Daily Health Policy Report

Friday, March 15, 2013

Last updated: Fri, Mar 15

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Care Marketplace

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Small Businesses Pursue Health Law 'Loophole'

Kaiser Health News staff writer Jay Hancock, working in collaboration with USA Today, reports: "NorthBay Adventure is the kind of small business that could be expected to buy medical insurance for workers under sweeping health-act rules taking effect in 2014. But executive director George Comfort says that's not likely to happen. Instead, NorthBay became self-insured last year, paying most of its workers' health costs directly, a practice more typical of large employers. The decision to self-insure was about free choice, savings and what’s best for his company, Comfort says. But others see it as a threat to the Affordable Care Act. As more small employers like NorthBay avoid the health act's requirements through self-coverage, small-business marketplaces intended to cover millions of Americans could break down and become unaffordable, they say" (Hancock, 3/15). Read the story.

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Medicare Revises Readmissions Penalties – Again

Kaiser Health News staff writer Jordan Rau reports: "In its effort to crack down on repeat hospitalizations, Medicare has its own readmission: for the second time in six months, it has erred in calculating penalties for more than 1,000 of the nation's hospitals. As a result, Medicare has slightly lessened its readmissions penalties for 1,246 hospitals as part of its new program pressuring hospitals to ensure patients stay healthy health after they leave" (Rau, 3/14). Read the story.

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Capsules: Midnight Drama As Minnesota House Passes Exchange Bill

Now on Kaiser Health News' blog, Minnesota Public Radio's Elizabeth Stawicki, working in partnership with KHN and NPR, reports: "Landmark health insurance legislation is on its way to the Minnesota Senate after the House approved it shortly after midnight on Friday. The House passed a conference committee’s proposal to reconcile the differences in House and Senate bills enacting a Minnesota health insurance exchange. The ever-controversial exchange bill had a bumpy ride in the House, as anti-abortion legislators tried to revive an amendment that would have banned coverage of the procedure for any insurance policy sold on the exchange" (Stawicki, updated 3/15). Check out what else is on the blog.

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Political Cartoon: 'Bad Form?'

Kaiser Health News provides a fresh take on health policy developments "Bad Form?" by Lisa Benson.

Meanwhile, here is today's health policy haiku:


Budget principles
are already trumped: What gives
'14 advantage?

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

Employers, Small Businesses Bristle Over Health Law

The Wall Street Journal reports on the fee that many employers will pay for each person that they insure next year while KHN details a possible "loophole" for small businesses. And, on Capitol Hill, a GOP bill is being advanced that would require insurance companies to disclose their health law tax burden and how it impacts premiums to consumers, and Senate Democrats press Health and Human Services Secretary Kathleen Sebelius to speed up the health law's implementation.

The Wall Street Journal: Employers Blast Fees From New Health Law
Employers are bracing for a little-noticed fee in the federal health care law that will charge them $63 for each person they insure next year, one of the clearest cost increases companies face when the law takes full effect. Companies and other plan providers will together pay $25 billion over three years to create a fund for insurance companies to offset the cost of covering people with high medical bills (Adamy, 3/14).

Kaiser Health News: Small Businesses Pursue Health Law 'Loophole'
NorthBay Adventure is the kind of small business that could be expected to buy medical insurance for workers under sweeping health-act rules taking effect in 2014. But executive director George Comfort says that's not likely to happen. Instead, NorthBay became self-insured last year, paying most of its workers' health costs directly, a practice more typical of large employers. The decision to self-insure was about free choice, savings and what’s best for his company, Comfort says. But others see it as a threat to the Affordable Care Act. As more small employers like NorthBay avoid the health act's requirements through self-coverage, small-business marketplaces intended to cover millions of Americans could break down and become unaffordable, they say (Hancock, 3/15).

The Hill: GOP Bill Slams Health Care Reform Taxes
A new GOP bill would require health insurance companies to describe their tax burden under health care reform to consumers in annual statements. Rep. Greg Walden (R-Ore.), a critic of the Affordable Care Act, said the measure would inform patients about the law's "nearly trillion dollars in taxes" and how they might affect premiums (Viebeck, 3/14).

The Hill: Dems Press Sebelius To Speed Up Obama Health Law Implementation
Senate Democrats raised concerns about the implementation of President Obama's signature health care law during closed-door meetings this week with Health and Human Services Secretary Kathleen Sebelius. Sebelius met Thursday morning with the Senate Finance Committee, following a series of one-on-one meetings with committee members on Wednesday (Baker, 3/14).

And in more news from Oklahoma --

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" (Murphy, 3/15).

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Deadline Pressures Could Put More Exchanges In The U.S. Govt's Hands

Reuters reports that if states that are pursuing their own insurance marketplaces can't keep up with the timeline, it could fall to Washington to run. Meanwhile, the Minnesota House approves legislation to set up its health exchange while advocates in Colorado press to make coverage of children's dental care mandatory in plans sold on that state's exchange.

Reuters: Washington Could Wind Up Running More Health Exchanges: Official
The U.S. government could have to run more state health insurance exchanges than expected under President Barack Obama's healthcare law, if U.S. states pursuing their own marketplaces cannot complete them on time, a senior official said on Thursday. The Obama administration has given 17 of the 50 states conditional approval to set up online exchanges where working families would purchase private plans at subsidized rates. The remaining 33 states will all have federally run markets, at least in the early years of the coming reform era (3/15).

MPR News: Abortion Restrictions Cut From Health Care Exchange Bill
Abortion restrictions have been cut from a final version of the health insurance exchange bill that will impact how more than a million Minnesotans obtain health coverage, starting in October. The House-Senate conference committee working on the bill Wednesday also settled on a way to fund the website that will allow consumers to compare private plans on the open market: There will be a 1.5 percent user fee on premiums for plans sold on the exchange in 2014 and up to 3.5 percent in 2015. The Senate had wanted to use an existing tobacco tax to fund the program (Stawicki, 3/14).

Pioneer Press: Minnesota House OKs Bill Creating Health Insurance Exchange
The slightest sliver of bipartisan support for a health insurance exchange in Minnesota apparently vanished early Friday morning, March 15, as the House of Representatives voted largely along party lines to support legislation to create the new marketplace. In the 72-61 vote, House Republicans were unanimous in voting against compromise legislation that was crafted this week by a conference committee (Snowbeck, 3/15).

Kaiser Health News: Capsules: Midnight Drama As Minnesota House Passes Exchange Bill
Landmark health insurance legislation is on its way to the Minnesota Senate after the House approved it shortly after midnight on Friday. The House passed a conference committee’s proposal to reconcile the differences in House and Senate bills enacting a Minnesota health insurance exchange. The ever-controversial exchange bill had a bumpy ride in the House, as anti-abortion legislators tried to revive an amendment that would have banned coverage of the procedure for any insurance policy sold on the exchange (Stawicki, 3/15).

The Denver Post: Colorado Advocates Rush To Save Kid Dental Benefits On Exchange
Colorado health advocates are renewing a push to make child dental care mandatory on the new state insurance exchange, after federal officials declared the benefits "essential" but "optional." Dental-care policies will be offered on the state exchange opening in October, parallel to health-insurance offers, but there is no federal mandate to buy oral-health coverage (Booth, 3/15).

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Medicaid Expansion: Moody's Outlines Hospital Economic Concerns

State legislatures around the country consider the implications of Medicaid expansion proposals under the federal health overhaul.

Modern Healthcare: Hospitals Face Dual Threat If States Don't Expand Medicaid: Moody's
Hospitals located in states that elect not to expand their Medicaid programs could find their bottom lines squeezed in the coming years as they're hit with higher charity-care costs and fewer insured patients. A report from Moody's Investors Service estimated that the Patient Protection and Affordable Care Act is expected to eliminate more than $17 billion in annual aid by 2019 when the government reduces its disproportionate-share hospital payments, which compensate facilities that treat large numbers of low-income patients. Lisa Goldstein, associate managing director at Moody's, said in an interview that safety net hospitals are likely to face the biggest hit to their credit ratings as uncompensated care increases and DSH payments dry up (Kutscher, 3/14).

Health News Florida: Feds To FL: We're Flexible; Show Us Your Plan
Medicaid expansion for 1 million low-income adults in Florida may technically be dead, after committees in both the House and Senate voted to kill it. And yet, chances for an alternative plan that would accomplish the same goals are looking up (Gentry, 3/15).

St. Louis Beacon: Missouri Senate GOP Leaders Declare There's No Chance They'll Back Medicaid Expansion
Before leaving the state Capitol for a one-week recess, the state Senate's Republican leaders have issued a joint statement declaring, in effect, that there's no way they will support an expansion of Medicaid. Among other things, the leaders -- including Senate President Pro Tem Tom Dempsey, R-St. Charles -- say they don't trust the federal government to pay its share of the costs. Under the Affordable Care Act, the federal government is to pay all the costs of the Medicaid expansion for three years, and then at least 90 percent thereafter (Mannies, 3/14).

St. Louis Beacon: Business Groups Use Economic Arguments To Prod State Lawmakers To Expand Medicaid
Branson, Mo., gets plenty of good press for being a magnet for millions of visitors who love country music, specialty shops and other amenities in the southwest corner of the state. But the town drew a different sort of attention to itself last month when its Chamber of Commerce endorsed Gov. Jay Nixon's controversial push to expand Missouri's Medicaid program (Joiner, 3/15).

The Associated Press: Lawmakers Hold Hearing On Federal Health Care Law
Gov. Bobby Jindal may have decided Louisiana won't expand its Medicaid program, but state lawmakers don't appear so settled on the issue. Lawmakers got a crash course Wednesday on the details of the federal health care law for the first time since it was upheld by the Supreme Court, and the Senate and House Insurance committees asked for more analysis (Deslatte, 3/15).

Des Moines Register: Health Leaders Seek Medicaid Deal
Iowa hospital executives publicly prodded state leaders Thursday to resolve their dispute over whether to expand the Medicaid insurance program for the poor. "We would really like to see both (legislative) houses working on this together and the governor's office -- just lay down the political banners on this and work to do what's right for the patients of Iowa," Iowa Health System Vice President Sabra Rosener said in a forum at Des Moines' Central Library (Leys, 3/15).

The Associated Press: Iowa Democrats Continue Medicaid Expansion Push
Senate Democrats on Thursday proposed a Medicaid expansion that would let the state back out if federal funding fell short, but it wasn't clear whether the plan would overcome Republican Gov. Terry Branstad's opposition to growing the program in Iowa. The Democrats who control the Iowa Senate have been pushing to expand Medicaid, but the governor has expressed concern that the federal government doesn't have the money to fulfill its promises (Lucey, 3/14).

Des Moines Register: Senate Offers Medicaid Deal
Iowa Senate Democrats are offering what they describe as a compromise to provide Medicaid health insurance to thousands of additional low-income Iowans, but Gov. Terry Branstad says he'll proceed with an alternative plan in the Republican-led House. Democrats proposed Thursday to draft Medicaid legislation allowing the state to pull out of the expanded program if the federal government fails to fulfill a promise to fund 100 percent of the program with federal money for the first three years and up to 90 percent in later years (Petroski, 3/15).

The Associated Press: Idaho State House Committee Introduces Proposal To Expand Medicaid
In the wake of one bruising fight over a key provision of President Barack Obama's health care overhaul, Idaho's Legislature may embark on another: Whether to expand Medicaid for another 104,000 low-income people, to replace an existing program that pays the costs of the medically indigent. The House Health and Welfare Committee introduced the proposal Thursday in a package to eliminate Idaho's catastrophic health care program (3/14).

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Federal Judge In Michigan Blocks Birth Control Coverage Mandate For Pizza Chain

On Thursday, U.S. District Judge Lawrence Zatkoff granted this preliminary injunction against the enforcement of the health law's contraception coverage requirement.

The Associated Press/Washington Post: Judge: Feds Can't Make Domino's Founder Tom Monaghan Offer Workers Contraceptive Coverage
A judge on Thursday blocked the federal government from requiring the founder of Domino's Pizza to provide mandatory contraception coverage to his employees under the health care law. U.S. District Judge Lawrence Zatkoff granted a preliminary injunction against enforcement of the contraception provision of the law against Tom Monaghan and Domino's Farms Corp., a management company located near Ann Arbor, Mich. (3/14).

Bloomberg: Michigan Judge Blocks Health-Care Birth-Control Mandate
The U.S. health-care reform's mandate requiring employee insurance plans to provide coverage of contraception was blocked by a federal judge in Michigan. Tom Monaghan and his property-management company, Domino's Farms Corp., sued the U.S. government in December, contending that complying with the mandate would require him to violate his religious beliefs as a member of the Catholic Church. Domino’s Farms would have to provide contraceptive products, including an abortion-inducing drug, or be forced to pay $200,000 a year as a tax or penalty, the plaintiffs said (Fisk, 3/15).

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Capitol Hill Watch

Analyzing The Budgets: How The House GOP And Senate Dems Treated Medicare

The Senate Democratic budget contained more than double the cuts to Medicare, but, like the Republican blueprint, it also assumed the repeal of Medicare's sustainable growth rate formula.

National Journal: Chickening Out On Medicare
There weren't many surprises in the budgets each party released this week, but here was one: Sen. Patty Murray's Democratic proposal had more than double the cuts to the biggest health entitlement, Medicare, as Rep. Paul Ryan's Republican proposal did. Despite the House Budget chairman's frequent critique of Medicare sustainability, he would trim only $129 billion over 10 years, mostly by capping malpractice awards and by asking seniors to pay higher premiums and higher prices for prescription drugs (Sanger-Katz, 3/14).

Medscape: Senate Democrats' Budget Assumes SGR Repeal
Senate Democrats released a budget proposal for fiscal 2014 yesterday that, unlike its House Republican counterpart, assumes the repeal of Medicare's sustainable growth rate (SGR) formula and the 26.5% physician pay cut that it would trigger. The plan from Sen. Patty Murray (D-WA), chair of the Senate budget committee, factors in the $138 billion cost of maintaining Medicare rates at their current level for 10 years. Another assumption in Murray's budget is the rollback of an additional 2% reduction to Medicare rates scheduled for April 1 that resulted from automatic, across-the-board cuts to military and domestic spending called sequestration. The budget allocates almost $1 trillion to replace the sequester cuts (Lowes, 3/14).

And here are reports about the politics and action related to both budget plans -

Politico: Sparks Fly At Senate Budget Hearing
The resolution heads to the full Senate, where it's expected to be subjected to a long list of floor amendments. Votes on the budget are expected next Thursday. The only major break from Murray by her Democratic colleagues was over an amendment offered by Sen. Ron Johnson (R-Wisc.) that requires the CBO to report the impact of the Affordable Health Care Act in terms of employers dropping coverage (Gibson, 3/14).

The New York Times: Boehner Says Losses In Election Won't Affect Budget Stance
In an interview, Mr. Boehner said that candidates and personalities — not Republican proposals on Medicare and spending cuts — accounted for the party's defeats, taking a hard line on further budget talks even as Senate Republicans met with President Obama in a search for common ground (Weisman and Peters, 3/14).

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Obama Lunches With Senate GOP, Focuses On Entitlement Programs

A key message from Republican lawmakers was that President Barack Obama should tone down his rhetoric on changes to Medicare.

Los Angeles Times: Obama Wraps Up His Three-Day Capitol Hill Tour
Wednesday's meeting with House Republicans had a more combative tone, and GOP lawmakers left unconvinced that the president was willing to move toward their positions, particularly on the budget. … Republican senators, though, have been more willing to consider new revenues as part of a broader package that would reduce deficits, particularly by trimming Medicare and Medicaid -- health care programs that are driving deficits. Particular interest seems to be forming on both sides of the aisle around Obama's proposal for tying the cost of living adjustment to higher income levels, so only wealthier recipients would see their Social Security or veterans' benefits reduced (Mascaro and Memoli, 3/14).

The Washington Post: Obama's Third Day Of Lawmaker Lunches Focuses On Tax, Entitlement Reform
GOP senators emerged from their lunch in a buoyant mood, saying that Obama fielded nearly a dozen questions over 90 minutes regarding budget negotiations, immigration, entitlement programs, corporate taxes and federal regulations. … A key focus was asking Obama to tone down his rhetoric on entitlement programs, as Republicans cited his interview with ABC News in which he accused the GOP of wanting to balance the budget by "gutting" Medicare and Social Security. Obama, Roberts said, "tried to better define what he said to George Stephanopoulos." The meeting was a stark contrast to a similar huddle three years ago in a Senate meeting room around the corner, a gathering that took place in the midst of Obama's push for a Democratic-only bill to dramatically reshape the health-care system (O’Keefe, Helderman and Kane, 3/14).

The Associated Press/Washington Post: Republicans: For Deficit Deal, Obama Must Tone Down Attacks And Push Dems To Support Changes
Polite yet firm, Senate Republicans told President Barack Obama on Thursday to tone down his political attacks and prod Democratic allies to support controversial changes in Medicare if he wants a compromise reducing deficits and providing stability to federal benefit programs. Participants at a 90-minute closed-door meeting said Obama acknowledged the point without yielding ground — and noted that Republicans criticize him freely. "To quote an old Chicago politician, 'Politics ain't beanbag,'" the president said (3/14).

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Health Care Marketplace

Medical Schools Are Expanding But Doctors Say Federal Budget Cuts Are Holding Down Number Of Residencies

As educators seek to help fill the large number of physicians needed under the health overhaul, they point out that the number of training programs paid for by the federal government needs to rise too.

The Wall Street Journal: Squeeze Looms For Doctors
U.S. medical schools are expanding to meet an expected need for more doctors due to the federal health law. With at least 12 new schools opening and existing ones growing, enrollment is on track to produce 5,000 more graduates a year by 2019. But medical educators are cautioning that those efforts won't do anything to alleviate a doctor shortage unless the number of medical residency positions rises as well (Beck, 3/14).

The Hill: House Bill Would Create 15K New Residency Positions
A bipartisan House bill reintroduced Thursday would create 15,000 more medical residency positions under Medicare in a move to alleviate the looming U.S. doctor shortage. The measure from Reps. Allyson Schwartz (D-Pa.) and Aaron Schock (R-Ill.) would mandate that 50 percent of the positions train residents in primary care (Viebeck, 3/15).

Meanwhile, other outlets examine some workplace issues for doctors.

Marketplace: From 'God-Like' To Team Huddle: Training Doctors For A New Health Care Future
Later today, 33,000 aspiring doctors will find out where they’ll be doing their residencies for the next three to seven years. In medical circles, they call it "Match Day." In the last few years, doctors and hospitals have begun adapting the on-the-job training residents receive, so they can better succeed in today’s tumultuous health care world. ... Dr. Bob Wachter at the University of California, San Francisco says doctors can no longer just take care of sick people. "I like to say that the doctor of the future has two sick patients. One is the patient they are taking care of. One is the system they are working in," says Wachter.  (Gorenstein, 3/15).

WBUR: Gender Bias In Medicine
Look into any operating room and odds are it’ll be a man wielding the scalpel. Women are making great gains in medicine, but many disciplines and many senior management jobs in the medical world are male-dominated. Consider neurosurgeons and orthopedic surgeons. Fewer than 5 percent of them are female. And it isn't just exclusion. There's a lot of outright hostility. Explicit gender discrimination was alleged in the big $7 million settlement awarded last month to Dr. Carol Warfield against the former chief of surgery at Beth Israel Deaconess Medical Center. Then there's money. A study published in 2011 found that women across the entire medical field are paid less and promoted more slowly than their male counterparts. We'll dig into the issues and take a look at changes underway to shift the balance (3/14).

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Supreme Court Slated To Hear Legal Arguments Regarding Generic Drug Liability Question

Politico: Supreme Court To Hear Generic Drug Suit Next Week
Generic drugs are supposed to be identical to the brand names that preceded them. And by law, they have to have identical warnings and labels. So what happens when a generic drug harms someone? How much liability does the generic drugmaker bear? That's a question that will be argued before the Supreme Court next Tuesday (Norman, 3/15).

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State Watch

State Highlights: Ga. Governor Gets Insurance 'Navigators' Bill

A selection of health policy news from Georgia, Texas, Minnesota, Michigan, West Virginia and California.

Atlanta Journal Constitution: Bill To License New Health Care Workers Clears Final Hurdle
A bill that would require a new group of health care workers called health insurance navigators to be licensed and regulated cleared its final legislative hurdle Thursday. The House of Representatives passed House Bill 198 after the Senate approved a version that would require navigators to be knowledgeable about the state's health programs for low-income Georgians: Medicaid and PeachCare for Kids. The legislation passed 136-24. It will now go to the governor's desk for his signature. The federal Affordable Care Act calls for health insurance navigators to help uninsured people and businesses use the new federally run online health insurance marketplaces starting this fall. The bill would require navigators to have at least 35 hours of training, be licensed and take continuing education classes (Williams, 3/14).

The New York Times: Focusing On Violence Before It Happens
In the national debate that has followed the killings at Sandy Hook Elementary School in Newtown, much of the focus has been on regulating firearms. But many law enforcement and mental health experts believe that developing comprehensive approaches to prevention is equally important. In many cases, they note, the perpetrators of such violence are troubled young people who have signaled their distress to others and who might have been stopped had they received appropriate help (Goode, 3/14).

MPR News: Dayton: Higher Tobacco Tax Is About Health, Not Revenue
DFL Gov. Mark Dayton says the income tax increase on top earners in his revised budget plan is all about fairness. But his proposal to raise the current tobacco tax of $1.23 per pack by an additional 94 cents will disproportionately hit Minnesotans of modest means, Dayton acknowledges. ... The increase is not about money, but instead about decreasing tobacco use, especially among young people, said Dr. Edward Ehlinger, state health commissioner. "Other than totally banning tobacco as a product in the United States, the most effective way of decreasing use is by raising the price," Ehlinger said (Zdechlik, 3/15).

The Texas Tribune/New York Times: Finding A Partner For Children's Health In Centralized Care
For the last year, Anna (Barkhuizen) has participated in a pilot program at the Seton Children's Comprehensive Care clinic at Dell Children's Medical Center of Central Texas in Austin. The three-year program, now in its second year, coordinates care for medically needy children, providing access to pediatric physicians, medical specialists and behavioral health care, while offering family support services. The program's founders hope comparative data collected from the pilot program and routine outpatient care will show that centralized coordination improves the quality of care while cutting costs (Aaronson, 3/14).

The Associated Press: Study: Michigan Cities Have $12.7B In Retiree Health Costs
Michigan cities and townships that provide health care for retired public workers face nearly $13 billion in unfunded costs, according to a report released Thursday, with half setting aside no money to cope with a bill gobbling up more of their budgets. The sobering study, released the same day an emergency financial manager was assigned to Detroit, shows the city is not alone in grappling with how to pay promised health benefits to retirees. More than 300 cities, townships and villages -- home to two-thirds of state residents -- face a combined $12.7 billion in unfunded liabilities in the next 30 years (Eggert, 3/15).

The Associated Press: Bill To Reduce Medicaid Costs Cut Up In Committee
A West Virginia bill intended to streamline the way Medicaid patients get to the doctor's office would be more difficult to manage and less effective after amendments made by a state Senate committee Thursday. The state reimburses Medicaid members for costs related to getting to the hospital for non-emergency services, whether they drive themselves, get a ride from a senior center, take a bus or take an ambulance. State rules dictate that the least expensive option must be used. ... The bill proposed by Gov. Earl Ray Tomblin would create a broker that would guide Medicaid patients toward the most convenient and least expensive option. But the Senate Health and Human Resources Committee voted unanimously to exempt ambulances, public transit and senior centers from being managed by the broker system (Gutman, 3/14).

California Healthline: Financial Concerns For Ambulance Services
Health care providers in California are waiting for judicial rulings to see if they will be hit by a 10 percent cut in Medi-Cal reimbursement rates as a result of a law passed in 2011 and currently tied up in federal appeals court. Ambulance service providers are among those who would be hit by the cut but they say they shouldn't be included for one large and simple reason: Unlike physicians, ambulance providers are required by law to transport Medi-Cal beneficiaries. They're not allowed to refuse them (Gorn, 3/14).

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Health Policy Research

Research Roundup: Nurse Education And Post-Surgery Mortality

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

Health Affairs: An Increase In The Number Of Nurses With Baccalaureate Degrees Is Linked To Lower Rates Of Postsurgery Mortality – A 2011 report by the Institute of Medicine called for a more highly educated workforce of registered nurses – one that would be well prepared to meet the health care demands of the public. According to the study authors, health care policymakers have little evidence to support the recommendation of increasing the number of nurses with baccalaureate degrees. Using nurse survey and patient discharge data from 1999 and 2006, the researchers examined whether the changes in the number of baccalaureate-level nurses impacted the death rate among surgical patients at acute care hospitals in Pennsylvania. "We found that increases in a hospital's percentage of nurses who held a baccalaureate degree in nursing were significantly associated with improvements over time in rates of surgical patient mortality and failure to rescue," the authors write (Kutney-Lee, Sloane and Aiken, March 2013).

Health Affairs: Publicly Reported Quality-Of-Care Measures Influenced Wisconsin Physician Group To Improve Performance – The Wisconsin Collaborative for Healthcare Quality is a voluntary, statewide consortium of physician groups aiming to improve the quality and cost of care in the state. As part of their efforts, the collaborative publicly reports how providers are performing on various quality of care measures. Although publicly reporting providers' performance on health measures is becoming more common, the overall impact of these disclosures on the quality of patient care is still unclear. Using Medicare billings and survey data, researchers compared the performances of members in the collaborative to other doctors in the state of Wisconsin. "The overall performance of the collaborative members in the aggregate improved significantly," the authors found. "All of the physician groups saw some improvement on a majority of the measures." Physician groups indicated that publicly reported data motivated them to act on improving some, though not all, of the quality of care measures (Lamb, Smith, Weeks and Queram, March 2013).

The Kaiser Family Foundation/Georgetown University Center for Children and Families: Premium Assistance In Medicaid And CHIP: An Overview Of Current Options And Implications Of The Affordable Care Act -- Implementation of the Affordable Care Act (ACA) coverage expansions is likely to spark renewed interest in the use of Medicaid or Children’s Health Insurance Program public funds to purchase private coverage, and option called premium assistance. To date, Medicaid and CHIP premium assistance programs remain relatively limited largely reflecting limited access to (employer sponsored insurance) among low-income individuals covered by Medicaid and CHIP and challenges to achieving cost effectiveness,"  the author wrote. "However the passage of the ACA with its expansion in Medicaid and the creation of new health insurance exchange marketplaces may spur increased interest among states in premium assistance options.” Still she concluded, "Private market trends, including greater employee cost sharing, declining availability of coverage for low-income workers, and higher rates of cost growth in private versus public coverage increase challenges to implementing premium assistance in the group market." This brief provides an overview of premium assistance options and examines how the ACA may impact the use of premium assistance (Alker, 3/12).

Kaiser Family Foundation: Establishing Health Insurance Exchanges: An Overview of State Efforts – According to this issue brief, states have made a number of decisions regarding state-based exchanges in the past two years, including how they'll be structured, governed and contracted with health insurance providers. "Exchanges must allow consumers to apply for and enroll in coverage online, in person, by phone, fax, or mail and provide culturally and linguistically appropriate assistance," the brief states, "To do this, states must provide access to telephone call centers, build a website with information about insurance options and application assistance, and create a Navigator program to improve public awareness and facilitate enrollment." This issue brief provides an overview of states' progress in setting up the state-based health insurance exchanges through which millions of Americans are expected to purchase coverage under The Patient Protection and Affordable Care Act (ACA) beginning in 2014 (3/11).

Here is a selection of news coverage of other recent research:

The New York Times' The New Old Age: New Data To Consider In D.N.R. Decisions
Every year in the United States, about 100,000 hospital patients age 65 and older experience what is known in medical parlance as Code Blue. ... Survival from these catastrophic medical events isn't the norm; only 18 to 20 percent of older patients in hospitals who suffer cardiac arrest end up leaving the hospital alive. But that is an improvement from years past, when survival rates were even more abysmal. What has not been clear is what happened to older hospital patients who left the hospital after a cardiac arrest. Now a new study in The New England Journal of Medicine of 6,972 elderly people who survived in-hospital cardiac arrests between 2000 and 2008 gives some answers (Graham, 3/14).

Reuters: Too Many Drug Types Are Compromising Heart Health: Doctors
About 80 million Americans suffer from heart disease, the nation's No. 1 killer, and most are on multiple drugs. Some cardiologists think prescribing has gotten out of hand. The criticism was voiced by a number of leading heart doctors who attended the annual scientific sessions of the American College of Cardiology, held on March 9-11 in San Francisco. They said eliminating certain drugs could potentially improve care without compromising treatment. Evidence is growing that some medications are not effective (Sherman, 3/13).

The New York Times: Widespread Flaws Found In Ovarian Cancer Treatment
Most women with ovarian cancer receive inadequate care and miss out on treatments that could add a year or more to their lives, a new study has found. The results highlight what many experts say is a neglected problem: widespread, persistent flaws in the care of women with this disease, which kills 15,000 a year in the United States. About 22,000 new cases are diagnosed annually, most of them discovered at an advanced stage and needing aggressive treatment. Worldwide, there are about 200,000 new cases a year (Grady, 3/11).

WBUR: Here And Now: Few Ovarian Cancer Patients Receive Best Possible Care (Audio)
A study presented yesterday at a meeting of the Society of Gynecologic Oncology found that only about 37 percent of ovarian cancer patients receive the kind of complex surgery and chemotherapy that can prolong life. The surgery is called "debulking" and involves removing all visible traces of tumor inside the abdomen. Too often, patients rely on general surgeons or OB/GYN (obstetrics and gynecology) doctors at hospitals where too few of the operations are performed, instead of gynecologic oncologists who regularly do the operations (3/12).

The Wall Street Journal: Breast-Cancer Radiation Raises Heart Risk: Study
Women who had radiation therapy for breast cancer are at increased risk of having a heart attack or other major coronary event, according to a large European study published in the New England Journal of Medicine Wednesday. The risk started climbing five years after treatment and continued for at least two decades, and the higher the dose of radiation the women's hearts received, the greater the risk of having a serious heart problem, the study found (Beck, 3/13).  

Medpage Today: Bonus For Work In Shortage Areas Questioned
Questions surrounding the necessity -- and ultimate value -- of a 25-year-old program to increase the number of physicians in shortage areas held the spotlight at a second day of hearings by the Medicare Payment Advisory Commission. Medicare has provided at least a 10% bonus for services provided by all physicians -- not just primary care or specialities deemed to be in short supply -- working in federally designated Health Professional Shortage Areas (HPSA) since 1987, as provided for in the Budget Reconciliation Act of 1987. But the average number of annual visits to a doctor's office or outpatient facility was 10.3 per beneficiary for HPSAs and 10.0 for non-HPSAs, suggesting that the bonuses may not be needed, according to a MedPAC analysis released at a commission meeting on Friday. Also, only about 40 percent of HPSAs are in non-metropolitan areas (Pittman, 3/9).

Medpage Today: MedPAC: Rx Adherence Not Always A Savings
Medicare patients who had better adherence to their medication regimen did not always have lower overall health costs, according to a study of patients with depression or certain cardiac or pulmonary conditions. Instead, the relationship between medication adherence and Medicare spending varied by condition, regimen, and income status, members of the Medicare Payment Advisory Commission (MedPAC) were told here Thursday. Past studies looking at medication adherence and its effects on healthcare costs "may have limited applicability to the Medicare population as those studies generally focus on younger population with less complex medical conditions," the staff members noted in their introductory materials. To explore the issue within the Medicare program, MedPAC staff undertook a study to understand how medication adherence effects Medicare Part A and B spending (Pittman, 3/8).

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Editorials and Opinions

Viewpoints: 'Namby-Pamby' Democratic Budget Offer; Murray Argues Her Plan Is Responsible; Officials Can Force Hospitals To Fix Pricing For Uninsured

USA Today: Democratic Budget Namby-Pamby Opening Bid: Over View
In the absence of an emergency, Washington can and should bring its budget into balance, even though that requires doing what politicians despise: for Republicans, raising taxes; for Democrats, curbing the rapid growth in benefit programs such as Medicare and Social Security that already make up three-fifths of federal spending. The Murray budget neither balances the budget nor reins in entitlements. Its one-to-one ratio of spending cuts to tax increases might sound balanced, but the spending cuts are not actual reductions. They are merely reductions in the expected rate of growth (3/14).

USA Today: Patty Murray: Our Budget Is Balanced, Fair
The highest priority of the Senate budget is protecting our economic recovery and laying down a strong foundation for broad-based economic growth. It responsibly replaces the harmful cuts from sequestration that threaten 750,000 jobs this year alone. And it invests in infrastructure, education and innovation to make sure businesses and families can compete and win in the 21st century economy. Our budget also strengthens and protects Medicare and other programs seniors and families depend on, because we don't think they should have to bear the burden of deficit reduction alone. Our budget also tackles our deficit and debt responsibly (Sen. Patty Murray, D-Wash., 3/14).

The Washington Post: The Democrats' Complacent Budget Plan
It is on the issue of entitlements that the Democrats' document really disappoints. There is literally nothing -- not a word -- suggestive of trimming Social Security, whether through greater means-testing, a more realistic inflation adjustment or reforming disability benefits. The document's fuzzy call for $275 billion in "health savings" is $125 billion less than the number President Obama has floated. As for the coming flow of baby boomers into Medicare, the Democrats declare that "new retirees deserve the same promise of quality, affordable health care from which their parents have benefitted — and it is the position of the Senate Budget that they ought to get it." There's plenty of excoriation for the GOP "premium support" plan. But there's no explanation of how the Democrats would pay for their "promise" -- nary a hint of the many cost-saving reforms that would extend Medicare's life without embracing the GOP plan (3/14).

The Wall Street Journal: Replacing Max Baucus
The bill manages the unique achievement of offering no net nondefense spending cuts and no entitlement reform worth the name, while proposing to raise $1.5 trillion in new tax revenue in such a way that would ruin the prospects for bipartisan tax reform. This budget has no chance of becoming law as long as Republicans run the House, but as a statement of Democratic intentions it deserves more attention (3/14).

Los Angeles Times: GOP's Effort To Roll Back Health Care Reforms Is Bad Policy
Republican lawmakers, in their budget proposal released this week, showed they're determined to roll back President Obama's health care reforms, deny coverage to millions, limit treatment of the poor and essentially hand Medicare over to private insurers. ... "There are goods and services that the private market does a very good job of providing," said Mindy Marks, an associate professor of economics at UC Riverside. "Health care isn't one of them" (David Lazarus, 3/14). 

Los Angeles Times: The Medicare Debate We Need
One criticism of the Medicare overhaul that House Budget Committee Chairman Paul D. Ryan (R-Wis.) has championed is that it would shift more and more of the program's costs onto seniors. In the latest version of his plan, Ryan acknowledges that capping the growth of the program could, in fact, make health insurance more expensive for some retirees. But that's part of the point of the change, which would concentrate Medicare spending on the poorest and sickest seniors (3/14). 

The Washington Post: The GOP And The Budget Boilerplate Gap
Ryan's budget proposal is similar to his previous two in both strengths and failures. It deserves everlasting fiduciary fame for proposing a plausible Medicare reform plan. … And yet . . . the refusal to consider additional revenue and the delayed implementation of proposed Medicare reform result in impossible reductions in Medicaid and discretionary spending. These elements of the budget proposal summarize the ideological predispositions of House Republicans rather than address objective economic needs, humanitarian requirements or even GOP political imperatives. Congressional Democrats, in turn, have emerged from nearly four years of budgetary silence with their own ideological caricature -- a proposal combining heavy taxes, budgetary gimmicks, a net increase in spending and a strident refusal to consider meaningful entitlement reform. The silence was more responsible (Michael Gerson, 3/14). 

The Washington Post: Obama Has To Be Dealmaker In Chief
It's true that there are times when presidential intervention in delicate congressional negotiations can be counterproductive. It's certainly true that there are times when congressional Democrats have advised the White House to butt out. But leading through diffidence is not a traditional presidential strategy, nor is there much reason to expect it to produce results. In the end, as Obama himself understands and has told the other side, he is the one who is going to have to sell the notion of unpopular changes -- curbing Medicare spending, reducing Social Security benefits or curtailing popular tax breaks -- to a nation that says it wants a balanced bargain but may balk when that bargain is translated into painful specifics. After all, Obama is the only dealmaker with no reelection worries (Ruth Marcus, 3/14). 

The New York Times' Economix: What Hospitals Charge The Uninsured
It is noteworthy that in its critique of Mr. Brill's work, the [American Hospital Association] statement is completely silent on this central issue of his report. A fair question one may ask leaders of the industry is this: Even if one grants that American hospitals must juggle their financing in the midst of a sea of price discrimination, should uninsured, sick, middle-class Americans serve as the proper tax base from which to recoup the negative margins imposed on them by some payers, notably by public payers? My answer is "No," and I am proud to say that when luck put in my way an opportunity to act on that view, I did (Uwe E. Reinhardt, 3/15).

The Wall Street Journal: The Doctor Won't See You Now. He's Clocked Out
Big government likes big providers. That's why ObamaCare is gradually making the local doctor-owned medical practice a relic. In the not too distant future, most physicians will be hourly wage earners, likely employed by a hospital chain. Why? Because when doctors practice in small offices, it is hard for Washington to regulate what they do. There are too many of them, and the government is too remote. It is far easier for federal agencies to regulate physicians if they work for big hospitals. So ObamaCare shifts money to favor the delivery of outpatient care through hospital-owned networks (Scott Gottlieb, 3/14). 

Georgia Health News: With Cancer Research Making Giant Strides, It's Wrong To Cut Budgets
We are at a point in the fight against cancer where decades of discoveries are translating into new diagnostic and treatment tools at an accelerated rate. Unfortunately, this comes at a time when the agencies that fund cancer research face dire cutbacks. Because Congress must make difficult decisions on what to cut, I went to Washington this week to speak to a committee of lawmakers about the relationship of the National Institutes of Health (NIH) to our nation's cancer centers. I felt it was important to offer tangible proof of the great strides that have been made in treating cancer because of NIH-funded research (Dr. Walter Curran, 3/14).

Health Policy Solutions (a Colo. news service): Sex Ed A Matter Of Public Health, Not Politics
In 2007, Colorado passed a law stating that if sexual health education is offered as part of a school’s curriculum, then it must be comprehensive in nature. In other words, education provided to youth must include information about abstinence in addition to the prevention of pregnancy and sexually transmitted diseases through condom and contraceptive use. However many school districts have elected to either not teach sex education due, in part, to the lack of resources or because they find the current legal guideline too vague and confusing -- making it extremely difficult to fully implement (Vicki Cowart, 3/14).

Health Policy Solutions (a Colo. news service): How Medicaid Expansion Harms Patients
Medicaid expansion would limit access to care for the significant fraction of the currently uninsured who would otherwise be eligible for federal premium subsidies under Obamacare. It raises costs for state taxpayers, increases costs for people who are hospitalized and prevents state insurers from collecting millions of dollars in federal subsidy money. Naturally, the Colorado Hospital Association favors it (Linda Gorman, 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.