Daily Health Policy Report

Wednesday, March 6, 2013

Last updated: Wed, Mar 6

KHN Original Reporting & Guest Opinion

Health Spending And Fiscal Battles

Capitol Hill Watch

Health Reform

Health Care Marketplace

Health Information Technology

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Minnesota Legislature Hammers Out Exchange Bill

MPR News' Elizabeth Stawicki, working in partnership with Kaiser Health News and NPR, reports: "The Democratic-majority 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 Monday could run into trouble with Gov. Mark Dayton, a Democrat" (Stawicki, 3/6). Read the story.

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Capsules: Got A Health Care Puzzle? There Should Be An App!

Kaiser Health News: Capsules: Got A Health Care Puzzle? There Should Be An App!
Now on Kaiser Health News’ blog, Capsules, KCUR’s Elana Gordon, working in partnership with KHN and NPR, reports: "Kansas City, Mo., is looking to boost its health-tech cred. So the city that’s home to Cerner Corp. and other health information firms seemed a natural to host something called the Hackovate Health Innovation Competition" (Gordon, 3/5). Check out what else is new on the blog.

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Political Cartoon: 'Use Only As Directed?'

Kaiser Health News provides a fresh take on health policy developments with "Use Only As Directed?" by Roy Delgado.

Meanwhile, here is today's health policy haiku:


What's this snowquester?
Is it real? Or is it hype? 
The truth comes later... 

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

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Health Spending And Fiscal Battles

Obama Reaches Out To Rank-And-File Republicans To Make Deal

Though the Obama administration and congressional Republicans are working to minimize the pinch of the sequester's short-term spending cuts, both sides are preparing for another Medicare battle.

The Associated Press/Washington Post: White House And Republicans Work To Ease Impact Of Spending Cuts; Fight Over Medicare Looms
The Obama administration and congressional Republicans are quietly working in tandem to blunt the impact of short-term spending cuts that kicked in with dire White House warnings a few days ago, with both sides eager to pocket the full savings for deficit reduction as they pivot to a new clash over Medicare. The overall size of the cuts remains in place: $85 billion in reductions through the end of the budget year on Sept. 30, half from defense and half from domestic programs as diverse as education, parks and payments to doctors and hospitals treating Medicare patients (3/6).

The New York Times: Trying To Revive Talks, Obama Goes Around GOP Leaders
Yet such expressions of hope are increasingly scarce in Washington. While Mr. Graham said he and Mr. Obama agreed that a comprehensive deal could be reached to both slow the growth of the entitlement programs like Medicare and raise revenues by curbing costly tax breaks, that optimism is not the prevailing sentiment. Proponents in both parties have all but given up on a grand bargain in view of the chasm between Mr. Obama, who insists that revenues be part of the equation, and Republican leaders, who are just as adamant against raising taxes further (Calmes and Weisman, 3/5).

The Washington Post: Seeking A Budget Deal, Obama Reaches Out To Republican Rank And File
In a flurry of meetings and phone calls over the past few days, Obama has courted more than half a dozen Republicans in the Senate, telling them that he is ready to overhaul expensive health and retirement programs if they agree to raise taxes to tame the national debt. Graham has repeatedly said he could support the White House's goal of raising $600 billion in new revenue over the next decade in exchange for reforms to health and retirement programs. Now, he said, "what I see from the president is probably the most encouraging engagement on a big issue I’ve seen since the early years of his presidency." Sen. Susan Collins (R-Maine) said she, too, welcomed Obama's call (Montgomery and Helderman, 3/5).

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Capitol Hill Watch

Ryan's Medicare Plan Said To Back Away From Age Cutoff

News organizations report that House Budget Committee Chairman Paul Ryan, R-Wis., is expected to exempt people 55 years old and older from his Medicare overhaul — despite his personal preference to raise that age to 56.

The Wall Street Journal: Ryan Budget Plan Draws GOP Flak
House Republican leaders, faced with the daunting task of writing a budget that would eliminate deficits within 10 years, are backing away from a proposal to revamp Medicare for more Americans than previously suggested. House Budget Committee Chairman Paul Ryan (R., Wis.) has in recent weeks floated the idea of rolling back the GOP promise that people 55 and older would be exempt from his signature plan to offer future retirees a subsidy to buy private health insurance as an alternative to traditional Medicare (Hook, Peterson and Boles, 3/5).

Politico: Sources: No Medicare Age Shift In Paul Ryan Budget
Rep. Paul Ryan's budget is now expected to exempt seniors 55 years old and above from his Medicare overhaul — despite his personal preference to raise that age to 56 — according to several GOP sources familiar with his plans. For years, the House Budget Committee chairman has sought to transform Medicare from its current fee-for-service format to one in which the government would give seniors limited subsidies to buy private insurance. The key political caveat: No one within a decade of the Medicare eligibility age of 65 would have been affected by the overhaul the Wisconsin Republican envisioned (Sherman and Allen, 3/5).

The Medicare NewsGroup: Rewind, Rehash And Reject: No Movement Expected On Medicare Reform In 2014 Budget
At least one thing is certain in this congressional budget season: disagreement will be the order of the day. The president and Congressional leaders have already failed to avert billions in across-the-board spending cuts under sequestration, setting the stage for more fighting over how to shrink the deficit. When it comes to Medicare reform, most experts say that they expect to see the same plans that lawmakers laid on the table last year and they don't expect that the feuding parties will reconcile their considerable differences. GOP congressional members have already pulled out old ideas, blown off the dust and called them by different names. Since the election, Republicans have reintroduced premium support proposals under the new moniker "competitive bidding." Rep. Paul Ryan (R-Wis.) and the House Republicans are poised to be the first out of the gate with another premium support proposal (Adamopoulos, 3/5).

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Health Reform

Feds To Kick Off Campaign To Reach Uninsured In July

Politico reports that the Obama administration will begin a pitch to enroll the uninsured beginning in July. Other media outlets explore how the sequester won't interrupt the startup of the health law's new fees and taxes, and how Republicans hope to eliminate those through a tax overhaul.

Politico: Feds Plan Pitch To Uninsured
The Obama administration will begin reaching out to people who could get insurance through the health reform law this July, less than three months before they can sign up for new coverage. "If we get too much of a head start with beneficiaries about what they can expect in 2014, … but say that it's not available to you for six months or seven months, then folks tend to lose interest," Marilyn Tavenner, the acting administrator of the Centers for Medicare & Medicaid Services, told the Federation of American Hospitals at its Washington conference Tuesday (Haberkorn, 3/6).

Politico: Smokers Can Skirt Higher Premiums
Under the health law, insurers next year will be able to charge smokers up to 50 percent more than nonsmokers. Unless smokers don't tell the truth. Or if they enroll in a smoking-cessation program. ... “Ultimately, the determination of whether or not a person is a smoker … is up to the honor of that individual,” said Tom Harte, president-elect of the National Association of Health Underwriters. “That is a real threat to the validity of the tobacco rating" (Norman, 3/6).

The Hill: Sequester Won’t Interrupt Collection Of Taxes From 'ObamaCare'
Implementation of the taxes and fees from President Obama’s healthcare law is on track despite the cutbacks at the IRS from sequestration. The Affordable Care Act (ACA), enacted in 2010 and derided by Republicans as "ObamaCare," contains the broadest set of tax changes enacted in some two decades — more than 40 alterations in all, including penalties on people who choose not to purchase insurance (Becker and Baker, 3/6).

CQ HealthBeat: Boustany: Health Care Law Tax Changes To Be Wrapped In Tax Code Overhaul
As the Ways and Means Committee prepares to overhaul the tax code, repeals or changes to health law taxes will be included, the chairman of the panel’s oversight subcommittee said Tuesday. Subcommittee Chairman Charles Boustany Jr., R-La., said simplification of the tax code is a priority as Ways and Means Chairman Dave Camp, R-Mich., embarks on a tax code overhaul. The health care law “took us in a different direction,” Boustany said, speaking after a hearing at which he heard from a series of unhappy business owners and tax experts (Norman, 3/5).

In related news -

The Hill: Insurers Ready To Battle Medicare Cuts
The health insurance industry is beginning a ferocious lobbying offensive aimed at warding off major cuts to Medicare payments. Insurers are hoping to block a 2.2 percent cut in government payments to the privately administered Medicare plans known as Medicare Advantage (Baker, 3/6).

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Va. Gov. McDonnell Sends Sebelius A Stern Message On Medicaid Expansion

Meanwhile, Iowa's governor offers an outline of his alternative expansion plan while Ohio officials continue to press federal officials for flexibility.

The Associated Press/Washington Post: McDonnell, Under Fire From GOP Right, Sends Sebelius Stern Letter On Va. Medicaid Expansion
Under fire from the conservatives in his own Republican Party, Virginia Gov. Bob McDonnell sent the Obama administration a letter Tuesday ruling out Medicaid expansion in the 10 months left in McDonnell’s four-year term. In the seven-paragraph letter, McDonnell bluntly states to U.S. Health and Human Services Secretary Kathleen Sebelius that the expansion of the federal-state health program for the poor, elderly and disabled is his prerogative, not that of a commission. He also lectures her on shortcomings he sees in the President Barack Obama's Patient Protection and Affordable Care Act (3/5).

The Washington Post: McDonnell To Feds: No Medicaid Expansion
The governor wrote the letter at a time when conservative critics are accusing him of giving ground on Medicaid expansion in order to bolster his legacy with a sweeping transportation funding plan (Vozzella, 3/5).

Richmond Times-Dispatch: McDonnell Tells U.S. That Va. Has Not Embraced Medicaid Expansion
Gov. Bob McDonnell told the Obama administration in a letter Tuesday that the state legislature’s actions regarding Medicaid are not tantamount to expansion. McDonnell, who leaves office in January, reiterated that the program must undergo significant reforms at the federal and state levels if Virginia is to expand coverage and that he is not inclined to endorse expansion on his watch (Cain, 3/6).

Des Moines Register: Branstad Outlines Alternative To Medicaid Expansion
Iowa should seek to change how poor people receive health insurance in the same kind of way the state reformed how people could qualify for welfare payments in the 1990s, Gov. Terry Branstad said Monday. The federal government wants Iowa to let about 150,000 more Iowans join Medicaid, the government health insurance program for the poor. Branstad, a Republican, instead proposed Monday that Iowa adopt a new program, the Healthy Iowa Plan, whose participants would have to pay small premiums or adopt healthful habits, such as getting regular checkups. The participants would get their care from clinics and hospitals that would be paid to keep them well instead of just providing more and more tests and treatments (Leys and Noble, 3/4).

The Associated Press: Ohio Officials Still Seek Medicaid Flexibility
Ohio continues to press the federal government for flexibility as state lawmakers review whether to expand the Medicaid program under President Barack Obama’s health care law. Greg Moody, director of the governor’s Office of Health Transformation, told reporters Tuesday he’s encouraged by discussions with the Obama administration, but he said it’s too soon to say the two sides have reached an agreement (3/5).

Stateline: Interview: A Southern Medicaid Director's Perspective On Health Care Reform
The ranks of Republican governors refusing to expand Medicaid has shrunk in recent weeks. Nationwide, 14 of the nation’s 28 Republican governors have rejected the federally funded expansion. Eight of the holdouts are in the South. Carol Steckel sides with the governors who have decided not to expand Medicaid. Newly appointed head of North Carolina’s Medicaid program, she will oversee a top-to-bottom internal overhaul. Shortly after Steckel took the job, the state’s new Republican governor, Pat McCrory, declared the Medicaid program "broken and not ready to expand" (Vestal, 3/6).

The Associated Press: Dem: Miss. Gov A 'Fool' Not To Expand Medicaid
A Democratic lawmaker said Monday that Mississippi's Republican governor is a "fool" and a "hypocrite" for opposing Medicaid expansion. Gov. Phil Bryant has said repeatedly during the past year that Mississippi, one of the poorest states in the nation, can't afford to add up to 300,000 people to the more than 640,000 who are already on the federal-state health insurance program for the needy. The state has about 3 million residents (3/5).

National Journal: The Obama Administration's Super-Expensive, Legally Dubious Medicaid Plan
The Obama administration has hit upon a creative strategy to encourage Republican politicians to expand state Medicaid under the health care law. The only trouble: The plan is costly and its legal justification tenuous. The plan was unveiled last week when Arkansas Gov. Mike Beebe, a Democrat, said his state might use Medicaid dollars to enroll new patients in the same private health plans that will be available for residents with higher incomes (Sanger-Katz, 3/6).

Bloomberg: Texas Protesters Urge Perry To Seek Medicaid Expansion For Poor
Hundreds of protesters gathered at the Texas Capitol demanding Governor Rick Perry join other Republican governors expanding Medicaid for the poor under the U.S. health-care overhaul. Enlarging the joint state-federal program would allow uninsured Texans to be treated by primary-care doctors instead of relying on emergency rooms, said Roland Goertz, a Waco physician, at the rally yesterday in Austin (Mildenberg, 3/6).

The New York Times: Anger And Kudos As Florida Governor Tacks Left
A few days after Gov. Rick Scott of Florida endorsed a Medicaid expansion, a U-turn so sharply executed that it flabbergasted his supporters, the head of a local Tea Party group typed up a "breakup note." … Mr. Scott, 60, a former health care executive who won the governorship by calling for deep budget cuts and fiercely criticizing President Obama's health care bill, has, in his third year in office, marched toward the political center, a necessity in this diverse swing state (Alvarez, 3/5).

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Minn. House's Exchange Bill Faces Challenges With Senate And Governor

The plan to create a state insurance marketplace includes some abortion restrictions that are expected to meet resistance.

Kaiser Health News: Minnesota Legislature Hammers Out Exchange Bill
The Democratic-majority 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 Monday could run into trouble with Gov. Mark Dayton, a Democrat" (Stawicki, 3/6).

The Associated Press: Minn. House Passes Health Exchange Proposal
The Minnesota House passed a bill Monday establishing the state's health insurance exchange, the first step toward enactment of an online marketplace that aims to give more than a million Minnesotans a new place to purchase affordable health insurance. Rep. Joe Atkins, the chief House sponsor, called the bill creating a health insurance exchange "the most significant health reform in 50 years" -- since Medicare and Medicaid were created in 1965. The exchanges are a centerpiece of the federal health care overhaul (Condon, 3/5).

MinnPost: Outlook For Minnesota's Health Exchange: It Will Come Down To Negotiations Later
The stage is set for lawmakers' final negotiations to shape Minnesota's landmark health insurance exchange. The state House passed the exchange legislation Monday night along roughly party lines, teeing up the measure for a Thursday vote in the Senate (Nord, 3/5).

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Health Care Marketplace

Medical Pricing Transparency: Sometimes The Real Cost Matters

Atlanta Journal Constitution: Push For Price Transparency In Health Care
For many people with health insurance, the actual final cost of a medical service they receive is a mystery not worth solving. After all, it’s covered. But for the nearly 50 million Americans without health insurance, as well as those with very high insurance deductibles, or who seek services not covered under their policies, the real price matters: They pay cash. Finding out what a certain procedure should fairly cost, however, can be difficult. Now, a few online companies, including a brand-new startup in Alpharetta, have emerged to serve the cash-paying health market niche, offering what they describe as greater price transparency and ease of use, not to mention discounts to their users (Markiewicz, 3/5).

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High Court To Consider Whether Drug Company Deals Restrain Trade

Philadelphia Inquirer: Case Pits Generic Drug Makers Against Insurers, Stores
Generic drugs have dramatically changed the pharmaceutical and health-care landscape in the last 25 years and now account for about 80 percent of prescriptions in the United States, with lower prices for consumers and insurers. But a U.S. Supreme Court case scheduled for argument March 25 pits drug companies, generic and branded, against government officials who argue that prices for consumers would be even lower if those companies did not strike deals to restrain trade. Drugstore chains and health insurers back the government's side. Trying to buttress his case, Ralph Neas, president of the Generic Pharmaceutical Association, said in a conference call with reporters Tuesday that the ruling "will define how an entire industry does business." An adverse decision will hurt drugmakers, consumers, and taxpayers, who pay the drug bill through public or private insurance, he argued (Sell, 3/6).

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Health Information Technology

Technology Aids, Such As Electronic Alerts, May Help Prevent Missed Diagnoses

But the authors of the analysis of past studies on electronic-based patient safety efforts say few of those studies have tracked direct improvements to patient health, Reuters reports.

Reuters: Patient Safety Efforts May Prevent Diagnostic Errors
Electronic alerts and other technology-based aids may help prevent costly missed or delayed diagnoses, according to a new review of past evidence. … But, according to the researchers behind the new analysis, most studies have not tracked whether patient safety efforts aimed at preventing such mistakes directly improve patient health down the line, or considered their costs and possible harms (Pittman, 3/5).

Modern Healthcare: CMS Launches eHealth Website
The CMS launched the eHealth initiative this week as a central repository for information on the federal government's digital record-keeping and electronic prescribing initiatives. The page provides a central location to search the CMS site for details of the major digital health initiatives, including the $22 billion electronic health-record incentive program, the hospital inpatient quality reporting system and the e-prescription incentive program. … Although the digital records initiatives were launched by different laws in recent years, Tagalicod framed them as part of an overarching eHealth infrastructure "that will transform our healthcare system by capturing and tracking health information electronically" (Daly, 3/5).

Modern Healthcare: Sequester Will Hit EHR Incentive Program
The fiscal trap that members of Congress and the president set for themselves will punch a 2% hole in one of the federal electronic health-record incentive payment programs under the American Recovery and Reinvestment Act, a federal official has confirmed. The cuts, called the sequester, include an across-the-board reduction in Medicare payments. EHR incentive payments distributed under Medicaid won't be affected. On March 1, President Barack Obama signed an order for sequestration that set in motion automatic federal budget cuts required by the Budget Control Act of 2011, the legislative effort passed by Congress with cuts promoted at the time to be so draconian that they would compel both Republicans and Democrats to reach a budget compromise (Conn and Zigmond, 3/5).

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State Watch

Ark. Senate Overrides Veto Of Bill That Would Ban Abortion After 12 Weeks; House Could Follow Wednesday

Lawmakers in the state House could as early as Wednesday follow the example of their Senate counterparts to override Ark. Gov. Mike Beebe's veto of a bill that would ban most abortions in that state after 12 weeks of pregnancy. If it becomes law, it will become one of the most restrictive laws on abortion in the nation.

The Associated Press/Wall Street Journal: Arkansas Senate Overrides Abortion-Ban Veto
The Arkansas Senate voted Tuesday to override Gov. Mike Beebe's veto of legislation that would ban most abortions from the 12th week of pregnancy onward and would give the state the most restrictive abortion laws in the country (3/5).

Politico: Arkansas Backs 12-Week Abortion Ban – Earliest In Nation
The Arkansas Senate voted Tuesday to override Democratic Gov. Mike Beebe's veto of a bill that could become the earliest abortion ban in the nation. The bill now goes to the Republican-controlled House, which could vote as early as Wednesday. If a majority votes to override the veto -- as advocates on both sides expect -- the bill will become law (Smith, 3/5).

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Mental Health News: Ore. Lawmakers Make Children's Funding Push

Lawmakers and officials from Oregon, Connecticut and around the nation deal with treating and paying for how they treat the mentally ill.

The Lund Report: State Could See "Game-Changing" Spike For Children's Mental Health
Courtney signaled for community mental health -- at least for children -- when the increased funding made a list of priorities when the co-chairs released their two-year spending plan Monday morning. Courtney's proposal called for a funding increase of $331 million for community mental health, including $46 million for children and adolescents -- $28 million more than what Gov. John Kitzhaber had earmarked (Gray, 3/5).

CT Mirror: Mental Health Panel Makes Four Recommendations
The bipartisan panel examining mental health issues agreed Tuesday to four recommendations that could become part of legislation intended to respond to the mass shooting at Newtown's Sandy Hook Elementary School. Legislative leaders are crafting a bill to address mental health, gun violence and school security. It's expected to be taken up in the coming weeks. The mental health panel also released 21 recommendations that didn't get support from the full group, including changes to insurance regulations and gun permit applications, expanding school-based health centers, allowing outpatient commitment, and moving responsibility for children's mental health from the Department of Children and Families to the Department of Mental Health and Addiction Services (Becker, 3/5).

CBS Evening News: Patients As Prisoners, Jails As New Mental Health Institutions (Video)
Congress today heard from parents of mentally-ill children, describing long waits for mental health care and a shortage of psychiatrists. The problems have become urgent in the wake of mass killings including those at Newtown, Connecticut and Aurora, Colorado. With a shortage of mental facilities, jails have become the new asylums. At Chicago's biggest jail, a mentally ill inmate does a front flip on her bed, refusing medication. Correctional and medical staff moves in as the inmate struggles and they put their hands on her back, trying to restrain her. Cook County Sheriff Tom Dart says it's just another day at his jail. ''This is something that happens all the time here and the heart of it is, we're not a mental health facility. These people should not be here,'' said Dart (Miller, 3/5).

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State Roundup: Panels Formed To Fight Federal Powers, Health Law

A selection of health policy stories from Oklahoma, Pennsylvania, California, Colorado and Maryland.

The Associated Press/Washington Post: In Oklahoma And Other GOP States, Lawmakers Form Special Panels To Fight Federal Powers
One bill would make it a felony to enforce the new federal health care law, punishable by up to five years in prison. Another prohibits a physician from asking a patient about firearms. Yet another is designed to curb the possible influence of the United Nations in local government. While provocative bills aren't particularly unusual in state legislatures, so many have been offered by conservatives in Oklahoma this year that GOP leaders have established a special committee to handle what is now a major category of business: measures to combat the federal government's influence in the states (3/5).

The Associated Press: About 3,000 People Who Were Eligible Lost Medicaid In Pennsylvania
About 3,000 people who had been bumped off the state's Medicaid rolls amid a case review that alarmed advocates for the poor were found to be eligible for the health care program, Gov. Tom Corbett's top public welfare official told senators on Tuesday. Bev Mackereth, the Department of Public Welfare's acting secretary, told a Senate Appropriations Committee hearing that her agency made the discovery after sending more than 100,000 letters to people who'd had their cases closed after the review began in August 2011 (3/5).

The Associated Press: Pa. Court Directs Tobacco Money To Health Care
Pennsylvania government officials were trying to determine the impact of a judge's ruling Tuesday that a portion of the state's unspent tobacco settlement money go to the defunct adultBasic health insurance program for lower-income adults or a similar plan, rather than be used to help balance the government budget. Commonwealth Court Judge Dan Pellegrini, applying a previous and related court ruling, declared unconstitutional two state laws that siphoned the money from adultBasic and Medicaid for disabled workers (3/6).

Los Angeles Times: Officials Consider Adding More Beds To County/USC Medical Center
Faced with severe overcrowding and emergency room wait times that average 12 hours, Los Angeles County officials are considering adding 150 more beds to County/USC Medical Center. The county opened a new state-of-the-art hospital in 2008 to replace an aging general hospital tower. But even before the doors opened, officials worried that it wouldn't be big enough. The new hospital has 600 inpatient beds, 224 fewer than its predecessor (Gorman, 3/5).

NPR: For Elderly Midwife, Delivering Babies Never Gets Old
Increasingly, people are continuing to work past 65. Almost a third of Americans between the ages of 65 and 70 are working, and among those older than 75, about 7 percent are still on the job. In Working Late, a series for Morning Edition, NPR profiles older adults who are still in the workforce. Sometimes you can't retire even if you want to. For Dian Sparling, a certified nurse midwife in Fort Collins, Colo., there's no one to take over her practice. But at 71, she's finding that staying up all night delivering babies is harder than it used to be (Jaffe, 3/6).

Baltimore Sun: Health Employees Seek Legislation To Address Workplace Violence
Bernice Troy, a geriatric nursing assistant in Baltimore for the past 20 years, has been spat on and cursed, scratched and punched on the job. A patient once slammed Jo Samrow, a nurse in Southern Maryland, into a wall so violently that she developed a large hematoma on the back of her head. In recent weeks, these nurses and other health care workers have shared their stories before lawmakers in Annapolis with one goal in mind -- reducing assaults in Maryland health care facilities. "All I want is for my facility to care about my safety," Troy told the House Economic Matters Committee during a recent hearing on a proposed bill that would bolster violence prevention standards at health facilities across the state (Rector, 3/5).

California Healthline: Oversight Hearing On CBAS Transition Generates Sparks
A legislative oversight hearing last week on the transition of about 37,000 frail and elderly enrollees from the Adult Day Health Care program, which was eliminated by the state, into the Community Based Adult Services managed care program was marked by skepticism and criticism. One year after the settlement of a lawsuit led to the creation of the CBAS program, legislators and advocates for the elderly questioned the state's handling of the transition at a hearing of the Assembly Budget Subcommittee on Health and Human Services. Department of Health Care Services Director Toby Douglas testified that 80 percent of the ADHC enrollees were found eligible for CBAS (Gorn, 3/5).

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Editorials and Opinions

Viewpoints: Doctors, Nurses Not Reaping Same Health Care 'Bonanzas' As Other Providers; House GOP Spending Plan Doesn't Solve Budget Problems

Reuters: Coming Up With "A Bitter Pill"
When I followed the money trail (in Time magazine's story "A Bitter Pill") behind the drugs, medical devices or CT scan equipment that the patients or their insurance companies were billed for, the profit margins for the hospitals that supplied them, as high as they were, were eclipsed by the margins of the manufacturers that sold them to the hospitals. In the case of the drug companies, their research and development costs, it turned out when their securities filings were examined, were not nearly high enough to justify prices. ... In other words, everyone along the supply chain – from hospital administrators (who enjoy multimillion-dollar salaries) to the salesmen, executives and shareholders of drug and equipment makers ‑ was reaping a bonanza. The only exceptions, I found, were those actually treating the patients ‑ the nurses and doctors (Steven Brill, 3/5).

Los Angeles Times: Fiscal Crisis? What Crisis?
Here's what is most maddening about the "Perils of Pauline" fiscal crises that President Obama and Congress have led us into during the last year: Both sides have known from the beginning what the final deals would look like, but neither side has been willing to budge before it had to. ... So why can't they stop dithering and do what needs to be done? Two reasons. First, any long-term solution requires each side to swallow something they find unpalatable. Democrats hate the idea of cutting government spending while the economy is still struggling. And they certainly don't relish cutting Medicare, Medicaid and Social Security. Republicans, for their part, don't want to raise taxes if they can avoid it; that's the core principle that ties their fraying party together. And that leads to the second reason we don't have a deal: The two sides don't trust each other (Doyle McManus, 3/6).

Los Angeles Times: The House GOP's Spending Problem
This week the (House) leadership plans to bring up a bill to fund the federal government's operations for the final six months of fiscal 2013. The measure would update the spending priorities for the military and veterans but leave the rest of the government on autopilot, with the funding for individual programs left exactly where it was set in 2011. Those funding levels would then be reduced by the mindless across-the-board cuts of the "sequester" that went into effect March 1. As a result of the outdated allocations and meat-cleaver cuts, some valuable programs would receive too little funding while low-priority projects would receive too much (3/6).

USA Today: Health Care Pricing Transparency For All: Our View
Cars are one of the most expensive things most people ever buy, so today's auto-buyers have easy access to information on quality, reliability and price. Empowered consumers help keep the prices of cars down and the quality up. On the other hand, shopping for another one of the most expensive things most people ever buy — health care procedures such as colonoscopies or hip replacements — just doesn't work. Prices are shrouded in secrecy (3/5).

USA Today: Most Health Costs Data Of Little Use: Opposing View
The idea of turning passive patients into active consumers using cost and quality to choose doctors, hospitals and treatment options is a compelling but unrealistic solution to our serious health care affordability problems, In theory, price transparency is a powerful tool. In practice, price transparency makes little difference to most insured consumers because the structure of their health benefits does not reward the choice of lower-cost providers (Paul Ginsburg, 3/5). 

Des Moines Register: Many Health Insurance Questions Still Need Branstad's Answers
Iowa's Republican Gov. Terry Branstad is philosophically opposed to expanding Medicaid. He wants to implement a different program, instead, and that’s what the Healthy Iowa Plan is. However, the people who will judge whether a Healthy Iowa is a suitable replacement for an expansion of Medicaid need lots and lots of details that Branstad’s staff has not fleshed out yet. It’s too early to predict the outcome of this. But time is running out to present these details to Iowans, to the Legislature and to the federal government (3/5).

Boston Globe: This Board Knows Best
Allow me to congratulate the board of directors of Blue Cross Blue Shield of Massachusetts for its part in continuing to support the public's mistrust of all things that emanate from the boardroom. Board members have voted to reinstate their own compensation. The move comes nearly two years after the state's largest health insurer suspended board compensation in response to Attorney General Martha Coakley's push for health care nonprofits to end pay for board members. But don’t worry — Blue Cross’s board did not make this move on a whim. According to spokesperson Jay McQuaide, the board did this only after undertaking a two-year process to strengthen its “governance practices to make sure they are in line with best practices.” I feel better now. That completely erases the fact that these are many of the same people that voted in 2010 to reward the insurer’s outgoing CEO an $11 million golden parachute after the company posted a $149 million loss (Mark Rogers, 3/6).

The Lund Report: The Hidden Truths Behind Health Reform
Outside of Medicaid, there are two groups of people in Oregon, those with insurance, and those without. The group with insurance, for the most part, has no clue that they will lose their existing coverage next year and will have to purchase one of the new plans. The only exception is those with grandfathered plans, of which there are very few in Oregon. The other group has been waiting for their free health care (we get calls weekly). What will these people do when they find out they still have to pay a premium and only 70 percent of their healthcare is covered? Add to that the 21-page draft application, that looks more like an IRS form than a health application, they will have to fill out to qualify for a subsidy (John Gridley, 3/5).

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Stephanie Stapleton

Andrew Villegas

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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.