Daily Health Policy Report

Thursday, March 21, 2013

Last updated: Thu, Mar 21

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Care Marketplace

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Grieving Doctor Regrets He Didn't Ask Depressed Patient About Gun

Colorado Public Radio's Eric Whitney, working in partnership with Kaiser Health News and NPR, reports: "Dumont's patient shot himself in the head with a rifle. Dumont was stunned, and guilt-ridden. He says he always asks his depressed patients about suicide, and whether they've thought about how they'd do it. But he regrets not asking this patient specifically whether he had any guns in the house" (Whitney, 3/20). Read the story.

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Capsules: Poll: Three Years Later, Americans Still Don't Understand Health Law; Some Medical Students Seek A Match For Two

Now on Kaiser Health News' blog, Jenny Gold reports on the findings of a new poll regarding the health law: "It's been three years since President Barack Obama signed the Affordable Care Act into law, yet two-thirds of uninsured adults — the very people the law sets out to help — say they still don't know what it means for them" (Gold, 3/20).

Also on Capsules, Alvin Tran reports on the particular interests of some medical students at match day: "More than 17,000 fourth-year medical students found out where they’ll be completing the final years of their medical education on “Match Day” last Friday. But unlike most of their peers at the Johns Hopkins University School of Medicine, John Zampella and Matthew Huddle weren’t focused on where they’ll be doing their medical residency training. Instead, they were more eager to find out if they had been accepted together" (Tran, 3/21). Check out what else is on the blog.

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Political Cartoon: 'Epic Gurney?'

Kaiser Health News provides a fresh take on health policy developments with "Epic Gurney?" by Matt Wuerker.

Meanwhile, here is today's health policy haiku:

MESSAGE TO CVS EMPLOYEES ABOUT INSURANCE CHOICE

Your employer wants
you to step on the scale. If
not... you will pay more. 
-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

Experts Say Health Law Expands Coverage But Is Too Confusing To Small Businesses

News outlets examine issues related to the health law's implementation including what is going right and wrong; how it might be applied on Capitol Hill and the White House; and confusion among small businesses.

California Healthline: Five Things Obamacare Got Right – And What Experts Would Fix
The law continues to delight supporters with what they see as positive surprises; for example, some backers say Obamacare deserves credit for the unexpected slowdown in national health spending. But critics warn that the law's perverse effects on premiums are just beginning to be felt. And there still are "vast parts of the bill you never hear about," notes Timothy Jost, a law professor at Washington & Lee. "I wonder if they're [even] being implemented." Jost and a half-dozen other health policy experts spoke with "Road to Reform," ahead of Obamacare's third birthday on Saturday, to discuss how the law's been implemented and what lawmakers could have done better (Diamond, 3/20).

Politico: Obama May Enroll Under Health Law
If President Barack Obama wants to make good on a promise to become one of Obamacare's first customers, he'll have to take a route most Americans are unlikely to choose. He'll have to enroll in a health plan that lacks a taxpayer subsidy, even though he has access to generous coverage through his day job (Cheney, 3/21).

Politico: Obamacare To Hit Home On Hill
During debate over the law in 2009, Republicans insisted that if members of Congress were going to put their fellow Americans into health care exchanges, they and their staffs should be in there, too. But vague language in this part of the law — which was passed three years ago this Saturday — has led to a slew of quirks and questions (Haberkorn, 3/20).

The New York Times: Case Study: Questions Abound In Learning To Adjust To Health Care Overhaul
The company is one of thousands of small businesses that employ more than 50 full-time employees and thus will be required to offer health insurance to their workers — or pay into a government fund — beginning Jan. 1. Rachel Shein and Steve Pilarski, the married owners of the bakery, which employs 95 people, estimate this could cost their business up to $108,000, and they are weighing their options as the date approaches (Weed, 3/20).

The Washington Post: Health-Care Law Uncertainty Grips Old Town Alexandria Café – And Other Small Businesses
Jody Manor has run a small cafe and catering company for nearly three decades in Old Town Alexandria. … Six years ago he purchased an adjoining building, and more recently he started searching for a second location. Whether he moves forward with expansion depends on the price tag of the requirements mandated by the Affordable Care Act, President Obama's signature health-care initiative. Manor's company employs 45 people. If he brings in just five more, his business would soon be subject to new minimum coverage standards under the 2010 law — and he does not know whether his current health plan would meet this threshold of coverage or how his premiums might be affected (Harrison, 3/20).

The Medicare NewsGroup: Protecting Patient Exposure: Is There Room In the Medicare Debate Climate?
Medicare has been considered the blue-ribbon, A-plus health insurance plan since its inception in 1966, when it began covering millions of disabled and elderly. But this perception may change in a big way on Jan. 1, 2014, when the Affordable Care Act (ACA) brings a new protection to consumers covered by private coverage. These policies will have annual out-of-pocket spending limits, offering protection for those facing big medical bills. The average maximum annual amount will be $6,400 for a single person and $12,800 for a family. Suddenly, Medicare will be the lone health insurance policy without any protection on the catastrophic end, meaning there is no limit to the amount a patient may be forced to pay out-of-pocket (Rosenblatt, 3/20).

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States Debate Health Law's Medicaid Expansion, Push For Special Deals

Coverage includes reports from Maine, Wisconsin, Indiana, Kansas, New Hampshire and Texas.

The Associated Press: Maine Gov. LePage Asks 10-Year Guarantee On Medicaid Expansion
The LePage administration is asking the federal government to pick up 100 percent of Maine's costs of expanding Medicaid for 10 years, if Maine is to agree to the expansion through the national health insurance law (Adams, 3/20).

The Associated Press: Democrats Speak Out Against Wis. Medicaid Changes
Gov. Scott Walker's plan to reject federally funded Medicaid expansion and instead tighten income eligibility for the program to move more people near the poverty line into private insurance drew criticism from Democrats and even one Republican on the Legislature's budget committee Wednesday. Walker's Medicaid plan is the centerpiece of his health care proposals, which were discussed by the Legislature's Republican-controlled Joint Finance Committee during the second of four days of budget briefings (3/21).

Milwaukee Journal Sentinel: Legislature's Budget Panel Appears To Back Scott Walker's Health Program Plan
Gov. Scott Walker's plan to avoid a federally funded expansion of the state's BadgerCare Plus health programs prompted pointed questions Wednesday from Democrats and one Republican on the Legislature's budget committee but still appeared to have solid support on the GOP-controlled panel (Stein, 3/20).

The Associated Press: Healthy Indiana Plan Gets Mixed Reviews At Hearing
Hospital officials praised Indiana's medical savings accounts but some consumer advocates panned them Wednesday during a public hearing as Gov. Mike Pence seeks federal approval to use the Healthy Indiana Plan to expand Medicaid in this state. The Indiana Hospital Association and representatives of hospitals in Indianapolis, Lake County and rural Rush County testified HIP would achieve the Medicaid expansion under the federal health care overhaul and reduce the amount of indigent care they must provide to uninsured patients (Kusmer, 3/20).

The Associated Press: Kan. House OKs Budget, Senate Advances Own Plan
Kansas senators gave first-round approval Wednesday to their version of the next state budget, including language that would require legislative approval before the state could expand Medicaid coverage. The bill, which would spend $14 billion in each of the next two fiscal years, was debated for more than five hours (Milburn, 3/20).

The Associated Press: N.H. House Kills Ban On Medicaid Expansion
The N.H. House rejected a bill Wednesday that would have prevented the state from expanding Medicaid under the federal health-care law. The Democrat-controlled House voted 206-155 largely along party lines to kill former House Speaker William O'Brien's bill to ban the expansion supported by Democratic Gov. Maggie Hassan (Love, 3/21).

The Texas Tribune: Medicaid Expansion Sparks Debate Over Asset Tests
Gov. Rick Perry said last week that any Medicaid overhaul in Texas should include so-called asset testing, "to ensure care is there for those who really need it most." With lawmakers eyeing a Medicaid expansion, such testing is stirring debate (Philpott, 3/21).

The Texas Tribune: TPPF Presents Plan To Reform Medicaid With Block Grant
In a report released Wednesday, the Texas Public Policy Foundation detailed how Texas could use a federal block grant to cut costs and fundamentally reform Medicaid, the state’s health program for the poor, without expansion (Aaronson, 3/20).

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Minnesota Exchange Legislation Signed Into Law

The measure, termed as "historic" and "controversial" in local media reports, will create the health law's online insurance marketplace. The next planning and implementation steps will now fall to the state's executive branch.

MPR News: Dayton Signs Health Exchange Law, Creating 'MNSURE'
Gov. Mark Dayton Wednesday signed into law historic and controversial legislation enacting the centerpiece of President Barack Obama's health care overhaul. The legislation creates a new marketplace for health insurance, which the administration has given the name, "MNSURE." Starting in October, more than a million Minnesotans, including 300,000 uninsured, are expected to shop -- and sign up for health plans using MNSURE. After exchange legislation stalled for two years when the GOP controlled the Legislature, the DFL pushed a bill through this year with remarkable speed. The legislation hit the governor's desk in plenty of time to meet state and federal deadlines (Stawicki, 3/20).

MinnPost: Supporters Celebrate As Gov. Dayton Signs 'MNsure' Health Exchange Into Law
DFL lawmakers and health insurance exchange supporters celebrated "MNsure" — the exchange's official brand — as Gov. Mark Dayton on Wednesday signed the measure into law. Lawmakers have now handed off the brunt of the exchange planning and implementation to executive branch staff, who have been working behind the scenes to make sure the project meets federal deadlines and is ready launch in January (Nord, 3/20).

Minneapolis Star-Tribune: Minnesota Health Insurance Exchange Becomes Law
Minnesota has a new online health insurance marketplace, with a new name: MNsure. Gov. Mark Dayton signed it into law Wednesday, enacting the most sweeping health care change the state has seen in half a century. Some 1.3 Minnesotans and small businesses are expected to buy their health coverage through the exchange, starting next year, including 300,000 who are now uninsured (Brooks, 3/20).

Meanwhile, in Kansas -

Kansas Health Institute: KID To Have No Say In Navigator Grants
A top official at the Kansas Insurance Department on Wednesday said the agency would have no say in deciding which organizations are awarded so-called "navigator" grants for helping Kansans understand and use the Affordable Care Act…Sheppard said that because Gov. Sam Brownback last year decided to have federal rather than Kansas officials set up the state’s ACA-required health insurance exchange, the decision making on the grants would rest solely with U.S. Department of Health and Human Services (Ranney, 3/20).

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Poll: Misunderstanding About The Health Law Persists

A new poll finds that, on its third birthday, many Americans -- especially those it was designed to help -- still don't understand much of what it means.

Los Angeles Times: Ignorance About Health Law Remains High
Misunderstandings about the law have dogged it since lawmakers debated the legislation in 2009 and 2010, in part because major benefits of the law do not go into effect until next year (Levey, 3/20).

Kaiser Health News: Capsules: Poll: Three Years Later, Americans Still Don't Understand Health Law
It's been three years since President Barack Obama signed the Affordable Care Act into law, yet two-thirds of uninsured adults — the very people the law sets out to help — say they still don't know what it means for them (Gold, 3/20).

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Politics May Be Shifting As Health Law Turns 3

Although many Democrats appear less fearful of political fallout from the measure, Republicans continue their efforts to unravel it.

The Hill: Dems No Longer Fear 'ObamaCare'
Three years after President Obama signed his landmark healthcare law, Democrats are confident they’ve finally played the politically divisive issue to a draw. Thursday marks the third anniversary of the final House vote to pass the Affordable Care Act, and Obama signed the bill into law three years ago Saturday (Baker, 3/21).

The Hill: GOP Bill Would Undo Health Law’s Auto-Enroll Provision
A Republican bill to toss the requirement that businesses automatically enroll new workers in the company health plan is winning praise from industry. Reps. Richard Hudson (R-N.C.) and Robert Pittenger (R-N.C.) are behind the measure (H.R. 1254), introduced Wednesday, which would undo a provision of President Obama's healthcare law (Viebeck, 3/20).

The New York Times: Neurosurgeon's Speeches Have Conservatives Dreaming Of 2016
Dr. Benjamin Carson was a political unknown just weeks ago. Then with a single speech delivered as President Obama looked stonily on, he was lofted into the conservative firmament as its newest star: a renowned neurosurgeon who is black and has the credibility to attack the president on health care (Gabriel, 3/20).

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Hearing Explores Potential Of Health Law's Medicare Payment Experiments

During a Senate Finance Committee hearing, an administration official said the potential of the these efforts to show cost-lowering results would take time.

Politico: Orrin Hatch Warns On Medicare Payment Experiments Under ACA
Medicare payment experiments are still in the test tube, but Republicans are already predicting their failure. The experiments are part of the Center for Medicare & Medicaid Innovation, which was created under the Affordable Care Act to test new ways of delivering and paying for health care. The innovation center's been a sticky issue for Republicans, who generally agree that Medicare needs to be more efficient, do a better job of coordinating care and stress value not volume of care. They aren't sure that the innovation center — and its $10 billion budget and wide-ranging approach — is the answer (Cunningham, 3/21).

Reuters: U.S. Health Innovations Need Time To Show Cost Results: Official
The Obama administration on Wednesday said its experiments at controlling healthcare costs could need up to a year to produce results, frustrating congressional lawmakers eager to know if new innovations in care delivery can actually work. Dr. Richard Gilfillan, who is overseeing the initiative at the U.S. Department of Health and Human Services, told the Senate Finance Committee that his agency is now testing three-dozen care delivery models involving 50,000 healthcare providers and more than 1 million beneficiaries (Morgan, 3/20).

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Capitol Hill Watch

Senate OKs Bill To Avert Government Shutdown; House GOP Moves Ahead On Budget Plan

The Senate measure, which funds federal operations through the end of September, is expected to gain House approval. However, the Republican's budget plan for the next fiscal year beginning Oct. 1, proposes to slash health and safety net programs and underscores the sharp differences between the parties.

The New York Times: As Senate Passes Spending Measure, Stark Budget Views Are On Display In House
The Senate passed a spending measure on Wednesday to keep the government financed through the end of September, resolving one contentious budget fight as Congress moved quickly to the next. While the Senate dealt with the most immediate financial concerns, the House of Representatives engaged in an animated debate over the budget for the 2014 fiscal year that begins when the spending measure expires Sept. 30. The irreconcilable views that the two parties hold on economics, public spending and the role of government could not have been in starker conflict. As House Republicans moved ahead with their latest attempt to dismantle President Obama's health care overhaul … Democrats were holding a news conference in the basement of the Capitol heralding the third anniversary of the law's passage (Peters and Weisman, 3/20).

The Wall Street Journal: Senate Passes Bill To Fund Operations
The Senate bill also included more money for an array of programs that enjoyed bipartisan support such as customs and border agents, disaster assistance, embassy security, and a new program to blunt cyber attacks and foreign espionage. But to offset those increases, the bill squeezed other programs, including Environmental Protection Agency programs and an Obama health-care panel (Hook, 3/20).

USA Today: Senate Approves Funding Bill To Avoid Shutdown
The spending bill, which is likely to be approved by the House and signed by the president this week, reflects the sequestration-mandated levels of spending for the remainder of the fiscal year. It includes measures that would give the Pentagon and other federal agencies more flexibility in implementing the cuts, a further acknowledgement that the reductions are here to stay. … Obama wants to replace the cuts with an equal ratio of targeted spending cuts and new revenue from closing tax loopholes. Republicans oppose any such revenue and seek only spending cuts and changes to entitlement programs such as Social Security and Medicare (Davis, 3/21).

The Associated Press/Washington Post: GOP-Dominated House Expected To Pass Budget Plan Promising Slashing Cuts, Balance In 10 Years
A familiar budget plan to sharply cut safety-net programs for the poor and clamp down on domestic agencies performing the nuts-and-bolts programs of the government is cruising to passage in the tea party-flavored House. The Republican measure is advancing to the finish line in the House as the Senate starts a lengthy slog toward passage of a rival budget measure. It takes a sharply different view, restoring automatic cuts to agency budgets and increasing taxes by $1 trillion over the coming decade (3/21).

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Health Care Marketplace

CVS Demands Employees Offer Health Info Or Pay More For Coverage

Chain drugstore CVS is offering employees a choice: Reveal health info, including their weight, or pay as much as $600 more per year for their health insurance.

Los Angeles Times: Report: CVS Caremark Demands Workers Disclose Weight, Health Info
Employees at one of the nation's largest drugstore chains must disclose personal health information -- including their weight -- or pay a $600-a-year fine, according to a published report. CVS Caremark Corp. is requiring workers to reveal the information to their company's insurance carrier or pay an extra $50 a month for health coverage, according to the Boston Herald (Hamilton, 3/20).

Marketplace: CVS Forces Workers To Reveal Weight Or Pay Up
Health care premiums being what they are, companies are trying to bring down costs by encouraging workers to get healthier. Maybe they pick up part of employees' gym membership tab. But the pharmacy chain CVS is planning a wellness program with a twist. CVS will require employees to disclose their weight and other health benchmarks -- or pay $600 more for health insurance. The data-driven program has inflamed privacy advocates. It’s also an open question as to whether these programs can achieve their goals of making people healthier and saving money (Garrison, 3/21).

In other news, walk-in clinics continue to pop up around the nation as an alternative to regular doctors --

Reuters: Analysis: Private Equity Funds Rapid Growth Of Walk-In Clinics
Walk-in clinics are popping up in shopping malls and main streets across the United States and private equity is helping fund the expansion. At least a dozen private equity firms have in the last few years plowed millions of dollars into urgent care clinics, which have become popular with people who do not have regular doctors or who like the convenience of their extended hours of operation (Abrahamian, 3/21).

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State Watch

Mo. Lawmaker Wants Appeal Of Ruling Striking State Law That Allows Employers To Opt Out Of Contraception, Abortion Coverage

Missouri's House speaker is calling on their state's attorney general to appeal a ruling that stops a state law from allowing employers to exclude contraception and abortion from insurance coverage.

St. Louis Beacon: Jones Seeks Appeal Of Ruling Blocking State Law Allowing Firms To Decline To Cover Contraception
Missouri House Speaker Tim Jones, R-Eureka, is calling on state Attorney General Chris Koster to appeal last week's court ruling that blocks provisions of a new state law that allows employers to exclude contraception, abortion or sterilization from insurance coverage. Jones said in a statement Wednesday that Koster, a Democrat, must "immediately appeal this case and defend the rights of Missouri citizens by challenging the contraception mandate as unconstitutional" (Mannies, 3/20).

In related news --

The Associated Press: Women Protest Proposal To Tighten Abortion Rules
In the 1970s, Wanda Webb Schrader marched in Washington, D.C., to support abortion rights. It didn't occur to her that she'd have to renew her efforts some 40 years later. But the retired junior high school teacher and counselor was back at it Wednesday (Waggoner, 3/20).

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State Roundup: Medicaid Causes Budget Headache In Wash. State

A selection of health policy stories from Washington state, Minnesota, North Carolina, Tennessee, Georgia, Arizona, California and Colorado.

The Associated Press: Washington Lawmakers Face $1.2 Billion Shortfall
Washington's budget shortfall has grown to $1.2 billion, officials said Wednesday, as increased reliance on government services overpowered relative stability in the state's economy. The state Economic and Revenue Forecast Council cited higher-than-forecast expenses in areas like Medicaid as the cause of new budget trouble. Government revenues remained stable, something Gov. Jay Inslee's budget director cited in calling the forecast relatively good news (Baker, 3/20).

MPR News: DFL's Plan To Cut Health, Human Services Spending Comes As A Surprised
With Minnesota House and Senate Democrats proposing $2 billion in new taxes to erase the budget deficit and spend more on schools, economic development and other state services, one area -- health and human services -- is getting left out. In fact, DFLers propose a spending cut. But some advocates for the poor say they can't handle any more spending reductions. Democrats in the House and Senate want to cut $150 million in spending from health and human services programs. After education, health and human services is the second-largest portion of the state's two-year budget at $11 billion in general fund spending. But it is increasing at a fast rate, and that worries DFL House Speaker Paul Thissen (Scheck, 3/21).

MPR News: Senate Committee Approves Measure On Nurse Staffing Levels
Legislation on minimum nurse staffing levels at Minnesota hospitals is moving forward at the state Capitol. A Senate committee Wednesday evening approved a measure that would direct the state health department to study the relationship between staff levels and patient health. And for the first time hospitals would have to disclose staffing information online. However the bill's chief author stripped out a provision sought by the nurses union that would set minimum nurse-to-patient ratios (Sepic, 3/20).

North Carolina Health News: Bill Would Expand Access To Midwives In N.C.
A bill making it's way through legislative committees would give certified nurse-midwives more latitude in their practices. … North Carolina is one of only six states that require that a CNM obtain this type agreement in order to practice, said Becky Bagley, director of the nurse-midwifery education program at the East Carolina University College of Nursing. Hers is the only midwifery training program in North Carolina (Hoban, 3/21).

The Associated Press: Courts Cut Fees For Lawyers For TennCare Patients
A federal appeals court has struck down a significant portion of the $2.57 million in legal fees awarded to attorneys who have represented TennCare patients in a years-long fight with the state of Tennessee. The 6th U.S. Circuit Court of Appeals on Wednesday said attorneys should not have been awarded fees on several billed items, including for such things as meetings with state lawmakers and doing work on a separate case that involved the same issues (3/20).

Georgia Health News: Struggling Rural Hospital Closing Door
Another rural hospital in southwest Georgia is closing. Stewart-Webster Hospital in Richland closed its emergency room Tuesday, and rest of the hospital will suspend operations at noon Friday. The for-profit, 25-bed "critical access" hospital is the largest employer in Richland, according to WRBL News. It follows the February closure of Calhoun Memorial in Arlington, 50 miles south of Richland. Stewart-Webster's president, Randy Stigleman, cited several factors, including high unemployment and low payments from Medicare and Medicaid, WRBL reported (Miller, 3/20).

The Associated Press/Washington Post: Arizona Hospice Company Settles Allegations That It Submitted False Medicare Claims
Federal prosecutors say a hospice company in Arizona has agreed to pay $12 million to settle allegations that the company submitted Medicare claims for patients who did not have a terminal prognosis of six months or less. The U.S. Attorney's Office for Maryland said Wednesday that Hospice of Arizona L.C. and related entities had reached the settlement. The company denied the allegations (3/20).

Los Angeles Times: Bill Aims To Tighten Restrictions On Painkiller Hydrocodone
Taking aim at "America's most abused narcotic," congressional lawmakers introduced legislation Wednesday that would place tighter restrictions on the painkiller hydrocodone, which is a key contributor to the nation's prescription drug death epidemic (Glover and Girion, 3/20).

Kaiser Health News: Grieving Doctor Regrets He Didn't Ask Depressed Patient About Gun
Dumont's patient shot himself in the head with a rifle. Dumont was stunned, and guilt-ridden. He says he always asks his depressed patients about suicide, and whether they've thought about how they'd do it. But he regrets not asking this patient specifically whether he had any guns in the house (Whitney, 3/20).

California Healthline: Settlement Called 'Less Harmful' For In-Home Support Recipients
California officials and disability rights advocates yesterday announced a settlement of a lawsuit challenging a 20 percent budget trigger cut in In-Home Supportive Services care. The settlement allows an 8 percent reduction this year and a 7 percent reduction in 2014. It also changes the cuts from permanent to temporary. The size and timing of the cuts are based, in part, on a current 3.6 percent IHSS cut established in 2009. That reduction will remain in effect, and an additional 4.4 percent cut will be added onto that this year followed by a 3.4 percent additional cut next year, bringing the totals to 8 percent this year and 7 percent next year (Gorn, 3/20).

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Weekend Reading

Weekend Reading: Spiritual Bedside Manner; Cancer And The Environment

Every week reporter Ankita Rao selects interesting reading from around the Web.

The Atlantic: Should Your Doctor Pray With You?
"I can fix this." The neurosurgeon was nothing if not confident. … Then, just when it looked like the surgeon would head back to the operating room, he instead lowered his head and held the professor's hands. And began to pray. Not pray as in silently meditate by the bedside. But pray out loud, in an almost Pentecostal, sermon-y kind of way. … As physicians, we interact with patients during some of the most important moments of their lives -- at their births and at their deathbeds, at events bursting with spiritual significance. And yet most of us are afraid to talk about spirituality with our patients, much less discuss religion, out of fear that such conversations would be inappropriate (Peter Ubel, 3/18).

Slate: Cancer Cluster Or Chance?
Lay a chessboard on a table. Then grab a handful of rice and let the grains fall and scatter where they may. They won't spread out uniformly with the same number occupying each square. Instead there will be clusters. Now suppose that the chessboard is a map of the United States and the grains are cases of cancer. Each year about 1.6 million cases of cancer are diagnosed in the United States, and epidemiologists regularly hear from people worried that their town has been plagued with an unusually large visitation. Time after time, the clusters have turned out to be statistical illusions—artifacts of chance. ... Of the handful of residential clusters that have not been dismissed as flukes, only two in the United States have been associated, with a great deal of uncertainty, with environmental contaminants. Both involved childhood cancer (George Johnson, 3/19).

The New York Times: The Face Of Future Health Care
When people talk about the future of health care, Kaiser Permanente is often the model they have in mind. The organization, which combines a nonprofit insurance plan with its own hospitals and clinics, is the kind of holistic health system that President Obama's health care law encourages. Kaiser has sophisticated electronic records and computer systems that — after 10 years and $30 billion in technology spending — have led to better-coordinated patient care, another goal of the president. And because the plan is paid a fixed amount for medical care per member, there is a strong financial incentive to keep people healthy and out of the hospital, the same goal of the hundreds of accountable care organizations now being created (Reed Abelson, 3/21). (Kaiser Health News is not affiliated with Kaiser Permanente.)

American Medical News: How To Talk About Hospice Care
About once a year, a patient or family member will "jump up and just walk out of the room when I mention hospice," says David Casarett, MD, chief medical officer of the University of Pennsylvania Health System's hospice program. … Even though such harsh reactions may be the exception, Dr. Casarett says, they are enough to make many doctors uneasy about bringing up hospice — a program that offers at-home nursing care, pain and symptom relief, spiritual counseling and other services but typically requires patients to forgo disease-directed treatments that aim to extend survival time (Kevin O’Reilly, 3/21).

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Editorials and Opinions

Viewpoints: Indian Health Hit By Budget Cuts; Health Care Doesn't Work Like Normal Markets; Gov. Rick Scott Paying A Price For Medicaid Expansion

The New York Times: The Sequester Hits The Reservation
The Congressional Republicans who brought us the mindless budget cuts known as the sequester have shown remarkable indifference to life-sustaining government services, American jobs and other programs. So what do they make of the country's commitments to American Indians, its longstanding obligations to tribal governments under the Constitution and treaties dating back centuries? Very little, it seems. The sequester will impose cuts of 5 percent across the Indian Health Service (3/20). 

Los Angeles Times: Health Care Reform And The Incentive To Keep Spending
Reforming the health care system is largely about fixing the incentives it provides for doctors, hospitals and patients to overspend. For example, the "fee for service" payment model that Medicare relies on encourages physicians to do as many things for a patient as they can bill for -- the more services provided, the higher the compensation. That's a model that profits from sickness, not health (Jon Healey, 3/20).

The Houston Chronicle: Health Care Is Not A Market
Here's a simple solution to our health care mess. Eliminate all the insurance companies, government subsidies, and other intermediaries and let people purchase medical services directly from a provider of their choice at the going market rate. Believe it or not, this is actually a popular concept on the Republican far right, and not just from Ron Paul. ... Republicans still struggle to promote a credible ownership culture largely because we refuse to wrestle honestly with the hard-cases; the situations in which market forces fail to allocate value effectively. Medical care is probably the most frustrating example since it stubbornly resists market solutions and affects everyone deeply. Health care is not a market (Chris Ladd, 3/21).

The Wall Street Journal: About That 'Scalpel'…
President Obama often claims he wants to cut the budget smartly, using a "scalpel" -- not a meat axe, machete, cleaver or chainsaw, to list a few of his favorite metaphors. He'll need a more inspired term to describe what he's now doing to Medicare Advantage, perhaps napalm or WMD. The Affordable Care Act drained $306 billion from this growing version of Medicare that 29 percent of seniors use to escape the traditional entitlement and obtain modern private insurance, but the Administration is imposing the cuts in ways that are even more harmful than the law requires. The post-election timing is no accident (3/20). 

USA Today: Republicans Bleed Slow-Moving ObamaCare
The House (continuing resolution to keep the government running) left out nearly a billion dollars in funding for insurance exchanges as well as funds for the IRS to prepare to enforce the law's tax rules. According to Rep. Nita Lowey, D-N.Y., this will delay "implementation of the Affordable Care Act. ... Without IT infrastructure to process enrollment and payments, verify eligibility and establish call centers, health insurance for millions of Americans would be delayed." Instead of repealing ObamaCare, an unlikely event with a Democratic Senate, Republicans aim to bleed it to death. The move fits with a pattern the GOP has followed since the law passed in 2010. Even as Republicans fail over and over again in high-profile efforts to simply destroy ObamaCare, they are succeeding with delaying tactics that may combine to turn the law's implementation into a fiasco (Kavon Nikrad, 3/20). 

Bloomberg: How Changes To Obamacare Can Cut The Deficit
Republicans in Washington have repeatedly called on President Barack Obama to make changes to the Affordable Care Act as a part of their efforts to deal with long-term budget deficits. Although complete repeal of the law is desirable, such an outcome is impossible in the near-term. This raises two questions: Should changes to the law be part of current budget negotiations? And, more important, what form should these changes take? The answer to the first question is yes (Lanhee Chen, 3/20). 

Bloomberg: Entice States To Expand Medicaid, Though Not At All Costs
Arkansas and a few other states are proposing to go a huge step further and use the federal Medicaid-expansion funds to give new enrollees "premium support" to buy individual policies on state insurance exchanges. Arkansas Governor Mike Beebe says this would satisfy Republican legislators' philosophical preference for private insurance over government programs. Presumably, it would give them a rhetorical path to accept billions of dollars in new federal Medicaid spending without seeming to compromise their anti-Obamacare principles. It's not clear, though, how the states could manage this in a way that would preserve the program's efficiency and taxpayer dollars. (Yes, Medicaid is efficient, delivering a high standard of care at rock-bottom cost.) Unless Arkansas and its counterparts include credible measures to ensure that private plans don’t squeeze beneficiaries' health care, Sebelius should draw a line -- the tradeoff won’t be worth it (3/20). 

Arizona Republic: Affordable Care Act Already Improving Ariz. Health Care
This week marks the third anniversary of the Affordable Care Act. For Arizonans, that means a health care system that is stronger than it was three years ago, and a future that looks even brighter. Arizonans who have health insurance now have more security thanks to new insurance-market reforms and consumer protections put into place by the law. Preventive services like mammograms and flu shots are newly available for free to 1.4 million people with private insurance plans. About 65,270 Arizona Medicare beneficiaries with the highest prescription drug costs have saved an average of $689 on their medications. And Arizonans are now protected from some of the worst insurance industry abuses, like lifetime coverage caps that could cut off benefits when people need them most (Sec. Kathleen Sebelius, 3/20).

The Wall Street Journal: Rick Scott's Slide
Two new polls show Florida Gov. Rick Scott skating on thin ice with approval ratings in the mid-30s. Suffice it to say the future doesn't look bright for the Republican. … Meanwhile, most of his reforms (e.g. requiring workers to contribute three percent of their salaries to their pensions) have been too timid to rally conservatives to his side. The legislature is now forging ahead with a more aggressive plan to shift new workers to defined contribution accounts. Republican legislative leaders have also rejected his plan to procure "free" federal money by expanding Medicaid. Notably, his waffling on the ObamaCare Medicaid expansion -- in an apparent effort to cozy up to Democrats -- didn't achieve his desired results (Allysia Finley, 3/20).

The New England Journal of Medicine: Budget Sequestration And The U.S. Health Sector
The inability of the Congress and President Barack Obama to agree by March 1 on a plan to reduce the budget deficit is triggering $85 billion in across-the-board cuts in most federal agencies and programs for the final 7 months of fiscal year 2013. These reductions will have adverse effects on many important governmental functions and activities affecting both the health sector and the health of Americans (John E. McDonough, 3/21).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
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.