Daily Health Policy Report

Wednesday, April 10, 2013

Last updated: Wed, Apr 10

KHN Original Reporting & Guest Opinion

Health Spending And Fiscal Battles

Health Reform

Capitol Hill Watch

Health Care Marketplace


State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Consumer Groups Fear Patients Could Be Hit With Large Out-Of-Pocket Costs

Kaiser Health News staff writer Julie Appleby reports: "Consumer groups are warning that insurers and employers may be able to keep offering health plans next year that include out-of-pocket caps for individuals of $12,500 or more -- double the amount allowed under the federal health law. The Obama administration has decided not to enforce that section of the law for some plans for another year, say 10 consumer groups which Monday wrote federal officials asking that the move be reconsidered" (Appleby, 4/9). Read the story.

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$54M In Grants Will Help Enroll Uninsured In 33 States

Kaiser Health News staff writers Phil Galewitz and Jenny Gold report: "The Obama administration on Tuesday said it will award $54 million to community groups in 33 states to help people sign up for insurance in the new online health insurance marketplaces that open for enrollment Oct. 1" (Galewitz and Gold, 4/9). Read the story.

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Health On The Hill: 'Remarkably Friendly' Hearing For Acting Medicare Chief

Kaiser Health News staff writer Mary Agnes Carey talks with Jackie Judd about a hearing Tuesday regarding the nomination of Marilyn Tavenner, the acting head of the Centers for Medicare & Medicaid Services, to keep the CMS top job, and when the Senate could vote on the confirmation (4/9). Listen to their conversation or read the transcript. You can also watch video highlights from the hearing.

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Capsules: Medicare Effort To Cut Readmissions Isn't Counting Patients Who Come Back To ER; Colorado's Pitch For New Business: Healthy, Lean Workers Cost Less

Now on Kaiser Health News' blog, Jordan Rau reports on a study examining a Medicare effort to cut readmissions: "A study published Tuesday says Medicare may be missing factors that lead to post-hospital health problems because it isn’t counting many discharged patients who come back to the emergency room but aren’t admitted" (Rau, 4/9).

Also on Capsules, Colorado Public Radio's Eric Whitney, working in partnership with KHN and NPR, reports on his state’s health-oriented new business pitch: "The cost of doing business may be lower in areas where there's a 'culture of health.' And that's put Colorado, which has lowest rates of obesity in the nation, on the map for companies looking to relocate or expand. Kelly Brough is proud of this. She runs the Denver Metro Chamber of Commerce, and she's creative about luring businesses to relocate in Colorado. For instance, she runs a 'Colorado loves California' campaign” (Whitney, 4/10). Check out what else is on the blog.

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Political Cartoon: 'By The Weigh?'

Kaiser Health News provides a fresh take on health policy developments with "By The Weigh?" by Dan Danglo.

Meanwhile, here is today's health policy haiku:


Same sex marriage fight
Put DOMA in a coma?
Now that would be nice!
-Beau Carter

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

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Health Spending And Fiscal Battles

Obama's $3.7T Spending Plan Would Cut $370B From Medicare

Despite the White House's effort to find middle ground, news outlets report that its proposal to raise $580B by limiting tax benefits for top earners is angering some Republicans, while cuts to entitlement programs are angering some Democrats.

The Washington Post: Obama To Unveil $3.77 Trillion Spending Plan
President Obama plans Wednesday to unveil a $3.77 trillion spending plan that proposes modest new investments in infrastructure and education, major new taxes for the wealthy and significant reforms aimed at reducing the cost of Social Security and Medicare. As Washington barrels toward another potential showdown over the federal debt limit later this summer, administration officials said the blueprint lays down the president's bottom-line offer for getting federal borrowing under control (Montgomery, 4/10).

Los Angeles Times: Obama To Unveil Budget Proposal, Latest Offer In Deficit Talks
Obama’s budget cuts $200 billion from domestic programs, including trims to farm subsidies and reductions in some federal retirement benefits. The proposal counts $400 billion in health savings and Medicare changes. It includes another $200 billion in savings from defense and non-defense programs (Hennessey, 4/10).

The Wall Street Journal: Obama Reaches For Middle Ground With New Budget Plan
Mr. Obama's budget proposal will call for $3.77 trillion in spending for the fiscal year that begins in October, a senior administration official said, up 6% from projected spending levels in the current fiscal year. The higher spending would come from a combination of canceling the across-the-board spending cuts, known as the sequester, that began in March and pumping more money into education, infrastructure and mental-health treatment, among other things. … The deficit would fall more sharply later in the decade under the president's plan, senior administration officials said, as a number of changes would kick in, affecting programs like Social Security, Medicare and military spending (Paletta, 4/9).

The Associated Press/Washington Post: Obama Sends Congress $3.77 Trillion Spending Plan For 2014 Seeking Elusive Grand Bargain
But instead of moving Congress nearer a grand bargain, Obama's proposals so far have managed to anger both Republicans, who are upset by higher taxes, and Democrats upset with cuts to Social Security benefits. The president's spending and tax plan is two months late. The administration blames the delay on the lengthy "fiscal cliff" negotiations at the end of December and then fights over the March 1 automatic spending cuts (4/10).

The Associated Press/Washington Post: Liberal Groups, Lawmakers Balk At Entitlement Cuts In Budget, 2nd Term Overtures To GOP
Liberal lawmakers from Congress and a coalition of like-minded groups rallied outside the White House on Tuesday, voicing frustration at the Democratic president they say has let them down by proposing cuts to Medicare and Social Security. One day before President Barack Obama was set to unveil his budget, organizers stacked nine file boxes in front of the White House that they said contained more than 2 million signatures on petitions telling Obama they won’t stand for cuts to entitlement programs cherished by the Democratic base (4/9).

USA Today: On Left And Right, Obama’s Budget Anticipated As A Dud
President Obama will unveil his budget later today, offering a fiscal plan that even before it's officially released is eliciting groans from his conservative opponents as well as his backers on the left. … The plan claims to achieve $400 billion in savings by cutting waste and fraud in Medicare and $580 billion in new revenues by limiting tax benefits for top earners. It also saves another $230 billion by restructuring cost-of-living adjustments for beneficiaries of social security, according to a White House overview of the budget (Madhani, 4/10).

Politico: Obama Budget Splits Medicare Cuts Between Patients And Providers
The Obama administration budget would squeeze $370 billion in Medicare savings by cutting payments to drug companies and providers but also by making some seniors pay more. The proposals, previewed by the White House and to be formally released later today, are familiar from deficit-reduction talks in Washington. They were included in the White House's most recent offer to House Speaker John Boehner (R-Ohio) "because that offer is still on the table," a senior administration official said in a background briefing call with reporters (Norman, 4/10).

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Health Reform

HHS Announces $54M For 'Navigators' To Help Consumers Use Insurance Exchanges

The $54 million to hire and train people to help the uninsured sign up for coverage will be distributed to groups in 33 states based on their number of uninsured. Texas and Florida, for instance, with almost nine million uninsured, will get $14 million.

Kaiser Health News: $54M In Grants Will Help Enroll Uninsured In 33 States
The Obama administration on Tuesday said it will award $54 million to community groups in 33 states to help people sign up for insurance in the new online health insurance marketplaces that open for enrollment Oct. 1 (Galewitz and Gold, 4/9).

Kansas Health Institute: Navigator Grants Announced For Helping Consumers Find Health Insurance Via Exchanges
The Centers for Medicare and Medicaid Services today announced its intent to award up to $54 million in grants to organizations interested in helping consumers navigate state health insurance exchanges. The exchanges, also known as marketplaces, are a key component of the Affordable Care Act, which required almost all Americans to have health insurance by Jan. 1 or pay a penalty (Ranney, 4/9).

The Hill: HHS Opens Applications For Obamacare 'Navigators'
The Health and Human Services (HHS) Department opened the application process Tuesday for $54 million in grants to help people navigate the new insurance marketplace under the Affordable Care Act. HHS released the grant opportunity for "navigators" — people who will help consumers shop for insurance in newly created exchange (Baker, 4/9).

Modern Healthcare: Federal Grants Available For Exchange 'Navigators'
Organizations and individuals that want to help consumers register for health coverage in federally run or state partnership exchanges can apply for $54 million in grant funding, the CMS said today. The grants are available to self-employed individuals, as well as private companies and public organizations that will serve as “navigators” for the new exchanges. … Last week, the CMS released a proposed rule describing the role of navigators, as well as standards and requirements. In addition, the draft said that while agents and brokers could be navigators in the federal exchanges, they can't receive commissions (Block, 4/9).

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State-Level Debate About Medicaid Expansion Heats Up

Medicaid expansion news from Missouri, Arkansas, Ohio and Florida.

The Associated Press/Kansas City Star: Missouri Gov. Nixon Seeks Medicaid Answers From Feds
Gov. Jay Nixon led a three-front charge Tuesday to expand Missouri’s Medicaid program, meeting privately with reluctant state senators, rallying publicly with hundreds of disability advocates and chatting with the nation’s top health care official about whether particular Medicaid proposals could win federal approval. Nixon, a Democrat, has made Medicaid expansion under the terms of President Barack Obama’s health care law his top legislative priority this year, despite resistance from a Republican-led legislature over expanding eligibility to as many lower-income adults as envisioned by the federal law (Lieb, 4/9).

St. Louis Beacon: Debate Over Medicaid Expansion Is At Hot As Gun Control In Parts Of South Missouri
While enjoying a plate of gravy and biscuits at Feller's Family Restaurant last Friday morning in Willow Springs, Mo., Johnny Morgan energized the breakfast conversation with examples of what he regards as unwarranted government intrusion into people's lives. … His tone had grown somber by the time he got around to another hot topic, Medicaid expansion, which he and many others derided as Obamacare. They said it means more government control and that Missouri would be better off rejecting Washington’s start-up money for it (Joiner, 4/10).

The Associated Press: Ark. House Panel Oks Medicaid 'Private Option'
A proposal to have Arkansas use federal Medicaid funds to subsidize private health insurance for low-income residents won approval from a state House committee on Tuesday, but the plan faced opposition from some Republicans as it moved toward a vote in the full chamber. House Public Health Committee approved the Senate-backed Medicaid "private option" proposal on a voice vote, minutes after the top Republican in the House withdrew his name as a sponsor of the bill and said he would vote against the proposal (Stratford, 4/9).

The Associated Press: Ohio House To Drop Medicaid Expansion
A Republican-controlled legislative panel will drop Gov. John Kasich's proposal to expand the Medicaid program from the state’s two-year budget plan, The Associated Press has learned, as advocates for extending the health care coverage to thousands more low-income Ohioans prepared to rally against the move. A person with knowledge of the budget negotiations confirmed to the AP on Monday that House lawmakers will strip the idea from their version of the state spending blueprint. The person requested anonymity because the information had not yet been made public (Smyth and Sanner, 4/9).

Health News Florida: Federal-Funding Frenzy Grows At Capitol
Republicans who control the Florida House hint they're about to unveil their version of a health plan for the state's low-income uninsured between now and Monday. It appears that they still intend to turn down more than $50 million in federal funds that would pay the tab (Gentry, 4/10).

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Consumer Groups Warn That Patients Could Face Large Out-Of-Pocket Costs

The Obama administration has opted to delay for some plans a health law provision that caps consumers' out-of-pocket exposure.   

Kaiser Health News: Consumer Groups Fear Patients Could Be Hit With Large Out-Of-Pocket Costs
Consumer groups are warning that insurers and employers may be able to keep offering health plans next year that include out-of-pocket caps for individuals of $12,500 or more -- double the amount allowed under the federal health law. The Obama administration has decided not to enforce that section of the law for some plans for another year, say 10 consumer groups which Monday wrote federal officials asking that the move be reconsidered (Appleby, 4/9).

Meanwhile, news on the District of Columbia's health insurance exchange -

The Washington Post: Smokers Will Pay Same Rates As Nonsmokers In D.C. Insurance Exchange
With less than six months until the District's health insurance exchange is set to debut, policymakers have made another momentous decision that will affect how much residents pay for coverage. On Monday, the D.C. exchange's executive board voted to prevent insurers from charging higher premiums to smokers than to nonsmokers — meaning nonsmokers are likely to pay modestly higher rates than if smoking surcharges were permitted (DeBonis, 4/9).

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Capitol Hill Watch

Tavenner Moves Closer To Senate Confirmation To Head CMS

Marilyn Tavenner, who has been the acting administrator of the Centers for Medicare & Medicaid Services since 2011, received a warm reception from Democrats and Republicans alike during a Tuesday Senate Finance Committee hearing.

The Associated Press: Senate Approval Seen For Obama Health Care Nominee
Republican lawmakers are heaping praise on a former nurse picked by President Barack Obama to run Medicare and Medicaid, and also oversee his health care law. If the Senate confirms Marilyn Tavenner, as expected, it may be the closest thing to a truce in the nation's political wars over health care (Alonso-Zaldivar, 4/10).

The Wall Street Journal: Medicare Chief Expected To Get Nod
In recent years, the job has become so politically contentious that lawmakers haven't been able to formally confirm a head of the Centers for Medicare and Medicaid Services. In a hearing Tuesday to vet her for the post, Ms. Tavenner gained support from both Republicans and Democrats on the Senate Finance Committee, who said she has proved herself capable as acting administrator of the agency since late 2011 (Dooren, 4/9).

Politico: Marilyn Tavenner Soars Through Senate Finance Hearing
The Senate Finance Committee on Tuesday overwhelmingly lauded President Barack Obama's nominee to run Medicare, Medicaid and even much of the health reform law. Marilyn Tavenner, who has run the sprawling Centers for Medicare & Medicaid Services as acting administrator for well over a year, was praised by Republicans and Democrats during her confirmation hearing, indicating that she is likely to sail through the full Senate without a reprise of the nasty politics of the health law (Haberkorn, 4/9).

Kaiser Health News: Health On The Hill: 'Remarkably Friendly' Hearing For Acting Medicare Chief
Kaiser Health News staff writer Mary Agnes Carey talks with Jackie Judd about a hearing Tuesday regarding the nomination of Marilyn Tavenner, the acting head of the Centers for Medicare & Medicaid Services, to keep the CMS top job, and when the Senate could vote on the confirmation (4/9).

KHN also offers video clips of the hearing: Tavenner Fields Questions on Leaks, Premium Costs, Future Of Medicare (4/9).

The New York Times: Three Obama Nominees Encounter No Opposition At Senate Confirmation Hearings
President Obama's three nominees to run Medicare and Medicaid, the Energy Department and the Office of Management and Budget sailed through their separate Senate confirmation hearings on Tuesday and appeared to be on track to win approval from the committees, though none of the panels voted on the nominations (Wald and Pear, 4/9).

Medscape: Phase In Medicare Pay-For-Performance, Says Tavenner
Marilyn Tavenner, the acting administrator of the Centers for Medicare & Medicaid Services (CMS), told lawmakers today that although the Obama administration wants to scrap the notorious sustainable growth rate (SGR) formula for setting Medicare pay for physicians, the switch to a new reimbursement scheme should happen incrementally. Tavenner made her remarks during a confirmation hearing before the Senate Finance Committee as President Barack Obama's nominee to be the first full-fledged, Senate-confirmed head of the sprawling agency since late 2006 (Lowes, 4/9).

Medpage Today: Tavenner Moves Closer To CMS Confirmation
Marilyn Tavenner, acting head of the Centers for Medicare and Medicaid Services (CMS), received bipartisan support at a Senate confirmation hearing Tuesday, taking her one step closer to becoming the agency's first confirmed administrator in 7 years. CMS hasn't had a confirmed head since Mark McClellan, MD, PhD, left the post in October 2006. McClellan was confirmed in March 2003. Since McClellan left, four acting administrators -- most recently Don Berwick, MD -- have come and gone without the needed confirmation of the Senate (Pittman, 4/9).

KHN's earlier, related coverage: The Hardest Job To Fill (And Keep) In Washington: CMS Chief (Gaul, 3/11/2012).

Also during the hearing -

Reuters: U.S. Agency To Investigate Possible Leak Medicare Rate Move
The nominee to lead a key healthcare agency said on Tuesday that the agency was investigating events surrounding a decision on Medicare Advantage payment rates that sent shares of insurance companies soaring. Marilyn Tavenner was asked about the April 1 rate decision at a Senate confirmation hearing by Republican Senator Charles Grassley of Iowa, who has said the rate decision might have been leaked to Height Securities, an investment research firm (Clarke, 4/9).

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House Panel Plans Review Of Federal Employee Health Plan

The Hill reports that a House Oversight subcommittee will likely debate possible changes to federal employee health benefits -- just two months after a pay freeze was put in place. Also in the news, Politico reports on how the mental health agenda has lost some momentum.

The Hill: House Hearing Will Scrutinize Federal Employee Health Plan
A House Oversight subcommittee will debate possible changes to federal employee health benefits in a hearing Thursday, two months after Congress approved a pay freeze for federal workers. The upcoming event will review the administration of the Federal Employee Health Benefits Program (FEHBP) by the Office of Personnel Management (OPM) and include testimony from Jonathan Foley, OPM's director of planning and policy analysis (Viebeck, 4/9).

Politico: Mental Health Is Pushed Down On Hill Agenda
Lawmakers have filed plenty of mental health care bills since the Newtown, Conn., killings, hoping they'd get attached to any agreement on gun control. But the ambitions are shrinking (Cunningham, 4/10).

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Health Care Marketplace

Nev. Jury Orders HMO To Pay $500M In Punitive Damages After Hep C Outbreak

A Nevada jury has awarded three plaintiffs $500 million in punitive damages after finding negligence. 

The Wall Street Journal: Jury Awards $500 Million Damages In Hepatitis Case
A Nevada jury said two UnitedHealth Group Inc. units should pay a total of $500 million in punitive damages in a case involving two members who contracted hepatitis C, an award that will draw close attention in the health-insurance industry. The decision follows the jury's decision last week that Health Plan of Nevada and a sister company, Sierra Health Services, bore responsibility for negligence in the two women's illness. At that time, it awarded $24 million in total compensatory damages to them and to the spouse of one of them (Mathews, 4/9).

The Associated Press: Nev. Jury Orders HMO To Pay $500M In Hepatitis Case
Two companies — both subsidiaries of publicly traded UnitedHealth Group Inc. — signed a low-bid contract with the physician who ran the clinic where the outbreak started, despite warnings that he sped through procedures and pinched pennies at his clinics so much that patients were at risk of contracting blood-borne diseases (Ritter, 4/9).

A Texas insurer is accused of overcharging Virginia Tech students for health coverage -- 

The Associated Press: Texas Student Insurance Firm Indicted In Va.
An indictment says a Texas company that provided health insurance to Virginia Tech students fraudulently overstated claims by more than $9 million to boost its profits. The grand jury indictment unsealed Tuesday in U.S. District Court in Abingdon, Va., charges GM-Southwest Inc. and its former owner, 73-year-old John Paul Gutschlag Sr., with racketeering, conspiracy, money laundering and fraud (O'Dell, 4/9).

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Controlling ER, Hospitals Admissions A Challenge For Medicare

A new study finds that Medicare isn't properly counting people who are released from hospitals and then come back to emergency rooms, while Reuters points out pay-for-performance incentives are aimed at keeping people out of ERs.

Kaiser Health News: Medicare Effort To Cut Readmissions Isn't Counting Patients Who Come Back To ER
A study published Tuesday says Medicare may be missing factors that lead to post-hospital health problems because it isn’t counting many discharged patients who come back to the emergency room but aren’t admitted. ... 54 percent of those visits to the emergency department (ED) did not lead to a readmission and thus would not have shown up in the statistics when Medicare calculated the hospital’s readmission rate. (Rau, 4/9).

Reuters: Insight: Insurers See Promise In Pay-For-Performance Health Plans
Insurers and doctors are testing a way to pay for healthcare that has been more common in the corporate suite than the emergency room - paying for better performance, betting it is the key to controlling runaway costs. Both private insurance plans and Medicare plans in hundreds of locations around the country are using incentives to try to cut healthcare spending and still keep Americans healthy (Humer, 4/9).

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The Truth About The 2 Percent Medicare Sequestration Cuts

News outlets examine what can be done about cuts to Medicare payments to cancer clinics, among others. And the IPAB deadline is three weeks away.

The Medicare NewsGroup: Fact/Fiction: The Obama Administration Can Spare Cancer Clinic Drugs From Sequestration Cuts
Some cancer clinics have said that the Obama administration has the power to save them from sequestration cuts that are forcing the clinics to turn away Medicare beneficiaries. Fact or Fiction? Fiction. Neither the Obama administration or the Centers for Medicare & Medicaid Services can decide which parts of Medicare spending should be cut or by how much. Only through legislation could cancer clinics be spared from the cuts (Sjoerdsma, 4/9).

CQ HealthBeat: Mayo Clinic To Take $47M Hit Under Medicare Cuts
Automatic across-the-board cuts in Medicare provider payments is costing the renowned Mayo Clinic $47 million a year, and "it slows us down," the head of the clinic told a Washington, D.C., audience on Tuesday. … The 2 percent Medicare provider cuts began this month under the budgetary sequestration process and [Dr. John] Noseworthy said a slower pace of research is harmful in the quest for innovation (Norman, 4/10).

CQ HealthBeat: Medicare Cost Board Could Come Into Play In Late April
The deadline is three weeks away for figuring out whether a controversial board included in the health care law will be responsible for coming up with Medicare cuts next year. Although the trigger is not expected to be met, the health care overhaul requires the chief actuary of the Centers for Medicare and Medicaid Services to determine whether the cuts will be necessary by April 30. Under the 2010 law, the Independent Payment Advisory Board is charged with making cost-cutting recommendations each year beginning in 2014 if Medicare spending exceeds a target growth rate (Attias, 4/10).

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State Watch

Kansas Joins Other States As Lawmakers Approve Bold New Abortion Restrictions

Analysis follows Kansas lawmakers' decision to place bold new restrictions on abortion, including defining life as beginning at conception. Gov. Sam Brownback is expected to sign the bill. Also, Alaska lawmakers also pass their own bill further restricting abortion.

The Wall Street Journal's Law Blog: Analyzing The Kansas Abortion Bill
Following in the footsteps of North Dakota and Arkansas, Kansas is poised to adopt new restrictions on abortion access. Arkansas in early March passed a law prohibiting most abortions after 12 weeks of pregnancy. North Dakota, three weeks later, banned the procedure as early as six weeks into a pregnancy (Gershman, 4/9).

Medpage Today: Kansas Passes More Curbs On Abortion Doctors
Kansas Gov. Sam Brownback (R) is expected to sign a bill into law that places new restrictions on abortion providers in the state while also defining life as starting at conception. Kansas House Bill 2253 mandates what opponents call disputed information that doctors and abortion clinics must provide to patients. For example, physicians would have to inform patients about a possible link between breast cancer and abortion, and say that a fetus can feel pain at 20 weeks of gestation -- both of which have been questioned (Pittman, 4/9).

The Associated Press: Alaska Senate Passes Abortion Bill 
The Alaska Senate on Tuesday passed a bill that would define what constitutes a "medically necessary" abortion for purposes of state funding. Supporters of the measure said public money should not be used to pay for "elective" abortions, but critics said the bill puts the state between a woman and her doctor and is unconstitutional (Bohrer, 4/9).

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State Roundup: Minn. Democrats Push Pay Hike For Nursing Home Workers

A selection of health policy stories from Minnesota, Colorado, New York, Delaware, Georgia, Oregon, Connecticut, Pennsylvania, Arizona, Massachusetts and California.

The Associated Press: Minnesota House Health Bill Has Care Worker Pay Hike
Minnesota House Democrats proposed a health programs spending bill Tuesday that includes new money for mental health treatment and small salary hikes for nursing home and long-term care workers, but helps pay for it with an increase in the state surcharge on hospitals that even the bill sponsor said was likely to be "very controversial." The health and human services (HHS) finance bill amounts to the DFL-controlled House's opening offer on how to divide public dollars in one of state government's largest spending areas (Condon, 4/9).

MPR News: DFL Spending Cuts Target Hospitals, HMOs
Minnesota House Democrats are proposing a health and human services budget that spares drastic cuts to poor people, the elderly and people with disabilities. But the plan would raise about $152 million from the state's hospitals and HMOs. It would also increase funding for the state's nursing homes and other long-term care facilities. Three weeks ago, DFL legislative leaders announced their intention to cut $150 million from the health and human services budget, but didn't explain how they would do it until now (Scheck, 4/9).

Health Policy Solutions (a Colo. news service): 'Risks' Loom For Health Exchange Technology
As Colorado’s health exchange managers sprint toward an October 1 launch, a top manager warned board members on Monday that a recent decision to build a new "eligibility" IT system poses the greatest risk of delay and could undermine the quality of the online health marketplace. … No. 1 on that list of risks is the new decision to divide one planned IT system into two. ... State Medicaid managers are building their own separate system to determine if exchange customers are eligible for Medicaid. Previously, Medicaid and the health exchange were planning to operate one "shared eligibility service," the report said (Kerwin McCrimmon, 4/9).

The Wall Street Journal: Health Care Ails In Rockaways
After superstorm Sandy disrupted many of the Rockaway Peninsula's health care facilities, volunteer doctors and nurses filtered into the devastated area, knocking on doors to see if residents needed help and serving hundreds of them from mobile medical units (Dawsey, 4/9).

The Associated Press/Washington Post: Del. Officials Reduce Hours At Public Health Clinic, Cite Low Patient Numbers, Consolidation
Delaware public health officials say services at a Middletown clinic are being reduced because of low patient number and a need to consolidate services. Officials say the Division of Public Health alerted patients last week of a reduction in service hours at the Middletown Health Unit, Sexual and Reproductive Health Clinic, effective last Friday (4/10).

Kaiser Health News: Capsules: Colorado's Pitch For New Business: Healthy, Lean Workers Cost Less
The cost of doing business may be lower in areas where there's a 'culture of health.' And that's put Colorado, which has the lowest rates of obesity in the nation, on the map for companies looking to relocate or expand. Kelly Brough is proud of this. She runs the Denver Metro Chamber of Commerce, and she's creative about luring businesses to relocate in Colorado. For instance, she runs a 'Colorado loves California' campaign (Whitney, 4/10).

Georgia Health News: Website Data For Some Ga. Hospitals Are Flat Wrong
One thousand, one hundred and fifteen minutes. That’s 18.5 hours. It’s not much time in the grand scheme of things. But it's a very long time for a person who arrives in an ER to have to wait before being sent home. The 1,115-minute figure is reported on a public federal website as the average time an emergency room patient waits at Archbold Medical Center in Thomasville before being sent home. The national average is just 140 minutes (Miller, 4/9).

The Lund Report: Bill Would Ban Pop And Junk Food In Public Vending Machines
 If you want to buy a Coke or a Snickers bar from a state Capitol vending machine, you’d better get yours while you can. If House Bill 3403 becomes law, those and other products like fatty potato chips or whole milk would be off-limits at any vending machine in Oregon public buildings. … House Bill 3403 requires that all food and drinks sold in public vending machines meet strict specifications. Snacks may not be more than 200 calories and may contain no more than 35 percent of their calories from fat or sugar (Gray, 4/9). 

CT Mirror: For Better Mental Health Coverage, Help With The Paperwork
Talk to people involved the mental health system and it won't be long before you hear complaints about the difficulty of getting private insurance to pay for mental health services. Some advocates say the answer is to better enforce state and federal laws requiring equal coverage for mental health and medical services. Some clinicians and lawmakers want the state to take over insurance coverage for mental health care, billing insurance carriers for the cost (Becker, 4/9).

Philadelphia Inquirer: IBC To Sell Percentage Of Insurance Subsidiary To Cooper
Independence Blue Cross has agreed to sell a 20 percent stake in its New Jersey health insurance subsidiary, AmeriHealth New Jersey, to Cooper University Health Care, of Camden, the organizations plan to announce Wednesday. The deal, which requires regulatory approval, is part of a trend toward increased integration of hospitals and insurers in preparation for a shift to a system that pays providers lump sums for all care needed by an individual rather than for each discrete visit and treatment (Brubaker, 4/10).

Arizona Republic: Human Side Of Arizona Debate Over Medicaid
John Froneberger has been without medication to treat his depression and high blood pressure since last fall, when a cost-of-living increase in his disability benefit, to $970 a month, put him just above the poverty level and cost him his health insurance. Froneberger’s monthly disability check helps pay for rent and food, but, as with hundreds of other Arizonans, it disqualifies him from the Arizona Health Care Cost Containment System, the state’s Medicaid program (Reinhart, 4/9). 

Boston Globe: Quincy Medical Center, Nurses Far Apart As Strike Nears
Quincy Medical Center nurses sat in a sea of blue in the basement of a Quincy church Tuesday morning, as they aired their grievances in a dispute that centers on staffing levels. The public event came a day after unsuccessful negotiations between the Massachusetts Nurses Association and hospital officials to call off a one-day nurses strike that is scheduled for Thursday (Bartlett, 4/10).

California Healthline: Physician Assistant Bill Clears First Hurdle
The Senate Committee on Business and Professions approved SB 352 by Sen. Fran Pavley (D-Agoura Hills), a bill designed to allow physician assistants and other providers to oversee work by medical assistants. … Pavley made it a point to say the bill doesn't change what medical assistants are allowed to do, or even what physician assistants or nurse practitioners are allowed to do (Gorn, 4/9).

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Editorials and Opinions

Viewpoints: Obama Budget Doesn't Address 'Heart Of Our Debt Crisis;' Attention Deficit Crisis; Insurer Sings A Different Song When Consumer Owes It Money

Politico: Obama Budget Likely To Play Same Old Song
The U.S. has huge budget challenges. And for the first time in years, we will have three budget proposals to carefully consider -- instead of speeches and talking points. Thus, the House, the Senate and the White House will all have plans on paper from which one could hope a serious grand bargain on the debt might emerge. For that to happen, the president's budget will have to be chock-full of detailed and serious entitlement reform proposals, tax reform specifics and mechanisms to enforce an agreement to keep the debt on a declining trajectory. Unfortunately, the administration's pre-release spin notwithstanding, that is too far a break from history to bet on. Instead, look for a spending-heavy, gimmick-laden budget proposal that never balances and refuses to get to the heart of our debt crisis (Douglas Holtz-Eakin, 4/9).

Tampa Bay Times: For A Responsible Budget, Both Sides Must Give
Finding a solution to America's deficit and budget impasse will take compromise on all sides. Neither tax increases nor budget cuts alone can solve the nation's fiscal problems. ... Under the plan, Obama bucks his own party and takes a big step toward meeting Republican demands on entitlement cuts to Medicare and Social Security. In exchange, he's proposing higher taxes on the wealthiest Americans. The president would cut about $400 billion from health care programs and $200 billion from domestic areas. The cutbacks to health care would be targeted largely to providers and pharmaceutical companies, though the president's plan does increase Medicare coverage costs for higher-income beneficiaries (4/9).

Los Angeles Times: Can Obama Sell 'Chained CPI'?
President Obama won't release his proposed budget for 2014 until Wednesday, but liberals and AARP have been howling all week about something they expect to be in it. What has our president done to provoke such outrage among his supporters? He's chained CPI (Doyle McManus, 4/10).

Bloomberg: Chained CPI's Diminishing Returns for U.S. Budget
The measure, called the chained consumer price index, would lower the annual payment increases for Social Security beneficiaries, saving the government money as it lowers the future monthly income of retirees and disabled Americans. The change would also raise revenue over time because it would cause more taxpayers to wind up in higher marginal brackets. What neither side seems to have noticed, however, is that the difference between the chained CPI and the standard CPI has been diminishing. That means the impact of switching indexes may not be as great as many assume. The change may still be a good idea, but it probably won’t matter as much as expected (Peter Orszag, 4/7). 

National Journal: GOP Health Experts Agree: Don't Count On 'Obamacare' To Fail
Is the Obama administration totally bungling implementation of its signature universal health care law? Is the law destined to collapse of its own weight? Or is that wishful conservative thinking? The administration gets some surprising backup from top health officials from two Republican administrations. Gail Wilensky and Tom Scully, who ran the Medicare and Medicaid programs in the early 1990s and in the 2000s, respectively, separately told National Journal Daily that the Obama White House is doing better than they expected in putting the complex law into place (Jill Lawrence, 4/8).

The New York Times: Worry Over Attention Deficit Cases
It is hard not to be concerned about the large number of children who have been given a diagnosis of attention deficit hyperactivity disorder, a condition that impairs the ability to focus on a task or to control impulses. A new analysis of government data found that almost one in five boys of high school age in the United States and 11 percent of school-age children over all had been reported to have the disorder at some point in their lives. The troubling question is whether they had or still have A.D.H.D. that actually needs treatment with potent drugs (4/9).

Los Angeles Times: 3 Million Californians Could Receive Health Insurance Subsidies
Some Republicans still cling to the hope that they'll be able to repeal Obamacare someday, but a report released Wednesday by Families USA shows why it may be even harder for them to do so after Jan. 1. The report estimates that nearly 3 million Californians could be eligible for generous insurance subsidies under the 2010 healthcare reform law, starting next year. Anyone with an income between one and four times the federal poverty line -- in other words, between $23,550 and $94,200 for a family of four -- could receive a tax credit that reduces monthly premiums dramatically (Jon Healey, 4/9).

Los Angeles Times: Blue Shield Quick To Demand Action From Policyholder Over Its Mistake
Health insurers don't exactly enjoy a reputation for timely payouts when people submit claims. They've been known to make policyholders jump through all sorts of hoops before coming across with a little cash. But when you owe them money, that's another story (David Lazarus, 4/9).

Des Moines Register: Judge's 'Morning After' Ruling Is The Right One
A federal judge in New York has done what President Barack Obama’s administration refused to do: help young women prevent unplanned pregnancies. U.S. District Judge Edward Korman ordered the U.S. Food and Drug Administration to make Plan B emergency contraception, also known as the "morning after pill," available without a prescription to women and girls of all ages within 30 days. The judge’s ruling rights the wrong-headed action taken in 2011 by U.S. Health and Human Services Secretary Kathleen Sebelius when she blocked over-the-counter availability of Plan B. Rather than appealing the ruling, the Obama administration should let the judge’s order stand (4/9). 

Des Moines Register: Please Drop This Political Fight, Governor
For a lot of low-income people, Medicaid, the government-funded health care program, is a lifeline. To Gov. Terry Branstad, it's one big political headache. ... if the federal government and Iowa Legislature approve his request to substitute his own plan, how does he rationalize to Iowa taxpayers that it will cost them more, yet provide less coverage to fewer people? One approach to the pickle he’s in is to slip his inferior plan quietly into the Iowa House on a Thursday afternoon when most lawmakers have gone home for the weekend, and then leave the country soon after, with little comment. Branstad chose that one (Rekha Basu, 4/9).

Des Moines Register: Health Bill Also Needs Governor's Attention
Legislative leaders of both parties have not ruled out a special session if needed to resolve the Medicaid issue before nearly 70,000 IowaCare recipients lose their coverage on Dec. 31. Whether this debate happens now or later, it’s going to take more than drive-by leadership from the governor to resolve (Kathie Obradovich, 4/9).

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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.