Daily Health Policy Report

Monday, February 25, 2013

Last updated: Mon, Feb 25

KHN Original Reporting & Guest Opinion

Health Spending And Fiscal Battles

Health Reform

Administration News

Public Health & Education

Health Care Marketplace

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Plans To Expand Florida Medicaid Welcomed And Feared

Kaiser Health News staff writer Phil Galewitz, working in collaboration with The Washington Post, reports: "Almost overnight, Florida has gone from being an ardent opponent of the federal health care law to a laboratory for an ambitious experiment under the law" (Galewitz, 2/24). Read the story.

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Capsules: 2 Hill Panels Examining Changes To Medicare

Now on Kaiser Health News' blog, Mary Agnes Carey reports: "With $85 billion in automatic federal spending cuts set to take effect on Friday and predictions of economic disruption, much of official Washington is focused on the 'blame game.' Publicly, there has been no sign that Congress or administration officials has made any progress on averting these cuts or finding common ground on tackling the country's fiscal problems" (Carey, 2/25). Check out what else is on the blog.

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Political Cartoon: 'No Man Is An Island?'

Kaiser Health News provides a fresh take on health policy developments with 'No Man Is An Island?' by Nick Anderson.

Meanwhile, here is today's health policy haiku: 

The ACA AT 40,000 FEET

Implementation
Like bags in overhead bins
Heavy and awkward 
-Alan Weil 

And, just because it's the morning after:

AND THE OSCAR GOES TO ...

Sunday show chatter
and sequester posturing.
Who wins best actor?
-Anonymous

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

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Health Spending And Fiscal Battles

With Sequester Day Looming, Politics Become More Entrenched

Some news outlets take a hard look at the impact that health programs would feel if the scheduled cuts go forward.

The New York Times: Budget Impasse Signals A Shift In GOP's Focus
But at the heart of the battle over sequestration — the nearly $1 trillion in budget cuts that are scheduled to begin on Friday and accelerate over the next decade — are fundamental misunderstandings between the two parties over their respective priorities. During the 2011 negotiations to raise the nation's statutory borrowing limit, Mr. Obama wanted an onerous "trigger" to force both sides to reach a compromise on deficit reduction. For Democrats, the bludgeon that would drive them to negotiate changes to entitlement programs like Medicare and Social Security would be cuts to domestic programs like child nutrition and national parks. For Republicans, the president wanted automatic tax increases to force a compromise on the broader tax code (Weisman and Parker, 2/24).

The New York Times' Political Memo: A Complex Role For Medicare In The Standoff In Washington
But the politics of one core dispute between Democrats and Republicans — what to do about Medicare — are changing. And some of those changes complicate President Obama's agenda, even as he continues to flex his postelection muscle (Harwood, 2/24).

Los Angeles Times: Neither Side Blinks In Federal Budget Standoff
Now the cuts that both said would never happen are only days away. With some of the largest government programs, including Medicaid and Social Security, fully walled off from the cuts, and Medicare only partially exposed, the reductions in other federal accounts work out to about 13% for defense and 9% for domestic spending for the rest of this year, according to the government's Office of Management and Budget. At first, the public likely will not notice huge changes. Many furlough notices for federal workers take at least 30 days to kick in, for example, and the effect on other programs will vary in timing (Mascaro, 2/23).

The Hill: Health World Braces For Sequester
Every corner of the healthcare world has something — and potentially a lot — to lose from the $85 billion in automatic spending cuts set to hit the government on March 1. Doctors and hospitals say the sequester’s Medicare cuts will cost their industries more than 200,000 jobs just this year (Baker, 2/24).

Medpage Today: Pressure Rising To Avoid Cuts To Health Programs
Pressure is mounting for Washington to find a way to avoid the automatic spending reductions set to begin March 1, with President Barack Obama Tuesday urging Congress to stop the "meat-cleaver approach" that he says will undermine U.S. military strength and "eviscerate job creating investments in education and energy and medical research." But while both Democrats and Republicans say they don't want the billions of dollars in cuts to kick in, there's no agreement on how to stop them. The nation's two major health entitlement programs, Medicare and Medicaid, are protected from the bulk of the cuts which will hit a wide swath of federal discretionary spending. Other government programs, including health-related programs, such as medical research, mental health treatment and approvals for new drugs, face reductions of 5 percent or more, according to the Congressional Budget Office (2/22).

Kaiser Health News: Capsules: 2 Hill Panels Examining Changes To Medicare
With $85 billion in automatic federal spending cuts set to take effect on Friday and predictions of economic disruption, much of official Washington is focused on the "blame game." Publicly, there has been no sign that Congress or administration officials have made any progress on averting these cuts or finding common ground on tackling the country's fiscal problems (Carey, 2/25).

Reuters: Latest Simpson-Bowles Health Plan Stirs Worry But Lacks Detail
A new bipartisan deficit-reduction plan to slash a massive $600 billion from U.S. healthcare spending over two decades has policy experts scratching their heads over how such an ambitious target can be reached. Democrat Erskine Bowles and Republican Alan Simpson have yet to declare what they would do to wring savings from Medicare, Medicaid and other programs, according to analysts who provide the two deficit hawks with their facts and figures (Morgan, 2/24).

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Governors Brace For Impact Of Scheduled Cuts In Home States

The nation's governors met in Washington over the weekend, and among their hottest topics: a White House warning regarding the state-by-state impact of sequestration, which is scheduled to kick in March 1. 

The New York Times: As Governors Meet, White House Outlines Drop In Aid To States
In an effort to put pressure on Congressional Republicans, the White House warned on Sunday that automatic budget cuts scheduled to take effect this week would have a devastating impact on programs for people of all ages in every state (Pear, 2/24).

The Washington Post: White House Releases State-By-State Breakdown Of Sequester's Effects
Republicans questioned whether the sequester would be as harmful as the White House predicted and worked on a proposal that could preserve the cuts while giving the administration more discretion to choose how to implement them. Democrats expressed worry that they might be forced to accept the cuts if the public outcry is not loud enough in coming weeks (Goldfarb and Kane, 2/24).

The Associated Press/Los Angeles Times: Governors From Both Parties Condemn Forced Federal Budget Cuts
At their weekend meetings, governors were focusing on ways to boost job development, expand their state economies, restrict gun violence and implement the new healthcare law approved during President Obama's first term. Some Republican governors have blocked the use of Medicaid to expand health insurance coverage for millions of uninsured; others have joined Democrats in a wholesale expansion as the law allows. The Medicaid expansion aims to cover about half of the 30 million uninsured people expected to eventually gain coverage under the healthcare overhaul. Yet for many governors, the budget fight remains front and center and fuels a pervasive sense of frustration with Washington (2/23).

The New York Times: In Impasse, New York Would Face Steep Cuts
The three states would also face nearly $1 million in curtailments to programs providing vaccinations to children against diseases like mumps, rubella, tetanus, measles, whooping cough, hepatitis B and influenza. If enacted, the cutbacks would mean that 12,670 fewer children would be receiving vaccinations in all three states, according to the White House estimate. … Programs providing meals for older people would also be hit. New York, New Jersey and Connecticut would face about $2.1 million in cuts to such programs, the White House estimated (Hernandez, 2/24).

Oregonian: Mandatory Spending Cuts Could Be Felt In Oregon In Ways Big And Small, White House Warns
With hope fading that a deal will be reached to avert $85 billion in across-the-board federal spending cuts that begin on Friday, here's what the failure could mean in Oregon. Air traffic control facilities in Portland, Klamath Falls, North Bend, Pendleton and Salem "could close," the Federal Aviation Administration says as part of its effort to cope with a $600 million gash in its operating budget. The FAA is considering closing control towers at 100 airports that have fewer than 150,000 flight operations per year. … Approximately 1,670 fewer children will receive vaccines for diseases such as measles, mumps, rubella, tetanus, whooping cough, influenza, and Hepatitis B due to reduced funding for vaccinations of about $114,000. Oregon will lose about $890,000 in grants to help prevent and treat substance abuse, resulting in around 3800 fewer admissions to substance abuse programs. And the Oregon Health Authority will lose about $113,000 resulting in around 2,800 fewer HIV tests (Pope, 2/25).

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Govs. Jindal, Walker Offer Views On Averting Sequester, Reducing Deficit

Louisiana Gov. Bobby Jindal suggested delaying implementation of parts of the health law. Wisconsin Gov. Scott Walker recommends focusing on paring back Medicare and Social Security spending.

The Washington Post: Jindal: Delaying Medicaid Expansion, Health Care Exchanges Could Avert Sequester
Louisiana Gov. Bobby Jindal (R) suggested Sunday that delaying elements of President Obama's health care law could help avert the across-the-board spending cuts known as the sequester (Sullivan, 2/24).

Politico: Jindal Pitches Obamacare Delay
Louisiana Gov. Bobby Jindal has one idea to help avoid the looming sequester: Use Obamacare. The Republican governor said delaying the expansion of Medicaid and delaying the health care exchanges created under the Affordable Care Act would help find the funds to offset the coming automatic budget cuts (Kim, 2/24).

The Hill: Jindal: Delaying Obama Health Care Law Could Help Offset Sequester
Republican Gov. Bobby Jindal (La.) on Sunday proposed delay the implementation of President Obama's healthcare reform law to help offset the looming sequester cuts. … Jindal has been a strong critic of the president's signature health care reform bill, and has said his state will not participate in the law's Medicaid expansion. The Louisiana governor's comments come ahead of the $85 billion in across-the-board sequester cuts set to take effect on Friday (Mali, 2/24).

Bloomberg: Walker Says Entitlements Should Be Cut To Reduce Deficit
Wisconsin Governor Scott Walker said Congress should reduce the budget deficit by paring back spending on Social Security and Medicare instead of relying on across-the-board spending cuts scheduled to begin on March 1. … The federal government shouldn't raise taxes again because that could exert a drag on the still-recovering U.S. economy, said Walker, who won election in 2010, when his party gained the majority in the U.S. House (Selway, 2/23).

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Health Reform

Re-Election Pressures May Be Driving Some GOP Govs Toward Medicaid Expansion

Meanwhile, news outlets report on health law implementation news from a variety of states, including Florida, California, Indiana, New Hampshire, Nebraska, Virgina, Kansas and Kentucky.

McClatchy: GOP Governors Turn Pragmatic As Election Nears
Faced with tough re-elections and constituents clamoring for government services, Republican governors in some big swing states are turning pragmatic, pulling away from the conservative line that helped them win in 2010. The clearest sign of the shift comes from seven Republican governors who have agreed to expand the Medicaid program, a key feature of President Barack Obama’s health care law that some bitterly opposed when winning their seats. But the governors are learning, as their predecessors did, that voters tend to judge them on how well they manage government, not how eloquently they articulate political theory (Lightman, 2/24).

CNN: Millions More Could Join Medicaid As Republican Governors Cave In
Despite their initial, vehement protests, a growing number of Republican governors are giving their blessing to expanding Medicaid in their states. That opens the door for millions of poor Americans to enroll in government health care coverage, beginning in 2014. Florida Governor Rick Scott on Wednesday became the latest to warm up to the expansion, which broadens coverage to adults with incomes below 138 percent of the poverty line. Medicaid rules vary from state to state, but many states (including Florida) do not currently cover most childless, non-disabled and non-elderly adults. Scott, a former health care executive, follows his GOP peers in Ohio, Michigan, Arizona, New Mexico, Nevada and North Dakota in accepting a reform they once strongly opposed (Luhby, 2/22).

Kaiser Health News: Plans To Expand Florida Medicaid Welcomed And Feared
Almost overnight, Florida has gone from being an ardent opponent of the federal health care law to a laboratory for an ambitious experiment under the law (Galewitz, 2/24).

Los Angeles Times: Jerry Brown Wants Wiggle Room From Feds On Health Care
(Gov. Jerry) Brown hopes to coordinate with other state leaders about how to expand coverage to the poor under the federal Medicaid program. Speaking to reporters at the National Governors Assn. winter meetings in Washington on Saturday, Brown said he wants to "build support among the governors for an appropriate state rule in the Medicaid expansion." With billions of dollars at stake, he said it was "absolutely critical that states have the authority they need to manage this very complex and expensive program" (York, 2/23).

The Associated Press: 'Elephant'-Size Prices For Health Care
The cost of health care for an additional 400,000 low income residents is something nobody in the Statehouse seems to be able to nail down firmly this year, even as the crucial decision about whether to expand Medicaid bears down on lawmakers midway through their annual session. The Medicaid expansion could end up costing Indiana $503 million in state dollars if the state expands coverage or $10.5 billion in lost federal aid if it does not, according to estimates from the Indiana Hospital Association (LoBianco, 2/24).

The Associated Press: NH Moves Forward With Health Overhaul Law
New Hampshire has taken two significant steps in implementing the Obama administration's health overhaul law, though there's a lot left to do and not a lot of time to do it. Gov. Maggie Hassan recently announced that New Hampshire will partner with the federal government to operate the new insurance markets required under the law, and she wants to take advantage of the federal government's offer to temporarily cover the cost of expanding the state's Medicaid program. In both cases, going further requires the approval of other parties, however (Ramer, 2/24).

The Associated Press: Neb. Schools May Cut Hours To Avoid Health Law
A lawyer for Nebraska public school districts said districts are considering cutting thousands of part-time non-teacher employees' hours next year to avoid offering them health insurance benefits mandated by the Affordable Health Care Act. The act requires large employers -- those with at least 50 full-time equivalent workers -- to cover at least 60 percent of health care costs for employees who works more than 30 hours per week, putting some businesses and government agencies in a difficult position (2/25).

The Associated Press: Dems Seek Vote On Medicaid
The Indiana House's top Democrat urged his Republican colleagues on Friday to consider expanding Medicaid before a key legislative deadline next week, calling it one of the most important job-creating needs this year. House Minority Leader Scott Pelath called on GOP leaders a day after Republican Gov. Mike Pence hit the brakes on legislation that would expand Medicaid in the state (LoBianco, 2/23).

Kansas Health Institute: Budget Committee Hears Resolution Opposing Medicaid Expansion
Expanding the Kansas Medicaid program is the "morally right thing to do," according to a spokesman for Via Christi Health, the state's largest medical provider -- and if the state says no to it, the financial costs to the health system would "be greater than if we say yes." Dr. Keven Hoppock of Via Christi, a Catholic non-profit based in Wichita, was among the spokespersons for major medical providers who testified today against House Concurrent Resolution 5013, which would declare that the "will of the Kansas Legislature is that the state of Kansas not expand Medicaid above its current eligiblity levels" (Shields, 2/22).

The Associated Press: Senate Oks Bills To Give Assembly Say On Medicaid
The Senate approved two bills Friday that would give the Legislature more say on the federal health care overhaul's role in Kentucky. The measures would allow lawmakers to vote on whether Kentucky expands the Medicaid program and sets up a state-run marketplace to sell insurance to individuals and small businesses (Finley, 2/22).

Richmond Times-Dispatch: Two Local Delegates Named To Medicaid Commission
The members of the House of Delegates who will sit on the Medicaid Innovation and Reform Commission were announced Sunday, and two represent the Richmond area. Dels. R. Steven Landes, R-Augusta, Jimmie Massie, R-Henrico, John M. O’Bannon III, R-Henrico, Johnny S. Joannou, D-Portsmouth, and Beverly J. Sherwood, R-Frederick, were named to the commission. The Senate appointees have not yet been chosen. O’Bannon, a physician, said in a statement that Medicaid is the fastest-growing item in the state budget, and that expansion "without significant reforms could wreck Virginia's finances" (2/15).

Kansas Health Institute: Budget Committee Hears Resolution Opposing Medicaid Expansion
Expanding the Kansas Medicaid program is the "morally right thing to do," according to a spokesman for Via Christi Health, the state's largest medical provider -- and if the state says no to it, the financial costs to the health system would "be greater than if we say yes." Dr. Keven Hoppock of Via Christi, a Catholic non-profit based in Wichita, was among the spokespersons for major medical providers who testified today against House Concurrent Resolution 5013, which would declare that the "will of the Kansas Legislature is that the state of Kansas not expand Medicaid above its current eligiblity levels" (Shields, 2/22).

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With No Budget, Panel To Study Health Care Work Force Shortage Has Never Met

As health law implementation efforts advance, workforce issues continue to draw headlines. Meanwhile, the Obama administration released final rules Friday regarding key elements of the overhaul, and the law's birth control coverage mandate continues to be the subject of court challenges.

The New York Times: Panel On Health Care Work Force, Lacking A Budget, Is Left Waiting
One of the biggest threats to the success of President Obama's health care law comes from shortages of doctors, nurses and other health care professionals. But a 15-member commission created to investigate the problem has never met in two and a half years because it has no money from Congress or the administration (Pear, 2/24).

The Wall Street Journal's Washington Wire: White House Doesn't Budge On Health Premiums
The Obama administration isn't budging on restrictions in the federal health-care law over how much insurance companies can reduce premiums for younger consumers. Federal officials released final rules Friday confirming that insurers will not be allowed to charge older people more than three times the amount they charge younger people starting in 2014 (Radnofsky, 2/22).

Medpage Today: HHS Finalizes ACA Consumer Protections
The Department of Health and Human Services (HHS) has finalized rules for implementing some of the key provisions of the Affordable Care Act, including guaranteed issue and guaranteed renewal of insurance policies. In addition to requiring insurers to issue policies to patients regardless of their health histories and to renew those policies at the patient's request, the rules also limit insurers to varying premiums based only on the patient's tobacco use, family size, and age -- with an older person paying no more than three times what a younger person is charged. Insurers will not be allowed to charge premiums based on health status, past claims, gender, occupation, length of time the person has been insured, or employer size (Frieden, 2/23).

Politico: Suits Hit Contraception Rule's 'Religious Burden'
The Obama administration is aggressively defending its contraception coverage policy in the courts, asking judges to require the companies bringing the lawsuits to provide contraceptives to their employees even before the legal fight over religious freedom is resolved (Haberkorn and Smith, 2/25).

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Administration News

Report: Insurance Rate Hike Requests Drop As A Result Of Govt. Scrutiny

According to the Department of Health and Human Services, requests by health insurers for double-digit rate increases dropped. The report credits the health law with this development.

The Washington Post: Big Health Insurance Rate Hikes Are Plummeting
The number of double-digit rate increases requested by health insurers has plummeted over the past four years, according to a Friday report from the Obama administration (Kliff, 2/23).

Bloomberg: Health Premium Increases Damped By Greater U.S. Scrutiny
The number of requests by health insurers for double-digit rate increases fell about 41 percentage points since the end of 2009, according to a U.S. report that cited the success of the health-care overhaul. The data today by the U.S. Department of Health and Human Services showed one-third of requests last year asked states to approve premium increases of more than 10 percent. In 2010, three-quarters of petitions sought double-digit jumps, according to the report, which compared 15 states in 2012 with 11 in 2010 (Wayne, 2/22).

In other insurance coverage news --

The Hill: Employer-Based Health Coverage Hits New Low
The number of people getting health care through an employer is at its lowest point since President Obama took office, according to new Gallup data. Republicans consistently argue that President Obama's health care law will erode employer-based coverage. And the latest Gallup figures show that while the economy has steadily added jobs over the past year, that trend hasn't come with rising levels of employer-based health care (Baker, 2/22).

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Public Health & Education

After Newtown Shootings, Advocates Hoping For Major Infusion In Mental Health Spending

Supporters of broader access to mental health care see the current debate as an opportunity to reverse long-time budget cuts across the country. Meanwhile in Texas, some mental health activists are seeking changes in detention policies.

The Washington Post: After Newtown, Support For Mental-Health Spending Grows
Mental-health advocates from coast to coast are seizing upon a rare and unexpected chance to stem the years-long tide of budget cuts and plug gaps in the nation's patchwork mental-health care system. In the wake of the massacre in Newtown, Conn., lawmakers from both parties, along with notoriously tight-belted governors, are pushing to restore some of the estimated $4.3 billion in mental-health spending that was slashed from state budgets between 2009 and 2012. At the same time, they are weighing new initiatives, such as adding beds at psychiatric hospitals and improving treatment for inmates with behavioral disorders (Dennis and Sun, 2/23).

The Texas Tribune/New York Times: Advocates Seek Mental Health Changes, Including Power To Detain
Hospitals do not have legal authority to detain people who voluntarily enter their facilities in search of mental health care but then decide to leave. It is one of many holes in the state's nearly 30-year-old mental health code that advocates, police officers and judges say lawmakers need to fix. In a report last year, Texas Appleseed, a nonprofit advocacy organization, called on lawmakers to replace the existing code with one that reflects contemporary mental health needs (Grissom, 2/23).

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Health Care Marketplace

Anemia Medication Recall Could Affect Thousands Of Kidney-Disease Patients

The Wall Street Journal: Drug Makers Recall Omontys Anemia Medication
The recall comes as a sharp blow to Affymax, a small biotechnology firm based in Palo Alto, Calif., that developed Omontys and has no other late-stage drugs in its pipeline. The move affects thousands of kidney-disease patients who have been receiving the drug, promoted as a cheaper and more convenient alternative to Amgen Inc.'s blockbuster Epogen, which holds a near-monopoly in treating anemia in that market (Walker, 2/24).

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State Watch

State Roundup: N.Y. GOP Readies Medicaid Probe After Allegations

A selection of health policy news from New York, Michigan, California, Minnesota and Massachusetts.

The Wall Street Journal: GOP Pledges Medicaid Probe
New York state Senate Republicans plan to investigate the state's Medicaid program after news reports and a congressional audit alleged it was fraught with waste and mismanagement (Nahmias, 2/22).

The Associated Press: Blue Cross Changes OK'd Without Abortion Provision
A House panel has overwhelmingly approved legislation to overhaul Blue Cross Blue Shield of Michigan, leaving out anti-abortion provisions that torpedoed an earlier effort to change the status of the state's largest health insurer. The 11-0 votes signaled -- at least for now -- that one of Republican Gov. Rick Snyder's top legislative priorities could reach his desk without language that led him to veto similar legislation in late December. The Senate OK'd the new Blue Cross bills in late January (Eggert, 2/25).

San Francisco Chronicle: Long-Term Care Rate Hike Stuns Retirees
When Marie Benedetto opened her mail last week and learned her long-term care premium was going up a stunning 85 percent, she did what a retired math teacher would do. She made a spreadsheet. Benedetto calculated she'd have to spend $1,328 a month or $15,936 a year for the policy after the increase goes into effect. That added up to a 415 percent increase in premiums since she first purchased the policy in 1997. For Benedetto, the rate increase makes her policy unaffordable. … The state pension fund's board decided in October to increase rates for the policies, which help pay for nursing-home care, home health care and other expenses not covered by Medicare (Colliver, 2/24).

Sacramento Bee: Q&A: Assemblywoman Mariko Yamada Looks At Long-Term Care Insurance
Long-term care doesn't come cheap – up to $72,000 a year in California nursing homes, a steep price tag that will provide sticker shock for the more than 70 percent of people age 65 and older who will require care at some point as they grow older. So it's not surprising that long-term care insurance was a hot, if costly, topic even before the California Public Employees' Retirement System last week announced an 85 percent rate hike at the top tier for its current policy holders. Supporters of better care see the current debate as an opportunity to reverse long-time budget cuts across the country (Creamer, 2/25).

MPR News: Mayo, A Financial Powerhouse, Is Poised To Propel Expansion
Mayo Clinic wants to invest billions of dollars of its own money in a project aimed at bolstering the medical center's position as a world destination for health care. The clinic is now trying to line up state subsidies and private investors to round out financing for what would be a grand expansion. But does Mayo itself have the money needed to pull off such a huge project? ... From 2009 to 2011, Mayo received about $900 million in gifts and pledges (Moylan, 2/25).

Boston Globe: UMass Boston A New Resource For Health Care Firms
The University of Massachusetts Boston is playing host to the latest entrant in a growing field of entrepreneurs helping others create cutting-edge health care businesses in the area. The university's Venture ¬≠Development Center has teamed up with MD Idea Lab to establish a new entrepreneurial resource that resembles a business incubator within an incubator -- specifically targeting early-stage firms that are developing information technology products for health care. MD Idea Lab was founded by a tech-savvy physician and a partner with experience in helping businesses get off the ground (Fitzgerald, 2/25).

California Healthline: Officials Dispute Suggestion Of 'Wrong' Estimate
Managed Risk Medical Insurance Board officials last week bristled at the suggestion that MRMIB somehow made a bad estimate of its budget that resulted in a $116 million general fund shortfall in the Healthy Families program. With an additional $216 million in federal money that hasn't come to California because of the shortfall, the total deficit now amounts to $332 million, according to MRMIB executive director Janette Casillas (Gorn, 2/25).

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Health Policy Research

Research Roundup: Patients Hesitant To Focus On Costs

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

Health Affairs: Focus Groups Highlight That Many Patients Object To Clinicians' Focusing On Costs – One way to contain health care spending is to get patients involved in weighing costs of treatment options with their doctors. Researchers recruited 211 medically insured participants to assess their willingness to consider costs when choosing treatments. The authors found that participants generally "preferred better care, even when the relative benefit it offered was marginal, and even when told that the second-best choice still met the threshold of 'good enough' care from a clinician's perspective. … This study’s findings suggest that for cost to be explicitly recognized and discussed factor in clinical decisions, public attitudes about health care costs must first undergo a significant shift" (Sommers et al., 2/2013).

Health Affairs: Seven Million Americans Live In Areas Where Demand For Primary Care May Exceed Supply By More Than 10 Percent –The federal health law's expansion of medical insurance coverage is expected to increase the demand for primary care services but the authors note that the "demand will not be uniform across each state." They identified the small areas expected to face the growing demand for primary care services to predict the number of people who may potentially experience its effects. Based on their analyses, the researchers anticipate that 4 million people are in areas where there will be a 5 percent increase in demand for primary care providers and 7 million people are in areas that can expect a 10 percent rise in demand. The authors conclude: "The results of this study suggest that promoting and refining policies related to the distribution of primary care providers and community health centers may be as important as policies aimed at increasing the overall supply of primary care providers" (Huang and Finegold, 2/20).

JAMA Internal Medicine: Association Of Hospice Patients' Income And Care Level With Place Of Death – Although most Americans say they would like to die at home, studies suggest that this wish isn't always granted. In this study, researchers examined how income levels and the intensity of home health care affected hospice patients' ability to stay in their homes until they died. After analyzing data from a for-profit hospice provider that runs programs in eight states, the researchers found that more than a fifth of hospice enrollees admitted to routine care in a private residence did not die at home but were transferred instead to hospitals, nursing homes and other facilities. "Among those who did not receive continuous care, those with lower median annual household incomes were more likely to transfer from home to another location before death," they report. "However, among those who received any continuous care, rates of transfer from home were similar across income levels." The authors conclude that "hospices may need to provide additional resources to help indigent patients die at home beyond those currently available via routine hospice care" (Barclay, Kuchibhatla, Tulsky, and Johnson, 2/18).

JAMA Surgery: Anticipating The Effects Of Accountable Care Organizations For Inpatient Surgery – According to the study's authors, "previous research about the benefits of integrated delivery systems (IDSs) in ambulatory care suggests that ACOs [accountable care organizations] are likely to improve efficiency." The benefits are less clear for complex hospital-based care which the authors say account for almost half of the country's total Medicare spending. The researchers analyzed nearly two years of Medicare data on patients getting heart bypass, hip replacement colon or back surgery and found few differences in quality or cost among patients treated at hospitals with integrated systems and those that don't have those systems. They said there are several reasons why the improvements seen in outpatient care don't translate to hospitals, including that some of the savings in the out-patient arena come from care of chronic illnesses in which shared information and resources can help lower costs which doesn't apply to hospital surgery units. They conclude: "improvements in the quality and cost-efficiency of hospital-based care may require adjuncts to current ACO programs" (Miller, Ye, Gust, and Birkmeyer, 2/20).

Here is a selection of news coverage of other recent research:

Reuters: Adults Cut Back Fast Food, But U.S. Kids Still Eat Too Much Fat: CDC
American adults have made a little progress in recent years in cutting back on calories from fast food, but children are still consuming too much fat, U.S. health researchers say. French fries, pizza and similar items accounted for about 11 percent of U.S. adults' caloric intake from 2007 to 2010, on average, down from about 13 percent between 2003 and 2006, the Centers for Disease Control and Prevention said in one of two reports released on Thursday (Heavey, 2/21).

Reuters: Almost One-Third Of Chemotherapy Used "Off-Label"
About one-third of chemotherapies are used to fight cancers that drug regulators never approved them to treat, says a new study. Chemotherapies - drugs that kill rapidly dividing cells - are approved by the Food and Drug Administration (FDA) to fight specific cancers, but there's nothing stopping doctors from prescribing the drugs "off-label" to treat other types of tumors. Some researchers have questioned whether doctors were prescribing the expensive and toxic drugs outside of their intended use, according to the study's researchers, led by Rena Conti, an assistant professor of health policy and economics at the University of Chicago (Seaman, 2/19).

Medscape: ACA Will Help Spark Boom In Remote Patient Monitoring
The number of Americans remotely monitored at home with devices such as pulse oximeters and peak-flow meters for 5 major chronic illnesses will grow 6-fold by 2017 as healthcare reform pushes hospitals and physicians to stop revolving-door admissions, reports InMedica, a division of IMS Research. In 2012, clinicians reviewed long-distance vital signs on computer screens for some 227,000 patients with congestive heart failure (CHF), chronic obstructive pulmonary disease, diabetes, hypertension, and mental illness, according to the InMedica report released in January. By 2017, that number will jump to almost 1.3 million. The figures include a smattering of patients followed for a grab bag of other conditions such as asthma, coronary artery disease, and hemophilia (Lowes, 2/14). 

MedPage Today: Groups Offer Guidance On Gene Testing In Kids
Decisions involving genetic testing of children must focus on the individual child's best interest, taking into account the implications for family members, according to a policy statement developed jointly by the American Academy of Pediatrics (AAP) and the American College of Medical Genetics and Genomics (ACMG). New recommendations have been needed because of the rapid technological advances in genetics in recent decades and broader interest on the part of the public in screening and testing, explained Lainie F. Ross, MD, PhD, of the University of Chicago, and colleagues from the two groups (Walsh, 2/21). 

MedPage Today: Malpractice: Laser Surgery Lawsuits Surge
Lawsuits relating to injury from laser surgery are on the rise, and physicians have been held liable even if they were not personally operating the device, a retrospective study found. Over a 25-year period, 174 cases of cutaneous injury were reported following procedures such as hair removal and facial rejuvenation, according to H. Ray Jalian, MD, of Harvard Medical School, and colleagues (Walsh, 2/20). 

MedPage Today: Generic Rx Plan Lowers Medicare Psych Costs
Providing generic drug coverage to mentally ill Medicare beneficiaries who hit the drug coverage gap cost less overall than leaving them with no drug coverage, a study found. Healthcare costs were lower by roughly 3% among Medicare beneficiaries with bipolar disorder who had generic-only coverage rather than no drug coverage, and 5% lower for those with schizophrenia and generic-only coverage, according to a study published in the February issue of the American Journal of Managed Care (Pittman, 2/20). 

Medscape: Doula Care Reduces Cesarean Deliveries in Medicaid Patients
Doula support in childbirth is associated with a 40% decrease in cesarean deliveries among Medicaid recipients, according to results from a study published online February 14 in the American Journal of Public Health (Laidman, 2/19).

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Editorials and Opinions

Opinions On State Medicaid Expansion: More GOP Governors Should Follow Lead Of Brewer And Scott; Va. Compromise A 'Fiasco'

Debate rages over state officials' decisions on whether to participate in the health law program.

USA Today: All States Need To Expand Medicaid
This month, Republican Governors Jan Brewer (Ariz.), John Kasich (Ohio) and most recently Rick Scott (Fla.) decided to accept the Medicaid expansion in the Affordable Care Act, bringing billions of dollars of federal funding to their states and ensuring access to medical care for thousands of their most vulnerable citizens. Republican governors of the more than 15 states still refusing to participate would do well to follow suit (Dhruv Khullar, 2/23).

The Wall Street Journal: A Cavalier Fiasco
There's one thing uglier than a Democratic tax-and-spend spree. A Republican one. … [Virginia Gov. Bob] McDonnell even cut an 11th-hour deal with Democrats over the expansion of Medicaid under ObamaCare. Last Wednesday Mr. McDonnell issued a press release declaring: "I cannot and will not support consideration of an expansion of Medicaid in Virginia until major reforms are authorized and completed, and until we receive guarantees that the federal government's promises to the states can be kept without increasing the immoral national debt." Two days later, to secure Democratic votes on his tax increase, he agreed to let a bicameral commission decide if the state will expand Medicaid (2/24).

Times Richmond-Dispatch: Sequester Medicaid
The federal government, Democratic politicians and liberal interest groups have been pushing states to expand their Medicaid rolls. (Florida Gov. Rick Scott, a Republican who was a fierce critic of Obamacare, is the latest to cave under pressure.) To sweeten the pot, Washington is picking up nearly the entire tab for such expansion. If every state goes along, the estimated cost would be roughly $1 trillion over the next nine years. By a remarkable coincidence, the grand total of all the sequestration cuts comes to $1.2 trillion over the next 10 years. In other words, nearly the entire sequestration bill could be paid for simply by refraining from going forward with the Obama administration’s plan to expand Medicaid (2/25).

Fort Worth Star-Telegram: Florida Governor's About-Face On Medicaid Expansion
The Affordable Care Act says the federal government will pay 100 percent of the cost of expanded coverage for three years beginning in 2014. After that, the bill says the feds would cover 95 percent of the cost. That's where Florida's (Gov. Rick) Scott left himself an escape plan. He said his state would join in "while the federal government is committed to paying 100 percent." (Texas Gov. Rick) Perry has sought federal dollars for many uses -- think disaster aid, for example. Federal taxes paid by Texans stay unchanged, but more comes back for their benefit. It would be the same with expanded Medicaid (Mike Norman, 2/22).

The Washington Post: GOP Governors Make Peace With Obamacare
The about-face by (Florida Gov. Rick) Scott, the seventh Republican governor to accept Obama's expansion of government-funded health care for the poor, is a crucial validation of the president's signature initiative. In his announcement, Scott made a moral case for the Medicaid expansion as compelling as the law's proponents ever made (Dana Milbank, 2/22).

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Viewpoints: Health Care 'Price Gouging;' Health Law Pushing Employers To Cut Workers' Hours; Medicare Spending Must Be Tamed

The Wall Street Journal's Corporate Intelligence: America's Doctors Feel The Heat
Steven Brill's cover story on the Looking Glass world of healthcare pricing may be the longest article Time Magazine has ever published, but more importantly, it is a fresh sign that the medical-industrial complex should be worried as the deadline for launching Obamacare rolls closer (Joseph B. White, 2/22).

Bloomberg: Bringing Down Health-Care Costs Isn't Always Complicated
Accustomed as we are to thinking of hospitals as beneficent providers of lifesaving and often charitable care, it comes as a shock to learn how many are engaging in, not to put too fine a point on it, price gouging. As Steven Brill shows in his cover story in this weeks' Time magazine, nonprofit hospitals, even more than for-profit ones, chase 12 percent profit margins with eye-popping markups on everything from cardio stress tests to gauze pads (2/24).

Reuters: Don't Let Doctors' Incomes Derail Healthcare-Cost Reform
In his conclusion, Brill says — again, without adducing any evidence whatsoever — that "we've squeezed the doctors who don't own their own clinics, don't work as drug or device consultants or don't otherwise game a system that is so game able". It's a bit weird, the degree to which Brill cares so greatly about keeping doctors' salaries high: he certainly doesn’t think the same way about teachers (Felix Salmon, 2/24).

Slate: Steven Brill's Opus on Health Care
The analytic core of the article shows that when it comes to hospital prices, who pays determines how high the price is. When an individual patient comes through the door of a hospital for treatment, he or she is subjected to wild price gouging. ... No insurer worth anything would actually pay the crazy-high rates hospitals charge to individuals. But in most markets, the hospitals have more bargaining leverage than the insurance companies, so there's still ample gouging. The best bargainer of all is Medicare, which is huge and can force hospitals to accept something much closer to marginal cost pricing, although even this is undermined in key areas (prescription drugs, for example) by interest group lobbying (Matthew Yglesias, 2/22). 

The New York Times: Overcoming Obstacles To Better Health Care
Unfortunately, no single change will transform our health care delivery system into one that we can afford. We are going to have to try lots of new approaches that depart from standard practices. I have several suggestions that I think would help, including an experiment that would require a change in either state or federal regulations: giving some high-quality health care providers the opportunity to practice in a world without malpractice lawsuits (Richard H. Thaler, 2/23).

The Wall Street Journal: ObamaCare And The '29ers'
Welcome to the strange new world of small-business hiring under ObamaCare. The law requires firms with 50 or more "full-time equivalent workers" to offer health plans to employees who work more than 30 hours a week. (The law says "equivalent" because two 15 hour a week workers equal one full-time worker.) Employers that pass the 50-employee threshold and don't offer insurance face a $2,000 penalty for each uncovered worker beyond 30 employees. So by hiring the 50th worker, the firm pays a penalty on the previous 20 as well (2/22).

USA Today: Medicare Spending Makes Me Ill
I'm no expert on Medicare, but I've seen enough recently of what it's paying for to gain a clear and troubling insight into why it's projected to go broke in just 11 more years. What I've witnessed makes me want to scream a plea that when the politicians in Washington debate entitlement reform in the coming weeks, they'll muster enough backbone to do something about it (Don Campbell, 2/24).

Los Angeles Times: D.C. Doubles Down On The Sequester
Most Americans do want to cut federal spending in general. But when it comes to individual programs, they want to protect them. The Pew poll found that a majority favored cuts in only one area: foreign aid. Most respondents didn't want cuts in education, healthcare, unemployment benefits or defense. That's why the administration has offered deliberately dramatic forecasts of what spending cuts could mean, from canceled military operations and reduced Border Patrol surveillance to fewer AIDS tests, fewer children in Head Start and even potential meat (Doyle McManus, 2/24).

The New York Times: Violent, Drunk and Holding a Gun
But a focus on mass murder, while critical, does not get at the broader issue of gun violence, including the hundreds of single-victim murders, suicides, nonfatal shootings and other gun crimes that occur daily in the United States. And focusing on the mentally ill, most of whom are not violent, overlooks people who are at demonstrably increased risk of committing violent crimes but are not barred by federal law from buying and having guns. These would include people who have been convicted of violent misdemeanors including assaults, and those who are alcohol abusers. Unless guns are also kept from these high-risk people, preventable gun violence will continue (2/23).

The New York Times: The Next Frontier Is Inside Your Brain
The Obama administration is planning a multiyear research effort to produce an "activity map" that would show in unprecedented detail the workings of the human brain, the most complex organ in the body. It is a breathtaking goal at a time when Washington, hobbled by partisan gridlock and deficit worries, seems unable to launch any major new programs (Philip M. Boffey, 2/23).

Arizona Republic: Flawed System Needs Reform
Severely troubled. Addicted. Emotionally unstable. These words describe some of Arizona's most challenged youths. In-depth reporting by The Arizona Republic's Craig Harris and Rob O'Dell and, earlier, Channel 12's Wendy Halloran found the residential treatment centers where some of these kids wind up have their own challenges. In their series of investigative stories that concludes today, Harris and O’Dell found lax oversight, poor record-keeping, and a lack of transparency about what goes on inside the facilities. There are also questions about whether residential treatment is the best option for these troubled kids  (2/23). 

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Shefali Luthra

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