Daily Health Policy Report

Thursday, March 14, 2013

Last updated: Thu, Mar 14

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Administration News

Health Care Marketplace

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Health On The Hill: Democrats, Republicans Clash Over Health Care Savings (Audio)

Kaiser Health News' Mary Agnes Carey talks with Jackie Judd about the competing budget proposals offered by leaders from each chamber of Congress this week that seek savings in health spending and what's next for the proposals and what President Obama could offer (3/13). Listen to the audio or read the transcript.

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Capsules: Colorado Sets Its Exchange Fee; Dick And Jane Sign Up For The Exchange

Now on Kaiser Health News' blog, Colorado Public Radio's Eric Whitney, working in partnership with KHN and NPR, reports on developments regarding how Colorado will pay for its health exchange operations: "The price of policies in Colorado's health insurance exchange will include a 1.4 percent fee to help fund exchange operations. The state's exchange board voted to enact the fee Monday. Board Chairwoman Gretchen Hammer characterized it as lean compared with the 3.5 percent fee the federal government is expected to tack on to policies sold in states that are not setting up their own exchanges" (Whitney, 3/13).

Also on the blog, Jenny Gold reports on federal government efforts to make signing up for health insurance more palatable: "Signing up for health insurance is intimidating — even if you know you might get some help paying for it. The federal government is trying hard to come up with a way to make the process a bit more palatable — about as simple as, say, doing your taxes online" (Gold, 3/13). Check out what else is on the blog.

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Political Cartoon: 'Pet Peeve?'

Kaiser Health News provides a fresh take on health policy developments "Pet Peeve?" by Steve Sack.

Meanwhile, here is today's health policy haiku:


Perhaps huge pope news
Means budget talks can proceed
Quietly? Let's hope! 

 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 Plans Underscore Deep Divide On Capitol Hill

News outlets compare and contrast how the two budget blueprints released this week -- one by House Republicans, the other by Senate Democrats -- treat Medicare, Medicaid and other entitlement programs.

Los Angeles Times: Stark Choice In Dueling Budget Plans
Under the 10-year budget plan released by House Republicans this week, tax rates would fall for high-income Americans and corporations, defense spending would be bolstered, and more than 30 million uninsured people would lose access to government-backed healthcare. Food stamps, student loans and free school lunches for children would be cut. The Senate Democrats' plan, released Wednesday, would increase taxes on the wealthy and some corporations, cut the Pentagon budget and add $100 billion in highway and school construction spending. Their plan would make modest reductions in healthcare and other domestic programs (Mascaro, 3/13).

USA Today: Senate Democrats Release First Budget In Four Years
The budget — the first one Senate Democrats have produced since 2009 — stands in sharp contrast to the House Republicans' plan released Tuesday that calls for cuts in corporate and individual taxes and aims to balance the budget in 10 years, fundamentally overhaul Medicare and eliminate President Obama's health care law (Davis, 3/13).

The Associated Press/Washington Post: Democratic-Led Senate Panel To Approve Budget To Raise Taxes, Spare Benefit Programs From Cuts
Acting on the Senate's first budget since President Barack Obama took office, a Democratic-led panel is moving toward party-line approval of a fiscal blueprint that would trim the budget deficit while protecting safety net programs from slashing cuts proposed by Republicans. The expected vote Thursday in the Senate Budget Committee comes as Obama heads to the Capitol for a third consecutive day, carrying his charm offensive with Congress to Senate Republicans and his Democratic allies in the House (3/13).

Politico: Patty Murray Plan Doesn't Balance Budget
In the committee, the 12 Democrats appeared united when they delivered their opening statements Wednesday. Assuming Murray succeeds in keeping her caucus largely in line and ushering the measure through the Senate, she will have an enormously challenging task of reconciling the plan with House Budget Committee Chairman Paul Ryan's approach, who proposes no tax increases and calls for a dramatic overhaul of Medicare and Medicaid, as well as a repeal of the president's health care law (Raju and Gibson, 3/13).

The Washington Post: Democrats Challenge Obama On Medicare And Social Security Cuts
On one side of the Capitol, President Obama sought to convince House Republicans on Wednesday that he is serious about reining in the rising cost of federal health and retirement programs. But on the other side of the Capitol, Senate Democrats rolled out a 10-year spending plan that sent a different message: Not so fast (Montgomery, 3/13).

Modern Healthcare: Senate Dems Propose $275B In Healthcare Cuts
The first Senate Democratic budget proposal in four years would cut federal healthcare spending by $275 billion over 10 years. The spending blueprint offered by Sen. Patty Murray (D-Wash.), chairman of the Budget Committee, would reduce—but not eliminate—annual deficits through an even combination of tax increases and spending cuts. The healthcare cuts—for which few details were provided—were part of $975 billion in overall cuts the budget would implement over the coming decade. Murray's budget specified only that it would derive the savings through accelerating provisions that tie provider reimbursements to patient outcomes, reducing waste and fraud, and encouraging greater provider "engagement" (Daly, 3/13).

Kaiser Health News: Health On The Hill: Democrats, Republicans Clash Over Health Care Savings (Audio)
KHN's Mary Agnes Carey talks with Jackie Judd about the competing budget proposals offered by leaders from each chamber of Congress this week that seek savings in health spending. They discuss what's next for the proposals and what President Obama might offer (3/13).

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Obama Visits House GOP, Points Out Willingness To Make Changes To Medicare

Lawmakers who attended the closed-door meeting said he focused on changes in how cost-of-living increases are calculated, but press reports indicate that partisan differences remain deep.

The New York Times: U.S. Budget Deal In Doubt; Obama's Trip To Hill Reveals Split
President Obama's meeting with a restive and resistant House Republican majority on Wednesday underscored their deep divisions over fiscal policy as both sides acknowledged that an overarching budget compromise was in doubt despite a new push by the White House. Under their budget, Senate Democrats would have the government running a deficit of nearly $600 billion in 10 years. In another sign of just how different the parties' priorities are, just before Mr. Obama arrived to meet with House Republicans, the Senate rejected a Republican effort to cut off financing for the president's signature health care overhaul in a party-line vote (Peters and Parker, 3/13).

The Wall Street Journal's Washington Wire: Obama Visit Leaves GOP House Members Skeptical
President Barack Obama visited the U.S. Capitol for a second day, this time meeting with House Republicans on their own turf to say he was sincere about trying to find compromise on the budget, immigration, and other policies. Mr. Obama, who is on a campaign to find common ground with Republicans, pointed to his willingness to change entitlement programs like Medicare and Social Security, specifically mentioning that he was open to controlling costs by changing the way cost-of-living increases are calculated, according to lawmakers who attended the closed-door meeting (Hughes and Boles, 3/13).

USA Today: Obama: Differences With GOP May Be Too Wide
Obama is seeking a new debt reduction agreement that includes both budget cuts and higher taxes, the latter by eliminating loopholes that benefit the wealthy. Republicans oppose higher taxes in a new debt deal, saying they would slow economic growth; they are also seeking changes to rapidly growing entitlement programs, Social Security, Medicare and Medicaid (Jackson, 3/13).

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Senate Dems Block Effort To Undo Health Law

The tea-party-led effort, which was defeated 52-45, attempted to add language to a government spending bill that would repeal the law's funding. But House Speaker John Boehner, R-Ohio, says the House -- which approved the effort -- will vote again to repeal the measure.

Politico: Senate Dems Block Tea Party Bid To Cut Obamacare
A stopgap spending bill advanced in the Senate Wednesday with Democrats keeping to a middle path in hopes of improving their chances for a strong bipartisan showing — and greater leverage with the Republican-controlled House. On a 52-45 vote, the majority quickly dispatched a tea-party-led bid to cut off funding for President Barack Obama's signature health care reforms (Rogers, 3/13).

The Associated Press/Washington Post: Democratic-Controlled Senate Rejects New Republican Effort To Repeal Obama's Health Care Law
The Democratic-controlled Senate has rejected a Republican effort to attach the repeal of President Barack Obama's health care law to a government spending bill. The 45-52 vote defeated the effort, which was led by conservatives. They say that when the law is fully in effect, it will jeopardize the nation's fragile economic recovery. But Obama's allies say national health care could help strengthen the economy in part by encouraging health maintenance and prevention. The law has been upheld by the Supreme Court (3/13).

The Hill: Boehner: House Will Vote Again To Block 'ObamaCare'
House Speaker John Boehner (R-Ohio) said Wednesday that the House will vote again soon to repeal or defund President Obama's healthcare law…The House held 33 votes over the last two years to repeal or defund all or part of the Affordable Care Act, but the repeal push has faded since the Supreme Court upheld the law and President Obama's reelection ensured that repeal votes would be futile (Strauss and Baker, 3/14).

Also in the news --

The New York Times: Clamor To Be Spared The Pain As Budget Cuts Descend
Anne Kauffman Nolon, the president of Hudson River HealthCare, which operates 22 community health centers in New York, is urging Congress to provide money to offset the cuts. If that is not possible, she said, it would be better to delay opening new clinics so she and her colleagues did not have to cut back care for patients they already served. Ms. Nolon said her clinics were losing $1 million of the $10.8 million they expected from the federal government this year to care for 87,000 patients. Nationwide, the number of clinics increased sharply under President George W. Bush, and Congress provided more money for clinics to serve people expected to gain insurance under Mr. Obama's health care overhaul. The pace of lobbying has picked up because of a widespread belief that this year’s cuts are locked in and may be a prelude to further cuts in the same programs in each of the next eight years (Pear, 3/13).

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Health Reform

Report Estimates Employer Costs From States' Refusal To Expand Medicaid

According to Bloomberg, the report by Jackson Hewitt Tax Service Inc. estimates the cost to employers to be $1 billion. Meanwhile, other news outlets report on state-level decisions and developments related to the expansion.

Bloomberg: Refusal To Expand Medicaid May Cost Employers $1 Billion
Governors who refuse to expand their Medicaid programs for the poor may cost employers in their states as much as $1.3 billion in federal fines, a study found. A clause in the 2010 health-care overhaul penalizes some employers when their workers aren’t able to obtain affordable medical coverage through the company. Employers can avoid those fees if their workers qualify for Medicaid as part of an expansion that as many as 22 states have rejected, according to a report today by Jackson Hewitt Tax Service Inc (Wayne, 3/13).

The Washington Post's WonkBlog: 'We're In An Analytical Mode': Ohio Weighs The Obamacare Medicaid Expansion
You probably haven’t heard of Ron Amstutz. He was raised on a dairy farm in Ohio and now lives in the city of Wooster (Population: 26,139). He is on the board of the Orrville Area Boys' and Girls' Club and a member of the Wooster Rotary Club. Turns out, though, that Ron Amstutz has one of the most important roles right now in implementing the Affordable Care Act: He leads a small committee that will get the first say on whether Ohio expands Medicaid to 684,000 residents (Kliff, 3/13).

The Associated Press: Mo. Senate, House Panels Defeat Medicaid Expansion
Missouri's Republican-led Legislature dealt a triple defeat Wednesday to a Medicaid expansion plan as Democratic Gov. Jay Nixon continued to travel the state trying to rally support for an enlarged health-care program for lower-income adults. In successive party-line votes, the Senate Appropriations Committee defeated legislation authorizing a Medicaid expansion after listening to more than two dozen witnesses in favor of it. Then the House Budget Committee defeated two amendments that would have added the Medicaid expansion to the next state budget (Lieb, 3/13).

The Associated Press: GOP Lawmaker Touts Medicaid Expansion In Idaho
A House Republican will introduce a measure March 14 seeking to expand Idaho's Medicaid program, a key provision in President Barack Obama's health insurance overhaul. Rep. Tom Loertscher of Bone said March 12 he’ll introduce two bills: One dissolving Idaho's existing program to pay indigent people's medical costs, and a second to expand Medicaid to include people up to 138 percent of the federal poverty line (3/13).

Arizona Republic: Arizona Medicaid-Expansion Bill Assigned To Panel Led By Foe
A day after Gov. Jan Brewer released draft legislation on her proposal to expand Medicaid, political jockeying began in earnest in the House with an “informational” hearing on the issue scheduled for a committee chaired by an opponent of the plan. House Speaker Andy Tobin’s decision to have the House Appropriations Committee begin considering the governor’s plan next week removes it from the far friendlier confines of the House Health Committee, whose chairman, Rep. Heather Carter, R-Cave Creek, supports Brewer’s call for Medicaid expansion. Carter spoke at a pro-expansion Capitol rally Tuesday when the governor released a draft of the bill to expand the state-federal health-insurance program for the poor and disabled under the federal health-care overhaul, and Brewer’s office had said Carter would hold a hearing on the issue (Reinhard, 3/13).

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Health Insurance Exchanges Likely To Offer Wide Choice

NBC News reports the exchanges may offer an "overwhelming" array of plans to choose from to people who have not purchased insurance before. Other media detail how the federal government is attempting to streamline the enrollment process and how states are racing to meet deadlines to set up the marketplaces.

NBC News: Health Insurance Exchanges: Be Ready To Be Overwhelmed
Twenty-four states now have been approved to set up their own health insurance exchanges, just seven months before people can start to enroll. That leaves the federal government to run 26 exchanges according to its own rules. No one's quite sure yet what they will look like, but it's becoming increasingly clear that many of them, at least, will provide an overwhelming range of choices for millions of people who may never have had to choose health insurance before (Fox, 3/13).

Kaiser Health News: Capsules: Dick And Jane Sign Up For The Exchange
Signing up for health insurance is intimidating — even if you know you might get some help paying for it. The federal government is trying hard to come up with a way to make the process a bit more palatable — about as simple as, say, doing your taxes online (Gold, 3/13).

Kaiser Health News: Capsules: Colorado Sets Its Exchange Fee 
The price of policies in Colorado's health insurance exchange will include a 1.4 percent fee to help fund exchange operations. The state's exchange board voted to enact the fee Monday. Board Chairwoman Gretchen Hammer characterized it as lean compared with the 3.5 percent fee the federal government is expected to tack on to policies sold in states that are not setting up their own exchanges (Whitney, 3/13).

The Washington Post: Small-Business Health Exchange Mandate Will Go To D.C. Council
A District board is moving full steam ahead with a controversial plan to require small businesses in the city to purchase their employee health insurance through a government exchange (DeBonis, 3/13).

The Associated Press: Nonprofit Insurance Exchange Plan Clears State House
The state House on Wednesday approved an Idaho-based, nonprofit insurance exchange, a provision of President Barack Obama's health care overhaul that inflamed passions of lawmakers during seven hours of debate. The vote was 41-29. All 13 Democrats but a minority of House Republicans, 28 GOP lawmakers, backed the plan pushed by Gov. C.L. "Butch" Otter to use about $30 million in federal grants to build Idaho's own insurance exchange (3/13).

HealthyCal: Spreading The Word About California's Health Care Exchange
California's new health insurance marketplace — part of federal health reform — is preparing a massive information blitz to let state residents know about their new options for buying coverage. The health benefit exchange, called Covered California, will start enrolling members in October of this year for insurance coverage that will begin next January (Potter, 3/14).

MinnPost: Three Major Health Exchange Hurdles Remain As Legislators Rush To Meet Deadline
Democrats are racing to come together on Minnesota’s most significant health reform in the last half-century, with just days remaining before the deadlines start rolling in. Health insurance exchange backers say they need to wrap up serious differences in the exchange legislation between both legislative chambers by midnight Wednesday to get the bill to the House floor on Thursday, which has been the goal (Nord, 3/13).

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As Health Law Nears Implementation, Concerns Raised About Premium Increases, Impact On Food Industry, Use Of Incentives

Several news outlets explore questions raised about the impact of the law.

The Associated Press/Washington Post: Insurers Warn Of Sticker Shock Due To Health Care Law's New Taxes, Requirements As It Expands
Some Americans could see their insurance bills double next year as the health care overhaul law expands coverage to millions of people. The nation's big health insurers say they expect premiums — or the cost for insurance coverage — to rise from 20 to 100 percent for millions of people due to changes that will occur when key provisions of the Affordable Care Act roll out in January 2014 (Murphy, 3/13).

CQ HealthBeat: Republicans Probe Health Care Law Impact on Food Service Industry
If there's a ground zero for the impact of the health insurance employer mandate, it appears to be the low-wage and high-turnover restaurant industry. But whether the result of the mandate turns out to be many fewer Dunkin’ Donuts or Outback Steakhouse locations — or much higher prices for lattes and burgers — will remain unclear until the requirement included in the health care law fully takes effect in 2014 (Norman, 3/14).

Medpage Today: Health Reform Success Requires Good Incentives
Improperly aligned incentives could undermine healthcare reform efforts by being either ineffective or leading physicians to think more about economics and less about the patients' interest, according to a perspective article. Instead, reform-related incentives should focus not just on economic motivation but on an array of financial and nonfinancial incentives across the delivery system, stated the piece published in the March 14 edition of the New England Journal of Medicine (Pittman, 3/13).

Also, several publications examined implementation issues in the states.

The Associated Press: Okla. House Oks Attempt To 'Nullify' Health Law
The Oklahoma House moved Wednesday to declare the federal health care law "null and void" in the state, approving a bill over the objection of Democrats who argued it was nothing more than a political statement. The House voted 72-20 for the bill by Republican Rep. Mike Ritze, a Broken Arrow physician and a fierce opponent of the federal Patient Protection and Affordable Care Act, which he frequently refers to as "Obamacare” (3/13).

Richmond Times-Dispatch: Future Challenges Loom Regarding Chesterfield’s Part-Time Employees
Future challenges have cast budgetary uncertainty over the Chesterfield County Human Services Division that some worry may affect services the county provides to its most vulnerable residents. One of the most pressing issues facing the division's mental health department is the nearly 200 part-time employees who would become eligible for health insurance benefits or have their hours cut back to fewer than 30 hours a week in order to comply with the Affordable Care Act (Slayton, 3/14).

HealthyCal: L.A. Care Health Plan Faces Challenges Of Today And Planning For ACA
When Steven Sample's health provider quit accepting Medi-Cal, he didn't know where to turn until he heard about L.A. Care Health Plan at a meeting near where he lived in downtown Los Angeles at the time. Sample's health emergency was a broken ankle he suffered stepping off a bus, and the injury required surgery. ... L.A. Care Health Plan is the nation's largest public health plan, providing coverage to approximately a little more than one million Los Angeles County residents. ... With the Affordable Care Act ramping up and the impending implementation of a state health insurance exchange, L.A. Care's role in the new world of health care is evolving along with the reform (Fulton, 3/13).

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Administration News

Stakeholder Associations Offer Limited Support For 'Enroll America' Efforts

CQ HealthBeat reports that insurers, hospitals and trade groups are offering only "limited interest" in the campaign to educate Americans about the health law's coverage expansion. Meanwhile, other supporters are backing the grassroots effort to keep the Obama administration's agenda -- including the Medicaid expansion -- on track.

CQ HealthBeat: Associations Barely Opening Their Wallets For Enroll America Campaign
Judging by their trade groups, insurers and hospitals are showing limited interest in funding a nongovernmental enrollment campaign that could be critical to the success of coverage expansion under the health care law next year. But officials spearheading the Enroll America campaign were upbeat Wednesday about the money they will have to wage a strong education and enrollment effort this summer (Reichard, 3/14).

The New York Times: Obama Rallies Supporters And Donors To Keep His Campaign Agenda Alive
President Obama joined former campaign staff members and some of his most ardent supporters on Wednesday night, headlining a two-day meeting of an independent group, Organizing for Action, that is intended to bolster his agenda in Congress. The new group hopes to cut through Washington's legislative logjams by harnessing the millions of volunteers and donors who helped elect Mr. Obama to a second term last fall, turning their enthusiasm and money to grass-roots lobbying on issues like immigration, climate change and the expansion of Medicaid (Confessore and Shear, 3/13).

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Health Care Marketplace

Experts Offer Views On Controlling Health Care Costs

At two different forums, health care policy experts talk about changes in policy that might slow health spending.

Politico: Experts Debate All-Payer Setups Vs. Medicare For All
Health care prices are too damn high. That's the punch line to the provocative Time magazine piece "Bitter Pill" by Steven Brill, who laid out his diagnosis of the problem Wednesday at a Center for American Progress panel. ... But while many policy experts agree with much of Brill’s diagnosis of factors that are driving up costs, there’s far less consensus on what to do about it. Brill said the voluminous feedback he's received since publishing the article breaks down along two lines. Conservatives believe consumers need to have more "skin in the game" — to pay more of health costs so they become more conscientious shoppers and put pressure on providers to more efficiently compete for their business. And liberals see the solution in Medicare-for-all, a single-payer system, amplifying the negotiating might the federal health care program already leverages to keep costs down (Norman, 3/14).

Medpage Today: Follow Medicare Savings Model, Insurers Told
To slow down growth in health spending, health insurers could employ the same strategy Medicare used a decade ago to increase use of generic drugs, a former Medicare czar said. Medicare's prescription drug benefit created tiers of products, with much higher copays for brand-name drugs compared with their generic counterparts. As a result, seniors accelerated their use of the lower-cost generics and caused Medicare Part D spending to be much less than initially anticipated. Today, generics account for about 80 percent of all drugs dispensed. "What we haven't seen is that kind of approach hitting the rest of our healthcare system in any big way," said Mark McClellan, MD, PhD, who ran the Centers for Medicare and Medicaid Services (CMS) when Part D was implemented in the middle of the last decade. But he added that such changes are starting to occur (Pittman, 3/13).

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UnitedHealth Faces Mental Health Parity Legal Challenge

Medpage Today: UnitedHealth Sued Over Mental Health Parity
Health insurance giant UnitedHealth Group has been sued in a class action for alleged violations of federal and state parity laws that mandate coverage for mental health claims on a level comparable to medical and surgical benefits. "Despite United's duty to adhere to these anti-discrimination safeguards, United has systematically implemented unlawful and deceptive practices designed to create the illusion of impartiality, fairness, and due process while simultaneously undermining access to treatment for the most vulnerable segment of our society," stated the suit filed Tuesday on behalf of the New York State Psychiatric Association and three patients (Struck, 3/13).

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State Watch

Calif. Lawmaker Pushes Expanded Role For Mid-Level Health Professionals

A series of proposed bills would widen how much care California's mid-level health workers could give to patients in order to meet the growing demand for health care services as the health law takes hold.

Los Angeles Times: Lawmaker Wants To Expand Roles Of Medical Professionals
Citing a doctor shortage in California, a state lawmaker wants to expand the roles of nurse practitioners, pharmacists and optometrists to help treat what is expected to be a crush of newly insured Californians seeking care next year under the federal health care law. At a news conference at a community clinic here, state Sen. Ed Hernandez (D-West Covina) announced plans Wednesday to introduce a series of bills that would redefine professional boundaries for certain mid-level health workers, allowing them to provide more services than currently allowed under state law (Mishak, 3/13).

Sacramento Bee: CA Lawmakers Look To Expand Scope Of Some Medical Professionals
Citing a need for more medical professionals able to treat patients who will soon have health insurance under the federal Affordable Care Act, state Sen. Ed Hernandez on Wednesday introduced a package of bills to expand the services that optometrists, pharmacists and nurse practitioners can offer patients. The so-called "scope of practice" bills set the stage for a massive fight with the state's physicians, who will look to protect their role as gatekeepers to medical care. In a news conference at a Sacramento health clinic, Hernandez, an optometrist, argued that because of a shortage of doctors in California, other medical professionals should be permitted to offer patients more care (Rosenhall, 3/14).

While some officials worry about who will care for patients, others worry about future holes in California's safety net coverage --

California Healthline: As Mass. Goes, So Goes California? Questioning The Safety Net’s Future
"What will happen to safety-net health care facilities when their patients obtain insurance?" That's one of many questions that county officials in California are asking about how the Affordable Care Act will affect health centers that serve patients regardless of ability to pay. The possibility of losing patients because of the ACA -- and of losing funding under state proposals to expand Medi-Cal, California's Medicaid program -- have led some to wonder what will become of the health centers. The future may be bleak in the eyes of some California officials, but health reform efforts in Massachusetts tell a different story (Wayt, 3/13).

Health coverage in California is also at issue for illegal immigrants and those with autism --

Los Angeles Times: Illegal Immigrants Should Have Health Coverage, Foundation Says
The California Endowment is launching a campaign to extend medical coverage to all uninsured state residents, including undocumented immigrants. An estimated 3 million to 4 million Californians, or about 10 percent of the state's population, could remain uninsured even after the national health care overhaul takes full effect in January (Chang, 3/13).

California Healthline: Administrative Law Office Oks Autism Measures
The California Office of Administrative Law on Monday approved emergency regulations governing health insurers' treatment of autism coverage. The regulations were issued by the Department of Insurance to implement details of the California Mental Health Parity Act as well as to implement SB 946 by Sen. Darrell Steinberg (D-Sacramento), an autism treatment law passed in 2011. "These emergency regulations will ensure that insurance companies cover medically necessary treatment," Insurance Commissioner Dave Jones said in a written statement (Gorn, 3/13).

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NYC Soda Ban Appeal Set For June

New York City's ban on large sugary drinks will get an appeal hearing in June after a judge struck down the law before it started being enforced.

Reuters: New York City's Appeal Of Soda Ban Ruling To Be Heard In June
The legal battle over New York City's ban of large sugary drinks is set to continue in early June, after a New York appellate court agreed on Wednesday to hear the city's appeal of a ruling that struck down the new law. Hours after state Supreme Court Justice Milton Tingling invalidated the ban in a last-minute decision on Monday, Mayor Michael Bloomberg, who has made the ban and other health measures a cornerstone of his tenure, expressed confidence the ruling would eventually be overturned (Ax, 3/13).

And The New York Times examines a bill that goes the other way on sugary drinks in Mississippi --

The New York Times: 'Anti-Bloomberg Bill' In Mississippi Bars Local Restrictions On Food And Drink
To that end, the people who govern the state with the highest rate of obesity in the nation have passed a bill saying that any law that might restrict what Mississippians eat or drink has to go through them — barring federal regulations (Severson, 3/13).

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State Roundup: Calif. GOP Wants Mental Health Gun Audit

A selection of health policy stories from California, Pennsylvania, North Carolina, Kansas and Colorado.

Los Angeles Times: Republicans Push Audit On Guns And Mental Health
State lawmakers Wednesday morning will discuss a Republican request for an audit of databases on mentally ill residents and gun ownership. Severe mental health cases are supposed to be reported to law enforcement so disturbed people can be barred from owning guns. However, some GOP lawmakers are concerned that the information may not be relayed consistently (Megerian, 3/13).

Philadelphia Inquirer: Hospital Admissions Continue To Decline
The number of "heads in the beds" remains a key factor in any hospital's financial success, despite the decades-long migration of health-care services to outpatient settings. But last year, the trend of declining inpatient admissions accelerated at many Philadelphia-area hospitals and health systems, according to municipal-bond disclosures analyzed by The Inquirer. A big factor is a surge in short hospital stays -- known as observation cases -- that do not count as full admissions and pay only about a third as much as inpatient admissions. But that's not the only reason, health-care executives said in interviews Wednesday. "Systemwide, we used to admit 28 percent of the patients that would come into the emergency room," said Jack Lynch, chief executive of Main Line Health. "We are down to 21 percent" (Brubaker, 3/14).

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 (3/14).

Kansas Health Institute: Competing Tax Plans In Play
The parameters of the debate over Gov. Sam Brownback's tax plan are starting to take shape. The Senate is expected today to take up the governor’s proposal, which includes incremental tax cuts and more immediate revenue raising measures aimed at keeping the state budget in the black. Approval of his plan is considered anything but certain despite the fact conservative Republicans generally aligned with him now control the chamber (McLean, 3/14).

Health Policy Solutions (a Colo. news service): The Risks Of Aging In The Closet
Today, as Colorado lawmakers are legalizing civil unions, President Obama has affirmed gay marriage and even the Boy Scouts are considering revisions to decades of discrimination, many gay, lesbian, bisexual and transgender seniors remain hidden and, as a result, don’t get the health care they need. A 2011 report from the Institute of Medicine found that far too little is known about the health of LGBT people. And a 2011 study from the University of Washington about health disparities among LGBT seniors found that nearly one-half have a disability, nearly one-third report depression, almost two-thirds say they have been victimized three or more times, 13 percent have been denied health care or believe they received inferior care, 20 percent do not disclose their sexual identity to their physician and one-third do not have a will or durable power of attorney for health care (Kerwin McCrimmon, 3/13).

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Weekend Reading

Weekend Reading: Humanizing Hospitals, Splurge Of Health Data and Huge Sodas

Every week reporter Ankita Rao selects interesting reading from around the Web.

The New York Times: Intensive Care
Our son was born healthy, large and pink-skinned, with a newborn assessment score of a perfect 10, but an hour after his birth, a nurse told us that something was wrong. He was jaundiced. It was not a typical case of jaundice; his bilirubin levels kept increasing at an alarming rate. I’d only seen him for a few moments -- he'd been delivered by C-section, then whisked away for the usual tests and procedures -- but now, as I was moved to a recovery room, the doctors couldn't tell me when I might see my baby again. ... At that point in my life, hospitals and I weren't on the best of terms. When I walked through their sliding doors, a version of the slogan from Roach Motel ads ran through my head: They check in, but they don't check out. More than 20 years ago, when I was still in my teens, my mother had been admitted to New York University Medical Center with stomach pains. Doctors initially thought she had an ulcer, and then they suspected hepatitis. They finally diagnosed it as melanoma that had metastasized to her liver. She died nine days later (Margo Rabb, 3/10).

The Atlantic: Human Connection And The Downside To Private Hospital Rooms
In a March 4 Atlantic article, Lindsay Abrams asks how much should be spent beautifying hospitals. She reviews evidence that making the hospital experience more appealing and comfortable can actually improve health outcomes. For example, natural lighting can ease pain and elevate mood. But the issue of how hospitals are designed goes far beyond creature comforts. Most notably, the move from shared to private hospital rooms has major implications for what the hospital experience means to patients. Given the choice, who wouldn't opt for a private room? But on closer analysis, the choice for many turns out not to be quite so clear (Richard Gunderman, 3/14).

Time: Will Collecting Data About Your Body Make You Healthier?
Not familiar with the "Quantified Self?" It's latest trend in obsessively tracking every possible health measure, in real time, that emerged as a major theme at South By Southwest (SXSW) Interactive Festival this year. With more body-tracking gadgets that can record everything from running blood pressure to respiration to perspiration rates and more, the next question is -- so what? ... There are a new generation of medical monitoring devices originally meant to evaluate patients in the hospital that have been made over into sexier, wearable versions for the health conscious or merely health-curious. The result? Sophisticated and personalized health monitoring that may be generating a lot of information that we are still learning to interpret (Alexandra Sifferlin, 3/14).

Mother Jones: Too Big To Chug: How Our Sodas Got So Huge
When McDonald's execs first struck up their lucrative business partnership with the Coca-Cola Company in 1955, they were thinking small -- literally. At the time, the only size of the beverage available for purchase was a measly 7-ounce cup. But by 1994, America's classic burger joint was offering a fountain drink size six times bigger. And that's not even the worst of it. Franchises like 7-Eleven, Arco, and the unfortunately named Midwestern chain Kum & Go have all offered drinks upwards of 85 ounces. (To put this in perspective, this is around three times the capacity of a normal human stomach.) Studies have shown that consumers have a hard time gauging sizes properly, so as fountain drinks continue to get bigger and bigger, it's less and less likely that we're able to make informed choices. But how did this problem get so big in the first place? Here's a look at how super sizes became the status quo (Azeen Ghorayshi, 3/14).

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Editorials and Opinions

Debate On Budget Options: Ryan Offer Is 'Cruel'; Obama Unwilling To Take Risks Necessary For Grand Bargain

The Washington Post: Paul Ryan's Cruelly Radical Vision
It's a cruel budget. To finance his largess to the very well-off, Ryan would — through steep Medicaid cuts and the repeal of Obamacare — leave an additional 40 million to 50 million poor or moderate-income Americans without health insurance, according to the Center on Budget and Policy Priorities (E.J. Dionne Jr., 3/13).

The Washington Post: Republicans Go After Obamacare. Again.
Here in Washington, though, it is as if tea party activists are still marching on the Capitol. On Wednesday, Senate Republicans supported legislation proposed by the freshman Cruz to defund Obamacare — the 35th attempt, give or take, to abolish the program. This one failed, like all the others. ... Cruz got all Senate Republicans to support his amendment, which he justified on the flimsy rationale that Obamacare (much of which is yet to be implemented) is responsible for the economy's slow growth — ignoring the housing collapse, the financial crisis and the deepest recession in generations (Dana Milbank, 3/13).

Fox News: A Conservative Economist Explains Why Ryan's Budget Plan Is All Wrong For The GOP
Ryan proposes offering seniors the choice of a subsidy to buy private insurance or continuing in the existing Medicare system, and giving the states block grants to manage Medicaid. ... Conservatives believe seniors could shop for health insurance, as they do for groceries, to drive down prices. The states, freed from excessive federal oversight, could similarly drive down costs. That's absolute fantasy. Seniors would confront large insurance companies armed with too little information, and limited choices or monopolies when they purchase drugs and hospital care. That's not a fair fight--like individuals with bows and arrows vs. B-52s (Peter Morici, 3/14).

The Weekly Standard: Obama's PR Stunt
The main reason there will be no grand bargain: The president will not take the political risks necessary to address an issue that he doesn’t regard as urgent. His party opposes reforming entitlements. He apparently views Republican plans to address long-term debt as attempts to “gut” these programs. A grand bargain was never a possibility without entitlement reform. Why would the president challenge his party’s liberal base, a constituency his advisers believe is the key to winning back Congress in 2014, in order to implement policies he opposes to address an issue he doesn’t regard as urgent? The simple answer: He won’t (Stephen F. Hayes, 3/13).

National Review: Ryan’s New Vision
Besides the repeal of Obamacare, the most controversial aspect of Ryan’s proposal will be his Medicare reforms. They will be controversial not because the policy itself is remarkably austere — it is in fact very mild — but because Democrats know from long experience that they can have a great deal of success frightening old people and their economically illiterate base with the specter of helpless grandmothers having their Medicare benefits snatched away. In reality, Ryan’s plan will affect nobody over 55 years old, and it will not necessarily affect anybody else, either: Ryan’s plan is to offer “premium support” — converting traditional Medicare benefits into a subsidy for buying health-care coverage in the private marketplace — as an option for those seniors who prefer it. The other option is Medicare. (3/13).

Bloomberg: A Model Medicare Program
We certainly need to slow the growth of health-care costs, especially for Medicare. Fortunately, the program has an in-house model for how to do this: Part D, the Medicare drug benefit passed in 2003. Part D gets high marks for controlling costs, protecting the elderly and driving the right kinds of health-care innovations. There is also much in the program that both the right and left can praise. Conservatives like Part D because private plans bargain with drug companies over prices and then compete with one another for senior citizens' business. Lower premiums attract more enrollees, leading to more profits for insurers and lower costs for taxpayers. Competition and consumer choice help keep costs down (Paul Howard, 3/13).

Reuters: Budgeting For Mistrust
Paul Ryan unveiled the House Republican budget this week with an ominous yet familiar warning: "America's national debt is over $16 trillion." Having stated the problem, he then offered a solution, one which differed only marginally from what he’s offered the past two years. Namely: restrain government healthcare spending on Medicare and Medicaid, reform the individual tax code, close loopholes, lower corporate taxes, and promote natural gas and energy independence. ... The strongest part of Ryan’s unveiling is not the specifics, which may not be very strong at all, but the unimpeachable critique of the White House and congressional Democrats for not offering their own blueprint and budget for the future (Zachary Karabell, 3/13).

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Viewpoints: Failures In Treating Ovarian Cancer; A Moral Analysis Of Obesity; Bloomberg's Overreach

The New York Times: Inadequate Treatment Of Ovarian Cancer
A new study has found widespread failure among doctors to follow clinical guidelines for treating ovarian cancer, which kills 15,000 women a year in this country. This disturbing news shows the kind of challenge that health care reformers are up against in improving medical care — even when cost is not the issue (3/13).

The New York Times: The Opinionator: The Benefits Of Mobile Health, On Hold
The world now has 5 billion mobile phones – one for every person over 15. Africa has a billion people and 750 million phones, and mobile is growing so fast there that in a few years there will be more phones than people. In some countries this is already true — South Africa has 47 million people, but 52 million SIM cards. The mobile phone is doing more than revolutionizing communication. It has the potential to improve many aspects of life in poor countries: commerce, health, agriculture, education (Tina Rosenberg, 3/13). 

Reuters: Obesity And The Unhealthy Economy
The problem of obesity is an adverse side effect of one of the greatest economic liberations ever, the freedom from want of food. ... In the new era, physical need is no longer a constraint and unhealthy eating is now an everyday reality. The threat must be countered by individuals, food producers – no longer primarily farmers, but companies with processing plants and factories – and governments. All have failed to live up to the challenge. The result is that food is often not used as it should be, to provide the benefits and pleasures of healthy eating (Edward Hadas, 3/13). 

Politico: Michael Bloomberg's Soda Folly
New York City Mayor Michael Bloomberg's ban on large-sized sodas at certain establishments, colloquially known as the soda ban, is a lesson in how to make your cause look ridiculous. Bloomberg hoped the ban would spark a nationwide crackdown on sugary beverages. Instead, it became the subject of widespread mockery, inspired an instant-classic New York Post headline ("Soda Jerk") and got struck down by a New York judge this week as "arbitrary and capricious" (Rich Lowry, 3/13).

Health Policy Solutions (a Colo. news service): Politicians Don't Understand What Citizens Want
The recent Time Magazine Special Report by Stephen Brill “Why Medical bills Are Killing Us” demonstrates a series of narratives that describe problems in our health care system. … So there is little good news on health care reform except that the situation is overwhelming. It appears that tinkering around the edges of America’s dysfunctional system for funding health care with private insurance companies and pharmaceutical companies is over. No small reform such as those suggested by Brill will begin to adequately control the legalized theft of the health care dollars. Universal health care coverage financed by a public single-payer system provides a solution to the health care crisis. (Dr. Tom Gottlieb, 3/13).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

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