Daily Health Policy Report

Friday, February 8, 2013

Last updated: Fri, Feb 8

KHN Original Reporting & Guest Opinion

Health Reform

Administration News

Capitol Hill Watch


Public Health & Education

Health Policy Research

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

San Diego Hospice Files For Bankruptcy

Writing for Kaiser Health News, Randy Dotinga reports: "Hobbled by a federal investigation into its practice of treating patients who had more than six months left to live, one of the biggest hospices in the country has filed for bankruptcy as it tries to continue operating. A local hospital chain is heeding San Diego Hospice's plea for help, however, and promising to provide services for as many patients as need it" (Dotinga, 2/7). Read the story.

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Capsules: Grassley Calls For Senate Consideration Of Tavenner's Nomination; HHS Denies Mississippi’s Bid To Run Its Own Exchange

Now on Kaiser Health News' blog, Mary Agnes Carey reports on the White House move to get Senate confirmation for a Medicare administrator: "President Barack Obama Thursday once again nominated Marilyn Tavenner to head the Centers for Medicare & Medicaid Services, and a key GOP senator said the chamber should consider the nomination. 'The Senate should give Ms. Tavenner every opportunity to show she is a worthy choice to lead the agency responsible for Medicare, Medicaid, the Children’s Health Insurance Program, and a lot of the implementation of the Obama health care law,' said Sen. Charles Grassley, R-Iowa., who is a member of the Finance Committee and its former chairman and ranking member. Grassley said he hoped the panel would give Tavenner’s nomination 'due consideration through regular order'" (Carey, 2/8).

In addition, Jeffrey Hess of Mississippi Public Broadcasting reports on the outcome of the disputed state effort to set up a health marketplace: "Mississippi Insurance Commissioner Mike Chaney, who has been the driving force behind creating a state based exchange, got his answer from the feds Thursday: Sure can’t. The U.S. Department of Health and Human Services rejected Mississippi’s plan Thursday afternoon, making Mississippi the only state to have its exchange blueprint nixed by the federal government. Instead, Mississippi will have a federal exchange like the more than two dozen other states that have balked at implementing the health law" (Hess, 2/8).

Check out what's on the blog.

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Political Cartoon: 'Coming To Your Neighborhood Soon?'

Kaiser Health News provides a fresh take on health policy developments with "Coming To Your Neighborhood Soon?" By Matt Wuerker, Politico.

Meanwhile, here is today's health policy haiku:


In Mississippi, 
the insurance exchange is
Seesawing away?
- Anonymous

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

Bishops Reject HHS Plan For Contraception Coverage

The Catholic leaders say that the compromise doesn't offer enough safeguards for religious institutions and that they will continue to fight the administration on the mandate.

The New York Times: Bishops Reject Birth Control Compromise
The nation's Roman Catholic bishops on Thursday rejected the latest White House proposal on health insurance coverage of contraceptives, saying it did not offer enough safeguards for religious hospitals, colleges and charities that objected to providing such coverage for their employees. The bishops said they would continue fighting the federal mandate in court (Pear, 2/7).

The Wall Street Journal: Latest Birth-Control Offer 'Falls Short'
The nation's Roman Catholic bishops on Thursday came out against the Obama administration's latest offer to resolve a yearlong standoff over mandatory insurance coverage of contraception. The bishops' fresh opposition paves the way for a protracted legal battle between religious groups and the federal government that could bring part of the health overhaul law back before the Supreme Court (Radnofsky and Bravin, 2/7).

NPR: Catholic Bishops Reject Compromise On Contraceptives
It seems the third time wasn't the charm, after all. The United States Conference of Catholic Bishops has officially rejected the Obama Administration's latest attempt to ensure that women with health insurance get access to no-cost contraceptive coverage without violating the rights of religious employers. ... The proposal calls for insurance companies -- rather than religious hospitals, universities or charities -- to provide contraceptive and sterilization coverage. But that's not good enough, said a statement from Cardinal Timothy Dolan, president of the conference (Rovner, 2/7).

Politico: Bishops Reject Contraception Rule Change
Catholic bishops on Thursday rejected the White House's latest attempt at compromise on contraception, saying it did not adequately accommodate religious organizations that object to covering free contraception in employee health plans. "Throughout the past year, we have been assured by the administration that we will not have to refer, pay for, or negotiate for the mandated coverage," Cardinal Timothy Dolan of New York, president of the U.S. Conference of Catholic Bishops, said in a statement. "We remain eager for the administration to fulfill that pledge" (Haberkorn and Smith, 2/7).

Reuters: Catholic Bishops Reject Obama Offer On Contraceptive Coverage
U.S. Roman Catholic bishops on Thursday rejected the Obama Administration's latest bid for compromise over a hotly disputed health policy that requires employees at religiously affiliated institutions to have access to insurance coverage for contraceptives. Cardinal Timothy Donlan of New York, president of the U.S. Conference of Catholic Bishops, said his group would redouble efforts to reach an agreement on the contraceptives issue after more than a year of protest and scores of federal lawsuits from Catholics groups and other social conservatives (Morgan, 2/7).

Fox News: Catholic Bishops Reject Revised ObamaCare Contraceptive Rule
Catholic bishops have rejected the Obama administration's latest proposal on mandatory contraceptive coverage, vowing to continue to fight for changes before the policy becomes final. After reviewing the administration's proposal unveiled last week, the U.S. Conference of Catholic Bishops said it stands by its earlier concerns. "Because the stakes are so high, we will not cease from our effort to assure that health care for all does not mean freedom for few," New York Cardinal Timothy Dolan, president of the bishops' conference, said in a statement. Under the federal health care overhaul, the administration has pressed to require most employers to provide access to free contraceptive coverage (2/8).

Modern Healthcare: Catholic Bishops Reject Obama Birth Control Move
The U.S. Conference of Catholic Bishops is not satisfied with the Obama administration's attempt to defuse opposition to mandatory birth-control coverage under the health care reform law. "The administration's proposal maintains its inaccurate distinction among religious ministries," Conference President Timothy Dolan said in a statement. "It appears to offer second-class status to our first-class institutions in Catholic healthvcare, Catholic education and Catholic charities." Dolan previously said the the federal government should exempt all Catholic institutions, including hospitals, from the mandate that health plans provide contraception at no out-of-pocket cost to beneficiaries (Selvam, 2/7).

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HHS Turns Down Miss. Insurance Commissioner's Bid For Exchange

Commissioner Mike Chaney wanted to set up a state-based marketplace for insurance to open next year as part of the health overhaul, but federal officials said the Mississippi governor's opposition made it impossible for the exchange to function as required by law.

The Wall Street Journal: Mississippi Health-Exchange Application Rejected
Republican insurance officials in Mississippi who had hoped to run their own insurance exchange as part of the federal health-care law have had their application turned down by the Obama administration, which said the opposition of the state's GOP governor made it impossible for them to proceed (Radnofsky, 2/7).

The Associated Press: Feds Reject Mississippi Proposal To Create State-Run Health Insurance Exchange
Mississippi Insurance Commissioner Mike Chaney says federal officials have rejected the state's proposed health insurance exchange. Chaney made the announcement Thursday. An exchange is an online marketplace where people can buy health insurance (2/7).

Kaiser Health News: HHS Denies Mississippi's Bid To Run Its Own Exchange
Mississippi Insurance Commissioner Mike Chaney, who has been the driving force behind creating a state based exchange, got his answer from the feds Thursday: Sure can't. The U.S. Department of Health and Human Services rejected Mississippi's plan Thursday afternoon, making Mississippi the only state to have its exchange blueprint nixed by the federal government. Instead, Mississippi will have a federal exchange like the more than two dozen other states that have balked at implementing the health law (Hess, 2/8).

In other states, the issue of the health law's Medicaid expansion is a hot topic.

Los Angeles Times: Medicaid Expansion Divides GOP Governors
Some of the nation's most prominent Republican governors have moved to embrace a key feature of President Obama's healthcare law, providing a significant boost to the administration and highlighting a fissure inside the GOP on an emerging campaign issue. At stake is the goal of expanding health insurance under the Medicaid program, one of two main ways the law is to provide coverage to those who lack it. Starting in 2014, the law broadens Medicaid to cover people who earn up to about $15,500 a year, but under last year's Supreme Court decision upholding the law's constitutionality, states have the option of rejecting the expansion and the federal money that comes with it (West, 2/7).

The Associated Press: Snyder Wants To Raise Gas Tax, Expand Medicaid
(Michigan Gov. Rick) Snyder also formally recommended making 320,000 more residents eligible for Medicaid in 2014, a move he said would initially save $200 million a year because people who receive care from state-funded programs would instead be covered with federal money. That was met with skepticism by Republican legislators who worry the federal government will renege on a promise to cover much the cost after 2017. ... To head off those kinds of concerns, Snyder called for setting aside $100 million a year of savings from Medicaid expansion so Michigan can pay a portion of the cost once the U.S. government stops covering 100 percent (Eggert, 2/7).

The Associated Press: Senate GOP Delays Bill To Ban Medicaid Growth
Republican lawmakers are putting the brakes on a bill seeking to bar Tennessee from expanding Medicaid under the federal health care law. Senate Speaker Ron Ramsey of Blountville announced the move at a legislative preview session Thursday hosted by The Associated Press and the Tennessee Press Association. He said he persuaded fellow Republican Sen. Brian Kelsey of Germantown to park his bill to block the expansion (Schelzig, 2/7).

The Hill: NJ Dems Push Christie To Expand Medicaid
Democratic lawmakers from New Jersey urged Gov. Chris Christie (R) Thursday to expand the state's Medicaid program under President Obama's healthcare law. Sens. Frank Lautenberg and Robert Menendez joined six House members in a letter highlighting the estimated $11 billion in federal funds that would come from growing the low-income health insurance program (Viebeck, 2/7).

Health Policy Solutions (a Colo. news service): New Medicaid Estimate: A Billion Dollar Bargain?
Expanding Medicaid would cost Colorado about $1 billion over 10 years and add an estimated 240,000 to the state’s Medicaid rolls, including as many as 73,000 people who could switch from private to public health insurance, according to a new cost-benefit analysis from the Colorado Health Institute (CHI). The Colorado Trust commissioned the study. Dr. Ned Calonge, president and CEO of The Trust, urged lawmakers to consider the profound impact that Medicaid expansion could have on the health of Coloradans as they ponder financial costs and benefits (Kerwin McCrimmon, 2/7).

The Washington Post: Va. General Assembly Approves Proposed Changes To Budget
The Virginia Senate and House of Delegates approved proposed changes to the current two-year budget, with Senate Democrats unanimously voting in favor of its version after changes were made that would set up a framework for the state to implement Medicaid expansion (Haines, 2/7).

MPR News: Report: Health Care Overhaul Would Reduce Hospitals' Costs
The federal health care overhaul will reduce the amount of money Minnesota hospitals pay each year to care for patients who can't afford their services, according to a new report from the Minnesota Department of Health. In 2011, uncompensated care cost hospitals $308 million, and without the federal Affordable Care Act it would grow to about $319 million by 2016, said the report issued Wednesday by the health department's Health Economics Program. Under the Affordable Care Act, which would include a health insurance exchange and an expanded basic health plan for lower income individuals, the state's hospitals would save between $134 million and $168 million on uncompensated care, the report said. However, if the state decides not to expand Medicaid in order to cover people with incomes 138 percent above federal poverty guidelines, hospitals would save less on uncompensated care, the report said (Dunbar, 2/7).

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, 2/7).

Philadelphia Inquirer: Uninsured S.E. Pennsylvanians Have Nearly Doubled Since 2000 – Survey
Nearly 29,000 people ages 18 to 64 lost health insurance coverage in Southeastern Pennsylvania over the last two years, according to a survey released Thursday. President Obama's health-care overhaul, approved in 2010, was meant to greatly reduce the numbers of uninsured people beginning next year, in large part by expanding Medicaid. But Gov. Corbett, who has cut state-subsidized insurance in several ways, said Tuesday that he would not accept the expansion for now, raising concerns that the trend will worsen. The ranks of the uninsured have been rising for more than a decade. The number in Southeastern Pennsylvania has nearly doubled from 2000 to 2012, reaching 305,000 nonelderly adults, the survey estimated (Sapatkin, 2/8).

Meanwhile, in Washington, senators seek to influence the implementation of the law.

Reuters: Senators Push To Repeal U.S. Medical Device Tax: Success Unlikely
A bipartisan group of U.S. senators introduced legislation on Thursday to repeal a tax on medical devices that is part of President Barack Obama's healthcare law, although the proposal likely faces an uphill climb in Congress. The tax applies to a range of medical products -- everything from bedpans and surgical tools to the expensive heart devices produced in the home states of the senators backing the repeal (Dixon, 2/7).

The Wall Street Journal: Senators Say No Subsidies For Unions
A group of 31 Republican senators asked the White House not to allow subsidies under the health-overhaul law for health-insurance plans jointly run by employers and unions. In a letter to President Barack Obama sent Thursday, the group, including Senate Minority Leader Mitch McConnell, said any expansion of insurance subsidies to union workers' plans would violate the 2010 law. The letter was in response to a page one story in The Wall Street Journal last week that said top labor leaders planned to press the Obama administration to get access to the law's insurance exchanges and subsidies (Adamy, 2/7).

In addition --

The Hill: Insurer: No Talk Of Seeking 'Obamacare' Delay
The nation's largest health insurer told reporters Thursday that it hasn't seriously discussed a delay in the implementation of President Obama's signature healthcare law — a move many Republicans support. Officials from the Blue Cross Blue Shield Association (BCBSA) said an across-the-board delay hasn't seriously come up in their internal preparations for the law's full implementation (Baker, 2/7).

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Administration News

Tavenner Nominated Again To Lead Medicare

President Obama asks the Senate to confirm the woman who is now acting administrator for the Centers for Medicare & Medicaid Services.

The Wall Street Journal: Tavenner Nominated For Medicare, Medicaid Post
The Obama administration on Thursday made its second formal nomination of Marilyn Tavenner to head the Centers for Medicare and Medicaid Services. Ms. Tavenner was first nominated for the post in November 2011 and has been the acting administrator of the agency since then, overseeing the two major health-insurance programs operated by the federal government, as well as implementation of key parts of the health-care law. She is a former nurse and hospital chief executive (Radnofsky, 2/7).

Kaiser Health News: Grassley Calls For Senate Consideration Of Tavenner's Nomination
President Barack Obama Thursday once again nominated Marilyn Tavenner to head the Centers for Medicare & Medicaid Services, and a key GOP senator said the chamber should consider the nomination. "The Senate should give Ms. Tavenner every opportunity to show she is a worthy choice to lead the agency responsible for Medicare, Medicaid, the Children's Health Insurance Program, and a lot of the implementation of the Obama health care law," said Sen. Charles Grassley, R-Iowa., who is a member of the Finance Committee and its former chairman and ranking member. Grassley said he hoped the panel would give Tavenner’s nomination "due consideration through regular order" (Carey, 2/8).

Politico: Tavenner Renominated For CMS Administrator
The White House on Thursday renominated Marilyn Tavenner to be administrator of the Centers for Medicare & Medicaid Services. But don’t expect to see action on her nomination soon. The second nomination was expected, as Tavenner's 2011 nomination to the same job expired at the end of the previous Congress. But it's unclear whether Senate Democrats will move her confirmation given that it has become so difficult to get a Medicare chief confirmed in the past few years under both Republican and Democratic administrations (Haberkorn, 2/7).

Modern Healthcare: Tavenner Nomination Could Face Resistance From ACA Foes
President Barack Obama's re-nomination of Marilyn Tavenner as administrator of the CMS on Thursday drew wide support from health industry leaders but an uncertain outlook on Capitol Hill. Tavenner, who leads the agency in an acting capacity, was first nominated in 2011 following the resignation of Dr. Donald Berwick, the previous acting administrator. Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee, opted not to advance her initial nomination and it expired at the end of the last Congress. Health industry leaders pushed for her new nomination to advance (Daly, 2/7).

Bloomberg: Tavenner Nominated By Obama To Run Medicare, Medicaid
President Barack Obama re-nominated Marilyn Tavenner to be the administrator in charge of the $820 billion U.S. Medicare and Medicaid programs. Obama asked the Senate in a notice today to confirm the appointment of Tavenner, 61, who has been acting administrator of the Centers for Medicare and Medicaid Services since 2011. The agency, which oversees taxpayer-funded health programs for the poor, elderly and disabled, hasn't had a Senate-confirmed leader since 2006 (Wayne, 2/7).

Meanwhile, a Republican senator is raising questions about Medicare funding.

The Hill: Sessions Warns Lew’s Nomination To Treasury At Risk Over Medicare Trigger
Sen. Jeff Sessions (R-Ala.) on Thursday criticized the Office of Management and Budget (OMB) for failing to answer questions about Treasury Secretary nominee Jack Lew's failure to propose legislation to shore up Medicare and said this failure could put Lew's nomination at risk. Sessions wrote to OMB over the weekend asking why it has not proposed a bill to deal with the shortfall in Medicare funding despite current law that requires the administration to propose a legislative fix when funding problems are identified (Kasperowicz, 2/7).

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Obama Says He Will Not Stop Sequester By Simply Cutting Entitlements

In an address to Democratic lawmakers, the president says Republicans want to substitute the impending budget cuts by instead cutting Medicare and Social Security. But, he says closing tax loopholes is a better strategy.

The New York Times: Obama Tells House Democrats He Will Confront Republicans On Taxes
President Obama vowed Thursday to confront Republicans over the issue of closing tax loopholes, saying that he would relish a debate with those who insist that Congress has done all it should to get more tax revenue from wealthy individuals and corporations. ... "What they've suggested," he added, "is that the only way to replace it now is for us to cut Social Security, cut Medicare and not close a single loophole, not raise any additional revenue from the wealthiest Americans or corporations who have a lot of lawyers and accountants who are able to maneuver and manage and work and game the system. ... And I have to tell you, if that's an argument that they want to have before the court of public opinion, that is an argument I am more than willing to engage in," he said (Peters, 2/7).

Los Angeles Times: Obama Previews State Of The Union Address, Challenges GOP On Sequester
President Obama previewed his State of the Union speech themes during a pep talk to House Democrats on Thursday, while framing the fiscal battles with Congress in familiar terms as he called for an end to "governance by crisis." ... Obama, speaking to lawmakers over lunch in a ballroom on the grounds of a golf resort where Democrats are huddling for three days to plot strategy for the coming year, claimed that Republicans would seek to replace the sequester with cuts to entitlement programs, such as Social Security and Medicare, while refusing to raise new tax revenue (Memoli, 2/7).

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Capitol Hill Watch

Senators Offer Plan To Improve Mental Health Coverage

The bipartisan group's plan would require community behavioral health centers to provide substance abuse treatment and 24-hour crisis care. In return, the centers could bill Medicaid for the services.

The Washington Post: Measure Would Strengthen Mental Health Care System
A bipartisan group of senators, citing renewed urgency after the shooting massacre at Sandy Hook Elementary School, introduced legislation Thursday aimed at strengthening the nation's fragmented mental health-care system and improving access at the community level. The bill would put in place standards for about 2,000 "federally qualified" community behavioral health centers, requiring them to provide such services as substance abuse treatment and 24-hour crisis care. In return, facilities meeting criteria would be able to bill Medicaid for their services -- a change intended to open the door to treatment for many more people and one that is estimated to cost about $1 billion over the next decade (Dennis and Kane, 2/7).

St. Louis Beacon: Silver Lining: Would Better Mental Health Services Help Lessen Gun Violence?
The bipartisan Excellence in Mental Health Act, whose main sponsors are U.S. Sen. Debbie Stabenow, D-Mich., and Blunt, R-Mo., aims to boost mental health centers to a more equal footing with other health centers, mainly by improving their quality standards and expanding access to people who need the care (Koenig, 2/7).

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House GOP Seeks To Change Medicare Doctor Payment Formula

The chairmen of the Ways and Means and Energy and Commerce committees want a permanent change to the current system that repeatedly threatens to cut doctor payments unless Congress steps in.

Medpage Today: Bill Near To Repeal SGR?
House Republicans are launching a renewed effort to repeal Medicare's sustainable growth rate (SGR) reimbursement formula, reaching out to Democrats and the medical community in favor of replacing yearly "fixes" with a permanent change in the system. Repealing and replacing the SGR is a priority for the law's two authorizing committees in the House -- the Energy and Commerce Committee and the Ways and Means Committee, an Energy and Commerce aide said Thursday. In a sign of how important this issue is, the Energy and Commerce Health Subcommitee's first hearing this year will be on the SGR. It's slated for Feb. 14, although a witness list hasn't yet been finalized (Pittman, 2/7).

Meanwhile, a hospice in San Diego faces financial difficulties after Medicare officials questioned whether it was adhering to their rules.

Kaiser Health News: San Diego Hospice Files For Bankruptcy
Hobbled by a federal investigation into its practice of treating patients who had more than six months left to live, one of the biggest hospices in the country has filed for bankruptcy as it tries to continue operating. A local hospital chain is heeding San Diego Hospice's plea for help, however, and promising to provide services for as many patients as need it (Dotinga, 2/7).

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Public Health & Education

FDA Hears Concerns On New Narcotic Pain Pill Rules

Survivors of those who died from opioid overdoses urge changes in the drugs' labels, but some patients express concerns that they might have trouble getting the drugs.

The Wall Street Journal: FDA Convenes Hearing On Pain-Pill Labels
Relatives of overdose victims pleaded with federal drug regulators Thursday to change the label on a widely used class of narcotic painkillers in a charged day of testimony in Washington. Some pain patients, meanwhile, warned that any action could limit their access to the drugs. The Food and Drug Administration convened the two-day public hearing on so-called opioid painkillers, amid concern that they are fueling an epidemic of addiction and overdose deaths (Catan, 2/7).

Meanwhile, The Washington Post examines the compounding pharmacies that were at the center of a recent outbreak of meningitis.

The Washington Post: Compounding Pharmacies Have Been Linked To Deaths, Illnesses And Safety Failures For Years
Shoddy practices and unsanitary conditions at three large-scale specialty pharmacies have been tied to deaths and illnesses over the past decade, revealing that the serious safety lapses at a Massachusetts pharmacy linked to last fall’s deadly meningitis outbreak were not an isolated occurrence, records and interviews show (Kindy, Sun and Crites, 2/7).

Medpage Today: State Shutters 10 Compounding Pharmacies
Officials in Massachusetts ordered 10 pharmacies to halt sterile compounding activities after surprise inspections found major violations of quality standards, the state's public health department said. … Complete or partial cease-and-desist letters were sent in November and December to a total of 11 Massachusetts pharmacies after the surprise inspections, according to a statement released this week by the state's Department of Public Health. In addition to ordering 10 of the pharmacies to stop all sterile compounding, officials told another to halt compounding of one particular drug, sildenafil citrate (Gever, 2/7).

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Christie Tries To Make Light Of His Weight But Then Gets Serious

The N.J. governor first teases David Letterman but later lashes out at a doctor who raises concerns about his girth.

The Wall Street Journal: Politics Of Christie's Weight
All it took was a late-night, nationally televised bite of a doughnut for New Jersey Gov. Chris Christie to set off an uncomfortable three-day conversation about his weight. A host of media questions and a warning from a former White House doctor this week represent a small sample of what could follow Mr. Christie both into a second term if he wins re-election in November and on a presidential campaign in 2016, should he choose to pursue one. ... Mr. Christie, 50 years old, said Tuesday excess weight has been an issue for the last 30 years—nearly his entire adult life. It came up during his 2009 run for governor, when his opponent, Democratic incumbent Jon Corzine, ran advertisements that seemed to make oblique references to Mr. Christie's girth. Mr. Christie hasn't divulged his weight, nor does he speak publicly about his eating habits, as (former Arkansas Gov. Mike) Huckabee did. He has told of his struggles, though, and uses it as fodder for jokes (Grossman, 2/7).

Politico: Chris Christie Struggles With Politics Of His Weight
After years of questions about his girth, Chris Christie seemed to settle on a strategy – leave them laughing. The overweight New Jersey governor took to Dave Letterman’s couch, donut in hand, on Monday night, joining one of his chief late night tormenters for some jokes at his own expense. ... When asked by reporters at a press conference Tuesday, he soberly acknowledged his struggles with his weight and said he wants to shed pounds. He's well aware of the underlying concerns about his wellbeing sources close to him say – and his frustration with (former White House doctor Connie) Mariano's remarks were rooted in his kids hearing that their dad faces serious health risks (Haberman, 2/7).

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Health Policy Research

Research Roundup: 'Shared Decision Making' Can Reduce Costs, Improve Care; Effects Of Mental Health Parity

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

Health Affairs: Enhanced Support For Shared Decision Making Reduced Costs Of Care For Patients With Preference-Sensitive Conditions – With shared decision making, patients and their clinicians collaboratively review the risks and benefits of available treatments options while also considering the patients’ preferences and values. The authors write: "We examined data obtained from a yearlong randomized investigation. The study compared the effects on patients of receiving a usual level of support in making a medical treatment decision with the effects of receiving enhanced support, which included more contact with trained health coaches through telephone, mail, e-mail, and the Internet. We found that patients who received enhanced support had 5.3 percent lower overall medical costs than patients who received the usual level of support." Patients with enhanced support also had fewer hospital admissions and surgeries for conditions such as angina, arthritis, back pain and early stage prostate cancer, conditions that "come with substantial trade-offs between benefits and risks to the patient." The conclusion: "These findings indicate that support for shared decision making can generate savings" (Veroff, Marr and Wennberg, 2/1).

Health Affairs: Patients With Mental Health Needs Are Engaged In Asking Questions, But Physicians’ Responses Vary – According to the authors, primary care doctors see and treat more than half of all cases of mental illness in the United States. Compared to other patients, however, those with mental health needs may be less likely to engage in that care and less willing to ask questions. Researchers analyzed more than 300 audio recordings of interactions between primary care providers and patients and found that "patients asked many questions—a median of fifteen per visit—but that they were more likely to ask about biomedical topics, such as diabetes, than about mental health topics. Patients received highly varied responses from physicians. Our findings suggest that efforts aimed at improving patient engagement should move beyond simply encouraging patients to ask questions. The goal should also be to support physicians in recognizing patients’ concerns and providing the most responsive answers" (Tai-Seale, Foo, and Stults, 2/1).

American Journal Of Psychiatry: The Effects Of Mental Health Parity On Spending And Utilization For Bipolar, Major Depression, And Adjustment Disorders – The 2010 Mental Health Parity and Addiction Equity Act requires many private health insurance plans to provide coverage for mental conditions in the same manner as they do for general health services. Researchers compared the 1999 behavioral health treatment use and spending in the Federal Employees Health Benefits plan, which had implemented a parity program, and privately insured patients unaffected by parity. They report: "Total spending was unchanged among enrollees with bipolar disorder and major depression but decreased for those with adjustment disorder. Out-of-pocket spending decreased for all three groups ... Total annual utilization ... remained unchanged across all diagnoses," and conclude: "Parity implemented under managed care improved financial protection and differentially affected spending and psychotherapy utilization across groups. There was some evidence that resources were preferentially preserved for diagnoses that are typically more severe or chronic and reduced for diagnoses expected to be less so" (Busch et al., 2/1). 

Journal Of Health Care For The Poor And Underserved: Reducing Disparities In Access To Primary Care And Patient Satisfaction With Care: The Role Of Health Centers – The authors note that federally supported health centers (HC) provide accessible and affordable health care services, such as primary and dental care, to people living in medically underserved areas. With data from two 2009 national surveys, researchers compared the primary care experiences of patients receiving their care at HCs to other patients. They found that "Health center patients were more racially and ethnically diverse than national patients, and health center patients were more likely than national patients to be uninsured or publicly insured. No significant health care disparities in access to care existed among patients from different racial/ethnic and insurance groups among health centers, unlike low-income patients nationwide or the U.S. population in general. Additional focus on the uninsured, in health centers and other health care settings nationwide, is needed to enhance satisfaction with care among these patients" (Shi et al., 2/2013).

Here is a selection of news coverage of other recent research:

Reuters: Longer Span Between Mammograms Okay For Older Women
Screening women over 65 each year for breast cancer doesn't catch any more early tumors -- but it does lead to more false positives -- than screening every other year, according to a new study. The findings are based on more than 140,000 older women included in five mammography registries across the United States. "This study clearly tells us that screening every two years may be more appropriate than screening women every year," said Dr. Otis Brawley, chief medical officer of the American Cancer Society (ACS) (Pittman, 2/7).

MedPage Today: 'Smarter Testing' May Resolve PSA Debate
More efficient prostate cancer screening might result from strategies that employ higher PSA thresholds for older men and longer screening intervals for low-risk patients, a computer modeling study suggested. Raising the threshold of biopsy referral for older men increased the risk of prostate cancer death by less than 0.1% versus a reference strategy but reduced the likelihood of overdiagnosis by a full percentage point, reported Ruth Etzioni, PhD, of the Fred Hutchinson Cancer Research Center in Seattle, and colleagues (Bankhead, 2/5).

Reuters: Uninsured Less Likely To Get Heart Meds
Uninsured Americans were less likely to get the best treatment for heart troubles than those with insurance in a new study that hints the blame may lie with the quality of physicians who typically treat the uninsured. ... The researchers, who published their findings in the Journal of the American College of Cardiology, looked to see which patients received the recommended medications for their heart conditions and whether the treatment they got was linked to their insurance status (Seaman, 2/1).

MedPage Today: More Insurance Claims Filed Electronically
Healthcare providers continue to file more insurance claims electronically and submit claims more quickly, a report from the leading health insurance industry group showed. In 2011, 94% of claims were submitted electronically, up from 82% in 2009, according to America's Health Insurance Plans (Pittman, 2/7). 

MedPage Today: Out-of-Network Charges Out Of Line With Medicare
Out-of-network doctors sometimes charge several times more -- often thousands of dollars more -- than Medicare pays for the same service in the same area, according to a report from the leading health insurance industry group. "Our survey ... indicated that health plans and their members routinely receive bills from physicians that are 10 to 20 or sometimes nearly 100 times higher than Medicare would allow," America's Health Insurance Plans (AHIP) found in its survey, "A Hidden Threat to Affordability" (Pittman, 2/6). 

Medscape: Stimulant Use Exceptionally High Among Medical Students
Medical students are significantly more likely to use prescription stimulant medications to boost academic performance compared with other college students, new research suggests. A survey conducted in third-year medical students at a single school in the United States showed a lifetime use prevalence of about 20%, a figure that is "distinctly higher" than the average of 6.9% among college students (Cassels, 2/6). 

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State Watch

N.Y. Hospitals, Nursing Homes Coping With Sandy, Other Closure Problems

In the wake of Superstorm Sandy, medical facilities are still coping with the after-effects.

The Associated Press: Sandy Highlights Nursing Home Evacuation Troubles
In Superstorm Sandy's wake, health experts and regulators are warning that thousands of nursing homes nationwide are still ill-prepared for a natural disaster. The late October storm was the latest in a string of disasters to reveal gaps in emergency planning, despite an industry-wide effort to improve preparedness in the years since Hurricane Katrina. ... Some changes could be in the works. The federal Centers for Medicare and Medicaid Services said it expects to issue new disaster planning requirements for nursing homes this year (Caruso, 2/7).

The New York Times: Bellevue Hospital Fully Returns 99 Days After Evacuation
Ninety-nine days after it was evacuated in the wake of Hurricane Sandy, Bellevue Hospital Center fully reopened on Thursday. Bellevue, New York City's flagship public hospital, had been reopening piecemeal, but it has now resumed its status as a Level 1 trauma center and opened all 828 inpatient beds. ... Another city hospital that was forced to evacuate by the storm, Coney Island Hospital, is also making progress. Its Tower Building has reopened along with most of its inpatient beds, and the hospital is admitting walk-in patients from its emergency department and patients from other city facilities (Newman, 2/7). 

Officials are also planning to close a hospital in Brooklyn to the consternation of some --

The Wall Street Journal: Closure Plan For Brooklyn Hospital
Long Island College Hospital officials on Thursday recommended closing the 155-year-old medical center in the heart of brownstone Brooklyn at a hearing that drew anger and sadness from the doctors, nurses and residents in attendance. ... An 2013 audit by New York state Comptroller Thomas DiNapoli said LICH had been operating with an annual operating loss since 1994. It was acquired by SUNY Downstate in 2011, which put significant stress on that hospital's finances, the report said. ... The hospital has 506 beds, but only 250 are in operation (Kusisto and Gay, 2/7). 

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Roundup: Assisted Suicide Legalization Urged; Abortion Bill Tensions In Wash., Ore.; Budget Squeezes In Ga., Conn.

The Associated Press: Assisted Suicide On Legal Agenda In Several States
A push for the legalization of physician-assisted suicide is under way in a half-dozen states where proponents say they see strong support for allowing doctors to prescribe mentally competent, dying individuals with the medications needed to end their own lives. ... Groups such as Compassion & Choices, a national end-of-life advocacy organization, have been working to advance the cause. ... Bills legalizing assisted suicide are being considered in Connecticut, Vermont, New Jersey, Kansas and Hawaii — and in Massachusetts ... There are also bills related to the issue under consideration in New Hampshire, New York, Arizona and Montana (Haigh, 2/8).

The New York Times: Smoking, Once Used To Reward, Faces A Ban In Mental Hospitals
Until recently, Louisiana law required psychiatric hospitals to accommodate smokers — unlike rules banning smoking at most other health facilities. The law was changed last year, and by March 30, smoking is supposed to end at Louisiana’s two remaining state psychiatric hospitals. ... smoking was endorsed by advocates for people with mental illness and family members, who sometimes sued to preserve smoking rights, considering cigarettes one of the few pleasures patients were allowed (Belluck, 2/6).

The Associated Press: Wash. Abortion Insurance Bill Prompts Tension
A measure to require most insurers in Washington state to cover abortions will receive a hearing before a Senate committee, Majority Leader Rodney Tom pledged late Thursday, setting up a discussion on a measure that had been thrown into limbo a day earlier by another key senator. The proposal has been a political hot-button in the state, as supporters say it would protect existing abortion coverage once new insurance rules come into effect under the federal health care overhaul (Kaminsky, 2/7).

Oregonian: Abortion Insurance Bill Will Be Heard By Committee, Washington State Senate Leader Says
A measure to require most insurers in Washington state to cover abortions will receive a hearing before a Senate committee, Majority Leader Rodney Tom pledged late Thursday ... The proposal has been a political hot-button in the state, as supporters say it would protect existing abortion coverage once new insurance rules come into effect under the federal health care overhaul. Opponents, however, say the measure puts federal dollars at risk and threatens the religious freedoms of those who oppose abortion rights (Yu, 2/7).

The Associated Press: NM Medical Board Exonerates Late-Term Abortion Doctor
The New Mexico Medical Board on Thursday exonerated an Albuquerque doctor of gross negligence for her handling of a late-term abortion in a case that raised questions about whether politics trumped patient privacy. Anti-abortion activists filed the complaint against Dr. Shelly Sella after hearing a 911 call from the Southwestern Women’s Options Clinic about a woman who suffered a ruptured uterus during a May 2011 abortion there and was rushed to a hospital. Sella is a former colleague of slain Kansas abortion doctor George Tiller and one of the few doctors in the country who still openly performs third-term abortions (Clausing, 2/7).

Georgia Health News: Rally Opposes Cuts In Care For Seniors
Dianna Massey of Norcross says respite care greatly helped her family when her mother had Alzheimer’s disease. For years, "she was aggressive and combative," Massey said. ... Concerned about those who cannot afford such care, Massey came to the state Capitol in Atlanta ... She joined lawmakers and other officials who spoke to scores of seniors gathered in a cold rain on the Capitol steps, attending a rally against proposed budget cuts in government aging programs. ... Because of state budget constraints amid a persistently weak economy, Gov. Nathan Deal has ordered every agency to trim 3 percent of its current year’s spending and to carry that over into next year (Miller, 2/7).

San Francisco Chronicle: UCSF, St. Mary's Hospitals Fined By State
California health officials fined two San Francisco hospitals -- UCSF and St. Mary's Medical Center -- for two violations each as part of the state's efforts to penalize hospitals for errors serious enough to cause major injury or put patients' lives at risk. UCSF's fines totaling $200,000 were for not following proper procedures in two cases in which foreign objects were left inside patients, resulting in additional surgeries and other complications. The fines were among the 10 violations and $775,000 in penalties issued Wednesday to seven California hospitals after state investigations found the hospitals failed to follow proper procedures (Colliver, 2/7).

CT Mirror: Some Want More, Some Less: Malloy Budget Sparks Tax Debate
 In the first 24 hours since unveiling his new budget, Gov. Dannel P. Malloy has heard from state and local officials, including some from other states. … Malloy's new budget would slash aid to hospitals to offset the cost of treating uninsured patients. It also would eliminate Medicaid coverage for thousands of poor parents with the expectation that they would get private coverage as part of federal health reform, eliminate the state-run Charter Oak Health Plan and slash payments to hospitals (Phaneuf, 2/7).

Boston Globe: Insurers Say Health Spending On Rise In Mass.
Despite more modest increases in recent years and a state push to hold down costs, the message from health insurance executives gathered here Thursday for a market outlook seminar was clear: Massachusetts health spending is heading up in 2013. Representatives from the state’s nonprofit health plans as well as national for-profit insurers doing business in Massachusetts estimated the “medical cost trend,” a key industry measure, will climb between 6 and 12 percent this year — higher than last year’s cost bump and more than double the 3.6 percent increase set as a target in a state law passed last year (Weisman, 2/8).

California Healthline: Health Reform Benchmarks Linked To FQHCs
Federally qualified health centers (FQHCs) already have shown some of the results pursued by the Affordable Care Act, according to a study released this week by the California Primary Care Association. The CPCA commissioned researchers to compare high-cost factors, such as hospital stays and emergency department use, as well as total cost of care, between FQHCs and non-FQHCs in California. Some of the findings from John Snow, Inc. Health Services Division, a public health research firm based in Boston, were released Monday and showed enviable differences in FQHC care (Gorn, 2/8).

Kansas Health Institute: Dentist Groups Announce Scholarships For Dentists Going To Rural Areas
Organizations representing dentists today announced the first three scholarships awarded under the Kansas Initiative for New Dentists (KIND), which is aimed at steering more dentists to rural parts of the state. Representatives from the Kansas Dental Association and the Delta Dental of Kansas Foundation said $25,000 per year scholarships would be given to three students who have agreed to serve in counties with fewer than 50,000 people for at least two years per year of scholarship accepted (Cauthon, 2/7).

The Denver Post: Colorado Loans To Groceries Aim For Greener Good In Obesity Fight
Frustrated by lack of progress in the obesity fight, one of the nation's richest health charities will pay to build better stores and buy greener groceries itself, if it has to. The Colorado Health Foundation has set aside $7.1 million for a loan-and-grant fund aimed at grocery stores and retail developers that need a subsidy to supply more nutritious goods in "food deserts” (Booth, 2/8).

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Editorials and Opinions

Viewpoints: Brewer's Stance On Medicaid Expansion May Signal Important Shift In GOP; A Shrinking Government--Except For Health Care

National Journal: Why The GOP's Resistance To Medicaid Expansion Is Eroding
Jan Brewer, Arizona's feisty Republican governor, is better known for wagging her finger at President Obama than for linking arms with him. That's why Brewer's recent announcement that her state intends to join the expansion of Medicaid central to Obama's health care law may represent an important shift. If even Brewer, who has battled repeatedly with Obama, finds the case for expansion compelling, other Republican governors now resisting may also reconsider (Ronald Brownstein, 2/7).

Health Policy Solutions (a Colo. news service): Medicaid Expansion Will Save Lives And Money
As Colorado lawmakers prepare to consider expansion of Medicaid – the publicly-funded health insurance program for low-income individuals – it is important they use an evidence-based approach that considers costs and savings in terms of the health impact on the lives of Coloradans, as well as our state budget. A July 2012 study, published in the New England Medical Journal, reported a demonstrated reduction in mortality associated with Medicaid expansion in a handful of other states. The study found that for every 100,000 citizens in the population between the ages of 20 and 64, Medicaid expansion saves 19.6 lives every year. Applying this result to our population, we can expect Medicaid expansion to save the lives of at least 629 Coloradans every year (Dr. Ned Calonge, 2/7).

The Wall Street Journal: Hidden Secrets Of Spending
While the debate rages over the size of government, a funny thing has been happening: Quietly, government has been shrinking. ... This reality has been masked by the fact that government spending isn't declining, although the rate of increase has moderated. But the part of government that is really increasing right now is the part that churns out checks for people receiving Medicare, Medicaid and Social Security. Meantime the ranks of government workers at the federal, state and local levels—the bureaucrats everybody loves to hate, as well as more beloved figures such as firefighters—are declining (Gerald F. Seib, 2/7).

Bloomberg: Why Health Care Challenges Conservatives
While I don't find Ramesh Ponnuru's overall case for a conservative middle-class agenda convincing, he does highlight one middle-class problem that both parties have given short shrift. He has correctly argued that health-care inflation is not just a source of fiscal woes, but also has deprived middle-class families of real wage increases as more of their compensation has gotten eaten up by health benefits. The big challenge for conservatives is to take Ponnuru's point and come up with an agenda that does better than liberals at controlling health-care costs, so families can spend more money on other things (Josh Barrow, 2/7).

The Fiscal Times: Christie's Big Chance To Help Cut Obesity Costs
Chris Christie, the N.J. governor, can dish all he wants about his weight – but he doesn't like it when others do, even physicians who once took care of U.S. presidents. ... you'd have to have lived in a cave for the past 30 years to not understand that there are serious health risks – and costs – that result from obesity. As an elected public official often mentioned as a potential Republican presidential candidate, the governor is being disingenuous if he can’t acknowledge that his weight is an issue worthy of political, economic and even fiscal discussion (Maureen Mackey, 2/7).

Bloomberg: What The Catholic Bishops Owe President Barack Obama
U.S. Catholic bishops have a lot to worry about: the gunning down of children; 11 million undocumented immigrants, many of them Catholic; a warming planet; a chilly economy. Instead they've spent the last year obsessed with contraception. The bishops are furious over the Affordable Care Act, which generally requires employers to cover contraception. It isn't a novel concept (Margaret Carlson, 2/5).

The New York Times: The Family And Medical Leave Act, 20 Years Later
Twenty years ago, just a few weeks after his inauguration, President Clinton fulfilled a campaign pledge and signed his first bill – the Family and Medical Leave Act. The law sent a strong signal of his commitment to provide more opportunities for American workers in return for more personal responsibility. ... Since its passage, the law has been used more than 100 million times to improve the lives of American workers. Meanwhile, dire predictions by critics that it would destroy jobs and harm business have proven wrong. Employers covered by the law report little or no difficulty complying with its provisions. Indeed, many businesses credit the law with reducing turnover and increasing worker morale (Laura D'Andrea Tyson, 2/8).

Journal of the American Medical Association: Mental Illness And New Gun Law Reforms
The December 2012 tragedy in Newtown, Connecticut, transfixed the nation in a moment of shared grief for 20 small children and 6 adults who died in a merciless hail of bullets. The weeks since have brought numerous federal and state policy proposals to curb gun violence. Whether these crisis-driven reforms can help inch society toward the goal of reducing firearm-related deaths, the new laws' broader social consequences could long outlast the memory of what happened at Sandy Hook Elementary School. Policy makers would do well to pause and think them through (Jeffrey Swanson, 2/7).

Journal of the American Medical Association: A Systematic Plan For Firearms Law Reform
The United States has nearly as many firearms as inhabitants; while mortality rates from most major causes of injury have significantly declined, the number of annual firearms fatalities (32,163 in 2011) has not decreased. Even the political discussion in the wake of Newtown resulted in a spike in firearm sales. ... The right to bear arms has never been more robust than at the turn of the century, with the expiration of a federal assault weapons ban, the Supreme Court reading the Second Amendment's "militia" to refer to civilians for the first time in history, and states relaxing concealed weapon laws. Although the president's plan is well within the confines of the Constitution, the limits imposed by the Court, combined with a fragmented mental health system, mean that no constitutionally permissible plan will be fully effective. Still, the president's plan could reduce the devastating toll of firearm injuries and deaths through a public health strategy (Katherine L. Record and Lawrence O. Goslin, 2/7).

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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.