Daily Health Policy Report

Tuesday, April 23, 2013

Last updated: Tue, Apr 23

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Coverage & Access

Health Care Marketplace

Administration News

Medicaid

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insuring Your Health: Questions Arise About Robotic Surgery's Cost, Effectiveness

Kaiser Health News consumer columnist Michelle Andrews writes: "In the dozen years since the Da Vinci robot has been approved for surgeries in the United States, it's been embraced by health care providers and patients alike. Surgeons routinely use the multi-armed metal assistant to remove cancerous prostate glands and uteruses, repair heart valves and perform gastric bypass operations, among many other procedures" (Andrews, 4/23). Read the column.

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Capsules: New Website Will Disclose Health Industry Payments To Doctors; Video: What Insurance Exchanges Mean For Consumers

Now on Kaiser Health News blog, Ankita Rao reports on a new government website that will make public information about financial relationships between physicians and other parts of the health care industry: "To comply with a provision in the Affordable Care Act, drug and device manufacturers, along with group purchasing organizations, will have to disclose all of their payments and other compensation to physicians and teaching hospitals. Those who don’t comply could be fined" (Rao, 4/23).

Also on Capsules, a video of Kaiser Health News' Jenny Gold, who appeared on C-SPAN to discuss the insurance exchanges where consumers will be able to purchase coverage beginning Oct. 1 (4/22). Check out what else is on the blog.

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Political Cartoon: 'A Bumpy Ride?'

Kaiser Health News provides a fresh take on health policy developments with "A Bumpy Ride?" by Steve Kelley.

Meanwhile, here is today's health policy haiku:

 MARILYN TAVENNER'S PATH TO CONFIRMATION?

First, the committee
votes
; then the full Senate. A
CMS chief soon?
-Anonymous

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

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Health Reform

Competition Key Ingredient To Success Of State Health Exchanges

Stateline reports that even some of the strongest health exchange enthusiasts are concerned that some states will still only have limited insurance choices for consumers. Meanwhile, in other news, the Arkansas Medicaid expansion model gains momentum, Florida's efforts face continued complications, Arizona's expansion standoff continues and the Missouri Senate rejects the concept. Also, the shape of Ohio's compromise exchange is beginning to emerge.  

Stateline: Lack Of Competition Might Hamper Health Exchange
The White House sums up the central idea behind the health care exchanges in the new federal health law with a simple motto: "more choices, greater competition." But even some stalwart supporters of the Affordable Care Act worry that in many states, people won’t have a lot of health insurance choices when the exchanges launch in October. Health economists predict that in states that already have robust competition among insurance companies—states such as Colorado, Minnesota and Oregon—the exchanges are likely to stimulate more. But according to Linda Blumberg of the Urban Institute, "There are still going to be states with virtual monopolies" (Vestal, 4/23).

Health News Florida: 'Private Option' Plan, Florida Model, Passes In Ark.
Arkansas' state legislature passed a model plan to expand Medicaid last week, even though its Legislature is dominated by Republicans and the measure had to pass by a three-quarters vote, the Associated Press reports. The Arkansas plan is the model for Florida state Sen. Joe Negron's plan, which would accept an estimated $51 billion in federal funds over 10 years to expand insurance to about 1 million of the state's low-income uninsured (Gentry, 4/22).

Miami Herald: Legislators Poised To Adjourn With No Medicaid Plan
As the clock winds down on the legislative session, Florida lawmakers are sending signals that they are likely to adjourn without resolving the issue of whether to accept federal Medicaid money to insure the state’s poorest residents. "It's not something you put together in a week,"’ said Sen. John Thrasher, R-St. Augustine, chairman of the Senate Rules Committee and a close adviser to Senate President Don Gaetz. "It's a very big, complicated issue and these issues take some time." He said he does not expect there would be political repercussions if the Republican-led Legislature waits another year (Klash, 4/22).

Arizona Republic: Brewer, GOP In Medicaid Standoff
Three months after she stunned political observers and made her case for expanding Medicaid coverage in Arizona, Gov. Jan Brewer is no closer to reaching agreement with Republican legislative leaders on the issue, which has driven a wedge through GOP ranks and is delaying work on the state budget. By most accounts at the Capitol, Brewer has just enough votes in the House and Senate to get expansion approved. Even some lawmakers who oppose the plan predict it eventually will pass, owing in large part to the power of the governor's veto pen and her reputation for tenacity, as well as pressure from top-flight lobbyists and heart-tugging health-care crisis stories (Reinhart, 4/22).

The Associated Press: Mo. Senate Votes Down Federal Medicaid Expansion
Republican senators have made it clear that there will be no Medicaid expansion in Missouri this session. The Republican-led Senate voted down a Democratic attempt Monday night to insert $890 million of federal funds into Missouri’s budget to expand Medicaid eligibility to an estimated 260,000 lower-income adults (4/23).

Cleveland Plain Dealer: Ohio's Medicaid Expansion Alternative Could Use Private Insurance
For the first time since Gov. John Kasich won national attention by supporting Medicaid expansion, a clear picture is emerging on how the Republican governor's compromise with federal regulators could work. Some uninsured Ohioans would be enrolled in the state's traditional Medicaid program, while others would sign up for private health insurance using federal funding, said Greg Moody, director of Ohio's Office of Health Transformation. The proposal, which Kasich hopes to sell to GOP lawmakers reluctant to support an outright Medicaid expansion, has been dubbed "The Ohio Plan." And it differs from the standard federal expansion program on one crucial point: It puts some enrollees in the private insurance market (Tribble, 4/22).

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Next Stage Of Health Law Triggers Concern, Confusion

News outlets report on the confusion that continues to surround the health law, especially as key provisions are about to take effect. Meanwhile, officials and activists strategize about how to educate consumers about their options.

Georgia Health News: Concern, Confusion Over The Next Stage Of Reform
In six months, Jimmy Rowalt will no longer have health insurance. For the past two and a half years, the 25-year-old Athens resident has worked at Highwire Lounge without worrying about the job's lack of health benefits. Now he’s a manager there, working 45 to 55 hours a week. A rule allowing young adults to remain on their parents’ health insurance policies until age 26 was one of the first provisions of the Affordable Care Act to go into effect, in September 2010. … Rowalt's options will be meager after his October birthday, when he will be dropped by his parents' insurance company (Murphy, 4/22).

CT Mirror: Strategizing On Helping The Uninsured With Health Care Reform
As the country gears up to launch the Affordable Health Act, one of the most difficult tasks will be to sell it to uninsured people who may have never heard of the word "co-pay" or know what a primary care physician is. That was the message of Alta Lash, a Connecticut community organizer who was one of several speakers from across the nation at a daylong roundtable discussion Monday on how to promote health equity through "Obamacare." The event attracted about 200 policymakers, social workers, physicians and researchers to the Mark Twain House in Hartford for a discussion of how to eliminate health disparities through the expanded coverage that will take effect in January (Merritt, 4/22).

CNN Money: Millions Eligible For Obamacare Subsidies, But Most Don't Know It
Nearly 26 million Americans could be eligible for health insurance subsidies next year, but most don't know it. That's because relatively few people are familiar with provisions in the Affordable Care Act, aka "Obamacare," that will provide tax credits to low- and middle-income consumers to help them purchase health coverage through state-run insurance exchanges (Luhby, 4/23).

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Capitol Hill Watch

Proposal Would Require Insurers To Report Health Law Taxes

The measure's sponsor, Sen. John Cornyn, R-Texas, bills it as a way to educate consumers about how the health law's benefits are funded.

The Hill: Insurers Would Report ObamaCare Taxes Under GOP Bill
A new bill from Sen. John Cornyn (R-Texas) would require health insurers to disclose taxes they pay under ObamaCare to policyholders. In a statement Monday, Cornyn touted the measure as a way to educate consumers about how the Affordable Care Act's benefits are funded (4/22).

Also in the news, health law opponents are pressing for repeal of the health law's medical device tax, among other provisions, in comprehensive tax reform legislation - 

Roll Call: Health Law Tax Foes Find Hope In Overhaul Effort
Proponents of doing away with provisions such as the medical-device tax and the annual fee on health insurance companies say they already have bipartisan support for their repeal legislation. But the efforts still will face health care politics and the need for significant offsets, making their inclusion far from certain as lawmakers work toward comprehensive tax legislation that can pass in both chambers (Attias, 4/22).

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Coverage & Access

Some Boston Marathon Bomb Victims Will Face Insurance Coverage Limits

Payments for prosthetics, rehabilitation and a range of other treatments may fall outside some insurance limits and could continue long into the future. 

The New York Times: For Wounded, Daunting Cost; For Aid Fund, Tough Decisions
Many of the wounded could face staggering bills not just for the trauma care they received in the days after the bombings, but for prosthetic limbs, lengthy rehabilitation and the equipment they will need to negotiate daily life with crippling injuries. Even those with health insurance may find that their plan places limits on specific services, like physical therapy or psychological counseling (Goodnough, 4/22).

Politico: Coverage Limits Are Harsh Reality For Amputees
Those who lost limbs in the Boston Marathon bombings now need care to learn to navigate the world in a new way — and navigate a thorny area of health care coverage, too. In the case of the Boston bombings, pledges and offers of support have poured in to help with the health care costs of the 14 people who reportedly lost all or part of a limb. But for some amputees, covering the staggering cost for prosthetics care can be a struggle (Smith, 4/23).

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Health Care Marketplace

Study Finds Health Care Spending Will Rebound When Economy Picks Up

The analysis by The Kaiser Family Foundation says the slowdown in health spending over the past several years was largely driven by the economic malaise.

Los Angeles Times: Study: Growth In Health Spending, Curbed By Recession, To Rebound
A new study attributes a slowdown in U.S. healthcare spending to the recent recession and predicts more rapid growth as the economy strengthens. The report issued Monday by the Kaiser Family Foundation seeks to shed light on the reasons behind the recent drop-off. The analysis found that economic factors related to the recession accounted for 77% of the reduced growth in national healthcare spending, which totaled an estimated $2.8 trillion in 2012 (Terhune, 4/22).

The Washington Post's WonkBlog: Here's Why Health-Care Costs Are Slowing
The answer has huge implications for the federal budget, which now faces threats of really fast growth in Medicare, Medicaid and other health programs. If those programs grow like they have for the past few years — at the same rate as the rest of the economy — then that frees up lots of funds for whatever other investments the federal government wants to make (Kliff, 4/22).

The Hill: Study Predicts Rise In Healthcare Cost Growth By 2019
A stronger U.S. economy will contribute to a rise in the growth of healthcare costs over the next six years, ending the current record-breaking slowdown, according to a new study. The Kaiser Family Foundation (KFF) predicted that by 2019, annual healthcare cost growth will be closer to historic averages — over 7 percent compared to 3.9 percent between 2009 and 2011 (Viebeck,4/22).

CQ HealthBeat: Nation's Health Spending Problem Remains Unsolved, Kaiser Analysts Say
Speculation that the nation's health spending problem has somehow been solved or cut down to size is unrealistic, says a new Kaiser Family Foundation study that concludes 77 percent of the slowdown stems from the weak economy. … But the analysts had a bit of good news. They said the chilling effect on individual health spending due to the weak economy will continue for a few more years (Reichard, 4/22).

(KHN is an editorially independent project of The Kaiser Family Foundation.)

Meanwhile, a different analysis is released on health issues--

Reuters: S&P Sees Pension Funding Burden Of Nonprofit Healthcare
Pension liabilities, expenses and contributions remain a burden on U.S. not-for-profit hospitals despite improvements in the investments used to fund the retirement systems, Standard & Poor's Ratings Services said on Monday. Large pension funding demands will likely "be a drag on the sector for several years," it added (Lambert and Trokie, 4/22).

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Hospitals Send Immigrant Patients To Their Home Countries To Curb Costs

The Associated Press/Washington Post: US Hospitals Send Hundreds Of Immigrant Patients Back To Home Countries To Curb Cost Of Care
In interviews with immigrants, their families, attorneys and advocates, The Associated Press reviewed the obscure process known formally as "medical repatriation," which allows hospitals to put patients on chartered international flights, often while they are still unconscious. Hospitals typically pay for the flights (4/23).

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Administration News

The Challenges Of Advancing Mental Health Parity

CQ HealthBeat: Mental-Health Parity, On Paper And In Practice
Having access to mental-health care ought to be as easy as getting a gun, President Barack Obama said days after a troubled young shooter killed 26 people in a Connecticut elementary school shortly before Christmas. Yet even though two recent laws have given Washington a head start toward reaching the goal of expansive mental-health care, challenges remain in converting statutory promises into benefits that patients can count on (Adams, 4/22).

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Medicaid

Adult Day Care Centers Tally Big Medicaid Costs

The New York Times: Day Centers Sprout Up, Luring Fit Elders And Costing Medicaid
Not a wheelchair or walker was in sight at these so-called social adult day care centers. Yet the cost of attendance was indirectly being paid by Medicaid, under Gov. Andrew M. Cuomo's sweeping redesign of $2 billion in spending on long-term care meant for the impaired elderly and those with disabilities. Such centers have mushroomed, from storefronts and basements to a new development in the Bronx that recently figured in a corruption scandal. With little regulation and less oversight, they grew in two years from eight tiny programs for people with dementia to at least 192 businesses across the city (Bernstein, 4/22).

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Public Health & Education

Supreme Court Rejects Tobacco Industry Challenge Regarding Graphic Cigarette Labels

Also, a New York City proposal would increase the age for buying cigarettes from 18 to 21.

The Wall Street Journal: Tobacco Industry's Challenge to Law Requiring Graphic Labels Is Rejected
The U.S. Supreme Court on Monday rejected a tobacco-industry challenge to a 2009 federal law that requires graphic warning labels on cigarettes and expanded marketing restrictions on tobacco products. The challengers argued that parts of the law, which gave the Food and Drug Administration authority to regulate tobacco, violated their constitutional free-speech rights (Kendall and Dooren, 4/22).

The Associated Press/Washington Post: NYC Proposes Raising Minimum Age For Cigarette Purchases From 18 To 21
After years of striving to set a national agenda for curbing smoking, New York City may set a new bar by becoming the most populous place in America to raise the minimum age for buying cigarettes to 21. A new proposal would increase the threshold from 18, a federal minimum that is the standard in many places. Four states and some communities have raised the age to 19, and at least two towns have agreed to raise it to 21 (4/23).

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State Watch

State Roundup: S.F. Looks Into Allegations Of Patient Dumping

A selection of health policy stories from Arizona, California and Oregon.

Bloomberg: San Francisco Probes Nevada For 'Dumping' Mental Cases
San Francisco will investigate allegations that Nevada has bused hundreds of indigent people with mental illnesses out of state, including to the Northern California city. San Francisco City Attorney Dennis Herrera said his office has opened a formal investigation and is requesting public records from the Nevada Health and Human Services Department, according to a letter today to Mike Willden, the agency’s director (Vekshin, 4/22).

Medscape: Reform-Minded Governor Is More Influential Physician Exec
John Kitzhaber, MD, the long-time Democratic governor of Oregon who has ushered in Medicaid and medical liability reform there, is the nation's most influential physician executive in healthcare in a poll conducted by the sister publications Modern Healthcare and Modern Physician. Just how influential is Dr. Kitzhaber? In sharp contrast to the partisan gridlock in Washington, DC, he helped bring together Republican and Democratic state lawmakers last year to approve a plan to improve care for Medicaid patients while saving an estimated $11 billion over 10 years (Lowes, 4/22).

Bloomberg: Stockton, Calif., Retirees Worry Pension Cuts Follow Health Losses
Retired public employees in bankrupt Stockton, California, who saw health-care coverage shrink last year may see their pensions decrease next as the city wrangles with creditors. The biggest U.S. city in bankruptcy, Stockton is preparing a plan for paying debt that may propose compensating some creditors less than the principal owed, setting up a likely court challenge from the creditors that the city’s pension contributions be subject to cuts as well (Vekshin,4/22).

Arizona Republic: Arizona Foster-Home Vaccination Bill Proceeds
Legislation to eliminate the requirement that foster families fully immunize their own children came one step closer to becoming law on Monday following a bitter partisan House floor debate. Republicans and Democrats sparred for almost an hour before Rep. Steve Montenegro, R-Litchfield Park, abruptly called for a vote, ending the discussion and surprising colleagues on both sides of the aisle. The measure passed on a voice vote and is scheduled for a roll-call vote today (Reinhart, 4/22).

California Healthline: School-Based Health Center Proponents Lobbying For Funding
California school and health care leaders have joined ranks with officials from other states urging Congress to put money behind an idea with widespread but underfunded support: health care centers based in schools. Tom Torlakson, California's state Superintendent of Public Instruction, and 18 superintendents from school districts across the state added their names to a letter delivered to Congress asking for $50 million in federal funding (Lauer, 4/22).

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Editorials and Opinions

Viewpoints: Time To Confirm Tavenner; 'Self-Defeating' GOP Plan For Prevention Fund; Parents Need Insurance Too

The New York Times: A Confirmation Too Long Delayed
The Senate Finance Committee is scheduled to hold a long-overdue vote on Tuesday on President Obama's nominee to lead the embattled agency responsible for overseeing Medicare, Medicaid and the implementation of health care reforms. The committee ought to set aside its deep partisan divisions and unanimously endorse Marilyn Tavenner to be the administrator of the Centers for Medicare and Medicaid Services. The full Senate should then confirm her (4/22).

The Wall Street Journal: An Ounce Of ObamaCare Prevention
Congressional Republicans have mapped out another way to obstruct ObamaCare, thanks to the incompetence of its architects. It's a shame certain absolutists on the right are mounting another self-defeating rebellion in the name of the impossible (4/22).

JAMA Pediatrics: Medicaid Expansion: Good for Children, Their Parents, And Providers
Public insurance makes a real difference in the health of children. Those who are covered are significantly more likely to have a usual source of care than those who are uninsured, which is strongly associated with better outcomes. ... Although Medicaid and SCHIP do a reasonably good job of covering children and pregnant women, the programs have not been nearly as universal when it comes to adults. This is important because the insurance status of a parent can significantly effect the health of his or her child. Children with uninsured parents are significantly less likely to receive recommended health services, even if they themselves are covered (Aaron E. Carroll and Austin B. Frakt, 4/22).

Journal of the American Medical Association: Cost Consequences Of The 340B Drug Discount Program
Created in 1992, a little-known federal drug discount program called "340B" allowed a handful of hospitals that cared for the poor to obtain drugs for their patients at substantially reduced prices. Today, through a series of expansions, including some enumerated in the Affordable Care Act, numerous other types of entities such as community hospitals and cancer centers that serve both the poor and the well-insured can participate. ... The original intent of the 340B program was presumably to enable underfinanced care facilities to purchase drugs that would be used for the treatment of medically and financially vulnerable patients they served. The program does not require hospitals to only provide the discounted drugs to patients who are poor and in need, nor does it include a requirement that the savings on drugs be passed on to patients or insurers (Rena M. Conti and Peter B. Bach, 4/22).

Los Angeles Times: A Roadblock To Collecting Travel Insurance Benefits
Barbara Butkus bought an airline ticket in November to fly from Palm Springs to Washington, D.C., a month later for a family reunion. Just to be on the safe side, Butkus, 80, also bought travel insurance while booking her flight through Orbitz, the online travel agency. The coverage was from Allianz, a leading provider of travel insurance. As it happened, Butkus had to cancel her trip for health reasons. She began experiencing shortness of breath in early December, and her doctor advised her not to travel. Butkus filed a claim with Allianz for a refund of her $451.20 airline ticket. Allianz denied her claim last month, concluding that she had an existing medical condition when she bought her airline ticket (David Lazarus, 4/23).

Miami Herald: Aging In Place: A New Frontier In Housing
For many seniors, aging in place reflects an aspiration to remain supported by the same personal connections that have given meaning to their lives. It can also be the most financially sensible housing option for those seniors with the physical ability to remain at home. Unfortunately, many of today's homes and neighborhoods were designed at an earlier time before the unique needs of an aging population were even recognized. For many seniors, their homes — rental or owned — lack the necessary structural features and support systems. Likewise, many of our nation's communities fail to provide the services and amenities that would make aging in place a realistic choice (Henry Cisneros, 4/22).

Kansas City Star: Protect Developmental Disability Services In Kansas
My sister Liz is 49 years old and has Down syndrome. Since our parents died 33 years ago, Liz has been my responsibility and my joy. Today she lives in her own apartment and works at Heartstrings Community Foundation in Overland Park. With the Medicaid money allocated to Liz, we hire staff that helps her with daily living skills: cooking, shopping, paying bills and getting to doctors' appointments. Liz has accomplished amazing things with an IQ of 65, and she loves her life (Effie Bradley, 4/21).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
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.