Daily Health Policy Report

Thursday, February 23, 2012

Last updated: Thu, Feb 23

KHN Original Reporting & Guest Opinion

Health Reform


Campaign 2012

Public Health & Education

Health Information Technology

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Analysis: Is A New Federal Patient Safety Effort Doing Enough To Curb Medical Errors?

In the following analysis for Kaiser Health News, Michael L. Millenson writes: "The Medicare program is betting on a new course of action to curb what one medical journal has dubbed an 'epidemic' of uncontrolled patient harm. The effort is pegged to the success of a little-known entity called a 'hospital engagement network'" (Millenson, 2/22). Read the story.

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Can Massachusetts Lead The Way On Controlling Health Costs?

WBUR's Martha Bebinger, working in partnership with Kaiser Health News and NPR, reports: "Employers in Massachusetts routinely complain about health insurance costs rising two, three or even eight times faster than inflation. But not so much lately. As of April 1, base insurance rates approved by the Democratic Gov. Deval Patrick's administration for small businesses will increase, on average, 1.8 percent. Interestingly, the state's economy grew at the same rate for the  last quarter of 2011" (Bebinger, 2/22). Read the story.

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Capsules: Council Publishes Plan For Alzheimer's Research, Care; More Exchange Money Headed To States

Now on Kaiser Health News' blog, Christian Torres reports on the release of the draft version of a national Alzheimer's plan: "Much of the plan was already known from the draft framework published in January. Experts put an emphasis on expanding and better coordinating disease research, especially through public-private partnerships. They also stressed better preparation for the health care workforce, improving public outreach and providing effected families with financial and other support" (Torres, 2/22).

Also on Capsules, Marilyn Werber Serafini writes about the latest on funding for state health exchanges: "New federal money is headed to ten states to help them establish insurance exchanges through which individuals and small businesses can buy insurance beginning in 2014. The Department of Health and Human Services is sending a total of $229 million in exchange establishment grants to ten states, the agency announced Wednesday. Half are receiving this kind of grant for the first time, and half are on the second round" (Werber Serafini, 2/22).Check out what else is on the blog.

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Testy Santorum, Romney Tussle Over Mass. Health Reform (Video Clips)

Kaiser Health News: In the last scheduled Republican debate, candidates Rick Santorum, Mitt Romney, Newt Gingrich and Ron Paul attacked the Obama administration on its birth control stance. Santorum dovetailed the issue into an attack of the 2006 Massachusetts health reform law, which Romney, as governor, endorsed (2/23). Watch video clips of these exchanges, or read a transcript of the health care portions of the debate.

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Political Cartoon: 'Someday?'

Kaiser Health News provides a fresh take on health policy developments with "Someday?" by Joel Pett.

Meanwhile, here's today's haiku, submitted by a reader in light of yesterday's Health and Human Services final rule on state innovation waivers:


Red states say it's like beauty
In beholder's eye

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 Award Health Exchange Grants To 10 States

The Department of Health and Human Services is sending $229 million in exchange establishment grants to 10 states -- half of which are receiving this funding for a second time around. However, an Associated Press analysis found that progress among states in setting up these health insurance marketplaces remains uneven.  

Kaiser Health News: Capsules: More Exchange Money Headed To States
New federal money is headed to ten states to help them establish insurance exchanges through which individuals and small businesses can buy insurance beginning in 2014. The Department of Health and Human Services is sending a total of $229 million in exchange establishment grants to ten states, the agency announced Wednesday. Half are receiving this kind of grant for the first time, and half are on the second round (Werber Serafini, 2/22).

The Associated Press: Feds Award Health Overhaul Grants To 10 States
Federal officials say another 10 states are getting a total of $230 million to set up new health insurance markets under President Barack Obama's overhaul. Seven of them — Colorado, Massachusetts, Minnesota, Nevada, New Jersey, New York, and Pennsylvania — have either adopted a plan or are making substantial headway. But a recent Associated Press analysis found uneven progress among states setting up the new insurance exchanges, a linchpin of the law (Alonzo-Saldivar, 2/22).

Modern Healthcare: States Get $229 Million For Insurance Exchanges
The total number of states receiving grants to establish state health insurance exchanges rose to 33 plus the District of Columbia with the issuance of $229 million in federal funds to 10 states Wednesday. According to officials, the exchange-building grants were the first such federal assistance provided to five of the recipient states: Arkansas, Colorado, Massachusetts, New Jersey and Pennsylvania (Daly, 2/22).

The Hill: Christie Among GOP Governors Taking Fed Funds For Health Law
Four states with Republican governors received federal grants Wednesday to help implement a key feature of President Obama’s healthcare law. The Health and Human Services Department (HHS) awarded nearly $230 million to 10 states to help them establish insurance exchanges — new marketplaces to compare and buy healthcare policies. Although most Republican governors have railed against the healthcare law, several have also taken steps to establish their own exchanges and avoid the prospect of the federal government taking over the task (Baker, 2/22).

Here's some local coverage of the health exchange grant awards -

Denver Post: Health Reform: Colorado Gets Another $17.9 Million To Start Health Insurance Exchange
The U.S. Department of Health and Human Services Wednesday awarded Colorado another $17.9 million to firmly establish the insurance exchange at the heart of national health reform. The second round of insurance exchange grants will allow the state board to hire more staff and contract with all-important tech and benefits vendors to shape the online guts of the plan (Booth, 2/22).

Boston Globe: State Insurance Exchange Awarded $11.6 Million To Adjust To Affordable Care Act
Massachusetts will receive $11.6 million from the Centers for Medicare & Medicaid Services to move the state’s online health insurance marketplace for individuals and small businesses toward compliance under the Affordable Care Act, the federal agency announced today... Massachusetts, which launched its exchange in 2006, has a leg up. But the Massachusetts Health Connector, which runs the program here, has work to do to adjust the state exchange to meet federal requirements, said Executive Director Glen Shor (Conaboy, 2/22).

Minneapolis Star Tribune: State Health Insurance Exchange Gets A $26 M Boost
Minnesota has received a $26 million federal grant to help build a health insurance exchange, a one-stop marketplace where individuals and small businesses will be able to purchase health coverage among various policies…. The federal money will allow the state to move ahead on creating the building blocks of the exchange -- particularly the high-tech backbone needed to run an online site and call center where consumers and businesses can buy private insurance and where low-income Minnesotans can sign up for public programs (Crosby, 2/22).

And in other implementation news -

California Healthline: Assessing the First Year of CMS' New Innovation Center
The Affordable Care Act calls on CMS to develop new tools to improve quality and reduce costs in government-subsidized health care programs. The Innovation Center is a sort of a designer/foundry combination, trying to draw and build new tools at the same time. So far, response has been mostly positive from industry and government leaders. ... Some reform critics predict the Innovation Center's projects are unlikely to result in savings, like most of their predecessors. [Robert] Laszewski said fear of failure isn't a good reason to turn away from the Innovation Center's goals (Lauer, 2/22). 

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Scalia Could Be Unlikely Health Law Ally

Bloomberg: Scalia Courted As Unlikely U.S. High Court Ally On Obama Health-Care Law
The fate of President Barack Obama's health-care law may hinge on the administration's ability to enlist an unlikely ally: Justice Antonin Scalia, the pillar of the U.S. Supreme Court's conservative wing. ... The Obama administration needs the vote of at least one of the five Republican appointees on the nine-member court to uphold the law and its requirement that everyone get insurance. It is appealing to Scalia based on the justice's own words from a 2005 opinion in an unrelated case affirming the federal government's power to control locally grown medical marijuana (Stohr, 2/23).

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Supreme Court Sends Calif. Medicaid Case Back To Lower Court

At issue was a federal appeals court ruling allowing patients and health care providers to sue over California's cuts in Medicaid payment rates. The high court sent the case back to the court in San Francisco to consider whether private parties or only the federal government can object to Medicaid reductions.

Los Angeles Times: Supreme Court Lets Providers Continue Suing To Stop Medi-Cal Cuts
A years-long legal fight over cuts in California's multibillion-dollar healthcare program for the poor took another twist Wednesday as the U.S. Supreme Court kicked the case back to a lower court. The high court's 5-4 decision allows medical providers to continue suing to stop the cuts, which would lower reimbursement rates for doctors who participate in the state's Medi-Cal program (Savage and Megerian, 2/23).

The Associated Press: Court Returns Calif. Medicaid Case To Lower Court
The Supreme Court has thrown out a federal appeals court ruling allowing patients and health care providers to sue over California's cuts in Medicaid payment rates. The narrow ruling Wednesday is not a total loss for the parties challenging the Medicaid cuts. By a 5-4 vote, the court sent the case back to the federal appeals court in San Francisco to consider whether private parties or only the federal government can object to Medicaid reductions (2/22).

California Healthline:  From Supreme Court to Appeals Court
Yesterday's decision by the U.S. Supreme Court had a ripple effect in California, influencing a number of lawsuits in the state over health care cuts. Four lawsuits have been filed over the 10% Medi-Cal provider rate cuts, and in all four cases, a federal judge has issued a temporary injunction blocking those cuts. In another court case, an injunction halted 20% trigger cuts to Californians receiving In-Home Supportive Services. All of those cases were waiting to see what the Supreme Court would decide in Douglas v. Independent Living Center of Southern California (Gorn, 2/23).

Politico: SCOTUS Punts On California Medicaid Lawsuit
The Supreme Court is punting on a key question about when Medicaid providers and beneficiaries have the right to sue over cuts to the federal-state health care program. That was the major question at the heart of Douglas v. Independent Living Center, in which provider and consumer groups claimed that California violated federal law by cutting Medicaid provider payment rates. They went to court under the Constitution's Supremacy Clause, essentially saying that provisions of the federal Medicaid statute should block the provider cuts (Millman, 2/22).

Reuters: Supreme Court Sends Back California Medicaid Cuts Case
The Supreme Court sent back to a lower court a case on whether Medicaid recipients and medical providers can sue California for cutting reimbursement rates in the healthcare program for low-income Americans. The high court said on Wednesday that after it heard oral arguments in the case on October 3, federal government officials approved the state's statutes as consistent with federal law (2/22).

NPR's Shots blog: High Court Punts On California Medicaid Ruling
At first, the federal Centers for Medicare and Medicaid Services agreed that California's proposed reductions were not consistent with the federal statute. But last October, after the Supreme Court heard oral arguments in the case, the federal agency reversed itself, at least in part, and said it would allow many of the cuts to go through.That didn't make the case moot, but it changed things considerably, Breyer wrote in the majority opinion (Rovner, 2/22). 

Modern Healthcare: Calif. Medicaid Case Heads Back To Lower Court
The U.S. Supreme Court sent a widely watched California Medicaid case back to a lower court, declining to rule whether providers can sue states to enforce the federal statute. The California Medical Association, however, viewed the decision as a "win for physicians and their patients" because the opinion suggests that providers may have a mechanism to challenge Medicaid policies in the courts, according to a news release (Blesch, 2/22).

Earlier, related KHN coverage: The Other Health Care Lawsuit: California Medicaid Case Headed To Supreme Court (Chase, 6/2/2011).

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Campaign 2012

Health Issues Create Political Flashpoints During GOP Presidential Primary Debate

GOP candidates sparred during last night's face-off over a range of issues including the Massachusetts health law that Mitt Romney signed while that state's governor, family planning and contraception, and abortion.

The Associated Press/Washington Post: Trading Fiery Charges, Romney And Santorum Go At It In 20th Debate Of Republican Fight
The most animated clash of the evening focused on health care in the United States. Santorum said that Romney had used government money to "fund a federal takeover of health care in Massachusetts," a reference to the state law that was enacted during Romney's term as governor. The law includes a requirement for individuals to purchase coverage that is similar to the one in Obama's landmark federal law that Romney and other Republicans have vowed to repeal. In rebuttal, Romney said Santorum, a former Pennsylvania senator, actually bore responsibility for passage of the health care law that Obama won from a Democratic-controlled Congress in 2010, even though he wasn't in office at the time. Romney said that in a primary battle in 2004, Santorum had supported then-Sen. Arlen Specter of Pennsylvania, who later switched parties and voted for the law Obama wanted (2/22).

Los Angeles Times: Romney Seeks To Undercut Santorum On Spending In GOP Debate
Wrestling for the front-runner's mantle in the Republican presidential race, Rick Santorum and Mitt Romney clashed fiercely Wednesday night over their conservative credentials and their past support of earmarks as the four GOP candidates met for the first debate in nearly a month. … Gingrich attacked Romney for requiring religious hospitals to provide rape victims with emergency contraception, a stance Romney said he did not take. And Paul took a shot at Santorum for voting to fund a federal program that provides family-planning health care to the poor, partly through Planned Parenthood (Reston and Mehta, 2/22).

Boston Globe: Santorum, Romney Square Off In Debate
When the discussion turned to birth control, the candidates all pounced on President Obama for recently enacting a rule, which he has since changed, that required religiously affiliated organizations to use health insurance plans that provide coverage for contraception. ... Santorum also criticized Romney for enacting Massachusetts' universal health care law. "It would be a difficult task for someone who had the model for ObamaCare, which is the biggest issue in this race of government in control of your lives, to be the nominee of our party,"’ he said (Levenson and Viser, 2/23).

The Wall Street Journal: Santorum Draws Fire In Fight For GOP Lead
Republican presidential candidate Mitt Romney sought Wednesday to portray Rick Santorum's 16-year career in Congress as a betrayal of conservative principles, using a televised debate to try to define his top rival at a moment when many voters are paying new attention to the former senator. … For his part, Mr. Santorum criticized Mr. Romney for shepherding, as Massachusetts governor, a state health care law that he said became the model for President Barack Obama's health law. He said Mr. Romney deserved little credit for balancing the Massachusetts budget, because doing so was a state requirement (Hook and O’Connor, 2/23).

The Hill: GOP Candidates Spar Over Government's Role In Americans' Sex Lives
All four Republican presidential candidates criticized the Obama administration's birth control mandate during Wednesday night's debate but sharply disagreed over government's proper role on the issue of sex. Former Pennsylvania Sen. Rick Santorum defended earlier remarks about "the dangers of contraception," saying he was concerned with sexual activity among young Americans. "What we're seeing is a problem in our culture with respect to children being raised by children, children being raised out of wedlock, and the impact on society," he said. "We have a problem in this country. The family is fracturing" (Pecquet, 2/22).

Kaiser Health News: Testy Santorum, Romney Tussle Over Mass. Health Reform (Video Clips)
In the last scheduled Republican debate, candidates Rick Santorum, Mitt Romney, Newt Gingrich and Ron Paul attacked the Obama administration on its birth control stance. Santorum dovetailed the issue into an attack of the 2006 Massachusetts health reform law, which Romney, as governor, endorsed (2/23).

Meanwhile, National Journal offers a pair of stories analyzing how birth control and contraception issues are playing -  

National Journal: Birth Control A Winning Issue For Dems, Poll Shows
More than half of American voters – 54 percent – approve of President Obama's compromise that would have insurance companies pay for birth control for employees of religious-affiliated institutions, according to the latest Quinnipiac University national poll, released on Thursday. Just 38 percent said they disapproved, the telephone poll of 2,605 registered voters found. The survey, conducted last week at the height of the controversy over the new policy, suggests that Democrats have the upper hand in defining the issue as one of women’s health, as opposed to Republican efforts to frame it as religious freedom (Fox, 2/23).

National Journal: Women To Congress: Contraception Conversation Isn't Over
When Georgetown Law student Sandra Fluke was denied the opportunity to testify before the House Oversight and Government Reform Committee last week, outraged Democrats and activists cried that a woman’s voice has been silenced on an issue that pertains to women’s health. But the conversation is far from over. Silence was not a symptom of a Wednesday evening panel discussion turned activist planning meeting, where Fluke and over two dozen women began to devise plans to make their voice heard in the contraception conversation (Belogolova, 2/22).

And The New York Times and Reuters offer other takes on policies being advanced on the campaign trail –

The New York Times: The Caucus Blog: Study Finds Mixed Results In GOP Candidates' Plans For Federal Debt
All four would repeal the 2010 health care law, which would not save much money since the law includes spending cuts and tax increases to offset expanded insurance coverage. All would shrink federal workforce costs. And they would cut and cap spending for Medicaid and other safety-net programs and turn those programs into block grants to the states (Calmes, 2/23).

Reuters: Listen Up Voters, Congress Is Messaging You
The administration's health care plan is certain to generate message voting as Republicans try to keep focus on it in 2012. The Republican campaign committee has already targeted some Democrats with Internet ads featuring a gathering storm as the narrator talks about "a cloud over our economy" created by what critics call "Obamacare." Both sides accuse the other of self-serving "message votes," while insisting they are driven by policy, not politics (Ferraro and Smith, 2/22).

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Public Health & Education

Draft National Plan To Fight Alzheimer's Released

A framework for the plan was unveiled in January. This more fleshed-out version builds on that outline, makes treatment a top priority and focuses on the burden the disease places on families and caregivers.   

Kaiser Health News: Capsules: Council Publishes Plan For Alzheimer's Research, Care
Much of the plan was already known from the draft framework published in January. Experts put an emphasis on expanding and better coordinating disease research, especially through public-private partnerships. They also stressed better preparation for the health care workforce, improving public outreach and providing effected families with financial and other support (Torres, 2/22).

Reuters: Obama's Alzheimer's Plan Focuses On Treatment, Care
The Obama administration's plan to fight Alzheimer's disease aims to harness the nation's expertise to find real treatments by 2025 and improve the care and treatment of the 5.1 million Americans already afflicted with the brain-wasting disease. The draft plan, issued by the U.S. Department of Health and Human Services on Wednesday, makes treatment a top priority, but it also focuses on the burden the disease places on families and caregivers (Steenhuysen, 2/22).

The Associated Press: US Drafts Plan To Fight Feared Alzheimer's Disease
The Obama administration declared Alzheimer's "one of the most-feared health conditions" on Wednesday as it issued a draft of the nation's first strategy to fight the ominous rise in the mind-destroying disease. More than 5 million Americans already have Alzheimer's or similar dementias, a toll expected to reach up to 16 million by 2050, along with skyrocketing medical and nursing home bills, because the population is aging so rapidly (Neergaard, 2/22).

Earlier, KHN coverage: Different Takes: The National Plan To Address Alzheimer's Disease (1/31).

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Health Information Technology

Federal Rules For HIT 'Meaningful Use' Expected Today

This long-awaited guidance will be published as a notice of proposed rulemaking in the Federal Register.  

Politico Pro: Stage Two Of HIT 'Meaningful Use' Delayed
Federal health IT officials said Wednesday that the proposed rules for the second stage of the federal program to fund electronic health records will be released Thursday. Office of the National Coordinator Director Farzad Mostashari and other top officials made the announcement at the Healthcare Information and Management Systems Society conference in Las Vegas to two ballrooms packed full of people who had hoped to see the details earlier this week (Norman, 2/22).

Modern Healthcare: Meaningful-Use Regs Arrive Thursday, Mostashari Says
Long-awaited proposed regulations for Stage 2 meaningful-use requirements will be out Thursday, Dr. Farzad Mostashari, head of the Office of the National Coordinator for Health Information Technology, said. The proposed requirements, which will be published as a notice of proposed rulemaking, were sent to the Office of the Federal Register Wednesday, Mostashari said in a joint CMS-ONC education session at the Healthcare Information and Management Systems Society's 2012 Annual Conference and Exhibition in Las Vegas (Grace, 2/22).

In related news -

The Hill: Sen. Warner Calls For Tougher Standards For Electronic Medical Records
Congress's gambit to create a national system of electronic health records is "at risk of failure or mediocrity" if federal regulators continue to water down the standards that doctors and hospitals must meet, Sen. Mark Warner (D-Va.) wrote in a letter to federal health officials. Lawmakers have set aside $27 billion in Medicare and Medicaid incentives for medical providers to switch to paperless records, and 780 products have already been certified under the first stage of the program created by the 2009 stimulus bill (Pecquet, 2/22).

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State Watch

Governor of Illinois Urges Medicaid Cuts

Pat Quinn, the Democratic governor, underscored the need for cuts to Medicaid and the state worker pension system, but some critics said his proposals did not offer enough specifics about how to reduce the state’s underfinanced liabilities.

Chicago Tribune: Quinn Asks Lawmakers To Put Some Skin In The Game On Pension, Health Care Cuts
The Democratic chief executive enumerated the long-standing challenges: too much money is spent on public worker pensions and health care for the poor, and too many loopholes have been carved into the state's tax code for businesses. Instead of spelling out specific solutions, however, Quinn suggested that the state wait for task forces to complete their work (Garcia, Long and Groeninger, 2/22).

Chicago Sun-Times: Gov. Pat Quinn On Pension Mess: 'Everything Is On The Table'
Quinn also addressed the need to cut state spending on Medicaid services for low-income Illinoisans and pension costs for state workers and teachers. … With Medicaid, the program that provides health care to 2.7 million low-income Illinoisans, Quinn warned of the program's potential "collapse" without action. "In order to reduce cost pressures, we need to reconsider the groups who are eligible for Medicaid, the services we cover under the program, the utilization of these services and the way and amount we pay them," he said. Another bi-partisan working group of legislators has Quinn's backing to offer up cuts to Medicaid, but the governor did not attach any sort of deadline to their endeavor (McKinney and Maloney, 2/22).

The New York Times: New Spending Plan Means New Round Of Pain For Illinois
Despite an income tax increase in Illinois last year, Gov. Pat Quinn delivered more grim news about the state’s fiscal crisis on Wednesday. … It has, it seems, been coming for a while, as the state’s unpaid bills have mounted and reports of its underfinanced state pension and Medicaid systems have grown ever more alarming. But while the governor spoke about the need for cuts in the Medicaid and pension systems, some critics said his proposals did not go far enough or provide specific steps to reduce the state’s unfinanced liabilities (Yaccino, 2/22).

The Wall Street Journal: Governor Of Illinois Urges Cuts To Medicaid
Illinois Gov. Pat Quinn pressed for cuts to Medicaid spending and major pension changes in an annual budget speech that underlined the huge challenges facing one of the country's most indebted states. Speaking Wednesday to the state legislature, Mr. Quinn, a Democrat, portrayed his prescriptions as the type of painful medicine that lawmakers have long failed to accept (Dean and Packowitz, 2/23).

Modern Healthcare: Providers Assail Proposed $2.7 Billion In Illinois Medicaid Cuts
Illinois healthcare providers ripped Gov. Pat Quinn's plan to cut $2.7 billion from the state's Medicaid program. Quinn didn't say where exactly those cuts would come from during his fiscal 2013 budget speech. He did say that last year state legislators couldn't cover the cost of Medicaid in Illinois, falling short by $1.9 billion (Selvam, 2/22).

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Vt., Okla. Lawmakers Mull Creating Health Insurance Exchanges

Lawmakers in Vermont and Oklahoma are the latest to grapple with creating a state health insurance exchange. In Vermont, the governor is defending his proposal for an exchange for small businesses while Oklahoma lawmakers are mulling creating their own so the federal government doesn't do it for them.

The Associated Press/Houston Chronicle: Vt. Governor Defends Health Care Exchange 
With the Vermont House poised to debate the next big step on the road to what Gov. Peter Shumlin hopes will be single-payer health care, the governor on Wednesday defended his proposed requirement that employees of small businesses get health insurance through a state-backed insurance market known as a health care exchange. Shumlin said about 96,000 Vermonters working for the 16,000 employers in the state with payrolls of 50 or fewer workers would be able to compare health plans, their benefits and costs on a website. The companies would have the option of continuing to offer employment-based health insurance — and get federal subsidies to do so — or let their employees buy federally subsidized health insurance on their own (Gram, 2/22).

The Associated Press/Boston Globe: Vt. House To Take Up Health Reform Bill 
The House on Thursday will debate a bill that would set up a new health insurance exchange ... [Gov. Peter] Shumlin and his fellow Democrats are hoping to use the exchange for bringing most Vermonters within a single-payer health insurance system by 2017 (2/23).

The Associated Press/Houston Chronicle: Committee Calls For Okla. Insurance Exchange 
A legislative committee recommended Wednesday that Oklahoma create its own health insurance exchange so the federal government doesn't establish one for it instead. Rep. Glen Mulready, R-Tulsa, said the exchange is a proactive choice, though he said he is hopeful the federal health care law will be overturned through litigation or the election of a different president. Mulready told The Associated Press he does not believe in the federal government's ability to impose an exchange cost effectively, and a state-based plan would give Oklahoma more control to decide the role of agents and brokers, as well as inviting more carriers and competition (Fretland, 2/22).

Meanwhile, in other news related to states and the health law —

Fox Business: The Best And Worst States For Health Care Costs
With the 2012 election season in full swing, and the fate of the Patient Protection and Affordable Care Act hanging in the air, health care cost and reform weigh heavy on the minds of small business owners across the country. The Small Business & Entrepreneurship Council released last week its "Health Care Policy Cost Index 2012," which ranks the states and the District of Columbia on public policy measures that impact the costs of health-care and health-insurance coverage. South Carolina and Iowa top the list (Roger, 2/22).

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Wash. Law Requiring Pharmacies Stock Emergency Contraception Struck Down

A federal judged ruled Wednesday that Washington can't require pharmacists to carry and give patients emergency contraception. Other cases included whether a lesbian couple can share health benefits, and a challenge to a Mass. law on abortion buffer zones.

Reuters: Judge Strikes Down Law Mandating Sale Of Contraception
A federal judge declared on Wednesday that a Washington state rule requiring pharmacists to dispense emergency contraceptives against their religious beliefs is unconstitutional. In a decision with national implications for the role of personal morality in the workplace, U.S. District Judge Ronald Leighton also imposed an injunction blocking enforcement of the regulation (Luck, 2/23).

The Hill: Federal Judge Strikes Down Washington State’s Morning-After Pill Mandate
The regulations were adopted in 2007 by the State Board of Pharmacy under pressure from Gov. Christine Gregoire, a Democrat who opposed the board's earlier unanimous support for conscience protections. ... Leighton added that while the regulation does not apply to individual pharmacists, it impacts them by making them harder to employ since pharmacies must have at least one person on shift at all times who is willing to dispense the morning-after pills( Pecquet, 2/22).

The Associated Press: Judge: Wash. Can't Make Pharmacies Sell Plan B
The state requires pharmacies to dispense any medication for which there is a community need and to stock a representative assortment of drugs needed by their patients. ... Leighton said Wednesday that the state allows all sorts of business exemptions to that rule. Pharmacies can decline to stock a drug, such as certain painkillers, if it's likely to increase the risk of theft, or if it requires an inordinate amount of paperwork, or if the drug is temporarily unavailable from suppliers, among other reasons (Johnson, 2/22).

Also from the courts -

Boston Globe: Federal Judge Rejects Challenge To State's Abortion Clinic Buffer Zone Law
U.S. District Judge Joseph L. Tauro rejected claims that the law violated abortion protesters' free speech rights, saying in a ruling issued yesterday that the law "as applied is a valid regulation of the time, place, and manner of Plaintiffs' speech." ... The law creates a 35-foot fixed buffer zone around the driveways and entrances of clinics (Finucane, 2/22).

The Associated Press: Lesbian Federal Worker Wins Health Benefits Case
[San Francisco--] The government cannot deny health benefits to the wife of a lesbian court employee by relying on the 1996 law that bars government recognition of same-sex unions, a federal judge has ruled. In Wednesday's ruling, U.S. District Judge Jeffrey White said the government's refusal to furnish health insurance to Karen Golinski's wife is unjustified because the Defense of Marriage Act unconstitutionally discriminates against same-sex married couples (Leff, 2/22).

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Va. Lawmakers Backdown From Requiring Invasive, Pre-Abortion Ultrasound

Virginia lawmakers backed off a proposal Wednesday to require women seeking abortions get an transvaginal ultrasound after Gov. Bob McDonnell said he wouldn't support it. Virginia House lawmakers instead approved an amended bill requiring only an external ultrasound. 

The Associated Press: Va. House Scraps Invasive Pre-Abortion Requirement
Amid a public uproar that prompted Virginia's governor to withdraw his support, Republican legislators on Wednesday dropped a bitterly contested proposal to require that women seeking abortions undergo invasive ultrasound imaging, likely dooming the bill. The Republican-controlled House of Delegates voted 65-32 for an amended bill that requires only an external ultrasound, not the vaginal insertion of a wand-like device that emits ultrasonic waves that are used to create images of the fetus (Lewis, 2/22).

The Washington Post: McDonnell, Virginia Republicans Back Off Mandatory Invasive Ultrasounds
A controversial bill that would require women to get an ultrasound before an abortion is now in doubt after Virginia Gov. Robert F. McDonnell diluted the measure Wednesday by making it optional in many cases (Kumar and Vozzella, 2/22).

Los Angeles Times: Virginia Governor Backs Off Requiring Ultrasound Before Abortion
Backing away from his support for a proposed law that would require women to submit to an invasive ultrasound before undergoing an abortion, Virginia Gov. Bob McDonnell on Wednesday asked the state Legislature to amend the bill to exclude the controversial requirement (Geiger, 2/22).

USA Today: Virginia Scraps Requiring Invasive Pre-Abortion Procedure
A Virginia bill that would have required women to undergo an invasive ultrasound before having an abortion failed Wednesday after Gov. Bob McDonnell withdrew his support (Leger, 2/23).

Politico: Bob McDonnell Won’t Back Ultrasound Bill
Virginia Gov. Bob McDonnell on Wednesday said he would not support a controversial bill requiring women undergo an invasive ultrasound before having an abortion. "Mandating an invasive procedure in order to give informed consent is not a proper role for the state. No person should be directed to undergo an invasive procedure by the state, without their consent, as a precondition to another medical procedure," said McDonnell in a statement (Weinger, 2/22).

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Ga. Vasectomy Bill Goes Viral

A Democratic lawmaker has proposed denying men vasectomies as a parody of a Republican bill that would prohibit abortions for women more than 20 weeks pregnant. Elsewhere, a Wisconsin bill would require physicians to give women a physical exam and be present when giving abortion-inducing drugs.

The Atlanta Journal-Constitution: Vasectomy Bill Goes Viral
Rep. Yasmin Neal, a Jonesboro (Ga.) Democrat, was a relatively unknown freshman state representative Tuesday morning but by Tuesday night she was featured on left-leaning TV commentator Rachel Maddow's blog, she became a trending topic on Twitter, and CNN called for an interview Wednesday. "I am floored," she said of her sudden fame. The blasting cap that set off the explosion of publicity was Neal's House Bill 1116, a parody of the abortion-limiting bill moving quickly through the Georgia House. Neal proposes instead limiting vasectomies for men, except in cases where not getting one would result in death or "impairment of a major bodily function” (Quinn, 2/22).

CNN: No Abortions For Women? Then No Vasectomies For Men, Lawmakers Say
As members of Georgia's House of Representatives debate whether to prohibit abortions for women more than 20 weeks pregnant, House Democrats planned to introduce their own reproductive rights plan: No more vasectomies that leave "thousands of children ... deprived of birth." Rep. Yasmin Neal, a Democrat from the Atlanta suburb of Jonesboro, planned to introduce a bill Wednesday that would prevent men from vasectomies unless needed to avert serious injury or death (Gumbrecht, 2/22).

In other state news on contraception and abortion —

The Texas Tribune: Updated: Map of Government-Funded Family Planning Providers in Texas
In Texas, the Legislature has drastically reduced funding for family planning agencies that serve low-income women statewide. ... [W]e have mapped out the locations of government-subsidized family planning clinics in 2010, 2011 and 2012. Not only are there fewer contractors each year, but those that receive grants are getting less money (Murphy and Tan, 2/22). 

Milwaukee Journal Sentinel: Senate Approves Abortion Bill On Party-Line Vote 
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 given final approval by the state Senate Wednesday.  The bill passed 17-15 with all Republicans voting in favor and all Democrats voting against. Democrats Tuesday used a procedural move to block a final vote on the measure, forcing the Senate to come back Wednesday to advance the bill and send it to the Assembly (Stein, 2/22). 

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State Legislatures Contemplate Controlling Costs, Health IT, Prescribing Authority

A selection of health policy stories from Oregon, Colorado, Massachusetts, Vermont, New Hampshire, California, Pennsylvania, Minnesota, Kansas and Arizona.

Los Angeles Times: California Health Insurers To Raise Average Rates 8% To 14%
The proposed premium hikes for hundreds of thousands of California consumers with individual coverage would outpace the cost of overall medical care, which has risen just 3.6 percent in the last year (Terhune, 2/23).

Kaiser Health News: Can Massachusetts Lead The Way On Controlling Health Costs? 
As of April 1, base insurance rates approved by the Democratic Gov. Deval Patrick's administration for small businesses will increase, on average, 1.8 percent. ... So is health care inflation tamed in the state? We put this question and a few others to four economists: MIT’s Jonathan Gruber. ... Harvard University’s David Cutler, ... Stuart Altman of Brandeis University ... and Meredith Rosenthal (Harvard School of Public Health) (Bebinger, 2/22).

Arizona Republic: Insider: Senator Pierce Eyes Health Care Costs
Look for state Senate President Steve Pierce to tackle health-care affordability. The rising cost of coverage for employers, plus the implications of the federal Affordable Care Act, add up to big dollar signs and big problems for the state, he said (Pitzl, 2/22).

The Philadelphia Inquirer: Health Official: Proposed Budget Cuts 'A Recipe For Disaster'
Philadelphia Health Commissioner Donald F. Schwarz said Wednesday that Gov. Corbett's proposed cuts for human services would have a sweeping impact on a wide variety of vulnerable populations. Affected by the cuts, Schwarz said, will be people with mental illness and intellectual disabilities; homeless individuals and families; children aging out of foster care; HIV patients needing hospice care; and elderly people in the city-run nursing home (Lin and Hill, 2/22).

The Associated Press/ABC News: NH Expands Fitness Program To Shrink Lifespan Gap Between General Population, Mentally Ill
The average life span for someone with a serious mental illness is 25 years shorter than someone in the general population, a gap that has been largely overlooked even though an estimated 10.4 million American adults — including about 43,000 in New Hampshire — fall into that category, said Dr. Stephen Bartels. He will supervise the program funded by the Centers for Medicare and Medicaid Services (2/23).

(St. Paul) Pioneer Press: Bill Allows Health Care Providers To Charge Copy Fees To Patients In Social Security Disability Appeals
A proposal to let doctors, hospitals and clinics charge a subset of disabled patients for extra copies of medical records stirred up a beehive of opposition during a legislative hearing Tuesday. … According to state law, all patients can get a free copy of medical records to review their current care. But health care providers can charge fees when patients or their attorneys request copies for other purposes (Snowbeck, 2/22).

The Lund Report (Oregon): House Passes Bill Allowing Zoomcare's Physician Assistants to Prescribe
A bill that colloquially became known as "the Zoomcare bill" passed the House with 58 votes on Wednesday, paving the way for the clinic chain's physician assistants to begin prescribing bottled, non-narcotic medication starting in June. ... The bill creates a new category for a "drug outlet," called a "practitioner's dispensing outlet," that would include any ZoomCare clinic that dispenses medications (Waldroupe, 2/22).  

Denver Post: Legislators Balk At Spending Millions More On Troubled Benefits Computer System
A plea for millions of dollars to fix the long-troubled state computer system for Medicaid and food assistance was met with bi-partisan skepticism Wednesday from legislators hesitant to pour more money into a system that has repeatedly failed to improve (Steffen, 2/22).

Denver Post: PERA Retirees Fear House Bill Will Expel Them From Coverage
Thousands of Coloradans who retired with a government pension are terrified that a bill to be heard today will drastically change their health care. ... [Colorado Public Employees' Retirement Association] executives believe the bill is written in such a way that about 33,900 retirees and 5,000 of their dependents who are eligible for Medicare would have to be kicked out of its health care program (Bartels, 2/23).

Kansas Health Institute News: Centene And Coventry Get Missouri Managed Care Contracts
Centene and Coventry, two of the five major managed care companies seeking a contract with the Kansas Medicaid program, have landed awards from the state of Missouri, officials there announced today. Today also was the deadline for bids on Gov. Sam Brownback's KanCare proposal. ... The KanCare plan was announced by administration officials in November 2011 and most of the nation's large managed care companies expressed early interest in bidding on it (Shields, 2/22).

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Editorials and Opinions

Viewpoints: A Missing Contraception Question, Obama's Budget Blind Spot, NEJM On Medicare Advantage

The New York Times: The Opinionator: Who Decided That This Election Should Be About Sex?
David Brooks and Gail Collins discuss the surprising role debates over contraception, abortion and unwed mothers have played so far in the campaign (2/22).

The Washington Post: The Missing Contraception Question
Can we please get one moment of contraceptive clarity Wednesday night in what may be the final big GOP debate of the year? All it will take is a simple line of questioning pressed by moderator John King (Matt Miller, 2/22).

The Washington Post: Virginia Gov. McDonnell’s Abortion Crucible 
Gov. Robert McDonnell and some of his fellow Virginia Republicans are shocked, shocked. It turns out that legislation mandating a costly, coercive, medically unnecessary ultrasound procedure would be physically invasive and personally offensive for thousands of women seeking abortions in the state (2/22).

McClatchy: GOP Goes Back To The 1960s On Birth Control
Ignoring years of public-opinion polls, the GOP is boldly marching backwards into the 1960s to question whether contraception is a legitimate health-care benefit. The target, as always, is President Obama. He issued an executive mandate requiring that free birth control be included in health plans provided to employees of schools, charities and hospitals connected to religiously affiliated institutions. Although the mandate excludes churches, Roman Catholic bishops are in a huff, saying the contraception provision violates the First Amendment and “freedom of religion” (Carl Hiaasen, 2/23).

McClatchy: Catholic Women Must Speak Out
The use of birth control is against Catholic teaching, a sin and part of "a culture of death," as New York's Archbishop Timothy M. Dolan has said. But the majority of Roman Catholic women - 98 percent according to one poll - have used birth control. Like me, many such women have received periodic fundraising letters from the church usually addressed to the woman of the house. They've enrolled their children in Catholic schools and watched their children participate in the sacraments. ... Of 100 Catholic women friends and acquaintances I could name, 99 use artificial birth control. But have we spoken out? No. Instead, we have spoken to each other (Maura Casey, 2/23).

Los Angeles Times: Obama’s Budget Blind Spot
On the spending side, the president calls for cuts across a wide range of programs, but his plan is also rife with gimmicks. He touts a 10-year "deficit reduction" of $850 billion from our reduced roles in Iraq and Afghanistan, but virtually nobody believes the country intended to spend that money. … Notably, the budget does nothing to restructure entitlements — Medicare, Social Security, Medicaid. A leadership budget would focus less on minor program changes and more on major reforms to combat the coming fiscal crisis driven by runaway entitlement spending (David M. Primo, 2/22).

The Washington Post: Mitt Romney's Tax Proposal May Not Be Narrative Campaign Wants
What’s important, as Hubbard correctly says, is the story the figures tell about a Romney administration. And that goes something like this: Under a Romney presidency, there would be a major redistribution — or perhaps it should be called a re-redistribution — from low-income people who depend on government programs such as Medicaid to higher-income folks who pay taxes (Ezra Klein, 2/22).

The Wall Street Journal: Health Care’s Coming Price Revolution
The old-line Marxists used to talk about "heightening the contradictions" of capitalism to make things worse and hasten the revolution. One of the great ironies of the Affordable Care Act is that it may be doing just that (Joseph Rago, 2/23).

The Wall Street Journal: A Tax Reform to Restore America’s Prosperity
Higher-income Americans who receive the greatest benefit from rate cuts will see the most significant limits. Middle-income Americans will continue to enjoy tax benefits that favor important priorities such as home ownership, charitable giving, health care, and savings. The result will be a pro-growth tax code that still raises the necessary revenue, retains the existing progressivity, and ensures that middle-income Americans will see real tax relief ( Mitt Romney, 2/23).

The Wall Street Journal: Romney’s Tax Reboot
Mr. Romney made the mistake yesterday of distinguishing between deductions for "middle-income families," which he said would be preserved, and for the "top 1 percent," which he said would be on the table. This sounds like a pollster's bad advice. It merely plays into Mr. Obama's class-war theme when Mr. Romney should be stressing growth. But at least Mr. Romney says all deductions would be on the reform table, including those for mortgage interest, state and local taxes and health care (2/23).

Boston Globe: Big Cases On High Court Docket Highlight Need To Allow Cameras
When the Supreme Court announced on Tuesday that it would reconsider its position on affirmative action at public universities - a legal flashpoint since the 1970s - it caught the attention of millions of Americans. With a test of President Obama’s health care overhaul already on the docket for April, the coming term promises to be one of the most consequential in memory. It would be a fine chance for the public to learn how the Constitution is applied to legal disputes, and to demystify the court. But the court’s own rectitude - emblemized by its refusal to allow cameras to record public hearings - is getting in the way (2/23).

The Philadelphia Inquirer: ‘Santorum Of Pennsylvania’: 14th Century Public Health Hero
Unlike SNL’s Theodoric of York, who at least tried to help people, even as he prescribed bleeding, leeching, worming, boar’s vomit, the Caladrius bird, and hanging one upside down from a gibbet to fight illness, Rick Santorum of Pennsylvania only has proscriptions for what ails us, proscriptions that threaten to return us to the unscientific and uncaring days of yore when science and medicine were based on superstition. Questioning his cures, Theodoric of York— who fictionally lived in the century before the European Renaissance (and popped up in Steve Martin skits in the 1970s) — wondered whether we should test our "assumptions analytically through experimentation and the scientific method" (Michael Yudell, 2/22).

The Houston Chronicle: Texas Can Lead The Way On Medicaid Reform
The innovation allowed under today's Medicaid program will never come close to closing the gap for the demands on state tax dollars for this federal health care program for the poor. Medicaid is in desperate need of overhaul….Texas has the opportunity to lead the reform movement by pursuing the waiver for an aggressive block grant as envisioned in the legislation (Arlene Wohlgemuth, 2/22).

The Minneapolis Star Tribune: Know The Full Story About Health Plans
The editorial focused on one program. The state groups three programs -- Medicaid, MinnesotaCare and the old General Assistance Medical Care -- into one contract. It's a package deal and must be scrutinized as such…..The editorial focused on one year. But insurance financing is cyclical, containing highs and lows from year to year. The average profit over the past five years for all state public programs is 1.6 percent of revenue, less than the margins reported in the editorial for both Michigan and Wisconsin (Julie Brunner, 2/22).

The Miami-Herald: Here’s Crazy: Reducing Money To Treat Mental Illness in Florida
Thank God for Texas. Else we’d rank as the most barbaric backwater in the nation. Even infamously unenlightened states like Mississippi, Alabama and South Carolina spend more per capita on mental health than Florida. Joe Negron aims to fix that. The powerful state senator from Hobe Sound, who oversees the Budget Subcommittee on Health and Human Services Appropriations, has pushed a $76.1 million reduction in the state’s mental health services budget through the Senate. Another $31.6 million would come out of the state’s substance abuse treatment programs….Most of the financial burden will land on local governments. The real costs of Negron’s cuts will be borne by county jails and public hospital emergency rooms (Fred Grimm, 2/22).

McClatchy: Medical Research Funding Cuts Could Be Hazardous To America’s Health
President Obama's budget recommendation to freeze funding for the National Institutes of Health is shortsighted. The NIH is the largest supporter of medical research in the world. But with a frozen budget, the research that could reduce chronic diseases disproportionately affecting minority populations will slow considerably (Louis W. Sullivan, 2/23).

Chicago Sun-Times: Quinn's Right — It's Time To Tackle Medicaid, Pensions
He proposed cutting Medicaid expenditures by $2.7 billion. And, here again, he dared to list the various unpopular measures that might be necessary to hit that target. "To reduce cost pressures," he said, "we need to reconsider the groups who are eligible for Medicaid, the services we cover under the program, the utilization of these services and the way and amount we pay for them." We heard a stir in the offices of the Illinois State Medical Society. Actually, they faxed us a statement after the speech. "Patching Illinois' budget shortfall on the backs of physicians is bad fiscal policy," the doctors said. They might be right. But when a state finds itself in such dire financial shape, there are no good fiscal policies, certainly no palatable ones (2/22).

New England Journal of Medicine: Colonoscopy as a Triage Screening Test 
[C]olonoscopy can be used to stratify patients according to their risk of colorectal cancer. An appealing concept would be to use colonoscopy as a triage screening test, offering it once for everybody at 60 years of age and using the results to classify persons as having a low risk of colorectal cancer ... or a high risk, ... with strict surveillance for the latter group but no further screening for the former (Drs. Michael Bretthauer and Mette Kalager, 2/22). 

New England Journal of Medicine: The Medicare Advantage Success Story — Looking Beyond The Cost Difference
[M]any policymakers seem to be overlooking the lessons of what may be the greatest source of innovation in care delivery in Medicare: Medicare Advantage ... Medicare Advantage plans innovate along many dimensions. ... They select providers for their networks and set providers' payment rates strategically. Whereas traditional Medicare offers a one-size-fits-all benefit, Medicare Advantage plans apply on-the-ground knowledge in tailoring benefits (Jeet S. Guram and Robert E. Moffit, 2/22).

New England Journal of Medicine: Medicare Advantage — Lessons for Medicare's Future 
[In general, Medicare's experience with private plans strongly suggests that hard decisions cannot be avoided merely by shifting to a different system. Private plans are not inherently more efficient than the those provided by the public sector. ... Studies comparing Medicare Advantage plans with traditional Medicare in terms of quality of care are limited, but their results do not justify a large differential in payment based on quality (Marsha Gold, 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.