Daily Health Policy Report

Friday, April 12, 2013

Last updated: Fri, Apr 12

KHN Original Reporting & Guest Opinion

Health Spending And Fiscal Battles

Health Reform

Capitol Hill Watch

Health Information Technology

Public Health & Education

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Is My Retiree Insurance Coverage Subject To The Health Law? (Video)

Kaiser Health News consumer columnist Michelle Andrews answers a reader's question about whether retiree health plans must comply with new rules under the ACA (4/12). Watch the video or read the transcript.

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Capsules: Wait For Obamacare Price Tags Could Be Months; Harkin Accuses Administration Of ‘Robbing Peter To Pay Paul’; Groups Seek To Fast-Track Efforts To Curb Costs, Boost Quality

Now on Kaiser Health News' blog, Jay Hancock reports on insurance rate disclosure: "Last week Vermont became the first state to provide a glimpse of how expensive individual health insurance might be under the Affordable Care Act. Proposed rates there, while of questionable relevance to the rest of the country because of the state’s unusual insurance market, showed little change from current prices and reassured health law supporters fearing headlines about 'sticker shock'" (Hancock, 4/12).

In addition, Jenny Gold reports on the latest plans for the health law's Prevention and Public Health Fund: "A Democratic senator chastised the White House Thursday for raiding the health law's Prevention and Public Health Fund to pay for a program to help the uninsured sign up for coverage in new insurance marketplaces. 'This is robbing Peter to pay Paul,' Sen. Tom Harkin, D-Iowa, chairman of the Senate Health, Education, Labor, and Pensions Committee, told a senior official at the Centers for Medicare & Medicaid Services" (Gold, 4/11).

Also on Capsules, Julie Appleby reports on a new set of recommendations regarding health costs and quality: "Five veteran health care leaders representing insurers, hospitals, employers and consumers on Thursday outlined an ambitious set of recommendations aimed at slowing rising costs, focused mainly on changing the way America pays for health care" (Appleby, 4/11). Check out what else is on the blog.

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Political Cartoon: 'Shovel-Ready?'

Kaiser Health News provides a fresh take on health policy developments with "Shovel-Ready?" by Lisa Benson.

Meanwhile, here is today's health policy haiku:

 

TO EVERYTHING THERE IS A SEASON 

Like cherry blossoms
Budget optimism blooms.
Wilt in summer heat?
-Anonymous

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

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Health Spending And Fiscal Battles

In The Wake Of Obama's Budget, Signs Of Optimism And Discontent

Even as House Budget Chairman Paul Ryan, R-Wis., expressed cautious optimism about some aspects of President Barack Obama's budget plan, others, like Rep. Greg Walden, R-Ore., took a harder line against it. Meanwhile, Health and Human Services Secretary Kathleen Sebelius will take to Capitol Hill to defend her agency's budget request.  

NPR: Ryan Says He's 'Cautiously Optimistic' On A Bipartisan Budget Deal
Speaking to NPR a day after President Obama unveiled a 2014 budget proposal that includes cuts to Social Security and Medicare, as well as tax increases and new investments in education and infrastructure, Ryan said he was encouraged by the broad outlines from the White House. "This is the first time in this presidency that I have seen a chance at a bipartisan budget agreement, so I am cautiously optimistic about that," Ryan said in the interview scheduled to be aired on Friday's Morning Edition (Neuman, 4/11).

National Journal: Changing Sides On Medicare And Social Security Is A Time-Honored Tactic
Republican Rep. Greg Walden's description of the White House budget as "a shocking attack on seniors" has set off another round of who's on first. It’s been hard to keep track of which party has the political advantage on Medicare and Social Security, and harder still to figure out where the GOP really stands. Walden, the chairman of the National Republican Congressional Committee, set out on his own path this week by going after President Obama's past Medicare cuts and a new spending blueprint that would charge wealthy people more for Medicare and reduce cost-of-living increases for future Social Security recipients by using a less-generous formula called "chained CPI" (Lawrence, 4/11).

The Hill: Sebelius Heads To Capitol Hill
Health and Human Services Secretary Kathleen Sebelius will head to Capitol Hill on Friday to defend her department's budget request — including $1.5 billion for exchanges that Congress is unlikely to provide. Sebelius is slated to testify before the Ways and Means Committee. It's the first time Sebelius has gone before lawmakers since acknowledging that some people will see their premiums rise because of the healthcare law — an admission that could provide fodder for Republican critics (Baker and Viebeck, 4/11).

CQ HealthBeat: GOP Lawmakers Propose Medicare Mixes
House Energy and Commerce Republicans on Thursday proposed seven ideas for modernizing and changing Medicare, several of which have been offered by members of both parties, economists and health care stakeholders. Although the ideas are not meant to constitute a comprehensive Medicare overhaul, the lawmakers said the "measured, short-term steps" could help improve the program (Ethridge, 4/12).

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Health Reform

Health Law Allows More Young Adults To Get Health Care - But With Cost Implications

A study by the Employee Benefit Research Institute offers insights regarding the impact of the health law's provision allowing young adults to stay on their parents' health plans.  

The Wall Street Journal's Washington Wire: Young Adults On Parents' Health Plans Cost More
Young adults who stayed on their parents' insurance plans under a popular provision in the federal health law incurred slightly higher health costs than young adults who had their own coverage, largely because they used more care for mental health, substance abuse and pregnancy, new research suggests (Radnofsky, 4/11).

Politico: ACA Allows More Young Adults To Get Treatment On Mental Health, Pregnancy
Millions of young adults with newfound coverage through the health care law are using it to meet a gaping need for mental health care and substance abuse treatment — and access pregnancy care, too. A new study from the Employee Benefit Research Institute looks at the experience of one large national employer to get a feel for how the Affordable Care Act’s rule allowing young adults to stay on their parents' plans up to age 26 is having an impact. Approximately 3.1 million young people nationwide have found coverage through this provision (Smith, 4/12).

Other coverage related to the health law's implementation -

WBUR: Here & Now: Sorting Out The Cost Of Obamacare (Audio)
Last month, the Society of Actuaries – the people who crunch statistics to come up with future predictions – released a study finding that insurance claims by individuals would soar 32 percent under the Affordable Care Act, commonly called Obamacare. That finding quickly turned into (inaccurate) headlines that premiums – the cost of individual insurance – would soar by 32 percent. Cost projections in the study vary widely from state to state (see infographic below). California’s costs are projected to go up 62 percent, while New York’s are expected to decrease by 10 percent (4/11).

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Health Exchange Cost Estimates Go Up

Meanwhile, uncertainty continues about the premium price tags consumers will pay if they purchase health insurance from these online marketplaces. Also, debate heats up about how the Obama administration hopes to offset the set-up costs.  

Politico: Cost Of Exchanges Shoots Up
The Obama administration's best guess of how much it will spend to subsidize insurance on Obamacare exchanges shot up substantially this year thanks in large part to the U.S. Supreme Court. But while the exchange costs rise, the Medicaid spending will probably be less than initially forecast as some states decline the expansion (Norman, 4/12).

Bloomberg: Obama Trims Details On Health Law As Exchange Cost Rises
The $1.3 trillion U.S. health-care system overhaul is getting more expensive and will initially accomplish less than intended. Costs for a network of health-insurance exchanges, a core part of the Affordable Care Act, have swelled to $4.4 billion for fiscal 2012 and 2013 combined, and will reach $5.7 billion in 2014, according to the budget President Barack Obama yesterday sent to Congress (Wayne, 4/12).

Kaiser Health News: Capsules: Wait For Obamacare Price Tags Could Be Months
Last week Vermont became the first state to provide a glimpse of how expensive individual health insurance might be under the Affordable Care Act. Proposed rates there, while of questionable relevance to the rest of the country because of the state’s unusual insurance market, showed little change from current prices and reassured health law supporters fearing headlines about "sticker shock" (Hancock, 4/12).

Kaiser Health News: Capsules: Harkin Accuses Administration Of 'Robbing Peter To Pay Paul'
A Democratic senator chastised the White House Thursday for raiding the health law's Prevention and Public Health Fund to pay for a program to help the uninsured sign up for coverage in new insurance marketplaces. "This is robbing Peter to pay Paul," Sen. Tom Harkin, D-Iowa, chairman of the Senate Health, Education, Labor, and Pensions Committee, told a senior official at the Centers for Medicare & Medicaid Services (Gold, 4/11).

Here's some health exchange news from Kansas and Massachusetts -

Kansas Health Institute: Kansas Share Of $54M In Grants To Help Consumers Find Insurance Capped At $600,000
Advocacy groups today learned that Kansas' share of a federal grant program meant to help more than 300,000 consumers navigate the state’s health insurance exchanges has been capped at $600,000…Federal officials on Tuesday announced that $54 million in so-called navigator grants were being made available to public and private consumer groups in the 33 states — including Kansas — that have decided to let the federal government administer their exchanges (Ranney, 4/10).

Modern Healthcare: Mass. Health Insurance Exchange Enrollment Hits Record High
Enrollment in Massachusetts’ health insurance exchange has hit an all-time high. In March, 201,178 state residents were enrolled in Commonwealth Care, the program created by Massachusetts’ pioneering 2006 health care reform law to provide subsidized coverage to the lower-income uninsured. The March Commonwealth Care enrollment was 2,900 higher than February and nearly 28,000 higher compared with March 2012 (Geisel, 4/11).

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Medicaid Expansion: Stiff Resistance In South, Fla. Gov. Scott Blasts Watered-Down Plan

While most Southern states resist expanding Medicaid under the health law, Virginia appoints its final voting members to a commission that will oversee expansion there. In Florida, Gov. Rick Scott is blasting a watered-down version of the expansion that lawmakers there favor.

McClatchy: Despite Health Challenges, Southern States Resist Medicaid Expansion
Michael White’s high blood pressure is acting up again. The 51-year-old casino janitor has recurring seizures and recently awoke in an ambulance after passing out at a bus stop. … If White had insurance, he’d be under the care of a primary physician and taking medications regularly. But he can’t afford job-based health insurance on his $8-an-hour wage and he earns too much to qualify for Medicaid, the state-federal health plan for poor people and those with disabilities. … But Mississippi and eight other contiguous Southern states, all led by Republican governors, have decided not to implement the Medicaid expansion, even though the federal government has pledged to pay all medical costs for the newly eligible enrollees in 2014, 2015 and 2016 and no less than 90 percent of their costs thereafter (Pugh, 4/11).

The Associated Press/Washington Post: Senators Appointed To Commission That Will Monitor Va. Medicaid Reforms
The last four voting members have been appointed to a state commission that will oversee Medicaid reform and expansion in Virginia. Senate Finance Committee chairman Walter Stosch on Thursday named Senators Emmett Hanger, John Watkins, Janet Howell and Louise Lucas to the Medicaid Innovation and Reform Commission. The 2013 General Assembly established the commission to monitor implementation of Medicaid reforms sought by Virginia as a condition for expanding the program to an additional 400,000 uninsured low-income Virginians (4/11).

Health News Florida: House Plan Leaves Out Most Adults Who Need Coverage
As promised, the Florida House released its answer to the federal Medicaid Expansion under the Affordable Care Act on Thursday morning. It would leave out most of those the federal health law intended to cover. … It would provide limited coverage to parents of minor children and to disabled adults under 100 percent of the federal poverty level (Gentry, 4/11).

The Associated Press: Scott Slams House Health Plan
Gov. Rick Scott slammed a Florida House proposal Thursday that would pass up billions of federal dollars to provide health care coverage to 115,000 uninsured Floridians in a watered down alternative to expanding Medicaid under the federal health law. The proposal relies entirely on $237 million in state taxpayer funds and would not tap into an estimated $51 billion dollars in federal aid available under the Affordable Care Act (4/11).

And the divide also deepens in Iowa and Michigan, where lawmakers too are butting heads with the governor over expansion plans --

The Associated Press: Iowa State Treasurer Attacks Branstad Health Plan
State Treasurer Michael Fitzgerald waded Thursday into the partisan debate over whether to expand Medicaid in Iowa, attacking Gov. Terry Branstad’s alternative proposal as a “bad financial deal.”  The Democratic treasurer said that Branstad’s Healthy Iowa proposal would cost the state $163 million in the 2014-15 fiscal year, compared with a $4.7 million price tag for expanding Medicaid under the federal health care law (Lucey, 4/12).

The Associated Press: Michigan Panels Reject Governor's Medicaid Expansion
Republican-led legislative panels on Thursday rejected expanding Medicaid eligibility to 320,000 Michigan residents next year but left open the possibility of reversing course in coming months if changes can be made to the health insurance program for the needy.  Gov. Rick Snyder wants to expand Medicaid under the federal health care overhaul, saying it makes financial sense and is a chance to improve the health of people without insurance (Eggert, 4/11).

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New Group Sets Sights On Curbing Health Care Costs

The Partnership for Sustainable Health Care, which is made up of leaders representing insurers, employers, consumers and a hospital, aims to put political muscle behind ideas about controlling costs and boosting quality.

Kaiser Health News: Capsules: Groups Seek To Fast-Track Efforts To Curb Costs, Boost Quality
Five veteran health care leaders representing insurers, hospitals, employers and consumers on Thursday outlined an ambitious set of recommendations aimed at slowing rising costs, focused mainly on changing the way America pays for health care (Appleby, 4/11).

The Washington Post's WonkBlog: Obamacare Expanded Health Access. Now Supporters Want Another Bill To Tackle Costs.
Five health policy wonks walk into a room and start talking about how to bend the health-care cost curve — stop us if you've heard this one before. Plans to bend the health-care cost curve are pretty plentiful in the nation's capital. Lots of think tanks and coalitions have plans to cut billions (even trillions) in health-care spending. The Partnership for Sustainable Health Care argues it's something different. The new alliance, which includes health plans, a hospital and consumer advocates, isn't looking to bring fresh ideas to the debate. It recognizes this city has no shortage of think tank proposals (Kliff, 4/11).

In related news -

Medpage Today: Docs Told They Must Drive Health System Change
Doctors are the only people who can drive the change in health care delivery that's needed to save the country from a financial crisis, a health policy expert said here. Ezekiel Emanuel, MD, PhD, chair of medical ethics and health policy at the University of Pennsylvania in Philadelphia, called physicians the most important group in determining the future of the U.S., because others who have tried to incite health delivery reform have run into a brick wall when doctors weren't on board (Pittman, 4/11).

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Capitol Hill Watch

UnitedHealthCare Pushing Congress To Open Up Federal Workers' Health Plan

At a congressional hearing yesterday, UnitedHealthCare executives said that Blue Cross Blue Shield dominates the FEHB market too much.

The Washington Post: Insurance Providers Debate Whether Federal Workers Should Have More Choices
Two leading health-insurance providers squared off during congressional testimony Thursday, debating whether the government should allow more plans to participate in the $47 billion health-benefits program for federal employees. At a hearing before the House subcommittee that oversees the federal workforce, United Healthcare urged lawmakers to allow regional and state preferred-provider organizations (PPOs) to join the health-benefit program, which covers about 8 million workers (Hicks, 4/11).

Kaiser Health News: Insurers Battle Over Federal Employees’ Health Coverage
Tom Choate, chief growth officer for UnitedHealthcare, said the Blues’ "monopoly" of the program is stifling competition and innovation of insurance products. "Much has changed since 1959. We’ve moved from typewriters to laptops; from rotary dial phones to smart phones; from 45s to iTunes,” Choate said at the hearing. “It’s time to update that 1959 law, so federal employees and the federal government can also benefit from innovation and competition in the health care marketplace" (Galewitz, updated 4/11). 

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Health Information Technology

Medical Society Suggests That Docs 'Pause Before Posting'

Modern Healthcare: Physicians Urged To 'Pause Before Posting'
Physicians should exercise caution—and "pause before posting"—when interacting in online settings in order to preserve professionalism and maintain appropriate patient-physician relationships, according to a policy paper released today by the American College of Physicians and the Federation of State Medical Boards. "This is a very important addition to the ethics literature," Dr. David Fleming, chair of the ACP's ethics, professionalism and human rights committee, said during a news briefing (Landen, 4/11).

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Public Health & Education

Crash Inspection Program Finds Problems At Some Compounding Pharmacies

The New York Times: Checks Find Unsafe Practices At Compounding Pharmacies
After a crash inspection program, federal regulators said Thursday that they had found numerous unsafe practices at about 30 compounding pharmacies, the same type of facility responsible for the tainted drug that caused a deadly meningitis outbreak last year (Pollack, 4/12).

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State Watch

Ryan: Strong GOP Opposition To Abortion Will Boost Party's Prospects

Rep. Paul Ryan, R-Wis., the Republican vice presidential candidate in 2012, said Thursday that anti-abortion activists should work with abortion-rights counterparts to advance their agenda and that the GOP must stay strong on the issue.

The Associated Press/Washington Post: Ryan Urges Anti-Abortion Activists To Work With Those Who Support Abortion Rights
Rep. Paul Ryan, the Republican vice presidential nominee in 2012 and an abortion opponent, said Thursday that anti-abortion activists should try to build a broad coalition and find common ground with supporters of abortion rights as a way to advance their agenda (4/11).

The Hill: Paul Ryan: Republicans Must Stay Strong On Abortion To Win Elections
Rep. Paul Ryan (R-Wis.) argued in a speech to activists Thursday night that robust opposition to abortion rights is crucial to the GOP's political chances. Ryan's remarks to the Susan B. Anthony (SBA) List gala were his most extended on abortion since the 2012 election cycle, when several GOP candidates lost following controversial remarks on abortion and rape (Viebeck, 4/11).

In addition, abortion regulation legislation in Missouri and Indiana is in the news --

St. Louis Beacon: Koster Won’t Appeal Ruling On Law Allowing Firms To Decline Contraception Coverage
Attorney General Chris Koster won't appeal a federal court decision striking down a new state law that allows employers to exclude contraception, abortion or sterilization from insurance coverage. Koster, a Democrat, asked the federal judge who wrote the decision to amend her ruling so that religious organizations could exclude contraceptive coverage if they’re exempt under federal law (Rosenbaum, 4/11).

The Associated Press: Tighter Abortion Pill Rules Head To Indiana Governor
A bill that would tighten Indiana's regulations on distribution of the abortion pill and on the clinics that provide only drug-induced abortions won final legislative approval Thursday and is headed to Republican Gov. Mike Pence. The state Senate voted 35-14 to agree with a version of the bill that the House approved last week. Pence has said he supports the bill and is expected to sign it into law (Davies, 4/12).

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State Medicaid News: California, N.C. Officials Explore Cost-Saving Measures

Media outlets report proposals to reduce Medicaid costs in California and North Carolina. In Maryland, the leader of a company with a $200 million Medicaid contract says he has not been told why that contract is being probed by state and federal investigators.

Sacramento Bee: Labor-Backed Plan Would Fine Large Employers Who Send Workers To Medi-Cal
A new and controversial proposal in California's health care overhaul calls for fining large employers if the wages they pay are not high enough to keep workers off Medi-Cal rolls. Assemblyman Jimmy Gomez will formally unveil the measure as Assembly Bill 880, perhaps today, in a drive sponsored by the California Labor Federation and United Food and Commercial Workers (Sanders, 4/12).

California Healthline: Medi-Cal Cut Could Force Some Rural Hospitals To Close Nursing Units
A looming cut in Medi-Cal provider reimbursement rates could cripple the Eastern Plumas Health Care facilities, and the banks know that, [Tom] Hayes said. ... "We had our line of credit cancelled by the bank when they heard about this." "This" is a 10 percent Medi-Cal rate reduction that the state imposed in 2011; the rate change is still in limbo, awaiting the outcome of legal challenges. … According to state officials, California will save about $50 million a month if the Medi-Cal cut takes effect (Gorn, 4/11).

North Carolina Health News: State Health Leaders Defend Overhaul Of 'Broken' Medicaid System
New Secretary of Health and Human Services Aldona Wos has had to get up to speed on state government -- and fast -- since arriving in Raleigh in January. Now three months into her time in office, Wos and her Medicaid director, Carol Steckel, said they have a vision and a plan for revamping the state’s Medicaid program and putting the Department of Health and Human Services on firm financial footing (Hoban, 4/12).

The Associated Press/Washington Post: CNSI Official Says He Has No Idea Why $200M Medicaid Contract Is Under Federal Investigation
A top official with the Maryland company whose nearly $200 million Medicaid contract with the state has been cancelled said the firm has never been contacted as part of an ongoing federal probe into the contract award (4/12).

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State Highlights: Calif. Judges Warn Gov. Over Prison Care

A selection of health policy stories from California, Georgia, Virginia, Oregon and Colorado.

Bloomberg: Boomers Push Doctor-Assisted Dying In End-Of-Life Revolt
Claudia Burzichelli doesn't want to die like her dad. … In states across the country, including New Jersey, Connecticut, Massachusetts and Vermont, graying baby boomers have been lobbying lawmakers in recent months at hearings, in letters and by phone, pushing to make it legal for doctors to prescribe life-ending drugs to terminally ill patients. Advocates and opponents say there is more support this year than in past attempts with five states considering such legislation (Pettypiece, 4/11).

Los Angeles Times: Judges Threaten Gov. Jerry Brown With Contempt Of Court
The order arrived amid escalating tension between Brown and the judges, who have handled a series of cases involving California prisons, and is a setback for the governor. In January, Brown declared the prison crisis over and launched a legal and public relations crusade to end court oversight of inmate health care, which has been in place since 2006, calling it unnecessarily costly and otherwise burdensome (Megerian, 4/11).

Los Angeles Times: LA Country Cites 16 'Maternity Hotel' Owners
Following a flurry of complaints, Los Angeles County inspectors have cited 16 "maternity hotel" owners for illegally operating boardinghouses in residential zones. The facilities, all in Rowland Heights or Hacienda Heights, will ultimately be shut down, county officials said. No major health or safety issues were found at the hotels, where women from Asia stay to give birth to U.S. citizen babies (Chang, 4/11).

Georgia Health News: Schools Urged To Plan More Exercise For Kids
State officials are urging Georgia school superintendents to consider adopting a daily 30-minute period of physical activity for elementary school students. A letter sent this week by state school Superintendent John Barge and by Dr. Brenda Fitzgerald, commissioner of the state Department of Public Health, cites the obesity epidemic as the impetus for the voluntary “Power Up for 30” program (Miller, 4/11).

Richmond Times-Dispatch: VCU Dentists And Nurse Practitioners Collaborate On Patient Care
Dominiquea Rosario sees a dentist regularly for debilitating jaw pain, but at her last two dental appointments at Virginia Commonwealth University she also saw a nurse practitioner who checked her blood sugar and blood pressure. In a new practice model, dentists and nurse practitioners at VCU are teaming up to see patients together, with goals of increasing access to care, better understanding the connection between oral health issues and disease elsewhere in the body and lowering health care costs (Smith, 4/12).  

The Lund Report: Dembrow Pitches Oregon Universal Health Care Study
The Affordable Care Act will roll out next year, and Oregon has instituted its own pioneering health care delivery reforms through coordinated care organizations. But Rep. Michael Dembrow, D-Portland, believes these reforms will not go nearly far enough to drive down the health care costs and make health care affordable for everyone. He and other liberal Democrats would like to go beyond the federal health insurance reforms and get rid of private health insurance once and for all, replacing it with a single-payer government health insurance similar to Medicare that would provide coverage to everyone from cradle-to-grave (Gray, 4/12).

California Watch: Lawmakers Mull Next Steps For Developmental Centers
State lawmakers weighed today whether to appoint an inspector general to oversee state centers for the developmentally disabled and close a center in Sonoma where patients suffered the worst instances of abuse, neglect and sexual assaults. During a daylong hearing, members of a Senate budget subcommittee on health and human services heard testimony from state officials and advocates for the developmentally disabled but did not indicate what action they might take (Harris, 4/11).

Oregonian: Essential Health Clinic: How It Collapsed After Spending Hundreds Of Thousands On Growth
The doctors volunteered. Most of the drugs were donated. The clinic space was free. And yet Essential Health Clinic -- which provided free urgent care to thousands of uninsured people in Washington County for 12 years -- abruptly shut its doors in Hillsboro and Tigard last month. Founder and interim executive director Sue Neal said it was a simple case of a nonprofit that didn't get funding (Nirappil, 4/11).

Health Policy Solutions (a Colo. news service): Attacks From Left And Right Undermine Gun Bill On Mental Health
As [Colo. State Rep. Beth] McCann has fought for a bill on guns and mental health, it turns out that forces on both the left and right colluded to undermine the effort. Gun-rights advocates in Colorado disagreed sharply with the NRA and didn’t want any lists of gun owners whether they had suffered mental illnesses or not. Civil libertarians objected to a lack of due process that could allow seizures of guns from innocent people. And advocates for people experiencing mental illnesses worried that the proposed bill would further stigmatize people in need of care and could frighten them away from seeking treatment (Kerwin McCrimmon, 4/11).

California Healthline: In-Home Support Services 8% Cut Approved
The Assembly Budget Subcommittee on Health and Human Services yesterday approved the settlement over cuts to In-Home Supportive Services. The agreement reduces the severity of the cut from the original 20% proposal to its current 8% cutback. … The original 20% IHSS cuts were triggered by lower-than-projected budget numbers at the end of 2011. A lawsuit filed by Service Employees International Union and Disability Rights California challenged the trigger reduction. A federal judge issued a temporary restraining order to halt it. Last month, the two sides worked out a compromise settlement. The agreement calls for an 8% cut in service hours this year, and a 7% cut in hours next year. It affects about 370,000 Californians, mostly seniors, who receive IHSS care (Gorn, 4/11).

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Health Policy Research

Research Roundup: Lesson For Insurance Exchanges From Europe

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

Health Affairs: Health Insurance Exchanges In Switzerland And The Netherlands Offer Five Key Lessons For Operations Of US Exchanges – As states and the federal government begin creating insurance exchanges under the health law, researchers highlight several lessons from Switzerland and the Netherlands. Those countries have private insurance markets with five aspects of success: "risk-adjustment mechanisms—which provide premium adjustments intended to compensate health plans for enrolling people expected to have high medical costs" are "sophisticated and continually updated;" the importance of identifying barriers to enrollment among those eligible; a simple application process for subsidies; clear negotiating power for insurers on prices and quality of service; easy availability of reliable data regarding providers’ costs and quality of care for insurers and consumers. "American policy makers will need to conduct ongoing analyses of the different ... [exchanges] to learn what works best to create incentives for efficiency," the authors concluded (van Ginneken, Swartz, and Van der Wees, 4/8).

Health Affairs/Robert Wood Johnson Foundation: Health Policy Brief: The Multi-State Plan Program - The insurance markets for individuals and small businesses are highly concentrated in some states, meaning a single insurer could dominate the market. To spur competition and increase the number of options for individuals, the federal health law created the Multi-State Plan Program and put it under the direction of the Office of Personal Management (OPM). "OPM must certify at least two issuers to be able to sell coverage in the exchanges in time for open enrollment on October 1, 2013," the author writes. "Also, under the law, insurers participating in the multistate program must offer at least two plans through each exchange." This brief delves into the program's background and explores the OPM's role and potential challenges as its administrator (Goodell, 4/3).

JAMA Pediatrics: Association Between State Laws Governing School Meal Nutrition Content And Student Weight Status – By studying 4,800 eighth-graders from 40 states, researchers aimed to determine if school meal nutrition standards that exceeded the Department of Agriculture’s school meal standards improved the weight status of adolescents. "The results of this study suggest that in states with laws that encouraged or required a specific number of fruits/vegetables, reductions in trans fats, 1% skim milk, and/or a minimum proportion of whole grains, students who obtained school lunches had a more favorable weight status, particularly among participants eligible for a free/reduced-price lunch," the authors wrote. "The evidence supporting stringent school meal standards is far from conclusive, but this study provides promising signs of the potential for the USDA updated standards to improve student weight status" (Taber, Chriqui, Powell and Chaloupka, 4/8).

The Kaiser Commission on Medicaid and the Uninsured/Kaiser Family Foundation: Health Coverage For The Hispanic Population Today And Under The Affordable Care Act –The authors of this brief write: "The more than 50 million Hispanics living in the United States make up 17 percent of the total population and are the nation's fastest growing racial or ethnic group. Many Hispanics continue to face disparities in health coverage and care, and they have the highest uninsured rate among racial/ethnic groups, with nearly one in three lacking coverage. The Affordable Care Act (ACA) could help many uninsured Hispanics through the law's expansion of Medicaid and the creation of new health insurance exchange marketplaces with tax credits to help moderate-income people purchase coverage" (4/9).

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

NPR' SHOTS blog: Seniors In The South Are More Apt To Be Prescribed Risky Drugs
Health care types have spent years trying to make the point that seniors are being prescribed medications are unnecessary and dangerous. But the message hasn't really sunk in. More than 20 percent of people with Medicare Advantage coverage are taking at least one high-risk medication, a new study finds (Shute, 4/11).

Medscape: Adverse Drug Events Found By Mining Clinical Notes In EHR
Mining unstructured clinical notes written in electronic health records (EHRs) can be used as a strategy to identify early signs of adverse drug events, according to the findings of a new study by Paea LePendu, PhD, and colleagues from Stanford University in California. The authors published their findings online April 10 in Clinical Pharmacology and Therapeutics (Barber, 4/10).

Medscape: Drug Reps Provide Little Information On Harmful Effects
Pharmaceutical sales representatives (PSRs) rarely present serious adverse events during their sales calls. France has stricter standards than the United States and Canada, and therefore presentation of "minimally adequate safety information" is slightly higher in France than in these North American countries. Barbara Mintzes, PhD, from the School of Population and Public Health, University of British Columbia in Vancouver, Canada, and colleagues published the results of their prospective cohort study online April 10 in the Journal of General Internal Medicine (Pullen, 4/10). 

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Editorials and Opinions

Viewpoints: Progress Toward A 'Grand Bargain'; States' 'Rare Chance' To Expand Medicaid

Los Angeles Times: Closer To Obama's 'Grand Bargain'
Obama has acknowledged that the federal budget is on an unsustainable path. ... The president has set the right contours for a deal, and some of the specific proposals — including higher Medicare premiums for high-income seniors and those with generous Medigap policies, as well as a more aggressive effort to move providers to more efficient payment systems — are welcome (4/11).

The Washington Post: It's The GOP's Turn To Be Serious With The Budget
Most of all, what's required of politicians as the baby boomers age is difficult. We use a shorthand: Republicans want entitlement reform; Democrats want higher taxes. But, really, neither of them wants either of those. Polls show that voters like deficit reduction in theory but don't favor the policies needed to bring it about: tax hikes and a scaling-back of promised retirement and health benefits. President Obama's proposed budget has taken a big step toward acknowledging reality. No, it's not big enough (4/11).

Los Angeles Times: The Fights Obama Picks Over Medicare
The budget that President Obama released Wednesday doesn't include the sort of headline-grabbing initiatives that House Budget Committee Chairman Paul D. Ryan (R-Wis.) included in his proposal for fiscal 2014, such as a dramatic overhaul of the tax code and a transformation of Medicaid into block grants. But it offers a few ideas on Medicare that, while not as cage-rattling as Ryan's plan, would still bring important changes to the program. Make that, important but unpopular changes (Jon Healey, 4/11).

Politico: States’ Rare Chance To Expand Medicaid
A proposal unveiled by Tennessee Gov. Bill Haslam late last month leverages federal funds to purchase private coverage for new Medicaid eligibles in the state’s health insurance exchange. ... Governors have a very real opportunity — and a rare one at that — to advocate for some of the program reforms they want to see in Medicaid while simultaneously expanding coverage to millions of Americans. Similarly, if the Obama administration wants to entice more states into broadening coverage, it needs to accept that premium assistance will continue to be a growing segment of the Medicaid program (Dr. Bill Frist, 4/11).

The Medicare NewsGroup: A Look At Who Gets Hurt By The Sequester
In one sense, the sequestration has given politicians convenient political cover for direct provider cuts because the reductions are across-the-board. ... If beneficiaries start to be turned away from health care providers in large numbers, the political calculus will change. What is not clear is whether that will happen, or if Congress will derail the locomotive powered by the powerful engine of the sequester (John Wasik, 4/11).

National Journal: The Upside Of Obama's Tobacco Tax Hike
Under his new budget plan, President Obama would use $78 billion from new tobacco taxes to fund early-childhood education. ... It also turns out that the tax hike could do even more good than Obama’s budget gives it credit for. ... The [CBO] itself said doubling the tax hike, as Obama nearly would, would yield twice the estimated health effects (Niraj Chokshi, 4/11).

The New York Times' Economix Blog: The Governance Of Nonprofit Hospitals
Is there anything like this transparency and public accountability in the nonprofit sector? Indeed, who actually owns these entities? To whom do they render account for the sizable real resources and finances under their control? And what benefits do they deliver in return for the exemption from income taxation they enjoy? ... I find it puzzling that nonprofit entities have been so reluctant to post their Form 990s on their Web sites, given that the form is available through Guidestar anyhow. What is there to hide? (Uwe E. Reinhardt, 4/12).

Los Angeles Times: CVS Customers Say Unauthorized Prescription Refills Still Occur
Federal and state authorities launched investigations into unauthorized refills after I wrote columns about how CVS and other drugstores were routinely signing up customers for automatic refills without their approval. CVS, for its part, blamed the practice on rogue drugstore managers and insisted that the company's official policy was that customers are always asked before being enrolled in ReadyFill, the chain's refill program (David Lazarus, 4/11).

The New York Times: Brain Disease And The NFL
More than 4,000 retired players are suing the National Football League for failing to protect players from chronic risks of head injuries routinely inflicted in professional football games — and then willfully concealing those risks from players. In a brief summarizing the players' position, lawyers say that serious head injuries "cause neurocognitive decline, permanent mental disability, and even death" (4/11).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
Lisa Gillespie
Shefali Luthra

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