Daily Health Policy Report

Thursday, March 7, 2013

Last updated: Thu, Mar 7

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform


Health Care Marketplace

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

In Conservative Arizona, Government-Run Health Care That Works

Kaiser Health News staff writer Sarah Varney reports: "In a low-slung building in the vast desert expanse east of Phoenix, a small school of tropical fish peer out, improbably, from a circular tank into the waiting lounge of the Apache Junction Health Center. The hallways of the nursing home are still. Only half of the rooms are filled, and the men and women who live here seem surely in life’s final season. 'These are folks that have chronic cognitive and physical disabilities that are not going to improve,' said George Jacobson, administrator of the nursing home" (Varney, 3/7). Read the story.

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Medicaid Expansion Divides Florida GOP

WFSU's Lynn Hatter, working in partnership with Kaiser Health News and NPR, reports: "As the Florida legislature convened this week, House Speaker Will Weatherford helped rally fellow Republicans opposed to expanding the state's Medicaid coverage to more than a million low-income residents, but he also acknowledged that his own family benefitted from a program for low-income families without health insurance" (Hatter, 3/7). Read the story.

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Capsules: House Spending Bill Cuts Funding For Exchanges

Now on Kaiser Health News' blog, Mary Agnes Carey reports: "You don't hear much these days about Republicans trying to repeal the 2010 health care law. The Supreme Court ruling last June upheld most of the measure. President Obama's re-election and Democrats' continued control of the Senate have helped 'Obamacare' implementation to move ahead" (Carey, 3/7). Check out what else is on the blog.

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Political Cartoon: 'No Moss?'

Kaiser Health News provides a fresh take on health policy developments with "No Moss?" by Paul Fell.

Meanwhile, here is today's health policy haiku:


The CR budget
passed with the snowquester's speed.
Both underwhelming.

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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Capitol Hill Watch

House GOP, Senate Dems To Unveil Competing Budget Plans Next Week

As President Barack Obama courts Republican lawmakers who might be interested in a "grand bargain," the chairmen of the House and Senate Budget Committees are expected to release competing budget proposals. Some hope a conference committee might be able to work out the differences on taxes and spending, including changes to Medicare.

The Washington Post: House Votes To Avert Shutdown As Obama Looks For Big Deal
With a government shutdown now unlikely, Obama is focusing on a new round of talks that the White House hopes could break the fiscal impasse. After more than two years of negotiations with GOP leaders that did not achieve a "grand bargain," the president is courting rank-and-file Republicans who may be interested in a deal that pairs cuts in entitlement programs with a tax overhaul that would include new revenue (Helderman and Rucker, 3/6).

USA Today: Congress To Kick Off Budget Debate Next Week
The debate that budget hawks have been waiting for kicks off in Washington next week when House Republicans and Senate Democrats unveil competing blueprints on the size and reach of the federal government. … Senate Budget Committee Chairwoman Patty Murray, D-Wash., has indicated Democrats will target tax loopholes to raise revenue, protect entitlement benefits and echo President Obama's fairness theme in paying down the debt. It is the first time since 2009 that Senate Democrats will produce and approve a budget resolution. … Ryan's budget is expected to again include a proposal to revamp Medicare from a guaranteed benefit to a premium support system in which seniors are given a federal subsidy to purchase health insurance on their own from the private market (Davis, 3/6).

The Washington Post: Paul Ryan, Patty Murray Hold The Keys To Any Budget Deal
Still, last year’s GOP budget hardly charted a path to bipartisan agreement. It proposed cutting deeply into domestic programs, and it would have converted many programs for the poor, such as food stamps and Medicaid, into state block grants with few federal controls. It eschewed higher taxes as a source of deficit reduction. And it proposed far-reaching changes to Medicare that would end the program’s open-ended guarantee for people 54 and younger. Senate Democrats haven't adopted a budget since 2009, Obama's first year in office. Murray has said her framework — which also will be unveiled next week — will propose replacing the automatic budget cuts known as the sequester in part with higher taxes. Democratic aides said that revenue would come from a far-reaching overhaul of the tax code under a fast-track process known as "reconciliation" (Montgomery, 3/6).

The Wall Street Journal’s Washington Wire: Paul Ryan Prepares 'No Surprises' Budget
House Budget Committee Chairman Paul Ryan (R., Wis.) said the budget he will unveil next week will make only "modest policy changes" in the conservative blueprint the House approved last year even though he is now aiming for a much more ambitious goal: balancing the budget in 10 years. "I wouldn't expect any big surprises," Mr. Ryan told reporters Wednesday. Last year’s House budget called for major changes in Medicare and deep spending cuts in other programs, but did not eliminate the deficit for nearly 30 years. GOP leaders have promised this year to pass a budget that balances in 10 years. Mr. Ryan said that the task is not as hard as it looks because in the interim there have been changes that have helped close the budget gap: Congress has passed a big tax increase and health care costs have dropped, among other economic factors (Hook, 3/6).

The New York Times: House GOP Plans A Budget That Retains Tax Increases And Medicare Cuts
House Republicans will preserve Medicare cuts that their presidential nominee loudly denounced last year and accept tax increases they sternly opposed just months ago in a new tax-and-spending blueprint that would bring the federal budget into balance by 2023, senior Republicans said Wednesday (Weisman, 3/6).

Los Angeles Times: House GOP Debates Changing Medicare Sooner Than They'd Planned
As Rep. Paul D. Ryan readies the new GOP budget, House Republicans are debating whether to apply the party’s proposed Medicare changes a year earlier than planned, when Americans who are now 56 reach retirement age. No decision has been made, and Ryan declined to address the internal debate Wednesday. The party's earlier promise to keep Medicare unchanged for those 55 and older has bumped up against its vow to balance the budget in 10 years (Mascaro, 3/7).

The Hill: Medicare Cut-Off In Ryan Budget Still Up In The Air
The House Budget Committee has not decided if it will change Medicare benefits for people 55 years and older in its fiscal blueprint due out Tuesday, Republican members of the panel said. Reps. Bill Flores (Texas) and Rob Woodall (Ga.) said that the choice about when to begin overhauling the program's benefit structure is still up in the air (Viebeck, 3/6).

CNN: Ryan Backs Off Medicare Proposal
Rep. Paul Ryan, R-Wisconsin, is backing off his proposal to change Medicare for people who are now 57 and younger, after personally lobbying fellow Republicans to support that change. Ryan, the Budget Committee Chairman and 2012 GOP vice presidential candidate, had urged his GOP colleagues to support the entitlement reform as part of next year's GOP budget. But many House Republicans resisted, worried that the plan would be politically perilous because it would break the party's pledge not to include Americans who are now older than 55. Ryan argued for the change because Americans are retiring later and he thought it was more "intellectually honest" to reflect that development in his plan, according to a GOP source. But House Republicans across the political spectrum worried – some openly – that moving the age from 55 to 57 would open them up to criticism that they were backtracking on a promise they had made to voters (3/6).

In other budget news -

The Fiscal Times: How Rolls Royce Health Plan Drives Pentagon Spending
Many critics of the Pentagon's massive overspending during the last decade point to out-of-control costs related to the Iraq and Afghanistan wars and overspending on ineffective weapons programs. But in the coming decade, as DOD looks to cut $600 billion from its budget, the largest area of expenditure is not expected to be on the battlefield – but in the doctor's office. Costs for the Pentagon's health care program, known as TRICARE, have been quietly but dramatically rising for the last decade (Francis, 3/7).

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Cruz To Offer Amendment To 'Defund' Health Law

The amendment to the continuing resolution -- a bill to fund the federal government after March 27 -- will be offered by freshman Sen. Ted Cruz, R-Texas, when the Democrat-controlled Senate considers the measure. Cruz's action is not expected to go anywhere, but it comes amid conservative griping that GOP lawmakers are not doing enough to block the law.

Politico: Cruz Amendment Would Defund Obamacare
Sen. Ted Cruz (R-Texas) will offer an amendment to the continuing resolution – the bill to keep the government open after March 27 — that would defund the Affordable Care Act. "The very first priority of every elected official—Democrat and Republican—should be restoring economic growth, so we can ensure continued strength, prosperity, and opportunity for the next generations," Cruz said in a statement. "Obamacare does precisely the opposite. It is already hurting small businesses, reducing the hours Americans are allowed to work, forcing employers to drop coverage, and leading to substantial increases in healthcare premiums—especially for young people" (Gibson, 3/6).

The Hill: Cruz: Spending Bill Must Defund Obama Healthcare Law
Sen. Ted Cruz (R-Texas) said Wednesday that he will object to a government spending bill if it does not cut off funds for President Obama's signature healthcare law. Cruz, a staunchly conservative freshman, said he will offer an amendment to delay the flow of funds to implement the healthcare law when the Senate takes up a continuing resolution to fund the federal government (Baker, 3/6).

Kaiser Health News: Capsules: House Spending Bill Cuts Funding For Exchanges
You don't hear much these days about Republicans trying to repeal the 2010 health care law. The Supreme Court ruling last June upheld most of the measure. President Obama's re-election and Democrats' continued control of the Senate have helped "Obamacare" implementation to move ahead. But there is one way to slow things down: use the power of the purse (Carey, 3/7).

Politico: Right Jabs GOP's Inaction On Obamacare
Once again, conservatives are unhappy with how congressional Republicans are handling a fiscal fight in Congress. This time, their ire is because Republicans aren't trying hard enough to defund, or at least whittle away at, the Affordable Care Act by attaching language to the continuing resolution that passed the House on Wednesday (Gibson, 3/7).

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Sen. Graham Gun Bill Would Bar More With Mental Illness From Buying Guns

Politico: Lindsey Graham Gun Bill Targets Mentally Ill
Three senators potentially facing tough re-election challenges next year introduced NRA-endorsed legislation Wednesday that would bar more people from buying guns due to mental illness. The bill would add people who plead not guilty by reason of insanity to the electronic background check system that determines if someone can purchase a gun. It adds a list of additional disqualifiers, including being deemed a risk and having a court find the personally mentally disabled (Gibson, 3/6).

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Health Reform

Statehouses Become Next Flashpoint For Medicaid Expansion Debates

Even as Republican governors like Rick Scott in Florida have chosen to back the health law's Medicaid expansion, they are facing push back from GOP-controlled legislatures.

Politico: For Republican Governors, Medicaid Expansion Is Hard Sell
Governors like Rick Scott of Florida and John Kasich of Ohio bucked their conservative base to accept billions in federal funds to provide basic health coverage to millions of uninsured constituents. But they need the support of their Republican-led legislatures to make it a reality. It's a tall task that's dividing statehouses around the country (Cheney and Millman, 3/7).

Kaiser Health News: Medicaid Expansion Divides Florida GOP
As the Florida legislature convened this week, House Speaker Will Weatherford helped rally fellow Republicans opposed to expanding the state's Medicaid coverage to more than a million low-income residents, but he also acknowledged that his own family benefitted from a program for low-income families without health insurance (Hatter, 3/7).

The Associated Press: Fla. Session Opens With Medicaid Expansion In Doubt
A bid to cover roughly 1 million Floridians by expanding the state Medicaid program is in doubt after one of the state's top legislative leaders called it a social experiment "destined for failure." House Speaker Will Weatherford used the opening day of the annual legislative session to denounce the idea of expanding the safety-net health insurance program. Within hours, Senate President Don Gaetz responded by suggesting that the Senate was unlikely to move forward in the face of such strong opposition (3/6).

Los Angeles Times: Protestors March To Urge Gov. Rick Perry To Expand Medicaid
Several hundred protesters marched in Austin on Tuesday to protest Texas Gov. Rick Perry's hard stance against expanding Medicaid coverage in the state. Perry has dismissed calls to follow two tenets of the federal Affordable Care Act: expand Medicaid, the government program providing health insurance for sick or low-income people, and set up a health insurance exchange where people can shop for coverage (Li, 3/6).

Sacramento Bee: Capitol Alert: State, Counties Joust Over Medi-Cal Expansion In California
The perennially contentious relationship between the state and county governments over money has a new flash point -- the expansion of Medi-Cal coverage to more than a million low-income Californians under the new Affordable Care Act. The conflict -- aired Wednesday in an Assembly budget subcommittee hearing -- has two prongs: Whether the state or counties will manage the expansion; Whether the state should "claw back" some of the money it now pays to counties to pay for indigent medical care -- on the theory that many of the half-million poor beneficiaries will become Medi-Cal patients next year, raising state costs (3/6).

California Healthline: Appropriations Approves Medi-Cal Expansion
The state Senate Committee on Appropriations endorsed a bill expanding Medi-Cal eligibility to 1.4 million Californians and to simplify the enrollment process for all Medi-Cal beneficiaries. The special session approval Monday means SBX1-1 by Sen. Ed Hernandez (D-West Covina) is headed to the Senate floor as soon as the end of this week. The Assembly version of the legislation -- ABX1-1 by John Pérez (D-Los Angeles) -- won committee approval last week is pending a floor vote now (Gorn, 3/6).

Meanwhile, also in the news -

MPR News: Minn. GOP Vows To Slow Health Exchange Bill
Republicans say they will offer about 100 amendments to an insurance exchange bill when the Minnesota Senate debates it Thursday. The state needs legislation in place by the end of this month. Republicans have complained the DFL-controlled Legislature is moving too fast on the health plan marketplace. But the GOP blocked exchange legislation when Republicans controlled the Legislature over the past two years. "We didn't think that government control of health care was a good idea and we hoped there would be another path out," said Assistant Minority Leader Sen. Michelle Benson, R-Ham Lake. "But frankly, this bill still isn't ready because there are so many unanswered questions" (Stawicki, 3/6).

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Health Law Implementation: Is The Overhaul Leading To Layoffs?

The Federal Reserve's "beige book" cites the law as a reason for layoffs and a hiring slowdown. Also, the National Retail Federation is backing efforts by some GOP congressional lawmakers to repeal the employer mandate.

The Hill: Fed: Obama's Health Law Leading To Layoffs
The Federal Reserve on Wednesday released an edition of its so-called "beige book," that said the 2010 health care law is being cited as a reason for layoffs and a slowdown in hiring…That line was found in a section of the Fed's report on employment, wages and prices. That same section also said the Atlanta district noted that health care regulations are so burdensome there is a shortage of compliance specialists (Kasperowicz).

The Hill: Retailers Group Backs Repeal Of Employer Mandate
A leading retail group is backing congressional Republican efforts to repeal key provision in President Obama's health care law that requires most employers provide benefits to their workers…NRF argues that the employer mandate is already stifling job growth because businesses are concerned about rising costs (Needham, 3/6).

And on another health law topic -

California Healthline: The Radical Rethinking Of Primary Care Starts Now
The Affordable Care Act does include a number of provisions intended to strengthen primary care; for example, the law increases payment rates for PCPs in 2013 and 2014, launches new training programs and includes a slew of pilots. Altogether, experts expect that the law will increase the number of PCPs by about 3,000 over a decade -- but that would still leave the nation more than 40,000 short by 2020, according to estimates from the Association of American Medical Colleges. That's partly because of the ACA's own coverage expansion. The nation will need as many as 7,000 more PCPs to care for the millions of newly insured patients under the law, one study concluded (Diamond, 3/6).

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Health Insurers Launch TV Campaign Opposing Medicare Advantage Cuts

The ads, including a 30-second TV spot that will run in a dozen states and Washington, D.C., are designed to increase pressure on Congress and the Obama administration to stop proposed 2.3 percent cuts to these private plans. In addition, some analysts predict earnings drops for some insurers if the cuts go forward.

Reuters: Health Insurers Launch TV War Over Medicare Advantage Cuts
The health insurance industry is escalating its lobbying battle against a proposed Medicare Advantage pay cut to insurers by launching a television and online advertising campaign to garner public support among the program's 14 million beneficiaries. America's Health Insurance Plans (AHIP), a leading Washington-based trade group, said a 30-second commercial titled "Too Much" would be shown in a dozen states and the Washington, D.C., area in hopes of dissuading the Obama administration from imposing a 2.3 percent cut in government payments next year (3/6).

CQ HealthBeat: AHIP Launches Ad Campaign In States Slamming Proposed Medicare Advantage Cuts
The health insurance industry is targeting states with high Medicare Advantage enrollment as well as influential members of Congress in a television and online ad campaign that raises the pressure yet another notch on the Obama administration to roll back proposed cuts in private plan payments. America’s Health Insurance Plans launched TV ad buys Wednesday on cable in the Washington, D.C., area, as well as ads with state-specific Medicare Advantage enrollment numbers in New York, Louisiana and Pennsylvania, where MA plans are popular, AHIP officials said in a news release (Norman, 3/6).

The Associated Press: Analysts Predicts Medicare Advantage Earnings Slip
A Goldman Sachs analyst says forecasts for some health insurer earnings per share next year could slide as much as 10 percent if steep Medicare Advantage funding cuts materialize. Analyst Matthew Borsch said in a Wednesday morning research note that insurers like Humana Inc. and Universal American Corp. face the most exposure to potential cuts. Medicare Advantage makes up a higher proportion of total enrollment for those insurers compared to other companies in the sector (3/6).

In other Medicare news -

The Medicare NewsGroup: Medicare's Middlemen Await Word From CMS To Put In Play Sequesration Cuts
Medicare’s middlemen, the companies that will carry out the administrative work of the automatic budget cuts set to hit Medicare providers on April 1, are waiting for directions from the Centers for Medicare & Medicaid Services (CMS) to put in play provider payment reductions. The updates to the payment systems will ultimately lead to $11 billion in reduced payments to hospitals, doctors and other health care providers for the remainder of fiscal year 2013. These middlemen are Medicare Administrative Contractors (MACs), the private companies that handle the bulk of the entitlement program’s administrative claims processes. They will implement the 2 percent across-the-board payment reductions, mandated by sequestration, which is the result of the federal government’s inability to reach a deficit-reduction deal totaling $1.2 trillion. This means a .02 cent cut for every $1 paid to health care services providers, such as doctors, hospitals, skilled nursing facilities, insurers, medical device suppliers and home health companies (Sjoerdsma, 3/6).

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Health Care Marketplace

Recession Not To Blame For Cost Increases At Not-For-Profit Hospitals, Study Says

Modern Healthcare: Recession Didn't Spur Price Increases At Most Not-For-Profit Hospitals: Study
Most not-for-profit hospitals did not offset investment losses from the Great Recession by raising prices, according to a new study. Its authors say the finding suggests private insurers may not pay the price as hospitals bear new cuts in Medicare and Medicaid. Hospitals that saw large losses did, however, curtail investment in information technology and unprofitable services, which included trauma care and treatment for drug and alcohol abuse, the authors wrote in a National Bureau of Economic Research working paper. A limited number of hospitals did raise prices, according to research conducted by David Dranove, director of Northwestern University's Center for Health Industry Market Economics, and Craig Garthwaite and Christopher Ody, assistant professors of management and strategy at Northwestern. Those hospitals likely had significant market clout, the paper said (Evans, 3/6).

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State Watch

Ark. Lawmakers Override Veto, Ban Most Abortions After 12 Weeks Of Pregnancy

The state House on Wednesday followed the Senate in overriding Gov. Mike Beebe's veto of the measure. Opponents say the law "would blatantly violate" the Constitution and plan to challenge it in court.

The New York Times: Arkansas Adopts A Ban On Abortions After 12 Weeks
The law, the sharpest challenge yet to Roe v. Wade, was passed by the newly Republican-controlled legislature over the veto of Gov. Mike Beebe, a Democrat, who called it "blatantly unconstitutional." The State Senate voted Tuesday to override his veto and the House followed suit on Wednesday, with several Democrats joining the Republican majority (Eckholm, 3/6).

The Wall Street Journal: Arkansas Abortion Law Is Now Nation's Strictest
The move will face stiff legal challenges. Mr. Beebe, who supports abortion rights but has backed some restrictions, said a series of Supreme Court decisions had established that states couldn't ban abortions carried out before a fetus becomes viable, or able to survive outside the womb. He said the proposed bill "would blatantly violate the United States Constitution" (Radnofsky, 3/6).

The Associated Press/Washington Post: Ark. Adopts U.S.'s Most Restrictive Abortion Law, A Near-Ban Starting In 12th Week Of Pregnancy
Lawmakers in the Republican-dominated Legislature defied Gov. Mike Beebe, overriding the Democrat's veto. The House voted 56-33 on Wednesday to override Beebe's veto, a day after the Senate voted to do the same. The votes come less than a week after the Legislature overrode a veto of a separate bill banning most abortions starting in the 20th week of pregnancy. That bill took effect immediately after the final override vote, whereas the 12-week ban won't take effect until this summer (3/7).

Politico: Legal Fight Brewing Over Strict Arkansas Abortion Law
Abortion rights groups said they plan to challenge it in court within the next few weeks and predicted it would be easily overturned as the 12-week limit flies in the face Supreme Court precedent established in Roe v. Wade (Smith, 3/6).

In the meantime, a federal judge in Idaho has struck down a law in that state that bans abortions after 20 weeks of pregnancy.

The Associated Press/Washington Post: Federal Judge Strikes Down Idaho's 2011 Law Banning Abortions After 20 Weeks
A federal judge has struck down Idaho's law banning abortions after 20 weeks of pregnancy based on beliefs held by physicians and others that the fetus is able to feel pain at that point (3/6).

Reuters: Federal Judge Strikes Down Idaho Ban On Late-Term Abortions
A federal judge on Wednesday struck down a 2011 Idaho law that banned most abortions after 20 weeks of pregnancy, in a decision believed to mark the first time a court has ruled that such a measure was unconstitutional. Idaho is one of at least eight states that have enacted late-term abortion prohibitions in recent years based on controversial medical research suggesting that a fetus feels pain starting at 20 weeks of gestation (Zuckerman, 3/7).

Lawmakers in South Dakota and Texas are also dealing with similar issues in their states.

The Associated Press: SD Lawmakers Reject Plan To Expand Prenatal Care
The South Dakota Legislature rejected a plan to provide government-funded prenatal care to more low-income women Wednesday after officials from Gov. Dennis Daugaard's office said it was unnecessary. The Medicaid program run jointly by the state and federal governments provides prenatal care to South Dakota women earning up to 133 percent of the federal poverty guidelines. The state Senate had passed a bill that would have raised the income limits to cover women earning up to 140 percent of the poverty level, but the House refused to accept the Senate version of the measure (Brokaw, 3/6).

The Texas Tribune: Group Targets Abortion Waiting Period Requirement
The Texas House Women's Health Caucus has announced plans to try to repeal the 24-hour waiting period imposed by the abortion sonogram law that legislators approved in 2011. …The abortion sonogram law requires a physician to perform a sonogram 24 hours before a woman can receive an abortion, play the sound of the heartbeat and describe the development of the fetus (Aaronson, 3/6).

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Officials, State Workers Criticize Different Health Coverage Rate Hikes In California

The increases are largely set to hit small businesses, individual plans and long-term care coverage.

Los Angeles Times: Blue Shield And Aetna To Raise Health Care Rates Over State Objections
Officials at the California Department of Managed Health Care said increases that average more than 11 percent for about 47,000 individual and small-business policyholders of Blue Shield and Aetna were unreasonable. But state officials don't have the authority to reject changes in premiums, and increasingly health insurers refuse state demands to lower rates (Terhune, 3/6).

Sacramento Bee: State Worker: CalPERS Insurance Rate Hike Upsets Employees
The recent CalPERS sign-off on an 85 percent premium hike for its most-costly long-term care insurance policies sparked more than 100 calls and emails to The State Worker. Here are some of the most common themes: How can they do this? They can't afford otherwise. The $3.6 billion privately funded pot of money is too small to cover higher-end policies and hold down premiums for those plans. Nursing home care claims and similar services have run higher than expected. Meanwhile, the California Public Employees' Retirement System's investments have taken a beating (Ortiz, 3/6).

In the meantime, the state's proposed partnership with Wal-Mart to help enroll people in new coverage comes under scrutiny --

Los Angeles Times: Covered California's Plan To Partner With Wal-Mart Is Criticized
California officials face mounting criticism from union leaders over plans to let retail giant Wal-Mart Stores Inc. enroll shoppers in President Obama's health care expansion. The state wants employees at Wal-Mart and other retailers to help consumers learn about their options and assist them in buying federally subsidized private insurance (Terhune, 3/7).

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State Roundup: Ga. Panel Picked To Implement Provider Fee

A selection of state health policy stories from New Jersey, Arizona, Georgia, Oregon, Pennsylvania and Colorado.

The Associated Press: NJ Comptroller's Office Faults Adult Day Care
A state agency that serves as a watchdog over New Jersey government announced Wednesday that it has found improper billing of Medicaid by five adult day care centers and is asking the centers to pay settlements totaling more than $10 million. The state comptroller’s office found that centers were charging the state for caring for patients when they did not receive care in some cases and for providing care that was not needed in others (3/6).

Georgia Health News: Deal Picks Panel To Oversee Provider Fee
Gov. Nathan Deal has appointed a committee to oversee implementation of the provider fee, the financing mechanism for Medicaid that's expected to fill a hole of more than $400 million in the program's budget. Deal recently signed the fast-tracked legislation that facilitated the renewal of the fee, known among critics as a "bed tax."’ The oversight panel will consist of six hospital representatives -- three from hospitals that have been "winners" under the current fee formula, and three from "losing" hospitals. The amount currently raised from hospitals is returned to the hospital industry through reimbursements. Individual hospitals get different amounts based on how much Medicaid business they do, so that some hospitals come out ahead under the formula while others lose money (Miller, 3/6).

Philadelphia Inquirer: Uncertainty For Thousands, Corbett After Judge's Health Ruling
Natalie Ross, who is prone to bronchitis, can tell you how her life is different without adultBasic: She put off seeing a doctor in January until her cough got so bad she was almost throwing up. With medication, the cough is better but still there. Her new health insurance covers just four office visits a year. … A judge's decision Tuesday has drawn renewed attention to the plight of Ross and 40,785 other Pennylvanians, most of them in low-income jobs, whose state-funded adultBasic health insurance ended two years ago when Gov. Corbett declined to pursue new funding for the program, saying it was unsustainable (Sapatkin and Worden, 3/7).

Georgia Health News: Health Care Regulatory Changes Fail To Advance
Proposed changes to Georgia's health care regulatory process hit a dead end in a House committee Wednesday, but only after a four-hour hearing that exposed a longstanding divide between physicians and hospitals. The House Health and Human Services Committee debated one bill that would exempt multi-service outpatient surgery centers owned by physicians from the state regulatory process, and then a second bill that would exempt standalone pediatric emergency rooms. The panel adjourned without taking a vote on either House Bill 279 or House Bill 404. Thursday is Crossover Day, the deadline for a bill to be passed by at least one chamber of the General Assembly or lose its chance of becoming law this session. So the two House bills are effectively dead until next year, except in the unlikely event that one of them is attached to legislation that has already moved forward (Miller, 3/6).

Kaiser Health News: In Conservative Arizona, Government-Run Health Care That Works
In a low-slung building in the vast desert expanse east of Phoenix, a small school of tropical fish peer out, improbably, from a circular tank into the waiting lounge of the Apache Junction Health Center. The hallways of the nursing home are still. Only half of the rooms are filled, and the men and women who live here seem surely in life's final season. 'These are folks that have chronic cognitive and physical disabilities that are not going to improve,' said George Jacobson, administrator of the nursing home (Varney, 3/7).

The Lund Report: Nurse Practitioners And Physician Assistants Put Forth Pay Equity Bill
A few years ago, private insurers cut the rates that they pay to nurse practitioners and physician assistants by as much as 25 percent and began paying them less than doctors for the same basic services. That's made it hard for physician assistants like Edwin Weih to leave the lights on at Five Rivers Family Practice where overhead for the clinic is the same regardless if it employs a full physician and a physician assistant. ... Nurse practitioners and physician assistants are getting another try at pay equity this session after legislation demanding that commercial insurers compensate them the same as doctors for the same services failed to pass the last two sessions (Gray, 3/6).

The Associated Press: Legislature Tackles Salem Medicaid Dispute
The Oregon Legislature is stepping into a conflict between Salem Hospital and the local coordinated care organization in charge of providing health coverage for low-income patients on Medicaid. The state Senate on Wednesday unanimously approved a measure creating a mediation process that might help resolve the Salem dispute and any other conflicts that may arise between CCOs and health-care providers (Cooper, 3/7).

Oregonian: Bill Offering Mediation For Medical Errors Passes State Senate Easily
A bill that makes it easier to use mediation instead of lawsuits to address medical errors easily passed the Oregon Senate today. Senate Bill 483 passed 26-3 and is now headed for the House. During floor debate, supporters said the measure could give patients and their families better ways to resolve grievances ithan filing malpractice lawsuits. Sen. Elizabeth Steiner Hayward, D-Portland, said she's been party to a frivolous lawsuit before, and the bill would ease an adversarial culture around medical errors, one "that's tearing us apart." Sen. Larry George, R-Sherwood, called the bill a good first step to addressing policies that hurt patient care. "Real decisions are being made that affect people's lives," George said (Budnick, 3/5).

Health Policy Solutions (a Colo. news service): Colorado Bill Aims To Keep Guns Away From People During Mental Illnesses
Colorado lawmakers plan to introduce legislation by next week to make it harder for people with mental illnesses to buy guns. The legislation, which does not yet have a bill number, marks the last of several measures that Democrats are sponsoring this year to try and curb gun violence in the wake of the Aurora theater shootings and the massacre at Sandy Hook Elementary School. The other bills include measures to limit magazines to 15 rounds, require background checks on all gun transactions, limit guns on campuses and require gun buyers to pay for their own background checks (Kerwin McCrimmon, 3/6).

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Weekend Reading

Weekend Reading: A Cancer Hospital's Controversial Admission Procedures

Every week Ankita Rao selects interesting reading from around the Web.

ProPublica: How Mom's Death Changed My Thinking About End-Of-Life Care
My father, sister and I sat in the near-empty Chinese restaurant, picking at our plates, unable to avoid the question that we'd gathered to discuss: When was it time to let Mom die? ... My father and sister looked to me for my thoughts. In our family, after all, I'm the go-to guy for all things medical. I've been a health care reporter for 15 years: at the Dallas Morning News, the Los Angeles Times and now ProPublica. And since I have a relatively good grasp on America's complex health care system, I was the one to help my parents sign up for their Medicare drug plans, research new diagnoses and question doctors about their recommended treatments. In this situation, like so many before, I was expected to have some answers. Yet none of my years of reporting had prepared me for this moment, this decision. In fact, I began to question some of my assumptions about the health care system (Charles Ornstein, 2/28)

Reuters: Behind A Cancer-Treatment Firm's Rosy Survival Claims
When the local doctor who had been treating Vicky Hilborn told her that her rare cancer had spread throughout her body, including her brain, she and her husband refused to accept a death sentence. Within days, Keith Hilborn was on the phone with an "oncology information specialist" at Cancer Treatment Centers of America. … His call secured Vicky an appointment at the for-profit, privately held company's Philadelphia affiliate, Eastern Regional Medical Center. There, the oncologist who examined Vicky told the couple he had treated other cases of histiocytic sarcoma, the cancer of immune-system cells that she had. … Vicky Hilborn never got another appointment with CTCA. She died on September 6, 2009, at age 48. CTCA is not unique in turning away patients. A lot of doctors, hospitals and other healthcare providers in the United States decline to treat people who can't pay, or have inadequate insurance, among other reasons. What sets CTCA apart is that rejecting certain patients and, even more, culling some of its patients from its survival data lets the company tout in ads and post on its website patient outcomes that look dramatically better than they would if the company treated all comers (Begley and Respaut, 3/6).

The Atlantic: Kind Neighbors Are Scarce, But Important
Suburbanites, as compared to urban and rural dwellers, are most certain of their access to community resources. They also care least about their neighbors. As such, their safe, affordable housing in unpolluted environments, with nearby health centers and plentiful recreation space, are good because they benefit them individually; that their fellow suburbanites benefit as well is almost incidental. It's not just them. Strong communities made up of neighbors that care for, and about, one another are low on the list of health concerns of most Americans. In a survey conducted for The Atlantic in conjunction with GlaxoSmithKline, a representative sample of 1,000 Americans revealed that our priorities for building healthy communities are inextricable from our reliance on institutions. The results of various questions show that many of us tend to put the responsibility for our community's' health in the hands of doctors and hospitals, whom we expect to be regularly available, in-person. Overall, participants ranked regular access to doctors and dentists (82 percent said it was "very important") second only to clean air and water (87 percent) as community resources that are important to their health (Lindsay Abrams, 3/6)

The New York Times: Construction That Focuses On Health Of Residents
Doctors, social agencies and community groups that have long been frustrated by the inability to alleviate environmental conditions that contribute to ailments like heart disease and obesity are promoting the idea that a shift in land-use planning and design can stanch some of the harmful influences. The concept is being put to one of its earliest and biggest tests in the La Alma/Lincoln Park neighborhood near downtown Denver. That's where the city's housing authority used a relatively new decision-making tool known as a health impact assessment to draft a redevelopment plan that encourages physical activity and environmental sustainability (Joe Gose, 3/5).

Health Affairs: How 'Person-Centered' Care Helped Guide Me Toward Recovery From Mental Illness
I was 14 and growing up in a small suburban town in Kentucky with my parents and 16-year-old brother. I loved school and I loved the arts, wandering my high school’s hallways with a paintbrush stuck in my messy ponytail. With my nose in a book or my feet in ballet slippers, I appeared to lead a relatively normal teenage life. Hidden beneath the surface, though, were secrets. A neighbor had sexually abused me for much of my childhood, until I was 13, manipulating me into believing that it was my fault. If I told anyone, he said, he would murder my family. … With the perspective of time, I can now reflect on what I learned from those experiences, what was and wasn't helpful for me during my time of crisis, and how mental health providers could treat their patients better (Ashley Clayton, 3/6).

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Editorials and Opinions

Viewpoints: Ryan's Efforts On Medicare Leave Republicans 'Howling;' Retirement May Be Too Expensive For Seniors

The Fiscal Times: Only Ryan Takes On The 800-Lb. Gorilla – Medicare
Paul Ryan is one of the few considering the long-term trajectory of federal spending who is also preparing a solution without artificial fiscal cliffs. Perhaps surprisingly, his ideas for structural budget and entitlement reform have some Republicans howling even before Democrats get an opportunity to speak up (Edward Morrissey, 3/6).

The New York Times: From One Budget Fight To The Next 
The Republicans have made it clear that the spending fight will never cease. They haven’t promised not to abuse the next debt-ceiling increase, necessary in the next few months, to get further cuts. And Paul Ryan, the House Budget Committee chairman, will soon unveil his caucus’s 2014 budget, which will start to make good on the party’s ruinous plan to balance the budget in 10 years. To do so, he is reviving his discredited proposal to turn Medicare into a voucher program, and considered making it worse by cutting benefits for people who are now 56 and younger; an earlier plan cut benefits for those 55 and below (3/6).

The Washington Post: Post Partisan: Paul Ryan To Change Medicare For Boomers Over 55? Good.
If Ryan follows through, Democrats would no doubt brutalize him for it. But promising current and soon-to-be seniors — who vote in droves – that they would not be expected to participate in righting the program set to bust the federal budget was bare election-year cowardice, fiscally unwise and deeply unfair. Even if Ryan’s next budget proposal is inadequate for other reasons, if he believes that Medicare reform is necessary, he should have the backbone to apply it to the boomers (Stephen Stromberg, 3/6). 

Medpage Today: About The Sequester
This Congress has not even begun to grapple with what the Congressional Budget Office (CBO) has called our greatest fiscal challenge: rising health care costs. In fact, the debate around the sequester has diverted attention from the more fundamental goals of "bending the curve" of rising per capita health care costs and getting more value for our public and private health care dollars. The need for further action to address these longer-term problems remains. Congress has three choices: continued, indiscriminate meat-ax cuts like the sequester; shifting of federal costs onto consumers, health plans or employers; or a smart savings approach that finally addresses the enormous levels of waste and inefficiency in our health system (John Rother, 3/6).

The New York Times: Opinionator: The War On Entitlements
The debate over reform of Social Security and Medicare is taking place in a vacuum, without adequate consideration of fundamental facts. These facts include the following: Two-thirds of Americans who are over the age of 65 depend on an average annual Social Security benefit of $15,168.36 for at least half of their income (Thomas B. Edsall, 3/6).

The Washington Post: Steering America Toward A More Secure Retirement
To the let's-cut-entitlements crowd, what's wrong with America is that seniors are living too high off the hog. With the cost of medical care still rising (though not as fast as it used to), the government is shelling out many more dollars per geezer (DPG) than it is per youngster (DPY). The solution, we're told, is to bring down DPG so we can boost DPY. We do indeed need to boost DPY. And we need to rein in medical costs by shifting away from the fee-for-service model of billing and paying. But as for changing the way we calculate cost-of-living adjustments for seniors to keep us from overpaying them — an idea beloved of Bowles, Simpson, Republicans and, apparently, the White House — this may not be such a hot idea, for one simple reason: An increasing number of seniors can't afford to retire (Harold Meyerson, 3/6).

New England Journal Of Medicine: A Path Forward on Medicare Readmissions
October 1, 2012, marked the beginning of the Hospital Readmissions Reduction Program (HRRP), an ambitious effort by the Centers for Medicare and Medicaid Services (CMS) to reduce the frequency of rehospitalization of Medicare patients. ... The latest evidence suggests that the readmissions-reduction program has potential: it can change the hospital business model by asking institutions to become increasingly accountable for what happens to their patients beyond their walls. ... However, the latest data also make it clear that the HRRP will penalize hospitals that care for the sickest and the poorest Americans, largely because readmissions are driven by the severity of underlying illness and social instability at home (Dr. Karen E. Joynt and Dr. Ashish K. Jha, 3/6).

New England Journal Of Medicine: Generalist Plus Specialist Palliative Care — Creating A More Sustainable Model
Palliative care, a medical field that has been practiced informally for centuries, was recently granted formal specialty status by the American Board of Medical Specialties. The demand for palliative care specialists is growing rapidly, since timely palliative care consultations have been shown to improve the quality of care, reduce overall costs, and sometimes even increase longevity. The field grew out of a hospice tradition in which palliative treatment was delivered only at the end of life, but its role has expanded so that palliative care specialists now also provide palliative treatment in the earlier stages of disease alongside disease-directed medical care, improving quality of care and medical decision making regardless of the stage of illness (Dr. Timothy Quill and Dr. Amy Abernethy, 3/6).

JAMA: The State Role In Health Care Innovations
A couple of weeks ago, the Centers for Medicare & Medicaid Services (CMS) announced a new round of grants from the Center for Medicare and Medicaid Innovation (CMMI). If you didn't pay much attention to the announcement, it's worth a second look. ... The most recent grants went to states to support policies and approaches that can transform payment and delivery of care. Large grants of $30 million or more went to Oregon, Minnesota, Arkansas, Massachusetts, Maine, and Vermont. Smaller planning grants went to 25 states, including Maryland. The summary page is worth a read to see what the future of health care may hold (Dr. Joshua M. Sharfstein, 3/6).

Health Policy Solutions (a Colo. news service): Domestic Violence And Guns A Deadly Combination
As the gun debate heats up in Colorado, it is victims of domestic violence who could be most affected by its outcome. On Monday, a Senate panel approved a bill that would require domestic violence offenders to relinquish their guns if a restraining order had been filed against them. When an offender has easy access to guns, there is nothing more dangerous for a victim (Sam Cole, 3/6). 

Health Policy Solutions (a Colo. news service): Getting Patients To Choose A Honda Over A BMW
As a part of CIVHC’s Colorado All Payer Claims Database  team, I'm working to develop publicly available consumer information on cost and quality for health care services. The primary purpose of the patient focused information (planned for release by the end of 2013), and the Colorado APCD in general, is to provide transparent health care data to support driving the market towards low cost, high quality care. So a study showing that insured consumers would select the most expensive procedures even when provided with transparent information about their effectiveness is disheartening to say the least. Then I stopped and asked myself -- if I were given those same two choices, would I have answered differently?  I'm not sure I would have (Cari Frank, 3/6).

Oregonian: Portland's Sick Leave-Mandate Fever: Agenda 2013
Forget for the next few paragraphs about the details of Portland Commissioner Amanda Fritz's sick-leave ordinance. Consider, instead, some of the reasons why she and others believe it's a good idea. Paid sick time, the ordinance reasons, "results in reduced worker turnover, which leads to reduced costs incurred from advertising, interviewing and training new hires creating a better trained and more reliable workforce." The Fritz plan also would dissuade people from coming to work with "conditions that reduce their productivity -- a problem that costs the national economy an estimated $160 billion annually" (3/6).

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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.