Daily Health Policy Report

Wednesday, February 6, 2013

Last updated: Wed, Feb 6

KHN Original Reporting & Guest Opinion

Health Spending And Fiscal Battles

Health Reform

Capitol Hill Watch


Veterans Health Care

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Kansas' Great Hope: Managed Care Will Tame Medicaid Costs

In partnership with Kaiser Health News, Bryan Thompson of KPR and Jim McLean of KHI News report: "And the costs have been escalating for the $2.9 billion Medicaid program. So Kansas is in the midst of huge changes. On Jan. 1, the state began enrolling nearly all of its Medicaid population -- including its most expensive patients – into a managed care program called KanCare. This effort is unrelated to the federal health law's Medicaid coverage expansion, on which Republican Gov. Sam Brownback has yet to take a position. Meanwhile, as the transition proceeds, many policy analysts are watching to see if the state has done enough to meet the goal of controlling costs while ensuring that these vulnerable patients receive quality health care" (Thompson and McLean, 2/6). Read the story.

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Capsules: Aggressive Care Still The Norm For Dying Seniors; Long-Term Care Protection May Be Toothless

Now on Kaiser Health News' blog, Alvin Tran writes about a new study finding that many seniors get aggressive care at the end of their lives: "Although federal data show that fewer Medicare beneficiaries are dying in hospitals, new research suggests that doesn't mean they're getting less aggressive care in their final days" (Tran, 2/5).

Also on the blog, KHN's consumer columnist Michelle Andrews writes about long-term care protection: "There aren't many investments people make to protect themselves against something that may happen 20 or 30 years down the road. Yet that's exactly what long-term care insurance purchasers do. But a provision in those policies that people rely on to help ensure their coverage will meet their needs decades hence may do nothing of the kind" (Andrews, 2/5). Check out what else is on the blog.

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Obama: 'I've Offered Sensible Reforms To Medicare' (Video)

This Kaiser Health News video excerpt features comments made by President Barack Obama during a statement to the press Tuesday in which he emphasized the need to reduce the cost of health care in the U.S. Watch the video.

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Twitter Topics: We're Talking #Medicare Advantage Plan Switching

Who are the beneficiaries that switch from private to traditional Medicare plans? Often, it's people sicker than those that stay. See what others are saying on KHN's Twitter Feed about just who it is that uses these Medicare Advantage plans as well as their traditional counterparts.

For more, join the #Medicare conversation on Twitter and follow @KHNews for the latest.

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Political Cartoon: 'But Does It Have Bluetooth?'

Kaiser Health News provides a fresh take on health policy developments with "But Does It Have Bluetooth?" by Chris Wildt.

Meanwhile, here is today's health policy haiku:


Some GOP govs
advance part of the health law...
As Dems predicted?

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

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Health Spending And Fiscal Battles

CBO Predicts Bright Short Term, But Unsustainable Health Costs As More Baby Boomers Retire

The Congressional Budget Office's report ups the ante in budget battles between the Obama administration and GOP lawmakers, who are staking out positions on the March 1 sequestration, as well as on trims to Medicare and other entitlement programs.

Los Angeles Times: Bright Fiscal Forecast For The Short Term
Revenue is increasing as the economy improves and as higher taxes on wealthier households take effect. The deficit is also shrinking because spending on unemployment insurance and other government assistance programs goes down as the economy improves. But the continued growth in healthcare costs and the increase in the nation's population of senior citizens eligible for Medicare will keep the budget on an unsustainable path. Even though health spending has slowed in recent years for reasons analysts do not fully understand, the sheer volume of new Medicare and Medicaid recipients means costs will rise (Mascaro and Parsons, 2/5).

The Washington Post: As Obama Calls For Short-Term Fix To Avert Sequester, CBO Reports Falling Deficits
Obama said that he is committed to a broad effort to restrain the national debt and that past White House proposals to rein in Medicare costs and increases in Social Security benefits "are still very much on the table" as part of that effort. But with the sequester due to hammer the fragile economic recovery in less than a month, the president said Congress should take quick action on a short-term measure to replace it, giving policymakers more time "to finish the job of deficit reduction" (Montgomery and Goldfarb, 2/5).

Bloomberg: Deficit To Shrink Below $1 Trillion, U.S. Agency Predicts
The federal budget deficit will total $845 billion this year, the first time in five that the gap between taxes and spending will be less than $1 trillion, according to a government report…The agency said that health-care spending is growing less quickly than anticipated. In 2012, Medicare costs rose by 3 percent, or $16 billion, the smallest annual gain since 2000 (Faler, 2/6).

The Wall Street Journal: Debt Rise Colors Budget Talks
The projections will become a measuring stick for a rapid-fire series of budget decisions on Capitol Hill. Three key dates loom for policy makers: the across-the-board spending cuts are set to bite both military and domestic spending on March 1; that is followed by a March 27 deadline for funding government operations for the rest of the fiscal year as well as a new law that withholds lawmakers' pay unless they vote by April 15 on budget outlines. Even if Congress allows across-the-board spending cuts to kick in, sunsetting tax provisions to actually expire and Medicare doctor fees to be cut, the deficit is projected to begin increasing gradually from 2016 onward as more of the baby boom generation qualifies for Social Security and Medicare (Paletta, 2/5).

The Associated Press/Washington Post: Congressional Budget Office: Budget Deficit Estimated At $845 Billion For 2013
But as more and more baby boomers retire and claim Medicare and Social Security and as Obama's health care law takes effect, deficits would move higher and again reach near $1 trillion in the latter portion of the 10-year window — despite the recently enacted tax increase on family income exceeding $450,000 and automatic spending cuts of about $100 billion a year. The package of spending cuts and tax increases are punishment for Washington’s failure to strike a long-term budget pact (2/5).

Reuters: Social Security, Health Spending To Hit $3.2 Trillion A Year
Spending on Social Security and healthcare will double to $3.2 trillion a year over the next decade, threatening a sharp rise in national debt unless Congress acts to avoid the danger, congressional researchers warned on Tuesday. A report from the nonpartisan Congressional Budget Office did not put forth a plan to resolve the long-term imbalance between revenues and spending on retirement and healthcare benefits (Morgan, 2/5).

The Associated Press/Washington Post: Analysis: Obama And GOP Want To Replace Across-The-Board Cuts, But With What?
As a result, they seem likely to spend the spring and perhaps a good part of the summer struggling to escape a bind of their own making. And this time, Medicare and the rest of the government's benefit programs are likely to face changes. Already, the two sides are laying down markers (2/6).

USA Today: Obama Seeks Short-Term Budget Plan To Avoid Sequester
The president said he is still looking for a major debt reduction deal for the long term of more than $1 trillion over the next 10 years, saying that earlier ideas are "still on the table." Obama said he still supports proposed changes to the tax code and to the ever-rising entitlement programs like Social Security and Medicare, but he did not provide many specifics. White House spokesman Jay Carney said Obama would work with Congress on the composition of a short-term budget plan that would require tens of billions of dollars in debt reduction to avoid the scheduled budget cuts. Carney noted that Obama and congressional Republicans have struck previous deals that add up to some $2.5 trillion in debt reduction over the next decade (Jackson, 2/6).

Meanwhile, CQ Healthbeat looks at how CBO's predictions could boost efforts to overhaul Medicare's formula for reimbursing doctors -

CQ Healthbeat: CBO Report Could Be Game Changer For SGR Overhaul
Buried deep inside a Congressional Budget Office report released Tuesday is an estimate that overhauling the Medicare physician payment formula over the next decade would cost just $138 billion. That’s dramatically lower than the roughly $300 billion CBO has previously estimated (Reichard, 2/5).

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Budget Report: More Employers Than Previously Estimated Will Drop Health Coverage

About 7 million people, nearly double the earlier estimates, will no longer get health insurance from their employers because of changes to the tax code made by the health law, according to CBO projections.

The Wall Street Journal's Washington Wire: Why CBO Figures More Employers Will Drop Health Coverage
The Congressional Budget Office says the year-end fiscal cliff deal that preserved lower tax rates for most households produced a little-noticed side-effect: Fewer people will get health insurance from their employer over the next decade. That nugget of economic thinking pops up in the nonpartisan office’s annual update of its budget and economic forecast (Radnofsky, 2/5).

The Fiscal Times: 7 Million Will Lose Employee Coverage Under Obamacare
A new report from the Congressional Budget Office estimates that nearly 7 million people will lose their employer-based health insurance coverage under President Obama's signature health care law, nearly twice the previous estimate. Changes to the tax code under Obamacare, said the CBO, have altered the incentives for the business sector, which will likely prefer to pay the penalty rather than the cost of workers’ health insurance. Overall, 27 million people are expected to gain coverage by 2017, roughly 5 million less than originally projected (Ehley, 2/5).

Bloomberg: Obama's Health-Insurance Expansion Eroding, CBO Projects
The number of Americans projected to gain insurance from the U.S. health care law is eroding, by at least 5 million people, as the Obama administration struggles to implement the $1.3 trillion overhaul amid Republican opposition. About 27 million people are expected to gain coverage by 2017, according to a report today from the Congressional Budget Office (Wayne, 2/5). 

National Journal: Budget Office Predicts Rocky Start For Health Care Law
The Obama administration has been publicly upbeat about the coming rollout of its health care law. But a new report from the nonpartisan Congressional Budget Office suggests that at least one set of influential observers anticipates some turbulence in the law’s first years. On several important measures of the law's success, CBO's numbers are pessimistic compared with earlier estimates: Fewer uninsured people will get coverage, insurance options will be more limited, and more employers will stop covering their workers (Sanger-Katz, 2/6). 

The Hill: Obama Health Law Will Cost $1.3T, CBO Says
The Congressional Budget Office (CBO) estimated Tuesday that President Obama's signature health care law will cost about $1.3 trillion over the next 10 years. The figure represents a slight increase since August, when the nonpartisan budget office estimated that the law would cost about $1.17 trillion before 2022 (Viebeck, 2/5). 

NBC News: Fewer To Get Health Insurance Under Reform Law, CBO Says
The new health care reform law is not going to provide health insurance for as many people, at least not as quickly, as the Obama administration had hoped, according to the latest look at the economy from the Congressional Budget Office. That's mostly because of the deal Congress made last month to keep the country from going over the fiscal cliff, the CBO says. About 8 million people who would have been insured by their employers will probably lose their coverage because of tax changes, the CBO projects. … But overall, instead of 32 million to 34 million new people getting health insurance by 2017, probably only about 27 million people will be covered by then, the CBO projects (Fox, 2/6).

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Health Reform

Medicaid Expansion, Health Exchanges Tempt Some GOP Governors

Politico reports that certain Republican governors are going forward with the implementation of these health law provisions without facing a backlash within their states.

Politico: Some GOP Governors Accepting Parts Of ACA
A handful of Republican governors are bucking their party and going ahead with key pieces of President Barack Obama's health care law — and so far, they're not being cast out by the GOP as Obamacare traitors. Nationally, the heated politics surrounding the health law have hardly died down almost three years since its passage. But some Republican governors — including prominent ones like Ohio's John Kasich — are expanding Medicaid or building an insurance exchange without facing similar opposition at home. These state moves represent a turning point in the fight over Obamacare (Haberkorn and Millman, 2/5).

On health exchanges --

Salt Lake City Tribune: Utah's online insurance marketplace, Avenue H, is still the focus of eleventh-hour negotiations with the Obama administration. Unable to win legislative support for a state-run exchange that meets all federal requirements, Gov. Gary Herbert on Tuesday pitched a new scenario to U.S. Health and Human Services Sec. Kathleen Sebelius. Utah is now proposing to keep and run Avenue H as a "shop" exchange for small businesses, relinquishing to federal officials the task of building a separate marketplace for individuals (Stewart, 2/5).

Meanwhile, coverage from the Associated Press and other news outlets details the positions being taken by various state leaders across the country on the expansion of Medicaid, and how public opinion is taking shape.

The Associated Press: Democrats, Others Call For Wis. Medicaid Expansion
Democratic lawmakers and others who are calling on Gov. Scott Walker and Republicans who control the Legislature to expand Medicaid coverage in Wisconsin pointed to a new analysis Tuesday that said the state could save $65 million by accepting the federal money. The savings would come by replacing state money to cover childless adults with money from the federal government made available under President Barack Obama's health care overhaul law (Bauer, 2/5).

The Associated Press: Corbett Won't Pursue Medicaid Expansion, For Now
Gov. Tom Corbett said Tuesday that he will not pursue an expansion of Pennsylvania's Medicaid program, at least for now, echoing the longstanding complaints of other Republican governors about the cost, inflexibility and inefficiency of Medicaid. Corbett has not made a specific request from the federal Department of Health and Human Services for the kind of flexibility he wants, and his administration characterized a Tuesday letter to the agency's secretary, Kathleen Sebelius, as a starting point (Levy, 2/5).

The Associated Press: Fla. Lawmakers Give Mild Criticism Of Scott Budget
Florida Gov. Rick Scott's $74.2 billion proposed budget isn't winning a lot of praise so far from state legislators. … Democratic legislators also questioned why Scott has refused so far to take a stance on whether the state should accept federal aid to expand Medicaid. ... Scott initially was opposed to expansion of the safety-net program but then softened his stance after President Barack Obama was re-elected (Fineout, 2/5).

Health News Florida: Could FL Build Exchange From These 2 Groups?
Two quite different programs that help Floridians find health insurance may end up competing to become the Florida face of the federal health-insurance exchange of the future. One or both would almost certainly not survive -- that is, unless they join forces (Gentry, 2/5).

The Associated Press: Hundreds Urge Okla. Governor To Expand Medicaid
Hundreds of people rallied at the state Capitol on Tuesday and urged Oklahoma Gov. Mary Fallin to reconsider her rejection of a Medicaid expansion that would provide health insurance to an estimated 200,000 working poor in the state. After about 200 people gathered on the north steps of the Capitol, some holding signs that read "Health Care is a Human Right" and "Expand Medicaid Now," organizers delivered more than 5,000 signatures from an online petition urging the Republican governor to reconsider her decision (Murphy, 2/5).

The Associated Press: NH Panel Hears From Public On Medicaid Expansion
A bill to ban New Hampshire from expanding its Medicaid program as part of the federal health overhaul law attracted scant support at a public hearing Tuesday. Instead, opponents dominated the debate, arguing that expansion would help struggling families, hospitals and the state's economy (Ramer, 2/5).

North Carolina Health News: Senators Debate Obamacare Bill, Move It Forward
State senators voted on a proposal to reject aspects of the Affordable Care Act Monday night and calendared the bill for final consideration for Tuesday, despite a call from Governor McCrory to slow down on the bill. With the chamber gallery populated with doctors wearing white coats and scrubs, senators voted 31-17 to move the bill forward after about an hour of debate. A final vote on the bill will be held Tuesday, according to Sen. Pete Brunstetter (R-Winston-Salem) (Hoban, 2/5).

Arizona Republic: Websites Tout Brewer's Plan To Expand Medicaid
Gov. Jan Brewer's administration has launched two websites to garner public support for her proposal to expand Medicaid and insure more low-income Arizonans. The websites are part of a sweeping effort by Brewer, health-care providers and the business community to win support from Republican lawmakers, in this case by going straight to their constituents. A page on the governor's official site calls Medicaid expansion "the conservative choice for Arizona." It generally restates the case Brewer made last month when she announced her plan to seek expansion of the state-federal program for the low-income and disabled as part of U.S. health-care reform (Reinhart, 2/5). 

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Insurers Prepare For 2014 When Major Health Law Provisions Kick In

And Medpage Today reports on how the changing marketplace will impact young healthy workers, who could face higher premiums, and those working part-time who may be newly eligible for workplace coverage.

The New York Times: Health Insurance Companies Get In Shape For 2014
Since Patrick J. Geraghty arrived here a year and a half ago to lead the state’s largest health insurer, Florida Blue, he has expanded its operations in Medicare and Medicaid, entered arrangements with hospitals and doctors, bought a medical group, and dabbled with a new private sector marketplace that allows employees to choose plans from different insurance companies (Abelson, 2/5).

Medpage Today: 'Sticker Shock' Ahead On Health Insurance
Separate surveys released this week give dramatically different outlooks for two groups of people under the Affordable Care Act (ACA): the young, healthy worker and the part-time worker. Premiums for a healthy, nonsmoking, 27-year-old in a "bronze" -- or relatively inexpensive -- small-group or individual policy would increase on average by 169 percent in five markets in 2014, a survey of major health insurers by the conservative American Action Forum (AAF) found. Meanwhile, premiums for an unhealthy, 55-year-old smoker in a more generous gold-rated policy would decrease by 22 percent, on average, in those same five markets in 2014 (Pittman, 2/5).

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Capitol Hill Watch

Cantor Calls For Repeal Of Medical Device Tax; Bipartisan Senate Bill Seeks To End Generic Drug Delays

In a speech, the House majority leader criticized the health law but focused his attention on the overhaul's taxes. Meanwhile, the Senate measure would prohibit companies that make brand-name drugs from paying generic manufacturers to keep their products off the market.

The Hill: Cantor: Repeal 'ObamaCare' Taxes
House Majority Leader Eric Cantor (R-Va.) emphasized repealing the taxes in President Obama's healthcare law during a speech outlining the House GOP's priorities. Although Cantor criticized the entire law, he focused his specific calls for repeal on the law's new taxes — specifically a 2 percent excise tax on medical device manufacturers (Baker, 2/5). 

Reuters: Senate To Mull Ban On 'Pay For Delay' Pharmaceutical Deals
Key Democratic and Republican senators reintroduced legislation on Tuesday that would make it illegal for brand-name pharmaceutical companies to pay generic drug makers to keep their cheaper medicines off the market. Such deals, in which big drug companies resolve patent litigation with potentially infringing generic firms by reaching a settlement that delays a generic version of a drug in exchange for a payment, have angered U.S. and European antitrust enforcers for years (Bartz, 2/5).

In other pharmaceutical industry news -

The Wall Street Journal: FDA Warns Of New Batch Of Fake Cancer Drug
The Food and Drug Administration said Tuesday it has warned doctors that another counterfeit batch of the cancer drug Avastin has reached medical practices in the U.S. The warning follows a string of alerts last year, when the agency told doctors that versions of Avastin sold by at least two drug-distribution networks were fakes, containing cornstarch, acetone and other chemicals and none of the genuine drug's active ingredient (Weaver, 2/5).

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Study: Hospice Use On The Rise, But After Late-Stage Aggressive Care

A study released Tuesday found that, although the number of elderly people who died in a hospice setting is increasing, it usually came late in the process and after highly aggressive care near the end of life.

USA Today: Hospice Care Used More, But Often Too Late
Twice as many elderly people died in hospice care as in a hospital or nursing home compared with a decade ago, but hospice is often treated as a last resort — and used too late to benefit patients and their families, says a study released Tuesday. The researchers examined Medicare records for 840,000 people 66 or older who died in 2000, 2005 and 2009 (Lloyd, 2/5).

Politico: Study: Boost In Hospice Visits By Way Of The ICU
At first blush it looks like great news: More Americans are choosing to die with hospice instead of spending their final days tethered to machines in a high-tech modern hospital. But a deeper look at the data finds a countervailing trend. Yes, more people are getting hospice care — but they are getting it for only a few days and often, only after highly aggressive care near the end of life, including multiple hospitalizations and stays in intensive care units (Kenen, 2/6).

Kaiser Health News: Capsules: Aggressive Care Still The Norm For Dying Seniors
Although federal data show that fewer Medicare beneficiaries are dying in hospitals, new research suggests that doesn't mean they're getting less aggressive care in their final days (Tran, 2/5).

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Veterans Health Care

Plans Scaled Back For Vets' Computerized Health Records System

Reuters: U.S. Scales Back Goal On Veterans' Health Records With An Eye On Costs
The U.S. government is ditching ambitious plans to create a single computer system for troops and military veterans to track their health records, opting instead for a more modest, less costly plan that officials said will deliver on goals faster. The decision announced on Tuesday is complicated and technical but goes to the core of President Barack Obama's goal to create a smooth transition for troops as they leave the military after 11 years of war and seek care at the Department of Veterans Affairs (Stewart, 2/5).

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State Watch

State Roundup: Mass. Finds More Problems At Compounding Pharmacies

A selection of health policy news from California, Massachusetts, Kansas, Minnesota, Connecticut and Colorado.

Los Angeles Times: California Passes Up Millions For Prison Health Care, Report Says
California's court-run prison health care program is missing out on tens of millions of dollars a year in federal funds because of disagreement with counties and software problems, a new legislative report states. The legislative analyst's office found increasing numbers of prison inmates who, because of their low income status, are eligible for the state's Medicaid program (St. John, 2/5).

Reuters: Massachusetts Cites Violations At 32 Compounding Pharmacies
Massachusetts health regulators have ordered 11 compounding pharmacies to partially or completely halt operations and cited another 21 for minor violations, after unannounced inspections of 40 pharmacies across the state. The wave of inspections follow a deadly U.S. meningitis outbreak stemming from a tainted steroid that was made by the New England Compounding Center in Framingham, Massachusetts (Clarke, 2/5).

Kaiser Health News: Kansas' Great Hope: Managed Care Will Tame Medicaid Costs
And the costs have been escalating for the $2.9 billion Medicaid program. So Kansas is in the midst of huge changes. On Jan. 1, the state began enrolling nearly all of its Medicaid population -- including its most expensive patients -- into a managed care program called KanCare. This effort is unrelated to the federal health law's Medicaid coverage expansion, on which Republican Gov. Sam Brownback has yet to take a position. Meanwhile, as the transition proceeds, many policy analysts are watching to see if the state has done enough to meet the goal of controlling costs while ensuring that these vulnerable patients receive quality health care" (Thompson and McLean, 2/6).

MPR: $3M Grant Project To Improve For Senior Citizen Care In Rural Areas
A pilot project to improve care for senior citizens in rural areas is being developed by a Minnesota-based senior housing and care services company. A $3 million grant from the Margaret A. Cargill Foundation will pay for a new facility in Detroit Lakes where elderly residents can access services from telemedicine to exercise programs in one location, says Kathryn Roberts, CEO of Ecumen. The new facility will be open sometime next year. The goal is to keep seniors independent and out of nursing homes. If successful, Roberts said it could provide a new model for rural communities (Gunderson, 2/5).

CT Mirror: Group Brings National Right-To-Die Movement To State Legislature
Leaders of a national right-to-die lobbying group came to Connecticut Tuesday to urge lawmakers to approve a bill to legalize assisted suicide for patients with a terminal illness. ... The controversial bill was recently raised by the legislature's Public Health Committee and will be aired at a public hearing this session. If approved, Connecticut would be the first state to approve the law legislatively. The other three states have approved the measure through the courts or ballot box (Merritt, 2/5).

Health Policy Solutions (a Colo. news service): Pilot Project Aims To Learn More, Spend Less On Health Care
As policymakers across the country grapple with the challenge of creating a better, less expensive health care system, one element often is overlooked: the role of the patient. An experiment in Colorado's San Luis Valley is testing the theory that better-informed patients who can weigh the pros and cons of medical procedures and their costs could help reduce demand for some expensive procedures. A new article in Health Affairs, co-authored by Denver health policy experts, explores how new state health exchanges could improve value in health care by cutting co-payments for health interventions that work while charging patients more for procedures with less impressive track records (Carman, 2/5).

California Watch: Prime Hospital Chain Acknowledges It Faces Two Federal Investigations
The Prime Healthcare Services hospital chain has acknowledged it is the target of two federal investigations: a U.S. Justice Department probe of its Medicare billings and an inquiry into alleged violations of patient confidentiality laws. The San Bernardino County-based company disclosed the investigations in a Jan. 2 filing with the state health department in Rhode Island, where Prime hopes to buy its 22nd hospital (Williams, 2/6).

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Editorials and Opinions

Viewpoints: Iowa 'Botched' High Risk Pool; Clinton Praises Family And Medical Leave Act; HHS Contraceptive Policy's 'Sensible Balance'

Des Moines Register: State Insurance Pools Have Been A Disservice
The health reform law will get millions of Americans coverage in 2014. Until then, Congress offered Iowa up to $35 million to provide temporary insurance for people whose health prevent them from buying coverage on their own. Iowa botched the entire concept behind the high-risk pool, and state and federal officials stood by and failed to take corrective action. That is simply inexcusable (2/5).

Politico: Why I Signed The Family And Medical Leave Act
Twenty years ago today, barely more than two weeks into my presidency, I stood in the White House Rose Garden to sign the Family and Medical Leave Act (FMLA), which provided millions of Americans with the opportunity to take time off to care for a new child or sick relative. It was then and remains today the embodiment of my governing philosophy of empowerment through opportunity and responsibility. To this day, I receive more thanks from citizens for the FMLA than any other single piece of legislation I signed into law (former President Bill Clinton, 2/5).

The Miami Herald: FMLA Still Helping Families Cope With Illness
In our struggle to balance our family lives and our work lives, one law has made a giant difference for me and 35 million other American workers — the Family Medical Leave Act. This week, the FMLA celebrates its 20th year in existence. It's been a godsend for those of us who want time to bond with our newborn, care for an aging parent or deal with a health emergency without the fear of losing our jobs (Cindy Krischer Goodman, 2/5).

Arizona Republic: Medicaid Expansion Not An Economic Issue
The benefits of the Medicaid expansion proposed by Gov. Jan Brewer greatly exceed the costs (indeed, there are actually state savings) and risks. That does not mean, however, that all the arguments being made on its behalf are valid. The claim that expansion is an important economic issue is particularly dubious (Robert Robb, 2/5).

Bloomberg: Why Opposition To Medicaid Expansion Is Nuts
Like declining to expand Medicaid, purposefully excluding your state from exchange subsidies is terrible policy that will end up being politically untenable. These recommendations -- decline Medicaid expansion even when there's almost no cost to state taxpayers; purposefully exclude your state’s residents from federal insurance subsidies -- are the dying gasps of a political movement that can't understand it was defeated. Reform opponents lost the fight over the program and it will be financed with federal tax dollars (Josh Barro, 2/5).

Health Policy Solutions (a Colo. news service): Medicaid Expansion An Investment In Colorado's Future
Young adults: What defines us? Taking pictures of our food and fixing computer problems for our parents? Unfortunately lacking health insurance may be the most common characteristic of our generation because young adults comprise one of the largest uninsured groups in the United States. ... Thanks to Obamacare, Colorado is creating the new Medicaid program to help young adults and other Coloradans find health care. Individuals earning $15,000 or less (and families of four making up to $30,000), will be insured through the new Medicaid program in 2014. The expansion is expected to reduce the number of uninsured Coloradans by 160,000 (Matt Valeta, 2/5)

The Washington Post: A Contraception Compromise In Good Faith
President Obama's 2010 health-care law requires large employers to provide health insurance and, according to the Department of Health and Human Services (HHS), that contraception be covered by those policies. From a policy perspective, the contraception mandate makes sense. But when the employers in question are affiliated with religious groups that object to birth control, balancing their religious liberty against public health is far from simple. On Friday, the Obama administration elaborated on its attempt — in our view, a successful one — to strike a sensible balance (2/5).

Seattle Times: Ensure Access To Birth Control Through Affordable Care Act
Last Friday, the administration announced that churches and other religious organizations would not have to provide or pay for coverage of contraceptive services. The revision also covers nonprofit religious organizations — such as universities, charities and hospitals — with religious objections. ... The debate has no end in sight, because others want an exemption for secular employers who have private religious objections. The Obama administration drew a reasonable line (2/5).

USA Today: Bring Mental Illness Out Of The Shadows
The vast majority of Americans with a mental health condition are not violent. In fact, just 3% to 5% of violent crimes are committed by individuals who suffer from a serious mental illness. But we know that some instances of mental illness can develop into crisis situations if left untreated, and those crises can lead to violence. More often than not, those with mental health conditions direct these violent acts at themselves. Tragically, there are more than 38,000 suicides in America each year, more than twice the number of homicides (HHS Secretary Kathleen Sebelius, 2/4).

Georgia Health News: Whistleblowers Are Our Best Weapon Against Fraud
In 1986, Congress rejuvenated the Civil War-era False Claims Act by permitting citizens with knowledge of fraud involving Medicare, Medicaid and other government programs to not only sue on behalf of the government but to be compensated for their part in fighting fraud with a portion of the funds recovered, typically 15 percent to 25 percent. In the years since, the whistleblower has become the single most effective weapon in the fight against health care fraud (Peter Canfield, 2/5). 

San Jose Mercury News: U.S. Needs To Reform Long-Term Care Assistance
Millions of elderly and disabled Americans need help with the basic activities of daily life -- from getting dressed to preparing meals and taking medications. Yet few can afford the care they need under the current system. In an important move, the U.S. Congress and the White House are setting up a new congressional commission that will deliver a plan -- within six months -- to reform long-term care assistance. I hope the commission will conclude that our country urgently needs a long-term care insurance program that is widely available and affordable (Larry Minnix, 2/5). 

Sacramento Bee: All Options Need To Be On Table For Medi-Cal Dental Program
The lack of timely and appropriate access to dental care for low-income children and adults is one of the most overlooked problems of California's health care system. It can also be life-threatening when not addressed. The challenges facing California policymakers will become more substantial as the state embarks on a massive expansion of Medi-Cal, the state's public insurance program for the poor (Barbara Aved, 2/6). 

JAMA: Patients Face Too Many Burdensome Care Transitions At The End Of Life
A growing number of older adults in the United States are dying at home, but many continue to face multiple health care transitions to different care sites and receive aggressive inpatient care in their final days, according to a study published in JAMA today. The majority of individuals report that they would prefer to die at home rather than in a health care facility (Bridget Kuehn, 2/5).

Kansas City Star: Health Care Pricing Makes No Sense
We can and should do better. The “we” are the health care providers. Everyone knows health care spending is out of control. Of the sacred triad of health care policy, (cost , access, and quality) the cost is the most important issue to address. Can we reduce cost, thus increasing access without affecting the quality of care? The answer is certainly “yes” (Stephen Kunz, 2/5). 

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Stephanie Stapleton

Andrew Villegas

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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.