Daily Health Policy Report

Tuesday, March 26, 2013

Last updated: Tue, Mar 26

KHN Original Reporting & Guest Opinion

Health Reform

Health Care Marketplace

Quality

Coverage & Access

Administration News

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Temp Agencies See Opportunity In Health Law

Kaiser Health News staff writer Jay Hancock, working in collaboration with The Washington Post, reports: "The rush to implement the Affordable Care Act, which is generating billions for insurers, hospitals and technology vendors, also looks like a boon for staffing companies, whose share prices have soared. But some suggest that exceptions for temporary employees could leave holes in the health law’s expanded coverage" (Hancock, 3/26). Read the story.

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Slow Progress On Efforts To Pay Docs, Hospitals For 'Value,' Not Volume

Reporting for Kaiser Health News in collaboration with USA Today, Russ Mitchell writes: "For decades, reformers have sought to change how doctors and hospitals are paid to reward quality and efficiency – efforts that accelerated as a result of the health care overhaul. But surprisingly little progress has been made to date, a consortium of large employers reported today" (Mitchell, 3/26). Read the story.

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Insuring Your Health: Large Companies Are Increasingly Offering Workers Only High Deductible Health Plans

In her latest Kaiser Health News consumer column, Michelle Andrews writes: "Historically, one of the perks of working at a big company has been generous health benefits with modest out-of-pocket costs. But increasingly, large companies are offering their employees only one option: a plan with a relatively high deductible linked to a savings account for medical expenses" (Andrews, 3/26). Read the column.

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Political Cartoon: 'When Life Gives You Lemons?'

Kaiser Health News provides a fresh take on health policy developments with 'When Life Gives You Lemons?' by Hilary Price.

Meanwhile, here is today's health policy haiku:

 
CONQUERING WINDMILLS

Medical Device
Tax
 fills impossible dream: 
Bipartisanship!
-Anonymous

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Health Reform

Stakeholders See Health Law Benefits, Challenges

News outlets explore issues emerging from the health law's implementation, including how the costs of insuring full-time employees could be a boon for temporary staffing agencies, how nurse practitioners are seeking a greater role in primary care and how some clinics are fighting to benefit from the law's changes.

Kaiser Health News: Temp Agencies See Opportunity In Health Law
The rush to implement the Affordable Care Act, which is generating billions for insurers, hospitals and technology vendors, also looks like a boon for staffing companies, whose share prices have soared. But some suggest that exceptions for temporary employees could leave holes in the health law's expanded coverage (Hancock, 3/26).

Marketplace: The Nurse Practitioner Will See You Now
It can be tough to see a primary care physician today. Just wait till next year when another 30 million patients or so get insurance under Obamacare. "We need all hands on deck. We need more family physicians. We need more primary care nurse practitioners, we need more physicians assistants…we need pharmacists. Everyone with a focus on the patient," says Dr. Wanda Filer, a physician in York, Penn., and board member of the American Academy of Family Physicians. The nation is facing a shortage of primary care physicians. Estimates range from several thousand today to 52,000 by 2050. Annual spending on primary care is approximately $200 billion (Gorenstein, 3/25).

HealthyCal: Feminist Clinic Fights To Be Included In Health Care Reform
As millions of Californians are projected to gain coverage over the next several years, the independent clinics that have traditionally served the uninsured are in for some big changes. Soon, many more low-income patients are expected to have private insurance, following the roll out of the Affordable Care Act’s signature reforms in 2014. That’s putting some clinics, like those in the Women’s Health Specialists network, in a quandary. They want to be a part of the system that’s creating a boon of paying patients – but in a way that allows them to hold onto their guiding principles (Bartos, 3/26).

The Hill: Study: Health Law Has Imposed 111 Million Hours Of Paperwork
In its first three years, President Obama's healthcare law has imposed more than $30 billion in costs and 111 million hours of paperwork burdens, according to a new study from the American Action Forum. The forum, a conservative think tank led by former Congressional Budget Office Director Douglas Holtz-Eakin, said the law will raise premiums and hurt small businesses (Baker, 3/25).

The Hill: GOP Lawmaker Wary Of Voter Registration Questions In Obama Health Law Forms
A Republican lawmaker is concerned about voter registration questions buried in a draft application to receive benefits under President Obama's healthcare law. Rep. Charles Boustany (R-La.), who leads a House subcommittee on oversight, said the questions' placement could lead some to believe that voter registration is tied to eligibility for the law's insurance exchanges (Viebeck, 3/25).

Meanwhile, the New York Times looks at how employers are using worker’s health care premiums on incentives programs -

The New York Times: Companies Get Strict On Health Of Workers
Employers are increasingly trying to lower health care costs by using incentives to persuade workers to make better lifestyle choices, a new survey shows, but what remains less clear is whether a reward is better than a punishment — or whether the programs work at all (Thomas, 3/25).

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Arkansas' 'Third Option' For Medicaid Expansion Draws Attention

The approach, which is under consideration by state lawmakers, has attracted the interest of conservative governors and legislators in other states who had previously opposed the program's expansion. Meanwhile, news outlets track Medicaid expansion news from Iowa and West Virginia.

NPR: Arkansas Medicaid Expansion Attracts Other States' Interest
Since the Supreme Court made the Medicaid expansion under the federal health law optional last year, states' decisions have largely split along party lines. States run by Democrats have been opting in; states run by Republicans have mostly been saying no or holding back. But now Arkansas – at the suggestion of the federal government – has suggested a third option: Enroll those newly eligible for Medicaid in the same private insurance plans available to individuals and small businesses. And some think that could shake things up. A lot (Rovner, 3/26).

The Associated Press: Ark. GOP Leader Floats Special Session On Medicaid
The top Republican in the Arkansas House on Monday said lawmakers should delay taking final action on a proposal to expand health insurance to low-income residents so state officials can answer questions about how the program would operate. Democratic Gov. Mike Beebe quickly dismissed the idea, repeating his call for lawmakers to vote on the proposal before the end of this year's legislative session (3/25).

The Associated Press: Iowa Senate Backs Medicaid Expansion Legislation
Lawmakers in the Democratic-controlled Senate approved an expansion of Iowa's Medicaid program Monday, though Republican Gov. Terry Branstad remains firmly opposed to growing the program in the state. In a 26-23 vote, split down party lines, the Senate backed the legislation. During the 90-minute debate, Democratic lawmakers argued that expanding Medicaid will provide care to more low-income Iowans with little cost to the state (3/26).

Des Moines Register: Senate Approves Medicaid Expansion Plan
The Iowa Senate approved legislation Monday night to add more than 100,000 low-income Iowans to the state-federal Medicaid health insurance program, setting up a showdown with Gov. Terry Branstad. Senate File 296 was approved 26-23 on a straight party line vote with Democrats in favor and Republicans against (Petroski, 3/25).

The Associated Press: W. Va. Diocese Joins Call For Expanding Medicaid
The leader of West Virginia's Roman Catholic community has joined the chorus urging Gov. Earl Ray Tomblin to expand Medicaid to cover more low-income residents. Bishop Michael J. Bransfield wrote the governor Friday, citing deep concerns about the health and wellbeing of West Virginians he's developed in his eight years with the Diocese of Wheeling-Charleston and its 83,000 or so Catholics (3/26).

And, on the topic of health exchanges -

The Associated Press/Washington Post: Maryland House Passed Bill Further Implements Health Care Reform
A measure to further implement federal health care reform in Maryland passed the House of Delegates on a 93-43 vote Monday with little debate. The measure creates a dedicated funding stream for the Maryland Health Benefit Exchange, which is a new insurance market that will offer residents a choice of private health plans. While the exchange is on track to be up and running by Jan. 1 with federal help in the first year, the state will begin paying roughly $24 million in fiscal year 2015. The money will come from an existing 2 percent tax on insurance plans that are state-regulated (3/25).

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Health Care Marketplace

Justice Dept. Closes Antitrust Case Against Blue Cross And Blue Shield Of Michigan

But the department is expected to continue investigating the use of "most-favored-nation" pricing contracts in other states.  

The Wall Street Journal: U.S. Moves To Dismiss Suit Against Michigan Blue Cross
The Justice Department on Monday moved to dismiss its long-running antitrust lawsuit against Blue Cross Blue Shield of Michigan. The department said that the state had resolved the agency's concerns by enacting a law that bans certain deals between insurers and health-care providers. The department, however, said it was continuing to investigate the use of the deals in health-plan contracts elsewhere (Kendall, 3/25).

Modern Healthcare: Feds Still Looking At Insurers' 'Most-Favored' Contracts
The U.S. Justice Department has closed its antitrust case against Blue Cross and Blue Shield of Michigan, but the government is expected to remain active in examining how insurers use controversial "most-favored-nation" pricing contracts in other states. The department opened investigations into preferred-pricing contracts by other Blues plans in several other states about the same time that it filed its antitrust lawsuit against the Michigan Blues plan. The Justice Department has closed several of those investigations—but not all of them—without filing lawsuits, according to an antitrust attorney involved with the investigations (Carlson, 3/25).

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Questions From High Court Suggest Concerns About 'Pay-For-Delay' Deals

The Supreme Court heard arguments yesterday in a case which pits brand name and generic drug manufacturers against the Federal Trade Commission.

Reuters: Supreme Court Justices Signal Uncertainty On Drug Settlements
Supreme Court justices on Monday signaled uncertainty over how they would rule on whether brand-name drug companies can settle patent litigation with generic rivals by making deals to keep cheaper products off the market. Eight justices, lacking the recused Justice Samuel Alito, asked questions that indicated concerns about such deals, but several seemed unsure how courts should approach the matter (Hurley, 3/25).

MedPage Today: SCOTUS Questions FTC Stance on 'Pay-for-Delay'
Several Supreme Court justices had hard questions about the Federal Trade Commission's (FTC) stance against "pay-for-delay" drug patent settlements during arguments before the court on Monday (Pittman, 3/25).

In other courtroom action -

The New York Times: Salesmen In The Surgical Suite
It is not the first time patients have claimed they were harmed by Intuitive's robotic surgical equipment, called the da Vinci Surgical System. But the Taylor case, set for trial in April, is unusual. Internal company e-mails, provided to The New York Times by lawyers for the Taylor estate, offer a glimpse into the aggressive tactics used to market high-tech medical devices and raise questions about the quality of training provided to doctors before they use new equipment on patients. Intuitive, based in Sunnyvale, Calif., declined to comment on the lawsuit but said studies showed that its robotic equipment results in better outcomes than conventional open surgery (Rabin, 3/25).

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Quality

Score Can Predict Risk For Hospital Readmission

A risk score for hospitalized patients can pinpoint those most at risk of having to be readmitted to the hospital for avoidable reasons.

MedPage Today: Score Predicts Preventable Readmissions
A risk prediction score for hospitalized patients can find those most at risk of returning for avoidable reasons, researchers found. The HOSPITAL score -- based on hemoglobin and sodium levels at discharge, whether the admission was elective, and similar factors -- identified 18% of patients as at high risk for a potentially avoidable readmission within 30 days with a "fair" level of accuracy (Phend, 3/25).

Also in the news, a progress report on efforts to reset hospital and doctor pay -

Kaiser Health News: Slow Progress On Efforts To Pay Docs, Hospitals For 'Value,' Not Volume
For decades, reformers have sought to change how doctors and hospitals are paid to reward quality and efficiency – efforts that accelerated as a result of the health care overhaul. But surprisingly little progress has been made to date, a consortium of large employers reported today (Mitchell, 3/26).

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Restricting Resident Work Hours May Not Reduce Errors

Research suggests that limiting the length of shifts may not cut medical error rates, but restricting hours for doctors in training may offer other reasons for concern.

Los Angeles Times: Limiting Hospital Intern Shifts May Not Cut Errors, Studies Find
It's been 15 years now, but Dr. Sanjay Desai remembers the brutal hours he worked as a young medical intern and how he struggled with fatigue while treating patients. "There were days we were easily working 36 hours straight and you couldn't remember how you got home — if you got home," Desai said. "It wasn't safe." Times have changed. Regulations now demand that teaching hospitals limit first-year trainees to 16-hour shifts. By reducing work hours, medical authorities reasoned, interns would get more sleep, suffer less fatigue and commit fewer mistakes (Morin, 3/25).

Reuters: Resident Work House Limits Introduce New Concerns
Restrictions on work hours for doctors-in-training may end up inadvertently limiting their educational opportunities and increasing errors, new research suggests. Long shifts and lack of sleep among medical residents have long been a concern, leading the Accreditation Council for Graduate Medical Education (ACGME) to introduce restrictions on work hours in 2003 and again in 2011 (Pittman, 3/25).

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Coverage & Access

Long-Term Care: Expense, Emotions Part Of Planning Dilemma

In other news, NPR explores the nation's high disability rate.

The New York Times: Expense And Emotions In Preparing For Long-Term Care
The emotional impact of witnessing the decline of a family member or helping to care for one is often the reason people seek coverage for long-term care, people who work in the aging field say (Carrns, 3/25).

The Fiscal Times: The Health Care Dilemma That Could Bankrupt Women
Nancy S. Buck, a 62-year-old divorced woman from Aurora, Colorado, wants to purchase long-term health care insurance because she doesn't want to be a financial burden on her children. But right now, that's not possible, since she's self-employed, earns only $20,000 a year (too much to qualify for Medicaid), and can barely afford the $450-a-month payment for basic health insurance…As difficult as it has been for single women like Buck to afford long-term health care insurance, it's about to get harder (Halpert, 3/25).

NPR: Unfit for Work: The Startling Rise Of Disability In America (A four-part series)
In the past three decades, the number of Americans who are on disability has skyrocketed. The rise has come even as medical advances have allowed many more people to remain on the job, and new laws have banned workplace discrimination against the disabled. Every month, 14 million people now get a disability check from the government (Joffe-Walt, 3/26).

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Administration News

HIPAA Rules In Effect Today

Modern Healthcare: New HIPAA Rules Go Into Effect Tuesday
While Tuesday marks the effective date of a host of new federal privacy and security rules, including extending legal liability to business associates of healthcare providers and restoring a measure of patient control over disclosure of their records, compliance won't be required until six months later. The rules, most of which are amendments to the privacy and security rules under the Health Insurance Portability and Accountability Act of 1996, were drafted by HHS under authorities given by health information technology provisions of the American Recovery and Reinvestment Act of 2009. A 563-page "omnibus" privacy and security rule was released by HHS on Jan. 17, with an effective date of March 26 (Conn, 3/25).

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State Watch

State Roundup: Federal Audit Calls For N.Y. Medicaid Program To Repay Funds

News outlets report on health care developments in California, Colorado, Georgia, Massachusetts, New York, North Carolina and Texas.

Boston Globe: Report Hails Mass. Biotech Spending As Job Creator
Halfway through a decade of investment promised by Governor Deval Patrick's 10-year, $1 billion life-sciences initiative, launched in 2008, the state has spent only about a third of the money targeted to promote the biotechnology and medical device industries in Massachusetts. But the authors of a report set to be released Tuesday by the Boston Foundation, a philanthropic group, say the effort has helped stimulate a key sector of the state's economy, creating more than 8,000 jobs through capital grants, tax incentives, and business loans. They urge state government leaders to continue funding the initiative in the face of stepped-up competition from other life-sciences hubs, such as California, Maryland, and New Jersey (Weisman, 3/26).

The New York Times: U.S. Wants State To Pay After Audit Of Youth Care
In another critical assessment of New York's multibillion-dollar Medicaid program, a federal audit says the state improperly claimed $27.5 million in reimbursements for services to mentally ill and emotionally disturbed children and teenagers (McKinley, 3/26).

The New York Times: Caregiver For Disabled People Sues New York State
A New York State-employed caregiver for people with developmental disabilities sued the state on Monday, accusing it of retaliating against him for whistle-blowing. The employee, Jeffrey Monsour, has brought to light a number of questionable practices by the state, as varied as routinely falsifying fire drills and turning a blind eye toward abuse of those in the state's system of care for people with developmental disabilities. He was one of the people interviewed and featured in a 2011 series of articles by The New York Times examining problems of abuse and corruption within the system (Hakim, 3/25).

Georgia Health News: Senate Limits Abortion Coverage In State Health Plan
A bill that would allow the Georgia World Congress Center Authority to provide its own insurance plan added an amendment Monday that would restrict abortion coverage for state employees. The amended legislation passed on a 34-15 vote in the Republican-dominated Senate. It would bar coverage for abortion in the 650,000-plus-member State Health Benefit Plan. The only exception would be for situations in which the life of the mother is in danger or it’s needed "due to the mother’s medical necessity." The bill still must be reconciled with the House version of the legislation, which does not address abortion (Miller, 3/26).

The Texas Tribune: Senate Approves Overhaul Of Long-Term Medicaid Care
The Texas Senate unanimously approved an overhaul of long-term and acute care Medicaid services on Monday in an effort to expand care to more Texans with disabilities while saving millions of state dollars. … SB 7 is expected to save $8.5 million in Medicaid costs in the 2014-15 biennium by expanding managed care services, establishing pilot programs to try to provide services at capitated costs and implementing measures to ensure more efficient monitoring of services (Aaronson, 3/25).

Health Policy Solutions: Colorado Third State To Ban Discrimination Against LGBT Patients
Colorado is the third state to prohibit discrimination in health coverage. California and Oregon have barred the practice along with the District of Columbia. The federal Affordable Care Act calls for equity in LGBT health care, but very few states have taken action thus far to codify these rights (Kerwin McCrimmon, 3/25).

San Jose Mercury News: Fremont's Washington Hospital: Joint Replacement Patients, Doctors Excluded From New Facility
When Robert Cantley needed both knees replaced in August, he was expecting to recover from the surgery at Washington Hospital's fancy, new $42.7 million Center for Joint Replacement. According to hospital marketing brochures, the center offered "A Higher Level of Care" in a 20,000-square-foot space featuring 25 private patient rooms, a "breathtaking physical therapy space" and a beautifully landscaped therapy garden. Instead, Cantley did his physical therapy sessions in a dimly lit hallway on the sixth floor of the main hospital in what he described as "a miserable set of circumstances." What Cantley and many other patients at the public hospital didn't know was that access to the new center, the only facility of its kind in the Bay Area, is restricted to just two orthopedic surgeons at the hospital -- the only ones on the Washington staff who met 24 criteria set by the hospital (McGlone, 3/25).

North Carolina Health News: Medicaid Schools' Tout High Numbers Of Primary Care Grads, But The Numbers Tell A Different Story
Medical schools in North Carolina are touting the high numbers of students they graduate who go on to primary care specialties. But those numbers aren't the whole story. … In North Carolina, numbers released by the state's four medical schools claim that from each, upwards of 42 percent of students will be headed into primary care. But Morris-Singer said matching for primary care doesn't mean those doctors will practice in primary care (Hoban, 3/26).

California Healthline: California Rural Health Association Closes Shop
The California State Rural Health Association, a unifying voice for the state's disparate rural health care providers for almost two decades, has laid off staff and closed its Sacramento office. The 16-member board of directors hopes to keep the trade association alive and active, "but it's becoming more difficult in this environment," said Dave Jones, president of the volunteer board (Lauer, 3/25).

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Editorials and Opinions

Viewpoints: Rising Cost Of Tricare; GOP Needs To Better Explain Medicare Eligibility Age Issue; Don't Forget Adult Immunizations

The Washington Post: Tricare The Untouchable
The U.S. government's fiscal predicament has many causes. But if you had to reduce them to one sentence, it might go like this: "Congress responds to the short-term demands of particular groups, not the long-term needs of the nation as a whole." Case in point: the seemingly unstoppable growth of medical benefits for former military personnel under Tricare, the Defense Department's health program. This mushrooming expense is a major reason that Pentagon health-care spending rose from $19 billion in fiscal 2001 to $52.8 billion in fiscal 2012 (Charles Lane, 3/25).

Los Angeles Times: An Insider's View Of Generic-Drug Pricing
The murky world of generic drug prices has been much on my mind after hearing from readers about costs for various medicines experiencing crazy fluctuations. I wrote the other day about a Target customer who saw the price for a generic antibiotic climb from $6 to $133 within just a few weeks (David Lazarus, 3/25).

The Wall Street Journal: 50 Vetoes: How States Can Stop The Obama Health Care Law
The Patient Protection and Affordable Care Act (PPACA) itself empowers states to block the employer mandate, to exempt many of their low- and middle-income taxpayers from the individual mandate, and to reduce federal deficit spending, simply by not establishing a health insurance "exchange." Supporters of the law do not care for this feature, yet they adopted it because they had no choice. The bill would not have become law without it (Michael F. Cannon, 3/25). 

New Orleans Times Picayune: It's Up To All Of Us To Understand, Rein In U.S. Health Care Costs
The cost of health care in the United States is rising quietly like a slow-growing cancer. It's a cancer that we as consumers don't find out about until it's too late -- when we get the final bill. The true cost of our health care is often hidden behind difficult-to-decipher medical bills and price negotiations we may never see -- or even care to see -- between health care providers and insurance companies. The hidden price tag for health care continues because we turn a blind eye to how much any particular procedure costs (Kevin Wildes, 3/25).

Des Moines Register: Raising Medicare Age Creates More Problems
It is hard to understand how it makes sense to increase the age when future Americans would be able to sign up for government health insurance. Lawmakers supporting the idea have much more explaining to do — in public. ... The attempt to shrink Medicare eligibility feels like yet another political attack on a program that has been helping Americans for nearly 50 years. Though the program has more to do in getting spending under control, it's unlikely eliminating the youngest, healthiest enrollees would help (3/25).

Minneapolis Star Tribune: Mental Health Needs The Nation's Attention
Millions of people in our country are struggling every day with mental illness — but most aren't getting help. Many don't have a support system. They may not have parents or friends who understand or have resources to help. They may not have health insurance that covers the cost of treatment. Or perhaps they feel ashamed or embarrassed to seek help, because mental illness still carries a stigma in our society. As my family searches for some type of meaning and comfort in the depths of our grief, we hold out hope that perhaps Andrew's story will help people have a greater understanding and compassion for those who struggle with mental illness (Chris Bauer, 3/25). 

Georgia Health News: Action Needed To Increase Adult Vaccinations
Everybody knows that kids need "baby shots" – immunizations that protect against formerly common childhood diseases. The shots are required for school entry, so most children are up to date by the time that they are 5 years old. But what many of their parents and grandparents don't realize is that adults need immunizations as well. And the adults lag far behind the kids in getting the shots that they need. A bill currently pending in the Georgia Legislature (SB 85) – which would permit pharmacists to administer some immunizations that are currently off-limits to them – might help rectify the situation (Daniel Blumenthal, 3/25).

Health Policy Solutions: Sex Ed A Matter Of Public Health, Not Politics
In 2007, Colorado passed a law stating that if sexual health education is offered as part of a school's curriculum, then it must be comprehensive in nature. … However many school districts have elected to either not teach sex education due, in part, to the lack of resources or because they find the current legal guideline too vague and confusing — making it extremely difficult to fully implement (Vicki Cowart, 3/25).

St. Louis Beacon: State Department Of Health Cancer Study Surveyed Wrong People
The Missouri Department of Health recently released a study looking at rates of cancer from 1996 to 2004 among then-current residents of a subset of the ZIP codes of concern. They concluded that there is nothing to worry about. While there are elevated rates of some types cancers, including breast, colon, kidney and prostate, the report claims are more likely the fault of the residents’ lifestyles. The report is completely uninformative, because like the man looking for his keys under the street light, they were looking for cancers among current residents (Diane Whitmore Schanzenbach and Jenell Rodden Wright, 3/26).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Ankita Rao
Marissa Evans

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2012 Kaiser Health News. All rights reserved.