Daily Health Policy Report

Monday, February 4, 2013

Last updated: Mon, Feb 4

KHN Original Reporting & Guest Opinion

Health Reform

Health Spending And Fiscal Battles

Administration News

Capitol Hill Watch

Health Care Marketplace

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Research Finds Link Between Poor Health And Seniors Switching Out Of Private Medicare Plans

Kaiser Health News staff writer Jordan Rau reports: "New research finds that many seniors who switch from their HMO-style Medicare Advantage plan to traditional Medicare have higher levels of significant health problems, fueling concerns that the private plans cater to more profitable, healthy beneficiaries but don't provide the most attractive care for the very ill" (Rau, 2/4). Read the story.

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Religious Nonprofits Won't Pay For Birth Control Under Proposal

Kaiser Health News staff writer Jenny Gold reports: "After a year of lawsuits and public outcry, the Obama administration proposed Friday a way for women who work at nonprofit religious institutions to get free birth control without requiring their employers to pay for it. Instead, institutions that insure themselves, such as hospitals and universities, could use a third party to find a separate health policy that would pay for and provide the coverage" (Gold, 2/1). Read the story as well as KHN's Six Questions And Answers About The Obama Administration’s Birth Control Rule (2/1).

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Political Cartoon: 'If You Can't Take The Heat ...'

Kaiser Health News provides a fresh take on health policy developments with "If You Can't Take The Heat ..." by Gary Varvel.

Meanwhile, here is today's health policy haiku:


The wait is over.
All those gifts to your doctor
must now be disclosed.


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

White House Restarts Birth Control Coverage Debate With Religious Groups

The rule, which was issued Friday, proposed a way for women who work at nonprofit religious institutions to get free birth control without requiring their employers to pay for it.

Politico: Obama Reopens Rift With Religious Groups
President Barack Obama wasn't looking for another fight with religious groups when the administration attempted Friday to clarify its birth control mandate. But he got one anyway (Budoff Brown, 2/4).

Kaiser Health News: Religious Nonprofits Won't Pay For Birth Control Under Proposal
After a year of lawsuits and public outcry, the Obama administration proposed Friday a way for women who work at nonprofit religious institutions to get free birth control without requiring their employers to pay for it. Instead, institutions that insure themselves, such as hospitals and universities, could use a third party to find a separate health policy that would pay for and provide the coverage (Gold, 2/1). Also from KHN: Six Questions And Answers About The Obama Administration's Birth Control Rule (2/1).

CQ HealthBeat: Retooled Obama Contraception Proposal Not Expected To Quell Controversy
A fresh Obama administration proposal issued Friday on birth control coverage under the health care law appeared unlikely to squelch a controversy that appears headed for the Supreme Court. In an attempt to appease religious colleges, hospitals and charities, the administration announced that those institutions’ insurers will take on the burden of providing no-cost birth control for workers through separate individual health insurance policies (Norman, 2/1).

The Wall Street Journal: Contraception Opt-Out Offer
The Obama administration on Friday offered an updated compromise to its requirement that employers cover contraception in workers' insurance plans, a step aimed at settling a yearlong contretemps over a mandate in the health care overhaul. The proposal is aimed at addressing the argument of Catholic bishops, along with religiously affiliated universities, hospitals and charities, that requiring employers to provide contraception violates their religious freedom (Radnofsky, 2/2).

Reuters: Obama Offers Compromise On Birth Control Health Coverage
The Obama administration on Friday sought to settle a dispute with religious leaders over whether employees at faith-affiliated universities, hospitals and other institutions should have access to health insurance coverage for contraceptives. The new set of proposals would instead guarantee that employees at religious nonprofits would get access to birth control coverage without out-of-pocket costs through separate plans with insurers picking up the tab (Morgan, 2/1).

The Fiscal Times: Birth Control Mandate Revised By Default, Not Design
One year after the Obama administration touched off a fight with the Catholic Church and a wide range of religious organizations over the freedom of religious expression, contraception, and intervention in free-market choice, Health and Human Services retreated -- a little. HHS revised its contraception mandate to restrict religious institutions, this time including affiliated non-profit organizations such as schools, hospitals, and charities. But those changes do not solve the core complaint over government defining religious expression, which the Obama administration had no intention of resolving (Morrissey, 2/1).

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State Officials, Policy Experts Mull Health Law Implementation Issues

The Medicaid expansion continues to trigger significant debate and discussion among state officials.

The Washington Post: Virginia Senate Could Be Headed For Budget Stalemate
Democrats in the evenly divided Senate signaled Sunday that they will try to force another budget stalemate unless the General Assembly agrees to expand Medicaid under the Affordable Care Act (Vozzella, 2/3).

Stateline: Diving Deeper: Nebraska Governor's Thinking On Tax Cuts, Medicaid
Few governors are in as enviable a position as Nebraska's Dave Heineman. The Republican has one of the highest approval rates of any governor in the country, and his state has one of the lowest unemployment rates. ... As Stateline recently reported, however, Heineman's test this year is whether he's popular with the 49 Nebraskans who matter most: the members of the state's one-chamber legislature. The governor is trying to persuade lawmakers to make Nebraska the first state since Alaska more than 30 years ago to end its income tax. Plus, he's hoping to convince them not to expand Medicaid under the federal Affordable Care Act. Stateline staff writer Josh Goodman asked Heineman about these two issues. Below is an edited transcript that explores in more detail his thinking on the topics (Goodman, 2/4).

McClatchy: Health Care Experts See Bumpy Road Ahead: 'Shift Happens'
The healthcare industry in South Florida, like the rest of the country, faces huge challenges in the year ahead as major federal reforms kick in, experts told about 700 people at a University of Miami conference on Friday. "We are at a critical time in health policy," said Mark McClellan, former head of the Centers for Medicare and Medicaid Services. "There are going to be some bumps along the way,” especially starting in 11 months, when the biggest changes in the Affordable Care Act kick in. "Bumps may be understating what we may go through," said Patrick Geraghty, chief executive of Florida Blue, the state's largest health insurer (Dorschner, 2/1).

The Associated Press: NH Health Care Partnerships Endorsed
New Hampshire's insurance and health departments are recommending that the state partner with the federal government to operate the new insurance markets required under President Barack Obama's health care overhaul law. Department officials will explain the details Monday to a legislative committee that must approve any major changes the agency makes in implementing that law, insurance department attorney Jennifer Patterson told The Associated Press (2/3).

CQ HealthBeat: States Eligible For Medicaid Funding Increase For Preventive Care
States can currently get a higher matching rate for covering preventive care and adult vaccines, Medicaid officials said in a letter to state officials on Friday. As of Jan. 1, the health care law allows states to get a federal matching rate increase of one percentage point if they offer patients free preventive care. It doesn’t matter whether the services are provided by a managed care plan or through a fee-for-service Medicaid system (Adams, 2/1).

The Texas Tribune: Medicaid Expansion In Spotlight As Session Heats Up
Will Texas expand Medicaid under the Affordable Care Act? That's the $100 billion question at the Capitol this session. The state’s Republican leadership says no, but supporters of federal health care reform may be gaining traction (Philpott, 2/4).

North Carolina Health News: Health Care Leaders React To Legislators' Stance On Obamacare
Robeson County has 134,000 residents and is one of North Carolina’s poorest counties, with an unemployment rate greater than 12 percent and some of the worst health outcomes in the country. "Our emergency room in Lumberton sees about 77,000 people at the back door of that hospital every year," said Sen. Michael Walters (D-Fairmont), addressing the state Senate insurance committee Thursday morning. Walters' voice was one of the chorus of those expressing concern in the past day over the decision by House and Senate Republicans to sponsor bills that would have North Carolina opt out of the Medicaid expansion allowed for under President Barack Obama's Affordable Care Act (Hoban, 2/1).

In other health law news --

Politico Pro: ACA Premium Sticker Shock Could Fuel Foes
The federal health care law could nearly triple premiums for some young and healthy men, according to a forthcoming survey of insurers that singles out a group that might become a major public opinion battleground in the Obamacare wars. The survey, fielded by the conservative American Action Forum and made available to Politico, found that if the law’s insurance rules were in force, the premium for a relatively bare-bones policy for a 27-year-old male nonsmoker on the individual market would be nearly 190 percent higher (Norman, 2/4).

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Health Spending And Fiscal Battles

In Upcoming Budget Battles, Democrats Appear Unlikely To Cut Medicaid Funding

News outlets report that the health care program for the poor seems secure in upcoming fiscal fights. Meanwhile, Senate Majority Leader Harry Reid says efforts to fix the fiscal problems will have to include new revenues and can't just be cuts in spending.

Los Angeles Times: Medicaid Appears Off-Limits To Talk Of Budget Cuts
Healthcare for the nation's poor, once viewed as especially vulnerable in this era of budget cutting, has emerged as a surprisingly secure government entitlement with as much political clout as the Medicare and Social Security retirement programs. Even as President Obama and congressional Republicans gear up for a new budget battle, Medicaid and the Children's Health Insurance Program, which together provide coverage to more than 1 in 5 Americans and almost 1 in 3 Californians over the course of a year, appear off-limits despite their huge price tag (Levey, 2/2).

Politico: Reid: Any Budget Deal Must Include Revenue
Any budget deal in Congress must "without any question" include revenue, Senate Majority Leader Harry Reid said on Sunday. "The American people are on our side,” the Nevada Democrat said on ABC's "This Week." "The American people don't believe in these austere things. We believe that the rich should contribute. We believe we should fill those tax loopholes, get rid of them, I should say. And that's where we need to go." To lift the sequester, Reid said, the deal needs to include new revenue (Weinger,

Meanwhile, on the Medicare front --

The Medicare NewsGroup: Budget Targets Drive Current Medicare Reform Agenda
When the experts in Washington, D.C., talk about Medicare reform these days, they are really talking about certain numbers, not about doctors, hospitals or patients. The Medicare reform discussions and the divergent plans, whether they come from a liberal Democrat or a conservative Republican, share one thing in common: They all have the goal of making Medicare spending grow more slowly than the U.S. economy. This became clear Thursday, January 31, as a panel of experts discussed competing Medicare reform proposals at the annual conference of the National Academy of Social Insurance, a nonpartisan think tank dealing with Medicare and Social Security issues (Rosenblatt, 2/3).

And the New York Times examines how the recent economic downturn is hurting baby boomers.

The New York Times: In Hard Economy For All Ages, Older Isn't Better ... It's Brutal
In the current listless economy, every generation has a claim to having been most injured. But the Labor Department’s latest jobs snapshot and other recent data reports present a strong case for crowning baby boomers as the greatest victims of the recession and its grim aftermath. These Americans in their 50s and early 60s — those near retirement age who do not yet have access to Medicare and Social Security — have lost the most earnings power of any age group. ... New research suggests that they may die sooner, because their health, income security and mental well-being were battered by recession at a crucial time in their lives (Rampell, 2/2).

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Administration News

CMS Releases Overdue Final 'Sunshine Act' Rule On Payments To Physicians

Under the Physician Payments Sunshine Act, financial relationships that drug and device makers have with doctors must be disclosed. 

The Hill: CMS Releases Long-Overdue 'Sunshine Act' Rule
The Centers for Medicare and Medicaid Services (CMS) released a final rule Friday that will expose financial relationships between doctors and industry in compliance with President Obama's healthcare law. Pressure had been mounting for the Obama administration to release the final "Sunshine Act" regulations, which are more than one year overdue. Critics blamed the wait on election-year politics (Vieback, 2/1).

MedPage Today: CMS Issues Sunshine Rule
Data collection will start on Aug. 1, CMS said, noting that "Applicable manufacturers and applicable GPOs will report the data for August through December of 2013 to CMS by March 31, 2014 and CMS will release the data on a public website by Sept. 30, 2014. CMS is developing an electronic system to facilitate the reporting process." The rule "is intended to help reduce the potential for conflicts of interest that physicians or teaching hospitals could face as a result of their relationships with manufacturers," the statement continued (Frieden, 2/1).

PoliticoPro: Long-Awaited Physician Sunshine Rule Released
The rule is 15 months overdue. Sen. Chuck Grassley (R-Iowa), biotech companies, consumer advocates and medical groups have been hounding the Obama administration with a torrent letters since the beginning of the year, pleading for the rule’s release. Friday, they got what they had been asking for (Norman, 2/1).

Fox Business/Dow Jones Newswires: Medicare Details Rules On Companies Disclosing Pay To Doctors
The rules are intended to bring transparency to the sometimes murky relationships between the drug and device manufacturers, and the doctors who recommend them to patients. Issued Friday by the Centers for Medicare and Medicaid Services, the rules will apply to all drugs and devices paid for by the federal government's major healthcare programs. All cash and in-kind gifts given to doctors for research, speaking fees, meals and travel are required to be disclosed. Likewise, doctors' investments in companies must also be revealed (2/1).

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Capitol Hill Watch

GOP Small Biz Chair Says Employer Mandate Hurting Growth

The House Small Business Committee chairman says the health law's employer insurance mandate will hurt small business growth in America while House Republicans will again this week try to pass bills on health care that the Senate ignored.

The Hill: GOP Panel Chairman Slams Employer Mandate Rule
The Obama administration's proposed rule on the employer mandate will hamper the growth and success of small U.S. firms, the chairman of the House Small Business Committee wrote Friday. In a letter to Timothy Geithner, now the former Treasury Secretary, Rep. Sam Graves (R-Mo.) quoted small-business owners saying the new rules under health care reform are impeding new hiring and raises for workers (Viebeck, 2/1).

The Hill: House To Try Again On Health Bills Ignored By The Senate
House Republicans next week will pass three non-controversial bills dealing with children's and veterans' health, all of which were easily approved with bipartisan support by the House in the last Congress, but were then ignored by the Senate. One of these, from Rep. Joe Pitts (R-Pa.), would continue a grant program for pediatric doctors that the Obama administration had proposed to scrap (Kasperowicz, 2/1).

Senators are also examining waste in Medicare with a report and soon-to-come legislation --

Modern Healthcare: Senate Committee To Target Waste In Medicare
The Senate Finance Committee will consider such nitty-gritty issues as patient observation status and the redundant overlap among CMS auditors when senators look at ways to reduce waste and abuse in federal health care spending. A 12-page summary report from the committee on Jan. 31 outlined the results of 2,000 pages of public comments received by the Senators in response to a call for recommendations last May on ways to fix Medicare. Those responses, boiled down into a list of bullet points in the summary, will inform the bipartisan group of six senators as they draft legislation for the 113th Congress, which ends in January 2015. Among the top items is the long-simmering issue of how hospitals decide whether a given patient's care justifies the most expensive Medicare benefits, known as Medicare Part A hospitalization, or if the patient should have gotten less-lucrative outpatient Part B observation care (Carlson, 2/1).

And a former congressman and mental health advocate calls for more from President Obama on the subject --

The Hill: Patrick Kennedy: Obama Should Address Nation On Mental Health
President Obama should address the country when his administration finally implements a law requiring insurers to cover mental health services, former Rep. Patrick Kennedy (D-Mass.) said Friday. Kennedy joined Sen. Debbie Stabenow (D-Mich.) and actor Bradley Cooper at a press conference to make the case that reducing the stigma associated with mental illness is just as important as a policy approach to mental health (Baker, 2/1).

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Health Care Marketplace

Turf Battles Emerge As Non-Physician Health Workers Step In To Fill Gaps

Also in the news, home health care aides are waiting for new labor rules which will determine whether they receive minimum wage.

The Wall Street Journal/US News: Battles Erupt Over Filling Doctors' Shoes
As physician assistants and other midlevel health professionals fill growing gaps in primary health care, turf battles are erupting in many states over what they can and can't do in medical practices. One of the bitterest fights is in Kentucky, where physician assistants are lobbying the state legislature to repeal a law that says that for the first 18 months after certification, physician assistants are allowed to treat patients only when a supervising physician is on site. Being in phone contact isn't deemed sufficient (Beck, 2/3).

NPR: Home Care Aides Await Decision On New Labor Rules
Home health care aides are waiting to find out if they will be entitled to receive minimum wage. A decades-old amendment in labor law means that the workers, approximately 2.5 million people, do not always receive minimum wage or overtime (2/3).

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Public Health & Education

New Standards Emphasize Healthier Snacks In Schools

Reuters: Rules Call For Swing To Healthier Snacks In Schools
Snacks sold in U.S. schools would need to be lower in fat, salt and sugar and include more nutritious items like fruits, vegetables and whole grains, under standards proposed on Friday by the U.S. Department of Agriculture. The proposal, more than a year overdue, also calls for a limit of 200 calories on items sold during the school day at vending machines or other venues outside the school lunch line (Heavey and Abbott, 2/1).

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State Watch

State Roundup: Minn. Officials Want Money For Coverage Expansion

A selection of health policy news from Virginia, Arkansas, Minnesota, California, Missouri and Colorado.

MPR: Dayton, Jesson Press For U.S. Health Money
Gov. Mark Dayton and his Human Services commissioner will travel to Washington, D.C., this week to lobby for federal money for MinnesotaCare. MinnesotaCare is a state-subsidized health plan that insures about 130,000 people under age 65. Dayton and Commissioner Lucinda Jesson are scheduled to meet Tuesday in Washington with Health and Human Services Secretary Kathleen Sebelius. The governor and Jesson will press Sebelius to let the state use federal health care law money to fund MinnesotaCare. The state program serves people who earn too much to qualify for Medicaid but still have difficulty affording commercial insurance (Stawicki, 2/3).

The Associated Press/Washington Post: Arkansas Judge Orders Johnson & Johnson To Pay $181 Million In Legal Fees In Risperdal Suit
An Arkansas judge says Johnson & Johnson must pay $181 million in fees to attorneys who successfully argued that the pharmaceutical company committed Medicaid fraud in the marketing of its antipsychotic drug Risperdal (2/1).

The Associated Press: Gov. Nixon Proposed $10M For Mo. Mental Health
Missouri Gov. Jay Nixon is proposing to spend $10 million to help get mental health care sooner for those who need it. The funding is included in the state budget released this past week by the governor's office and is part of Nixon's response to recent gun violence (2/3).

The Associated Press: Analysis: Nixon’s Plan Could Boost Pay For Doctors
In the American health care system, some patients are worth more money than others. As cold and clinical as that may sound, it has long been the reality under a government-run Medicaid system that pays doctors less money to treat the poor than those same physicians receive for treating the elderly covered by Medicare or middle- and upper-income individuals who have private insurance (Lieb, 2/3).

Los Angeles Times: Medical Clinic Workers Struggle With Burnout
The jobs are demanding -- providers spend long hours treating patients who have multiple chronic illnesses and often have gone years without care. Administrators have trouble finding enough doctors, nurse practitioners and physician assistants to staff their clinics. That is expected to cause a major roadblock next year, when the bulk of the national health care reform law takes effect, aiming to help 30 million uninsured Americans gain coverage. In preparation, clinics -- expected to get an influx of new patients -- are stepping up recruitment and trying to hold on to the care providers they have. But burnout is common, and staff members often leave for less-stressful, higher-paying positions elsewhere (Gorman, 2/3).

Los Angeles Times: L.A. County Removing Metal Detectors From Some Hospital Facilities
Now, 20 years after the attack, officials want the metal detectors removed from parts of county hospitals to make them more welcoming to patients in the newly competitive marketplace being created by the Obama administration's health care overhaul. The machines in the emergency rooms will remain, but the others are to be taken out by summer. The proposal comes at a time when high-profile shootings have put the nation on edge and prompted emotionally charged debates about the availability of assault weapons and the presence of armed officers in schools (Gorman, 2/3).

Health Policy Solutions (a Colo. news service): Less Money For Health, More For Preschool
Spend less on health care and much more on preschool. That’s the prescription that an international expert on health disparities gave Thursday in Denver to help reverse inequities that leave low-income racial and ethnic minorities much sicker and facing shorter life expectancies than wealthier whites. … A new report from The Trust has found that racial and ethnic minorities make up more than 346,000 of Colorado’s 829,000 uninsured people. Not only are minorities less likely than the general public to have insurance and access to health care, but they also suffer worse health outcomes, the report found (Kerwin McCrimmon, 2/1).

California Healthline: First Step In Reform: Primary Care
The heart of a successful reform effort under the Affordable Care Act will be the creation and implementation of the patient-centered medical home model of care, according to testimony at an Assembly Committee on Health hearing in the Capitol Tuesday. "We need to look at better management of chronic conditions," said Assembly member Richard Pan (D-Sacramento), chair of the Committee on Health. "It's one of the greatest cost factors in our health care system." How much cost? The numbers are "astounding," according to Sophia Chang, director of the Better Chronic Disease Care Program at the California HealthCare Foundation and one of the panelists at yesterday's hearing (Gorn, 2/1).

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Editorials and Opinions

Viewpoints: Obama's 'Olive Branch' On Birth Control Coverage; Sen. Kirk Recounts His Stroke Therapy; Nurses Oppose Mandatory Flu Shots

Los Angeles Times: A Better Approach To Religious Employers And Contraception
The Obama administration released the final details Friday of the exemption it will provide religious-affiliated employers from the requirement to include free birth control in employees' insurance policies. Not surprisingly, the announcement didn't seem to mollify any of the critics who'd been arguing that the exemption was inadequate. That's true in part because the critics don't believe the exemption will function the way the administration has said it will. I think they're wrong, but I also think the administration should have taken a much different tack to resolve the dispute (Jon Healey, 2/1).

The Washington Post: From Obama, An Olive Branch To The Catholic Church On Contraception Coverage
The decision, the administration's second attempt at compromise, ought to be taken by the nation's Catholic bishops as the victory it is. Many of the country's most prominent prelates are inclined to do just that — even if the most conservative bishops seem to want to keep the battle raging. But more importantly, the final HHS rules are the product of a genuine and heartfelt struggle over the meaning of religious liberty in a pluralistic society. The contraception dispute was difficult because legitimate claims and interests were in conflict (E.J. Dionne Jr., 2/1).

The New York Times: A Good Compromise On Contraception
The Obama administration has proposed a sensible way to provide women who work for religiously affiliated institutions with free coverage of contraceptives while exempting the organizations they work for from financial or administrative obligations to provide the coverage. For the past year, the administration has been battered by lawsuits and denunciations from religious conservatives that its health care reforms violate religious liberties by requiring employers to provide free birth control coverage even if the employers have moral objections. Those attacks were designed to try to discredit the health care reform law and hurt President Obama politically by portraying him, falsely, as an opponent of religious freedom (2/1).

Los Angeles Times: In The Dark On Doctor Perks
Though few patients realize it, many doctors receive thousands of dollars from pharmaceutical companies for each patient enrolled in an experimental drug trial. The medication might be the best thing for the patient's condition. The doctor's motives might be pure. But patients should be able to find out about such payments so they can discuss them with their doctors and decide for themselves whether the doctor's participation in an experiment might compromise his medical advice (2/1). 

The Washington Post: Sen. Mark Kirk On How His Stroke Made Him A Better Senator -- And A Better Man
I wanted to give up almost every day. I was indescribably fatigued. I wanted to sleep all the time, a common desire in stroke sufferers. But I was beginning to believe. I used the prospect of returning to work, of climbing up the steps of the Capitol and walking the 50 paces to the Senate floor, as motivation. With every swing of my leg on the treadmill, I became more convinced I would do it (Sen. Mark Kirk, R-Ill, 2/2).

The Washington Post: The Risk Of Skimping On Mental Health Funding
A 14-year-old with large brown eyes and tightly cropped hair told me a few weeks ago that voices were telling him to kill people. A day before the Sandy Hook school massacre, he threatened to light his house on fire and stab everyone in the family, according to his mother. ... I am an outpatient therapist, working primarily with children and adolescents from disadvantaged backgrounds. Trevor is on Medicaid, yet cuts to Medicaid funding in recent years, here in North Carolina and throughout the country, mean that children like him slip through the cracks (Alyx Beckwith, 2/1).

The New York Times: We Can Be Healthy And Rich
Just about everyone agrees that health care in America is too expensive, and that something must be done to control the rising costs. Except for one group: hospitals and the unions representing hospital workers. ... But the truth is that bending the health care cost curve will actually spur the economy forward (Ezekiel J. Emanuel, 2/2).

Los Angeles Times: U.S. Debt Woes Are Not So Dire, Experts Say
Moreover, financial experts agree that although America's burgeoning health care costs pose huge long-term challenges for the budget, the nation's debt could most likely be controlled for at least the next decade by making a series of relatively moderate policy changes. Those changes, although perhaps unwelcome, would not require drastic adjustments in the lives of most Americans. ... Even if the bulk of the additional deficit savings needed came from reduced spending as opposed to higher taxes, (Moody's Analytics economist Mark Zandi) said, those cuts could be done by "tweaking programs," such as changing the inflation index for
Social Security, aligning Medicare drug payments with Medicaid and reducing some farm subsidies. "It wouldn't be a wrenching restructuring," he said (Don Lee and Jim Puzzanghera, 1/31).

The Texas Tribune/The New York Times: Plenty Of Money In State Coffers, But Not To Spend
Two years ago, Texas lawmakers didn't have enough money to spend. Now, it seems, they can't spend all the money they have. ... Last time, the solution was to play some accounting tricks and ignore certain expenses. ... Legislators decided to delete five months of Medicaid expenses from the back of the budget in the hope that the money to cover those costs would arrive before the bills did. Two years later, the comptroller said the state had $8.8 billion left, unspent, in its current accounts. Lawmakers will need most of it to fill that Medicaid hole and for other expenses that have surfaced since the budget was written (Ross Ramsey, 2/2).

The New York Times: Health Care's Trick Coin
This month, Johnson & Johnson is facing more than 10,000 lawsuits over an artificial hip that has been recalled because of a 40 percent failure rate within five years. Mistakes happen in medicine, but internal documents showed that executives had known of flaws with the device for some time, but had failed to make them public. It would be nice to imagine that this kind of behavior is exceptional, but in reality, the entire evidence base for medicine has been undermined by a casual lack of transparency (Ben Goldacre, 2/1).

The New York Times: Weighing The End Of Life
To many people's surprise, most of my patients are as satisfied with their lives as they were when they were less debilitated. But this isn't true for everyone, and some are eager to say they've had enough. They are bedbound or dependent, unable to do any of the things they once valued so dearly — working, caring for their families, eating solid food or even hearing the conversation of those who come to see them. Still others cannot express their wishes or needs but sit propped in chairs frowning and grimacing, despite attentive care and trials of antidepressants and pain medications (Louise Aronson, 2/2).

The New York Times: A Cruel Blow To American Families
The Internal Revenue Service has issued a hugely disappointing ruling on how to calculate the affordability of health insurance offered by employers. Its needlessly strict interpretation of the Affordable Care Act could leave millions of Americans with modest incomes unable to afford family coverage under their employers’ health insurance but ineligible for subsidies to buy coverage elsewhere (2/2).

USA Today: Flu Vaccine Mandate Protects Patients' Rights: Our View
Because so many of the most susceptible people are in hospitals and long-term care facilities, it's imperative that health care workers not spread the infection. In too many places, however, too many workers are balking at flu shot requirements, with potentially tragic consequences (2/3). 

USA Today: Forced Flu Shots Provide No Cure: Opposing View
America's nurses strongly encourage health care workers and patients to get vaccinated. But nurses, joined by many physician organizations and researchers, reject the notion that vaccination is a fail-safe solution to prevent the spread of the flu virus. We oppose forced vaccinations or the related mandate that those who decline the shots must wear masks or risk losing their jobs (Karen Higgins, 2/3). 

San Francisco Chronicle: Health Care Premiums Sometimes Taxed
Readers brought up some good comments about my Thursday column on the provision in the Affordable Care Act that requires most employers to begin reporting the cost of employer-provided health care on their W-2 forms, starting with W-2 forms issued for 2012. The cost, reported in Box 12 with the code DD, includes both the employer and employee share of health insurance premiums for the year. It might or might not include dental and vision care premiums depending on how the employer packages benefits. Some employers were exempt from the requirement for 2012 W-2s including those who filed fewer than 250 W-2s in 2011 (Kathleen Pender, 2/1).

Des Moines Register: Changes To Part D Won't Save Medicare
With a debt-ceiling showdown just around the corner, Republican lawmakers are insisting upon more government spending cuts in exchange for raising the country’s borrowing limit.
President Obama says the debt ceiling shouldn’t be used as a negotiating tool. But it’s inevitable that additional cuts will be seriously considered. And, unfortunately, lawmakers are likely to take aim at Medicare Part D, the highly successful prescription drug benefit. This approach is misguided. Cuts to Medicare Part D would have devastating consequences for seniors and taxpayers (Peter Pitts, 2/3).

Sacramento Bee: California Under The Microscope On Health Reform
The November election ensured that the most ambitious health care reform since the creation of Medicare in 1965 will take full effect come January 2014. California, like other states, is gearing up to ensure that affordable insurance is available when the individual mandate kicks in next January, requiring Americans to maintain health insurance coverage so they don't pass their costs to others. We already are far ahead of most states in setting up a marketplace – an "exchange" called "Covered California" – where people will be able to buy health insurance if their employer doesn't provide coverage (2/3).

San Francisco Chronicle: California Must Expand Medi-Cal
The Legislature is in a special session on health care to consider legislation that's designed to help California prepare for full implementation of the federal Affordable Care Act. Most Americans will have to buy health insurance in January 2014, or pay a penalty for not doing so. There are exceptions to this rule, of course, and one of the most important things that the Legislature is working on is the question of how to help the lowest income Californians get coverage. Assembly Speaker John Pérez, D-Los Angeles, has introduced AB1X1, which would greatly expand Medi-Cal, the state's health insurance program for the poor (2/1).

Kansas City Star: Medicaid Expansion In Missouri Would Help Patients And Hospitals
In return for financing the Medicaid expansion, Washington is going to phase out its “disproportionate share” payments to hospitals. That’s money it channels to hospitals to help cover losses incurred from treating uninsured patients. And this money is going away, whether a state like Missouri does or does not raise its Medicaid limits. Democratic Gov. Jay Nixon is pushing for the expansion, as are Missouri’s leading business and health care groups. Their hurdle is convincing Republican lawmakers who control the General Assembly, and who almost uniformly abhor "Obamacare"(2/1).

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