Daily Health Policy Report

Tuesday, February 21, 2012

Last updated: Tue, Feb 21

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Campaign 2012

Health Care Marketplace


Public Health & Education

Coverage & Access

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Hospitals Demand Payment Upfront From ER Patients With Routine Problems

Kaiser Health News staff writer Phil Galewitz, in collaboration with The Washington Post, reports: "Next time you go to an emergency room, be prepared for this: If your problem isn't urgent, you may have to pay upfront. Last year, about 80,000 emergency-room patients at hospitals owned by HCA, the nation's largest for-profit hospital chain, left without treatment after being told they would have to first pay $150 because they did not have a true emergency" (Galewitz, 2/19). Read the story

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Insuring Your Health: Insurance Coverage Might Steer Women To Costlier—But More Effective—Birth Control

In her weekly Kaiser Health News column, Michelle Andrews writes: "In the heated debate over to what extent religiously affiliated employers should be required to provide free contraception for workers, no one has talked much about what methods are available to women who want to prevent pregnancy and how their choices might change if cost were removed from the equation. But it's an important subject" (Andrews, 2/21). Read the column.

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Seniors Need To Reevaluate Their Needs For Popular Medical Treatments: The KHN Interview

Judy Graham, reporting for Kaiser Health News in collaboration with The Washington Post, interviews Dr. Nortin Hadler, a professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill. She writes: "In his newest book, 'Rethinking Aging: Growing Old and Living Well in an Overtreated Society,' the 69-year-old Hadler turns his attention to older Americans and the challenging medical decisions they face" (Graham, 2/21). Read the interview.

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FAQ: The 'Doc Fix' Dilemma

Kaiser Health News staff writer Mary Agnes Carey provides updated information about the “doc fix”: “Now that Congress has passed legislation to avert drastic payment cuts to physicians who treat Medicare patients, attention is turning to what will happen when the temporary solution expires at the end of this year (Carey, 2/17). Read the updated FAQ.

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Political Cartoons: 'One Pill Makes You...' And 'True Confession?'

Kaiser Health News provides a double dose of health policy cartoons with "One Pill Makes You..." by John Cole and "True Confession?" by R.J. Matson.

Meanwhile, here's today's haiku:


Goodbye, not farewell
to the SGR debate.
See you next winter!

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

Congress Approves Tax Package Including Temporary 'Doc Fix'

In Friday action, the House and Senate OK'd legislation that prevented a 27.4 percent reduction in Medicare physician pay, which was scheduled to kick in on March 1.

Modern Healthcare: Congress OKs Measure Averting Doc-Pay Cut
The House and Senate approved a payroll tax package that includes a provision to stave off a 27.4% cut in Medicare physician payment rates scheduled for March 1 and freezes rates at their current level until Dec. 31, 2012. House members voted 293 to 132 to approve the legislation, which received support from 146 Republicans and 147 Democrats. Meanwhile, 91 Republicans and 41 Democrats voted against it. Reps. Phil Gingrey (R-Ga.) and Michael Burgess (R-Texas), both physicians, did not vote in favor of the bill (Zigmond, 2/17).

Kaiser Health News: FAQ: The 'Doc Fix' Dilemma
Now that Congress has passed legislation to avert drastic payment cuts to physicians who treat Medicare patients, attention is turning to what will happen when the temporary solution expires at the end of this year (Carey, 2/17).

Reuters: U.S. Congress Ends Bitter Tax Battle With Bill Passage
The U.S. Congress ended a three-month battle on Friday by passing legislation to extend a tax cut for 160 million workers, a boon for both the economy and Democratic President Barack Obama in this election year. The outcome for Republicans and House of Representatives Speaker John Boehner is far more murky. While Boehner has put behind him a bill that has been nothing but political heartache, nearly 40 percent of his rank-and-file voted against the measure he advanced by compromising on a core Republican cause - deficit reduction (Cowan and Smith, 2/17).

Market Watch: Congress Approves Extension Of Payroll-Tax Cut
In a rare show of bipartisanship, House and Senate lawmakers voted Friday to extend a two-percentage-point payroll-tax cut for the rest of the year, sending legislation to President Barack Obama nearly two weeks before a tax hike would have gone into effect for about 160 million Americans (Schroeder, 2/17).

The Hill: Congress Approves Payroll Tax Cut Extension, Sending Bill To Obama
The House and Senate quickly approved the payroll tax cut bill on Friday, sending the legislation to the White House for President Obama's signature. Both chambers easily approved the measure. In the House, the measure was approved in a 293-132 vote that split both parties. The vote was 146-91 among Republicans, and 147-41 among Democrats. The Senate acted less than an hour later and approved the bill in a 60-36 vote. Senate Republican and Democratic leaders agreed the bill would not require a 60-vote super majority for passage, a move intended to allow more Republicans to vote against the measure. In the end that procedural maneuver didn't matter (Kasperowicz and Ryan, 2/17).

In the background -

California Healthline: Polarization Evident at National Health Policy Conference
The annual AcademyHealth National Health Policy Conference offered more than 800 policy wonks a varied overview of the industry at the start of what many feel will be a pivotal year in the evolution of the nation's health care system. ... Republicans and Democrats representing committees and leadership from the House and Senate were predictably partisan -- and sometimes brisk (Lauer, 2/17). 

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Health Reform

Analyzing The Impact Of The Court's Consideration Of The Health Law

USA Today reports that the Supreme Court's review could cause the the health law debate to stretch through the presidential campaign. Other media outlets take a look at what would happen without the individual mandate, and at stakeholders' positions related to the law's Medicaid expansion.

USA Today: Court Action Could Prolong Health Care Fight
Next month's challenge to the Obama-sponsored health care law could affect the care available to most Americans, alter the balance of power between Washington and the states and remain a flash point through this presidential campaign (Biskupic, 2/21).

Politico Pro: Attorney: No 'Death Spiral' If Mandate Goes
A court-appointed attorney on Friday told the Supreme Court that there is no reason to eliminate health care reform's guaranteed issue and community rating provisions if it declares the individual mandate unconstitutional. "Although the guaranteed issue and community rating provisions were meant to work together with the minimum coverage provision, and likely will operate less ideally without the minimum coverage provision, it does not follow that Congress, confronted with that prospect, would prefer to return to the prior health insurance system, where large numbers of people, in need of insurance but with pre-existing illnesses or conditions, were excluded from the market," the attorney, Bartow Farr, wrote in a brief (Haberkorn, 2/17).

Modern Healthcare: Hospital Groups Dispute States' Arguments Against Medicaid Expansion
A friend-of-the-court brief filed by interest groups representing virtually every hospital in America urges the Supreme Court to reject arguments by 26 states that the expanded Medicaid eligibility called for under the Patient Protection and Affordable Care is unconstitutionally "coercive."... The hospitals' 30-page brief counters that allowing states to torpedo the reform law's Medicaid changes would amount to a kind of "heckler's veto" in which all states would have to approve changes to the program before Congress could pass them (Carlson, 2/17).

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Essential Benefits, Health Exchanges Trigger Questions, Answers

Today's headlines include a range of stories about the implementation of the health law and related policy developments.

CQ HealthBeat: Questions on Essential Health Benefits? CMS Has Some Answers
The Centers for Medicare and Medicaid Services published a fact sheet Friday that deals with questions that have been raised by states, patient groups and others about how states should develop their essential health benefits packages. A bulletin unveiled by CMS in December gave flexibility to the states to select among various existing plans as models for their benefits packages, which will be offered in individual and small-group insurance plans in state exchanges (Norman, 2/17).

Politico Pro: Mixed Messages On Federal Exchanges Funds
The Obama administration might have handed Congress a guide to defunding a key part of the health care reform law — without taking away a penny that the administration already has at its disposal. Without doing anything at all, in fact. The president’s fiscal 2013 budget requests an additional $864 million to build the federal health insurance exchange, which will operate in states that don’t set up these new insurance markets on their own by 2014. Precisely how many states that will include is still an open question. The budget request caught many observers by surprise — especially Republican critics who suspected all along that the administration had lowballed estimates. HHS had long maintained that an earlier $1 billion appropriation in the health care law would be enough to set up a federal exchange and pay for other implementation tasks (Feder, 2/21).

JAMA: Daunting Challenges for Creating, Implementing Health Reform Law's Insurance Exchange Program
One of the considerable challenges presented by the Affordable Care Act (ACA) is implementing the insurance exchange program required by the ACA, agreed a panel of state insurance regulators gathered earlier this week at the AcademyHealth Health Policy Conference in Washington, DC (Livingston, 2/17).

Also in the news -

The Philadelphia Inquirer: Drug Prices Too High Or Too Low?
Referring to the now nearly two-year-old health-care law, Sebelius said, "We didn't get as far as you are suggesting in terms of price controls, but we came some of that distance. It is illegal for us who run Medicare to negotiate for prices. As a former governor, I could negotiate for Medicaid prices and Medicaid drug prices are significantly lower than Medicare drug prices. But that is a change that has to be passed by Congress." Sebelius noted the donut hole problem in Medicare drug plans and that the administration's plan closed that by 50 percent right away and will change further (Sell, 2/17).

The Philadelphia Inquirer: Small Matters: Health Insurance A Big Headache For Small Firms
The government is going to decide the minimum that insurance carriers must provide in their coverage. And, the administration's spokesman said that the president wanted women to receive this preventive care/contraceptive benefit without having to pay anything to get it. But the cost of insurance will rise as regulators add more and more benefits like this one to the required package. About 40 percent of small firms (50 or fewer employees) offer some type of health-care benefit. Many plans will not qualify under the health law's requirements and will be dropped; others will be upgraded to meet the minimum, raising the cost of the insurance benefit that small-business owners must pay. Opting to offer no insurance still raises worker costs, and small firms will have to pay a "fine" for each worker not covered if the mandate begins in 2014, as planned (Dunkelberg, 2/20).

Reuters: Insurance Eligibility Improves Medical Care: Study
A new study suggests young adults are more likely to get care and see a doctor when states extend the time they can stay on their parents' health insurance -- a measure also mandated by the 2010 federal health care law. The laws are meant to help those over 18, who typically outgrow their parents' plans but have trouble getting full-time jobs with health coverage after high school (Seaman, 2/17).

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Campaign 2012

Birth Control Issues Crop Up On The Campaign Trail

Republicans cast the debate over mandatory coverage as one of religious freedom, while Democrats frame it as a matter of women's health.

The Washington Post: Birth Control As Election Issue? Why?
[E]lections have a way of becoming national conversations, often unwieldy ones. ... As is often the case in these matters, a variety of seemingly disparate issues get all tangled up — the Commerce Clause and Catholic doctrine, religious freedom and the right to privacy, feminism and liberty and conscience — at a time of economic uncertainty and vast demographic and societal transition (Gerhart, 2/20). 

Los Angeles Times: Before Current Birth-Control Fight, Republicans Backed Mandates
Republicans have rushed to accuse the administration of an unprecedented attack on religious freedoms. None has been more forceful than former Arkansas Gov. Mike Huckabee, who accused Obama of "a direct violation of the 1st Amendment." But years before the current partisan firestorm, GOP lawmakers and governors around the country, including Huckabee, backed similar mandates. Twenty-two states have laws or regulations that resemble, at least in part, the Obama administration's original rule. ... In six states, including Arkansas, those contraceptive mandates were signed by GOP governors (Geiger and Levey, 2/15).

Roll Call: Welcome Or Not, Back To Culture War
The problem, Republicans acknowledged, is their inability to keep the issue focused on religious freedoms, which some polling indicates plays well with independents and Catholic voters. But with the issue being increasingly viewed as a question of women's health and access to contraception, those same polls show Republicans taking criticism, particularly with women. If the issue is to work for the GOP, Republicans need to keep the focus on "the Obama administration's efforts to intervene into people's everyday lives," a GOP leadership aide said (Stanton, 2/21).

Politico: 2012: The Year Of 'Birth Control Moms'?
Will 2012 be the year of the "birth control moms"? Just a few weeks ago, the notion would have seemed far-fetched…But then Rick Santorum said states ought to have the right to outlaw the sale of contraception. And Susan G. Komen for the Cure yanked its funding for Planned Parenthood. And the U.S. Conference of Catholic Bishops teed off on President Barack Obama's contraception policy. And House Republicans invited a panel of five men — and no women — to debate the issue. And a prominent Santorum supporter pined for the days when "the gals" put aspirin "between their knees" to ward off pregnancy. Democratic strategist Celinda Lake says it's enough to "really irritate" independent suburban moms and "re-engage" young, single women who haven't tuned into the campaign so far (Kenen, 2/18).

The Associated Press/USA Today: Evangelicals Join Catholics In Opposing Birth Control Rule
A group of evangelical pastors on Monday joined Roman Catholic clergy who oppose an Obama administration requirement that employees of religiously affiliated businesses receive birth control coverage (2/20).

Boston Globe: Birth Control Splits GOP In New England
The roiling debate over coverage for birth control is fracturing New England Republicans, as some moderates in the GOP - particularly women - say they feel marginalized by the positions taken by Senators Scott Brown of Massachusetts and Kelly Ayotte of New Hampshire. The divisions point to the potential dangers for Brown as he seeks reelection in a state that is not as conservative as those represented by fellow GOP senators who are supporting a controversial health care bill in the Senate (Jan, 2/18).

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Health Policies Part Of Political Buzz Words In Presidential, Congressional Races

While GOP presidential hopeful Rick Santorum says the health law could discourage marriage, first lady Michelle Obama is courting women to back her husband's re-election efforts.

Reuters: Santorum Calls Obama Health Program Bad For Marriage
Republican presidential candidate Rick Santorum accused Democratic President Barack Obama's administration on Monday of implementing health care policies that discourage marriage and hurt families. The former Pennsylvania senator, trying to rally conservative voters and put pressure on Republican rival Mitt Romney, said Obama's 2010 health care overhaul gave couples financial incentives to remain unmarried (Jacobs, 2/20).

Bloomberg: Michelle Obama Courts Women Voters On Campaign
Michelle Obama is being billed as the featured attraction in house parties her husband's re-election campaign is organizing around the country tomorrow to try to boost his support among women voters. The first lady is to appear via conference call at the "Women for Obama" gatherings, President Barack Obama’s re-election campaign said in an e-mail sent to supporters last night. … The e-mail mentions access to contraception without a co-pay among the administration's accomplishments for women, in addition to Obama's signing of the "Lilly Ledbetter Fair Pay Act" and the 2010 health care overhaul that includes mammogram coverage and a restriction on charging women higher premiums than men (Talev, 2/21).

The Associated Press: As Santorum Seizes Social Issues, Romney Demurs
Philosophical differences between the top two Republican presidential candidates are becoming starker as Rick Santorum drives harder on religious and social issues that Mitt Romney rarely discusses in detail. In recent days, Santorum has questioned the usefulness of public schools, criticized prenatal testing and said President Barack Obama's theology is not "based on the Bible" (Babington and Hunt, 2/20).

Denver Post: Ad Supporting Rep. Mike Coffman Attacks Obama On Unemployment, Health Care
The U.S. Chamber of Commerce is running a TV ad supporting Rep. Mike Coffman, a two-term GOP congressman from Aurora, that makes two central claims in attacking President Barack Obama's policies. ... The ad also claims that "Obama-care will kill jobs." There are scores of studies and opinion articles regarding the Affordable Care Act's potential impact on employment. The bottom line with any of the claims is that they are largely hypothetical because many aspects of the law have not been implemented (Painter, 2/21).

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Health Care Marketplace

Obama Contraceptive Rule Reverberates Through Health Care Marketplace

Before the federal rule was advanced, the policies put in place by various states allowed employers room to manuever, The Washington Post reports. Meanwhile, the insurance industry fears it may be left holding the bag for this requirement, and the New York Times explores the market share of Catholic hospitals.

The Washington Post: Different States' Contraceptive Rules Leave Employers Room To Maneuver
When California adopted a law in 1999 requiring health insurance plans to include birth control if they cover prescription drugs, Catholic Charities of Sacramento was determined to fight (Aizenman and Sun, 2/19).

The Hill: Insurance Industry Could Take Hit From Birth Control Mandate
The insurance industry is concerned it will take a hit from the Obama administration’s mandate that they provide birth control in health plans for employees of religious organizations that object to the coverage. Publicly, the health insurance industry has avoided getting involved in the fight. But in private, the industry is dubious of the administration’s argument that the insurance industry wouldn't take a hit because birth control is cheaper than unwanted pregnancies (Pecquet, 2/19).

The New York Times: Catholic Hospitals Expand, Religious Strings Attached
As Roman Catholic leaders and government officials clash over the proper role of religion and reproductive health, shifts in health care economics are magnifying the tension. Financially stronger Catholic-sponsored medical centers are increasingly joining with smaller secular hospitals, in some cases limiting access to treatments like contraception, abortion and sterilization (Abelson, 2/20).

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CMS Unveils 2013 Medicare Advantage Payment And Policy Guidelines

Federal officials said  Friday that the trend toward relatively low premium charges and stable benefits will likely continue.

Reuters: Government Issues Medicare Advantage Guidelines
The Obama administration on Friday issued 2013 payment and policy guidelines for U.S. health insurers that participate in the Medicare Advantage program, saying the proposed changes would bring lower premiums and stable or improved benefits. But the documents did not include an official preliminary estimate for the net average percentage change in reimbursements, leaving insurers and financial markets in the dark about the guidelines' potential impact on the industry (2/17).

CQ HealthBeat: CMS: Trend Toward Low Premiums, Stable Benefits To Continue
Relatively low premium charges and stable benefits have been a hallmark of the private health care plans and prescription drug plans in the Medicare program of late, and that trend will continue, federal officials said Friday. Officials released a "growth percentage" for per capita expenditures in Medicare and said it will be used to set 2013 rates for Medicare Advantage plans, the private managed care health plans in Medicare. The figure — 2.47 percent — "will help ensure that beneficiaries maintain a choice of plans without significant increases in premiums or decreases in benefits," said a CMS news release. CMS will publish a rate announcement for 2013 on April 2 (Reichard, 2/17).

Politico Pro: CMS Releases Medicare Advantage Guidance
CMS posted its 2013 payment guidance for Medicare Advantage and Part D plans late Friday, projecting an estimated annual growth rate of about 2.5 percent for the private Medicare plans. The document lays out guidance for insurance plans that want to participate in the programs in the coming year. It’s open for public comment, and final rates will be published April 2. CMS will again exercise the authority granted by health reform to deny bids from plan sponsors that propose “too significant” an increase in beneficiary cost-sharing or a decrease in benefits, according to a release announcing the guidance (Norman, 2/17).

Modern Healthcare: CMS Seeks Input On Payment, Policy Updates For Advantage, Prescription-Drug Plans
The CMS announced it is accepting public comments on the agency's proposed payment and policy guidance for Medicare Advantage and prescription drug plans in 2013. According to the Advance Notice and draft Call Letter for 2013, the CMS proposes that it will again use its authority under the Patient Protection and Affordable Care Act to deny bids if the agency decides the bid proposes too high of an increase in cost sharing or a decrease in benefits (Zigmond, 2/19).

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Public Health & Education

How 30 Kidneys Linked 60 Lives

The New York Times examines a lengthy kidney transplant chain and explores how the current system continues to hamper transplantation efforts.

The New York Times: 60 Lives, 30 Kidneys, All Linked
In February 2011, the desk clerk at Mr. Ruzzamenti’s yoga studio told him she had recently donated a kidney to an ailing friend she had bumped into at Target. Mr. Ruzzamenti, 44, had never even donated blood, but the story so captivated him that two days later he called Riverside Community Hospital to ask how he might do the same thing. ... What made the domino chain of 60 operations possible was the willingness of a Good Samaritan, Mr. Ruzzamenti, to give the initial kidney, expecting nothing in return (Sack, 2/18).

The New York Times: Lack of Unified System Hampers Kidney Transplant Efforts
Many of the most prominent names in the field of kidney transplantation agree that the way to maximize the number of transplants through paired exchanges is to create a single, nationwide registry. ... And yet, more than a decade after the first organ swap in the United States, the transplant world remains disjointed, with competing private registries operating with little government oversight or regulation (Sack, 2/18). 

In related news -

USA Today/Detroit Free Press: Organs From Less-Than-Ideal Donors Save Patients' Lives
For a half-century, most organ donations have come from young or middle-age people who died in auto and other accidents. ... But today, with people waiting for organs far outnumbering donations, more centers are asking patients whether they would consider an organ from a nontraditional source: a person older than 50; someone with high blood pressure or kidney issues, or someone who died after a heart attack, leaving an organ without blood, a factor that can affect its viability (Anstett, 2/20).

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Coverage & Access

Meeting Demand For Primary Care, Family Physicians

New medical schools are opening with an emphasis on training young physicians in primary care. Meanwhile, the federal government awarded funds to medical students in 30 states and the District of Columbia to encourage their pursuit of family medicine.

Los Angeles Times: A Push To Train More Primary-Care Doctors
[N]ew medical schools are opening with an emphasis on primary care and others are changing their curricula to boost the number of graduates interested in the field. Medical school professors are pairing students with family doctors and assigning them to community clinics so they see firsthand what it's like to practice preventive care and manage chronic diseases (Gorman, 2/19).

CBS News: Family Care Doctors Are In High Demand
The federal government this week awarded $9.1 million to medical students in 30 states and the District of Columbia. The recipients will serve as primary care doctors. ... Under the law, 32 million people without insurance are supposed to be covered by 2014. Combine that with 78 million aging baby boomers and there just won't be enough doctors to go around (Johnson, 2/18). 

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State Watch

Medicaid: Bachmann Calls For Scrutiny Of Minn. System, Other State Developments

Rep. Michele Bachmann, R-Minn., has called for a broader investigation of Minnesota's Medicaid system after allegations that the state inflated premiums for low-income residents. Elsewhere, Maine's Medicaid system costs more than in other states, and the Florida Hospital Association is pushing back against forced contracting with Medicaid managed care providers.

(St. Paul) Pioneer Press: Bachmann Wants Medicaid Rates To Get Closer Scrutiny
Following word last week of a federal investigation into how Minnesota finances its public health insurance programs, U.S. Rep. Michele Bachmann said Monday that more audits might be needed for the Medicaid program. The Minnesota Republican held a news conference Monday at the Capitol to say she plans to introduce federal legislation related to questions raised last week about the state's version of Medicaid, a health insurance program for low-income and disabled residents that is jointly funded by the federal government. Last Tuesday, the commissioner of the state's Department of Human Services told a legislative committee that the federal government is investigating whether Minnesota has wrongly received excess federal funds by manipulating the rate certification process for Medicaid (Snowbeck, 2/20).

Minneapolis Star Tribune: Bachmann, In St. Paul, Urges Medicaid Audit
U.S. Rep. Michele Bachmann put in a rare appearance at the State Capitol Monday to join the growing bipartisan chorus calling for closer scrutiny of the state's Medicaid accounting. Minnesota is under federal investigation for allegedly inflating health care premiums for low-income recipients of the federal health-insurance program. State legislators from both parties are calling for independent third-party auditors to review Medicaid's recordkeeping. Bachmann said she plans to introduce similar legislation at the federal level. "It's not a partisan issue," said Bachmann. "We, as lawmakers, have an obligation to ensure that Minnesota's payment and oversight practices are both accountable and transparent" (Brooks, 2/20).

The Associated Press/Houston Chronicle: Maine Medicaid Costs Above Average 
In his relentless demands for steep Medicaid cuts, Gov. Paul LePage has said Maine spends far more per capita than other states on Medicaid and is high above the national average. Whether you support or oppose LePage's cost-cutting proposals, he's right. Maine had the nation's fifth-highest Medicaid coverage rate in fiscal year 2009, 27.8 percent, behind California, New Mexico, Louisiana and Vermont, according to the latest statistics for Maine from the Centers for Medicare and Medicaid Services. The national rate for the same period was 21 percent (Canfield, 2/20).

Modern Healthcare: Fla. Association Opposes Measure Requiring Managed-Care Medicaid Contracts
The Florida Hospital Association is pushing back against a proposed state law that would force hospitals to contract with Medicaid managed-care programs at a time when legislators have approved changes to state law that are expected to move more of Florida's 3.1 million beneficiaries into the programs. The state hospital association said data from 196 Florida hospitals show that the providers have struck a total of 1,333 contracts with Medicaid managed-care companies. Hospital officials say the data prove that state officials don't need a law to mandate that hospitals strike contracts with the insurance administrators (Carlson, 2/18).

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Nebraska Readies For Exchange Debate

Nebraska's state legislature is set to debate formation of a health insurance exchange as other states introduce measures that would extend exemptions on a controversial contraception rule in health reform to secular insurers and businesses, if they so choose.

The Associated Press/Houston Chronicle: Neb. Lawmakers To Debate Health Insurance Exchange 
Lawmakers will begin work Tuesday on the state's version of health insurance reform as they take up two bills to create the Nebraska Health Benefit Exchange Act. The bills, which will come before the Banking, Commerce and Insurance Committee, are expected to get plenty of attention in the coming weeks as the Legislature passes its half-way point for the session. Sen. Rich Pahls of Boys Town and Sen. Jeremy Nordquist of Omaha each have introduced a bill that would meet the requirements of the federal Affordable Care Act, which calls for states to have an operating exchange by 2014 (Avok, 2/18).

The Atlanta Journal-Constitution: States Attack 'Obamacare' With Birth Control Bills
Republican lawmakers in a handful of states are opening another front in the war against President Obama's health care overhaul, seizing on the hot-button issue of birth control with bills that would allow insurance companies to ignore new federal rules requiring them to cover contraception.  Measures introduced recently in Idaho, Missouri and Arizona would go beyond religious nonprofits and expand exemptions to secular insurers or businesses that object to covering contraception, abortion and sterilization. "In its present state, the health care bill is an affront to my religious freedoms," said Idaho Republican Rep. Carlos Bilbao, who is sponsoring the bill (Miller, 2/17).

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State Roundup: Calif. Expands Uninsured Access, Gives Adult Day Care Reprieve

A selection of stories from Arizona, California, Virginia, Iowa, Georgia, Maryland, Connecticut, Massachusetts, Kansas and Oklahoma.

Los Angeles Times: 10 Counties Expand Medical Coverage For Low-Income Residents
Nearly two years before the federal health reform law kicks in, 10 California counties have expanded medical coverage to more than 250,000 people who were previously uninsured, according to new state data (Gorman, 2/18).

The Associated Press/Washington Post: Women Protest Anti-Abortion Bills In Va. By Locking Arms, Standing Mute Outside State Capitol
Hundreds of women locked arms and stood mute outside the Virginia State Capitol on Monday to protest a wave of anti-abortion legislation coursing through the General Assembly (2/20).

Arizona Republic: Arizona Legislature Releases Budget
Senate Appropriations Committee Chairman Don Shooter, R-Yuma, said the budget is a continuation of last year's efforts to balance the state's budget without gimmicks or borrowing. He said while the state is now in the black, it still needs to prepare for three possible looming financial cliffs: the sunset of the sales-tax increase, state costs related to the national health-care law and a double-dip recession (Ray and Pitzl, 2/20).

Des Moines Register: Wellmark Gives Up Some Tax Credits
Wellmark will give up $5 million in tax credits the state provided as incentives for its new $240 million headquarters in downtown Des Moines. The state, in return, will cut the number of jobs Iowa’s largest health insurer is required to create by 10 to 53... The agreement outlines penalties — repayment of the loan and tax credits — if Wellmark fails to maintain the promised number of workers, which it should reach by month's end, it said. Wellmark cited the recession, uncertainty over federal health care rules, and difficulty finding "qualified professionals" for failing to meet the job-creation goal (Eller, 2/20).

The Atlanta Journal-Constitution: Drug Tests, 'Personal Growth' For Those Who Need Help
Proposed mandates requiring drug tests and "personal growth" activities for parents and others who apply for public assistance in Georgia ran into resistance Monday in the state Senate, although not enough to derail them. The bills' sponsoring lawmakers made their pitch before a packed conference room, as the Senate Health and Human Services Committee heard testimony by more than a dozen people concerned about the cost of the mandates and how they would be implemented. The drug-test mandate of Senate Bill 292 would be for anyone applying for Medicaid or for the federal Temporary Assistance for Needy Families (TANF) program (Torres, 2/20).

The Atlanta Journal-Constitution: Federal Government Questions Move Of Georgia Rehabilitation Services
Georgia must hold hearings across the state before it can go forward with a plan to transfer from one state agency to another services that help disabled adults, according to the U.S. Department of Education. In response to issues raised by the federal government, a Georgia council that advocates for adults with disabilities is calling on the state to retract House Bill 831. The bill, which would move the division of rehabilitation services from the Department of Labor to the Department of Human Services, was approved by a House committee Feb. 7 and is expected to go before the full House (Diamond, 2/20).

San Francisco Chronicle: Adult Day Health Care End To Cut Off Frail Seniors
Chan Soon Fong suffers from dementia, memory loss, hypertension, osteoporosis, anemia, arthritis, ulcers, a compressed lumbar spine and diabetes….She's one of thousands of elderly and disabled low-income adults who have been or are expected to be deemed ineligible to participate in a new program that will replace Adult Day Health Care this year. The transition was scheduled to take place March 1, but on Friday, state officials announced it will be delayed for another month to give the federal government, which helps fund the Medi-Cal program, more time to process the paperwork associated with the change (Lagos, 2/19).

California Healthline: Adult Day Care Transition Gets Another Month
The state's move on Friday to shift the transition date for Adult Day Health Care elimination by a month was borne of a request by CMS, according to officials from the Department of Health Care Services. Advocates say the delay may be due to the scattered nature of the state's transition so far. "It's been a royal mess," Corinne Jan of the Family Bridges ADHC in Oakland said (Gorn, 2/21).

Baltimore Sun: Maryland Hospitals Share Data On Patients Electronically
Maryland's 46 acute care hospitals can now all share information electronically on patients admitted, discharged for transferred. The "encounter level" data can be passed along in real time via the Maryland Health Information Exchange, a statewide system of secure information sharing among hospitals, doctors' offices and health organizations, according to Lt. Gov. Anthony Brown, who announced the system recently. Some hospitals also are sharing lab and radiology reports, consult notes and other clinical data. Brown said Maryland is ahead of other states in its level of connectivity, which should help doctors' better coordinate care and improve outcomes (Cohn, 2/20).

Georgia Health News: Struggling Rural Hospital Seeks Partner
Like other small hospitals, Elbert Memorial has been struggling financially for several years. Many of the hospital's patients are uninsured or covered by Medicare or Medicaid, while an increasing number of better-insured and private-pay patients travel to Athens for their care (Cai, 2/20).

The Connecticut Mirror: After Years Of Debate, Health Care Pooling Ready To Become Reality -- For Some
The state is poised to open its employee health plan to municipalities and school districts, a controversial concept long advocated by labor unions, town officials and Democratic legislators. ... A health care "pooling" bill that would have allowed municipalities, nonprofits and small businesses to participate in the state employee plan passed the legislature in 2009, but Gov. M. Jodi Rell vetoed it (Levin Becker, 2/20).

Modern Healthcare: There Was A High Wage In Nantucket …
HHS Secretary Kathleen Sebelius weighed in for the first time publicly this week on an ongoing battle between hospitals in Massachusetts' and those in at least 19 other states. Sebelius told the Senate Finance Committee on Wednesday that the Patient Protection and Affordable Care Act required her to change Medicare's reimbursement of employee wages at all hospitals in Massachusetts to match the rate it pays for those at Nantucket Cottage Hospital. The wage match to a 19-bed hospital located in one of the wealthiest localities in the nation had the effect of increasing Medicare wage reimbursements for all state hospitals by $275 million annually (Daly, 2/17).

Kansas Health Institute News: Doctors Serve As Laboratory For Medical Homes In Kansas
Larry Rahn had never heard of a "patient-centered medical home," though his doctor's practice here is one of a handful certified in Kansas. Nonetheless, the 49-year-old John Deere mechanic said he had noticed something different about Dr. Jerad Widman's approach to medicine and that his health has improved in seven years under Widman's care (Cauthon, 2/21). 

KQED's State of Health blog: Law Seeks to Stop Fake Prescription Drugs
The announcement by the Food and Drug Administration last week that sixteen California clinics and physicians were sold bogus vials of the cancer drug Avastin did not surprise regulators and researchers who study the counterfeit drug trade. Indeed, it was after fake AIDS drugs were discovered in California that state legislators passed the "e-pedigree law" mandating that all prescription drugs carry an electronic tag (Varney, 2/20).

Stateline: Business Gets Its Way In Republican Oklahoma
Oklahoma, ranked as one of the most pro-life states, enacted three abortion-related measures last year, including one that bans abortions after 20 weeks of pregnancy. But social conservatives have made it clear they want to go further ... on the fiscal front, Tea Party conservatives ... are livid that the state even considered accepting $54 million in federal funds to create a state-based health care exchange system under the federal health care law (Prah, 2/21). 

WBUR's CommonHealth blog: Gov. Patrick Addresses Children's, Dana-Farber Controversy
There's been a lot of grumbling around the health care water cooler in Massachusetts lately about "favoritism" for Children's Hospital Boston and Dana-Farber Cancer Institute. The grumbling is based on an exemption that would let patients with tiered or limited network plans receive care at these two high-cost, specialized hospitals without paying higher co-payments or deductibles (Bebinger, 2/17). 

Boston Globe: Health Aid Urged For Low-Wage Workers
Thousands of uninsured Massachusetts workers in low-wage jobs are ineligible for state-subsidized health coverage, but they will qualify for these low-cost plans under the new national health care overhaul — in 2014. Now, some consumer advocates, arguing that the wait is unfair and a black eye for the state, want the Patrick administration and legislators to launch a program to cover at least part of this group. Administration officials, already facing huge budget deficits, say the state can't afford the tens of millions of dollars it would cost to subsidize additional workers' insurance (Lazar, 2/17).

California Watch: Lack Of Primary And Preventative Care Sends Thousands To Hospitals
According to new data released last week by the Office of Statewide Health Planning and Development, there were more than 335,000 adult hospitalizations in California that could have been avoided if the patient had seen a doctor sooner. ... The latest figures are based on an analysis of 2009 hospital inpatient discharges by state-licensed facilities of 13 "prevention quality indicators," or readily treatable medical conditions such as chest pains and dehydration (Yeung, 2/20).

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Editorials and Opinions

Contraception Opinions: We're All Catholics Now, A Sex Tax? And The 'Safe, Legal, Rare' Illusion

The Washington Post: Why We Are All Catholics Now
Because when the state comes against the Catholics, or the Jews, or the Muslims, or the Pentecostals, or the Mormons or those of any other faith – exotic or familiar – we must all stand up as one: We are all Catholics now. ... Perhaps this is a hard line. But when it comes to the separation of church and state, we need absolutes (Glenn Beck, 2/20). 

McClatchy/Lexington Herald Leader: Dust-Up Over Contraceptive Rule Ignores Rights Of Employees
[DePaul University's] president, the Rev. Dennis Holtschneider, told the newspaper, "DePaul fully supports the bishops' stance, but has offered (contraceptive) benefits ever since both Illinois and the federal government required us to do so several years ago." No one accused Illinois of trampling on religious freedoms. Why are Republicans trying to make hay now? (Merlene Davis, 2/19).

McClatchy/Miami Herald: As A Compromise, How About A Federal Sex Tax?
Here's a modest proposal: Let's tax sex and use the proceeds to fund birth control for women whose health plans don't cover it. ... The Catholic bishops and other protesters are making precisely the same argument as would arise against my proposal for a sex tax: that it violates a fundamental right. And, unlike the right to sex (which I take it most of us hold dear) the right to religion is actually mentioned in the Constitution (Stephen L. Carter, 2/19).

Miami Herald: On Birth Control, GOP Shoots Itself In The Foot
Republican strategists see the controversy as another opportunity to bash Obama's health care reforms, and also to rile up white Christian evangelicals who don't like the president anyway. As political miscalculations go, this one could be epic (Carl Hiaasen, 2/18).

The New York Times: The 'Safe, Legal, Rare' Illusion
[A]bortion rates are frequently higher in more liberal states, where access is often largely unrestricted, than in more conservative states, which are more likely to have parental consent laws, waiting periods, and so on. "Safe, legal and rare" is a nice slogan, but liberal policies don’t always seem to deliver the "rare" part (Ross Douthat, 2/18).

Los Angeles Times: Darrell Issa's Political Theater
When Rep. Darrell Issa, the California Republican who chairs the House Committee on Oversight and Government Reform, convened a hearing Thursday on religious freedom and the mandate that health insurers cover contraception, he ignited a firestorm of protest before he even started (2/19). 

Los Angeles Times: Republican Hearing On Contraceptives Was Dumb Politics
Fairly or not, the spin coming out of the hearing was not about how religious institutions might be threatened by a federal requirement that employees be provided insurance coverage for contraceptives, which is what the committee chairman, Rep. Darrell Issa of California, intended. Instead, the story became how women were left out of a discussion about birth control (David Horsey, 2/20).

Houston Chronicle: Health Law A Threat To Our Religious Freedom
It is distressing to realize the government is creating its own definitions of which ministries are religious enough to qualify for an exemption to a policy that violates a church's teachings. Even more, the updated mandate would pass the objectionable coverage on to the insurer; the insurer would be compensated through premiums paid by the religious employer. The coverage of these services would therefore still be provided through the objecting religious employer's plan. And the "accommodation" does not offer any clarity on exemptions for entities that have self-funded health plans or for business employers that are Catholic (DiNardo, 2/17).

Boston Globe: Obama's Compromise Respects Rights Of Church And Of Women
The administration was right to make a good-faith effort to respect the religious beliefs of those signing the checks, ensuring they don't pay for contraception, but now the administration must stand against efforts to weaken the coverage of individual employees (2/21).

Boston Globe: Birth Control And Church's Power Grab
Here's a book title suited to recent headlines: "The Time Has Come: A Catholic Doctor's Proposals to End the Battle Over Birth Control." Alas, the battle over birth control has been reignited, with Catholic doctors (and nurses, professors, social workers, and others whose health insurance is at issue) finding themselves in the thick of conflict, whether they want to be or not. Catholic bishops, having a generation ago squandered the treasure of moral leadership, have lately been offered a pulpit from which to bully. They're back (James Carroll, 2/20).

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Viewpoints: Medicare Mudslinging, 'Pound-Foolish' Doc Fix And Unrealistic Death Attitudes

The Washington Post: Our Unrealistic Attitudes About Death, Through A Doctor's Eyes
For all its technological sophistication and hefty price tag, modern medicine may be doing more to complicate the end of life than to prolong or improve it. ... When families talk about letting their loved ones die "naturally," they often mean "in their sleep" — not from a treatable illness such as a stroke, cancer or an infection. ... While it's easy to empathize with these family members' wishes, what they don't appreciate is that very few elderly patients are lucky enough to die in their sleep (Dr. Craig Bowron, 2/1).

Los Angeles Times: Mixing Medicare And Mudslinging
It's going to be a campaign issue, but the problem with that is that a heated, polarized election race isn't the best forum to debate complex, competing proposals for bringing down health care costs (Doyle McManus, 2/19).

Los Angeles Times: Payroll Tax Cut Undermines Social Security’s Security
The accepted response to the economic deal reached in Congress last week, extending the Social Security payroll tax holiday and unemployment insurance and maintaining reimbursement levels for Medicare doctors, is huzzah! Finally Congress got something important done with a minimum of brinkmanship and posturing, and more than a few minutes before the deadline. A threat to the embryonic economic recovery was averted, and the extensions even pushed any subsequent fracas over the same issues to the end of this year, safely past the presidential election (Michael Hiltzik, 2/19).

The Washington Post: Ideological Hypocrites
Why do they criticize "entitlements" and "big government" while promising today's senior citizens — an important part of the conservative base — never, ever to cut their Medicare or Social Security? Why do they claim that they want government out of the marketplace while not only rejecting cuts in defense but also lauding large defense contracts that are an enormous intrusion in the operation of the "free market"? (E.J. Dionne Jr., 2/19).

The Fiscal Times: Health Care: A Penny-Wise, Pound Foolish Doc-Fix 
Would you sell your home's storm doors to pay for this winter's heating bills? That's what Congress did Friday to pay for part of a 10-month "doc fix." ... "We're robbing from the one place in the Affordable Care Act where we can really do something about prevention," lamented Kenneth Thorpe, director of the Partnership to Fight Chronic Disease and a professor at Emory University (Merrill Goozner, 2/17).

iWatch News: ANALYSIS: Taking The Initiative In A Struggle Against Excessive Rate Increases
The biggest applause line Senator Dianne Feinstein (D-Calif.) got at a gathering of Democratic Party activists last week came when she endorsed a ballot initiative to give the California Insurance Commissioner power to reject excessive health insurance rate increases. Consumer advocates there decided to go the ballot initiative route after the insurance industry's friends in the legislature blocked a bill last year that would do the same thing (Wendell Potter, 2/20).

The Philadelphia Inquirer: Shortage Of Nurses In Philadelphia Schools Costs Everyone
Yet, since the summer, the Department of Public Welfare has removed 25,000 city children from the medical assistance rolls, kids whose family incomes are believed to still fall within the qualifying guidelines. For these now-uninsured children - and every other child who attends the city public schools - the district's layoff of 47 school nurses means that the children's health and educational prospects have taken a step backward. The result - predicted a school nurse who barely escaped losing her job - will be "more chaos" added to an already overburdened system of no-fee health services that acts as a safety net (Sid Holmes, 2/21).

USA Today: Prescription Drugs Deaths Demand Attention
While Xanax and similar drugs are less notorious than narcotic painkillers such as OxyContin and Vicodin, they're addictive, widely prescribed and, combined with alcohol, can be just as dangerous. They cause 373,000 overdoses a year, almost as many as the narcotic painkillers. Collectively, the two classes of drugs kill about 70 people a day, according to estimates by the Prescription Monitoring Program Center of Excellence at Brandeis University (2/20).

Politico Pro: Nursing Homes Can't Take More Cuts
Medicare funding for nursing homes is scheduled to be reduced by more than $125 billion over the next decade. At the same time, Medicaid has restricted or frozen reimbursements in 29 states in the fiscal year that just ended. These state budget shortfalls make it likely this trend will continue. If further reductions in Medicare are imposed — like those recommended by the Medicare Payment Advisory Commission — it will be difficult for facilities to continue using Medicare to help make up for the underpayment of Medicaid for long-stay patients (Vincent Mor and Gail Wilensky, 2/21).

Des Moines Register: Lawmakers Are Right To Intervene
In the summer of 2010, this state opened a new "high risk pool" to provide health insurance to Americans with health problems. It was created by the federal health reform law and funded with $35 million from Washington. As the editorial page has reported, Iowa's program has enrolled hundreds fewer people than projected. It has spent a higher percentage of its money on administration than most other states. And it is one of the few states prohibiting “third parties” from paying premiums for enrollees (2/19).

Denver Post: Why Obamacare Is Good For America
Decisions about our health care are too personal and important to be left to insurance companies. The Affordable Care Act, dubbed Obamacare, is putting all of us back in the driver's seat when it comes to our own health care. While full implementation of reform is being phased in over several years, health care reform has already helped hundreds of thousands of Coloradans access the health care they need (Dede de Percin, 2/19).

Denver Post: Why Obamacare Works: Four Reasons
Now that Obamacare is making preventive care available with no co-pays or cost-sharing, Coloradans can get advice they need to stay healthy and the screenings they need to halt a serious disease at an early, more treatable, and more affordable stage. Preventive care has given me the opportunity to live a long and full life; I urge every insured Coloradan to take advantage of this key benefit so you can, too (Kathy Leinz, David Taft, Sonji Wilkes and Chris Crigler, 2/19).

Houston Chronicle: Remaking Medicaid's Complicated, and Important
At this early, confusing stage, it's not clear yet how many regional partnerships there will be, or which counties will belong to which partnership - much less what rules each region will play by. And yes, that stuff matters. In the short term, we need to make sure of three things. … That counties forge regional partnerships that make sense. … That counties (and to a lesser extent, other local-government health care entities, such as medical schools) ante up their share of the money needed to pull down the enormous federal match. … That hospital districts, hospitals and other health-related entities in each region share the sandbox nicely.

The Dallas Morning News: You Might Not Choose Parkland But It's Still Your Problem
Wealthy, poor, homed or homeless, no one in America deserves such horrific basic care. For another, if you own property in Dallas County, you're paying for it. Shouldn’t you expect more? And your safety cushion of choice might disappear at your most critical moment of need (2/20).

Modern Healthcare: Health Care's Waffle House
Health policy in this country lacks direction because of a shortage of decisive leadership in both the public and private health care sectors. The past few weeks have witnessed an unprecedented amount of waffling on important health care topics that only feeds the belief that if you just shout loud enough, the object of your ire will back off their position rather than stand firm. The fact that this is an election year only makes things worse (Burda, 2/18).

Boston Globe: Big Savings For Small Business In New, Innovative Health Plans
For years now, small businesses have complained about the big annual premium increases they faced for health insurance. Two years ago, state policymakers agreed to let small companies form purchasing cooperatives to bargain for better rates. Now that experiment is paying off. New health plans announced last week will allow members of the first such cooperative to save at least 20 percent, and in some instances double that, on premiums. Those small businesses have every reason to be pleased, but they should share some of the new savings with their employees (2/19).

Kansas City Star: Give Raises To KC Police For Joining Health Plan
Members of Kansas City's police force are paying extremely close attention to proposed changes in their health insurance. But they also need to do the math when it comes to the possibility of getting pay raises in 2012. … That’s a strong reason the Board of Police Commissioners next Tuesday should approve a unified health insurance program. That would give the department enough money to hand out raises of $1,000 or more a year to most officers and civilian employees (2/20).

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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.