Daily Health Policy Report

Tuesday, April 30, 2013

Last updated: Tue, Apr 30

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch


Health Care Marketplace

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Health Care's 'Dirty Little Secret': No One May Be Coordinating Care

Reporting for Kaiser Health News, in collaboration with The Washington Post, Roni Caryn Rabin writes: "Coordinated care is touted as the key to better and more cost-effective care, and is being encouraged with financial rewards and penalties under the 2010 federal health care overhaul, as well as by private insurers. But experts say the communication failures that landed Gabay in a rehab center, rather than in surgery, remain disturbingly common" (Rabin, 4/30). Read the story or the related sidebar: Tip Sheet On Staying Safe In The Hospital (Rabin, 4/30).

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California Moves To Protect Smokers From Higher Obamacare Insurance Costs

Southern California Public Radio's Stephanie O'Neill, working in partnership with Kaiser Health News and NPR, reports: "The federal health law allows states to charge smokers up to 50 percent more for a health plan – but legislation is moving forward in the California legislature that will make sure that doesn't happen. And unlike other efforts around the country to alter the law, this is one coming from a Democrat" (O’Neill, 4/30). Read the story.

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Insuring Your Health: For Some People Covered Through Work, An Exchange Might Be A Good Option For The Family

In her latest Kaiser Health News consumer column, Michelle Andrews answers questions from readers, such as "How does the Affordable Care Act affect children in low-income families and people who want to buy coverage on the new state insurance exchanges?" (Andrews, 4/30). Read the column.

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Health On The Hill: What's Next In The Senate: In The Coming Weeks And After 2014 (Video)

Kaiser Health News staff writer Mary Agnes Carey talks with Jackie Judd about what's next for the stalled confirmation of Marilyn Tavenner, and who will fill the void in health policy when three senior Senate Democrats retire in 2014 (4/29). Watch the video or read the transcript.

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Capsules: Colorado Medicaid Expansion Moves Forward With One Republican Vote

Now on Kaiser Health News' blog, Colorado Public Radio's Eric Whitney, working in partnership with KHN and NPR, reports: "Both chambers of Colorado's legislature passed bills late last week to expand Medicaid as called for in the Affordable Care Act. The next step is the state Senate is expected to approve amendments to the House version of the bill on Tuesday and send it to the desk of Gov. John Hickenlooper, a Democrat, who has said he will sign it" (Whitney, 4/29). Check out what else is on the blog.

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Political Cartoon: 'Heal Thyself?'

Kaiser Health News provides a fresh take on health policy developments with "Heal Thyself?" by Nate Beeler.

Meanwhile, here is today's health policy haiku:


What had been complex
is now down to three pages.
Application joy!

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 Administration Simplifies Application For Health Insurance

After the first draft was criticized for its length, the administration made the new version shorter and simpler -- only three pages for a single person.

The Associated Press/Washington Post: Responding To Critics, Obama Administration Unveils Simplified Health Insurance Application
The first draft was as mind-numbing and complex as tax forms. Now the Obama administration is unveiling a simplified application for health insurance benefits under the federal health care overhaul. Details to be released Tuesday include a three-page short form that single people can fill out, administration officials said. Medicare chief Marilyn Tavenner, also overseeing the rollout of the health care law, called it "significantly shorter than industry standards" (4/30).

USA Today: New Health Insurance Form Now Down To Three Pages
A second form for families has been reduced by two-thirds, according to the Department of Health and Human Services. … An online version of the form will further shorten the application based on a person's answers, according to an HHS news release (Kennedy, 4/29).

The Hill: Officials Cut ObamaCare Application Form To Three Pages
The Obama administration will unveil a more simplified application for those seeking insurance under the president’s landmark healthcare reform law, after criticisms the initial forms were too complex. Reports said the new form, which will be previewed on Tuesday, would be three-pages long for individuals and seven pages for families, according to reports (Mali, 4/30).

On the topic of how much insurance coverage might cost in 2014 -

Oregonian: Oregon Insurers Filing 2014 Individual Health Policies; Sticker Shock Likely
If you buy your own health insurance, you're about to find out how your wallet could be affected next year by federal reforms. Today, about 17 insurers will finish filing more than two dozen separate policies and 2014 premium rate hikes for review by the state. While several early filings lack clear comparison to 2013 rates, one by Providence Health Plans shows how federal changes in the individual market could translate to the sticker shock insurers have predicted. Providence requests premium hikes of 53 percent for more than 8,000 policyholders who buy their own insurance (Budnick, 4/29).

Also in the news -

The New York Times: Next Big Challenge for Health Law: Carrying It Out
Among the complex imperatives: pushing reluctant states to set up insurance marketplaces and expand Medicaid programs, keeping an eye on insurance companies as they issue new rate schedules, measuring the law's effects on small-business hiring, and coaxing healthy young people to buy coverage so the system works economically for everyone else. Gail Wilensky, who ran Medicare and Medicaid under President George Bush and supports the new law, said that 2014, when the law will make it mandatory to have insurance, "is going to be quite a bumpy year" (Harwood, 4/29).

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Small Businesses In States That Don't Expand Medicaid Could Face Penalties

Stateline reports that small businesses in these states are seeking relief from the health law's penalities, which could leave them liable for billions that their counterparts in states that expand Medicaid will not have to pay. Meanwhile, the stalemate in Florida continues. News outlets also report on related developments in Colorado, Iowa, Maine, Michigan, Missouri and Wisconsin.

Stateline: Small Businesses Seek Relief From ACA Penalties
When the Affordable Care Act was written, its authors assumed that Medicaid — the federal-state health care plan for the poor — would be expanded to low-income adults in every state. But the U.S. Supreme Court's decision in July 2012 largely upholding the law made the expansion optional. Since then, governors in nearly half of all states have refused to take it up. As a result, small businesses in states that choose not to expand could be liable for billions in federal tax penalties that companies in states that expand Medicaid will not have to pay. "We're strongly advocating that businesses in non-expansion states not be punished," said Kevin Kuhlman, legislative affairs manager for the National Federation of Independent Businesses (Vestal, 4/29).

The Associated Press: Fla. Senate Not Backing Down On Medicaid Expansion
With just four days left in the Legislative session and neither the House nor Senate willing to concede, it seems the Medicaid expansion alternative is at a stalemate and may have to wait until next year, leaving roughly 1.1 million eligible Floridians without health insurance. The Senate had been juggling two proposals for the past few weeks in hopes of reaching an agreement with the House, but on Monday senators squashed the proposal that mirrored the House's plan with little fanfare and no debate (4/30).

Tampa Bay Times: Negron: Compromise On Medicaid Expansion 'Unlikely'
Chances are not good that the House and the Senate will reach agreement on Medicaid expansion or any alternative, Sen. Joe Negron, R-Stuart, said today. ... "I’d like to pass a bill that provides health insurance premium assistance to a million Floridians who get up and go to work everyday but need some help with paying for their health insurance premiums, that’s what I would prefer," he said. "But that appears unlikely at this point" (Mitchell, 4/29).

Miami Herald: Senate And House Play Hot Potato With Medicaid Bills
The Florida Senate effectively rejected the House’s alternative to expanding Medicaid on Monday, prolonging a stalemate that may prove too difficult to resolve before the legislative session wraps up this week. Senators on Monday took up the House plan, which passed last week, but quickly amended the bill by swapping in their own plan. The Senate is expected to pass the amended bill and send it back to the House Tuesday. What happens after that is anyone's guess (Mitchell, 4/29).

Kaiser Health News: Capsules: Colorado Medicaid Expansion Moves Forward With One Republican Vote
Both chambers of Colorado's legislature passed bills late last week to expand Medicaid as called for in the Affordable Care Act. The next step is the state Senate is expected to approve amendments to the House version of the bill on Tuesday and send it to the desk of Gov. John Hickenlooper, a Democrat, who has said he will sign it (Whitney, 4/29).

The Associated Press: Governor's Health Care Proposal Approved By Iowa House Committee
Gov. Terry Branstad's health care proposal for low-income Iowa residents received committee-level approval in the Republican-majority state House Monday, but the Democratic-controlled Senate instead favors a plan to expand Medicaid. The House appropriations committee approved legislation for the "Healthy Iowa" plan in a party-line vote(Lucey, 4/29).

St. Louis Public Radio: Mo. House Rejects Senate Version Of State Budget, Defeats Another Medicaid Expansion Attempt
As the House went through each bill Monday, another attempt was made by Democrats to expand Medicaid. State Representative Jeff Roorda (D, Barnhart) sponsored the motion. "If you cobbled together every jobs bill, every economic development bill, that has been filed, not passed, but filed in the seven years that I’ve served up here, they don’t even come close to creating the number of jobs that we (would) create through Medicaid expansion," Roorda said. State Representative Jay Barnes (R, Jefferson City) argued that Medicaid should not be expanded without first reforming the system. ... The attempt to add nearly $900 million for Medicaid expansion to House Bill 11 failed on a party-line vote (Griffin, 4/30).

The Associated Press: GOP Senator Seeks Delay In Medicaid Shift
A Republican state senator says the state should slow down Gov. Scott Walker's plans to shift thousands of patients from state coverage into the federal health care program, citing concerns that the program won’t be up and running as scheduled by the beginning of 2014. But Sen. Alberta Darling's suggestion faces opposition from within her own party, with Assembly Speaker Robin Vos flatly saying, "Not going to happen" (4/29).

The Associated Press/Detroit Free Press: Michigan Law Enforcement Call For Medicaid Expansion
Law enforcement officials plan to call on state lawmakers to expand Medicaid coverage to more than 300,000 Michigan residents. The group Fight Crime: Invest in Kids and Republican Rep. Matt Lori of Constantine plan to hold an event at the Capitol today. Members of the group include Lansing Township Police Chief Kay Hoffman. The group says Medicaid coverage for expectant mothers can help prevent children from being born with fetal alcohol syndrome or fetal alcohol effects. They will also advocate for Medicaid coverage for interventions such as substance abuse and mental and behavioral health issues as a way to cut crime (4/30).

Bangor Daily News: Advocacy Groups Put Pressure On Maine Lawmakers To Support Medicaid Expansion
A coalition of advocacy groups, including AARP Maine, the American Cancer Society Cancer Action Network and the American Heart Association, will launch newspaper and radio advertisements Tuesday urging legislators to support a plan that would allow the state to expand Medicaid benefits under the Affordable Care Act. The ad campaign comes after a weekend in which Republican Gov. Paul LePage and Democratic legislative leaders sparred over the proposal and whether it should be linked to a plan to repay the state’s Medicaid debt to Maine's hospitals (Long, 4/29).

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Capitol Hill Watch

What's On Tap In The Senate?

In addition to consideration of the stalled nomination of Marilyn Tavenner to head the Centers of Medicare & Medicaid Services, one senator appeared optimistic about repealing the health law's tax on medical devices. 

Kaiser Health News: Health On The Hill: What's Next In The Senate: In The Coming Weeks And After 2014 (Video)
Kaiser Health News staff writer Mary Agnes Carey talks with Jackie Judd about what's next for the stalled confirmation of Marilyn Tavenner, and who will fill the void in health policy when three senior Senate Democrats retire in 2014 (4/29).

MPR News: Klobuchar Hopeful On Repeal Of Med-Tech Tax
U.S. Sen. Amy Klobuchar on Monday said she's optimistic a tax on medical devices will be overturned. The senator told executives at a Minneapolis medical device industry conference she's not only confident Congress will repeal the 2.3 percent tax, she expects the measure can be linked to tax reform or other legislation likely to avoid a presidential veto. One such bill could be soon-to-be-retiring Sen. Max Baucus' tax reform effort, Klobuchar said (Moylan, 4/29).

CQ HealthBeat: End-of-Life Planning Must Be Addressed, Some Members Say
Few issues are tougher to tackle than death and dying, as evidenced by the huge flap over mythical "death panels" during the debate over the health care law. Yet some members of Congress remain willing to advocate for better end-of-life planning, just as millions of aging baby boomers enter their later years (Norman, 4/29).

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CMS Pay Boost Triggers Hospital Stocks To Rally

The Medicare pay increase for hospitals comes with strings attached -- an even stronger tie to how well facilities do at preventing readmissions.

Bloomberg: Hospital Stocks Rally As Medicare Tempers Budget Cut Blow
HCA Holdings Inc. (HCA) led hospital stocks higher after the U.S. government proposed new Medicare payment rates that would soften the blow of federal budget cuts…The U.S. Centers for Medicare and Medicaid Services said April 26 that it plans a net raise in payments to acute-care hospitals of 0.8 percent beginning Oct. 1. Investors were expecting no change to as much as a 1 percent decrease, according to Brian Tanquilut, an analyst at Jefferies & Co (Armour, 4/29).

The Washington Post's Wonk Blog: Medicare Releases 1,424-Page Rule That's Actually Really Interesting!
Overall, hospitals seemed pretty happy with the top line number: a 0.8 percent increase in their payments next year. That works out to about $27 million more going to the Medicare program in 2014 than will in 2013. That’s significant when you consider that Medicare costs grew at half that rate — by 0.4 percent — in 2012. … At the same time, Medicare is making it harder to earn those dollars by increasing the payments to the very best hospitals — and trimming what it will pay poor performers. Starting in 2014, 2 percent of hospitals’ reimbursements will depend on how well they prevent readmissions. That’s twice as much as what’s at stake this year and, combined with a few other quality programs in the health law, some think it could be enough to turn hospitals' heads (Kliff, 4/29).

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Health Care Marketplace

The Challenges Of Coordinating Care

News outlet explore issues related to hospital quality of care, costs and a predicted shift from inpatient to outpatient treatment.

Kaiser Health News: Health Care's 'Dirty Little Secret': No One May Be Coordinating Care
Coordinated care is touted as the key to better and more cost-effective care, and is being encouraged with financial rewards and penalties under the 2010 federal health care overhaul, as well as by private insurers. But experts say the communication failures that landed [Betsy] Gabay in a rehab center, rather than in surgery, remain disturbingly common" (Rabin, 4/30).

Bloomberg: Hiring A Guide To The Medical Bill Maze
When Annrose Isaac's twins were born prematurely, she thought her insurer would cover their stay in the neonatal intensive care unit. "The hospital was in our network, but it turned out the physician in the NICU who saw our daughters didn't participate with our insurer," says the Westwood (New Jersey)-based financial planner. "All of a sudden we were getting bills for over $30,000" (Braham, 4/29).

Modern Healthcare: Healthcare Leaders Expect Big Shift Toward Outpatient Care
As the care delivery models of hospitals and health systems evolve, healthcare executives and materials and practice area managers predict a major shift in admissions from inpatient to outpatient settings. According to Premier healthcare alliance's spring 2013 Economic Outlook, 69% of the survey participants predict that outpatient volume will rise in 2013, as compared to last year's volume. And as outpatient admissions are projected to increase, nearly 24% of respondents suggest that inpatient volume this year will drop (Landen, 4/29).

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Public Health & Education

Preventive Services Task Force Urges HIV Screening For Adults

The recommendation of this government-backed panel is consistent with a long-standing Centers for Disease Control and Prevention policy.

Reuters: Task Force Calls For Routine HIV Testing For All Adults
An influential U.S. panel is calling for HIV screening for all Americans aged 15 to 65, regardless of whether they are considered to be at high risk, a change that may help lift some of the stigma associated with HIV testing. The new guidelines from the U.S. Preventive Services Task Force (USPSTF), a government-backed panel of doctors and scientists, now align with longstanding recommendations by the U.S. Centers for Disease Control and Prevention for testing of all adults aged 15 to 65, regardless of their risk (Steenhuysen, 4/29).

Meanwhile, in Georgia -

Georgia Health News: State To Skip Federal Funds Over Sex Questions
For at least a decade, Georgia has steadfastly refused to include questions about sexual behavior in a CDC-sponsored survey of high school students. Now that decision apparently will cost the state a shot at federal money for HIV/STD prevention. In an April 4 letter from a Department of Education official to the CDC, the state said it would not apply for a round of federal funding for HIV/STD education because "it will not be able to comply with the new requirements." Those new rules from the CDC require a state to include sex questions in the Youth Risk Behavior Survey in order to qualify for the extra funds (Miller, 4/29).

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State Watch

University of Calif. Workers Mull Strike; Two Unions Battle Over Representing Kaiser Permanente Workers

Patient-care workers at the University of California's hospitals will vote this week on whether to strike over staffing levels, pay and their pensions. In the meantime, two unions vie to represent health care workers at Kaiser Permanente.

Los Angeles Times: Union For Patient-Care Workers At UC Hospitals To Take Strike Vote
The union representing nearly 13,000 University of California patient-care workers plans to take a strike vote beginning Tuesday. The American Federation of State, County and Municipal Employees, or AFSCME 3299, will hold the strike vote through Thursday and announce results next week. The vote comes after nearly a year of negotiations between the workers and UC over staffing, pay and pension reforms. The contract expired in September (Gorman, 4/29).

The Wall Street Journal: Powerful Union, Upstart Battle Over Shrinking Pie
The Service Employees International Union is locked in battle here with an unusual opponent: another union. SEIU has enjoyed years of rapid growth even as organized labor has withered in the U.S. Now, it is competing with the National Union of Healthcare Workers to represent 45,000 nursing aides, pharmacy technicians and janitors at health-care giant Kaiser Permanente. The fight is playing out in cafeterias and break rooms, where NUHW supporters and organizers in bright red T-shirts have clashed in recent weeks with purple-clad SEIU backers. The National Labor Relations Board will begin counting ballots of Kaiser Permanente workers on Wednesday. The board threw out the results of a previous election in 2010, which the SEIU won, after finding that the SEIU had threatened members who backed the NUHW (Maher, 4/29).

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California Wrestles With Growing Medicaid Costs

California Healthline talks to officials and consumer advocates about changes in the program. Meanwhile, a D.C.-based firm looks likely to get a new contract and Kansas is planning to give more residents services.

California Healthline: Managing Medi-Cal With Enrollment Up, Spending Down
Although the federal government initially will cover costs for many new Medi-Cal beneficiaries, the size and cost of the program are growing. Even if federal courts deny the state's proposal to reduce reimbursement by 10 percent, pressure will be applied to reduce program spending. With enrollment going up and already-low reimbursements going down, we asked legislators, state officials and consumer advocates how policymakers should steer California's Medi-Cal course (4/29).

The Washington Post: Thrive Likely To Get D.C. Health Contract
An upstart firm that has undergone tough scrutiny from lawmakers and health care providers appears set to receive a major chunk of the District's $2.4 billion-a-year Medicaid business (DeBonis, 4/29).

Kansas Health Institute: Governor's Plan Would Take 600 Off Waiting Lists for Social Services
Gov. Sam Brownback today released details of his plan to reduce the waiting lists for home- and community-based Medicaid services. The $18.5 million in additional spending would move "approximately" 400 physically disabled and 200 developmentally disabled Kansans into services, if approved by the Legislature, according to administration officials who said it would be "difficult to project exactly how many on the waiting lists will be removed” (Ranney, 4/29).

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State Roundup: Health Costs Could Undermine State Budget Recoveries

A selection of health policy stories from California, Virginia, Nevada, Missouri, Minnesota and Wisconsin.

Reuters: Health Care Costs To Negate State, Local Budget Improvements: Outlook
State and local governments can expect ever-widening budget gaps through 2060, as rising health care costs for both citizens and public employees surpass recent improvements in their revenue, the Government Accountability Office said on Monday. Closing the gap may require drastic action (4/29).

Kaiser Health News: California Moves To Protect Smokers From Higher Obamacare Insurance Costs
The federal health law allows states to charge smokers up to 50 percent more for a health plan -- but legislation is moving forward in the California legislature that will make sure that doesn't happen. And unlike other efforts around the country to alter the law, this is one coming from a Democrat (O’Neill, 4/30). 

The Associated Press: Lawmakers Approve Health Insurance Protections
State lawmakers sent Gov. Jerry Brown a pair of consumer protection bills Monday that prevent health insurance companies from discriminating against people with pre-existing conditions and limit how much more insurers can charge older residents. The legislation updates California laws to match new rules under the federal Affordable Care Act and will give state agencies the power to enforce and regulate individual insurance rules (Lin, 4/29).

The Associated Press/Washington Post: Former Owner Of Texas Student Health Insurance Company Set For Arraignment In Va.
The former owner of a Texas company that provided health insurance to Virginia Tech students is due in federal court for arraignment on charges of racketeering, conspiracy, money laundering and fraud. A 57-count federal indictment accuses 73-year-old John Paul Gutschlag Sr. and GM-Southwest Inc. of overstating claims by more than $9 million to boost profits (4/30).

The Associated Press/Washington Post: Nev. Governor: People Who Violated Psych Hospital Policies Fired Amid Alleged Patient Dumping
Two staff members who violated discharge policies at a Las Vegas psychiatric hospital were fired Monday and three others are being disciplined following an investigation into busing patients to other states, the governor's office and agency officials said Monday (4/29).

The Associated Press/Washington Post: Bankruptcy Hearing Under Way On Coal Company's Bid To Cut Pension, Health Benefits For Workers
A long-awaited bankruptcy hearing began Monday in which a St. Louis-based coal company insists it must significantly cut thousands of retirees' health care and pension benefits or risk liquidation -- a claim that its miners union strongly rejects (4/29).

MPR News: State Updates Vaccination Requirements For Schoolkids
State health officials are planning to add new vaccination requirements for children in school and day care. The proposed rule change would mean vaccinations against hepatitis A and B for kids in child care and early childhood programs, as well as immunizations against pertussis and meningococcal infections for seventh graders. The vaccinations are part of national recommendations, state epidemiologist Kris Ehresmann said (Sepic, 4/29).

Milwaukee Journal Sentinel: Safety Net Clinics Try A High-Tech New Model
The waiting room at Cedar Riverside Clinic was packed with patients and translators one recent morning and buzzing with multiple languages. To Julie Tate, waiting to see her doctor, it was a familiar sight. "I used to go to the emergency room" for medical care, Tate said. But now, after 14 years as a patient at the Minneapolis clinic, she knows her doctor personally -- and much of the staff as well. ... That's exactly the sort of bond that state health officials hope to build on as they embark on an experiment between community clinics like Tate's and the state of Minnesota to reform medical care for thousands of underprivileged patients (Hargarten, 4/29).

California Healthline: Money To Be Made, Saved With Biosimilars?
A heated fight has developed over legislation to regulate a biotech development that hasn't yet hit the U.S. market. On Wednesday, the state  Senate Committee on Health will take up the topic of biosimilars and the  surprisingly robust debate they've sparked. … The proposed legislation before the Senate Committee on Health this week is SB 598 by Sen. Jerry Hill (D-San Mateo). It would allow a pharmacist to substitute a less-expensive biosimilar for a biologic, in some cases, and require that pharmacist to notify the prescribing physician of the change. It's the notification requirement that has caused all the uproar, because pharmacists are not currently required to notify physicians when switching to generic medications (Gorn, 4/29).

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Editorials and Opinions

Viewpoints: Democrats Signaling Problems Ahead On Health Law; GOP's 'Harping' On The Coming Problems Will Help Public's Expectations

The Wall Street Journal: The Coming ObamaCare Shock
In recent weeks, there have been increasing expressions of concern from surprising quarters about the implementation of ObamaCare. Montana Sen. Max Baucus, a Democrat, called it a "train wreck." A Democratic colleague, West Virginia's Sen. Jay Rockefeller, described the massive Affordable Care Act as "beyond comprehension." Henry Chao, the government's chief technical officer in charge of putting in place the insurance exchanges mandated by the law, was quoted in the Congressional Quarterly as saying "I'm pretty nervous ... Let's just make sure it's not a third-world experience." These individuals are worried for good reason. The unpopular health care law's rollout is going to be rough. It will also administer several price (and other) shocks to tens of millions of Americans (Daniel P. Kessler, 4/29). 

Bloomberg: How Conservatives Are Helping Obamacare
Yuval Levin, among other conservatives, has made an offer to liberals: Let's delay the implementation of Obamacare for a year and make everybody better off. … Liberals, wisely, are saying no. What's funny about this conversation is that conservatives have been accidentally managing expectations for implementation: By harping constantly on what a disaster the rollout is going to be, they will make what actually happens look good by comparison (Josh Barro, 4/29).

The Washington Post: For GOP, Opposition Shouldn't Only Mean Obstruction
Defeating Obama is no longer a sufficient Republican goal. What Mitt Romney couldn’t manage is eventually accomplished by the 22nd Amendment. Instead, Republicans face a series of complicated political tasks. ... There is no economic value or political appeal in austerity for its own sake. One reason the health entitlement crisis is so dangerous is that it progressively squeezes domestic discretionary spending. Republicans need to accompany proposals for structural entitlement reform with creative measures to encourage education, job training and entrepreneurship (Michael Gerson, 4/29).

San Jose Mercury News: Employer Health Programs Can Backfire On Employees
Central to health care reform has been an increased focus on health promotion and prevention programs, including programs based in workplaces commonly referred to as "health and wellness programs." In concept, encouraging employee health and wellness is a great idea. Many of us spend a majority of our waking hours at work and would welcome environments that encourage and support healthy lifestyles. Unfortunately, there is a serious risk that employers might use these workplace programs and incentives to shift health care costs or to discriminate against employees with pre-existing health conditions or other risk factors (Bill Monning, 4/29).

CNN World: Governors Missing The Point On Medicaid
So while a governor or legislator may disagree with Medicaid expansion for philosophical reasons, the claims that the expansion will be a burden on states' economies seem misguided given the full range of projected economic impacts on the states. The fact is that not expanding Medicaid will hurt state economies. This is even true for states that do not have lower-than-average incomes (Carter C. Price, 4/29).

The (Helena, Mt.) Independent Record: The Moderate Majority Worked Hard This Session
Unfortunately, the moderate majority couldn't capitalize on one of the largest economic opportunities this session, Medicaid expansion. On Medicaid, partisanship won the day. Without Medicaid expansion, more than 70,000 Montanans will be without affordable health coverage next year. We'll miss the opportunity to create 14,000 new, good-paying jobs in the medical field. We'll still pay for it through federal taxes, but rather than giving those dollars back to invest in Montana, the federal government will just spend them in other states (Monica J. Lindeen, 4/29).

Health Policy Solutions (a Colo. news service): Health Care Just Around The Corner
The most recent law, the Affordable Care Act of 2010 promises to reshape the health care landscape on a scale not witnessed since Medicare's passage in 1965. Everyone will be required to purchase insurance. Medicaid will be enlarged, and much of the regulation of insurance will be transferred to federal oversight. On the surface it all sounds good until you meet the devil in the details (Francis Miller, 4/29).

The Wall Street Journal: Teeth-Whitening Rules Take A Bite Out of Business
When special interests use government power to limit competition, that is not just a stain on representative government. Now it's also leaving a stain on teeth. According to a new study by our organization, the Institute for Justice, licensed dentists across the country have been lobbying successfully for government-imposed restrictions that create a lucrative monopoly on the field of teeth whitening. Dozens of states have now passed laws, or applied existing ones, to shut out entrepreneurs and thus raise the cost of acquiring a brighter smile (Angela C. Erickson and Paul Sherman, 4/29).

Oregonian: What Price Life? Pushback By OHSU's Brian Druker Against High Drug Costs Should Prod Review
It's one thing to be told you have cancer and a few years to live. It's entirely another to be told Wait, you do have cancer, but a medication that will extend your life by several years is available for $100,000 a year. Reasonable people would scoff at the sum, even though insurance might reduce the out-of-pocket co-pay to, say, $1,400 a month -- for many, another mortgage. But being told you'll die is calamitous on its face and does not produce entirely reasonable behavior. Doing anything to gain those precious years, including selling one's house or canceling retirement, might look necessary if not sane. That's to say nothing of those without insurance or a house or a planned retirement (4/29).

Sacramento Bee: California's Health Turf War Should Cause Fear
Senate Bills 491, 492 and 493 won approval of a Senate committee Monday and we should all be afraid -- very afraid -- because once again, state legislators are voting on "scope of practice." It means that politics -- sometimes raw politics -- are determining which medical practitioner can perform which procedure on which part of the human body, rather than leaving those decisions in the hands of medical experts. It's not a new phenomenon (Dan Walters, 4/30).

Journal of the American Medical Association: Identification Of Physician Impairment
The need to detect and prevent physician impairment must be balanced with the rights of privacy and autonomy. Patients and their family members have a right to be protected from impaired physicians. In other high-risk industries, this right is supported by regulations and surveillance. Shouldn't medicine be the same? A robust system to identify impaired physicians may enhance the professionalism that peer review seeks to protect (Drs. Julius Cuong Pham, Peter J. Pronovost and Gregory E. Skipper, 4/29).

Medpage Today: Rediscovering The Lost Art Of Civil Discourse
Although we still have a long way to go in reducing waste and addressing a medical error rate that, in any other industry, would not be tolerated, positive change is happening as a direct result of the payment reforms (e.g., bundled payments) and new models of care (e.g., medical homes) that are integral to the ACA (Dr. David Nash, 4/29).

The Medicare NewsGroup: Nobel Prize-Winning Economist Becker Has Seminal Ideas That Are Gaining Favor, But Can They Work?
Even with greater price transparency, how would 65- to 69-year-olds effectively negotiate reasonable medical expenses without the bargaining power of a Medicare or an employer? Would insurers come to their rescue? How would policies for this age group be affordably priced? Would policy premiums need to be subsidized in some way by the government, which would nullify the nominal savings of raising the retirement age? While [Nobel-prize-winning economist Gary] Becker's ideas sound logical and hint at a degree of common sense and equity, the political and everyday reality is much more difficult terrain (John Wasik, 4/29).

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Stephanie Stapleton

Andrew Villegas

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Shefali Luthra

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