Daily Health Policy Report

Thursday, March 15, 2012

Last updated: Thu, Mar 15

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Campaign 2012

Administration News

Public Health & Education

Health Care Marketplace

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

The Health Law And The Supreme Court: A Primer For The Upcoming Oral Arguments

Writing for Kaiser Health News, Stuart Taylor, Jr., details the dynamics to watch in the upcoming Supreme Court health law oral arguments: "How big is the constitutional challenge to the Obama health care law, which the Supreme Court will hear on March 26-28? For starters, it's big enough for the justices to schedule six hours of arguments -- more time than given to any case since 1966. After all, the Affordable Care Act is arguably the most consequential domestic legislation since the creation of Medicare in 1965" (Taylor, 3/15). Read the story.

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Mississippi Builds Insurance Exchange, Even As It Fights Health Law

Mississippi Public Broadcasting's Jeffrey Hess, working in partnership with Kaiser Health News and NPR, reports: "Mississippi, a deeply red Southern state that is part of the Supreme Court case against the health law, is moving full speed ahead with one of the key provisions of that law: an online health insurance exchange" (Hess, 3/14). Read the story.

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Capsules: Personal Views Color Public Opinion Of Health Law Court Case

Now on Kaiser Health News' blog, Jordan Rau reports: "Half the country hopes the Supreme Court will throw out the health law's mandate that Americans carry health insurance, according to a new poll released Wednesday. In what may be a sign of political wish fulfillment, half of Americans expect that the court will take that course when it takes up the case later this month. Only 33 percent of people expect the court will uphold the individual mandate, which has long been one of the least popular provisions of the Affordable Care Act" (Rau, 3/14).Check out what else is on the blog.

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Political Cartoon: 'Drip, Drip, Drip'

Kaiser Health News provides a fresh take on health policy developments with "Drip, Drip, Drip" By Matt Wuerker.

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


For health reform law
"March madness" has deep meanings
beyond the bracket

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

What's In Store At The Supreme Court

News outlets report on the issues in play when the high court hears the health law oral arguments later this month, how particular justices might form their opinions and lay out the new, all-or-nothing position adopted by the U.S. Chamber of Commerce.

Kaiser Health News: The Health Law And The Supreme Court: A Primer For The Upcoming Oral Arguments
How big is the constitutional challenge to the Obama health care law, which the Supreme Court will hear on March 26-28? For starters, it's big enough for the justices to schedule six hours of arguments -- more time than given to any case since 1966. After all, the Affordable Care Act is arguably the most consequential domestic legislation since the creation of Medicare in 1965 (Taylor, 3/15).

ABC: Health Care: Liberals Eye Scalia And Roberts Vote
With less than two weeks to go before the Supreme Court is scheduled to hear six hours of oral arguments in the case challenging the constitutionality of the Obama Administration's health care law, supporters of the law are eyeing the votes of the more conservative justices. If, as expected, the four liberal justices vote to uphold the law, the government will need the vote of at least one of the five justices nominated to the bench by a Republican president. Speculation has gone into overdrive (de Vogue, 3/14).

Bloomberg: Big Business Wants All Or Nothing Court Ruling On Health Law
The U.S. Chamber of Commerce, the leading Washington lobbyist for big corporations, spent $86 million two years ago trying to keep the Obama administration's health-care overhaul from passing Congress. Now, as the Supreme Court is set to begin reviewing a key provision of the law, the group's message is different: If you can't kill it, don't maim it, the chamber said in a legal brief filed separately with the court.The chamber is among lobby groups for large companies caught between their own distaste for the law and the self-interest of members who have won concessions since it was passed (Wayne, 3/15).

Modern Healthcare: High Court Arguments On Reform Will Test Share Prices, Experts Say
Hospital share prices will be tested as the Supreme Court hears arguments on the Patient Protection and Affordable Care Act, health policy experts said at a Nashville Health Care Council panel discussion. ... "If the expansion is struck, I think that would be a far greater surprise to the market than if the mandate is struck," said Paul Heldman, senior health policy analyst at the Potomac Research Group (Kutscher, 3/14).

Reuters: Day In Court For Healthcare Revives Public Fight
The fate of President Barack Obama's healthcare overhaul will be debated at the Supreme Court this month, reviving controversy over his signature domestic policy achievement in a year when Americans vote on whether to give him a second term. Democrats and Republicans, backers and foes, are spoiling for a battle ahead of the court's six hours of hearings on March 26-28, the most time given to a single topic in 44 years (Morgan, 3/14).

Politico: Max Baucus Is Still Health Bill Fan
When the Supreme Court takes up the health care law a week from Monday, Max Baucus will be front and center to watch the proceedings. … Baucus, chairman of the Senate Finance Committee, isn't exactly the loudest voice in the cheering section for the law. Most of that work is being done by top Obama administration officials, other Hill Democrats (especially in the House) and pro-reform groups. When there are new benefits of the law to talk about, or a damaging story to push back against, it's usually these other voices that get all the attention. But Baucus did write big pieces of the law, so he hasn't dropped off the face of the earth (Nocera, 3/14).

CQ HealthBeat: Congress Won't Agree On A Next Step If Health Care Law Is Gutted, Experts Say
If the Supreme Court strikes down part of the health care law, don't look for a quick solution from Congress to resolve the resulting chaos and confusion over implementation, two health policy experts on opposite sides of the partisan divide agreed Wednesday. Chris Jennings, former senior health care adviser in the Clinton administration, and Sheila Burke, former chief of staff to GOP Majority Leader Bob Dole, told a Kaiser Family Foundation forum that the atmosphere around the law has become so partisan and poisoned that they don’t see where agreement on a fix could be found (Norman, 3/14).

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Individuals' Views On Health Law Form Hopes, Predictions About Court Decision

New polls from the Kaiser Family Foundation, Pew Research Center and Bloomberg explore what the public expects of the high court's proceedings.  

Kaiser Health News: Capsules: Personal Views Color Public Opinion Of Health Law Court Case
Half the country hopes the Supreme Court will throw out the health law's mandate that Americans carry health insurance, according to a new poll released Wednesday. In what may be a sign of political wish fulfillment, half of Americans expect that the court will take that course when it takes up the case later this month. Only 33 percent of people expect the court will uphold the individual mandate, which has long been one of the least popular provisions of the Affordable Care Act (Rau, 3/14).

National Journal: Politics Drives People's Supreme Court Predications, Poll Finds
People who oppose the 2010 health care reform law think it will be struck down: 83 percent to 7 percent. And those who support it think it will stand, though by a smaller margin of 50 percent compared to 26 percent.  ... Twenty-two percent said that the most important factor shaping the justices' decision would be whether they hold liberal or conservative views, compared with 19 percent who credit analysis and interpretation of the law (Sanger-Katz, 3/14).

MedPage Today: ACA Poll: Public Short on Facts, Long on Opinions
Despite the administration's near-constant push to highlight the benefits of the law -- elimination of co-pays for preventive care, raising dependent health coverage to age 26 -- most people don't have real experience with ACA. When asked about their personal views of the law, 51% said they thought the individual mandate was unconstitutional; 28% thought it was constitutional; and the rest didn't know (Walker, 3/14). 

And, in another poll's findings -

Bloomberg: Supreme Court Seen Influenced By Politics In Health-Care Ruling
Three-quarters of Americans say the U.S. Supreme Court (1000L) will be influenced by politics when it rules on the constitutionality of a health-care law signed by President Barack Obama two years ago. The sentiment crosses party lines and is especially held by independents, 80 percent of whom say the court will not base its ruling solely on legal merits, according to a Bloomberg National Poll (Bykowicz and Stohr, 3/14).

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Translating The Health Law Into Reality One Regulation At A Time

Part of implementing the health law includes replacing jargon in health insurance policies with plain English. Meanwhile, the release of a federal mental health parity rule is held up to coordinate it with the overhaul.  

St. Louis Beacon: Plain English Will Replace Jargon In Health Insurance Policy
[Dr. Karen Edison and Stanton Hudson of the Center for Health Policy at the University of Missouri at Columbia] are pleased by the Department of Health and Human Services' recent decision to require insurers to provide consumers with clear and understandable summaries of what's covered in their health plans. But both add that this federal effort should be regarded as a first step. ... Edison says the group needing the most help is the roughly 20 percent of the population that is functionally illiterate (Joiner, 3/14).

Earlier, related KHN story: Medicare Combats Fraud With Billing Statements That Beneficiaries Can Understand (Jaffe, 3/7). 

CQ HealthBeat: Mental Health Parity Rule Hold-Up Attributed to Inclusion In Health Care Law
Health and Human Services officials haven't issued final regulations for mental health parity because they want the requirements for such coverage to be part of the health care law implementation, the agency's Assistant Secretary for Planning and Evaluation Sherry Glied said Wednesday. "I don't think it's a hold-up around parity,"’ Glied said. Implementing the health care law includes "the challenge of building this regulatory infrastructure around the insurance industry that should incorporate [mental health benefits]" (Bristol, 3/14).

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Capitol Hill Watch

In Congress, A Budget Battle Is Brewing

House GOP lawmakers are pushing cuts in the 2013 budget plan that go much deeper than the outline agreed upon last summer as part of a Republican-Democratic deal to raise the debt ceiling.

The Wall Street Journal's Washington Wire: Fight Breaks Out Over 2013 Budget Cuts
A battle has erupted over House Republicans' plans to offer a budget next week that will likely cut 2013 spending below the level the two parties agreed on last August. … After bitter fighting over whether and how to raise the nation's debt ceiling last summer, the two parties agreed on a deal that, among other things, set a level of $1.047 trillion in discretionary spending for 2013. That excludes spending on Medicare, Social Security and other formula-based programs. Now House conservatives are pushing for a budget that spends less next year, and GOP leaders appear ready to agree—in part because otherwise they would risk conservative defections and might be unable to pass their own budget (Bendavid, 3/14).

Reuters: Deal Or No Deal? Republicans Say Budget Law Allows Cuts
Republicans in the U.S. House of Representatives pushed back on Wednesday against suggestions that their drive for deeper spending cuts would break a budget deal they made last summer with Democrats and President Barack Obama. House Republicans are expected to unveil a budget plan next week that contains at least a $19 billion cut in discretionary spending below the caps enshrined in the Budget Control Act, passed in August to end an impasse over raising the debt limit (Lawder, 3/14).

Meanwhile, when the GOP House budget is unveiled, Medicaid caps will likely be absent.

Politico Pro: Medicaid Caps Unlikely To Be In GOP Budget
When House Republicans unveil their budget next week, it's not expected to include a Louisiana Republican's proposal designed to cap Medicaid spending on certain types of enrollees. Congressional sources Wednesday confirmed to POLITICO that the House budget would pass over Rep. Bill Cassidy's proposed Medicaid per capita caps. House aides have been tight-lipped about what Medicaid proposals would be included, but many expect the GOP budget will rely on a block grant as it did last year (DoBias, 3/14).

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Campaign 2012

Romney Critics Cite Mass. Health Law, Planned Parenthood Statement

The Massachusetts health law, which GOP presidential hopeful Mitt Romney signed while governor and which includes an individual mandate, continues to haunt him in the primaries. Meanwhile, Democrats use his recent pledge to 'get rid of' Planned Parenthood to diminish his appeal with female voters.

MSNBC: Romney Plays Defense On Health Care
For Mitt Romney, the issue of health-care mandates just won't seem to go away. In an interview on FOX News today, Romney was questioned about his apparent support for an individual health-care mandate -- even on the federal level -- during a 2008 Republican presidential debate. Romney sidestepped the specific question on FOX and repeated his familiar line on the campaign trail: "I believe we should get rid of Obamacare," Romney responded. "It's a disaster." His critics continue to point to that 2008 Republican presidential debate, in which Romney responded to Charlie Gibson's comment that Romney "backed away from mandates on a national basis" by saying, "No, no, I like mandates" (Loffman, 3/14).

The Associated Press/Washington Post: In Planned Parenthood Remark, Democrats See Another Chance To Rip Romney On Women's Issues
A coordinated attack by Democrats on Mitt Romney's plan to "get rid of" Planned Parenthood to help balance the federal budget is part of a larger campaign to ensure that Romney and other Republicans lose credibility with female voters. The Romney campaign contends that the remark has been taken out of context. Yet even the debate over what Romney meant or didn’t mean underscores the political peril he faces as the GOP nomination fight rages on (3/15).

The Hill: Democrats Hammer Romney For Planned Parenthood Comments
Planned Parenthood and Democratic lawmakers slammed Mitt Romney on Wednesday for saying he would cut off federal funds to Planned Parenthood. During a recent interview in Missouri, while ticking off federal programs he would defund as president, Romney said, "Planned Parenthood, we're going to get rid of that." Romney's remarks are the latest in a string of controversies that Democrats hope will help turn female voters against the GOP this fall (Baker, 3/14).

Boston Globe: Planned Parenthood Blasts Romney's Call To End Its Funding
The president of Planned Parenthood blasted Republican presidential candidate Mitt Romney Wednesday, a day after the former Massachusetts governor said he would "get rid" of the federally funded program. "Really what that means," Cecile Richards said, "is he wants to get rid of preventive health care for three million folks every year who come to Planned Parenthood for reproductive health care, for cancer screenings, for birth control" (Borchers, 3/14).

But when it comes to the health law, some Democrats will face attacks, too -

The Associated Press/Modern Healthcare: Group's Ads In 5 States Criticize Healthcare Law
Democratic senators up for re-election in five states are being targeted by issue ads run by the conservative 60 Plus Association, but one senator being hit says the ads are full of false claims already debunked by independent fact-checkers. The 60-second ads feature singer Pat Boone warning seniors about portions of the federal healthcare law he says could harm their Medicare benefits and are identical to an ad run last November in Ohio targeting Sen. Sherrod Brown (3/14).

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Administration News

Questions Continue About Obama Birth Control Coverage Compromise

The Associated Press/Denver Post: Bishops: Obama Birth Control Compromise Is Dubious
U.S. Roman Catholic bishops called the Obama administration's pledge to soften an employer birth control mandate "dubious," saying Wednesday they would continue fighting for a broader religious exemption to the rule. ... After meeting in Washington, the top committee of the U.S. Conference of Catholic Bishops said they would "continue to accept any invitation to dialogue with the executive branch to protect the religious freedom that is rightly ours" (3/14).

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Public Health & Education

Guidelines For Cervical Cancer Screening Revised

The guidelines say that women between 30 and 65 can wait five years between screenings if they get both a Pap test and an HPV test.

NPR: Doctors Revamp Guidelines For Pap Smears
Women should get screened for cervical cancer far less frequently than doctors have long recommended, according to new guidelines released Wednesday. ... For years, doctors have recommended that women start getting Pap smears every year or two to try to catch signs of cancer early, when it's easiest to prevent and treat (Stein, 3/14).

The Associated Press: Options For Cervical Cancer Check Depend On Age
Once recommended every year, many major medical groups have long said that a Pap test every three years is the best way to screen most women, starting at age 21 and ending at 65. But starting at age 30, you could choose to be tested for the cancer-causing HPV virus along with your Pap — and get checked every five years instead, say separate guidelines issued by the U.S. Preventive Services Task Force, the American Cancer Society and some other organizations (Neergaard, 3/14).

MSNBC: Pap Smear Every Five Years? Panel Says It's Safe
[T]hose younger than 21 and older than 65 can skip the screen altogether, the experts concluded. The panel is urging a extended intervals in screenings in an attempt to cut back on the number of women who end up being treated for lesions that might resolve on their own (Carroll, 3/14).

National Journal: New Cervical Cancer Screening Guidelines Call For Fewer Pap Tests
(The U.S. Preventive Health Services Task Force) has now revised downward its cancer-screening guidelines for the three most common cancer tests: mammograms, prostate specific antigen testing, and the Pap. The guidelines for breast- and prostate-cancer screening got a big backlash, as critics charged that the group—which does not consider cost in its calculations—would harm patients and encourage a rationing of care by suggesting less frequent tests (Sanger-Katz, 3/14).

Meanwhile, in other news about screening and preventive health -

MedPage Today: PSA Testing Still Has Value, Trial Suggests
[A]lthough screening resulted in about a 21% reduction in the rate of prostate cancer deaths, there was no effect on all-cause mortality. ... [The findings] leave practitioners in an "unsatisfactory situation" in which they may feel there is not yet enough data to abandon PSA screening, according to Anthony Miller, MD, of the University of Toronto. In an accompanying editorial, Miller ... said, it would be "unwise" to increase PSA testing in the U.S. and doctors would be well advised to follow the preliminary recommendations of the U.S. Preventive Services Task Force (Smith, 3/14). 

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Health Care Marketplace

New Payment Methods Squeezing Doctors

As the government and insurers push to switch from traditional fee-for-service payments, doctors scramble to find ways to keep practices afloat.

The Wall Street Journal: Doctors Struggle To Make Ends Meet
It is a dilemma facing practices around the country as the U.S. begins a transition toward new ways of paying for health care. Insurers are increasingly targeting the traditional system that has paid hospitals and doctors for each service provided (rewarding them for more care but not better results). In the past few months, UnitedHealth, WellPoint and Aetna, the three biggest American health insurers, have announced plans to pay practices more if they make efforts like those at Westminster. The new reimbursement designs also can offer doctors significant financial rewards if they hit quality goals and reduce costs (Mathews, 3/14).

Georgia Health News: The New Health Care -- For Better Or Worse
The "good old days" of health care are disappearing -- if they're not gone already. Those were the days of consumers going anywhere they wanted to get medical care, and not paying any attention to the price, or to their state of  "wellness." And the days of doctors and hospitals charging an extremely high price for services, and not paying close attention to the quality of their care, are also fading. The new landscape in health care was dissected by a panel of experts at a Wednesday symposium (Miller, 3/14). 

Meanwhile, some parts of the country continue to face a doctor shortage --

California Healthline: Trying To Provide Solutions To Patient Access
The current primary care workforce shortage hits two areas in particular, according to researcher Catherine Dower of UCSF: the rural areas, and in urban areas among communities of color. "The biggest problem is the maldistribution of providers," Dower said. "Physicians tend to congregate in urban and suburban areas and along the coast. For every one new physician who goes to an underserved area, we have four that go to already-served areas" (Gorn, 3/15). 

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Are HIPAA Rules Impeding Medical Research?

The Philadelphia Inquirer: Health-Record Privacy Impeding Medical Research
[Health records] have been sealed since 1996, when the Health Insurance Portability and Accountability Act (HIPAA) was signed into law to protect the privacy of personal health records. That protection applies not only to the charts of the living or recently deceased, but also to records dating to the 1700s and 1800s. Which poses a problem for historians and researchers such as Segesser, who say the public is being denied important information that could help guide current health care practices and policies (Dribben, 3/13).

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State Watch

Medicaid Cost-Shifting Measures Move Forward In Fla., Wis.

States are searching for ways to contain their Medicaid costs.

The Miami Herald: Clock Ticking For Governor To Sign Controversial Medicaid Legislation
A controversial measure that would shift $300 million in disputed Medicaid bills to counties has been received by Gov. Rick Scott’s office ... If Scott does neither by the March 29 deadline, it becomes law automatically. Counties are lobbying the governor to veto HB 5301, arguing that it will put an undue burden on local governments for Medicaid bills they don't believe they owe. Under the plan outlined in the legislation, the state would withhold revenue sharing dollars to cover both the backlog and future Medicaid payments (Mitchell, 3/14).

Milwaukee Journal Sentinel: Lawmakers Approve Medicaid Cuts
An estimated 22,800 people would leave or be turned away from the state's health programs for the poor, under a cost-cutting proposal revised by a legislative committee Wednesday. The Joint Finance Committee approved the revised Medicaid cuts on a 12-4 vote, with all Republicans voting in favor and all Democrats voting against (Stein, 3/14).

Also in Wisconsin --

The Associated Press/(St. Paul) Pioneer Press: Budget Committee OKs Plan To Raise Medicaid Premiums
A plan to raise premiums for some of the poorest people enrolled in Wisconsin's Medicaid programs passed a Legislature budget committee Wednesday, but officials say it won't affect enrolled children, pregnant women, disabled people or the elderly. The Joint Committee on Finance voted along party lines to approve the plan proposed by the state Department of Health Services, which wants to lower the income level at which families must pay a premium. That would affect about 44,000 participants who previously didn't have to pay (3/14).

In other Medicaid-related news --

Stateline: Do 'Medical Home' Programs Save Money? 
The aim of the "medical home" concept is simple -- improve primary care so fewer people need to go to the hospital. ... But what about the short run? Can medical homes cut Medicaid costs? There, experts differ. A new study published in The American Journal of Managed Care reports that only one of hundreds of peer-reviewed studies of patient-centered medical homes definitively showed real cost savings -- and it did not involve a Medicaid program. This contradicts claims by medical home supporters that significant cost reduction have been achieved in the first few years of adopting the approach (Vestal, 3/15). 

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S.C. Won't Have To Refund Exchange Grant, Other Exchange News

South Carolina won't have to refund the federal government a $1 million grant it received, even though the state decided not to create a health insurance exchange. Mississippi and California, in the meantime, are moving along on creating such marketplaces, despite differing views on the health law.

Politico Pro: South Carolina Won't Have To Refund 'Non'-Exchange Planning
South Carolina won't have to pay back its health insurance exchange planning grant after Gov. Nikki Haley instructed an advisory committee not to consider a state-based exchange. Federal auditors had been exploring whether South Carolina misused a $1 million HHS grant to plan a state-based exchange, but decided to drop the investigation this week (Millman, 3/14).

Kaiser Health News: Mississippi Builds Insurance Exchange, Even As It Fights Health Law
Mississippi, a deeply red Southern state that is part of the Supreme Court case against the health law, is moving full speed ahead with one of the key provisions of that law: an online health insurance exchange (Hess, 3/14).

California Healthline: On the Health Reform Trail: The Good, the Bad and the Ugly 
Health reform is a bit like the Wild West -- a staggered movement across many different paths with little tested experience to guide the way. Some states have rebuffed the mission, some have taken tentative steps and some have become trailblazers. Compared with other states, California is ahead of the pack in many respects. But it still has much to do (Wayt, 3/14).

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Wis., N.H. Advance Bills Limiting Abortion Coverage, Availability

Wisconsin's measure affects insurance coverage while New Hampshire's would require women to wait 24 hours for an abortion.

Reuters/Chicago Tribune: Wisconsin To Ban Some Abortion Coverage, Refocus Sex-Education
Wisconsin lawmakers have approved controversial measures to block the state's new health insurance exchange from covering abortions and require sex education classes to emphasize abstinence as the preferred method of birth control (3/14).

The Associated Press/Boston Globe: N.H. House Passes 24-Hour Wait For Abortion
New Hampshire's House passed a trio of bills Wednesday limiting abortions, including one that would make pregnant women wait 24 hours and certify they had been given information on fetal development before getting an abortion. The House voted 189-151 on the 24-hour wait bill, which also requires that the women receive explicit information about the fetus and an opportunity to view a video on the issue (Love, 3/15).

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State Roundup: Ariz.'s Long-Term Care Plan; N.H. Moves To Repeal 'Certificate-Of-Need'

A selection of health policy news from Arizona, Colorado, New Hampshire, Minnesota, California and Massachusetts.

Arizona Republic: Arizona Panel OKs Plan For Long-Term Health Care
The Senate Appropriations Committee unanimously passed a bill Tuesday that would make long-term health care more affordable for middle-class families. Rep. Steve Farley, D-Tucson, sponsored House Bill 2713, which would allow Arizonans to set aside money in a tax-deductible savings account to pay for long-term health-care expenses. It would also create tax deductions for long-term health insurance premiums (Ferri, 3/14).

WBUR's CommonHealth blog: Mass. Health Scorecard: A+ On Insurance And Treatment But Not On Cost 
[According to the] Commonwealth Fund's new "Scorecard on Local Health System Performance," ... Massachusetts ranks tops on health insurance and on many other health and medical treatment measures, but is closer to middling on keeping costs down and keeping people out of the hospital and emergency room (Goldberg, 3/14). 

Arizona Republic: Medical Records In Maricopa County Jails To Go Electronic
The Maricopa County Board of Supervisors on Wednesday agreed unanimously to enter a $4.55 million contract to develop the long-awaited electronic medical-records system for the county's inmate health-care organization. ... The county for years has been criticized for providing inadequate medical care at its jails and for its outdated medical record-keeping system (Lee, 3/14).

Denver Post: Budget Committee Staff Calls For More Details On Fixing Colorado Benefits Management System
An analysis of Gov. John Hickenlooper's request for more money to fix a beleaguered state computer system that manages programs ranging from food stamps to Medicaid says the legislature's Joint Budget Committee should get more guarantees the repairs will work (Hoover, 3/14).

Modern Healthcare: Bill To Repeal CON Law Clears N.H. House
The New Hampshire House of Representatives passed a bill that would repeal the state's certificate-of-need law for hospitals and other health care facilities, services and diagnostic and therapeutic equipment. Rep. Frank Holden introduced the bill earlier this year. Opponents of the bill say repealing the CON law will lead to higher health care costs (Lee, 3/14).

Minnesota Public Radio: Business-Backed ALEC's Relations With Conservative Lawmakers Riles Democrats 
ALEC's ideas can also be found in bills that would relax tort law, repeal the new federal health care law, and change union fee rules. And the group's views are found in obscure legislation as well, including a bill that would create online car insurance registry and a bill that would prevent asbestos lawsuits from being brought against a company that has offices in Minnesota. (Richert, 3/15). 

KQED's State of Health: L.A. Health Care Director's Vision Brings Change, Challenge 
Mitch Katz is Director of Los Angeles County's Department of Health Services, long one of the most beleaguered in the country. Katz oversees L.A.'s public hospitals and clinics, the place of last resort for millions of low-income Angelenos. ... Katz's primary aim ... is to steer low-income Angelenos away from the emergency rooms they've long relied on and into primary care clinics where problems, like a tumor, can be detected earlier (Varney, 3/14). 

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Weekend Reading

Longer Looks: Med Students Spurn Primary Care For Hospital Jobs

Every week, reporter Jessica Marcy selects interesting reads from around the Web.

Time: Peter Goodwin: The Dying Doctor's Last Interview (Video)
Dr. Peter Goodwin, a family physician and right-to-die activist, took his own life on March 11, 2012, at age 83. He did it legally, with the blessing of his family and doctors, under the Oregon law allowing physician-assisted suicide — the first such law in the country — that Goodwin was instrumental in creating. … He did not look like a dying man; he was chirpy and alert ... However, as a result of his fatal disease — a Parkinsons-like condition called coritcobasal degeneration — he could not use his right hand or do much reliably with his left. ... "I can no longer eat in public," Goodwin said. "My balance is gradually deteriorating. My three doctors agree that I’m within six months of dying. My attending physician has given me a prescription for medication to end my life and I have had it filled" (Belinda Luscombe, 3/14).

The Atlantic: The Doctor Is Out: Young Talent Is Turning Away From Primary Care
Couple the lifestyle and the training experience with the huge debt burden that U.S. medical students accrue, and deciding on a hospitalist career becomes a rational choice. Dr. Wachter of UCSF compares hospital medicine to site-based specialties that came before it: emergency medicine and critical care. All of these specialties represent a convergence of high-complexity and high-cost care in a single location, where it makes sense to have well-trained specialists who handle the specific set of problems encountered there (John Henning Schumann, 3/14).

American Medical News: How Selling A Practice Kept It In The Family
For the past 30 years, Domingo Ngo, MD, has loved being a gastroenterologist owning a solo practice and the small, one-story building it occupies on a tree-lined street in Stuart, Fla. His wife, Josefina Ngo, RN, was the practice's nurse. ... If Dr. Ngo retired and was unable to find another physician to take his place, there was a chance it would have closed. He hoped it would be able to continue if his son (Benjamin Ngo, MD) joined him. They wanted to work together, but the son ... didn't want to be a solo-practice physician. … Dr. Domingo Ngo did what many other practices have done, or are considering doing -- he contacted a local hospital to see whether it would buy the practice (Victoria Stagg Elliott, 3/12).

The Atlantic: Daddy Issues
Recently, a colleague at my radio station asked me, in the most cursory way, as we were waiting for the coffee to finish brewing, how I was. To my surprise, in a motion as automatic as the reflex of a mussel being poked, my body bent double and I heard myself screaming: "I WAAAAAAAANT MY FATHERRRRRR TO DIEEEEE!!!" ... let us begin by considering A Bittersweet Season, by Jane Gross. A journalist for 29 years at The New York Times and the founder of a Times blog called The New Old Age, Gross is hardly Kafkaesque. An ultra-responsible daughter given to drawing up to-do lists for caregivers and pre-loosening caps on Snapple bottles, Gross undertook the care of her mother in as professional a way as possible. ... What could go wrong? (Sandra Tsing Loh, March 2012).

AARP Bulletin: Hospitals May Be The Worst Place To Stay When You're Sick
Today, more than a decade into the fight against medical errors, there's little reason to believe the risks have declined substantially for the 37 million people hospitalized each year. In fact, recent studies suggest a problem that's bigger and more complex than many had imagined. A report released in January on Medicare patients found that hospital staff did not report a whopping 86 percent of harms done to patients. If most errors that harm patients aren't even reported, they can never be tracked or corrected (Katharine Greider, 3/1).

Columbia Journalism Review: Should Health Journos Use Hospital Safety Data?
In a highly touted effort to improve the quality of hospital care, the federal government has started disclosing data that ostensibly reveals which hospitals are best (and worst) at keeping their patients safe. But a few weeks ago, Kaiser Health News presented some not entirely unexpected news that turned conventional wisdom about patient safety data into, well, not-so-conventional wisdom. A piece by Jordan Rau raised serious questions about the efficacy of the federal government’s efforts to turn patients into savvy shoppers. The data, it seems, may not be ready for prime time. I rang up Rau, a veteran health journalist and an expert in these matters, for a Q and A to help all of us who may be tempted to use the data in ways we probably shouldn't (Trudy Lieberman, 3/12).

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Editorials and Opinions

Viewpoints: Health Costs Crushing Detroit; Military Care Still Faces Funding Issues; Romneycare Scores

The Wall Street Journal: The Message Of Motown
Legacy costs are bankrupting Detroit just as they crushed its automakers. Firefighters can retire at 55 and earn 70% of their highest salary plus a 2.25% annual cost-of-living inflator in perpetuity. The result? Employee benefits alone now make up about half of the city's general fund. Health costs have grown by more than 60% since 2008 while the city's pension bill has quadrupled to $200 million (3/14).

The Washington Post: Military, Heal Thyself – Health Programs Still A Challenge
The Pentagon health program's budget issues are well known, the overall costs having more than doubled in the past 10 years and expected to continue to shoot up unless tough changes are made. The health-care headquarters staff has already been cut by 440 employees from 2011, and aligning its reimbursement rates for outpatient services with Medicare rates will save $900 million annually (Walter Pincus, 3/14). 

Boston Globe: Attacks On Romneycare Come Even As Costs Turn The Corner
Just as the Massachusetts system of delivering health care is under attack from Republicans across the country, along comes more evidence of its success -- this time, in helping to create more affordable options for individuals and small businesses. The cost savings are important because both "Romneycare’" and its famous offspring, President Obama's health care overhaul, were branded mainly as ways to decrease the number of uninsured people, partly through the much-demonized requirement that individuals who can afford insurance must buy it, and the mandate on some employers to provide insurance, as well. But those mandates also served to bring together larger groups of customers, giving insurers greater incentive to provide competitive rates (3/14). 

The New York Times: Hospitals Aren't Hotels
For several years now, hospitals around the country have been independently collecting data in different categories of patient satisfaction. More recently, the Centers for Medicare and Medicaid Services developed the Hospital Consumer Assessment of Healthcare Providers and Systems survey and announced that by October 2012, Medicare reimbursements and bonuses were going to be linked in part to scores on the survey. ... But implied in the proposal is a troubling misapprehension of how unpleasant a lot of actual health care is (Theresa Brown, 3/14). 

USA Today: Challenge For Our (Ripe Old) Age
Longer lives ... and smaller families ... are aging society. ... They also create challenges science cannot solve. One of the most worrying is that soon, people will routinely reach old age with very few, if any, immediate family members. Humankind has marshaled every intelligence to achieve long life, and now we need to be just as smart as we try to make the most of it (Ted C. Fishman, 3/14). 

Roll Call: Give Young Adults Needed Privacy For Health
Under the 2010 health care overhaul, millions of young adults in the United States can access health care on a parent's health insurance policy. That's a good thing because it means they are more likely to get preventive care that can keep them from getting sick in the first place. Yet a glitch in the system means that young adults might forgo treatment for conditions they don't want their parents to know about — such as sexually transmitted diseases. These young people are afraid, and rightly so, that an insurance company will send an explanation of benefits home to the parent who holds the health insurance policy (Denise Chrysler and Robyn Rontal, 3/15).

The Fiscal Times: A Bold New Attack on the Alzheimer's Scourge
Dr. [Peter] Piot, who served as executive director of the United Nation’s UNAIDS organization and now serves at Imperial College in London, delivered an impassioned call to action before some 1500 scientists, patients, caregivers, advocate, and health officials who gathered from every corner of the globe. According to Piot, we need a global political movement to fund cures and preventions as the global aging phenomenon will give rise to unprecedented rates of Alzheimer’s. In short, we need to rally against Alzheimer’s exactly as we did with HIV/AIDS in order to make a difference (Michael W. Hodin, 3/14).

McClatchy: Colon Tests Save Lives, Study Shows
There wasn't much doubt about the value of colonoscopies, the rather invasive screening tests for colorectal cancer. Now there should be none. These screenings, unpleasant as they are, do indeed save lives. The New England Journal of Medicine recently reported that in patients tracked for as long as 20 years, the death rate from colorectal cancer was cut by 53 percent in those who had the test and had precancerous polyps removed.  … While there is always a small chance of complications, most people come out of the examination saying, "It wasn't nearly as bad as I feared” (3/14).

Health Policy Solutions (a Colorado news service): Obamacare's Medicaid Mandates Are Unconstitutional
For split sovereignty to work, both the states and the feds must be able to make independent decisions within their respective spheres. The federal government must be free from state coercion, and the states must be free from federal coercion. ... Obamacare attempts to crack the constitution by directing and empowering administrators in the U.S. Department of Health and Human Services (HHS) to effectively bankrupt any state that makes Medicaid decisions different from those approved by Obamacare (Rob Natelson, 3/14) 

New England Journal of Medicine: Warning: Contraceptive Drugs May Cause Political Headaches
Americans don't usually succeed in claims that the use of their funds in contravention of their religious views violates their constitutional or statutory rights: tax resisters, for instance, have been swatted down by the courts, even when they were objecting to state-ordered killing in the form of capital punishment or war. ... This debate deserves more than partisan sound bites and slogans (R. Alta Charo, 3/21).

New England Journal of Medicine: The Severability Of The Individual Mandate
In our view, however, only a functional, not a structural, relationship exists between the mandate and both insurance-market reforms, and a clean conceptual line can be drawn between the mandate and everything else in the ACA. ... If the Supreme Court holds the mandate unconstitutional, it should therefore leave the rest of health care reform on the books (Drs. Samuel Y. Sessions and Allan S. Detsky, 3/14).

New England Journal of Medicine: A Successful And Sustainable Health System — How To Get There From Here 
A successful and sustainable health system will not be achieved by supporting prevention, it will not be achieved by championing competition, it will not be achieved by comparing the effectiveness of different practices, it will not be achieved by striking commercial influence from professional decision making, it will not be achieved by changing the way we pay doctors, and it will not be achieved by just reengineering the system. It requires all these changes and more (Dr. Harvey V. Fineberg, 3/14).

Journal of the American Medical Association: Eliminating Waste In US Health Care
The need is urgent to bring US health care costs into a sustainable range for both public and private payers. Commonly, programs to contain costs use cuts, such as reductions in payment levels, benefit structures, and eligibility. A less harmful strategy would reduce waste, not value-added care. The opportunity is immense (Dr. Donald M. Berwick and Andrew D. Hackbarth, 3/14).

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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.