Daily Health Policy Report

Wednesday, March 14, 2012

Last updated: Wed, Mar 14

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Campaign 2012

Administration News

Quality

Coverage & Access

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Connecticut Weighs Its 'Nurses Only' Medication Policy For Homebound Seniors

WNPR's Jeff Cohen, working in partnership with Kaiser Health News and NPR, reports: "Connecticut, like every state trying to reduce health care spending, is looking closely at how it cares for people with chronic conditions. Gov. Dannel Malloy has promised to move more than 5,000 poor and disabled patients out of nursing homes in five years. But the Democratic governor says there's an expensive obstacle in the way – Connecticut law says nurses have to give medications to people in the Medicaid system living at home, and that costs a lot of money" (Cohen, 3/13). Read the story.

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Capsules: Study Of Canadian Hospitals' Spending; Timing Of Birth Control May Differ For Students, Profs

Kaiser Health News: Capsules: Study Finds High-Spending Canadian Hospitals Do Better; Timing Of Birth Control Coverage May Differ For Students, Profs
Now on Kaiser Health News' blog, Jordan Rau reports: "Canada has long been a favored talking point for debates over the quality of America’s health system, alternatively cast as either Eden or Gomorrah. A new paper adds a shade of gray into the understanding of Canadian hospitals — and the ongoing debate here about whether when it comes to medical spending, less is more" (Rau, 3/13).

Also on the blog, KHN's Insuring Your Health columnist Michelle Andrews writes: "Under the health care overhaul, new health plans (or those that change their benefits enough to lose grandfathered status) have to begin providing free contraceptive services to women in August. Religious institutions, such as churches, are exempt from the requirement, but colleges and hospitals and other employers that are affiliated with religious institutions aren't. …There's a wrinkle in the timing, however. Religiously affiliated institutions have a one-year transition period before they have to be in compliance. Could that mean that students at Georgetown University, a Catholic and Jesuit institution, as well as other religiously affiliated colleges might have to wait until August 2013 for the provision to take effect?" (Andrews, 3/13). Check out what else is on the blog.

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Political Cartoon: 'That's D, As In D'Oh!'

Kaiser Health News provides a fresh take on health policy developments with "That's D, As In D'Oh!" by Chip Bok.

Meanwhile, here's today's health policy haiku:

THE POLITICS OF SOUTHERN HOSPITALITY

Governor Romney
eats his grits, but passes up
Medicare Part B
-Anonymous

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

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Health Reform

Republicans, Democrats Spin Health Law As Supreme Court Review Approaches

With oral arguments set for later this month, the health law is getting more attention from Republicans and the administration as well as from news outlets, which are examining various aspects of the upcoming legal proceedings. 

The Wall Street Journal: Health-Law War Heats Up As Court Review Nears
Democrats and Republicans are reviving their competing campaigns over the health-overhaul law in advance of the Supreme Court's review of the measure this month. After largely avoiding the issue in the 2010 midterm elections, a handful of Democrats are extolling the law on the campaign trail and their websites. Later this week, top Obama administration officials will start traveling to events across the country to celebrate the law in conjunction with its two-year anniversary on March 23 (Radnofsky, 3/13).

Reuters: Insight: Behind The Healthcare-Law Case: The Challengers' Tale
Defending the law, the Obama administration has argued that even opting not to buy health insurance affects commerce because uninsured people inevitably require healthcare and raise the cost for everyone. That argument has largely prevailed in the lower courts, and the administration has hewed to it. In contrast, as the challengers developed their strategy, they have reworked and broadened their case. They pivoted to sweeping arguments they believed highlighted the administration's vulnerability: If government could force people to buy health insurance, what couldn't government force people to buy? What was the limit? (Biskupic, 3/13).

CQ HealthBeat: Will The Supreme Court Punt On The Health Care Law? Two Experts Doubt It
On March 26, the first day of Supreme Court oral arguments in the health care lawsuit, the justices will consider the question of whether the nation's courts should just forget about the whole thing until 2014. But two Supreme Court experts said Tuesday they doubt that the justices will opt to punt the case until the law is actually in effect. Meanwhile, a special lawyer appointed by the court solely to advocate for a postponement has filed his last brief prior to the arguments (Norman, 3/13).

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Capitol Hill Watch

CBO: Deficit Estimate For 2012 Increased To $1.2 Trillion

The Congressional Budget Office issued a new round of estimates that also included revisions of the health law's costs and coverage expansion.

The Associated Press: CBO: Deficit Estimate For 2012 Hiked To $1.2T
While the short-term deficit mess is largely a product of the recent recession and slow recovery, the long-term crisis is a result of the impact baby boomers will have on federal retirement programs and the large projected increases in health care inflation. ... The budget office estimated somewhat lower costs for covering the uninsured under President Barack Obama's health care overhaul law, as well as slightly fewer people gaining coverage. Assuming the Supreme Court does not overturn the law, it would reduce the number of uninsured by 30 million in 2016, or 2 million fewer people than estimated last year. Total costs from 2012-2021 are about $50 billion lower than estimated last year. That's due to a combination of factors, including overall health care costs rising more slowly than in the recent past (Taylor, 3/13).

Reuters: CBO Cuts Cost Estimate For Obama Healthcare Law
The estimated net costs of expanding healthcare coverage under President Barack Obama's landmark restructuring have been reduced by $48 billion through 2021, though fewer people would be covered under private insurance plans, a new analysis from the nonpartisan Congressional Budget Office showed on Tuesday. The CBO also revised its overall federal budget deficit estimates to show a $92 billion increase in the projected fiscal gap for 2012, confirming a fourth straight year of $1 trillion-plus deficits (Lawder, 3/13).

The Hill: CBO: Obama's Health Law To Cost Less, Cover Fewer People Than First Thought
President Obama's healthcare reform law coverage provisons will cost less but cover fewer people than first thought, the nonpartisan Congressional Budget Office said Tuesday. The revised estimate of the law's coverage provisions shows about 2 million fewer people gaining coverage by 2016, reducing the number of uninsured Americans by 30 million instead of the 32 million projected a year ago. That would leave about 27 million people uninsured in 2016, two years after the law's insurance exchanges go online (Pecquet, 3/13).

USA Today: Obama Budget Deficit Rises With Payroll Tax Cut
Those gloomy figures are based on what CBO calls its "alternative fiscal scenario." Its basic projections are much rosier but are based on existing laws, rather than likely changes. Because Congress and the White House are almost certain to extend expiring tax cuts and avoid Medicare payment cuts to doctors, for instance, the alternative scenario becomes more likely (Wolf, 3/13).

Politico: White House Setbacks On Health Care, Energy
The White House ran into two bumps in the road on domestic policy Tuesday: higher gross costs for healthcare reform and stiffer Senate resistance to wind and solar power subsidies backed by President Barack Obama. … The uptick in healthcare costs is largely attributed by CBO to the slow economic recovery. And while the deficit doesn't suffer as a result, the numbers suggest that the level of coverage achieved will be less than once hoped. The biggest single cost increase is in Medicaid and CHIP programs. … At the same time, cuts by Congress in the past year have reduced the cost of projected subsidies and tax credits for those enrolled through the state exchanges (Rogers, 3/13).

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House IPAB Repeal Linked To Tort Reform Legislation

Joining the two measures is causing some Democrats who back the repeal of the health law's Independent Payment Advisory Board to change their positions.

Politico: GOP Links IPAB Repeal And Malpractice Reform
IPAB repeal legislation began to hemorrhage Democratic support Monday, after Republicans said they intend to pair the broadly popular House bill with a more partisan medical malpractice reform package (Dobias, 3/13).

Modern Healthcare: IPAB Repeal Attached To House Tort-Reform Bill
House members are expected to vote next week on a medical liability reform bill that includes language to repeal the health reform law's Independent Payment Advisory Board, House Republican aides say.When they return to Capitol Hill after a weeklong recess, House members will consider the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2011, a bill introduced last year by Reps. Phil Gingrey (R-Ga.), Lamar Smith (R-Texas) and David Scott (D-Ga.). That bill calls for capping punitive damages in healthcare lawsuits to $250,000 or two times the amount of economic damages awarded, whichever is greater (Zigmond, 3/13).

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Preparing For 'Ryan 2.0'

Democrats and Republicans alike are girding for the unveiling of the 2013 budget plan by House Budget Committee Chairman Paul Ryan, R- Wis., and its provisions to overhaul Medicare.

Politico Pro: Medicare And The Budget Battle—Again
For House Democrats, this week's recess is a warm-up exercise for a battle over what they call Ryan 2.0. Never mind that House Budget Committee Chairman Paul Ryan has one key Democratic ally, or that he made concessions to Oregon Sen. Ron Wyden as they worked out their Medicare premium support plan, expected to be part of Ryan's fiscal 2013 budget. Democrats don't plan on letting such subtleties slow down their election year refrain that Republicans will "end Medicare as we know it." And it was spelled out in the talking points House Democrats took home this week (DoBias, 3/14).

CQ HealthBeat: Wyden Sees Future For His And Ryan's Medicare Plan
Sen. Ron Wyden is standing behind the Medicare plan he cosponsored with House Budget Chairman Paul D. Ryan, a plan that is expected to be a centerpiece of a House budget resolution scheduled to be unveiled next week. "I do think that there’s a bipartisan opportunity for a premium support program, which guarantees affordability for every senior," the Oregon Democrat said Tuesday. "And you get that through competitive bidding where the bid is tiered to the actual costs of a senior's health care in that area" (Krawzak, 3/13).

Meanwhile, the GOP is still confronting intra-party differences of opinion regarding the budget -

Reuters: House Republican Leaders Set To Break Budget Deal
Republican leaders in the House of Representatives are ready to break a hard-fought budget deal with Democrats as they try to quell a revolt by conservatives who are insisting on deeper spending cuts ahead of the November elections. House Republican aides said on Tuesday that House Speaker John Boehner and Majority Leader Eric Cantor were pressing for a modest $19 billion reduction of discretionary spending caps in this year's Republican budget plan (Lawder, 3/14).

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Campaign 2012

Santorum Wins The South, But Romney Focuses On Obama

GOP presidential hopeful Rick Santorum solidified his claim to be the favored candidate of the party's conservative base with his wins in Alabama and Mississippi Tuesday night, while rival Mitt Romney stepped up his attacks on President Barack Obama.

The Wall Street Journal: Wins In South For Santorum
Rick Santorum won the Republican presidential primaries in Alabama and Mississippi Tuesday, solidifying his claim to be the favored candidate of the party's conservative base and the main challenger to front-runner Mitt Romney (O’Connor and Murray, 3/14).

The Associated Press: Romney Increasingly Hits Obama, Ignores GOP Rivals
Mitt Romney isn't waiting to lock down the GOP presidential nomination to begin focusing his campaign chiefly on President Barack Obama... The former Massachusetts governor is doing his best to pretend Santorum and his fellow rivals Newt Gingrich and Ron Paul hardly exist. Romney ignored them Tuesday at his two public events, in Missouri, which holds caucuses Saturday. Instead he ripped into Obama on health care, gasoline prices, foreign policy, the deficit and other issues (Babington, 3/14).

News outlets also examine Romney's statements, policy positions -

Politico: Mitt May Find Avoiding Medicare Isn't That Simple
It's one thing to say you're not going to enroll in Medicare. But it's hard to actually escape it. Massachusetts Gov. Mitt Romney's campaign said on Monday — the Republican presidential candidate's 65th birthday — that he doesn't plan to enroll in the Medicare program (Haberkorn, 3/14). 

The Hill: Think Tank's Book Says Romney Not To Blame For Obama Health Law
It's unfair to call Mitt Romney the architect of President Obama's healthcare law because of how thoroughly the Republican presidential candidate's reforms were altered under his Democratic successor, a new book argues (Pecquet, 3/13).

CNN: When Romney Says 'Get Rid Of' Planned Parenthood He Means…
Mitt Romney reiterated his pledge to defund Planned Parenthood Tuesday, telling a local television reporter in a St. Louis suburb he would "get rid of" the women's health organization if he were president. In context, Romney's remark appeared to refer to revoking federal funding for the group, which many conservatives oppose because it provides abortions. As president, Romney wouldn't be in position to "get rid of" Planned Parenthood because it isn't a government entity. But his Democratic critics were still quick to pounce with context or not (3/13).

Also in the news, the AFL-CIO endorses Obama, with a new strategy to combat super PACs -

The Associated Press/Washington Post: AFL-CIO Endorses Obama, Puts Focus On Voter Turnout Rather Than Campaign Cash
Labor unions, saying they can't hope to compete with the new breed of conservative fundraising groups, plan to spend less money this year on specific candidates and political party organizations and more on door-to-door canvassing, phone banks and registration drives to help President Barack Obama and other Democrats. … The shift in spending comes as AFL-CIO leaders officially endorsed Obama for a second term Tuesday. AFL-CIO President Richard Trumka praised Obama for passing the $800 billion stimulus package, pushing a health care overhaul and insisting on Wall Street reforms (3/14).

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Administration News

Polls Offer Snapshots Of Public Thinking On Birth Control Coverage Rule

Meanwhile, other reports explore whether the U.S. Catholic bishops may be considering a change in strategy regarding their opposition to this policy.

The Wall Street Journal: Birth-Control Rule Debate Intensifying
New polling data are sparking a vigorous debate over whether an Obama administration rule requiring employers to offer free birth control is a political winner for the White House, particularly among women, as many Democrats have assumed (Seib, 3/13).

New Orleans Times-Picayune: Birth Control Exemption For Employers With Moral Qualms Supported In Poll
Employers who object on moral or religious grounds should be able to opt out of providing birth control for their employees, a slight majority of Americans told a new CBS News/New York Times poll. Fifty-one percent said that such employers should be able to opt out. According to the same poll, support for the opt-out increased when people were asked specifically whether religiously affiliated employers, like hospitals or universities, should be exempted when they have religious or moral objections (Nolan, 3/13). 

Reuters: Bishops Consider Broader Focus In Birth-Control Fight
Facing small but clear signs of discontent within their own ranks, U.S. Catholic bishops may be poised to rethink their aggressive tactics for fighting a federal mandate that health insurance plans cover contraception, according to sources close to influential bishops. There are no indications that the bishops will drop their fight against the federal mandate. But dozens of bishops, meeting this week in Washington, are likely to discuss concerns that their battle against the Obama administration over birth control risks being viewed by the public as narrow and partisan and thus diminishes the church's moral authority, the sources said (Simon, 3/13).

Kaiser Health News: Timing Of Birth Control Coverage May Differ For Students, Profs
Under the health care overhaul, new health plans (or those that change their benefits enough to lose grandfathered status) have to begin providing free contraceptive services to women in August. Religious institutions, such as churches, are exempt from the requirement, but colleges and hospitals and other employers that are affiliated with religious institutions aren't. …There's a wrinkle in the timing, however. Religiously affiliated institutions have a one-year transition period before they have to be in compliance. Could that mean that students at Georgetown University, a Catholic and Jesuit institution, as well as other religiously affiliated colleges might have to wait until August 2013 for the provision to take effect? (Andrews, 3/13).

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Quality

JAMA Study: Higher Spending = Better Quality In Canadian Hospitals

The study in the Journal of the American Medical Association appears, at first blush, to contradict findings from the Dartmouth Atlas research.

Bloomberg: Canadian Hospitals That Spend More On Patients Get More
Canadian hospitals that spent the most on patient care may be getting a bigger bang for their buck than their U.S. counterparts, researchers suggested. A study reported in the Journal of the American Medical Association compared patient results between Canadian hospitals that spent more on care, and those that spent less (Armstrong, 3/14).

Reuters: More Spending Equals Better Care - In Canada
The finding raises questions about an idea at the heart of a major argument in U.S. health care reform: that hospitals can provide equal or even better care after government reimbursements are cut (Pittman, 3/13).

MedPage Today: Best Care May Be At Hospitals That Spend Most
At baseline, illness severity among patients with each condition did not vary based on the hospitals' spending intensity. In general, patients treated at higher-spending hospitals had longer lengths of stay, a lower likelihood of being admitted to the intensive care unit, and more specialist visits and nursing care (Neale, 3/13). 

Modern Healthcare: Higher-Spending Facilities Tied To Better Survival, Lower Readmissions, Study Finds
Heart failure, hip fracture and colon cancer patients at high-spending Canadian hospitals were less likely to return to the hospital or die soon after being treated than those treated at low-spending hospitals ... [the research] analyzed 30-day and one-year readmissions and death rates for adults admitted to Canadian hospitals between 1998 and 2008 (Evans, 3/13).

Kaiser Health News: Capsules: Study Finds High-Spending Canadian Hospitals Do Better
At first glance, this conclusion would seem to contradict the world view of the Dartmouth Atlas, which maintains that American hospitals that throw more resources at patients — more specialists, tests, procedures — don't get better results. ... But the paper explains that Canadian hospitals have far fewer resources than do American ones (Rau, 3/13).

HealthyCal: Canadian Study Says Patients Fare Better In Higher-Spending Hospitals
Taken together, both of the studies suggest that there are limits to the health benefits that can be achieved with more spending, as there are diminishing returns as more medical technology and specialized services are used. Canada's health care expenditures per capita are about 57% those of the U.S., which has a 3- to 4 times higher per capita supply of specialized technologies, including MRIs and CAT scans, and triple the number of specialists (Portner, 3/13). 

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Coverage & Access

Quality, Access and Cost: It's About Location, Location, Location, A Study Finds

The Commonwealth Fund found significant variation based on "hospital referral regions."  

National Journal: Big Variations Found In Health Care Quality, Community To Community
Health care reform may be coming to the whole country, but our health care system is still very local. That's the conclusion of a new scorecard from the Commonwealth Fund that looks at health and health care in regions around the country. The report split up the country into small "hospital referral regions," and tracked a wide array of health measures and evaluations of system performances (Sanger-Katz, 3/14).

Modern Healthcare: Access, Quality, Costs Vary Widely, Says Commonwealth Report
Healthcare access, quality and costs vary widely from one community to another, according to a report from the Commonwealth Fund. Using 43 metrics, including percentage of insured adults and 30-day mortality rates for heart attack, Commonwealth Fund researchers assessed health system performance in 306 hospital referral regions across the country. St. Paul, Minn., Dubuque, Iowa, and Appleton, Wis., were among the top communities overall, while Shreveport, La., and Jackson, Miss, were ranked among the bottom 10 (McKinney, 3/14).

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Health Care Marketplace

Kodak Retirees Seek To Protect Health Benefits In The Face Of Chapter 11 Proceedings

The Associated Press/Washington Post: Kodak Retirees Seek Appointment Of Committee To Protect Benefits Amid Chapter 11 Proceedings
Some former Kodak employees are asking a judge to appoint a retiree committee to protect their benefits as the photography company reorganizes under bankruptcy protection. The retirees say in a motion filed in U.S. Bankruptcy Court in New York that a committee is appropriate given Kodak's current proposal to end health care benefits for about 16,000 retirees who are eligible for Medicare (3/13).

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State Watch

State Legislatures Consider Medicaid, Health Cost And Health Program Bills

State legislatures around America are considering laws to change their Medicaid programs and to address how patients can learn their doctor's malpractice history. They are also contemplating how to cut health care costs and adjusting prescription privileges for nurses.

(St. Paul) Pioneer Press: Minnesota Bill To Change HMO Medicaid Requirements Advances
A state House committee advanced a bill Tuesday that would eliminate a requirement for nonprofit health plans to participate in the state's Medicaid program. The change would amount to a fundamental shift in how Minnesota buys health insurance for low-income and disabled residents who rely on the program, which is jointly funded by the state and federal government. Currently, the majority of Medicaid recipients in the state have their care administered by managed care organizations, including nonprofit HMOs (Snowbeck, 3/13). 

Minneapolis Star Tribune: Bill To Disclose Malpractice Data Gets Scaled Back 
An effort at the State Capitol to give consumers more information about the malpractice histories of doctors has been scaled back under concerted lobbying by the Minnesota Medical Association (MMA). … MMA officials called the amended bill "significantly improved" in a recent news release, arguing that malpractice information can often be misleading and isn't a good indicator of the quality of care provided by a given physician. … But a leading malpractice authority said the amended bill would hide large quantities of malpractice data that could be useful to consumers (Meryhew and Howatt, 3/13).

WBUR's CommonHealth blog: The Fight Over How Deeply To Cut Health Care Costs
A behind-the-scenes fight about what goal Massachusetts should set for cutting health care costs burst into the open tonight. The Greater Boston Interfaith Organization (GBIO) and the state's largest employer group, Associated Industries of Massachusetts (AIM) are both calling for a target that would mean deep cuts (Bebinger, 3/13). 

Boston Globe: Religious, Business Leaders Support Aggressive Cap On Health Cost Increases
Religious and business leaders in Massachusetts called Tuesday for state lawmakers to rein in health spending more aggressively than House Speaker Robert A. DeLeo has proposed, but groups representing doctors and hospitals warned that slowing spending too sharply could be harmful. The Greater Boston Interfaith Organization, which has provided a significant consumer voice throughout the state's health care overhaul, said Tuesday night that DeLeo's proposal to cap health care cost increases at about 3.7 percent annually, a number comparable to the yearly growth in the state's economy, was insufficient. DeLeo said recently that would be his goal for containing costs in a long-awaited bill expected to be filed shortly and acted on by legislators this summer (Conaboy and Kowalczyk, 3/14).

Kansas Health Institute News: Governor's Budget Amendment Would Beef Up KanCare Plan
Gov. Sam Brownback has asked the Legislature to amend his original budget recommendations for the coming fiscal year to include an additional $3.4 million to beef up his administration's Medicaid makeover plan. ... [T]he request includes $1 million for a statewide education campaign aimed at Medicaid providers and clients. ... The budget amendment also would add $2.4 million to update the state's Medicaid billing system (3/13).

New Orleans Times-Picayune: Today at the Capitol: Senators Take First Crack At State Medicaid Overhaul
Unlike his approach to the slate of education proposals that will dominate the 2012 legislative session, Gov. Bobby Jindal did not mount much of a public campaign before he decided to shift more than $2 billion of state Medicaid business to private insurers during his first term.  But the move to private managed-care, which went live Feb. 1, is no less significant a shift in public policy than Jindal's sweeping proposals for K-12 education. To date, the new model ranks as Jindal's most significant privatization of government functions (Barrow, 3/13).

Colorado Public Radio: Nurses: Punishment Doesn't Fit The Crime
This year's legislative session has been edge-of-your-seat stuff for about 300 Colorado nurses. They're rooting for a bill created just for them. It restores their ability to write prescriptions. These are so-called "Advance Practice Nurses" (Whitney, 3/13).

Des Moines Register: HIV Insurance Fix Passes In The Iowa Senate
A fix to a program that is denying health care coverage to an estimated 100 HIV-positive residents in Iowa passed in the Iowa Senate this afternoon after initially failing. The bill, Senate File 2293, generally updates law to the state's insurance division. But it also includes what some say is a fix to a $35 million state program charged with insuring Iowans with pre-existing conditions that is denying coverage to HIV-positive residents (Clayworth, 3/13).

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S.D. Allows Insurers To Deny Some Kids Coverage, Mo. Still Won't Start Health Exchange

South Dakota is allowing insurers to deny children insurance coverage if they don't enroll during open enrollment, a possible violation of the health law. In Missouri, flexibility won't persuade the state to set up a health insurance exchange.

Politico Pro: S.D. Restricts Coverage, HHS Looks Other Way
The state is South Dakota, and the provision is a small but popular one -- a ban on insurers denying coverage for kids because of their health status or excluding coverage for pre-existing conditions. The fact that HHS hasn't done anything about it has some consumer advocates worried about how it will affect states that flout the law after more health care reform provisions take effect in 2014. "When the state responds to the needs of their market by undermining a provision that is as central to the Affordable Care Act as ending health discrimination against children, then people should sit up and take notice," said Sabrina Corlette, a National Association of Insurance Commissioners consumer representative. ... In September 2010, the South Dakota Department of Insurance issued regulations that allow insurers to continue denying coverage to children under 19 or excluding coverage for their pre-existing conditions if the policies are sold outside an open-enrollment period where insurers must cover all comers (Feder, 3/14).

St. Louis Beacon: Federal Flexibility Won't Persuade Missouri To Set Up Insurance Exchange System, Rupp Says 
Missouri will take no immediate steps to establish an insurance exchange in spite of the federal offer to give states more flexibility in setting up this key part of the health-reform law, a key state senator said Monday. ... "The federal government has always pushed back all these supposedly hard deadlines," [Sen. Scott Rupp, R-Wentzville] says. "So that threat of you have to have it done by this date has pretty much fallen on deaf ears" (Joiner, 3/13). 

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States Consider Abortion And Contraception Legislation

News outlets are considering the next moves for Texas' Women's Health Program after the federal government said it won't renew its funding for the program over the state's plan to cut off funding for Planned Parenthood. In the meantime, state legislatures in Colorado, Mississippi, New Hampshire and Pennsylvania consider contraception and abortion legislation.

Bloomberg:  Texas Fight With Obama on Women's Health May Cut Care
Texas public health officials say women who get family-planning services at Planned Parenthood clinics will struggle to find other providers once the nonprofit group is expelled from the state Women's Health Program. A dispute pitting Governor Rick Perry, a Republican, against President Barack Obama, a Democrat, over a state ban on aid to abortion providers or their affiliates is expected to force out the nonprofit organization, which cares for almost half of the program’s 130,000 participants (Mildenberg, 3/14).

The Texas Tribune: What's Next for Texas' Women's Health Program? 
[A]bortion opponents have argued that there are thousands of more comprehensive health care providers available to take Planned Parenthood's place. ... But Fran Hagerty, the head of the Women's Health and Family Planning Association of Texas -- which represents non-Planned Parenthood providers in Texas, including clinics, hospitals and medical schools -- said she seriously doubts Gov. Rick Perry will be able to keep the pledge he made last week to maintain the roughly $30 million-per-year program without federal help (Tan, 3/14). 

Denver Post: Focus On The Family To Push Ballot Initiative To Ban State Government Interference
Focus on the Family will build a coalition to back a constitutional amendment prohibiting state government from interfering with the religious freedom of a person or religious organization. ... [Senior vice president Tom] Minnery said recurring problems of government interference with or exclusion of religious people and groups prompted the ballot measure. He denies it's spurred by the national debate over religious freedom and conscience-based exemptions to national health care mandates, such as required coverage of birth control (Draper, 3/13).

Reuters: Mississippi Lawmakers Approve Abortion Restrictions
Mississippi's House of Representatives on Tuesday overwhelmingly passed a bill that would tighten regulations for abortion facilities in the conservative state. The bill, approved by a 80-37 margin in the Republican-controlled House, would require doctors performing abortions to have admitting privileges at a local hospital and be board-certified or eligible in obstetrics and gynecology (Ward, 3/13).

Fox News: New Hampshire GOP Works To Reverse State's Contraceptive Coverage Rule
While the battle over birth control, women's rights and religious freedom rages in Washington, Republicans in New Hampshire are firing a preemptive strike, aiming to reverse a 12-year-old state law requiring health plans with prescription coverage to include contraceptives. Republican House Speaker William O'Brien is leading the charge to allow employers with religious objections to exclude contraceptive coverage from their health plans. He believes the law as it stands can be legally challenged (Line, 3/13).

The Philadelphia Inquirer: Corbett Says He Supports 'External' Ultrasounds For Abortion Patient
Gov. Corbett says he supports mandatory ultrasounds for abortion patients, the subject of one of the most controversial pieces of legislation before the General Assembly. Corbett said Tuesday he would support a bill that would force doctors to show women an ultrasound before an abortion is performed as long as it was not "obtrusive" (Worden, 3/13).

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Blue Cross Blue Shield in Tenn. To Pay $1.5M To Settle HIPAA Breach

Blue Cross and Blue Shield in Tennessee will pay $1.5 million to the federal government to settle a HIPAA breach. Insurer and hospital business practices also make news in Georgia and Maine.

Modern Healthcare: Blue Cross And Blue Shield Of Tenn. To Pay $1.5 Million In HIPAA Settlement
In the first enforcement action stemming from the HITECH Act breach notification rule, Blue Cross and Blue Shield of Tennessee has agreed to pay federal regulators $1.5 million and enter into a corrective action plan after 57 hard drives were stolen from the insurer. Blue Cross told government authorities that the computer drives contained unencrypted private health information for more than 1 million people, including names, Social Security numbers, dates of birth, diagnosis codes and health plan ID numbers, according to an announcement by HHS' Office for Civil Rights (Carlson, 3/13).

WBUR's CommonHealth blog: Maine Hospital Price Lists: Everything's Better Up North
Around ten years ago or so, Maine law was amended to require hospitals to provide the prices of common procedures. But paper lists are something of a "horse and buggy" version of price transparency, and about four years ago, Maine established an online database — run by the Maine Health Data Organization and funded by the hospitals and the health insurers. ... The limits of the transparency: We can tell you what, say, knee surgery costs but there are all kinds of associated costs that we may or may not be able to tell you (Goldberg, 3/13). 

Georgia Health News: Kaiser Wins Regional Satisfaction Ranking
Kaiser Permanente ranked first in customer satisfaction in the three-state region that includes Georgia, according to a 2012 study by J.D. Power and Associates released Tuesday. The nonprofit health plan, with 240,000 members in the state, won the top honor in the region for the third straight year, earning 770 points on a 1,000-point scale. That was 66 points higher than the average for the South Atlantic region, which also includes North Carolina and South Carolina (Miller, 3/14).

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State Roundup: Caregivers Face 'Burnout' Threat As Need Grows

A selection of health policy news from Connecticut and California, North Carolina, Kansas and Wisconsin.

Wisconsin Public Radio: Health Officials Look For Savings From Long Term Care Program
Long term care advocates say they're concerned about caregiver burnout. And they say Wisconsin may be overestimating projected savings from uncompensated care that relatives provide. State health officials need to find nearly $80 million in savings from a popular program that keeps the elderly and disabled out of nursing homes. The administration wants to know what assistance friends and family are giving so that care isn't replaced by Medicaid services  (Mills, 3/13).

California Healthline: Who Cares for the Caregivers?
Caregivers make up a sizable volunteer workforce in California -- people who put in about 1.7 billion hours of care last year and didn't get paid for it. If they did, all of that work is valued at more than $20 billion. In California, where more than 10,000 people turn 65 every day, the need for that workforce will only grow. That's according to a raft of testimony yesterday at the Capitol Building in Sacramento ... The state doesn't do much for this vast and contributing population, and is about to do even less, according to Michelle Pope, executive director for Alzheimer's Services of the East Bay (Gorn, 3/14).

The Associated Press/Raleigh News & Observer: NC Personal Care Services For Thousands May End
Thousands of North Carolina residents mostly living in North Carolina adult care homes could lose Medicaid personal assistance services this spring as regulators comply with federal mandates to align service qualifications with people living in their own residences. ... Residents in adult care homes historically have had to meet less stringent eligibility requirements to qualify for Medicaid help (Robertson, 3/13).

Kaiser Health News: Connecticut Weighs Its 'Nurses Only' Medication Policy For Homebound Seniors
Connecticut, like every state trying to reduce health care spending, is looking closely at how it cares for people with chronic conditions. Gov. Dannel Malloy has promised to move more than 5,000 poor and disabled patients out of nursing homes in five years. But the Democratic governor says there's an expensive obstacle in the way – Connecticut law says nurses have to give medications to people in the Medicaid system living at home, and that costs a lot of money (Cohen, 3/13).

Kansas Health Institute News: Advocates Push For Increased Staffing At Nursing Homes
The administration of Gov. Sam Brownback is working to expand managed care to all currently on Medicaid, including those in nursing homes. ... In Kansas, nursing homes are required to give direct staff care for at least 1.85 hours per resident per day, and to average at least 2.0 hours per day throughout the week. The minimum staffing level is one qualified employee per 30 residents, which translates to 2.06 hours per resident per day. ... Several people who testified cited a 2002 study by the Centers for Medicare & Medicaid Services that recommended at least 4.85 hours of combined staff time per resident per day (Cauthon, 3/13).

California Watch: Developmental Centers' Police Need Immediate Fixes, State Officials Say 
Investigations of patient abuse by in-house police at California's institutions for the developmentally disabled have been unacceptably poor for years and must be fixed immediately, state officials and patient advocates agreed during a hearing today. ... In a series of stories, California Watch has reported that detectives and patrol officers at the state's five board-and-care institutions – home to about 1,800 severely disabled men and women – routinely fail to conduct basic police work even when patients die under mysterious circumstances (Gabrielson, 3/13).

In other state health policy news --

San Francisco Chronicle: Mental Patients Who Refuse Drugs Must Get Hearing
In a ruling that could affect thousands of mental patients in California, a state appeals court has ordered Marin County to provide judicial hearings before administering drugs to patients who have been held in the county hospital longer than two weeks. Patients who refuse their medication are entitled to legal representation at a hearing that will determine whether they are able to make the decision on their own, the First District Court of Appeal in San Francisco said Friday (Egelko, 3/14).

The Sacramento Bee: Steinberg To Introduce Change To Sacramento County's Kids' Dental Program
Seeking to break managed care's monopoly on dental care for Sacramento County’s poor children, state Senate President Pro Tem Darrell Steinberg plans to introduce legislation to allow more choice in dentists, his aide told the Sacramento County Board of Supervisors on Tuesday. More than 110,000 Sacramento County children on Medi-Cal participate in a mandatory dental managed care model (Bazar, 3/14).

The Connecticut Mirror: Donovan Launches His Final Push For Pooling 
Flanked by fellow legislators and advocates for health reform, Speaker of the House Christopher G. Donovan launched what's likely to be his final push for the state to adopt one of his favorite causes -- opening the state employee health care pool to the public. ... Gov. Dannel P. Malloy's administration has been cool to the concept, which has drawn opposition from the insurance industry and some business groups (Levin Becker, 3/13). 

The Connecticut Mirror: Malloy Administration: Basic Health Program "Premature" 
The Malloy administration is urging lawmakers to hold off on creating a health program for low-income adults who don't qualify for Medicaid under federal health reform, saying action now is premature. As it did last year, the administration is arguing that more information needs to be available from the federal government before the state can make a decision on whether to create a "basic health program" (Levin Becker, 3/13). 

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Editorials and Opinions

Viewpoints: Health Law Savings Questioned; Ryan-Wyden Plan For All; Penalizing Hospitals May Not Save Money

The Wall Street Journal: ObamaCare's Bogus Cost Savings
As we approach the second anniversary of ObamaCare, it's worth re-examining some of the claims its proponents made about the impact of the law on health-care costs. Three of the law's most-touted cost-control measures have already been shown to be unlikely to succeed (Daniel P. Kessler, 3/14).

The Fiscal Times: The Game Plan That Lets Romney Beat Obama
(Mitt) Romney has already laid out a reasonable defense of the bill he adopted while Governor of Massachusetts. He portrays Obamacare as an attempt to conclude a "government takeover of health care," while his program was focused on helping people obtain health insurance. He has noted that his health care bill raised no new taxes and cut nothing from seniors' benefits; Obamacare does both. As we race closer to the huge tax increases Obamacare will levy in 2013 and 2014, this is a powerful distinction (Liz Peek, 3/14). 

Roll Call: Health Care Debate Remains Mired In Politics
If I were in the Democratic leadership, I would be tempted to propose a grand compromise: Take the Ryan-Wyden plan and apply it to everyone — insurance exchanges with Medicare as an option for all. That won't happen, of course. The Supreme Court may blow up all or part of the 2010 law, throwing its implementation into turmoil. Whether that happens (and there is a good chance the court will punt, putting off a decision until after the elections), if Republicans win the White House and Congress, they will move via reconciliation to repeal as much of the plan as they can. And they will discover that the "repeal" part of "repeal and replace" is a lot easier than the "replace" part (Norman  Ornstein, 3/14).

Politico: Government Cannot Regulate Beliefs
The issue is not one of good health — despite election-year efforts to frame it as such. If it were only about good health, government would have long ago outlawed smoking, mandated daily vitamins and forced employers to provide gym memberships. The issue is not even "free" contraception. If it were, a member of Congress with an elastic view of the Commerce Clause would have long ago introduced a bill providing it to the public for "free" — whatever that means. The real issues are whether the First Amendment is broad enough to include beliefs with which we disagree, and whether government can tacitly or otherwise force us to abandon our religious beliefs simply because something constitutes sound public policy (Rep. Trey Gowdy (R-S.C.), 3/13).

The Dallas Morning News: Rick Perry And Women's Health
Gov. Rick Perry now promises to save the state’s endangered Women’s Health Program, so let’s begin by acknowledging this heartening development…. If you think Perry's late save hints at a game of chicken, you would not be far off…. As everyone scrambles to adjust, it's worth noting again that all of this is driven by politics and not by the real imperative — providing accessible contraception and health care to a most vulnerable population (3/14).

Journal of the American Medical Association: The Relationship Between Cost and Quality
Data from Dartmouth researchers and others have thus led policy makers to feel comfortable with broad payment reductions, in many cases targeting hospitals as a major source of savings for the Medicare program. ... Nearly every proposal to reduce Medicare spending, from Democrats and Republicans alike, seems to contain reductions in Medicare payments to hospitals. The notion that payments to hospitals can be reduced while maintaining or improving the quality of care delivered at these hospitals has become so ingrained in policy circles as to be a given. Recently, however, an increasing amount of evidence has emerged that should counter this misperception (Dr. Karen E. Joynt and Dr. Ashish K. Jha, 3/14).

Journal of the American Medical Association: "Transparency Reports" on Industry Payments to Physicians and Teaching Hospitals
Public awareness of industry payments to physicians and teaching hospitals in the United States is about to markedly increase. As required by the "Sunshine" provisions of the Patient Protection and Affordable Care Act, by September 2013 the Centers for Medicare & Medicaid Services (CMS) is to publish "transparency reports" that disclose these industry payments on a public website; the information must be "searchable," "clear and understandable," and "able to be easily aggregated and downloaded" (Dr. Robert Steinbrook and Dr. Joseph S. Ross, 3/14).

The Washington Post: Whitman-Walker's Stunning Turnaround
Whitman-Walker Health (WWH) Executive Director Don Blanchon attributes the stunning turn around to three factors. The clinic is seeing more patients. Its fundraising exceeded expectations. And it's living within its budgetary means. The result is a nearly $7 million swing from the red to the black in five years (Jonathan Capehart, 3/13).

The Seattle Times: Hospitals Ill-Equipped To Handle Psychiatric 'Boarders'
Because there are not enough psychiatric beds available for persons requiring inpatient mental-health treatment, those held under Washington's Involuntary Treatment Act are being "boarded" in hospitals throughout King County…. It is unsafe and unreasonable for patients with serious medical and psychiatric needs; their collective families, who rightly expect that their loved ones are being tended to in a safe and appropriate environment; and hospital staff, who bear the responsibility of caring for whomever is admitted to the hospital, regardless of the economic climate that causes resources to crumble around them as they work (Molly Murphy, 3/13).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.