Daily Health Policy Report

Monday, April 30, 2012

Last updated: Mon, Apr 30

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Coverage & Access

Health Care Marketplace


Health Information Technology

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Conflicts Arise As Health Insurers Diversify

Kaiser Health News staff writer Jay Hancock, working in collaboration with The Washington Post, reports: "As insurers eager to add revenue streams convert themselves into diversified health-services companies, they often buy traditional business adversaries, including physician groups and hospital consultants such as EHR. They're also buying technology companies and research firms that serve medical-care providers, raising questions not only about independence but about the privacy of patient information" (Hancock, 4/29). Read the story.

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Sued Over An $1,800 Hospital Bill

Kaiser Health News staff writer Jenny Gold, working in collaboration with NPR, reports: "Nonprofit hospitals, including Mount Carmel, pay no federal, state or local taxes, giving them a competitive edge over their for-profit counterparts. In return, they are expected to offer a community benefit, including free and discounted care for low-income patients. But even as more and more Americans need extra help after losing their jobs and health insurance in the recession, studies suggest that on average, nonprofits provide only slightly more free and reduced-cost care than for-profit hospitals. Patient advocates argue the line dividing nonprofit hospitals and for-profit hospitals, which do not receive the tax exemption, has blurred" (Gold, 4/27). Read the story.

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Quick Facts About High-Deductible Health Plans

Kaiser Health News staff writer Shefali S. Kulkarni, working in collaboration with PBS Newhour, reports: "High-deductible health care plans are no longer a novelty—they are becoming mainstream. According to the industry trade group America's Health Insurance Plans, the number of people with this kind of coverage reached more than 11.4 million in January 2011, up from 10 million in January 2010" (Kulkarni, 4/27). Read the story.

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Capsules: Breaux: Bipartisanship Necessary To Fix Medicare Finances; What Is The Future Of Health Care? Watson Has An Answer

Now on Kaiser Health News' blog, Marilyn Werber Serafini and Mary Agnes Carey report on former Sen. John Breaux's take on fixing Medicare's finances: "Louisiana Democrat John B. Breaux left the Senate seven years ago, but old habits die hard. Today he fell back easily into his former role of compromise builder as he stressed the need for political common ground to overhaul Medicare next year" (Werber Serafini and Carey, 4/27).

Also on Capsules, Christian Torres reports on the future of health care -- Watson: "IBM's Watson frequently had the right answer when the supercomputer competed on Jeopardy last year. Now, the nation's second largest health insurer is hoping it will have the right diagnosis and treatment for patients" Torres, 4/30).

Check out what else is on the blog.

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Political Cartoon: 'Circle The Date?'

Kaiser Health News provides a fresh take on health policy developments with "Circle The Date?" by R.J. Matson.

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


Note to insurers:
Oh please stay out of health care
We can't afford you.

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

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Capitol Hill Watch

House Passes Student Loan Plan That Siphons Health Law's Prevention Trust Fund

The student loan issue has become a politically charged showdown with the health law in the middle of the controversy.

The Associated Press: Analysis: Student Loan Agreement? Not So Fast.
In the political campaigns still taking shape, President Barack Obama, Republican challenger Mitt Romney and lawmakers of both parties say they want to protect college students from a sharp increase in interest rates on federally subsidized loans. ... [But] what might have looked like a relatively simple matter mushroomed into a politically charged veto showdown that touched on the economy and health care, tax cuts and policies affecting women (Espo, 4/30).

Boston Globe: House Approves Republican-Backed Student Loan Proposal
[Friday,] the House approved by a 215-195 margin a largely Republican-backed proposal to extend college loan subsidies by siphoning funding from health care programs authorized by the president's health care overhaul legislation (Calvan, 4/27).

MarketWatch: House Defies Veto Threat, Passes Loan Bill
Defying a White House veto threat, the House of Representatives on Friday passed a Republican bill to keep interest rates on federal loans carried by college students from doubling on July 1. The nearly $6 billion cost of the House bill is paid for by taking money out of a prevention and public-health fund included in President Barack Obama's health-care law, a move opposed by many Democrats. Republicans pointed out that Democrats have voted to tap the fund to prevent reductions in payments to Medicare doctors (Schroeder, 4/27).

CBS News: WH Threatens Veto On Student Loan Bill Because Of Health Reform Repeal
"This is a politically-motivated proposal and not the serious response that the problem facing America's college students deserves," the Office of Management and Budget (OMB) said in a statement (Condon, 4/27).

The Hill: Boehner Says Obama 'Picking Fake Fights' With GOP Lawmakers
CNN host Candy Crowley pressed (House Speaker John) Boehner on why he has insisted that Congress pay for extending the low student loan rate by cutting a fund for preventative healthcare. ... Crowley said Democrats argue Congress should pay for the student loans by closing tax loopholes for oil companies and that slashing the health fund would cut services for women's health. "That is just nonsense," Boehner said. "There is no women's health issue here" (Sasso, 4/29).

Politico: 5 Prevention Programs GOP Hopes To Target
Here’s a look at five programs currently funded that could find themselves without cash, depending on how this fight plays out. Tobacco prevention ... Suicide prevention ... Community transformation grants ... Immunization ... Health care-associated infections (Smith, 4/29).

In other Capitol Hill news -

Modern Healthcare: House Proposal Would Reform Medical Liability
The House Judiciary Committee has approved a proposal that includes earlier-passed medical liability reform legislation as a way to find savings to avoid arbitrary, across-the-board cuts to federal programs next year... In a 16-14 vote, the panel approved the Help Efficient, Accessible, Low-cost, Timely Healthcare, or HEALTH, Act of 2011, which Rep. Phil Gingrey (R-Ga.), a physician, introduced last year (Zigmond, 4/27).

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Ryan's Medicare Plan Moves Him Into The Headlines

The New York Times reports on how the budget plan advanced Rep. Paul Ryan, R-Wis., has become the GOP's marching orders. In related news, the Medicare component of the Republican budget blueprint overhaul drew in-depth scrutiny during a House hearing last week.

The New York Times: The Ticket: Ryan's Rise From Follower To GOP Trialblazer
His prescriptions in the Republican budget plan he devised have become his party's marching orders: cut income tax rates and simplify the code, privatize Medicare, shrink the food-stamp and Medicaid programs and turn almost all control over to the states, and reduce domestic federal spending to its smallest share of the economy since World War II (Weisman, 4/29).

The Fiscal Times: What to Call Ryan's Private Medicare Plan
Architects of the plan call it "premium support." Opponents call it a voucher, which they say will over time lag behind medical inflation and force seniors to pay an ever-growing share of their health care bills. ... And it was that label that Republicans on the House Ways and Means health subcommittee repeatedly attacked during Friday's hearing on the Republican (Goozner, 4/27). 

Politico Pro: Medicare Hearing Explores Risks
The Ryan model greatly expands the role of private insurers in Medicare. It allows them to compete against a traditional Medicare fee-for-service option. Under the plan, seniors receive a risk-adjusted subsidy to help pay for their coverage. Critics contend the amount of the subsidy won't be enough to keep up with rising health care costs, and instead would shift costs to seniors (Dobias, 4/27).

Kaiser Health News: Capsules: Breaux: Bipartisanship Necessary To Fix Medicare Finances
Louisiana Democrat John B. Breaux left the Senate seven years ago, but old habits die hard. Today he fell back easily into his former role of compromise builder as he stressed the need for political common ground to overhaul Medicare next year (Werber Serafini and Carey, 4/27).

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Health Reform

Some Parts Of Health Law Expected To Take Hold Regardless of Court Decision

Many experts believe state-level health exchanges are here to stay. However, Politico reports that some state officials worry that if the individual mandate is struck down, healthy people could avoid buying policies and premiums for everyone else could skyrocket, putting them in a bind.

St. Louis Beacon: Some Health Reforms Will Continue No Matter What Supreme Court Says About The Affordable Care Act
Though efforts to set up a health insurance exchange in Missouri have failed so far, the concept is regarded nationally as one of many Affordable Care Act measures that will take root and thrive ... Among those betting on the survival of some form of insurance exchange and a few other measures that are expected to result in a sea change in health care access and delivery is Christopher Condeluci, who was tax counsel for the Senate Finance Committee during the period when the health reform legislation was crafted (Joiner, 4/28).

Politico: States Could Be In A Bind On Mandate
If the Supreme Court strikes down the health reform law's individual mandate, the states at the forefront of implementing the law could find themselves like Wile E. Coyote in the Road Runner cartoons: racing ahead only to discover there's no ground underneath their feet. These states were all counting on the individual mandate to make health insurance exchanges viable — because without a requirement for most people to buy coverage, there's a chance that healthy people could avoid paying into the system, making premiums skyrocket (Feder and Millman, 4/29).

In related news, the White House is reportedly eyeing a loophole in the law -

Politico Pro: W.H. Watches For Small-Business Dodge 
The Obama administration may be laying the groundwork to close a loophole in the health reform law that some worry could undermine the small-group market. The administration requested comment Friday on whether regulations are needed to prevent small employers from becoming self-insured in order to get around some Affordable Care Act rules. Historically, only large employers have decided to self-insure. That’s largely because small employers could find themselves bankrupt if just one of their employees fell seriously ill. But now, there’s a growing market for stop-loss insurance with low "attachment points" — meaning it starts paying the costs after employers have paid only a small amount out of their own pockets. And these policies could make it possible for large numbers of small employers to exit the small-group market and the rules that will apply to it under the ACA (Feder, 4/27).

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Coverage & Access

High-Deductible Plans Become 'Mainstream' In The Marketplace

The PBS News Hour story examined how high-deductible health plans work, and possible consumer risks with this form of health coverage.

PBS News Hour: High-Deductible Plans A 'Quiet Revolution In Health Insurance'
Dennis Adams is what the insurance industry calls a young invincible. ... So when the non-profit Oberlin Dance Company of San Francisco offered a new type of health insurance three years ago, the 27-year-old professional dancer didn't think twice. He signed up right away. It was a high-deductible insurance plan that traded lower monthly premiums for higher out-of-pocket costs to employees. In this case, Adams would have to pay $2,500 up front before his health insurance would kick in, if he needed it. Then, the unthinkable. ... Adams tore his ACL. When he need an MRI to determine how bad the damage was, the provider demanded the $1,600 test be paid for up front. Adams was stunned, but, even worse, he didn't have the money (Bowser, 4/27).

Kaiser Health News: Quick Facts About High-Deductible Health Plans
High-deductible health care plans are no longer a novelty—they are becoming mainstream. According to the industry trade group America's Health Insurance Plans, the number of people with this kind of coverage reached more than 11.4 million in January 2011, up from 10 million in January 2010 (Kulkarni, 4/27, done in collaboration with the News Hour).

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Health Care Marketplace

Hospital Collection Co. Says Minn. Attorney General 'Grossly' Distorted Its Work

Accretive says it is seeking to address concerns. The Minnesota probe suggested the company may have thwarted state and federal rules to get payments from patients even as they were seeking hospital care.

Modern Healthcare: Accretive Hits Back At AG Report
Materials from a state attorney general "grossly distort and mischaracterize Accretive Health's revenue cycle services," the Chicago-based billing company said in a lengthy statement Sunday, days after Rep. Pete Stark (D-Calif.) called for a federal probe into the company's collection practices. A report last week from Minnesota Attorney General Lori Swanson showed Accretive may have violated both state and federal laws that protect consumers and patient privacy by urging patients to pay bills as they sought care, even in the emergency room. According to the report, patients' private medical records were also used in efforts to collect payment (Zigmond, 4/29).

Bloomberg: Accretive Says It's Working To Address Minnesota Concern
Accretive Health Inc. (AH), a hospital billings-collection company, said it's working with advisers to address concerns raised by the Minnesota attorney general’s office that it puts bedside pressure on patients to pay bills. ... The suggestion Accretive puts bedside pressure on patients to pay their bills out of pocket are a "flagrant distortion of fact," the company said. Accretive shares tumbled by the most ever on April 25, just after Minnesota Attorney General Lori Swanson issued a report alleging Accretive violated U.S. and state patient-privacy and debt-collection laws (Hart and Wayne, 4/30).

Minneapolis Star Tribune: Billing Company Denies It Pressured Fairview Hospital Patients
The Illinois firm accused of pressuring Fairview hospital patients to pay even as they waited in emergency rooms pushed back against critics Sunday, accusing Minnesota Attorney General Lori Swanson of grossly distorting its collection practices. "The inaccuracies, innuendo and unfounded speculation that have been part of the Minnesota attorney general's recent allegations are extensive," the company said in a statement. "We are working with our advisors to address the allegations." In a six-volume report earlier this month, Swanson described in detail how patients were harassed and manipulated after Accretive Health introduced sweeping changes at Fairview's seven Twin Cities hospitals and implemented new strategies for collecting revenue (Marquez Estrada, 4/29).

Chicago Tribune: Accretive Gets Clean Bill Of Health From Other Customers
Health systems that work with Chicago-based Accretive Health backed the company Friday, saying they hadn't seen evidence of the allegations raised in Minnesota that the debt collector violated patients' rights. Their endorsements came as the Minnesota-based hospital system embroiled in the payment controversy severed its remaining contracts with the Chicago-based company (Frost, 4/28).

Meanwhile, in other news about hospital billing practices -

Kaiser Health News: Sued Over An $1,800 Hospital Bill
Nonprofit hospitals, including Mount Carmel, pay no federal, state or local taxes, giving them a competitive edge over their for-profit counterparts. In return, they are expected to offer a community benefit, including free and discounted care for low-income patients. But even as more and more Americans need extra help after losing their jobs and health insurance in the recession, studies suggest that on average, nonprofits provide only slightly more free and reduced-cost care than for-profit hospitals. Patient advocates argue the line dividing nonprofit hospitals and for-profit hospitals, which do not receive the tax exemption, has blurred (Gold, 4/27).

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Health Care Spending: A Change In Behavior?

This pair of New York Times' stories examines how a recent "flattening out" trend in health spending may be the result of a change in behavior by both providers and consumers.  

The New York Times: In Hopeful Sign, Health Spending Is Flattening Out
The growth of health spending has slowed substantially in the last few years, surprising experts and offering some fuel for optimism about the federal government's long-term fiscal performance. Much of the slowdown is because of the recession, and thus not unexpected, health experts say. But some of it seems to be attributable to changing behavior by consumers and providers of health care — meaning that the lower rates of growth might persist even as the economy picks up (Lowrey, 4/28).

The New York Times: How One Hospital Bent The Cost Curve
Many economists and health policy specialists think that changes made by insurers, hospitals and doctors to emphasize the quality of care rather than the quantity of care is a major factor, and Children's Hospital Boston offers a good test case. But about four years ago, the hospital recognized the growth in costs as unsustainable — as many institutions in Massachusetts did after the state passed an individual mandate law. ... All in all, the hospital made more than 100 changes and cut tens of millions of dollars in costs (Lowrey, 4/28).

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Humana Reports Drop In First Quarter Profits

The insurer attributed the decrease to paying out more in claims, as well as additional investment as it anticipates strong growth in its Medicare Advantage plans.

The Wall Street Journal: Ahead Of The Tape: Humana Is Poised To Weather Any Ills
Careful what you wish for—you just might get it. Investors in health insurers squirmed through the first year-and-a-half of Barack Obama's presidency as his industry overhaul took shape. Now, the sector that seemingly stood to lose the most from the Patient Protection and Affordable Care Act is in no mood to cheer the constitutional challenge the law faces in the Supreme Court. Happily for Humana, the possible repeal of all or part of the health-care law would be less of a blow than that faced by insurers such as Aetna Inc. or WellPoint Inc. For them, the individual mandate, the requirement that everyone carry coverage or face penalties, amounts to the government forcing tens of millions of people to use their services (Jakab, 4/29).

The Associated Press: Humana Reports 21 Percent Drop In 1Q Profit
Humana Inc. said Monday that its first-quarter profit fell 21 percent as the health insurer paid out more in claims and bolstered spending in anticipation of growth in its lucrative Medicare Advantage membership. ... Humana cited favorable claims trends from prior periods in raising its forecast. In essence, Humana set aside more money in previous quarters than was needed to pay claims during a slowdown in the use of health care services by consumers who felt pinched during the recession (Schreiner, 4/30).

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Report: Nursing Homes And Anti-Psychotic Drugs

A report by the Boston Globe based on government information finds many nursing homes use powerful sedatives on patients who should not be getting them.

Boston Globe: Over two months in early 2006, she visited 10 facilities, trying to make sure she picked the right one. Weingartner finally chose Ledgewood Rehabilitation and Skilled Nursing Center in Beverly because it had an Alzheimer’s special care unit and it was near her home. She could visit her mother often (Lazar and Carroll, 4/29).

USA Today: Report: Anti-Psychotics Wrongly Prescribed In Nursing Homes
Many nursing homes are typically using anti-psychotic drugs in residents who display agitation and combative behavior, but who should not be administered the powerful sedatives, a Boston Globe report based on government data has found (Eversley, 4/29).

Earlier, related KHN coverage: Off-Label Use Of Risky Antipsychotic Drugs Raises Concerns (Boodman, 3/12).

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Health Information Technology

Health Information Technology Gains Momentum, Uses

Media outlets report on various issues related to health information technology.

Boston Globe: Medical Care Shifting To Electronic Data Files
One in 10 doctors who work outside hospitals in the United States began using electronic health records in 2011, helped along by the promise of $27 billion in incentives from the federal government. As of the end of last year, 35 percent of such doctors had a system that performed at least basic functions, including ordering of prescriptions and storing doctor notes and test results, according to one in a series of studies on the topic published in the latest issue of the journal Health Affairs (Conaboy, 4/30).

The New York Times: Chicken Scratches Vs. Electronic Prescriptions
E-prescribing comes as part of the switch to electronic health records, which can cost a medical practice tens of thousands of dollars. The stimulus package passed in 2009 included provisions that theoretically ease the financial burden for doctors, but the payments are tied to Medicare and Medicaid reimbursements that are spread out over five years. So the upfront costs remain substantial (Stross, 4/28).

The Atlanta Journal-Constitution: Elder Care Enters The Digital Age 
The growing business of taking care of aging seniors at home is getting help from a powerful, but unlikely suspect: the mobile phone industry.  With rising health care costs, the soaring baby boomer population and an increased emphasis on keeping people out of hospitals for conditions that can be monitored and treated at home, Atlanta-based AT&T Mobility and other major wireless phone companies have found a sweet spot for new growth. ... Concerns about privacy, how doctors get paid and whether traditional geriatric facilities — such as nursing homes — will go away as more people choose to remain in their homes (Swartz, 4/29).

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State Watch

Feds Approve Wisconsin Medicaid Cuts

Meanwhile, Kansas applies for waiver to shift Medicaid beneficiaries into managed care plans and Medicaid costs in Kentucky weigh on one insurer.

Milwaukee Journal Sentinel: Feds OK Walker Plans To Cut Medicaid Costs
Federal officials have signed off on plans by Gov. Scott Walker's administration to cut costs in state health programs that will lead to an estimated more than 17,000 people leaving or being turned away. President Barack Obama's administration announced late Friday it had approved the changes after previously requiring the Walker administration to scale back the cuts, which would have originally affected 64,800 people. The changes will cause some adults to leave the program but will shield children from changes originally proposed by the state (Stein, 4/27).

The Associated Press/Kansas City Star: Kansas Confident Feds Will Approve Medicaid Changes
Top Kansas officials expressed confidence Friday that the federal government will allow the state to overhaul its Medicaid program, but critics questioned moving ahead before securing permission. Gov. Sam Brownback's administration has formally applied for a waiver of federal Medicaid regulations that would impede efforts to redesign the state's $2.9 billion-a-year program, which covers health care for the poor, needy and disabled. The application was submitted Thursday to the federal Centers for Medicare and Medicaid Services – a day before other, new rules changed how such requests are handled (Hanna, 4/27).

Kansas Health Institute News: KanCare Waiver Application Completed
Brownback officials need the waiver approved in order to move forward with their plan to shift the state's 350,000 Medicaid beneficiaries into managed care plans operated by three insurance companies. ... The new program would be launched Jan. 1, 2013, assuming the federal approvals are secured and the managed care companies have been certified ready to go. The waiver application included information about the administration's recent agreement to postpone until January 2014 the inclusion in KanCare of long-term services for the developmentally disabled (Shields, 4/27). 

Reuters: Medicaid Costs Weigh On Coventry; Shares Dive
Insurer Coventry Health Care Inc reported a lower-than-expected quarterly profit and issued a disappointing full-year outlook as costs from a Medicaid plan for low-income Americans weighed heavily on results, and its shares fell 11 percent. While overall enrollment in Coventry's Medicaid plans nearly doubled in the first quarter, costs for a plan in Kentucky were well above premiums (Krauskopf, 4/27).

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Out-Of-State Insurers Show No Interest In Georgia

Also, CalPERS finds wide variation in knee and hip replacement costs, and Allina Health offers grants for wellness programs in Minnesota.

The Atlanta Journal-Constitution: No Out-Of-State Insurers Offer Plans In Georgia
A new law that allows Georgians to buy health insurance plans approved by other states was envisioned as free-market solution that would lower prices and increase choices.  So far, the law has failed to produce results: Not a single insurer is offering a policy under the new law. "Nobody has even asked to be approved to sell across state lines," Georgia Insurance Commissioner Ralph Hudgens said. "We're dumbfounded. We are absolutely dumbfounded" (Teegardin, 4/30).

KQED's State of Health blog: Steps Toward Lower Cost, Higher Quality Health Care
In 2008 [the California Public Employees' Retirement System] conducted an analysis of its claims database and learned it was paying $55 million a year in knee and hip replacements. ... CalPERS asked Anthem Blue Cross — which manages its PPO plans — to examine the range of prices for these operations in California. Anthem came back with the startling information that CalPERS was paying $15,000 on the low end to $110,000 on the high end, a more than seven-fold difference from lowest to highest (Aliferis, 4/27).

Minnesota Public Radio: Allina Health Launches Healthy Neighborhoods Program
Allina Health said its new Neighborhood Health Connection program will allow community members to apply for grants to support activities like building a community garden or starting a yoga group. ... Dr. Courtney Jordan Baechler, medical director of the Penny George Institute for Health and Healing at Allina Health, said the program builds on research suggesting neighborhood health initiatives can work (Dunbar, 4/28). 

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Hospitals Seek To Cut Costs, Compete Smartly

In Colorado, New Hampshire, Florida and Kansas, hospitals are trying to be strategic to beat marketplace challenges.

Denver Post: Colorado Hospitals' Competition Has Eye On Bigger Health Care Forces
The fierce battle for patients between Poudre Valley Health System and Banner Health is a glorious competition for quality and convenience across northern Colorado. Or it stands for all that is wrong with the careening spending in the U.S. health system. ... The competition is echoed across Colorado and the nation, as hospitals acquire, merge, build, affiliate and swallow doctor practices (Booth, 4/29).

Modern Healthcare: N.H. Hospital Trustees Seek CMS Help On Medicaid Reimbursements
The trustees of 10 hospitals in New Hampshire that have sued the state over reductions in Medicaid reimbursements are now asking the CMS to intervene. In an April 26 letter to CMS Deputy Administrator Cindy Mann, 166 trustees said that the state cut Medicaid funding and disproportionate share payments by more than $130 million in the current fiscal year (Lee, 4/29).

The Miami Herald: Strong Leaders, Wise Investments Keep Baptist Healthy
It may seem illogical — a healthcare system actively working to keep patients from spending heavily for the hospital care that has long been its bread-and-butter business. But that's exactly what Baptist's newest mission is all about, said longtime Baptist Health CEO Brian Keeley. The reason: Preventive medicine and primary care improve the public health of the community, cut healthcare costs and reduce hospital expenditures for nonpaying or uninsured patients (Tate, 4/29).

The Associated Press/Kansas City Star: Its Certification At Risk, Larned State Hospital Seeks $2 Million From Kansas Legislature
The Kansas Legislature is being asked to appropriate about $2 million to Larned State Hospital, which is threatened with losing federal certification because of chronic problems with staffing. Losing the certification from the Joint Commission, a national organization that accredits hospitals, would cost the state $14.5 million in federal funds each year….The Joint Commission recently cited Larned for a number of deficiencies related to inadequate staffing at the hospital for the mentally ill (4/28).

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State Roundup: Mass. May Vote On Assisted Suicide; Colo. To Try Medical Homes

Health policy news from Masschusetts, California, Iowa, Kansas, Colorado and Connecticut.

Boston Globe: Dying Wishes Expected To Be Decided On November Ballot
Heather Clish has become a leading advocate for affording terminally ill patients in Massachusetts the same choice her father had. Clish and other supporters are pushing a ballot initiative to legalize the practice they call Death with Dignity, more commonly known as physician-assisted suicide. Voters will almost certainly decide at the polls this November whether it should be allowed here, as in Oregon and Washington, the only two states where voters have explicitly authorized it (Helman, 4/29).

KQED/The California Report: Hospice Homes Provide End-of-Life Care Alternative
According to a recent survey, the vast majority of Californians would prefer to die at home. But year after year, most people die in hospitals or nursing homes. It's expensive and not especially comfortable for patients or their families. Hospice homes offer an alternative for the terminally ill -- and they provide end-of-life care at a fraction of the cost (Goldberg, 4/27). 

The Connecticut Mirror: As DSS Seeks Public Comment, Advocates Critique Proposal For "Dual Eligibles"
The Department of Social Services is seeking public comments on an application to run a federal demonstration program ... At issue is a proposal to create a new model for providing and coordinating care for state residents who receive health care coverage through both Medicaid and Medicare. ... Their care costs more than $3 billion a year, an average of $53,500 a person. And despite the price tag, it's often inadequate and poorly coordinated (Levin Becker, 4/27). 

Reuters: Kansas Lawmakers To Debate Who Can Pull Baby Teeth
The problem is that rural areas in the United States have a shortage of dentists, and one proposed solution is to license "dental practitioners" who could do things such as fill cavities and pull baby teeth. But the lobbying group representing dentists in Kansas wants no part of non-dentists messing with people's mouths, saying that only a person with a four-year graduate degree and additional training should be allowed to extract teeth (Murphy, 4/28).

Related, earlier KHN story: In Kansas, No Consensus On How To End ‘Dental Deserts’ (Thompson, 4/8)

Des Moines Register: Addition To Spending Bill Would Benefit One C.R. Doctor
When it comes to state permission to run a surgery center alongside his medical practice in Cedar Rapids, Dr. Lee Birchansky won’t take no for an answer. ... Republican lawmakers in the Iowa House last week added an amendment to a state spending bill providing an exception to the authorization process that has tripped up Birchansky all these years. ... Birchansky has been a generous political donor in recent years, contributing more than $18,000 to gubernatorial and legislative candidates since 1997 (Noble, 4/27).

Denver Post: Partisan Debate Over 'War On Women' Legislative Proposal
Senate Memorial 3, by Sen. Tim Neville, a Littleton Republican, urged Congress to enact what is known as the "Blunt amendment," which allows a health plan to decline coverage or services that are contrary to its religious beliefs. ... Neville's measure died on a party-line vote, with all 20 Democrats opposed and all 15 Republicans in support (Bartels, 4/27).

California Healthline: Mixed Reviews At Basic Health Program Briefing
The state Legislature is considering a bill to create a Basic Health Program in California. If adopted, SB 703 by Ed Hernandez (D-West Covina) would create low-cost health care insurance for as many as one million low-income Californians. ... The BHP is an alternative to the exchange's coverage for two sets of Californians -- adults with income between 133% and 200% of the federal poverty level, and for legal immigrants with income below 133% of the poverty level (Gorn, 4/30).

HealthyCal: Mental Health Treatment Newly Available At Clinics
Federal funding is available to help community clinics transition towards what they will resemble in 2014. ... community clinics are moving towards becoming ‘medical homes,’ or centers of care. That means qualifying low-income patients have access to primary care, pharmacy services, or specialty care (by referral). And especially exciting to health specialists is the new availability of mental health and substance abuse services, which are being included at clinics for the first time (Flynn, 4/29). 

Colorado Public Radio: Home Sweet Medical Home
Colorado's just been chosen to be part of a big federal initiative to encourage medical homes. Doctors will get paid more if they take on greater responsibility for their patients. Here to explain is Dr. Marjie Harbrecht with the non-profit health consulting group HealtTeamWorks in Lakewood, and Julie Schilz, with Anthem-Wellpoint Health Insurance in Denver (Whitney, 4/27). 

Medscape: Providers to Test Power of Apology in Malpractice Claims
The Massachusetts Medical Society (MMS) wants to prove that clinicians and hospitals can keep medical malpractice out of the courtroom by owning up to their mistakes with apologies — and sometimes cash as well. ... In the Massachusetts pilot project, participating hospitals would inform patients about adverse events as soon as they become aware of them and begin conducting a root-cause analysis (Lowes, 4/27).

Boston Globe: Patrick Signs Law To Allow HIV Test With Verbal Consent
Governor Deval Patrick signed into law Friday a bill that supporters say will provide greater access to HIV tests and bring Massachusetts into compliance with federal recommendations ... But some physician groups said the law did not go far enough because the rules still require written informed consent from a patient each time information is released from a patient’s file pertaining to HIV (Lazar, 4/27). 

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Editorials and Opinions

Viewpoints On Health Law: Concerns About 'Lake Wobegon-ization' Of Medicare Advantage; Romney's Efforts To Raise Fears

The Washington Post: Medicare's $8 Billion Advantage
One of the significant reforms in the health-care law was to put private Medicare plans on a more equal footing with the traditional government program. ... But the immediate sting of the cuts was significantly lessened by the Obama administration's move to expand and speed up a program to pay bonuses to high-performing programs. ... Instead, the Centers for Medicare and Medicaid Services decided — in the biggest such "demonstration project"  it has ever undertaken — to make bonus payments available to plans with three or more stars and increase the size of bonuses this year and next. Think of it as the Lake Wobegon-ization of Medicare Advantage (4/27).

Columbus Dispatch: Pilot Project Another Pile Of Politics
We now have another unsavory example of how government-controlled health means politicized health care. ... It's no surprise that Medicare's most market-focused program pushes down premiums and pushes up enrollment. So rather than allow millions of enrollees in swing states, such as Florida, to experience a benefit cut right before an election, the administration founded an $8.5 billion pilot program. This year, for example, the program offsets about 70 percent of the cuts in Advantage. The cost will be paid from the Medicare trust fund (which had a $288.3 billion shortfall this year). The consequences will be put off until after the election (David Harsanyi, 4/28).

Des Moines Register: Obama Disappoints On Health Reform
The Register’s editorial page has criticized Republicans who seek to repeal or nullify the so-called "Obamacare." But the Obama administration deserves scolding, too, for the way it is implementing parts of the law. The president's staff has botched some important provisions. The president should stand up for the law and do what a majority in Congress intended. Instead, he appears to be pandering to critics and trying to pacify senior voters (4/28).

Los Angeles Times: Mitt Romney Stays Put
(Mitt Romney) signed onto the tea party's portrayal of Obama as a secret socialist, with health insurance at the center of the plot. "With Obamacare fully installed," he warned, "government will come to control half the economy, and we will have effectively ceased to be a free-enterprise society." That's right: Obamacare, which relies mostly on free-enterprise health insurance companies, is going to usher in Marxism's red dawn. (The arithmetic's a little dubious, though; to reach 50%, the Romneyites count all health expenditures, including private insurance and doctor bills, as "under federal control.") (Doyle McManus, 4/29).

The Wall Street Journal: A Choice, Not An Echo 
If the Supreme Court strikes down ObamaCare, Congress and whoever is president in January will have to rethink what to do next. Congress and the president should reorganize the health-care system to give people more choice, spur more innovation, and drive down the costs of health care. Rep. Paul Ryan's plan that is already before the House would get things going in the right direction (Pete Du Pont, 4/29).

Des Moines Register: Freedom To Fear And Need Is Here
According to the Supreme Court majority, we can't prevent anyone from carrying a gun into a school, church or Fourth of July picnic. And we can't stop billionaires from buying up our system of democracy by the board foot, shoveling unlimited amounts of money into Super PACs, which then buy vicious ads aimed at their favorite candidate's opponent. And now it looks like we can’t provide health care insurance to people in our society who need but can't afford it (Donald Kaul, 4/29).

JAMA: Mitt Romney On Health Care: No, We Can't
Now that Mitt Romney is the presumptive Republican presidential nominee, it is worth paying more attention to his health care proposals. Governor Romney has said many things about health care—mostly negative. He wants to repeal the Affordable Care Act (ACA), cut Medicaid, and fundamentally restructure Medicare. For the privately insured, he pushes a vision where employers are less involved in insurance and government support is reduced. The philosophical principles of the Romney plan are profound and worrying (David M. Cutler, 4/27).

Roll Call: Health Care Overhaul Is Wrong for Families
President Barack Obama promised, "If you like your health care plan, you can keep your health care plan," but the facts now say otherwise. With the government takeover of health care beginning to take effect, it now seems millions of families will be forced to find health care elsewhere when the big-government law applies its mandates and fees. The nonpartisan Congressional Budget Office estimates that as many as 20 million people will be forced from their health insurance plans as the 2010 law takes full effect. This represents an enormous broken promise (Maggie Brooks, Kim Vann and Jackie Walorski, 4/30). 

Arizona Republic: Repealing 'Obamacare' Would Be Bad For All Of Us
What will happen if the Affordable Care Act ("Obamacare") is ruled unconstitutional or repealed by Congress? It will have a negative impact on nearly every American. Two hundred million Americans with private health insurance will again have to worry that their insurance may be canceled if they have a serious and expensive-to-treat illness, or that their benefits will be cut off if they exceed an annual or lifetime limit (James E. Dalen, 4/28).

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Viewpoints: Entitlement 'Train Wrecks' Approaching; Collecting For Health Bills At The Hospital

Arizona Republic: Hard Choices Have To Be Made
The evidence has been clear for a long time now regarding the future of those twin financial train wrecks known as Social Security and Medicare. We have known for decades that without significant reform both are on a path toward insolvency. We learned this week, however, that both runaway trains took a shortcut at the last switching station. The train wrecks are approaching faster than we thought (4/28).

The Dallas Morning News: Entitlement Reforms Are Needed Now
Here we go again. The experts who oversee Social Security and Medicare rang the alarm bells once more last week. ... Stabilizing Medicare is too big an issue for the last few months of an election year, but President Barack Obama and likely GOP nominee Mitt Romney still should lay the groundwork for action next year. ... We can't afford to waste this election. The warning bells are sounding, very clearly (4/29).

CNN: Obama, Democrats Not Serious About Passing Budget
Democrats claim that last year's Budget Control Act is an adequate substitute for a real budget because it "deems" spending caps. Obviously, it is not. It is only half the equation. It includes no plan for saving Social Security or Medicare, for reforming taxes, or for ever living within our means. But it does prove that Washington is certainly good at making sure spending continues (Sen. Ron Johnson, R-Wis., 4/29).

Minneapolis Star Tribune: Pay Up Front For Health Care? Not So Outrageous
If anyone is shocked to learn that hospitals must either cajole patients into paying their share of bills or else try to stick somebody else with their costs (that is, the rest of us, through higher prices or increased insurance premiums or bigger taxes or all of the above), they have been living in fantasyland. Fairview is admitting to mistakes, though not to breaking the law…. There may have been violations of privacy that raise altogether different issues. And of course those who truly can't pay are entitled to treatment all the same. But it's hard to condemn reasonable attempts to collect from everyone else (D.J. Tice, 4/27).

San Francisco Chronicle: Feds' War On Medical Marijuana Goes Overboard
Obama is right to note that even though California and 15 other states have legalized medical marijuana, its trade violates federal law. But it is one thing for federal law enforcement to investigate dispensaries that have sold marijuana for recreational use and prosecute offenders. It is overboard when prosecutors raid establishments on a wholesale basis, seize their records and assets, arrest individuals and otherwise attempt to drive dispensaries out of business, even if that means denying access to legitimate medical marijuana users (4/30).

Des Moines Register: A Couple Of Options For VA Health Care
As it is currently structured, the VA health system doesn't make sense for anyone. Hiring nearly 2,000 more workers is just the latest example of what's wrong. Where will it find these people? It will recruit them away from the country's existing workforce that serves 300 million Americans and is already grappling with a shortage of mental health professionals. These people will become government employees and work for the VA, which serves about 6 million people each year. The VA system also doesn't make sense for veterans or taxpayers (4/27).

The Washington Post: Psychiatry's Bible, The DSM, Is Doing More Harm Than Good 
About half of all Americans get a psychiatric diagnosis in their lifetimes. Receiving any of the 374 psychiatric labels — from nicotine dependence disorder to schizophrenia — can cost anyone their health insurance, job, custody of their children, or right to make their own medical and legal decisions. And if patients take psychiatric drugs, they risk developing physical disorders such as diabetes, heart problems, weight gain and other serious conditions (Paula J. Caplan, 4/27).

Des Moines Register: House Action Shows A Lack Of Compassion
This past week, the Iowa House passed a health and human services budget that shows just how out of touch extreme legislators are with the people of Iowa, particularly women. Part I of an amendment attached to the budget was an example of politics at its worst, with legislators trying to push their ideological views into Iowa law. ... The Iowa House version of the budget included an amendment that would strip the rape or incest exception, essentially telling all women in Iowa that if you are a victim of rape or incest that results in a pregnancy and you receive health benefits through Medicaid — well, that's just too bad (Jill June, 4/28).

Modern Healthcare: Meeting Critical Needs
Many healthcare leaders have looked to hospital emergency departments as a logical focus for implementing changes in their systems. Emergency departments have always served as the main entry portal into hospitals, and the quality of care delivered by a hospital system begins with the emergency department. Strategies for improvement include optimizing work flow, improved care pathways, technological advances and improved physician and nursing performance. Transforming emergency departments to meet modern demands is critical to the viability of hospitals and health systems, and physician workforce issues are a key component in this change (Danny Greig, W. Anthony Gerard, Kim Bullock and Kim Yu, 4/28).

Sacramento Bee: Big Tobacco Wants You To Think Doctors Oppose Cigarette Tax
We knew it was only a matter of time before the tobacco industry unleashed a media barrage that would attempt to confuse voters about Proposition 29, the initiative on the June ballot that seeks to raise the tobacco tax to increase funding for cancer research. ... And so we are now seeing the first salvo in their misinformation campaign. Watch out for a television ad that attempts to convince you that doctors actually oppose Proposition 29, which The Bee and many health groups have endorsed (4/29).

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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.