Daily Health Policy Report

Monday, April 23, 2012

Last updated: Mon, Apr 23

KHN Original Reporting & Guest Opinion


Health Reform

Capitol Hill Watch

Campaign 2012

Administration News

Health Care Marketplace

Public Health & Education

Health Information Technology

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

States Consider Limiting Patient Costs For Physical, Speech, Occupational Therapy

Kaiser Health News staff writer Julie Appleby reports: "In the case of physical therapy, a growing number of insurers and employers classify those visits as specialty care, so patients generally pay a higher copayment, often the same amount as for a visit to a specialist, such as a surgeon, neurologist or cardiologist" (Appleby, 4/22). Read the story.

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Capsules: Maryland's First Green House Project Nursing Home Aids Low-Income Seniors

Now on Kaiser Health News' blog, Shefali S. Kulkarni writes: "What was once a novel idea for  longterm care for the elderly — small, homey facilities of 10 to 12 residents each — is now a model cropping up around the country" (Kulkarni, 4/20). Read what else is on the blog.

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Political Cartoon: 'Birds And Bees'

Kaiser Health News provides a fresh take on health policy developments with "Birds and Bees" by Nick Anderson.

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


Surgery's fine in 
Central America where
I can afford it.
-Carmela Landes, MD

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 Trustees Project Funding Will Fall Short By 2024

Last year's report predicted the same timeline for the Medicare trust fund's insolvency. Kaiser Health News is tracking today's news coverage.

The Associated Press: Aging Workforce Strains Social Security, Medicare
An aging population and an economy that has been slow to rebound are straining the long-term finances of Social Security and Medicare, the government's two largest benefit programs. Those problems are getting new attention Monday as the trustees who oversee the massive programs release their annual financial reports. Medicare is in worse shape than Social Security because of rising health care costs (Ohlemacher, 4/23).

Kaiser Health News: Trustees: Aging Population, Costs Worsen Medicare's Long-term Prognosis
Overall, the outlook for the social insurance program that covers nearly 50 million elderly and disabled people was only slightly worse than findings from last year. Once again, trustees forecast that Medicare’s hospital fund would begin to run out of money beginning in 2024, but in a politically charged campaign season, both Democrats and Republicans can be expected to use the report to their advantage. ... Today’s report emphasized that Medicare costs in both the short term and long term would rise higher than previously reported but these costs would be offset by 2 percent cuts to the program agreed to in last year’s deficit reduction agreement, unless Congress passes an alternative cost-cutting plan (Werber Serafini and Galewitz, 4/23).

The Wall Street Journal: Outlook For Social Security, Medicare Continues To Deteriorate
The trustees for the two programs said in their annual report that the long-run deficit projections for both Social Security and Medicare worsened over the last year, putting the onus on U.S. policy makers to address the problems sooner rather than later to avoid hurting seniors, low-income households and others who depend on the program (Crittenden and Morath, 4/23).

CNN: Medicare Funding Runs Short By 2024, Trustees Say
Highlighting the fiscal problems posed by growing health costs and an aging population, the trustees of Medicare estimated Monday that the program will be able to pay only a portion of promised benefits starting in 2024. That's the same year the trustees had estimated last year(Sahadi, 4/23).

Reuters: U.S. Retirement Fund To Run Dry Earlier
The deteriorating shape of Medicare and Social Security funds -- largely because of an aging U.S. population and rising healthcare costs -- highlights the need to overhaul the costly benefits programs and adds fire to the debate over how to rein in government spending (4/23).

The Hill: Trustees Say Medicare, Social Security Funds Running Out Quickly
Treasury Secretary Timothy Geithner said the trustees' reports show a clear need for Congress to make significant changes to entitlement programs, but he continued to hold firm against Republican proposals to partially privatize Medicare (Baker, 4/23).

The New York Times: Financial Outlook Dims For Social Security
The central message of the new report remains the same: the two entitlement programs are unsustainable without structural changes that have so far eluded Congress and the administration. ... The estimates ... come as Republicans and Democrats are noisily blaming each other for the perilous straits of the retirement programs. The Medicare projection also plays into the continuing battle over President Obama's health care overhaul, with his representatives among the trustees saying that Medicare would be running out of money even sooner without the new law, while opponents call into question the law’s Medicare savings (Cushman and Pear, 4/23). 

Bloomberg Businessweek: Medicare Financial Condition Holds Pat
The deal President Barack Obama made last year with Republicans to reduce the U.S. deficit may have stalled a worsening in the financial condition of Medicare. The debt-reduction legislation included cuts to Medicare payments that will be automatically enacted in 2013. Those reductions are offsetting gloomier assumptions about the nation’s future economic performance, leading to no change in the 2024 date that trustees said Medicare will exhaust its main trust fund (Wayne, 4/23).

KHN's coverage of the 2011 Medicare report: Gloomier-Than-Expected Forecast For Medicare (Galewitz and Carey, 5/13/11).


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GAO Report Offers Rebuke Of Medicare Bonus Program

A report to be released today by government auditors calls the Medicare bonus program wasteful and questions claims it improves quality of care.

The New York Times: GAO Calls Test Project By Medicare Costly Waste
Medicare is wasting more than $8 billion on an experimental program that rewards providers of mediocre health care and is unlikely to produce useful results, federal investigators say in a new report (Pear, 4/22).

The Associated Press: Auditors Call For End To Medicare Bonus Program
In a rebuke to the Obama administration, government auditors are calling for the cancellation of an $8 billion Medicare program that congressional Republicans have criticized as a political ploy. The nonpartisan Government Accountability Office says in a report to be released Monday that the $8.3 billion the administration has earmarked for quality bonuses to Medicare Advantage insurance plans would postpone the pain of cuts to the plans under the new health care law. Most of the money would go to plans rated merely average (Alonso-Zaldivar, 4/23).

Related, much earlier KHN coverage: 
Effort To Reward Medicare Advantage Plans Draws Criticism (Appleby, 1/10/11). 

Winners And Losers In Medicare Advantage Extras: Avalere Report (Werber Serafini, 3/12). 

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Health Reform

Politics And Policy: Exploring The GOP's Health Law Alternatives

The Los Angeles Times reports that the health reform plan embraced by Republican presidential hopeful Mitt Romney may be "more revolutionary" than the current health law. Also, Reuters examines some of the policies congressional Republicans are considering if the Supreme Court overturns the law.

Los Angeles Times: Romney's Healthcare Plan May Be More Revolutionary Than Obama's
As he pushes to "repeal and replace" President Obama's healthcare law, former Massachusetts Gov. Mitt Romney has turned to proposals that could alter the way hundreds of millions of Americans get their medical insurance. In public, Romney has only sketched the outlines of a plan. … But his public statements and interviews with advisors make clear that Romney has embraced a strategy that in crucial ways is more revolutionary — and potentially more disruptive — than the law Obama signed two years ago (Levey, 4/23).

Reuters: Republicans Eye Health Plan Should Court Overturn Reform
House Republicans are working to create a legislative blueprint they can sell to voters after the Supreme Court rules on Obama's Patient Protection and Affordable Care Act, the nation's most sweeping healthcare legislation since Medicare and Medicaid in the 1960s. Lawmakers and their aides say a Republican plan would focus on controlling healthcare costs and allowing people to retain coverage while changing jobs. They will avoid Obama's comprehensive approach to extend coverage to 32 million uninsured Americans (Morgan, 4/22).

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Health Law Uncertainty Sets Up 'Moment-Of-Truth' Situations

This circumstance is particularly acute regarding states' decisions about setting up health exchanges.   

Politico: Health Reform Law Poses Quandary For States
If the Supreme Court upholds the health reform law this summer, states could be forced to a moment-of-truth situation: Do they set up a health insurance exchange, or do they let the feds come in and run theirs? (Millman, 4/22).

Meanwhile, Modern Healthcare provides a pair of stories that explore the dynamics involved in the industry's interest in accountable care organizations.

Modern Healthcare: Then There Were Six—ACOs
Ten physician groups agreed in 2011 to extend their test of Medicare accountable care, which began in 2005, for another two years. Now, six remain. Three did not go far. Dartmouth Hitchcock in New Hampshire, Park Nicollet Health Services in Minnesota and the University of Michigan all moved into another more sophisticated Medicare accountable care experiment known as the Pioneer program in January. But one made a complete exit: the Everett (Wash.) Clinic. After six years working with Medicare to make accountable care work, the group practice preferred Medicare managed care, or Medicare Advantage (Evans, 4/20).

Modern Healthcare: No ROI In ACO
The healthcare reform law created a flurry of activity among hospitals and systems laying the groundwork to get in on Medicare's new incentive programs for accountable care organizations. But most of the largest for-profit healthcare groups have been absent from the clamor, hardly represented in the first few waves of participants in the CMS experiments. Instead, their executives have said publicly and privately that they're waiting to see how the program evolves before investing resources in it (Kutscher, 4/21).

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Capitol Hill Watch

Hearings And Analyses Frame Capitol Hill Budget Fight Over Medicare, Deficit

Lawmakers on Capitol Hill are tussling over budget proposals that would change Medicare and/or reduce the budget deficit.

The Hill: Ways And Means Wades Into Controversial Medicare Proposals
The House Ways and Means Committee’s health panel will hold a hearing next week on proposals to at least partially privatize Medicare -- proposals that landed with a thud just a year ago. Democrats have hammered the Medicare plans championed by Rep. Paul Ryan (R-Wis.), and his budget outline last year helped bolster Democrats’ hopes of winning back the House majority. Establishment Republicans were also wary of the idea last year, warning against moving forward with Ryan’s plan (Baker, 4/20).

The Hill: Analysis Says Ryan Plan Would Have Cost States $500 Billion Over Past Decade
States would have lost more than $500 billion over the past decade if Rep. Paul Ryan’s (R-Wis.) proposed Medicaid cuts had been in place, the Center on Budget and Policy Priorities said Friday. ... CBPP tried to demonstrate the magnitude of Ryan’s proposal by calculating how much money states would have lost if Ryan’s proposal had taken effect in 2001. The hypothetical provides 10 years of real spending data, rather than estimates (Baker, 4/20).

Modern Healthcare: Dueling Budget Plans
Democratic and Republican lawmakers laid out conflicting long-term markers for health care spending on Capitol Hill last week as policymakers continue to battle over the federal deficit and government spending. Sen. Kent Conrad (D-N.D.), chairman of the Senate Budget Committee, offered a draft budget that was largely based on the deficit-reduction commission appointed by President Barack Obama. The measure was significant as the first Senate Democratic budget in four years (Daly and Zigmond, 4/21).

Meanwhile, ob-gyns are making their mark on Congress while a postal reform bill could boost health premiums for some federal workers --

Politico: Ob-Gyns Aim To Deliver On The Hill
They rush to meetings, deal with crying babies, talk about contraception and fall behind on their schedules. It's the daily schedule for a typical obstetrician and gynecologist, but also for the lawmakers who were ob-gyns before they ditched their white coats for pinstriped suits and became some of the most conservative and outspoken members of Congress (Nocera, 4/22).

The Hill: Postal Bill Could Bring Hike In Health Premiums For Federal Workers
Thousands of federal workers could see a double-digit jump in their health care premiums under a postal reform bill that is moving through the Senate. The bill would change the way postal workers get their health benefits and could have a ripple effect across the Federal Employees Health Benefits Program (FEHBP), which provides coverage for the federal workforce. The postal bill would lead to premium hikes of at least 10 percent in three of the largest plans in the entire FEHBP, according to an estimate that the Office of Personnel Management that was provided to congressional aides (Baker, 4/20).

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Campaign 2012

Despite Campaign Rhetoric, Medicare Deal May Be Possible

Still, some say Mitt Romney, if elected president, couldn't deliver on his promise to cut the budget without harming health care programs.

The New York Times: In Presidential Race's Give-And-Take, Hope For A Fiscal Compromise
The potential breakthrough in question is the sort that the Simpson-Bowles commission proposed in 2010: roughly $4 trillion in deficit reduction over 10 years in a compromise requiring Republicans to accept tax increases and Democrats big changes in Medicare and other entitlement programs. ... A growing group of Senate Democrats is concluding that overhauling Medicare through a premium support option “makes an awful lot of sense,” said Maya MacGuineas, president of the Committee for a Responsible Federal Budget (Harwood, 4/22).

The Associated Press: Romney On Spending: Guns Trump Butter
Reducing government deficits Mitt Romney's way would mean less money for health care for the poor and disabled and big cuts to nuts-and-bolts functions such as food inspection, border security and education. ... He generally endorses a plan by House Budget Committee Chairman Paul Ryan, R-Wis., to gradually transform Medicare from a program that directly pays hospital and doctor bills into vouchers for subsidizing future beneficiaries in buying health insurance (Taylor, 4/23).

The Wall Street Journal: Budget Promise Proves Tough Test
During his long primary campaign, Mitt Romney vowed to balance the federal budget by 2020 and sharply shrink spending by 2016. He pledged to do so without cutting Social Security or Medicare benefits, two of the main drivers of federal spending ... These twin promises are causing some headaches for his economic-policy team. ... To cut $500 billion from projected spending in 2016 as promised, Mr. Romney might have to reduce all other federal spending by 25%, including programs such as Medicaid (Paletta and Murray, 4/20).

The New York Times: Conservative Nonprofit Acts as a Stealth Business Lobbyist
ALEC also sends talking points to its lawmakers to use when speaking publicly about issues like President Obama's health care law. Last month, on the day that Supreme Court arguments on the law began, ALEC sent an e-mail to legislators with a bullet-point list of criticisms of it, to be used "in your next radio interview, town hall meeting, op-ed or letter to the editor" (McIntire, 4/21).

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Administration News

Former Planned Parenthood Spokesman To Join HHS Public Affairs Shop

Politico: HHS Hires Former Planned Parenthood Spokesman
If the Obama administration was already on bad terms with abortion opponents, it's not going to improve relations by hiring Planned Parenthood's former spokesman for a job at the Department of Health and Human Services. Tait Sye, Planned Parenthood's former media director, has joined HHS as deputy assistant secretary for public affairs, HHS made public Friday. He'll have the public health portfolio — an area where you can be pretty sure abortion and contraception issues will come up (Feder, 4/20).

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Health Care Marketplace

Calif. Officials Propose Controversial Insurance Rules

The health insurance marketplace continues its march toward change as California's Department of Insurance proposes new controversial rules on small business self-insurance and officials mull increasing premiums on those with unhealthy lifestyles.

Los Angeles Times: Proposed Limits On Health Self-Insurance Plans Debated
Business and insurance groups are attacking a proposal by state regulators to impose new limits on a controversial form of health coverage that insurers are selling to small employers. The California Department of Insurance is pushing legislation that calls for new rules on a type of company self-insurance that's growing more popular as small businesses seek alternatives to ever-rising premiums for conventional health coverage (Terhune, 4/21).

Kansas Health Institute News: Workers With Unhealthy Lifestyles Can Expect Premium Increases, Expert Says
"Companies are moving more toward a pure insurance philosophy where people who create more risk are going to pay more," said J. Michael Brewer, president of Lockton Benefit Group, the world's largest independent and privately owned insurance brokerage firm. The concept, he said, is similar to high-risk drivers having to pay higher car-insurance premiums than low-risk drivers (Ranney, 4/20).

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Older Patients Trigger New Ideas For Health Care Facilities

News outlets report on innovations in the design of health care facilities that respond to the needs of older patients. 

MSNBC: Emergency Rooms Designed For The Older Set
At Mount Sinai Hospital in New York City, he found thick mattresses to prevent bedsores, skid-proof floors, and curtains designed to produce less noise. It's only a few examples of the features designed specifically for senior citizens. According to the Centers for Disease Control and Prevention, individuals 65 years and older typically make up nearly 25 percent of adult emergency room visits. The creation of the geriatric centered emergency department, or geri-ed, at Mount Sinai Hospital represents a shift towards catering to the health needs of the growing aging population (Ho and Snyderman, 4/22).

Kaiser Health News: Capsules: Maryland's First Green House Project Nursing Home Aids Low-Income Seniors
What was once a novel idea for  longterm care for the elderly — small, homey facilities of 10 to 12 residents each — is now a model cropping up around the country (Kulkarni, 4/20).

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Public Health & Education

Cancer, Genetic Screenings Under Scrutiny

Various news outlets covered issues around cancer screening, diagnosis and treatment.

Reuters/The Fiscal Times: Cancer Screenings Stoke The Overdiagnosis Debate
Screening for rare but deadly esophageal cancer is typically a laborious and costly procedure, requiring sedation and a day off from work. The new technology [Dr. Jonathan] Aviv uses makes it a cinch. That's why the few minutes he spent on Henry's screening threatens to open a new front in the fight over the costs and benefits of looking for disease in patients who aren't sick (Joelving, 4/22).

MedPage Today: Lung Cancer Screening Wins More Support
Consensus is starting to build that long-time smokers should have annual CT-based screenings to reduce lung cancer mortality, a researcher said here. A series of studies suggesting a mortality reduction in high-risk current and former smokers who underwent screening -- capped by last year's report from the National Lung Screening Trial (NLST) -- has built a case in favor of screening, which is still officially discouraged in primary care, said James Jett, MD, of National Jewish Medical Center in Denver, at the annual meeting of the American College of Physicians (Gever, 4/20). 

USA Today: Genetic Testing And Disease: Would You Want To Know
Gone would be the days of waiting to develop a disease. People would know about diseases they are at risk for and could change their living habits or consider treatments. Opponents warn about the potential for invasion of privacy — threatening employment and insurance — and the possibility that people equipped with the knowledge of their genetic makeup might make risky and unhealthy decisions (Lloyd, 4/22).

The Wall Street Journal: Lab Mistakes Hobble Cancer Studies But Scientists Slow to Take Remedies
Cancer experts seeking to solve the problem have found that a fifth to a third or more of cancer cell lines tested were mistakenly identified—with researchers unwittingly studying the wrong cancers, slowing progress toward new treatments and wasting precious time and money. ... It is a problem hiding in plain sight. Warnings to properly test cancer cell lines have sounded since the 1960s (Marcus, 4/20).

Roll Call: Health Care: From Lab To The Patient
Sometime this summer, researchers funded by a new center at the National Institutes of Health will begin trying to construct a new tool to test whether drugs are likely to be safe in humans. If successful, the technique could significantly shorten the time it takes for drug developers to figure out whether a product can pass the first test facing a proposed therapy — whether it will end up hurting the patients that it’s intended to help (Adams, 4/23).


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Health Information Technology

Online Health Record Safeguards May Not Be As Secure As Consumers Hope

Chicago Tribune: Health Records Lost, Stolen Or Revealed Online
Almost a decade after a new law went into effect to strengthen health privacy protections, the number of breaches of patient records and databases across the U.S. suggests that personal health information is not as private or secure as many consumers might want or expect (Shelton, 4/23).

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State Watch

Conn., Wis. Collective Bargaining Agreements Mean Public Employee Benefit Changes

Collective bargaining agreements are changing health plans in Connecticut and Wisconsin for home care workers, teachers and a police union -- which, if it was not granted an injunction from a judge, would have had to pay new deductibles and copays in Milwaukee.

The Connecticut Mirror: House Approves Controversial Collective Bargaining Proposal
The House approved a controversial proposal to give collective bargaining rights to certain home care workers and daycare providers Friday night, a matter that has galvanized union supporters and opponents, people with disabilities, child care providers and critics of Gov. Dannel P. Malloy (Levin Becker, 4/20).

Milwaukee Journal Sentinel: Teachers Moving To Pricier Health Plans
Coming into the second year of restricted collective bargaining, school districts that last year handed off higher premium contributions to teachers are now moving to high-deductible health plans like those commonly seen in private business. Teachers' new medical plans are featuring annual deductibles of $2,000 for individuals and $4,000 for families but also come with wellness program incentives that fund health accounts designed to cover much of a teacher's out-of-pocket expenses (Breunlin, 4/21).

Milwaukee Journal Sentinel: Judge Signs With Police Union On New Co-Pays, Deductibles
A judge on Friday granted a permanent injunction blocking Milwaukee's efforts to make its police officers pay new deductibles and co-pays as part of their health insurance. In a rambling, hourlong oral ruling, Circuit Judge Dominic Amato said the city's attempts to distinguish such payments from health insurance premiums was a "red herring," and that the Legislature clearly intended to preserve all collective bargaining for public safety employees -- including the right to bargain over who pays the costs of health insurance (Vielmetti, 4/20).

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Wis. Planned Parenthoods Stops Non-Surgical Abortions

Planned Parenthood of Wisconsin has stopped giving non-surgical abortions after a new law took effect that requires women to have three doctor visits before getting a drug-induced abortion. In Iowa, Planned Parenthood of the Heartland is criticizing the state budget that would disallow public Medicaid funding for abortions in cases of rape or incest.

Reuters/MSNBC: Wisconsin's Planned Parenthood Suspends Non-Surgical Abortions
Planned Parenthood of Wisconsin has suspended non-surgical abortions in response to a new state law that makes it harder for women to have the procedure, a move that followed anti-abortion measures in several Republican-controlled states. The law, which took effect on Friday, requires women visit a doctor at least three times before having a drug-induced abortion, forces physicians to determine whether women are being coerced into having an abortion and prohibits women and doctors from using web cams during the procedure (O’Brian, 4/21).

The Associated Press: Planned Parenthood Suspends Pill Abortions In Wis.
Planned Parenthood ended nonsurgical abortions at its Wisconsin clinics Friday because of a new state law that subjects doctors who perform abortions but don't follow certain procedures to criminal penalties. The law, signed by Gov. Scott Walker two weeks ago after the Republican-controlled state Legislature passed it earlier this year, took effect Friday (Bauer, 4/20).

Des Moines Register: Planned Parenthood Criticizes Abortion Restrictions In Iowa House Version Of State Budget
The leader of Planned Parenthood of the Heartland on Friday sharply criticized Iowa lawmakers for abortion restrictions and possible changes to state funding for women’s health care services included in a state budget bill. The budget for health and human services passed Wednesday in the House includes language removing an exception allowing the state Medicaid program to pay for abortions of pregnancies that result from rape or incest and reprioritizing how state and federal family planning funds are to be spent (Noble, 4/20).

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State Roundup: Mo. Bill Would Outlaw Federal Health Law

A selection of health policy news from New York, Missouri, Texas, Massachusetts, Minnesota, Kansas and California.

Politico Pro: Missouri Bill: ACA Implementation A Crime
The Missouri House thinks the dreaded federal health care reform law is a crime. Or at least a misdemeanor. Going even further than other state legislatures fighting the law, the Missouri state House has passed a bill declaring the Affordable Care Act unconstitutional and therefore "altogether void and of no force." Any federal worker who tries to implement it would be committing a misdemeanor (Smith, 4/23).

Houston Chronicle: Taxpayers Footed The Bill For Medicare Bonuses To Doctors
The American public for years paid physicians millions of dollars in Medicare bonuses to treat the medically needy in parts of Texas and across the country -- even though many doctors no longer qualified for the cash and federal officials knew it, a Houston Chronicle investigation has found. Documents show primary care physicians in Hidalgo County were overpaid $64 million from 2003 until last year. Doctors at 31 other Texas locations also received a still undetermined amount in bonuses for providing medical and mental health care in parts of Spring Branch, the Third Ward, Pasadena, Baytown and Texas City, as well as parts of San Antonio and North Central Bexar County, among others (Langford, 4/23).

Boston Globe: Three Mass. ERs Cited For Denial Of Care
Health officials cited three Massachusetts hospitals in the past six months for wrongly sending away patients from their emergency rooms, in one case resulting in the death of a patient while en route to another facility. ... Hospitals that break federal rules ensuring public access to emergency services can face especially tough sanctions. Flagrant or repeat violators risk losing their right to treat Medicare and Medicaid patients, which can cost a hospital millions of dollars (Kowalczyk, 4/23). 

California Watch:  Lawmakers Move To Curb Hospitals From 'Capturing' Patients
The emergency room practices of a major California hospital chain have prompted new legislation to reduce what critics describe as a pattern of "capturing" insured patients in order to boost bills. Sen. Ed Hernandez, D-West Covina, chairman of the state Senate Health Committee, is carrying the bill limiting how much hospitals are paid after they admit a certain rate of out-of-network, privately insured patients (Jewett, 4/23).

The Wall Street Journal: Cuomo Keeps Grip On Funds In Settlement
In the waning days of New York Gov. Andrew Cuomo's tenure as attorney general, his office shifted tens of millions of dollars in settlement funds from a high-profile insurance probe to an account controlled by the state Department of Health. … The transfer was approved on Dec. 22, 2010. The attorney general's office has since sought an analysis of Fair Health's expenditures from the Health Department but hasn't yet received the information, said an attorney general official (Gershman, 4/22).

(St. Paul) Pioneer Press: At The Capitol: Health Departments Seeks Law Change After High Court Ruling
A state Supreme Court ruling last year could prevent the Minnesota Department of Health from collecting certain kinds of important public health information, according to a letter sent to state lawmakers Friday, April 20.  Because of the ruling, Dr. Ed Ehlinger, the health commissioner, is asking leaders in the state House and Senate to bring forth legislation to amend certain data practices laws before the end of the current legislative session (Snowbeck, 4/20).

Kansas Health Institute News: Dentists Shouldn't Fear Mid-Level Dental Care, Expert Says
Proponents in at least 15 states including Kansas are pushing their legislatures to license mid-level dental providers as a way to extend basic oral health care access to thousands who have none. But those efforts are running up against a common obstacle: opposition from dentists. ... Fear of the unknown is likely behind most dentists' opposition to mid-level providers, said panelist Michael Helgeson, a dentist in Minnesota. Alaska and Minnesota are the only two states that currently license mid-level dental providers (Cauthon, 4/21). 

California Healthline: Three Bills Aim To Change Nursing Home Care
The Assembly Committee on Health last week approved two bills to alter nursing home care in California and it will hear a third one this week. ... [The Nursing Facility Bed Hold Protection Act of 2012] would require the Department of Health Care Services to penalize facilities for refusal to readmit a patient on appeal (Gorn, 4/23). 

KQED's State of Health: California Prison Medical Costs Higher Than Average
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 (Schwartz, 4/20). 

HealthyCal:  Shattering The Constraints Of Aging
As Fred Olson’s body is wheeled out of AgeSong, the senior community’s founder Nader Shabahangi is offered a basket with red and white flower petals. … One of the country’s leaders in redefining aging, Shabahangi’s rebel philosophy is filtered into six AgeSong Assisted Living and Elder Communities in San Francisco, Oakland, and neighboring Emeryville, which house nearly 400 residents. His approach actively counters today’s constricted views on aging (Perry, 4/22).

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Editorials and Opinions

Viewpoints: Myths About Women Voters; Stopping Fake Drugs; Medicaid Innovation Not Easy; The War Over Women

The Washington Post: Five Myths About Female Voters
3. Women vote based on "women’s issues," such as abortion rights and contraception. A recent poll of voters in swing states showed that women’s top priorities are health care, gas prices, unemployment and the deficit -- in that order -- with “government policies toward contraception” coming in last (Melinda Henneberger, 4/20).

The New York Times: The Wrong Way To Stop Fake Drugs
Careless buyers play Russian roulette, but those who look for credentialed sites can purchase safe drugs at a significant discount. Some Americans know this, but far more should. And it should be made entirely legal for them to do so (Roger Bate, 4/22).

JAMA: Innovation Isn’t Easy When it Comes to Medicaid
The fiscal-year 2013 budget recently passed by the House of Representatives would reduce federal Medicaid spending by $750 billion over the next decade, even if the Affordable Care Act (ACA) is repealed or struck down. It would do so by changing the program from an open-ended program for eligible individuals using matching funds from both the federal and state governments to a block grant of a fixed sum given to states, and the states decide how to allocate the money. The idea is that states can "innovate" at a local level to find ways to deliver needed benefits at reduced cost. The question is, though, can they? (Aaron Carroll, 4/20).

Minneapolis Star Tribune: Congress Ramps Up Medicaid Scrutiny
On Wednesday, the state's Medicaid program will be a key focus of a congressional hearing probing potentially deep flaws in federal and state oversight of this nationwide safety net program…. The congressional hearing validates the questions raised repeatedly by this page and by some state lawmakers about whether Minnesota overpays private health plans to administer Medicaid care…. The Minnesota Medicaid questions deserve a thorough airing, but this congressional hearing must go beyond it to ask broader questions about national Medicaid oversight (4/21).

Milwaukee Journal Sentinel: Dissecting Phony ‘War On Women’
All I can say about the "war on women" is: WOW! Let's manufacture a phony "war on women" and try to sell it to you and me. I'm not fooled, and you should not be, either, after reading about these common-sense protections of women (Barbara L. Lyons).

CNN: Phony "Mommy Wars" Avoid Real Issues For Women
[T]here is a serious issue hidden in the silliness of the alleged mommy wars, and it is the contradictory, conflicting beliefs we have about the value of taking time to care for other people. Who should take care of young people and their grandparents, and how should they be rewarded? We claim to value families, but we don't really value what it takes to care for them (Barbara Risman, 4/20).

Arizona Republic: Stripping Health Choices From Women Isn't Priority
Among Republicans there is a history of support for access to health care, including Planned Parenthood, and rejection of the intrusive laws being passed by the more extreme-right members of the party now. In fact, we Republicans just a short decade ago passed Arizona's state law requiring insurance companies to provide fair coverage of contraception -- the very bill these extreme right Republicans now are working to repeal (Linda Binder, Susan Gerard and Roberta Voss, 4/21).

The Seattle Times: Expand The Experiment With Competitive Bids To Cut Medicare Costs
The Centers for Medicare and Medicaid Services (CMS) discovered there were vast sums of money to be saved with competitive bidding for power wheelchairs, diabetic supplies and other medical goods and services…. CMS, a division of the U.S. Department of Health and Human Services, is already getting some push-back from members of Congress with political constituents who have prospered under the largely unexamined, unregulated fee-for-service approach…. Cutting waste, fraud and abuse in a major cost category for Medicare is huge, and it's about time. For the loudest complainers about government spending to suddenly whine about the effects of market competition on prices is over the top (4/20).

Denver Post: Health Care Change Is Inevitable
No matter what the Supreme Court decides is or is not constitutional about the Affordable Care Act (aka Obamacare), one thing is certain: The health care industry, which consumes roughly one- sixth of our resources, is changing dramatically. Currently under enormous financial strain and demographic pressure, health care will have to reinvent itself over the next few decades -- whether or not the Supreme Court upholds the Affordable Care Act this spring (Henry Dubroff and John J. Huggins, 4/22).

Denver Post: Should Health-Care Insurers Be Forced To Pay For Contraception Coverage? No
When the government mandates that health insurers provide a new benefit, the government does not pay for the benefit and neither do the health insurance companies. You do! The government can mandate that insurers provide more benefits, but government does not give money to the health insurers to pay for them. Insurers get the money they use to pay for your medical bills from the premiums paid by you and your employer (Burke A. Christensen, 4/22).

Denver Post: Should Health-Care Insurers Be Forced To Pay For Contraception Coverage? Yes
The Republicans' gamble that they could ride a backlash against the Obama administration's efforts to increase the availability of contraception has gone terribly bad. It turns out that most Americans, especially women, agree that insurance companies should have to cover contraception -- for example, birth-control pills -- in their health insurance plans (Mark Weisbrot, 4/22).

Des Moines Register: Mental Health, Education Reforms Still Percolating
The budget bill appropriating $1.6 billion for the departments of aging, public health, human services and veterans affairs finally made it to the floor of the Senate. After 12 weeks of listening to Iowans about the services they would like the state to support, my colleagues in the Senate Democrat caucus voted with me to support strong funding for Medicaid, a health care safety net collaborative for community health centers, free clinics and rural clinics. It also funds hospitals, physicians, child care centers, child abuse prevention, family sufficiency programs, veteran’s home services, mental health services and dozens of other family services programs that touch every home in our state (Iowa state Sen. Jack Hatch, 4/21).

Des Moines Register: If Not This Health Reform, Then What?
It took hundreds of lawmakers in Washington more than a year to come to an agreement on health reform. Now the future of the 2010 law is in the hands of nine U.S. Supreme Court justices. Opponents of so-called "ObamaCare" say it is unconstitutional to require Americans to buy insurance or face a penalty. But they are salivating over the prospect of the court striking down the entire law. Let’s pretend for a moment they get what they’re hoping for. Then what? (4/20).

Boston Globe: Despite Vaccine Scare, Vermont Should Protect Public Health
Now, in both California and Vermont, where the number of incoming kindergartners with vaccinations plunged from 93 percent in 2005 to 83 percent in 2010, lawmakers are considering narrowing the rules that allow parents to claim philosophical objections to having their kids immunized in order to attend school. (Medical exemptions and religious exemptions would remain.) Lawmakers would be wise to take action (4/22).

Boston Globe: Tauton State Hospital: A Jewel, Or A Redundancy?
The Taunton State Hospital specializes in treating a serious subset of the mentally ill, including people with severe psychosis. Patients include women who are too dangerous to be in correctional facilities and men fresh from the higher-security Bridgewater facility for the criminally insane. It's a population that can’t easily -- or, in some cases, safely -- be absorbed into the state Department of Mental Health’s network of community-based group homes. Nonetheless, the Patrick administration is still planning to shutter the 169-bed facility by year’s end and insists that there are enough beds to accommodate the patients at other facilities (4/23).

Milwaukee Journal Sentinel: Health Care Is A Basic Human Right
Providing essential health care to women should not be a partisan issue. Whether you are a Democrat or a Republican, we all should agree that ensuring women access to health care is an important priority. Yet despite a historic economic recession, the Republican leaders in our state government have instead waged a war on women's health care access since taking office in January 2011 (Teri Huyck, 4/21).

Milwaukee Journal Sentinel: Affordable Care Act Matters
Obamacare. Or, more aptly, Mamacare, Babycare or simply Healthcare. Despite all the name-calling, there's much more to health care reform than the name. And when we push beyond the political brawls over health care, particularly women's health care, and talk about the real benefits of the Affordable Care Act - the new protections against unfair insurance practices and new coverage for needed health services - women love it. Women need it. Women deserve it (Sara Finger, 4/21).

Chicago Sun-Times: Raising Cigarette Tax $1 Makes Sense For Illinois
Cigarette taxes have gone up a bunch since then. … Illinois’ tax is 98 cents a pack, 32nd highest among the states. Gov. Pat Quinn wants to raise that by $1 a pack to generate about $3 38 million a year for Medicaid. The new revenue would be matched dollar for dollar by the federal government. Nobody likes tax increases. But this is one that makes sense, and the Legislature should approve it (4/22).

Medscape: Asking the Right Questions, Choosing the Right Tests
When we treat our patients, are we treating them appropriately? Do we order tests that may be duplicate testing? The answer is probably "yes." Do we order tests that perhaps are not necessary? The answer is probably "yes." Do we order tests that are potentially harmful, more so than beneficial? The answer is probably "yes." Are these tests really cost-effective? Probably not. I would hold all of us culpable to these in some way or other (Dr. David Johnson, 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.