Daily Health Policy Report

Friday, February 22, 2013

Last updated: Fri, Feb 22

KHN Original Reporting & Guest Opinion

Health Reform

Health Spending And Fiscal Battles



Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Activist Ignites A Movement For Patients Through Art And Story

Reporting for Kaiser Health News, Sarah Barr reports: "Regina Holliday bounds across the stage at the old Sam's Town casino, jumps onto a grey cinder block and flings her arms open wide in welcome. Holliday, an artist and patient advocate from Washington, balances there for just a moment, beaming before the small cadre of advocates, doctors and tech gurus who are as determined as she is to make patients equal participants in every area of health care" (Barr, 2/22). Read the story.

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D.C. Hospitals And Nurses Fight Over Staffing Ratios

Reporting for Kaiser Health News, David Schultz writes: "Hospital administrators in Washington, D.C., are furiously lobbying against a bill modeled on a California law that would require them to maintain a minimum nurse-to-patient ratio at all times" (Schultz, 2/22). Read the story.

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Political Cartoon: 'Not Feeling Perky?'

Kaiser Health News provides a fresh take on health policy developments with 'Not Feeling Perky?' by Ron Morgan.

Meanwhile, here is today's health policy haiku:


Governor Rick Scott
steps through the looking glass and
expands Medicaid.

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

Some Red States Wavering On Opposition To Medicaid Expansion

This week, Florida Gov. Rick Scott, one of the fiercest critics of this health law provision, reversed his position and said he would proceed with the expansion. But he's not the only one, and, according to Health and Human Services Secretary Kathleen Sebelius, it's because the idea is just "too good to pass up."

The New York Times: Governors Fall Away In GOP Opposition To More Medicaid
Under pressure from the health care industry and consumer advocates, seven Republican governors are cautiously moving to expand Medicaid, giving an unexpected boost to President Obama's plan to insure some 30 million more Americans (Goodnough and Pear, 2/21).

NBC News: Red State Medicaid Expansion No Shock, Policy Experts Say
Florida governor Rick Scott created a stir this week when he said he'd expand Medicaid as requested by the Obama administration -- even though he plans to defy the health reform law as much as he can. But health policy experts are hardly surprised. They say it's a no-brainer for even the reddest states to take the federal government up on its offer to pay for the expansion for the first few years. That doesn't mean all Republican governors will do it, however. A lot, they say, depends on what concessions these governors can get out of the Health and Human Services Department in return. "It's a lot of money when the feds pick up the tab for the first three years,” said Sarah Hale, who directs health policy at the right-leaning American Action Forum (Fox, 2/21).

The Associated Press/Washington Post: HHS Secretary Sebelius Says States Are Finding Medicaid Expansion Too Good To Pass Up
A day after Florida's Republican governor endorsed a key part of the federal health care overhaul, the Obama administration says it's encouraged by the progress. Health and Human Services Secretary Kathleen Sebelius says that states are deciding the Medicaid expansion is, quote, "simply too good to pass up" (2/21).

National Journal: Florida Governor's Embrace Of Medicaid Money Undercuts GOP Attacks On 'Obamacare'
Bashing "Obamacare" just isn't what it used to be. Just over two years ago, the rallying cry against President Obama's health care overhaul unified Republicans and hoisted the party to historic electoral gains in state capitals and in Washington (Reinhard and Sanger-Katz, 2/21).

Los Angeles Times: Brown May Forge Alliance With GOP Governors On Health Plan
When Gov. Jerry Brown meets with the nation's other governors this weekend in Washington, D.C., he will find common ground with some unlikely counterparts on an unlikely issue: President Obama's healthcare plan. Among the governors now moving nearly as aggressively as Brown to implement the federal healthcare law are conservatives who have long fought to unravel it. They are finding that they cannot afford to pass up Obama's offer of billions of dollars in federal aid to cover expansion of their Medicaid programs for the poor (York, 2/21).

PBS Newshour: Republican Governors Rethink Opposition To Medicaid Expansion (Video)
At first, many Republican governors actively opposed expanding the Medicaid program and said they would not participate. Now, some of them, including Florida Gov. Rick Scott, have reconsidered. Judy Woodruff talks to Paul Howard of the Center for Medical Progress at the Manhattan Institute and Ron Pollack of Families USA (2/21).

Marketplace: The Medicaid Question: To Expand Or Not Expand (Audio)
Florida’s Gov. Rick Scott is now urging his state to expand Medicaid under President Obama's health care overhaul, a significant policy shift after it was Scott who helped lead the charge against the new health care law. But the question states like Florida aren't facing isn't just a political one -- it's economic as well. Think about it: Washington picks up the tab on expanding Medicaid for the first three years, what’s not to love about that? Starting next year, individuals and families who earn up to 133 percent of the federal poverty level -- about $25,000 for a family of three -- will become eligible for Medicaid. And the government will pick up 100 percent of the tab (Gorenstein, 2/21).

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Expansion Debate, Decisions Play Out In Va., Ga., Texas

As state legislators and governors wrestle with budget issues and health law implementation decisions, the role of the Medicaid expansion is shaping up in different ways in different locations.

The Washington Post: Va. Assembly Showdown Over Medicaid Expansion Threatened
One day after House and Senate negotiators struck a transportation funding deal, some Democrats were trying to link passage of that plan to the issue of Medicaid expansion. Some House Democrats vowed to vote against the transportation package if the General Assembly does not lay the groundwork this year for expanding Medicaid. They are also threatening to vote against state budget amendments if they do not include a framework for expansion (Vozzella and Kunkle, 2/21).

Richmond Times-Dispatch: Showdown Looms Over Transportation, Medicaid
The two most important issues before the General Assembly — new funding for transportation needs and expansion of Medicaid — could converge today in a tense political showdown prompted by a letter from Gov. Bob McDonnell that may undermine his biggest legislative priority. The letter, vowing not to consider expansion of Medicaid in Virginia if it would increase “the immoral national debt,” prompted Senate Democrats to threaten on Thursday to withhold support for the transportation package endorsed by McDonnell and Republican legislative leaders, while House Democrats vowed not to support the proposed budget without the Medicaid expansion (Nolan and Martz, 2/22).

Atlanta Journal-Constitution: Georgia Gov. Deal Unswayed By Florida's Switch On Medicaid
Florida's Rick Scott this week became the seventh Republican governor to embrace a key element of the federal health overhaul by enrolling more poor people in Medicaid. Don’t expect Gov. Nathan Deal to make it eight any time soon. Deal, also a Republican, has remained outspoken in his refusal to expand Medicaid coverage to at least 650,000 more Georgians, citing the budget woes already facing the government health program. He said the state's share of the cost of expanding Medicaid - a projected $4.5 billion over a decade - would be too great. "My position hasn't changed," Deal said Thursday. "Our financial situation hasn't changed either. It is on that basis that I made my judgment call." Still, he said, he’s interested in talking with Scott and other GOP governors about why they made their decisions (Bluestein, 2/22).

The Texas Tribune/New York Times: At A Loss On Refusing Medicaid Cash
State officials, starting with Gov. Rick Perry, want the state to stay away from any expansion outlined in the federal Affordable Care Act. They object to creating an entitlement program where none currently exists, because they say they fear it will grow into a money-gobbling monument to big government — socialism, even. Besides, they say, Texas doesn’t have enough doctors and other medical professionals to provide care for the newly insured (Ramsey, 2/21).

The Texas Tribune: After Florida Medicaid Reversal, Hints Of Compromise In Texas
Florida Gov. Rick Scott announced on Wednesday that he would accept an expansion of Medicaid under the Affordable Care Act. The decision leaves Texas as the last big-state holdout. In a statement on Wednesday, Gov. Rick Perry reiterated his stance on the expansion, saying it would be "to add more Texans and dump more taxpayer dollars into an unsustainable system." State Sen. Jane Nelson, R-Flower Mound, has a slightly softer stance. “I’m opposed to any expansion of Medicaid that doesn’t give Texas the flexibility that we want” (Philpott, 2/22).

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

The Hill: HHS: Most States On Track With Health Law's Technical Demands
Thirty-five states will be ready with new healthcare eligibility and enrollment systems by Jan. 1 of next year, according to a new federal report. The Health and Human Services (HHS) Inspector General surveyed states in March and April 2012 about their readiness to comply with a variety of technical requirements under President Obama's healthcare law (Viebeck, 2/21).

California Healthline: Historic Week In Health Reform
California has been working on health care reform for years, but this week's legislative special session had that distinctive sound of a starting gun for the last, big dash toward the Affordable Care Act finish line. … This week's work included committee passage of a streamlined eligibility and enrollment process, which is likely to sail through the Legislature. The other big piece of legislation created more controversy. The adoption of a plan to establish geographic rating areas for the individual and small group health insurance market was accompanied by media reports of premium rate increases of 20 percent or higher. Insurance Commissioner Dave Jones proposed a different type of geographic breakdown that he said would cut down on those rate increases (Gorn, 2/22).

The Associated Press: Idaho Gov. Otter's Insurance Exchange Plan Gets Backing From State Senate
Idaho senators voted Thursday to back the governor's plan to create a state-based nonprofit insurance exchange, rather than defaulting to an exchange run by the federal government, as many other Republican-led states have done. The 23-12 vote after six hours of debate marked a key milestone for Gov. C.L. "Butch" Otter's bill. The GOP governor contends the proposal will result in a marketplace for individuals and small businesses to compare and buy insurance that's less expensive and friendlier to Idaho insurers and agents than what Washington, D.C., would come up with (2/21).

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Health Spending And Fiscal Battles

Sequester: Who's To Blame? Who Will Feel The Pain?

News outlets analyze the political pressure and partisan in-fighting that is taking shape as the sequester countdown continues. Meanwhile, McClatchy and The New York Times attempt to answer questions about the impact of the scheduled cuts.

The Wall Street Journal: The GOP Splits Over Pressure To Slash Defense Budget
The president, meanwhile, has the easier task of traveling the country and claiming congressional Republicans are the sole impediment to his call for offsetting the cuts by closing tax loopholes. And Democratic leaders in Congress face no contingent of members agitating for the budget cuts to go through, as GOP leaders do. Most Republicans in the House would rather see the cuts kick in than agree to additional tax revenue, which Mr. Obama has said must be included in any plan to replace the budget cuts. Party leaders have counseled their rank-and-file to blame the president for coming up with the idea of the sequestration, while they highlight House-passed alternatives to find savings in Medicare and other programs (O'Connor, 2/21).

McClatchy: Not Everyone Will Feel Impact Of Federal Budget Cuts
Don't be too frightened by the doomsday talk about the automatic spending cuts that look more and more likely to kick in next week. There would be pain, to be sure, with some federal workers taking unpaid furloughs, some programs cut and as many as 700,000 jobs nationwide left uncreated. But programs that touch millions who rely on government checks most, including Social Security recipients and the poor, will not be affected. … Big chunks of the budget are exempt, notably Social Security, Medicaid, veterans benefits, the Children's Health Insurance Program, Pell grants for students, and a host of programs that help the poor. Medicare spending is not subject to the entire reduction (Lightman, 2/21).

The New York Times: Answers To Questions On Capital's Top Topic
Unless Congress intervenes, the law requires the Obama administration to impose $85 billion in across-the-board spending cuts to military and domestic programs on March 1. Those cuts would be the start of $1 trillion in cuts over the next decade. … Here is a primer on what the sequester is and how we got here (Weisman, 2/21).

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HHS Funds Projects In 25 States To Try To Lower Medicaid Costs, Improve Care

The first wave of grants, totaling $300 million, were announced Thursday and included Arkansas, Maine, Massachusetts, Minnesota, Oregon and Vermont.

Reuters: U.S. Funds 25 States To Test New Medicaid Models
The Department of Health and Human Services said on Thursday that it would provide 25 of the 50 states with funding to test new ways to lower costs and improve care within the national Medicaid program for the poor. The first states to receive State Innovation Model awards are Arkansas, Maine, Massachusetts, Minnesota, Oregon and Vermont, which will implement plans to transform their health care delivery system under President Barack Obama's health care reform law, which sets aside $300 million for the overall venture (2/21).

Modern Healthcare: $300M To Boost Medicaid, CHIP Innovation
Six states were awarded nearly $300 million by HHS to implement payment and delivery changes to their Medicaid and Children's Health Insurance Program plans. The State Innovation Model awards, which were authorized by the Patient Protection and Affordable Care Act, will fund Medicaid pilot programs in Arkansas, Maine, Massachusetts, Minnesota, Oregon and Vermont that aim to improve care quality and lower costs. "As a former governor, I understand the real sense of urgency that states feel to improve the health of their populations while also reducing total health care costs, and it's critical that the many elements of health care in each state -- including Medicaid, public health, and workforce training -- work together," HHS Secretary Kathleen Sebelius said in a news release. The CMS will track the efficacy of those pilot programs for possible wider implementation nationwide (Daly, 2/21).

Bloomberg: States Receive $300 Million From U.S. To Trim Health Costs
Arkansas, Maine and Oregon are among 25 states that will split as much as $300 million from the federal government to test new ways to pay for medical care in an experiment funded by the 2010 health care law. The three states, plus Massachusetts, Minnesota, and Vermont will get most of the money, or about $250 million, the U.S. Department of Health and Human Services said today in a statement (2/21).

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After January Renomination, A Hearing For Tavenner Appears Likely

The Washington Post inteviewed the Obama administration's pick to head the Centers for Medicare & Medicaid Services.

The Washington Post: Exclusive: An Interview With Marilyn Tavenner, Obama's Pick To Head Medicare
For over a year now, Marilyn Tavenner has run the federal government's largest agency: the Centers for Medicare and Medicaid Services. With a budget of nearly $1 trillion, Tavenner oversees everything from the implementation of the Affordable Care Act to programs that already administer health benefits to more than 80 million Americans (Kliff, 2/21).

Meanwhile, the American College of Physicians identifies challenges ahead and additional reforms that need to be made in order to build upon the federal health law --

Medpage Today: ACP Wants More Reforms
Congress and the U.S. healthcare system need to build upon reforms in the Affordable Care Act (ACA) and enact changes to improve the work of physicians, according to a prominent internal medicine organization. Aside from echoing the oft-repeated calls to repeal the sustainable growth rate formula for physician payment under Medicare and to enact medical liability reforms, the American College of Physicians (ACP) also called Wednesday for harmonizing quality reporting measures across the variety of programs now being used to track physician performance (Pittman, 2/21).

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Public Health & Education

Compounding Pharmacy Trade Group Changes Position On FDA Oversight

The Washington Post: Pharmacy Trade Group Shifts Position On Federal Oversight
The head of the nation's largest trade group for the specialty pharmacies known as compounders said he will support legislation requiring pharmacies that operate like drug manufacturers to register with the Food and Drug Administration and be subject to stricter standards enforced by the agency (Kindy and Sun, 2/21).

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State Watch

Texas, S.C. Lawmakers Weigh Added Spending For Medicaid

The Texas House approved supplemental funding while a S.C. legislative committee passed a bill with $75 million in new spending for that state's Medicaid program.

The Associated Press: House Approves $4B Bill To Close Medicaid Deficit
The Texas House approved a supplemental spending bill Thursday to close a $4 billion budget deficit for Medicaid. The move was an important step toward balancing the current budget after lawmakers in 2011 failed to set aside enough money to pay for the program, which provides health care for the poor and disabled. The state will run out of money for Medicaid in March, and the measure now goes to the Senate for consideration (Tomlinson, 2/21).

The Associated Press: House Ways and Means Advances Spending Bill
The (S.C.) House budget-writing committee has advanced a spending plan that includes $75 million for Medicaid initiatives designed to improve residents' health. House Republicans have repeatedly refused Democrats' efforts to expand Medicaid eligibility under the federal health care reform act. The budget proposal that advanced Thursday to the House floor contains what Ways and Means Chairman Brian White calls an overhaul of the program (Adcox, 2/21).

Meanwhile, efforts to cut back spending in Illinois are running into trouble --

The Associated Press: Ill. Medicaid Cuts Fall Short Of Projected Savings
Savings from cuts to the Illinois Medicaid program have fallen short by $464 million, about 30 percent of the expected $1.6 billion in projected savings that Gov. Pat Quinn pushed for last year. In the first public report on how cuts to the health care safety-net program are being carried out, Illinois Department of Healthcare and Family Services Director Julie Hamos detailed the actual savings of cost-cutting measures so far. Hamos reported to the House Human Services Appropriation Committee on Thursday in Springfield (Johnson, 2/21).

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D.C., Minn. Lawmakers Consider Mandating Hospital Nurse-Patient Ratios

The measures would force hospitals to maintain lower nurse-to-patient ratios to try to reduce workload on nurses and to provide better care. Hospitals say the moves would be too expensive.

Kaiser Health News: D.C. Hospitals And Nurses Fight Over Staffing Ratios
Hospital administrators in Washington, D.C., are furiously lobbying against a bill modeled on a California law that would require them to maintain a minimum nurse-to-patient ratio at all times" (Schultz, 2/22).

Pioneer Press: Nurse Staffing Standards Pass Partisan Test In Minnesota House
The push to mandate nurse staffing levels in Minnesota hospitals appears to be developing into a partisan battle at the Capitol. DFLers and Republicans lined up on opposite sides of a bill to enforce staffing standards as the legislation cleared its first committee hurdle by a 9-6 vote Thursday, Feb. 21. The bill does not specify particular nurse-to-patient ratios. It instead would direct medical centers to implement staffing standards set by professional societies or a group appointed by the state health commissioner (Snowbeck, 2/21).

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Mich. Panel Strips Abortion From Blue Cross Bill; Ark. House Takes Action

State legislatures wrestle with measures that deal with abortion.

The Associated Press: Michigan House Panel Oks Blue Cross Changes Without Abortion Provision
A House panel on Thursday overwhelmingly approved legislation to overhaul Blue Cross Blue Shield of Michigan, leaving out anti-abortion provisions that torpedoed an earlier effort to change the status of the state’s largest health insurer. The 11-0 votes signaled — at least for now — that one of Republican Gov. Rick Snyder’s top legislative priorities could reach his desk without language that led him to veto similar legislation in late December. The Senate OK’d the new Blue Cross bills in late January (Eggert, 2/22).

Reuters: Arkansas House Approves Bill Banning Abortions At 20 Weeks
The Republican-controlled Arkansas House of Representatives approved a bill on Thursday to ban abortions at 20 weeks into a pregnancy and a separate measure that, if it becomes law, would be the stiffest abortion restriction in the country. Lawmakers voted 80-10 to pass the 20-week legislation that would only allow exceptions in the case of rape, incest or to save the mother's life (Parker, 2/21).

In related news -

NPR: Morning-After Pills Don't Cause Abortion, Studies Say
The constant references to Plan B and ella as abortion-causing pills frustrates Susan Wood, a professor of health policy at George Washington University and a former assistant commissioner for women's health at the FDA. ... For years, scientists knew the pills, particularly Plan B, were highly effective in preventing pregnancy after unprotected sex but weren't exactly sure how they managed that. "It wasn't really clear whether it worked before ovulation or after ovulation," says Wood. Scientists did know the drug worked primarily by preventing ovulation. It stops an egg from being released from a woman's ovary and thus prevents any chance of fertilization and pregnancy. But they also thought the drug might make it more difficult for a fertilized egg to implant in a woman's uterus. Technically, that's not an abortion, says Wood (Rovner, 2/21).

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State Roundup: Long-Term Care Rate Hike Planned In Calif.

A selection of state health policy stories from California, Oregon, Vermont, New York and North Carolina.

Los Angeles Times: CalPERS Plans 85% Rate Hike For Long-Term-Care Insurance
Dailey Mayo received some stunning news in the mail last week: an 85% rate increase for the long-term-care insurance he has had for 15 years from the California Public Employees' Retirement System. ... More than 110,000 CalPERS policyholders are receiving similar news after the pension fund's board approved the changes late last year. CalPERS said the hefty rate hikes won't take effect until 2015 and are necessary to keep this $3.6-billion insurance fund intact for future claims. This CalPERS program, like other plans sold by private insurers, has been plagued by higher-than-expected claims, lower investment returns and poor pricing (Terhune, 2/21).

The Associated Press: Gov. Kitzhaber Will Pitch Oregon Health Overhaul To Other Governors In DC Meeting
Oregon Gov. John Kitzhaber will brief other state leaders this weekend on his plan to lower Medicaid costs, touting an overhaul that President Barack Obama highlighted in his State of the Union address for its potential to lower the deficit even as health care expenses climb. The Oregon Democrat leaves for Washington, D.C., on Friday to pitch his plan that changes the way doctors and hospitals are paid and improves health care coordination for low income residents so that treatable medical problems don't grow in severity or expense (2/22).

The Associated Press: Critics: Shumlin Aides Buried Health Care Tax Plan
Consultants working on [Vermont] Gov. Peter Shumlin's push for a universal health care system were paid tens of thousands of dollars for work that never appeared in their recommendations, a group critical of the plan said Thursday, accusing the governor of hiding yet again how much universal health care would cost. The University of Massachusetts Medical School consultants were nearly ready to recommend tax increases to pay for universal health care last fall when they were steered away from completing the work, said Jeff Wennberg, executive director of Vermonters for Health Care Freedom (Gram, 2/21).

The New York Times: Court Temporarily Halts Plan To Close Brooklyn Hospital
A state judge has temporarily halted plans to close the financially ailing Long Island College Hospital, giving a victory to hospital workers who say that its closing would be devastating to community health care (Hartocollis, 2/21).

Los Angeles Times: City Of Hope Picks A Longtime Executive To Be Next CEO
City of Hope, a leading cancer hospital and medical research center, has tapped one of its veteran leaders to take over as chief executive in January. Dr. Michael Friedman, 69, said he plans to retire as CEO at year's end after 10 years at the helm. Robert Stone, 44, currently City of Hope's president and an executive there since 1996, will take the top job in January (Terhune, 2/21).

North Carolina Health News: Lawmakers Move Forward Fix For Group Homes, Alzheimer's Units
Residents in group homes and special care units for seniors with Alzheimer's can finally exhale after months of worrying about whether they could stay in their homes. In November, dozens gathered in front of the legislature to ask lawmakers to maintain funding for group homes for people with mental health disabilities. In a long-awaited fix to funding problems that have loomed over some of North Carolina's most vulnerable residents, legislators amended a bill to ensure funding for group homes (Hoban, 2/21).

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Editorials and Opinions

Viewpoints: Other GOP Governors Should Note What Scott Wrangled Out Of HHS; Curbs On Painkillers Need To Be Tougher

The Wall Street Journal: Political Diary: Rick Scott's Medicaid Gambit
Those governors who earlier embraced ObamaCare's Medicaid expansion—here's looking at you, Jan Brewer—might be feeling a little cheated. If only they had held out a bit longer, they might have been able to obtain something from the Obama administration in return, as Florida's Rick Scott purports to have done (Allysia Finley, 2/21).

Tampa Bay Times: Scott Takes Right Step With Medicaid Expansion
Gov. Rick Scott made the right decision by endorsing the expansion of Medicaid that would provide health care to more than 1 million uninsured Floridians, including perhaps 225,000 in Tampa Bay. Give the governor credit for looking beyond his opposition to the Affordable Care Act, negotiating with the Obama administration and making the best decision for this state. Now the Republican-led Legislature should be just as pragmatic, follow the governor's lead and approve the expansion (2/21).

The National Review: Twelve Reasons to Say No
While Florida governor Rick Scott has endorsed Medicaid expansion, Virginia governor Bob McDonnell has taken a different stance. Leading legislators, including Virginia house speaker Bill Howell, also have indicated they cannot support Medicaid expansion and are insisting on major reforms to the program, including giving states more control over spending and benefits. The final vote by the General Assembly is expected before adjournment this weekend, but Democrats are threatening to hold up transportation funding if Republicans don’t agree to expand Medicaid. Governors and legislators are waging similar battles in other states. (Avik Roy and Grace Marie Turner, 2/22). 

The New York Times: What Gov. Cuomo's Budget Needs
The latest budget package from Gov. Andrew Cuomo of New York, unveiled this week, has a distressing $500 million hole, caused by a change in the way the federal government will reimburse the state for the care of people with disabilities. Federal regulators have said that the state has been overbilling Medicaid for those services (2/21). 

The New York Times: Making Some Painkillers Harder To Get
Painkillers like Vicodin that contain hydrocodone are the most widely prescribed drugs in the United States — and the most widely abused because they are relatively easy to obtain. The Food and Drug Administration has an opportunity to help tighten restrictions on drugs whose use has spiraled out of control over the past two decades (2/21).

WBUR: Cognoscenti: Health, Happiness, And Time Well Spent
In a nutshell, people around the world place a special premium on 'time well spent.' Over and over, in our interviews and surveys, we found that individuals were especially pleased when they had an experience that was enjoyable and fulfilling, and conversely frustrated when they felt that they had not spent their time well. For example, they could have a delicious meal at a high quality restaurant. But they much preferred a meal of mediocre quality, if they could be surrounded by friends whose company they enjoyed (Howard Gardner, 2/22).

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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.