Daily Health Policy Report

Monday, March 12, 2012

Last updated: Mon, Mar 12

KHN Original Reporting & Guest Opinion

Health Reform

Campaign 2012

Health Care Marketplace


Health Information Technology

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

The Hardest Job To Fill (And Keep) In Washington: CMS Chief

Reporting for Kaiser Health News in collaboration with The Washington Post, Gibert M. Gaul writes: "President Obama is fighting to save his signature health law on two fronts: in the Supreme Court and on the campaign trail. … Yet even if the president prevails, he faces another daunting challenge: implementing the law in a seamless, timely manner. The Centers for Medicare & Medicaid Services is charged with making the health law work, drafting regulations, setting up new programs and providing oversight. But for years Congress has undermined the agency's leadership and potential effectiveness, raising questions about its capabilities and resources even as the health law ramps up its responsibilities. For starters: consider the revolving door leadership at CMS" (Gaul, 3/11). Read the story.

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Political Cartoon: 'Aerodynamic Drag?'

Kaiser Health News provides a fresh take on health policy developments with "Aerodynamic Drag?" by Lisa Benson.

Meanwhile, here's today's haiku:


That Bon Jovi flame
Whose love was bad medicine?
Sued for malpractice

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Health Reform

Analyzing Dynamics Of Supreme Court Health Law Arguments

News outlets report on the key issues, dynamics and personalities that will be in play when the Supreme Court takes up the health law.

Politico: On Health Care, Supreme Court's Final Word May Not Be Final
In two weeks, the U.S. Supreme Court takes up the case that could lead to the biggest "I told you so" of 2012. The challenge to President Barack Obama's health care reform law will result in the court either upholding it — giving bragging rights to Obama and congressional Democrats — or finding major pieces of it unconstitutional, setting off a political earthquake that would vindicate Republicans and conservative groups (Haberkorn, 3/11).

Politico: Health Care Reform Issues Go Beyond Mandate
If the court decides the mandate is unconstitutional, it will have to figure out what happens to the rest of the health care law, which also contains insurance market and health care delivery system reforms as well as changes to Medicare and Medicaid (Millman, 3/11).

The New York Times: Health Care Act Offers Roberts A Signature Case
On the one hand, he views himself as a steward of the court’s prestige and authority, and he has called for incremental decisions from large majorities rather than broad but sharply divided rulings.  ... At the same time, Chief Justice Roberts has embraced an array of assertive judicial projects that have interpreted the Constitution in ways that have fundamentally reshaped American law (Liptak, 3/11).

The Associated Press: Health Care Lawyer Clement As High Court Regular
Paul Clement used to argue for the federal government's power until he started arguing against it. ... Clement is playing a key role in three politically charged Supreme Court cases in which Republican-led states object to Obama administration policies or federal laws on health care, immigration and redrawing political boundaries. In the biggest of those, the 45-year-old law school acquaintance of President Barack Obama will be trying to sink Obama's health care overhaul (Sherman, 3/12).

The Washington Post: Esteemed Lawyer Paul Clement's Next Challenge Is Arguing Against Health-Care Law
[W]hen Clement, a Republican and former U.S. solicitor general, is on his game, he is a grandmaster, conservative and liberal lawyers agree. ... "You want him; he is the best advocate of his generation,"says an old boss, another former solicitor general and Democratic nemesis, Kenneth W. Starr (Leahy, 3/11).

The Associated Press: Verrilli: Point Man In Looming Health Care Battle
In 16 appearances before the Supreme Court, Donald Verrilli has advocated for the rights of death row inmates and has successfully argued fine points of telecommunications law in cases with billions of dollars in the balance. Now as the Obama administration's solicitor general, Verrilli faces what for any lawyer would be the challenge of a lifetime: persuading at least five Supreme Court justices to uphold the president's overhaul of the nation's health care system (Yost, 3/12).

Politico: Backup Plans If Individual Mandate Is Struck Down
If the U.S. Supreme Court strikes down health reform's individual mandate and leaves the rest of the law in place — what happens next? The backup plan could be automatic enrollment in your employer's health insurance, a lot like the way you get signed up for the 401(k) plan. If Congress decides to act to repair that hole in the Affordable Care Act — and that's a big if — an auto-enrollment requirement is the option that's getting the most attention from health policy experts (Norman, 3/11).

The Associated Press: Obama's Health Care Law: A Trek, Not A Sprint
It took only a year to set up Medicare. But if President Barack Obama's health care law survives Supreme Court scrutiny, it will be nearly a decade before all its major pieces are in place. And that means even if Obama is re-elected, he won't be in office to oversee completion of his signature domestic policy accomplishment, assuming Republicans don't succeed in repealing it (Alonso-Zaldivar, 3/12).

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Overcoming Challenges To Health Law Implementation At Federal, State Levels

The Centers for Medicare & Medicaid Services is central to implementing the health law, which leads to questions about its capabilities and resources. Meanwhile, states await a final rule on health exchanges.

Kaiser Health News: The Hardest Job To Fill (And Keep) In Washington: CMS Chief
President Obama is fighting to save his signature health law on two fronts: in the Supreme Court and on the campaign trail. … Yet even if the president prevails, he faces another daunting challenge: implementing the law in a seamless, timely manner. The Centers for Medicare & Medicaid Services is charged with making the health law work, drafting regulations, setting up new programs and providing oversight. But for years Congress has undermined the agency's leadership and potential effectiveness, raising questions about its capabilities and resources even as the health law ramps up its responsibilities. For starters: consider the revolving door leadership at CMS (Gaul, 3/11).

CQ HealthBeat: No Sign Of Exchange Rule As Some States Hit The Pause Button On Legislation
An anxiously awaited final rule on the structure of health benefits exchanges remained stuck in regulatory limbo on Friday, following Wednesday's abrupt cancellation of a press call featuring top Health and Human Services officials. Meanwhile, an expert on state health policy says exchange action appears to be slowing in states where largely Republican lawmakers are reluctant to move before the Supreme Court decides later this year whether the health care law is constitutional (Norman, 3/9).

Politico Pro: If Court Upholds ACA, States Could Still Resist
The law is very clear: HHS has the power to set up a federal health insurance exchange in states that don't set up their own. But a federal exchange can't function solo. It needs some help from a state's Medicaid program and insurance department…HHS has the legal authority to fight back — but it's not easy. The steps it can take are like a nuclear bomb: they're useful as a deterrent, but have fallout that the department would likely try hard to avoid. For instance, Washington could penalize a state by cutting off its Medicaid funds. But blowing holes in state budgets and taking away coverage from thousands of people would accomplish precisely the opposite of the health care law's goals (Feder, 3/12).

Billings Gazette: Health Care Law's Preventive-Care Rules Snare Insured Patients
Carmen Hodges wasn't going to get a colonoscopy screening this year until she received a letter from her insurance company urging her to "take advantage of preventive benefits paid at 100 percent." ... The nation's new Affordable Care Act requires most insurance plans to cover all costs for preventive care, including colon cancer screening. So Hodges, 57, had the procedure in November. Then the bill arrived: $3,535 (Uken, 3/11).

MedPage Today: Child Advocates Call for Fix to ACA's 'Family Glitch'
In a letter dated March 12, 2012, several groups, including the American Academy of Family Physicians, the American Academy of Pediatrics, and the Children's Hospital Association, pointed out that when the Affordable Care Act (ACA) passed, it contained a "family glitch" that fails to take into account the cost of providing health insurance for an entire family versus a single employee. ... It's significantly less expensive to cover an individual rather than the worker's whole family (Walker, 3/11). 

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Campaign 2012

Santorum's Message: Romney Would Face Trouble Against Obama On Health Issues

GOP presidential hopeful Rick Santorum continues to attack rival Mitt Romney's Massachusetts' health reform record, arguing that it weakens his ability to run against President Barack Obama, and candidate Newt Gingrich also is not escaping the criticism.

The Washington Post: Santorum Steps Up Attacks On Romney's Massachusetts Record
In an interview on NBC’s "Meet the Press," Santorum told host David Gregory that Romney has sought to mislead voters about what his position on health-care reform was when he was governor of Massachusetts. "Governor Romney in the state of Massachusetts mandated every person in Massachusetts had to buy health care," Santorum said (Sonmez, 3/11).

Boston Globe: Santorum Says Romney Untruthful On Health Law
"Governor Romney actually advocated for the Massachusetts model that President Obama adopted with mandates, and then went out on the campaign trail and repeatedly didn't tell the truth,"’ the former Pennsylvania senator said on NBC's "Meet the Press" (Schoenberg, 3/12).

CNN: Santorum Blasts Gingrich Over 'Romneycare'
Saturday, fresh off his projected win in the Kansas caucuses, Santorum added that GOP presidential rival Newt Gingrich is "honestly not a whole lot better." "For 20 years when I was pushing medical savings accounts, he was pushing a federal mandate for health insurance," Santorum said. "And when 'Romneycare' passed, he sent out a glowing statement talking about how this wonderful bill had just passed in Massachusetts" (Welch, 3/10).

The Hill: Health Care Issues Will Be A Heavy Lift For Romney Against President Obama
[A]s an Obama-Romney matchup becomes increasingly likely, so does the prospect that Republicans won’t be able to aggressively campaign against a law that helped propel their historic wins in 2010 — and hasn’t gotten much more popular since (Baker, 3/10).

Reuters: Analysis: Romney Is Clear Favorite Of Washington Lobbyists
Apart from the financial industry, most notable was the connection of many Romney donors to healthcare. The industry awaits drastic changes from Obama's signature healthcare reform that is scheduled to kick into full gear in 2013. ... Several of Romney's donors came from the drug lobby and work for the Pharmaceutical Research and Manufacturers of America (PhRMA) and makers of medicines and medical devices (Selyukh and Cohen, 3/9).

The Associated Press: Romney Used Private Email Accounts As Governor
Republican presidential candidate Mitt Romney and some of his top aides used private email accounts to conduct state business at times when Romney was governor of Massachusetts, according to documents obtained by The Associated Press. The communications were legal ... Some of the emails obtained by AP describe Romney's internal deliberations on his health care policy (Braun, 3/9).

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Health Care Marketplace

UnitedHealth Report: Spending On Genetic Tests To Rise Sharply In A Decade

Genetic tests could become a $25 billion market by 2021. Currently, spending on these tests is estimated at $5 billion annually.

Los Angeles Times: Spending On Genetic Tests Is Forecast To Rise Sharply by 2021
Spending on genetic tests has reached $5 billion annually and could top $25 billion within a decade, according to an insurance industry study published Monday. The rise in spending is likely to intensify the debate over genetic testing as policymakers and employers struggle to contain spiraling healthcare costs (Terhune, 2/12).

Bloomberg: Genetic Tests To Generate $25 Billion A Year, UnitedHealth Says
Genetic tests may become a $25 billion annual market in the U.S. within a decade, highlighting the need to identify which exams work the best, insurer UnitedHealth Group Inc. (UNH) said. A majority of the 1,800 DNA tests developed to identify or manage medical conditions still haven’t been studied enough to prove their effectiveness, UnitedHealth, the biggest U.S. insurer by sales, said in a report today. The technology generated $5 billion in 2010, the insurer said, and three to five new tests are being introduced each month (Nussbaum, 3/12).

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Feds Reject J&J's $1 Billion Drug Settlement

The Wall Street Journal: J & J's Drug Settlement For $1 Billion Is Rejected
Prosecutors in Washington, D.C., have rejected a roughly $1 billion proposed settlement to resolve allegations that Johnson & Johnson promoted the antipsychotic drug Risperdal for unapproved uses, according to people familiar with the matter. J&J and the federal prosecutors in Philadelphia who had reached the tentative deal now must go back to the drawing board, because the officials in Washington are seeking a larger settlement, the people said (Rockoff and Lublin, 3/9).

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Quality Issues: Patient Safety And Physicians' Well-Being

Medscape investigates the intersection between patient safety initiatives and how physicians practice medicine.  

Medscape: Will Patient Safety Initiatives Harm Physicians?
Peer review, the patient safety method designed to identify ineffective, unethical, or impaired physicians, can help improve the delivery of medical care, provide risk-management lessons, and lead to improved policies and procedures. At the same time, some doctors and hospital administrators have expressed concern that peer review produces fodder for civil or criminal lawsuits against physicians and healthcare institutions (Kern, 3/9).

In other news related to health care quality, researchers find that older men treated for cancer fare well at Veterans Health Administration hospitals.

Reuters: Cancer Patients Do Well At Veterans' Hospitals
Older men treated for cancer at Veterans Health Administration hospitals do just as well, if not better, than men covered by Medicare, a new study suggests. That finding is a testament to massive changes in the organization of the VHA started in the mid-1990s that made patient care more coordinated, strengthened preventive care and allowed medical mistakes to be spotted faster, researchers said (Pittman, 3/9).

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Health Information Technology

Park Named Federal Chief Technology Officer

Todd Park, who held the CTO position at the Department of Health and Human Services, will replace Aneesh Chopra in this post.

Politico: White House Names HHS's Todd Park CTO
Todd Park, the chief technology officer at Health and Human Services, has been tapped by President Barack Obama to replace Aneesh Chopra as the White House's new tech guru. In a blog post Friday, White House Office of Science and Technology Policy Director John Holdren said Park will have "the important task of applying the newest technology and latest advances to make the federal government work better for the American people" (Saleh Rauf, 3/9).

Modern Healthcare: White House Names Park As Federal CTO
President Barack Obama is appointing HHS Chief Technology Officer Todd Park as the new federal chief technology officer, the White House announced Friday. In a blog post announcing the appointment, the White House said Park has served as a "hugely energetic force for positive change." at HHS. "He led the successful execution of an array of breakthrough initiatives, including the creation of HealthCare.gov, the first website to provide consumers with a comprehensive inventory of public and private health insurance plans available across the nation by ZIP code in a single, easy-to-use tool," the White House said (Conn, 3/9).

In other health information technology news --

Modern Healthcare: AHRQ: 'Disappointing Results' Often Seen In Health IT Deployment
Citing "disappointing results" observed often in implementing health information technology, HHS' Agency for Healthcare Research and Quality is looking to evaluate the work-flow toolkit it created for clinical practices to solve problems related to health IT deployment. AHRQ funded development of the Workflow Assessment for Health IT Toolkit in 2008. The kit is designed to promote a better understanding of how health IT issues affect workflow in ambulatory care at several stages of health IT adoption: determining system requirements, selecting a vendor, preparing for implementation, and using the newly implemented technology (Zigmond, 3/9).

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State Watch

Health Program Cuts, Cost-Saving Measures Big Issues At State Capitols

Legislatures around the country are dealing with changes or cost-saving measures to health programs as they consider their budgets.

Arizona Republic: Bill Targets Rule Halting Funds For Cancer Care
Rep. Matt Heinz, D-Tucson, and Rep. Kate Brophy McGee, R-Phoenix, believe that "bureaucratic glitch" is not fair. The pair sponsored House Bill 2472, which would let eligible women get treatment dollars regardless of where they get screened for breast or cervical cancer. The proposal cleared the House unanimously and is scheduled to go before the Senate's Health Committee on Wednesday (Munshi, 3/10).

Denver Post: Colorado Budget Awaits As Legislators Start Second Half
Democratic Gov. John Hickenlooper's budget is based on the assumption that the legislature will once again suspend a property-tax break for seniors that costs the state $100 million. Hickenlooper and Democratic lawmakers say the state can't afford to grant the tax break, which isn't means-tested, and the governor has instead proposed more assistance targeted to the poorest seniors. Not suspending the tax break again means even deeper cuts to education, Hickenlooper said, while Republicans argue that cuts should be made to Medicaid (Hoover, 3/12).

(St. Paul) Pioneer Press: Minnesota Health Care: HMO Cash Cushions At Issue In Legislature 
As the surplus funds held in reserve by the state's nonprofit HMOs continue to grow, so too have the questions at the state Capitol about just how much they should store away. … State records show that from 2006 to 2010, the collective total for reserves at the state's four largest health plans increased from $1.82 billion to $2.48 billion. While that might seem high, insurers say, the sums make sense considering the relentless growth in health costs. Despite all the talk, legislative leaders don't sound like they're ready to jump in this session with bills to impose a cap (Snowbeck, 3/10). 

California Healthline: Legislature Examines Duals Transition 
[Toby] Douglas -- director of the state Department of Health Care Services -- with a full array of budget cuts, program transitions and agency reorganization on his plate, has been making presentations and fielding questions at a number of legislative hearings recently. ... At issue is the passive enrollment and transition of 1.2 million Californians eligible for both Medicare and Med-Cal benefits to managed care plans. California is one of 15 states working on a federal demonstration project to convert duals to managed care (Gorn, 3/12). 

California Watch: Patients Suffer As State Overhauls Medi-Cal, Advocates Say 
The changes are part of a wide-ranging plan that is meant to improve care and cut costs in the state's Medi-Cal program, California's version of Medicaid. In June, the first wave of Medi-Cal patients moved to managed care plans. The effort is planned to extend to about 1.2 million seniors who are covered by both Medicare and Medi-Cal and projected to save the state a billion dollars within five years (Jewett, 3/9). 

News Service of Florida/Palm Beach Post: Big Health Bills Die At The Session's End 
After weeks of lobbying and debate, Florida lawmakers ended the 2012 session without passing major health-care bills dealing with assisted-living facilities, malpractice lawsuits and physicians dispensing drugs to workers-compensation patients. A bill (HB 7133) that would have increased oversight of assisted living facilities bounced between the House and Senate in the final hours of the session, but lawmakers could not reach agreement (Saunders, 3/11). 

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Officials Examine Medicaid Coverage, Quality In Context Of Burgeoning Costs

Growing demand for Medicaid services puts a burden on states as they wrestle with tight budgets and patient quality issues.

Chicago Sun-Times: Medicaid Birth Coverage Fact Of Life 
Among the facts of life when trying to balance the Illinois budget is this: Medicaid plays a huge role in paying for childbirth in Illinois. It's not going to change any time soon and illustrates why lawmakers may have so much difficulty reining in spending this year. As Gov. Pat Quinn noted in his budget address last month, more than 50 percent of all Illinois births are paid for by the state and federal health care program for the poor and disabled. In part, that's because Illinois has fairly liberal income eligibility levels for pregnant women compared to other states (Johnson, 3/12).

The Connecticut Mirror: Providers: Communications Glitch Keeping Patients From Getting Meds 
More than 5,000 people in the HUSKY program for low-income children and their parents had ... problems filling prescriptions during a 10-month period in 2008 and 2009. Medicaid, like most insurance plans, has a list of drugs it regularly covers. If a health care provider prescribes a drug not on the list, he or she must submit documentation about why it's necessary before the plan will cover it. Because health plans have different lists of routinely covered drugs, prescribers don't always know when they need to get approval for a prescription (Levin Becker, 3/9).

The Associated Press/Wall Street Journal: NY Dems, Patient Advocates Seek New Drug Policy
Influential black legislative leaders as well as patient advocacy groups targeting mental illness, arthritis, diabetes, AIDS and other chronic diseases and conditions are pushing to get the Cuomo administration to relax a cost-cutting measure that they say forces patients to use inadequate medications (3/11).

Milwaukee Journal-Sentinel: As U.S. Health Care Changes Near, State's Medicaid Costs Still Unknown
Whether federal health care reform will require Wisconsin to spend more or less money on Medicaid should be a fairly simple question nearly two years after Congress passed the historic law. Apparently it isn't. And hundreds of millions of dollars in state spending could hinge on the answer (Boulton, 3/10).

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Feds Won't Renew $30 Million Funding For Texas' Women's Health Program

Health and Human Services Secretary Kathleen Sebelius confirmed Friday that the federal government would stop funding the program which provides health care to more than 100,000 women after Texas  barred Planned Parenthood and other "affiliates of abortion providers" from participating. Gov. Rick Perry has pledged to replace the money, but has not said where it would come from.

The Associated Press: Health Program Losing Federal Funds, Clinics
But under a state law taking effect Wednesday, Henry and other eligible women won't be able to get care at Planned Parenthood clinics -- which treat about 44 percent of the program's patients -- or other facilities with ties to abortion providers, meaning those women will have to find new health care providers. The $40 million program is at the center of a faceoff between conservative Republican lawmakers and the federal government, which provides 90 percent of the program's funding (Brown, 3/11).

Bloomberg: Perry Vows To Replace U.S. Funds That May Be Cut Off Over Abortion-Aid Ban
Governor Rick Perry pledged to replace almost $30 million in federal funds for a family- planning program for low-income women in Texas that may be cut off because of a state ban on aid to abortion providers. … The U.S. Centers for Medicare and Medicaid Services advised Texas officials that a waiver for the Women's Health Program won't be extended, Perry said in the letter. A statement yesterday from Perry's office said the cutoff would result from the state ban on abortion funding. The $33 million program provides services to more than 100,000 women. Nicholas Papas, a White House spokesman, didn't have an immediate comment on Perry's letter (Mildenberg, 3/9). 

The Hill: Obama Administration Nixes Texas Medicaid Program Over Planned Parenthood Ban
The Obama administration confirmed Friday that it will stop funding a Medicaid family-planning and preventive care program for 130,000 low-income Texas women after the state barred Planned Parenthood and other "affiliates of abortion providers" from participating. The Health and Human Services Department will "let Texas know that that waiver will not be extended," HHS Secretary Kathleen Sebelius said Friday, according to The Associated Press (Pecquet, 3/9).

Reuters: Government To Cut Texas Women's Health Funds In Abortion Dispute
The federal government will withdraw funding for a Texas program providing more than 100,000 poor women with birth control and other health services because Planned Parenthood clinics are not allowed to participate, a U.S. Health and Human Services spokeswoman said on Friday. Health and Human Services Secretary Kathleen Sebelius announced the decision in Houston on Friday, prompting a furious response from Texas Governor Rick Perry, who called it an "egregious federal overreach" (3/9).

The Texas Tribune: Feds Will Not Renew Women's Health Program 
Though Perry says the state has the medical capacity to continue to treat the more than 100,000 women enrolled in the program without Planned Parenthood clinics, other health leaders vehemently disagree. And Perry didn't say where cash-strapped Texas will find the roughly $30 million per year the federal government provides to help low-income women on Medicaid receive birth control, cancer screenings and STD tests (Ramshaw, 3/9). 

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State Abortion Bills Keep Coming

Some call such legislation an "overreach," but at least some of the proposals are getting political traction, including a push in Washington State this week to require insurance plans to cover abortion.

The Associated Press/Washington Post: Republicans, Democrats Disregarded McDonnell's Day 1 Advice Not To Overreach Or Obstruct
Republicans introduced bills that conservatives had dreamed of for years. Among them were measures to compel voters to bring identification to the polls; make public school teachers easier to fire; … apply legal rights of personhood to embryos from the moment of conception; and divert a share of the state sales tax to transportation. But none got more public notice than a bill that would have required women who seek abortions to undergo vaginally invasive ultrasound exams. Were they an overreach? Depends on whom you ask (3/11).

Politico Pro: Wash. Abortion Act May Get Second Chance
Abortion rights advocates in Washington state will make a new push in the special legislative session starting Monday to pass a bill requiring insurance plans to cover abortion. The bill, known as the Reproductive Parity Act, seemed destined for passage in the regular legislative session until it was blocked on a procedural vote in the state Senate. It had already passed in the House (Millman and Feder, 3/9).

The Atlanta Journal-Constitution: Planned Parenthood Stirs Passion
There's little middle ground when it comes to Planned Parenthood. To some, the organization is akin to an evil empire.To others, it provides much-needed health and reproductive services to women, particularly those with little or no health insurance (Poole, 3/12).

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State Roundup: Wash. State Insurers' Surplus Cash; Calif. Million Dollar Bills

A selection of stories from California, Louisiana, Wisconsin, Minnesota, Washington, Pennsylvania and Texas.

Minneapolis Star Tribune: Many Firms Missing Out On Health Care Tax Credit
A relatively new tax credit is available to certain small businesses and charities to help offset the cost of providing health insurance to their workers. But tens of thousands of businesses in Minnesota and across the nation are leaving money on the table, according to the U.S. Treasury Department (Crosby, 3/11).

The Seattle Times: Health Insurers Premera, Regence Report Gains In Surplus Cash
Two of Washington's three largest health insurers reported gains in surplus cash in their annual reports to the state insurance commissioner ... These companies, all nonprofits, refer to the money not earmarked to pay claims as "reserves," and argue it is needed to beef up computer systems, cope with changes in health-insurance laws, and other contingencies. Insurance Commissioner Mike Kreidler ... argues that what these companies have amassed goes far beyond what might be needed (Ostrom, 3/10). 

The Sacramento Bee: Million-Dollar Hospital Bills Rise Sharply In Northern California
The number of Northern California hospital stays resulting in charges of $1 million or more rose sevenfold in the past decade, from 430 in 2000 to almost 3,000 during 2010, according to a Bee review of new data from the Office of Statewide Health Planning and Development. Most of those bills will be lowered significantly – up to 80 percent – following negotiations between hospitals and insurers. Even then, they will usually still cost more than a typical Sacramento home (Reese and Smith, 3/11).

KQED's State of Health blog: Infection Rates: Did Your Hospital Earn a White Dot?
The web abounds in hospital ratings these days, most of them based on consumer comments rather than hard data. Readers of Yelp, for instance, can rate, not only the local Chinese takeout place, but the hospital up the street. Long Beach Memorial Medical Center – generally respected among its peers – earned only two and a half gold stars out of five on Yelp (Schoch, 3/9). 

Wisconsin Public Radio: State Must Prepare For Growing Elderly Population
By the year 2034, it's projected those 85 years and older will increase 28 percent. Who will care for them, asks Robyn Stone? She's with the Institute for the Future of Aging Services. By the year 2030, she says, the competition for caregivers in Wisconsin will be intense. Stone says the workforce isn't growing as fast as those they'll care for (Mills, 3/9). 

New Orleans Times-Picayune: For Many New Orleanians With Serious Mental Illness, Life Is A Delicate Balance
As of Monday, Interim LSU Public Hospital implemented $15 million of cuts to the mental health safety net in New Orleans. The hospital, which most still refer to as University, eliminated its 20-bed chemical detox unit, cut beds at the psychiatric inpatient unit at its DePaul Hospital campus and closed beds in the emergency department and in what’s known as “the M” — the mental health emergency extension (Reckdahl, 3/12). 

The Dallas Morning News:  Leadership Discussing Backup Plans If Parkland Is Forced To Close Or Cut Back
Government and hospital leaders have been quietly preparing to provide backup care for patients if Parkland Memorial Hospital loses federal health care funding, which could force it to close all or some of its departments. A shutdown is considered unlikely by officials and regulators, who nevertheless stress that a plan must be ready (Tarrant and Moffeit, 3/10).

MSNBC: Joining Forces Could Help District Save On Health Care
Rising health care costs and future uncertainties have Quakertown [Pa.] school officials considering joining forces with area districts to pool their buying power to get better health insurance rates (Bentman, 3/9).

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Editorials and Opinions

Views On Supreme Court Case: Both Sides Stage Assault On The Constitution; Obama Overreached; Law Provides Basic Needs

As the date of the high court arguments grows nearer, news outlets have a number of editorials and opinions about the health law case.

The New York Times: Cry, The Beloved Constitution 
Conservatives increasingly bemoan Congress's power to regulate interstate commerce, as illustrated by the debate over the Affordable Care Act's requirement that individuals buy health insurance. They argue that Congress can only regulate activity, not inactivity, and so when it gets involved in a decision by a consumer to not purchase health care, it is going far beyond its reach. If only it were that simple (J. Harvie Wilkinson III, 3/11).

Politico: ACA Case Reminiscent Of 19th-Century Litigation
More fundamentally, in 1937, the court stopped asking these kinds of questions. It concluded that Congress should decide how to regulate the economy. … In other words, as the court decided in the wake of the New Deal, democratic accountability provides the real defense against intrusive economic regulations. Whatever one thinks of the wisdom of the individual mandate or of health insurance reform generally, the lesson of the past 75 years has been that the Constitution provides for a democratic resolution of the issue. Ever since 1937, the court has not needed six hours of argument to figure out that the choice lies with the people's representatives, in Congress. We'll see if the court's ruling, like its argument schedule, reflects a return to an earlier period (Robert Schapiro, 3/11).

Politico: Striking 'Obamacare' A Rejection Of Overreach
Striking down the law would certainly be a direct rejection of the federal government overreach by the president, a repudiation of what is touted as his major legislative achievement. A decision supporting the constitutionality of the individual mandate might intuitively seem to be a validation of the vision of Obama and fellow Democrats of expanding government authority. A ruling of constitutionality, however, also promises to galvanize the opposition and become a rallying point for Republicans (Scott Atlas, 3/11).

Politico: Affordable Care Act's Many Benefits
Congress carefully weighed its authority in writing the law. And a majority of lower-court judges who have ruled on it, including some of the leading conservatives on the bench, have agreed that it's constitutional. In fact, it was Reagan appointee Laurence Silberman who declared last year that challenges to the law have no support "in either the text of the Constitution or Supreme Court precedent." We have every reason to believe the Supreme Court will take the same view. And that's good news because by protecting the law it will also be protecting the care of countless Americans who are already being helped by the law's new benefits, protections and tax breaks (HHS Secretary Kathleen Sebelius, 3/11).

Politico: Feds' Power Grab Must Be Stopped
The court should reaffirm the basic constitutional bargain struck among the states that makes our federal government one of limited, enumerated powers. The act's chief problem is its individual mandate, which requires virtually everyone to obtain health insurance coverage simply as a condition of living in America. Forced conscription into a commercial market is a startling new exercise of federal power that Congress has never before attempted (Florida Attorney General Pam Bondi, 3/11).

(San Jose) Mercury News: Study Reveals Need To Continue Obama's Health Care Reforms
The court should uphold the reforms. Mandating insurance is hardly different from mandating payments into Social Security. And the need for the significant reforms advocated by President Barack Obama and denounced by all of the Republican presidential candidates has never been more apparent. A shocking study released Wednesday by the Centers for Disease Control and Prevention revealed that 20 percent of U.S. families are having trouble paying their medical bills (3/10).

The Wall Street Journal: Coffee Is An Essential Benefit Too
Dear President Obama, Can you believe the nerve of employers? Many of them still seem to think that they should be allowed to determine the benefits they offer. I guess they haven't read your 2,000-page health law. It's the government's job now. That's a good thing, too. Employers for too long have been able to restrict our access to essential health services like contraception by making us pay some of the bill. Really, it's amazing that we aren't all dead. Now, thanks to you, we'll enjoy free and universal access to preventative care just like workers do in Cuba. Even so, there are still many essential benefits that the government must mandate to make the U.S. the freest country in the world (Allysia Finley, 3/12).

Los Angeles Times: Mary Brown, 'Obamacare' Foe -- and Broke
A woman whose case is before the Supreme Court is an exemplar of a problem the health care law was designed to address (3/11).

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Viewpoints: America's Mixed Views On Health; Contraception And Political 'Excesses'; Colorado Medicaid Debate

Los Angeles Times: Obama's Healthcare Albatross
Most people tell pollsters they like the parts of the law that have gone into effect: health insurance for people with preexisting conditions, a clause that allows children to stay on their parents' health plans until the age of 26 and discounts for prescription drugs on Medicare. And, as time goes by, Americans seem less worried that the law will have a negative effect on their own medical care ... But the law itself isn't any more popular than the day it passed (Doyle McManus, 3/11). 

McClatchy: Premiums Buy Health Care, Not Sex
Despite the misrepresentations out there, the Georgetown law student Rush Limbaugh took after wasn't begging Congress for a federal handout or asking taxpayers to fund wanton fornication. She was talking about having the health insurance she pays for -- just as many individuals, workers and their employers do from their own pockets -- cover the cost of prescription drugs that many American women use in a perfectly legal and responsible way (Linda P. Campbell, 3/9).

Boston Globe: Contraception, The Economic Miracle Drug
As she stumps for the Senate these days, Elizabeth Warren is trying her best to emphasize economics over gender.  ... Contraception, she said, is "an economic issue, as well as a social issue.’" ... For fiscal conservatives and deficit hawks, birth control turns out to be something of a miracle drug. It saves everyone money (Joanna Weiss, 3/11).

Arizona Republic: Amid Antics By Right, President Is Attacking Religious Conscience
The president's health-care reform mandates assault religious freedom on a number of fronts. ... But nowhere are the mandates more obviously in conflict with religious independence from government control than where they cross paths with self-insured religious organizations, a cohort that includes more than 600,000 insured employees nationally (Doug MacEachern, 3/10).

Houston Chronicle: Save The Women's Health Program
When it comes to women's health issues, it is time for policymakers in Austin to focus on what best serves Texas.  (The Women's Health Program) in its current form saves the state a lot of money, keeps women healthy and prevents unplanned pregnancies. We shouldn't undermine a program that accomplishes so much so economically (3/9).

The Dallas Morning News: Abortion Ploy Hurts Women More Than Planned Parenthood
Texas is about to get a nose job. And it won't be pretty. Mania over the abortion issue is leading our state into a classic case of cutting off its own nose to spite its face. And the real tragedy is that this fit of pique will very likely lead to more unintended pregnancies and more abortions, not fewer (Steve Blow, 3/10).

Bloomberg: How To Stop Medicare's Multibillion Dollar Fraud Siphon
The government estimates that improper payments, which include error and fraud, in the fee-for-service element of Medicare equaled $28.8 billion last year. ... Yet neither Congress nor the Obama administration -- professed enemies of waste, fraud and abuse -- has taken up the cause with the urgency it requires. Overhauling Medicare’s payment system is a daunting task ... The system was designed to correct errors, not root out fraud  (3/11).

Denver Post: Does Medicaid Receive Too Great A Share Of Colorado's Budget? No
Medicaid, the federal-state program that provides health services to low-income families, helps provide an important safety net for families, the elderly and disabled across Colorado. Republicans say Medicaid is taking too big a bite out of our state budget. However, they still have not provided details of their solutions to help control the growing cost of Medicaid (Rhonda Fields and Beth McCann, 3/11).

Denver Post: Does Medicaid Receive Too Great A Share Of Colorado's Budget? Yes
The problem is that states no longer have the ability to set their own priorities. The federal-state Medicaid "partnership" increasingly resembles a shotgun wedding. A state that rejects the federal spending mandates also loses out on federal matching funds that pay for half of the $5 billion price tag of Colorado's program. In the past five years, the number of Coloradans participating in Medicaid has swollen from 391,962 to 613,148 (Mark Hillman, 3/11).

Denver Post: Why Nursing Is Critical To Colorado's Future
For the next 20 years, Colorado will need over 3,000 nurses per year.  Yet, each year our state's nursing schools graduate 900 fewer nurses than we need. Where will the additional nurses come from? As president of a school of nursing, I'm asked every day: Can Colorado grow its own qualified nursing candidates for employment? I respond with a resounding "Yes." But much needs to be done (Marcia Bankirer, 3/10).

Minneapolis Star Tribune: An Affront To Cancer Survivors
This burden is imposed by legislation that places a moratorium on the construction of any new cancer radiation facilities in a 14-county area encompassing the entire metro area and other populous counties. ... The only clear results of this legislation are to make life tougher for cancer patients and likely increase the future cost of medical care (Dr. Irv Lerner, 3/11).

Detroit Free Press: Fix A Cruel Inequality For Mental Health Care Coverage
(A)n estimated 1.5 million to 2 million privately insured Michigan residents lack coverage for mental health treatment. Michigan must resolve that problem in a comprehensive way. Bills now before the state Senate would take a step toward parity by mandating private insurance coverage for the treatment of one pervasive developmental disorder: autism (9/12). 

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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.