Daily Health Policy Report

Monday, March 18, 2013

Last updated: Mon, Mar 18

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Coverage & Access


Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Hospital Ratings Are In The Eye Of The Beholder

Kaiser Health News staff writer Jordan Rau reports: "Evaluations of hospitals are proliferating, giving patients unprecedented insight into institutions where variations in quality can determine whether they live or die. Many have similar names, such as 'Best Hospitals Honor Roll,' 'America's Best Hospitals' and '100 Top Hospitals.' Illinois, Florida and other states have created their own report cards. In some places, such as California, there are more than a dozen organizations offering assessments on hospital quality" (Rau, 3/18). Read the story and check out the list of hospital ratings websites.

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Capsules: 29 States Get 'F' For Price Transparency Laws; Matchmaker, Er, Match Week, Make Me A Doc

Now on Kaiser Health News' blog, Russ Mitchell reports on state health care cost transparency laws: "Wonder why you can't get a straight answer on how much a health care procedure will cost you? One big reason: State laws which allow hospitals and other providers to keep costs hidden until they send you the bill. A report card on price transparency released today gives 29 states an 'F' and seven states a 'D' for policies that keep patients and their families in the dark on prices. The failing grade went to those with practically no transparency requirements (Mitchell, 3/18).

Also, Ankita Rao reports on medical students and their hope to find a perfect match: "Fourth-year medical students have been talking a lot about their perfect match these days: first impressions, the one who called right after they met, some that were too far away. For many, 'match week' – this week — is what they've been working toward over the past four years. It's the week that decides if, and where, they will complete the next step of their training and become a full-fledged doctor" (Rao, 3/15). Check out what else is on the blog.

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Political Cartoon: 'Parlor Games?'

Kaiser Health News provides a fresh take on health policy developments with 'Parlor Games?' by Clay Bennett.

Meanwhile, here is today's health policy haiku:


'Big Dance' time again
And not just the b-ball kind:
Continuing Rez.

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

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Capitol Hill Watch

Some Lawmakers Signal Openness To Grand Deal On Deficit

Sen. Bob Corker, R-Tenn., suggested during the Sunday talk shows that a deal that includes tax revenue and changes to entitlement programs including Medicare is possible while Sen. Dick Durbin, D-Ill., conveyed openness to Medicare changes. Durbin's comments included shots at the House budget plan advanced by Rep. Paul Ryan, R-Wis.

The New York Times: Republicans Act With Air, If Not A Vote, Of Confidence
In Congress, Republicans are pushing an agenda that is almost identical to the one that their party lost with in November, with no regrets and few efforts to reframe it even rhetorically. The House will vote this week on the third iteration of Mr. Ryan's budget, which would again try to turn Medicare into a subsidy for private insurance purchases, slash the top income tax rate and cut deeply into programs the president campaigned to protect (Weisman, 3/17).

The Wall Street Journal's Washington Wire: Corker: Deal Possible On Taxes, Entitlements
A Republican senator said Sunday that his party would be open to raising tax revenue as part of a broader deal that makes changes to Social Security and Medicare, a sign that President Barack Obama and at least some GOP lawmakers have a pathway to starting talks on a sweeping deficit-reduction package (Nicholas, 3/17).

Politico: Durbin Hits Ryan Budget, Eyes Medicare Reform
While suggesting Democrats were open to reforming Medicare and other entitlements, Senate Majority Whip Dick Durbin also took some shots Sunday at Rep. Paul Ryan's budget, saying it would eliminate Medicare. Appearing on "Fox News Sunday," Durbin said that once the Senate passes the budget resolution fashioned by Sen. Patty Murray (D-Wash.), "we're going to move to the next stage, and that is the grand bargain stage" (Kopan, 3/17).

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Health Reform

Medicaid Expansion Continues To Be Florida Flashpoint

Health advocates and some lawmakers rallied last week in Tallahassee to expand Medicaid coverage, but the Florida House speaker says the expansion is "dead" in his state. In addition, debate over this health law provision continues in Louisiana.

The Associated Press: Lawmakers, Health Advocates Lobby For Medicaid Expansion
Health advocates and a few lawmakers spent the week in Tallahassee rallying the Legislature to expand Medicaid coverage to roughly 1 million Floridians after panels in both chambers rejected traditional Medicaid expansion under the Affordable Care Act. A House committee first rejected expansion, calling Medicaid a broken program and citing fears the federal government would not live up to its promise to fund 100 percent of the program for the first three years and 90 percent after that. A Senate committee also shot down straight Medicaid expansion Monday (3/18).

Politico: Florida House Speaker Will Weatherford: No Medicaid Expansion
Florida GOP House Speaker Will Weatherford declared in an interview that the prospect of Medicaid expansion in his state is "dead" – regardless of any additional lobbying from Gov. Rick Scott (Martin, 3/16).

The Associated Press: Louisiana Spotlight: Little Data For Medicaid Opposition
If Gov. Bobby Jindal's administration wants to back up its claims that the governor's rejection of the expansion of Medicaid isn't political grandstanding, it might be helpful to present more data and research to citizens and lawmakers. A former Jindal administration Medicaid director and Republican lawmakers say they haven't received enough information to support the GOP governor’s refusal to cover more uninsured adults through Medicaid under the new federal health care law (Deslatte, 3/17).

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Minnesota Senate Poised To Vote On Health Exchanges

Meanwhile, a New Hampshire survey finds few residents are aware of the health insurance marketplaces starting soon, and a fight is brewing in California over how "enrollers" for the state's exchange will be screened.

The Associated Press: Minn. Health Care Exchange Heads For Final Votes
The Minnesota House moved closer Thursday to final passage of a plan to create an online health insurance marketplace that would give 1.3 million residents a new way to get coverage, a key element of the federal health care law. The House debated the bill for about two hours in the afternoon, then recessed with plans to take it up again later in the evening. Majority Democrats managed to narrowly defeat a Republican effort to send the bill back to committee, in a vote that hinged on the issue of abortion (Condon, 3/15).

MPR News: Senate To Vote On Revised Exchange Bill
The Minnesota Senate is expected to vote on a revised health insurance exchange bill on Monday in what could be the last stop for the bill before the governor's desk. The exchange will provide a new online marketplace for more than a million Minnesotans to obtain health insurance starting in October. The legislation to create an exchange in Minnesota has been controversial from Day 1. As a cornerstone of President Barack Obama's health care law, Republicans have lined up against it, arguing that it's part of a government takeover of health care (Stawicki, 3/17).

The Associated Press: Survey: Few NH Residents Aware Of New Health Insurance Markets
As New Hampshire prepares for the new insurance markets required under the federal health care overhaul, a recent survey highlights how little residents agree on or even know about the looming changes. New Hampshire Voices for Health — a network of more than 40 organizations that advocates for affordable, quality health care — hired an independent consultant to design and administer an online survey seeking input on how the marketplace should operate in New Hampshire (3/16).

Los Angeles Times: Call For Screening Of Healthcare Enrollers Meets Resistance
State officials say they need 20,000 people for the job of signing up millions of Californians for health insurance in the coming months, but a battle is brewing over whether these workers should undergo background checks and fingerprinting (Terhune, 3/15).

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A Key Health Law Question: Will Premium Costs Rise Or Not?

Politico explores how this issue is at the heart of how the health law will be judged.

Politico: Will Health Premiums Jump Or Not?
One major question remains at the center of the health care overhaul's ultimate success or failure — and Democrats and Republicans have spent the past three years each swearing they know the answer. Will the law cause insurance premiums to skyrocket, as Republicans vow, or will it slow costs down, as Democrats predict? (Cunningham, 3/18).

In other news, The Wall Street Journal writes about an emerging marketplace entity that is catching employees' interest -- the private health exchange.

The Wall Street Journal: To Save, Workers Take On Health-Cost Risk
Last fall, two big employers embarked on a radical new approach to employee health benefits, offering workers a sum of money and allowing them to choose their health plans on an online marketplace. Now, the first results are in: Many workers were willing to choose lower-priced plans that required them to pay more out of their pockets for health care (Mathews, 3/17).

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Coverage & Access

Retirees Struggle To Retain Health Benefits

News outlets offer several articles on how retiree health care costs continue to be an issue for both industries and cities. 

The Wall Street Journal: Retired Coal Miners Fight To Retain Health Benefits
Chief Executive Bennett Hatfield reiterated that the company's bankruptcy filing last July stemmed from weak coal markets "coupled with increased costs and unsustainable legacy liabilities." He argued that Patriot's "labor and retiree benefit costs have risen to levels that simply cannot be sustained" amid shrinking demand for coal. Instead, Patriot would like to create a trust with a maximum of $300 million from future profit-sharing to fund some level of retiree health benefits, far below its current retiree health liability of $1.6 billion. Some industry experts say Patriot also needs to shed retiree coverage because the health plans make its overall labor costs far higher than those of its nonunion competitors (Maher, 3/17).

The Associated Press: Study: 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, 3/16).

San Francisco Chronicle: S.F. Avoids Retirees' Health Care Issues
For politicians who get awfully riled up about exposed genitalia in the Castro or what to call our local airport, the good folks at City Hall sure do have a knack for looking the other way when it comes to matters of huge financial import. Take the city's $4.4 billion unfunded liability to pay for health care for its employees and retirees over the next 30 years. A new report from the Pew Charitable Trust crunched figures for the largest city in each of the country's 30 most populous metro regions for a look at how they're faring when it comes to affording the tab on their pension and retiree health care obligations (Knight, 3/16).

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Who Is Watching Hospital Quality, Price Transparency?

Kaiser Health News takes a look at the organizations that evaluate hospital quality. In addition, KHN reports on a grading system for state price transparency laws.

Kaiser Health News: Hospital Ratings Are In The Eye Of The Beholder
Kaiser Health News staff writer Jordan Rau reports: "Evaluations of hospitals are proliferating, giving patients unprecedented insight into institutions where variations in quality can determine whether they live or die. Many have similar names, such as 'Best Hospitals Honor Roll,' 'America's Best Hospitals' and '100 Top Hospitals.' Illinois, Florida and other states have created their own report cards. In some places, such as California, there are more than a dozen organizations offering assessments on hospital quality" (Rau, 3/18).

Kaiser Health News: Capsules: 29 States Get 'F' For Price Transparency Laws
Wonder why you can't get a straight answer on how much a health care procedure will cost you? One big reason: State laws which allow hospitals and other providers to keep costs hidden until they send you the bill. A report card on price transparency released today gives 29 states an 'F' and seven states a 'D' for policies that keep patients and their families in the dark on prices. The failing grade went to those with practically no transparency requirements (Mitchell, 3/18).

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Health Care Marketplace

More Med School Seniors Seek Primary Care Residency

The increased interest in residencies for internal medicine, family medicine or pediatrics may, in part, be the result of increased competition for specialty slots.

Medpage Today: Specialty Slot Contest Good For Primary Care?
More U.S. medical school seniors chose a primary care residency this year, but that may be driven by increased competition for specialty programs as the applicant pool widens, some experts say. Almost 400 more students opted for a residency in internal medicine, family medicine, or pediatrics this year than last, according to the National Resident Matching Program (NRMP). … The total number of applicants topped 40,000 this year. That's the largest figure in Match history and includes nearly 1,000 more U.S. seniors as three new medical schools -- two in Florida, one in Pennsylvania -- graduated their first classes (Fiore, 3/17).

Kaiser Health News: Capsules: Matchmaker, Er, Match Week, Make Me A Doc
Fourth-year medical students have been talking a lot about their perfect match these days: first impressions, the one who called right after they met, some that were too far away. For many, 'match week' – this week — is what they've been working toward over the past four years. It's the week that decides if, and where, they will complete the next step of their training and become a full-fledged doctor (Rao, 3/15).

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Generic Drugmaker Liability Question To Be Argued Tuesday Before The High Court

Reuters: Top Court To Hear Arguments Over Generic Drugmaker Liability
The Supreme Court will hear arguments on Tuesday in a case that could decide whether generic drugmakers can be held liable for alleged flaws in the designs of their medications, even though federal law requires generic manufacturers to copy the brand drugmaker's design. The case, closely watched by pharmaceutical companies, regulators and lawyers, could determine the extent to which individuals can hold generic drug manufacturers liable for injuries allegedly caused by their copycat products (Baynes, 3/18).

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State Watch

N.D. Lawmakers Pass 'Heartbeat' Abortion Ban

North Dakota lawmakers have passed a bill that would ban abortions there, with few exceptions, after a fetal heartbeat can be detected -- after about six weeks. The ban would one of the most restrictive abortion laws in the nation.

Politico: North Dakota Passes Restrictive Abortion Law
The North Dakota Legislature has approved a bill that would ban abortions at approximately six weeks. That would be the earliest abortion ban in the nation and likely set up a clash with the Supreme Court's long-established Roe v. Wade precedent. The bill, passed by the state Senate on Friday after passage in the House last month, is one of a half-dozen strict anti-abortion bills the Legislature is considering this session. It would ban most abortions after a heartbeat is detected -- which is typically six weeks to seven weeks into a pregnancy -- with an exception for the health or the life of the mother (Smith, 3/18).

Reuters: North Dakota Senate Approves 'Heartbeat' Abortion Ban
The North Dakota Senate approved what would be the most restrictive abortion law in the United States on Friday, a measure banning the procedure in most cases once a fetal heartbeat can be detected, as early as six weeks. Senators also approved a second bill on Friday that bans abortions based solely on genetic abnormalities, the first state ban of its kind if signed into law (Thompson, 3/15).

In San Francisco, a city leader wants to expand the "bubble" around abortion clinics from anti-abortion protesters --

San Francisco Chronicle: Measure Expands Abortion Clinic 'Bubble'
Anti-abortion protesters will no longer be able to stand directly in front of Planned Parenthood and other San Francisco clinics that offer reproductive services if one city supervisor has his way. Supervisor David Campos is planning to introduce legislation Tuesday that would create a 25-foot buffer zone around the entrances, exits and driveways of those facilities, excluding hospitals. He and supporters of the proposal say it would spare women who use the facilities from harassment. … A city law passed in 1993 created an 8-foot "bubble zone" around anyone who is within 100 feet of a health care facility, but Campos said that has been ineffective. Demonstrators, he said, get around the law by staying in one spot and not approaching clinic visitors (Riley, 3/17).

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State Roundup: Minn. Nurses Give On Staff Levels For Study

A selection of health policy news from California, Massachusetts, the District of Columbia, Minnesota and Oregon.

Los Angeles Times: L.A. County Backs Bills On Outpatient Mental Health Treatment
The Los Angeles County Board of Supervisors has thrown its weight behind Laura's Law -- which allows counties to create court-ordered outpatient mental health treatment for the severely ill who have cycled through hospitals or jails and refused voluntary care -- saying in a resolution that such programs have been shown to "significantly reduce" homelessness, hospitalization and arrest (Romney, 3/18).

PBS NewsHour: California Law That Aspires To Improve Mental Health Raises Coercion Concerns (Video)
In the wake of several recent shootings, politicians and commentators have called for improved mental health screening and treatment. Spencer Michels reports on a program in California called "Laura's Law," an unfunded mandate that has proven difficult to implement and has drawn concern about involuntary treatment for patients (3/15).

The Washington Post: Future Of D.C.'s United Medical Center Still Uncertain
In the fractious universe of D.C. politics, there is one thing upon which virtually every elected city official agrees: There must be a full-service hospital east of the Anacostia River. But nearly three years after the city seized control of United Medical Center, the fate of the 354-bed facility on Southern Avenue SE remains uncertain (DeBonis, 3/17).

MPR News: Nurses Set Aside Goal On Hospital Staffing
Minnesota nurses have agreed to relinquish a legislative goal to establish mandated staffing levels in hospitals. The Minnesota Nurses Association and hospitals reached a compromise on Friday that would direct the state Department of Health to study the correlation between staffing levels and patient outcomes. It would mean the hospitals' first public disclosure of staffing levels. Nurses association first vice president Bernadine Engeldorf said the union made the compromise so the two sides could work toward increased patient safety (Shenoy, 3/16).

The Oregonian: Oregon Nurses Association Joins 1.5 Million-Member National Union
The Oregon Nurses Association today approved an affiliation agreement with the American Federation of Teachers, bringing more than 10,400 Oregon registered nurses into the 1.5 million-member union of educators and government and health care employees. Union officials called the agreement historic. "Educators and nurses share a mutual respect, mutual priorities and a mutual desire to provide our members with the tools and conditions they need to do their jobs," AFT President Randi Weingarten said in a statement. ... ONA President Steve Rooney said in a statement that the affiliation is important as nurses deal with a rapidly changing health care industry and the implementation of the Affordable Care Act, the controversial health care overhaul legislation (Hottman, 3/16).

Boston Globe: Children's Access To Mental Care In Mass. Is Growing
Children who go to a Wellesley pediatrician can, if needed, see a psychologist in a nearby exam room. At a medical office in Peabody, boys and girls with anxiety issues can simply go upstairs to see a social worker. And at a Newton pediatric clinic, children with attention-deficit hyperactivity disorder are able to see an on-site nurse practitioner specializing in mental health. These are among a growing number of Massachusetts pediatric practices that are sharing space with mental health professionals, a move aimed at improving access to hard-to-obtain psychological services and at sending the message that treating children's depression and behavioral issues is as important as following their asthma and diabetes (Wen, 3/18).

Los Angeles Times: Addressing Girls' Health Needs At Juvenile Detention Centers
Now 18, she is in Los Angeles County's juvenile justice system because she violated probation. Latrice says she has been locked up more than 20 times in four years. Petite and talkative, she has attention deficit hyperactivity disorder and takes antidepressants. Her health issues -- and those of about 9,400 girls in juvenile detention centers around the nation -- are serious and complex. Many of the girls don't have regular doctors, so their physical and emotional problems often go undiagnosed and untreated. That continues when they enter a system that was designed for boys and has been slow to adapt to girls (Gorman, 3/16).

California Healthline: State Advocates Happy Over Federal WIC Action
Action by a U.S. Senate committee has family advocates in California breathing a sigh of relief. The Women, Infants and Children program -- which supplies food, breastfeeding services and other benefits to low-income mothers -- was included in the federal sequestration cuts, but this week the Senate appropriations committee included funding for it in an amendment to the Consolidated and Further Continuing Appropriations Act of 2013, and that means good things for the WIC program in California, according to Laurie True, executive director at the California WIC Association. True spoke yesterday at a state budget subcommittee hearing (Gorn, 3/15).

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Editorials and Opinions

Viewpoints: Two Views Of Medicare Equipment Bidding Changes; High Court Case May Impact FDA Approval Process

USA Today: Medicare Bidding Competition In Danger: Our View
In 2010, Medicare spent more than $14 billion on oxygen devices, mobility scooters, diabetes test strips and other "durable medical equipment" and supplies that patients use at home. For taxpayers, and for beneficiaries with a 20% co-pay, that was about $5 billion too much. Everyone overpaid because for years, Medicare bought or rented things like this on a fee schedule set by Congress, for prices that had nothing to do with normal market competition (3/18).

USA Today: Fix The Sham Bidding Program: Opposing View
In 2003, Congress required Medicare to ensure that medical equipment and supplies used by beneficiaries at home (known as "durable medical equipment," or DME) are procured through a system that increases competition and achieves market-based prices, but doesn't diminish quality. Unfortunately, Medicare has completely mismanaged the design and implementation of its bidding program for home oxygen equipment, power wheelchairs, diabetic supplies and other critical home medical products (Tyler J. Wilson, 3/18).

The New York Times: Drugs For Early Stage Alzheimer's
The Food and Drug Administration has proposed lowering the bar for approving drugs to treat people at the earliest stages of Alzheimer's disease, before they have developed any serious impairment or overt dementia. The goal is commendable — to find ways to prevent or slow the progression of this terrible disease before it can rob people of their mental capacities. But the proposal raises troubling questions as to whether the agency would end up approving drugs that provide little or no clinical benefit yet cause harmful side effects in people who take the medications for extended periods (3/17). 

Los Angeles Times: Battle Over 'Biosimilars'
One of the most promising frontiers in healthcare is biologic medicines — complex substances derived from living cells that can help fight chronic diseases and cancers. To encourage investment in biologics, Congress in 2010 gave drug companies what amounts to a 12-year monopoly on the substances they developed. Now, supporters of biologics are pushing lawmakers in Sacramento and other state capitals to put new hurdles in the way of knock-off compounds, called "biosimilars" (3/17). 

Politico: Court Case Could Undermine Drug Approval Process
On Tuesday, the Supreme Court will weigh a novel legal theory being advanced by the trial bar that, if upheld, could become the torts' next big payday against drugmakers. The case could also undermine the basic tenets of the Food and Drug Administration's process for approving new medicines. For this latter reason, the trial bar finds itself on the other side of the Obama administration, which has filed an amicus brief in the case (Scott Gottlieb, 3/17).

The New York Times: The Real Spending Problem
[T]he taxes-versus-spending distinction is largely meaningless. Each year, the government doles out tax breaks worth $1.1 trillion. That is more than the cost of Medicare and Medicaid combined. ... Yet in budget talks, Republicans ignore tax entitlements, which flow mostly to high-income taxpayers, while pushing to cut Medicare, Medicaid and Social Security (3/16).

The Washington Post: America The Retirement Home
The budget debate' central reality is that federal retirement programs, led by Social Security and Medicare, are crowding out most other government spending. Until we openly recognize and discuss this, it will be impossible to have a "balanced approach" — to use one of President Obama's favorite phrases. It's the math: In fiscal 2012, Social Security, Medicare, Medicaid and civil service and military retirement cost $1.7 trillion, about half the budget (Robert J. Samuelson, 3/17).

Reuters: 2014: The Democrats' Dilemma
Obama continues to seek a "grand bargain," reiterating his willingness to cut Medicare and Social Security in exchange for Republican acceptance of greater revenue – largely from closing loopholes. Entrenched Republican opposition to any tax increase has thus far saved the country and the president from any deal. But the president's very public pursuit makes more and more Americans aware of the proposed terms. Republicans show their base that they are standing staunch against any further tax hikes, while pushing hard to slash spending. In contrast, the president suggests to his base that he is open to abandoning the commitment to defend Social Security and Medicare if the price is right (Robert L. Borosage, 3/18).

The Medicare NewsGroup: The Potent Opposition To Medicare's Proposal For Greater Drug Rebates
One of the largest potential savings Medicare could reap is from drug costs, and that would come from asking drug companies for bigger rebates. Medicaid and the Veteran's Administration each demand steep discounts as single payers, as do most governments with national health programs. But Medicare is unlikely to get similar huge markdowns from drug companies and middlemen anytime soon because the proposal faces a torrent of opposition from the pharmaceutical lobby and legislators allied with it (John Wasik, 3/15).

The Wall Street Journal: New Medicaid's Roach Motel
The Republican Governors of Arizona, Florida and Ohio who helped lead the constitutional challenge to ObamaCare but have since decided to expand Medicaid have a problem. They need to persuade their skeptical Republican legislatures to pass bills endorsing their flips, and now they're searching for any legal alibi in a storm (3/15). 

Des Moines Register: Medicaid Expansion Is No Pot Of Gold
My personal view is that it’s in the public interest to make sure everyone has access to health care at the least possible cost to taxpayers. ... If Medicaid doesn't shift to quality-based payment models and discourage patients from using the emergency room as a walk-in clinic, the state should find a way to do that. There's no free pot of gold. Taxpayers are paying for this health care out of one pocket or the other. Leaving people without insurance raises health care costs for everyone. So the argument is not really about who pays. It’s about who will get health care, how much they’ll get and who will manage it. Better that we recognize that and stop chasing rainbows (Kathie Obradovich, 3/16).

Kansas City Star: Renew KC's Vital Health Levy For Indigent Care
Compassionate Kansas City voters approved a property tax increase in 2005 to help provide medical care for thousands of indigent people and operate the city’s ambulances. The need for those crucial health care services still exists. The Star recommends a yes vote on Question 1 on April 2, to renew that property tax through 2023. ... If Missouri legislators refuse to take hundreds of millions in federal funds for better Medicaid coverage — an unfortunate possibility, given GOP intransigence on the matter — Truman (Medical Center) in particular could sustain a severe financial hit. Keeping the full health levy in place would be a smart move for taxpayers and a crucial investment in better health for the entire community (3/16).

The Lund Report: Breaking Down Healthcare's Silos
I have often thought that breaking down the silos that exist in our healthcare system is an important step in transforming our fee-for-service healthcare system into one where we pay for health, quality, and cost-effectiveness. My thoughts about silos have focused on clinicians' reluctance to adapt to electronic health records (EHRs), hospitals purchasing physician practices (e.g., we must own them) and not properly incentivizing them, and health information technology vendors insisting on their form of contracts, and contending they are the platform, rather than facilitating interoperability (Paul DeMuro, 3/16).

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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.