Daily Health Policy Report

Tuesday, March 12, 2013

Last updated: Tue, Mar 12

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Health Care Marketplace

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Osteopathic Physicians: An Answer To Rural Health Care Needs?

Kaiser Health News staff writer Ankita Rao, working in collaboration with The Washington Post, reports: "With a tradition more than 100 years old, osteopathic physicians are hardly the new doctors in town. But the profession's recent growth -- in both training facilities and number of graduates -- could help reverse a looming shortage of primary-care providers that experts say will hit rural communities especially hard" (Rao, 3/11). Read the story. Also, check out the sidebar, The Mainstreaming Of Osteopathic Medicine, and watch the related video.

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Insuring Your Health: Consumers Don't View Curbing Costs As Their Job When Choosing Treatments, Study Finds

In her latest Kaiser Health News consumer column, Michelle Andrews writes: "In recent years, consumers have increasingly been encouraged by employers and insurers to help control rising health care costs by avoiding unnecessary tests, buying generic drugs and reducing visits to the emergency room, among other things. The hope is that a patient better educated and more engaged in health decisions will choose options that will promote better health and decrease costs" (Andrews, 3/12). Read the column.

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Capsules: Mississippi Legislature Passes 'Anti-Bloomberg' Bill

Now on Kaiser Health News' blog, Mississippi Public Broadcasting's Jeffrey Hess, working in partnership with KHN and NPR, reports: "Mayor Mike and his public health edicts are having a rough ride. On Monday, a state judge in Manhattan knocked down the rule capping soda sizes that Mayor Michael Bloomberg championed. Lawmakers in Mississippi are taking things one step further" (Hess, 3/11). Check out what else is on the blog.

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Political Cartoon: 'It's What's For Dinner?'

Kaiser Health News provides a fresh take on health policy developments with "It's What's For Dinner?" by Steve Kelley.

Meanwhile, here is today's health policy haiku:


Soda ban ruling:
A big gulp of due process
for New York mayor.

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.


Editor's Note: A video featuring "Insuring Your Health" columnist Michelle Andrews contained out-of-date information for uninsured consumers seeking coverage when they have a medical problem. The video, published March 11, had been taped before the federal government announced last month that it was stopping enrollment in the Pre-Existing Condition Insurance Plans (PCIP). Those plans, also known as high-risk pools, operate in each state and were established as part of the 2010 federal health law to help provide coverage to people with medical problems who could not get insurance on the private market. The government began closing enrollment on Feb. 15 and the last enrollments were allowed on March 2.

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Capitol Hill Watch

This Week Marked By Flurry Of Congressional Budget Activity

House Republicans and Senate Democrats will release their budgets this week as President Barack Obama continues to work to find areas of fiscal compromise.

The New York Times: House And Senate Work Simultaneously To Create Budgets, A Rarity
But the fact that both houses of Congress are working on their budgets simultaneously after years of impasse raised some measure of hope — albeit slight — that Democrats and Republicans might be able to work out some sort of compromise. Compromise between the two parties, however, is only half of a more complicated bargain. Democrats also have to bridge the divide among a politically diverse group of Democrats on the Senate Budget Committee (Peters, 3/11).

USA Today: Obama, Hill Leaders Knuckle Down On Budget Talks
President Obama and a divided Congress kick off a week of jockeying over the federal budget as House Republicans and Senate Democrats unveil competing fiscal blueprints and the president heads to Capitol Hill to continue his personal campaign for compromise. The president spent part of Monday prepping for three trips to Capitol Hill over the next three days for closed-door meetings with House and Senate lawmakers in both parties. Obama is seeking an alternative to the sequestration, a $1.2 trillion, across-the-board spending cut over the next decade that kicked in March 1 after Congress failed to find a better alternative to cut spending (Davis and Jackson, 3/12).

The New York Times: Obama's GOP Outreach Hits Barriers
What spurred Mr. Obama to reach out to rank-and-file Republicans with a flurry of phone calls, meals and now Capitol visits were the recent announcements by their leaders — Speaker John A. Boehner and Senator Mitch McConnell of Kentucky — that they will no longer negotiate with Mr. Obama on budget policy as long as he keeps demanding more tax revenues as the condition for Democrats' support of reduced spending on Medicare and other entitlement programs. Both leaders face political risks from deal-making with the president — Mr. Boehner the potential loss of his leadership job; Mr. McConnell the danger of a Tea Party challenge as he faces re-election next year (Calmes, 3/11).

CNN Money: How Obama Plans To Save Medicare
The White House often says President Obama has a plan for reforming entitlements, particularly Medicare. However, the specifics of that proposal don't spring to mind as easily as the reforms being bandied about in Republican circles, such as providing seniors with vouchers to pay for premiums or raising the retirement age. That's partly because Obama last laid out his reforms in February 2012 as part of his budget proposal. The president did little more than touch on these plans on the campaign trail last year and again in last month's State of the Union address (Luhby, 3/11).

The Senate Democrats' budget is expected to be released Wednesday -

The Washington Post: Senate Democrats Prepare To Roll Out Budget Blueprint
Murray plans to unveil her budget proposal on Wednesday, marking the first time Senate Democrats have drafted a budget since 2009. Aides said Murray will not offer explicit policies for raising new revenue or trimming expensive health programs, but will instead leave those details to other committees, including the tax-writing Senate Finance Committee. The president's budget request, meanwhile, is expected in early April — more than two months late (Montgomery, 3/11).

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Ryan's Budget Plan -- To Be Released Today -- Reprises 2012 Election Issues With Medicare, Medicaid Changes

Early reports on the budget being advanced by House Budget Committee Chairman Paul Ryan, R-Wis., suggest the blueprint will score savings by proposing to turn Medicaid into a block grant program, repealing much of the 2010 health law and applying a premium support model to Medicare.

The Wall Street Journal: Ryan Plan Revives '12 Election Issues
He will propose letting seniors buy private insurance or remain in Medicare, with premiums subsidized by the federal government, and turning Medicaid into a block-grant program. The moves would save hundreds of billions of dollars over 10 years, while potentially raising costs for Medicare beneficiaries and sharply cutting the number of Medicaid recipients. His budget would also repeal the White House's 2010 health care law (Paletta and Peterson, 3/11).

The Associated Press/Washington Post: New House GOP Budget Again Takes Aim At Obamacare, Medicaid, Would Lead To Balance In 10 Years
House Republicans are sticking to their guns on the federal budget, promising to try to repeal so-called Obamacare, cut domestic programs from Medicaid to college grants and require future Medicare patients to bear more of the program's cost. The point is to prove it's possible to balance the budget within 10 years by simply cutting spending and avoiding further tax hikes, even as the fiscal blueprint to be released Tuesday by Budget Committee Chairman Paul Ryan, R-Wis., will be dead on arrival with the White House and Democrats controlling the Senate (3/12).

Politico: Ryan Budget Targets Obamacare, Oil Drilling
The House Republican budget will balance in 10 years by increasing oil drilling, repealing President Barack Obama's health care law, changing Medicare, overhauling welfare and rewriting the tax code (Sherman, 3/11).

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).

National Journal: House GOP Confident On Paul Ryan's Medicare Plan
Rep. Paul Ryan's plan to balance the federal budget in 10 years would have been, until recently, cause for House Republicans to fret. But emboldened by last year's elections, in which they say attacks on Ryan's previous proposals fizzled, the House GOP believes it can adopt the Budget Committee chairman's new proposal and avoid backlash at the same time. There are limits to that confidence. Moderate Republicans scuttled a push for Ryan's Medicare overhaul to take effect earlier, something they say would have broken a promise that Americans now as young as 55 would still be able to enroll later in the traditional health care program (Roarty, 3/11).

In related news -

Politico: Sen. Ron Johnson Pounds Obamacare
Sen. Ron Johnson on Monday ripped into Obamacare, trying to back up House Budget Committee Chairman Paul Ryan's decision to seek the law's repeal in his proposed budget. "I think the cost estimate of Obamacare is grossly understated," Johnson said on MSNBC's "Morning Joe." "I think far more Americans are going to lose their employer-sponsored care because there are incentives for employers to drop their coverage and make their employees eligible for huge subsidies and exchanges. I think this is going to explode our deficit, I think this is going to lead to rationing. It will lead to rationing, lower quality of care" (Robillard, 3/11).

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Senate Democrats To Take Up Government Funding Bill

The measure does not include the additional money the Obama administration was seeking to implement parts of the health law.

Politico: Senate Takes Its Own Path On CR
Behind the numbers is also a political lesson -- aptly timed the week before St. Patrick's Day. President Barack Obama is denied added money he wanted for health care and Wall Street reforms -- a penalty born of Democratic frustration with this White House's diffidence toward the appropriations machinery that funds its agenda (Rogers, 3/12).

The Associated Press/Washington Post: Senate Democrats Prepare Government Funding Bill To Prevent Shutdown As Long-Term Battles Loom
Senate Democrats are preparing a catchall government funding bill that denies President Barack Obama money for implementing signature first-term accomplishments like new regulations on Wall Street and his expansion of government health care subsidies but provides modest additional funding for domestic priorities like health research. The measure expected to be released Monday is the product of bipartisan negotiations and is the legislative vehicle to fund the day-to-day operations of government through Sept. 30 -- and prevent a government shutdown when current funding runs out March 27 (3/11).

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Health Reform

Florida Senate Committee Rejects Medicaid Expansion

The vote doesn't stop an expansion of coverage to the state's uninsured since the panel could make an alternative recommendation. But it indicates that Gov. Rick Scott faces considerable pushback from his own party regarding his support of this provision of the health law.

The New York Times: Medicaid Expansion Is Rejected In Florida
Rebuffing Gov. Rick Scott's support of Medicaid expansion, a Florida Senate committee on Monday rejected the idea, all but ending the possibility that the state would add more poor people to Medicaid rolls (Alvarez, 3/11).

The Wall Street Journal: Florida Lawmakers Balk At Health Shift
The vote doesn't halt the Medicaid expansion in its tracks, as the panel could still make an alternative recommendation about expanding Medicaid, and other lawmakers could also propose their own bills. But it is a sign that Mr. Scott will continue to face high obstacles from members of his own party. The governor, a leading critic of the 2010 health-care law, changed his opposition to taking federal dollars to expand the program after reaching an agreement with Washington officials to let the state contract with private insurance companies to manage the care of new Medicaid enrollees (Radnofsky and Campoy, 3/11).

Health News Florida: Senate Panel Says No To Medicaid Expansion, Wants 'Florida Plan'
The Senate's special committee on the Affordable Care Act voted along party lines Monday to reject Medicaid expansion, with members saying they want to develop a Florida-specific plan. The vote was 7 to 4…Negron offered an alternative -- which members of the committee dubbed the "Negron Plan" -- that would offer 1 million low-income uninsured in Florida a basic plan tied to a health-reimbursement account (Gentry, 3/12).

The Washington Post's WonkBlog: Florida Senate Panel Rejects Medicaid Expansion – But It's Not Dead Yet
It was a huge coup for the Obama administration when they won Florida Gov. Rick Scott's endorsement of the Medicaid expansion. In his state alone, the Obamacare program could cover 1.3 million people. But the governor wasn't the only endorsement they had to secure: The Republican-controlled Florida legislature would also need to sign off on the expansion. And as of Monday afternoon, they don't appear inclined to move forward: Committees in the Florida House and Senate have rejected the Medicaid expansion as proposed by Gov. Scott (Kliff, 3/11).

Meanwhile, debates over whether and how to expand Medicaid continue in other states -

The Wall Street Journal: Private Medicaid Plans Get Push
A pair of states are proposing to use new Medicaid funding to help the poor buy private health insurance, a new twist in how to implement the 2010 federal health-care law that is winning support from some Republicans (Campoy and Radnofsky, 3/11).

The Associated Press: Medicaid Discussions Continue Among Miss. Lawmakers
The Mississippi Hospital Association announced Monday that it's working with Gov. Phil Bryant’s office to address budget constraints resulting from the Affordable Care Act amid Bryant's ongoing opposition to the federal health care overhaul. Claude Harbarger, leader of the MHA Board of Governors, said he is grateful that Bryant is willing to work toward a solution. He said the state's hospitals are already losing millions of dollars as they begin to implement the Affordable Care Act (Tillman, 3/12).

Also in the news, Health and Human Services Secretary Kathleen Sebelius pitches the Medicaid expansion to city leaders -

Modern Healthcare: Sebelius Urges Expansion Of Medicaid Programs
The Obama administration sought to recruit city leaders Monday in the ongoing battle to expand Medicaid nationwide. HHS Secretary Kathleen Sebelius urged attendees at the National League of Cities' annual legislative forum to join in the administration's ongoing push to convince Republican governors to expand their Medicaid programs, as called for by the Patient Protection and Affordable Care Act. … Sebelius characterized governors who are refusing the expansion as “playing politics” because they were opposed to the underlying 2010 federal healthcare overhaul. That law envisioned using a national Medicaid expansion to provide coverage to about half of the 30 million people who were expected to gain insurance under its provisions (Daly, 3/11).

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Blue Cross Of Texas Kicks Off Enrollment Campaign For Insurance Marketplace

News outlets also report on health exchange developments in Michigan and the District of Columbia.

The Texas Tribune: Blue Cross Launches Campaign For Insurance Exchange
Blue Cross Blue Shield of Texas, the state's largest health insurance provider, is launching a statewide campaign on Tuesday aimed at getting Texans enrolled in health plans through an online marketplace created by federal health reform. Texas won't have its own state-specific health insurance exchange; Republican leaders here have rejected that option as part of their opposition to the Affordable Care Act (Ramshaw, 3/12).

The Associated Press: Mich. Health Exchange: The Fight Is Not Over Yet
Gov. Rick Snyder's attempt for legislative approval of a new health insurance market in Michigan has been a 1 1/2-year odyssey - and it's not over yet. ... With Plan B, the governor pitched a partnership website controlled almost entirely by the federal government. The House assented to spending $31 million in federal money for the exchange - reasoning the contentious law is here to stay - only now support may be fading among Senate Republicans (3/11).

CQ HealthBeat: District Of Columbia Exchange Making A Splash
The District of Columbia Health Benefits Exchange is getting attention for its ambitious policy plans and veteran inside-the-beltway hires. Mila Kofman, a former superintendent of insurance for Maine, took the helm as executive director on Jan. 2 and has been moving forward quickly since then. Instead of relying only on officials with experience within the D.C. government, she recruited a number of policy analysts who are well-known for their work on Capitol Hill, in federal agencies or at the nation’s largest health plan trade association, America's Health Insurance Plans (Adams, 3/12).

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Health Law Challenges Leave Some Democrats Complaining -- In Public, Even

Some challenges associated with implementing the health law have some Democrats complaining about the law in public -- something once unthinkable. In the meantime, California runs into problems using the law to enroll the uninsured, and physicians who treat Medicaid patients have yet to see a raise the health law promised.

Politico: With Obamacare Entrenched, Democrats Feel Free To Gripe
A funny thing happened once Democrats grew confident that Obamacare is truly the "law of the land." They started complaining about pieces of it in public. Democrats aren't walking away from the overall law and its sweeping goals; they still see it as a historic achievement they had sought for generations (Haberkorn, 3/11).

Roll Call: Signing Up Uninsured For Health Care A Big Challenge
When a California county wanted to encourage residents to buy health insurance earlier this year, officials employed a time-tested tactic for generating interest: nudity. The Alameda County Social Services Agency’s ad campaign featured bare-skinned people who held up signs in strategic spots that read, “Cover your family.” The use of naked people in ads about health care underscores the desperation felt by organizations and government entities that want to encourage enrollment as the launch of new coverage under the 2010 health care law approaches. On Oct. 1, people all over the nation can start signing up for coverage, which kicks in on Jan. 1, 2014 (Adams, 3/11).

Medscape: Check Is Not in the Mail for Medicaid Primary Care Raise
A Medicaid raise for primary care physicians in 2013 is a "slow train coming," in the words of a Bob Dylan song. As in months and months behind schedule. The Affordable Care Act (ACA) boosted Medicaid rates for evaluation and management (E/M) services and vaccine administration to far more generous Medicare levels for primary care physicians effective January 1. By all accounts, however, eligible physicians have yet to see the pay hike, thanks to the grinding wheels of state and federal bureaucracy. The extra money may not materialize until spring or summer, depending on the state (Lowes, 3/11).

The Washington Post fact-checks a claim on the health law's tax hikes --

The Washington Post's The Fact Checker: Does 'Obamacare' Have $1 Trillion In Tax Hikes, Aimed At The Middle Class?
The argument over President Obama's health-care law, aka Obamacare, never seems to end, as witnessed by the fact that House Republicans on Tuesday will unveil a budget that yet again seeks to eliminate it. This exchange on one of the Sunday shows caught our attention, as the battling lawmakers appear to be completely at odds. Are there $1 trillion in taxes in the law, which Wasserman Schultz denies? And are these "middle-income" tax increases, as Johnson asserts? (Kessler, 3/12).

In other health law news --

The Associated Press: Health Care Law To Create Gap For 21K In Hawaii
Roughly 21,000 people in Hawaii who were previously covered under Medicaid will need to buy their own health insurance once President Barack Obama's sweeping federal health care overhaul takes effect next year, the chief executive of the Hawaii Primary Care Association told a state Senate committee Monday. Robert Hirokawa, of the Hawaii Primary Care Association, said during an informational briefing of the Senate Health Committee that the group represents a so-called "gray" zone that lawmakers should consider as they approach implementing the law (Garcia, 3/11).

CQ HealthBeat: Health Law Provisions To Spur Shared Decision-Making Neglected, Some Analysts Say
A strategy designed to give patients a deeper understanding of their treatment options for certain serious medical conditions isn’t getting the boost it was intended to under the health law, some analysts say. Shared decision-making, which the chairman of the Medicare Payment Advisory Commission late last week described as an ethical imperative, is an approach designed to better incorporate patient preferences when it comes to treating such diseases as prostate and breast cancer and other serious medical conditions where the medical evidence is unclear about which of several treatment options is best (Reichard, 3/12).

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Health Care Marketplace

Cleveland Clinic, Community Health Systems Inc. Join Forces

The two well-known medical names say the collaboration is aimed at improving the quality of care while lowering costs at community hospitals across the nation.

The Wall Street Journal: Cleveland Clinic, Hospital Operator Forge Alliance
The Cleveland Clinic is forging an alliance with the big for-profit hospital operator Community Health Systems Inc., in a sign of how prestigious medical centers are leveraging their brands to extend their reach into untapped local markets. The new tie-up, which will involve quality-improvement efforts and other areas, comes as top medical names are creating more affiliations with health-care providers around the country (Mathews, 3/11).

Modern Healthcare: CHS, Cleveland Clinic Join Forces For 'Quality Alliance'
One of the nation's leading academic medical centers and the second-largest for-profit hospital chain by revenue announced a far-reaching collaboration Monday aimed at improving the quality of care while lowering costs at community hospitals across the U.S. The Cleveland Clinic, world-renowned for its cardiovascular care, will lend its expertise to the more than 130 hospitals in 29 states run by Community Health Systems, which is headquartered in Franklin, Tenn. CHS will gain access to a "quality alliance" already in place at the Cleveland Clinic that can electronically capture, report and compare data about patient outcomes; come up with predictive models for improving patient outcomes; and share those best practices across the CHS system (Lee, 3/11).

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Brand-Name And Generic Drug Makers Join Forces To Challege FTC

Politico: Brand-Name, Generic Drugmakers Fight FTC
Brand and generic drug companies are usually at each other' throats. But they will stand shoulder to shoulder against the Federal Trade Commission and other health care interests come March 25, when the Supreme Court will hear oral arguments about a controversial way of settling patent disputes that’s worth billions to the drug industry (Norman, 3/12).

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Public Health & Education

Judge Blocks NYC's Big Gulp Ban, Bloomberg Vows Appeal

A New York state judge blocked New York City's limit on big sugary drinks Monday, just a day before the law was set to take effect, calling the limits "arbitrary and capricious." And in a preemptive strike, Mississippi lawmakers have sent legislation to the governor's desk which would bar counties and towns from enacting rules that require calorie counts to be posted, cap portion sizes, or keep toys out of kids’ meals. 

The New York Times: Judge Blocks New York City's Limits On Big Sugary Drinks
In an unusually critical opinion, Justice Milton A. Tingling Jr. of State Supreme Court in Manhattan called the limits "arbitrary and capricious," echoing the complaints of city business owners and consumers who had deemed the rules unworkable and unenforceable, with confusing loopholes and voluminous exemptions (Grynbaum, 3/11).

NPR: Judge Overturns New York City Ban On Big Sugary Sodas
A New York state judge has knocked down New York City's landmark new ban on big, sugary drinks, just one day before it was set to take effect. Calling them "arbitrary and capricious," state Supreme Court Justice Milton Tingling on Monday invalidated regulations that would have banned New York City restaurants, movie theaters and other food service establishments from serving sugary drinks in sizes bigger than 16 ounces. The ban would have covered not just sodas but a wide array of other sugar-sweetened drinks, from smoothies to coffee (Godoy and Aubrey, 3/11).

The Wall Street Journal: Judge Cans Soda Ban
At a late afternoon news conference, Mr. Bloomberg and the city's top lawyer, Michael Cardozo, said they believed the judge erred in his ruling and vowed to appeal. The decision was both lauded and criticized by city officials and others. … New York state Supreme Court Judge Milton Tingling declared invalid Mr. Bloomberg's plan to prohibit restaurants, mobile food carts, delis and concessions at movie theaters, stadiums or arenas from selling sugary drinks in cups or containers larger than 16 ounces. The ban was set to begin Tuesday (Saul, 3/11).

Reuters: Judge Blocks New York City Large-Soda Ban, Mayor Bloomberg Vows Fight
New York City Mayor Michael Bloomberg vowed on Monday to appeal a judge's ruling that struck down his pioneering ban on large sugary drinks sold by the city's restaurants, movie theaters and other food service businesses just a day before it was to take effect. The judge called the ban "arbitrary and capricious" in an 11th-hour decision that dealt a serious blow to Bloomberg, who has made public health a cornerstone of his administration, with laws prohibiting smoking in restaurants, bars and parks; banning trans fats; and requiring chain restaurants to post calorie counts (Ax, 3/12).

Medpage Today: ‘Nanny State’ Soda Ban Shot Down By Court
A ban on sugary beverages sold in New York City has been ruled unconstitutional by a state Supreme Court judge, but as the city mulls its next move, other jurisdictions are already implementing their own restrictions on unhealthy behaviors. Judge Milton Tingling wrote in his decision that the regulations, set to go into effect Tuesday, were "fraught with arbitrary and capricious consequences." "The loopholes in this rule effectively defeat the state purpose of the rule," Judge Tingling said. The controversial soda ban aims to prohibit the sale of sugared beverages in quantities larger than 16 ounces in places regulated by the city health department, including national chains such as Dunkin' Donuts and Subway sandwich shops (Struck, 3/12).

Kaiser Health News: Capsules: Mississippi Legislature Passes 'Anti-Bloomberg' Bill
Mayor Mike and his public health edicts are having a rough ride. On Monday, a state judge in Manhattan knocked down the rule capping soda sizes that Mayor Michael Bloomberg championed. Lawmakers in Mississippi are taking things one step further. A bill on the governor’s desk would bar counties and towns from enacting rules that require calorie counts to be posted, that cap portion sizes, or that keep toys out of kids’ meals (Hess, 3/11).

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State Watch

Arkansas' Abortion Ban Energizes Backers Of Fetal Heartbeat Laws

That state's adoption of the nation's strictest abortion ban -- prohibiting abortion after 12 weeks of pregnancy, when a fetal heartbeat is usually found -- is spurring advocates to push similar legislation in Kansas, Kentucky, Mississippi, Ohio, North Dakota and Wyoming. Legal scholars say such laws have little chance of withstanding federal court scrutiny.

The New York Times: Arkansas's Abortion Ban And One Man's Strong Will
The adoption by Arkansas last week of the country's strictest abortion ban -- at 12 weeks of pregnancy, when a fetal heartbeat is typically detected -- gave a new jolt of energy to a loose band of abortion foes who are pushing similar measures in several states. Fetal heartbeat laws are already under consideration by legislatures in Ohio, Kansas and North Dakota, and have a good chance of passage in the coming year, their proponents believe, even though legal experts say they have little chance of surviving in federal courts (Eckholm 3/11).

Fox News: Anti-Abortion Law Makes Arkansas Ground Zero In Intensifying National Debate
Arkansas has become ground zero in the battle over abortion rights and limitations in the country. Just last week, lawmakers overrode Gov. Mike Beebe's veto of a law that will ban most abortions after the 12th week of pregnancy. Under the Arkansas Human Heartbeat Protection Act, which is scheduled to go into effect later this summer, women seeking an abortion who are at least 12 weeks pregnant will be required to undergo an ultrasound. If a heartbeat is detected, the abortion would not be permitted. The law includes jail time and fines for doctors who violate the law but no penalties for women who seek or undergo an illegal abortion (Bream, 3/11).

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State Roundup: N.Y. Psychiatrists Sue Insurer Over Parity

News outlets cover health care developments in California, Georgia, Iowa, Kansas, Maine, Missouri and New York.

MPR News: N.Y. Psychiatrists Group Sues UnitedHealth
A group representing psychiatrists in New York state is suing Minnetonka-based UnitedHealth Group for violating laws requiring parity in mental health coverage. The complaint filed in New York federal court accuses the giant health insurer of limiting, delaying and denying mental health treatment. The New York State Psychiatric Association alleges UnitedHealth systematically refused to cover mental health services where the provider was not part of UnitedHealth's network. The suit says the insurer routinely blamed a failure to respond to United's requests for additional information, but the psychiatric association contends the health insurer never made those requests (Stawicki, 3/11).

Los Angeles Times: LA Population Will Be Much Older, More Settled, Study Says
Seventeen years from now, senior citizens will make up nearly one-fifth of the county population, almost twice as many as at the start of the millennium, say Dowell Myers and John Pitkin of the USC Population Dynamics Research Group. ... The predicted result is fewer young workers to care for the growing ranks of the elderly – a trend that could pinch pocketbooks for families and the government. The study predicts that over the next two decades, Los Angeles County will gain 867,000 senior citizens and lose 630,000 people younger than 25. A similar trend is underway nationwide but Los Angeles stands out because the shift comes after its earlier explosion in immigration and growth, Myers said (Alpert, 3/12).

Los Angeles Times: Parents Of Prescription Overdose Victims Plead With Legislators
After hearing emotional testimony from parents whose children died of drug overdoses, lawmakers in Sacramento called Monday for the Medical Board of California to mine a statewide database of prescriptions to help identify doctors who recklessly prescribe narcotics (Girion and Glover, 3/11).

The Associated Press/Washington Post: Veterans Administration Says Its Mental Health Counselors Won't Obey NY Gun Reporting Laws
The federal Department of Veterans Affairs said Monday its mental health professionals won't comply with a new gun law in New York that requires reporting the names of patients they believe likely to hurt themselves or others. That provision is set to take effect Saturday. Several veterans and their advocates warned it would deter many from seeking counseling and medications to deal with post-traumatic stress disorder or other psychological issues (3/11).

The Associated Press: Mo. House Endorses Health Care Conscience Measure
Missouri health care workers could refuse to participate in procedures and research that run afoul of their religious, moral or ethical beliefs under legislation given first-round approval Monday by the House. Physicians, nurses, medical researchers, and certain others involved in health care could not be discriminated against for refusing (Blank, 3/11).

The Associated Press: Iowa Lawmakers Ponder Paying For Own Health Plans
After losing his effort to get state workers to pay a portion of their health care costs, Gov. Terry Branstad called on lawmakers Monday to start contributing to their own plans. Branstad said legislators should pay 20 percent of their health care premiums. Currently, lawmakers, like state union workers, don't have to pay a health care contribution (Lucey, 3/11).

The Associated Press: Hospital Debt Debate Gets Hotter
As a legislative committee took up competing plans to pay Maine's $484 million debt to the state's hospitals for past Medicaid debts, Gov. Paul LePage on Monday signaled for the first time a willingness to discuss expansion of Medicaid under the national health care law. But LePage rejected Democratic efforts to link Medicaid expansion with paying the debt to Maine's nearly 40 hospitals (Adams, 3/12).

Kansas Health Institute: The Whirl Of Hospital Revolving Doors Appears To Be Slowing
Is the whirl of hospital revolving doors slowing? Federal health officials are now reporting that the rate of preventable and costly hospital readmissions is down for the first time in more than five years, which meant about 70,000 fewer hospital returns nationally in 2012 for the Medicare program alone. ... The readmission rate in Kansas was already lower than the national average, but recent numbers show even that somewhat lower rate has dropped (Shields, 3/11).

California Healthline: Geographic Rating Regions Amended
The Assembly and Senate last week introduced amendments to SBX1-2 by Sen. Ed Hernández (D-West Covina) and ABX1-2 by Assembly member Richard Pan (D-Sacramento), which change the geographic rating regions for the individual and small health insurance markets in California. The amendments establish the 19-region plan, the same regions adopted by the Legislature last year for larger-market insurers. The state's health benefit exchange, Covered California, favored the 19-region plan in part because it mirrors last year's large-market legislation and could avoid consumer and industry confusion (Gorn, 3/11).

California Healthline: Inland Empire Provider Positioning For Growth In Reform
Marking yet another step in the steady expansion of its reach in the Inland Empire, Loma Linda University Health is planning to construct a medical and educational complex in San Bernardino that could serve up to 250,000 patients each year. Experts said the expansion is likely part of the health system's strategy to better position itself for changes to health care reimbursement and hospital patient volume expected as a result of the Affordable Care Act. In recent years, Loma Linda University Health has undertaken a number of construction projects in San Bernardino County, where its main medical campus is based, and in Riverside County (McSherry, 3/11).

Bloomberg: Uninsured Americans Get Hit With Biggest Hospital Bills
By the time Astra Augustus left Virtual Memorial Hospital in New Jersey after the last of four surgeries, she’d run up about $255,000 in bills. … Hospitals' fast-rising sticker prices are adding to the financial burdens of the 49 million Americans without insurance, more than 20 million of whom won’t be covered under President Barack Obama’s Affordable Care Act (Babcock, 3/11). 

Los Angeles Times: Survey: Kaiser Tops In Customer Satisfaction For Health Insurance
For the sixth consecutive year, Kaiser Permanente ranked highest in customer satisfaction for health insurance among California policyholders, according to ratings firm J.D. Power and Associates. Anthem Blue Cross, the state's largest for-profit health insurer, and Woodland Hills insurer Health Net Inc. scored the lowest on customer satisfaction among seven California health plans (Terhune, 3/11).

Georgia Health News: Kaiser Wins Regional Patient Satisfaction Survey
Kaiser Permanente again ranked No. 1 in customer satisfaction among health plans in the three-state region that includes Georgia, according to a newly released 2013 study by J.D. Power and Associates. It's the fourth straight year the nonprofit health plan gained the top ranking in the South Atlantic region, which also includes North Carolina and South Carolina. Kaiser has 240,000 members in Georgia. It does not operate in the Carolinas. Second in the region was Cigna, followed by UnitedHealthcare; Aetna; Blue Cross and Blue Shield of North Carolina; Blue Cross and Blue Shield of Georgia; Coventry; and Blue Cross and Blue Shield of South Carolina (Miller, 3/11).

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Editorials and Opinions

Ryan Says Critics Of His Budget Need To Offer 'Credible Alternative' For Medicare; Opponents Blast Plan As Repeat Of Failed Past Efforts

The Wall Street Journal: The GOP Plan To Balance The Budget By 2023
On Tuesday, we're introducing a budget that balances in 10 years—without raising taxes. How do we do it? We stop spending money the government doesn't have. ... Our budget repeals the president's health-care law and replaces it with patient-centered reforms. It also protects and strengthens Medicare. I want Medicare to be there for my kids—just as it's there for my mom today. But Medicare is going broke. Under our proposal, those in or near retirement will see no changes, and future beneficiaries will inherit a program they can count on. Starting in 2024, we'll offer eligible seniors a range of insurance plans from which they can choose—including traditional Medicare—and help them pay the premiums. The other side will demagogue this issue. But remember: Anyone who attacks our Medicare proposal without offering a credible alternative is complicit in the program's demise (Rep. Paul Ryan, R-Wis., 3/11).

The Washington Post: Paul Ryan's Make-Believe Budget
Ryan is likely to reprise — and even augment — the hundreds of billions of dollars in cuts he proposed last year for social programs. He indicated that he still believes Medicare should be voucherized, although he objects to the word and insists that what he advocates is "premium support." And he asserted that Obamacare’s expansion of Medicaid, the health-care program for the poor, is "reckless" — even as tea party-approved Republican governors such as Rick Scott of Florida announce their states’ participation (Eugene Robinson, 3/11).

The Washington Post's The Plum Line: What Do You Do When One Party Is This Dishonest?
We're still waiting for a full rollout of House Budget Chair Paul Ryan’s Republican budget, but there's confirmation now that it will once again rely heavily on retaining the Medicare cuts passed in the Affordable Care Act (even as Ryan's budget repeals the rest of the law). Others have noted the hypocrisy at work here. But everyone is under-appreciating just how outrageous this is. For the second time in a row, Paul Ryan and the Republicans have run a national election campaign (the 2012 presidential election) in which the main theme was bashing the Democrats … for a policy which Republicans support -- and indeed are making a key part of the most important policy blueprint that they will roll out this year (Jonathan Bernstein, 3/11).

USA Today: RyanCare, Third Time's No Charm: Our View
Ryan is right to focus on the cost of Medicare, as well as other health care programs funded by government. The programs are popular, but they also are the biggest drivers of federal deficits. The taxpayer's tab for health care has grown from $260 billion in 1993 to more than $1 trillion this year — and is projected to grow by roughly $100 billion per year for the next several years. That's unsustainable, particularly as the Baby Boom generation retires. But Ryan's approach, apparently offered as a bargaining position in upcoming budget talks with the White House and congressional Democrats, is not the way to go (3/11).

USA Today: To Save Medicare, Change The Model: Opposing View
House Budget Committee Chairman Paul Ryan is proposing important Medicare reforms as part of a 10-year balanced budget plan. He's absolutely right to do so. Medicare is not sustainable in its current form. It costs too much even as the quality of care it provides falls well short of what seniors deserve. The Congressional Budget Office estimates that Medicare's costs will reach $1.09 trillion in 2023, up from $551 billion in 2012 (James C. Capretta, 3/11).

Politico: Paul Ryan Budget Plan Is Same Old Trickery
Ryan will undoubtedly once again employ budget gimmicks of the type he and Governor Romney made a hallmark of their economic plan. His past budgets have included lofty rhetoric about deficit savings but very few actual details of how those savings are found. In addition to the Medicare and Medicaid cuts touted in his viral videos, Ryan will once again need to rely on trillions in additional spending cuts (Rep. Steny Hoyer, D-Md., 3/11).

National Journal: Paul Ryan's Obamacare Repeal Fantasy
Democratic reactions to Paul Ryan's past budget proposals have run the gamut from skeptical to hostile to dismissive. Now add one more reason for all of the above: Even though President Obama won the 2012 election, Ryan's new plan to balance the federal budget in 10 years relies on repealing the Affordable Care Act (Jill Lawrence, 3/11).

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Viewpoints: 'Grim' Backlog At VA; Feds Should Stay Away From Reforming Medical Malpractice

The New York Times: The Grim Backlog At Veterans Affairs
A new report based on previously unreleased data from the Department of Veterans Affairs paints a distressing portrait of an agency buried helplessly in paperwork -- with a claims backlog that has gotten far worse in the past four years. The average wait to begin receiving disability compensation and other benefits is 273 days, and up to 327 days for veterans making claims for the first time. Those in big cities wait far longer -- up to 642 days in New York. The total number of veterans with backlogged claims, about 900,000, is expected to pass a million by the end of this month and keep growing through the year (3/11).

Bloomberg: Feds Shouldn't Meddle With Medical Malpractice
At the end of a long cover story for Time magazine on high U.S. health-care costs, Steven Brill suggested that doctors who follow the best practices in the field should be shielded from liability. Peter Orszag, writing for Bloomberg View, argued that this policy could do a lot to reduce costs. One of the few health-care ideas that almost all congressional Republicans have agreed on, meanwhile, is caps on medical-malpractice awards. ... I don't deny that medical-malpractice law needs reform. Every doctor I know has a horror story. But lawsuits over medical care have traditionally been governed by state law -- and they should continue to be. (Ramesh Ponnuru, 3/11).

Los Angeles Times: Obamacare's Other Benefit
If it is done right, the Affordable Care Act (a.k.a. Obamacare) may well promise uninsured Americans a lot more than cheap, reliable medical care. It can also open the door to the democratic empowerment of millions of poor people, who are often alienated from much of the nation's civic life, by strengthening the organizations that give them a voice (Nelson Lichtenstein, 3/12). 

WBUR: CommonHealth: When Health Care Costs Help Threaten Teachers We Need
For many of us, there comes a moment when the high cost of health care suddenly turns from an abstract public issue into a deeply personal one. Often, it’s an astronomical out-of-pocket medical bill. Or a family calculation that the price of health insurance means no new car, or no summer trip. For me, that moment came last week at a PTO meeting held at my children's Brookline public school. At issue: plans to eliminate the "Enrichment and Challenge Support" program (Carey Goldberg, 3/11).

Kansas City Star: Big Holes In The Medical Safety Net
Paul Chan is a heart specialist at St. Luke's Hospital and part of a group of superstar researchers there who have been mining national data on heart patients and coming up with findings that have major implications about poverty, race and health care. Chan's previous work has found that uninsured patients are more likely to delay going to the hospital when they have urgent heart attack symptoms such as chest pains, and that people in cardiac arrest are less likely to get CPR from a bystander in neighborhoods that are predominantly poor or black (Alan Bavley, 3/12).

Des Moines Register: State Needs More Consistency In Inspections
A few decades ago, thousands of Iowans with mental and physical disabilities lived in large, government-run institutions. A national movement away from this model of care didn't eliminate the need to help these people. Instead, it gave rise to smaller, "community-based" facilities. The change was not accompanied by changes in laws to require adequate government oversight of these facilities, however (3/12).

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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.