Daily Health Policy Report

Thursday, February 21, 2013

Last updated: Thu, Feb 21

KHN Original Reporting & Guest Opinion

Health Reform

Health Spending And Fiscal Battles


Public Health & Education

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Hospitals Clamp Down On Dangerous Early Elective Deliveries

Kaiser Health News staff writer Phil Galewitz reports: "Now, with pressure on doctors and hospitals from the federal government, private and public insurers and patient advocacy groups, the rate of elective deliveries before 39 weeks is dropping significantly, according to latest hospital survey from The Leapfrog Group, a coalition of some of the nation's largest corporations that buy health benefits for their employees" (Galewitz, 2/21). Read the story.

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In Arizona, Poorest, Sickest Patients Get Coordinated Care

Kaiser Health News staff writer Sarah Varney, working in collaboration with NPR, reports: "Can for-profit health insurance companies be trusted to take care of the nation's sickest and most expensive patients? Many states, under an effort supported by the Obama Administration, are planning to let the companies manage health care for those elderly and disabled people covered by both Medicare and Medicaid. Patient advocates have warned that private health insurance companies are ill-equipped to provide the complex medical care and at-home services many of these people need to survive. It turns out that Arizona, a state that has been known to resist federal health programs, has been doing just that for many years" (Varney, 2/20). Read the story.

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Capsules: Feds Outline What Insurers Must Cover, Down To Polyp Removal; Waiver In Hand, Florida's Rick Scott Backs Medicaid Expansion; Dartmouth Study Questions Widely Used Risk-Adjustment Methods

Now on Kaiser Health News' blog, Diane Webber offers this take on the Florida Gov.'s decision on the health law's Medicaid expansion: "Florida Gov. Rick Scott announced Wednesday that he would back expansion of the Medicaid program under the federal health law. At a hastily-called press conference, Scott, a Republican, said he supported expanding Medicaid for three years — the amount of time the federal government picks up the whole cost" (Webber, 2/20).

In addition, Julie Appleby reports on the Obama administration's final essential benefits rule: "Essential benefit requirements apply mainly to individual and small group plans. They also apply to plans provided to those newly eligible for Medicaid coverage. A few provisions also affect self-insured plans and large group plans offered by employers" (Appleby, 2/20).

Also on Capsules, Jordan Rau reports on a new Dartmouth study: "In evaluating a hospital and health plan in the increasingly expensive U.S. health care system, federal officials and researchers often first factor in an assessment of how sick their patients are. A new study, however, challenges the validity of several widely used 'risk-adjustment' efforts and suggests that Medicare is overpaying some plans and facilities while underpaying others" (Rau, 2/21). Check out what else is on the blog.

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Political Cartoon: 'Caution: May Cause Confusion?'

Kaiser Health News provides a fresh take on health policy developments with "Caution: May Cause Confusion?" by Gary Varvel.

Meanwhile, here is today's health policy haiku:


Seems sequestration
should be a four-letter word ...
not four syllables.

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

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Health Reform

Feds Outline What Insurers Must Cover

The final rule on essential health benefits, issued yesterday, defines what must be covered in health plans sold in online marketplaces beginning this fall, including prescription benefits and mental health services, and prohibits discrimination based on age or pre-existing medical conditions.

The Wall Street Journal: Health-Plan Details Unveiled
Health-insurance plans that cover tens of millions of Americans will have to pay for mental-health and substance-abuse treatments starting next year under federal rules the Obama administration finalized Wednesday. The provision, part of the 2010 Affordable Care Act, requires health plans for individuals and small businesses to cover 10 categories of services, including prescription drugs, maternity care and physical rehabilitation. Many of the specifics of what is covered in those categories will be left to states to decide (Dooren, 2/20).

USA Today: HHS Releases Rule On Insurers' Essential Health Benefits
The rule defines what must be covered in exchange plans, prohibits discrimination based on age or pre-existing conditions, describes prescription drug benefits and determines levels of coverage (Kennedy, 2/20).

Kaiser Health News: Capsules: Feds Outline What Insurers Must Cover, Down To Polyp Removal
Essential benefit requirements apply mainly to individual and small group plans. They also apply to plans provided to those newly eligible for Medicaid coverage. A few provisions also affect self-insured plans and large group plans offered by employers (Appleby, 2/20).

The New York Times: New Federal Rule Requires Insurers To Offer Mental Health Coverage
The Obama administration issued a final rule on Wednesday defining "essential health benefits" that must be offered by most health insurance plans next year, and it said that 32 million people would gain access to coverage of mental health care as a result (Pear, 2/20).

The Associated Press: Obama Administration Tackles Colonoscopy Confusion
It's one part of the new health care law that seemed clear: free coverage for preventive care under most insurance plans. Only it didn't turn out that way. So on Wednesday, the Obama administration had to straighten out the confusion. Have you gone for a colonoscopy thinking it was free, only to get a hefty bill because the doctor removed a polyp? No more. Taking out such precancerous growths as part of a routine colon cancer screening procedure will now be considered preventive care (Alonso-Zaldivar, 2/20).

Reuters: U.S. Issues Final Word On Essential Benefits Under "Obamacare"
The Obama administration on Wednesday issued its long-awaited final rule on what states and insurers must do to provide the essential health benefits required in the individual and small-group market beginning in 2014 under the healthcare reform law. A cornerstone of President Barack Obama's plan to enhance the breadth of healthcare coverage in the United States, the mandate allows the 50 U.S. states a role in identifying benefit requirements and grants insurers a phased-in accreditation process for plans sold on federal healthcare exchanges (Morgan, 2/20).

The Hill: New Healthcare Rule Expands Benefits For Substance Abuse, Mental Disorders
The Obama administration on Wednesday finalized a key Affordable Care Act rule predicted to expand substance abuse and mental disorder benefits to 62 million Americans. The rule, to take effect next year, lays out new "essential health benefits" standards for insurers, as required by the landmark legislation. It was designed to allow consumers a simplified and consistent way to shop for, and enroll in, healthcare plans that best suit them (Goad, 2/20).

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Medicaid Expansion Divides GOP Governors

Florida Gov. Rick Scott is the latest Republican executive to reverse his opposition to the health law's Medicaid expansion. Some other fervent opponents, however -- among them, Rick Perry of Texas and Bobby Jindal of Louisiana -- continue to hold the line.

Politico: Governors On ACA: Ideologues Vs. Pragmatists
The next stage of Obamacare is shaping up into a fight between two camps of Republican governors sure to duke it out in the 2016 presidential primary — ideologues versus pragmatists. The ideological purists are big-name Southern governors — like Bobby Jindal, Nikki Haley, Bob McDonnell and Rick Perry — who have all said "hell no" to major pieces of the law, even turning down free federal cash to expand Medicaid in their states (Nather and Millman, 2/21).

The New York Times: In Reversal, Florida to Take Health Law's Medicaid Expansion
Gov. Rick Scott of Florida reversed himself on Wednesday and announced that he would expand his state's Medicaid program to cover the poor, becoming the latest — and, perhaps, most prominent — Republican critic of President Obama's health care law to decide to put it into effect (Alvarez, 2/20).

The Washington Post: Affordable Care Act Clears Another Hurdle Toward Implementation
President Obama's Affordable Care Act cleared another hurdle toward implementation Wednesday when one of its fiercest opponents, Florida Gov. Rick Scott, embraced a key pillar of the law by voicing support for its critical Medicaid expansion component. Scott joins six other Republican governors who have recently come to back a provision meant to extend coverage to 17 million Americans nationwide (Kliff, 2/20).

Tampa Bay Times: Gov. Rick Scott's 'New Perspective': Expand Medicaid After All
Scott's endorsement means that as many as 1 million Floridians could gain access to health care, if the Republican-controlled Legislature agrees. That is not a certainty. "Gov. Scott has made his decision and I certainly respect his thoughts," House Speaker Will Weatherford, R-Wesley Chapel, said. "However, the Florida Legislature will make the ultimate decision. I am personally skeptical that this inflexible law will improve the quality of health care in our state and ensure our long-term financial stability" (Mitchell, 2/20).

Miami Herald: Florida Gov. Rick Scott Supports Medicaid Expansion
Gov. Rick Scott said Wednesday he supports expanding Medicaid and funneling billions of federal dollars to Florida, a significant policy reversal that could bring health care coverage to 1 million additional Floridians…Scott, a former hospital executive, spoke with unusual directness about helping the "poorest and weakest" Floridians — a stunning about-face for a small-government Republican who was one of the loudest voices in an aggressive, and ultimately unsuccessful, legal strategy to kill a law he derided as "Obamacare" (2/21).

NPR: In Reversal, Florida Gov. Scott Agrees To Medicaid Expansion
But Wednesday, Scott, a Republican, pulled a complete turnabout. He said Florida would accept the federal government's offer of funding, at least for the three years it has promised to pay the entire bill (Rovner, 2/20).

Kaiser Health News: Waiver In Hand, Florida's Rick Scott Backs Medicaid Expansion
Florida Gov. Rick Scott announced Wednesday that he would back expansion of the Medicaid program under the federal health law. At a hastily-called press conference, Scott, a Republican, said he supported expanding Medicaid for three years — the amount of time the federal government picks up the whole cost (Webber, 2/20).

The Wall Street Journal: Florida Governor Now Supports Broader Medicaid
Mr. Scott said he would support a three-year expansion "as long as the federal government meets their commitment to pay 100% of the cost during this time." He called it a "a compassionate, common-sense step forward" (Camp-Flores, McWhirter and Martin, 2/20).

The Associated Press/Los Angeles Times: In Reversal, Florida To Expand Medicaid Under Healthcare Overhaul
Florida Gov. Rick Scott announced Wednesday that he intended to expand Medicaid coverage to about 900,000 more people in his state under the federal healthcare overhaul, a surprise decision from a vocal critic of President Obama's plan. Scott is the seventh Republican governor to propose expanding the taxpayer-funded health insurance program. The governor said he gained new perspective after his mother's death last year, calling his decision to support a key provision of the Affordable Care Act a "compassionate, common-sense step forward," and not a "white flag of surrender to government-run healthcare" (2/21).

Politico: Gov. Rick Scott Embraces Medicaid Expansion In Florida
Scott had campaigned against the health legislation even before he began running for office, and Florida led the 26 states that fought it in court. On Wednesday, that changed as he agreed to take the federally financed expansion that would cover more than 1 million people — at least for the first three years (Millman, 2/21).

Reuters: Florida Governor Backs Limited Medicaid Expansion
Florida Governor Rick Scott backed a limited expansion of healthcare coverage for the poor on Wednesday, joining six other Republican governors who have agreed to the measure under President Barack Obama's landmark reform law. Scott, a wealthy former healthcare executive and vocal critic of the law known as Obamacare, had balked previously at expanding Medicaid (Cotterell, 2/20).

National Journal: Rick Scott’s Medicaid Decision Is A Big Win For The White House
Florida Gov. Rick Scott’s decision to expand his state’s Medicaid program is a huge political and practical win for President Obama's White House. Scott, who rose to the governor’s mansion on an anti-Obamacare campaign, also led the legal effort to overturn the president’s health reform law last year. Without the multistate lawsuit led by Florida, expanding state Medicaid programs would never have been optional. Now, he is one of seven Republican governors who have endorsed expanding their programs (Sanger-Katz, 2/20).

News from other states on the expansion --

The Texas Tribune: Perry Stands Firm On Rejecting Medicaid Expansion
Just six months ago, Texas Gov. Rick Perry and Florida Gov. Rick Scott were fishing together on Fox News, pitching then-presidential contender Mitt Romney’s Medicare plan and arguing that decisions about health care should be made by states, not the federal government. On Wednesday, Scott reversed course, joining a growing number of Republican governors who are reluctantly embracing the key tenet of President Obama’s federal health reform — a sweeping Medicaid expansion (Ramshaw, 2/20).

The Texas Tribune: Interfaith Groups Rally For Medicaid Expansion
Interfaith groups and Democratic state legislators rallied on the Capitol steps Wednesday in support of expanding Medicaid to impoverished adults, as directed by federal health reform…Gov. Rick Perry has repeatedly said Texas will not expand Medicaid when the federal mandate to purchase health insurance begins in 2014 (White, 2/20).

The Associated Press/Washington Post: McDonnell To Budget Panel: No Medicaid Expansion Absent Federal And State Cost Cutting Reforms
Gov. Bob McDonnell warned state legislative negotiators on Wednesday not to expand Medicaid in Virginia without major federal and state cost reductions first. McDonnell wrote to the legislature’s top budget chiefs — Senate Finance Committee chairman Walter A. Stosch and House Appropriations Committee chairman Lacey E. Putney — as they and 10 other negotiators grappled with Medicaid expansion, the largest remaining obstacle to reaching a budget compromise in time for Saturday’s final adjournment (2/20).

The Associated Press: Panel Oks Bill To Give Lawmakers Say On Medicaid
Two bills approved by a Senate panel on Wednesday would require the approval of legislators for Kentucky to expand Medicaid or proceed with the state's planned insurance marketplace under the federal health care overhaul. The bills are expected to eventually die in the mostly Democratic House (Finley, 2/20).

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Health Spending And Fiscal Battles

Looming Cuts Fuel Debate Over Medicare And Medicaid Spending

As the March 1 deadline for the sequester approaches, news outlets analyze the impact budget cuts might have on the U.S. economy in general and on Medicare specifically.

The New York Times: Budget Cuts Seen As Risk To Growth Of U.S. Economy
Sequestration would slash agencies' "budget authority" by about $85 billion, but the Congressional Budget Office this month estimated that actual outlays would fall by only about $44 billion in the 2013 fiscal year, with the rest accruing over time. That is still about 1 percent of total federal spending to be squeezed out in a matter of months. Many economists argue that the same cuts could be made with less pain by postponing some of them until later in the decade, when the economy is likely to be stronger. Many argue that growing spending on health care programs like Medicaid and Medicare is the real threat to the federal budget, not domestic spending on areas like education and support for poor families (Appelbaum and Lowrey, 2/20).

The Medicare NewsGroup: Automatic Cuts Or Not? A Primer On Sequestration And The Impact On Medicare
But if a deficit reduction deal is reached, it could still result in cuts to Medicare. Providers may not escape unscathed in such a deal and it could have a direct impact on beneficiaries. President Obama is open to increasing the Medicare Part B and D premiums paid by higher-income beneficiaries, while House Speaker John Boehner proposed raising the Medicare eligibility age from 65- to 67-years-old during the fiscal-cliff standoff last December (Sjoerdsma, 2/20).

In other budget news -

The Washington Post: Business Owners Urge Congress To Take Medicare, Social Security Cuts Off The Table
Responding to a series of policy questions posed by lobbying group Small Business Majority, 80 percent of business owners said they oppose proposals to save federal money by curbing Social Security benefits, which have been floated in varying degrees by both parties in Washington. Nearly three in four said lawmakers shouldn't cut back on Medicare, and two in three said the same about proposed cuts to Medicaid, according to the poll, which will be published Wednesday (Harrison, 2/20).

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Major Doctor Group Coalition Expands List Of Overused Tests, Treatments

The American Board of Internal Medicine, as part of its "Choosing Wisely" campaign, expanded the number of medical societies recommending caution before certain tests and procedures are ordered.

The Fiscal Times: Do You Really Need That Test? Doctors Warn On 90 Treatments
When it comes to medical treatment, more isn’t necessarily better. Americans might not like hearing it, but that’s the message from 17 separate medical societies out with a new list of 90 tests and procedures they say are commonly ordered by doctors but aren’t always necessary – and may sometimes be harmful. The medical groups behind the list represent more than 350,000 physicians across a range of specialties, from family doctors and pediatricians to rheumatologists and geriatricians (Rosenberg, 2/21).

Los Angeles Times: Doctors List Overused Medical Treatments
The medical interventions — including early caesarean deliveries, CT scans for head injuries in children and annual Pap tests for middle-aged women — may be necessary in some cases, the physician groups said. But often they are not beneficial and may even cause harm (Levey, 2/20).

Modern Healthcare: Campaign Expands List Of Questionable Tests, Procedures
The American Board of Internal Medicine Foundation expanded its Choosing Wisely campaign ... Seventeen newly participating medical societies each submitted at least five tests or procedures to the campaign, which was launched in 2011 by the ABIM Foundation, a not-for-profit that seeks to advance medical professionalism. The campaign recommends that physicians question the more than 130 tests and procedures cited by the campaign before they are ordered (Lee, 2/21).

Reuters: Just Say Don't: Doctors Question Routine Tests And Treatments
Other specialists say no cough and cold medications for kids under 4, no oral antibiotics for acute infections of the ear canal ("swimmer's ear") and no use of drugs to keep blood sugar in older adults with type 2 diabetes within tight limits. There is no evidence that tight "glycemic control" - which is widely practiced - is beneficial, said the American Geriatrics Society. ... Some recommendations, if widely adopted, would mean significant changes in patient care. The geriatricians, for example, recommend against feeding tubes in patients with advanced dementia. The tubes hurt and cause problems; carefully feeding the patient is better (Begley, 2/21).

Medpage Today: 17 Doc Groups Add To 'Overused' Test List
A couple of recommendations appeared in multiple groups' lists. AAFP and ACOG both urged against scheduling elective labor inducements or cesarean deliveries before 39 weeks, since doing so is associated with an increased risk of learning disabilities, respiratory problems, and other potential problems. ... ABIM hopes to release a third list later this year which will include 13 more societies (Pittman, 2/21).

In related news --

Kaiser Health News: Hospitals Clamp Down On Dangerous Early Elective Deliveries
For decades, doctors have been warned about the dangers of delivering babies early without a medical reason. But the practice remained stubbornly persistent. Now, with pressure on doctors and hospitals from the federal government, private and public insurers and patient advocacy groups, the rate of elective deliveries before 39 weeks is dropping significantly, according to latest hospital survey from The Leapfrog Group, a coalition of some of the nation's largest corporations that buy health benefits for their employees (Galewitz, 2/21).

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Public Health & Education

Study Finds Bariatric Surgery Does Not Reduce Long-Term Medical Costs

Research disputes widely-held beliefs that the weight-loss operations cut the need for treatments and medicine after patients shed pounds.

Los Angeles Times: Study Disputes Long-Term Medical Savings From Bariatric Surgery
Despite the daunting price tag, mounting research has boosted hopes that the stomach-stapling operations could reduce the nation's healthcare bill by weaning patients off the costly drugs and frequent doctor visits that come with chronic obesity-related diseases like diabetes and arthritis. But a new study has found that the surgery does not reduce patients' medical costs over the six years after they are wheeled out of the operating room (Healy, 2/20).

Reuters: No Long-Term Cost Savings With Weight Loss Surgery
Weight loss surgery does not lower health costs over the long run for people who are obese, according to a new study. Some researchers had suggested that the initial costs of surgery may pay off down the road, when people who've dropped the extra weight need fewer medications and less care in general (Pittman, 2/20).

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State Watch

North Dakota, Kansas Join List Of States Considering Further Abortion Restrictions

An abortion clinic fights to stay open amid new proposed restrictions in North Dakota while Kansas lawmakers spar over new proposed restrictions on using state money for the procedure in that state.

The Associated Press: Abortion Proposal Faces Legal Challenges
Nearly two dozen women get abortions on an average Wednesday at the lone North Dakota clinic that performs them, often spending scarce resources to travel long distances to the Fargo building, where volunteers escort them through a crowd of protesters lining the street outside. The Red River Valley Women's Clinic, which opened under another name in 1981, is the only place within 230 miles where abortions are performed legally -- an estimated 1,200 a year. Now clinic officials fear they may need to go to court just to stay in business (Kolpack, 2/21).

Kansas City Star: Proposed Abortion Law Draws Heated Debate In Kansas House Committee
A bill forbidding the use of state money, tax credits or tax exemptions for abortion drew heated debate Wednesday in the House Federal and State Affairs Committee. ... It revises a law requiring doctors to give women certain information before terminating their pregnancies. And it includes language indicating that "the life of each human being begins at fertilization." Anti-abortion advocates said that government money should not be allocated for abortion procedures and that the bill provides general protection and rights for the unborn. ... Elise Higgins, Kansas National Organization for Women lobbyist and state co-coordinator, said the bill triggers a "blanket ban on all abortions" based on pseudoscience rather than evidence (2/21).

And there's a new poll on Texans' access to birth control --

The Houston Chronicle: Poll Results: 'The Pill Is Not Fair Game In The Culture Wars'
The Texas Freedom Network, which describes itself as a watchdog monitoring far-right issues, released a poll Tuesday showing strong support among Texans for state-funded family planning and birth control. Among its findings, the poll said 73 percent of Texans favor or somewhat favor state-funded family planning services, including birth control, for women. The network said it found support among 77 percent of Hispanics, 69 percent of Republican women and 66 percent of born-again Christians. ... The Texas Freedom Network Education Fund comissioned the poll by Washington-based Democratic pollster Anna Greenberg and Maryland-based Republican pollster Bob Carpenter (2/19).

And Georgia public health officials worry that the CDC could cut funding for its STD programs --

Georgia Health News: Will CDC Cut Funds For STD Programs?
State public health officials are worried that Georgia will soon lose up to $1.5 million in CDC funds for treating sexually transmitted diseases. ... The funding cut would affect clinical services, including lab testing, nurses, lab positions, and gonorrhea and chlamydia testing kits for all 18 districts, [the state Department of] Public Health said. Georgia has one of the highest rates of STDs in the nation. A 2010 CDC report said Georgia was No. 3 among states in its syphilis rate, 13th in chlamydial infections and sixth in gonorrheal infections (Miller, 2/20).

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Amid Budget Woes, States Consider Changes To Care For Developmentally Disabled

Fiscal concerns have lawmakers in New York and Kansas considering changes in how they fund care for the developmentally disabled.

The New York Times: $500 Million Chasm Opens In Proposed State Budget
A $500 million hole has opened in Gov. Andrew M. Cuomo's proposed state budget because of changes in how Washington plans to reimburse the state for the care of people with developmental disabilities, the governor said on Wednesday. The state has been negotiating with the federal government for several months over the state’s billing practices; federal officials have said that the state has overbilled Medicaid for the institutional care of people with disabilities (Hakim, 2/20).

Kansas Health Institute: House Panel Hears Bill To "Carve Out" DD Services From KanCare
Parents and groups that represent persons with developmental disabilities testified today in favor of a bill that would keep developmental disability services out of KanCare. But officials from the administration of Gov. Sam Brownback said if the bill were to become law, it would hinder their efforts to reduce Medicaid costs and better coordinate care for the program's enrollees. They said it would add $126.2 million to government spending by 2017, a number questioned by the bill's supporters (Shields, 2/20).

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State Roundup: Calif. Lawmakers To Consider Health Insurance Market Rules

A selection of health policy stories from Florida, California, Colorado, Oregon and Arizona.

Modern Healthcare: HHS Lets Fla. Proceed With Managed-Care Push
The state of Florida won a second victory from HHS that will help the state introduce a statewide Medicaid managed-care program. The agency notified the state that it would grant its request for a medical assistance waiver -- a decision that comes just weeks after the department granted Florida's first request for a waiver for its long-term-care program. The waivers allow the state to enroll virtually all Medicaid beneficiaries into the managed-care program, including elderly and disabled beneficiaries currently in nursing homes. However, HHS noted in a letter that the agency will work with the state's Agency for Health Care Administration to ensure a "robust independent consumer support program" to help address beneficiary concerns (Kutscher, 2/20).

Los Angeles Times: Lawmakers To Consider Rules For Health Insurance Market
Lawmakers are set to consider new rules for California's health insurance market on Wednesday, including a requirement for insurers to cover consumers who have preexisting medical conditions, and limits on how much they can charge based on age (Mishak, 2/20).

Health Policy Solutions (a Colo. news service): Payroll Taxes Would Fund Universal Health Care Proposal
Sen. Irene Aguilar, D-Denver, plans to introduce a bill on Friday seeking universal health care in Colorado. Under her plan, employers would pay a 6 percent payroll tax for each worker while employees would pay a 3 percent share. Self-employed people and investors would pay a 9 percent tax on income and capital gains. In exchange for those costs, all Coloradans who have lived in the state for at least one year by the beginning of 2016 would become part of a statewide health care "co-op" and would get "platinum-level" health plans, the most generous package of essential benefits under the Affordable Care Act (Kerwin McCrimmon, 2/20).

The Lund Report: House Health Committee Votes For Better Data Amid Talk Of Cultural Competency
The House Health Committee has taken up a pair of bills that aim to more effectively provide services to ethnic minorities, one by gathering more specific data about ethnicity and another requiring that health professionals to be trained in cultural competency if they want to be licensed in Oregon. "We're tired of being invisible. Our children need to be seen," testified Alberto Moreno, the executive director of the Oregon Latino Health Coalition (Gray, 2/20).

HealthyCal: Mobile Health At The Market
When it comes to getting her kids the health care she needs, Monica Villalobos faces many challenges. A single mom with three kids under five, she doesn’t have a car, works long hours and shares parenting with her mom, who speaks very little English. But it was easy for her to find her way to the Healthy Steps Medical Mobile Unit from the San Ysidro Health Center -- they set up a mobile services truck in the parking lot of her grocery store on Thursdays. The grocery store parking lot is across from the mobile home park where her family lives (Graham, 2/20).

Arizona Republic: Arizona Panel OKs Violence-Prevention Bill
A bill intended to help prevent mass shootings like Tucson and Newtown by requiring Arizona's teachers and health care workers to notify police if they believe someone could become violent passed its first legislative hurdle Wednesday. But several lawmakers expressed concerns that the measure was too broad and, though well-intentioned, could sweep troubled kids and adults who aren’t a real threat into the criminal-justice system (Reinhart, 2/20).

Kaiser Health News: In Arizona, Poorest, Sickest Patients Get Coordinated Care
Can for-profit health insurance companies be trusted to take care of the nation's sickest and most expensive patients? Many states, under an effort supported by the Obama Administration, are planning to let the companies manage health care for those elderly and disabled people covered by both Medicare and Medicaid. Patient advocates have warned that private health insurance companies are ill-equipped to provide the complex medical care and at-home services many of these people need to survive. It turns out that Arizona, a state that has been known to resist federal health programs, has been doing just that for many years (Varney, 2/20). 

California Healthline: Deadline Set To End Federal High-Risk Pool
Managed Risk Medical Insurance Board officials yesterday outlined plans to deal with the federal announcement that the Pre-existing Condition Insurance Plan will not accept new applicants after March 2. The federal PCIP program will continue to provide coverage for enrollees through the end of the year. The program will no longer be needed in 2014 when the Affordable Care Act provision that insurers may not deny coverage because of pre-existing conditions takes effect (Gorn, 2/21).

California Healthline: Higher Cost, Inferior Care: Dental Health In Emergency Departments
Each year, nearly one million U.S. residents visit hospital emergency departments seeking treatment that EDs are not equipped to provide: dental care. Most people seeking dental help at EDs have low incomes and receive health benefits through Medicaid. They often resort to emergency care because few dentists are willing to treat the program's beneficiaries. The outcome, observers say, is inadequate dental services for those patients and hundreds of millions of dollars added to U.S. health care spending. … In California, the number of ED visits for preventable dental conditions is growing at a rate faster than the state's population, according to a 2009 report by the California HealthCare Foundation, which publishes California Healthline (Wayt, 2/20).

Health Policy Solutions (a Colo. news service): Gun Rights Advocates Want Control Of The Mentally Ill, Not Firearms
The debate over what’s to blame for gun violence -- easy access to guns or lack of access to mental health care – ensued in earnest Tuesday night, with intense partisans from both sides in the audience erupting in applause frequently throughout a forum in Denver. It’s unlikely that many minds were changed by the time the 90-minute standoff ended in what appeared to be a draw. But the debate highlighted the heated controversy that is being played out across the country as states and the federal government consider gun control bills and mental health care measures in the wake of the slaughter of 20 children and six adults in December at an elementary school in Newtown, Conn. (Carman, 2/20).

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Weekend Reading

Weekend Reading: Why A Trip To The ER Costs More Than A College Semester

Every week Ankita Rao selects interesting reading from around the Web.

Time Magazine (special coverage): Bitter Pill: Why Medical Bills Are Killing Us
1. Routine Care, Unforgettable Bills .... Sean was allowed to see the doctor only after he advanced MD Anderson $7,500 from his credit card. ... The total cost, in advance, for Sean to get his treatment plan and initial doses of chemotherapy was $83,900. ... When we debate health care policy, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high? What are the reasons, good or bad, that cancer means a half-million- or million-dollar tab? ... What makes a single dose of even the most wonderful wonder drug cost thousands of dollars? Why does simple lab work done during a few days in a hospital cost more than a car? And what is so different about the medical ecosystem that causes technology advances to drive bills up instead of down? (Steven Brill, 2/20).

MedPage Today's KevinMD: The Transformation Of Health Care In The Information Age
Knowledge has been democratized: patients now commonly search for information from Dr. Google before they consult Dr. Welby. ... In the old days, the office visit (or the hospitalization) was the fleeting interlude during which the business of doctoring was conducted. Today, these face-to-face meetings are punctuation marks in a narrative arc that is no longer bound by physical proximity. Even with all these changes in the nature of the doctor-patient relationship, there may be none as transformative, and unsettling to physicians, as the fact that patients are increasingly learning about their doctors based on the doctors’ online presence (Dr. Bob Wachter, 2/18).

The New York Times: The Extraordinary Science Of Addictive Junk Food
On the evening of April 8, 1999, a long line of Town Cars and taxis pulled up to the Minneapolis headquarters of Pillsbury and discharged 11 men who controlled America's largest food companies. Nestlé was in attendance, as were Kraft and Nabisco, General Mills and Procter & Gamble, Coca-Cola and Mars. Rivals any other day, the C.E.O.'s and company presidents had come together for a rare, private meeting. On the agenda was one item: the emerging obesity epidemic and how to deal with it. While the atmosphere was cordial, the men assembled were hardly friends. Their stature was defined by their skill in fighting one another for what they called "stomach share" — the amount of digestive space that any one company's brand can grab from the competition (Michael Moss, 2/20).

Forbes: Employers Dropping Health Care Coverage Could Benefit Health Care Quality And Cost 
It is projected that a consequence of the coverage provisions implemented in 2014 will be for many companies to drop health care coverage for their employees. To date, the majority of research studies, modeling estimates and employer surveys have predicted some level of employer insurance drop. While this is usually framed as a negative consequence of the law, moving away from our employer system may actually have positive implications for the health care system and individuals. ... the transition is unlikely to be a smooth one in the coming years, but the benefits of changes in individual market insurance coverage could outweigh the unavoidable growing pains of the changing market (Nicole Fisher, 2/20).

The Atlantic: Rwanda's Historic Health Recovery: What The U.S. Might Learn
Since the genocide with which its name is still synonymous in the United States, Rwanda has doubled its life expectancy and now offers a replicable model for delivery of high quality health care with limited resources.  Dr. Paul Farmer, Chair of the Department of Global Health and Social Medicine at Harvard Medical School and co-founder of Partners In Health, says that, "Rwanda has shown on a national level that you can break the cycle of poverty and disease" (Neil Emery, 2/20).

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Editorials and Opinions

Gov. Scott's Medicaid Decision Riles Conservatives

The Florida governor's move to expand Medicaid under the health law disappoints some of his supporters, but one newspaper praises the decision.

The Wall Street Journal: ObamaCare's Baby Elephant
On Wednesday Florida Republican Rick Scott became the latest GOP Governor to volunteer to shoulder some responsibility for ObamaCare, which has liberal sages gloating about a resistance-is-futile shift in the GOP. The media don't want to discuss the substance, only the politics, so allow us to report how the flippers are justifying their flips (2/20).

Palm Beach Post: Legislature Should Follow Governor And Expand Florida's Medicaid Program
Gov. Rick Scott is finally paying more than lip service to "putting Florida families first" with his announcement Wednesday that he supports expanding the state's Medicaid program under the Affordable Care Act for three years. The announcement came only hours after the U.S. Department of Health and Human Services said it will allow Florida to put all Medicaid recipients into managed care. The move explains why Gov. Scott, who bashed the law, refused for two years to implement it and said he would not expand Medicaid, changed his mind (Rhonda Swan, 2/21).

Reason: ObamaCare Opponent Rick Scott To Proceed With Health Law's Medicaid Expansion In Florida
So why did Scott fold? (Michael) Cannon suggests that the governor is "doing it because he thinks it will help him get reelected.” But there may be a more immediate payoff. On Wednesday, Scott was granted a long-pending request for a Medicaid waiver up for approval with the Obama administration. With the waiver approved, the governor can shift large portions of the state's Medicaid population into privately run Medicaid "managed care" plans (Peter Suderman, 2/20).

National Review: Rick Scott’s Big Reversal
Governor Rick Scott expressed his support this afternoon for expansion of Florida’s Medicaid program, describing the decision as a choice between "having Floridians pay to fund this program in other states while denying health care to our citizens — or using federal funding to help some of the poorest in our state with the Medicaid program as we explore other health-care reforms." The decision is a major reversal for Scott, whose 2010 electoral victory derived largely from his fight against the Obama health law. It apparently came after furious lobbying by Florida conservatives and Scott allies to keep him from breaking ranks (Jillian Kay Melchior, 2/20).

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Viewpoints: Holtz-Eakin And Roy Offer Prescription To Fix Health Law; Iowa Lawmakers Opposed To Medicaid Expansion Should Give Up Their Coverage

Reuters: The Future Of Free-Market Healthcare
Over nearly a century, progressives have pressed for a national, single-payer healthcare system. When it comes to health reform, what have conservatives stood for? For far too long, conservatives have failed to coalesce around a long-term vision of what a free-market healthcare system should look like. ... Obamacare is the logical byproduct of this conservative policy neglect. ... The great irony of Obama's triumph, however, is that it can pave the way for Republicans to adopt a comprehensive, market-oriented healthcare agenda. ... conservatives can use Obamacare's important concession to the private sector — its establishment of subsidized insurance marketplaces — as a vehicle for broader entitlement reforms (Douglas Holtz-Eakin and Avik Roy, 2/20).

The Washington Post: Health Premiums For Smokers Should Be Tweaked
When venerable anti-tobacco groups such as the American Cancer Society and cigarette makers such as Altria align in opposition to a policy, it's got to be pretty bad, right? But, when it comes to whether health-insurance companies can charge higher premiums from smokers, the fact that these mortal enemies oppose the idea doesn't mean policymakers should throw it out (2/20).

Des Moines Register: There's Irony In Lawmakers' Medicaid View
The Republicans continue to complain about a supposed "government takeover" of health care. Iowa House Speaker Kraig Paulsen, R-Hiawatha, told The Des Moines Register editorial board last week that he has no plans to pursue a Medicaid expansion. There's a troubling irony here. Last year, Paulsen gladly allowed Iowa taxpayers to pay the entire cost of his health insurance. He was enrolled in a plan offered to full-time state government employees and to members of the Legislature, although they work only parttime during the year. It cost taxpayers $13,000 for the state to insure Paulsen and his family. The amount he contributed to the premiums: $0. ... Perhaps it is time for members of Iowa's Legislature to walk in the shoes of tens of thousands of other citizens who don’t qualify for any benefits from their part-time jobs. Lawmakers should give up their taxpayer-financed insurance benefits (2/20).

The New England Journal of Medicine: Routine HIV Testing, Public Health, and the USPSTF — An End to the Debate 
The U.S. Preventive Services Task Force (USPSTF) is poised to release recommendations on screening for human immunodeficiency virus (HIV) infection that will endorse the routine testing of adults and adolescents. ... They will also carry important policy implications, since the Affordable Care Act (ACA) mandates that all public and private health plans provide coverage for USPSTF-recommended preventive services without patient copayments (Ronald Bayer and Gerald M. Oppenheimer, 2/20).

The New England Journal of Medicine: Updating the HIV-Testing Guidelines — A Modest Change With Major Consequences 
The rationale for a grade A recommendation from the USPSTF is that there is "high certainty that the net benefit is substantial." In the case of HIV screening, that benefit can be achieved only if people identified as HIV-infected are effectively linked to and retained in HIV care and are supported in adhering to an effective antiretroviral regimen. The proposed USPSTF recommendations may remove financial barriers to routine HIV screening, but that is only the first step in ensuring that all HIV-infected Americans have access to the full continuum of care (Erika G. Martin and Bruce R. Schackman, 2/21).

The New York Times' Opinionator: Our MIA Surgeon General
But (Surgeon General Regina Benjamin's) most public work, the 2010 document called "The Surgeon General's Vision for a Healthy and Fit Nation," has a decidedly mild Michelle Obama-ish tone. In discussing the obesity crisis, it lays the blame squarely at the feet of … the victims: "In addition to consuming too many calories and not getting enough physical activity, genes, metabolism, behavior, environment, and culture can also play a role in causing people to be overweight and obese" (Mark Bittman, 2/20).

Los Angeles Times: Breast Practices: The Mammogram Dilemma
There is growing evidence that screening mammograms aren't all they've been cracked up to be. This month it was "More mammograms, more problems" — a study showing that screening every year (instead of every other) didn't produce any benefit but did produce twice as many false alarms and twice as many biopsies. A few weeks earlier, another study (which I coauthored) suggested that roughly one-third of breast cancers diagnosed under current screening guidelines would never cause problems and didn't actually need to be diagnosed (H. Gilbert Welch, 2/21).

The New England Journal of Medicine: Medicare's Transitional Care Payment — A Step Toward The Medical Home
In adopting the transitional care payment policy, CMS has begun shifting more financial resources toward primary care. ... Using the fee schedule to expand the delivery of advanced primary care services might well benefit the Medicare population, but such payments might also provide an incentive for visits that won't yield the anticipated benefits of higher quality and lower costs. CMS aims to formulate policy on the basis of [Center for Medicare and Medicaid Innovation] studies, but at some point it will need to take the leap to something better. The 2013 physician-payment rule suggests that day is coming soon (Dr. Andrew B. Bindman, Jonathan D. Blum and Richard Kronick 2/21).

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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.