Daily Health Policy Report

Friday, March 22, 2013

Last updated: Fri, Mar 22

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Information Technology

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

At Health Law Anniversary, Even Bigger Changes Loom (Video)

This Kaiser Health News webcast features a roundtable of reporters weighing in on what's changed since the Affordable Care Act became law three years ago for consumers, businesses, state governments, and what's next for expanding Medicaid and launching exchanges (3/21). Watch the video or read the transcript.

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From The State Capitals: The ACA At Three

Kaiser Health News checked in with reporters on the ground in Colorado, Florida and Minnesota to find out what they view as the most significant developments to happen in their states since the law's passage and what future challenges they see ahead. Watch the skype interviews or read the transcripts.

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In The Emergency Department, Gunshot Fatalities Often 'Hard To Forget'

Colorado Public Radio's Eric Whitney, working in partnership with Kaiser Health Newsand NPR, reports: "In Colorado, where more people die from gunshots than car crashes, the victims have a profound effect on the physicians who treat them. For some of the doctors on the front lines, the experiences lead to a strong opposition to guns, questions about gun laws and even activism" (Whitney, 3/21). Read the story.

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Capsules: Who Are The Uninsured? The Feds Parse The Numbers

Now on Kaiser Health News' blog, Jenny Gold reports: "There are 48.4 million uninsured Americans — about 18 percent of the population — according to the last Census. But who are they? And what is the best way to get them signed up for new health insurance coverage options that roll out this fall? The U.S. Centers for Medicare and Medicaid Services has just released a brief for those with a stake in getting people signed up, including insurers, consumer advocates and state officials. The analysis breaks the uninsured down by age, race, geography and 'lifestyle and psychographic segments'" (Gold, 3/22). Check out what else is on the blog.

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Political Cartoon: 'Pop Culture?'

Kaiser Health News provides a fresh take on health policy developments with "Pop Culture?" by Keith Knight.

Meanwhile, here is today's health policy haiku:


Some brackets, busted...
What's left for celebration?
The health law turns 3.

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

Health Law Still Misunderstood, Divisive At Age 3

News outlets examine how the health law is impacting various Americans and changing the health care system.

The Associated Press: Obama Health Law Anniversary Finds Two Americas
Three years, two elections, and one Supreme Court decision after President Barack Obama signed the Affordable Care Act, its promise of health care for the uninsured may be delayed or undercut in much of the country because of entrenched opposition from many Republican state leaders. In half the states, mainly led by Democrats, officials are racing deadlines to connect uninsured residents to coverage now only months away. In others it’s as if "Obamacare" — signed Mar. 23, 2010 — had never passed (Alonso-Zaldivar, 3/21).

Politico: Will Americans Ever Love Obamacare?
Someday, the law's backers insisted, Obamacare will make the transition from a divisive idea to a widely popular one, from a program that many people still find confusing and scary to a familiar and comforting part of American life. This weekend, which marks the third anniversary of the law's passage, one thing remains clear: Someday has not yet arrived, and may not for a long time (Millman and Norman, 3/22).

CBS News: Obamacare's 3rd Anniversary: By The Numbers
The Affordable Care Act has been law of the land for three years now -- President Obama signed the legislation on March 23, 2010 -- but it remains a source of controversy and mystery for many Americans. Meanwhile, some of the most significant parts of the law have yet to take effect. Three years after the enactment of Obamacare, here's a look at some key figures that shed light on the status of the law's implementation, its impact on the nation and public opinion (Condon, 3/22).

Kaiser Health News: Video Roundtable: At Health Law Anniversary, Even Bigger Changes Loom?
A roundtable of reporters weigh in on what's changed since the ACA became law three years ago for consumers, businesses, state governments, and what's next for expanding Medicaid and launching exchanges (3/21).

Kaiser Health News: From The State Capitals: The ACA At Three??
As the health law marks its third anniversary, much of the action surrounding its implementation has shifted to the states. ... We checked in with reporters on the ground in Colorado, Florida and Minnesota to find out what they view as the most significant developments to happen in their states since the law’s passage and what future challenges they see ahead (3/22).

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States And Exchanges: Mich. Senate Rejects Plan To Partner With Feds

The Michigan action means that running the health insurance marketplace in that state will fall to the federal government. In Idaho, the Senate approved a proposal to create a state-based health exchange.

The Associated Press: Mich. Senate Rejects Partnering On Health Exchange
The U.S. government will fully run a health insurance market in Michigan after Republican senators on Thursday decided against Gov. Rick Snyder's call to partner with federal officials on consumer assistance and oversight of health plans offered in the exchange. It was the last day to act before lawmakers take a two-week break. Because the GOP-led Senate refused to spend a $31 million federal grant for the partnership exchange – a key component of the contentious 2010 federal health care law – the state will have to spend about $8 million of its own money to link computer systems to the federal exchange, Snyder spokesman Kurt Weiss said (Eggert, 3/21).

Detroit Free Press: Senate Inaction Means Michigan Gives All Control Of Health Exchange To Feds
Senate Republicans, wary of anything to do with the Affordable Care Act, couldn't reach a consensus on the best way to form the exchange, which will allow Michigan residents to research and ultimately buy health insurance mandated under the ACA. Gov. Rick Snyder said the measure had to be decided before the Legislature goes on a two-week spring break this week in order to get the work done to create the exchange. He favors the state/federal partnership as a way for the state to still have some control over the exchange (Gray, 3/21).

The Associated Press: Idaho State Senate Approves State-Based Health Insurance Exchange
The Idaho state Senate approved a proposed state-based health insurance exchange on Thursday after a debate in which it was alternately bashed as federal tyranny and praised as protecting Idaho's sovereignty. Unlike two dozen Republican governors in other states, Gov. C.L. "Butch" Otter backs such an exchange run by a state-created, nonprofit corporation. He argues it will be cheaper and more responsive to Idaho residents and better for insurers based in Idaho (3/21).

In addition, while the U.S. Senate debated the Democrats' budget plan, some Republicans offered amendments to force President Barack Obama and Vice President Joe Biden to purchase their health insurance through the new exchanges.

The Hill: Senate GOP Proposals Would Force Obama Into Health Law Exchanges
Republican amendments to the Senate's budget proposal would require President Obama and Vice President Biden to get their medical care through the new exchanges created by Obama's signature healthcare law. Sens. Susan Collins (R-Maine) and Kelly Ayotte (R-N.H.) both offered amendments to move the president and vice president into the healthcare law's exchanges (Baker, 3/21).

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States Encouraged To Use Medicaid Expansion Money To Buy Private Insurance For Poor

The New York Times reports that the White House is encouraging skeptical state officials to expand Medicaid by using federal money to subsidize the purchase of private insurance for low-income people -- a model not envisioned by drafters of the law. Meanwhile, Health and Human Services Secretary Kathleen Sebelius predicts that Republican governors will eventually expand the program.

The New York Times: States Urged To Expand Medicaid With Private Insurance
The White House is encouraging skeptical state officials to expand Medicaid by subsidizing the purchase of private insurance for low-income people, even though that approach might be somewhat more expensive, federal and state officials say (Pear, 3/21).

USA Today: Sebelius: GOP Governors Will Eventually Expand Medicaid
Republican governors and GOP-controlled legislatures will eventually decide to expand Medicaid in their states because the financial benefits are too big to ignore, Health and Human Services Secretary Kathleen Sebelius said in an interview Thursday with USA TODAY. … Sebelius … said governors are talking with hospital and patients groups within their states and beginning to understand the economic advantages of Medicaid expansion. Not only would more people have basic coverage, but the number of unpaid hospitalizations would be dramatically reduced, Sebelius said. She cited research that shows the average American pays an extra $1,000 a year in insurance premiums to cover costs of the uninsured at hospitals (Kennedy, 3/21).

In state-level news -

Kansas Health Institute: Senate Budget Amendment Underscores Opposition To Medicaid Expansion
The budget bill that passed the Senate today includes an amendment that would bar state agencies from spending any money to expand eligibility for the Kansas Medicaid program without the express consent of the Legislature (Ranney, 3/21).

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Health Insurers Urge Brokers To Brace For Sharp Increases In Premium Costs

The Wall Street Journal reports that health insurers are quietly issuing this warning to brokers. Meanwhile, an Ohio insurance company will drop its lawsuit regarding confusion over rules related to the health law's high risk insurance program.

The Wall Street Journal: Health Insurers Warn On Premiums
Health insurers are privately warning brokers that premiums for many individuals and small businesses could increase sharply next year because of the health-care overhaul law, with the nation's biggest firm projecting that rates could more than double for some consumers buying their own plans (Mathews and Radnofsky, 3/21).

The Associated Press: Ohio Health Insurance Company Drops Lawsuit
An Ohio health insurance company dropped its lawsuit Thursday against state and federal officials over confusion in rules for a program for patients with pre-existing medical conditions. At issue is a high-risk insurance pool created by President Barack Obama's health care law targeting patients turned away by insurance companies because of such conditions as cancer or heart disease (Sanner, 3/21).

Meanwhile, in other news, the Centers for Medicare and Medicaid released a brief about who the nation's uninsured are.

Kaiser Health News: Capsules: Who Are The Uninsured? The Feds Parse The Numbers
There are 48.4 million uninsured Americans — about 18 percent of the population — according to the last Census. But who are they? And what is the best way to get them signed up for new health insurance coverage options that roll out this fall? The U.S. Centers for Medicare and Medicaid Services has just released a brief for those with a stake in getting people signed up, including insurers, consumer advocates and state officials. The analysis breaks the uninsured down by age, race, geography and "lifestyle and psychographic segments" (Gold, 3/22).

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Berwick Weighs In On Dispute Over ACO Quality Standards

Also, the Medicare Newsgroup reports that industry players are cautiously upbeat about the potential of accountable care organizations to improve quality and lower costs.

WBUR: Berwick Weighs In On Despute Over Medical Quality Standards
Medicare's Pioneer ACOs are arguably leading the most important experiment under the Affordable Care Act. ... Berwick, who is also busy helping Britian’s National Health Service recover from an “enormous illness”, offers the Pioneer ACOs some guidance. “As you work through solutions, stay on the high road. And then, try to get to a platform where the discussion is not, will we play or not, but can we work this through at a technical level" (Bebinger, 3/21).

The Medicare Newsgroup: Industry Players Express Cautious Optimism on ACO Potential
Providers, researchers and industry stakeholders expressed simultaneous hopefulness and skepticism about whether ACOs will achieve their goal of improving quality while lowering costs, on Wednesday, March 20 at the National Press Club during the free-wheeling discussion held by The Medicare NewsGroup (Rosenblatt, 3/21).

In other news related to health care quality -

ProPublica: When Harm In The Hospital Follows You Home
A slip of the scalpel, an invisible microbe, a minute miscalculation. It's estimated that something goes wrong for more than one million people per year during a visit to the hospital. Some patients experience a full physical recovery. Some are never fully healed. but even if patients are lucky enough to physically heal, their lives may never be the same (Pierce, 3/21).

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Capitol Hill Watch

House Passes Short-Term Spending Bill, But Bigger Budget Obstacles Remain

The measure, which now goes to President Barack Obama for his signature, will fund the government through September. Meanwhile, the Senate and House still have larger issues on the long-term budget, including conflicting views on funding levels for entitlements such as Medicaid.

The New York Times: House Passes Money Bill And Budget Blueprint
The House gave final approval on Thursday to legislation to keep government financed through September, and it also passed a Republican blueprint that enshrined the party's vision of a balanced budget that would substantially shrink spending, privatize Medicare and rewrite the tax code to make it simpler (Weisman, 3/21).

The Wall Street Journal: Tired Of Fights, Congress Passes Funding Bill
The spending bill keeps the government funded through the end of its 2013 fiscal year. It keeps overall spending to the level mandated by the sequester, the $85 billion in cuts that began March 1, despite strenuous efforts by Mr. Obama to replace them. The bill blunts the impact of the cuts in some areas such as military operations and maintenance, nutrition aid for women and children, and border security, but cuts deeper in other areas to make up for it. Republicans also blocked increased spending on top Obama priorities like health care and financial regulation (Hook, 3/21).

Modern Healthcare: Gov't Shutdown Averted; Sequester Cuts Remain
Federal lawmakers averted a government shutdown after the House of Representatives approved a $984 billion spending bill (PDF) that will keep the government operating through Sept. 30 and maintains the sequestration cuts that will hit Medicare providers starting on April 1. ... Meanwhile, the Senate version added more dollars for healthcare than the initial spending bill the House passed in March. For instance, the final bill added about $71 million for research under the National Institutes of Health. With both chambers approving the measure, it now moves to President Barack Obama's desk for his signature (Zigmond, 3/21).

Los Angeles Times: Republicans In Congress Shift Focus to Long Term
Sending President Obama a bill Thursday that averts a government shutdown, Congress proved that it can, in fact, function. Not long ago, this was considered an unlikely outcome. … Even as the House voted Thursday to fund the government for the next six months, Republicans also pushed through an austere budget plan that would balance revenue and spending in 10 years. Drafted by Rep. Paul D. Ryan (R-Wis.), the former vice presidential nominee, the proposal would overhaul Medicare and the social safety net, while dropping taxes for the wealthy and corporations. In the Senate, Democrats are expected to approve their own 10-year budget plan Friday that goes in the opposite direction (Mascaro and Memoli, 3/21).

The Washington Post: House Approves Resolution To Keep Government Running; Bill Heads To White House
Lawmakers are debating how much to tax and spend for the years to come. On Thursday, the House also approved a budget blueprint by Rep. Paul Ryan (R-Wis.) in a mostly partisan 221 to 207 vote. Ten Republicans joined House Democrats in opposing the Ryan budget measure. ... Democrats slammed Ryan’s plan as too austere — particularly its proposal to end Medicare as a guaranteed benefit for seniors. They said voters defeated that idea in the presidential election in November. ... In blunt terms, House Speaker John A. Boehner (R-Ohio) acknowledged Thursday that the path ahead is murky: Republicans are demanding reforms to reduce entitlement spending in exchange for increasing the debt ceiling — a position Democrats object to unless large tax revenue is included beyond the more than $600 billion in tax hikes approved New Year’s Day (Helderman and Rein, 3/21).

The Associated Press: Senate Democrats On Track To Pass Budget Protecting Safety Net And Raising Taxes
The nonbinding but politically symbolic measure would protect safety-net programs for the poor and popular domestic priorities like education, health research and federal law enforcement agencies from cuts sought by House Republicans, who adopted a far more austere plan on Thursday morning. … The dueling House and Senate budget plans are anchored on opposite ends of the ideological spectrum in Washington, appealing to core partisans in warring GOP and Democratic tribes long gridlocked over how to attack budget deficits. The GOP plan caters to tea party forces while Senate Budget Committee Chairman Patty Murray, D-Wash., crafted a measure designed to nail down support from liberal senators like Bernie Sanders, I-Vt., and Tom Harkin, D-Iowa, who vehemently oppose cuts to safety net programs (3/22).

The Wall Street Journal: Sen. Warner Sees Greater Odds For Big Budget Deal
(Sen. Mark) Warner said one purpose of "new ideas"—both on taxes and on slowing Medicare spending—is "so people can get off their established positions" and agree to things without accepting proposals they have rejected in previous rounds of deficit talks. He also sketched out an approach to Medicare. He said a mechanism that sets a ceiling on Medicare spending as a percentage of gross domestic product would force Congress to change course if legislated changes to the program don't save as much money as forecast (Wessel, 3/21).

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Senate Backs Repeal Of Health Law's Medical Device Tax

The repeal was offered as an amendment to the Senate Democrats' fiscal year 2014 budget plan. Although the vote was largely symbolic, it signals strong opposition to the tax.

The Wall Street Journal: Senate Votes Against Key Health-Law Tax
The Senate voted overwhelmingly Thursday night to repeal a tax on medical-device sales, despite the fact that the levy helps finance the health-care overhaul. The vote was largely symbolic, but the 79-20 tally signals strong opposition to the 2.3% tax on device sales that went into effect Jan. 1. Even though the levy is meant to help foot the bill for the signature legislative achievement of President Barack Obama's first term, 33 Democrats as well as independent Sen. Angus King of Maine joined Republican senators in voting to repeal the tax. The vote came as an amendment to the Senate Democrats' fiscal year 2014 budget, a partisan tax-and-spending blueprint that stands no chance of passing the GOP-controlled House (Peterson, 3/21).

The Hill: Senate Calls For An End To Medical Device Tax
The Senate on Thursday approved a bipartisan budget amendment calling for the end of a medical device tax enacted as part of President Obama's healthcare reform bill. The amendment was agreed to by a vote of 79 to 20. It was sponsored by Sens. Orrin Hatch (R-Utah) and Amy Klobuchar (D-Minn.) (Wasson,3/21).

Fox News: Bipartisan Push To Repeal Medical Device Tax Gains Traction In Senate
The Senate gave sweeping bipartisan approval Thursday to a proposal by Orrin Hatch, R-Utah, and Amy Klobuchar, D-Minn., to put senators on record in favor of repealing a tax on medical devices – a key part of President Obama’s controversial health care law. The Hatch-Klobuchar amendment to the GOP budget plan is the latest effort to roll back the tax that applies to a range of medical products, from surgical tools to heart devices. It’s among several taxes in Obama’s 2010 health care overhaul. The amendment passed the Senate by a vote of 79 to 20 (3/22).

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Health Information Technology

Study: Experts Question Cost Benefits Of 'Telehealth'

Reuters: As 'Telehealth' Grows, Experts Question Cost Benefits
Monitoring patients at home using modern technology, so-called 'telehealth', is tipped as the next big thing in healthcare, but a new study by British researchers suggests it may not be worth the extra expense. The findings will fuel controversy over the economic case for telehealth, which many information technology and telecoms companies are betting on as a multibillion-dollar market opportunity (Hirschler, 3/21).

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State Watch

State Highlights: Minn. Democrats Propose Cuts To Health Services

A selection of health policy stories from Minnesota, Maryland, Louisiana, Colorado, Nebraska and Florida.

Minneapolis Star Tribune: Minnesota Lawmakers Call For Deep Cuts To Health, Human Services Budget
House and Senate [Democrats] are eyeing Minnesota's health and human services budget and sharpening their knives. "It's going to swallow up our entire budget," said House Speaker Paul Thissen, who this week proposed cutting $150 million from the budget, shrinking the governor's proposed $11.3 billion budget for health and human services to $11.2 billion. "It's the part of the budget that’s growing too quickly to keep up with the revenues that are coming in" (Brooks, 3/21).

MPR News: DFL's Plan To Cut Health, Human Services Spending Comes As A Surprise
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, [Democrats] 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 (Scheck, 3/21).

Baltimore Sun: Advocates, Insurers Duel Cover Cost Of Child Dental Coverage
Like most 3-year-olds, Mariah Venable is a climber and a jumper. And sometimes she lands on her face instead of her legs. Her acrobatic attempts have cost her two baby teeth already — and have left her mother thankful she has good dental insurance. "You have to start on their teeth early so they don't have issues when they get older," said Cheryl Venable, who recently took her daughter — smiling wide through the gaps — to a city clinic that offers dental care to low-income and uninsured families. Health advocates are concerned that new guidance from the Obama administration could make it more expensive for some low- and middle-income parents to pay for dental insurance for their children once the new health care law takes effect next year (Fritze, 3/21).

The Associated Press/Washington Post: Jindal Administration Cancels Medicaid Contract That Is Subject Of Federal Grand Jury Subpoena
Gov. Bobby Jindal’s administration announced Thursday it is scrapping a lucrative state Medicaid contract that is the subject of a federal grand jury investigation. Commissioner of Administration Kristy Nichols issued a statement announcing the cancellation of the more than $185 million contract with Maryland-based CNSI, which was supposed to take over Medicaid claims processing next year (3/21).

Kaiser Health News: In The Emergency Department, Gunshot Fatalities Often 'Hard To Forget'
In Colorado, where more people die from gunshots than car crashes, the victims have a profound effect on the physicians who treat them. For some of the doctors on the front lines, the experiences lead to a strong opposition to guns, questions about gun laws and even activism (Whitney, 3/21).

The Associated Press: Nebraska Lawmaker Revives Prenatal Care Debate
A long-shot attempt to repeal state-funded prenatal care services for illegal immigrants drew criticism Thursday from a variety of Nebraska groups. Advocates for children, immigrants and medical clinics convened at the Capitol to oppose a bill by Sen. Charlie Janssen of Fremont. Several people said Janssen, a Republican candidate for governor, was exploiting the issue for political gain (Schulte, 3/21).

Health News Florida: Judge Orders Universal Into State Receivership
A bankrupt Medicare plan based in St. Petersburg will be turned over to the State of Florida's Division of Financial Services  by April 1 under an order issued Thursday by a circuit court judge in Tallahassee. The decision on what to do with thousands of Medicare and Medicaid members enrolled in the plans marketed by sister companies Universal Health Care Inc. and Universal Health Care Insurance Co. is now up to state and federal officials (Gentry, 3/21).

Health News Florida: Courthouse Steps Getting Steeper For Patients, Families
In Florida, medical-negligence cases already take more time, money and evidence to bring than any other kind of civil suit. Now the Florida Legislature is considering raising the bar again. ... Shannon Lawley was a healthy 31-year-old when she got sick and sought help at a Brevard County emergency room last year. Her father, Michael, says she died there because of mistakes (Gentry, 3/22).

Minneapolis Star Tribune: Hospital Drug Thefts To Get More Scrutiny
Jerold L. Mullins stole meds from a hospital where he worked, went through drug treatment three times and was disciplined once after testing positive for a powerful painkiller while working as a nurse. Yet the state board that licenses nurses in Minnesota didn't find out for 15 years. Mullins' case is one of several high-profile incidents in recent years that have led to a proposal that would force more scrutiny of medical drug thieves. The legislation, which is scheduled for a House committee hearing Friday, would require hospitals and other health care employers to report employees to the state's professional licensing boards if they steal medication intended for patients (Schrade, 3/21). 

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Health Policy Research

Research Roundup: Comparing Medicare Budget Plans

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

JAMA Pediatrics: Nurse Staffing And NICU Infection Rates –Neonatal intensive care units (NICU) – which provide care for infants who are critically ill – are costly and require a significant amount of nursing services. Little is known, however, about the adequacy of nurse staffing at these units. Using data from 2008 and 2009, researchers analyzed the relationship between adherence to national staffing guidelines and hospitals-associated infections among very low birth-weight (VLBW) infants. "Our results document widespread understaffing relative to guidelines: one-third of NICU infants were understaffed… ," the authors write. "In VLBW infants, NICU nurse understaffing relative to guidelines was associated with a sizable increase in infection risk." They conclude that their findings "suggest that the most vulnerable hospitalized patients, unstable newborns require complex critical care, do not received recommended levels of nursing care. Even in some of the nation’s best NICUs, nurse staffing does not match guidelines" (Rogowski et al., 3/18).

State Health Access Data/Robert Wood Johnson Foundation: State Estimates Of The Low-Income Uninsured Not Eligible For The ACA Medicaid Expansion – Millions of Americans will gain access to affordable health insurance under the federal health law, but some immigrants are excluded. "Legal permanent residents, in most circumstances, are ineligible for Medicaid benefits for the first five years during which they result legally in the U.S. and unauthorized immigrants are excluded from Medicaid coverage," the authors of the brief state. They provide estimates of the number of uninsured low-income adults in each state that may be excluded from Medicaid expansion because of their immigration status. "Safety-net health care providers are likely to continue to be key providers for this population after health reform, and the need for safety-net care will not be spread evenly across states," the authors conclude (3/14).

The Kaiser Family Foundation: Illinois, Massachusetts, Ohio, and Washington: Financial Alignment Demonstrations for Dual Eligible Beneficiaries Compared – The Centers for Medicare & Medicaid Services (CMS) has established demonstration projects with with Illinois, Massachusetts Ohio and Washington to test changes in delivery care systems for people who qualify for both Medicare and Medicaid, often called dual eligibles. These are among the poorest and sickest beneficiaries in the programs and their care is expensive. This policy brief compares the four programs. The author notes, “While the demonstrations offer the potential opportunity to improve care coordination, lower program costs, and achieve outcomes such as the increased use of HCBS instead of institutionalization, at the same time the high care needs of many dual eligible beneficiaries increase their vulnerability when care delivery systems are changed” (Musumeci, 3/18).

The Kaiser Family Foundation: Medicare and the Federal Budget: Comparison of Medicare Provisions In Recent Federal Debt And Deficit Reduction Proposals -- As Congress and the Obama administration have looked for budget savings, the Medicare program has come under scrutiny. According to the author, over the next decade, Medicare spending “is projected to grow slower than private insurance on a per capita basis, and at about the same rate as the economy.” This brief features a side-by-side comparison of the key Medicare provisions in four major budget and debt-reduction plans. The brief also includes short descriptions of Medicare proposals in several other deficit-reduction proposals recently put forward by other members of Congress and influential policy groups (Jacobson, 3/15).

Here is a selection of news coverage of other recent research:

Medscape: False-Positive Mammogram Is Far From Harmless
A false-positive screening mammogram can cause lasting psychological harm, according to a study from Denmark. Even after 3 years of being declared free of suspected cancer, women who had a false-positive mammography result consistently reported greater negative psychosocial consequences than their peers with normal findings and those with true breast cancer, report John Brodersen, MD, PhD, and Volkert Dirk Siersma, PhD, from the University of Copenhagen (Brooks, 3/19). 

Medscape: Blacks More Likely Than Whites To Undergo Leg Amputation
Black patients have greater odds than white patients of undergoing lower-extremity amputation rather than revascularization for ischemia, according to a hospital database study reported online March 20 in JAMA Surgery. These disparities persisted after correction for a range of confounding parameters and were greater in wealthier neighborhoods and in hospitals with greater resources (Barclay, 3/20).

Reuters: Less-Invasive Surgery Tied To Less Cost, Absenteeism
Minimally-invasive forms of heart surgery and fibroid removal may be less expensive - and cause patients to take fewer days off from work - than standard versions of the same procedures, a new study suggests. Researchers looking at six common surgeries found that if every one of them performed in the U.S. in 2009 had used minimally-invasive techniques, health plans would have saved $2.3 billion and employees would have missed about 20,000 fewer days of work (Pittman, 3/20). 

Medscape: Study Criticizes Policy Penalizing Nonemergency ED Visits
In an effort to control Medicaid costs, some state legislators have wanted to deny or limit payment for emergency department (ED) visits if a later discharge diagnosis indicated the problem was a nonemergency that could have been handled in a physician's office. Good luck making that work, says a new study published in the Journal of the American Medical Association (JAMA). Lead author Maria Raven, MD, MPH, and colleagues write that in ED visits later deemed to be primary care treatable based on the discharge diagnosis, patients presented the same chief complaints given by the vast majority of all ED patients (Lowes, 3/19).

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Editorials and Opinions

Opposing Views On Health Law's Birthday; Krauthammer Calls For Compromise With Obama On Entitlements, Taxes

USA Today: Happy Birthday ObamaCare!
A year ago, the Affordable Care Act's outlook appeared uncertain, with the Supreme Court decision on the law's legality and a contentious election fight over its merits still on the horizon. Today, with both of those events unfolding in favor of the landmark law, ObamaCare continues to take effect, having already achieved so much, yet with so much more to come later this year (Rep. Sander Levin, D-Mich., and Rep. Jim McDermott, D-Wash., 3/21).

USA Today: Affordable Care Act Hasn't Earned Its Name
It was three years ago this weekend that President Obama signed a law that fundamentally changed our nation's healthcare system. While reform was needed, change is only good if it brings with it real reforms that reduce costs and empower individuals and small-business owners in making healthcare choices for themselves, their employees and their families. The Patient Protection and Affordable Care Act (ACA) does neither of those things. Three years later, the law is not living up to its moniker (Dan Danner, Bruce Josten and Mattew Shay, 3/21). 

The Washington Post: The 50 Percent Solution
The proposition that entitlement curbs are the key to maintaining national solvency is widely accepted, though not by many congressional Democrats. President Obama, however, has endorsed it on various occasions. And he could make it happen. If he wants. I remain skeptical that he does. But national solvency is important enough to test this proposition at least once more (Charles Krauthammer, 3/21).

Kansas City Star: Medicaid Expansion Is Still A Big Pill For Missouri GOP
Missouri's Republican legislative leaders used their last few hours before spring break to make it known they are not on board with raising the state's miserly income qualifications for Medicaid. "We do not believe it's prudent to double down on a broken system," said Tom Dempsey, the Republican Senate president pro tem. Medicaid actually works very efficiently for a lot of people, but that's their story and they're sticking with it. This doesn't necessarily mean Republicans won't ultimately expand Medicaid eligibility. Virtually every business group in the state wants them to do so, and Democrats are already sharpening their knives for the campaign season two years hence (Barbara Shelly, 3/21).

The New York Times Opinionator: Burgers, Fries And Lies
So, Mike Ruffer (a Five Guys franchise owner) was brought in as the star witness at a Heritage forum designed to show just how egregious it is that businesses will have to provide health care for their employees, or pay a fine. Right wing media — Drudge, Breitbart, Fox — played their part, sounding alarms over a cheeseburger that may cost an additional quarter. But what the Heritage histrionics unintentionally showed was everything that is absurd, wrong and darkly humorous about the American approach to diet and health care economics (Timothy Egan, 3/21).

The New York Times: North Carolina Overreaches
Under the federal Medicaid statute, states must seek reimbursement for medical expenses if the beneficiary also receives money from an insurance company or another third party. This week, the Supreme Court correctly slapped down a North Carolina law that could squeeze far more from beneficiaries than they actually owe (3/21).

Minneapolis Star Tribune: North Dakota Governor Should Veto Abortion Limits
After losing badly at the polls in Mississippi and Colorado, proponents of life-begins-at-conception measures kept shopping for new states that might not only pass a sweeping abortion ban but also conscript taxpayer dollars to fund proponents' grander ambition — a legal challenge to Roe vs. Wade. Unfortunately, they found an easy mark with money in oil-rich and socially conservative North Dakota (3/21).

Baltimore Sun: Sickening Cuts To NIH
Albert Einstein was 26 when he published his Special Theory of Relativity; James Watson, at age 25, explained the structure of DNA. Here in Baltimore, many great medical achievements were developed by early-career researchers at Johns Hopkins. "The young do not know enough to be prudent," said Pearl Buck. "They attempt the impossible, and achieve it, generation after generation." Today's young American scientists are no less inspired but are discouraged by a perceived lack of opportunity after long, grueling years of training. Unfortunately, the federal budget sequester is turning that perception to reality. We appreciate the nation's long-term fiscal challenges and recognize that overall spending must be cut. Precisely because of these pressures, not in spite of them, we should reallocate priorities to invest in America's future (Michael Milken and Elias Zerhouni, 3/21).

WBUR: CommonHealth: The Big Lesson From Brill's 'Bitter Pill' Story, So Big It's Hard To See
I stopped in to get my car fixed yesterday and found the recent Time issue featuring Steve Brill's mega-story — Bitter Pill: Why Medical Bills Are Killing Us — still lingering on the waiting-room table, well-thumbed and dog-eared. For a story about a problem that just about everyone already knew existed, the piece has clearly been having a major impact and sparked widespread discussion. Today, the Cambridge-based Institute for Healthcare Improvement posts a lively and provocative piece that concludes that the current payment system is broken and must be blown up (Carey Goldberg, 3/22).

Journal of the American Medical Association: Pushing the Outpatient Quality Envelope
The rapidly changing payment and delivery system may introduce the risk of many unintended consequences if quality measurement is too myopic. Fortunately, the present era is characterized by more knowledge about quality and more tools to measure quality. Nevertheless, pushing quality measurement for the outpatient setting needs to be a priority for the medical community, and more work must be done to develop, test, and use new measures (Dr. Tara F. Bishop, 3/21).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

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