Daily Health Policy Report

Wednesday, April 24, 2013

Last updated: Wed, Apr 24

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Coverage & Access

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Nurses Fighting State By State For Minimum Staffing Laws

Reporting for Kaiser Health News, David Schultz writes: "How many nurses does it take to run a hospital? Legislatures in at least seven states and the District of Columbia are trying to answer that question as they debate bills that would require hospitals to have a minimum number of nurses on staff at all times" (Schultz, 4/23). Read the story.

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Capsules: Baucus Vows To Keep Watch On Health Law Rollout Before Leaving Senate; Insurer Centene: We Can Do Arkansas-Style Medicaid

Now on Kaiser Health News' blog, Mary Agnes Carey reports on the announcement by Sen. Max Baucus, D-Mont., that he will not seek re-election: "Senate Finance Committee Chairman Max Baucus stunned his colleagues Tuesday when he announced he would not seek a seventh term next year. But don't expect him to go quietly. Implementation of the 2010 health care law is a top priority for the Montana Democrat, as is overhauling the tax code, tackling the nation’s debt and pushing 'job-creating trade agreements' through the Senate, Baucus said in a statement" (Carey, 4/24).

Also on Capsules, Jay Hancock reports on one insurer's plans for the health law's Medicaid expansion: "Last week the Arkansas legislature approved a plan to give Medicaid beneficiaries money to buy individual policies from private insurers on the state’s health insurance exchange — the subsidized, online marketplaces due to be in business next year. The governor signed the bill Tuesday — making it law. The Department of Health and Human Services, which has said it 'will consider approving a limited number' of such arrangements, still needs to negotiate details and sign off. One insurer is already expressing interest" (Hancock, 4/23). Check out what else is on the blog.

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Political Cartoon: 'Job Security?'

Kaiser Health News provides a fresh take on health policy developments with "Job Security?" by Roy Delgado.

Meanwhile, here is today's health policy haiku:


Senate Democrats
are heading for the exit. 
Max is the latest.

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

Health Providers Are Joining With Community Organizers, Insurers To Get The Word Out On Health Law Benefits

The New York Times examines how the law's backers are working to explain it to the public. Meanwhile, other outlets report on accountable care organizations and concerns -- from business leaders and HIV advocates -- about changes coming from the overhaul.

The New York Times: Racing To Spread Word About New Health Plans
President Obama and the Democrats passed the 2010 health care law to make medical insurance available to more than 30 million people who do not have it. But with recent studies showing that as many as three-fourths of those people are unaware of their new options, health care providers are joining community organizers and insurance companies in an ambitious effort to spread the word in the six months remaining before the health plans become available (Pear, 4/23).

The New York Times: A Health Provider Finds Success In Keeping Hospital Beds Empty
Advocate Health Care, based in Oak Brook, Ill., [is] a pioneer in an approach known as "accountable care" that offers financial incentives for doctors and hospitals to cut costs rather than funnel patients through an ever-greater volume of costly medical services. Under the agreement, hospital admissions are down 6 percent. Days spent in the hospital are down nearly 9 percent. The average length of a stay has declined, and many other measures show doctors providing less care, too (Lowry, 4/23).

The Fiscal Times: The CEOs Driving Our Recovery Fear Obamacare
But the National Center for the Middle Market—run out of Ohio State University’s Fisher College of Business—offers a glimpse into how these [privately held] businesses think. On Wednesday, the center released its first quarter 2013 survey of companies with revenues between $10 million and $1 billion. The survey indicates that Obamacare and health insurance costs are the primary challenge for this group of 197,000 companies that account for 43 million jobs (Boak, 4/24).

Medpage Today: HIV Care Groups Fear Post-ACA Future
Community-based providers of HIV care and social services are expressing fear they could disappear as the health system becomes more integrated and their funding sources potentially dry up. In a panel discussion Tuesday on the future of Ryan White Program providers in a post-Affordable Care Act (ACA) world, organizations at the 10th Annual National Summit on Health Disparities here said they need to learn how they will fit into the more integrated health system that health reform efforts have created. … Although the Ryan White program will not be disappearing with the advent of the ACA, the program's role in paying for services is unclear given the new, integrated healthcare systems now being formed (Pittman, 4/23).

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States Continue Tussling With Medicaid Expansion Plans

CQ HealthBeat reports that even in jurisdictions that opt not to pursue the Medicaid expansion, the number of people who are left without insurance coverage will not be as large as expected. Meanwhile, Arkansas Gov. Mike Beebe signed his state's private insurance option plan into law while debate is ongoing in Pennsylvania, Texas, Florida and South Dakota.

CQ HealthBeat: In States That Don't Expand Medicaid, One Of Four Uninsured Poor May Still Get Coverage
Advocates for the poor are alarmed that if states do not expand their Medicaid programs under the health care law, millions of uninsured Americans will continue to go without coverage next year. There’s no doubt that’s true. But the size of the group that will go without isn’t as big as one might think (Reichard, 4/24).

Reuters: Arkansas Governor Signs Private Insurance Option Into Law
Arkansas's Democratic governor signed into law on Tuesday a plan to extend health insurance to more of the state's low-income residents in a move that could offer a model for other states wrestling with opposition to the federal government's Medicaid expansion plan. The Arkansas law uses federal Medicaid funds to buy private insurance for about 250,000 state residents who earn up to 133 percent of the poverty line, or $15,415 per year (Parker, 4/23).

The Associated Press: Beebe Signs 'Private Option' Plan Into Law
Arkansas Gov. Mike Beebe on Tuesday signed into law a plan to use federal Medicaid money to purchase private insurance for thousands of low-income workers, and state officials said they will now work to get final federal approval for the proposal (DeMillo, 4/23).

Kaiser Health News: Capsules: Insurer Centene: We Can Do Arkansas-Style Medicaid
Last week the Arkansas legislature approved a plan to give Medicaid beneficiaries money to buy individual policies from private insurers on the state’s health insurance exchange — the subsidized, online marketplaces due to be in business next year. The governor signed the bill Tuesday — making it law. The Department of Health and Human Services, which has said it “will consider approving a limited number” of such arrangements, still needs to negotiate details and sign off. One insurer is already expressing interest" (Hancock, 4/23).

The Associated Press: Pa. Legislature’s Analysts See Benefit In Medicaid
An expansion of Medicaid eligibility under a 2010 landmark federal health care law would boost the state’s finances by hundreds of millions of dollars a year, the Pennsylvania Legislature’s nonpartisan fiscal analysts said Tuesday. The report echoes the conclusions of previous studies sponsored by health care groups that support a Medicaid expansion (Levy, 4/23).

Philadelphia Inquirer: Independent Agency Sees Savings In Medicaid Expansion
A new analysis by the state’s Independent Fiscal Office says the proposed expansion of Medicaid under the federal Affordable Care Act (known popularly as Obamacare) will dramatically boost the Pennsylvania economy and help the state’s budget rather than hurt it­ – contrary to the fears of Gov. Corbett, who has so far balked at the expansion, in spite of a federal commitment to pick up the bulk of the costs (Warner, 4/23).

KYW Philly: Supporters And Opponents Weigh In On Medicaid Expansion In Pennsylvania
A new report from an independent agency created by the state legislature, and a warning from the state welfare secretary, add to the debate over whether Pennsylvania should opt for Medicaid expansion under the new federal health care law. The Independent Fiscal Office analysis of Medicaid expansion adds to other previous studies that project significant benefits for Pennsylvania. But Governor Corbett has said all along that he’s concerned about whether long-term assumptions are accurate (Romeo, 4/24).

The Associated Press: House Could Be On Way To Medicaid Fight
Another — and perhaps final — fight over Medicaid expansion may be on the horizon in the Texas Legislature. Despite notable reluctance and the House instructing budget negotiators this week to not even consider voting on Medicaid proposals, a House panel on Tuesday cleared the way for the full chamber to debate drawing down millions of federal dollars to provide health care for more low-income Texas residents (Weber, 4/23).

The Texas Tribune: House Panel Advances Zerwas' Medicaid Proposal
Despite opposition from conservative Republicans, the House Appropriations Committee on Tuesday advanced a proposal that would reform Medicaid by allowing the state to request a block grant from the federal government and expand coverage to low-income Texans… Members of Appropriations voted 15 to 9 to move the legislation out of committee and continue debate on the House floor (Aaronson, 4/23).

Houston Chronicle: House Committee Advances Medicaid Alternative Bill
House budget-writers approved a bill Tuesday meant to draw down billions of federal health-care dollars without, they insist, expanding Medicaid. The Appropriations Committee voted 15-9 for House Bill 3791 by Rep. John Zerwas, R-Simonton, which would express a preference for a Medicaid block grant. If the block grant were denied, as is expected, the legislation would rely on buying private insurance policies for the neediest Texans who otherwise would be covered under Medicaid expansion (4/23).

Austin American Statesman: Divided Panel OKs Medicaid Bill; House Fight Likely
Setting the stage for a raucous vote in the Texas House, a divided Appropriations Committee approved a bill Tuesday that rejects Medicaid expansion in favor of private market strategies for insuring low-income Texans. After a rushed morning meeting that featured little debate, the chamber’s largest committee voted 15-9 to approve the bill by Rep. John Zerwas, R-Simonton. All no votes were from Republicans, including several who said they felt hurried and wanted a longer committee debate. ... Conservative Republicans in the House have made it clear that they will oppose any attempt to increase the state’s Medicaid rolls, a key provision of the Affordable Care Act, the reform law many call Obamacare, and Tuesday’s committee vote showed that many remain skeptical of any related measures (Lindell, 4/23).

Associated Press/Miami Herald: Fla. House, Senate Not Budging On Medicaid Plans
Sen. John Thrasher, one of the top ranking Republicans in the Senate, predicted Monday the Senate will vote on a bill by Sen. Joe Negron. It would provide health coverage to roughly 1.1 million Floridians, drawing down an estimate $51 billion in federal funds over the next decade and giving that money to residents to purchase private health insurance. House Republicans, however, have thumbed their nose at any proposal that would accept money tied to the so-called "Obamacare." "The Florida Senate never waves the white flag," Thrasher said. "That would be an embarrassment to wave the white flag." Seeking a compromise, Republican Sen. Aaron Bean proposed a plan that won approval from the Senate's budget panel Monday. It would bypass federal dollars and spend state money to provide health coverage to roughly 115,000 residents. Bean urged colleagues to pass it, "just so we can keep our options open." But Thrasher said the Senate does not plan to take up Bean's bill on the floor or endorse the House approach (Kennedy and Fineout, 4/23).

Tampa Bay Times: Tweaked Medicaid Billing System For Counties Headed To Senate Floor
The Senate budget committee agreed to phase in a new Medicaid billing system for counties over seven years instead of five. But that didn't stop county commissioners from across the state from speaking out against the legislation. Senate Bill 1884 is headed for a floor vote but could see additional tweaks before then. Senators said the proposal may not be perfect right now, but it's their best attempt to create a new system to collect counties' share of Medicaid costs. Sen. Arthenia Joyner, D-Tampa, voiced concerns but still voted in favor of the bill (Mitchell, 4/23).

The Associated Press: SD Health Care Workers Urge Medicaid Expansion
A doctor, directors of medical facilities and other health care workers told a state task force Tuesday they believe South Dakota should expand its Medicaid program to provide health insurance to thousands more low-income people. They said low-income people without health insurance now delay getting medical care until they are seriously ill because they know they cannot pay the bill (Brokaw, 4/23).

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Wash., Pa. Develop Strategies, Take Actions On Health Exchanges

Washington state lawmakers are eyeing a way to push certain state employees away from their current health insurance coverage and instead send them into the health insurance exchange to obtain a health plan. In Pennsylvania, the House approved legislation to limit coverage for most abortions by plans available on the exchange.

The Associated Press/Washington Post: Governments May Push Workers Out Of Employer Health Care And Into Health Exchange
In a move that would capitalize on provisions under President Barack Obama's health care law but could cost the federal government millions of dollars, Washington state lawmakers have found a creative way to pass a large chunk of their health care expenses along to Washington, D.C. — and analysts say others are likely to follow suit. The plan threatens to affect the federal budget and the pocketbooks of some part-time workers, as it would push a group of employees out of their current health care plans and into an exchange developed under the Affordable Care Act (4/24).

The Associated Press: Pa. House Passes Abortion Limits Under Health Law
A bill to prevent coverage for most abortions under the insurance marketplace being set up as part of the federal health care overhaul is on its way to the Pennsylvania Senate after approval Tuesday by the House. The House voted 144-53 in favor of the proposal that would provide exceptions only for rape, incest or when the mother's life is in danger (Scolforo, 4/23).

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Capitol Hill Watch

Sen. Baucus' Retirement Leaves Door Open For Sen. Wyden On Health Issues

Sen. Max Baucus' announcement Tuesday that he will not seek re-election in 2014 could open the door for Sen. Ron Wyden to become the most powerful Senate Democrat on health care issues. Some groups are claiming victory on the retirement announcement while others look at what Wyden could accomplish.

The New York Times: Baucus, Powerful Montana Democrat, Will Leave Senate
If Democrats do keep control of the Senate next year, Senator Ron Wyden of Oregon would be next in line for the chairmanship of the Finance Committee, which has jurisdiction not only over taxes but health care and entitlements like Medicare. If anything, Mr. Wyden has been more of an iconoclast on the committee’s issues than Mr. Baucus, teaming with Representative Paul D. Ryan, Republican of Wisconsin, on a drastic overhaul of Medicare that still rankles many Democrats (Weisman, 4/23).

Kaiser Health News: Capsules: Baucus Vows To Keep Watch On Health Law Rollout Before Leaving Senate
Senate Finance Committee Chairman Max Baucus stunned his colleagues Tuesday when he announced he would not seek a seventh term next year. But don't expect him to go quietly. Implementation of the 2010 health care law is a top priority for the Montana Democrat, as is overhauling the tax code, tackling the nation's debt and pushing 'job-creating trade agreements' through the Senate, Baucus said in a statement (Carey, 4/24).

Los Angeles Times: Montana's Max Baucus Announces Retirement From The Senate
Baucus first went to Washington in 1974 as part of a post-Watergate wave of Democrats. Despite his rank, he was never one to adhere to party lines. He angered many Democrats by working closely with former President George W. Bush on tax and Medicare legislation, and some blamed him for complicating the passage of President Obama's sweeping health care law. Although he voted for the measure, Baucus has criticized its implementation (Barabak, 4/23).

The Washington Post: Baucus Retirement Opens Way For Sweeping Legislative Changes
Baucus, chairman of the Senate Finance Committee, which has jurisdiction over tax issues, said his decision not to seek reelection frees him from the demands of a campaign and will also allow him to focus on new trade agreements and implementation of the Obama health care initiative, which he played a major role in drafting (Kane and Montgomery, 4/23).

Politico: Max Baucus Will Continue To Be ACA’s Driving Force
Sen. Max Baucus said Tuesday that he’ll retire at the end of 2014, but he could still deepen his already considerable imprint on federal health policy through the rollout of the health reform law this fall and the entitlement battles likely to rage as the debt ceiling deadline approaches this summer. And Baucus’s departure could thrust the gavel of the Finance Committee into the hands of Oregon Sen. Ron Wyden, a sometimes-rebellious Democrat, just one year after the health care reform law’s major programs go into effect (Haberkorn, 4/24).

The Hill: Tea Party Groups Claim Victory Over Baucus, ObamaCare
The two leading Tea Party groups cheered Sen. Max Baucus's decision to retire as a major blow against ObamaCare, a law the Montana Democrat helped craft. Health care reform has been a unifying issue for Tea Party activists since 2009. One group, Tea Party Patriots, jumped on Baucus's announcement Tuesday and tied it to his recent warning that the law could become a "huge train wreck” (Viebeck, 4/23).

CQ HealthBeat: What Would Ron Wyden In Finance Committee Chair Mean For Health Care?
If Oregon Sen. Ron Wyden takes over as chairman of the Senate Finance Committee, a partisan Democrat also known for forging dramatic and high-profile partnerships with Republicans when it comes to health care would be at the helm of the panel. Wyden has a long history in delving into the complexities of health care, dating back to his 20s when he was executive director of the Gray Panthers in Oregon, where he advocated for the well-being of the elderly (Norman, 4/23).

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Senate Finance Committee OKs CMS Nominee

The next step for former nurse and hospital executive Marilyn Tavenner, who already has been serving as the Centers for Medicare & Medicaid Services acting administrator, is consideration by the full Senate. 

The Wall Street Journal: Senate Panel Clears Medicare Nominee
The Senate Finance Committee voted Tuesday to advance the nomination of Marilyn Tavenner to formally head the Centers for Medicare and Medicaid Services, bringing the former hospital executive one step closer to becoming the programs' first confirmed administrator in seven years (Dooren, 4/23).

Medpage Today: Tavenner Gets OK From Senate Committee
With a Senate committee vote in her favor Tuesday morning, Marilyn Tavenner moved a step closer to becoming the first confirmed administrator that the Centers for Medicare and Medicaid Services (CMS) has had in 7 years. The Senate Finance Committee voted by a simple vote of yeas and nays with no recorded individual vote. Tavenner must next be confirmed by the full Senate, but a time frame on that vote is unclear. The American Medical Association urged a swift confirmation from the full body, calling Tavenner the right candidate for the job (Pittman, 4/23).

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GOP Bill To Extend Pre-Existing Condition Coverage Gets Veto Threat Over Prevention Fund Diversion

Republicans are offering a bill to keep coverage available for people with pre-existing conditions under the health law but want to use the law's prevention money to do so, prompting a veto threat from the White House.

The Associated Press/Washington Post: House Bill Uses Prevention Money To Extend Health Care Law Coverage To High-Risk Patients
House Republicans are coming to the aid of high-risk patients trying to get insurance under the new health care law. But they do so by diverting money from a prevention program that is key to the law, ensuring stiff opposition from Democrats and a veto threat from the White House. The GOP bill would provide up to $3.6 billion to ensure that people with pre-existing conditions continue to have access to private coverage until Jan. 1, when the law will fully take effect. In February the administration said it would stop taking applications for the Pre-Existing Condition Insurance Plan because it was running out of money (4/24).

Politico: Right Turns On GOP Obamacare Bill
Republican-backed legislation meant to alter a piece of Obamacare has picked up some unlikely opponents: conservatives. The Club for Growth, ForAmerica and the Heritage Foundation have come out against the bill, which the House is expected to take up later this week (Gibson, 4/23).

Politico: GOP May Pull Contentious Obamacare Bill
House Republican leadership is considering canceling a vote this week on the “Helping Sick Americans Now Act,” a bill touted by Majority Leader Eric Cantor as a critical way to improve President Barack Obama’s health care law, according to multiple sources. Republicans will make a final push to garner support to pass the bill in a closed meeting Wednesday in the Capitol (Sherman, 4/24).

In other news, House lawmakers from both parties urge Medicare to stop planned cuts to cancer clinics, and Senate Majority Leader Harry Reid plans a way around the rest of the fiscal year's sequester cuts --

The Hill: Bipartisan Group Of House Members Presses Medicare Agency On Cancer Cuts
A solidly bipartisan group of more than 100 lawmakers is urging the Obama administration to reverse Medicare cuts to cancer clinics. The lawmakers questioned whether the Medicare agency can change the way the automatic cuts have been applied, so that cancer clinics won't be hit as severely (Baker, 4/23).

Modern Healthcare: Reid Plans To Fast-Track Senate Bill To Eliminate Sequester Cuts For Rest Of Fiscal 2013
Senate leaders plan to introduce a bill this week that would eliminate sequester cuts for the remainder of the fiscal year. Sen. Majority Leader Harry Reid (D-Nev.) plans to fast-track a bill to eliminate about $85 billion in sequester cuts left for this fiscal year, according to a leadership aide. The cost of eliminating those cuts would be covered by expected savings from winding down the wars in Iraq and Afghanistan. The Budget Control Act of 2011 required $1.2 trillion in deficit reduction from cuts to a variety of government programs, including reduced payments to providers and insurers from 2013 until 2021 (Daly, 4/23).

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Coverage & Access

AP Poll: Americans Underestimate Their Chances Of Needing Long-Term Care As They Age

The Associated Press/Washington Post: Poll Finds People In Denial About The Need For Long-Term Care As They Get Older
We’re in denial: Americans underestimate their chances of needing long-term care as they get older — and are taking few steps to get ready. A new poll examined how people 40 and over are preparing for this difficult and often pricey reality of aging, and found two-thirds say they've done little to no planning (4/24).

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Health Care Marketplace

U.S. Files Suit Against Novartis In Alleged Kickback Scheme

The suit accuses the drugmaker of giving pharmacies discounts and rebates to promote the use of the drug Myfortic.

The New York Times: U.S. Accuses Novartis Of Providing Kickbacks
Federal prosecutors in New York filed a lawsuit on Tuesday accusing Novartis of providing illegal kickbacks to pharmacies, in the form of discounts and rebates, to promote use of one of the company’s drugs (Pollack, 4/23).

The Wall Street Journal: U.S. Alleges Novartis Kickbacks To Pharmacies
In a civil-fraud lawsuit filed Tuesday in federal court in Manhattan, prosecutors said Novartis Pharmaceuticals, the U.S. unit of Swiss drug giant Novartis AG, used a program of rebates and discounts to boost sales of its anti-rejection drug, Myfortic, at the expense of Medicare and Medicaid, which they said paid tens of millions of dollars in reimbursements to pharmacies for which they were never entitled (Bray and Loftus, 4/23).

The Associated Press/Washington Post: US Sues Pharmaceutical Firm Novartis In NY, Accusing It Of Prescription Drugs Kickback Scheme
The U.S. government sued Novartis Pharmaceuticals Corp. Tuesday, claiming it gave kickbacks to pharmacies to switch kidney transplant patients from competitors' drugs to its own. The civil health care fraud lawsuit in U.S. District Court in Manhattan seeks unspecified damages and civil penalties for a scheme that the government said has been carried out since 2005 (4/23).

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State Watch

Insurers, Hospitals Promise To Lower Medical Cost Strain For Boston Marathon Bombing Victims

Health insurers and hospitals in Boston said this week that they will scale back the cost of medical care for those affected by the Boston Marathon bombing. In the meantime, donations for their medical costs from one campaign have topped $1.8 million.

Boston Globe: State's Providers, Hospitals to Ease Medical Expenses
The largest health insurers in Massachusetts said they will ease the strain of medical costs for those injured in the Marathon bombing by waiving out-of-pocket fees, while three Boston hospitals promised to hold off mailing bills to those patients. Donations have poured in to the One Fund launched last week by the city and the state to help those most affected by the April 15 attack, and to funds created by patients’ friends and families to offset treatment costs. But many who were seriously injured, including at least 14 who had limbs amputated, could require expensive medical and rehabilitative care for months to come (Conaboy and Lazar, 4/24).

Fox News: Online Donations Pour In For Boston Victims’ Medical Costs
While victims of the Boston Marathon bombings have a long recovery ahead of them, many will receive financial help thanks to viral online fundraising campaigns started by friends and family. Popular fundraising site GoFundMe.com has amassed more than $1.8 million in donations over the past seven days, as strangers, corporations and even celebrities donate to funds set up for individual victims and share the links over their social networks (Woerner, 4/23). 

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State Roundup: Calif. Health Care Cuts Attract Opponents

A selection of health policy stories from California, Virginia, Maryland, Georgia, Oregon, Connecticut and North Carolina.

Los Angeles Times: Gov. Brown's Donors Rally Against His Health Care Cuts
In the health care world, there's not a whole lot that insurers, doctors and union workers all agree on. But a new coalition of powerful Capitol players from all three groups is hoping to reverse recent budget cuts, pushed by Gov. Jerry Brown, to those who provide care to the poorest Californians. But doctors, hospital officials and others say the rate cuts could threaten the success of the federal law. They say lower reimbursements for treating poor patients will reduce the number of people who agree to treat Medi-Cal patients (York, 4/23).

The Associated Press/Washington Post: New Federal Health Reform Regs Cut Hours, Pay For 
Some Va Community College Adjunct Faculty
Many adjunct instructors at Virginia's 23 community colleges will see their hours cut starting this summer thanks to Virginia’s response to the new federal health reform law, a change that could cripple or kill livelihoods teachers like Ann Hubbard worked hard to build. The onrushing 2010 Patient Protection and Affordable Care Act is forcing governments at all levels to scramble to accommodate changes -- some intended, some not -- to public- and private-sector jobs over the next year (4/24).

California Healthline: Autism Families Directed To Regional Centers
Department of Health Care Services director Toby Douglas testified yesterday that some Healthy Families participants will probably lose a type of autism service in the transition to Medi-Cal managed care plans. The service -- applied behavioral analysis -- is still covered by Medi-Cal, Douglas said, but in a different way. Families with an autistic child will need to reapply for the service through the state's regional centers, where eligibility criteria are stiffer. Some children who qualified in Healthy Families may not be eligible under new guidelines, officials said (Gorn, 4/23).

The Associated Press/Washington Post: Appeals Court Upholds Md. Doctors Convictions For Implanting Unnecessary Stents
A federal appeals court has upheld the convictions of a Maryland cardiologist who implanted unnecessary heart stents in more than 100 patients. A three-judge panel of the 4th U.S. Circuit Court of Appeals on Tuesday unanimously rejected John McLean's claim that the evidence was insufficient to convict him on six counts of health care fraud. McLean was sentenced to eight years and one month in prison after his November 2011 trial (4/23).

Kaiser Health News: Nurses Fighting State By State For Minimum Staffing Laws
How many nurses does it take to run a hospital? Legislatures in at least seven states and the District of Columbia are trying to answer that question as they debate bills that would require hospitals to have a minimum number of nurses on staff at all times (Schultz, 4/23).

Georgia Health News: List Of ER Wait Times Improves For Some Hospitals
The ER waiting times for some Georgia hospitals have been reduced dramatically on a public federal website, thanks to some updated numbers. Georgia Health News reported earlier this month that data on 11 hospitals showed wildly exaggerated times for ER waits before patients were discharged. Waits for an emergency department patient to see a health care professional were also listed as alarmingly high (Miller, 4/23).

Georgia Health News: New Law, New Awareness On Concussions
Children's Healthcare of Atlanta treated 1,400 children last year for concussions at its emergency rooms and urgent care centers. Meanwhile, the Atlanta health system received 5,000 calls to its hotline fielding queries about possible concussions. Dr. David Marshall, medical director for sports medicine at Children's Healthcare, told GHN on Tuesday that he does not believe the incidence of concussions has jumped, but that public awareness of them "has exploded" (Miller, 4/23). 

The Lund Report: Med Students, Rural Providers Continue To Question Future Of Rural Clerkships
Medical students at Oregon Health & Science University are circulating an online petition asking the school to keep the five-week rural clerkship that has been a required part of OHSU's medical curriculum since 1994 -- but the university's administration maintains it doesn't intend to reduce or eliminate the clerkships, and in fact plans to offer more rural clerkships. So far the petition has gathered 280 signatures from around the state, and it's generated an ongoing discussion about the future of OHSU's rural curriculum (McCurdy, 4/23).  

CT Mirror: Towns Call Dibs On Any April Windfall In State Tax Receipt 
How tight is state revenue? Even the possibility of a small windfall is causing cities and towns to stake a claim. Municipal leaders, who were disappointed last week by the lean town aid package recommended by legislators, called dibs Tuesday on any last-minute revenue bonanza that sometimes is found after the April 15 income tax filing deadline. … The panel did endorse giving some hospitals a small amount back: $15 million per year to bolster payments to hospitals that have lower-than-average costs and where at least 64 percent of patients are covered by Medicare or Medicaid (Phaneuf, 4/23).

North Carolina Health News: Bill Would Reduce Co-Pays On Oral Cancer Drugs
When Amelia Borelli was first diagnosed with a form of leukemia in 2010, for treatment she went the traditional route of having intravenous chemotherapy. But her first chemo treatment landed her in a coma. Borelli, 68, spent the next six months in the hospital and rehab (Hoban, 4/24).

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Editorials and Opinions

Viewpoints: Physician Payment Sunshine Rules May Not Stop Conflicts Of Interest; Support Wanes For Health Law

The Wall Street Journal: Medical Conflicts Of Interest Are Dangerous
The federal Center for Medicare & Medicaid Services recently announced final regulations for the Physician Payment Sunshine Act, which requires pharmaceutical and medical-device companies to disclose payments they make to doctors, hospitals and other health-care providers. This information will be publicly available starting in 2014. ... But the reality is that this practice will continue—and patients will continue to be at risk for potential harm—until physicians themselves stop participating in these relationships (Robert Pearl, 4/23).

The Washington Post: Baucus Retires, A Grateful Nation Cheers
The Montana senator was the delayer-in-chief on President Obama’s health reform, persuading the White House to let crucial time pass in 2009 while he tried and failed to secure Republican Chuck Grassley’s support. Baucus’s pussyfooting gave the GOP an opening to demagogue Obamacare and move public sentiment against it. Baucus isn't to blame for the White House’s communications failures, but his ineffectual delay helped inflict scars on Obama’s signature initiative that have never healed (Matt Miller, 8/24).

Kansas City Star: A Moratorium For Obamacare
Obamacare has never been popular and as time passes it has become even less so. As John Fund points out at National Review online, the latest Kaiser Family Health Foundation poll puts Obamacare's support at an anemic 37 percent. Not surprisingly, many Democratic supporters in Congress are becoming antsy about the implications for 2014, given that implementation of its main provisions is supposed to happen months before the mid-term elections (E. Thomas McClanahan, 4/23).

The Lund Report: Is It R.I.P For Solo And Small Physician Practices?
Although many of the reasons vary for the dire predictions of the "futurists," some common reasons suggested are the increasing costs of operating a private medical practice, declining reimbursement, increasing government scrutiny of practice operations, lack of autonomy, compliance headaches, and competition by medical groups owned by hospitals and health plans, or those that are substantially aligned with same. Other reasons cited are some physicians "just want to practice medicine," some do not want to have to deal with heath reform and its new payment methodologies and the increasing patient populations (Paul DeMuro, 4/24).

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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.