Daily Health Policy Report

Wednesday, March 5, 2014

Last updated: Wed, Mar 5

KHN Original Reporting & Guest Opinion

Health Reform

Administration News

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

HHS Seeks $600 Million For Health Law Enrollment Efforts

Kaiser Health News staff writer Mary Agnes Carey reports: "Just in case Congress doesn’t pass President Barack Obama’s fiscal 2015 budget plan, officials at the Department of Health and Human Services say they have other options for finding the money they need to implement the health care law" (Carey, 3/5 ). Read the story.

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L.A. County Health Officials Grilled Over Nursing Home Inspections

Kaiser Health News staff writer Anna Gorman, working in collaboration with the Los Angeles Daily News, reports: "The Los Angeles County Board of Supervisors unanimously ordered an audit Tuesday of how the public health department oversees nursing homes, after a news report revealed that managers told inspectors to close cases without fully investigating them. Expressing anger and shock, the supervisors summoned Department of Public Health Director Jonathan Fielding to the meeting to answer questions about the nursing home inspection process. During the heated discussion, Supervisor Mark Ridley-Thomas called for the audit" (Gorman, 3/5). Read the story.

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Health Workers' Union Pushes Hospital Cost Control In California

Capital Public Radio’s Pauline Bartolone, working in partnership with Kaiser Health News and NPR, reports: "A California health care workers’ union is collecting signatures to get two measures onto the ballot that it says would lower health care costs. United Health Care Workers West, or SEIU-UHW, wants to cap what hospitals can charge to 25 percent above the actual cost of services. SEIU-UHW says on average, hospitals charge 320 percent above the cost of care" (Bartolone, 3/5). Read the story.

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Capsules: Washington State's Insurance Ads: Quirky And Hip Or Offensive?

Now on Kaiser Health News’ blog, The Seattle Times’ Lisa Stiffler writes: "Are the new ads promoting health insurance for Washington state’s young people quirky, hip and funny — or are they insulting and offensive? Michael Marchand says it doesn’t matter. ‘I don’t care if people like or hate what I’m doing, so long as they get the URL right,’ said Marchand, director of communications for the Washington Healthplanfinder, the website where people can buy subsidized health insurance plans" (Stiffler, 3/4). Check out what else is on the blog.

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Political Cartoon: 'Poetic Justice?'

Kaiser Health News provides a fresh take on health policy developments with "Poetic Justice?" by Chip Bok.

And here's today's health policy haiku:


The feds' marketplace
is an expensive website.
Who will foot the bill?

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

Administration Announces 2nd Renewal For Old Health Plans

Americans who kept health plans that didn't comply with the health law's coverage requirements will be able to renew those policies again.

Politico: Canceled Health Plans Get Reprieve
The Obama administration will allow some health plans that fall short of Obamacare coverage requirements to continue past the November elections and through most of President Barack Obama’s second term. The decision, announced Wednesday by federal health officials, extends for two years an earlier decision by the White House to let people keep their existing health plans through 2014, even if those plans fell short of the Affordable Care Act requirements (Cheney, 3/5).

The New York Times: Obama Extends Renewal Period for Noncompliant Insurance Policies 
“This approach incorporates the flexibility that exists under the law,” said a senior administration official. Republicans said they were not surprised by the president’s latest move. Indeed, they said it confirmed their contention that parts of the health care law were unpopular and unworkable. The reprieve for noncompliant policies was the latest in a series of waivers, deadline extensions, delays and dispensations announced by the administration. Lawyers said that Mr. Obama was testing the limits of his powers (Pear, 3/5).

Bloomberg: Obama Said To Allow Two-Year Renewal For Old Health Plans
People who stayed on old plans, which don’t carry the Affordable Care Act’s consumer protections, are believed to be younger and healthier in general than people on exchange plans. The insurer Humana Inc. (HUM) said in January that its exchange customers would be sicker and older than it expected in part because Obama allowed renewals of old plans (Wayne, 3/5).

Earlier coverage:

The Wall Street Journal: Extension Expected On Health Policies Not Meeting Law
 Millions of Americans received notices last fall saying their health-insurance policies would be canceled because they didn't meet the Affordable Care Act's stricter coverage standards. In November, President Barack Obama said state insurance commissioners could let health plans reinstate such policies for 12 months since many consumers were unable to use the balky HealthCare.gov website to obtain replacement coverage (Radnofsky and Mathews, 3/4).

Reuters: White House Readies Health Insurance Renewal Extension - Sources
The Obama administration will allow consumers to extend health insurance plans that fail to comply with President Barack Obama's health care law beyond 2014, according to three people familiar with the matter. In a move that could help Democrats avoid a repeat of last autumn's public outcry over canceled health policies, administration officials are expected to announce the change within the next few days, according to the sources (Morgan, 3/4).

CBS News: Obamacare's "Keep Your Plan" Fix To Be Extended
President Obama took some serious heat last year when insurers started dropping millions of Americans from health plans that were no longer Obamacare-compliant, seemingly breaking his promise, "If you have insurance that you like, then you will be able to keep that insurance." Consequently, he enacted an administrative policy change allowing insurers to extend existing plans on the individual and small-group markets for a year (Condon, 3/4).


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Arkansas House Votes To Fund Medicaid Expansion Private Option

The measure, which extended for one year this "private" approach to expanding health insurance coverage to low-income state residents, failed in four previous votes. Its opponents say the debate is not over -- they are just "hitting the pause button."   

Arkansas News: House Approves Funding For Private Option
The private option is Arkansas’ alternative to the expansion of state Medicaid rolls that was proposed under the federal Affordable Care Act. The state obtained permission from the federal government to use the federal Medicaid money that would have gone to state Medicaid expansion to subsidize private health insurance for people earning up to 138 percent of the federal poverty level. About 94,000 people have enrolled in private plans through the program, and another 11,000 who applied have been enrolled in traditional Medicaid because that program is more suited to their needs, according to the state Department of Human Services. About 105,000 people have applied since the program launched in October (Lyon, 3/4).

KUAR: Arkansas House Passes Private Option On 5th Vote
State Representatives Kim Hammer of Saline County, Mary Slinkard of Gravette and Les Carnine of Rogers reversed their positions and voted yes on the appropriation bill. On the House floor, Hammer explained his new stance. He said through the private option, those with “honorable needs” and those who are “probably just trying to build their welthfare portfolio” are likely part of the mix of healthcare recipients. “But for me to point and to say which ones that are and which ones that aren't, I can't do that. But I do know this: there are people that are going to be hurt if I don't vote for this,” he said (Hickey, 3/4). 

The New York Times: Arkansas House Votes To Extend Health Insurance Program
The Arkansas House of Representatives voted Tuesday to let the state keep taking federal money for the expansion of Medicaid under President Obama’s health care law and using it to buy private insurance for poor people. The measure, which failed in four previous votes, extended coverage for another year under the so-called private option, which the state’s Republican-controlled legislature devised last year as a politically acceptable alternative to expanding traditional Medicaid. Nearly 100,000 people have enrolled in the coverage so far, which allows them to choose among plans offered by four companies on the state’s new health insurance exchange (Goodnough, 3 4).

The Associated Press/Washington Post: Ark. Medicaid Plan Opponents Hit Pause On Fight
Ending a budget standoff reminiscent of the fight that shuttered the federal government last year, Arkansas lawmakers have spared the state’s first-in-the nation plan to use Medicaid funds to purchase private insurance for the poor. But opponents said they’re merely hitting the pause button on debating a program that has extended health coverage to nearly 94,000 people (3/5).

The Wall Street Journal: Arkansas Lawmakers Pass 'Private Option' Health-Care Law
Arkansas last fall became the first state to offer a "private option" to extend coverage to lower-income residents, the result of a compromise between state Republicans and Democrats over how to implement a crucial provision of the health law. The program, endorsed by the Obama administration, was seen by supporters in Arkansas as a way to accept federal dollars and cut the number of uninsured residents without enlarging Medicaid (Campoy and Radnofsky, 3/4).

Reuters: Arkansas Lawmakers Vote To Fund State's Alternative To Obamacare 
The Arkansas House of Representatives voted on Tuesday to fund the state's so-called "Private Option" medical insurance program that has drawn interest from lawmakers in other states as an alternative to Obamacare. The measure, which had earlier passed the state Senate, received 76 votes, one more than necessary in the 100-member House (Barnes, 3/4).

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Va. House Republicans Press For Special Session To Debate Expansion Proposal

The expansion is currently being tackled as part of the state's two-year budget blueprint, but the House GOP is urging that it be considered separately in order to avert a potential government shutdown.   

The Washington Post: Va. House Republicans Up Political Ante, Call For Special Session On Medicaid Expansion
House Republicans on Tuesday called for a special legislative session on Medicaid expansion, a surprise move meant to extricate the issue from the state budget, avert a potential government shutdown — and put Democrats on the defensive. With just days left in the regular session, the evenly split Senate and GOP-dominated House are deadlocked on whether to expand Medicaid under the federal health-care law known as Obamacare (Vozzella, 3/4).

The Richmond Times-Dispatch: As Adjournment Nears, Medicaid Divide Persists
Four days before the legislature’s scheduled adjournment, House Republicans on Tuesday urged Gov. Terry McAuliffe and a Senate majority to pass a budget without any form of Medicaid expansion and debate the issue in a special session. At the same time, Senate negotiators faulted the House for refusing to discuss the issue as part of the conference to resolve differences over the two-year budget. Speaker of the House William J. Howell, R-Stafford, said at a news conference that school boards and others need information for their own budgeting process before the July 1 deadline to approve a new state funding plan (Meola, 3/4).

Norfolk Virginian-Pilot: Va. Senators: Medicaid 'Integral' To Budget Talks
Virginia Senate budget negotiators say considering Medicaid expansion in deliberations on the proposed two-year state spending plan is appropriate, a forceful response to House of Delegates Republicans who see it as a separate issue. Senate budget negotiators staked out that position in a written statement Tuesday evening, hours after a House GOP leaders in a morning news conference again accused Democrats of causing gridlock over Medicaid. Those GOP officials said the General Assembly should allow the proposed $96 billion budget to pass in time for the legislature's scheduled March 8 adjournment, then convene a Medicaid special session. "We flatly reject this notion," the senators wrote in the two-page statement. "As we stated previously, the Marketplace Virginia proposal is integral to the Senate budget" (Walker, 3/4).

The Associated Press/Washington Post: McAuliffe Stumps For Medicaid Expansion In SW Va.
Gov. Terry McAuliffe went to the heart of coal country in one of the state’s poorest regions Tuesday to make the case that Virginia needs to expand Medicaid eligibility to about 400,000 low-income residents (3/4).

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Feds Give South Dakota's Partial Medicaid Expansion Plan A Thumbs Down; Utah May Need A Special Session

News outlets report on these and other state efforts to address issues related to expanding the state-federal health insurance program for low-income people.

The Washington Post: Four States Maneuver On Medicaid Expansion
Faced with the prospect of tens of millions, if not hundreds of millions, in federal funding, states are racing to find politically palatable ways to expand Medicaid. Here are the four states moving this week toward — or in one case away from — expanding Medicaid to cover those earning up to 138 percent of the federal poverty line (Wilson, 3/4).

Sioux City Argus Leader: Feds Reject Daugaard's Partial Medicaid Plan
Republican leaders in South Dakota had hope Monday that the U.S. government would let them cover only half the people federal law calls on South Dakota to add to Medicaid. On Tuesday, that hope was quashed. In a conference call late Tuesday afternoon involving legislative leaders from both parties and federal Medicaid chief Cindy Mann, South Dakota officials were told their request for a partial Medicaid expansion would not be allowed (Montgomery, 3/5). 

Salt Lake Tribune: Will Utah’s Lawmakers Take Action On Medicaid This Session?
With time running out in the 2014 session, Senate Majority Leader Ralph Okerlund says it is likely that the Legislature will not act on Medicaid expansion or any of the various health reform proposals on the table. "It’s definitely getting less and less likely as we get closer to the end of the session that [senators] end up taking a firm position," Okerlund, R-Monroe, said in an interview (Gerhke, 3/4). 

Deseret News: Governor Says Special Session May Be Needed On Medicaid Expansion
After pitching his plan personally to GOP lawmakers Tuesday, Gov. Gary Herbert said the details of how Medicaid expansion money would be used may have to be sorted out in a special session of the Legislature. But the governor said he expects "clear direction" before the 2014 Legislature ends March 13 to start negotiations about how the state can use what he says is $258 million available under the Affordable Care Act, also known as Obamacare (Riley Roche, 3/4). 

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CBO Projects Lower Health Law Cost; Oregon Lawmakers Seek Exchange Review

The cost estimate from the Congressional Budget Office takes into account lower-than-projected enrollment this year. Meanwhile, Oregon's Democratic senators ask the Government Accountability Office to examine federal funding of that state's website a day after House Republicans make a similar request.

CQ HealthBeat: CBO Projects Lower 10-Year Cost For Health Insurance Expansion
The Congressional Budget Office on Tuesday reduced its estimate for the cost of expanding coverage under the health care law by $9 billion over 10 years, thanks mostly to lower-than-projected enrollment. In its annual budget outlook released last month, the CBO had said that 1 million fewer people will receive coverage through the law's exchanges in 2014 than previously projected (Ethridge, 3/4).

Politico Pro: Lawmakers Seek GAO Review Of Oregon Health Exchange Problems
Two Senate Democrats have joined a Republican call for a federal investigation into how federal money was spent implementing Obamacare in Oregon. Sens. Ron Wyden and Jeff Merkley, both of Oregon, have requested that the Government Accountability Office look into the approximately $300 million in federal money that was authorized to be spent on Cover Oregon, the state’s deeply troubled insurance exchange. Their request is dated the day after Republican Rep. Greg Walden and House Energy and Commerce Committee Chairman Fred Upton made a similar request of the GAO (Haberkorn, 3/4).

The Oregonian: Cover Oregon: Legislature Passes Bills On IT Contracting, Enrollment Deadline Extensions
Two bills aimed at addressing problems with the troubled Cover Oregon health insurance exchange passed in the [state] House and Senate on Tuesday. House Bill 4122 would require independent quality assurance oversight on contracted technology projects that cost more than $5 million and other projects that meet certain criteria. The bill passed the Senate 25 to 5 and returns to the House for approval of Senate amendments. 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. It would also direct Cover Oregon to seek a federal waiver to extend the enrollment deadline by a month to April 30, and to seek federal tax credits for small businesses (Zheng, 3/4).

In other marketplace news -

Kaiser Health News: Capsules: Washington State's Insurance Ads: Quirky And Hip Or Offensive?
Are the new ads promoting health insurance for Washington state's young people quirky, hip and funny — or are they insulting and offensive? Michael Marchand says it doesn't matter. "I don't care if people like or hate what I'm doing, so long as they get the URL right," said Marchand, director of communications for the Washington Healthplanfinder, the website where people can buy subsidized health insurance plans (Stiffler, 3/4).

The Associated Press: Fla. Health Choices Launches State Exchange 
The troubled Florida Health Choices program launched an insurance exchange Tuesday, after several delays, that is separate from the Affordable Care Act marketplace. CEO Rose Naff delayed the launch last month after 10 times higher than anticipated interest in the site prompted technology experts to retool the website (Kennedy, 3/4).

The Baltimore Sun: Maryland Health Exchange To Create Advisory Panel 
The Maryland Health Benefit Exchange said Tuesday it is forming a "standing advisory committee" to address policy and other issues (Walker, 3/4).

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Poll: Public Is Split On Candidates Who Backed Obamacare

But support has significantly increased for lawmakers who voted for the law, according to the Washington Post/ABC News poll. Meanwhile, New Jersey Gov. Chris Christie, a potential GOP presidential candidate, tells a constituent worried about Obamacare to "elect a new president," and former White House adviser Ezekiel Emanuel writes in a new book that many of the early problems with the law were "self-inflicted."

The Wall Street Journal’s Washington Wire: Poll: Support Rises For Lawmakers Who Back Obamacare
Support for candidates who voted for the health-care law has improved dramatically in recent months, a Washington Post/ABC News poll released Tuesday shows. The survey found respondents almost exactly split on the question of whether they would be more or less likely to vote for a congressional candidate who supports the Affordable Care Act, with 34% saying they would be more likely to vote for the candidate and 36% saying they would be less likely to do so. Some 27% said it would not make a difference (Ballhaus, 3/4).

Politico: Chris Christie: Tired Of Obamacare? Elect New President
Chris Christie had some advice Tuesday for a constituent worried about Obamacare: “Elect a new president.” The exchange occurred during a town hall-style event the same day that the GOP New Jersey governor, a potential White House hopeful, came under fire for his own support for Medicaid expansion under the health care law (Titus, 3/4).

CNN: Christie On Dealing With Obamacare Concerns: ‘Elect A New President’
Gov. Chris Christie didn’t get any questions about the traffic scandal that’s plaguing his administration at his latest town hall, but he got the crowd on its feet when he addressed a concern about the federal health care law. A woman named Sharon asked the Republican governor Tuesday what seniors can expect from the Affordable Care Act, known as Obamacare, and how to combat negative experiences she has heard about. “What do we do?” she asked. "Elect a new President. That's what you do," Christie replied (Kastenbaum and Killough, 3/4).

ABC News: Harry Reid: Republicans Are ‘Addicted to Koch’
Senate Majority Leader Harry Reid is leading a crusade against the Koch brothers, whose name is pronounced “coke,” blasting them for pouring millions of dollars into campaigns to boost conservative candidates. “Senate Republicans, madam president, are addicted to Koch,” Reid said today on the Senate floor. Reid’s vocal opposition to the wealthy conservative moneymen kicked off last week, when he took to the Senate floor and accused the Koch brothers of “trying to buy America” and supporting a group running ads that he said are “absolutely false.” The Nevada senator continued his string of attacks today (Saenz, 3/4).

Marketplace: Dr. Ezekiel Emanuel Calls Early ACA Problems 'Self-Inflicted'
One of President Barack Obama’s advisers on health care reform, Dr. Ezekiel Emanuel, acknowledges that many of the problems the Affordable Care Act faced during the first few months of its implementation were self-inflicted wounds. "It’s a tremendous achievement, and I think unfortunately, the communication strategy wasn’t everything it should have been." Emanuel chronicles the rollout and the history of health care reform in the United States in his new book, “Reinventing American Health Care” (Ryssdal, 3/4).

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Administration News

President Obama's Budget: Medicare Means Testing And Lower Drug Costs

The budget proposal includes a provision to make wealthier seniors in Medicare pay more as well and another to try to drive down the cost of prescription drugs. A rival Republican plan is also expected to propose cuts to Medicare and Medicaid.

Los Angeles Times: Obama Issues A Campaign-Ready Budget Proposal
Obama's current plan would cut the deficit by adjusting the way the government means-tests Medicare, requiring higher premiums for some wealthy seniors. He would include measures to force down the cost of prescription drugs, which also reduces federal spending, and would count on the deficit-reducing impact of his proposed immigration reform measure (Hennessey and Parsons, 3/4).

The Associated Press: Obama’s Budget: Election-Year Themes To Rally Dems
The Obama budget projects a 2015 deficit of $564 billion and a shortfall this year of $649 billion. If those come true, it would mark three straight years of annual red ink under $1 trillion. … Overall, the 2015 budget projects a $250 billion increase in spending over the record $3.65 trillion expected for the current year. Spending actually dropped to $3.46 trillion in the 2013 fiscal year completed last Sept. 30. Republicans instead want Obama to join them in taking on expensive benefit programs like Medicare and Social Security, whose growth is driving future deficits and squeezing other priorities like defense, education, transportation and research. Medicare costs are projected to almost double over the coming decade. … The plan relies on tax increases and modest spending cuts such as curbing payments to Medicare providers to bring the budget deficit to sustainable levels of below 2 percent of the size of the economy by 2023 (Taylor, 3/4).

The Washington Post: Obama Sends $3.9 Trillion Budget Plan For Fiscal 2015 To Congress
Congress will again be required to address the federal debt limit next March. Lawmakers will face the prospect of full-strength sequester cuts in fiscal 2016 and beyond. And after three years of rapidly declining, deficits once again will begin to rise in 2016, according to the nonpartisan Congressional Budget Office, creating new concern about the sustainability of federal health and retirement programs as the American population ages (Goldfarb, 3/4).

Los Angeles Times: Republicans Draw Election-Year Battle Line Over Obama Budget
House Republicans have promised to respond with their own 2015 budget proposal, even though their document, and the president's, are largely theoretical exercises this year. Thanks to a budget accord reached in December between [Republican Rep. Paul] Ryan and Sen. Patty Murray (D-Wash.), his counterpart in the Senate, spending levels for this year and next have already been approved by Congress and signed into law. Ryan's budget is expected to revisit his ideas for cutting Medicaid and Medicare, including his own signature proposal to cap health care spending for the next generation of Medicare recipients with a voucher program (Mascaro, 3/4).

And an up-close look at the budget for the Department of Health and Human Services -

The Associated Press: Health Care Agency Passes $1 Trillion Milestone
President Barack Obama’s budget pushes Health and Human Services spending over $1 trillion for the first time, reflecting an aging population adding to the Medicare rolls, as well as expanded coverage for younger people through the new health law. Released Tuesday, the HHS budget for the 2015 fiscal year calls for just over $1 trillion, which budget officials said is a new milestone for the department (Alonso-Zaldivar, 3/4).

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$600M For Health Law Implementation In President's Proposed Budget

In the meantime, the budget also proposes $5.5 billion for "risk corridors" in 2015 to pay insurers who find themselves with a higher number of sicker and older people they must insure. Some call that program a bailout.

Kaiser Health News: HHS Seeks $600 Million For Health Law Enrollment Efforts
Just in case Congress doesn’t pass President Barack Obama’s fiscal 2015 budget plan, officials at the Department of Health and Human Services say they have other options for finding the money they need to implement the health care law (Carey, 3/5 ).

The Wall Street Journal: Obama Health Budget Seeks Funds For Health-Law Rollout, Doctor Training
The Obama administration has asked Congress for about $600 million in new funds to continue implementing the Affordable Care Act in 2015, including work on the insurance-enrollment website HealthCare.gov. Health and Human Services Secretary Kathleen Sebelius said Tuesday that it will cost about a total of $1.8 billion to keep rolling out the president's signature health-care law. However, the administration estimates that about $1.2 billion will come from various taxes and fees that were created by the health law. Part of the law's funding comes from fees imposed on the pharmaceutical and health-insurance industries (Corbett Dooren and Burton, 3/4).

Bloomberg: Insurers' Obamacare Losses May Reach $5.5 Billion in 2015
Health insurers such as WellPoint Inc. (WLP) and Humana Inc. (HUM) stand to gain $5.5 billion next year to cover losses from Obamacare in a program the law’s opponents label a bailout. The money, outlined in President Barack Obama’s proposed budget for the fiscal year that begins in October, is designated to help insurers who find the cost of the law higher than expected, based on the percentage of older, sicker people who sign up compared with younger enrollees (Wayne, 3/4).

The Hill: Budget Allots $5.5B For Obamacare Program Decried As A 'Bailout'
The White House’s 2015 budget proposes spending $5.5 billion next year on an Obamacare program that Republicans have labeled a “bailout” of the insurance industry. The Affordable Care Act creates a temporary pool of money, known as risk corridors, to pay insurers who enroll a higher-than-expected number of sick patients through 2016 (Easley, 3/4).

The Fiscal Times: $5.5 Billion For Obama’s Contested Risk Corridors
The president’s 2015 budget proposal includes $5.5 billion in new spending for a controversial Obamacare provision that Republicans have dubbed a “bailout” for insurance companies. Here’s how it works: If signups and pay-ups fall short of the administration’s anticipated goals of getting 6 - 7 million people to pay for Obamacare, with about 40 percent being young and healthy, the cost to insurers would explode. They would, in turn, pass those costs on to consumers in the form of increased premiums and deductibles. The “risk corridor” program establishes a safety net for insurers that don’t earn enough revenue in order to stabilize those premium prices under the health care law (Ehley, 3/4).

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Obama's Budget Eyes Provider Cuts To Save Money

The president's proposal would save $402 billion from Medicare and Medicaid over 10 years, mostly from lower reimbursements to health care providers and drugmakers.

Reuters: Obama Budget Sets Medicare Savings, Hospitals Seek Reprieve
President Barack Obama's budget plan for 2015 would save $402 billion from the Medicare and Medicaid government health care programs for the elderly and poor over the next 10 years, primarily due to reduced reimbursement to health care providers and drugmakers. A White House budget proposal for the fiscal year beginning October 1, released on Tuesday, would save more than $350 billion by pursuing a familiar menu of options that range from increased drug rebates to more efficient post-acute care, reduced hospital admissions and new means testing for Medicare (Morgan, 3/4).

Modern Healthcare: Health Care Providers Oppose Medicare Cuts In Obama's 2025 Budget
President Barack Obama is proposing more than $400 billion in cuts to Medicare over the next decade in his fiscal 2015 budget, an almost identical amount to what he recommended last year. But those cuts are heavily weighted toward future years, with only $3.5 billion occurring in 2015 (Demko and Zigmond, 3/4).

CQ HealthBeat: White House Shies Away From Major Change In Medicare, Medicaid
President Barack Obama’s fiscal 2015 budget would fully fund ongoing implementation of his health care overhaul, while again calling on Medicare beneficiaries and providers to pay more to extend the program’s solvency. Obama’s budget proposal draws on familiar ideas for revamping Medicare and Medicaid and avoids major structural changes to the programs. The proposal’s changes to federal health programs would save approximately $402 billion over 10 years, including $354.1 billion in cuts to Medicare providers and $8.9 billion in savings from Medicaid and the Children’s Health Insurance Program (Ethridge, 3/4).

The Hill: Obama Budget Hits Post-Acute Care, Drugmakers
President Obama's latest budget proposal would hit post-acute-care providers, drug companies and wealthier seniors on Medicare as part of $402 billion in estimated health care savings over the next decade. Familiar from previous White House budgets, the proposals appeared in a document notable for its continuity on health care spending for 2015 (Easley, 3/4).

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State Watch

Highlights: L.A. Nursing Homes Scrutiny

A selection of health policy stories from Texas, California, Arizona, Wisconsin, Connecticut, Virginia and Georgia.

The New York Times: Texas G.O.P. Beats Back Challengers From Right
The primary served as a kind of referendum on Mr. Cornyn. He faced seven challengers, a sign of the frustration among some Tea Party activists and conservative groups with him for failing to back Mr. Cruz in his efforts to shut down the government over Mr. Obama’s health care law and to block a vote to raise the federal debt ceiling. But Mr. Cornyn’s main challenger, Representative Steve Stockman, made few campaign appearances, and Mr. Cornyn beat him easily (Fernandez, 3/4).

Kaiser Health News: L.A. County Health Officials Grilled Over Nursing Home Inspections
The Los Angeles County Board of Supervisors unanimously ordered an audit Tuesday of how the public health department oversees nursing homes, after a news report revealed that managers told inspectors to close cases without fully investigating them. Expressing anger and shock, the supervisors summoned Department of Public Health Director Jonathan Fielding to the meeting to answer questions about the nursing home inspection process. During the heated discussion, Supervisor Mark Ridley-Thomas called for the audit (Gorman, 3/5).

Los Angeles Times: L.A. County Orders Audit Of Department Over Nursing Home Complaints
Los Angeles County supervisors ordered an audit Tuesday of how the county's Public Health Department investigates complaints about health and safety issues at nursing homes. Members of the county board sharply criticized health officials over a report that complaints were not always thoroughly investigated. An investigation by Kaiser Health News found that public health officials told inspectors to close certain cases without fully investigating them in an effort to reduce a backlog (Sewell and Brown, 3/4). 

Kaiser Health News: Health Workers' Union Pushes Hospital Cost Control In California
A California health care workers’ union is collecting signatures to get two measures onto the ballot that it says would lower health care costs. United Health Care Workers West, or SEIU-UHW, wants to cap what hospitals can charge to 25 percent above the actual cost of services. SEIU-UHW says on average, hospitals charge 320 percent above the cost of care (Bartolone, 3/5).

The Arizona Republic: Childhood Trauma Common In Arizona
Growing up in a single-parent household as a result of divorce, death or incarceration. Being the victim of racial or ethnic discrimination. Witnessing gun violence in the neighborhood. A report being released today concludes that children in Arizona experience more trauma than those in other states and that those experiences put them at greater risk for health problems later in life. Several Arizona leaders say the data are the latest alarm bell indicating that the state should focus more resources on child welfare (Wang, 3/4).

The Milwaukee Journal Sentinel: Bill Creating Mental Health Board For Milwaukee County Advances
A bill with bipartisan support that would put control of Milwaukee County's troubled mental health system in the hands of a board of professionals is advancing despite union opposition. A final vote could come as soon as March 18. The measure was prompted by the Milwaukee Journal Sentinel's "Chronic Crisis" investigation, which showed how politicians had ignored decades of calls for reform while patients suffered, many dying of neglect or abuse, in an outdated system (Kissinger, 3/4). 

The CT Mirror: Analysis: Obamacare Won’t Replace Connecticut’s Mental Health Cuts
An early analysis suggests that the assumptions behind a $15.2 million cut to mental health and substance abuse treatment services in this year’s budget aren’t being realized and could leave some service providers with significantly less funding than lawmakers intended. And several legislators said Monday that they’re concerned about what the cuts could mean for access to care. “We’re going to have to do something because we can’t go down this path,” Rep. Cathy Abercrombie, D-Meriden, said during a work session with other members of the legislature’s Appropriations Committee (Becker, 3/4). 

The CT Mirror: CT Mission Of Mercy Free Dental Clinic Targets Pregnant Women
Hoping to correct misconceptions while providing care, the organizers of the Connecticut Mission of Mercy dental clinic are planning a special section for pregnant women at this year’s free clinic in Hartford. Research suggests that fewer than half of pregnant women seek dental care, despite evidence that mothers’ oral health is strongly connected to their children’s dental health. Some research has also suggested that women who don't receive dental care during pregnancy are at a slightly higher risk for preterm delivery (Becker, 3/4).

The Richmond Times-Dispatch: Resignation Raises Questions In Mental Health Probe
A cloud hangs over a state inspector general’s investigation that is supposed to give a long-awaited public accounting of how Virginia’s mental health system treated the son of Sen. R. Creigh Deeds, D-Bath, before he attacked his father Nov. 19. G. Douglas Bevelacqua, who led the investigation as director of the behavioral health division of the Office of the State Inspector General, abruptly resigned his position Tuesday, citing interference by office leadership that weakened the still-unreleased report. The investigation has focused on why Austin C. “Gus” Deeds was released from an expired emergency custody order 13 hours before he stabbed his father multiple times and then shot himself to death at their home in rural Millboro (Martz, 3/4).

Georgia Health News: Hospitalists: The Specialists Whose Patients All Have Beds
Morgan Memorial Hospital in Madison got tired of having so many patients who were just passing through. Too often in the past, the hospital has stabilized newly arrived patients, only to see them quickly bundled off to Athens for further treatment. Ralph Castillo, the administrator for the 25-bed hospital in one of the most famously beautiful communities in Georgia, thinks he has the solution to this stopover problem.  He has launched a program that he says will save lives and keep more patients in Morgan County, closer to home and family. Castillo introduced a team of hospitalists -- mainly physicians who specialize in the care of patients who are admitted to a hospital (Adcock, 3/4).

The California Health Report: As Doctors Struggle With New Electronic Record Systems, Care Can Suffer
According to recent surveys, more than half of California physicians and clinics have switched to electronic health records to comply with the federal Affordable Care Act -- but for many it has not been a smooth process. Implementation problems are, in some cases, hurting patients. “While vendors are making an effort to make their (electronic health) systems more usable, there’s still a lot of room for improvement,” said Glen Moy, senior program officer at the California Healthcare Foundation (Guzik, 3/5).

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Editorials and Opinions

Viewpoints: Obama's Budget Punts On Entitlements; Medicaid Debate Rankles States

The Washington Post: Obama Budget Avoids Needed Entitlement And Tax Reform
There is a lesson in this unexpected juxtaposition nevertheless: No nation can safely base its tax and spending plans on inflexible commitments. Political life, both domestic and international, is too unpredictable. Yet U.S. government spending is mostly on autopilot. The government is scheduled to lay out $3.8 trillion this fiscal year — 70 percent of which will go to mandatory-spending programs, chiefly Social Security, Medicare, Medicaid and interest on the federal debt. Mr. Obama's plan for fiscal 2015 does not change this; it would increase overall spending slightly, paying for it with selected tax increases, while shifting money among priorities here and there. But these tweaks would take place within the same 30 percent of discretionary spending that the current budget contains (3/4).

The Washington Post: A Budget Without Vision
Gone was the proposal from a previous Obama budget to restrain the growth of Social Security costs. Missing was any major proposal to fix the huge long-term deficits in Medicare. Included: $1 trillion in tax increases on business and the wealthy over 10 years, and a wish list of government initiatives, with names such as "Opportunity, Growth, and Security Initiative," "ConnectEDucatos" and "Climate Resilience Fund" (Dana Milbank, 3/4).

In commentary on the Medicaid expansion debates in the states-

Bangor Daily News: LePage's Medicaid Expansion Rhetoric Is Straight Out Of '1984'
The Maine Department of Health and Human Services is apparently employing the concept of doublethink as it continues its attack against Medicaid expansion, resorting to distortion of facts to serve an ideological purpose. On Friday, the department, which has staunchly opposed expansion under Gov. Paul LePage, questioned the preliminary analysis of the nonpartisan Office of Fiscal and Program Review, which found expanding Maine’s health insurance program to 70,000 low-income people would cost the state $ 683,520 over three years (3/4).

Foster's Daily Democrat: Why I Will Always Fight For Life-Saving Health Care
I have championed legislation, LD 1578, to help 70,000 Mainers, including nearly 3,000 veterans, get health care. ... In recent weeks, opponents of our compromise proposal have resorted to desperate attacks on my ethics, alleging that I will see personal financial gain from more Mainers getting health care because I work for a behavioral health organization when the Legislature is not in session. ... As Speaker of the Maine House, I urge lawmakers to debate the merits of the issues not launch desperate or unfounded personal attacks on your opponent’s ethics. We see enough of that in Washington (Speaker of the Maine House Mark Eves, 3/4).

Portland Press Herald: Changes To Plan Don't Redeem MaineCare Expansion's Flaws, Republican Legislator Says
I don’t blame many people for thinking that expanding Medicaid in Maine under Obamacare sounds like a great idea at first glance. Free money from the federal government? More people covered by free health insurance? Where do we sign up? However, when you examine the fine print, as well as Maine’s past experiences with welfare expansion, you quickly begin to have second thoughts. Medicaid expansion entails putting 70,000 or more able-bodied adults on medical welfare at a massive cost to the state (Republican Rep. Deborah Sanderson, 3/3).

Bangor Daily News: Help Us Serve Low-Income Patients In Maine By Expanding Medicaid
Recently, as leaders from the federally qualified health centers of Washington County, we spent a day in the Hall of Flags at the State House in Augusta to showcase the resources, initiatives and services we provide to our communities. ... we stressed how an additional $300 million in federal funds to the state of Maine would ease the hard times for many people. With those funds, Maine will provide health care service to an additional 70,000 people while thoughtfully looking at ways to reduce costs. ... Sadly, Maine is one of 25 states that have not chosen to accept the federal funds, and it's hurting poor parents and other adults who otherwise remain ineligible (Lee Umphrey and Holly Gartmayer-DeYoung, 3/4). 

Miami Herald: Lawmakers Would Be Negligent In Declining Federal Help
It's this simple: The Florida Legislature cannot afford to decline federal dollars for healthcare. A state with an estimated 3.3 million uninsured — even in a post-Affordable Care Act world — can't continue to play political games and forgo $51.3 billion in federal funds (Fabiola Santiago, 3/4).

Roanoke Times: Make Health Care A Priority In Va.
Under full Medicaid expansion, or even the Republican Senate compromise I spoke in favor of on the House floor, we will shift the overwhelming majority of indigent care costs away from the commonwealth. This would save Virginia $1.1 billion. Some Virginia legislators would rather mask the issue by funding our health care priorities through cuts in core government functions such as education, law enforcement and economic development. However, the expansion of health care to all Virginians is the fiscally responsible option for the commonwealth. Not making health care coverage available to everyone hurts society in many ways, as we inevitably pay for all health care costs in one way or another (Democratic State Del. Sam Rasoul, 3/5).

And on other health issues-

The New York Times: Some Progress On Eating And Health
For those concerned about eating and health, the glass was more than half full last week; some activists were actually exuberant. First, there was evidence that obesity rates among pre-school children had fallen significantly. Then Michelle Obama announced plans to further reduce junk food marketing in public schools. Finally, she unveiled the Food and Drug Administration’s proposed revision of the nutrition label that appears on (literally, incredibly) something like 700,000 packaged foods (many of which only pretend to be foods); the new label will include a line for "added sugars" and makes other important changes, too (Mark Bittman, 3/4).

Los Angeles Times: Fecal Transplants: A Therapy Whose Time Has Come
Clostridium difficile is a dangerous infection that, as its name implies, is not always easy to treat successfully with antibiotics. In many cases, the infection is actually triggered by antibiotic use during hospitalization; the medications kill beneficial bacteria that keep C. difficile in check. Now, some doctors are treating the infection with a procedure called fecal transplant, an unappealing but extremely effective approach that involves transferring filtered stool from a healthy donor to a patient afflicted with the disease, to reintroduce the helpful gut bacteria (3/5).

JAMA Internal Medicine: Comparing Diabetes Medications: Where Do We Set the Bar?
More than 25 million Americans have type 2 diabetes mellitus and face decisions about which medications to use to lower glucose levels. These decisions are increasingly complex (now involving 12 different classes of glucose-lowering agents) and increasingly costly (resulting in over $18 billion in annual expenditures). Yet, despite the enormous health and economic implications of these decisions, there are few comparative effectiveness outcomes studies to guide clinical practice (Drs. Kasia J. Lipska and Harlan M. Krumholz, 3/3).

JAMA Neurology: Medicare Coverage of Investigational Devices: The Troubled Path Forward For Deep Brain Stimulation
Medicare coverage plays an important role in innovative device-based therapy in a market with increasing medical device costs and scarce financial resources. In January 2014, the Centers for Medicare and Medicaid Services (CMS) implemented changes to coverage policies for items and services associated with investigational device exemption (IDE) studies.1 Medicare’s changes centralize coverage decisions and establish 10 new ethical and scientific criteria for coverage determination. Despite revision, current policies risk curbing the advancement of an innovative treatment known as deep brain stimulation (DBS) (P. Justin Rossi, Dr. Andre Machado and Dr. Michael S. Okun, 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.