Daily Health Policy Report

Friday, March 8, 2013

Last updated: Fri, Mar 8

KHN Original Reporting & Guest Opinion

Health Spending And Fiscal Battles

Health Reform

Health Care Marketplace

Quality

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Health Insurers See Big Opportunities In Health Law's Medicaid Expansion

Kaiser Health News staff writer Phil Galewitz, working in collaboration with USA Today, reports: "For industry titans such as UnitedHealthcare and WellPoint, as well as smaller, Medicaid-focused plans such as Molina, the Medicaid expansion is expected to bring significant enrollment and revenue growth. 'This is several hundreds of billions of dollars of new market opportunity for these plans over the next couple of years,' says Jason Gurda, managing director of healthcare with investment bank Leerink Swann in New York" (Galewitz, 3/8). Read the story.

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Minnesota Senate Passes Exchange Bill

MPR News' Elisabeth Stawicki, working in partnership with Kaiser Health News and NPR, reports: "The Minnesota Senate on Thursday night followed the House in passing legislation to create an online health insurance marketplace under the federal health law. A legislative conference committee will meet in coming days to resolve differences between the House and Senate bills. More than one million Minnesotans are projected to find health coverage through the exchange, which is slated to be up and running in October" (Stawicki, 3/8). Read the story.

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Capsules: A Bump In The Road To Accountable Care?; Idaho, Utah, N.M. Running Out Of Time To Set Up State Exchanges; What's The Price? Simple Question, Complicated Answer In Medicare

Now on Kaiser Health News' blog, Jenny Gold reports on accountable care organizations: "For the first year of the program, everything seemed like smooth sailing. But the pioneers appear to have hit their first pothole—and the administration is scrambling to make sure the project goes forward. The problem: That pesky little part about accountability" (Gold, 3/8).

In addition, Phil Galewitz reports on the time pressures some states face regarding health exchanges: "Three western states which had gotten tentative go-aheads to run their own online health insurance websites — Utah, Idaho and New Mexico — are running out of time to be ready for an Oct. 1 launch and experts doubt they will get green lights from the federal government" (Galewitz, 3/8).

Also on Capsules, WBUR's Martha Bebinger, working in partnerhship with KHN and NPR, reports on her efforts to uncover one single Medicare number: "I wrote to Medicare a while back, asking for a price. I know nothing is simple in the world of health care costs, but I just needed one number, a number Medicare uses all the time, I supposed, to calculate payments to doctors and hospitals. Here’s what I wanted to know: How much does Medicare pay a particular hospital in Boston for a colonoscopy?" (Bebinger, 3/8). Check out what else is on the blog.

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Political Cartoon: 'Say That Again?'

Kaiser Health News provides a fresh take on health policy developments with "Say That Again?" by Nate Beeler.

Meanwhile, here is today's health policy haiku:

12-WEEKS LAW LEADS TO ABORTION CHALLENGES

Arkansas' new law--
the toughest in the country.
What will courts decide?
-Anonymous

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

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Health Spending And Fiscal Battles

Obama Continues Efforts To Woo Republicans

In what one news outlet described as a "charm offensive," President Barack Obama is seeking common ground with rank-and-file Republicans for a deficit reduction deal that would overhaul the tax code and slow the growth of Medicare and other entitlement programs.

The Wall Street Journal: Republicans Warm To Obama's Efforts
Both Republicans and administration officials described the discussions as productive and even pleasant. But while the lawmakers' mood may be improving, fundamental disagreements over taxes and spending persist, and lawmakers in both parties acknowledged that any significant deal would be months away at best. … Both the president and some GOP members have indicated a willingness to discuss a deficit-reduction approach that would involve overhauling the tax code and slowing the growth of spending on entitlement programs such as Medicare and Social Security. But, as Sen. Lindsey Graham (R., S.C.) noted, "The details may trip us up" (Nelson and Paletta, 3/7).

Los Angeles Times: Obama Charm Offensive Sows Goodwill
White House officials say the president is trying to find congressional allies to chart a new path on deficit reduction. Both parties have an interest in trying to strike a big deal, preferably before the next budget showdown in summer, when Obama must ask Congress to raise the legal limit on the national debt (Hennessey and Mascaro, 3/7).

The Wall Street Journal's Washington Wire: New Idea On Tweaking Medicare Eligibility
Raising the Medicare eligibility age to 67 from 65 is a third-rail for many Democrats, who argue that it could leave some seniors without access to insurance. It's also difficult to do without disrupting the implementation of the federal health-care law, as we noted in this story, which makes it a tough proposition for the White House to swallow (Radnofsky, 3/7).

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Health Reform

Insurers See Opportunities In Medicaid Expansion While States Mull Pros And Cons

Business analysts view the expansion as "several hundreds of billions of dollars" worth of opportunity for Medicaid health plans. Meanwhile, news organizations track the continuing debate in Kentucky, Florida, New Hampshire and Texas about whether to participate in the expansion.

Kaiser Health News: Health Insurers See Big Opportunities In Health Law's Medicaid Expansion
For industry titans such as UnitedHealthcare and WellPoint, as well as smaller, Medicaid-focused plans such as Molina, the Medicaid expansion is expected to bring significant enrollment and revenue growth. "This is several hundreds of billions of dollars of new market opportunity for these plans over the next couple of years," says Jason Gurda, managing director of healthcare with investment bank Leerink Swann in New York (Galewitz, 3/8).

The Associated Press: Bullock Takes Medicaid Expansion To Constituents
[Montana] Gov. Steve Bullock is ramping up the pressure on lawmakers by taking his Medicaid expansion request, one of the legislative session's bigger issues, straight to his constituents. Bullock has been touring the state selling his proposal, and he pitched it Thursday to the Helena Chamber of Commerce (3/7).

The Associated Press: Price Tag Of Health Overhaul Adjusted Downward
Florida economists on Thursday came out with a new price tag for President Barack Obama's health care overhaul that is dramatically lower than the one cited earlier this year by Gov. Rick Scott. Economists are now projecting that it would cost Florida taxpayers about $5.2 billion over the next decade to pay for the changes (Fineout, 3/7).

The Associated Press: NH Lawmakers Host Hearing On Medicaid Expansion
Low-paid health care workers who provide critical services deserve access to quality care themselves, supporters of expanding New Hampshire's Medicaid program told House lawmakers Thursday. The state is deciding whether to expand Medicaid under the federal health overhaul law to include more poor adults in addition to the children, pregnant women and other groups who are currently covered. If it opts for expansion, the federal government would pick up the entire cost for the first three years and 90 percent after that, though some opponents question whether that promise would be kept (Ramer, 3/7).

The Texas Tribune: Lawmakers Seeking 'Texas Solution' To Medicaid Reform
Momentum is building in the Capitol to find a "Texas solution" for reforming — and possibly expanding — Medicaid, the joint state-federal health program for children, the disabled and the very poor. The influential House Appropriations Committee plans to discuss options for Medicaid reform on Friday (Aaronson, 3/8).

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CMS Signals Exhanges Are 'On Track'; HHS Gives 4 More States Conditional Approval

Also, three states -- Utah, Idaho and New Mexico -- are facing a time crunch to be ready for an Oct. 1 launch for their exchanges, and some states are seeking an OK from the federal government to direct low-income residents who are eligible for Medicaid to buy health coverage with tax dollars from the exchanges.

CQ HealthBeat: CMS Says Exchanges On Track Even Though House Rejects Added Funds For Agency
A federal official who Thursday announced another round of conditional approvals for partnership exchanges also said that the new marketplaces will open as scheduled in all states on Oct. 1, despite Congress’ refusal to increase the Centers for Medicaid and Medicaid Service’s administrative budget. Gary Cohen made that prediction after he was asked about the refusal by the House Wednesday to agree to an Obama administration request to add $949 million to the agency’s fiscal 2013 administrative budget. Cohen heads the CMS Center for Consumer Information and Insurance Oversight (Reichard, 3/8).

The Hill: HHS Approves 4 More Exchanges Under Obama's Health Law
Four states won conditional approval from the Obama administration Thursday to implement the key piece of President Obama's healthcare law in partnership with the federal government. The Health and Human Services Department conditionally approved insurance exchanges in Iowa, Michigan, New Hampshire and West Virginia (Baker, 3/7).

Kaiser Health News: Capsules: Idaho, Utah, N.M. Running Out Of Time To Set Up State Exchanges
Three western states which had gotten tentative go-aheads to run their own online health insurance websites — Utah, Idaho and New Mexico — are running out of time to be ready for an Oct. 1 launch and experts doubt they will get green lights from the federal government (Galewitz, 3/8).

Kaiser Health News/MPR News: Minnesota Senate Passes Exchange Bill
The Minnesota Senate on Thursday night followed the House in passing legislation to create an online health insurance marketplace under the federal health law. A legislative conference committee will meet in coming days to resolve differences between the House and Senate bills. More than one million Minnesotans are projected to find health coverage through the exchange, which is slated to be up and running in October (Stawicki, 3/8).

Bloomberg: States Seek To Direct Medicaid Patients To Exchanges
Lower-income residents eligible for Medicaid may be directed to buy coverage from health insurance exchanges using tax dollars, an option the Obama administration is weighing. Multiple states have asked about the arrangement, Gary Cohen, the director of the U.S. Center for Consumer Information and Insurance Oversight, said today on a conference call with reporters. Cohen, whose agency is implementing much of the 2010 health-care law, didn’t say how many governors made the request to use Medicaid money as a conduit for people to obtain private health plans next year through the new exchanges (Wayne, 3/8).

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ACO 'Pioneers' Feeling Skittish About Next Stage Of Implementation

The providers who are participating in this health law effort to control costs and improve quality are nervous about the second year's emphasis on accountability.

The Washington Post: Hospitals Want To Delay A Key Obamacare Program
In 2011, the Obama administration settled on 32 health care systems, scattered across the country, to lead the Affordable Care Act's most ambitious cost-control effort. ... For the past year, the Pioneer ACOs have received payments just for reporting data on the 33 metrics, which includes data on how many patients receive mammograms or end up back in the hospital 30 days after their discharge. In 2012, no payments were tethered to how good or bad their outcomes were. That changed in 2013. Now, the health care providers are scheduled to move from pay-for-reporting to pay-for-performance—and are getting nervous about how they will be judged (Kliff, 3/6).

Kaiser Health News: Capsules: A Bump In The Road To Accountable Care?
For the first year of the program, everything seemed like smooth sailing. But the pioneers appear to have hit their first pothole—and the administration is scrambling to make sure the project goes forward. The problem: That pesky little part about accountability (Gold, 3/8).

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Sebelius Credits Health Law With Slowing Medical Cost Growth

News outlets report on various aspects of the health law's implementation.

The Hill: Sebelius: Health Law Has Slowed Growth In Medical Costs
Health and Human Services Secretary Kathleen Sebelius on Thursday credited President Obama's health care law with a recent slowdown in medical spending. The Congressional Budget Office has projected a significant slowing in the growth of Medicare spending and healthcare costs more generally (Baker, 3/7).

McClatchy: Few Insurers Now Cover Services Required In 2014 Under Health Care Law
Just 2 percent of health plans available to consumers in the private insurance market offer all the coverage that will become mandatory next year under the health care overhaul, a new analysis has found. That means that only about one in 50 plans are now in compliance with the main requirements of the Patient Protection and Affordable Care Act, according to HealthPocket Inc., a Sunnyvale, Calif., technology firm that "compares and ranks" health plans. And consumers and the federal government might end up paying the cost of those new requirements in higher premiums (Pugh, 3/7).

Modern Healthcare: CMS Adds 20 More Organizations To Care Transitions Program
Twenty more organizations will join the 82 already participating in the CMS's community-based care transitions program, launched in 2011 under the Patient Protection and Affordable Care Act. The program was designed to reduce hospital readmissions among high-risk Medicare beneficiaries. Close to one in five Medicare patients -- or about 2.6 million seniors -- are readmitted to the hospital within 30 days of discharge. That comes at a cost of more than $26 billion a year, the government estimates. With the 20 additional sites, the program will be offering care transition services to more than 700,000 patients in 40 states (Landen, 3/7).

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Health Care Marketplace

Survey: Large Employers Pushing Health Providers For More Price Transparency

The survey, conducted by Towers Watson and the National Business Group on Health, also found that most large companies plan to keep continue offering employees an insurance benefit in the next five years. 

Modern Healthcare: Employers Pressing Providers For Price Transparency
Large companies are ratcheting up efforts to make providers more accountable and transparent on quality and price as businesses struggle to control healthcare costs, according to an employer survey. A quarter of large employers now use financial incentives to obtain provider accountability for their care, according to a Towers Watson and National Business Group on Health survey of 583 companies with at least 1,000 employees. By next year, 33% expect to use such incentives. "We expect this trend to grow now that Medicare, Medicaid and many insurance companies have started using value-based purchasing," wrote the authors of a report on the survey results (Daly, 3/7).

Reuters: Most Large Employers To Keep Health Insurance Benefit: Survey
Most large employers don't expect to send their full-time employees to government health exchanges for insurance during the next five years, but some retirees and part-time workers will end up there, a new survey has found. The outlook for corporate insurance in the long term is less certain (Humer, 3/7).

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Quality

Operating Rooms, Hospitals Face Challenges In Eliminating Risks, Delivering High Quality Of Care

USA Today reports that many hospitals have not adopted technologies that would help elminate the risk of leaving sponges in patients during surgery. Meanwhile, the Associated Press offers a list to help patients avoid problems in the hospital.

USA Today: What Surgeons Leave Behind Costs Some Patients
Thousands of patients a year leave the nation's operating rooms with surgical items in their bodies. And despite occasional tales of forceps, clamps and other hardware showing up in post-operative X-rays, those items are almost never the problem. Most often, it's the gauzy, cotton sponges that doctors use throughout operations to soak up blood and other fluids, a USA TODAY examination shows. Yet thousands of hospitals and surgical centers have failed to adopt readily available technologies that all but eliminate the risk of leaving sponges in patients (Eisler, 3/8).

The Associated Press: How To Avert Problems For A Happy Hospital Stay
Hospital stays can be scary, but they don't have to be. A stay in the hospital can be stressful, whether it's an emergency visit, a birth of a child or a planned surgery. But there are a number of things patients and their relatives or friends can do in order to make stays in the hospital more comfortable (Johnson, 3/7).

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State Watch

Ark. Abortion Law Sets Off New Clash Over Reproductive Rights

The law, which the legislature passed by overriding the governor's veto, comes as a strict Idaho law was struck down by a federal judge.

The Wall Street Journal's Law Blog: Arkansas A.G. Says He'll Defend Abortion Ban Despite Concerns
A day after Arkansas lawmakers voted to enact the most-stringent abortion restrictions in the nation, the state's attorney general said he is preparing to defend the law against inevitable challenges – despite his personal feelings on the matter. Some abortion rights supporters indicated that they would sue Arkansas in federal court to try and overturn the law, which bars most abortions after 12 weeks of pregnancy (Gershman, 3/7).

PBS NewsHour: Arkansas Abortion Law Bans Procedures After 12 Weeks of Pregnancy (Video)
The Arkansas legislature passed the nation's strictest abortion rules, outlawing any procedures done after the 12th week of pregnancy. To learn more about the legal ramifications for doctors under the new law and how it will effect other states, Hari Sreenivasan talks with Suzi Parker, a reporter for Reuters from Little Rock (3/7).

Reuters: In Arkansas, Challenges Expected For Nation’s Strictest Abortion Law
Abortion rights groups say they plan to challenge a new Arkansas law adopted on Wednesday that will prohibit most abortions after about 12 weeks of pregnancy and is the most restrictive abortion law in the United States. The measure, which lawmakers approved over Democratic Governor Mike Beebe's veto, prohibits abortions once a fetal heartbeat can be detected by a standard ultrasound (Parker, 3/7).

The Associated Press: Arkansas Republicans Eye Planned Parenthood Funds Next
State Sen. Jason Rapert, who was behind the 12-week ban, now wants to cut all public funding to Planned Parenthood. And the state’s top anti-abortion advocacy group is urging lawmakers to ban providers from remotely administering the abortion pill via a video hookup — a practice they've derided as "webcam abortions." The moves mark a major shift in a state already considered to have some of the most tightest restrictions on abortion in the nation (DeMillo, 3/7).

Bloomberg: Abortion War Renewed As Arkansas Passes Toughest Limits
An Idaho ban on abortions after 20 weeks was overturned just as Arkansas lawmakers passed a more restrictive law opponents vowed to fight, intensifying a renewed debate over reproductive rights that has involved at least 10 states. U.S. District Judge Lynn Winmill in Boise on March 6 granted a mother's request to strike down the state's ban and denied a prosecutor’s request to dismiss her challenge, saying the law was an unconstitutional obstacle to women's rights (Milford and Schneider, 3/8).

Los Angeles Times: Idaho Law Banning Abortions After 20 Weeks Ruled Unconstitutional
A federal judge has struck down an Idaho law prohibiting abortions after 20 weeks, ruling that the so-called fetal pain law violates U.S. Supreme Court prohibitions against unduly impeding a woman's ability to seek an abortion before her fetus is able to live outside the womb. U.S. District Judge B. Lynn Winmill in Boise declared the 2011 law -- similar to limits adopted in at least seven other states -- to be unconstitutional in a ruling that took the Idaho Legislature to task for acting against the advice of its own attorney general (Murphy, 3/7).

Politico: Idaho 'Fetal Pain' Abortion Law Is Struck Down
The ruling, by a Democrat-nominated district judge, begins a new phase in the legal fight over a spate of laws enacted in the past couple of years that push earlier and earlier bans on abortion, mostly based on the argument that a fetus can feel pain after 20 weeks. Arkansas is the most recent to act, passing both a 20-week ban and a 12-week one — constituting what abortion rights proponents consider the most restrictive state laws in the nation (Smith, 3/8).

Meanwhile abortion issues are also simmering in other states.

The Texas Tribune: Hundreds Rally To Let Banned Providers Back In WHP
Hundreds of people rallied at the Capitol on Thursday, demanding that Planned Parenthood clinics be allowed back into the Women's Health Program. They called on lawmakers to pass House Bill 2819, authored by state Rep. Senfronia Thompson, D-Houston, which would restore the Medicaid Women’s Health Program to the way it was before last session, when Republican lawmakers implemented a ban on clinics "affiliated" with abortion providers (Chammah, 3/7).

The Associated Press/Washington Post: Va. Board Of Health Conducts Public Hearing On New Abortion Clinic Regulations
Former Virginia Health Commissioner Karen Remley was among more than two dozen people who testified Thursday at the latest in a series of public hearings on the state's new abortion clinic regulations (3/7).

Richmond Times Dispatch: Both Sides Air Arguments Over Proposed Abortion Clinic Rules
More than two dozen advocates were given 2 minutes each to voice support or criticism over the regulations, which, if approved during a Board of Health meeting next month, would make Virginia among the most restrictive states in the nation in regulating abortion clinics. Several former and current officials expressed reservations about the new rules going forward — most prominently Dr. Karen Remley, the former state health commissioner who resigned in October (Nolan, 3/8).

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Calif. Insurance Commissioner Calls Blue Shield Rate Hike 'Unreasonable'

The state's top insurance regulator criticized proposed rate hikes of as much as 20 percent for 268,000 individual policyholders, but he and other state officials don't have the authority to reject the increases.

Los Angeles Times: California Insurance Commissioner Chides Blue Shield Over Rates
For the second time in two days, a state regulator criticized Blue Shield of California for an "unreasonable" rate hike affecting tens of thousands of individual policyholders. California Insurance Commissioner Dave Jones said Thursday that the nonprofit health insurer's latest rate hike of as much as 20 percent for about 268,000 individual policyholders was excessive. But he and other state officials don't have the authority to reject changes in premiums (Terhune, 3/7).

San Francisco Chronicle: Health Premium Increases Meet Resistance
Hundreds of thousands of Californians covered by the state's largest health insurers are facing double-digit premium hikes, and regulators and consumers are pushing back. On Thursday, the state insurance commissioner said Blue Shield of California's proposed health premium increases - averaging 11.7 percent for most policyholders, but nearing 20 percent for some - were unreasonable. "California's health insurers are proposing double-digit increases in spite of the fact the data doesn't support them," said Insurance Commissioner Dave Jones. He said the department's review of the March 1 increases for 268,000 individual policyholders showed Blue Shield overestimated how much medical care its consumers would use (Colliver, 3/7).

Also, insurer profit in Oregon stays flat --

The Lund Report: Oregon Insurer Profits Remain Thin In 2012
Was 2012 the year of the health insurance upstart? While Oregon’s two largest plans either shed members (in the case of Kaiser Permanente) or barely grew (Regence BlueCross BlueShield), two smaller companies made strong inroads within the market, according to annual reports released in the past week by the National Association of Insurance Commissioners. Regence and Kaiser continue to each outweigh any other plan in the state by more than a quarter million covered lives. But PacificSource Health Plans appears willing to post financial losses to woo customers away from the competition. Reporting a 2012 net loss of $25.9 million – about $60 per person covered – PacificSource grew enrollment by 10.2 percent, or more than 20,000 people. Much smaller ODS Health Plans, meanwhile, managed to stay profitable while attracting 11,185 new members, a 17.6 percent climb (Sherwood, 3/7).

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College Students Face Long Waits For Mental Health Care As Demand Grows

College students are facing long waits for mental health care as their educational institutions struggle to keep up with demand.

Baltimore Sun: Colleges Struggling With Growing Demand For Mental Health Services
Within a week of arriving on campus this semester, University of Maryland junior Grace Freund felt the familiar symptoms of a depression creeping up — ones she knew to address quickly, lest they slip from her control. The 21-year-old psychology major called the counseling center on the College Park campus soon after to set up an appointment. However, she said, her request was rebuffed. "They said, 'Call back next week. We can't even schedule an intake appointment today,'" said Freund, a graduate of Mount Hebron High School in Ellicott City. Across the state and nation, college students -- an age group particularly prone to mental illness -- report similar frustration. Campus counseling centers often have insufficient staff and long waiting lists, mental health professionals say. In Maryland, counseling center directors say they are nearly overwhelmed with the ballooning numbers of students requesting services (Rector, 3/7).

In the meantime, lawmakers in Georgia are pushing to allow those who've had mental illnesses to get gun licenses --

The Associated Press/Washington Post: After Conn. Massacre, Ga. Lawmakers Back Relaxing Gun Laws For Mentally Ill
While some states push to tighten gun control laws after the Connecticut school massacre, lawmakers in gun-friendly Georgia want to ease rules preventing some mentally ill people from getting licenses to carry firearms. Legislators in Georgia's House voted 117-56 on Thursday to allow people who have voluntarily sought inpatient treatment for mental illness or substance abuse to get licenses (3/7).

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State Highlights: Ga. Health Bills Advance On 'Crossover Day'

A selection of health policy stories from Georgia, New York, Massachusetts, Kentucky and California.

Georgia Health News: Making The Cut On Crossover Day
A handful of health-related bills moved forward on Crossover Day at the Georgia General Assembly. A piece of legislation must pass at least one chamber by the close of the 30th legislative day to have a shot at becoming law during the session. Thursday was this year's deadline. Bills passed by one chamber before the midnight deadline include one that would create a new home for the dentistry and pharmacy licensing boards, and another that would publicize insurance policy costs related to Obamacare. Among others that survived Crossover Day are bills that seek to expand use of playgrounds after school, aid prosecutions of elder abuse cases, and give advanced practice nurses the authority to order imaging tests (Miller, 3/7).

The New York Times: Opposition Emerges To Cuomo's Plan To Cut $120 Million For The Disabled
A plan by Gov. Andrew M. Cuomo to cut $120 million in financing for nonprofit organizations that serve people with developmental disabilities is emerging as a flash point in this year's budget negotiations (Kaplan, 3/7).

Boston Globe: Lynch's Health Care Vote At Issue In Senate Campaign
After a year of heated national debate and decades of failed attempts to achieve universal health coverage, it was all coming down to one moment in the U.S. House. The Democrats needed every vote they could get. Smart money said the Massachusetts delegation was a lock. All 10 members had supported an earlier version that narrowly passed the House. They hailed from the same state that had crafted the landmark law which provided the template for health care reform, the home of the late senator Edward M. Kennedy, who made universal coverage his life’s cause. But Stephen F. Lynch, the South Boston Democrat now running for Senate, refused to get on board that week in March 2010. President Obama, House Speaker Nancy Pelosi, old labor allies from Boston, and even Kennedy’s widow all tried to get Lynch to come around. He wouldn’t budge (Moskowitz, 3/8).

The Associated Press: Bill To Save Christian Health Care Plan Revived
A Christians-only health care ministry would be allowed to resume operating in Kentucky under a measure that had been languishing in the Legislature only to be revived by a House committee on Thursday.The House Banking and Insurance Committee voted 28-0 to pass the measure on behalf of Florida-based Medi-Share just minutes before the Senate Banking and Insurance committee voted 8-0 to confirm the appointment of Insurance Commissioner Sharon Clark (Alford, 3/7).

California Healthline: Expansion Hearing Highlights County-State Struggle
California health officials and legislators yesterday had a lively discussion over the two proposed choices for the optional Medi-Cal expansion. At the onset, yesterday's discussion in the Budget Subcommittee on Health and Human Services centered on the Brown Administration's choices for a state-based or county-based approach to implementing expansion of Medi-Cal to adults up to 138 percent of federal poverty level, which is expected to open eligibility to as many as 1.4 million Californians. But the meat of the conversation evolved into something else. Since counties have pretty firmly asserted they're in favor of the state-based plan, and state officials have not stated a preference for either option, choosing one approach over another was not really the main issue during yesterday's hearing. The sharing of money from the optional expansion became the central topic (Gorn, 3/7).

California Healthline: Should California Expand Providers’ Scope Of Practice?
This month, state Sen. Ed Hernandez (D-West Covina), chair of the Senate Committee on Health, plans to introduce legislation that would expand the scope of practice for mid-level health care providers in California. Hernandez and many stakeholders say the state does not have enough physicians to meet demands of millions of newly insured Californians when the Affordable Care Act's mandatory coverage provisions kick in next year. His bill would allow physician assistants to treat more patients with more latitude and to allow nurse practitioners to establish independent practices. His bill also will propose that pharmacists and optometrists be able to serve as primary care providers and diagnose and manage some chronic conditions (3/7).

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Health Policy Research

Research Roundup: Insurance Coverage And Access To Care In Massachusetts

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

Health Affairs: Survey Finds Public Support For Legal Interventions Directed At Health Behavior To Fight Noncommunicable Disease – With increasing interest in public health problems such as obesity and alcohol and tobacco use, lawmakers are increasingly considering using policy to modify behavior. According to the authors, little is currently known about the public’s willingness to accept such policies.  The researchers surveyed more than 1,800 adults to assess their attitudes toward government interventions aimed at these issues. They found that strong support, especially among African Americans and Hispanics. "There was much support for strategies that enable people to exercise healthful choices—for example, menu labeling and improving access to nicotine patches—but considerably less for more coercive measures, such as insurance premium surcharges," the authors write. Policy makers "should involve the public in priority-setting activities in public health" and "seek to understand the values held by different segments of the population and incorporate those values in to policy decisions," the authors suggest (Morain and Mello, 3/2013).

Health Affairs: Insurance Expansion In Massachusetts Did Not Reduce Access Among Previously Insured Medicare Patients – In 2006 Massachusetts passed health overhaul legislation that sought to get universal coverage in the state. Opponents suggested it could have a negative impact on people who already had insurance. They said that the sudden increase in the number of people with insurance might overwhelm doctors and other health care providers, creating shortages and poor health care for some people who were already in the system, especially Medicare beneficiaries who are older and often need more medical care. In this study, researchers analyzed Medicare data from 2004 to 2009 to determine how insurance expansion under the Massachusetts' health reform law affected beneficiaries. "We found no evidence that Massachusetts' health care reform, with its resulting insurance expansion and consequent threat of negative spillover on the previously insured, led to an increase in preventable hospitalization among Medicare patients," the authors write. Their study found that preventable hospitalizations among beneficiaries in Massachusetts dropped slightly more than rates in comparison New England states (Joynt, Chan, Orav, and Jha, 3/2013).  

The Kaiser Family Foundation/The Urban Institute: Reversing The Trend? Understanding The Recent Increase In Health Insurance Coverage Among The Nonelderly Population -- According to the authors of this brief, the number of uninsured people in the U.S. decreased by 1.2 million in 2011. They suggest that this decrease was the result of an increase in coverage through public programs such as Medicaid and the Children's Health Insurance Program. "Most of the growth in public coverage, and the attendant reduction in the nonelderly uninsured, was concentrated among adults, while the number of uninsured children was largely unchanged between 2010 and 2011," the synopsis of the study notes. This brief includes discussions of trends in coverage by work status, race and ethnicity and region, and of the impact of the Affordable Care Act (Holahan and McGrath, 3/1).

Journal Of General Internal Medicine: Access, Interest, and Attitudes Toward Electronic Communication For Health Care Among Patients In The Medical Safety Net – According to the authors, e-mail communication between patients and clinicians "is a promising application of health information technology." There are disparities, however, in adoption of the tool. The researchers surveyed a group of patients from a large urban safety net clinic network to assess their level of access to and attitudes toward using e-mails to communicate with their doctors. "In our study of ethnically diverse, low-income patients, we found that the majority use email; nearly three out of every four patients were interested in using email for health communication with their medical providers," the authors write, although less than 20 percent of patients had used e-mail to communicate with their providers. "This demonstrates and unmet interest in health-related electronic communication among patients in the safety net," the researchers said (Schickedanz et al., 2/20).

Here is a selection of news coverage of other recent research:

Reuters: Study Results Take Almost Two Years To Be Released
Results from the average clinical trial take almost two years to be published, according to a new study, despite U.S. regulations calling for a 12-month maximum lag time on the release of most research findings. That's concerning, researchers said, because publication delays hinder doctors' ability to make the most well-informed treatment choices with their patients and slow progress within the scientific community (Pittman, 3/6). 

Reuters: Doctors Don't Often Tell Patients Of CT Scan Risks
Only about a third of patients surveyed at one U.S. medical center said their doctors told them about the possible risks of a CT scan, such as radiation exposure, a new study finds. Researchers, who published their findings in JAMA Internal Medicine on Monday, also found that most patients thought their doctors made the final decision to have the scans (Seaman, 3/4).

Reuters: Is Enrolling In A Clinical Trial Tied To Survival?
People with certain cancers enrolled in clinical trials survive longer, not necessarily from the treatment itself but potentially because those enrolled are better off to begin with, according to new research. "The survival benefits for an individual to be on a cancer trial are not necessarily to be on a trial itself. Cancer trials select patients who are healthier and are able to tolerate treatments," said senior study author Dr. Waddah Al-Refaie, chief of surgical oncology at MedStar Georgetown University Hospital in Washington, D.C. (Stokes, 2/28).

MedPage Today: Dissatisfaction With EHRs Rising, Survey Finds
Physician satisfaction and usability ratings for certified electronic health records (EHRs) have fallen since 2010, a survey of more than 4,200 doctors found. The number of physicians who said they would not recommend their EHR to a colleague rose to 39% in 2012 from 24 percent 3 years ago, the survey found. It was released Tuesday by the American College of Physicians (ACP) and AmericanEHR Partners, the web-based resource arm that ACP helped create. Much of the physicians' dissatisfaction was due to EHRs' failure to increase productivity (Pittman, 3/7). 

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Editorials and Opinions

Viewpoints: Congress Should Make CMS Leader Nonpartisan Position; 'Extreme' Attack On Abortion In Arkansas; Daschle On New Health Workforce

The Washington Post: Making The Centers For Medicare & Medicaid Services Nonpartisan
Mr. Obama has nominated the acting CMS administrator, Marilyn Tavenner, to head the agency permanently. ... The Senate should move expeditiously to confirm Ms. Tavenner. More broadly, Congress should consider whether short-term political appointment remains the best way to fill this trillion-dollar post. The director of the Federal Bureau of Investigation serves a 10-year term. The commissioner of Social Security serves six years. These arrangements help minimize the politicization of functions that need to be carried out in as nonpartisan a manner as possible. Running the gigantic CMS is the same kind of job (3/7).

The Washington Post: Deficits Do Matter
It doesn't have to be this way. Republicans and Democrats can still find common ground to address our long-term debt. Military spending can be reduced, and our decade-long wars can be brought to an end. The Pentagon should move beyond a defense strategy based on a Cold War threat that no longer exists. Americans also know that costs for Medicare, Medicaid and private health services must be brought under control. A recent study by the prestigious Institute of Medicine puts the waste in total health-care spending — both public and private — at $750 billion per year. And a bipartisan tax reform plan could close egregious loopholes, promote fairness and economic efficiency and align revenues with spending (Joe Scarborough and Jeffrey D. Sachs, 3/7).

The Wall Street Journal: Obama's Not So Grand Offer
When Republicans say they want to reform Medicare, they mean they want to make durable changes to the program's structure and operations so that this gap narrows over time while achieving the same or better results. They don't want to cut for the sake of cutting or "austerity." They want to solve Medicare's problems. Mr. Obama's definition of reform is different. Medicare would continue its current march into insolvency, but at a slightly slower pace: some nips and tucks, but nothing approaching the larger modernization that the health safety net needs to survive (3/7). 

The New York Times: Arkansas's Attack On Abortion
Republican-controlled legislatures have been working for many years to limit women's access to legal abortion care, but the Republican-led Legislature in Arkansas took the campaign to a new extreme on Wednesday when it overrode the veto of Gov. Mike Beebe, a Democrat, and ignored the Supreme Court to adopt the most restrictive abortion ban in the country (3/7).

Health Affairs: Creating A Workforce For The New Health Care World
The ACA's recent enactment has triggered a series of new and concerted efforts to address some of the many challenges relating to health care cost, access and quality that the U.S. faces today. One of the most important challenges involves the number and mix of health providers that will be needed to meet the demand resulting from changing demographics, more expansive availability of health insurance, and a new emphasis on wellness and preventive care. In this post, I discuss some of the factors that bear on this challenge, and I suggest some policy steps that we could take to help develop the workforce needed for the post-health reform world (Tom Daschle, 3/7).

Los Angeles Times: When A Drug Costs 30 Times What It Once Did
Manufacturers can charge wildly different prices for essentially the same generic medicine. Pharmacies should make clear whether a customer is getting the lowest-priced generic available (David Lazarus, 3/7).

WBUR Cognoscenti: 'I Am Listening': What Every Autistic Child Wants You To Know
Elizabeth’s first typed word was "agony," and her first sentence was "I need to talk," at age 6. Before and since, she would storm and tantrum and hit herself and rock, like so many people on the autism spectrum. So Elizabeth looks far more "lower functioning" than she actually is (because her typed sentences and poems and high IQ score show this). One of her most compelling responses to the question, "How did you learn all this?" was "I am listening." I am listening. Elizabeth's sentence blew me away. This what so many autism parents like me believe about our own children, but forget (Susan Senator, 3/8).

Boston Globe: Colleges Should Grant Amnesty If Students Seeks Alcohol Help
Boston University  freshman Anthony Barksdale II's death in the early hours of March 2 appears to be a tragedy too often repeated: another young person's life cut short after a night of underage drinking. ... it needs to think about more creative ways to educate students on the dangers of drinking while showing them that the school is there to help. An obvious next step would be for BU to follow the lead of other local campuses, including Harvard, MIT, Northeastern, and Emerson, and institute a medical amnesty policy. Under such a Good Samaritan provision, if one student seeks help for another out of concern about alcohol toxicity or overdose, there are no disciplinary repercussions for either student for violating campus rules on alcohol or drug use (3/8).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
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.