Daily Health Policy Report

Tuesday, April 3, 2012

Last updated: Tue, Apr 3

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Campaign 2012

Health Care Marketplace

Administration News


Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insuring Your Health: Medicare Now Covers Annual Screening For Depression

In her latest Kaiser Health News consumer column, Michelle Andrews writes: "Many people assume that as health problems multiply and loved ones die, it's inevitable that the elderly become depressed. Not true, say experts. Older people have lower rates of depression than younger groups" (Andrews, 4/3). Read the column.

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Health Insurers Move Ahead, With Or Without Individual Mandate

WNPR's Jeff Cohen, working in partnership with Kaiser Health News and NPR, reports: "Cigna, like the broader insurance industry, hasn't taken a position on whether or not the mandate requiring Americans to buy health coverage is constitutional. Cordani points out that it really only deals with expanding care to people in the small-group and individual markets. That's a fraction of the total number of people insured, and it's not a major market for Cigna" (Cohen, 4/2). Read the story.

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Capsules: Measuring Health County-By-County

Now on Kaiser Health News' blog, Jenny Gold reports: "The 2012 County Health Rankings are out this week from the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation. The rankings assess the health of nearly every county in all 50 states and the District of Columbia, and they allow you to compare rankings on a handy calculator of key health indicators, including their percentage of uninsured citizens" (Gold, 4/2). Check out what else is on the blog.  

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Political Cartoon: 'Scales Of Justice?'

Kaiser Health News provides a fresh take on health policy developments with "Scales Of Justice?" by Matt Wuerker.

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


Bad health? Pay up here.
Social contract? That's passe.
You are on your own.
-Don McCanne, MD

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

Obama Confident The Health Law Will Be Upheld

In his first public comments about the law since last week's Supreme Court oral arguments, President Barack Obama not only defended the measure and maintained confidence that it would not be overturned, but he also offered warnings against judicial activism.    

The Wall Street Journal: Obama Warns Supreme Court
President Barack Obama predicted Monday that the Supreme Court would uphold his signature health-care law and said that overturning it would be a prime example of judicial overreach. It was a rare instance of a president laying out his own arguments about a Supreme Court case before the justices are set to reach their decision (Meckler and Lee, 4/2).

The Associated Press: Obama Confident Health Care Law Will Be Upheld
President Barack Obama offered a firm defense of his health care law, saying Monday he remains confident that the law will be upheld by the U.S. Supreme Court and warning that "unelected" justices should not overturn the will of Congress. "We are confident that this will be upheld because it should be upheld," Obama said during a joint news conference with the leaders of Canada and Mexico. Obama said bluntly: "It's constitutional" (Feller, 4/2).

The New York Times: President Confident Health Law Will Stand
On Monday, Mr. Obama rejected the idea that the individual mandate could be struck down without crippling the whole law. "I think the justices should understand that, in the absence of an individual mandate, you cannot have a mechanism to insure that people with pre-existing conditions can actually get health care," he said. The White House has insisted it is not developing contingency plans if the law is struck down. While a negative ruling would be a major symbolic defeat for the president, it is not clear how it would affect his re-election bid (Landler, 4/2).

USA Today: Obama Warns Against 'Judicial Activism' On Health Care Law
Obama predicted the justices would uphold the law, despite strong reservations voiced by four conservative justices about its requirement that most Americans buy insurance or pay a penalty. A fifth justice, Clarence Thomas, is widely expected to vote against the "individual mandate" (Wolf and Jackson, 4/2).

Market Watch: Obama Warns Supreme Court On Health-Care Law
President Barack Obama on Monday said he was confident that the Supreme Court would uphold the constitutionality of his signature health-care law. "We are confident this will be upheld, because it should be upheld," Obama said in a joint press conference in the Rose Garden with Canadian Prime Minister Stephen Harper and Mexican President Felipe Calderon (Robb, 4/2).

Reuters: Obama Takes A Shot At Supreme Court Over Healthcare
President Barack Obama took an opening shot at conservative justices on the Supreme Court on Monday, warning that a rejection of his sweeping healthcare law would be an act of "judicial activism" that Republicans say they abhor. Obama, a Democrat, had not commented publicly on the Supreme Court's deliberations since it heard arguments for and against the healthcare law last week (Mason, 4/2).

Politico: Obama, The Left Take On Supreme Court
President Barack Obama has joined a growing number of Democratic lawmakers, left-leaning commentators and progressive activists who are warning the Supreme Court on the health care law: Don' you dare overturn it (Budoff Brown and Epstein, 4/3).

CNN: Obama Says Health Care Law Is Constitutional
President Barack Obama weighed in Monday on last week's Supreme Court arguments about health care reform, saying he expected the justices to rule the act is constitutional. "In accordance with precedents out there, it is constitutional," Obama said of the 2010 Affordable Care and Prevention Act passed by congressional Democrats with no Republican support. "That's not just my opinion, by the way, that's the opinion of legal experts across the ideological spectrum, including two very conservative appellate court justices that said this wasn't even a close case" (Cohen, 4/2).

Fox News: Obama Warns 'Unelected' Supreme Court Against Striking Down Health Law
The Supreme Court spent three days hearing arguments last week in four separate challenges to the health care law, which stands as the president's signature domestic policy accomplishment. A central challenge was over the individual mandate -- the requirement that Americans buy health insurance. Critics say the mandate is unconstitutional, and that the federal government cannot force people into the insurance marketplace. Obama on Monday said that without such a mandate, the law would not have a mechanism to ensure those with preexisting conditions get health care (4/2).

The Hill: Dems Wage Pressure Campaign On Supreme Court Over Health Ruling
Democrats have waged a not-so-subtle pressure campaign on the Supreme Court in recent days by warning a ruling against the healthcare reform law would smash precedent and threaten popular social programs. President Obama ... declared Monday that a wide array of legal experts would be astonished if the court struck down part or all of his signature domestic initiative. … Nan Aron, president of the Alliance for Justice and a prominent advocate during Supreme Court confirmation battles, said Obama and Democrats have made it clear that they would fiercely criticize a ruling against the healthcare law (Bolton, 4/2).

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Health Law Action At The High Court Takes A Political Toll

Findings from a new poll indicate that the public felt less favorable about both the health law and the Supreme Court after last week's oral arguments.

Politico: Poll: The High Court And Health Care
Almost two in three people, 63 percent, said what they saw and heard about the Supreme Court hearings on the health care law didn’t change their opinion of the measure, according to a Pew Research Center-Washington Post survey. Still, 23 percent said they had a less favorable view of the divisive law after the three-day hearings, compared with 7 percent who said they had a more favorable opinion after last week (Lee, 4/3).

The Hill: Poll: Supreme Court Arguments On Health Law Reinforced Partisan Divide
But when attitudes did shift, they followed a partisan division. According to the Pew poll, 35 percent of Republicans said they came away with a less favorable impression of the health law, and 32 percent of Democrats reported a more negative view of the Supreme Court (Baker, 4/2).

The Washington Post: Behind The Numbers: Political Fallout: High Court Showdown Hurts Health Care Law, And Justices
Almost four in 10 Republicans who followed the hearings “very” or “somewhat” closely say they are less favorable toward the health care law. The same number of attentive Democrats — 39 percent — say they now have lower regard for the Supreme Court (Cohen, Craighill and Clement, 4/2).

The Washington Post: The Fact Checker: 'Obamacare' And Rising Health Insurance Premiums
Be wary of the single data point, exploited either by Democrats or Republicans. This new RNC ad slams the Obama health care law for already causing a boost in health care premiums. … The ad, repeating the myth that the law is a "health care takeover," also asserts that costs in one part of the health care law are soaring, a claim we have debunked before. ... We offer no defense of Obama’s claim that his health care law will reduce premiums by $2,500 (Kessler, 4/2).

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Oral Arguments Showcased Justices' Personailities

The New York Times reports that last week's action at the Supreme Court gave the public an in-depth view of the insitution and the justices. Meanwhile, the Associated Press reports that, in a recent speech, Justice Sonia Sotomayor didn't give any hints about what the high court will do on the health law question.

The New York Times: Justices' Cerebral Combativeness On Display
Over three days of intense arguments on the future of President Obama's health care law, the public got a vivid glimpse of an institution at once immensely powerful and intensely human, one packed with brainy, funny and assertive justices prepared to confront and decide the most urgent issues of the day (Liptak, 4/2).

The Associated Press/Washington Post: Sotomayor Doesn't Drop Any Health Care Hints At UDC Speech
Justice Sonia Sotomayor is giving no hints on what the Supreme Court is going to do on the question of whether President Barack Obama's signature health care overhaul law is constitutional. Sotomayor was the featured speaker Monday night at a lecture hosted by the University of the District of Columbia (4/2).

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Capitol Hill Watch

Ryan Budget Plan Draws Tough Talk From Obama While Insurers Keep Their Distance

President Barack Obama offers sharp critcism of the GOP budget plan, which passed the House on a near-party-line vote last week and which has been embraced by GOP presidential hopefuls.  Although the plan, written by House Budget Chairman Paul Ryan, R-Wis., would greatly expand the role of private insurers in Medicare, the insurance industry has been mostly silent as well.

The Associated Press/Washington Post: Obama Calls House GOP Budget Plan A Trojan Horse For 'Radical' Change
Obama, in a speech to newspaper executives, is sharply criticizing a $3.5 trillion budget proposal pushed by Rep. Paul Ryan, R-Wis., which passed on a near-party-line vote last week and has been embraced by GOP presidential hopefuls. The plan has faced fierce resistance from Democrats, who say it would gut Medicare, slash taxes for the wealthy and lead to deep cuts to crucial programs such as aid to college students and highway and rail projects (4/2).

Politico Pro: Insurers Keep Distance From Ryan Plan
The Paul Ryan budget would greatly expand the market for private insurers, offering them the chance to enroll millions of new Medicare customers under a premium support model. So you would think insurers would be overjoyed. Guess again. What at first blush looks like a boon for insurance companies instead appears to be more of a bane — or at least a big question mark. The politics behind the Ryan proposal are noxious enough that the industry is keeping its distance. No House Democrat supports the Ryan budget, and even some House Republicans bailed. And the policy behind the budget blueprint hasn't been fleshed out enough for insurers to feel confident that they really know how it would work (DoBias, 4/3).

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Campaign 2012

Health Care Issues Among Women Voters Fueling Obama Lead On Romney

A new poll finds that President Obama leads GOP presidential hopeful Mitt Romney among women in 12 swing states -- a finding fueled mostly by health care, the top issue for women, according to the poll.

Boston Globe: Poll: Obama Leads Romney By 9 Points In Swing States
Women have propelled President Obama to a widening lead over Republican frontrunner Mitt Romney in a dozen swing states, according to a poll released Monday. ... Women said health care is the most important issue in the campaign. Obama in 2010 led passage of a health care reform law, which Romney has vowed to repeal if elected. The Supreme Court is expected to rule on the constitutionality of the law in June (Borchers, 4/2).

Another GOP presidential hopeful, Rick Santorum, lays out his plan for health care --

National Journal: Santorum Offers Health Care Plan In Op-Ed
Rick Santorum offered a stark contrast to President Obama's health care law on Monday, saying he would repeal the legislation and propose a plan that relies on private insurance. In an op-ed in USA Today, the former Pennsylvania senator said he would repeal the Affordable Care Act and replace it with a plan that will allow companies to compete over state lines and allow Americans to buy health insurance with pre-tax dollars. He also contends that those with pre-existing conditions, who have gaps in their coverage, would pay more "afterward" to sign up for care (Miller, 4/2).

And the health care issue is playing out in races for congressional seats as well --

Des Moines Register: Democratic Radio Ad Accuses Latham Of 'Choosing Millionaires Over Medicare'
A new radio ad is running in Iowa today that accuse Republican U.S. Rep. Tom Latham of "choosing millionaires over Medicare." The Democratic Congressional Campaign Committee is running the ads, which hinge on last week's U.S. House budget vote. ... Latham and U.S. Rep. Leonard Boswell are locked in a tight battle to represent Iowa's 3rd Congressional District, which includes the Des Moines area (Jacobs, 4/2).

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Health Care Marketplace

FTC Approval Of Express Scripts-Medco Merger Triggers New Battlegrounds

Drug stores and community pharmacists have pledged to fight on in the courts, but some consumer advocates see a silver lining in the merger.

Arizona Republic: Express Scripts Cleared For Merger With Medco
The Federal Trade Commission on Monday approved the $29.1 billion merger of pharmaceutical giants Medco and Express Scripts, one of the largest private employers in Tempe. The FTC's 3-1 vote clearing Express Scripts' acquisition of Medco followed an eight-month investigation into the effects the merger would have on the industry (Rodriguez, 4/2).

CQ HealthBeat: FTC Allows Pharmacy Benefit Manager Merger, But the Battle Rages On
Pharmacists and retailers vowed to keep fighting in the courts following Monday's announcement that the Federal Trade Commission voted 3-1 to close an investigation into the Express Scripts-Medco merger after finding that it will not "substantially lessen competition" among pharmacy benefit managers. The high-profile $29 billion deal combining the two PBM giants has been strongly opposed by the National Association of Chain Drug Stores and National Community Pharmacists Association (Norman, 4/2).

NPR Shots Blog: As Health Care Giants Merge, Pharmacies Aren't Happy
Express Scripts sealed its long-planned deal to buy Medco Health Solutions on Monday after the Federal Trade Commission voted 3-1 that it would not stifle competition in the industry. The two companies already provide prescription drug benefit services to some 135 million people -- more than 1 out of every 3 Americans. But while the FTC might not think the $29 billion union of Express Scripts and Medco threatens the market for how prescription drugs are distributed to patients, owners of brick-and-mortar drugstores certainly do (Rovner, 4/2).

Politico Pro: Groups See Silver Lining In PBM Fight
Consumer advocates who fought the merger of Express Scripts and Medco have found a silver lining in the FTC's drawn-out investigation of the deal, even though the agency ultimately voted to let it go through. "It has really forced [pharmacy benefit managers] to come out of the shadows a little bit, and now there's serious national scrutiny," said Sharon Treat, a state legislator in Maine and president of the National Legislative Association on Prescription Drug Prices (Norman, 4/3).

The Hill: Senate Judiciary Republican Lauds FTC Approval Of Medco Merger
The top Republican on the Senate Judiciary antitrust panel on Monday applauded the Federal Trade Commission's approval of the merger between pharmacy benefit managers Medco Health Solutions and Express Scripts. More than 80 lawmakers of both parties had raised concerns that the merger would lead to fewer choices for patients. Sen. Mike Lee (R-Utah), however, said antitrust regulators made the right choice (Pecquet, 4/2).

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Administration News

White House, FDA Often Clash

The New York Times: White House And The FDA Often At Odds
The internal clashes over F.D.A. policy played out against a broader backdrop of regulatory politics. Republicans have made the charge that Mr. Obama is an overzealous and job-killing regulator — a central element of their case against his re-election. And on issues from clean air to investor protections, the White House has been carefully calibrating its election season positions (Harris, 4/2).

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CMS: Medicare Advantage, Part D To Get 3 Percent Boost In 2013 Reimbursements

Also in the news, the Centers for Medicare & Medicaid Services announced nearly $50 million in grants to state agencies to help seniors better understand Medicare.  

CQ HealthBeat: CMS Allows 3 Percent Growth Rate For Medicare Advantage, Part D
Officials at the Centers for Medicare and Medicaid Services late Monday announced that the estimated annual average reimbursement growth rate for Medicare Advantage and Part D prescription drug plans in 2013 will be 3.07 percent. The average plan increase is likely better news than last year's increase for the private health plans that serve Medicare patients; the reimbursement increase then was 0.4 percent on average. This year's uptick, beginning Jan. 1, will promote a "stable" landscape for the plans' insurers, officials said (Norman,4/2).

The Hill: Medicare Counselors Get Nearly $50M In Grants
The federal Medicare agency awarded nearly $50 million in grants Monday to state offices that help seniors understand Medicare. The agency will award $46.5 million over the next year to State Health Insurance Assistance Programs (SHIPs). There are 54 SHIPS in the United States and the territories. The organizations provide one-on-one counseling to seniors about their Medicare benefits. A second round of SHIP grants, based on performance, will be awarded in September (Baker, 4/2).

CMS also backtracked on a recent policy affecting nursing homes and pharmacies.

Bloomberg: Nursing Homes Won't Have To Hire Independent Pharmacists
The U.S. Centers for Medicare and Medicaid Services backtracked on a plan that would have required nursing homes to hire independent pharmacists to assess residents' prescriptions. Regulators "decided to further study the issue for future policy considerations," Jonathan Blum, deputy director of the agency, said in a conference call with reporters late yesterday. The centers said in October it was considering stricter rules to oversee patients' drug regimens, an announcement that sent the stocks of nursing home pharmacies, including Omnicare Inc. (OCR) and PharMerica Corp. (PMC), tumbling (Wayne, 4/3).

The Hill: Medicare Agency Drops Proposed Pharmacy Restrictions At Nursing Homes
The Medicare agency announced Monday that it has dropped a proposed requirement that nursing homes and other long-term-care facilities work with independent pharmacists in an effort to tamp down on overprescribing of antipsychotics and other drugs. The agency has decided to "further study the issue" after stakeholders raised concerns that doctors' prescription patterns, rather than consultant pharmacists, were driving overuse, said Jonathan Blum, the director for the Center for Medicare at the Centers for Medicare and Medicaid Services (Pecquet, 4/2).

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Public Health & Education

Norway Study Raises New U.S. Mammogram Overdiagnosis Questions

An analysis showing significant mammogram overdiagnosis in Norway has raised new questions about mammograms in the U.S., where some say the overdiagnosis problem could be more rampant because of how early most women begin getting them.

MedPage Today: Breast Cancer Screening Under Fire Again 
A retrospective analysis in Norway found 6 to 10 cases of overdiagnosis for every 2,500 women invited to have mammographic screening, according to Mette Kalager, MD, of Harvard School of Public Health in Boston, and colleagues. In other words, the screening found a relatively large number of cancers that would not have become clinically significant during the woman's lifetime, Kalager and colleagues concluded in the April 3 issue of Annals of Internal Medicine (Smith, 4/2). 

Medscape: Mammography Screening Linked to Overdiagnosis of Cancer 
The investigators suggest that overdiagnosis not only poses a significant ethical dilemma but also burdens the patient and the health care system. ... Overdiagnosis is probably even more common in the United States than in Norway, because U.S. radiologists are more likely than European radiologists to report mammographic abnormalities, and because U.S. women often start annual mammography screening at 40 years of age, whereas Norwegian women start biennial screening at 50 years of age (Barclay, 4/2). 

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New County Health Rankings Released

Researchers found distinct regional patterns: They reported that excessive drinking rates were highest in the northern states, while rates of teen births, sexually transmitted infections and children in poverty were highest in the South.

USA Today: Health Statistics Help Shape Local Policies
Better access to health care data helps local governments improve preventive health policies aimed at reducing overall medical costs, say researchers who released the third annual national County Health Rankings today (Kennedy, 4/2).

Kaiser Health News: Capsules: Measuring Health County-By-County
The 2012 County Health Rankings are out this week from the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation. The rankings assess the health of nearly every county in all 50 states and the District of Columbia, and they allow you to compare rankings on a handy calculator of key health indicators, including their percentage of uninsured citizens (Gold, 4/2).

Modern Healthcare: County Health Data Released: Heavy Drinking Up North; Teen Pregnancy In South
Using a long list of factors that includes rates of teenage pregnancy, obesity, unemployment, preventable hospital stays and deaths from car crashes, the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute have released a report detailing public health status in more than 3,000 counties across the U.S. ... Researchers found distinct regional patterns, according to the release. Excessive drinking rates were highest in the Northern states, and rates of teen births, sexually transmitted infection and children in poverty were highest in the South (McKinney, 4/3).

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State Watch

Blues Insurers Win Antitrust Case In Mich., See Profits Increase 20% In Minn.

Blue Cross and Blue Shield in Michigan won a hospital pricing antitrust case. In Minnesota, nonprofit insurer UCare prepares to return $8 million to the state, while Blue Cross and Blue Shield of Minnesota's profit rose 20 percent in 2011.

Modern Healthcare: Michigan Blues Wins One Antitrust Case
Blue Cross and Blue Shield of Michigan and 22 hospitals have successfully fought off an antitrust lawsuit from the city of Pontiac, Mich., in one of several pending cases that allege a pattern of anticompetitive activity that mirrors allegations in an ongoing federal lawsuit against the state's dominant insurer. At issue are two types of "most-favored nation" pricing contracts used by Blue Cross that require competing insurance companies to pay at least as much, and sometimes more, than the prices Blue Cross receives in exchange for bringing its volume of business to the health care providers (Carlson, 4/2).

(St. Paul) Pioneer Press: HMO Profits Cap Means Nearly $8 Million For Minnesota 
A cap on HMO profits instituted in Minnesota last year will generate about $8 million for state government, a number that could grow. That's the early conclusion from filings being submitted to regulators this week by the state's nonprofit health plans. In a filing Monday, April 2, Minneapolis-based UCare said it expects to return $7,977,270 million to the state, a sum that represents the amount of excess earnings that UCare received last year through its contracts with Minnesota (Snowbeck, 4/2).

(St. Paul) Pioneer Press: Blue Cross Profit Up 20% In 2011; Reserves At $1.15 Billion
Eagan-based Blue Cross and Blue Shield of Minnesota saw its profit grow by just over 20 percent in 2011 as financial reserves at the state's largest health insurer grew to $1.15 billion. Most of the profit and reserves came from the company's commercial health insurance business, Blue Cross officials said in a regulatory filing Monday, April 2.  As has been true for other commercial insurers, the strong financial results were driven in part by depressed use of health care services, the company said (Snowbeck, 4/2).

In the meantime, the Oregon Insurance Division has approved a rate increase for Providence Health Plans.

The Lund Report (an Oregon news service): Insurance Division Approves 2.2 Percent Rate Increase for Providence 
Small employers who have coverage through Providence Health Plans will see their rates climb, on average, by 2.2 percent starting August 1. The rate hike will impact about 30,000 people over nine months ... Initially, Providence had requested a 5 percent rate hike. However, the Insurance Division lowered that increase primarily because Providence had erroneously overstated its administrative expense costs and other expenses related to federal health reform (Lund-Muzikant, 4/2).

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FTC Blocks Ohio Hospital Merger; Kan. Mental Hospital's 'Poor Working Conditions'

A summary of hospital news from Kansas, California, Wisconsin and Ohio.

The New York Times: Regulator Orders Hospitals To Undo A Merger In Ohio
The Federal Trade Commission has blocked an Ohio hospital merger in a closely watched case that could slow the consolidation of health care providers around the country. ... [the FTC] ruled that the merger of the ProMedica Health System and St. Luke’s Hospital would “substantially lessen competition” in the Toledo area, allowing the hospitals to charge higher prices. ... ProMedica had argued that the merger would advance the type of collaboration promoted by President Obama under the new health care law (Pear, 4/2).

Milwaukee Journal Sentinel: Hospital Performance Rewards Fail to Cut Death Rates
A six-year experiment that rewarded hospitals - including those in the Aurora Health Care system - for their performance on an array of quality measures did not lead to a decrease in mortality rates ...  Aurora's hospitals received $1.9 million in additional Medicare payments for achieving certain quality benchmarks during the program (Boulton, 4/2).

Earlier, related KHN story: Effort To Pay Hospitals Based On Quality Didn’t Cut Death Rates, Study Finds (Rau, 3/28)

Kansas Health Institute News: Accrediting Team Cites Problems At Larned State Hospital
A new inspection report on the state mental hospital here has underscored the severity of what has been a major problem at the facility for months and years: Because of the poor working conditions, state officials are having a hard time keeping doctors, nurses and others on the job (4/2). 

California Healthline: Community Rallies To Keep Kern Residency Program on Track
Zack Scrivner wasn't quite sure what to do. The chair of the Kern County Board of Supervisors was presiding over a meeting in Bakersfield to determine the direction of the Kern Medical Center family practice residency program, and there were just too many people there who wanted to say something. ... People from all over the county came to the meeting to express opposition to the cutback of the family practice residency program (Gorn, 4/2). 

Minneapolis Star Tribune: Tiny Sandstone. Minn., Fights For Its 25-Bed Hospital 
Civic leaders here are crying foul over what they view as a hostile takeover of one of Sandstone's most precious assets: a 25-bed hospital that has the only 24-hour emergency room and heliport for miles. Last fall, the citizens' board that controls the hospital's land and building served notice that it was essentially evicting the Duluth-based medical corporation Essentia Health, which had run the hospital for 15 years. Board members say they were frustrated that Essentia didn't want to expand or rebuild. ... The controversy comes as more of Minnesota's small, so-called "critical-access" hospitals like Sandstone's are being absorbed by health care corporations such as Mayo, Sanford and Essentia. And it's sparked debate about the purpose of the extra Medicare reimbursements such hospitals get (Oakes, 4/2).

Des Moines Register: Grassley Calls For Probe Of Iowa City VA Hospital
U.S. Sen. Chuck Grassley is asking for a comprehensive investigation of the Iowa City Veterans Affairs Health Care System after his office received reports of "serious allegations" of patient care issues at the facility. In a March 7 letter to George Opfer, inspector general of the Department of Veterans Affairs, Grassley, R-Ia., said he had heard from people "concerned about the direction of the facility and its impact on patient care" (Schettler, 4/2).

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Wash. State Suspends ER-Payment Plan; Penn. 'Slashes' Kids From Medicaid Rolls

A selection of Medicaid news from Pennsylvania, Washington state, Colorado and California.

The Wall Street Journal: State Suspends Plan To End ER-Visit Payments
Washington Gov. Chris Gregoire has suspended a plan for the state's Medicaid agency to stop paying for certain emergency-room visits. The planned cuts, which were designed to reduce health-care costs and were set to go into effect April 1, drew opposition from hospitals and doctors, who said they would be stuck with bills for care they often would be legally required to provide (Mathews, 4/2).

Seattle Times: Gregoire Suspends Plan To Limit Medicaid Emergency-Room Visits
Gregoire's budget director, Marty Brown, said Saturday that Gregoire on Friday stopped the Medicaid plan from going into effect, noting growing legislative support for a less-drastic alternative. The alternative plan, pushed by Rep. Eileen Cody, D-West Seattle, is a modified version of a proposal offered by emergency-room doctors and hospitals (Ostrom, 3/31).

Denver Post: Colorado Medicaid Expansion To Add 10,000, But Many More Out Of Luck
Colorado's latest Medicaid expansion is long overdue, health advocates say, but is burdened from the outset with a lottery system serving only 1 in 5 of those in need. The state starts taking applications this week for a new group of Medicaid patients — adults without dependent children — breaking a mold that long defined the insurance program in both scope and cost (Booth, 4/3).

Colorado Public Radio: State Launches Historic Medicaid Expansion
There are 650,000 people on Medicaid in Colorado, about 13% of the state population ... ten percent of the federal poverty level means an income of about $1,100 per year (Whitney, 4/2).

The Philadelphia Inquirer: Uncovering Kids: 89,000 Poor Pa. Kids Slashed From Medicaid
At least 89,000 children vanished from the state Medicaid rolls between August and January - roughly 25,000 of them in Philadelphia, according to the state Department of Public Welfare. Most of those kids - about 71,000 statewide - were removed as part of a massive effort to clear a backlog of recipients whose paperwork was not up to date … But many of the children were wrongfully kicked off, and 23,180 have been reinstated in the program so far (Hinkelman and Lucey, 4/3).

California Healthline: New Adult Program Launches With a Few Issues Still To Be Resolved
It was January 2011 when the governor first red-lined the Adult Day Health Care program for elimination as a Medi-Cal benefit. Since then, it has been rescued, cut in half, eliminated altogether, reinstated and replaced. Yesterday the replacement program, Community Based Adult Services, went into effect (Gorn, 4/3).

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State Roundup: Docs Fight Over HMO In Fla.; Calif. Mulls Public Employee 'Bill Of Rights'

A selection of state health care stories from Florida, Minnesota, California and Georgia.

Health News Florida: Doctors Fight Over Universal HMO
Two doctors who are among Florida's most aggressive fundraisers for the Republican Party have had a nasty falling-out over control of an HMO. Dr. Zachariah P. Zachariah, a prominent Broward cardiologist, has filed suit against Dr. Akshay Desai, the chairman and CEO of Universal Health Care. Universal, founded in 2002, is a fast-growing Medicare HMO based in St. Petersburg (Gentry, 4/3).

Minneapolis Star Tribune: A Health Care Ruling Not Apt To End Minn.'s Reform Efforts 
If the U.S. Supreme Court pulls the plug on all or part of the federal health care law, hold off on scrawling R.I.P. on reform efforts in Minnesota. The path might change but the momentum won't die, say some observers and industry leaders. "There's enough happening on the reform side, you can't roll that one back. You can't stop it," said former U.S. Sen. David Durenberger, who now chairs a health policy institute at the University of St. Thomas. "Health systems are going to be hurt here, no question about that. But it's much less difficult to see us tackling this now than it will be in other parts of the country” (Crosby, 4/2).

Stateline: A Bill Of Rights For State Workers? 
It may not seem as though a "Public Employees' Bill of Rights" is an idea whose time has come in California. ... But for the bill's sponsor, Democratic Assemblyman Roger Dickinson, the very real, ongoing threat of major changes to the state's relationship with its employees is just proof that the legislation is needed. ... Stuart Bussey, president of the Union of American Physicians & Dentists, which is pushing the legislation, says some of the most important provisions for his members relate to oversight of employees who are required to maintain professional licenses, such as nurses (Maynard, 4/3). 

Georgia Health News: A Powerful Voice In Health Care - Q & A With David Cook 
If you add Medicaid and PeachCare beneficiaries to the members of the state employees' health plan, it comes to more than 2 million Georgians. The Department of Community Health, in charge of those three health programs, oversees the health care of more than 20 percent of the state’s population. David Cook has presided over DCH as commissioner for more than a year (Miller, 4/2).

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Editorials and Opinions

Viewpoints: Shouldering The Health Costs Of The 'Irresponsible'; Learning From the Parallels Between Obamacare And The 'War On Terror'

Chicago Tribune: The Imagination Goes Wild: Paying For The Health Care Of The Irresponsible
The central idea of the Patient Protection and Affordable Care Act — the formal name of the Obamacare law — emphasized in the hearings is to spread the cost of health care to ever-larger pools of Americans. In particular, to those who pay low health insurance premiums, the young who choose to have no insurance and the healthy (Dennis Byrne, 4/3).

McClatchy: Health Care Mandate Is About Personal Responsibility
Following the debate over the Affordable Care Act has reminded me of that old saw, everybody wants to get to heaven but nobody wants to die. … The problem we've long had with balancing our books is that we too frequently demand things for which we don’t want to pay. The individual mandate is unpopular largely because it threatens to shift that paradigm (Issac J. Bailey, 4/3).

The Washington Post: The War On Terror And Obamacare: Mirror Images
As policies, Obamacare and George W. Bush's war on terror have almost nothing in common. ... Yet from the Supreme Court's perspective, they pose practically the same question: How much more authority over individuals can the federal government assume, consistent with the Founders' notion of limited and enumerated powers? ... In cases stemming from the war on terrorism, the court consistently ruled against the Bush administration. ... The justices were not willing to let the government claim unlimited powers of arrest and detention, even in the name of such a good cause as national security (Charles Lane, 4/2).

The Wall Street Journal: What To Do On The Day After ObamaCare
Last week, the Supreme Court heard arguments on the constitutionality of the administration's health law, aka ObamaCare. Opponents are giddy with the possibility that the law might be struck down. But what then? Millions of uninsured, both those who choose not to purchase coverage and those who can't due to pre-existing conditions, will still be with us. The rising costs and inefficient delivery of health care will still be with us (Cochrane, 4/2).

The Wall Street Journal: Obama Vs. Marbury V. Madison
President Obama is a former president of the Harvard Law Review and famously taught constitutional law at the University of Chicago. But did he somehow not teach the historic case of Marbury v. Madison? That's a fair question after Mr. Obama's astonishing remarks on Monday at the White House when he ruminated for the first time in public on the Supreme Court's recent ObamaCare deliberations. "I'm confident that the Supreme Court will not take what would be an unprecedented, extraordinary step of overturning a law that was passed by a strong majority of a democratically elected Congress," he declared (4/2). 

The Washington Post: Obama's Unsettling Attack On The Supreme Court
And yet, Obama's assault on "an unelected group of people" stopped me cold. Because, as the former constitutional law professor certainly understands, it is the essence of our governmental system to vest in the court the ultimate power to decide the meaning of the constitution. Even if, as the president said, it means overturning "a duly constituted and passed law" (Ruth Marcus, 4/2).

The Washington Post: The Real Reason SCOTUS Could Save POTUS
Obamacare may be President Obama's proudest legislative achievement, but the fact is it has been a political disaster for Democrats. The unpopular law has galvanized Obama's conservative opponents, driven away moderates and independents, and hung like an albatross around the neck of the U.S. economy. A decision by the Supreme Court to overturn the law in its entirety could be the best thing that ever happened to Obama's prospects for reelection (Marc A. Thiessen, 4/2).

The Wall Street Journal: Capital Journal: Court Lands On Campaign's Front Lines
Regardless of the judicial outcome, the Supreme Court's coming decision on the health-care overhaul will have one clear political impact: It guarantees the court will be with us for the next seven months as a front-line campaign topic. This will excite activists of the left and the right. It will be less thrilling for already-jaundiced independent voters in the middle, who spend a lot less time thinking about the virtues and demerits of, say, Justice Antonin Scalia than do the ideologues. And it surely isn't great for the Supreme Court itself (Gerald F. Seib, 4/2).

USA Today: Why Justice Kennedy Should Rule 'No'
Justice Anthony Kennedy is, in a sense, the king of the United States of America. As the deciding vote on the U.S. Supreme Court in dozens of important cases where the liberals and conservatives are evenly divided, he has become, in effect, a jurisprudential monarch (hence columnist Mark Steyn's nickname for him, "the Sultan of Swing"). He has been the final word on everything from the 2000 Bush-Gore presidential election to partial-birth abortion and terrorist detention. And now he will, in all likelihood, decide the constitutionality of the Patient Protection and Affordable Care Act— aka ObamaCare (Jonah Goldberg, 4/2).

The Washington Post: The Flawed Case Against Donald Verrilli
A Supreme Court argument was never intended to be a public-speaking contest in which each contestant has an equal chance to showcase his ability to deliver a polished oration. All of the justices may interrupt at any time — out of puzzlement, to test his or her tentative views of a case, or to persuade other justices of his or her view. Oral argument is the time to address the issues on the justices' minds. The advocate does not get to ask for time to complete a thought. He or she has to break off mid-sentence to address whatever question is asked (Feldman, 4/2).

The Baltimore Sun: The Supreme Court Should Be Televised
Nothing has focused as much attention on the Supreme Court since the 2000 Florida election recount case as last week's arguments over the constitutionality of President Obama's health care act. The outcome, expected this summer, will hang ominously over this year's presidential campaign until then, and beyond. … While virtually all other aspects of the American political system at work can today be observed directly by the citizenry, either live or on taped rebroadcast on television, the Supreme Court in session remains essentially in the dark (Jules Witcover, 4/3).

Politico: Battle Hymn Of The Anti-Abortion Feminist
In the ongoing debate over women’s health care, one voice has been mostly absent: that of the anti-abortion feminist. ... But women are not a monolith. And there is a growing group of passionate young women who are transforming what it means to be a woman. Allow me to introduce them to you. We are women who reject both the anti-male feminism of the 1960s and the "girls gone wild" mentality that’s pervasive today (Lila Rose, 4/2).

JAMA: High-Quality, Affordable Health Care Is a "Greater Freedom"
This week’s historic hearings at the US Supreme Court were political as much as they were constitutional. The justices borrowed the Republican framing of health care reform as one of individual freedom rather than the public's health. However, high-quality, affordable health care is the "greater freedom," as I explain in taking readers through the critical arguments at the Supreme Court (Lawrence Gostin, 4/2).

Boston Globe: Health Care Vs. Sick Care: Why Prevention Is Essential To Payment Reform
The foundation of our current health care system is the treatment of illness and disease rather than the promotion of good health. If we created the conditions to make it possible for people to take better care of themselves, countless medical conditions such as type II diabetes, certain cancers, heart disease, and obesity could be prevented. And the treatment of these diseases is what leads to skyrocketing health care costs (Thomas M. Menino and Paula Johnson, 4/2).

The Wall Street Journal: Antitrust Enlightenment
Too often modern antitrust policy seems to exist to justify the existence of the antitrust cops, not to defend competition. Recall the Federal Trade Commission's dogging of the Whole Foods bid to buy Wild Oats—would consumers ever be able to buy arugula again? So a round of applause for the FTC for committing antitrust heresy and signing off Monday on the $29.1 billion Express Scripts acquisition of Medco Health Solutions (4/2).

Seattle Times: A Lesson In Public-School Health Coverage From Oregon
Oregon made the change to consolidate health-insurance plans for its public school employees in 2007 and is saving about $45 million a year. If Washington made the same change — and it should — the state auditor estimated it could save as much as $90 million (4/2).

Minneapolis Star Tribune: The Case For Universal Care At the State Level
Surely few of us are satisfied with the way things are, or are convinced that the Affordable Care Act is the final reform, even if the U.S. Supreme Court upholds it. So let's hold onto the "unified and universal" option for Minnesota, with the knowledge that we can afford a system in which all newborns can be assured the essential human dignity of access to life-giving care, from the moment they enter the world until they draw their last breath (Amy Lange, 4/2).

WBUR’s CommonHealth blog: What Med Students Learn From Sticking With Their Patients
This Monday, my internal medicine supervising physician and I saw Helen's bald head for the first time. "Do you want to see it?" she asked. And, with our encouragement, she slowly removed her caramel-colored wig. ... Helen (not her real name) is one of nearly 500 patients I have seen as part of my third year at the Cambridge Health Alliance. I am one of ten students in this year's Harvard Medical School-Cambridge Integrated Clerkship, an innovative model for third year medical education that centers learning on the experience of the patient (Altaf Saadi, 4/2).

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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.