Daily Health Policy Report

Thursday, February 16, 2012

Last updated: Thu, Feb 16

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Administration News

Campaign 2012

Health Reform

Health Care Marketplace

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Preview: The 'Very Big Deal' – SCOTUS Takes On The Health Law

In just over 5 weeks, the Supreme Court will hear challenges and defenses of the 2010 Affordable Care Act – the federal health overhaul law. In part one of two conversations for Kaiser Health News about the case, Jackie Judd talks with Stuart Taylor, an attorney and contributing editor for the National Journal, about why these cases are so significant. Watch the video or read the transcript.

This Story: Print | Link to | Top

Capsules: Tentative 'Doc Fix' Deal Would Cut Health Law's Prevention Fund by $5B

Now on the Kaiser Health News blog, Mary Agnes Carey reports: "After wrangling for weeks over how to finance a Medicare 'doc fix,' House and Senate conferees have a plan. The proposal would cut Medicare payments to hospitals and other providers for 'bad debt,' Medicare payments to clinical laboratories and Medicaid 'disproportionate share' payments to hospitals that serve many poor patients, and divert $5 billion from the health law’s $15 billion prevention fund (Carey, 2/15). See what else is on the blog.

This Story: Print | Link to | Top

Really, America, Most Mass. Residents Like Health Reform

WBUR's Martha Bebinger, working in partnership with Kaiser Health News, NPR and WBUR, reports: "Across the national airwaves and on the Republican campaign trail, the Massachusetts health law that many now call "Romneycare" is routinely trashed. ... So you might think this drubbing would rub off on Massachusetts residents, about two-thirds of whom have consistently endorsed the state’s coverage plan since it passed in 2006. Not so" (Bebinger, 2/15). Read the story.

This Story: Print | Link to | Top

Political Cartoon: "Keep Away?" By Mike Luckovich

Kaiser Health News provides a fresh perspective on health policy developments with "Keep Away?" By Mike Luckovich, Atlanta Journal-Constitution.

Meanwhile, here's today's haiku:

Budget deals go slow
Bickering over money
Patient care is lost
-- Brett Kay 

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.

This Story: Print | Link to | Top

Capitol Hill Watch

Congressional Negotiators Announce 'Doc Fix,' Payroll Tax Cut Deal

Some Democrats fretted over cuts to the health care law to help pay for the package; physician groups were disappointed it did not replace Medicare's sustainable growth rate formula.

Los Angeles Times: Lawmakers Reach Tentative Deal To Extend Payroll Tax Break
Despite discomfort in the Republican ranks, House and Senate negotiators reached a deal in principle early Thursday to extend a payroll tax break, continue unemployment benefits and ensure that Medicare doctors do not get a pay cut this year. ... One of the issues holding up the agreement late Wednesday was Republicans' insistence on a provision allowing Medicare to pay for services at newly built doctor-owned hospitals. Under the nation's new healthcare law, such hospitals would no longer be reimbursed because their services were deemed too costly (Mascaro, 2/16).

The Washington Post: Congressional Negotiators Reach Deal On $150 Billion Economic Plan
In a pact early Thursday morning, congressional negotiators gave final approval to an economic plan worth more than $150 billion that would extend a payroll tax holiday and unemployment benefits. ... It also includes a temporary fix for Medicare’s payment plan, which, left unchecked, would lead to a 27 percent drop in fees paid to doctors who treat elderly patients (Kane, 2/16).

The New York Times: Panel Completes Last Details Of Payroll Tax Cut Extension
Dr. Peter W. Carmel, president of the American Medical Association, said his group was "deeply disappointed" that the agreement, while delaying the (Medicare) cut for 10 months, did not replace the statutory formula that requires such cuts. Republicans boasted that they had cut spending under the new health care law to help pay for Medicare spending under the agreement. For example, the agreement cuts $5 billion from a special account created by the new law to promote public health (Steinhauer and Pear, 2/15).

Modern Healthcare: Doc Associations Rip Medicare Pay Deal
Physician associations denounced Congress for failing to find a permanent solution to Medicare's sustainable growth-rate formula after lawmakers reached a tentative agreement that would force them to revisit the issue at the end of the year. The deal would avert a 27.4% Medicare payment cut to physicians after Feb. 29 and extend current payment rates through the end of 2012, according to a GOP aide (Zigmond, 2/15).

The Wall Street Journal: Lawmakers Finalize Payroll-Tax Agreement
Democrats were fretting about the cuts to Mr. Obama's health-care law. Outlines of the package called for tentative cuts of $5 billion from a "prevention and public health fund," which had been set to spend $15 billion over 10 years. In addition, it would remove some funding from Louisiana, which had received increased Medicaid funding under the health law. These are relatively small cuts to a $930 billion law, but they are highly symbolic. Republicans have been promising to cut or kill the law since taking over the House in January 2011. Republicans call the prevention fund, which funds items like immunizations and health screenings, a "slush fund." ... The cuts to the health law could make it easier for GOP leaders to sell the deal to their more conservative members (Bendavid and Hughes, 2/16).

Kaiser Health News:  Tentative 'Doc Fix' Deal Would Cut Health Law’s Prevention Fund by $5B
After wrangling for weeks over how to finance a Medicare 'doc fix,' House and Senate conferees have a plan. The proposal would cut  Medicare payments to hospitals and other providers for 'bad debt,' Medicare payments to clinical laboratories and Medicaid 'disproportionate share' payments to hospitals that serve many poor patients,  and divert $5 billion  from the health law's $15 billion prevention fund (Carey, 2/15).

Politico: Payroll Tax Cut Deal Finalized
Senate Finance Chairman Max Baucus (D-Mont.) and House Ways and Means Chairman Dave Camp (R-Mich.) emerged from a Capitol meeting room to say the agreement — hashed out by a bicameral, bipartisan conference committee — would garner enough support to move forward in both chambers. They declined to discuss the details of the compromise, but it would extend for 10 months both the 4.2 percent Social Security payroll tax rate and unemployment benefits, and it would forestall a sharp decrease in payment cuts to physicians servicing Medicare patients (Rogers and Sherman, 2/16).

The Associated Press: Top Bargainers Announce Payroll Tax Cut Deal
Relieved congressional bargainers say they've reached agreement on compromise legislation extending payroll tax cuts and benefits for the long-term unemployed through 2012, edging a white-hot political battle a major step closer to finally being resolved. ... The bill would assure a continued tax cut for 160 million workers and jobless benefits for several million others, delivering top election-year priorities for President Barack Obama (Fram, 2/16).

This Story: Print | Link to | Top

Two GOP Senators Propose Medicare Overhaul Plan

Tom Coburn of Oklahoma and Richard Burr of North Carolina call for a "grown-up" conversation about the changes needed to preserve Medicare for future generations.

The Associated Press: GOP Senators Unveil New Medicare Overhaul Plan
Two Republican senators are unveiling a Medicare rescue plan that features an accelerated transition to private health insurance for many seniors, a gradual increase in the eligibility age, and higher premiums for middle-class and upper-income retirees. Sens. Tom Coburn of Oklahoma and Richard Burr of North Carolina say they're not out to win a political popularity contest. Instead, they want to engage fellow policymakers and the public in a "grown-up" conversation about the scope of changes needed to preserve Medicare in some form for future generations (Alonso-Zaldivar, 2/16).

Fox News/AP: New GOP Medicare Plan Features Accelerated Transition To Private Insurance For Seniors
Two Republican senators are unveiling a Medicare rescue plan that features an accelerated transition to private health insurance for many seniors, a gradual increase in the eligibility age, and higher premiums for middle-class and upper-income retirees. Sens. Tom Coburn of Oklahoma and Richard Burr of North Carolina say they’re not out to win a political popularity contest. Instead, they want to engage fellow policymakers and the public in a "grown-up" conversation about the scope of changes needed to preserve Medicare in some form for future generations (2/16).

This Story: Print | Link to | Top

Bill To Bar Synthetic Recreational Drugs Hits Roadblock

Legislation's sponsors assail Sen. Rand Paul for putting a hold on the bill.

McClatchy / Star Tribune (Minneapolis): Rand Paul Puts Synthetic Drug Bill On Hold
A broadly popular bill by Sen. Amy Klobuchar, D-Minn., to outlaw synthetic recreational drugs across the nation has run into an increasingly common obstacle in the U.S. Senate: the objection of a single senator. Klobuchar and two other senators backing similar measures took the unusual step of taking to the Senate floor Wednesday to publicly denounce a "hold" placed on their bills by freshman Kentucky Republican Rand Paul. ... Paul spokeswoman Moira Bagley said he believes "law enforcement of most drug laws can and should be local and state issues" (Diaz, 2/15).

CQ HealthBeat: Senators Pressure Paul To Drop Objections To 'Designer' Drug Bills
Three senators are trying to persuade Kentucky Republican Rand Paul to drop his objections to a set of bills intended to restrict "designer" drugs that have been linked to incidences of overdose, violence and suicide. The synthetic drugs are designed to simulate the effects of controlled substances and are marketed as a safe, legal high. The three measures would block the use of certain chemicals in such drugs, making their possession and sale illegal (Lesniewski, 2/15).

This Story: Print | Link to | Top

Administration News

Birth Control Rule Will Apply To Self-Insured Groups, Sebelius Says; Political Fallout Continues

Both sides mount what they say will be prolonged campaigns to shape public perceptions on the issue, both on Capitol Hill and in races around the country.

Modern Healthcare: Birth-Control Rule Will Apply To Self-Insured Organizations, Sebelius Says
The revised rule on insurance coverage of birth control that HHS will formulate, finalize and implement by August 2013 will apply to self-insured entities, as well as policies issued by insurance companies, HHS Secretary Kathleen Sebelius told reporters. The details of the revised birth-control rule—announced after a furor from Catholic employers who object to funding something to which they are morally opposed—remain undefined, except that it will require insurance companies to pay for the drugs instead of religious employers (Daly, 2/15).

The New York Times: Self-Insured Complicate Health Deal
The Obama administration thought it had found a way to ease mounting objections to a requirement in the new health care act that all employers — including religiously affiliated hospitals and universities — offer coverage for birth control to women free of charge. It would make the insurers cover the costs, rather than the organizations themselves. But the administration announced the compromise plan before it had figured out how to address one conspicuous point: Like most large employers, many religiously affiliated organizations choose to insure themselves rather than hire an outside company to assume the risk (Thomas, 2/15).

Bloomberg: Priests For Life Group Sues U.S. Over Birth-Control Insurance Requirement
A Christian organization called Priests for Life sued the Obama administration, saying its mandate that insurance providers cover birth control violates the organization’s religious and free-speech rights. Priests for Life, in a lawsuit filed today in federal court in Brooklyn, New York, also objected to the requirement that employers provide coverage for sterilization and related education, and to the penalties for not complying(Weidlich, 2/15).

CQ HealthBeat: HHS To Publish New Rule On Employer-Paid Insurance, Contraceptives
The Health and Human Services Department will issue an additional final rule governing insurance coverage of contraceptive services, Secretary Kathleen Sebelius said Wednesday. Sebelius, speaking at a Senate Finance Committee hearing, said the department would publish the new rule by August 2013 as part of the Obama administration decision to modify the existing final rule on the coverage (Ethridge, 2/15).

Politico: Sebelius: Contraception Rule 'Major Step Forward'
HHS Secretary Kathleen Sebelius called the contraceptive coverage requirement "a major step forward" on Wednesday, making it clear that she's back to full-scale advocacy mode after the Obama administration’s compromise on the rule last week. In comments to reporters following a Senate Finance Committee hearing, Sebelius said the requirement was the latest in a series of steps to ensure that women get equal treatment in the medical system. ... The reason 28 states passed their own contraceptive coverage requirements, she added, was that plans were covering Viagra but not contraception (Feder, 2/15).

Politico: Republicans Let Kathleen Seblius Off Easy On Contraception Rule
Republican senators had a golden opportunity to score points Wednesday by blasting the new contraception coverage rule when HHS Secretary Kathleen Sebelius testified before the Senate Finance Committee. They barely took a shot (Feder, 2/15).

The Hill: GOP Largely Ignores Birth-Control Furor In Hearing With Sebelius
Republicans have vowed to keep pressing their attack against the White House’s birth-control mandate, but you wouldn’t know it from the way they approached a hearing with Health and Human Services Secretary Kathleen Sebelius on Wednesday. It was the first time Sebelius has testified before Congress since announcing the contraception mandate. Yet despite a flood of statements and speeches denouncing the policy as an attack on religious freedom, Republicans on the Senate Finance Committee barely mentioned it Wednesday (Baker, 2/15). 

The New York Times: Both Sides Eager To Take Birth Control Coverage Issue To Voters
The furor over President Obama’s birth control mandate has swiftly entered a new plane, with supporters and opponents alike calling the subject a potent weapon for the November elections and mounting what they say will be prolonged campaigns to shape public perceptions of the issue: Is it about religious liberty or women’s health? (Eckholm, 2/15).

Politico Pro: House GOP Focuses On Conscience Message
House Republicans want to make one thing very, very clear: their beef with the Obama administration’s contraceptive mandate has nothing to do with birth control and everything to do with religious liberty. Two big events in the House this week are trying to drive that point home (Nocera, 2/16).

St. Louis Beacon: Blunt, Under Fire For 'Rights Of Conscience' Amendment, Claims 'Misinformation'
According to a fact sheet circulated by opponents, Blunt's amendment could impact the access of many employees to "a variety of essential health services." That is because employers could refuse coverage based on the "moral convictions" clause. ... Disturbed by such claims, Blunt issued what his office called a "fact check" document ... [which] labels as "unequivocally false" any suggestion that his amendment would allow anyone to deny health care for just about any reason (Koenig, 2/15).

CQ HealthBeat: Catholics Leaders Speak Out in Favor of Obama Contraception Compromise
A group of Catholic and university leaders said Wednesday that they support President Obama's regulation on contraceptive coverage for Catholic institutions, and criticized Republicans who have said that the president is waging a "war on religion." the announcement illustrated the continuing split — even among Catholics — over the highly controversial contraception rule, which will be implemented as part of the health care law (Norman, 2/15).

The Hill: Social Conservatives Press Obama On Administration’s Birth Control Mandate
A group of social conservative lawmakers on Wednesday intensified its push to overturn President Obama's new birth-control mandate. The lawmakers, representing both parties and both chambers, said the president's recent "accommodation" would still force some employers — particularly faith-based nonprofits — to cover contraception in defiance of their moral convictions (Lillis, 2/15).

The Associated Press: Contraception Battle Looms In Mass. Senate Race
The debate over the line between religious freedom and federal health care mandates has made its way into Massachusetts' closely watched U.S. Senate race, with Republican Sen. Scott Brown accusing his chief Democratic rival of wanting to "dictate to religious people about what they should believe." Consumer advocate and Harvard professor Elizabeth Warren has responded by criticizing Brown for signing on to a Republican-backed bill that would allow employers and health care plans to deny coverage for any service they say violates their moral or religious beliefs (LeBlanc, 2/16).

This Story: Print | Link to | Top

Federal Probe Of FDA's Treatment Of Whistleblowers Widens

Investigators say they are broadening their efforts because of "new and troubling allegations."

Modern Healthcare: Investigators Widen Probe Of FDA Actions Regarding Whistle-Blowers
An independent federal investigative agency broadened the scope of an investigation into Food and Drug Administration mistreatment of employee whistle-blowers. The Office of Special Counsel expanded an existing investigation into FDA surveillance of e-mails of its employees in the Center for Devices and Radiological Health based on "new and troubling allegations" (Daly, 2/15).

The Hill: Federal Investigators Probe Drug Agency’s Crackdown On Whistleblowers
(The U.S. Office of Special Counsel) said in a release that it has "received new and troubling allegations of retaliatory surveillance of OSC communications and other acts of retaliation against the whistleblowers, including FDA attempts to initiate criminal prosecution of the whistleblowers" (Pecquet, 2/15).

Meanwhile, a key House Republican warns FDA officials that he might not support additional user fees.

CQ HealthBeat: Barton Balks At Device User Fee Increase, Citing FDA Performance
House Republicans on Wednesday challenged the Food and Drug Administration’s progress in shortening device approval times, with a least one lawmaker suggesting he would not support additional user fees for the agency given its track record. "Don't ask this member to rubber-stamp a doubling of the user fee when we have the program performance, or lack thereof, at this FDA," Energy and Commerce Republican Joe Barton of Texas said at a Health Subcommittee hearing on the reauthorization of the agency’s user fees (Bristol, 2/15). 

This Story: Print | Link to | Top

Campaign 2012

Campaign 2012: Santorum's Hospital Board Compensation; Sebelius 'Urged To Sit Out' Fundraisers

Rick Santorum's newly released tax returns show his wealth has increased substantially since leaving the Senate — leaving him subject him to an attack from Mitt Romney.

The Associated Press: Santorum's Tax Returns Show Rise In Wealth
Republican presidential candidate Rick Santorum released four years of federal income tax returns on Wednesday night ... Santorum was also paid nearly $400,000 in compensation and stock options as a board director at Universal Health Services, a hospital management firm, after he left the Senate in 2006. He also owns up to $250,000 in Universal stock. As a senator, Santorum had sponsored several unsuccessful bills that would have secured more Medicaid funding hospitals run by Universal and other medical firms in Puerto Rico (Braun, 2/16).

The Associated Press: Santorum Targets Romney 'Negative Attack Machine'
[In a new Santorum ad] the narrator says Romney is "trying to hide from his big-government Romneycare" that's not completely true. Since the GOP race began, Romney has walked a delicate line by refusing to apologize for the health care plan he implemented while governor and distancing himself from a similar health care plan President Barack Obama's signed into law in 2010 (Jackson, 2/15).

Politico: Rush Limbaugh: Birth Control Plot Against Rick Santorum
Rush Limbaugh charged Wednesday that Democrats are using the Obama administration's controversial mandate on contraception coverage to plot against one presidential candidate: Rick Santorum. "The whole point of this contraception stuff [that] started last week is to make sure that if Santorum get this Republican nomination, that's what he's going to be known for" ... the conservative radio host said on his show (Lee, 2/15).

In the meantime, a GOP senator is cautioning the president —

The Hill: Health Agency Chief Urged To Sit Out Obama Fundraisers
President Obama's top health official shouldn't speak at fundraising events for his reelection, the top Republican on the Senate committee with jurisdiction over health policy told the president on Wednesday. ... The letter comes after The New York Times reported that Obama would dispatch "Cabinet officials, senior advisers at the White House and top campaign staff members" to speak at Democrats' Priorities USA Action (Pecquet, 2/15).

CQ HealthBeat: Enzi: Fundraising A Conflict Of Interest For Sebelius As Regulator
Sen. Michael B. Enzi has sent a letter to President Obama expressing "deep disappointment" with his decision to send Cabinet officials — including Health and Human Services Secretary Kathleen Sebelius — to Super PAC fundraisers. Her appearance will create a conflict of interest given her role as a regulator and could coerce companies with business before the federal government to contribute to the Obama campaign, said Enzi, R-Wyo. (Reichard, 2/15).

This Story: Print | Link to | Top

Health Reform

White House Budget Director Stumbles On Question About Mandate

The health law’s individual mandate is not a tax, the OMB director said under questioning at a Capitol Hill hearing Wednesday, even though the administration has claimed the opposite in its defense of the law before the Supreme Court.  

Politico: Did OMB Director Not Get The Mandate Memo?
On Wednesday, acting Office of Management and Budget Director Jeffrey Zients appeared to tell the House Budget Committee that the individual mandate isn’t a tax. Which could be a bit of a problem, since the Obama administration is defending the mandate before the Supreme Court by arguing that it is a tax — for legal purposes, anyway (Nather, 2/15).

The Hill: House GOP Pounces After Obama Budget Director Says Health Mandate 'Not A Tax'
House Republicans quickly pounced Wednesday after the White House's top budget official said the healthcare reform law's penalty on people who don't buy insurance isn't a tax. Republicans argue the admission from Acting White House Budget Director Jeff Zients undermines the White House's defense of the law before the Supreme Court. Congress has broad power to impose taxes (Pecquet, 2/15).

One expert talks about the import of that case.

Kaiser Health News (Video): Preview: The 'Very Big Deal' – SCOTUS Takes On The Health Law
In just over five weeks, the Supreme Court will hear challenges and defenses of the 2010 Affordable Care Act – the federal health reform law. In part one of two conversations about the case, Jackie Judd talks with Stuart Taylor, an attorney and contributing editor for the National Journal, about why these cases are so significant (2/15).

Meanwhile, a new study by RAND Health suggests that even without the mandate, the health law would survive.

National Journal: Health Law Would Not Implode Without Mandate, RAND Study Finds
If the Supreme Court knocked out the health care reform law’s individual mandate, but preserved everything else, the sky would not fall, according to a new analysis from RAND Health. The study, published on Thursday, looked at the effects of enrollment and premium increases in a universe in which health care reform stayed on the books without the controversial requirement. … the Obama administration is arguing that the mandate is the key piece of a larger regulatory structure that expands coverage without causing premiums to skyrocket (Sanger-Katz).

This Story: Print | Link to | Top

Sebelius: Exchanges Will Strengthen Employer Health Coverage

The Health and Human Services secretary told Senate Finance Committee members she expects health insurance exchanges to give employers another option to provide coverage to workers. In the meantime, HHS is touting newly covered preventive services it says 86 million Americans have used.

Modern Healthcare: Sebelius Sees Exchanges Bolstering Employer Coverage
A year and a half before HHS plans to begin enrolling people in state and federal health insurance exchanges, it remains unclear how many employers will drop their employee coverage due to that option, said HHS Secretary Kathleen Sebelius. In testimony before the Senate Finance Committee Wednesday on the administration's fiscal 2013 budget proposal, Sebelius said she expects the coming insurance marketplaces to bolster employer-sponsored coverage by allowing those companies to buy coverage there (Daly, 2/15).

CQ HealthBeat: HHS Officials Tout Health Care Law Preventive-Services Results
In their continuing effort to highlight the benefits of President Obama's health care overhaul, Health and Human Services officials announced Wednesday that in 2011, an estimated 86 million Americans took advantage of the prevention coverage improvements in the measure. Among those enrolled in private health insurance plans, 54 million received at least one new preventive service. The health care law requires insurance plans to cover a variety of preventive services for free, including colonoscopy screening for colon cancer, Pap smears and mammograms for women, well-child visits, and flu shots for all children and adults (2/15).

This Story: Print | Link to | Top

Health Care Marketplace

Shortage Looming, Drug Maker Agrees To Release Emergency Supplies Of Kids' Cancer Drug

A shortage of a drug used to treat children's cancer seems to have been averted for a time as the Food and Drug Administration says it reached an agreement with the drug supplier to release emergency supplies. Elsewhere, rules sometimes force hospitals to throw away scarce drugs. 

NPR: Latest Drug Shortage Threatens Children With Leukemia
It's a new kind of brinkmanship for U.S. doctors: caring for patients with life-threatening diseases when the supply of critical drugs threatens to disappear. The latest crisis concerns the old standby cancer drug methotrexate. For six decades, it's made the difference between rapid death and lifelong cure for thousands of children with acute lymphoblastic leukemia, or ALL, and a type of bone cancer called osteogenic sarcoma. Many hospitals around the nation are perilously close to running out of a form of methotrexate that's necessary to inject in high doses to treat these forms of cancer (Knox, 2/16).

Chicago Sun-Times: Kids' Cancer-Drug Shortage Averted
The federal Food and Drug Administration says it managed to avert a "crisis" for kids with cancer by preventing a looming shortage of the lifesaving drug methotrexate, a mainstay of treatment for a type of childhood leukemia. The shortage is the latest in a series of serious shortages of cancer medications and other drugs that have frustrated doctors and patients over the past year and a half (Szabo, 2/16).

PBS Newshour: What's Causing a Shortage of Pediatric Cancer Drugs?
The FDA for its part said this afternoon: "This issue has been of the highest priority for the FDA. As of today, Bedford" — that's the maker — "advised FDA it will release emergency supplies. This additional quantity of medicine was produced before the company voluntarily shut down, and the company has worked to ensure that drug was not impacted by the issues that led to the plant shutdown" (Suarez, 2/15).

MSNBC: Amid Shortages, Rules Force Hospitals To Trash Scarce Drugs
Mounting shortages of crucial drugs are creating a new dilemma for the nation's hospital pharmacists, who say they find themselves caught between breaking government rules for storage and safety — or throwing away vital and lifesaving medications. At one hospital in Florida, officials acknowledge they've discarded the scarce cancer drug doxorubicin, even as patients nationwide clamor for treatment. "I'd never want to take a chance with not following the rules," said Alan K. Knudsen, director of pharmacy legal services for Shands HealthCare at the University of Florida in Gainesville. "I wish I didn't have to throw it out" (Aleccia, 2/15).

And doctors are busy rooting out a counterfeit version of a popular cancer drug after the FDA notified some doctors that their practices had purchased the fakes —

Reuters: Doctors Scour Drug Supplies After Fake Avastin Found
A U.S. distributor of phony vials of the widely-used cancer drug Avastin aroused suspicion at doctor's offices as early as July, well before health regulators issued their own warning and sparked new alarm over counterfeit medicines. The U.S. Food and Drug Administration said this week it notified 19 oncology practices they had purchased drugs from a supplier not approved by the agency, including a counterfeit version of Roche Holding AG's, Avastin, that did not contain the multibillion-dollar drug's active ingredient, bevacizumab (Berkrot, 2/15).

This Story: Print | Link to | Top

Home Health Industry Fights Minimum Wage Rule

USA Today reports about the effort by home health care companies fighting an administration proposal on pay. Meanwhile in Connecticut, officials are considering changes in pay rules.

USA Today: Home Health Industry Fights Minimum Wage Rule
Home health care companies are leading the fight against an Obama administration proposal to require them to pay their workers the minimum wage, despite data showing that the industry was one of the few nationally to maintain profits during the worst of the recession (Kennedy, 2/15).

The Connecticut Mirror: Gov Gets Recs For Home Care, Child Care Worker Collective Bargaining
The working groups charged with recommending how to structure collective bargaining rights for home care workers and daycare providers in state-funded programs issued their reports to the governor Wednesday. ... Supporters say collective bargaining will benefit low-paid workers and improve the quality and stability of needed work forces. Opponents say workers will lose money by paying union dues (Levin Becker, 2/15).

This Story: Print | Link to | Top

State Watch

States And The Health Law: Wyoming Exchange, N.H. Compact Legislation, Texas Lawsuit

The Associated Press/Houston Chronicle: Wyoming Legislation Addresses Health Care Exchange
A Wyoming Senate committee has voted to advance a bill that would give lawmakers until 2013 to decide whether the state should create its own health care exchange. … A committee of state lawmakers, health-care representatives and members of the public has been trying to determine if it would be cost-effective for Wyoming to form its own exchange and how one would be managed (2/15).

The Associated Press/Boston Globe: N.H. House Gives Preliminary OK To Health Care Compact
An effort intended to free (New Hampshire) from the mandates of President Barack Obama's health care overhaul received preliminary approval in the New Hampshire House Wednesday. The bill would create an interstate compact that would place all health care programs under the member states' control, including federal programs like Medicare and Medicaid, while enabling the states to continue receiving federal funding. The House voted 253-92 in favor of the bill (Brnger, 2/15).

Related, earlier KHN story: Some States Seeking Health Care Compact (Gugliotta, 9/18)

The Texas Tribune: Interactive: Texas vs. the Federal Government
In the fight for states’ rights, no other state comes to mind before Texas. Gov. Rick Perry has pitted the state's interests against those of the federal government on a variety of issues — including health care reform and environmental standards — arguing that the 10th Amendment grants state governments more autonomy than many of the laws passed by the federal government allow. Texas has 16 lawsuits currently pending against the federal government (Aaronson, Chang, Hasson and Wiseman, 2/15).

Kaiser Health News: Really, America, Most Mass. Residents Like Health Reform 
In the latest WBUR poll, 62 percent support the law and 33 percent oppose it. Steve Koczela is president of the Mass, Inc. polling group, which conducted the poll. "Even with all the attention the Massachusetts law has gotten nationally," said Koczela, "it really hasn’t driven down support among voters here in Massachusetts" (Bebinger, 2/15).

This Story: Print | Link to | Top

State Roundup: Settlements For Mental Health Facilities Lawsuits; Minn., Oregon Insurers Face Scrutiny

The Washington Post: Prince George's County Survey Intended To Gauge State Of Health Care
But the survey underway in Prince George’s County is intended to address a complex problem. Officials expect the data to give them a detailed look at the state of health and health care in the county, where conditions such as diabetes and heart disease are much more common than in the rest of the region and most of the state (Spivak, 2/15).

The Washington Post: A Mother Writes About Her Concerns To Judge Dealing With D.C. Mental Health Care Suit
On Thursday, U.S District Judge Thomas F. Hogan is expected to approve a settlement in a case that has outlasted the terms of five D.C. mayors and is now known as Dixon v. Gray. ... The widely anticipated settlement marks a major milestone for the city, ending court oversight of a mental health system that has made vast improvements, but that all sides agree has room for more. ... When the suit was launched in 1974, lead plaintiff William Dixon and other patients at St. Elizabeths Hospital sought less restrictive treatment options [at] the problem-ridden psychiatric institution (Vargas, 2/15).

Boston Globe: Deal Reached On Treatment Of State's Mentally Ill Inmates
Years after a series of suicides in state prison segregation units, the state Department of Correction has reached a landmark agreement with advocate groups to better care for prisoners with severe mental illnesses. The agreement, still under seal ... calls for the Department of Correction to maintain two recently created units at high-level security prisons as alternatives to disciplinary segregation for prisoners with mental illness (Valencia, 2/16).

Tampa Bay Times: Senate Plan Includes Big Cuts To Mental Health Programs
Programs that serve mentally ill patients or addicts could see their state funding zeroed out this year under a Senate budget proposal. The proposal would slash overall state spending on adult mental health and substance abuse treatment by about 40 percent, or $87 million. .... [Sen. Joe Negron, the Republican in charge of the Senate's health care budget] said he would rather make these cuts than reduce spending on programs for the disabled, the elderly and children (Mitchell, 2/15).

New Orleans Times-Picayune: New Orleans' Frayed Mental Health Safety Net Could Collapse, Officials Warn
Frustration and anger boiled over Wednesday as members of New Orleans' political, criminal justice and medical communities pondered the dire consequences of pending cuts to state-financed mental health services for the poor and uninsured. ... With an estimated 27,000 people in the metropolitan area grappling with serious mental illnesses like schizophrenia, speaker after speaker said the region should be in line for increased funding for services, not cuts (Donze, 2/15).

Chicago Tribune: Deadly Fight Prompts Questions About Nursing Home
An Oak Park nursing home failed to report to the state health department a deadly altercation between anAlzheimer's patient and another resident, authorities said Wednesday. Anibal Calderon, 80, died of head injuries early Tuesday after an alleged fight that took place Sunday at Oak Park Healthcare Center, authorities said (Doyle and Meyer, 2/15).

Des Moines Register: Senators: Program Could Dump HIV Patients
A state program responsible for insuring Iowans with pre-existing health problems is taking actions that at least two lawmakers say will lead to the disenrollment of 13 to 15 HIV-positive patients. The key administrator of the program denies the allegations (Clayworth, 2/16).

Minnesota Public Radio: Legislative Auditor To Review HMO Process For Setting Rates
Minnesota's legislative auditor says he will seek a new review of the rate-setting process for HMOs providing services to Medicaid patients. The move comes a day after the human services commissioner told lawmakers that federal authorities are investigating the state's Medicaid program (Stawicki, 2/15). 

The Lund Report: Providence Asks for 5.4 Percent Rate Hike for Small Businesses
Providence Health Plans is seeking a 5.4 percent average rate increase for small businesses, which would affect 2,645 employers who have 30,869 employees. If approved, the increase would take effect August 1 (Lund-Muzikant, 2/15). 

California Healthline: Can Health Equity Be a Moneymaker?
Californians from different cultures, who speak languages other than English or who live in remote areas ... often have have a high percentage of chronic health conditions, such as diabetes, obesity and high blood pressure. In an era when more of these people have coverage with the expansion of Medi-Cal, and when health organizations are paid based on efficiency of care, those people may be the ticket to better overall treatment numbers (Gorn, 2/16).

Los Angeles Times: UCLA School Of Public Health Gets $50-Million Gift
Jonathan Fielding works 70-hour weeks in a relatively obscure and overwhelming job: He is Los Angeles County's top public health doctor. Friends and colleagues have long praised his professional contributions to the field. But to their surprise, Fielding and his wife are now making another huge contribution: $50 million to the UCLA School of Public Health (Gorman, 2/16).

Arizona Republic: Arizona Supreme Court Lets AHCCCS Cuts Stand
The Arizona Supreme Court on Wednesday declined to review an appeal challenging cuts to the state's Medicaid program, letting stand an enrollment freeze that has locked thousands of poor residents out of government-paid health insurance. An estimated 100,000 childless adults will lose Arizona Health Care Cost Containment System coverage this fiscal year. The state has turned away an untold number since a lower-court judge allowed the cap to take effect in July. The high court's decision effectively ends the case, which centers on a 2000 voter- approved measure that expanded the AHCCCS population (Reinhart, 2/15).

This Story: Print | Link to | Top

Hospital News: Colorado Legislature Considers Limits On Charges, Philly Children's Hospital Apology, Mass. Facility Closure

Colorado Public Radio: Colorado Senator Wants To Limit Hospital Bills
Colorado's legislature is taking up a bill Thursday that would limit how much hospitals can charge people without insurance. ... The lawmaker who wrote it is trying to reduce the number of Coloradans bankrupted by medical bills (Whitney, 2/15).

Denver Post: Proposal At Capitol Today Limits Financial Pain On Colorado's Medically Uninsured
Easing the pressure on beleaguered patients ... is the primary push by consumer advocates at the state Capitol this year. They will pack a hearing today on a proposal to limit hospital bills to actual costs for the uninsured, delay medical-debt collectors and require hospitals to highlight charity policies in plain language at every turn. ... Hospital advocates say the sticker-price charges are nearly meaningless, since almost no one pays that full amount. They say they write off hundreds of millions of dollars a year in charity care and bad debt from the uninsured (Booth, 2/16).

Boston Globe: Taunton State Hospital Closing Opposed
Patient advocates and officials in communities south of Boston are lobbying to block the state Department of Mental Health’s plan to close Taunton State Hospital, saying it would leave Southeastern Massachusetts without a single bed for the mentally ill. Taunton State Hospital, which opened its doors in 1854, has 169 beds and 410 employees (Legere, 2/16).

The Dallas Morning News: Parkland Chief Tries To Encourage Employees After Report Exposing Widespread Problems
Parkland's interim CEO stood before hundreds of people from the hospital on Wednesday in an attempt to blunt the impact of a sweeping report that exposed widespread threats to patient safety. ... [Dr. Thomas] Royer said the hospital has been making improvements. But on the same afternoon he was speaking, Texas health officials said the state is considering whether to fine Parkland (Jacobson, 2/15).

Des Moines Register: Independence Hospital To Pay U.S. $406,030 For Employing Barred Nurse
A Buchanan County hospital has agreed to pay $406,030 to the federal government to settle allegations that it employed a nurse who was barred from working there because of past allegations of drug use and theft from patients. State and federal records show that in January 2007 Buchanan County Health Center in Independence hired Stephanie Davison of Mitchellville to work in the hospital. She continued to work there through May 2011 (Kauffman, 2/16).

The Philadelphia Inquirer: Children's Hospital Apologizes To Family Of Disabled Girl For Insensitive Statement
Children's Hospital of Philadelphia apologized Wednesday for the way it had communicated with the parents of Amelia Rivera, the 3-year-old disabled girl whose quest for a kidney transplant has garnered national attention. ... the hospital said it was reviewing its processes to ensure that it was "sensitive to the needs of all families." In January, Joe and Chrissy Rivera said that a hospital physician had told them the girl should not have a transplant because of her mental disability (Avril, 2/16).

This Story: Print | Link to | Top

Iowa, Ga. Legislatures Consider Anti-Abortion Bills

Iowa lawmakers consider banning all abortions while Georgia is weighing banning health insurers from covering the procedure.

Des Moines Register: Responding To Abortion Bill, Iowa Dems Accuse Republicans Of Losing Jobs, Economy Focus
Citing abortion legislation introduced this morning, Iowa Democrats accused House Republicans of pursuing divisive social issues rather than policies to boost job growth and the economy. The bill, House File 2298, introduced by Rep. Kim Pearson, R-Pleasant Hill, is an outright ban on abortion, and includes criminal penalties of up to life in prison for those who perform abortions. Republicans hold a 60-to-40 majority in the House, and largely set and direct the agenda for consideration of legislation (Noble, 2/15).

The Atlanta Journal-Constitution: Anti-Abortion Bills Filed In Senate
Health insurance plans would be banned from providing abortion coverage under two bills filed Wednesday in the state Senate. Senate Bill 434 would block qualified health plans from providing abortion coverage as allowed by federal law, except when the life of the mother is endangered. Sen. Judson Hill, R-Marietta, sponsored the bill and proposed calling it the "Federal Abortion Mandate Opt-Out Act." The second bill, Senate Bill 438, would ban state employee health insurance plans from offering coverage for abortion services. Sen. Mike Crane, R-Newnan, is the bill's sponsor (Torres, 2/15).

This Story: Print | Link to | Top

Weekend Reading

Longer Looks: GOP Contraceptive Amendment Could Have Wider Effect; The Love Of Caregiving

Every week, reporter Jessica Marcy selects interesting reading from around the Web.

Mother Jones: The GOP Plan To Give Your Boss 'Moral' Control Over Your Health Insurance
In their latest move in the battle over contraception coverage, top Republicans in Congress are going for broke: They're now pushing a bill that would allow employers and insurance companies to pick and choose which health benefits to provide based simply on executives' personal moral beliefs. ... Last week, Sen. Roy Blunt (R-Mo.) offered a "conscience amendment," to the law, pitching it as a way to allay religious employers' qualms about providing birth control to their employees. But Blunt's proposal doesn't just apply to religious employers and birth control. Instead, it would allow any insurer or employer, religiously affiliated or otherwise, to opt out of providing any health care services required by federal law—everything from maternity care to screening for diabetes. Employers wouldn't have to cite religious reasons for their decision; they could just say the treatment goes against their moral convictions (Adam Serwer, 2/14).

The Washington Post Magazine: First Person Singular: Reina Vasquez, 50, Woodbridge, Home Health Care Provider
I was with one lady for 10 years. You see a lot happen to someone in 10 years, big changes and small things that only you notice at first, until that person doesn't look like herself anymore. She had been a lieutenant colonel, very high up, very respected, and when I started she was still in charge. She still was running her life. But the longer I was with her, the more I did. I cried and cried at her funeral. … After she died, I said, "No more." This is just too hard. It hurt too much.  ... (Then), I had to start doing home health care again; it’s what I know best. It's where my heart is. ... I am trying not to get too close. I do my job, but it is not easy to not care too much, you know? My job is to care (Amanda Long, 2/9).

Huffington Post: Relationships, Menopause, And Health
Who you spend time with and the quality of your relationships not only says a lot about who you are as a person, but it has a tremendous impact on your health. A now classic study published in the Journal of the American Medical Association showed that -- even after controlling for risk factors like smoking, poverty low socio-economic status, alcohol consumption, lack of exercise and obesity -- lack of social relationships, personality dispositions, and acute stress, including the stress of racism were better predictors for increased risk of death and disease. Other studies have shown that you are more likely to be overweight (and suffer from all of the resulting health consequences) if your friends are overweight than if your parents are overweight. And we are now learning that when you join together in community to lose weight and heal you are far more likely to succeed (Dr. Mark Hyman, 2/15).

Governing: Obama's Budget Could Shift Medicaid Costs To States
As Medicaid costs escalate and states prepare for further implementation of the Affordable Care Act (ACA), President Barack Obama sought to address both of those areas of concern in his fiscal year 2013 budget, released Monday. According to the White House’s budget for the U.S. Department of Health and Human Services (HHS), Obama's proposal would save nearly $360 in Medicare and Medicaid over the next 10 years: $56 billion would come through Medicaid reforms. Those reforms, though, could result in greater costs to states, policy analysts say (Dylan Scott, 2/13).

Slate: The Secret of American Health Care: Surprise! It's Already Socialized
The furor over Donald Berwick reflects a broader, fundamental disagreement over the nature of health insurance. Should it be "social" insurance, with which financial risk is leveled between those who are ill and healthy, so the carefree twentysomething and diabetic elderly man pay equally into the system? Or would it be better structured as "actuarial" insurance, where those expected to consume more shell out more, just as those who drive flashy, expensive cars or rack up speeding tickets pay higher auto insurance rates? … This dispute is central to continuing political wrangling over the 2010 health reform legislation, the main provisions of which are scheduled to take effect in a few years. But Americans made their choice clear long before Barack Obama ever signed the law—and they picked social insurance (Darshak Sanghavi, 1/31).

This Story: Print | Link to | Top

Editorials and Opinions

Viewpoints: Contraception Conscience Vs. Political Objections; Is The Mandate The 'Non-Tax' Tax?

Chicago Tribune: Obama Has It Right On Birth Control
The president's new birth control plan would insure coverage of women's birth control without copayments or deductibles. Sounds fair, especially given that men's anti-impotence Viagra treatments have been covered by insurance plans for years (Rachel Marsden, 2/16).

The Washington Post: Objections Of Conscience? Or Of Politics?
You might think that Sen. David Vitter would observe a lifetime moratorium on public moralizing after his phone number was found in the little black book of a prostitution ring’s madam. But there he was in the House TV studio on Wednesday afternoon, informing a bank of cameras about President Obama’s inferior conscience, as evidenced by a new rule that requires employers to provide birth-control coverage. ... The continuing contretemps concerning contraception offers a reminder that in Washington, the usual laws of physics don’t apply (Dana Milbank, 2/16).

Roll Call: Contraception Mandate Doesn’t Break New Ground
True religious freedom gives everyone the right to make personal decisions, including whether to use birth control, based on our own beliefs and according to what is best for our health and our families. It fiercely protects the rights of all of us to practice our faith. It does not, however, give anyone, including the bishops, the right to impose their beliefs on others (Sarah Lipton-Lubet, 2/16).

Boston Globe: Blunt Words For Brown
Why would a Republican hoping to be reelected in Massachusetts leap headlong onto Missouri Senator Roy Blunt’s slippery-slope? In case you missed it, Brown cosponsored Blunt’s legislation allowing employers to limit insurance coverage for treatments they find objectionable on moral or religious grounds. ... So any Catholic employer could refuse to cover contraception ... A Jehovah’s Witness who believes blood transfusions are against God’s will could refuse to provide coverage for those (Yvonne Abraham, 2/16).

The Wall Street Journal: Meet The ObamaCare Mandate Committee
Offended by President Obama's decision to force health insurers to pay for contraception and surgical sterilization? It gets worse: In the future, thanks to ObamaCare, the government will issue such health edicts on a routine basis — and largely insulated from public view. This goes beyond contraception to cancer screenings, the use of common drugs like aspirin, and much more (Dr. Scott Gottlieb, 2/16).

The Wall Street Journal: ObamaCare's Non-Tax Tax
The quicksilver qualities of the Affordable Care Act individual mandate penalties — what you pay if you don't buy government approved health coverage — are something to behold. Does the Obama Administration think they're a fine, a tax, or maybe something else? Well, that depends, as revealed in a telling exchange at a House budget hearing Wednesday (2/16).

Boston Globe: The Doomed But Useful Budget
Even before President Obama introduced his 2013 budget on Monday, the condemnatory e-mails from Republicans were rolling in: The budget raises taxes, especially on the rich; it does nothing to rein in entitlement programs like Medicare and Medicaid, the biggest drivers of projected future deficits. ... But Obama’s budget is noteworthy nonetheless (Joshua Green, 2/16).

Milwaukee Journal Sentinel: Mr. President: Take A Stand On Entitlement Spending
What's really needed is a realistic, long-term approach to the biggest budget-eaters — military spending, Social Security, Medicare and Medicaid. Those four broad categories occupy 68 percent of the space in the federal budget. With more than two-thirds of the federal budget consumed by military spending and insurance programs, cutting spending for everything else - as the GOP candidates propose — doesn't do much to bring budgets under control and harms the nation's well-being (2/14).

The Baltimore Sun: Health Exchanges Will Benefit Maryland families
It's no wonder Maryland families are so hard pressed to find good, affordable health insurance — premiums have outpaced earnings, and the field of insurance options is confusing. … That's why our Health Care for All Coalition is so excited about Gov. Martin O'Malley's health care bill (SB 238). By setting up a competitive insurance marketplace for private health insurance, also known as an exchange, this bill will give Marylanders more choice, more control and more peace of mind about their health care (Vincent DeMarco, 2/15).

The Seattle Times: More Cuts To Home-Care Workforce Will be Costly In The Long Run
As the Legislature considers more budget cuts on top of the more than $10 billion already slashed, a new report, "Why They Leave; Turnover Among Washington's Home Care Workers," shows that further targeting the long-term-care workforce would be costly to the state. One in five of the more than 42,000 people who care for seniors and people with disabilities lives in poverty, making barely more than $10 per hour on average (David Rolf, 2/15).

Minneapolis Star Tribune: Bachmann, Cravaak Push For Greater Health Plan Scrutiny
Two members of Minnesota's Republican congressional delegation have joined the push for greater scrutiny of state health plans’ management of Medicaid patients. … Bachmann and Cravaack deserve credit for weighing in on a complicated issue, and their timing couldn't be better. Their concerns should add momentum to efforts underway at the Capitol to increase HMO transparency (Jill Burcum, 2/15).

Houston Chronicle: Texans Need Access to Basic Health Care
You know it's serious when the Harris County Hospital District, which provides more than a million outpatient visits a year in its community health centers, has to turn away at least 340 people a day who request appointments with a primary care doctor. ... We need to support all areas of adequate funding and resources that will enhance Texans' access to primary care (2/15).

This Story: Print | Link to | Top

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.