Daily Health Policy Report

Tuesday, March 13, 2012

Last updated: Tue, Mar 13

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Campaign 2012

Health Care Marketplace

Health Information Technology

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Off-Label Use Of Risky Antipsychotic Drugs Raises Concerns

Reporting for Kaiser Health News, in collaboration with The Washington Post, Sandra G. Boodman writes: "But these days atypical antipsychotics -- the most popular are Seroquel, Zyprexa and Abilify -- are being prescribed by psychiatrists and primary-care doctors to treat a panoply of conditions for which they have not been approved, including anxiety, attention-deficit disorder, sleep difficulties, behavioral problems in toddlers and dementia. These new drugs account for more than 90 percent of the market and have eclipsed an older generation of antipsychotics. Two recent reports found that children and adolescents in foster care, some less than a year old, are taking more psychotropic drugs than other children, including those with the severest forms of mental illness" (Boodman, 3/12). Read the story.

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Rules For New Insurance Marketplaces Give Insurers Clout

Kaiser Health News staff writer Julie Appleby reports: "Insurers and other industry representatives will get to fill as many as half the seats on the governing boards for state health insurance exchanges, under final rules for the marketplaces issued today by the Department of Health and Human Services.  At least one seat must be reserved for a consumer representative. The long-awaited rules are likely to disappoint consumer advocates who would have preferred the governing boards 'be dominated by consumers,' said Timothy Jost, who speaks as a consumer advocate before the National Association of Insurance Commissioners and is a professor at the Washington and Lee University School of Law" (Appleby, 3/12). Read the story.

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Insuring Your Health: Premium Rebates, Coverage Labels, Reduced Medicare Drug Costs Highlight 2012 Health Law Changes

In her latest Kaiser Health News consumer column, Michelle Andrews writes: "Two years after its passage, the sweeping health care overhaul remains deeply controversial, with both political parties trying to use it to their advantage in the upcoming elections. As GOP lawmakers constantly deride 'Obamacare' and threaten to repeal it, it's easy to forget that implementation marches on, and a number of notable changes will take effect for consumers this year" (Andrews, 3/12). Read the column.

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Capsules: Winners And Losers In Medicare Advantage Extras: Avalere Report

Now on Kaiser Health News' blog, Marilyn Werber Serafini reports: "Medicare beneficiaries in private health plans throughout the country get significantly different levels of extra benefits, and that disparity will continue with the implementation of the 2010 health law, according to an analysis released Monday by the health care consultant Avalere Health. Moving forward, some extra benefits that seniors are getting in these plans are likely to diminish and some are likely to disappear altogether depending on where a senior lives, according to the report" (Werber Serafini, 3/12). Check out what else is on the blog.

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Political Cartoon: 'A Man's Reach Should...?'

Kaiser Health News provides a fresh take on health policy developments with "A Man's Reach Should...?" By Lee Judge.

Meanwhile, in honor of yesterday's health exchanges regs, here are two haikus:


Exchanges are keyed
to state flexibility
But they still might flee



To be/not to be
Insurance Exchanges – Oy!
States still on the fence

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

Obama Administration Releases Rules For Health Exchanges

The regulations outline minimum standards that states must meet to set up and run these health insurance marketplaces by a Jan. 1, 2014, deadline. 

Kaiser Health News: Rules For New Insurance Marketplaces Give Insurers Clout
Insurers and other industry representatives will get to fill as many as half the seats on the governing boards for state health insurance exchanges, under final rules for the marketplaces issued today by the Department of Health and Human Services.  At least one seat must be reserved for a consumer representative. The long-awaited rules are likely to disappoint consumer advocates who would have preferred the governing boards "be dominated by consumers," said Timothy Jost, who speaks as a consumer advocate before the National Association of Insurance Commissioners and is a professor at the Washington and Lee University School of Law (Appleby, 3/12).

NewsHour: New Health Reform Rules Issued As Supreme Court Review Nears
The much-anticipated final regulations for health insurance exchanges -- released Monday in a 644-page document -- emphasized the broad latitude states will have in developing and implementing their own health insurance marketplaces by 2014. The virtual shopping centers will aim to make the process of buying health insurance as easy as navigating a site like Amazon.com and are expected to serve about 21 million Americans by 2017. According to Health and Human Services Secretary Kathleen Sebelius, the final exchange regulations give states "the flexibility they need to design an exchange that works for them." She also reiterated the administration's belief that the exchanges will boost competition in the individual and small-business marketplace and will give both groups "the same purchasing power big businesses have today" (Kane, 3/12).

The Associated Press/Washington Post: Ambitious Health Care Blueprint Stresses State Flexibility, Sets Up Huge Logistical Challenge
Democratic state officials are praising the flexibility in federal rules issued Monday, a long-awaited blueprint for state health insurance markets where millions of consumers will shop starting in 2014. States have a range of options for designing and running the new markets, called exchanges. … But Republicans say the health care law still amounts to a power grab by Washington. "Once again, the Obama administration has overpromised, oversold and under-delivered," said Bob McDonnell, Virginia's GOP governor (3/13).

Los Angeles Times: White House Relaxes Key Rule In New Healthcare Law
The administration moved to ease development of state-based insurance exchanges for Americans not covered by employers. States will get more flexibility in running the exchanges and may get help setting them up (Levey, 3/12).

Modern Healthcare: Official Notes Exchange Rule's Flexibility
The final rule that outlined design requirements of state health insurance exchanges differed in some ways from the proposed rules that preceded it. The 644-page final rule outlined details of the exchanges, or insurance marketplaces, which are scheduled to launch Jan. 1, 2014, and offer insurance plan options for individuals and small businesses. The final rule outlined the minimum standards states must meet in establishing and operating their exchanges, such as individual and employer eligibility for enrollment. The rule also outlines minimum standards that health insurers must meet to participate in an exchange and the standards employers must meet to participate in the exchange (Daly, 3/12).

Reuters: New Healthcare Exchange Rules Issued For States
The Obama administration on Monday released broad new operating rules for state-run health insurance exchanges, which form a key part of the 2010 federal healthcare reform law that will face landmark Supreme Court hearings in just two weeks. The long-awaited regulations, released by the Department of Health and Human Services, are intended to provide state lawmakers and officials flexibility on federal deadlines as they meet the complex task of building state and regional insurance markets before a January 1, 2014, deadline (Morgan, 3/12).

National Journal: New Health Exchange Regulations Make Room For Brokers
Brokers and other third-party administrators will be allowed to direct people to state insurance exchanges — the marketplaces created by the 2010 health care reform law where people can buy insurance policies — and check to see if they are qualified for tax credits under long-awaited final regulations released on Monday. That means a possible new business model for insurance brokers or any other companies looking to set up an access point to the state insurance exchanges — something that concerns some consumer groups (McCarthy, 3/12).

CQ HealthBeat: HHS Keeps Exchange Rulemaking Moving Via Staggered Approach
The Obama administration has resorted to various tactics over the past two years to keep rulemaking moving under the health law despite the enormity of the job. On Monday it struck again, moving long-awaited final health insurance exchange regulations out the door, thanks to a staggered approach. It was a little like giving a college professor a big chunk of a mammoth final term paper to read while promising to turn in the rest before she finished reading the first part (Reichard, 3/12).

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

CQ HealthBeat: HHS Officials Pledge 'Partnership' To Launch Co-Ops
To some they may seem as babes in the woods about to be menaced by large animals. But people launching health care cooperatives with loans issued under the health law are brimming with hope and basking in the good wishes of federal officials, for now at least. In Washington on Friday for a conference sponsored by the National Alliance of State Health Cooperatives (NASHCO), the organizers of the new ventures heard expressions of admiration from government officials but also blunt advice that they face "a huge lift," in the words of Barbara Smith, associate director of the Co-op Program at Health and Human Services (Reichard, 3/12).

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Capitol Hill Watch

IPAB Opponents Eye Malpractice Lawsuit Curbs To Pay For Repeal

This idea has drawn support for some GOP lawmakers seeking to get rid of the Independent Payment Advisory Board, but trial lawyers are already lining up against it. Meanwhile, a new Congressional Budget Office estimate indicates that because Medicare spending is slowing, the board may never actually have to spring into action.

Politico Pro: CBO Score On IPAB Is $3 Billion Bet Hedge
The Congressional Budget Office's estimate that repealing IPAB would cost $3.1 billion has people on the Hill scratching their heads even more than they usually do on a CBO health spending score. On one hand, the CBO is looking at Medicare spending trends and seeing signs that growth is truly slowing. Not a recession-linked short-term blip, but a trend. And that means that the Independent Payment Advisory Board — which was designed as a backstop to curb spending if needed — probably won't have to recommend payment changes until at least 2022 (DoBias, 3/13).

CQ HealthBeat: House GOP Weighs Curbs On Malpractice Suits To Offset IPAB Repeal Cost
House Republicans are planning to use an amended measure to restrict medical malpractice lawsuits as a way to offset the cost of abolishing a board created by the 2010 health care law to restrain Medicare spending, according to a GOP leadership aide. A bill to scrap the Independent Payment Advisory Board (IPAB) is expected to reach the House floor during the week of March 19, when the chamber returns from its current recess. The Congressional Budget Office estimates that the legislation would increase federal direct spending by $3.1 billion over 10 years (Attias and Ethridge, 3/12).

The Hill: Health Law Board Repeal Bill Raises Concerns With Trial Lawyers
The powerful trial lawyers' lobby has come out in force against a bill to repeal the healthcare reform law's cost-cutting board because of the way it's paid for, possibly depriving House Republicans of a unique chance to deal a bipartisan blow to President Obama ahead of the November election. To pay for their repeal of the Independent Payment Advisory Board (IPAB), House leaders have proposed coupling it with legislation capping medical malpractice damages when it comes up for a vote next week. Tort reform has long been a Republican priority, but linking the two bills is likely to cause a number of defections among the 20 Democratic co-sponsors of IPAB repeal while diluting the GOP's message about the unelected board's lack of accountability (Pecquet, 3/12).

The Hill: Dems Targeted Over Support For Health Care Law's 'Rationing Board'
The conservative seniors' lobby 60 Plus launched a $3.5 million ad campaign on Monday targeting five vulnerable Senate Democrats over their support for the healthcare reform law's cost-control board. The TV and Internet ads call on viewers to contact the senators and urge them to repeal the Independent Payment Advisory Board, which the House is scheduled to vote on next week. The ads target Sens. Bill Nelson (D-Fla.), Debbie Stabenow (D-Mich.), Sherrod Brown (D-Ohio), Jon Tester (D-Mont.) and Claire McCaskill (D-Mo.) (Pecquet, 3/12).

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GOP Fissures Likely To Emerge With Efforts To Revamp Budget Deal, Medicare

House Republicans appear divided over whether to push for deeper spending cuts in the 2013 budget plan than those agreed upon during last year's debt ceiling deal. Democrats and Republicans are also preparing for a Medicare fight. Meanwhile, some GOP senators have requested a hearing with Health and Human Services Secretary Kathleen Sebelius to discuss revised cost estimates for the health law.

The New York Times: GOP Split Over A Bid To Revise Budget Deal
The House is bracing for a rancorous showdown over a 2013 budget plan that has already divided Republicans because of a push by conservatives to cut spending below the level both parties agreed to in last year's deal to raise the federal deficit. … The budget blueprint for the coming fiscal year — to be unveiled next week — will also reignite the fight over Medicare, an election-year prospect that has both parties digging in (Weisman, 3/12).

The Hill: GOP Senators Request Budget Hearing With Seblius
Republicans on the Senate Budget Committee want a hearing with Health and Human Services Secretary Kathleen Sebelius, following an exchange last week in which she was not sure of details about the healthcare law's effect on the deficit. Sens. Jeff Sessions (R-Ala.) and Ron Johnson (R-Wis.) requested the hearing Monday in a letter to Budget Committee Chairman Kent Conrad (D-N.D.) They said the committee should look into revised cost estimates for the Affordable Care Act before marking up a budget resolution for next year (Baker, 3/12).

CNN Money: Health Reform's Cost Under Scrutiny
Capitol Hill's official budget cruncher will offer new estimates on Tuesday of one of the most controversial parts of health care reform: the government's cost of covering tens of millions of uninsured Americans. The Congressional Budget Office's estimates will be part of its annual March revision to its budget baseline -- the marker against which any spending and tax proposals are measured. But they also will come just two weeks before the Supreme Court will hear arguments in a landmark case brought by 26 states and the National Federation of Independent Business, which contend certain provisions in the law are unconstitutional (Sahadi, 3/12).

The Washington Post: The Fact Checker: Is The Health Law Already Running A Deficit
A reader asked us to fact-check these claims by Sen. Johnson, a trained accountant who won election in part on clever ads that played up his experience in the real world of budget numbers. ... Secretary Sebelius certainly appears to be a bit clueless as Johnson tosses a bunch of numbers at her, clearly trying to show that the Obama health care law is now projected to show a deficit. But he gets his own facts and figures mixed up, as we will demonstrate (Kessler, 3/13).

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Campaign 2012

Romney, Now 65, Won't Enroll In Medicare

Instead, GOP presidential hopeful Mitt Romney will buy private health insurance. News reports describe this step as Romney's effort to make a political point. He supports transforming Medicare into a premium support program and has taken the position that wealthier seniors should pay more for their Medicare benefits.   

The Wall Street Journal's Washington Wire: Romney Isn't Signing Up For Medicare
The newly 65-year-old presidential candidate Mitt Romney isn't enrolling in Social Security and he's not signing up for Medicare, either, a campaign aide said Monday. Mr. Romney will keep his private health insurance plan, the aide said, without elaborating on whether he accessed that plan through a former employer or purchased it on the individual market (Radnofsky, 3/12).

Politico: Mitt Romney Won't Sign Up For Medicare
The decision puts Romney in a tiny minority. A vast majority of seniors choose to participate in Medicare. Nearly all seniors are automatically enrolled in Medicare Part A, which covers hospital care. But they can choose not to use it (Haberkorn, 3/12).

Boston Globe: Mitt Romney Turns 65, Will Not Enroll In Medicare
Former Massachusetts Governor Mitt Romney, who celebrated his 65th birthday Monday, does not plan to enroll in Medicare, the federal senior health care program he has pledged to change if elected president. The Republican frontrunner has proposed offering seniors "premium support" — money they could use to pay for Medicare or for private insurance. Wealthy seniors, like Romney, would receive less government assistance than those of more modest means (Borchers, 3/12).

NPR's SHOTS blog: Romney Says No Thanks To Medicare
Romney is clearly making a political point. Wealthy people like him ought to pay more for their Medicare benefits (if they get them at all) and that perhaps 65 is a little young to qualify, too. "Wealthier seniors will receive less support," under the changes Romney is proposing for Medicare, according to his website. At the same time, he is proposing to "gradually raise the retirement age to reflect increases in longevity" (Rovner, 3/12). 

Also on the campaign trail, Newt Gingrich launches a new web video - 

The Hill: Gingrich Ad: Romney 'Can't Beat Obama' Because Of Health Care
Mitt Romney "can't beat Obama" because of the similarities in their healthcare laws, Republican presidential candidate Newt Gingrich said in a Web video Monday. Gingrich and former Sen. Rick Santorum (R-Pa.) have argued before that Romney won't be able to draw a sharp contrast with President Obama on healthcare. The new ad, though, goes further than simply arguing that Gingrich would be stronger on the issue, and claims that Romney would lose a general-election match-up (Baker, 3/12).

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Democrats Launch Efforts To Educate Voters About Health Law's Benefits

The Democratic National Committee will do targeted mailings to improve the law's image. In addition, the Obama campaign posted an interactive website to spell out the measure's benefits.

Des Moines Register: Democrats Plan Mailing To Improve Health Law's Image
Iowa is one of the states Democrats are targeting for a multifaceted campaign meant to improve opinions about the contentious law opponents have labeled Obamacare. More than 70,000 pieces of mail will be sent to Iowans this month by the Democratic National Committee, starting this week. The Obama campaign on Sunday posted a new interactive website that spells out benefits of the law, with examples tailored to whether people have private insurance, government coverage or no insurance (Jacobs, 3/12).

ABC: Million Mailers To Women Plug Obama Health Law
Seeking to expand the edge that President Obama holds over Mitt Romney among women voters, the Democratic National Committee is this week sending out 1 million mailers to women in several states to show how the health care law benefits them. The two-sided flyers aim to succeed where previous Democratic messaging campaigns have failed:  to convince women voters in key general election battlegrounds that the law is laden with cost-saving benefits specially for them, and that the savings could be quickly lost if a Republican wins the White House (Dwyer, 3/12).

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Health Care Marketplace

The Economics Of ACOs

The New York Times: Small-Picture Approach Flips Medical Economics
A.C.O.'s, as they are known, are collections of medical providers who band together under one business umbrella. The organization can include primary care doctors, specialists, social workers, pharmacists and nurses. The difference is in how these providers are paid: Instead of an insurance company or the government reimbursing each provider for each service provided to each patient, the A.C.O. is paid simply to care for a group of patients (Japsen, 3/12).

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Health Information Technology

Authors Defend Study That Concluded Electronic Health Records May Not Reduce Health Care Costs

Boston Globe: Critic Of Electronic Health Records Study "Mistaken," Authors Say
Dr. Danny McCormick of Cambridge Health Alliance and colleagues faced heavy criticism last week when they published a study saying that electronic health records may not be the panacea for skyrocketing costs that many have hoped for. Dr. Farzad Mostashari, the national coordinator for health information technology, posted a blog criticizing the study as too narrow and outdated, saying it "tells us little" about the systems' ability to save money (Conaboy, 3/12).

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State Watch

State Budget Burdens, Cost-Cutting Efforts Focus On Health Programs

Burdened by budget deficits, states are cutting health programs to the chagrin of some. But others say the economic downturn has allowed states to take up long-term economic problems they wouldn't have addressed otherwise.

The Wall Street Journal: States Keep Axes Sharpened
States are moving to cut jobs and other spending to close budget deficits, even though their protracted fiscal crisis is easing a bit in an improving economy. … But other economists more critical of government spending say the fiscal challenges of recent years helped states by forcing them to confront long-term problems, such as rising pension and health care costs, that they had avoided for years. Some states have restructured their worker pension and health care plans to reduce projected spending (Mitchell, 3/12).

In the meantime, states are putting the new cost-saving measures into action, and much of it focuses on Medicaid costs and health care for the poor programs --

Stateline: West Virginia Tackles Retiree Health Costs 
West Virginia has become the first state to pledge tax revenue to help finance its retiree health care burden ... lawmakers approved legislation proposed by Governor Earl Ray Tomblin pledging $30 million a year in personal income tax collections to help reduce the gap between what the state promised to pay its retired employees for health care and what it set aside to meet those obligations. West Virginia's retiree health care debt, which had reached $10 billion, was one of the highest per capita burdens in the country (Fehr, 3/13).

Arizona Republic: Arizona House Democrats Unveil Own Budget
House Democrats released a 2012-13 spending plan Monday that would restore funding for health coverage for poor children and increase funding for education, aging school facilities, state parks and tourism -- programs they say would boost job creation. Their proposal is largely symbolic and has little chance of passing in the Republican-controlled Legislature (Sanchez and Pitzl, 3/12).

Modern Healthcare: Fla. Budget Bill Includes Medicaid Cuts, Usage Caps
The Florida Legislature has passed its 2012-13 budget, including deep cuts to Medicaid that will hit hospitals and long-term-care providers. The $70 billion budget is now headed to Gov. Rick Scott after passing 80-37 in the House and 32-8 in the Senate. Scott favored a more austere $66.4 billion budget, which would have taken a heavier hand with state healthcare programs. The current bill, passed late Friday, includes a Medicaid rate reduction of about 5.6 percent, which amounts to a cut of more than $303 million to hospitals (Kutscher, 3/12).

Minneapolis Star Tribune: Minneapolis Copes With A Smaller Slice Of Federal Funding
Joanne Bondy has lost most of the feeling in her feet. So every six weeks, a nurse stops by her Minneapolis home to check and treat them for infections she is at risk for developing as a 63-year-old diabetic. Other days, volunteers drive her to doctor's appointments. But the $20,000 yearly contribution from the federal government to Nokomis Healthy Seniors, the nonprofit that aids Bondy and 500 other elderly citizens, will soon expire. It's one of the small but varied ways that Washington's pullback of community development funds is playing out in Minneapolis (Rao, 3/12).

HealthyCal: Governor Proposes Cuts To Caregiver Centers
Nearly 12,000 caregivers across California will feel the effects of Gov. Jerry Brown's proposal to cut state aid to caregiver resource centers. The cuts will touch the lives of women like Audrey, 77, who has relied on the Del Mar Caregiver Resource Center in Santa Cruz for the last five years. She cares for her husband, who has multiple sclerosis and is almost 81. ... The current proposed budget calls for all state funding to be withdrawn from resource centers for a savings of $2.9 million statewide (Flores, 3/12). 

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Calif. Insurers, Doctor Groups Band Together To Fight Insurance Referendum

California health insurers and several doctors groups are banding together to oppose a ballot measure that would let officials regulate health insurance rate increases.

California Healthline: Health Insurers, Physician Group Oppose Ballot Initiative
Yesterday, a coalition of health insurance organizations, the California Medical Association, the California Hospital Association and other groups announced they were joining forces to fight a ballot measure designed to regulate health insurance rate increases. "This initiative does nothing to address the cost drivers in the health care system," according to Paul Phinney, president-elect of the CMA (Gorn, 3/13).

Los Angeles Times: Ballot Escalates Over Ballot Measure On Health Insurance Premiums
The proposed ballot initiative seeks to give the California Department of Insurance the same rate-setting authority over health insurance that it already holds over auto and property policies. This issue has generated strong interest among many consumers hit with significant rate hikes on their health coverage in recent years 
(Terhune, 3/13).

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Texas, Feds Standoff On Women's Health Continues

HHS Secretary Sebelius warned the state that funds would be cut off if officials carry out the threat of excluding Planned Parenthood.

The Texas Tribune: Video: Kathleen Sebelius On The Women's Health Program
On a Houston hospital tour on Friday, U.S. Health and Human Services Secretary Kathleen Sebelius warned that the federal government is on the brink of cutting off funding for Texas' Women's Health Program over the state's insistence on excluding Planned Parenthood (Dehn, 3/12). 

The Texas Tribune: Storify Timeline on the Texas Women's Health Program
Started in 2006 with goals that included reducing the number of Medicaid births in the state, The Women's Health Program saved the Medicaid program approximately $75.2 million by averting an anticipated 6,721 births in 2009. ... Here's a look at the Tribune's coverage of this issue since it came onto the political radar during last year's legislative session. The Women's Health Program is separate from the state's family-planning funds, which lawmakers reduced by two-thirds. (Tan, 3/12). 

Houston Chronicle: Houston Democrats Seek Alternative Funding For Women's Program
Leading Houston Democrats in favor of a seemingly doomed health care program for low-income women are pushing to bypass the state to keep federal money flowing to Planned Parenthood. U.S. Rep. Sheila Jackson Lee and state Rep. Garnet Coleman said Monday they are negotiating with U.S. Health and Human Services in hopes of finding alternative funding for the program, which provides health screenings and contraceptive services to 130,000 Texas women on Medicaid (Ackerman, 3/12).

Also in the news --

USA Today/Religion News Service: Bishop Hopes To Restart White House Contraception Talks
The Catholic bishop leading the push against the White House's contraception mandate says the bishops hope to restart contentious talks with the Obama administration, but cautioned that church leaders "have gotten mixed signals from the administration" and the situation "is very fluid." Bishop William E. Lori of Bridgeport, Conn., who chairs the religious liberty committee of the U.S. Conference of Catholic Bishops, told Religion News Service that Catholics have to stay united if the hierarchy is to have any chance of prevailing in negotiations with the White House (Gibson, 3/12).

Denver Post: Birth-Control Debate Lands At Colorado Capitol With Competing Rallies
The national debate over birth control arrived on the west steps of the state Capitol on Monday with two rallies featuring competing messages from legislators, activists and faith leaders over whether insurers should be required to cover contraception. Democratic legislators gathered with officials from Planned Parenthood in a rally they styled as an effort to protect women's health. Hours later, Republicans assembled to cast the debate in terms of religious liberty (Lee, 3/13).

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Assisted-Suicide Advocate Uses Ore. Law To End Own Life

The assisted-suicide advocate, who was also a physician, used lethal chemicals and an Oregon law he helped pass to end his own life. He was 83.

The Associated Press/Washington Post: Oregon Physician Behind Death With Dignity Dies At 83, Using Aid-IN Dying Law He Championed
Peter Goodwin fought for years to give terminally ill patients the right to die on their own terms. When he couldn't fight anymore, that's exactly what he did. The Portland physician died Sunday in his home after using lethal chemicals obtained under an Oregon law he championed. He was 83 (3/13).

NPR: Assisted Suicide Advocate Uses Law To End His Life 
Oregon's Death with Dignity Act was the first like it in the nation. Peter Goodwin considered it his life's work. Earlier this month, Goodwin said his decision to use the law himself was the most difficult of all. "I'm going to be saying goodbye to a lot of people, a lot of people whom I love," he said. ... Goodwin said having control over his own death allowed him to face it without fear (Sabatier, 3/12).

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State Legislatures Consider Exchanges, HMO Audits, Mental Health Care

A selection of health policy news from Iowa, Oregon, California, Oregon, Maryland, Connecticut, Kansas and Texas.

The Associated Press/Washington Post: Committee Considers Next Steps For Health Care Exchange, Vote On Legislation Could Come Friday
A House of Delegates committee is expected to vote on a bill to create the framework for a health insurance marketplace that is designed to provide coverage for the 700,000 uninsured people in Maryland (Breitenbach, 3/12).

(St. Paul) Pioneer Press: Senate Committee Adds Sweeping Amendments TO HMO Audit Bill
A Minnesota Senate committee deferred action Monday night on a bill that would require independent audits of the state's HMOs -- but not until it was amended in ways that could dramatically change how Minnesota buys health insurance for low-income residents. ... The audit bill in the House would require annual independent financial audits of the state's nonprofit health plans, which manage care for most of the state's Medicaid beneficiaries (Snowbeck, 3/12).

The Associated Press/Des Moines Register: Senate Approves Overhaul Of Mental Health System
Iowa's mental health system would be subjected to statewide standards, and six regional hubs rather than the state’s 99 counties [to] coordinate the services under an overhaul approved Monday by the Senate.  ... Services would still be done at the local level, but supporters said the regionalized approach would be an improvement from the current system, where the quality of care can vary widely from county to county (3/12).

The Lund Report (an Oregon news service): Mental Health Carve Out Bill Faced Governor's Veto
A bill that would have required the state to continue paying for drugs used for mental illnesses, HIV/AIDS, cancer, and immunosuppressant drugs until 2016 died in the last days of the Legislature, blocked by the House and facing a veto threat from Governor Kitzhaber. ... The bill would have expanded what's known as a "carve out" of mental health drugs, which DMAP currently pays for (rather than the managed care plans that are responsible for Oregon Health Plan members) (Waldroupe, 3/12). 

The Connecticut Mirror: Up Tuesday: Hearing On PCA, Child Care Unionization Bills
The fight over unionizing home care and child care workers will continue at the state Capitol complex Tuesday as legislators hear public testimony on controversial proposals to give the two groups collective bargaining rights (Levin Becker, 3/12). 

California Healthline: Health Care Lobbying in California Tops List in Record Year
Health care generated more spending on lobbyists in California last year than any other non-government category, according to the California secretary of state. Insurers, hospitals, physicians and other health care groups spent $35.7 million to influence California's decisions in 2011. ... The two top spenders in health care lobbying in California last year were Kaiser [Permanente] and the California Hospital (Lauer, 3/12).

Kansas Health Institute News: More KU Med-Wichita Grads Headed To Rural Kansas Practices
Dr. Beth Loney graduated from the University of Kansas School of Medicine's Wichita campus in June and then went into practice in Stockton, a town of about 1,300 people in Rooks County, north of Hays. When she started medical school, she had no plans to become a rural doctor. ... That changed thanks to an exposure to rural medicine during her second year of medical school (Cauthon, 3/12). 

The Dallas Morning News: Parkland's Troubles Post Test For Dallas Hospital's Inexperienced Board
As Parkland Memorial Hospital's board of managers undertakes the Herculean task of repairing Dallas County's badly fractured public hospital system, its members concede they have little experience in how public hospitals work. "Five of the six of us arrived here together about a year ago," board member Jerry Bryant noted at a recent meeting. ... [the board] is tasked with restructuring and improving the medical care provided by the 118-year-old charity hospital (Jacobson, 3/12).

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Editorials and Opinions

Viewpoints: Sandra Fluke On Slurs; Shifting The Cost Of Uncompensated Care

CNN: Slurs Won't Silence Women 
(D)espite the misinformation being spread, the regulation under discussion has absolutely nothing to do with government funding: It is all about the insurance policies provided by private employers and universities that are financed by individual workers, students and their families -- not taxpayers. I am talking about women who, despite paying their own premiums, cannot obtain coverage of contraception on their private insurance, even when their employer or university contributes nothing to that insurance. Restricting access to such a basic health care service, which 99% of sexually experienced American women have used and 62% of American women are using right now, is out of touch with public sentiment (Sandra Fluke, 3/13).

The New York Times: Yet Another Curb On Abortion
Republicans on Capitol Hill chose an odd way to mark International Women’s Day on Thursday. The Judiciary Committee in the Republican-controlled House held a hearing to promote a mean-spirited and constitutionally suspect bill called the Child Interstate Abortion Notification Act. It is both an attack on women’s rights and on the basic principles of federalism (3/12).

Politico: Medicare Fight Is Not Over Yet
It's déjà vu all over again. This Republican Congress of Chronic Chaos is dusting off last year's same failed playbook — where seniors would lose their Medicare while Republicans give more tax breaks to millionaires and Big Oil companies. I have one response: Bring it on. Tone-deaf House Republicans are preparing a budget that will — again — protect millionaires over Medicare. As with their last budget, House Republicans are giving Americans a window into their souls. And the American people don’t like what they're seeing (Rep. Steve Israel (D-N.Y.), 3/12).

The Sacramento Bee: 2014's Health Changes Can't Come Too Soon
The harsh reality is that in the United States nearly 50 million people have no insurance – and, what is perhaps equally disturbing, many are underinsured. When the uninsured and underinsured cannot pay all of their out-of-pocket medical costs, these costs are written off by doctors and hospitals as "uncompensated care" and get shifted to other people with insurance. This cycle of cost-shifting is a large part of what the national Patient Protection and Affordable Care Act, passed by Congress and signed by President Barack Obama in March 2010, attempts to address. Though change can't come fast enough, there is an inevitable time lag, with most improvements taking effect in 2014. To set things up takes some time (3/13).

iWatch News: Ripple Effect Of 'Cost-Shifting' Uncompensated Medical Care
It is not truly accurate, of course, that that $30 million a year in uncompensated care at Bay Medical Center (in Panama City, Fla.) is, indeed, uncompensated. Somebody has to pay for it. And guess who that is? It is all of us. Even Mary Brown (one of the people who filed suit against the federal health law). She and the rest of us cover that uncompensated care either through higher taxes to support the Medicare and Medicaid programs or through higher health insurance premiums (Wendell Potter, 3/12).

Medscape: Don't Dismiss Patients Who Won't Vaccinate!
[Y]ou can try and get over vaccine hesitancy by pointing out that you are not just having your child vaccinated because you want to protect them, but you want to protect others who can't receive vaccines, such as babies, people with immune diseases, people who have had transplants, and the elderly. You want to have your child vaccinated to protect grandmothers, grandfathers, or a new baby in the family. That moral reason may swing some parents over, too (Art Caplan, 3/12).

Archives of Internal Medicine: How To Feed And Grow Your Health Care System
While most Americans may accurately assess how well their washing machines, their hairdressers, or even their airlines are performing, their evaluations of physicians and health care interventions may have limited validity. ... Satisfaction with seemingly adverse outcomes of potentially excessive medical care appears to be the norm. Numerous studies have found that patients are consistently highly satisfied with one of the most common downsides of medical care—false-positive test results and the downstream events that follow. Moreover, such patients are more likely to undergo the same (and likely other) testing in the future, dismissing their anxiety and other adverse effects as a negligible price for a good outcome. The same heuristic operates on the physician (Dr. Brenda E. Sirovich, 3/13).

Archives of Internal Medicine: Holy Cow! What's Good For You Is Good For Our Planet
More than 75% of the $2.6 trillion in annual US health care costs are from chronic diseases. Eating less red meat is likely to reduce morbidity from these illnesses, thereby reducing health care costs. In the European Prospective Investigation into Cancer and Nutrition (EPIC) study, patients who adhered to healthy dietary principles (low meat consumption and high intake of fruits, vegetables, and whole-grain bread), never smoked, had a body mass index (calculated as weight in kilograms divided by height in meters squared) less than 30, and had at least 30 minutes per day of physical activity had a 78% lower overall risk of developing a chronic disease (Dr. Dean Ornish, 3/13).

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Stephanie Stapleton

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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.