Daily Health Policy Report

Thursday, April 4, 2013

Last updated: Thu, Apr 4

KHN Original Reporting & Guest Opinion

Health Spending And Fiscal Battles

Health Reform

Capitol Hill Watch

Health Care Marketplace

Coverage & Access

Public Health & Education

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Walgreens Becomes 1st Retail Chain To Diagnose, Treat Chronic Conditions

Kaiser Health News staff writer Julie Appleby, working in collaboration with USA Today, reports: "It's not just sore throats and flu shots anymore. Walgreens today became the first retail store chain to expand its health care services to include diagnosing and treating patients for chronic conditions such as asthma, diabetes and high cholesterol. The move is the retail industry's boldest push yet into an area long controlled by physicians, and comes amid continuing concerns about health care costs and a potential shortage of primary care doctors" (Appleby, 4/4). Read the story.

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Capsules: Texas Legislature Weighing 5 Key Proposals To Limit Abortions; GOP Members Call For Increased Spending To Cover Pre-Existing Conditions; Despite Federal Delay, Minn. Vows To Have Small Business Options On New Health Exchange

Now on Kaiser Health News' blog, KUHF’s Carrie Feibel, working in partnership with KHN and NPR, reports on abortion news from Texas: "Anti-abortion forces in Texas achieved a major triumph in 2011, the last time the state legislature convened. They passed laws requiring a 24-hour waiting period and requiring all women seeking an abortion to undergo a fetal ultrasound. The idea was to force down abortion rates by changing women's minds. A follow-up study indicated that abortions did decline by 10-15 percent, but probably because the waiting period created logistical and financial hurdles for many women, not because women’s minds were changed" (Feibel, 4/4).

In addition, Phil Galewitz reports on a Capitol Hill hearing focusing on funding for coverage of pre-existing conditions: "Republicans who have spent the past three years blasting the health care overhaul as an overreach by the federal government said Wednesday the law didn't allocate nearly enough money for a temporary program offering insurance coverage to those with pre-existing conditions" (Galewitz, 4/3).

Also on Capsules, Minnesota Public Radio's Elizabeth Stawicki, working in partnership with KHN NPR, reports on her state's small business insurance exchange: "Workers at small businesses that buy health insurance on MNSURE — Minnesota's new online marketplace — will have access to features that will be delayed in many other states" (Stawicki, 4/3). Check out what else is on the blog.

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Political Cartoon: 'Hyper-Sensitive?'

Kaiser Health News provides a fresh take on health policy developments with "Hyper-Sensitive?" by Lee Judge.

Meanwhile, here is today's health policy haiku:


Dementia's price tag
keeps going up, adding to
nation's health care costs.

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 Spending And Fiscal Battles

Medicare Misperceptions Create Tougher Task For Lawmakers

The New York Times reports that public misunderstandings about the specifics of entitlement benefits make trimming Medicare spending more difficult. Meanwhile, Politico reports on an idea that might bridge the partisan divide that plagues these efforts.

The New York Times: Misperceptions Of Benefits Make Trimming Harder
President Obama had Senate Republicans nodding in agreement during a recent ice-breaking dinner as he described a basic problem for the nation's fiscal future: For each dollar that Americans pay for Medicare, they ultimately draw about $3 in benefits. What's more, he added, most people do not understand that. … [T]he president was referring to the widespread and incorrect view, especially among older Americans, that Medicare recipients get only what they have paid for through taxes, premiums and medical co-payments. Now that misperception is making it all the harder for politicians to consider trimming those benefits or raising out-of-pocket expenses as they seek to restrain Medicare spending that is rising unsustainably while baby boomers age and medical prices increase (Calmes, 4/3).

Politico: Medicare Buy-In A Budget Solution?
To get to a budget deal, could Washington buy in to a Medicare buy-in? That's the question left hanging by a recent Urban Institute paper which maps out one path to bridge the partisan divide over Republican demands that the eligibility age for Medicare be adjusted upward from 65 to 67 so as to conform with Social Security (Rogers, 4/3).

Also in the news, tangible impacts of budget sequester -

The Washington Post's WonkBlog: Cancer Clinics Are Turning Away Thousands Of Medicare Patients. Blame The Sequester.
Cancer clinics across the country have begun turning away thousands of Medicare patients, blaming the sequester budget cuts. Oncologists say the reduced funding, which took effect for Medicare on April 1, makes it impossible to administer expensive chemotherapy drugs while staying afloat financially. Patients at these clinics would need to seek treatment elsewhere, such as at hospitals that might not have the capacity to accommodate them (Kliff, 4/3).

The Medicare NewsGroup: Medicare Sequestration Cuts Begin, Pain Yet To Come
When the budget axe swung Monday, hospitals, doctors, insurers, prescription drug plans, graduate medical education and other health care providers were on the chopping block. Providers that offer Medicare Advantage (Part C) plans and Medicare Prescription Drug (Part D) plans felt the effect of the cuts immediately. Medicare pays these providers on the first business day of every month to operate for the coming month. But a majority of health care providers won’t feel the pain until weeks, even months, after the budget cuts technically go into effect (Sjoerdsma, 4/4).

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Health Reform

Feds Issue Rules For 'Navigators' Who Will Help Consumers Buy Health Insurance

As the Obama administration published rules for "navigators," who will be hired in every state to help consumers shop in new insurance marketplaces, news outlets examine how states are setting up those marketplaces and the impact on consumers.

The Hill: HHS Sets Rules For ObamaCare 'Navigators'
The Health and Human Services Department (HHS) on Wednesday outlined the standards for "navigators" who will help consumers shop for health insurance in new marketplaces created by the Affordable Care Act. The healthcare law establishes insurance exchanges in each state, where consumers who don't get insurance through their employer can compare and buy plans (Baker, 4/3).

Georgia Health News: Many Georgians Projected To Get Exchange Subsidy
More than 800,000 Georgians will be eligible for new government subsidies next year to buy coverage in a health insurance exchange, according to a report released Wednesday. The subsidies or tax credits will help defray the cost of insurance for individuals and families on the new exchanges, set to launch in January under the Affordable Care Act. The report, from consumer advocacy group Families USA, a longtime supporter of the 2010 health care law, also found that most Georgians eligible for credits are in working families and have incomes between two and four times the federal poverty level, or about $47,100 to $94,200 for a family of four (Miller, 4/3).

The Washington Post: Va. General Assembly Reconvenes To Vote On McDonnell’s Amendments
But the bipartisan spirit that coalesced around the historic compromise on transportation soon evaporated as the legislature voted to adopt an amendment by McDonnell that would forbid insurers in federally managed exchanges under President Obama’s health-care plan from covering most abortions (Whack and Kunkle, 4/3).

Kaiser Health News: Capsules: Despite Federal Delay, Minn. Vows To Have Small Business Options On New Health Exchange
Workers at small businesses that buy health insurance on MNSURE — Minnesota's new online marketplace — will have access to features that will be delayed in many other states (Stawicki, 4/3).

Meanwhile, CNN examines the health law's impact on those who buy their own insurance -

CNN Money: Most Individual Health Insurance Isn’t Good Enough For Obamacare
If you buy your own health insurance now, you'll be in for a big change when you sign up for coverage in 2014. Just over half of the individual plans currently on the market do not meet the standards to be sold next year, when many key provisions of President Obama's Affordable Care Act kick in, according to a University of Chicago study. That's because the law sets new minimums for the basic coverage every individual health care plan must provide (Luhby, 4/3).

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Burden Of Care For Many Immigrants Untouched By Medicaid Expansion

Also in the news, media outlets offer news and analysis regarding Medicaid expansion plans and debates in Florida, Pennsylvania and Missouri.

California Healthline: Immigrant Health Care: Many Not Eligible For Medicaid Expansion
For years, health officials in Southern and Southwestern states have struggled to provide adequate care for immigrants, and now it seems that the ACA will do little to ease their burden. The ACA does not change the current eligibility standard preventing most documented immigrants from enrolling in Medicaid or the Children's Health Insurance Program if they have resided in the U.S. for fewer than five years. States are permitted to cover such immigrants in the programs at their own expense, and Medicaid will cover emergency care for all immigrants. Undocumented immigrants are not eligible for public health insurance programs, and the ACA in most cases will further exclude them from new coverage opportunities (Wayt, 4/3).

Health News Florida: Making Sense Of Medicaid Expansion
One million of the lowest-income adults in Florida may get health coverage on Jan. 1 as part of the Affordable Care Act, paid for mostly with federal funds. Or maybe not. It all depends on what the Florida Legislature decides in the coming four weeks (Gentry, 4/4).

Philadelphia Inquirers: Corbett Says He May Accept Medicaid Plan To Finance Private Coverage
Gov. Corbett, under pressure to accept a federal expansion of Medicaid, said Wednesday he was looking at ways to use that money to fund private coverage for hundreds of thousands of uninsured Pennsylvanians. Corbett has resisted opting into the Medicaid expansion envisioned under President Obama's health care overhaul, saying he is concerned it would be too costly for the state down the road. He did not commit to changing his mind on Wednesday. After a late Tuesday meeting with Health and Human Services Secretary Kathleen Sebelius, however, he said he may consider pursuing a private plan similar to what Arkansas, Ohio, and a handful of other states are exploring. Arkansas Gov. Mike Beebe, a Democrat, floated the concept as a way to win support from his Republican-controlled legislature (Worden, 4/3).

The Associated Press: Mo. House Panel Backs Medicaid Legislation
A Republican-led House committee approved a plan to expand and remake Missouri's Medicaid program Wednesday, but it may never take effect because it falls short of the demands of President Barack Obama's health care law. The legislation would authorize a fivefold increase in Missouri's income eligibility thresholds for adults to qualify for Medicaid. Yet it would not go as far as Obama's administration has said is necessary for states to receive full federal funding for the Medicaid expansion (Lieb, 4/3).

Kansas City Star: Nixon And Republicans Inching Toward Possible Missouri Medicaid Expansion
Gov. Jay Nixon hopscotched across the state for months trying to line up public support for adding 300,000 uninsured Missourians to Medicaid. Yet each time the issue has come before lawmakers, the Republican supermajority rejected it. On Wednesday, he made his case directly to those very lawmakers. They didn't sign on to his plan, but something in the middle looks to be taking shape. For the first time as governor, the Democrat met with the entire House GOP caucus for nearly an hour Wednesday. He emerged optimistic that Republicans will come on board with a middle-ground idea for expanding the public health insurance program for the poor -- a key component of the federal Affordable Care Act commonly known as Obamacare (Hancock and Kraske, 4/3).

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Capitol Hill Watch

Proposal To Eliminate SGR Payment Formula Is Revised

The House panels' proposal to replace Medicare's sustainable growth rate formula is seen as a way to change how Medicare delivers care. Meanwhile, some House GOP lawmakers who have complained about the health law's costs said Wednesday that it should have allocated more money to a program to cover people with pre-existing health conditions.

Modern Healthcare: House GOP Releases Revised Proposal For Replacing SGR
House Republican leaders released a revised proposal to replace Medicare's sustainable growth-rate physician payment formula. The proposed system would include specialty-specific performance measures, payment rates partly based on patient experience, and development of an appeals process to contest or reconsider a provider's quality score. Chairmen of the House Energy and Commerce and Ways and Means committees along with their respective health subcommittees issued the revised proposal on April 3 with a letter to the "provider community" (PDF) requesting comments on the new draft by April 15 (Robeznieks, 4/3).

The Hill: House Panels Release New Outline For Permanent 'Doc Fix'
Leaders of two top House committees are circulating an expanded draft of their plan to repeal Medicare's sustainable growth rate (SGR), the flawed physician payment formula that necessitates an annual "doc fix." The plan from the Energy and Commerce and Ways and Means panels would use SGR repeal as an opportunity to make dramatic changes to healthcare delivery within Medicare (Viebeck, 4/3).

Kaiser Health News: Capsules: GOP Members Call For Increased Spending To Cover Pre-Existing Conditions
Republicans who have spent the past three years blasting the health care overhaul as an overreach by the federal government said Wednesday the law didn't allocate nearly enough money for a temporary program offering insurance coverage to those with pre-existing conditions (Galewitz, 4/3).

Medpage Today: $$$ For Pre-existing Conditions Pain ACA
The high cost of covering adults with preexisting conditions before 2014 could signal greater costs for all individuals within the broader health insurance market, a health economist warned lawmakers. The Pre-Existing Condition Insurance Plan (PCIP), which the Affordable Care Act (ACA) created as a way to provide health coverage to those with preexisting medical conditions before other aspects of the law take effect in 2014, does nothing to reduce the costs of care for those patients, Thomas Miller, JD, resident fellow at the conservative American Enterprise Institute here, said at a congressional hearing Wednesday. Despite garnering only 110,000 enrollees -- far less than the 375,000 expected -- the PCIP program has run out of the $5 billion Congress gave it (Pittman, 4/3).

In other Capitol Hill action, Rep. Diane Black, R-Tenn., introduced legislation to give some physicians nearing retirement a break regarding electronic health record adoption penalities -

Medscape: Bill Would Exempt Retirement-Age Physicians From EHR Penalty
Physicians near retirement wouldn't suffer a Medicare pay cut for failing to adopt an electronic health record (EHRs) system, and soloists would get a 3-year hiatus from this penalty under a bill introduced last month by Rep. Diane Black (R-TN). The measure, which Black had introduced in the previous session of Congress, also would give specialists some breaks in earning bonuses and avoiding penalties in the incentive program, designed to promote "meaningful use" of EHRs for the sake of improved patient care and lower costs (Lowes, 4/3).

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Health Care Marketplace

Walgreens To Expand Health Services To Include Treatment Of Chronic Illness

The retail chain becomes the first to offer such extensive primary care through nurse practitioners and physician assistants at more than 300 in-store clinics in 18 states.

Kaiser Health News: Walgreens Becomes 1st Retail Chain To Diagnose, Treat Chronic Conditions
It's not just sore throats and flu shots anymore. Walgreens today became the first retail store chain to expand its health care services to include diagnosing and treating patients for chronic conditions such as asthma, diabetes and high cholesterol. The move is the retail industry's boldest push yet into an area long controlled by physicians, and comes amid continuing concerns about health care costs and a potential shortage of primary care doctors (Appleby, 4/4).

The Associated Press: Walgreen Clinics Expand Care Into Chronic Illness
Walgreen Co. has expanded the reach of its drugstore clinics beyond treating ankle sprains and sinus infections to handling chronic diseases such as diabetes, asthma and high blood pressure. The company, based in Deerfield, Ill., said Thursday that most of its 370 in-store Take Care Clinics now will diagnosis, treat and monitor patients with some chronic conditions that are typically handled by doctors (Murphy, 4/4).

In other health care marketplace news -

Modern Healthcare: New Accretive CEO Plans To Bring Discipline
The new CEO at Accretive Health, the beleaguered revenue-cycle management company, faces the challenging task of moving the company beyond its immediate financial problems and the glare of national publicity stemming from its allegedly aggressive billing collection practices. The Chicago-based company on Wednesday introduced its new leader, Stephen Schuckenbrock, the former president of Dell Services. He was introduced by Accretive co-founder and current CEO Mary Tolan, who earned $3.9 million in 2011 and will be stepping down from that post (Kutscher, 4/3).

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The Stock Market, Medicare Advantage Rates And 'Political Intelligence'

The Wall Street Journal: Tip On Policy Shift Jolted Health Shares
Alerted by a private message about a potential coming change in government health-care policy, certain investors earlier this week sparked a frenzy of trading in some of the industry's largest companies. The last-minute action, which drove the shares sharply higher before the close of trading, is throwing a spotlight on the controversial "political intelligence" industry, the subject of a report due Thursday by the investigative arm of Congress (Mullins and McGinty, 4/3).

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Coverage & Access

Study: Tricare Not Widely Accepted By Physicians

USA Today: Civilian Doctors Wary Of Accepting Military's Tricare
An estimated 620,000 Pentagon health care recipients -- a group that includes military retirees, National Guard members and reservists and the children of some active-duty troops -- struggle to find private doctors who will accept them as patients, according to a new government study. Many doctors reported that they turn away these patients because they are unfamiliar with the Pentagon health care program known as Tricare. Others say they did not like how little they are compensated or how long it takes Tricare to reimburse them (Zoroya, 4/3).

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Public Health & Education

Dementia's Price Tag Can Exceed $50,000 A Year, Study Finds

The study, published in the April 3 edition of the New England Journal of Medicine, found this medical condition costs the nation as much as $215 billion a year.

The Wall Street Journal: Dementia's Cost To Nation Piles Up
Dementia is one of the country's most expensive medical conditions, costing the U.S. between $157 billion and $215 billion a year in medical care and other costs, such as lost wages for caregivers, according to a new study (Wang, 4/3).

CBS News: Dementia Costs U.S. Up To $215 Billion Per Year, Study Finds
The average cost of care for a patient with dementia can exceed $50,000 a year, according to new research. A study published April 3 in the New England Journal of Medicine that tracked elderly adults found dementia can represent a significant financial burden not only on individual families but society at large. Researchers determined the annual costs associated with a patient with dementia were between $41,689 and $56,290. That added up to between $159 billion and $215 billion in American health care dollars, $11 billion of which is paid for by Medicare, the study found (Jaslow, 4/3).

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State Watch

Ala. Lawmakers Approve Controversial New Abortion Clinic Regulations

The measure, which still must be signed by the governor, would make abortion clinics use doctors with admitting privileges at local hospitals, a move opponents say could force the state's five clinics to close.

The New York Times: Alabama Legislature Passes New Limits On Abortion Clinics
The Alabama Legislature late Tuesday adopted stringent new regulations for abortion clinics that supporters called a step to protect women but that others called medically unnecessary and a disguised effort to force the closing of the state's five abortion clinics (Eckholm, 4/3).

The Wall Street Journal: Abortion Clinics Face State Curbs
The measure comes on the heels of controversial laws passed recently in Arkansas, which prohibited most abortions after 12 weeks of pregnancy, and North Dakota, which banned the procedure as early as six weeks into a pregnancy. Legal analysts don't expect those laws to survive legal challenges under the Supreme Court's Roe v. Wade ruling (Campo-Flores, 4/3).

The Associated Press/Washington Post: Alabama Legislature Passes Bill Setting Stricter Standards For Abortion Clinics
The bill requires abortion clinics to use doctors who have approval to admit patients to hospitals in the same city. Some clinics now use doctors from other cities that don't have local hospital privileges. A similar law in Mississippi is threatening to close that state's only abortion clinic, which is challenging the law in court. The bill also sets stricter building requirements, including wider halls and doors and better fire suppression systems (4/3).

Elsewhere, Texas legislators are considering stricter regulation to limit abortions --

Kaiser Health News: Texas Legislature Weighing 5 Key Proposals To Limit Abortions
Anti-abortion rights forces in Texas achieved a major triumph in 2011, the last time the state legislature convened. They passed laws requiring a 24-hour waiting period and requiring all women seeking an abortion to undergo a fetal ultrasound. The idea was to force down abortion rates by changing women’s minds. A follow-up study indicated that abortions did decline by 10-15 percent, but probably because the waiting period created logistical and financial hurdles for many women, not because women’s minds were changed (Feibel, 4/4).

And Planned Parenthood pushes for a bill in Oregon that would make clinics post what services they offer --

Lund Report: Planned Parenthood Wants Pregnancy Centers To Display Their Services
Planned Parenthood is pushing Senate Bill 490, which would require crisis pregnancy centers to declare upfront in signs whether they offer abortion, contraceptive or adoption services and if patients will receive services from a medical provider. Many of the crisis pregnancy centers offer only one or none of those services, and are merely a way of pushing an anti-abortion and anti-contraception religious agenda on unsuspecting and vulnerable women, according to Planned Parenthood (Gray, 4/3).

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N.C. Governor Proposes Managed Care Move For State's Medicaid Program

North Carolina Gov. Pay McCrory is proposing to privatize Medicaid to save money in the $13 billion program while stakeholders in Texas, Florida and California also consider changes to their Medicaid plans.

The Associated Press: N.C. Gov. Pat McCrory Offers Plan To Privatize Medicaid Care
North Carolina’s $13 billion Medicaid program needs a big dose of private competition that will come from paying a handful of statewide managed-care providers to deliver medical, mental, and dental care to the elderly and disabled for a stable cost, Gov. Pat McCrory said Wednesday. McCrory and state Health and Human Services Secretary Aldona Wos unveiled a proposal that would largely privatize management of Medicaid while keeping ultimate responsibility in state hands (4/4).

North Carolina Health News: McCrory Proposes Medicaid Overhaul
Gov. Pat McCrory rolled out his plan for revamping the state's Medicaid program Wednesday morning, describing a managed care plan that could lead to the privatization of the program that serves more than 1.5 million people with disabilities, the low-income elderly, pregnant women and children. The governor and Health and Human Services Secretary Aldona Wos said that too often Medicaid recipients receive uncoordinated care that doesn’t serve them well (Hoban, 4/4).

The Texas Tribune: Zerwas: House Medicaid Bill Will Include Williams' Plan
State Rep. John Zerwas, R-Simonton, confirmed Wednesday that he will incorporate into his own Medicaid reform bill a proposal by Sen. Tommy Williams, R-The Woodlands, to use premium tax revenue to subsidize private health policies for the uninsured (Ramshaw and Aaronson, 4/3).

Health News Florida: Now, The Teeny Weeny Bean Plan
What kind of health coverage can you buy for $20 to $30 a month? "You can't," says John Sinibaldi, an independent broker in Seminole. That may sum up the real-world prospects for Health Choice Plus, the plan for extremely low-income uninsured Florida adults that State Sen. Aaron Bean's Health Policy Committee approved Tuesday along party lines (Gentry, 4/3).

California Healthline: Public Involvement In Managed Care Licensing?
One of the bills that stirred up opposition from health plans was a proposal by Assembly member Roger Dickinson (D-Sacramento) to open the managed care licensing process to public scrutiny and input. "We know that millions more Californians will attain coverage under the Affordable Care Act, along with millions more in the impending Medi-Cal expansion, and [the effort] to move current enrollees in Healthy Families and other programs into Medi-Cal managed care," Dickinson said, "making it an opportune time to apply for managed care licensure." Dickinson said there have been 19 new applicants for managed care licenses in the last three years and he expects that number to rise. With so many state beneficiaries moving into managed care plans, he said there should be more public involvement in the licensing process (Gorn, 4/3).

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State Roundup: Texas Hospitals Spar Over Indigent Care Payments

A selection of health policy stories from California, Texas, Kansas, Tennessee, Ohio, Oregon and Massachusetts.

Los Angeles Times: Closure Of Three Southland Hospitals May Be Part Of A Trend
Hospital owner Pacific Health Corp. said it will close its three remaining Southern California hospitals, citing the fallout from a federal fraud case last year in which the company admitted paying to recruit homeless people off skid row in Los Angeles and billing the government for unnecessary care (Terhune, 4/3).

The Texas Tribune: Public, Private Hospitals At Odds Over Budget Rider
Private and public hospitals are at odds over how they should be reimbursed for uncompensated care -- and at the crux of the fight is a budget provision hitting the House floor on Thursday. The budget rider, backed by private hospitals, calls for the state to fully maintain the Disproportionate Share Hospital program, or DSH, under which the state's large public hospital systems use local taxpayer dollars to draw down federal matching money to cover indigent care at both public and private hospitals (Ramshaw, 4/4).

Kansas Health Institute: Controversial Infectious Disease Bill Appears Headed For Passage
House and Senate negotiators appear headed toward approval of a controversial bill that critics fear would make possible quarantining people infected with or exposed to HIV. After the committee debated for a half-hour adding language to the bill that would have explicitly excluded the possibility of HIV quarantine, negotiators asked Kansas State Epidemiologist Charlie Hunt whether further changes to the bill were necessary (Cauthon, 4/3).

USA Today/The Tennessean: Many Meningitis Victims Owe Tens Of Thousands In Bills
Deol is one of dozens of Tennessee residents who face continuing health problems and mounting expenses from a fungal meningitis outbreak more than six months after it began. ... More than a dozen have filed lawsuits, but most have been put on hold because the supplier of the tainted drugs filed for bankruptcy late last year. Billing statements reviewed by The Tennessean for three patients show the amounts charged for treatment and hospitalization ranged from Deol's $66,000 partial bill to nearly $200,000 (Roche, 4/3).

NPR: Lawyers Join Doctors To Ease Patients' Legal Anxieties
Two professions that have traditionally had a rocky relationship -- doctors and lawyers -- are finding some common ground in clinics and hospitals across the country. In Akron, Ohio, for instance, doctors are studying how adding a lawyer to the health care team can help improve a patient's health (St. Clair, 4/4).

Lund Report: Oregon House Votes To Include Insurers In Consumer Fraud Act
Seven years ago, Regence BlueCross BlueShield blithely declared that Azusa Suzuki was dead and refused to honor a supplemental insurance claim after she was injured in a car accident. But on Tuesday, Rep. Brian Clem, D-Salem, was able to bring his mother-in-law to the State Capitol, and like Lazarus, she witnessed the passage of House Bill 3160, which would roll Regence and other insurers under the state's chief consumer fraud protection act (Gray, 4/3).

Boston Globe: Cambridge Health Alliance Latest To Cut Beds For Children With Mental Illness
Cambridge Health Alliance said Wednesday it will eliminate 11 of its 27 beds for treating children and teens with acute mental illness and will end inpatient care for its youngest children as it grapples with financial losses. The hospital system has two highly regarded inpatient units -- one serving adolescents ages 12 to 19 and another for children as young as 3. The two units will be combined into one smaller unit serving patients ages 8 to 18, said Dr. Jay Burke, chief of psychiatry, and the hospital will focus more on providing community-based services (Conaboy, 4/3).

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Weekend Reading

Longer Looks: Embarrassing Accolades; Mapping the Brain; Physician Pay

Every week reporter Ankita Rao selects interesting reading from around the Web.

The New York Times: Of Medical Giants, Accolades And Feet Of Clay
Medicine honors its heroes in many ways. But sometimes high accolades can turn out to be highly embarrassing. Consider the annual award for lifetime achievement in preventing and controlling sexual infections, given since 1972 by the American Sexually Transmitted Diseases Association. The prize is named for an authentic giant of medicine: Dr. Thomas Parran Jr., the nation's sixth surgeon general (from 1936 to 1948) who used what was then a supremely powerful position to lift American public health to the front ranks. He defined the basic epidemiological principles of tracing all sexual contacts of infected individuals so they could be treated. ... Beyond that, he fought to clean up polluted waterways, crusaded for truth in radio drug advertising and was an architect of the World Health Organization. But if Dr. Parran was ahead of his time, he was also complicit in two of the most egregious medical scandals of the 20th century. And that blight on his record is now endangering his honored place in the world of public health (Lawrence K. Altman, 4/1).

Slate: Unfit To Bear Arms
In the last few days, investigators in Connecticut and Arizona have released thousands of pages of documents about the Tucson and Sandy Hook massacres. The documents, coupled with investigative leaks and with testimony about the movie theater shooting in Aurora, Colo., paint a clearer picture of what caused these tragedies. It isn't just high-capacity magazines or defenseless victims. It's a failure to link firearms access to mental health information (Will Saletan, 4/1).

The New York Times: Diagnosis: Human
The news that 11 percent of school-age children now receive a diagnosis of attention deficit hyperactivity disorder — some 6.4 million — gave me a chill. My son David was one of those who received that diagnosis. ... As a 21-year-old college senior, he was found on the floor of his room, dead from a fatal mix of alcohol and drugs. The date was Oct. 18, 2011. No one made him take the heroin and alcohol, and yet I cannot help but hold myself and others to account. I had unknowingly colluded with a system that devalues talking therapy and rushes to medicate, inadvertently sending a message that self-medication, too, is perfectly acceptable (Ted Gup, 4/2).

The Atlantic: Why Spend A Billion Dollars To Map The Human Brain?
In January, the European Commission pledged 500 million euros to work towards creating a functional model of the human brain. Then, yesterday, Barack Obama officially announced an initiative to advance neuroscience, funding a large-scale research project aimed at unlocking the secrets of the brain that involves over $100 million in federal spending in the first year alone, as well as investments from private organizations. Both projects are geared towards creating a working model of the brain, mapping its 100 billion neurons. ... However, there is a long list of obstacles these projects must overcome before we get too excited, not the least of which are the 100,000,000,000,000 connections that need to be measured and modeled. That's over one million times as many neurons as there were genes to map in the Human Genome Project, the closest approximation to the current endeavors (Dana Smith, 4/3).

New England Journal Of Medicine: Phasing Out Fee-For-Service Payment
In March 2012, the Society of General Internal Medicine convened the National Commission on Physician Payment Reform to recommend forms of payment that would maximize good clinical outcomes, enhance patient and physician satisfaction and autonomy, and provide cost-effective care. The formation of the commission was spurred by the recognition that the level of spending on health care in the United States is unsustainable, that the return on investment is poor, and that the way physicians are paid drives high medical expenditures (Steven A. Schroeder and William Frist, 3/27).

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Editorials and Opinions

Viewpoints: Rove Offers Strategy To Fight Democrats' 'Mediscare' Tactics; GOP Offers No 'Pragmatic Alternative' To Health Law

The Wall Street Journal: The Return Of The Mediscare-Mongers
The midterm election is still 19 months away, but for some it's never too early for demagoguery. And so this week the Democratic Congressional Campaign Committee launched a new "Mediscare" ad. The targets are 17 Republican congressmen who supported the House budget framework that includes Medicare reforms. ... Here's how Republicans might pull off a successful counterpunch (Karl Rove, 4/3).

Los Angeles Times: Insurance Industry Lobbies Its Way To Medicare Pay Raise
What's most impressive about our highly dysfunctional heath care system is that we're always finding clever new ways to make it worse. The latest such move comes on the Medicare front, where lawmakers had been trying to rein in costs by modestly lowering the amount that large insurers would be paid for managing Medicare Advantage plans, which are a private-sector version of the government program. ... But after the insurance industry unleashed its lobbyists and started throwing its considerable political muscle around, it ended up not with a pay cut from the Centers for Medicare and Medicaid Services, but a 3.3 percent increase (David Lazarus, 4/3).

Houston Chronicle: Universal Health Care For The Ownership Society
Sooner or later, Republicans will be forced to offer a pragmatic alternative to the Affordable Care Act. We haven't done this because health care is a miserable political swamp for the GOP. It forces us out of our comfort zone, leaving us to confront problems that do not yield to our favorite, market-driven solutions. We can't put this off forever. We need to move past slogans and build a plan (Chris Ladd, 4/4).

Bloomberg: Obamacare 'Repeal And Replace' Still Light On 'Replace'
Yuval Levin and Bloomberg View columnist Ramesh Ponnuru argue in the cover story of the current National Review that "repeal and replace" should remain the conservative mantra on the Patient Protection and Affordable Care Act. The law is so unworkable, they say, that it can't be molded into something workable; conservatives must focus on outright replacement. ... When someone tells you a health care policy is terrible, the most important question is "compared with what"? And so it's disappointing that Levin and Ponnuru devoted just three paragraphs of their 3,100-word piece to discussing how a replacement for the Affordable Care Act might look (Josh Barro, 4/3).

Journal of the American Medical Association: Is Medicaid Expansion Really A No-Brainer For States
Even after the Supreme Court struck down a requirement of the Affordable Care Act (ACA) that required states to expand Medicaid coverage to low-income individuals, states still seemed to have a juicy carrot to do so. … It turns out that the picture is not so simple (Stuart Butler, 4/3).

WBUR: CommonHealth: Cambridge Backs Abortion Rights, And The Feds Should Too
There is one part of the abortion story that tends to get less attention: the part about federal restrictions that prevent many women from exercising their constitutional right to an abortion. The Hyde Amendment, originally passed by Congress only a handful of years after Roe v. Wade, withholds federal health care assistance funds for abortion. This means that millions of women who qualify for Medicaid, as well as federal employees, military service members, veterans and Peace Corps volunteers who receive their insurance from the federal government, are unable to use their insurance to cover the costs of an abortion (Diane Roseman and Megan Smith, 4/4).

The New York Times' Taking Note: Affirming Abortion Rights
Anti-abortion activists are nothing if not inventive. State legislatures sympathetic to the cause are constantly finding new ways to restrict the legality or availability of the procedure, passing bans on so-called "partial-birth" abortion, parental consent requirements, and, more recently, "fetal heartbeat" laws. Choking off money is also wildly popular. According to the Guttmacher Institute, 32 states and the District of Columbia prohibit the use of state funds except in cases where the woman's life is at risk or the pregnancy is the result of rape or incest. Another eight states limit coverage in private insurance plans. The pro-choice side, perhaps necessarily, is usually on the defensive. But active attempts to affirm reproductive rights are not unheard of (Juliet Lapidos, 4/3).

New England Journal of Medicine: Limiting "Sugary Drinks" To Reduce Obesity -- Who Decides?
Perhaps the most important lesson is old news: economics often drives health policy. New York City's efforts to reduce obesity grew with its desire to control its health care costs for its residents, a disproportionate share of whom are obese or have diabetes. Meanwhile, large corporations continue to use their influence and money to derail public health measures that could reduce their profits. Although the general public shares the goals of public health, many people remain skeptical of government's choice of means for achieving those goals. Agencies that overstep their bounds or adopt rules that are intrusive or just plain silly invite backlash, which can make effective public health regulation impossible (Wendy K. Mariner and George J. Annas, 4/3).

New England Journal of Medicine: Half Empty Or Half Full? New York’s Soda Rule In Historical Perspective
Despite New York City Mayor Michael Bloomberg's plans to appeal it, the March 11 decision by Justice Milton A. Tingling of the New York State Supreme Court striking down the city's partial ban on sugar-sweetened drinks larger than 16 fluid ounces might easily be seen as a cup half empty. The ruling represents a major setback for a controversial and ambitious proposal, which was approved by the New York City Board of Health on September 13, 2012, and was immediately challenged in court by a group of small businesses along with the National Restaurant Association and the American Beverage Association. But many people remain torn over whether the giant-soda ban is an important measure for combating obesity or a gross intrusion on personal liberty -- and so whether such a public health regulation should itself be seen as a glass half empty or a glass half full (Amy L. Fairchild, 4/3).

Health Policy Solutions (a Colo. News service): Uninsured Young Adults: Are They Really Invincible?
[A] twenty-something chooses not to purchase health insurance, the thinking goes, because getting sick is not something he or she can even picture -- a perceived invincibility -- and there are plenty of more fun things to buy. Findings from the 2011 Colorado Health Access Survey (CHAS) suggest that last sentence isn't true for most young adults between the ages of 19 and 29 in Colorado. In fact, a perceived "invincibility" is way down on the list of reasons that uninsured young adults lack coverage. The top of the list? Cost (Emily King, 4/3).

Medpage Today: The Changing Role Of The Doctor
ObamaCare is changing the image of the doctor we know and love. For better or worse, gone are the days of a physician carrying a black bag and making house calls. The new-age doctor is someone who is probably comfortable communicating via text message (secure, of course), or by email. With the rising demands of a new dimension of healthcare delivery, where doctors need to see more patients to make up for lower reimbursement, you will soon see some innovative ways by which doctors will be communicating with patients, and still getting paid (Dr. Sreedhar Potarazu, 4/3).

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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.