Daily Health Policy Report

Tuesday, February 26, 2013

Last updated: Tue, Feb 26

KHN Original Reporting & Guest Opinion

Health Reform

Health Spending And Fiscal Battles

Capitol Hill Watch

Coverage & Access

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insuring Your Health: Key Long-Term-Care Insurer To Raise Women's Premiums

In her latest Kaiser Health News consumer column, Michelle Andrews writes: "Starting next year, the Affordable Care Act will largely prohibit insurers who sell individual and small-group health policies from charging women higher premiums than men for the same coverage. Long-term-care insurance, however, isn't bound by that law, and the country's largest provider of such coverage has announced it will begin setting its prices based on sex this spring" (Andrews, 2/26). Read the column.

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Political Cartoon: 'A Close Shave?'

Kaiser Health News provides a fresh take on health policy developments with "A Close Shave?" by Steve Benson.

Meanwhile, here is today's health policy haiku:


Affordable care:
Soon, for most, in many states.
Texas Gov says no.

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

Governors Mull Medicaid Expansion As White House Signals States May Reduce Payments

With federal budget cuts looming, the nation's governors met in Washington and discussed whether or not to expand Medicaid as part of the Affordable Care Act.

NPR: Governors' DC Summit Dominated By Medicaid And The Sequester
When the nation's governors gathered in Washington, D.C., over the weekend for their annual winter meeting, the gathering's official theme was about efforts to hire people with disabilities. But out of the public eye, at the sessions for "governors only," the discussion reportedly was dominated by two more pressing issues of the day: whether or not to expand the Medicaid program as part of the Affordable Care Act; and the potential upcoming budget cuts set for the end of the week, known as the sequester (Rovner, 2/25).

The New York Times: States Can Cut Back On Medicaid Payments, Administration Says
The Obama administration said Monday that states could cut Medicaid payments to many doctors and other health care providers to hold down costs in the program, which insures 60 million low-income people and will soon cover many more under the new health care law (Pear, 2/25).

Meanwhile, states continue to take action regarding Medicaid and other aspects of health law implementation --

The Associated Press: Mo. House GOP Lawmakers Defeat Medicaid Expansion
Missouri House Republicans gave a resounding "no" Monday to Democratic plans to expand Medicaid coverage in a strategic preview to the unveiling of an alternative plan touted to transform the state's health care program for the poor into "the most free-market-based Medicaid system in the entire country." Two separate House committees simultaneously heard arguments for — and then rejected — proposals to adopt a central component of President Barack Obama's health care law that could have eventually extended government-funded Medicaid coverage to an additional 300,000 lower-income adults in Missouri (Lieb, 2/25).

The Associated Press/Washington Post: Health Care Exchange Hires Va. Company With Troubled History In Conn. To Help Consumers
The state’s health care exchange announced Monday it has selected a Virginia company with a troubled history in Connecticut to run a new center to help consumers enroll in a health insurance plan beginning later this year (2/25).

In other news, CQ HealthBeat examines a health law regulation released last week and Politico details a study tracking health care tweets --

CQ Healthbeat: Remaining Health Care Law Regs Won't Solve Affordability Problem, Insurers Say
Insurers are still waiting for some federal regulations before they file applications to sell coverage under the health care law next year. But two big final rules Health and Human Services officials released last week have left companies with little doubt that a significant number of people will find it difficult to find affordable coverage next year (Reichard, 2/25).

Politico: Health Care Twitter Depends On Who's Tweeting
The study will be made public Tuesday, and an advance copy was given to POLITICO. Kaiser Permanente said it was interested in tracking patterns and also looking at how some topics it was particularly interested in — like low-cost interventions to prevent disease including sunscreen or hand washing — were showing up on Twitter. The bottom line: Overall, physicians prioritized health education, the media paid a lot of attention to the business end of health care and lawmakers had their thumbs on the politics (Kenen, 2/26).

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Health Spending And Fiscal Battles

Is Avoiding Sequestration Possible?

Sen. Lindsay Graham, R-S.C., told the Wall Street Journal that he would consider a tax increase if it is accompanied by reductions in entitlement spending. Meanwhile, administration, state and local officials continue to express concern about the automatic cuts that are scheduled to kick in Friday.

The Wall Street Journal's Washington Wire: GOP Senator Open To Tax Hike For Entitlement-Cut Deal
Mr. Graham said he also hoped to bring up budget issues and encourage Mr. Obama to look beyond the immediate battle over the across-the-board spending cuts due to begin Friday and refocus on seeking a broader deficit-reduction deal that includes both tax increases and overhaul of entitlement programs like Medicare. "I'm willing to raise revenue. I'm willing to raise $600 billion of new revenue if my Democratic friends would be willing to reform entitlements," Mr. Graham said (Hook, 2/25).

Politico: Cuts Could Harm Health Emergency Preparedness
The Centers for Disease Control and Prevention has put out a new game called Solve the Outbreak that allows would-be medical sleuths to track dangerous diseases in a frightening cyber world. But if the sequester takes effect, CDC's actual disease detectives may be a lot less prepared for an epidemic in the real world (Norman, 2/25).

CBS Evening News: Sequestration Threatens Health Research Projects
The whole federal budget is more than $3.5 trillion. The budget cut that would start on Friday is $85 billion, or 2.4 percent of the budget. But some big programs -- such as Social Security -- are exempt. So the cuts will be focused this way: 7.7 percent will come out of Defense and a 5.2 percent out of other spending. Here's the trouble. The law does not allow bureaucrats to decide where to take the cuts. They must be across the board, cutting the useless as well as the vital. Professor Laura Niedernhofer at the Scripps Research Institute in Florida believes her team of 40 scientists can find a drug to diminish the impact of old age. The drug won't keep you young, she says, it would make the old less frail (Andrews, 2/25).

NBC News: Budget Sequester: Cuts Would Hit Vaccination, Elderly Meals, Childcare
Four thousand children in Georgia who won't get free vaccines. More than 2,000 food safety inspections cancelled. Four million meals that won’t go to homebound seniors. The Obama administration is scrambling in the last few days to gin up pressure on Republican members of Congress who increasingly look like they will willingly let what was supposed to have been unthinkable – a budget sequester – happen by Friday. The budget sequester was designed to be a consequence so dreadful that members of Congress would come up with more sensible budget cuts instead. Now it’s been delayed so long that if and when it does hit, it will mean a 5 percent across-the-board cut for government agencies, squeezed into the seven months left in the fiscal year (Fox, 2/26).

Boston Globe: State, Local Officials Fret Over Federal Cutbacks
State and local officials said they are worried about large federal budget cuts set to take effect Friday, even as they have little ­official guidance on what, if any, immediate impacts they would face. … Governor Deval Patrick and his budget chief, Glen Shor, said Monday that they had no plans to cut services, freeze hiring, or furlough employees Friday, when $85 billion in automatic spending cuts would take effect on the federal level unless President Obama and congressional leaders agree on a plan to stop them. … Patrick, a top political ally of Obama, has been speaking out nationally about the potential devastation from the cuts, defend­ing the president as he blames House Republicans. But when addressing reporters at the State House Monday, he struggled to single out specific effects on state services. Instead, he said the biggest impact would be felt by those who receive grants for military, medical, or scientific research (Bierman and Moskowitz, 2/26).

North Carolina Health News: Sequester's Effects On NC Healthcare
New numbers out this morning from the White House break down the state-by-state reductions in various programs. Here are details from the cuts to North Carolina’s health care programs (Hoban, 2/25).

Philadelphia Inquirer: Funding Cuts Could Cost Region’s Hospitals $50 Million
In a region that counts medicine and medical research among its strengths, a new condition has been detected: fear of sequestration. Hospitals and health researchers are warning that sequestration, the automatic federal funding cuts that are due to begin Friday, could deal devastating blows in the Philadelphia area. Sequestration could cut Medicare payments by 2 percent, which would cost hospitals in Southeastern Pennsylvania at least $50 million a year, according to the Delaware Valley Healthcare Council, a lobbying group for hospitals. If the National Institutes of Health budget is cut by 5.1 percent, that would reduce its funding here by $41.5 million, the council projected. Most of those cuts would come in Philadelphia, a national leader in NIH-funded research (Burling, 2/26).

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Capitol Hill Watch

Capitol Hill Hot Topics: Mental Health, Abortion And Entitlement Cuts

Roll Call explores how some lawmakers have strong personal connections to issues related to mental health and gun violence. Meanwhile, anti-abortion advocates are eyeing the next continuing resolution as a vehicle to soften the Obama administration's birth control coverage mandate. Finally, Treasury secretary nominee Jack Lew answers questions about entitlements.

Roll Call: Mental-Health Interest Is Personal For Many Lawmakers
For Rep. Ron Barber, the discussion about gun violence and mental health that has followed December's elementary school shooting has a deeply personal element: The Arizona Democrat was among the injured after a mentally unstable gunman opened fire on Rep. Gabrielle Giffords and others in 2011…Barber is one of many lawmakers who has a strong connection to the issue, either personally, because of a career before Congress, or both, and has made mental health a priority. A number of those members have introduced legislation focused on mental health in the wake of the Newtown, Conn., shooting, hoping to parlay their knowledge and the energy of the moment into change (Attias, 2/25).

The Hill: Anti-Abortion-Rights Groups Demand Protections In CR Bill
Opponents of abortion rights are rallying support for softening President Obama's birth-control mandate in a bill to fund the government. The current continuing resolution, or CR, expires March 27. On Monday, a coalition of groups that oppose abortion called for a new CR that will allow certain non-religious groups not to cover the "morning after" pill in their health plans (Viebeck, 2/25).

The Hill: Lew: White House Opposes Higher Medicare Age, Medicaid Cuts
The White House still opposes entitlement cuts it once supported, Treasury secretary nominee Jack Lew said in response to questions from Sen. Orrin Hatch (R-Utah). Hatch, the top Republican on the Senate Finance Committee, asked Lew about Medicare and Medicaid cuts in written questions following a hearing on his nomination (Baker, 2/25).

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Coverage & Access

Long-Term Care Poses Health Policy Challenges

CQ Healthbeat examines how the challenges of providing long-term care services to the nation's aging population are growing. Meanwhile, writing for KHN, consumer columnist Michelle Andrews details a development in the long-term care insurance market.

CQ Healthbeat: The Aging Population: A Crisis In Plain Sight
The stories are ubiquitous and intensely personal. You hear them at work, at dinner parties, at kids' soccer games. Someone's mother, or widowed dad, or favorite aunt, or disabled brother needs long-term care — and that person has no idea where to turn for help…. Providing long-term-care services and support for the elderly and people with disabilities arguably is the biggest problem in health care policy today (Norman, 2/25).

Kaiser Health News: Insuring Your Health: Key Long-Term-Care Insurer To Raise Women's Premiums
Starting next year, the Affordable Care Act will largely prohibit insurers who sell individual and small-group health policies from charging women higher premiums than men for the same coverage. Long-term-care insurance, however, isn't bound by that law, and the country's largest provider of such coverage has announced it will begin setting its prices based on sex this spring (Andrews, 2/26).

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Public Health & Education

Remembrance: C. Everett Koop, Influential Surgeon General, Dies At 96

Koop was well-known for confronting high visibility and sometimes controversial public health issues.

The New York Times: C. Everett Koop, Forceful U.S. Surgeon General, Dies At 96
Dr. C. Everett Koop, who was widely regarded as the most influential surgeon general in American history and played a crucial role in changing public attitudes about smoking, died on Monday at his home in Hanover, N.H. He was 96 (Noble, 2/25).

The Associated Press/Washington Post: C. Everett Koop, Former Surgeon General, Dies At 96
Dr. Koop was the most recognized surgeon general of the 20th century. He almost always appeared in the epauleted and ribboned blue or white uniform denoting his leadership of the commissioned corps of the U.S. Public Health Service. With his mustacheless beard, deep voice and grim expression, he looked like a Civil War admiral or, as some cartoonists suggested, a refugee from a Gilbert and Sullivan musical (2/25).

Medpage Today: Obituary: C. Everett Koop, MD, 96, Iconic Surgeon General
C. Everett Koop, MD, President Ronald Reagan's iconic surgeon general who waged a public war against smoking, defended the right to life of disabled newborns, and championed knowledge over prejudice to educate the nation about AIDS, is dead at age 96. A bear of a man who insisted that public health officers wear the navy-inspired uniform of the U.S. Public Health Service, Koop elevated the image of the Surgeon General to heights not realized before or after his time. His death was announced late Monday afternoon by the Koop Institute, based at Dartmouth College in Hanover, N.H. No cause of death was given. Koop was often in the headlines during his tenure, but few remember his first brush with media fame: the Baby Doe law (Peck, 2/25).

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State Watch

Report: Calif. Could Save $110B By Better Coordinating Health Care

A new report from a team of health care CEOs and researchers says California could save $110 billion over a decade if the state moved away from "fee-for-service" payment to doctors and into more coordinated care.

Los Angeles Times: Coordinated Health Care Could Save California $110 Billion, Group Says
California could cut $110 billion in health care spending over the next decade, saving the average household $800 a year, by quickly moving away from conventional fee-for-service medicine and embracing more coordinated care, a new report says (Terhune, 2/26).

Sacramento Bee: California Coalition's Report Calls For Overhaul To Rein In Health Care Costs
California's health industry heavyweights, warning that insurance premiums will soon consume a third of people's incomes, today threw their weight behind a plan to revamp the health care delivery system. A dozen CEOs from health care providers and insurers spent the past year participating in an unprecedented, collaborative effort with public policymakers and health care researchers, dubbed the Berkeley Forum and based at UC Berkeley School of Public Health. The result: a report that contains a variety of proposals for changing health care delivery and also stresses the need for Californians to take more responsibility for staying healthy (Craft, 2/26).

In addition, state lawmakers and others consider what changes the health law could have in store for coverage in California -- and not all of them are good.

Los Angeles Times: Health Care Overhaul May Threaten California's Safety Net
An estimated 3 million to 4 million Californians -- about 10 percent of the state's population -- could remain uninsured even after the health care overhaul law takes full effect. The burden of their care will fall to public hospitals, county health centers and community clinics. And those institutions may be in jeopardy (Gorman, 2/25).

California Healthline: Rating Regions Headed For Floor Debate
The debate over geographic rating regions has not ended, despite being approved by the Assembly and Senate health committees last week and by the Senate Committee on Appropriations on Friday. Competing interests want to change it -- in different ways. At the appropriations committee meeting Friday, two groups took oppose-unless-amended positions on the six-region legislation, but were not in agreement on how to divide the geographic rating regions in California. Janice Rocco, deputy commissioner of the Department of Insurance, said her department's opposition was based on preference for an 18-region proposal from DOI, which she said could keep premium increases down to a maximum of 8%, rather than almost three times that with the six-region plan (Gorn, 2/26).

California Healthline: Individual Market Reforms Called 'Historic'
Two health reform bills working their way through the state Legislature still contain question marks about some of the details, but overall they represent a major milestone for Californians who buy their own health insurance, according to consumer advocates. … The two companion bills, ABx1 2 and SBx1 2, retool the laws governing California's individual insurance market to align with new regulations in the Affordable Care Act. Similar legislation was proposed and passed by the Legislature last year but vetoed by Gov. Jerry Brown (D). The governor didn't want the state to make new laws based on a federal law that could be repealed if a Republican moved into the White House. The bills, moving through committees now, are expected to be approved in both houses and signed by the governor (Lauer, 2/25).

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State Roundup: Kan. Eyes Rural Residencies To Solve Doc Shortage; More Hats In Mass. Gov. Race

A selection of health policy stories from Kansas, New York, Massachusetts, South Carolina, North Carolina and Connecticut.

Kansas Health Institute: Rural Residencies Could Help Solve Coming Doc Shortage
Rural hospitals could provide critical help addressing the state’s expected doctor shortage, according to Dr. Douglas Girod, the new executive vice chancellor of the University of Kansas Medical Center…KU officials estimate Kansas will need 213 new doctors a year by 2030 just to maintain what is now a physician-per-resident ratio that lags the national average. To meet the national average ratio, Kansas would need about 285 new doctors a year by 2030 (Sherry, 2/25).

WBUR: CommonHealth: Another Health Care Leader Eyes Mass. Governor's Seat
The election of 2014 is shaping up to be the year of the health-care-leader-as-politician, with another health expert today announcing his intention to run for Governor of Massachusetts. WBUR’s Martha Bebinger reports that Evan Falchuk, of Newton, an executive with the online referral and consultation site Best Doctors, is jumping into the race. In his bid for governor, Martha reports that Falchuk is also starting the United Independent Party aimed at "voters [who] feel shut out of politics" (Zimmerman, 2/25).

The Wall Street Journal's Metropolis: Cuomo Administration: Opposition To Abortion Bill 'Outrageous'
Gov. Andrew Cuomo's administration defended forthcoming legislation that would guarantee women the right to late-term abortions in certain cases by describing opposition as "outrageous" in an op-ed distributed Monday to media organizations (Orden, 2/25).

The Associated Press/Wall Street Journal: Brooklyn DA Unveils New Focus On Health Fraud
The Brooklyn district attorney is leading an unusual city and federal team effort to crack down on doctors and pharmacists who bilk Medicare and Medicaid. DA Charles Hynes and other officials announced the collaboration Monday (2/25).

The Associated Press: SC Medicaid Agency Hopes Home Visits Cut Costs
South Carolina's Medicaid agency hopes home visits steer patients away from frequent and expensive trips to the emergency room. The idea involves training trusted community representatives, such as church leaders, to help Medicaid patients navigate the health care system (Adcox, 2/25).

Kansas Health Institute: Large Assisted-Living Chain Curtails Medicaid Participation
One of the state's largest assisted-living chains has curtailed its participation in the Kansas Medicaid program. … The decision, German said, was driven by a 2012 reduction in Medicaid reimbursements and by concerns that payments would be cut more under KanCare (Ranney, 2/25).

North Carolina Health News: State, Local Officials Have Little Power Over Adult Care Homes
When the owners of several adult care homes walked away from their duties, there was little recourse for local or state officials who wanted to prosecute or punish the owners for abandoning dozens of residents. And the system has been designed that way (Hoban, 2/26).

CT Mirror: Team Provides Intensive Support For People With Mental Illness
Timothy Sacerdote's morning medication run was nearly done, without a hitch so far. He'd visited four clients, opened the combination locks on the boxes of medication in their homes and handed them pills while chatting about how they were doing, whether they'd be coming to group, and, in the case of one man, buying a cellphone. But there was a problem brewing: Another client was facing eviction from his apartment and fuming about it. Sacerdote and Laura Magisano, his team leader, would be stopping by for his medication later in the morning, but first they had another client to see. As Sacerdote drove, Magisano worked the phone, trying to buy them time (Becker, 2/25).

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Editorials and Opinions

Viewpoints: GOP Faces Pressure From Spending Cuts Effects On Daily Life; President Needs To Lead On Medicare Cuts

The New York Times: The States Get The Bad News
Cuts this draconian have no place in a tottering economy. But, realistically, the only way to break this standoff is for the cuts to exact their toll on daily life, causing Republicans to face pressure from the public to negotiate an alternative plan with higher revenues in March as part of talks to finance the government for the final six months of the fiscal year. The details the White House released over the weekend are eye-opening. In Ohio, Mr. Boehner' home state, the cuts could cost 30,000 jobs. An 8 percent cut in federal research grants "would probably bring us to our knees," said Dr. Thomas Boat, dean of the University of Cincinnati's College of Medicine, according to The Cincinnati Enquirer (2/25).

The Washington Post: Sequester Offers President Obama A Time To Lead
Much of what President Obama hopes to accomplish in his second term would tap into what's known as the "discretionary budget" — money not already claimed by entitlement programs such as Medicare and Social Security. But the discretionary budget itself is about tapped out, squeezed by the growth of entitlement spending. That's what makes the minimal presidential leadership on entitlement reform so baffling (2/25).

Reuters: The Route To A Real Budget Deal
The deal we need is about far more than addressing the sequester. Our elected officials must agree to a fiscal Grand Bargain in 2013 ‑ or they will have once again punted on the tough decisions that define leadership. We know the issues that could eventually sink our ship of state: demographics that are predicted to overwhelm our social insurance programs, rising healthcare costs and an outdated, unfair and inadequate tax system (David M. Walker, 2/25).

The Wall Street Journal: Is Obama Overconfident?
The idea that $85 billion in cuts to a $3.6 trillion budget would mean that children would go without vaccines and battered women would have nowhere to turn is preposterous, but it demonstrates the rhetorical lengths to which the president will go to score political points. It also shows that the White House and Democrats are very confident that they will win this latest showdown with Republicans. Where is that confidence coming from? (Jason L. Riley, 2/25).

Des Moines Register: It's Time For Lawmakers To Act On Medicaid
Gov. Terry Branstad has a lot in common with Florida Gov. Rick Scott. Both are Republicans. Both have worked in the health field. Both have been staunch opponents of the federal health reform law. Both repeatedly vowed not to implement a provision in the law to expand the eligibility for Medicaid and provide health insurance to more low-income people in their states. The difference between the two governors: Scott found his moral compass; Branstad has not. ... So now it is up to the Iowa Legislature to stand up for the people of Iowa — and to stand up to Branstad (2/25). 

The Washington Post: PEPFAR's Glowing Report Card, 10 Years Later
Since 2003, Congress has appropriated more than $38 billion for the President's Emergency Plan for AIDS Relief, known as PEPFAR — the largest global health initiative ever undertaken focused on a single disease. Congress reauthorized the program for five years in 2008 and asked for a report card. Now, after four years of work, some 400 interviews and visits to 13 nations, the Institute of Medicine of the National Academy of Sciences has provided a 678-page examination of this incredibly ambitious program. The verdict: PEPFAR has been "globally transformative," a "lifeline" and credited around the world for "restoring hope" in the long, difficult struggle against HIV/AIDS (2/25).

The Seattle Times: Address Gaps In Mental Health Tracking For Gun Buyers
The fierce politics of universal gun-buyer background checks has stirred up such a cloud of dust in Olympia this session that a simple fact has been obscured: Washington doesn't have a foolproof way to tell who has been civilly committed for mental illness. That's a big hole. Federal law bans firearms for people who have been involuntarily committed by a court; in Washington, that means a 14-day involuntary commitment to a psychiatric hospital (2/25).

Boston Globe: The Guilt Of Caring For Elderly Parents
Four years ago, at 8 p.m. on Valentine's Day, my mother died. A few hours earlier I had taken a brief break from my vigil in the hospice to wander through an excessively air-conditioned Florida mall. The kiosks were overflowing with heart-shaped Mylar balloons, stuffed bears, and chocolate roses. As I surveyed the depressingly cheerful Valentine's paraphernalia, I thought: I really should bring her something. It was a ridiculous thought, since my mother was in a coma and had no use for balloons or bears. Why did I feel obligated to do something more for Mom just then — as if the years my brothers and I had spent flying back and forth to be with her, the thousands of phone calls, the long hours spent at countless hospital bedsides had not adequately expressed our loyalty and affection (Dr. Suzanne Koven, 2/25)?

WBUR: Cognoscenti: Beyond Awareness: The Fight Against Rare Diseases
Did you know that February 28 is Rare Disease Day? Probably not, despite the fact that more than 700,000 classified rare disorders affect nearly 30 million Americans. Whether it's finding specialists who can diagnose us, advocating for our needs, or getting effective medications when blockbuster drugs get much of the funding, rare disease patients live beyond the fray in many senses (Laurie Edwards, 2/26). 

The Medicare NewsGroup: Why Consumers Aren't Ready For Medicare Self-Directed Decision-Making
In recent years, one of the prevailing schools of thought in health-care reform has been to put consumers more in charge of their health care. ... It may very well be that the consumer-driven model will be inadequate when it comes to informing future beneficiaries of every aspect of treatment. It's too much to ask of average health care consumers to understand scientific method, the limits of medical science and the tremendous economic pressures behind certain drugs and treatments (John Wasik, 2/25).

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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.