Daily Health Policy Report

Tuesday, February 14, 2012

Last updated: Tue, Feb 14

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Administration News


Coverage & Access

Health Reform


Health Information Technology

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Despite Doctors’ Concerns, Home Births Are Increasing

In her latest Kaiser Health News column, Michelle Andrews writes: "For the vast majority of parents-to-be, giving birth involves a stay at a hospital or birthing center. But a growing minority are choosing instead to have babies at home, where, they hope, they can have a more private, low-tech experience and allow the process to unfold naturally. It doesn't hurt that in these days of rising health-care costs, having a baby at home is a lot cheaper, too" (Andrews, 2/14). Read the story.

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Capsules: It's That Time Of Year Again; Getting More KHN

Now on Kaiser Health News' blog, Mary Agnes Carey reports: "If it’s the middle of February, it’s time for the yearly Washington ritual: a president proposes Medicare and Medicaid cuts and then nursing homes and hospitals complain that those cuts will destroy the quality of care. Today was no different: President Barack Obama released his fiscal 2013 budget plan" (Carey, 2/13).

Also, Karl Eisenhower writes: "Can’t get enough Kaiser Health News? Now there’s a new way to take KHN with you everywhere you go. KHN is available on Google Currents, a mobile news app for smartphones and tablets" (Eisenhower, 2/13). See what else is on the blog.

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Political Cartoon: "Love, Mitch?" By John Cole, Scranton Times-Tribune

Kaiser Health News provides a fresh perspective on health policy developments with "Love, Mitch?" By John Cole, Scranton Times-Tribune

Meanwhile, here's today's health policy haiku:

The seasons of life
Deal unaffordable care
Up single payer
-- Don McCanne, M.D.

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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Capitol Hill Watch

House GOP Proposes Separating Payroll Tax Extension From 'Doc Fix,' Unemployment Debate

But some Republicans are cool to the proposal that would extend the tax cut without offsetting spending.

The New York Times: House Republicans Yield On Extending Payroll Tax Cut
Congressional Republicans backed down on Monday from a demand that a payroll tax rollback be paid for with reductions in other programs, clearing the way for an extension of the tax cut for 160 million Americans through 2012. After months of partisan confrontation that left the tax break hanging in the balance, Republicans suddenly offered to extend the two-percentage-point cut while continuing to haggle over added unemployment benefits and a measure to prevent a drop in fees paid to doctors by Medicare. The payroll tax holiday and jobless benefits expire at month’s end, and doctors would face a 27 percent reduction in Medicare reimbursements (Steinhauer, 2/13).

The Chicago Tribune: House Republican Leaders Agree To Extend Payroll Tax Cut
Democratic leaders, including (House Democratic leader Nancy) Pelosi, were cool to the overture, largely because it failed to resolve two other issues that have been part of the $160-billion package along with the payroll tax cut — measures to continue long-term unemployment benefits and block a pay cut for doctors who treat Medicare patients. At the White House, Press Secretary Jay Carney said, "We need to do all three" (Mascaro, 2/13).

The Washington Post: House Republican Leaders Agree To Payroll Tax Holiday Extension Without Offsets
Republicans want to continue negotiations over financing the rest of the original legislative package, including an extension of un­employment benefits and a key tweak to maintain Medicare reimbursement rates for doctors, while ensuring that taxes will not rise on workers (Kane, 2/13).

The Wall Street Journal: GOP Pivots On Payroll-Tax Cut
In addition to the payroll-tax reduction, the two parties are negotiating how to pay for enhanced unemployment benefits, an arrangement that expires at the end of the month, and an adjustment of the Medicare system so that doctors don't face a steep drop in fees. Republicans want to cover the $50 billion cost for those items by continuing a freeze of federal workers' salaries, while Democrats resist that approach (Bendavid, 2/13).

Politico: House GOP Reverses On Payroll Tax Cut
The announcement shocked rank-and-file members, who were back in their House districts. Senate Republicans were likewise caught off guard — even one GOP leader who was trying to negotiate a compromise had no idea it was coming. And conservative ire rose throughout the day, threatening to derail Speaker John Boehner's plan to take the thorny issue off the table. "We need to stop bowing to political pressure and do the right thing and make sure we don’t bankrupt Social Security even further," Sen. Ron Johnson of Wisconsin told POLITICO. Added Missouri Sen. Roy Blunt, a former House GOP leader: "I think the whole policy is a bad policy" (Raju and Sherman, 2/13).

Reuters: Republicans Drop Demand To Pay For Payroll Tax Cut
The Democratic-led Senate would likely support the payroll tax extension as laid out by the Republicans, even though they prefer including in the deal provisions on jobless benefits and payments for doctors treating Medicare patients that Republicans now want to negotiate separately (Smith and Ferraro, 2/13).

Modern Healthcare: No Remedy For Docs In GOP's Payroll Tax-Cut Plan
House Republican leaders announced they will introduce a bill to extend a middle-class payroll tax holiday in legislation that won't include a solution to Medicare's sustainable growth-rate formula for physicians. Beginning March 1, physicians who participate in the Medicare program will face a 27.4% cut in reimbursement if Congress does not address the issue by Feb. 29 (Zigmond, 2/13).

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Administration News

Obama 2013 Budget Would Cut $360 Billion From Medicaid And Medicare

Those cuts, which would be made over 10 years, would come primarily from reduced payments to drug companies and health care providers.

The Washington Post: Obama Budget: National Debt Will Be $1 Trillion Higher In A Decade Than Forecast
The budget released Monday would trim spending on federal health-care programs by about $360 billion over the next decade, primarily by reducing payments to drug companies and other providers. Starting in 2017, Obama also proposes to raise Medicare premiums for new retirees and seniors with higher incomes, start charging co-payments for home health-care services, and penalize patients who buy Medigap policies to take care of Medicare co-payments and deductibles (Montgomery, 2/13).

The Associated Press/Businessweek: Obama Sends FY2013 Budget Proposals To Congress
The projections in Obama's budget show that he is doing little to restrain the surge in (Medicare and Medicaid) expected in coming years with the retirement of baby boomers. Obama's budget projects that Medicare spending will double over the coming decade from $478 billion this year to almost $1 trillion in 2022. Medicaid, the government health care program for the poor and disabled, would more than double from $255 billion this year to $589 billion by 2022. (Crutsinger, 2/13).

CQ HealthBeat: Obama Budget Slices Medicare, Medicaid Through Provider Cuts
President Obama’s $76.4 billion fiscal 2013 Health and Human Services budget proposal would trim $360 billion in Medicare and Medicaid payments over 10 years, in part by cutting payments to certain providers. It also cuts $664 million from the Centers for Disease Control and Prevention, freezes the National Institutes of Health budget at $31 billion and adds about $1 billion to the Centers for Medicare and Medicaid Services. Administration officials explained the NIH’s stagnant funding by saying that “new grant management policies” would increase the number of new research grants (Reichard and Norman, 2/13).

The Hill: Budget Includes Familiar Cuts To Medicare, Medicaid
President Obama's budget proposal would require wealthy seniors to pay for a higher share of certain Medicare benefits. It would charge a co-pay for home healthcare services and put new limits on supplemental policies known as Medigap. ... On Medicaid, the White House again proposed a streamlined funding system that states do not support. The plan would combine various rates of federal funding into a single percentage. States and budget analysts say that approach would simply shift costs to the states, rather than actually controlling the cost of Medicaid. Washington Gov. Christine Gregoire, a Democrat, said last year that the consolidated payment rates could be a "huge problem" for states (Baker, 2/13).

The New York Times: Military Cuts And Tax Plan Are Central To Obama Budget
But the question this year is whether Mr. Obama after the election, win or lose, can use his veto and looming budget deadlines to force some compromises — even a “grand bargain” of spending cuts and revenue increases for deficit reduction could be possible, Mr. Obama has told people privately. “The president’s budget is a reasonable opening move for what will likely be major budget negotiations after the election and before the Bush tax cuts are due to expire at the end of the year,” said Jim Kessler, vice president for policy at Third Way, a centrist policy organization (Calmes, 2/13).

Modern Healthcare: Reform Funding Remains Priority In Obama Budget
The administration's fiscal 2013 budget has requested $76.4 billion for HHS, or about $300 million above fiscal 2012's funding level. "The budget maintains investments in the administration priorities such as the Affordable Care Act implementation and Head Start," according to an HHS summary in the administration's financial blueprint  (Zigmond and Daly, 2/13). 

The New York Times: Pentagon Wants To Raise Some Retirees' Health Fees
Defense Secretary Leon E. Panetta has warned that runaway personnel costs at the Pentagon are "unsustainable," and on Monday he tried to put a big brake on the spending: Over the next five years the Defense Department plans to nearly quadruple the health insurance fees paid by many working-age military retirees (Bumiller, 2/13).

Medscape: New Federal Budget Proposal Mostly Spares Physicians
As they feared, hospitals take it on the chin in the president's new set of numbers. Under the plan, hospitals would receive $36 billion less over the course of the next 10 years in Medicare funds that offset unpaid deductibles and copayments owed by patients. At this time, Medicare covers 70% of patient bad debt. The Obama administration considers a 25% offset more reasonable. Medicare funding of residency training programs also would fall by $10 billion, with the Obama administration reasoning that they are overcompensated for their costs (Lowes, 2/13). 

Bloomberg: Drugmaker Rebates Would Rise $156B In Obama Budget
President Barack Obama’s budget plan would trim spending on federal health programs at the expense of drugmakers, hospitals and nursing homes while seeking nearly $1 billion for carrying out the 2010 health-care law. ... Drug companies led by Pfizer Inc. (PFE) would have to provide $156 billion in discounts over the next decade for medicines sold to low-income senior citizens, on top of $80 billion in discounts and rebates the industry agreed to help fund the cost of the health-care overhaul (Wayne, 2/14).

Reuters: Obama Seeks To Cut Municipal Bond Tax Breaks
As the sweeping healthcare overhaul comes on-line, fewer people will lack health insurance, according to the budget. Obama would cut $18.1 billion through 2020 in "Disportionate Share Hospital" payments intended to support hospitals that treat low-income and uninsured patients. Altogether, the budget "provides $623.7 billion in outlays for state and local governments in 2013, an increase of $20.2 billion from 2012." Nearly half would go to healthcare, according to budget documents, with 17 percent for income security programs, 15 percent for education and social services, and 13 percent for transportation (Lambert, 2/13).

Reuters: What's In That Obama Budget For You?
You'd pay more for Medicare. There's a slew of smaller provisions aimed at making Medicare slightly more means tested than it is now. Starting in 2017, the proposal would increase income-related premiums in section B (which covers doctors visits and similar services) and D (which covers prescription drugs) by 15 percent. Those higher premiums currently are required of taxpayers with income over $85,000 ($170,000 for couples filing joint returns). Obama proposes keeping the income threshold stable (not adjusting for inflation) until one in four beneficiaries are paying extra premiums which currently start at $55.60 a month (for B and D) and go up to $286.20 a month (Stern, 2/13).

The Associated Press: Analysis: A Budget Plan Or A Campaign Document?
Obama's budget blueprint showcases the major priorities of his presidency, ones that contrast sharply with Republicans' near-solid opposition to tax increases and advocacy for deep spending cuts, including in popular benefit programs such as Medicare and Medicare. ... Obama's budget does claim $360 billion in savings over the next decade in Medicare and Medicaid programs, but he proposes to do it with relatively modest changes. White House officials defended the cuts to so-called entitlement programs (Raum, 2/14).

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Critics Find Much To Fault In Obama Budget

Republicans say the budget doesn't do enough to restrain entitlement spending. Health care industry groups, meanwhile, call proposed payment cuts unfair and unworkable.

The Wall Street Journal: Obama Seeks New Taxes On Rich
[Mitt] Romney issued a statement Monday criticizing the president's budget for not taking "any meaningful steps toward solving our entitlement crisis." Congressional Republicans also criticized Mr. Obama for offering no new proposals to reform Medicare, Medicaid or Social Security, which are expanding rapidly as Americans age and health costs climb (Lee and Paletta, 2/14).

USA Today: Obama's Budget Proposal Draws Fire, Praise In Congress
Republicans plan to put forward specific plans to rein in the debt and reform entitlement programs, but that path is riddled with political land mines. Last year, Ryan included in the House-passed budget a plan to phase Medicare in to a premium support system that Democrats are keen to use against Republicans in congressional races this November. Ryan signaled Monday that Republicans would not back away from offering specific policy positions on entitlements (Davis, 2/14).

National Journal: Romney Highlights Social Security, Medicare In Budget Critique
In what is likely to become a recurring campaign theme, Mitt Romney on Monday focused on Medicare and Social Security in his harsh critique of President Obama’s fiscal 2013 budget proposal, saying the blueprint "had nothing to say about making sure those programs are solvent and permanent"  (Boxer, 2/13).

NPR: What Would The GOP Candidates Do With The Federal Budget? A Look At Their Plans
Veterans benefits, Medicare, food stamps, education funding — you name it — it would probably have to be cut, says [the Center on Budget and Policy Priorities' Paul] Van de Water. "I don't see how non-defense cuts of this magnitude could possibly be achieved" (Keith, 2/14).

Modern Healthcare: Obama Budget Brings Quick, Critical Response From Industry
Healthcare industry groups were quick to criticize the Obama administration's fiscal 2013 budget, referring to the plan as both shortsighted and unfair to providers. ... Tom Nickels, senior vice president of federal relations at the American Hospital Association, said providers, who already are dealing with payment cuts through regulatory and legislative changes, must also face nearly $130 billion in cuts over 10 years when sequestration kicks in next year (Zigmond and Daly, 2/13).

Kaiser Health News: Health Budget Battle Redux 
Of course, health care providers never like payment cuts, and some said Monday that they understood that Obama has to take steps to reduce the federal deficit. But they may be especially nervous this year because of what awaits them in January unless Congress steps in: the automatic 2 percent Medicare payment cut for providers, triggered by the super committee’s lack of action (Carey, 2/13).

Modern Healthcare: Association Condemns Critical-Access Cuts
The Obama administration's proposed Medicare cuts of $2 billion over 10 years to critical-access hospitals were criticized by the National Rural Health Association as being unrealistic and not easily workable. The president's proposed budget for 2013 includes the suggestion to reduce critical-access hospitals' Medicare reimbursement to 100% of reasonable costs from its current 101% of costs, and to prohibit critical-access hospital designation for facilities within 10 miles from the nearest rural hospitals (Barr, 2/13).

CQ HealthBeat: Health Stakeholders Slam Cutbacks In President’s Proposed HHS Budget
Advocates of preventive health and medical research raised strong objections Monday to President Obama’s proposed budget for the Department of Health and Human Services, as did providers ... the plan would cut Medicaid and Medicare providers’ payments over the next 10 years, trim the Centers for Disease Control and Prevention budget and freeze spending the National Institutes of Health (Norman, 2/13).

National Journal: Obama’s Budget Finally Pleases AIDS Activists
President Obama may finally be living up to the expectations of AIDS activists, who had long hoped the first African-American president might pay close attention to the HIV epidemic. The president’s 2013 budget request includes an increase of $58 million to the Centers for Disease Control and Prevention for AIDS, as well as $10 million for hard-hit urban areas and $88 million more for care and treatment under the Ryan White program (Fox, 2/13).

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Fewer Health Care Dollars Would Flow To States Under Obama Budget Plan

Some cuts would come in Medicaid rates and medical research.

The Connecticut Mirror: Obama Budget Mixed Bag For Connecticut
The president wants to phase out a Medicaid provider tax that Malloy has used to help balance his budget. The White House also wants to "blend" Medicaid rates with the rates received from the federal government for a health program for children. That could mean fewer federal health dollars for Connecticut (Radelat, 2/13).

Boston Globe: Obama Takes A Stand In Budget
[F]ewer Medicare training funds would reach Boston’s renowned teaching hospitals, but extra money for research and higher education would bolster some Bay State firms and institutions (Jan and Bender, 2/14).

The Baltimore Sun: Obama Budget Cuts Would Hit Maryland
The $3.8 trillion spending plan for 2013 would trim $4 trillion from the national debt over a decade ... Many of those reductions would affect Maryland, including funding for Chesapeake Bay cleanup, teaching hospitals such as Johns Hopkins and research grants awarded by the Bethesda-based National Institutes of Health (Fritze and Walker, 2/13).

Minneapolis Star Tribune: In Minnesota, Health Care, Farmers May Feel Budget Squeeze
Drug companies and hospitals that treat Medicare patients also are looking at some $267 billion in total cuts during the next decade, part of a broader initiative to squeeze efficiencies out of the national health care system for seniors ... At Children's Hospitals and Clinics of Minnesota, the mood was equally sour because of a proposal to cut two-thirds of a program used to train pediatricians and pediatric specialists, such as heart doctors and surgeons (Diaz and Spencer, 2/13).

Meanwhile, the budget proposal would help states with funds to build exchanges -

The Hill: Obama Budget Sets Aside $864M Set Up Health Care Law
The law requires health insurance exchanges to be in place in all 50 states by Jan. 1, 2014. States that want to run their own exchanges must pass muster with the federal government by the end of 2013; the federal government will operate a default exchange in states that fail to launch their own (Pecquet, 2/13).

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Feds Recover Record Amounts From Fraudulent Medicare Claims

Federal authorities say they recovered $4.1 billion in health care fraud judgments last year, a record high which officials on Monday credited to new tools for cracking down on deceitful Medicare claims.

The Associated Press: Feds Recover $4.1B In Health Care Fraud In 2011
Federal authorities say they recovered $4.1 billion in health care fraud judgments last year, a record high which officials on Monday credited to new tools for cracking down on deceitful Medicare claims. The recovered funds are up roughly 50 percent from 2009. Attorney General Eric Holder and Department of Health and Human Services Secretary Kathleen Sebelius were expected to make the announcement at a news conference Tuesday (Kennedy, 2/13).

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Coverage & Access

Debate Shifts On Contraception Rule

While congressional Republicans say the fight isn't over on the administration's birth control mandate, the measured support for President Obama's compromise from some Catholic groups and a few Republicans has tamped down the political furor.

Politico: Republicans Say It's Not Over On Contraception Rule
Buoyed by the support of the Catholic bishops, congressional Republicans say they’re going all out against President Barack Obama’s modified contraceptives policy, ensuring that the compromise hasn’t ended the controversy over the health care reform rule after all. Senate Republicans say they want to force a vote on conscience legislation as soon as possible, and the House has already been drafting legislation in the Energy and Commerce Committee. "We to need to work out a strategy and that probably involves the House," Sen. Roy Blunt (R-Mo.), one of the Republicans’ leaders on the issue, said Monday (Haberkorn and Nocera, 2/14).

The Associated Press: White House Attacks Contraception Bills
The White House says legislation in the Senate that would give employers broad leeway to restrict coverage for contraception is "dangerous and wrong." Press secretary Jay Carney took aim Monday at a bill by Republican Sen. Marco Rubio of Florida — a possible GOP vice presidential candidate — and Democratic Sen. Joe Manchin of West Virginia that would allow any employer to deny birth control coverage if it runs counter to their religious or moral beliefs (2/13).

The Hill: Debate Suddenly Shifts On Birth Control
The furor over President Obama’s birth-control insurance mandate appears to have vaporized as quickly as it blew up. The White House faced just two questions on the issue at a briefing with reporters Monday, just days after the intense controversy threatened to swamp the president’s reelection campaign. While the president’s Friday "accommodation" did not win over the White House’s most harsh critics, some Republicans and Catholic groups have offered measured support, including centrist Maine Republican Sens. Olympia Snowe and Susan Collins, suggesting Obama might have at least muddied the waters (Parnes and Baker, 2/13).

CNN: Pro-Choice Group Thanks Obama In New Ads
NARAL Pro-Choice America will air radio ads for the next week in support of the Obama administration's policy toward coverage for female contraception. The spot, which thanks President Barack Obama for guaranteeing insurance coverage for birth control, will air in Denver, Colorado, Orlando, Florida, Northern Virginia and Madison, Wisconsin, according to the group (2/13).

NPR: Why Catholic Groups' Health Plans Say No To Contraceptives, Yes To Viagra
If health insurance plans offered by Catholic-sponsored entities refuse to cover contraceptives for women because of the religion's moral teachings banning artificial birth control, do they cover Viagra for men? ... Procreation is something the Catholic church encourages. And Viagra and other erectile dysfunction drugs can be of help. ... Vasectomies, on the other hand, are banned by Catholic-sponsored health insurance (Rovner, 2/13).

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Fewer People Getting Health Insurance Through Employer

Fewer people — 44.6 percent of all Americans — are getting health insurance through their employer, a new Gallup poll finds. In other news, as health care costs increase, giving birth at home is becoming a more attractive option despite doctors' concerns.

Politico: Employer Insurance Declines, Survey Shows
Fewer Americans received health insurance from their employer in 2011, continuing a trend that has seen the figure decline over the past three years. According to Gallup, 44.6 percent of Americans received health insurance from an employer in 2011, compared with 45.8 percent in 2010. In 2008, 49.2 percent of Americans received their insurance from their employer  (Mak, 2/14).

Kaiser Health News: Despite Doctors' Concerns, Home Births Are Increasing
For the vast majority of parents-to-be, giving birth involves a stay at a hospital or birthing center. But a growing minority are choosing instead to have babies at home, where, they hope, they can have a more private, low-tech experience and allow the process to unfold naturally. It doesn't hurt that in these days of rising health care costs, having a baby at home is a lot cheaper, too (Andrews, 2/14). 

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Health Reform

States' Experiences With High-Risk Pools Vary

One of the early provisions of the health law set up temporary insurance pools for people with medical conditions who couldn't buy insurance. Politico looks at what the varied state experiences in that program suggest about other aspects of the health overhaul.

Politico: High-Risk Insurance Pools Short On Enrollees
When the health care law passed nearly two years ago, the conventional wisdom was that the temporary insurance pools meant to carry the high-risk uninsured until the coverage expansion kicked in would tear through their $5 billion budget in no time. That didn’t happen. The next conventional wisdom was that the pools were ridiculously undersubscribed. ... Now the conventional wisdom is — there is no conventional wisdom. Some states are tearing through their money, having attracted a small but very, very sick pool of people. And others are not. And the varying experiences of the states have taught officials some lessons about care-seeking patterns of the chronically uninsured that may help smooth things out when state exchanges open in 2014 (Millman, 2/13).

Also, changes in the health system will need a larger primary care workforce. HHS announced funding to help with that.

Los Angeles Times: Obama Health Chief Visits L.A. Clinic, Announces Plan To Help Students
Health and Human Services Secretary Kathleen Sebelius visited a health clinic in downtown Los Angeles on Monday and announced more than $9 million in funding to help medical students repay school loans if they agree to work in underserved areas. Sebelius said the program will encourage more students to pursue careers in family medicine and will help relieve a shortage of primary care doctors (Gorman, 2/14).

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Senate Republicans Ask Supreme Court To Strike Mandate

In a brief filed Monday, 43 Senate Republicans said that if the Supreme Court allows the mandate to buy health insurance in the Democrats' health law to stand, then Congress could require Americans to buy almost anything.

The Hill: Senate Republicans Press Supreme Court To Strike Health Care Mandate
Forty-three Senate Republicans filed a brief Monday urging the Supreme Court to strike the individual mandate in President Obama's health care law. The brief echoes the arguments made by the 26 states that filed the legal challenge. If Congress can require people to buy health insurance, the brief argues, it could mandate almost any purchase. Critics of the mandate say it takes the unprecedented and unconstitutional step of requiring economic activity, rather than regulating it (Baker, 2/13).

CQ HealthBeat: GOP Senators File Brief In Health Care Lawsuit
Republican senators on Monday filed a brief with U.S. Supreme Court saying that "Congress acted without constitutional authority" when it approved the requirement in the health care law that all Americans must have health insurance. Senate Minority Leader Mitch McConnell of Kentucky and others said that the individual mandate included in the law has damaged the legitimacy of Congress as an institution and triggered conflicts between the states and the federal government (Norman, 2/13).

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Patient Satisfaction Not Linked With Health Status

Modern Healthcare: Study Questions Utility Of Satisfaction Scores
Newly released research has linked higher patient satisfaction scores with greater healthcare costs and increased risk of mortality. Despite the growing reliance on satisfaction scores as a tool for evaluating physician performance, "research suggests a tenuous link between patient satisfaction and healthcare quality and outcomes," according to the study published online Feb. 13 in the Archives of Internal Medicine (McKinney, 2/13). 

The Sacramento Bee: Satisfied Patients Not Always Healthiest, UC Davis Study Shows
 In fact, satisfied patients are more likely to be hospitalized, have higher health care costs and be more likely to die than less-satisfied ones, according to a study released Monday by UC Davis researchers. … [The  study] is believed to be the first to suggest that emphasizing patient satisfaction could have unanticipated adverse effects (Garza, 2/14).

Related, earlier KHN story: When TLC Doesn't Satisfy Patients, Elite Hospitals May Pay A Price (Rau, 11/7) 

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Health Information Technology

UnitedHealth To Offer Industry Cloud Computing Option

The idea is to get health care data out of scattered hospitals, doctors' offices and insurance claims departments and allow doctors and patients better access to complete information.

Minneapolis Star Tribune: Optum Takes Health Care To The Cloud
UnitedHealth Group's health services division, Optum, hopes to do for the complex and fragmented health care system what Apple has done for all manner of information that consumers need. The idea is to get health care data out of scattered hospitals, doctors' offices and insurance claims departments and move it to the cloud, an Internet-based platform that would let doctors and patients get access to all the information they need through one website. The bold business strategy is expected to be announced Tuesday, when the Eden Prairie-based company launches a secure, cloud-based environment that will offer access to its 700 technology-based products (Crosby, 2/14).

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State Watch

State Roundup: Mass. Small Biz Co-Ops Start, Miss. Medicaid Changes

Boston Globe: Small-Business Health Co-Op Will Slash Rates
Thousands of small businesses will be offered discounts of at least 20 percent on health insurance rates under a new group purchasing cooperative, formed by the Retailers Association of Massachusetts, that will begin enrolling members this week. The co-op is the first permitted to do business under a 2010 Massachusetts law that allows small employers to band together in large groups and negotiate for better-priced health coverage (Weisman, 2/14).

California Healthline: Health Reform Shifting From Planning to Action
[H]ealth reform these days means taking action — actually implementing plans rather than talking about them."Enrollment and eligibility [in the exchange] is where it's at," Kim Belshé, a board member for California's Health Benefit Exchange, said. "This is where the action is. What we aspire to achieve — seamless, coordinated care for millions of Californians" (Gorn, 2/13).

HealthyCal: Riverside County Launches Insurance Plan For Low-Income Families
Riverside County took a first step toward federal health care reform last month with the launch of Riverside County Healthcare, an insurance plan for poor people who don't qualify for Medi-Cal. Some 20,000 people — about 10 percent of the county’s uninsured population — will be covered. ... [T]en California counties, including Los Angeles, Alameda and San Diego, began to expand services to low income people in programs similar to Riverside’s in 2007. Among their challenges was teaching people how to use health insurance (Urevich, 2/13).

California Healthline: Getting a Head Start on Medi-Cal Expansion
For a program no one's really heard of, this one is pretty successful. Counties started enrolling people into the Low-Income Health Program in July 2011, and four months later (at the most recent count in November) about 260,000 Californians were enrolled in it, according to Linda Leu, a health care policy analyst with Health Access California (Gorn, 2/14).

Related, earlier KHN story: The Public Option Did Not Die (Varney, 1/12).

Kansas Health Institute News: Centers Struggle To Cope With New Rules
The system that helps more than 6,000 physically disabled Kansans across the state live in their own homes instead of long-term care facilities is undergoing sweeping changes that have been launched by the administration of Gov. Sam Brownback. Administration officials say the shake-ups ultimately will result in a more efficient and accountable system with potential for helping more people. But those who deliver the services at the local level through the state’s 12 regional independent living centers say they don’t see how those outcomes will be possible (Shield, 2/13). 

New Orleans Times-Picayune: Council on Aging Officials Concerned About Proposed Move Under Department Of Health And Hospitals
[Kathy Kliebert, Louisiana's deputy secretary of health and hospitals, said she understands the anxiety. ... "Right now, about 18 percent of the state's population is over 60. By 2030, it will be nearly 25 percent. We have a critical responsibility to make sure we build an infrastructure of support for this population that is sustainable, coordinated and comprehensive moving forward," Kliebert said (Ross, 2/13).

Mississippi Public Broadcasting: Proposed Medicaid Changes Could Affect Enrollment
Mississippi lawmakers are looking at ways of trimming and cutting the cost of the state's Medicaid program. Currently 1 in 4 Mississippi is on Medicaid. ... At least two bills have been introduced in the legislature, controlling who gets on Medicaid and how they stay on, including one by [state Sen. Chris] McDaniel to test Medicaid recipients for nicotine (Hess, 2/13). 

The Lund Report (Oregon): Republicans Block House Passage of Exchange Bill, Sending It To Budget Committee
The bill allowing Oregon's health insurance exchange was expected to pass easily out of the House today, but House Republicans and one Democrat blocked its passage, instead referring it to the budget-writing Ways and Means Committee. [Republicans raised] "specific questions" about the state's financial commitments to the exchange, and how the federal government’s $48 million grant currently funding the exchange will work (Waldroupe, 2/13). 

MSNBC/KNBN: S.D. Lawmakers Work To Change Health Care Regulations
A South Dakota House panel says if the new federal health care law is thrown out, the state should start over with its own health care regulations. South Dakota law now says the state handles its own health insurance regulations as long as they comply with the federal law (2/13).

The Sacramento Bee: Darrell Steinberg Wants Probe Of Sacramento County Dental Program
Senate President Pro Tem Darrell Steinberg is calling for a state review of a Sacramento County pilot program that provides state-funded dental coverage for low-income children. ... Steinberg asked the administration to step up its monitoring of dental plans under contract with the program and withhold payments or cancel contracts with plans that fail to provide proper access to care or meet other performance standards (Van Oot, 2/14).

San Jose Mercury News: New Survey About Californians' End-Of-Life Wishes
Fewer than one in four Californians has written instructions about how and where they would like to die — risking the immense emotional, physical and financial burden of end-of-life hospital care. Yet an overwhelming majority of Californians would rather die at home, far from the tumult of a hospital, according to a poll released Tuesday (Krieger, 2/14). 

San Francisco Chronicle: Survey Shows Disconnect On End-Of-Life Health Care 
[The survey] also showed broad public support for reimbursing physicians who take the time to talk to them about their end-of-life options, the very issue that sparked the infamous "death panel" debate in 2009 over President Obama's federal health care legislation (Colliver, 2/14).

Modern Healthcare: R.I. Hospital Agrees To $5.3 Million Settlement
Rhode Island Hospital in Providence has agreed to pay the federal government $5.3 million to resolve allegations that the medical center improperly kept about 260 patients in overnight stays after stereotactic radiosurgery, otherwise known as Gamma Knife treatments. ... The 683-bed hospital stands accused of billing Medicare and Medicaid for the overnight stays, even though the treatments didn't justify the extra expense of hospitalization, the Justice Department said (Carlson, 2/13).

The Atlanta Journal-Constitution: Infection Rate Too High In Seven Georgia Hospitals
Seven Georgia hospitals — including four in metro Atlanta — scored worse than the national benchmark for cases of potentially-deadly bloodstream infections. Emory Midtown, Northside Hospital, Piedmont Henry Hospital and Southern Regional Medical Center all performed worse than their peers for rates of central line-associated bloodstream infections in intensive care units, according to new data released by the U.S. Centers for Medicare & Medicaid Services (Teegardin, 2/14).

Related KHN story: Experts Question Medicare's Effort To Rate Hospitals' Patient Safety Records (Rau, 2/13). 

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Editorials and Opinions

Viewpoints: Obama's Budget, Birth Control Choices; Planning Hospital Readmissions

The New York Times: A Responsible Budget
In poll after poll, the public has made clear that it prefers the president’s approach of rebuilding the economy now and tackling the deficit when the fundamentals are stronger. While Republicans have counted on voters blaming Mr. Obama for the hard times, some are beginning to worry that they will be blamed for their obstructionism. That was clear on Monday when House leaders announced that they would agree to Mr. Obama’s proposal to extend the payroll tax cut for the rest of this year without insisting on drastic cuts elsewhere to pay for it. ... Unlike Republicans, Mr. Obama would trim only slightly from growth in Medicare and Medicaid (2/13).

The Washington Post: Obama’s Budget Falls Short, But It Beats Many Alternatives
To reduce debt, the first order of business must be Medicare. As he recommended with his debt reduction package last fall, Mr. Obama would introduce useful changes such as a premium surcharge for new Medicare beneficiaries who purchase first-dollar Medigap coverage. Still, most of the envisioned cuts fall on Medicare providers and do not go far enough to restructure the system (2/13).

The Wall Street Journal: The Amazing Obama Budget
His budget also proposes no meaningful reforms in entitlements, which are the fastest growing part of the budget and will grow even faster once ObamaCare really kicks in (2/14).

USA Today: Editorial: Obama's Budget Plan Leaves Debt Bomb Ticking
Everyone serious in Washington knows that the key to defusing the debt bomb is a "grand bargain" that combines cuts in the big entitlement programs with tax increases, and not just on the rich. As long as Republicans remain intransigent on taxes and Democrats balk on entitlement reform, the deficits will keep piling up (2/13).

USA Today: Opposing View: President's Budget Makes Many Tough Choices
Two weeks ago, President Obama outlined in his State of the Union address a blueprint for an economy built to last — where everyone gets a fair shot, everyone does their fair share, and everyone plays by the same rules so that there are good jobs that pay well and there is security for the middle class (Jeff Zients, 2/13).

The Chicago Tribune: Free Government-Imposed Health Care For All?
Yes, the Obama administration's fiat that religious institutions and now insurance companies — a difference without a distinction — must pay for contraceptives raises profound constitutional and religious liberty issues. But why government should be able to dictate whether we pay for every "preventive care" medical service that comes along has been pushed out of sight. It's accepted as a given by so many that it has taken on aspects of holy writ (Dennis Byrne, 2/14).

The Washington Post: Obama’s Epic Blunder On Birth-Control Mandate
The initial policy was a disaster. The partial retreat was more skilled. Obama’s goal was not resolution but obfuscation. The contraceptive mandate was shifted from Catholic employers to insurance companies. Instead of being forced to buy an insurance product that violates their beliefs, religious institutions will be forced to buy an insurance product that contributes to the profits and viability of a company that is federally mandated to violate their beliefs. Creative accounting, it seems, can cover a multitude of sins (2/13).

Los Angeles Times: Birth-Control Flap Shows The Need To Abort Employer-Based Health Care
Our employer-based health care system — a historical anomaly — is more trouble than it's worth. Yes, it provides coverage for about 55 percent of the population, according to the Census Bureau, and polls show that most of those with employer-provided insurance are happy with their plans. But the number of people with employer-based coverage is steadily shrinking. In 2000, 64% of Americans were insured through their jobs (David Lazarus, 2/14).

Reuters: U.S. 'Pro-Life' And 'Pro-Choice' Extremists, You Don’t Speak For Me
"Pro-life" and "pro-choice" extremists, you don’t speak for me. And, by the way, you don’t happen to speak for the majority of the American people either. Over the past few weeks, the hot button issue of abortion rights in the United States has once again drawn national and sustained media attention in two events that almost seemed scripted to galvanize the certain on both sides (Elizabeth E. Evans, 2/13).

Des Moines Register: Where Has The Birth Control Furor Been?
Health insurance should cover basic services and medications, including birth control. One of the goals of federal health reform is to make sure it does. ... After much public attention, on Friday President Barack Obama announced Catholic institutions do not have to use their own money to pay for the medication. Instead, insurance companies will take care of it. The administration knows insurance companies have no problem with this for the same reason almost all pay for contraceptives now: The cost of birth control is less than the costs associated with a pregnancy (2/13).

Politico: Obama’s High Price For Birth Control
President Barack Obama’s decision requiring that Catholic institutions offer health plans with free birth control may cost him far more than the Catholic vote. Obama’s edict, a curtailment of freedom that can result from his type of regulatory regime and statist interventions, could ultimately threaten his entire reelection. It may also set off alarms in the corridors of the Supreme Court, which now has six Catholic justices. Including one, Anthony Kennedy, who is considered the crucial swing vote in deciding the constitutionality of Obama’s health reform law. If the court strikes down the insurance mandate, the entire law is likely to collapse — and Obama’s most significant achievement will disappear  (Keith Koffler, 2/14).

Archives of Internal Medicine: Planned Readmissions: A Potential Solution
As a result of the Patient Protection and Affordable Care Act (hereinafter, "ACA"), the Centers for Medicare and Medicaid Services (CMS) will be targeting avoidable readmissions to improve quality and reduce Medicare spending. ... A more sustainable option is to create a planned readmission code that could be used to prospectively indicate a planned procedure. At the time of discharge, hospitals would need to provide specific diagnosis and procedure codes for the planned readmission procedure on the discharge paperwork as well as the date and location of the planned readmission (Dr. Scott A. Berkowitz and Gerard F. Anderson, 2/13).

Chicago Sun-Times: Take A New Look At Cost Of Keeping Old Prisoners
A new study by Human Rights Watch reports that American prisons are fast becoming geriatric facilities, with the number of prisoners 55 and older growing at a rate six times that of the rest of the prison population. The Illinois Department of Corrections spends about $428 million a year — about a third of its budget — on older inmates. We’re frankly torn on what to do about this problem, but feel surely it deserves greater attention. Fortunately, a state panel, the Sentencing Policy Advisory Council, is collecting data on the issue (2/13).

McClatchy: Raising A Healthier Generation Of Americans
As the United States moves toward rebuilding its economy and ensuring the long-term strength of our middle class, we're mindful of the wise words of President Harry Truman: "In the long view, no nation is healthier than its children." By that measure, we have some work to do, and we're tackling it head on. Over the last three decades, obesity rates have tripled. Today one in three children is at risk for preventable diseases such as diabetes and heart disease due to being overweight (Agriculture Secretary Tom Vilsack, 2/13).

Milwaukee Journal Sentinel: What Doctor Shortage Means For Wisconsin
Most do not want to recognize that health care is rationed. It is done so by lack of insurance. Health reform is expected to rectify that, but it will exacerbate a new form of rationing: The doctor is not in (Steve Jacob, 2/13).

The Sacramento Bee: Dental Plan For Poor Kids Is A Mess
In 1994, Sacramento was chosen to test a new dental health care model, "geographic managed care." Under it, dental plans that contract with the state receive a set amount of money, $12 per child assigned to them per month. Managed care is supposed to be cheaper than traditional fee-for-service and more comprehensive because it covers preventive as well as emergency services. Apparently no one from the state bothered to monitor the program to make sure children were getting the services for which the state paid. … Last year, Sacramento ranked third worst in the state in the number of dentist visits per child enrolled in Medi-Cal. Sacramento was dead last in percentage of poor kids seen by dentists in the previous three years (2/14).

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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.