in the Medicaid expansion program created under the Affordable Care Act, arguing that it would allow Wisconsin access to "free" federal money. According to the Legislative Fiscal Bureau, Wisconsin would be eligible for $4.38 billion in federal aid until 2020 under the plan, with the state picking up an increasing share as the program moves forward (Christian Schneider, 2/12).

Health Policy Solutions (a Colo. news service): Health Care Cost Increases Under Scrutiny In San Luis Valley
In 2012, (the Robert Wood Johnson Foundation), a grant-making foundation focusing on improving health, conducted focus groups in four American cities to gauge consumer attitudes on health care costs.  The focus groups revealed that although most Americans are unclear as to why health care costs are increasing, many if not most know down to the penny how those increases are affecting their wallets. This should be expected in a time when workers covered through their employers pay 97 percent more for their family insurance premiums than they did in 2002, while wages increased just 33 percent over the same period (Gena Akers, 2/12).

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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.