Daily Health Policy Report

Wednesday, April 25, 2012

Last updated: Wed, Apr 25

KHN Original Reporting & Guest Opinion

Capitol Hill Watch


Campaign 2012

Health Care Marketplace

Health Reform

Coverage & Access


State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Los Angeles Is Betting On One Crusading Doc To Turn Public Health System Around

KQED's Sarah Varney, working in partnership with Kaiser Health News and NPR, reports: "It would be easy to confuse Dr. Mitch Katz with any other doctor at the Roybal Comprehensive Health Center in East Los Angeles. His desk in a closet-sized, windowless office is littered with patient records, X-rays and cans of Diet Coke" (Varney, 4/24). Read the story.

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Capsules: Medicare To Add Hospital Efficiency, Patient Safety To Payment Formula; An Even Bleaker Prognosis For Medicare

Now on Kaiser Health News' blog, Jordan Rau reports: "Medicare is proposing a significant change in how it decides on hospital reimbursements, adding two measures of patient safety and a financial assessment of whether hospitals are careful stewards of Medicare's money" (Rau, 4/24).

Also on Capsules, Marilyn Werber Serafini reports on the prognosis for Medicare: "If readers can bear the first 276 pages of bad news in the annual Medicare trustees report,  released Monday, they will come to several pages in which Medicare Chief Actuary Richard Foster argues the program’s financial future is even bleaker than what the trustees suggest. Foster acknowledges the trustees did exactly the job they were asked to do, basing their findings on current law, including the 2010 overhaul" (Werber Serafini, 4/24). Check out what else is on the blog.

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Video: In Victory Speech, Romney Goes After Health Law

As Mitt Romney celebrated his primary night wins in Connecticut, Delaware, Rhode Island, Pennsylvania and New York, he attacked the Affordable Care Act and the president. Kaiser Health News has video clips and a transcript of the portion of his speech which affects health care. Watch or read it here

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Political Cartoon: 'Kiss Of Death (Panel)?'

Kaiser Health News provides a fresh take on health policy developments with "Kiss of Death (Panel)?" by Lisa Benson.

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


Romneycare: Who cares?
There's bigger news from Boston.
Let's Go Capitals!

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

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Capitol Hill Watch

GOP Budget Focuses On Cutting Health Law Funds Rather Than Trimming Medicare, Medicaid

House Republican lawmakers propose big spending cuts to health care, labor and foreign aid programs. Meanwhile, progress on Food and Drug Administration user fee legislation could stall over "key differences" on proposed amendments.

The Associated Press/Washington Post: GOP Pulls Its Budget Punches As Follow Up Legislation Advances On Capitol Hill
Instead of big reductions in Medicaid and Medicare, top GOP lawmakers are sticking mostly with familiar proposals like cutting money for President Barack Obama's health care overhaul and federal employee pensions while reaching out to Democrats to help pass annual spending bills (4/24).

Politico Pro: Appropriators Seek 4% Health Spending Cut
House appropriators have set a $150 billion ceiling for fiscal 2013 spending on health and labor programs even though few anticipate a package to clear the committee and reach the floor anytime soon. The 2013 numbers released Tuesday are about $6 billion (about 4 percent) less than what's currently allocated to HHS and the Department of Labor, and are part of a much broader focus by House Republicans to slow discretionary spending (Dobias, 4/24).

The Hill: House Appropriators Plan Big Cuts To Labor, Healthcare, Foreign Aid
The House Appropriations Committee on Tuesday announced its plans to hit jobs, healthcare and foreign aid programs the hardest as it seeks to meet the requirements of the House-passed budget authored by Rep. Paul Ryan (R-Wis.)... Compared to the Senate spending plan, the House will increase baseline military spending by $8 billion in 2013 to $519 billion. The House will then cut the Labor, Health and Human Services budget by $7 billion to $150 billion, and the State Department budget by $9 billion to $40 billion, compared to the Senate plan (Wasson, 4/24).

Politico: FDA Bill Up In The Air Over Proposed Changes
The only health legislation that has any chance of passing before the elections this fall will be marked up by both chambers later this week, but key differences over proposed amendments to the FDA user fee bill in the House and Senate could lead to a protracted fight (Norman, 4/25).

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CMS Proposal Would Factor Patient Safety, Efficiency Into Hospital Pay Formula

The draft rule adds measures of patient safety and a financial assessment to determine whether hospitals are careful with Medicare's money. 

Kaiser Health News: Capsules: Medicare To Add Hospital Efficiency, Patient Safety To Payment Formula
Medicare is proposing a significant change in how it decides on hospital reimbursements, adding two measures of patient safety and a financial assessment of whether hospitals are careful stewards of Medicare's money (Rau, 4/24).

Modern Healthcare: CMS Proposes Small Pay Hike For Acute-Care Hospitals
In a proposed rule, the CMS said it expects operating payments to acute-care hospitals will increase by about 0.9% in 2013. That figure includes a 2.3% net payment update—which accounts for inflation, productivity improvements, coding changes and other adjustments—and other policies included in the rule. Overall, the CMS said it expects total Medicare spending on inpatient hospital services will increase by about $175 million in fiscal 2013 (Zigmond, 4/24).

HealthBeat: CMS Issues Proposed Inpatient Hospital Payment Rule
The agency added in a news release that "the rate increase, together with other policies in the proposed rule and projected utilization of inpatient services, would increase Medicare's operating payments to acute care hospitals by approximately 0.9 percent in FY 2013." This means total Medicare operating payments to acute care hospitals would rise by a total of about $904 million in fiscal 2013. However, because of expiring statutory provisions providing special temporary increases in payments, plus other proposed changes, CMS said "total Medicare spending on inpatient hospital services will increase by about $175 million in FY 2013" (Reichard, 4/24).

In other Medicare news, the program's chief actuary argues that its financial well-being is even worse than the latest Trustees' report suggests, and the New York Times reports that Social Security Disability Insurance payments are spiralling out of control. 

Kaiser Health News: Capsules: An Even Bleaker Prognosis For Medicare?
If readers can bear the first 276 pages of bad news in the annual Medicare trustees report,  released Monday, they will come to several pages in which Medicare Chief Actuary Richard Foster argues the program’s financial future is even bleaker than what the trustees suggest. Foster acknowledges the trustees did exactly the job they were asked to do, basing their findings on current law, including the 2010 overhaul (Werber Serafini, 4/24).

The New York Times: Disability Insurance Causes Pain
Every year, when the trustees of Social Security and Medicare publish their report on the programs' finances they set off a round of partisan bickering about the solvency of the twin programs covering pensions and health care for retired Americans. Every year, a vitally important issue gets lost in the din: disability insurance payments, which account for almost $1 out of every $5 spent by Social Security, are growing out of control (Porter, 4/24).

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Campaign 2012

Romney Sweeps 5 GOP Primaries, Moves Closer To Presidential Nomination

Meanwhile, news outlets report on criticism aimed at Senate Minority Leader Mitch McConnell, R-Ky., and action in congressional races in Arizona and Pennsylvania. 

The Wall Street Journal/Associated Press: Romney Sweeps 5 Wins, Promises 'Better America'
In his remarks, Romney spoke dismissively of Obama's tenure in office. "Government is at the center of his vision. It dispenses the benefits, borrows what it cannot take and consumes a greater and greater share of the economy," he said. He added that if the president's hard-won health care law is fully installed, "government will continue to control half the economy, and we will have effectively ceased to be a free enterprise society" (4/24).

Kaiser Health News: Video: In Victory Speech, Romney Goes After Health Law
As Mitt Romney celebrated his primary night wins in Connecticut, Delaware, Rhode Island, Pennsylvania and New York, he attacked the Affordable Care Act and the president. KHN has video clips and a transcript of his comments (4/25).

RollCall: Vocal Conservatives Blame Mitch McConnell
Behind every tea party defeat in the Senate lurks Minority Leader Mitch McConnell (R-Ky.)  — at least according to a small but vocal band of conservative activists. Led by RedState.com’s Erick Erickson, some in the Republican Party's conservative wing have blamed McConnell for just about everything they view as wrong with Washington, D.C. From the GOP's failure to block President Barack Obama’s health care law to Sen. Ron Johnson’s (Wis.) defeat in the race for Conference vice chairman at the hands of Sen. Roy Blunt (Mo.), these activists and commentators see McConnell’s quiet hand (Drucker, 4/25).

Arizona Republic: 5 Candidates Square Off In GOP Congress Debate
The five Republican candidates running to represent Congressional District 9 faced each other Tuesday night in their first debate... Health care is a not right for Americans, they said, and competition among insurance companies should drive down costs, not legislation such as President Barack Obama's health- care reform (Sanders, 4/24).

Politico: Jason Altimire, Tim Holden Fall In Pennsylvania Primaries
Two conservative Democrats who voted against the president’s health care plan went down in defeat Tuesday, falling victim to primary opponents who cast them as far out of step with their party. Redistricting played a role in both defeats. Pennsylvania Rep. Jason Altmire lost to Rep. Mark Critz, a fellow Democrat who was drawn into the same southwestern Pennsylvania district. Across the state, veteran Democratic Rep. Tim Holden lost re-nomination in a seat that had been dramatically redrawn (Isenstadt, 4/25).

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Health Care Marketplace

Hospital Debt Collector Puts 'The Squeeze' On Patients

A report released Tuesday by the Minnesota Attorney General spotlights aggressive practices used by one of the nation's largest collectors of medical debts, including demanding payments from people seeking care in emergency rooms, cancer wards and delivery rooms.

The New York Times: Debt Collector Is Faulted For Tough Tactics In Hospitals
Hospital patients waiting in an emergency room or convalescing after surgery are being confronted by an unexpected visitor: a debt collector at bedside. This and other aggressive tactics by one of the nation's largest collectors of medical debts, Accretive Health, were revealed on Tuesday by the Minnesota attorney general, raising concerns that such practices have become common at hospitals across the country (Silver-Greenberg, 4/24).

Bloomberg: Accretive Put Debt Collectors In Hospitals, State AG Says
Patients at a Minnesota hospital chain were pressured for payment in the emergency room and at their bedsides by debt collectors from a company that didn't disclose its role, the state's attorney general alleges. Employees of Fairview Health Services, a nonprofit chain of seven hospitals based in Minneapolis, were required to use a computer system derisively called "Blue Balls" to track whether patients paid their bills and push for payment before they received care, Minnesota Attorney General Lori Swanson said. The payment system began after Fairview hired the collection agency Accretive Health Inc. (AH) in May 2010, Swanson said in a report describing the companies’ relationship (Wayne, 4/25).

(St. Paul) Pioneer Press: ER Doctor, Nurse… And Debt Collector
A Chicago-based consultant hired by the Fairview health system pushed hospital workers to engage in overly aggressive bill collection tactics that included pressuring patients in the emergency room, according to an investigative report released Tuesday, April 24, by Minnesota Attorney General Lori Swanson.  Accretive Health Inc. imposed quotas on hospital personnel to collect money before treatment was provided in some cases, according to Swanson's report, and ignored concerns from some Fairview workers that the tactics were going too far. The report described Accretive's methods as being akin to those "commonly utilized in high-pressure boiler-room-style sales atmospheres" (Snowbeck, 4/24).

Minneapolis Star Tribune: Attorney General: Fairview Put Squeeze On Patients
Fairview hospital employees used high-pressure tactics in emergency rooms, cancer units and delivery wards to try to collect money from patients before they were treated, according to a blistering report issued Tuesday by Minnesota Attorney General Lori Swanson. The collections strategy, designed by an Illinois consulting firm called Accretive Health, was so heavy-handed that several doctors complained it might discourage patients from seeking medical care, the report found. Swanson said the practices, uncovered during a review of Fairview's management contracts with Accretive, appear to have violated federal and state laws, including those regulating debt collection and patient privacy (Kennedy and Lerner, 4/24).

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Physicians, Med Schools Fret About Future, But Some See Signs Of Hope

One survey reveals that doctors fear some of the changes due to the health law, while primary care physicians say the law may spur needed change.

Medscape: Physician Frustration Grows, Income Falls -- But A Ray Of Hope
Physician income overall has declined since 2010, yet there are tiny glimmers of hope in some specialties. Frustration is mounting, however, and doctors in every specialty are bracing for what they expect to be further income declines as healthcare elements are implemented, such as ACOs and required treatment and quality guidelines. Those are some of the insights from Medscape's Physician Compensation Survey Report: 2012 (Crane, 4/24).

Georgia Health News: Team Approach May Help Fill Gaps In Primary Care
Georgia and the rest of the nation already have a general shortage of obstetricians, internists, pediatricians and family medicine doctors, especially in rural and urban areas. ... Many uninsured patients put off seeking care until "the pain is unbearable," said Dr. David Satcher. ... Dr. Frank Don Diego of Rome said the patient-centered concept known as a "medical home" has the potential to revamp primary care -- and attract more providers (Miller, 4/24). 

Meanwhile, in Texas a proposal on doctor training has raised some concerns.

The Texas Tribune: Higher-Ed Board Mulls Access For Caribbean Med School
The American University of the Caribbean, a for-profit medical school owned by DeVry Inc., has requested authorization from the coordinating board to allow its students — and in particular those from Texas — to have the opportunity to spend years three and four of medical school in Texas hospitals. ... Texas medical schools, charged with increasing enrollment to meet the state's physician shortage, are already "starting to stumble over each other" finding their students the right clerkships, said Dr. Cynthia Jumper, who heads the Texas Medical Association's medical education council (Hamilton and Ramshaw, 4/25).

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Health Reform

Nonprofit Hospitals Will Likely Face Higher Costs If Mandate Is Overturned

Striking the mandate but leaving other parts of the law would put many hospitals in a bind, according to Moody's Investors Service. Meanwhile, The Hill reports that a majority of hospital executives expect the overhaul to shrink revenues.

Reuters: Lack Of Insurance Mandate Would Hurt Hospitals -Moodys
Non-profit hospitals will struggle with higher costs if the U.S. Supreme Court overturns a key part of the healthcare reform law that requires individuals to buy insurance, Moody's Investors Service said on Tuesday... It "would result in a significant reduction in uncompensated care delivered by hospitals" and reduce "utilization of expensive emergency room services," the rating agency said in a special report (4/24).

The Hill: Poll: Majority Of Hospital Executives Expect Health Law To Shrink Revenues
By a nearly five-to-one margin, hospitals expect the 2010 healthcare law to shrink their revenues, according to a recent poll. The result suggests that hospital executives are doubting the deal they struck with the Obama administration in exchange for supporting the healthcare overhaul will help them weather the law's financial repercussions (Viebeck, 4/24).

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Coverage & Access

Study: Fewer Employers Offer Health Benefits For Workers

The Hill: Fewer Employers Offering Health Benefits, Study Says
Fewer employers are offering healthcare coverage and fewer employees are taking it, a new study reports. The survey, conducted by the Employee Benefit Research Institute (EBRI), found a steady drop in the number of private-sector employers that offer health benefits to their workers (Baker, 4/24).

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Studies: Against Best Advice, Docs Continue Unneeded Prostate Screenings

JAMA and another journal found that despite government recommendations, doctors continue to screen too many men for prostate cancer.

ABC News: US Men Ignoring 2008 Prostate Screening Guidelines
Warren Buffett’s decision to undergo prostate cancer screening reflects the reality that nearly half of American men 75 and older continue being tested despite official recommendations against doing so, researchers reported today. … In 2008, the USPSTF issued a recommendation that found limited benefit for screening men ages 75 and older for prostate cancer (Allen, 4/24).

MedPage Today: Docs May Resist PSA Screening Recommendations 
In the Journal of the American Medical Association, researchers led by Sandip Prasad, MD, of the University of Chicago Medical Center, reported that a previous recommendation of the task force had almost no effect on clinical practice. And in Archives of Neurology, researchers led by Craig Pollack, MD, of Johns Hopkins University School of Medicine in Baltimore, found that, in a diverse sample of doctors, the current recommendation was unlikely to change their practice markedly (Smith, 4/24).

Boston Globe: Older Men Failing To Follow Prostate Cancer Screening Recommendations
Last week, we heard news that 81-year-old billionaire Warren Buffett was diagnosed with prostate cancer after having the finding initially detected through a screening blood test to measure a cancer marker called prostate specific antigen. That was despite guidelines from a national task force that have been in place since 2008 recommending against the use of PSA screening in men over age 75 due to its lack of benefit. As it turns out, Buffett stands in good company. Nearly 44 percent of men his age got screened with a PSA test in 2010, a rate that has remained unchanged since 2005, according to a research letter published Tuesday in the Journal of the American Medical Association (Kotz, 4/24). 

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State Watch

Iowa House Approves Mental Health Reforms

The bill would replace the county-by-county system in Iowa. Also in state legislative news, N.H. gubernatorial candidate opposes health care compact proposal and California lawmaker seeks cap on consumers' prescription drug expenses.

Des Moines Register: Mental-Health Reform Clears House Despite Concerns That It Could Cause Cuts
After weeks of off-the-record negotiations, the Iowa House of Representatives today approved major reforms to the state's mental health system. The bill would replace the current county-by-county system with one in which counties would band together into regions to provide services to people with mental illnesses or disabilities. The bill, Senate File 2315, passed on a 65-32 vote, and it goes back to the Senate (Leys, 4/24).

The Associated Press/Houston Chronicle: Hassan: Health Compact Bill Wrong For NH
Democratic gubernatorial candidate Maggie Hassan said Tuesday that a GOP proposal to form a compact to assume control over Medicare and Medicaid within New Hampshire's boundaries is a risky proposition that is wrong for the state. ... Hassan said the proposal would let the state decide to delay coverage until 70 or to raise [seniors'] out-of-pocket costs. She noted that the Republican-controlled Legislature cut funding to programs for the poor in the state budget adopted last year (4/24).

California Healthline: Health Debt Bill Passes Committee
When she first found out she had multiple sclerosis, [Melanie] Rowen had health care insurance but her medication was still expensive. "My insurance plan required me to pay 30% of it," Rowen said. "I couldn't afford it, but I put it on credit cards." As she watched her disease progress, she saw her bank account drain away and her health care debt pile up. Assembly member Fiona Ma (D-San Francisco) hopes to prevent similar scenarios with AB 1800 which would establish a limit on annual out-of-pocket expenses for prescription medications for insured Californians (Gorn, 4/25). 

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Marketplace News: UnitedHealthcare Flexes Its Muscle In Iowa, Nebraska

UnitedHealthcare expands its reach in Iowa and gets the go-ahead to intervene in a Nebraska lawsuit.

Des Moines Register: UnitedHealthcare Now Covers All 99 Counties
UnitedHealthcare has made a deal with Fort Dodge-based Trimark Physicians Group that will expand the health insurance provider's footprint into 13 new counties in rural northwest central Iowa. The deal allows UnitedHealthcare to lay claim to covering all 99 counties in Iowa. UnitedHealth has more than 5,400 physicians and 130 hospitals (Belz, 4/24).

The Associated Press/Modern Healthcare: United Healthcare Can Intervene In Neb. Lawsuit
A judge has ruled that United Healthcare can intervene in a lawsuit filed by Blue Cross and Blue Shield of Nebraska over the state's planned switch to United Healthcare for health insurance administration. The Lincoln Journal Star reports that Judge Steven Burns on Monday approved United Healthcare's request to intervene in the action against the state. Blue Cross had sued earlier this month, alleging improper lobbying on United Healthcare's behalf (4/24).

Also in the news, an Alaska hospital demonstrates results based on quality improvement measures and a state hospital for the mentally ill in Kansas seeks additional funding to offset staffing shortfalls.

Alaska Public Radio: Quality Improvement Measures Get Results At Providence
In a bright room on the Cardiovascular Unit at Providence, Genaro Reyes is perched on the edge of his bed in hospital issued pajamas. ... Today, he's talking to a brand new type of health worker at Providence. Nurse Maike Henning became the hospital’s first Clinical Heart Failure Coordinator in 2008. One of her main jobs is to help keep heart failure patients like Reyes from coming back to the hospital within 30 days (Feidt, 4/24). 

Kansas Health Institute News: Larned State Hospital Seeks Additional $2.1 million
Larned State Hospital officials say they need an additional $2.1 million to offset staffing shortfalls cited during a recent accreditation survey. ... Larned State Hospital is one of three state-run hospitals for the mentally ill. The request for additional funding comes on the heels of The Joint Commission, a national organization that accredits hospitals, last month citing the hospital for 30 deficiencies, most of which were tied to understaffing (Ranney, 4/24). 

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Medicaid News: Florida Prepares For Shift To Managed Care

News about Medicaid developments in Florida and Minnesota.

News Service of Florida: Heath Plans Lining Up For State's New Medicaid System
Preparing for Florida's shift to a statewide Medicaid managed-care system, 20 health companies and organizations are interested in competing for contracts to serve seniors who need long-term care. ... The list of potential bidders only reflects health plans interested in the long-term care portion of a statewide managed-care system. AHCA has not sought similar letters of intent for plans hoping to serve the broader Medicaid population, such as children and women (Saunders, 4/24). 

Minnesota Public Radio: Congressional Hearing Today On Minn. Medicaid
Republicans in the U.S. House and Senate called the joint hearing saying that recent actions by the state of Minnesota suggested possible fraud and abuse of the Medicaid program (which) ... covers more than 600,000 Minnesotans (Neely, 4/25). 

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Ariz. Senate Approves Bill To Ban State Funds For Planned Parenthood

The vote follows abortion restrictions passed by the Arizona legislature this year. In addition, N.H., Calif. and La. lawmakers are weighing abortion bills.

Arizona Republic: Planned Parenthood Funds At Risk In Arizona
Arizona is on the verge of joining eight other states that have banned the use of public dollars for Planned Parenthood. The Senate on Tuesday approved a bill that would bar the state or any local government from using public money to support an organization that includes abortions among its services. Although House Bill 2800 does not mention Planned Parenthood by name, it's clear the organization is the target (Pitzl, 4/24).

The Associated Press/Houston Chronicle: AZ Senate OKs Ban On Planned Parenthood Funding
Senate Republicans completed a legislative push to bar any public money from being funneled through the state to any abortion provider, including Planned Parenthood. Arizona lawmakers have already approved a bill to impose new restrictions on abortion, including a ban on terminating pregnancies starting at 20 weeks after conception (Davenport, 4/24).

The Associated Press/Boston Globe: N.H. Senate Will Vote On Abortion Bills
The New Hampshire Senate is taking up a half-dozen abortion bills Wednesday, including one that could jeopardize the state's federal funding for its Medicaid program. The bill would cut off taxpayer funding to hospitals, clinics, and others who perform elective abortions, although an amendment proposes exempting hospitals. That would end funding to six Planned Parenthood of Northern New England centers and several other rural clinics (Love, 4/24).

The Sacramento Bee: Bill To Expand Abortion Access In California Falters In State Senate
A proposal aimed at expanding access to a first-trimester abortion procedure in California advanced Tuesday after being stripped of its key provisions, signaling that lawmakers could punt on the issue amid opposition from the California Nurses Association. The original version of Senate Bill 1338, by Democratic Sen. Christine Kehoe, would have allowed trained nurse practitioners, physicians assistants and certified nurse midwives to perform aspiration abortions. Under current law, only doctors can conduct the procedure, which uses a suction method to remove a fetus from a patient's uterus (Van Oot, 4/24).

New Orleans Times-Picayune: Senators Approve Abortion Law Changes
Lawmakers voted overwhelmingly Tuesday to advance proposals that would impose new strictures on abortion providers, including a measure to require clinicians to make an ultrasound both visible and audible to a woman seeking to terminate a pregnancy. ... Several senators noted that [Rep. Sharon Weston] Broome's proposal, filed at the urging of social conservatives, goes beyond a simple addition. The bill also changes the time frame for the ultrasound, requiring that it occurs at least 24 hours before the procedure (Barrow, 4/24).

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State Roundup: Calif. Exchanges Forge Ahead; Mo. Grappling With Costs, Quality

A selection of state policy news from North Carolina, California, Florida, Missouri, Georgia, Oregon and Michigan.

HealthyCal: California Moves Forward With Insurance Exchange
Despite a potentially disruptive U.S. Supreme Court Decision expected this summer, California officials are moving forward with the creation of a new, online health insurance market. ... "There are many different scenarios," said David Panush, director of government relations for the California Health Benefit Exchange. "Rather than trying to crystal-ball what the court may or may not do, we've got our foot on the pedal and we're going full speed ahead" (Smith, 4/24). 

CQ HealthBeat: Fraud Busting in Florida Shows Successes, Shortcomings of Federal Effort to Protect Medicare
Enforcement officials at a Senate Finance Committee hearing Tuesday laid out how a Florida strike force of federal and local officials last fall produced what Chairman Max Baucus called "the largest Medicare fraud bust in history." ... Miami-based U.S. Attorney Wilfredo A. Ferrer, on hand to describe the bust, cautioned lawmakers that "we cannot prosecute our way out of this." He emphasized that ways must be found to prevent fraud in the first place (Reichard, 4/24).

St. Louis Beacon: Report Says State Can Save Money And Improve Health Care
Annual medical spending in Missouri is expected to rise faster than the national average in the next decade, but the state has several options for lowering costs and raising quality during that period, according to a report commissioned by the Missouri Foundation for Health. ... The foundation's report projects spending in Missouri to rise faster during that period, by about 6.2 percent a year (Joiner, 4/24).

The Atlanta Journal-Constitution: Progress Being Made In Closing Funding Gap In State Benefits Program
State officials are working on how to close a shortfall of roughly $63 million for the health insurance plan that serves state workers and retirees. Still, it's a big improvement over a multiyear deficit of more than $800 million the plan originally faced. ... [There is] a three-year plan requiring every public school district in the state to contribute hundreds of dollars more every month for each noncertificated employee, such as custodians (Williams, 4/25).  

The Lund Report: Department of Corrections' TPA May Create CCO For Prisoners And Parolees
Eyebrows almost instantaneously raised during the Oregon Health Policy Board's meeting earlier this month when board members realized that an organization serving the Department of Corrections' inmates had submitted a letter of intent to become a coordinated care organization (CCO). That's because CCOs are intended to serve Oregon Health Plan patients, who are on Medicaid. Oregon's 14,000 prisoners are not covered by Medicaid (Waldroupe, 4/25). 

Kaiser Health News: Los Angeles Is Betting On One Crusading Doc To Turn Public Health System Around
Los Angeles, the nation's second largest city with some 2 million uninsured residents, has long had one of the most disorganized systems. To fix it, [Dr. Mitch] Katz, the former director of San Francisco's health department, insists on seeing patients at this public health clinic one afternoon a week (Varney, 4/24).

The Detroit Free Press: Help Is Limited For Michigan Adults With Autism
The number of those diagnosed with autism has increased dramatically in the last 20 years, threatening to overwhelm the already limited services available. ... Most of those aging into adulthood will find an alarming lack of services designed to help transition into the next stage of their lives (Walsh-Sarnecki, 4/25).

McClatchy: Search Continues For More N.C. Sterilization Victims
The N.C. Justice for Sterilization Victims Foundation continues to seek people who were involuntarily sterilized by the state, but progress has been slow. ... Gov. Bev Perdue's Eugenics Compensation Task Force recommended giving a tax-free payment of $50,000 and mental health services to victims verified by the foundation. Perdue has said she will include the compensation plan in the budget she submits this spring (Vaughn, 4/24).

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Editorials and Opinions

Viewpoints: Fixes To Medicare Should Improve Seniors' Access To Care; Lifestyle Changes Could Help Fix Budget

The Philadelphia Inquirer: The Right Way To Fix Medicare
Medicare, which according to a new assessment will go bankrupt by 2024, is in dire need of reform. But there are right ways and wrong ways to go about it. The right reform would save money while giving seniors better access to care. ... The hard truth is that that's impossible. Both Republicans and Democrats recognize the need for change. Unfortunately, their proposals have come up short (Douglas Schoen, 4/25).

Fortune/CNN Money: We're Having The Wrong Debate About Rising Health Care Costs
If Americans behaved just a little differently, our health care costs could settle down to a sustainable growth rate that matches the economy's growth, or could even fall further. ... Unfortunately, instead of talking about it, we're focused on how to apportion our rising health care costs. That's a tragic missed opportunity. We need to reframe the debate: not how to share health care's economic burden, but how to seize the enormous opportunity to reduce it (Geoff Colvin, 4/25). 

Politico: Paradox: Dems Protect Seniors Who Back GOP
Why are America's senior citizens such staunch Republicans? Even drastic GOP plans to change Social Security and Medicare guarantees, led by House Budget Committee Chairman Paul Ryan's budget reforms, don't seem to drive older voters away. ... Whether we admit it or not, modern generational divisions are deep and real, and older voters today stand squarely with Republicans. The GOP does promise to preserve generous government benefits for today's seniors — but talks about denying them to tomorrow's (Mike Males, 4/24).

Los Angeles Times: Cut Social Security And Medicare? Sure, After The Last Boomer Is Dead
OK, so Social Security is going to be in trouble in, oh, 2033. And Medicare? Uh oh, 2024. Hmmm. Let's see. That's close but probably OK on Social Security; not so good on Medicare (especially with my -- how to put this? -- non-vegan lifestyle). What? You weren't thinking the same thing? Tell me you didn't read The Times' article Tuesday and then do the math, trying to figure out if the two safety-net programs will be around long enough for you? (Paul Whitefield, 424).

Mercury News: Coordinated Care Key To Saving Health Care For Seniors
Rising health care costs and the downturn in the economy have meant disaster for California's seniors, resulting in huge budget cuts to health care programs that serve our vulnerable population. ... (Gov. Jerry Brown's) plan represents an opportunity for California to deliver more care for the dollar through better coordinated, more effective care. However, we believe his plan must be improved upon by investing in the tools seniors need to proactively manage our health and maintaining our choices when it comes to directing our care (Gary Passmore, 4/24).

The Wall Street Journal: Why We Have Gone To Court Against The Obama Mandate
We are presidents of three private, evangelical colleges throughout the country. ... We provide jobs to many hundreds of citizens and provide their families generous health insurance. But the Obama administration has passed a rule that will penalize our colleges with faith-based fines merely because we center our beliefs about the sanctity of human life on the Bible, not on the demands of federal bureaucrats. The administration's mandate that religious employers provide coverage of abortion-inducing drugs for their faculty, staff, and students is a bridge too far in America (William Armstrong, Ken Smith and Joe Aguillard, 4/23).

Journal of the American Medical Association: New Physicians, The Affordable Care Act, And The Changing Practice of Medicine
Several key features of the law designed to improve the access to and quality of the US health care system could also improve the quality of life and job satisfaction for physicians. First, the ACA will expand insurance coverage to more than 30 million currently uninsured US residents. Furthermore, all US residents with health insurance will have guaranteed coverage of essential health benefits, as opposed to the past of patchwork coverage with numerous exclusions and high rates of underinsurance. Together, these provisions offer physicians the opportunity to improve health care for vulnerable populations, reduce long-standing racial and ethnic disparities in health, and practice medicine without worrying about whether patients will be able to pay for needed care (Dr. Benjamin D. Sommers and Dr. Andrew B. Bindman, 4/25).

Journal of the American Medical Association: Sharing Clinical Data Electronically
The vision of complete patient information available across care delivery settings is compelling and central to a high-functioning health care system. However, the vision is deceptively simple: there are enormous challenges to enabling clinical data to flow across organizations. These challenges are substantially greater than those associated with transitioning physicians and hospitals to electronic health records (Julia Adler-Milstein and Dr. Ashish Jha, 4/25).

WBUR's CommonHealth blog: Can You Hear Me Now? Why Isn't My Hearing Aid Covered?
I took the hearing test on a whim at a health fair, pretty confident that as a healthy 35-year-old, I would pass with flying colors. Not so. I failed, miserably. ... Like me, most people are surprised to learn that hearing aids are not routinely covered under most private insurance plans or traditional Medicare. ... It is deeply troubling that something so critical to overall health is not routinely covered by insurance (Ellen Berlin, 4/24).

Related KHN story: Say What? Most Insurance Covers Little Of The Cost Of Hearing Aids (Andrews, 4/9).

Milwaukee Journal Sentinel: Sexual Assault A Reminder Of Continuing Problems
Two things need to come out of the April 4 sexual assault at the Milwaukee County Mental Health Complex: a thorough investigation and public explanation of how this incident was allowed to happen and a renewed urgency in changing the way the county delivers mental health care. To be sure, significant steps have been taken on the latter, but progress has still been too slow, especially for the most vulnerable and neediest patients at the complex (4/25).

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Stephanie Stapleton

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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.