Daily Health Policy Report

Friday, April 20, 2012

Last updated: Fri, Apr 20

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Coverage & Access

Health Care Marketplace


Health Information Technology

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Q & A: Can I Be Denied Coverage For My Daughter Who Is Returning To College?

Kaiser Health News consumer columnist Michelle Andrews answers this question from a reader. Watch the video (4/19).

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Capsules: Growth In Health Costs Limited As Americans Avoid Hospital Stays

Now on Kaiser Health News' blog, Jay Hancock reports: "Americans continued to seek moderate amounts of medical care in the first quarter, helping insurer UnitedHealth Group beat profit expectations amid signs of continued restraint in health-care spending" (Hancock, 4/19). Check out what else is on the blog.

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Political Cartoon: 'Knights of Entitlements'

Kaiser Health News provides a fresh take on health policy developments with "Knights Of Entitlements" by Chris Weyant.

And, to celebrate the fact that we've made it to the end of the week, KHN has decided it's "Limerick Friday" -- inspired by the following submission:


Washington's President Obama
Has passed health care reform - PPACA
All factions criticize 
Ideology emphasize 
Fiscal truth is the delayed trauma
-Rachel Hayes

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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Capitol Hill Watch

Budget Battle Frames Election Campaigns

The budget debate focuses on competing priorities -- spending on defense versus the health law or making chocies between tax cuts for business or safety net programs. Also in the news, spending bills continue to percolate in Congress.   

Politico: House GOP Pits Defense Vs. Health Law
Guns or bandages. That's the choice House Republicans are framing for the White House in the early phases of a battle over budget cuts that will hammer the Pentagon later this year if Congress and President Barack Obama don't slash other programs. GOP lawmakers are moving to eliminate so-called slush funds in Obama's health care law, save $44 billion by cracking down on overpayments to people who are insured through its new health exchanges and wring out tens of billions of dollars more by limiting medical malpractice awards and overhauling Medicaid (Haberkorn and Allen, 4/19).

Los Angeles Times: House Passes 20% Tax Cut For Businesses
Despite a veto threat from President Obama, the Republican-led House approved a 20% election-year tax cut for most companies intended to entice them to pick up the pace of hiring and, thus, boost the economy. Democrats, though, said the 20% tax-cut measure comes as Republicans work to revamp Medicare and slash domestic programs, including the Meals on Wheels program for seniors (Mascaro and Lee, 4/19).

Modern Healthcare: Spending Measure Includes Provision To Aid Rural Hospitals
Nearly nine months after many rural hospitals lost access to a program that provides federal backing to lower the cost of hospital construction and renovation loans, a provision to reinstate that fiscal backstop advanced in the Senate. Sen. Herb Kohl (D-Wis.) added a provision to the Transportation, Housing and Urban Development spending bill to renew an exemption for critical-access hospitals that allowed more of them to qualify for the Federal Housing Authority's Section 242 mortgage-insurance program (Daly, 4/19).

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Health Reform

Consumer-Directed Health Plans Surge, Get Boost From Health Law

The concept is also central to Republican-backed market-based reforms. Also in the news, media outlets analyze what's a stake as the Supreme Court considers challenges to the health law, and Health and Human Services Secretary Kathleen Sebelius reiterates the administration's confidence that the law will be upheld. 

Reuters: Consumer-Directed U.S. Health Insurance Surges
There may not be a consensus in the nation's capital on how to control the cost of health care, but businesses and their employees are not sitting around waiting for clarity. They are voting with their wallets for one approach that's already available: Account-based health insurance plans, which offer lower premiums in exchange for high deductibles. Consumer-directed health insurance is a cornerstone of Republican-backed market-oriented health reform solutions. It will also be offered as an option to shoppers in the public health insurance exchanges under the Affordable Care Act (ACA), if the law isn't struck down by the U.S. Supreme Court in June (Miller, 4/19).

Palm Beach Post: Health Mandate's Affordable Care Act: What's At Stake
The intense debate over whether the U.S. should oblige all citizens to have health insurance has been accompanied in recent days by another spirited squabble: Just whose idea was it in the first place? When it comes to the individual mandate in the Affordable Care Act, which the Supreme Court is expected to rule on in June, no one claims original ownership (Lantigua, 4/19). 

Modern Healthcare: Sebelius: Focus Is On Reform Implementation
HHS Secretary Kathleen Sebelius reiterated the administration's position that it does not have a contingency plan ready should the U.S. Supreme Court rule this summer that the 2010 healthcare-reform law is unconstitutional. "We're confident that the law is constitutional and we are moving forward with implementation," Sebelius said after her keynote address at the Atlantic's Health Care Forum in Washington (Zigmond, 4/19).

But the buzz surrounding the high court examination of the law has focused attention on the makeup of the court -- both in terms of the presidential campaign and the public's questions about what kinds of health coverage the justices enjoy -

Reuters/Chicago Tribune: Analysis: A Romney Pick For Top U.S. Court? Frontrunners Emerge
As a candidate, Romney has pledged to nominate judges in the mold of the Supreme Court's four most conservative justices, and he has said the court should overrule Roe v. Wade, the 1973 opinion that said women have a right to an abortion. … Paul Clement, who served as U.S. solicitor general under President George W. Bush and is now a lawyer in private practice, is the favorite of many conservatives. Clement argued last month for the Supreme Court to strike down Obama's 2010 healthcare law (Ingram, 4/19).

NewsHour: Just Ask: What Health Benefits Do The Supreme Court Justices Receive?
Rob Rabie has some health care advice for the Supreme Court, straight from St. Johns, Ariz. "Perhaps the justices would better appreciate the problem if they were to forego their health insurance plans for a year or so and just pay the medical bills out of pocket like many Americans," he said. "I am sure they could all afford it, but I suspect sticker shock would be rampant." The idea that nine justices with access to "generous" health care insurance will be deciding the fate of the entire health reform law makes Rabie nervous (Kane, 4/19)?

Meanwhile, news outlets also report on how states are handling the uncertainties involved in implementing the health law as they wait for the Supreme Court's decision, as well as a health law program that is popular at the state level and how the federal government is poised to lend a hand -

Politico Pro: Post-SCOTUS Special Sessions Look Unlikely
If the Supreme Court upholds the health reform law this summer, states could be forced into a moment-of-truth situation: Do they set up a health insurance exchange, or do they let the feds come in and run theirs? The problem is that most legislatures will be long gone by the time the Supreme Court will have an answer. That leaves special sessions as their main option for sorting out the exchange question — but state lawmakers and those working with these states aren’t hopeful about the chances of calling them in the aftermath of the court's ruling (Millman, 4/20).

CQ HealthBeat: A Health Law Program States Actually Like? Yes, In The Case Of Duals Demo
The deep disdain expressed by many state officials for "Obamacare" doesn't extend to everything in the health care law — witness their response to a program to test the widespread use of managed care for the so-called dual-eligible population. Melanie Bella, the head of a new office created by the law to improve care for people eligible for both Medicare and Medicaid, said Thursday that 28 states want to take part in the managed care demonstration. It's expected to start in January and enroll up to two million duals (Reichard, 4/19).

CQ HealthBeat: Sebelius: HHS Ready To Lend A Hand To States 'When' Health Law Is Upheld
While Republican state leaders are declaring that they won't implement the health care law pending a U.S. Supreme Court decision, top Health and Human Services officials insisted on Thursday they remain utterly confident the Obama administration's landmark overhaul will be upheld. In fact, HHS Secretary Kathleen Sebelius said that the agency is planning for an onslaught of requests from states that will be in a hurry to set up their health benefits exchanges and will need federal assistance if the law is found constitutional (Norman, 4/19).

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Dems Express Regrets, Grievances Over Health Law Push

Some prominent Democrats wish for a political do-over as they criticize the White House for focusing on the health law instead of the economy during President Barack Obama's first term.

The Hill: Democrats Expressing Buyers' Remorse On Obama's Health Care Law
An increasing number of Democrats are taking potshots at President Obama's healthcare law ahead of a Supreme Court decision that could overturn it. The public grievances have come from centrists and liberals and reflect rising anxiety ahead of November's elections. "I think we would all have been better off — President Obama politically, Democrats in Congress politically, and the nation would have been better off — if we had dealt first with the financial system and the other related economic issues and then come back to healthcare," said Rep. Brad Miller (D-N.C.), who is retiring at the end of this Congress (Pecquet and Baker, 4/19).

Market Watch: Pair Of Top Democrats Lament Obama's Health-Care Push
With polls showing President Obama in a tight race vs. Mitt Romney, several prominent Democrats are lamenting the White House push to pass health-care reform three years ago. In the past few days, Massachusetts Rep. Barney Frank and Virginia Sen. James Webb have both said the bitter battle over the health-care law severely wounded Democrats. Frank, a staunch liberal, and Webb, a moderate, are both retiring at the end of the year (Bartash, 4/19).

In related news -

The Hill: Report: Former Democratic Senator's Wife Pressed To Resign Insurance Co. Board Over Political Spending On Health Law Foes
The wife of former Sen. Evan Bayh (D-Ind.) is under pressure to resign from the board of insurance giant WellPoint after the insurance lobby America's Health Insurance Plans transferred $86 million to the U.S. Chamber of Commerce while the chamber was actively opposing President Obama's healthcare reform law in 2010. A coalition of activist investor groups is launching a campaign calling for the heads of Susan Bayh and another WellPoint board member, The Washington Post reports. The groups allege that the board failed to oversee "high risk political spending" in the run-up to the 2010 midterm elections that saw Democrats lose 66 seats in the House and another six in the Senate (Pecquet, 4/19).

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Coverage & Access

VA Plans Big Boost In Mental Health Staff

The Department of Veterans Affairs will increase its corps of mental health professionals to try to cope with the increased demand from vets of the Iraq and Afghanistan wars.

The New York Times: Veterans Dept. Will Increase Mental Health Staffing
The Department of Veterans Affairs announced on Thursday that it plans to hire about 1,600 additional psychiatrists, psychologists, social workers and other mental health clinicians in an effort to reduce long wait times for services at many veterans medical centers. ... The announcement comes as the department is facing intensified criticism for delays in providing psychological services to veterans at some of its major medical centers (Dao, 4/19).

USA Today: Veterans Affairs To Get 10% Hike In Mental Health Workers
The agency treats 1.3 million veterans for mental health problems, including nearly 400,000 who served in Iraq and Afghanistan. There are 10,000 new patients with post-traumatic stress disorder checking in at hospitals every three months, according to VA data (Zoroya, 4/19).

Modern Healthcare: VA Expanding Mental Health Workforce
The increase follows growing alarm in Congress about the impact on veterans' health of lengthening wait times for such care. The department will add about 1,600 nurses, psychiatrists, psychologists and social workers, as well as about 300 support staff, to its 20,590-member mental health staff (Daly, 4/19).

The Associated Press: VA To Add About 1,900 To Mental Health Staff 
The mental well-being of U.S. veterans has been a critical area of concern in recent years, especially amid reports showing high suicide rates and long wait times for those seeking treatment. A VA survey released last fall, for instance, reported that nearly 40 percent of the 272 mental health providers surveyed said they could not schedule a new patient for an appointment in their own clinic within the VA-mandated window of 14 days, and 70 percent said they lacked adequate space and staff (Tucker, 4/19).

Minneapolis Star Tribune: VA Responds To Iraq, Afghan Vets By Adding Mental Health Workers
The VA will allocate funds from the current budget to 21 VA service networks across the country this month to begin immediate recruiting. The announcement of the increase comes a week before the expected release of a VA inspector general report on long wait times for VA mental health care (Brunswick, 4/19).

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Health Care Marketplace

UnitedHealth Sees Bright Skies Ahead -- Earnings Up

The country's biggest health insurer had a 3.1% increase in first-quarter earnings.

Bloomberg: UnitedHealth Raises Profit Forecast On Higher Enrollment
UnitedHealth Group Inc. (UNH), the biggest U.S. health insurer, increased its 2012 earnings forecast after reporting that first-quarter profit beat analysts' estimates for higher enrollment and low medical costs. ... UnitedHealth's shares climbed, along with other health insurers, after Chief Executive Officer Stephen Hemsley said he expects only a "gradual" rise in health spending this year (Nussbaum, 4/19).

The Wall Street Journal: UnitedHealth's Net Rises As Membership Climbs
UnitedHealth Group Inc.'s first-quarter earnings rose 3.1% behind swelling health-insurance membership and revenue growth across the company's insurance and health-services businesses, and as the company indicated patient traffic in hospitals remains muted. ... UnitedHealth, which added more than 1 million new members in the first quarter, despite a decline among some commercially-insured customers, also raised its full-year membership forecast (Kamp, 4/19).

Reuters: UnitedHealth Raises Outlook As Profit Rises
Investors also are concerned about the impact of the Supreme Court's decision on President Barack Obama's healthcare overhaul law. Worries about the decision, which is expected in June, may prevent health insurance stocks from making more significant gains during the first-quarter reporting period (Krauskopf, 4/19).

Kaiser Health News: Capsules: Growth In Health Costs Limited As Americans Avoid Hospital Stays
Growth in the demand for care fell sharply after the economy tanked in 2008, and analysts have wondered when it would pick up as a recovery took hold. UnitedHealth's results from its 36 million members suggest: Not yet (Hancock, 4/19). 

Minneapolis Star Tribune: Cautious Patients Help UnitedHealth
Price-sensitive Americans are avoiding the hospital and going to urgent care instead, and it's continuing to help insurance companies such as UnitedHealth Group Inc. (Alexander, 4/19).

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Health Costs Up Nearly 6%; Medicare Trustees Solvency Report Due Monday

The cost of health care rose nearly 6 percent in the last year, according to a key indicator. In the meantime, Medicare's trustees will release its forecast on the solvency of the program on Monday.

Milwaukee Journal Sentinel: Cost Of Health Care Services Rises 5.75% Nationally
The average per capita cost of health care services covered by commercial insurance and Medicare increased 5.75 percent over the 12 months ended February 2012, according to the S&P Healthcare Economic Composite Index. Costs covered by commercial insurance plans increased 7.73 percent, as measured by the S&P Healthcare Economic Commercial Index. In contrast, Medicare claim costs rose by 2.72 percent, as measured by the S&P Healthcare Economic Medicare Index (Boulton, 4/19).

CNN Money: Social Security, Medicare Report Card On Tap
Critical to reining in the United States' long-term debt will be finding ways to control the burgeoning costs of Medicare and Social Security, both of which will face serious funding shortfalls over the next two decades. On Monday, the trustees of those programs will offer their annual update on just when those shortfalls will occur. Experts said they expect the trustees' conclusions to be similar to their findings last year. Then again, "It's like trying to predict elections. You never know," said Don Fuerst, senior pension fellow at the American Academy of Actuaries (Sahadi, 4/20).

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Physician Group Touts 'High-Value' Care

News reports indicate that the American College of Physicians, which is focusing this message on treatment choices for diabetes and back pain, sees this idea as a way for patients to get the most out of their their health care dollars.

NPR's SHOTS blog: Doctors Group Tells Patients To Go For Cheaper, High-Value Treatments
The American College of Physicians is urging patients with newly diagnosed diabetes and back pain not to opt for the latest-and-supposedly-greatest. It's part of a new campaign to steer patients (and their doctors) to what the College of Physicians calls "high value care," and away from expensive tests and treatments that aren't any better -- and often are worse. ... Instead of highly touted diabetes brands such as Actos, Januvia and Avandia, the College of Physicians says, patients with type 2 diabetes should start out on a tried-and-true generic  (Knox, 4/19).

MedPage Today: 'High Value' Care Goal of New ACP Partnership
The American College of Physicians (ACP) and Consumer Reports are teaming up to help patients get the biggest bang for their health care bucks, starting with management of low back pain and diabetes, officials of both groups said here. In a joint program called High Value Care, the two organizations are developing brief, to-the-point brochures that advise on expensive tests and treatments to avoid because they lack evidence that their benefits outweigh the costs and risks (Gever, 4/19). 

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Health Information Technology

What Does Technology, Mean For Doctor-Patient Relationships

Confronted with a range of new options, doctors are considering technology's place in their examination rooms.

KQED: Technology Enables Collaborative Doctor-Patient Relationships
Not very long ago, a patient’s medical chart was considered proprietary information belonging to a doctor or a hospital. But just as technology is remaking the rest of the world, it’s also contributing to remaking the relationship between your doctor and you. More patients have access to their data now that more doctors are moving to electronic medical records. Emerging technologies are also driving change (Harris, 4/19).

Medscape: iPad, Notebook, Laptop, Netbook: What's Best for Doctors?
More than 30 percent of U.S. doctors now own an iPad -- not just any touch-screen tablet, but the iconic Apple product specifically -- and some have speculated that the rate could be approaching 50 percent. ... And the iPad is not a perfect device for health care by any stretch of the imagination. A February report from Spyglass Consulting Group, [of] Menlo Park, California, indicated that 80 percent of US physicians think the iPad has a "promising future in health care," but most do not believe that it is "ready to transform patient care delivery today" (Versel, 4/19).

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State Watch

Arizona OKs Contraception Bill, Moves Close To Defunding Planned Parenthood

Arizona legislators gave final approval to a bill allowing employers to opt out of covering contraception in their health plans while moving one step closer to barring Planned Parenthood from public funding in a separate bill. Debates over contraception and abortion also dominate state capitols in Texas, Nebraska and Minnesota.

Arizona Republic: Arizona House Gives Final OK To Contraception Bill
The Arizona House has given its final OK to a measure to allow certain businesses to opt out of providing contraceptive coverage as part of their health care benefits. Supporters of House Bill 2625 say it has been revised to apply to a limited number of "religiously affiliated" businesses. Opponents say the definition of such businesses has been written so broadly that it would let any employer opt out. The bill still needs a final vote in the Senate and then the approval of Gov. Jan Brewer before it becomes law. The Senate may vote on it next week (Rau, 4/19).

Arizona Republic: Arizona Senate To Vote On Planned Parenthood Funding
The Arizona Senate is scheduled to vote on a bill to bar Planned Parenthood from receiving public funding through the state for non-abortion health services. Senate approval on Thursday would complete legislative action on the bill already approved by the House. Arizona already prohibits using tax dollars for abortions except to save the woman's life. But supporters say the bill is needed to cut off indirect funding for Planned Parenthood (4/19).

The Texas Tribune/New York Times: In Tough Times, Three Planned Parenthood Branches Fight Back By Merging
Texas Planned Parenthood advocates have been outspoken about the hits they have taken from state lawmakers in the last year -- including major cuts to family-planning financing, a new abortion sonogram law and being kicked out of a Medicaid health program for poor women (Ramshaw, 4/19).

Los Angeles Times: Nebraska Approves Prenatal Care For Illegal Immigrants
Nebraska legislators handed the governor a political defeat by overriding his veto of a bill that forced conservatives to choose among conflicting priorities, such as care for the unborn, illegal immigrants and even fiscal austerity. On the final day of the state's legislative session Wednesday, lawmakers in the single-chamber, nonpartisan house overrode the governor's veto of a prenatal health bill for illegal immigrants in a narrow 30-16 vote with three present but not voting (Muskal, 4/19).

MinnPost: What's Really Behind The Abortion Bills In Legislature?
One of the bills would require physicians to be physically present in prescribing use of the pill. A second, an even more restrictive measure, would require a doctor to be present when a woman ingested the pill. Both measures passed 80-48, meaning they had substantial [Democratic] votes. .. Even if the bills don't get past [Gov.] Dayton's veto pen, they surely will be factors in some legislative elections. For example, the newly drawn district maps pair seven-term Republican Rep. Larry Howes of Walker and Rep. John Persell, a two-term DFLer from Bemidji (Grow, 4/19). 

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State Highlights: Ill. Gov. Proposes $1.35B Cuts To Medicaid

News outlets report on health care policy issues in California, D.C., Florida, Illinois, Kansas, Kentucky, Massachusetts, Minnesota and South Carolina.

Reuters: Illinois Governor Proposes Plan To Rein In Medicaid
Illinois Governor Pat Quinn on Thursday proposed a plan that he said would save the state's Medicaid health program for the poor from collapse by slashing spending and raising revenue via an increase in the cigarette tax. The Democratic governor's $2.7 billion plan calls for saving $1.35 billion a year by reducing eligibility and coverage, eliminating programs, and other efficiencies. It also calls for dropping rates paid to providers to save another $675 million, and increasing the state's cigarette tax by $1 per pack to raise $335.7 million annually (Pierog, 4/19).

Chicago Tribune: Lawmakers Skeptical Of Quinn Medicaid Cuts, $1 Tax On Cigarette Packs
Gov. Pat Quinn challenged lawmakers Thursday to approve a $1-a-pack increase in the cigarette tax and accept major cuts in the state's health care program for the poor, but many Democrats and Republicans view the plan as more a work in progress than a final deal. ... Among Quinn's suggested cuts are eliminating a discount prescription program for seniors and people with disabilities as well as removing thousands of patients from Medicaid by scaling back who is eligible. The governor also called for getting rid of dental and chiropractic care for adults and limiting what the state would cover for people with HIV and cancer (Garcia, Long and Groeninger, 4/20).

The Wall Street Journal: Police, Pill Mills And Privacy
Politicians, law-enforcement officials and physicians in Kentucky are locking horns over a proposed bill to crack down on the abuse of prescription drugs, in a debate that pits patient privacy against efforts to curb the nation's expanding epidemic of addiction to painkillers. … The Republican-controlled Senate is considering a vote as early as Friday on a bill that would restrict ownership of pain clinics to licensed physicians and give law enforcement easier access to the state's prescription-drug database, which tracks writers and recipients of prescriptions, as well as where the drugs are dispensed (Martin, 4/19).

The Washington Post: If Thompson Doesn't Sell Chartered, It Will Likely Lose DC Health-Care Contract
Wayne Turnage, director of the District's Department of Health Care Finance, told a D.C. Council committee that as long as D.C. Chartered Health Plan remains in (Jeffrey E.) Thompson's hands, it should not expect to continue managing the health care of low-income city residents after its contract expires in May 2013 (DeBonis, 4/19).

The Associated Press: SC Agency Says Information Leaked On 228K People
Authorities say personal information was stolen from more than 228,000 Medicaid patients in South Carolina. Anthony Keck is the state's Health and Human Services director. He says information such as Medicaid ID numbers, names and addresses were taken by an employee. Keck says the employee compiled the data over several months and then sent it to his private email account (Collins, 4/19).

Los Angeles Times: UCLA Doctor Sues Regents, Alleging Bias
A UCLA physician has filed a racial discrimination lawsuit against the UC Board of Regents, alleging that he was routinely publicly humiliated and once was depicted as a gorilla being sodomized in a slide show presentation during a resident graduation event. In a 40-page complaint filed in Los Angeles County Superior Court on Tuesday, Dr. Christian Head, a head and neck surgeon, accused the university of failing to prevent discrimination, harassment and retaliation (Branson-Potts, 4/20).

Kansas Health Institute: House Leader Preparing Proviso For KanCare Carve-Out
House Majority Leader Arlen Siegfreid is preparing a budget proviso that would "carve out" until 2014 long-term services for the developmentally disabled from Gov. Sam Brownback's Medicaid makeover plan. The proviso has been cleared with the Governor's Office, according to sources in the Legislature and the administration, which means it likely will move through the Legislature with little or no opposition (Shields, 4/19).

Kansas Health Institute: New Drug Disposal Program Unveiled
The new program will allow people to return unused drugs that are not controlled substances to participating pharmacies. "Storing unwanted or expired medications in the home poses a significant health risk to Kansas families. Children can be injured or even die from accidental ingestion," said KDHE Secretary Dr. Robert Moser. "This medication disposal program is a collaborative effort in providing a way for Kansans to safely and conveniently get rid of uncontrolled medications" (McLean, 3/19).

Milwaukee Journal Sentinel: Judge To Rule On City's New Health Plan
A judge will decide Friday whether Milwaukee police must pay deductibles as part of a new health insurance plan imposed by the city, the first time a state court will weigh in on a wrinkle that emerged from Gov. Scott Walker's budget-repair bill. While Act 10 removed nearly all collective bargaining for most public employees, it specifically exempted police and firefighters. But the 2011-'13 state budget gave local governments authority to select and design health insurance plans and noted that even the impact of those choices on workers' wages, hours and conditions of employment are not subject to bargaining. With that tool in hand, the Milwaukee Common Council last July tried to impose $500 and $1,000 deductibles for single and family plans, as well as 10% co-pays with $1,000 maximums for singles and $2,000 for families. The union objected (Bruce Vielmetti, 4/19).

The Sacramento Bee: Health Resources On Spanish-Language Site
Californians for Patient Care, the Sacramento-based patient advocacy organization, has launched a Spanish-language website and online database providing access to more than 5,000 low- and no-cost health care resources statewide (Glover, 4/20).

WBUR's CommonHealth blog: Communities Find Health Cost Savings Through New Law
A new survey finds that about three-quarters of cities and towns in the region are beginning to save millions of dollars in health insurance costs after a 2011 law that made it easier for communities to change health plans or join with the Group Insurance Commission. According to the new report from the Metropolitan Area Planning Council and The Boston Foundation, 78 of 101 communities have implemented such reforms, or are planning to (Zimmerman, 4/19). 

San Francisco Chronicle: Analysis Says Calif. Prison Medical Costs Too High
As the state prepares to resume control of inmate medical care, it must find ways to reduce costs that are triple the national average, the nonpartisan Legislative Analyst's Office said Thursday. The federal receivership that has been in place since 2006 has greatly improved the medical care of state prison inmates but also has caused costs to soar, according to the report. California spends $16,000 per inmate for health care services, compared to an average of $5,000 in other states (Thompson, 4/19). 

The Miami Herald: Jackson Health System Reveals A Few Details On Strategic Plan
In the midst of the largest layoffs in Jackson Health System’s 94-year history, the new chief strategy officer offered some thoughts Thursday to the governing board on ways to create revenue for the troubled system — while county commissioners demanded a closed-door meeting to hear specifics. Jeffrey Crudele, who took over the strategy job two weeks ago after the sudden death of Donn Szaro, gave board members timetables for some ideas — such as hiring 100 primary care physicians in the next three years — but he said that these were just initial thoughts, not a complete strategic plan (Dorschner, 4/19).

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Health Policy Research

Research Roundup: Caring For Dual Eligibles; Antitrust Policy And The Law

Every week, KHN reporter Shefali S. Kulkarni compiles a selection of recently released health policy studies and briefs.

PLoS ONE: Geographic And Racial Variation In Premature Mortality In The U.S.: Analyzing The Disparities -- Using data from the Centers for Disease Control and Prevention (CDC), this report notes a systematic difference in life expectancy across region and race. "Within in each sex-race group, there are striking geographical differences in the probability of survival to age 70. ... These differences are larger for males than females within each race and larger for blacks than whites within each sex” (Cullen, Cummins and Fuchs, 4/17).

Urban Institute/Robert Wood Johnson Foundation: ACA Implementation-Monitoring And Tracking: Colorado Site Visit Report -- This report looks at how the state of Colorado created bipartisan health reform. The authors note that "stakeholders have largely worked collaboratively to begin putting various required policies and structures in place. Adopting a 'Colorado-specific' version of health reform has been critical for state policymakers in responding to the ACA, and was a key factor in the successful passage of exchange legislation. Strong leadership, bipartisan political support, and continued aggressive action will be needed for Colorado to succeed in implementing reform on time" (Hill, Courtot, Bovbjerg and Adams, 4/12).

Kaiser Commission on Medicaid and the Uninsured: Massachusetts' Proposed Demonstration To Integrate Care For Dual Eligibles -- The author writes: "This brief examines Massachusetts' proposal to CMS to create an integrated service delivery and payment model in that state. Massachusetts is the first state to submit such a proposal as a part of a nationwide effort guided by the Centers for Medicare and Medicaid Services (CMS). Beginning in January, 2013, CMS will implement a three-year multi-state demonstration to test new service delivery and payment models for people dually eligible for Medicare and Medicaid. These demonstrations will enroll full dual eligibles in managed fee-for-service or capitated managed care plans that seek to integrate benefits and align financial incentives between the two programs" (Musumeci, 4/18).

Government Accountability Office: Federal Antitrust Policy: Stakeholders' Perspectives Differed On The Adequacy Of Guidance For Collaboration Among Health Care Providers -- This report explores how the possibility of creating a collaborative arrangement in the health care system would be received by stakeholders -- "health care industry groups and experts in antitrust law." These collaborative arrangements could include a hospital cooperating with a group of health plans and physicians, for example. The authors write: "The use of exclusive arrangements has the potential to improve or reduce competition, depending on the circumstances. Four of the experts said that the agencies' guidance on exclusive arrangements was reasonable, while three industry groups stated that the agencies should permit greater use of exclusive arrangements" (4/16). 

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

MedPage Today: HIV Prevention Pill's Value Varies by Target
The pill-a-day approach to HIV prevention can be cost-effective in men who have sex with men, but only in those at high risk for infection, researchers reported. In a complex mathematical model, so-called pre-exposure prophylaxis, or PrEP, was found to prevent a large number of infections over a 20-year period, according to Jessie Juusola, MS, and colleagues at Stanford University in Palo Alto, Calif. But the best bang for the buck came when PrEP was aimed mainly at men who have more than five sex partners a year, Juusola and colleagues reported in the April 17 issue of Annals of Internal Medicine (Smith, 4/16).

Reuters/Chicago Tribune: Interpreters In ER May Limit Medical Errors: Study
The study, conducted at two pediatric ERs and published in the Annals of Emergency Medicine, found that mistakes which could have "clinical consequences," like giving the wrong medication dose, were about twice as likely if there were no interpreters or if the translator was an amateur (4/17).

KQED's State of Health blog: Smoking Or Schools: Which Is More Important To Your Health?
Too often, we confuse health with health care. ... health comes from many places we don't normally think of as health at all — things like good schools, safe neighborhoods and access to a variety of jobs. In other words, if you live in places without those things, you have a lower likelihood of enjoying good health. Today, a new study from researchers at Stanford's School of Medicine confirms that health disparities across the country have more to do with social factors than the color of your skin or where you live (Aliferis, 4/17).

MedPage Today: Cheaper Lung Screen May Help in CT Quandary 
A less expensive alternative to CT might help identify patients with suspicious lung lesions that require further evaluation, initial data from an ongoing study showed. ... In the recent National Lung Screening Trial (NLST), screening high-risk patients with chest CT led to a 20% reduction in lung cancer-specific mortality and a 7% reduction in overall mortality compared with conventional chest x-rays. However, CT costs substantially more than chest x-rays do, and increased radiation exposure with CT remains a concern, even with low-dose protocols, said Bertolaccini (Bankhead, 4/19)

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Editorials and Opinions

Viewpoints: Health Law's Legal Peril; Barney Frank's Misdiagnosis

The Wall Street Journal: Life, Liberty And The Pursuit Of Insurance
Health-care reform, the impossible dream that seemed to become a reality in 2010, is now in mortal danger. Republicans want to repeal it even though the federal law is patterned after a Massachusetts law that their apparent presidential nominee signed in 2006. They can't do that, of course, unless they sweep the next election. So the clear and present danger comes from the Supreme Court, where a majority of justices seemed to snarl at the law in open session last month. Health-care reform is clearly in legal peril (Alan S. Blinder, 4/19).

Bloomberg: Barney Frank Makes A Misdiagnosis On Obamacare
Representative Barney Frank, who is not seeking re-election, gave a memorable exit interview this week to New York magazine suggesting that President Barack Obama "underestimated, as did Clinton, the sensitivity of people to what they see as an effort to make them share the health care with poor people." The Democratic Party "paid a terrible price for health care," Frank said. ... Democrats are wondering if it was worth it to lose the House in 2010 and perhaps the White House in 2012 over a bill that may be declared unconstitutional, anyway. The answer is yes (Jonathan Alter, 4/19).

The Atlanta Journal-Constitution: Abortion Bill Fosters Safety
My experience in taking care of the vast majority of bleeding complications of late-term abortions in Atlanta since 1983 tells me that the bill tweaks Georgia abortion rights into the mainstream of medical opinion. Maximizing maternal safety now overrides the right to choose with regard to late-term abortion, something pro-choice advocates, in an effort to thwart attempts to whittle away abortion rights entirely, refuse to concede (Kenneth Braunstein, 4/19).

The Atlanta Journal-Constitution: Women's Rights Imperiled
The old expression "the wolf at the door" aptly describes the recent war on women's health in Georgia. ... The wolf also can be seen in patronizing legislators who profess to know more about a woman's health and family than she does and more than physicians about the practice of medicine. Last month, state legislators passed — in the waning minutes of the session — HB 954, a bill to shorten the period of time in which a woman could seek an abortion (Leola Reis, 4/19).

Arizona Republic: No Contraception For Bad Ideas
The state House approved the bill allowing some businesses to opt out of providing contraception health-care coverage, supposedly because of their religious convictions. It now has to go to the Senate. Then the governor. It's a bad idea. It’s not about "religious freedom." It's about special consideration for religious institutions when they're operating outside of their churches in the secular world, a place where everyone should be required to play by the same rules (E.J. Montini, 4/19).

The Sacramento Bee: Backlog In VA Benefit Claims Is Shameful
Tens of thousands of veterans are coming home to California after serving with honor in Afghanistan and Iraq. Many are carrying the physical and mental wounds of war. The least our country can do is to give them the help they have earned. But in Northern California, it is taking ridiculously, unconscionably long for veterans to get their claims for disability benefits completed. Worse still, the U.S. Department of Veterans Affairs, even as it acknowledges the problem, isn't doing enough to fix it. That became all too clear at a congressional hearing Wednesday (4/20).

Medscape: EHR: Forget Billing And Go For The Registry
I have a small practice in the Bronx, consisting of myself and a nurse practitioner, and we have had many adventures with different electronic records. I have been an electronic prescriber for more than 10 years and have thrown out more than I have kept in terms of programs and health information technology. ... When this type of situation has been studied, particularly the integrated practices, it has been found that these systems are driving up costs rather than dropping costs. It is not an information highway; it is branding. Many large institutions brand their electronic records so that they don't "talk" to each other. In New York, where we have at least 10 institutions that are the best in the world, their systems don't talk to each other (Dr. Robert Morrow, 4/19).

Denver Post: HBO's "The Weight of the Nation" Series And America's Obesity Problem
In a new documentary series, "The Weight of the Nation," debuting exclusively on HBO next month, we see the story of our nation's transformation to a land of overweight and obese citizens. It is a compelling story of overproduction and mass marketing of poor quality food, decrease in physical activity in our daily activities, and decreased accessibility of healthy foods and active places for many of us. The current food and fitness environment described in the series naturally produces an overweight/obese population, for which we are all paying dearly (Eric France, 4/20).

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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.