Daily Health Policy Report

Monday, April 29, 2013

Last updated: Mon, Apr 29

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch


State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Obama Administration Mulls Rule To Give Home Health Aides Better Wages

Kaiser Health News staff writer Alvin Tran reports that "close to 2 million in-home care workers and personal care aides in the United States don't always get paid for overtime work or receive minimum wage, according to the U.S. Department of Labor. They are explicitly excluded from a key federal wage law that carved out exceptions for causal babysitters and companions for people who are sick or disabled" (Tran, 4/29). Read the story.

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Oregon's Dilemma: How To Measure Health?

Oregon Public Broadcasting's Kristian Foden-Vencil, working in partnership with Kaiser Health News and NPR, reports: "There are hundreds, if not thousands, of ways to track the health of a population: the average blood pressure of a large group of people, the rate of mental illness, the average weight. Epidemiologists have been collecting this kind of data for years, but now, in Oregon, there is cold, hard cash riding on these metrics" (Foden-Vencil, 4/26). Read the story.

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Capsules: Vangent Gets $28 Million Contract For Health Marketplace Call Center

Now on Kaiser Health News' blog, Phil Galewitz reports: "The federal government has awarded a $28.2 million contract to a General Dynamics subsidiary to run a call center to handle consumer questions about the new online insurance marketplaces that are slated to begin selling insurance policies Oct. 1" (Galewitz, 4/26). Check out what else is on the blog.

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Political Cartoon: 'Negative Diagnosis?'

Kaiser Health News provides a fresh take on health policy developments with "Negative Diagnosis?" by Chris Wildt.

Meanwhile, here is today's health policy haiku:


It was smiles and hugs
at Correspondents Dinner.
Back to trench warfare.

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

Exchange Implementation: News From The White House And The Field

Politico reports that the Obama administration is facing challenges as it moves into a critical time implementing the health law. Meanwhile, a contract is awarded for a call center to handle questions about the health exchanges run by the federal government.

Politico: Obamacare 2.0: Shaky Like 1.0
Obamacare fires are flaring up all over — in Hill hearings, in scary headlines about big rate hikes and in closed-door meetings of nervous Democrats. The White House response: We'll get to that (Nather, 4/26).

Kaiser Health News: Capsules: Vangent Gets $28 Million Contract For Health Marketplace Call Center
The federal government has awarded a $28.2 million contract to a General Dynamics subsidiary to run a call center to handle consumer questions about the new online insurance marketplaces that are slated to begin selling insurance policies Oct. 1 (Galewitz, 4/26).

News outlets also report on exchange implementation news around the country -

Columbus Dispatch: Ohio's Health-Insurance Exchange A Mystery
In five months, Ohio's health-insurance exchange will enroll the first of hundreds of thousands of Ohioans for coverage that takes effect on Jan. 1. By Oct. 1, the federal government will have to prepare the online marketplace, which a state-commissioned report estimated will serve 540,000 Ohioans by 2017. And in Ohio and 33 other states that opted for federally run or partnership exchanges instead of setting up their own, there won't be much money from the federal government to help get the word out (Sutherly, 4/28).

The Lund Report: Regence And Health Net Take Different Approach To Exchange
Oregon's health insurance exchange is about to take a decisive step forward next Tuesday. That's when health insurers must file their proposed rates for individual and small group coverage with the Insurance Division. Those rates will be made public May 10, and public hearings have already been scheduled starting in late May. Lou Savage, the state's insurance commissioner, is optimistic the highly competitive health insurance market will help keep prices low. … Next year, Cover Oregon projects that 160,500 individuals, including 55,000 uninsured and 56,900 employers will join the exchange, and start signing up in October (Lund-Muzikant, 4/26).

Milwaukee Journal Sentinel: State's Hospitals, Key Republican Concerned Federal Insurance Pools May Be Delayed
The state's hospitals -- and a key Republican senator -- say the state should consider slowing down Gov. Scott Walker's plan to shift tens of thousands of patients out of state coverage and into the federal health care program next year. Walker's plan still has strong support in the GOP-controlled Legislature, but the Wisconsin Hospital Association and Sen. Alberta Darling (R-River Hills) point to growing concerns that there could be delays in setting up the online insurance marketplaces called for under President Barack Obama's federal health care law (Stein, 4/28).

Des Moines Register: Official Navigating Health Law
Nick Gerhart knew what he was taking on when he agreed last year to become Iowa’s insurance commissioner. Gerhart, 37, stepped into the middle of a national storm over health care. His main assignment this year will be to educate Iowans on what they can expect when a blizzard of new health-insurance regulations take effect next year, and to help prepare a new electronic system consumers and small businesses can use to buy policies. The soft-spoken former life insurance company executive expects the turmoil to last a while (Leys, 4/28).

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Florida House Rejects Federal Medicaid Expansion Funds

The Florida House of Representatives passed its own limited health care bill that relies on state money to expand coverage to the state's neediest residents. Also in the news, reports from Ohio, Montana, Texas, Nebraska and Arizona on the status of state decision-making regarding the expansion.

The Associated Press: Florida House Passes Limited Health Care Bill
The Republican-controlled Florida House on Friday passed its plan to provide health coverage to about 115,000 of the state's neediest residents but bypassed tens of billions of federal dollars available under the Affordable Care Act. The bill's passage now sets up a standoff between the House and Senate in the final week of the legislative session. If neither side blinks, a health insurance overhaul could well be over till next year, quashing one of Gov. Rick Scott's priorities (4/26).

Health News Florida: It's Official: House Turns Down $$
By a 71 to 45 vote, the Florida House of Representatives on Friday passed its own health plan, which relies on state money and bypasses more than $50 billion in federal funds. The vote, as expected, fell almost entirely along party lines (Gentry, 4/26).

Health News Florida: Employers Face Penalty If FL Rejects $
Florida businesses have more at stake in the Legislature’s decision on Medicaid expansion than they might realize, tax-policy experts say. Florida’s larger employers could face tax penalties of $146 million to $219 million a year if the state says no to federal funds and fails to cover low-income uninsured people via Medicaid, as called for in the Affordable Care Act, says tax-policy expert Brian Haile of Jackson Hewitt Tax Service (Gentry and Lamendola, 4/26).

The Associated Press: More Than Just Numbers In Ohio's Medicaid Debate
The debate over whether Ohio should make health care coverage available to more low-income residents has been framed largely by numbers and dollar signs. Behind those figures, though, are thousands of people who have little or no access to medical care and treatment programs. Many are making just enough to stay above the poverty line (4/28).

The Associated Press: Health Care Fight To Continue After Session Ends
The Montana legislative session may be over, but Medicaid expansion advocates say the fight to get health insurance to the working poor will continue. Advocates and Gov. Steve Bullock are considering their options after the Legislature killed the governor's bill to expand Medicaid to up to 70,000 Montanans who cannot afford to purchase health insurance (4/26).

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, 4/26).

Omaha World-Herald: Nebraska Lawmakers Take Note Of Arkansas Medicaid Plan
Could the "private option" that brought together Republicans and Democrats in Arkansas offer an alternative to expanding Medicaid in Nebraska? Some Nebraska lawmakers say the idea is worth checking out. "I'm very much in support of looking into it," said State Sen. Beau McCoy of Omaha, a leading opponent of adding more low-income adults to Nebraska's Medicaid program (Stoddard, 4/28).

San Antonio Express: Personal Stories Help Shape Medicaid Debate, Decisions
Like everyone, lawmakers are shaped by their experiences as they mull key decisions, such as what to do about the million-plus Texans who could be insured if Texas expanded Medicaid or found some alternative to draw down the federal dollars for private coverage. Rep. Ruth Jones McClendon, a San Antonio Democrat on Appropriations, said fighting cancer into remission has helped shape her views, and others' stories make a difference, too. She wants to pass a measure that will give people the coverage they need. ... [Lois]Kolkhorst said she's concerned that Medicaid coverage won't be meaningful if the program isn't made sustainable. She suggests that the insurance subsidies, starting at 100 percent of poverty absent Medicaid expansion, could help people like Veloz strive to reach the income level at which they could get coverage (Fikac, 4/28).

Dallas Morning News: Texas Medicaid Debate Pits Rival Visions Of Health Care Law
A battle at the Capitol over whether Texas should expand Medicaid is coming down to two competing philosophies. One, the likely winner, is pushed by Brenham Republican Rep. Lois Kolkhorst, chairwoman of the House Public Health Committee. She says the state should wait to gauge the effect of the other major provision that the Affordable Care Act uses to expand health coverage, a new insurance exchange. ... The other view, represented by Houston Democratic Rep. Garnet Coleman, says that only Medicaid expansion can provide enough coverage, and that it’s too good a deal to pass up (Garrett, 4/28).

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Capitol Hill Watch

Some GOP Lawmakers Are Shifting Focus From Medicare To The Tax Code

House Republican leaders began a series of meetings last week to sell this idea to their rank-and-file members. Also in Capitol Hill news, cancer clinics argue that Congress should have addressed the cuts they took as a result of sequestration before turning to the spending reductions' impact on air travel.

The Washington Post: GOP Moves Away From Entitlements And Toward Tax Reform In Budget Deal
With another fight over the national debt brewing this summer, congressional Republicans are de-emphasizing their demand for politically painful cuts to retirement programs and focusing on a more popular prize: a thorough rewrite of the U.S. tax code. Reining in spending on Social Security and Medicare remains an important policy goal for the GOP. But House leaders launched a series of meetings last week aimed at convincing rank-and-file lawmakers that tax reform is both wise policy and good politics and should be their top priority (Montgomery, 4/27).

The Hill: Cancer Clinics: Our Cuts From Sequester Needed Earlier Remedy Than FAA's
Congress should have addressed deep cuts to cancer clinics before tackling airline delays caused by sequestration, people at several of those clinics said Friday. Both the House and Senate have now voted to restore funding that the Federal Aviation Administration lost through the automatic budget cuts known as "sequestration." The bill is headed to President Obama's desk (Baker, 4/28).

A Friday hearing explored how Health Insurance Portability and Accountaiblity Act rules are being interpreted by providers -

Medpage Today: HIPAA Being Misinterpreted, Congress Told
Health care providers often misunderstand or over-interpret a 1996 health privacy law and as a result frequently do not share vital health information with family, caregivers, and others, lawmakers heard Friday. Some members of Congress have expressed concern that certain provisions of the Health Insurance Portability and Accountability Act -- called HIPAA for short -- have prevented providers from sharing information with loved ones and law enforcement that may have saved a patient's life or the lives of others. The law restricts the sharing of information in most circumstances unless the patient grants permission (Pittman, 4/26)

Also in the news, a bipartisan bill was introduced in the Senate last week regarding Food and Drug Administration oversight of compounding pharmacies -

Reuters: Draft Bill Gives FDA Authority Over Some Pharmacies
The Food and Drug Administration would gain greater authority over pharmacies that compound sterile drugs and ship them across state lines under proposed legislation announced on Friday. The proposal from a bipartisan group of U.S. senators comes in the wake of a meningitis outbreak last fall that killed 53 people and sickened more than 700. The outbreak was linked to a tainted steroid distributed by the New England Compounding Center (Clarke, 4/26).

The Hill: Senators Push Expanded Oversight Of Compound Pharmacies
A bipartisan group of senators wants to give federal regulators greater oversight of compound pharmacies following bacterial contaminations nationwide that have killed at least 50 people and sickened hundreds more. Sens. Tom Harkin (D-Iowa), Lamar Alexander (R-Tenn.), Al Franken (D-Minn.) and Pat Roberts (R-Kan.) released a draft bill on Friday to make the blurry regulatory lines surrounding the pharmacies more clear (Wilson, 4/26).

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CMS Plans To Increase Medicare Hospital Payments By 0.8%

The Centers for Medicare & Medicaid Services announced the proposed increase Friday, which will raise payments for services that elderly and disabled patients receive after being admitted to hospitals.

Bloomberg: Medicare Plans To Boost Pay To U.S. Hospitals By 0.8%
Hospitals will get a pay raise from the U.S. government for treating patients in the nation’s Medicare program. The U.S. Centers for Medicare and Medicaid Services plans to raise payments 0.8 percent beginning Oct. 1 for services that elderly and disabled patients receive after being admitted to hospitals, according to a regulatory proposal today (Wayne, 4/29).

CQ HealthBeat: Hospital Payment Increase Totals $27 Million Nationwide In Proposed CMS Rule
Hospitals would get a fairly skimpy net rate increase of 0.8 percent in fiscal 2014, under a rule that the Centers for Medicare and Medicaid Services posted late Friday. In addition, that large of an increase would go only to hospitals that successfully participate in a quality reporting program developed by CMS, according to documents released by the agency (Norman and Reichard, 4/26).

Medpage Today: Medicare Offers Pay Boost To Hospitals
The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule late Friday that would increase payments to the nation's 3,400 acute care hospitals by nearly $27 million in fiscal 2014. Under its proposed Inpatient Prospective Payment System (IPPS) rule, payments for inpatient stays at hospitals that participate in CMS' Inpatient Quality Reporting Program would increase by 0.8 percent. Hospitals not successfully participating would see their payments cut by 2.0 percent, CMS said in its proposed rule. The $27 million increase takes into account both an increase for inflation as well as an 0.8 percent cut that CMS took in order to recover part of $11 billion in overpayments from prior years as required by the American Taxpayer Relief Act of 2012 (Pittman, 4/26).

Additionally, The Washington Post reports on a care-management system that has not experienced great success --

The Washington Post: The Solution Medicare Is Shutting Down
Health Quality Partners is all about going there. The program enrolls Medicare patients with at least one chronic illness and one hospitalization in the past year. It then sends a trained nurse to see them every week, or every month, whether they’re healthy or sick. It sounds simple and, in a way, it is. But simple things can be revolutionary. Most care-management systems rely on nurses sitting in call centers, checking up on patients over the phone. That model has mostly been a failure. And while many health systems send a nurse regularly in the weeks or months after a serious hospitalization, few send one regularly to even seemingly healthy patients. This a radical redefinition of the health-care system's role in the lives of the elderly. It redefines being old and chronically ill as a condition requiring professional medical management (Klein, 4/27).

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State Watch

Federal Gov't. Moves Against Nevada Hospital For Alleged Patient Dumping

The Centers for Medicare & Medicaid Services gave Nevada 10 days to correct problems at Rawson-Neal Psychiatric Hospital following reports it may have improperly discharged patients and bused them out of state.

Los Angeles Times: Feds Take Action Over Alleged Patient Dumping At Nevada Hospital
Following state Senate President Pro Tem Darrell Steinberg's call for an investigation, federal authorities have taken disciplinary action against a Nevada hospital in an alleged case of "patient dumping" in California. In a letter dated Thursday, the Centers for Medicare & Medicaid Services gave Nevada 10 days to correct problems at Rawson-Neal Psychiatric Hospital following reports it may have improperly discharged patients and bused them out of state (Romney, 4/26).

The Wall Street Journal: Nevada Told To Fix Mental-Health Facility
Federal officials have ordered the state of Nevada to correct a mental-health facility in Las Vegas that they claim discharged patients improperly. A regional director for the federal Centers for Medicare & Medicaid Services, which oversees facilities that participate in the federal health programs, sent a letter Wednesday to Rawson-Neal Psychiatric Hospital in Las Vegas, stating that a survey last month showed that the hospital was "out of compliance" with requirements for patient discharge planning and governance (Phillips, 4/26).

The Associated Press/Washington Post: Federal Government Demands Answers From Nevada Psychiatric Hospital Accused Of Busing Patients
The federal agency that oversees Medicaid and Medicare compliance has put Nevada on notice of "serious deficiencies" at a Las Vegas psychiatric hospital following reports of patients being improperly discharged. A letter Thursday from the Centers for Medicare and Medicaid Services, first reported by The Sacramento Bee and obtained Friday by The Associated Press, gave Nevada 10 days to correct problems in its mental health discharge policies at Rawson-Neal Psychiatric Hospital or risk the loss of federal funding, potentially tens of millions of dollars (4/26).

Reuters: U.S. Agency Moves Against Nevada Hospital Cited For "Patient Dumping"
Federal authorities have taken disciplinary action against a Las Vegas hospital cited for improperly sending newly released psychiatric patients by bus to neighboring California and other states in a practice called "patient dumping." The Rawson-Neal Psychiatric Hospital was warned it was in violation of Medicare rules governing the discharge of patients and could lose critical funding under the federal healthcare insurance program if it failed to correct the problem (Cohen, 4/27).

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Obama Tells Planned Parenthood He'll Fight To Maintain Abortion Rights

President Obama told attendees of Planned Parenthood's annual meeting that he will fight to maintain abortion rights and the group's federal backing. In the meantime, an antiabortion group releases undercover videos it took at abortion clinics.

Bloomberg: Obama Says Women Risk Losing Health Choices In State Battles
President Barack Obama said women are at risk of losing access to health care services because of attacks on Planned Parenthood and efforts to restrict abortion rights in U.S. states.  Speaking to the annual meeting of Planned Parenthood Federation of America, Obama said he would fight to keep federal backing for the organization and maintain abortion rights, upheld 40 years ago in the U.S. Supreme Court's landmark Roe v. Wade decision (Runningen, 4/26).

The New York Times: Group Shows Covert Video of a Bronx Abortion Clinic
An anti-abortion group that previously released several videotapes of undercover visits to abortion clinics released another video on Sunday of a staff member at a Bronx clinic describing late-term abortion procedures. The group likened the practices to those at the clinic of Dr. Kermit Gosnell, the Philadelphia doctor charged with killing viable fetuses (Yee, 4/28).

The Washington Post: Antiabortion Group Releases Videos Of Clinic Workers Discussing Live Births
One video features a D.C. doctor, Cesare Santangelo, who said that in the unlikely event that an abortion resulted in a live birth, "we would not help it." Santangelo was answering repeated questions from an undercover operative about what would happen, hypothetically, if she gave birth after an unsuccessful abortion (Somashekhar and Sun, 4/29).

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Medicaid: Texas Docs Lose Money; Jindal Adm. Official Has 'Improper Contact' With Contractor

News outlets report on Medicaid developments in Louisiana and Texas.

The Associated Press: Medicaid Problems Hinge On Texas Doctor, Nurse Pay
The first question many doctors ask when new patients call for appointments is how they intend to pay. If the answer is Medicaid, the doctor can expect to lose money. The Texas Legislature has been balancing the state's budget by intentionally paying doctors 40 to 75 percent less for Medicaid patients than what private insurers pay for the same treatment (4/27).

The Associated Press/Washington Post: Jindal Administration: Greenstein Had Improper Contact With Medicaid Contractor In Bid Process
Gov. Bobby Jindal’s administration said Friday that his former health secretary, Bruce Greenstein, improperly exchanged repeated phone calls and text messages with a company bidding for a lucrative Medicaid contract, creating an "unfair advantage" for the firm (4/26).

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State Highlights: Ore. For-Profit Hospitals' Charity Care Lags

A selection of health policy stories from Mississippi, Oregon, Connecticut and California.

The Associated Press: Healthy Officials Trying To Save Jobs
Top officials at the Mississippi State Department of Health say they're trying to prevent layoffs for 41 employees and 41 contract workers who were part of a program to help women with high-risk pregnancies. Dr. Mary Currier, the state health officer, said Friday that the social workers were told April 15 their jobs could be eliminated July 1 (4/28).

The Lund Report: For-Profit Hospitals Skimp On Charity Care
Oregon's two for-profit hospitals are among the stingiest hospitals in the state when it comes to providing care for the poor. Willamette Valley Medical Center spent less than 1 percent of patient revenue on charity care in 2011, a tenth the average of its peers, according to a Lund Report review of the state's major hospitals. And McKenzie-Willamette Medical Center, the only other major for-profit hospital in Oregon, spent 3.2 percent of patient revenue on charity care (Sherwood, 4/26).

Kaiser Health News: Oregon's Dilemma: How To Measure Health?
There are hundreds, if not thousands, of ways to track the health of a population: the average blood pressure of a large group of people, the rate of mental illness, the average weight. Epidemiologists have been collecting this kind of data for years, but now, in Oregon, there is cold, hard cash riding on these metrics (Foden-Vencil, 4/26).

CT Mirror: Hospitals Working Together To Reduce Surgical Complications
Connecticut hospitals traditionally considered competitors have been quietly teaming up to share techniques to reduce surgical infections and complications. The idea is to improve patient care and efficiency in a landscape of skyrocketing health care costs and pressure from the federal Affordable Care Act to improve performance. On Friday, surgeons, hospitals, health plan providers, physicians and politicians gathered at the state Capitol for a symposium to raise public awareness of hospitals' efforts to contain costs and to discuss challenges that lie ahead in health care reform (Merritt, 4/26).

HealthyCal: 'Show Me The Money'
Imagine taking a job without knowing how much you’ll be paid. Or having your car fixed without knowing the cost. That’s how state health insurers and our most vulnerable patients -- the old, sick, and poor -- feel about California’s latest plan to squeeze them into a new managed care program that may be woefully unprepared for a transition scheduled for the fall (Perry, 4/28).

California Healthline: Legislature OKs First Special Session Bills
The Assembly and Senate yesterday voted to approve two similar bills that would reform the individual health insurance market and ban pre-existing conditions as a reason for denying health insurance. They are the first bills from the special session on health care reform to pass legislative floor votes. The bills now must pass a procedural vote by both houses of origination before heading to the governor's desk. The governor's office has expressed support for the bills, so both are expected to be signed into law (Gorn, 4/26).

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Health Policy Research

Research Roundup: Young Women And Delays In Breast Cancer Diagnosis

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

JAMA Surgery: Delay In Surgical Treatment And Survival After Breast Cancer Diagnosis In Young Women By Race/Ethnicity –Adolescents and young adults (ages 15-39) make up 5 and 6 percent of all breast cancer cases in the United States and have the lowest five-year survival rates. Using 1997-2006 data from the California Cancer Registry, researchers found "that young women with a delay in surgical treatment (>6 weeks) have shorter survival compared with those who had surgery closer to their diagnosis." The impact on survival rate was greater for African Americans, publicly insured or uninsured individuals, and those with low socioeconomic status. "It is crucial to prevent further physician-related delays before and after the diagnosis of breast cancer is established to maximize the survival of these young women who are in the most productive time of their life," they concluded (Smith, Ziogas, Anton-Culver, 4/24).

American Journal Of Public Health: Change In Health Insurance Coverage In Massachusetts And Other New England States By Perceived Health Status: Potential Impact Of Health Reform – The 2010 federal health law is modeled on Massachusetts' 2006 revamping of its system. Using population-based survey data, the researchers found that coverage increased more in in Massachusetts than in other New England states. "This increase was strong and statistically significant for those most in need of health care such as individuals reporting poor mental health, poor physical health, and more limitations in their activities because of poor physical or mental health," the authors write. People with medical problems "were more likely to purchase insurance than those with better perceived health" after the new law, likely because they had been denied coverage before or it was priced too high based on their conditions. The authors conclude: "This study indicates that if the health care coverage trends observed in the natural experiment in Massachusetts foreshadow what will occur in the United States following full implementation of the ACA, the rate of decrease in health insurance coverage will be slowed and an increase in health insurance coverage is predicted" (Dhingra et al., 4/18).

Health Affairs: Per Capita Caps In Medicaid – Some analysts have suggested that calculating per capita spending and setting an allowable annual rate of growth could slow the growth of federal spending on Medicaid, the federal-state health care program for the poor. Supporters of this proposed change, the author of this brief adds, "describe the approach as a middle ground between the program as it currently operates and other proposals such as block grants, which would more dramatically change the way federal Medicaid funding is calculated.' Others are concerned that a per capita cap approach would shift costs to the states. "Whether a Medicaid per capita cap will emerge as part of negotiations on the federal budget, or entitlement reform efforts, isn't known," the author notes, adding that "several approaches are being discussed" by policymakers looking for ways to cut federal spending (Cassidy, 4/18).

U.S. Department Of Health And Human Services (HHS): National Culturally And Linguistically Appropriate Services (CLAS) Standards In Health And Health Care – In 2000, the HHS Office of Minority Health published its first National CLAS Standards in order to provide a framework aimed at helping all health care organizations in better serving the increasingly diverse communities. Last week, the office released its most updated framework, consisting of 15 measures, that aims to "advance health equity, improve quality, and help eliminate health care disparities by providing a blueprint for individuals and health and health care organizations to implement culturally and linguistically appropriate services" (4/24). 

Here is a selection of news coverage of other recent research:

MedPage Today: Senior-Centered Hospital Care Boosts Outcomes
Older patients, who are making up more of the U.S. population, are at increased vulnerability for adverse events during a hospital stay. As a result, the development of older-patient-centered hospital care practices may help improve patient outcomes, the research teams wrote online in the April 22 issue of JAMA Internal Medicine (Petrochko, 4/22).

Reuters: Aging U.S. To Drive Up Heart-Related Health Costs: Study
The costs linked to heart failure in the United States are expected to more than double within the next two decades as the population ages and treatments help patients with the disease live longer, a study released on Wednesday found. The American Heart Association predicted that the number of Americans with the fatal condition will grow to 8 million in 2030 from about 5 million in 2012 (Heavey, 4/24).

Reuters: Psychiatric Insurance Approval Takes Time In ERs
Doctors spend about 40 minutes getting approvals from insurance companies to get a psychiatric patient from the emergency room to a hospital bed, according to a new study. In some cases, the researchers found the approval process took more than an hour, which the study's senior author said results in patients being kept in ERs longer and doctors taken away from other duties. ... [Dr. J. Wesley Boyd and his colleagues] published their findings in a letter to the Annals of Emergency Medicine (Seaman, 4/23).

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Editorials and Opinions

Viewpoints: Bowles, Simpson Renew Push For 'Grand Bargain;' The Debate On FDA Oversight Of Pharmacies; Kasich And Feds Work To Find Formula For Medicaid Expansion

The Washington Post: A Grand Bargain Is Still Possible. Here's How.
To be sure, some progress has been made the past two years. Policymakers have enacted about $2.7 trillion in deficit reduction, primarily through cuts in discretionary spending and higher taxes on wealthy individuals. Yet what we have achieved so far is insufficient. Nothing has been done to make our entitlement programs sustainable for future generations, make our tax code more globally competitive and pro-growth, or put our debt on a downward path. Instead, we have allowed a "sequestration" to mindlessly cut spending across the board — except in those areas that contribute the most to spending growth. But there are seeds of hope that a bipartisan agreement might be achievable (Erskine Bowles and Alan Simpson, 4/28).

The Washington Post: The Twilight Of Entitlement
We are passing through something more than a period of disappointing economic growth and increasing political polarization. What's happening is more powerful: the collapse of "entitlement." By this, I do not mean primarily cuts in specific government benefits, most prominently Social Security, but the demise of a broader mind-set — attitudes and beliefs — that, in one form or another, has gripped Americans since the 1960s. The breakdown of these ideas has rattled us psychologically as well as politically and economically (Robert J. Samuelson, 4/28).

USA Today: Fix 'Compounding Pharmacy' Oversight: Our View
In the aftermath of this public health disaster, Republicans and Democrats in Congress are debating two questions: Has the Food and Drug Administration failed to use its existing authority to oversee compounders such as NECC? Or does the FDA need broader powers? The answers are yes, and yes. The FDA repeatedly dropped the ball. And the agency's authority does need to be clarified and expanded (4/28).

USA Today: We're Dedicated To Patients' Health: Another View
When the tragic news of the deaths and sickness associated with products made at the New England Compounding Center came out last fall, the nation's attention appropriately focused on what went terribly wrong — and what steps to take to keep anything like it from ever happening again. Pharmacists were more concerned than anyone because our profession is dedicated to one thing: the health of the patients we serve by compounding drugs upon request from authorized prescribers, such as doctors. NECC was essentially manufacturing drugs, not compounding (David G. Miller, 4/28).

The New York Times: Another Alleged Drug Kickback Scheme
Two federal lawsuits charging a prominent drug company with making fraudulent kickbacks to promote sales of its drugs raise disturbing questions about how to control fraudulent behavior in the pharmaceutical industry, behavior that appears to be on the rise. The company is Novartis Pharmaceuticals, the American subsidiary of a Swiss-based multinational. Novartis denies any wrongdoing and vows to defend itself in court (4/27).

The New York Times: Wins And Losses In The Fight Against Tobacco
Cigarette packages are unlikely to carry graphic warning labels anytime soon as a result of separate actions by the Supreme Court and the Food and Drug Administration. That is a setback, though perhaps temporary, for the federal government's campaign to reduce the health damage caused by this highly lethal product. The silver lining is that the Supreme Court left intact most of the F.D.A.'s powers to regulate this industry (4/28).

The Wall Street Journal: Exempting Congress From ObamaCare
Congress will eventually find some way to protect itself, but its subterranean scrambling to do so exposes one of ObamaCare's greatest deceits: That if you like the insurance you have, you'll be able to keep it. Even the people who wrote the law don't believe it (4/26). 

Arizona Republic: Don't Let Deficit Preclude Arizona Medicaid Expansion
The controversy surrounding Gov. Jan Brewer's recommendation to expand health-care coverage to low-income Arizonans could leave a casual observer with the impression that she is proposing a massive public-policy change. The truth is her proposal is a relatively minor expansion of the current coverage already required by Arizona voters through the passage of Proposition 204 in 2000, and it is a modest change in Arizona's current financial relationship with the federal government (Kevin McCarthy, 4/28). 

Pittsburgh Tribune-Review: Don't Commit Medicaid-Assisted Suicide In Pennsylvania
Everybody and his brother, sister, mother, father and, heck, maybe even the family fido suddenly is citing this or that study in an attempt to persuade Gov. Tom Corbett to expand Pennsylvania's Medicaid program under ObamaCare. All types of multibillion-dollar economic nirvana, including jobs!, Jobs!, JOBS!, are being touted. ... Medicaid already is a failure. Expanding it — a new government intervention to cover up the lie of the last government intervention — would only make it a larger failure. State-based solutions remain the better option (Colin McNickle, 4/28). 

Cleveland Plain Dealer: Kasich, Obama Administration Hatching Clever Ideas To Win Medicaid Expansion
Gov. John Kasich's staff, working with the Obama administration, is deploying imagination and flexibility to overcome shortsighted objections from some of Kasich's fellow Republicans to Medicaid expansion in Ohio. His eye on a second term and possibly another presidential bid down the road, Kasich also needs to salvage political capital by avoiding an outright GOP rebellion on the issue. But Kasich also is right: Medicaid expansion is a win-win for Ohio (4/26). 

Tampa Bay Times: House Republicans' Medicaid Argument Ignores Logic
This week's debate on the expansion of Medicaid funds was stunning for its obfuscation, bombast and sheer nonsense. By sticking to their pretend war with the federal government, House Republicans are shamelessly snubbing minimum wage-type workers as well as endangering the financial well-being of state hospitals. Who's on board with House Republicans? (John Romano, 4/27).

The New York Times Economix: Hammurabi's Code And U.S. Health Care
According to a recent estimate, almost a third of American physicians are unwilling to accept any new patients covered by Medicaid. In New Jersey in 2011, only 40 percent of physicians accepted new Medicaid patients (see Exhibit 4). Given the insulting valuations many state Medicaid programs put upon the physicians' work, that's understandable. ... Nationwide, the fee paid physicians for an "office visit, new patient, 30 minutes" (C.P.T. Code 99203) in 2012 ranged from $29 to $165, with an average of $63.36. The minimum of $29 is probably a weighted average of the two fees for New Jersey cited earlier. There is a similarly wide range of Medicaid fees across the nation for other C.P.T. codes (Uwe E. Reinhardt, 4/26).

Los Angeles Times: Legislature Should Pull Plug On Inept Medical Board Of California
The time has come to put the Medical Board of California out of its misery. The board oversees the licensing of doctors and their discipline for misdeeds or incompetence. It also has jurisdiction over doctor-owned surgical clinics. Long ago the board acquired the reputation of being one of the least effective regulatory bodies in Sacramento. But evidence has mounted that it's worse: It's a danger to the community (Michael Hiltzik, 4/26). 

Kansas City Star: Protect Seniors From Unscrupulous Medicare Scams
Kathleen Kennedy, a Chesterfield, Mo., internist, had seen enough. Faxes sent to her office requested authorization for medical equipment and testing products her patients didn’t want or need. One patient reported badgering sales calls over several days. Medicare would have paid the bills, had she obliged. But she wasn't about to let taxpayers foot unnecessary bills. So she started writing complaints: to her U.S. senators, state officials and federal hotlines. Attached to her letters was evidence — faxes from out-of-state medical equipment providers seeking her approval (4/27).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.