Daily Health Policy Report

Thursday, April 12, 2012

Last updated: Thu, Apr 12

KHN Original Reporting & Guest Opinion

Campaign 2012

Health Reform

Health Care Marketplace

Health Information Technology

Public Health & Education

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Q & A: Navigating Options For Long-Term Care (Video)

This Kaiser Health News video  discusses the many restrictions on purchasing long-term care insurance. KHN’s consumer columnist Michelle Andrews answers a reader question about other options (4/11). Watch the video.

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Capsules: Planned Parenthood Sues Texas Over Defunding; Fast Food's Slow Exit From Hospitals

Now on Kaiser Health News' blog, KUHF's Carrie Feibel, working in collaboration with Kaiser Health News and NPR, reports: "Planned Parenthood branches across Texas have filed a federal lawsuit to prevent Gov. Rick Perry's administration from excluding them from a women's health program. A month ago, Texas was dropped from a federal program that helps subsidize contraception and reproductive check-ups for poor women. Even though the program has nothing to do with abortion, Perry wanted to exclude Planned Parenthood affiliates from participating" (Feibel, 4/11).

Also on the blog, KCUR's Elana Gordon, also in partnership with Kaiser Health News and NPR, reports: "But times have changed, and now other hospitals interested in replacing fast food with more healthful options may find it isn’t as easy as it seems. In Ohio, the Cleveland Clinic tried in vain to terminate its contract early with McDonald's 10 years ago. At the time, the clinic’s lead heart surgeon (and now hospital CEO), Delos Cosgove, proposed removing all fast food vendors" (4/12).
Check out what else is on the blog.

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Political Cartoon: 'Pick-Up Line?'

Kaiser Health News provides a fresh take on health policy developments with "Pick-Up Line?" by Joel Pett.

Meanwhile, here's today's health policy haiku:


Key to improved health
Leverage, focus, align
Local resources
-Desiree de la Torre

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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Campaign 2012

Anniversary Of Mass. Health Law Puts Romney In The Hot Seat

Politics swirled around events designed to mark the sixth anniversary of the state's health reforms -- with a focus on GOP presidential hopeful Mitt Romney, who signed the measure when he was governor and is now campaigning against the federal health law, which includes many similar provisions.  

The Wall Street Journal's Washington Wire: Romney Faces Heat On Birthday Of Massachusetts Health Law
The state's Democratic governor on Wednesday celebrated the sixth birthday of the Massachusetts health-care law — and took some jabs at its creator, Republican presidential contender Mitt Romney. The ceremony at historic Faneuil Hall was in the spot where Mr. Romney signed the legislation into law in April 2006 when he was governor of the state. He has promised to repeal the national version of the legislation. … Mr. Romney has said that he believes the federal requirement to do this is unconstitutional (Levitz and Radnofsky, 4/11).

The New York Times: Massachusetts Health Law Is Celebrated, With A Poke At Romney
Former Gov. Mitt Romney, needless to say, did not attend. But at a sixth-anniversary celebration of Massachusetts' landmark health care law on Wednesday, Gov. Deval Patrick, a Democrat, pointedly said his predecessor should be proud of the law, which has been a hot potato for Mr. Romney on the Republican presidential campaign trail (Goodnough, 4/11).

Politico: Romney's Health Care Law Gets Awkward Birthday Party
Massachusetts Gov. Deval Patrick marked the state's landmark health care reform law Wednesday with a ceremony at Faneuil Hall — the same place where Mitt Romney signed the bill almost six years ago, long before the state's reform became the model for the federal reform reviled by conservatives. The actual anniversary is Thursday (Millman, 4/11).

WBUR's CommonHealth blog: Faneuil Hall Celebration Of Mass. Health Reform Turning Six
But not everyone at the ceremony was willing to give Romney so much credit. Former Senate President Robert Travaglini said it was the Senate that pushed for reform. "Romney had the political skills and sense to realize that there was a potential victory here, and at the time, he was looking for victories as evidence of his success in a blue state," said Travaglini. Travaglini said Romney was not the driving force or even a leader in getting the Massachusetts health care law passed (Thys, 4/11). 

CNN: Obama Campaign Salutes Anniversary Of Romney's Health Care Law
Maybe you've heard the president's top aides call Mitt Romney the "godfather" of the Obama health care law? Now the Obama campaign is out with a web video that drives home the message. "I helped Gov. Romney develop his health care reform or Romneycare, before going down to Washington to help President Obama develop his national version of that law," says Jonathan Gruber a bright eyed MIT Health Consultant featured prominently in the video. The spot includes old footage of Romney thanking Gruber for his work on the Massachusetts health bill. Gruber's verdict: "The core of the Affordable Care Act or Obamacare and what we did in Massachusetts are identical" (4/12).

ABC: On 'RomneyCare' Birthday Video Traces Ties To 'ObamaCare'
The Obama campaign is marking the six-year anniversary of Mitt Romney's Massachusetts health care law with a new mini-documentary that traces its path from "model for the nation" to Republicans' enemy number one. The three-minute video features key figures who helped craft "Romneycare" and appeared in public with then-Gov. Romney as he heralded passage of the landmark law in 2006 (Dwyer, 4/12).

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Romney Says He'll Dismantle Health Law Day 1 At The White House -- Will That Help Him Win Over The Right?

On the Democratic side, Vice President Joe Biden takes on Romney, while news outlets offer fact checks and reports of health policy sparring on the congressional campaign trail.   

The Washington Post: Romney's Ambitious Agenda For First Day In Office Wouldn't Be Easy To Achieve
It’s Jan. 20, 2013. This is the agenda for President Romney's first day in office: … Allow states to escape parts of the health-care law (if it still exists). … A big list for day one (or two or three) is something of a campaign tradition, a way to underline your priorities and show where your predecessor went astray (Fahrenthold, 4/11).

Politico Pro: 4 Ways Romney Can Win The Right On Reform
Conservatives may be willing to forgive Gov. Mitt Romney for enacting the Massachusetts health care reform law, but some still need convincing that he's serious about repealing President Barack Obama's law if he becomes president. Rick Santorum’s withdrawal from the race Tuesday made it all but official that the nominee of the Republican Party will be the man whose health care reform law directly inspired Obama's. So several prominent conservatives say Romney needs to continue to make his case that he'll do all he can to repeal, or at least disrupt, the law they call "Obamacare" (Haberkorn, 4/12).

The Associated Press: As Race Shifts, Biden Gets Task Of Scuffing Romney
Want a peek inside the Democratic playbook as the presidential race shifts fully into general election mode? Just listen to Joe Biden. In the past few weeks, the Democratic vice president has branded presumptive GOP nominee Mitt Romney "consistently wrong," ''uninformed" on foreign policy, someone aiming to "end Medicare as we know it" and an advocate of the wealthy at the expense of the middle class (Bakst, 4/11).

The Washington Post: The Fact Checker: 'Obamacare' Or The GOP: Which Would Throw Granny Off A Cliff?
This ad parodies a previous video from The Agenda Project, which ran a similar spot suggesting that Republicans were trying to end Medicare and privatize it with a proposal from House Budget Committee Chairman Paul Ryan (R-Wis.). Our colleagues at FlackCheck.org ran a film-noir parody covering both of these commercials (Hicks, 4/11).

The Hill: Kentucky Democrat Challenges McConnell Over Health Law Claims
Democratic Kentucky Rep. John Yarmuth offered a rare and detailed point-by-point rebuttal to a newspaper column Senate Minority Leader Mitch McConnell (R-Ky.) penned for the congressman's hometown newspaper. The March 22 op-ed in the Louisville Courier-Journal blames Democrats' healthcare reform law for increasing premiums for the "average family" by $2,100, among other claims. Yarmuth, who voted for the law, offers detailed criticism of McConnell's figures and conclusions and goes on to say Republican "distortions and misinformation" about the law have put people and businesses at a disadvantage (Pecquet, 4/11).

Democratic leaders talk health care to high school students and senior citizens -

Des Moines Register: What The No. 2 Democrat In Congress Taught An Iowa High School Class Today
"What we've said is the same thing Gov. Romney said in Massachusetts. We've got to have everybody participate," [Steny] Hoyer told reporters after class was dismissed. He said everyone in the country needs affordable access to health care, and that need won't go away if the U.S. Supreme Court strikes down the law (Jacobs, 4/11).

Milwaukee Journal Sentinel: Health Secretary Makes Pitch For Affordable Care Act
Secretary of Health and Human Services Kathleen Sebelius was in Milwaukee on Wednesday to draw attention to provisions in health care reform that benefit a key constituency: The 49 million people, including 650,000 in Wisconsin, covered by Medicare. The event, held at the Washington Park Senior Center, 4420 W. Vliet St., shows one of the challenges facing the Obama administration: Two years after the Affordable Care Act was passed, the administration is holding events to explain relatively basic and minor provisions in the law (Boulton, 4/11).

And, the Washington Post details the 2012 campaign's "great moral debate" -

The Washington Post: 'Buffet Rule' Vs. Ryan Plan: Who Should Chip In More
The great moral debate of the 2012 campaign is turning out to be as inspiring as drunks arguing over a bar tab. The basic argument is this: "Who's not paying their fair share?" Democrats have pointed the finger at millionaires, and this week, President Obama is pushing, again, for the "Buffett Rule". ... Republicans have turned to people who use Medicare and Medicaid. A new proposal from GOP budget guru Rep. Paul Ryan (Wis.), praised by presidential- nominee-to-be Mitt Romney, would shrink the government spending on these programs (Fahrenthold and Nakamura, 4/11).

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Health Reform

ACOs, IRS Roles In Health Reform Implementation Grab Headlines

Subscription websites report on recent developments related to the health law.

Politico Pro: Consultants Wait For Word On ACA's Future
The inside joke among lobbyists as the health care law took shape was that it was so big and so sprawling, it would provide enough work for all of them for years to come. It became known as the "Full Employment Act." Now, it's not looking like such a sure thing anymore. The Supreme Court this summer will decide how much of the law can stay intact. And what the court leaves behind could be subject to the outcome of the general election (DoBias, 4/12).

Modern Healthcare: Lawmakers Ask About HHS Funds Going To IRS
Concerned that the Internal Revenue Service may be receiving additional funding from HHS to implement the healthcare reform law, two House lawmakers have asked the federal agency to answer a series of questions by the month's end. House Ways and Means Committee Chairman Dave Camp (R-Mich.) and Rep. Charles Boustany (R-La.), a physician who serves as chairman of the tax panel's oversight subcommittee, sent a letter to IRS Commissioner Douglas Shulman asking if the IRS intends to seek additional funds from HHS to implement the Patient Protection and Affordable Care Act (Zigmond, 4/11).

Modern Healthcare: AMA, AHA Weigh In On Shared-Savings ACOs
The American Medical Association applauded physicians' leading role in many of the 27 healthcare organizations designated as the first Medicare Shared Savings Program accountable care organizations, while the American Hospital Association expressed support for accountable care's expansion. The AMA, in a news release, praised the fact that more than half of the first Medicare Shared Savings ACOs are being led by physicians and said that this bodes well for long-term physician interest and participation in the program (Robeznieks, 4/11).

Related, earlier KHN story: ACOs Multiply As Medicare Announces 27 New Ones (Gold and Torres, 4/10)

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Health Care Marketplace

J&J Fined $1.2B For Hiding Anti-Psychotic Drug Dangers, Deceptive Marketing

An Arkansas judge fined the drug maker and a subsidiary for misleading doctors and the public on the risks involved with taking an anti-psychotic drug, Risperdal, and for marketing the drug for an off-label use to the state's Medicaid system.

The New York Times: J&J Fined $1.2 Billion In Drug Case
A judge in Arkansas ordered Johnson & Johnson and a subsidiary to pay more than $1.2 billion in fines on Wednesday, a day after a jury found that the companies had minimized or concealed the dangers associated with an antipsychotic drug (Thomas, 4/11).

Los Angeles Times: Companies Belittled Risks Of Risperdal, Slapped With Huge Fine
In a verbal ruling from the bench, Circuit Judge Tim Fox held that Johnson & Johnson and its subsidiary Janssen Pharmaceuticals Inc. committed nearly 240,000 violations of the state's Medicaid fraud law -- one for each Risperdal prescription issued to state Medicaid patients over a 3 1/2-year period. Each violation carried a $5,000 fine. He also fined the companies $11 million for more than 4,500 violations of the state's deceptive practices laws (Muskal, 4/11).

The Associated Press/Los Angeles Times: Arkansas Judge Fines J&J $1.1 Billion In Risperdal Case
Atty. Gen. Dustin McDaniel said the ruling "sends a clear signal that big drug companies like Johnson & Johnson and Janssen Pharmaceuticals cannot lie to the (U.S. Food and Drug Administration), patients and doctors in order to defraud Arkansas taxpayers of our Medicaid dollars." Janssen issued a statement in which it said, "We are disappointed with the judge's decision on penalties. If our motion for a new trial is denied, we will appeal" (4/11).

The Wall Street Journal: Judge Orders J&J To Pay $1.2 Billion
The Arkansas penalty is the largest to date in a series of state legal cases accusing J&J of improperly marketing Risperdal, which was once J&J's top-selling drug before generic copycats hit the market (Loftus, 4/11).

Bloomberg: J&J Ordered To Pay $1.1 Billion Penalty Over Risperdal
Along with contending that J&J and Janssen defrauded the Medicaid program by failing to properly outline the antipsychotic medicine’s risks, Arkansas officials alleged J&J officials deceptively marketed the drug as safer and better than competing medicines. The state also argued the companies marketed the drug for "unapproved uses, including various symptoms in children and the elderly" after being warned by federal authorities to halt such sales (Francis, Feeley and Voreacos, 4/12).

Reuters: J&J Hit With $1.1 Billion Risperdal Penalty In Arkansas
Arkansas sued the diversified health care company, saying it had deceived thousands of doctors in the state by touting the one-time blockbuster medicine as better and safer than rival therapies and marketing it for unapproved uses in children and the elderly. The state alleged the company had caused its Medicaid insurance program for the poor to greatly overpay for Risperdal (4/11).

The Philadelphia Inquirer: J&J Unit Fined $1.1 Billion-Plus In Risperdal Case
The award, if upheld on appeal, could reverberate through the many courts in which J&J is fighting lawsuits about the drug, which was approved only for schizophrenia and bipolar mania but was prescribed for other ailments (Sell, 4/12).

Earlier, related KHN coverage: Off-Label Use Of Risky Antipsychotic Drugs Raises Concerns.

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Survey: Health Insurance Cost Growth Outpaces Everything Else

But the rate of increase was less than 10 percent for the first time since 2001.

Des Moines Register: Survey: Health Insurance Costs Still Outpace Everything Else, But Slowing Slightly
Costs for all types of medical plans are expected to increase by 9.9 percent in 2012, according to a survey by Buck Consultants, a division of Xerox. This is the first time since 2001 that the survey has projected cost increases less than 10 percent for any type of plan, so a 9.9 percent increase can almost be seen as a victory. Employers are looking for ways to cut the rising cost of health insurance. Buck has been conducting its survey since 1999 (Belz, 4/11).

The Hill: Survey: Growth In Health Costs Is Slowing
Healthcare costs aren’t growing quite as rapidly as they have in the past, according to new research from Buck Consultants. The study predicts that health insurance costs will rise this year by less than 10 percent — the first time growth has been that low in more than a decade. The findings could undermine Republicans' argument that President Obama’s healthcare law is driving costs higher (Baker, 4/11).

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The Practice Of Medicine: What Does The Future Hold?

Reuters reports on a survey of physician attitudes about how the health law might change their profession. Meanwhile, in California, family physicians are targeting young people in efforts to recruit future doctors.

Reuters: Next Generation Of Doctors Sees Gloomy Future
A majority of young doctors feel pessimistic about the future of the U.S. health care system, with the new health care law cited as the main reason, according to a survey released to Reuters on Wednesday. Nearly half of the 500 doctors surveyed think the Affordable Care Act, President Barack Obama's signature domestic policy achievement, will have a negative effect on their practices, compared with 23 percent who think it will be positive (Yukhananov, 4/11).

The Sacramento Bee: Family Doctors Try To Recruit Sacramento Teens To Profession
The Future Faces of Family Medicine (is) a program started last school year by family medicine residents at UC Davis and Sutter Health, along with the California Academy of Family Physicians, to recruit more youths -- especially those from low-income and ethnic minority backgrounds -- into their often-unsung profession. California and the United States face a shortage of primary care doctors that threatens to get worse. The CAFP expects as many as 30 percent of California family physicians to retire within the next few years, and for the state's deficit to reach 17,000 doctors by 2015 (Rubenstein, 4/12).

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Health Information Technology

Entrepreneurs Dig Into Health IT

The New York Times: Vital Signs By Phone, Then, With A Click, A Doctor's Appointment
If ever an industry were ready for disruption, it is the American health care industry. Americans spend about $7,600 a year per person on health care, one in two adults lives with a chronic disease and the average wait time to see a doctor in a metropolitan area is 20 days. Entrepreneurs have responded by starting health care technology companies that are changing the way we interact with the entire system (Zimmerman, 4/11).

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Public Health & Education

Hospitals Feel Pressure To Part Ways With Fast Food

News outlets report on how a corporate watchdog group is pressing a Minneapolis hospital to get rid of its on-site McDonald's while a Kansas City, Mo., hospital is also working in this direction.

Minnesota Public Radio: Corporate Watchdog Group: Get Rid Of Hospital McDonald's Restaurants
Abbott Northwestern Hospital in Minneapolis is one of 22 hospitals across the country being asked to get rid of its McDonald's restaurant. ... Abbott has had a McDonald's since 1990 and is open 24 hours a day, seven days a week. When the hospital contracted with McDonald's, it was the only vendor willing to negotiate a menu with healthier options, said Abbott Northwestern spokeswoman Gloria O'Connell. O'Connell said Abbott has a long-term agreement with McDonald's that has a costly buy-out option (Dunbar, 4/11). 

Kaiser Health News: Capsules: Fast Food' Slow Exit From Hospitals
On one side of a wall inside the Truman Medical Center cafeteria in Kansas City, Mo., the menu features low-calorie, low-fat and low-sodium meals. On the other side of the wall is a McDonald's, featuring hamburgers and french fries. The pairing is a sore point for hospital CEO John Bluford who, as chair last year of the American Hospital Association, issued a call to action urging hospitals to eliminate unhealthy food in cafeterias as one way to create a culture of wellness (Gordon, 4/12).

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State Watch

Planned Parenthood Sues Texas After Exclusion From Women's Health Program

In March, Texas dropped its state Medicaid funding for Planned Parenthood because the organization provides abortion services.

The Associated Press: Planned Parenthood Sues Texas Over Exclusion
Eight Planned Parenthood organizations sued Texas on Wednesday for excluding them from participating in a program that provides contraception and check-ups to women, saying the new rule violates their constitutional rights to freedom of speech and association. The groups, none of which provide abortions, contend in the federal lawsuit that a new state law banning organizations affiliated with abortion providers from participating in the Women's Health Program has nothing to do with providing medical care (Tomlinson, 4/11).

Kaiser Health News: Capsules: Planned Parenthood Sues Texas Over Defunding
A month ago, Texas was dropped from a federal program that helps subsidize contraception and reproductive check-ups for poor women. Even though the program has nothing to do with abortion, [Gov. Rick] Perry wanted to exclude Planned Parenthood affiliates from participating (Feibel, 4/11).

Houston Chronicle: Planned Parenthood Sues Over Abortions Exclusion
The suit, filed in Austin, says Texas' exclusion of Planned Parenthood from the Medicaid Women's Health Program violates the organization's constitutional rights to freedom of speech and association. It asks the court to stop the rule from taking effect May 1 (Ackerman, 4/11).

The Dallas Morning News: Planned Parenthood Sues Texas For Cutting It From Women's Health Care
"They don't get to say everyone can be in this program as long as they give up their rights to free speech and freedom of association," said Pete Schenkkan, the Austin-based attorney for Planned Parenthood. State leaders defended their actions, saying the state should be allowed to set funding rules, including deciding which health providers are eligible (Hoppe, 4/11).

Politico Pro: Planned Parenthood Sues Texas Over Funding
After Texas moved forward with the rule, which blocks funding to clinics affiliated with abortion providers, CMS denied an extension of the state's Women's Health Program waiver in March, saying the state violated federal Medicaid laws and the waiver agreement by deciding which clinics could receive funding (Smith, 4/11).

The Hill: Planned Parenthood Sues Over Policy Cutting Off Medicaid Funds
It's just one in a series of state-level efforts to defund Planned Parenthood clinics because the organization provides abortions in addition to its other health care services (Baker, 4/11).

Reuters: Family Planning Group Sues Over Exclusion From Texas Program
Since the Texas Women's Health Program began in 2007, state law has technically banned its money from going to abortion providers or affiliates of abortion providers, but the state did not enforce the ban on affiliates. ... State officials say they want to continue the program - which is part of the Medicaid health program for the poor and disabled - and will work to extend federal funding or find a way to pay for it with state dollars. The federal government pays 90 percent of the $33-million-a-year program (MacLaggan, 4/11).

The Texas Tribune: Planned Parenthood Sues to Halt Exclusion From Program
In a conference call with reporters, Patricio Gonzales, the CEO of the Planned Parenthood Association of Hidalgo County, warned that his four remaining clinics along the border are at risk of shutting down by the end of May because half of their patients are Women's Health Program clients. The Hidalgo County Planned Parenthood group already closed four other clinics last September as a result of state family planning reductions (Ramshaw and Tan, 4/11). 

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Mass. Hospitals Mull Acquisition, Layoffs; Calif. Hospital Districts Questioned

In Massachusetts, Partners HealthCare is in talks to acquire South Shore hospital and Beth Israel Deaconess cuts jobs after an admissions dip. In California, lawmakers probe taxpayer-funded hospital districts and their stockpiling of cash.

Boston Globe: Partners In Talks To Acquire South Shore Hospital
Partners HealthCare System Inc. is in talks to acquire South Shore Hospital in Weymouth, one of the largest remaining independent hospitals in the Boston area, in a deal that would reshape the competitive landscape in the region's health care market, according to two health care professionals who have been briefed by the parties on the negotiations. The 318-bed regional hospital serves a swath of southeastern Massachusetts extending from Quincy to Taunton to Cape Cod (Weisman, 4/11).

Boston Globe: Beth Israel Deaconess Medical Center To Shed Jobs, Close Patient Unit
Responding to a "small dip"’ in patient admissions, Beth Israel Deaconess Medical Center has laid off 40 to 50 employees and closed a 24-bed unit, executives said. The hospital, which has about 9,000 employees, said in March that it planned to eliminate roughly 15 jobs, but that number has grown. Spokeswoman Judy Glasser said Wednesday that the layoffs "were across the board"’ and include nurses, patient transporters, and support staff (Kowalczyk, 4/11).

The Sacramento Bee: Dickinson Questions Whether California Hospital Districts Are Past Their Prime
After World War II, California lawmakers created taxpayer-funded hospital districts to serve rural and poor regions, particularly as soldiers required medical care at home. Some of California's remaining 73 districts still treat residents who would otherwise go without medical services. … In a Wednesday hearing, Assembly members questioned whether health care districts remain the best use of scarce tax dollars in a post-recession world (Yamamura, 4/12).

California Watch/The Bay Citizen: State Lawmakers Question Health Districts' Spending
Taxpayer-funded health care districts should reduce their administrative costs, spend more on public health programs and stop stockpiling money for dubious projects, critics told a state legislative oversight committee today. Public health officials and taxpayer groups urged lawmakers to demand more accountability from the roughly 30 health care districts in California that no longer run hospitals, in a departure from their original mission (Gollan and Mieszkowski, 4/11). 

In the meantime, St. Jude answers critics after reports of problems with some of their implanted heart devices --

The New York Times: At St. Jude, Firing Back At Critics
As St. Jude Medical defends itself against reports of deaths and injuries linked to problems with an implanted heart device, it finds itself in familiar territory. Since 2005, two competitors, Medtronic and Guidant, have faced similar scrutiny about critical flaws in their products (Meier and Thomas, 4/11).

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State Roundup: No New Policies From Cross-Border Insurance Law

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

Georgia Health News: Out-Of-State Insurance Law Does Nothing Yet
Proponents said these out-of-state policies, stripped of Georgia's mandates, would have lower premiums – and allow more people to afford individual health insurance coverage. ... But a year later, nothing has happened. No insurer here has started selling a non-Georgia health plan. ... Experts speculate that health insurers, here and elsewhere, have their focus squarely on the pending Supreme Court decision on the 2010 federal health care (Miller, 4/11). 

The Associated Press/Wall Street Journal: NY Auditors Cite Medical Insurance Overpayments
State auditors say the New York State Health Insurance Program erroneously paid up to $11 million for special items like implants, drugs and evaluation procedures for public employees ... contract insurers Blue Cross and Blue Shield and United Health Care failed to effectively monitor bills (4/11).

Boston Globe: Mass. To Save $91M In Health Insurance Costs
Massachusetts will save approximately $91 million -- and thousands of residents who receive state-subsidized health insurance will keep the same benefits with no co-payment increases -- thanks to renegotiated contracts with insurers, regulators announced Wednesday. ... Commonwealth Care is the Health Connector’s health insurance program for uninsured adults who meet income and other eligibility requirements (Lazar, 4/12).

Boston Globe: Health Advocates Say New Fund Needed To Improve Public Health In Massachusetts
A coalition of Massachusetts health advocates and civic leaders is lobbying for a new pool of money, possibly funded by a tax on insurers, that would pay for programs to stem preventable illnesses such as diabetes, asthma, and heart disease that are fueling medical costs. Under the plan, insurers would be assessed a tax on what they now pay each year to cover the hospital bills of their subscribers (Lazar, 4/12).

The Dallas Morning News: Texas Board Says It's Falling Short In Regulating Bad Dentists
The agency that polices Texas dentists told lawmakers Wednesday that it doesn’t have enough resources or legal authority to crack down on careless and abusive dentists. An advocacy group led the charge against the Texas State Board of Dental Examiners, telling a legislative panel that the regulatory board doesn’t do enough to discipline bad dentists or alert the public which dentists have been sanctioned (Ingram, 4/11).

The Texas Tribune: Texas Dental Board Is Accused Of Ineptitude
The clinics in question often serve only Medicaid patients and pay one dentist to act as a prop by claiming ownership. The real owners of the clinics — usually private equity firms — are in the dental business for profit, and encourage overutilization of Medicaid services by dictating a “one-size-fits-all treatment plan” or setting quotas for the number of procedures that dentists should perform, said [the Texas Dental Association's Richard] Black (Aaronson, 4/12). 

Stateline: Computer Matching System Could Limit Safety Net 'Double Dipping'
States could cut costs by millions of dollars a year if they took full advantage of a computerized matching system that can determine whether people are getting welfare, food stamps and other public assistance in more than one state at a time. ... The process, called Public Assistance Reporting Information System (PARIS), is a set of computer matches that relies on Social Security numbers and other personal data. ... New York, for example, saved an estimated $65 million in 2011 by removing more than 12,000 people from its welfare and food stamps programs, based on PARIS matches (Prah, 4/12).

Earlier, related KHN coverage: Different Takes: Shifting Vets From Medicaid To The VA Is A Win-Win (11/9/11).  

St. Louis Beacon: Insurance Consortium Keeps Costs Down For County Municipalities
While competition, usually for shopping centers, may grab the headlines, the 90 municipalities of St. Louis County actually cooperate in many ways, some of which are largely invisible to residents. ... the St. Louis Area Insurance Trust may be one of the most important ways cities have come together to help each other. ... Although Missouri has its own insurance purchasing pool, founding members felt that their needs would be better served by joining forces with similar cities (Davidson, 4/11).

Kansas Health Institute News: KanCare Bidder Settles With U.S. Justice Department
A company that is among the five bidding on the state's Medicaid managed care contract has agreed to pay $137.5 million to settle claims it defrauded Medicaid programs in nine states. The U.S. Department of Justice announced the settlement with WellCare Health Plans Inc. last week. ... WellCare officials said the settlement wiped the slate clean for the company (Ranney, 4/11). 

California Healthline: 'It Can Be Costly To Treat CCS Kids'
Assembly member Cathleen Galgiani (D-Tracy) is well aware of the budget crisis in California. But she's also aware of another crisis in children's hospitals, she said. "It can be costly to treat CCS (California Children's Services) kids," Galgiani said. "All we're asking is for the state to use the CMAC rate for reimbursement. This bill would clarify that rate." The CMAC rate is a hospital rate of reimbursement negotiated by the California Medical Assistance Commission. It was the standard for reimbursement before last year's cuts (Gorn, 4/12). 

Los Angeles Times: California Workers' Comp Overhaul Effort Is Stirring
The two biggest players in California's workers' compensation system — labor unions and large employers — are quietly crafting the biggest overhaul of the mandatory insurance program in a decade. The goal: provide more care to injured workers without raising premiums for businesses (Lifsher, 4/12).

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Weekend Reading

Longer Looks: Diagnosing Autism In Minutes; Finding New Uses For Old Drugs

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

Time: Can Autism Really Be Diagnosed In Minutes?
Autism is an extremely complex diagnosis. Parental insight, physician observations and hours of data can factor into determining whether a child actually has the condition or is just a little on the quirky side. Now a Harvard researcher, Dennis P. Wall, has published research about a Web-based tool he developed that promises to diagnose autism in minutes, not hours — a proposition that Wall has floated for some time now and has some autism experts so skeptical they’re not even willing to speak on the record about it. Wall, director of the computational biology initiative at the Center for Biomedical Informatics at Harvard Medical School and associate professor of pathology at the school, combines computer algorithms along with a seven-point parent questionnaire and a home video clip to make a speedy online assessment of whether a child has autism (Bonnie Rochman, 4/11).

The Atlantic: Teaching Old Drugs New Tricks
Even as the medical world makes great advances in drug testing, development cycles can still take years, if not decades. In the case of cystic fibrosis, for instance, scientists were able to detect the disease's molecular cause by as early as 1989 -- but it's taken nearly three decades to push a drug to market. Could there be a faster way to cures? If NIH director Francis Collins has his way -- perhaps. By studying the human genome and noticing similarities among the molecular effects of certain diseases, Collins believes pharmaceuticals designed to target one affliction can have surprisingly positive effects on other illnesses. We just need to match the right drugs with the right diseases (Brian Fung, 4/11).

The New Yorker: Club Med
This year, a few hundred thousand intrepid American travellers will head to places like Thailand and Costa Rica, in search of something that they can't find in the United States. They won't be looking for Mayan ruins or ancient Buddhist temples, but something a bit more practical: affordable medical care. These medical tourists will be getting root canals, knee surgeries, and hip replacements at foreign hospitals. If health-care costs in the U.S. keep rising—and especially if Obamacare is overturned by the Supreme Court—more of us may soon be joining them. For decades, wealthy people from developing countries have come here for care, but these days medical tourists travel all over the world. And while it's hard to disentangle the stats from the hype—a number of countries portray themselves as favored destinations—it's clear that millions of people are now doing this. The Bumrungrad hospital, in Bangkok, treats four hundred thousand foreign patients annually. Malaysia had almost six hundred thousand medical tourists last year. And South Korea had more than a hundred thousand, nearly a third of them American. For Americans, the attraction is obvious: medical care is a lot cheaper abroad (James Surowiecki, 4/16).

American Medical News: California, Vermont Consider Tougher Vaccine-Exemption Rules
Recent outbreaks of vaccine-preventable diseases and a growing immunization opt-out rate are pushing physician organizations in California and Vermont to seek greater restrictions on exemptions from school-entry immunization requirements. Every state allows exemptions for children with medical contraindications verified by a physician, and all but two states let parents with religious objections skip immunizing their children. An additional 20 states allow exemptions based on parents' philosophical or personal beliefs. Requirements for securing personal-belief exemptions vary by state but are often as easy as signing a form (Kevin B. O’Reilly, 4/9).

AARP Magazine: The War On Cancer
In this era of pink ribbons and yellow Livestrong bracelets and a proliferation of races to cure cancer, it's easy to forget that just three or four decades ago, a cancer diagnosis was likely a death sentence. In the early 1970s, the five-year survival rate for all invasive cancers was a dismal 43 percent, and the treatments — disfiguring surgery, almost unbearably toxic chemotherapy, indiscriminate radiation — were so dreadful that many patients considered them worse than the disease. Today, the five-year survival rate for all cancers is 67 percent. Surgery, chemotherapy and radiation — still the triad of successful cancer treatment — are more precise, causing much less pain and disfigurement. But the real turning point for patients ... occurred in 1971, with the signing of the National Cancer Act (Tom Slear, April/May 2012).

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Editorials and Opinions

Viewpoints: Medicare May Be Unintended Victim Of Bank Crisis; Health Care Industry's Fears Of Law's Reversal

The New York Times: Economix: How The Banks Endangered Medicare
The banks' actions led directly to an increase in government debt, which in turn has made the reduction of that debt by "cutting runaway spending" a centerpiece of the Republican presidential campaign to date. As a result of this pressure, Medicare now stands on the brink of being eliminated as a viable form of social insurance. Yet the executives who lead these banks – and the politicians with whom they work closely – will not be held accountable this election season (Simon Johnson, 4/12).

The Wall Street Journal: Faust Visits The Insurance Lobby
Liberals are still reeling from the Supreme Court's oral arguments on ObamaCare, but they've got nothing on the health-care industry. Most of its biggest players backed the White House because they figured the individual mandate to buy insurance would give them a huge new customer base. Now they may get stuck with all the new regulations but without the mandate (4/11).

Fox Business: Health Insurers Should Stop Paying For Painkiller Abuse
The contents of the nation's medicine cabinets are likely impacting the cost of your health insurance. Back in 2007, the Coalition Against Insurance Fraud (CAIF), an alliance of consumer groups, insurance companies and government agencies, reported that misuse of prescription painkillers was costing health insurers more than $72.5 billion a year. ... Health insurance companies are aware of the problem and its staggering cost to all consumers, says Susan Pisano, spokesperson for America's Health Insurance Plans. "We strongly agree that prescription drug abuse is a concern, not only in terms of the extra burden on health care but most importantly in terms of patient safety," she says. Still, painkiller abuse poses a dilemma for health plans. Insurers aren't able to refuse to pay for valid prescriptions that are covered under a policy (Beth Orenstein, 4/11).

The Fiscal Times: The Health Cost That Can Ruin the Economy
There is no disease that needs health innovations more than Alzheimer's, a disease that is directly correlated with aging and it is already consuming one percent of global GDP.  Not only is the Alzheimer's trajectory fiscally unsustainable, but it's also immoral for us to address the tragic human suffering it creates only through better care. ... Without innovations to treat, prevent, and ultimately cure it, Alzheimer's is, according to Dr. Peter Piot, former head of UNAIDS, a global "time bomb". ... it is time for our presidential candidates to also get serious and honest  about health policy fit for this century's demographics truths (Michael Hodin, 4/11).

Chicago Sun-Times: How To Keep Teen Birth Rates Low
The best national news story of the week might be this: Teen births are at their lowest level in almost 70 years. … sexually active teens finally are getting the message that being a mom at so young an age is a terrible idea, and so they are using contraception more. Equally important, contraceptives are more easily available, prescribed more readily, often even provided at school-based clinics (4/11).

Forbes: ACOs, Accountable Care To Flourish No Matter What Supreme Court Says On Obama Health Law
No matter what happens to President Obama's health care law sitting before the Supreme Court, fee-for-service medicine may still morph into a new model of health care delivery his administration is pushing that rewards doctors and hospitals for working together to improve quality. A key part of the Affordable Care Act launched this spring with the first groups of medical-care providers forming Accountable Care Organizations across the country (Bruce Japsen, 4/11).

Denver Post: Behavioral Health Care For Veterans
The March 11 civilian shootings in Afghanistan have brought to light the invisible scars of war that can plague members of the military. According to "The Status of Behavioral Health Care in Colorado," a report released by Advancing Colorado's Mental Health Care last December, more than 8,000 Coloradans have been deployed to Iraq or Afghanistan since September 11, 2001. With so many troops from our own communities stepping up to serve our country, we must step up to support them, too (George DelGrosso, 4/12).

Medscape Today: Exercise for Any Patient, Every Patient
Recent data from an American College of Sports Medicine survey suggest that nearly two thirds of patients would be more interested in being physically active if advised by their doctor to do so. Exercise is Medicine focuses on encouraging primary care physicians and other healthcare providers to include physical activity when designing treatment plans for patients and to routinely assess physical activity at every patient interaction (Jackie Epping, 4/9).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

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