Daily Health Policy Report

Thursday, April 18, 2013

Last updated: Thu, Apr 18

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform


State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Health Insurance Actuaries In the Hot Seat On 'Rate Shock'

Kaiser Health News staff writer Jay Hancock, working in collaboration with Politico Pro, reports: "Few aspects of the Affordable Care Act are more critical to its success than affordability, but in recent weeks experts have predicted costs for some health plans could soar next year. Now health law supporters are pushing back, noting close ties between the actuaries making the forecasts and an insurance industry that has been complaining about taxes and other factors it says will lead to rate shock for consumers" (Hancock, 4/18). Read the story.

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Health On The Hill: Sebelius Gets Grilling In Senate Committee Hearing

Kaiser Health News staff writer Mary Agnes Carey talks with Jackie Judd about Wednesday's Senate Finance Committee hearing during which Chairman Max Baucus, a "key architect" of the health law, was "visibly angry and frustrated" as he questioned HHS Secretary Kathleen Sebelius about progress implementing the law (4/17). Listen to the discussion or read the transcript.

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Capsules: Report: Health Law Tax Credit Could Benefit 26 Million; The Medicare Budget Cuts No One Likes; Study: Patient Satisfaction May Not Be Good Quality Indicator; Innovators Preach Health Care Change At TED MED

Now on Kaiser Health News' blog, Mary Agnes Carey reports on Medicare budget cuts: "Just in case the Obama administration didn't know it already, cutting Medicare is hard to do. During a Senate Finance Committee hearing Wednesday on President Barack Obama’s fiscal 2014 budget, Democrats and Republicans proved that. Both Republicans, who have sought major changes to entitlements, and Democrats, who have vowed to preserve the programs, expressed concerns with the president's blueprint" (Carey, 4/18).

In addition, Jay Hancock reports on a new Families USA report detailing who might benefit from the health law's tax credits: "As experts focus on the cost of requiring everybody to have health coverage next year, a new study highlights the broad reach of federal subsidies to help people pay for it. Nearly 26 million Americans will be eligible for tax credits under the Affordable Care Act to partly offset the cost of insurance in online state marketplaces, says Families USA, a consumer interest group that supports the health law" (Hancock, 4/18).

Also on the blog, Jordan Rau reports on findings from a patient satisfaction study: "You may have found your doctor to be a great communicator, your hospital room clean and quiet and your pain well controlled. Yet a study finds these opinions are not barometers of whether your hospital's surgical care is any good" (Rau, 4/17).

And, Ankita Rao reports on TEDMED: "The annual conference, part of the media and innovation company TED (of new-media favorite TED Talks) is being held this week at Washington's John F. Kennedy Center For Performing Arts, and it features a range of speakers meant to stir imaginative solutions and conversations around health care. There are also TEDMED live events happening in 81 countries, with broadcasts reaching an estimated 200,000 people" (Rao, 4/17). Check out what else is on the blog.

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Political Cartoon: 'Down To The Wire?'

Kaiser Health News provides a fresh take on health policy developments with "Down To The Wire?" by Steve Sack.

Meanwhile, here is today's health policy haiku:


Karl says to Kathleen:
Our govs are not the problem…
It is 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.

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Capitol Hill Watch

A Health Law Architect Worries That Public Confusion Could Lead To 'Train Wreck'

At a Wednesday Senate Finance Committee Hearing, Sen. Max Baucus, D-Mont., grilled Health and Human Services Secretary Kathleen Sebelius about what the administration is doing to educate the public as it rolls out key provisions of the law.

The Washington Post: Senator Gives Administration 'F’ On Public Education For Health-Care Law
A Democratic senator who helped craft President Obama’s signature health-care law gave the administration "a failing grade" Wednesday for its efforts to educate the public and small employers about sweeping changes set to take effect in eight months (Morgan, 4/17).

The Associated Press/Washington Post: Co-Author Of Obama Health Care Law Sees 'Huge Train Wreck' In Implementation
Baucus is the first top Democrat to publicly voice fears about the rollout of the new health care law, designed to bring coverage to some 30 million uninsured people through a mix of government programs and tax credits for private insurance. Polls show that Americans remain confused by the complex law, and even many uninsured people are skeptical they will be helped by benefits that start next year (4/17).

The New York Times' The Caucus: Misconceptions Could Lead To Health Law 'Train Wreck,' Baucus Warns
A routine Senate budget hearing turned into a public scolding as a prominent backer of the health care overhaul warned that a lack of public information could cause a "train wreck" as the law's implementation moves forward (Wheaton, 4/17).

The Wall Street Journal's Washington Wire: Baucus Warns of Health-Law 'Train Wreck'
Mr. Baucus, the Senate Finance Committee chairman and a key figure in the crafting of the overhaul, grilled Health and Human Services Secretary Kathleen Sebelius at a Senate hearing Wednesday morning, telling her that he was getting increasingly worried because she couldn't give him the answers he wanted to assess the administration's progress (Radnofsky, 4/17).

Politico: Max Baucus Worried About Health Law 'Train Wreck'
After the hearing, Baucus explained that the train wreck is "that consumers and businesses will just not have enough information. That it will be too confusing." He also expressed frustration that the White House and HHS are not providing details of its outreach efforts (Haberkorn, 4/17).

Kaiser Health News: Health On The Hill: Sebelius Gets Grilling In Senate Committee Hearing
Kaiser Health News staff writer Mary Agnes Carey talks with Jackie Judd about Wednesday's Senate Finance Committee hearing during which Chairman Max Baucus, a "key architect" of the health law, was "visibly angry and frustrated" as he questioned HHS Secretary Kathleen Sebelius about progress implementing the law (4/17).

CQ HealthBeat: Sebelius Aims To Set Record Straight On Small Business Exchanges
Among the groups most confused about the health care law are small businesses — a charge Chairman Max Baucus leveled at a Senate Finance Committee hearing Wednesday. But Health and Human Services Secretary Kathleen Sebelius sought to clear away at least one area of confusion: what choices will be offered to small businesses and when the new insurance marketplaces — called SHOP exchanges — will be available (Reichard, 4/17).

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Former Congressional Staffer Faces Scrutiny In Medicare Advantage Leak

Sen. Chuck Grassley, R-Iowa, continues asking questions about a recent Medicare Advantage leak that reverberated through the stock market, while members of the Senate Finance Committee react to the Medicare funding reductions advanced by President Barack Obama.

Politico: Chuck Grassley Eyes Former Aide In Medicare Advantage Leak
A Washington law firm and a former congressional aide are facing scrutiny over a leak of sensitive details on Medicare Advantage payment rates that may have sparked hundreds of millions of dollars in stock trading on insurance companies before the information was made public. Sen. Chuck Grassley (R-Iowa) is questioning whether a lobbyist at Greenberg Traurig, a K Street law firm, tipped off Height Securities, a political intelligence firm, regarding a soon-to-be-announced increase in Medicare Advantage rates. Height quickly put out an investor alert before the markets closed on April 1 -- and before the government announced it was raising the rates after earlier proposing the largest cuts in the history of Medicare Advantage (Millman, 4/17).

Kaiser Health News: Capsules: The Medicare Budget Cuts No One Likes
Just in case the Obama administration didn't know it already, cutting Medicare is hard to do. During a Senate Finance Committee hearing Wednesday on President Barack Obama's fiscal 2014 budget, Democrats and Republicans proved that. Both Republicans, who have sought major changes to entitlements, and Democrats, who have vowed to preserve the programs, expressed concerns with the president's blueprint (Carey, 4/18).

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Health Reform

Ark. Medicaid Expansion Plan Survives Gains State Legislators' Final OK

The GOP-controlled legislature narrowly approved the compromise that would use federal funds to buy private insurance for low-income residents.

The Associated Press: Arkansas OKs Compromise Plan To Use Federal Medicaid Expansion Funds For Private Insurance
Arkansas' plan to use federal money to buy private insurance for low-income residents won final approval from state lawmakers Wednesday, endorsing a model that several other states are eyeing as a possible alternative to expanding Medicaid. The Republican-controlled Legislature narrowly reached the three-fourths majority needed to pass the proposal, which was a compromise reached between leading GOP lawmakers and Democratic Gov. Mike Beebe (Stratford, 4/18).

Modern Healthcare: State Reform Update: Ark. Medicaid Alternative In Spotlight As Other States Mull Similar Plans
The bumpy advance of Arkansas' unusual Medicaid plan is continuing to get notice in other conservative-leaning states. It's also likely to draw intense federal scrutiny if it keeps moving. The state's plan to expand Medicaid coverage through the private health insurance on the state's coming federal insurance exchange gained passage Tuesday in the Republican-led House, 77-23, after it failed in the same chamber a day earlier. The approach is seen as an attractive compromise in other Republican-led states where healthcare providers and others are lobbying officials to find a way to raise Medicaid eligibility and qualify for new federal funding under the Patient Protection and Affordable Care Act (Daly, 4/17).

California Healthline: Arkansas Medicaid Plan May Not Change Game After All
For seven heady weeks, Arkansas -- not Massachusetts, or Oregon, or California -- has been at the center of the health policy world. The state's eye-catching proposal to expand health coverage with Medicaid dollars but using private insurance raised questions for policy wonks and lawmakers across the nation. Was the plan legal? Was expanding coverage by relying on private payers too expensive? Would other states follow suit? ... While Republicans in several other states -- including Florida, Louisiana, Ohio, Pennsylvania, Tennessee and Texas -- had expressed interest in their own version of the private option, that ardor has cooled in recent weeks because of an HHS memo that essentially set a high bar for participation, according to Matt Salo, executive director of the National Association of Medicaid Directors (Diamond, 4/17).

Meanwhile, in Florida -

The Associated Press: Fla. Senate Panel Approves 2 Insurance Proposals
A Senate panel on Wednesday passed two very different proposals to expand health insurance for low-income Floridians under the federal health law, leaving billions of federal dollars at stake. With less than three weeks left in the Legislative session, lawmakers in the House and Senate are still worlds apart on whether to accept as much as $50 billion from the feds over the next decade to offer health coverage to roughly 1.1 million residents or to rely on state funds to cover only about 115,000 residents (Kennedy and Fineout, 4/17).

Health News Florida: Senate Panel Passes 2 Medicaid Plans: 1 Big, 1 'Teeny Weeny'
Two more different health plans for low-income people could hardly be imagined. But the Senate Appropriations Committee for Health and Human Services adopted both of them, to keep the Senate's options open in dealing with the House. House Republican leaders have refused to consider accepting any federal funds, even though an estimated $51 billion over a decade is available for the asking (Gentry, 4/17).

And in news from other states -

Des Moines Register: Critic Calls Branstad's Health Plan 'IowaCare On Steroids'
A leader of the Iowa Hospital Association warned legislators Wednesday that many poor Iowans could continue to be denied close-to-home care if the state forces them to choose hospitals participating in new Accountable Care Organizations. That idea is stressed in Gov. Terry Branstad’s Healthy Iowa Plan, which is an alternative to expanding the state’s Medicaid program (Leys, 4/18).

Billings (Mont.) Gazette: Montana Senate Dems, Handful Of Republicans Roll New Medicaid Program Into 'Compromise' Bill
In dramatic fashion, Senate Democrats and a handful of Republicans Tuesday defied the body’s GOP leadership to cram a Medicaid proposal into a bill that would use federal dollars to buy private health insurance for thousands of uninsured, low-income Montanans. The same coalition then endorsed the measure on a 27-23 vote, setting up a final vote Thursday and a possible showdown in the state House over whether the contentious Medicaid proposal may head directly to Democratic Gov. Steve Bullock for his signature (Dennison, 4/16).

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Implementation: Tax Subsidy Projections, Finding Money For High-Risk Pools

Health law backers question the predictions of insurance "rate shock," because they are made by actuaries who have close ties to the industry. Meanwhile, news outlets report on a study that projects who will get the health law's tax subsidies on a state-by-state basis.

Kaiser Health News: Health Insurance Actuaries In the Hot Seat On 'Rate Shock'
Few aspects of the Affordable Care Act are more critical to its success than affordability, but in recent weeks experts have predicted costs for some health plans could soar next year. Now health law supporters are pushing back, noting close ties between the actuaries making the forecasts and an insurance industry that has been complaining about taxes and other factors it says will lead to rate shock for consumers (Hancock, 4/18).

USA Today: Study: Most Health Subsidies To Aid Working Families
The majority of tax subsidies to help Americans pay for health insurance starting in January will go to working families, according to a nationwide study to be released Thursday and obtained by USA TODAY (Kennedy, 4/18).

Kaiser Health News: Capsules: Report: Health Law Tax Credit Could Benefit 26 Million
As experts focus on the cost of requiring everybody to have health coverage next year, a new study highlights the broad reach of federal subsidies to help people pay for it. Nearly 26 million Americans will be eligible for tax credits under the Affordable Care Act to partly offset the cost of insurance in online state marketplaces, says Families USA, a consumer interest group that supports the health law (Hancock, 4/18).

Oregonian: More Than 400,000 Oregonians Will Be Eligible For New Federal Health Care Tax Credits: Report
About 400,000 Oregonians will be eligible for new federal tax credits to help pay for health insurance premiums next year, according to a study released by a pro-reform advocacy group. The study, released by the nonprofit Families USA, for the first time puts a number on those whose income qualifies them for a sliding scale of tax credits available under the federal Affordable Care Act. The law was passed by Congress in 2010 to expand health care coverage. The tax credits will in some cases eliminate premium costs, and in other cases they will lower those costs. To qualify, recipients will have incomes ranging from 138 percent to 400 percent of the federal poverty level (Budnick, 4/17).

Also in the news, the health law's struggling high-risk pools draw congressional attention -

The Hill: Dems Offer Alternate Ways To Fix ObamaCare's High-Risk Pools
A new bill from House Democrats would reopen enrollment in ObamaCare's struggling temporary insurance plan by raising taxes on cigarettes. The measure from Rep. Frank Pallone (N.J.) and colleagues counters GOP legislation that would shore up the Pre-Existing Conditions Insurance Plan (PCIP) using funds for public and preventive health initiatives. The Republican bill was introduced Monday and marked up Wednesday morning (Viebeck, 4/17).

Modern Healthcare: GOP Backs Prevention Cuts To Fund High-Risk Pool
House Republicans moved to divert money from the healthcare reform law's prevention and public health fund to shore up a program the law created to give temporary relief to Americans who can't otherwise afford health insurance because of pre-existing conditions. The committee voted 27 to 20 along party lines to approve H.R. 1549, known as The Helping Sick Americans Now Act. The legislation would fund the Pre-Existing Condition Insurance Plan through the remainder of the year. HHS suspended enrollment in February after the $5 billion appropriated for it ran dry (Block, 4/17).

And the latest on health exchanges and consumer "helpers" -

CQ HealthBeat: Navigators, Assisters, Counselors Pack The Ranks Of Exchange Helpers
When enrollment in the new health insurance exchanges launches in October, states with federally operated exchanges may have far fewer government-funded people to help consumers choose plans than states that decided to run their own exchanges. Yet many of those states with federal exchanges are also home to the largest crowds of uninsured people who will need information and hand-holding when they sign up for coverage (Norman, 4/17).

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Study Finds Tax-Exempt Hospitals Spend Little On 'Community Benefit'

New research also offers insights regarding the value of patient satisfaction as a quality indicator and the impact that context has on improving care.

Medpage Today: Hospitals Spend Little On Health Of Community
Tax-exempt hospitals spend only a very small fraction of their operating expenses on improving community health, researchers found. In 2009, of the mean 7.5 percent of operating expenses set aside for community benefits by tax-exempt hospitals, an average of 5 percent of that very small slice was used to improve health in the community, according to Gary Young, PhD, of Northeastern University in Boston, and colleagues. The majority of fiscal community benefit resources -- 85 percent -- were used for charity care and other care-related services, while the remaining 10 percent was used for education, research, and community group contributions, they wrote in the April 18 New England Journal of Medicine (Petrochko, 4/17).

Los Angeles Times: Study Questions 'Community Benefits' Paid By Tax-Exempt Hospitals
Private, tax-exempt hospitals spent an average of 7.5 percent of their operating expenses on community benefits in 2009, according to a new study that raises questions about whether the amount is enough. Overall, the study published Wednesday in the New England Journal of Medicine showed hospitals "varied widely" in the level of "community benefits" they provided, ranging from 20 percent of the operating budget at some to 1 percent at others. They concluded that most of the expenditures benefited patient care while "little was spent on community health improvement" (Bloomekatz, 4/17).

Kaiser Health News: Capsules: Study: Patient Satisfaction May Not Be Good Quality Indicator
You may have found your doctor to be a great communicator, your hospital room clean and quiet and your pain well controlled. Yet a study finds these opinions are not barometers of whether your hospital's surgical care is any good (Rau, 4/17).

Medpage Today: Care Improves When Docs Consider Context
Patients benefit when clinicians included "context" -- life circumstances and needs -- in decision-making and formulating care plans, an observational study found. Just over 70 percent of patient-physician encounters that produced a "contextualized" plan for care led to a positive outcome, compared with 46 percent of visits that disregarded patient life factors, according to Saul J. Weiner, MD, of the University of Illinois at Chicago, and colleagues. After controlling for variables such as clinician gender, patients with contextualized care plans -- also called patient-centered decision making -- were almost four times as likely to show improvements, the researchers reported in the April 16 issue of Annals of Internal Medicine (Walsh, 4/17).

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State Watch

Kids Mental Health Cuts At Issue In Mass.; Colo. Mulls Mental Illness 'Hold' Laws

Massachusetts officials are planning hearings about the Cambridge Health Alliance's planned cuts to pediatric services -- mainly to mental health care, while Colorado lawmakers consider their "involuntary hold" laws governing the treatment and holding of mentally ill people deemed a danger to themselves or others.

Boston Globe: Hearings Scheduled On Proposed Pediatric-Care Cuts
The Department of Public Health will hold a hearing May 8 on Cambridge Health Alliance’s plans to eliminate 11 of 27 beds for treating children and teens with acute mental illness. Hospital officials said this month that they planned to consolidate their child and adolescent units, the latest in years of steady statewide cuts to pediatric services. While several other hospitals have psychiatry units that serve children of all ages, Cambridge Health Alliance's Child Assessment Unit accounts for nearly one-third of the hospital mental health beds in Massachusetts designated specifically for the younger age group, typically under 12 (Conaboy, 4/17).

Health Policy Solutions (a Colo. news service): Colorado Clarifying Involuntary Hold Laws
Colorado is the only state in the country where three separate laws govern the actions of police, emergency doctors, mental health and substance abuse experts  when patients appear to be a danger to themselves or others and need to be held against their will for 72 hours. A new law winding its way through the legislature … for the first time defines key terms related to involuntary holds including "danger to self or others" and what it means to be "gravely disabled" because of a mental health crisis. Originally intended to meld and clarify the three disparate involuntary commitment laws, the bill instead creates a task force of health and law enforcement experts who will spend the summer studying how best to streamline Colorado’s laws relating to emergency holds. The task force is expected to produce draft legislation for 2014 (Kerwin McCrimmon, 4/17).

In Connecticut, many look for answers on preventing mental illness --

CT Mirror: 'The Single Greatest Preventable Cause Of Mental Illness'
Sometimes the symptoms suggest anxiety or attention deficit hyperactivity disorder. But often, the root cause is something else: sexual abuse, domestic violence, the loss of a parent, surviving a car accident, or another form of trauma. "Trauma is missed all the time because the lay person doesn't really recognize the connection between a child or adolescent's misbehavior and how that misbehavior can be a result of a traumatic incident that happened to them," said Kane, a psychologist and vice president for child services at Waterbury-based Wellmore Behavioral Health (Becker, 4/17).

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Medical Costs After Boston Bombing Could Tally Into Millions

Boston -- with its many centrally located medical facilities -- was primed to care for the victims of this week's Boston Marathon bombing. In the meantime, the medical bills for the trauma care given after the bombing could tally into the millions, some estimate.

Politico: 'Medical Mecca' Boston Was Equipped For Mass Trauma
Here's an unsettling thought: Monday's Boston Marathon carnage could've been a whole lot worse if it had happened almost anywhere else. But the bombings happened in the heart of a world-class medical cluster. And local hospitals were already bracing for a flood of patients -- though they were expecting dehydrated runners, not blast and burn victims, some of whom had lost limbs (Cheney, 4/18).

NBC News: Vitals: Bomb's Medical Costs Could Be In The Millions, Experts Say
As surgeons and physicians worked to mend nearly 70 hospitalized victims of the Boston Marathon bombing, a new toll emerged: The total medical costs inflicted by the attack may eventually reach or surpass $9 million, according to a rough calculation. The precise health-care price tag won’t be fully known for months as some of the injured, particularly those who lost limbs, undergo extended rehabilitation (which can cost more than $200 per hour) to re-learn walking. … A blend of million-dollar donations, Massachusetts' mandatory health insurance -- and perhaps an agreement by Boston hospitals and insurance providers to eat some bills -- may compose the safety net that ultimately covers the staggering medical costs, say mass casualty experts (Briggs, 4/17).

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State Roundup: D.C. Delegate Joins Abortion Bill Fight

A selection of health policy stories from California, the District of Columbia, Puerto Rico, Georgia, Minnesota, Oregon and Colorado.

Los Angeles Times: CalPERS Picks Four New HMO Plans For 5-Year Contracts
The California Public Employees' Retirement System picked four new HMO plans for five-year health insurance contracts starting next year, a blow to incumbent carrier Blue Shield of California. The giant pension fund voted Wednesday to split up Blue Shield's statewide HMO contract and offer additional plans from Anthem Blue Cross, UnitedHealth Group Inc., Sharp Health Plan and Health Net Inc. alongside Blue Shield (Terhune, 4/17).

The Hill: Norton Fires Warning Shots Over Impending DC Abortion Bill
Del. Eleanor Holmes Norton (D-D.C.) vowed Wednesday to join with abortion-rights groups and fight a forthcoming GOP bill to ban most abortions in the District of Columbia after 20 weeks of pregnancy (Viebeck, 4/17).

The Associated Press: Doctors Flee Puerto Rico For U.S. Mainland
Going to the doctor in Puerto Rico has for years often meant getting in line. Now, it might mean getting on a plane. A medical exodus is taking place in the Caribbean territory as doctors and nurses flee for the U.S. mainland, seeking higher salaries and better reimbursement from insurers. Many of their patients, frustrated by long waits and a scarcity of specialists, are finding they have no choice but to follow them off the island (Coto, 4/16).

Georgia Health News: Southeast Seniors Get Risky Meds More Often
Seniors in the Southeast take more high-risk medications than their counterparts in other regions, a study has found. Nationally, about one in five people in Medicare Advantage plans take at least one of these dangerous drugs. But in many parts of the Southeast, including Georgia, the percentage of seniors in these plans taking high-risk medications is about one in three (Miler, 4/17).

MPR News: Rochester Town Hall Focuses On Mayo Clinic Expansion Plan
Mayo Clinic's proposed expansion plan in Rochester drew more than 200 people to a town hall meeting Wednesday evening. The hour-long forum focused on what Rochester needs to do to retain Mayo Clinic and improve infrastructure over the next 20 years. Mayo Clinic's proposal is still making its way through the state Legislature. Panelists included the bill's sponsors, DFL Rep. Kim Norton and Republican Sen. Dave Senjem, as well as Mayo Clinic representatives and city officials (Baier, 4/17).

Lund Report: Private Insurers May Be Forced To Keep Coverage For Inmates
Jails and prisons are required by law to provide necessary health care to anyone in custody -- the Supreme Court has said anything else would be inhumane. But the minute someone is arrested or jailed, the federal government stops providing health care coverage, and many private insurers follow suit. The situation leaves county sheriff’s offices with an unfunded mandate -- precisely at the time health care costs are skyrocketing and county budgets in Oregon are being decimated, either from the recession or the loss of timber subsidies (Gray, 4/17).

Lund Report: Bates Offers Path For CCOs To Roll In Dental Networks
Sen. Alan Bates, D-Medford, has pushed a last-minute bill that would require coordinated care organizations to first provide contracts to all the dental care organizations in its geographic area before hiring independent dentists. Senate Bill 373 has an escape clause allowing a CCO to boot a dental organization that fails to meet the CCO's standards. The amended bill also allows dental organizations to pool their resources and sign a uniform contract with a CCO (Gray, 4/17).

Oregonian: Legislation Calling For Healthier Snacks In Oregon Vending Machines Turns Into Task Force Bill
A divisive bill that would have mandated healthier snacks in vending machines has turned into more palatable legislation creating a new 15-person task force to study how to offer more nutritious options in public buildings. Oregon Rep. Alissa Keny-Guyer, D-Portland, offered the friendly "gut and stuff" of her original bill, saying that the idea warranted a broader look at the barriers to and benefits of healthful snacking among state workers (Har, 4/17).

Health Policy Solutions (a Colo. news service): Fight For Universal Care Just Beginning
Sen. Irene Aguilar, D-Denver, withdrew her universal health care bill but has no intention of giving up the fight. … Aguilar introduced a different measure calling for a study of universal care. That measure … passed the Senate and now moves to the House. Aguilar has twice introduced measures into the Colorado Legislature -- both in 2010 and this year -- seeking universal health care only to face a buzz saw of opposition from health insurance and business lobbyists. This year, Aguilar hoped to win support from at least one Republican colleague so that she could put an amendment to the Constitution before Colorado voters seeking universal care (Kerwin McCrimmon, 4/17).

California Healthline: New Bill Proposes Insurer Fee To Expand Residencies
An Assembly committee yesterday approved a plan to provide a major boost to California's physician-training residency programs by generating roughly $100 million a year with a $5-per-covered-life fee to be imposed on health care insurers. The new bill is one of several legislative efforts to address a provider shortage in California that's likely to intensify when the Affordable Care Act is implemented and Medi-Cal is expanded starting in 2014. AB 1176, co-authored by Assembly member Raul Bocanegra (D-Pacoima) and Assembly member Rob Bonta (D-Oakland), would expand the number of resident physicians in California by an estimated 1,000 with the expectation that new physicians would remain in California and practice in the underserved areas where they fulfilled their residency training (Gorn, 4/17).

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Weekend Reading

Longer Looks: Problems With Aging Doctors; Transplants From Donors With HIV

Every week reporter Ankita Rao selects interesting reading from around the Web.

The New Yorker: Why Boston's Hospitals Were Ready
The bombs at the Boston Marathon were designed to maim and kill, and they did. Three people died within the first moments of the blast. More than a hundred and seventy people were injured. They had their limbs blown off, vital arteries severed, bones fractured, flesh torn open by shrapnel or scorched by the blasts' heat. Yet it now appears that every one of the wounded alive when rescuers reached them will survive. Medically speaking, this is no small accomplishment (Dr. Atul Gawande, 4/17).

The New York Times: For Trauma Surgeons, Saving Lives, If Not Legs, With No Time To Fret
So many patients arrived at once, with variations of the same gruesome leg injuries. Shattered bones, shredded tissue, nails burrowed deep beneath the flesh. The decision had to be made, over and over, with little time to deliberate. Should this leg be amputated? What about this one? ... The toll from the bombs Monday at the Boston Marathon, which killed at least three and injured more than 170, will long be felt by anyone involved with the city’s iconic sporting event (Gina Kolata, Jere Longma and Mary Pilon, 4/16).

Time: How Terror Hijacks the Brain
Fear short circuits the brain, especially when it hits close to home, experts say— making coping with events like the bombings at the Boston Marathon especially tricky. "When people are terrorized, the smartest parts of our brain tend to shut down," says Dr. Bruce Perry, Senior Fellow of the ChildTrauma Academy. (Disclosure: he and I have written books together). When the brain is under severe threat, it immediately changes the way it processes information, and starts to prioritize rapid responses (Maia Szalavitz, 4/16).

The New York World: Are Some Doctors Too Old To Practice Medicine?
While only a little over one-quarter of New York State's doctors are 60 or older, more than 40 percent of all the enforcement actions taken by the state since 2008 targeted senior doctors, according to an analysis of recently published actions by the state Office of Professional Medical Conduct. ... Specialty boards—like orthopedic surgery and internal medicine—do require physicians to recertify, usually about every 10 years. And hospitals by and large won't grant privileges to a doctor that doesn't have certification. But board certification is not a requirement for state licensure to practice — meaning those that work outside of a hospital setting have no duty to remain certified. In 2010, about 1 in 5 doctors in New York State were not board certified (Curtis Skinner, 4/12).

Related KHN coverage: Aging Doctors Face Greater Scrutiny (Boodman, 12/10).

Slate: A Kidney For A Kidney
Last month, the Senate Health, Education, Labor and Pensions Committee made life a little better for people awaiting an organ transplant. It passed the HIV Organ Policy Equity (HOPE) Act, legislation designed to end the federal ban on research into organ donations from deceased HIV-positive donors to HIV-positive recipients. It would permit the Secretary of Health and Human Services to sanction such transplant operations if the research establishes their safety (Sally Satel, 4/15).

The New Yorker: How Damaged Are N.F.L. Players' Brains?
In November of 2010, a few dozen retired players from the National Football League gathered with their wives in a large living room. Snacking on appetizers and soft drinks, they listened to an informal pitch by John Hart, Jr., a neurologist at the University of Texas at Dallas. He wanted to scan their brains. Since that first meeting, Hart's team has recruited more than fifty former N.F.L. players for an ongoing study tracking their brain connections and mental health. The scientists' latest batch of data, presented at a meeting of the Cognitive Neuroscience Society in San Francisco on April 15th, shows that retired N.F.L. players are more likely to have memory problems and depression than non-athletes of the same age, and that these deficits may stem from damage in certain bundles of white matter in the brain. But the researchers were more surprised by what the study didn't show: nearly sixty per cent of the group had no mood issues, cognitive disability, or irregular brain patterns (Virginia Hughes, 4/16).

NewsHour: The Day Polio Began Losing Its Grip on America
April 12, 1955, was supposed to be Tommy Francis's day. At 10:20 a.m., the distinguished epidemiologist conducted an international press conference in Rackham Auditorium at the University of Michigan. The topic was the field trial he had just completed -- the largest of its kind ever -- evaluating the efficacy of the poliovirus vaccine developed by Dr. Jonas Salk at the University of Pittsburgh. ... By early 1953, Salk had begun campaigning relentlessly for a national field trial of his vaccine. For this critical but unglamorous task, the NFIP turned to Salk's former teacher, Thomas Francis, who had introduced Salk to the design of killed-virus vaccines at the University of Michigan School of Public Health (Dr. Howard Markel, 4/12).

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Editorials and Opinions

Viewpoints: Karl Rove Says GOP Reluctance Isn't Hampering Exchanges; CDC's Efforts On 'Sugary' Snacks Assailed

The Wall Street Journal: Steaming Toward the ObamaCare 'Train Wreck'
In congressional testimony last week, Health and Human Services Secretary Kathleen Sebelius blamed Republican governors for her department's failure to create a "model exchange" where consumers could shop for health-insurance coverage in states that don't set up their own exchange. Nice try, but GOP governors aren't the problem. Team Obama's tendency to blame someone else for its shortcomings is tiresome (Karl Rove, 4/17). 

The Wall Street Journal's Wonderland: Clinging To Guns—And Abortion 
Everyone clings to something. But when it comes to criticizing unseemly political dependencies, it's almost always liberals accusing [conservatives] of clinging to positions and ideas that an enlightened society would have abandoned. But what do liberals cling to? Recent events have revealed two things. Gun control and abortion (Daniel Henninger, 4/17). 

Politico: CDC Needs Balance
Following the passage of the American Recovery and Reinvestment Act, more commonly known as the stimulus, the Centers for Disease Control and Prevention was allocated taxpayer dollars to award grants for wellness efforts — on its face, a worthy effort. However, these taxpayer funds are being used to run ads attacking and singling out legal American products and industries; attacks that will slow job growth and cost our communities jobs. ... In many cases, the grant recipients have used these federal dollars to run advertisements against "sugary products" or other food and beverages that they believe have an adverse impact on the health of American citizens, regardless of the quantity consumed. We are talking about hundreds of millions of tax dollars that are being used to discourage the consumption of lawfully marketed American-made products (Rep. Aaron Schock, R-Ill, 4/17).

Oregonian: Oregon Should Regulate Vending-Machine Snacks
One of government's primary goals is protecting the health and safety of its people. The Oregonian editorial board agrees that state lawmakers have a role in "encouraging good health." It's time to look for innovative strategies to make it easier for Oregonians to maintain a healthy lifestyle. Obesity-related diseases drive up health care costs and cause unnecessary disability and suffering. As the Oregon Legislature struggles to find the revenue to cover the costs of providing health care to government employees and others, it just makes sense to find ways to prevent disease and promote health (Mary Lou Hennrich, 4/17).

The New England Journal of Medicine: Government's Role In Protecting Health And Safety
What is the appropriate role of governmental public health action? Law and public opinion recognize protection of health and safety as a core government function, but public health actions are sometimes characterized as inappropriately intrusive. Such criticism has a long history, but today we accept many public health measures that were once considered misguided, intrusive, or controversial (Dr. Thomas R. Frieden, 4/18).

The New England Journal of Medicine: Assessing Competency For Concealed-Weapons Permits — The Physician's Role
Shortly after the shootings in Newtown, Connecticut, two of us received letters from our county sheriff in North Carolina asking whether one of our patients had medical or physical conditions that would preclude issuance of a permit to carry a concealed weapon. Uncomfortable with our limited knowledge about such permits and our expected role, and fearing that our participation could affect our relationships with patients, we began exploring the ethical, legal, and policy considerations regarding physician involvement in this process. ... Although denying weapons to people with prior convictions seems relatively straightforward, it's more difficult to assess mental competence and current or future risk for violence (Adam O. Goldstein, Kathleen K. Barnhouse, Anthony J. Viera, James A. Tulsky and Barak D. Richman, 4/18).

The New England Journal of Medicine: The Nursing Workforce In An Era Of Health Care Reform
The foundation of the health care delivery system is its workforce, including the 2.8 million registered nurses (RNs) who provide health care services in countless settings. The importance of RNs is expected to increase in the coming decades, as new models of care delivery, global payment, and a greater emphasis on prevention are embraced. These and other changes associated with health care reform will require the provision of holistic care, greater care coordination, greater adherence to protocols, and improved management of chronic disease — roles that are inherently aligned with the nursing model of care. Will the nursing workforce be ready to respond to these challenges? (David I. Auerbach, Douglas O. Staiger, Ulrike Muench and Peter I. Buerhaus, 4/18).

Sacramento Bee: Stereotyping In Medical Settings – Ouch
'Could you help me get the cirrhotic liver in bed 403B down for his CT scan?" … "You know what the sheik admitted yesterday morning? Well, he needs some additional blood tests." Hearing comments such as these is not uncommon in hospitals across the nation. The people who speak them are probably not biased, nor are they bad people. They are selecting these quick descriptors as short cuts in language to quickly convey a message to a co-worker. But to many of those people being assigned these labels, the descriptors are stigmatizing and even offensive. Such comments are perceived as taking away a person's individual identity. The labels can even have adverse consequences (Dr. Michael Wilkes, 4/18).

Health Policy Solutions (a Colo. news service): A Role Model Inspires A Model Health Care System
To her patients and their families, Dr. Allers was a warm, soft-spoken woman who inspired confidence. She took time to talk to me and offer support to my single Mom rearing three kids in the shadow of her incorrectly diagnosed mental illness. No hospital owned Dr. Allers or told her how much time she could spend with her patients, now called consumers by insurance companies. ... What happened to this beloved profession?  It has become a profit-driven financial institution owned by the medical equivalent of the big Wall Street banks.  These "owners" are insurance companies and corporate hospital entities all about profits. ... Medicine has been hijacked and held hostage by corporate control and greed (Dr. Shelley Dworet, 4/17).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

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