Daily Health Policy Report

Friday, February 24, 2012

Last updated: Fri, Feb 24

KHN Original Reporting & Guest Opinion

Health Reform

Administration News

Capitol Hill Watch

Campaign 2012

Health Information Technology


Health Care Fraud & Abuse

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Minnesota Exchange Grant Arrives In Politically Divided State

Minnesota Public Radio's Elizabeth Stawicki, reporting in partnership with Kaiser Health News and NPR, writes: "The federal government has awarded Minnesota a $26 million grant to help fund the creation of the state insurance exchange — a key part of the federal health care law. The grant comes to a state government bitterly divided over carrying out federal health reform" (Stawicki, 2/23). Read the story.

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Capsules: Health IT Coordinator: Release Of Stage 2 Guidelines A 'Push Ahead'

Now on Kaiser Health News' blog, Chrisitian Torres writes about the new "meaningful use" regulation: "It's time to take electronic health records to the next level. Federal officials on Thursday released their second-stage guidelines for "meaningful use" of electronic records, which advocates say have the potential to reduce medical errors and streamline care. The proposed rules require doctors and hospitals to significantly step up their usage, as well as better engage patients and improve the transferability of records." Check out what else is on the blog.

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Different Takes: Maryland Advances An 'Enterprising' Plan To Eliminate Health Disparities

In this Kaiser Health News Different Takes feature, the University Of Maryland's Dr. E. Albert Reece and The Heritage Foundation's Stuart Butler discuss how health enterprise zones, a new take on an old economic development idea, might be used to improve the health of the state's minority populations (2/23). Read the commentaries by Reece and Butler.

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Political Cartoon: 'Focus, Focus, Focus'

Kaiser Health News provides a fresh take on health policy developments with "Focus, Focus, Focus" by Mike Luckovich.

Meanwhile, here's today's haiku:


Romney, Santorum
Paul, Gingrich – All Against Law?
What's The Replacement?

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

High-Risk Pools Expand Coverage For People With Serious Conditions, But At Greater Cost Than Predicted

The Washington Post reports that per patient costs will likely be more than double the initial projections.

The Washington Post: Per Person Cost Of Federal High-Risk Medical Plan Doubles
Medical costs for enrollees in the health-care law's high-risk insurance pools are expected to more than double initial predictions, the Obama administration said Thursday in a report on the new program (Kliff, 2/23).

The Hill: Report: Health Care Law Helping Cover 50K People With Serious Conditions
Almost 50,000 Americans with serious medical conditions have gained insurance coverage thanks to the healthcare reform law, the Obama administration said in a new report Thursday. The law set aside $5 billion for Americans who couldn't get insurance to join federally or state-run high-risk pools before 2014, when insurance plans will have to accept all applicants regardless of pre-existing conditions. The new report found that enrollment increased 400 percent between November 2010 and November 2011, with about 8,000 new applications per month in the second half of 2011 (Pecquet, 2/23).

Miami Herald: Healthcare Reform Pays For 4,000 High-Risk Patients In Florida
About 4,000 of Florida's sickest uninsured residents are now benefiting from a new federal health insurance program, according to a report released Thursday. They have joined the Pre-Existing Condition Insurance Plan, set up by the Affordable Care Act for people who have been without health insurance for at least six months and have a pre-existing condition or have been denied coverage for health reasons…. The 3,736 people covered by the plan in Florida, as of Dec. 31, represent less than one-tenth of 1 percent of the state’s 3.8 million uninsured (Dorschner, 2/23).

Also in the news, a Rand study estimates health insurance costs with and without the individual mandate, and Politico Pro takes a look at the administration's record on rate reviews -

Modern Healthcare: Mandate Math
RAND Corp. recently released one more estimate of health insurance coverage and costs with and without the health reform law mandate that (pretty much) everyone must be insured. About 12.5 million fewer people would be covered minus the requirement, which is being challenged in a case before the U.S. Supreme Court. Those that would be covered would be those eligible for hefty subsidies, RAND said, leaving the federal government tab unchanged despite millions fewer insured (Evans, 2/23).

Politico Pro: HHS Approves Rate Hikes Over 20 Percent
The Obama administration has made a big deal of cracking down on insurers that try to raise their rates more than 10 percent — the standard for the new rate reviews under the health care law. And yet, this one almost slipped under the radar: The same Obama administration has quietly approved three rate hikes of at least 20 percent. HHS approved premium rate hikes of 26 percent in Alaska, 23.3 percent in Florida and 20.4 percent in Washington state, according to decisions posted on an HHS website. That’s after approving a hike of 18 percent for a Montana insurer in November (Millman, 2/24).

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Handicapping The Role Of Health Care In 2012

Politico Pro: Health Care Vulnerabilities For 2012 Hopefuls
So does that mean President Barack Obama is winning the argument on health care? Contraception is the hot topic of the moment, and judging from the polls, the Republican candidates aren’t in any danger of finding the center on that issue. But then there’s that health care law. The one that’s about to go before the Supreme Court — and the one that has a lot more enemies than fans right now. In fact, the same Quinnipiac poll found that the public wants the Supremes to overturn the health care law by a margin of 50 percent to 39 percent — and that independents mostly side with the Republicans on this one. (Other polls show less support for striking the whole law.) So, who’s winning the health care fight (Nather, 2/24)?

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Administration News

Seven States File Lawsuit To Block Obama Administration Birth Control Coverage Rule

The states joined with Catholic groups and individuals to file the first major lawsuit challenging these regulations.

The Wall Street Journal: Seven States File Lawsuit Over Contraception Rule
The lawsuit, led by Nebraska's attorney general, contends that the proposed rule violates Roman Catholic institutions' rights under the First Amendment to express their beliefs and practice their religion. The move is the first legal action by state attorneys general in the heated debate over the requirement (Radnofsky, 2/24).

The Associated Press: 7 States Challenge Birth Control Coverage Rule
It marks the first legal challenge filed by states. ... The rule, announced as part of the federal health care law, has come under fire from religious groups that object to the use of contraceptives, sterilization and abortion-inducing drugs. In response to the criticism, Obama administration officials have said they will shift the requirement from the employers to health insurers themselves (Schulte, 2/23).

Reuters: States, Catholics Sue Over Contraceptives Rule
Florida, Michigan, Nebraska, Ohio, Oklahoma, South Carolina and Texas joined with Catholic organizations and two Catholics to fight the new rules issued earlier this month requiring healthcare coverage for free birth control (Pelofsky, 2/23).

Modern Healthcare: State Attorneys General Sue To Block Contraception Rule
The lawsuit alleges that the contraception rule violates three clauses in the First Amendment as well as the federal Religious Freedom Restoration Act by forcing Catholic employers to either subsidize services and drugs they find morally objectionable or essentially withdraw from the insurance market (Carlson, 2/23).

The Hill: Seven States Sue Over Contraception Mandate
The Health and Human Services Department has said it will delay the requirements for religious employers for one year. But the states’ lawsuit, which was joined by several Catholic organizations, states that HHS has already finalized the rule and therefore Catholic institutions are subject to the mandate now (Baker, 2/23).

CNN (Video): Seven States Sue Government Over Contraceptive Mandate
The issue has become a political flashpoint in a presidential election year .. Officials from the White House and the Department of Justice had no comment on the pending litigation. However, it is not the first court challenge to the Obama administration's new mandate on contraceptive coverage (Cohen, 2/23).

Miami Herald: Florida Joins Multi-State Suit Over Obama Contraception Requirement 
Florida Attorney General Pam Bondi said requiring religious organizations to include contraception, sterilizations and related services as part of healthcare coverage violates religious protections in the U.S. Constitution. ... The Obama administration has defended its decision, saying the rule assures that a woman can have access to free contraception regardless of where she works or whom she works for (Mitchell, 2/24).

In related news -

McClatchy: 7 Female Missouri House Members Say They Were Kept Out Of Contraception Debate
It was a purely symbolic move when the Missouri House passed a resolution this week decrying the Obama administration’s mandate that health insurance policies include birth-control coverage. But it still managed to spark outrage from a group of seven female Democratic lawmakers, who said they were denied a chance to speak on an issue that affects them. "These women stood and waited to be recognized for two hours," said Rep. Tishaura Jones, a St. Louis Democrat (Hancock, 2/24).

St. Louis Beacon: 'Mad Men' vs. Angry Women? 'Culture war' Reruns In Contraception Debate
No matter how you view the hot debate over the Obama administration's new rule on contraceptives coverage — and U.S. Sen. Roy Blunt's "Rights of Conscience" amendment that would block it — many hear echoes of the "culture wars" of previous decades over issues like birth control. Today the Missouri House approved by a vote of 114-45 its own resolution opposing the new contraception rule; it was denounced by women in the Democratic minority as affecting access to contraceptives. ... Blunt has remained typically low key in appearances across Missouri during the Senate's recess this week (Koenig, 2/22). 

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Capitol Hill Watch

Woman Barred From House Contraception Hearing Testifies At Dems' Event

A woman barred by Republican Rep. Darrell Issa, R- Calif., last week from testifying at a hearing on contraception and religion starred in a House Democratic hearing on Capitol Hill Thursday, saying women are "energized" on the contraception issue. 

NPR Shots Blog: Law Student Makes Case For Contraceptive Coverage
Congress is in recess this week, but that didn't stop House Democrats from holding a hearing to take testimony from a Georgetown law student who was barred from testifying in last week's hearing about President Obama's policy on contraceptives, health insurance and religiously affiliated organizations (Rovner, 2/23).

The Associated Press: Democrats Hear From Woman Snubbed By GOP Lawmakers
Georgetown University law student Sandra Fluke was given her chance to talk to Congress Thursday, even though lawmakers were on a break and just a few Democratic allies were there to cheer her on. But what a difference a week makes. ... This week she received almost rock-star treatment as the lone witness at an unofficial Democratic-sponsored hearing. While the rest of the Capitol was mostly empty, Democratic leader Nancy Pelosi, three other Democrats and dozens of mainly young women supporters crowded into a House office building room to applaud Fluke as she spoke of the importance of reproductive health care to women (Abrams, 2/23).

The Hill: Pelosi Hits GOP At Contraception Hearing
House Democrats kept pressing their case on contraception Thursday, using a hearing on the issue to hammer the GOP and frame the debate around women's health. Minority Leader Nancy Pelosi (D-Calif.) organized the hearing after an Oversight Committee panel last week did not include any female witnesses who support the White House’s order requiring employers and insurance companies to cover birth control (Baker, 2/23).

National Journal: 'Women Are Energized,' Witness Tells Contraception Hearing
Georgetown law student Sandra Fluke, barred last week  by Rep. Darrell Issa, R-Calif., on contraception and religion that featured a shouting match, got her moment in the sun on Thursday at a hearing replete with activists and capped off by a standing ovation. "Many women in this country are energized about this issue," Fluke told the hearing called by House Minority Leader Nancy Pelosi, D-Calif., on Thursday morning (Sanger-Katz, 2/23).

Meanwhile, women's issues could play a big role in this year's election —

San Francisco Chronicle: Boxer: Birth Control Debate Will Help Elect Women
Two decades after U.S. Sen. Barbara Boxer became a symbol of the "Year of the Woman" in Congress, the California Democrat is predicting that this year may see a repeat of woman-fueled political victories in response to the Republican Party's approach to birth control. "The Republicans' hostility to women's health is having a ripple effect across this land," Boxer said Thursday at a news conference in San Francisco. "I think we're in for another 'Year of the Woman.' I really do," she said (Marinucci, 2/24).

NBC (Video): Why Birth Control Is Pushing Political Buttons
Birth control was the boo-eliciting buzz word during Wednesday night's Republican debates in Mesa, Arizona — a hot-button topic that brought to the fore political and gender differences on the debate over contraception. ... But political experts say the GOP presidential hopefuls will have to navigate the culture wars carefully if they want to avoid alienating moderate women voters. A recent poll by Quinnipiac University showed that 54 percent of Americans approve and 38 percent disapprove of the president's compromise on health insurance coverage for employees of religious institutions seeking birth control. Women approved the president's move 56 to 36 percent, the poll showed (Abdullah, 2/23).

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Campaign 2012

Study: GOP Candidates' Plans Would Leader To Larger Deficits

Proposals put forth by Newt Gingrich and Rick Santorum would pile up the largest increases in debt, while Mitt Romney's initial plan, since revised with bigger suggested tax cuts, would increase it by a smaller amount over the next decade.

Los Angeles Times: Debt Would Grow Under Most GOP Candidates' Plans, Report Says
The sober analysis shows how difficult it will be for any new inhabitant in the White House to shift the nation's debt trajectory, and the need for long-term and bipartisan efforts to gain revenues and curb spending -- particularly at a time of rising Medicare costs for the aging population, the budget watchdog group said (Mascaro, 2/23).

The Associated Press: Study: Candidates' Plans Lead To Huge Deficits
Paul's budget plans include eliminating five Cabinet departments, immediately ending operations in Iraq and Afghanistan, and sharply cutting federal programs like Medicaid and food stamps. It would reduce the deficit by $2.2 trillion over nine years. He is the only candidate whose spending cuts exceed the amount of revenue lost by cutting taxes (Taylor, 2/24).

The Wall Street Journal: Report Says Candidates' Plans Boost Federal Debt
While Republican presidential candidates are campaigning against President Barack Obama's deficit-laden budgets, a new report concludes that three of the four contenders' fiscal proposals would likely increase the federal debt. … The government's debt is now at $15.4 trillion. It's on track to grow rapidly in coming decades as the population ages and the costs of Medicare, Social Security and other entitlement programs soar. The issue has received attention from blue-ribbon study commissions and in Congress, where a deficit-reduction "super committee" tried but failed last year to come up with a plan to trim the deficit by $1.2 trillion over 10 years (Hook, 2/24).

Reuters: US Debt Would Swell Under Republican Candidates' Tax Plans-Study
The middle-path analysis of Romney's plan, before his pledge for deeper individual tax cuts, would have seen a modest $250 billion increase in debt by 2021 as more of his spending cuts were specified. These included deep cuts to the federal workforce and the Medicaid health care program for the poor. The debt-to-GDP ratio would have ended up at 86 percent under this plan, 1 percentage point above the baseline (Lawder, 2/23).

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Romney Defends Health Care Record On The Campaign Trail

News outlets report on how GOP presidential hopeful Mitt Romney is casting his health care policies as he moves toward the Tuesday's Michigan and Arizona primaries.   

The Associated Press: It's All Economy, All The Time For Romney
That was an invitation to discuss a requirement for all residents to purchase insurance, a feature that conservatives loathe in Obama's health care bill but is also present in the Massachusetts law. Romney steered clear. Instead, he said: "The first thing I'd say to him is, 'You say you copied (the Massachusetts law), how come you didn't give me a call? I'd have told you what worked, what did not work'" (Espo, 2/24).

Boston Globe: Fact Check: The GOP Debate
Mitt Romney was asked by moderator John King about a bill signed during his tenure as Massachusetts governor requiring Catholic hospitals to provide emergency contraception to rape victims. Asked if he made such a requirement, Romney responded: "No, absolutely not." …under Romney, Catholic hospitals became required to make the morning-after pill available to rape victims. In a Globe interview [in 2005], Romney said, "My personal view, in my heart of hearts, is that people who are subject to rape should have the option of having emergency contraception" (Schoenberg, 2/23).

Boston Globe: Romney Emphasizes Michigan Roots To Tea Party Crowd
On the biggest sticking point that Tea Party activists have with Romney – his health care plan in Massachusetts – he amped up his critique of the federal model that was patterned after his plan. "On every basis I can think of - it's bad policy, it's bad spending, it's bad for American people, it's bad for the practice of medicine," Romney said. "If I'm president, we’re getting rid of ObamaCare" (Viser, 2/24).

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Senate Contests Touch On Contraception, Health Reform Issues

Media outlets report on how these issues are being debated in Senate campaigns in Massachusetts and Texas.  

The Associated Press: In Mass., GOP's US Sen. Brown Invoking Kennedy
[Sen. Scott] Brown, who favors giving employers and health insurers broad moral and religious exemptions in health care coverage, has repeatedly quoted a letter that Kennedy, dying from brain cancer, asked President Barack Obama to hand-deliver to Pope Benedict XVI in Rome in 2009. ... Brown has seized on a portion of the letter in which the prominent Catholic politician tells the Pope that he believes "in a conscience protection for Catholics in the health field." Kennedy made the comments in the context of the fight over Obama's health care overhaul bill (LeBlanc, 2/23).

Boston Globe: Brown, Warren Release Radio Ads On Contraception Issue
Brown's ad highlights his support for amendment which would allow all employers to deny medical coverage based on moral objections. He calls it a religious freedom issue, "one of our most precious rights." [Democratic challenger Elizabeth] Warren's ad refers to a recent Congressional hearing about birth control that had no women testifying as an example that "Washington really doesn't get it" (Bierman, 2/23).

The Dallas Morning News: James Proposes Amendment To Gut 'Obamacare'
Republican Senate hopeful Craig James, saying he fears the Supreme Court will uphold the federal health care law and President Barack Obama could get re-elected, says he would propose changing the U.S. Constitution to outlaw any government requirement that individuals buy health insurance. "I would file a bill that would call for a constitutional amendment that guarantees the freedom and the liberty of every citizen to pick and choose if and what kind of health care they want," James said Thursday (Garrett, 2/23).

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Health Information Technology

Administration Releases New Health IT 'Meaningful Use' Rules

Officials with the Centers For Medicare & Medicaid Services published the second stage of "meaningful-use" rules for adoption of electronic medical records Thursday, laying out requirements for better digital communication among doctors and expanded patient access to records, in order for doctors and hospitals to get incentive payments.

Modern Healthcare: Proposed Stage 2 Requirements Raise The Bar For Providers
The proposed Stage 2 meaningful-use requirements raise the bar for hospitals and eligible professionals on the use of computerized physician order entry, electronic prescribing and electronic recording of several patient-health measures, according to CMS officials. ... Under the proposed Stage 2 standards, hospitals as well as eligible professionals — the latter category includes physicians not employed by hospitals — would have to use CPOE for more than 60 percent of medication, laboratory and radiology orders, double the share required under the Stage 1 standards (Grace, 2/23).

Kaiser Health News: Capsules: Health IT Coordinator: Release Of Stage 2 Guidelines A 'Push Ahead'
It's time to take electronic health records to the next level. Federal officials on Thursday released their second-stage guidelines for "meaningful use" of electronic records, which advocates say have the potential to reduce medical errors and streamline care. The proposed rules require doctors and hospitals to significantly step up their usage, as well as better engage patients and improve the transferability of records (Torres, 2/24).

Politico Pro: 'Meaningful Use' Rule Released After Delay
The delayed rule for Stage 2 of the government's program to expand the use of electronic medical records was released Thursday, proposing an expanded emphasis to online patient access and better digital communication among doctors caring for a patient. A second, technical rule that will describe what standards an electronic health record system must meet in order to be certified has not yet been released, but is expected to follow soon. Much in the rule follows the recommendations from an advisory panel on the second phase of the program, which will take effect in 2014, a year later than initially planned (Norman and DoBias, 2/23).

Medscape: New Meaningful-Use Rules Stress Online Contact With Patients 
Last year, CMS began awarding bonuses under Medicare and Medicaid to physicians who meet an initial set of meaningful-use requirements designed to improve the quality of care. There are currently 25 Stage 1 objectives, 15 mandatory and 10 elective. The mandatory ones include electronically prescribing more than 40 percent of prescriptions and recording demographic information such as date of birth, sex, and race as structured data for more than 50 percent of patients seen. Physicians must satisfy any 5 of the 10 elective requirements (Lowes, 2/23).

Bloomberg: Hospitals Face Added Tests To Access $14.6 Billion for Digital Health Data
Hospitals would have to show they've amassed the vital statistics of more than 80 percent of their patients in digital form, among other targets, to continue collecting as much as $14.6 billion in federal grants for installing electronic records technology sold by General Electric Co. (GE) and smaller suppliers. Awards of as much as $11.5 million are available to hospitals that demonstrate "meaningful use" of the equipment, under preliminary rules issued yesterday by the Obama administration. Doctors can apply for grants of $44,000 or $64,000, depending on whether they treat patients in Medicare, the federal health program for the elderly and disabled, or Medicaid, the program for the poor (Wayne, 2/24).

Medpage Today: Feds Finalize Next Stage of 'Meaningful Use' Guidelines
Providers must prove their EHR system is capable of meeting a list of specific objectives outlined by CMS, such as having the capability of exchanging a patient's notes, medication list, allergies, and diagnostic test results. ... The federal government will provide incentive payments of up to $44,000 per clinician (Walker, 2/23). 

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A Shifting Model Of Care For Older Patients

The New York Times reports on an emerging approach that allows many elderly patients to stay in their homes and still receive the medical care and social services the usually would get in a nursing home.

The New York Times: A Shift From Nursing Homes To Managed Care At Home
Faced with soaring health care costs and shrinking Medicare and Medicaid financing, nursing home operators are closing some facilities and embracing an emerging model of care that allows many elderly patients to remain in their homes and still receive the medical and social services available in institutions. ... The rapid expansion of this new type of care comes at a time when health care experts argue that for many aged patients, the nursing home model is no longer financially viable or medically justified (Berger, 2/23).

In other Medicare news -

Medscape: Top Hospitals for Emergency Care Have 40% Lower Death Rate
Medicare patients admitted to the nation's best-performing hospitals for emergency medicine have a 40% lower death rate compared with all other hospitals, according to a new survey by HealthGrades, a Denver, Colorado–based provider of information about physicians and hospitals. Some 263 hospitals of the nation's 4783 short-term acute care hospitals were chosen among the top 5% in providing emergency care (Crane, 2/22). 

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Cardiologists Not Satisfied With 'Doc Fix'

Medpage Today: Cardiologists Not Happy With SGR 'Fix'
The continual postponement of the SGR cuts has dampened the enthusiasm of younger cardiologists, said Robert O. Bonow, MD, director of the Center for Cardiovascular Innovation at Northwestern University Feinberg School of Medicine. ... In addition to the current economic uncertainty, cardiologists had already been dealing with slashes in reimbursement that took effect in 2010. These included cuts to nuclear imaging, echocardiograms, left heart catheterizations, and EKGs (Kaiser, 2/22). 

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Health Care Fraud & Abuse

Medicare's Fraud-Busting Computer Has Slow Start

The Associated Press/Washington Post: Inside Washington: Slow Start For Medicare's New Fraud-Busting Computer Disappoints Lawmakers
Launched last summer, a $77 million computer system to stop Medicare fraud before it happens had prevented just one suspicious payment by Christmas. That saved taxpayers exactly $7,591. Hoping for much better results, a disappointed Sen. Tom Carper, D-Del., says, "I wondered, did they leave out some zeros?" (2/23).

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State Watch

State Health Insurance Exchanges Moving In Fits And Starts

Vermont, Kansas, Missouri, Minnesota, Texas and California are grappling with various aspects of implementing the health law.

The Associated Press/Boston Globe: Vt. House Advances Health Insurance Overhaul Bill
The Vermont House on Thursday gave preliminary approval to a bill under which the state would take the next big step on a path to sweeping health insurance reform passed in broad outline last year. ... Vermont's version of the [health insurance] exchange called for under the federal health overhaul passed two years ago would go further than most, and it would be used as a springboard for moving the state toward a government-run single-payer health insurance system by decade's end (Gram, 2/23).

Kaiser Health News: Minnesota Exchange Grant Arrives In Politically Divided State
The federal government has awarded Minnesota a $26 million grant to help fund the creation of the state insurance exchange — a key part of the federal health care law. The grant comes to a state government bitterly divided over carrying out federal health reform (Stawicki, 2/23).

Kansas City Star: Kansas, Missouri Unlikely To Meet Deadline On Health Care
Kansas and Missouri are almost certain to miss an end-of-the-year deadline for establishing a key component of the nation’s health care law — health insurance "exchanges" where individuals and businesses can compare and purchase coverage. ... For months, experts in both states have been working quietly to figure out how to meet that Dec. 31 deadline. But conservative Republican lawmakers — concerned that the exchanges are an implicit endorsement of President Barack Obama's Affordable Care Act — have blocked further implementation of the exchanges (Helling, 2/23).

Kansas Health Institute News: Kansas Senate Narrowly Rejects Health Reform Protest
The Kansas Senate today narrowly rejected a proposed amendment to the state constitution protesting the federal health reform law. ... The supporters of House Concurrent Resolution 5007 said it would exempt Kansans from parts of the federal health reform law, specifically the mandate that those who can afford health insurance must have it or pay a tax penalty (Cauthon, 2/23). 

The Associated Press/Kansas City Star: Kansas Senate Rejects Health 'Freedom' Proposal
The chamber's eight Democrats were joined by six of the 32 Republicans to block it. One of them, Senate Judiciary Committee Chairman Tim Owens of Overland Park, said lawmakers shouldn't tell voters that a state policy can protect them from a federal law (Hanna, 2/23).

The Texas Tribune/New York Times: State To Close Program On Federal Health Law
A program created to help insurance-seekers in Texas cut through the complexities of federal health care reforms is shutting down in April, just 15 months after it opened its call center and years before the law goes into full effect. ...  federal financing was not renewed, and unlike some other states, Texas is not seeking alternative means to maintain its program (Tan, 2/23).

California Healthline: Pre-Reform Pressures Mount for California Hospitals
The California Hospital Association released a dire forecast for this year, predicting that most hospitals in the Golden State will face significant financial obstacles in 2012 and that some may be forced to close. According to the forecast, "California hospitals are facing pressures from every direction." The report cites the stalled economy, increasing dependence on government health insurance programs and implementation of the federal health reform law as the root of some of the most significant financial pressures (2/23). 

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Calif. Medicaid Chief Promises Dental Changes For Kids

California's state Medicaid chief is promising changes to dental care for kids, and North Carolina rolls out a medical home model for pregnant women.

Sacramento Bee: State Health Chief Vows Changes To Sacramento County Dental Program
The state's Medi-Cal chief, under pressure to improve dental care for Sacramento's poor children, pledged this week to implement changes so kids won't have to wait months to receive treatment for painful, rotted or broken teeth. In response to concerns raised by Senate President Pro Tem Darrell Steinberg, D-Sacramento, Toby Douglas outlined the steps that the state Department of Health Care Services will take to ensure that the more than 110,000 Sacramento County children with Medi-Cal get "high quality and timely" dental care (Bazar, 2/24). 

Stateline: Pregnancy Medical Homes Gain Momentum In North Carolina
Launched less than a year ago, [North Carolina Medicaid Director Craigan] Gray's program, called pregnancy medical homes, is showing promise. ... To qualify, primary care doctors, obstetricians, nurse midwives and public health clinics must agree to screen every Medicaid-eligible woman who tests positive for pregnancy to determine whether she is at risk for complications. ... As an encouragement to participate in pregnancy medical homes, the Medicaid program pays doctors an additional $200 per patient (Vestal, 2/24).

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Texas Bars Abortion Providers From Medicaid, Endangering Federal Money

Texas is barring abortion providers from the state's Medicaid program in defiance of the federal government, sparking a showdown that could close the state's Women's Health Program.

The Hill: Texas Defies Obama Administration, Bars Abortion Providers From Medicaid
Texas on Thursday passed regulations barring Planned Parenthood clinics and other "affiliates of abortion providers" from participating in the state's Medicaid program starting March 14, the Texas Tribune is reporting. The Obama administration has told Texas that its plans violate federal law. If the two parties can't reach agreement, the newspaper reports, the state's Women's Health Program could be dismantled, leaving 130,000 low-income women without access to birth control, cancer screenings and other preventive benefits (Pecquet, 2/23).

The Dallas Morning News: Texas May End Program That Provides Contraceptives, Cancer Screenings To Poor Women
Texas has signaled that it would rather lose $35 million annually in federal help to provide 130,000 poor women access to health care than allow Planned Parenthood to receive part of the funding. Health and Human Services Commissioner Tom Suehs signed a rule Thursday that officially bans Planned Parenthood and abortion provider affiliates from getting funding from Texas' largely successful Women's Health Program (Ingram, 2/23).

The Associated Press/Houston Chronicle: New Texas Rule Could End Women's Health Program
The Texas Department of Health and Human Services announced Thursday it will enforce a new state law that could shut down the Women's Health Program, which provides health care to more than impoverished 130,000 women. Last year, the Republican-controlled Legislature passed a law making it illegal for the state to provide Medicaid funds to a doctor or clinic that is affiliated with an organization that provides elective abortions, even if the institution receiving the money does not provide them (Tomlinson, 2/23).

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Va. Considering New Abortion Ultrasound Bill After More Controversial Bill Pulled

Fallout over Virginia Gov. Bob McDonnell's decision to pull support for a controversial ultrasound abortion bill continues as a similar piece of legislation, which would require a less-invasive ultrasound, winds through that state's legislature.

NPR: Virginia Governor Backs Down From Ultrasound Bill
Several states are considering laws that would mandate an ultrasound before a woman has an abortion. Critics say the laws are unnecessary and intrusive, and the debate reached a fever pitch recently over a Virginia bill that would have required an invasive ultrasound procedure. On Wednesday, Virginia's Republican governor, Bob McDonnell, asked legislators to back off and revise the House bill. Later that day, the Senate version of the bill was withdrawn by its sponsor. Now, a version of the bill that calls for a less invasive ultrasound is working its way through the Virginia General Assembly (Lohr, 2/23).

The Associated Press: Ridicule Helped Doom Va. Ultrasound Bill
Once the word "transvaginal" became a big joke on "Saturday Night Live" and "The Daily Show With Jon Stewart," it wasn't long before Virginia's conservative Republicans realized they had overreached on abortion. Gov. Bob McDonnell and GOP state lawmakers Wednesday abandoned a bill requiring women to undergo an intrusive type of sonogram before an abortion — an abrupt reversal that demonstrated the power of political satire and illustrated again how combustible the issue of women's reproductive health has become over the past few weeks (Lewis, 2/23).

Politico: Blogs Hit Bob McDonnell On Ultrasound Bill
The conservative blogosphere collectively bemoaned Virginia Gov. Bob McDonnell's decision to withdraw his support for legislation requiring invasive ultrasounds to be performed before abortions. "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 Wednesday. Bloggers on the right expressed dismay – even feelings of betrayal – over the move (Mak, 2/23).

The Texas Tribune: In Texas and Va., Different Reactions to Sonogram Bills
The original Virginia bill that garnered so much national outrage required doctors to perform a sonogram in advance of the abortion, using a transvaginal ultrasound if necessary, to determine the gestational age of the fetus. ... The Texas law is more strict: It requires women to have a sonogram at least 24 hours ahead of an abortion, and the doctor to play the heartbeat aloud, describe the fetus, and show the woman the image, unless she chooses not to view it. Although the Texas law doesn't specify what kind of ultrasound — belly or transvaginal — abortion providers say they almost always must use the transvaginal probe to pick up the heartbeat and describe the fetus at the early stage of pregnancy when most women seek abortions (Ramshaw, 2/23).

In the meantime, a "personhood" bill in Virginia won't be considered before the 2012 election –

Politico: Virginia Stalls 'Personhood' Bill Until 2013
The Virginia state Senate sent a controversial "personhood" bill that would define life as starting at conception back to committee on Thursday, killing any chance of action on the measure before the 2012 election (Weinger, 2/23).

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State Roundup: Calif. Prison Medical Facilities; New Ore. Rx Dispensing Rules

A selection of health policy stories from Texas, Oregon, Louisiana, Pennsylvania, California, Massachusetts and Colorado.

WBUR's CommonHealth blog: Top Health Care Official In Patrick Administration Departs
David Martin, who helped write Governor Deval Patrick's health care payment reform bill, is leaving. Martin, the Director of Health Care Policy and Strategy in the office of Health and Human Services, is taking a job at Covidien as Senior Director of Health Care Economics and Policy (Bebinger, 2/23).

Los Angeles Times: New Prison Medical Facilities Unnecessary, Analyst Says
California should hold off on building new medical facilities for prison inmates, according to report released Thursday by the legislative analyst's office. The report contradicts plans by a court-appointed receiver, who has run the prison health system since a federal judge declared it unconstitutionally inadequate, for $2.3 billion in new clinics and upgrades (Megerian, 2/23).

Denver Post: Colorado Lawmaker Kills Own Health Care Bill For Retired Public Employees As PERA Issues Pile Up At Capitol
In a stunning twist, a Republican lawmaker killed his bill that would have changed health care for retired public employees while another measure inspired in part by former Gov. Bill Ritter's jump in salary was delayed for a week. The two bills were among four Republican measures concerning the Public Employees' Retirement Association (Bartels, 2/24).

The Philadelphia Inquirer: Report Shows Jefferson Hospitals’ Billing Errors Resulted In Medicare Overpayment
Billing errors at two of the three Thomas Jefferson University Hospitals in 2008 and 2009 resulted in Medicare overpaying the hospital system $43,438, according to a report released Thursday by the Department of Health and Human Services Office of Inspector General. ... This case involved no apparent fraud, but it did touch a problematic area for hospitals - readmissions and the errors that cause them (Sell, 2/23).

New Orleans Times-Picayune: Mental Health Cutbacks Can't Be Stopped, New Orleans Legislator Tells City Council Members
Hoping to beat back pending cuts to state-financed mental health and substance abuse services, New Orleans City Council members on Thursday invited New Orleans' legislative delegation and leaders of key city public health agencies to discuss a strategy for reversing a $15 million reduction in the budget of Interim LSU Public Hospital beginning next month. ... The reduction is expected to lead to elimination of the facility's chemical detox unit and the closure of beds in the emergency department, mental health emergency extension and psychiatric inpatient unit at the DePaul Hospital campus (Krupa, 2/23).

California Healthline: Hearing Examines States' Behavioral Health Restructuring
The state is moving to eliminate the Department of Mental Health, essentially folding it into the Department of Health Care Services. According to state HHS undersecretary Michael Wilkening, almost all the functions of the current Department of Alcohol and Drug Programs also will shift to DHCS. "We think there will be efficiencies gained from elimination of those two departments," Wilkening said (Gorn, 2/24).

The Texas Tribune: Perry Surgeon Has Been Critic of Texas Health Policies
When Gov. Rick Perry goes under the knife on Friday morning to repair his right clavicle, he'll be in the hands of the president of the Texas Medical Association. ... [Dr. Bruce Malone] told The Texas Tribune last month that slashing family planning dollars and eliminating the Medicaid Women's Health Program to force Planned Parenthood out of Texas would be "a very stupid political thing," adding that there is not "another safety net for these women for medical care" (Ramshaw and Tan, 2/24).

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Health Policy Research

Research Roundup: Hospital Medication Errors; Key Medicaid Issues In 2014

Every week, KHN reporter Shefali S. Kulkarni compiles a selection of recently-released health policy studies and briefs.

Government Accountability Office: Use Of Preventive Services Could Be Better Aligned With Clinical Recommendations -- This report looks at Medicare patients' use of eight specific preventive services, which have "the potential to improve health outcomes and lower health care expenditures," according to the authors. Use of cardiovascular and cervical cancer screenings "generally aligned with clinical recommendations, ... but use of other cancer screenings" did not. GAO recommended that Congress "consider requiring beneficiaries to share the cost of a service if the [U.S. Preventive Services] Task Force recommends against use of that particular service for those beneficiaries. The Administrator of CMS should provide coverage for Task Force recommended services" (2/17).

Health Affairs: The Prevention and Public Health Fund -- This brief outlines why the Prevention and Public Health Fund was created as part of the health law, "examines where spending has gone to date; and lays out the debate over preserving, cutting, or eliminating the fund altogether." The author concludes: "It is not clear how the Obama administration will carry out the $250 million cuts in prevention fund spending in fiscal year 2013. Meanwhile, some observers worry that the dollars the fund does provide will simply be used to offset cuts in existing federal health programs, rather than to support new prevention efforts and spending that many believe are needed. Such an outcome could pose special challenges at the state level, where many localities are operating under extremely tight budgets"  (Haberkorn, 2/23).

Journal Of General Internal Medicine: Effects Of Patient- And Medication-Related Factors On Inpatient Medication Reconciliation Errors -- By analyzing a group of more than 400 adults with acute coronary syndromes who were hospitalized, researchers saw that these pre-admission medication list (PAML) errors were most common at hospital admission and discharge. "Errors in preadmission medication histories are associated with older age and number of medications and lead to more discharge reconciliation errors. A recent medication list in the EMR is protective against medication reconciliation errors" (Salanitro et. al., 2/15).

Journal Of The American Medical Association: Association Of Age And Sex With Myocardial Infarction Symptom Presentation And In-Hospital Mortality -- Women are usually older than men when they are hospitalized with a heart attack. This observational study of more than one million patients from 1994-2006 found that "women were more likely than men to present without chest pain and had higher mortality than men, especially among younger age groups, but sex difference in clinical presentation without chest pain and in mortality were attenuated with increasing age” (Canto et. al., 2/23).  

The RAND Institute: The Effect Of The Affordable Care Act On Enrollment And Premiums, With And Without The Individual Mandate -- This analysis uses RAND's "COMPARE microsimulation model" to predict that if the health law's individual mandate begins, as scheduled, in 2014, "91 percent of the nonelderly population," would have health insurance coverage, "compared with 81 percent without any policy change. ... If the ACA is implemented but the mandate is voided, we predict that 87 percent of the population would have insurance coverage" (Eibner and Price, 2/15). 

Kaiser Commission on Medicaid and the Uninsured: Key Issues To Consider For Outreach And Enrollment Efforts Under Health Reform -- "Based on a discussion with federal and state officials and experts, this report identifies key issues to consider with regard to outreach and enrollment under reform," according to the authors. Experts noted that preparing for 2014 "will entail a significant organizational and cultural shift" among state Medicaid eligibility staffs, and add: "Proven Medicaid and CHIP outreach and enrollment strategies will serve as a roadmap for enrolling individuals under reform, but new approaches will also be required" (Stephens and Artiga, 2/21).

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Editorials and Opinions

Viewpoints: Elizabeth Warren On Contraception Mandate, Comparison Shopping For Drugs, 'Dismantling' Illinois

Kaiser Health News: Different Takes: Maryland Advances An 'Enterprising' Plan To Eliminate Health Disparities
In this Kaiser Health News Different Takes feature, The University Of Maryland's Dr. E. Albert Reece and The Heritage Foundation's Stuart Butler discuss how health enterprise zones, a new take on an old economic development idea, might be used to improve the health of the state's minority populations (2/23). Read the commentaries by Reece and Butler

Boston Globe: Denying Women Coverage Under Any Guise Is A Big Step Backward
Maybe you saw the pictures. Five middle-age men seated at a congressional hearing table to discuss freedom of religion and contraception. And not a single woman was on the panel. Unbelievable. Do you think Congress would ever have a hearing on prostate cancer and only have women speak? Of course not. Washington is so out of touch with what’s happening to families across this country that the Senate is about to vote on an amendment that would allow any insurance company or any employer to claim a vague “moral conviction’’ as an excuse to deny you health care coverage. Here’s the really astonishing news: Senator Scott Brown is not only voting for this amendment, he is fighting to get it passed (Elizabeth Warren, 2/24).

Los Angeles Times: Making It Easy To Comparison Shop For Prescription Drugs
The Internet has already changed how people shop for books, music, cars and a host of other consumer goods. Next up: prescription drugs. Or so the founders of a Santa Monica start-up called GoodRx are hoping (David Lazarus, 2/24).

Chicago Tribune: Dismantling Illinois
We realize the human costs of closing redundant institutions and offices: Dismantling Illinois affects employees, their families and citizens. We also, though, realize the need for this downsizing. Expect cuts to overhead next year and in years after. The higher income tax you pay? In the next budget, virtually every penny of that $7 billion in new revenue goes to pension obligations. Nor would Quinn's proposed cuts salvage Illinois: Pension funds still will be underfunded by more than $80 billion, retiree health care by perhaps $40 billion. On Tuesday we wrote that you would know Quinn is serious about improving Illinois' finances if he cleared five hurdles in Wednesday's address. How did he do? Pretty well, to a point (2/23).

The Washington Post: The Elderly Should Share The Burden
One hallmark of the Obama administration’s budget policy has been to exempt the elderly from major cuts, even though spending on the elderly — mainly through Social Security, Medicare and Medicaid — represents 40 percent or more of the budget. The main reason is political: The elderly (it’s presumed) would vote against politicians who would cut their benefits. But to justify the policy, politicians and others often portray the elderly as financially vulnerable with scant savings. Surprise: It’s not true (Robert J. Samuelson, 2/23).

The Washington Post: Santorum’s Lightning–Fast Flip-Flop On Birth Control Funding
I was getting ready to write something nice about Rick Santorum. Then Rick Santorum talked me out of it. The nice thing was about the former Pennsylvania senator’s self-described support for Title X, the federally funded family planning program that provides contraceptive services for low-income women (Ruth Marcus, 2/23).

The Seattle Times: State Should Appeal Ruling That Pharmacists Cannot Be Compelled To Dispense Contraceptives
Failure to ensure timely access to emergency contraceptives denies critical health care to women. Yet U.S. District Judge Ronald Leighton ruled this week that Washington state cannot compel pharmacies to sell emergency contraceptives. How disappointing. Pharmacies are licensed by the state, which has a compelling interest in requiring them to dispense any medication for which there is a community need. … The state should appeal (2/23).

The Atlanta Journal-Constitution: The Doctor Is Not In
Most do not want to recognize that health care is rationed. It is done so by lack of insurance. Health reform is expected to rectify that, but it will exacerbate a new form of rationing: the doctor is not in (Steve Jacob, 2/23).

The Atlanta Journal-Constitution: Mercer Works Hard to Fix Medical Ills
So what else is needed to address this crisis? First, continue the expansion of medical school enrollments. … Georgia also must invest in expanding medical residency training positions at both existing and new sites. Finally, Georgia must invest in incentives to attract physicians, such as more loan repayment options for those who practice in rural and underserved areas, increased scholarship funding for those who agree to practice in rural and underserved areas and additional tax credits (William F. Bina III).

Philadelphia Daily News/Philadelphia Inquirer: State Budget Cuts Will Make All Of Us Vulnerable
Testifying at a two-hour PhillyStat meeting were people on the front lines of those areas that will be affected by Corbett's proposal to consolidate seven state appropriations - including services for mental health, intellectual disabilities, county child welfare, behavioral health, homeless help, and drug and alcohol treatment - into a single block grant, while slashing the money for these by 20 percent. Also, the general assistance grant, a $205-per-month - yes, that's per month - stipend to sick and disabled adults, victims of domestic violence, and very low-income children, is being eliminated. Deputy Mayor for Health Don Schwarz calls the budget a recipe for disaster. Every state budget prompts worries that the sky will fall, especially in cities like ours, and few are better meteorologists of this phenomenon than advocates for the poor, disabled and vulnerable (2/24).

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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.