Daily Health Policy Report

Tuesday, February 19, 2013

Last updated: Tue, Feb 19

KHN Original Reporting & Guest Opinion

Health Reform

Health Spending And Fiscal Battles


Capitol Hill Watch

Public Health & Education

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Walmart Health Screening Stations Touted As Part Of 'Self-Service Revolution'

Kaiser Health News staff writer Julie Appleby, working in collaboration with USA Today, reports: "As Americans gain coverage under the federal health law, putting increased demand on primary care doctors and spurring interest in cheaper, more convenient care, unmanned kiosks like these may be part of what their manufacturer bills as a 'self-service healthcare revolution.' From SoloHealth's stations, slated to be in 2,500 Walmarts and Sam's Clubs next month, to video consultations with doctors, to smartphone apps that track blood pressure and heart rate, consumer health technology is attracting big-name backers such as retailer Walmart, health insurers Wellpoint and UnitedHealthcare and companies that make or distribute medical products, such as Johnson & Johnson and Cardinal Health" (Appleby, 2/19). Read the story.

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Health Technology's 'Essential Critic' Warns Of Medical Mistakes

Kaiser Health News staff writer Jay Hancock, working in collaboration with The Philadelphia Inquirer, reports: "Computer mistakes like the one that produced incorrect prescriptions for thousands of Rhode Island patients are probably far more common and dangerous than the Obama administration wants you to believe, says Drexel University's Dr. Scot Silverstein" (Hancock, 2/18). Read the story.

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Insuring Your Health: New Coverage May Spur Younger Women To Use Long-Acting Contraceptives

In her latest Kaiser Health News consumer column, Michelle Andrews writes: "Even though they're more effective at preventing pregnancy than most other forms of contraception, long-acting birth-control methods such as intrauterine devices and hormonal implants have been a tough sell for women, especially younger ones. But changes in health-care laws and the introduction of the first new IUD in 12 years may make these methods more attractive. Increased interest in the devices could benefit younger women because of their high rates of unintended pregnancy, according to experts in women's reproductive health" (Andrews, 2/18). Read the column.

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Cancer Rehab Begins To Bridge A Gap For Patients

Reporting for Kaiser Health News, in collaboration with NPR, Rachel Gotbaum writes: "It was her own experience with debilitating side effects after cancer treatment that led Dr. Julie Silver to realize there is a huge gap in care that keeps cancer patients from getting rehabilitation services" (Gotbaum, 2/18). Read the story.

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Federal Government To Run Insurance Marketplaces In Half The States

Kaiser Health News staff writers Phil Galewitz and Alvin Tran report: "It's official. The Obama administration will be running new health insurance marketplaces in half the states— including the major population centers of Texas, Florida and Pennsylvania. The federal government had hoped more states this week would agree to form a partnership exchange—the deadline to apply was Friday—but the offer was largely rebuffed. New Jersey, Ohio and Florida, several of the biggest states that had not declared their intentions, officially said no late in the week (Galewitz and Tran, updated 2/16). Read the story.

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Political Cartoon: 'Look, Up In The Sky ...'

Kaiser Health News provides a fresh take on health policy developments with "Look, Up In The Sky ..." by Nate Beeler.

Meanwhile, here is today's health policy haiku:


Mapping brain action:
Obama's new pet project
finds place in budget.

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

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Health Reform

States Pursue Different Paths To Health Exchanges

With Friday's deadline now passed, it is clear the federal government will run the insurance marketplaces created by the health law in about half the states. Only a handful of the states opted to partner with the feds.

The Associated Press/Washington Post: States Or Feds: Who Will Do A Better Job Covering Uninsured Americans Under Obama's Health Law?
President Barack Obama's health care overhaul is unfolding as a national experiment with American consumers as the guinea pigs: Who will do a better job getting uninsured people covered, the states or the feds? The nation is about evenly split between states that decided by Friday's deadline they want a say in running new insurance markets and states that are defaulting to federal control because they don’t want to participate in "Obamacare." That choice was left to state governments under the law: Establish the market or Washington will (2/16).

Kaiser Health News: Federal Government To Run Insurance Marketplaces In Half The States
It's official. The Obama administration will be running new health insurance marketplaces in half the states— including the major population centers of Texas, Florida and Pennsylvania. The federal government had hoped more states this week would agree to form a partnership exchange—the deadline to apply was Friday—but the offer was largely rebuffed. New Jersey, Ohio and Florida, several of the biggest states that had not declared their intentions, officially said no late in the week (Galewitz and Tran, updated 2/16).

Politico: Health Care Exchanges And The Two Americas
In the Obamacare era, there are two Americas. Half the states have refused to set up the health insurance exchanges, ignoring a Friday deadline for states to take on core requirements of the law. They’ll hand over the keys to the Obama administration, which will play an outsize and risky role in driving critical health insurance decisions that are typically the province of state governments (Cheney and Millman, 2/15).

Here's some state-specific coverage on health exchange news --

MPR News: Minnesota Health Exchange On Deadline, Moving Swiftly
Legislation that would create a new online marketplace for Minnesotans to buy health insurance will be making its last state Senate committee stop this week. More than a million residents are expected to use the so-called insurance exchange as a Web-based gateway to comparison shop for coverage and enroll in government plans. But in order for the exchange to open for business in October as required, state lawmakers must pass a bill by the third week in March. The complex and controversial legislation to create a Minnesota exchange is moving through committees with remarkable speed (Stawicki, 2/18).

Bloomberg: N.J. To Join Federal Health-Care Exchange, Christie Says
Governor Chris Christie said he gave formal notice to the U.S. Department of Health and Human Services that New Jersey will join a federally administered exchange in 2014. Today was the deadline for states to join the federal system, declare a state-federal partnership or create their own (Young, 2/15).

The Associated Press: Maine Gets Pieces In Place For Health Care Law
Though Maine has not embraced all of the components of the federal health care overhaul, the state is still ahead of most others preparing for changes coming next year, an analysis shows. Maine is one of 11 states, including New Hampshire and Vermont, to approve at least some of the Affordable Care Act's so-called market reforms, according to the Commonwealth Fund, a private group that promotes improved health care (Adams, 2/17).

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In Various States, Groups Battle Over Expanding Medicaid

Lawmakers and stakeholders continue to wrestle with the pros and cons of the health law's Medicaid expansion, as well as with the budget issues related to the state-federal insurance program for low-income people.

Los Angeles Times: Key Legislative Committee To Consider Medi-Cal Expansion
A key Assembly panel will consider legislation Tuesday that would dramatically expand Medi-Cal, the state's public insurance program for the poor. The proposal, authored by Assembly Speaker John A. Perez (D-Los Angeles), is part of a legislative package that aims to help California implement President Obama's healthcare overhaul (Mishak, 2/18).

The Associated Press: Miss. Dems Push GOP For Medicaid Expansion Vote
Mississippi House Democrats said Monday they're trying to bring pressure on Republicans to revive a Medicaid bill that's blocked in a committee. Republicans, meanwhile, say Democrats are playing politics with a government health insurance program that covers about 1 in every 5 Mississippi residents (Pettus, 2/18).

The Associated Press: Medicaid Takes A Back Seat In The 89th General Assembly
What happened to the Medicaid session? Despite all the talk before lawmakers gathered at the Arkansas Capitol that Medicaid's finances and future would overshadow just about every other issue, there's been scant attention paid to the $5 billion program and efforts to expand it under the federal health care law (DeMillo, 2/17).

Kansas Health Institute: Kansas Hospital Group Study Predicts Expanding Medicaid Would Generate 4,000 Jobs
A study released today by the Kansas Hospital Association says that expanding Medicaid eligibility to levels called for in the federal health reform law would pump more than $3 billion into the state’s economy and create 4,000 new jobs by 2020. The study, done for the association by the Center for Health Policy Research at George Washington University and Regional Economic Models, Inc., also shows that expansion would save the state more than it would cost (McLean, 2/18).

North Carolina Health News: Hospitals, Patients To See Red Ink Without Medicaid Expansion
As North Carolina lawmakers move forward on a bill that would reject the expansion of Medicaid allowed under the Affordable Care Act, patients and hospital administrators are expressing dismay. ... The expansion would cost North Carolina about $900 million over six years and bring in at least $15 billion of federal dollars over the same time period to cover the bulk of expenses. But this week, lawmakers voted to reject extending the program, passing the bill along mostly party lines (Hoban, 2/15).

Kansas City Star: Missouri Democrats Say Rural Hospitals Need Expanded Medicaid
The leader of a rural Missouri hospital warned lawmakers Monday that failure to expand eligibility for Medicaid could put institutions like his at risk of failure. Kerry Noble, the CEO of Pemiscot Memorial Hospital in Hayti, stood alongside Rep. Jake Hummel, the House minority leader, to unveil legislation that would expand Missouri’s Medicaid eligibility requirements to 138 percent of the federal poverty level, as called for by the federal health-care law. If Medicaid is not expanded — and Republican legislative leaders have opposed the idea — Noble said his hospital, in southeast Missouri, would lose around $1 million a year in federal reimbursements for treating uninsured patients (Hancock, 2/18).

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Reports Warn Premium Spikes, Dropped Workers Could Result From Health Law

The New York Times reports that some companies could avoid requirements in the health law by insuring their own employees -- a move that might drive up costs for workers of other companies. Other outlets look at concerns that young, healthy people buying policies in new online markets could see a jump in insurance costs.

The New York Times: Some Employers Could Opt Out Of Insurance Market, Raising Others' Costs
Companies can avoid many standards in the new law by insuring their own employees, rather than signing up with commercial insurers, because Congress did not want to disrupt self-insurance arrangements that were seen as working well for many large employers. Federal and state officials and consumer advocates have grown worried that companies with relatively young, healthy employees may opt out of the regular health insurance market to avoid the minimum coverage standards in President Obama's sweeping law, a move that could drive up costs for workers at other companies (Pear, 2/17).

The Fiscal Times: Obamacare Fallout: Cut Workers Hours Or Drop Coverage
For large retail and restaurant chains, the big unknown in the year ahead is how much more they'll pay for health coverage. Employers with 50 or more workers who put in 30 hours a week will be required to provide health care coverage or pay a fine, under the Affordable Care Act, also called the ACA or Obamacare. But the details haven't been settled (Coombs, 2/14).

Los Angeles Times: States Worry About Rate Shock During Shift To New Health Law
Less than a year before Americans will be required to have insurance under President Obama's healthcare law, many of its backers are growing increasingly anxious that premiums could jump, driven up by the legislation itself (Levey, 2/18).

The Washington Post: Funds Run Low For Health Insurance In State 'High-Risk Pools'
Tens of thousands of Americans who cannot get health insurance because of preexisting medical problems will be blocked from a program designed to help them because funding is running low. Obama administration officials said Friday that the state-based "high-risk pools" set up under the 2010 health-care law will be closed to new applicants as soon as Saturday and no later than March 2, depending on the state (Aizenman, 2/16).

The Washington Post: Will Young Adults Face 'Rate Shock' Because Of The Health Law?
Many young, healthy Americans could soon see a jump in their health insurance costs, and insurance companies are saying: It's not our fault. The nation’s insurers are engaged in an all-out, last-ditch effort to shield themselves from blame for what they predict will be rate increases on policies they must unveil this spring to comply with President Obama's health-care law (Aizenman, 2/15).

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Health Spending And Fiscal Battles

Medicare Trims, Scaled-Back Tax Breaks Debated As Part Of Budget Fix

The Washington Post reports that President Barack Obama favors replacing the automatic cuts slated to take effect on March 1 with a combination of budget moves, including spending cuts in Medicare and Medicaid.

The Washington Post: Obama To Press For Sequester Fix
Obama favors replacing the sequester with a combination of spending cuts in automatic programs like Medicare and Medicaid and new tax revenue, raised by scaling back tax breaks that benefit the wealthy and select industries, such as energy firms. With a sweeping deal unlikely in two weeks, Obama is pushing for a short-term measure to delay the start of the sequester — such as one proposed last week by Senate Democrats that would use alternative spending cuts and tax hikes to postpone the sequester through the end of the year. Republicans argue that Obama has focused too much on raising taxes to solve the nation's debt problem and not enough on cutting spending (Goldfarb, 2/19).

Bloomberg: Van Hollen Would Weigh Medicare Cuts As Part Of Tax Deal
U.S. Representative Chris Van Hollen scoffed at House Majority Leader Eric Cantor's recent bid to remake the Republican Party as little more than public relations while expressing a willingness to consider one Republican proposal to restructure Medicare…Still, the top Democrat on the House Budget Committee said he's willing to consider combining Medicare's Part A and B, which pay for hospital and doctors' services, to wring inefficiencies out of the health-care program for the aged (Faler, 2/16).

Roll Call: House GOP To Propose Budget Balance Within A Decade Sans Medicare Cuts
A pending budget proposal from House Republicans won't be "significantly different" on Medicare despite the fact that it will balance in 10 years rather than over several decades, according to Rep. Tom Price of Georgia, vice-chairman of the House Budget Committee…The GOP's fiscal 2012 budget, which sought to achieve balance over three decades, called for a "premium support" model for those 54 and younger. Under premium support, Medicare would allow a menu of competing plans to offer coverage with government payments (Strong, 2/15).

Medpage Today: Groups Clamor For Medicare Rx Drug Savings
The battle lines are shaping up again now that President Obama has renewed his call to allow Medicare to negotiate drug prices directly with pharmaceutical companies. The plan -- referenced early in Obama's State of the Union Address Tuesday -- has been suggested by the president before, and backed by liberal lawmakers and left-leaning healthcare lobbying groups. However, it's opposed by the powerful pharmaceutical lobby. Both sides again staked their claim this week after Obama pitched the plan Tuesday night. The Medicare drug benefit, known as Part D, is delivered by private insurers through free-standing drug plans. Those plans negotiate their prices with the drugmakers. The prices are higher than what is paid by Medicaid, whose prices are more restricted by law (Pittman, 2/15).

Meanwhile, in Massachusetts where biomedical research is key to the state's economy, politicians and scientists offered a grim prognosis of the impact of sequestration's scheduled spending cuts --

Boston Globe: Mass. Officials, Scientists Warn About NIH Cuts
With little more than a week left before across-the-board federal budget cuts could go into effect, Massachusetts politicians joined scientists and the state's top health care administrators Monday to offer a grim prognosis of the impact National Institutes of Health spending cuts would have on the Bay State, and Boston in particular. NIH grants fund hundreds of millions in research annually at the Commonwealth's hospitals and colleges. Those research dollars support about 34,000 jobs in Massachusetts, said Dr. Gary Gottlieb, president and chief executive of Partners HealthCare, and about 1,700 could be lost if the automatic cuts slice tens of millions of dollars from state’s share of NIH funding for the remaining months of this year (Marquard, 2/19).

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CMS Issues MLR Rules For Medicare Plans

Also in the news, Medicare beneficiaries are slated to receive a reduction in out-of-pocket drug costs.

Bloomberg: Medicare Drug Costs To Be Reduced For Seniors, U.S. Says
Elderly and disabled patients enrolled in Medicare will for the first time receive an annual reduction in out-of-pocket costs for drugs, the government announced. The standard deductible for plans in Medicare’s drug program, called Part D, will be $310 in 2014, about 4.6 percent less than this year, the Centers for Medicare and Medicaid Services said in a statement today. Copayments also will be reduced for the program that began in 2006 (Wayne, 2/15).

Medpage Today: CMS Issues Rules On Loss Ratios For Medicare Plans
Rules that spell out what Medicare plans must spend on care rather than marketing and overhead will mirror those of commercial plans, the Obama administration said late Friday. Starting in 2014, Medicare Advantage plans and Part D prescription drug plans will have to spend 85 percent of revenue on clinical services, prescription drugs, quality improvements, and other direct patient benefits, the Centers for Medicare and Medicaid Services (CMS) said in a proposed rule that details medical loss ratio (MLR) requirements established by the Affordable Care Act (Pittman, 2/18).

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Capitol Hill Watch

Bipartisan Measure Introduced To Undo Health Law's Insurance Tax

In other Capitol Hill news, some GOP lawmakers are upset with a physician group that encourages pediatricians to ask about gun ownership during kids' check-ups.

The Hill: Bipartisan Bill Would Repeal Health Insurance Tax
Reps. Charles Boustany Jr. (R-La.) and Jim Matheson (D-Utah) reintroduced a bill Friday to repeal the health insurance tax in President Obama's healthcare law. The health insurance tax is set to raise about $100 billion over 10 years to help pay for the coverage expansion in the healthcare law, the bulk of which will likely come from private insurance (Baker, 2/15).

The Hill: Republican Lawmakers Slam Doctors On Questions About Gun Ownership
Republican lawmakers are furious with the American Academy of Pediatrics (AAP) for backing questions about gun ownership during kids' check-ups. The practice is common among doctors, who argue it is vital to ensuring children's safety at home. President Obama has vowed to protect doctors' right to ask (Viebeck, 2/16).

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Public Health & Education

Surveying The Landscape From Bench To Bedside

News outlets report on various medical research and treatment developments.

The New York Times: Obama Seeking To Boost Study Of Human Brain
The Obama administration is planning a decade-long scientific effort to examine the workings of the human brain and build a comprehensive map of its activity, seeking to do for the brain what the Human Genome Project did for genetics (Markoff, 2/17).

Medpage Today: Obama Plans $3 Billion 'Brain Map'
The Obama administration wants to put its stamp on a major scientific initiative -- mapping the human brain to understand how it functions and malfunctions. The initiative is dubbed the "Brain Activity Map," according to the New York Times, which reported the administration's plan. The newspaper said the proposal will be delivered to Congress as part of the president's budget package, and will carry a price tag of roughly $300 million a year over 10 years. The effort would be a collaboration between federal agencies including the National Institutes of Health (NIH) and National Science Foundation and private organizations. The federal government, including the NIH and White House, weren't available for comment Monday on the Presidents Day holiday (Pittman, 2/18).

The New York Times: DNA Test For Rare Disorders Becomes Routine
Even if there is no treatment, there is almost always some benefit to diagnosis, geneticists say. It can give patients and their families the certainty of knowing what is wrong and even a prognosis. It can also ease the processing of medical claims, qualifying for special education services, and learning whether subsequent children might be at risk (Kolata, 2/18).

Kaiser Health News: Cancer Rehab Begins To Bridge A Gap For Patients
It was her own experience with debilitating side effects after cancer treatment that led Dr. Julie Silver to realize there is a huge gap in care that keeps cancer patients from getting rehabilitation services (Gotbaum, 2/18).

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Health Care Marketplace

Novartis CEO Upbeat In The Midst Of Market Challenges

USA Today: Novartis CEO Upbeat On Company, Health Care
One of the worst flu seasons in decades is finally showing signs of abating. But health care companies and individuals are still absorbing higher costs as the president's health care legislation begins to take effect. The fees and taxes related to Obamacare take effect this year, while the rest will be implemented in the coming two years. For the latest, I caught up with Joe Jimenez, the CEO of Novartis, one of the largest pharma companies and maker of the leading flu vaccine. Our interview follows, edited for clarity and length (Bartiromo, 2/17).

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State Watch

Ark., N.Y. Head In Opposite Directions On Abortion Regulation

Arkansas and New York are states headed in opposite directions on new abortion regulation: Arkansas's Senate passes a bill banning the procedure after 20 weeks while New York's governor works on legislation guaranteeing access to late-term abortions.

Reuters: Arkansas Senate Passes Bill To Ban Abortions After 20 Weeks
The Republican-controlled Arkansas state Senate approved a measure on Monday to ban abortions after 20 weeks of pregnancy except in the case of rape, incest or to save the mother's life. The Pain Capable Unborn Child Protection Act passed the Senate, 25-7, with amendments that allowed for the exemptions in the case of rape or incest. An earlier version of the bill that passed the Republican-controlled House allowed exemptions only for pregnancies that threatened the mother's life (2/18).

The New York Times: Cuomo Bucks Tide With Bill To Ease Limits On Abortion
Bucking a trend in which states have been seeking to restrict abortion, Gov. Andrew M. Cuomo is putting the finishing touches on legislation that would guarantee women in New York the right to late-term abortions when their health is in danger or the fetus is not viable (Kaplan, 2/16).

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State Roundup: Calif. Opens Prison Psychiatric Ward, Hopes To Shed Fed Oversight

A selection of health policy stories from Virginia, California, Maryland, Oregon, Massachusetts, New Jersey and Kansas.

The Washington Post: Plan To Close Va. Institutions Stokes Worry For Families Of The Developmentally Disabled
Virginia is among the last states to begin dismantling its large institutions for the developmentally disabled, a decision that was made as part of a year-old settlement agreement with the Justice Department, which argued in a lawsuit that Virginia was discriminating against training center residents by keeping them institutionalized. All but one of the commonwealth's five training centers, as the state calls them, are to be shuttered by 2020, with the one in Fairfax set to close by July 2015 (Reilly, 2/17).

Los Angeles Times: State Opens New Prison Psychiatric Ward
California prison officials have opened a new psychiatric center for inmates, contending that the $24-million treatment facility is proof the state is ready to shed federal oversight of mental health care for prisoners (St. John, 2/19).

Los Angeles Times: Nursing Home Chain Settles With State Over Poor Patient Care
Hit with dozens of citations over poor patient care, a company that operates 20 nursing homes in Los Angeles County and elsewhere in California will increase its staffing levels under a settlement with the state attorney general's office. As part of the agreement, an independent monitor will ensure that Skilled Healthcare Group Inc. complies with state staffing laws, Atty. Gen. Kamala Harris's office said Friday (Pringle, 2/15).

The Washington Post: Clinics Bring Together Doctors And Psychiatrists To Cure Physical, Mental Health Ailments
On a recent day at Family Services Inc., a low-income mental health clinic in Gaithersburg, clinic director Amy Van Grack was treating one of her regular patients when she realized the patient was homeless, pregnant and hadn't seen a primary care doctor in months. So Van Grack walked the patient down the hall to meet with one. In addition to therapists, counselors and psychiatrists, FSI in December added a medical clinic to its site. The idea: Individuals with behavioral health disorders are more likely to get the physical treatments they need when a doctor is readily available, affordable and near their mental health care provider (Khazan, 2/18).

The Lund Report: Sen. Monnes Anderson Creates Work Group To Require Evidence-Based Medicine
Oregon took a novel step toward improving health care while cutting costs last week with the creation of a work group to hash out a measure that would restrict health insurance companies from covering procedures that a state commission finds are not medically necessary or not best practices. "Most people really don't understand that depending on where you live … medicine will be practiced one way or another way," said Larry Kirsch, a Portland health economist at IMR Health Economics (Gray, 2/18).

Boston Globe: A Data Gap On Mass. Doctors' Troubles
The board that oversees physician discipline in Massachusetts has yet to deliver on its promise to post more information online about doctors who are charged with a crime or who have a history of negligent care. Now, doctors whose licenses are revoked or allowed to expire as a result of disciplinary actions are absent from the board's public database. And information about malpractice cases or board actions is removed after 10 years from the profiles of still-licensed physicians. After The Boston Globe reported last March about the Board of Registration in Medicine's practice of pulling information about the most troubled doctors from public view, board leaders promised to do better (Conaboy, 2/19).

The Associated Press: N.J. Hospitals Pioneering Efforts To Cut Health Costs
When a patient was moved from the intensive care unit to a regular hospital bed, it used to be routine for Anthony Granato, a pulmonary critical-care doctor, to order 24 hours of heart monitoring, just in case. A few years ago, his thinking changed: If the patient was in good enough condition to be out of the ICU, he would not need the extra monitoring at a cost of more than $1,000 per day. The main reason for the shift for Granato is a program introduced in a dozen New Jersey hospitals in 2009. It pays doctors when they save money for the hospitals as they treat patients covered by Medicare (Mulvihill, 2/19).

Kansas Health Institute: Senate Committee Axes $10 Million For KU Medical School Expansion
As part of their ongoing consideration of subcommittee reports, members of the Senate Ways and Means Committee today voted to cut the $10 million proposed earlier this year by Gov. Sam Brownback to be used as a down payment on modernization of the University of Kansas School of Medicine's facilities in Kansas City. The action was taken with a voice vote, but the two Democrats on the eight-person panel asked to have their opposition to the move recorded. The six Republicans supported it (Shields, 2/18).

California Healthline: UC System May End Health Care Caps, Making New Bill Moot
A bill introduced last week, AB 314 by Assembly member Richard Pan (D-Sacramento), would eliminate fiscal caps on medical care for University of California students. UC officials said they're considering their own internal proposal to erase the caps, which would make the proposed legislation moot, but bill author Pan said he plans to go ahead with the legislation to ensure the rule is changed. "It's only fair that [UC students] should have the same protections as the rest of California," Pan said, referring to provisions in the Affordable Care Act that prohibit lifetime caps on care (Gorn, 2/19).

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Editorials and Opinions

Viewpoints: Obama Needs To Offer Plan On Entitlements And Spending; Assessing The Paycheck Crimp From Health Costs

The New York Times: How To Unparalyze Us
(President Barack Obama) owes it to himself and to the country to make one more good shot at a Grand Bargain on spending, investment and tax reform before he opts for a strategy of trying to pummel the Republican Party. ... He has to lead with his chin and put a concrete, comprehensive package on the table, encompassing three areas. First, new investments that would combine immediate jobs in infrastructure with some long-term growth-enablers like a massive build-out in the nation’s high-speed broadband capabilities. That would have to be married with a long-term fiscal restructuring, written into law, that slows the growth of both Social Security and Medicare entitlements (Thomas L. Friedman, 2/16). 

The Washington Post: A Permanent Financial Fix
Now, not later, is the time to put the debt on a downward trajectory. The sudden, blunt-force spending shrinkage embodied in the "sequester" scheduled to take effect on March 1 might do more harm than good. What's needed instead is a serious, sustained effort to reform the entitlements that increasingly dominate the federal budget: especially Medicare and Social Security, including the latter's fast-growing disability program (2/16).

The Washington Post: Americans' Mental Health
With the Sandy Hook shootings still in the public mind, it seems as though every legislator, from the NRA-friendly to the anti-gun, is paying attention to mental health care in America. But lawmakers must also keep an eye on the bigger transformation of the country's mental health system that is already in the works. According to a 2011 study from the Kaiser Commission on Medicaid and the Uninsured, 60 percent of Americans and 70 percent of U.S. children suffering from mental illness aren't getting treatment. One reason, no doubt, is stigma associated with seeking help for mental rather than physical problems. Another is that out-of-pocket costs and a shortage of mental health professionals limit access (2/16).

The New York Times: The Health Benefits That Cut Your Pay
The Affordable Care Act does require employers, beginning this year, to note on W-2's how much both the employee and the employer contributed to health care costs. Maybe that will help diminish the ignorance regarding true health care costs. But even with greater awareness, many Americans still might not understand that the largest effect of the cost of our health care system is to reduce the amount of money they actually take home (David Goodhill, 2/16). 

The New York Times: Finding Out Who Pays Your Doctor
The Obama administration issued a new rule this month that requires the makers of prescription drugs and other medical products to disclose what they pay doctors for various purposes, like consulting or speaking on behalf of the manufacturer. This overdue rule adds much-needed weight to previous, more limited disclosure requirements (2/18). 

USA Today: How ObamaCare Can Improve For States
As the key months for implementing the Affordable Care Act begin, 30 governors are resisting key provisions of the law. But these leaders don't need to act just as a phalanx of opposition; if they work with President Obama and Obama works with them, they can change the law's future for the better (Peter Nelson and Josh Archambault, 2/17).

USA Today: Affordable Care Act Will Work If We Embrace It
President Obama mentioned the Affordable Care Act only once during his 2013 State of the Union address, a startling oversight considering the paradigmatic shift his landmark reforms will require of the U.S. health care system in the coming year. At first glance, the future of the U.S. health care system looks bleak, and many in the medical community are complaining about the extra pressures that the ACA will put on the system. The president missed an important opportunity to explain how the reforms will make the system better from the ground up (Peter Anderson, 2/17). 

Des Moines Register: Expanding Medicaid Is The Right Thing To Do
Providing health insurance to poor people isn't a political issue. It's the morally right thing to do. It's the financially smart thing to do — for patients, state and local governments, businesses, hospitals and doctors. Supporters have come out of the woodwork to make their case. The opponents have yet to materialize. It's time for them to stand up in a public meeting at the state Capitol and explain why providing poor, uninsured Iowans with something as basic as access to health care is a bad idea. They should also outline a viable alternative that costs less than what Washington is offering or tell their own personal stories about how being uninsured works so great for them (2/16).

The Seattle Times: Ensure Washington State Medicaid Expansion
The operative phrase is "newly eligible." Expansion of the state Medicaid program via the federal Affordable Care Act will extend health insurance to legions of people. Among those who would have access to medical care are single men earning less than $14,850 a year. Another current gap in coverage hits a swath of adults ages 50 to 64 (2/18).

The Wall Street Journal: Should Healthy People Have Their Genomes Sequenced At This Time?
Decoding a genetic sequence can be very useful for a patient with symptoms doctors can't interpret, or for couples with troubling family medical histories who are thinking of having children. But what if a person is healthy? Is there a compelling reason to know if your genes make you susceptible to a specific disease or condition? Or are there some things you're better off not knowing (Atul J. Butte and Robert Green, 2/16).

Los Angeles Times: Medicare Says Drug Refills Shouldn't Be Done Without Patient's OK
Medicare called Friday for administrators of its Part D prescription-drug program to ensure that drugstores refill prescriptions only after receiving patient approval. The move follows a series of columns in the Los Angeles Times revealing how CVS and other drugstore chains were routinely refilling prescriptions and billing insurers, including Medicare, without authorization (David Lazarus, 2/15).

Boston Globe: Medicine By Metrics
Having spent decades in search of the next wonder drug, American medicine has started to think about improving the way care is actually delivered, and has begun to dig deeply into the processes of health care. The science of operational improvement is on the rise. There's been an explosion of interest in measurement, metrics, and analytics, as researchers try to figure out how best to improve the quality of care. The pursuit of quality is powerfully enabled by the emerging "digital health" sector, which develops the tools and technologies that enable improved health data collection and sophisticated analysis, and permits us to contemplate the transition of medicine from an episodic, symptom-driven practice to a more holistic vision focused on presymptomatic care and a more continuous assessment of health (David Shaywitz and Dennis Ausiello, 2/19).

Boston Globe: Encouraging Patients To Discuss End-Of-Life Wishes
While many elderly and chronically ill patients designate an official health care proxy, few discuss their specific wishes should they later face life-threatening illness. As a result, when patients become too ill to make decisions for themselves, health care proxies are often overwhelmed by the tremendous responsibility suddenly placed in their hands. Ideally, these conversations should take place prior to the onset of severe illness (Kiran Gupta, 2/18).

Health Policy Solutions (a Colo. news service): Physician-Assisted Suicide A Slippery Slope
None of us is competent to make the decision when to end life.  We just don't, and never will, have all the data.  Since we cannot see into the mind or the heart, we cannot weigh all the factors that may be going into a patient's decision to end  life.  Patients are not obligated to fully disclose everything. We have no idea what is going on in the conscious or unconscious of a person during the last moments. When we artificially bring them to the last moment, we are interfering with that process (Dr. Anthony Vigil, 2/18).

St. Paul Pioneer Press: Nurse Ratios Are For Hospitals, Not Legislators, To Decide
They couldn't make headway on hospital staffing standards at the bargaining table, so Minnesota nurses again are taking their cause to the Legislature. With all due respect to these dedicated health professionals, that's misguided. What do legislators know about running a hospital and caring for patients? Generally speaking, nothing (2/16).

Georgia Health News: Georgia Has A 'Dental Desert,' But Hygienists Want It To Bloom
Looking at the lush greenery of the Georgia mountains or the enticing beaches and barrier islands along the Georgia coast, few people would describe the state as a desert, except for the thousands of Georgians who lack dental insurance or funds for basic preventive dental care. … Georgia ranks among the top 10 states both in current population and rate of population growth. But with just one dental school, Georgia is ranked 46th among states for its number of dentists per capita. This means that too many people in Georgia don't have access to dental care (Suzanne Newkirk and Lynne Slim, 2/17).

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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.