Daily Health Policy Report

Thursday, February 14, 2013

Last updated: Thu, Feb 14

KHN Original Reporting & Guest Opinion

Health Reform

Health Spending And Fiscal Battles

Capitol Hill Watch

Health Care Marketplace

Public Health & Education

Health Information Technology

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

California Health Chief Looks Within For Solution To Rising Health Costs

Reporting for Kaiser Health News, Russ Mitchell writes: "Van Gorder, an ex-cop turned hospital executive, rescued troubled Scripps from near insolvency a dozen years ago as its new CEO. Now, he's put Scripps in the middle of a cultural transformation aimed at saving hundreds of millions of dollars a year by -- get this -- coaxing physicians and managers at Scripps to work together, and standardizing care across every hospital in the system" (Mitchell, 2/14). Read the story.

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President Barack Obama Calls For 'Modest Reforms' To Medicare

Kaiser Health News' Mary Agnes Carey and Jackie Judd examine the health care issues in Tuesday night's State of the Union address -- and Sen. Marco Rubio's Republican response -- in this Health on the Hill discussion (2/13). Read the transcript.

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Capsules: Study: Expanding Medicaid Cheaper Than Not In Colorado; California Sets Standard Deductibles, Copays For Insurance Plans; San Diego Hospice Will Close As Financial Problems Grow; The 'Yawning' Chart Med School Students Fear

Now on Kaiser Health News' blog, Colorado Public Radio's Eric Whitney, working in partnership with KHN and NPR, reports on Colorado's Medicaid expansion: "Opponents of the Medicaid expansion called for in the Affordable Care Act say states can't afford it, even with the federal government picking up most of the tab. But a new analysis says it would actually be more expensive for Colorado to not expand Medicaid" (Whitney, 2/14).

In addition, Julie Appleby reports the latest on California's new online marketplaces: "California on Wednesday became the first state to standardize health insurance plans under the federal health law, which regulators say will make shopping for health insurance easier when new online marketplaces begin enrolling customers in the fall" (Appleby, 2/14).

Meanwhile, Randy Dotinga reports on the latest news related to San Diego Hospice's woes: "San Diego Hospice, one of the nation’s oldest and busiest, is closing its doors permanently in response to financial problems stemming from an investigation of its practices by Medicare. The hospice announced last week that it planned to file for bankruptcy. On Wednesday, San Diego Hospice said it would cease operating in the next 60 to 90 days and that Scripps Health has offered to buy the hospice's small hospital and hire hospice employees to care for current patients" (Dotinga, 2/14).

Also on Capsules, Ankita Rao reports on the supply and demand of medical residency slots: "The graph from the Association of American Medical Colleges displays a yawning gap between the increasing number of med school grads looking for residencies and the number of residency slots available to them" (Rao, 2/13). Check out what else is on the blog.

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Political Cartoon: 'Don't Go Breakin' My Heart?'

Kaiser Health News provides a fresh take on health policy developments with "Don't Go Breakin' My Heart?" by Gary Markstein.

Meanwhile, here is today's health policy haiku:


Fake and phony drugs...
IOM mulls the question:
How to close pipeline?

 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

California Unveils Standards For Health Plans

By taking this step, California became the first state to standardize health insurance plans under the federal health law.

Los Angeles Times: California Reveals Details Of Health-Law Insurance Plans
Consumers are getting their first glimpse at what health insurance will look like in California as the state prepares to implement the federal health care law. On Wednesday, state officials will spell out the details on policies available next year to people buying their own coverage. In January 2014, most Americans will be required to have health insurance or face a penalty (Terhune, 2/13).

Kaiser Health News: Capsules: California Sets Standard Deductibles, Copays For Insurance Plans
California on Wednesday became the first state to standardize health insurance plans under the federal health law, which regulators say will make shopping for health insurance easier when new online marketplaces begin enrolling customers in the fall (Appleby, 2/14).

The Associated Press: Calif. First To Set Standards For Health Benefits
California's health benefits exchange became the first in the nation Wednesday to set a standard benefits design to help people comparison shop for insurance under the federal health care overhaul. The move will help consumers more easily determine what kind of coverage they want to buy, said Peter Lee, executive director of Covered California (Lin, 2/13).

HealthyCal: Covered California Unveils Benefit Plans
California consumers got their first glimpse Wednesday at the insurance coverage that will be available later this year when the state implements the federal health reform known as the Affordable Care Act. The benefit plans and the first-year cost to consumers who will be eligible for federal subsidies were unveiled by Covered California, the agency in charge of implementing the new federal law, which Congress and President Obama adopted nearly three years ago and the US Supreme Court upheld last summer (Weintraub, 2/13).

Sacramento Bee: California Health Exchange Rolls Out Options
Millions of uninsured Californians will soon be required to buy health insurance or face a penalty, and Wednesday morning they got a glimpse of what to expect. Covered California, the organization responsible for implementing the federal health insurance overhaul, released a blueprint for what types of coverage will be available on the state's insurance marketplace. The Affordable Care Act requires state exchanges to be up and running by 2014. Peter Lee, executive director of Covered California, said the exchange will add some much-needed standards and transparency to California's health insurance market. "They are ready to play by the rules," Lee said of the insurance industry at a news conference. "They are ready to embrace the opportunity to compete not based on a shell game of hidden benefits but based on quality and value" (White, 2/14).

California Healthline: Standards Release A ‘Milestone’ For Exchange
Covered California, the state's health benefit exchange, yesterday released its benefit standards outlining the basis for choosing qualified health plans that will participate in the exchange. "This is another milestone for the exchange," said Diana Dooley, secretary of the state Health and Human Services Agency. "We have a lot of hurdles to get over, we still have a lot to do, but this is another successful milestone toward the health care reform effort." Covered California also submitted an intention to file emergency regulations with the Office of Administrative Law last week, outlining its pediatric dental benefit policy. The exchange is expected to file those regulations Friday, according to Brandon Ross, staff counsel for Covered California (Gorn, 2/14).

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Illinois Is 3rd State Approved To Partner With Feds

Health and Human Services Secretary Kathleen Sebelius joined Illinois Gov. Pat Quinn Wednesday to announce the state had become the third to receive conditional approval to run a health insurance exchange in partnership with the federal government. Other states are also taking steps to develop their exchanges -- or, at least, mulling what to do next.

California Healthline: Path To Partnership: More States Opt For HHS' Hybrid Exchanges
New Hampshire: We're in. North Carolina: We're not. The two states on Tuesday were the latest to announce their intentions on the Affordable Care Act's health insurance exchanges. States have until Feb. 15 to tell HHS whether they'll retain even some control over the exchanges, or let the Obama administration run the exchanges for them. And while New Hampshire made clear that it wants to partner with the federal government to launch an insurance exchange, North Carolina backed out of a previous plan to do exactly that. By Friday, we'll know where half a dozen other states stand, too (Diamond, 2/13).

The Hill: Illinois To Partner With HHS On Healthcare Exchange
The Health and Human Services Department gave conditional approval Wednesday to a "partnership" insurance exchange in Illinois. HHS has been pushing states toward a partnership model if they're not prepared to run their entire exchange alone but also want to retain some control over the new marketplace, rather than ceding it entirely to the federal government (Baker, 2/13).

CQ Healthbeat: Sebelius Visits Illinois To Announce Conditional Approval For Partnership Exchange
Aiming to build a sense of momentum surrounding implementation of the health care law, HHS Secretary Kathleen Sebelius announced at an event in Chicago with Illinois Gov. Pat Quinn Wednesday that his state has received a conditional nod to run a health insurance exchange in partnership with the federal government. Illinois becomes the third state to receive a conditional approval for a partnership. HHS had already given that status to Arkansas and Delaware (Reichard, 2/13).

Modern Healthcare: Ill. Joins Feds As Exchange Deadline Nears
Illinois became the third state to receive conditional approval to launch a health insurance exchange in partnership with the federal government less than eight months from now. The announcement came days before a Feb. 15 deadline for states to apply to participate in that model in 2014. The deadline is three months later than originally planned. The Obama administration extended the window in November to give more time to states with newly elected governors and others that awaited the presidential election outcome to choose a direction. The partnership model is one of three options for health insurance exchanges—recently rebranded by HHS as marketplaces—required by the Patient Protection and Affordable Care Act. States also can apply to operate their own marketplaces or they can take no action and default to a federally operated exchange (Daly, 2/13).

The Associated Press: Michigan Lawmakers Mull $31M For Health Care Exchange
Gov. Rick Snyder's administration told lawmakers Wednesday it needs their approval within weeks to spend a $31 million federal grant to help build a consumer-friendly health insurance marketplace under the contentious federal health care overhaul, or else the state will be stuck with a bill. Though Republicans rejected the GOP governor's request to spend federal money on a state-run exchange last year, the issue is not going away because open enrollment for hundreds of thousands of uninsured Michigan residents is less than eight months away (Eggert, 2/13).

Atlanta Journal Constitution: House Passes Bill To Create License Standards For Health Care Exchange
The Georgia House passed a bill Wednesday that would require health insurance navigators to be licensed in order to help uninsured Georgians and businesses use a federally backed online health insurance exchange. House Bill 198, introduced by Rep. Richard Smith, R-Columbus, would establish training and licensing procedures for the navigators, whose positions are required elements of the Affordable Care Act. The navigators cannot advise consumers to opt for specific plans, but they can help consumers learn about Medicaid eligibility, federal tax subsidies and health plan options (Leslie, 2/13).

The Associated Press/Washington Post: Measure Would Create Funding Stream For Exchange And Expand Medicaid
Lt. Gov. Anthony Brown and state health officials on Wednesday outlined some of the final steps in a three-year effort to create a health benefit exchange in Maryland as part of the federal health care overhaul (2/13).

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Wisconsin's Walker Walks Away From Medicaid Expansion

But studies conducted in other states -- such as Colorado and Georgia -- predict the expansion will have a positive impact.

Politico: Scott Walker Picks Obamacare Over Medicaid
Wisconsin Gov. Scott Walker, avowed Obamacare foe, proposed an ambitious plan Wednesday to cut his state's uninsured population in half — by getting them covered through Obamacare. The Republican announced that he is rejecting Medicaid expansion and the billions of federal dollars that would come with it. In fact, he's proposing a net cut in the state Medicaid program (Cheney, 2/14).

The Associated Press: Walker Says No To Federal Medicaid Expansion
Gov. Scott Walker announced Wednesday that he won't propose expanding Medicaid services in Wisconsin, joining other Republican governors who have decided to reject federal money for covering more low-income residents under the health care overhaul law. Instead, Walker outlined a hybrid approach that would allow more adults into the state health program, which he said would help cut the state's uninsured rate of 14 percent in half (Bauer, 2/13).

Milwaukee Journal Sentinel: Walker Rejects Full Medicaid Expansion, Says 224,000 More To Be Covered
The state would turn down a full expansion of the BadgerCare program under the federal health care law, but 224,600 more state residents would still gain coverage as the law takes effect, under a proposal unveiled Wednesday by Gov. Scott Walker. Speaking to an audience of hundreds at a meeting here of business lobby Wisconsin Manufacturers & Commerce, Walker said his plan would cover somewhat fewer people than a full expansion of Medicaid as provided under the federal health care law, which he said would cover 252,700 people, or 28,100 more than his own approach. But the Republican governor said that his proposal, which shrinks state health programs by a few thousand patients, would reduce the role of government in people's lives and make them more independent (Stein, 2/13).

Kaiser Health News: Capsules: Study: Expanding Medicaid Cheaper Than Not In Colorado
Opponents of the Medicaid expansion called for in the Affordable Care Act say states can't afford it, even with the federal government picking up most of the tab. But a new analysis says it would actually be more expensive for Colorado to not expand Medicaid (Whitney, 2/14).

Georgia Health News: Study Says Medicaid Expansion Would Enrich State
The theme of the Affordable Care Act as a job creator in Georgia gained steam Wednesday after release of a report on the projected benefits of Medicaid expansion. An estimated 70,000 new jobs would be gained if Gov. Nathan Deal approved expansion of the state’s Medicaid program, according to the report, from Georgia State University’s Bill Custer. The study, commissioned and released by Healthcare Georgia Foundation, also said expansion would produce an economic impact statewide of $8 billion annually. Deal, though, has remained steadfast in his opposition to Medicaid expansion, citing an estimated $4.5 billion cost to the state over 10 years (Miller, 2/13).

The Associated Press: SD Lawmakers Exploring Medicaid Expansion
South Dakota lawmakers, including leaders from both parties, announced Wednesday they are continuing to seek more information about the possible expansion of Medicaid. A group of 19 lawmakers said they have formed a committee to learn more about the advantages and drawbacks of expanding Medicaid (Brokaw, 2/13).

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State Officials Worry That Docs May Not Accept New Wave Of Medicaid Patients

More than 7 million people are expected to gain insurance through Medicaid under the federal health law next year. In other news about implementation of the health overhaul, the trade group representing Catholic hospitals reserves judgment for now on the latest administration policy requiring contraception coverage.

Stateline: Luring Primary Care Docs Into Medicaid
The Affordable Care Act will usher at least seven million more Americans into Medicaid next year, but the question of whether enough doctors will be there to welcome them is keeping some state health policymakers up at night. A report published last year in Health Affairs signaled trouble ahead. According to that study by Sandra Decker, an economist at the National Center for Health Statistics, only two out of three primary care physicians surveyed in 2011 were willing to accept new Medicaid patients. Larger numbers said they would take on new Medicare patients or see new patients with private insurance. Medicare, health care for the elderly, is a purely federal program; Medicaid, which covers many poor people, is a joint state and federal enterprise (Ollove, 2/14).

The Associated Press/Washington Post: Catholic Hospitals: Latest Compromise On Birth Control An Improvement For Faith Groups
A trade group for Roman Catholic hospitals says the latest federal rules on birth control coverage are an improvement. But the Catholic Health Association said Wednesday it won't make a final judgment until after canvassing its members (2/13).

The Wall Street Journal's Washington Wire: Catholic Health Assn. Sees 'Progress' In Contraception Proposal
The Catholic Health Association said Wednesday that the Obama administration’s latest proposal on how employees of religiously affiliated institutions would get contraception under the 2010 health law represents "substantial progress." The response from the group's president, Sister Carol Keehan, was considerably warmer than the one issued last week by the U.S. Conference of Catholic Bishops, who said the new rules "fall short" (Radnofsky, 2/13).

And in other news --

Politico: Obamacare Deadline Looms For Holdout States
For those states that just can't quite make up their mind, time's up. Friday is the day when states are due to declare whether they'll partner with the White House to build Affordable Care Act health insurance exchanges. After that, the sprint to the finish begins (Cheney and Millman, 2/13).

The Washington Post's The Fact Checker: Obama And Rubio: Dueling Visions Of 'Obamacare'
Obama's health-care law was in many ways the dog that did not bark during the State of the Union. Obama felt no need to defend it, and Republicans no longer declared that they would repeal it. (Sen. Marco) Rubio simply referenced "Obamacare" as a government program that could hurt the middle class — while Sen. Rand Paul (R-Ky.), in the Tea Party response, made no mention of the health-care law. In other words, the law is more or less here to stay. The race is now on to define the law's legacy and impact. Let's take a look at whether either man has the facts to back up their diametrically opposed statements (Kessler, 2/14).

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Health Spending And Fiscal Battles

Treasury Pick Says He Will Work To Reduce Medicare Spending, But Offers Few Specifics

Meanwhile, President Barack Obama's references in his State of the Union address to modest changes to Medicare continue to generate examination.

The Wall Street Journal: Treasury Pick Focuses On Taxes, Spending
Jacob Lew, the Treasury secretary nominee, told lawmakers Wednesday he would work to overhaul the tax code and reduce costs of programs such as Medicare, but largely avoided delving into specifics about how he would tackle such tasks (Paletta, 2/13).

Kaiser Health News: President Obama Calls For 'Modest Reforms' To Medicare
Kaiser Health News' Mary Agnes Carey and Jackie Judd examine the health care issues in Tuesday's State of the Union address as well as in Sen. Rubio's Republican response (2/13).

Reuters: Obama Medicare Rebate Plan Could Hurt Drug Companies
President Barack Obama's decision to spotlight drug rebates as a way to save money on Medicare is likely to be opposed by the pharmaceutical industry, which could potentially lose billions of dollars in profits. In his annual State of the Union speech on Tuesday, Obama said he would "reduce taxpayer subsidies to prescription drug companies" to rein in the rising cost of Medicare, the $600 billion healthcare program for the elderly and disabled (Berkrot and Morgan, 2/13).

And sequester concerns continue to emanate from public health agencies --

CQ Healthbeat: CDC Director Frieden Predicts Local Public Health Cuts Under Sequester
The Centers for Disease Control and Prevention would have "no alternative" but to reduce funding for state and local public health agencies if automatic budget cuts go into effect on March 1, the director of the agency told a House panel on Wednesday. CDC Director Thomas Frieden said that if the agency's funds are reduced under sequester provisions in the 2011 budget control law, "we have to do everything we can to limit the harm we have to do." Leaders of the agency are "focusing on efficiencies" and trimming administrative costs, he told the Subcommittee on Oversight and Investigations of the House Energy and Commerce Committee (Norman, 2/13).

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Capitol Hill Watch

House GOP Chairman Seeks Permanent Solution To Medicare Doc Pay Problem

Rep. Fred Upton, R-Mich., chairman of the House Energy and Commerce Committee, told physicians this week that he hopes to send "doc fix" legislation to the House floor this summer. Meanwhile, Senate Finance Committee Chairman Max Baucus, D-Mont., plans hearings for President Barack Obama's pick to head the Centers for Medicare & Medicaid Services.

Reuters: House Republican Aims To Repeal Medicare Doctor Pay Cuts
Republicans in the House of Representatives will seek a permanent solution to scheduled steep cuts in physician payments from the federal Medicare health insurance plan for retirees and disabled people, a House committee chairman said on Wednesday. Rep. Fred Upton, chairman of the House Energy and Commerce Committee, told doctors he hopes to send so-called "Doc Fix" legislation to the House floor this summer that would repeal payment reductions enacted in 1997 as part of a law to balance the federal budget (Morgan, 2/13).

The Hill: Upton: Obama Stalled On Permanent 'Doc Fix'
The Republican leader of a powerful House committee slammed President Obama on Wednesday because the healthcare law did not include a permanent "doc fix." Obama "deliberately failed to address what has been the greatest threat in the medical profession since the last decade," said Rep. Fred Upton (R-Mich.), referring to Medicare's sustainable growth rate (SGR) formula (Viebeck, 2/13).

The Hill: Rep. Upton Unsure Of Another Repeal Vote On Medicare Cost Board
A top Republican committee chairman said he's not sure the House will vote again to repeal President Obama's controversial Medicare cost-cutting board. Rep. Fred Upton (R-Mich.), who leads the Energy and Commerce panel, said Wednesday that plans for the current legislative term are still in the works (Viebeck, 2/13).

The Wall Street Journal's Washington Wire: Baucus Plans Hearing For Medicare-Medicaid Nominee
Senate Finance Committee Chairman Max Baucus said Wednesday that he plans to hold a confirmation hearing for President Barack Obama's pick to head the Centers for Medicare and Medicaid Services, raising the prospect of another nomination fight that will revive health-care and entitlement program debates (Radnofsky, 2/13).

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Post Office Seeks To Revamp Health Plan And Retiree Funding

The postmaster general asks for congressional permission for the post office to run its own health plan for employees and retirees and modify the mandate that the agency pay $5.5 billion annually to fund future health benefits.

The New York Times: Debt Mounting, Postal Service Asks To Alter Business Model
During a hearing before the Senate Homeland Security and Governmental Affairs Committee, Patrick R. Donahoe, the postmaster general, asked Congress to give the Postal Service permission to run its own health plan for employees and retirees, modify a Congressional mandate that requires the agency to pay $5.5 billion a year into its fund for future employee health benefits, and end Saturday mail delivery. Mr. Donahoe said the changes would allow the agency to save $20 billion by 2016 (Nixon, 2/13).

The Wall Street Journal: Senator To Press For Overhaul Of U.S. Postal Operations
The Postal Service recorded a nearly $16 billion loss during its last fiscal year. Mr. Donahoe said losses near that level are likely to continue, as mail volumes continue to decline and as Congress restricts the ability to take cost-saving actions such as placing postal workers on a private health care plan (Morath, 2/13).

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Health Care Marketplace

Investors Send WellPoint Stock Lower As They Try To Learn More About New CEO Choice

Investors gave WellPoint's choice for a new CEO a chilly reception Wednesday, selling off shares in the insurer and driving its stock price down.

Los Angeles Times: New WellPoint CEO Gets Cool Reception On Wall Street
Investors didn't give a warm welcome to the incoming chief executive of health insurance giant WellPoint Inc. Shares of the nation's second-largest health insurer fell $3.01, or nearly 5 percent, to $63 in trading Wednesday, a day after the company named a veteran hospital executive to be its next CEO (Terhune, 2/13).

The Wall Street Journal: Investors Balk At WellPoint's Pick For CEO
Investors reacted with surprise to WellPoint Inc.'s choice of hospital executive Joseph R. Swedish as its new chief executive, sending the company's shares down 4.6 percent Wednesday as many scrambled to learn more about the incoming leader of the second-largest health insurer (Mathews, 2/13).

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Public Health & Education

IOM Proposes State, FDA Actions To Stop Growth Of Counterfeit Drugs

The Institute of Medicine Wednesday urged a series regulatory changes to help protect the public against buying fake or poorly made drugs.

Medpage Today: IOM: Work Needed On Counterfeit Drug Problem
State licensing boards should restrict their licensing activities to drug wholesalers who have been vetted by the National Association of Boards of Pharmacy (NABP) as a way of strengthening the nation's drug distribution system, the Institute of Medicine (IOM) said Wednesday. Also, FDA should establish a public database to share information on suspended or revoked wholesale licenses, the body suggested as part of its long list of recommendations. "Some states require NABP accreditation of wholesalers, but unscrupulous businesses can seek out states with lower standards for their headquarters," the IOM's "Countering the Problem of Falsified and Substandard Drugs" report stated. "And, because the wholesale trade is national, weaknesses in one state's system can become vulnerabilities in another” (Pittman, 2/13).

NPR: Report: Action Needed To Wipe Out Fake And Substandard Drugs
The National Academies of Science, of which the IOM is part, was commissioned by the Food and Drug Administration to look at how to protect people against fake and substandard drugs (Knox, 2/13).

The Wall Street Journal: More Lucrative Than Cocaine: Fake Medicine On The Rise
The risks of fake and flawed medicines have leapt from developing nations to Western supply chains, thanks to gaps in oversight of drug wholesalers, lax law enforcement, and ineffective tactics for tracking drugs as they change hands, according to a report released Wednesday by the Institute of Medicine. "It's distressing to see vividly just how huge a problem it is in the United States," said Larry Gostin, a Georgetown University law professor and World Health Organization adviser who led the study. "It's more lucrative to traffic in illegitimate drugs than cocaine or heroin," he said (Weaver, 2/13).

The Hill: Report: Fake Drugs Pose Threat To US
The Food and Drug Administration (FDA) says it has taken on the issue, already practicing the recommendations offered by the Institute of Medicine report, called "Countering the Problem of Falsified and Substandard Drugs," including strengthening global regulatory capacity and drug manufacturing surveillance. The FDA sponsored the study. ... But members of Congress want to create legislation to increase the crackdown and oversight effort (Wilson, 2/13).

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Wider Use Among Young Women Drives Higher Use Of 'Morning-After' Pill

Growth in use among 20-somethings has doubled the use of the "morning-after" contraceptive pill in recent years, the Centers for Disease Control and Prevention says.

The New York Times: Use Of Morning-After Pill Is Rising, Report Says
The use of morning-after pills by American women has more than doubled in recent years, driven largely by rising rates of use among women in their early 20s, according to new federal data released Thursday (Tavernise, 2/14).

Reuters: More U.S. Women Using The "Morning-After" Pill: Report
More U.S. women are taking the "morning-after" pill, but generally just once, according to the government's first report on how the emergency contraception drug has been used since regulators eased access to it in 2006. About 11 percent of sexually active women, or 5.8 million, used the pill between 2006 and 2010, compared to about 4 percent in 2002, the Centers for Disease Control and Prevention said in its report released on Thursday (Heavey, 2/14).

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Health Information Technology

Examining Electronic Medical Records And Over-Billing

Center for Public Integrity: Electronic Medical Records Probed For Over-Billing
The Obama administration is forging ahead with a multi-billion dollar plan to shift from paper to electronic medical records, despite continuing concerns the program may be prompting some doctors and hospitals to improperly bill higher fees to Medicare. An investigation into those billing questions — which convened a hearing Wednesday — has yet to produce much in the way of results, and critics are questioning the seriousness of the efforts (Schulte, 2/14).

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State Watch

States Roundup: N.Y. Budget Woes Include Medicaid Money Worry

A selection of health policy stories from New York, Georgia, Kansas, California, Iowa, Colorado, Oregon and North Carolina.

NBC News: Health Reform Hands States Surprising Weapon Against Abortion
Abortion opponents have found a new way to restrict access to abortion -- by using the authority states have over the new health insurance exchanges, which will be up and running in a year. At least 21 states have legislation in place or in the works that will stop health insurance companies from paying for abortions for women. Arkansas governor Mike Beebe signed the latest piece on Monday. The 2010 Affordable Care Act requires states to set up health insurance marketplaces called exchanges by October of this year. Through exchanges, people who don't have health insurance through the government or an employer can buy health insurance (Fox, 2/14).

The New York Times: Comptroller Criticizes Budget Plan Of Governor
But the comptroller's office raised concerns that the budget depended on federal aid that might not come to fruition, including $1.1 billion in Medicaid reimbursements, and counted on wage and job growth producing significant increases in tax collections (Kaplan, 2/13).

Atlanta Journal Constitution: Gov. Deal Signs Hospital 'Bed Tax' Bill, But Health Care Woes Persist
Georgia’s faltering Medicaid program received a massive financial bandage Wednesday when Gov. Nathan Deal signed a measure into law to avert a roughly $700 million hole in the state’s health care budget. But the funding generated through the measure -- which clears the way for renewal of a fee on hospitals -- is not nearly enough to cover the health care needs of Georgia’s growing population over the next two years. The state’s community health agency and Georgia’s Medicaid program are still short hundreds of millions of dollars, and there’s no solution in sight. For now, that means growing health care costs will continue to be passed on to consumers as hospitals try to make up for money lost caring for the uninsured by hiking up prices for those patients who can pay (Bluestein and Williams, 2/13).

The New York Times: Four Years Later, Slain Abortion Doctor's Aide Steps Into The Void
This spring, Julie Burkhart, an abortion-rights advocate who lives in Wichita, is planning to reopen the abortion clinic that occupied this space for decades, setting the stage for a re-emergence of the fiery passions that once made this conservative manufacturing town the center of the abortion battle in the United States (Eligon, 2/13).

Kansas Health Institute: No Opposition To Create A KanCare Oversight Committee
It appears a proposal to create a new legislative committee to oversee the implementation of KanCare could have smoother sailing this year than last. A hearing on House Bill 2025 was held today in the House Health and Human Services Committee and lawmakers heard it endorsed by officials from the Kansas Department of Health and Environment and the Kansas Department for Aging and Disability Services, the state's two main Medicaid agencies (Shields, 2/13).

Kaiser Health News: California Health Chief Looks Within For Solution To Rising Health Costs
Reporting for Kaiser Health News, Russ Mitchell writes: "Van Gorder, an ex-cop turned hospital executive, rescued troubled Scripps from near insolvency a dozen years ago as its new CEO. Now, he's put Scripps in the middle of a cultural transformation aimed at saving hundreds of millions of dollars a year by -- get this -- coaxing physicians and managers at Scripps to work together, and standardizing care across every hospital in the system" (Mitchell, 2/14). Read the story.

Georgia Health News: Georgia Firms To Share Ideas On Cutting Health Costs
Two years ago, Jamie Benton of RaceTrac confronted a problem that vexes human resources directors across the nation: increasing health care costs. By 2011, employee health costs for the gas station/convenience store company were going up 9 percent a year. So Benton and RaceTrac, a private company headquartered in Atlanta, switched to a “consumer-driven’’ health plan. It has a high deductible, but that is coupled with health incentives for the company’s thousands of employees. If the workers do a health risk assessment, are nonsmokers and join a wellness program, RaceTrac will pay nearly half of their deductible (Miller, 2/13).

The Associated Press: House Approves Money For Mental Health Transition In Iowa
Iowa House lawmakers approved a bill Wednesday that would give some counties a share of $11.6 million to continue treatment of mental health patients as the state transitions to a regional system. The measure, which now moves to the Senate, would give money to 26 of the 32 counties seeking extra help to get them through this fiscal year (Elmer, 2/13).

The Denver Post: Colorado Mental Health Experts Propose Changes To Hickenlooper's Plan
Less than two months after Gov. John Hickenlooper announced a plan to spend $7.5 million to open new mental health crisis centers, experts have offered an alternative, saying the funds could be better spent strengthening Colorado's existing centers and expanding programs in rural areas. Hickenlooper and the Colorado Department of Human Services revealed a five-point plan to revamp Colorado's mental health services in response to this summer's deadly shootings at an Aurora movie theater. (Robles and Steffen, 2/14).

The Associated Press: Study: California Saved $134B In Health Care Costs Thanks To Tobacco Control Program
California's tobacco prevention program saved $134 billion in health care costs over the last two decades, according to a new study published Wednesday about the smoking control program’s impacts in the most populous state. California spent about $2.4 billion from 1989 through 2008 on one of the nation’s most aggressive tobacco control programs, buying up billboards and TV time to run ads against smoking, as well as promoting smoke-free bars and restaurants and tobacco cessation programs (2/13).

The Lund Report: Oregon's FamilyCare Bumps Up Primary Care Reimbursement Rate
Doctors and nurse practitioners who provide primary care to patients enrolled in FamilyCare will soon get a little more money for their time in the office. Starting in March, FamilyCare will be paying primary care providers more per primary care visit -- an average of $75 per visit versus the $50 it and other managed care providers typically pay now, which is still higher than the $37 base rate for Medicaid visits, FamilyCare president and CEO Dr. Jeff Heatherington announced at a press conference yesterday hosted at Dr. Robin Richardson's southeast Portland office (McCurdy, 2/13).

Kansas Health Institute: Bill Would Allow Sale Of 'Mandate Lite' Health Insurance Policies
A bill that would allow health insurance companies to develop and market so-called ‘mandate lite’ policies in Kansas was the subject of a legislative committee hearing today. Senate Bill 163 calls for allowing companies to sell major-medical policies that could, for example, exclude coverage of mental health, pharmacy, chiropractic or allergy treatments (Ranney, 2/13).

North Carolina Health News: DHHS Secretary Wos Lays Out Priorities To Legislators
Medicaid and information technology – those were the two priorities laid out by the new Health and Human Services secretary for her department Wednesday at the General Assembly. HHS Secretary Aldona Wos came to the state legislature for the second time since taking her position five weeks ago to tell lawmakers what she thinks DHHS needs to do (Hoban, 2/14).

Health Policy Solutions (a Colo. news service)/EdNews Colorado: School Health Data System Gets $3 Million, Five-Year Grant
Kaiser Permanente and the Colorado Legacy Foundation on Thursday announced a $3 million, five-year plan to create a comprehensive data reporting system for school health and wellness indicators. The new School Health Policy and Practice Data Collection Program will help demonstrate the link between health and education, and provide feedback to schools to help them improve programming. The project is a collaboration among Kaiser Permanente, which will provide the funding, and the Colorado Legacy Foundation, the Colorado Department of Education and the Colorado Coalition for Healthy Schools. Helayne Jones, president and CEO of Colorado Legacy Foundation, said part of the problem is that "we don't know what is working because we haven’t had a consistent way of measuring health and wellness practices" (Schimke, 2/13).

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Weekend Reading

Weekend Reading: What Your Doctor Should Tell You, New Stages of Grief

Every week Ankita Rao selects interesting reading from around the Web.

The Atlantic: Keeping Patients Out Of Hospitals: A Private-Sector Approach To Health Reform
Dr. Jim Dougher climbs into his white SUV, plugs the address of his next patient into the GPS, and he's off. The SUV is well stocked: He has a large Tupperware bin in the back full of bandages and wound cleaning supplies; he has a variation on the old-time doctor's bag with a stethoscope and blood-pressure cuff; and he has a dedicated cellular wifi hotspot and a laptop that can communicate with HealthCare Partner's electronic medical record…This payment system creates a remarkable alignment of interests: It is irrelevant that Dougher's home-visit unit would lose massive amounts of money in a traditional fee-for-service system (Adam Wolfberg, 2/13).

Mother Jones: 5 Things Your Doctor Should Tell You, But Won't
As a lifelong hypochondriac, I've always been comforted by the Hippocratic oath. What an excellent idea, having doctors pledge to put patients first. So I was less than thrilled to learn that doctors are under increasing pressure—from state legislatures, industry, and other groups—to break that oath by withholding key pieces of information from their patients. "We are very concerned about special interests attempting to influence our practices," says Valerie Arkoosh, president of the National Physicians Alliance (NPA). "We've seen state legislatures overreaching a lot with regard to doctor-patient relationship." Here are five things that—depending on where you live—your doctor could be keeping from you (Kiera Butler, 2/11).

Slate: The Five Stages Of Grief Should Be Changed
When Elisabeth Kübler-Ross debuted the five stages of grief in her book On Death and Dying, published in 1969, they were intended for people facing their own deaths. Kübler-Ross later went on to apply these same five stages to the bereaved, to people who had lost a loved one, but upon closer inspection, I'm not sure they work as well. Losing a loved one is not the same as losing your life. Grief thrusts us into an uncertain world where anxiety often reigns supreme. Yet anxiety is the very element missing from Kübler-Ross' stages (Claire Bidwell Smith, 2/11).

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Editorials and Opinions

Viewpoints: FDA Needs More Power To Regulate Compounding Pharmacies; Time To Revamp Military Benefits, Including Health

The Washington Post: The Crisis Of Compounding Pharmacies
Traditionally, the licensing and control of pharmacies has been left to the states, but their performance has been uneven. The federal role has been thrown into question in recent years by lawsuits. ... compounding pharmacies are not generally required to inform the FDA that they are in business nor to register with the FDA or disclose what products they are making. ... Congress needs to give the FDA new tools and enforcement powers. Congress also needs to close a standards gap. The nation’s major pharmaceutical companies must meet Good Manufacturing Practices, a set of strict standards for the production of drugs so that consumers know that each and every dose is correctly formulated and sterile. But these do not apply to compounding pharmacies (2/13). 

Los Angeles Times: Covered California Previews The New Marketplace For Health Insurance
You might not know it from the near-incessant fighting over the 2010 federal healthcare law, but its main provisions -- the ones designed to bring coverage to millions of the uninsured -- won't go into effect until next year. State officials gave Californians their first look Wednesday at some of those changes, revealing what the out-of-pocket costs would be for a new, standardized set of insurance policies (Jon Healey, 2/13).

The Wall Street Journal: Four Key Questions For Health-Care Law
Thanks to the Supreme Court and Barack Obama's re-election, the Affordable Care Act—"Obamacare" to foes and a few of its friends—isn't going away. The issue now is how it will work. Even by Washington standards, implementing this law is extraordinarily complex. The federal government last year issued 70,000 pages of guidance, including 130 pages on the look of websites for new marketplaces where many will shop for insurance (David Wessel, 2/13). 

The Wall Street Journal: From SEAL Team Six To Retiring Without Health Insurance
Esquire magazine's report this week that a retired 16-year veteran of the United States military—a Navy SEAL who played a key role in the May 2011 raid that killed Osama bin Laden—now struggles without health care has become a mini cause celebre. The story is an opportune time to review how the U.S. takes care of the men and women who do so much to protect it (John Barnett and Michael O'Hanlon, 2/13). 

Politico: Ben Carson Vs. Obama
The National Prayer Breakfast is not supposed to serve as a forum for a clash of political visions, but that was what Ben Carson made it last week. The Johns Hopkins Hospital neurosurgeon and motivational speaker lit up the event with a politically charged speech that quickly went viral. Mention "death panels" standing a few yards from the president, who is professionally obligated to sit and listen, and that tends to happen. ... Warning of the disastrous effects of "moral decay" and "fiscal irresponsibility," Carson touched on a very different approach in his speech at the prayer breakfast, advocating government frugality, a flat tax and health care accounts controlled by individuals. Carson said — not persuasively given the complexities involved — that these items are just common sense (Rich Lowry, 2/13). 

The Seattle Times: Painful Tales Of Mental Illness Spur Lawmakers To Action
There is finally urgency in Olympia to reform mental-health care. One lawmaker after another has heard harrowing first-person accounts of scant treatment, denied at critical moments. ... (Jordan Taylor-McPhail’s) story underlines the costs of our last-in-the-nation ranking for community psychiatric beds. In the last decade alone, the tally of beds certified for involuntarily committed patients dropped by a third (Jonathan Martin, 2/13). 

Boston Globe: A Strong Message For Beth Israel Deaconess
The settlement between Beth Israel Deaconess Medical Center and the Harvard doctor who said she endured years of sexist treatment — and punishment for complaining about it — is a hallelujah moment for working women everywhere. It took courage for Dr. Carol Warfield, the former chief of anesthesia there, to file suit against a premier teaching hospital, the chief of surgery who she said humiliated her, and the chief executive who she said ignored her complaints. It also took tenacity to press forward as the defendants tried to bury her in endless paper and pleadings (Joan Vennochi, 2/14).

Oregonian: Oregon Lawmakers Eye Smoking In The Car: Agenda 2013
People make a lot of bad parenting decisions. They let their kids overindulge on junk food and slip into obesity. They blow the family paycheck on video lottery games provided thoughtfully by the state of Oregon. Sometimes, they even light up a cigarette in the family SUV while Junior's in the back seat. Parents shouldn't do any of this stuff, of course. But should the state make bad parenting a crime? If it involves tobacco, lawmakers seem particularly inclined to say "yes" (2/13).

Health Policy Solutions (a Colo. news service): Medicaid Expansions Will Help Colorado's Economy
When the Colorado Health Foundation commissioned my team to study the economic and budgetary impacts of expanding eligibility for the Medicaid program, we looked at the issue objectively through a dollars-and-cents lens. ... The results of our analysis, highlighted in the just-released Colorado Health Foundation report, "Medicaid Expansion: Examining the Impact on Colorado’s Economy," show that the Colorado economy will grow more with Medicaid expansion than without it. In short, expansion will have a net positive impact on the Colorado economy (Charles Brown, 2/13).

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Andrew Villegas

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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.