Daily Health Policy Report

Thursday, March 8, 2012

Last updated: Thu, Mar 8

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Campaign 2012

Coverage & Access

Health Care Marketplace

Public Health & Education

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Coming Soon To Massachusetts' Dental Offices – Maybe

WBUR's Martha Bebinger, working as part of a partnership with Kaiser Health News and NPR, reports: "In Massachusetts, one in six residents lives in an area with a shortage of dental care, including parts of central and western Massachusetts, Cape Cod and many low-income urban communities. In addition, almost 750,000 low-income residents on Medicaid have coverage to get their teeth cleaned or pulled, but nothing more. Health care advocates are pressing the legislature to restore full dental benefits" (Bebinger, 3/7). Read the story.

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Capsules: Health IT Chief Disputes Study On EHR Testing, Costs

Now on Kaiser Health News' blog, Jenny Gold reports: "A study published in the journal Health Affairs this week found that doctors who use electronic health records may order more diagnostic testing, and therefore drive up the cost of health care, despite claims to the contrary by the federal government and health IT industry. Now, Dr. Farzad Mostashari, national coordinator for health information technology, is pushing back" (Gold, 3/7). Check out what else is on the blog.

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Political Cartoon: 'Cheapskate?'

Kaiser Health News provides a fresh take on health policy developments with  "Cheapskate?" by Harley Schwadron.

Meanwhile, here's today's haiku:


Concussion science
Great strides made since the hit song
"You Can Ring My Bell"

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

Are GOP Lawmakers Walking Away From The Budget Pact?

Conservative Republicans are seeking deeper cuts in both discretionary and mandatory spending. The White House and Democratic lawmakers are "crying foul" and some GOP veterans caution it could produce gridlock. In the background, three key departures from the Senate Finance Committee could make that panel, which oversees Medicare and much of the health law, less centrist.

Reuters: Conservative U.S. Republicans Seek Deeper Spending Cuts
Conservative Republicans in the U.S. House of Representatives are not satisfied with spending caps mandated by last year's debt limit deal and are seeking deeper cuts - even if this raises the risk of another government shutdown fight. Republican aides said on Wednesday some members of the House Budget Committee are pressing for a budget resolution that holds discretionary spending at least $97 billion below the $1.047 trillion cap set by the Budget Control Act for fiscal 2013 (Lawder, 3/7).

The Associated Press: House GOP May Abandon Budget Pact With Obama
Less than a year after reaching a budget agreement with President Barack Obama, House GOP leaders now seem likely to walk away from it under pressure from tea party-backed conservatives eager to show voters they're serious about shrinking the government. Democrats and the White House are crying foul and many GOP veterans warn it will produce gridlock later, when the House turns to spending bills setting agency budgets for the fiscal year that begins Oct. 1 (Taylor, 3/7).

Politico Pro: Finance Committee May Become Less Centrist
The Senate committee responsible with oversight of Medicare and much of the health care reform law is going to look a lot different in 2013, with at least four of its members retiring at the end of the year and others possibly facing tough elections…Democratic Sens. Kent Conrad of North Dakota and Jeff Bingaman of New Mexico and Republican Sen. Olympia Snowe of Maine — three of the highest-ranking committee members from both parties — all plan to retire at the end of the year. Each has a record as a moderate, a bridge-builder, or both (Haberkorn and DoBias, 3/7).

Also in the news from Capitol Hill -

CQ HealthBeat: Boustany Presses Sebelius On Possible CLASS Act 'Conspiracy'
A round of hearings on Capitol Hill over the past week has given Republicans a chance to go after the health care law through some harsh questioning of Health and Human Services Secretary Kathleen Sebelius. ... Following one those hearings, Charles Boustany Jr., chairman of the House Ways and Means Subcommittee on Oversight, is pressing Sebelius on whether there was a "conspiracy of silence" involving administration officials and advocacy groups regarding "secret" changes to the Community Living Assistance Services and Supports (CLASS) program before the health care overhaul law passed (Reichard, 3/7).

And the Obama birth control coverage rule continues to draw attention -

CQ HealthBeat: Fortenberry Pushes Reversal Of HHS Contraceptive Rule Despite Setbacks
Rep. Jeff Fortenberry said Wednesday that he must "rebuild the momentum" for his bill addressing health insurance coverage of contraceptive services, following GOP leaders' shift to near silence on the issue. It wasn't long ago that Republicans were eager to challenge a recent Obama administration ruling that requires most employers, including some with religious affiliations, to offer insurance that covers contraceptives without co-payments, co-insurance or deductibles (Ethridge, 3/7).

Politico: Are 'Birth Panels' Next? Ask Michele Bachmann
The Minnesota congresswoman said the Obama administration's contraception coverage mandate could be a slippery slope to a point where a "health dictator" decrees that women could only have one or two children. Bachmann, in an appearance on Glenn Beck's online television venture GBTV that was picked up by media watchdogs and liberal websites, said "it isn't beyond the pale" to move from the birth control policy to a government-mandated childbirth policy (Kenen, 3/7).

The Hill (Video): Bachmann Warns Health Care Reform Law Could Be Used To Limit Family Birth Rates
Rep. Michelle Bachmann (R-Minn.) suggested Tuesday that President Obama's health care reform law could give the government a dangerous amount of power in individual's health care decisions, going as far as to say "it isn't farfetched" that the federal government could try to limit birth rates by refusing to cover associated health costs after a family has a certain number of children (Sink, 3/7).

The Washington Post reports on the lawsuits surrounding the controversial rule -

The Washington Post: New Front In Birth Control Rule Battle: The Courts
Since November, at least eight lawsuits have been filed in federal district courts across the country challenging the constitutionality of the rule, which requires employers, including church-affiliated organizations that object to contraception on religious grounds, to cover birth control in workers' health plans with no out-of-pocket charges (Aizenman, 3/7).

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Health Reform

Obama Administration: Mandate Is Respectful Of Individual Rights

The Department of Justice argues that the individual mandate is more protective of individual choices than programs such as Medicare. In other news related to the health law, the clashes between consumer and business groups over the measure's required benefit summaries don't appear to be over.  

Politico Pro: DOJ: Mandate Approach 'Protective' Of Choice
The Obama administration on Wednesday defended the health care reform law's individual mandate as more respectful of individual rights than a program such as Medicare, which operates essentially as government-run health care. Opponents of the health care reform law — which will go before the Supreme Court later this month — argue that the government has never before tried to require Americans to purchase something, in this case health insurance (Haberkorn, 3/7).

Politico Pro: Fight Over Insurance Summaries Persists
The clash between businesses and consumer groups over when health plans must start providing beneficiaries with simplified benefit summaries shows no sign of winding down. The Obama administration released a final rule last month detailing the simplified benefit summaries that health plans must provide to consumers. But business groups want to push it back for another year, while consumer advocates are fighting back to keep the consumer protection provision on track for implementation in September (Millman, 3/7).

Fox News: Health Care Law To Treat Unequal Access In 2012
The Department of Health and Human Services' Agency for Healthcare Research and Quality, or AHRQ, has been tracking disparities annually since 2003. Dr. Ernest Moy, a medical officer at the Center for Quality Improvement and Patient Safety within the AHRQ, says that while overall health care quality in the U.S. has been improving by roughly 2.5% per year, disparities have refused to budge. ... Beginning in March 2012, the Affordable Care Act will target disparities by requiring all new and existing federal health programs, including Medicare and Medicaid, to collect and report racial, ethnic and language information on all applicants, recipients and participants (MacDonald, 3/7).

California Healthline: Health Care Reform Driving Physicians Together
When the American Hospital Association recently reported that the number of physicians employed by hospitals rose 34% between 2000 and 2010, it was interesting but not exactly earth-shattering news. ... the total number of hospital-employed physicians -- AHA placed it at about 25% of active physicians -- still doesn't seem that enormous. But numbers like these, which measure across a long period and consider only the employment relationship, don't necessarily show the true extent of changes under way in the physician marketplace. ... the physician marketplace is shifting rapidly toward an environment more dominated by large health care provider networks (O'Hara, 3/7).

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Campaign 2012

On The Campaign Trail, Santorum Hits Romney On Mass. Health Law

GOP presidential hopeful Rick Santorum continued to press the parallels between the state law signed by his rival, former Massachusetts Gov. Mitt Romney, and the federal measure, as well as to question Romney's explanation of his positions. Meanwhile, news outlets report on how the gender gap and social issues like contraception are playing in this election cycle.

The Associated Press: Santorum: Mississippi Could Make It A 2-Man Race
As he closed his day in Jackson, he flat-out called Romney a liar over how he describes Massachusetts' health care law that many conservatives see as the forefather of Democrats' national health law. "It's one thing to argue for bad policies," Santorum said. "It's another thing to impose it on the people of your state. ... There's a final thing: When you don't have the courage to stand up and tell the truth about what you did" (Schelzig and Elliott, 3/7).

The Washington Post: Fact Checker: Rick Santorum's Latest, Strangest 'Obamacare' Claim
Rick Santorum has made the growth of entitlement spending a key focus of his campaign for the presidency, and he touched upon the subject again when he addressed supporters after the Super Tuesday primaries. We were struck by both figures he used in the speech — that 50 percent of Americans "depend on some form of federal payment" and that Obama's health care law would bring the figure to an eye-popping 100 percent. In other words, in just two years, every single American would begin to get federal handouts, according to Santorum’s calculation. As usual, the Santorum campaign did not respond to a request for documentation, so we searched for the best data we could find (Kessler, 3/8).

ABC: Rick Santorum Says Mitt Romney Not Being 'Truthful' With The American People
As he has since a 2009 op-ed came to light where the former Massachusetts governor recommended part of his signature health care law as a national model, Santorum tried to define Romney as someone who can’t be trusted, and compared him to President Barack Obama. "He told the American public repeatedly, 'Oh no, I never did that. I never recommended that Romneycare be used as a national model for Obamacare just parts of it. We find now in the last two weeks that's wrong," Santorum said to cheers from a crowd of about 300 at a local museum (Walshe, 3/8).

The Wall Street Journal's Capital Journal: Both Parties Are Facing A Growing Gender Gap
Andrew Kohut, head of the Pew Research Center, says the gender gap began emerging during the 1980s, driven by a split over Ronald Reagan's assertive foreign policy, but also by a debate over the role of government. Then, as now, women tended to favor a larger role for government programs than do men. ... But Mr. Kohut notes that the gap also is being driven by the Republican primary campaign's focus in recent weeks on social issues, and particularly by the debate over whether the government should require insurance coverage of contraception in employer insurance policies, as the Obama administration has ordered. On those issues, women tend to agree more with the administration (Seib, 3/7).

The Associated Press: Democratic Women Citing Limbaugh In Fundraising
Sen. Claire McCaskill was so disturbed by Rush Limbaugh's description of a law school student as a "slut" and "prostitute" that she decided to repeat his rhetoric, featuring it in a fundraising appeal sent to thousands of supporters around the country. The tactic has paid off nicely for the Democrat's re-election campaign. McCaskill is one of several female Democratic candidates facing competitive races who are seeking to capitalize on the conservative radio host's comments to fuel their quests for the U.S. Senate or House. Their message: You can help fight Limbaugh -- and, by extension, Republicans or tea party activists -- by financing candidates who will stand up for women's rights (Lieb, 3/7).

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Coverage & Access

Report: Alzheimer's Care To Cost $200 Billion This Year

The report issued by the Alzheimer's Association also estimates that as many as 800,000 Americans have this illness and live alone. As many as half of these people don't have specific arrangements to help them get care.

San Francisco Chronicle: About 800,000 In U.S. Have Alzheimer's, Live Alone
Joseph Engh was visiting his father in San Francisco six months ago when he noticed something was wrong. … Roughly 800,000 people in the United States have Alzheimer's and live alone, according to an Alzheimer's Association report released today. … A lot of services exist for older adults who have dementia, but if patients don't have someone to help them apply for those services, they may not get the help they need, said Cynthia Barton, a geriatric nurse practitioner at UCSF's Memory and Aging Center (Allday, 3/8).

National Journal: Dementia To Cost $200 Billion In 2012, Report Finds
The bill for taking care of people with Alzheimer's and other dementias will reach $200 billion this year in the United States, including  $140 billion paid by Medicare and Medicaid, the Alzheimer's Association said on Thursday. The group estimated that 800,000 Americans have Alzheimer's and live alone, and as many as half don't have any set person to help care for them (Fox, 3/8).

CNN: Report: Yearly Cost Of Alzheimer's Tops $200 Billion
Caring for the estimated 5.4 million Americans living with Alzheimer's disease is not just a medical crisis, it's also an economic one according to a new report released Thursday.  The Alzheimer's Association's "2012 Alzheimer's Disease Facts and Figures" finds that the cost of caring for patients with Alzheimer's and other dementias will total $200 billion this year and is projected to increase to $1.1 trillion a year by 2050. "That is real money, even in government terms," says Dr. William Thies, Chief Medical and Scientific Officer with the Alzheimer's Association (Hagan, 3/8).

In related news, here's a sampling of articles from The New York Times about caring for the nation's aging population -

The New York Times: Needed: Health Professionals To Treat The Aging
Laura Kaufman no longer treats her patients in a suburban dental office. These days, she cleans teeth, does simple extractions and provides other basic care in the homes of inner-city elderly who are too frail to travel. After a decade of private practice in the Boston area, Ms. Kaufman found that a growing number of her dental patients were older people and that she often had little idea of their complete medical picture. So she decided to become "geriatricized" — educated on how to recognize and handle aging patients, who typically have several chronic conditions, as well as multiple prescription medications (Olson, 3/7).

The New York Times: Found: Older Volunteers To Fill Labor Shortage
At the Spring Institute for Intercultural Learning, also in Denver, older volunteers help teach health literacy, arrange transportation and accompany Bhutanese and Burmese refugees and immigrants to medical appointments, said Brandy Kramer, the institute's volunteer coordinator. "Our boomers are wonderful advocates for our community members; they are tenacious and won't take no for an answer from a health care provider" (Pope, 3/7).

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Health Care Marketplace

CDC: Medical Bills Present Hardship To Many Families

Researchers from the Centers for Disease Control and Prevention reported on the financial stress caused by high medical costs.  

NPR Shots Blog: 1 In 3 Americans Is Having A Hard Time Paying Medical Bills
While politicians and soon, the Supreme Court, are fighting about the fate of the Affordable Care Act, a new government study finds that a growing number of Americans are having difficulty coping with the high cost of health care (Rovner, 3/7).

Modern Healthcare: Medical Bills Strain Many Families: CDC
One out of 10 families had medical bills that they could not pay during the first half of 2011, according to newly released figures from the Centers for Disease Control and Prevention. ... One out of 5 families struggled to pay medical bills during the same period. And one-quarter of households had one family member who paid off a medical bill over time. Medical bills were more problematic among low-income households (Evans, 3/7).

JAMA: High Health Costs Burdening Many Families
Differing levels of financial burden related to health cost were seen when looking at race or ethnicity. The researchers found about 28% of blacks reported problems paying medical bills in the 12 months just prior to answering the survey questions, as did about 25% of Hispanics, 20% of whites, and 10% of Asians (Mitka, 3/7).

The Hill: Report: Americans Still Struggling With Medical Debt
The report found that low-income people had the hardest time paying the bills: More than 40 percent of percent of poor and near-poor people under the age of 65 were in families with medical debt, versus 31 percent for the nonpoor. The results also varied with age, with younger Americans more likely to live in families that are struggling with the cost of medical care (Pecquet, 3/7).

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Hospital Groups Will Get Bigger; Unlikely Partnerships Could Emerge, Says Moody's

A new report by Moody's outlines how not-for-profit hospitals are being driven by reimbursement pressures and healthcare reform to join forces with health insurers and for-profit companies, among others.

The New York Times: Hospital Groups Will Get Bigger, Moody's Predicts
Responding to changes in health care, big hospital groups are expected to get even bigger. And some hospitals will join forces with once-unlikely partners, health insurers and for-profit companies, a new report says (Abelson, 3/8).

Bloomberg: Hospital Mergers May Enhance Debt Ratings By Reducing Risk, Moody's Says
A wave of hospital mergers, driven partly by the slow economic recovery, reduces financial risks for many institutions and may boost credit ratings in the $3.7 trillion municipal bond market, Moody’s Investors Service said. Reimbursement pressures and rising costs coupled with the prospect of “healthcare reform and an unsustainable payment system” have driven not-for-profit hospitals to look for partnerships, Moody’s said in a report released today. They are choosing to consolidate with other health-care systems to boost their market presence and strengthen balance sheets, analysts led by Lisa Goldstein said in the report (Kaske, 3/8).

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Consumer Coalition Sues Drugmakers Over Coupon Programs

The lawsuit claims that these popular programs, which appear to save money for patients, actually increase costs and conceal information about the discounts from health plans. 

The Associated Press: Consumer Group Sues 8 Drugmakers Over Drug Coupons
Eight major drugmakers are being sued by a consumer coalition claiming the companies' popular coupon programs, which lower patient co-payments for hundreds of brand-name prescription medicines, are illegal. Community Catalyst alleges the increasingly common coupons appear to save patients money but increase overall health care costs significantly and violate federal bribery laws by concealing information about the payments from health insurance plans (Johnson, 3/7).

The Philadelphia Inquirer: Insurance Plans Sue Drug Companies Over Coupons
Coupons for drug co-payments are illegal and drive up long-term health-care costs for all, a consumer group and four trade-union health-insurance plans said Wednesday in announcing lawsuits against eight pharmaceutical companies. Drug companies use co-pay coupons to entice patients to stay with higher-cost brand-name drugs and not switch to lower-cost generics. Coupons reduce the consumer's out-of-pocket cost at the pharmacy counter, but the payment process keeps that information from the health insurer, which still pays the previously negotiated price to the drug company (Sell, 3/8).

In other news related to the drug industry -

The Associated Press: FDA Weighs Over-The-Counter Switch For Key Drugs
Some of the most widely used prescription drugs, including those to treat cholesterol and high blood pressure, could be available over the counter under a new proposal being weighed by government regulators. Food and Drug Administration officials said Wednesday they are considering waiving prescription requirements for certain drugs used to treat ailments like diabetes, asthma and migraine. Driving the move is a wave of computer technology, including touch-screen kiosks found in pharmacies, designed to help patients self-diagnose common diseases (Perrone, 3/7).

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Public Health & Education

Surgeon General Finds Much Work Needed To Stop Teen Smoking

The federal report documents an "epidemic" of tobacco use among teens, which it says can stunt lung growth and accelerate development of health problems.

The Washington Post: Surgeon General's Report Takes Aim At Youth Smoking
Smoking during the teenage years stunts lung growth and accelerates the decline in their function that inevitably comes with age. At the same time, the habit damages blood vessels in ways that can later lead to a heart attack, stroke and aortic rupture. Those are among the conclusions of a report by the U.S. Surgeon General on tobacco use by young people. The 899-page document gathers recent research on the epidemiology, effects and strategies to fight youth smoking (Brown, 3/8).

USA Today: Teen Tobacco 'Epidemic' Shocks Surgeon General
Many of America's teens smoke cigarettes as well as use smokeless tobacco, and the tobacco industry's marketing fuels their addiction, says the first U.S. surgeon general's report on youth tobacco use since 1994 (Koch, 3/7).

The Associated Press: US Report Studies Youth Tobacco Use, Prevention
More work needs to be done to keep young Americans from using tobacco, including creating smoking bans and increasing taxes on tobacco products to deter youth, the U.S. Surgeon General's office said in a report released Thursday. The report said it's particularly important to stop young people from using tobacco because those who start smoking as teenagers can increase their chances of long-term addiction. They also quickly can develop reduced lung function, early heart disease and other health problems (Felberbaum, 3/8).

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State Watch

Va. Gov. Signs Pre-Abortion Ultrasound Bill

Virginia Gov. Bob McDonnell has signed a contentious bill mandating women who want an abortion get an ultrasound before the procedure.

Los Angeles Times: Virginia Gov. Bob McDonnell Signs Pre-Abortion Ultrasound Bill
Virginia Gov. Bob McDonnell has signed into law a controversial bill requiring women to have an ultrasound before undergoing an abortion. The bill sparked a national furor among abortion rights activists who argued that the intent was to make it more costly and more difficult for women to receive abortions. The bill ... is a watered-down version of an earlier bill that would have required women to undergo a trans-vaginal ultrasound (Geiger, 3/7).

The Associated Press: Va. Governor Signs Pre-Abortion Ultrasound Bill
The Republican governor's signature means the mandate takes effect in July for abortion providers across Virginia. The bill not only sparked protests the past three weeks by angry women's rights groups and others that led to 30 arrests at the Capitol Saturday, it subjected Virginia to scorn by columnists and political talk shows and ridicule from television comedians (Lewis, 3/7).

Stateline: Abortion Ultrasound Debate Intensifies
Virginia has grabbed national headlines over its plan to require every woman seeking an abortion get an ultrasound, but it's not the first or only state taking up such a proposal. States started discussing whether to require ultrasounds before abortions back in the 1990s and began enacting laws a decade ago (Prah, 3/8).

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Contraception, Abortion Issues Crop Up In State Legislatures, Political Races

The debate over the birth control mandate is seeping into West Virginia's governor race as reproductive-rights supporters assess their place amid losses in state legislatures.

National Journal: Abortion-Rights Supporters, Losing In State Legislatures, Retaliate With Jokes
A bill giving sperm special status and another requiring men to undergo invasive exams before they can get Viagra are among some of the tongue-in-cheek pushback measures being offered up this year by legislators backing abortion rights. The liberal blog Think Progress published a list of such measures on Tuesday. They include laws that would protect the rights of sperm and laws that would require onerous medical tests before men could seek prescriptions for drugs to treat erectile dysfunction (Sanger-Katz, 3/7).

Politico: Contraception Debate Seeps Into Gov Races
Fallout from the Obama administration's contraception rule is now seeping into governors' races. And it's immediately evident which candidates see the issue as a winner. In West Virginia, Republican candidate Bill Maloney is calling on Gov. Earl Ray Tomblin to join a multi-state lawsuit charging the federal regulation violates the First Amendment. "Earl Ray Tomblin should end his silence and immediately join the seven other states that have sued the Obama administration’s ruling that violates religious freedom," said Maloney in a statement (Catanese, 3/7).

The Texas Tribune/New York Times: Women In Texas Losing Options For Health Care In Abortion Fight
The cuts, which left many low-income women with inconvenient or costly options, grew out of the effort to eliminate state support for Planned Parenthood. Although the cuts also forced clinics that were not affiliated with the agency to close -- and none of them, even the ones run by Planned Parenthood, performed abortions -- supporters of the cutbacks said they were motivated by the fight against abortion (Belluck and Ramshaw, 3/7).

And lawmakers in New Hampshire and Georgia pass legislation that exempts religious institutions from having to provide contraception coverage in their health plans --

Reuters: New Hampshire House Passes Birth Control Exemption
New Hampshire's Republican-controlled House of Representatives voted on Wednesday to exempt religious institutions from having to include contraceptive coverage in health insurance plans. The move was the latest in a national effort by Republicans opposed to provisions of President Obama's 2010 national health care reform law that would require all insurance plans -- even those sponsored by religious institutions -- to provide coverage for birth control pills and other contraception for women (McClure, 3/8). 

The Atlanta Journal Constitution: Conservative Social Issues Rule Crossover Day
With Georgia state lawmakers in an election year, the Republican-controlled Gold Dome struck a familiar chord Wednesday by demanding more personal responsibility from the state's neediest residents. … New restrictions on protests and picketing that drew the ire of community leaders and workers' groups also passed the Senate, as did a bill exempting some employers from providing contraception coverage in their health plans. … Most of the passionate debate was reserved for bills that would ban state employee health insurance plans from offering coverage for abortion services, SB 438, and SB 460, which would allow Georgia to exempt religiously affiliated businesses from having to provide birth control coverage.  The Senate passed the abortion bill (Torres and Quinn, 3/8).

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States Consider Dental Care Access Issues

Bettering the health of America's poorest through greater access to dental care is on the minds of state lawmakers and dental care advocates in Kansas and Massachusetts as they consider legislation to expand who can practice basic dentistry.

Kansas Health Institute News: Committee Considers Bill To Increase Dental Access
One of the provisions of House Bill 2631 would require the Kansas Board of Regents to seek additional openings for Kansas students at the University of Missouri-Kansas City School of Dentistry. ... Other provisions of the bill, which passed the House last month by wide margin, are: ... Expand the locations where charitable dental services could be performed while providing dentists with exemptions from liability. ... Create a new permit level for dental hygienists to allow them to provide more types of care to underserved patients (Cauthon, 3/7).  

Kaiser Health News: Coming Soon To Massachusetts' Dental Offices – Maybe
WBUR's Martha Bebinger, working as part of a partnership with Kaiser Health News and NPR, reports: "In Massachusetts, one in six residents lives in an area with a shortage of dental care, including parts of central and western Massachusetts, Cape Cod and many low-income urban communities. In addition, almost 750,000 low-income residents on Medicaid have coverage to get their teeth cleaned or pulled, but nothing more. Health care advocates are pressing the legislature to restore full dental benefits" (Bebinger, 3/7).

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Critics Raise Alarms About Downsizing Of Calif. Adult Day Health Care Program

Some say the state has predetermined how many people it can serve and is manipulating the process for assessing clients so the results fit within the new program’s slimmer budget.

HealthyCal: Program's Transition Mired In Confusion
California is bungling its planned transition to a less expensive way to care for older adults and disabled people trying to stay out of nursing homes, leaving thousands of vulnerable people at risk of being forced into institutions, critics say. ... The most damning criticism, if true, is that the state has predetermined how many people it is prepared to serve and is manipulating the process for assessing individual clients so that the results fit within the new program's slimmer budget. ... State officials stand firm that budget cuts have forced a much needed change with the new program, and say those who truly need the services will continue receiving them (Perry, 3/7). 

California Healthline: More People May Be Eligible for Adult Day Services
There was a glimmer of good news for the 35,000 adult day health care Medi-Cal patients in California. It looks like a much higher percentage of them than previously estimated will be eligible to receive the new benefit called Community Based Adult Services. Department of Health Care Services Director Toby Douglas originally said he expected about 50 percent of current ADHC patients to qualify for the new program. ... and the CBAS program starts Apr. 1 (Gorn, 3/8).

In the meantime, care at California nursing homes lack oversight, a new report says --

California Watch: Oversight Of California Nursing Homes Lacking, Report Finds 
California nursing home inspectors fall short in following up on their own investigative findings, possibly enabling sustained neglect or lax practices that can injure residents, according to a new federal report. The Department of Health and Human Services' Office of Inspector General, which oversees Medicare and Medicaid, identified shortcomings by the California Department of Public Health, which inspects the state's 1,150 nursing homes. ... The report released last week examined the handling of 178 findings of deficiencies at three nursing homes that send a high rate of patients to nearby hospitals with bedsores and severe infections (Jewett, 3/7).

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State Legislatures Take On Employee Health Plans, Medicaid Reform, Malpractice

News outlets report on a variety of state health policy news.

The Associated Press/NBC Washington: Virginia Senate Democrats Send Budget Wish List to McDonnell
Democrats in the state Senate have sent Republican Gov. Bob McDonnell a list of conditions they want addressed before allowing a new state budget necessary to fund state services and operations to pass. … They want the state to pay for the ultrasound exams now mandated for women seeking abortions under a bill McDonnell signed Wednesday. ... And they want Medicaid eligibility restored for about 4,500 nursing home residents (Lewis, 3/7).

Des Moines Register: Multi-Faceted Bill Gets Multi-Faceted Critique In House Subcommittee
A bill offering a grab-bag of measures meant to save money and improve government efficiency received a grab-bag of criticism during a House subcommittee hearing this afternoon. The bill, House File 2434, requires married state employees to enroll together in a family health insurance plan. That yielded criticism from union officials (Noble, 3/7).

Kansas Health Institute News: Legislators Push To Delay KanCare Start
A resolution urging Gov. Sam Brownback to delay by six months the start of his Medicaid reform plan was introduced today in the Kansas Senate. ... Brownback's reform plan, KanCare, is scheduled to start Jan. 1, 2013, contingent on federal approval. The resolution asks that the start date be postponed to July 1, 2013. Under KanCare, three managed care companies would oversee the day-to-day operations of the state's $2.8 billion Medicaid program (Ranney, 3/7).

The Connecticut Mirror: Malpractice, ODs, And A Big Database On Tap For Discussion
Lawmakers are hearing testimony on several health-related bills today, including: Treatment for drug overdoses: ....  Medical malpractice ... Create an all-payer claims database: A proposal from the governor's office would create a database of health care claims information that would provide information about the use, cost and effectiveness of medical services in the state (Levin Becker, 3/7).

Chicago Sun-Times: State Health Contracts Had Flaws, Auditor Says
The state awarded $7 billion in health-care contracts for state employees and retirees despite several flaws, including lax oversight and possible conflicts of interest, the state's top auditor concluded Wednesday. The report by Auditor General William Holland knocked the state's Department of Healthcare and Family Services, which was responsible for evaluating proposals from healthcare providers as it tried ditching the state's long-term health insurer in a move designed to save money (Maloney, 3/8).

New Orleans Times-Picayune: Jindal Staffer Fired For Opposing Plan To Move Office Of Elderly Affairs Martha Manuel's cell phone started ringing almost as soon as she walked out of a House committee room Tuesday afternoon, having just told legislators that Gov. Bobby Jindal's plans to have the Department of Health and Hospitals absorb the Governor's Office of Elderly Affairs would lead to cuts in senior programs and worse services for aging residents (Adelson, 3/7).

Health News Florida: Anonymous Letters Worry AHCA
Someone is sending warning letters to elderly Medicaid patients about the state's plan to move them all into managed care. ... In its release about the anonymous letter, the [Agency for Health Care Administration] said its purpose "appears to be to alarm" those enrolled in programs aimed at helping the elderly and disabled remain in their home or in community-based care, rather than in a nursing home (Gentry, 3/8).

Boston Globe: Tufts To Launch Physician Assistant Program
Tufts University School of Medicine plans to launch a master's program in January to train physician assistants, the fourth such program in Massachusetts and the first affiliated with a medical school. The 25-month program, which is in the accreditation process now, could begin accepting applications in May for enrollment of its first class of 30 students in January (Conaboy, 3/7).

The Wall Street Journal: New Front Open In Florida's Pill War
Now, a year after Florida stepped up its battle against pill mills, the state can point to some notable successes. ... The number of pain clinics in the state has fallen 38 percent from its peak, according to the Florida Department of Health. Yet Florida's pill problem persists as drug users and dealers adapt to the changing landscape and pill demand shifts to retail pharmacies and other establishments (Martin and Campo-Flores, 3/7).

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Weekend Reading

Longer Looks: Santorum's Pro-Government Record

Every week, reporter Jessica Marcy selects interesting reading from around the Web.

Mother Jones: Santorum In '93: More Government Needed in Health Care 
If elected president, Santorum vows, he will end the "tyranny" of President Obama's Affordable Care Act. Yet as an up-and-coming congressman in the early 1990s, Santorum took a much different line. Then—like now—health care was one of the nation's most divisive issues. In 1993, Republicans were up in arms about a health care reform bill spearheaded by Hillary Clinton and pushed by President Bill Clinton. … During that fiery debate, Santorum said it would be a mistake to allow the delivery of health care services to be determined only by the market. He asserted that Republicans were "wrong" to let the marketplace decide how health care works. He instead argued that government should play a "proactive" role in shaping the health care marketplace "to make it work better" (Andy Kroll and Tim Murphy, 3/5).

The Atlantic: Making The Best Of What Is Often The Very Worst Time Of Our Lives (Book Excerpt)
As difficult as things are now, these may turn out to be the good old days. How we die is already a public health crisis, and care for people through the end of life is poised to become a generation-long social catastrophe. ... Very soon, for the first time in human history, older people will outnumber younger people on our planet. In the United States, one in five adults is 65 or older. ... Those of us who are concerned about long-term care have good reasons to worry. The nursing homes of the future -- our future! -- may make today's nursing homes look like luxury hotels. It doesn't have to turn out that way (Ira Byock, 3/7). 

American Medical News: Legal Risks Of Going Paperless
System breaches. Modification allegations. E-discovery demands. These issues are becoming common courtroom themes as physicians transition from paper to EMRs, legal experts say. Not only are EMRs becoming part of medical negligence lawsuits, they are creating additional liability. … Studies are mixed about how EMRs will impact liability for physicians. … Whatever the future holds for EMRs, it’s important that doctors reduce their liability risks during system implementation, legal experts say. Being aware of potential legal pitfalls prevents doctors from falling victim to technology intended to do good — not cause hardship (Alicia Gallegos, 3/5).

The Daily Beast: Talking About Sex Is the Only Way To Stop HIV 
[The United States has] been stuck at about 50,000 new infections each year for more than a decade. Compared with the challenges facing places like sub-Saharan Africa, our failure is particularly galling: we have plenty of drugs that work, the money and systems to administer them, and effective, if not particularly popular, ways to interrupt the spread (condoms, clean needles, abstinence). So why aren’t we doing better? The answer is blindingly simple: sex. Almost all HIV in the U.S. is spread by sexual intercourse, yet when faced with this fact, we act like a bumbling junior-high-school kid hearing about the birds and the bees for the first time. As a result, we have before us an unabated 30-year epidemic of a sexually transmitted disease (Kent Sepkowitz, 3/5). 

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Editorials and Opinions

Viewpoints: Wilensky On Bipartisan Medicare Reform; Mass. 2006 Health Law And 2012 GOP Politics; Reinstating Advanced Care Planning

The Wall Street Journal's Political Diary: Exit Poll Statistic Of The Year
The Super Tuesday exit polls yielded a mountain of data in 10 states, but the most telling single statistic may have been in Massachusetts, which Mitt Romney won in a largely uncontested rout. Yet believe it or not, he still lost on health care. The exit poll asked voters their opinion of the "Massachusetts Health Care Law," with the options of Did Not Go Far Enough, About Right and Went Too Far. Remarkably, 51% said the bill went too far, while only 37% said it was about right, and 6% said not far enough. ... the result reveals how unpopular government-mandated health care is, even in its Massachusetts birthplace (Paul A. Gigot, 3/7).

The Wall Street Journal: Santorum And Freedom 
[W]hen he tore into ObamaCare, his mostly working-class audience exploded into applause and cries of "Rick! Rick! Rick!" Mr. Santorum didn't get this response by discussing health-insurance exchanges and guaranteed issue. He told these people that ObamaCare "is usurping your rights. It is creating a culture of dependency." ... His call for repeal produced the explosion  (Daniel Henninger, 3/8).

The Washington Post: A GOP Campaign That No One Seems Able To Win
The fact that none of (Mitt) Romney’s opponents had turned up the July 2009 op-ed he penned for USA Today, in which he called for a national health insurance plan that included an individual mandate — a column that all but neutralizes any Romney attack on Obamacare — is further confirmation that their campaign operations are stunningly incompetent (Harold Meyerson, 3/7).

Modern Healthcare: Over The Top And Into The Political Woods
For nearly a year now, Democrats have repeated a phrase ad nauseam to describe their take on House Budget Committee Chairman Paul Ryan's plan to privatize the Medicare program. "It's the end of Medicare as we know it," they've said. After listening to some remarks that GOP presidential hopeful Rick Santorum gave last night, I wonder if he might steal that phrase and make it his own. ... like: “Obamacare: The end of freedom as we know it" (Jessica Zigmond, 3/8).

Boston Globe: Taking Measure Of Health And Wealth
Because of Romney’s leadership in Massachusetts, Ann Romney could not be denied health insurance because of a pre-existing condition [MS]. In other states, she could be. That would change under the national health care reform act. ... Does Romney really want to stop that, as he salutes the right by promising to repeal Obamacare? (Joan Vennochi, 3/8).

Journal of the American Medical Association: Seven Provocative Principles For Health Care Reform
This Viewpoint accordingly sets out 7 principles for broad health care reform ... There is no perfect health care system. ... Simplicity in legislation and regulation trumps complexity. The more changes that are made concurrently, the greater the risk of unintended consequences.  ... Every efficient health care system imposes caps on spending and engages in strategic rationing (Dr. C. David Naylor and Karline Treurnicht Naylor, 3/7).

New England Journal of Medicine: Directions For Bipartisan Medicare Reform
Even those who most celebrate Medicare's success in expanding seniors' access to care generally agree that the program provides too much uncoordinated, fragmented care to a population primarily characterized by chronic disease. There are important differences of perspective regarding how best to transform the delivery system and who should lead that transformation, but the disillusionment and frustration with the current reimbursement system could not be stronger. ... areas of agreement are developing, even in these most partisan of times. Sometimes it's important to celebrate even these small, interim successes (Gail R. Wilensky, 3/7).

New England Journal of Medicine: Slower Growth In Medicare Spending — Is This The New Normal?
On the whole, we do not believe that the recent slowdown in Medicare spending growth is a fluke. There has been a long-term trend toward tighter Medicare payment policy, and policy changes that began in the middle of the 2000s have continued that tightening. ... We see a combination of reformed delivery of care and broader units of payment as having the potential to allow providers to generate savings through steps that are less threatening to quality of care and access than are cuts in payment rates (Chapin White and Paul B. Ginsburg, 3/7).

The Kansas City Star: Stop The Rush Toward Risky Medicaid Change
A sizable and bipartisan group of Kansas lawmakers on Wednesday called on Gov. Sam Brownback and Lt. Gov. Jeff Colyer to slow down their plans to hand the care of the state’s Medicaid patients over to private insurance companies....  coordinated care, if done well, could prevent hospitalizations and nursing home stays and serve patients better. But the fears of lawmakers, medical professionals and defenders of vulnerable Kansas citizens are well-founded. A six-month delay and some sensitivity to the needs of disabled citizens are not too much to ask (3/7). 

Georgia Health News: Challenge For Pharma Firms: Funding For HIV Research
[D]espite the continuing importance of developing HIV vaccines, a range of research groups and small biopharma companies are finding challenges in obtaining the amount of funding that is required to conduct effective research and clinical trials. ... there are certain factors behind the roadblocks currently faced by small biopharma companies engaged in HIV/AIDS vaccine research.  An enhanced recognition of these and other factors could lead to a more suitable level of funding for a disease that still threatens millions worldwide (Robert McNally, 3/7).

The Seattle Times: K-12 Health-Insurance Reforms Are Part Of Long-Term State Budget Stability
Washington's pernicious state budget deficits will persist until known, expensive problems are boldly confronted. A prime example is the cozy system that provides health insurance and other benefits for teachers and other public-school employees. A credible alternative exists, and it is being fiercely resisted (3/7).

The Seattle Times: Planning For Old Age At A Premium
Care is expensive. I had no idea how costly until my wife and I began to deal with parents who needed it. ...There are good places out there, but they're harder to get into and usually cost more. Some of the most desirable places take Medicaid clients, but placements are limited. ... he problem of what to do with old people who need help is a creation of modern society that we haven't committed ourselves to solving (Jerry Large, 3/7).

Journal of the American Medical Association: The Retreat From Advanced Care Planning
To repair the harm done by discussion of death panels and by the administration's apparent retreat on this issue, this important patient need must be depoliticized. This is an opportunity for medical organizations to advocate for something other than higher reimbursements and reduced administrative burdens for their members. Medical organizations and patient advocacy groups should demand that politicians across the spectrum stay out of the patient-physician relationship. These groups also should encourage interested patients to participate in advanced care planning, recognizing that not every patient will want to do so (Dr. Mary E. Tinetti, 3/7).

Journal of the American Medical Association: Time To Revise The Approach to Determining Cardiopulmonary Resuscitation Status
In US hospitals, cardiopulmonary resuscitation (CPR) is the de facto default option—patients must "opt out" by requesting or consenting to a do-not-attempt-resuscitation order. Despite its worthy intent, requiring all patients or their surrogates to consent to a do-not-attempt-resuscitation order to avoid CPR has resulted in an ethically unjustifiable practice that exposes many patients to substantial harms (Dr. Craig D. Blinderman, Dr. Eric L. Krakauer and Mildred Z. Solomon, 3/7).

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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.