Daily Health Policy Report

Thursday, April 19, 2012

Last updated: Thu, Apr 19

KHN Original Reporting & Guest Opinion


Health Reform

Capitol Hill Watch

Campaign 2012

Health Care Marketplace

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Some Women's Groups See Another Agenda In Attacks On Contraceptive Coverage

Reporting for Kaiser Health News, Judith Graham writes: "Opponents of the Obama administration's contraceptive coverage mandate -- including likely GOP presidential nominee Mitt Romney -- invoke 'religious freedom.' But women's groups and family planning organizations are convinced that the real objective is to limit access to birth control" (Graham, 4/18). Read the story.

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Capsules: Survey: Key Groups Unaware Of Health Law Benefits

Now on Kaiser Health News' blog, Christian Torres reports: "Despite the millions of people who have gained insurance coverage as a result of the health law, a survey released Thursday shows outreach efforts for two popular provisions are missing key parts of their target audience" (Torres, 4/19). Check out what else is on the blog.

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Political Cartoon: 'Get To The Greek?'

Kaiser Health News provides a fresh take on health policy developments with "Get To The Greek?" by John Darkow.

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


Have a cold? Fever?
Fret no more... Post your ailments
and the doc will call. 

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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Medicare To Expand Use Of Competitive Bidding

A year-long experiment found that the competitive bidding approach saved money without harming beneficiaries. It also made inroads against waste and fraud.   

The New York Times: In A Shift, Medicare Pushes Bids
The Obama administration said Wednesday that it would vastly expand the use of competitive bidding to buy medical equipment for Medicare beneficiaries after a one-year experiment saved money for taxpayers and patients without harming the quality of care (Pear, 4/18).

The Associated Press: Competition Cuts Down Medicare Fraud
A yearlong experiment with competitive bidding for power wheelchairs, diabetic supplies and other personal medical equipment produced $200 million in savings for Medicare, and government officials said Wednesday they are expanding the pilot program in search of even greater dividends. The nine-city crackdown targeting waste and fraud has drawn a strong protest from the medical supply industry, which is warning of shortages for people receiving Medicare benefits and economic hardship for small suppliers. But the shift to competitive bidding has led to few complaints from those in Medicare, according to a new government report (Alonso-Zaldivar, 4/18).

CQ HealthBeat: Medicare Officials Say Equipment Bidding Program Saved $200 Million
A controversial competitive bidding program to supply medical equipment to Medicare patients in nine markets netted $202 million in savings in its first year, the Centers for Medicare and Medicaid Services announced Wednesday. Contrary to the claims of critics, the program hasn't led to disruptions in access to products such as wheelchairs, hospital beds, and oxygen supplies, Deputy CMS Administrator Jonathan Blum said in a telephone press briefing. Nor has it led to adverse health effects requiring more hospital, doctor, or skilled nursing care, added Blum (Reichard, 4/18).

The Hill: Obama Administration Claims $42.8 Billion In Savings From Health Law Bidding Program
The healthcare reform law's competitive bidding program for durable medical equipment such as hospital beds and wheelchairs is projected to save $42.8 billion over the next 10 years, the Medicare agency said in a report Wednesday. Competitive bidding, an effort to replace Medicare's standard fees with market competition among providers, was created by the 2003 Medicare reform law and began on Jan. 1, 2011 in nine pilot metropolitan areas (Pecquet, 4/18).

California Healthline: A Second Opinion on Medicare 'Double Counting'
[T]he ACA's budget impact -- and its Congressional Budget Office score -- are making headlines again, sparked by a new study from conservative scholar Charles Blahous. Blahous has a prominent perch: He's one of two White House-appointed trustees for Medicare. And he's made an eye-catching contention: The CBO wonks are wrong, and ObamaCare could add as much as $527 billion to the U.S. deficit across the next decade. But this latest debate doesn't expose anything new about the health law. What it does illustrate is the flawed approach to Medicare accounting -- and how easy it is to gin up another fight over health spending (Diamond, 4/18). 

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Health Reform

Survey: Gaps In Health Insurance Coverage, Knowledge Persist

A Commonwealth Fund survey found that many U.S. adults didn't have health insurance over the course of a year.  

Los Angeles Times: Survey Shows Holes In Health Insurance Coverage
With the future of the healthcare law emerging as a major campaign issue this fall, a new survey has found that more than a quarter of adults ages 19 to 64 in the United States lacked health insurance for at least some time [within the past year]. … And the vast majority of those people – nearly 70 percent – had been without coverage for more than a year, according to the study by the nonprofit Commonwealth Fund, a leading authority on health policy (Levey, 4/19).

Modern Healthcare: Many Experience Gaps In Health Coverage, Report Finds
Adults with intermittent insurance were less likely to have a regular doctor ... The report, based on a nationally representative survey for the Commonwealth Fund, found employer health benefits had been the source of coverage for 41% of those who went without insurance at some point during the period. Another 27% never had insurance, according to the report. The online survey was conducted last year between June 24 and July 5 (Evans, 4/19).

National Journal: Survey Finds Gaps In Health Insurance
And most of those who tried to buy insurance on their own said it was difficult, said the group, which advocates for single-payer national health insurance and does research to back it up. But the 2010 health reform law is starting to help, most notably by allowing young adults to stay on their parents’ health insurance plans until age 26, the survey found. The non-profit Kaiser Family Foundation says 18.5 percent of non-elderly Americans do not have any health insurance. The health reform law aims to close this gap (Fox, 4/19).

Kaiser Health News: Capsules: Survey: Key Groups Unaware Of Health Law Benefits
[O]utreach efforts for two popular provisions are missing key parts of their target audience. ... For example, 40 percent of respondents age 19 to 29 didn’t know about the benefit that permits those under 26 to obtain coverage from their parents’ plan. When asked about the high-risk pools, 45 percent of people in fair or poor health and 65 percent of people who were uninsured didn’t know about that coverage option (Torres, 4/19).

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Health Law Implementation News: Most Red States Slow Walk Health Exchanges

Politico reports that most GOP-controlled states are holding off on building insurance exchanges until the Supreme Court issues its decision. Meanwhile, the Internal Revenue Service's ability to enforce the health law is the topic of a Capitol Hill hearing, and a former White House adviser offers his views during a Madison speech.

Politico: Right Winning War On State Health-Insurance Exchanges
Two years into the law's implementation, conservative emissaries have contributed to impressive stats. Almost all red states are holding off on exchange legislation at least until the Supreme Court decides on the Affordable Care Act, and in most of those states, exchange-building legislation has crawled to a stop (Feder and Millman, 4/18).

The Hill: GOP Witness: IRS Understaffed For Health Law Tax Enforcement
The federal government's Internal Revenue Service has too few employees to be able to implement the healthcare reform law's tax penalties on employers who don't offer insurance, a Republican witness testified Wednesday. "There are consequences to having that tax passed, and No. 1 would be whether the IRS has the resources to be able to enforce it," tax accountant Leonard Steinberg testified on behalf of the Small Business and Entrepreneurship Council. "Right now the IRS is operating razor thin, as it is, with their budget (Pecquet, 4/18).

Wisconsin Public Radio: Former White House Health Policy Advisor Speaks In Madison
Some question whether patient expectations will thwart the effort to control rising health bills. Dr. Ezekiel Emanuel is a medical ethicist and oncologist who advised President Obama on health reform. ... Emanuel says studies in shared decision making between doctor and patient show videos or brochures on the pros and cons of a procedure can sometimes prompt patients to change their mind, "It's not going to affect the vast majority of people but 10 to 20 percent not wanting a knee replacement or prostate surgery is a large number" (Mills, 4/18). 

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Capitol Hill Watch

Budget Consideration Continues In Both The Senate And The House

In the Senate, a "voteless" markup was held on Budget Committee Chairman Kent Conrad's, D-N.D., presentation of the Bowles-Simpson plan. Meanwhile, Sen. Pat Toomey, R-Pa., says he will bring the House GOP budget plan advanced by Rep. Paul Ryan, R-Wis., up for a vote by the full Senate later this year.

The Hill: Senate Voteless 'Markup' May Be Another Blow To Bowles-Simpson
A decision by Senate Budget Committee Chairman Kent Conrad (D-N.D.) to present the recommendations of President Obama's fiscal commission in committee but not to bring them to a vote shows how far Congress remains from producing a debt "grand bargain," supporters and critics of the fiscal commission said Wednesday. The fiscal commission report, authored by former Clinton chief of staff Erskine Bowles and former Sen. Alan Simpson (R-Wyo.) evoked hopes of a grand bargain when it received bipartisan support of 12 of 18 commission members in 2010 (Wasson, 4/18).

The Hill: Toomey To Force Vote On Ryan Budget
Congressional Republicans are coalescing around a plan for reforming Medicare sponsored by House Budget Committee Chairman Paul Ryan (R-Wis.) and Sen. Ron Wyden (D-Ore.). Sen. Pat Toomey (R-Pa.), an influential voice on budget issues in the Senate, adopted Ryan's Medicare plan in the budget proposal he unveiled Wednesday. He said he will force the Senate to vote on the proposal later this year by taking advantage of a rule that allows any senator to offer a budget if the Budget Committee fails to act (Bolton, 4/18).

On the House side, Republicans on the Ways & Means Committee are targeting subsidy overpayments as a way to chip away at funds that would be gained by the sequester.  

Modern Healthcare: Proposal Targets Subsidy Overpayments
A House tax panel's proposal that would require individuals to fully repay overpayments in federal subsidies for insurance exchanges aims to save about $43.9 billion over 10 years, but a congressional tax expert estimates it would lead to an annual average net increase of about 350,000 more uninsured individuals. The provision is one of three measures that the Republican-led House Ways and Means Committee will propose to the House Budget Committee as a way to reduce the nation's debt and deficits in place of the sequester, which will make across-the-board cuts to federal programs next year (Zigmond, 4/18).

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Leahy Introduces Generic Drug Label Legislation

The measure, which was introduced in the Senate and has a House companion, would permit generic drug companies to update safety information about the drugs they manufacture, enabling patients to sue the companies for failing to issue warnings about risks. It aims to address a gap in the law that allows people to sue brand-name drug makers for insufficient warnings, but not generics manufacturers.

The New York Times: Bills Seek To Change Rule On Generic Drug Labels
Democrats in the Senate and House introduced companion bills Wednesday that would permit generic drug companies to update warning information about the drugs they manufacture, a change that could allow patients to sue the companies for failing to warn about the risks of taking their drugs (Thomas, 4/18).

CQ HealthBeat: Leahy Offers Bill To Ease Recovery Of Damages From Generic Drugmakers
Sen. Patrick J. Leahy announced Wednesday that he has introduced legislation to ensure that generic drugmakers can add safety information for their products to the prescribing instructions doctors receive. The legislation aims to address a gap in the law that allows consumers to sue brand name drug manufacturers for the failure to warn consumers against hazards but not the maker of the generic equivalents. The U.S. Supreme Court held in a 2011 ruling, Pliva v. Mansing, that generic drug makers cannot be held liable under state tort law for failure to warn consumers about drug hazards even if they know their labeling is inadequate, Leahy noted (Reichard, 4/18).

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Campaign 2012

Obama And Romney Start Long-Distance Debate Over Medicare

President Barack Obama and GOP presidential hopeful Mitt Romney have started a long-distance health care debate, fighting over how to reform the Medicare system. Other politicians are getting in on the act too, as Sen. Jim Webb, D-Va., and Mass. Senate hopeful Elizabeth Warren weigh in on the health reform law.

Los Angeles Times: Obama, Romney Debate From States Apart
President Obama and Republican challenger Mitt Romney engaged in a long-distance debate over the key issue in the election …  as both campaigned through key swing states more than six months ahead of November's election. … [Obama's] "fair shot" argument focused on the House Republican budget, which Romney has said he supports. In the name of cutting the deficit, the Republican budget would overhaul Medicare and cut spending on programs throughout government, while lowering tax rates. "By the time you retire, Medicare would be turned into a voucher system that likely would not cover the doctors or the care that you need," Obama said (Hennessey and Reston, 4/18).

Bloomberg: Webb Says Virginia A Challenge For Obama Over Health Care
Democratic Senator Jim Webb of Virginia said it's a "big question mark" whether President Barack Obama will be able to carry his state again in this year's election because Obama's handling of the health care overhaul harmed his credibility.  While Virginia's recent demographic changes, including an influx of immigrants into the northern part of the state, should favor Democrats, Obama's fate there -- and nationally -- will be tied to how people perceive his leadership, Webb, who's retiring after one Senate term, said at a Bloomberg Breakfast in Washington (Hirschfeld Davis, 4/18). 

The Washington Post: Jim Webb: Health-Care Law Represents A Leadership Failure For Obama
President Obama's new health care law will be his greatest liability as he attempts to once again win the critical swing state of Virginia, Sen. Jim Webb (D-Va.) warned Wednesday. "I'll be real frank here," Webb said at a breakfast organized by Bloomberg News. "I think that the manner in which the health care reform issue was put in front of the Congress, the way that the issue was dealt with by the White House, cost Obama a lot of credibility as a leader" (Tumulty, 4/18).

The Hill: Elizabeth Warren Says Part Of The Health Care Law Should Be Repealed
Elizabeth Warren -- the liberal icon challenging Sen. Scott Brown (R-Mass.) -- said she would support repealing part of President Obama's health care law. Warren said in an op-ed that Congress should repeal the health law's tax on medical devices. Massachusetts is home to several large device companies. The health care law's device tax will hit small, innovative firms especially hard and cause them to roll back their research budgets, Warren wrote in the trade publication Mass Device (Baker, 4/18).

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Vatican Rebukes Group Of Nuns On Support For Health Law

The Catholic Church hierarchy cracks down on the Leadership Conference of Women Religious, a group of nuns who supported the 2010 health reform.

The Associated Press: Vatican Orders Crackdown On US Nun Association
The Vatican orthodoxy watchdog announced Wednesday a full-scale overhaul of the largest umbrella group for nuns in the United States. ... [Church officials] said the reform would include a review of ties between the [Leadership Conference of Women Religious] and NETWORK, a Catholic social justice lobby. NETWORK played a key role in supporting the Obama administration's health care overhaul despite the bishops' objections that the bill would provide government funding for abortion (Zoll, 4/18).

The New York Times: Vatican Reprimands A Groups Of U.S. Nuns And Plans Changes
The sisters were also reprimanded for making public statements that "disagree with or challenge the bishops, who are the church's authentic teachers of faith and morals." During the debate over the health care overhaul in 2010, American bishops came out in opposition to the health plan, but dozens of sisters, many of whom belong to the Leadership Conference, signed a statement supporting it — support that provided crucial cover for the Obama administration in the battle over health care (Goodstein, 4/18).

USA Today/Religion News Service: Vatican Orders Crackdown On American Nuns
It added that "crucial" issues like "the church's biblical view of family life and human sexuality, are not part of the [Leadership Conference of Women Religious] agenda in a way that promotes church teaching. Moreover, occasional public statements by the LCWR that disagree with or challenge positions taken by the bishops, who are the church's authentic teachers of faith and morals, are not compatible with its purpose" (Gibson, 4/18).

Kaiser Health News: Some Women's Groups See Another Agenda In Attacks On Contraceptive Coverage
Catholic bishops make no bones about their church's condemnation of birth control, but other organizations that oppose the Obama administration's contraceptive policy haven't embraced that position. Particularly noteworthy is the stance of groups that have led the nation’s decades-long fight against abortion. Publicly, these groups say they are against the coverage mandate because it violates religious freedoms and claim that they don’t take a stand on contraception (Graham, 4/18).

Meanwhile --

Reuters: Top US Republican Rejects Criticism By Catholic Bishops
The top Republican in the U.S. Congress on Wednesday defended his party's proposed deficit-cutting federal budget plan against complaints by Roman Catholic bishops that it would hurt the poor and violate certain "moral criteria." House of Representatives Speaker John Boehner argued that matters would worsen, with the government eventually unable to afford programs for the needy, unless it stops spending more money than it takes in (Ferraro, 4/18).

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Health Care Marketplace

WellPoint's Political Spending Draws Scrutiny

The Washington Post: WellPoint Is Focus Of Aggressive Effort To Force Political Spending Disclosures
Health insurance giant WellPoint is the latest target of an increasingly aggressive campaign to force disclosure of corporate political and lobbying expenditures, including payments to the U.S. Chamber of Commerce, which has become more active in elections over the past decade (Hamburger, 4/18).

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State Watch

N.Y. Medicaid Audit Finds $42M In Improper Payments

Auditors in New York have found $42 million in improper payments were doled out to Medicaid providers. In the meantime, Minnesota's human services commissioner will testify before a congressional committee next week about financing and a payment made to the state by a managed care plan with Medicaid contract.

The Associated Press/Wall Street Journal: NY Audits Fault $42 Million In Medicaid Payments
State auditors say data problems and information delays at New York's Medicaid claims processing system have caused $36 million in improper payments and another $6.3 million in overpayments. State Comptroller Thomas DiNapoli said Wednesday that $3.2 million has been recouped and the health department says it has changed practices (4/19).

Minnesota Public Radio: Human Services Commissioner To Testify Before Congress On Medicaid
State Sen. Sean Nienow, R-Cambridge, said the hearing called by U.S. Rep. Darrell Issa, R-Calif., focuses on oversight of state and federal Medicaid dollars. ... Nienow said he expects a $30 million donation the state received last year from the managed care plan, UCare, will be discussed during the hearing (Dunbar, 4/18). 

(St. Paul) Pioneer Press: Minnesota Commissioner To Testify Before U.S. House Hearing Over HMO Payment
Questions about the financing of Minnesota's Medicaid health insurance program will be a key part of an upcoming congressional hearing, a state senator announced Wednesday, April 18, during a news conference at the Capitol. A subcommittee of the U.S. House of Representatives will hold the hearing April 25 to consider whether the government is adequately protecting taxpayers from fraud, said Sen. Sean Nienow, a Republican from Cambridge. Lucinda Jesson, the state's commissioner for human services, is scheduled to testify (Snowbeck, 4/18).

In Iowa, a budget bill includes $950 million for Medicaid, the most for any line item --

Des Moines Register: Iowa House Passes $1.6 Billion Budget For Health Care And Social Services
The Iowa Legislature inched closer to resolving next year's budget on Wednesday, with House passage of a bill funding state health care programs and social services.. .. The bulk of the bill's outlays -- more than $950 million -- go to Medicaid, the health-care program for the poor, but the departments of public health, veterans affairs and aging, welfare programs and the Iowa Veterans Home are funded in it as well. The budget is for the fiscal year that begins July 1 (Noble, 4/19).

And a Michigan health plan acquires a Medicaid HMO --

Modern Healthcare: McLaren Health Acquires Medicaid HMO
McLaren Health Plan, a Flint, Mich.-based HMO that counts 150,000 total beneficiaries, has acquired CareSource Michigan, a 34,500-member Medicaid HMO. CareSource's parent is based in Dayton, Ohio, and the deal won't have any impact on CareSource Ohio members, according to a news release. Michigan officials must approve the purchase, and the process could take 90 days (Selvam, 4/18). 

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Neb., Ohio And Minn. State Legislatures Tackle Abortion, Contraception Restrictions

In various states, lawmakers are concentrating on abortion or contraception bills. Meanwhile, some Texas chapters of Planned Parenthood are merging.

The Associated Press: Nebraska Lawmakers Override Prenatal Care Veto
Nebraska lawmakers have voted to restore taxpayer-funded prenatal care benefits for illegal immigrants, despite the objections of Gov. Dave Heineman. ... Heineman argued the state should not spend tax dollars to provide care to women who are in the country illegally (4/18).

The Associated Press/USA Today: Dems Blast Effort To Cut Planned Parenthood Money 
Ohio Democrats on Wednesday blasted a proposal intended to cut federal funding to dozens of Planned Parenthood centers in the state, arguing it's a sneak assault against women's health that's being undertaken by other state governments around the country. ... The proposal was introduced Tuesday by House Republicans as one of dozens of amendments to a budget bill by Republican Gov. John Kasich that would make a number of spending and policy changes outside of Ohio's normal two-year budget cycle (Rodriguez, 4/18).

Minneapolis Star Tribune: Legislature Wades Into Abortion Fray
If a woman is going to take an abortion pill, she should do it under the eyes of her doctor, the Minnesota House decided on Wednesday. But legislators rejected an amendment -- offered by a woman -- that would have required a physician's presence every time a man pops a Viagra. Framed by some Republicans as common-sense discussions about women's health and by some DFLers as a Minnesota skirmish in a wider effort to restrict women's rights, Wednesday's debates in the House and Senate brought the national debate home (Brooks, 4/18).

(St. Paul) Pioneer Press: Minnesota Legislature Votes To Toughen Regulations On Abortions
The bill that would prohibit so-called "webcam abortions" was approved by the House on a 80-48 vote Wednesday, April 18. It takes aim at a videoconferencing program started last year by Planned Parenthood to give patients in parts of southern Minnesota easier access to medication abortions. … On Tuesday, the Minnesota Senate also approved a bill that would require yearly inspections of clinics performing 10 or more abortions a month (Boldt, 4/18).

The Texas Tribune: Planned Parenthood Branches Vote to Merge
The boards of three regional Planned Parenthood branches -- North Texas, Central Texas and the Capital Region -- have voted to merge, forming a $29 million-per-year mega-organization with 26 clinics up and down the Interstate 35 corridor. ... "The timing is right, in terms of looking ahead at the challenges we will face politically, and from a health care standpoint," said Leslie MacLean, board chairwoman of Planned Parenthood of North Texas (Ramshaw, 4/18).

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State Roundup: State Spending Drops $290 Billion In 5 Years

News outlets examine a variety of state health policy issues, including articles from California, Colorado, Florida, Georgia, Kansas, Louisiana, Maine, Massachusetts, New Hampshire and Oregon.

Reuters: Revenue Wilted, States Rely On Cuts To Meet Budget
Trapped in a revenue wasteland, U.S. states have cut spending by $290 billion over the last five years, with the largest reductions coming this year, according to a think tank that tracks state fiscal conditions. In fiscal 2012, which for most states began last July, cuts totaled $140 billion, "almost as much as the combined total for the previous four years," according to the Center on Budget and Policy Priorities. ... More than half the 50 states cut higher education spending this year, and at least 20 states have "made identifiable, deep cuts in healthcare," CBPP said (4/18).

The Fiscal Times: Taxing Drugs, Doc Visits And Even Surgery?
One of the major flaws in the nation's health care system is that most resources go to treating people with chronic diseases, while little goes to preventative care. So, what to do? One controversial idea being promoted by a team of health care experts is to impose a tax on every doctor visit, surgical procedure and prescription. ... The [Institute of Medicine] study said that a medical transactions tax could be a key ingredient in bolstering public health care services enough to bring down long-term health costs (Hirsch, 4/19).

Boston Globe: Another Take On "Budget Buster" Report: Health Law Was More Expensive, One Analyst Says
Josh Archambault appreciates that there are other people in the state, besides him, trying to calculate the overall cost of the 2006 Massachusetts law requiring most residents to have health insurance. And, he said, he thinks a report out last week from the Massachusetts Taxpayers Foundation mostly got it right. But one figure in the report, putting the annual increase in state spending for health reform between fiscal year 2006 and fiscal year 2011 at about $91 million, just struck him as odd (Conaboy, 4/18).

The Atlanta Journal-Constitution: Patient Data Missing For 315,000 Emory Patients
Personal and health information for about 315,000 patients is missing, Emory Healthcare announced Wednesday. The hospital system has been unable to find 10 computer discs containing the data. The missing discs held information on all patients who had surgery at Emory University Hospital, Emory University Hospital Midtown and The Emory Clinic Ambulatory Surgery Center between September 1990 and April 2007. The discs contained protected health information, including patient names, along with the diagnosis, the name of the surgical procedure and the surgeon (Teegardin, 4/18).

The Atlanta Journal-Constitution: HIV/AIDS Confab At Morehouse Tackles Ongoing Epidemic
Nearly 500 low-income, uninsured Georgians with HIV/AIDS have gained access to life-saving drugs with the help of federal emergency funding in recent months, though nearly 1,000 remain on a waiting list. The improvement reflects a nationwide decline in the number of people waiting for drug assistance, which dropped by more than 3,700 since last fall, according to the National Alliance of State & Territorial AIDS Directors (Williams, 4/18).

Boston Globe: Senate Power Struggle Fuels Maine Race
Former (Maine) independent governor Angus King strolled into a barbershop, an insurance agency, and a pub on a recent afternoon, reintroducing himself to voters, one handshake at a time, in his bid for a US Senate seat. But those introductions ignored the one thing most people want to know: would King caucus with Senate Democrats or Republicans if he wins? ... King would pass a general Democratic litmus test: He is prochoice on abortion, supports gay marriage, backs President Obama's health care law, and opposes GOP efforts to transform Medicare into a voucher program. Indeed, he has endorsed Obama for reelection. But he insists that he has conservative values when it comes to fiscal responsibility (Calvan, 4/19).

NPR: Few Answers In Abuse Probes At Homes For Disabled
Fairview is one of five state-run developmental centers in California — homes for people with developmental disabilities who are unable to care for themselves. An investigation by member station KQED and the nonprofit group California Watch has uncovered patterns of abuse at a number of these institutions, including Fairview (Montgomery, 4/19).

HealthyState/WLRN: Gov. Rick Scott Vetoes Millions Of Dollars In Health Programs
[Fla.] Gov. Rick Scott signed Florida's budget Tuesday – and more than three dozen health-related programs across the state were casualties of the governor's veto pen. Health programs represented more than a quarter of Scott's $142 million in line-item vetoes to the $70 billion state budget. Among the cuts: medical school projects, rape crisis centers, devices for people with epilepsy and childhood vaccination programs (Mack, 4/18).

Denver Post: Colorado Community Health Centers Show Mixed Results In New Screening Of Federal Quality Measures
The 15 clinics listed for Colorado do better in some places and worse in others. In diabetes control, the patient populations at 11 of the 15 state clinics are better than the national average. In hypertension control, 8 are better than average. For immunizations, 9 of the 15 top the average, which could be a success given that Colorado has fared badly in immunization rankings in recent years (Booth, 4/18).

Earlier, related KHN coverage: Community Health Centers Under Pressure To Improve Care (Galewitz and Monies, 4/17).

The Associated Press/Houston Chronicle: NH Senate Considers Health Compact Bill
A Senate committee is weighing the merits of forming an interstate compact to assume control for health care within New Hampshire's boundaries. The House passed the bill last month that proposes that New Hampshire join with other states in delivering health care to its residents. Under the bill, the states would receive block grants from the federal government and would take over Medicare and Medicaid. Congress would have to approve the compact for it to take effect (4/19).

Related, earlier KHN story: Some States Seeking Health Care Compact (Gugliotta, 9/18)

Boston Globe: President's Exit Stirs Fears On Hospital's Fate
Dorchester community leaders are worried about the future of Carney Hospital after last week's abrupt departure -- some say firing -- of its president, Bill Walczak, a longtime neighborhood activist hired by Carney's new corporate owner only 14 months ago. Walczak took issue with a spokesman for Steward Health Care System, the parent company of Carney, who said Friday that Walczak had quit (Weisman, 4/19).

Modern Healthcare: La. Reaches Meaningful-Use Milestone
For physicians and other eligible professionals, payments for the second year of the Medicaid electronic health-record incentive program—this time for meaningful use of an EHR—have begun to flow, according to the CMS. Louisiana is the first state in the country to issue an incentive payment to an eligible professional that has achieved meaningful use under the Medicaid program, according to an e-mailed CMS statement (Conn, 4/18).

Georgia Health News: Shortage Of Emergency Drugs Alarms Doctors
Georgia emergency physicians say a shortage of drugs to treat critically ill and injured people poses a "real danger to our patients today, without relief in sight." ... A spokesman for Public Health said Tuesday that the agency is aware of the shortages and is taking steps to deal with them. The Georgia situation is part of a nationwide gap in availability of EMS medications (Miller, 4/18).

Kansas Health Institute News: Tobacco Settlement Money Received
The state this week received $56 million as its latest installment payment from a national settlement with the major tobacco companies. Children's advocates say that's a reason to fully fund a range of programs for youngsters. The Legislature apparently agrees. But the Governor's Office said the fresh payment was no reason to back away from the administration's "conservative" approach to the tobacco funding, which would mean a cut of about $16 million for programs paid for from the Children's Initiative Fund (4/18). 

California Healthline: Pre-Existing Condition Reform Passes Committee
The Senate Committee on Health yesterday passed SB 961 by Ed Hernandez (D-West Covina), which would change the individual health insurance market in California, in part by halting insurer denials based on pre-existing conditions. It is similar to a bill -- AB 1461 by Bill Monning (D-Carmel) -- approved by the Assembly health committee one day earlier. Both measures are designed to conform to the federal Affordable Care Act, Hernandez said, in advance of many other states (Gorn, 4/19).

The Lund Report (an Oregon news service): Patient Physician Cooperative Offers Discounted Fees Without Insurance
Portland is home to numerous co-operatives. ... So a healthcare co-op model allowing patients to choose a naturopathic doctor or acupuncturist as their primary care provider might seem like a uniquely Portland idea. But actually, the Patient/Physician Cooperative (PPC) – which started advertising in Portland last May – is an import from Houston, Texas. ... Members pay a base fee each month that entitles them to reduced costs for provider visits and prescriptions and tele-doc services for online consultations, or pay a larger fee that covers one primary care visit per month without copay (McCurdy, 4/18).

Health Policy Solutions (a Colorado news service): Colorado's Exchange Progressing, But IT Problems Loom
Colorado has made substantial progress in implementing a health insurance exchange, but significant work remains in part because of Colorado's flawed computer systems, a new report from the Urban Institute has found. ... Colorado was the first state where a divided legislature voted to create a health insurance exchange (Kerwin McCrimmon, 4/18).

HealthyCal: Creative Movement: Transportation And The Elderly
When Aghavni Davis gave up driving because of failing eyesight, she never imagined the strain it would put on her ability to stay healthy. ... Davis' story illustrates a growing fear among aging adults: finding transportation to medical appointments. As the population ages and an estimated 10,000 baby boomers reach the age of 65 every day, governments, senior agencies, and non-profits are devising creative solutions to help with "Driving Miss Daisy" (Perry, 4/18).

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Weekend Reading

Longer Looks: Rushed Medicine; Exercising Your Way To A Smarter Brain

Every week, Kaiser Health News reporter Jessica Marcy selects interesting reading from around the Web.

Newsweek: The Doctor Will See You--If You're Quick
Something in the world of medicine is seriously amiss. Unhappy patients gripe about their doctors’ brusque manner and give them bad marks on surveys and consumer websites like HealthGrades and Angie’s List. They tell tales of being rushed out of the office by harried doctors who miss crucial diagnoses, never look up from their computers during an exam, make errors in prescriptions, and just plain don’t listen to their patients. ... And things don’t seem much better from the other side of the stethoscope. In a recent survey by Consumer Reports, 70 percent of doctors reported that since they began practicing medicine, the bond with their patients has eroded (Shannon Brownlee, 4/16).

The New York Times Magazine: How Exercise Could Lead To A Better Brain
For more than a decade, neuroscientists and physiologists have been gathering evidence of the beneficial relationship between exercise and brainpower. But the newest findings make it clear that this isn't just a relationship; it is the relationship. Using sophisticated technologies to examine the workings of individual neurons — and the makeup of brain matter itself — scientists in just the past few months have discovered that exercise appears to build a brain that resists physical shrinkage and enhance cognitive flexibility. Exercise, the latest neuroscience suggests, does more to bolster thinking than thinking does (Gretchen Reynolds, 4/18).

The Economist: Up In Smoke
The raids on (Richard Lee’s) properties are only the most telegenic instances of a much wider federal crackdown (on marijuana) that has taken states and counties by surprise. Dispensaries, and even landlords of dispensary-operators, all over California, Colorado and Montana have been getting menacing letters. Many have closed shop. ... The question is why the federal government is doing this. On the one hand there is a federal law, the Controlled Substances Act, which recognises no exception for medical marijuana and thus considers all use and trade of it criminal. But on the other hand the Obama administration originally signalled that it would not deliberately clash with the states about weed. … The overall effect has been to confuse everybody and leave matters entirely at the discretion of individual prosecutors (4/14).

The Atlantic: Using Social Media To Prevent Suicide
College students and adolescents now congregate in online social networks just as much as they do in dormitory common rooms. So organizations like the National Suicide Prevention LifeLine seek to be present in these environments. The LifeLine recently developed a Facebook chat add-on that enables users to report updates to Facebook that they feel are indicative of suicidal behavior. These then trigger a connection to a trained counselor. The service functions in ostensibly the same manner as the LifeLine's telephone service, which took its first call in January of 2005. There are two ways of accessing the chat -- either by clicking on the user's post or by reporting it to the Facebook Help Center. The user is then contacted by a crisis center via email, encouraging them to either call the help line or click on a link to start an online chat with a counselor(Anna Codreo-Rado, 4/18).

The New Yorker: T-Cell Army
In the last hundred years, progress in the treatment of cancer has come mostly from radiation and chemotherapy. Previously fatal blood-cell cancers, such as childhood leukemia and Hodgkin’s disease, are now curable. But solid tumors, which grow in the lungs, the colon, and the breast, have stubbornly resisted treatment once they spread beyond their initial site. … Targeted therapies, which are designed to disarm these mutations, are now at the forefront of care. The first successful targeted therapy was Gleevec, which caused rapid remissions in chronic myelogenous leukemia, with few and mild side effects. … But now patients who did not respond to available therapies have shown dramatic and unexpected responses to a new series of treatments that unleash the immune system (Jerome Groopman, 4/23).

MedPage Today: Why Patients Should Be Paid For Good Health
Over the past few years, insurers and Medicare officials have fostered the idea that physicians should be reimbursed on a pay for performance (P4P) basis.  Many articles, both pro and con, have been written regarding P4P.  I have been strongly opposed to P4P, believing that the sole purpose of the performance indicators designed by the government and insurers is to reduce payments to docs and hospitals.  I also believe that the establishment of performance guidelines will lead to the mechanization of medical care as physicians and hospital administrators will learn what they need to do to "perform" and practice guideline-based medicine as opposed to providing personalized care. Recently, I have reassessed my P4P stance and believe that a system that pays patients for performance could work.  Yes. "patient pay for performance (PP4P)" would be a good thing (Stewart Segal, April 2012).

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Editorials and Opinions

Viewpoints: Bishops Find Fault With GOP Budget; Pelosi On Court's Role In Health Law

The New York Times: The Loyal Opposition: The Church Versus The Right
In February, the Catholic Church attempted to impose its opposition to birth control on its employees, upsetting Democrats and the left. This week, the Church is criticizing Republicans, acting in the highest tradition of its social mission by speaking out against spending cuts on programs for the poor. … The House recently passed a budget, written by Paul Ryan, Republican of Wisconsin, that would cut precisely the kind of safety-net programs championed by the church, while offering tax cuts to the rich. It has been fully embraced by the Republican party’s presumptive presidential nominee, Mitt Romney (David Firestone, 4/18).

The New York Times: Birth Control And Teenage Pregnancy
An encouraging new report shows a big decline in the rate of teenage births. From 2009 to 2010, the birth rate among young women ages 15 to 19 fell 9 percent, to 34.9 per thousand, according to the Centers for Disease Control and Prevention. That is a record low for the 65 years that data have been available, and a remarkable 44 percent drop from the 1991 rate. This good shift is largely the result of an increase in teenagers' use of birth control — a fact that Congressional Republicans ignore as they seek to dismantle reproductive health programs (4/18).

Chicago Tribune: Respecting The Constitution And The Role Of The Supreme Court
It is with respect for the fundamental American value of judicial review that Democrats wrote and Congress passed health care reform. We believe it is constitutionally sound. On the other hand, Republicans have had a long-standing opposition to judicial review — until now (Rep. Nancy Pelosi, D-Calif., 4/19).

Roll Call: Abortion Was Always Heart Of Health Care Overhaul
Through a mandate issued by the Department of Health and Human Services, nearly all private insurance plans must fully cover the abortion-inducing drug ella. But instead of listening to the people (or the Constitution) and abandoning the ill-advised mandate, the Obama administration and HHS seek to blunt the criticism, in part by claiming they are merely following the "marching orders" given by the "independent Institute of Medicine" — the organization tasked with advising HHS on what should be included as "preventive services" in the mandate. In other words, HHS is claiming the allegedly independent and unbiased IOM made it include life-ending drugs in the mandate (Anna Franzonello, 4/19).

Des Moines Register: HIV Pool Needs Lawmakers' Action
The health reform law created a temporary insurance program to immediately help uninsured Americans. These people have preexisting health problems and cannot buy traditional insurance coverage on their own. The federal government allocated $35 million to Iowa, which projected it would insure about 1,000 people in its new high-risk insurance pool. But in the most recent federal count, only 238 Iowans were enrolled. One of the reasons the number is so low: The board overseeing Iowa's high-risk pool has made it nearly impossible for HIV-positive Iowans to sign up (4/18).

Houston Chronicle: A States' Rights Compromise On Health Care
The collapse of Obamacare need not be a legislative nightmare. Here's an alternative approach that could meet constitutional requirements and potentially garner enough support to pass. Congress could set up two tracks for health care coverage. One would be facilitated, but not operated by the Federal government. States would decide whether to participate in that track or opt out and go their own way (Chris Ladd, 4/19).

WBUR's CommonHealth blog: Five Myths About Massachusetts Health Reform (By A Former Romney Executive)
Myth Number 1: Uninsured rates in Massachusetts are 2% compared to nation's 16%. ... 2: There has been no evidence of crowd-out in Massachusetts. ... 3: The individual mandate is responsible for lowering premiums in the individual market. ... 4: The 2006 reform was never about costs. ... 5: The additional State cost per year of the reform has averaged $91 million a year (Amy Lischko, 4/19).

New England Journal of Medicine: Is Medicaid Constitutional?
Although the media and the U.S. public focused primarily on the minimum-coverage requirement, or individual mandate, during the recent oral arguments in the challenges to the Affordable Care Act (ACA) before the Supreme Court, the most important issue before the Court may well be the constitutionality of the ACA's Medicaid expansion. There are potential alternatives to the minimum-coverage requirement, but a finding that the Medicaid expansion is unconstitutional could threaten all federal spending programs that set minimum participation standards (Timothy Stoltzfus Jost, 4/19).

New England Journal of Medicine: Making The Best Of Hospital Pay For Performance
Over the past decade, "pay for performance" in health care has evolved from concept to policy with remarkable speed. In October 2012, U.S. acute care hospitals will begin to be paid for performance under the Medicare Hospital Value-Based Purchasing (VBP) program. Accumulating evidence, however, raises serious doubts about whether the program will improve value in health care. How did we get to this point, and what can be done to redirect the policy as VBP is rolled out nationally? (Andrew Ryan and Dr. Jan Blustein, 4/19).

Los Angeles Times: For A Healthier Economy, Fewer Oreos, More Granola
But try passing a law that forbids anyone under 17 from buying a can of Coke. We'd sooner see a pig sprout wings and escape the pen in which it's cooped before slaughter. Perhaps there is another approach to changing this country's eating habits, one that embraces our freedoms while fattening up the economy (Alexandra Le Tellier, 4/18).

The Wall Street Journal: Why I Donated A Kidney
The truth is that once you make the decision, the transplant itself is kind of easy. There are two days in the hospital, a week or two away from work, another few weeks without exercise, and that's about it. No long-term consequences (yes, I can still drink)—except a sense of happiness I didn't expect to feel. So why did I do it? For the same reason I do a lot of things: because someone I know did it (Jim Sollisch, 4/18).

The Dallas Morning News: Untreated Mental Illness Plays Havoc, But We're Not Helpless
The daily dramas of mental illness occur mostly out of sight. But lately, the chaos keeps bursting into view…. A new training program seems so obvious that you wonder why it didn't come along much sooner. It's called Mental Health First Aid. And just as we're trained to deal with a heart attack or a bleeding wound, Mental Health First Aid teaches us how to deal with someone in mental crisis (Steve Blow, 4/18).

The Baltimore Sun: Crack Epidemic's Legacy In Baltimore
In Baltimore, where we had so much addiction and violence associated with the crack epidemic, crime has been in decline. So has crack use, according to records the government keeps. It might have been passed from parents to children, from siblings to little brothers and sisters. But generally, by most indications, the crack-using population is aging out, and the next generation hasn't picked up the pipe. If that trend continues, maybe in another 10 years we'll see the end of crack's long legacy in Baltimore (Dan Rodricks, 4/18).

The Washington Post: Jeffrey Thompson's Chartered Health Plan Had A Very Bad 2011
A recent annual filing with the Department of Insurance, Securities and Banking shows that D.C. Chartered Health Plan recorded a $14.9 million operating loss in 2011, even after accounting for a $7.5 million payment from the District to settle a billing dispute. Chartered is the largest of two companies that manage health care for low-income District residents under government-funded programs (DeBonis, 4/18).

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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.