Daily Health Policy Report

Wednesday, February 22, 2012

Last updated: Wed, Feb 22

KHN Original Reporting & Guest Opinion

Health Reform

Campaign 2012

Capitol Hill Watch

Health Care Marketplace

Quality

Coverage & Access

Health Information Technology

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Feds Jump Start Health Insurance Co-Ops With Loans

Reporting for Kaiser Health News, Harris Meyer writes: "Seven organizations will receive a total of $639 million in federal low-interest loans to launch new, consumer-governed health insurance plans in eight states, the federal government announced Tuesday" (Meyer, 2/21). Read the story.

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Capsules: Convenient Methods For Birth Control Aren't Always Easy To Pay For

Now on Kaiser Health News' blog, consumer columnist Michelle Andrews writes: "Free contraception has sure been a hot topic lately. But there’s still one facet that hasn’t received much attention. Religious leaders and politicians have debated whether requiring employers to cover prescription birth control for employees gratis — as required under the health care overhaul — tramples on religious freedom. But what about over-the-counter methods like condoms, spermicides and contraceptive sponges?" (Andrews, 2/21). Check out what else is on the blog.

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Political Cartoon: 'High Occupancy?'

Kaiser Health News provides a fresh take on health policy developments with "High Occupancy?" by Mike Peters.

Meanwhile, here's today's haiku:

WHERE'S THE EVIDENCE?

Evidence be damn'd.
Essential Health Benefits:
Whatever we want
-Anonymous

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

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Health Reform

Feds Launch Health Co-Op Program With Low-Interest Loans

Seven organizations received the funding, which is designed to advance the formation of health insurance co-operatives -- an alternative to the idea of a government-run public option and an entity to compete against private insurance plans.

Kaiser Health News: Feds Jump-Start Health Insurance Co-Ops With Loans
Seven organizations will receive a total of $639 million in federal low-interest loans to launch new, consumer-governed health insurance plans in eight states, the federal government announced Tuesday (Meyer, 2/21).

The Hill: Administration Announces First Reform Law Loans To Nonprofit Insurance Co-Ops
The Obama administration on Tuesday announced the first low-interest loans to nonprofit health insurance co-operatives funded under the healthcare reform law. The loan program was created as an alternative to the politically doomed government-run public option as a way to compete against private plans. Seven plans covering eight states have been awarded $640 million, part of the $6 billion the law sets aside in loans and grants (Pecquet, 2/21).

Politico Pro: Co-Ops In Eight States Win Start Up Funds
CCIIO Deputy Director Tim Hill said Tuesday the agency has awarded about $639 million in loans to health care reform’s upstart consumer-oriented insurance cooperatives in eight states. The Freelancers Union, a 170,000-member organization based in New York City, sponsored three — in New York, New Jersey and Oregon. Consumer Operated and Oriented Plans were also funded in Iowa, Montana, Nebraska, New Mexico and Wisconsin. The announcements, expected last month, were delayed due to "strong numbers" of applicants, CCIIO officials said. Many of them were not funded in the initial round, but are retooling their applications (Norman, 2/21).

The Associated Press/Washington Post: Obama Administration Loans $638M In Startup Money For Health Insurance Co-Ops In 8 States
Health care cooperatives that are being launched in eight states announced Tuesday they will receive a total of $638 million in loans from the Obama administration under the federal health insurance law. The administration said the new nonprofit health insurers will be run by their customers and will be designed to offer coverage to individuals and small businesses. Supporters say the co-ops will keep pressure on private insurance companies for both price and coverage (2/21).

Modern Healthcare: $639 Million In Loans For Insurance Co-Ops
The CMS has provided seven not-for-profit organizations a total of about $639 million in repayable loans to establish not-for-profit, consumer-governed health insurance companies, a type of plan that was created by the Patient Protection and Affordable Care Act. Funded through the 2010 law, the co-op plans are intended to be directed by customers and designed to give both individuals and small businesses more health insurance options (Zigmond, 2/21).

In related coverage, details regarding some of the organizations that will receive the loans -

The Associated Press/Des Moines Register: Loan Announced For New Iowa Nonprofit Health Insurer
The Obama administration is loaning $112.6 million to a health care cooperative that will serve Iowa and Nebraska, authorities said. The loans are part of the federal health insurance law... The Iowa provider is Midwest Members Health, which is sponsored by the Iowa Institute. The government said the new nonprofit health insurers will be run by their customers and will be designed to offer coverage to individuals and small businesses (2/21).

Bloomberg: Union For Independent Contractors To Offer Health Insurance
The Freelancers Union, a nonprofit created to represent freelance workers and independent contractors, will receive $341 million in loans from the U.S. government to start health insurance plans in three states. The plans will compete with for-profit offerings from companies including UnitedHealth Group Inc. (UNH) and WellPoint Inc. (WLP) and nonprofit Blue Cross plans beginning in 2014, Marilyn Tavenner, the acting administrator of the Centers for Medicare and Medicaid Services, said in a statement. The programs are called "co-op" plans, after a provision of the 2010 health law that authorized them (Wayne, 2/21).

Milwaukee Journal Sentinel: Federal Loans To Fund Nonprofit Health Insurer
Common Ground, a coalition of religious groups and other organizations, has been awarded two federal loans potentially totaling $56.4 million to start a nonprofit health insurer that would be run by its members. The money is part of $3.8 billion included in federal health care reform to help start nonprofit health insurers, similar to cooperatives, to compete in the market for individuals and small businesses. "We've got to try something new," said Robert Connolly, a small-business owner and president of the board of the Common Ground Healthcare Cooperative (Boulton, 2/21).

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High Court Extends Time Allocated For Health Law Arguments

The Supreme Court on Tuesday added an extra 30 minutes to the time provided for oral arguments, bumping up the total to six hours over three days.

Politico: Supreme Court Allows Extra Half Hour For Arguments
The Supreme Court on Tuesday allotted an extra 30 minutes to oral arguments on the health care reform law, giving another half an hour to the debate over whether a federal tax law should prevent a ruling this year. The decision bumps up the total argument time to six hours over three days in late March (Haberkorn, 2/21).

The Associated Press: High Court Health Care Argument Extended To 6 Hrs
The Supreme Court has added another 30 minutes to upcoming arguments over President Barack Obama's health care overhaul. The sessions now will span six hours over three days in late March. The justices on Tuesday set aside 30 more minutes, 90 minutes overall, for discussion of the effect on the health care case of a federal law intended to make tax collections run smoothly. That law forces people who want to challenge taxes to pay them first (2/21).

In other news from the high court -

National Journal: Supreme Court Still Considering Whether To Take Gene Patenting Case
The Supreme Court has delayed a decision on whether to hear a case that could affect the entire biotech industry -- one asking whether Myriad Genetics can own the patents on two breast cancer genes. Because it had been scheduled for a conference discussion by the justices earlier this month, a decision about whether to consider the case was expected on Tuesday. But the Court declined to accept or reject the case, suggesting that the justices will want to discuss it again (Sanger-Katz and McCarthy, 2/22).

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Can Health Law's Lifetime-Limits Ban Can Be Circumvented?

Politico Pro reports on questions raised about essential benefit rules, while other news outlets report on high-risk pools and preventive services coverage. 

Politico Pro: Did CMS Offer A Way Around Coverage Limits Ban?
Two sentences buried in a guidance released on Friday have set off alarms with consumer advocates, who say they may have exposed a significant loophole in the health care reform law's consumer protections. The document is a set of 22 frequently asked questions about the Obama administration's developing policy on essential health benefits. ... Though the Affordable Care Act “does not permit annual or lifetime dollar limits” for essential health benefits, the document says, "plans would be permitted to impose nondollar limits..." (Feder, 2/22).

Wisconsin Public Radio: Low Enrollment In New Federal High-Risk Insurance Pool
Low participation has eased concerns that the program will run out of money, but high health costs means there probably won't be funds left over. ... It was estimated 8000 people with pre-existing conditions would apply; two years later, only 1100 have (Mills, 2/21). 

St. Louis Beacon: Affordable Care Act Provides 3.4 Million In Missouri, Illinois With Preventive Services
[A]n estimated 54 million Americans ... now have access to preventive services, ranging from colonoscopies to mammograms, that previously had required co-payments. ... federal health officials concede it's hardly a new policy among many major businesses and insurers whose wellness programs predate ACA (Joiner, 2/21). 

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Campaign 2012

GOP Presidential Hopefuls Face Off In Two Battleground States

Issues ranging from plans to cap or cut Medicaid spending to voting positions on the Medicare prescription drug program are among the policies being tossed about as candidates jockey for tea party votes and conservative credentials.

The New York Times: In Tightening Race, Top GOP Candidates Race To Capture 2 Battleground States
In the brilliant sunshine of Arizona, Rick Santorum aggressively challenged Mitt Romney in a state where the Tea Party is strong and the politics of immigration are poised to take center stage at a debate on Wednesday night. Speaking to about 500 people at the Maricopa County Lincoln Day luncheon, Mr. Santorum tipped his hat to the Tea Party movement, many of whose members had packed into the large Shriners' hall to hear him speak. "We need to take everything from food stamps to Medicaid to housing programs to education training programs," he said. "We need to cut 'em, cap 'em, freeze 'em, send 'em to the states and say that there has to be a time limit and a work requirement," he said, the rest of his words drowned out by thunderous applause (Shear and Zeleny, 2/21).

Los Angeles Times: Ron Paul's 'Groovy' New Ad Calls Santorum A Fake Conservative
If the enemy of my enemy is my friend, Mitt Romney and Ron Paul are best buds these days. As Romney fights to stave off a potentially debilitating loss in Michigan's Feb. 28 primary, Paul is taking to the airwaves there with an ad that reinforces Romney's message that Rick Santorum betrayed conservative principles on spending when he served in Congress. … It says Santorum voted to raise the debt ceiling, doubled the size of the Education Department, and "supported the biggest entitlement expansion since the '60s," referring to the Medicare prescription drug plan (Memoli, 2/21).

The Associated Press/Washington Post: Gingrich Asks Oklahoma Lawmakers For Input On Getting 'Federal Government Out Of Your Hair'
The former House speaker said he'd focus most on regulations he thinks are hindering energy development and on giving states greater flexibility to implement Medicaid programs for the poor. Gingrich praised House Budget Committee Chairman Paul Ryan's ideas for turning more Medicaid funds into block grants to states. Gingrich drew conservative blowback last May for suggesting Ryan's plan for Medicare for seniors constituted "right-wing social engineering" (2/21).

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Birth Control Mandate, Abortion Draw Lines In Presidential Debate

Increasingly, these are the flashpoint issues on the campaign trail.

The Hill: Fight Over Birth Control Mandate Becomes Battle To Frame Debate
Democrats successfully shifted a debate over religious liberty to birth control last week, but opponents of the contraception mandate are trying to shift it right back. The political debate over the birth-control mandate in the health care law is largely a fight over how to frame the issue. To the left, it's about women's health; to the right, it's a question of religious freedom. And the battle between those two narratives is far from over (Baker, 2/22).

The Hill: Critics Say Obama Doesn't Speak For All Women On Birth Control
Two female attorneys — Helen Alvaré, a law professor at George Mason University, and Kim Daniels, former counsel for the Thomas More Law Center — have launched an open letter saying the White House's allies don't speak for all women. "Those currently invoking 'women's health' in an attempt to shout down anyone who disagrees with forcing religious institutions or individuals to violate deeply held beliefs are more than a little mistaken, and more than a little dishonest," the letter states. Hundreds of women from across the country have signed on (Baker, 2/21).

The Hill: Report: Santorum Supported Abortion Rights In Early Career
Rick Santorum supported abortion rights for most of his life before he ran for Congress and was a centrist on the issue in his early years in office, according to campaign documents obtained by The Huffington Post. The tone of the documents and his comments on the subject are a far cry from the culture warrior persona Santorum developed in his years in the Senate, and threaten to undercut his image as a purist conservative. He has long opposed any legalized abortion including in cases of rape and incest, and has attacked rival Mitt Romney for flip-flopping on the same issue (Joseph, 2/21).

The Associated Press: Santorum Makes Prenatal Testing A Campaign Issue
First birth control, now prenatal testing? Once again a fact of life for many American women has become a jarring issue in the presidential race. Republican candidate Rick Santorum is making free screenings for birth defects part of his attack on President Barack Obama's health care law. Santorum charges that the law requiring insurers to cover the tests is a way to encourage more women to have abortions that will "cull the ranks of the disabled in our society" (Cass, 2/22).

The Associated Press: Santorum Blasts Obama's Motives On Power, Abortion
Santorum, the former Pennsylvania senator who suddenly is threatening Romney in his native state of Michigan, says Obama cares only about power, not the "interests of people." He says "Obamacare," the health care overhaul Obama enacted, includes a "hidden message" about the president's disregard for impaired fetuses, which might be aborted (Babington, 2/21).

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Capitol Hill Watch

Dems Schedule Own Contraception Hearing

House Democrats have scheduled their own hearing in response to last week's all-male panel organized by House Republicans on the Obama administration's contraception rule. The Democrats have invited a young woman to testify but say that GOP leaders won't allow them to televise it.  

Politico: Dems: GOP Won't Let Us Televise Contraception Hearing
First, House Democrats couldn't get a woman onto the all-male panel at a contraception hearing last week. Now, they've invited her to testify at their own unofficial hearing — and they say the Republicans won't let them televise it (Haberkorn, 2/21).

National Journal: In Contraception Fracas, Pelosi And Other Dems Schedule Own Hearing
House Minority Leader Nancy Pelosi, D-Calif., announced that she and members of the House Democratic Steering and Policy Committee will hold their own hearing Thursday on the "issue of women's health." Last week the House Oversight and Government Reform Committee, led by its chairman, Darrell Issa, R-Calif., held a hearing into the controversial rule from the Obama administration requiring all employers, including religious-affiliated institutions, to offer health insurance plans that cover birth control free of cost to women (House, 2/21).

Chicago Sun-Times: Cranking It Up: Pelosi Leading Contraception War Charge
Pelosi announced that Democrats will hold a hearing Thursday featuring the woman, Sandra Fluke, a law student, who was not allowed to be part of that panel. Some Republicans — including the presidential candidates — are trying to frame getting contraception for women covered through the new Obama health care law as an issue of religious liberty. But the reality is — as women who use birth control know — there is a lot more to the story (Sweet, 2/21).

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Health Care Marketplace

FDA, Pharmaceutical Companies Announce Solution To Cancer Drug Shortage

The medicines, Doxil and methotrexate, are used to treat blood, breast and lung cancers.

The Philadelphia Inquirer: FDA, Drugmakers Say They've Solved Two Drug Shortages
The U.S. Food and Drug Administration and several pharmaceutical companies said Tuesday they have reached agreements to alleviate shortages for the drugs methotrexate and Doxil. Methotrexate is used to treat children with a form of leukemia and others with tumors of the breast and lungs. Doxil is used to treat ovarian cancer and multiple myeloma (Sell, 2/21).

Bloomberg: Cancer-Drug Shortages Targeted By Stopgap FDA Approval Of Similar Products
Caraco Pharmaceutical Laboratories Ltd. (CPD) will import an unapproved drug from India with the same active ingredient as Doxil, made by New Brunswick, New Jersey-based Johnson & Johnson ... A generic form of methotreaxate, made by APP Pharmaceuticals Inc (APPX)., has received expedited approval from the agency (Edney, 2/21).

ABC News: FDA Efforts Reversal Of Critical Cancer Drug Shortage
The FDA said its approval of a new supply method would increase production of the injection form of the drug methotrexate, which is used to treat children with the most common form of childhood leukemia. ... According to Michael Link, a pediatric oncologist and president of the American Society of Clinical Oncology, some hospital pharmacies reported having only a couple of weeks of supplies left (Salahi, 2/21).

MSNBC: Patients Cheer As FDA Eases Shortages Of 2 Crucial Cancer Drugs
Ovarian cancer patients whose treatment was interrupted or even stopped entirely because they couldn't get supplies of the critical chemotherapy drug Doxil applauded news early Tuesday that federal health officials have found a solution to the shortage (Aleccia, 2/21).

Minnesota Public Radio: Minn. Hospitals Encouraged By FDA's Cancer Drug Approvals 
Pediatric oncologist Dr. Bruce Bostrom said methotrexate supplies have been stable at Children's Hospitals and Clinics of Minnesota. But he said doctors — and parents — have been watching the situation carefully. ... Bostrom said Children's uses methotrexate every day and currently has about 150 leukemia patients in its care. Some parents have considered going to Canada to access the drugs, he said (Dunbar, 2/21). 

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Quality

Surgical Instruments, CT Pan-Scans Under Scrutiny

iWatch News and Medscape each report on patient safety issues.

iWatch News: Filthy Surgical Instruments: The Hidden Threat In America's Operating Rooms
Filthy, dangerous medical implements have been showing up in hospitals and outpatient surgery centers with alarming regularity. In 2009, the Department of Veterans Affairs admitted that 10,737 veterans in Florida, Tennessee and Georgia were given endoscopies or colonoscopies between 2002 and 2009 with endoscopes that may have been improperly cleaned (Eaton, 2/22). 

Medscape: CT Pan-Scans Raise Radiation Dose Without Improving Results
An Australian study of emergency department imaging practices has raised radiation safety concerns and new arguments about the clinical benefits of whole-body computed tomography (CT) imaging for the initial emergency department evaluation of critically injured patients. ... According to Dr. Stengel, the findings suggest that pan-scanning may be 26 times as likely to harm patients in the long run as to immediately help them in the acute care setting (Brice, 2/21). 

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Coverage & Access

A Job Doesn't Always Solve Health Insurance Difficulties

NPR: Even When Employed, Health Care A Challenge
[Casundra] Bronner is one of six people from the St. Louis area whom NPR has been following for a little more than a year. Like the others, she started 2011 unemployed and searching for work. Like so many Americans who have struggled in this tough labor market, the people we followed have had difficulty getting health coverage. And for some, including Bronner, it didn't stop when they got jobs (Keith, 2/21).

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Medical Homes Offer Model For Better, Less Expensive Health Care

News outlets explore how emerging models for delivering care, such as patient-centered medical homes and dental therapists, can lead to lower costs and improved access.

JAMA: Patient-Centered Medical Homes Offer a Model for Better, Cheaper Health Care
As policy makers and health care delivery experts seek to redesign medical care in the United States to rein in costs while improving quality, a growing chorus is singing the praises of the patient-centered medical home model. ... Although medical homes are a recent phenomenon, initial results are encouraging (Mitka, 2/22).

WBUR: Dental Therapists Are Debated For Filling Coverage Gaps
[Christy Jo] Fogarty is on the forefront of what she calls a paradigm shift in dental care, one that rivals the expansion of nurse practitioners. She's the first advanced dental therapist to be licensed in Minnesota since the state approved such providers in 2009. Alaska is the only other state that allows dental therapists. Whether other states will follow is becoming one of the most heated topics in health care reform (Bebinger, 2/22). 

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Health Information Technology

Adoption Of Health IT Still An Uphill Climb

Meanwhile, the Health Resources and Services Administration and the Labor Department have signed an agreement to advance this cause.  

MarketWatch: Automating Health Care Still A Daunting Task
The effort to drag the health-care industry into the technology age trudges onward, and it's still not clear whether the nation's 500,000 to 600,000 physicians will successfully make the journey. That's the finding from a number of health-care industry officials charged with pulling the medical profession into the 21st Century when it comes to managing patient records as well as automating the back-office operations of hospitals and clinics (Britt, 2/21).

Modern Healthcare: HRSA, Labor Department Sign Health IT Training Agreement
Health Resources and Services Administration Administrator Make Wakefield on Monday announced that her agency and the U.S. Labor Department have signed an agreement to use existing resources at community colleges and technical colleges to support the training of health information technology professionals at rural hospitals and clinics (Zigmond, 2/21).

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State Watch

Officials Debate Whether, How To Set Up Health Exchanges

Lawmakers in Maryland, Nebraska and Kansas consider bills to advance or block the marketplaces. California officials wrestle with the nitty gritty of implementation.

The Associated Press/USA Today: Md. Lt. Gov. To Speak To Senate, House Committees About Legislation To Implement Health Reform
[Maryland's Lt. Gov. Anthony] Brown will testify Wednesday before a state Senate committee in favor of legislation that builds on the state's efforts to create a Health Benefit Exchange, which is intended to help individuals and small businesses buy health insurance (Breitenbach, 2/22).

The Associated Press: Nebraska Health Insurance Plan Debate Begins
The road to Nebraska creating its own health insurance exchange could be a long one, as indicated Tuesday by nearly three hours of testimony before lawmakers. Lawmakers began discussion on two bills that would form the Nebraska Health Benefit Exchange Act, a plan offered as an alternative to the federal health insurance plan now being scrutinized by the U.S. Supreme Court (Avok, 2/21).

The Associated Press/Houston Chronicle: Protest Of Obama Policies Advances In Kan. House
A bill conservative Republicans see as an important step toward giving Kansas full control over health care programs received first-round approval Tuesday in the state House, advancing another protest from the GOP-controlled Legislature against Democratic President Barack Obama's policies (Hanna, 2/21).

Kansas Health Institute News: Health Care Bills Advanced
Legislators in the House today moved forward a bill that would authorize Kansas participation in the Interstate Health Care Compact. ... Once 20 or more states have joined the compact, proponents of the bill have said, the member states will demand that Congress ratify an agreement to return tax dollars used to fund Medicare, Medicaid and the Children’s Health Insurance Program to the states (2/21).

California Healthline: Working Out the Details of the Exchange
With a June deadline looming for submitting its Level II implementation grant, the exchange board finds itself grappling with some of the hard questions and sticky details around creation of the Health Benefit Exchange. ... According to executive director Peter Lee, other news discussed at the exchange board meeting included: [considering] cost-sharing with qualified health plans (Gorn, 2/22).

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Medicaid Cuts, Changes Proposed To Save Money

Illinois Gov. Pat Quinn is proposing cutting $2.7 billion from that state's Medicaid program. Also, New Mexico's governor is proposing Medicaid patients pay more out of pocket if they go to the ER for care that's not an emergency. Georgia may drug-test Medicaid patients, and California Medicaid changes are questioned by patient advocates.

Bloomberg: Illinois's 'Toughest' Budget May Cut $2.7 Billion From Medicaid
Illinois Governor Pat Quinn will propose a $33.8 billion spending plan that would cut $2.7 billion from the Medicaid program, which provides health care for the poor. It's the "toughest budget," Jack Lavin, Quinn's chief of staff, told reporters in Springfield, capital of the fifth-most-populous U.S. state. The plan, an increase from the current $33 billion, would close two prisons and four mental-health facilities, he said. The state faces a backlog of $9 billion in unpaid bills (Jones, 2/22).

Chicago Tribune: Quinn To Call For Dozens Of Prison, Human Services Closures
Democratic Gov. Pat Quinn will deliver a bad-news budget Wednesday, suggesting that Illinois close numerous prisons, mental health centers and social service offices, cut health care for the poor and shut down popular tourist sites for two days a week at times during the year. The problem is the same as it's been for years at the Capitol — there's not enough money coming in while costs are rising. The quick math: The state expects to take in about $700 million more during the financial year that starts July 1. State worker pension costs alone will rise by more than $1 billion (Long and Garcia, 2/21).

Reuters: Pension, Medicaid Changes Sought In Illinois Budget
Illinois Governor Pat Quinn will call for cuts to escalating pension and Medicaid costs in his budget address on Wednesday to stop the two programs From devouring more of the cash-strapped state's general funds budget, top officials in his office said on Tuesday. ... As for Medicaid, the Democratic governor's $33.7 billion general funds budget aims to reduce spending by $2.7 billion. Without fundamental changes to the program, Stermer warned that deferred Medicaid bills would mushroom in future fiscal years, resulting in "a recipe for collapse of the Medicaid program" (Pierog, 2/21).

The Associated Press/San Francisco Chronicle: New Mexico Proposed To Overhaul Medicaid Program
Gov. Susana Martinez's administration is proposing to overhaul a program that provides health care to a fourth of the state's population, and the changes could require some needy New Mexicans to dig into their pockets to pay a fee if they go to an emergency room for medical care that's not considered an emergency. One of the goals of the planned revision is to slow the rate of growth in Medicaid, which accounts for 16 percent of this year's state budget and costs New Mexico taxpayers nearly $1 billion (Massey, 2/21).

Georgia Health News: State Drug-Testing Bill Would Break New Ground
Georgia could become the first state to require drug testing of Medicaid applicants, if a Senate bill becomes law. ... Claudette Bazile, the Community Health official, told the Senate Health and Human Services Committee that a federal agency has not approved any state for such a mandate. She said the Centers for Medicare and Medicaid Services (CMS) denied requests by Alaska and Idaho to drug-test Medicaid applicants (Miller, 2/21).

California Watch: Major Medi-Cal Changes Raise Questions
Sweeping changes for the state's medical program for the needy are taking shape, even as legislative advisers and advocates raise major questions. Changes include more seniors being routed to managed care programs, a reinvention of how hospitals are paid and the collapse of two state agencies that currently serve beneficiaries (Jewett, 2/22).

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States Wage Internal Battles To Fund Mental Health Systems, Overhauls

States are grappling with funding mental health programs: Iowa lawmakers are fighting over how to pay for an overhaul of the system, Kansas' mental health workforce is dwindling, and Illinois cuts endanger emergency care for the mentally ill.

The Associated Press/Des Moines Register: Mental Health Funding: Dems Say Counties Must Pick Up Some Costs; Republicans Disagree
Despite weeks of quiet bargaining, legislators acknowledged Tuesday that deep divisions remain about paying for an overhaul of Iowa's mental health system. Lawmakers of both parties support dramatically changing the system, now financed by local property taxes and augmented by federal Medicaid funding. Although legislators want to use state money to replace at least some of the local property taxes, they haven't been able to agree to specific figures (2/22).

Des Moines Register: Senate Democrats: No Way We're Backing Down On Iowa Mental Health Finances
One of the biggest differences in a major reform of Iowa's mental health system between the House and the Senate would be how the ultimate changes are paid, which was highlighted today in a Senate Human Resources subcommittee meeting. Parts of Iowa's mental health system have been broken for years, both Democrats and Republicans agree. Long waiting lists in some counties and inconsistent services are among the chief complaints (Clayworth, 2/21).

Kansas Health Institute News: Fewer Workers Caring For More Patients At State Hospitals
State hospitals for the mentally ill and the developmentally disabled have not replaced many employees who've quit or accepted Gov. Sam Brownback's invitation to take early retirement. ... The governor’s budget proposal for the coming fiscal year would allow for 2,298 full-time positions at the five state hospitals, or 311 fewer slots than there were in fiscal 2011 and about 100 fewer than the current fiscal year (Ranney, 2/21).

Bloomberg: Illinois Mental-Health Cuts Endanger Patients' Access to Emergency Care
The cutting of mental-health facilities and Medicaid payments in budget-challenged Illinois threatens to swamp emergency rooms with low-income psychiatric patients and limit doctors' ability to treat others. Chicago's Public Health Department will shutter half its 12 psychiatric clinics by the end of April, and the state will close as many as two hospitals in the coming budget year. The measures are in addition to state trims in Medicaid that Governor Pat Quinn, a Democrat, is expected to announce today in his fiscal 2013 budget address (Kazel, 2/22).

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Ariz. Advocates Ask For Better Pay For Disabled Caregivers

Arizona patient advocates are asking lawmakers to pay providers more who tend to the severely disabled. In the meantime, in Virginia, the older disabled find a new home.

Arizona Republic: Budget Committees Sign Off On GOP Proposal
Advocates for the state's developmentally disabled asked both House and Senate members to add 5 percent to the rate paid to health care providers who tend to the severely disabled. Their rates were cut several years ago as the state entered its budget crisis, and the low rates have made it increasingly difficult to attract workers, said Monica Attridge of the Arizona Association of Providers for People With Disabilities (Pitzl, 2/21).

The Washington Post: Older Arlingtonians With Disabilities Find A Home
Twenty-five people with intellectual disabilities or mental illnesses are now living in the 52-unit center in the Fort Myer area of Arlington County. All are 55 or older, and that makes this new center unique in the nation (Sullivan, 2/21).

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State Lawmakers Take Up Contraception Coverage, Abortion Fights

States are taking up the fight over the Obama administration's contraception coverage mandate with several state legislatures proposing bills of their own to block the mandate. In the meantime, Virginia mulls a bill that would require women to get a sonogram before an abortion, and a federal judge is set to rule on requiring pharmacists there to carry emergency contraception.

Politico Pro: Contraception Coverage Fights Spread To States
The contraception fight is expanding far beyond Washington, with several states eyeing ways of blocking the new Obama administration rule requiring most insurers cover contraception, or considering rolling back rules that the states themselves already had on the books. The combination of a hot-button social issue and the calendar for state implementation of the health care reform law's fine print virtually guarantees the fight will continue for months. Even if the debate subsides in Washington, voters may hear about it in their states for some time to come (Feder and Millman, 2/21).

MSNBC: Ave Maria Files Suit Over Health Care Mandate
Ave Maria University is suing the federal government over the health care mandate that requires employers' health insurance to cover contraception drugs. University President Jim Towey says he wants the federal government to leave them alone. The university made that point clear by becoming the first religious institution in Florida to file suit against the federal government on this issue. And he admits that it's going to be quite the legal battle (2/21).

The Atlanta Journal-Constitution: Abortion Bill Gaining Momentum, Has Support Of Georgia Speaker

Legislation is moving quickly through the House that would leave women with less time to have an abortion without restrictions, and it appears destined for a floor debate with the support of House Speaker David Ralston. House Bill 954 would cut the time a woman could have an unimpeded abortion to 20 weeks from about 26 weeks. … That Ralston, R-Blue Ridge, will push this abortion bill among those that are routinely filed in the General Assembly is noteworthy. He helped rein in abortion bills in previous years that he believed were designed to put the state in jeopardy as a legal test case or to raise the profiles of activists (Quinn, 2/21).

Milwaukee Journal Sentinel: State Senate's Bill To Limit Abortion Drugs Blocked 
Women could not receive drugs that induce abortions unless a doctor gives them a physical exam and is in the same room when they receive the drugs, under a bill that received preliminary approval by the state Senate on Tuesday. But Democrats used a procedural move to block a final vote on the measure. An aide to Senate Majority Leader Scott Fitzgerald (R-Juneau) said the bill is expected to be taken up again Wednesday (Bergquist and Stein, 2/21).

Associated Press/(St. Paul) Pioneer Press: Madision: Bill Affecting Abortion Providers Is Delayed
A contentious bill to add rules for physicians treating patients who are seeking an abortion was blocked Tuesday — at least temporarily — by a Democratic member of the Wisconsin Senate. The proposed bill would add specific rules for physicians that supporters say would ensure a pregnant woman isn't intimidated by a partner or family member into having an abortion. It also would ban physicians from using a webcam to consult with patients before prescribing abortion-inducing drugs (Rodriguez, 2/21).

Meanwhile, a bill in Virginia that would require a woman get a sonogram before an abortion is pending — 

The Washington Post: Virginia Governor No Longer Fully Supports Ultrasounds Before Abortions
Gov. Robert F. McDonnell is backing off his unconditional support for a bill requiring women to have an ultrasound before an abortion, focusing new attention on one of the most controversial pieces of legislation in Virginia's General Assembly this year. Until this weekend, McDonnell (R) and his aides had said the governor would sign the measure if it made it to his desk. McDonnell, who strongly opposes abortion, will no longer make that commitment (Kumar, 2/21).

CBS (Video): Is A Required Ultrasound A Barrier To Abortion?
Abortion is being debated once again on the campaign trail and in state capitals. Lawmakers in Virginia could vote as early as Wednesday on a law that would require women to have an ultrasound before getting an abortion. A similar law is already on the books in Texas. … Republican State Senator Dan Patrick insists this law was designed to address what he says was a lack of adequate health care for women seeking abortions. … One of the requirements of the law is that only doctors or certified sonographers perform the sonogram. It's a requirement unique to women wanting abortions: CBS News found there are no similar requirements for any other sonogram procedures in Texas (Werner, 2/21).

And a ruling is expected in Washington state Wednesday on requiring pharmacists to carry contraception —

Reuters: Debate Over Conscience In The Workplace Intensifies
Can a state require a pharmacy to stock and dispense emergency contraception — even when the owner considers the drug immoral? That's the question at the heart of a long-running legal battle in Washington state, expected to be decided Wednesday with a ruling from U.S. District Court in Seattle. It's the latest twist in a contentious national debate over the role of conscience in the workplace (Simon, 2/21).

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State Roundup: Ore. Family Planning Bills Challenged, Texas Managed Care

A selection of health policy stories from California, Pennsylvania, Texas, Delaware, Oregon and Florida.

The Philadelphia Inquirer: Philly Takes $42M Hit In New Budget
Gov. Corbett's new budget proposal would cost the city $42 million in mostly mental health and addiction treatment funding, but city officials say the impact will be worsened by ensuing needs for emergency shelter, child welfare, and other services. … The city Health Department faces an additional $7 million in state cuts. That would reduce the number of beds in the city nursing home and cost hospice beds for AIDS victims, officials said (Warner, 2/22).

Los Angeles Times: Health Plans Get Mixed Reviews In Annual California Report Card
California's annual report card on many of the state's HMOs and other health insurance plans gave most of those rated high marks for customer satisfaction but said they need to improve treatment for lung disease, attention-deficit disorder and throat infections in children. ... [The report] rated California's nine largest health maintenance organizations, six largest preferred provider organizations and 212 medical groups representing 16 million consumers with private health plans (Terhune, 2/22).

San Jose Mercury News: State Rates Health Plans On Quality Measures
California's largest health plans have improved their care for diabetic patients, but many need to do better at treating children with throat infections, testing for lung disease and helping people overcome drug and alcohol addictions (Kleffman, 2/22).

The Texas Tribune: Opinions Mixed as Managed Care Comes To [Rio Grande] Valley
Advocates of managed health care say the program has proven to be cost-effective in parts of the state where it has been implemented. But others say ...  unique conditions made the Valley unsuitable for managed care, citing the region’s high rate of chronic, expensive-to-treat illnesses such as diabetes, and also said managed care would put economic pressure on the Valley’s already scarce physicians (Heinrich, 2/21). 

NPR Shots Blog: The Big Squeeze: Calif. Weight Loss Clinics Under Investigation
A group of weight-loss clinics in Southern California is under fire for an aggressive advertising campaign and the death of five patients. The 1-800-GET-THIN marketing campaign and its affiliated surgical centers are being investigated by local, state and federal agencies ... And according to a spokesman at the California Department of Insurance, the agency has initiated an investigation into allegations of insurance fraud (Kahn, 2/21).

The Lund Report (Oregon): State Overbilled The Feds for Family Planning
A federal audit recently found the Oregon Health Authority improperly claimed $1.7 million in federal reimbursement for a program that offers family planning services to low-income Oregonians. A routine audit by [HHS] found the state had not properly verified the income or social security numbers of enrollees to an expanded Medicaid program known as Oregon Contraceptive Care (Rosenfeld, 2/22). 

The Lund Report: Oregon House and Senate Unanimously Agree on New Changes to HIV Testing
Both the House and Senate have unanimously passed a bill that will make HIV testing a part of routine blood work and other lab tests performed by a physician or hospital. That change is expected to reduce the social stigma associated with HIV, transmission of the disease, as well as increase the number of people who are tested (Waldroupe, 2/22). 

Modern Healthcare: Delaware's Acute-Care Hospitals All Join HIE
All Delaware acute-care hospitals and skilled-nursing facilities have enrolled in the state's health information exchange, according to the Delaware Health Information Network. ...
To date, the Delaware exchange has received $4.7 million through the federal program that aims to spur the development of such state systems, according to HHS (Daly, 2/21).

Health News Florida: Consumers May Retain Medical-Board Seats
The state’s association for physician assistants has agreed to drop its request for one of the consumer slots on each medical board, the group’s chief lobbyist said today. Consumers currently hold three of 15 seats on the Florida Board of Medicine and just two of seven on the Board of Osteopathic Medicine (Gentry, 2/21).

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Editorials and Opinions

Viewpoints: Real 'Doc Fix,' Saint Santorum And Why Supreme Court TV Is 'A Bad Idea'

The New York Times: A Real 'Doc Fix'
In last week's flurry of budget deals, Congress patched together yet another temporary fix for a flawed formula used to calculate the fees paid to doctors by Medicare. It will hold payments flat for the next 10 months instead of cutting them by 27 percent as the formula required, and the $18 billion to pay for it will be taken from other health care programs. But the fix only lasts until the end of the year. On Jan. 1, doctors will face another big cut unless Congress again steps in (2/21).

The New York Times: Contraception, Against Conscience
EWTN cannot comply with the recent mandate from the Department of Health and Human Services requiring the insurance plans of all employers, with the exception of some houses of worship, to cover the contraceptives and sterilization procedures approved by the Food and Drug Administration. These include emergency contraceptives like Plan B and Ella that can destroy human embryos — an act that we consider a violation of church teaching that all life is a sacred gift that begins at conception (Michael P. Warsaw, 2/21). 

McClatchy: Obama Boosted By GOP Birth-Control Stance
I've been puzzled for weeks by all the talk about how Obama has supposedly blown it with Catholic voters after requiring that many Catholic institutions offer free birth control in their employee insurance plans. Church leaders are naturally upset, but they don't speak for most Catholics on the issue of contraception. And Republicans, eager to gin up anything against Obama now that the economy is improving, are naturally cranking up the hyperbole about a supposed "war on religion," but they too seem blind to how most Catholic women conduct their private lives (Dick Polman, 2/21).

The Washington Post: The Trials Of Saint Santorum
You've likely heard by now that the presidential election may pivot on the unlikely "controversy" of birth control. This is the latest trope to evolve from a campaign that is already two years too long. A conspiracy-minded person might imagine that this faux battle over reproductive rights was designed to distract from other more pressing concerns and to demonize — or would that be angelize? — Republicans who, we’re also told, want to turn back the clock to the 1950s (Kathleen Parker, 2/21).

WBUR's CommonHealth blog: Religious Exemption For Contraception Is Bad Medicine
The message from Washington politicians that contraception access has nothing to do with medicine is news to the 99 percent of women in the U.S. who are or have been sexually active. ... It is news to the women who use contraceptives to manage menstrual complications, avoid unintended pregnancy, and ensure the social and economic stability of their families. ... It is bad news for the 1.5 million women nationwide who use contraceptives only as treatment for serious medical conditions (Dr. Paula A. Johnson, 2/21).

Los Angeles Times: Health Care Reform's Missing Link – Nurse Practitioners
Within the next two years, if federal health care reforms proceed as expected, roughly 30 million of the estimated 50 million uninsured people in the United States — 6.9 million in California — will be trying to find new health care providers (Patricia Dennehy, 2/22).

USA Today: Televise Supreme Court's Health Care Case? Bad Idea
Not since Bush v. Gore has a U.S. Supreme Court case roused as much public interest as next month's highly anticipated review of the 2010 health care law. It would make a spectacular TV show and lift the curtain on the workings of the nation's highest court. But cameras in the high court are a bad idea (Peter Funt, 2/21).

Des Moines Register: Rhode Island Health Plan Reform Good Model For Iowa
Health insurance is expensive because medical care is expensive. Medical care is expensive because the prices we pay are too high and the numbers of services are too numerous. We will never fully recover if higher insurance premiums and fewer benefits remain the new normal. And, more affordable rates will not occur until we change the way our medical care is organized and delivered. This is the reason Democrats are introducing a proposed Iowa Health Insurance Affordability Reform (Iowa HIAR) program. It is modeled after Rhode Island’s successful reform, which is considered one of the most innovative methods developed to tackle the high costs of health care insurance (Iowa state Sen. Jack Hatch, 2/21).

Des Moines Register: Bill Would Redesign Iowa's Mental Health And Disability Services
After months of public discussion and interim committee meetings, the House Human Resources Committee has begun work on three pieces of the legislation that will redesign Iowa’s mental health and disability services system. ... The group put together a series of recommendations ranging from ongoing mental health and disability services training for law enforcement officers, the ability of residential care facilities to determine whether to accept people referred to them by the court, and clearing up conflicts within the law on which mental health professionals may be involved in the commitment process (Iowa state Rep. Scott Raecker, 2/21).

Chicago Sun-Times: Hospitals' Impact
So when government at the state and national levels begin talking about Medicaid cuts and property taxes on hospitals, not only health-care officials are taking notice, but so should Illinois residents and taxpayers. Such actions would harm one of the few sectors that has been creating jobs and could damage the state’s health-care system as well (2/21).

Minneapolis Star Tribune: Overpaying On Health?  Let's Really Find Out
A truly independent third-party audit is important to gain the information we need to better oversee this large expenditure of $3.8 billion. I now encourage the Republicans to work in bipartisan fashion with those of us who have been pushing for more transparency for a long time. Republicans and Democrats may disagree about how best to reform our health care system, but neither side can promote effective change without this accurate information (Carolyn Laine, 2/21).

Detroit Free Press: A Cruel, Costly Restriction On Certain Mental Health Drugs
But the new budget also includes some misfires — and none more off-target than a shortsighted plan to restrict mental health drugs to Medicaid patients. Legislators ought to remove this proposal from the budget. Efforts to undo Public Act 248 of 2004, which has protected access to brand-only medication for some of the state's poorest patients, are especially troubling coming from a governor who has supported improving Michigan's anemic mental health care system (2/22).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.