Daily Health Policy Report

Wednesday, April 17, 2013

Last updated: Wed, Apr 17

KHN Original Reporting & Guest Opinion

Health Reform

Quality

Capitol Hill Watch

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

As Refugees Settle In, Health Care Becomes A Hurdle

Kaiser Health News staff writer Ankita Rao reports: "A refugee's relationship with American health care can vary widely by community and circumstances, said Heather Burke, a domestic team leader at the committee on migrant and refugee health at the Centers for Disease Control and Prevention. Refugees might be resettled in a well-established community with neighbors from their home country, or they may reach a destination where the government caseworker who greets them at the airport is the only person they know to call" (Rao, 4/17). Read the story.

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Capsules: Democratic Lawmakers Seek To Restore Drugmaker Rebates For 'Dual Eligibles'; Mississippi's Lone Abortion Clinic Is Still Open And Still Controversial

Now on Kaiser Health News' blog, Mary Agnes Carey reports on new legislation introduced regarding Medicare drug rebates: "The legislation would require drug companies to provide rebates to the federal government for drugs used by a group of beneficiaries often called "dual eligibles." These beneficiaries are predominantly low-income seniors and people with disabilities who qualify for both Medicare and Medicaid" (Carey, 4/16).

Also on the blog, Mississippi Public Radio's Jeffrey Hess, working in partnership with KHN and NPR, reports on the status of his state's only abortion clinic: "Protesters clashed Tuesday outside the Jackson Women's Health Organization, the only abortion clinic in Mississippi, which won a victory in federal court that allows the facility to continue to operate, at least for now. The legal victory for the clinic came Monday when U.S. District Judge Daniel Jordan III temporarily blocked a state law that requires all the doctors at the facility to have admitting privileges at a local hospital. The judge is preventing the law from taking effect until a legal challenge against it is settled" (Hess, 4/17). Check out what else is on the blog.

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Political Cartoon: 'Private I?'

Kaiser Health News provides a fresh take on health policy developments with "Private I?" by Ron Morgan.

Meanwhile, here is today's health policy haiku:

 

COMPARISON SHOPPING?

Diff'rent drug prices 
for two government programs:
What's the bottom line?
-Anonymous

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

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Health Reform

Hospitals Push Hard For Medicaid Expansion

Stateline reports that with billions at stake, hospitals are lobbying to change the minds of state lawmakers opposed to this health law provision. Meanwhile, Arkansas's House narrowly approved its "private option" approach to expansion, a day after the idea had been initially rejected. News outlets also offer progress reports from New Jersey, Iowa, Florida and California.

Stateline: Hospitals Lobby Hard For Medicaid Expansion
With billions of dollars at stake, hospitals are lobbying hard for Medicaid expansion in Columbus, Tallahassee and other state capitals where state legislators oppose the extension of the program to some 17 million Americans. Hospital associations have paid for television and newspaper ads, organized rallies, and choreographed legislative testimony in support of the Medicaid expansion, which is part of the Affordable Care Act. They also have united disparate groups which are used to being on opposite sides of legislative debates. In Columbus, for example, Ohio Right to Life and Planned Parenthood Advocates of Ohio are working side-by-side to persuade state lawmakers to approve the expansion. Both groups say they want to make health insurance available to the poor (Ollove, 4/17).

Politico: Ark. House Oks Medicaid Proposal
The Arkansas House on Tuesday narrowly approved the state’s unusual approach to Obamacare's Medicaid expansion, keeping alive an effort that has led several GOP-led states to consider similar ways of using health law dollars to cover low-income people with private insurance (Cheney, 4/17).

The Associated Press: Ark. House Passes 'Private Option' Medicaid Funds
Arkansas moved a step closer Tuesday to adopting an alternative to the Medicaid expansion called for under the federal health care law, as the state House approved a budget bill authorizing a program to subsidize private insurance for low-income residents. The plan — which would allow the state to use federal Medicaid funds to buy private insurance for 250,000 residents making up to $15,415 per year — is being eyed by a number of other states where Republicans have pushed for more flexibility under the federal health care law (4/16).

Philadelphia Inquirer: New Jersey Medicaid Expansion Seen As On Schedule
New Jersey is gearing up for a huge expansion of its Medicaid health-care plan for the poor and, despite uncertainty over federal eligibility requirements, new enrollees are expected to begin receiving services by the Jan. 1 deadline, Human Services Commissioner Jennifer Velez said Tuesday. Velez, who testified before the Assembly Budget Committee on her department's proposed $15 billion budget for the fiscal year that begins July 1, said she expected about 300,000 new Medicaid enrollees to be added to the 1.3 million who receive care under the program (Mondics, 4/17).

Des Moines Register: Medicaid Expansion Takes Center Stage At Statehouse
A parade of Iowans took turns at the Statehouse on Tuesday night arguing for expanding the state’s Medicaid health insurance program for the poor or for accepting an alternative plan proposed by Gov. Terry Branstad. The issue is one of the most controversial issues remaining before the Legislature this year, and could affect whether tens of thousands of poor Iowans have insurance next year. ... Kirk Norris, president of the Iowa Hospital Association, said legislators have plenty of room to compromise on the issue. The hospital association has been one of the most prominent supporters of expanding Medicaid, but is open to any plan that provides mental health coverage, allows care at hometown hospitals and provides coverage to everyone who makes up to 138 percent of the federal poverty level, or about $15,415 for a single person (Leys, 4/17).

Health News Florida: House Math Doesn't Add Up: Fasano
State Rep. Mike Fasano of Pasco County went through the math of the House's health plan and showed how any family poor enough to qualify for it would be unable to afford it. But then the House Select Committee on the Patient Protection and Affordable Care Act passed it anyway, with Republicans all voting yes and Democrats no (Gentry, 4/16).

HealthyCal: Faith-Based Organizations Help Step Up ACA Enrollment Efforts
By the time national health-care reform takes effect next year, Los Angeles County health officials expect to enroll 300,000 people in an expanded Medi-Cal program. But some estimates put the number of people eligible for the low-income insurance coverage countywide at more than half a million (Richard, 4/17).

In other state-level news regarding the health law -

CQ HealthBeat: On The Ground In Louisiana: A 'Tremendous Void' Of Health Law Information
From a controversial move to divert $450 million from a prevention fund to the federal exchange to a meeting last Friday with insurance groups, there are increasing signs that the Obama administration is stepping up its game when it comes to flakking upcoming coverage options under the health law. But in states like Louisiana that have huge uninsured populations, it appears there's an enormous dearth of information getting to those who could most benefit from the overhaul (Reichard, 4/17).

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Health Law Creates Challeges For Various Parts Of The System

News outlets report on a variety of implementation issues, including the question of how to provide treatment for the millions of people with addiction and alcohol dependencies who will have insurance for the first time and the difficulties faced by safety-net hospitals. In addition, one labor union is urging repeal.

The Associated Press: Millions More To Get Coverage For Addiction, Alcoholism Treatment, But Can The System Deliver?
It has been six decades since doctors concluded that addiction was a disease that could be treated, but today the condition still dwells on the fringes of the medical community. Only 1 cent of every health care dollar in the United States goes toward addiction, and few alcoholics and drug addicts receive treatment. One huge barrier, according to many experts, has been a lack of health insurance. But that barrier crumbles in less than a year. In a major break with the past, 3 million to 5 million people with drug and alcohol problems — from homeless drug addicts to working moms who drink too much — suddenly will become eligible for insurance coverage under the new health care overhaul (Johnson, 4/16).

The Washington Post's WonkBlog: Hospitals Serving The Uninsured Face Challenge Under Obamacare
Under the Affordable Care Act, the safety-net hospitals will gain a new source of revenue when millions of the uninsured gain coverage. At the same time, the law's spending cuts could prove challenging for hospitals that tend to operate with relatively small profit margins (Kliff, 4/16).

The Wall Street Journal's Washington Wire: Roofer Union Calls For Repeal Of Obama Health Law
A labor union representing roofers is reversing course and calling for repeal of the federal health law, citing concerns the law will raise its cost for insuring members. Organized labor was instrumental in getting the Affordable Care Act passed in 2010, but more recently has voiced concerns that the law could lead members to lose their existing health plans. The United Union of Roofers, Waterproofers and Allied Workers is believed to be the first union to initially support the law and later call for its repeal (Adamy, 4/16).

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Quality

Hospitals Profit When Surgeries Go Wrong, Study Finds

The study, which was published Tuesday in The Journal of the American Medical Association, found that hospitals earned 330 percent higher profit margins on surgeries with one or more complications, because private insurers pay them for longer stays and extra care.

The New York Times: Hospitals Profit From Surgical Errors, Study Finds
Hospitals make money from their own mistakes because insurers pay them for the longer stays and extra care that patients need to treat surgical complications that could have been prevented, a new study finds (Grady, 4/16).

The Wall Street Journal: Treatment Woes Can Bolster Hospitals' Profit
Hospitals have faced pressure for years to make visits to their wards safer. But their investments in everything from hand-washing campaigns to infection-fighting robots have done little to curb the thousands of yearly injuries and deaths caused by avoidable medical complications (Weaver, 4/16).

Politico: Study: Hospitals Profit When Surgeries Go Awry
Perverse financial incentives offered by private insurers and Medicare actually pad hospitals’ profits when surgeries go awry, according to the study. Hospitals earned 330 percent higher profit margins on surgeries with one or more complications when they were paid for by private insurers, according to the study (Cheney, 4/17).

Reuters: Reducing Complications May Cost Hospitals Money
U.S. hospitals may have a financial incentive not to implement strategies and techniques that are known to reduce surgery-related complications, according to a new study.The findings do not mean that "any hospital out there is saying, 'we can make more money if we have more complications,'" said Dr. Atul Gawande, the study's senior author from Brigham and Women's Hospital and the Harvard School of Public Health in Boston (Seaman, 4/16).

Modern Healthcare: Hospital Profits Higher With Patient Complications: Study
Hospitals earn higher profit margins when their patients experience surgical complications, according to a study in the Journal of the American Medical Association. The authors claim the study is the first to quantify how complications impact a hospital's bottom line and illustrate the challenge of pushing hospitals to improve outcomes when the current system still rewards more care over better care. After looking at more than 34,000 inpatient surgical procedures, the study authors found that profit margins were 330% higher when privately insured patients suffered at least one complication. Among Medicare patients, profit margins were 190% higher (Kutscher, 4/16).

The Hill: Study: Hospital Profits Soar When Surgeries Go Wrong
Hospitals profit heavily from their own mistakes, according to a study published Tuesday in the Journal of the American Medical Association. Hospitals make roughly $30,000 more from patients who suffer at least one complication than they do from patients whose procedures go smoothly, the research found (Baker, 4/16).

CNN Money: Hospital Finances Are Broken. How To Fix Them
American health care is screwed up. It is a bizarre market where the prices that patients pay do not match the quality of care. Unfortunately, that's old news. What is new is the nitty gritty -- details about why hospitals might not have any financial incentive to follow best practices. A new paper from researchers affiliated with Harvard, Boston Consulting Group and nonprofit health care delivery system Texas Health Resources suggests that, in some cases, providing worse care pays off for hospitals. On a hopeful note, some companies are stepping in to challenge the system. The research group published a paper in the Journal of the American Medical Association on April 16 that looked at more than 34,000 surgical patients who were discharged from 12 hospitals in 2010 (DuBois, 4/17).

In other news related to quality -

Reuters: Patient-Centered Care Linked To Better Outcomes
Patients tend to do better when their doctors pay attention to their individual needs and circumstances, according to a new study…[Dr. Saul] Weiner, a physician and health services researcher at Jesse Brown VA Medical Center and the University of Illinois at Chicago, said doctors are often focused on meeting recommended guidelines, such as prescribing certain medications for a condition like high blood pressure (Seaman, 4/16).

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Capitol Hill Watch

House-Senate 'Endgame Talks' Face Political Hurdles, Delays

The House GOP is moving slowly in naming negotiators to work through differences between the House- and Senate-passed budgets. The reason -- Republicans may want to avoid being on the record regarding politically-charged proposals related to Medicare and other issues. Also on Capitol Hill, new legislation was introduced regarding drugmaker rebates for "dual eligibles," and lawmakers scrutinize the Food and Drug Administration's oversight of drug compounders and raise concerns about electronic medical records.    

The Associated Press/Washington Post: After Demanding Budget Debate, GOP Resists Naming Negotiators For Endgame Talks
What may be really motivating House Republicans to delay is a wish to avoid a series of politically difficult votes that Democrats could force upon them soon after a conference committee is named. Democrats could force such votes on a daily basis for months if negotiations drag on, and the tallies on highly charged topics like Medicare could produce fodder for campaign commercials. "We don't want to ... have an endless process that focuses on our differences," Ryan said (4/16).

Kaiser Health News: Capsules: Democratic Lawmakers Seek To Restore Drugmaker Rebates For 'Dual Eligibles'
The legislation would require drug companies to provide rebates to the federal government for drugs used by a group of beneficiaries often called 'dual eligibles.' These beneficiaries are predominantly low-income seniors and people with disabilities who qualify for both Medicare and Medicaid (Carey, 4/16).

Politico: Lawmakers Blast FDA On Outbreak
House Energy and Commerce Committee Republicans blasted Food and Drug Administration Commissioner Margaret Hamburg on Tuesday for failing to crack down on the compounding pharmacy responsible for a deadly fungal meningitis outbreak last fall despite a history of known problems. The committee released a report at an oversight hearing Tuesday showing the agency chose to suspend its inspections of the New England Compounding Center and a sister company in 2011 while it worked to clarify its policy toward compounders (Norman, 4/17).

Medpage Today: GOP Report: FDA Failed To Act On Compounder
The FDA had all the authority it needed to take action against the compounding pharmacy at the center of last fall's fungal meningitis outbreak, the results of a Congressional investigation showed. However, the agency failed to act; 53 people died, and more than 700 were infected, Republican lawmakers said in a report issued Tuesday. … "In the 6 years following [a] 2006 Warning Letter, FDA failed to take any enforcement action against NECC or Ameridose despite receiving complaint after complaint, often relating to the safety of the companies' drugs," the report stated. "Though several inspections and related enforcement actions were considered during this time period, they were repeatedly delayed and ultimately cancelled” (Pittman, 4/16).

The Hill: GOP Senators Raise Concerns With Push For Electronic Medical Records
A 2009 law designed to promote electronic health records and make the healthcare system more efficient isn't living up to its goals, Republican senators said Tuesday. Six GOP senators, led by Sen. John Thune (R-S.D.) released a lengthy report Tuesday criticizing the execution of a $35 billion initiative to promote the use of electronic health records (Baker, 4/16).

Also in the headlines, the increasingly dark outlook for the federal government's long-term care panel and how the blanks are being filled in regarding this month's Medicare Advantage stock surge.

Medpage Today: Long-Term Care Panel Seen As Likely To Flop
Without financial support, the federal government's new unpaid and volunteer long-term care commission is likely to do little more than produce yet another report about the challenge of providing care for an aging nation, experts said. The federal Commission on Long-Term Care has been asked to evaluate long-term care in the U.S. and suggest solutions in a report due next fall. Just last month, President Obama appointed the final three of 15 panel members; three each were selected by Senate Majority Leader Harry Reid (D-Nev.), Senate Minority Leader Mitch McConnell (R-Ky.), House Speaker John Boehner (R-Ohio), and House Minority Leader Nancy Pelosi (D-Calif.). Commission members include a state Medicaid director, a nursing home executive, an advocate for persons with disabilities, and advocates for and against government involvement in long-term care financing (Struck, 4/16).

The Wall Street Journal: Stock Surge Linked To Lobbyist
A key source for a private report that sent health-care stocks on a tear earlier this month is a former top congressional aide who is now a health-industry lobbyist, according to emails reviewed by The Wall Street Journal. Mark Hayes is currently an outside lobbyist for health-insurance giant Humana Inc. His email to Washington investment-research firm Height Securities, alerting it to a government decision that will save the industry billions of dollars, was a final piece of confirmation Height received before blasting a news alert to its clients, according to emails and people familiar with the matter (Mullins, Strasburg and McGinty, 4/17).

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Health Care Marketplace

Amgen Agrees To $25M Settlement After Kickback Allegations

The biotech drug maker was accused of paying kickbacks to increase sales of its anemia drug Aranesp.

The Associated Press/Los Angeles Times: Amgen Will Pay $25 Million To Resolve Kickback Case 
The U.S. Department of Justice said Tuesday that biotech drug maker Amgen Inc. will pay $24.9 million to resolve claims it paid kickbacks to increase sales of its anemia drug Aranesp. The Justice Department said Amgen paid kickbacks to Omnicare Inc. and PharMerica Corp., which sell drugs to long-term care providers such as nursing homes and hospitals, and Kindred Healthcare Inc., which runs long-term acute-care hospitals and nursing and rehabilitation centers (4/16).

And Johnson & Johnson reported its first quarter profits are down --

The Associated Press/Washington Post: Johnson & Johnson's 1Q Profit Down 10.6 Pct As Higher Costs Offset Rising Drug, Device Sales 
Johnson & Johnson’s first-quarter profit fell by just over 10 percent as increased sales were offset by higher costs for production, marketing and administration, plus charges for litigation and other items. The maker of No More Tears baby shampoo, prescription drugs and surgical tools said Tuesday repeatedly during a conference call with analysts that revenue for a wide range of products is being hurt by "pricing pressures" from insurers and government health programs (4/16).

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Hospital Prices For Consumers Slow Slightly

Modern Healthcare: Hospital CPI Growth Eases In March
Hospital consumer prices increased 0.4 percent last month following the 0.8 percent gain in February, newly released figures from the U.S. Bureau of Labor Statistics show. By comparison, the March rise in hospital consumer prices a year ago was 0.3 percent, the agency's Consumer Price Index shows. Outpatient hospital consumer prices increased last month slightly faster, at 0.4 percent, than the 0.3 percent gain for inpatient prices (Evans, 4/16).

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State Watch

Sole Abortion Clinic In Miss. Remains Open After Judge Blocks State Law

Mississippi's sole abortion clinic remains open after a U.S. district judge blocked -- for now -- a state law that would require the clinic's doctors have admitting privileges at local hospitals. State officials had a hearing planned to consider revoking the clinic's license if it had not complied with the law.

The Wall Street Journal: Mississippi Clinic Gets A Reprieve From Judge 
Prior to the injunction granted earlier this week by U.S. District Judge Daniel Jordan III in Jackson, Miss., the state had scheduled a hearing this Thursday to consider revoking the license of the Jackson Women's Health Organization. The Mississippi Department of Health hearing was to determine whether the clinic was complying with a state law passed last year mandating that all doctors who practice at abortion clinics must have admitting privileges at a local hospital. If the clinic was found to be in violation, the state was expected to begin revoking the clinic's license (McWhirter, 4/16).

Kaiser Health News: Mississippi's Lone Abortion Clinic Is Still Open And Still Controversial
Protesters clashed Tuesday outside the Jackson Women's Health Organization, the only abortion clinic in Mississippi, which won a victory in federal court that allows the facility to continue to operate, at least for now. The legal victory for the clinic came Monday when U.S. District Judge Daniel Jordan III temporarily blocked a state law that requires all the doctors at the facility to have admitting privileges at a local hospital. The judge is preventing the law from taking effect until a legal challenge against it is settled (Hess, 4/17).

In Arkansas, abortion-rights groups are suing to stop a new state law that bans most abortions after 12 weeks of pregnancy --

The New York Times: Suit Seeks To Block Arkansas Abortion Law 
Supporters of abortion rights on Tuesday filed a challenge to the new Arkansas law banning most abortions at the 12th week of pregnancy, calling it a "violation of over 40 years of settled United States Supreme Court precedent" and a threat to "the rights, liberty and well-being of Arkansas women and their families" (Eckholm, 4/16).

The Associated Press/Washington Post: Groups Sue To Overturn Arkansas' New 12-Week Abortion Ban, Saying It's Unconstitutional 
The American Civil Liberties Union of Arkansas and the Center for Reproductive Rights, which filed the suit on behalf of Dr. Louis Jerry Edwards and Dr. Tom Tvedten, who provide abortions at a Little Rock clinic, say Arkansas' ban clearly contradicts the standard of viability established by the U.S. Supreme Court's landmark Roe v. Wade decision (4/16).

Reuters: Arkansas Sued Over Ban On Abortion After 12 Weeks Pregnancy
Groups supporting the right to abortion filed suit on Tuesday challenging an Arkansas law that would ban most abortions after 12 weeks, seeking to block one of the nation's most restrictive abortion measures before it takes effect in July. The Republican-controlled Arkansas legislature overrode Democratic Governor Mike Beebe's veto of the controversial measure in March (Parker, 4/16).

And North Dakota's governor has signed a measure into law that outlaws abortions there after 20 weeks of pregnancy --

The Associated Press/Washington Post: North Dakota Governor Signs 'Fetal Pain' Measure That Outlaws Abortions After 20 Weeks 
Republican Gov. Jack Dalrymple signed into law a measure that outlaws abortions after 20 weeks of pregnancy based on the disputed premise that at that point a fetus can feel pain. The law signed Tuesday is the latest among a raft of measures passed in North Dakota this session that are meant to challenge the U.S. Supreme Court's 1973 Roe v. Wade ruling that legalized abortion up until viability, usually at 22 to 24 weeks (4/16).

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State Roundup: Immigration Proposal Could Mean Big State Health Care Costs

A selection of health policy stories from California, Oregon, Georgia, Texas, North Carolina, Kansas and Massachusetts.

Los Angeles Times: Immigration Proposal Could Affect California Health Safety Net 
Making immigrants ineligible for public health benefits -- at least initially -- under proposed immigration law changes would push the costs of health care from the federal government to states and counties, said Sonal Ambegaokar, a health policy attorney at the National Immigration Law Center. And those costs could be sizable in a state like California, where there are an estimated 2.5 million illegal immigrants (Gorman, 4/16).

The Lund Report: Greenlick Wants Public Comment Period, But Ore. CCOs Resist
Rep. Mitch Greenlick, D-Portland, has put forth a compromise bill that would ensure greater public scrutiny of coordinated care organizations without putting them under Oregon’s public meetings law. House Bill 2960 would require that each monthly board meeting have a public comment period where people would have the right to address each CCO's board of directors. It would also require community advisory councils to meet in public (Gray, 4/16).

The Wall Street Journal: Kickbacks Alleged At Spine Hospital 
The U.S. attorney for the Central District of California is investigating allegations that a hospital executive paid kickbacks to physicians so they would refer their patients for spine surgery at his facility, according to people familiar with the probe. Over the past 15 years, Michael D. Drobot built a Southern California business empire centered on treating people with back problems, many of them workers' compensation patients. At the heart of the operation is Pacific Hospital of Long Beach, a 184-bed facility that Mr. Drobot bought in 1997 and turned into a spine-surgery center (Carreyou, 4/16).

Georgia Health News: Child Obesity Dips; Need For Healthy Food Remains
Georgia has recorded a 5 percent drop in its childhood obesity figures, according to state officials, citing new federal statistics. The decrease helped move Georgia's ranking as having the second most obese child population in the nation, which came from 2007 data, to No. 17 in the new figures, from 2011, Public Health officials say. … Recommendations in the report include governments aggressively marketing economic development programs and public incentives to the grocery industry for supermarket and other healthy food retail projects in underserved areas (Miller, 4/16). 

The Texas Tribune: Cancer-Fighting Charity Hired Tobacco Lobbyist
A beleaguered cancer-fighting charity paid a tobacco lobbyist $5,000 a month to represent its interests in the Texas Legislature, even as it was winding down its operations and facing the wrath of lawmakers (Root, 4/17).

The Texas Tribune: Interactive: Health Care Lobbying
Ahead of the 83rd legislative session, the state's 10 leading health care associations gave more than $4.6 million to Texas candidates. This interactive shows how much -- and to whom -- health care associations donated in 2011 and 2012 (Aaronson, 4/17).

North Carolina Health News: NC Medicaid Has Strengths, Weaknesses, But Broken?
Medicaid in North Carolina has some profound strengths and also some glaring weaknesses. In the second of a two-part story, we examine the question, how broken is Medicaid? (Hoban, 4/16).

Kansas Health Institute: Drug Screening Bill Signed Into Law
A bill authorizing state officials to order drug tests of people receiving or applying for unemployment or some welfare benefits was signed into law today by Gov. Sam Brownback. Senate Bill 149, which passed the House and Senate by large majorities, would allow officials to order the screening if they have a "reasonable suspicion" that an applicant or recipient of the benefits is using a "controlled substance” (Shields, 4/16).

Boston Globe: At Hospitals, Training For Disasters Gets Put To Test
Dr. Stephanie Kayden had just returned to the emergency room, after grabbing a slice of quiche in the hospital cafeteria. A resident pulled aside the senior doctor to discuss a pregnant woman who was vomiting. It was strangely serene for Marathon Monday. Suddenly, a dispatcher's voice crackled over a speakerphone at the nurses’ station. All Kayden caught was "Bombings" and "Copley Square." … Hospitals put in place long-rehearsed emergency plans, summoning help from across their campuses, and paging off-duty staff. Dozens of caregivers, including some unable to finish running the Marathon, simply showed up. (Kowalczyk, Lazar, Conaboy, 4/17).

California Healthline: Pre-Existing Conditions Bill Up For Final Vote
The Senate Committee on Appropriations yesterday unanimously approved ABX1-2 by Assembly member Richard Pan (D-Sacramento), the bill to ban pre-existing conditions as a means of denial for health coverage. It now heads to the Senate floor for a final confirmation vote. The bill already passed the Assembly, so Senate confirmation would be its ticket to the governor's desk. Brown Administration officials have said they support the bill (Gorn, 4/16).

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Editorials and Opinions

Viewpoints: Boston Hospitals, Doctors Rose To The Challenge; Physicians Need To Understand Health Law To Advise Patients; Florida's Budget Problems Could Be Eased By Medicaid Expansion

Boston Globe: Boston's Hospitals Make Their World-Class Presence Felt
If there is any silver lining in the violent Marathon attacks Monday, it is that Boston is home to some of the world's finest hospitals, physicians, nurses, and medical staff. These highly trained professionals must be thanked and praised for their calm, heroic response in the face of unprecedented carnage. They not only ably treated the wounded but also provided some of the most accurate information available in the first hours after the explosions. Care for the injured began at the scene, where the medical tents usually reserved for treating dehydration and blisters suddenly became field hospitals. First responders, including military medical personnel returned from Iraq and Afghanistan, raced to stem the bleeding and stabilize patients for transfer. Others simply sat with victims, holding their hands while trying to quiet anxieties as they waited for treatment (4/17).

Journal of the American Medical Association: Connecting To Health Insurance Coverage
October 1, 2013, marks the beginning of a new era when millions will be able to enroll in health insurance at the Health Insurance Marketplace. Ushering in this new era presents an enormous opportunity for the entire health care system. It has never been more important for physicians and other health care professionals to be engaged in connecting people to coverage. As a physician and nurse, respectively, we have too often witnessed how the lack of health insurance can negatively affect a patient's health. ... That is why clinicians should prepare now to understand the changes that are coming, the new benefits, the key deadlines, and opportunities for information and assistance. With the upcoming major shifts on the health care landscape, patients and the public will be turning to their physicians and other health care professionals to help them successfully navigate the future (Dr. Howard Koh and Marilyn Tavenner, 4/15). 

Tampa Bay Times: Math For Accepting Medicaid Only Gets Better
As the economy struggled, Florida deeply cut spending on public schools, higher education, land preservation, the courts and every other corner of discretionary spending. Now the state could save $430 million spent on a state health care program if legislators would agree to accept billions of federal dollars and expand Medicaid. But even those savings, which could be spent on other priorities, may not sway House Speaker Will Weatherford and other Republicans who refuse to accept federal Medicaid expansion money (4/16).

Politico: CO-OP Movement Far From Dead
Though it received little attention at the time, the "fiscal cliff" agreement rolled back a major component of the Affordable Care Act. Buried in the legislation was a provision to rescind nearly all of the unobligated funding for the health insurance CO-OP loan program. For a negligible savings, one of the key programs designed to drive innovation and lower costs will now only be available in half of the United States (Kent Conrad and John Morrison, 4/17).

Politico: Medicare Drug Rebates Needed
This week, Sen. Jay Rockefeller, (D-W. Va.), will introduce a bill to ensure Medicare and taxpayers pay lower prices for prescription drugs. The bill, known as the Medicare Drug Savings Act of 2013, would ensure taxpayers get a better deal by requiring drug manufacturers to once again provide rebates for prescription drugs for people who are dually eligible for Medicare and Medicaid and for lower-income Medicare beneficiaries. While Washington has been debating how to preserve a fiscally sound Medicare program, Rockefeller offers an important, relatively simple step forward (Judith Stein, 4/17).

The New York Times: The False Alarm Over U.S. Fertility
As a bipartisan group of senators prepares to release its plan for comprehensive immigration reform, a curious argument is emerging from across the political spectrum: the United States needs immigration to make up for its declining birthrate. … These fears are hogwash. Unlike many wealthy nations that will see their populations stabilize or decrease in coming decades, the United States, the world's third most populous country, is expected to grow — to 420.3 million by 2060 from 315.7 million people today. Our fertility rate (1.9 births per woman, slightly below the "replacement rate" of 2.1) has dipped since the Great Recession but is still among the highest of rich countries' and ties or exceeds fertility rates in middle-income countries like Brazil, Iran, Thailand and Vietnam (Derek S. Hoff, 4/16).

Health Policy Solutions: Growth In Senior Populations Requires Attention To Health Care Needs
Colorado has one of the fastest growing aging populations in the U.S. Currently, one in nine Coloradans is a senior citizen. By the year 2030, that will increase to about one in five. While Colorado historically has had one of the smallest percentages of seniors, our annual growth rate is now three percent above the national average. The increasing number and percent of older adults in Colorado presents new opportunities and challenges to communities across the state. With the baby boomer generation aging, a larger number of active older adults will be available to contribute to the community as volunteers, board members, community leaders, employees, and caregivers (Denali Johnson, 4/16).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Ankita Rao
Marissa Evans

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2012 Kaiser Health News. All rights reserved.