Daily Health Policy Report

Tuesday, March 20, 2012

Last updated: Tue, Mar 20

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Campaign 2012


Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

New Ryan Budget Would Transform Medicare And Medicaid

Kaiser Health News staff writer Marilyn Werber Serafini reports: "The Republican chairman of the House Budget Committee surprised no one Tuesday when he released a spending blueprint that would drastically reshape the Medicare and Medicaid programs for the elderly and poor in an attempt to rein in their soaring costs. ... The plan, which the committee will consider over the next couple of weeks, would cap Medicare spending at Gross Domestic Product plus 0.5 percent. It would turn Medicaid over to the states in the form of a federal block grant, "constraining Medicaid's growing cost trajectory by $810 billion over ten years," according to the document (Werber Serafini, 3/20). Read the story.

KHN also posted documents related to the Ryan budget plan.

Check Kaiser Health News for more information on the budget proposal, including summaries of the news coverage detailing the plan's release.

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Insuring Your Health: Some States Limit How Uninsured Pay For High-Risk Insurance

In her latest Kaiser Health News consumer column, Michelle Andrews writes: "The 'uninsurables' -- people with serious medical conditions who can't buy health coverage on the private market -- are supposed to have a safety net to rely on in the new preexisting condition insurance plans (PCIPs). These comprehensive plans, created by the federal health care law, take all comers who have been uninsured for at least six months. The premiums can be expensive, however, running several hundred dollars a month" (Andrews, 3/19). Read the column.

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A Tale Of Two Health Insurance Extremes

Reporting for Kaiser Health News and NPR, Nicole Cohen, Carrie Feibel and Martha Bebinger write: "The U.S. spent $2.6 trillion on health care in 2010 — more than the entire economy of France or Britain. But the amount spent and how it's used varies from state to state. And, at the opposite ends of the spectrum: Texas and Massachusetts. At 25 percent, Texas has the highest rate of uninsured people in the nation. Massachusetts, where a 2006 law made coverage mandatory, has the lowest rate — less than 2 percent of people are uninsured. Here's a look at two Americans who are living the reality of that difference" (Cohen, Feibel and Bebinger, 3/19). Read the story.

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Capsules: Illustrating Illinois Insurance Coverage Before And After The Health Law; Why Are Health Costs So High? The Robot Knows

Now on the blog, Julie Appleby reports: "Health care advocates in Illinois are marking the two-year anniversary of the 2010 health law with an interactive map that shows how two provisions – expansion of Medicaid eligibility and the creation of new insurance marketplaces called exchanges – could expand coverage to the state’s residents, some 13 percent of whom are currently uninsured" (Appleby, 3/20).

Also on Capsules, KQED's Sarah Varney, working in partnership with Kaiser Health News and NPR, reports: "Americans have always loved the next big thing: the newest iPhone, the freshest hi-def television, and the latest and greatest … medical technology. But that quick embrace of new innovations has come at a cost: It's driving up the prices hospitals charge insurance companies who in turn raise premiums for the rest of us" (Varney, 3/19). Check out what else is on the blog.

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Political Cartoon: 'Hippocratic Oath?'

Kaiser Health News provides a fresh take on health policy developments with "Hippocratic Oath?" by Mike Peters.

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


Report: red meat bad
Plate of premature demise
T-Bone medium

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

Republican 2013 Budget Plan Includes Major Medicare Changes

The Wisconsin Republican's proposal places greater limits on federal spending for Medicare than last year's blueprint.

Kaiser Health News: New Ryan Budget Would Transform Medicare, Medicaid
The plan would gradually raise the eligibility age to 67 by 2034 and cap Medicare spending growth at Gross Domestic Product growth plus 0.5 percentIt would turn Medicaid over to the states in the form of a federal block grant, "constraining Medicaid's growing cost trajectory by $810 billion over ten years," according to the document (Werber Serafini, 3/20).

Kaiser Health News posted documents related to the Ryan budget plan.

In addition, KHN has video clips of the Tuesday news conference on Capitol Hill, at which House Budget Committee Chairman Paul Ryan, R-Wis., as well as Rep. Tom Price, R-Ga., said that the sweeping changes proposed to Medicare in the GOP 2013 budget would protect the program (3/20).

CBS News: GOP House Budget Sets Up Next Spending, Medicare Fights
As he did in last year's proposed budget, Ryan once again proposes significant changes to Medicare. ... This year, Ryan's plan is modeled after a bipartisan proposal (which Ryan crafted with Democratic Sen. Ron Wyden of Oregon) -- though it still calls for significant changes many Democrats are likely to strongly oppose. Starting in 2023, the plan would give seniors subsidies to purchase either private insurance or traditional, government-run insurance on an exchange (Condon, 3/20).

The Washington Post: GOP Budget Plan Cuts Deeply Into Domestic Programs, Reshapes Medicare, Medicaid
House Republicans laid down a bold but risky election-year marker Tuesday, unveiling a budget proposal that will reduce the debt by reshaping Medicare and Medicaid and cut deeply into other domestic programs, while reshuffling the tax code to lower tax rates. ... That path includes proposals to turn Medicaid spending into a block grant program. ... On Medicare ... Ryan once again proposes to offer seniors retiring in future years payments with which to buy private health insurance coverage (Helderman, 3/20).

The Wall Street Journal: GOP Budget Calls for Spending Cuts
The budget, which sets spending for the 2013 fiscal year, which starts Oct. 1, also takes aim at a variety of high-profile programs. It recommends repealing President Barack Obama's health plan, eventually eliminating Fannie Mae and Freddie Mac, and turning Medicaid and the Supplemental Nutritional Assistance Program, formerly known as food stamps, into block-grant programs. Medicaid growth would be cut by $810 billion over 10 years (Bendavid, 3/20).

The Associated Press/Boston Herald: House GOP Unveils Budget Blueprint
To deal with the influx of retiring Baby Boomers, the GOP budget reprises a controversial approach to overhauling Medicare that would switch the program — for those under 55 today — from a traditional "fee for service" framework in which the government pays doctor and hospital bills to a voucherlike "premium support" approach in which the government subsidizes purchases of health insurance (3/20).

Bloomberg/San Franciso Chronicle: House Republicans Release Lower-Spending Budget With Tax Cuts The proposal reiterates Republicans' call last year for overhauling Medicare, though with some changes reflecting a compromise plan Ryan of Wisconsin has since written with Senator Ron Wyden, an Oregon Democrat. It would offer seniors, starting in 2023, subsidies they could use to buy private health insurance or use in Medicare. Either way, benefits would be capped, which would be a major change in how the open-ended program now operates (Faler, 3/20).

Reuters/The Baltimore Sun: Republican Budget Targets Tax Reforms, Medicare
The Republican budget achieves much of its deficit-reduction goals through savings gained by dismantling Obama's 2010 healthcare reform law and by turning social safety net programs like food stamps and the Medicaid program for the poor into block grants for states. After proposing last year to convert Medicare into a voucher-like program ... , Ryan has modified his reforms in a bid to blunt criticism that it would shift too many costs onto the elderly. The new plan offers so-called premium support to allow beneficiaries to purchase either traditional Medicare or competing plans through a government-run exchange (Lawder, 3/20).

Reuters: Factbox: House Republican Budget Medicare Revamp
Here are some details of the plan outlined by House Budget Committee Chairman Paul Ryan. It is similar to the privatization proposal set out in his budget plan last year but this year's proposal includes elements of a compromise Ryan worked out with Democratic Senator Ron Wyden. Ryan argues that the current Medicare program is financially unsustainable (2/20).

ABC News: House Republicans Unveil New Budget Blueprint
One suggestion Democrats are likely to resist is the repeal of the Affordable Care Act. House Democrats have mounted opposition to the budget, instead highlighting the two-year anniversary of the president’s health care law. Ryan partnered with Democratic Sen. Ron Wyden of Oregon late last year to craft an alternative to Medicare that would let beneficiaries use premiums to buy into traditional Medicare as well as opt into private insurance (Parkinson, 3/20).

The Hill: Ryan Budget To Cut $5.3 Trillion In Spending Over Next Decade
[T]he new Ryan budget offers a modified version of the controversial Medicare plan from last year. Whereas last year's plan moved all future seniors into a privatized system, where the government subsidized premium payments, the current plan keeps traditional Medicare as an option. It also has new protections for low-income seniors and restrictions that could keep the traditional plan from being saddled with only the sickest patients. It is based on a models developed by Ryan and Sen. Ron Wyden (D-Ore.) and long championed by Budget Committee member Rep. Tom Price (R-Ga.). Despite Wyden's support, Democrats are already pouncing on the new Medicare proposal. A protest is planned by seniors groups at a Tuesday morning speech by Ryan at the American Enterprise Institute (Wasson, 3/20).

Politico: Ryan Plan Triggers Budget Wars Anew
After the brutal political reaction last year, he has refined his Medicare reform ideas to move more toward the center. And his greater emphasis on long-range tax reform will give rank-and-file Republicans something else to talk about on the campaign trail. But the basic math still rests heavily on achieving an additional $5.3 trillion in savings from federal spending over the next 10 years, half of which would be healthcare-related, including the total elimination of Obama’s signature reforms (Rogers, 3/20).

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Malpractice Reform, IPAB Repeal, NIH Funding Among Hot Topics On Capitol Hill

News outlets report on various legislative proposals and planned funding cuts, and what kind of reactions they are drawing.

Modern Healthcare: Consumer Group, Lawmaker Weigh In On Malpractice Measure
The Public Citizen consumer advocacy organization is urging Congress to reject current medical tort reform legislation calling it "deeply flawed." Meanwhile, a Democratic member of the House is asking her GOP colleagues to disconnect the malpractice measure from legislation calling for the repeal of the Independent Payment Advisory Board. In a letter to members of the House, Public Citizen said the tort reform measure would "prove devastating to medical malpractice victims, overturn numerous state laws and escalate the costs of existing government programs by saddling the state with costs created by private wrongdoers" and it would also "shield physicians and hospitals, drug and medical device manufacturers and nursing home operators from accountability" (Robeznieks, 3/19).

CQ HealthBeat: NIH Officials Aiming To Head Off 8 Percent Budget Cut In FY 2013
National Institutes of Health officials are heading into a House appropriations hearing Tuesday with an 8 percent fiscal 2013 budget cut hanging over their heads -- a reduction that would have a "devastating" impact on medical research, says agency Director Francis Collins. The cut would occur automatically in January 2013 under the budget control law unless an alternative plan becomes law later this year to meet deficit reduction targets (Reichard, 3/19).

CQ HealthBeat: Repealing IPAB Will Result In More Drastic Alternatives, Analysts Say
While some members of Congress say if the Independent Payment Advisory Board gets up and running there will be draconian provider and benefit cuts, several economic analysts said Monday that without the panel, the situation would be worse. The board, which House Republicans plan to vote to repeal this week, would move Medicare toward more efficient modes of care and better value for the dollar, said Peter Orszag, vice chairman of global banking at Citigroup (Bristol, 3/19).

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Health Reform

GOP Renews Health Law Assault As Two-Year Anniversary, Court Date Near

The fight for public opinion is expected to intensify in the days ahead -- as the date of the health law's Supreme Court oral arguments closes in.

The New York Times: Publicity Push As Health Law's Court Date Nears
Republicans on Capitol Hill have put together a highly coordinated two-week renewed assault on the health care law, seizing on the legislation's second anniversary and the next week's oral arguments before the Supreme Court concerning its constitutionality (Steinhauer and Pear, 3/19).

Roll Call: GOP To Sustain Attack On Health Care Law
Republicans and Democrats are skirmishing over President Barack Obama's health care law this week, and the fight is expected to intensify with the Supreme Court hearing arguments over the law's constitutionality starting next week. The battle is part of an underlying war — the presidential campaign — and top Republicans hope to leverage the attention on the 2-year-old law for maximum political effect. In the House, Republicans are bringing up a bill this week to eliminate a cost-control panel created in the law (Strong, 3/20).

Politico Pro: Outside Court Groups Try To Sway Opinions
Hundreds — perhaps thousands — of people will fill 1 First St. Northeast as the justices hear the arguments. There will be a rally to repeal the law, a prayer vigil to keep it in place and potentially more television cameras focused on the court than at any point since the infamous 2000 Bush v. Gore case. For many Americans, the Supreme Court case — which will be spread over three days beginning March 26 — will be the first they've heard about the law in a while. And both sides are hoping to get on the public’s radar when it's paying attention (Haberkorn, 3/20).

NPR Shots Blog: How Do Racial Attitudes Affect Opinions About The Health Care Overhaul?
As the Supreme Court gets ready to hear a case involving the constitutionality of President Obama's health care overhaul, social scientists are asking a disturbing — and controversial — question: Do the intense feelings about the health care overhaul among ordinary Americans stem from their philosophical views about the appropriate role of government, or from their racial attitudes about the signature policy of the country's first black president? (Vedantam, 3/20).

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Health Law Oral Arguments: Analyzing The Moving Parts

News reports explore the constitutional questions to be explored in the high court's review of the health law and the most likely potential outcomes.

The Associated Press: High Court Has Options On Health Care Law
The Supreme Court has several options in ruling on President Barack Obama's health care overhaul, from upholding the law to striking it down in its entirety. The court also could avoid deciding the law's constitutionality at all, if it finds the lawsuits challenging the law are premature. Here is a look at six potential outcomes, from the simplest to the most complicated possible rulings (Sherman and Alonso-Zaldivar, 3/20).

McClatchy: Supreme Court To Weigh Key Constitutional Issues With Health Care Law
When the Supreme Court hears arguments on President Barack Obama's health care law, what will be at stake is not just whether Americans can be required to have health insurance, but whether the Constitution puts any limit on Congress' power to regulate the economy.  Since 1936, the justices have not struck down a major federal regulatory law on the grounds that Congress went too far. The court's forbearance on matters touching Congress' authority to regulate commerce has allowed Washington's power to grow, to protect civil rights and the environment, to ensure safer automobiles and drugs, and to help boost the wages and benefits of workers (Savage, 3/19).

Bloomberg: Insurers At Risk In Challenge To Health Care Law's Medicaid Plan
A Supreme Court decision striking down the U.S. health-care law’s expansion of Medicaid might expose environmental and educational laws to legal challenges while hurting stocks that surged anticipating more than $600 billion in new spending over the next decade….Managed-care companies with large Medicaid businesses, such as Centene Corp. (CNC) of St. Louis, Missouri, have seen their stock prices more than double since March 2010 on the expectation that states with rising caseloads will turn to them to help control program spending. An adverse decision might affect those gains while also hurting hospitals, nursing homes and other health providers (Crawford, 3/20).

ABC: What To Expect: Supreme Court To Hear Health Care Law Challenge
Next week when the U.S. Supreme Court considers the constitutionality of the president's health care reform law and whether the government can require Americans to buy health insurance through a so-called "individual mandate" there will be six hours of arguments featuring six different lawyers over three days. That's a marathon by Supreme Court standards. Most cases are heard over a single day and rarely for longer than an hour (de Vogue, 3/20).

The New York Times: At Heart Of Health Law Clash, A 1942 Case Of A Farmer's Wheat
If the Obama administration persuades the Supreme Court to uphold its health care overhaul law, it will be in large part thanks to a 70-year-old precedent involving an Ohio farmer named Roscoe C. Filburn. ... The 1942 decision against him, Wickard v. Filburn, is the basis for the Supreme Court's modern understanding of the scope of federal power. It is the contested ground on which the health care case has been fought in the lower courts and in the parties' briefs. And it is likely to be crucial to the votes of Justices Anthony M. Kennedy and Antonin Scalia, who are widely seen as open to persuasion by either side (Liptak, 3/19).

KQED's State of Health blog: The Supreme Court's 4 Health Care Reform Questions
Legal scholars, pundits and those suitably opinionated have been pontificating about all kinds of legal issues. But the average American might want to know, in straightforward language, what those Four Questions actually mean. Here’s my take on them: 1. Can the Supreme Court Consider the ACA Now, Anyway? ... 2. Is the Individual Mandate Constitutional? ... 3. If the Individual Mandate is Unconstitutional, Can the Rest of the ACA Go Forward? ... 4. Is the Medicaid Expansion Constitutional? (Aliferis, 3/19). 

Related, earlier KHN coverage: The Health Law And The Supreme Court: A Primer For The Upcoming Oral Arguments (Taylor, 3/15).

Medscape: Supreme Court Oral Arguments on the ACA, Part I: Wheat, Guns, and Yes, Healthcare Reform
The Obama administration, challengers of the ACA, and dozens of "friends of the court" or amici curiae allied with each side have filed a veritable library of legal briefs in the Supreme Court case. These come on top of their pleadings in lower federal courts that issued conflicting opinions on the law's constitutionality. The 9 high-court justices presumably have digested them all (Lowes, 3/19).

St. Louis Beacon: HHS Secretary Predicts Supreme Court Will Uphold Health Reform Law
"I'm confident that the law will be found constitutional," [HHS Secretary Kathleen Sebelius] said Monday during a forum at St. Louis Community College at Forest Park. "A majority of  (appellate court) judges have found the law constitutional. There's about 70 years of precedent where the Supreme Court has continued to uphold Congress in broadening the powers of the Ccommerce Clause, which is really what this case is about" (Joiner, 3/19).

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Marking The Health Law's Second Anniversary

News outlets report on what the future holds as the health law turns 2. Meanwhile, the Department of Health and Human Services steps up its messaging related to the measure's benefits.

Politico: Health Care Reform: What To Watch For
The law turns two years old on Friday, and its third year will see other milestones that will determine how it works -- if it survives. States have to do their part to implement it, and some will do little or nothing. Health care providers have to decide whether to participate in experiments on controlling costs and testing new ways of delivering care (Nather, 3/19).

Fox News: Health Care Anniversary: Not Such A Big 'Bleeping' Deal?
Friday marks the second anniversary of Obama signing his health care reform bill into law, which Vice President Joe Biden was famously caught calling a "big (bleeping) deal" at the ceremonial event that day. White House spokesman Jay Carney told reporters Monday it's unclear what will be on the president's schedule this Friday, but he's looking beyond past battles. "He is focused on a forward agenda right now, and working with Congress and doing the things he can through executive action to grow the economy and create jobs," Carney said (Henry, 3/19).

The Hill: Dems Hail Health Law's Benefits For Seniors
Democrats and their allies on Monday began a week-long celebration of the health care reform law's second anniversary with a coordinated push to defend its benefits for seniors -- one day before House Budget Chairman Paul Ryan (R-Wis.) unveils his newest Medicare overhaul proposal. The White House and House Democrats touted the latest figures on how many Medicare beneficiaries have already benefited from the law, while the Democratic Congressional Campaign Committee launched robocalls in 41 Republican districts attacking Medicare cuts that could result from Ryan's budget proposal (Pecquet, 3/19).

National Journal: HHS Health Message Of The Day: Doughnut-Hole Savings
The White House kicked off a week of events marking the second anniversary of the health reform law by reminding seniors, that always-important voting block, just how much health care reform has helped them. Monday's message: coverage of the "doughnut hole" in prescription drug plans saved 5 million seniors and disabled people $3.2 billion. The Centers for Medicare & Medicaid Services released data showing that through the first two months of 2012, about 103,000 seniors and people with disabilities saved $93 million in the donut hole (McCarthy, 3/19).

Politico Pro: Birth Control Policy Ties Into ACA Anniversary
For backers of the health care reform law, contraception may help connect the dots. Supporters of the law are using its second anniversary this week to try to remind the public of the law’s benefits. The public remains divided about the law, but polls show some of its components are quite popular. And whether women realize it or not, the requirement that most health plans in August start to cover all FDA-approved contraceptives with no co-pay is part of the health care law’s women’s preventive health benefits (Feder, 3/19).

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Campaign 2012

On Campaign Trail, Santorum Bashes Romney On Health Care

Mitt Romney's Medicare plan is dissected by the Boston Globe, and neither he nor the president are talking up their health reform plans.

The Associated Press: Obama, Romney Talk Little About Health Care Laws
Now here's a tag team for the ages: Richard Nixon, Mitt Romney, Barack Obama. The arc of history joins all three in the cause of universal health care, a goal promoted by Nixon four decades ago and advanced in laws enacted by Romney and Obama in turn. So where are the high fives between the president and the former Massachusetts governor? The most significant health care law since Medicare gets barely a shout-out from Obama. And when Romney must talk about the law he won in Massachusetts, it's because someone's got him on the defensive (Woodward, 3/20).

Boston Globe: As Illinois Votes, Mitt Romney Focuses On Obama
[Rick] Santorum, before visiting the birthplace of President Reagan, continued to make the case that health care would be the driving force against Obama. Standing in front of a statue of Reagan in Dixon, the late president's childhood home, Santorum said Romney was in no position to take on Obama over the federal health care law (Viser, 3/20).

The Washington Post: Romney, Santorum Each Claim Conservative Mantle Before Illinois Primary
[Santorum] attacked Romney for enacting a health-care law in Massachusetts that included a mandate that everyone purchase insurance or pay a penalty. Calling repeal of Obama's health-care law the No. 1 issue of the campaign, Santorum said: "Why would the Republican Party nominate someone on the most important issue of the day — freedom, Reagan's freedom — why would we take that off the table?" (Rucker and Balz, 3/19).

Chicago Tribune: Romney, Santorum Make Final Push For Illinois Republican Votes
Santorum used his father's story of working his way up the economic ladder in America through hard work to mount a criticism he commonly makes of President Barack Obama: that Obama's federal health care plan is emblematic of the president's attempt to move the country away from personal liberty. ... "With Obamacare, we have a bill that will deny (liberty)," he added (Byrne and Groeninger, 3/19).

CBS (Video): Santorum's Health Care Overhaul
Santorum has vowed to repeal the national health care law President Obama signed two years ago and replace it with a major overhaul centered on what he refers to as health savings accounts (Reynolds, 3/19).

Boston Globe: Romney's Medicare Plan Could Create Gap For Seniors
Romney's plan to repeal President Obama's health reform law would strip 65- and 66-year-olds of that law's assurance that insurers would have to cover them even if they have preexisting conditions, as many elders do. The two policies -- simultaneously raising the Medicare eligibility age while removing a new safety net for ailing individuals to obtain affordable health insurance -- would result in many more uninsured seniors because they could not afford -- or even obtain -- coverage, according to many health care analysts and studies about the issue (Jan, 3/20).

National Journal: College Students Pointedly Question Romney On Social Issues
Another questioner brought up Romney's plan to eliminate federal funding for Planned Parenthood. She asked Romney where he might suggest "millions of women go" without the organization offering reproductive and sexual health care. "Well, they can go wherever they'd like to go," Romney told her. "This is a free society. But here's what I'd say, which is the federal government should not tax these people to pay for Planned Parenthood.… The idea of the federal government funding Planned Parenthood, I'm going to say no, we're going to stop that" (Boxer, 3/19).

The Associated Press: Romney Faces Tough Questions On Women's Issues
Romney says people should vote "for the other guy" if they want "free stuff" like female contraception. ... [Romney says] that the government shouldn't send tax dollars to Planned Parenthood, which provides abortions (Peoples, 3/19).

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Improving Care For Advanced Illnesses Can Lead To Reduced Costs

The Wall Street Journal's Health Blog: Cutting Costs With Better Care For Advanced Illness
A better approach to advanced illness, including fewer hospitalizations, could improve quality of life and satisfaction for the sickest patients — and save $25 billion in annual health-care costs, according to Gundersen Health System (Landro, 3/19).

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Health Care Marketplace

Following Health Care's Cash

NPR Shots Blog: Health Care In America: Follow The Money
Some know how much we pay for our own medical care, but many aren't aware of how immense an industry health care is in the U.S. Our trips to the doctor employ a lot of people, and our schools play an important role in preparing those people to take care of us (Jones, 3/19).

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State Watch

Six State Attorneys General To Hear Supreme Court Health Law Arguments

Attorneys general from six states will sit in the Supreme Court to hear the oral arguments over the health reform law. In the meantime, Pennsylvania lawmakers may offer a constitutional amendment to ban laws mandating that people have health insurance.

Denver Post: AG Suthers Will Be In Supreme Court Chambers To Hear Obamacare Arguments
Colorado Attorney General John Suthers will be in Washington next week to sit in the Supreme Court chambers to hear oral arguments for the Affordable Care Act. Suthers is among 26 state Attorneys General who has sued the federal government for implementation of the health care law that passed two years ago. The group of state Attorneys General asked for 26 seats in the small chamber, but received six, Suthers told The Denver Post Monday. Suthers gets a seat along with state Attorneys General from Florida, South Carolina, Nebraska, Texas and Washington (Sherry, 3/19).

Kansas Health Institute News: Kansas Solicitor General Goes To D.C. For Health Reform Case
Attorney General Derek Schmidt has dispatched Kansas Solicitor General Stephen McAllister to Washington, D.C., to help prepare the attorneys representing Kansas and 25 other states in their challenge of the federal health reform law. ... McAllister, a former law clerk for two Supreme Court justices, will spend this week helping prepare former U.S. Solicitor General Paul Clement to present the states' case. Clement, who served in the most recent Bush administration, will present the states’ oral arguments to the court (McLean, 3/19).

Bloomberg: Pennsylvania Lawmakers Mine Discontent On Health Care Law
Pennsylvania (STOPA1) legislators are poised to become the latest to offer voters a chance to say yes or no to a key part of President Barack Obama's health care overhaul, under challenges that have spread nationwide. A measure pending in the state Senate would let citizens ban laws forcing people to obtain health insurance, except under court order. The constitutional amendment proposed by the bill may go on ballots as soon as next year if lawmakers pass it and Republican Governor Tom Corbett signs the measure (Varghese, 3/20). 

In Connecticut, insurers headquartered there and state officials have very different ideas about what happens if the Supreme Court strikes down the health law ---

The Connecticut Mirror: Without Federal Law, Some Pieces Of Health Reform Could Continue In Connecticut 
[T]he creation of a marketplace for buying insurance coverage, known as a health insurance exchange, could happen even if the federal law is altered substantially, those planning the state's exchange say. Connecticut has already received more than $7 million in federal funds to develop the exchange, and is expected to have applied for most or all necessary federal start-up money by June, when the Supreme Court ruling is expected (Levin Becker, 3/19).  

The Connecticut Mirror: Connecticut Health Insurers Say End Of Health Mandate Is End Of Reform 
Few will be watching the arguments next week in front of the Supreme Court over the health care law more closely than Connecticut insurers whose financial health hinges on the justices' decision. ... The [individual] mandate, which would bring many young and healthy people into insurance pools, is what persuaded health insurers to accept other reforms in the health care act. "If you're going to ... take all comers, which the law requires by 2014, then you have to have a means to get the healthy people into the pool also," said Mickey Herbert, former CEO of ConnectiCare (Radelat, 3/19).

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State Lawmkers Consider Abortion, Contraception Legislation

A bill in Arizona would allow employers to deny contraception coverage on religious grounds, and a Tenn. bill would require the state publish the names of doctors who perform abortions.

Arizona Republic: Sponsor Working To Amend Birth-Control Bill
The sponsor of a bill that would allow employers to deny contraceptive coverage on religious grounds said she is working on amendments to clarify the measure. Rep. Debbie Lesko, R-Glendale, said her bill has been widely misunderstood and misinterpreted, particularly an exception that would allow female employees to still be covered if they need the contraceptives for health reasons, such as controlling endometriosis. Lesko said critics have wrongly read House Bill 2625 as requiring the employee to disclose her medical condition to her employer in order to continue coverage (Pitzl, 3/19).

McClatchy: Tennessee Abortion Bill Would Require Publishing Names Of Doctors
The latest salvo in the abortion wars comes in the form of a bill in the Tennessee Legislature that would result in the online publication of the names of doctors who perform abortions, and -- according to critics of the measure -- potentially out individual women who undergo the controversial procedure. The Life Defense Act of 2012 ... would direct the state Health Department to post on its website a report on every abortion (Fausset, 3/19).

Fallout from abortion-related issues continues, in the meantime, in Texas and Missouri --

The Texas Tribune: Inside Intelligence: Retirement and Planned Parenthood
This week in our nonscientific survey, we asked our insiders about Planned Parenthood, lawmakers collecting retirement and term limits. ... The debate over the end of the Women's Health Program in Texas because of the state's refusal to allow Planned Parenthood to participate, has kept the organization in the spotlight. Will the issue play at the ballot box? Nearly two-thirds of insiders who responded this week said yes (Grissom, 3/19). 

Kansas City Star: Anti-Abortion Centers Draw Renewed Look In Jeff City
Millions of dollars in state funds and tax credits have been doled out in recent years to assist mostly faith-based nonprofits in their efforts to reduce the number of abortions performed in Missouri. Critics complain, however, that much of the money ends up benefiting what are called pregnancy resource centers, which they contend often pose as medical clinics while providing inaccurate information designed to scare women away from having an abortion. Now lawmakers are wrestling with the sensitive issue once again (Hancock, 3/20).

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Roundup: States Face New Revenue Downturn; Calif. County Has Disparities In Life Expectancy

News outlets report on a variety of state health policy issues.

Reuters: States' Revenue Surge Ebbs At End Of 2011: Report
Revenues in most U.S. states increased in the fourth quarter of 2011, but their recent surge is tapering off, as they grew just 2.7 percent from the final quarter of 2010, according to a report released on Monday. "This is a noticeable slowdown from the 11.1 (percent) and 6.1 percent year-over-year growth reported in the second and third quarters of 2011, respectively," the Rockefeller Institute, a think tank that closely watches states' revenues, said in the report. ... As revenue slows, "states' education and healthcare obligations continue to grow," the Center on Budget and Policy Priorities found (Lambert, 3/19).

California Healthline: Report Shows Health Disparities In Valley ZIP Codes
A recent report on health inequities in the San Joaquin Valley gives new meaning to the real estate mantra: location, location, location. The report by the Joint Center for Political and Economic Studies and Fresno State's Central Valley Health Policy Institute found that location plays a very real role in health -- so real in fact that life expectancy rates can vary by as much as 21 years in the valley, depending on the ZIP code. There are generally much smaller gaps in life expectancy rates, even between developing countries and industrialized nations (Daniel, 3/19). 

California Healthline: Hearing Focuses On Children's Dental Care
A recent report revealed that only 30% of Medi-Cal children saw a dentist in fiscal 2010-2011 in Sacramento County. In other recent years, the utilization rate was even worse. Statewide, closer to 50% of Medi-Cal children saw a dentist last year. The difference in Sacramento is attributed in part to the county's payment model of geographic managed care in which dentists get a capitated rate for caring for a population in a certain area. Critics say there is little incentive for dentists to see more children since they get paid the same amount whether they see more patients or not (Gorn, 3/20). 

Arizona Republic: Sponsor Working To Amend Birth-Control Bill
The sponsor of a bill that would allow employers to deny contraceptive coverage on religious grounds said she is working on amendments to clarify the measure. Rep. Debbie Lesko, R-Glendale, said her bill has been widely misunderstood and misinterpreted, particularly an exception that would allow female employees to still be covered if they need the contraceptives for health reasons, such as controlling endometriosis (Pitzl, 3/19).

The Associated Press/Washington Post: Birth Control Bill Stalls In Arizona Senate But Supporters Plan Changes To Address Concerns
A bill that would let more Arizona employers drop coverage for birth control drugs stalled Monday in the state Senate because of increasing opposition from women who feared they would have to reveal private health information to employers (3/19).

Arizona Republic: Obama Campaign Memo Slams 'Romney-Arizona Tea Party Agenda' On Women's Issues
In another sign of how much traction the Arizona Legislature's contraception bill is getting at the national level, President Barack Obama's re-election campaign is tethering the controversial legislation to Republican frontrunner Mitt Romney. In a memorandum dated Monday, Mahen Gunaratna, Obama's Arizona campaign press secretary, charges that Romney, a former Massachusetts governor, and conservative "tea party" GOP legislators in Arizona "are set on limiting women's access to health care and seek to insert themselves in decisions that should be made between Arizona women and their doctors (Nowicki, 3/19).

Arizona Republic: Democrats, GOP Clash Over Bills Vs. Feds
House Democrats lambasted Republicans Monday for introducing "extreme" and "ideologically driven" legislation targeting the federal government. In recent years, state lawmakers have been working to challenge or supersede existing federal law on issues ranging from health care to immigration and land management. Many of the proposed laws are an attempt to make a statement to Washington, D.C. (Sanchez, 3/19).

Kaiser Health News/NPR: A Tale Of Two Health Insurance Extremes
The U.S. spent $2.6 trillion on health care in 2010 — more than the entire economy of France or Britain. But the amount spent and how it's used varies from state to state. And, at the opposite ends of the spectrum: Texas and Massachusetts. At 25 percent, Texas has the highest rate of uninsured people in the nation. Massachusetts, where a 2006 law made coverage mandatory, has the lowest rate — less than 2 percent of people are uninsured. Here's a look at two Americans who are living the reality of that difference (Cohen, Feibel and Bebinger, 3/19).

Boston Globe: Group: Localities Saved $80 Million After Curbing Benefits
A taxpayer group said Monday that Massachusetts cities and towns have saved $80 million on health care since the state enacted a controversial law last year that forced teachers, firefighters, and other municipal employees to give up some of their collective bargaining rights. The Massachusetts Taxpayers Foundation, a business-funded watchdog that advocated for the law, said in its report that the overhaul was likely to save more than the $100 million annually that had initially been projected by the group (Bierman, 3/19).

Georgia Health News: Why Free Clinics Help More Than Just Their Patients (Video)
(Tiffany Miller has) been to the ER "countless times" for sudden fainting spells due to an unidentified central nervous system condition that has plagued her for the last four years. ... Visiting the ER has become "pointless," Miller said. "I just lay there, sometimes in a hallway, until I've regained full mobility and can leave." But to stay out of the ER, Miller would need to see a primary care doctor monthly and take five different medications daily. Uninsured and unable to work for the past two years, Miller couldn't afford any of those preventive measures until she turned to Gainesville’s Good News Clinics (Abree, 3/19). 

The Associated Press: Expert Says Idaho Prison Care 'Cruel'
Medical care is so poor at an Idaho state prison that it amounts to neglect and cruel and unusual punishment, according to a report that was unsealed Monday. Correctional health care expert Dr. Marc Stern said there have been some improvements at the Idaho State Correctional Institution south of Boise. But terminal and long-term inmates sometimes went unfed, nursing mistakes or failure likely resulted in some deaths, and one inmate wasn't told for seven months that he likely had cancer, he said (Boone, 3/19).

Milwaukee Journal Sentinel: Walker Signs Family Care Expansion Amid Criticism
Gov. Scott Walker signed legislation on Monday that expands access to a long-term assistance program known as Family Care, but no sooner had he signed it than Walker was derided by Democrats for having his hand forced by the federal government. Walker signed several bills at Independence First in Milwaukee, including lifting the enrollment cap on the long-term care program for the elderly and disabled (Bergquist, 3/19).

Kansas Health Institute News: KanCare Bidders Heavily Courting Medicaid Providers
"I feel like I'm the pretty girl in high school and it's two weeks before prom," said Krista Postai, who runs the Community Health Center of Southeast Kansas, a multisite safety-net clinic headquartered in Pittsburg. "I have lots of offers." Postai and other Medicaid providers – a group that includes doctors, hospitals, pharmacies, home health agencies, nursing homes, mental health centers and community-based programs for the developmentally disabled – are being wooed by the five companies that have submitted bids to manage the state's $2.8 billion Medicaid program (Ranney, 3/19). 

Health Policy Solutions (a Colorado news service): Consumers Want Live Help With Online Exchange
Surveys of nearly 700 Coloradans found they support the state’s new health insurance exchange, but found they want hands-on help to make sense of the online market slated to go into effect in 2014. "A navigator system is critical," said Danny Katz, director of the Colorado Public Interest Research Group Foundation, CoPIRG, one of the groups that conducted focus group meetings in October and November at 53 sites across Colorado (Kerwin McCrimmon, 3/19).

The Lund Report (an Oregon news service): Health Plans Shift Pharmacy Costs Onto Vulnerable Patients
Industry insiders and patients are raising alarm about what they’re calling an insidious trend in the price of life-saving pharmaceuticals by insurance companies, which began shifting, they say, an unprecedented burden of drug costs onto people with chronic diseases. More people are having to pay upwards of 30 to 50 percent for medications that can cost $600 a month, compared to $35 copayments last year, said Shelley Bailey, owner of Central Pharmacy in downtown Portland (Rendleman, 3/19).

The Lund Report (an Oregon news service): A Tight Timeline for CCO Development Worries Policy Board Members, Advocates
The Oregon Health Authority is racing against the clock in order to have coordinated care organizations (CCOs) certified and providing care to Oregon Health Plan patients by August 1st amid growing concern that the tight timeline doesn't leave enough time for a thorough vetting public process. ... These CCOs will replace the state's managed care organizations, and integrate the physical, mental and dental healthcare for the 650,000 patients on the Oregon Health Plan (Waldroupe, 3/19).

HealthyCal: "It Takes a Village"
The rapidly-spreading Village Movement is helping older adults age gracefully by offering the best of two colliding worlds: “aging in place” to avoid institutional living while creating tight community bonds to foster better health and social connections. But these villages are not retirement communities with fixed geographic boundaries. They are collections of individuals living in their own homes across traditional neighborhoods, communities, even entire cities or regions, with the members of each community connected by a network that offers them essential services allowing them to remain independent (Perry, 3/19).

HealthyCal: LAO: Brown's Plan For In-Home Care Might Not Work
Gov. Jerry Brown’s proposed cuts to the budget for In-Home Supportive Services would probably face legal challenges and, even if they survived the courts, would be difficult to implement, according to a new report from the Legislative Analyst (3/19).

St. Louis Beacon: Missouri Pioneers Community-Based Mental And Medical Health Services
For years, poor people suffering from a combination of mental and physical health conditions have had few options beyond walking through the door at an emergency room or finding a bed in a nursing home until the crisis eases. Now come unique services through Hopewell and People's Health Centers. Both are among Missouri pioneers in integrating mental and physical health services to help people remain in the community rather than in institutions (Joiner, 3/20).

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Editorials and Opinions

Viewpoints: Rep. Ryan On His Budget Plan; Obama's Contraceptive Mandate Could Hurt McCaskill In Tight Missouri Race;

The Wall Street Journal: The GOP Budget And America's Future
On the critical issues of health security and tax reform, our budget draws a clear distinction between serious reformers and those who stand in the way of the growing bipartisan consensus for principled solutions. Our budget's Medicare reforms make no changes for those in or near retirement. For those who will retire a decade from now, our plan provides guaranteed coverage options financed by a premium-support payment. And this year, our budget adds even more choices for seniors, including a traditional fee-for-service Medicare option (Rep. Paul Ryan, 3/20).

The Wall Street Journal: ObamaCare's Flawed Economic Foundations
ObamaCare will be argued next week in the Supreme Court. While the justices will consider the intricacies of constitutional law, at their heart the arguments in favor of the legislation have to do with the economics of health care. Consider the individual mandate to purchase health insurance. The Obama administration defends the mandate on the ground that a person's decision to not buy health insurance affects commerce by materially increasing the costs of others' health insurance (Douglas Holtz-Eakin and Vernon L. Smith, 3/19).

The Wall Street Journal's Political Diary: McCaskill's ObamaCare Baggage
Many conservatives are calling President Obama's contraception mandate a "war on religion," and Missouri Sen. Claire McCaskill could become a political casualty. A new Rasmussen poll shows the Democratic incumbent trailing all three of her potential Republican opponents. According to the poll, Sarah Steelman, a former state treasurer who ran for governor in 2008, boasts a 10-point lead. A month ago, Public Policy Polling had the senator and Ms. Steelman running even (Allysia Finley, 3/19).

The New York Times: The States Get A Poor Report Card
State governments have long been accused of backroom dealing, cozy relationships with moneyed lobbyists, and disconnection from ordinary citizens. A new study suggests those accusations barely scratch the surface. … And yet all the Republican presidential candidates think it would be a good idea to hand some of Washington’s most important programs to state governments. … In a speech on Monday, Mitt Romney said he would dump onto the states most federal anti-poverty programs, including Medicaid, food stamps and housing assistance, because states know best what their local needs are (3/19).

Chicago Tribune: What Romney Wants To 'Get Rid Of'
When I was 17, I was diagnosed with endometriosis, a condition that can cause infertility. During graduate school, when many of us "aged out" of our parent's medical insurance, Planned Parenthood provided me with affordable birth control, which manages the condition and prevents long-term damage to the reproductive system. So I was shocked and taken aback to hear Mitt Romney say he would "get rid of" Planned Parenthood (Courtney Everette, 3/20).

Arizona Republic: Republicans Need To Focus On Something Other Than The Uterus
Republicans in the Arizona Legislature continue their quest this week to alienate every last woman in the state (and a fair number of men). ... Even as Sen. John McCain warned the Legislature this weekend to back off, state House Majority Whip Debbie Lesko was preparing her final push to make it more difficult for women – or at least, some women -- to get The Pill. ... the Republican Party has become, as one reader put it, the party of "Guns, God and Gynecology" (Laurie Roberts, 3/20).

The Baltimore Sun: O'Malley Gets It Wrong On Medical Marijuana
On March 9, Gov. Martin O'Malley said he is likely to veto a medical marijuana law if the Maryland General Assembly passes one. His spokeswoman said he is concerned about a Feb. 9, 2012 letter from Charles Oberly, Delaware's U.S. attorney, to Gov. Jack Merkell, threatening to prosecute Delaware officials as common drug traffickers if they carry out their state's medical marijuana law. ... I believe Mr. Oberly dishonestly manipulated Governor Markell by threatening prosecutions he is forbidden to bring (Eric E. Sterling, 3/19).

Mercury News: Santa Clara Family Health Plan's Future Deserves Full Discussion
Fifteen years ago Santa Clara County established the independent Santa Clara Family Health Plan to deliver quality care to low-income families. The nonprofit public agency, with a multitude of providers throughout the county, serves 139,000 people, including nearly 100,000 children. Its hallmark plan, Healthy Kids, is a model for programs throughout California and beyond. But the Health Plan's survival as an independent agency is in doubt, threatening the collaborative relationships among providers that are essential for the county's transition to health care reform (3/19).

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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.