Daily Health Policy Report

Tuesday, February 28, 2012

Last updated: Tue, Feb 28

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Coverage & Access

Administration News

Campaign 2012

Health Information Technology

Health Care Fraud & Abuse

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insuring Your Health: Insurers Open Stores To Peddle Health Plans

In her latest Kaiser Health News consumer column, Michelle Andrews writes: "When Ronda Austin's employer stopped offering health coverage last spring, she bought an individual policy from Blue Cross and Blue Shield of Florida. A month later she was given a diagnosis of multiple myeloma and began chemotherapy at her oncologist's office near her home in Tampa" (Andrews, 2/27). Read the column.

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Political Cartoon: 'New Testament?'

Kaiser Health News provides a fresh take on health policy developments with "New Testament?" by Clay Bennett.

Meanwhile, here's today's haiku:


Uninsured come in
Use ER for minor ills
Hospitals lose out
-Nicole Ausmus

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

'Obamacare' Draws More Opposition Than 'Romneycare'

Politico reports on new polling that shows the federal health law draws more negative public opinions than does the Massachusetts law signed by Mitt Romney when he was the state's governor. Also, the LA Times reports that a majority of registered voters believe the health law's individual mandate is unconstitutional.

Politico: The Romneycare – Obamacare Gap
New polling shows President Obama's signature health care law generates more opposition than a similar law signed by Mitt Romney as Massachusetts governor. According to Gallup, 32 percent of voters say they're much less likely to vote for President Obama because of his 2010 health care reform bill. By contrast, only 14 percent of voters say Mitt Romney's 2006 law makes them less likely to vote for him. On the other hand, 22 percent of voters say Obama's bill makes them more inclined to back him in November, versus just 6 percent for Romney (Tau, 2/28).

Los Angeles Times: Poll: Most Voters Believe Healthcare Mandate Is Unconstitutional
Nearly two years after President Obama signed his landmark healthcare package into law, three-quarters of registered voters believe the law's requirement that every American carry health insurance is unconstitutional, according to a new survey. A USA Today/Gallup poll taken earlier this month and released Monday found that a majority of voters -- those surveyed in battleground states and nationwide generally -- agreed in their dislike of the Affordable Care Act. Voters in battleground states are more likely to want it repealed, the poll showed (Geiger, 2/27).

In related news, the latest on the Supreme Court's upcoming health law deliberations  -

CQ HealthBeat: States, NFIB Tell Supreme Court That Health Care Suit Must Go Forward
The 26 states and a business group that are challenging the health care law fought back Monday against arguments that a tax law dating from the 1800s could put their suit on hold until the health care overhaul goes into effect in 2014. Were the Supreme Court to decide to postpone consideration of the health care law, it likely would dilute the power of the measure as a campaign issue in 2012 and give the Obama administration more time to implement the overhaul. It’s not inconceivable that justices might choose such a path. The court has ordered that the first day of oral arguments in March be devoted to the tax law and a federal appeals court has already thrown out one suit on the basis of that law (Norman, 2/27).

The Hill: Bill To Put Cameras In Supreme Court Won't Pass Before Health Care Challenge
A bipartisan effort to allow cameras in the Supreme Court is not going to pass Congress before justices tackle what has been dubbed the "case of the century." The legislation, which has bounced around in both the House and Senate for a decade, gathered momentum last year when the high court agreed to hear challenges to President Obama's healthcare reform law. The idea of putting cameras in the Supreme Court is supported by politicians on the left and right, including House Minority Leader Nancy Pelosi (D-Calif.), Senate Majority Whip Dick Durbin (D-Ill.), Sen. Chuck Grassley (R-Iowa) and Rep. Ted Poe (R-Texas) (Pecquet, 2/28).

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On Health Exchange, Neb. Makes Progress, Wis. and Texas Mull Next Steps

A roundup of reports on what's happening on the ground in several states, where Republican governors have been opposed to implementing the health law's insurance exchanges.

Politico Pro: Neb. Exchange In Works Despite ACA Stance
Nebraska Republican Gov. Dave Heineman officially opposes implementing an exchange until after the Supreme Court rules on the health care reform suit, but his state's department of insurance appears to be doing the work necessary to have an exchange certified by HHS on time if the law is upheld. In fact, while the Heineman administration is rooting against the law, officials think a Nebraska-based exchange will be ready as soon as the Supreme Court issues its decision. In an email obtained by POLITICO, Nebraska Department of Insurance health analyst Michael Sciullo wrote to vendors on Monday to let them know the department would soon issue a request for information on "vendor progress ... for the continued planning and design of Nebraska’s potential Health Insurance Exchange" (Feder, 2/27).

Politico Pro: Walker: We May Wind Up With An Exchange
Wisconsin Gov. Scott Walker, who last month rejected $38 million from the Obama administration to build a health insurance exchange, says his state may wind up doing its own exchange if "legal and political options are exhausted" by November. But if it does, it's likely to be as market-driven as possible — with the state staying far in the background. Before returning the HHS funding, Walker announced late last year that Wisconsin would halt all exchange planning unless the Supreme Court upheld the Affordable Care Act. However, Walker told POLITICO on Sunday that he would wait until the November elections to figure out a path for a state-based exchange (Millman, 2/27).

Meanwhile, a Texas official says the state is ready to move forward in its implementation efforts -

The Texas Tribune: Health and Human Services Commission Health Leaders Say They're Ready for Federal Reforms
On Monday, state officials at a joint meeting of the House Insurance and Public Health committees told lawmakers that Texas is ready to move forward with President Obama's health care reform package next month, regardless of whether the U.S. Supreme Court strikes down parts or all of it. "It has been a balancing act trying to determine how much planning to do versus waiting for the outcome," Billy Millwee, the deputy commissioner of the Health and Human Services Commission, told the panel. ... "I don't think we've lost anything, given the unknown factors" (Tan, 2/27). 

Houston Chronicle: Texans With Health Insurance Expected To Reach 91 Percent 
The percentage of Texans with health insurance will increase to 91 percent - up from 74 percent today - after the national health care law takes effect in 2014, the state's Medicaid director told lawmakers Monday. ... An estimated 2.3 million Texans will still lack health insurance after the Affordable Care Act takes effect, partially because undocumented immigrants are not eligible for coverage, State Medicaid Director Billy Millwee told a joint meeting of the House Public Health and Insurance committees (Scharrer, 2/27).

And in other health law implementation news -  

Politico Pro: PCORI Told To Keep The Focus On Patients' Needs
Listen to the patients. That was the message of the daylong second stakeholder meeting of the Patient-Centered Research Outcomes Institute on Monday. But what the patients actually want, or need, depended entirely on who you asked. Hours of the afternoon were dedicated to hearing nearly 70 public comments from patients, providers, payers and advocates for a wide variety of diseases. The outpouring of comments just proved exactly how daunting a task the PCORI board has ahead: accelerate comparative effectiveness research, but in a way that doesn't leave it open to "rationing" charges (Nocera, 2/27).

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Capitol Hill Watch

Senate Republican Renews Effort To Repeal Independent Payment Advisory Board

Meanwhile, on the House side, a top Democrat has said he will support efforts to undo the panel created to curb Medicare spending growth. The American Medical Association also reiterated its support for repeal. 

Politico Pro: Cornyn Reintroduces IPAB Bill
Sen. John Cornyn has reintroduced his legislation to repeal the health care reform law's Independent Payment Advisory Board with a way to pay for it, a sign that Senate Republicans are preparing to go after the provision. Cornyn (R-Texas) would pay for the IPAB repeal by requiring people to repay more of their premium subsidies if their income changes during the year, after the subsidies go into effect in 2014. Republicans and Democrats have used the same provision to pay for other legislation before, but this version would require consumers to repay even more (Haberkorn, 2/27).

CQ HealthBeat: Pallone To Back GOP Effort To Repeal Medicare Cost-Cutting Panel
A top House Democrat on health issues plans to vote in favor of a GOP bill that would repeal an independent board created by President Obama's health care overhaul to curb Medicare spending growth. Frank Pallone Jr. of New Jersey, the ranking member on the Energy and Commerce Health Subcommittee, said Feb. 24 that he will support the measure at a panel markup Feb. 29, despite his concern that Republicans are using the bill to attack the 2010 health care law (Attias, 2/27).

The Hill: AMA Pushes IPAB Repeal Ahead Of House Panel's Vote
The American Medical Association reiterated its support Monday for Republican-led efforts to repeal the controversial cost-cutting board created by President Obama's healthcare law. The House Energy and Commerce Committee's health panel is scheduled to vote this week to repeal the Independent Payment Advisory Board (IPAB). The panel of healthcare experts would be tasked with cutting Medicare payments to doctors if spending rises faster than a certain rate (Baker, 2/27).

And The Washington Post reports on the Senate politics swirling in the background -

The Washington Post: The Fight For The Senate Majority Headed For Deadlock
A key reason is that the Senate, which will provide some of the most competitive and expensive contests on the election calendar, is likely to function, or not, in January 2013 the way it does now, regardless of which party holds the majority. Neither the Democrats nor the Republicans are expected to make the sort of sweeping gains at the polls that are necessary to take effective control of the chamber, where work has been hobbled by a constant flow of filibusters and other political and procedural gimmicks (Kane, 2/27).

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Coverage & Access

Lack Of Insurance Driving Up Number Of Patients Who Seek ER Dental Care

With that increase comes a related jump in costs.

The Associated Press: More Americans Seeking Dental Treatment At The ER
More Americans are turning to the emergency room for routine dental problems — a choice that often costs 10 times more than preventive care and offers far fewer treatment options than a dentist's office, according to an analysis of government data and dental research. Most of those emergency visits involve trouble such as toothaches that could have been avoided with regular checkups but went untreated, in many cases because of a shortage of dentists, particularly those willing to treat Medicaid patients, the analysis said (Tanner, 2/28).

Milwaukee Journal Sentinel: Emergency Dental Care Up 16%; Lack Of Insurance Cited
Preventable dental conditions resulted in an estimated 890,000 emergency department visits nationally in 2009, a 16% increase from 2006, according to a report from the Pew Center on the States. The problem can be seen in Wisconsin and is a long-standing frustration for the Wisconsin Hospital Association. The association has estimated that 32,000 patients with dental problems, such as an infected tooth, are seen by hospital emergency departments each year (Boulton, 2/27).

California Healthline: Dental Problems Showing Up as Emergencies
In fact, [Shelly Gehshan, director of the national Pew Children’s Dental Campaign] said, California's dental care system can only handle about 70% of the need in the state, and that's if the system were actually at full capacity. ... Training more dentists is likely not the full solution, she said. "Generally, dentists go out and practice in the same ways and places that dentists already practice," Gehshan said. "Most of them don't accept Medi-Cal, so in a way you'd just be adding more dentists to the current system" (Gorn, 2/28).

In other news related to health insurance coverage and access to care -

The New York Times: At-Risk Patients Gain Attention Of Health Insurers
One percent of patients account for more than 25 percent of health care spending among the privately insured, according to a new study. Their medical bills average nearly $100,000 a year for multiple hospital stays, doctors' visits, trips to emergency rooms and prescription drugs. And they are not always the end-of-lifers. They are people who suffer from chronic and increasingly common diseases like diabetes and high blood pressure (Abelson, 2/27).

(Minneapolis) Star-Tribune: Rosenblum: Fighting For His Life - And For A Bed To Sleep In
(Editor's note: Blake Anderson died Monday morning, a day after this column was published.)
Since being diagnosed with acute myelogenous leukemia in 2008, [17-year old Blake Anderson] and his single mom, Michelle Anderson, have been couch-hopping and hoping for a miracle -- or two. ... Apartment evictions have dogged her since Blake's diagnosis, mainly because she finds it impossible to work and be the full-time support system her son needs as he navigates life with endless medications and doctor's appointments (Rosenblum, 2/27). 

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Administration News

Obama Contraception Rule Continues To Fuel Arguments

Conservative women opposed to the birth control mandate are pushing to reframe the debate around religious liberty. Meanwhile, a range of organizations, including pediatricians, labor unions and charities that fight birth defects, oppose an amendment by Sen. Roy Blunt, R-Mo., that would allow employers to exclude any insurance benefit they deemed immoral.

National Journal: Public Divided Over Birth-Control Coverage
The issue of contraception has ignited a series of conflicts in recent weeks. The confrontation escalated in January when Obama announced a policy that initially would have required religiously affiliated employers like Catholic universities or hospitals (though not churches themselves) to fund birth control at no cost if they provide health insurance to their workers. After a backlash, Obama unveiled a plan to require the insurance companies, rather than the religiously affiliated employers, to fund coverage for contraception at no additional cost to the worker (Brownstein, 2/28).

Politico: Quiet Fade Out For Obama's Faith Council
His faith under attack, his contraception decision savaged on all sides, President Barack Obama could use backup in the religious community right now. But three years into his presidency, Obama's marquee council of faith advisers has gone dark — a little-noticed postscript for a panel that he rolled out with fanfare and high expectations during his first weeks in office but ended up playing only a limited role in West Wing deliberations. The president's first Advisory Council on Faith-Based and Neighborhood Partnerships delivered a 163-page report in March 2010 and then disbanded (Brown, 2/28).

The Hill: Conservative Women Opposed To Birth Control Mandate Push To Reframe Debate
Conservatives — including conservative women — are pushing back hard against charges that opposition to the White House's contraception mandate is an attack on women. Democrats and supporters of the birth-control mandate are framing the debate around women's health. They've seized on the catchphrase "Where are the women?" following a House hearing that featured an all-male panel of witnesses testifying against the White House policy. Women who oppose the mandate are taking on an increasingly public role as the right tries to refocus the debate around religious liberty (Baker, 2/27).

Politico Pro: Heritage Features Women Who Oppose Contraception Rule
The Heritage Foundation agrees with Rep. Nancy Pelosi — women have been silenced in the debate about the contraception coverage mandate. Of course, the Heritage panelists are talking about different women. The ones who think the issue is religious freedom — not the ones who think the contraception rule is a good idea. "They're silenced, they're intimidated," Rep. Ann Marie Buerkle (R-N.Y.) said Monday during an all-female panel discussion of the new health care reform rule (Feder, 2/27).

The New York Times: Democrats See Benefits In Battle On Contraception
Democratic leaders, who set the Senate floor schedule, plan to hold a vote this week on a measure offered by Senator Roy Blunt, Republican of Missouri, that would in effect reduce insurance coverage of contraception, by allowing religious institutions not to cover it in the health plans they offer employees. Democrats see the vote as a way to embarrass Republicans — especially those up for re-election in moderate states like Maine and Massachusetts — and believe that the battle may alienate women and moderates from the Republican Party (Steinhauer and Cooper, 2/27).

National Journal: Groups Oppose Blunt's Contraceptive Amendment
Pediatricians, labor unions, charities that fight birth defects, and other groups came out in unsurprising opposition on Monday to an amendment proposed by Sen. Roy Blunt, R-Mo., that would allow employers to exclude any insurance benefit that they deem immoral. The Senate is expected to vote sometime this week on Blunt's proposal, a vote that almost certainly will kill it. The newest United Technologies/National Journal Congressional Connection Poll shows that 49 percent of adults support President Obama’s plan to have health insurance companies pay for contraception coverage in cases where religiously affiliated employers object; 40 percent oppose it (Fox and Sanger-Katz, 2/27).

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Campaign 2012

Health Law, Entitlement Programs Part Of GOP Campaign Talk

News outlets report on the positions taken and jabs traded by the GOP presidential candidates as they position themselves for primary elections in Michigan and Arizona.  

McClatchy: GOP Candidates Say They Care For Poor But Would Cut Safety Net
After he appeared to dismiss the very poor, Mitt Romney was forced to backpedal from his politically perilous remarks. But he and other candidates stand by bedrock conservative principles of cutting entitlement programs and government spending…Several other states have recently trimmed programs for the poor. Wisconsin and New Jersey cut the percentage they contribute to the earned income tax credit. Washington froze enrollment for a state-run health care plan. South Carolina wants to impose a drug test on people receiving unemployment benefits (Semuels, 2/27).

Los Angeles Times: Rick Santorum Predicts A 'Surprise' On Eve Of Primaries
[Santorum] contrasted that with President Obama, who he said claimed that America was not a great country until entitlement programs were passed. [The president actually said "we would not be a great country" without safety-net programs such as Social Security and Medicaid.] … Santorum also repeated his arguments that Romney would be a weak competitor for Obama because of the healthcare plan he crafted while he was governor of Massachusetts and his positions on issues such as global warming. He also argued that voters ought to consider that while Romney and his supporters spent millions of dollars in state-by-state battles to crush rivals, such a strategy would not work in the general election against Obama (Mehta, 2/27).

Reuters: Santorum's Plan To Gut Obama Regulations Faces Hurdles
Republican candidates have pledged to reverse the controversial healthcare law, which requires all Americans to carry health insurance and imposes new obligations on insurers, such as requiring them to take patients regardless of pre-existing conditions. Because these rules are not yet implemented and they come from an Executive Branch agency controlled by the White House, a President Santorum would have a better chance of canceling them (Lawder, 2/27).

Boston Globe: Republican Rivals Trade Last Jabs In Michigan
Rick Santorum and Mitt Romney yesterday accused each other of being unfit for the Republican presidential nomination in the finale to a primary vote today that could reshape the contest once again. Santorum called Romney "uniquely unqualified"’ to be the nominee, saying his rival's Massachusetts health care plan would hinder Republicans from criticizing President Obama's similar federal plan. He also again described Romney's claim of conservatism as laughable. "Michigan, you have the opportunity to stop the joke,’" Santorum said (Viser and Calvan, 2/28).

The Wall Street Journal’s Washington Wire: Gingrich Turns To Health Care, Etc.
Newt Gingrich sat in a law firm’s event room here Monday with a small panel of health-care professionals to discuss overhauling President Barack Obama’s 2010 health-care law, among other things. For the first 20 minutes, he let others talk. Apparently realizing their guest had gone silent — an aide to Mr. Gingrich at one point brought him a cup of coffee — a panelist turned the microphone over to the presidential candidate. But the former House speaker did not seize the opportunity to reassert himself in the conversation (Yadron, 2/27).

Meanwhile, it appears, according to the Associated Press, that President Barack Obama is gaining support among women as birth control and other social issues become a "bigger part of the national discourse" -

The Associated Press: Obama Gains With Women: Jobs, Social Issues Help
It's looking like President Barack Obama may be back in the good graces of women. His support dropped among this critical constituency just before the new year began and the presidential campaign got under way in earnest. But his standing with female voters is strengthening, polls show, as the economy improves and social issues, including birth control, become a bigger part of the nation's political discourse (Agiesta and Kellman, 2/27).

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Mass. Senate Race: Brown-Kennedy Dust-Up Continues

Sen. Scott Brown, R-Mass., has refused a request from former Rep. Patrick Kennedy, D-R.I., to pull a campaign advertisement rejecting the federal birth control mandate that features Kennedy's father, the late Sen. Edward Kennedy, D-Mass.

Fox News: Brown Refuses To Pull Ad Mentioning Late Sen. Kennedy
Massachusetts Sen. Scott Brown says he won't [bow] to pressure from former Rep. Patrick Kennedy, whose father, the late Sen. Edward Kennedy, is being featured in a radio ad rejecting the mandate requiring religious employers to provide birth control coverage. Kennedy asked the Republican senator to pull the ad claiming his father supported religious exemptions for employers and health insurers, but only on certain medical procedures, and not as a blanket exemption to deny birth control to employees (2/27).

The Associated Press: Brown Declines To Pull Ad Mentioning Ted Kennedy
Massachusetts Sen. Scott Brown said Monday he would not be pressured by the late Sen. Edward Kennedy's family to stop running a radio ad claiming that Kennedy's position was similar to Brown's in the fight over whether employers should be required to provide birth control coverage or other procedures they oppose on religious or moral grounds. Kennedy's son, former U.S. Rep. Patrick Kennedy, has issued an open letter to the Republican senator asking him to pull the ad claiming that the elder Kennedy supported religious exemptions for employers and health insurers, as Brown does (Salsberg, 2/27).

Boston Globe: Kennedy Bills Appear To Undercut Brown
The late Senator Edward M. Kennedy sponsored bills in the 1990s and 2000s that would have required all employers who offer prescription drug coverage to include contraception coverage, an action that seems to undercut Senator Scott Brown's contention that Kennedy shared his views on allowing exemptions based on moral objections. The most recent version of the bill, in 2005, did not allow for exemptions based on moral objections of churches or other employers. Advocates said earlier bills were similar (Bierman, 2/28).

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Health Information Technology

Hospitals, Consumer Groups Have Postive View Of 'Stage 2' Health IT Rules

Both hospital and consumer groups are reacting positively to new federal rules meant to improve the effective use of the technology, and new electronic health records certification rules are released.

CQ HealthBeat: Hospitals, Consumers Give Cautious Thumbs Up To IT Proposal
Hospital and consumer groups for the most part reacted favorably Monday to two Obama administration regulatory proposals to improve the quality and safety of medical treatment through more effective use of health information technology. Hospitals praised the long-awaited "stage two" proposed rules to spur "meaningful use" of IT for providing a flexible approach. Meanwhile, a consumer group said the stage two proposals will increase online patient access to their own medical data and ease e-mail communication with their doctors (Reichard, 2/27).

Modern Healthcare: Proposed New EHR Certification Rules Released
While most of the attention in the health information technology industry last week was focused on the newly proposed Stage 2 standards that providers would have to meet to achieve meaningful use of electronic health-record systems, a companion proposed rule affecting EHR vendors and the organizations that test and certify them also was made public. ... The ONC-developed rule sets the standards that EHRs must meet to become certified and thus eligible for use by hospitals, physicians and other qualifying professionals seeking to become meaningful users and receive federal EHR incentive payments under the Medicare and Medicaid programs created by the American Recovery and Reinvestment Act of 2009 (Conn, 2/27).

In other technology news -

Florida Public Media: How Telemedicine Works At Home
Every morning at 10:00 a.m., congestive heart failure patient Marilyn Yeats of Naples conducts her own health checkup with the help of a computer. ... Yeats is part of a pilot program through Humana Cares. The insurance company is targeting patients with congestive heart failure in efforts to manage their symptoms and reduce their hospital readmissions (Mack, 2/27).

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Health Care Fraud & Abuse

Financial Crime Convictions - Including Health Care Fraud - Reap Billions In Restitution Payments

The Associated Press/Washington Post: FBI Says Probes Of Financial Crime Led To Restitution Orders In The Billions
The FBI said Monday that its probes of financial crime last year led to more than 3,000 convictions and over $12 billion in court-ordered restitution as agents attacked insider trading, Ponzi schemes and Medicare fraud in high-dollar scams that victimized thousands of investors and the government (2/27).

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Public Health & Education

HPV Vaccine Recommended For Boys

The American Academy of Pediatrics has recommended boys — not just girls — be vaccinated against HPV, though questions about its cost-effectiveness remain.

NPR's SHOTS blog: Pediatricians Recommend HPV Vaccination For Boys
The vaccination is expensive. Full immunization takes three shots (either with Merck's Gardasil or GlaxoSmithKline's Cervarix), which run about $100 or more each. The cost-effectiveness of vaccination for boys is an issue. The recommendation notes that "a range of assumptions," including the vaccination rates for girls, can affect how much each prevented case of illness costs (Hensley, 2/26).

Medscape: HPV Vaccine Recommended for Boys in New AAP Guidelines
The American Academy of Pediatrics (AAP) has published new guidelines for the use of the human papillomavirus vaccine and, for the first time, has specifically recommended use of the vaccine in adolescent boys as well as girls. ... HPV infection has been associated with increased risk for cervical cancer, anal cancer, and oropharyngeal cancer (Fox, 2/27). 

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State Watch

State Budgets Improve But Not Enough To Spare Medicaid

Medicaid news from California, Georgia and New York.

Modern Healthcare: Better State Budget Picture, But Medicaid Still In Jeopardy
State budget shortfalls for the coming year total about $47 billion, the smallest aggregate deficit since the Great Recession, a report says. The Center on Budget and Policy Priorities found deficits in 29 states for the fiscal year ahead and another 10 states reported revenue for the current year fell $3.2 billion short of budget. ... [A] marked improvement from the $106 billion this year (so far) and $430 million the prior three years (Evans, 2/27).

Sacramento Bee: Jerry Brown Presses Obama On Medi-Cal, Meets With Labor
Gov. Jerry Brown continued to press President Barack Obama today for authorization to enact further cuts to Medi-Cal to help balance California's budget, even as the administration showed no sign of relenting and complained about the severity of state budget cuts in other areas. ... The Obama administration recently denied Brown's bid to charge Medi-Cal recipients co-payments for prescription drugs, doctor visits and other services. After meeting privately with Health and Human Services Secretary Kathleen Sebelius on Sunday, Brown said there are "some legal issues being raised about our ability to require co-pays" (Siders, 2/27).

Sacramento Bee: Jerry Brown Advised Not To 'Talk Too Much' About Medi-Cal
"There are possibilities that are being examined that will enable California to more tightly manage its Medi-Cal program, and some of that involves co-payments," the Democratic governor was telling reporters. "But if you talk too much about it, you might hurt your negotiations," [Brown aide Nancy] McFadden said (Siders, 2/27).

Georgia Health News: Senate Panel Oks Welfare Drug Testing
A Senate health committee Monday approved a bill requiring drug testing for Georgia welfare applicants, after a similar provision for Medicaid enrollees was dropped from the legislation. ... Federal approval would have been necessary to put [the Medicaid rule] into effect, and last week a state official testified that a federal agency had already denied permission for other states to require drug-testing of Medicaid enrollees (Miller, 2/27). 

California Healthline: New California Law Seeks To Expand Telehealth Services for Medicaid Beneficiaries
The law allows for a broader range of telehealth services, expands the definition of telehealth providers to include all licensed health care professionals, expands telehealth care settings and allows state hospitals to establish medical credentials for telehealth providers more easily (Kennedy, 2/27). 

The Associated Press/Wall Street Journal: NY Probe Results In Medicaid Overbilling Recovery
A New York state commission says a joint investigation has resulted in recovering more than $153,000 in Medicaid funds overbilled for services to the disabled. ... Investigators say they also found that Guest House Executive Director Joseph Akumu diverted more than $132,000 from Medicaid checks (2/28).

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Minn. Senate Takes On Anti-Abortion Bills; 'Personhood' Initiatives Advance

Across the nation, state legislatures are considering various bills to restrict access to abortion and contraception services.

Minneapolis Star Tribune: Two Anti-Abortion Bills Pass Senate Committee
Two bills back by Minnesota Citizens Concerned for Life, the state's largest anti-abortion organization, passed a divided Senate committee on Monday. The bills passed by the Senate Health and Human Services Committee would: Require a new license and inspections for any "clinic, health center or other facility" that performs ten or more abortions per month. Require a doctor's presence when an abortion-inducing drug such as RU-486 is administered, and would prohibit the physician from participating via video conference (2/27).

Minnesota Public Radio: Two Bills Regulating Abortion Advance In Senate 
One bill that could restrict the use of an abortion pill was approved by the Senate Health and Human Services Committee. The bill prohibits doctors from monitoring via videoconference women on the early term abortion pill RU-486 (Dunbar, 2/27). 

(St. Paul) Pioneer Press: Two Bills Increase Abortion Regulation
Medical experts testified in support of using "telemedicine" and in support of the medication. ... But supporters of the bill said the medication was dangerous and should be administered cautiously. ... In 2010, medication abortions accounted for 2,378 of the 11,550 abortions in the state, according to the Minnesota Department of Health (Snowbeck, 2/27).

The Texas Tribune: Interactive: Mapping the Women's Health Program Providers
The Texas Women's Health Program (WHP) is in serious jeopardy and likely to end after Mar. 14. The Legislature has indicated it would prefer to end the 5-year-old program rather than allow Planned Parenthood to be part of it, because the organization offers abortions at some of its Texas locations — though none that receive taxpayer dollars. ... Out of nearly 130,000 WHP clients statewide, the Texas Health and Human Services Commission reports that nearly 44 percent receive services at a Planned Parenthood clinic (Aaronson and Tan, 2/28).

The Atlanta Journal-Constitution: Committee Advances 'Fetal Pain' Abortion Bill In Georgia
A judiciary committee in the state House approved a bill Monday that would cut the amount of time women have to get elective abortions from 26 weeks to 20 weeks (Quinn, 2/27).

Politico Pro: 'Personhood' Movement Gains Steam
In at least seven states, activists are trying to place initiatives on the November ballot that would extend legal rights to the moment of conception. Among them are swing states including Florida, Ohio and Nevada, where the initiatives could add an unpredictable element to an election year that in recent weeks has focused increasingly on reproductive politics (Feder, 2/28).

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Feds Pursue Anti-Trust Action Against Georgia Hospital Chain

Hospital news from around the country includes: concern in Mass. about the bottom line, mergers in Georgia and more about Dallas' troubled Parkland facility. 

Boston Globe: Tax Deal Reduces Funds For Hospitals
The recent payroll tax cut package passed by Congress — heralded as a bipartisan nod to working families — has Massachusetts hospitals reeling over a little-noted section that will cost them tens of millions of dollars. Tucked into the legislation are cuts to the rates paid to hospitals to care for the elderly and poor (Jan, 2/28).

Related, earlier KHN story: Tentative ‘Doc Fix’ Deal Would Cut Health Law’s Prevention Fund by $5B (Carey, 2/15) 

Modern Healthcare: Feds To Appeal Phoebe Putney Ruling
In another sign of government interest in health care market power, U.S. Solicitor General Donald Verrilli Jr. plans to appeal to the Supreme Court a decision that allowed a $198 million hospital purchase that greatly consolidated hospital acute-care services in southwest Georgia. ... The FTC says the transaction gives Phoebe Putney control over 100 percent of the acute-care hospital beds in Dougherty County, and 86 percent control in the surrounding six-county market, which would "tend to create a monopoly," Verrilli's application for an extension says (Carlson, 2/27).

Georgia Health News: Feds Try Again To Block Albany Hospital Merger
The FTC, in an October hearing in Atlanta, argued before a three-judge panel of the 11th U.S. Circuit Court of Appeals that while the hospital authority was technically making the acquisition, Phoebe Putney Health System would be running the hospital once it was purchased from HCA. But the appeals court upheld a lower court ruling that the deal was protected under the state-action doctrine – that the hospital authority is a government entity and thus immune from antitrust law (Miller, 2/27).

The Dallas Morning News: Parkland CEO: Transparency To The Public Will Not Help Correct Problems
[Parkland Memorial Hospital interim CEO Dr. Thomas Royer] said "internal transparency'' is what's necessary: "being totally honest with ourselves — that we, working together in partnership with the Board, will create the highest possible quality and safety environment for our patients'' (Moffeit, 2/27).

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State Roundup: Helping Hand For Safety-Net Clinics; Conn. Tries Medical Homes

A selection of health policy stories from Kansas, Connecticut, the Washington D.C. area and California

The Washington Post: CareFirst To Give $8.5 Million In Grants To Safety-Net Clinics
CareFirst BlueCross BlueShield, the largest private insurer in the Washington [DC] region, plans to announce Tuesday that it will give $8.5 million to a dozen safety-net clinics to help them use a coordinated primary-care approach to treat their most vulnerable patients, executives said. ... One of the recipients is the Arlington Free Clinic, which provides free health care to about 1,600 low-income, uninsured residents (Sun, 2/27).

The Connecticut Mirror: Through Pilot Program, Small Practices Become 'Medical Homes'
A pilot program has helped 13 small Connecticut primary care practices achieve recognition as patient-centered medical homes from the National Committee on Quality Assurance, a certifying organization. ... Practices that use the model take a more active role in their patients' health, coordinating care received from other health care providers, following up with patients who need more work managing their health (Levin Becker 2/27). 

The Connecticut Mirror: State Seeking Nursing Home To Take Sick, Disabled Prisoners
Like many states, Connecticut has a growing population of older prisoners whose care, officials say, could be provided less expensively outside prison. The state already has legal mechanisms to parole inmates who are "physically incapable of presenting a danger to society," but they're rarely used. ... Many states facing budget woes have contemplated ways to parole inmates who need long-term or hospice care, but research suggests that few have been released (Levin Becker, 2/27). 

Kansas Health Institute News: Kansas Officials To Sit Down With Feds Over Waiting List Concerns
Advocates for the disabled say they believe the federal government is close to taking action against the state of Kansas for violating the Americans with Disabilities Act. ... Since President Obama took office, the U.S. Department of Justice has joined or filed more than 25 lawsuits alleging discrimination against the disabled in 17 states. ... Might Kansas be next? (Ranney, 2/27).

KQED's State of Health blog: Proposed Ballot Measure Seeks Tougher Health Insurance Rate Regulation
In more than 30 states, government insurance departments have the authority to reject what they determine to be excessive rate hikes for health insurance. But not in California. Earlier this month, consumer advocates launched a drive to put an initiative on the November ballot to let voters decide if California's Insurance Commissioner should have this power (Aliferis, 2/27). 

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Editorials and Opinions

Viewpoints: Disabled 'Disdain' A Poisonous Meme? Two Sides On Physician Payments Issue, Letting Mich.'s Community Colleges Train Nurses

The New York Times: Do Liberals Disdain The Disabled?
Disability advocates across the political spectrum strongly supported the 2010 health care reform. They had obvious reasons to do so. The new law provides protections for people with preexisting conditions, regulations to make sure insurers properly cover care for chronic illnesses and expanded coverage for young adults and low-income families. But more is at stake here than factual inaccuracies. Mr. Santorum and Ms. Palin are spreading a poisonous meme: that liberals disdain the disabled and look down upon parents who raise children with physical or intellectual limitations (Harold Pollack, 2/27).

The New York Times: If You Feel OK, Maybe You Are OK
Early diagnosis has become one of the most fundamental precepts of modern medicine. It goes something like this: The best way to keep people healthy is to find out if they have (pick one) heart disease, autism, glaucoma, diabetes, vascular problems, osteoporosis or, of course, cancer — early. And the way to find these conditions early is through screening (H. Gilbert Welch, 2/27).

USA Today: Editorial: Who Else Is Paying Your Doctor?
When you get a prescription from your doctor, you shouldn't have to wonder whether his or her decision was influenced by payments from the drug's maker. But little by little, small-bore favors such as free samples, promotional trinkets, tickets to sporting events, and deli trays delivered to the office have evolved into practices that look more like outright bribes (2/27).

USA Today: Opposing View: Physician Payments Sunshine Act's Expensive
Supporters of the Physician Payments Sunshine Act failed to take into account how expensive "sunshine" would be. Requiring drug and medical device manufacturers to publicly report virtually every payment they make to physicians, physician groups and teaching hospitals will end up costing far more than the $224 million estimated for just the first year of compliance. The biggest cost will be the valuable, socially useful physician-industry collaborations that simply won't occur (Lance K. Stell, 2/27). 

Detroit Free Press: Editorial: Expand The Role Of State’s Community Colleges
A bill passed by the state House and now pending before the Senate Education Committee would authorize Michigan's community colleges to offer four-year degrees in five fields, including nursing, thereby giving thousands of students a way to earn degrees in high-demand fields. It would ease Michigan's nursing shortage and give students closer and more affordable options. Michigan's Department of Community Health projects a shortage of more than 18,000 nurses by 2015. Given those demands, state senators ought to pass this bill and send it to the governor's desk (2/28).

The Fiscal Times: Inflating the Deficit with Futile Health Therapies
Experts estimate anywhere from 10 to 30 percent of the health care that Americans receive is wasted. It is either ineffective or does more harm than good. To put that in perspective, waste costs anywhere from $250 billion and $750 billion a year, or as much as three-fourths of the annual federal deficit. Yet every effort to curb wasteful spending (health care fraud, though pervasive, is estimated at less than a quarter of the total) has come up short (Goozner, 2/27).

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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.