Daily Health Policy Report

Wednesday, March 13, 2013

Last updated: Wed, Mar 13

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Coverage & Access

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Capsules: Difference In What Medicare Spends On Cancer Care May Not Affect Survival Rates

Now on Kaiser Health News' blog, Alvin Tran writes: "Although Medicare spending for patients with advance cancers varies regionally, a new study suggests that those differences are not related to survival rates" (Tran, 3/12). Check out what else is on the blog.

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Letters To The Editor: Readers' Thoughts On Patient Safety Activist Regina Holliday, Nurse-Staffing Issues, The Role Of Nurse Practitioners

Kaiser Health News stories that drew reader reaction included a profile of patient safety advocate Regina Holliday; a story about that gap that often prevents cancer patients from getting rehabilitation services; an interview with the CEO of the American College of Nurse Practitioners; coverage of San Diego Hospice's bankruptcy; and a piece about a fight brewing in Washington, D.C., over nurse-staffing issues. Read a sample of the reader comments.

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Political Cartoon: 'Cola-teral Damage?'

Kaiser Health News provides a fresh take on health policy developments with "Cola-teral Damage?" by Randy Bish.

Meanwhile, here is today's health policy haiku:


Maybe you thought that
Premium support was dead 
Ryan says: Not yet 

And, for today, a bonus:


Ryan, Obama,
Murray budgets' share Sartre
Essence: No Exit

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

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Capitol Hill Watch

Budget Proposals Show Democrats And Republicans Far Apart

The House GOP plan, which was unveiled yesterday, would repeal the health law's subsidized insurance exchanges and Medicaid expansion and turn Medicare into a premium-support system. The Senate Democrats' plan, scheduled for release today, would lower domestic spending in part by saving $275 billion through changes to Medicare and Medicaid that are smaller than those proposed by Republicans.

The New York Times: Two Parties' Budgets Show Big Rift As GOP Renews 2012 Proposals
Senate Democrats and House Republicans on Tuesday outlined vastly divergent approaches to shoring up the government’s finances, a reminder of how far apart they remain on fiscal policy even as both sides insist publicly that a bipartisan compromise is possible. … The Republican plan sets out to balance the budget in a decade and would cut spending by $4.6 trillion through 2023, in large part by rolling back many of Mr. Obama's signature legislative accomplishments. It would repeal the health care overhaul of 2009, eliminate the subsidized insurance exchanges and Medicaid expansion that make up the core of the law, and turn Medicare into a system of private insurance plans financed by federal vouchers (Peters and Weisman, 3/12).

Los Angeles Times: Two Sides Still Far Apart In Budget Proposals
Just before Obama arrived for the latest installment of his Capitol Hill charm offensive, House Republicans, led by Rep. Paul D. Ryan of Wisconsin, unveiled an austere budget proposal that looks a lot like one they approved last year that Democrats quickly dismissed. Republicans revived plans to overhaul Medicare, slash the social safety net for the poor and bolster defense — all while lowering corporate and individual tax rates to no more than 25%. … Senate Democrats, meanwhile, sitting down to lunch with the president, offered a counterproposal that would raise nearly $2 trillion toward deficit reduction, with equal parts coming from taxes and spending cuts. But their plan does not balance the budget for the foreseeable future (Mascaro and Memoli, 3/12).

Politico: Budget Plans Or Works Of Fiction
Democrats and Republicans have put together their dream budgets — political documents that are more like wish lists than usable road maps for the future of government spending. Both have no chance of becoming law, but they do help explain the impasse over spending and debt in Washington (Nather, 3/12).

The Wall Street Journal: GOP Budget Establishes Contrast With Democrats
Republican budget standard-bearer Paul Ryan on Tuesday offered his party's most provocative fiscal framework in years, calling for Medicare and Medicaid overhauls and new limits on defense spending not previously endorsed by party leaders. The White House criticized Mr. Ryan's budget proposal Tuesday, calling it the "wrong course" to reduce the deficit. The House Republican plan would burden the middle class by slashing spending without raising taxes on upper-income households, White House Press Secretary Jay Carney said in a written statement (Paletta, 3/12).

Politico: Paul Ryan Budget Ax Hits Health Programs Hard
The House Republican budget released Tuesday would wring about 70 percent of its spending cuts from health programs — including defunding Obamacare — to bring the budget into balance a decade from now. Even though the federal health care law has survived the gauntlet of the Supreme Court and the presidential election since Rep. Paul Ryan released his last budget one year ago, the Wisconsin lawmaker again calls for defunding it. In fact, defunding the Affordable Care Act accounts for close to half, or about $1.84 trillion, of his proposed deficit reduction. His plan calls for balancing the budget in 2023 (Norman, 3/13).

The Washington Post: Ryan Sets Stage For A Budget Duel, Targets Health-Care Law
On Tuesday, House Budget Committee Chairman Paul Ryan (R-Wis.) rolled out a 10-year spending plan that would revive the most controversial prescriptions from last year's GOP budget, including a partial privatization of Medicare and a repeal of the health-care law that is Obama's signature policy achievement. Meanwhile, Senate Budget Committee Chairman Patty Murray (D-Wash.) briefed her colleagues on a competing plan, to be released Wednesday, that would raise taxes by nearly $1 trillion over the next decade and spend nearly $100 billion on a new jobs package — ideas Republicans have firmly rejected (Montgomery, 3/12).

NPR: Ryan Budget Proposal Echoes Obamacare While Rejecting It
Health policy watchers might have been amused reading the latest blueprint for the federal budget, out today. That's because once again House Budget Committee Chairman Paul Ryan proposes a full repeal of the Affordable Care Act, which Republicans refer to as "Obamacare." But this time, the proposal describes the changes it envisions to the Medicare program in very Obamacare-like terms (Rovner, 3/12).

Medscape: House GOP Budget Would Repeal ACA, Voucherize Medicare
In a replay of the 2012 presidential campaign, House Republicans today released a proposed budget for fiscal 2014 that would repeal the Affordable Care Act (ACA), partially privatize Medicare, block-grant Medicaid, and when all is said and done, reduce the federal deficit by $4.6 trillion over 10 years, leading to a balanced budget in 2023. Congress has "to fix our entitlements and to grow our economy" to avoid a debt crisis, said Rep. Paul Ryan (R-WI), who chairs the House budget committee, in an introduction to the document (Lowes, 3/12).

The Associated Press: House Republicans Again Plan To Repeal Health Care, Cut Medicaid
House Republicans unveiled their latest budget outline on Tuesday, sticking to their plans to try to repeal so-called Obamacare, cut domestic programs ranging from Medicaid to college grants and require future Medicare patients to bear more of the program's cost. The GOP plan came as President Barack Obama traveled to Capitol Hill to meet with Senate Democrats on the budget and a broad range of other proposals that are part of his second-term agenda. The president has launched a new outreach to rank-and-file Republicans, and his Hill visit is one of several planned with lawmakers of both parties this week (3/12).

National Journal: House Republican Budget Offers More Of The Same
By unveiling a budget blueprint that would erase the deficit in just 10 years, House Republicans sought on Tuesday to make that goal the gold standard and bare minimum for all future budget battles between the two parties…Ryan would turn Medicare into a fixed-cost program for people 54 and younger, beginning in 2024, by giving them a set amount of money to purchase their own health care or a traditional Medicare plan on the private market…His budget turns Medicaid and food-stamp funding over to the states—effectively transforming these programs from open-ended entitlements and forms of assistance for anyone in need into programs with set budgets (Cook, 3/12).

MinnPost: GOP Budget Cuts Spending, Changes Medicare And Kicks Off Fresh Budget Battles
U.S. Rep. Paul Ryan introduced the House GOP budget plan on Tuesday, kicking off a new round of budget battles on Capitol Hill. Ryan’s budget balances in 10 years, thanks to both $4.6 trillion in spending cuts (out of $46 trillion-worth of spending over 10-year budget, he said) and by accepting the new revenue that came from January's fiscal cliff deal (Henry, 3/12).

Politico: At Heart Of Paul Ryan Budget: Repealing Obamacare
This week's dueling budget releases show that the fight over health care reform and entitlements is far from over — and the parties are still miles apart on how to move forward with either plan. But what is clear is that implementation of the health law is moving forward, Medicaid won't be converted into a "block grant" anytime soon and there is no politically easy answer for Medicare (Haberkorn and Norman, 3/13).

CNN Money: Republicans Revive Medicare Subsidy Plan
Ryan's proposal, unveiled Tuesday, is essentially the same as others the House Budget Committee chair has proposed in previous years. This plan formed the heart of the Republicans' entitlement reform platform during last year's election, when Ryan ran as the GOP vice presidential candidate. Ryan argues that the Republican Medicare proposal keeps costs under control through competition and more choices for patients. President Obama and other Democrats deride it as a voucher program that will leave seniors with higher health care costs (Luhby, 3/12).

The Associated Press/Washington Post: Obama Says He Won't 'Chase A Balanced Budget Just For The Sake Of Balance'
President Barack Obama is criticizing a proposed House Republican budget, saying it would turn Medicare into a voucher-like program, cut deeply into programs such as Medicaid and increase tax payments by the middle class in order to achieve promised lower tax rates. Asked in an ABC World News interview Tuesday whether he will propose a budget that balances in 10 years, Obama said he would not (3/12).

The Wall Street Journal: Democrats' Budget Mixes Tax Increases, Spending Cuts
Senate Democrats will propose raising $975 billion in new taxes over the next decade in the budget they will release this week, setting up a sharp contrast with a House Republican plan to balance the budget over 10 years without new tax increases. … Democrats would lower domestic spending in part by saving $275 billion through changes to federal health-care programs that are smaller in scale than Republicans have proposed for Medicare and Medicaid (Peterson, 3/12).

And regarding the continuing resolution -

The Hill: Harkin: White House Backed Off Push For More Healthcare Funding
The Obama administration decided it could live without extra money it had requested to help implement its signature healthcare law, Sen. Tom Harkin (D-Iowa) said Tuesday. Senate Democrats released a bill Tuesday to fund the government through the end of the fiscal year. The proposal does not include an extra $1 billion the White House had requested for the healthcare implementation effort (Baker, 3/12).

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Obama Tells Senate Dems Entitlement Programs May Have To Change

In a meeting on Capitol Hill, President Barack Obama told members of his party that some changes to Medicare might be necessary to ensure the program's survival. Obama also said that Republicans would have to give on revenue hikes before he would agree to entitlement changes.

The New York Times: Obama Discusses Entitlement Changes With Senate Democrats
Mr. Obama expressed hope of reaching a "grand bargain" in the next few months, according to the senators at the meeting, and said he was optimistic about an immigration bill. The president arrived at 1:30 p.m. and stayed until 2:45 p.m., which was a half-hour longer than scheduled, largely because he was peppered with so many questions. While the tenor of the discussion was civil, several senators voiced concerns about cuts in popular programs like Medicare and Social Security, according to people at the meeting. "He clearly shares our concern that we're not going to do this deal on the backs of needy Medicare and Social Security recipients," said Senator Christopher S. Murphy, Democrat of Connecticut (Landler and Steinhauer, 3/12).

Politico: President Obama To Democrats: Entitlements May Have To Change
But Obama acknowledged that Social Security and Medicare — big drivers of federal spending — wouldn't survive without some changes to save money. Obama added that Republicans must first agree to more revenue hikes before the White House would concede on changes to entitlement programs, senators attending the luncheon said. Obama seemed to be opening the door a crack toward a way forward: if the White House is seen as willing to put entitlements on the table, some Republicans may reconsider their staunch opposition to new revenue (Gibson, 3/13).

The Wall Street Journal: Obama, Democrats Discuss Safety-Net Programs
President Barack Obama, meeting behind closed doors with Senate Democrats on Tuesday, indicated he was open to negotiating changes to entitlement programs, something that Republicans have demanded, according to lawmakers who attended the meeting. Mr. Obama met with Senate Democrats as he was making a new push with lawmakers to reach a broad deficit-reduction deal. Lawmakers emerging from the meeting said Mr. Obama had a wide-ranging conversation with Senate Democrats on sensitive party issues surrounding federal safety-net programs (Hughes, 3/12).

CQ HealthBeat: Obama Bucks Up Democrats
President Barack Obama told Senate Democrats he would not negotiate over the expiring debt ceiling and would stick to his demand for new revenue as part of any grand bargain to cut the deficit and eliminate the sequester, Democrats said Tuesday. But during the president’s visit to Senate Democrats’ regular Tuesday luncheon, the president pushed back against liberals, saying that entitlement changes to Medicare and other programs would ultimately be needed (Dennis and Sanchez, 3/13).

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Health Reform

Ariz., Fla. Governors Face Intra-Party Opposition To Medicaid Expansion

News outlets reports that, in Florida, Gov. Rick Scott's support for the expansion was rebuffed by a Senate panel that voted against the expansion plan and instead is advancing an idea that would use federal money for private insurance. Meanwhile, in Arizona, Gov. Jan Brewer rolled out draft legislation to advance the Medicaid expansion, even though she was a vocal opponent of the health law.

Bloomberg: Republican Governors Face Party Opposition Over Medicaid
Republican governors pushing to expand Medicaid for the poor under President Barack Obama’s health-care law are facing opposition from their own party. In Florida, Republican Governor Rick Scott, 60, was rebuked by a Senate panel that voted yesterday against expanding Medicaid, instead deciding to craft a plan that would propose spending federal money for private insurance. A state House of Representatives committee voted March 4 against expanding Medicaid, an option for states made possible by Obama's Patient Protection and Affordable Care Act (Bender, 3/12).

Health News Florida: Big Medicaid Gamble Based On Letter
Florida's Republican legislative leaders say they believe they can get full federal funding for Medicaid expansion under the Affordable Care Act, even though they propose to use it to buy subsidized private health insurance. If they are wrong, they will be giving up a huge windfall of federal funding, which state economists last week estimated at $51 billion over the next decade (Gentry, 3/13).

The New York Times' The Caucus: Arizona Governor Introduces Bill To Expand Medicaid
In her brief remarks, Ms. Brewer twice used the word "conservative" to describe Arizona's Medicaid program, a managed-care system whose cost per patient is $680 less than the national average, and the bill she was endorsing, which would extend Medicaid coverage to anyone who made up to 133 percent of the federal poverty line (Santos, 3/12).

Arizona Republic: Brewer Unveils Legislation To Broaden Medicaid Eligibility
Gov. Jan Brewer unveiled draft legislation Tuesday detailing her plans for expanding Medicaid, while putting a human face on the contentious issue in hopes of convincing skeptical GOP lawmakers whose votes she needs to get it approved. During a rally at the state Capitol designed to kick-start legislative debate over the governor’s proposal to broaden eligibility under federal health-care reform, Brewer said expansion would bring in billions of federal dollars and save the lives of people who would otherwise be without health coverage (Reinhart, 3/13).

The Associated Press: Gov. Brewer Rolls Out Medicaid Expansion Bill
Gov. Jan Brewer appealed to fellow Republicans Tuesday to back her proposed expansion of Arizona's Medicaid program by citing the party's opposition to abortion and painting the issue as another way to protect the sanctity of life. Brewer, who fought President Barack Obama's health care overhaul law but now is embracing one of its key provisions, said expanding the insurance to about 300,000 low-income Arizonans will save lives and prevent 50,000 childless adults now enrolled in the state program from losing coverage at the end of the year (3/12).

Meanwhile, in South Carolina and Alabama --

The Associated Press: House Defeats Medicaid Expansion
The South Carolina House on Tuesday rejected attempts by Democrats to extend Medicaid to hundreds of thousands of additional poor adults, before approving a $6.3 billion spending plan for state taxes. The House voted along party lines -- 73-45, 74-42, and 76-41 -- to defeat proposals expanding eligibility while the federal government covers all but some administrative costs (Adcox, 3/13).

The Associated Press: Bentley Backs Plan To Change Medicaid
Gov. Robert Bentley on Tuesday announced his support for changes to Alabama's Medicaid system that would affect one out of every five state residents. The Medicaid Advisory Commission advocates changing the basic operating model from a fee-for-service system to a managed care program (3/13).

Also in the news, a round of reports analyze the Medicaid expansion's impact on state budgets in Texas, Louisiana and Maine --

The Texas Tribune: Impact Of Medicaid Expansion On State Budget Examined
As state legislators consider what "a Texas solution" to Medicaid expansion would look like, others have begun addressing the question of how Medicaid expansion would affect the state budget and local taxes. With extra federal money coming in, Medicaid expansion could offset $1.2 billion in the 2014-15 biennium budget that Texas would spend on other health programs to cover poor populations, according to a report released Tuesday by Billy Hamilton, the state’s former budget estimator and former deputy comptroller (Aaronson, 3/12).

The Associated Press: Watchdog Group Pushes For More Study Of Medicaid Expansion
Gov. Bobby Jindal's administration has done too little research to back up the Republican governor's refusal to expand Louisiana's Medicaid program to cover more uninsured adults, a watchdog group said today. The Public Affairs Research Council of Louisiana urged Jindal and lawmakers to do more detailed analysis about the costs and benefits of an expansion before choosing to reject billions of dollars in federal health care money (Deslatte, 3/13).

The Associated Press: Report Backs Medicaid Expansion In Maine
Expanding Medicaid in Maine would stimulate $350 million in economic activity, create more than 3,100 jobs and generate as much as $18 million in state and local taxes annually, according to a policy report released Tuesday. But if Maine decides against expanding Medicaid, it stands to lose to other states the $256 million it could receive through the national health care law, while foregoing the other potential benefits, said Garrett Martin, executive director of the Maine Center for Economic Policy, a public policy research group that co-authored the report (Adams, 3/12).

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Applying For Benefits In Online Marketplaces Might Be Daunting

The Associated Press reports that the draft version of the application for a three-person family is 15 pages while the online version has 21 steps, some with additional questions. In other implementation news, a Commonwealth Fund study finds that 24 states and the District of Columbia have chosen benchmark plans that specify what must be covered by health insurance policies sold in and out of their online marketplaces.

The Associated Press/Washington Post: Will Nation's Uninsured Get Lost In Long Application For Obama Health Care Plan?
Applying for benefits under President Barack Obama's health care overhaul could be as daunting as doing your taxes. The government's draft application runs 15 pages for a three-person family. An outline of the online version has 21 steps, some with additional questions (Alonso-Zaldivar, 3/12).

Modern Healthcare: Half Of States Have Chosen Benchmark Insurance Plan: Report
A little more than six months before open enrollment begins, 24 states and Washington, D.C., have chosen a benchmark plan that will determine what health insurers must cover in health plans sold in the state exchanges and individual and small-group markets, according to a new study from the Commonwealth Fund. In the rest of the country, the snapshot suggests, the federal government will model the minimum benefits on the largest small-group plan sold in the state. Under the Patient Protection and Affordable Care Act, individual and small-group plans must offer an "essential health benefits" package (Zigmond, 3/13).

Other headlines include a progress report on Colorado's health exchange, details regarding a round of new ads related to the health law's birth control coverage mandate and an analysis of how Native American clinics will fare.  

Health Policy Solutions (a Colo. news service): User Fees To Fund Colorado Exchange
Colorado’s health exchange board approved administrative fees of 1.4 percent on insurance plans that will be passed on to customers to help fund the exchange. If Colorado lawmakers do not back a proposed measure that aims to divert cash from Colorado’s high-risk health insurance fund — Cover Colorado — to the exchange to help cover their costs, those fees could rise to an estimated 3.4 percent. Cover Colorado will no longer exist because the federal Affordable Care Act requires commercial health insurance companies to accept all customers, including those with serious health problems and pre-existing conditions. The high-risk pool is expected to have some remaining funds after it pays all its claims. The funds also came from consumers who paid higher health insurance rates to cover people who couldn’t get insurance (Kerwin McCrimmon, 3/12).

Roll Call: Rival Lobby Campaigns Focus On Birth Control Mandate
Activists on both sides of the abortion debate have unleashed new ads and grass-roots lobbying drives in the ongoing fight over birth control requirements in the 2010 health care law. A campaign dubbed “Birth Control: We All Benefit” launched by the Planned Parenthood Federation of America includes TV ads in Kentucky that targeted Senate Minority Leader Mitch McConnell, R-Ky (Carney, 3/13).

HealthyCal: Obamacare Means More Funding For Native American Clinics
Molin Malicay, director of the Sonoma County Indian Health Project clinic, has read all 976 pages of the Affordable Care Act—the legislation that created what’s become known as Obamacare. His copy has 46 tabs, each marking a point where Native Americans are mentioned. The country’s First Peoples are uniquely affected by the federal reforms. But because federal responsibility for tribal health is already in place, individual Native Americans may not notice the effects of Obamacare as much as Native American clinic directors (Shanafelt, 3/13).

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Coverage & Access

Homelessness And Aging Combine For Significant Health Challenges

NPR: Aging Homeless Face More Health Issues, Early Death
If aging is not for sissies, that's especially true if you're homeless. You can be on your feet for hours, forced to sleep in the frigid cold, or seriously ill with no place to go. But increasingly, the nation's homeless population is getting older. By some estimates, more than half of single homeless adults are 47 or older (Fessler, 3/13).

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State Watch

Medicaid Financing Issues Grab Attention Of State Lawmakers

State legislators deal with Medicaid financing issues including increasing hospital assessments to leverage federal money in Oregon, paying off Medicaid bills in Texas and detailing a shortfall in North Carolina.

The Lund Report: House Committee OKs Hospital Assessment Increase
The House Health Committee unanimously passed House Bill 2216, renewing and extending the hospital assessment tax used to help fund the Oregon Health Plan. HB 2216 must next go to the House Revenue Committee before a full House vote. Under an agreement worked out between the governor's office and the Oregon Health Leadership Council -- a collaborative of doctors, hospitals and insurance companies -- hospitals will be assessed 5.32 of net patient revenue to count as matching state funds that help Oregon gain federal dollars. The hospitals get all of that money back once the federal Medicaid money comes through at a 2 to 1 ratio. In the current biennium, with the state's 26 largest hospitals assessed at 4.32 percent, $650 million in these funds generated $1.16 billion in federal matching funds (Gray, 3/12).

The Texas Tribune: House Sends Medicaid IOU Bill To Perry
Two days ahead of a crucial deadline, the Texas House sent a bill to Gov. Rick Perry Tuesday that pays off $4.5 billion in Medicaid IOUs and speeds up a $1.75 billion payment that schools were already expecting. House members unanimously approved changes the Senate made last week to House Bill 10, the first supplemental budget bill of the session, after state Rep. Jim Pitts, R-Waxahachie and the chamber’s chief budget writer, endorsed them (Batheja, 3/13).

North Carolina Health News: Medicaid Director Details Budget Shortfall For Legislators
The state's Medicaid director told legislators Tuesday morning that she's getting a handle on the expenses for the program that covers health care for 1.5 million low-income and disabled North Carolinians, and then went on to outline a projected budget shortfall of between $70 million and $132 million for the fiscal year. Medicaid head Carol Steckel’s presentation to the Joint Appropriations Subcommittee on Health and Human Services came just days after Gov. Pat McCrory released a memo telling state agency leaders to limit expenses for their departments in order to cover a shortfall in the Medicaid budget (Hoban, 3/13).

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State Roundup: Conn. Bill Would Require Kids Behavioral Health Assessments

A selection of health policy stories from New York, Connecticut, Oregon, Idaho, Georgia, Texas and California.

The New York Times: Legal Battle Over Limits On Sugary Drinks May Outlast Mayor's Tenure
But if the case over the soda wars was shaping up as a landmark of the Bloomberg administration, the timing of the legal battle suggested that a definitive ruling was not likely to come before Mr. Bloomberg leaves office on Dec. 31 (Glaberson, 3/12).

Medpage Today: NYC To Appeal Soda Ban Ruling, Miss. Forbids Such Bans
New York City will appeal a judge's ruling against its ban on extra-large sugary drinks, the mayor's office announced Monday; meanwhile, legislators in Mississippi are making sure towns in their state don't follow NYC's lead. "We plan to appeal the sugary drinks decision as soon as possible, and we are confident the measure will ultimately be upheld," Mayor Michael Bloomberg's office tweeted Monday night, a few hours after the decision by state Supreme Court Judge Milton Tingling. In Mississippi lawmakers passed what's being referred to as an "anti-Bloomberg bill" that would prevent municipalities there from regulating nutrition (Struck, 3/12).

CT Mirror: Bill Would Screen School Kids For Behavioral Health Problems
A bill requiring all public school and homeschooled children in Connecticut to have behavioral health assessments in grades 6, 8, 10 and 12 is drawing criticism from parents and homeschool advocates who say it would stigmatize children and intrude on parents' rights. The bill was crafted in the aftermath of the Newtown shooting with the hope of identifying mental health problems in youths in a timely way. The bill is intended to make sure that pediatricians are screening for behavioral health problems routinely during annual physical exams, said Sen. Toni Harp, D-New Haven, who proposed the bill with Rep. Toni E. Walker, D-New Haven (Merritt, 3/12).

Oregonian: Medical Malpractice Mediation Bill Passes Oregon House
A bill offering mediation for medical errors passed the Oregon House Tuesday, its final hurdle before reaching the desk of Gov. John Kitzhaber. Senate Bill 483 is the result of a work group Kitzhaber convened in order to address concerns about medical malpractice lawsuits. The bill easily passed the Senate in a 26-3 vote March 5. The margin in the house was even greater, passing 55-1. Rep. Gene Whisnant, R-Sunriver, cast the lone no vote. Kitzhaber is expected to sign the bill into law soon (Gaston, 3/12).

The Wall Street Journal: Health Merger in Idaho Challenged
The Federal Trade Commission and Idaho's attorney general have challenged the acquisition of a physician group by a Boise, Idaho-based hospital system, in the latest sign of antitrust regulators' close focus on health-care mergers. The antitrust complaint, filed Tuesday under seal in U.S. District Court in Boise, says that the merger between St. Luke's Health System and Saltzer Medical Group gave the combined entity an approximately 60 percent share of the primary-care physicians in Nampa, Idaho, the state's second-largest city (Mathews, 3/12).

Georgia Health News: Health Agencies Await Sequestration
The state Department of Public Health said Tuesday that it expects funding reductions from sequestration, but added that it’s unclear so far how much money or what programs will be cut. And the timeline for decisions on federal reductions is also unknown, said Kate Pfirman, chief financial officer of Public Health, at an agency board meeting Tuesday. Sequestration, or the “sequester,’’ is a series of automatic cuts to government agencies, resulting from the federal debt ceiling compromise of 2011. Areas expected to see large cuts in federal health spending include maternal and children’s health, mental health, and community health centers, according to a Stateline article (Miller, 3/12).

The Lund Report: Legislature May Narrow Rural Tax Credit for Doctors
Legislators heard two bills on Monday that would make it easier for doctors and other health care providers to practice in rural Oregon. The House Health Committee quickly approved House Bill 2858, renewing and strengthening the Oregon Primary Health Care Loan Forgiveness Program, while down the hall, the Senate Health Committee delayed a vote on Senate Bill 325 that would extend a tax credit for rural health practitioners. "I want to consider this tax credit, I just want to be smart about it," said Sen. Elizabeth Steiner-Hayward, a family physician at Oregon Health & Science University (Gray, 3/13).

The Texas Tribune: Bill Excludes Elective Abortions In State Health Care
State Rep. John Smithee, R-Amarillo, told a committee of his colleagues on Tuesday that Texans should not be forced to pay for abortion coverage they don't want and won't use, and he urged the House Insurance Committee to approve House Bill 997. … Anti-abortion and pro-choice advocates lined up to debate Smithee's bill, which the committee left pending (Schneiders, 3/12).

California Healthline: CBAS Hearings Nearing An End
Of the roughly 2,600 appeal hearings filed over eligibility for the Community Based Adult Services program, only 47 are still to be heard, according to Michael Weston, deputy director of public affairs for the Department of Social Services. Administrative law judges from the Department of Social Services heard the appeal hearings and then forwarded their opinions to Toby Douglas, director of the Department of Health Care Services, the agency that issued the denials of eligibility. Douglas reviewed each case and made the final ruling on CBAS eligibility. According to Douglas, about 49 percent of the appellants were granted eligibility as a result of the appeal (Gorn, 3/12).

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Editorials and Opinions

Viewpoints: Ryan's 'Tired Ideas;' House GOP 'Reboots' On Budget; Bloomberg's Soda Campaign 'Ill-Conceived'

The New York Times: The Worst Of The Ryan Budgets
All the tired ideas from 2011 and 2012 are back: eliminating Medicare's guarantee to retirees by turning it into a voucher plan; dispensing with Medicaid and food stamps by turning them into block grants for states to cut freely; repealing most of the reforms to health care and Wall Street; shrinking beyond recognition the federal role in education, job training, transportation and scientific and medical research. The public opinion of these callous proposals was made clear in the fall election, but Mr. Ryan is too ideologically fervid to have learned that lesson (3/12). 

The Wall Street Journal: A Ryan Reboot
Mr. Ryan retains the current Congressional Budget Office baseline that says revenue will average 18.8% of GDP between 2014 and 2023, nearly a percentage point above the post-1980 average of 17.9%. That may be achievable, or not, though the numbers depend on CBO growth projections that assume little or no economic benefit from better policy. What really matters for spending over the long term is health care and the vast and growing entitlements. Here Mr. Ryan doesn't shrink from his ambition to convert Medicare into a market-driven program with more competition and choices for seniors. ... The idea is to revamp Medicare's benefits and premium structure so these relics from 1965 work like normal insurance and give seniors the incentive to take a larger role in their own care (3/12).

The New York Times: The Ryan Budget's Step Backward
There were two obvious ways that the Ryan Budget 3.0., which rolled out today, could have further improved on its predecessors. The new budget could have beefed up its Medicare proposals by phasing in reform sooner, instead of continuing to set a ten-year gap between passage and implementation and exempting everyone over 55 from the new regime. Alternatively, it could have addressed the various problems and implausibilities in the non-Medicare portions of the budget roadmap — by making fewer not-gonna-happen promises on discretionary spending cuts, by offering a real alternative to/replacement for the Obama health care bill, or by making the sketch of revenue-neutral tax reform more plausible by setting the proposed new tax rates higher than 10 percent and 25 percent. The first option would have made for trickier politics but better policy; the latter options would have made for better policy and politics alike (Ross Douthat, 3/12).

Los Angeles Times: Sadder But Wiser Pols
There's been gradual movement toward the center on the substance of the budget as well as the politics. Republicans still oppose tax increases, but some senators have acknowledged that they'll have to accept revenue increases to make a deal. And Obama has been more explicit than before about his willingness to cut future spending on Medicare and Social Security, bitter pills for liberals. The more often the president repeats that message to Democrats, the more skeptical Republicans believe he might mean it. Finally, leaders on both sides know how to get to an agreement — or, more precisely, how not to get there — because they've tried so many routes before (Doyle McManus, 3/13). 

Los Angeles Times: Paul Ryan Drinks Deeply From Pool Of Social Security Lies
I'd like to offer my thanks to House Budget Committee Chairman Paul D. Ryan (R-Wis.) for doing so much to validate my list of the five biggest lies about "entitlement" programs published on Sunday. … The ones from my list are: He uses the thoroughly discredited "infinite horizon" projection to claim that Social Security and Medicare are "tens of trillions" of dollars in the hole; he suggests that retirees aren't paying their fair share for their benefits; he suggests that the programs are hammered by benefits going to the wealthy; and he treats Medicare and Social Security as though they're similar programs with similar issues (Michael Hiltzik, 3/12). 

The Washington Post: Paul Ryan's Budget: The Good, The Bad And The Unrealistic
Once again, Mr. Ryan proposes to convert Medicare into a premium-support program, under which seniors would receive a subsidy to shop for insurance on a regulated but competitive market. Unlike some reflexive critics of "vouchers," we think the concept is worth discussing, in that it promises to achieve cost-control through market mechanisms. Alas, even if premium support is workable, Mr. Ryan wouldn’t start it for a decade, which makes it all the more disappointing that his budget only calls for a modest $129 billion trim to Medicare in the meantime. That’s less than the Obama administration has advocated (3/12). 

The Washington Post's The Plum Line: Budget War Showcases Sharp Contrast In Values And Priorities
According to the source, the plan — which is being presented by Senate Budget Committee Chairperson Patty Murray to the Dem caucus today — replaces the whole sequester and includes a total of $1.85 trillion in deficit reduction, derived from a 50-50 split of cuts and revenues derived from closing tax loopholes. The spending cuts include $275 billion in cuts to health care spending (but no Medicare benefits cuts; the source says cuts would be focused on the provider side), another $200 billion in non-defense spending cuts, $240 billion in defense cuts, and $242 billion in reduced interest rates (Greg Sargent, 3/12). 

The Washington Post: Paul Ryan's Magical Budget
Paul Ryan's budget is an amazing and wondrous document. Not only does it balance the budget in 10 years while reducing tax rates, it also does so without any pain or suffering — or even breaking a sweat. It achieves not just the longtime goals of policymakers — "a safety net strengthened . . . retirement secured . . . a nation protected" — but also brings about changes in human nature that have bedeviled civilization from the beginning of time. "This budget ends cronyism; eliminates waste, fraud and abuse," Ryan’s plan promises (Dana Milbank, 3/12). 

Bloomberg: Ryan Budget Replays Republican Hits As Time Marches On
Still, it’s hard to view this latest budget as anything more than a holding pattern for a political party caught between its past and its future. Like the fiscal outlook, the nation’s politics have shifted. Ryan’s budget pockets the savings from Obama’s health-care plan while calling again for its repeal. As Jim Nussle, a former Republican congressman and budget director under George W. Bush, said to CNBC: “I think we fought that battle.” Pretending otherwise is silly (3/12).

And on other issues --

WBUR: A Not-So-Rosy View Of Mass. Health Reform
Hundreds of healthcare journalists will be attending the Association of Health Care Journalists’ (AHCJ) conference in Boston this week to hear from many speakers with rose-colored ideas about both our Romneycare law and a brand new state cost-control law. Yet all is not well in the Commonwealth. State officials now predict "extreme premium increases" for many small businesses under Obamacare. In a letter to federal regulators the day after Christmas 2012, a perfect day to bury news, Massachusetts officials floated the idea of obtaining a waiver from the Affordable Care Act (ACA) out of fear of the premium spikes. Yet, recently finalized federal regulations slammed the door on that flexibility. Many small companies justifiably feel sick over the decision (Josh Archambault, 3/12). 

Fox News: How ObamaCare Is Dividing The U.S.
As the experiment for transforming the American health care system ensues, consumers face the potential for a disastrous outcome on October 1, when the marketplaces are supposed to be up and running. As of a few weeks ago, the states were evenly split as to whether they will establish their own marketplace, or whether they will defer to the federal government to set it up. For the most part, states led by Democrats have opted to set up their own marketplaces, while most Republican states have declined (Dr. Sreedhar Potarazu, 3/13).

San Jose Mercury News: Feinstein Fighting Outrageous Health Insurance Rate Hikes
Thirty three states have laws regulating insurance rates. Private insurers have had ample opportunity to get behind fair regulation in California to allow reasonable rate increases and profits, but they have fought it at every turn. Instead, for years they have been pounding customers with double-digit rate increases far beyond the rise in medical costs and raking in record profits. Sen. Dianne Feinstein has the solution for the 17 states lacking the authority to block or modify egregious rate increases. She is proposing to give the secretary of Health and Human Services power to examine health insurance premiums and deny unjustified or excessive rate hikes. Congress should pass Feinstein's bill, and if it doesn't, Californians should protect their own interests with a ballot proposition planned in 2014 (3/12). 

The New York Times: Mayor Bloomberg's Anti-Obesity Campaign
The mayor and his health officials are right to assert that sugary drinks contribute to obesity, a leading cause of diabetes, heart disease and other chronic health problems. And they've done a good job of advertising the dangers of these drinks: a particularly powerful ad shows a young man eating 16 packets of sugar, which is the amount in 20 ounces of soda — while others watch in disbelief. But the big-drinks ban was ill conceived and poorly constructed from the start (3/12).

Los Angeles Times: When CPR Isn't The Right Medicine
The 911 call last month that led to an emergency dispatcher begging workers at a Bakersfield senior living facility to perform CPR on a woman captured the attention of the public. A staff worker told the dispatcher it was against the facility's policy to intervene. The woman, Lorraine Bayless, died. It is difficult to understand how liability concerns could dissuade anyone from helping a person in distress. However, this stark event should awaken us to another question: Should we be performing CPR on 87-year-olds in a community setting such as a senior home (Kevin M. Dirksen and Neil S. Wenger, 3/13)?

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Stephanie Stapleton

Andrew Villegas

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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.