Daily Health Policy Report

Friday, March 30, 2012

Last updated: Fri, Mar 30

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Campaign 2012

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insurers Push Back On Consumer Rebate Letter

Kaiser Health News staff writer Jay Hancock reports: "Thanks to hefty profits and a requirement in the health law that takes effect this year, insurers will send subscribers hundreds of millions of dollars in rebate checks this August. But the industry and the Obama administration are at odds over proposed language in the letter that goes with the checks as well as who gets notification. The administration may require insurers to send notices about rebate rules even to customers who aren't getting a rebate" (Hancock, 3/29). Read the story.

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Webcast Replay: Deconstructing The Supreme Court's Historic Health Law Arguments

This Kaiser Health News webcast examines this week's Supreme Court action. After six hours of historic arguments on the health law, the court now begins its deliberations. What were the key moments in the debate, and how might they affect the outcome? Our panel includes KHN Senior Correspondent Mary Agnes Carey, who is joined by Stuart Taylor, attorney, author and KHN legal analyst; Tom Goldstein, Goldstein & Russell, P.C., and publisher of SCOTUSblog; and Julie Rovner, health policy correspondent, NPR (3/28). Watch the discussion or read the transcript.

 

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Capsules: Social Media Rundown - Three Days At The Supreme Court

Now on Kaiser Health News blog, Shefali S. Kulkarni tracks the week in tweets: "This week, the Supreme Court heard oral arguments on the 2010 health law, in what court watchers are calling the biggest case at the high court in decades. Here's a rundown from the social media-sphere of what happened in those three days" (Kulkarni, 3/29). Check out what else is on the blog.

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Political Cartoon: 'In Your Wallet?'

Kaiser Health News provides a fresh take on health policy developments with "In Your Wallet?" By R.J. Matson.

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

MESSAGES FOR AND AGAINST 

House GOP votes
for Ryan budget blueprint
while Dems buy billboard.
-Anonymous 

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

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Capitol Hill Watch

House OKs Ryan Budget -- With Medicare Changes; Entitlement Program Cuts

The budget blueprint, advanced by Rep. Paul Ryan, R-Wis., is unlikely to gain passage in the Senate but will be a key marker in the upcoming election season. 

The Washington Post: House Approves $3.5 Trillion Budget Plan Proposed By Paul Ryan
The Ryan plan, which proposes cutting tax rates and a dramatic revamping of Medicare to curb costs for future retirees, faces all but certain rejection in the Senate but will frame the parties' election-year debate on fiscal issues. The plan cuts $5.3 trillion over the next decade — entirely through deep cuts in entitlements and agency spending (Helderman and Kane, 3/29).

The New York Times: House Passes GOP Budget Plan, Mostly Along Party Lines
A fierce two-day debate over a Republican budget plan portrayed as either a path to prosperity or a road to ruin ended Thursday with House passage of a blueprint that would transform Medicare, cut domestic spending to levels not seen since World War II and order up a drastic overhaul of the tax code (Weisman, 3/29).

The Wall Street Journal: House Approves Ryan's Budget Plan
The 2013 budget by Rep. Paul Ryan (R., Wis.), chairman of the House Budget Committee, stakes out a clear Republican position by proposing to cut spending, reduce taxes, and overhaul Medicare and Medicaid (Bendavid and Paletta, 3/29). 

Market Watch: House Passes Ryan Budget Plan
House Republicans threw their support behind Rep. Paul Ryan's budget plan on Thursday, ramping up an election-year clash with Democrats over Medicare and federal spending. ... No Democrats voted for the Ryan budget on Thursday. Democrats assail it for what they say is an assault on Medicare, the medical care program for the elderly. House Budget Committee Chairman Ryan and other Republicans say that their plan to turn Medicare into a voucher-style program for future — not current — retirees will save it from going bankrupt as more U.S. seniors participate (Schroeder, 3/29).

The Hill: House Republican Rips 'Drastic' Medicare Cuts In Ryan Budget
Rep. David McKinley (R-W. Va.) slammed the Medicare cuts in House Republicans' budget resolution Thursday, saying he couldn't support the plan because it cut Medicare but still would not balance the budget. McKinley was one of 10 Republicans to vote against Rep. Paul Ryan's (R-Wis.) budget proposal, which passed the House 228-191. In a statement Thursday, McKinley emphasized that he has voted to cut more than $5 trillion in government spending, but said the House budget was unacceptable (Baker, 3/29).

MedPage Today: House Passes Ryan's Medicare Overhaul Bill
Once a beneficiary chooses a plan, the government would send that plan a "premium support" payment equal to either the cost of traditional Medicare or the second least-expensive private plan, whichever is less. Beneficiaries who chose a plan costing more than the amount of the premium support payment would have to make up the difference (Walker, 3/29). 

Reuters: House Vote Sets Up Republican Budget As Manifesto, Target
House Republicans passed congressman Paul Ryan's deficit-cutting budget plan on Thursday, setting it up as a central theme for their election-year campaign efforts and as a target for Democratic attacks over its proposed healthcare cuts. In a preview of the messages they will carry home to their constituents during a two-week break, Republicans hailed the plan as a bold step toward reining in U.S. deficits, while Democrats decried it as an assault on the cherished Medicare healthcare system for the elderly (Lawder, 3/29).

The Associated Press: Dems, GOP Lawmakers Sell Budgets Back Home
Republicans and Democrats are selling their budget plans back home as models for how they would run Washington if they win the November elections. With the presidency and the majorities of Congress at stake, House Republicans are showing off their $3.5 trillion plan, which passed Thursday on a near-party-line 228-191 vote, to slash the deficit and the size of government by far more than Democrats want. Democrats, meanwhile, insist on imposing higher taxes on the rich and preserving Medicare, transportation, research and other programs they say are jeopardized by the Republicans (Kellman, 3/30).

The Fiscal Times: The Battle Of The Budgets: More Hype Than Hope
Perhaps the starkest contrast between the two plans comes in their competing ideas for how to contend with the growing costs of health care for the elderly and poor. Ryan proposes repealing Obama's signature health care law and overhauling Medicare, Medicaid, and cutting back other entitlement health spending programs. Over ten years, his plan cuts Medicare by $205 billion, and Medicaid and smaller health programs by $770 billion. ... (Rep. Chris) Van Hollen's proposal, on the other hand, largely leaves Medicare and Medicaid untouched, and defers to cost-saving provisions of Obama's health care law to control Medicare costs for seniors (Hirsch, 3/29). 

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Health Reform

Justices Hold First Vote Today On Health Law's Fate

If past practice holds, the Supreme Court will meet privately today to cast a preliminary vote. No one else will be present, and drafts of opinions are likely to be written and rewritten many times in the next few months before the actual decision is issued, likely sometime in June.

The Washington Post: The Supreme Court Will Decide On The Health-Care Law Soon. It Will Tell You Later.
If the usual process occurs, the justices of the Supreme Court will gather around a large rectangular table Friday morning and, one by one, cast their votes on the constitutionality of President Obama's health-care law. They will let the rest of us know the outcome in due time (Barnes, 3/29).

The Associated Press: Justices Meet Friday To Vote On Health Care Case
While the rest of us have to wait until June, the justices of the Supreme Court will know the likely outcome of the historic health care case by the time they go home this weekend. After months of anticipation, thousands of pages of briefs and more than six hours of arguments, the justices will vote on the fate of President Barack Obama's health care overhaul in under an hour Friday morning. They will meet in a wood-paneled conference room on the court's main floor. No one else will be present (Sherman, 3/29).

USA Today: Supreme Court Likely To Vote On Health Care Law Friday
That initial decision may be altered as drafts of majority and dissenting opinions are written, circulated and rewritten, often many times. It might even be reversed during the lengthy writing process if one or more justices switch sides (Wolf, 3/29). 

Meanwhile, news outlets analyze how various arguments may or may not have appealed to justices and what their opinions might be and how this case could be a defining moment for their legacies.

The New York Times: In Health Case, Appeals To A Justice's Idea Of Liberty
The way to frame a Supreme Court argument meant to persuade Justice Anthony M. Kennedy is to talk about liberty. It is his touchstone and guiding principle, and his conception of liberty is likely to determine the future of President Obama's health care law (Liptak, 3/20).

McClatchy: Can You Predict An Outcome From Supreme Court Justices' Questions?
Supreme Court justices can hide their intentions in plain sight, even with something as complicated as health care. The judicial utterances during this week's lengthy oral arguments left a common impression that the conservative-led court might strike down some or all of the 2010 health care law. Unfortunately for the White House, these kinds of impressions can be valid clues (Doyle, 3/29).

The Wall Street Journal: Health-Law Case Puts Roberts In Crucible
If there was any doubt beforehand, three momentous days of argument this week established that the health-care ruling is sure to be a defining moment for the Supreme Court—and a crucible for Chief Justice John Roberts (Bravin, 3/29). 

Reuters: Analysis: Chief Justice Roberts May Cast Deciding Healthcare Vote
If their usual practice holds, the justices will convene privately on Friday in a small oak-paneled conference room adjoining the chief's chambers to take a preliminary vote. With no law clerks or secretaries present, Roberts will open the discussion and cast the first vote. The justices will go around the table in order of seniority, voting and laying out their rationales. A decision in the dispute is not likely until late June. On the most crucial question - whether the individual insurance requirement is valid - it appeared that Roberts, a conservative appointed to the court by former President George W. Bush, could easily cast the deciding vote (Biskupic, 3/29).

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Contemplating The Options: What Will Become Of The Health Law?

With the Supreme Court arguments complete, media outlets consider the various scenarios that could play out, and the complications that could arise. To quote the Tom Petty song: "The waiting is the hardest part."

Politico: States Stick To Health Law Strategies
This week at the Supreme Court showed that President Barack Obama's health care law could face a real threat of being overturned — but so far, the states don't show any signs that they're going to change their implementation plans (Millman, 3/29). 

The Associated Press: High Court Has Options On Health Care Law
The arguments are done and the case has been submitted, as Chief Justice John Roberts says at the end of every Supreme Court argument. Now the justices will wrestle with what to do with President Barack Obama's health care overhaul. They have a range of options, from upholding the law to striking it down in its entirety. The court also could avoid deciding the law's constitutionality at all, although that prospect seems remote after this week's arguments (Sherman and Alonso-Zaldivar, 3/30).

NPR's SHOTS blog: Thinking The Unthinkable: What If The Whole Affordable Care Act Goes Down?
Here are just a few of the questions a complete declaration of unconstitutionality might raise: Almost every state, including many that have sued to block the health law, has received millions of dollars to start planning to put the law into effect. Will they have to give that money back? ... About 50,000 people are enrolled in temporary "Pre-Existing Condition Insurance Plans" for those who were previously uninsured for at least six months. If the law is declared invalid, that program would very likely have to shut down in fairly short order, leaving those people once again uninsured. ... In some cases the federal government would simply lose the ability to enforce rules (Rovner, 3/29).

Kaiser Health News: Webcast Replay: Deconstructing The Supreme Court's Historic Health Law Arguments
After six hours of historic arguments on the health law, the court now begins its deliberations. What were the key moments in the debate, and how might they affect the outcome? Our panel includes KHN Senior Correspondent Mary Agnes Carey, who is joined by Stuart Taylor, attorney, author and KHN legal analyst; Tom Goldstein, Goldstein & Russell, P.C., and publisher of SCOTUSblog; and Julie Rovner, health policy correspondent, NPR (3/28). 

The New York Times: Here To There, It All Hinges On One Person
No, the spokeswoman said, Pedro Espada Jr. is not currently serving as president of the Soundview Health Care Network. … That is because he has daily appointments in a federal court in Brooklyn to listen to a parade of witnesses testify that he looted the clinics run by Soundview. … Whatever version of reality the jury settles on, the Espada trial … has common strands with the case argued this week in the United States Supreme Court over the constitutionality of the national health care reform act that became law in March 2010. Much depends on a single person (Dwyer, 3/29).

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Insurers, Employers React To Idea Of A Health Law Without An Individual Mandate

Insurers' "worst nightmare" is that the Supreme Court would overturn the health law's insurance requirement but leave the rest of the overhaul intact. Employers are being advised to continue working toward meeting the law's deadlines.

Boston Globe: Insurers Fear Ruling That Ends Only The Coverage Mandate
It would be the health insurance industry's worst nightmare: if the Supreme Court strikes down the mandate that individuals obtain coverage but leaves the rest of President Obama's signature law intact. Most concerning, industry representatives say, would be the requirement to cover people with preexisting medical conditions without the ability to charge higher premiums for the sickliest (Jan, 3/30). 

Politico Pro: Employers Told Not To Wait For SCOTUS Ruling
What should employers do now that the Supreme Court has thrown the health reform law into greater uncertainty? The same things they were doing before, according to a top business consulting firm that's fielding a lot of nervous questions. The main deadlines businesses face are either so tight that they can't afford to stop working on them, or so far off that they will have time to change their plans once the court rules (Nather, 3/29).

In spite of the uncertainty, the health sector fared well in the markets -

Market Watch: Court Ambiguous On Health Care, But Insurers OK
It's uncertain how the Supreme Court will rule after this week's historic set of hearings on the Affordable Care Act, but insurers seem to be taking comfort in what the justices had to say. The nation's major managed-care providers all enjoyed robust gains in their stock prices Thursday, lifting the health-care sector near the top of the S&P 500. It was the first trading session after the nine justices concluded a rare six hours of arguments over the health-care reform bill that is considered President Barack Obama’s signature achievement (Britt, 3/29).

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Course Of State Implementation Efforts Unchanged By High Court's Review

Politico reports that state plans appear unchanged by this week's events. Those that were moving ahead at full speed will likely continue to do so. Those who were taking a go-slow approach have no need to change strategies now. But for Massachusetts, the justices' questions regarding the individual mandate have triggered concerns that the challenges to the federal law could spur similar efforts at the state level.

Politico: States Stick To Their Plans Despite SCOTUS
The red states that have been moving ahead — reluctantly — to build the new health insurance exchanges are still working on them. The red states that were holding off, waiting on a Supreme Court decision, are still doing that. And so far, the blue states don't seem to have any second thoughts about moving full speed ahead. To be sure, oral arguments aren't always a reliable predictor of how the court will eventually decide. But supporters of the law have been taken aback by some of the aggressive questioning from the court's conservative justices this week (Millman, 3/29).

CQ HealthBeat: Expert: Exchanges Could Survive Without Mandate, But Rates Would Rise
If the U.S. Supreme Court rules that the individual mandate is unconstitutional but otherwise upholds the health care law, will state insurance exchanges survive? Yes, says one of the nation’s leading experts on exchanges. But he thinks premiums charged on the exchanges will be higher than if the mandate were in effect (Reichard, 3/29).

Boston Globe: Ruling May Spur Foes To Mass. Health Law
A Supreme Court ruling against President Obama's landmark health care law could prompt challenges to the Massachusetts law that inspired it, according to legal experts and activists following the case. The tenor and aggressiveness of the justices' questions during three days of oral arguments on the federal law have caused some legal experts to predict the nation's highest court could strike down the individual mandate - if not the entire law. If that happens, observers say, the ruling would likely encourage a lawsuit in Massachusetts court, or embolden organizers of a ballot initiative to repeal the state's individual mandate (Borchers, 3/30).

California Healthline: Experts: Medicaid Expansion Will Stand; Mandate's Fate Unclear
Although they were divided in their predictions about specific challenges to the law, all of the experts agreed that substantive changes to the law could have profound impacts on plans to reform California's health care system. ... Francisco Silva, general counsel for the California Medical Association, said California has a lot riding on the Supreme Court's rulings expected in June. "We're so far ahead of most states in setting up our exchange, for California to all of a sudden have to switch gears and shift course would be difficult," Silva said (Lauer, 3/29).

Governors also begin taking positions and developing their own contingency plans -

The Connecticut Mirror: If Supreme Court Tosses Mandate, Malloy May Pick It Up
Jeannette DeJesús, the governor's special adviser on health reform, said Thursday that Connecticut may implement its own requirement that residents buy health insurance. ... Connecticut is ahead of many states in implementing the Affordable Care Act, moving forward quickly on a requirement for a health insurance exchange that would help people buy affordable policies. The state is also counting on millions of dollars the act will provide the state to expand coverage to the uninsured (Radelat, 3/29). 

The Sacramento Bee: California Gov. Brown Wants Health Care Changes Regardless Of Supreme Court Decision
Gov. Jerry Brown's administration vowed Thursday to continue pushing forward elements of the federal health care overhaul in California, even if the U.S. Supreme Court strikes it down. If the court does rule the federal law unconstitutional, state Health and Human Services Secretary Diana Dooley said California should at least consider enacting its own universal health care legislation, including requiring every Californian to buy insurance (Siders and Yamamura, 3/30).

The Baltimore Sun: O'Malley Still Thinks Health Care Will Be Upheld
While this week's Supreme Court hearings left many Democrats apprehensive that the justices will overturn President Obama's landmark health care law, Gov. Martin O'Malley remains an optimist. The governor said that after reading over transcripts of the hearings, at which Republican-appointed justices expressed deep skepticism about the constitutionality of the law, he's not at all sure that they're poised to strike it down in whole or in part (Dresser, 3/29).

The Atlanta Journal-Constitution: Healthcare Decision Has High Stakes For 2 Million Uninsured Georgians
The Supreme Court hearings this week on the federal law requiring citizens to buy health insurance have widespread implications in Georgia -- where about 2 million residents have no health insurance. The mandate calls for almost everyone to obtain insurance or face a penalty. But studies of the law's potential impact in Georgia predict that about 800,000 Georgians may remain uninsured even if the law is implemented (Teegardin, 3/29). 

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High Court's Health Law Consideration Has Political Repercussions

The pending ruling could be a stamp of "repudiation or endorsement" during the upcoming election season. But, if the court overturns the health law, will the GOP be prepared to turn the decision into political victory and could that outcome have a "silver lining" for the Obama administration?

Bloomberg: Health-Care Case Injects High Court Into Election Debate
The U.S. Supreme Court's pending ruling on the health-care law will put a rare judicial stamp of repudiation or endorsement on an incumbent president's most prominent achievement just as he faces re-election. "There's been no measure this central to an administration knocked down by a court just a few years after it passed," including when parts of President Franklin D. Roosevelt's New Deal were ruled unconstitutional in the 1930s, said Julian Zelizer, a presidential historian at Princeton University (Dorning, 3/29).

The Washington Post: On Health Care, Are Republicans Ready For Victory?
Three days of oral arguments at the Supreme Court have given Republicans reason for optimism that President Obama's health-care law could be heading for a legal defeat in a few months. But would such a victory for the GOP this summer mean political success for the party in November and beyond? (Balz, 3/29).

Reuters: Analysis: Obama Could See Silver Lining If Healthcare Law Rejected
The conventional wisdom is that it would be a political disaster for Democratic President Barack Obama, and a boon for Republicans, if the U.S. Supreme Court strikes down all or most of Obama's healthcare overhaul. That could be: The healthcare law -- which among other things would require most Americans to buy health insurance -- is Obama's signature achievement in domestic policy, and the number-one target of many Republicans in this year's elections. However, that doesn't necessarily mean a loss before the Supreme Court would cripple Obama's re-election argument in November (Zengerle, 3/29).

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Campaign 2012

Oral Arguments Inspire RNC Ad

The Republican National Committee uses audio from Supreme Court oral arguments to craft a campaign ad criticizing President Barack Obama and the health law. Meanwhile, the Obama campaign has had a health law strategy of its own in place.

The Associated Press: GOP Ad Plays With Audio From Supreme Court Hearing
A website ad from the Republican National Committee edits audio from this week's Supreme Court hearing on the health care law to exaggerate Solicitor General Donald Verrilli's struggle to find the words to defend President Barack Obama's initiative. The ad shows a photograph of the Supreme Court Building as it plays audio from Tuesday's arguments on the constitutionality of the mandate that all Americans have health care insurance. As Verrilli speaks, the ad flashes the words: "ObamaCare. It's a tough sell" (Daniel, 3/29).

Bloomberg: Republicans Tampered With Court Audio In Obama Attack Ad
A Republican Party Internet advertisement altered the audio of U.S. Supreme Court oral arguments in an attack on President Barack Obama’s health-care law. In a web ad circulated this week, the Republican National Committee excerpts the opening seconds of the March 27 presentation by Obama’s top Supreme Court lawyer, Solicitor General Donald Verrilli. In the ad, he is heard struggling for words and twice stopping to drink water. A review of a transcript and recordings of those moments shows that Verrilli took a sip of water just once, paused for a much briefer period and completed his thought -- rather than stuttering and trailing off as heard in the edited version (Hirschfeld and Stohr, 3/30).

Los Angeles Times: Obama Targets Groups That Would Be Hurt By Overturned The Health Law
Even before the Supreme Court heard arguments about the constitutionality of the federal healthcare law, President Obama's campaign had begun targeting key voter groups that might be most affected by a loss (Memoli and West, 3/28).

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Public Health & Education

Autism Rate Soars To 1 in 88 Children

The number of children with autism in America has climbed 23 percent in the last two years, but the increase could be partially attributable to better diagnoses, officials say.

Boston Globe: Rate Of Autism Diagnosis In Children Rises To 1 In 88 
The number of children identified as having an autism spectrum disorder in the United States is soaring, with roughly 1 in 88 being found to have this condition, according to a study released Thursday morning by the federal Centers for Disease Control and Prevention. The new figure reflects a 23 percent increase compared with the autism rate the public health agency released two years ago (Wen, 3/29). 

The Baltimore Sun: 1 In 80 Maryland Children Diagnosed With Autism, CDC Says
One in 88 American children has an autism spectrum disorder, according to a new estimate from the U.S. Centers for Disease Control and Prevention. The rate is 23 percent higher than one the agency released three years ago. Federal officials said some of the increase is attributable to better diagnoses, though it's not clear how much (Cohn, 3/29).

Detroit Free Press: 1 In 88 Children Has Autism, CDC Now Says
On the same day Michigan lawmakers may finalize legislation requiring insurers to pay for certain behavioral therapy for autistic children, the U.S. Centers for Disease Control and Prevention (CDC) have boosted prevalence rates once again. One in 88 children now have autism spectrum disorder, according to a report released today which drew from 2008 data from 14 communities. Prevalence rates varied, depending on gender, geography and race. Previously, the CDC estimated 1 in 110 children had autism spectrum disorder (Erb, 3/29).

MedPage Today: Autism Rate Climbs Again 
CDC director Thomas Frieden, MD, MPH, noted on a conference call with reporters that doctors have gotten better at diagnosing autism and communities have gotten better at providing needed services. "So at this point I think there is the possibility that the increase … is entirely the result of better detection," Frieden said, while acknowledging the uncertainty (Neale, 3/29). 

NPR's SHOTS blog: Autism Rates Jump Again, As Diagnosis Improves 
A survey released yesterday by Autism Speaks estimates that direct and indirect costs of caring for children with autism costs $126 billion a year. But that number is based on the 2006 estimate of prevalence, which is 1 in 110. Bump that up to 1 in 88, and the cost would be $137 billion a year, Roithmayr said (Shute, 3/29).

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State Watch

Ariz. Hospitals Drop Medicaid Cuts Lawsuit; Fla. Gov. Signs Controversial Medicaid Bill

Both states have news happening in their Medicaid programs.

Arizona Republic: Hospital Association Drops AHCCCS Lawsuit
The Arizona Hospital and Healthcare Association has dropped a lawsuit challenging payment cuts from the state's Medicaid program. The hospital group in November sued the Arizona Health Care Cost Containment System to reverse a 5 percent cut in hospital payment rates. Rather than pursue the court case, Arizona Hospital and Healthcare Association President and CEO Laurie Liles said her group would seek to work with lawmakers to restore hospital funding rates (Alltucker, 3/29).

The Miami Herald: Gov. Rick Scott Signs Medicaid Billing Changes; May Cost Counties $326 Million
Against the wishes of counties and tea party leaders, Gov. Rick Scott signed a controversial bill into law Thursday that will change the way counties are billed for Medicaid costs and could set up a legal showdown. If nothing changes, counties could be forced to pay the state an additional $325.5 million in the coming years in disputed Medicaid bills (Mitchell, 3/29).

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State Roundup: Texas, Minn. Scrutinize Psychiatric Care

A selection of health policy news from Georgia, Louisiana, Minnesota, Texas and Kansas.

The Dallas Morning News: Justice Department Explores Possible Civil Rights Investigation Of Parkland
U.S. Justice Department officials in Washington are weighing whether to investigate potential civil rights violations of psychiatric patients at Parkland Memorial Hospital. Sarah Saldaña, the U.S. attorney for the Northern District of Texas, said the review stems from news stories in The Dallas Morning News exposing cases of neglect, violence and questionable deaths (Moffeit and Egerton, 3/29).

Minnesota Public Radio: State Failed To Review Troubled Past Of Ousted Minn. Security Hospital Administrator
[O]fficials at the Minnesota Department of Human Services did not bother to investigate [David Proffitt's] time at his former employers in any detail, according to interviews with DHS officials and 57 pages of documents related to the hiring provided by the agency in response to an MPR News request. They did not talk to former supervisors before they offered Proffitt the job, ... They did not attempt to contact any of the disgruntled former employees (Baran, 3/30).

(St. Paul) Pioneer Press: House Democrats Unable To Restore Pay Cuts To Personal Care Assistants Of Relatives
Democrats failed in their attempt to amend a Republican bill in the House on Thursday, March 29, so it would restore a wage cut for about 7,000 personal care assistants who provide care to their relatives. Last year, to help balance the state's budget, the Legislature reduced by 20 percent the pay of personal care assistants - PCAs, for short - who care for a relative (Snowbeck, 3/29).

(St. Paul) Pioneer Press: Data Show Minnesota Hospitals Getting Healthier By The Year
Over the past decade, a growing number of hospitals in greater Minnesota have consolidated into larger health systems. Now, a new report shows that those medical centers are doing very well financially (Snowbeck, 3/30).

Kansas Health Institute News: Budget Deal Struck
House and Senate budget negotiators today agreed to postpone dealing with the thorniest issues dividing them until legislators return for the wrap-up session in late April. Among [them]: A House proviso that would block the Kansas Insurance Department from spending any money to implement the federal health reform law until the U.S. Supreme Court has ruled on the Affordable Care Act's constitutionality. The Senate did not include the provision in its version of the budget (3/29). 

New Orleans Times-Picayune: New Orleans Children's Hospital Confirms Plan To Buy Empty Adolescent Hospital
Gov. Bobby Jindal's proposed executive budget presumes the sale will net $35 million, with the money eventually distributed to the state public hospital system using a series of complicated budget maneuvers. The administration had not publicly identified Children’s Hospital as the buyer, but Jindal's first health secretary, Alan Levine, previously stated his preference for a transfer to Children's (Barrow, 3/29).

The Atlanta Journal Constitution: Georgia Lawmakers Pass Abortion Bill On Last, Emotional Day
Two of the most contentious issues of this year's General Assembly passed on the last day of this year's session, salvaged by Republican leaders who wanted to tout them as major victories this election year. New restrictions on late-term abortions in Georgia, which had appeared dead in the morning, and a bill that would cut unemployment benefits for Georgians, passed with just minutes remaining in the 2012 session….The day's most intense dealmaking was on abortion, the passage of which sparked protests in both the House and Senate (Torres and Quinn).

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Editorials and Opinions

Perspectives: All This Fuss About The Word 'Tax'; Civic Lessons From The Supreme Court

Commentators offer further thoughts about the Supreme Court's review of the health law.

The Wall Street Journal: ObamaCare Will Punish State Budgets 
It is now clear that the law will impose heavy burdens on state and family budgets and increasingly possible that its mandate that all Americans purchase health insurance or face penalties will be ruled unconstitutional. ... We and our Republican colleagues voted against the law two years ago and will continue to work toward a smarter, step-by-step solution that will make health care available to more Americans at a lower cost to the federal government, the states, and individuals seeking care (Sens. Lamar Alexander, Mike Johanns, John Hoeven and Jim Risch, 3/29).

Chicago Tribune: Reading The Court's Mind 
[T]he court took up the question of whether, if it ruled against the mandate, the whole law would have to go. Simply doing so in a sense raised whether the bathwater would also have to be thrown out with the baby -- including concomitant features such as the requirement that insurers cover pre-existing conditions and dependent children up to age 26. One may wonder why that discussion could not have been held later, in the event the conservative guillotine did fall (Jules Witcover, 3/30).

Chicago Tribune: Obama’s 'Tax' Lapse
In 2009, President Barack Obama was asked whether the individual mandate in his health care plan was really just a tax in disguise. "I absolutely reject that notion," he responded. But if the president had been brave enough back then to call a tax a tax, his health care law might not be in such a mess today (Doyle McManus, 3/29).

The Washington Post: Civics Lessons From The Supreme Court
We share in the disappointment that the justices on both sides of their ideological divide are, for the most part, so predictable. That's not, in the ideal world, how judging is supposed to work. But we also think there's a kind of cynicism, or at least intellectual laziness, in asserting that this is an easy or obvious call — that no justice could possibly strike down the mandate out of honest, reasoned conviction (3/29).

The Washington Post: A Stronger Prescription For What Ails Health Care
If Obamacare is struck down, the short-term implications are uncertain. ... The long-term consequences, however, are obvious: Sooner or later, a much more far-reaching overhaul of the health-care system will be inevitable (Eugene Robinson, 3/29).

The Wall Street Journal: The GOP’s Health-Care Eeyores
Conservatives are meant to be optimists, yet by the mutterings attending this week's Supreme Court drama, more than a few have been eating thistles with one depressive, gray donkey. To listen to this troop, the worst thing that might happen in this election season is for the court to . . . wait for it . . . kill ObamaCare. … Whatever the Eeyores say, ObamaCare—upheld or repealed—remains Republicans' most potent issue this fall (Kimberley A. Strassel, 3/29).

The Wall Street Journal: What Conservative Legal Revolution? 
Questions from the bench hint that the court's conservative wing may hold together to strike down the individual mandate, which requires all American adults to purchase health insurance. But this week's arguments also reveal the risky gamble of placing all hopes of stopping ObamaCare in the courts, and they underscore the pivotal importance of this year's elections to restoring limited government (John Yoo, 3/29).

USA Today: Individual Mandate Vs. 'Do Not Treat' 
Now it appears at least as likely that the court will throw out the mandate, and perhaps even the entire law, when it issues its decisions, likely in late June. Opponents would celebrate such an outcome, but none of the problems the law was designed to address will disappear just because the law does. The prospect requires some preliminary thinking about other options (3/29).

Boston Globe: If Obamacare Is Struck Down, The Court Loses
[B]y comparing the individual mandate at the heart of Obamacare to the government forcing people to join a health club or to buy broccoli or to purchase cars, Scalia displayed an astonishing intellectual imprecision. That kind of “reasoning’’ doesn’t reflect ratiocination; it shows reflexive rejectionism (Scot Lehigh, 3/30).

The Kansas City Star: Health Care Freedom Means All Of Us Are On Our Own
All I know is that my concept of freedom seems to be different from the way conservatives define freedom these days. My idea of freedom is knowing that I could afford a health insurance policy if I happen to lose my job (Barb Shelley, 3/29).

The Fiscal Times: Missing: 1,726 Pages From The Health Care Bill!
It's true that conservatives in the media on the campaign stump have routinely attacked the "2,000-page Obamacare" bill. And the original Senate submission did clock in at 1,994 pages, according to media reports at the time. But the final legislation, as printed by the Government Printing Office, is just 974 pages (Merrill Goozner, 3/29).

Reuters: Obama Backs Healthcare Defender – Until He Doesn’t
It may not matter, because the justices often make up their minds before oral argument. But they do respect the solicitor general’s positions more than most, and Verrilli’s failure to offer persuasive answers may have undermined his credibility with the court. He may even doubt it himself (Reynolds Holding, 3/29).

Bloomberg: Orange County Dropped Out Of Obamacare. Why Haven't More? 
[S]o far Orange County, California, appears to be the only county government brave enough to express its opposition by refusing funds made available under the law. ... If the Supreme Court votes to strike down the law, or key provisions of it, state and local governments might incur expenses because federal dollars would no longer be available to finance the programs they approved. Maybe that prospect will encourage other local and state governments to follow Orange County's lead (Brian Calle, 3/29).

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Economics Lessons For The Court: Broccoli Isn't The Same As Health Care

Several opinion writers offer insurance primers for the justices.

The New York Times: Broccoli And Bad Faith
Given the stakes, one might have expected all the court’s members to be very careful in speaking about both health care realities and legal precedents. In reality, however, the second day of hearings suggested that the justices most hostile to the law don’t understand, or choose not to understand, how insurance works (Paul Krugman, 3/29).

Reuters: Here's Why Health Insurance Is Not Like Broccoli
The High Court never got clear on why health insurance is not like broccoli and can thus be constitutionally regulated. There are two important differences that inform the principle for limiting congressional power to compel people to purchase goods and services. First, as George H.W. Bush made quite clear, you need never eat broccoli. But unless you are a hermit in Alaska, you will use healthcare at some point in your life (Ezekiel Emanuel, 3/29).

JAMA: The Supreme Court Flunks Economics—And That's Bad News For Patients And Physicians
This week, we were treated to the spectacle of the US Supreme Court debating economics. They called it a discussion about the Affordable Care Act (ACA), but it was more economic than legal. They spent an enormous amount of time on markets for health insurance and food (broccoli, to be specific); they spent little time analyzing precedent. Between the 9 justices and the 7 lawyers, there were 16 people who took part in the debate. As best as I can tell, not one of them had any training in economics (David Cutler, 3/29).

Chicago Tribune: Stuck In The Muddle With You
I'm troubled by the concept of government forcing people to buy something from a private business ... I'm also in tune with the majority of Americans ... who favor the "guaranteed issue" provision in Obamacare that allows those with prior illnesses or existing medical conditions to buy private health insurance. The problem with these two points of view is that they're in direct conflict. If people can wait until they're sick or injured to buy a health plan, the insurance industry stands to become an ATM for the ailing. And those of us who pay for insurance anyway — at no doubt greater and greater cost — stand to become the suckers who finance the freeloaders (Eric Zorn, 3/30).

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Viewpoints: Ryan's Budget Called 'Cruel' Or 'Sophisticated'

The New York Times: A Cruel Budget
In February, after embarrassing himself by saying he was "not concerned about the very poor," Mitt Romney explained that the government's safety net would take care of them, and he promised to repair any holes in the net. That promise didn't last very long. On Thursday, House Republicans approved, on a party-line vote, a disastrous new budget that would leave millions of struggling families desperate for food, shelter and health care — and Mr. Romney has embraced it (3/29). 

The Washington Post: Paul Ryan Unplugs The Political Third Rail
Now he has dared again. And the absence of an apocalypse is a victory of sorts. Americans are not suddenly enthusiastic about Medicare reform. But Ryan has made a sophisticated case for its necessity. His proposals have been generally embraced by congressional Republicans and the GOP's likely presidential candidate. If Mitt Romney manages to win, the presentation of Ryan's budget in 2013 would kick off a momentous national debate on the size and role of government (Michael Gerson, 3/29).

The Wall Street Journal: Calling The Budget Roll
The repudiation of Mr. Obama's budget was one of several votes this week that revealed the state of fiscal politics in this election year. Most notably, Wisconsin Congressman Paul Ryan's budget passed 228-191 on Thursday, amid Democratic chortling for the second straight year that this will cost Republicans their majority because it dares to reform Medicare. Most Republicans apparently disagree (3/29).

Politico: Ryan Budget Is Not A Balanced Approach
If we're going to address the root of our country’s mounting financial problems and ensure our long-term economic growth, we need a budget plan that negotiates revenue and spending in a strategic, comprehensive and, most important, bipartisan way. Previous bipartisan commissions that have looked at our deficit challenge, including Bowles-Simpson and Rivlin-Domenici, concluded that we cannot place America on a fiscally sustainable path without a balanced package that includes new revenue (Rep. Dutch Ruppersberger, Rep. Adam Smith and Rep. Norm Dicks, 3/29).

The Wall Street Journal: Why I'm Optimistic About Cutting The Deficit
With Washington mired in partisan gridlock, presidential candidates promising tax cuts with no specific revenue offsets, and no agreement on reforms and reductions in entitlement spending, Americans are understandably worried about the nation's rising debt. Yet I'm still hopeful we'll address the nation's long-term fiscal problems. I base my optimism on three promising developments (Erskine Bowles, 3/29).

The Miami Herald: Poor Children Deserve Equal Care
When Florida and many other states began to close institutions for people with mental and developmental disorders 50 years ago, they held out great hope for families. … This promise for families has hardly been fulfilled. For many states, cheaper trumps better. … The latest example came this week in a ruling from U.S. District Judge Joan Lenard. In a decision sizzling with outrage, she ordered that Florida provide the same opportunities for help to autistic children covered by Medicaid as its own Legislature has required for children covered by private insurance (3/29). 

Medscape: Chilling New Ways Patients Are Suing Doctors
Just when you think doctors have enough to worry about with malpractice lawsuits, plaintiff attorneys are becoming more aggressive with new traps. ... Several novel approaches for bringing suit diverge from standard medical malpractice cases. Plaintiff attorneys have attempted to expand tort law to successfully sue physicians, such as "loss of chance," failure to medically monitor, and civil rights violations (Dr. Anthony Francis, 3/29).

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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.