Daily Health Policy Report

Tuesday, April 2, 2013

Last updated: Tue, Apr 2

KHN Original Reporting & Guest Opinion


Health Reform

Capitol Hill Watch

Women's Health

Administration News

Health Care Marketplace

Veterans Health Care

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Despite Fears Of 'Sticker Shock,' Young Adults Should Have Reasonable Plan Options On Exchanges

Kaiser Health News consumer columnist Michelle Andrews answers readers' questions about the new marketplaces for health plans, including what to expect on the premium prices for young adults, pre-tax contributions to health savings accounts and choosing between work-provided coverage and buying a plan on their own (Andrews, 4/2). Read the story.

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New Med School Aims To Train Primary Care Docs

WNPR's Jeffrey Cohen, working in partnership with Kaiser Health News and NPR, reports: "Michael Ellison has a tough assignment. He's the associate dean of admissions choosing the first class of a brand new medical school, the Frank H. Netter MD School of Medicine at Quinnipiac University in Connecticut. It’s a school with a very specific mission: minting new doctors who want to go into primary care practice" (Cohen, 4/2). Read the story.

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Capsules: No Rate Shock Seen In Proposed 2014 Premiums In Vermont

Now on Kaiser Health News’ blog, Phil Galewitz reports on premium costs in Vermont: "After years of anticipation, Vermont became the first state Monday to publish proposed 2014 individual health insurance rates under the federal health law. Despite Republican and insurers’ predictions, there was no “rate shock” in the new premiums, according to the Vermont governor’s office and insurance representatives" (Galewitz, 4/1). Check out what else is on the blog.

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Political Cartoon: 'Zeroing In?' By Clay Bennett, Chattanooga Times Free Press

Kaiser Health News provides a fresh take on health policy developments with  "Zeroing In?" by Clay Bennett, Chattanooga Times Free Press

Meanwhile, here is today's health policy haiku:


Bracing for rate shock
in Green Mountain State health plans?

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

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Medicare Boosts Rather Than Cuts Payments To Advantage Plans

The insurance industry won a major lobbying victory Monday after the Obama administration backtracked on an earlier plan to cut Medicare Advantage payments to insurers by 2.2 percent in 2014 and instead decided to give them a 3.3 percent increase.

The Wall Street Journal: Medicare Advantage Insurers Win Round
Health insurers stand to get significantly more money for running Medicare Advantage plans next year than they had feared, according to new government rates announced late Monday. The final announcement appeared to significantly improve on a mid-February proposal that featured unexpectedly sharp cuts and prompted a busy lobbying effort from health insurers. Companies that sell the plans, such as Humana Inc., warned that cutting funding too much would hurt benefits for seniors while driving plans out of some markets. The warnings and the lobbying push drew substantial support in Congress, where at least 160 lawmakers signed letters to regulators urging industry-friendly changes (Kamp, 4/1).

The Washington Post: U.S. To Boost Rather Than Cut Payments To Health Insurers
The Obama administration reversed itself Monday, scrapping plans to cut by 2.2 percent the rates paid to health insurers that take part in the Medicare Advantage program. The insurance industry and more than 100 members of Congress had objected to the cut in the per capita growth rate, which was proposed in February. They argued that the administration was using faulty methodology. The insurers mounted a vigorous campaign, using television ads and phone banks, to persuade lawmakers to oppose the reduction (Somashekhar, 4/1).

The Associated Press: CMS Softens Medicare Advantage Funding Changes
Medicare Advantage customers may not see the drastic benefit cuts or premium hikes next year that insurers have been warning about after all. Health insurers had predicted big, painful changes for many of their Medicare Advantage customers after the federal government said in February that the amount it pays per person for the popular coverage could fall more than 2 percent in 2014. The Centers for Medicare and Medicaid Services then changed course on Monday and said it now expects that the cost per person to climb more than 3 percent (Murphy, 4/1).

The Hill: HHS Scraps Proposed Cuts To Private Medicare Plans
The insurance industry won a major lobbying victory Monday as the federal Medicare agency scrapped a proposed cut to Medicare Advantage plans. The Health and Human Services Department announced Monday that it will not follow through on a proposed cut to Medicare Advantage plans, which are administered by private insurers (Baker, 4/1).

Modern Healthcare: CMS Does About-Face On Medicare Advantage Payment Cuts
Apparently swayed by insurers and lawmakers, the CMS backtracked on an earlier plan to cut Medicare Advantage payments to insurers by 2.2% in 2014 and instead decided to give them a 3.3% increase. The CMS ultimately agreed, according to a final payment policy issued today (PDF), that "it is a more reasonable expectation" that Congress will again act to avert the dramatic physician pay cut scheduled under Medicare's sustainable growth rate formula. A draft policy issued in February was based on the CMS' actuary's customary calculation based on current law (Block, 4/1).

Meanwhile, Medicare has proposed ending reimbursement for post-treatment PET scans in prostate cancer patients based on evidence it provides no useful information.

Modern HealthCare: Limited Funding
In an effort to scale back use of high-priced imaging of questionable value in cancer treatment, Medicare has proposed ending reimbursement for post-treatment positron emission tomography scanning in prostate cancer patients and limiting its use to one scan for most other cancer indications. Use of the technology, which involves injecting F-18 fluorodeoxyglucose (FDG) into the blood so the PET scan can identify regions of heightened metabolic activity, a sign of cancer metastasis, has grown sharply in recent years. The CMS, in giving preliminary approval to payments for the technology in 2005, required manufacturers and radiologists to establish a registry to monitor outcomes from its use. The evidence garnered from that registry convinced the CMS that the scans provided no useful information for oncologists treating prostate cancer patients who had already completed their initial therapy, according to the March 13 proposed decision memo (Lee, 3/30).

Medicare also announced it would allow an independent board of attorneys to decide whether it should cover sex-change surgery for some patients.

Medpage Today: CMS Flip-Flops On Sex Change Surgery
On the same day Medicare said it would reconsider whether to cover sex-change surgery for certain patients, officials shifted gears and will now allow an independent board of attorneys to make the judgment. The Centers for Medicare and Medicaid Services (CMS) announced Friday it would open a national coverage determination for gender-change surgery under Medicare for patients with gender identity disorder, otherwise known as severe gender dysphoria. Medicare currently does not cover the surgery; CMS last looked at the procedure in 1981 and decided that it was "experimental" and therefore could not be covered. But soon after CMS placed the call for public comments on the medical evidence of the procedure Friday afternoon, it removed the announcement from its website (Pittman, 4/1).

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Health Reform

Administration Delays Health Law Provision For Small Businesses

The Small Business Health Options Program, or SHOP, would have provided a variety of insurance options for small firms. When the law takes effect next year in states with federally run exchanges, these businesses will be able to offer workers a single plan instead.

The New York Times: Small Firms' Offer Of Plan Choices Under Health Law Delayed
Unable to meet tight deadlines in the new health care law, the Obama administration is delaying parts of a program intended to provide affordable health insurance to small businesses and their employees — a major selling point for the health care legislation. The law calls for a new insurance marketplace specifically for small businesses, starting next year. But in most states, employers will not be able to get what Congress intended: the option to provide workers with a choice of health plans. They will instead be limited to a single plan (Pear, 4/1).

The Wall Street Journal: Small-Business Insurance-Shopping Feature Is Delayed
The Obama administration plans to delay a piece of the federal health law designed to help small businesses shop for insurance policies, citing the need for additional time to prepare. The Small Business Health Options Program, or SHOP, is supposed to provide small employers with an insurance marketplace, or exchange, that offers multiple plan options starting in 2014. But the Department of Health and Human Services has proposed that for the first year, businesses that use the 33 state exchanges run fully or in part by the U.S. will be able to offer only one plan to their workers, rather than pick from a range of options. Washington officials said the 17 states running their own exchanges under the law could choose to enact a similar delay for 2014 (Needleman and Radnofsky, 4/1).

USA Today: Feds Delay Small Business Health Care Program
Small businesses may not have an insurance market set up specifically for them when the state and federal health exchanges begin in January, government officials said Monday. Instead, the federal government announced that the Small Business Health Options Program (SHOP) will be delayed until 2015. Small business employees will still be able to get insurance, but the states have the option to limit that to one choice, rather than a variety of plans, for the first year (Kennedy, 4/1).

Bloomberg: Small-Business Insurance Market From Health Law Delayed A Year
Small-business employees will have to wait a year before they can choose their own medical plans after the Obama administration delayed a part of the 2010 U.S. health-care law intended to provide them with coverage options. Starting in 2014, workers at companies with fewer than 100 employees were supposed to have been able to choose from a variety of health plans through new small-business insurance marketplaces. They'll instead wait until at least 2015, according to regulations released by the U.S. Department of Health and Human Services (Armstrong, 4/2).

Meanwhile, a consumer columnist examines some other exchange issues.

Kaiser Health News: Insuring Your Health: Despite Fears Of 'Sticker Shock,' Young Adults Should Have Reasonable Plan Options On Exchanges
Kaiser Health News consumer columnist Michelle Andrews answers readers' questions about the new marketplaces where consumers can buy 2014 health policies as part of the federal health law. (Andrews, 4/2).

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Indiana House Panel Approves Medicaid Expansion Option

The legislation would use the state's Healthy Indiana Plan to add coverage for 400,000 low-income residents.

The Associated Press: House Panel Oks Medicaid Expansion Through HIP Plan
Medicaid would be expanded in Indiana through a state-run program under legislation approved Monday by a House committee, but while the plan keeps an opt-out provision should federal aid ever dry up, it reverses the governor's preferred funding mechanism. The measure approved 8-5 by the House Public Health Committee removes a major part of the Senate's Medicaid proposal, which was supported by Gov. Mike Pence (4/1).

Indianapolis Star: House Committee Alters Controversial Medicaid Expansion Plan Backed By Gov. Mike Pence
The Indiana House Public Health Committee passed legislation today by an 8-5 bipartisan vote that could expand Medicaid through the Healthy Indiana Plan. Gov. Mike Pence proposes to expand the federal program for the uninsured to about 400,000 more Hoosiers. But he wants to merge Medicaid with the state's own program for the uninsured. Indiana has asked Washington for permission to do so — no sure thing. Pence and lawmakers like the mix of copays, managed and preventive health-care options and spending controls within the Healthy Indiana Plan, which was passed in 2007 with bipartisan support (Sikich, 4/1).

In Texas, state officials held a battle of the press conferences on the expansion question.

Reuters: Texas Governor Reiterates Medicaid Expansion Opposition
Texas Governor Rick Perry on Monday firmly reiterated that the state will not expand its Medicaid program, saying it is a broken system that needs to be reformed by allowing states more flexibility. Perry, who notified the Obama administration last summer that his state would not expand Medicaid, was joined on Monday by other Texas Republican officials, including U.S. Senators John Cornyn and Ted Cruz (MacLaggan, 4/1).

The Hill: Perry Doubles Down Against ObamaCare's Medicaid Expansion
Texas Gov. Rick Perry (R) doubled down Monday in his opposition to expanding Medicaid under President Obama's healthcare law, even though opposing it could cost his state $90 billion. At a press conference where he was flanked by other conservatives, Perry argued expanding the health insurance program for the poor would make Texas "hostage" to the federal government (Viebeck, 4/1).

Politico: Rick Perry: White House Holding States 'Hostage' With Medicaid Expansion
Texas Gov. Rick Perry issued his most forceful rejection yet of the health law's massive Medicaid expansion, calling it a "fool's errand" and promising that governors in pro-expansion states would regret their support. … Perry’s comments are a direct rejection of a recent movement among Republican governors in support of Medicaid expansion. Those governors have argued that expansion would provide an economic windfall for their states, offer basic health coverage to the most vulnerable and prop up struggling hospitals (Cheney, 4/2).

The Texas Tribune: State Leaders Make Case For, Against Expanding Medicaid
The Republican event was followed by a Democratic one led by U.S. Rep. Joaquin Castro, D-San Antonio; his brother, San Antonio Mayor Julián Castro; U.S. Rep. Lloyd Doggett, D-Austin; and legislative Democrats. They demanded that state leaders find a way to draw down the federal money and lift Texas' stigma as having the highest uninsured population of any state. (Ramshaw, 4/1).

And in other states --

St. Louis Beacon: Vote Set On Plan To Change Medicaid In Missouri
The Missouri House has passed a new state budget without Gov. Jay Nixon's sought-after Medicaid expansion, but that doesn't mean Republicans are dropping the topic entirely. The House Government Oversight and Accountability Committee is slated to vote Wednesday on HB700, a bill proposed by state Rep. Jay Barnes, R-Jefferson City, to dramatically change the state's current Medicaid program (Rosenbaum and Mannies, 4/2).

Health News Florida: Feds Like FL Plan, But Some FL Officials Don't Want Feds' Money
In the Friday afternoon rush, those who are tracking the debate on Florida Medicaid expansion may have missed three important events. … Economists from the University of Florida released a study indicating that accepting the money and expanding Medicaid to those under 138 percent of the poverty level -- an approach that State Sen. Joe Negron's "Healthy Florida" plan adopts -- would add 122,000 jobs in the state. State Sen. Aaron Bean offered an alternative plan that is more to the liking of House leaders -- it offers benefit accounts, not insurance, to those at 100 percent of the poverty level. And it would reject the extra federal funds. The federal government released the official rules that say it will cover 100 percent of the cost of expansion for the joint federal-state insurance program for the poor for three years, tapering to 90 percent by 2020 (Gentry, 4/2).

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Vermont First In Parade Of States To Publish Premium Costs

The state is the first to publish proposed 2014 individual health insurance rates under the federal health law.

The Wall Street Journal: First Peek At Health-Law Cost
Two health-insurance carriers in Vermont are proposing to keep their rates about flat next year when the Obama health law overhaul takes full effect, a development that experts say is unlikely to be matched in other states where premiums could surge. Vermont on Monday became the first state to signal how much insurers are seeking to charge when the federal law kicks in (Radnofsky and Mathews, 4/1).

Kaiser Health News: Capsules: No Rate Shock Seen In Proposed 2014 Premiums In Vermont
After years of anticipation, Vermont became the first state Monday to publish proposed 2014 individual health insurance rates under the federal health law. Despite Republican and insurers' predictions, there was no "rate shock" in the new premiums, according to the Vermont governor's office and insurance representatives (Galewitz, 4/1).

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Capitol Hill Watch

Senate Races: Health Law Divides Candidates in Mass., Ga.

In the Massachusetts special election for former Sen. John Kerry's seat, only one candidate is campaigning as a supporter of the 2010 health law.  In Georgia, three physicians are among those contemplating a run for retiring Sen. Saxby Chambliss' seat.

The Associated Press: Health Care Law Divides Massachusetts Senate Candidates
Three years after it split Massachusetts voters in the 2010 special U.S. Senate election, the debate over President Barack Obama's health care law has lost little of its political punch. Of the five candidates vying to fill the seat left vacant by John Kerry's resignation, just one has offered a full-throated defense of the law. Democratic U.S. Rep. Edward Markey has described his vote for the Affordable Care Act as "the proudest vote of my career” (LeBlanc, 4/1).

Medpage Today: U.S. Senate Race In Ga. Filling Up With Docs
Three of the 17 physicians currently serving in the House of Representatives could soon be vying for the same Senate seat in a rare political contest heating up in Georgia. Reps. Paul Broun, MD (R) and Phil Gingrey, MD (R) have already stated their intention to run for a soon-to-be open Senate seat of Sen. Saxby Chambliss (R-Ga.). Meanwhile, the third physician congressman from the state, Rep. Tom Price, MD (R), may also throw his hat in the ring before the start of summer. Chambliss announced in late January he would not seek a third Senate term when his current term ends in 2014 (Pittman, 4/1).

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Women's Health

North Dakota Abortion Clinic Pledges To Fight New State Law

Meanwhile, lawmakers in Washington state, Kansas and Oregon debate proposals to strengthen or weaken abortion rights.

Reuters: North Dakota Abortion Clinic Vows Fight Against Tough New State Laws
North Dakota's only clinic that offers abortion services is vowing to challenge the state's adoption of new restrictions that its backers say imperil its ability to operate. The Red River Women's Clinic, which is tucked inside a downtown Fargo building that once housed one of the state's first beauty shops, is the only alternative for women seeking abortion services for hundreds of miles (Nelson, 4/1).

The New York Times: In Washington, Abortion Debate Counters Trend
The legality or availability of abortion is under challenge from North Dakota to Arkansas this spring as conservative state legislatures throw down roadblocks. But here (in Washington state) in this corner of the Far West, winds may blow the other way. Washington already was the only state ever to have legalized abortion through a popular vote — in 1970, three years before the United States Supreme Court defined the national legal terrain on the issue in Roe v. Wade — and is now debating a law that would require health insurers to pay for an elective abortion (Johnson, 4/1).

The Associated Press: GOP Senators Block Abortion Insurance Bill
Despite a majority of Washington state senators having signed a letter in support of a measure requiring insurers to cover abortion, a key lawmaker said Monday it will not advance from her committee. Republican Sen. Randi Becker, of Eatonville, chairwoman of the Senate Health Care Committee, announced hours after her panel heard testimony on the bill that it would not move forward (Kaminsky, 4/1).

Kansas City Star: Kansas Senate Passes Anti-Abortion Bill Defining Life As Beginning At Fertilization
A bill defining human life as beginning at fertilization and outlawing any direct or indirect state support for abortions cruised to Senate approval Monday. But not before outnumbered Democrats forced Republicans into politically risky roll-call votes over birth control and whether to exempt victims of rape and incest from state abortion restrictions (Lefler, 4/2).

Oregonian: Abortion Rights Resolution In Oregon House Sparks Controversy, Accusations Of Politics
A divisive informational meeting on an abortion rights resolution stirred controversy and sparked Republican accusations of political maneuvering by Democrats, who won control of the House in the November elections. The controversy centered on House Concurrent Resolution 6, which would reaffirm a woman's right to make reproductive decisions. "It is vital to women's health and well-being that abortion remain a safe and legal medical procedure for a woman to consider, if and when she needs it," the resolution reads (Zheng, 4/1).

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Administration News

Obama To Announce Initiative To Map Human Brain

The New York Times reports that President Barack Obama will unveil a broad new research initiative Tuesday, starting with $100 million next year, to find ways to record and map human brain circuits.

The New York Times: Obama To Unveil Initiative To Map The Human Brain
President Obama on Tuesday will announce a broad new research initiative, starting with $100 million in 2014, to invent and refine new technologies to understand the human brain, senior administration officials said Monday. A senior administration scientist compared the new initiative to the Human Genome Project, in that it is directed at a problem that has seemed insoluble up to now: the recording and mapping of brain circuits in action in an effort to “show how millions of brain cells interact.” It is different, however, in that it has, as yet, no clearly defined goals or endpoint. Coming up with those goals will be up to the scientists involved and may take more than year (Markoff and Gorman, 4/2).

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Health Care Marketplace

Image Sharing Aims To Reduce Need For Repeat Scans

Several state and regional health-information exchanges have begun sharing images electronically, and a number of companies sell image-sharing technology directly to hospitals and radiology clinics in a development that could slow health care spending.

The Wall Street Journal: Image Sharing Seeks to Reduce Repeat Scans 
When 5-year-old Piper Gibson was hospitalized in Oklahoma City last summer with frightening strokelike symptoms, her father, Chris, got a same-day second opinion on her brain scan from another neurologist -- in Boston. Mr. Gibson was able to get the second opinion with unusual efficiency by taking advantage of a secure electronic network that can transfer medical images in minutes. It is one of a growing number of image-exchange services that eliminate many of the hassles patients encounter in transferring CT-scans, MRIs, X-rays and ultrasounds whenever they seek a second opinion, consult a specialist or start seeing a new doctor (Landro, 4/1).

Aspiring nurses will soon have a new exam to take --

Marketplace: Nursing Exams Keep Pace With Health Care Tech Advances
This week the National Council of State Boards of Nursing, which administers nurse licensing exams, is rolling out a new update to its test. Remember those Johnson & Johnson ads from the early 2000s? The sentimental long-form tributes to nurses? Consider how much those nurses have had to adapt to big changes in their tool kit in the last ten years -- and the exam that licenses new nurses is changing too. "We've just seen technological revolution in medicine and nursing," says Susan Sanders, Vice President of Kaplan Nursing, who has been a nurse for 34 years (Casey, 4/2).

In the meantime, a new medical school in Connecticut seeks to train primary care doctors --

Kaiser Health News: New Med School Aims To Train Primary Care Docs
Michael Ellison has a tough assignment. He's the associate dean of admissions choosing the first class of a brand new medical school, the Frank H. Netter MD School of Medicine at Quinnipiac University in Connecticut. It’s a school with a very specific mission: minting new doctors who want to go into primary care practice (Cohen, 4/2).

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Veterans Health Care

Legislation Proposed To Help Vets Wrongly Denied Benefits

Two Minnesota lawmakers are pushing a bill to help veterans with post-traumatic stress disorder who may have been discharged from the military after being diagnosed inaccurately. Meanwhile, veterans groups oppose efforts to change disability payments in connection with debt reduction talks.

MPR News: Walz, Klobchar Back Legislation On Mental Health Aid For Misdiagnosed Vets
Two Minnesota lawmakers are pushing legislation they say will help thousands of military veterans who were wrongly denied VA benefits. They say thousands of veterans who may have had post-traumatic stress disorder were wrongly diagnosed. A national study by Yale University found that more than 31,000 veterans were wrongly discharged from the military after being inaccurately diagnosed with either personality or adjustment disorder (Mador, 4/1).

The Associated Press: Veterans Fight Changes To Disability Payments
Veterans groups are rallying to fight any proposal to change disability payments as the federal government attempts to address its long-term debt problem. They say they’ve sacrificed already. Government benefits are adjusted according to inflation, and President Barack Obama has endorsed using a slightly different measure of inflation to calculate Social Security benefits. Benefits would still grow but at a slower rate (Freking, 4/2).

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State Watch

Roundup: Feds Cut N.Y. Medicaid Payments $1.2B; 93,000 Fewer Kids Enroll In CHIP In Pa.

Reuters: Federal Government Slashes New York's Medicaid Payments
Federal authorities have dramatically lowered the amount that New York state can claim from the federal government for certain medical services, costing the state an estimated $1.2 billion. The Center for Medicaid Services (CMS), the federal agency that administers the nation's medical insurance system for people on low incomes, cut the per-patient reimbursement rate for patients in developmental centers to $1,200 from $5,100 from April 1, according to CMS documents seen by Reuters (Krudy, 4/1).

Philadelphia Inquirer: 93,000 Fewer Kids Enrolled In CHIP Under Corbett
For years, the Philadelphia region has been among the best places for a child to get sick. Pennsylvania's Children's Health Insurance Program, dating to 1992, was a model for what Congress expanded to all the states five years later. New Jersey set one of the easiest income thresholds for SCHIP and has aggressively enrolled children into Medicaid as well. New Jersey still has a top reputation, with more than 25,000 children added to the public insurance rolls since July 1, 2011. It has won more than $50 million in federal "bonus" grants for its performance.There have been no bonuses for Pennsylvania. Since Gov. Corbett's first budget took effect in mid-2011, enrollment has dropped by 93,000 (Sapatkin, 4/2).

The Wall Street Journal: Lawmakers Back Fight to Maintain Miners' Benefits 
West Virginia's top lawmakers pledged at a rally Monday to ramp up pressure on Patriot Coal Corp. to continue providing health benefits to 23,000 retired coal miners and their dependents who could lose much of their coverage in bankruptcy court. U.S. Sens. Joe Manchin and Jay Rockefeller, and Rep. Nick Rahall, all Democrats, told several thousand gathered in the Charleston Civic Center that the retirees were entitled to keep receiving benefits, and that the company is breaking a contractual promise negotiated with the United Mine Workers of America to maintain benefits for life (Maher, 4/1).

Asbury Park (N.J.) Press/USA Today: Health Care Costs For Older Inmates Skyrocket 
Older prisoners are also the fastest growing segment of the U.S. prison population. There were an estimated 246,000 people over 50 behind bars last year, according to a 2012 American Civil Liberties Union report. The growing number of older prisoners like (Stephen) Thomas represents a potential fiscal time bomb for the state and nation: Elderly prisoners cost more because almost all expenses related to their health care must be borne by state tax dollars (Mikle, 3/30).

Georgia Health News: Coverage Switch Affects Many Georgia Seniors
More than 7,000 Medicare beneficiaries in Georgia are switching health plans after a Florida-based insurer was ordered to liquidate. All policies of Universal Health Care have been canceled. Last week, federal agents raided the St. Petersburg headquarters of Universal Health Care, after a bankruptcy court trustee alleged a "pattern of dishonesty or gross mismanagement" at the company, including "side deals" that benefited insiders, according to a Tampa Bay Times article. A judge placed the insolvent Medicare insurer into receivership a week prior to the FBI raid. About 800 Universal employees lost their jobs last week after the company shut down (Miller, 4/1). 

MPR News: Legislators Balk At $500M Request From Mayo To Aid Expansion
When Minnesota lawmakers return to the state Capitol on Tuesday to focus on a two-year budget, they will also weigh whether to approve the Mayo Clinic's request for $500 million to support its $3 billion expansion plan. Supporters of the project say state financing for roads, bridges, parking garages and other improvements would ensure that the hospital and clinic system cements its future in the Rochester area (Scheck, 4/2). 

MPR News: 2012 Health Care Spending Per Person Up 5%
Health care spending per person rose 5 percent in Minnesota last year, reports the Minnesota Council of Health Plans, the trade group representing the state's health insurers. HMOs are required to annually report their financial reports to the state. The Minnesota health plans reported total revenue of nearly $21 billion; with an operating profit of $120 million. That's a margin of about six-tenths of a percent. Part of the rise in total spending per person is due to increased costs for chemical dependency and mental health services; chiropractors and social workers -- all were up 15 percent, said Julie Brunner, the council's executive director (Stawicki, 4/1). 

Kansas City Star: Prime Healthcare Completes Hospital Purchases In Kansas City Area
A few hours after gaining Kansas regulatory clearance, Prime Healthcare Services on Monday said it completed its purchase of hospitals in Kansas City, Kan., and Leavenworth. The 400-bed Providence Medical Center and 80-bed St. John Hospital join 23 acute-care hospitals in the California-based Prime chain (4/1). 

CT Mirror: Attorneys Press For Change In Medical Malpractice Procedure
Medical malpractice laws are getting an airing at the Capitol today as the Judiciary Committee hears testimony on a proposed change to how cases against physicians come to court. Since 2005, a patient wanting to claim damages from a doctor for alleged negligence must have his or her case reviewed by a similar health care provider, who will certify whether the claim has merit. If the patient can't get what's known as a good faith certificate, the courts will dismiss the case before it gets to trial. Attorneys say the statute has a chilling effect on cases (Jones, 4/1).

Baltimore Sun: Bill To Increase Oversight Of Cosmetic Surgery Centers Making Late Push In Assembly
A bill to give health regulators more oversight of facilities like the now-closed Monarch Medspa in Timonium is making a late surge in the General Assembly after weeks of discussions among state and industry officials. The House of Delegates unanimously passed the legislation Monday afternoon. It needs to clear the Senate, including an extra procedural step, within the next week (Dance, 4/1). 

The Lund Report: Ore. House Bill 3000 Requires Children To Have Eyes Checked For School
Sen. Richard Devlin, D-Tualatin, as the co-chairman of the Joint Ways & Means Committee, presides over much of the budget and has to be well-versed on statistics and figures. But to show his support for House Bill 3000 -- which would require all Oregon children entering public schools to have a vision screening -- Devlin told the House Education Committee last week he didn't want to focus on statistics and reports, but wanted to tell a story (Gray, 4/1).

Modern Healthcare: Bill Would Offer Meaningful-Use Exemptions
A Republican congresswoman from Tennessee has introduced legislation that would exempt solo practitioners and physicians nearing retirement from the upcoming Medicare reimbursement cuts for physicians who do not meet meaningful-use requirements for electronic health-record systems under the American Recovery and Reinvestment Act. Rep. Diane Lynn Black, a former nurse and member of the House Budget and Ways and Means committees, re-introduced her Electronic Health Records Improvement Act last month (Conn, 4/1). 

California Healthline: Mobile App Highlights Patient Advocate Site
Ratings of health plans' performance put together by the state Office of the Patient Advocate and newly displayed on its website are now accessible by mobile application. "This is the first app of this type nationally," said OPA director Amy Krause. "We hope this makes quality an important part of every doctor visit." At the heart of what makes the mobile app worthwhile, Krause said, is the rating system itself, which is based on information provided by the Department of Insurance. Patients can compare performance and quality factors among HMOs, PPOs and medical groups in California, both overall and within specific categories, such as how plans' providers handle diabetes prevention and treatment (Gorn, 4/1).

California Healthline: Changes Set Stage For 'Shakeout' Of Medical Suppliers, Services
Shifts in contracting practices -- part of the trickle-down effects of health care reform -- are going to change the landscape of medical equipment and service suppliers in California, stakeholders predict. ... Bob Achermann, executive director of the California Association of Medical Product Suppliers ... predicted the number of California businesses providing medical supplies and services may be cut in half over the next few years. Two changes are at the heart of the "thinning of the herd," as Achermann calls it. One is state-driven: California is shifting beneficiaries of Medi-Cal -- California's Medicaid program -- from fee-for-service to managed care. The second is a federally mandated change in the way Medicare contracts with suppliers (Lauer, 4/1).

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Editorials and Opinions

Viewpoints: Actuaries Report Validates Critics' Skepticism Of Law; Campaign To Repeal Medical Devices Tax Is Paying Off

USA Today: ObamaCare Fails To Keep Promises
The non-partisan Society of Actuaries last week said that because of Obamacare, insurers could pay an average of 32% more for medical claims. Those costs will be passed onto those who buy insurance on the individual market in the form of dramatically higher premiums. The new report is further proof that this law is failing to deliver on its promises -- and that the opponents were right to be skeptical (Senate Minority Leader Mitch McConnell, 3/31).

The New York Times: One Industry's Hold On The Senate
Ever since Congress included a 2.3 percent tax on medical devices in President Obama's health care reform law in 2009, there has been a forceful and well-financed campaign to repeal the tax — waged, naturally, by the medical device industry. It has donated generously to lawmakers and candidates, taken them on tours of their plants and spent tens of millions in lobbying. The effort is paying off (4/1). 

Politico: Why Texas Should Not Expand Medicaid
America is facing an entitlement spending crisis, with unfunded liabilities for Medicare, Social Security and Medicaid approaching $100 trillion. This is an outrageous situation that threatens our fiscal and economic well-being as a country. And few brave souls are tackling these problems to find real solutions. Maybe we should start with the smallest of the big three entitlement programs: Medicaid. ... Here in Texas, the Medicaid program truly needs fundamental reform. The status quo leaves enrollees with inadequate access to providers and poor health outcomes. Part of the reason for this is that many Texas physicians, particularly specialists, won't accept Medicaid patients because payments from the state aren't even enough to cover the cost of providing care (Dick Armey and Arlene Wohlgemuth, 4/1).

Los Angeles Times: Don't Cut Lifesaving Dollars
For the last several years, the federal budget for the National Institutes of Health, the world's largest source of basic research funding, has remained at about $30 billion a year. If inflation is factored into the numbers, funding has decreased since 2002. The 2012 NIH budget was $30.7 billion, a $299-million increase over 2011 levels, but accounting for only about 1.25% of all tax revenue collected in 2012. The sequestration enacted March 1 cut the NIH budget 5.1%, a loss of $1.6 billion annually. ... But whatever the problems with current funding structures, the fact remains that public support for basic science is inherent to medical progress (Jessica Wapner, 4/2).

Kansas City Star: Should Companies Play Or Pay On Affordable Care Act?
November's presidential election made it clear that the Affordable Care Act would, indeed, be the law of the land. Early the day after the election, phones at our law office started ringing. The question on callers' minds: Should my company "play" by providing employees "affordable" health insurance coverage, or should we pay the penalty of $2,000 per employee per year beginning in 2014? For companies with more than 50 employees, if the penalty is less costly, paying the fine and turning employees over to the state or federal exchange for health benefits might seem the obvious choice. But it isn’t quite that simple. (Jim Holland, 4/2). 

Medpage Today: Match Day Highlights Growing Doctor Shortage
Medicare has written big checks when it comes to graduate medical education (GME). The program spends approximately $3 billion each year to assist in training doctors. … All told, Medicare spends $15 billion to $20 billion annually on training. The result of this investment, most critics agree, produces some of the best-trained physicians in the world. But is it worth the cost at a time when the system has come under fire for its huge price tag and the relatively low number of doctors who will eventually directly treat the elderly? (John Wasik, 4/1).

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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.