Daily Health Policy Report

Friday, April 19, 2013

Last updated: Fri, Apr 19

KHN Original Reporting & Guest Opinion

Health Spending And Fiscal Battles

Health Reform

Capitol Hill Watch

Health Care Marketplace

Administration News

Health Care Fraud & Abuse

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

My Child Moved Away, Can I Keep Him On My Insurance? (Video)

Kaiser Health News consumer columnist Michelle Andrews answers a reader question about keeping your children on your health plan until they turn 26, even if they move away (4/19). Watch the video or read the transcript.

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Capsules: Bipartisan Center Offers Plan To Reduce Health Spending; Despite Win, UnitedHealth Criticizes Medicare Rates, Eyes Pruning Business; Jonathan Bush Makes Case For Entrepreneurs In Health Care At TEDMED; Beginning End-Of-Life Care At The Dinner Table

Now on Kaiser Health News' blog, Mary Agnes Carey reports on a new budget plan released by the Bipartisan Policy Center: "Medicare beneficiaries would have access to better coordinated medical care and the current Medicare physician payment formula would be scrapped as part of a health care cost containment plan the Bipartisan Policy Center unveiled Thursday. The plan offers more than 50 recommendations that would cut the federal deficit by about $560 billion over the next decade. About $300 billion of those savings would come from Medicare" (Carey, 4/19).

In addition, Jay Hancock reports on UnitedHealth's earnings report and the company's warnings about Medicare Advantage: "If the Obama administration expected the biggest health insurance company to give thanks for this month's decision to reverse cuts to private Medicare plans, it was wrong. UnitedHealth Group CEO Stephen Hemsley said Thursday that Medicare Advantage rates are still far too low and that the company may shrink its business of managing care for seniors" (Hancock, 4/19). 

Also on the blog, Ankita Rao offers a pair of reports from TEDMED. First, Jonathan Bush and health care entrepreneurs: "Bush wants to know why entrepreneurs can come up with an entire Starbucks-style language and culture for coffee but have little traction in health care" (Rao, 4/18). Second, Michael Hebb and talking about end-of-life care: "Hebb wants you to pass the butter, and then talk about passing on. As the founder of 'Let's Have Dinner and Talk About Death,' he urged Americans to engage in a conversation about how they want to die, a conversation that could change the high cost of caring for the terminally ill and grant patients their ultimate requests" (Rao, 4/19). Check out what else is on the blog.

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Letters To The Editor: Readers' Thoughts On Critical Access Hospitals, Angry Doctors And A Range Of Other Health Care Subjects

In recent weeks, Kaiser Health News readers have reacted to stories about climbing death rates at critical access hospitals, the readmissions penalties being imposed on some hospitals and Walgreens' move to become the first retail chain to diagnose and treat chronic conditions. Other coverage that drew responses included a story about angry doctors as well as coverage of decisions made both by physicians and consumers that impact the cost of care (4/18). Read the comments.

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Political Cartoon: 'A Bridge Too Far?'

Kaiser Health News provides a fresh take on health policy developments with "A Bridge Too Far?" by Nate Beeler.

Meanwhile, here is today's health policy haiku:


Week's been so grueling...
Even budget plans are a
happier topic.

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

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Health Spending And Fiscal Battles

Group Offers Budget Plan With $560 Billion In Health Care Savings

The Bipartisan Policy Center released a new fiscal blueprint on Thursday that includes -- among its 40 recommendations -- significant trims to Medicare and changes that would scrap the current Medicare physician payment formula while also improving the program's coordination of care. Another approach is being advanced by former Sen. Alan Simpson, R-Wyo., and former Clinton White House chief of staff Erskine Bowles, who headed President Barack Obama's fiscal commission.

Kaiser Health News: Capsules: Bipartisan Center Offers Plan To Reduce Health Spending
Medicare beneficiaries would have access to better coordinated medical care and the current Medicare physician payment formula would be scrapped as part of a health care cost containment plan the Bipartisan Policy Center unveiled Thursday. The plan offers more than 50 recommendations that would cut the federal deficit by about $560 billion over the next decade. About $300 billion of those savings would come from Medicare (Carey, 4/19).

The Fiscal Times: New Plan Targets $560 Billion Of Health Care Savings
Just in time for Washington's latest debate over spending, taxes and entitlement reform, the Bipartisan Policy Center on Thursday unveiled a series of proposals aimed at lowering the government's health care costs and improving the quality and value of medical services (Pianin, 4/19).

The Associated Press/Washington Post: Fiscal Commission Leaders Alan Simpson And Erskine Bowles Introduce Modified Budget Plan
The plan released Thursday by and former Sen. Alan Simpson, R-Wyo., and former Clinton White House chief of staff Erskine Bowles would lop more than $5 trillion from deficits over the upcoming decade when combined with the deficit-cutting steps enacted in fits and starts since his 2010 proposal. … The revised Simpson-Bowles plan proposes about $600 billion in increased taxes over the coming 10 years on top of the $600 billion-plus signed by Obama in January, another $600 billion or so in cuts to Medicare, and deeper cuts to domestic agencies and the Pentagon than proposed by the president (4/19).

Also in the news, a new poll gauges public opinion about changes to Medicare -

The Associated Press/Washington Post: AP-GfK Poll: Public Lacks Faith In Government, Opposes Changes To Medicare, Social Security
Most adults disapprove of Obama's handling of the federal deficit, a festering national problem. But they also dislike key proposals to reduce deficit spending, including a slower growth in Social Security benefits and changes to Medicare (4/18).

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Health Reform

State Organizations, Officials Advance Health Law Implementation Positions

In Florida, the state hospital association is pressing for a cost-benefit analysis before lawmakers take a final vote on Medicaid expansion, and in Ohio, GOP lawmakers leave the door open for a move later this year. In Connecticut, officials are proceeding with plans to launch the state's Small Business Health Options Program despite the federal delay.

Health News Florida: Look At Hidden Savings On Medicaid Expansion, Hospitals Plead
The Florida Hospital Association wants state budget estimators to finish their cost-benefit on Medicaid expansion now, before lawmakers take a fateful vote that would send billions of dollars earmarked for Florida off to some other state (Gentry, 4/18).

Cleveland Plain Dealer: Ohio House Keeps Medicaid Discussion Going, Scraps Sex Education Restrictions
House Republicans kept alive the possibility that Ohio may expand its Medicaid program to cover the working poor, approving an amendment to its budget that could open the door to changes later this year. ... The GOP amendment on Medicaid expansion, introduced by Republican Rep. Barbara Sears of suburban Toledo, requires that legislation to reform the Medicaid program in Ohio be introduced in the House, but does not specify what shape that reform will take. It directs the governor's Office of Health Transformation and his Medicaid director to provide assistance in developing the legislation. And if the legislation is not enacted before the year ends, efforts to change Medicaid must cease. Minority Democrats, who unsuccessfully tried to get a full Medicaid expansion included in the budget, reluctantly went along with the GOP amendment (Blackwell, 4/18).

Modern Healthcare: Connecticut To Proceed With Small-Business Health Insurance Exchange
The directors of Connecticut's public health insurance exchange are moving ahead with plans to launch the state's Small Business Health Options Program marketplace in October, despite the federal government's proposed delay of the program's full rollout until 2015. On Wednesday, Access Health CT — the quasi-public agency commissioned in 2011 by the Connecticut Legislature to run the state's insurance exchange — announced that it has selected New York-based HealthPass and Chicago-based Bswift Inc. to provide technology and administrative support for the state's SHOP exchange (Dunning, 4/18).

Also in the health law coverage -

HealthyCal: The Limits Of Obamacare
Kalwis Lo, 24, says Obamacare saved his life. But his story is also a cautionary tale about the limitations of the Affordable Care Act — especially as it applies to young people. Lo could not access insurance through a provision of the health care law meant to help younger adults like him, so he went without coverage (Shanafelt, 4/19).

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Capitol Hill Watch

Senate OKs Mental Health Amendment To 'Effectively Derailed' Gun Bill

The amendment, which was added to the gun control bill a day after the broader measure that included background checks on gun purchases was rejected by the Senate, would expand a range of mental health programs. 

The Hill: Senate Votes 95-2 For Bipartisan Mental Health Amendment
The Senate voted 95-2 for an amendment to the gun control bill that would address mental health issues. The amendment, introduced by Sens. Tom Harkin (D-Iowa) and Lamar Alexander (R-Tenn.), expands federal mental health programs, including in education, suicide prevention, substance abuse and trauma centers (Cox, 4/18).

Politico: Senate OKs Mental Health Amendment To Gun Bill
The Senate agreed Thursday to tack a bipartisan mental health measure onto gun control legislation -- but the measure is more modest than advocates had sought, and the underlying gun bill has already been effectively derailed, at least for the time being. The vote on the mental health amendment offered by Sens. Tom Harkin (D-Iowa) and Lamar Alexander (R-Tenn.) was 95-2, with Republican Sens. Rand Paul of Kentucky and Mike Lee of Utah opposing. But it came a day after the Senate rejected broader background checks on gun purchases, prompting Senate Majority Leader Harry Reid to suspend further votes on amendments to the bill (Cunningham, 4/19).

Some conservative groups break with GOP leaders in opposing legislation designed to bolster high-risk pools --

The Hill: GOP ObamaCare Bill Hits A Snag
Two powerful conservative groups broke with House GOP leaders Thursday to oppose a bill that would increase funding for part of President Obama's health care law. The Heritage Foundation and the fiscally conservative Club for Growth both said they oppose the bill, which passed out of a House committee yesterday (Baker and Viebeck, 4/18).

Meanwhile, Politico explores the current political challenges faced by Sen. Max Baucus, D-Mont. --

Politico: Max Baucus Stirring Controversy On All Sides
Up for reelection next year, the Senate Finance chairman and Montana Democrat is taking heat from all sides after -- within the space of a few hours -- he slammed the health reform law he helped write. … It all began with his widely reported comment to HHS Secretary Kathleen Sebelius on Wednesday that he sees "a huge train wreck coming down" -- meaning the implementation of Obamacare, the law he helped write and shepherded through the Senate. … Baucus was talking about his worries about implementation and public outreach -- he didn't repudiate the health law itself (Cheney, 4/18).

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Health Care Marketplace

UnitedHealth Issues Warning Over Medicare Advantage Cuts

UnitedHealth attributed a 14 percent drop in profits in the first quarter to higher medical costs. The nation's largest insurer also warned that cuts to Medicare Advantage plans could hamper its earnings growth next year.

The Wall Street Journal: UnitedHealth's Outlook Cautious Amid Medicare Debate
UnitedHealth Group Inc. on Thursday sounded a cautious tone as it deals with the near-term impact of the government's crackdown on spending and looks ahead to lower funding for its Medicare plans. The comments, from the nation's largest managed-care company by both revenue and members, indicate the uncertainty that the industry is experiencing as insurers gear up for fuller implementation of the Affordable Care Act in 2014. That process has been made more complicated by the recent automatic U.S. spending cuts known as the sequestration and expectations for lower incoming payments for Medicare Advantage plans next year (Kamp, 4/18).

Kaiser Health News: Capsules: Despite Win, UnitedHealth Criticizes Medicare Rates, Eyes Pruning Business
If the Obama administration expected the biggest health insurance company to give thanks for this month’s decision to reverse cuts to private Medicare plans, it was wrong. UnitedHealth Group CEO Stephen Hemsley said Thursday that Medicare Advantage rates are still far too low and that the company may shrink its business of managing care for seniors. ... But in Thursday’s call to discuss the company’s quarterly profits of $2.1 billion on revenue of $30.3 billion, Hemsley said other changes — including the Affordable Care Act’s long-term reduction in Medicare Advantage payments – would still lead to a net reduction next year of more than 4 percent. That's inadequate when medical costs are rising in the 3 percent neighborhood, he said" (Hancock, 4/19).

Los Angeles Times: UnitedHealth Reports Lower First-Quarter Profit, Higher Costs
UnitedHealth Group Inc., the nation's largest health insurer, said its first-quarter profit dropped 14 percent as medical costs climbed higher. The Minnetonka, Minn., company said its health plan membership increased 18 percent in the quarter to 42 million people, boosted by international growth (Terhune, 4/18).

The Associated Press: UnitedHealth Warns Of Medicare Profit Squeeze
UnitedHealth Group, the largest provider of Medicare Advantage plans, warned Thursday that funding cuts for the privately-run versions of the federal Medicare program will force it to reconsider its expectations for earnings growth next year. CEO Stephen Hemsley told analysts that the government-subsidized coverage for elderly and disabled people faces a reimbursement cut of about 4 percent next year (Murphy, 4/18).

In the meantime, Humana has launched an internal investigation after leak of a significant government policy change led to some suspicious stock trading --

The Wall Street Journal: Humana Fires Lobbying Firm, Launches Internal Review
Health insurer Humana Inc. said it has started an internal probe into the circumstances surrounding the leak of a significant change in government health-care policy. "We have launched an internal review primarily to determine whether our interests were harmed" by the tie between an outside lobbyist employed by Humana and an investment firm that sent out early word of the policy shift, a Humana spokesman said. That alert set off a sudden jump in shares of Humana and other insurers late April 1 (Mullins and Mathews, 4/18).

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Administration News

Vladeck Urges Obama Administration To Act On Home Health Worker Overtime Rule

CQ HealthBeat: Vladeck Blasts Obama Administration For Dragging Feet On Overtime Proposal
The former head of Medicare and Medicaid in the Clinton administration on Thursday called on the Obama administration to act soon on a proposed rule to extend overtime and minimum wage pay to in-home health care workers. Bruce C. Vladeck said opposition to the proposal comes mainly from home care staffing agencies that have managed to "frighten" state Medicaid directors into an alliance (Norman, 4/18).

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Health Care Fraud & Abuse

'Wired Colleagues' Tell All To FBI About Alleged Medicare Kickbacks At Chicago Hospital

Medscape: Medicare Kickback Bust In Chicago Hinged On Wired Colleagues
Two executives of a hospital in Chicago, Illinois, along with 3 physicians and a podiatrist were arrested by federal agents April 16 for allegedly conspiring to give and receive illegal kickbacks for referring Medicare and Medicaid patients in a case built with "wired" colleagues who had flipped for law enforcement. The 6 individuals could face more charges as the FBI and the US Department of Health & Human Services (HHS) sift through records seized from the hospital in their investigation of other alleged fraud schemes (Lowes, 4/18).

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State Watch

State Highlights: Conn. Officials Want Stricter Limit On Insurer Markup

A selection of health policy stories from Kansas, Connecticut, Oregon, the District of Columbia, Texas, Florida, Minnesota and California.

Kansas Health Institute: County Meals On Wheels Program Aims To Prevent Hospital Readmissions
Officials at Johnson County Meals on Wheels say they are hoping the program can become a national model for preventing hospital readmissions among senior citizens. The program was one of seven nationally to be awarded a $50,000 grant by the Walmart Foundation, which officials plan to use to pilot a home nutrition program designed to get needy seniors seven frozen meals within 72 hours of their discharge from a hospital (Sherry, 4/18).

CT Mirror: Barnes, Exchange Board Want To Limit Health Insurers’ Profits, Administrative Costs
Concerned that high health insurance costs could undermine federal health reform, Office of Policy and Management Secretary Benjamin Barnes on Thursday suggested changing state law to limit health insurance carriers' administrative costs and profits beyond what federal law requires. The board of the state's health insurance exchange -- the authority that oversees a health insurance marketplace being created as part of health reform -- agreed in a unanimous vote to recommend that legislators do so (Becker, 4/18).

Oregonian: Oregonians Saved $80 Million Through Beefed-Up Health Insurance Oversight, Consumer Group Says
Beefing up Oregon's review of health insurance rate requests saved consumers and small businesses $80 million since 2010, according to a consumer advocacy group. Lawmakers' passage of a 2009 bill giving regulators more authority to deny rate hikes has resulted in lower premiums and less administrative overhead, according to a foundation affiliated with the Oregon State Public Interest Research group (Budnick, 4/18). 

Washington Post: D.C. Officials Postpone Vote On Hospital Cancer Treatment Option
D.C. health officials postponed making a recommendation Thursday on two competing hospital proposals to establish a controversial cancer treatment. MedStar Georgetown University Hospital and Sibley Memorial Hospital, part of Johns Hopkins Medicine, are both vying to offer proton beam therapy, a cutting-edge radiation treatment that hospital executives say is more precise in targeting tumors and safer for healthy tissue than conventional X-rays (Sun, 4/18).

Texas Tribune: House Backs Bill On Psychotropic Drugs For Foster Kids
The Texas House approved legislation Thursday on a voice vote that would require the guardians of foster children to give informed consent before a foster child could be put on psychotropic drugs (Aaronson, 4/18).

Health News Florida: Safety Questions Arise On Pharmacy Staffing
The Florida House has passed a bill that makes a lot of pharmacists nervous. Patients might be, too, if they were aware of it. The bill sharply raises the number of technicians who can be assigned to a single pharmacist for supervision, from a maximum of three to six.  And it takes away the Florida Board of Pharmacy's power to keep the ratio below the limit in cases where it sees a risk (Lamendola and Gentry, 4/19).

Des Moines Register: Anti-Abortion Amendment Fails As Health Bill Advances
The Iowa Senate passed a $1.9 billion spending bill Thursday for state health and human services programs, although much of the debate focused on whether taxpayer money should pay for certain abortions. ... The bill provides money for the Departments on Aging, Department of Public Health, Department of Veterans Affairs, Iowa Veterans Home, and the Department of Human Services. This is an increase of $230.2 million compared to the current state budget year and $72.6 million higher than Gov. Terry Branstad’s recommendation. ... Sen. Amy Sinclair, R-Allerton, proposed an amendment to restrict the use of taxpayer money for certain abortions. It failed with 23 lawmakers in support and 24 opposed (Petroski, 4/18).

MPR News: Health Costs Worry Minnesota Manufacturers
A survey of Minnesota's manufacturing executives shows that the cost of health care is one of their top concerns. Since 2008, the trade group Enterprise Minnesota has conducted a yearly survey of 400 manufacturers about their confidence in the future. The percentage of respondents citing health care as their top concern peaked in 2011, the year after Congress passed the federal health care overhaul. However, it continues to be a major worry (Baxter, 4/18).

California Healthline: Bill Aims To Reverse 10% Provider Rate Reduction
Assembly member Luis Alejo (D-Salinas) yesterday said he wants to undo the 10% Medi-Cal provider reimbursement rate cut passed by the Legislature in 2011. The across-the-board reductions were challenged in a lawsuit still pending in federal court and have not taken effect. California lawmakers in 2011 faced a huge budget shortfall, and this particular cut was made to save the state an estimated $50 million a month, health officials say. Physicians and other providers of Medi-Cal services have been leery of this further reduction, when California already ranks near the bottom in the nation in Medicaid reimbursement rates (Gorn, 4/18).

California Healthline: Competition Spurs Northern Expansion In San Diego
Competition is heating up among San Diego's health care systems as they work to capture the area's most lucrative patient population in an economic environment of shrinking reimbursement and growing uncertainty. The northern part of the county, with its wealthier and better-insured population, has seen an expansion of services among a number of the region's health systems, as outlined in California HealthCare Foundation's Health Care Almanac, published earlier this year. CHCH publishes California Healthline. Strategies vary among the region's big players in terms of how they compete for market share under the Affordable Care Act (Zamosky, 4/18).

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Health Policy Research

Research Roundup: Community Benefits and Hospitals' Tax-Exempt Status

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

The New England Journal Of Medicine: Provision Of Community Benefits By Tax-Exempt U.S. Hospitals –The federal health law requires tax-exempt hospitals to assess and address the needs of the community in which they serve by the end of 2013. These hospitals are exempted from federal and local taxes because to help finance their charitable efforts but the question as of these hospitals provide appropriate levels of community benefits remains unclear and controversial. In this study, researchers analyzed 2009 tax reports of more 1,800 tax-exempt hospitals to assess the level and pattern of community benefits they provide. "We found that hospitals devoted, on average, 7.5% of their operating expenditures to community benefits," the authors reported. "However, the level of benefits provided varied widely among the hospitals." They also add that most of those expenditures go to charity care and other patient benefits and compared to other expenditures, hospitals spent little on community health improvement (Young et al., 4/18).

JAMA Internal Medicine: Impact Of Providing Fee Data On Laboratory Test Ordering – Between 2000 and 2009, the number of imaging and diagnostic tests increased by 85 percent – but according to the study authors, empirical evidence suggests that not all tests are needed for provide high quality care. The researchers presented fees of 61 procedures and examinations to physicians and non-physicians at the Johns Hopkins Hospital and compared the number of tests they ordered to a control group of physicians who did not see the cost information. Their study showed a 9.1 percent reduction in the number of tests ordered among participants exposed to the fees. "Displaying the Medicare allowable fees of diagnostic tests at the time of offering can modestly affect provider ordering behavior," the authors  concluded (Feldman et al., 4/15).

The Kaiser Family Foundation: Impact Of The Medicaid Expansion For Low-Income Communities Of Color Across States –Some states are wrestling with the question of whether to expand their Medicaid programs under the provisions of the federal health law. "While the Medicaid expansion will increase coverage options for all low-income Americans, it will disproportionately impact low-income people of color," the authors of this brief write. "Overall, people of color are more likely than whites to be uninsured and low-income, since they are more likely to work in low-wage jobs that do not offer employer-sponsored insurance and often have difficulty affording coverage when it is offered." This brief provides data on the uninsured by race and ethnicity across states based on analysis of the 2011 American Community Survey (Artiga and Stephens, 4/16).

The American Enterprise Institute/Robert Wood Johnson Foundation: Preserving The Future of Medicare: Three New Papers -- These research papers, released together, examine some of the key issues currently surround Medicare and its role in the federal budget. "The authors explain why reform matters, how to properly implement premium support, how to fix traditional Medicare, and how to structure a system of competitive bidding," AEI and RWJF said in announcing the publication of the papers. They include:

--The Role Of Medicare Fee-for-Service In Inefficient Health Care Delivery
This report looks at the fee-for-service system within Medicare, which comprises the third largest category of federal spending, and its effects on health care across the country and its cost. "At the heart of the crisis is rapid growth of entitlement spending driven by health care cost inflation. And at the heart of the health cost problem is Medicare. Put simply, America cannot solve its budget problems without slowing the pace of rising costs, and it cannot slow the pace of rising health costs without fundamental Medicare reform. ... In the end, real change will almost certainly require a more fundamental reform than has been enacted to date, such as using market forces to encourage the kind of far-reaching changes in how services are delivered to Medicare patients that are needed to bring costs under control," the author concludes (Capretta, 4/16).

--Plan Competition And Consumer Choice In Medicare: The Case For Premium Support
This brief reviews the difficulties Congress has had in reducing costs in the program and examines the plan by Republicans to offer premium supports to Medicare beneficiaries. "There is broad agreement," the author writes, "that our future depends on slowing the growth of Medicare spending while ensuring seniors’ access to appropriate care. Premium support is the core of a marketbased reform of Medicare financing. By shifting from defined benefits to defined contributions, premium support dramatically alters the economic incentives that drive program spending rather than program value, and it makes consumers an active part of the solution. The political and technical challenges of instituting marketbased reforms cannot be overstated, but the alternative approach of centralized decision making and cost control is less appealing" (Antos, 4/16).

--A Competitive Bidding Approach To Medicare Reform
This paper looks at the proposals to use competitive bidding among insurance plans to provide Medicare coverage, its potential to save money and improve the program and the challenges to such a system. "The most promising option for addressing Medicare reform is competitive bidding—using health plans’ bids to determine the government’s contribution to a basic set of benefits in every market area" (Feldman, Dowd and Coulam, 4/16).

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

Reuters: Hospital Program Improves Antibiotic Prescribing
A quality improvement program at a single children's hospital succeeded in cutting back inappropriate antibiotic prescribing, in a new study. Researchers found within six months of introducing new electronic and educational tools, doctors were meeting national guidelines for treatment of childhood pneumonia in 100 percent of patients (Grens, 4/17).

MinnPost: Pharmaceutical Reps Rarely Tell Doctors About Drugs' Potential Harms, Study Finds
U.S., French and Canadian doctors receive little or no safety information about drugs when visited in their offices by pharmaceutical sales reps for the drugs, a new study has found. That failure to include information on harm occurred even though the United States, France and Canada all have national laws that require drug sales reps to discuss safety information about their products with doctors (Perry, 4/12).

Reuters: People, Networks May Sway Parents' Vaccine Choices
The people and information sources parents surround themselves with may influence their choice to vaccinate their children or not, according to a survey from one county in Washington state. Of almost 200 parents who took the survey, almost all said they had groups of people offering advice on vaccination, but those who chose not to fully vaccinate their children were more likely to have larger social groups and to turn to other sources, such as books, pamphlets and the Internet, for guidance (Seaman, 4/15).

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Editorials and Opinions

Viewpoints: A Plan For Cheaper, Better Care; The Philly Abortion Trial Raises Questions About Regulations

The Washington Post: How To Build A Better Health Care System
The four of us came together to change the conversation around how to improve health care and constrain cost growth. What we learned is that, until better care is prioritized over more care, our nation will continue to face a problem with health-care costs. The good news is that, through thoughtful policy, health-care practitioners can be encouraged through rewards to focus far more on what is best for their patients and less on the number of tests and procedures they can order. The even better news is that such a health-care vision can not only produce better care but also cost less (Tom Daschle, Bill Frist, Pete Domenici and Alice Rivlin, 4/18).

Los Angeles Times: Why Are Prices For Medical Care Such A Mystery?
Ted Kamp wanted to make sure his daughter received the medical treatment she needed. That was his first priority. His second was making sure his insurance would cover things and that he'd pay a fair price for any procedures. The fact that this proved so difficult highlights one of the crazier aspects of the U.S. healthcare system: the inability of patients to know how much their treatment really costs (David Lazarus, 4/18).

USA Today: Philadelphia Abortion House Of Horrors: Our View
The ongoing trial of Philadelphia abortion doctor Kermit Gosnell is finally getting the attention it deserves, and for good reason. The 2011 grand jury report on Gosnell, charged with murder in the deaths of a patient and seven babies, is a gruesome and disturbing document. It includes accounts of fully delivered, live babies having their spinal chords severed by scissors. And it describes horribly unsafe and unsanitary conditions at a business that allegedly operated as a pill mill by day and rogue abortion clinic by night. ... Aside from the obvious — that regulators should do their jobs, and that criminal doctors should be harshly prosecuted — it's hard to say what else should be concluded from the Gosnell case. Unless evidence emerges that clinics like his exist in other parts of the country, the case looks like an appalling anomaly (4/18).

USA Today: Abortion Regulation Not Enough: Opposing View
How do we prevent another Kermit Gosnell? That's the question hanging over the trial of the Philadelphia abortionist accused of murdering a pregnant woman and seven babies born alive after attempted late-term abortions. ... Abortion is one of the least regulated surgical procedures in America. Just 29 states regulate abortion centers at all, and a minority of these states have anything approaching comprehensive regulation. ... So yes, let's pass stronger "physician-only" laws and hospital admitting privileges requirements. And let's mandate comprehensive reporting requirements for abortions and abortion complications (Lila Rose, 4/18).  

The Washington Post: Five Myths About Abortion
When debating whether a fetus's "right to life" trumps a woman's "right to choose" — or whether the news media has paid enough attention to the trial of a Philadelphia doctor who allegedly killed seven babies born alive during late-term abortions, as well as a pregnant woman — Americans are bitterly divided on abortion. Before abandoning facts for rhetoric, let's tackle some misunderstandings about this procedure (Rickie Solinger, 4/18). 

The Wall Street Journal: Back-Alley Abortion Never Ended
Safety is one of the most potent defenses of Roe v. Wade, the 1973 U.S. Supreme Court decision that imposed a national policy of abortion on demand. Women had abortions even before it was legal to do so, the argument goes, but restrictive laws forced them to go to back-alley quacks. In this view, the story of Kermit Gosnell, the Philadelphia abortionist on trial for the murders of one woman and seven infants, is a cautionary tale about illegal, not legal, abortion. The facts tell a different story (James Taranto, 4/18).

The Wall Street Journal: The Sanctity Of Life, Even In A Test Tube
Sir Robert Edwards, the Nobel Prize-winning British "test tube baby" pioneer who died last week at age 87, devoted his career to developing in vitro fertilization as a technique to enable women afflicted with certain forms of infertility to conceive and bear children. As a result, there are millions of people in the world today—some now in their 30s—who otherwise would not have been born. According to Edwards's admirers, their lives are his legacy. Yet Edwards was, and remains, a controversial figure (Robert P. George, 4/18). 

Des Moines Register: Medicaid Expansion Gives States Flexibility
(Iowa Gov.) Terry Branstad says Medicaid is outdated. So he hired a consultant and whipped up an alternative called the "Healthy Iowa Plan." In the unlikely event it is approved by both the Iowa Legislature and Washington, Iowa would receive a fraction of the federal money it would receive under a Medicaid expansion. What kind of health coverage would Branstad's plan provide for 89,000 of the poorest Iowans? According to a one-page document released last week, it would cover everything from prescription drugs and hospitalization to mental health and home care with a cost to the state of only $23 million. Just do the math on that one (4/18).

Miami Herald: Don't Reject Medicaid Funds
The Florida House's refusal to accept federal funds to expand Medicaid stands as the most confounding action of the 2013 legislative session thus far, and probably the most irresponsible. Money that could be used to help more than a million needy Floridians who lack access to healthcare is in danger of being rejected for political reasons that fly in the face of common sense and elementary mathematics. The federal proposal is unquestionably favorable for Florida and its taxpayers (4/19).

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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.