Daily Health Policy Report

Tuesday, April 19, 2011

Last updated: Tue, Apr 19

KHN Original Reporting & Guest Opinion


Health Reform

Capitol Hill Watch

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insuring Your Health: People Who Donate Organs For Transplants Can Have Difficulty Getting Insurance

In her latest Kaiser Health News consumer column, Michelle Andrews writes: "Most people would agree that donating an organ to someone in need is a selfless act. There's no medical upside in giving up one of your kidneys or part of your liver, lung or pancreas. It's a risk people take so that someone else -- often but not always a loved one in desperate need -- may live a better, longer life" (Andrews, 4/18). Read the column.

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HHS Will 'Hold Ourselves Accountable' On Plan to Lessen Health Disparities – The KHN Interview

Kaiser Health News staff writer Mary Agnes Carey talked to Dr. Garth Graham, HHS deputy assistant secretary for minority health, about  the department's recently unveiled comprehensive strategy to reduce health disparities among racial and ethnic minorities (Carey, 4/18). Read the interview.

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Guest Opinion: ACO Fairy Tale Faces A Rumpelstiltskin Moment

In his latest Kaiser Health News column, Michael Millenson writes: "The government's long-awaited draft regulations on Accountable Care Organizations have brought a dose of ugly reality to a concept that's always seemed coated with a patina of pixie dust. Unless those regs are substantially changed before the clock strikes Jan. 1, 2012 -- the statutory date for ACO implementation -- Cinderella's going to turn back into a scullery maid and the horse-drawn carriage transporting her to the Health System Transformation Ball will be revealed as nothing more than four mice and a pumpkin" (4/19). Read the column.

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Political Cartoon: 'William Tell, Circa 2012'

Kaiser Health News provides a fresh look at health policy developments with "William Tell, Circa 2012" by Mike Luckovich.

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New Guidelines Allow Definition Of Pre-Alzheimer's

The emphasis on the need to diagnose Alzeheimer's during its earliest stages is also evident in Congress, where legislation introduced this month would create new, specific Medicare cost codes for early-disease diagnosis to address these steps, including the discussions between the physician and caregivers.

The New York Times: Guidelines Allow Earlier Definition Of Alzeheimer's
The drive to diagnose Alzheimer's before it has progressed into profound dementia is also reflected in a bill introduced in Congress this month, which would create specific Medicare cost codes for Alzheimer's diagnosis, including steps involving discussions between the patient's doctor and caregivers, a recognition that keeping family members well-informed can result in better planning and care (Belluck, 4/19).

The Associated Press: New Guidelines Define Pre-Alzheimer's Disease
The first new guidelines for diagnosing Alzheimer's disease in nearly 30 years establish earlier stages of the mind-robbing disease, paving the way for spotting and possibly treating these conditions much sooner than they are now. The change reflects a modern view that Alzheimer's is a spectrum of mental decline, with damage that can start many years before symptoms appear. The new guidance describes three phases: early brain changes, mild cognitive impairment and full-blown Alzheimer's (Marchione, 4/19).

Chicago Sun Times: New Guidelines For Identifying Alzheimer's Before Symptoms Occur
Medical experts have issued new guidelines for diagnosing Alzheimer's disease that, for the first time, attempt to identify the hallmarks of the disease before symptoms occur. The original guidelines, published in 1984, dealt only with diagnosing Alzheimer's once a person started showing signs of dementia. Since then, new discoveries have shown the disease can cause changes in the brain a decade or more before symptoms appear (Thomas, 4/19).

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Poll: Fight Deficit By Raising Taxes For Rich, Steer Clear Of Medicare, Medicaid

A new McClatchy-Marist poll found that Americans overwhelming oppose Medicare and Medicaid cuts as a means to address the nation's deficit. Meanwhile, House Minority Leader Nancy Pelosi, D-Calif.,  is pushing seniors to oppose the GOP's proposed Medicare changes.

McClatchy: Best Way To Fight Deficits: Raise Taxes On The Rich
Alarmed by rising national debt and increasingly downbeat about their country's course, Americans are clear about how they want to attack the government's runway budget deficits: raise taxes on the wealthy and keep hands off of Medicare and Medicaid (Thomma, 4/18).

The Wall Street Journal: Social Security Talks Benefit From Quiet
Amid political fireworks over Medicare, both President Barack Obama and congressional Republicans have left themselves room to negotiate on another thorny problem: What to do about Social Security. The question is whether partisan bickering, combined with divisions within each party, will get in the way (Meckler, 4/18).

The Hill: In Florida Pelosi Lobbies Seniors Against GOP's Proposed Changes To Medicare
House Minority Leader Nancy Pelosi (D-Calif.) lobbied seniors Monday against the Republicans' 2012 budget proposal, warning it will erode their Medicare benefits to fund tax cuts for the wealthy. "When Medicare was passed it was a pillar of stability for our seniors … much of which is being undermined by Republicans," Pelosi told dozens of seniors gathered at a retirement home in Orlando. "Why should the federal government save money on the backs of seniors at the same time that they are giving tax breaks to millionaires, giving subsidies to Big Oil, and tax cuts to companies that send jobs overseas?" (Lillis, 4/18).

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Health Reform

Supreme Court Stays Quiet On Fast-Tracking Review Of Health Law

The court released a list of cases it has decided to take up or decline and Virginia's lawsuit regarding the health law was not included. Because the Court releases "a regular list of orders" every Monday it is in session, there was speculation that the justices would act on this issue yesterday.

Bloomberg: U.S. Supreme Court Doesn't Act On Virginia Bid To Scuttle Health Care Law
The U.S. Supreme Court deferred taking action on a bid by Virginia's attorney general for fast-track consideration of the state's challenge to President Barack Obama's health care overhaul. Virginia, one of 27 states that say the measure is unconstitutional, is urging the justices to take the unusual step of scheduling arguments without waiting for rulings by the four appeals courts that are poised to consider the law (Stohr, 4/18).

The Hill: Supreme Court Punts On Fast Track Review Of Health Care Law
The Supreme Court has not acted on a request to expedite a review of legal challenges to the health care reform law. The high court on Monday released the list of cases it has decided to take up or decline, and Virginia's health care reform challenge was not included. Court watchers had expected the high court to announce whether it would expedite Virginia's lawsuit against the law, but the justices aren't saying either way — for now. The Supreme Court issues a regular list of orders on each Monday it is in session, but the justices can also issue "miscellaneous" orders in individual cases at any time (Pecquet, 4/18).

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Report: Impact Of Ryan's 'Roadmap' On Health Law Unclear

A report by the Congressional Research Service found that neither the House-passed budget resolution nor the "Roadmap to Prosperity" document provide enough detail to make a determination.

The Hill: Budget's Effect On Health Law Unclear
The CRS report obtained by The Hill says that neither the budget resolution nor the "Roadmap to Prosperity" that preceded it "provided sufficient detail regarding specific provisions that would be repealed or retained to determine the disposition of [numerous] provisions." The House approved Ryan's budget last week in a party-line vote. Some effects from the Ryan budget are clear: The Republican budget retains a half-trillion dollars in cuts to Medicare payments, for example (Pecquet, 4/18).

Meanwhile, in other news related to health reform, Politico reports on how The Boston Globe defended Mitt Romney on health care.

Politico: Boston Globe Has Mitt Romney's Back On Health Care
After a week of broadsides marked the fifth anniversary of his controversial Massachusetts health care law, Mitt Romney is getting some support from his home-state paper. In an editorial Monday, The Boston Globe writes that conservatives should give Romney credit for for "warding off various schemes feared by business." "After an Urban Institute study recommended an individual mandate, Romney made that the core of his plan," the paper says. "That was a way of sidestepping the approach many Democrats favored: a payroll tax of 5 to 7 percent on businesses that did not offer health coverage" (Summers, 4/18).

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Capitol Hill Watch

Planned Parenthood Backers: Group Does More Than Perform Abortions

The Washington Post: In Montana And Elsewhere, Planned Parenthood Serves Broad Function
House Republicans were eager to cut off money to the organization, which is the nation's largest abortion provider and a political force in Washington. President Obama blocked the effort, but groups that oppose abortion rights have vowed to raise the issue again and, in the meantime, are pushing for congressional hearings. Planned Parenthood and its backers say that it serves a broader function than performing abortions, particularly in rural and medically underserved communities where the group has most of its clinics (Somashekhar, 4/18).

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Health Care Marketplace

In Ongoing Take-Over Saga, Community Health Makes All-Cash Offer For Tenet

On Monday, Community Health made its $3.3 billion offer for rival Tenet Healthcare Corp. an all-cash bid.

Reuters: Community Health Changes Tenet Offer To All Cash
Community Health Systems Inc sweetened its $3.3 billion offer for Tenet Healthcare Corp on Monday, persisting with its hostile bid even as revelations of a U.S. government probe into Community's billing practices sent its shares lower. Community Health, whose shares fell over 4 percent on Monday, changed its $6 per share offer to all cash from $1 in Community Health stock and $5 in cash, meaning Tenet shareholders would not be vulnerable to risks associated with Community's shares (Kelly and Davies, 4/18).

The Associated Press: Community Health Makes All-Cash Bid For Tenet
Hospital operator Community Health Systems Inc. on Monday revised its $3 billion offer for rival Tenet Healthcare Corp. to an all-cash bid  (4/18).

Modern Healthcare: Community Health Announces Revised All-Cash Tenet Bid
Community Health Systems, Franklin, Tenn., announced a revised, all-cash $7.3 billion offer [which includes $4 billion in assumed debt] to acquire Tenet Healthcare Corp., according to a Community news release. Community's offer is still valued at $6 per share. Under the revised offer, made in a letter to Tenet's board of directors, according to the release, Community would pay Tenet shareholders all in cash. Previously, Community offered Tenet shareholders $5 in cash per share plus $1 worth of Community stock (Galloro, 4/18). 

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State Watch

State Roundup: Michigan Tries New Strategy On High Risk Pools

The Detroit Free Press: State Tries Again To Draw Uninsured Into Health Plans
Michigan today announced a new effort to sign up the chronically uninsured onto health plans after the state's first attempt did not attract enough customers. Michigan's new high-risk insurance pool unveiled two new health plans today that will be available May 1. Cost has been a barrier for consumers and a reason the plan decided to offer the new options. The two plans will have lowered premiums – compared to the current plan – but with higher deductibles (Anstett, 4/18).

Bloomberg: Public Retiree Numbers Surge As States Reduce Benefits To Shrink Deficits
California, Florida and Texas are seeing more retirements as rising benefit costs, pay cuts and looming furloughs prompt workers to leave. Inducements to quit early also boosted departures in New York as U.S. states tackled budget gaps totaling more than $540 billion since fiscal 2009, according to the Center on Budget and Policy Priorities. In New Jersey, Wisconsin and Ohio, added motivation came from attacks on unions over costs that strained budgets (Baribeau, 4/19).

NPR: Changes Sought After Death At Calif. Mental Hospital
Earlier this month, NPR reported on the dramatic increase in violence at California's state psychiatric hospitals. At Napa State Hospital, an employee was killed last year, allegedly by a patient. Now, less than six months later, there has been another death at the hospital in Napa. This time, though, it was a patient who died (Jaffe, 4/19).

KQED: Napa State Hospital Workers Rally for Safer Working Conditions
The workers at the state mental health facility are asking for safer working conditions after one nurse was murdered last year and a rehabilitation therapist was badly beaten. Speakers called for a number of improvements, including an increased police presence. ... Others expressed concern about the uptick in patients being transferred directly from the criminal justice system. One RN said the increase in violence was directly related (Dornhelm, 4/19).

Health News Florida: Who Wins In Medicaid Overhaul?
As the Florida House and Senate transform the $20 billion Medicaid system, they will create winners and losers. One winner is easy to predict. The House and Senate both want to put almost all Medicaid beneficiaries into managed-care plans, giving HMOs a flood of new customers. But numerous other groups will have to wait for the outcome of House and Senate negotiations to find out how they fare. .. here are some groups that have a lot at stake: Disabled people ... Hospitals .... Medically needy. ... Trial lawyers and doctors (Saunders, 4/18).

The Texas Tribune: Senate Budget Takes Aim at Texas Hospitals
[T]he Senate version of the state's 2012-13 budget still takes direct aim at hospitals, in an effort to find hundreds of millions of dollars in cost savings and narrow the state's revenue gap. Several budget riders the Senate Finance Committee quietly approved late last week curb how much hospitals are paid for uninsured and underinsured patients, limit how they can use state and federal reimbursements, and open the door to even bigger cuts — all on top of a 10 percent reduction in what the state will pay most health care providers for Medicaid-covered patients, who are typically the neediest (Ramshaw, 4/19).

The Texas Tribune: Soda Tax Could Raise $1 Billion Per Biennium
Republican lawmakers have vowed to close the budget hole without a new tax. But that hasn't stopped Sen. Eddie Lucio Jr., D-Brownsville, from proposing a penny per ounce tax on soft drinks. At a Senate Finance hearing this morning, he suggested his measure could bring in billions of dollars to the state, while curbing consumption of sugary drinks linked to childhood obesity and diabetes (Ramshaw, 4/18).

The Houston Chronicle: Texas Facing Severe Mental Health Services Shortage
A new policy brief says the growing shortage of mental health services in Texas is a crisis that will only get worse if the state doesn't invest in its mental health workforce now. In 2009, 171 Texas counties out of 254 lacked a psychiatrist, 102 counties lacked a psychologist, 48 counties did not have a licensed professional counselor and 40 counties had no social worker, according to the brief published by the Hogg Foundation for Mental Health at the University of Texas at Austin and the San Antonio-based nonprofit Methodist Healthcare Ministries (George, 4/18).

Milwaukee Journal Sentinel: End-Of-Life Care Shifting From Hospital To Home
More patients are receiving hospice care in their homes and similar settings, and fewer patients are spending the final days of their lives in the hospital. From 2003 through 2007, the hospital more than doubled the number of days that chronically ill Medicare patients received hospice care in the last six months of their lives (Boulton, 4/19).

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Editorials and Opinions

Viewpoints: On Debt, Medicaid, Medicare And The Budget; Planned Parenthood; One Couple's Insurance Rates

The Washington Post: If You Thought The Financial Crisis Was Bad, Wait Till The Debt Ceiling Caves In 
Sen. Marco Rubio said he wouldn’t vote for an increase unless it included "a plan for fundamental tax reform, an overhaul of our regulatory structure, a cut to discretionary spending, a balanced-budget amendment, and reforms to save Social Security, Medicare and Medicaid" — everything on the conservative agenda, basically. And this is where things get dangerous. ... The Bush tax cuts and the Medicare Prescription Drug Benefit and our various wars ... were passed by Republican majorities (Ezra Klein, 4/18).

The Wall Street Journal: Paul Ryan's Reverse Robin Hood Budget
Why do I oppose Rep. Paul Ryan's plan for reducing the federal budget deficit, the one House Republicans approved overwhelmingly last week? ... Worst things first. The plan threatens to eviscerate Medicare by privatizing it—with vouchers that, absent some sort of cost-control miracle, would fall further and further behind the rising cost of health insurance. And to make that miracle even less likely, House Republicans want to repeal every cost-containment measure enacted in last year's health-reform legislation (Alan S. Blinder, 4/19).

Dallas Morning News: Dems' Worry About Ryan Should Be Medicaid
From Barack Obama down, Democrats are worrying about the wrong part of the 2012 budget blueprint that House Republicans passed last week. Democrats are wrought up over Paul Ryan's Medicare reform proposal when they really should go nuclear about his Medicaid idea (William McKenzie, 4/18).

The Wall Street Journal: ObamaCare Opt Out
It's not often that states turn their back on money from Washington, but at least two states may say no thanks to federal grants to implement the new federal health-care law. ... the political trend shows that the President's health reform is not getting any more popular with age, despite Democratic and media predictions. The states are concluding that the more they get to know about ObamaCare, the less they think they can afford it (4/19). 

The Wall Street Journal: Praise Romney Doesn’t Need
As Mitt Romney gears up for another presidential run, he seems to be haunted by liberals who want to praise him for the health-care plan he enacted while he was governor of Massachusetts. He knows their bear hugs are meant to smother his candidacy, but so far he hasn't found an effective way to avoid them (John Fund, 4/18).

Kaiser Health News Guest Opinion: ACO Fairy Tale Faces A Rupelstiltskin Moment
When writing the final ACO rules, CMS has the chance to spin the dross of the current regulations into something of genuine value to providers, even if it's not quite Rumpelstiltskin-quality gold. If the feds fail, it is all of us, not just those on Medicare program, who could live unhappily ever after (Michael Millenson, 4/19).

Des Moines Register: Let Washington Fashion Health Options 
The health care reform law will get people insured, and it relies heavily on state-based insurance exchanges to do so. People will be able to shop in these marketplaces for private coverage that meets federal guidelines. Many will get help paying for it. Now it's up to states to either set up the exchanges or allow the federal government to do it for them. Iowa lawmakers tried this session. They failed. The best thing they can do now: Forget it. Leave it to the federal government (4/18).

The Baltimore Sun: Health Co-ops Should Be Expanded, Not Limited
One of the casualties of the recent budget deal is a potential game-changer in health care: nonprofit health insurance cooperatives
(co-ops). Although not eliminated, the funding to help launch the co-ops was cut significantly. ... By protecting the remaining funding for co-ops, Congress and the president can support the implementation of model plans, which can be incubators for change (Peter Beilenson, 4/18).

Los Angeles Times: Couple's Health Insurance Choices Are Bad And Worse
Stuart and Cathy Selter recently learned that Anthem Blue Cross is cutting off sales of their plan, which costs them about $1,500 a month with a $2,500 deductible. They can either stick with that plan and pay higher premiums or switch to another plan with a higher deductible. ... In the case of individual health insurance, policyholders enjoy no group rates or safety in numbers. They are at the mercy of their insurers (David Lazarus, 4/19). 

Des Moines Register: Guest Opinion: Goals Address Mental Health Needs
Gov. Terry Branstad and Lt. Gov. Kim Reynolds last week outlined broad goals with the administration's plans to address mental health reform in Iowa. Iowa has 99 counties with 99 plans for mental health care. With these different plans come inconsistency in access, service and quality. ... Changes are needed. In Polk County alone there are more than 1,000 people on a one-year waiting list for mental health services. Personally, I believe this is a basic responsibility of government (State Sen. Brad Zaun, 4/18). 

Seattle Times: Planned Parenthood Pays Off 
Do lawmakers realize what could have happened, had they barred Planned Parenthood from receiving federal funds to provide preventive health care? By preserving the funding, they caught cancers of all kinds. Sexually transmitted diseases that could lead to worse things. They saved lives, saved families. Saved money in the long run. ... But now it's the Washington state Senate that needs to look women in the eye and listen ... The proposal to cut $2.25 million from the state Department of Health for family planning for the biennium is a fool's errand (Nicole Brodeur, 4/18). 

The Connecticut Mirror: Taxing Medical Procedures Doesn't Work
[P]roponents of the cosmetic tax here argue that the procedures are a luxury, performed largely on wealthy patients who can afford to pay the additional tax, despite recent studies that show the majority of patients have household incomes of less than $60K. ... But taxing medical procedures raises issues that can be difficult if not impossible to address. While the proposed tax legislation would exempt reconstructive surgery, there is often a fine line between what is deemed medically necessary and cosmetic. Some procedures are a mix of both. Who will decide which procedures should be taxed? (Dr. Patrick Felice, 4/18).

Atlanta Journal Constitution: Ga. May Forfeit Health-Insurance Authority
The net effect of letting companies "sell insurance across state lines" is to gut that state-based regulation in favor of lax or non-existent regulation. Such a step is particularly hypocritical given the emphasis that Rogers and others have placed on defending Georgia's sovereignty. In effect, they're now giving it away (Jay Bookman, 4/19).

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Stephanie Stapleton

Andrew Villegas

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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.