Daily Health Policy Report

Thursday, April 25, 2013

Last updated: Thu, Apr 25

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Health Care Marketplace

Health Spending And Fiscal Battles

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Maryland Offers Glimpse At Obamacare Insurance Math

Kaiser Health News staff writer Jay Hancock reports: "In the latest preview of prices for health coverage under the Affordable Care Act, Maryland's dominant insurer says proposed premiums for new policies for individuals will rise by 25 percent on average next year. That's lower than what some had predicted. Just three weeks ago, the insurer, CareFirst BlueCross BlueShield, had been looking at a proposed 50 percent increase. But the company revised that initial estimate, citing worries about affordability for consumers" (Hancock, 4/24). Read the story.

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Capsules: States Spend $28M, Then Leave Exchanges To The Feds

Now on Kaiser Health News' blog, Phil Galewitz writes: "Late last year, Arizona Gov. Jan Brewer announced that her state would not build its own online insurance marketplace, a pillar of the Affordable Care Act, because there were too many unknowns. What Brewer didn't say was that her state had spent $9 million in federal money to reach that conclusion. Arizona was one of 10 states that received federal grants over the past two years to help establish a state exchange only to decide later to let the federal government handle it" (Galewitz, 4/24). Check out what else is on the blog.

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Political Cartoon: 'On Florida Time?'

Kaiser Health News provides a fresh take on health policy developments with "On Florida Time?" by Jeff Parker.

Meanwhile, here is today's health policy haiku:


Cantor can't convince
 to vote to shift
prevention funding.

 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 Leader Pulls Bill To Redirect Prevention Funds To Health Law's High-Risk Pools

Shelving the measure to provide more money for coverage for people with pre-existing conditions, which faced strong opposition from conservatives, is viewed as a setback for House Majority Leader Eric Cantor, R-Va., and efforts to rebrand the Republican Party.

The Washington Post: House GOP Leadership Falls On Health Vote
House Republican leaders suffered a humiliating legislative setback Wednesday when a large faction of GOP lawmakers rebelled against a leadership proposal that had drawn the opposition of powerful outside activists. The mutiny forced House Majority Leader Eric Cantor (Va.) to abruptly pull from the floor legislation to shore up a program that allows people with preexisting health conditions to buy into an insurance pool for high-risk patients before they are able to transition to coverage under President Obama’s health-care law. … The Club for Growth led a contingent of right-leaning groups that urged Republican lawmakers to oppose the bill, casting it as a costly boondoggle that would do nothing to dismantle the health-care law (Kane, 4/24).

The Associated Press/Washington Post: GOP Postpones Vote To Use Disease-Prevention Money To Extend Coverage For High-Risk Patients
GOP leaders postponed a scheduled vote after the measure met strong opposition from two directions: from conservative groups resistant to any federal role in health care and from Democrats who objected that the Republicans planned to pay for the high-risk patient program by raiding a disease prevention provision the administration says is essential to the overhaul (4/24).

The Wall Street Journal's Washington Wire: GOP Shelves Legislation Attacking Obama Health Law
Their bill had been scheduled for a House vote but was abruptly pulled from the calendar in the face of conservative and Democratic opposition. The measure would abolish a $2 billion fund to pay for public health initiatives and channel the money instead to a program to help provide insurance for people with pre-existing conditions (Hook, 4/24).

Politico: GOP Pulls Contentious Obamacare Bill
It's a blow to the Virginia Republican, who touted the "Helping Sick Americans Now Act" and visited the Republican Study Committee meeting Wednesday to try to move votes (Sherman, 4/24).

Reuters: Republican Leaders Withdraw Healthcare Bill Amid Conservative Concerns
Republican leaders in the House of Representatives on Wednesday withdrew a bill that would change the Obama administration's healthcare law amid conservative concerns that the legislation was replacing one big government program with another. The House cleared the way to debate the bill, which was designed to help Americans with pre-existing medical conditions while preventing the administration from using an alternate source of funding to implement its healthcare law (Cowan, 4/24).

The New York Times: House Majority Leader's Quest To Soften G.O.P.'s Image Hits A Wall Within
On Wednesday, Republican leaders abruptly shelved one of the centerpieces of Mr. Cantor's "Making Life Work" agenda — a bill to extend insurance coverage to people with pre-existing medical conditions — in the face of a conservative revolt. Last month, legislation to streamline worker retraining programs barely squeaked through. … So it has gone. Items that Mr. Cantor had hoped would change the Republican Party's look, if not its priorities, have been ignored, have been greeted with yawns or have only worsened Republican divisions (Weisman, 4/24).

Los Angeles Times: Republican Effort To Rebrand The Party Takes A Hit
Cantor's approach echoed the "compassionate conservatism" of an earlier Republican era. … That ambitious goal ran smack into political reality Wednesday as conservative lawmakers rejected a Republican bill to help Americans with preexisting health conditions gain access to insurance coverage. Republican leaders had to abruptly yank the bill from consideration because they did not have enough votes from their rank and file to pass it. The episode was another example of the difficulty the Republican Party faces in corralling its unruly majority and finding a common message to attract voters (Mascaro, 4/24).

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Tavenner's Smooth Path To Confirmation Hits A Bump

Sen. Tom Harkin, D-Iowa, has put a hold on the Obama administration's pick to head the Centers for Medicare & Medicaid Services in order to highlight his concerns about the administration's interest in raiding the health law's prevention fund to pay for the costs of getting health exchanges up and running.  

The Washington Post's Wonk Blog: Sen. Harkin Has A Hold On Obama's Medicare Pick. What Gives?
The Senate Finance Committee unanimously supported her nomination. She has the support of multiple former Medicare heads; one compared her to Mother Teresa. Even House Majority Leader Eric Cantor (R-Va.), who does not like Obamacare one bit, really likes Marilyn Tavenner. Enter, Sen. Tom Harkin, the Iowa Democrat who has put a hold on Tavenner's nomination. Harkin is demanding, according to spokeswoman Katie Cyrul Frischmann, "An ongoing conversation about the future of the prevention fund" (Kliff, 4/24).

The Hill: Harkin Places Hold On Top Healthcare Nominee
Sen. Tom Harkin (D-Iowa) has placed a hold on one of President Obama's top healthcare nominees. Marilyn Tavenner had previously seemed poised for an easy, bipartisan confirmation as the administrator of the federal Medicare and Medicaid agency (Baker, 4/24).

Politico: Tom Harkin Makes Hurdle For Obama's CMS Chief
Harkin told POLITICO he'd hold up the confirmation "until we get some things worked out." He said he's meeting with the administration about the prevention money and has some ideas about other ways to get the funds. Congress has not granted HHS the money it has requested to get the health insurance exchanges up and running (Cunningham and Haberkorn, 4/24).

Health and Human Services Secretary Kathleen Sebelius defends the idea of redirecting these funds -

CQ HealthBeat: Sebelius Defends Transfer Of Health Law Money
Health and Human Services Secretary Kathleen Sebelius on Wednesday defended the Obama administration’s decision to take money from a preventive health fund to help implement the upcoming insurance exchanges, despite concerns from leading Senate appropriators. Jerry Moran, ranking member on the Senate Appropriations Labor-HHS-Education Subcommittee, questioned the secretary’s authority to transfer preventive health funds for the exchanges that would be run by the federal government (Attias, 4/24).

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House Measure Introduced To 'Eliminate Consumer Confusion' About Who Is, And Is Not, A Doctor

The measure would make it illegal for health care professionals to make false or deceptive advertising claims. In addition, two Senate committees are focusing on various aspects of either fraud within the health care marketplace, or misleading sales tactics, as a means to find savings in Medicare and Medicaid. 

Medscape: New Bill Would Clarify Who Is A Medical Doctor And Who Isn't
Sponsors of a bill recently introduced in the House of Representatives aim to eliminate consumers' confusion over who is considered a medical doctor. Rep. Larry Bucshon, MD, (R-In.) and Rep. David Scott, (D-Ga.) are cosponsors of the bill, called the "Truth in Healthcare Marketing Act of 2013," (HR 1427), which was introduced on April 9 and referred to the Energy & Commerce committee. The bill would make it illegal for any healthcare professional to make false or deceptive claims in advertisements and marketing materials regarding their training, degree, license, or clinical expertise. Anyone marketing a health provider's services also must clearly state the license the provider holds (Frellick, 4/24).

St. Louis Beacon: McCaskill Grills Federal Officials, Bashes Firms On Medical Equipment Sales Tactics
A Chesterfield physician is deluged by faxes from companies claiming falsely that her patients had requested medical equipment. An elderly Missouri woman gets three or four calls a day from marketing firms trying to convince her to ask her doctor for equipment she doesn't need or want. … [Sen. Claire McCaskill at a hearing] alleged that misleading and possibly fradulent tactics by companies that sell durable medical equipment – such as diabetic testing and sleep apnea equipment – may be costing Medicare and Medicaid billions a year (Koenig, 4/24).

Modern Healthcare: Healthcare Industry Asks Feds For Clearer Guidance On Fraud, Fewer Audits
After sifting through 2,000 pages of public comments, staff members for the Senate Finance Committee say the healthcare industry wants clearer rules, fewer redundant audits and more focus on proactive healthcare fraud prevention. The committee was swamped with more than 150 reports from healthcare providers, insurers and suppliers last year after asking for suggestions on ways to prevent waste and improve fraud-fighting efforts in Medicare and Medicaid. About $65 billion was lost to improper payments from Medicare in 2011, according to one government estimate (Carlson, 4/24).

In related news -

Bloomberg: Medicare-Fraud Tip Rewards Boosted To $10 Million By U.S.
Tips that uncover Medicare fraud may be worth as much as $10 million for whistle-blowers, a boost from a maximum payout of $1,000, as the government seeks to reduce misuse of the health program. The action to raise the potential payments, modeled after an Internal Revenue Service program, may increase antifraud rewards to Medicare beneficiaries to 149 a year on average, compared with a total of 18 from 2000 to 2012, the Department of Health and Human Services said today in a statement (Wayne, 4/24).

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Health Reform

Co-ops Face Historic Test, White House Makes Hire For Health Law PR Push

Politico notes the support and challenges of nonprofit co-ops as alternatives to commercial insurance plans, while HealthyCal examines parts of the health law that may be giving pause to small businesses. Meanwhile, California Healthline examines whether the higher-than-expected costs and lower-than-expected enrollment in high-risk pools might foreshadow the future of new insurance exchanges.

Politico: CO-OP 'Movement' Offers An Insurance Alternative
The public option is dead. Long live CO-OPs! That's the chant from mostly grass-roots health reformers in 24 states, backed by billions of dollars in government loans, who are gearing up to offer alternatives to commercial insurance plans on the exchanges next fall. ... [But] to succeed, CO-OPs will have to compete with large established insurers that are also hungry for the new exchange business under the health law (Norman, 4/25).

HealthyCal: Benefits In Federal Health Reform May Not Entice Small Businesses
The federal Affordable Care Act kept the nation’s employer-based health insurance system intact – and that decision may leave small business struggling to provide health care to their employees…But critics say provisions in the Affordable Care Act aren’t enough to ensure that small businesses can provide coverage to their employees. Some provisions may actually discourage employers from providing insurance (Shanafelt, 4/25).

California Healthline: Are High-Risk Pools A Preview Of Obamacare's Failure?
Following the Obama administration's announcement about the suspension of enrollment in a high-risk health insurance program known as the Pre-Existing Condition Insurance Plan, a flurry of commentary began on what the move means for the Affordable Care Act. Some observers said that the program's underwhelming enrollment numbers and high costs foreshadow inevitable problems with the ACA's health insurance exchanges, while others drew a clear division between a program intended to insure only those with pre-existing health conditions and state marketplaces designed to spread risk by insuring both those who are sick and those in good health. Two months after the halted enrollment, the debate continues (Wayt, 4/24).

In other news -

Politico: WH Taps CAP's McGuinness For Obamacare Push
Tara McGuinness, a well-regarded strategic communications expert currently serving as a senior vice-president at the Center for American Progress and executive director of the think-tank's advocacy arm, and will be reunited with former CAP-er Jen Palmieri as a senior White House communications advisor. She'll be focusing on communications and outreach around Affordable Care Act implementation. The move signals a new focus in the White House communications operation on the ACA, an administration official tells POLITICO (Thrush, 4/24).

NPR: Family Doctors Consider Dropping Birth Control Training Rule
One of the more popular provisions of the federal health law requires that women be given much freer access to prescription methods of birth control. That includes not only the pill, but implants and IUDs as well. But what happens if there are not enough doctors to prescribe those contraceptives? That's exactly what worries some reproductive health advocates, as efforts are underway to rewrite rules governing the training of the nation's family doctors (Rovner, 4/25).

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Will Lawmakers, Staff Be Exempt From Health Exchanges?

News outlets also report on whether health exchanges will end insurance monopolies; on efforts to address possible "churning" between Medicaid and the new insurance marketplaces; and the money states spent to decide against running their own exchanges.  

Politico: Lawmakers, Aides May Get Obamacare Exemption
Congressional leaders in both parties are engaged in high-level, confidential talks about exempting lawmakers and Capitol Hill aides from the insurance exchanges they are mandated to join as part of President Barack Obama's health care overhaul, sources in both parties said (Bresnahan and Sherman, 4/24).

Stateline: New Health Exchanges Unlikely To End Insurance Monopolies In The United States
In Alabama, if you get your health insurance through your employer and you lose your job, you quickly realize there aren't a lot options for purchasing coverage on your own. Blue Cross and Blue Shield of Alabama has had a virtual monopoly in the state since the Great Depression, and today it covers a whopping 89 percent of Alabamians. In part, Blue Cross and Blue Shield is dominant in Alabama simply because it has been there for so long -- it sold its first policy in 1936 -- and potential newcomers have found it difficult to convince hospitals and doctors to give them favorable prices so they can compete with the entrenched carrier. But it also has to do with Alabamians themselves: On average, residents of the state are poorer and less healthy than other Americans, making them more expensive to cover and thus less attractive customers (Vestal, 4/25).

The Lund Report: 'Churn Bill' Looks To Help People Switching From Medicaid To Cover Oregon
Next year, the Affordable Care Act will allow people whose income falls below 138 percent of the federal poverty level to receive coverage through the Oregon Health Plan. Meanwhile, people who earn up to 400 percent of the poverty line will be eligible for federal tax subsidies to help purchase private health insurance on the exchange, Cover Oregon, unless, that is, their employer decides to pay for the coverage. Realizing that incomes fluctuate, the Oregon Health Authority estimates that up to 60,000 Oregonians will "churn" between Medicaid and Cover Oregon each year (Gray, 4/24).

Kaiser Health News: Capsules: States Spend $28M, Then Leave Exchanges To The Feds
Late last year, Arizona Gov. Jan Brewer announced that her state would not build its own online insurance marketplace, a pillar of the Affordable Care Act, because there were too many unknowns. What Brewer didn't say was that her state had spent $9 million in federal money to reach that conclusion. Arizona was one of 10 states that received federal grants over the past two years to help establish a state exchange only to decide later to let the federal government handle it (Galewitz, 4/24).

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Fla. Lawmakers Close In On Medicaid Expansion Deal

Florida lawmakers are closer to a deal that would OK a Medicaid expansion there -- the state would use federal funds to cover more vulnerable residents while providing childless adults and adult parents with state money to buy private insurance.

The Associated Press: Fla. House, Senate Negotiating Medicaid Compromise
Florida House and Senate leaders are negotiating a deal that would use state and federal dollars to offer health coverage to thousands of uninsured Floridians under President Barack Obama's health care overhaul, according to a person close to the talks. The state would use federal funds to cover more vulnerable populations, including pregnant women and the disabled, and would pony up state funds to offer more limited health coverage to about 300,000 childless adults and roughly 57,000 adult parents, giving the latter groups a set amount to purchase private insurance (Kennedy, 4/24).

Health News Florida: FL Medicaid: Why Doesn't House Take The Money
The hottest issue of this legislative session has been the question "Will Florida take $50 billion in federal Medicaid funds to cover over 1 million uninsured?" The Senate and governor say yes, while the House says no, no, no.  While so far every Democrat in the Capitol has favored taking the money, it's not wholly a partisan split; many Republicans want to, as well (Gentry, 4/24).

In Ohio, Republicans strip the governor's plan for expansion from a state budget bill --

The Associated Press: Medicaid Expansion Plan In Ohio Takes Another Hit
Gov. John Kasich's plan to expand Medicaid health insurance coverage to more low-income Ohioans as part of the state budget has come up against another roadblock from Republicans who control the Legislature. The Senate's version of the state budget won't include the governor's proposed Medicaid expansion, Senate President Keith Faber said Wednesday, but he said that Medicaid "reform" is not dead in Ohio (Seewer, 4/24).

The Columbus Dispatch: Medicaid Changes Will Be Taken Up Separately, GOP Legislator Says
The debate over how to alter the Medicaid program and cover more low-income Ohioans is not over, but the expansion is dead as it relates to the two-year state budget, Senate President Keith Faber said yesterday. ... In his two-year budget proposal, Gov. John Kasich suggested expanding Medicaid under the federal health-care law to people earning 138 percent of the federal poverty level. That would cover 275,000 low-income Ohioans and bring $13 billion in federal money to Ohio over seven years. House Republicans rejected that plan and instead pledged to work with the Kasich administration to develop a new Medicaid proposal this fall (Siegel and Candisky, 4/25).

In Louisiana, a House panel rejects the expansion --

New Orleans Times Picayune: Louisiana Health Committee Rejects Medicaid Expansion Bill
After nearly five hours of testimony, a House health panel voted along party lines to reject a bill that would have forced Gov. Bobby Jindal to opt into the Medicaid expansion envisioned under the federal health care law. Jindal has consistently resisted the expansion, though the cost would largely be covered by the federal government, saying Medicaid is badly flawed and must be reformed (Kumar, 4/24).

The Associated Press: House Health Committee Rebuffs Medicaid Expansion
An attempt to cover more uninsured people in [Louisiana's] Medicaid program, as allowed under the federal Affordable Care Act, was rejected Wednesday by a House committee. After five hours of debate, the House Health and Welfare Committee voted along party lines, 11-8, to defeat the measure and support the stance of Gov. Bobby Jindal. Republicans opposed the Medicaid expansion and Democrats supported it (Deslatte, 4/24).

In Colorado, the expansion moves forward without Republican support, and Missouri lawmakers won't consider an alternative to the expansion --

Health Policy Solutions (a Colo. news service): Medicaid Expansion Moves Toward Passage Without Republicans
A bill that would expand Medicaid to about 200,000 more low-income Coloradans continues to move through the Colorado legislature without support from Republicans in the House. Bill sponsor and House Speaker Mark Ferrandino, D-Denver, said Medicaid expansion would boost Colorado’s economy by $4.4 billion and add up to 22,000 jobs by 2026 while saving taxpayers money in the long run. Ferrandino sold Medicaid expansion as a measure that is winning support from Republican governors around the country. But in Colorado, members of the GOP are not biting. While no opponents spoke against the bill -- just like an earlier Senate hearing -- Republicans remained deeply opposed. They said Medicaid doesn’t pay doctors enough and that in future years the federal government could break its promise  to pay the bulk of the costs to add new patients (Kerwin McCrimmon, 4/24).

St. Louis Post Dispatch: Barnes: Mo. Senate Unwilling To Take Up Medicaid Expansion Alternative
The Missouri House signaled on Wednesday an end to this session’s Medicaid expansion battle, blaming the Senate for its unwillingness to explore an alternative proposal backed by some House Republicans. "Unfortunately, the Missouri state Senate has indicated it does not have the stomach to pick up a Medicaid transformation bill this year," said Rep. Jay Barnes, R-Jefferson City, after proposing and then withdrawing an amendment containing his alternative proposal on the House floor. "Rather than figure out how we can make the best out of a bad situation, they are ceding the field for another year" (Crisp, 4/24).

And details emerge about how a mistakenly cast vote killed Montana's try at expansion --

The Washington Post: Accidents happen: How One Mistaken Vote Killed Montana's Medicaid Expansion
Some states have declined to expand Medicaid because they oppose Obamacare. Others worry about the financial burden of expanding the entitlement. But there appears to be only one state where the Medicaid expansion failed due to a Democratic legislator accidentally voting against it. Congratulations, Montana (Kliff, 4/24).

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Health Care Marketplace

Md. Insurer Proposes 25% Rate Hike Because Of Health Reform

The state's largest insurer -- CareFirst BlueCross BlueShield -- wants to raise rates for individuals buying coverage on their own in order to offset the cost of the health law requiring that insurers accept patients with pre-existing conditions.

Kaiser Health News: Maryland Offers Glimpse At Obamacare Insurance Math
Kaiser Health News staff writer Jay Hancock reports: "In the latest preview of prices for health coverage under the Affordable Care Act, Maryland's dominant insurer says proposed premiums for new policies for individuals will rise by 25 percent on average next year. That's lower than what some had predicted. Just three weeks ago, the insurer, CareFirst BlueCross BlueShield, had been looking at a proposed 50 percent increase. But the company revised that initial estimate, citing worries about affordability for consumers" (Hancock, 4/24).

Baltimore Sun: CareFirst Proposed 25 Percent Rate Increase Under Health Care Reform
Blaming the cost to implement health care reform, the state's largest health insurer has proposed eye-popping rate increases to state regulators for individuals and small businesses. CareFirst BlueCross BlueShield wants to raise rates an average of 25 percent on those who buy coverage individually. Chet Burrell, the insurer's CEO, said the increase was needed to cover the cost of more sick people who will be joining the insurance rolls under health care reform. People with pre-existing conditions were denied coverage prior to health care reform, keeping insurance costs down (Walker, 4/24).

The Washington Post: With Health Law Looming, One Large Insurer Wants A 25 Percent Premium Hike
Maryland's biggest health insurer proposed raising premiums for individual policies by an average of 25 percent next year, saying that President Obama's health law would require it to accept even the sickest applicants, driving up costs. The CareFirst BlueCross BlueShield plan must be approved by the state, and officials immediately indicated that there would be close scrutiny of the double-digit boost (Kliff and Somashekhar, 4/24).

In other insurer news -

Los Angeles Times: WellPoint Posts 3% Profit Gain And Raises Full-Year Outlook
Insurance giant WellPoint Inc. reported a 3 percent increase in first-quarter profit and raised its full-year outlook as the company prepares for major changes under the federal health care overhaul. WellPoint, which runs Anthem Blue Cross in California and health plans in 13 other states, said its results were lifted by a recent acquisition that helped boost enrollment of the nation's second-largest health insurer to nearly 36 million people (Terhune, 4/25).

The Associated Press/Washington Post: WellPoint's 1st Quarter Profit Rises 3 Percent, Health Insurer Raises 2013 Forecast
WellPoint shares hit their highest level since the summer of 2011 on Wednesday after the nation's second largest health insurer trumped first-quarter earnings expectations, raised its 2013 forecast and said it could profit immediately from a key health care overhaul coverage expansion next year (4/24).

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Health Spending And Fiscal Battles

Efforts Toward Common Ground On Budget Still Marked By Differences

The Associated Press reports that, across party lines, positions on new revenue as well as changes to Medicare and other entitlement programs are clouding the outlook for success. Meanwhile, The Medicare NewsGroup examines how certain Medicare proposals are playing.

The Associated Press/Washington Post: For GOP And Democrats, Deficit Reduction Is More Talk Than Action As Neither Side Compromises
For years, House Republicans have adamantly refused to raise income taxes, even though U.S. taxes are historically low, and the Bush-era tax cuts were a major cause of the current deficit. And now, top Democrats are staunchly opposing changes to Medicare and Social Security benefits, despite studies showing the programs' financial paths are unsustainable. Unless something gives, it's hard to see what will produce the significant compromises needed to tame the federal debt, which is nearing $17 trillion (4/25).

The Medicare NewsGroup: Is Offering A Medicare Buy-In – While Raising The Eligibility Age – A Bridge To A Reform Deal?
To those watching and participating in the Medicare reform debate, raising the Medicare eligibility age is the devil they know. On the one hand, there are plenty of estimates on how much ratcheting the age from 65 to 67 will save: as much as $148 billion over 10 years. What these estimates don’t take into the account are the collateral costs. Those who don't qualify for Medicare will either need to buy a private plan, which can cost more than $2,000 annually, or hope that their employer covers them until they qualify for Medicare (Wasik, 4/24).

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State Watch

State Roundup: Mass. AG Warns On Hospital Sale Market Impact

A selection of health policy stories from California, Minnesota, Massachusetts, Oregon, Texas and Colorado.

Los Angeles Times: Employer Health Premiums Rose 170% In California In Last Decade
Premiums for employer health insurance in California jumped 170 percent over the last decade, more than five times the 32 percent increase in the state's inflation rate. That escalation in premiums has taken a toll on employers' willingness to offer health benefits, according to an annual survey by the California HealthCare Foundation (Terhune, 4/24).

MPR News: Blue Cross Blue Shield Cut Payments, Hospital Organization Alleges
Blue Cross and Blue Shield of Minnesota is accused of slashing payments to hospitals by the Minnesota Hospital Association. The organization represents most of Minnesota's hospitals. Lawrence Massa, President and CEO of the association, says Blue Cross will change its payment system for at least a dozen hospitals by May 1 from a negotiated discount to a rate unilaterally set by Blue Cross (Stawicki, 4/24).

Boston Globe: Coakley: State Should Monitor Hospital Sales For Market Impact
The pace at which hospitals and doctors are consolidating or forming new affiliations could enable some health systems to gain significant market power, a factor that already contributes to high prices for medical care in Massachusetts, according to the latest report on health costs released Wednesday by Attorney General Martha Coakley. Coakley highlighted market clout as a driver of health care costs in a 2010 report. The latest findings point to the rate at which hospitals are consolidating or expanding their contracted physician networks, in the name of better care coordination for patients or management of risk-based insurance contracts under which providers could lose money if patient care is too expensive (Conaboy, 4/24).

The Associated Press: Care Worker Raises In Minn. House Health Budget
The Minnesota House passed a health and social programs budget late Monday with a small salary increase for nursing home and long-term care workers, but some lawmakers questioned whether they were enough for struggling homes in rural areas. The Democratic-sponsored, $7 billion health and human services bill passed on a mostly party-line vote of 70-64 (Condon, 4/24).

Los Angeles Times: Federal Judge Renews Order For California Prison Mental Health Plan
Even as California makes preparations to appeal federal court rulings on the quality of care and crowding of conditions in state prisons, new orders are in the making. U.S. District Judge Lawrence Karlton on Tuesday dusted off a pending August 2012 order for the state to produce a plan to improve the quality of inmate mental health care, and gave it a new July 1 deadline. The judge's order notes that compliance was interrupted by the state's bid in January to end court oversight of prison mental health care (St. John, 4/24).

The Associated Press: Rural Oregon County Sees More Physician Assistants
The number of physician assistants has more than doubled in Malheur County over the past five years, helping to fill a gap in medical care for a rural county at the edge of Eastern Oregon that has trouble attracting doctors. The county has one primary care physician for every 1,958 residents, but, statewide, the number is one primary care physician per 1,134 residents, the Ontario Argus Observer reported (4/24).

The Texas Tribune: Legislators Seek Action On Medicaid Fraud Measures
After the discovery that the state was spending millions of dollars on fraudulent Medicaid dental and orthodontic care, state lawmakers held hearings ahead of the legislative session to identify what went wrong and how to prevent future fraud. And this session, lawmakers have filed a handful of bills to reform how Texas addresses Medicaid fraud. But the bills aren't progressing as fast as some would like (Aaronson, 4/25).

Health Policy Solutions (a Colo. news service): Hidden Gun Injuries ‘Routine’ Among Children
The horror of 20 children being shot to death at Sandy Hook Elementary School shocked the nation and the world. But Colorado researchers — who initially set out to study playground accidents — found that gun violence is harming children every day. Very few people know about these gun injuries because federal law has prohibited funding for research on gun accidents and fatalities. The Colorado researchers combed through every single injury over an eight-year period at Denver’s two primary trauma hospitals that serve children, Denver Health and Children’s Hospital Colorado. They expected to find information about playground injuries and were surprised to learn that violence was harming a significant number of children every year (Kerwin McCrimmon, 4/24).

California Healthline: Committee Oks 'Culture Change' Spending
A new bill aimed at changing the culture of long-term care in part by redirecting nursing home penalty fees passed a surprisingly controversial hearing yesterday before the Assembly Committee on Health. AB 973 by Assembly member Sharon Quirk-Silva (D-Fullerton) would direct roughly $150,000 a year in state penalty funds collected from long-term care facility violations to be used to "change the culture" at nursing homes, Quirk Silva said (Gorn, 4/24).

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Weekend Reading

Longer Looks: Plenty of Diagnostic Errors; A Patient Revolution

Every week reporter Ankita Rao selects interesting reading from around the Web.

National Journal: No, Oncologists Are Not Going Broke
When the automatic spending cuts kicked in for Medicare this month, every doctor saw a 2 percent reduction in reimbursement from the government insurance program. But cancer doctors have made the most noise. … Partly, this is political theater. While some oncologists warn that patients will lose access to lifesaving care, others admit they'll simply absorb the cuts and keep treating their ailing charges. Their median compensation was $430,695 in 2011, according to the Medical Group Management Association. But the situation also highlights how problematic the business of oncology has become. Federal-payment policies have distorted the market and perverted incentives for providers (Margot Sanger-Katz, 4/18).

Time: Diagnostic Errors Are The Most Common Type Of Medical Mistake
When Dr. David Newman-Toker was a medical resident at a Boston hospital, he witnessed what he calls tragic cases in which otherwise healthy people suffered serious consequences from misdiagnoses that could have been prevented. Newman-Toker, now an associate professor of neurology at the Johns Hopkins University School of Medicine, recalls an 18-year-old aspiring Olympic skater who fell on a ski slope and came to the hospital with weakness on one side of her body and a headache. She was told she had a migraine and was sent home. Six days later, she returned to the hospital after a stroke compromised the entire right side of her brain … Not every visit to the hospital has a happy ending, and neither does every misdiagnosis lead to severe harm, but Newman-Toker's personal experiences motivated him to improve medical misdiagnoses, which he says are not only common, but preventable in most cases (Alexandra Sifferlin, 4/24).

Forbes: A Former Google Exec Aims To Power A Patient Revolution
Last week I went to TedMed, the big medical innovation summit run by Priceline founder Jay Walker. The most important presentation I saw may have come from Roni Zeiger, who for six years ending in 2012 was the chief health strategist at Google. The Google Health application created on Zeiger's watch, which was meant to allow patients to upload their medical records, ended in failure in 2011. But his new effort, a five-person outfit called Smart Patients, actually does look like something that could actually change the way patients, doctors, and industry interact. Its web site, envisioned as a kind of combination of clinical trials search engine and message board community, might further empower cancer patients whose relationship with their disease has already been changed fundamentally by the Internet (Matthew Herper, 4/24).

The Atlantic: Medical Research Cuts Have Immediate Health Effects
I have always been an athlete. Running, swimming, and skiing give me mental clarity and a lot of joy. So it was shattering to get a diagnosis two months ago, at the age of 37, that meant my lungs were slowly being replaced by cysts. … Now, with research funding at an all time low, the odds of continued development are not in our favor. The sequester is essentially slowly killing me and millions of patients still looking for cures. This week my doctor, a lung disease specialist at Columbia University, marched on Washington in the Rally for Medical Research to protest the sequester-induced 5 percent budget cut to the NIH (Sarah Bacon, 4/17).

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Editorials and Opinions

Viewpoints: Obama Must Address Health Law 'Train Wreck;' GOP Rebranding Effort Spurs Revolt; Will Health Law Help Or Hurt Democrats In Next Campaign?

Reuters: President Must Address Obamacare 'Train Wreck'
When even a key architect of Obamacare says the law's implementation will resemble a "train wreck," it is clear that its biggest remaining supporters need to finally level with the American people about what’s in store — starting with President Barack Obama. The president must step into the breach and explain to the public that skyrocketing premiums and a raft of new taxes, penalties and fees are coming their way (Sen. Mitch McConnell, R-Ky., 4/24).

The Washington Post: Fight Club On The Hill
Republican leaders had scheduled a vote in the chamber for Wednesday on a plan to help people with preexisting health problems get insurance — part of a broader scheme by Majority Leader Eric Cantor (Va.) to make Republicans appear to care about the little guy. But the conservatives lunching in the Rayburn House Office Building weren't biting. … In this case, Democrats opposed the bill because it proposed changes to Obamacare, which they considered an attempt to undermine the program. That meant the measure would pass only with near-unanimous Republican support, which seemed unlikely because conservative groups such as the Club for Growth and the Heritage Foundation spinoff Heritage Action opposed it, arguing that it wouldn't repeal Obamacare (Dana Milbank, 4/24). 

Bloomberg: Republicans Will Clobber Obamacare Until They Hug It
The Affordable Care Act is the law of the land, and the Obama administration is legally bound to implement it. Having denied the necessary funding to do so, Republicans now want to hinder the administration’s ability to transfer other funding, to ensure that Obamacare becomes the disaster Republicans have promised. The more horrendous the rollout, the more effectively Republicans can run against Obamacare in 2014. That might work: I wouldn’t be surprised to see Obamacare end up as a net negative for Democrats in the 2014 election -- much as Medicare Part D was for Republicans in 2006. But by the 2016 presidential election, it’s likely to be a law that Democrats brag about and Republicans scamper to get behind. And the final act of this depressing little political play will be Republicans embracing this policy that they did everything to destroy, and trying to build on it (Ezra Klein, 4/24).

JAMA Psychiatry: Two Steps Forward, One Step Back?
The Supreme Court ruling in the case of National Federation of Independent Business v Sebelius to uphold most of the significant pieces of the ACA, but permit states to opt out of the ACA's Medicaid expansions while still maintaining their current Medicaid funding, may have major consequences for Americans with mental disorders. ... Currently uninsured individuals in states that choose not to expand Medicaid who have income greater than 100% of the federal poverty line will receive subsidies to participate in the exchanges, while the population below the poverty line, which has disproportionately high levels of mental disorders, will likely remain uninsured. Therefore, people with mental disorders who live in states that do not participate in the Medicaid expansion may have much to lose compared with the residents of states that fully expand Medicaid (Ezra Golberstein and Susan H. Busch, 4/24).

Indianapolis Star: Why Indiana Shouldn't Fall For Obamacare's Medicaid Expansion
Ever since the Supreme Court let states opt out of the new health-care law's Medicaid expansion, supporters have been pressuring them to opt in. Before dissecting the supporters' unbelievable arguments, it's important to look at what they're asking states to expand. Medicaid already spends $460 billion annually, ostensibly on health care for the poor. A lot of that money never reaches the poor. Shady providers, drug dealers, organized criminals, states and even middle-class families all take a big slice. Medicaid fraud and abuse cost taxpayers maybe $100 billion annually. Meanwhile, many enrollees can't even find a doctor (Michael Cannon, 4/24).

The New England Journal of Medicine: The Medical Device Excise Tax — Over before It Begins?
The uncertainty surrounding the medical device excise tax raises unsettling questions about other future efforts to tackle rising health care costs in the context of the ACA's expansion of health insurance. The legislation to repeal the tax was sponsored and supported by Democrats who also initially supported the ACA, from states such as Minnesota that are home to large medical device companies. No player in the health care arena that is currently entrenched in the patchwork U.S. system is likely to volunteer to receive payment reductions, new levies, or fewer choices in order to fund expanded coverage and other initiatives included in the ACA. Losing the revenue that would have been provided by the medical device excise tax would not by itself cause the ACA to crumble, but it would send a powerful signal to other groups and their lobbyists about the law's vulnerability to piecemeal erosion (Dr. Daniel B. Kramer and Dr. Aaron S. Kesselheim, 4/25).

Los Angeles Times' Capitol Journal: Obamacare Fuels Turf War
Obamacare is supplying fresh ammunition for one of the oldest turf wars in Sacramento. It pits doctors — represented by the politically powerful California Medical Assn. — defending their turf against other medical providers. They're nurse practitioners, optometrists and pharmacists. In political speak, it's about "scope of practice" — the type of medical care non-doctors are allowed to provide. The war has been waged for many decades, at times also involving chiropractors, podiatrists and any number of medical professions trying to encroach on the docs' terrain (George Skelton, 4/24).

Journal of the American Medical Association: Are Health Insurers' Administrative Costs Too High Or Too Low?
There are few minutiae of health care economics that policy wonks love to fight about more than insurers' administrative costs. These are costs for things like management and marketing that are not directly related to care delivery. Are they too high or too low? To many, this would seem a strange question. Who wants to pay more in administrative costs? I'll get to that (Austin Frakt, 4/24).

JAMA Psychiatry: Public Safety, Mental Disorders, And Guns
Violence is a complex, multicausal phenomenon, and its prevention requires attention to the means used to perpetrate violence; in the United States of the 21st century, that means guns. Pointing the finger at people with mental illness as the cause of the problem of violence in this country is misleading, counterproductive, and just plain mean (Dr. Paul S. Appelbaum, 4/24).

Roll Call: Noseworthy: Not All Health Care Is Equal
In America, we've come to expect the best of everything. However, when it comes to health care, we pay more in this country than anywhere else in the world — yet the United States falls behind other countries on measures of health outcomes. Millions of Americans do not have or cannot afford the health care they need. We need to rethink how we pay for health care and develop differentiated payment models across the spectrum of primary, intermediate and complex care (John Noseworthy, 4/24).

Baltimore Sun: The Myths That Undermine Medicare And Social Security
The talk in Washington and among opinion leaders around the country's budget issues today centers on "balance" and "responsibility." Many conservatives declare that these terms mean that there should be no new revenue, only spending cuts to programs such as Social Security and Medicare. They also propose to reduce cost of living adjustments for all Social Security recipients, a group of Americans who have seen traditional pensions eliminated and savings devastated by the Great Recession — and who rely more and more on our Social Security system, into which they paid during their entire working lives (Frank Stell, 4/23).

Des Moines Register: 'Medical Repatriation' Is A Troubling Practice
Jacinto Cruz and Jose Rodriguez-Saldana were among those caught at the intersection of perhaps the two most dysfunctional systems in the United States, immigration and health care. The two had health insurance through their jobs at Iowa Select Farms, but neither had legal permission to live in the United States. Then they were badly injured in a car accident on the way home from a fishing trip in 2008. According to the Associated Press, Iowa Methodist Medical Center contemplated what to do with the men. Though their insurance paid more than $100,000 for their treatment, it was unclear whether it would cover needed, long-term care. Two rehabilitation centers refused to admit them. So the hospital put the comatose men on an airplane to a hospital in Mexico. Both survived, but they have debilitating injuries (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.