Daily Health Policy Report

Tuesday, March 4, 2014

Last updated: Tue, Mar 4

KHN Original Reporting & Guest Opinion

Health Reform

Administration News

Health Care Marketplace

Medicare

Quality

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

L.A. County Officials Told Inspectors To Cut Short Nursing Home Probes

Kaiser Health News staff writer Anna Gorman, working in collaboration with the Los Angeles Daily News, reports: "Facing a backlog of hundreds of health and safety complaints about nursing homes, Los Angeles County public health officials told inspectors to close cases without fully investigating them, according to internal documents and interviews" (Gorman, 3/3). Read the story.

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Insuring Your Health: Health Law Provides No Guarantees Of Access To Midwives, Birthing Centers

Kaiser Health News consumer columnist Michelle Andrews writes: "Insurance coverage for maternity care is required in most individual and small group plans under the federal health law, extending such coverage to plans where it used to be rare. But for women who are interested in services provided by midwives and birthing centers, there are no coverage guarantees, despite the law’s provisions that prohibit insurers from discriminating against licensed medical providers" (Andrews, 3/4). Read the column.

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Capsules: 60,000 With HIV Left Uninsured In States Not Expanding Medicaid

Now on Kaiser Health News’ blog, Jenny Gold reports: "The Affordable Care Act is generally a win for people living with HIV and AIDS, about 30 percent of whom are uninsured. It offers new health insurance options — both private and public — to a group that had been largely locked out of the individual insurance market because of rules about preexisting conditions. In 2010, just 17 percent of people with HIV and AIDS have private insurance, compared to 65 percent of the general U.S. population. Many others are low-income and childless, making them ineligible for Medicaid in most states" (Gold, 3/4) Check out what else is on the blog.

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Political Cartoon: 'O-Trauma-Care?'

Kaiser Health News provides a fresh take on health policy developments with "O-Trauma-Care?" by Mike Luckovich.

And here's today's health policy haiku:

MARYLAND, OREGON CONTEMPLATE MARKETPLACE FUTURE

States ponder next steps.
Fix it or just start over?
Oh... these exchange woes.
-Anonymous 

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

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Health Reform

With Final Enrollment Push, Obama Focuses On Latinos

President Barack Obama will participate in a Thursday town hall meeting with Latinos, which will include an in-depth discussion about the law's impact on this population. Still, some consumers -- many of whom might fall into the coveted young adult category -- are getting health coverage outside of the state and federal health exchanges. And reports continue regarding consumer confusion about the health law and its deadlines.

Los Angeles Times: Obama Launches Final Push For Healthcare Sign-Ups
President Obama is scheduled to hold a town hall meeting with Latinos this week in an attempt to boost enrollment in the healthcare law's new insurance marketplaces before an end-of-the-month deadline. The meeting set for Thursday is part of a March push by the White House to drive sign-ups (Parsons, 3/3).

Politico: Viva Obamacare? President Obama Makes Spanish Media Push
According to White House officials, the president will appear for the first half of the hourlong televised event, answering questions that attendees submit in advance. During the second half experts will take in-depth questions about the law and its impact on the Latino community, which has a far higher uninsurance rate than the nation overall (Cheney, 3/3).

NPR: Flagging Down Taxi Drivers To Sign Up For Obamacare
Dan Ware has been driving a taxicab in Chicago for more than a decade, but he still doesn't have what many jobs offer: health insurance. "I'm without health coverage," he says. And that's not unusual, says Chicago Public Health Commissioner Bechara Choucair. "What we know in Chicago is that around 70 percent of taxi drivers are uninsured," Choucair says (Corley, 3/4).

The California Health Report: Covering Cambodia Town
At the Mietphoum Khmer Spirit Center in the heart of Long Beach’s Cambodia Town, Vouchmeng Sieng is talking, as always, about health insurance. A small gathering of Cambodian American immigrants have trickled into the center on a bright Saturday afternoon to find out about the new, still mysterious, Affordable Care Act. In rapid-fire Khmei, the patient care manager for The Children’s Clinic of Long Beach, spells out enrollment protocols under Covered California, doles out benefit information, and patiently answers questions from the multi-age, monolingual group. “A lot of Cambodians don’t go to the doctor because they have no insurance and that’s why a lot of them will die young…they wait until the water gets to here,” she said, lifting her hand to her throat, “and then they start to swim" (Portner,  3/4).

CNN:  The Hidden Number Key To Obamacare's Success
Enrollment on the Obamacare exchanges isn't the only number to watch. Lots of Americans are signing up for health insurance outside the exchanges -- plans that are not offered on the federal and state marketplaces. They are adding to the overall enrollment figures and bolstering the share of young adults, who are particularly coveted because they're considered healthier and less costly (Luhby, 3/3).

Modern Healthcare: Exchange Enrollees Confused Over When Their Coverage Starts 
Some physicians and other healthcare providers are experiencing new challenges associated with enrollees of the new health plans sold on the Obamacare insurance exchanges (Rice, 3/3).

The Fiscal Times: Uninsured And Still Unaware Of Obamacare Deadline
The majority of uninsured Americans are still largely unaware of Obamacare and the crucial March 31 deadline to sign up for coverage through the new exchanges. Those without health insurance April 1 and beyond will be subjected to a tax penalty imposed under the new healthcare law. The latest survey from Kaiser Family Foundation found some 76 percent of Americans without coverage are unaware of the deadline.  Moreover, just 12 percent of uninsured respondents said they knew “a lot” about Obamacare, while 24 percent knew “some” information about the law, 36 percent knew “a little” and 26 percent knew “nothing at all" (Ehley, 3/4).

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Is Another Health Law Delay On The Horizon?

The Hill reports that the Obama administration is preparing to announce as early as this week a directive that would allow insurers to continue offering plans that do not meet the overhaul's minimum coverage requirements. 

The Hill: New O-Care Delay To Help Midterm Dems 
The Obama administration is set to announce another major delay in implementing the Affordable Care Act, easing election pressure on Democrats. As early as this week, according to two sources, the White House will announce a new directive allowing insurers to continue offering health plans that do not meet ObamaCare’s minimum coverage requirements (Viebeck, 3/3).

Fox News: Administration Reportedly Will Extend ObamaCare Fix For Canceled Health Plans
The Obama administration is preparing to announce a new delay in the health care law's implementation that would allow insurers to continue offering health plans that do not meet ObamaCare's minimum coverage requirements, The Hill reported. President Obama, under pressure over widespread health plan cancellations, offered a solution in November allowing Americans to keep their current insurance policies for another year, even if their plans didn't meet the minimum standards. The latest delay, expected to be announced as early as next week, would allow insurers to continue selling insurance plans that would otherwise be banned under the law, The Hill reported late Monday, citing insurance industry sources (3/4).

In other, related news -

CQ HealthBeat: Health And Business Groups Seek Further Delay On Choice Of Exchange Plans For Workers
A coalition of business groups, health industry associations and insurers is asking federal officials to extend through 2015 a delay of a health care law provision that would allow workers at small companies to choose which health plan they want to enroll in. "At this time, employers and health plans do not have milestones or timelines for adequate implementation and testing of the complicated employee-choice model later this year," the Choice and Competition Coalition wrote in a letter to Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner (Adams, 3/3).

News outlets also explore the overhaul's economic impact -

CQ HealthBeat: Health Law's Legacy May Be Cost Controls More Than Expanded Coverage
Republicans, whether during the 2008 presidential election or the subsequent health care overhaul debate, faulted Democrats as being too focused on expanding coverage and not enough on controlling costs. But some analysts, including former Congressional Budget Office Director Peter Orszag, suggest that perhaps the biggest change the law has delivered is in helping to slow down health care spending (Reichard, 3/3).

The Wall Street Journal's Real Time Economics: Obamacare Effects Account For Most of Income, Spending Increases
The Affordable Care Act, President Barack Barack Obama's signature health law, is already boosting household income and spending. … On the incomes side, the law’s expanded coverage boosted Medicaid benefits by an estimated $19.2 billion, according to Commerce’s Bureau of Economic Analysis. The ACA also offered several refundable tax credits, including health insurance premium subsidies, which added up to $14.7 billion (Sparshott, 3/3).

While some consumers are choosing an alternative -

Fox News: Christian Alternative To ObamaCare Growing Fast As Deadline Nears
With just weeks left to sign up for insurance on HealthCare.gov, a growing number of people are opting to enroll in a Christian alternative to traditional health insurance. Nationwide networks of fellow believers help share each other's major medical bills through what's known as health care sharing ministries. "It works just like insurance. I have an insurance card. I show it just like anyone else would. I have a deductible. I have a monthly premium that I pay," explained Eileen Wade, who joined the health care sharing ministry, Medi-Share, in 2011 (Tenney, 3/4).

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Ore. Health Exchange, Oracle Begin 'Transition' Agreement; Md. Marketplace Wrestles With Next Steps

Updates on state-based exchanges in Minnesota and Washington as well as news from Wyoming regarding the Medicaid expansion.

The Baltimore Sun: Health Exchange Mulling Scenarios To Move Beyond Troubled Site 
After the state severed ties with the contractor that built its problem-plagued health insurance exchange, officials face the looming question of what to do with it — continue throwing money toward fixing it or replace it. Every option is potentially fraught with more technical headaches and expense (Walker and Cohn, 3/1).

The Associated Press: Cover Oregon, Oracle Enter Transition Agreement
Oregon's troubled health insurance exchange said Monday it will pay its main technology contractor much of the money it's been withholding in payments, in exchange for Oracle's promise to continue working with the state during a transition period. Meanwhile, Gov. John Kitzhaber expressed pessimism about the prospects for Cover Oregon and Oracle finishing the website before the end of March, when nearly all Americans are required to have insurance under the federal health care law (Wozniacka, 3/3).

The Oregonian: Cover Oregon: Oregon Reaches 'Transition Agreement' With Oracle
Oracle Corp. delivered an ultimatum to the state of Oregon last week and it has paid off handsomely. After Oracle threatened to walk away from the state's health care exchange with the IT project still unfinished, the state agreed to pay $24 million to the company on Monday and will pay them another $19.9 million by Thursday. Oregon did withhold payment of $26.5 million and reserved its right haul Oracle into court and litigate their dispute over the troubled technology project
(Manning, 3/3).

The Oregonian: Cover Oregon: Legislature's Budget Committed Approves Two Bills
Two bills on Cover Oregon, the state's troubled health insurance exchange, are headed to the House and Senate floors after the Legislature's main budget committee approved them Monday. Senate Bill 1582 would ensure money is available for a temporary health plan that Oregon Health Authority officials created at the beginning of the year to provide continued coverage for a pool of high-risk residents who weren’t able to enroll through Cover Oregon by Jan. 1. House Bill 4154 would extend whistleblower protections to Cover Oregon employees and allow the governor to remove all Cover Oregon board members in a single year
(Zheng, 3/3).

The Oregonian: Oregon's U.S. Senators Join Call For Federal Probe Of Cover Oregon Health Insurance Exchange
A decision on whether the investigative arm of Congress will probe the Cover Oregon health insurance exchange could come as early as this week, and the request for an audit has gone bipartisan. Oregon’s two U.S. Senators, Jeff Merkley and Ron Wyden, both Democrats, have joined a call by Congressional Republicans for a federal audit of the Oregon’s exchange. Thanks to technical problems, Oregon’s is the last exchange in the country that doesn’t allow the public to self-enroll (Budnick, 3/3).

The Seattle Times: 15,000 Applicants 'Stuck' In State's Insurance Exchange 
Five months since the launch of the Washington Healthplanfinder insurance exchange, officials say many of the website problems consumers experienced in the early weeks have been fully resolved. At the same time, they acknowledge there are still thorny issues they are working to fix (Marshall, 3/2).

The Star Tribune: Glitch-Weary MNsure Customers May Get Break
Minnesotans who threw up their hands in frustration over technical problems with the MNsure website and bought health insurance outside of the state exchange may be able to apply for subsidies retroactively. The Obama administration made the policy change in part to help states such as Minnesota, where technical problems prevented consumers from using exchanges to buy insurance. In a bulletin issued last week, the Centers for Medicare and Medicaid Services said consumers who were prevented from shopping for coverage because of technical issues “may be considered an exceptional circumstance,” but offered vague guidance in how to carry out the new policy (Crosby, 3/4).

Meanwhile, in state action on Medicaid expansion -

The Associated Press: Wyoming Legislature Moves Medicaid Expansion Study
Both houses of the Wyoming Legislature on passed a budget bill Monday that calls on Gov. Matt Mead and other Wyoming officials to investigate whether they can reach an agreement with the federal government to expand Medicaid on the state's terms. The Senate voted 20-10 to approve the general government appropriations bill including the Medicaid negotiation language (Neary, 3/3).

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3.5 Million Estimated Medicaid Signups Under Health Law

Avalere Health projects that of the 8.9 million people "determined eligible" for Medicaid starting last Oct. 1, the number of new enrollees under the health law is likely much smaller -- between 2.4 million and 3.5 million. Other reports look at how health insurance could result in nearly half a million more Americans getting tested for HIV by 2017 -- but how 60,000 people with the virus will be left uninsured in states not expanding Medicaid.

The Associated Press/Washington Post: Lower Medicaid Signups Seen In Health Law Study
It’s one of the most impressive statistics about the new health care law. The Obama administration says more than 8.9 million people have been, quote “determined eligible” for Medicaid from Oct. 1 through the end of January. But a new study Monday from Avalere Health estimates the actual number of new sign-ups could be much lower, between 2.4 million and 3.5 million (3/3).

Kaiser Health News: Capsules: 60,000 With HIV Left Uninsured In States Not Expanding Medicaid
The Affordable Care Act is generally a win for people living with HIV and AIDS, about 30 percent of whom are uninsured. It offers new health insurance options -- both private and public -- to a group that had been largely locked out of the individual insurance market because of rules about preexisting conditions. In 2010, just 17 percent of people with HIV and AIDS had private insurance, compared to 65 percent of the general U.S. population. Many others are low-income and childless, making them ineligible for Medicaid in most states (Gold, 3/4). 

Politico Pro: HIV Studies Show Impact Of Coverage, Early Treatment
Health insurance under the Affordable Care Act could mean nearly half a million more Americans get tested for HIV by 2017, which a new study concludes would have significant implications for reducing transmission of the virus. Those numbers would rise further if all states expanded Medicaid. The findings are part of a series of research papers published in the March edition of Health Affairs. They look at the impact of the health law on HIV testing and diagnoses and at the substantial evidence that early treatment helps prevent additional infections (Levine, 3/3).

The CT Mirror: For Some New Medicaid Clients, Delays Getting Care, Prescriptions
Margaret Hagins felt like crying when she learned she’d qualify for Medicaid under the federal health law. Even now, four months later, she chokes up when she talks about it. Having coverage means she no longer has to figure out how to pay for enough pills to keep her bipolar disorder in control, or choose between buying food, paying bills or filling her prescriptions. In theory, Hagins, like thousands of other Connecticut residents, got Medicaid coverage Jan. 1, the date the program expanded as part of the law commonly known as Obamacare. But for close to six weeks, she said she couldn’t use it or get a prescription paid for because she didn’t have a Medicaid card (Becker, 3/4).

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New Poll: Democrats' Advantage On Health Care, Other Issues Not Translating Into Election Edge

In other political news, the conservative group Americans for Prosperity is pushing back against Democratic criticism of its recent health law attack ad by releasing another one.  

The Washington Post: Poll: Democrats' Advantage On Key Issues Is Not Translating To A Midterm-Election Edge
Majorities of Americans continue to disapprove of the president's handling of the economy and of the implementation of his signature health-care law. But after a noticeable decline late last year after the botched rollout of the Affordable Care Act, attitudes about his handling of the law have stabilized over the first months of this year. Despite the problems with the health-care law’s implementation, Democrats maintain an edge over Republicans on which party Americans trust to deal with the issue, by a margin of 44 percent to 36 percent (Balz and Clement, 3/4).

The New York Times: Conservative Group Counters Criticism Of Ad Against Health Law
Americans for Prosperity, the conservative advocacy group being challenged by Democrats over the content of its ads attacking the health care law, is pushing back with a new commercial that will begin airing Tuesday in Michigan. The commercial features Julie Boonstra, a Michigan woman who was the subject of an earlier ad, in which she said she had lost the health plan that she preferred for treatment of her leukemia and was facing higher costs because of the health care law (Hulse, 3/3).

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Administration News

President's Budget Expected To Outline Health Law Spending

President Barack Obama's proposed budget will lay out steps to prevent illegal immigrants from obtaining Medicare and is expected to lay out how much has been spent to carry out the health law so far. It will also seek more money for anti-poverty programs.

The New York Times: Crackdown Proposed To Prevent Illegal Immigrants From Obtaining Medicare
The Obama administration is planning new steps to prevent people in the country illegally from obtaining Medicare after finding that tens of thousands were improperly receiving benefits. In President Obama’s budget for 2015, to be unveiled on Tuesday, and in new regulations, the administration proposes to remove illegal immigrants from the Medicare rolls and explicitly require citizenship or lawful presence in the United States as a condition of getting Medicare (Pear, 3/3).

Politico Pro: New Budget May Reveal Old ACA Spending
The Obama administration’s proposed budget documents on Tuesday could provide the clearest picture yet on what federal officials have spent and plan to spend on the Affordable Care Act, a question on which the White House has offered limited details so far. The massive spending bill signed in January to fund the government in 2014 requires HHS to detail the creative accounting it has used to finance the implementation of the federal health care law including the healthcare.gov disaster as Republicans have sought to strangle the project by tying off its funding streams. The omnibus requires HHS to include with its 2015 budget request an account of all of the personnel and contracts to administer the law, and how all the money was spent for the federal and state exchanges since the law was signed in 2010 (Norman, 3/3).

The Associated Press/Washington Post: Obama’s 2015 Budget Appeals To Democrats
The success that Washington has had in curbing spending over the past several years has come mostly at the expense of “discretionary” spending for agency operating budgets approved by Congress each year. The $521 billion defense budget for this year amounts to 3.5 percent of the size of the economy, according to the Congressional Budget Office, down from 5.4 percent of gross domestic product 40 years ago. Discretionary spending on nondefense programs has dropped from 3.9 percent in 1974 to 3.4 percent today. Meanwhile, autopilot spending on benefit programs like Social Security, Medicare, food stamps and insurance subsidies under the new health care law are growing rapidly as a percentage of the economy (3/3).

The Washington Post: In Budget Proposal, Obama To Seek More Money For Anti-Poverty Programs
The Obama administration budget to be released Tuesday will set the stage for an election-year debate over government’s role in creating economic opportunity, with President Obama calling for more federal spending to help the poor and Republicans charging that such programs waste money and foster dependency. With his budget still being drafted, Ryan declined to say which programs would get the ax. But his report argues that the nearly $800 billion the federal government spends on anti-poverty programs each year should be trimmed. In last year’s GOP budget blueprint, Ryan proposed to sharply slow spending on domestic social programs, such as Medicaid, food stamps and Pell grants for college students (Goldfarb and Costa, 3/3).

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Health Care Marketplace

Drug Firms Trimming Speaking Fees To Doctors

ProPublica examines a shift in the money that pharmaceutical companies gave physicans for promotional speeches.

ProPublica/NPR: Drugmakers Slash Spending On Doctors' Sales Talks
Some of the nation's largest pharmaceutical companies have dramatically reduced payments to health professionals for promotional speeches amid heightened public scrutiny of such spending, a ProPublica analysis shows. Eli Lilly & Co.'s payments to speakers dropped by 55 percent, from $47.9 million in 2011 to $21.6 million in 2012 (Ornstein, Sagara and Grochowski Jones, 3/4).

Meanwhile, the Supreme Court agreed to take up a case involving a pharmaceutical services company.

The Wall Street Journal: Supreme Court Takes Omnicare Challenge To Securities Suit
The plaintiff investors allege Omnicare stated falsely it had complied with relevant laws in its 2005 Securities and Exchange Commission registration to sell more than 12 million shares. The lawsuit alleges Omnicare effectively hid from investors that it paid kickbacks to nursing homes, received kickbacks from drug companies and submitted false claims to Medicare and Medicaid (Kendall, 3/3).

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Medicare

Medicare Drug Program Falls Short In Tracking Fraud

Medicare's massive drug program continues to be in the news, from a report finding that it fails to adequately track fraud, to continued opposition to an administration proposal that would revamp the program.

ProPublica: Medicare's Drug Program Needs Stronger Protections Against Fraud, Watchdog Says
Medicare has failed to adequately track fraud in its massive prescription drug program, according to a new report today from the agency’s watchdog. In particular, the inspector general of the U.S. Department of Health and Human Services found that fewer than half of the insurance companies paid to administer Medicare’s drug program reported data to the federal government about potential fraud and abuse cases between 2010 and 2012 (Ornstein, 3/4).

CQ HealthBeat: Medicare Drug Proposal Riles Lawmakers And Health Industry
Opponents of a proposal to remove antidepressant and immunosuppressant drugs from all Medicare drug formularies are ramping up calls for the administration to withdraw the proposed rule entirely. Friday is the deadline for comments on the proposed regulations, and lawmakers of both parties as well as many stakeholder groups have voiced opposition to the changes to the Medicare Part D program (Ethridge, 3/3).

Earlier, related KHN coverage: Administration Faces Opposition To Changes In Medicare Prescription Drug Program (Carey, 3/3).

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Quality

One Third Of Nursing Home Patients Harmed By Caregivers

The finding by the Health and Human Services Inspector General emphasizes the extent of medication errors, preventable infections and other care issues in skilled nursing facilities. Also, California's Sutter Health system says it has developed a program to make end of life care both more caring and more economical.

ProPublica: One Third Of Skilled Nursing Patients Harmed In Treatment 
One in three patients in skilled nursing facilities suffered a medication error, infection or some other type of harm related to their treatment, according to a government report released today that underscores the widespread nature of the country’s patient harm problem. Doctors who reviewed the patients’ records determined that 59 percent of the errors and injuries were preventable (Allen, 3/3). 

The California Health Report: Taking AIM at End-of-Life Care: Kinder, Gentler, and More Cost-Effective
Imagine you are old and dying, told by doctors you have less than a year to live. As you face one health crisis after another, you crave to be held in the loving embrace of a warm healthcare system. Instead, you face a confusing maze of revolving physicians, recurring hospitalizations, and rising frustration. ... To combat this maddening and expensive problem, northern California’s Sutter Health has developed an Advanced Illness Management program (AIM) to make the last 6-18 months of life more personal, caring, and economical (Perry, 3/3).

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Public Health & Education

Study: Nearly 1 in 5 Had Mental Illness Before Military Enlistment

The findings, published as three papers in JAMA Psychiatry, show that soldiers who join the military come in with much higher rates of mental illness than the general public.

Los Angeles Times: Nearly 1 In 5 Had Mental Illness Before Enlisting In Army, Study Says
Nearly 1 in 5 U.S. soldiers had a common mental illness, such as depression, panic disorder or ADHD, before enlisting in the Army, according to a new study that raises questions about the military's assessment and screening of recruits (Zarembo, 3/3).

WBUR: Study: Soldiers Enter Military With Higher Rates Of Mental Illness
As suicide rates among soldiers climbed to new highs four years ago, researchers prepared surveys for the largest study to date of mental health risk within the military. The findings, published as three papers in JAMA Psychiatry, show that soldiers who join the military come in with much higher rates of mental illness than the general public and that most suicides can be traced to these pre-enlistment conditions. Researchers organized 327 meetings at Army installations across the country in 2011. A total of 5,428 soldiers, some in large auditoriums, some in small field offices, filled out questionnaires that they knew would be matched to their administrative records (Bebinger, 3/4).

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State Watch

State Highlights: Fla.'s New Medicaid Hospital Formula; Va. Hospitals Expand In Richmond

A selection of health policy stories from Florida, Kansas, Virginia, California and Georgia.

Health News Florida: Hospitals Lose With New Medicaid Formula
The funding formula in Florida’s Medicaid reform law means hospitals across the state will see millions of dollars in cuts, the Tampa Bay Times reports, while a handful will see funding increase ... Safety net hospitals as a group are expected to see cuts of $300 million under the new payment formula that in essence penalizes communities that have a local sales tax to benefit health care (3/3).

Kansas Health Institute: Legislature Still Wrestling With Bills Dealing With Health Insurance And Autism
Unlike here in Kansas, Missouri requires its state-regulated health insurance plans to offer coverage of autism diagnosis and treatment for children. That’s why most of the youngsters enrolled at the Kansas City Autism Training Center in Prairie Village, actually live on the Missouri side of the state line, which is about four miles east of here as the crow flies (Ranney, 3/3).

The Richmond Times-Dispatch: As Economy Rebounds, Richmond Hospitals Expand
Hospital systems in the Richmond area are building, renovating and expanding -- taking advantage of improving economic conditions to do some much-needed projects. If there is a theme among the projects, it’s that health care is coming to a neighborhood nearer to you, with both the Bon Secours Virginia and HCA Virginia health systems planning midsize projects in growing suburban areas. VCU Health System is making progress on its new children’s hospital (Smith, 3/4).

Kaiser Health News: L.A. County Officials Told Inspectors To Cut Short Nursing Home Probes
Facing a backlog of hundreds of health and safety complaints about nursing homes, Los Angeles County public health officials told inspectors to close cases without fully investigating them, according to internal documents and interviews (Gorman, 3/3).

Georgia Health News: Update: House OKs Bills On Obamacare, Food Stamps
The 2014 legislative session was expected to be a quiet one for health care. Experts predicted that little of significance on health issues would pass before Georgia lawmakers wrapped up a quick, tidy General Assembly session.The predictions of a dull session were way off target -- sort of like picking Denver to beat Seattle in the Super Bowl. Major bills on medical marijuana, Medicaid expansion, insurance navigators, autism coverage, abortion, foster care, and the Department of Community Health board have all moved through a chamber or were pending for a vote Monday. In the process, these and other health care proposals captured major legislative attention (Miller, 3/3). 

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Editorials and Opinions

Viewpoints: Ryan's Attack On Medicaid; Time To Fix Medicare's Doc Pay

Los Angeles Times: The Zombie Walks: Yet Another Attack On Medicaid
House Budget Committee Chairman Paul D. Ryan, R-Wis., obviously is a great adherent of the adage, "If at first you don't succeed, try, try again." On Monday his committee released another attack on Medicaid, one of the linchpins of the Affordable Care Act and one that for some reason is especially detested by conservatives, like the majority members of Ryan's committee (Michael Hiltzik, 3/3). 

The New York Times: Mr. Ryan's Small Ideas On Poverty
To fit that broad and unsupportable argument, Mr. Ryan then goes about distorting the facts. For all of Medicaid's billions, the report says, its recipients are less healthy than people on private insurance or Medicare! Well, yes, that’s not exactly surprising because Medicaid cares for the nation's poorest residents, many of whom come from troubled backgrounds and have trouble attending to their own needs. But that's hardly a reason to turn it into a block grant and dump it on the states, as Mr. Ryan proposed in 2012. Medicaid has made millions of low-income people healthier, and its expansions have dramatically reduced infant mortality and childhood deaths (3/3).

Los Angeles Times: Paul Ryan, Anti-Poverty Sage Or Partisan Hack?
Another piece of baggage for Ryan is his stance on Medicaid, the federal health insurance program for the poor. In his budget proposals, Ryan has sought to cut Medicaid spending not by offering a more effective or efficient way to deliver healthcare but by capping the federal government's responsibility and shifting risk to the states. Those proposals seem to emanate more from a desire to cut handouts than an effort to provide a stronger hand up (Jon Healey, 3/3). 

Los Angeles Times: Fixing The Way Medicare Doctors Are Paid
Republicans and Democrats can't seem to agree on anything related to the 2010 healthcare law, but they may come together soon on a crucial fix to the nation's largest federal healthcare program, Medicare. At issue is the "sustainable growth rate," a mechanism Congress enacted in 1997 to limit Medicare costs. It hasn't; instead, it has simply threatened physicians with ever-larger and more unreasonable cuts in fees, which Congress has routinely waived. Now, the top Republicans and Democrats on three congressional committees have come up with a replacement formula; the only missing piece is a way to pay for it. Although that's a significant issue, it shouldn't stop Congress from adopting the proposal (3/3). 

The Washington Post’s The Plum Line: The Medicaid Expansion Is Bad Because It’s Obamacare
As I've noted before, the Medicaid expansion has taken on a kind of political life of its own, separate from Big Bad Obamacare. In Michigan, the expected GOP Senate candidate has come out for the expansion. In deep red Louisiana, Dem Mary Landrieu will make it a big issue when it’s debated this spring. Dems in tough red state Senate battles — Michelle Nunn in Georgia and Alison Lundergan Grimes in Kentucky — are standing up for the expansion (Greg Sargent, 3/3). 

4 NBC Washington: Medicaid Expansion In Va.'s Fight Against History
In pushing for a large scale expansion of Medicaid eligibility, Democratic Gov. Terry McAuliffe isn't just up against House Republicans who are leery of supporting a key aspect of President Obama's signature health care law. He's also trying to upend the commonwealth's long tradition of resistance to public aid (Alan Suderman, 3/3).

Bloomberg: Can Lipitor Save Big Pharma?
It’s long been in the works. Pfizer Inc. has begun testing an over-the-counter version of Lipitor, the blockbuster drug that has plumped up the pharmaceutical giant’s coffers for more than a decade. You may wonder: Why go OTC? ... Insurance companies have become a lot more price-sensitive over the years. Now they tend to press for generics to be prescribed unless there is some compelling reason to take the brand name. Which means that as drugs go off patent -- which Lipitor did at the end of 2011 -- there’s quite a bit of wallet shock (Megan McArdle, 3/3).

The Washington Post: The U.S. Can't Afford To Get Complacent About Obesity
Headlines last week offered a glimmer of hope on obesity: A government study found that the obesity rate for children ages 2 to 5 dropped by about 40 percent between 2003 and 2012. That comports with another recent government report finding that, in several states, young, poor children are healthier. This is encouraging but no reason for complacency. In fact, last week’s announcement shows that obesity remains a daunting problem that demands more effort — from Americans and their government (3/3). 

WBUR: Project Louise: Three Meals A Day — Is That So Hard?
Sometimes I wonder why it’s so hard to lose weight when, really, we all know what it takes: Eat less, move more. I mean, that’s all it is, right? So why don’t we just do that and be done with it? (Louise Kennedy, 3/3).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
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.