Daily Health Policy Report

Monday, February 27, 2012

Last updated: Mon, Feb 27

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Administration News

Health Care Marketplace

Campaign 2012


Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Five Questions About The Health Law's Mandate To Cover Birth Control

Kaiser Health News staff writer Julie Appleby writes: "While controversy over one aspect of the Obama administration's contraception rule – whether and when religiously affiliated employers must comply – has dominated recent headlines, that debate has obscured other questions about how the rules will actually be implemented" (Appleby, 2/27). Read the story.

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Q & A: I Was Billed, But Aren't Colonoscopies Free Under The Health Law? (Video)

Kaiser Health News consumer columnist Michelle Andrews answers a question from a reader who had a colonoscopy and was billed a 30 percent co-pay. The reader asks: Aren't preventive services like that free under the health law? (2/27). Watch the video.

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Capsules: By The Numbers: Wisconsin’s High Risk Pool

Wisconsin Public Radio's Shamane Mills, reporting in partnership with Kaiser Health News and NPR, writes on the blog: "This week the federal government touted the number of people who have enrolled in the high risk insurance pools created in every state. After a slow start, some 50,000 people with serious illnesses nationwide have signed up for the insurance plans created by the federal health law" (Mills, 2/27). Check out what else is on the blog.

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Political Cartoon: 'Organ Rejection'

Kaiser Health News provides a fresh take on health policy developments with "Organ Rejection" by John Deering.

Meanwhile, here's today's haiku:


Dolphin bite, space junk
Skis in flames, parrot attack
There are codes for those

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

Poll: Public Opinion Sharply Divided On Health Law Repeal

Politico reports on a new poll that shows the nation is almost evenly split on whether, if elected, a Republican president should repeal the health law. Meanwhile, in related news, The Hill reports that House GOP lawmakers will renew their attacks on the overhaul to correspond with the Supreme Court review of the measure.  

Politico: Poll: Sharp Split On Health Care Repeal
Americans are deeply divided over whether a Republican president should repeal President Barack Obama's health care law if elected this November, a new poll Monday shows, although the vast majority of those surveyed believe the individual mandate is unconstitutional. Gallup found that 47 percent of Americans want a GOP president to repeal the law, while 44 percent oppose that (Mak, 2/27).

The Hill: House GOP To Renew Attacks On Health Law As Supreme Court Hears Case
House Republicans are planning renewed attacks against President Obama's health care reform law to coincide with Supreme Court arguments next month. The high court will hear challenges to the law's individual mandate and Medicaid expansion for six hours over three days, starting March 26. House Republicans are planning to ride the renewed focus on the law to chip away at controversial provisions, a leadership aide told The Hill, including its cost-control panel – the Independent Payment Advisory Board, or IPAB – that some Republicans have labeled a "death panel" (Pecquet, 2/25).

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States, Governors Have Different Views On Exchanges, Impact Of Health Law

News outlets also offer status checks on the measure's high risk insurance polls.

The New York Times: Many States Take A Wait-And-See Approach On New Insurance Exchanges
States are lagging in the creation of health insurance exchanges, the supermarkets where millions of consumers are supposed to buy subsidized private coverage under President Obama's health care overhaul (Pear, 2/27).

The Washington Post: Governors Split Over Effects Of Obama's Health-Care Law
Republicans and Democrats, as expected, disagree heartily about whether the health-care reform law is worth its benefits to state residents — or creates more harm by overburdening state budgets. Both Walker and Quinn are members of the National Governors Association's health committee, which met Sunday morning in a downtown Washington hotel with the goal of recommending ideas to cut states' health-care costs for needy residents (Leonnig, 2/26).

KQED's State of Health blog: High-Risk Insurance Pool Helps … But What About Cost?
Until the law goes into full effect in 2014, the government has created a bridge program to help – the Pre-Existing Condition Insurance Plan, or PCIP. But ... California is spending three times more than anticipated to insure the people who have enrolled in this program (Menghrajani, 2/24). 

Related, earlier KHN story: 9 States Seek Help For High-Risk Pools (Galewitz, 1/5).

Kaiser Health News: Capsules: By The Numbers: Wisconsin's High Risk Pool
This week the federal government touted the number of people who have enrolled in the high risk insurance pools created in every state. After a slow start, some 50,000 people with serious illnesses nationwide have signed up for the insurance plans created by the federal health law (Mills, 2/27).

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Health Law Implementation: Actuarial Value, Health Disparities Draw Attention

The Department of Health and Human Services offered a bulletin last week to provide guidance on how insurers should calculate actuarial value. Also, some health policy experts are beginning to question whether the health law's quality provisions might exacerbate the nation's health disparities.

Politico Pro: AV Guidance Leaves Room For States
A new HHS bulletin on how insurers should calculate actuarial value follows the pattern established by other recent health reform regulations: CMS will provide a national standard, but allow for state flexibility. Actuarial value is a measure of the share of health costs a plan covers for a standard population. The health reform law requires plans sold in the exchanges to be marketed in different tiers, based on their AV scores, so that consumers can compare benefits side by side. These range from "platinum" plans, with an actuarial value of 90 percent, to "bronze" plans, which would have an actuarial value of 60 percent. To make sure all insurers are calculating their AV scores the same way, CMS will develop its own standard population and create an "AV calculator" that will score plans based on key features of their benefit designs, the guidance explains (Feder, 2/24).

Modern Healthcare: Disparity Clarity
One of the central themes of the Patient Protection and Affordable Care Act, mentioned numerous times throughout the law, is the pressing need to eliminate health care disparities. But some health policy experts worry that provisions of the law designed to improve health care quality could exacerbate gaps in access and outcomes by penalizing the hospitals that minority and poor patients depend on the most (McKinney, 2/25).

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Capitol Hill Watch

Senate To Debate GOP Plan To Allow Religous 'Opt Out' From Birth Control Rule

The proposal is expected to be offered as an amendment this week to a transportation bill being considered by the Senate.

Roll Call: Birth Control Rule May Take Center Stage This Week
Like two boxers returning to the center of the ring, Senate Democrats and Republicans return from a weeklong recess this week to debate and vote on a GOP proposal that would allow companies and insurance providers to opt out of mandated birth control coverage for religious reasons. Democrats are eagerly anticipating the debate because they see an opportunity to use the issue for political gain in the upcoming November elections. The GOP proposal — expected to be offered as an amendment sometime this week to a transportation bill currently being considered by the Senate — would "give employers an unprecedented license to dictate what women and men can have covered," said Sen. Patty Murray (D-Wash.) on a conference call with reporters Friday (Sanchez and Staton, 2/26).

Meanwhile, news outlets continue to analyze the rule's specifics, as well as its political implications.

Kaiser Health News: Five Questions About The Health Law's Mandate To Cover Birth Control
Kaiser Health News staff writer Julie Appleby writes: "While controversy over one aspect of the Obama administration's contraception rule – whether and when religiously affiliated employers must comply – has dominated recent headlines, that debate has obscured other questions about how the rules will actually be implemented" (Appleby, 2/27).

Politico Pro: Questions About Contraception Rule
Questions abound about how the rule — issued by HHS in January — works, how it will be enforced and how it interacts with other rules and regulations being developed to implement the health care law. All that becomes more important as a growing number of religious employers declare they will refuse to comply with the requirement despite the president’s concessions. In several states, lawmakers have introduced legislation seeking to undermine the federal rule (Feder, 2/27).

San Francisco Chronicle: Birth Control Issue Rankles Women Of Both Parties
The sputtering economy and fast-rising gas prices fire the passions of California Republicans when the objective is beating President Obama in the 2012 election. Which is why not all state GOP activists are happy that the party's candidates and elected officials keep making headlines on another issue - birth control.  "It's a losing proposition," Gail Neira, head of the San Francisco Republican Bay Area Alliance, said as she roamed the state GOP convention in Burlingame over the weekend. Especially, she said, when it appears most of the talk is coming from male presidential candidates and officeholders (Marinucci, Garofoli, 2/27).

The Associated Press/Boston Globe: Insurance Fight Shows Catholic-Evangelical Ties
After the White House decreed this month that religious employers would have to pay for workers' birth control, it was no surprise that Roman Catholic leaders would protest. That evangelical Protestants would rally to their cause was less expected and unthinkable even a generation ago... Contraception is one of the very issues that have been a wedge between Catholics and evangelical Protestants for decades. But for Protestants who've rallied to the Catholic bishops' side, the question this time is one of religious liberty rather than dogma (Breen, 2/25).

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Administration News

A Look At Obama's 'Deficit Dilemma'

The New York Times: A Measure Of Change: Obama's Deficit Dilemma
Yet starting with that April speech, Mr. Obama has come to adopt most of the major tenets supported by a majority of the commission's members, though his proposals do not go as far. He has called for cutting deficits more than $4 trillion over 10 years by shaving all spending, including for the military, Medicare and Social Security; overhauling the tax code to raise revenues and lower rates; and writing rules to lock in savings (Calmes, 2/27).

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Health Care Marketplace

A Health Care History Lesson

Los Angeles Times: Healthcare History: How The Patchwork Coverage Came To Be
Most of us get health insurance through our jobs, a system puzzling to the rest of the industrial world, where the government levies taxes and offers health coverage to all as a basic right of modern society. But for many Americans, their way feels alien — the heavy hand of government reaching into our business as some bureaucrat tells doctors and patients what to do (Rosenblatt, 2/26).

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Campaign 2012

Romney's Medicare Plan Would Gradually Raise Eligibility Age

The plan was released just days before just days before the next round of primary elections. Also in the news, more on GOP presidential hopeful Mitt Romney's tea party appeal and position on abortion, while rival Rick Santorum offers more charges that the former Massachusetts governor is not conservative enough.  

The Wall Street Journal: Romney Offers Medicare Plan
Republican presidential hopeful Mitt Romney unveiled a plan Friday to increase the Medicare eligibility age and laid out a time line under which the government would offer a new private option for care. Mr. Romney has said he would offer seniors a choice between the traditional fee-for-service government health-care program and a new option to purchase private insurance, with the cost partly supported by the government (Murray and King, 2/25).

MSNBC/AP: Romney Would Raise Eligibility Age For Medicare
Four days before critical primary elections, Republican presidential contender Mitt Romney outlined a far-reaching plan Friday to gradually delay Americans' eligibility for Medicare as well as Social Security. Romney said the shift, as people live longer, is needed to steer the giant benefit programs toward economic sustainability (Espo, 2/24).

The Associated Press: A Political Tip Sheet For The Rest Of Us
Former Massachusetts Gov. Mitt Romney offered a fix for Medicare: raise the eligibility age one month per year until it's tied with life expectancy. It was a new detail in a campaign speech that was otherwise short on new policy ideas (Salcedo, 2/24).

The Wall Street Journal: Romney Hits The Tea Party Notes
Standing before a wall-size American flag in a banquet hall here, Mr. Romney drew cheers from some 500 tea-party supporters Thursday as he touched one chord after another that resonates with the limited-government movement. Programs for the poor, such as Medicaid, should be run by the states, "as the Constitution intended," he said. Federal workers? Mr. Romney won applause by saying he would cut their pay by 10% (White and Nelson, 2/25).

National Journal: Romney: Regan Switched On Abortion, Too
At a town hall meeting at Western Michigan University, a woman in the audience asked Romney why "we should regard you as a man of high standards and integrity when you have flip flopped on your position regarding the sanctity of life?" Romney replied that Reagan was "pro-choice before he became pro-life," and named other Republican figures who he said had similar transformations on the issue, including former President George H.W. Bush and the late former Rep. Henry Hyde of Illinois, who went on to become a leader in the effort to stop the expansion of abortion rights in Congress (Boxer, 2/24).

The Associated Press: Santorum: Romney Isn't Conservative Enough For GOP
Santorum got a rare hostile question from Wally Tuccini, 57, a heavy equipment operator from Marquette. Tuccini said his mother was a Roman Catholic who personally opposed birth control, as does Santorum. When she delivered her eighth child, Tuccini said, the family was so poor they barely obtained essential medical care in time, and he asked why Santorum wants to reduce the government's social safety net. "We don't need a government health care plan to be able to solve the problem," Santorum replied. ... Santorum noted that he supports a refundable tax credit for low-income people seeking health insurance. He did not offer details, nor does his campaign website (Babington, 2/26).

Also in the news, governors express thoughts on the continuing campaign -

The Associated Press: GOP Governors Concerned About Long Primary Race
Some Republican governors voiced concern that social issues like contraception and gay marriage had at times eclipsed discussion of the economy in the primary race. "I do agree those social issues are not as significant as some of the economic and fiscal issues that really threaten our way of life," South Dakota Gov. Dennis Daugaard said, saying he was worried the debate over such issues might alienate uncommitted voters (Fouhy, 2/25).

Boston Globe: Deval Patrick Defends President Obama On Energy Policy
In one instance, Patrick may have actually helped former Massachusetts governor Mitt Romney. In his Republican presidential campaign, Romney has stood by the health care overhaul he implemented in Massachusetts, while saying he opposes Obama’s overhaul nationally. Romney has said the Massachusetts reform worked for the state – something his successor agrees with. Patrick said the program has been "enormously important and successful" in Massachusetts, noting that 98 percent of residents have health insurance, including 99.8 percent of children, while 90 percent of residents have access to primary care. Patrick said the reform added just 1 percent to state spending (Schoenberg, 2/26).

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Patrick Kennedy Takes Offense At Ad By Sen. Scott Brown

The campaign advertisement invokes the name of the late Sen. Edward Kennedy, D-Mass. The younger Kennedy calls the ad, which suggests that Brown shares the late senator's position on religious exemptions for health care providers, "misleading and untrue."

Politico: Patrick Kennedy Knocks Scott Ad
Former Rep. Patrick Kennedy, the son of the late Sen. Ted Kennedy, is demanding that Sen. Scott Brown stop invoking his father's name in his radio ad about insurance coverage for birth control, charging the Massachusetts Republican is making "misleading and untrue" claims. "You are entitled to your own opinions, of course, but I ask that, moving forward, you do not confuse my father's positions with your own. I appreciate the past respect you have expressed for his legacy, but misstating his positions is no way to honor his life's work," Kennedy said in a letter to Brown on Sunday published online. "I respectfully request that you immediately stop broadcast of this radio ad and from citing my father any further" (Lee, 2/27).

Boston Globe: Senator Brown, Patrick Kennedy Spar Over Radio Ad
US Senator Scott Brown's suggestion that he shares with the late Senator Edward M. Kennedy a position on religious exemptions for health care providers is "misleading and untrue," said Kennedy's son, Patrick, who wants Brown to stop citing the elder Kennedy in radio advertisements. "You are entitled to your own opinions, of course, but I ask that, moving forward, you do not confuse my father's positions with your own," Kennedy wrote to Brown (Arsenault, 2/26).

WBUR: Patrick Kennedy Raps Brown Over Health Care
Sen. Scott Brown said Sunday he will continue to run an ad that invokes the name of the late Sen. Ted Kennedy despite calls from Kennedy's son to pull the ad. ... In the ad, Brown suggests the late senator would have supported an amendment that would allow all employers — not just religious ones — to deny medical coverage based on moral objections. ... In an open letter, Patrick Kennedy told Brown, a Republican, that his father's support for a conscience exemption is different (2/27).

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Feds Tighten Medicare Plans Oversight To Curb Improper Payments

The Centers for Medicare & Medicaid Services announced an initiative Friday designed to reduce the number of Medicare advantage payments made in error.

The Associated Press: Feds To Curb Improper Payments To Medicare Plans
The Obama administration says it's taking steps to fix a longstanding problem of improper payments to private health plans that serve 1 in 4 Medicare beneficiaries. So-called Medicare Advantage plans face tighter audits under a policy issued Friday. The rules say Medicare must pay the plans a higher rate to care for sicker beneficiaries. But previous government audits discovered many claims were not backed up by proper medical documentation (2/24).

Politico Pro: CMS Tightens Medicare Advantage Oversight
Federal health officials will tighten their oversight and audit procedures under a new initiative to reduce payment errors made to Medicare Advantage plans. The tighter audits will focus on the additional payments Medicare makes to private insurers to help offset the cost of treating sicker patients. On Friday, CMS officials said they expect to recoup as much as $370 million in the program's first year. From 2010 through 2011, CMS reduced the payment error rate by three percentage points, going from 14.1 percent down to 11 percent. The downward trajectory is expected to continue, with the agency projecting a 10.4 percent rate this year, and 9.8 percent in 2013 (Dobias, 2/24).

Modern Healthcare: New Initiative Reclaims $370 Million In Overpayments, CMS Says
A new effort from the CMS to reduce improper payments in Medicare Advantage plans is estimated to recover about $370 million in overpayments for the first year, the agency announced Friday. Medicare Advantage organizations are required to submit data to the CMS to receive risk-adjustment payments, and 2010's Improper Payments Elimination and Recovery Act requires that the CMS audit these data each year (Zigmond, 2/24).

Modern Healthcare: Advantage Plans Vary On Fraud Detection: Study
Medicare Advantage insurers lack a "common understanding" about federal anti-fraud requirements and that may limit their ability to detect and mitigate the problem, according to a broad review of those entities by HHS' inspector general's office. The agency study of insurers covering 94 percent of Medicare beneficiaries enrolled in Medicare Advantage plans in 2009 found wide variation in the rate of potential fraud incidents flagged by plans and in their rate of reporting those incidents for further investigation (Daly, 2/24).

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Public Health & Education

The High Cost Of Cancer Care

The Associated Press: Cancer's Growing Burden: The High Cost Of Care
Forty years after the National Cancer Act launched the "war on cancer," the battle is not just finding cures and better treatments but also being able to afford them. New drugs often cost $100,000 or more a year. Patients are being put on them sooner in the course of their illness and for a longer time — sometimes for the rest of their lives. The latest trend is to use these drugs in combination, guided by genetic tests that allow more personalized treatment but also add to its expense (Marchione, 2/25).

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State Watch

Sebelius Casts Doubt On Calif. Medi-Cal Changes; Other State Actions Scrutinized

Medicaid cuts in California, Washington and Texas prove controversial, while changes or proposed changes in Florida, Georgia and Minnesota get closer looks.

Los Angeles Times: Brown Gets No Promise Of Federal Help For Medi-Cal
Health and Human Services Secretary Kathleen Sebelius on Sunday threw cold water on Gov. Jerry Brown's plan to ask California's poor to contribute to their federally subsidized health care — payments the governor has proposed to save the state more than $500 million a year (York, 2/26).

The Wall Street Journal: Medicaid Cuts Rile Doctors
A plan by Washington state's Medicaid agency to stop paying for certain emergency-room visits is prompting pushback from hospitals and doctors, who say they will be stuck with bills for vital care they often are legally required to provide (Mathews, 2/25).

The Hill: Texas Dem Hammers Gov. Perry's New Anti-Abortion Medicaid Funding Rule
A senior Texas Democrat hammered GOP Gov. Rick Perry this week over new rules blocking Medicaid funding to providers affiliated with abortion services. Rep. Lloyd Doggett suggested the move is a direct threat to the roughly 130,000 low-income women who receive cancer screenings and other preventive services under the state's Women's Health Program, which could crumble without the federal funds (Lillis, 2/25).

Health News Florida: WellCare: Free At Last?
After holding out for years, the chief whistleblower in the long-running case against WellCare Health Plans has removed his objection to a settlement of civil fraud charges with the federal government and nine states. ... When the Hellein lawsuit was unsealed in June 2010, ... [it alleged]: --WellCare conducted a study to figure out which Medicaid recipients were profitable and which were not so that it could engage in "cherry-picking" ... WellCare moved money between accounts to make it appear that patients' treatment cost much more than it actually did (Gentry, 2/24). 

Georgia Health News: Medicaid Task Force To Focus On Kids, Families
State officials have created a third task force to discuss proposals for a revamp of Medicaid and PeachCare services in Georgia. The new grouping will focus on children and families. Like the other two task forces, members will be asked to give input on a consulting firm’s report on the future of the two government health insurance programs (Miller, 2/24). 

(St. Paul) Pioneer Press: Senator Nienow Seeks Congressional Inquiry Into Minnesota’s Handling Of Medicaid Program
A state senator is asking Congress to investigate whether Minnesota's version of the Medicaid health insurance program has been manipulating a rate certification process in order to receive excess federal funds. Sen. Sean Nienow, R-Cambridge, wrote in a letter this month to U.S. Sen. Charles Grassley, R-Iowa, that a Congressional inquiry would be "extremely useful." "The misdirection or misallocation of federal funding is stealing and a serious problem which must be addressed if it is taking place," Nienow wrote in the letter, which was dated Feb. 18 (Snowbeck, 2/24).

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Abortion Legislation Making Noise At State Capitols

A host of abortion legislation proposals in state capitols around America — ranging from requiring Colorado doctors with religious objections give patients notice to mandated insurance coverage of abortion in Washington — are making news.

The Associated Press/Denver Post: Colo. Bill Requires Abortion Notice From Hospitals
Hospitals with religious objections to procedures such as abortions would have to tell patients in a special notice Colorado's Senate approved Friday. The measure was approved over vigorous objections from Senate Republicans, who called the notification bill a thinly veiled attempt to stigmatize religious hospitals. The bill, which requires one more procedural vote before it heads to the House, would require hospitals to tell patients that any service not provided because of religious beliefs or moral convictions can be obtained from another hospital (Wyatt, 2/24).

The Washington Post: Virginia Ultrasound Bill Joins Other States' Measures
Virginia officials backed off last week from requiring vaginal ultrasounds before abortions, but state legislators are still expected to pass a bill that mandates abdominal ultrasounds and adds other significant requirements for women seeking abortions (Sun, 2/26).

The Associated Press/The Seattle Times: State May Become First To Require Insurance To Cover Abortion
At a time when many states are making it harder for women to get abortions, Washington state appears headed in the opposite direction. Fifteen states have passed laws restricting insurers from covering abortions and 12 others are considering similar measures. By contrast, a bill that has passed Washington's House and is working its way through the Senate would make the state the first to require all health-insurance plans under its jurisdiction — except those claiming a conscience-based exemption — to include abortion coverage (Kaminsky, 2/26).

NPR: N.H. GOP Moves To Revise State's Contraception Law
New Hampshire, one of the least religious states in the nation, has become the latest front in the political battle over contraception. State GOP leaders oppose the new federal rule compelling insurers to provide birth control to employees of religious organizations. They want to change a 12-year-old state law that requires contraceptive coverage under insurers' prescription drug policies (Rogers, 2/24). 

Fox News: Gov. Brewer: I Think I Could Join On Contraception Mandate Lawsuit
Gov. Jan Brewer, R-Ariz., says she may be willing to add her state to the list of those suing the Obama administration over its contraceptive coverage mandate. "I actually haven't seen the lawsuit, but I think I could join in on a lawsuit," said Brewer during an interview with Fox News. Governor Brewer says she feels strongly about the issue because she believes in separation of church and state (Halpern, 2/25).

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State Roundup: More Allegations Against Calif.'s Prime Healthcare; Ore. CCOs Get Green Light

A selection of health policy stories from California, Oregon, Maryland, Massachusetts, Iowa, Arizona, Mississippi and Michigan.

The Associated Press: States Called On To Restore Anti-Smoking Funds
A U.S. Surgeon General's report due to be released March 8 will come down hard on states that have cut anti-smoking funds in tough fiscal times, said Terry Pechacek, who oversees the report as director for Science in the Office on Smoking and Health at the Centers for Disease Control and Prevention. The report can't result in sanctions, but it has proven to move public opinion in the past to force changes by tobacco companies in how they sell cigarettes, how states fund efforts and how the federal government regulates the trade (Gormley, 2/25).

Earlier, related KHN story: Kansas Tobacco Prevention Funds Diverted To Other Uses (Thompson, 1/20)

Los Angeles Times: Lawmakers Probe Prime Healthcare Services' Billing Practices
Controversial medical and billing practices by hospital chain Prime Healthcare Services came under scrutiny at a hearing before California lawmakers one day after the company's chief executive abruptly resigned (Terhune, 2/25).

California Watch: Lawmakers Alarmed By Hospital Chain's Practices
If a Kaiser Permanente customer ends up in the emergency room of another hospital, Dr. John Shohfi and his team of Kaiser doctors and nurses expect to be informed. ... But when Prime Healthcare Services took over a chain of Southern California hospitals, Shohfi testified today, there was a noticeable change in his relationship with Prime and its doctors. "No calls," said Shohfi, an emergency room physician (Jewett, 2/24).

Sacramento Bee: Consumer Advocates, Unions Back Health Care Ballot Measures
Consumer advocates and labor unions are looking to tap into Californians' anxiety over health care costs with ballot measures targeting insurance companies and hospitals. ... The so-called Insurance Rate Public Justification and Accountability Act also would require insurers to publicly justify proposed rate increases and get permission from the state before putting them into effect (Smith, 2/26).

The Lund Report (Oregon): Transformation Bill Passes the House
The bill allows the Oregon Health Authority to move forward with creating coordinated care organizations (CCOs) throughout the state by July 1. At the heart of CCOs will be patient teams made up of doctors, nurses, behavioral health providers, community health workers, and other providers who will integrate physical, mental and dental healthcare to the 600,000 patients on the Oregon Health Plan (Waldroupe, 2/25).

Des Moines Register: Nonprofit Co-Operative To Offer Health Insurance In Iowa
Two heavy hitters in Iowa's insurance industry are teaming up to compete with the state's dominant health insurer, Wellmark Blue Cross and Blue Shield. Several past efforts have failed to dent Wellmark's hold on the market, but this one has financial backing from the federal government. ... The new venture will be a nonprofit insurance co-op, owned by its members and led by a board they elect (Leys, 2/25).

Des Moines Register: Peers Give Hope To Mental Health Patients
Taylor was one of the first clients of a pilot project that pairs psychiatric patients in emergency rooms with specially trained "peer support specialists," who have learned to cope with their own mental illnesses. State leaders hope to expand the idea across Iowa to help prevent people with mental health crises from being locked needlessly in psychiatric wards (Leys, 2/25).

Arizona Republic: Giving New Mothers A Helping Hand
Home-visiting programs like Healthy Families are considered among the most effective efforts to prevent child abuse and neglect, promote healthy child development. ... A $9.4 million federal health grant — part of $88 million provided under federal health reform to support home-visiting programs — is expected to offer home visits to about 2,000 additional Arizona families in the coming year and lead to a more coordinated statewide effort (Reinhart, 2/26).

California Healthline: Exemption Granted for Pediatric Day Health
For months, Terry Racciato, ... who runs two PDHC centers in the San Diego area, has been arguing with the Department of Health Care Services that pediatric day health care services should be exempted from that 10 percent rate cut, as home health agencies were. ... The state's new course means PDHC centers will remain open (Gorn, 2/27). 

Mississippi Public Broadcasting: Black Doctors Call On Black Students To Enter Medicine
The number of black doctors in Mississippi is vastly disproportionately low, and some say that is harming public health in the state. ... [B]lack doctors from around the country and trying to persuade more black students to enter the medical field. ... African-Americans make up 37-percent of the state population but account for a little as 3 percent of its doctors (Hess, 2/24). 

Detroit Free Press: Bill In Works To Let Michigan's Community Colleges Offer 4-Year Degrees In Nursing, Other Fields
Community colleges and a number of students support the change, saying it's cheaper and would increase the number of people with degrees in areas that could be facing shortfalls (Jesse, 2/27).

Baltimore Sun: St. Joseph Considers Merger With Non-Catholic Hospital System
Financially troubled St. Joseph Medical Center may soon become part of a hospital system that does not follow its strict Catholic beliefs on abortion and reproductive rights. The Towson hospital's owner, Catholic Health Initiatives, put it up for sale after a surgical scandal threatened its business and besmirched its reputation (Walker, 2/26).

Boston Globe: New Data Posted On Payments From Drug And Device Makers To Providers
Massachusetts public health officials have published online the latest list of payments from drug and medical device makers to doctors, nurses, pharmacists, hospitals, and other health care providers. The data includes $64 million in payments from hundreds of companies in 2010 for speaking, consulting, food, educational programs, marketing studies, and charitable donations (Kowalczyk, 2/24). 

The Associated Press: Conn. Pharmacies Say They Lose Out In State Deal
Connecticut pharmacies say they have lost a substantial amount of business under the 2011 state employee bargaining agreement that funnels long-term prescriptions into CVS pharmacies in an effort to reduce costs. Now some state lawmakers are looking to enact legislation that directs business back to independent pharmacies (Young, 2/25). 

The New York Times: Life, With Dementia
Dementia Behind Bars: Dementia is a fast-growing phenomenon in prisons that many are not prepared to handle. The California Men's Colony is using convicted killers to care for inmates who can no longer care for themselves. ... Dementia in prison is an underreported but fast-growing phenomenon, one that many prisons are desperately unprepared to handle (Belluck, 2/25). 

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Editorials and Opinions

Viewpoints: Santorum On Repeal; Ariz. Republic Endorses Romney; How Catholic Church Almost Accepted Birth Control

The Wall Street Journal: My Economic Freedom Agenda
I'll submit legislation to repeal ObamaCare, and on day one issue an executive order ending related regulatory obligations on the states. I'll work with Congress to replace ObamaCare with competitive insurance choices to improve quality and limit the costs of health care, while protecting those with uninsurable health conditions. In contrast, Gov. Romney signed into law RomneyCare, which provided the model for ObamaCare. Its best-known feature is its overreaching individual health-care mandate. But it shares over a dozen other similarities with ObamaCare and has given Massachusetts the highest health-care premiums in the nation, and longer waits for health care (Rick Santorum, 2/27).

Arizona Republic: Romney Right For These Times
The Arizona Republic recommends that, in Tuesday's primary election, Republican voters support Mitt Romney for president. ... Despite the similarities between the national law and the health-care he championed in Massachusetts, Romney has been the most forceful of all GOP candidates at insisting that ousting Obamacare would be his first priority (2/24).

The Washington Post: How The Catholic Church Almost Came To Accept Birth Control
There is something truly baffling about the 2012 presidential candidates hotly debating Planned Parenthood and birth control. These battles were fought — and won — half a century ago. At that time, the vast majority of Americans, nearly all mainstream religious organizations and leaders in both political parties accepted contraception as beneficial to families, society and the world (Elaine Tyler May, 2/24).

The New York Times: Back to First Principles on Religious Freedom
The political ruckus over the issue has tended to obscure a central fact: the legal case against the policy is remarkably weak. The contraception benefit is plainly constitutional and a proper exercise of government power under Supreme Court precedent and a federal law dealing with exercise of religion (Dorothy Samuels, 2/25).

The New York Times: Ultrasound: A Pawn in the Abortion Wars
"Informed consent." It sounds so reasonable. That’s the stated goal of legislation being considered in Virginia that would require a woman seeking an abortion to first have an ultrasound, giving her an opportunity to examine the developing fetus and hear its heartbeat. ... [A]bortion rights advocates succeeded in reframing the proposal in the public mind as, instead, an outrageous threat to women's dignity (Eric Eckhom, 2/25).

Chicago Tribune: How Sex Hijacked Election Talk
How has an election year that was supposed to be all about economic recovery suddenly become all about sex? ... When you have made social issues like abortion, gay marriage and reproductive rights your central issues, you should not be shocked that media cover them. ... As long as the party's right wing seeks perfection in mere mortal politicians, its members will be disappointed, especially when they're talking about matters as touchy as sex (Clarence Page, 2/26).

The Washington Post: No One Is 'Playing Politics' On Solyndra Or Birth Control. This Is Politics.
But there is something troubling about the extent to which our leaders have made politics their bogeyman. Most important issues, from reproductive health to clean-energy investment, are riddled with politics — as they should be. They involve serious questions about what the country values and where it wants to invest its resources. To suggest that one’s own side is free of politics is not only sanctimonious, it’s also destructive (Alec MacGillis, 2/24).

Modern Healthcare: Politics Vs. Medicine
Clearly a goal of prenatal testing is to track the health of a developing fetus, looking for chromosomal abnormalities that might indicate any number of serious developmental problems. Could such information play a role in a decision to terminate a pregnancy? Of course. But in 21st-century medicine, that's also true of other technologies. Even some simple blood tests are used in prenatal diagnostic screening. Should governmental healthcare programs impose stricter limitations on which blood tests they will pay for? (David May, 2/25).

Des Moines Register: The Fight Over Reproductive Rights
The administration backed off in the face of a firestorm of protest, retreating to a compromise that would provide the insurance without requiring religious organizations to pay for it. Even so, Republicans are still denouncing the original plan as a violation of the freedom of religion guaranteed by the Constitution. I don’t see it. The original Obama mandate didn’t require Catholics or anyone else to use birth control. That’s a personal choice. What it did was keep institutions from denying their employees a right that’s guaranteed by law (Donald Kaul, 2/25).

Boston Globe: Scott Brown's Presumption
Those who knew Kennedy, including his son, have lined up to say he would never have said that Catholic institutions should be able to refuse their employees birth control. Yet Brown wrote to Patrick Kennedy that he chooses to believe that he and the elder Kennedy would have been “working together’’ on this issue. Not likely (Adrian Walker, 2/27).

The Washington Post: How The GOP Would Expand The Deficit
Mr. Santorum outlines some $2.2 trillion in specific policies, such as shifting Medicare to a premium support system, transforming social programs into block grants to states and capping their growth, and cutting other domestic spending. Then he offers up the biggest magic asterisk of all time, cutting another $5 trillion within five years, details not provided. Wisely discounting that gauzy promise, the CRFB projects that under its intermediate scenario Mr. Santorum’s policies would increase deficits by $4.5 trillion through 2021, bringing the debt to a scary 107 percent of the economy (2/26).

The Washington Post: Five Myths About Medicare
Because of Medicare’s size and growth, the health-care program has taken center stage on the campaign trail and in Capitol Hill discussions about the federal budget deficit. Medicare covers almost one in six Americans and comprises about 15 percent of the federal budget, but it is often misunderstood. Let’s take a few minutes to separate fact from fiction (John Rother, 2/24).

The Washington Post: Does The Supreme Court Think Like The Average American?
By November’s elections, the Supreme Court will have heard challenges to President Obama’s health-care overhaul, Arizona’s immigration law and, as announced this past week, the consideration of race in college admissions. If the court preserves "Obamacare" or affirmative action, conservatives will cry judicial activism. If Arizona’s immigration statute survives, liberals will take up the charge, just as they did after the court’s Citizens United campaign finance decision in 2010. But is judicial activism a problem if, as a recent study found, the high court’s views mirror those of the American public? (Justin Moyer, 2/24). 

Reuters: Time Nears For An American Tax Overhaul
While almost everyone agrees on the desirability of containing federal health care spending, this is likely to be more difficult than we’d like to believe. Certainly beneficiaries can bear more of the cost of their government insurance than others, and there are steps like malpractice reform and the further encouragement of preventive medicine that should be taken. Yet without intrusions into the private health care system that are unlikely to be politically acceptable, there are severe limits on what can be done (Lawrence Summers, 2/26).

The Philadelphia Inquirer: Health Reform Scare Tactics Move Beyond Broccoli
Remember when opponents warned that it could lead to the mandated purchase of broccoli? Now some say it would let Congress require that everyone buy a car. That’s the prediction of Paul Clement, the lead attorney for the health reform challengers in the pending Supreme Court case. He issued it in a briefing last week sponsored by SCOTUSblog, an influential website that covers the Court, and Bloomberg Law. What doomsday scenario will opponents dream up next? (Robert Field, 2/24).

Des Moines Register: Court, Congress Should Avoid Showdown
The tension that always exists to some degree between Congress and the U.S. Supreme Court may be getting more intense. This tension was triggered by a pending decision in the constitutionality of the 2010 health care reform law. This has the makings of a nasty battle for supremacy between Congress and the courts, and both sides should tread lightly as they approach that line of separation between the two equal branches of government (2/24).

Denver Post: The Wrong Prescription
No one denies that America needs serious health care reform, but President Obama's health care overhaul — the Patient Protection and Affordable Care Act — is the wrong way to go about it. Federally mandated health care will put hundreds of thousands of Americans out of work; add to the already numerous obstacles employers offering insurance plans face; increase the amount of uncompensated care in America; and, in the words of U.S. District Judge Henry Hudson, "invites unbridled exercise of federal police power" (Colorado State Rep. Amy Stephens, 2/26).

HealthyCal: Death of Single Payer Health Plan Inspires Change of Thought
California's so-called “Medicare for all” bill has died. ... an increasing number of Californians are also finding that the answers they’re looking for are literally as close as their next thought. For medical researchers and Everyday Joes alike, the connection between better thinking and better health is becoming increasingly obvious – not to mention better understood (Eric Nelson, 2/24).

Houston Chronicle: Menninger’s High Hopes For Mental Health Care
The opening this spring of the Menninger Clinic Mental Health Epicenter just eight miles from the Medical Center signals a new level of commitment to mental health treatment here. … But the costs of treatment, while high, pale in comparison with the costs of ignoring mental illness and substance abuse. In terms of both dollars and human misery, the costs of refusing to face this crisis are almost beyond count (2/24).

Baltimore Sun: Fair Treatment For All Cancer Patients
Simply put, when cancer patients are treated with intravenous chemotherapy drugs — which for years were virtually the only treatment option — their share of the costs under most insurance plans is limited to office visit co-pays, usually about $20 or $30 per session. … But the cost impact on patients has created heartbreaking situations, some of which patients shared recently with members of the General Assembly (Paul Celano, 2/27).

The Washington Post: A D.C. Hospital On Life Support
D.C. officials have made many of the decisions about United Medical Center with their backs to the wall. To save the only hospital east of the Anacostia River, they ousted one owner, helped another and eventually took control of the troubled facility — all to the tune of tens of millions of public dollars. Now the hospital is asking for more money. That should make the city pause and clearly assess its hopes and its chances of success (2/26).

Milwaukee Journal Sentinel: Aurora Stands Up For City, But Access Still A Problem
Aurora Sinai Medical Center, a bastion of medical care for Milwaukee's central city, will keep its emergency department and other services open at its downtown location. … Aurora made a difficult decision to keep Sinai's ER and other services open despite financial pressure to do otherwise. Give the company credit for that. Now, Aurora and the city's other health care systems should put more money and effort into bolstering federally subsidized clinics, which could ensure better and more sustainable access to quality care (2/25).

Minneapolis Star Tribune: Editorial: Medical Board Fails Quality Examination
Readers shouldn't conclude that Minnesota has a bad board, but it clearly hasn't moved as aggressively as some states to improve its transparency or evaluate how it could better protect the public. Minnesota lawmakers are now stepping in to do what some other states' medical boards have already pushed for: legislation that allows and speeds access to greater information about physicians — such as info from others states' disciplinary actions or information from malpractice cases. … Lawmakers should seize this opportunity to ensure that the state has the leading-edge medical board it deserves (2/25).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

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