Daily Health Policy Report

Tuesday, March 5, 2013

Last updated: Tue, Mar 5

KHN Original Reporting & Guest Opinion

Health Reform

Health Spending And Fiscal Battles


Health Care Marketplace

Health Information Technology


State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Hospitals Crack Down On Tirades By Angry Doctors

Sandra G. Boodman, writing for Kaiser Health News in cooperation with The Washington Post, reports: "At a critical point in a complex abdominal operation, a surgeon was handed a device that didn't work because it had been loaded incorrectly by a surgical technician. Furious that she couldn't use it, the surgeon slammed it down, accidentally breaking the technician's finger. 'I felt pushed beyond my limits,' recalled the surgeon, who was suspended for two weeks and told to attend an anger management course for doctors" (Boodman, 3/5). Read the story.

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Insuring Your Health: Caveat For Contraceptive Coverage; Early Retirees May Get Cheaper Plans On Exchanges

Kaiser Health News consumer columnist Michelle Andrews answers readers' questions about birth-control coverage requirements under the Affordable Care Act and subsidized coverage on the state-based health insurance exchanges (Andrews, 3/4). Read the story.

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Capsules: Florida House Panel Opposes Medicaid Expansion; C-Section Delivery Rates Vary Widely Across Nation; Prostate Screening Tests In Older Men Decline, But Many Still Get Them, Study Finds

Now on Kaiser Health News' blog, WFSU's Lynn Hatter, working in partnership with KHN and NPR, reports on Florida action related to the Medicaid expansion: "The Florida House of Representatives has signaled it won't go along with Gov. Rick Scott to expand Medicaid coverage to more than a million low-income Floridians under the Affordable Care Act. The party-line vote came Monday shortly after a joint committee hearing on the law's financial impact on the state" (Hatter, 3/4).

Also on Capsules, Alvin Tran reports on a study regarding C-section rates: "The study, published Monday in the journal Health Affairs, found that the overall rates of C-sections — the most common type of surgery in the U.S. — varied from about 7 to 70 percent across the nation's hospitals" (Tran, 3/4).

In addition, Julie Appleby writes about new findings related to prostate screening tests in older men: "Fewer men over age 75 are being routinely screened for cancer with a prostate-specific antigen (PSA) test following a 2008 recommendation against the tests, researchers said today, suggesting a less-is-more approach sometimes works. But while the numbers have declined, they remain significant – more than 4 in 10 men in that group still get the tests" (Appleby, 3/4). Check out what else is on the blog.

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Political Cartoon: 'Going Viral?'

Kaiser Health News provides a fresh take on health policy developments with 'Going Viral?' by Matt Wuerker.

Meanwhile, here is today's health policy haiku:


Sequester squabblin'
will certainly fade away
when the BIG snow starts.

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

Activists, Lawmakers Wrestle With Medicaid Expansion

This aspect of the health law is a hot topic in Texas, Florida, California and Missouri -- among other places. Meanwhile, a Medicare trustee questions the viability of the federal funding commitment.

The Hill: Medicare Trustee Doubts Future Funding For Medicaid Expansion
A Medicare trustee is questioning whether the federal government will maintain its commitment to foot most of the cost of expanding Medicaid under the healthcare law. Charles Blahous released a report Monday cautioning states to "consider the likelihood that federal financing support may be ultimately reduced from current schedules" (Viebeck, 3/5).

The New York Times: Texans Rebut Governor On Expansion Of Medicaid
Hundreds of activists and uninsured Texans plan to rally at the steps of the Capitol here Tuesday, increasing the pressure on Gov. Rick Perry and other Republican leaders to switch their stance on expanding Medicaid, a major provision of President Obama's health care overhaul (Fernandez, 3/4).

The Associated Press: GOP Caucus In Texas House Rejects Medicaid Expansion
Republicans in the Texas House voted Monday against expanding Medicaid in its current form, but left open the door to negotiations with the federal government. The House Republican Caucus met behind closed doors and voted against expanding Medicaid under the Affordable Care Act's current regulations, said Rep. Lois Kolkhorst, Republican chairwoman of the Public Health Committee. In return for spending $15 billion over the next 10 years on Medicaid, Texas would get $100 billion to provide health care to an additional 1.5 million poor people (Tomlinson and Weissert, 3/4).

Los Angeles Times: Key Senate Panel Approves Medi-Cal Expansion
A key Senate panel supported legislation Monday that would dramatically expand Medi-Cal, the state's public insurance program for the poor. The proposal, authored by state Sen. Ed Hernandez (D-West Covina) and Senate leader Darrell Steinberg (D-Sacramento), is part of a legislative package that aims to help California implement President Obama's healthcare overhaul (Mishak, 3/4).

Kaiser Health News: Capsules: Florida House Panel Opposes Medicaid Expansion
The Florida House of Representatives has signaled it won't go along with Gov. Rick Scott to expand Medicaid coverage to more than a million low-income Floridians under the Affordable Care Act. The party-line vote came Monday shortly after a joint committee hearing on the law's financial impact on the state (Hatter, 3/4).

The Associated Press: House Panel Rejects Medicaid Expansion In Florida
A key legislative panel voted on Monday against expanding Medicaid coverage to roughly 1 million more residents under the federal health overhaul, expressing fears that the federal government would ultimately back out of paying its share and leave the state on the hook for billions. The vote was strictly partisan, with House Republicans contending that the state’s current safety net program — which costs about $21 billion a year to cover more than 3 million Floridians — is already broken and that adding more patients would only exacerbate problems while increasing the federal deficit (3/5).

Health News Florida: House Panel Rejects Medicaid Expansion
Only a few hours after Florida's chief economist said the state can't afford to leave billions of federal dollars sitting on the table, the House committee on the Affordable Care Act voted to do exactly that. The vote fell along party lines, as the Republicans on the committee said they didn't trust the federal government to come through with the money, given the state of the federal budget. They also expressed an extreme distaste for the Medicaid program, saying it's far inferior to private insurance (Gentry, 3/4).

Health News Florida: 'This Decision Will Impact Floridians For Decades'
There was an uncommonly stirring debate Monday in the House Select Committee on the Patient Protection and Affordable Care Act before the 10 to 5 party-line vote killing the Medicaid expansion plan (Pusateri, 3/4).

St. Louis Beacon: Doctors, Police Join Gov .Nixon In Calling For Expanding Medicaid To Boost Services For The Mentally Ill In Missouri
When Gov. Jay Nixon decided to visit the Metropolitan St. Louis Psychiatric Center to make a case for expanding Medicaid, few people in the audience were more pleased than Dr. Roy Wilson, the center's medical director. He says the visit helped to shed more light on the fact that facilities like his often lack the money for services to head off the adverse consequences of being mentally ill and uninsured (Joiner, 3/5).

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Minn. House Passes Bill To Create A Health Exchange

An amendment restricting abortion coverage was also approved. In Connecticut, the state awarded a contract to handle its exchange to a company that has come under fire in the state before.

MPR News: Health Exchange Passes Minn. House; Amendment Restricts Abortion Coverage
The DFL-controlled Minnesota House has passed a key part of the Obama administration's health care law -- a state-based health insurance exchange. The bill's chief author called the measure the most significant health reform in 50 years. But abortion restrictions adopted last night could run into trouble with Gov. Mark Dayton(Stawicki, 3/4).

CT Mirror: Company With Checkered Record To Handle State's Health Insurance Exchange
The state's health care exchange has awarded a $15 million contract to a Virginia company with a mixed track record in Connecticut. Through a competitive process, the exchange, called Access Health CT, selected Maximus Inc. of Reston, Va., to run its call center operation. Maximus will handle phone calls and guide consumers through buying and enrolling in a health insurance plan through the Affordable Care Act. Exchange leaders said they hired the company because it did a fantastic job handling similar contracts in other states, including running a call center for Medicaid in New York. Maximus came under fire in Connecticut several years ago for the way it handled work to upgrade a police database and handle child care payments for the state Department of Social Services (Merritt, 3/4).

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Health Spending And Fiscal Battles

After Sequester, What Comes Next?

News outlets report that the next step for some GOP lawmakers will revolve around a budget plan that will end deficits by 2023. Along those lines, House Budget Committee Chairman Paul Ryan, R-Wis., has suggested a change in his Medicare plan.

The Washington Post: Republican Goal To Balance Budget Could Mean Deep Cuts To Health Programs
Anxiety is rising among House Republicans about a strategy of appeasement toward fiscal hard-liners that could require them to embrace not only the sequester but also sharp new cuts to federal health and retirement programs. Letting the sequester hit was just the first step in a pact forged in January between conservative leaders and Speaker John A. Boehner (R-Ohio) to keep the government open and the nation out of default. Now comes step 2: adopting a budget plan that would wipe out deficits entirely by 2023 (Montgomery, 3/4).

Politico: Paul Ryan Floats Change To Medicare Plan
Paul Ryan's budget will show how Republicans can balance a budget that's trillions of dollars out of whack. But the most significant unresolved issue comes down to a minuscule number: one year. Ryan — the House Budget Committee chairman — has privately been floating the idea of allowing his changes to Medicare to kick in for Americans younger than 56. In previous budgets, those 55 and older were exempted from his plan to turn Medicare into a premium-support — or voucher — program (Sherman and Allen, 3/4).

The Hill: GOP Centrists Balk At Ryan Medicare Shift
House Republican centrists are furious that GOP leaders are considering abandoning their pledge not to change Medicare retirement benefits for people 55 years and older. According to several sources, a handful of centrist GOP lawmakers attending a recent Tuesday Group luncheon erupted when Budget Committee Chairman Paul Ryan (R-Wis.) and House Majority Whip Kevin McCarthy (R-Calif.) broke the news (Hooper, 3/5).

The Medicare NewsGroup: Distrust Of Government Is A Hard Hurdle To Jump In Medicare Reform
One reason that changes to the Medicare program will be hard to make is because people distrust the federal government yet cherish what it offers them. This is a hard conundrum to overcome. The latest polling makes this point with great vigor. And the discussions among experts within different parts of the political spectrum illustrate why President Obama and Congress have scant prospect of success in producing any alterations to Medicare. … Skepticism about government is the deepest since the Pew Foundation began polling in 1958, when it found that 73 percent of Americans trusted the government in Washington, D.C., "all the time or most of the time." Today, the level of trust has shrunk to a meager 26 percent, according to the latest polling, conducted last month (Rosenblatt, 3/4).

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Automatic Cuts To Take Toll On Community Health Centers

Estimates suggest these centers will serve about 900,000 fewer patients in 2013 because of the sequester.

Modern Healthcare: Sequester Expected To Sock Health Centers
Community health centers will serve about 900,000 fewer patients in 2013 because of sequester-related funding cuts, according to a report. Researchers at the School of Public Health and Health Services at George Washington University projected the service delivery impacts on the federally funded health centers from the sequester, which four days ago began cutting $85 billion in federal spending this year. Those 1,200 centers, which operate 8,500 locations, serve primarily low-income residents and will lose about $120 million in federal funds this year, according to the researchers. … Because the Obama administration has provided little detail on the implementation of the sequester, the researchers' report was an "initial assessment" of its impacts on the health centers. The scope of the patient impact was magnified by researchers' conclusion that the $120 million in grant funding losses will result in an additional loss of $230 million in third-party insurance funding (Daly, 3/4).

CQ HealthBeat: Report Projects Community Health Center Cutbacks Under Sequester
About 900,000 fewer patients could be served in community health centers due to cutbacks imposed by the sequester, according to a report issued on Monday by researchers at the George Washington University School of Public Health and Health Services. That’s because the 1,200 federally funded community health centers and their satellite locations will lose about $120 million as a result of the automatic budget cuts ordered under the Budget Control Act (PL 112-125), said the report by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative (Norman, 3/4).

Other programs that will feel a strain from the sequster -

CNN Money: HIV 'Cure' At Risk From Budget Cuts
The automatic cuts in federal spending known as sequestration could take a bite out of crucial medical research, such as the recently unveiled study in which a toddler was cured of HIV. The National Institutes of Health, which co-funded the study, stands to lose $1.6 billion of its $31 billion budget through September as a result of the sequester, which went into effect on Friday. As the largest supporter of biomedical research in the United States, it could slash funding for hundreds of research programs, such as the HIV case. he NIH, in conjunction with the Foundation for AIDS Research, also known as amfAR, paid for the research of the child who was infected with HIV, the virus that causes AIDS (Smith, 3/5).

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IG: Lack Of Clarity On 'Conflicts Of Interest' May Impact Medicare Coverage Decisions

The New York Times reports that large amounts of money are in play.

The New York Times: Lax Policing Of Doctor And Pharmacy Conflicts Is Found In Medicare Coverage Decisions
Deciding which drugs will be covered by Medicare can influence huge amounts of spending, but government officials do little to police conflict of interest among doctors and pharmacists who make those decisions, federal investigators said Monday (Pear, 3/5).

Meanwhile, PBS NewsHour examines developments in Texas to determine why access-to-care may become an issue for some seniors - 

PBS NewsHour: Access To Doctors Shrinks For Some Medicare Patients (Video)
It's getting harder and harder for some seniors to find a primary care physician. Ray Suarez reports on why the threat of massive cuts to Medicare reimbursement rates has left some doctors so worried that they've decided to stop taking new Medicare patients (3/4).

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Health Care Marketplace

Explaining The Factors Behind Health Care Spending's Modest Increases

USA Today analyzes this trend and details some of the reasons that could be driving it.

USA Today: Health Care Spending Is Transferred Out Of ICU
Health care spending last year rose at one of the lowest rates in a half-century, partly the result of cost-saving measures put in place by the 2009 health care law, a USA TODAY analysis finds. Spending for medical care has increased modestly for five consecutive years, the longest period of slow growth since Medicare began in 1966 (Cauchon, 3/4).

In related news --

USA Today: Gunshot Wounds Drive Up Government Health Care Costs
Gunshot wounds and deaths cost Americans at least $12 billion a year in court proceedings, insurance costs and hospitalizations paid for by government health programs, according to a recent study (Kennedy, 3/4).

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Health Information Technology

EHR 'Information Overload' Can Mean Doctors Overlook Key Test Results

Researchers report that nearly 30 percent of doctors responding to a survey say they have failed to notice important test results because of the deluge of information available with electronic records.

Politico: For Doctors, Too Much Information?
A new research letter published in JAMA Internal Medicine on Monday finds just that: Electronic health records may cause doctors the unintended side effect of information overload. The survey of primary-care practitioners from the Department of Veterans Affairs shows nearly one-third of those using the EHR system reported having missed or failed to follow up on key electronic alerts about patient test results (Smith, 3/5).

Medpage Today: Many Docs Miss Test Results In VA's EHR
About 30 percent of physicians in the Department of Veterans Affairs (VA) health system participating in a survey said they had failed to notice important test results, sent via the VA's electronic records system, on at least one occasion. The survey's authors, most of whom worked in the Michael DeBakey VA Medical Center in Houston, blamed "information overload" related to electronic health records (EHR) systems for the findings (Gever, 3/4).

Modern Healthcare: Survey: Too Many EHR Alerts Could Lead To Missing Test Results
Researchers from several Houston institutions—including the Houston VA Health Services Research and Development Center of Excellence—surveyed almost 2,600 VA primary-care practitioners from June 2010 through November 2010 regarding EHR-based alerts. Almost 30% acknowledged missing notification of test results that led to care delays, according to a research letter in the American Medical Association journal JAMA Internal Medicine (Robeznieks, 3/4).

In other IT news -

Medpage Today: If Practices Don't Change, EHRs Lose Money
The average physician lost nearly $44,000 over 5 years implementing an electronic health record system, a large pilot study found, but the technology itself was just part of the reason. Just 27 percent of practices achieved a positive 5-year return on investment -- a number that would rise to 41 percent with the addition of federal incentives to use EHRs, the study in the March issue of Health Affairs stated. But the vast majority of practices lost money because they failed to make operational changes to realize the benefits of EHRs such as ditching paper medical records after adoption, Julia Adler-Milstein, PhD, of the University of Michigan in Ann Arbor, and colleagues wrote (Pittman, 3/4).

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Across The Nation, C-Section Rates Show Wide Variation

C-sections, a very common operating room procedure, can boost the cost of delivery from about $9,000 for a vaginal birth to $13,000.  

Medpage Today: C-Section Rates Vary Widely
C-section is the most common procedure done in the operating room, and boosted the cost of delivery to an average of almost $13,000 compared with $9,000 for vaginal births ... based on a prior study of private health insurance payments. Both overuse and underuse of cesarean delivery may be clinically harmful as well, with higher risk of infection, injury, and need for emergency hysterectomy for the mother and greater risk of asphyxia, respiratory distress, and other pulmonary disorders for the baby compared with vaginal birth. The group analyzed inpatient claims data from the 593 hospitals with at least 100 deliveries included in the 2009 Nationwide Inpatient Sample, which covers about 20 percent of all U.S. centers (Phend, 3/4).

Kaiser Health News: Capsules: C-Section Delivery Rates Vary Widely Across Nation
The study, published Monday in the journal Health Affairs, found that the overall rates of C-sections — the most common type of surgery in the U.S. — varied from about 7 to 70 percent across the nation's hospitals (Tran, 3/4).

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State Watch

Texas Clergy Asks Lawmakers To Boost Women's Health Funding

Elsewhere, New York Gov. Andrew Cuomo links the fight for women's rights to his proposed abortion legislation, and Arkansas' governor vetoes a bill that would ban most abortions at 12 weeks, setting up another override fight in that state.

The Associated Press: Texas Clergy Call For More Women's Health Funding
More than 370 members of the clergy asked the Texas Legislature on Tuesday to boost funding for women's health programs. Leaders of Methodist, Buddhist, Presbyterian, Jewish, Baptist and Unitarian congregations lobbied lawmakers for more spending to help poor women, particularly with birth control. The Republican-controlled Legislature cut spending on health programs for poor women by $73 million - about two-thirds - in 2011. Experts predict that will led to an additional 23,760 pregnancies in 2014-15, all of which will fall under Medicaid, the health care program for the poor, and cost the state an additional $273 million (Tomlinson, 3/4).

The Associated Press/Wall Street Journal: Women's Group Works With Cuomo On Rights, Abortion
A new coalition lobbying for Gov. Andrew Cuomo's women's rights agenda said it supports his decision to link popular measures against workplace discrimination and human trafficking with a hotly debated abortion measure. It's a political gamble that faces strong opposition among Senate Republicans (3/4).

Reuters: Arkansas Governor Vetoes Bill Banning Most Abortions At 12 Weeks
Democratic Governor Mike Beebe on Monday vetoed legislation that would ban most abortions in Arkansas after 12 weeks of pregnancy, a restriction that would be the most severe in the nation. The bill's supporters say they plan to seek a vote on Tuesday to override Beebe's veto, which would require only a simple majority in Arkansas (Parker, 3/4).

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State Roundup: Medicaid Safety-Net Struggles In Kansas

A selection of health policy stories from Texas, California, Arizona and Kansas.

San Francisco Chronicle: City Strikes Deal For Two New Hospitals
San Francisco officials have struck a deal with California Pacific Medical Center to build two seismically safe hospitals following months of negotiations after city supervisors balked at the original agreement Mayor Ed Lee had negotiated. Under the new compromise, to be announced Tuesday, the Sutter Health affiliate will scale back the size of its planned hospital on Cathedral Hill from 555 beds to 274, and expand the capacity of a rebuilt St. Luke's Hospital in the Mission District from 80 beds to 120, steps designed to ease congestion concerns around Cathedral Hill and maintain the viability of St. Luke's, those familiar with the talks said (Coté and Tucker, 3/4).

Arizona Republic: Arizona Foster-Care Mental Health Bill Gains
The Senate gave unanimous approval Monday to a slimmed-down version of a bill aimed at improving behavioral-health care for foster children. Senate Bill 1375 now requires two state agencies to issue detailed monthly reports to the governor and lawmakers on foster kids' mental-health treatment, including how many children are moved from a placement due to behavioral problems. The bill also requires the Arizona Departments of Economic Security and Health Services and the state's Medicaid program to recommend the most efficient way to provide physical and mental-health care to children (Reinhart, 3/4).

Kansas Health Institute: Safety-Net Clinics Struggling With KanCare
While acknowledging "bumps in the road," state officials for several weeks have been saying that the launch of KanCare, the state's new Medicaid program, has been going better than they expected. But people who work at some of the clinics that specialize in treating poor and uninsured Kansans describe it differently (Shields, 3/4).

California Healthline: Notice, Grace Period At Issue In Rescission Rules
California Insurance Commissioner Dave Jones filed a cross-appeal in the ongoing fight over how to implement California's 2010 passage of AB 2470, authored by then-Assembly member Hector De La Torre (D-South Gate). The bill, approved by Gov. Arnold Schwarzenegger, banned rescission of consumers' health coverage except in cases of non-payment or fraud. The rules laid out by Commissioner Jones spelling out how insurers needed to comply with the law were challenged in court by the Association of Life & Health Insurance Companies in 2011. This year, on Feb. 1, the association filed an appeal of a decision by Sacramento Superior Court judge Michael Kenny, and on Feb. 25, the Commissioner announced his department filed a cross-appeal on two different aspects of the ruling (Gorn, 3/4).

California Healthline: Pharmacies, Not-For-Profit Groups Could Help Enroll More Californians
As director of communication and public affairs at Covered California, Oscar Hidalgo is in charge of the exchange's marketing and outreach efforts. His job is to make millions of Californians aware of the exchange, help them understand their health insurance options and then get them to enroll. It's a big task with some unusual challenges. Many prospective enrollees are not proficient English speakers. They also have little contact with mainstream media. As a result, the exchange is taking a couple of non-traditional tacks to reach more people. … The exchange will launch a huge media advertising campaign in August. Paid employees in an "assisters" program will help individuals sign up for Covered California. The exchange will staff a telephone call-in center to help potential enrollees sign up for the right program (Gorn, 3/4).

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Editorials and Opinions

Viewpoints: Disappointing 'Surprises' In Health Law; Cuts In Graduate Medical Training Threatens Physician Supply; Va. Can Afford Medicaid Expansion

Politico: Medicare Cuts Are A Giant Step Backward
The proposed 2.3 percent reduction in (Medicare Advantage plan) payments, which comes on top of cuts already scheduled under the Affordable Care Act, pays no mind to the potential impact on quality of care throughout the program. These cuts will apply to all plans no matter the value they bring in providing quality care to beneficiaries or offering innovative solutions that could ultimately be scaled and applied to the broader program. Blind cuts are the same as those of the impending sequester; their sole aim is to save money and they do nothing to reform the Medicare program, and may even harm it (Douglas Holtz-Eakin and Ken Thorpe, 3/4).

Los Angeles Times: It's 'I Told You So' On Obamacare
"What we've learned through the course of this program is that this is really not a sensible way for the healthcare system to be run." That was Gary Cohen, director of the Department of Health and Human Services' Center for Consumer Information and Insurance Oversight, talking. He was specifically responding to the apparently surprising need to halt enrollments in a program designed as a temporary bridge for people with preexisting conditions who couldn't wait until the Affordable Care Act (a.k.a. Obamacare) fully kicks in next year. The program was allocated $5 billion, but some estimate it will take $40 billion to fund the effort. Such surprises are becoming routine (Jonah Goldberg, 3/5).

Politico: Demand For Doctors Soaring As Cuts Loom
As House Speaker John Boehner has said, the Affordable Care Act is the "law of the land." ... Yet at the very moment we are inviting people into the health system, Congress is considering cutting the single source of training that will ensure we have the physicians we need to look after these individuals, by drastically reducing federal funding for graduate medical education (Kenneth L. Davis, 3/5).

The Wall Street Journal: The Real Promise Of 'Accountable Care'
For decades, the inexorable rise in health-care costs has been accompanied by growing evidence of large variations in care and widespread gaps in quality and efficiency. Almost daily, new developments come along that in other industries would improve quality and access — such as Web- and phone-based services, electronic transactions and more-convenient facilities. In health care, however, innovative technologies and services seem to increase costs and complexity (Elliott Fisher, Mark McClellan and Stephen Shortell, 3/4).

Boston Globe: Mass. Needs An Obamacare Waiver For Small-Business Health Plans
Massachusetts has made a concerted effort in the last few years to rein in health care costs for small businesses. But new federal regulations written to implement the Affordable Care Act threaten to undercut those efforts — and saddle thousands of Bay State businesses with big increases in premiums. State law currently allows insurers to consider a range of factors that often reduce premiums for small firms. But under the new federal regulations, most of those rating factors will no longer be allowed. For example, insurers won't be able to consider the risks inherent to the industry a company is in, or whether the company has a wellness program, or how many employees it has, or what percentage of them participate in its health plan (3/5).

The Washington Post: Medicare Reform's Slow Progress
As I reported in January, the publisher of the Wall Street Journal and others are suing to gain detailed access to Medicare billing records through the Freedom of Information Act. ... Doctors are fighting the lawsuit, claiming that their taxpayer-funded earnings are none of the public's business. There's still no ruling in the case, but readers I heard from unanimously backed the Journal. I didn't receive one e-mail supporting the doctors. What I did get was a flood of first-person testimony about outrageous Medicare bills (Charles Lane, 3/4).

The Washington Post: Virginia Ignores Neediest By Obstructing Medicaid Expansion
Virginia Gov. Robert M. McDonnell (R), under attack by his erstwhile conservative allies for having overseen the enactment of a desperately needed tax increase for transportation, is trying to protect his right flank by vowing not to permit any expansion of Medicaid while he is governor. We salute Mr. McDonnell for his guts on the transportation bill, but on Medicaid he is posturing. Even under the most aggressive scenario, the state would not be in a position to expand Medicaid before July 2014 — six months after Mr. McDonnell leaves office. Still, that sluggish pace raises a broader question: Why is Virginia, one of the seven or eight richest states, one of the stingiest in providing health-care coverage for its poorest residents, including the working poor? (3/4). 

The Washington Post: C. Everett Koop, The Nation's Doctor
Koop turned his notoriety into influence, undertaking public health campaigns against smoking, domestic violence and preventable accidents. But his main contribution concerned HIV/AIDS. ... Koop was initially ordered by a superior to keep to himself any views on the topic. But Koop maneuvered to produce the "Surgeon General's Report on Acquired Immune Deficiency Syndrome," explicitly detailing the modes of HIV transmission, making clear it could not be spread by casual contact and affirming that "We are fighting a disease, not people" (Michael Gerson, 3/4).

San Francisco Chronicle: Biological-Material Laws Need Refining
It seems like the simplest thing in the world: your cells, tissues and fluids should belong to you. After all, your body belongs to you, doesn't it? It's not that simple. In fact, this question is at the heart of decades' worth of biomedical research. Though we've come a long way from the early days of research done without patient consent, there are still too many gray areas around what patients do know and what they can do with their own bodies' material. In a crucial case that shows just how murky the law is, in April the U.S. Supreme Court will hear arguments on whether Myriad Genetics and the University of Utah Research Foundation have the right to patent two human genes associated with breast and ovarian cancer (3/1).

San Francisco Chronicle: Baby's Cure Marks Milestone In AIDS War
The tantalizing and long-sought dream of an AIDS cure appears to have arrived. The almost unkillable virus, which until now could be suppressed but not eradicated, was snuffed out in a Mississippi infant infected at birth by a mother who tested positive for AIDS. The results come loaded with caveats and conditions and are tied to just one case. But the result is hugely important because 330,000 infections per year occur worldwide at childbirth, when a mother transmits the virus to a newborn (3/4).

San Jose Mercury News: Children's Health: California's Shift From Healthy Families To Medi-Cal May Harm Kids
Protecting the health of California's children is an ongoing priority, even as we deal with state budget deficits and realignment of government spending. As a cost-saving measure, state policymakers are moving 875,000 children who were receiving health coverage through the California Healthy Families Program to the Medi-Cal program. We are concerned that the state has not done all the necessary planning to ensure children's ongoing access to health care services. State and federal lawmakers have already expressed serious apprehensions about this transition and have urged the state to move slowly and cautiously to protect children's health (Shelly Kessler and Anne Wilson, 3/4).

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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.