Daily Health Policy Report

Tuesday, March 19, 2013

Last updated: Tue, Mar 19

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Care Marketplace

Public Health & Education

Coverage & Access

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insuring Your Health: Group Appointments With Doctors: When Three Isn't A Crowd

Kaiser Health News: Insuring Your Health: Group Appointments With Doctors: When Three Isn't A Crowd
In her latest Kaiser Health News' consumer column, Michelle Andrews writes: "When visiting the doctor, there may be strength in numbers. In recent years, a growing number of doctors have begun holding group appointments -- seeing up to a dozen patients with similar medical concerns all at once. Advocates of the approach say such visits allow doctors to treat more patients, spend more time with them (even if not one-on-one), increase appointment availability and improve health outcomes" (Andrews, 3/19). Read the column.

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Political Cartoon: 'Don't Count Your Chickens?'

Kaiser Health News provides a fresh take on health policy developments with "Don't Count Your Chickens?" by Steve Kelley.

Meanwhile, here is today's health policy haiku:

A ROSE BY ANY OTHER NAME

Expand Medicaid
but give it another name:
The Florida plan.
-Anonymous 

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

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Health Reform

Federal Government May Need To Enforce Health Law In Some States

Politico reports that insurance officials in at least four states won't implement insurance market changes that are part of the law, leaving that task to federal officials. Meanwhile, the Obama administration offers new rules and statistics related to implementation.

Politico: Feds Will Need To Enforce ACA Reforms In 4 States
At least four states won't enforce new sweeping insurance market reforms rolling out next year with the health law — leaving federal health officials in Washington to pick up the slack, yet another wrinkle in Obamacare implementation. Insurance regulation is a huge responsibility that’s been closely guarded by the states. That’s why the Obama administration and those closely watching the rollout of Obamacare believe that even states that have sworn off the law’s coverage expansions will still enforce its new measures — including new benefit mandates, cost-sharing guidelines and rules on how insurers rate customers — to retain control over their health insurance markets (Millman, 3/19).

The Associated Press: Senate Health Committee Wants Feds To Set Rates For Insurers
A [Florida] Senate health committee recommended Monday that the state suspend the Office of Insurance Regulation's power to set rates for insurers under the Affordable Care Act and instead let the federal government handle that responsibility. With federal officials issuing new regulations weekly, lawmakers decided it would be best for those officials to oversee that approval process for the next year or two, especially because there likely will be large rate increases (Kennedy, 3/18).

The Hill: New Regulations Limit Waiting Periods For Employer Health Plans
Employers can't make workers wait more than 90 days to use their healthcare coverage, the Obama administration said in new regulations Monday. The proposed rules implement part of the Affordable Care Act that prohibit waiting periods longer than 90 days before health coverage kicks in (Baker,3/18).

Modern Healthcare: 71 Million Received Free Preventive Care Under ACA: HHS
The Obama administration says about 71 million privately insured Americans received coverage for at least one free preventive healthcare service as a result of the Patient Protection and Affordable Care Act in 2011 and 2012. HHS' Office of the Assistant Secretary for Planning and Evaluation arrived at that conclusion using data from a Kaiser Family Foundation survey and U.S. Census Bureau data. The Kaiser survey estimated that 41% of all workers had employer-backed insurance that expanded coverage as a result of the ACA. That figure, when applied to Census Bureau data showing that 173 million Americans have such coverage, results in the estimate of 71 million people receiving the free services (Barr, 3/18).

Also in the news, Medpage Today reports on the impact of the health law on HIV coverage -

Medpage Today: ACA: HIV Coverage Still Unclear
The Affordable Care Act (ACA) goes a long way to protect gays and lesbians against discrimination, but much of the law's impact on them -- as well as on anyone living with HIV -- remains to be seen, advocates [in Washington] said Monday. The recently finalized Essential Health Benefits rules, which lay out the minimum coverage requirements for health plans, prevent insurers from discriminating based on sexual orientation, gender identity, and preexisting health conditions including HIV, noted Kellan Baker, associate director for LGBT [lesbians, gays, bisexuals, and transgendered people] research and communications at the Center for American Progress (CAP), a left-leaning advocacy group. The landmark 2010 health law also ends the lifetime cap on health insurance benefits and extends coverage to those with preexisting conditions -- both important provisions for those living with HIV because the cost of care is so high, Baker said at an event sponsored by the center (Pittman, 3/18).

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Minnesota Legislature Approves Health Exchange Bill, Sends It To Governor

Minnesota Gov. Mark Dayton has vowed to sign the measure. In Michigan, though, Gov. Rick Snyder warned that time is running out and state lawmakers have until the week's end to approve a partnership exchange.

MPR News: Health Exchange Bill Passes Minn. Senate, Heads To Dayton's Desk
Historic and controversial legislation creating a new way for a fifth of Minnesota's population to obtain health insurance is now on its way to Gov. Dayton's desk. And he has promised to sign it. ... Minnesota will now become one of at least 17 states that develop and run their own exchanges (Stawicki, 3/18)

The Associated Press: Major Insurance Overhaul Passes At Minnesota Capitol
More than 300,000 uninsured Minnesotans will have a route toward health coverage under a bill the state Senate passed Monday, the final legislative step toward implementing one of the major features of the new federal health-care law. The Senate approved the health insurance exchange bill on a party-line vote of 39-28. They sent the bill to Gov. Mark Dayton, who has vowed to sign it and whose administration already has been working for months on setting up the venture and hiring its employees ahead of a planned Oct. 1 enrollment debate (Condon, 3/19).

The Associated Press: Michigan Governor Says Time Running Out To Work With Feds On Health Exchange
Gov. Rick Snyder warned Monday that time is running out to work with the federal government to establish an online health care marketplace and that people would likely regret lawmakers' failure to act. The Republican governor told The Associated Press the GOP-dominated Senate has until week's end to approve a partnership exchange — a key component of the federal health care overhaul — before legislators go on a two-week spring break. He said there is not enough time afterward, and his administration is talking with lawmakers in an effort to get legislation passed this week (Karoub and Eggert, 3/19).

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Arkansas Report Finds Little Additional Federal Costs Would Result From State's 'Private Option' For Medicaid Expansion

The report, issued by the Arkansas Department of Human Services, found that the plan would add less than 15 percent to federal health care costs in the state. In Florida, an alternate Medicaid plan was unveiled and slated for a hearing by a key Senate panel. In addition, news outlets offer reports from Texas, Wisconsin and Kansas.

Reuters: Arkansas Health Plan For Poor To Add Limited Federal Costs: Report
A cost analysis released on Monday shows that a state plan to move Medicaid-eligible low-income citizens into a "private option" under upcoming federal healthcare exchanges would result in little additional federal costs. The report by the state Department of Human Services, with input from the Arkansas Insurance Commission and consultants, addresses concerns that private insurance would cost up to 50 percent more than standard Medicaid (Parker, 3/18).

The Associated Press: Ark. DHS Releases New Estimates For Plan To Allow Medicaid To Purchase Private Insurance
A plan to use Medicaid funds to purchase private insurance for newly eligible recipients would add less than 15 percent to federal health care costs in the state, according to new estimates that the Arkansas Department of Human Services released Monday. DHS officials said it's also possible that the so-called 'private option' plan would add no additional federal costs (Nuss, 3/18).

Health News Florida: Sen. Negron Unveils Alternative Plan
"Healthy Florida," Sen. Joe Negron's plan to cover 1 million low-income working adults, is now in writing and has been placed on the agenda for Thursday's meeting of the Senate Appropriations Committee. SPB 7038 is likely to get a respectful hearing there, since Negron chairs that committee. The bill is posted for reading online, with the pertinent section beginning at line 1077 (Gentry, 3/19).

Bloomberg: Perry Pressured By Texas Businesses Over Medicaid Refusal
Chambers of commerce representing companies such as Exxon Mobil Corp. (XOM) and Kimberly-Clark Corp. (KMB) are challenging Texas Governor Rick Perry and lawmakers to expand health care for the poor in the state with the highest percentage of uninsured people. The chambers of five cities are sending lobbyists to press Republican leaders to increase Medicaid coverage under President Barack Obama’s health-care law (Mildenberg, 3/18).

Milwaukee Journal Sentinel: Scott Walker Medicaid Decision Could Cost Wisconsin Employers $36 Million
Caught between President Barack Obama's health care law and Gov. Scott Walker's resistance to it, Wisconsin employers could pay up to $36 million more in federal taxes next year, a new study has found. Walker last month rejected expanding the state's BadgerCare Plus health care program to the full limits called for and funded under the federal health care law. The federal government is supposed to pay the largest share of expanded coverage through 2020, but Walker has said he's not convinced it will be able to sustain its part of the deal - in which case the costs could fall back to the state. However, a national study by Jackson Hewitt Tax Service Inc. estimates that Walker's decision could leave Wisconsin employers with federal penalties of between $24.1 million and $36.1 million a year (Stein, 3/18).

Kansas Health Institute: Kansas On Track For Oct. 1/Medicaid/Insurance Exchange Connection
After months of trying to dance around the politically charged issue, the administration of Gov. Sam Brownback has openly acknowledged that the $139 million Medicaid enrollment system that it is building will be interconnected with the online health insurance exchange required by the Affordable Care Act, and that the system will be ready to go by the Oct. 1 federal deadline (Cauthon, 3/18).

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Capitol Hill Watch

Passage Likely For Government-Wide Spending Bill

Even as the bipartisan measure, which would fund the federal government through the current fiscal year, progresses through Congress, the larger deficit debate continues as the parties move forward with starkly different fiscal blueprints.

The Associated Press/Washington Post: Congress Works On Budget For Both 2013 And Future; Passage Of Catchall Spending Bill Likely
Congress is finally cleaning up its unfinished budget business for the long-underway 2013 budget year with a bipartisan government-wide funding bill, even as the combatants in the House and Senate gear up for votes this week on largely symbolic measures outlining stark differences between Democrats and Republicans about how to fix the nation’s long-term deficit woes. … House Republicans are moving first with a plan sharply slashing health care for the poor, budgets for domestic agencies like the FBI and the National Park Service, and safety net programs like food stamps. Senate Democrats are countering with a mostly stand-pat approach that hikes taxes by almost $1 trillion over a decade while reversing already-enacted across-the-board spending cuts that are slamming both the Pentagon and domestic agencies (3/19).

The Wall Street Journal's Washington Wire: House GOP Group Would End Deficit In 4 Years
The Republican Study Committee, an influential group of 171 conservative House lawmakers, introduced a budget Monday that it says would eliminate the deficit in four years through deeper spending cuts and more immediate changes to federal health-care programs than the Ryan plan, which the House is expected to vote on later this week. Unlike the blueprint from Mr. Ryan, a Wisconsin Republican, the RSC plan would offer seniors the option of buying private health insurance or traditional Medicare beginning in 2019 and exempt only those 60 years old and older. The House Budget Committee plan for Medicare would not kick in until 2024, and wouldn't affect those 55 and older. And only the conservative plan proposes raising the Medicare eligibility age to 70 from 65, starting in 2024 (Peterson, 3/18).

Politico: New Republican Message: Balanced Budgets
Instead of focusing on selling the conversion of Medicare into a premium support program, Republicans will incessantly pound home the theme of balancing the budget, GOP leaders say. When talking about the Democrats’ plan, Republicans criticize it for attempting to raise taxes and the fact that it doesn’t balance the budget (Sherman, 3/18).

Georgia Health News: Rep. Upton Urges Bipartisanship On Entitlements
Both political parties must work together to produce savings in entitlement programs, which is necessary to balance the federal budget, the chairman of a key congressional committee told an Atlanta audience Monday. Entitlement programs Medicare, Medicaid and Social Security are "the big elephant in the room," Rep. Fred Upton (R-Mich.), chairman of the House Energy and Commerce Committee, said at a health care forum sponsored by the law firm King & Spalding. He noted that the budget plan released last week by House Budget Committee Chairman Paul Ryan (R-Wis.) did not include savings from entitlement programs (Miller, 3/18).

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Health Care Marketplace

Spending On Prescription Drugs Dropped Slightly in 2012

The decrease was miniscule, but it was the first time since 1957 that the research firm IMS Health had recorded a dip in United States drug expenditures, reports The New York Times. In related news, more effective use of medications could lead to Medicare savings, according to the Congressional Budget Office.

The New York Times: U.S. Drug Costs Dropped In 2012, But Rises Loom
Spending on prescription drugs nationwide has been slowing for years because of the increasingly widespread use of low-cost generics. But in 2012, something unheard-of happened: money spent on prescription drugs actually dropped (Thomas, 3/18).

The Medicare NewsGroup: Spend More, Save More: How Expanding Part D Could Pay Off For Medicare
Better use of medications can save money for Medicare by helping beneficiaries avoid some hospital and physician services, and growth in Part D activity is expected to shave $35 billion from Medicare’s expected spending of $5.6 trillion between 2011 and 2022, according to the Congressional Budget Office (CBO). The savings bolster the political argument for supporting Part D expansion at a time when politicians and health care experts worry about slowing the growth of the mammoth federal budget deficit. The CBO’s proof of savings is new (Rosenblatt, 3/18).

In other news, The New York Times reports on calls to ensure that taxpayers benefit from government-subsidized research that helps to produce lucrative drugs -

The New York Times: Seeking Profit For Taxpayers In Potential Of New Drug
With automatic spending cuts cascading through the government, lawmakers are calling for a review of federal policies they say have allowed businesses to profit on government research with limited return for taxpayers or consumers. That re-examination could be particularly intense in federal science, once a corner of the government with bipartisan protection that has become something of an orphan caught between Republican efforts to protect the military and Democrats’ defense of Social Security and Medicare. Now, advocates for creative new funding policies might have an example for their cause (Weisman, 3/18).

Finally, the Supreme Court will hear arguments today in Mutual Pharmaceutical v. Bartlett, a case that could impact the availability of generic drugs in the U.S.

Marketplace: Cheap Generic Drugs Face Possible Legal Liabilities
According to John Hertig, associate director of the Center for Medication Safety at Purdue University's College of Pharmacy, a generic drug and a brand name drug are chemically identical. "We are talking about medications that are intended to do the same thing," he says, and they can have the same adverse reactions. Later this morning, the Supreme Court hears arguments in Mutual Pharmaceutical v. Bartlett, a case that could have big implications on the availability of generic drugs in the U.S. (Gura, 3/19).

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Public Health & Education

New Alzheimer's Data Highlight The Disease's Deadly Toll

According to figures released by the Alzheimer's Association, deaths from Alzheimer's and other forms of dementia rose 68 percent  between 2000 and 2010.  

NPR: Alzheimer's 'Epidemic' Now A Deadlier Threat To Elderly
Alzheimer's disease doesn't just steal memories. It takes lives. The disease is now the sixth leading cause of death in the U.S., and figures released Tuesday by the Alzheimer's Association show that deaths from the disease increased by 68 percent between 2000 and 2010 (Hamilton, 3/19).

The Associated Press/Washington Post: Beyond Memory Loss, Report Finds 1 in 3 Seniors Dies With Dementia That Can Impede Other Care
A staggering 1 in 3 seniors dies with Alzheimer's disease or other types of dementia, says a new report that highlights the impact the mind-destroying disease is having on the rapidly aging population (3/19).

USA Today: One In Three Elderly Have Dementia When They Die
Deaths from Alzheimer's and other forms of dementia have increased 68% from 2000 to 2010, according to the report being released today by the Alzheimer's Association, an advocacy group. Meanwhile, deaths from heart disease, HIV/AIDS and stroke have declined. The numbers are taken from Medicare and Medicaid reports (Lloyd, 3/19).

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Coverage & Access

Study: Patients In Wheelchairs Often Have Trouble Making Appointments With Specialty Docs

One in five speciality practices said they couldn't accommodate the needs of disabled patients using wheelchairs, researchers report.

Reuters: Disabled People May Struggle To Get Specialty Care
Rachel Markley often feels uncomfortable when she goes to the doctor. … A new study suggests she's far from alone. More than one in five specialty practices told referring doctors they couldn't accommodate a wheelchair-bound patient during phone surveys of 256 U.S. offices. Another 40 percent of practices told callers they could accept the patient, but would have to transfer her manually to an examination table -- which could be risky for patients and healthcare workers alike, researchers said (Pittman, 3/19).

The Boston Globe: Doctors Say Offices Not Equipped For Disabled
More than one in six Boston doctors' offices refused to schedule appointments for callers posing as disabled patients in wheelchairs, researchers at Baystate Medical Center reported Monday in a study of specialty practices that highlights obstacles to routine medical care. Legal specialists say the practice violates a federal law requiring that people with disabilities have access to appropriate care. Callers turned away by physicians in Boston and three other cities were mostly told the offices lacked an exam table that could be raised and lowered or a lift for transferring a patient out of their wheelchair. In some cases, practices were located in buildings inaccessible to people in wheelchairs (Kotz, 3/19).

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Do Workplace Wellness Programs Really Save Money?

The Associated Press/Washington Post: A Study Raises Doubts That Workplace Wellness Programs Save Companies Money
Your bosses want you to eat your broccoli, hit the treadmill and pledge you'll never puff on a cigarette. But a new study raises doubts that workplace wellness programs save the company money. Independent researchers tracking the wellness program at a major St. Louis hospital system for two years found that while hospitalizations for employees and family members dropped dramatically — by 41 percent overall for six major conditions — increased outpatient costs erased those savings (Alonso-Zaldivar, 3/18).

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State Watch

Federal Judge Strikes Mo. Law Exempting Some From Health Law's Birth Control Mandate

A federal judge has ruled that a Missouri law exempting moral objectors from the health law’s mandate on birth control coverage cannot stand.

The Associated Press/Washington Post: Federal Judge Strikes Down Mo. Law On Birth Control Coverage, Cites Conflict With Federal Law
A federal judge has struck down a Missouri law exempting moral objectors from mandatory birth control coverage because it conflicts with an insurance requirement under President Barrack Obama's health care law (3/18).

In the meantime, South Dakota lawmakers consider a ban on all abortions by defining life as beginning with conception.

The Associated Press/Washington Post: North Dakota Looks At Banning All Abortions By Defining Life As Beginning With Conception
North Dakota lawmakers who approved what would be some of the most restrictive abortion laws in the U.S. are now considering outlawing all abortions. The "personhood" measures would ban abortions by defining human life as beginning with conception. It's drawing opposition from some doctors who say it could cause problems for infertile couples seeking to use in vitro fertilization to conceive, but supporters insist that's addressed in the legislation (3/19).

And an influential anti-abortion group criticizes Republican efforts on abortion in 2012 races --

The Hill: Anti-Abortion-Rights Group Criticizes RNC Reboot
The Republican National Committee has learned the wrong lessons from its 2012 losses, the Susan B. Anthony List said Monday. SBA List, which opposes abortion rights, said the RNC took the wrong approach to abortion and other social issues in its report evaluating the 2012 election and making recommendations for future races (Baker, 3/18).

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State Roundup: Inmates Sue Calif. Counties Over Prison Care

A selection of health policy stories from California, Oregon, Michigan, Kansas, Massachusetts and New Jersey.

Los Angeles Times: California Scores Poorly On Posting Health Care Prices, Report Says
California consumers don't have easy access to prices for medical care, according to a national report card that gave the state a letter grade of D for its dismal showing. Overall, 36 states received grades of D or F in the report issued Monday by two nonprofit healthcare groups that analyzed government efforts to make pricing information widely available to consumers (Terhune, 3/18).

The Associated Press: Counties Now Facing Inmate Lawsuits
California has spent billions of dollars and endured years of federal lawsuits to improve conditions in its state prisons, but the problems it has been trying to correct are now trickling down to local governments as county jails deal with thousands of additional inmates. Law firms advocating for inmates' rights have sued or threatened lawsuits against a handful of California counties because of Gov. Jerry Brown's plan to send lower-level offenders to local jails instead of state prisons as a way to comply with a federal court order (Thompson, 3/19).

The Lund Report: Shields And Holvey Want Unlawful Trade Act To Cover Insurers
Sen. Chip Shields, D-Portland and Rep. Paul Holvey, D-Eugene, rolled out legislation last week that would open up the insurance industry to torts under the state's Unlawful Trade Practices Act and allow the attorney general to sue insurers for fraud. ... Shields said the special exemption allows insurance companies to act with impunity and reduces their incentive to pay out claims as warranted. If they commit fraud, they cannot be sued by the attorney general under any tort or statute (Gray, 3/19).

The Associated Press: Michigan Reveals Goals For State Autism Services
State health officials laid out long-term goals Monday designed to improve access to services for the estimated 50,000 people living with autism spectrum disorders in Michigan, including more early screening and the creation of a state resource center to provide families with information about services. The Autism Spectrum Disorders State Plan revealed by the Michigan Department of Community Health and Autism Council identifies gaps in the availability of services and makes recommendations for how to improve the lives of adults and children with autism spectrum disorders (Durkin, 3/19).

Los Angeles Times: Two Former CalPERS Officials Indicted On Fraud Charges
Three years after a major influence-peddling scandal rocked California and the nation's largest public pension fund, a federal grand jury indicted two former top officials on fraud, conspiracy and obstruction charges (Lifsher, 3/19).

The Lund Report: Troubled Oregon Counties Turn To Cigarette Tax For Public Health
Portland City Commissioner Steve Novick told the House Revenue Committee Friday that the state of Oregon trusts local governments to do a lot of things -- arrest people, put them in jail, set zoning ordinances, raise property taxes, even generate income taxes (Gray, 3/19).

Kansas Health Institute: Senate Panel Advances HIE Bill
A Senate panel voted today to advance favorably a bill that would shift regulatory power from KHIE, Inc. to the Kansas Department of Health and Environment. KHIE is the entity created in 2010 to oversee the digital exchange of patient records. State officials have said they could regulate the exchange networks without requiring additional funding. The shift also has been endorsed by the KHIE, Inc. board of directors (Shields, 3/18).

Medpage Today: Mass. Health Plans Aim To Slow Rising Costs
The state -- policymakers, insurers, and providers -- is taking steps to rein in cost. Gov. Deval Patrick (D) signed into law this summer a bill aimed at doing just that. Among its many provisions, the law tries to move providers away from a fee-for-service model, creates an independent Health Policy Commission, and sets a target growth rate of 3.6 percent in 2013. Patrick told attendees at the Association of Health Care Journalists' annual meeting here that the state "will crack the code on cost containment." In 2008, Blue Cross Blue Shield created an "Alternative Quality Contract" which provides a global payment to providers to care for the insurers' members (Pittman, 3/18).

California Healthline: Concern Over Mental Health Provider Shortage
Legislation introduced last week would expand the scope of practice for nurse practitioners, optometrists and pharmacists. Separate legislation looks to expand scope of practice for physician assistants, as well. The bills hope to address the dearth of primary care providers in California by allowing some mid-level health care providers to do more. With the Affordable Care Act's expansion of Medi-Cal and introduction of the state exchange starting in 2014, there is expected to be a much greater need for primary care services. Some mental health providers are citing a similar access concern for mental health professionals (Gorn, 3/18).

California Healthline: Legislature Will 'Look Carefully' At UC Medical System After Report
California state Sen. Ed Hernandez (D-West Covina), chair of the Senate Committee on Health, said state legislators will look into allegations of mismanagement at University of California medical centers that have put patient safety in jeopardy. A new report from the American Federation of State, County and Municipal Employees Local 3299 contends that the UC system's five medical centers are understaffed and patient care is suffering. … The report says frontline providers in hospitals and medical centers are understaffed, sometimes leading to dangerous situations threatening patient safety (Lauer, 3/18).

Medpage Today: One More Compounding Pharmacy Recalls Drugs
In a move that is reminiscent of last fall's fungal meningitis outbreak, a New Jersey compounding pharmacy is recalling all its products after fungal particles were found in bags of magnesium sulfate intravenous solution. The FDA said Med Prep Consulting of Tinton Falls, N.J., recalled all lots of all products after a Connecticut hospital observed the particles in the solution. As well, the FDA said in a release, the firm has temporarily halted production, including processing and shipping drugs, under an order from the New Jersey State Board of Pharmacy. There have been no reports of patients being infected, according to Janet Woodcock, MD, director of the FDA's Center for Drug Evaluation and Research (Smith, 3/18).

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Editorials and Opinions

Viewpoints: Protect The FDA's Regulatory Efforts; Generic Drug 'Shenanigans;' Does Ryan Not Understand The 2012 Election?

The Wall Street Journal: The Best Prescription For Pre-Emption
On Tuesday, the Supreme Court will hear arguments in Mutual Pharmaceutical v. Bartlett, a case about the ability of consumers to bring lawsuits against the makers of generic drugs. A central issue is the Food and Drug Administration's doctrine of federal "pre-emption," meaning that state tort law cannot trump FDA regulation. In Bartlett, the manufacturer is being sued for selling an allegedly flawed drug that was nevertheless approved by the FDA, which also regulated the manufacturer's exact formula. The pre-emption doctrine … was established to protect the agency's ability and authority to regulate the safety and effectiveness of drugs nationwide. The left detested pre-emption, since it impeded the ability of trial lawyers to bring big dollar lawsuits in state courts challenging FDA regulatory decisions (Tevi Troy, 3/18).

Los Angeles Times: Prescription Needed To Remedy Generic Drug Pricing Shenanigans
Wanda Ferrin fills her husband's prescription for the generic antibiotic doxycycline at a Target in Simi Valley. For years, the medication has cost her $6 a month. In February, however, the price tripled to $18 for 30 pills. And this month, it skyrocketed to $133. This is noteworthy enough. But what happened next makes the entire business of drug pricing a study in lunacy (David Lazarus, 3/18).

Milwaukee Journal Sentinel: A New Ryan Budget That Looks A Lot Like The Others
We're tempted to ask U.S. Rep. Paul Ryan: What part about losing the 2012 presidential election didn't you understand? ... The new spending plan, like the others Ryan has written, would make big changes to Medicare and Medicaid, cut tax rates on individuals and corporations, and reduce the size of domestic spending programs over time. The plan would restructure Medicare by paying subsidies to the insured rather than paying directly for medical services. Medicaid would become a block grant program. It repeals Obamacare while leaving in place Obamacare's taxes. ... continuing to call for a repeal of the Affordable Care Act is the height of folly (3/17).

Bloomberg: Paul Ryan's Budget Won't Help Republicans Win
Now that (Rep. Paul Ryan's budget plan is) advancing a version of Medicare reform with fewer risks for seniors, that slow phase-in makes less sense. And the plan should raise co-pays, especially for the affluent, which would also lighten the burden on younger people. A budget that reduced spending on those older than 55 would make it possible to bring the government's long-term debt to a manageable level while allowing for a higher (and more realistic) level of Medicaid spending than the Ryan budget includes. The House Republicans should have been bolder on health care, too. Their new budget envisions the repeal of President Barack Obama's health-care law but outlines no replacement for it, which is rather odd for a document that purports to provide a Republican vision for the future of the welfare state (Ramesh Ponnuru, 3/18).

The New York Times: Paul Ryan's Ax Isn't Sharp Enough
As a family doctor for more than 30 years, I understand that we must look for savings in our health care system too. I recently co-sponsored legislation that would convert Medicaid and the Children's Health Insurance Program into state-managed programs through a single federal block grant. This would save approximately $2 trillion over 10 years by capping federal funding at 2012 levels for the next 10 years and giving states an incentive to seek out and eliminate waste, fraud and abuse. ... We must repeal Obamacare — including the associated taxes, which the Ryan budget leaves intact by assuming the enactment of tax reform later on. We’ll replace it with a market-based health care system devoid of government involvement and managed by patients and their doctors. … If we get government out of the way and put Medicare in patients’ hands by increasing contribution limits to health savings accounts, it will transform Medicare into a more flexible premium assistance program (Rep. Paul C. Broun Jr., R-Ga., 3/18).

The Washington Post: Progressives' Budget Merits A Closer Look
Ryan’s budget is cruel, deceptive and incomplete. Even as the Affordable Care Act and Medicare expansion are being embraced by reality-based Republican governors (or those, such as Florida’s Rick Scott, who are experiencing a momentary bout of poll-induced realism), Ryan stubbornly ignores Congressional Budget Office evidence that the ACA decreases the deficit. Even at a moment when we need the safety net more than ever, Ryan wants to shred and slash programs including Medicare, Medicaid, food stamps and domestic violence prevention. And even as Ryan coasts on his unearned reputation as a serious wonk, his budget math is full of holes (Katrina vanden Heuvel, 3/18).

Houston Chronicle: The Case For A Texas Solution
The Texas Medicaid program as it presently exists has reached an unsustainable capacity. The current network of hospitals and physicians who care for our state's Medicaid population has reached a true breaking point. They can no longer welcome new patients under the existing model of coverage. ... It is true that Texas stands to gain coverage for a significant number of now-uninsured residents through any healthcare expansion, but an expansion of Medicaid also results in an expansion of patient need. As it stands, only about 30 percent of Texas physicians are willing to accept new Medicaid patients. Without reforms, those new patients will still find the Texas health care system inaccessible for preventive and primary care, leaving them seeking care in emergency rooms at a continued high cost to Texas taxpayers. The state's existing system is broken, and placing more pressure on an already broken system sets us up for a crisis (State Rep. John Zerwas, 3/17). 

Seattle Times: Expand Medicaid Under The Affordable Care Act To Improve Mental-Health Care
Our mental-health system has gaping holes and we cannot continue to ignore them. In our work at Downtown Emergency Service Center we see these holes reflected every day in the people who fall through them. Our mission is to provide the kind of care that helps people get back on their feet and find stability. Expanding Medicaid access to 250,000 people in our state under the Affordable Care Act will (Bill Hobson and Paul Tipps, 3/18).

The New York Times: A Cure, In Essence, For HIV In Some Adults
Two weeks ago, American doctors reported that they had "functionally" cured a baby infected with H.I.V., the virus that causes AIDS, with an aggressive treatment of drugs starting some 30 hours after the baby was born. Experts hailed the feat but cautioned that the findings might have little relevance to adults. Now French researchers have identified 14 adults whose treatments with antiviral drugs began within a couple of months of infection, continued for one to seven and a half years, and then stopped (3/18).

The Washington Post: Why Should Food Stamps Pay For Junk Food?
What really caught my attention, though, were the photographs that showed what some SNAP recipients bought with their government-funded debit cards: Cheetos Puffs, a one-ounce handful of which contains 10 grams of fat; a box containing two dozen 12-ounce cans of Fanta Orange soda, each of which contains 44 grams of sugar; a carton of six-ounce Capri Sun drink pouches, each of which contains 16 grams of sugar. In short, this immense nutrition program pays for a lot of stuff that is the opposite of nutritious (Charles Lane, 3/18).

WBUR: Cognoscenti: Medical School Debt And The Potential Impact On Patient Care
As we waited for an operating room before my recent knee surgery, I lay on a gurney making small talk with the five doctors and nurses who surrounded me. My anesthesia had just started to kick in when one of the doctors mentioned his eye-popping student debt. His admission prompted his colleagues to chime in with what they owed. They were all resigned to the fact that borrowing insane amounts of money was required to pursue a medical profession. As I fell into a deep sleep, I tallied their collective student loans in my head; about a half-million dollars in unpaid debt went into the operating room with me that day. Tuition and fees at public medical schools increased by an average of 133 percent  between 1984 and 2004. At private schools, costs went up by 50 percent in the same period (Bob Hildreth, 3/19).

Journal of the American Medical Association: Ushering In A New Era Of Open Science Through Data Sharing
A wall surrounds much of these clinical research data, sequestering knowledge, impeding the free flow of information, and obscuring a clear view of the totality of evidence relevant to many research questions and clinical decisions. Nearly half of clinical research trials are never published. Moreover, publications are often incomplete, selectively reporting favorable outcomes and infrequently reporting relevant safety findings. Motivations and explanations for this phenomenon vary, but whether intended or not, selective publication distorts the medical evidence and inhibits the flow of information that is vital to decision making by patients and their clinicians (Dr. Joseph S. Ross and Dr. Harlan M. Krumholz, 3/18).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Shefali Luthra

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