Daily Health Policy Report

Friday, March 1, 2013

Last updated: Fri, Mar 1

KHN Original Reporting & Guest Opinion

Health Spending And Fiscal Battles

Health Reform

Capitol Hill Watch

Health Care Marketplace

Health Information Technology

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Hospital Executive Bracing For Budget Cuts Says 'We Need To Deal With Medicare'

Kaiser Health News staff writer Mary Agnes Carey reports: "David P. Blom is one of thousands of hospital executives across the country who are bracing for a reduction in Medicare payments as part of a series of federal spending cuts that begin Friday. Blom, 58, is president and chief executive officer of OhioHealth, a Columbus, Ohio, based not-for-profit health care system that includes 18 hospitals, 23 health and surgery centers, home-health providers and other facilities" (Carey, 3/1). Read the story.

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Medical Research, FDA And Mental Health Programs Face Budget Bite

Kaiser Health News staff writer Mary Agnes Carey reports: "Doctors serving Medicare patients. Scientists looking for a better way to treat diabetes. HIV patients who can’t afford to buy their medications. These are but some of the many people who will be affected by the automatic federal spending cuts that officially take effect today" (Carey, 3/1). Read the story.

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Capsules: Hospital Consolidation Dance Heats Up In NYC; Mass. Weighs Governor's Plan To Tax Candy And Soda

Now on Kaiser Health News' blog, Jenny Gold reports on developments in the New York City hospital markets: "The health care game of musical chairs is picking up speed in New York City, one of the most competitive markets in the country. The Mount Sinai Medical Center and Continuum Health Partners announced today that their boards of trustees have reached a tentative agreement on a possible merger" (Gold, 2/28).

Also on Capsules, WBUR's Martha Bebinger, working in partnership with KHN and NPR, reports on legislation in Massachusetts to tax candy and soda: "Are candy and soda food? In Massachusetts, candy and soda are considered food and are exempt from the state’s 6.25 percent sales tax. But Gov. Deval Patrick wants to change that. He's proposing that the legislature tax every bag of M&M’s and bottle of Pepsi bought in the state" (Bebinger, 3/1). Check out what else is on the blog.

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Political Cartoon: 'Beware The First Of March?'

Kaiser Health News provides a fresh take on health policy developments with "Beware The First Of March?" by Randy Bish.

Meanwhile, here is today's health policy haiku:

WHAT HAPPENS NEXT?

Sequestration day.
A deal will be struck, some say.
But whom will deal strike?
-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 Spending And Fiscal Battles

The Clock Runs Out On Averting Sequestration

Time ticked down to March 1 -- also known as sequestration D-day -- without the White House and lawmakers finding a way to avert the scheduled cuts.

The Wall Street Journal: Cuts Roll In As Time Runs Out
The federal government enters a controversial new phase of deficit cutting Friday, as an automatic trigger begins slicing budgets in some areas while leaving programs such as Medicare and Medicaid—among the largest drivers of future debt—largely untouched (Paletta and Hook, 2/28).

The Associated Press/Washington Post: Obama Still Betting On A Big Fiscal Deal As Automatic Cuts Kick In, But Odds Weigh Against Him
A fiscal deadline all but blown, President Barack Obama says he once again wants to seek a big fiscal deal that would raise taxes and trim billions from expensive and ever growing entitlement programs. But with automatic federal spending cuts ready to start taking their toll, the path toward that grand bargain Obama campaigned on last year has significantly narrowed. The president has summoned the top bipartisan congressional leadership to the White House, a meeting designed to give all sides a chance to stake out their fiscal positions with a new threat of a government shutdown less than four weeks away. There were no expectations of a breakthrough (3/1).

The New York Times: Boehner Halts Talks On Cuts, And House GOP Cheers
Speaker John A. Boehner, the man who spent significant portions of the last Congress shuttling to and from the White House for fiscal talks with President Obama that ultimately failed twice to produce a grand bargain, has come around to the idea that the best negotiations are no negotiations (Parker, 2/28).

USA Today: Senate Rejects Sequester Alternatives
The Democratic alternative would have replaced the cuts, known as the sequester, with a combination of a minimum 30% tax on millionaires and cuts to defense and farm programs. It failed 51-49. The Republican alternative would have transferred sweeping authority to President Obama to force him to determine how to implement $85 billion in cuts instead of the across-the-board spending cut affecting most reaches of the federal government. The sequester exempts military personnel accounts and the social safety net including Social Security and Medicare. The GOP measure also failed, 38-62 (Davis, 2/28).

Boston Globe: Sequester's Long-Term Effects Still Unclear
For some, the sky is falling. But for many others, the budget cuts will hardly register. That may explain why legislative efforts to forestall the cuts this week were barely evident, despite dire warnings from President Obama and administration officials. … Medicaid and Social Security benefits won't be touched by the cuts, while Medicare payments to health providers will drop 2 percent. Head Start, the federally funded early childhood education initiative, will also see budget cuts, leaving 1,100 Massachusetts children out of the program this year, according to the White House (Uberti, 3/1).

CBS News: 4 Possible Silver Linings In The Sequester
The dreaded sequester takes effect today as $85 billion in automatic cuts to 2013 federal spending begin rolling in, slashing services and sowing all manner of chaos, according to government officials who have warned for months about the harmful economic impact of allowing the cuts to proceed. Nobody is particularly happy about it. President Obama and congressional Democrats have sounded the alarm most urgently. ... During the negotiations that produced the sequester, Democrats successfully pushed to exempt most forms of politically sensitive entitlement spending from the automatic cuts. As a result, Social Security, Medicaid, veterans' benefits, unemployment insurance, and food stamps will not see any reduction in funding. Medicare beneficiaries were also spared the axe, while Medicare providers will see only a 2 percent reduction in payments. Mr. Obama's healthcare bill, some recall, also opted to slash payments to Medicare providers in lieu of targeting beneficiaries (Miller, 3/1).

Medscape: Medicare Pay Cut From Sequester To Go Into Effect March 1
The US Senate rejected two competing proposals today that would have replaced the "sequester" — $85 billion worth of automatic, across-the-board budget cuts set to take effect March 1. Barring some last-minute rescue, that means Medicare reimbursement for physicians and other healthcare providers will decrease by 2%. The scheduled 2% reduction in Medicare reimbursement to physicians and other providers presumably would apply to all services rendered, beginning March 1. The Centers for Medicare & Medicaid Services had no comment as yet on how the pay cut would be implemented (Crane, 2/28).

Kaiser Health News: Hospital Executive Bracing For Budget Cuts Says 'We Need To Deal With Medicare'
David P. Blom is one of thousands of hospital executives across the country who are bracing for a reduction in Medicare payments as part of a series of federal spending cuts that begin Friday. Blom, 58, is president and chief executive officer of OhioHealth, a Columbus, Ohio, based not-for-profit health care system that includes 18 hospitals, 23 health and surgery centers, home-health providers and other facilities (Carey, 3/1).

USA Today: Interest Groups Barrage Congress With Sequester Pleas
Hematologists are sending tweets to members of Congress, warning that looming cuts to federal research funding threaten to slow medical advances for diseases such as sickle-cell anemia and lymphoma. … Hundreds of elected officials from cash-strapped counties will swarm Capitol Hill in the coming days to decry reductions to federal grant programs that help fund everything from libraries to sewage systems. Public-sector unions began running television ads in in seven cities Thursday that target Republicans and warn of financial pain for millions. Lobbyists and interest groups representing almost every corner of the country have spent months and millions trying to forestall what now seems inevitable: automatic across-the-board cuts totaling an estimated $85 billion that will kick in starting Friday without action by Congress and the White House (Schouten, 2/28).

Kaiser Health News: Medical Research, FDA And Mental Health Programs Face Budget Bite 
Doctors serving Medicare patients. Scientists looking for a better way to treat diabetes. HIV patients who can’t afford to buy their medications. These are but some of the many people who will be affected by the automatic federal spending cuts that officially take effect today (Carey, 3/1).

Oregonian: Oregon Health & Science University Freezes Hiring, Citing Federal Cuts
Oregon Health & Science University officials will largely freeze hiring in response to looming federal cuts that could mean a $32 million budget hit to one of the state's largest employers. Triggered by a Congressional failure to reach agreement on debt reduction, the cuts are scheduled to kick in on Friday, Mar 1, trickling down to OHSU. The cuts will carve at least 10 percent from the university's federal research funds, and hurt Medicare revenue as well. "I think that like everyone else we hoped it would not come to this," said OHSU President Joe Robertson. The university employs more than 14,000 people with a payroll of more than $900 million. The OHSU hiring freeze and other cuts, including to travel and consultants, will be focused on education programs and research to preserve its hospitals and clinics, Robertson said: "The quantity and quality of our health care will remain unchanged" (Budnick, 2/28).

Baltimore Sun: Sequestration Will Hit Health Care In Maryland
The chief financial officer at Anne Arundel Medical Center is watching the fight over federal spending closely. If the federal government goes through with sequestration cuts beginning today, Maryland stands to lose millions of dollars in health-related funding that could leave hospitals such as Anne Arundel Medical Center looking for ways to make up lost revenue without weakening medical care. "We're here for the community and, like all hospitals, we are here 24/7 and will not jeopardize the care of patients," said Bob Reilly, the Annapolis hospital's finance director. "We'll have to look elsewhere — back office or other support functions — and not impact patient care" (Walker, 2/28).

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Health Reform

Health Law Implementation Likely To Proceed - Despite Sequester's Cuts To Other Health Programs

Meanwhile, news outlets report on how the health law is "reshaping" the health care marketplace and how the measure's medical device tax continues to be a point of contention.

Politico: Friends And Foes Expect Obamacare Rollout Amid Sequestration
The Obama administration has issued ample warnings how the sequester can have dire effects on health programs. Official talk about fewer vaccines, cuts in medical research grants, less money to treat HIV, fund cancer screenings or respond to outbreaks. But they haven't been issuing a lot of warnings about how it's slowing down the rollout of Obamacare. Because sequester or no sequester, the administration is trying to keep work on the core elements full steam ahead (Norman, 3/1).

The Wall Street Journal: Another Big Step In Reshaping Health Care
Hospitals and health insurers are locking horns over how much health-care providers will get paid under new insurance plans that will be sold as the federal health law is rolled out. The results will play a major role in determining how much insurers will ultimately charge consumers for these policies, which will be offered to individuals through so-called exchanges in each state. The upshot: Many plans sold on the exchanges will include smaller choices of health-care providers in an effort to bring down premiums (Mathews and Kamp, 2/28).

KHN's related coverage: Tenet Shows Hospitals Will Cut Prices For Exchange Patients — But Only So Much (Hancock, 2/28).

Reuters: Trade Group Identifies Medical Device Makers Passing On Federal Tax
Some medical device manufacturers are trying to pass on the cost of the new federal tax on medical devices to hospitals, and a trade group on Thursday said it has launched a website to identify those companies publicly. Congress imposed the 2.3 percent tax on the manufacturers as part of the Affordable Care Act. It is expected to collect more than $30 billion over the next decade to help extend healthcare coverage to millions of Americans who would otherwise be uninsured (Sherman, 2/28).

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Medicaid Expansion In The States: Who's In? Who's Out?

The tally continues to change regarding the governors who have said they will pursue the health law's Medicaid expansion. Most recently, Alaska Gov. Sean Parnell said he is opposed to it, while Pennsylvania Gov. Tom Corbett appears to be on the verge of reversing his position against the expansion. And, in Ohio, Gov. John Kasich is looking for allies to convince Republicans in the state legislature to follow his lead.

The Associated Press: Parnell Opposed To Medicaid Expansion Now
Alaska Gov. Sean Parnell said Thursday he is opposed to expanding Medicaid in the state, given what he knows about the federal budget. Parnell told reporters he will not ask the Legislature this session for funding or authorization to expand the program. He said he will continue to study the issue, with his next decision point coming when he submits his next budget in December (Bohrer, 2/28).

Politico: Tom Corbett May Be On Verge Of Medicaid Reversal
Pennsylvania Gov. Tom Corbett is feeling the Medicaid squeeze. A Republican governor of a Democratic state, Corbett has railed against the health law's massive Medicaid expansion and omitted it from his proposed budget. But all around him, governors are opting in — including Republicans John Kasich just west of him in Ohio and Chris Christie just east in New Jersey (Cheney, 2/28).

The Associated Press: Kasich Sees Medicaid Ally In Backers Of Food Banks
Gov. John Kasich implored supporters of the state's food banks Thursday to help him convince his fellow Republicans in the legislature to extend Medicaid coverage to thousands of low-income Ohio residents…The GOP controls both chambers of the legislature, whose approval Kasich needs to expand coverage under the taxpayer-funded health insurance program (Sanner, 2/28).

Health New Florida: Medicaid Expansion: Not A Done Deal
A week ago, Gov. Rick Scott made a surprising announcement that he will support one of the key parts of the Affordable Care Act: the expansion of Medicaid coverage to about 1 million Floridians. He was the seventh Republican governor to do so; Chris Christie of New Jersey became No. 8 this week. On a color-coded Medicaid expansion map published and updated by The Advisory Board, a consulting company, Florida shows up as one of 24 blue states -- a "yes." (Another four are leaning yes; so the positives outnumber the negatives 28 to 16.)…It may be a BIG deal, but it's not a DONE deal (Gentry, 2/28).

The Washington Post's WonkBlog: Interview: Sen. Rockefeller On The Future Of Obamacare
On Tuesday, Sen. John J. Rockefeller (D-W.Va.) chaired a Commerce Committee hearing on the Affordable Care Act's summary of benefits and coverage provision, which requires insurance companies to summarize all benefits in a standardized, four-page document. It's something akin to a nutrition label for health insurance. We spoke afterward about that part of the law, as well as the Medicaid expansion, the possibility of rate shock and why he isn't worried about getting Americans enrolled in health law programs. What follows is a transcript of our conversation, edited for length and clarity (Kliff, 2/28).

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State Lawmakers Consider Bills To Establish Health Exchanges

Also in the news, data indicate the federal government will ultimately be running the insurance marketplaces for the states that have the highest rates of uninsured residents.

The Associated Press: Health Exchange Bill Runs Into Trouble In House
A measure to establish a state-operated health insurance exchange stumbled in the [New Mexico] House on Thursday after critics objected that the proposal would overly regulate medical coverage plans offered to consumers. The bill initially failed in the House on a 39-30 vote - with eight Democrats opposing it. However, the measure was immediately revived and set aside, which will give majority Democrats a possible chance for another vote at a later date if they can round up more support or after making changes to meet some of the concerns of critics, including Republican Gov. Susana Martinez (Massey,2/28).

The Associated Press: Michigan House OKs $31M Grant For Health Exchange
Rejecting pressure from conservatives, the Republican-led Michigan House voted Thursday to spend a $31 million federal grant for an online health insurance marketplace called for by the federal health care law. The 78-31 vote clears the way for the Senate to vote next week (Eggert, 2/28).

CQ Healthbeat: Federal Exchange To Handle States With Most Uninsured, Data Shows
At a time when federal officials are struggling to find the money to implement the health care law, it's clear from new data that it will be up to them to run the new exchange marketplaces in the states with the most uninsured Americans. New data from Enroll America, established to boost coverage levels under the health law, show that 13 states account for two-thirds of the uninsured population (Reichard, 2/28).

In other state-level news related to the health law's implementation -

The Associated Press: California Lawmakers Move Forward On Health Insurance Law
California lawmakers took the first step Thursday toward passing new consumer protections, such as guaranteeing coverage even with pre-existing conditions, under the federal health care overhaul. Democrats in both houses of the Legislature passed bills dealing with individual insurance regulations that would prevent insurers from discriminating and overcharging customers. The bills, ABx1 2 by Assemblyman Richard Pan, D-Sacramento, and SBx1 2 by Sen. Ed Hernandez, D-West Covina, also seek to ensure quality health coverage (3/1).

The Associated Press: Panel Backs Health Coverage For Part-Time Workers
Members of a Florida House panel reluctantly agreed Thursday that they would rather extend health coverage to part-time employees than pay a roughly $300 million fine under President Barack Obama's federal health care law. Residents and businesses are required to purchase health insurance under the Affordable Care Act or face a fine, and the state of Florida, which employs roughly 170,000 people, is also included in that mandate (Kennedy, 2/28).

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Capitol Hill Watch

GOP Bills Would Kill Health Law's Employer Mandate

The legislation, which has little chance of passage, would undo requirements that large employers offer workers insurance or pay a fine. Meanwhile, two Senate committees examine changes to Medicare.

The Hill: Bills Would Halt Health Law's Employer Mandate
House and Senate bills introduced Thursday would kill a key provision of President Obama's healthcare law — the mandate that most employers must offer health benefits to workers. The legislation was introduced by prominent Republicans, who called the requirement a "job killer” (Viebeck, 2/28).

CQ Healthbeat: Health Care Policies Focusing On Quality Instead Of Volume, Official Says
Policies aimed at moving the health care delivery system toward a focus on value rather than volume of services are showing signs of progress, an Obama administration official told the Senate Finance Committee on Thursday. Jonathan Blum, the head of Medicare at the Centers for Medicare and Medicaid Services, pointed to four pieces of information that he said are reasons for optimism. But Finance Chairman Max Baucus indicated that he wants his panel to be kept in the loop as the new efforts are implemented and to work out a system to share interim results (Attias, 2/28).

Medpage Today: Big Incentives Needed For Health Change, Senators Told
Healthcare providers won't implement delivery system reforms imposed by Congress and Medicare unless the incentives to change are strong enough, a health policy expert told Congress. "There [have] to be financing systems [such] that it's very much in the organization's interest to improve care and improve efficiency," David Goodman, MD, co-principal investigator of the Dartmouth Atlas of Health Care in Hanover, N.H., told members of the Senate Special Committee on Aging Wednesday afternoon. … Healthcare payers and providers are trying to figure out what those incentives should be and how strong to make them; many are experimenting with new models like accountable care organizations (ACOs), according to testimony from witnesses at the hearing, which was aimed at discussing ways to control Medicare costs while improving care (Pittman, 2/28).

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Health Care Marketplace

Hip Implant Safety At Issue In High-Stakes Trial

Los Angeles Times: J&J Gambled On Hip Implant Safety, Lawyer Alleges
Healthcare giant Johnson & Johnson played "Russian roulette" with patient safety by ignoring high failure rates and surgeons' complaints about its once-popular artificial hip, a Los Angeles jury was told during closing arguments at a high-stakes medical trial for the company. Jurors heard arguments from both sides Thursday in a case that pits the world's biggest seller of medical products against Loren Kransky, a 65-year-old former prison guard in Montana who claims he suffered metal poisoning and other health problems from the company's ASR XL hip implant he received in 2007 (Terhune, 2/28).

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Health Information Technology

Improvements Needed To Safeguard Medical Records

Medpage Today: Better Safeguards Urged For Medical Records
Hacking into patient medical records can be as easy as tapping into a hospital's unsecured wireless network from a laptop in the parking lot. Government auditors proved it "by sitting in hospital parking lots with simple laptop computers" and obtaining "patient information from unsecured hospital wireless networks," according to Julie K. Taitsman, M.D., J.D., and colleagues from the Office of the Inspector General at the Department of Health and Human Services (HHS). … Nearly 300,000 Medicare beneficiary numbers have been compromised and are now being tracked by the Centers for Medicare and Medicaid Services, according to the article. The HHS' Office for Civil Rights has received more than 77,000 complaints about health information breaches. The office has been able to take action in 18,000 cases stemming from 27,000 investigations, the authors said (Struck, 2/28).

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State Watch

Idaho Lawmakers Consider Allowing Doctors To Order Teens With Severe Mental Illness Held

In Idaho, doctors and advanced nurses soon may be able to commit teens with severe mental illness into temporary custody.

The Associated Press: Idaho House Panel Approves Teen Mental Health Custody Bill
Physicians and nurse practitioners soon may have the authority to order juveniles who are suicidal, severely mentally ill or pose a threat to others into temporary custody at a hospital or some other health care facility. A bill approved Thursday by the House Health and Welfare Committee sets out to fix a void in Idaho law and streamline a process that now requires law enforcement involvement (2/28).

Lawmakers in Texas are also considering changes to their mental health program: greater funding to treat mental illness and more training for their teachers --

The Associated Press: Texas Lawmakers Hear Mental Health Concerns
Advocates for enhanced mental health care are taking their cause to the [Texas] state Capitol. At an outdoor rally on Thursday, a bipartisan group of lawmakers spoke in support of more funding for treatment programs. According to the Kaiser Family Foundation, Texas spends $39 per capita on mental health services every year compared to a national average of $121. Only Idaho spends less (Brick, 2/28).

The Texas Tribune: Senator Would Fund Mental Health Training For Teachers
State Sen. Charles Schwertner, R-Georgetown, filed legislation Thursday that would provide mental health training to Texas teachers. The latest in a series of proposals at the Legislature aimed at improving school safety in the wake of the school shooting in Newtown, Conn., it focuses on mental health rather than beefing up security. Senate Bill 955, coauthored by several state senators, would provide state funds for Mental Health First Aid training to Texas teachers who volunteer (Chammah, 2/28).

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Ark. Lawmakers Override Veto Of Bill Banning Most Abortions After 20 Weeks Of Pregnancy

Arkansas' Republican-controlled Senate voted to override Democratic Gov. Mike Beebe's veto of a bill that will ban most abortions after 20 weeks of pregnancy. The chamber also approved a bill -- and sent it to Beebe -- that would ban most abortions when a fetal heartbeat can be detected -- typically after 12 weeks of pregnancy.

Reuters: Arkansas Bans Most Abortions After 20 Weeks Of Pregnancy
Arkansas joined seven other U.S. states on Thursday in banning most abortions after 20 weeks of pregnancy as the Republican-controlled state Senate voted to override a veto of the legislation by Democratic Governor Mike Beebe. Arkansas senators also gave final approval to a proposal that would ban most abortions once a fetal heartbeat could be detected by a standard ultrasound, or about 12 weeks into pregnancy, and forwarded that bill to Beebe (Parker, 2/28).

Politico: Arkansas Legislature Passes 12-Week Abortion Ban
The Arkansas Legislature has approved the earliest abortion ban in the nation. And it’s now up to Democratic Gov. Mike Beebe to decide what to do next. If he vetoes the bill, his veto could be overridden by a simple majority in the Republican Legislature as it was earlier Thursday on a similar 20-week abortion ban bill. The Arkansas Senate gave final approval Thursday morning to the Human Heartbeat Protection Act, which would ban abortions at 12 weeks into pregnancy if a heartbeat is detected, with exceptions for cases of rape or incest, to save the life of the mother or for a lethal fetal condition. The bill now goes directly to Beebe (Smith, 2/28).

Elsewhere, South Dakota and Oklahoma consider legislation that would also affect abortion or contraception:

Reuters: South Dakota Extends Abortion Wait Period For Weekends, Holidays
The South Dakota Senate on Thursday passed a bill affecting abortion waiting times that could potentially make them the longest in the country. The bill, passed by a 24-9 vote in the Republican-controlled Senate, would exclude weekends and holidays from the calculation of a 72-hour waiting period for an abortion (2/28).

The Associated Press: Okla. House 'Morning-After' Pill Vote Delayed
The Oklahoma House delayed a vote Thursday on a bill that would prohibit the state's Medicaid authority from paying for emergency contraception coverage, after Speaker T.W. Shannon raised concerns that his proposal might jeopardize the program's federal funding. Shannon's proposal would prevent the Oklahoma Health Care Authority, which oversees the state's SoonerCare Medicaid program, from covering the use of the so-called "morning-after" pill. Many conservatives say they consider the pill's use to be an abortion and don't want the state supporting it (2/28).

Issues in Virginia and Texas are also explored --

Politico: Anti-Abortion Group Susan B. Anthony List Endorses Ken Cuccinelli
The anti-abortion group Susan B. Anthony List endorsed Virginia Attorney General Ken Cuccinelli in the state's gubernatorial race, committing $1.5 million to the Republican candidate’s campaign and in the process drawing criticism from Democrats. The SBA List's $1.5 million is the biggest financial commitment so far in the race, and could give Cuccinelli a boost with more than eight months to go until Election Day (Schultheis, 2/28).

The Texas Tribune: Restoring Family Planning Services Through Primary Care
The fight to restore family planning financing that was cut from the Texas budget in the last legislative session has taken a turn toward primary care. Republican state senators have proposed adding $100 million to a state-run primary care program specifically for women’s health services, an effort that would help avoid a political fight over subsidizing specialty family planning clinics (Aaronson, 3/1).

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D.C., N.Y. Hospitals Consider New Team-Ups, Merger

Health systems and hospitals in Washington and New York City are joining forces: In Washington, health systems are forming a bond they say will improve pediatric care. In New York, a merger of hospitals is proposed.

The Washington Post: Children's, Inova Form New Group Of Pediatric Specialists In Northern Virginia
Children's National Medical Center and Inova Health, two of the Washington area's largest health systems, are forming a new organization to give families in Northern Virginia more direct access to doctors who treat specialized children's illnesses, including cancer, genetic disorders and bone problems, officials said (Sun, 2/28).

Kaiser Health News: Hospital Consolidation Dance Heats Up In NYC
The health care game of musical chairs is picking up speed in New York City, one of the most competitive markets in the country. The Mount Sinai Medical Center and Continuum Health Partners announced today that their boards of trustees have reached a tentative agreement on a possible merger (Gold, 2/28).

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State Roundup: Ga. Considers Novel Malpractice Reform

A selection of health policy news from Massachusetts, New Hampshire, Georgia, Connecticut, Texas, Kansas and California.

WBUR/Kaiser Health News: Mass. Weighs Governor's Plan To Tax Candy And Soda
Are candy and soda food? In Massachusetts, candy and soda are considered food and are exempt from the state's 6.25 percent sales tax. But Gov. Deval Patrick wants to change that. He's proposing that the legislature tax every bag of M&M's and bottle of Pepsi bought in the state (Bebinger, 3/1).

The Associated Press: NH Health Group Oppose Higher Smoker Premiums
Several health advocacy groups are opposing a bill aimed at bringing New Hampshire's insurance laws in line with President Barack Obama's health overhaul plan because they disagree with a provision that would allow insurers to charge smokers thousands of dollars more for coverage. State law already allows insurers to make tobacco use a factor in setting rates for individual insurance plans (Ramer, 2/28).

Georgia Health News: Two Malpractice Bills Stir Passions Under Dome
Proposed changes to Georgia's medical malpractice system consumed a marathon Senate committee hearing Wednesday, as nursing home representatives, physicians, lawyers and patient advocates battled over two bills breaking late in the General Assembly session. The first bill would promote the signing of voluntary agreements that would send nursing home patients' injury claims to arbitration. The second bill proposes a novel type of tort reform that would shift the process of pursuing injury claims to a system modeled after workers' compensation. Both pieces of legislation are nearing a de facto deadline. A bill must pass at least one chamber by Crossover Day -- expected to be Thursday -- in order to have a shot at becoming law (Miller, 2/28).

CT Mirror: Hospitals Warn Budget Cuts Will Cut Jobs And Services -- Maybe Close Doors
For Connecticut hospitals, the good news is their patient caseloads have grown dramatically since 2009. The bad news is those are Medicaid patients, and government payments don't cover the full cost of treatment. And then there's really bad news: Gov. Dannel P. Malloy would cut their state funding by one-fifth over the next two years. Put it all together, hospitals say, and at best, they will cut jobs and services. At worst, some will shut their doors. And facilities in the state's poor northeastern corner say they are particularly at risk (Phaneuf and Gambina, 3/1).

The Texas Tribune: TribLive: A Conversation About Health Care
Full video of Emily Ramshaw's 2/27 TribLive conversation about health care with state Rep. John Zerwas, R-Simonton, and state Sen. Charles Schwertner, R-Georgetown (Smith, 2/28).

Kansas Health Institute: House Approves Six Health Bills, Four More Up Before Friday Deadline
Six health-related bills were approved today by the state House (Cauthon, 2/28).

California Healthline: School-Based Wellness Centers Making The Grade In Los Angeles
Timing may be just right for 14 wellness centers and networks that will operate in Los Angeles schools by 2014, all offering prevention, education, early intervention, and screening to students and their families. L.A.'s school-based clinics, planned before the Affordable Care Act took effect, dovetail with reforms spelled out in the new law and take the idea of school-based health care one step further by teaming up with community clinic and mental health providers who will work not only with students, but with family members as well (Stephens, 2/28).

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Editorials and Opinions

Viewpoints: A Failure To Govern; Democrats 'Moved The Goal Posts' In Va. Deal On Medicaid Panel; Hospitals 'Squeeze' The Uninsured

The Washington Post: Washington Fails To Govern, As Sequester Arrives
To govern is to choose. By missing Friday's deadline for averting $85 billion worth of across-the-board spending cuts to defense and domestic programs, Congress and President Obama have chosen not to govern. Instead, each side has concluded that its interest lies in letting the "sequester" proceed as scheduled — and then trying to win the political blame game (2/28).

The New York Times’ Opinionator: Breaking Down The Budget Mess
[T]he spending reductions mandated by the sequester legislation are confined to a group of programs representing less than half of the budget, as shown in chart 1. Even within this select group, all programs are not alike. Medicare is slated to be trimmed by only 2 percent, while a 7.9 percent reduction will be imposed on the military. Nondefense discretionary spending – everything from education aid to research grants – will be reduced by 5.3 percent (Steven Rattner, 2/28).

Los Angeles Times: The All-Pain, No-Gain 'Sequester'
Republicans like to say Washington has a spending problem, but they confuse the current recession-driven budget gap with the long-term, structural issues. The titanic deficits of Obama's first term are already shrinking, and the gap will continue to narrow as the economy regains strength. But even vigorous economic growth won't solve the longer-term fiscal problems caused by the ever-increasing cost of healthcare entitlements such as Medicare and by an aging population that will require fewer workers to support more retirees. That's why Washington needs to adopt a plan that phases in solutions to the long-term problems as the economy grows stronger. That's not what the sequester will do (2/28). 

USA Today: Cut Federal Spending In A Smart Way: Our View
Virtually all the sequester's cuts are concentrated in the one-third of the budget that funds core government services. The cuts are front-loaded, with the biggest impact coming in the early years. And they give federal departments little flexibility on how to impose them. This will be a drag on the economy and bring significant headaches in select areas — such as air traffic control, food inspection and immigration enforcement — where government is already stretched thin. And the surging cost of entitlements, such as Medicare and Social Security, guarantees the sequester won't do that much to reduce the deficit (2/28). 

USA Today: Sequestration Will Restore Balance: Opposing View
Government overspending is the greatest threat to economic prosperity we face today. After four years of unprecedented trillion dollar deficits, Washington politicians are complaining that the sequester cuts are going to slow the growth of the federal budget by a mere two cents on the dollar. … These modest cuts are an important step forward for economic growth. While perhaps painful at first, they will restore some balance to our fiscal system, allowing government to prioritize properly and function in line with the American people (Tim Phillips, 2/28). 

The Wall Street Journal: Obamageddon
If you're reading this after midnight on Friday, March 1, the dreaded Beltway hour of doom known as the "sequester" has arrived and the news is that the world has not ended. You can pinch yourself to make sure. This does not mean there won't be more political histrionics, but the beginning of applying reason to Washington is understanding that it is possible to cut at least some federal spending (2/28).

Bloomberg: Why Democrats Must Get Smart On Entitlements
In a season of depressing budget news, the worst may have been that a majority of U.S. House Democrats signed a letter urging President Barack Obama to oppose any benefit cuts to Social Security, Medicare, Medicaid and other entitlements. That's the last thing we need. To hold the line on harmful cuts to discretionary spending, Obama and the Democrats must educate the public about the necessity of entitlement reform. Otherwise, the poor and needy -- largely spared by the automatic reductions under sequestration -- will get hit much harder down the road (Jonathan Alter, 2/28). 

Boston Globe: Baby Boomers Are The Economy's 'Oh, No!'
Over the longer term, which (Alan) Blinder defines as the 2020s, 2030s, and beyond, the picture gets considerably grimmer. Mind you, that’s not because of new spending by President Obama. Rather, it's largely due to the increasing number of baby boomers who will be tapping Medicare or Medicaid, and to the growing interest payments on our burgeoning national debt. There are some lessons here for both sides of the political aisle (Scot Lehigh, 3/1).

San Francisco Chronicle: Time For Long View On Federal Deficit
Many Americans no doubt wonder how a 2.4 percent cut in a $3.6 trillion budget can create so much havoc. The answer shows the cost of avoidance and denial. The so-called sequester exempted more than 60 percent of all federal spending -- most notably Medicare, Medicaid and Social Security benefits. It also concentrated the cuts to the last seven months of the fiscal year, thanks in part to the kick-the-can deal to avoid the Jan. 1 "fiscal cliff" (2/28).

Roll Call: Durkin: 'Primary Prevention' Two Important Words For Policymakers
Just two words: primary prevention. They aren't heard much in the ongoing health care debate. They haven’t caught on as political buzz words on Capitol Hill. They didn't find their way among the utterances that grabbed our attention during the 112th Congress. But they are the very foundation on which a revitalized U.S. health care system must be built. Not to be confused with health screenings and early diagnosis — which do matter in the effective treatment of many illnesses — primary prevention encompasses healthy lifestyle practices that deter diseases before they start. This is where we save lives, improve quality of life and avoid preventable health care spending (Helen Durkin, 2/28).

The Wall Street Journal: Dominion State Disaster
Liberals don't become more reasonable in their demands for spending increases when Republicans give them more revenues. They become much less so. When Senate Democrats in Richmond realized that Mr. McDonnell would stop at nothing to get his "legacy" transportation tax increase enacted, and that he couldn't do it without their votes, they moved the goal posts. Democrats added a demand that Mr. McDonnell drop his opposition to the Medicaid expansion in Virginia under ObamaCare. Mr. McDonnell, who just two days earlier swore that he would not allow the expansion without substantial reforms, was so far out on the limb on taxes that he caved to the Democrats and agreed to kick the Medicaid issue to a commission, which almost certainly will approve the ObamaCare expansions. All this to get Democratic votes for a tax increase they long sought (Stephen Moore, 2/28).

The New York Times: Economix: Shocked, Shocked, Over Hospital Bills
Americans are shocked, just shocked. But what they should have known for years is that in most states, hospitals are free to squeeze uninsured middle- and upper-middle-class patients for every penny of savings or assets they and their families may have. That's despite the fact that the economic turf of these hospitals – for the most part so-called nonprofit hospitals – is often protected by state Certificate of Need laws that bestow on them monopolistic power by keeping new potential competitors at bay (Uwe E. Reinhardt, 3/1).

Health Policy Solutions (a Colo. news service): Arkansas Deal With HHS On Medicaid Expansion A Model For Colorado
New results from Arkansas suggest that Colorado officials who favor Medicaid expansion may be able to negotiate a better deal for both low-income people and state taxpayers. Arkansas Gov. Mike Beebe has negotiated an alternative to the standard Medicaid expansion offered by the U.S. Department of Health and Human Services under Obamacare. Health and Human Services has agreed that Arkansas can pay premiums for commercial insurance purchased through the state's health insurance exchange using the federal funding that would have gone to expand Medicaid. The program will extend commercial coverage to adults earning up to 138 percent of the federal poverty level. New reports say Arkansas can opt out and return to regular Medicaid at any time (Linda Gorman, 2/28).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Marissa Evans

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.