Daily Health Policy Report

Wednesday, April 4, 2012

Last updated: Wed, Apr 4

KHN Original Reporting & Guest Opinion

Administration News

Health Reform



Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Revamping Medicare: A Guide To The Proposals, Politics And Timeline

Kaiser Health News staff writer Marilyn Werber Serafini reports: "Congress is unlikely to consider legislation that would fundamentally restructure Medicare until a new Congress -- and possibly a new president -- are seated in 2013. But politicians have sought to tackle the growth in Medicare costs several times in the past two years, most notably in the 2010 health care law and, then again, in last year's budget deal" (Werber Serafini, 4/3). Read the story.

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Physicians Wade Into Efforts To Curb Unnecessary Treatments

Kaiser Health News staff writer Julie Appleby reports: "Nine prominent physician groups today released lists of 45 common tests and treatments they say are often unnecessary and may even harm patients. The move represents a high-profile effort by physicians to help reduce the extraordinary amount of unnecessary treatment, said to account for as much as a third of the $2.6 trillion Americans spend on health care each year" (Appleby, 4/4). Read the story.

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Capsules: Hospital Group: Ditch Fast Food, Turn Down The Lights; Feds Reject Hawaii’s 10-Day Medicaid Hospital Limit

Now on Kaiser Health News’ blog, Phil Galewitz reports: "Eleven of the nation's largest hospitals systems –including Kaiser Permanente, HCA Healthcare,  and Boston-based Partners HealthCare — today called on their industry to be better environmental stewards" (Galewitz, 4/3). Also on the blog, Galewitz reports on news from Hawaii: "The Obama administration has rejected Hawaii's proposal to limit most adult Medicaid recipients to 10 days of hospital coverage per year, which would have been the strictest in the nation. Instead, Hawaii has been approved to implement a 30-day hospital coverage limit starting July 1, state and federal health officials say" (Galewitz, 4/3). Check out what else is on the blog.

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Video: Santorum Still Swinging At Romney About Health Care Record

This Kaiser Health News video offers excerpts of how, after his primary victories in Wisconsin, Maryland and the District of Columbia, Mitt Romney attacked President Obama on a variety of social and economic issues, briefly mentioning health care. Meanwhile, challenger Rick Santorum went after Romney by reprising his theme that the former Massachusetts governor would be a weak candidate against Obama on health care. Watch the video or read the transcript.

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Video: Obama Blasts GOP Medicare, Medicaid Plans

This Kaiser Health News video features clips from a speech given yesterday by President Barack Obama in which he attacked the Republican 2013 budget as a "Trojan horse" and "thinly veiled social Darwinism."  Speaking in Washington to an association of newspaper editors, Obama not only attacked Republican budget proposals, but in response to a question, he also laid out a defense of the 2010 health law and why he thinks the Supreme Court will uphold the law as constitutional (4/3). Watch the video.

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Political Cartoon: 'Cut Off?'

Kaiser Health News provides a fresh take on health policy developments with "Cut Off?" by John Cole.

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


Doctors want to curb
Unnecessary treatments.
Hmmm…  How will that work?

And, as a reminder and a request that our readers keep those creative juices flowing coming, here's a bonus haiku:


Spring weather arrives;
Haiku submissions thin out.
Step it up, poets! 

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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Administration News

President Lashes Out At GOP Budget, Medicare Plan

In a Tuesday speech billed by many as a preview of the Obama reelection campaign's favorite themes, President Barack Obama blasted the treatment of Medicare, Medicaid and other entitlement programs by the Republicans and warned that their spending blueprint is a form of "Social Darwinism."  

The Fiscal Times: Obama Comes Out Firing in Campaign Kickoff Speech
Beyond the immediate budget politics in Washington, the speech, likely written by the David Axelrod-run campaign operation in Chicago, offered a major preview of the themes the president will offer on the campaign trail ... "We're told that Medicaid would simply be handed over to the states [that] can experiment. But here's the deal the states would be getting. They would have to be running these programs in the face of the largest cut to Medicaid that has ever been proposed—a cut that, according to one nonpartisan group, would take away health care for about 19 million Americans" (Goozner, 4/3). 

Medscape: Obama Calls GOP Budget, Medicare Plan a 'Radical Vision'
The non-partisan Congressional Budget Office (CBO) estimates that the GOP plan would gradually shrink annual budget deficits and put the federal government back in the black by 2040. ... Much of the GOP’s deficit reduction is achieved by partially privatizing Medicare. ... The president also predicted that private insurers would cherry-pick younger, healthier seniors, leaving older, sicker ones in traditional Medicare. Because traditional Medicare would offer more generous benefits, its premiums would need to increase due to adverse selection, making it less affordable (Lowes, 4/3). 

CQ HealthBeat: Obama Blasts Medicare, Medicaid Elements Of House GOP Budget
President Obama maintained Tuesday that the House Republican budget would "ultimately end Medicare as we know it" and that it includes the largest cut ever to Medicaid. In a seething election year speech, Obama went after the Republican budget and restated Democratic opposition to the Medicare proposal engineered by House Budget Chairman Paul D. Ryan, R-Wis (Bunis, 4/3).

Politico Pro: Health At Center Of Obama Economic Vision
President Barack Obama on Tuesday sought to draw bright and clear differences between his vision for the country and the Republicans' — and health care and entitlements were among the brightest. Addressing the American Society of Newspaper Editors, Obama devoted nearly a third of his speech on the economy to health. He attacked the polarized political climate that has endangered his health care overhaul law and he bashed the policy behind the House GOP budget's treatment of Medicare and Medicaid. And he reminded his audience that the health care law affects the lives of millions of Americans, many of whom now lack affordable insurance (DoBias, 4/3).

The Hill: Obama Sticks With Charge That Ryan Plan Would 'End Medicare'
President Obama made clear Tuesday that he's not about to soften his criticism of Republicans' Medicare proposals, charging again that the GOP plan would "end Medicare as we know it." Obama also referred to the GOP's Medicare proposal as a "voucher" system — another characterization that Republicans insist is inaccurate. The plan, crafted by Rep. Paul Ryan (R-Wis.), would convert some federal Medicare funding into subsidies for private insurance. Seniors would choose between the traditional program and subsidized private coverage (Baker, 4/3).

Kaiser Health News: Video: Obama Blasts GOP Medicare, Medicaid Plans
This Kaiser Health News video features clips from a speech given yesterday by President Barack Obama in which he attacked the Republican 2013 budget as a "Trojan horse" and "thinly veiled social Darwinism."  Speaking in Washington to an association of newspaper editors, Obama not only attacked Republican budget proposals, but in response to a question, he also laid out a defense of the 2010 health law and why he thinks the Supreme Court will uphold the law as constitutional (4/3).

The New York Times: Obama, In Talk, Calls House GOP Budget The Work Of Rightist Radicals
President Obama opened a full-frontal assault on Tuesday on the federal budget adopted by House Republicans, condemning it as a "Trojan horse" that would greatly deepen inequality in the United States, and painting it as the manifesto of a party that has swung radically to the right. … Singling out Medicare, the president asserted that the Republican plan to shift people to a system of vouchers would drive up the cost of health care for the elderly, since private insurance companies would target the youngest and healthiest people and leave the rest to rely on Medicare (Landler, 4/3).

The Washington Post: Obama: GOP Budget Plan Would Create Form Of 'Social Darwinism'
President Obama delivered a stern and stinging rebuke of the Republican vision for the country Tuesday, castigating the GOP as a "radical" party that has strayed so far from the political middle that its policies represent an affront to core American values. … Obama said the House Republican budget plan, which has been endorsed by Romney and would slash entitlements and agency spending, is "so far to the right" on the political spectrum that it makes the Republicans’ 1994 Contract With America "look like the New Deal" (Nakamura, 4/3).

The Wall Street Journal: Obama Blasts GOP Budget As 'Trojan Horse'
For the first time the president singled out Mr. Romney by name, unprompted, to highlight the former Massachusetts governor's support for the GOP budget. He even poked fun at Mr. Romney, whom the Obama campaign has cast as out of touch with average Americans, for describing the GOP budget as "marvelous." … The GOP budget proposes, among other things, turning Medicaid into a block-grant program controlled by the states, restructuring Medicare and reducing the top individual and corporate tax rates to 25% from 35%. The Republican plan also calls for deep spending cuts (Lee, 4/3).

The Washington Post's The Fact Checker: Obama's Attack On The GOP Budget
With President Obama's speech before the Associated Press on Tuesday, one can say the 2012 presidential contest has begun in earnest. For the moment, we will ignore some of his stylistic bloopers — "the Republicans running Congress right now" ignores the fact that the Senate is still in Democratic hands — and instead concentrate on how the White House backs up some of his claims about the House Republican budget. As usual, we will not judge the politics of the speech — just the facts. We will also delve more deeply in other parts of the speech, such as the Medicare portion, later in the week (Kessler, 4/4).

Market Watch: Obama Likens Republican Budget To Trojan Horse
President Barack Obama on Tuesday took aim at the budget passed by House Republicans, saying spending cuts are too deep and would eliminate needed investment... He also said the program would make Medicare more risky for seniors. Referring to when Ryan’s voucher proposal starts in a decade’s time, he said seniors run the risk that they will have to pay out of their own pockets for medical care if health-care costs continue to outstrip the amount of the voucher (Goldstein, 4/3).

Reuters: Obama Assails Republican Budget Plan, Aims At Romney
President Barack Obama accused Republicans on Tuesday of favoring the rich with a "radical" budget plan that focuses on cutting popular programs, which the White House sees as a potent vote winner for Democrats in this year's election... "It is a bad idea and it will ultimately end Medicare as we know it," Obama said, tapping into fears of what might happen to the federal healthcare plan for the elderly which Democrats will play up in the election (Bull, 4/3).

Roll Call: Barack Obama Blames GOP For Gridlock Slams House Budget
President Barack Obama dished out partisan red meat today, blaming a GOP shift to the right for the gridlock in Washington, D.C., and warning that Rep. Paul Ryan’s budget plan would decimate important government programs. In a speech to a conference of newspaper editors in Washington, Obama pitched the contrasting economic visions as the defining issue of the elections — whether the nation will double-down on tax cuts for the wealthy or continue investing in education, health care and other programs…Obama noted that cap-and-trade started as a Republican idea, as did the individual mandate for health care (Dennis, 4/3).

Politico: Obama's Fighting Words On The Ryan Budget
President Barack Obama's back in campaign mode. And this time, it's personal. On Tuesday, he called House Republicans' budget a "Trojan horse" for "Social Darwinism" that is "so far to the right, it makes the Contract With America look like the New Deal." He also mocked Mitt Romney for calling that budget "marvelous," a word "you don't often hear when it comes to describing a budget … a word you don't often hear, generally." The shots at his Republican adversaries followed a more subtle — but no less pointed — admonition Monday to the Supreme Court not to cross him by striking down all or part of his cherished overhaul of the nation's health care system (Allen, Budoff Brown, 4/3).

Boston Globe: Obama Criticizes GOP Budget, Calls Romney Out
President Obama eviscerated the Republicans’ budget proposal Tuesday, calling it a radical blueprint that bolsters the rich and decimates the middle class, and he leveled criticism at Mitt Romney, his probable Republican opponent in the fall, for the first time in a speech... Obama’s address carried the tenor and themes of a campaign speech, with the president seeking to paint himself as savior of the middle class and guardian of popular entitlement programs such as Medicare, while portraying Republicans as Wall Street protectors who look out only for the wealthy (Jan, 4/3).

In related news -

Kaiser Health News: Revamping Medicare: A Guide To The Proposals, Politics And Timeline
Congress is unlikely to consider legislation that would fundamentally restructure Medicare until a new Congress -- and possibly a new president -- are seated in 2013. But politicians have sought to tackle the growth in Medicare costs several times in the past two years, most notably in the 2010 health care law and, then again, in last year's budget deal (Werber Serafini, 4/3).

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Health Reform

GOP Plans For Health Law Replacement; Obama Softens Court Rhetoric

Republican lawmakers say they are beginning to pull together a health care package that could replace the 2010 law if the Supreme Court overturns it.

The New York Times: Looking Ahead, Republicans Examine Options In Health Care Fight
Republican lawmakers who have spent two years railing against President Obama's health care law are beginning to devise alternatives so they can be ready if the Supreme Court forces the issue of the uninsured back into the center of political debate. ... Their approach is likely to set aside universal health insurance coverage as the main objective. Instead, they would focus on lowering costs as “the overriding goal,” said Senator John Barrasso, Republican of Wyoming, a medical doctor and party spokesman on health issues (Pear and Weisman, 4/3).

Reuters: Obama: Not Spending Much Time On Healthcare Contingency Plans
President Barack Obama said on Tuesday he was not spending "a whole bunch of time" preparing contingency plans should the Supreme Court overturn his healthcare overhaul law because he is confident the justices will uphold it. Obama, a former constitutional law professor, also weighed in with a legal argument, saying the high court was unlikely to strike down a law passed by Congress "on an economic issue like healthcare that I think most people would clearly consider commerce" (Spetalnick, 4/3).

Politico: White House Pushes Back On Single-Payer Claims
Obama said during remarks Tuesday that either a mandate or a single-payer government health plan were the only way to ensure coverage of everyone with pre-existing conditions. "The President was simply explaining the individual responsibility provision in the context of the decades-long debate about fixing America's healthcare system. He was not talking about any hypothetical situation where ACA is overturned, nor has the White House commented on such hypotheticals, because we firmly believe the law is Constitutional and will be upheld," a White House official said (Tau, 4/3).

National Journal: Supreme Court Hearings Didn't Help Obama's Case, Poll Finds
Though a majority of Americans weren't swayed either way by the Supreme Court's hearings on the health care reform law, the hearings did negatively affect public perception of both the law and the Court, according to a new Pew Center survey. The survey, conducted with The Washington Post, polled adults nationwide from March 29 to April 1, just days after the three-day SCOTUS hearings on the law last week. Though cameras and recording devices weren't allowed in the courtroom, the public received a barrage of news reports from reporters witnessing the hearings firsthand and from the transcripts released at the end of each day (Jaffe, 4/3).

Meanwhile, Obama's comments about the Supreme Court Monday prompted GOP criticism.

CQ HealthBeat: McConnell, Hatch Say Obama Remarks On Court Case Are Politically Motivated
Top Senate Republicans accused President Obama of trying to intimidate the Supreme Court by saying that overturning his 2010 health care overhaul law could be seen as judicial activism. Senate Minority Leader Mitch McConnell and Sen. Orrin G. Hatch, R-Utah, said the president's remarks foreshadow a strategy by Democrats to campaign against the court's justices if they do not rule in their favor (Ethridge, 4/3).

The Hill: Obama Says He Will 'Respect' Supreme Court's Ruling On His Health Care Law
President Obama softened his rhetoric Tuesday about the possibility of a Supreme Court decision striking down his healthcare reform law, after Republicans accused him of "threatening" the high court. Obama said Monday that a ruling against the healthcare law would show a "lack of judicial restraint." Republicans quickly accused the president of trying to intimidate the court (Baker, 4/3).

National Journal: Romney: Court Decision Won't Be 'Activist'
[Mitt Romney] leveled attacks instead against President Obama, saying that he is "consumed with trying to find someone to blame for an extraordinarily failed presidency." Romney also dismissed Obama's assertion on Monday that if the Supreme Court struck down his health care law it would be the actions of an activist Court. On Fox & Friends, Romney reacted to news that Obama would be delivering a speech on the economy. "He's trying to find someone to blame, some scapegoat that he can point to and say, 'This is the person responsible,'" Romney said. "The truth is, the buck stops at his desk, and it's time he realizes it" (Miller, 4/3).

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Federal Court Judge Takes Umbrage At Obama's Remarks On Judicial Activism

The judge ordered the Justice Department to explain whether Attorney General Eric Holder Jr. believes federal judges have the authority to strike down federal law.

The Washington Post: Judge Tells Justice Dept.: Clarify Remarks On Judicial Activism Amid Health-Care Debate
A federal judge on Tuesday expressed concern over President Obama's comments on the Supreme Court's consideration of the health-care law and demanded a letter explaining whether Attorney General Eric H. Holder Jr. believes federal judges have the authority to strike down federal laws (Markon, 4/3).

The Associated Press: Judge Upset By Obama's Comments On Health Care Law
A federal appeals court judge on Tuesday seemed to take offense to comments President Barack Obama made earlier this week in which he warned that if the Supreme Court overturned his signature health care overhaul it would amount to overreach by an "unelected" court... During oral arguments in Houston in a separate challenge to another aspect of the federal health care law, U.S. 5th Circuit Court of Appeals Judge Jerry Smith said Obama's comments troubled a number of people who have read them as a challenge to the authority of federal courts (Lozano, 4/3).

The Wall Street Journal's Washington Wire: Judge Pokes Obama Over Court Comment
On Tuesday, a three-judge panel in the U.S. Court of Appeals for the Fifth Circuit ordered the Justice Department to explain whether courts indeed have the right to strike down a federal law. It's been well-established since the 1803 case of Marbury v. Madison that they do, and the Justice Department is expected to say as much in its response. The answer is due by Thursday. The order came during a proceeding on a separate challenge to the health law by physician-owned hospitals (Meckler, 4/3).

Politico: Report: Federal Judge Hits Back At Obama
The request — from 5th Circuit Judge Jerry E. Smith, a Ronald Reagan-appointee — seemed to be a direct shot at Obama, who said Monday that the Supreme Court would be guilty of an "unprecedented" act of "judicial activism" if it strikes down the health care reform law. Obama's comments have "troubled a number of people who have read it as somehow a challenge to the federal courts or to their authority or to the appropriateness of the concept of judicial review," Smith told a Justice Department attorney during oral arguments in a case involving the health reform law's limits on physician-owned hospitals. "And that's not a small matter" (Haberkorn, 4/3).

The Hill: Texas Judge Confronts Obama Administration Over 'Judicial Restraint' Statement
A federal judge in Texas is demanding that the Department of Justice clarify whether President Obama's dig about "judicial restraint" means the administration thinks the Judicial Branch has no right to overturn unconstitutional laws. Fifth Circuit Judge Jerry Edwin Smith, a Reagan appointee, is part of a three-judge panel hearing a lawsuit challenging the law's restriction on physician-owned hospitals. During oral arguments Tuesday, Smith demanded that Attorney General Eric Holder send him a three-page, single-spaced letter by noon Thursday explaining what Obama meant when he said Monday that ruling against his health law would be an "unprecedented" act of judicial activism (Pecquet, 4/3).

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Quantifying The Health Law's Medicaid Expansion

The Fiscal Times: Medicaid Expansion Will Rise To 13 Percent By 2017
Taking the recession's impact and reform together, the Obama years' Medicaid expansion (assuming the president and reform survive) will come to about 26 percent, higher than the Clinton years, no doubt, but significantly smaller than the increases experienced under either of the Bushes (Goozner, 4/3).

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Physician Groups Identify Unnecessary Procedures

The list of 45 tests and procedures was pulled together by nine medical speciality groups to help reduce spending and improve patients' health.

Boston Globe: Many Common Procedures Unneeded, Say Doctors Groups
Nine medical specialty groups have released a list of 45 tests and procedures that patients often do not need -- even though doctors routinely perform them. They include annual electrocardiograms, CT scans for low back pain, and chest X-rays before surgery. Ordering these tests when they are not merited wastes money and can harm patients by exposing them to radiation and more unneeded medical procedures, the physician groups said (Kowalczyk, 4/4).

Kaiser Health News: Physicians Wade Into Efforts To Curb Unnecessary Treatments
Nine prominent physician groups today released lists of 45 common tests and treatments they say are often unnecessary and may even harm patients. The move represents a high-profile effort by physicians to help reduce the extraordinary amount of unnecessary treatment, said to account for as much as a third of the $2.6 trillion Americans spend on health care each year (Appleby, 4/4).

The Associated Press: New Effort By MDs To Cut Wasteful Medical Spending
Until now, the health care system has rewarded doctors for volume. Now the focus is shifting to paying for results and coordination. That explains the urgency for doctors themselves to identify areas of questionable spending. It's unclear how much money would be saved if doctors followed the 45 recommendations rigorously. Probably tens of billions of dollars, and maybe hundreds of billions over time. That would help, but come nowhere near solving, the problem of high health care costs (Alonso-Zaldivar, 4/4).

The New York Times: Doctor Panels Recommend Fewer Tests For Patients
The recommendations represent an unusually frank acknowledgment by physicians that many profitable tests and procedures are performed unnecessarily and may harm patients. By some estimates, unnecessary treatment constitutes one-third of medical spending in the United States (Rabin, 4/4).

Reuters: Doctors Call For End To Five Cancer Tests, Treatments
One recommendation likely to stir controversy, and even revive charges of "death panels," is to not use chemotherapy and other treatments in patients with advanced solid-tumor cancers such as colorectal or lung who are in poor health and did not benefit from previous chemo. Such treatment is widespread (Begley, 4/4).

ABC: 5 Medical Tests You May Not Need
For many patients and doctors, it's easy to adopt the notion that if a little screening is good, more of it is better, "just to be sure" nothing is wrong. But that approach is costly, both in terms of health care dollars spent and the potential risks of the screenings (Gann, 4/4).

CNN: 5 Medical Tests You Often Don't Need
Forty-five tests and procedures routinely performed on patients are often unnecessary, according to a report released Wednesday by nine physician groups, the Consumers Union, and the American Board of Internal Medicine Foundation (Bonifield, 4/4).

Meanwhile, in other medical news, some hospital officials are pressing their peers for more environmentally-friendly policies.

Kaiser Health News: Capsules: Hospital Group: Ditch Fast Food, Turn Down The Lights;
Eleven of the nation's largest hospitals systems – including Kaiser Permanente, HCA Healthcare,  and Boston-based Partners HealthCare — today called on their industry to be better environmental stewards (Galewitz, 4/3).

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Health Care Marketplace

WellPoint CEO's Compensation Slid In 2011

The Associated Press: WellPoint CEO Compensation Slipped In 2011
WellPoint Inc.'s earnings sank last year, as the health insurer struggled with losses in its Medicare Advantage business, and the total compensation delivered to Chairwoman and CEO Angela Braly slipped as well... Health insurers have been targeted for criticism in recent years for churning out large profits and giving their top executives big compensation hikes while the cost of insurance for many people continues to outpace inflation and wage growth. Insurers have said executive compensation makes up a small part of their total expenses, and the biggest driver behind the growing premiums for their coverage is the spiraling cost of health care (Murphy, 4/3).

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Hearing Date Set For Injunction Request On Express Scripts-Medco Merger

Bloomberg: Express Scripts Judge Sets Hearing On Injunction Request
The judge overseeing a private antitrust lawsuit seeking to block Express Scripts Inc. (ESRX)'s acquisition of Medco Health Solutions Inc. (MHS) set a hearing for April 10 on a request for an injunction to undo the deal. ... She ordered Express Scripts to respond by April 6. The National Association of Chain Drug Stores, the National Community Pharmacists Association and independent pharmacies yesterday filed the emergency request to "hold separate Medco’s assets and operations," hours after the $29.1 billion acquisition closed (Schoenberg, 4/3).

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State Watch

Health Plan Settles Fla. Lawsuits; Minn. HMOs Return $73M To State, Feds

In Florida, a health plan in Tampa will pay $137.5 million to settle lawsuits over Medicare and Medicaid claims, while Earvin "Magic" Johnson plans to invest in a new HIV plan there. In Minnesota, the federal government and the state will split $73 million nonprofit HMOs are returning while other Minnesota health plans profits jump 21 percent.

The Associated Press: Tampa-Based WellCare Agrees To $137.5M Settlement
Federal prosecutors say a Tampa-based health care provider has agreed to pay $137.5 million to settle four lawsuits involving fraudulent Medicare and Medicaid claims in nine states. The U.S. Attorney in Tampa announced the settlement Tuesday. The suits claimed WellCare Health Plans Inc. falsely inflated the amount it claimed to be spending on medical care to avoid returning the money to Medicaid and other programs (4/3).

The Miami Herald: Magic Johnson Invests In Miami-Dade Health Plan
Magic Johnson Enterprises is investing in a Miami-based insurer, Simply Healthcare Plans, to create a major Medicaid program for HIV-AIDS patients that takes advantage of a bill signed last week by Gov. Rick Scott. The companies announced the partnership Tuesday to mark the official launch of Clear Health Alliance, a subsidiary of Simply that is a Medicaid plan for those with HIV and AIDS. The alliance will start in Miami-Dade and expand throughout Florida (Dorschner, 4/3).

Minnesota Public Radio: Minn. HMOs To Return $73M To State
Four big Minnesota managed-care plans will repay state and federal taxpayers an estimated $73 million as part of a deal the HMOs made with Gov. Mark Dayton's administration last year (Stawicki, 4/3). 

(St. Paul) Pioneer Press: Minnesota Nonprofit HMOs To Pay State $73 Million
The state and federal governments will split $73 million in expected repayments from Minnesota's HMOs as a result of a cap on health plan profits during 2011. State officials expect to receive the money by the summer and anticipate about half of it will go to the federal government, Gov. Mark Dayton said Tuesday, April 3. Many options are on the table, but the money could be used help restore pay for personal care assistants, which has been cut, officials said (Snowbeck, 4/4).

(St. Paul) Pioneer Press: Minnesota Health Plans' Operating Earnings Jump 21%
Minnesota's nonprofit health plans collectively saw operating profit increase by 21 percent last year as the industry's financial reserves reached $2.8 billion. As a group, health plans saw income from operations of $355.7 million last year on premium revenue of $19.8 billion. That works out to just under cents of profit per dollar of revenue, according to figures released Tuesday, April 3, by the Minnesota Council of Health Plans (Snowbeck, 4/3).

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Hospital News: Officials Plan New Building In Colo.; Mich. Facility Is Shutting Down

Denver hospital officials plan an expansion, a Michigan hospital says it's shutting down, and in Massachusetts, Steward Health Care plans to buy a hospital.

Denver Post: Sky Ridge Hospital Plans Expansion South Of Denver
Sky Ridge Medical Center will add to the boom in south suburban medical growth with a 90-bed, $107 million expansion of its Lone Tree hospital. The investment by Sky Ridge owner HealthONE, part of the Nashville for-profit hospital chain HCA, comes soon after HealthONE consolidated its control of metro Denver's largest hospital group. HealthONE already managed Sky Ridge, Rose, Swedish, Presbyterian/St. Luke's and other hospitals, and bought remaining control in October from the nonprofit Colorado Health Foundation (Booth, 4/3).

The Associated Press/Modern Healthcare: Mich. Hospital Says It's Closing Down
Cheboygan (Mich.) Memorial Hospital said it has been forced to shut down Tuesday after a proposed sale of the facility to McLaren Health Care Corp. was blocked, throwing hopes of preserving health services at the area's largest employer into doubt. ... The hospital's CEO Shari Schult said the facility's emergency room will be closed and that arrangements will be made to divert ambulances to other hospitals. She said in a statement that other services also will be shut down, including outpatient clinics, laboratories and rehabilitation (4/3).

Boston Globe: Steward To Acquire Stoughton's New England Sinai
In its latest expansion move, fast-growing Steward Health Care System has agreed to buy New England Sinai Hospital, a 212-bed "post-acute care" site in Stoughton that treats patients recovering from serious illnesses or accidents after they leave other hospitals. Steward, which already owns 10 community hospitals and doctors groups across Eastern Massachusetts, said it plans to use New England Sinai to strengthen its "continuum of care"’ and lower costs by moving patients from more expensive hospitals and reducing readmissions (Weisman, 4/4).

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Catholic University Ends Birth Control Coverage

A Catholic University in Ohio ends its health plan coverage of birth control, and Texas is planning to apply for federal block grants to free up money to use on its Women's Health Program, which is closing.

Reuters: Catholic University In Ohio Ends Birth-Control Coverage
Xavier University, one of the oldest Roman Catholic colleges in the United States, will cut off birth-control coverage for its employees in July, a move that has divided faculty members and students on the Cincinnati campus. The abrupt cancellation of insurance benefits at the Jesuit university in Ohio comes amid a furious dispute between the Obama administration and the nation's Catholic bishops over contraception (Simon, 4/3).

The Texas Tribune: Texas Could Use Feds' Grants to Free Up Women's Health Money
In a fiscal switcheroo, Texas could free up state dollars to fund the embattled Women's Health Program by seeking federal block grants for other programs, the state's health commissioner wrote in a letter to House Democrats on Tuesday. Texas is losing more than $30 million in annual federal funding for the Women's Health Program over the state's decision to force Planned Parenthood clinics out of the Medicaid program. Gov. Rick Perry has vowed that the state will find the (Ramshaw, 4/3).

In the meantime, WBUR examines birth control and its history in the United States.

WBUR: The History Of Birth Control In The U.S.
Today’s hand-wringing about birth control is nothing new. Did you know, for instance, that the birth control pill was not allowed in Massachusetts as recently as 1970? At one point, the Pittsburgh branch of the NAACP charged that Planned Parenthood clinics were in effect using the pill as an instrument of racial genocide. Andrea Tone, professor of history & Canada Research Chair in the social history of medicine at McGill University in Montreal, Canada, says that when the pill was first put on the market, there was a unique debate (Young, 4/3).

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State Roundup: Feds Deny Hawaii Medicaid Hospital Limit

A selection of state health policy stories from Hawaii, Arizona, Wisconsin, California, Texas, Oregon and New York.

Kaiser Health News: Capsules: Feds Reject Hawaii’s 10-Day Medicaid Hospital Limit
The Obama administration has rejected Hawaii's proposal to limit most adult Medicaid recipients to 10 days of hospital coverage per year, which would have been the strictest in the nation. Instead, Hawaii has been approved to implement a 30-day hospital coverage limit starting July 1, state and federal health officials say (Galewitz, 4/3).

Arizona Republic: Arizona Prisons' Health Care To Be Run By Pa. Company
Arizona's Department of Corrections awarded a $349 million, three-year contract Tuesday to privatize health care for prison inmates that will cost the state $5 million a year more than it spent in 2011. The contract to privatize prison health care -- originally pushed by Rep. John Kavanagh as a way to save the state money -- was awarded to privately held Wexford Health Sources Inc. of Pittsburgh (Ortega, 4/3).

Arizona Republic: Arizona Lawmakers Question Health Pact
Seven members of Arizona's congressional delegation have demanded the Department of Defense answer questions about its decision to select UnitedHealth Group over a Phoenix-based company for a lucrative military health-care contract. In a letter sent this week to Defense Secretary Leon Panetta, Arizona members of the U.S. House of Representatives wanted to know how the federal agency evaluated the competing proposals and considered the costs associated with swapping contractors (Alltucker, 4/3).

Milwaukee Journal Sentinel: Wis. State Employee Benefits Cost More Than Neighboring States
The estimated cost of providing health benefits to state employees in Wisconsin is higher than in surrounding states, even with employees paying a larger share of the cost, according to a study released Tuesday by HCTrends. The study is based on the estimated costs in Wisconsin and the other states. For Wisconsin, the study used the average of the cost of health plans available to employees, not the actual cost based on enrollment in specific plans and the cost of those plans. But the average came close to the actual figure. HCTrends estimated that Wisconsin will pay on average $13,972 a year to provide health insurance to a state employee (Boulton, 4/3).

California Watch: Long Beach Managed Care Firm Under Civil, Criminal Investigation
A Long Beach-based health plan seeking new contracts to serve 54,000 Southern California low-income seniors has set aside $125 million to resolve claims by state and federal authorities that it overbilled Medi-Cal and Medicare (Jewett, 4/4).

Healthy Cal: State Launches Smaller Program For Adult Day Health Care
Monday's launch of California's new, smaller adult day health care program unleashed an emotional torrent of relief and anger for thousands of current clients and their providers after more than a year of threatened closures, lawsuits, patient assessments, rushed timelines and maddening uncertainty. ... More than 80 percent of about 35,000 existing clients have been approved for the new program. Original estimates by the state were that just 50 percent would be found eligible (Perry, 4/3).

States are also grappling with the implementation of the health reform law:

The Texas Tribune: Report: Texas Businesses Wary of Health Care Reform
Texas business owners have "significant doubts" about the federal health care law being considered by the U.S. Supreme Court, according to a report released Tuesday by the state comptroller’s office.Nearly two-thirds of the 919 business owners surveyed -- members of either the National Federation of Independent Business or the Texas Association of Business -- said they feared the law, if upheld, would be bad for business. ... Most respondents to the survey were businesses with fewer than 25 employees. Seven percent had more than 100 workers (Park, 4/3). 

Lund Report (an Ore. news service): Oregon’s Health Care Co-op Receives $57 Million In Federal Startup Funds
With support from the federal government, a second consumer owned and operated health plan is on its way to becoming a reality in Oregon and could begin enrolling members by January 2014. Known as Community Care of Oregon, it received $57 million in grant and loan funding last week from the Centers for Medicare and Medicaid Services. … Funding for health care co-ops was a last-minute addition to the Affordable Care Act after the public option didn’t get off the ground. Congress set aside $6 billion to create nonprofit health plans with the stipulation that members be able to elect the board and have a voice in how those plans are run -- similar to credit unions (McCurdy, 4/3).

The Wall Street Journal: Troubled Firm Wins Health Exchange Bid
The company the Cuomo administration has hired to design a state health-insurance exchange has been dogged by critical audits and lawsuits in the U.S. and abroad. The state Department of Health awarded the five-year contract to Virginia-based Computer Sciences Corp. in mid-March, state officials said. Its main duty will be developing a major local element of President Barack Obama's medical care overhaul: an online New York marketplace of insurance plans (Gershman, 4/3).

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Editorials and Opinions

Viewpoints: Obama's 'Diatribe' On Ryan Budget; President 'Recovers' On Statements About The Court; Other Health Care Mandates

The Wall Street Journal: Paul Ryan's Hunger Games
If there's a Laffer Curve for Presidential invective—some point at which dishonest political abuse yields diminishing returns—the White House political team must not think their boss has hit it. Even in this hyperpartisan age, President Obama's speech to the Associated Press yesterday was a parody of the form. This was a diatribe that managed to invoke "Social Darwinism" and "a Trojan Horse" in the same paragraph, amid the other high crimes that Mr. Obama says Paul Ryan wants to commit (4/3).

The New York Times: Calling Radicalism By Its Name
The speech was immediately attacked by the House speaker, John Boehner, for failing to deal with the debt crisis, but Mr. Obama pointed out how hollow that charge has become. "That argument might have a shred of credibility were it not for their proposal to also spend $4.6 trillion over the next decade on lower tax rates," he said. The math is, in fact, quite simple: cutting both taxes and the deficit can mean only more sacrifice from the middle class and the poor, ending the promise of Medicare and Medicaid. Over the long term, the deficit can be brought down through a combination of cuts and new revenues; doing so immediately, as Mr. Romney and his party want to do, would reverse the fragile recovery (4/3). 

The New York Times’ The Loyal Opposition: Exit Bad Obama, Enter Good Obama
President Obama's comments yesterday on the Supreme Court and health care reform were utterly inept, but he recovered today. The president's speech on the economy was a powerful argument against the calculated cruelty of the Republicans' failed economic policies. … Medicaid would be gutted, Medicare would be turned into a voucher program – but the Republicans would still cut taxes by $4.6 trillion over the next decade. The cuts, as usual, would mostly benefit the wealthy (Andrew Rosenthal, 4/3).

The Washington Post: President Obama's Reversal On The High Court
President Obama's comments Monday about the Supreme Court were jarring. If the court were to strike down the health-care law, Mr. Obama said, it would be a blatant example of judicial activism. … Well, not exactly, and the comments strayed perilously close to a preemptive strike on the court's legitimacy if it were to declare the individual mandate unconstitutional. Which is why Mr. Obama was wise to revise and extend his remarks Tuesday in comments to newspaper editors. Mr. Obama was more careful in the details and tone of his critique (4/3).

Chicago Tribune: Taking On The Court
It's another matter altogether, though, for a president to predict the outcome of a Supreme Court decision. Barack Obama did just that the other day in the Rose Garden, expressing his confidence that justices in the end will declare his health care act constitutional. They're hardly going to be swayed either way by what he says, however (Jules Witcover, 4/4).

Boston Globe: Better To Take The High Road
Maybe because every other constitutional professor in the country has been interviewed about last week’s Supreme Court oral arguments on the health care overhaul, President Obama -- himself a former professor -- just couldn't help himself. His comments on the case, during a news conference with leaders from Mexico and Canada, were a pointed warning to the court that invalidating his signature piece of legislation would be an "unprecedented, extraordinary" act of judicial activism. Yet while Obama is right to worry about a waning sense of judicial restraint among the court's most conservative members, he still should have taken the high road and left it to his lawyers to defend the law (4/4).

Des Moines Register: An Ironic Claim Of Judicial Activism
The U.S. solicitor general last week argued the government's case for the constitutionality of the new Affordable Care Act while standing at a lectern before the nine justices of U.S. Supreme Court. On Monday, President Barack Obama made his case to the court using what one of his predecessors referred to as a "bully" pulpit. ... It was a fairly remarkable pitch from a sitting president while the Supreme Court has a case under consideration. President Franklin D. Roosevelt had a famous war with the court over his New Deal laws, but at least he usually waited to criticize the court until after it had ruled (4/3).

CNN: Epic Failure By Washington Sets Us Adrift
There are plenty of ways to game the upcoming Supreme Court decision on health care reform, and they've all been said: President Obama loses in court, he wins with his base. Or it's a severe blow, potentially fatal. Or Republicans benefit if they win, because they were "right" all along. Or the GOP loses, because it has to figure out what to offer for health care instead. And so it goes. But there's something else going on here, and it's more meaningful than some short-term political skirmishing. This Supreme Court case is the Waterloo for political polarization, because it underscores something we should have known all along: Great changes in national public policy should never be erected on slender partisan majorities (Gloria Borger, 4/4).

Times Of Trenton (New Jersey): Obama’s Health Care Reform—A Big Swing And A Miss
Instead of encouraging states to improve health care at reduced costs for taxpayers, the Obama administration has decided to force states to enroll more patients in Medicaid without concern for costs. In New Jersey, these mandates entailed a 40 percent increase of enrollees at an estimated cost of more than $900 million from 2014 to 2020, when all of the act’s increases are implemented (Amy H. Handlin, 4/4).

The Wall Street Journal: Obama's Mandate Flashback
President Obama joined the liberal security detail yesterday that is attempting to protect his new health-care entitlement by threatening the Supreme Court with political blowback, and no surprise there. But given that political memory only lasts for days and sometimes weeks, recall the relatively recent vintage of Mr. Obama's support for the individual mandate. Yesterday he was extolling the mandate's "human element," yet just a few years ago his predictions of the end of human freedom would make the staunchest tea partier blush (Joseph Rago, 4/3).

Politico: Being Uninsured Is A Mandate, Too
The market for health care services is ubiquitous; the question is whether Congress mandates emergency-room market participation or a rational health insurance market system. The old system is no less a "mandate" than the Affordable Care Act. And let's be honest about where the pre-"Obamacare" emergency-room mandate is coming from. That mandate comes from congressional acts, too — for example, the 1986 Emergency Medical Treatment and Active Labor Act, which requires hospitals to treat anyone needing emergency care regardless of ability to pay. Indeed, Congress has enacted over the years a complex web of authorizing statutes and rules that regulate health care and allow insurance companies to price people out of the market (Jennifer Granholm, 4/3).

The Wall Street Journal: Another Case Against ObamaCare
With all the attention last week on the oral arguments before the Supreme Court, a report on the dire fiscal consequences of ObamaCare was overlooked by many. Republicans on the Senate Budget Committee released an analysis that draws on models from the Centers for Medicare & Medicaid Services and found that "the U.S. health-related unfunded obligations increased by $17 trillion since the law was passed, from $65 trillion to $82 trillion over the next 75 years." Sen. Jeff Sessions of Alabama says this is "more than twice the unfunded liability of Social Security" (Steve Moore, 4/3).

Houston Chronicle: Texas Is Already Reaping The Benefits Of Health Reform
No law is ever perfect and Congress will need to work together in a bipartisan manner to identify areas of health reform that can be improved, but there is no doubt that the health care reform law has already made a significant and beneficial impact on our nation and community. Out of all 50 states, Texas has the greatest need for health care reform. The 2010 census found that Texas has the highest rate of uninsured residents in the U.S., with one in four Texans uninsured (Rep. Gene Green, D-Texas, 4/3).

Reuters: Romney's Second Shot At Healthcare Reform
Even with poor implementation, the Massachusetts law has yielded some positive results, including broadening insurance coverage, especially for minorities, and decreasing premiums for individual purchasers of insurance. Candidate Romney must, however, do more than defend decisions made in Massachusetts as "a state solution to a state problem." The governor should articulate a broader vision that respects and leverages the strengths of our federal political system (Jim Stergios and Josh Archambault, 4/3).

The Washington Post: Are Women Just Not That Into Mitt?
Recent polls show single women under 50 scrambling back into the warm embrace of Barack Obama after a brief flirtation with the Republican boy band — Mitt, Rick, Ron and Newt. Was it something they said about birth control? (Kathleen Parker, 4/3).

USA Today: Schools Dispensing Birth Control
The school moved an adolescent health center that since 1986 had been three blocks from the campus into the school, right next to the guidance office. ... Of all the benefits of the move, the most striking to me and other veteran teachers here on the front lines is that we have not been seeing as many girls making their way down the hallways seven or eight months pregnant (Patrick Welsh, 4/3).

McClatchy: Exercise Pays Dividends
Study after study also show that regular exercise returns great mental health dividends — lowering chances of depression, decreasing anxiety levels, and improving overall mood. … Exercise really does pay dividends for both physical and mental health. And in a time of fiscal austerity, when the strain of prolonged economic hardship weighs heavily on the mental and physical health of so many Americans, the value, efficacy, and cost-effectiveness of physical activity should be recognized and leveraged (Helen Durkin, 4/4).

The Kansas City Star: Loophole In Tobacco Law Could Cost Missouri $1 Billion
Not only does the Missouri legislature foolishly ignore ways to raise revenues for its anemic coffers, its inaction threatens to cost the state hundreds of millions of dollars. Here again, the problem is Missouri’s unique propensity to coddle cigarette manufacturers and vendors. The state's ridiculously low tobacco tax — at 17 cents a pack the nation’s lowest — is only the start of the problem. For years, the legislature has balked at addressing a loophole in a legal settlement among states and tobacco manufacturers. That obstinance has turned Missouri into an open marketplace for smaller manufacturers and put the state in legal jeopardy (4/3).

Archives of Pediatrics and Adolescent Medicine: Expanding The Envelope Of Care
Pediatric cardiac surgery and cardiology care have been transformed during the past 3 decades by tremendous innovation and steady improvements. ... Yet, with expanding capabilities come increasingly demanding choices. The key question is how to enlarge the envelope of care so that children (and their families) receive technically outstanding care ... without crossing a line—admittedly, and yet also essentially, a line based on judgment—and lapsing into doing merely what, technically, can be done to the patient (Drs. Chris Feudtner and Antonio R. Mott, 4/2).

Journal of the American Medical Association: Incentives in Health: Different Prescriptions For Physicians And Patients
There is ample evidence that physicians, who typically fulfill the criteria for being economically rational, are exquisitely sensitive to the incentives they face. Physicians tend to recommend tests and treatments that will provide them with financial benefit. ... On average, compared to physicians paid on a capitated basis, physicians paid for specific procedures tend to recommend more of those procedures. Clearly, if the US health care system is to improve the value of health care spending, it will have to do so, in part, by exploiting this very rationality of physicians and by moving away from payment systems that contribute to excess use of high-cost, low-value services (George Loewenstein, Dr. Kevin G. Volpp and Dr. David A. Asch, 4/4).

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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.