Daily Health Policy Report

Friday, April 13, 2012

Last updated: Fri, Apr 13

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform


Campaign 2012

Health Care Marketplace

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Different Takes: How Massachusetts Can Control Health Care Costs

This Kaiser Health News feature explores different perspectives on Massachusetts' health care cost control efforts. It's been six years since Massachusetts put in place its own sweeping set of health reforms designed to expand access to health care. Now public officials and the major stakeholders are debating the best ways to control rising health care costs and insurance premiums. Kaiser Health News asked Massachusetts Gov. Deval Patrick, Massachusetts Hospital Association President Lynn Nichols, Massachusetts' Health Care For All's Paul Williams and Massachusetts Medical Society's Lynda Young about their views on what's been accomplished so far and their take on how the state might tackle this next wave of policy challenges (4/12). Read the perspectives.

This Story: Print | Link to | Top

Political Cartoon: 'Push-Me—Pull-You?'

Kaiser Health News provides a fresh take on health policy developments with "Push-Me—Pull-You?" by Adam Zyglis.

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


With spring comes pollen
baseball and speculation
about the health law.

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.

This Story: Print | Link to | Top

Capitol Hill Watch

House GOP Dusts Off Old Budget Ideas To Replace Automatic Cuts

When they return to Capitol Hill next week, Republicans on key House committees are expected to take up earlier proposals as they look for ways to replace some of the automatic budget cuts scheduled to take effect in January. Members of the House Judiciary Committee will make another go at revamping medical liability laws.

Reuters: House Panels Turn Budget Axe To Automatic Cuts
Republicans in six House of Representatives committees next week will dust off their past proposals for reducing the deficit as they try to replace some of the automatic spending cuts set to take place in January... Expected targets for cuts include food stamps, farm subsidies and crop insurance, federal employee pensions and health care. A repeal of President Barack Obama's health reform law would prevent new coverage expenses from occurring from 2014 (Lawder, 4/12).

Politico Pro: House Judiciary To Take Up Med Mal – Again
The House Judiciary Committee is expected to mark up a bill Tuesday that overhauls the nation’s medical liability laws, even though it has already cleared the legislation twice before — and the full House passed it only last month as part of a package to repeal the Independent Payment Advisory Board. The move, confirmed by sources on and off Capitol Hill, indicates that House Republicans want to use the bill’s nearly $46 billion in scored savings to meet the savings targets the committee must achieve under Paul Ryan’s budget resolution (DoBias, 4/12).

This Story: Print | Link to | Top

Health Reform

Sebelius Appeals To Civil Rights Groups For Health Law Support

Health and Human Services Secretary Kathleen Sebelius asked civil rights activists to help defend the health law. Meanwhile, other news outlets report on specific aspects of the law, including how contractors have been preparing for its implementation, and the latest on accountable care organizations. 

Reuters/Chicago Tribune: Sebelius Seeks Civil Rights Support For U.S. Healthcare Law
A top U.S. administration official asked civil rights activists on Thursday to help defend President Barack Obama's embattled healthcare law, saying the reform package faces an "enemy" determined to set American health policy back half a century. The remarks in a charged election year come two months before the Supreme Court is expected to issue a ruling that could make or break the law (Morgan, 4/12).

Politico: Kathleen Sebelius: We Don't Have A Health Care Backup Plan
HHS Secretary Kathleen Sebelius said Thursday that it would "probably" be a good idea for the department to have a backup plan in case the Supreme Court strikes down the health reform law, but the department isn’t working on one (Feder, 4/12).

The Washington Post: As Supreme Court Weighs Health Care Reform, Contractors Await Their Fate
Government contractors like PCG are involved in every aspect of setting up the new health insurance exchanges — the "marketplaces" for health plans that the Affordable Care Act established. But depending on the outcome of March’s Supreme Court case, which will be revealed in June, the exchanges — along with the rest of the law— may be scrapped, leaving some health insurance contractors uncertain about the end result of their labor (Khazan, 4/12).

Chicago Tribune: Many Seniors Unaware Of Benefits Now At Risk
As the Supreme Court decides the fate of the Affordable Care Act, seniors may want to grab the law's perks while they can. Opinion is mixed on whether other provisions in the law will stand if the mandate on individuals to purchase insurance is struck down. Prescription drug cost relief and free wellness exams are two key provisions under way, and they affect millions of seniors, said Howard Bedlin, vice president of public policy and advocacy for the National Council on Aging (Kidd Stewart, 4/13).

Politico Pro: Pioneer ACOs Find CMS's Speed Needs Work
There's an important skill CMS will need if it wants its accountable care organizations to succeed. It will have to be able to give them good information on their patients — and it will have to do it fast. So far, though, the experience of the Pioneers — the 32 fast-track accountable care organizations that were set up first — suggests CMS may have to work on the "fast" part. Executives with several of the Pioneer ACOs report two- to three-month delays in getting historical data on their beneficiaries — including what services they use — that they were promised in January (Feder, 4/13).

This Story: Print | Link to | Top


CMS Settles Medicare Reimbursement Dispute With Hospitals

With a price tag of about $3 billion, the agreement ends a decade-long dispute between an estimated 2,200 hospitals and the Centers for Medicare & Medicaid Services over the calculation of pay rate cuts and offsets for rural hospitals.  

Los Angeles Times: Medicare To Settle Hospital Reimbursement Dispute
Medicare agreed to settle a dispute with about 2,200 hospitals nationwide over a decade-long error in reimbursement rates, offering what could amount to a $3-billion infusion to hospitals already bracing for funding cuts under the federal healthcare law. More than 200 California hospitals are included in three similar agreements reached April 5, and they stand to share a total of more than $310 million (Terhune, 4/12).

Modern Healthcare: CMS' Hospital Settlements Seen Costing At Least $3 Billion
Ongoing CMS settlement negotiations with about 2,200 hospitals are expected to cost the federal government at least $3 billion, according to parties involved in the deal. The payments to hospitals will settle several similar years-long federal lawsuits in which those providers alleged CMS officials erred in calculating pay rate cuts needed to offset an increase for rural hospitals required by a 15-year-old law. The settlement process began when a federal appeals court struck down a lower court ruling that sided with the CMS (Daly, 4/12).

This Story: Print | Link to | Top

Campaign 2012

Presidential Campaign Veers Back To Women's Issues, Mass. Health Law

Obama and Romney campaigns are getting tangled in questions about women's life choices. But at the same time, Democrats are seeking to use the sixth anniversary of Romney's Massachusetts health law signing to remind voters about its similarities to the federal health overhaul.

The Associated Press/Washington Post: The Race: War Fever Over Religion, Women And The High Court Enlivens U.S. Presidential Race
Everywhere you turn in politics a war is raging -- at least of words. Republicans say President Barack Obama is pursuing wars on religion and the Supreme Court. Democrats counter that Republicans are waging a war on women. And now Republicans are accusing Democrats of mounting an offensive against women (4/12).

Los Angeles Times: Larger Women's Issues Loom Over Romney Campaign
While the campaigns tangled this week over ancillary issues like whether Romney was using a fair statistic to describe job losses among women during Obama's presidency, or the stances of several of his female surrogates on controversial issues like transvaginal ultrasounds for women seeking abortions, the more crucial question is what the toll has been of his sometimes harsh rhetoric on issues of concern to moderate women, like budget priorities, immigration and the nation's social safety net (Reston, 4/12).

National Journal: Romney's Successor Ties Him To Health Care Law On Signing Anniversary
On the sixth anniversary of the signing of Massachusetts's health care reform law, Democratic Gov. Deval Patrick did not pass up an opportunity to tie Mitt Romney's name to the controversial measure. Patrick said on Thursday that Romney, who was governor when the law passed, played an important role in its development and should be "proud" of the large coalition of Democratic, labor and business leaders that made the legislation a reality. But more than just signing the bill, Patrick said Romney created one of the law's key tenants: the now-infamous mandate (Vasilogambros, 4/12).

The Hill (Video): Gov. Patrick: Romney's Contribution To Mass. Health Care Law Was 'Individual Mandate'
The Obama team attempted to use the anniversary of Massachusetts' healthcare reform law to link Mitt Romney to President Obama's controversial legislation. Obama's reelection campaign released a three-minute video Thursday portraying Romney as the inspiration behind the president's health care law. And Massachusetts Gov. Deval Patrick (D) joined MSNBC's "Morning Joe" to tout the success of the state's legislation, which contains an individual mandate provision similar to Obama's national law (Sands, 4/12).

Boston Globe: Obama Campaign Video Accuses Mitt Romney Of Health Care Backtracking On Sixth Anniversary Of Massachusetts Law's Signing
Six years to the day after Mitt Romney signed Massachusetts' health care law, the Obama campaign released a video that serves as a sort of backhanded compliment, chiding the former governor for inconsistent statements about health care reform, even as it praises his work on the state law. The three-minute video features two men who helped craft both Romney's law and Obama's law vouching for similarities between the two and affirming Romney's belief in 2006 that Massachusetts' version could serve as a national model (Borchers, 4/12).

The Hill: Anti-Abortion Rights Groups Rally Behind Romney's Campaign
Two of the nation's leading anti-abortion-rights groups rallied behind Mitt Romney on Thursday following the exit of Rick Santorum from the presidential race. The Susan B. Anthony (SBA) List and the National Right to Life Committee (NRLC) both endorsed Romney's candidacy, burnishing the former governor's credentials with conservatives. SBA had previously endorsed Santorum, while the NRLC had taken a wait-and-see approach out of fear of weakening the eventual nominee. Romney supported abortion rights during his 2002 campaign for governor, but has worked to convince Republicans he had a genuine change of heart in 2004 (Pecquet, 4/12).

And one Democrat says passing the health law -- politically, at least -- was probably not worth it --

Roll Call: Kentucky: John Yarmuth Says Health Care Law Probably Wasn't Worth Political Cost
Publicly meditating on the past is not a normal activity for vulnerable Members looking to get re-elected. But from his safe Louisville-based district, Kentucky Rep. John Yarmuth (D) has the luxury of mulling about what could have been. In an interview with Roll Call on Wednesday, the three-term lawmaker was asked whether the Affordable Care Act — which will be a burden to Democrats for the second consecutive cycle — was worth the political cost. "Oh, politically? Politically?" Yarmuth paused for a moment. "Big picture, politically, it probably wasn't worth it. Policy-wise, it was worth it because it's going to move the country dramatically in the right direction," he said. "Even if it were to fail [at the Supreme Court], it's going to move the country dramatically in the right direction" (Miller, 4/12).

This Story: Print | Link to | Top

Catholic Bishops' 'Religious Freedom' Campaign Includes Action Against Contraception Coverage Mandate

The organization released a document on Thursday about its upcoming religious freedom campaign.

The Hill: Catholic Bishops Issue 'Call To Action' On Religious Freedom
All Americans should be "on guard" as the Obama administration threatens religious liberty, the U.S. Conference of Catholic Bishops declared Thursday. The call to action is spelled out in a document, "Our First, Most Cherished Liberty," developed by the conference's Ad Hoc Committee on Religious Liberty (Pecquet, 4/12).

The New York Times: Catholic Bishops Urge Campaign For Religious Freedom
In the document, the bishops seek to explain that their alarm is not only about the mandate in the health reform act that requires even Catholic colleges and hospitals to have insurance plans that cover birth control. They cite seven examples of what they say are violations of religious freedom (Goodstein, 4/12).

CNN: After Contraception Controversy, Catholic Church Announces Religious Freedom Campaign
The document also said that the federal government recently revised its contract with the Catholic Church's Migration and Refugee Services to require it to provide or refer women to contraceptive and abortion services, in violation of Catholic teaching (Gilgoff, 4/12).

In other news related to the coverage mandate -

Politico Pro: Contraception Fight May Preview Suits Ahead
As the Supreme Court prepares to decide the fate of the health reform law's individual mandate, the next round of legal punches to the law is waiting in the wings — but they'll have to clear some big legal hurdles. At least nine groups have already filed lawsuits challenging the law's requirement that nearly all employers provide insurance coverage for contraceptives, including the so-called "morning after pill." Before the lawsuits can go anywhere, the challengers will have to prove that they have the right to sue now. That could be difficult because the Obama administration says the lawsuits should be stalled until it finishes its work on new policy to shift the coverage burden to insurance companies. Plus, one of the challengers has a health plan that currently covers birth control (Haberkorn, 4/13).

This Story: Print | Link to | Top

Health Care Marketplace

Grants Flow From Komen To Planned Parenthood

The Washington Post: Komen Grants Flowing To Planned Parenthood
Grants from the Susan G. Komen Foundation for the Cure are flowing to Planned Parenthood, as the women's health organizations seek to rebuild their relationship after the controversy in February over the breast cancer charity's unsuccessful attempt to defund Planned Parenthood (Sun and Kliff, 4/12).

This Story: Print | Link to | Top

State Watch

N.Y. Governor Signs Order Establishing State Health Insurance Exchange

New York Gov. Andrew Cuomo bypassed the state legislature where Republicans had blocked a bill and issued an executive order establishing a new health insurance exchange, a major part of the health care law.

The New York Times: Cuomo Acts To Advance Health Law In New York
Gov. Andrew M. Cuomo, stepping into the national debate over President Obama's health care law, used his executive power on Thursday to carry out one of its critical features in New York after the state’s Republican lawmakers blocked legislation to do so (Kaplan, 4/12).

The Associated Press/Wall Street Journal: Cuomo Orders NY Health Insurance Exchange
Gov. Andrew Cuomo issued an executive order Thursday to establish a statewide health insurance exchange intended to reduce coverage costs for individuals, small businesses and local governments. The New York Health Benefit Exchange, a federally authorized and financed marketplace for buyers, is also aimed at including more than a million New Yorkers now without coverage (4/12).

Modern Healthcare: Cuomo Signs Order To Create Insurance Exchange
New York Gov. Andrew Cuomo has signed an executive order for his state to join the 13 others that have established health insurance exchanges. "Establishing the health exchange will bring true competition into the health care marketplace, driving costs down across the state," Cuomo said in a news release (Selvam, 4/12).

This Story: Print | Link to | Top

As Fiscal Years Start To Wind Down, States Confront Medicaid Issues

In Georgia, Kansas, Colorado, Connecticut and other states, Medicaid costs are daunting.

The Washington Post: States' Tax Revenue Rose 8.9 Percent In Last Fiscal Year
Although their tax revenue has improved substantially since the worst of the recession, states continue to face severe fiscal challenges as they are called on to spend more because of the economic stress caused largely by continued high unemployment. Many states face increasing caseloads for Medicaid, the combined federal-state health program for the poor and disabled (Fletcher, 4/12).

Georgia Health News: Medicaid, PeachCare Cope With Cash Problem
The cash-flow problem has prompted the Department of Community Health to ask medical providers and insurers to give the agency some flexibility on payments. The financial situation came up Thursday at a Department of Community Health board meeting. ... Including federal funds, the state Medicaid and PeachCare budgets total more than $7 billion annually. The state’s fiscal year ends June 30 (Miller, 4/13).

The Associated Press/Denver Post: Colo. House Approves $7.4 Billion Spending Plan
The Colorado House approved a $7.4 billion spending plan Thursday ... Overall, the bulk of the increases in general fund spending is going to K-12 education, the senior property tax, and federally mandated Medicaid spending (Moreno, 4/12).

The Connecticut Mirror: State Trying To Improve Care For High-Need, High-Cost Clients
[A] group of just over 57,500 people represents nearly 40 percent of the cost of Medicaid, the largest single item in the state budget. The group includes poor seniors and younger adults with disabilities who receive coverage through both Medicaid and Medicare. Their care costs more than $3 billion a year -- an average of $53,500 per person, or 55 percent higher than the national average (Levin Becker, 4/12).

Kansas Health Institute News: KanCare Reorganization Moves Forward
Had either the House or Senate rejected the order, the reshuffle would have been halted. ... [Brownback administration officials] said moving long-term care services from the Kansas Department of Social and Rehabilitation Services would cement their efforts to better coordinate care for elderly and disabled Medicaid beneficiaries. Brownback has forecast at least $850 million in savings over five years for the state and federal governments thanks to KanCare (Shields, 4/12). 

This Story: Print | Link to | Top

Abortion: Restrictive Bills Proceed In Ariz., Iowa; Miss. Law Targets States Only Clinic

A pair of bills passed the Arizona Senate Thursday to prohibit public money for family-planning from going to organizations that give abortions and to allow some businesses to avoid paying for contraception for employees. Ariz. Gov. Jan Brewer also signed a bill banning most late-term abortions.

Arizona Republic: Bill On Abortion Funding Advances In Senate
The state Senate gave preliminary approval Thursday to a bill that would prohibit public money intended for family-planning services from going to organizations that provide abortions. Opponents called House Bill 2800 a thinly veiled swipe at Planned Parenthood that would curtail access to health-care services such as breast exams and testing for sexually transmitted diseases, particularly for Medicaid recipients (Smith, 4/12).

Arizona Republic: Arizona Senate Passes Controversial Contraception Measure
The Arizona Senate passed a controversial bill Thursday to allow certain businesses to opt out of providing contraception health-care coverage, with a promise from the bill's sponsor to amend it before it goes to the governor. The revised version would only apply to religious-based employers such as St. Vincent de Paul. According to a draft of the proposed amendment, it would be revised to apply to only "religiously affiliated" employers (Rau, 4/12).

Reuters: Arizona Governor Signs Law Banning Most Late-Term Abortions
The measure, which state lawmakers gave a final nod to on Tuesday, would bar health care professionals from performing abortions after 20 weeks of pregnancy, except in the case of a medical emergency. ... With [Gov. Jan] Brewer's signature, Arizona joins six other states that have put similar late-term abortion bans in place in the past two years  (Schwartz, 4/12).

Iowa lawmakers are also fighting about public money and contraception --

Des Moines Register: GOP Proposals Set Off Firestorm In Senate
Democrats and Republicans clashed in the Iowa Senate on Thursday in one of the most stinging rounds of political debate so far this session. One Republican proposal ... would have yanked all state money for women’s health services at any organization that performs abortions, which is most directly targeted at Planned Parenthood (Clayworth, 4/12).

Des Moines Register: Iowa House Leaders Differ On End Of Legislative Session, Reasons For Delay
[Democratic Minority Leader Kevin] McCarthy noted that one of the biggest pieces of the budget – funding for health and human services, including Medicaid – has been delayed for weeks in the House. He suggested the delay resulted from divisions within the Republican caucus, with the social conservatives among them refusing to support the budget unless it contains further restrictions on abortion or funding for organizations that offer abortion services (Noble, 4/12).

And a soon-to-be-new law in Mississippi is aimed at shutting down abortions --

The Associated Press: New Law Targets Lone Abortion Clinic In Miss.
Mississippi's abortion laws, already among the strictest in the nation, are poised to become even tighter after a push by social conservatives to shut down the state's only clinic providing the procedure. ... A bill passed by the Republican-controlled Legislature and awaiting the signature of GOP Gov. Phil Bryant requires anyone performing abortions in a clinic to be a certified OB-GYN with admitting privileges at a local hospital. Those privileges aren't easy for doctors to get, either because they live out of state or because some religious-affiliated hospitals might be unwilling to associate themselves with people who perform elective abortions (Pettus and Tillman, 4/12).

Earlier, related KHN story: Mississippi Legislature Passes Abortion Clinic Bill (Hess, 4/4).

This Story: Print | Link to | Top

States Weigh Bills To Protect Consumers Against High Drug Costs; Other State News

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

The Wall Street Journal: Texas Eyes Change In Stem-Cell Rules
A Texas agency will vote Friday on whether to enact new rules that would make it easier for doctors to offer experimental treatments using adult stem cells without federal approval. The Texas Medical Board, which licenses and disciplines doctors in the state, recently drafted stem-cell rules at the behest of Dr. Stanley Jones of Houston, who in July injected Gov. Rick Perry with the governor's own stem cells to try to aid his recovery from a back injury (Koppel, 4/12).

The New York Times: States Seek Curb On Patient Bills For Costly Drugs
Spurred by patients and patient advocates ... lawmakers in at least 20 states, from Maine to Hawaii, have introduced bills that would limit out-of-pocket payments by consumers for expensive drugs used to treat diseases like cancer, rheumatoid arthritis, multiple sclerosis and inherited disorders (Pollack, 4/12).

The Dallas Morning News: North Texas Digital Patient Record Exchange Launched
A health information exchange designed to link 140 hospitals and more than 12,000 physicians across North Texas was launched Thursday with a contract award to Orion Health Inc., a New Zealand software company. The cost of the contract was not disclosed, but it comes under a $4.9 million state grant given last year for a North Texas Accountable Healthcare Partnership. The contract with Orion Health marks the culmination of more than six years of negotiations across the Dallas-Fort Worth area aimed at letting health care providers share information on patients (Landers, 4/12).

Minnesota Public Radio: Health Care Reform Doesn't Have To Be A Spectator Sport
You don't have to just sit there waiting for the U.S. Supreme Court to rule on national health care reform. You can instead sign up for one of about 40 two-hour conversations in the next several months around Minnesota that will let you talk about your own experience with the real-world balancing act among costs, care and health. The conversations are being sponsored by the Citizens League and the Bush Foundation. ... The discussions will lead to a written report in August to the state's bipartisan health care reform task force (Peters, 4/12).

MedPage Today: State Mandates Stent Necessity Review
In the aftermath of several high-profile cases of "overstenting," the Maryland General Assembly has passed legislation establishing an independent review process to ensure the medical necessity of coronary stent placement. The legislation, passed as part of a larger bill dealing with cardiac surgery and stenting, calls for independent, external review that is "free of bias and politics," said Marc Mugmon, MD, president of the Maryland chapter of the American College of Cardiology (Kaiser, 4/12). 

WBUR: Report: Mass. Health Coverage Law Not A 'Budget Buster'
Outside Massachusetts, talk show hosts and politicians frequently blast the state's health coverage law as a "budget buster." ... That's just one of the myths the Massachusetts Taxpayers Foundation (MTF) hopes to debunk with a report out Friday. The facts will help. Michael Widmer, president of the MTF, says the state has spent just $91 million more since 2006 to cover the uninsured than it was spending before the law passed. ... Now keep in mind that Massachusetts was already spending roughly $1 billion per year on care for uninsured residents who received free care at hospitals and clinics (Bebinger, 4/13). 

California Healthline: New Leader, New Plan, New EHR Initiative for Cal eConnect
Cal eConnect is a not-for-profit health information technology liaison between public and private stakeholders in California. Its task is a big one: to help integrate electronic health records into the fabric of medical practice throughout the state and to coordinate health information exchange among public agencies, providers, pharmacies, laboratories and health plans. ... Getting everyone in the state on the same EHR interface is one of several big steps Cal eConnect and state health data exchange participants are about to take (Gorn, 4/12). 

This Story: Print | Link to | Top

Health Policy Research

Research Roundup: Medicare Vs. Private Plans

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

Archives Of Internal Medicine: Obesity Treatment For Socioeconomically Disadvantaged Patients In Primary Care Practice – Low-income patients are underrepresented in clinical trials and are disproportionately prone to obesity and the related problems of high blood pressure and heart disease. Researchers conducted a 24-month trial of more than 300 low-income, obese patients from various Boston community health centers, randomizing participants "to usual care or a behavioral intervention that promoted weight loss and hypertension self-management using eHealth components. The intervention included tailored behavior change goals, self-monitoring, and skills training, available via a website or interactive voice response." The intervention resulted in "modest weight losses, improved blood pressure control and slowed systolic blood pressure" (Bennett et al., 4/9).

Kaiser Family Foundation: How Does The Benefit Value Of Medicare Compare To The Benefit Of Typical Large Employer Plans? A 2012 Update -- This study, updated from 2008, found that "Medicare remains less generous on average than typical large employer health plans, even after recent improvements in the program's drug coverage. Overall, Medicare would cover $11,930 on average of the $14,890 in estimated annual spending for an individual age 65 and older, less than would be covered under either the federal employee plan ($12,260) or the typical PPO comparison plan ($12,800) for an individual age 65 and older. The gap was narrower in 2011 than it was in 2007, largely due to provisions in the Affordable Care Act that provide discounts on brand-name drugs purchased in the Medicare drug benefit's coverage gap, or "doughnut hole" (McArdle, Levinson, Stark and Neuman, 4/4).

The Heritage Foundation: Saving The American Dream: Comparing Medicare Reform Plans – The Heritage Foundation has proposed a premium support plan for Medicare as part of a comprehensive defict reduction package. This backgrounder looks at that proposal and five other plans that offer such supports. In a plan with a premium support, sometimes called a voucher, the government makes a fixed payment to Medicare beneficiaries, who then can shop for appropriate health insurance.  The author writes that, while details vary, each requires "traditional Medicare to compete with private plans, using competitive bidding to determine market-based payments to health plans, requiring upper-income retirees to pay more for their benefits, providing extra assistance to lower-income enrollees, and adding a risk-adjustment mechanism to guarantee market stability and security for older and sicker retirees. The breadth of the consensus on key policy components could be the basis for a strong bipartisan agreement" (Moffit, 4/4).

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

KQED's State of Health blog: Who Will Care for the Caregivers?
Some people who care for vulnerable older adults are in dire economic straits, according to a new study from the UCLA Center of Health Policy Research. Hundreds of thousands of people provide care – from cooking and cleaning to bathing and dressing – for adults with disabilities or long-term illnesses who receive benefits from Medi-Cal. ... At issue is the amount that Medi-Cal is paying these caregivers. Even if you add income from other jobs, they earn a little over $11 per hour on average (Menghrajani, 4/12). 

MedPageToday: Insurers Dodged Billions In Rebate Payments
If the Affordable Care Act's requirement that insurers spend at least 80% on patient care had come into effect a year early, policyholders would have received about $2 billion in rebates from insurance companies, according to a new report from the Commonwealth Fund. ... If that MLR provision had been in effect in 2010, 5.3 million people insured through the individual market -- or about half of everyone with individual coverage -- would have split $1 billion in rebates. Another $1 billion would have gone to about 10 million people with small- and large-group policies (Walker, 4/9).

Medscape: Should Statins Be Used in Primary Prevention? JAMA Gets in on the Debate
For Drs Rita Redberg and William Katz (University of San Francisco, California), who argue that healthy men should not take statins, there are other effective means to reduce cardiovascular risk, including dietary changes, weight loss, and increased exercise.  ... In their counterpoint, Drs Michael Blaha, Khurram Nasir, and Roger Blumenthal (Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD) agree that the cornerstone of treatment for patients with elevated cholesterol levels will always be diet and exercise but that statins can be a "critical adjunct for those identified to be at increased coronary heart disease risk" (O'Riordan, 4/10).

This Story: Print | Link to | Top

Editorials and Opinions

Viewpoints: Politics Distorting Views Of The Health System; U.S. Is More Efficient Than Most People Think

Los Angeles Times: Healthcare Reform Is About Lives, Not Just Politics
If health insurers can keep denying coverage to anyone, millions of Americans could be left to fend for themselves in a system that openly discriminates against the sick and leaves many destitute (David Lazarus, 4/13).

Chicago Tribune: When Is Judicial Activism Appropriate?
The Supreme Court's consideration of the constitutionality of the Patient Protection and Affordable Care Act has renewed debate about judicial activism versus judicial restraint. Liberals have warned that a U.S. Supreme Court decision invalidating this act would represent unwarranted judicial activism. In response, conservatives have accused liberals of hypocrisy. After all, if liberals celebrated the judicial activism of the Warren court, why should they decry the judicial activism of the Roberts court? (Geoffrey R. Stone, 4/13).

The Washington Post: Waiting For Mental Health Parity
Every day across the United States, families struggle with the challenges of mental illness or substance abuse. The 68 million Americans with these issues include people of all income levels, all races and all political affiliations. Mental illness does not discriminate (Pete Domenici and Gordon H. Smith, 4/12).

The Wall Street Journal: Cancer Care Grand Rounds
A persistent health-care myth is that the U.S. system is uniquely wasteful versus the European countries that spend far less per patient as a result of tight government control. Only the establishment experts who spread this myth will be surprised, but new research shows American patients are often getting more value—better outcomes and longer lives—in return for those extra dollars (4/12).

Boston Globe: How Human Nature Drives Up Health Costs
Imagine you are at a dinner party. The conversation turns to medical ailments. Joe says his orthopedist ordered an MRI on his sore back and reassured him that nothing terrible was wrong. Fred says that he also has a sore back, but his doctor told him that he didn't need an MRI and recommended he take it easy. Fred says he will go see Joe's orthopedist. Last week's recommendations by nine medical organizations to rein in medical testing by "choosing wisely’" would help bring down the costs of health care. But is choosing wisely in our blood? (Lisa Rosenbaum, 4/13).

Reuters: Romney Should Be Proud Of Massachusetts Health Law
It's been six years since Mitt Romney signed the Massachusetts healthcare reform law. That law was a framework for change, a values statement about what we believe in Massachusetts: that health is a public good and that everyone deserves access to affordable, high-quality healthcare. Six years after its passage, our experiment in universal healthcare is working, expanding coverage while helping to control costs. Mitt Romney should be proud of the law he signed. As the one responsible for implementing it, I know I am (Massachusetts Gov. Deval Patrick, 4/12).

Kaiser Health News: Different Takes: How Massachusetts Can Control Health Care Costs
It's been six years since Massachusetts put in place its own sweeping set of health reforms designed to expand access to health care. Today, more than 98 percent of residents are covered. Now public officials and the major stakeholders are debating the best ways to control rising health care costs and insurance premiums. Kaiser Health News asked Gov. Deval Patrick, Massachusetts Hospital Association President Lynn Nichols, Massachusetts' Health Care For All's Paul Williams and Massachusetts Medical Society's Lynda Young about their views on what's been accomplished so far and their take on how the state might tackle this next wave of policy challenges (4/12).

The New England Journal of Medicine: Controlling Health Care Spending — The Massachusetts Experiment
As debate rages on about implementation of the Affordable Care Act (ACA), national attention is once again focused on Massachusetts, which instituted a similar comprehensive health care reform package in 2006. After expanding health insurance coverage to almost 98% of the state population, Massachusetts is now struggling to control increasing health care costs that threaten the continued viability of its reforms. This second phase of health care reform presents entirely new challenges. Whereas expanding coverage has popular appeal, cost control does not (Zirui Song and Dr. Bruce E. Landon, 4/12).

Milwaukee Journal Sentinel: The Value Of Mammograms
(R)esearchers reported that 15% to 25% of breast cancers found on mammograms would not have caused a problem during the patient's lifetime; thus, early diagnosis led to those patients being treated with possibly unnecessary surgery, radiation therapy and chemotherapy. ... I am concerned that asking radiologists to raise their threshold for recommending biopsies will lead to an increase in stage at the time of initial diagnosis. ... I agree with the recent article's tenet that we may be identifying cancer in individuals who otherwise would live their lives completely unaware of their disease. However, of the 40,000 breast cancer cases analyzed in the study, 38,000 needed some form of treatment (Dr. Jodi Brehm, 4/12).

This Story: Print | Link to | Top

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.