Daily Health Policy Report

Monday, March 11, 2013

Last updated: Mon, Mar 11

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Q&A: I Have A Pre-Existing Condition, Where Can I Get Health Insurance? (Video)

Kaiser Health News consumer columnist Michelle Andrews answers a reader question about insurance options for people with pre-existing conditions (3/11). Watch the video.

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Capsules: GOP Senators Seek To Cut Health Law Funding

Now on Kaiser Health News' blog, Mary Agnes Carey reports: "This week, the Senate is expected to consider – and amend — House-passed legislation that would fund the government through the end of the fiscal year. The bill did not include $949 million in additional funding that the Office of Management and Budget requested for the Centers for Medicare and Medicaid Services, which is overseeing much of the roll-out of the health law. … While the OMB request did not specify what the $949 million would fund, 'it was pretty well known' that the money was to be used to implement the health law's exchanges, said Matt Dennis, a spokesman for Rep. Nita Lowey, D-N.Y., ranking member of the House Appropriations Committee" (Carey, 3/11). Check out what else is on the blog.

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Political Cartoon: 'Outrageous Fortune?'

Kaiser Health News provides a fresh take on health policy developments with "Outrageous Fortune?" by Rex May.

Meanwhile, here is today's health policy haiku:

GRAB YOUR PARTNER?

Ryan, budgetgrand
bargain do-si-do
drags on,
when will music stop?
-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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Capitol Hill Watch

Dueling Budgets Will Show Partisan Differences On Medicare And Medicaid

At the same time, President Barack Obama appears to be harboring hopes of reaching a big deficit-reduction deal that could include some of the money-saving changes that Republicans favor. The idea worries some congressional Democrats.

The Wall Street Journal: Opening Budget Bids Set Parties' Battle Lines
Congress opens a new chapter in the budget debate this week with the introduction of dueling blueprints from two lawmakers who illustrate their parties' vastly different approaches to the role of government. … (Rep. Paul) Ryan's budget will include no new tax increases or Pentagon cuts while advancing big changes to Medicare and Medicaid, all with the goal of erasing the annual federal deficit in 10 years. (Sen. Patty) Murray's plan is expected to increase taxes on upper-income households and corporations and make modest spending cuts to domestic programs; it wouldn't balance the budget anytime soon (Hook and Peterson, 3/10).

The New York Times' Political Memo: In Search Of Debt Deal, Obama Walks A Narrow Path
President Obama will go to Capitol Hill this week to try to salvage a big deficit-reduction deal, battling not only Republican resistance but also complaints from Democrats that he mishandled his last attempt. … White House aides have not ruled out some money-saving structural reforms to Medicare that Republicans favor, notably an idea promoted by the House majority leader, Eric Cantor, to combine the program's doctor and hospital components with a single deductible for beneficiaries. Using savings from entitlement shifts like that to replace sequestration, as the automatic cuts are called, would meet Republicans' demands not to use tax increases for that purpose (Stevenson and Harwood, 3/10).

Politico: Democrats Not Sold On A Safety Net Bargain
The talk of any deal with congressional Republicans — and for now, it's just that: talk — has liberals worried the White House will give in to changes to safety net programs including Medicare, Medicaid and Social Security (Nocera, 3/10).

In other budget news -

The Washington Post: Research Ties Economic Inequality To Gap In Life Expectancy
The tightening economic connection to longevity has profound implications for the simmering debate about trimming the nation's entitlement programs. Citing rising life expectancy, influential voices including the Simpson-Bowles deficit reduction commission, the Business Roundtable and lawmakers on both sides of the aisle have argued that it makes sense to raise the eligibility age for Social Security and Medicare. But raising the eligibility ages — currently 65 for Medicare and moving toward 67 for full Social Security benefits — would mean fewer benefits for lower-income workers, who typically die younger than those who make more (Fletcher, 3/10).

The New York Times: Cuts Give Obama Path To Create Leaner Military
But the next set of cuts will be much harder, because they involve huge constituencies — in Congressional districts, inside the military services and among veterans' groups. "The problem is that the biggest, most-needed cuts are in programs that also have the broadest set of defenders," said Maren Leed, the director of the defense policy studies group at the Center for Strategic and International Studies in Washington and a former top aide to Gen. Ray Odierno, now the Army's chief of staff. The most obvious examples of those problems come in base closings and higher co-payments or premiums for the beneficiaries of Tricare, the military's sprawling health care program, which costs upward of $51 billion a year (Sanger and Shanker, 3/10).

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With Budget, GOP Lawmakers Renew Push To Undo Health Law

The budget plan for 2014 being advanced by Rep. Paul Ryan, R-Wis., includes a proposal to give states more authority over Medicaid. Meanwhile, the bill being considered by the Senate to fund the federal government through the end of this year does not include the funds for the exchanges that the administration wanted.

The Washington Post: Ryan Calls For Both Obamacare Repeal And Finding 'Common Ground' In Budget Fight
Past House Republican efforts to repeal the president's health-care law failed, and the Supreme Court upheld the constitutionality of the law last year. Ryan's budget proposal, which includes controversial proposals for giving states more authority over Medicaid, is sure to encounter stiff resistance from Democrats in Congress who are committed to protecting Obamacare. That push back is likely to complicate Obama's efforts this week to advance a dialogue he reopened with Republicans last week on reaching a grand bargain on budget cuts and entitlement reform (Brown and Sullivan, 3/10).

Roll Call: Budget Chairman Ryan Projects Balance Through $5 Trillion In Spending Cuts, Medicare Shift
The House Republican budget will balance the budget over 10 years in part by cutting spending by about $5 trillion and turning Medicare into a premium support program, Rep. Paul D. Ryan said Sunday. The Wisconsin Republican, whose previous budget resolutions have been signposts for GOP economic policy priorities, said the fiscal 2014 plan that he will release Tuesday will not need to make dramatic changes from previous proposals because of improved economic circumstances (Ethridge, 3/10).

Los Angeles Times: Republicans Resume Effort To Repeal 'Obamacare'
Republicans in Congress are renewing their political assault on the nation's new healthcare law, trying to repeal President Obama's signature domestic achievement as part of the next battle over the federal budget (Masacaro, 3/10).

CNN: Ryan Says House GOP Budget Will Include Obamacare Repeal
House Budget Committee Chairman Paul Ryan says the budget he will unveil this week counts on a repeal of President Barack Obama's signature health reform law, a position which is unacceptable to many Democrats and unlikely to become law. Asked on "Fox News Sunday" about the political reality that a repeal of Obamacare is unlikely, Ryan responded, "Well, we believe it should, that's the point. That's what budgeting is all about. … It's about making tough choices to fix our country's problems. We believe that Obamacare is a program that will not work." The Wisconsin Republican has taken aim at the program in previous budget proposals and on the 2012 campaign trail as the GOP vice presidential nominee (Wallace, 3/10).

Modern Healthcare: New Ryan Plan Sticks To Familiar Themes: ACA Repeal, Medicare Premium Support
Offering a sneak preview of the 2014 budget he will propose this week, House Budget Committee Chairman Paul Ryan (R-Wis.) said on the TV program Fox News Sunday that his fiscal plan—similar to his fiscal 2012 and 2013 blueprints—will promote repealing the 2010 healthcare law and transforming Medicare into a premium-support system. After Fox News Sunday host Chris Wallace confirmed with Ryan that the House GOP plan again assumes overturning the Patient Protection and Affordable Care Act, Wallace told Ryan: "That's not going to happen." Ryan didn't flinch when he replied that House Republicans think that it should (Zigmond, 3/10).

The Hill: Rep. Paul Ryan: House Budget Will Assume The Repeal Of 'ObamaCare'
House Budget Committee Chairman Paul Ryan (R-Wis.) on Sunday said he will not back down from the battle to repeal the 2010 Affordable Care Act even though some Republicans think the party should move on. Ryan dismissed criticism that House Republicans have virtually no chance of dismantling the signature legislative accomplishment of Obama’s first term and their efforts might be better expended elsewhere (Bolton, 3/10).

Meanwhile, the bill now before Congress to fund spending for the rest of 2013 has sparked some concerns.

Kaiser Health News: Capsules: GOP Senators Seek To Cut Health Law Funding
This week, the Senate is expected to consider – and amend — House-passed legislation that would fund the government through the end of the fiscal year. The bill did not include $949 million in additional funding that the Office of Management and Budget requested for the Centers for Medicare and Medicaid Services, which is overseeing much of the roll-out of the health law. … While the OMB request did not specify what the $949 million would fund, 'it was pretty well known' that the money was to be used to implement the health law's exchanges, said Matt Dennis, a spokesman for Rep. Nita Lowey, D-N.Y., ranking member of the House Appropriations Committee" (Carey, 3/11).

Politico: Senate Bill Won’t Include President Obama Priorities
Paying a price for his indifference, President Barack Obama is expected to get little or none of the extra money for health care and Wall Street reforms that the administration has been seeking in a six-month stopgap spending bill coming to the Senate floor this week. ... The White House had wanted $949 million added within the Department of Health and Human Services to help lay the groundwork for setting up state health-care exchanges to begin enrollment next fall (Rogers, 3/10).

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Some Republican Health Staffers Flee The Hill

Politico reports that some GOP health care staffers have left Capitol Hill to take lobbying jobs that offer more money, fewer hours and less frustration.

Politico: Frustrated GOP Health Staffers Jump Ship
If you want to see how frustrated Republicans are with health care, just look at their staffs. Since the election, one top Republican health policy staffer after another has fled the Hill for consulting and lobbying gigs that promise better pay, fewer hours and less obstructionism. ... It's been a bumpy few years for these staffers, most of whom participated in the health care law negotiations in 2009 and 2010, watched as Democrats passed the law without a single Republican's vote, stood by as their bosses continually tried — and failed — to ditch the law and saw GOP hopes for entitlement reform fall by the wayside (Cunningham, 3/8).

In other Congressional news, Sen. Marco Rubio, R-Fla., is pushing the Centers for Medicare & Medicaid Services to scale back proposed cuts to Medicare Advantage -

The Hill: Rubio Presses HHS To Soften Medicare Advantage Cuts
Sen. Marco Rubio (R-Fla.) pushed the federal Medicare agency on Friday to scale back its proposed cuts to private Medicare Advantage plans. The insurance industry is aggressively fighting the cuts, and has been looking for lawmakers to take up their case with the Centers for Medicare and Medicaid Services (CMS). Rubio urged CMS Friday to use different assumptions about how Medicare will pay doctors next year — a change that would almost certainly lead the agency to scale back its proposed 2.2 percent cut (Baker, 3/8).

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Health Reform

State Progress Report On Health Exchanges: More May Be Happening Than Expected

Politico reports some states that have been reticent or even opposed to setting up their own exchanges, like Ohio and Virginia, may be more hands-on than expected. Various reports from the Associated Press and MinnPost chart action in other states.

Politico: States Wrestle With New Obamacare Exchanges
Wanted: States to work on Obamacare health insurance exchanges. OK to keep it sort of hush-hush. More than half the states have declared they want nothing to do with setting up or running those health insurance marketplaces opening in their states later this year. But a closer look shows that at least a few of these states, like Ohio and Virginia, may have a larger role than they're letting on (Millman, 3/10).

CQ HealthBeat: Officials Have Different Views On States' Use Of Bargaining Power
Two longtime supporters of the health care law presented different views at a briefing on Friday of how insurance exchanges should be run. Jay Angoff, the former director of the federal Office of Consumer Information and Insurance Oversight, said that states should be aggressive in standardizing benefits and negotiating rates with insurance carriers. He worried that the widespread use of brokers could drive up rates (Adams, 3/11).

The Associated Press: NM Health Insurance Exchange Proposal Advances
A proposal to create a state-operated health insurance exchange is heading to the Senate with bipartisan support, including from Republican Gov. Susana Martinez. Supporters said Saturday the latest proposal was a compromise that will allow New Mexico to meet a deadline for having an exchange ready to enroll uninsured New Mexicans in October and be fully operating by January (Massey, 3/10).

The Associated Press: Conn. Pushes Ahead With Health Care Exchange
As one of the states furthest along in preparing to enroll patients this fall in the new health insurance marketplace, Connecticut has discovered that being first comes with some challenges. The staff at Connecticut's quasi-public exchange, known as Access Health CT, has had to build both an agency and an online health insurance marketplace from the ground up, relying on directives and guidance from the U.S. Department of Health and Human Services that can change or need to be clarified (Haigh, 3/11).

The Associated Press: Fight Over Health Insurance Exchange Not Over In Michigan
Gov. Rick Snyder's attempt for legislative approval of a new health insurance market in Michigan has been 1 ½-year odyssey — and it’s not over yet. The GOP-led Senate quickly got behind his state-run marketplace, or online exchange, in 2011 so the state could have more say in a key component of the federal health care law that will help people shop for required insurance. But House Republicans opposed to the law resisted throughout 2012, even after President Barack Obama’s re-election (Eggert, 3/11).

MinnPost: GOP Legislators Hope To Change Exchange Bill In Conference
Republican lawmakers continued pressuring Democrats on Friday to compromise with the GOP on the implementation of Minnesota’s health insurance exchange. The chambers of the DFL-controlled Legislature this week passed different versions of legislation to establish a state-based exchange along near party lines. Republicans have raised alarms about the Democrat-backed exchange since session began, and they say their concerns have largely been ignored (Nord, 3/8).

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Medicaid Expansion Triggers Flurry Of State Legislature Debates, Decisions

The Washington Post reports that Arkansas has discovered "wiggle room" regarding the expansion. Meanwhile, debates in state legislatures continue over what should happen in Arizona, Utah, California and Texas. And, in Pennsylvania, Gov. Tom Corbett plans a meeting with Health and Human Services Secretary Kathleen Sebelius.

The Washington Post: Arkansas Plan Shows That Health Care Law's Medicaid Expansion Leaves Flexibility For States
The Obama administration has taken a hard line with governors about an option to expand Medicaid under the new health law, telling them to take it or leave it — but leave it and lose access to millions of federal dollars. It turns out there is some wiggle room after all (Somashkhar, 3/9).

The New York Times: GOP In Arizona Is Pushed To Expand Medicaid
In the battle to get the Medicaid expansion being championed by Gov. Jan Brewer approved by the state's legislators, her closest advisers are hanging their hopes on the number eight. That is how many of the 17 Republicans in the State Senate they believe they can get on their side (Santos, 3/10).

The Associated Press: Utah Lawmakers Try To Prohibit Medicaid Expansion
Utah Gov. Gary Herbert is still waiting to decide whether to accept the federal government's offer to expand Medicaid, but a group of Utah lawmakers wants to let him know where they stand by passing a law prohibiting the expansion. Republican lawmakers say the expansion offers a "false promise" of federal support (3/11).

California Healthline: Floor Votes In Favor Of Expansion Bills
The state Assembly and Senate yesterday passed companion bills to expand Medi-Cal eligibility to more than one million Californians making up to 138 percent of federal poverty level. The bills also simplify the Medi-Cal enrollment process. "This bill takes an important step to make sure California remains a leader in health care reform," said Assembly Speaker John Pérez (D-Los Angeles), author of ABX1-1. "And this also helps bring billions of dollars in federal funds into California." The Senate passed its version of the legislation, SBX1-1, authored by Sen. Ed Hernandez (D-West Covina). The expansion will be fully funded with federal money for the first three years, declining to 90 percent in 2020 (Gorn, 3/8).

Los Angeles Times: Democrats, Brown At Odds Over Health Care Act
As Democratic lawmakers speed to implement President Obama's health care overhaul in California, they are finding themselves at odds with the leader of their own party: Gov. Jerry Brown. The governor and legislators disagree over how the state should expand Medicaid to more than 1 million low-income Californians, a critical component of the federal Affordable Care Act (Mishak, 3/9).

The Texas Tribune: Bill Grants HHSC Power To Address Medicaid Reform
State Rep. John Zerwas, R-Simonton, filed legislation Friday that would grant the Health and Human Services Commission authority to craft "a Texas solution" to Medicaid reform and negotiate with the Obama administration to draw down billions in federal financing to expand Medicaid services. As debate in the House Appropriations Committee on Medicaid expansion revealed Friday morning, the House remains divided on how Medicaid should be reformed and whether the program should be expanded. Currently, House Bill 3791 is a shell bill that will be altered as state legislators continue to negotiate how Medicaid should be reformed (Aaronson, 3/9).

The Associated Press: Corbett's Meeting With Sebelius About Medicaid Looms Large
Gov. Tom Corbett's top Department of Public Welfare official smiled and once again offered a variation of a statement that she had made countless times already in the past 24 hours to lawmakers pressing her for answers. "At this time we're moving down the path to look at all ways we can allow Pennsylvanians to have access to affordable, quality health care," Bev Mackereth [said]....That path will take Corbett to Washington to meet with U.S. Health and Human Services Secretary Kathleen Sebelius about whether Pennsylvania should undertake a massive expansion of Medicaid's health care coverage, largely to low-income adults, under the 2010 Affordable Care Act (3/10).

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State Health Law Implementation Efforts Trigger Confusion -- And Even Arguments

The Richmond Times-Dispatch reports that businesses continue to find some provisions of the law "bewildering" while the Milwaukee Journal-Sentinel offers a view on the size and scope of issues in play in Wisconsin.

Richmond Times-Dispatch: Businesses Find Health Care Law Bewildering
Part-time employees make up about a fifth of Virginia's workforce, and their employers usually aren't required to offer them health care coverage. But the federal health care reform is changing the playing field. Employees working 30 hours or more a week will count as full-timers under the new law and, as a result, they will be eligible for coverage, according to the Society for Human Resource Management. This will have the biggest impact on employers who do not provide coverage to part-time employees or who limit eligibility to only those part-timers who work more than 30 hours a week, the HR group said (Bacqué, 3/10).

Milwaukee Journal-Sentinel: Federal Health Care Law Continues To Create Arguments
The state would spend $76.5 million and hire 89 workers over the next two years to implement federal legislation such as the health care law, under Gov. Scott Walker's budget bill. That spending request shows just a part of the massive task -- encompassing everything from computer projects to consumer outreach -- that must be completed to expand coverage for the uninsured under the federal Affordable Care Act, sometimes called Obamacare. How well this implementation goes will have substantial effects on both the uninsured and state and federal taxpayers (Stein, 3/9).

The Hill: States Balk At $15B Obama Health Care 'Tax'
A newly unveiled component of President Obama’s health care law forcing insurers to pay annual fees is sowing angst in state capitols, where officials view the provision as a $15 billion tax that could disrupt Medicaid programs and other services. The health insurance providers fee, included in the health care reform law over the objections of congressional Republicans, is designed to raise tens of billions of dollars in the coming years (Goad, 3/8).

In other news --

Medpage Today: Health Reform: Costlier Than Planned?
Higher-than-expected costs for the Affordable Care Act's (ACA) preexisting condition risk pool are a sign that the law will cost more than first expected, according to some lawmakers and analysts. The Centers for Medicare and Medicaid Services (CMS) last month told states that it was suspending enrollment in the Pre-Existing Condition Insurance Plan (PCIP), a program created under the ACA to help provide health coverage to those with preexisting medical conditions before other aspects of the law take effect in 2014. CMS said it would no longer enroll individuals because of financial constraints in the $5 billion program, even though enrollment has been lower than expected (Pittman, 3/8).

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Health Care Marketplace

Patients Challenge Hospital Fees

The Boston Globe reports on this trend. In other news, CQ HealthBeat reports that the Medicare Payment Advisory Commission gave a nod to shared-decision making between doctors and patients.

Boston Globe: Hospital Charges Bring A Backlash
Patients, angered by surprise surcharges that hospitals tack on bills for doctor visits, are increasingly challenging these fees — sometimes even refusing to pay. Hospitals say the charges cover their overhead, but the fees are sometimes added to the bill even when patients are treated in offices miles away from the medical centers. The fees can reach hundreds of dollars, and some resistant patients end up being pursued by collection agencies. Others, such as Wendy Frosh, are dropping longtime caregivers in favor of physicians not employed by hospitals (Kowalczyk, 3/11).

CQ HealthBeat: Shared Decision-Making By Doctors, Patients Elusive Goal In Medicare, Panel Says
Medicare Payment Advisory Commission members agreed Friday that doctors should give patients a much better sense of their treatment options for certain serious medical conditions. But they were at a loss to recommend how to make that happen on a widespread basis…Commissioners specifically wrestled with "shared decision-making," an approach designed to better incorporate patient preferences when it comes to treating such diseases as prostate and breast cancer and cardiovascular conditions where the medical evidence is unclear about which of several treatment options is best (Reichard, 3/8).

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State Watch

States Consider 'Dental Therapists' To Address Shortage Concerns

Dentists are voicing their concerns over patient care as more states consider licensing "dental therapists" to help alleviate a dental care shortage -- and so far only two states are using them.

Politico: 'Dental Therapists' Help Deal With Access Gap
Some state lawmakers think they've found the solution to the nation's severe dental care access problem, but so far, only two states are using the touted "dental therapists" -- and dentists aren't thrilled about the idea. According to the Pew Center on the States, more than 40 million Americans reside in areas with a shortage of dentists (Smith, 3/11).

The Associated Press: Dentists Wary Of New Role
Dental hygienists with advanced training could perform certain procedures now reserved for dentists, including routine fillings and tooth extractions, under a bill that supporters believe would improve access to oral health care for low-income Massachusetts residents and underprivileged children. The legislation would create a new, midlevel position called advanced dental hygiene practitioner, similar to a nurse practitioner in a physician's office and comparable to dental therapists that operate in more than 50 other countries (Salsberg, 3/11).

And in Minnesota, a report says dentists are underpaid by a state low-income medical assistance program --

MPR News: Report: Dentists Underpaid By State For Low-Income Patient Care
Minnesota doesn't pay dentists enough to treat patients enrolled in the state's Medical Assistance program, says a report issued Friday by the Minnesota Office of the Legislative Auditor. The report says the state should increase the base rate for dentists treating MA patients and it should simplify the claims process, so dentists will be more willing to continue serving these low-income patients. Dentists have long complained that Medical Assistance, the state's program for the poor, doesn't cover their expenses (Benson, 3/8).

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State Roundup: Sequestration's Impacts Include Less Grant Dollars

A selection of state health policy stories from Texas, Missouri, Connecticut and North Carolina.

Stateline: Health Care Cuts From Vaccinations To Research
Sequestration spares Medicaid and almost all of Medicare, but automatic cuts to other federal health-care programs will make it more difficult for low-income Americans to get maternal and infant care, vaccinate their children, and receive treatment for mental illness. The federal government gives states tens of millions of dollars in grant money for health services each year, and all of those programs are subject to sequestration cuts. In addition, Washington will be funneling less public health and research money to states because of automatic cuts to federal agencies such as the Centers for Disease Control and the National Institutes of Health (Ollove, 3/11).

The Associated Press: Right-To-Life Groups Split On End-Of-Life Decision
A battle is brewing at the Texas Legislature among right-to-life groups, but rather than debating when life begins, they are fighting over the rules that govern the end of a terminally ill person's life. The dispute revolves around what should happen when the patient's family wants to continue medical treatment when the doctors think it would only prolong the suffering (Tomlinson, 3/10).

Kansas City Star: Missouri Bill Would Let Health Providers Opt Out Of More Reproductive Services
Laws allowing health care workers to refuse to participate in an abortion have been on the books for decades. Missouri legislators, however, don’t think they go far enough. They want to expand those laws to allow medical professionals to opt out of providing birth control, sterilization and assisted reproduction services and stem cell research. They would also be able to deny referrals for care. Under legislation that could come up for a vote in the Missouri House as early as today, health care providers would be shielded from punishment for refusing to provide this type of care if it violates their religious or moral principles (Hancock, 3/10).

CT Mirror: Residents Want Local Approval Power Over Inmate Nursing Home
Feeling duped and fearful of the state's plan to move inmates and mentally ill patients into a former nursing home without zoning approval, Rocky Hill neighbors and town leaders testified Friday for a bill that would require local site approval. Lawmakers representing Rocky Hill proposed the bill to prevent the state from opening similar prison nursing homes in the future. … The state Department of Mental Health and Addiction Services and the Department of Corrections plan to place infirm inmates who are near parole and mentally ill patients from the Connecticut Valley Hospital in the 95-bed nursing home. The home is privately owned will be privately run by iCare Inc. of Manchester (Merritt, 3/9).

North Carolina Health News: More Changes, Consolidation To Come In Mental Health System
The future for mental health care services in North Carolina looks like one with fewer agencies managing the dollars and still more upheaval. There are presently 11 managed care organizations delivering mental health, intellectual and developmental disability and substance abuse services around the state (Sisk, 3/8).

North Carolina Health News: Bill Provides Relief For Mentally Ill In Legal Limbo
A bill revived from last year’s session would keep defendants with mental health problems from bouncing between state psychiatric hospitals and county jails while waiting to be tried (Hoban, 3/11).

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Editorials and Opinions

Viewpoints: 5 Lies About Entitlements; Obama's Plans For Medicare Still Not Clear; Generic Drug Makers Need To Be Accountable

Los Angeles Times: The Five Biggest Lies About Entitlement Programs
So here's a list with a bit more gravitas: The five biggest lies you're being told about entitlement programs. Never mind that the very word "entitlement" is a lie. Social Security and Medicare got that name because workers became "entitled" to those benefits by paying into the system. In recent years, however, the term has become distorted to signify benefits people are entitled to without earning them. Leaving that whopper aside, here are the top five (Michael Hiltzik, 3/8).

Forbes: Did You Really Pay For Your Medicare Benefits?
Time after time during Election Year 2012, seniors and near-seniors reacted to the slightest mention of Medicare reform with indignation and the emphatic insistence, "Don't you dare touch Medicare; I've paid for it!" There is only one problem with that statement: In a mathematical sense, it isn't true (Mark Hendrickson, 3/7).

The Washington Post: Payments To Elders Are Harming Our Future
Foolish, indiscriminate and badly timed cuts in the federal budget have begun. The primary reason is that Republicans have refused to budge any further on taxes. Still, Democrats must share some of the blame. By failing to propose more specific cuts to entitlement spending, they have forfeited the high ground and allowed a small but critical set of programs to absorb all of the pain (Harry J. Holzer and Isabel Sawhill, 3/8).

The Washington Post: Budget Ideas That Democrats And Republicans Might Agree On
Arizona's John McCain, South Carolina's Lindsey Graham, New Hampshire's Kelly Ayotte -- have dared to say that they would, gasp!, consider raising revenue. The senators attach two caveats: Revenue must come through fundamental tax reform (getting rid of loopholes, not raising rates) and be accompanied by reined in entitlement spending. In theory, both sides agree on these approaches (Ruth Marcus, 3/8).

The Washington Post: A Grand Bargain On The Menu?
Mr. Obama's Republican dinner partners could and should respond favorably to his publicly announced proposal to raise $580 billion over the next decade by closing tax loopholes and limiting tax deductions to 28 percent of income for top earners. They can't and won't do that, however, without a bigger and more detailed commitment on entitlement reform than Mr. Obama has given publicly so far. Specifically, his offer of $400 billion in health program savings over ten years strikes us as both too small and insufficiently fleshed out, though it's a start (3/9).

The Washington Post: The High Costs Of Medicare's Low Prices
Steven Brill's recent Time magazine cover story, "Bitter Pill: Why Medical Bills Are Killing Us," is an extraordinarily well-reported look at medical pricing, demonstrating that high health-care prices have little relationship to underlying cost. For many commentators, the much lower prices paid by Medicare suggests an obvious solution to our health-care problems -- "Medicare for all." There's only one problem with this "obvious" solution: Medicare has been a primary driver of the explosion of health-care costs in the United States despite -- and perhaps because of -- the low prices it pays (David Goldhill, 3/10).

Boston Globe: Reducing Health Costs: A Bitter Pill, Chewable For Doctors
When I read Steven Brill's epic takedown of health care costs in Time magazine, my first reactions were sticker shock and outrage. This was followed by unease: Did I really need to use that second square of gauze (priced at $77 a box, according to Brill) after placing that central venous catheter the other week? As he dissects a series of medical bills and follows each line item to its source, Brill points the finger both at marked-up prices by manufacturers and hospital administrators stemming from our lack of price controls and at the quantity of line items (i.e. the overuse of resources). Setting aside the critical need for payment reform and true price competition, doctors have a significant role to play in mitigating that second offense. To this end, we're now meant to learn about medical costs as part of our medical training, though institutional norms and perverse incentives have made this challenging (Ishani Ganguli, 3/11).

Roll Call: Fiscal Cliff Health Care Policy Fix Is Good For Rural Patients And Taxpayers
Rarely do federal lawmakers come upon a policy that can expand access to critical health care services and simultaneously save taxpayers money. But according to a new report from the Congressional Budget Office, a tweak in the way Medicare pays for certain kidney disease drugs could do just that -- preserving the availability of crucial treatments to rural patients and saving the program billions. At issue is Medicare’s handling of a few "oral-only" dialysis medications designed for end-stage renal disease, the most severe version of chronic kidney disease (Grace Boatright, 3/8).

San Jose Mercury News: Sequester And Health: Blind Cuts In Medical Research Will Cost Lives And Hurt The Economy
As of March 1, sequestration has become a reality. Arbitrary, across-the-board cuts to most federal programs are being implemented to address our nation's budget crisis. As a physician, the CEO of a company that focuses on therapies to tackle some of the world's deadliest cancers and, most important, the father of a cancer survivor, the impact of this approach is very real to me. Put simply, sequestration threatens to stifle the biomedical breakthroughs that have distinguished us as global leaders and given hope to millions of patients and families grappling with life-threatening diseases (Anthony Coles, 3/8).

The Wall Street Journal: A New Obama?
Meantime, the real measure of Mr. Obama's seriousness isn't whether he's willing to spar over dinner but what kind of specific policy compromises he's willing to make. ... Will he put more than token entitlement reforms on the table? ... the President's Medicare proposals don't begin to solve the health-care spending problem. Short of Paul Ryan's premium-support plan, the only chance for reform worth the name is "comprehensive cost-sharing" that forces individuals to confront at least some of the costs of their own care. Count us as skeptical that Mr. Obama is willing to do any of this (3/10). 

National Review: Escape From Obamacare
In the next nine months, young Americans -- particularly those who believed in President Obama's promise of health-care "reform" -- are about to get the biggest sticker shock of their lives. ... The respected economic consulting firm Oliver Wyman estimates that 80 percent of adults 21 to 29 years of age who make more than $16,000 a year will pay more for coverage, even after accounting for Obamacare's subsidies. Fortunately, there appears to be a partial escape hatch for young workers and others hit by Obamacare's premium increases, even if they don't work for big companies. Small firms and the specialized insurers that serve them may have found the lifeboats (to borrow Texas governor Rick Perry's comparison of Obamacare to the Titanic) to sail away from many of Obamacare's mandates (John Berlau, 3/11). 

Politico: GOP Folds On Obamacare
The winter of conservative discontent continues. On Wednesday, the House Republican majority led by Speaker John Boehner used the cover of a fake "snowstorm" to pass a continuing resolution that funds Obamacare for the rest of the 2013 fiscal year and they could lose their majority as a result of the decision (L. Brent Bozell, 3/8).

The New York Times: Dwindling Deficit Disorder
Right now, a sustainable deficit would be around $460 billion. The actual deficit is bigger than that. But according to new estimates by the budget office, half of our current deficit reflects the effects of a still-depressed economy. The "cyclically adjusted" deficit -- what the deficit would be if we were near full employment -- is only about $423 billion, which puts it in the sustainable range; next year the budget office expects that number to fall to just $172 billion. … So we do not, repeat do not, face any kind of deficit crisis either now or for years to come. There are, of course, longer-term fiscal issues: rising health costs and an aging population will put the budget under growing pressure over the course of the 2020s. But I have yet to see any coherent explanation of why these longer-run concerns should determine budget policy right now. And as I said, given the needs of the economy, the deficit is currently too small (Paul Krugman, 3/10).

The New York Times: Hold Generic Drug Makers Accountable
A New Hampshire woman who was severely injured by a generic drug in 2004 is still struggling to hold the manufacturer liable. Her case will be argued this month before the Supreme Court, which has already severely limited the ability of consumers to sue generic manufacturers and may well limit it further. If so, some way must be found to compensate this plaintiff, Karen Bartlett, and others who have been hurt by generic drugs, which account for 80 percent of all prescriptions in this country (3/10).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
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.