Daily Health Policy Report

Wednesday, March 20, 2013

Last updated: Wed, Mar 20

KHN Original Reporting & Guest Opinion

Health Reform

Medicare

Capitol Hill Watch

Quality

Health Care Marketplace

Health Information Technology

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Health Law Covers Breast Pumps, But Not All Moms Get The Best

Oregon Public Broadcasting's Kristian Foden-Vencil, working in partnership with Kaiser Health News and NPR, reports: "Under the Affordable Care Act, insurance plans are required to give new mothers equipment and services to enable them to breast feed. What that means in practical terms for most moms is that insurers have to cover the cost of a breast pump – either a rental or a new one" (Foden-Vencil, 3/20). Read the story.

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Q&A: I Had To Return To The Hospital; Will They Be Penalized? (Video)

Kaiser Health News consumer columnist Michelle Andrews answers a reader question about what triggers Medicare's penalties for hospitals that readmit patients too frequently (3/20). Watch the video.

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Capsules: Some States Balk At Enforcing Health Law's Insurance Protections

Now on Kaiser Health News' blog, Phil Galewitz reports: "Florida regulators won't penalize insurance companies that violate new health law consumer protections that take effect in January but will report them to the federal government, according to an agreement between the state and federal officials. Citing lack of money and legal authority, Pennsylvania's top insurance regulator hasn't decided whether his agency can enforce the provisions, … such as requiring insurers to provide coverage to all applicants regardless of their health status, prohibiting insurers from charging more based on gender or health, and greatly limiting what insurers can charge for premiums based on age. At least three others— Missouri, Oklahoma and Wyoming — have informed the Obama administration that they can't or won't enforce the law. … While federal officials say they will step in if necessary, policy experts note they have little experience enforcing health insurance laws and few resources in states to do it" (Galewitz, 3/19). Check out what else is on the blog.

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Political Cartoon: 'Fountain Head?'

Kaiser Health News provides a fresh take on health policy developments with "Fountain Head?" by Jen Sorensen.

Meanwhile, here is today's health policy haiku:  

IS THERE A BRACKET FOR THIS?

Are we still talking
Budget? Or sequestration?
Or CR? Please help! 
-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

Turning Three: Progess Reports On Health Overhaul Abound

As the law approaches its third birthday, news outlets examine a variety of issues surrounding its implementation.

National Journal: Obamacare At Age 3: Still Too Young For Prognosis
The Affordable Care Act, the Obama administration's signature attempt to broadly transform the health care system, marks its third anniversary this weekend. And it is still very much a toddler. Advocates and opponents have been seizing on the anniversary to offer their assessments of the law. On Monday, the Health and Human Services Department took credit for the more than 100 million Americans who have received at least one free preventive health service because of the law (Sanger-Katz, 3/19).

Kaiser Health News: Capsules: Some States Balk At Enforcing Health Law's Insurance Protections
Florida regulators won't penalize insurance companies that violate new health law consumer protections that take effect in January but will report them to the federal government, according to an agreement between the state and federal officials. Citing lack of money and legal authority, Pennsylvania's top insurance regulator hasn't decided whether his agency can enforce the provisions, … such as requiring insurers to provide coverage to all applicants regardless of their health status, prohibiting insurers from charging more based on gender or health, and greatly limiting what insurers can charge for premiums based on age. At least three others— Missouri, Oklahoma and Wyoming — have informed the Obama administration that they can't or won't enforce the law. … While federal officials say they will step in if necessary, policy experts note they have little experience enforcing health insurance laws and few resources in states to do it (Galewitz, 3/19).

Modern Healthcare: Proposal Limits Waiting Period For Health Insurance
Employers who offer health insurance coverage to their employees must offer that benefit no more than 90 days after those employees start working, according to a proposed rule that implements part of the healthcare reform law. Before the Patient Protection and Affordable Act, employers could have waited longer to provide health insurance coverage to employees, said Michael Rosenbaum, a partner with Drinker, Biddle & Reath in Chicago. The reform law changed that, and the new regulation this week from HHS, the Labor department and the Internal Revenue Service makes clear that starting in 2014, the waiting period for employees and their dependents to receive coverage should not last beyond 90 days (Zigmond, 3/19).

Los Angeles Times: Richer Health Benefits Cost 47% More, Industry Report Warns
This latest report examined the cost of about 30,000 individual plans that included eight health benefits and were purchased across 32 states through eHealth Insurance. The federal law requires coverage for a similar group of 10 "essential health benefits," such as maternity care, mental health services and prescription drugs (Terhune, 3/19).

Politico: Under New Health Law, Battles Over Who'll Do What
State legislatures are wrestling with all kinds of "scope-of-practice" issues — turf battles over who can provide what kind of health care, under whose supervision and for what kind of payment. And with the health law coverage expansion going into effect in earnest in 2014, the battles are sharp and numerous, particularly regarding primary care. Everyone agrees there's a primary care shortage, at least in underserved areas. There's less agreement on the role of other practitioners — notably physicians' assistants and nurse practitioners with advanced degrees — in preventing the already-strained primary-care system from buckling (Smith and Cheney, 3/20).

Politico: Experts: Obamacare Insurance Gains Could Stress Primary Care System
The health system is girding for millions of new patients under Obamacare, and experts are worried that an already-strained primary care system could buckle unless other health care professionals are marshaled to perform primary care. "We need to get away from the old system of fragmented care and really work on team-based care," said Wanda Filer, director of the American Academy of Family Physicians, at a POLITICO Pro Breakfast Briefing on Tuesday morning (Cheney, 3/19).

Kaiser Health News: Health Law Covers Breast Pumps, But Not All Moms Get The Best
Under the Affordable Care Act, insurance plans are required to give new mothers equipment and services to enable them to breast feed. What that means in practical terms for most moms is that insurers have to cover the cost of a breast pump – either a rental or a new one (Foden-Vencil, 3/20).

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Private Insurance Twist On Medicaid Expansion May Make 'Obamacare' Palatable To Conservatives

Some GOP state lawmakers, especially those who do not favor expanding the health insurance program for the poor, appear to be warming to this notion. Meanwhile, media outlets offer related updates from Arkansas, Florida and Mississippi.

CNN Money: States Eye Private Insurance For Medicaid Expansion Enrollees
Republican state lawmakers may not want to expand Medicaid, but some are warming up to the idea of using federal funds to buy private insurance for the poor. That twist is keeping alive the possibility of broadening Medicaid coverage in states where conservative legislators are bucking their governors' acceptance of the optional -- and controversial -- Affordable Care Act provision. Republican governors in at least eight states have agreed to Medicaid expansion, which would extend coverage to all adults with income below 138% of the poverty line. It's part of the Obama administration's push for universal insurance, and the federal government is dangling a big carrot to make it happen. It will cover each state's expansion costs in full for the first three years. After that, states will be responsible for no more than 10% of the tab (Luhby, 3/20).

Reuters: Analysis: Arkansas Republicans Seek An Acceptable 'Obamacare'
Two Republican state senators from Arkansas may soon accomplish what seasoned Washington politicians couldn't: make the main provisions of President Barack Obama's healthcare overhaul palatable to hard-core conservatives. Jonathan Dismang and David Sanders, with two colleagues from the state House, believe they have come up with an alternative to the Medicaid expansion, as laid out in the law (Morgan, 3/19).

The Associated Press: Fla. Senators Reveal Medicaid Expansion Plan
The decision to offer Medicaid coverage to roughly 1 million Florida residents under the federal health law is triggering partisan bickering amid competing proposals to pass up billions of federal dollars entirely or to accept the money, but funnel it into private insurance. A week after House and Senate committees in the Republican-led legislature vetoed expanding Medicaid, two very different Medicaid expansion proposals are emerging in the Senate (Kennedy and Fineout, 3/19).

The Associated Press: Dems: Rejecting Medicaid Expansion Will Hurt State's Rating
Mississippi House Democrats said yesterday that the state could hurt its own financial standing if it rejects Medicaid expansion, but Republican Gov. Phil Bryant said he's not convinced that would happen and he still opposes putting more people on the government health program. Democrats pointed to a statement made last week by Moody's Investors Service, which is one of the financial firms that ranks the creditworthiness of Mississippi and other states (3/19).

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Minnesota Authorizes Online Health Insurance Marketplace

Gov. Mark Dayton has promised to sign the legislation, which enables his administration to move forward on building the infrastructure necessary for the marketplace to begin enrolling people Oct. 1 -- a tight deadline that officials said would require massive work to meet.

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 [date] (Condon, 3/20).

MPR News: Minnesota's Health Insurance Exchange: What's Next
Gov. Mark Dayton has promised to sign into law the contentious health insurance exchange bill that was approved by the House and Senate. The legislation enacts a new online marketplace where more than a million Minnesotans will obtain health insurance starting in October. But that's only the beginning of the exchange story. Here's a list of six next steps to watch for as the health exchanges take shape (Stawicki, 3/19).

MinnPost: Minnesota Health Exchange A Step Nearer, But Massive Work And Tight Deadlines Remain
Minnesota's health insurance exchange is a major step closer on the long path to becoming a reality. The state-based exchange — the linchpin of federal health reform — is on its way to Gov. Mark Dayton for his signature, following Senate approval Monday on the compromise bill. Major work remains, though, in designing the physical exchange and in working out rules and regulations (Nord, 3/19).

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Medicare

Advocates, Public Consider Medicare Cost Savings As Debate Continues

Medicare costs -- and controlling them -- are on the minds of the public, patient advocates, lawmakers and doctors as the debate spills off Capitol Hill and into American discourse.

The Washington Post's The Fact Checker: Are People Getting $3 In Medicare Benefits For Every $1 In Taxes
Back when the Fact Checker covered politics, "person in the street" interviews generally yielded a similar answer when people were asked about the government — and whether they got much in benefits for the taxes they pay. The common response: It's a raw deal for me. So we were struck by Barrasso's comment. Are folks really getting $3 in benefits for every $1 in taxes they have paid? And is this really the right way to look at this statistic? (Kessler, 3/20).

The Hill: Patient Groups Criticize Dem Calls For Medicare Price Negotiations
Patient groups and conservative activists pushed back Tuesday against renewed calls for Medicare to negotiate the prices it pays for prescription drugs. More than 330 patient groups, most of them state-based, wrote to lawmakers to oppose price negotiations in Medicare's drug benefit (Baker, 3/19).

Medpage Today: Docs Need To Learn More About Billing, Coding
Bigger steps should be taken to make physicians more aware of the inefficiencies that cause billions in lost health care dollars every year, according to Medicare officials. Physicians receive little education in how to manage and limit program inefficiencies, inappropriate payments, and exploitation, they wrote in a Viewpoint published in Wednesday's Journal of the American Medical Association. More work is needed to ensure doctors are aware of "program integrity" -- a term payers use to refer to losses due to inappropriate payments or exploitation, Shantanu Agrawal, MD, medical director for the Center for Program Integrity at the Centers for Medicare and Medicaid Services (CMS) in Baltimore, and colleagues wrote (Pittman, 3/19).

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Capitol Hill Watch

Progress Slows On Spending Bill To Avert Government Shutdown

The Senate's consideration of the measure, which protects some programs from sequestration cuts, is taking place against the backdrop of Capitol Hill's broader debate about the deficit.

The New York Times: Finance Bill, Nearing Senate Passage, Would Protect Some Favored Programs
With the expected Senate passage this week of broad legislation to finance the federal government through Sept. 30, a lucky few programs will be spared the brunt of the automatic spending cuts now coursing through the federal government. … The overall size of the cuts will remain the same, as will the short-term impact on the economy, because total spending outside of entitlement programs like Medicare and Social Security must remain beneath a hard cap of $984 billion (Weisman and Lowrey, 3/19).

The Associated Press/Washington Post: Squabble Over Spending Cuts Slows Progress On Bill To Avoid Government Shutdown
Across the Capitol, the Republican-controlled House began debate on a budget that promises to eliminate federal deficits in decade. The blueprint, authored by Rep. Paul Ryan, D-Wis., calls for $6.4 trillion in spending cuts and no tax increases, and is expected to clear by week's end. For their part, Senate Republicans kept their distance from the plan, deciding not to seek a symbolic vote on it when the Senate begins its own budget debate later in the week. Sensing an opportunity for political mischief, Senate Democrats vowed not to let Republicans off easy. They said they would require a vote on Ryan's budget — even though they unanimously oppose it (3/19).

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Lobbyists Update Strategy To Repeal Health Law Medical Device Tax

The New York Times reports that industry lobbyists are courting Democrats. Meanwhile, in other congressional news, two House lawmakers have reintroduced legislation to improve Medicare's Recovery Audit Program. 

The New York Times: In Shift, Lobbyists Look For Bipartisan Support To Repeal A Tax
When executives from Cook Medical gathered last month to offer Representative Cheri Bustos a tour of their central Illinois medical equipment plant, they had good reason to expect a frosty reception from Ms. Bustos, a new Democratic congresswoman. Cook executives had backed Representative Bobby Schilling, her Republican opponent in last year’s election for Illinois's 17th District seat, after he had joined with other House Republicans to push for the repeal of a new medical device tax imposed to pay for President Obama's health care law. The company said the tax would cut its profits this year by an estimated $15 million, perhaps limiting future expansions. But in a hint of a shift in corporate lobbying strategy now under way in Washington, the industry pitch is now focused on Democrats like Ms. Bustos (Lipton, 3/19).

Modern Healthcare: House Lawmakers Reintroduce RAC Reform Legislation
Two House members are again pushing legislation aimed at improving the Recovery Audit Contractor program, which the lawmakers say causes unnecessary costs and bureaucratic headaches for hospitals. Reps. Sam Graves (R-Mo.) and Adam Schiff (D-Calif.) introduced the Medicare Audit Improvement Act of 2013, which would make changes to the law that created the RAC program, the decade-old Medicare Modernization Act. For instance, the legislation would place a hard cap on Medicare auditors' additional document requests—or "ADRs"—to 2% of hospital claims, with a maximum of 500 ADRs for every 45 days. Graves and Schiff introduced a version of the bipartisan legislation last October during the 112th Congress (Zigmond, 3/19).

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Quality

Database Offers National Overview Of Hospital Violation Reports

Stateline reports that information about hospital errors dating back to January 2011 will be available to the public on a new website. Meanwhile, a report by the Robert Wood Johnson Foundation draws parallels between the nation's most unhealthy counties and those that have the highest rates of preventable hospital stays.

Stateline: New Database Reveals Thousands Of Hospital Violation Reports
Hospitals make mistakes, sometimes deadly mistakes. A patient may get the wrong medication or even undergo surgery intended for another person. When errors like these are reported, state and federal officials inspect the hospital in question and file a detailed report. Now, for the first time, this vital information on the quality and safety of the nation's hospitals has been made available to the public online. A new website, www.hospitalinspections.org, includes detailed reports of hospital violations dating back to January 2011, searchable by city, state, name of the hospital and key word (Vestal, 3/19).

Modern Healthcare: Unhealthiest Counties Lead In Preventable Hospital Stays
The unhealthiest counties in the nation have the highest rates of preventable hospital stays, smoking and adult obesity, according to the 2013 County Health Rankings, a joint effort of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. The healthiest counties, meanwhile, had higher numbers of primary-care doctors. The least-healthy counties experienced 82.8 preventable hospital stays per 1,000 Medicare enrollees, while in the healthiest counties the rate was 57.2 per 1,000. The rest of the nation's counties experienced 74 preventable hospital stays per 1,000 Medicare enrollees. The report's authors also found that 24% of adults smoke in the least-healthy counties, compared with 16% in the healthiest and 21% in the other counties (Barr, 3/20).

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Health Care Marketplace

Supreme Court Considering Generic Drugmaker Safety Liability

The Supreme Court is weighing whether generic drugmakers can be sued over the safety of their drugs or whether federal regulators' safety approval is enough to block all such legal challenges.

Los Angeles Times: Supreme Court Hears Suit Over Liability Of Generic Drug Makers
Nearly 80 percent of prescriptions that Americans now fill are for generic drugs, and the high court finds itself at a crossroads on how to resolve claims from patients who are badly injured by these copycat products. Should patients have a right to take their cases to a jury and seek damages? Or should the court block all such claims on the grounds that federal regulators already decided the drug was safe for sale? (Savage, 3/19).

Reuters: High Court Weighs Generic Drugmaker Liability
Supreme Court justices weighed on Tuesday whether makers of generic drugs already approved by the Food and Drug Administration can be held liable under state law for claims of design defects. During a one-hour oral argument justices questioned whether federal law, in this case the requirement that generics have same design as the name-brand version, prevents plaintiffs from making such claims under state law (Hurley, 3/19).

In the meantime, the federal government will not -- at least for now -- continue to pursue putting graphic images on packs of cigarettes meant to deter people from smoking --

The Washington Post: Government Quits Legal Battle Over Graphic Cigarette Warnings
The federal government, facing a court-imposed deadline and fierce opposition from the tobacco industry, has decided to abandon its legal fight to require cigarette makers to place large, graphic labels on their products warning of the dangers of smoking. The decision marks a setback for the Food and Drug Administration, which two years ago announced that it would require tobacco manufacturers to include ghastly images on all cigarette packages (Dennis, 3/19).

The Wall Street Journal: FDA Scraps Graphic Cigarette Warnings
The decision is at least a temporary victory for tobacco makers and leaves it up to the Food and Drug Administration to propose a new set of labels aimed at discouraging smoking. Any new labels aren't expected to appear on cigarette packages for years. The government opted against seeking Supreme Court review of a case that challenged warning labels bearing striking images, such as diseased lungs and a dead body. In August, the U.S. Court of Appeals for the District of Columbia Circuit, in a 2-1 decision, ruled that the proposed labels violated the tobacco industry's free-speech rights under the First Amendment (Dooren, 3/19).

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Health Information Technology

New Apps, Social Networks Shaping Doctor Delivery Of Care

Adoption of health information technology is examined as new computer application development and adoption change how doctors deliver care. In Kansas, developers are trying to quicken the pace of doctors adopting new technologies.

The New York Times: The Doctor Is In (Well, Logged In)
Surfing the Web in his all-white Dumbo loft, Dr. Jay Parkinson, 37, looks like any other young tech visionary. He has a trim beard and thick-framed glasses. He wears slim-fitting black outfits and jaunty scarves. He speaks with a measured, "This American Life"-like cadence. And he's a firm believer in the utopian promise of the Internet. But Dr. Parkinson's start-up isn't a new app or social network. He is a founder of Sherpaa, a Web site that operates like a virtual doctor's office, examining patients by e-mail and text message (Stein, 3/19).

Kansas Health Institute: Health IT Innovations, Value Of EHR Systems Discussed
If there were as many software developers working on applications for storing and exchanging patient data as there are working on apps like Angry Birds, electronic health record systems wouldn't be so chronically outdated. That's the mantra of experts working on a software project based here that is aimed at transforming a "monolithic and slow-to-evolve" health information technology industry into one modeled after the iPhone app developer community (Cauthon, 3/19).

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Public Health & Education

Motivating Food Shoppers To Make Healthy Choices

Researchers at RAND found offering rebates for healthy foods can lead to shifts in diets, which could have public policy implications.

NPR: Cash Back On Broccoli: Health Insurers Nudge Shoppers To Be Well
In the U.S., Wal-Mart and a company called HumanaVitality are now testing a similar healthful food incentives pilot program. Members of HumanaVitality, a partnership between the Vitality Group (owned by Discovery) and health insurer Humana, save 5 percent when they buy foods with the Great For You label at Wal-Mart. But is a 5 percent rebate, or discount, enough to motivate people to change their shopping patterns? It's not clear. HumanaVitality will find out when they analyze the results in September (Aubrey, 3/19).

Los Angeles Times: Rebates Motivate Shoppers To Buy Produce, Whole Grains, Study Says
The Rand study said interest is growing in food discount programs as motivators to improve diet. Nutrient-rich foods have become more expensive, compared with calorie-dense, nutrient-poor foods, and some speculate that this contributes to obesity, the researchers noted. The U.S. Congress funded a demonstration discount project that took place last year in Massachusetts; results are being analyzed (MacVean, 3/19).

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State Watch

Texas Lawmakers Consider Stricter Licensing For Abortion Clinics

In Texas, a state Senate committee is considering a bill that Democrats say would effectively ban abortion.

The Texas Tribune: Senate Committee Advances Abortion Clinic Bill
A Senate committee on Tuesday approved a controversial Republican-backed bill that would raise licensing standards for abortion clinics. Democrats say the legislation would effectively ban abortion in Texas (Philpott, 3/20).

In the meantime, Catholic clergy met with New York Gov. Andrew Cuomo on his push for greater abortion rights --

The New York Times: Bishops Challenge Cuomo On Stronger Abortion Rights
As Roman Catholics worldwide celebrated the inauguration of Pope Francis, New York bishops traveled to Albany on Tuesday to meet with Gov. Andrew M. Cuomo, whose looming effort to strengthen abortion rights in the state has met with strong protests from Catholic and evangelical clergy (McKinley, 3/19).

And Sen. Rand Paul is outlining his views on abortion --

The Hill: Paul: 'Thousands Of Exceptions' To Ban On Abortion
Sen. Rand Paul (R-Ky.) said Tuesday he's open to "thousands of exceptions" to a ban on abortion. Paul has said he believes life begins at conception, but in an interview with CNN the Republican emphasized he is also a physician who treats each case individually (Jaffe, 3/20).

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State Roundup: Texas Senate Panel Weighs End-Of-Life Bills

A selection of health policy stories from California, Mississippi, Oregon, Texas, Florida, Kansas and Colorado.

Los Angeles Times: Deal Will Avoid Deep Cuts In Home Care For Elderly, Disabled
Gov. Jerry Brown will no longer seek steep cuts in home care for the elderly and the disabled, ending a prolonged court battle spawned by the state's persistent budget crisis. The Brown administration reached an agreement with unions and social service advocates to allow an 8 percent cut in service hours, less than half the 20 percent reduction the state tried to enact last year (Megerian, 3/19).

Reuters: Mississippi Forbids Local Laws On Nutrition, Super-Size Drinks
Mississippi, the state with the highest rate of obesity, has banned its cities and counties from trying to stop restaurants from selling super-sized soft drinks or requiring them to post nutritional information about meals. The move came a week after a judge blocked an effort by New York City Mayor Michael Bloomberg to prohibit vending machines, movie theaters and retailers from selling single-serving sugary drinks larger than 16 ounces (473 ml), an effort that was intended to tackle the public health problems caused by rising rates of obesity (Le Coz, 3/19).

San Francisco Chronicle: Kaiser Mental Health Service Reprimanded
State regulators reprimanded Kaiser Permanente for mismanaging its mental health services, making patients wait excessively long periods between appointments and offering members inaccurate information that may have dissuaded them from receiving long-term individual therapy. The state Department of Managed Health, which regulates Kaiser and other health maintenance organizations, or HMOs, detailed the deficiencies in a report released Monday and referred the matter to the department's enforcement division (Colliver, 3/19).

The Lund Report: House Bill Requires Midwives To Be Licensed In Oregon
At a House Health Committee hearing last week, Margarita Mareboina held up pictures of her son, who died during labor after a botched delivery by unlicensed midwives in 2011. The baby was covered in meconium, the viscous, tar-like stools of a newborn’s first bowel movement. She said the unlicensed midwives told her that her pregnancy was low-risk, but she also didn't trust them in hindsight and an obstetrician may have disagreed (Gray, 3/20).

The Texas Tribune: Senate Panel Considers End-of-Life Bills
A panel of state senators on Tuesday considered two bills that would take drastically different approaches to modifying laws regarding end-of-life care in Texas. Senate Bill 303 would give patients and their surrogates more discretion under the state's existing advance directives law, while preserving physicians' ability to make a medical judgment to end treatment. Senate Bill 675 would prohibit physicians from discontinuing a patient's life-sustaining care against a family's wishes (Aaronson, 3/19).

Health News Florida: Doctors Lose On Database, Comp Votes
A bill that would require doctors to check with the state's drug database before writing a prescription for addictive medications passed today in a House panel despite the opposition of organized medicine. The House Health Quality Subcommittee also passed two other controversial bills, one on abortion and one on workers' compensation (Gentry, 3/19).

Kansas Health Institute: Senate Committee Amends KanCare Oversight Bill
The Senate Public Health and Welfare Committee today agreed to amend a House-passed bill that would create a joint legislative committee for overseeing KanCare and state efforts to develop home and community-based alternatives to institutional care. The amendment, introduced by Sen. Jim Denning, an Overland Park Republican, would have the committee meet at least once during regular legislative sessions (Ranney, 3/19).

Health Policy Solutions (a Colo. news service): Health Access Improves, But More Children In Poverty
The percentage of Colorado children whose families live in poverty nearly doubled over the last decade from 10 to 18 percent, marking the steepest increase in the country except for Nevada, according to the 2013 KIDS COUNT in Colorado report. … the percentage of children who now have health insurance has increased dramatically over the last decade. In 2010, the most recent year for which data are available, 9 percent of all Colorado children under age 18 were uninsured, the lowest percentage since 1992. Between 2009 and 2010, the number of uninsured Colorado children dropped from 117,000 to 113,000 according to U.S. Census data. [Colo. Gov. John] Hickenlooper is banking on Colorado’s health exchange -- slated to open on Oct. 1 -- to help more families get health insurance (Kerwin McCrimmon, 3/19).

St. Louis Beacon: Families In Poverty
Dr. Dolores J. Gunn, director of the St. Louis County Department of Health talks about poverty and its effects on health. In 2010, the federal poverty level was just over $22,000 for a family of four. Picture of Health is a series of graphics and audio from experts drawn from the St. Louis Regional Health Commission's Decade Review of Health Status and other sources (Joiner and Jones, 3/18).

California Healthline: Federal Approval Of Duals Plan May Come Soon
At a budget subcommittee hearing yesterday, Department of Health Care Services Director Toby Douglas said he hopes to get federal approval for the Coordinated Care Initiative within weeks. The CCI, also known as the duals demonstration project, is a plan to move half a million Californians with dual eligibility in both Medicare and Medicaid into Medi-Cal managed care programs. The plan calls for consolidating disparate health care services and funding streams to improve and integrate care for seniors and persons with disabilities, while saving the state money as well (Gorn, 3/19).

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Editorials and Opinions

Viewpoints: N.D. Abortion Law Is 'Repressive And Extreme;' States Identify 'Promising' Ideas To Overhaul Medical Malpractice

Los Angeles Times: Subverting Reproductive Rights: North Dakota's Dubious Honor
Late last week, the North Dakota legislature passed a bill that would ban a woman from having an abortion as soon as the heartbeat of the fetus is detected, which can happen as early as six weeks into a pregnancy. If Republican Gov. Jack Dalrymple signs it into law, North Dakota will have the ignominious distinction of being the most restrictive state in the country on abortion. A measure to ban abortions so early — at a point when many women don't yet know they're pregnant — is not only repressive and extreme but also likely to be struck down in the courts (3/19). 

Los Angeles Times: Is Prime Healthcare Settling Scores With Union?
In recent years, Prime Healthcare has built a reputation as a take-no-prisoners company willing to run roughshod over patients and employees alike in its quest for profits — $283 million on revenue of $1.6 billion in 2010, according to a financial statement filed with the Securities and Exchange Commission. ... The company has picked a courtroom fight with the Service Employees International Union, which represents about 1,200 workers at three of its hospitals — filing a lawsuit asserting that the union and Kaiser Foundation Health Plan conspired to drive Prime out of the Southern California hospital market. The lawsuit contained the remarkable assertion that the SEIU and Kaiser aimed to hurt Prime by agreeing on higher wages and increased nurse staffing ratios at Kaiser (Michael Hiltzik, 3/19).

The New York Times' Opinionator: Banning The Big Gulp Ban
Neither I nor anyone else I've read on last week's judicial stay of New York City's "Big Gulp Ban" is a lawyer. (We call it the Big Gulp Ban, though in fact it famously would not have banned 7-Eleven's massive drinks.) But I doubt that our Board of Health was being "capricious" or "arbitrary" — those were the words of the ruling justice, Milton A. Tingling — when it decided last September, by a vote of 8 to 0 (you read that right), to forbid the sale, where it could, of super-size sugary drinks. … Nor do the proposers of the ban, Mayor Bloomberg and the health commissioner, Thomas Farley, seem like capricious guys to me (Mark Bittman, 3/19).

The Wall Street Journal: Kicking The Malpractice Tort Out Of Court
March 23 marks the third anniversary of the passage of the most controversial legislation in a generation, the Affordable Care Act, better known as ObamaCare. As the federal law moves toward a more thorough implementation next year, states are grappling with the costs and obligations imposed on them, such as the need to establish health-insurance "exchanges" where low-income workers can obtain coverage. Some states are also searching for ways, outside the scope of ObamaCare, to improve health care and lower costs. A promising idea that is gaining traction is to completely overhaul medical malpractice by kicking it out of courtrooms (Wayne W. Oliver, 3/19).

Bloomberg: Medicare Cost Slowdown Could Close U.S. Budget Gap
New evidence that the slowdown in health care costs over the past five years is happening not only because of a weak economy comes from the Economic Report of the President, released last week by the President's Council of Economic Advisers. If the slowdown were to continue in the future, the report shows, Medicare spending would basically remain flat as a share of the economy. Nevertheless, new data suggest Medicare spending growth may be picking up a bit. So it's important to take more aggressive action to improve value in health care (Peter Orszag, 3/19).

Minneapolis Star Tribune: Minnesota Health Insurance Exchange Done Wrong
When the Affordable Care Act (ACA), also known as Obamacare, was passed in Washington, it was done with the members of one party taking over and doing it all their way. In Minnesota, we said we could do better. But when the time came for Minnesota to lead the way, those in one party took over and did it all their way. We could have done better. ... As the exchange adds a hoped-for 300,000 people to the insurance rolls (subsidized with borrowed federal money), the rest of those who buy insurance are certain to pay more (Jim Abeler, 3/19).

Detroit Free Press: Mental Health Act A Big Step Toward Getting People Help
Less controversial is the proposed Excellence in Mental Health Act of 2013, which could bring Medicaid-funded mental health services to 1.5 million Americans. The act, co-sponsored by U.S. Sen. Debbie Stabenow, a Michigan Democrat, is in response to President Barack Obama's call to action in the wake of the Newtown, Conn., shootings late last year. We support the passage of this act. Of the roughly 4.8 million Americans who struggled with mood disorders, an estimated one-third don't receive treatment. This bill would take an important step toward bridging this gap (3/19). 

Journal of the American Medical Association: Health Services Innovation: The Time Is Now
Biomedical innovation has improved prevention, diagnosis, and treatment resulting in reduction in mortality for most diseases. However, health and health care disparities remain across the lifespan because these advances have not been matched by advances in delivering care, patient engagement, adherence, or access to these advanced care strategies. Clinicians interested in these failures have an opportunity to make health systems more effective by bringing their insights and creativity to developing innovations in care delivery (Dr. Barry Zuckerman, Dr. Peter A. Margolis and Dr. Kedar S. Mate, 3/20).

Journal of the American Medical Association: Educating Physicians About Responsible Management of Finite Resources
Physicians are principal gatekeepers who decide when, how, and what health care services are delivered, with some estimates that at least 60% of health care costs are determined or influenced by physicians. Despite the enormous resources at stake, physicians receive little education in how to manage and steward finite resources, making formal education of physicians in "program integrity" an essential component of medical professionalism (Dr. Shantanu Agrawal, Dr. Julie Taitsman and Dr. Christine Cassel, 3/20).

Journal of the American Medical Association: Can Accountable Care Organizations Improve Population Health? Should They Try? 
The number of accountable care organizations (ACOs) increased rapidly during 2012. There are now more than 250. This increase is likely to accelerate. ... The goals for ACOs are well known: to control health care costs, to drive quality in health care, and to improve population health. ... Many ACOs appear to interpret their responsibility for population health in medical terms—that is, as a responsibility to provide preventive care for all their patients and care management for their patients with serious chronic diseases. This is a major step forward from the traditional model in medical care, which has been to focus on whatever patients appear in the physician's office, while the patient is in the office. However, it falls far short of working to improve the health of the population in a geographic area (Dr. Douglas J. Noble and Dr. Lawrence P. Casalino, 3/20). 

Journal of the American Medical Association: Bridging The Divide Between Health And Health Care
The US health care system can do a better job of providing patient care while moderating the rate of increase in cost, but it can do little about improving overall population health. This is because health care delivery accounts for only 10% of preventable deaths, with the remainder attributable to personal behaviors, social and environmental determinants, and genetic predisposition. As currently constituted, the health care delivery system has little direct control over these other factors. However, consensus is developing that truly controlling health care costs and improving the overall health of the American people will require a much closer partnership, permeable boundaries, and increased interdependence among the health care delivery system, the public health sector, and the community development and social service sectors (Stephen M. Shortell, 3/20).

Health Policy Solutions (a Colo. news service): Medicare Part D Helps Seniors, Keeps Costs Down
Colorado's seniors are benefiting as never before from prescription drugs that are saving and prolonging their lives—and uplifting the quality of those lives. And believe it or not, a federal program -- Medicare Part D -- has played a pivotal role in that success. Part D saves U.S. taxpayers billions of dollars, stimulates investment in breakthrough pharmaceutical research, and is immensely popular among some 30 million Americans who take advantage of it. It's not often you can say that about any government effort, and Medicare's singularly successful Part D program represents a distinct exception (Margie Ball Cook, 3/19).

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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.