Daily Health Policy Report

Thursday, April 26, 2012

Last updated: Thu, Apr 26

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Campaign 2012

Health Care Marketplace

Public Health & Education

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Checks In The Mail: Millions Expected To Receive Insurance Rebates Totaling $1.3 Billion

Kaiser Health News staff writer Julie Appleby reports: "Millions of consumers and small businesses will receive an estimated $1.3 billion in rebates from their health plans this summer under a provision of the health care law that effectively limits what insurers can charge for administration and profits, a new study 
projects" (Appleby, 4/26). Read the story.  

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Health On The Hill: Competing Prescriptions For Medicare's Financial Health

Kaiser Health News' Mary Agnes Carey and Marilyn Werber Serafini join Jackie Judd to preview this week's House hearings on Medicare and to dig into the details of the Medicare trustees' report (4/25). Watch the video or read the transcript.

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Capsules: Few Doctors Consider Themselves Rich, Survey Says

Now on Kaiser Health News' blog, Sarah Barr writes: "Few doctors think of themselves as rich, and only about half think they're fairly compensated, according to survey results released this week by Medscape. The annual survey isn't scientific – and perhaps, not surprising, either — but it offers insights into what nearly 25,000 physicians earn, and how they view that number (Barr, 4/25). Check out what else is on the blog.

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Political Cartoon: 'No, Please, After You!'

Kaiser Health News provides a fresh take on health policy developments with "No, Please, After You!" by Chip Bok.

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


How can I spend thee?
Let me double count the ways... 
Prevention "slush" fund

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

Shutdown Concerns Loom As Lawmakers Spar Over Spending

The House Energy and Commerce Commitee, as well as other House panels, worked yesterday on various spending cuts and policy items with an eye on budget reconciliation. The GOP-led effort, which has very little chance of being taken up by the Senate, could lead to "a long summer of political skirmishing." 

Politico: Government Shutdown On The Horizon?
Plunging ahead along party lines, the House Appropriations Committee on Wednesday approved a set of Republican-backed spending targets that break with the August debt accords by demanding more than $27 billion in additional savings from non-defense programs. The 28-21 vote sets up a long summer of political skirmishing, all leading to what could be another government shutdown fight Oct. 1 when a new fiscal year begins and the GOP must come to terms with the White House and Democratic Senate (Rogers, 4/25).

Politico Pro: E&C OKs Cuts To Health Reform, Medicaid
The House Energy and Commerce Committee approved a package of nearly $115 billion in projected health care savings Wednesday night, voting to send the measures to the House Budget Committee to meet the panel's deficit reduction targets. Even though the committee's package has no chance of being taken up by the Senate, the approval by voice vote ensures a protracted fight among provider groups, Medicaid advocates and champions of the Affordable Care Act who aligned against the cuts (DoBias, 4/25).

The Hill: Democrats Push Women's Health Amendment In Fight Over Spending Cuts
House Democrats sought Wednesday to force a committee vote on women's healthcare, an issue they hope will mobilize women voters this fall. The maneuver came during a sprawling markup in the Energy and Commerce Committee, which is debating a slew of spending cuts that could be included in next year's budget. Committee Republicans want to repeal a fund, established in President Obama's healthcare law, that covers preventive services. Rep. Jan Schakowsky (D-Ill.) offered an amendment that would have repealed most of the fund while leaving intact funding for women’s healthcare services (Baker, 4/25).

CQ HealthBeat: Panel Backs Reconciliation Bill That Would Target Medical Malpractice Lawsuits
A House panel on Wednesday approved a budget reconciliation measure that would cap certain damages in medical malpractice lawsuits, limit attorneys’ fees and establish a statute of limitations for filing health care cases. The Judiciary Committee approved 16-14 the draft bill, which would cut federal spending by $39.7 billion over 10 years. Ted Poe of Texas was the only Republican to vote against the measure (Holden, 4/25).

Kaiser Health News: Health On The Hill: Competing Prescriptions For Medicare's Financial Health
Kaiser Health News' Mary Agnes Carey and Marilyn Werber Serafini join Jackie Judd to preview this week's House hearings on Medicare and to dig into the details of the Medicare trustees' report (4/25). Watch the video or read the transcript.

CQ HealthBeat: GOP Pushing To Allow Health Savings Accounts To Be Used To Pay For OTC Medications
House GOP lawmakers and stakeholder groups on Wednesday pushed for the repeal of a provision in the health care overhaul that places restrictions on using tax-preferred accounts to pay for over-the-counter drugs, despite concerns from a Democrat that they lack a proposal to pay for the costs. The House Ways and Means Subcommittee on Oversight held a hearing on Wednesday afternoon on the impact of the provision, which prevents people from using money from their health savings accounts (HSA) or flexible spending arrangements (FSA) to buy over-the-counter drugs without a prescription. The limitation took effect Jan. 1, 2011, and excludes the purchase of insulin (Attias, 4/25).

Meanwhile, on the Senate side -

Minneapolis Star Tribune: Franken's Push To Allow Canadian Drugs Falls Short 
An attempt by Sens. John McCain and Al Franken to let Americans buy cheap Canadian drugs failed to make it out of committee Wednesday on a close vote. The push reprised fruitless tries by some members of Congress to give people in the United States more affordable alternatives to prescription and over-the-counter drugs. Critics have raised questions about counterfeit or unsafe drugs. The debate, which dates back at least a decade, drew strong talk from McCain, an Arizona Republican, and Franken, a Minnesota Democrat (Spencer, 4/25).

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House GOP Eyes Prevention Trust Fund As Means To Pay For Student Loan Plan

House Speaker John Boehner, R-Ohio, has scheduled a Friday vote on the proposal, which some news outlets describe as a "bitter pill" for Democrats.

The New York Times: Two Parties Find A Way To Agree, And Disagree, On Student Loan Rates
Republicans were equally indignant at what they saw as game-playing, saying that they, too, want to forestall the rate increase. They quickly tried to outmaneuver the president. Late Wednesday afternoon, Mr. Boehner hastily called a news conference to announce that the House would vote Friday on a student loan bill that seemed to take shape just as suddenly. The proposal would extend the current interest rate for federal student loans for one year. The $6 billion cost would be offset by eliminating the remainder of the money from the Prevention and Public Health Fund, a portion of the health care law (Baker and Steinhauer, 4/25).

The Associated Press: Political Battle Over Student Loans Heating Up
Democrats and Republicans alike say they want to prevent the cost of federal loans from ballooning for millions of students. But the effort has evolved into an election-year battle each side is using to embarrass the other and spotlight its own priorities to voters. In the latest political chess move, Speaker John Boehner, R-Ohio, scheduled a House vote for Friday on legislation preventing the 3.4 percent interest rate on subsidized Stafford student loans from doubling as scheduled on July 1. In a bitter pill for Democrats, the measure's $5.9 billion cost would be paid for with cuts from President Barack Obama's health care overhaul bill (Fram, 4/26).

The Washington Post: Republicans Announce House Vote To Keep Student-Loan Rates Steady
Congressional Republicans on Wednesday announced their opposition to a Democratic proposal to pay for extending low rates for college loans by imposing new payroll taxes on some small businesses. Instead, House Speaker John A. Boehner (R-Ohio) said the House would vote Friday on a proposal to hold the interest rates steady — offsetting the $6 billion cost with a cut in a health prevention fund created under President Obama’s health-care law (Helderman and Kane, 4/25).

Los Angeles Times: Student Loans, Violence Against Women Act Spur Fights In Congress
The looming confrontations on both issues show how hard it is for Republicans — or Democrats, for that matter — to compromise in this highly contentious environment, even when doing so would arguably be in their political interest. Although Republicans say they support keeping student loan interest rates low, they oppose the tax hike on higher incomes proposed by Democrats to pay for it. Instead, they want to pull money from Obama's healthcare programs. Republicans also are unveiling an alternative to the Violence Against Women legislation (Mascaro, 4/25).

The Hill: Democrats Oppose Health Cuts In Boehner's Student Loan Bill
Democrats quickly panned House Speaker John Boehner's proposal to pay for a student loan bill by cutting into President Obama's healthcare law. Boehner (R-Ohio) said the House will vote Friday on a proposal that would block a major increase in student loan interest rates, which he plans to offset by cutting the healthcare law's prevention fund (Baker, 4/25).

Reuters: U.S. House To Vote On Student Loan Rate Extension
The Republican-led House of Representatives, in an election-year showdown with President Barack Obama, moved on Wednesday to avert a doubling of a low-federal student loan rate by taking money from Obama's healthcare overhaul. House Speaker John Boehner unveiled the proposal and announced that his chamber would vote on it on Friday - after Obama on a campaign-style tour pushed Congress to take action to preserve the low rate for millions of students (Ferraro, 4/25).

Meanwhile, on the Senate side, a plan is taking shape to restructure health benefits for future postal service retirees.

The New York Times: Senate Passes Plan To Give Postal Service Fiscal Relief
Perhaps most significant, the bill would restructure the payments the agency makes into a health benefits fund for future retirees. Under a 2006 law, the agency has to pay $5.5 billion annually into the fund, which the Postal Service said had added $20 billion in debt to its balance sheet since 2007 (Nixon, 4/25).

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Health Reform

Interests And Advocates Wait Anxiously For Supreme Court's Health Law Decision

The Associated Press reports that people with HIV/AIDS have a lot at stake regarding the health law's future -- specifically, its Medicaid expansion and ban on pre-existing condition exclusions. In a second story, though, AP reports on why the small business group, the NFIB, hopes to see the law overturned. Meanwhile, MarketWatch reports that some wealthy Americans would save big money if the high court rejects the overhaul.   

The Associated Press: Health Care Debate: High Stakes For Those With HIV
For many HIV-positive Americans, and those who advocate on their behalf, these are days of anxious waiting as the Supreme Court ponders President Barack Obama's health care overhaul... Among its many provisions, the health care law has two major benefits for HIV-positive people: It expands Medicaid so that those with low incomes can get earlier access to treatment, and it eliminates limits on pre-existing conditions that have prevented many people with HIV from obtaining private insurance (Crary, 4/25).

The Associated Press/Washington Post: Health Insurance Costs And Taxes Top Small Business Advocate NFIB's Agenda
Dan Danner never expected to end up in the middle of the health care debate. Or, for that matter, in politics. As president of the National Federation of Independent Business, the biggest advocacy group representing small business owners in the U.S., Danner helped oversee the organization's attempt to overturn the health care overhaul. Last month, the NFIB's lawyers were among those arguing against the law before the Supreme Court (4/25).

Market Watch: Health Law's Demise Would Save Big Bucks, For Some
Whatever their opinion of the health-care reform law, wealthy Americans have a lot of money at risk in the Supreme Court's coming decision on the law's constitutionality. If the court decides the law is unconstitutional, high-income taxpayers would avoid a 3.8% tax hike on investment earnings, plus a 0.9% increase in their payroll taxes, come 2013. For people in the top 1% of income earners, avoiding those two tax provisions would translate into savings of, on average, about $21,000 per year, according to the Tax Policy Center, a joint venture of the Brookings Institution and Urban Institute (Coombes, 4/26).

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Campaign 2012

The Shrinking Ranks Of Blue Dogs: What Tuesday's Primaries Say About Democrats And The Health Law

Also in the news, GOP presidential candidate Newt Gingrich announced Wednesday that he would suspend his campaign. 

The New York Times: 2 House Democrats Defeated After Opposing Health Law
The defeat of two conservative House Democrats by more liberal opponents in Tuesday's Pennsylvania primary illustrates the strong hold the new health care law still has over committed Democratic voters and foreshadows an even more polarized Congress next year in the aftermath of the latest round of redistricting. Representatives Jason Altmire and Tim Holden both lost in primaries to opponents who joined together with activist groups to pummel the veteran lawmakers over the opposition to the new health care law… (Weisman, 4/25).

The Wall Street Journal: The Bite Of Redistricting Shrinks Ranks Of Blue Dogs
The ranks of the Blue Dogs … have already fallen from 54 members before the last election to 25 today. With the defeat of two leading members in Tuesday's Pennsylvania primaries, Reps. Tim Holden and Jason Altmire, the group has absorbed another blow. … Blue Dogs forced President Barack Obama two years ago to drop his goal of including a government-run insurance plan in his health-care overhaul, which eventually won a House majority and became law. In recent months, Blue Dogs have taken a leading role in trying to forge a deficit-cutting deal with both spending cuts and tax increases (Bendavid, 4/25).

Boston Globe: Push For Health Care An Error, Frank Says
Republicans and Tea Party activists have made the strongest ideological case against President Obama's health care law. Now, some Democrats are leveling their own complaints, focused on the politics of the debate. US Representative Barney Frank, the liberal stalwart from Newton who is retiring next year, has helped fuel the criticism by arguing that it was a mistake for the president to push the health care bill before overhauling the financial system and that Democrats paid a high price when they lost the House in the 2010 mid-term elections (Levenson, 4/26).

The Associated Press: Gingrich Faces Uncertain Future After Failed Run
As he winds down his presidential campaign, Newt Gingrich faces a new challenge: reinventing himself politically yet again... Several GOP strategists and leaders suggested that Gingrich could still play a political role by reviving organizations he previously led that fought President Barack Obama's health care overhaul and raised millions of dollars for conservative causes (Henry, 4/26).

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Health Care Marketplace

Wellpoint's Profit Shrinks But Still Exceeds Wall Street's Target

The insurer's gains were undermined by membership declines and high costs in some markets. However, the company still raised its outlook. But another insurer, Aetna, reported lower-than-expected quarterly profits.

Los Angeles Times: WellPoint Earnings Drop 8%; Insurer Seeks Medicare Growth
The nation's second-largest health insurer, after UnitedHealth Group Inc., runs Anthem Blue Cross in California and plans in 13 other states. It reported net income of $856.5 million, or $2.53 a share, for the three months ended March 31, compared to net of $926.6 million, or $2.44 a share, a year ago. Revenue grew 4% to $15.42 billion in the quarter (Terhune, 4/25).

The Wall Street Journal: WellPoint's Profit, Membership Shrinks
While health insurers, in general, have benefited from the sluggish pace of patient visits to operating rooms and doctors' offices, WellPoint's gains have been muted by unexpectedly high costs for seniors in Northern California, where the company picked up thousands of members with expensive health issues. The company has said it has fixed the problem by walking away from the difficult market, which is part of some planned membership losses for the new year aimed at boosting profit margins (Athavaley, 4/25).

Reuters: WellPoint Raises Outlook As Profit Tops Views
WellPoint Inc reported a lower quarterly profit as membership fell, but the results topped Wall Street's target, and the health insurer raised its outlook. The No. 2 health insurer by market value also said the performance of its Medicare business had improved after problems with such plans dragged down results in 2011. ... In an interview, WellPoint Chief Financial Officer Wayne DeVeydt said the company saw a small increase in the utilization of healthcare services in the latest quarter, but that was driven by the extra day because of the leap year and an unseasonable warm winter, which meant more people could get to the doctor (Krauskopf and Sherman, 4/25).

The Associated Press/Washington Post: WellPoint's 1st Quarter Profit Drops Nearly 8 Percent; Health Insurer Raises 2012 Forecast
The Indianapolis company said Wednesday that it expects its capital management to improve after earning $169 million in investment income in the first quarter. Company leaders also said they anticipate improvements in their main businesses and more growth from a Medicare Advantage segment that hurt WellPoint last year (4/25).

Reuters: Aetna Profit Misses Wall Street Target
Health insurer Aetna Inc reported a lower-than-expected quarterly profit on Thursday as higher claim costs and administrative expenses weighed on results. Aetna is the first major health insurer to miss earnings estimates after rivals WellPoint Inc and UnitedHealth Group Inc have posted higher-than-expected profits this quarter and raised their full-year outlooks (4/26).

The Associated Press: Insurer Aetna's 1Q Profit Falls 13 Percent
Aetna Inc.'s first-quarter profit fell 13 percent as benefits and expenses rose and the health insurer faced a tough comparison to year-ago earnings that included a one-time gain... The insurer's medical enrollment, which includes commercial health insurance and people covered by Medicare and Medicaid, fell 3 percent to 17.9 million in the quarter compared to the end of last year (4/26).

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Judge Rejects Trade Groups' Effort To Stall Express Scripts-Medco Deal

Modern Healthcare: Judge Rejects Bid To Halt Express Scripts-Medco Deal
A U.S. district judge denied an effort by trade groups representing pharmacies and drugstore chains to halt Express Scripts' acquisition of Medco Health Solutions until their lawsuit to block the deal is reviewed. The National Association of Chain Drug Stores, the National Community Pharmacists Association and nine retail pharmacy companies had filed a lawsuit March 29 in U.S. District Court for the Western District of Pennsylvania to block the merger (Lee, 4/25).

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Doctor Pay: Specialists Earn More, But Few Overall Think They Are Rich

A survey conducted by Medscape provides insights into physicians' earnings, and how they view them. 

Kaiser Health News: Capsules: Few Doctors Consider Themselves Rich, Survey Says
Few doctors think of themselves as rich, and only about half think they're fairly compensated, according to survey results released this week by Medscape. The annual survey isn't scientific – and perhaps, not surprising, either — but it offers insights into what nearly 25,000 physicians earn, and how they view that number (Barr, 4/25).

NPR Shots Blog: Doctor Pay: Where The Specialists Are Above Average
Making a living practicing medicine is more complicated and frustrating than ever. But it still pays. And pretty well (Hensley, 4/25).

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Public Health & Education

Report: 5% Of Americans Have A Serious Mental Illness

According to figures from the Substance Abuse and Mental Health Sevices Administration, an estimated 11 million people have some type of mental illness.

National Journal: Mental Health Report Shows 11 Million With Serious Illness
Just under five percent of U.S. adults, or 11 million people, had a serious mental illness in 2009, US mental health officials report in the latest update. And 34,000 Americans committed suicide linked to mental illness. More than one quarter of adults with mental illness also had a substance abuse problem, according to the figures from the Substance Abuse and Mental Health Services Administration. The latest data shows 13 percent of U.S. children aged 8 to 15  had a mental health disorder (Fox, 4/25).

Also, mental health care from Veterans Affairs draws more headlines -

The Associated Press: Ex-VA Hospital Official Faults Mental Health Care
Veterans are waiting too long for mental health care and are unaware that hospitals sometimes manipulate records in an attempt to make it appear that standards are being met, a former Veterans Affairs hospital official told senators Wednesday. Hospitals are "gaming the system," with administrators so focused on achieving performance targets, in part to get bonuses, that they don't always do what's best for the patient, said Nicholas Tolentino, former mental health administrative officer at the VA medical center in Manchester, N.H. (Freking, 4/26).

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State Watch

Mass. Cost Control Legislation Advances

The measure, more than a year old, was initially put forth by Gov. Deval Patrick, but a Senate panel's chair predicted "a significant redraft" before it reaches the Senate flooor.

Boston Globe: Health Care Bill Advances To Mass. Senate Panel
After more than a year of review, Governor Deval Patrick's health care bill advanced Wednesday without changes, but a Senate committee chairman indicated that the proposal will receive a makeover before it reaches the Senate floor. "The bill that advances to the Ways and Means Committee today will be subject to a significant redraft by the committee," Senator Richard Moore said in a statement. Moore cochairs the joint committee that released Patrick's bill to the Senate Ways and Means Committee (Cheney and Murphy, 4/26).

WBUR: Report: Lower Health Care Cost Growth Means Big Savings
As state legislators put the finishing touches on a major health care cost-control bill, one big question is: How much will it save? A report out Thursday says employers and employees would see between $8 billion and $35 billion in savings over nine years (Bebinger, 4/26).

Earlier, related KHN coverage: Different Takes: How Massachusetts Can Control Health Care Costs (4/12).

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Congressional Panel Grills Minn. Official Over Possible Medicaid Overpayments

The state's commissioner for human services was called on to answer questions about why Minnesota got a $30 million payment from a managed care company.

(St. Paul) Pioneer Press: Congress Puts Minnesota Medicaid On The Hot Seat
Minnesota's national reputation for being a leader in health care took some hits in Congress with more questions about whether the state manipulated the rate certification process in the Medicaid program to wrongly obtain federal dollars. Meanwhile, the state's commissioner for human services faced a bipartisan grilling Wednesday, April 25, on how she handled a $30 million payment to the state last year from UCare, a health plan based in Minneapolis that manages care for Medicaid patients. The testimony came before a subcommittee on oversight and government reform in the U.S. House, where Democrats from the Minnesota congressional delegation tried to cast blame for any questions about the state's Medicaid program on the administration of Republican Gov. Tim Pawlenty (Snowbeck, 4/26).

Minneapolis Star Tribune: Congress Scrutinizes $30 Million Medicaid 'Gift' To Minnesota 
A $30 million "gift" to Minnesota from one of the state's principal Medicaid contractors has put Gov. Mark Dayton's administration in the sights of a congressional investigation, with lawmakers examining whether state officials tried to shortchange the federal government for medical services to the poor and disabled. Commissioner Lucinda Jesson of the Minnesota Department of Human Services came under withering fire on Wednesday before a U.S. House committee hearing testimony from a state whistleblower alleging massive fraud. Facing questions from GOP lawmakers, Jesson was called on to explain how the state handled an unprecedented $30 million windfall from UCare, one of four contractors that administer Medicaid programs for the state (Diaz, 4/26).

MinnPost: Congressional Panel Grills DHS Commissioner Lucinda Jesson On State Medicaid Spending
Gov. Mark Dayton's human services commissioner on Wednesday faced a combative congressional panel that accused Minnesota officials of requesting an improper amount of Medicaid money from the federal government. At the heart of the hearing were years of overpayments in Medicaid reimbursements from the federal government to managed care organizations in Minnesota (Henry, 4/25).

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As Hundreds Protest, Kansas Gov. Agrees To Delay In Changes To Disability Services

Gov. Sam Brownback's plan would have moved thousands of developmentally disabled state residents into a managed-care health plan.

Kansas City Star: Kansas Governor Relents On Managed Health Care For The Disabled
In the face of hundreds of protesters outside the Capitol on Wednesday, Kansas Gov. Sam Brownback agreed to delay plans to move thousands of developmentally disabled into a managed-care health plan. Brownback, along with Lt. Gov. Jeff Colyer, said they would agree to a legislative plan that would keep the developmentally disabled in the state Medicaid program for a year to give them more time to increase their comfort level (Cooper, 4/25).

Kansas Health Institute: Hundreds Protest Inclusion Of Disability Services In KanCare
Hundreds of developmentally disabled people and their advocates gathered today outside the Statehouse to protest the inclusion of long-term care services in KanCare, Gov. Sam Brownback's Medicaid makeover plan. ... Among the concerns about the KanCare plan is that service providers already operate on tight margins, said Jerry Michaud, chief executive at Developmental Services of Northwest Kansas. Contracting with managed care companies could lead to staff shake-ups and providers being driven out of business. ... Speakers at the rally — including Sen. Dick Kelsey, a Goddard Republican — said non-medical services, such as transportation and assistance with daily living, should not be thrust into KanCare (Cauthon, 4/25).

Kansas Health Institute: Brownback Responds To DoJ Investigation
"Not only is Kansas in full compliance with all federal requirements, we have a strong history as an innovator in the delivery of home- and community-based services to those with physical disabilities since the waiver programs began in the 1980's," the governor said in a prepared statement. The statement signaled that the Brownback administration does not intend to retreat from the threat of a possible federal lawsuit over complaints from disabled persons about Kansas' growing waiting list for home and community based services for the disabled (Shields, 4/25).

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California Senate Scales Back Bill To Broaden Abortion Access

In its current form, the bill would allow 41 Californians who are not physicians to perform a certain first-trimester abortion procedure.

San Francisco Chronicle: State Bill Would Let Non-Doctors Perform Abortions
As states across the country are passing laws to restrict access to abortion, California lawmakers are considering a significant expansion of who would be able to perform the procedure in the state. Under a bill that passed its first committee hearing Tuesday, nurse practitioners, nurse midwives and physician assistants would be able to perform what is known as an "aspiration" abortion, which is the most common abortion procedure and takes place in the first trimester of a pregnancy. The current form of the bill, SB1338 by Sen. Christine Kehoe, D-San Diego, would allow for only 41 people in the state, in addition to doctors, who have been through a pilot study on the issue to perform aspiration abortions, but backers say they expect that number to be significantly expanded as the proposal moves forward (Buchanan, 4/25).

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 (Van Oot, 4/25).

The Associated Press/USA Today: Abortion Restrictions Gain Steam In The States
The 2012 anti-abortion push is not as heavy as last year, when legislators in 24 states, many elected in the 2010 Republican tide, passed a record 92 laws restricting abortions, according to the Guttmacher Institute, a group that conducts sexual and reproductive health research, policy analysis and public education (Goldman, 4/26).

Arizona Republic: Arizona Legislature OKs Contraception Coverage Bill
More Arizona employers with objections to birth control will be able to drop contraception coverage from health-care plans under a bill approved by state lawmakers Wednesday. House Bill 2625 was one of several issues related to reproductive care that led to intense debate this year in Arizona and across the nation. The bill passed Wednesday by the Senate was criticized as stepping on women's rights by privacy advocates and those who said it would limit care (Davenport, 4/25).

The Texas Tribune (Video): Measuring The Effects Of Texas Family Planning Cuts
The first part in our occasional series examining the battle over family planning in Texas considers the impact of lawmakers' orders to reduce spending on birth control and cancer screenings (Tan, 4/26).

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State News: Calif. 'Green Houses'; Minn. Looks At 'Accretive Secret Sauce'

A selection of state policy news from California, Connecticut, Florida, Georgia, Kentucky, Maryland, Minnesota, and Wisconsin.

California Healthline: Senate Committee Approves New Type Of Nursing Home
A new idea elbowed its way into the familiar pile of health care legislation in the Senate Committee on Health yesterday. A nursing home model -- the "Green House Project" -- bucks the cold, institutional feel of many long-term care facilities. ... The idea is to have a small facility laid out like a regular home, with living areas such as a dining room and kitchen, as well as a private room and bathroom for each patient (Gorn, 4/26).

Related KHN blog post: Maryland’s First Green House Project Nursing Home Aids Low-Income Seniors (Kulkarni, 4/20).

Minneapolis Star Tribune: Hospitals Tread Fine Line In Pressing Patients For Money
The consultants at Accretive Health readily admitted that a "typical hospital" doesn't do financial counseling in the emergency room. But, they boasted, they had found a way to get 15 percent of ER patients to pay upfront. They called it the "Accretive Secret Sauce." Accretive's secret was roundly attacked in a report this week by Minnesota Attorney General Lori Swanson. But in Minnesota hospitals, it's no longer unusual to approach patients in advance about paying their bills, according to hospital executives (Lerner, 4/25).

Stateline: Drug Database Dilemma
To deal with the growing problem of prescription drug abuse, Kentucky legislators enacted tougher regulations on doctors and pain management clinics. The law mandates that all physicians and pharmacists who prescribe schedule II and III drugs, such as oxycodone (OxyContin) and hydrocodone (Vicodin), check the patient’s prescription record before writing or filling a prescription. They also have to register prescriptions for those drugs in a state database within 24 hours of writing or filling the prescription (Clark, 4/26).

The Connecticut Mirror: House Votes To Legalize 'Medical Marijuana'
The House of Representatives overwhelmingly voted Wednesday night to legalize the production, distribution and use of marijuana as a palliative for the chronically ill, reviving Connecticut's role in a national debate. ... If passed by the Senate and signed by the governor as proponents expect, Connecticut will join the ranks of states with a softening attitude toward the dangers and beneficial uses of marijuana (Pazniokas, 4/25).

The Baltimore Sun: New Web Portal Provides County By County Health Data
A new state web portal was recently launched that provides this and other health data for every county in Maryland. The Maryland Department of Health and Mental Hygiene with the Hilltop Institute at the University of Maryland at Baltimore County to create the website that uses data about Medicaid recipients (Walker, 4/26).

Georgia Health News: County Rankings Show Link Between Economy, Health
A county-by-county ranking of health statistics, released earlier this month, showed a geographic divide in Georgia. Rural South and Middle Georgia counties were clustered at the bottom of the state's health rankings, and urban/suburban at the top. ... It's the second year that Partner Up for Public Health, an advocacy campaign, has generated this comparison. The top 10 and the bottom 10 show that counties tend to score well or poorly on both measures (Miller, 4/25).

Health News Florida:  Suit Reveals Financial Incentives
A Clearwater doctor has filed a "whistleblower" suit against the medical practice that employed him, saying he was fired for complaining about how patients were treated. His contract offered financial incentives, such as a percent of the profits on ultrasound tests he ordered (Gentry and Clear, 4/25).

(Eau-Claire) Leader-Telegram/(St. Paul) Pioneer Press: Eau Claire OKs Health Plans For Same-Sex Couples
When Eau Claire city employees re-enroll in June for their health insurance, police Detective Clay Wanta plans to switch from single-person coverage to a limited family plan to include his partner, Pete Brandt.  The 12-year Eau Claire Police Department veteran watched Tuesday, April 24, as the city council debated the cost versus the fairness of allowing domestic partnerships to qualify for the same health benefits married couples can receive. ... The council voted 10-1 in favor of extending benefits, after almost two hours of debate (Dowd, 4/25).

Mercury News / Bay Area News Group: Tobacco Industry Gearing Up To Take Down California Cigarette Tax Initiative
In what is quickly turning into another high-stakes policy battle to be decided by California voters, tobacco giants Philip Morris and R.J. Reynolds are forking over tens of millions of dollars to defeat a new tobacco tax on the June ballot. Proposition 29, which would boost taxes by $1 a pack of cigarettes to $1.87, would raise about $735 million annually, most of which would go toward cancer research (Harmon, 4/25). 

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Weekend Reading

Longer Looks: Why We Still Have Faith In Physicians

Every week, Kaiser Health News reporter Jessica Marcy selects interesting reading from around the Web.

National Journal: Why We Trust Doctors
This patient is no fool, and she does't award trust liberally. … Yet, somehow, (Mary) Morse-Dwelley never lost faith in Pellegrini. She’d hear the click of her doctor's shoes in the hallway, see her blond hair and funky glasses, and feel confident that she was in good hands. This, too, represents a broad trend: As we have become better-informed patients, we have grown more cynical about a health care system that is ever more corporate and reliant on technology. Nevertheless, our faith in physicians has proved incredibly durable. Gallup, which has polled on public trust in professionals every year since 1976, reports high and rising marks for doctors. In the latest survey, from 2011, 70 percent of respondents rated medical doctors as high or very high when asked about their "honesty and ethical standards," a record. When the Kaiser Family Foundation asked Americans whom they trusted in 2009—the height of the debate over the health care law—78 percent said they believed that their doctors put patients’ interests ahead of their own (Margot Sanger-Katz, 4/26).

American Medical News: Bariatric Surgery Maintains, Doesn't Gain
In a way, bariatric surgery is like the member of the chorus who spent years waiting for a big break, got it, became a star, and then found out that success was harder than it looked. After decades of slow growth since the first procedure was performed in 1954, rates escalated rapidly in the first few years of the 2000s but hit a wall recently. That wall may not be so easy to get past, even if the economy fully recovers. A total of 36,700 bariatric surgeries were carried out in 2000, and then jumped 29% to 47,200 in 2001, according to the American Society for Metabolic & Bariatric Surgery. An additional 63,100 were carried out in 2002, an increase of 34% from the previous year. In 2003, 103,200 procedures were performed for an annual growth rate of 64%, the biggest increase in the previous decade. Hospitals and large health systems opened bariatric surgery centers as revenue builders and to serve their communities. General surgeons started specializing in the procedure (Victoria Stagg Elliott, 4/23).

The New York Review of Books: Why the Mandate Is Constitutional: The Real Argument
The Supreme Court's hearings in the health care case, US Department of Health and Human Services v. Florida, over a nearly unprecedented three days of oral argument in late March, generated all the attention, passion, theater, and constant media and editorial coverage of a national election or a Super Bowl. Nothing in our history has more dramatically illustrated the unique role of courtroom drama in American government and politics as well as entertainment. … The prospect of an overruling is frightening. American health care is an unjust and expensive shambles; only a comprehensive national program can even begin to repair it. One in six Americans lacks any health insurance, and the uninsured of working age have a 40 percent higher risk of death than those who are privately insured (Ronald Dworkin, 5/10).

TIME: Debt Collectors In The E.R. And Delivery Room: Is Profit-Driven Medicine At A Breakpoint?
Imagine that you've brought your child to the emergency room and you’re revealing your most private health information to the hospital staff member at the desk, desperate because you fear your child’s very life is at risk. But the desk clerk seems more concerned about getting paid than giving care, and even makes veiled threats against your credit score if you’re not able to cough up the money to cover the bill. Who is this heartless bureaucrat? Is it a hardened triage nurse? A bored clerk? Would you believe it could be a third-party bill collector posing as a hospital staffer? Welcome to 21st-century American medicine (Maia Szalavitz, 4/25).

The Atlantic: Women Rejoice: Time To Bid Farewell To Your Annual Pap Smear
For fifty years an annual Pap smear has been the gold standard of screening for cervical cancer in women. Now a federal advisory group and the nation's leading cancer organization have changed their tune. They no longer recommend that women have a Pap test each year. The recommendations do not apply to women who are at very high risk for cancer, such as those who have been diagnosed with a high-grade precancerous cervical lesion or who have weakened immune systems. The US Preventive Services Task Force, (USPSTF) a panel of independent experts convened by the government, and the American Cancer Society (ACS) have each released new guidelines for cervical cancer screening that recommend against routine yearly testing. Instead, the guidelines recommend testing every 3 years for women aged 21 to 65 (Susan H. Scher, 4/24).

American Medical News: Health System Changes Inspire More Med Students To Pursue Dual Degrees
As they contemplate careers in a rapidly changing health care landscape, a growing number of medical students are deciding that a medical degree is not enough. Most U.S. medical schools offer students the chance simultaneously to get advanced degrees in a variety of other areas, such as public health, law, business administration, mass communications and the sciences. Some schools have offered the programs for more than two decades. However, more recently, dual degrees are growing in popularity as prospective physicians feel they must develop expertise beyond medicine to compete in a dynamic health care market. Combined enrollment nationwide in MD/PhD, MD/JD and MD/MBA programs alone has increased 36%, from 3,921 in 2002 to 5,349 in 2011, according to the Assn. of American Medical Colleges. Most of them, 5,023, are in MD/PhD programs. The AAMC suspects its MD/JD and MD/MBA tallies are undercounted (Carolyne Krupa, 4/23).

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Editorials and Opinions

Viewpoints: Mass. Health Law Trips Up Even Bosses Offering Insurance; Traumatic Brain Disease May Be Complicating Veterans' Recoveries

Boston Globe: Cut Health Bills For All
[Ronn] Garry is an owner of Tropical Foods, the independent Roxbury market that has anchored Dudley Square for 36 years. He has 70 employees, 45 of them full time. The 2006 [health] law says he has to offer those full-time employees health insurance, cover at least 33 percent of their premiums, and get a quarter of them to take up his offer. Otherwise, he must pay a fine, called a Fair Share Contribution: $295 for every worker. ... Fair enough. But Garry has a problem. Even though he offers health insurance and pays 50 percent of his employees' premiums, he can't get 25 percent to sign up. Two workers short of the threshold, he has been fined: About $29,000, including thousands in penalties (Yvonne Abraham, 4/26).

The New York Times: Veterans And Brain Disease
That story is devastatingly common, but the autopsy of this young man's brain may have been historic. It revealed something startling that may shed light on the epidemic of suicides and other troubles experienced by veterans of wars in Iraq and Afghanistan. His brain had been physically changed by a disease called chronic traumatic encephalopathy, or C.T.E. (Nicholas D. Kristof, 4/25). 

Politico: Social Security Trustees: We're Going Broke
Here's some bad news: The latest report of the Social Security and Medicare trustees shows an unfunded liability for both programs of $63 trillion. ... The actual liability is almost twice what the government is reporting (John C. Goodman, 4/25).

Des Moines Register: Outlook Is Not As Bleak As You Think
Another year. Another bleak report on the finances of government programs providing income and health insurance to millions of Americans. Social Security will empty its trust fund in 2033, three years sooner than trustees projected one year ago. Medicare will deplete its hospital trust fund in a dozen years. Improving the solvency of these programs is not as difficult as some political leaders make it sound. They just need to muster some backbone and vow to embrace, rather than dismantle, programs every American who plans on getting older should care about (4/25).

Fortune: We're Having The Wrong Debate About Rising Health Care Costs
Today the top causes of death are noncommunicable diseases that result mostly from the way we live --coronary artery disease, hypertension, diabetes, some cancers. Medical researchers call them lifestyle diseases. What's important from a policy perspective is not just that these diseases cause the most deaths, but also that they cause the most spending. The great majority of America's staggering $2.6 trillion health care tab (as of 2010) was spent treating lifestyle diseases. While we rightly worry about health care costs rising 8% or 9% a year, we spend well over 50% of our costs on diseases caused mostly by the way we choose to behave (Geoff Golvin, 4/25).

Des Moines Register: U.S. Nuns Are Under Attack -- From The Pope
The Catholic church has launched disciplinary action against the Leadership Conference of Women Religious, which represents about 80 percent of the 57,000 U.S. nuns. The church avers the nuns have not been loud enough in speaking out against gay marriage, abortion and women's ordination. The Vatican's Congregation for the Doctrine of the Faith claims the nuns are pushing "radical feminist themes incompatible with the Catholic faith." This comes following the contraception controversy (Steffen Schmidt, 4/25).

The Fiscal Times: The Extreme Leftward March Of The Democrats
Consider the state of the Blue Dog Democrat coalition in the House. … At the height of their power, the Blue Dog caucus had 54 members and wielded considerable clout – or so voters assumed. The Obamacare debate stripped that fantasy from the electorate. Instead of forcing the Obama administration to moderate its approach to health-insurance reform, the Blue Dogs rolled over and played dead (Edward Morrissey 4/26).

The New York Times: A Database To Curb Abuse
The use and abuse in this country of powerful pain medications has spiraled upward in recent years. A report by New York's attorney general, Eric Schneiderman, showed prescriptions in the state for oxycodone, the active ingredient in OxyContin, rose a remarkable 82 percent from 2007 to 2010, and nearly 17 percent for hydrocodone, the main ingredient in Vicodin (4/25).

The Kansas City Star: Our Unhealthy Obsession With Body Image
Imagine walking around with a tube that goes through your nose and passes through your esophagus, right down into your stomach. … Last week, the New York Times ran a story about crash-dieting brides willing to undergo the 10-day K-E diet that costs $1,500 and requires a doctor's supervision. It's an eyebrow-raising trend, but we know where it stems from. The pressure on brides and women in general to look a certain way is not imaginary (Jenee Osterheldt, 4/26).

Des Moines Register: Abortion Legal, But Often Not Option For Poor
Before it adjourns, the Iowa Legislature will have to decide whether to make it even harder for low-income women on Medicaid to get crisis abortions covered. The state already refuses Medicaid payment for routine abortions. Under a bill passed by the Republican-controlled House, the state would also refuse payment when the pregnancy resulted from rape or incest. ... But the cost alone, which ranges from $500 to $1,500, depending on the stage, can make abortions in Iowa inaccessible to the women who can least afford to add a child (Rekha Basu, 4/25).

The Dallas Morning News: Parkland's Massive Challenge Found In Monitors' Plan
Now that our investigative reporting team has seen the Corrective Action Plan — which Parkland officials, in typical bunker-think, tried to keep secret — the public should have a better idea about how massive and at what cost. The stakes are nothing short of the survival of Dallas County's public hospital system…. Close enough isn't going to be good enough, as it shouldn't be when people's lives are at stake. A few fixes here or there won't meet the standard; the transformation must be precisely that (4/25).

The Sacramento Bee: Nurses Union Puts Politics Ahead Of Health
State Sen. Lois Wolk wants to encourage – not require – that health care workers get annual flu vaccinations if they come into contact with patients in hospitals. No right-thinking person could possibly oppose her legislation. But in our dysfunctional Capitol, public health has become a contested issue. Too often, lobbyists place the interests of the organizations they represent ahead of what's best for the rest of us (Dan Morain, 4/25).

New England Journal of Medicine: Performance Improvement in Health Care — Seizing the Moment
We have an unprecedented opportunity to create a high-performance health system in the United States. Recent statutes ... provide the federal government with important powers for catalyzing improvement in service delivery. These new powers touch all the critical levers for advancing health system performance: payment policy, organization and infrastructure, public health, and essential information for health care decision making. ... [But federal] budget deficits and rising health care expenditures create pressures to quickly adopt simple expedients, such as cuts in benefits and provider payments. At the same time, the very number and diversity of available forms of authority, each with its own legal quirks and restrictions, creates huge conceptual and logistic complexity (Dr. David Blumenthal, 4/25).

New England Journal of Medicine: Implications for ACOs of Variations in Spending Growth
The Medicare Pioneer and Shared Savings Accountable Care Organization (ACO) programs offer health care provider organizations contracts with Medicare whereby the organizations assume financial risk and are rewarded for providing high-quality care at lower cost. ACO spending targets will be determined on the basis of baseline Medicare spending for assigned populations, projected forward by average increases in national Medicare spending. The stated rationale for using national spending growth factors is to exert greater downward pressure on organizations in regions with high spending and rapid spending growth, while permitting greater savings in regions with low spending and slow growth to support organizational investments in infrastructure (Dr. J. Michael McWilliams and Zirui Song, 4/25).

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Andrew Villegas

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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.