Daily Health Policy Report

Thursday, March 22, 2012

Last updated: Thu, Mar 22

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Campaign 2012

Health Care Marketplace

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Two Years In, A Consumer Guide To The Health Reform Law

Kaiser Health News staff writer Mary Agnes Carey reports: "Friday marks the two-year anniversary of the 2010 health care overhaul law, and despite an upcoming challenge in the Supreme Court, it has already begun to be implemented. While some of the key features don't kick in until 2014, the still-controversial law has already altered the health care industry and established a number of consumer benefits" (Carey, 3/21). Read the story.

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The IPAB: The Center Of A Political Clash Over How To Change Medicare

This updated Kaiser Health News story by Bara Vaida explains the ins and outs of this panel: "It sounds like a new Apple product, but IPAB is actually a controversial board that is at the heart of House Republicans' efforts to upend the 2010 federal health law--or at least make it a strong campaign issue" (Vaida, 3/21). Read the story.

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Capsules: Berwick Still Looking Ahead, On The Bright Side

Now on Kaiser Health News' blog, Christian Torres and Shefali S. Kulkarni offer this video report: "Donald Berwick said he didn't want to focus on the fate of the 2010 federal health law, but eventually the physician and former administrator of the Centers for Medicare and Medicaid Services addressed the elephant in the room" (Torres and Kulkarni, 3/21). Check out what else is on the blog.

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Political Cartoon: 'Up!?' By Gary Varvel

Kaiser Health News provides a fresh take on health policy developments with "Up!?" by Gary Varvel.

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

CELEBRITY ENDORSEMENT?

M.C. Hammer has
health law message for SCOTUS:
too legit to quit.
-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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Capitol Hill Watch

Ryan Budget Floor Vote Foreshadows Fiscal Showdown

The House Budget Committee approved the measure in a late vote Wednesday. Meanwhile, because it "fractures" the spending agreement reached last summer between the White House and congressional Republicans, both sides may be fixing for a fight as the election gets closer. 

The Associated Press/Washington Post: House Floor Next For Contentious GOP Budget Plan That Cuts Social Safety Net, Tax Rates
It's on to the House floor for a deficit-slashing GOP budget plan. That's the next step after the House Budget Committee approved the bold but contentious blueprint by a near party-line vote late Wednesday. … The GOP plan is nonbinding but calls for repealing Obama's health care law, while transforming Medicare into a system in which the government subsidizes purchases of health insurance on the private market instead of directly paying medical bills (3/22).

The New York Times: House GOP Budget Riles Some On The Right, And Democrats See A Campaign Issue
House Republicans pressed forward on Wednesday with a politically freighted budget and tax plan, taking fire from the left and the right, as well as from the powerful senior citizens lobby, AARP, which said the plan "lacks balance" and "jeopardizes the health and economic security of older Americans." Before the House Budget Committee passed the plan on Wednesday night, its advocates were running a gantlet of opposition (Weisman, 3/22).

The Wall Street Journal: Spending Clash Looms On Election Eve
A fracturing agreement between the White House and congressional Republicans over spending levels has heightened the chance of a government shutdown just weeks before the November election. … The flashpoint came this week when House Budget Committee Chairman Paul Ryan (R., Wis.) called for $1.028 trillion in discretionary spending for the year beginning Oct. 1—$19 billion less than the level agreed to with the White House last year and put into law. Discretionary spending requires annual approval by Congress and excludes formula-based programs like Medicare and Social Security (Paletta and Bendavid, 3/21).

The Fiscal Times: 5 Things You Don't Know About Paul Ryan's Budget
4) It Could Leave More People Uninsured: According to a preliminary Congressional Budget Office analysis of Ryan's health care proposals, a "much higher" number of people would be without health insurance under his plan because it would repeal Obama's signature health care reform, which is designed to extend insurance coverage to more than 30 million Americans (Hirsch, 3/22). 

The Fiscal Times: Ryan's Plan Could Decimate The Social Safety Net
Ryan contends that Medicaid health services for the poor and other programs are growing at an unsustainable rate and must be curtailed. Medicaid for example has been growing on average of 9 percent a year – far faster than the overall economy. ... But the Obama administration and liberal budget advocacy groups voiced alarm on Tuesday that in the name of deficit reduction, House Republicans were seeking to repeal the president's health care reform law, slash overall Medicaid spending 30 percent or more by 2022 and cut spending for food stamps, college aid and education and job training (Pianin, 3/21). 

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House Votes To Repeal Medicare's IPAB

The Hill: House Approves The Repeal Of Cost-Cutting Healthcare Board
The House on Thursday afternoon approved legislation that would repeal a government board tasked with finding Medicare savings, and institute medical tort reform across the country. Members approved H.R. 5, the Protecting Access to Healthcare (PATH) Act, by a 223-181 vote in which only seven Democrats supported the bill and 10 Republican opposed (Kasperowicz, 3/22).

The Associated Press: House Moves To Repeal Medicare Cost Board
The Independent Payment Advisory Board was created by President Barack Obama's health care overhaul law to keep Medicare costs from zooming out of control. Republicans have branded the panel a rationing board. By targeting IPAB (pronounced "EYE-pab"), Republicans hope they can persuade seniors that they, and not the Democrats, are the best stewards of Medicare. ... Even some Democrats oppose the panel, but House Republicans have made it difficult to attract Democratic votes for repeal by adding other politically charged provisions to their bill (Alonso-Zaldivar, 3/22).

CNN: House Votes To Repeal Key Health Care Reform Provision
While the move to repeal the Independent Payment Advisory Board is expected to eventually fall short in the Senate, it gives opponents of health care reform a rallying point for their continued efforts to undermine the 2010 law. Opponents said the board would ration medical coverage for senior citizens based on cost and effectiveness, something more appropriately addressed, they said, between individual doctors and patients. ... That's not the intent or the reality of the advisory board, said Dr. Donald Berwick, the former administrator of the federal Centers for Medicare and Medicaid Services (Cohen, 3/22).

MSNBC: House Votes To Repeal Key 'Obamacare' Provision
The 2010 Affordable Care Act which created the board, says IPAB can’t ration care, restrict benefits, increase the premiums Medicare recipients must pay, or alter the eligibility for Medicare. But it can limit or change payments to doctors, hospitals, hospices, and other providers. After the vote, the chief proponent of IPAB, Sen. Jay Rockefeller, D- W.V., issued a statement denouncing the move to abolish it. “Today’s House vote is a good example of what happens when special interests win – seniors lose,” he said
(Curry, 3/22).

Earlier coverage included information about a controversial aspect of the bill -- 

Politico Pro: IPAB-Tort Reform Link Disappoints Some
Some congressional Republicans are venting their frustrations with GOP leaders for using tort reform to pay for a repeal of the Independent Payment Advisory Board, saying the decision ruined their shot at a successful bipartisan repeal of the board (Nocera, 3/22).

Kaiser Health News: The IPAB: The Center Of A Political Clash Over How To Change Medicare
It sounds like a new Apple product, but IPAB is actually a controversial board that is at the heart of House Republicans' efforts to upend the 2010 federal health law--or at least make it a strong campaign issue (Vaida, updated 3/21).

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Health Reform

The Health Law's Second Anniversary: Where Do Things Stand?

As the sweeping overhaul turns two and the Supreme Court prepares to review its constitutionality, news outlets report on what provisions have taken effect, what changes are still in the pipeline and how people have been affected so far.

Kaiser Health News: Two Years In, A Consumer Guide To Health Reform Law
Friday marks the two-year anniversary of the 2010 health care overhaul law, and despite an upcoming challenge in the Supreme Court, it has already begun to be implemented. While some of the key features don't kick in until 2014, the still-controversial law has already altered the health care industry and established a number of consumer benefits (Carey, 3/21).

The Wall Street Journal: Health-Care Law's Many Unknown Side Effects
Two years after Congress passed President Barack Obama's health-care legislation, despite all the assertions about what it will or won't do, no one really knows how it's going to work. The U.S. has rarely attempted anything of this scale before. If the law survives the Supreme Court and Republican repeal efforts, its impact turns on what Paul Keckley, head of the Deloitte Center for Health Solutions, a unit of the accounting firm, calls "four big bets" (Wessel, 3/21).

USA Today: Obama's Health Care Law From 4 Real People's Perspectives
One is a young, healthy paramedic who can't afford health care coverage for himself. Another is a breast cancer survivor with leukemia bouncing from private insurance to Medicaid to Medicare. A third is an ailing ex-smoker who believes citizens, not the government, should buy insurance or pay the consequences. And then there is the feed store owner who cannot offer insurance to her employees (Wolf, 3/21).

Bloomberg: Health Law Transforming U.S. As Court Threat Looms
More than one of every four Americans last year received a free mammogram, colonoscopy or flu shot, thanks to a federal law that many of them despise. Roughly 3.6 million Medicare (USBOMDCA) recipients saved an average of $604 as the same law began closing a gap in their prescription- drug coverage. And 2.5 million young adults were allowed to remain on their parents' health-insurance plans until their 26th birthday. For two years, even as a debate has raged over what Republicans deride as "Obamacare," the new health-care law has begun benefiting consumers and refashioning a $2.6 trillion industry (Lynch, 3/22).

NPR: Why Obama Hasn't Won The Battle Over Messaging About Health Care Law
The sweeping health overhaul law turns 2 years old this Friday. And as it heads toward a constitutional showdown at the Supreme Court next week, the debate over the measure remains almost as heated as the day President Obama signed it into law. In fact, public opinion about the law remains divided along partisan lines to almost exactly the same extent it was when the law was signed on March 23, 2010. …  Opponents of the law say the main reason for that is the so-called individual mandate (Rovner, 3/21).

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Anticipating The Health Law's Day In Court

Coverage of next week's Supreme Court arguments on the health law includes a variety of takes on the key issues.   

The Associated Press: Court Weighs US Power Over States In Health Case
Congress will help pay for your roads, but your state can't lower its drinking age below 21. There's federal money for colleges, but they can't discriminate against women in the classroom or on the athletic field. Federal cash comes with strings. Now 26 states are telling the Supreme Court that President Barack Obama's health care law has stretched an old rule too far. The new law's requirements for expanding Medicaid amount, in their view, to coercion that violates the U.S. Constitution's division of power between the national government and the states (Alonso-Zaldivar, 3/22).

The Wall Street Journal: Courtly Battle In Health-Care Case
The fight over President Barack Obama's health-care overhaul has featured nearly three years of name-calling and shouting matches. But don't expect to hear supporters accused of creating "death panels," or opponents of preferring the uninsured to "die quickly," when the issue lands at the Supreme Court next week (Bravin, 3/21).

Politico: Health Law Could Hinge On Wheat, Pot And Broccoli
The survival of President Barack Obama's signature health care law may come down to wheat, pot, guns — and a nagging question about broccoli. Strange as it may seem, those diverse topics are apt to surface repeatedly during next week's arguments at the Supreme Court over the health law's constitutionality (Gerstein, 3/22).

NPR: Obama's Health Care Law In Court: An Overview
The Supreme Court is getting ready to hear its biggest case in decades — or at least its longest. Next week, three days and six hours of hearings may determine whether President Obama's landmark health care law lives or dies (Inskeep and Shapiro, 3/22). 

CQ HealthBeat: Nixing Medicaid Expansion Would Leave Millions Uninsured Below The Poverty Line
If the U.S. Supreme Court affirms the health care law but strikes down its Medicaid expansion, millions of uninsured Americans with incomes below the poverty line won’t get government help to line up health coverage, unlike their somewhat better off compatriots. Hospitals would find themselves with rising uncompensated care costs at the same time their Medicare payments are being cut (Reichard, 3/21).

California Healthline: Clues To How The Supreme Court Might Rule On Health Reform
California Healthline consulted with several health policy and legal experts to uncover clues about what might influence justices' thinking as they consider the case. Here's eight Supreme Court decisions to keep in mind as oral arguments begin (Wilson and Rao, 3/21).

MedPage Today: ACA On Trial: 'The Mandate'
President Obama's landmark healthcare reform law contains a provision that many consider its linchpin: a requirement that nearly every U.S. citizen have health insurance or else pay a penalty. ... Without the mandate, many people would not buy insurance (as happens now) or would wait to buy insurance until they are sick, mandate supporters argue. ... Opponents of the law -- including the 26 states who are suing the Obama administration over the ACA -- say it is a violation of the Constitution for the government to require everyone to purchase health insurance (Walker, 3/21).

Modern Healthcare: Fitch Doesn't See Reform Ruling Affecting Ratings
The U.S. Supreme Court decision on the Patient Protection and Affordable Care Act is not expected to affect the ratings or outlooks of healthcare companies, analysts at Fitch Ratings said. ... "We believe the [individual] mandate is necessary in order for the ACA to at least partially share risk and avoid adverse selection," the analysts wrote in a news release (Kutscher, 3/21).

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Election-Year Politics Swirl Around Health Law Arguments

Democrats, including President Barack Obama and members of Congress, have different strategies for how they will handle the spotlight on the health law next week, when it comes before the Supreme Court.  House Democrats plan to celebrate the law's achievements. President Obama will be in Korea. Republicans, meanwhile, are attempting to turn it into campaign fodder.

The Washington Post: Obama Tries To Reclaim Advantage On Gas Prices, Health Care
The White House has launched a concerted effort to turn political weakness into strength on two critical election-year issues that have become big vulnerabilities for President Obama: rising gas prices and the controversial health-care law (Gardner and Wilson, 3/21).

Politico: The Obama Vacuum: House Dems Defend Health-Care Reform
House Democrats are going all out to defend their health care reform law as the Supreme Court takes the case next week. President Barack Obama is talking about energy and jobs. Next week, he's going to Korea (Allen and Nocera, 3/21).

The Hill: Liberal Dems Back Obama's No Show On Health Law Anniversary
President Obama has been a no-show on the law's second anniversary, but Rep. George Miller (D-Calif.) says he's fine with that. Miller, the chairman of the Democratic Policy Committee, recalled Wednesday how "proud" he was to stand by Obama two years ago when the president signed healthcare reform into law. "He's been very outspoken on healthcare, and I think the opponents of the plan have made the case for him," Miller told The Hill. The Supreme Court case challenging the law's individual mandate, which starts next week," is where the administration should be focusing its talents" (Pecquet, 3/21).

Arizona Republic: Flake Marks 'Obamacare' Birthday With Web Video
Rep. Jeff Flake, a Republican running for the Senate, on Wednesday marked the anniversary of the congressional passage of President Barack Obama's health-care overhaul with a statement and campaign web video that highlights his opposition to the 2010 legislation... Flake hopes to succeed the retiring three-term Sen. Jon Kyl, R-Ariz. (Nowicki, 3/21).

Boston Globe: Governor Patrick: Affordable Care Act 'Deserves To Be Defended'
The Affordable Care Act is a "value statement," affirming that access to health care is a public health concern, Governor Deval Patrick said Wednesday morning. Speaking after an appearance with Surgeon General Regina Benjamin to promote the National Prevention Strategy, Patrick declined to offer predictions about how the law will fare next week as the US Supreme Court hears a case challenging the law. But he offered an opinion on how he thinks it should go (Conaboy, 3/21).

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Status Checks On The Health Overhaul's Implementation

News outlets detail various progress reports from administration officials as well as several studies. 

CQ HealthBeat: HHS Tackling Employer Mandate Question For 2014
A top Health and Human Services official told a congressional panel on Wednesday that his office is still figuring out how employers will be asked to determine their workers' health insurance status once the overhaul law goes into effect. The issue is important because beginning in 2014, companies with 50 or more full-time workers will be required to provide health insurance coverage or face paying a penalty (Norman, 3/21).

The Hill: HHS Study: Health Law Guarantees Stable Coverage For Young Americans
President Obama's healthcare reform law not only helps young adults get coverage but also ensures they're able to keep it over time, the administration said in a new report released Wednesday to mark the law's second anniversary. Previous reports had shown that 2.5 million more young adults were insured in June 2011 than in September 2010 thanks to a provision of the law that requires insurers to allow people up to age 26 on their parents' plans (Pecquet, 3/21).

Milwaukee Journal Sentinel: Report Finds Health Reform Helped State Children Get Preventive Care
Roughly 281,000 children in Wisconsin are receiving additional preventive health care benefits because of requirements imposed by federal health care reform, according to a study released Wednesday by the Center for Children and Families at Georgetown University.  The federal law requires health plans introduced after Sept. 23, 2010, to cover all preventive services recommended by the American Academy of Pediatrics with no co-pays, deductibles or coinsurance. Existing health plans were exempt from the new regulations (Boulton, 3/21).

Politico Pro: Report: Most States Enforce Law's Patient Protections
Virtually all the states — with just one exception — have made at least some effort to implement health care reform's so-called Patient's Bill of Rights, a new Commonwealth Fund report finds. The study found that most states have either acted through law or the regulatory process to align themselves with the Affordable Care Act's early insurance market reforms, like a ban on denying coverage to children because of pre-existing conditions and allowing young adults to stay on their parents' health plans until age 26 (Millman, 3/22).

Modern Healthcare: Ariz. Lags In Reform Implementation, Study Finds
Despite the sweeping federal changes included in the Patient Protection and Affordable Care Act, a new Commonwealth Fund study notes that "states continue to be the primary regulators of health insurance" and they are implementing the federal laws at varying speeds—or, in the case of Arizona, not at all. The Commonwealth Fund study looks at 10 "early market reforms," collectively known as the Patient's Bill of Rights, which went into effect Sept. 23, 2010, and were designed to fill gaps in coverage such as banning lifetime or annual limits on benefits and retroactively cancelling coverage (Robeznieks, 3/22).

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Campaign 2012

Health Policies Continue To Play Role In GOP Presidential Primary

An analysis by The Associated Press points out that the GOP may be gelling around presidential hopeful Mitt Romney despite his role while governor in advancing the Massachusetts health law. Meanwhile, the AP also reports that rival candidate Rick Santorum offered his support for the budget plan announced this week by Rep. Paul Ryan, R-Wis., but said he would be more aggressive in achieving savings. Medicaid would be one of his targets.  

The Associated Press: Analysis: The GOP Race Is Now Lining Up For Romney
It hasn't been pretty, but the Republican establishment, the delegate math, the money and more are increasingly lining up in Mitt Romney's favor in the long and grinding race for the party's presidential nomination. ... It's taken months, far longer than anticipated, for Romney to begin to take charge of a race that he began with overwhelming financial and organizational advantages. His record as a Massachusetts governor, particularly his embrace of a requirement for state residents to purchase health insurance, has made it hard for him to win over doubting conservatives in the South and elsewhere (Espo, 3/21).

The Associated Press: Santorum: Accelerate Cuts In House GOP Budget
Republican presidential candidate Rick Santorum says he supports a House Republican budget proposal, but adds that the spending cuts included in it should be accelerated. Santorum says he would be more aggressive in achieving budget savings, including by doing away with cost-of-living increases in federal grants to states for Medicaid and food stamps (Kuhnhenn, 3/21).

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Health Care Marketplace

Lawmakers Allege Some Drug Companies Inflate Cost Of Scarce Drugs With 'Fake Pharmacies'

Rep. Elijah Cummings, D-Md., is leading a congressional investigation accusing some drug distributors of opening "fake pharmacies" to drive up the cost of some pharmacueticals that are in short supply.

The Wall Street Journal: Drug Resales Get Scrutiny
Some drug distributors are setting up fake pharmacies that allow them to obtain and then artificially raise the prices for cancer drugs and other medicines that are in short supply, according to letters written by lawmakers Wednesday. Lawmakers are looking into what they claim is a "gray market" for scarce prescription drugs that has emerged in recent months (Dooren, 3/21).

Reuters: Lawmakers Probe Pharmacy Ties To Price Gouging
Lawmakers are investigating three shadowy pharmacies in Maryland and North Carolina for diverting critical but scarce drugs from patients to wholesalers, who are then able to resell the medicine at sometimes big markups. Elijah Cummings, the senior Democrat on the House Committee on Oversight and Government Reform, began a probe in October to discover why certain companies were selling cancer drugs at more than a hundred times their normal cost (Yukhananov, 3/21).

The Baltimore Sun: Drug Company Deals Eyed In Probe Of Shortage
Congressional lawmakers investigating the shortage of lifesaving drugs used to treat cancer and other illnesses are looking into three companies in North Carolina and Maryland that they believe set up "fake pharmacies" to access the drugs that they then sold at a markup. The lawmakers, led by Rep. Elijah E. Cummings, a Baltimore Democrat, said Wednesday that they sent letters to the three pharmacies that they believe sold drugs to wholesalers that they also owned, which then sold the drugs on the "gray market" to entities that do not manufacture drugs or treat patients (Walker, 3/21).

The Associated Press: Lawmakers: Fake Pharmacies Price Gouging On Drugs
Members of Congress investigating shortages of crucial drugs are targeting nearly two dozen fake pharmacies allegedly set up solely to buy and resell the drugs at huge markups. Two senators and one U.S. representative on Wednesday sent letters to three individuals believed to have obtained licenses to operate both a pharmacy and a prescription drug wholesale business in a "shell game" -- to make money by taking advantage of the drug shortage crisis that's disrupting hospital and other patient care. The letters request detailed information by April 11 about the businesses and their purchases and resale of cancer and other lifesaving drugs (Johnson, 3/21).

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As Need For Nurses Increases, More Men Enter The Profession

As the country faces a shortage of doctors, nurses may help fill the void and the government and industry are working to make sure there are enough of these professionals.

The New York Times: More Men Trading Overalls For Nursing Scrubs
Hard figures are elusive, but the Michigan Department of Energy, Labor and Economic Growth estimates a shortage of 18,000 nurses in the state by 2015 — and the labor force is adapting. Oakland University in nearby Rochester, Mich., has established a program specifically to retrain autoworkers in nursing. …  And the College of Nursing at Wayne State University in Detroit is enrolling a wide range of people switching to health careers, including former manufacturing workers (Vigeland, 2/21).

CQ HealthBeat: Wanted: More Advanced Practice Nurses
Hospitals can apply to share in $200 million in health care law money that will be used to encourage the training of more advanced practice nurses, one way federal officials hope to meet an overhaul goal of strengthening primary care. Centers for Medicare & Medicaid Services (CMS) officials announced details of the Graduate Nurse Education Demonstration on Wednesday (3/21).

California Healthline: Solution To Physician Shortage May Lie In Mid-Level Practitioners
[Kevin Barnett of the Public Health Institute] had a number of recommendations for expanding the current health care provider system: To better recruit and retain providers in underserved areas, the state should look at loan repayment for providers just out of school. Increase the number of residencies in areas that are underserved ... expand the scope of practice for less-traditional providers, such as nurse practitioners, physician assistants and others (Gorn, 3/22). 

Meanwhile, some doctors are moving to a more flexible schedule.

Medscape: 1 In 4 Physicians Employed By Large Groups Are Part-Time
The nation's largest medical groups increasingly rely on part-timers, and a higher percentage of them are men. In 2011, part-time physicians represented 25% of the workforce in large groups, up from 13% in 2005, according to the latest physician retention survey conducted by the American Medical Group Association (AMGA) and Cejka Search, a healthcare recruitment firm (Lowes, 3/21). 

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State Watch

Va. Voters Divided Over Support For Ultrasound Law; Other Related News

Voters are split over a new Virginia law that mandates women get ultrasounds before an abortion. Abortion and contraception issues are also making news in Iowa, Idaho, Texas, Washington, Kansas and Utah.

NPR: Poll: Voters Split Over Virginia Abortion Ultrasound Bill
Voters in Virginia appear to be at odds with the state legislature and the governor over a new law that sets guidelines on ultrasounds and abortions, according to the results of the latest opinion poll from Quinnipiac University. The poll finds that 52 percent of Virginia voters polled disagree with a new law that requires women seeking an abortion to undergo an ultrasound examination at least 24 hours before the procedure. 41 percent of those polled agreed with the law (Trull, 3/21).

Politico: Virginia Poll: 52% Oppose Ultrasound Law
A majority of Virginians stand against the state's new law that requires women seeking an abortion to undergo an ultrasound before the procedure, a new survey shows. Fifty-two percent of voters said they opposed the law, compared with 41 percent who support it, according to a Quinnipiac University poll released Wednesday. Further, an overwhelming 72 percent of Virginians said that the government should not make laws aimed at changing the minds of women who are seeking abortions (Mak, 3/21).

Des Moines Register: Iowa Bishops Call For Spiritual Battle Against HHS Mandate
The four Catholic Bishops of Iowa -- Archbishop Jerome Hanus of Dubuque, Bishop Richard Pates of Des Moines, Bishop Martin Amos of Davenport and Bishop Walker Nickless of Sioux City -- have issued a joint letter calling for all Iowa Catholics to dedicate the traditional Lenten practices of prayer, abstinence and fasting on Friday, March 30 toward the resolution of ongoing religious liberty concerns related to the implementation of federal health care mandates (Erzen, 3/21).

The Associated Press: Abortion Foes Do Live Ultrasounds In Idaho Capitol
The Idaho Capitol was part medical clinic, part reality TV show and all cultural battlefield on Wednesday, as an anti-abortion advocate secured a basement meeting room to conduct live ultrasound procedures on six women before a mostly female audience of 150. Some were ejected from the room by Idaho State Police troopers after interrupting activist Brandi Swindell's descriptions of the ultrasound images shown on three projector screens (Miller, 3/21).

The Texas Tribune: Interactive: Texas vs. the Federal Government
Gov. Rick Perry has pitted the state's interests against those of the federal government on a variety of issues -- including health care reform and environmental standards -- arguing the 10th Amendment grants state governments more autonomy than many of the laws passed by the federal government allow. ... Texas filed another suit on March 16 to overturn the federal decision to cut funding for the Texas Women’s Health Program. It's the second lawsuit involving women's health (Aaronson, Chang, Hasson and Wiseman, 3/21).

The Seattle Times: State To Appeal Judge's Ruling On Emergency Contraceptives
State officials announced Wednesday they will appeal a federal judge's ruling that Washington state cannot force pharmacies to sell Plan B or other emergency contraceptives. Gov. Chris Gregoire issued a statement announcing the action, saying she fully supports the appeal that will be filed by the office of Attorney General Rob McKenna on behalf of the state Department of Health and the state Board of Pharmacy (La Corte, 3/21).

The Kansas City Star: Miami [Kansas] County Again Decides To Forgo Contraceptive Funds
For a second time, Miami County commissioners have decided to forgo a government grant for contraceptives. More than 75 people packed a meeting Wednesday in Paola, Kan., where commissioners revisited an earlier decision not to seek the funds. After audience members spoke on both sides of the issue, commissioners reaffirmed their original position. That places in question an even greater amount of aid for family-planning services to the poor, according to a county commissioner. The board voted 3-2 earlier this month, on a motion by Commissioner Danny Gallagher, to delete about $9,000 from the county's annual grant request from the Kansas Department of Health and Environment (Campbell, 3/22).

Stateline: Herbert Reverses Course, Vetoes Abstinence Education Bill 
Republicans in Utah say they were caught off-guard last week when Governor Gary Herbert vetoed an abstinence-only sex education bill that had easily passed both chambers of the Republican-controlled legislature. ... The legislation, proposed by Representative Bill Wright, would have made it illegal to discuss contraception other than abstinence in the classroom (Wieder, 3/22). 

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Disabled Care In N.Y., Va., Ore. Examined Through Reports, Agreements And Budgets

Care for the disabled, as well as funding for programs that support them, is making news in New York, Virginia and Oregon. 

The New York Times: State Faults Care For The Disabled
Nearly 300,000 disabled and mentally ill New Yorkers face a "needless risk of harm" because of conflicting regulations, a lack of oversight and even disagreements over what constitutes abuse, according to a draft state report obtained by The New York Times (Hakim, 3/22).

The Associated Press/Washington Post: U.S., Va. Both Claim Settlement Agreement Doesn't Mandate Disabled Training Center Shutdowns
But residents' families who are challenging the agreement argue closure is the end goal. The settlement requires that Virginia add more than 4,000 Medicaid-funded slots for people waiting to receive community-based services -- and it's unlikely that Virginia could afford to operate both systems (3/22).

The Lund Report (an Oregon news service): No Need for Provider Tax on Developmental Disability Programs 
People who provide services to the developmentally disabled were willing to pay a provider tax out of their own pockets in order to receive federal matching dollars, but such a tax ended up being unnecessary. ... The Legislature's rebalanced budget, which filled a $300 million hole created by declining revenues, made no reductions in programs that serve people with developmental disabilities, including the program's reimbursement rates (Waldroupe, 3/21).

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Survey: Doctors Violate Professionalism Online

A letter in JAMA found most state medical licensing boards are receiving complaints about some doctors' online behavior.

Modern Healthcare: Doctors' Online Practices Need Improvement
A research letter published in the Journal of the American Medical Association found that most state medical licensing boards have reported cases of "physician violations of online professionalism," and some of these violations have resulted in serious disciplinary actions such as license revocation or suspension. In a survey of 68 licensing boards, researchers found that inappropriate online patient communications or sexual misconduct were reported to the boards at 69% of the 48 boards responding (Robeznieks, 3/21).

MedPage Today: Physicians in Hot Water for Online Missteps
Many of the boards indicated that they had received more than three reports of potential violations in some of the eight specific categories covered in the survey (Gever, 3/21).

NPR's SHOTS blog: Doctors' Missteps Online Can Lead To Disciplinary Action 
And then there are the doctors who go online to prescribe medicines for patients they've never seen. A majority of state medical boards, the groups that license and discipline doctors, have received reports of doctor behaving badly online, according to a nationwide survey (Hensley, 3/21). 

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Hospital News: Community Health Systems Victorious Over Tenet Healthcare

A U.S. District court in Dallas dismissed Tenet's suit against Community.

Modern Healthcare: U.S. District Court Grants CHS' Motion To Dismiss Tenet Lawsuit
The U.S. District Court in Dallas has granted Community Health Systems' motion to dismiss a lawsuit brought by Tenet Healthcare Corp. The Dallas-based hospital giant had sought to recoup damages relating to Brentwood, Tenn.-based CHS' failed merger attempt, which was launched in November 2010 and withdrawn in May (Kutscher, 3/21).

Reuters: US Court Rules For Community In Suit By Rival Tenet
In an unusual move against a hostile suitor, Tenet sued Community Health, accusing it of admitting too many patients to its hospitals in order to inflate profits and overcharge Medicare (3/21).

The Miami Herald: Miami-Dade Commissioners To Discuss Jackson Hospital Layoffs
The Miami-Dade Board of County Commissioners has scheduled two hours Thursday, starting at 10 a.m., to discuss Jackson Health System's decision to eliminate 1,117 positions, a move that will require firing 920 persons. ... Hardest hit will be the nurses: About 400 will be laid off, according to documents Jackson filed with the state (Dorschner, 3/22).

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State Roundup: Union Seeks $80M From N.Y. For Health Aides' Insurance

Health policy news centers around the legislatures in various states.

The Wall Street Journal: Union Seeks New Bailout In Budget Deal
As Gov. Andrew Cuomo and lawmakers lurch toward a budget deal, the state's largest health-care union is asking Albany for another bailout of its troubled insurance fund. The union, 1199SEIU United Healthcare Workers East, is asking the state for $80 million more in Medicaid dollars so it can keep on providing health insurance to personal-care aides (Gershman, 3/21).

Kansas Health Institute News: Committee Approves Using HMO Tax To Pay For Newborn Screenings
The House Appropriations Committee today approved a bill that would use an existing tax on health maintenance organizations to pay for the state's newborn screening program. The program tests infants for 29 metabolic and health disorders to help catch them early and prevent disability or death (Cauthon, 3/21).

Kansas Health Institute News: House Endorses Bill Requiring Insurance Coverage Of Autism Disorders
House BIll 2764, as amended during the floor debate, also would require autism coverage by the state's HealtWave program. HealthWave covers children in the Kansas Medicaid and Children's Health Insurance programs. Estimated cost of the HealthWave provision was about $26 million, with about $12 million of that coming from the State General Fund. The balance would be covered by federal Medicaid dollars (Shields, 3/21). 

Georgia Health News: Not All Health Bills Draw Controversy
Pulse oximetry is a test to help detect congenital heart defects in newborns by measuring how much oxygen is in their blood. A proposal for Georgia to study the efficacy of this screening was approved by a Senate health committee Wednesday. ... The cost of such testing would be roughly $4 per child,[ Dr. Cyrus Samai,] said. "It's cheap, easy and readily available,"’ he said (Miller, 3/21). 

WBUR's CommonHealth blog: Book: 'Great Experiment' Of Mass. Reform Should Not Go National
In Democrat-dominated, famously liberal Massachusetts, the Pioneer Institute is a downright dissident voice. [Its] arguments often challenge the state's party line. Such as, for example, that Massachusetts reform is such a clear success that it can serve as a model for the rest of the country. The Pioneer Institute... has just come out with a book: "The Great Experiment: the States, the Feds and Your Healthcare" (Goldberg, 3/21). 

HealthyCal: Survey: Californians Concerned About Rising Health Costs
[M]any report delaying care because of its cost. But only one in four has asked for pricing information before getting care and nearly half don’t know how much their insurance deductible is. The findings are from a survey by the California Healthcare Foundation. Other findings: In spite of rising health care costs, most report flat premium rates and stable benefits (3/21). 

Denver Post: Report: Colorado Grows Lazy About Fat; Chances Of Funding New Help Are Thin
The health status of many Coloradans is weighed down by expanding obesity challenges, with bleak prospects for public spending to attack the problems, according to a top foundation's annual "health report card." In the Colorado Health Foundation's five measures of overall citizen wellness, one reading fell, another rose slightly and three stayed flat from the year before, foundation researchers said (Booth, 3/22).

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Weekend Reading

Longer Looks: Health Literacy's Effect On Costs

Every week, reporter Jessica Marcy selects interesting reads from around the Web.

Huffington Post: Women's Health Care Is Stronger Thanks To The Health Care Law
In many families, women are the health care decision makers. When children go for their checkups, we are often the ones who make the appointment and sit in the room holding their hand. When elderly parents see a new specialist, we are the ones carrying the folder with all their health information. ... In the past, this also meant that many women would take care of their own health last. By the time they got around to it, women found a system stacked against them. But thanks to the health care law, that's changed (Kathleen Sebelius, 3/20).

The New Yorker: Holding Court
Late last year, a three-judge panel of the D.C. Circuit [Court of Appeals] voted, two to one, to uphold President Obama’s health-care reform, known as the Affordable Care Act (ACA). [Brett M.] Kavanaugh dissented, primarily on the ground that the lawsuit was premature. ... "Under the Constitution," Kavanaugh wrote, "the President may decline to enforce a statute that regulates private individuals when the President deems the statute unconstitutional, even if a court has held or would hold the statute constitutional." … In other words, according to Kavanaugh, even if the Supreme Court upholds the law this spring, a President Santorum, say, could refuse to enforce ACA because he "deems" the law unconstitutional. That, to put the matter plainly, is not how it works (Jeffrey Toobin, 3/26).

Governing: What Will The Supreme Court Ask About Health Reform?
If the court decides to rule on the lawsuit, a decision is expected by the end of June before the conclusion of the court’s current session. That decision has heavy implications for states. The ACA includes an extensive expansion of Medicaid (expected to add up to 20 million people to the program's rolls) and asks states to create a health insurance exchange where individuals and small businesses can compare and purchase insurance plans. Market reforms, such as rules for the medical loss ratios that insurance companies must maintain, would also require cooperation from state governments (Dylan Scott, 3/15).

The Atlantic: The Most Scientific Birth Is Often The Least Technological Birth
When I ask my medical students to describe their image of a woman who elects to birth with a midwife rather than with an obstetrician, they generally describe a woman who wears long cotton skirts, braids her hair, eats only organic vegan food, does yoga, and maybe drives a VW microbus. ... Many medical students, like most American patients, confuse science and technology. They think that what it means to be a scientific doctor is to bring to bear the maximum amount of technology on any given patient. And this makes them dangerous. In fact, if you look at scientific studies of birth, you find over and over again that many technological interventions increase risk to the mother and child rather than decreasing it (Alice Dreger, 3/20).

TIME: Inside America's Drug Shortage
Lynn Divers thought she had heard the worst of it when doctors told her that her daughter Alyssa had cancer. … Then came the truly heartbreaking news. In late February, when Divers called the hospital to confirm Alyssa’s upcoming chemotherapy treatment, the nurse informed her that there was a drug shortage. The hospital couldn't be sure that there would be enough methotrexate — the cornerstone of therapy for some childhood cancers, including leukemia and osteosarcoma — to treat Alyssa, now 10. … How did this happen? How could hundreds, perhaps thousands of cancer patients suddenly find themselves without the drug treatments that could save their lives? (Alice Park, 3/19).

American Medical News: The ABCs Of Health Literacy
One in three patients has "basic" or "below basic" health literacy, meaning he or she struggles with tasks such as completing a health insurance application or understanding a short set of instructions about what liquids to avoid drinking before a medical test. This literacy gap has medical consequences. A wide body of research has found that patients with poor literacy skills have much worse health outcomes than patients who can read well. They make more medication or treatment errors, are less compliant and are 50% likelier to be hospitalized, says the National Patient Safety Foundation. Low-literacy patients with chronic diseases ... rack up four times more in annual medical costs than patients with higher reading ability (Kevin B. O'Reilly, 3/19)

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Editorials and Opinions

Ryan Praised For 'Sticking His Neck Out'; Others Call Budget Plan A 'Path To Nowhere'

Commentators review the federal budget proposal announced Tuesday by House Budget Chairman Paul Ryan.

Chicago Tribune: Ryan's Challenge, Part 2
(Rep. Paul) Ryan's new plan isn't an instant fix. Like Version 1.0, it goes easy on defense spending, calls for repealing Obamacare, and leaves Social Security for later. Ryan's plan also has some holes in it. The nonpartisan deficit hawks at the Concord Coalition praised him for sticking his neck out on health spending and tax reform, but also said he's missing key details and his "assumptions for discretionary spending appear unrealistic, both in the short term and longer term." What we like is that Ryan, unlike a lot of people in Washington, is willing, at significant political risk, to force the debate on the grim budget decisions that have to be made (3/22).

The Washington Post: Flunking The Medicare Debate
One thing that we in the so-called mainstream media — those of us who still believe in striving for some semblance of fairness and objectivity — need to avoid is adopting the partisan vocabulary of left or right and treating it as neutral. On Medicare, we're flunking that test (Robert J. Samuelson, 3/21).

The Washington Post: Paul Ryan's Path To Nowhere
Ryan wants to use an aging America and the bogus but superficially appealing constraint of "historic levels of spending and taxation" to force massive reductions in the rest of government. That’s why the Center on Budget and Policy Priorities and others Tuesday were already calculating that Ryan’s new plan would basically zero out everything in government a few decades from now, save for Social Security, Medicare and defense (Matt Miller, 3/21).

Bloomberg: Ryan May Lead to Single-Payer Health Care
It’s unlikely that the model in the Republican budget will prove sustainable. That legislation would repeal the Affordable Care Act, cut Medicaid by a third and adopt competitive bidding for Medicare. The likely result? The nation's uninsured population would soar. In the long run -- and quite possibly in the short run -- that will increase the pressure for a universal system. Because Republicans don't really have an idea for creating one, Democrats will step into the void (Ezra Klein, 3/21).

The Wall Street Journal: Ryan's Hat Is In The Ring
Paul Ryan's admirers had their reasons for wanting him on the (presidential candidate) field, and mine comes down to one—the single, stark point Mr. Ryan has made since his side lost the health-care battle with Barack Obama, and which he made this week: "It is rare in American politics to arrive at a moment in which the debate revolves around the fundamental nature of American democracy and the social contract. But that is where we are" (Daniel Henninger, 3/21).

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Viewpoints: Health Law's Threat To Individual Liberty; Conflicting Opinions On The Constitutionality Of The Individual Mandate

The Wall Street Journal: The Supreme Court Weighs ObamaCare
On Monday, the Supreme Court will begin an extraordinary three-day hearing on the constitutionality of ObamaCare. At stake are the Constitution's structural guarantees of individual liberty, which limit governmental power and ensure political accountability by dividing that power between federal and state authorities. Upholding ObamaCare would destroy this dual-sovereignty system, the most distinctive feature of American constitutionalism (David B. Rivkin Jr. and Lee A. Casey, 3/21).

The New York Times' Opinionator: Never Before
So it's perhaps not surprising that just about half the public apparently believes that the Affordable Care Act's individual mandate is unconstitutional. Free of convention, and fresh from reading the main briefs in the case to be argued before the Supreme Court next week, I'm here to tell you: that belief is simply wrong (Linda Greenhouse, 3/21).

Politico: Health Care And Constitutional Armageddon
By every indication, this is constitutional Armageddon, an epic battle for the heart and soul of our constitutional democracy. But the case could end with a whimper instead of a bang. And our democracy might be better off if it does (Daniel Conkle, 3/21).

Roll Call: Necessary, Proper And The Individual Mandate
The question is whether the individual mandate is within Congress' power to regulate interstate commerce ("Commerce ... among the several States") or is "necessary and proper for carrying into Execution" that power. ... Ultimately, the Obama administration’s arguments on the "necessary" test undermine its arguments on the "proper" test and render the individual mandate unconstitutional (Jack Painter, 3/22).

The Washington Post: The Supreme Court's Other Monumental Health-Care Hearing
Contrary to nearly universal expectations, the justices decided to review the constitutionality of the law’s expansion of the federal-state Medicaid program for the poor. That expansion focuses on low-income adults: It requires all states that want federal Medicaid funding to set a floor under program eligibility at 133 percent of the federal poverty level — $14,856 in annual income for an individual, $20,123 for a couple (Ron Pollack and Wade Henderson, 3/21).

Fox News: Battle Of The Health Care Flip-Floppers--How Romney Can Defeat Obama
If Romney squares off with Obama in the general election, the American people will face a choice between two flip-floppers on the issue. But it is Obama, not Romney, who is presently wrong on the issue. And it was Obama who broke a specific campaign promise in actually imposing this disastrous policy on the American people (Phil Kerpen, 3/21).

Politico: Health Care Reform: Repeal Disastrous Affordable Care Act
As the implementation of this monstrosity proceeds, we see that the president's promises to lower costs and allow Americans to keep the coverage they have were just talking points, designed to secure this unrealistic expansion of the federal government. The reality is that the president’s signature domestic achievement massively expands entitlement spending, contributes to an already unsustainable debt, raises taxes on millions of families and businesses and puts Washington between patients and their doctors (Sens. Orrin Hatch, R-Utah, and Mike Enzi, R-Wyo., 3/21).

The Fiscal Times: Health-Care Giants Warn Sickly Earnings Ahead
Not a single one of the 16 health-care companies in the Standard & Poor’s 500-stock index that issued guidance on their first-quarter results took an optimistic perspective. ... Health-care costs have soared at rates that greatly exceed the official rate of inflation. Insurers are scrambling to keep up ... but the combination of the recession and pushback by hospitals and other providers has put downward pressure on prices (Suzanne McGee, 3/22).

The Seattle Times: Rolling Back The Clock On Women's Health
Just when you thought the top issues in America were jobs and the economy, along comes a raft of anti-women's health-care rhetoric and lawmaking. It looks like an all-out effort to roll back the 1960s and 1970s. Or, for that matter, much of the 20th century…. I suspect many female voters feel like I do. I will not vote for any candidate who participates in these absurd attacks on women and their need for legitimate, comprehensive health care (Joni Balter, 3/21).

The Baltimore Sun: Why I Demanded A Voice For Sandra Fluke
But there is another core interest we must consider as part of this debate, and that is the interest of the women affected by these policies. Even if the chairman and other Republicans disagree with women who support insurance coverage for contraceptives, these women have a right to their position, and we in Congress have an obligation to listen. Frankly, my Republican colleagues just don't seem to get that (Rep. Elijah E. Cummings, D-Md., 3/21).

Medscape: Contraceptives and Government: PCPs, Add Your Voice
This is a debate many of us thought was settled by the Supreme Court in the 1960s, and of course the folks at the Institute of Medicine issued a report that made it stunningly clear that investments in contraception improved the health of women dramatically, improved the economy, and in general improved the status of women by enabling all sorts of control over their life (Dr. Robert W. Morrow, 3/21).

Roll Call: The Budget Case For Combating Childhood Obesity
A new study, released today by the Campaign to End Obesity, points to the economic imperative of taking real action on obesity, especially when it comes to our children. ... Today, our nation spends $147 billion each year on obesity-related health care expenses, and this fails to count the billions more in costs to businesses, communities and families. Clearly, if we don’t address this epidemic, health care costs, already the fastest-growing area of federal spending, will continue to skyrocket (Rep. Ron Kind, D-Wis., and Donna Katen-Bahensky, 3/21).

Denver Post: Doctors' Preference Should Be Natural Childbirth
The World Health Organization determined that there is no medical reason for any region to have a cesarean birthrate higher than 15 percent. In Colorado, the C-section rate is 24 percent, making it one of the most common operations in the state. ... We questioned why doctors would take greater risks with Lindsey's low-risk pregnancy. In our research, we found this statistic: According to the Colorado Department of Public Health and Environment, cesarean rates increase from 13 percent for women paying out of pocket to 27 percent for women with private health insurance (Kevin Mohatt, 3/22).

Reuters: Six Keys To Long-Term Care Coverage
Some 70 percent of people over 65 will require long-term care services —- including assisted living, nursing home or home care —- during their lifetime, according to the U.S. Department of Health and Human Services. Costs, on average, range from $4,000 to $8,000 per month. For consumers who can't afford to self-insure against big costs like that, there are few alternatives. Medicare doesn't cover such expenses, and individuals with more than $2,000 in assets can't qualify for Medicaid assistance (Kathleen Kingsbury, 3/21).

Boston Globe: Mass. Lawmakers Should Pass Sick-Leave Bill
For years, legislators have proposed laws giving all workers in the state the right to stay home without penalty when they are ill. For years, they've hit brick walls. But this year might be different. Legislation sponsored by Representative Kay Khan and Senator Pat Jehlen is gathering momentum on Beacon Hill. It would require employers to give workers up to seven paid sick days a year. ... Supporters say paid sick leave would actually save businesses more than it would cost: It would reduce turnover, keep workplaces healthier and more productive, hold down health care expenses, and foster loyalty (Yvonne Abraham, 3/22).

(St. Paul) Pioneer Press: Medical Device Tax Will Hit Small and Mid-Size Companies Hard
We need to look for ways to encourage -- not tax and stifle -- an environment of innovation for Minnesota's medical technology companies, large and small, to continue creating high-paying, private-sector jobs that develop critical life- and cost-saving technology. Repealing Obamacare and the harmful medical device tax would be a step in leveling the playing field and moving in the right direction (Pete Hegseth, 3/21).

New England of Medicine: The Potential for Cost Savings Through Bundled Episode Payments
[O]ur results suggest that it is possible to achieve very substantial health care savings by moving from a fee-for-service model to bundled payments for episodes of care, whether in a stand-alone program or as a component of an overall global-payment model (David M. Cutler and Kaushik Ghosh, 3/21).

New England Journal of Medicine: Registered Nurse Labor Supply And The Recession — Are We In A Bubble?
Employers and workforce policymakers should not be lulled into complacency by the current absence of a nursing shortage. ... Shortages of RNs may reduce access to care and increase costs as employers raise salaries to attract nurses, potentially imperiling the success of health care reform (Douglas O. Staiger, David I. Auerbach and Peter I. Buerhaus, 3/21).

New England Journal of Medicine: Financing Graduate Medical Education — Mounting Pressure For Reform
Disparate voices from the White House, a national fiscal commission, Congress, a Medicare advisory body, private foundations, and academic medical leaders are advocating changes to Medicare's investment in graduate medical education (GME), which currently totals $9.5 billion annually (John K. Iglehart, 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.