Daily Health Policy Report

Friday, February 15, 2013

Last updated: Fri, Feb 15

KHN Original Reporting & Guest Opinion

Health Reform

Administration News

Capitol Hill Watch

Health Care Marketplace

Public Health & Education

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

States Face Friday Deadline For Partnership With Feds On Marketplaces

Kaiser Health News staff writer Phil Galewitz reports: "States face another Affordable Care Act deadline Friday— their last chance to work with the federal government in setting up new online health insurance marketplaces that open for business Oct. 1" (Galewitz, 2/15). Read the story.

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Capsules: Feds Increase Costs To High-Risk Pool Members; Valentine's Day Surprise: Senate Democrats Blast Obamacare Implementation; As Hospital Challenges Rise, Their Bond Ratings Fall

Now on Kaiser Health News' blog, Phil Galewitz reports on news related to federal high-risk pools: "The Obama administration has increased costs for about 38,000 people enrolled in high-risk insurance pools run under the federal health law to prevent the program from running out of money" (Galewitz, 2/14).

In addition, he filed a report about some Senate Democrats' criticism of certain elements of the health law: "Testifying before the powerful Senate Finance Committee, the administration’s top regulator on new health exchanges encountered criticism from several Democrats who helped push through the 2010 federal health overhaul — among them Chairman Max Baucus of Montana and Sens. Ron Wyden of Oregon, Bill Nelson of Florida and Maria Cantwell of Washington" (Galewitz, 2/14).

Also on Capsules, Jay Hancock writes about hospital bond ratings: "Nonprofit hospitals don't issue stock, so you can't track their financial health by the ups and downs of share prices. But many sell bonds, and it's fair to say that hospital bonds haven't fared as well recently as the Dow Jones average. Last year set a record for hospital-bond downgrades, as debt levels rose and hospitals faced the uncertainty of business under the Affordable Care Act, debt-rater Moody's said this week" (Hancock, 2/15). Check out what else is on the blog.

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Political Cartoon: 'Radical Surgery?'

Kaiser Health News provides a fresh take on health policy developments with "Radical Surgery?" by John Darkow.

Meanwhile, here is today's health policy haiku:


Health care cost curve bent?
Vegas says don't bet on it.
Strong evidence mounts.
-- Paul Hughes-Cromwick

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

Health Exchanges: Today Is States' Decision Day

States have to decide by Feb. 15 whether they will create their own health insurance exchanges, partner with the federal government partner with the federal government or allow the federal government to do it for them. Meanwhile, during a congressional hearing marked by skepticism, a Health and Human Services official told lawmakers that the government would be ready to enroll people this fall.

USA Today: States Face Friday Deadline On Health Care Exchanges
As states work to decide by Friday whether they plan to create their own or partner with the federal government to run health exchanges, there has been one last-minute surprise and one skin-of-the teeth agreement (Kennedy, 2/15).

Kaiser Health News: States Face Friday Deadline For Partnership With Feds On Marketplaces
States face another Affordable Care Act deadline Friday— their last chance to work with the federal government in setting up new online health insurance marketplaces that open for business Oct. 1. The Obama administration has given "conditional approval" to 17 states and the District of Columbia to run their own marketplaces, which will offer one-stop shopping for private insurance or Medicaid, the state-federal health insurance program for the poor (Galewitz, 2/15).

The New York Times: Enrollments For Insurance Start Oct. 1, Official Says
An Obama administration official told Congress on Thursday that the government would be ready to enroll millions of people in private health insurance plans this fall, but senators of both parties expressed doubts (Pear, 2/14).

Bloomberg: Insurance Exchanges Are On Track, Official Says
The Obama administration will meet an Oct. 1 deadline for setting up new state insurance exchanges, said a top U.S. health official who met skepticism from lawmakers at a congressional hearing today. The exchanges, created by the 2010 U.S. health-care overhaul, are online marketplaces where people will be able to compare and buy government-subsidized insurance. Their scheduled implementation next year has been called into doubt because of the complexity of the law and opposition in some states (Wayne, 2/14).

CQ Healthbeat: Cohen Lays Out Path For Standing Up Federal Exchange
The top federal official in charge of establishing health insurance marketplaces under the health care law detailed plans Thursday for a poorly understood but major part of that effort: the federally facilitated exchange. It was long past time to do so, Sen. Orrin G. Hatch, R-Utah, indicated in his opening remarks at a Senate Finance Committee hearing on exchanges. “Many key details remain unanswered,” Hatch complained in his opening statement at the hearing, which centered on testimony by Gary Cohen, head of the Centers for Consumer Information and Insurance Oversight at the Centers for Medicare and Medicaid Services (Reichard, 2/14).

The Washington Post's WonkBlog: Inside The Obama Administration's Plan To Build 25 Insurance Markets
For months now, it's been one of the health care overhaul’s biggest unknowns: Will the federal government be ready to run two dozen state insurance marketplaces? On Thursday Gary Cohen, director of the Center for Consumer Information and Insurance Oversight gave the Senate Finance Committee the most comprehensive explanation to date of what the agency has achieved so far—and what remains to be done (Kliff, 2/14).

Kaiser Health News: Capsules: Valentine's Day Surprise: Senate Democrats Blast Obamacare Implementation
Testifying before the powerful Senate Finance Committee, the administration's top regulator on new health exchanges encountered criticism from several Democrats who helped push through the 2010 federal health overhaul — among them Chairman Max Baucus of Montana and Sens. Ron Wyden of Oregon, Bill Nelson of Florida and Maria Cantwell of Washington (Galewitz, 2/14).

Modern Healthcare: Baucus Demands Details On Progress Toward Insurance Exchanges
Despite renewed assurances that the federal government will have its insurance exchanges ready to begin enrollments Oct. 1, the senior Senate health policy Democrat demanded more details on the secretive effort. Sen. Max Baucus, chairman of the Senate Finance Committee, on Thursday required the CMS to provide his panel with the agencies' specific goals for the establishment of federally operated health insurance exchanges and the timeframes for accomplishing those benchmarks. The status of those exchanges is critical because the CMS may need to launch and operate up to 30 of them in states that do not have either self-operated exchanges or insurance marketplaces operated in tandem with the federal government. But the CMS has generally not specified the status of many of the critical elements of the federal exchanges, even to congressional Democrats (Daly, 2/14).

On the state level, governors continue to make clear the finer points of what their respective states plan to do --

The Associated Press/Washington Post: McDonnell To Feds: Virginia Will Use Federal Health Exchange But Retain Oversight On Providers
Gov. Bob McDonnell told the Obama administration Thursday that while Virginia will use a federally run health insurance exchange, the state intends to retain regulatory authority over insurance providers that do business with Virginians through the exchange. McDonnell's Feb. 14 letter to Gary Cohen of the U.S. Department of Health and Human Services confirms his December position not to commit Virginia to establishing its own exchange that would be financed and operated by the state (2/14).

The Associated Press: Ohio To Let Feds Run Health Exchange
Ohio officials on Thursday confirmed the state's intentions not to run its own health insurance exchange but, instead, have the federal government operate the new online marketplace under President Barack Obama's health care law. A letter sent Thursday to the Obama administration reiterates what Republican Gov. John Kasich told federal officials in November — that Ohio will keep its authority to regulate health plans in and out of the exchange, but leave running it to the federal government (Sanner, 2/15).

The Associated Press: 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 (Eggert, 2/14).

Health Policy Solutions (a Colo. news service): Medicaid Expansion A 'No Brainer': Hike In GDP And New Jobs By 2015
Expanding Medicaid to an estimated 275,000 additional people will cost Colorado less than the price of not adding them. That's the bold prediction from a new study of Medicaid expansion commissioned by the Colorado Health Foundation, which supports expansion, and conducted by seasoned legislative budget analyst Charlie Brown and a team of economists (Kerwin McCrimmon, 2/14).

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The Politics And Policies Of The Medicaid Expansion

State executives ranging from Louisiana Gov. Bobby Jindal and Wisconsin Gov. Scott Walker to Indiana Gov. Mike Pence and Missouri Gov. Jay Nixon continue to wrestle with their plans regarding the expansion -- and repercussions, in terms of public opinon, budgets and policy decisions -- that are emerging as a result.

The Associated Press: Jindal Says He Won't Reconsider Medicaid Expansion
Gov. Bobby Jindal said Thursday he won't reconsider his refusal to expand Louisiana's Medicaid coverage under the federal health care law, even though a half dozen other Republican governors have agreed to participate. Jindal said he won't include federal funding for a Medicaid expansion in his state budget proposal for the 2013-14 fiscal year, which will be released to lawmakers Feb. 22 (Deslatte, 2/14).

The Washington Post’s The Fix: Bobby Jindal's Make-Or-Break Moment
But since then Jindal has made some tough budget choices and has pushed some difficult education reforms. Perhaps most troubling for him right now is his decision to reject a federal Medicaid expansion – a decision the Voter/Consumer Research poll showed is unpopular with the state's voters. Jindal has been out front among Republican governors in rejecting the Medicaid expansion, even as a growing number of GOP governors have decided to take part. In fact, Jindal wrote an op-ed in the Washington Post last month about why he decided to reject the expansion (Blake, 2/14).

The Associated Press: Analyst Says Walker's Health Care Plan Won't Work
Gov. Scott Walker's plan to move more people off state Medicaid plans and onto private insurance through a federal marketplace won’t result in cutting the number of uninsured Wisconsin residents in half as promised, an independent analyst said Thursday. Walker's numbers are inflated because poor people near the poverty line won't be able to afford private health insurance that requires individuals to pay for annual deductibles and other cost-sharing expenses, Bob Laszewski, a Washington-based insurance industry consultant, told The Associated Press after reviewing the Republican governor’s plan (Bauer, 2/14).

The Associated Press: Pence Pushes State Solutions For Health Care – 'Medicaid Is Broken' He Tells Feds
Indiana Gov. Mike Pence asked the federal government Wednesday to approve a three-year extension of the Healthy Indiana Plan health savings accounts in lieu of an expansion of the federal Medicaid system he called "broken." Pence wrote a fiery letter to Health and Human Services Secretary Kathleen Sebelius on Wednesday saying Medicaid is fraught with "waste, fraud and abuse," while also seeking approval for the HIP extension (LoBianco, 2/14).

The Associated Press: Mo. House Budget Plan Skips Medicaid Expansion
Following through on Republican opposition, the top budget writer for the Missouri House outlined a spending plan Thursday that omits Gov. Jay Nixon's proposed Medicaid expansion. The plan by Budget Committee Chairman Rick Stream also provides a smaller increase for public colleges and universities, early childhood initiatives and various other programs that the Democratic governor had proposed for the 2014 fiscal year (2/14).

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Dentists Concerned About Gaps In Health Law Coverage; Mass. Effort For Small Business Insurance Hampered By Federal Law

The federal overhaul requires dental care for children but advocates say the mechanism for that will often be complicated. Meanwhile, in a different article about the complications of implementing the health law, the Boston Globe examines efforts by small businesses to buy insurance.

Politico: Gaps In Health Law Dental Coverage
The health care law was supposed to go a long way toward getting more kids access to dental care. But as it stands now, the effort may fall short. Children's dental coverage is considered an "essential health benefit" under the law. But the way it's likely to be offered — through separate dental policies with no penalties for parents who don't get them — has dentists and child health advocates worried (Cunningham, 2/15).

Boston Globe: Small Businesses Fear Rise In Health Costs Under New US Rules
Small businesses, which bore the brunt of health insurance increases over the past decade, were heartened when a state law passed in 2010 allowed­ them to band together to buy coverage at a discount through newly established health insurance cooperatives. But trade groups that set up such group-purchasing co-ops now say they are threatened by new federal rules stemming from the national health care overhaul that would override Massachusetts insurance rating factors, boosting the premiums small employers pay (Weisman, 2/15).

In other implementation news --

Kaiser Health News: Capsules: Feds Increase Costs To High-Risk Pool Members
The Obama administration has increased costs for about 38,000 people enrolled in high-risk insurance pools run under the federal health law to prevent the program from running out of money (Galewitz, 2/14). 

Politico: Courts Split On Contraception, Cases Plow Forward
The cases brought against the Obama administration's employer contraception coverage rule are largely marching forward, despite the White House's recent attempt at compromise, the American Civil Liberties Union noted in an update Thursday (Smith, 2/15).

The Wall Street Journal's Washington Wire: CDC Report Sheds Light On Contraception Use
Two statistics at the heart of the controversy over mandatory insurance coverage of contraception — that 99% of American women have used contraception, including 98% of Catholics — are getting fresh attention from the Centers for Disease Control and Prevention. The topline findings in a Valentine's Day release from CDC back both of those claims, but with important caveats that are sometimes blurred in the debate (Radnofsky, 2/14).

Medscape: ACA Will Help Spark Boom In Remote Patient Monitoring
The number of Americans remotely monitored at home with devices such as pulse oximeters and peak-flow meters for 5 major chronic illnesses will grow 6-fold by 2017 as healthcare reform pushes hospitals and physicians to stop revolving-door admissions, reports InMedica, a division of IMS Research. In 2012, clinicians reviewed long-distance vital signs on computer screens for some 227,000 patients with congestive heart failure (CHF), chronic obstructive pulmonary disease, diabetes, hypertension, and mental illness, according to the InMedica report released in January. By 2017, that number will jump to almost 1.3 million (Lowes, 2/14).

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Administration News

Obama's Medicare Drug Rebate Plan Could Save The Government Money But Also Hit Drug Industry's Bottom Line

During his State of the Union address, President Barack Obama renewed a proposal to use drug rebates to save Medicare money -- a step that would trigger strong opposition from pharmaceutical companies.

The New York Times: Uphill Road For Plan To Cut Government's Drug Costs
In just a handful of words in his State of the Union address, President Obama renewed a proposal to lower the amount that the federal government pays for drugs taken by low-income seniors — a measure that supporters say would save the government more than $150 billion over the next decade. But it faces formidable opposition from Republicans, some Democrats and the powerful pharmaceutical industry, making passage unlikely (Thomas and Pear, 2/14).

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).

In the background --

The Associated Press/Washington Post: A Look At How Administration Says Automatic Budget Cuts Would Diminish Government Services
The sequester law exempts Social Security, Medicaid, food stamps and Medicare recipients’ benefits from cuts, but most programs are vulnerable. … The National Institutes of Health would lose $1.6 billion, trimming research on cancer, drying up money for hundreds of other research projects and eliminating up 20,000 private research positions nationwide. Health departments would give 424,000 fewer tests for the AIDS virus this year. More than 373,000 seriously ill people may not receive needed mental health services (2/15).

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Capitol Hill Watch

Hearing Raises Questions About How To Replace Medicare's SGR Formula

Medpage Today: Repealing SGR Raises Questions For Congress
Opinions on what to replace Medicare's sustainable growth rate (SGR) formula with and how to get there vary greatly, comments during a Thursday hearing showed. Lawmakers looking to pull the trigger on finally doing away with the SGR, which is used to determine physician payments, must iron out many of the details that came to light during a hearing Thursday before the House Energy and Commerce Health Subcommittee. An outline of a Republican-offered plan to repeal and replace the SGR released last week by the House Energy and Commerce Committee and House Ways and Means Committee looked remarkably similar to that of bipartisan bills offered in the past. The plan would repeal the SGR and provide statutorily defined payment rates for a period of years before moving to a payment model that rewards quality and efficiency (Pittman, 2/14).

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Health Care Marketplace

Anthem Blue Cross Will Reduce Rate Increase For About 630,000 Individual Policyholders

The move is in resonse to pressure from California's insurance regulator. Meanwhile, Cardinal Health, the nation's second-largest distributor of prescription drugs, will buy a large medical supplier. Cardinal Health hopes to expand into home health care.

Los Angeles Times: Anthem Blue Cross Rolls Back Rate Increase
In response to pressure from California regulators, Anthem Blue Cross agreed to a slightly lower rate increase for about 630,000 individual policyholders that will save consumers an estimated $54 million. Anthem, a unit of Indianapolis insurance giant WellPoint Inc., had sought to raise rates an average of 18% beginning Feb. 1. California Insurance Commissioner Dave Jones said Thursday that the company had agreed to reduce the average increase to 14% after regulators reviewed Anthem's rate filing (Terhune, 2/15).

The Associated Press: Anthem Reduces Rate Hikes On 630,000 Policyholders
California's insurance watchdog said Thursday that Anthem Blue Cross has agreed to reduce its rate increase for 630,000 policyholders. Insurance Commissioner Dave Jones announced Anthem has voluntarily agreed to reduce its premium increase for the individual market after his department conducted a review (2/14).

The New York Times: Cardinal Health Is Buying Large Medical Supplier For $2 Billion
Cardinal Health, the second-largest distributor of prescription drugs, announced on Thursday that it was buying a large medical supplier in a $2 billion deal aimed at expanding the business into the growing area of home health care (Thomas, 2/14).

In other marketplace news -

Kaiser Health News: Capsules: As Hospital Challenges Rise, Their Bond Ratings Fall
Nonprofit hospitals don't issue stock, so you can't track their financial health by the ups and downs of share prices. But many sell bonds, and it's fair to say that hospital bonds haven't fared as well recently as the Dow Jones average. Last year set a record for hospital-bond downgrades, as debt levels rose and hospitals faced the uncertainty of business under the Affordable Care Act, debt-rater Moody's said this week (Hancock, 2/15).

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National Federation Of Nurses Joining Forces With American Federation Of Teachers

The nurses' group says this step will give them the added leverage they need to address issues related to conditions and to protect against unfair hospital management attacks.

Modern Healthcare: Nurses Union Moves To Boost Clout By Teaming Up With Teachers
Members of the National Federation of Nurses said affiliating with the American Federation of Teachers will give them the leverage they need to improve working conditions and protect themselves from unfair attacks from hospital management. Affiliation talks have been ongoing for the past year, said NFN President Barbara Crane in a Thursday conference call with reporters. Over the next few weeks, NFN membership will finalize the deal that will combine their 34,000 members with the 1.2 million members of the AFT. About 48,000 of AFT's members are nurses. The move brings together two of the more vocal union groups—teachers and nurses—and continues a trend seeing smaller unions partner with larger collective bargaining units. Last month the 10,000 members of National Union of Healthcare Workers combined with the 95,000 California Nurses Association (Selvam, 2/14).

Kansas City Star: National Federation Of Nurses Will Affiliate With Teachers Union
The leaders of two labor organizations representing health care professionals announced Thursday that they had approved an affiliation agreement that will bring 34,000 registered nurses into the American Federation of Teachers, the largest union of professionals in the AFL-CIO. The National Federation of Nurses, which represents nurses across the country, will affiliate with the teachers union, whose 1.5 million members include more than 48,000 nurses and thousands of other health care professionals. Barbara Crane, the president of the nurses federation, said her group’s national board voted to join forces with the teachers union to give the nurses more political clout and money to try to unionize more nurses (2/14).

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Within The Health Care Sector, Data Viewed In New Light

The Wall Street Journal: Numbers, Numbers And More Numbers
Under pressure to do more with less, insurers, pharmacy benefit managers and health care providers are all pushing data analysis to new heights. Insurers have been crunching numbers for years to figure out which patients are most likely to generate high costs. Now other groups are gauging probabilities of relapses, and the likelihood of a patient's not taking his or her medicine. Using models that draw on massive troves of medical and other data, some are also focusing on seemingly healthy individuals, trying to prevent problems before they occur (Tibken, 2/14).

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Public Health & Education

The Y Rolls Out New Health Program Targeting Diabetes

YMCAs will advance the program nationally with support from insurers and employers. Also in the news, researchers express concern about the increasing costs likely to accompany soaring Alzheimer's disease rates.

The Wall Street Journal: The Y Takes On Diabetes
A new health program being rolled out at YMCAs across the country shows the potential for a community-based organization to deliver a nationwide health care intervention. The Y's target is diabetes. Research has shown that the program, which combines exercise, dieting and individual counseling, can have a big impact in reducing incidences of diabetes. Impressed by the research, insurers and employers are providing direct funding as the YMCA seeks to enroll participants in the program and induce them to reach weight-loss targets (Dooren, 2/14).

USA Today: As Alzheimer's Rate Soars, Concern Rises Over Costs
Patients with Alzheimer's and other forms of dementia will spend three times more on health care than patients with other types of illnesses, the association says. Medicare patients with Alzheimer's and other dementias spent $43,847 on health care and long-term care services, compared to $13,879 spent by patients without those illnesses, the association said in a 2012 report. For government health care programs already facing economic strain, these estimates are daunting, researchers and advocates say (Lloyd, 2/14).

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State Watch

Medicaid: Audits Find Overspending In Ga. Program

States deal with personnel, budget, and contractor issues as they relate to their Medicaid programs.

Georgia Health News: Audit Targets Overspending At Community Health
A recent audit gave the state Department of Community Health a "clean report" but also found that the agency overspent its Medicaid budget by $32 million in fiscal 2012. The audit findings were discussed at an agency board meeting Thursday. Board Chairman Norm Boyd said that though the amount of money appears large, it represents just one day of Medicaid spending in Georgia. The budgetary control problem was the one "significant"’ finding in an audit assessment that otherwise showed improvement in the agency, said Boyd, who was elected chairman at the meeting Thursday. DCH Commissioner David Cook said the overspending won’t happen again. He said the agency currently has "zero money’" for Medicaid reserves, and that the Medicaid program is already underfunded by $1.2 million under the current House budget (Miller, 2/14).

North Carolina Health News: DHHS Secretary Wos Lays Out Priorities For 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).

Milwaukee Journal Sentinel: LogistiCare To Bid On New Medicaid Transportation Contract
LogistiCare, the company blamed for thousands of late and no-show medical rides for Wisconsin Medicaid patients, intends to bid on a new contract. That became official this week when the Department of Health Services revealed, in response to a Journal Sentinel request, that LogistiCare had submitted a notice of intent to bid, as have four others - Access2Care, American United Taxi Services, MTM Inc. and Wisconsin Coordinated Transportation Cooperative. Proposals are due Thursday. LogistiCare terminated its $38 million contract with the State of Wisconsin effective Feb. 17, saying it was losing money and it should have asked for twice as much. The company will continue to dispatch rides until a new contract is signed (Laasby, 2/14).

The Associated Press: Oklahoma Medicaid Agency Says Goodbye To Director
The agency that administers Oklahoma's Medicaid program said goodbye to its longtime director Thursday, while promising to still explore new ways to deliver health care services to the state's uninsured. Mike Fogarty, 64, is stepping down as CEO of the Oklahoma Health Care Authority effective March 1. He announced his retirement in September, two months before Gov. Mary Fallin rejected an opportunity to expand the state's Medicaid program under the federal health care overhaul law to provide services to 200,000 uninsured, low-income Oklahomans (Talley, 2/14).

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State Highlights: Calif. Opens New Prison Mental Health Facility

A selection of health policy news from California, Vermont, Minnesota and Kansas.

The Associated Press: California Opens $24M Prison Mental Health Center
California prison officials are opening a $24 million treatment center for mentally ill inmates as they urge a federal judge to end his oversight of the state's correctional system. The 44,000-square-foot building at the California Medical Facility in Vacaville opened Thursday. It includes rooms where inmates will undergo outpatient therapy, as well as offices for therapists (Thompson, 2/14).

The Associated Press: Vermont Senate Approves Assisted Death Bill
The Vermont Senate on Thursday passed a stripped-down version of a bill that would let doctors help terminally ill patients die, relieving health workers and family members of criminal or civil liability but removing several patient protections that were in the original version of the bill. The final vote was 22-8 (Gram, 2/15).

MPR: Mayo Expansion Bill Eases Past 1st Capitol Hurdle
A bill that would finance redevelopment around the Mayo Clinic's proposed expansion in Rochester is starting to move through the Legislature. The House Jobs and Economic Development Committee approved the measure easily Thursday, but the bill's financing plan is expected to face some much tougher questions soon. Members of the committee spent most of their time praising the bill and the Mayo Clinic's promise to invest in Rochester. Clinic officials again emphasized their promise to spend $3 billion to expand in Minnesota (Scheck, 2/14).

Kansas Health Institute: Effort Underway To Link Safety Net Clinics With Health Information Exchanges
Regional healthcare officials say they are close to hiring a consultant to assist safety net providers establish a computer network aimed at providing better care while reducing costs. Officials with the Regional Health Care Initiative (RHCI) are conducting final interviews with three companies that could help the safety net providers connect to patient-record-sharing networks known as health information exchanges (Sherry, 2/14).

California Healthline: Race, Gender, Age Lead To Disparities In Care
Health care providers from around the state gathered in Sacramento this week to examine disparities in medical care. They started by examining their own treatment of patients. The annual conference of the California Association of Physician Groups took an unusual approach Wednesday to improving care, focusing on possible misconceptions or biased treatment by physicians of some patients. The conference looked at possible disparities in treatment of Muslims or other culturally different patients, bias based on appearance and even bias toward patients who can't be cured (Gorn, 2/15).

California Healthline: What Will Happen With Millions Of 'Residually Uninsured' Californians?
Estimates vary, but the thumbnail breakdown is about one million undocumented immigrants will be ineligible for coverage and another three million will be citizens who, by chance or by choice, won't receive the benefits or subsidies for which they qualify. For lack of a better term, those four million people are referred to as the "residually uninsured" (Gorn 2/14).

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Health Policy Research

Research Roundup: Conflicts Of Interest In Medicaid Drug Purchasing

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

JAMA Internal Medicine: Medicaid Drug Selection Committees And Inadequate Management Of Conflicts Of Interest – The authors of this study assert that the decisions about which drugs are selected for state Medicaid reimbursement programs "should be based on available evidence and free of conflicts of interests (COIs)." They add, however, that little is known about how Medicaid drug selection committees identify and manage conflicts of interest. The researchers searched Medicaid websites and contacted staff to identify policies in the 47 states and the District of Columbia that have Medicaid preferred drug lists. "Our findings show the need for a model COI policy for drug selection committees that can be adapted for individual states …," the authors write. "The COI policies were difficult or impossible to find for many states. Only about half of the policies were readily available on state websites, and at least 1 program stated that its policies were not in the public domain." They conclude that the wide variation across the country suggests that the drug selection process is not adequately protected against industry influence (Nguyen and Bero, 2/11).

Kaiser Family Foundation/University Of California At Los Angeles: Medigap: Spotlight On Enrollment, Premiums And Recent Trends –Nearly one in four Medicare beneficiaries have a private supplemental insurance plan to help cover expenses that Medicare doesn't. This report examines enrollment and premium trends for these Medigap plans. The authors find that although Medigap policies must offer a set of standardized benefits, "premiums for identical plans vary greatly both across the country and within states." They also report that "more than half of all Medigap enrollees in 2010 were in plans that cover Medicare's entire Part A and B deductibles" (Huang, Desmond et al, 2/14).

Kaiser Family Foundation: Policy Options To Sustain Medicare For The Future
This report  "presents a compendium of policy ideas that have the potential to produce Medicare savings" and examines "a wide array of options in several areas and lays out the possible implications of these options for Medicare beneficiaries, health care providers, and others, as well as estimates of potential savings, when available." This report is a guide for policymakers as officials debate changes to Medicare and ways to find savings (Neuman and Cubanski, 1/30).

BMC Health Services Research: The Effect Of Electronic Medical Record Adoption On Outcomes In US Hospitals – Researchers in this study examined the relationship between adoption of electronic medical record (EMR) systems at 708 acute-care hospitals in the U.S. and 30-day re-hospitalization of patients, deaths within 30 days of admission, deaths of patients in the hospital and patients' length of stay. They compared the outcomes two years before and after the hospitals adopted electronic medical record systems from 2000 to 2007. "We found that EMR adoption was associated with a small but significant reduction in length of stay and 30-day mortality as well as an increase in 30-day re-hospitalization," the authors write. "The reduced length of stay associated with EMR suggests that EMR might allow faster physician ordering of tests, produces, and medications, speed the process/scheduling of discharge, and reduce delays in the service ordering process." They add, however, that shorter length of stay may increase the 30-day re-hospitalization rate because patients with more severe conditions may return due to being discharged early (Lee, Kuo and Goodwin, 2/1).

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

Medscape: Hospitals Steadily Reducing Most Inpatient Infection Rates
Hospitals throughout the United States have made significant progress in reducing healthcare-associated infections and are on track to meet goals set in 2008 as part of the National Action Plan to Prevent Healthcare-Associated Acquired Infections, according to a report published online February 11 by the Centers for Disease Control and Prevention (CDC). The CDC analysis found that central line–associated bloodstream infections have decreased by 41% (toward a goal of a 50% decrease) and surgical site infections have decreased by 17% (toward a goal of 25%). Rates for both infection sites improved from 2008 to 2010 and continued to improve from 2010 to 2011 (Kelly, 2/12).

MedPage Today: Black Males Not Applying To Med School
Fewer black men are applying to, accepted to, and attending U.S. medical schools despite an increase in the number of overall applicants and uptick in matriculation among other minorities, a report found. Black applicants were the second most populous demographic behind whites in the late 1970s. There were more black applicants than Asians and Hispanics combined. But in 2011, first-time African-American applicants were surpassed by Asians and Hispanics, the Association of American Medical Colleges (AAMC) said (Pittman, 2/10). 

Reuters: U.S.-Wide Salt Reduction Could Prevent Deaths: Study
The United States could prevent up to half a million deaths over the next decade if Americans cut their salt intake to within national guidelines, according to a new study. That finding -- which comes the week New York City announced success toward its goals of cutting salt levels by one-quarter by 2014 -- is based on computer simulations using data from various studies on the effects of extra sodium on blood pressure and heart risks (Pittman, 2/14).

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Editorials and Opinions

Viewpoints: Bowles And Simpson Urge Obama To Seek Medicare Savings; Health Care Industry Helps Stabilize The Economy

Politico: Memo To Congress, White House: Get Serious On Debt
The president deserves credit for putting forward Medicare savings in his budget and offering further entitlement savings in the negotiations, but he and his fellow Democrats must be willing to do more to reform our entitlement programs. ... For health savings, we'll have to look at everything from increasing premiums for well-off beneficiaries to reducing reimbursements to providers and drug companies to modernizing cost-sharing rules to tort reform. We will also need to reorient incentives to change the delivery of care and make adjustments to reflect the aging of society. In short, it will require taking on favored and well-entrenched constituencies across the health care system (Erskine Bowles and Alan Simpson, 2/14).

The New York Times: Health Care's Good News
Most of the recent talk about health care spending has been pretty bleak. Just take a look at the Rate Review Tool on Healthcare.gov and you'll know why. Major insurers are proposing painful, double-digit premium increases in 2013. In California, Anthem Blue Cross, Blue Shield of California and Aetna all announced rate increases of 20 percent or higher for some of their customers. Many are taking this as a sign that, despite its intentions, the health care reform law is failing and costs are going up as a result. But there is something bigger going on here, though commentators may not be shouting about it. Health care spending is still going up, but the rate at which it grows year to year has actually been declining for about a decade now (Ezekiel J. Emanuel, 2/14).

The New York Times Economix blog: Health Care As An Economic Stabilizer
From a macroeconomic perspective, the health care sector has functioned for some time as the main economic locomotive pulling the economy along. In the last two decades, it has created more jobs on a net basis than any other sector. Oddly, not much is made of the job-creating ability of the health care sector in political debate over health policy, in contrast to discussions of military spending, where employment always ranks high among the arguments against cuts (Uwe E. Reinhardt, 2/15). 

The New England Journal of Medicine: The Oregon ACO Experiment — Bold Design, Challenging Execution
(Accountable Care Organizations) are expected to contain costs through improvements in health care delivery and realignment of financial incentives, but their effectiveness remains unproved, and there are reasons for concern that they may fail. Oregon has embarked on an ambitious program centered on the ACO model, which aims to change Medicaid financing and health care delivery. The Oregon experiment highlights both the bold vision of ACO-based health care reform and the potential challenges to executing that vision. Failure of the Oregon experiment would not only jeopardize health care for vulnerable Oregonians but also call into question the viability of central tenets of the ACA (Dr. Eric C. Stecker, 2/13).

The Wall Street Journal: Why The NHS Keeps Failing Britain
In February 2003 Gordon Brown, then Britain's chancellor, declared that "in health care, we know that the consumer is not sovereign." A decade later, the final report of the public inquiry into the failings of the Mid-Staffordshire NHS Trust between 2005 and 2009 has revealed the consequences—what happens when the patient is not sovereign but subject. The Mid-Staffs story, according to inquiry chairman Robert Francis, is one of "appalling and unnecessary suffering of hundreds of people" (Rupert Darwall, 2/14).

The New York Times: Suicide Made Easier
The current gun control debate is focused, not surprisingly, on the carnage from rapid-firing assault weapons, like the one used in the Connecticut school massacre. But beneath the surface lies a disturbing reality: nearly two-thirds of the 30,000 gun deaths each year are not the work of deranged mass shooters but the suicides of troubled individuals with easy access to firearms, often in quiet family homes (2/14).

Boston Globe: Linsky Starts A Conversation On Guns And Public Health
A new bill from state Representative David Linsky, a Democrat from Natick, is a good way to launch a serious debate, because it takes many cues from the public health field. Rather than simply attempt to ban certain weapons, it tries to influence the behavior of gun owners. For instance, Linsky’s bill would require gun owners to purchase liability insurance, with rates that could vary depending on the type of weapon and storage situation. Gun owners fear that the state could use such a mandate as a stealth way to outlaw guns, by making insurance too costly to obtain. Indeed, the premiums should be based only on a rational accounting of the risks presented by gun ownership (2/15).

Health Policy Solutions (a Colo. news service): Broader Approach Necessary For Achieving African American Health Equity
It is clear from the data that African Americans face increased obstacles to a healthy life; to achieve a healthier Colorado, we must raise the collective awareness in our state of the challenges individuals from racial and ethnic minority groups face, and tackle them with the same fervor and leadership we have other health issues (Aubrey Hill, 2/13).

Medpage Today: Population Health Management – Not Just a Concept
A host of new patient care models aimed at making healthcare more team-based are emerging. Reimbursement tied to outcomes will demand a greater level of patient management and engagement in the care process. Often, though, an (electronic health records system) alone cannot provide the functionality necessary to manage a specific population of patients. There are many reasons a practice may need to identify and proactively work with a defined group of patients. Primarily, it's to insure they are receiving care according to the evidenced-based standards agreed upon by the practice (Rosemarie Nelson, 2/14).

Boston Globe: A Doctor Takes On Militias
If there is any hope for healing in the war-ravaged eastern region of the Democratic Republic of Congo, it lies in activists like Dr. Denis Mukwege. A world-renowned gynecological surgeon, Mukwege founded a hospital that has treated tens of thousands of survivors of sexual violence, many of whom were raped during the armed conflict that has raged, off and on, for the past 16 years. In addition to being a skilled doctor in a country with few medical supplies, he is also a relentless advocate for women. He has traveled the world speaking out against the use of rape as a weapon in war, and outlining steps that must be taken to end it (2/15).

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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.