Daily Health Policy Report

Monday, April 2, 2012

Last updated: Mon, Apr 2

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch


Campaign 2012

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Employers Tie Financial Rewards, Penalties To Health Tests, Lifestyle Choices

Kaiser Health News staff writer Julie Appleby, working in collaboration with USA Today, reports: "Gone are the days of just signing up for health insurance and hoping you don’t have to use it. Now, more employees are being asked to roll up their sleeves for medical tests — and to exercise, participate in disease management programs and quit smoking to qualify for hundreds, even thousands of dollars' worth of premium or deductible discounts" (Appleby, 4/2). Read the story. In addition, there is a video offering consumer tips on workplace wellness plans.

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Political Cartoon: 'Second Guessing?'

Kaiser Health News provides a fresh take on health policy developments with "Second Guessing?" by Mike Smith.

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


Seniors, Here is cash.
No more Medicare. You get
Ryan(we don't)care.


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

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Health Reform

Supreme Court's Health Law Ruling: If The Mandate Falls, What's Next?

News outlets offer analysis about how the high court's decision could play out -- both in terms of policy and politics.

Politico: The Health Reform Ruling: Four Likely Scenarios
A victory in the Supreme Court — less than five months before the presidential election — doesn't guarantee that either party can win over public opinion. And it certainly doesn't signal the end of the debate over health care reform (Haberkorn, 4/1).

The Hill: 5 Key Questions For The Supreme Court To Consider In A Health Care Decision
The over-arching question before the court is whether the law's individual mandate is constitutional. But that's a complicated question, and the two sides of the case don't even agree about how best to ask it. A decision is expected to come in June — just months before the presidential election. The biggest takeaway from last week's arguments was that the mandate is very much in jeopardy. That doesn't mean, however, that the court is sure to strike it down, and the oral arguments helped illuminate several areas the justices will likely consider in their private deliberations (Baker, 3/31).

The Los Angeles Times: Signs Of Supreme Court Activism Worry Reagan Administration Lawyers
After the healthcare arguments, (President Reagan's solicitor general Charles) Fried was among those who worried aloud about the prospect of the Roberts court embarking on a new era of judicial activism. ... His comments highlight a growing divide between an earlier generation of judicial conservatives who stressed a small role for the courts in deciding national controversies and many of today's conservative justices who are more inclined to rein in the government. At the heart of last week's argument over the healthcare law was a dispute over power. Does Congress or the Supreme Court define the limits of economic regulation? (Savage, 3/31).

Politico: Supreme Court Health Care Debate: If The Law Fails, What's Next?
If the justices knock out key parts of the law or bring down the whole thing, the reverberations could be felt across the legal landscape for generations to come, radically reining in the scope of federal power, according to supporters of the law and others who closely track the high court. And if the justices decide the individual mandate is a constitutional overreach, these observers say, federal labor and environmental laws could be the next on the firing line (Gerstein, 4/1).

NPR: The Individual Mandate's Growth In Unpopularity
The idea of an individual mandate to control health care costs, however, is not new. It goes back to 1989 and a man named Mark Pauly. An expert on health care policy, Pauly was part of a group of academics brought to the White House by President George H.W. Bush. The group's task was to fix health care; its solution was to let the marketplace solve it and create an individual mandate. Pauly tells weekends on All Things Considered host Guy Raz that, at the time, many Republicans, including the president, loved the idea (3/31).

The Associated Press: Obama's Insurance Requirement Not The Only Mandate
The individual insurance requirement that the Supreme Court is reviewing isn't the first federal mandate involving health care. There's a Medicare payroll tax on workers and employers, for example, and a requirement that hospitals provide free emergency services to indigents. Health care is full of government dictates, some arguably more intrusive than President Barack Obama's overhaul law. It's a wrinkle that has caught the attention of the justices (Alonso-Zaldivar, 4/1).

Stateline: Would 'Obamacare' Demise Mean End Of 'Romneycare,' Too?
With the conservative majority of the Supreme Court asking tough questions about the Affordable Care Act this week in Washington ... legal experts are debating what would happen to the Massachusetts law if some or all of its federal counterpart is struck down. At the center of that question is the constitutional validity of the "individual mandate,"’ which both Massachusetts and the federal government use to require residents to purchase health insurance (Gramlich, 3/30).

St. Louis Beacon: As Supreme Court Ponders Health-Care Law, It May Also Be Pondering Its Credibility
But a 5-4 partisan divide could damage the court's credibility, opening it to criticism that it is acting like just another political branch of government rather than as a neutral interpreter of the law.  Concern about that institutional damage could prompt Chief Justice John G. Roberts Jr. or Justice Anthony Kennedy to uphold the law (Freivogel, 3/30).

The Associated Press: Congress Gets Rough Treatment At Supreme Court
The Supreme Court left little doubt during last week's marathon arguments over President Barack Obama's health care overhaul that it has scant faith in Congress' ability to get anything done. The views about Congress underlay questions from justices who appear to be on both sides of the argument over the constitutionality of the law's key provision, the individual insurance requirement, as well as whether the entire law should be thrown out if the mandate is struck down (Sherman, 3/31).

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Democrats Offer Optimistic Take On Court's Health Law Decision

Appearing on the Sunday talk shows, Vice President Joseph Biden and Sen. Charles Schumer, D-N.Y., defended the health law and predicted it would be upheld by the high court.

The Washington Post: Biden Says Supreme Court Will Uphold Health-Care Law
Days after the Supreme Court wrapped up oral arguments on the constitutionality of the national health-care overhaul, Vice President Biden predicted Sunday that the high court will not throw out the Obama administration' signature agenda item (Sonmez, 4/1).

The Hill: Biden: 'Don't Believe' High Court Will Strike Down Health Care Law
When host Bob Schieffer pressed the vice president further on what the consequences of an invalidated healthcare law would be, Biden declined to imagine the possibilities. "Look I'm not going to speculate about something I don't believe will happen. I don't believe it will happen," Biden said (Leven, 4/1).

Politico: Biden: Supreme Court Will Back 'Obamacare'
Vice President Joe Biden predicts the Supreme Court will uphold the new health care law, despite the blundering defense of the administration's signature accomplishment by Solicitor General Donald Verrilli (Boak, 4/1).

Politico: Schumer Says Safety Net Could Be At Risk
New York Sen. Chuck Schumer said on Sunday the entire social safety net could be yanked out from under Americans if the Supreme Court overturns the new health care law. The case argued before the court last week rests on whether the law requiring health insurance is allowed under the Constitution’s interstate commerce clause, a basis for many federal programs. "If they were to throw out the health care law, things like Medicare, Social Security, food safety laws could be in jeopardy on the very same ground," the Democrat said on NBC's "Meet the Press." "It would be a dramatic, 180 degree turn of the tradition of the commerce clause" (Boak, 4/1).

Fox News: Dean: Individual Mandate 'Not Really Necessary'
Former Democratic Party chief Howard Dean said Sunday that the so-called individual mandate is "not really necessary" to the federal health care overhaul, and said a Supreme Court decision to invalidate the provision could end up helping President Obama. The Supreme Court met privately on Friday to discuss the case, though a decision is not expected to be made public until June. A central challenge in the case was over whether the requirement that Americans buy health insurance is constitutional. Further, the justices heard arguments on whether a ruling against the mandate should invalidate the health care law as a whole (4/1).

In other news, Politico reports that the state attorneys general involved in the case find themselves in the political limelight.

Politico: State Attorneys General Work The Limelight
They came to Washington to make the case for overturning the Obama administration’s health care law. They left after a burst of free media and attention in the wake of the Supreme Court arguments, an intense dose of publicity that most politicians only dream of. While serving as a state’s top law enforcement official has always been one of the better stepping stones to higher office, the ambitious attorneys general who have led the charge against the Affordable Care Act ...  appear to have found an issue that could advance their political fortunes regardless of how the court rules (Hohmann, 4/1).

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State-Based Health Policies Grab Attention

With the federal law's fate uncertain, action taken so far by the states -- either to implement the national overhaul or to advance reforms of their own -- have claimed more significance and headlines.

The Washington Post: New Spotlight On State Responses To Health-Care Law
Variations in the way states have moved to implement the 2010 federal health-care law have taken on greater significance after last week's Supreme Court hearings, whose tone heightened speculation that the statute would be overturned (Aizenman, 3/31).

The Wall Street Journal: Health Exchanges Have Fans In Some States
A handful of states say they are planning to press ahead and voluntarily implement a key part of the 2010 federal health-care law even if it is wiped out by the Supreme Court (Radnofsky, 3/31). 

Los Angeles Times: If Justices Kill Health Law, California May Just Revive It
Even if the whole law is scrapped nationally, many of its consumer protections, such as guaranteed coverage for children, are expected to survive in the state (Terhune, 4/2).

Bloomberg: State Laws Boosting Insurer Cost Without Adding Customers Failed
The worst-case scenario for insurers in the Supreme Court review of the U.S. health-care law -- eliminating the mandate that everyone have insurance while other changes remain intact -- has been tested in states such as New York, Maine and Vermont. It failed, insurers say. The three states were among nine in the 1990s that tried to force insurers to sell policies to anyone who asked, regardless of health, without also mandating that other residents maintain coverage. As a result, as many as 90 percent of those under age 30 dropped their plans, knowing they could always pick them back up if they got sick (Wayne and Nussbaum, 3/30).

CT Mirror: Malloy Unsure If State Could Impose Insurance Mandate If Feds Can’t
[Connecticut] Gov. Dannel P. Malloy said Friday that no one should count on his administration's adopting an individual health insurance mandate for the state if the U.S. Supreme Court strikes down the federal health reform law. … "Everything's on the table," he said. "But if you're asking whether I'm proposing a state mandate, I am not proposing a mandate at this time and I'm not sure that we would ever do it” (Levin Becker, 3/30).

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Health Insurers Continue To Rally After High Court Hearings

Certain segments of the health care marketplace appeared to be optimistic about signals from the court's consideration of the individual mandate and the sweeping health law.  

Market Watch: Insurers Continue To Rally In Wake Of Hearings
Health insurers continued to rally Friday as the U.S. Supreme Court was set to deliberate behind closed doors over whether parts of the Affordable Care Act are constitutional. Insurers were further boosted by a Jefferies & Co. note that said if the court additionally ruled to overturn a part of the health-reform law that ordered states to expand their Medicaid programs — with federal assistance — it probably wouldn't have long-lasting effects on insurers with a heavy Medicaid portfolio (Britt, 3/30).

Reuters: Analysis: HMO Investors Breathe Easier About Health Law Ruling
Now that the Supreme Court has given a glimpse of how it will consider the healthcare overhaul, more investors in health insurance stocks are breathing easier about the eventual ruling. Wall Street is less worried about the worst-case scenario for insurers: that the court strikes down the individual mandate requiring people buy insurance, but keeps in place provisions that could force insurers to cover more sick, high-cost Americans. Investors also increasingly believe the whole law may be tossed out, analysts said, which could boost health insurer stocks in the near term. Several analysts pointed to UnitedHealth Group as a stock that should do well regardless of the ruling, while Aetna Inc has been a strong performer this week (Krauskopf, 3/30).

Minneapolis Star Tribune: Analysts Don't Predict Doomsday For Insurers 
Within the debate over the law that overhauls the U.S. health care system, speculation swirls about a doomsday scenario for the health insurance industry…. Those fearing such a scenario say it would cripple the health insurance industry. But few, if any, financial analysts or health economists share the same level of concern."It's not like an apocalyptic disaster," said Chuck Phelps, a retired professor of health economics at the University of Rochester. "The people harmed are not the insurance companies. The people harmed are relatively healthy people who want to buy individual policies. They won't be able to" (Spencer, 4/1).

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Capitol Hill Watch

Medicare: Republicans Face Uphill Battle To Find Like Minds Across The Aisle

House GOP lawmakers are having a hard time making the case that plans to revamp Medicare have broad bipartisan support.

The Hill: House Republicans Struggle To Find Allies Across The Aisle For Medicare Overhaul
House Republicans are struggling to make the case that their proposed Medicare overhaul has broad support. The GOP has been ramping up its argument that Democrats have, in the past, supported "premium support" reforms despite the party's united attacks against the proposal ahead of the November elections. They are trying to persuade voters that Republicans have a bipartisan plan to save the program from bankruptcy, while painting Democrats as hypocrites out to scare seniors (Pecquet, 4/1).

Meanwhile, Medscape offers more detail on the plan.

Medscape: House Passes Budget Plan Shaking Up Medicare, Medicaid
Besides repealing the ACA, the bill would give new Medicare beneficiaries beginning in 2023 a choice between traditional fee-for-service Medicare and any number of approved private health plans. If a senior chooses to go with a private plan, the government would help him or her pay for it by giving the plan a "premium support payment." Americans who are sick and poor would receive more assistance. In addition, the eligibility age would be gradually raised from 65 to 67 (Lowes, 3/30).

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Medicaid Long-Term Care Restrictions Tighten

The Wall Street Journal offers tips on how to preserve some assets while attempting to qualify for Medicaid assistance.

The Wall Street Journal: Medicaid Gets Harder To Tap
Families hoping to use Medicaid to help pay for long-term care are facing tougher restrictions—though some states are getting stricter than others. ... Here's how to preserve some assets and possibly still qualify for help (Greene, 3/30).

Also in the news, Politico Pro reports on how what some view as a simple change that could save Medicaid big money.

Politico Pro: Groups, Medicaid Work To End Early Births
Turns out there's one deceptively simple change in obstetric care that can save millions of dollars and lead to healthier babies and healthier moms: stopping women and their obstetricians from inducing births before 39 weeks without a pressing medical reason. That could be a tough sell, though — because early induction has become part of the culture. About one in 10 births in the United States is intentionally early, and some estimates are higher. It's a matter of choice and convenience, sometimes of efficiency, for both women and their doctors. A baby born at 38 weeks — a common time for early induction — isn't premature. It sounds safe. But mounting evidence shows these planned early births put babies at risk — more infants staying in neonatal intensive care units, more complications, more permanent damage and a higher death rate (Kenen, 4/2).

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Campaign 2012

Supreme Court Justices Emerge As Possible Players In Upcoming Presidential Election

Also in the news, President Obama talks about the health law while on the campaign trail, Vice President Joe Biden takes on GOP presidential hopeful Mitt Romney, and health law supporters begin to embrace the term "Obamacare."

The Hill: Obama, Running Against Congress, Could Find A New Foe In The Supreme Court
President Obama might be campaigning this summer not just against the GOP nominee and congressional Republicans but also the Supreme Court. Obama faces a bigger and more direct threat from the court than any candidate in recent history. The justices are expected to rule in June on whether his signature health care law is constitutional, and oral arguments this week indicated there’s a good chance they will strike down at least part of the law: the mandate to have insurance (Baker, 3/30).

NPR: Health Care Ruling Could Impact Presidential Race
The health care case and other high profile Supreme Court rulings expected in June suggest that the justices may become a bigger part of this year's presidential race than the court has been in decades (Shapiro, 3/30).

Politico Pro: Obama Pitches ACA, But Not SCOTUS
President Barack Obama is back to giving his standard pitch for the health reform law -- but he's leaving the Supreme Court alone for now. Campaigning in Burlington, Vt., on Friday, Obama said nothing about the surprisingly tough questions the health care law got from the justices this week -- or the signs that the law is in more trouble with the court than most legal observers had predicted. Instead, he stuck to the selling points he usually uses with friendly audiences: The health care law has already brought crucial benefits, and Republicans would turn back the clock if they win the White House (Nather, 3/30).

Los Angeles Times: Biden: Romney 'Out Of Touch' With The Middle Class
[Biden] attacked Romney and the GOP broadly for only staking out a position against what the Obama administration has done, and not offering an alternative. Biden used the healthcare reform law as an example. "What is the Romney answer? There's nothing. All they argue is cut, get rid of that," he said. Biden said that there are "millions of people" benefiting from the law already, and that he was confident the Supreme Court would uphold it when it rules in June (Memoli, 4/1).

NPR: 'Obamacare' Sounds Different When Supporters Say It
Until recently, "Obamacare" was a word mostly used by opponents of President Obama's health care law. Now, supporters of the law are attempting to claim it as their own. During the three days of health care hearings, protesters outside of the Supreme Court in favor of the law returned to one chant more than any other: "We love Obamacare." The phrase was not somebody's impromptu brainstorm on the steps of the Supreme Court. People carried mass-printed black-and-yellow signs that said it in big, bold letters (Shapiro, 3/31).

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Health Care Marketplace

Federal Trade Commission OKs $29 Billion Merger By Express Scripts, Medco

By a three-to-one vote, regulators approved Express Scripts' plan to purchase Medco, ending an eight-month inquiry into whether the deal would stifle competition in the pharmacy benefits industry.

Bloomberg: Express Scripts, Medco Win Approval For $29 Billion Deal
Express Scripts Inc. (ESRX)'s $29.1 billion bid for rival drug benefit manager Medco Health Solutions Inc. (MHS) won unconditional approval from U.S. antitrust regulators, clearing the way for the biggest manager of prescription-drug benefits for corporate and government clients. The FTC's decision, which was approved by a three-to-one vote of the commissioners, enables St. Louis-based Express Scripts to complete the purchase of Medco of Franklin Lakes, New Jersey. The FTC said its eight-month investigation "revealed a competitive market for pharmacy benefit management services characterized by numerous, vigorous competitors who are expanding and winning business from traditional market leaders," in an e-mailed statement (Forden and Bliss, 4/2).

The New York Times: FTC Approves Express Scripts-Medco Deal
Regulators have given their blessing for Express Scripts to buy Medco Health Solutions, the final hurdle in a $29 billion deal that has created the nation’s largest pharmacy benefits provider. The Federal Trade Commission voted 3-1 to approve the acquisition on Monday, ending an eight-month inquiry into whether the deal would stifle competition in the pharmacy benefits industry. The agency’s approval marks the closing of one of the largest deals of 2011, and one that was subjected to a bevy of antitrust concerns (Roose, 4/2).

The Hill: Federal Regulators Approve Pharmacy Benefit Manager Merger Despite Congressional Objections
Federal antitrust regulators on Monday approved a $29 billion merger creating the nation's largest manager of prescription drug benefits despite widespread congressional objections. Express Scripts and Medco Health Solutions immediately announced the completion of their merger after the Federal Trade Commission gave its approval. More than 80 members of Congress, lobbied by pharmacies in their districts, have weighed in against the merger and  raised concerns that it could lead to fewer choices for consumers (Pecquet, 4/2).

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State Watch

State Capitols: Social Issues A Hot Topic; Iowa Short On Time For State Budget

Legislatures in Iowa and Kansas consider bills on health care, while Stateline looks at the social issues debates going on in many state capitols around the nation.

Stateline: Social Debates Rage In State Legislatures
Even though most legislatures are still in session, 2012 already has seen debate on a wide range of social issues that range from gun control to sex education. But it has been abortion and gay marriage that have attracted the most attention. Virginia was one of several all-Republican states, including Alabama, Idaho and Pennsylvania, where lawmakers debated legislation requiring women to undergo ultrasound tests before having an abortion. Virginia's measure sparked national protests due to a provision — later removed — that could have forced some women to undergo invasive vaginal ultrasounds (Gramlich, 4/2).

Des Moines Register: Iowa Legislature: Time Short For deals On State Budget, 3 Big Reforms
Much work remains in what could be a scrambled final few weeks in which lawmakers must finalize next year's budget and try to overhaul the state's K-12 education, mental health care delivery and property tax systems. ... And amid all the negotiations over dollars and cents, policy skirmishes may erupt as well. A potentially divisive battle may be looming on the House floor over new abortion restrictions, which conservative Republicans want to write into the budget bill for health and human services (Noble and Clayworth, 4/2).

Kansas Health Institute News: Conference Committee Advances Two Health Bills
Two bills dealing with drug prescriptions were combined into a single measure and advanced Thursday by House and Senate negotiators. The conference committee agreed to fold these bills into Senate Bill 134: SB 325 -- would allow for the distribution to practitioners of free samples of Schedule V non-narcotic depressants. It also would add Carisoprodol, a muscle relaxant, to the Schedule IV controlled substances list and Ezogabine, an anticonvulsant, to the Schedule V list. SB 327 -- among other things would lay out who could access data from the Prescription Monitoring Program and modify regulations to allow electronic prescriptions for controlled substances (3/30).

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Medicaid News: Wash. Pauses Plan To Not Pay For Some ER Visits

Texas' public hospitals want some Medicaid money shifted to pay for the uninsured while a proposal in Washington state to stop paying for some Medicaid ER visits deemed unnecessary is paused. Ohio is also trying to save money on its Medicare and Medicaid dual-eligible population by restructuring the program.

Houston Chronicle: Public, Private Texas Hospitals Spar Over Medicaid
Texas' public hospitals are asking the state to make some taxpayer money now spent on Medicaid care instead pay for the uninsured, a group that soon may be mostly illegal immigrants. The proposal, under consideration by the Texas Health and Human Services Commission, is pitting public and private hospitals against each other for hundreds of millions of dollars allocated annually in a supplementary Medicaid program. The public hospitals argue the program favors private hospitals (Ackerman, 4/1).

The Seattle Times: Gregoire Suspends Plan to Limit Medicaid Emergency-Room Visits
A plan by the state Medicaid program to stop paying for emergency-room visits for all conditions deemed "nonemergency" -- set to go into effect Sunday -- has been suspended by Gov. Chris Gregoire pending the outcome of budget negotiations under way in the state Legislature. Gregoire's budget director, Marty Brown, said Saturday that Gregoire on Friday stopped the Medicaid plan from going into effect, noting growing legislative support for a less-drastic alternative. The alternative plan, pushed by Rep. Eileen Cody, D-West Seattle, is a modified version of a proposal offered by emergency-room doctors and hospitals, Brown said (Ostrom, 3/31).

The Associated Press/Houston Chronicle: Details Emerge On Ohio's Health Plan 
The state's plan to streamline medical care for some of its sickest, most expensive and difficult to treat patients includes changes designed to eliminate unnecessary health tests, prevent medication errors and keep people healthier and out of emergency rooms. The proposal for those enrolled in both Medicaid and Medicare could end up being a model for other states, said Ohio officials who drafted the plan. The officials are expected to send the details on Monday to the federal government, which must sign off on the changes (Sanner, 3/30).

In California, transitioning tens of thousands of Medi-Cal beneficiaries into a new adult day health care program begins:

California Healthline: Out With ADHC, In With CBAS
Late Friday night, CMS approved implementation of the Community Based Adult Services program. That means the state has successfully eliminated adult day health care as a Medi-Cal benefit, and is replacing it with CBAS, starting today. According to officials from the Department of Health Care Services, almost 32,000 of the nearly 40,000 ADHC beneficiaries have been deemed eligible for CBAS. That's more than 80 percent of the ADHC population (Gorn, 4/2).

California Healthline: State: DHCS Contempt Motion Won’t Delay New Program Launch
Attorneys gathered in U.S. District Court yesterday morning to argue whether or not the state Department of Health Care Services should be found in contempt of court for its handling of the adult day health transition. That argument will wait a week, at least. After meeting two hours yesterday, the two sides agreed to delay court proceedings (Gorn, 3/30).

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Health Reform Means ER Use Jumps In Colo.; Calif. Insurance Premiums Rise

A selection of state health policy stories from Colorado, California, Oregon, South Carolina, New Hampshire, Minnesota, Connecticut and Massachusetts.

Denver Post: Health Reform Means Huge Rise In ER Use, CU School of Medicine Says
Even people who just got health insurance use the emergency departments to access their care, according to a new study by University of Colorado School of Medicine researchers. It's not just people who lost insurance or people living long without it, the researchers note -- any change in health insurance status, whether positive or negative, tends to send people to the ER because they don’t know where else to go. The study has huge implications if SCOTUS leaves health care reform intact this summer. With 32 million Americans getting new health insurance under the Affordable Care Act, and at least half of those coming through Medicaid, Colorado and national ER use will spike to unmanageable levels, the authors say (Booth, 3/30).

San Francisco Chronicle: Health Insurance Premiums To Rise Soon For Many
More than a million California small-business owners and individual policyholders face a wave of health insurance premium increases in the coming months that range from single digits to as high as 20 percent. Starting Sunday, about 101,000 Anthem Blue Cross small-group customers will see their premiums go up an average of 13.8 percent but as high as 20.5 percent. At the same time, more than 16,000 small businesses covered by Aetna will receive hikes averaging 3.7 percent. While a few will see decreases, others will get hit with increases of more than 20 percent (Colliver, 3/31).

Healthy Cal: Scribes: Helping Overworked Primary Care Physicians
Doctors and patients alike have experienced rising frustration as physicians using electronic health records bury their heads in computer screens, rarely making eye contact while listening to highly personal tales of sickness and woe. But a Northern California community clinic has found a solution to this technological glitch that calms frustrated patients, frees overworked physicians, and improves the clinic's bottom line. Shasta Community Health Center (SCHC) in October completed a successful pilot program that paired "scribes" with physicians at its six clinics (Perry, 4/1).

The Associated Press/Modern Healthcare: Oregon Waits To See How Many Providers Want To Try Coordinated Care
The Oregon Legislature has bought into Gov. John Kitzhaber's ideas for redesigning the state's health care system for low-income patients. Now, it's about to become plain how many Oregon doctors, hospitals and other care providers are ready to put his vision into practice. Organizations that want a piece of the redesigned Oregon Health Plan must declare their intentions to the state by the end of the day April 2 or miss their chance until next year. Letters to state health officials will reveal which care providers are planning to participate, what areas of the state they want to cover and how quickly they're hoping to get their plans off the ground (4/1).

The Lund Report: Committee Creating Community Health Worker Standards Plans To Continue Meeting
The Non-Traditional Healthcare Workforce Committee, which has been designing standards for community health workers in Oregon, believes it’s important to continue its work to oversee the development of that work force. It intends to ask the Oregon Health Policy Board for permission to become a formal advisory body. … Last year, the committee began developing training and education standards for community health workers, and make recommendations to the Policy Board about how the work force should be incorporated into coordinated care organizations (CCOs). The CCOs are part of a major overhaul to the Oregon Health Plan’s delivery system, and are expected to integrate physical and mental healthcare for 650,000 Oregon Health Plan patients in August (Waldroupe, 3/30).

Modern Healthcare: Appeals Court Overturns Order For S.C. Hospital To Pay $45 million In Stark Case
A federal appeals court overturned a district judge's unusual 2010 order for Tuomey Healthcare System to pay more than $45 million for alleged Stark law violations. The 4th U.S. Circuit Court of Appeals concluded that the outcome denied the Sumter, S.C., hospital its constitutional right to a jury trial. In False Claims Act complaints filed in U.S. District Court in Columbia, S.C., a whistle-blower and the U.S. Justice Department alleged that Tuomey entered contracts with specialists that illegally rewarded the physicians for the amount of money they generated for Tuomey (Blesch, 4/1).

New Hampshire Public Radio: DOJ: N.H.'s Mental Health System In Crisis
Earlier this week, the U.S. Department of Justice moved to join a federal lawsuit suing New Hampshire over its mental health system. Government lawyers allege without adequate community-based services, the state is violating the American with Disabilities Act. NHPR's Dan Gorenstein spoke with Department of Justice Attorney Alison Barkoff (Gorenstein, 3/30).

Minnesota Public Radio: State Failed To Review Troubled Past Of Ousted Minn. Security Hospital Administrator
It was April Fool's Day and David Proffitt was a man with a problem. … But just two weeks later, on April 14, 2011, he sent an email to a state agency more than 1,000 miles away to inquire about a job opening at a facility for the mentally ill and dangerous. The agency had just asked the program's long-time administrator to resign. It needed someone who could correct years of problems with staff morale and patient care. The facility in question was the Minnesota Security Hospital in rural St. Peter, Minn., about 70 miles southwest of the Twin Cities. This was Proffitt's chance to redeem himself — if Minnesota did not look too deeply into his past (Baran, 3/30).

CT Mirror: A Judge's Frustrations Lead To Proposal, Outcry From Advocates
Probate Court Judge Robert Killian wants Connecticut to follow the lead of the majority of other states by allowing for people with psychiatric disabilities to be medicated, even if they object, while they're in the community -- if remaining unmedicated would leave them or others at risk of harm. The concept, part of a bill pending before the legislature's Judiciary Committee, is vehemently opposed by advocates for people with mental illness (Levin Becker, 3/30).

Boston Globe: Patients Risk Addiction Relapse With Closure Of Doctors' Clinics
At least 21 doctors who prescribed substance abuse medications in the state have closed their clinics unexpectedly since 2004, leaving more than 1,000 recovering drug addicts looking for urgently needed care. In all but two cases, the doctors faced legal trouble or disciplinary actions, often for fraud, over-prescribing, or their own drug use. The exodus of such providers has strained the limited resources available for substance abuse treatment in the state and, in many cases, put patients in danger of relapse, said Colleen LaBelle, who tracks the closures and runs a state-funded program at Boston Medical Center to connect patients affected by them with new providers (Conaboy, 4/1).

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Editorials and Opinions

Perspectives On The Health Law: Santorum Offers His Plan For Health Freedom; Cardinal Dolan's Meeting With Obama; Dems' and GOP's 'Misconception'

Commentators examine a number of issues related to the federal health law.

USA Today: Santorum: My Plan Offers A Better Way Than ObamaRomneyCare
As the Supreme Court considers the constitutionality of the individual mandate in the Patient Protection and Affordable Care Act, we Americans need to remember that we have the freedom to make choices for ourselves. We, not our government, choose the food to eat, the clothes to wear, the ideas to believe. "ObamaCare" is the opposite of freedom. Under ObamaCare, the government, not the individual, has freedom. We can do better (Rick Santorum, 4/1). 

The Wall Street Journal: When The Archbishop Met The President
The president of the U.S. Conference of Bishops is careful to show due respect for the president of the United States. "I was deeply honored that he would call me and discuss these things with me," says the newly elevated Cardinal Timothy Dolan, archbishop of New York. But when Archbishop Dolan tells me his account of their discussions of the ObamaCare birth-control mandate, Barack Obama sounds imperious and deceitful to me (James Taranto, 3/31).

Denver Post: The Truth About Unintended Pregnancy
While the national debate over birth control ... continues, an important element of the story is being neglected — the truth about the consequences of unintended pregnancies in Colorado, including on the parents, the children and on taxpayers. Unintended pregnancy stretches the state budget, costing Medicaid in Colorado more than $160 million annually. Research shows that investing in planning and prevention saves money. For every public dollar invested in family planning, nearly four dollars are saved in unintended pregnancy costs (Judith C. Shlay, 4/1).

The Wall Street Journal: Rise Of The Medical Expertocracy
As the health-care debate heats up again in Washington, both Democrats and Republicans will try to convince us that they have the experts to answer all our health questions. President Barack Obama and the Democrats propose panels of government experts to evaluate treatments and, in the president's words, "Figure out what works and what doesn't." Republicans claim that the free market (that is, insurance companies with their own experts) will pay for value and empower consumers. Both sides insist that no one will come between us and our doctors. Democrats and Republicans share a fundamental misconception about medical care (Pamela Hartzband and Jerome Groopman, 3/31).

Des Moines Register: Health Care Bills Can Make You Sick
Every one of my neighbors likely has a different health insurance plan. It might be Medicare or Medicaid or one of the thousands of different plans offered by hundreds of private insurers. Navigating all this requires scores of workers behind the scenes in health care. ... As The Des Moines Register's editorial page staff has argued for years, a single-payer health care system would streamline this process and save money. There could be one insurer, one set of rules for billing and less money being dedicated to paperwork. That is money that could be used for care (Andie Dominick, 3/31).

McClatchy / The Myrtle Beach Sun: Health Care, Finite Resources And Endless Problems
The biggest story in the health care debate this week had nothing to do with three days of historic debate at the Supreme Court and everything to do with the failing heart of a 71-year-old man whose fans believe is an American hero and detractors think is Darth Vader, sans the personality. Former vice president Dick Cheney received a new heart this past weekend in a Northern Virginia hospital. … Because of Cheney’s age and well-documented heart problems, questions have been raised about who should be given priority for organ donations. … That question goes to the heart of the debate over health care reform (Issac J.Bailey, 4/1).

The Baltimore Sun: Many Oppose Health Care Act, And Many Don't Know Its Benefits
The fate of the Affordable Care Act is in the hands of the Supreme Court justices. But in the court of public opinion, a large percentage of people polled recently want the law scrapped. A CBS/New York Times survey found nearly half of those polled disapprove of the law, while 40 percent want the entire act overturned. Rasmussen Reports says 56 percent of people surveyed want the act repealed. And the Kaiser Family Foundation found that nearly six out of 10 people don't even know how health care reform affects them — though that didn't stop many of them from disliking it (Eileen Ambrose, 4/1).

Modern Healthcare: Marketing Prevention
Coverage for prevention should be broader. There is both opportunity and threat in the federal government's decision to give states latitude in configuring "essential health benefits" under reform. If Medicaid benefits design is any indication, many states could ignore some preventive services. The federal commitment appears ambivalent as well; in order to pay for postponing the looming Medicare fee reduction for physicians, Congress cut $5 billion from the ACA's prevention fund (Emily Friedman, 3/31).

Modern Healthcare: Local Lessons
The attention of Americans interested in healthcare reform has largely been focused on Washington of late, but a new report from the Commonwealth Fund Commission on a High Performance Health System reminds us that examining the situation closer to home is just as important. The report's key message: Where you live in the U.S. largely determines, for better or for worse, the kind of healthcare you can expect to receive. That shouldn't be the case (Christine Cassel, 3/31). 

Politico: The Next Health Care Frontier
As the debate on health care reignites, many reformers are promoting new ideas to improve transparency in the dynamic marketplace of health services. Central to the private-sector model for the health care delivery system is an emporium of competing institutions and services that can provide consumers with a variety of choices with visible costs and measurable quality. This approach is clearly the best alternative to a government-run, bureaucratic system that rations health care choices as a strategy for controlling costs. Transparency in the marketplace, however, is essential to the efficient functioning of a consumer-driven health care system (Phil English, 4/1).

Arizona Republic: Brewer Correct To Get Framework In Place
Critics are seeing inconsistency in Gov. Jan Brewer's plan to prepare Arizona for the federal health-care reforms at the same time she is suing to spike the sweeping, new law. ... The dichotomy makes sense for a simple reason: The state may lose its court challenge. Should repeal efforts fail as well, states lacking the necessary framework for implementing the health-care law will have to allow the feds to do it for them, resulting in an exchange that reflects Washington's view of Arizona's health-care needs. That is not a prescription for an effective system (3/31).

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Views On The Supreme Court Review: No Matter What The Decision, Reform Will Go On; The Case Threatens The Court's Legacy

Commentators offer a wide variety of views as they look back on last week's case at the high court.

The Washington Post: The Court Can't Stop The Health-Care Revolution
Listening to the lawyers talking nonstop last week about health care gave me a headache, so I decided to consult one of the nation’s top doctors. He offered a real-world diagnosis of what's happening in health care — and a reminder of how much it's changing, regardless of what the Supreme Court decides about Obamacare. My medical guru is Delos "Toby" Cosgrove, chief executive of Cleveland Clinic, a $6 billion network that's one of the biggest and best providers in the country (David Ignatius, 3/30).

The New York Times: The Roberts Court Defines Itself
For anyone who still thought legal conservatives are dedicated to judicial restraint, the oral arguments before the Supreme Court on the health care case should put that idea to rest. There has been no court less restrained in signaling its willingness to replace law made by Congress with law made by justices (3/31).

The Wall Street Journal: Assailing The Supreme Court
After last week's Supreme Court argument on ObamaCare, the political left seems to be suffering a nervous breakdown. Only a week ago, the liberal consensus was that the federal mandate to buy insurance couldn't possibly be overturned. Now as panic sets in, the left has taken to mau-mauing the Justices by saying that if they overturn the mandate they'll be acting like political partisans. The High Court's very "legitimacy" will be in question, as one editorial put it—a view repeated across the liberal commentariat (4/1).

Boston Globe: If Obamacare Is Struck Down, The Court Loses
If the US Supreme Court strikes down Obamacare, there will be one big loser. No, not Barack Obama. Nor Congress. It will be the high court itself. This was a case many thought the government would win relatively easily, based both on a landmark 1942 precedent and on a 2005 case whose six-vote majority included Antonin Scalia and Anthony Kennedy. But judging from Wednesday's arguments and exchanges, the court's conservative judicial activists are much less likely to take a traditionally broad and deferential view of Congress’s Commerce Clause powers in this matter (Lehigh, 3/30).

Chicago Tribune: Justice Kennedy's Obamacare Swing Vote
Obamacare faced a tough crowd at the U.S. Supreme Court last week. But those tough, probing questions from Justice Anthony Kennedy, the court's key swing voter, give defenders of the Affordable Care Act reasons to have hope (Clarence Page, 4/1).

The Washington Post: Commentary: Small-Business Owners Say The Future Looks Bleak If Health Care Law Overturned
As a group of long-standing small-business owners who have been suffering for decades under ever-rising health-care costs, it's frightening to think the safeguards put in place by the law could be undone with the drop of a gavel. The new law has already reined in costs through provisions such as the medical loss ratio. … Just a couple years ago, a member of our group … was quoted a 130 percent increase to his premium. This year, because of the MLR provision, (Walt Rowen's) premium increased by just 4 percent — the smallest increase he's seen to his premiums in 10 years (Jamal Lee, 4/1).

The Washington Post: Eat Your Broccoli, Justice Scalia
My first thought on perusing the briefs filed in the combined cases was to notice what wasn't there: any involvement on the part of Corporate America. For the past 20 years, big business has complained endlessly about escalating health-care premiums, which they correctly blamed on "cost-shifting," including paying indirectly for the free care provided to the workers at firms that did not provide health benefits. ... Yet despite the fact that "Obamacare" did all of those things and more, there was not a single brief in support of the law from an organization representing big business (Steven Pearlstein, 3/31).  

The Washington Post: Could Defeat For Obamacare Mean Victory For Obama?
If the Supreme Court knocks out the guts of the Affordable Care Act — the individual mandate requiring people to purchase health insurance or pay a fine — the battle within the Obama campaign will be fierce. The president will be faced with two stark alternatives: launch the political equivalent of a drone strike on the Supreme Court and use the ruling to energize his base, or accept the decision and move on, hoping to neutralize the divisive law in the general election (Mark Penn, 3/30).

The Washington Post: The Right's Stealthy Coup
Last week's Supreme Court oral arguments on health care were the most dramatic example of how radical tea partyism has displaced mainstream conservative thinking. It's not just that the law's individual mandate was, until very recently, a conservative idea. Even conservative legal analysts were insisting it was impossible to imagine the court declaring the health-care mandate unconstitutional, given its past decisions (E.J. Dionne Jr., 4/1).

Arizona Republic: Court Walks A Fine Line On 'Obamacare'
It would not be an act of judicial activism for the U.S. Supreme Court to declare that the individual mandate in "Obamacare" exceeds Congress' constitutional authority. It would be an act of judicial activism to invalidate the entire law simply because the individual mandate is unconstitutional. The job of the U.S. Supreme Court is to enforce the limits on governmental authority that are contained in the Constitution. It does woefully too little of that (Robert Robb, 3/31).

The New York Times: The Genius Of The Mandate
In arguments before the Supreme Court last week, the health care mandate was defended as a kind of technocratic marvel — the only policy capable of preventing the complex machinery of reform from leaking smoke and spitting lug nuts. But the mandate is actually a more political sort of marvel. In the negotiations over health care reform, it protected the Democratic bill on two fronts at once: buying off some of the most influential interest groups even as it hid the true cost of universal coverage (Ross Douthat, 3/31). 

The Baltimore Sun: A Death-Knell For Employer-Funded Insurance
The Supreme Court directed a harsh spotlight on Obamacare this past week, but the problems with the law go far beyond the constitutionality of the "individual mandate." One of the great unknowns generated by the passage of Obamacare goes directly to the heart of health care choice: the notion that increased employer costs and regulatory burdens would cause employers to simply pay fines (and send their newly insurance-deprived employees to state-run exchanges) rather than continue employer-subsidized insurance (Robert L. Ehrlich Jr., 4/1).

JAMA: Can The Affordable Care Act Proceed Without The Mandate? Should It?
As a policy person and an economist, the answer for me is that the lack of a mandate need not take down the rest of the bill. If the entire bill goes down, it would be far preferable that it be by an act of Congress, as happened with the Medicare Catastrophic Act in 1989, and not by the Supreme Court. Because most of the significant changes regarding ACA-related subsidies and the establishment of state health insurance exchanges don’t occur until 2014, there is ample time for the Congress to make clear its intentions as a result of any action taken by the Court (Gail Wilensky, 3/30).

CNN: In Opposing Obamacare, We Were Serious The Whole Time
"Can you create commerce in order to regulate it?"  With those words, Justice Anthony Kennedy sent the legal establishment reeling. Was the Supreme Court really taking seriously the preposterous claims of the Tea Party-inspired hacks who were suing the federal government?  Was there really a chance that five justices, acting as would-be partisan hacks themselves, would throw out President Obama’s signature achievement?  ... In a word, yes (Ilya Shapiro, 3/2).

CNN: After The Mandate, Government-Run Health Care Would Grow
Suppose the Supreme Court does rule that the health care mandate is unconstitutional? What happens then? (I'm not saying that they will, but let's play "what if?") The famous individual mandate is just one piece of the new health care law enacted in 2010. Take away the mandate, and here are two principal elements left behind:... The majority of those who'd gain health coverage under the new health care law, an estimated 18 million people, would gain it from being enrolled in Medicaid, the health care program for the poor… The new health care law forbids insurers to refuse coverage on the basis of "pre-existing conditions" (David Frum, 4/2).

San Francisco Chronicle: Supreme Court Should Support Health Care Act
Part of a worthy law may be better than none. But saving the entirety of Obamacare would be best. This court and past ones have upheld Congress' right to oversee commercial affairs, a significant and essential duty of government. The issue, divisive as it is, is still one that the high court should support as constitutionally sound (4/1).

Minneapolis Star Tribune: Is Health Care Mandate A Tax?
While some of its key reforms are valuable, I have doubts about Obamacare, most of all about its ability to control costs. But if it is to be abandoned, it should be forthrightly repealed as an unwanted policy…. In 2009, in a television interview, President Obama rejected the tax label for his mandate -- er, provision -- in tolerably unmistakable language. "It is absolutely not a tax increase," he declared, adding, "I absolutely reject that notion." But now, the survival of the president's main achievement may hinge on the willingness of a few Supreme Court justices to give his "absolutism" no more respect than it deserves (D.J. Tice, 3/31).

The Miami Herald: Uphold Healthcare Reform
The indispensable need for change — to cut costs, provide universal coverage, increase efficiency and eliminate waste and unfair practices — will exist regardless of whether the Patient Protection and Affordable Care Act that Congress passed two years ago is upheld. … The court should uphold the law. But whatever decision it makes, there can be no denying that reform in one form or another is coming our way because healthcare is too important to ignore (4/1).

Minneapolis Star Tribune: Michele Bachmann: The Health Care Debate
Obamacare represents the greatest expansion of federal power, the largest entitlement program and the largest social-engineering project of our lifetimes. Obamacare allows the government to tell you what you must purchase. But government should never infringe on personal liberty like this, as it opens a gateway to more egregious government abuses of power that border on tyranny, including socialized medicine (Michele Bachmann, 3/31).

MinnPost: Health Care Case Illustrates Problem Of Life-Time Supreme Court Appointments
It seems likely that this diatribe/tour-of-the-Constitution will be taken as sour grapes by a liberal who fears that the health care law will be struck down and has decided to vent spleen at the poor old framers. In fact, I had been working on this and other similar diatribes/tours-of-the-Constitution for an occasional series that I hope to produce before Election Day. So I moved it up and here it is (Eric Black, 3/30).

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Viewpoints: 'Outrageously High Fee' For Emergency Services; Mysterious Rise In Autism Cases

A selection of editorials and opinions on health policy from around the country.

The Los Angeles Times: The Bizarre Calculus Of Emergency Room Charges
(T)he calculus for medical charges in general is beyond comprehension, with outrageously high fees used as a starting point in a bizarre game of bargaining. Glenn Melnick, who teaches hospital finance at USC, told me it's as crazy as if he asked to buy the TV in my living room, and I gave him a price of $1 million to start the conversation. This is the kind of insanity that exists when medicine and medical insurance are about private profit rather than public health, when 50 million people are uninsured, when Medicare and Medicaid reimbursements don't always cover true costs and when polarized politics prevent the kind of reasonable discussions that could lead to solutions (Steve Lopez, 3/31).

The New York Times: The Puzzle Of More Autism Cases
The latest federal survey suggests that more than 1 percent of all children in the country have been identified as having autism or two related disorders by the age of 8, a far higher percentage than found in previous surveys. But no one knows whether the increase shows that the disorders are more common or whether it simply reflects better detection of cases that would previously have been missed. Either way, the survey by the Centers for Disease Control and Prevention suggests that more children and parents may need help in coping with these disorders in their schools and communities (4/1).

The New York Times: Pink Slime Economics
The trouble with the budget devised by Paul Ryan, the chairman of the House Budget Committee, isn’t just its almost inconceivably cruel priorities, the way it slashes taxes for corporations and the rich while drastically cutting food and medical aid to the needy. Even aside from all that, the Ryan budget purports to reduce the deficit — but the alleged deficit reduction depends on the completely unsupported assertion that trillions of dollars in revenue can be found by closing tax loopholes (Paul Krugman, 4/1).

The Wall Street Journal: Ryan Endorses Romney
Mr. Ryan's endorsement is especially notable because it also reflects the policy progress that Mr. Romney has made over the course of the campaign. The former Massachusetts Governor has embraced a modified version of Mr. Ryan's premium-support Medicare reform. ... . More recently, Mr. Romney endorsed Mr. Ryan's House budget, which the presidential candidate could have ducked. No doubt all of this influenced Mr. Ryan's thinking (Paul A. Gigot, 4/1).

Chicago Tribune: Deluding Ourselves On Medical 'Cures'
"To promote gastric bypass surgery as a quick fix for diabetes is unconscionable," said Dr. Jane L. Delgado. ... The rush to celebrate a cure du jour to medicine's most intractable problems is a result of people's deep desire for science to come up with some "solution" that will enable them to engage in pleasurable, sometimes destructive behaviors, without fear of unhappy consequences (Esther J. Cepeda, 4/2).

USA Today: Complex Health Choices Require Shared Decisions
Involving patient input in medical decisions is a concept known as shared decision-making. According to the Institute of Medicine, it is a foundation of patient-centered care, where care is "responsive to individual patient preferences, needs and values" (Kevin Pho, 4/1). 

WBUR's Common Health blog: On Being Gay In Medicine: A Leading Harvard Pediatrician's Story
I am currently serving on the new Institute of Medicine Committee on Lesbian, Gay, Bisexual and Transgender Health Issues. The public testimony has been moving. The enthusiasm that people have for the very existence of the committee and the expectations they have for our report have been humbling. Their comments have been a reminder of just how marginalized people still feel, and how alienated they feel from the clinicians whom they depend on in their time of greatest need (Dr. Mark Schuster, 3/30).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

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