Daily Health Policy Report

Wednesday, March 27, 2013

Last updated: Wed, Mar 27

KHN Original Reporting & Guest Opinion

Health Reform

Coverage & Access

Health Care Marketplace

Quality

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Economic Changes Hurt The Bottom Line For Rural Ga. Hospitals

Reporting for Kaiser Health News, Georgia Health News' Andy Miller writes: "In the small Georgia town of Demorest, Habersham Medical Center, like many rural hospitals, has seen its patient base change in a way that hurts its bottom line. As unemployment in the northeast Georgia mountains remains stubbornly high, more of the hospital's patients have no health insurance. Among those patients with private coverage, an increasing number have high-deductible policies, which means that patients must pay all or a large portion of the bills out of pocket. And a large share of patients have Medicaid, the federal-state program for low-income people that often doesn't reimburse enough to cover the cost of services, hospital officials say" (Miller, 3/27). Read the story.

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Capsules: A Bridge To Health — And Away From ER Overuse

Now on Kaiser Health News' blog, North Carolina Health News' Nancy Wang reports: "North Carolina's Pardee Memorial Hospital, located in Hendersonville, has joined forces with local physicians in an attempt to reverse this cycle – and program data suggest the plan is working. In 2009, Pardee's emergency department treated approximately 45,000 patients. Among them the hospital identified 255 as 'frequent flyers' – meaning they used the emergency room six or more times and racked up more than $3 million in unpaid medical bills. They were all uninsured, low-income patients, many with a history of substance abuse or mental health issues" (Wang, 3/27). Check out what else is on the blog.  

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Political Cartoon: 'Hold The Pickles?'

Kaiser Health News provides a fresh take on health policy developments with "Hold The Pickles?" by Lisa Benson.

Meanwhile, here is today's health policy haiku:

WHO'S ON WHAT MESSAGE?

Actuaries say 
The health law will drive costs up.
Maybe for some folks?
-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

Actuaries Project Health Law Will Boost Claims Costs 32 Percent

Although some states would see claims costs decline, the study by the Society of Actuaries forecasts that a majority will experience double-digit increases in the individual health insurance market. Officials in some states disputed the analysis, saying it was based on flawed data.

The Associated Press/Washington Post: Study: Claims Costs That Drive Premiums Will Rise 32 Percent In Under Health Law
A new study finds that insurance companies will have to pay out an average of 32 percent more for medical claims under President Barack Obama's health care overhaul. What does that mean for you? (3/27).

USA Today/The Associated Press: Study: Health Overhaul To Raise Claims Costs 32%
While some states will see medical claims costs per person decline, the report prepared by the Society of Actuaries concluded that the overwhelming majority will see double-digit increases in their individual health insurance markets, where people purchase coverage directly from insurers. The disparities are striking. By 2017, the estimated increase would be 62% for California, about 80% for Ohio, more than 20% for Florida and 67% for Maryland. Much of the reason for the higher claims costs is that sicker people are expected to join the pool, the report said (3/26).

The Associated Press/Washington Post: DC Officials Say Actuarial Study On Health Overhaul
Costs Uses Flawed Data
A study that shows medical claims costs will increase by more than 50 percent for District of Columbia residents under the federal health care overhaul is inaccurate in part because it dramatically overstates the number of city residents who lack insurance, district officials said Tuesday (3/26).

The Associated Press/Washington Post: State Official Disputes Study Citing Potential 67 Percent Hike In Medical Claims Costs
Medical claims costs in Maryland could jump 67 percent for residents' individual policies by 2017 under the federal health care overhaul, according to a study released Tuesday by the nation's leading group of financial risk analysts. But a Maryland official said the study is flawed, because it doesn't consider state-level policy decisions that will have a big impact on costs (3/26).

The Associated Press: Study: Health Overhaul To Increase Cost In Fla.
Medical claims costs — the biggest driver of health insurance premiums — could jump more than 20 percent for Floridian's individual policies under the federal health overhaul, according to a study by the nation's leading group of financial risk analysts. Uncertainty over costs associated with the Affordable Care Act has been a major concern among Florida's GOP-controlled Legislature (Schreiner, 3/26).

Meanwhile, another study looks at how health costs in the U.S. compare internationally -

Los Angeles Times: Survey: U.S. Medical Costs Top Other Developed Nations'
An average day in a U.S. hospital cost $4,287 last year. It was less than $1,000 in New Zealand, France, South Africa and Spain. That's one of several cost comparisons reported Tuesday in an annual report by the International Federation of Health Plans, an industry trade group. The London organization surveyed its member companies in 12 different countries to gauge the variation in medical prices (Terhune, 3/26).

Modern Healthcare: Health Costs Significantly Higher In The U.S., Report Finds
Private insurers in the U.S. last year paid significantly more—up to 26 times as much in one case—for common procedures, hospital and doctor visits and prescriptions when compared with private and public insurers in 10 other countries, a report shows. The report, by the International Federation of Health Plans (PDF), did find a few instances where average prices paid in other countries mostly matched those of the U.S., but such occurrences were rare. Instead, U.S. private insurance prices widely exceeded those of other countries (Evans, 3/26).

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Sebelius: Some Insurance Costs Could Increase When Law Is Implemented

The HHS secretary's remarks came as insurers are becoming increasingly jittery about how sweeping health law changes will impact the marketplace and on the same day that the Society of Actuaries released a study that predicted increased medical claims costs.

The Wall Street Journal's Washington Wire: Sebelius: Some Could See Insurance Premiums Rise
Some people purchasing new insurance policies for themselves this fall could see premiums rise because of requirements in the health-care law, Health and Human Services Secretary Kathleen Sebelius told reporters Tuesday. Ms. Sebelius's remarks come weeks before insurers are expected to begin releasing rates for plans that start on Jan. 1, 2014, when key provisions of the health law kick in (Radnofsky, 3/26).

Reuters: Some Healthcare Costs May Rise When 'Obamacare' Implemented: Official
President Barack Obama's top healthcare adviser acknowledged on Tuesday that costs could rise in the individual health insurance market, particularly for men and younger people, because of the landmark 2010 healthcare restructuring due to take effect next year. U.S. Health and Human Services Secretary Kathleen Sebelius said definitive data on costs will not be available until later this year when private health plans become authorized to sell federally subsidized coverage on new state-based online marketplaces, known as exchanges (Mason and Morgan, 3/26).

She also spoke about Medicare -

USA Today: White House Warns Cutting Medicare Will Shift Costs
If Congress addresses the nation's budget deficit by cutting Medicare, that will simply shift health care costs to the private sector and not address the underlying issues, Obama administration officials said Tuesday at a White House briefing. "If you only focus on Medicare, you shift the costs," Health and Human Services Secretary Kathleen Sebelius said, adding that Medicare and Medicaid are not the reason health costs are going up (Kennedy, 3/26).

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Urban Institute: Medicaid Expansion Will Benefit Veterans

Overall, the health law could help as many as 40 percent of uninsured veterans gain access to health coverage. News outlets also report on Medicaid expansion news from Tennessee, Missouri and Louisiana.

The Hill: Analysis Finds Medicaid Expansion Will Benefit Veterans
Veterans stand to benefit substantially from President Obama's healthcare law, particularly in states that choose to expand their Medicaid programs, a new analysis found. Researchers with the Urban Institute reported that as many as 40 percent of uninsured U.S. veterans would be eligible for healthcare under the law's insurance exchanges or its expanded Medicaid program (Viebeck, 3/26).

The Associated Press: Haslam To Announce Medicaid Decision
Republican Gov. Bill Haslam will address a joint session of the Tennessee General Assembly on Wednesday about his decision on whether to expand Medicaid to cover more uninsured people under the federal health care overhaul, according to a person familiar with the plans. Lawmakers plan to authorize the gathering during regular floor sessions Wednesday morning, the official told The Associated Press on the condition of anonymity because the joint assembly hadn't yet been publicly announced (Schelzig, 3/26).

The Associated Press: Mo. House Defeats Medicaid Expansion Effort
Missouri's Republican-led House dealt a resounding defeat Tuesday to Democratic attempts to expand Medicaid, refusing to add more than $900 million to the state budget to cover 260,000 lower-income adults because of concerns about a future drag on state finances. The largely party-line votes against the Medicaid expansion marked the climax of a daylong House debate on Missouri's budget but were almost a foregone conclusion (Lieb, 3/26).

New Orleans Times Picayune: Louisiana State Analysis Of Medicaid Expansion Shows State Could Financially Benefit
An analysis by the state Department of Health and Hospitals shows that accepting the Medicaid expansion envisioned in the federal health law would likely save Louisiana millions in 2014 and possibly for years beyond that. Under a "low-impact" scenario that envisions 577,329 new enrollees in the program, the state could save as much as $367 million over the course of a decade. In a "high-impact" scenario, the state could end up spending $1.71 billion over a decade, but that not only factors in 76,000 more people getting coverage but the state also drastically ramping up reimbursement rates for doctors and hospitals who accept Medicaid (Maggi, 3/26).

In other news, an ad campaign is launched in Florida, to urge the state to turn down federal Medicaid expansion funding.

Health News Florida: Ad Urges FL To Turn Down Federal $$
A small-business lobbying group has launched a TV and online ad campaign to do the seemingly impossible: Persuade Floridians to turn down an estimated $51 billion in federal funds over the next decade -- money that would provide health coverage to about 1 million of the state's uninsured. The sponsor of the ad is the Florida arm of The National Federation of Independent Business. It is the same group that partnered with Florida in a failed effort to get the Patient Protection and Affordable Care Act declared unconstitutional after President Obama signed it into law in 2010 (Gentry, 3/27).

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Va. Gov. Seeks To Bar Abortion Coverage From The Federal Exchange That Will Serve The State

Gov. Bob McDonnell added the provision Monday to recently passed legislation. Meanwhile, in other news, the Maryland Senate could vote as early as today on a bill that implements the state's new insurance marketplace and Louisiana insurers and nonprofits form group to help consumers understand new insurance options.

The Associated Press: McDonnell's Amendment Would Bar Abortion In Va. Federal Health Care Exchange
Insurance policies that cover abortions couldn't be purchased through the federally run health care exchange that will serve Virginia under an amendment Gov. Bob McDonnell offered Monday to recently passed legislation. The Republican governor's action, which reproductive rights organizations had warned for weeks was imminent, would forbid policies providing abortions to be sold through the exchange that is authorized by President Barack Obama's health care overhaul (3/26).

The Washington Post: McDonnell Aims To Block Abortion Coverage
Health plans offered to Virginians through federal insurance exchanges could not cover most abortions under amendments that Gov. Robert F. McDonnell has proposed to two General Assembly bills. The Republican governor’s recommendations, which the legislature could accept or reject along with McDonnell's other amendments when it reconvenes April 3, does not represent a shift in state policy (Vozzella, 3/26).  

Baltimore Sun: Final Vote Expected In Senate On Health Bill
The Maryland Senate could vote as early as Wednesday on a bill that would qualify more Marylanders for government health care and pay for a new health insurance marketplace, both part of advancing the rollout of federal health reform. The House of Delegates approved an identical bill Monday, clearing the way for the legislation to make its way to Gov. Martin O'Malley for his signature. Initiatives in the bill spell out changes in the way poor or uninsured residents and small businesses would access health care once the federal law becomes effective next year (Dance and Cox, 3/26).

New Orleans Times Picayune: New Coalition Hopes To Provide Public With Information About Federal Health Law
Anticipating widespread consumer confusion as the Affordable Care Act mandates kick in next year, a group of nonprofits and businesses led by Blue Cross and Blue Shield of Louisiana are forming a coalition to help people wade through the complicated new marketplace. The Louisiana Healthcare Education Coalition will hold news conferences across the state this week. Over the coming months, the group wants to disseminate information about the federal law’s implementation by helping educate members, attending health fairs and other efforts (Maggi, 3/26).

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Examining 'A Glitch' In The Health Law's Tax Credits

Reuters reports on a health law consequence that Families USA says needs to be fixed: that millions of "modest earners" could be priced out of health insurance. The Fiscal Times analyzes the current state of play regarding the measure's new taxes and other moving parts.

Reuters: Little Hope Seen For Millions Priced Out Of Health Overhaul
Millions of Americans will be priced out of health insurance under President Barack Obama's healthcare overhaul because of a glitch in the law that adversely affects people with modest incomes who cannot afford family coverage offered by their employers, a leading healthcare advocacy group said on Tuesday. Tax credits are a key component of the law and the White House has said the credits, averaging about $4,000 apiece, will help about 18 million individuals and families pay for health insurance once the Affordable Care Act takes full effect, beginning in January 2014 (Brown, 3/26).

The Fiscal Times: $1 Trillion In New Taxes From Health Reform Is Coming
Three years after enactment of the landmark legislation extending health care coverage to 27 million uninsured people, many in Congress and a majority of Americans are coming face to face with a daunting reality. Consumers will face higher insurance premiums, insurers will see a 32 percent increase in medical claims costs, and almost everyone in the upper middle class or higher will pay a slew of new taxes (Pianin, 3/27).

Also in the news, the latest developments regarding efforts to repeal the health law's medical device tax.

Roll Call: McConnell To House: Move Device Tax Repeal Soon
The top Senate Republican is calling on the House to send over legislation to repeal the health care law's tax on medical devices, following a bipartisan vote among senators in favor of such a move last week. Appearing Monday evening on the Hugh Hewitt radio show along with Florida GOP Sen. Marco Rubio, Minority Leader Mitch McConnell, R-Ky., said he thought House Republicans should pass a stand-alone repeal of the medical-device tax to see how the Senate would handle it (Lesniewski and Attias, 3/26).

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Coverage & Access

DOMA's Impact On Same-Sex Couples' Access To Federal Health Programs, Health Insurance

Politico: It's Not Just A Marriage Issue; It's The Insurance
The federal Defense of Marriage Act, under review by the high court this week, allows states to ignore gay marriages or unions sanctioned outside their borders, and it excludes legally married gay couples from the same protections offered to heterosexual couples under federal health programs, like Medicare, Medicaid and the Consolidated Omnibus Budget Reconciliation Act. The result is thousands of same-sex couples facing more limited access to health insurance and steeper costs for coverage than their heterosexual counterparts (Cheney, 3/27).

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Health Care Marketplace

Federal Agency Issues 'Fraud Alert' About Physician-Owned Distributorships

The Health and Human Services inspector general said these commercial ventures, which are widespread in the fields of orthepedic and spine surgery, are "inherently suspect."  

The Wall Street Journal: Warning Over Doctor-Run Groups
A federal agency issued a special fraud alert about physician-owned distributorships—commercial entities run by doctors that have proliferated in the fields of orthopedic and spine surgery—calling them "inherently suspect" and warning they "pose dangers to patient safety" (Carreyrou, 3/26).

Bloomberg: Doctor-Owned Device Suppliers Deemed Inherently Suspect
Doctor-owned businesses that act as middlemen between medical device makers and hospitals are "inherently suspect" and some of their practices may violate U.S. anti-kickback laws, a government inspector general said. Daniel Levinson, the inspector general for the Health and Human Services Department, today issued an unusual "special fraud alert" about so-called physician-owned distributorships, or PODs (Wayne, 3/26).

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Quality

Adding Muscle To Plans' Push For Value-Based Health Care

A survey from Catalyst for Payment Reform, a nonprofit lobbying group comprising highly profitable Fortune 500 giants, found that many of  its members do not feel like they are getting the value for which they are paying.

Medscape: Corporations Demand More Bang For Their Healthcare Buck
A coalition comprising some of the largest and most powerful healthcare buyers in the United States claims its members are not getting the value they are paying for. Only 10.9% of commercial in-network payments to doctors and hospitals goes toward "value-oriented" care, defined as payments that are either tied to performance or designed to cut waste, according to Catalyst for Payment Reform (CPR), a nonprofit lobbying group comprising highly profitable Fortune 500 giants, including 3M, Boeing, Dow Chemical, Verizon, and Walmart, among others (Osterweil, 3/26).

Modern Healthcare: Value-Based Insurance Plans Gain Momentum
The movement among employers to push insurers to adopt health plan benefit designs that improve medical outcomes without raising costs is slowly gathering steam, according to an employer coalition pushing payment reform. While only 11% of payments that commercial insurers made to in-network providers in 2012 were "value-oriented," according to a survey from Catalyst for Payment Reform, that's more than halfway to its goal of 20%, which the group hopes to attain by 2020. The numbers suggest there is reason to believe the insurance industry and providers can achieve the coalition's goal, said Suzanne Delbanco, executive director of the not-for-profit coalition of employer groups, which issued its first-ever National Scorecard on Payment Reform (Block, 3/26).

Related KHN Coverage: Slow Progress On Efforts To Pay Docs, Hospitals For 'Value,' Not Volume (Mitchell, 3/26).  

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Public Health & Education

Mental-Health System Feeling The Pinch Of Sequestration

MinnPost: Sequestration Is A Big Blow To An Already Ailing Mental-Health System
Despite recent alarms to give mental health a more serious approach and to mobilize more funding to address a broken mental-health system across the country and in Minnesota, sequestration is here. According to the White House, if sequestration is fully implemented 373,000 mentally-ill adults and children across our nation will have to go untreated. Mental Health America reports that over the past three years, states across the country have had to cut approximately $4 billion in mental-health budgets — yet there are more cuts on the way with sequestration (Kuria, 3/27).

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State Watch

North Dakota Governor Signs Nation's Most Restrictive Abortion Law

Gov. Jack Dalrymple, a Republican, signed three anti-abortion bills Tuesday, one of which bans abortions as soon as a fetal heartbeat is detectable, which could be as early as six weeks into pregnancy.

The New York Times: New Laws Ban Most Abortions In North Dakota
Gov. Jack Dalrymple of North Dakota approved the nation’s toughest abortion restrictions on Tuesday, signing into law a measure that would ban nearly all abortions and inviting a legal showdown over just how much states can limit access to the procedure (Eligon and Eckholm, 3/26).

Reuters: North Dakota Governor Signs 'Heartbeat' Abortion Ban
North Dakota on Tuesday adopted the most restrictive abortion law in the United States, as the governor signed a bill that bans the procedure in most cases once a fetal heartbeat can be detected, as early as six weeks. Supporters of abortion rights said they would challenge the measure in court (Thompson, 3/26).

The Associated Press/Washington Post: North Dakota GOP Governor Signs Bill Banning Most Abortions As Early As 6 Weeks Into Pregnancy
The Republican governor signed three anti-abortion measures on Tuesday — including one banning abortions as early as six weeks into a pregnancy, or when a heartbeat can be detected. By doing so, Dalrymple positioned his oil-rich state as a primary battleground in the decades-old fight over abortion rights (3/27).

The Wall Street Journal: North Dakota Adopts Strict Abortion Law
The law, which prohibits an abortion after a fetal heartbeat is detected, is expected to face a court challenge from abortion-rights advocates who say it conflicts with U.S. Supreme Court rulings. Gov. Jack Dalrymple, a Republican, said it is unclear whether the law would survive a court challenge, but that it stands as "a legitimate attempt by a state legislature to discover the boundaries" of Roe v. Wade, the Supreme Court's 40-year-old abortion rights ruling (Peters, 3/26).

Politico: Activists Push Abortion Issue Forward
Anti-abortion activists are pushing earlier and earlier bans on abortion, with at least one state outlawing the procedure at the first sign of a detectable heartbeat. Arkansas’s new law limits most abortions at 12 weeks, and a North Dakota law signed by the governor Tuesday bans most after six weeks (Smith, 3/26).

CNN: North Dakota Governor Signs Law Banning Most Abortions
What is being called the nation's toughest anti-abortion measure -- a law that bans most abortions after six weeks, when a fetal heartbeat can be first detected -- was signed into law on Tuesday by North Dakota's governor. The law sets the stage for an almost guaranteed legal showdown, with proponents saying the law is intended to test the 1973 U.S. Supreme Court ruling that made abortion legal. … The governor directed the legislature to set aside funds to cover the cost of the expected legal battle, which opponents vowed to mount if the governor signed the measure into law (Carter and Hassan, 3/27).

Meanwhile, in other states --

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 a surprise 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. The Georgia World Congress Center recently left the state health plan, which covers teachers, other school personnel and state employees, along with dependents and retirees (Miller, 3/26).

Los Angeles Times: Following In Dr. George Tiller’s Footsteps
The [Wichita, Kan.] clinic had been closed for nearly four years. Two weeks before the clinic's reopening, Burkhart pushes open the silver double doors to the empty surgical room. Her pace slows. A sadness flickers across her eyes. This room has been a symbol for decades of a fierce national fight over abortion, and that battle is about to return to her city, her doorstep. But then, just as quickly, she shakes it off. The political activist in her takes over. There is work to be done (Deam, 3/26).

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State Roundup: Court To Hear Calif. Inmate Mental Health Case

News outlets report on health care developments in California, Georgia, Louisiana, Minnesota, New York, Oregon and Texas.

The Associated Press: Court Considers Calif. Prison Mental Health Care
A federal judge in Sacramento is set to hear arguments Wednesday over Gov. Jerry Brown's push to regain state control of inmate mental health care after 18 years of federal oversight and billions of dollars spent to improve treatment. Lawyers representing the state argue that California is now providing a constitutional level of care to its prison inmates, while attorneys for the inmates say more improvement is needed (Thompson, 3/27).

The Associated Press/Washington Post: La. Health Secretary A No-Show At His Department’s Budget Hearing Amid Ongoing Investigations
Lawmakers seeking more information about the Jindal administration’s cancellation of a nearly $200 million Medicaid contract amid an ongoing criminal investigation were told Tuesday that administration leaders were advised against discussing it. The now-scrapped contract for Medicaid claims processing and bill payment had been awarded to CNSI, a Maryland-based company that once employed Gov. Bobby Jindal’s health secretary, Bruce Greenstein (3/26).

Kaiser Health News: Economic Changes Hurt The Bottom Line For Rural Ga. Hospitals
In the small Georgia town of Demorest, Habersham Medical Center, like many rural hospitals, has seen its patient base change in a way that hurts its bottom line. As unemployment in the northeast Georgia mountains remains stubbornly high, more of the hospital’s patients have no health insurance. Among those patients with private coverage, an increasing number have high-deductible policies, which means that patients must pay all or a large portion of the bills out of pocket. And a large share of patients have Medicaid, the federal-state program for low-income people that often doesn't reimburse enough to cover the cost of services, hospital officials say (Miller, 3/27).

The Texas Tribune: House Budget Spends More On Schools, Less On Medicaid
More than $1.6 billion and disagreements on how much Texas should spend on public education and Medicaid separate the budgets proposed by the House and Senate. The Senate budget proposal, passed 29-2 by the upper chamber last week, spends $195.5 billion, a 2.9 percent increase from the current two-year budget (Batheja, 3/27).

The New York Times: Plan To Allow Investment In 2 Hospitals Is Dropped
A proposal to allow for-profit investment in two hospitals in New York State has been dropped from the budget, an unexpected setback to a push to open health care systems to private investors for the first time (Bernstein, 3/26).

Pioneer Press: Legislative Auditor Assails MinnesotaCare Verifications
The state Department of Human Services has failed for years to comply with federal and state requirements to verify income and Social Security numbers reported by recipients of MinnesotaCare health insurance, the legislative auditor concluded in a report released Tuesday, March 26. The requirements are in place to guard against fraud (Belden, 3/26).

MPR News: Possible Fairview Health Takeover Raises Alarms
University of Minnesota officials are raising concerns over a possible merger between Fairview Health Services and South Dakota-based Sanford Health. Sanford, which has facilities in eight states, has expanded into parts of Minnesota in recent years. Fairview controls the University of Minnesota's hospital. "The university educates and trains about 70 percent of the medical doctors in Minnesota, We are the only school in Minnesota that has schools of dentistry and pharmacy," said Mark Rotenberg general counsel for the university (Mador, 3/26).

MPR News: Mayo's Saint Marys Hospital A Priority For Expansion
Saint Marys Hospital is usually a busy place, so much so that it is chronically short of administrative and research space. Doctors hustle across the Mayo Clinic hospital, which extends more than a city block, and emergency room nurses push carts from one patient room to another. Shared offices are the norm. … To solve its space woes, the Mayo Clinic plans to spend $3 billion to expand in Rochester in the next 20 years. It's asking the state of Minnesota to pitch in $500 million to pay for public parking, transportation, transit, utilities and other improvements. (Baier, 3/27).

The Oregonian: Washington Health Care Bills That Would Benefit Vancouver Residents Move Out Of Committee
The House Health Care and Wellness Committee on Tuesday approved two bills aimed at making health care easier to obtain for those who live in border communities like Vancouver. Senate Bill 5524 would allow Washington pharmacists to fill prescriptions written by out-of-state physician assistants. Currently, Washington pharmacies may fill prescriptions written by doctors, dentists and others who are not licensed in the state. The legislation would expand this list to include physician assistants (Marum, 3/26).

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Editorials and Opinions

Viewpoints: Calif. Insurers Ignore Commissioner On Premiums; Rick Perry Says 'Broken' Medicaid Can't Handle Expansion; Doctor Says NRA Let Him Down

Los Angeles Times: Insurers Eager To Maintain Authority Over Healthcare Premiums
While most of us face uncertainty with the rollout of healthcare reform, some insurance companies in California have been feeling their oats lately. Here's how they're responding to Insurance Commissioner Dave Jones' warnings that their latest rate increases are unreasonable: Stuff it, Dave. That essentially was the response of Blue Shield of California and Anthem Blue Cross after Jones flayed their proposed premium hikes — up to 20% for Blue Shield customers and up to 18% for Anthem. The companies moved to implement the increases anyway, although Anthem thought better of it after it started charging the higher rates, and reduced them a bit. Anthem further said it would start passing on to customers a fee related to the federal Affordable Care Act this year, which Jones considered unlawful since the government fee doesn't go into effect until next year (Michael Hiltzik, 3/26). 

USA Today: Medicaid Expansion Fight Harms You: Our View
Now, in too many states, the Medicaid portion is in serious jeopardy. Thanks to last June's Supreme Court ruling that made the expansion optional for states, a group of Republican governors and legislators has opened a new front in their ideological war against ObamaCare — at the expense of their poorest residents, their state's hospitals and their own state budgets (3/26). 

USA Today: Rick Perry: Don't Expand Medicaid
Of all the bad ideas related to ObamaCare, depending upon Medicaid to do the heavy lifting to "insure" Americans is about the worst of the bunch. Medicaid was not built to handle the economic stresses of dealing with the number of people it already has in the program. If you don't believe me, ask President Obama himself, who in 2009 called Medicaid a "broken system that doesn't work." This broken system is already putting extreme pressure on state budgets, and that will only increase over time (Texas Gov. Rick Perry, 3/26).

Bloomberg: When The Affordable Care Act Becomes Unaffordable
The New York Times reports that U.S. President Barack Obama's administration is encouraging Republican-led states to follow Arkansas's lead and use Medicaid expansion dollars to buy private insurance for people with low incomes. This is going to make a lot of people happy. But it's not good for taxpayers or for the project of making medical costs sustainable (Josh Barro, 3/26).

Richmond Times-Dispatch: Obamacare Details Still To Be Worked Out
Mitt Romney promised during his presidential campaign to repeal the health law on his first day in office. Big mistake, he says now. "I think Obamacare attractiveness … was something we underestimated, particularly among lower incomes," Romney said in an interview March 3 on "Fox News Sunday," adding, "Obamacare was very attractive, particularly to those without health insurance." Leaving aside the reference to people as "lower incomes," this is like Romney's saying he underestimated how attractive food is to someone who's starving (Marsha Mercer, 3/27).

The New York Times' Room For Debate: Re-Engineering Health Care
Consumers tend to dislike the idea of rationing, but would it be better than the alternatives? If "re-engineering" means consolidation and vertical integration, is that a good thing for patients? For the industry? (3/26).

Journal of the American Medical Association: The NRA Let Me Down
The National Rifle Association let me down. What it taught me as a teen was to use guns "safely and responsibly." I believe that the NRA is not teaching that now nor following the tenets of safety or responsible gun use in its public policy stance. Instead, it uses fear and condemnation to avoid even the most sensible, obvious changes needed in our gun laws. ... We in medicine can only sigh. Trauma centers continue to be filled with gun violence, and we in psychiatry see those injured in drug abuse-related violence or families of our patients who die by suicide (Dr. Paul Kettl, 3/27).

New Orleans Times Picayune: Health Secretary Conveniently Forgot To Mention Helping His Old Employer Get State Work
The way the specs were written, Bruce Greenstein's former employer could not bid for one of the most lucrative contracts in Louisiana government. But, lo and behold, after Greenstein was named health secretary in 2010, a little judicious rewriting soon made his old pals at CNSI eligible. They submitted one of four proposals to handle Medicaid claims, starting in 2014. You'll never guess what happened next. CNSI won the contract! It was worth almost $200 million (James Gill, 3/27).

Fox News: Has New York Mayor Bloomberg Made Americans 'Soda Shy'?
Has New York Mayor Bloomberg already made Americans soda shy? The New York State Supreme Court wisely rejected New York Mayor Michael Bloomberg’s ban on the sale of super-sized sodas, but people who once loved 32-ounce sodas may, wisely, be banning the drinks on their own.   After all, ordering an extra-large drink of soda in New York with your sandwich or pizza, if you're overweight, is now more likely to invite subtle shakes of the head and knowing glances exchanged a few tables away (Keith Ablow, 3/26).  

The Lund Report: Real Life Consequences Of Health Reform
A southern Oregon non-profit organization, currently employing 205 employees, is wrestling with the implications of health reform on its organization. Of the 205 employees, 63 employees are considered administrative staff or professional and they are covered by health insurance with the employee premium fully paid. There are an additional 90 employees who would now meet the new definition of full-time employees at 30 hours per week. These employees are not currently offered health insurance. ... When it is time for this non-profit organization to renew their plan in 2014, they face some really tough choices relative to accomplishing their primary goal, choices that directly impact their employees in unintended ways (John Gridley, 3/26).

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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.