Daily Health Policy Report

Wednesday, February 20, 2013

Last updated: Wed, Feb 20

KHN Original Reporting & Guest Opinion

Health Spending And Fiscal Battles

Health Reform

Health Care Marketplace

Health Information Technology

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Pressure Rising To Avoid Federal Spending Cuts That Will Impact Health Programs

Kaiser Health News staff writer Mary Agnes Carey reports: "Pressure is mounting for Washington to find a way to avoid the automatic spending reductions set to begin March 1, with President Barack Obama Tuesday urging Congress to stop the 'meat-cleaver approach' that he says will undermine U.S. military strength and 'eviscerate job creating investments in education and energy and medical research'" (Carey, 2/20). Read the story.

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Nurse Practitioners Push To Help Care For Health Law's Newly Insured

Kaiser Health News staff writer Alvin Tran sat down recently with David Hebert, a veteran health care lobbyist and former CEO of the American College of Nurse Practitioners, who now is the first CEO of the American Association of Nurse Practitioners (AANP). Hebert discussed the changing role nurse practitioners may soon have, as well as some physicians' efforts to stop them (Tran, 2/20). Read the interview.

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Capsules: Hospitals Hook Up With Drugstore Giants To Lower Readmissions; Big Firms Win Multimillion Dollar Contracts To Build Insurance Marketplaces; Today Few Public Family Planning Centers Accept Insurance

Now on Kaiser Health News' blog, Colorado Public Radio's Eric Whitney, working in partnership with KHN and NPR, reports on how Walgreens is working with hospitals to reduce admissions: "Dr. Jeffery Kang is a vice president at Walgreens, and describes the new role as 'our grandfather's Walgreens on steroids.' Walgreens is now contracting with hospitals to eliminate conflicting prescriptions on discharge, and then the pharmacy will follow up with patients to make sure they understand all their medications and take them properly when they get home" (Whitney, 2/20).

In addition, Phil Galewitz reports on companies' that are winning contracts to build health exchanges: "President Barack Obama's health law has been criticized as a 'government takeover' of health care. But private companies are building the underpinnings of the online health insurance marketplaces that are a key element of the law – and winning contracts worth hundreds of millions to do so” (Galewitz, 2/19).

Also on the blog, Kaiser Health News consumer columnist Michelle Andrews writes about insurance and family planning centers: "Many of the state and local health departments, community health centers, Planned Parenthood clinics and other family planning centers that serve these women don't accept insurance, not even publicly funded insurance such as Medicaid. Not yet, anyway" (Andrews, 2/19). Check out what else is on the blog.

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Political Cartoon: 'Playing The Percentages?'

Kaiser Health News provides a fresh take on health policy developments with "Playing The Percentages?" by Ron Morgan.

Meanwhile, here is today's health policy haiku:

WILL ANYONE COME TOGETHER?

Sequestration threat
Triggers a bipartisan
Kumbaya Blamestorming moment.
--Michael Reinemer

 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 Spending And Fiscal Battles

Plans, Partisan Rhetoric Fly In Countdown To March 1 Cuts

News outlets report how spending reductions will impact health care programs. Meanwhile, in hopes of creating momentum toward a compromise, Alan Simpson and Erskine Bowles on Tuesday unveiled a $2.4 trillion proposal that includes $600 billion in spending reductions to health-care programs such as Medicare and Medicaid.

The New York Times: With Cutbacks Days Away, Obama Tries To Pressure GOP
Mr. Obama once again finds himself in a budget showdown with the opposing party, and numerous polls show his position to be more popular than Republican calls for spending cuts only, including cuts in Medicare. Mr. Obama and senior aides hardly disguised their sense of political advantage. Still, the president’s leverage might in fact be limited, since by all appearances he seems to want a deal far more than Republicans do. As the leader of the nation, Mr. Obama is eager to see an end to the repeated evidence of Washington dysfunction, or what he referred to again on Tuesday as the cycle of "manufactured crisis." And with his legacy ultimately at stake, he needs to lift the fiscal uncertainty that since 2011 has held down economic growth (Calmes, 2/19).

The Wall Street Journal: Rhetoric Turns Harsh As Budget Cuts Loom
The verbal jabs came after deficit hawks Alan Simpson and Erskine Bowles on Tuesday proposed a detailed plan for rewriting the tax code and implementing deep spending cuts, hoping it would be a road map to compromise. The two men served as co-chairmen of the White House's 2010 deficit-reduction panel, which put together a package of tax and spending changes that fell flat after the White House and congressional leaders took a look (Hook and Nelson, 2/20).

Kaiser Health News: Pressure Rising To Avoid Federal Spending Cuts That Will Impact Health Programs
Pressure is mounting for Washington to find a way to avoid the automatic spending reductions set to begin March 1, with President Barack Obama Tuesday urging Congress to stop the "meat-cleaver approach" that he says will undermine U.S. military strength and "eviscerate job creating investments in education and energy and medical research" (Carey, 2/20).

NPR: How The Sequester Could Affect Health Care
According to a letter to the Senate Appropriations Committee from Department of Health and Human Services Secretary Kathleen Sebelius, the required cuts "would result in about 3,000 fewer inpatient admissions and 804,000 fewer outpatient visits provided in [Indian Health Service] and tribal hospitals and clinics." Sebelius said the reduced funding would also result in 424,000 fewer HIV tests conducted by grantees of the Centers for Disease Control and Prevention and "2,100 fewer domestic and foreign facility inspections of firms that manufacture food products to verify that domestic and imported foods meet safety standards" by the Food and Drug Administration (Rovner, 2/19).

The Wall Street Journal: Simpson And Bowles Offer Up Deficit Fix
The new $2.4 trillion Simpson-Bowles proposal would identify $600 billion in spending reductions through changes to health-care programs such as Medicare and Medicaid. That is roughly $200 billion more than the White House has said it is willing to accept. The health-care component is perhaps the most detailed of any part of the package, calling for "improving provider and beneficiary incentives throughout the health care system, reducing provider payments, reforming cost-sharing, increasing premiums for higher earners, adjusting benefits to account for population aging, reducing drug costs, and getting better value for our health care dollars" (Paletta, 2/19).

Los Angeles Times: Bowles, Simpson Unveil Plan To Cut Deal $2.4 Trillion Over 10 Years
Erskine Bowles and Alan Simpson, who have been pushing for a major deficit reduction plan since co-chairing a bipartisan commission on fiscal reform, released a new proposal Tuesday to cut the nation's debt by $2.4 trillion over the next decade. Called "A Bipartisan Path Forward to Securing America's Future," the plan attempts to avoid the large automatic spending cuts set to hit March 1 while also dealing with long-term debt drivers such as Medicare (Puzzanghera, 2/19).

Modern Healthcare: New Deficit-Reduction Plan Seeks $600B In Healthcare Cuts
The former co-chairmen of the president's bipartisan fiscal commission have introduced a deficit-reduction proposal that calls for an additional $2.4 trillion in savings over 10 years, with roughly a quarter of those savings—or about $600 billion—coming from Medicare and Medicaid. Erskine Bowles, former White House chief of staff in the Clinton administration, and former Sen. Alan Simpson (R-Wyo.) unveiled the framework as a way to show lawmakers that a so-called grand bargain to lower the nation's ballooning deficit is still within reach. Bowles and Simpson indicated that a more detailed plan is expected in the coming weeks to give others both on and off Capitol Hill a chance to comment on the proposal (Zigmond, 2/19).

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Health Reform

Feds Will Run At Least 26 Health Insurance Marketplaces

Meanwhile, Kaiser Health News reports that private companies have won lucrative contracts to build the information technology infrastructure of the online marketplaces, also known as exchanges.

Reuters: U.S. To Operate 26 State Health Exchanges With Little Local Help
The Obama administration said on Tuesday that it will operate federal online health insurance marketplaces in 26 of the 50 U.S. states with little or no input from local state officials. The U.S. Department of Health and Human Services announced that a total of 24 states, including six with Republican governors, plus the District of Columbia, are on track to run their own marketplaces, known as healthcare exchanges, or to do so in partnership with the federal government (Morgan, 2/19).

Medpage Today: HHS To Run Health Exchanges In 27 States
The 27 states that defaulted to a federal exchange include heavily populated states like Florida, Georgia, Pennsylvania, and Texas. Many of the states in the group are politically conservative areas in the deep South and Midwest. The seven states that have decided to partner with the federal government will manage qualified health plans and provide consumer assistance and outreach for residents eligible to participate in the exchanges, while the federal government sets up the exchange infrastructure and determines eligibility. It's that partnership which Gruber sees as becoming more prevalent in the future (Pittman, 2/19).

Kaiser Health News: Capsules: Big Firms Win Multimillion Dollar Contracts To Build Insurance Marketplaces
President Barack Obama's health law has been criticized as a 'government takeover' of health care. But private companies are building the underpinnings of the online health insurance marketplaces that are a key element of the law – and winning contracts worth hundreds of millions to do so (Galewitz, 2/19).

Also in the news related to the health law's implementation --

Politico: ACA Mental Health Plan's Growing Pains
Aided by the health care law, some states have already put in place a model that creates a dramatically different way of caring for Medicaid mental health patients. But if the slow state uptake of the program is any indication, the patterns of spotty care for most low-income people with big mental health problems won’t change quickly (Smith, 2/20).

Kaiser Health News: Nurse Practitioners Push To Help Care For Health Law's Newly Insured
Kaiser Health News staff writer Alvin Tran sat down recently with David Hebert, a veteran health care lobbyist and former CEO of the American College of Nurse Practitioners, who now is the first CEO of the American Association of Nurse Practitioners (AANP). Hebert discussed the changing role nurse practitioners may soon have, as well as some physicians' efforts to stop them (Tran, 2/20).

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States Continue Mulling Medicaid Expansion's Costs And Benefits

News outlets report on analyses in California, Georgia, Florida, Texas and Wyoming.

California Healthline: State Based Expansion Makes More Sense, LAO Says
After conducting a review of the two choices California officials are considering for optional Medi-Cal expansion, the state Legislative Analyst's Office yesterday strongly recommended the state-based option, rather than a county-based plan. On a busy Tuesday for health care policy in Sacramento, the Assembly Committee on Health yesterday convened the first hearing of the legislative special session on health care reform and passed the first component of it. … The proposed bill establishes the framework to expand Medi-Cal to childless adults under age 65 in California, up to 138 percent of federal poverty level. It would streamline the eligibility and enrollment process to follow the mandate of the Affordable Care Act, and offer California's version of federally-required essential health benefits (Gorn, 2/20).

The Associated Press: Analyst Says California Should Expand Medicaid
The benefits of expanding health care for California's poor under the Affordable Care Act far outweigh the costs to the state, according to a report released Tuesday by the nonpartisan Legislative Analyst's Office. Legislative analyst Mac Taylor urged lawmakers to adopt an optional Medicaid expansion that features an enhanced cost match from the federal government, meaning Uncle Sam will pick up most of the tab and send billions of dollars flowing into the state (Lin, 2/19).

Georgia Health News: Medicaid Expansion Seen As A Lifeline
The economic arguments on Medicaid expansion have grabbed headlines in Georgia recently, from projections of the cost to the number of jobs created. But a news conference Tuesday by advocates for expansion took a different approach. It highlighted the human side of the decision. A number of uninsured men in their 40s are getting care in nursing homes because their hypertension went untreated and led to a stroke, said Dr. Harry Strothers of Morehouse School of Medicine, a family physician who practices in Atlanta and East Point (Miller, 2/19).

The Texas Tribune: Interactive: Economic Impact Of Medicaid Expansion By Legislative District
Expanding Medicaid to cover poor adults is incredibly unpopular among most Texas Republicans — and Gov. Rick Perry has vowed the key tenet of the federal Affordable Care Act won't be rolled out here. But proposals to do it have gained traction among some fiscal conservatives, who argue the long-term economic benefits of expanding Medicaid could outweigh the political backlash. This interactive map shows the estimated economic impact of expanding Medicaid by legislative district, according to a report by Billy Hamilton, the state’s former chief revenue estimator and a consultant commissioned by the interfaith group Texas Impact and Methodist Healthcare Ministries (Aaronson, 2/20).

Health News Florida: Medicaid Expansion Cost? Still A Guess
As legislative hearings continue on the cost vs. benefit of Medicaid expansion – a decision Florida must make in the coming session -- only a few things are clear: No one knows for sure whether the expansion to approximately 1 million uninsured Floridians whose incomes are below 138 percent of the federal poverty level will end up being a net plus to the state – since the federal government is putting up over $26 billion over 10 years – or a net minus. A study is available to fit every opinion (Gentry, 2/19).

The Associated Press: Fla. Hospitals Push For Medicaid Expansion
Florida hospital executives warned they will be hit hard if the state does not expand Medicaid coverage under the federal health overhaul because hospitals will lose federal funding they've been relying on to care for uninsured patients. Florida hospitals spent more than $2.8 billion caring for uninsured patients in 2011, hospital officials said Monday (Kennedy, 2/19).

The Associated Press: Despite Rejection, Wyo. Studies Medicaid Expansion
Despite the Wyoming Legislature's recent rejection of a plan to extend Medicaid coverage to 17,600 additional low-income adults, the state's Department of Health continues to study the possibility. Expanding Medicaid is a cornerstone of the Affordable Care Act, and the federal government has pledged to initially pay the total cost of the optional expansion that lawmakers rejected last month (Neary, 2/19).

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Health Care Marketplace

Supreme Court Gives FTC More Power To Police Hospital Mergers

The decision is a win for the federal government as it seeks to monitor the trend toward consolidations around the country.

The New York Times: Supreme Court Gives FTC A Win On Hospital Mergers
The Supreme Court on Tuesday strengthened the power of the Federal Trade Commission to block hospital mergers, issuing an opinion that could limit the ability of public hospital authorities to claim immunity from federal antitrust laws (Pollack, 2/19).

The Wall Street Journal: FTC Gets More Muscle In Policing Hospital Mergers
The U.S. Supreme Court on Tuesday gave more muscle to federal antitrust enforcers' ability to police hospital mergers, the latest win for the government in its campaign to monitor the fast-consolidating industry. The court, in a unanimous decision, revived the Federal Trade Commission's challenge to a Georgia hospital deal, ruling the merger wasn't immune to federal antitrust scrutiny. The decision placed limits on the circumstances in which local governments are exempt from federal antitrust laws (Kendall, 2/19).

Georgia Health News: A Stunning Blow To Albany Hospital Merger
The U.S. Supreme Court, in a unanimous decision Tuesday, ruled that an acquisition by a hospital authority that owns Phoebe Putney Memorial Hospital was not immune from antitrust scrutiny. The decision represents a victory for the Federal Trade Commission, which argued that the Albany merger was anti-competitive. The Albany-Dougherty County Hospital Authority's bid to acquire Palmyra Medical Center drew opposition because Phoebe Putney and Palmyra are the only two hospitals in the Albany area. In 2011, the Atlanta-based 11th U.S. Circuit Court of Appeals ruled that the Georgia General Assembly had granted antitrust immunity to such deals through a hospital authorities law, trumping the FTC's argument that the acquisition would cause higher health costs in the Albany area (Miller, 2/19).

In another court decision --

San Francisco Chronicle: U.S. Supreme Court Sides With Optometrists
The U.S. Supreme Court rejected optical companies' challenge Tuesday to a California law, backed by optometrists, that prohibits eyeglass sellers from using their offices to conduct eye exams. The 1969 law bars opticians who sell eyewear from leasing space to eye doctors, while allowing doctors who check patients' eyesight to also sell eyeglasses in their offices. It thus reserves to optometrists and ophthalmologists the ability to offer "one-stop shopping" for exams and glasses while denying it to optical companies, many of them national chains (Egelko, 2/19).

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Possible Medicare Advantage Pay Reductions Cause Insurer Stocks To Slip

The proposed cuts in federal payments, which are open to comment until March 1, could lead to reduced coverage or fewer options for people who choose to buy these plans.   

The Associated Press/Washington Post: Health Insurer Stocks Slip Over Possible Medicare Advantage Payment Cuts
Health insurance stocks wobbled Tuesday after data released by the federal government pointed to possible steep Medicare Advantage payment cuts in 2014, which could lead to reduced coverage or fewer options for people buying the plans. The Centers for Medicare and Medicaid Services said Friday after markets closed that it expects costs per person for Medicare Advantage plans to fall more than 2 percent in 2014, a bigger drop than many analysts who cover the industry anticipated (2/19).

The Wall Street Journal: Health Insurers Tumble Amid Medicare Proposal
Shares in Humana Inc. and other major health insurers fell Tuesday after analysts said a government proposal for Medicare Advantage rates in 2014 is unfavorable for the companies. The late-Friday proposal is open to outside comments until March 1, ahead of a final announcement due April 1, so there is time for the industry to lobby for less pressure on rates. Insurers see Medicare Advantage—their version of the government health plan for seniors—as a key growth area, but expanding any presence there means taking on exposure to government payment decisions (Kamp, 2/19).

Reuters: Proposed 2014 Medicare Advantage Rates Cut Insurer Payments
Proposed reductions in government payments for Medicare Advantage insurance plans - estimated at $11 billion by an insurance industry trade group - sent health insurer shares lower on Tuesday. Humana Inc said that the planned cuts would affect its growth in 2014, and its shares fell as much as 10 percent. Insurers UnitedHealth Group Inc, Aetna Inc and Cigna Corp also were slightly down (Humer, 2/19).

Modern Healthcare: Insurers See Proposed Medicare Advantage Rates Hitting Revenue
Health insurance companies are expecting reduced Medicare Advantage payments to unfavorably impact revenue next year. The CMS on Friday released its proposed 2014 rates for Medicare Advantage plans, prompting negative reaction from payers and investors. Shares of health insurance plans such as Humana, Universal American Corp. and Health Net took a dive on the news when they opened for trading this morning. The CMS proposal calls for a 2.2% decline in Medicare Advantage benchmark payment rates. Humana, which derives most of its revenue from Medicare Advantage, saw one of the largest decreases in its share price (Kutscher, 2/19).

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Health Information Technology

Push For Electronic Medical Records Leads To Profits For Some Companies

The New York Times: A Digital Shift On Health Data Swells Profits In An Industry
The approach came in 2009, in a presentation to doctors by Allscripts Healthcare Solutions of Chicago, a well-connected player in the lucrative business of digital medical records. That February, after years of behind-the-scenes lobbying by Allscripts and others, legislation to promote the use of electronic records was signed into law as part of President Obama’s economic stimulus bill. The rewards, Allscripts suggested, were at hand. But today, as doctors and hospitals struggle to make new records systems work, the clear winners are big companies like Allscripts that lobbied for that legislation and pushed aside smaller competitors (Creswell, 2/19).

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State Watch

Calif. Insurance Official Pans Rate Map Proposal, Warns Of 20% Hikes

California's insurance commissioner says that residents in some areas of the state could see premiums rise 20 percent if a proposal in the state legislature to split California into six insurance rates zones is approved. He urges an 18-region plan.

Los Angeles Times: Health Insurance Rate-Setting Map Would Increase Costs, Official Says
A proposal to split California into six zones for setting health insurance rates would drive premiums up as much as 23 percent for some policyholders next year as part of the federal health care overhaul, the state insurance commissioner is warning (Terhune, 2/20).

Sacramento Bee: Insurance Commissioner Touts New Plan For CA Health-Care Regions
Saying the Legislature's existing proposal could exacerbate rate shock, state Insurance Commissioner Dave Jones unveiled his own proposal Tuesday for dividing California into geographic regions for implementing federal health care reform. Jones vowed to appear Wednesday before Senate and Assembly health committees to push his 18-region plan instead of existing legislative proposals for six regions in 2014 and 13 regions in 2015. "I believe very strongly that we should draw regions in a way that minimizes rate increases," Jones said. Because costs of providing health care differ among communities, residents could find themselves paying higher or lower premiums based on the extent to which regions drawn by the state differ from those currently used by health insurance firms (Sanders, 2/19).

San Francisco Chronicle: 20% Health Insurance Hike For Some In Bay Area?
Bay Area consumers could see health insurance rates rise by more than 20 percent under proposals being considered by state lawmakers to carry out the new federal health legislation, according to the state Insurance Department. The federal health law requires most Americans to have health insurance by Jan. 1, 2014, and many people will be purchasing coverage through state- or federal-run insurance exchanges, or virtual marketplaces. The law, often referred to as Obamacare, will prohibit health insurers from rejecting or charging consumers more based on their medical histories. Charging more based on age will be limited so older consumers cannot pay more than three times what a younger person would pay (Colliver, 2/19).

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Pa., Wis. Governors Face Scrutiny, Decisions On Medicaid Programs

Governors in Pennsylvania and Wisconsin are facing questions from their legislatures over plans to expand or limit Medicaid enrollment.

The Associated Press: Dems Take On Corbett Over Medicaid, Pensions
Pennsylvania Senate Democrats on Tuesday challenged Gov. Tom Corbett's top budget adviser over the necessity of carrying out the administration's proposed pension fund changes and to explain how it developed an analysis that a Medicaid expansion would cost state taxpayers billions of dollars. Corbett's budget secretary, Charles Zogby, gamely answered questions for nearly 2 1/2 hours during the Senate's first Appropriations Committee hearing of 2013 as lawmakers begin to pick apart the Republican governor's spending plan (Levy, 2/20).

Milwaukee Journal Sentinel: Scott Walker To Unveil Budget That Will Address Medicaid, Schools, And Jobs
Facing re-election in less than two years, Gov. Scott Walker on Wednesday will lay out budget proposals to cut income taxes, limit a state BadgerCare expansion and widen the reach of private voucher schools. The Republican governor will deliver his second budget address at 7 p.m., detailing his taxing and spending priorities for the next two years. His speech will be carried live on Wisconsin Public Television and Wisconsin Public Radio. Many of Walker's priorities have already been revealed over the past two weeks, from his plans for state Medicaid programs to his aim of refocusing the state's public universities and technical colleges on in-demand professions such as nursing, accounting and machining. One proposal with few details released so far is the governor's plans for a $300 million, or 2 percent, income tax cut over the next two years. The governor says that would work out to about $100 a year for a "typical family" (Stein, Glauber, and Mulvany, 2/19).

In the meantime, West Virginia and Texas take aim at recovering Medicaid fraud dollars --

The Associated Press: W. Va. Proposal Aims To Help Medicaid Recover Costs
A state Supreme Court justice has warned that a recent ruling will cost West Virginia taxpayers millions of dollars, prompting Gov. Earl Ray Tomblin to ask the Legislature to revamp the way Medicaid recovers some of its spending. Legislation introduced on the governor's behalf this session would apply when Medicaid recipients or their survivors stand to receive damage awards or court settlements (2/20).

The Texas Tribune: Senate Panel Backs Bill That Targets Medicaid Fraud
The Senate Health and Human Services Committee gave its endorsement Tuesday to legislation that tackles Medicaid fraud and could save the state millions of dollars…The state comptroller anticipates the actions called for in SB 8 would save $14 million annually in state funds after 2015, and shrink state employment by nearly 300 full-time positions (Aaronson, 2/19).

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State Roundup: N.H. Governor Wants Taxpayers To Foot Part Of Charity Care Bill

A selection of health policy stories from New Hampshire, Alabama, Tennessee, Maryland, Minnesota, California, Pennsylvania and the District of Columbia.

The Associated Press: Hassan Wants Taxpayers To Share Charity Care Cost
Gov. Maggie Hassan told a joint legislative panel Tuesday that taxpayers should help offset New Hampshire hospitals' charity care costs to ensure the state's poor citizens have access to the medical care they need. The current budget, written by Republicans, cut state hospital aid for the care for all but a handful of critical access hospitals (Love, 2/19).

Reuters: Alabama House Passes Passes Bill Tightening Restrictions On Abortion Clinics
The Alabama House of Representatives passed legislation on Tuesday that would tighten regulations for abortion clinics in a move critics say could force many in the state to close. The Republican-controlled House approved the bill in a 73-23 vote. The bill now moves to the Senate, which also has a Republican majority, for consideration (Wilkinson, 2/19).

The Associated Press: Health Care Compact Fails In House Committee
A measure that would have allowed Tennessee to approach Congress about forming the state's own health care system has failed a second consecutive year after opponents said Tuesday it's unnecessary and could hurt the state's other health initiatives. The proposal was developed last year as a challenge to the federal health overhaul championed by President Barack Obama and would have sought waivers for each participating state to create its own health care system (Johnson, 2/19).

The Washington Post: O'Malley Agrees To Tougher Gun Prohibition Aimed At The Dangerously Mentally Ill
Maryland Gov. Martin O'Malley's (D) administration will bow to mounting opposition from members of his own party and back significantly tougher rules to get guns out of the hands of the dangerously mentally ill, administration officials said Tuesday (Davis, 2/19).

MPR News: Half Of Minn. 3rd Graders Have Had Cavities
Minnesota health officials on Tuesday said they plan to put new emphasis on oral health, saying it's an often-overlooked aspect of human health. In releasing its first-ever Minnesota Oral Health Plan, the Minnesota Department of Health released new data showing that 55 percent of Minnesota third graders have or have had tooth decay. The data come from a 2010 survey of about 1,000 Minnesota children. The national average for tooth decay among third graders was 53 percent. "We certainly can do better," state Health Commissioner Dr. Ed Ehlinger said. Health officials will meet with dentists, doctors and others on Friday to discuss how to better include oral health in efforts aimed at improving overall health (Dunbar, 2/19).

HealthyCal: Bridging The Health Gap May Start With Building Trust
Health care professionals, policymakers and African American women recently gathered in Merced to share their views on the social and racial barriers that keep women of color from being active participants in their own health care and to develop strategies that will improve the health outcomes of all African American women in the county (Perez, 2/20).

Philadelphia Inquirer: Penn Health System To Stop Hiring Smokers
The University of Pennsylvania Health System will no longer hire smokers and other tobacco users, starting in July. The system, which includes the Hospital of the University of Pennsylvania, said the policy would improve the health of its workforce and reduce the cost of health-care benefits. A job applicant must be tobacco-free for six months. New employees, including doctors, who are caught lying about their tobacco use may be fired. Current employees are not subject to the prohibition, but they already pay a higher premium on their health-care benefits if they are tobacco users and are not participating in free antitobacco programs offered by the system (Moran, 2/20).

The Washington Post: $12.7 Million Contract Approved To Overhaul D.C.-Owned Hospital
The D.C. Council voted Tuesday to approve a $12.7 million, two-year contract to overhaul management of United Medical Center, the city-owned hospital that has bedeviled officials for a decade. The 8 to 3 vote followed a lengthy debate that touched on various aspects of the hospital deal, including concerns about the contracting process, the necessity of the costly turnaround and what form the hospital might take afterward (Craig and DeBonis, 2/19).

Baltimore Sun: Legislation Would Require Participation In Psychiatric Bed Registry
A Baltimore lawmaker plans to introduce legislation that would require all Maryland hospitals to participate in an online psychiatric bed registry meant to expedite care for the mentally ill. ... The Baltimore Sun reported Tuesday that some hospitals have been reluctant to take part in a new registry launched by state health officials. The registry, which currently is voluntary, allows hospitals with psychiatric units to routinely post notice of available beds. This lets emergency rooms more easily determine where patients can be transferred. Launched in November, the registry is being used by about a dozen hospitals with psychiatric units, or a third of the total number statewide (Rector, 2/19).

California Healthline: New Navy Hospital In San Diego May Be Sign Of The Changing Times
A major construction project is under way to replace the existing Naval Hospital on the Marine Corps base at Camp Pendleton, the largest military training facility on the West Coast. … Like the Navy, providers nationwide are building new hospitals with an eye toward the primacy of ambulatory care. ... Steven Escoboza, president and CEO of the Hospital Association of San Diego and Imperial Counties, said the planning process for new and remodeled hospitals is made more complex by the need for flexibility to meet the unknown future demands of a fast-changing health care market (Zamosky, 2/19).

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Editorials and Opinions

Opinions On The Sequester: Too Much Medicare Spending On The Affluent; Boehner Says Obama Got More Taxes In The Health Law

As the automatic spending cuts grow nearer, some analysts offer their perspective.

The Wall Street Journal: The President Is Raging Against A Budget Crisis He Created
The president has repeatedly called for even more tax revenue, but the American people don't support trading spending cuts for higher taxes. They understand that the tax debate is now closed. The president got his higher taxes—$600 billion from higher earners, with no spending cuts—at the end of 2012. He also got higher taxes via ObamaCare. Meanwhile, no one should be talking about raising taxes when the government is still paying people to play videogames, giving folks free cellphones, and buying $47,000 cigarette-smoking machines (House Speaker John Boehner, R-Ohio, 2/19).

The New York Times: Old And Rich? Less Help For You
Democrats want to close the budget gap by having the government lean more heavily on the wealthy, while Republicans want to close it by having the government spend less money. Both sides should agree at least to spend less money on the wealthy — via means testing. It may surprise some Americans to learn that the United States spends quite a lot on the affluent, especially through the entitlement programs at the heart of the budget fight: Social Security and Medicare. Both programs move money from relatively poorer young people to relatively richer old people, and they are growing ever more expensive. Means-testing — allocating benefits according to need — might offer both sides a way out (Yuval Levin, 2/19).

The Washington Post: A Grand Bargain On Life Support
(Alan) Simpson and (Erskine) Bowles said Tuesday that health-care cuts would need to be $600 billion over a decade. That's part of their new plan to shave $2.4 trillion from the deficit over 10 years; they would also raise $600 billion in tax revenue by limiting deductions, and they would cut an additional $1.2 trillion from farm subsidies, Social Security and other programs. Bowles on Tuesday restated the obvious: Obama needs to accept deeper cuts to the government's health-care spending, and Republicans need to accept more tax increases. But this assumes both sides want a grand bargain to right the nation’s finances — and it's no longer obvious that they do (Dana Milbank, 2/19).

The Washington Post: The Blame Game Over Sequestration
The sequester would slash $85 billion between now and Sept. 30, half from discretionary programs and half from defense. Both of these have already been trimmed in previous budget deals — defense to the point where Pentagon leaders predict damage to national security if the sequester goes through on March 1. Entitlements, meanwhile, remain unreformed (2/19).

The Wall Street Journal: President Armageddon
The sequester is far from ideal and it would make much more sense to work with Congress to set priorities. But Mr. Obama has rejected every meaningful reform in entitlements that Republicans or his own Simpson-Bowles commission have offered. ObamaCare will add more than $1 trillion in new costs and add some 17 million people to Medicaid, but he says this can't be touched. In his State of the Union address Mr. Obama proposed $83.4 billion in new spending, according to a tally by the National Taxpayers Union (2/19).

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Viewpoints: ACOs Are Doomed To Fail; The Need To Expand Medicaid In Texas; The Case Against Malpractice Changes In Iowa

The Wall Street Journal: The Coming Failure Of 'Accountable Care'
Spurred by the Affordable Care Act, hundreds of pilot programs called Accountable Care Organizations have been launched over the past year, affecting tens of millions on Medicare and many who have commercial health insurance. ... The ACO concept is based on assumptions about personal and economic behavior—by doctors, patients and others—that aren't realistic. Health-care providers are spending hundreds of millions of dollars to build the technology and infrastructure necessary to establish ACOs. But the country isn't likely to get the improvements in cost, quality and access that it so desperately needs (Clayton Christensen, Jeffrey Flier and Vineeta Vijayaraghavan, 2/18).

The Texas Tribune: Why Texas Should Expand Medicaid
Medicaid expansion is the most important health care opportunity in a generation. The Dallas Regional Chamber of Commerce, Texas Medical Association, Texas Hospital Association, Interfaith Alliance and many others across the business, faith, and healthcare communities recognize this and are advocating for expansion. State leaders can improve public health and our economy by working collaboratively with others to create a Texas plan that will improve the Medicaid delivery system and bring expansion dollars to Texas (Clay Jenkins, 2/19).

The Wall Street Journal: Should States Opt Out Of The Health Law's Medicaid Expansion?
Part of the court's decision made it easier for states not to participate in expanding Medicaid benefits to subsidize health-care coverage for a broader swath of poor Americans. ... States are deciding now, as the law's major provisions take effect in 2014, and state budgets have already been outlined. Ed Haislmaier, a senior research fellow at the Heritage Foundation, in Washington, D.C., argues that states should opt out of the expansion. Taking the view that states should go along with the expansion is Sara Rosenbaum, the Harold and Jane Hirsh professor in the School of Public Health and Health Services at George Washington University, also in Washington (2/18).

The New York Times: Reproductive Rights In New York
New York State once led the nation in advancing women's rights. Gov. Andrew Cuomo wants to re-establish that pre-eminence with an omnibus agenda on women's equality. The most important piece of that agenda would essentially enshrine in state law existing federal protections for abortion rights (2/19). 

The New York Times: Losing My Leg To A Medical Error
I lost my leg because of a preventable error. The loss of a limb is traumatic, and I experience waves of sorrow and regret. I struggle with continual pain in my residual limb, and am trying to learn how to walk with my prosthesis. My work as a physician has been put on hold. For the past two decades I have been studying how to prevent errors in health care, and the irony of my present predicament strengthens my motivation to continue the quest. No one should ever have to experience such preventable harm (Dr. Frederick S. Southwick, 2/19). 

Des Moines Register: Iowa Doesn't Have A Malpractice Crisis
Gov. Terry Branstad says "frivolous" medical malpractice lawsuits make it more difficult for Iowa to recruit and retain physicians. He has asked state lawmakers to require a medical expert to screen cases before they can move forward in court. He also wants to cap the amount of "non-economic" damages juries could award when someone is injured by a doctor. The governor's assertions are not rooted in facts, and the Legislature should not entertain such measures (2/19).

Health Policy Solutions (a Colo. news service): Churning Isn't Just For Butter Anymore
Churning is the policy wonk term for those who qualify and are covered by a public program, like Medicaid, and then have access to a private insurance plan through a new job that offers it or through a family member's coverage, but then lose that coverage and end up back on the public insurance for which they qualify. They churn. And they suffer (Donna Smith, 2/19).

The Fiscal Times: Alzheimer's: A Spending Program All Can Agree On
In the course of President Obama's SOTU litany, his recommitment to spending resources on Alzheimer's research stands out as the one topic that brought applause from both sides of the aisle. It even earned praise from some of Obama's most severe ideological critics. On Fox News, Jim Pinkerton claimed that "Alzheimer's research is a cause Obama and his critics should all support – to save both money and lives." This is exactly right, and it's why bitter political rivals can overlook their cantankerous disputes to join forces. Investing in Alzheimer’s research is both a social and economic investment that will pay dividends if we get it right (Michael Hodin, 2/18).

Boston Globe: Sex-Bias Case Has Lessons For The Medical Profession
(Dr. Josef Fischer) is the central figure behind (Beth Israel Deaconess Medical Center's) $7 million settlement with the female former chief of anesthesia, who says he tried to ruin her career because she is a woman. Dr. Carol Warfield's claims, which were backed up by testimony from senior female surgeons, illustrate the dark side of superstar surgeons like Fischer. Historically, the most celebrated surgeons were swashbuckling men who could make snap judgments and act on them without fear of the consequences — traits that may have contributed to Fischer’s lack of concern for his colleagues' feelings (2/20).

Richmond Times Dispatch: At Odds Over A Hospital For Children
In the simplest terms, the issue of a children’s hospital is this: A group of 250 strong-minded pediatricians called PACKids — backed by major pledges from local philanthropists — thinks Richmond should build a new, free-standing hospital to better care for sick children. (It’s an idea that has been growing for several years.) Others say we already have an excellent children’s hospital: a full-service operation embedded in a nationally recognized medical college, Virginia Commonwealth University. Still others question whether a standalone hospital can be sustained, when pediatric medicine already makes up an important chunk of existing institutions. Adding investment is a stronger move than reinventing, they add (Tom Silvestri, 2/17).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
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.