Daily Health Policy Report

Thursday, February 7, 2013

Last updated: Thu, Feb 7

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Spending And Fiscal Battles


Public Health & Education

Health Care Marketplace

Health Information Technology

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Q&A: How Does Marriage Affect Health Coverage For The Young? (Video)

Kaiser Health News consumer columnist Michelle Andrews answers a reader question about under-26 insurance coverage for newlyweds (2/7). Watch the video.

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Capsules: HHS Delays Basic Health Plan Option Until 2015; Study: Premium Increases To Be Offset By Subsidies, Better Coverage; Despite Possible Ease In Regulations, Rural Hospitals Face Challenges

Now on Kaiser Health News' blog, Phil Galewitz reports on developments related to the basic health plan options: "The Obama administration has delayed by one year the rollout of a health program aimed at low to moderate-income people who won't qualify for the expanded Medicaid program under the federal health law" (Galewitz, 2/7).

In addition, Ankita Rao writes about the fiscal challenges ahead for rural hospitals: " Rural health care administrators got some good news this week. The Obama administration Monday proposed to ease some Medicare regulations – a change that could save rural hospitals much-needed money by allowing for more flexible staffing requirements. But for about 450 health care professionals who attended this week’s National Rural Health Association Policy Institute in Washington, D.C., sustaining the often low-volume hospitals will continue to be an uphill battle" (Rao, 2/7).

Also on Capsules, Julie Appleby reports on a white paper out Wednesday that finds premium increases will be offset by subsidies and better coverage: "How the federal health law will affect premiums is among the most asked – and most controversial – questions in the final months before new rules kick in requiring most Americans to carry coverage" (Appleby, 2/6). Check out what else is on the blog.

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Political Cartoon: 'Sucking The Oxygen Out Of The Room?'

Kaiser Health News provides a fresh take on health policy developments with "Sucking The Oxygen Out Of The Room?" by Lisa Benson.

Meanwhile, here is today's health policy haiku:


 Regulations out:
"Marketplaces" not exchange!
ACA in full?
-Paul Hughes-Cromwick

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

Michigan's Rick Snyder Becomes Sixth GOP Governor To Back Health Law's Medicaid Expansion

News outlets examine the political dynamics spurring some former opponents of the law to sign onto one of its most significant provisions.

The Associated Press/Washington Post: Republican Gov. Rick Snyder Backs Expanding Medicaid To Michigan's Uninsured In US Health Plan
Republican Gov. Rick Snyder on Wednesday backed the extension of Medicaid coverage to 470,000 residents under the Obama administration’s health care overhaul, saying it is the right thing to do despite resistance from his own party that controls the Legislature. He is the sixth GOP governor to propose expanding the taxpayer-funded health insurance program, joining the leaders of Ohio, Arizona, New Mexico, Nevada and North Dakota. Snyder has criticized the federal health care law in the past but to a lesser extent than other Republican governors (2/6).

Reuters: Michigan Republican Governor Snyder Backs Medicaid Expansion
Michigan Governor Rick Snyder on Wednesday endorsed an expansion of health coverage for the poor under President Barack Obama's reform law, joining five other Republican governors who have agreed to widen the Medicaid program in their states. Snyder made his announcement at a hospital in the state capitol of Lansing (Wisniewski, 2/6).

Richmond Times-Dispatch: Senate To Consider Quicker Decision On Medicaid
The Virginia Senate is having second thoughts about waiting another year to decide whether to expand the state’s Medicaid program to hundreds of thousands of uninsured Virginians under the national Affordable Care Act. The Senate Finance Committee is expected to introduce an amendment to the state budget today that would allow expansion of Medicaid this year if the state succeeds in getting federal approval of changes to the program. Committee Chairman Walter A. Stosch, R-Henrico, said Wednesday that the committee is preparing language for the budget that would change a previous provision requiring General Assembly approval next year for the program to expand (Martz, 2/7).

Kansas City Star: Some GOP Politicians Drop Their Resistance To Medicaid Expansion
Cracks continue to develop in the Republican Party’s concrete opposition to Obamacare's state expansions of Medicaid, the health insurance program for the poor. Whether those fissures will crumble Medicaid opposition in Kansas and Missouri, though, remains very much in doubt. On Wednesday, Gov. Rick Snyder of Michigan became the sixth GOP governor out of 30 to recommend expanding Medicaid eligibility in their state. … And on Monday, Ohio Gov. John Kasich, another Republican, recommended Medicaid expansion in his state. An estimated 684,000 people would have new access to health coverage in Ohio, fully paid for by the federal government over the next three years, if Ohio lawmakers agree (Helling, 2/6).

California Healthline: Insuring A Better Future For The State?
State officials and health care experts yesterday said the governor's decision to sign on to optional expansion of Medi-Cal could be a huge step forward for California's health system -- and a huge challenge, as well, they said. More than 700 stakeholders gathered in downtown Sacramento for the annual conference of the Insure the Uninsured Project heard dozens of experts evaluate how far California has come in implementing health care reform, and how far it still has to go. Adding roughly 1.4 million Californians to Medi-Cal eligibility in the optional expansion (adding adults up to 138 percent of federal poverty level) may be fully funded by the federal government for the first three years, but it also brings a boatload of work to the state (Gorn, 2/6).

Bloomberg: Republican Governors Finding Sense In Medicaid Expansion
Six Republican governors have agreed to expand Medicaid, the second-largest piece of President Barack Obama’s U.S. health-care overhaul, accepting federal money to ensure their state’s residents have access to medical coverage. Michigan Governor Rick Snyder, an Affordable Care Act opponent, said yesterday it makes sense for the "physical and fiscal health" of his state to participate in the law's expansion of Medicaid, the state-federal health plan for the poor. He became the sixth Republican governor to jump on board, following John Kasich of Ohio's announcement three days ago (Wayne, 2/7).

Fox News: Poison Pill? GOP Governors Divided Over Whether To Accept ObamaCare Medicaid Expansion
Little has changed in the year since Arizona Gov. Jan Brewer famously pointed an accusatory finger at President Obama on an airport tarmac. Brewer still fancies herself as a states' rights advocate fighting against the perceived excesses of the federal government. And Obama, fresh off a reaffirming election victory, remains in the White House and overseeing massive reforms in health care coverage he says are necessary for the country's future. That's why Brewer's recent decision to accept a huge pot of money available to states under ObamaCare's Medicaid expansion was a notable act of cooperation between the Republican governor and the Democratic administration she's berated, scolded and sued (Ross, 2/6).

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AARP Opposes Bill That Would Allow Insurers To Charge Older People More

The powerful seniors lobby says it cannot support proposals that would let premiums go higher for older beneficiaries. Meanwhile, the administration announces that a health program for low- and moderate-income people, which is optional for states, will not be able to start until 2015.

The Hill: AARP Slams Bill To Loosen Health Law's Rules On Age Rating
AARP pushed back Wednesday against proposals to let insurance companies charge higher premiums to older patients. The nation's largest seniors' lobby criticized proposals to change a provision in the Affordable Care Act that limits varying premiums based on age, or "age rating” (Baker, 2/6).

Kaiser Health News: Study: Premium Increases To Be Offset By Subsidies, Better Coverage
The paper says the law’s provision that limits premiums for older consumers to no more than three times what younger people pay will mean those younger beneficiaries, particularly men, will pay more than they do now. Older people and many women will see lower rates, the paper says (Appleby, 2/6).

Kaiser Health News: HHS Delays Basic Health Plan Option Until 2015
The Obama administration has delayed by one year the rollout of a health program aimed at low to moderate-income people who won’t qualify for the expanded Medicaid program under the federal health law (Galewitz, 2/7).

In other news about the implementation of the law --

The Wall Street Journal's Washington Wire: Utah Offers To Split Health Insurance Exchange
Utah Gov. Gary Herbert said Wednesday that he's made a new offer to Health and Human Services Secretary Kathleen Sebelius: His state will run half of a health insurance exchange, and let the federal government run the other half (Radnofsky, 2/6).

California Healthline: Higher Profile Coming To Exchange
California's health benefit exchange is nearing its move into the mainstream public spotlight -- but there is a lot of work still ahead, according to experts who gathered in Sacramento yesterday for a roundtable discussion of the exchange. ... Assembly member Richard Pan (D-Sacramento) acknowledged that creation of the exchange has helped place California at the head of the health care reform pack, but he said that leadership role doesn't change the 2014 deadline that's looming for health care reform and the exchange (Gorn, 2/7).

California Healthline: Obamacare Will Bring Changes – And Walgreens Wants To Fill The Void
Two-hundred-and-fifty-nine organizations have been named Medicare accountable care organizations. Most were formed by hospitals. Some were launched by physician groups. And three were created by a pharmacy chain. Walgreens' move into shared savings is many things: unusual, eye-catching, a sign of the times. But it's not surprising, observers say, as the pharmacy chain has been cultivating a broader strategy to ramp up its role in frontline care. And through a handful of new programs, Walgreens already has "demonstrated ... the valuable role our pharmacists can play working with physicians to meet the triple aim" of improving patient outcomes and satisfaction while cutting health costs, spokesperson Jim Cohn told California Healthline (Diamond, 2/6).

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Capitol Hill Watch

Bipartisan Duo Introduces Medicare 'Doc Fix' Bill In House

The effort, by Reps. Schwartz and Heck, would change the system known as the sustainable growth rate for Medicare physician payments.

CQ Healthbeat: House Members Hope Time Is Right For Medicare Payment Change
A bipartisan pair of House members hopes that three developments will give momentum to their bill to replace the formula that dictates how Medicare pays physicians. The measure, from Allyson Y. Schwartz, D-Pa., and Joe Heck, R-Nev., would establish new payment systems for Medicare physicians and looks very similar to their stalled bill from last year. But the lawmakers said a significantly lower cost estimate for repealing the formula, along with other members’ increased acceptance of their ideas, could mean passage this year (Ethridge, 2/6).

Politico: Medicare Pay Formula May Finally Get Fixed
Efforts to finally get rid of that dreaded Medicare payment formula could see smoother sailing now that the Congressional Budget Office has sliced the price tag nearly in half. ... Even though that job is now a lot easier, it’s unclear how far this particular piece of legislation will actually get. Other SGR repeal bills are in the mix. Republicans on the House Ways and Means Committee have been circulating their own memo on SGR repeal, and while it contains many similar ideas, they could choose to act on their own bill instead (Cunningham, 2/7).

The Hill: Bipartisan 'Doc Fix' Bill Introduced
Schwartz said there's no reason for Congress to wait until the end of the year, when the latest temporary patch is set to expire, before tackling the problem permanently. She and Heck also said they'd like to see SGR repeal as one in a series of incremental steps toward Medicare reform, rather than packaging it with a broader — and more controversial — overhaul (Baker, 2/6).

MedPage Today:  House Bill Will Repeal SGR, Raise Doc Pay Yearly
[The bill] would identify new payment and delivery models, including for different specialties, practice types, and geographic regions. It also would stabilize reimbursement for providers who exhibit "quality and efficiency within a fee-for-service model," according to the release. .... John Rother, president and CEO of the National Coalition on Health Care, which represents businesses, medical societies, unions, insurers, healthcare providers, and patients, noted in the press release that "This bipartisan legislation would help deliver the real reform we need, moving us away from today's fee-for-service system to higher-quality, lower-cost care" (Struck, 2/6).

Modern Healthcare: Lawmakers Offer Dueling Approaches On Fixing Doc Pay
[The bill] introduced Wednesday by Rep. Allyson Schwartz (D-Pa.) and a bill expected from Ways and Means Health subcommittee Chairman Kevin Brady (R-Texas) would replace the sustainable growth-rate formula with temporary increases while replacement methodologies were devised. But the bills differ on important points, including whether federal officials or physician groups would take the lead in developing new payment systems and the degree to which fee-for-service payments would be eliminated (Daly, 2/6).

The Medicare NewsGroup: How To Pay For Medicare? The Answer Is Unclear, No Matter Who You Ask
Everybody agrees on what a reformed Medicare system should look like, but nobody knows how to get there from here. This was the blunt, discouraging consensus emerging from a discussion of health care experts speculating on what a modernized version of the program should offer its 49 million beneficiaries. Gail Wilensky, an economist and a former director of Medicare, warned that nothing will happen until Congress is forced into choosing between unattractive alternatives: making taxpayers pay more, or making beneficiaries pay more (Rosenblatt, 2/6).

Also on Capitol Hill --

MinnPost: Erik Paulsen Tries Again To Dump Medical Device Tax
Rep. Erik Paulsen's campaign to forestall an Affordable Care Act tax increase on medical device companies came up short last session. ... Paulsen will reintroduce legislation repealing the tax on Wednesday, looking to leverage the tax’s impact on business to try steering the bill through a friendly House, a potentially hostile Senate, and a White House thus far completely opposed to the effort (Henry, 2/6).

The Washington Post: Sen. Menendez Contacted Top Officials In Friend's Medicare Dispute
Sen. Robert Menendez raised concerns with top federal health-care officials twice in recent years about their finding that a Florida eye doctor — a close friend and major campaign donor — had overbilled the government by $8.9 million for care at his clinic, Menendez aides said Wednesday (Leonnig and Markon, 2/6).

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Health Spending And Fiscal Battles

Advocates Warn About The Impact Of Automatic Cuts On Medical Research

Supporters of the National Institutes of Health argue that an anticipated $1.6 billion cut would undermine cancer, heart and AIDS research, while adding to economic and unemployment woes.

Los Angeles Times: House Republicans Remain Torn Over Automatic Budget Cuts
Democrats appear to have embraced [Obama's] call for a balanced approach, believing Americans prefer that to the austerity measures proposed by Republicans, according to Senate aides who asked not to be identified so they could talk about the internal discussions. But Republicans remain torn over whether to stick with the automatic cuts as a trophy in their deficit busting crusade, or seek another approach that would avoid the deep hits to the military by shifting the burden onto Medicare and other domestic accounts (Mascaro, 2/6).

The Fiscal Times: Health Care Research Now Braces For Cuts
Industry and consumer advocates of health and science research today warned that an anticipated $1.6 billion cut in the budget for the National Institutes of Health (NIH) would seriously hamper cancer, heart, AIDS and other critical research, while also adding to the nation’s economic and unemployment woes (Pianin, 2/6).

The Hill: NIH Sequester Cuts Will Harm Economy, Advocates Say
Budget sequestration will curtail $3 billion in economic activity if cuts hit the National Institutes of Health (NIH) on March 1, advocates said Tuesday. Advocacy coalition United for Medical Research (UMR) released new figures showing that the NIH supported more than 402,000 jobs and about $58 billion in economic output last year. The group warned that if sequestration takes effect, 20,500 life science jobs would be lost along with $3 billion in economic activity (Viebeck, 2/6).

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Health Law Provisions Saved Seniors $5.7B On Rx Drugs

USA Today: HHS Report: Medicare Prescription Drug Savings Hit $5.7B
Seniors have saved about $5.7 billion on prescription drugs since January 2011 because of provisions in the 2010 health care law meant to close the Medicare "doughnut hole," the government plans to announce today (Kennedy, 2/7).

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Public Health & Education

Report: The Number Of Americans With Alzheimer's Will Almost Triple By 2050

The government-funded report projects the Alzheimer's cases will rise from 5 million to about 13.8 million, thereby straining the nation's health care system.

Los Angeles Times: Alzheimer's Cases, And Costs, Projected To Swell
As baby boomers enter their golden years, the number of people afflicted with Alzheimer's disease is expected to reach 13.8 million by 2050 — millions more than previously anticipated, according to a new study in the journal Neurology (Serna, 2/6).

USA Today: An Alzheimer's 'Epidemic' Could Hit The USA By 2050
A new government-funded report confirms what advocacy groups have been warning for years: The number of people in the USA with Alzheimer's disease will almost triple by 2050, straining the health care system and taxing the health of caregivers. Numbers are projected to rise from about 5 million now to 13.8 million. The disease robs people of their memory, erases personality and makes even routine tasks like dressing and bathing impossible (Lloyd, 2/6).

In related news -

Reuters: Baby Boomers' Health Worse Than Past Generation's
Members of the baby boomer generation are in worse health than their parents were at the same age, according to a new study. In a large national survey, about 13 percent of baby boomers -- the generation born in the two decades after World War Two -- reported being in "excellent" health in middle age, compared to 32 percent of the previous generation who said the same at the same stage of life (Seaman, 2/6).

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Parity Delays, Payment Snafus, Frustrate Mental Health Providers

News outlets anticipate the release of rules regarding the types of mental health care insurers must provide under the federal health care law, as well as the payment fallout from new treatment codes.

USA Today: Impending Rules Will Guide Equality For Mental Health
Regulations to be issued this month on the type of mental health coverage insurers must provide under the 2010 health care law may elevate mental illness to the status it needs, mental health experts say. … Since the shooting of 26 people at Sandy Hook Elementary School in Newtown, Conn., President Obama ... has vowed to issue final rules this month that extend mental health parity to everyone who has health insurance under the health care law, also known as the Affordable Care Act. Those regulations would go into effect in January, and though the specifics of those rules are unknown, advocates have clear ideas of what they'd like to see parity look like (Kennedy, 2/6).

NBC News: Therapists: Change In Medical Coding Threatens Mental Health Care
Marc Milhander conducted more than 100 psychotherapy sessions in the first few weeks of this year, treating patients ranging from the mildly anxious to the severely depressed and the 24-year-old with antisocial personality disorder who really wants to get his hands on a gun. But Milhander, 54, a psychologist who co-owns a busy Niles, Mich., counseling center, is getting pretty anxious himself. He’s among a growing number of U.S. mental health professionals who say their insurance claims have been denied -- and their payments have been withheld -- because of problems resulting from nationwide changes in psychotherapy treatment codes that took effect Jan. 1 (Aleccia, 2/7).

CQ Healthbeat: Efforts To Simplify Medicaid And Mental Health Create A Complicated Mix
The Medicaid expansion under the health care overhaul and the mental health parity law share a common goal: to broaden and simplify coverage. But the combination of the two statutes results in a structure that is anything but universal or easy to understand. The resulting scheme would be hard for the average American to follow (Adams, 2/6).

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Health Care Marketplace

CVS Caremark Profits Up In Fourth Quarter

The retail pharmacy weathered the wave of generic drugs.

The Wall Street Journal: CVS Caremark Raises Outlook
CVS's retail pharmacy business gained customers last year in the wake of a contract dispute between rival Walgreen Co.'s and pharmacy-benefits manager Express Scripts Holding Co. that has since been resolved. A wave of major generic drugs introductions is having a mixed effect on the industry. Though the copycat drugs carry higher margins than branded products, they command lower prices, hurting sales revenue (Stynes, 2/6).

The Associated Press: CVS Caremark's 4th-Qtr Profit Rises 6 Pct 
Overall, one of the nation's largest drugstore chains said revenue climbed nearly 11 percent in the quarter to $31.4 billion, even though a wave of generic drugs recently has been hurting topline growth for drugstores and pharmacy benefits managers, which run prescription drug plans for employers, insurers and other customers. Generic equivalents to top-selling medicines like the cholesterol fighter Lipitor hurt revenue for these companies because they are cheaper than their brand-name counterparts. But they boost earnings because they come with a wider margin between the price drugstores and PBMs pay to buy them and the reimbursement they receive for doling them out (Murphy, 2/6).

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Health Information Technology

Lawmaker Advances Bill To Create FDA Office Of Wireless Health

The Wall Street Journal's Venture Capital Dispatch: Q&A: Rep. Mike Honda On Proposed FDA Office Of Wireless Health
Congressman Michael Honda (D., Calif.), who has been representing Silicon Valley in the U.S. House of Representatives for the past 12 years, recently submitted a bill asking for Congress to create and fund a new office at the U.S. Food and Drug Administration, which would be called the Office of Wireless Health. The office would be tasked with regulating the growing number of mobile, wireless health gadgets and applications, which have been proliferating wildly since the start of the smartphone craze (Hay, 2/6).

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State Watch

Health Care Action At State Capitols: Hospital Fees, Nurses' Prescribing Power

Lawmakers around the country consider a bevy of bills related to health policy.

The Associated Press: Okla. Senate Panel Approves Hospital Fee Extension
Legislation that would extend a program that helps reimburse hospitals and other health care providers that provide Medicaid services was approved by a state Senate panel Wednesday. The Senate Appropriations Committee's Subcommittee on Health and Human Services voted to extend the Supplemental Hospital Offset Payment Program through 2019. The measure now goes to the full Appropriations Committee for consideration (Talley, 2/6).

The Associated Press: Senate Panel Backs Abortion Coverage Ban
An Arkansas Senate panel approved a measure Wednesday banning insurers participating in an exchange created under the health care law from covering most abortions, while the sponsor of legislation banning abortions 20 weeks into a pregnancy said he's facing resistance for it not exempting victims of rape or incest. By a 5-2 vote, the Senate Public Health, Welfare and Labor Committee advanced legislation barring abortion coverage in the health insurance exchange, with exemptions for rape, incest and the life of the mother (2/6).

The Associated Press: ND Bill Aims To Protect Seniors, Vulnerable Adults
Health care workers, law enforcement and other professionals would be required to report the abuse of senior citizens and other vulnerable adults under bipartisan legislation considered by the North Dakota Senate. Sen. Phil Murphy, D-Portland, said North Dakota and Colorado are the only two states that don't require the reporting of adult abuse (MacPherson, 2/6).

The Texas Tribune: Bill Targets Caribbean Medical School With Eye On Texas
For more than a year, a foreign medical school has been seeking approval to operate in Texas, and its controversial bid has overcome a number of roadblocks. This legislative session, a recently filed bill will put it to one more high-stakes test. What the American University of the Caribbean, a for-profit medical school owned by DeVry Inc., wants is a certificate of authority from the Texas Higher Education Coordinating Board (Hamilton, 2/7).

The Texas Tribune: Bill Would Strengthen Nurses' Prescriptive Power
A long-awaited agreement between physicians, nurses and state legislators to increase the prescriptive power of advanced practice nurses could improve Texans' access to care, health care leaders said Wednesday. … The legislation, filed by Rep. Lois Kolkhorst, R-Brenham, chairwoman of the House Public Health Committee, and Sen. Jane Nelson, R-Flower Mound, chairwoman of the Senate Health and Human Services Committee, will eliminate on-site physician supervision requirements to allow doctors to delegate the authority to prescribe and order medical devices to advanced practitioner nurses; increase the number of advanced practice nurses a physician can supervise from four to seven; and improve coordination between the Texas Medical Board and the Board of Nursing and Physician Assistants (Aaronson, 2/6).

The Lund Report: Senate Committee Votes To Give Urban Nurse Practitioners Prescriptive Powers
The Senate Health Committee unanimously passed a bill Monday that would allow nurse practitioners across the state to prescribe and dispense medicine. Senate Bill 8 could go to a full senate vote as early as tomorrow when it's expected to pass. The bill would then be heard before the appropriate House committee. Nurse practitioners have had the ability to prescribe and dispense medicine for about a decade in rural counties, where access to doctors and pharmacies may be limited. The Portland-based clinic chain ZoomCare pushed the bill because its medical model often uses lower-cost medical providers such as nurse practitioners and physician’s assistants to provide basic care (Gray, 2/6).

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Considering Mental Health Care Changes In Aftermath Of Shootings

Missouri and Wisconsin officials suggest moves to expand state mental health services while a Georgia Senate panel approves changes in procedures for involuntary commitments to psychiatric care.

St. Louis Beacon: Nixon Says Expanding Mental Health Services Offers Better Crime Prevention Than Guns In Classrooms
Missouri Gov. Jay Nixon is touting his $10 million proposal to expand the state's mental health services as a key component of any effort to prevent a school-shooting tragedy like the December mass shooting at a grade school in Connecticut. … When asked, Nixon acknowledged that he believed that expanding mental health treatment services was a better focus for the General Assembly than some legislative proposals calling for more guns in schools (Mannies, 2/6).

Milwaukee Journal Sentinel: Gov. Scott Walker's Budget To Include $29 Million For Mental Health
In the wake of recent mass shootings in Wisconsin and elsewhere nationally, Gov. Scott Walker Wednesday proposed nearly $29 million more in state money for treating mental illness -- a move that could have a big impact on efforts to update Milwaukee County's outdated system of care. Speaking to the Wisconsin Counties Association, the Republican governor said that the funding would improve children's lives, lower the use of other public services by mentally ill residents left untreated and pull in millions of dollars in additional federal money. Also Wednesday, Assembly Speaker Robin Vos (R-Rochester) announced a bipartisan task force that will hold hearings around the state to address mental illness (Stein, 2/6).

Georgia Health News: Panels OKs Letting Counselors Commit People
A state Senate panel unanimously approved a bill Tuesday that would allow licensed professional counselors to make involuntary commitments of people with mental illness or an addiction. The licensed professional counselors would join physicians, psychologists, clinical social workers and clinical nurse specialists in being able to order involuntary treatment in Georgia. A similar bill passed the Senate last year but failed to clear the House (Miller, 2/6).

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Federal, State Officials Seek Ways To Preserve MinnesotaCare

Officials have been working to preserve -- after the federal health law takes effect -- this health insurance program for lower-income residents who lack coverage through their jobs.  

Pioneer Press: MinnesotaCare Funding Deal With Feds Closer To Realization, State Officials Say
The Dayton administration reports it is moving closer to an agreement with the federal government over how to split costs on an enhanced MinnesotaCare health insurance program. In his budget proposal for the two-year period beginning in July, Gov. Mark Dayton anticipates spending an extra $300 million to improve MinnesotaCare, which provides health insurance to lower-income residents who lack job-based coverage (Snowbeck, 2/6).

The Associated Press: Officials Find Way To Preserve MinnesotaCare
State and federal officials have come up with a way to preserve Minnesota's subsidized health care plan for the working poor when the federal health overhaul takes effect, Minnesota's human services commissioner said Wednesday. Around 130,000 Minnesotans are currently enrolled in MinnesotaCare, which helps cover premiums for people who make too much to enroll in Medicaid but not enough to afford regular insurance (Karnowski, 2/6).

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State Roundup: Insurance Rates To Rise 2.7% In Mass.

A selection of health policy stories from Connecticut, Massaschusetts, California, Minnesota, Kansas, Iowa and Colorado.

The Wall Street Journal: Malloy Takes Hacks At Budget Gap
Gov. Dannel Malloy said he would close [Connecticut's] $1.2 billion budget gap with a mix of spending cuts, including to hospitals and programs for the poor, and new revenues, including the extension of some business taxes that were scheduled to expire (De Avila, 2/6).

CT Mirror: Malloy Proposal Cuts Medicaid, Payments To Working Poor, Hospitals
Gov. Dannel P. Malloy's budget proposal would eliminate Medicaid coverage for thousands of poor parents, reduce a tax credit for low-income workers, eliminate the state-run Charter Oak Health Plan and slash payments to hospitals. It would also take advantage of federal funds to increase Medicaid enrollment and raise rates paid to primary care providers who treat Medicaid patients, both of which are required by federal health reform. Several of the governor's health care proposals are related to new federal health reform provisions slated to roll out Jan. 1, 2014, six months into the new budget. A major one is the proposal to eliminate Medicaid coverage for certain poor parents once alternative insurance options become available in 2014, something many advocates for low-income residents have feared would be an inadvertent consequence of health reform (Becker, 2/6).

Boston Globe: Average State Health Care Base Rates To Rise 2.7%
Massachusetts small businesses and individuals whose annual health insurance policies renew in the three months starting April 1 face average premium base rate increases of 2.7 percent -- more modest than the 3.6 percent boost in base rates for the current quarter -- according to data released Wednesday by the state Division of Insurance. The rate hikes for the second quarter, the largest renewal period for small employers and independent contractors, follow two quarters in which average base rates edged up in that market. In the second quarter of last year, the average increase was 1.8 percent. Overall, however, health insurance rate increases have been moderating in recent years after a decade of mostly double-digit advances in the state's so-called small group market, which is made up of individuals and small businesses (Weisman, 2/6).

Los Angeles Times: Consumer Group Calls For Laws To Boost Monitoring Of Doctors
A consumer advocacy group Wednesday called for new laws to improve the state's monitoring of doctors who prescribe dangerous narcotics. Consumer Watchdog said reforms were needed to reduce surging prescription drug overdoses and to rein in incompetent and corrupt physicians. "We call upon you to convene hearings immediately to deal with this crisis and consider appropriate solutions," the Santa Monica-based group wrote in a letter to Gov. Jerry Brown and lawmakers (Girion, 2/7).

MPR News: $3M Grant For 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).

Pioneer Press: Minnesota Charity Care Costs Vary In State, Hospital Association Reports
Are charity care costs going up or down in Minnesota? It's a question raised by dueling reports this week from the Minnesota Department of Health and the trade group for hospitals in the state. According to the state government report, the total cost of uncompensated care -- a category that includes charity care and the cost of people not paying medical bills -- declined at Minnesota hospitals in 2011 for the first time in years (Snowbeck, 2/6).

Kansas Health Institute: Parents Urge Legislators To Do More To Reduce Waiting Lists For Social Services
Several parents of disabled children today urged House budget writers to disregard Gov. Sam Brownback's spending proposal for the coming two fiscal years and instead do something to reduce the waiting lists for social services. … Prusick and her husband Terry were among the various parents who attended Wednesday's meeting of the House Social Services Budget Committee to ask lawmakers to reconsider the governor's proposed budget, which would hold steady state spending on various Medicaid programs that provide home and community based services for the disabled and would keep intact long waiting lists of people seeking them (Shields, 2/6).

Des Moines Tribune: Claims About Medical Malpractice Lawsuits Rejected
Iowa should not blame its doctor shortage on the cost of medical malpractice lawsuits, a national expert says. Gov. Terry Branstad is pushing for limits on such lawsuits, saying they’re a major reason the state has trouble recruiting enough doctors. But Mike Matray, editor of the trade journal Medical Liability Monitor, said the governor's contention "doesn’t stack up with the reality of the situation." Matray tracks premiums doctors pay for such insurance, and he noted that those costs have been unchanged in Iowa since 2008, after declining in the previous three years (Leys, 2/6).

Health Policy Solutions (a Colo. news service)/I-News Network: Medicaid Patients Struggle To Access Dental Care
State Medicaid data reported to the federal government show that less than half of the 453,000 Coloradans under age 21 who were eligible for benefits in federal fiscal year 2011 received some kind of dental service. Only a quarter of Colorado counties met a 2010 state goal of getting at least 44 percent of Medicaid-eligible residents under age 19 to visit a dentist, according to an I-News analysis of state records. … While the state appears to be making strides in improving its numbers, part of the problem is the paucity of dentists willing to see Medicaid children. Only 10 percent of Colorado’s 3,500 or so dentists are considered "significant" Medicaid providers, meaning that they are reimbursed for at least 100 visits per year. Moreover, 20 of Colorado's 64 counties do not have a dentist who accepts Medicaid (Roberts, 2/6).

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Weekend Reading

Weekend Reading: A Doctor Faces Hard Questions

Every week Ankita Rao selects interesting reading from around the Web.

The CT Mirror: In Mental Illness, Is 'Stigma' The Wrong Word? What About 'Discrimination?'
"When I had cancer, I got cards and flowers," Karen Kangas' sign reads. "When I was diagnosed with bipolar disorder, I got no cards and a pink slip." A picture of Kangas holding the sign hangs in the state Capitol complex, part of an exhibit called "Discrimination: A Roadblock to Recovery." The title is no accident. People often talk about the stigma of mental illness. But some, including Patricia Rehmer, prefer the term "discrimination." It's stronger. It makes people uncomfortable (Arielle Levin Becker, 2/5).

The New York Times' Opinionator blog: Depression and the Limits of Psychiatry
Current psychiatric practice is guided by the “Diagnostic and Statistical Manual of Mental Disorders” (DSM). Its new 5th edition makes controversial revisions in the definition of depression, eliminating a long-standing “bereavement exception” in the guidelines for diagnosing a “major depressive disorder.” ... psychiatric practice makes essential use of moral (and other evaluative) judgments. Why is this dangerous? Because, first of all, psychiatrists as such have no special knowledge about how people should live (Gary Gutting, 2/6).

Consumer Reports: The Cancer Tests You Need – And Those You Don't
Early detection saves lives. That's the assumption that drives aggressive cancer-screening campaigns. It's what persuades women to host "mammogram parties" where they gather friends for wine, cheese, massages, and breast-cancer screenings. It's what persuades men to offer up blood for prostate-cancer tests at hockey games or onboard a huge red bus parked at sporting-goods stores. But the big red bus and other direct-to-consumer screening efforts raise big red flags, our experts say. ... the message that you have nothing to lose and everything to gain from being screened—that is, to be tested for a cancer before you have any symptoms of it—simply isn’t true (March 2013).

The New York Times: A Doctor's Struggle With Numbers
Oncologists are notoriously bad at predicting survival, and none of us wants to be known as “the doctor who told me I would be dead by now,” the doctor who made a prediction of imminent demise, sending a family into a terrifying tailspin of goodbyes, only to be proven wrong and subsequently mocked for years to come. One of my patients, upon being told by another doctor that she had two months to live, held Christmas in April so she could spend one last holiday with her grandchildren. She survived to see two more Christmases. At the same time, we need to be truthful and give guidance to people who want time to prepare (Dr. Mikkael Sekeres, 1/31).

National Journal: Health Care: Great For The Economy Today, Terrible Later
Health care is the leading-edge of a nationwide trend. The number of jobs in this sector is climbing steadily, in contrast to the erosion in so many other areas of the economy. Since the Great Recession began in December 2007, health care jobs are up nationwide by 10.5 percent. … If health care jobs had plunged like those in other sectors, U.S. unemployment would be a staggering 10.8 percent. ... But the long term may not be as rosy—for Pittsburgh or for the country. The growth in the health care sector also produces ever-growing costs (Margot Sanger-Katz, 2/2).

American Medical News: HIPAA Gets Tougher On Physicians
A revised set of federal privacy rules is expected to have a significant impact on the way physicians run their practices. Revised privacy notices will need to be displayed in prominent areas of doctors’ offices and on practices’ websites. Patients will be able to ask for copies of their electronic health records or restrict the information given to health plans if they self-pay for services. And perhaps most important, practices might be subject to serious fines if any of their business associates cause security breaches (Jennifer Lubell, 2/4). 

The Atlantic: What The Sunshine Act Means For Health Care Transparency
Curious whether a prescription or medical device your doctor is recommending comes from a manufacturer who has been paying your doctor? Good news, then: The federal government has finally developed a plan for how the Physician Payments Sunshine Act will work. The Sunshine Act, made federal law as part of the Affordable Care Act in 2010, was designed to allow anyone -- patients, doctors, journal editors -- to look up which doctors are getting how much from which companies. ... Although transparency about financial ties does not "cure" influence, it at least helps us understand it. There may, of course, be legitimate reasons for a physician to be paid by a pharmaceutical company -- for example, for conducting a study -- but watchdogs like Angell, Goldacre, and Brody see no reason why such relationships should be obscured (Alice Dreger, 2/6).

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Editorials and Opinions

Viewpoints: 'Empty Budget Gestures'; GOP Should Endorse 'Doomsday' Sequester; 'Imagined Dangers' Imperil Vaccine Successes

Los Angeles Times: Obama And House Republicans Trade Empty Budget Gestures
President Obama on Tuesday called on Congress to put off -- again -- the start of the "sequester," a series of across-the-board spending cuts that would save $1.2 billion over 10 years. ... The president's speech is likely to have zero effect on Capitol Hill. ... Republicans believe they've done enough on the revenue side of the equation. Their focus now is on finding a way to force Democrats to accept cuts in entitlement programs, which are the main driver in Washington's long-term budget problems. So, what did House Republicans do Wednesday? They rammed through a bill (HR 444) that would require Obama to submit a budget proposal by April 1 that would eliminate the deficit within 10 years -- something Republicans have yet to do with any of their deficit-slashing budget resolutions (Jon Healey, 2/6). 

The Wall Street Journal: A Fiscal Fantasy
Meanwhile, the entitlements that Mr. Obama refuses to reform continue on autopilot. Government health-care spending will double over the decade, with Medicare rising to $1.079 trillion in 2023 from $592 billion this year, Medicaid to $572 billion from $265 billion. ObamaCare insurance subsidies add another $949 billion. For the first time the U.S. will spend more on health programs ($13.850 trillion in 10 years) than on Social Security (2/5). 

The Wall Street Journal: The Unscary Sequester
The sequester that nobody seems to love would cut an estimated $85 billion from the budget this fiscal year starting in March. Half of the savings would come from defense and half from domestic discretionary programs. Medicare providers would take a 2% cut. This "doomsday mechanism" … was the fallback when the White House and Republicans couldn't agree during the 2011 debt-ceiling negotiations. The White House strategy was to create a fiscal hatchet that would disproportionately carve up the defense budget to force the GOP to raise taxes. … This hasn't worked. Republicans have rightly concluded after two years of being sucker-punched that the sequester is the main negotiating leverage they have and may be the only way to restrain spending. So now Democrats and a gaggle of interest groups are denouncing Mr. Obama's fiscal brainchild because the programs they cherish—from job training to education … to money for Planned Parenthood—are about to get chopped too (2/6). 

Tampa Bay Times: Lifetime Medicare And Social Security Taxes Vs. Benefits
Are Social Security and Medicare benefits actually a partial refund of what the beneficiary has already paid in taxes? The Tampa Bay Times takes a closer look in a February 2013 story by Louis Jacobson. Here we provide a visual display in bar charts of the Times' findings, which were researched from the Urban Institute, a nonpartisan research institute that produces annual statistics on the topic. ... In most cases, people get more from Social Security and Medicare combined than they put in, though the specific amount can vary depending on income and family circumstances (2/6).

The Medicare NewsGroup: Ending SGR: The Time Is Now
The failed Medicare physician payment formula known as the SGR, which has plagued Medicare patients and physicians for over a decade, must be eliminated now and replaced with policies that promote efficiency, quality and value in Medicare for patients and taxpayers. The AMA has called on Congress again and again to stop the broken cycle of scheduled cuts and short-term patches that impede the development and adoption of new ways to deliver and pay for high quality patient care (Dr. Jeremy Lazarus, 2/6).

The Wall Street Journal: Rolling Back The War On Vaccines
Thanks to a massive international vaccination effort, world-wide fatalities from smallpox fell from two million annually in 1967 to zero by 1980, when health authorities confirmed the complete eradication of the disease. The Salk and Sabin vaccines have saved five million people from paralytic polio, and eradication of that once common disease is in sight. Vaccination against infectious childhood diseases now prevents more than 2.5 million deaths annually, with an extremely low risk of serious side effects. Yet these achievements have rendered the benefits less visible to young parents, enabling imagined dangers and the rare side effects of vaccines to capture heightened attention (Jay Winsten and Emily Serazin, 2/6).

Dallas Morning News: Erasing The Stigma Of Mental Illness
The baseline for Mayor Mike Rawlings' call to action on mental illness was to get the vexing, pervasive subject on the table, where it can emerge as a community focus. Consider the first step a positive one. The 600-plus people who gathered at City Performance Hall in downtown Dallas on Tuesday night were focused and ready to move forward, in a number of directions. The event was "Erasing the Stigma: Mental Illness and the Search for Solutions," a joint project of the mayor, The Dallas Morning News and KERA. It sprang from Rawlings' alarm that any community — not just Newtown, Conn. — can experience unspeakable tragedies if it stays oblivious to festering problems related to mental illness (2/6).

Miami Herald: The Trauma Over Trauma
For anyone wondering what all the drama was about at the Miami-Dade County Commission meeting this week involving workers from Kendall Regional Medical Center, here's a clue: Trauma patients can mean big money for revenue-starved hospitals, and suddenly everyone wants a piece of the action. ... The issue was whether the commission should reconsider a vote to allow Jackson Health System to take legal action to defend its ability to provide quality trauma care to the community. Wisely, the commission decided to leave Jackson free to protect itself by resorting to the courts, if necessary, to defend the level of service offered by its Ryder Trauma Center, one of the top-rated emergency treatment hospitals in the country (2/6).

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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.