Daily Health Policy Report

Friday, March 9, 2012

Last updated: Fri, Mar 9

KHN Original Reporting & Guest Opinion

Medicare

Health Reform

Capitol Hill Watch

Health Care Marketplace

Health Information Technology

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Can GOP Deliver On Its Promise To Preserve Traditional Medicare?

Kaiser Health News staff writer Marilyn Werber Serafini, in collaboration with the National Journal, reports: "House Budget Chairman Paul Ryan's promise to preserve traditional Medicare, which is likely to appear in his soon-to-be unveiled budget plan, could have big implications for Republican presidential and congressional candidates in November. That pledge -- to allow future beneficiaries to remain in the government-run program that allows them to choose their own doctors and pay a percentage of the costs -- was part of a proposal to overhaul Medicare that the Wisconsin Republican put forward in December with Sen. Ron Wyden, D-Ore" (Werber Serafini, 3/8). Read the story.  

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Oregon Emphasizes Choices At Life's End

Oregon Public Broadcasting's Kristian Foden-Vencil, working in partnership with Kaiser Health News and NPR, reports: "Oregon has been in the forefront of trying to make sure a person has as much control over the end of his or her life as possible. The state pioneered a form known as a POLST, for Physician Orders for Life-Sustaining Treatment, that has been adopted by 14 states and is being considered in 20 more. The form offers many more detailed options than a simple "do not resuscitate" directive" (Foden-Vencil, 3/8). Read the story.

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Farzad Mostashari Is A Man On A Digital Mission

Russ Mitchell, reporting for Kaiser Health News in collaboration with Fortune magazine, writes: "New York hookers spreading HIV. Killer mosquitos.  An anthrax-toting terrorist. An urban-scape rife with the sick and poor.  These are just some of the challenges tackled by Farzad Mostashari, a Yale-educated physician, epidemiologist and self-confessed computer nerd.  His current mission: moving doctors from the Age of Gutenberg into the 21st century.  For starters, he’d like them to use e-mail at the office" (Mitchell, 3/9). Read the story.

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Forget The Robots: Venture Capitalists Change Their Health Care Investments

Sarah Varney, reporting as part of a partnership with Kaiser Health News, NPR and KQED, writes: "The share of venture dollars flowing to seed and early-stage investments in biotechnology and medical devices has plummeted since 2007, when investors pumped $3.6 billion into 332 deals in which a price was disclosed, according to data compiled for Kaiser Health News by FactSet Research Systems. Overall venture investing declined by nearly one-third as the economic recession set in" (Varney, 3/9). Read the story.

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Capsules: N.Y. Governor Raps Insurers, Health Providers For 'Unacceptable Opaqueness' In Billing; New Insurer-Hospital ACO Touts Early Success; IPAB Status Check

Now on Kaiser Health News's blog, Julie Appleby reports that the N.Y. governor rapped insurers and health providers For "unacceptable opaqueness" in billing: "Too often patients who thought they had all the right approvals from their insurers get hit with surprise bills for out-of-network medical costs, New York Gov. Andrew Cuomo says in a report that calls on insurers, doctors and hospitals to help craft reforms. Complaints about out-of-network costs were among the most common found in a state investigation of consumer complaints" (Appleby, 3/8).

Also on Capsules, Jay Hancock reports on a new insurer-hospital ACO: "Illinois' largest hospital system and biggest health insurer agreed in late 2010 to form an accountable care organization, a network in which the organizations would cooperate to boost quality and restrain cost increases, sharing in any savings. Chicago-based Advocate Health Care gambled that its portion would compensate for the lost revenue from the resulting empty beds" (Hancock, 3/8).

Meanwhile, Mary Agnes Carey offered the following Capsules post on the IPAB repeal effort: "Later this month, just as the Supreme Court is hearing arguments on the 2010 health law, the House is expected to pass a measure that would repeal an advisory board created in the law to curb Medicare spending if it exceeds specific targets. But the debate is not shaping up like the usual House legislative fight over the law, where Republicans want to either strike a particular provision or repeal the whole thing and Democrats fight back to stop it" (Carey, 3/8). Check out what else is on the blog.

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Political Cartoon: 'Playing Chicken?'

Kaiser Health News provides a fresh take on health policy developments with "Playing Chicken?" by Chris Weyant.

Meanwhile, here's today's haiku:

WHITHER QUALITY 

Quality reports 
Give no extra value to
Unaware patients
-Anonomous

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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Medicare

What Will Become Of Traditional Medicare In The GOP Budget Plan?

How this question is answered could have big implications for the GOP's presidential and congressional candidates. Meanwhile, Politico Pro reports the plan being prepared by House Budget Committee Chairman Paul Ryan, R- Wis., is likely to include a reserve fund to deal with Medicare's sustainable growth rate formula.  

Kaiser Health News: Can The GOP Deliver On Its Promise To Preserve Traditional Medicare?
House Budget Chairman Paul Ryan's promise to preserve traditional Medicare, which is likely to appear in his soon-to-be unveiled budget plan, could have big implications for Republican presidential and congressional candidates in November. That pledge -- to allow future beneficiaries to remain in the government-run program that allows them to choose their own doctors and pay a percentage of the costs -- was part of a proposal to overhaul Medicare that the Wisconsin Republican put forward in December with Sen. Ron Wyden, D-Ore. (Werber Serafini, 3/8).

Politico Pro: Ryan Budget To Include SGR 'Reserve Fund'
House Budget Committee Chairman Paul Ryan's upcoming budget proposal is expected to include a deficit neutral "reserve fund" to deal with Medicare's Sustainable Growth Rate formula, a common fiscal measure that seldom translates into action. Rep. Tom Price (R-Ga.), a member of the committee and a physician, told POLITICO that the House Republican budget would include the "dedicated SGR fund," but declined to go into specifics. "It will allow us an opportunity to change the funding formula," he said. Ryan's previous blueprint included a similar type of fund (DoBias, 3/8).

Politico: Medicare Cuts Hurt Smaller Providers
For Congress, the lessons are two-fold. First, there are the unintended consequences of policy decisions made without full knowledge of how they affect service providers. Second, is the heavy price all sides pay without some long-term resolution to the Medicare formula for paying physicians. Indeed, the 10-year savings will pay for only a 10-month truce before Congress has to again come up with new ways to keep physicians paid after the November elections. A permanent solution to the so-called doc fix would be simple enough if lawmakers could ever agree on a $300 billion package. But absent that, Washington resembles some Delta tenant farmer, never able to make himself whole and trapped in an endless cycle of rental payments (Rogers, 3/8).

In other Medicare-related news -

The Fiscal Times: Millions Made Off Medicare Wheelchair Scams
Suppliers of durable medical equipment like motorized wheelchairs can play a critical role in the lives of many seniors. Yet the frequency of fraud in the industry has turned its supply into Medicare’s most vilified program, subjected for two decades to repeated Congressional hearings and government reports alleging rampant overutilization, overpricing and fraud (Goozner, 3/9).

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Health Reform

White House Views Supreme Court Health Law Arguments As Teachable Moments

The New York Times reports that the Obama administration has begun an effort to use these arguments as an opportunity to educate the public and build support for the overhaul. Meanwhile, the Los Angeles Times reports that one of the lead plaintiffs in a challenge to the law has gone bankrupt with outstanding medical bills, leading some to question whether this transforms her from a "symbol of proud independence into an example of exactly the problem the healthcare law was intended to address."    

The New York Times: White House Works To Shape Debate Over Health Law
The White House has begun an aggressive campaign to use approaching Supreme Court arguments on the new health care law as a moment to build support for the measure seen as President Obama's signature legislative achievement, hoping to shape public opinion on an issue at the center of the battle for the White House and Congress (Pear, 3/9).

Los Angeles Times: Plaintiff Challenging Healthcare Law Went Bankrupt – With Unpaid Medical Bills
Mary Brown … became the lead plaintiff challenging President Obama's healthcare law because she was passionate about the issue. Brown "doesn't have insurance. She doesn't want to pay for it. And she doesn't want the government to tell her she has to have it," said Karen Harned, a lawyer for the National Federation of Independent Business. Brown is a plaintiff in the federation's case. … But court records reveal that Brown and her husband filed for bankruptcy last fall with $4,500 in unpaid medical bills. Those bills could change Brown from a symbol of proud independence into an example of exactly the problem the healthcare law was intended to address (Savage, 3/8).

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AP Poll: Health Law Still Divisive, But Americans Worry Less About Their Own Care

Also in the news, a study in the journal American Politics Research quantifies in percentage points the support Democratic incumbents lost as a result of voting for the 2010 health overhaul.

The Associated Press: Poll: Health Overhaul Unpopular, But Not As Feared
Attacked as a rationing scheme and praised as a lifesaver, President Barack Obama's health care law remains as divisive and confusing as ever. But a new poll finds Americans are less worried that the overhaul will undermine their own care. As the Supreme Court prepares to hear arguments on the constitutionality of the Affordable Care Act, the Associated Press-GfK poll shows that Americans are less concerned their own personal health care will suffer as a result of it (Agiesta and Alonso-Zaldivar, 3/8).m

The Hill: Study: Votes In Favor Of Health Care Reform Cost Dems 5.8 Points In 2010 Vote
Voting for President Obama's health care reform law cost Democratic incumbents 5.8 percentage points of support at the polls in 2010, according to a new study in the journal American Politics Research. The study helps explain why Democrats lost 66 House seats, significantly more than the median academic forecast of 44 to 45 seats, study co-author Brendan Nyhan of Dartmouth College writes on his blog (Pecquet, 3/8).

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Exchanges, High Risk Pools Grab Headlines

News outlets also continue to explore issues related to the development of state-based health exchanges as well as the costs and enrollment numbers associated with high-risk insurance.   

Politico Pro: Roles In Exchanges Evolve As Deadline Nears
When HHS issues revised rules for health insurance exchanges -- some of which are expected any day -- it may be like watching a mourner enter the "acceptance" phase of grief. Draft rules issued last July were written in a "bargaining" mode. They signaled that HHS was willing to go to great lengths to work with states that couldn't do everything necessary to run their own exchange under the timeline spelled out by the health care reform law. This was a major step beyond their initial position, that states would drive exchange development. That increasingly sounded like "denial" against the backdrop of exchange bills stalling in one state legislature after another (Feder and Millman, 3/9).

Stateline: In High-Risk Insurance, Enrollment Lags And Costs Soar
One of the most popular provisions of the Affordable Care Act -- cheap insurance plans for people with medical conditions that prevent them from getting coverage anywhere else -- has run into a couple of snags. Though nearly everyone agrees a lifeline for sick people is needed, these new so-called high-risk insurance plans have attracted fewer than 50,000 -- far less than the 375,000 Congress anticipated. At the same time, the costs of health care services for each member are more than twice as much as projected (Vestal, 3/9).

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Capitol Hill Watch

IPAB Repeal Progresses In The House

On Thursday, the House Ways and Means Committee approved legislation that would eliminate the health law's Independent Payment Advisory Board. The bill could be considered by the full House as early as the week of March 19, and it could attract some Democratic support.

Kaiser Health News: Capsules: House Republicans Find Democratic Allies In IPAB Repeal Effort
Later this month, just as the Supreme Court is hearing arguments on the 2010 health law, the House is expected to pass a measure that would repeal an advisory board created in the law to curb Medicare spending if it exceeds specific targets. But the debate is not shaping up like the usual House legislative fight over the law, where Republicans want to either strike a particular provision or repeal the whole thing and Democrats fight back to stop it (Carey, 3/8). 

CQ HealthBeat: Second House Panel Approves Bill Repealing Medicare Board
The House Ways and Means Committee approved legislation Thursday that would eliminate an independent board charged with curbing Medicare spending growth, days after the bill was advanced by the Energy and Commerce panel. The amended measure, approved by voice vote, would abolish the 15-member Independent Payment Advisory Board (IPAB), a panel created by the 2010 health care overhaul. Floor consideration is expected as early as the week of March 19, according to the office of Majority Leader Eric Cantor, R-Va (Khatami, 3/8).

Politico Pro: W.H. To Dems: Don't Support IPAB Repeal
The White House is pushing back against Democrats who are considering supporting a Republican bill to repeal the health care reform law's Independent Payment Advisory Board, showing a greater concern about this vote than they have about other efforts to roll back the law. The Obama administration is trying to limit the damage on a potentially overwhelmingly bipartisan repeal vote. House Republicans have timed the vote — slated for the week of March 19 — to fall just ahead of two high-profile events for the law: its two-year anniversary on March 23 and the Supreme Court arguments on its constitutionality on March 26 (Haberkorn, 3/8).

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GOP Lawmakers Demand Medicaid Financial Report

The lawmakers charge that this actuarial information was due to them by Jan. 1 and is central to their ability to make decisions related to the entitlement program.  

The Hill: Republicans Demand Update On Medicaid Finances
The top Republicans with jurisdiction over Medicaid demanded Thursday that the Obama administration provide them with an update on the program's financial status that was due Jan. 1. Energy and Commerce Chairman Fred Upton (R-Mich.) and Senate Finance ranking member Orrin Hatch (R-Utah) point out in a letter to Health and Human Services Secretary Kathleen Sebelius that the federal government's share of Medicaid spending is expected to reach $4.4 trillion over the new 10 years. Over that time period, Medicaid spending as a percentage of the national economy is projected to grow by 35 percent, they add (Pecquet, 3/8).

CQ HealthBeat: GOP Lawmakers Want Medicaid Actuarial Report From Sebelius
Two Republicans have sent a letter to Health and Human Services Secretary Kathleen Sebelius asking her to release the agency's annual Medicaid Actuarial report to Congress which they say was due on Jan. 1. Orrin G. Hatch of Utah, ranking member on the Senate Finance Committee, and Fred Upton of Michigan, chairman of the House Energy and Commerce Committee, said in the letter that an up-to-date financial status of the program -- which is included in the annual reports -- is "critical" and "contributes to our decision-making process concerning the health care entitlement program and health care spending more broadly" (3/8).

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Women Democratic Senators To Boehner: 'Nix' Vote On Birth Control Coverage Rule

The 12 senators wrote a letter to the House Speaker, asking him not to hold a vote on proposals to expand exemptions from the Obama administration's birth control coverage mandate.

The Hill: Dem Women Senators Press Boehner To Nix Birth-Control Vote
Twelve Democratic women senators urged House Speaker John Boehner (R-Ohio) on Thursday not to hold a vote on controversial proposals to let religious employers opt out of the Obama administration's contraception mandate. Republicans are downplaying the issue on their own after losing a Senate vote last week and seeing their narrative sidetracked by radio host Rush Limbaugh. Democrats have framed the issue around women's health, rather than religious freedom, and Thursday’s letter to Boehner drove that theme home once more (Baker, 3/8).

MinnPost: Klobuchar, Democratic Women Urge Boehner To Skip Contraception Vote
Sen. Amy Klobuchar joined her 11 fellow Senate Democratic women in asking House Republican leadership to not bring up for a vote controversial legislation allowing employers to opt out of extending health care coverage to contraception. The senators wrote House Speaker John Boehner asking him to "abandon the promise you have made to bring legislation to the House floor similar to the Blunt amendment, which was defeated in the Senate last week, and which would turn the clock back on women's access to health care" (Henry, 3/8).

In related news -

The Associated Press: $100 Or $1,000? Wide Price Range For Birth Control
What does birth control really cost anyway? It varies dramatically, from $9 a month for generic pills to $90 a month for some of the newest brands — plus a doctor's visit for the prescription. Want a more goof-proof option? The most reliable contraceptives, so-called long-acting types like IUDs or implants, can cost $600 to nearly $1,000 upfront to be inserted by a doctor. That's if you don't have insurance that covers at least some of the tab — although many women do. And if those prices are too much, crowded public clinics offer free or reduced-price options. But it might take a while to get an appointment (Neergaard, 3/9).

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Health Care Marketplace

4th Quarter Hospital Revenues Increase

Reuters: Hospital Spending Hints Q4 GDP May Be Revised Higher
Spending at hospitals surged in the fourth quarter, government data showed on Thursday, suggesting economic growth during that period could be revised significantly higher. Hospital revenue increased a seasonally adjusted 3.5 percent after declining 1.5 percent in the third quarter, the Commerce Department said in its Quarterly Services Survey report (3/8).

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Health Information Technology

Farzad Mostashari: Focusing On Moving Doctors Into The Digital Age

News outlets report on health information technology developments, including a profile of Farzad Mostashari and a push by governors to improve health IT use.

Kaiser Health News: Farzad Mostashari Is A Man On A Digital Mission
New York hookers spreading HIV. Killer mosquitos. An anthrax-toting terrorist. An urban-scape rife with the sick and poor. These are just some of the challenges tackled by Farzad Mostashari, a Yale-educated physician, epidemiologist and self-confessed computer nerd. His current mission: moving doctors from the Age of Gutenberg into the 21st century. For starters, he’d like them to use e-mail at the office (Mitchell, 3/9).

And Modern Healthcare offers a pair of stories related to Health IT news --

Modern Healthcare: Governors Call On States To Improve IT Use
States could make better use of information technology to improve services to their residents and be more efficient, according to a new report and accompanying white paper from the National Governors Association. The 12-page white paper "Top IT Actions to Save States Money and Boost Efficiency" lauds Kansas for using IT to help identify a form of employer fraud that impacts state-administered employee health benefits costs (Conn, 3/8).

Modern Healthcare: Midwest Health Organizations Form 'Virtual' Network
Seven Upper Midwest hospitals and health systems and a medical college in Milwaukee have banded together in a "virtual health care network" called Quality Health Solutions that will allow the members in the accountable care group to pursue population-based health initiatives and new health insurance products (Carlson, 3/8).

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State Watch

Grassley Sends Letter To Minnesota Questioning Medicaid 'Donation'

Sen. Chuck Grassley, R-Iowa, sent a letter to Minnesota Gov. Mark Dayton Thursday questioning if the federal government should receive a portion of a "donation" a nonprofit health insurer made to Minnesota's Medicaid program and why Minnesota classified the payment as such.

Minneapolis Star Tribune: UCare's $30 Million Payment To Minnesota Questioned 
A $30 million payment to Minnesota coffers last year by one of the state's nonprofit health plans is coming under renewed scrutiny after an influential U.S. senator on Thursday questioned whether part of that largesse belongs to the federal government. U.S. Sen. Chuck Grassley, R- Iowa, sent letters to Gov. Mark Dayton, the Department of Justice and four HMOs saying he wanted to gain "a better understanding of the nature of the $30 million 'donation'" made by UCare. "I am particularly concerned about evidence I received which appears to suggest that the funds returned by UCare were tailored in a way to avoid returning any of said funds to the federal government," wrote Grassley, the ranking member of the U.S. Senate Judiciary Committee (Crosby, 3/8).

(St. Paul) Pioneer Press: UCare's $30M Payment To Minnesota Under Scrutiny
When a health plan in Minneapolis made a $30 million payment last year to help the state through its budget crisis, should the federal government have received a piece of the action? That's the question at the heart of a letter sent Thursday to the Dayton administration by U.S. Sen. Charles Grassley, R-Iowa. The payment came from a nonprofit health plan called UCare, which the state hired to manage care for patients covered by the Medicaid health insurance program (Snowbeck, 3/8).

Minnesota Public Radio: Grassley Questions Minn.'s Handling Of Medicaid Funds
The ranking member of the U.S. Senate Judiciary Committee sent a letter to Gov. Mark Dayton Thursday asking why UCare, a Minnesota health plan company, repaid $30 million in Medicaid funds to the state as a "gift," rather than a reimbursement. In the letter, Sen. Chuck Grassley, R-Iowa, said he's concerned that the way the funds were returned was meant to avoid reimbursing money to the federal government. Grassley was referring to e-mails sent by Minnesota Department of Human Services Commissioner Lucinda Jesson in March 2011, in which she described how UCare should draft its press release about returning the Medicaid funds to the state (Collins, 3/8).

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Medicaid: Kan. Considers Changes; Calif. Advocates Concerned About Overhaul

The Kansas legislature is considering changes to the state's Medicaid program including exempting long-term care services from some planned reforms.

Kansas Health Institute: Committee To Examine KanCare
The House Health and Human Services Committee is scheduled to hold hearings next week on a bill that would exempt long-term care services for the developmentally disabled from the managed care provisions in KanCare, Gov. Sam Brownback's Medicaid reform plan. The panel also will hear testimony on a bill to require an annual evaluation of the state's Medicaid managed care contractors (Ranney, 3/8).

Kansas Health Institute: House Advances Medicaid Eligibility Bill
The Kansas House today advanced a measure that would let prospective Medicaid beneficiaries assign their life insurance policies to the state in order to meet the program's eligibility standards. Currently, life insurance policyholders must cash out and spend the money before qualifying for Medicaid. Legislative backers of the proposal said it would help the state Medicaid program recoup some expenses and help people who need the program but otherwise would have to "spend down" to qualify for it (Shields, 3/8).

In California, some worry patients may suffer as the state overhauls its Medicaid program.

California Watch: Advocates Say Patients Suffer As State Overhauls Medi-Cal
Patients who are being moved into Medi-Cal managed care plans as part of a major statewide policy shift are facing life-threatening obstacles to getting needed care, according to patient advocates who testified in a legislative oversight hearing. An attorney, doctor and lobbyist pleaded with lawmakers on Wednesday to slow the pace of a program overhaul that they say has knocked patients off organ transplant waiting lists or upended care that kept chronic diseases under control. The changes are part of a wide-ranging plan that is meant to improve care and cut costs in the state’s Medi-Cal program, California's version of Medicaid. In June, the first wave of Medi-Cal patients moved to managed care plans (Jewett, 3/9).

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State Legislatures Split On Forming Health Insurance Exchanges

Oregon and California are moving forward with creating health insurance exchanges called for in the health reform law while lawmakers in New Hampshire pass legislation barring the state from creating an exchange. 

Lund Report: Governor Kitzhaber Signs Health Exchange Bill
Governor John Kitzhaber lauded the bipartisan support by legislators in passing legislation to enact the health insurance exchange, declaring that the exchange will play a pivotal role in improving the quality and health of Oregonians, and, at the same reduce costs. He signed House Bill 4164 in front of consumer advocates, business and healthcare leaders at the Exchange Board meeting this afternoon (Lund-Muzikant, 3/8).

NHPR: House Votes Against State Run Health Insurance Exchange
A bill which prevents the state from creating its own exchange passed overwhelmingly in the house on Thursday. ... In New Hampshire, small businesses, health insurers and patient advocates support a state-run exchange. Democratic Representative Donna Schlachman of Exeter spoke in opposition of the bill (Gotbaum, 3/8).

California Healthline: Reforms Will Continue In California, Leaders Predict
The sky is not falling, according to Peter Lee, executive director of the California Health Benefit Exchange board. … No matter what decision is reached by the Supreme Court, the California exchange will continue its work, Lee said. California's other health care reform plans will continue and the exchange will still apply for a Level II implementation grant in June, as planned. "Any vision of the future that I can see includes the exchange," Lee said. "That's clear to me. And any vision of the future includes the work California has been doing on reform, to expand coverage to millions of Californians, starting in 2014” (Gorn, 3/8).

Also, California estimates that 32 million of its residents will be covered by health mandates passed by its legislature --

California Healthline: California Mandates 48 Specific Areas Of Coverage
An analysis released yesterday by the California Health Benefits Review Program shows that a large cross-section of Californians  -- about 32 million people -- will be covered by health care mandates passed by the Legislature. There are now 48 of those mandates that either require coverage or require an offer of coverage, and another five mandates that deal with more general terms and conditions of coverage. … State-passed mandates could have a financial impact on the health plans that need to cover those conditions and also may affect the list of essential health benefits offered by the California health benefit exchange (Gorn, 3/9).

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Calif. Audit Finds Hospital Did Business With Firms Tied To CEO

Reports on the business of healthcare also look at an Illinois ACO that is showing some progress and at New York Gov. Andrew Cuomo's call for greater transparency in how insurers and providers bill consumers for out-of-network medical costs.

Los Angeles Times: Hospital Did Business With Firms Tied To Its CEO, Board Members
A Monterey County public hospital district did $21 million in business over the last five years with firms in which its chief executive and board members held financial interests, according to a state audit released Thursday. The audit was launched in response to a series of articles in The Times last year that highlighted the huge supplemental pension and severance package, totaling nearly $5 million, that the hospital's former chief executive received (Allen and Becerra, 3/9).

Kaiser Health News: Capsules: N.Y. Governor Raps Insurers, Health Providers For 'Unacceptable Opaqueness' In Billing
Too often patients who thought they had all the right approvals from their insurers get hit with surprise bills for out-of-network medical costs, New York Gov. Andrew Cuomo says in a report that calls on insurers, doctors and hospitals to help craft reforms. Complaints about out-of-network costs were among the most common found in a state investigation of consumer complaints (Appleby, 3/8).

Kaiser Health News: Capsules: New Insurer-Hospital ACO Touts Early Success   
Illinois' largest hospital system and biggest health insurer agreed in late 2010 to form an accountable care organization, a network in which the organizations would cooperate to boost quality and restrain cost increases, sharing in any savings. Chicago-based Advocate Health Care gambled that its portion would compensate for the lost revenue from the resulting empty beds (Hancock, 3/8).

The Associated Press/Boston Globe: Steward Wants Power To Cut Landmark Medical Staff
A Boston-based company that wants to merge with Landmark Medical Center in Woonsocket, R.I., is trying to change the terms of the original agreement to add authority to lay off staff and cut services. Lawyers for the for-profit hospital chain Steward Health Care System are due Friday in Superior Court in efforts to add the new terms and extend the original merger agreement. The agreement approved last May is set to expire Friday (3/8).

The Detroit Free Press: Agreement Signed To Take Marquette General Hospital Private
Marquette General Hospital would become Michigan's second largest privately-run acute-care hospital under an agreement it has signed with Duke LifePoint Healthcare. The hospital board this week signed a memorandum of understanding to join the company, which is a joint venture between Duke University and LifePoint Hospitals, a Brentwood, Tenn., firm with 53 U.S. hospitals. … For the next two to four months, the hospital and the company will negotiate an agreement, which would have to be reviewed by the Michigan Attorney General's office (Anstett, 3/8).

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Texas Gov. Says They'll Find Money For Women's Health Program

Texas Gov. Rick Perry is directing officials to find money to help finance Texas' Women's Health Program after the state's move to kick Planned Parenthood out of the program endangered federal funds for the program.

The New York Times: Perry Pledges To Finance Women's Health Program
Responding to intensifying criticism about the Texas government's decision to exclude Planned Parenthood from a health care program for low-income women -- a move that the federal government considers illegal -- Gov. Rick Perry said at a news conference on Thursday that the state would use its own money to operate the program if Washington stops financing it (Ramshaw and Belluck, 3/8).

The Associated Press: Texas Looks To Fund Health Program Without Feds
Texas Republican Gov. Rick Perry on Thursday directed state officials to begin looking for money to keep the Medicaid Women's Health Program, even if the Obama administration revokes federal funding amid a fight over clinics affiliated with abortion providers. "We'll find the money. The state is committed to this program," Perry told reporters, shortly before he issued a letter directing Thomas Suehs, head of the Texas Health and Human Services Commission, to work with legislative leaders and identify money to keep the program going if federal funds are halted (Weissert, 3/8). 

Dallas Morning News: Perry Vows To Find Funding For Women's Health Program But Doesn't Say Where
Gov. Rick Perry dismissed concerns that 130,000 Texas women will lose cancer screenings and contraceptive services, saying Thursday that the Women's Health Program -- caught in a political crossfire between his administration and the federal government -- will live on. The governor suggested that the state would find money elsewhere within its multibillion-dollar budget to make up for lost federal funds, but he wouldn't give specifics on where the funding would come from. The Medicaid program could be on its last leg because of a standoff between the Obama administration and Texas officials who want to ban Planned Parenthood from participating (Ingram, 3/8).

Texas Tribune: Anti-Abortion Advocates Blast Planned Parenthood
Countering Planned Parenthood's statewide bus tour to defend its status as a beneficiary of the Women's Health Program, leaders from several Texas pregnancy resource centers held a news conference Thursday in Austin to say that the program should move forward without Planned Parenthood (Tan, 3/8).

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Virginia Uproar Frames Abortion, Contraception Legislation In Many States

States are grappling with reproduction-related issues after Virginia's pre-abortion ultrasound bill passed: In California, lawmakers are set to consider a bill to give more women access to early-term abortions while lawmakers in Ohio and Minnesota consider legislation on contraception.

McClatchy: Abortion Bill Brings Issue To The Forefront In California 
As proposals to tighten abortion laws work their way through statehouses across the country, California lawmakers are set to consider legislation aimed at giving more women access to first-term pregnancy terminations. The California bill, by Democratic Sen. Christine Kehoe, would allow nurse practitioners, physicians assistants and certified nurse midwives to perform a procedure known as "aspiration" abortion, which employs a suction method to remove a fetus from a uterus. The push, which would make the state the fifth to allow non-doctors to perform the procedure, comes as debate over abortion and reproductive health issues, including birth control coverage, heats up across the nation (Van Oot, 3/8).

Politico Pro: Va. Ultrasound Uproar Shapes National Debate
Virginia Gov. Bob McDonnell signed legislation Wednesday that would require abdominal ultrasounds for women requesting abortions, but it was a toned-down version of the original, which would have included, in some cases, ultrasounds that use a transvaginal procedure. The firestorm over that proposal has had an impact in other states. In Pennsylvania, House Majority Leader Mike Turzai canceled a debate on the state's proposed ultrasound law last week, saying it would not be scheduled for a vote anytime soon (Smith, 3/9).

MSNBC: Want Viagra? Ohio Lawmaker Wants Men To Get Second Opinion
Men in the Buckeye State seeking prescription drugs for erectile dysfunction such as Viagra will have a tougher time getting their little blue pills if one Ohio lawmaker has her way. State Sen. Nina Turner, a Cleveland Democrat, this week introduced Senate Bill 307, which is aimed at protecting men from the risks of PDE-5 inhibitors -- drugs like Viagra that are commonly used to treat symptoms of erectile dysfunction -- in an effort to "guide men to make the right decision for their bodies." Turner told msnbc.com on Thursday that the measure was her way of sending a message to the Legislature in response to Ohio's so-called Heartbeat Bill. ... That measure would ban abortions once a fetal heartbeat is detected -- sometimes as early as in the sixth week of pregnancy (Omer, 3/8).

MinnPost: Does DFL's Proposed Birth-Control Benefit Conflict With Obama's Health Care Efforts?
A DFL legislative proposal to require insurance plans to cover birth control without co-pays may run counter to President Obama's efforts to reform health care. As part of guidelines to help states conform to the Affordable Care Act, the Department of Health and Human Services has directed that states not add benefits as part of the "Essential Health Benefits" (EHB) of health care reform. … However, state Rep. Erin Murphy of St. Paul, one of the authors of the birth control proposal, believes the proposed legislation is in line with the spirit of health care reform (Brucato, 3/8).

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State Highlights: Iowa Advocates Seeking Better Services For Disabled

News outlets report on a variety of health policy issues from around the country.

Texas Tribune: State Cuts Squeezing Elderly Poor And Their Doctors
(Dr. Javier Saenz's) troubles reflect a statewide problem for doctors who treat a disproportionately high number of the reported 320,000 low-income Texans who are fully and dually eligible for Medicare, the federal insurer of the elderly, and Medicaid, the joint state-federal health care program for indigent children, the disabled and the very poor. On Jan. 1, the state reduced its share of co-payments for such patients. Physicians who treat them are seeing revenue disruptions. Many, like Saenz, are not sure they can stay in business (Tan, 3/9).

Des Moines Register: Advocates For Brain-Injured Patients Seek Better Services, Weigh Lawsuit Against State
Advocates for Iowans with brain injuries have prepared a federal civil rights lawsuit to try to force the state to provide better services. The advocates haven't decided whether to file the lawsuit, but they say the state is violating a landmark U.S. Supreme Court decision declaring that disabled Americans have a right to live outside institutions if they're capable of doing so. Too many of Iowa's 95,000 brain-injured people wind up in nursing homes, jails or psychiatric wards because they lack services that would help them live in their homes or in small group homes, the advocates say (Leys, 3/7).

Kaiser Health News: Oregon Emphasizes Choices At Life's End
Oregon has been in the forefront of trying to make sure a person has as much control over the end of his or her life as possible. The state pioneered a form known as a POLST, for Physician Orders for Life-Sustaining Treatment, that has been adopted by 14 states and is being considered in 20 more. The form offers many more detailed options than a simple "do not resuscitate" directive (Foden-Vencil, 3/8).

Lund Report: Budget Rebalance Largely Spares Oregon Health Authority
The state's rebalanced budget, one of the last bills the Legislature passed before adjourning Monday evening, largely spares the Oregon Health Authority from deep cuts. Out of an $11.9 billion budget passed by the Legislature last year, $26 million general fund dollars were cut. But $15.4 million in other funds were added to the budget, meaning there was less than a $10 million cut (Waldroupe, 3/8).

Kansas Health Institute: New Caucus Told Of Oral Health Success In SEK
Members of the Legislature's newly formed oral health caucus heard today how a school district in southeast Kansas reduced student tooth decay by half in five years, even though most of the students had no dental insurance (Cauthon, 3/8).

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Health Policy Research

Research Roundup: Confusing High Priced For High Quality Care

Every week, KHN reporter Shefali S. Kulkarni compiles a selection of recently-released health policy studies and briefs.

Health Affairs: An Experiment Shows That A Well-Designed Report On Costs And Quality Can Help Consumers Choose High-Value Health Care -- Researchers conducted an experiment with more than 1,400 people to see if the way information on quality and cost of care is displayed affects consumers' decision to choose a high value health care plan. The group was shown different presentations of the same information and was asked to pick their preferred plan. The researchers found that respondents are more interested in quality than cost in health care, but they often associated a high cost with high quality. "It appears that how cost data are presented make more of a difference when those data are not accompanied by quality data or when quality data are difficult to understand," they wrote. (Hibbard, Greene, Sofaer, et. al., March 2012).

Health Affairs: Hospitals Ineligible For Federal Meaningful-Use Incentives Have Dismally Low Rates Of Adoption Of Electronic Health Records -- Researchers used national data to assess the electronic health record (EHR) adoption rates for various inpatient providers that are ineligible for the U.S. government's resources, including long-term acute care hospitals, rehabilitation hospitals, and psychiatric hospitals. The report shows a very low EHR system adoption rate among these hospitals and suggests this delay in implementing technology may hamper the federal government's efforts to increase efficiency in health care through electronic records. "By leaving out ineligible providers, the nation risks building a new digital divide in which key providers, which already have low levels of electronic clinical data may fall further behind" (Wolf, Harveil and Jha, March 2012).

The Kaiser Family Foundation: The Role Of The Basic Health Program In The Coverage Continuum: Opportunities, Risks & Considerations For States -- This issue brief looks at the benefits and drawbacks of the Basic Health Plan (BHP), "an optional coverage program" established in the federal health law "that allows states to use federal tax subsidy dollars to offer subsidized coverage for individuals with incomes between 139-200% of the federal poverty level (FPL) who would otherwise be eligible to purchase coverage through state Health Insurance Exchanges." The BHP could affect the risk pool in the exchanges so states would be allowed to increase premiums if the BHP population is healthier than those enrolled in the exchange, or it may decrease if those in the BHP are sicker than the exchange population. The brief explains that although federal funding will be available for the BHPs, states have not yet been given details about financing. The authors also suggest that states opting to use a BHP program will want to minimize their financial exposure and address impacts on the exchange (Bachrach, Dutton, Tolbert, et. al., 3/5).

Journal of the American Medical Association: Association Of Mental Health Disorders With Prescription Opiods And High-Risk Opiod Use In US Veterans Of Iraq and Afghanistan -- This study looks at a national sample of Iraq and Afghanistan veterans enrolled in the VA health care system and the effect of mental health disorders, especially among those suffering from post-traumatic stress disorder, on the risks of prescription opiod use. The researchers found that veterans with PTSD and those with other mental health issues were more likely to be prescribed opiods for pain than veterans without such conditions. They also found that those with PTSD were likely to get the condition and they were more likely to get a higher dose or have more than one prescription. The medications were "associated with an increased risk of adverse clinical outcomes for all veterans …, which was most pronounced in veterans with PTSD" (Seal, Shi, Cohen, et. al., 3/7).

Government Accountability Office: CMS Should Improve Efforts To Monitor Implementation Of The Quality Indicator Survey -- The Centers for Medicare and Medicaid Services (CMS) aims to implement the Quality Indicator Survey (QIS) -- a survey used to periodically inspect nursing homes -- by 2018. "We examined the extent to which CMS (1) evaluates whether progress is being made in meeting the objectives of the QIS and (2) monitors and facilitates states’ implementation of the QIS.” CMS conducted three studies to assess the QIS--the last study was finished in 2011 and “identified aspects of the QIS process that could affect the consistency with which surveyors identify quality problems." Overall, the GAO suggests that CMS create a timeline to develop a more systematic process for monitoring states' implementation progress (3/2).

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Editorials and Opinions

Viewpoints: The Fight Against IPAB; Chinks In GOP Armor On Health Care Law

The New York Times: We Thought They Were Worried About Costs
As part of their broader campaign to repeal health care reform, House Republicans are determined to kill off an independent board that is supposed to help rein in federal spending on Medicare. Their rhetoric is predictably distorted: charging that "15 unelected bureaucrats" should not be able to "ration care." In truth, the independent payment advisory board of nongovernmental experts is specifically precluded from rationing care, and Congress, not the board, has the final say on what cuts should be made (3/8).

The Wall Street Journal: Independent Payment Advisory Revolt
Public opposition to the Affordable Care Act has grown in surprising and unpredictable ways since the entitlement passed two years ago, but few would have predicted then that so many Democrats would repudiate so many of President Obama's core promises. Yet that is happening now, as Congress targets the 15-member central committee that is supposed to control health costs (3/9). 

Boston Globe: Maybe It's Not Mitt's Fault
What if the real problem is less with (Mitt) Romney than with the conservatives and Tea Party types he's having trouble winning over? One big starboard side objection to Romney is that he authored Romneycare, which, with its individual mandate to carry health insurance, became the model for Obamacare. And that's certainly true. But at the time, an individual mandate, based as it is on the notion of individual responsibility, was a well-regarded conservative idea. It certainly didn't make him anathema to conservatives when he ran in 2008 (Scot Lehigh, 3/9).

The Sacramento Bee: GOP Distortions On Health Law Sink To New Lows
Be afraid. Be very afraid. Republican presidential candidates believe that the national Patient Protection and Affordable Care Act, passed by Congress and signed by President Barack Obama in March 2010, is crushing the American people under the boot of an oppressive government. … It would be one thing if the Republican candidates had some thoughtful ideas on how to improve the 2010 law – and the mosaic of health systems that we have in the United States that leaves nearly 50 million Americans without health coverage. So far, they've served up only hypocrisy and fear mongering (3/9).

Health Policy Solutions (Colo. news service): No Cost Remedies In A Cost-Filled World
Concerns about the cost of health care aren’t going away.  In an election year, the conversations will just get more heated. However, like fasting and bed rest, some of the solutions to high health care costs are in your control and can’t be outsourced to better drugs and more expensive diagnostic tools.  The toughest part of these solutions, and why they aren’t popular, is that there is no silver bullet (Gena Akers, 3/8).

Los Angeles Times: Rush Limbaugh's Blind Spot
Anyone who heard or read (Sandra) Fluke's testimony in its entirety would know that Fluke was hardly banging her fists on the table and demanding free birth control. Instead, she focused on the fact that contraceptives, particularly the pill, can have medical uses (even lifesaving ones) that have nothing to do with the number of babies brought into the world. Limbaugh, however, is not in the business of understanding things in their entirety. He practices the "skim and scream" method of political and cultural analysis (Meghan Daum, 3/8).

The Wall Street Journal: Sandra Fluke's Amazing Testimony
There are a lot of questions here that go right to the heart of ObamaCare. Why is the president getting involved in setting prices for prescription drugs in the first place? Where in the Constitution does he get that power? Why should people past reproductive age who are paying copayments for their heart or arthritis medication be paying taxes to subsidize free prescription contraceptives for law students? No wonder a lot of people would prefer, instead, to discuss Rush Limbaugh's word choices (Ira Stoll, 3/9).

Bloomberg: Fight Birth-Control Battle Over the Counter
Anyone -- a local teenager, a traveling businessman, a married mother of four, an illegal immigrant, even a student at a Jesuit university -- can walk into my neighborhood CVS any time, day or night, and, for less than $30, buy a 36-count "value pack" of Trojan condoms. … Contrary to widespread belief, there's no good reason that oral contraceptives -- a far more effective form of birth control -- can't be equally convenient…. If you're actually interested in preventing unwanted pregnancies rather than merely scoring political points, these are the questions you should be asking (Virginia Postrel, 3/8).

The Dallas Morning News: The State Of Texas Vs. Its Women
With respect, caution and clarity I propose the following: Let’s galvanize our spirit of statehood and rally on behalf of Texas' most valuable asset — our citizens. More specifically, our ladies and their basic health care. Cutting the funding to Planned Parenthood is a grave error and an act unworthy of our great state (Stephanie March, 3/8).

The Seattle Times: The War On Women Might Be Settled At The Ballot Box
Remember the good old days when women's access to contraception, abortion choice and education was a given? Few people talked about these rights because the dialogue had progressed beyond such debates. At a time when politicians should be hyper-focused on jobs and the economy, a ridiculous shadow war on women and their health-care rights has taken center stage…. Women make up 53 percent of the electorate in our state and a sizable percentage elsewhere. Smacking them and their health care derails a meaningful national discussion and prompts voter payback (3/8).

Minneapolis Star Tribune: Grassley Ramps Up Health Plan Inquiry
Minnesota policymakers foolishly brushed off concerns raised last week by U.S. Sen. Chuck Grassley about the state's management of its taxpayer-paid medical assistance programs. They shouldn't make that mistake again…. Grassley is asking the hard questions that Minnesota lawmakers should have demanded answers to a year ago. Legislators need to follow his lead and ensure that Minnesota's nonprofit plans aren't profiting too much at taxpayers' expense (3/8).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Marissa Evans

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.