Daily Health Policy Report

Friday, February 17, 2012

Last updated: Fri, Feb 17

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

State Watch

Administration News

Health Care Marketplace


Public Health & Education

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

SCOTUS Preview Part 2: Analyzing The Likely High Court Arguments On The Health Law

In part two of his video analysis for Kaiser Health News of the Supreme Court's upcoming decision on the health law, Stuart Taylor talks with Jackie Judd about the arguments each side is likely to make defending or challenging the individual mandate and the Medicaid expansion. Watch the video or read the transcript.

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Health On The Hill: Congressional Leaders Reach Deal On 10-Month 'Doc Fix'

Kaiser Health News reporter Mary Agnes Carey talks with Jackie Judd about the agreement Senate and House negotiators reached on the "doc fix." Carey reports: "The big news here is that the physicians will not see a payment cut starting March 1st. They were scheduled to get a 27 percent payment cut. That payment cut will not happen for the rest of the year. But they also did not get a payment increase, which is what the House-passed bill would have done. Many physicians who take Medicare patients would have liked to have seen that." Listen to the audio or read the transcript.

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Kaiser Health News: Capsules: Reid Vows To Replenish Prevention Fund

On the Kaiser Health News blog, Mary Agnes Carey reports: "Prevention advocates, take heart. The $5 billion cut to the health law’s prevention fund included in a House-Senate conference deal on the doc fix to help stop a Medicare physician pay cut will be replenished in the years ahead as the fund grows, Senate Majority Leader Harry Reid, D-Nev., said Thursday" (Carey, 2/17).

Also on the blog, Karl Eisenhower reports: "Accountable Care Organizations are a continuing source of interest to both health care providers and consumers. We at KHN have called them 'the hottest three-letter word in health care.' Now WBUR’s CommonHealth blog has put together a video animation that walks viewers through how ACOs work and what that means for consumers" (Eisenhower, 2/16). Check out what else is on the blog

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Political Cartoon: "The 'Why' Chromosome?" By Rob Tornoe

Kaiser Health News provides a fresh perspective on health policy developments with "The 'Why' Chromosome?" By Rob Tornoe.

Meanwhile, here's today's haiku:

A week of recess
Twenty-seven percent cut
Common ground is found
-- Anonymous

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Capitol Hill Watch

Catholic Bishops Call Birth Control Compromise 'Simply Unworkable'

A wealthy backer of GOP presidential candidate Rick Santorum apologizes for aspirin-as-birth-control comment, a day after female lawmakers stage walkout from a GOP-led committee hearing after no women were allowed to testify for the contraception mandate.

No women were allowed to testify on contraception at a House Oversight and Government Reform Committee hearing Thursday. Here, the five male witnesses, are sworn in (Photo by the Oversight Committee).

The Wall Street Journal: Catholic Bishops Fight Contraception Rule At House Hearing
Catholic bishops took their fight against a new federal rule requiring health insurance plans to cover contraception to a House hearing, where a representative of the U.S. Conference of Catholic Bishops testified that Obama administration changes announced last week are "simply unworkable" (Radnofsky, 2/16).

The Washington Post: Lawmakers Debate Mandated Coverage Of Contraceptives In Health-Care Law
Tempers flared on Capitol Hill on Thursday as lawmakers waded into an increasingly heated debate over the mandated coverage of contraceptives under the nation’s new health-care law. Several Democrats walked out of a House hearing on the provision, accusing Oversight and Government Reform Committee Chairman Darrell Issa (R-Calif.) of blocking testimony from a female witness who supports the mandate (Kliff, 2/16).

NPR: Birth Control: Latest Collision Between Individual Conscience And Society
Thursday, a House committee heard representatives from groups representing some Catholics, Jews, Lutherans, Baptists and others upset that the decision was infringing on their religious freedom. ... Democrats and other critics protested the hearing because initially, the witnesses only included men. Two women testified in a later panel. The current controversy over insurance coverage of contraceptives is the latest chapter in the long and often bitter history of conflicts between the right to follow one's conscience and the demands of society (Stein, 2/16).

The New York Times: Passions Flare As House Debates Birth Control Rule
Lutheran and Baptist clergymen and an Orthodox rabbi joined a Roman Catholic bishop in telling lawmakers that Mr. Obama’s latest policy of shifting the responsibility for paying for the contraceptives from religious institutions to their health insurers was unworkable and did not allay concerns about government entanglement with religion (Pear, 2/16).

CQ HealthBeat: Catholics, Religious Leaders Slam Contraception Rule At House Hearing
Republicans portrayed the issue as one of religious freedom rather than access to health care. Democrats, however, labeled the hearing that featured only a lineup of Catholic and religious leaders opposed to the rule a “sham” and told the clerics that they were being used for GOP political purposes. Two Democratic women — Carolyn B. Maloney of New York and Eleanor Holmes Norton of the District of Columbia — walked out in protest because their female witness was not included on the all-male hearing panel. Maloney later returned to the session (Norman, 2/16).

The New York Times: Religious Groups Equate Some Contraceptives With Abortion
Adding to their passionate opposition to the rule that employees of religiously affiliated institutions must receive insurance coverage for birth control, Roman Catholic bishops and some evangelical groups have asserted that it also requires coverage of some forms of abortion. They contend that methods of contraception including morning-after pills and IUDs can be considered “abortifacients” because, these advocates say, they can act to prevent pregnancy after a man’s sperm has fertilized a woman’s egg (Belluck and Eckholm, 2/16).

McClatchy: At Religious Freedom Hearing On Contraception: 'This Is An Issue Worth Dying For'
Religious leaders of different faiths stoked the national debate over contraception Thursday, converging on Capitol Hill and charging the Obama administration with attempting to violate their religious freedoms. ... "I don't think there should be any compromise when it comes to our rights to religious freedom," said William Thierfelder, president of Belmont Abbey College in Charlotte, N.C. "I came here to ask for your help. This is an issue worth dying for" (Ordonez, 2/16).

National Journal: Contraception Circus Reigns At Oversight Hearing
Chairman Darrell Issa’s House Oversight and Government Reform Committee almost always delivers a good show. So when the California Republican dove into the tidal wave of contraception controversy on Thursday, it was bound to be a circus. But it might not have been the kind of circus he intended: Planned Parenthood coined the hashtag #Issacircus on Twitter, prompting hundreds of tweets about the committee’s hearing on a controversial rule from the Obama administration requiring religious organizations to offer health insurance plans that cover birth control free of cost to women (McCarthy, 2/16).

The Hill: All-Male Picture Tells 1,000 Words, Say Backers Of Birth Control Policy
Female Democrats staged a walkout from a GOP-led committee hearing Thursday after no women were allowed to testify in support of the White House’s contraception mandate.  Their protest, and the optics of an initial panel consisting only of men, underscored the difficulty Republicans are having in framing the issue as a fight over religious freedom. Democrats want to make it a debate over contraception and women’s health, a shift that could help the party win over female voters in an election year (Baker and Lillis, 2/16).

The controversy also spilled over to the presidential campaign.

The Hill: Santorum Donor Friess Apologizes For ‘Aspirin Joke’
Foster Friess, a high-profile donor for Republican presidential candidate Rick Santorum, apologized on Friday for what he called his failed "aspirin joke." Friess, referencing an old joke about closed knees when discussing the controversy over mandatory access to contraception, told MSNBC's Andrea Mitchell on Thursday, "back in my days, they used Bayer aspirin for contraception. ...  The gals put it between their knees, and it wasn't that costly" (Cohn, 2/17).

Talking Points Memo: Santorum Backer Apologizes For Birth Control ‘Joke’
Foster Friess, the billionaire backer of the pro-Rick Santorum super PAC, apologized early Friday for "joking" that women should put "aspirin between their knees" as a form of birth control. Friess wrote on his blog: After listening to the segment tonight, I can understand how I confused people with the way I worded the joke and their taking offense is very understandable. To all those who took my joke as modern day approach I deeply apologize and seek your forgiveness (2/17).

Los Angeles Times: Santorum Dogged By Donor's Aspirin-As-Birth-Control Remark
A wealthy backer of GOP presidential contender Rick Santorum left his interviewer scratching her head Thursday when he suggested that in the olden days, birth control was less expensive because women just squeezed an aspirin between their knees to prevent them from having sex. The remark was about the last thing Santorum needed on a day that featured a renewed discussion of a 2006 interview in which he said he believed birth control was "harmful to women" and "harmful to our society" because it encouraged sex outside of marriage (Geiger, 2/16).

In other contraception-related news, a survey of insurers shows skepticism they will make up the costs of covering birth control.

Reuters: Insurers See Costs In Obama Birth Control Rule
The administration has said insurers should ultimately make up any initial costs by avoiding expenses associated with unintended pregnancies. But a new survey of 15 large health plans shows they are dubious of such savings. Asked what impact the requirement will have on their costs in the year to two years after it goes into effect, 40 percent of the participants said they expect the requirement will increase costs through higher pharmacy expenses (Krauskopf, 2/16).

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Congress Passes 'Doc Fix,' Payroll-Tax Bill By Wide Margins

The Wall Street Journal: Payroll-Tax Cut Pact Clears Congress
Congress quickly passed a deal to extend the payroll-tax-cut through year-end, continue unemployment benefits and avoid a steep cut in Medicare doctors' fees, moving on from a fight that tied up legislators for months. By 293-132, the House voted to pass the measure. The Senate quickly followed with a 60-36 vote (Hughes, 2/17).

The New York Times: Congress Acts to Extend Aid to Jobless and Payroll Tax Cut
Republicans who said they supported the deal said they had won several important concessions during the talks, like imposing new conditions and limits on unemployment compensation and making a significant cut in the preventive-health spending called for in the health care overhaul that Democrats pushed through Congress in 2010. Representative Renee Ellmers, Republican of North Carolina, called that cut “the most dramatic blow to Obamacare yet" (Cushman Jr. and Pear, 2/17).

Earlier news coverage noted the details of the final deal:

Modern Healthcare: Details Of SGR Deal Released
[The bill] would prevent a 27.4% cut in Medicare physician payment rates scheduled for March 1 and would freeze current payment rates through Dec. 31, 2012. The provision also requires that the Government Accountability Office and HHS submit reports to help Congress develop a long-term replacement of the existing Medicare physician payment system (Zigmond, 2/16).

The Associated Press: How Parts Of Payroll Tax Cut Package Are Paid For
The approximately $20 billion cost of preventing payment cuts to Medicare doctors would be paid for with cuts in other areas of health care. All these cuts and savings would be achieved from 2012 through 2022. ... President Barack Obama sought similar cuts in his proposed 2013 budget (2/17).

Kaiser Health News: Health On The Hill: Congressional Leaders Reach Deal On 10-Month 'Doc Fix'
Five billion dollars comes from the health law’s prevention fund, and this would be over the next 10 years. $2.5 billion comes from additional Medicaid money for Louisiana that was contained in the health law. And there’s also an extension of a phasing-down of Medicaid payments to hospitals that take a lot of lower-income folks. Those reductions would be extended for another year (Carey and Judd, 2/16). Listen to the audio or read the transcript.

KQED's State of Health blog: Money From Prevention Is First To Go In 'Doc Fix'
The goal of the Prevention Fund is to provide communities around the country with billions of dollars over the next ten years to invest in effective prevention efforts against heart attacks, cancer and strokes and to reduce tobacco use as well as prevent obesity. And if you’re wondering if prevention money is well spent, the most recent research says it is (Aliferis, 2/16).

Politico: Tom Harkin Rips 'Devil's Deal' On Payroll Tax
Sen. Tom Harkin (D-Iowa) unleashed fury at President Barack Obama and fellow Democrats over the deal to extend the payroll tax holiday, ripping the agreement apart as a "devil’s deal." ... Harkin, who chairs the Senate Health, Education, Labor and Pensions Committee, took particular aim at one component: that will slash about $5 billion from the Prevention and Public Health Fund - a program created by the health care law that Harkin has championed (Kim, 2/16).

Kaiser Health News Capsules blog: Reid Vows Health Prevention Fund Will Be Replenished, Eventually 
Reid said, "We put into law that this fund grows. … This program is going to grow at the rate of about $2 billion a year in the next few years." But if the conference report to stop the Medicare physician pay cut becomes law, the fund’s growth would be significantly slowed, and supporters say that will hurt its ability to finance programs (Carey, 2/17).

NPR: Doctors 'Disgruntled' And Frustrated By Looming Medicare Cuts
[The fix] isn't permanent. It only extends to the end of the year. And then, if Congress doesn't act again, the cut it is expected to be in the neighborhood of 32 percent. ... while Congress mostly hasn't let the scheduled cuts take effect, it also hasn't given doctors a raise, either (Rovner, 2/16).

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GOP Lawmakers Defend Proposed Overhaul Of Medicare

Sens. Richard Burr and Tom Coburn are proposing a plan to raise Medicare's eligibility age and premiums and require the program to compete with private insurers. Rep. Paul Ryan, in the meantime, is "excited" to defend his own plan.

The Hill: GOP Senators Push For Medicare Cuts
Sens. Richard Burr (R-N.C.) and Tom Coburn (R-Okla.) are pushing for major reductions in Medicare spending, even though they know the idea probably won't be popular with GOP colleagues in an election year. Burr and Coburn announced their plan, which is expected to reduce Medicare spending by between $300 billion and $1 trillion in the next decade, at a news conference Thursday (Bolton, 2/16).

CQ HealthBeat: Republican Senators Float Medicare Transformation
Republicans Tom Coburn and Richard M. Burr introduced a plan Thursday to transform Medicare by increasing the eligibility age, raising premiums for middle- and high-income seniors and requiring the traditional fee-for-service plan to compete with private insurers. The two senators said they had a "moral obligation" to make a serious effort to save the Medicare program, admitting they were taking a political gamble by touching a hot topic (Ethridge, 2/16).

Politico: Paul Ryan 'Excited' To Defend Medicare Plan
House Democrats have made no secret of their desire to make Rep. Paul Ryan (R-Wis.) and his Medicare reforms their biggest weapon against Republicans in November. Ryan has a simple response: Bring it on. "If you just play defense or ignore this, they're going to define this, they're going to demagogue you and they'll get away with it," Ryan told reporters Thursday during a breakfast sponsored by the Christian Science Monitor. ... Ryan said the May 2011 special election in New York, where now Rep. Kathy Hochul and fellow Democrats seized on the Medicare issue to win control of the traditionally GOP district, taught Republicans to play offense on health care (Kim, 2/16).

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Health Reform

New Solicitor General Gets Ready For Supreme Court Health Law Showdown

Donald Verrilli will bring a new voice to the debate when he defends the law before the high court next month. In the meantime, an attorney challenging the law argues that if the mandate stands, the government could also force Americans to buy a car, and KHN presents the second part of an analysis of the legal arguments before the court.

USA Today: Solicitor General Brings Voice Of Reason To Health Care Case
When the new health care law comes to the Supreme Court for a crucial test next month, the voice defending it will be a new one. Donald Verrilli, who is less than a year into his post as U.S. solicitor general, did not argue the case in lower courts. And unlike officials who have been public boosters of President Obama's initiatives, Verrilli has worked mostly behind the scenes (Biskupic, 2/16).

Reuters: Could Obama Health Care Law Force You To Buy A Car?
An attorney challenging President Barack Obama's landmark health care law before the U.S. Supreme Court said on Thursday that Congress could require Americans to buy a car or other product if people were compelled to obtain medical insurance. But a former Obama administration attorney dismissed those concerns, calling them "absurd hypotheticals," and defended the insurance purchase requirement in the 2010 law as part of a comprehensive scheme to address a national problem of soaring health care costs.

Kaiser Health News: SCOTUS Preview Part 2: Analyzing The Likely High Court Arguments On The Health Law (Video) 
In part two of analysis of the Supreme Court's upcoming decision on the health law, Stuart Taylor talks with Jackie Judd about the arguments each side is likely to make defending or against the individual mandate and the Medicaid expansion. Watch the video or read the transcript.

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State Watch

Health Law Implementation: State Insurance Exchange Bills; HHS Rules On MLR Waiver Requests

States are grappling to implement aspects of the Affordable Care Act.

Minneapolis Star Tribune: Bipartisan House Bill Outlines State Health Insurance Exchange
In a rare display of bipartisanship, three powerful Republican House committee chairmen have signed on to a DFL bill to establish a health insurance exchange for Minnesota, a required but controversial piece of the Obama administration's health care law. … While still lacking much detail, the bill begins to "put some meat on the bones" of a recommendation earlier this month by a task force appointed by Gov. Mark Dayton. It would be enough to meet a year-end federal deadline to show that Minnesota can have an exchange in operation by 2014, he said (Warren Wolfe, 2/16).

(St. Paul) Pioneer Press: At The Capitol: Health Care Exchange Bill Faces Long Odds
[The bill] featured bipartisan support in the form of co-sponsorship from Rep. Greg Davids, R-Preston, and two other Republicans. But Davids was clear in saying he thinks the federal legislation is a "scourge," adding that he hopes it will be overturned this year by the U.S. Supreme Court. More broadly, Davids said he wasn't aware of any broad change of heart among Republicans who last year blocked legislation on the subject (Snowbeck, 2/16).

The Atlanta Journal-Constitution: Legislators Seek Action On Georgia Insurance Exchange
Sen. Nan Orrock, D-Atlanta, and Rep. Pat Gardner, D-Atlanta, urged the General Assembly on Thursday to take action on legislation (House Bill 801 and Senate Bill 418) that would establish a new health insurance marketplace in Georgia. … Gov. Nathan Deal has said he doesn't want Georgia to move forward with planning for a state-based exchange until the Supreme Court decides whether the health law is constitutional. But Orrock and Gardner said Georgians need the marketplace now (Teegardin, 2/16).

CQ HealthBeat: Health Officials Deny Wisconsin Medical Loss Ratio Waiver Request, Give North Carolina Partial Reprieve
Federal health officials on Thursday denied Wisconsin's request for a waiver from a health care law requirement that insurers spend 80 percent of premium dollars on benefits. They required North Carolina insurers to meet that threshold beginning this year, but said that those who paid out at least 75 percent of premiums last year won't be penalized (Adams, 2/16).

Milwaukee Journal Sentinel: U.S. Rejects Waiver For State On Health Insurer Rule
The Obama administration has rejected Wisconsin's request to exempt health insurers from a new federal requirement that they spend 80 cents of every dollar in premiums on medical care. ... The Office of the Commissioner of Insurance contended the requirement could force companies to leave the Wisconsin market, potentially harming consumers. The U.S. Department of Health and Human Services found that the state did not provide data to support that contention (Boulton, 2/16).

Stateline: Illinois Tightens Medicaid Without Federal Approval
The 2010 federal health law has a so-called "maintenance of effort" requirement, which expressly prohibits states from doing anything that would reduce the number of people who qualify for Medicaid. But it's not clear whether the ban includes measures aimed at winnowing out people whose incomes are too high or who don't actually live within the state's borders (Vestal, 2/17).

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Ala. Mental Hospitals To Close; La. Hospital Copes With Budget Cuts; D.C. Gets Mental Health System

The New York Times: Alabama Plans To Close Most Hospitals For Mentally Ill
Alabama will shut down most of its mental health hospitals by the spring of 2013 in a sweeping plan to cut costs and change how the state's psychiatric patients receive treatment, state officials announced on Wednesday. The decision to close four hospitals and lay off 948 employees is a bleak reminder of Alabama's shrinking budget. But it is also the latest example in a longstanding national effort among states to relocate mentally ill patients from government hospitals to small group homes and private hospitals (Brown, 2/16).

Reuters: After 37 Years, Washington D.C. Gets Mental Health System
The nation's capital regained control of its mental health system on Thursday when a federal judge approved a settlement in a 37-year-old class-action lawsuit, the mayor's office said. The District of Columbia's mental health system had been under court supervision since patients at St. Elizabeth's Hospital, Washington's psychiatric center, accused the capital in 1974 of not providing enough community-based mental health services (2/16).

New Orleans Times-Picayune: Plans Made To Shore Up Mental Health Services In New Orleans Despite Cuts
LSU two weeks ago announced $34 million in cuts to its public hospital system, with $15 million of them at the New Orleans hospital. ... Thursday's LSU statement said that even though the Interim Public Hospital will not have a dedicated detox unit, it can use "general medical beds" for patients who display symptoms of impending alcohol or drug withdrawal and who require medical detoxification (Eggler, 2/16).

The Baltimore Sun: Perkins Hospital Workers Rally For More Jobs
Workers at the Clifton T. Perkins Hospital Center in Jessup held a rally Wednesday to urge state lawmakers to add more jobs at the troubled mental facility where three patients were killed in a 14-month span. Gov. Martin O'Malley has included 93 additional jobs in his budget proposal, but workers and hospital leaders worry that that number might get pared down by nearly 30 as the state faces fiscal pressure. ... [Lamont Baker, a security attendant at Perkins] said having more workers makes the patients feel safer and prevents problems that may arise when patients are anxious (Walker, 2/15).

The Miami Herald: Small City Of Wilton Manors Sees A Big Rise In Suicides
Mental-health service providers say the city’s disproportionate number of 40- to 60-year-olds along with the economy and potential issues of sexuality may be among the causes. … An uptick in suicides has caught the attention of officials in Wilton Manors, who fear they may be dealing with more than a statistical aberration (Barszewski and Williams, 2/16). 

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State Roundup: U.S. Senators Demand More Medical Board Oversight; Californians Losing Coverage; Arizona's Prison 'Quandary'

The Connecticut Mirror: Connecticut Insurers Wary Of Obama's Contraceptive Plan
"The administration never consulted us," said Susan Millerick, spokeswoman for the Hartford-based Aetna. Other Connecticut health insurers are letting the American Health Insurance Plans, a Washington-based trade association, voice their concerns. ... "We are concerned about the precedent this proposed rule would set," [AHIP spokesman Robert] Zirkelbach said (Radelat, 2/16).

Minneapolis Star Tribune: U.S. Senators Ask For More Oversight Of Medical Boards
Three U.S. Senators have asked federal health officials to review the way state medical boards regulate the nation's physicians. The request was prompted by recent reports from a citizen's watchdog group and three newspapers, including the Star Tribune, that "highlighted disturbing failures of state medical boards to discipline physicians," the senators said (Meryhew and Howatt, 2/16).

California Healthline: More Uninsured Could Put Pressure on State
A UCLA Center for Health Policy Research report showed that 670,000 Californians lost employer-based health insurance in 2008 and 2009. That is a far cry from the earlier estimate of 2 million newly uninsured in the state. ... A majority -- if not all -- of those working-age Californians who lost coverage over that two-year period could have been considered residents of "Main Street" (Gorn, 2/17).

Chicago News Cooperative/The New York Times: Illinois Medicaid Cuts Will Hit a System Already in Crisis 
Dental services are among the benefits lawmakers are considering cutting as they look for ways to reduce the cost of the state’s health care system for the poor. ... From the enrollment of patients through treatment and payment, the Medicaid program in Illinois has been plagued by fraud, inefficiency, unsustainable costs and a paralyzing political climate with often-competing doctor, hospital and health care lobbies (McQuery, 2/17).

Stateline: Illinois Tightens Medicaid Without Federal Approval
The 2010 federal health law has a so-called “maintenance of effort” requirement, which expressly prohibits states from doing anything that would reduce the number of people who qualify for Medicaid. But it’s not clear whether the ban includes measures aimed at winnowing out people whose incomes are too high or who don’t actually live within the state’s borders (Vestal, 2/17).

Arizona Republic: Arizona Prisons In Health-Care Quandary
[The Arizona Department of Corrections] is expected shortly to award a three-year contract to provide medical and mental-health care for the nearly 34,000 inmates in Arizona's 10 state-run prisons. Lawmakers adopted legislation two years ago and revised it last year, requiring Corrections to privatize the health-care system regardless of whether it saves money. But the choices are between two companies with checkered records and a third company that has no track record in correctional health care (Ortega, 2/16).

The Associated Press/Boston Globe: Vt. Health Bill Builds Risk Pool, Limits Choice
Business lobbyists are turning up the heat on the administration of Gov. Peter Shumlin to detail the costs of the governor's ambitious health insurance plan, now that three possible benefit packages have been made public. "You should be as transparent as you can so that we can understand the changes that may be coming," said Jim Harrison, president of the 600-member Vermont Grocers' Association (Gram, 2/16).

Denver Post: Colorado Senate Hearing On Medical Debt Packed
Consumer advocates and patients buried by towering medical bills called for transparency in hospital costs and limits on charges to those lacking insurance at a Colorado Senate hearing Thursday. Patient advocates cited heart attack sufferers refusing ambulance transport to avoid sticking family members with bills, and hospitals alternating harsh debt collections with mysterious, arbitrary discounts (Booth, 2/16).

WBUR's CommonHealth blog: Must-See Video: What If Your Hotel Bill Was Like A Hospital Bill?
A month after his stay, the hotel guest has just gotten a horrifying bill in the mail for $20,000. He reaches Paolo, chief financial manager of “Hotel Hopital, where you let us care for you,” and demands to know how the bill could be so high ... It’s a delicious and enlightening five minutes, this new video (Goldberg, 2/16). 

Georgia Health News: Health Proposals: For Some, They're Personal
Nine years ago, Carla Harrison of Augusta weighed 381 pounds. ... Then, in 2003, she had gastric bypass surgery, paid for by her health insurance. ... In all, she lost about 200 pounds. ... Harrison came to the state Capitol on Wednesday to testify to lawmakers about the state’s removal of bariatric surgery as a covered benefit in the state employees’ health plan (Miller, 2/16).

Minnesota Public Radio: HMO Enters Market In Southeastern Minn.
The first HMO to enter the Minnesota market since 1998 will offer health coverage in four southeastern counties. The Minnesota Department of Health certified Wisconsin-based Gunderson Lutheran Health Plan to operate in Fillmore, Houston, Olmsted and Winona counties. Minnesota's Department of Commerce must review and approve Gunderson's insurance (Baier, 2/16).

The Lund Report (Oregon): DOJ Memo Reveals Constitutional Concerns About Medical Liability Amendments The vote of Sen. Betsy Johnson (D-Scappoose), a crucial swing vote when the Senate decided to allow the Oregon Health Authority to move ahead with creating coordinated care organizations (CCOs) and overhauling the Oregon Health Plan’s delivery system, changed at the last moment because memos from the Department of Justice and Oregon Health & Science University (OHSU) revealed serious constitutional concerns about the proposed medical liability language (Waldroupe, 2/17). 

Kansas Health Institute News: Committee Votes To Cut Tobacco Program Spending
A House budget committee has recommended spending an additional $635,000 on the state’s safety-net clinics. To pay for the increase, the committee voted to cut funding for smoking prevention and cessation programs by almost 64 percent (Ranney, 2/16).

Related, earlier KHN story: Kansas Tobacco Prevention Funds Diverted To Other Uses (Thompson, 1/20) 

Minneapolis Star Tribune: Clinic Mergers Shaking Up The Medical Office Market 
Independent clinics are integrating into larger systems in an era of tighter federal reimbursement dollars. That means there will be greater cooperation among health care providers, real estate brokers say. "I'm not surprised when the bigger systems acquire general practices, but I didn't think I'd see as many higher-end specialty practices being acquired as I did last year," said Jill Rasmussen of the Davis Group (Jacobson, 2/16).

The Washington Post: Maryland Hospitals To Share Patient Data
Maryland’s 46 acute-care hospitals will soon be able to share basic patient information among themselves and with credentialed doctors, a key step that health officials and clinicians say will improve patient care and cut costs (Sun, 2/16).

Chicago Tribune: Health Officials Backtrack, Say Nursing Home Did Notify Them About Death
The Illinois Department of Public Health made a mistake when it said Wednesday that an Oak Park nursing home failed to notify the state about an altercation between two residents that left an Alzheimer’s patient dead, an official said today (Meyer, 2/17).

The Washington Post: United Medical Center Seeks $15 Million From The D.C. Government
United Medical Center is requesting an additional $15 million from D.C. taxpayers to help finance a turnaround, likely renewing debate about whether the city should own a cash-starved hospital (Craig, 2/16).

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Administration News

Administration Touts Health Care Tax Credits For Small Businesses

White House officials on Thursday highlighted a budget proposal to spend $14 billion over a decade to expand a health care tax credit for small businesses, a move they say would benefit about 4 million workers this year.

The Hill: Administration Highlights Business Health Care Tax Credits In Obama Budget
President Obama's proposed budget would expand the health law's health care tax credits by about $14 billion over a decade, the administration highlighted Thursday. Under the law, companies with 25 or fewer workers that pay for at least half of employees' healthcare coverage can claim progressively higher tax credits (up to 50 percent starting in 2014). The president's budget would increase the size of eligible companies to those with 50 or fewer workers, make it more generous and make it easier to claim (Pecquet, 2/16).

Modern Healthcare: White House Pushes Healthcare Tax Credit
The White House hopes more small-business owners would take advantage of its expanded $14 billion healthcare tax credit plan outlined in President Barack Obama's fiscal 2013 budget proposal by better publicizing the incentives and simplifying the application process. The proposal increases the number of businesses eligible for the tax credits, allowing firms with 50 or fewer employees to qualify (Selvam, 2/16).

CQ HealthBeat: Administration Officials Campaign To Raise Awareness Of Health Care Tax Credit
White House officials on Thursday highlighted a fiscal 2013 budget proposal to spend $14 billion over a decade to expand a health care tax credit for small businesses, a move they say would benefit about 4 million workers this year. The proposal would simplify and build on a credit that was part of the 2010 health care law. In 2011, about 360,000 of the estimated 6 million small business employers in the United States are expected to benefit from the existing tax credit. That means about 2 million workers will be helped to get insurance, Karen Mills, head of the Small Business Administration, and Small Business Majority CEO John Arensmeyer noted on a phone call with reporters (Adams, 2/16).

Obama's proposed budget would also reduce reimbursements for advanced imaging tests.

Medscape: Imaging Reimbursement Reduced in Proposed Federal Budget
The Obama administration debuted its proposed budget earlier this week, and part of the plan calls for cuts in Medicare reimbursement for advanced imaging tests. The proposal has been met with a blistering attack from the American College of Radiology (ACR). ... [one provision] would require physicians to get prior authorization before ordering expensive tests. The Medicare prior authorization program would be more or less modeled after programs that private insurers have increasingly plugged into their plans in recent years (Fox, 2/16). 

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Health Care Marketplace

Questions and Answers About ACOs

News organizations field questions and offer answers about accountable care organizations.

Medscape: 15 Tough Questions Doctors Ask About ACOs
Many hospitals, health centers, large physician groups, and insurers are working toward or considering forming ACOs, and physicians are being approached to participate. ... The CMS have implemented demonstration projects that incorporate the ACO concept, and several private payers have fielded their own versions of the idea. ... Medscape spoke to Anders M. Gilberg, senior vice president of Government Affairs, Medical Group Management Association (Guglielmo, 2/16).

California Healthline: Sharp's Pioneering ACO May Raise Bar in San Diego
Sharp HealthCare's selection as the only San Diego-based provider and one of six in California to participate in the federal Pioneer Accountable Care Organization program could raise the bar for health care providers throughout San Diego County. Through ACOs, a central feature of the Affordable Care Act, health care providers receive financial incentives to team up to provide higher-quality and lower-cost care to Medicare beneficiaries (Zamosky, 2/16).

Kaiser Health News: Capsules: An Animated Conversation Over ACOs
Accountable Care Organizations are a continuing source of interest to both health care providers and consumers. We at KHN have called them 'the hottest three-letter word in health care.' Now WBUR's CommonHealth blog has put together a video animation that walks viewers through how ACOs work and what that means for consumers" (Eisenhower, 2/16).

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Doctors Group Seeks To Stem Excessive Testing

The American College of Physicians is issuing guidelines to help doctors better identify when patients should be screened for specific diseases and when they can be spared the cost and the potentially invasive procedures that follow.

Reuters: Stemming The Tide Of Overtreatment In U.S. Healthcare
A leading group of U.S. doctors is trying to tackle the costly problem of excessive medical testing, hoping to avoid more government intervention in how they practice. The American College of Physicians (ACP), the largest U.S. medical specialty group, is rolling out guidelines to help doctors better identify when patients should screen for specific diseases and when they can be spared the cost, and potentially invasive procedures that follow (Sherman, 2/16).

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Public Health & Education

FDA To Reconsider Diet Drug That Failed To Get Approval In 2010

With the obesity crisis, many patients are eager for medication help, but the FDA is wary.

The New York Times: U.S. To Review Diet Treatment Once Rejected
Next week, advisers to the Food and Drug Administration will recommend whether the agency should approve the first new prescription diet pill in 13 years. The F.D.A. rejected the drug under review, Qnexa, in 2010, amid safety concerns, and the drug's manufacturer is now presenting additional data to argue its case. ... Through a regulatory loophole of sorts, many obesity doctors prescribe two separate drugs that, when taken together, are essentially the same medicine. The widespread use of the unsanctioned combination reflects the often desperate desire for a medicine to help overcome the nation's epidemic of obesity, doctors and patients say (Pollack, 2/16).

NPR: Weight-Loss Drugs Face High Hurdles At FDA
[T]he FDA rejected Qnexa in 2010 because of concerns about side effects, especially possible heart problems and birth defects. Qnexa's rejection came amid a flurry of failed attempts by drug companies to win approvals of new weight-loss drugs. The setbacks put a spotlight on how the FDA handles these drugs. Even though obesity is at epidemic levels, the FDA hasn't approved any new weight-loss medicines since 1999. ... The FDA has been especially tough on weight-loss drugs because of previous problems with those drugs, such as the diet drug cocktail fen-phen (Stein, 2/17).

In other news on weight issues, Reuters reports on a new study looking at obesity costs:

Reuters: Medicare Expenses Growing Faster For Obese Seniors: Study
Medicare is spending more money every year per person, and each obese beneficiary tacks on an extra $149 a year to that increase, according to a new study. The researchers say chronic conditions associated with obesity, such as high blood pressure and diabetes, are to blame for the steeper climb in health care expenses (Grens, 2/16).

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Health Policy Research

Research Roundup: Patient Satisfaction, Community Health Centers As Medical Homes, Analyzing Controversial Medicare Coverage

Every week, KHN reporter Shefali S. Kulkarni compiles a selection of recently-released health policy studies and briefs.

Archives Of Internal Medicine: The Cost Of Satisfaction: A National Study Of Patient Satisfaction, Health Care Utilization, Expenditures, And Mortality -- Using the Medical Expenditure Panel Survey from 2000 -2007, researchers conducted a "prospective cohort study of adult respondents (N = 51,946)" and found that "higher patient satisfaction was associated with less emergency department use, but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality" (Fenton et al., 2/13).

Center For Studying Health System Change/National Institute For Health Reform: Health Status And Hospital Prices Key To Regional Variation In Private Health Care Spending -- The author analyzed claims from 218,000 autoworkers to understand health care spending patterns. "Although autoworkers’ health benefits essentially are uniform nationally, health spending per enrollee in 2009 varied widely across 19 communities within a large concentration of autoworkers, from a low of $4,500 in Buffalo, N.Y. to a high of $9,000 in Lake County, Ill." The study suggests that the variation in health care spending is a quality and price problem. "Restraining hospital prices and improving people’s health status," will push purchasers to create new cost-effective strategies (White, February 2012).

Related KHN story: Autoworkers’ Health Claims Offer Clues To Regional Spending Variation (Rau, 2/15)

Health Affairs: Tool Used To Assess How Well Community Health Centers Function As Medical Homes May Be Flawed -- The Health Resources and Services Administration (HRSA) and CMS are trying to promote and test the adoption of a patient-centered medical home model within community health centers. However, after looking at 30 community health centers in the Los Angeles area, researchers found "that there was no significant relationship between how well these centers performed on the assessment and whether they achieved a range of process or outcome measures for diabetes care. ... Therefore, additional methods are required for measuring and improving the capabilities of community health centers to function as medical homes and to deliver the scope of services that impoverished patients genuinely need" (Clarke, Tseng, Brook and Brown, 2/15).

Medical Care Journal: Factors Predicting Medicare National Coverage: An Empirical Analysis --"Interventions considered to be particularly controversial or expected to significantly impact the Medicare program in the United States are considered in National Coverage Determinations," the authors of this analytical review write. They looked at coverage decisions from 1999 to 2007 and concluded that "good or fair quality supporting evidence is a strong predictor of positive coverage. Availability of alternative interventions, more recent decisions, and lack of an associated estimate of cost-effectiveness are associated with a decreased likelihood of positive coverage. The findings highlight Medicare’s move to evidence-based coverage decisions, and suggest that coverage decisions are influenced by the availability of cost-effectiveness evidence" (Chambers, Morris, Neumann and Buxton, 2/13).

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Editorials and Opinions

Viewpoints: The Constitution And Birth Control; War On Wyden

The Washington Post: Overreach: Obamacare Vs. The Constitution
Give him points for cleverness. President Obama’s birth control "accommodation" was as politically successful as it was morally meaningless. It was nothing but an accounting trick that still forces Catholic (and other religious) institutions to provide medical insurance that guarantees free birth control, tubal ligation and morning-after abortifacients — all of which violate church doctrine on the sanctity of life (Charles Krauthammer, 2/16).

Politico: HHS Mandate Flouts Religious Freedom
There’s nothing more fundamental to American exceptionalism than our First Freedom — our freedom of religion. The Obama administration’s mandate that employers, including religious institutions, provide insurance coverage for abortion-producing drugs, sterilizations and contraception is a threat to this freedom (Sen. Orrin Hatch, R-Utah, and Tony Perkins, 2/16).

National Journal: Birth-Control Blues
Obama's initial proposal on contraception coverage brought this simmering conflict to a boil. Backlash not only from Catholic bishops usually aligned with conservative social causes but liberal Catholic groups forced the administration last week to unveil a fallback position that required insurers, not the religious-affiliated employers themselves, to fund contraception. … Yet the administration’s ability to formulate a more widely acceptable alternative so quickly begs the question of why it didn’t choose Version 2.0 to start (Ronald Brownstein, 2/17).

Bloomberg: Republicans Are Unprotected On Contraception
But the firestorm may prove to be a political blessing. If the president had started on Jan. 20 with the compromise he eventually arrived at on Feb. 10, it would have been a one-day story for health-care policy wonks. Birth control would never have surfaced as a political issue. Instead contraception is now the elephant in the bedroom — the issue that no one in the Republican establishment wants to talk about because they know it’s a disaster for them (Jonathan Alter, 2/16).

The Wall Street Journal: The War On Wyden
Mr. Wyden is the Democrat who in December had the audacity to team up with House Republican Paul Ryan on a proposal to reform and strengthen Medicare — the entitlement that is pushing the country, and seniors, off a cliff. As bipartisan exercises go, this was big, thoughtful, promising. It was also a complete anathema to a Democratic establishment that is ideologically opposed to change, and cynically intent on using Mediscare to beat Republicans in 2012. Mr. Wyden, as a result, is taking a beating from his own (Kimberley A. Strassel, 2/17).

The Wall Street Journal: The Myth Of Runaway Health Spending
New data show that health spending over the past several years has been normalizing toward the rate of general inflation, rather than growing higher and higher, as had been the case almost continuously since the 1970s. This moderation in the growth rate of spending predates the national recession. And it puts the lie to the claim that we need government to put the brakes on an "out-of-control" health-care system (J.D. Kleinke, 2/17).

USA Today: Investing: Follow The Boomers And Buy Health Care Stocks
The aging of the 77 million Boomers is one reason that the health care sector has fared so well recently. The Standard & Poor's health care index has gained 12.9 percent the past 12 months, vs. 2.7 percent for the S&P 500 with dividends reinvested. But there are other reasons to be bullish on health care, too, ranging from dividend payouts to mergers and acquisitions to the Affordable Care Act (John Waggoner, 2/16).

Chicago Tribune: Ultra-Creepy New Ultrasound Laws Are The Shame Of The Ultra-Right
The party that claims to champion small government is at it again. This month Republican majorities in both chambers in Virginia's Legislature passed one of the strictest mandatory pre-abortion ultrasound bills in the nation — a measure that's certain to require women seeking early-stage abortions to submit to being vaginally penetrated by a condom-covered electronic probe before the abortion is allowed to proceed (Eric Zorn, 2/17).

Politico: Framers' Own Words Condemn Health Care Reform
The Framers sought a careful balance between a government strong enough to last but limited enough to avert a return to tyranny. … Thus, if the health care law does not fall within the construct of the Constitution, the Framers could not have supported it. In terms of its constitutionality, the health care law’s most problematic provision is the individual mandate. Legal scholars and judges — including district court judges who upheld the law — agree that the constitutionality of the mandate depends on whether it falls within the scope of the Commerce Clause (Sen. Mike Johanns, R-Neb., 2/16).

The New York Times: Moochers Against Welfare
Now, there's no mystery about red-state reliance on government programs. These states are relatively poor, which means both that people have fewer sources of income other than safety-net programs and that more of them qualify for "means-tested" programs such as Medicaid (Paul Krugman, 2/16).

The Fiscal Times: What Those New Super Drugs Really Cost
The folks in the R&D departments at major drug companies and biotech start-ups spend lots of money doing a multitude of tasks. ... But never forget that many of those tasks have little to do with what it "costs" to develop a new drug, which is a metric more useful to companies trying to justify the high prices of their latest medicines than a society trying to figure out how it is going to afford them (Merrill Goozner, 2/16).

Minneapolis Star Tribune: Is State Overpaying Health Plans?
But the hearing -- and legislators' intelligent handling of the issue — is a strong, if overdue, step toward addressing accountability concerns about the $3.8 billion spent annually in the state to outsource public patients to private health plans. There's too much money at stake, and too little understanding of how the state pays the plans, to let that momentum flag (2/16).

The Detroit Free Press: MSU's Insurance Mandate Makes Healthy Sense
Michigan State University has been criticized for requiring newly admitted students to have health care insurance. MSU is not alone in this mandate. ... It serves to protect students and their families from large, sometimes catastrophically large, unexpected medical bills they can't afford (John J.H. Schwarz, 2/16).

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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.