Daily Health Policy Report

Monday, April 1, 2013

Last updated: Mon, Apr 1

KHN Original Reporting & Guest Opinion

Health Reform

Health Care Marketplace

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Maryland’s Tough New Hospital Spending Proposal Seen As 'Nationally Significant'

Kaiser Health News staff writer Jay Hancock, working in collaboration with The Washington Post, reports: "Maryland officials have proposed what analysts call the most ambitious initiative in the country to control soaring medical spending, a plan that would bring relief to employers and consumers footing the bill while bluntly challenging the state’s powerful hospital industry. The blueprint, which needs the Obama administration’s approval, would use Maryland's unique rate-setting system to keep hospital spending from growing no faster than the overall economy — roughly half its recent rate of increase" (Hancock, 4/1). Read the story.

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Why Uninsured Might Not Flock To Health Law's Marketplaces

Kaiser Health News staff writer Phil Galewitz in collaboration with The Washington Post reports: "With almost one in five of its residents lacking health insurance, officials in Palm Beach County thought they had hit on a smart solution. The county launched a program that offered subsidized coverage to residents who couldn't afford private insurance, but made too much to qualify for Medicaid, the state-federal program for the poor. Enrollees would be able to buy policies for about $52 a month -- far cheaper than what private insurers were offering. But a year after the program began, fewer than 500 people had signed up - less than a third of the number expected" (Galewitz, 4/1). Read the story.

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IG Report Slaps Medicare For Not Recouping More Overpayment For Equipment

Now on Kaiser Health News' blog, Mary Agnes Carey writes about a new report on Medicare spending for expensive medical equipment for beneficiaries: "Medicare has made nearly $70 million in overpayments to suppliers of consumer medical equipment and more than half of that money is unlikely to be recovered, according to a new report from the Department of Health and Human Services Inspector General" (Carey, 4/1). Check out what else is on the blog.

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Political Cartoon: 'New Math?' By Gary Varvel, Indianapolis Star

Kaiser Health News provides a fresh take on health policy developments with "New Math?" By Gary Varvel, Indianapolis Star.

Meanwhile, here is today's health policy haiku:

GET KEVIN COSTNER ON THE LINE

when enrolling uninsured
in a health care plan
-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 Reform

Federal Officials Look To Mass Marketing To Sell Health Law

The administration faces a tough challenge to get the public to understand and accept the health law -- and, then, to sign up the millions without coverage.

The Associated Press: Can Mass Marketing Heal The Splits On 'Obamacare'?
How do you convince millions of average Americans that one of the most complex and controversial programs devised by government may actually be a good deal for them? With the nation still split over President Barack Obama's health care law, the administration has turned to the science of mass marketing for help in understanding the lives of uninsured people, hoping to craft winning pitches for a surprisingly varied group in society (Alonso-Zaldivar, 4/1).

Kaiser Health News: Why Uninsured Might Not Flock To Health Law's Marketplaces
With almost one in five of its residents lacking health insurance, officials in Palm Beach County thought they had hit on a smart solution. The county launched a program that offered subsidized coverage to residents who couldn't afford private insurance, but made too much to qualify for Medicaid, the state-federal program for the poor. Enrollees would be able to buy policies for about $52 a month -- far cheaper than what private insurers were offering. But a year after the program began, fewer than 500 people had signed up -- less than a third of the number expected (Galewitz, 4/1).

NPR: Three Years On, States Still Struggle With Health Care Law Messaging
It is hard to imagine that after three years of acrimony and debate we could still be so confused about President Obama's Affordable Care Act. ... There are essentially three big pieces to the Affordable Care Act: the insurance reforms (also known as the patients' bill of rights), quality and cost measures, and the health care mandate. .... For consumers, however, it doesn't matter if you're in Texas or California or anywhere else in the country, the law is clear: The uninsured are expected to get coverage by January. Whether those folks will be informed and ready by then is not so clear (Sullivan, 3/30).

The Medicare NewsGroup: Obama's 2014 Budget Could Mean Significant Change For Medicare
On April 10, President Obama will enter the ongoing 2014 budget battle when the White House releases its budget blueprint, joining Senate Democrats and both parties in the House in a partisan scuffle over the nation’s fiscal future. If it’s anything like what the president put forth last year, the Medicare-related parts of the White House budget will focus on containing costs by reforming the Medicare payment system and reducing fraud and waste while maintaining the Traditional Medicare structure (Adamopoulos, 3/31).

Meanwhile, federal officials released rules Friday reiterating their plans for expanded Medicaid funding under the health law -

Modern Healthcare: CMS Considering Waivers For Private Coverage Medicaid Alternative
The Obama administration is showing willingness to let some states steer new Medicaid funding to private coverage in the new individual insurance marketplaces in order meet the coverage goals of the healthcare reform law. The CMS will consider granting a "limited number" of state waivers for demonstration that test what happens when states give Medicaid enrollees the option of taking a subsidy to buy a private plan, according to new guidance issued Friday (Blesch, 3/31).

Bloomberg: Some U.S. States Can Shift Medicaid Funds To Exchanges
Low-income people may get Medicaid money to buy health insurance from private plans such as UnitedHealth Group Inc. (UNH) or Humana Inc. (HUM) in a "limited number" of states, U.S. officials said. Arkansas and Ohio have asked President Barack Obama's administration to allow them to adjust how Medicaid dollars are used (Wayne, 3/30).

The Hill: Obama Administration Finalizes Key Affordable Care Act Rule
The federal government will reimburse states for 100 percent of the costs for some newly eligible Medicaid patients, under new regulations finalized Friday as part of the Obama administration's implementation of the Affordable Care Act (ACA). The healthcare law authorizes states to expand Medicaid to adults under 65 with incomes up to 135 percent of the federal poverty level — roughly $15,000 for a single adult in 2012 (Goad, 3/29).

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Supporters Of Medicaid Expansion Fight To Be Heard In Some Statehouses

Mississippi House Democrats blocked passage of the state's Medicaid budget Sunday to force a vote on expanding the program, while supporters and critics do battle in Missouri, Montana and Arkansas. 

Clarion Ledger: Mississippi House Democrats Block Medicaid Budget
House Democrats on Sunday night blocked passage of the $840 million Medicaid budget, a move to try to force a vote on expanding the program and to block Gov. Phil Bryant from running it by executive order. "The federal government is offering venture capital to expand the largest industry we've got in this state, and we can’t even get a vote and debate on it," said Rep. Steve Holland, D-Plantersville. "So we're doing what we have to do. We are going to have an up-or-down vote on Medicaid expansion — it may be in a special session — or we are not going to have Medicaid" (Pender, 3/31).

The Associated Press: FACT CHECK: Corbett And The Medicaid Expansion
For now, (Pennsylvania) Gov. Tom Corbett has decided against embracing an expansion of Medicaid that could extend taxpayer-paid health care coverage to hundreds of thousands of low-income adult Pennsylvanians. The 2010 Affordable Care Act pledges to shoulder the lion's share of the cost of the expansion, but Corbett says he is still concerned about the cost to Pennsylvania taxpayers and cautions that the federal government cannot always be trusted to deliver on its funding promises to states. Here is a look at the validity of some of his claims about the Medicaid expansion (Levy, 3/31).

The Associated Press/Kansas City Star: Medicaid Debate In Missouri Gets Hyperbolic
If Missouri expands Medicaid health coverage for lower-income adults, could it create a crisis for public schools? If Missouri fails to expand Medicaid, could it result in millions of Missourians' tax dollars going to health care in other states? In the tense Medicaid debate at the Missouri Capitol, both assertions have been put forth as plain facts by opponents or supporters of a plan that could add as many as 300,000 adults to the Medicaid rolls. But they might best be labeled as hyperbole (Lieb, 3/31).

Helena Independent Record: Democrats Vow To Pass Medicaid Expansion As Republicans Say It Will Blow State Budget
Last week, Republicans on two legislative committees used their majorities to kill Democrat-sponsored bills to expand the program starting in 2014. Gov. Steve Bullock and fellow Democrats vow to keep searching for a way to pass the expansion, although it could be difficult, as long as Republican majorities at the Legislature oppose it (Dennison, 3/31).

The Associated Press: Health Care, Tax Cuts Issues Colliding (AP Analysis)
How do you convince Republicans who took over the Arkansas Legislature by vowing to fight "Obamacare" to support government-subsidized health insurance? The same way you convince a Democratic governor who has said his budget can't include more tax cuts to agree to a large package of reductions. As Arkansas lawmakers approach what could be the final weeks of this year's session, it's becoming clearer that proposals to expand health insurance to low-income workers and to cut $100 million in taxes are colliding (DeMillo, 3/31).

Baltimore Sun: Health Reform's Changes Stir Worries As They Take Shape In Md.
State lawmakers put finishing touches last week on plans to apply federal health care reforms in Maryland come Jan. 1. But who becomes newly insured — and at what cost —still worries stakeholders as the state speeds toward becoming one of the first to adopt a revamped system. Under legislation passed by the House of Delegates and Senate, more low-income Marylanders would qualify for government-funded health care through Medicaid, and an existing tax on health insurers would sustain a new insurance marketplace once federal support wanes (Dance, 3/31).

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GOP Opposition To Health Law Hurts Efforts To Court Hispanics

The Los Angeles Times reports that Latinos, who have the lowest rates of health coverage in the country, are among the strongest supporters of the health law. Meanwhile, AP examines the hard opposition to the overhaul in the South, led by Republican governors representing some of the poorest and least healthy states.

Los Angeles Times: Healthcare An Obstacle As Republicans Court Latinos
As Republican leaders try to woo Latino voters with a new openness to legal status for the nation's illegal immigrants, the party remains at odds with America's fastest-growing ethnic community on another key issue: healthcare. Latinos, who have the lowest rates of health coverage in the country, are among the strongest backers of President Obama's healthcare law (Levey, 3/31).

The Associated Press: The South: A Near-Solid Block Against 'Obamacare'
As more Republicans give in to President Barack Obama's health-care overhaul, an opposition bloc remains across the South, including from governors who lead some of the nation's poorest and unhealthiest states…So why are these states holding out? The short-term calculus seems heavily influenced by politics (Barrow, 3/31).

The Hill: GOP Seeks To Benefit From Sebelius Admission On Healthcare Cost Hikes
Republican campaign officials are claiming new momentum for 2014 after the Obama administration admitted that some consumers could see their health insurance premiums rise under healthcare reform. This week's surprise concession from federal Health secretary Kathleen Sebelius played into the GOP's No. 1 message against the Affordable Care Act — that it will raise healthcare costs. The remark triggered a rush of campaign messaging against vulnerable Democrats who supported healthcare reform (Viebeck, 3/31).

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Health Care Marketplace

Concerns Raised About Effect Of Medicare's Readmission Penalty

The New York Times explores the new policy that penalizes hospitals if they have too many patients return within 30 days. Meanwhile, in Maryland, officials are weighing an ambitious plan to control hospital costs.

The New York Times: Hospitals Question Medicare Rules On Readmissions
While federal statistics show the effort is beginning to reduce costly and unnecessary readmissions, a growing chorus of critics is asking whether the government policy, which penalizes hospitals that have high readmission rates, is unfair. They are also questioning whether hospitals should be responsible for managing the personal lives of patients once they are released — or whether they should focus on other ways to improve care (Abelson, 3/29).

Kaiser Health News: Maryland's Tough New Hospital Spending Proposal Seen As 'Nationally Significant'
Maryland officials have proposed what analysts call the most ambitious initiative in the country to control soaring medical spending, a plan that would bring relief to employers and consumers footing the bill while bluntly challenging the state’s powerful hospital industry. The blueprint, which needs the Obama administration's approval, would use Maryland’s unique rate-setting system to keep hospital spending from growing no faster than the overall economy — roughly half its recent rate of increase (Hancock, 4/1).

In other health industry news, federal officials release more details about hospital problems and a federal watchdog focuses on Medicare spending for equipment.

The Associated Press: Reports Of Hospital Mistakes Now Available Online
At St. Charles Medical Center in Bend, (Oregon) employees failed to notice that a cleaning machine was accidentally reprogrammed to leave out the disinfection cycle. Eighteen patients received colonoscopies with scopes that had been only rinsed with water and alcohol. ... Hospitals make mistakes. When they are reported — by patients, employees or family members — state and federal officials investigate. Now, for the first time, the U.S. Centers for Medicare and Medicaid (CMS) has released those inspection reports for hospitals nationwide from the past two years. The release was in response to requests from the Association of Health Care Journalists, which has compiled them into a searchable database available to the public
(Peterson, 3/31).

Kaiser Health News: Capsules: IG Report Slaps Medicare For Not Recouping More Overpayment For Equipment
Medicare has made nearly $70 million in overpayments to suppliers of consumer medical equipment and more than half of that money is unlikely to be recovered, according to a new report from the Department of Health and Human Services Inspector General (Carey, 4/1).

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Public Health & Education

As Hyperactivity Diagnoses Rise, Concerns Grow About Overmedication Of Children

New CDC data shows that nearly one in five boys have a medical diagnosis of attention deficit hyperactivity disorder. Other public health issues highlighted by news outlets include stroke risks in younger people, prescription-drug deaths and OSHA policies.

The New York Times: More Diagnoses Of Hyperactivity In New C.D.C. Data
Nearly one in five high school age boys in the United States and 11 percent of school-age children over all have received a medical diagnosis of attention deficit hyperactivity disorder, according to new data from the federal Centers for Disease Control and Prevention. These rates reflect a marked rise over the last decade and could fuel growing concern among many doctors that the A.D.H.D. diagnosis and its medication are overused in American children (Schwarz and Cohen, 3/31).

NPR: As Stroke Risk Rises Among Younger Adults, So Does Early Death
Most people (including a lot of doctors) think of a stroke as something that happens to old people. But the rate is increasing among those in their 50s, 40s and even younger (Knox, 4/1).

Los Angeles Times: Prescription Drug-Related Deaths Continue To Rise In U.S.
Despite efforts by law enforcement and public health officials to curb prescription drug abuse, drug-related deaths in the United States have continued to rise, the latest data show. Figures from the U.S. Centers for Disease Control and Prevention reveal that drug fatalities increased 3% in 2010, the most recent year for which complete data are available. Preliminary data for 2011 indicate the trend has continued (Glover and Girion, 3/29).

The New York Times: As OSHA Emphasizes Safety, Long-Term Health Risks Fester
OSHA, the watchdog agency that many Americans love to hate and industry often faults as overzealous, has largely ignored long-term threats. Partly out of pragmatism, the agency created by President Richard M. Nixon to give greater attention to health issues has largely done the opposite. OSHA devotes most of its budget and attention to responding to here-and-now dangers rather than preventing the silent, slow killers that, in the end, take far more lives. Over the past four decades, the agency has written new standards with exposure limits for 16 of the most deadly workplace hazards, including lead, asbestos and arsenic. But for the tens of thousands of other dangerous substances American workers handle each day, employers are largely left to decide what exposure level is safe (Urbina, 3/30).

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State Watch

States Boost Laws, Regulations Governing Abortion

States have passed a record number of abortion bills since 2011, including curbs on clinics and chemically induced abortions, and in North Dakota, a ban on abortions as early as six weeks. On the other side, New York and Washington are weighing measures to ensure abortion rights.

The Wall Street Journal: States Harden Views Over Laws Governing Abortion
States are becoming increasingly polarized over abortion, as some legislatures pass ever-tighter restrictions on the procedure while others consider stronger legal protections for it, advocates on both sides say. ... At the same time, Washington state is weighing a measure that would require all insurers doing business in new health insurance exchanges created by the Affordable Care Act to reimburse women for abortions. And New York Democratic Gov. Andrew Cuomo is seeking to update his state's laws to clarify that women can obtain an abortion late in pregnancy if they have a medical reason (Radnofsky, 3/31).

The Associated Press: Abortion Clinics Need License, Check For Coercion
Michigan abortion clinics will need a state license and must check to make sure women are not being bullied or pressured into getting an abortion under a new law that took effect Sunday. Other regulations make clearer the proper disposal of fetal remains, after anti-abortion advocates expressed concern some were not disposed of with dignity (Eggert, 3/31).

In Montana, lawmakers are seeking to cut funding to some organizations that provide women's health care.

The Associated Press: Women's Health Funding Faces Cuts: House Budget Excludes $4.5M For Title X Funds
When Jennifer Strickley first learned she had ovarian cancer, it was Planned Parenthood that detected the disease. She had been going to a clinic in Billings (Montana) for about a decade, as the discounts on Pap tests, contraception and regular checkups provided an essential break for the single mom working without health insurance as a waitress to support her two kids ... Strickley is one of 26,000 Montanans who rely upon clinics that receive federal family planning and preventive health funds in the form of Title X. ... But the Montana House unanimously passed a state budget that excludes these funds — some $4.5 million — accounting for 30 percent of the budgets for 20 community clinics and five Planned Parenthood Clinics in the state (4/1).

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Louisiana Health Secretary Submits Resignation

Louisiana Gov. Bobby Jindal's health secretary -- Bruce Greenstein -- is resigning amid a probe into a Medicaid contract he awarded to a former employer.

The Associated Press: La. Gov. Jindal’s Health Secretary Resigns As Probes Continue Into Medicaid Contract
Louisiana Gov. Bobby Jindal’s health secretary and close ally, Bruce Greenstein, is resigning amid ongoing state and federal investigations into the awarding of a Medicaid contract to a company where Greenstein once worked, officials said Friday. The Jindal administration canceled the nearly $200 million contract with Maryland-based CNSI last week after details leaked of a federal grand jury subpoena involving the contract award (3/29).

New Orleans Times Picayune: DHH Secretary Bruce Greenstein Resigns In Wake Of Federal Investigation 
Louisiana Department of Health and Hospitals Secretary Bruce Greenstein has resigned, a statement from Gov. Bobby Jindal's office confirmed Friday. Speculation Greenstein would resign was rampant after news broke he allegedly used his influence as department head to secure a contract for a former employer. ... Asked whether the hospitals secretary was forced out, Jindal spokesman Sean Lansing said in an email, "The governor did not ask Bruce to resign." He later added that no one in the administration or among Jindal's advisers asked Greenstein to resign (McGaughy, 3/29).

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Years After Law, Kennedy Continues Mental Health Coverage Parity Battle

A mental health parity law passed in 2008, yet one of the measure's key backers -- former Congressman Patrick Kennedy -- continues the fight for equal coverage of mental illness. He is meeting mixed success.

WBUR: CommonHealth: Kennedy Calling For Equal Coverage Of Mental Health -- Yes, Still
Mental health "parity" is officially a done deal. Congress passed a law back in 2008 requiring health insurers to treat mental health on a par with physical health, covering care for mental illness and addiction no less than they cover physical care. Many states have also passed their own mental health parity laws. So why has former Congressman Patrick Kennedy of Rhode Island -- lead sponsor of the 2008 bill together with his late father, Sen. Ted Kennedy -- spent much of the last couple of years criss-crossing the country to advocate for mental health parity? (3/29).

In Texas, mental health funding faces a tough road ahead after budget gaps appear --

The Associated Press: Texas Mental Health Funding Leaves Gaps
Standing in a courtyard by the state Capitol, Sen. Judith Zaffirini reached out to touch the Mental Health Bell, forged in the 1950s from chains once used to shackle asylum patients, brought to Texas this year on display as a 300-pound symbol of hope. … But while advocates for the mentally ill roundly cheer their gains, it is becoming clear the money will go only so far. Lawmakers are scrambling to repair a patchwork system spread among community centers, state agencies and all levels of the criminal justice system (Brick, 3/30).

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Roundup: D.C. Sued Over Medicaid Reimbursement; Vt. To Post Health Care Rates

The Washington Post: Specialty Hospital Centers Sue D.C. For Reimbursement Of Medicaid Costs 
Two facilities that treat severely ill poor patients could be forced to curtail services if the District does not fully reimburse them for Medicaid costs, according to a lawsuit filed this week. In the suit, Specialty Hospital of Washington Capitol Hill and Specialty Hospital of Washington Hadley claim the city has failed to reimburse them $24.7 million over the past four years (Craig, 3/29).

The Texas Tribune/New York Times: Texas Senate Bill Would Revise the State's End-of-Life Procedure 
Texas lawmakers have grappled year after year over whether families or medical professionals should decide when to end a terminally ill patient’s life-sustaining care. This year, they seem closer to a compromise (Aaronson, 3/30).

The Associated Press: Vt. To Be First State To Post Health Care Rates
Vermont is poised to become the first state in the country to let people without health insurance see how much they will have to pay to get coverage through the federal Affordable Care Act next year. On Monday, the state is going to post the proposed rates to be offered through the state's health insurance marketplace for various levels of coverage (Ring, 4/1).

Richmond Times-Dispatch: Your Health: Virginia Graded "B" On Health Price Transparency
A recent report gave Virginia a grade of B on health care price transparency. What does that mean? The report graded states on whether consumers had access to public information that would allow them to compare prices of health care services. States' grades were based on whether there were state laws or policies requiring price information to be made available to consumers upon request or disseminated in a report or posted to a public website (4/1).

MPR News: 'Urgency Center' Clinic To Open In Blaine
A new facility opening soon in Blaine (Minnesota) will serve people with medical conditions that are not serious enough for an emergency room but still require care unavailable in most medical clinics. The new facility, called an urgency center, will open in partnership with a clinic in Blaine, said Dr. Amy Kolar, the director of the emergency room at North Memorial Hospital, which is opening the center. The urgency center will be ideal for people who break a bone or dislocate a shoulder but do not need to be admitted to a hospital, Kolar said (Williams, 3/31).

MPR News: $50K Grant Targets Overused Medical Tests
The Minnesota Medical Association, the state's largest doctor group, has received a $50,000 grant to educate physicians and patients about overused medical tests and procedures. The grant, funded by the Robert Wood Johnson Foundation, is one of nearly two dozen awarded to health organizations around the United States. The medical association's CEO, Dr. Robert Meiches, said that the initiative, called Choosing Wisely, encourages doctors and patients to select care that is supported by evidence; does not duplicate previous tests; and is free from harm (Stawicki, 3/30).

The Associated Press: Gov. Fallin Releases Health Care Documents, Withholds Others
Oklahoma Gov. Mary Fallin's office refused Friday to release dozens of documents surrounding decisions she made connected to the federal health care law, citing exemptions to the state's Open Records Act that media experts say do not exist. In response to a request from several media outlets, including The Associated Press, the governor’s office released in digital form more than 50,000 pages of documents relating to the federal Patient Protection and Affordable Care Act (3/30).

EdSource: Schools Struggle To Provide Dental Health Safety Net
As California educators grapple with boosting student achievement across economic lines, the teeth of poor children are holding them back. Hundreds of thousands of low-income children suffering from dental disease, some with teeth rotted to the gum line, are presenting California school districts with a widespread public health problem. Increasingly, dental health advocates are looking to school districts to help solve the crisis (Adams, 3/31).

HealthyCal: School Clinics Put Emphasis On Wellness
Just in time for the advent of national health care reform next year, Los Angeles-area schools are opening their first campus-based wellness centers, offering services not just to students and their families, but to entire neighborhoods. On a recent day in Compton, the Dominguez High School Marching Band played and drill team dancers whirled and pranced to celebrate the opening of their new center (Richard, 4/1).

California Healthline: New Survey Offers First Data On Managed Care Shift 
A survey released yesterday revealed strengths and weaknesses in the state's 2011 transition of about 172,000 seniors and persons with disabilities into Medi-Cal managed care plans. Two-thirds of the responding beneficiaries said their care was the same or better than it had been before the transition but the survey raised concerns on several fronts, most notably a lower level of notification and communication, according to Carrie Graham, assistant director of research at Health Research for Action at UC-Berkeley School of Public Health. Health Research for Action conducted the survey in partnership with the California HealthCare Foundation, which publishes California Healthline (Gorn, 3/29). 

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Editorials and Opinions

Viewpoints: 'Big Risks' Of Buying Private Insurance With Medicaid Dollars; One Month Of Sequestration

The New York Times: Using Medicaid Dollars For Private Insurance 
The Obama administration and Republican officials in several states are exploring ways to redirect federal money intended to expand Medicaid, the main public insurance program for the poor, and use it instead to buy private health insurance for Medicaid recipients. The approach could have important benefits for beneficiaries and for the future of health care reform. But the idea also carries big risks. Federal officials will need to enforce strict conditions before agreeing to any redirection of Medicaid dollars that were originally intended to enlarge the Medicaid rolls (3/31).

Forbes: The Arkansas-Obamacare Medicaid Deal: Far Less Than It First Appeared 
When Arkansas Gov. Mike Beebe (D.) first announced that he had reached a deal with the Obama administration to use the Affordable Care Act's private insurance exchanges to expand coverage to poor Arkansans, it seemed like an important, and potentially transformative, development. ... A Good Friday memo from the U.S. Department of Health and Human Services, however, splashes cold water on that aspiration. It's now clear that the Beebe-HHS deal applies a kind of private-sector window dressing on the dysfunctional Medicaid program, and it’s not obvious that the Arkansas legislature should go along (Avik Roy, 4/1).

USA Today: 'Sequester' Still Looks Stupid, As Planned: Our View 
Congress and the White House exempted some programs when they finalized the original deal, and the spending bill they agreed to last month to keep the government open to Sept. 30 spared some vital functions — food inspections, for example. But not enough. Nor does the sequester seriously address the major spending driver: health care costs. The best outcome would be for the sort of anger that forced Congress and the White House to re-open the government in 1996 to push Congress and the White House back to the table on a realistic budget deal this year. The outlines of that deal have been obvious for too long: Trim entitlement programs such as Medicare and Social Security, overhaul the hopelessly inefficient and corrupt tax code to bring in more money, and cut defense and domestic programs with a scalpel instead of an ax (3/31). 

USA Today: 'Sequester' Needed To Rein In Spending: Another View 
Let's get real on the "sequester." One month in, not much has changed. Nor is it likely to. Rather than devastating the federal government, the sequester is necessary to rein in the unbridled growth of federal spending. The sequester is certainly flawed. It's a blunt instrument leaving the biggest spending drivers, entitlements, virtually untouched (Alison Fraser, 3/31). 

The Wall Street Journal: The Liberal Medicare Advantage Revolt 
A big political story this year is likely to be Democrats turning on their White House minders as the harmful and unpopular parts of the Affordable Care Act ramp up. On the heels of the recent 79-20 Senate uprising against the 2.3% medical device tax, now comes the surge of Democrats pleading on behalf of Medicare Advantage. Liberals have claimed for years to hate this program, but by now Advantage provides private insurance coverage to more than one of four seniors. And those seniors like it (3/29).

The Chicago Tribune: Scrubbing Medicaid 
In January, Illinois launched an effort to scrub ineligible people from the state's Medicaid rolls. ... The initial results of this audit are ... astonishing: Of the first 20,500 recipients screened by an outside contractor, the auditors recommend that 13,709 be removed from the rolls. Yes, that's two-thirds of the first group screened, flagged as ineligible to receive their current Medicaid benefits. How so? In some cases, the recipients make too much money to qualify. In other cases, they don't live in Illinois (3/31).

The New York Times: The Campaign to Outlaw Abortion
Anti-abortion groups have been trying to re-impose restrictions on abortion rights for 40 years, but the Legislature and governor of North Dakota have taken this attack on women's reproductive health and freedom to a shocking new low ... The clear message is the need for a stepped-up effort to hold state officials electorally accountable for policies that harm women in states where right-wing Republicans control the machinery of government (3/29).

The Seattle Times: State Senate Health Care Committee Should Vote On Abortion Measure
After the Senate Health Care Committee hearing on the Reproductive Parity Act Monday, members should vote for it before a key deadline Wednesday. State lawmakers do not need to complicate this issue. House Bill 1044 would maintain insurance coverage for women seeking abortions after federal health reforms take effect (3/31).

Los Angeles Times: The Starbucks Syndrome In Healthcare
Medicare statistics, for example, reveal that Los Angeles leads the nation in the amount of medical services provided during the last six months of a person's life. Healthy seniors here are also big consumers of healthcare, getting about 65% more MRI studies and utilizing ambulances three times as often as seniors elsewhere. Commercial insurance data point to similar patterns in the healthcare of the younger population in Southern California. What explains such avid use of medical services. ... Part of the problem is that Angelenos approach healthcare as they do other kinds of consumption. They expect their CT scans, when they want them, in much the same way they expect their decaf caramel extra hot low-fat macchiatos. (Daniel J. Stone, 3/31).

Los Angeles Times: Bump In The Road For Healthcare Law
One figure in a new report neatly summarizes the potential pitfalls for Obamacare: 30.1%. That's how much premiums could rise next year, on average, for the roughly 1.3 million moderate- and upper-income Californians who buy individual health insurance policies. Most of that increase is attributable to the insurance reforms in the 2010 law, also known as the Affordable Care Act. The bill's title is not ironic — its provisions will slow the growth of healthcare costs and lead over time to a more rational and efficient system. But the transition will have some rough patches, and we're about to hit one (3/29). 

Houston Chronicle: The Affordable Care Act Is A Poor Solution
Senator Orrin Hatch has speculated that the Affordable Care Act was designed to fail. A close look at the Act's contents and history suggests he may be right. The Affordable Care Act is nothing more than a political stopgap, a waypoint on the road to something that might work. Republicans could stand around complaining or we could seize this opportunity to determine what comes next (Chris Ladd, 4/1).

Richmond Times-Dispatch: Moving Forward On Medicaid: More Important Than Ever
As a community physician for more than eight years, I've seen how medical care helps keep families strong and secure. When parents and their kids can access health care — and have a way to pay for it — they are much less likely to face unpaid bills or have to put off doctor visits. Instead of worrying about how their family is going to survive, they can focus on how their family is going to thrive. Unfortunately, too many Virginians — more than a million, in fact — find that getting health care is a real challenge because they don't have insurance (Dr. Christopher Lillis, 4/1).

The Wall Street Journal: The Skinny On Anti-Obesity Soda Laws 
New York Mayor Michael Bloomberg's anti-obesity campaign to ban the sale of certain sugary drinks in large servings, especially sodas, was struck down last month in state court. A proposal for a penny-per-ounce excise tax on sweetened beverages also floundered in Vermont's House of Representatives in February. ... As an economist, I have two big gripes with such paternalistic public-health initiatives: The proposals aren't grounded in data or compelling economic models, and soda taxes might catalyze a dismal chain reaction, with escalating government intrusions on personal freedom (Michael L. Marlow, 3/31).

Oregonian: Don't Take Portland's Sick-Leave Mistake Statewide: Agenda 2013
By voting to mandate paid sick leave last month, Amanda Fritz and her city council colleagues furthered Portland's reputation as a place where businesses fear to tread. One way to protect city employers burdened by this mandate is to adopt a similar requirement statewide, erasing a competitive advantage a restaurant in, say, Beaverton might have over one in Portland. In other words, bail out Portland by making things tougher all over (3/31).

USA Today: ER Key To Curb Painkiller Abuse
Most opioids are prescribed in the doctor's office, which has prompted some states to restrict primary care physicians like myself from prescribing them and to encourage referrals to pain specialists. New York City Mayor Michael Bloomberg has taken these curbs a step further by focusing on emergency departments. In January, he announced a voluntary initiative to limit prescription of opioid painkillers in the emergency rooms of the city's 11 public hospitals. This approach should be expanded across the nation. From 2004 to 2009, the number of emergency visits in New York City hospitals related to opioid abuse or misuse more than doubled (Dr. Kevin Pho, 3/31). 

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

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The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.