Daily Health Policy Report

Monday, March 4, 2013

Last updated: Mon, Mar 4

KHN Original Reporting & Guest Opinion

Health Spending And Fiscal Battles

Health Reform


Coverage & Access

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Capsules: Expert: Hospitals' 'Humongous Monopoly' Drives Prices High; Panel Calls For 'Drastic Changes' In Medicare Doctor Pay; Nurse Practitioners Say How They're Paid Affects Care They Can Provide; New Reasons To 'Like' Online Hospital Reviews

Now on Kaiser Health News' blog, Jay Hancock reports on hospital consolidations and cost issues: "The American Enterprise Institute didn’t plan its panel last week on hospital consolidation to coincide with Steve Brill's much-talked-about Time magazine article on hospital prices. But the Friday session could have taken the piece, Bitter Pill: Why Medical Bills Are Killing Us, as its text. Participants mentioned it several times" (Hancock, 3/4).

Also on Capsules, Jordan Rau reports on panel's new doctor-pay recommendations: "A panel convened by a major medical group is recommending that Medicare heal its physician payment shortfalls with 'drastic changes' in how it reimburses doctors and other providers, rather than seeking more taxpayer money" (Rau, 3/4).

In addition, Alvin Tran reports on a study exploring nurse practitioners' attitudes about how they are paid and scope-of-practice law: "In the study, published Thursday by the National Institute for Health Care Reform, researchers found that while so-called 'scope of practice' laws did not appear to restrict the primary care services nurse practitioners can provide to patients, they do affect how the advanced nurses are paid" (Tran, 3/1).

In another blog post, Jordan Rau details studies about online hospital reviews: "Millions of dollars and some of the best minds in health care have been devoted to measuring how good a hospital is. But two studies suggest users of two social media giants, Facebook and Yelp, may do a solid job of reflecting quality" (Rau, 3/1). Check out what else is on the blog.

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Political Cartoon: 'Boxed In?'

Kaiser Health News provides a fresh take on health policy developments with "Boxed In?" by John Branch.

Meanwhile, here is today's health policy haiku:


Let the sunshine in...
Make medicine transparent...
Reveal pay data.

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 Spending And Fiscal Battles

Automatic Budget Cuts Lead GOP To Sharpen Focus On Medicare Cost-Cutting

With the deadline for averting sequestration having come and gone, lawmakers and the White House are jockeying for position in the next round of budget battles.

The New York Times: Seeking Compromise, President Reaches Out To The Rank And File
Appearing immediately before him on the program, Speaker John A. Boehner reinforced his opposition to any deal to reverse the cuts in military and domestic programs -- $85 billion this year and nearly $1 trillion over 10 years -- that includes raising new revenue. But he did leave open a narrow path to a comprehensive budget agreement that could restore at least some of the money at some point. Mr. Boehner said Mr. Obama had already raised nearly $1 trillion to finance his health care program and, in January, won $650 billion from tax increases on high incomes. (Weisman, 3/3).

The New York Times: As Automatic Budget Cuts Go Into Effect, Poor May Be Hit Particularly Hard
The $85 billion in automatic cuts working their way through the federal budget spare many programs that aid the poorest and most vulnerable Americans, including the Children's Health Insurance Program and food stamps. But the sequestration cuts, as they are called, still contain billions of dollars in mandatory budget reductions in programs that help low-income Americans, including one that gives vouchers for housing to the poor and disabled and another that provides fortified baby formula to the children of poor women (Lowry, 3/3).

The Los Angeles Times: Republicans Revisit Medicare Reform To Cut Spending
Fired up as once-unimaginable spending cuts start to slice the federal budget, Republicans are launching a new phase in their austerity campaign -- resurrecting the party's cost-cutting plan to turn Medicare into a voucher-like system for future seniors. Despite public uncertainty Saturday about the $85 billion in so-called sequester cuts, Republicans now believe they have momentum to ask Americans to make tough choices on Medicare, as rising health care costs combine with an aging population to form a growing part of future deficits (Mascaro and Memoli, 3/2).

The Medicare NewsGroup: Automatic Cuts Are Underway: A Primer On Sequestration And The Impact On Medicare
Doctors, hospitals, insurers and other health care providers will be subject to the cuts starting April 1. Some parts of the government are subject to bigger cuts, while others, such as Medicaid, are exempt. But if a deficit reduction deal is eventually reached it could still result in cuts to Medicare. Providers may not escape unscathed in such a deal and it could have a direct impact on beneficiaries. President Obama is open to increasing the Medicare Part B and D premiums paid by higher-income beneficiaries, while House Speaker John Boehner proposed raising the Medicare eligibility age from 65- to 67-years-old during the fiscal-cliff standoff last December (Sjoerdsma, 3/1).

CBS News: With Sequester In Place, What's Next?
The government is not going to shut down on March 27, lawmakers from both parties are assuring their constituents, three days after an axe dropped indiscriminately across the federal budget leaving millions of jobs and government-funded projects in flux. It's a mad scramble to save face following yet another failure by Congress in recent years to avert a budget crisis, but it comes with a stipulation: To agree on a drama-free measure to fund the government through the remainder of the fiscal year, legislators are unlikely to include in the deal a replacement package for sequestration, despite pressure from all sides to do so (Boerma, 3/4).

Meanwhile, local sources continue to report on the cuts' impact-

Denver Post: Sequester Means Cuts To Colorado Health, Medical Programs
Sequestration will pare millions of dollars from Colorado Medicare payments, medical research, pure lab science and doctor education in coming months, local health officials said Friday. As a result, there could eventually be longer waiting times for elderly hospital patients, fewer childhood vaccinations, and roadblocks for groundbreaking research proposals (Booth, 3/2).

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Health Reform

States Continue To Formulate Medicaid Expansion Strategies

As the Obama administration gives some states the OK to pursue alternatives to the health law's Medicaid expansion, the shape of the debate in state legislatures changes.

The Associated Press: Branstad Keeps Focus On IowaCare, Not Medicaid
Gov. Terry Branstad is expected to soon reveal his plans for revamping the IowaCare health program for low-income adults, sticking to an approach he holds is better for the state than the Medicaid expansion Democrats are clamoring for. Without details, it's hard to know if a beefed-up IowaCare would solve Linda Cunningham's problems. The 58-year-old, who complains of fatigue and chest pain, said she can't afford the bus ride from her Council Bluffs home to Broadlawns Medical Center in Des Moines, one of just two locations where IowaCare patients can get hospital treatment (Lucey, 3/4).

The Associated Press: Legislators Seek Details On Medicaid Deal
Republican legislators who had resisted expanding Medicaid in Arkansas say they're encouraged by a new plan that would allow funds from the federal-state program to purchase private insurance for the newly eligible, but say they need more details on how such a system would work. The announcement last week that the Obama administration had given Arkansas permission to pursue the plan as an alternative to expanding Medicaid eligibility alters a debate that legislators had said would be the top issue of this legislative session. But state officials and legislators say the idea still has hurdles to face in a majority-Republican Legislature that has generally opposed a straight-up expansion of Medicaid (3/3).

San Francisco Chronicle: Medi-Cal Expansion Will Test Capacity
In less than one year, the Affordable Care Act's promise to bring health care to perhaps 1 million more California residents will be tested. On Jan. 1, 2014, Medi-Cal, the publicly funded health program for low-income and disabled residents, launches a huge statewide expansion. But making a promise is one thing, and delivering is another. In some places, it's already difficult for many poor California residents to find a doctor who is able -- or willing -- to see them. Many medical providers who see these patients say they are overwhelmed, a situation that could worsen when those newly covered by Medi-Cal arrive for care (Bazar, 3/2).

The Miami Herald: Legislature Could Tip Hand On Medicaid Expansion Monday
Gov. Rick Scott has said what he would do. So have the other three members of the Florida Cabinet. But it is the Legislature that will ultimately decide whether the state will expand Medicaid under the Affordable Care Act. House and Senate committees studying the health care law could make their recommendations Monday (Mitchell, 3/3).

The Associated Press/Washington Post: Va. Panel Faces Contentious -- Possibly Litigious -- Task As Brakeman On Medicaid Expansion
There are blue-ribbon commissions and task forces in Virginia government that have done little more than huddle in conference rooms and pack hundreds of pages of dense bureaucratic jargon into binders set on backroom bookshelves or in forgotten archives boxes. There they gather dust for generations. The new Medicaid Innovation and Reform Commission won't have that luxury, provided it survives its infancy (3/3).

In other state news on implementation --

HealthyCal: Months Ahead Of ACA Sign-Up, Outreach Underway
Tracking down Monterey County residents who become eligible for free or discounted health insurance under federal health care reform might take an army. But an army is not what the county will get. Instead, officials are working with their counterparts in Santa Cruz County to land a $500,000 grant (Griffy, 3/4).

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Health Law Implementation Largely Untouched By Automatic Spending Cuts

The Associated Press reports that only a small fraction of the overhaul's funding is subject to the sequester's cuts. Meanwhile, the Obama administration indicates that insurers will have to report rate increases no matter how small and offers rules to clarify other provisions.

The Associated Press: Health Care Overhaul Rolls On Despite Budget Havoc
But President Barack Obama's health care law - a program Republicans have spent the last three years trying to kill - will roll out on time, the administration says. Only a small fraction of the $1.6 trillion the Affordable Care Act spends to cover the uninsured over the next decade is subject to the so-called sequester. ... Some independent experts see irony in the situation. Others say the administration must be bluffing, and surely the cuts will slow the health law in some way. "It's so strange that the one thing Republicans were so ticked off at was the ACA, and now, when it comes time for reductions in spending, for all practical purposes the ACA gets a pass," said Bill Hoagland, senior vice president at the Bipartisan Policy Center, and formerly a long-serving GOP budget aide in Congress (Alonso-Zaldivar, 3/1).

The New York Times: Obama Asks Health Plans To Report Rising Rates
The Obama administration says it will require health insurance companies to report all price increases, no matter how small, to the federal government so officials can monitor the impact of the new health care law and insurers' compliance with it (Pear, 3/3).

The Wall Street Journal: Obama Clarifies Part Of Health Law
The Obama administration on Friday released new rules aimed at smoothing the rollout of a piece of the 2010 federal health-care law designed to give Americans more insurance options. Federal officials said insurers that get a contract to offer a so-called multistate plan will have to adhere to most of the insurance laws in each state, but in some cases they would be allowed to use a federally approved package of benefits rather than replicating ones set for each state (Radnofsky and Mathews, 3/1).

CQ HealthBeat: CMS Issues Rules To Tame Premium Hikes, Launch SHOP Exchanges, Set Premium Subsidies
With the deadline bearing down on insurers for filing rate applications to sell coverage next year under the health care law, federal officials on Friday announced a series of regulations plans will need to help them set their prices and meet other requirements for offering coverage. The regulations are part of a final rule and interim final rule dryly titled "notice of benefit and payment parameters" (Reichard, 3/1).

CQ HealthBeat: CMS Fine-Tunes A 'Single, Streamlined Application' Crucial To Health Law Success
In just seven months, millions of Americans are expected to start filling out what's supposed to be an easy-to-understand application for health insurance coverage under the health care law. Public comments on a prototype exchange application that the Centers for Medicare and Medicaid Services proposed were due Thursday. And there are plenty of suggestions for improvement (Norman, 3/1).

The Associated Press/Washington Post: Hard Time Understanding Health Reform Law? Try Figuring It Out In Tagalog, Hmong Or Vietnamese
Set on a gritty corner of Oakland's International Boulevard, the nonprofit Street Level Health Project offers free checkups to patients who speak a total of 22 languages, from recent Mongolian immigrants seeking a doctor to Burmese refugees in need of a basic dental exam. It also provides a window into one of the challenges for state officials who are trying to implement the Affordable Care Act, President Barack Obama's sweeping health care overhaul (3/4).

Politico: Loophole For Mental Health Care
Even if you get insurance under the new health care law, that's no guarantee you'll be able to pay your shrink. With mental health on the front burner since the Newtown, Conn., school shooting, Democrats have pointed out that the Affordable Care Act expands access to mental health care in several ways. It will get coverage for more people, either through private plans or Medicaid — and the benefits will have to include mental health. A number of other proposals are circulating on Capitol Hill to address gaps in behavioral health (Cunningham, 3/4).

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Commission Urges Changing Medicare Physician Payment

The panel, the National Commission on Physician Payment Reform, released a dozen recommendations to ultimately change how physicians are paid.

Politico: Commission Advocates Ending Fee-For-Service System
The National Commission on Physician Payment Reform is calling for eliminating the fee-for-service model within seven years, starting with a five-year transition period to a blended payment system. The group, whose honorary chairman is former Senate Majority Leader Bill Frist (R-Tenn.) and includes representatives from Tufts Medical Center, Harvard School of Public Health, CVS Caremark and WellPoint, said the sustainable growth rate repeal should be paid for by cuts in Medicare "physician payments and reductions in inappropriate utilization of Medicare services" (Haberkorn, 3/4).

Kaiser Health News: Capsules: Panel Calls For 'Drastic Changes' In Medicare Doctor Pay
A panel convened by a major medical group is recommending that Medicare heal its physician payment shortfalls with "drastic changes" in how it reimburses doctors and other providers, rather than seeking more taxpayer money (Rau, 3/4).

Modern Healthcare: Commission On Doc Pay Urges End To Fee-For-Service, SGR
Starting with the premise that physician salary and expenses account for 20% of healthcare spending but the decisions doctors make influence another 60% of that spending, the National Commission on Physician Payment Reform has released a dozen recommendations to ultimately change how physicians are paid by public and private payers. ... In a report released Monday, the commission concluded that the problems of physician payment are based on systemic issues, such as the traditional fee-for-service payment model, and problems pertaining specifically to Medicare, including the sustainable growth-rate formula to pay physicians and the operation of the Relative Value Scale Update Committee (RUC), which makes recommendations to the CMS (Zigmond, 3/4).

In other physician-payment news --

MedPage Today: Specialists Next Medicare Reform Target
The next round of initiatives to link physician performance with Medicare payments will focus more on specialists, a high-ranking Medicare administrator said Thursday. The first wave of work from the Centers for Medicare and Medicaid Services (CMS) emphasized the creation of medical homes within primary care practices to better coordinate care, reduce costs, and improve quality. But that will soon change, Jonathan Blum, PhD, acting principal deputy administrator at CMS, told the Senate Finance Committee. "We are hearing from physician speciality societies that want to shift to a different model, that want to be accountable for the total quality, total cost of care," Blum said Thursday during a hearing examining delivery system reform (Pittman, 3/1).

MedPage Today: Medicaid Pay Boost Slow For Primary Care
Primary care providers haven't been receiving a boost in Medicaid reimbursements in 2013 as promised by the Affordable Care Act (ACA), doctor groups and Medicaid plans said. Instead, states are still submitting necessary amendments to Medicaid plans to the Centers for Medicare and Medicaid Services (CMS) to allow the agency to pay Medicaid primary care providers at the higher Medicare rates. The ACA provision sought to incentivize primary care physicians to see Medicaid patients, while another provision of the law was aimed at adding more than 30 million new beneficiaries to the rolls by increasing eligibility to include those with incomes up to 138 percent of the federal poverty level. States have until March 31 to file paperwork with CMS on their plans, and the agency has 90 days to respond to it (Pittman, 3/1).

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Coverage & Access

Nurse Practitioners Juggle Scope-Of-Practice Issues With Providing Care

A study published last week, for instance, notes that although scope-of-practice laws might not restrict nurse pratitioners' ability to provide primary care, it does impact how they are paid.

The Associated Press: Nurses Spar With Doctors As 30 Million Insured Seek Care
Christy Blanco's health clinic in El Paso, Texas, is sitting empty. Blanco, a nurse practitioner, says she has a waiting list of patients, all the necessary equipment, and a Ph.D. in nursing that gives her the training to start treating patients. About 50 miles (80 kilometers) away in Las Cruces, New Mexico, dozens of nurse practitioners at clinics like Blanco's are busy caring for patients with a range of diseases from diabetes to asthma to depression (Pettypiece, 3/4).

Kaiser Health News: Nurse Practitioners Say How They're Paid Affects Care They Can Provide
In the study, published Thursday by the National Institute for Health Care Reform, researchers found that while so-called "scope of practice" laws did not appear to restrict the primary care services nurse practitioners can provide to patients, they do affect how the advanced nurses are paid (Tran, 3/1).

In related news, proposed legislation in Maryland would lead to the licensing of midwives without nursing degrees --

Baltimore Sun: Proposed Legislation Would Allow Midwives To Conduct Home Births
Supporters of home births are trying to convince legislators to create a pilot program that could eventually lead to the licensing of midwives without nursing degrees. The three-year pilot would allow certified professional midwives to deliver babies in a home setting without worry of arrest or prosecution. Certified professional midwives are trained in midwifery and meet standards set by the North American Registry of Midwives. Under the pilot program, midwives would share their birth outcomes with the state Department of Health and Mental Hygiene. The pilot would allow time for the state to figure out the best way to structure a legal midwifery licensing or certification program and look at what other states do, said Del. Ariana Kelly, a Montgomery County Democrat who sponsored the legislation to create the pilot (Walker, 3/1).

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Health Care Marketplace

Hospital Costs Under Microscope

An article that appeared in Time Magazine, "Bitter Pill: Why Medical Bills Are Killing Us," has fueled a new round of discussions about health care cost excesses -- especially in the hospital setting.

Bloomberg News/The New York Times: Letter From Washington: Cataloging Health Care's Excesses
Nonprofit hospitals, the cornerstone of many communities, capriciously overcharge patients, sticking the powerless with exorbitant bills, while paying lavish salaries to their executives; drug companies, which charge humongous markups to American customers, rake in huge profits; trial lawyers, with the threat of legal action, add to the cost of defensive medicine; President Barack Obama's Affordable Care Act does little to bend the cost curve, and while conservatives rail against Medicare, the government-run insurance program is more efficient and customer-friendly than the private system. None of this is new. Yet it resonates for several reasons: Mr. Brill documents the particulars more forcefully, and as health care spending approaches 20 percent of the U.S. economy, almost every American is affected and the debate is politically polarizing. When asked to respond to these charges, most of the system’s stakeholders react in similar ways: Many of these criticisms are valid -- except when it applies to us (Hunt, 3/3).

Kaiser Health News: Capsules: Expert: Hospitals' 'Humongous Monopoly' Drives Prices High
The American Enterprise Institute didn’t plan its panel last week on hospital consolidation to coincide with Steve Brill's much-talked-about Time magazine article on hospital prices. But the Friday session could have taken the piece, Bitter Pill: Why Medical Bills Are Killing Us, as its text. Participants mentioned it several times (Hancock, 3/4).

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Much Anticipation Surrounds Push To Bring More Transparency To Medicine

ProPublica: Feds To Publicize Drug And Device Company Payments To Doctors Next Year
After years of anticipation, all of the nation's drug and medical device makers must soon begin publicly reporting payments they make to U.S. physicians, according to final regulations announced this afternoon by the federal government. The release of payments data in September 2014 would mark a milestone in the push to bring transparency to medicine (Ornstein and Weber, 3/1).

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State Watch

Roundup: Mass. Health Costs May Start Accelerating Again

A selection of health policy stories from Massachusetts, Minnesota, California, New York and North Carolina.

Boston Globe: Health Costs In Mass. Are Heading Upward
After several years of moderating costs, there are signs the rate of increase in Massachusetts health care prices -- and insurance premiums -- may soon start accelerating again, exceeding a heralded cost cap set by the state last year. Three factors are threatening to push residents' annual health care costs up faster than the state's overall rate of economic growth: First, health insurers in Massachusetts estimate the "medical cost trend" -- an industry measure based on the price of services and the volume of doctor visits, procedures, and tests -- will rise between 6 and 12 percent this year. That would be more than double the state's anticipated rate of economic growth (Weisman, 3/4).

MPR News: Review Raises Questions About Payment Rates To HMOs
A review of how the [Minn. Gov. Tim] Pawlenty administration set payment rates for HMOs managing care for public health programs raises questions about high profit margins for the private health plans. The audit is one of several underway and comes in response to questions from the federal government about whether the state's managed care contracts for public programs have been too generous. The report by Segal Company, an actuarial consulting firm, said the Pawlenty administration, the state's actuary and the federal government all missed opportunities to hold down payment rates (Stawicki, 3/1).

California Healthline: Geographic Regions Set At Six, But Only For Now
Floor votes in the Assembly and Senate [last week] approved the first bills of the special session on health care. The bills would eliminate pre-existing conditions as a means for denying health insurance coverage. They also would establish new geographic rating regions to help determine variable rates by area in California, one provision in the bills that recently has become contentious. The Assembly passed ABX1-2 by Assembly member Richard Pan (D-Sacramento) on a 53-25 vote. The Senate passed its version of the bill, SBX1-2 by Ed Hernandez (D-West Covina), where the vote was 26-10-1. Most of the objections raised [last week] on the Senate and Assembly floors to the two bills came from Republicans who oppose the Affordable Care Act (Gorn, 3/1).

Los Angeles Times: Atty. Gen. Kamala Harris Urges Funding For Prescription Tracking
Calling prescription drug abuse an urgent public health problem, California Atty. Gen. Kamala D. Harris is pushing lawmakers to fund an effort to identify physicians who recklessly prescribe addictive medications (Girion and Glover, 3/3).

Stateline: New York Takes The Lead On Palliative Care
The palliative care team at Mount Sinai Hospital gathers on a Thursday morning to exchange the latest information on the patients in their ward. It is a raw, unforgiving day outside, but the weather, the news, most everything beyond these walls are concerns that patients on this ward do not have the luxury to worry about. Theirs is a shrunken world measured in degrees of pain, blood pressure, heart rate, and a set of poor options -- none of which any healthy person would welcome. The simplest definition for palliative care is that it is treatment designed to reduce the pain, discomfort and stress associated with a serious disease. But it also entails eliciting from patients and families in dire circumstances their priorities and wishes to make sure the treatment conforms to those desires (Ollove, 3/4).

North Carolina Health News: Telepsychiatry Project Delivers Mental Health Care To Remote Corners Of NC
A pilot program to provide psychiatric assessments to patients in the emergency department is proving so successful that it will be rolled out statewide. … Mental health patients presenting to these rural emergency departments have long experienced excessive wait times, unnecessary involuntary commitments and admissions, extended lengths of stay and disjointed care (Ellis, 3/1).

Los Angeles Times: Motion Picture Home Ranks Among California's Best Nursing Homes
The long-term care facility operated by the Motion Picture & Television Fund, which in previous years faced criticism from nursing home advocates over quality of care issues and staffing levels, got some good news this week. U.S. News & World Report placed the fund's nursing home, which caters to entertainment industry workers and was once slated for closure, on its 2013 list of "Best Nursing Homes in California" (Verrier, 3/2).

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Editorials and Opinions

Viewpoints: Daschle, Frist Urge Senate To Confirm CMS Chief; 'Insane' Incentives In Health Law; Medicaid Does Better Job Than Private Insurance So Why Change It?

The Washington Post: The Health Care Leader We Need
Imagine a large company operating for seven years without a CEO. A company with a product that accounts for more than 15 percent of our nation's gross domestic product. A company implementing the largest national effort at reform since its creation. A company set to gain an additional 30 million customers in the next year. Unfathomable. Yet that is exactly the situation at one of the largest federal "companies." The Centers for Medicare and Medicaid Services (CMS) has not had a Senate-confirmed administrator since 2006 (Tom Daschle and Bill Frist, 3/3).

Politico: To Contain Health Care Costs, Pay Doctors Differently
We cannot control runaway medical spending without changing how physicians in this country are paid — currently the single most significant driver of health care costs. We pay physicians according to the number of services they provide. The skewed financial incentives inherent in a fee-for-service model promote fragmented care and encourage doctors to provide more — and more costly — care, regardless as to whether those services improve the health of patients (Bill Frist and Steven Schroeder, 3/4).

The Wall Street Journal: Yes, Hospital Pricing Is Insane, But Why?
Put aside whether President Obama could have pushed real reform if he wanted to. ObamaCare as it emerged from Congress fulfills the insight that any highly regulated system ends up benefiting those with influence, i.e., health-care providers and high-end customers, not those of modest means. What are ObamaCare's mandates on individuals and employers except an attempt to force back into the insurance market those who have been priced out by previous "reforms" so their money can be used to prop up a system of gold-plated coverage that mostly benefits those in the highest tax brackets? What are ObamaCare's minimum coverage standards except a requirement that these customers buy more costly coverage than they would choose for themselves so their money can be used for somebody else? (Holman W. Jenkins Jr., 3/1).

The New York Times: Mooching Off Medicaid
Now, in the end most states will probably go along with the (Medicaid) expansion because of the huge financial incentives: the federal government will pay the full cost of the expansion for the first three years, and the additional spending will benefit hospitals and doctors as well as patients. Still, some of the states grudgingly allowing the federal government to help their neediest citizens are placing a condition on this aid, insisting that it must be run through private insurance companies. And that tells you a lot about what conservative politicians really want. ... But why would you insist on privatizing a health program that is already public, and that does a much better job than the private sector of controlling costs? The answer is pretty obvious: the flip side of higher taxpayer costs is higher medical-industry profits (Paul Krugman, 2/3). 

Los Angeles Times: Put Medi-Cal Expansion On The Front Burner
The state is expected to expand Medi-Cal eligibility to childless adults and more families near the poverty line, as allowed by the 2010 law. But even so, it will barely make a dent in the number of eligible Californians who sign up for coverage, recent projections show — in part because of the difficulties faced by those who don't speak English. In other words, the lack of coverage among the very poor is deeply entrenched. The Brown administration should join lawmakers in attacking the problem as aggressively as it can (3/4).

Kansas City Star: Listen To Those Who Need Medicaid Expansion
In the state capitols of Missouri and Kansas, elected officials dither over expanding Medicaid. For them, the debate is about numbers, future budgets, free market arguments, and the merits and flaws of the federal Affordable Care Act. For Kierra Hawkins, it is about the fist-sized cyst on her right ovary. Hawkins, a 23-year-old community college student in Kansas City, was at her job as an aide in a day-care center when acute stomach pains sent her to the hospital in late September. Tests detected the cyst, and found it was not cancerous. Still, doctors said it would need to be removed. Hawkins skipped her follow-up doctor's visit. She is uninsured and couldn't afford the $350 initial copay, much less the entire bill (3/2).

Politico: A Blueprint To Improve Health Care For Minorities
With so many advances in medical technologies and treatments, many of us are living longer and healthier lives. Too often, however, how long we live and what we die of are largely determined by the color of our skin, our gender and where we live. Despite all the progress minorities have made over the past few decades in areas of employment, education and politics — health remains an area of significant disparity (Tom Daschle and John Whyte, 3/3).

Des Moines Register: Price-Gouging In Medicine On 'Free Market'
When folks pan the Affordable Care Act for being nearly 3,000 pages long, here's a sensible response: It could have been done in a page and a half if it simply declared that Medicare would cover everyone. The concept of Medicare for All was pushed by a few lonely liberals. And it would have been, ironically, the most conservative approach to bringing down health care costs while maintaining quality (Froma Harrop, 3/3).

MinnPost: The Health Care Pandora's Box
On November 7, 2012, the world changed — by not changing. So says Margo Struthers, a partner specializing in health care law at the Oppenheimer Wolff & Donnelly law firm in Minneapolis. Now that President Obama has been re-elected and the Patient Protection and Affordable Care Act (popularly known as Obamacare) is unlikely to be repealed, Struthers expects a significant impact on her work (Jamie Swedberg, 3/4).

The Wall Street Journal: Federal Drug Bust
(FedEx and UPS) have long cooperated with the feds to break up criminal shipping schemes. But in recent years the Justice Department has also taken action against pharmacy chains like CVS merely for filling orders they have no reason to know are illegal. Now Justice is also going after the shippers. The government's position is that FedEx and UPS are abetting illegal drug sales from online pharmacies merely by unwittingly shipping their products. The feds are threatening criminal charges (3/3).

Baltimore Sun: Disability Insurance Entitlement Explodes Under Obama
Those of you paying attention have noticed that the Obama administration is actually doing what it promised: transforming America into a gigantic welfare state. And there are plenty of takers willing to cash in on it and "get mine." Numbers don't lie. Forty percent of the population was on some form of public assistance when the president took office; today, that number stands at 55 percent. And fraud is rampant. "Exhibit A" is the Social Security Disability Insurance program (SSDI), a classic Washington entitlement that chews up tax dollars while (often) negligently providing for unqualified beneficiaries, an increasing number of whom are wont to remain on the public dole for … well, forever if they don't get caught (Robert Ehrlich, 3/3).

Des Moines Register: Our Antibiotics Are Less Effective; Routine Use In Farming Is Cited
But the vast majority of antibiotics developed to treat people are given to the animals people eat. Farmers add low doses to feed and water to prevent disease in crowded livestock facilities. The drugs also promote growth. A bigger cow, pig, turkey or chicken translates into more money for producers. How does this widespread use in animals affect humans? It is killing us, a growing number of scientists say (3/3).

The New York Times: Snubbing Our Cigarettes For Good
Perhaps no public official was as synonymous with the antismoking movement as C. Everett Koop, who died last Monday at age 96. Dr. Koop, who worked tirelessly to turn America into "a smoke-free society," did not live to see that goal reached. But the rest of us have the power to make it happen (Richard A. Daynard, 3/3).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

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