Daily Health Policy Report

Thursday, March 1, 2012

Last updated: Thu, Mar 1

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Campaign 2012

Health Care Fraud & Abuse

Public Health & Education

Coverage & Access

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Poll: Most Americans Support Contraception Rule

Kaiser Health News staff writer Marilyn Werber Serafini reports: "Six in ten Americans, including Catholics, said they support a requirement by the Obama administration that health plans supply free contraceptives as a preventive benefit for women, according to the latest tracking poll by the Kaiser Family Foundation" (Werber Serafini, 3/1). Read the story.

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Health On The Hill And Other New KHN Material

Due to technical difficulties on our site yesterday, you may not have seen Wednesday's original KHN work. Here's a review of what was featured:

Health On The Hill: House Republicans Pound Sebelius On Health Law (2/28)
Medicare Spends Less Than Private Insurers On Knee Replacements (Appleby, 2/28)

On Capsules: 
Wash. Senate Nears Vote To Require Abortion Coverage (Torres, 2/29) 
Maine's Top Court Backs State Authority To Limit Health Plan's Profits (Appleby, 2/28)
More Americans Head To The ER For Dental Emergencies (Kulkarni, 2/28)

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Political Cartoon: 'Call An Ambulance?'

Kaiser Health News provides a fresh take on health policy developments with "Call An Ambulance?" by Lisa Benson.

Meanwhile, here's today's haiku:


"Repeal then replace" --
Repeal we've seen, but the rest?
Lost in outer space!

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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Capitol Hill Watch

Senate Set For Showdown On Obama Birth Control Rule

An amendment by Sen. Roy Blunt, R-Mo., which is scheduled for a Senate vote today, would allow employers and insurers to opt out of provisions in Obama's health care law to which they object on religious or moral grounds.

The Associated Press: First Vote Looms On Obama Birth Control Policy
The Senate is considering GOP legislation aimed at rolling back President Barack Obama's policy on birth control coverage. At issue is a measure sponsored by Sen. Roy Blunt of Missouri that would allow employers and insurers to opt out of provisions in Obama's health care law to which they object on religious or moral grounds. That includes the recently rewritten requirement that insurers cover the cost of birth control, even for religiously affiliated employers whose faith forbids contraception (Kellman, 3/1).

Reuters: Senate Heads For Showdown Over Contraceptives
The Democratic-led U.S. Senate is expected on Thursday to defeat a largely symbolic measure that would exempt employers such as Roman Catholic hospitals, universities and charities from a controversial White House rule requiring free birth control coverage. Debate on the Republican proposal, introduced by Missouri Senator Roy Blunt as an amendment to an unrelated highway bill, began on Wednesday and both parties seized the opportunity to play to voting constituencies considered crucial in November's election (Morgan, 3/1).

Politico: Senate GOP Centrists Undecided On Blunt Vote
The handful of moderate Republicans in the Senate say they're not quite sure yet how they'll vote Thursday on the proposal to allow employers to decline to cover certain health benefits that conflict with their religious beliefs. Sen. Susan Collins (R-Maine) told POLITICO she hasn't decided how she'll vote yet on the measure offered by Roy Blunt (R-Mo), and is waiting for details from HHS about how self-insured religious-affiliated institutions would be treated under the Obama administration's rules (Haberkorn, 2/29).

CNN: Senate To Vote On Controversial Contraception Amendment
The Senate is set to vote Thursday on a controversial amendment pushed by Senate Republicans that would allow employers to opt out of health care coverage they disagree with on moral grounds. The so-called "conscience" amendment, sponsored by Sen. Roy Blunt of Missouri, is the Senate Republicans' response to the simmering controversy over a recent Obama administration decision to mandate the type of health care coverage religious employers are required to provide. "This bill would just simply say that those health care providers don't have to follow that mandate if it violates their faith principles," stated an early February press release from Blunt. "This is about the First Amendment. It's about religious beliefs. It's not about any one issue" (Merica, 3/1).

Fox News: Controversial Obama Birth Control Policy Faces First Vote In Senate
Democrats and Republicans in the Senate are gearing up for first vote in what has become a fierce fight over President Obama's mandate that health insurers must cover the cost of contraceptives. The Senate will vote Thursday on whether or not they want to quash the so-called "conscience" amendment authored by Sen. Roy Blunt, R-Mo, a measure designed to counter Obama's mandate. The amendment would allow insurers and employers to opt out of any provision in the president's health care law to which they object on moral or religious grounds. That includes the requirement to cover the cost of birth control (3/1).

St. Louis Beacon: Blunt Assails Critics 'Fiction' As Senate Liberals Blast 'Conscience' Amendment
In his Senate remarks, Blunt criticized "the fiction writers out there and fundraising letters ... saying things like women who have contraceptive services today wouldn't have them" under the Blunt amendment. "Of course that's not true," Blunt asserted, noting that the measure "doesn't mention any procedure of any kind" (Koenig, 2/29). 

In the background -  

The Wall Street Journal: Schools Navigate State Birth-Control Patchwork
The Obama administration's decision requiring that employers, including large Catholic institutions, provide contraception coverage without out-of-pocket costs in their insurance plans has prompted calls by bishops to overturn the regulation. The Senate is set to vote Thursday on a proposal to effectively reverse the decision. But there was less outcry when states first passed laws with similar requirements in the 1990s, according to legislators and some Catholic institutions (Radnofsky, 2/29).

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House Subcommittee OKs IPAB Repeal

The House Energy and Commerce Health Subcommittee voted 17 to 5 to do away with a Medicare cost-cutting panel derided by Republicans as a "rationing board."

The Hill: Pressure Is On Senate After House Kills Health Care Law's 'Rationing Board'
The Senate is under increasing pressure to bring up legislation repealing a key part of President Obama's healthcare law. A House subpanel on Wednesday easily approved a measure to repeal a Medicare cost-cutting panel derided by Republicans as a "rationing board." Two Democrats — including the panel's ranking member — crossed the aisle and joined Republicans in voting to nix the Independent Payment Advisory Board (IPAB) (Pecquet, 2/29).

Modern Healthcare: House Subcommittee Votes To Repeal IPAB
Members of the House Energy and Commerce Health Subcommittee approved a bill to repeal the Independent Payment Advisory Board created in the health reform law. In a 17-5 vote, the panel supported the Medicare Decisions Accountability Act of 2011, a bill introduced last year by Rep. Phil Roe (R-Tenn.), a physician. Roe's bill now has 226 co-sponsors, including 17 Democrats (Zigmond, 2/29).

CQ HealthBeat: GOP Bill To Repeal Medicare Cost-Cutting Panel Advances
A House panel on Wednesday backed legislation that would abolish an independent board charged with curbing Medicare spending growth, a GOP bill that has won some Democratic supporters. The Energy and Commerce Health Subcommittee voted 17-5 for the measure, which would repeal the 15-person Independent Payment Advisory Board (IPAB) created by the 2010 health care overhaul. The board — which will comprise independent experts appointed by the president and confirmed by the Senate — is tasked with making cost-cutting recommendations if Medicare spending exceeds target growth rates (Bade, 2/29).

In other Medicare news -

CQ HealthBeat: Conrad 'Really Encouraged' About Options For Reining In Medicare Spending
The Senate Budget chairman entered Wednesday's hearing about curbing Medicare spending as a skeptic, but he left optimistic that viable options exist. "This is the most encouraging hearing on health care I've been part of in probably five years," said Kent Conrad, D-N.D. "I really think we’re on the brink of finding a way forward, and I’m really encouraged by it" (Ethridge, 2/29).

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Snowe's Departure From The Senate Highlights Ever-Shrinking Political Center

Her surprise retirement also underscores what some say is a rift within the GOP between conservatives who demand allegiance to bedrock principles and those concerned with courting swing voters.

The Associated Press: Analysis: Snowe Departure Will Widen Partisan Gulf
The surprising retirement of moderate Republican Sen. Olympia Snowe of Maine moves congressional centrists a step closer to extinction and highlights the great paradox of American politics. Voters say they want bipartisan solutions to the nation's problems. But they congregate and vote in ways that ensure partisan warfare, driving the GOP further right and the Democratic Party further left (Babington, 3/1).

The Wall Street Journal: Political Center Shrinks In Congress
Ms. Snowe is one of an increasingly rare breed of senator willing to back legislation crafted by the other side. After President Barack Obama came to office, she supplied a crucial vote for his stimulus plan and supported his health law in committee, though she later opposed it on the floor. She also backed the New Start arms-reduction treaty at the end of last year. … A new analysis by the National Journal ranks Ms. Snowe the 46th most-conservative senator, placing her on the fault line between the two parties. Many of her colleagues said her departure reflects poorly on the chamber (Bendavid, 2/29).

Politico: Olympia Snowe Departure Exposes GOP Rift
Sen. Olympia Snowe’s bombshell retirement announcement brought into focus the fault line within GOP ranks: Conservatives are demanding a sharper focus on bedrock principles, and party strategists are more concerned with courting swing voters. It is a fight that has raged inside the GOP since the rise of the tea party movement in 2009 — the "electability" vs. "real conservative" argument — and is also playing out in the nominating battle between Mitt Romney and Rick Santorum (Raju and Bresnahan, 3/1).

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Sanders: Dental Care Crisis Is 'Next Health Problem' That Needs Attention

A report released Wednesday by Sen. Bernie Sanders, I-Vt., noted that more than 47 million people live in places where it is difficult to access dental care.

The Hill: Sen. Sanders Unveils Report On Nation's 'Dental Crisis'
Liberal firebrand Bernie Sanders (I-Vt.) released a report Wednesday that concludes America faces a "dental crisis" and urgently needs to boost the number of dentists and dental assistants while expanding Medicaid's dental benefit to cover adults. According to the report: more than 47 million people live in places where it is difficult to access dental care; more than 130 million Americans do not have dental insurance; about 17 million low-income children see a dentist less than once a year; and only 45 percent of Americans age 2 and older saw a dental provider in the past 12 months (Pecquet, 2/29).

CQ HealthBeat: Sanders Targets Access To Dental Care As The Next Health Problem To Address
The health care overhaul laid out a new system for providing health care in America. But Sen. Bernard Sanders says another major health crisis is not gaining the attention it deserves: the lack of dental care for the poor and elderly. So the Vermont independent on Wednesday issued a report that said 130 million Americans have no dental insurance and costly visits to hospital emergency rooms for preventable dental conditions are on the rise (Norman, 2/29).

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Health Reform

Poll: Democrats Hold Political Advantage on Contraception, Medicare Debates

According to the Kaiser Family Foundation's February poll, opinions tracked more closely with party affiliation than gender. Meanwhile, the public remains skeptical of the health law.

Reuters: 63 Percent Of Voters Back Obama Birth Control Policy - Poll
Nearly two-thirds of Americans favor President Barack Obama's policy requiring birth control coverage for female employees, including clear majorities of Roman Catholic, Protestant evangelical and independent voters, a poll showed on Thursday. A Kaiser Family Foundation survey of 1,500 adults showed public opinion breaking more strongly according to party affiliation than gender on contraceptives, with 83 percent of Democrats, 62 percent of independents and 42 percent of Republicans favoring the policy (Morgan, 3/1).

Kaiser Health News: Poll: Most Americans Support Contraception Rule
Kaiser Health News staff writer Marilyn Werber Serafini reports: "Six in ten Americans, including Catholics, said they support a requirement by the Obama administration that health plans supply free contraceptives as a preventive benefit for women, according to the latest tracking poll by the Kaiser Family Foundation" (Werber Serafini, 3/1).

National Journal: Poll: Democrats Hold Edge On Contraception Debate, Medicare
Though the public remains skeptical of the health care law, a Kaiser Family Foundation survey suggests that Democrats hold a political advantage in the live policy debates surrounding the issue. The survey, part of the organization’s monthly tracking poll, found support for the 2010 law split nearly evenly. Forty-two percent of the adults surveyed had a favorable view of the law, while 43 percent viewed it unfavorably. But despite the continued lukewarm reception for the health care law generally, the survey found that the public still trusts President Obama to make the right decisions about the future of the law more than any of his Republican challengers. The survey shows that 58 percent trust the president, compared with between 33 and 43 percent for his challengers (Sanger-Katz, 3/1).

Modern Healthcare: Most Americans Like Medicare The Way It Is: Survey
About 70% of Americans say they favor the Medicare program as it exists today, while 25% say they would support a premium-support model in the federal healthcare program, according to a February survey from the Kaiser Family Foundation. Among those surveyed, 83% of Democrats said they want to keep Medicare as it is and 14% say they would support the change. That compares with 53% of Republicans who prefer the status quo and 39% who said they would like to see a premium-support model, which is the basis of a proposal from House Budget Committee Chairman Paul Ryan (R-Wis.) and Sen. Ron Wyden (D-Ore.), as well as GOP presidential candidate Mitt Romney (Zigmond, 3/1).

Politico Pro: Poll: GOP Stances On Health Care Unpopular
A new poll suggests that Republicans are staking out unpopular positions on two of the biggest health care issues in this election year: contraception coverage and Medicare. The findings of the latest poll by the Kaiser Family Foundation, released Thursday morning, are a warning to the party as the Senate prepares to vote later Thursday on a Republican-sponsored measure to let employers refuse to cover health services, including birth control, if they have moral objections (Nather, 3/1).

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The Health Law And The States

Stateline reports that some GOP governors are moving very slowly on health insurance exchanges. Also in the news, a bill in the Georgia House would restore child-only plans.

Stateline: GOP Governors Stall Health Insurance Exchange Plans
It's hard to find a governor who doesn’t agree that creating an organized marketplace to help consumers and small businesses shop for health insurance is a good idea. But when it comes to implementing the state-run exchanges called for in the controversial 2010 federal health law, many GOP governors are balking. ... Waiting with Nebraska are Alabama, Florida, Georgia, Indiana, Kansas, Missouri, Michigan, South Dakota, Texas, Virginia and Wisconsin, according to news reports compiled by the Center for Budget and Policy Priorities (Vestal, 3/1). 

California Healthline: Study Looks at Language Barriers To Exchange Coverage
Communities of color are expected to make up a large portion of the California Health Benefit Exchange population. Many potential enrollees have limited English skills, which could get in the way of obtaining coverage. ... "We estimate that about 2.65 million nonelderly adults will be eligible for the exchange. Of that 2.65 million, about 67% of them are people of color," UCLA researcher Daphna Gans said. "That's mostly Latino, followed by African American, then Asian" (Gorn, 2/29). 

Georgia Health News: New Bill Would Restore Child-Only Policies
An unintended consequence of the Affordable Care Act was a halt in sales of "child-only"’ policies in Georgia and other states. ... The measure, which passed the House Insurance Committee on Wednesday, would require insurers that sell individual health policies in Georgia to also offer child-only plans during an open enrollment period. The legislation would allow insurers to impose a surcharge of up to 50 percent of the premium if a child has been uninsured for more than 63 days prior to the application for coverage (Miller, 2/29). 

The Connecticut Mirror: Two Years After Passage, Courtney Still Selling Health Reform
Joe Courtney held up the poster-sized chart and pointed to the numbers printed in purple: 7,700 seniors in his Eastern Connecticut district got a discount on their prescription drug payments last year, thanks to federal health reform. ... The third-term congressman from Vernon hasn't missed many chances to tout the upsides of a law that many of his fellow Democrats have not gone out of their way to promote (Levin Becker, 2/29).

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Detailing Health Insurance Coverage Forms - A Health Law Requirement

The Associated Press reports on how consumers can navigate insurance choices while waiting for the more user-friendly summaries called for by the law.

The Associated Press: Health Coverage Search Should Start With Key Steps
Help is on the way for consumers flummoxed by health insurance forms, but they'll need to be patient. The healthcare overhaul, which aims to provide coverage for millions of uninsured, requires private health plans to offer a user-friendly coverage summary. This form must explain key terms and cost details. The goal is to make it easier for people shopping for individual or employer-sponsored group coverage to compare policies and understand how different parts of the coverage will affect them (Murphy, 2/29).

Meanwhile, on Capitol Hill -

The Hill: McConnell To Skip Health Care Reform Repeal Votes Until After Election
Senate Republican Leader Mitch McConnell (Ky.) told his colleagues this week that he does not want to vote again on repealing President Obama's healthcare reform law until after the November elections. The GOP’s game plan on healthcare is politically sensitive because influential conservative activists have called for repeated votes on repeal. But many Republicans on Capitol Hill want to focus on other issues in the coming months, most notably gas prices and the economy (Bolton, 3/1).

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Campaign 2012

Romney: Blunting Confusion On Support Of Contraception Amendment

The campaign issued a clarification Wednesday after comments made by GOP presidential hopeful Mitt Romney to an Ohio reporter about the contraception-related Senate amendment. Romney's camp clarified his support for the amendment. 

The Washington Post: Romney Camp Says Candidate Supports Blunt Amendment On Contraceptive Coverage
One day after his big wins in Michigan and Arizona, former Massachusetts governor Mitt Romney (R) found himself in the eye of a media storm Wednesday afternoon after his response to an Ohio reporter about a contraception-related Senate amendment began making the rounds. Romney’s camp clarified after the interview that the candidate supports Sen. Roy Blunt's (R-Mo.) amendment, which is aimed at reversing the Obama administration’s policy requiring religious-affiliated institutions to provide health insurance that covers contraception (Sonmez, 2/29).

The Hill: Campaign: Romney Would Support Blunt Birth-Control Measure
Mitt Romney's presidential campaign says he does support an amendment that would overturn the White House's controversial contraception mandate, following an interview in which Romney said he would not vote for the proposal. The Ohio News Network reported Wednesday that Romney had said he would not support Sen. Roy Blunt’s (R-Mo.) amendment, which is coming up in the Senate for a vote on Thursday. The measure would let employers opt out of healthcare mandates that violate their religious or moral beliefs, including the controversial contraception mandate (Baker, 2/29).

The Associated Press: Romney Clarifies His Position On Blunt Amendment
Presidential candidate Mitt Romney said Wednesday he opposed Senate Republicans' effort that critics say would limit insurance coverage of birth control, then reversed himself quickly in a second interview saying he misunderstood the question. Romney told Ohio News Network during an interview that he opposed a measure by Sen. Roy Blunt, R-Mo., that was scheduled for a vote Thursday. "I'm not for the bill," Romney said before urging the interviewer to move on. Romney later said he didn't understand the question (Elliott, 2/29).

Boston Globe: Amid Confusion, Romney Says He Supports Blunt Amendment
Mitt Romney this afternoon initially said he was opposed to legislation granting employers the right to exclude medical services from workers’ insurance on moral or religious grounds, telling an Ohio television station that he would not support the controversial Blunt amendment backed by many Senate Republicans, including Scott Brown of Massachusetts. ... Romney’s campaign quickly clarified, claiming that Romney does support the legislation and was confused by the question (Viser, 2/29).

Politico: Mitt: I Misunderstood Blunt Bill Question
Mitt Romney moved quickly tonight to clean up the budding controversy over his interview with the Ohio News Network, in which he appeared to say he didn't support the amendment in the Senate that would overturn President Obama's contraception mandate. In a radio interview on the Howie Carr show, Romney said he merely misunderstood the question on what the ONN reporter referred to as the "Blunt-Rubio amendment" (Schultheis, 2/29).

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GOP Presidential Candidates Look To Health Policies To Highlight Differences

The New York Times: Political Memo: Candidates Scramble To Create Differences
Mr. Romney and Mr. Santorum both support the repeal of President Obama's national health care law. Mr. Santorum has criticized Mr. Romney for creating the Massachusetts plan that served as the federal model. Mr. Romney, meanwhile, recently blamed Mr. Santorum for playing a crucial role in the passing of the federal bill, because in 2004 he endorsed the re-election of Senator Arlen Specter, who later voted for the Obama health plan. … Mr. Santorum backed Mr. Bush's expansion of the Medicare prescription drug program. Jim Talent, the former senator of Missouri who has endorsed Mr. Romney, recently slammed Mr. Santorum for that support on a conference call (Harwood, 2/29).

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Bob Kerrey Jumps Into Nebraska Senate Race

Reuters: Bob Kerrey Buoys Democrats With Nebraska Senate Bid
Bob Kerrey, the former Nebraska governor and U.S. senator, said on Wednesday he will run for his old Senate seat, raising the hopes of Democrats that they can keep control of the chamber this election year. ... Kerrey is the Democrat's best hope of keeping the Nebraska Senate seat because he is well known and can raise money, Jennifer Duffy, a senior editor at nonpartisan Cook Political Report, told Reuters earlier in the week. But Duffy predicted that some of Kerrey's positions, including his belief "that health care reform didn't go far enough, will not be popular in Nebraska" (Kelleher, 2/29).

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Health Care Fraud & Abuse

Ten Physicians Indicted In Alleged $250 Million Fraud Scheme

As has been the trend in some recent health care fraud cases, the physicians were not the ringmasters. Instead, the indictments allege that they were fronts for others — primarily immigrants from the former Soviet Union.

The New York Times: A $250 Million Fraud Scheme Finds A Path To Brighton Beach
The plot involved 10 doctors, 9 separate clinics in New York City and 105 different corporations, all in service of a health care fraud ring that federal authorities say conspired to steal more than a quarter of a billion dollars from insurance companies. And when the details were announced on Wednesday, they cast an unflattering spotlight on how immigrants from the former Soviet Union have often dominated such schemes in the city (Rashbaum, 2/29).

Medscape: Ten Physicians Indicted as Fronts for 'Russian Criminals'
As in many other recent health care fraud cases, physicians are not the ringmasters in this alleged criminal enterprise. Rather, the indictment, unsealed today, states that they are fronts and underlings for a cadre of nonphysicians, primarily "individuals of Russian descent" with Mafia-style nicknames like "Russian Mike," "Fat Mike," "Skinny Mike," "KGB," and "Nose." ... Authorities call the clinics "no-fault clinics" because they were reimbursed by auto insurers under a no-fault law in New York that entitles accident victims to as much as $50,000 in medical benefits regardless of who caused the accident (Lowes, 2/29).

In other news —

The Associated Press: $375M Health Care Scheme Went Unnoticed For Years
The Texas doctor accused of "selling his signature" to process almost $375 million in false Medicare and Medicaid claims went unnoticed for half a decade by a fraud detection system that some critics say is broken. Authorities say Jacques Roy and six others indicted for health care fraud certified 11,000 Medicare beneficiaries through more than 500 home health providers over five years. Those numbers would have made Roy's Medicare practice the busiest in the country. But an investigation into Roy and his business practices didn't begin until about a year ago, officials said (Merchant, 2/29).

The Dallas Morning News: Home Health Care Advocates Praise Government's Billing Fraud Investigation
Home health care advocates on Wednesday lauded the government's investigation of a Rockwall doctor and six associates accused of masterminding the largest medical billing fraud scheme of its kind in the country. "It is critical that scarce Medicare and Medicaid funds are protected from fraud and abuse schemes," Anita Bradberry, executive director of the Texas Association for Home Care & Hospice, said about the alleged $375 million swindle (Trahan, 2/29).

ABC: Exclusive: Undercover Grandma Catches Medicare Fraud On Tape
In the wake of an ABC News undercover investigation, federal authorities in Texas are investigating how an active 82-year-old grandmother was diagnosed as homebound, with a range of ailments that she did not have, including Type 2 diabetes, opening the door to potentially tens of thousands of dollars in Medicare payments for home health care, supplies and equipment she did not need. A hidden camera recorded the undercover grandmother's visit to a doctor in McAllen, Texas, where she told the doctor and nurses she exercised regularly and, other than some hypertension and arthritis, was in excellent health (Chuchmach and Ross, 3/1).

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Public Health & Education

Federal Judge Says Govt. Can't Require Grisly Images On Cigarette Packages

The judge ruled on constitutional free speech grounds, but the case could end up in the Supreme Court.

NPR: Federal Judge Rules Graphic Cigarette Labels Violate Constitution
Scary labels the U.S. Food and Drug Administration would require on cigarette packages later this year were nixed today. ... Five tobacco companies, including R.J. Reynolds and Lorillard, are plaintiffs in the case (Hensley, 2/29).

The New York Times: U.S. Judge Strikes Down FDA Cigarette Labels
Judge Richard J. Leon of the United States District Court in Washington ruled that forcing the companies to use the labels, which show staged images like a man breathing smoke out of a tracheotomy hole in his neck and a mouth punctured with what appear to be cancerous lesions, violated their free speech rights under the First Amendment (Strom, 2/29).

The Wall Street Journal: Grisly Tobacco Labels Thrown Out By Judge
The summary judgment follows a preliminary ruling in November. At that time, Judge Leon issued a temporary injunction, adding that tobacco companies had demonstrated "a substantial likelihood" of winning the case on constitutional grounds. The government has appealed the November ruling, and some observers have predicted the U.S. Supreme Court ultimately could decide the matter (Esterl, 2/29).

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Coverage & Access

Unpaid Caregivers Provided An Estimated $202 Billion In Dementia Care In 2010

NPR reports unpaid caregiver costs for those with dementia was an estimated $202 billion in 2010 alone. In other news, the income of Massachusetts' elderly covers only 60 percent of living expenses, and at the Mayo Clinic, researchers are trying to learn more about the effects of old age.

NPR's SHOTS blog: The High Price Of Caring For A Loved One With Alzheimer's
Caring for a family member with the personality-draining disease can take a hefty financial and emotional toll. Nearly 15 million people fall into the role of unpaid caregiver for those sick with dementia, according to the Alzheimer's Association. Add it all up, and it comes to about 17 billion hours of unpaid care valued at $202 billion in 2010 alone. ... The job is so time-consuming that caregivers can become isolated from other family members and friends (Husted, 2/29).

Minnesota Public Radio: Mayo's Living Lab Learns Real Life Lessons About Aging
Researchers at the Mayo Clinic have set up what they're calling a "living lab" to learn more about the effects of old age. ... Scientists say such multi-disciplinary research is increasingly needed, as demographic estimates indicate the number of Minnesotans age 65 and older will increase by 40 percent in the next 10 years (Baier, 3/1).

Boston Globe: Income For Elderly Falls Short, Study Finds
The elderly in Massachusetts struggle with the nation's largest shortfall between income and costs, with the age group's median income covering only about 60 percent of basic living expenses here, according to a study to be released today. ... The study aims to underscore the importance of entitlement programs — Social Security and Medicare — that support the elderly and face potential cuts as Congress grapples with long-term deficits. Without changes, the costs of the programs are expected to explode as the baby boom generation moves into retirement (Waterhouse, 3/1).

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State Watch

Some Medicaid Patients Denied Coverage If Final Diagnosis Doesn't Merit ER Care

Some states are not considering the symptoms that brought the patients to the hospital, the doctors charge. In other Medicaid news, Texas is looking at several options for Medicaid reform, Pennsylvania looks at human service program cuts, Wisconsin Democrats seek to stop reductions there and Minnesota officials respond to criticism from Sen. Charles Grassley.

MedPage Today: Coverage Denials Draw Ire of Emergency Docs
Medicaid officials in some states are denying coverage for emergency department visits based on final diagnosis codes rather than the symptoms that brought the patient in, according to the American College of Emergency Physicians (ACEP). ACEP said cash-strapped Medicaid officials are increasingly implementing plans to deny payment for emergency department services if the patient is ultimately determined to have a non-urgent condition (Walker, 2/29).

Earlier, related KHN story: Hospitals Demand Payment Upfront From ER Patients With Routine Problems (Galewitz, 2/20).

The Texas Tribune: Texas Lawmakers Working To Reform Medicaid
Regardless of how the Supreme Court rules on President Obama's health care reforms next month, the state of Texas is pursuing plans to completely revamp the way it runs Medicaid. Of course, it must first get the federal government's approval. ... In 2014, the Affordable Care Act will require all Texans to sign up for health benefits (though the state estimates about 9 percent will still fall through the cracks and remain uninsured). Medicaid is expected to increase from 3.5 million to 5.7 million beneficiaries. To deal with the increase in demand, the state is pursuing changes on two fronts (Tan, 2/29). 

The Philadelphia Inquirer:  Pa. Welfare Secretary Defends Proposed Funding Cuts, Program Rollbacks
In his budget blueprint for the fiscal year beginning in July, (Gov. Tom) Corbett is proposing roughly $620 million in cuts and savings to human services programs. They include eliminating cash payments to poor adults, cutting aid by 20 percent for county-run social service programs, and reducing reimbursements to hospitals and nursing homes serving the poor. Those changes come on top of reports that 89,000 children have been dropped from the state's Medicaid rolls since August, and the administration's plan to impose an assets test, come May, on people seeking to receive food stamps (Couloumbis, 2/29).

Wisconsin Public Radio: Dem Bill To Stop Proposed Cuts To BadgerCare
Two Democrats have a bill that would stop proposed cuts to BadgerCare. Health care changes passed in Act 10 last year didn't immediately get the overwhelming attention that other changes in the budget repair bill did: namely limits on collective bargaining. That's partly because it wasn't clear how the state's health secretary would control Medicaid costs using new-found power that restricted legislative oversight (Mills, 2/29). 

(St. Paul) Pioneer Press: U.S. Senator Raises Questions About Prescriptions Written Under Minnesota Medicaid Program
A prominent U.S. senator is raising concerns about the potential for doctors in Minnesota to abuse the Medicaid health-insurance program by prescribing large numbers of painkillers and other medicines.  In a January letter to state officials, Sen. Charles Grassley, R-Iowa, wrote that he found several "shocking" examples of potential abuse in Minnesota from his review of the prescribing habits of certain physicians.… The state has referred two cases highlighted by the Grassley investigation to the state Board of Medical Practice for investigation, wrote David Godfrey, medical director of the state's Medicaid program, in a letter dated Feb. 10. But those referrals predated the Grassley inquiry, according to state officials (Snowbeck, 3/1). 

Minneapolis Star Tribune: Doctors’ Prescriptions Raise Suspicions Of Medicaid Fraud
Minnesota officials are reporting a handful of doctors to the state medical board for potential disciplinary action because of the amount of addictive painkillers and potent psychotropic drugs they have prescribed. In a Feb. 13 letter to U.S. Sen. Charles Grassley, R-Iowa, the Department of Human Services said it has reported two doctors for excessive prescriptions and was "in the process of reporting others." The letter was an update to Grassley, a member of the Senate Judiciary Committee who has been investigating whether doctors are bilking the Medicaid system by writing too many prescriptions or are prescribing certain medications more often because of financial ties to drug manufacturers (Olson, 2/29).

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Ga. House Passes Bill Restricting Abortion To Limit Fetal Pain

The legislation would cut six weeks from the time women can have an elective abortion, the Atlanta Journal-Constitution reports.

The Atlanta Journal-Constitution: Georgia House Passes 'Fetal Pain' Abortion Bill
The state House, after emotional debate, passed a bill Wednesday that would cut six weeks from the time women can have elective abortion. The legislation, House Bill 954, also would tighten medical exemptions for terminating pregnancies and require any abortion performed after 20 weeks of pregnancy be done in a way to bring the fetus out alive. The measure is commonly referred to as a "fetal pain" bill and says that a fetus can feel pain at 20 weeks, therefore the state has an interest in protecting it (Quinn, 2/29).

Meanwhile, in Pennsylvania, lawmakers have put the brakes on a bill to require an ultrasound before an abortion.

The Associated Press/Philadelphia Inquirer: No Vote Set On Bill For Ultrasound
The Republican leader in the Pennsylvania House says he doesn't plan to schedule a vote on a bill to mandate ultrasounds for women seeking abortions while members address questions that have arisen about it. A spokesman for Majority Leader Mike Turzai told the Associated Press on Wednesday that concerns about the bill in the medical community would also be fully vetted before the bill would be advanced. Sponsors of the Pennsylvania bill say it would require an ultrasound, but a woman wouldn't have to look at the printout. It would also require that all questions about the fetus' health and gestational age be answered completely. Opponents say the bill would subject many women to ultrasounds with a vaginal probe (Scolforo, 3/1).

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Cities, States Balancing Health Costs Amid Continuing Economic Problems

A selection of health policy stories from around the country, including Colorado, California, Kansas and Arizona.

CNN Money: States Still Hurting, Just Not As Much
Some 29 states are dealing with a total budget deficit of $47 billion for fiscal 2013, according to the Center on Budget and Policy Priorities. Unlike the federal government, nearly all states must balance their budgets every year. Though tax revenues are slowly recovering after bottoming out in 2010, they're still not back to pre-recession levels. That means some governors and lawmakers will continue to chop spending on education, health care and human services, the left-leaning center warns (Luhby, 2/29).

Health Policy Solutions (a Colorado news service): Costly Health Insurance Driving Workers, Employers Away
Many Coloradans with jobs say they can no longer afford health insurance, a new analysis from the Colorado Health Access Survey has found. ... 85 percent of uninsured Coloradans say they don’t have health insurance because it’s too expensive. Job loss and poverty used to be the key causes for poor health coverage. But the landscape in Colorado is changing dramatically. Today, a good job no longer guarantees affordable health insurance (Kerwin McCrimmon, 2/29).

Colorado Public Radio: Health Care Law Turns Two, Insurance Prices Still Rising
The average cost of a family health insurance policy offered through a job in Colorado nearly doubled between 2000 and 2010 ... if the law rolls out according to plan, people like Maya Wheeler should have an easier time affording health premiums (Whitney, 3/1). 

The Wall Street Journal: California Cities Hit The Wall
Confronted by declining tax revenue and rising employee costs, Stockton, Calif., is considering bankruptcy—while several other struggling California cities warn they could eventually face the same predicament. … Bankruptcy is painful for municipalities, [Randall Newsome, a retired federal bankruptcy judge] said, since it entails restructuring long-standing contracts. including retiree health-care benefits (White and Vara, 2/29).

Los Angeles Times: Blue Shield Seeks $10.5 Million In Damages From O.C. Doctor Group
Blue Shield of California has demanded $10.5 million in damages from a large Orange County physician group that was recently acquired by rival insurer UnitedHealth Group Inc., a sign of rising tension as insurers and hospitals snap up more medical providers in advance of federal reform. ... Blue Shield alleges that Monarch [the largest physician group in Orange County], under its new ownership, refused to treat some of its members and tried to switch them from Blue Shield coverage (Terhune, 3/1).

Arizona Republic: Child-Vaccine Proponents Urge Stronger Legislation
Right now, Arizona parents need only fill out a short form to exempt their child from the state's immunization requirements. But there's a push under way to toughen state exemption laws. Doctors and state health experts say parents have an obligation not only to their children but to their community to help prevent the spread of serious diseases like mumps or measles (Rau, 2/29).

Kansas Health Institute News: Bill Would Use HMO Tax To Pay For Newborn Screenings
Since 2009, lawmakers have used tobacco revenues to fund the newborn screening program, which tests infants for 29 metabolic and health disorders. Gov. Sam Brownback included the program in his proposed budget for the coming fiscal year but directed KDHE to find an alternate source of revenue for it in the fiscal year that begins July 1, 2013 (Ranney, 2/29). 

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Weekend Reading

Longer Looks: Romney's Evolution On Abortion; The Birth Of The HIV Epidemic

This week's selection of intriguing weekend reading includes articles from Slate, the Los Angeles Times, American Medical News, Salon, Columbia Journalism Review, The Washington Post, BBC and Medscape.

Slate: The Conversion: How, When, And Why Mitt Romney Changed His Mind On Abortion
(GOP presidential candidate Mitt) Romney began his political career as a pro-choicer. In the story he tells, he had an epiphany, a flash of insight, and committed himself thereafter to protecting life. But that isn't what happened. The real story of Romney's conversion—a series of tentative, equivocal, and confused shifts, accompanied by a constant rewriting of his past—paints a more accurate picture of who he is. Romney has complex views and a talent for framing them either way, depending on his audience. He values truth, so he makes sure there's an element of it in everything he says. He can’t stand to break his promises, so he reinterprets them (William Saletan, 2/22).

Los Angeles Times: Healthcare History: How The Patchwork Coverage Came To Be
Most of us get health insurance through our jobs, a system puzzling to the rest of the industrial world, where the government levies taxes and offers health coverage to all as a basic right of modern society. But for many Americans, their way feels alien — the heavy hand of government reaching into our business as some bureaucrat tells doctors and patients what to do. ... The long-standing tension between public and private healthcare in America has produced a unique and confusing way to provide protection against the cost of ill health (Bob Rosenblatt, 2/27).

Also included in this package, are stories about the diverse ways hospital bills are paid; the backlash against a Medicare expansion in 1988; and the high cost of long-term care.

American Medical News: Insurers Think Outside The Policy
Once upon a time, U.S. insurers' business was paying claims and putting together networks of physicians and hospitals. Today, they are selling health benefits for workers in Brazil, developing health information exchange systems and even helping big physician groups bill patients. That work was once outside the purview of the largest U.S. health insurers -- or relegated to side projects. But in 2012, after U.S. health system reform and amid other changes sweeping the industry, health plans are relying on businesses that were once peripheral to drive company profits (Emily Berry, 2/27).

Salon: The Billion-Dollar Battle Over Premenstrual Disorder
For about five to seven days of every month, a woman may as feel as though she were a different person. A person she doesn’t like. ... Doctors and psychiatrists at work on the newest version of the Diagnostic Manual of Mental Disorders — the American Psychiatric Association’s bible for mental-health professionals — describe this confluence of symptoms as Premenstrual Dysphoric Disorder (PMDD). The revised version of the DSM, just the fourth new edition in 52 years, will be published next year. ... Since 1987, PMDD has lingered in the ghetto of the DSM: the appendix pages where proposed diagnoses are deemed in need of "further study." But right now, it appears as though PMDD will ascend in the ranks from a hypothetical ailment to illness to become a full-blown depressive disorder; taking a place alongside Major Depression and Bi-Polar Depression (Natasha Vargas-Cooper, 2/25).

Columbia Journalism Review: A Medicare Memo To Campaign Reporters
Hmmm, I thought. Seniors already can choose between Medicare and private plans. I asked my Arkansas host how these private plans were being sold in her county. She told me insurance agents selling private plans had teamed up with local pharmacists, who told seniors that if they didn’t sign up for a particular agent’s policy, the pharmacists whom they trusted said they wouldn’t be their pharmacists any more. Well, you don’t have to be a brain surgeon to know what most of the seniors did (Trudy Lieberman, 2/27).

Washington Post: Co­lo­ni­al­ism In Africa Helped Launch The HIV Epidemic A Century Ago
We now know where the epidemic began: a small patch of dense forest in southeastern Cameroon. We know when: within a couple of decades on either side of 1900. We have a good idea of how: A hunter caught an infected chimpanzee for food, allowing the virus to pass from the chimp’s blood into the hunter’s body, probably through a cut during butchering. As to the why, here is where the story gets even more fascinating, and terrible (Craig Timberg and Daniel Halperin, 2/27).

BBC: Will We Ever... Grow Organs?
In June 2011, an Eritrean man entered an operating theatre with a cancer-ridden windpipe, but left with a brand new one. People had received windpipe transplants before, but Andemariam Teklesenbet Beyene’s was different. His was the first organ of its kind to be completely grown in a lab using the patient's own cells (Ed Yong, 2/24).

Medscape: Tracking Healthcare Variability: Is More Care Better Care?
Dr. [Eli] Adashi: It's undeniable that we as a nation are going through a difficult patch with respect to a variety of aspects, not least of which is healthcare. If we were to liken for a moment the American healthcare system to a patient, what is the prognosis of this patient? Dr. [John] Wennberg: It's certainly going to have to figure out how to go from a spurt of growth to a spurt of maturity and stability. ... certainly the great difficulty is whether the adolescent can enter into a new phase in which there is cooperation and an understanding of the requirements for building systems of care, and doing things that physicians were not trained to do, work in teams, and ultimately limiting capacity (2/24).

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Editorials and Opinions

Viewpoints: Ryan And Medicare; Va. Ultrasound Bill 'Overreaches'?; NEJM On Patient-Centered Care

The Wall Street Journal: Ryan's Medicare Revolution
Over the past year, an entitlement revolution has taken place on Capitol Hill. ... The revolution involves Medicare, the health-care program for the elderly and the single biggest cause of America's looming debt crisis. Reform of Medicare would be achieved by a policy known as "premium support." It would bring consumer choice and spending restraint to the beleaguered program (Fred Barnes, 3/1).

USA Today: Editorial: Olympia Snowe Leaves Void At The Center
Snowe stood out. Despite great pressure, she voted for the 2009 stimulus measure and the 2010 banking reform law, and she worked to craft the health reform law (though she voted against the final version). Without people like her, the Congress, indeed the whole nation, will suffer (2/29).

Boston Globe: Warren Risks Morphing Into The 'Woman’s Candidate'
Talking about sex is so much better than talking about gas prices. Democrats are thrilled that birth control is a major issue not only in the presidential election, but in Senate contests across the country. But be careful what you wish for, especially if you are a woman running for the US Senate in Massachusetts (Joan Vennochi, 3/1).

The Washington Post: Even With Watered-Down Ultrasound Bill, Virginia GOP Overreaches 
When doctors elect to do ultrasounds that early in a pregnancy, they are generally the transvaginal variety. But it’s critical that they be done consensually, within the privacy of a doctor’s relationship with a woman seeking an abortion — not as the result of meddlesome state intrusion (2/29).

Chicago Sun-Times: Women, Be Aware: Access To Birth Control Coming Under Fire
The reality is that no woman wants to get an abortion. ... Yet mistakes do happen. Condoms break and the Pill doesn’t always work. And, worse, horrific crimes occur against women everyday. Women are raped and pregnancies can happen as a result. Nothing could be worse than making these victims endure another rape at the hands of their doctor, especially in the name of a political agenda (Dr. Laura Berman, 2/28).

Sacramento Bee: Head to Head: Should Birth Control Be Considered An 'Essential Benefit' In Health Plans?
Ben Boychuk: No. ... there is no compelling government interest in making contraception an "essential benefit" of health insurance under the Affordable Care Act – certainly not at the expense of religious liberty. ... Pia Lopez: Yes.  
... Clearly, teens and women of childbearing age have unique health care needs – from birth control to prenatal care – that should be covered by health insurance (3/1).

Houston Chronicle: Health Care Work Force Will Be Tested By Reform
In order to address potential shortages that might be driven by the ACA, and take full advantage of the ACA's focus on preventive care and integrated care delivery, Congress and state legislatures need to focus on expanding the health work force and supporting collaboration between health workers (Joanne Spetz, 2/29).

The Dallas Morning News: Editorial: Better Reporting Of Medical Reviews Is Needed
This gap in the medical reporting process — in which the medical board is aware of investigations but hospitals are not alerted case by case — needs to be closed. Like anyone else, doctors should be presumed innocent until all the facts are in. But for the safety of patients, hospitals should have a better way to find out about complaints than hoping that patients, internal whistle-blowers or the doctors themselves come forward (2/29).

Minneapolis Star Tribune: Let's Not Lose The Progress We've Made For Mentally Ill
Treatment must be based on the current reality that mental illnesses, including major illnesses such as schizophrenia, can be effectively treated, managed and even cured. In order to achieve this result, however, mental health facilities, including the Security Hospital, must use best practices in treatment and care. The Department of Human Services sent an important message when it placed the Security Hospital on a conditional license (Susan Segal, 2/29).

Sacramento Bee: Medi-Cal Needs To Move On Helping Kids
Perhaps the bureaucrats who run the state's Medi-Cal dental program would move more quickly to improve dental service for Sacramento kids if it were their own children waiting for months for their cavities, broken teeth and abscessed molars to be treated (3/1).

St. Louis Post-Dispatch: The Many Ways Benefits Managers Help Pharmacies
Express Scripts, Medco and other PBMs have played an important role in helping retail pharmacies gain the benefits of modern technology. Before PBMs existed, reimbursement from insurers involved paper forms, carbon copies and long waits for payment. Today, our payment processing systems give pharmacists more time to spend counseling patients instead of filling out forms. ... Express Scripts and other PBMs partnered with independent and chain pharmacies to create the nation's largest e-prescribing network. ... The use and promotion of e-prescribing saves lives, improves quality and decreases costs for pharmacies. This type of innovation is a hallmark of what we do currently and what we expect to do more of if our merger with Medco is completed (Dr. Steve Miller, 2/29).

In addition, the New England Journal of Medicine had a number of "Perspectives" pieces in this week's issue:

New England Journal of Medicine: Supreme Court Review of the Health Care Reform Law 
If the Court upholds the ACA, the number of people with health insurance coverage will swell by as many as 32 million. This result would put pressure on providers to deliver more care. Currently, only about two thirds of physicians accept Medicaid patients, so the burden of serving the newly eligible populations would fall disproportionately on these physicians. The ACA begins to address this problem with workforce-development provisions. In addition, at least in the short run, health care costs would probably increase, though the ACA contains some cost-control measures (Dr. Gregory D. Curfman, Brendan S. Abel,  and Renée M. Landers, 2/29).

New England Journal of Medicine: Goal-Oriented Patient Care — An Alternative Health Outcomes Paradigm 
Attention to patient-centered measures and outcomes will be particularly important as CMS moves increasingly to link health care providers' reimbursement to their performance on selected measures. ... Perhaps the most important barrier to goal-oriented care is that medicine is deeply rooted in a disease-outcome–based paradigm. ... Ultimately, good medicine is about doing right for the patient. For patients with multiple chronic diseases, severe disability, or limited life expectancy, any accounting of how well we're succeeding in providing care must above all consider patients' preferred outcomes (Drs. David B. Reuben and Mary E. Tinetti, 3/1).

New England Journal of Medicine: Shared Decision Making — The Pinnacle of Patient-Centered Care 
Over time, advances in medical science have provided new options that, although often improving outcomes, have inadvertently distanced physicians from their patients. ... Patients should be educated about the essential role they play in decision making and be given effective tools to help them understand their options and the consequences of their decisions. ... Clinicians, in turn, need to relinquish their role as the single, paternalistic authority and train to become more effective coaches or partners — learning, in other words, how to ask, "What matters to you?" as well as "What is the matter?" (Dr. Michael J. Barry and Susan Edgman-Levitan, 3/1).

New England Journal of Medicine: Defining "Patient-Centered Medicine" 
A patient consults an orthopedist because of knee pain. The surgeon determines that no operation is indicated and refers her to a rheumatologist, who finds no systemic inflammatory disease and refers her to a physiatrist, who sends her to a physical therapist, who administers the actual treatment. Each clinician has executed his or her craft with impeccable authority and skill, but the patient has become a shuttlecock. Probably a hassled, frustrated, and maybe bankrupt shuttlecock. ... Health relies on collaboration between the patient and the doctor, with many others serving as interested third parties. Patient and physician must therefore meet as equals (Dr. Charles L. Bardes, 3/1).

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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.