Daily Health Policy Report

Friday, April 26, 2013

Last updated: Fri, Apr 26

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Spending And Fiscal Battles

Coverage & Access

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

With Time Running Out, Florida Medicaid Expansion Is In Doubt

Kaiser Health News staff writer Phil Galewitz, working in collaboration with USA Today, reports: "When the U.S. Supreme Court upheld the health law last year … the justices made the expansion of Medicaid voluntary. Of the 27 million people projected to gain coverage under the law, about 13 million are expected to do so through Medicaid. … Fourteen states, many in the Republican-controlled South, have already rejected the Medicaid expansion, while 20 have agreed to comply with the law, according to consulting firm Avalere Health. Florida, with nearly four million uninsured residents, is one of more than a dozen still weighing the issue. And just as it has an outsized impact on presidential elections, it is likely to play a significant role in the success of the 2010 health law" (Galewitz, 4/26). Read the story. Galewitz also sat down with Florida Senate President Don Gaetz in his office in Tallahassee last week to discuss the issue. Read the interview.

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Capsules: Survey Finds Rate For Young Adult Coverage Improves While Others Decline; Bid To Cover Abortion After Rape For Peace Corps Volunteers

Now on Kaiser Health News' blog, Alvin Tran reports on survey findings regarding health coverage: "While the number of medically uninsured young adults dropped over the past two years, coverage of the overall working age population failed to improve, according to the findings of the Commonwealth Fund's 2012 biennial health insurance survey released Friday" (4/25).

Also on Capsules, Ankita Rao reports on a new bill introduced in Congress regarding Peace Corps' vounteers' and abortion coverage: "The Peace Corps Equity Act of 2013 echoes the Shaheen Amendment, which President Barack Obama signed into law in 2012. That law provides military women coverage for abortions in these instances. The new bill, also co-sponsored by Sen. Jeanne Shaheen (D.-N.H.), would extend coverage to women volunteers – who make up about 60 percent of those serving abroad – and overturn a 1979 appropriations bill that banned the Peace Corps from offering this benefit in its federal health plan" (Rao, 4/25). Check out what else is on the blog.

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Political Cartoon: 'Keeps The Doctor Away?'

Kaiser Health News provides a fresh take on health policy developments with 'Keeps The Doctor Away?" by John Rose.

Meanwhile, here is today's health policy haiku:

HOT PURSUIT: EXCHANGE ESCAPE ROUTES ON CAPITOL HILL

Hill staff exemption
equals health care law headache.
What is one to do?
-Anonymous

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

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Health Reform

Dems Worry About Health Law Rollout, GOP Plans Attacks

For Democrats, anxieties are running high regarding the political impact of a messy rollout of the overhaul and expected premium increases for some groups. Meanwhile, GOP leaders push a series of bills aimed at dismantling or altering the law in an effort to publicize what they say are its shortcomings.

The New York Times: Democratic Senators Tell White House of Concerns About Health Care Law Rollout
Democrats in both houses of Congress said some members of their party were getting nervous that they could pay a political price if the rollout of the law was messy or if premiums went up significantly (Pear, 4/26).

CQ HealthBeat: Obama Administration Peppered With Questions On Health Law 'Rate Shock'
The Obama administration dealt on multiple fronts Thursday with the hot-button issue of rate hikes under the health law, a foreshadowing no doubt of other such days to come this summer and fall as full implementation of the overhaul approaches. Republicans wasted no time in calling attention to a proposed 25 percent rate hike by Maryland insurer CareFirst Blue Cross/Blue Shield in individual policies to be sold this fall on the state’s health insurance exchange (Reichard, 4/25).

Roll Call: GOP At Cross Purposes On 'Obamacare'
To repeal or dismantle? That is the internal debate roiling House Republicans as they plot their strategy on the landmark 2010 health care law, as its implementation accelerates. Recognizing that neither President Barack Obama nor the Democratic Senate will entertain legislation that fully repeals the Affordable Care Act, House GOP leaders are pushing their conference to embrace a series of messaging bills altering or dismantling pieces of the law to publicize for voters what Republicans argue are the statute’s many failed and damaging policies (Drucker, 4/25).

CBS News: GOP Slams Obamacare Rollout, Works To Repeal Law
The rollout of a new national health care program is sure to hit some bumps in the road. But after one of the Affordable Care Act's authors and proponents called the implementation a potential train wreck, Republicans in Congress seized the opportunity to point out the law's shortcomings and revive their arguments for repealing it. After Sen. Max Baucus, D-Mont., who helped draft the health care law, used the phrase "train wreck" to characterize the potentially rocky implementation, Senate Minority Leader Mitch McConnell, R-Ky., on Thursday penned an op-ed for Reuters arguing that President Obama should explain to the public the hardships they'll face after the law is implemented (Condon, 4/26).

The Fiscal Times: Why A Part-Time Workforce Is The New Normal
Darrell McCall, 29, worked full time as a salesperson at Juicy Couture’s flagship store in New York City for two and a half years …That changed last year when Juicy started letting full-time workers go and replacing them with part-timers who accepted lower pay and no benefits, McCall says …The “part-time only” trend picked up steam during the recession. Analysts say one reason is the passage of the Affordable Care Act—commonly called Obamacare—and the mandate that businesses with 50 full-time employees or more must provide health insurance, which has become even more expensive. In January 2006, there were about 4.6 million involuntary part-time workers. In January of 2013, there were about 8.6 million—almost double, according to the BLS (Kade, 4/25).

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A Health Exchange Exemption: Capitol Hill's Big Headache

There is talk around the halls of Congress regarding whether lawmakers and congressional aides will be given an exemption from a part of the health law that requires them to obtain their health coverage from online insurance marketplaces.

Politico: Obamacare Exemption Talk Lights Up Capitol Hill
The Obamacare war is on in Congress. A top aide to House Minority Leader Nancy Pelosi sent an email to Democratic offices Thursday afternoon, warning that "Republican trackers" are on Independence Avenue asking lawmakers about the effort to rework which health care insurance members of Congress must use (Sherman, 4/25).

Bloomberg/The Washington Post: Aide: Congressional Leaders Consulting On Health Law's Effects On Legislators, Hill Staffers
Congressional leaders are discussing how to mitigate the potential effects of a section of the 2010 health-care law that could cost lawmakers and their employees subsidies for health insurance, an aide said. The Affordable Care Act included a provision requiring members of Congress and their staffs to obtain insurance from online marketplaces set to open in 2014. The exchanges will sell insurance to Americans who don’t have health-care coverage from their employers (Wayne and Hunter, 4/25).

The Wall Street Journal's Washington Wire: Obamacare Gives Hill Big Headaches
President Barack Obama's health-care law could cause big headaches for members of Congress and their staff, but efforts to address the potential problem are drawing complaints that congressional leaders are trying to protect their own. At issue is a provision that requires lawmakers and their staff to participate in the health-insurance exchanges that are being set up to help individuals who do not have group coverage to get affordable policies (Hook, 4/25).

Roll Call: Health Insurance Anxiety On Capitol Hill
Lawmakers and congressional staff members are concerned about whether the federal government will continue to pay part of their premiums as they move to buying insurance through the exchanges next year. The 2010 health care law (PL 111-148, PL 111-152) requires lawmakers and their personal staff to buy insurance through the exchanges, a provision originally added by Sen. Charles E. Grassley, R-Iowa (Ethridge, 4/25).

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Medicaid Expansion Challenges: Which States Are Facing Roadblocks, Running Out Of Time?

News outlets report on recent events in Florida, Ohio, Texas, Arizona and South Carolina.

The Washington Post's Wonk Blog: 'The Outlook For Medicaid Expansion Looks Bleak'
Twenty states and the District of Columbia have agreed to expand their Medicaid programs, to cover everyone under 133 percent of the federal poverty line. That leaves 30 states that haven't, although Avalere categorizes four states as leaning in that direction (Tennessee, Kentucky, Florida and New York). Some of these states have especially large uninsured populations. Texas, for example, has an estimated 1.8 million people who would be expected to enroll in Medicaid under the expansion (Kliff, 4/25).

Kaiser Health News: With Time Running Out, Florida Medicaid Expansion Is In Doubt
When the U.S. Supreme Court upheld the health law last year … the justices made the expansion of Medicaid voluntary. Of the 27 million people projected to gain coverage under the law, about 13 million are expected to do so through Medicaid. … Fourteen states, many in the Republican-controlled South, have already rejected the Medicaid expansion, while 20 have agreed to comply with the law, according to consulting firm Avalere Health. Florida, with nearly four million uninsured residents, is one of more than a dozen still weighing the issue. And just as it has an outsized impact on presidential elections, it is likely to play a significant role in the success of the 2010 health law (Galewitz, 4/26).

The Associated Press: House Shoots Down Plan To Offer Health Care To 1M
The Florida House rejected an amendment Thursday that would have accepted tens of billions of federal dollars and provided health coverage to an estimated 1.1 million residents, setting up a standoff between the House and Senate in the final week of the legislative session. Republican Rep. Mike Fasano sponsored the amendment in hopes of ending a legislative stalemate and extending coverage to hundreds of thousands more Floridians (Kennedy and Rosica, 4/25).

Health News Florida: House Says No To Fasano, Federal Funds
State Rep. Mike Fasano, a longtime Republican legislator from New Port Richey, pleaded with his GOP colleagues to vote for the Senate's "bipartisan plan" to cover 1.1 million low-income uninsured Floridians. Fasano begged them to "bridge the aisle" that separates the political parties in Tallahassee. ... But House leaders said that was a bridge too far (Gentry and Watts, 4/25).

The Miami Herald/Tampa Bay Times: Hope For Health Care Compromise Dwindles
House Republicans rejected a bipartisan Senate proposal to accept $51 billion in federal health care money on Thursday, diminishing hopes that lawmakers will reach a health care compromise before the legislative session ends next week. After five hours of targeted questions and impassioned debate, Republicans rejected an attempt by renegade Republican Rep. Mike Fasano to accept the Senate plan to provide federally subsidized health coverage to more than 1 million Floridians (Mitchell, 4/25).

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 (4/25).

The Texas Tribune: Janek Awaits Direction From Lege On Medicaid Expansion
Texas Executive Health Commissioner Kyle Janek clarified on Thursday why negotiations between the federal government and the Health and Human Services Commission on whether to expand Medicaid are at a standstill: He's waiting on the Legislature (Aaronson, 4/25).

Arizona Republic: Feds Say No To Funding A Leaner Arizona Medicaid
Federal health officials dealt a blow to opponents of Medicaid expansion Thursday, saying they're unlikely to fund a slimmed-down version of the state's indigent-health-care program as the political battle over the issue intensified. Gov. Jan Brewer declared the federal announcement a game-changer in the debate, which is holding up a new state budget. She told GOP legislative leaders to stop delaying a vote on Medicaid expansion and move swiftly to present her expansion plan to lawmakers (Reinhart, 4/25).

The Wall Street Journal's Risk & Compliance Journal: South Carolina Upgrades Medicaid System To Prepare For ACA
South Carolina is rolling out a new Medicaid platform to meet rules mandated under the Affordable Care Act that require states significantly upgrade their technology and accept more enrollees. The state is turning to an International Business Machines Corp. platform to meet the new requirements. But upgrades to social service platforms aren't without risk, as illustrated by another IBM deal to modernize a state welfare system (Schectman, 4/24).

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States Mull Methods To Raise Health Exchange Awarenesss, Provide Consumer Assistance

News outlets report on developments in California and Maryland.

Marketplace: California Bets Big On Marketing To Spread The Health Care Gospel
California has more uninsured people than other states have people. With that in mind, think about this: By Oct. 1, the state has to have its health insurance exchange up and running, ready to offer an estimated five million people some kind of insurance. However, polls indicate a good portion of the uninsured don't know about the push to recruit them. The state has a lot of ground to cover before the looming deadline, and is banking on an all-out marketing blitz (Shahani, 4/25).

The Washington Post: Maryland Announces Connector Program To Help Enroll Residents Under Federal Health Overhaul
Maryland launched an initiative on Thursday to help residents get health insurance under the federal health care law. Lt. Gov. Anthony Brown and the Maryland Health Benefit Exchange announced the start of the Connector Program, which will be funded with about $24 million in anticipated state and federal grants. The money will be used to fund six organizations that will provide consumer assistance and enrollment resources throughout the state (4/25).

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Capitol Hill Watch

Prescription Drug 'Track And Trace' Bill Splits House Lawmakers

House lawmakers are split on how the federal government should better track prescription drugs with one powerful Republican promising a "track and trace" law by August while Democrats press for stronger safeguards in the proposal.

The Hill: GOP Chairman Promises Drug-Tracking Law By August
A powerful House chairman vowed Thursday to put legislation on President Obama's desk that would give regulators more power to track prescription drugs…Lawmakers on Thursday examined a draft bill from Reps. Bob Latta (R-Ohio) and Jim Matheson (D-Utah) that attempts to address loopholes in the drug supply system and give regulators tools to close them (Wilson, 4/25).

CQ HealthBeat: Democrats Voice Concerns About Bill To Change Drug Supply Oversight
House Energy and Commerce Committee Chairman Fred Upton said at a hearing Thursday that he would like to mark up a "track and trace" bill to improve the security of the nation's drug supply in May, but several Democrats want the bill to have stronger safeguards (Adams, 4/25).

Modern Healthcare: Lawmakers Urge National Drug-Tracking System
House lawmakers pressed a Food and Drug Administration official on the need for a federal "track-and-trace" system that would boost the security of the pharmaceutical supply chain in the U.S. at a time when counterfeit or substandard drugs are increasingly of concern. States, for the most part, regulate the drug supply chains in their regions, with some requiring paper or electronic transaction histories of drugs, which are called pedigrees (Lee, 4/25).

In other news, a new bill would provide abortion coverage for Peace Corps volunteers who are raped --

The Washington Post: Women's Health Groups Want Peace Corps Volunteers To Have Insurance Coverage For Abortions
If a Peace Corps volunteer is raped and becomes pregnant as a result, she has to pay for an abortion herself, because the federal government refuses to cover the cost. Yet women on the paid Peace Corps staff, along with other federal employees, federal prisoners, women on Medicaid and Native Americans, have long received insurance coverage for abortions in cases of rape or incest or if their health is in danger. In January, women in the military got the same access (Rein, 4/25).

Kaiser Health News: Bid To Cover Abortion After Rape For Peace Corps Volunteers
Sen. Frank Lautenberg (D-N.J.) introduced a bill Thursday that would provide health insurance coverage for abortions to Peace Corps volunteers in the case of rape or incest (Rao, 4/25).

Also, fallout from a GOP split on a now-dead plan to extend coverage for people with pre-existing conditions continues --

Politico: Ted Cruz Aide On Health Law Fix: 'We Oppose Obamacare'
Members of Sen. Ted Cruz's staff wrote highly critical emails saying House Majority Leader Eric Cantor’s support of a bill that would have shored up a piece of Obamacare strayed unacceptably from the GOP repeal message. In an unusual public display of an intraparty dispute, the emails were made available to Buzzfeed (Smith, 4/25).

And House Minority Leader Nancy Pelosi says Democratic political race losses over the health law were worth it --

The Hill: Pelosi: Health Care Reform Was Worth Any Dem Defeats
Passage of health care reform was worth any defeat the Democrats might have suffered at the polls as a result, Rep. Nancy Pelosi (D-Calif.) said Thursday. Democrats passed President Obama's signature health care law in early 2010 and were walloped in the midterm elections roughly eight months later (Lillis, 4/25).

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Health Spending And Fiscal Battles

White House Chief Of Staff Holds Budget Meeting With Senate Republicans

The Washington Post: White House Chief Of Staff Meets With Senate Republicans On Budget Deal
Earlier this week, the White House considered trying to assemble a group of interested Republicans for further talks, according to Democratic congressional aides. But the administration rejected that approach, and is encouraging Republicans to choose their own negotiating party. Still, several Republicans involved in the process say there is little interest in setting up another "gang" or "supercommittee" to hold private talks with the White House outside the normal committee structure. Instead, senators are talking to the White House about setting a broad framework for moving forward, and then handing the job of drafting a deal off to the Senate Finance Committee, which has jurisdiction over Medicare as well as tax policy (Montgomery, 4/25).

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Coverage & Access

Study: Almost Half Of Working-Age Adults Have Inadequate Health Coverage

The Commonwealth Fund concluded that, while the number of uninsured adults dropped during the past two years, a large number of working-age adults had little or no coverage.

Kaiser Health News: Capsules: Survey Finds Rate For Young Adult Coverage Improves While Others Decline
While the number of medically uninsured young adults dropped over the past two years, coverage of the overall working age population failed to improve, according to the findings of the Commonwealth Fund's 2012 biennial health insurance survey released Friday (4/25).

Bloomberg: Uninsured Population Swells In Advance Of U.S. Health Law
Almost half of working-age adults in the U.S. had inadequate health insurance or no coverage at all last year, a widening deficit that the Affordable Care Act should mitigate, according to data from the Commonwealth Fund. About 84 million were uninsured or underinsured, 3 million more than when the 2010 health law was signed and 20 million more than in 2003, the New York-based nonprofit group, which advocates for better health care, said today in a report (Wayne, 4/26).

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Health Care Marketplace

Doctors Assail Drugmakers For $100K Cancer Medicines

More than 100 cancer specialists call for pharmaceutical companies to lower the prices of these drugs that patients need to live.

The New York Times: Doctors Denounce Cancer Drug Prices Of $100,000 A Year
With the cost of some lifesaving cancer drugs exceeding $100,000 a year, more than 100 influential cancer specialists from around the world have taken the unusual step of banding together in hopes of persuading some leading pharmaceutical companies to bring prices down (Pollack, 4/25).

Bloomberg: Cancer Therapy Cost Too High For Patients, Doctors Say
Cancer medicines that cost more than $100,000 a year aren't morally justifiable and may keep patients from getting life-saving treatments, a group of more than 100 leukemia doctors said. Of the 12 cancer medications approved by the Food and Drug Administration last year, 11 cost more than $100,000 annually, the physicians said in an article in Blood, the journal of the American Society of Hematology, published online. ... While companies should be allowed to profit, a product that can help a patient survive should be priced affordably, the cancer specialists wrote (Edney, 4/26).

CNN Money: Doctors Blast Ethics Of $100,000 Cancer Drugs
Should a life-saving drug that can be profitably sold for far less cost more than $100,000 per year? A group of more than 120 cancer researchers and physicians took the unusual step this week of publishing a research paper taking aim at pharmaceutical prices they see as exorbitant and unjustifiable. Drug companies are profiteering, the doctors say, by charging whatever the market will bear for medications that patients literally can't live without (Cowley, 4/25).

Oregonian: Top Oregon Health & Science University Researcher To Doctors: Rise Up Over Drug Prices
Brian Druker, a top researcher who heads the Knight Cancer Institute at Oregon Health & Science University, joined more than 100 cancer specialists Thursday questioning the price of Gleevec, the groundbreaking cancer drug that made him famous. It can cost patients $100,000 a year. Druker wants the medical community to lead a broad movement that takes the fight for affordable life-saving drugs to Washington D.C. (Budnick, 4/25).

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State Watch

N.Y. Suspends Adult Day Care Enrollment; Texas Lawmakers Push Action On Medicaid Fraud

Fraud concerns in New York and Texas are sparking changes to health care programs: New York officials have suspended enrollment in an adult day care program, and lawmakers in Texas plan action on Medicaid fraud.

The New York Times: State Suspends Enrollment In Adult Care Plan Amid Fraud Concerns
State officials have suspended enrollment in New York's largest managed long-term care plan for frail elderly and disabled people, and investigators have begun examining the relationships between such plans, which are financed by Medicaid, and the social adult day care centers that send them new customers (Bernstein, 4/25).

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).

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State Roundup: Md. Panel Says Hospitals Should Absorb Sequester Cuts

A selection of health policy stories from Maryland, Iowa, California, Oregon, Pennsylvania and the District of Columbia.

The Associated Press/Washington Post: Md. Hospital Association Asks State Panel To Spare Hospitals From A Medicare Cut
The Maryland Hospital Association urged a state commission on Thursday to spare hospitals from a 2 percent Medicare cut that is part of federal budget reductions. In response to the recommendation by staff members of the Health Service Cost Review Commission to have hospitals absorb the cuts for the rest of the fiscal year, the group issued a report warning the panel about deteriorating financial health of hospitals in the state (4/25).

Baltimore Sun: Rate-Setting Commission Recommends No Increase In Hospital Charges
The state's hospitals would absorb all of the 2 percent Medicare cuts required by federal sequestration under a proposal released Thursday by the state panel that sets hospital rates. The recommendation by the staff of the Health Services Cost Review Commission would mean that state hospitals would not get rate increases for the last three months of fiscal year 2013, a decision that prompted intense criticism from medical institutions that say they already operate on slim margins. Hospitals sought a rate increase to help offset the cost of the federal budget cuts and said they will have to cut services and jobs without one (Walker, 4/25).

Los Angeles Times: Medical Board Of California Could Lose Investigative Powers
The Medical Board of California would be stripped of its power to investigate physician misconduct under a sweeping reform plan by legislators who say the agency has struggled to hold problem doctors accountable. The medical board has come under fire for failing to discipline doctors accused of harming patients, particularly those suspected of recklessly prescribing drugs (Glover and Girion, 4/25).

Des Moines Register: Senators File Fetal 'Personhood' Resolution
Twenty-one members of the Iowa Senate filed a resolution Thursday proposing a fetal "personhood" amendment to the Iowa Constitution that would give human embryos a right to life beginning at conception. ... The resolution has little chance of winning approval in the 50-member Senate, where Democrats who support legal abortion would be expected to block the initiative. Senators opposed to abortion tried last week to amend a $1.9 billion state health and human services spending bill to prohibit use of taxpayer money for certain abortions. But it failed with 23 senators in support and 24 against (Petroski, 4/26).

Los Angeles Times: Labor Groups Renew Push For Paid Sick Leave
Following recent legislative victories in New York and Portland, Ore. -- and one of the worst flu seasons in years -- advocates for paid sick leave are hoping to ride that momentum to win victories locally. Previous failures to get the Legislature to mandate paid sick leave have taught labor groups a few lessons. Among them: Focusing on passing legislation on a city-by-city basis appears to be more fruitful (Lopez, 4/26).

The Lund Report: Oregon Senate Votes To Give Nurse Anesthetists Prescriptive Powers
The Senate passed Senate Bill 136 on a 26-3 vote, which will allow certified registered nurse anesthetists to write prescriptions for up to 10 days. Sen. Laurie Monnes Anderson, D-Gresham, the chief sponsor of Senate Bill 136, said nurse anesthetists already administer medications to patients within a care setting, but cannot ensure that patients will be able to have the medication they need to combat nausea or anxiety related to surgery or anesthesia as they recover at home (Gray, 4/25).

The Lund Report: Periodontal Hygienists, Kaiser Likely To Face Arbitration Over Union Contract
Jackie Farlinger-King has worked for Kaiser Permanente as a periodontal hygienist -- treating only patients with gum disease -- since the mid-1980s, and has been a hygienist with Kaiser for 32 years. But last September, she learned that her position may be phased out. Jeffrey Carr, an organizer with the Oregon Federation of Nurses and Health Professionals, which represents hygienists at Kaiser, said that's when the union learned that Kaiser Permanente Northwest intended to sunset the periodontal hygienist classification in its next contract (McCurdy, 4/26). 

Philadelphia Inquirer: Urgent-Care Centers Drawing Investor Attention
Three private equity firms have contacted Children's Hospital of Philadelphia during the last six months about partnering to open urgent-care centers, Steven Altschuler, the hospital's chief executive, said Thursday. Urgent-care centers are increasingly common, staffed by doctors and touted as a way to keep people out of emergency rooms for relatively minor ailments. … Children's turned down the invitations and is trying to get more out of its existing primary-care network while pursuing other experiments, Altschuler said (Brubaker, 4/26).

The Associated Press: Judge Rules Same-Sex Spouse Should Get Health Benefits
A federal appellate judge ruled this week the judiciary must grant health care benefits to the same-sex spouse of a federal public defender in Portland. Ninth U.S. Circuit Court of Appeals Judge Harry Pregerson said in a ruling Wednesday that the court's administrative office discriminated against Alison "Tex" Clark when it refused to add her spouse to Clark's benefit plan. Pregerson ruled that Oregon's same-sex marriage ban -- Measure 36, enacted by voters in 2004 -- and the federal Defense of Marriage Act are both unconstitutional (Cooper, 4/25). 

California Healthline: No Diversion Of Mental Health Money
A Senate budget subcommittee last week rejected a plan to divert roughly $34 million a year for mental health services to a CalWORKs (California Work Opportunity and Responsibility to Kids) fund. The California Department of Finance wanted to redistribute realignment money so half the funds currently going to mental health services would instead be shared equally between mental health and CalWORKs starting in 2015-16 (Gorn, 4/25).

The Washington Post: Plan Coming For Unpaid Chartered Health Claims, Gray Says
Not quite a week after it was announced that D.C. Chartered Health Plan could owe tens of millions more than previously anticipated to city health-care providers, Mayor Vincent C. Gray said Thursday his administration is "developing a plan to provide relief." Chartered Health Plan is currently the city's largest Medicaid contractor, handling the care of more than 104,000 District residents (DeBonis, 4/25).

California Healthline: Autism, Dental, Mental Health Focus Of Transition Concerns
Under the first phase of the transition, 600,000 Healthy Families children were moved into Medi-Cal managed care plans. In the next transition phase, set to begin May 1, the remaining 260,000 children will be moved into managed care plans by the end of the year, according to the state's timeline. … Of the first set of beneficiaries who have transitioned, 207 families will not be able to receive autism services known as applied behavioral analysis -- or ABA therapy -- through Medi-Cal managed care plans. … The loss of coverage for ABA therapy is the first indication that services have changed because of the transition. Some state officials and children's advocates are concerned about coverage for other services, particularly mental health services and dental care (Gorn, 4/25).

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Editorials and Opinions

Viewpoints: David Brooks Sees Growing Concerns About Health Law Implementation; Congress Should Stick To Requirement To Join The Exchanges

The New York Times: Health Chaos Ahead
It was always going to be difficult to implement Obamacare, but even fervent supporters of the law admit that things are going worse than expected. Implementation got off to a bad start because the Obama administration didn't want to release unpopular rules before the election. Regulators have been working hard but are clearly overwhelmed, trying to write rules that influence the entire health care sector — an economic unit roughly the size of France. Republicans in Congress have made things much more difficult by refusing to provide enough money for implementation. By now, everybody involved seems to be in a state of anxiety (David Brooks, 4/25). 

Kansas City Star: Passive Resistance Won't Kill Obamacare Either
Obamacare haters first looked to the U.S. Supreme Court to kill health care reform. When that didn't work, they fixed their hopes on Mitt Romney's election and a Republican takeover of the U.S. Senate. Foiled again. Opponents in Washington and state legislatures are now turning to passive resistance. If you follow the legislatures in Missouri and Kansas you see how it works. Refuse to set up a state insurance exchange. Turn down an opportunity to reform Medicaid and get more people into health insurance. Cheer Congress as it denies federal agencies the funds needed to get the Affordable Care Act up and running (Barbara Shelly, 4/25).

The New York Times' Taking Note: Tom Harkin's Political Jockeying
No sooner had Congressional Republicans stopped blocking President Obama's nominee to head Medicare and Medicaid to emphasize their opposition to the President on totally separate issues than a leading Democratic senator stepped in to do the same thing. This kind of political jockeying unrelated to the merit of the nominee is destructive no matter which party is doing it (Philip M. Boffey, 4/25).

St. Louis Post Dispatch: Avert The Mental Health Crisis: Expand Medicaid In Missouri
Missouri went on to establish the first mental hospital west of the Mississippi at Fulton. Missouri has been continuously committed ever since to serving those with serious mental illness. That covenant is now in jeopardy of being critically compromised due to the Legislature's plan to reject Medicaid expansion for the state (Karl Wilson and Mark Utterback, 4/26).

Florida Sun Sentinel: Healthy Florida Program Would Provide Shot In The Arm For Needy Families
The time has come for the Florida Legislature to take action to provide health coverage for those most in need. The choice facing us is which plan provides more Floridians the most affordable health care possible. It is evident that the House plan limits not only the number of potential enrollees, but also places huge obstacles to accessing that care. The plan I advocate will provide meaningful coverage for nearly 10 times the number of Floridians. The economic health of our state hinges upon the health of its citizens. The plan I support will provide a way for as many uninsured Floridians as possible to get and stay healthy (State Rep. Mike Fasano, 4/26). 

Pittsburgh Post Gazette: Growing Evidence: Corbett Should Heed The Pa. Reports On Medicaid
Every week seems to bring fresh evidence that expanding the state's Medicaid eligibility rules under the federal Affordable Care Act would be good for Pennsylvania. Let's hope Gov. Tom Corbett is paying attention. ... There are slight variations in their numbers, but the Pennsylvania Economy League, Rand Corp. and, most recently, the state's Independent Fiscal Office all reached the same conclusion: Expanding Medicaid will mean health insurance coverage for hundreds of thousands of additional Pennsylvanians, could create thousands of new jobs in the state and will trigger billions of dollars in economic activity (4/26).

Arizona Republic: Why Is Medicaid Expansion Even An Issue At This Point?
Arizona Republicans in the Legislature held a press conference this morning to denounce Gov. Jan Brewer's proposal to expand Medicaid to insure nearly 300,000 people, all without doing massive damage to the state’s budget. I wish I'd gone because I would have loved to ask those who oppose Brewer's plan one simple question: Which of you wants to be the one to inform 63,000 childless adults in this state – people whom voters in 2000 said they wanted to cover with AHCCCS – that they're being cut off? … That’s certainly an option, if the Arizona Legislature decides to terminate coverage for childless adults under the Arizona Health Care Cost Containment System (Laurie Roberts, 4/25).

Bloomberg: What's So Bad About Grassley's Obamacare Amendment?
Ezra Klein and Brian Beutler are writing about today's latest mini-outrage: Some Congressional offices are looking for a workaround for the Grassley Amendment to the Affordable Care Act, which states that Congress can't offer its employees health plans that are not on the Obamacare insurance exchanges. Grassley devised the amendment as a "gotcha" during the debate over health reform. It was intended to demonstrate that congressional staff would want to avoid the exchanges; instead, Democrats surprised him by agreeing to make his proposal law (Josh Barro, 4/25).

The Washington Post Wonkblog: No, Congress Isn’t Trying To Exempt Itself From Obamacare
There’s no effort to "exempt" Congress from Obamacare. No matter how this shakes out, Congress will have to follow the law, just like everyone else does. Based on conversations I’ve had with a number of the staffs involved in these talks, the actual issue here is far less interesting, and far less explosive, than an exemption. Rather, a Republican amendment meant to embarrass Democrats and a too-clever-by-half Democratic response has possibly created a problem in which the federal government can’t make its normal contribution to the insurance premiums of congressional staffers. ... [Sen. Chuck] Grassley's amendment means that the largest employer in the country is required to put some of its employees — the ones working for Congress — on the exchanges. But the exchanges don't have any procedures for handling premium contributions for large employers (Ezra Klein, 4/25).

Fox News: Obama Must Help Small Business Owners With Burden Of Health Care Law
The health care law is "the most disruptive instrument to the American workplace in my lifetime." That’s the perspective of Richmond businessman William J. Goldin, Jr., president of family-owned Strange's Florists, Greenhouses and Garden Centers since 1978, who testified before the Small Business Committee last week. Even proponents of the controversial health care law are now worried, as the predictable problems become a reality (Rep. Sam Graves, R-Mo., 4/25).

The New York Times: Room For Debate: Organ Donors Behind Bars
Utah recently became the first state to explicitly permit general prisoners – not death-row inmates – to donate their organs if they die while incarcerated. Should more states have laws like this? Should prisoners be allowed to make live donations to people other than family members? And with nearly 118,000 people in the U.S. waiting for hearts, kidneys, livers and other life-saving transplants, why not include death-row inmates? (4/25).

The Medicare NewsGroup: To Impove Health Outcomes, AMA Tackles Cardiovascular Disease, Type 2 Diabetes
As part of the American Medical Association’s (AMA) three-part strategy, we have launched the first phase of an initiative to measurably improve patient health outcomes for two of the nation's most troubling disease burdens. Our initial focus is on preventing cardiovascular disease and type 2 diabetes and also improving outcomes for those already living with these conditions. The AMA is committing its focus, resources and deep public health knowledge to work side by side with physicians and care teams, patients and families, communities and public health agencies to reduce the prevalence of these two diseases (Dr. Jeremy Lazarus, 4/25).

Politico: End Childhood Hunger In America
There are more than 16 million kids in America who are struggling with hunger and who need our help. My marching orders that day were to ensure that every reporter in the room understood that hunger is a solvable problem. I wanted them to know that there are programs and federal dollars already in place to help these kids. We don’t need to create new solutions, we just need to help kids take advantage of existing programs like school breakfast, the Summer Food Service Program and the after-school meals program. Children are the most vulnerable members of our society. They don’t have a voice in the halls of Congress. So I speak for them, to whoever will listen (Jeff Bridges, 4/26).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
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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.