Daily Health Policy Report

Thursday, March 28, 2013

Last updated: Thu, Mar 28

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch


Health Care Marketplace

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

FAQ On The Latest Study: Obamacare's Impact On Insurance Claim Costs

Kaiser Health News' staff writer Jay Hancock reports: "It's too early to know how much individual health insurance policies will cost once the online marketplaces created under the Affordable Care Act launch Jan. 1. But that hasn’t stopped experts and interest groups from making predictions. The latest analysis comes from the Society of Actuaries. It's attracting attention because of the group's expertise and nonpartisanship. What actuaries do for a living — predicting future expense based on multiple squishy factors — is at the core of figuring out what will happen under Obamacare" (Hancock, 3/28). Read the story.

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Capsules: Tight Medicaid Eligibility Leads To More Adults Delaying Care; Audit Finds Shortcomings In Minn. Verifications Of Income, Other Information

Now on Kaiser Health News' blog, Ankita Rao reports on research related to tight Medicaid eligibility and the incidence of delayed medical care: "The research letter in the March 28 issue of the journal found this number to vary significantly across the country and to be lower in places with less restrictive eligibility criteria for Medicaid, the federal-state insurance program for low-income citizens" (Rao, 3/27).

Also on Capsules, Minnesota Public Radio's Elizabeth Stawicki, working in partnership with KHN and NPR, reports on a Minnesota audit: "An audit released Tuesday shows Minnesota's Department of Human Services has not been adequately verifying the eligibility of participants in some of its public assistance programs. Such verifications are a requirement of state and federal law, and the legislative auditor says his office first alerted the department to some of the problems more than a decade ago" (Stawicki, 3/27). Check out what else is on the blog.

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Political Cartoon: 'Open Late?'

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

Meanwhile, here is today's health policy haiku:


Time will reveal the
truths about costs, coverage.
For now, predictions...

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

How Much Will The Health Law Cost? Depends On Whom You Ask

Some restaurant chains now say the health law may not cost them so much after all -- mostly because many employees either won't qualify for coverage or may decline it. Meanwhile, analysis continues of a Society of Actuaries projection of big increases in medical claims costs for insurers in the individual market. And the Associated Press examines President Barack Obama's promises regarding health care.

The Wall Street Journal: Restaurant Chains Cut Estimates For Health-Law Costs
Restaurant owners have been fierce critics of the health-care overhaul law, fearing that its mandate for employers to offer insurance more broadly will drive up costs and deter hiring. Now, some operators say the law may not be that costly after all. They say many employees won't qualify for coverage, and many of those who do qualify will decline company-offered insurance (Thurm, 3/27).

Kaiser Health News: FAQ On The Latest Study: Obamacare's Impact On Insurance Claim Costs
It's too early to know how much individual health insurance policies will cost once the online marketplaces created under the Affordable Care Act launch Jan. 1. But that hasn’t stopped experts and interest groups from making predictions. The latest analysis comes from the Society of Actuaries. It's attracting attention because of the group's expertise and nonpartisanship. What actuaries do for a living — predicting future expense based on multiple squishy factors — is at the core of figuring out what will happen under Obamacare (Hancock, 3/28).

The Associated Press: Promises, Promises: Obama On Health Care
The issue: Health care was the defining political battle of President Barack Obama's first term, and — after the economy— it remains his most complicated policy challenge at home, central to his place in history. Fixing the system is a tall order as "Obamacare's" major coverage expansion takes effect this year and next (Alonso-Zaldivar, 3/28).

National Journal: The Secret Republican Plan To Repeal 'Obamacare'
A few minutes after the Supreme Court issued its landmark decision upholding President Obama’s health care law last summer, a senior adviser to Mitch McConnell walked into the Senate Republican leader’s office to gauge his reaction. McConnell was clearly disappointed, and for good reason. For many conservatives, the decision was the death knell in a three-year fight to defeat reforms that epitomized everything they thought was wrong with Obama’s governing philosophy (Frates, 3/27).

In California -

Los Angeles Times: Low-Income California Seniors To Move Into New Managed Care Plan
In a major shift triggered by the national healthcare law, nearly half a million low-income California seniors and disabled patients will begin moving into a new managed care program this fall. The patients, who receive both Medi-Cal and Medicare, are among the most costly in the state. Officials believe that the program, Cal MediConnect, will reduce spending and improve care by shifting the patients out of a fragmented system and into one that is more coordinated (Gorman, 3/27).

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Tenn. Governor Refuses To Expand Medicaid

Gov. Bill Haslam said he wants to expand health insurance coverage for low-income residents, but "on his own terms" by enrolling large numbers in private insurance plans. Media outlets also track developments in Texas, Arizona and Virginia, where pollsters find opinion about the expansion divided along party, gender and racial lines.

The New York Times: Governor Of Tennessee Joins Peers Refusing Medicaid Plan
Gov. Bill Haslam of Tennessee said Wednesday that he would not expand Medicaid in his state as called for in the federal health care overhaul, joining 18 other Republican governors who have rejected expansion for now (Goodnough, 3/27).

The Wall Street Journal: Tennessee Holds Off On Medicaid Expansion
Mr. Haslam, a Republican, said he wants to broaden health-insurance coverage to more low-income residents in Tennessee using federal funds from the health-care law. But the governor said he wouldn't move forward until he reaches an agreement with federal regulators that allows his state to do so on its own terms. The governor told state lawmakers that he favors enrolling tens of thousands more people in private insurance policies, rather than signing them up for the state's Medicaid program (Radnofsky, 3/27).

USA Today/The Tennessean: Tenn. Gov. Won't Expand Medicaid To Cover Uninsured
Gov. Bill Haslam said he wants to leverage federal dollars to purchase private health insurance for Tennesseans without coverage who can't afford it. But the federal Department of Health and Human Services has not signed off on his idea (Sisk and Wilemon, 3/27).

The Hill: Tenn. Governor Rejects Medicaid Expansion
Tennessee will not expand its Medicaid program under President Obama's healthcare law, the governor announced Wednesday. Gov. Bill Haslam (R) was petitioning to use the expansion's federal dollars to subsidize private insurance for low-income Tennesseans, but no agreement was reached before a fiscal deadline forced his hand, according to reports (Viebeck, 3/27).

Richmond Times-Dispatch: McAuliffe Strongly Backs Medicaid Expansion
Democratic gubernatorial candidate Terry McAuliffe on Wednesday came out strongly in favor of expanding Medicaid in Virginia under the federal Affordable Care Act. “We need to have the Medicaid expansion here in Virginia,” McAuliffe said outside the State Board of Elections headquarters in Richmond, after dropping off petitions with more than 35,000 signatures to qualify for the June 11 primary ballot. … McAuliffe said the state would reap billions in economic benefits (Nolan, 3/28).

The Associated Press/Washington Post: Quinnipiac Statewide Survey Shows Sharp Gender, Racial Divides In Va. Over Medicaid Expansion
A new statewide poll in Virginia shows a sharp societal divide over the question of whether to expand Medicaid — something that won’t happen for a while in the state because of reform hurdles Gov. Bob McDonnell has set for it. Quinnipiac University’s survey of 1,098 registered Virginia voters found 45 percent favor expanding the federal-state program that helps pay healthcare costs for the elderly, poor and disabled to about 400,000 Virginians just above the poverty level. Forty-three percent did not (3/28).

Richmond Times-Dispatch: Virginians Split On Medicaid Expansion, New Poll Finds
Virginians are split on whether the state should expand Medicaid, but less divided when it comes to barring concealed handgun permits from public inspection, according to a poll released this morning. Voters disagree on whether the state should expand the health care program for low-income residents, 45 percent-43 percent with deep divisions along party lines, according to Quinnipiac University’s survey of 1,098 registered voters (Meola, 3/28).

The Texas Tribune: Perry, Cruz, Cornyn To Present United Front On Medicaid
Gov. Rick Perry and Texas' two U.S. senators will join forces at the state Capitol on Monday to reassert their opposition to expanding Medicaid, a central tenet of federal health reform that has been a subject of much debate among state lawmakers on both sides of the aisle. The details of the Monday morning press conference, which will also include representatives from the Texas Public Policy Foundation (TPPF), a conservative think tank, are still being worked out (Ramshaw, 3/27).

Arizona Republic: Abortion Enters Arizona Debate On Medicaid Expansion
One of the Legislature’s most powerful lobbying groups says Gov. Jan Brewer’s Medicaid-expansion plan would subsidize abortions and is pushing for an amendment that complicates negotiations and threatens the proposal. The Center for Arizona Policy is using an opinion from the Arizona-based Alliance Defending Freedom, a Christian legal-defense organization, to argue that the draft Medicaid legislation should be amended to disqualify the non-profit women’s health provider Planned Parenthood from receiving public money (Reinhart, 3/27).

In related news -

Kaiser Health News: Capsules: Tight Medicaid Eligibility Leads To More Adults Delaying Care
The research letter in the March 28 issue of the journal found the number [of adults delaying necessary care] to vary significantly across the country and to be lower in places with less restrictive eligibility criteria for Medicaid, the federal-state insurance program for low-income citizens (Rao, 3/27).

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Capitol Hill Watch

Another Date Night On Tap For Obama, GOP Senators

With budget issues -- including changes to Medicare and Medicaid -- still very much in play, President Barack Obama is planning another outing with Republican lawmakers in an effort to build relationships and smooth the path for possible negotiations this summer. 

Los Angeles Times: One Date Is Not Enough: Obama To Dine Again With GOP Senators
This summer, Congress will be asked to raise the U.S. debt limit to avoid defaulting on obligations. Republicans will press the White House for budget cuts in exchange, and will likely target the Medicare and Medicaid health programs, which are driving much of the red ink. Democrats will insist on raising tax revenue to help plug the budget gaps. The debate is likely to be difficult, and one that could easily fall into the cycle of brinkmanship that has complicated past budget battles between Congress and the White House. The dinner dates may help set the tone, House Speaker John A. Boehner (R-Ohio) has said, but will not resolve the differences (Mascaro and Hennessey, 3/27).

In other Capitol Hill news -

The Fiscal Times: Health Care Reform Tax Battle: Medical Devices
The Senate vote last week seeking to eliminate a new tax on medical devices was prompted by a strong and well-financed lobbying effort by health care industry manufacturers. However, it will take a lot more than a largely symbolic vote on an amendment to the 2014 budget resolution to knock out the 2.3 percent sale tax – one of many new taxes imposed by President Obama's health care reform law (Pianin, 3/27).

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How Will Immigration Reform Intersect With Medicare?

In this pair of stories, news outlets examine whether immigration reform will stress the Medicare program as well as what hospitals are doing to address the health law's Medicare Wage Index.   

The Medicare Newsgroup: Jury Is Out On The Impact Immigration Reform Will Have On Medicare
As Congress grapples with immigration reform, questions are arising about the impact new Americans and legal residents could have on U.S. social programs, among them the health care system. For Medicare, which annually garners a large share of the U.S. budget, the jury is out on whether immigration expansion will stress the program (Solana, 3/27).

Modern Healthcare: Support Seen For Ditching ACA Shift On Medicare Wage Index
Hospitals pushing to reverse a payment provision of the healthcare reform law scored two victories recently, but the war appears far from over. The Coalition of America's Hospitals, a group of 20 state hospital associations, successfully pushed for an amendment to the Senate budget bill reversing a change to the hospital wage index by the Patient Protection and Affordable Care Act. Federal law previously required that wage-index adjustments to Medicare payments produce no new net costs to the program within each state (Daly, 3/27).

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Health Care Marketplace

Drug Costs And Pricing Issues Touch Hospitals, Independent Pharmacies

NPR reports on how one hospital made what is termed an "unusual decision" -- it chose to not stock a new drug because it was very costly.

NPR: When A Famous Hospital Didn't Want An Expensive New Drug
Last year, a new drug called Zaltrap was approved as a kind of last-chance therapy for patients with colorectal cancer. Studies suggested Zaltrap worked almost exactly as well as an existing drug, called Avastin. In fact, the main difference between the two drugs seemed to be the price. "I was rather stunned," Dr. Leonard Saltz, who specializes in colorectal cancer, told me. Zaltrap costs about $11,000 per month — about twice as much as Avastin, Saltz said. Saltz and his colleagues at Memorial Sloan Kettering Cancer Center in New York made what seemed like a very reasonable decision: The hospital would not stock the more expensive drug. But taking cost into account for a new cancer drug was a very unusual decision for the hospital (Kestenbaum, 3/28).

Also in the news, how independent pharmacies are seeking help from state legislators regarding the shift to generics and the role of pharmacy benefit managers -

The Wall Street Journal: Drugstores Press For Pricing Data
America's shift to generic drugs has saved consumers more than a $1 trillion over a decade, but it has taken a heavy toll on independent pharmacists. Now these small businesses are turning to state legislators across the country for help against powerful middlemen that determine how much drugstores are reimbursed for certain medicines. Currently, eight states, including Oregon, are considering such legislation (Martin, 3/27).

The Lund Report: Small Pharmacies Getting Squeeze From Goliath PBMs
Central Drugs Pharmacy has been open for 110 years in downtown Portland, and it specializes in dispensing drugs for those who suffer from HIV. But owner Shelley Bailey told two legislative committees that if abusive business practices by pharmacy benefit managers are not curtailed, she may have to close its doors. She said that pharmacists have been struggling with reimbursements that are completely unpredictable and punitive audits that are often unfounded (Gray, 3/27).

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Radiology Trainees Face Earning Challenges

The New York Times: Job Prospects Are Dimming For Radiology Trainees
For years, medical students who chose a residency in radiology were said to be on the ROAD to happiness. The acronym highlighted the specialties — radiology, ophthalmology, anesthesiology and dermatology — said to promise the best lifestyle for doctors, including the most money for the least grueling work. Not anymore. Radiologists still make twice as much as family doctors, but are high on the list of specialists whose incomes are in steepest decline (Bernstein, 3/27).

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State Watch

Federal Court Weighs Calif. Progress On Mental Health Care For Prisoners

Federal Judge Lawrence Karlton must rule on the case by April 7.

Los Angeles Times: Judge Weighs Brown's Bid To End Court Oversight
California's bid to end court oversight of the care it gives about 33,000 mentally ill inmates was heard Wednesday by a federal judge who voiced concern that he had only days to weigh thousands of pages of contradictory claims and issue a decision (St. John, 3/27).

The Associated Press: Judge Hears Arguments About Calif. Prisons Mental Health Care Oversight
A federal judge on Wednesday struggled with how to gauge whether conditions for mentally ill inmates in California prisons have improved enough under federal oversight to return control of the facilities to the state, as Gov. Jerry Brown is seeking. Lawyers for California argued in court that after 18 years of federal oversight and billions of dollars in state spending, the care now meets the requirements of the U.S. Constitution (Thompson, 3/28).

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Physicians React To New N.D. Abortion Laws

Also, Mississippi Gov. Phil Bryant nominates anti-abortion activist to state board.

MedPage Today: N.D. Abortion Laws Dare Legal Challenge
Physicians on both sides of the abortion argument disagree on whether restrictions such as the hospital privileges requirement are medically necessary or whether they instead intrude upon patients' rights (Pittman, 3/27).

The Associated Press: Gov. Taps Anti-Abortion Activist For Health Board
Mississippi Gov. Phil Bryant has nominated anti-abortion activist Terri Herring for a six-year term on the state Board of Health, a position that could give Herring influence over Health Department policies that affect the state's only abortion clinic. Hers is one of several nominations awaiting consideration in the Senate Public Health and Welfare Committee in the next 10 days. If confirmed by a majority of the Senate, Herring would serve July 1 to June 30, 2019 (3/28).

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State Roundup: Calif. Report Card Shows Improved Care For Kids

The latest developments in health policy from California, the District of Columbia, Georgia, Maryland, Minnesota, Oregon and Texas.

Los Angeles Times: California Issues Annual Ratings For Health Plans, Physician Groups
Kaiser Permanente was the only HMO to earn a top four-star rating for providing recommended care on California's annual report card, while Cigna and UnitedHealthcare led the way with three-star ratings among PPO plans. The report issued Wednesday on California's biggest HMOs and other health insurance plans showed improvement in care for children, but mixed results for treating adults with chronic medical conditions (Terhune, 3/27).

San Jose Mercury News: Health Plans In California Rated In New State Report Card: Which Ones Got The Most Stars? The Least?
California's largest health plans are now immunizing more children and meeting other quality measures, but many patients report they are not able to get the care they need quickly and easily. These are among the findings of the 12th annual report card released Wednesday by the state Office of the Patient Advocate. The report is designed to enable consumers to compare the quality of care delivered by the state's 10 largest commercial health maintenance organizations, six largest preferred provider organizations and 209 medical groups (Kleffman, 3/27).

The Washington Post: Maryland Officials Outline Huge Changes To Payment System For State Hospitals
Maryland health officials on Wednesday outlined major changes to how hospital costs are paid in an effort to keep the state’s unique Medicare waiver agreement with the federal government — a deal that has provided enormous financial benefits to the state in recent decades (3/28).

Kaiser Health News: Audit Finds Shortcomings In Minn. Verifications Of Income, Other Information
An audit released Tuesday shows Minnesota's Department of Human Services has not been adequately verifying the eligibility of participants in some of its public assistance programs. Such verifications are a requirement of state and federal law, and the legislative auditor says his office first alerted the department to some of the problems more than a decade ago (Stawicki, 3/27).

Georgia Health News: Baldwin County, Groups Go To Bat For Kids
One of every five children in Baldwin County is obese. Faced with that stark statistic, health organizations, elected officials and schools in the Middle Georgia county have formed Live Healthy Baldwin, a coalition that is fighting the area's childhood obesity problem. The group’s projects include starting community and school gardens; making roads safer for bicyclists and pedestrians; building trails; and supporting farmer's markets. Area schools in the fall will offer 60 minutes of physical activity for students (Miller, 3/27).

The Washington Post: Three Firms Picked For D.C. Medicaid Contracts
City officials have chosen three firms to receive some of the city's largest contracts, to provide health care to low-income D.C. residents enrolled in Medicaid and other government health programs (DeBonis, 3/27).

MPR News: Mayo Adds Shriners Hospital To Its Network
The Mayo Clinic is adding Shriners Hospitals for Children-Twin Cities to its Clinic Care Network, the health care provider announced Wednesday. The 90-year-old Shriners Hospitals for Children-Twin Cities specializes in orthopedic medicine for children. It'll be the 15th member of the Mayo Clinic Care Network, and the first standalone pediatric hospital in the group (Shenoy, 3/27).

The Lund Report: In Health Insurance, Unhappy Customers Don't Mean Lower Revenue
The number of confirmed consumer complaints made against an insurer doesn't affect that insurer's market share, according to a multiyear analysis of complaints registered with the Oregon Insurance Division. While the insurance division classifies dozens of insurers – small and large – as health insurers in its statistics reporting, many of those are smaller insurers, life and dental plans, said Ron Frederickson, manager of the complaints department for the Insurance Division (McCurdy, 3/27).

The Texas Tribune: Texas Project Targets Patients With Behavioral Disorders
Texas' health department has embarked on a $10 million project aimed at preventing people with mental health or substance abuse issues from developing chronic diseases (McGee, 3/28).

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Weekend Reading

Weekend Reading: Seniors Smoking Marijuana; Same-Sex Marriage And Public Health

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

The New York Times: Shuffleboard? Oh, Maybe Let's Get High Instead
For Cher Neufer, a 65-year-old retired teacher, socializing with friends (all in their 60s) means using marijuana. Once a week they get together to play Texas Hold ’Em poker "and pass around a doobie," Ms. Neufer said. … Statistics suggest that more members of the older generations, like Ms. Neufer, are using marijuana. The National Survey on Drug Use and Health reported in 2011 that 6.3 percent of adults between the ages of 50 and 59 used the drug. That number has risen from 2.7 percent in 2002. And anecdotal evidence points to much of this use being sociable rather than medical (Alyson Krueger, 3/22).

The Wall Street Journal: Science Fiction Comes Alive As Researchers Grow Organs In Lab
Reaching into a stainless steel tray, Francisco Fernandez-Aviles lifted up a gray, rubbery mass the size of a fat fist. … Inside a warren of rooms buried in the basement of Gregorio Marañón hospital here, Dr. Aviles and his team are at the sharpest edge of the bioengineering revolution that has turned the science-fiction dream of building replacement parts for the human body into a reality. … Now, with the quest to build a heart, researchers are tackling the most complex organ yet. The payoff could be huge, both medically and financially, because so many people around the world are afflicted with heart disease. Researchers see a multi-billion-dollar market developing for heart parts that could repair diseased hearts and clogged arteries (Gautam Naik, 3/22). 

NPR: Unfit For Work
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. … But the story of these programs -- who goes on them, and why, and what happens after that -- is, to a large extent, the story of the U.S. economy. It's the story not only of an aging workforce, but also of a hidden, increasingly expensive safety net (Chana Joffe-Walt, 3/25). 

Forbes: Medicare Has Stopped Paying Bills For Medical Diagnostic Tests. Patients Will Feel The Effects
The Obama Administration has stopped paying the bills from hundreds of health care companies, and it has nothing to do with sequestration. ... At issue is the way that Medicare reimburses everyone from the big laboratory companies such as the Laboratory Corp of America and Quest Diagnostics Inc., to the molecular diagnostic labs inside academic hospitals, and especially smaller firms that make proprietary tests used by doctors to more effectively target treatments to patients with conditions like cancer (Scott Gottlieb, 3/27).

Los Angeles Times: Fate Of Same-Sex Marriage Cases Likely To Influence Public Health
Advocates for and against same-sex marriage will make legal arguments to the Supreme Court this week about whether laws such as the federal  Defense of Marriage Act and California's Proposition 8 run afoul of the Constitution.  Meanwhile, in medical literature, doctors, psychologists, sociologists and other researchers have been making the case that allowing gays and lesbians to marry results in tangible health benefits for the couples involved, their children and even taxpayers as a whole (Karen Kaplan, 3/26).

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Editorials and Opinions

Viewpoints: Budget Woes Leave Democrats With Painful Choices; David Kessler On Health Hazards Of Antibiotics In Meat; The Pros And Cons Of Not Hiring Smokers

USA Today: Entitlements Or Investment? Democrats Must Pick
Democrats therefore face a fundamental and inescapable choice: they can support funding current consumption, especially by older Americans who are not working, or future investment, particularly in scientific research and innovation. The main cause of this conflict between goals is the fact that one half of the Democratic coin, entitlements (Social Security, Medicare and Medicaid), has become an uncontrollable monolith eating up more and more of the federal budget, while growth-inducing investments get left behind (Robert Atkinson, 3/27). 

The Wall Street Journal: Obama's Incredible Shrinking Clout
This year, Republicans will block any new taxes or mandatory spending. Democrats are likely to oppose any significant entitlement savings. There is little chance of a "grand bargain" of tax increases, spending restraint and entitlement reform without serious presidential leadership. In any case that would require trust, something Mr. Obama has not done much to create and a lot to destroy. ... The budget drama reveals a more important phenomenon—that Mr. Obama has become a minor actor on Capitol Hill (Karl Rove, 3/27).

Roll Call: Striking The Right Balance When Controlling Health Care Costs
The president recently met with about a dozen GOP leaders to try to find some common ground on deficit reduction policy. The session was closed door. But as the congressional budget war begins, there are serious indicators that if there is a "grand bargain" on fiscal reform it will include changes to Medicare. This makes sense. Medicare is a big part of the debt problem. What's disturbing, however, is that some in Congress want to aim their cuts at the one part of the program that’s been exceptionally effective at containing costs: the Medicare Part D drug benefit (Joan Koerber-Walker, 3/27).

The Fiscal Times: The Cost Explosion Of Obamacare Begins To Hit Home
When Democrats insisted on turning their attention to the health-system overhaul in 2009 rather than the jobs crisis, they argued that the rapid increase in health-care costs kept American businesses from creating employment opportunities.  Barack Obama insisted that greater government control over insurance plans, including a first-ever mandate for citizens to buy insurance, would "bend the cost curve downward" (Edward Morrissey, 3/28).

Bloomberg: The Battle Over Obamacare Moves To States
President Barack Obama's Patient Protection and Affordable Care Act celebrated its third birthday last weekend. This particular anniversary was a big deal, because it was often unclear whether the law would reach it. ... Republicans, however, haven't quite given up. Their slogan, "repeal and replace," has given way to "resist and annoy." ... At the state level, most Republican governors have refused to set up insurance exchanges, and many have refused to expand Medicaid, which is the primary vehicle for insuring those currently uninsured. The question, though, is whether governors who purposefully do a very bad job implementing Obamacare will hurt the law or hurt themselves and their states (Ezra Klein, 3/27).

The New York Times: Antibiotics And The Meat We Eat
Scientists at the Food and Drug Administration systematically monitor the meat and poultry sold in supermarkets around the country for the presence of disease-causing bacteria that are resistant to antibiotics. These food products are bellwethers that tell us how bad the crisis of antibiotic resistance is getting. And they're telling us it's getting worse. But this is only part of the story. While the F.D.A. can see what kinds of antibiotic-resistant bacteria are coming out of livestock facilities, the agency doesn’t know enough about the antibiotics that are being fed to these animals. This is a major public health problem, because giving healthy livestock these drugs breeds superbugs that can infect people (David A. Kessler, 3/27). 

The New York Times: Is Abortion Heading Back To The Supreme Court?
Forty years after the Roe v. Wade decision made abortion legal and recognized a woman's right to control her body and her life, the issue may well be headed back to the Supreme Court. Opponents of abortion rights have been patiently and methodically chipping away at the 1973 decision, getting laws passed that restrict the circumstances under which women can exercise their right to have a legal abortion, and making it harder for doctors to provide abortions or even abortion counseling. Republican governors and legislatures in several states, notably Texas, have made an even broader assault on women’s health by trying to close clinics that provide birth control counseling, breast cancer screening and other important services. The movement has accelerated dramatically in recent weeks with the passage of new anti-abortion laws in Arkansas and North Dakota (Andrew Rosenthal, 3/27).  

The New England Journal of Medicine: The Ethics of Not Hiring Smokers
Finding employment is becoming increasingly difficult for smokers. Twenty-nine U.S. states have passed legislation prohibiting employers from refusing to hire job candidates because they smoke, but 21 states have no such restrictions. Many health care organizations, such as the Cleveland Clinic and Baylor Health Care System, and some large non–health care employers, including Scotts Miracle-Gro, Union Pacific Railroad, and Alaska Airlines, now have a policy of not hiring smokers — a practice opposed by 65% of Americans, according to a 2012 poll by Harris International. We agree with those polled, believing that categorically refusing to hire smokers is unethical (Harald Schmidt, Kristin Voigt and Ezekiel J. Emanuel, 3/28).

The New England Journal of Medicine: Conflicts And Compromises In Not Hiring Smokers
A small but increasing number of employers — including health care systems such as the Cleveland Clinic, Geisinger, Baylor, and the University of Pennsylvania Health System — have established policies of no longer hiring tobacco users. ... These policies engender controversy, and we recognize that they risk creating or perpetuating injustices. ... However, these policies may also save lives, directly and through their potential effects on social norms, and these same disadvantaged populations are at greatest risk for smoking-related harms and ensuing disparities in health (David A. Asch, Ralph W. Muller and Kevin G. Volpp, 3/28).

The New York Times: Down Syndrome And A Death
A grand jury in Frederick County, Md., decided last week not to bring criminal charges in the death of Robert Ethan Saylor, a 26-year-old man with Down syndrome who was killed in a struggle with three off-duty county sheriff's deputies at a movie theater in January. Advocates for people with intellectual disabilities are bewildered and furious, and it is easy to see why (3/27).

The Seattle Times: Get Kids Mental-Health Care Instead Of Sending Them To Juvenile Courts
Imagine you have a 14-year-old daughter named Carla with a mental-health disorder. Carla is at the mall with friends when she begins to experience an unusual burst of energy and a feeling of being indestructible. She starts climbing on counters and knocks down a display of baseball caps. ... Engrossed Substitute House Bill 1524, which has already passed the state House of Representatives, would expand the list of facilities where law-enforcement officials can take nonviolent youth they believe are suffering from mental disorders (Mary Helen Roberts and Eric Trupin, 3/28).

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Stephanie Stapleton

Andrew Villegas

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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.