Daily Health Policy Report

Thursday, April 5, 2012

Last updated: Thu, Apr 5

KHN Original Reporting & Guest Opinion

Health Reform

Campaign 2012

Health Care Marketplace

Coverage & Access

Public Health & Education

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Mississippi Legislature Passes Abortion Clinic Bill

Mississippi Public Broadcasting's Jeffrey Hess, working in collaboration with Kaiser Health News and NPR, reports: "The Mississippi legislature has passed a bill that will require any doctor performing abortions in the state to be a board-certified OB-GYN with admitting privileges at a local hospital. The change could make staffing the state's sole abortion clinic very difficult, since most of the doctors who practice at Jackson Women's Health live out-of-state and admitting privileges at the nearest hospital are given only to local physicians" (Hess, 4/4). Read the story.

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Capsules: Study: Chemo Costs Less In Doctors' Offices; 2010 Insurance Rebates Would Have Hit $2 Billion Study Says

Now on Kaiser Health News' blog, Christian Torres writes: "Chemotherapy costs significantly more at a hospital than at a physician’s office, and patients might have decreased access to the cheaper option, according to reports out this week. The first report, by Avalere Health, found that chemotherapy received in a hospital outpatient setting costs, on average, 24 percent more than when received at a physician’s office – or nearly $7,000 more" (Torres, 4/4).

Also on the blog, Jay Hancock reports: "Consumers would have received rebates of nearly $2 billion — in some cases as much as $300 member – if the health-law cap on insurance profits and overhead had been in place in 2010, estimates a new study" (Hancock, 4/5). Check out what else is on the blog.

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Political Cartoon: 'Vegetable Tale'

Kaiser Health News provides a fresh take on health policy developments with "Vegetable Tale" by Jen Sorensen.

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


You could draft a bill
Keeping healthcare's status quo
No one would vote yes
-Julie Miller

Plus, a bonus offering, though not in 3-D:


Titanic returns... 
Supremes discuss health care law...
An iceberg ahead?

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

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Health Reform

Questions Emerge After Obama Spars With The Supreme Court

Earlier this week, President Barack Obama made comments that "implicitly" warned the court against overturning the health law. Since then, defenders and critics have weighed in on his words and strategy.

The New York Times: Court's Potential To Goad Voters Swings To Democrats
Now strategists in both parties are suggesting this could be the Democrats' year to make the court a foil to mobilize voters. The prospect arises both because of President Obama's comments this week implicitly warning the court against striking down his signature domestic achievement, the expanded health insurance law, and because of recent court rulings, chiefly the Citizens United campaign finance decision, and looming cases on immigration and affirmative action that incite passions on the left (Calmes, 4/4).

Reuters: White House In Damage Control Over Obama Supreme Court Remarks
The White House was forced on the defensive on Wednesday as it sought to explain controversial remarks President Barack Obama made earlier in the week about the Supreme Court's review of his signature healthcare reform law. "What he did was make an unremarkable observation about 80 years of Supreme Court history," White House spokesman Jay Carney told reporters during a White House briefing dominated by the topic (Bull, 4/4).

The Washington Post: Obama's Supreme Court Comments Lead Some To Question His Strategy
Many conservatives charged that Obama's words amounted to a stark warning that he intends to campaign against the court if the law or its key elements are struck down, while some speculated that he was trying to bully the justices. One Texas judge … ordered the Justice Department to submit a three-page explanation of what role the administration believes the courts have. Even some legal scholars sympathetic to Obama and the health-care law are saying that the president might have been better off keeping quiet (Wallsten and Barnes, 4/4).

The Wall Street Journal’s Washington Wire: Laurence Tribe: Obama Misspoke On Supreme Court
Constitutional law scholar Laurence Tribe, a Harvard Law School professor and former mentor to President Barack Obama, said the president "obviously misspoke" earlier this week when he made comments about the Supreme Court possibly overturning the health-care law. Mr. Tribe, who calls the president one of his best students, said in an interview: "He didn’t say what he meant…and having said that, in order to avoid misleading anyone, he had to clarify it" (Favole, 4/4).

CQ HealthBeat: Did Obama Cross The Line With His Comments On Health Law Case?
With oral argument in the constitutional challenge to the health care law wrapped up and U.S. Supreme Court justices now thinking over their decision, did President Obama cross the line this week by making extensive comments on the case? To Senate Minority Leader Mitch McConnell, R-Ky., Obama was clearly trying to intimidate the court on Monday with his remarks...The bottom line is that Obama simply couldn't resist throwing in a few arguments of his own to back up those made last week on the law's behalf by U.S. Solicitor General Donald Verrilli Jr. What's not known is if Obama continues to comment on the case, whether it will help the law's chances in what's expected to be a very close decision that will shape health policy for years, if not decades (Reichard, 4/4).

Roll Call: White House Still Playing Defense On Barack Obama SCOTUS Remarks
White House Press Secretary Jay Carney struggled today to walk back President Barack Obama's false statement Monday that it would be "unprecedented" for the Supreme Court to overturn a law "passed by a strong majority of a democratically elected Congress."... Carney said Obama does not regret using the word "unprecedented" and noted that Obama clarified the remark Tuesday during questioning at an Associated Press conference. But the unedited original remark appears just plain wrong. And giddy Republicans released an extensive list of laws passed by Congress but overturned by the courts. And they have ridiculed his claim that the 219-212 majority for the health care reform law in the House represented a "strong majority" (Dennis, 4/4).

The Hill (Video): Carney: Obama Remark About Supreme Court Was Misunderstood
In an occasionally testy exchange with reporters, White House press secretary Jay Carney defended President Obama’s remark that it would be "unprecedented" for the Supreme Court to overturn the administration's health care law, saying the comment had been misunderstood. Speaking at a Rose Garden news conference on Monday, Obama weighed in on the matter for the first time since last week's high court hearings that left many Democrats fearful that the five conservative judges would band together to strike down his signature domestic achievement (Easley, 4/4).

Bloomberg: Obama Risks Voter Backlash By Warning High Court On Health Law
President Barack Obama has shown a willingness to campaign against the U.S. Supreme Court if the justices strike down his 2010 health-care law. It's a strategy that’s as risky as it is rare. With the court months away from a ruling, Obama ratcheted up the political stakes this week by saying a decision to reject the law and its requirement that Americans get insurance would be "judicial activism" by "an unelected group of people." Taking on the court would mean fighting an institution that polls show is historically the most admired branch of government (Stohr and Stern, 4/5).

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Attorney General: DOJ Will Respond To Federal Judge On Judicial Review

In what has become a charged exchange, a federal judge in Texas demanded the Obama administration explain its views on the court's authority to overturn acts of Congress. Attorney General Eric Holder said yesterday the Justice Department would respond "appropriately."

The Associated Press: Holder: Justice Department Will Respond To Judge
U.S. Attorney General Eric Holder said Wednesday that the Justice Department will respond "appropriately" to a federal appellate judge in Texas who demanded a letter recognizing federal courts' authority to strike down laws passed by Congress. Holder spoke a day after 5th U.S. Circuit Court of Appeals Judge Jerry Smith questioned President Barack Obama's remarks this week about an "unelected" court possibly striking down the president's health care overhaul. Smith, during oral arguments in a separate challenge to the health law, asked the Justice Department for a three-page, single-spaced letter affirming the federal court's authority (Johnson, 4/4).

Bloomberg: Obama Health Remarks Draw Order For U.S. View On Court
A federal appeals court hearing a challenge to part of the 2010 health-care law ordered President Barack Obama's administration to give its view on whether the U.S. Supreme Court can strike down laws it considers unconstitutional. Obama, a Democrat, said April 2 that it would amount to "judicial activism" for the Supreme Court to throw out the statute….U.S. Circuit Judge Jerry Smith, who was appointed by Ronald Reagan, a Republican, asked U.S. Justice Department lawyer Dana Lydia Kaersvang during oral arguments in Houston yesterday to supply the administration’s position on so-called judicial review (Brubaker Calkins, 4/4).

Boston Globe: Judge Orders Justice Dept. To Acknowledge Courts' Power
A federal judge in Texas has demanded the Department of Justice acknowledge courts' authority to strike down acts of Congress, after President Obama said Monday that a Supreme Court ruling against his signature health care law would be an "unprecedented" display of "judicial activism." Fifth Circuit Court of Appeals Judge Jerry E. Smith, appointed by Republican President Ronald Reagan, said Tuesday that Obama's statements "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" (Borchers, 4/4).

The Hill: Bush Attorney General Defends Judge's Probe Of Obama Health Care Comments
A former attorney general on Wednesday defended the federal judge who demanded an explanation of comments President Obama has made about the Supreme Court and healthcare reform. Judge Jerry Smith, who sits on the 5th Circuit Court of Appeals, ordered the Justice Department to file a three-page letter explaining whether it believes courts have the power to strike down federal laws (Baker, 4/4).

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Study: MLR Rule Would Have Translated Into $2B In Rebates To Consumers

If the health law's requirement that insurers spend at least 80 percent of premiums on medical care had gone into effect in 2010, instead of a year later, private plans would have had to refund as much as $2 billion to consumers, either in rebates or reduced premiums, according to a study by the Commonwealth Fund, which supports the law.

Modern Healthcare: MLR Rule Would Have Meant Rebates For Many: Study
Private health insurers would have paid about $2 billion in rebates or reduced premiums to about a quarter of policyholders if a healthcare law provision scheduled this summer had instead started a year earlier, according to a study... A study issued by the Commonwealth Fund, which supports the law, concluded that almost $1 billion in rebates would have been issued to about 5.3 million people who receive coverage through the individual market if it started tracking spending in 2010, instead of in 2011 (Daly, 4/5).

Politico Pro: Report: $2B In Rebates If MLR Applied In '10
Consumers would have received about $2 billion in rebates if health care reform’s new medical loss ratio requirements had been in effect in 2010, according to a new Commonwealth Fund report. The MLR rule, which requires health insurers to pay back customers if the plan spends more than 20 percent to 25 percent of their premium dollars on administrative expenses, would have required about $1 billion in rebates to 5.3 million people in the individual market. Another $1 billion would have gone to 10 million people in the small- and large-group markets (Millman, 4/5).

Kaiser Health News: Capsules: 2010 Insurance Rebates Would Have Hit $2 Billion Study Says
Consumers would have received rebates of nearly $2 billion — in some cases as much as $300 a member – if the health-law cap on insurance profits and overhead had been in place in 2010, estimates a new study (Hancock, 4/5). 

Arizona Republic: New Law May Bring Health Rebates
A new report shows Arizona consumers would have collected more than $69 million in rebates from their health-insurance companies if new regulations over how much insurers must spend on medical care were in effect in 2010. Arizona consumers will begin receiving rebate checks this summer from their health-insurance companies under the nation's health-care law (Alltucker, 4/4).

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Campaign 2012

Presidential Campaign Focus Turns To Budget, Medicare Issues

President Barack Obama and Mitt Romney are using their differences on Medicare issues and entitlement spending -- in the context of the nation's fiscal challenges -- as key campaign themes.   

Politico: The Barack Obama, Mitt Romney Budget Battle
"What is clear is that neither party, nor either likely presidential candidate, has put forward a solution that fixes the country’s dire fiscal situation," New York City Mayor Michael Bloomberg told POLITICO. ... He said the candidates could appeal to the broader electorate by having an honest conversation about what’s needed, which he and many others view as a mix of broad-based tax increases, painful cuts to all discretionary spending programs and trims to long-term entitlement spending, including Medicare and Social Security (White, 4/5).

The New York Times: Romney Says Obama Hides His Agenda
He said there was no better example of the president's vacillation than on the question of federal spending, especially on Medicare and other entitlement programs. "He has failed to enact or even propose a serious plan to solve the entitlement crisis," he said. … Politically, the Ryan approach would require making some unpopular choices in an election year. The Republican argument, which Mr. Romney echoes, is that the alternative is an irresponsible bleeding of the nation’s already debt-laden balance sheet. The Ryan plan seeks to rein in debt largely through changes in entitlement and discretionary spending rather than through increases in tax rates (Cushman, 4/4).

The New York Times: Budget Author, A Romney Ally, Turns Into A Campaign Focus
For Mr. Obama, painting the conservative lawmaker as a sort of wild-eyed wingman to Mr. Romney carries clear benefits, according to his advisers: it yokes Mr. Romney to the unpopular elements of the Ryan budget — from deep cuts in cherished social programs to a Medicare overhaul that could drive up costs for future retirees and fundamentally change the popular health plan — and it makes it tougher for Mr. Romney to tack to the center once he gets past the primaries (Landler, 4/4).

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Race Pits Obamacare Against Romneycare

News outlets analyze how health policy positions taken by GOP presidential hopeful Mitt Romney and President Barack Obama are playing on the campaign trail.

The Associated Press: Fact Check: Romney, Obama Gloss Over Realities
Republican presidential hopeful Mitt Romney accused President Barack Obama on Wednesday of inflicting a "government takeover of health care" on Americans, even though Obama's law is closely modeled on the plan Romney achieved in Massachusetts... Obama's law keeps the private insurance industry at the heart of the health care system and avoids a single-payer government system like Canada's (Woodward, 4/4).

National Journal: Romney's Health Care Scare Averted
Mitt Romney's trio of victories Tuesday could mark the moment when he vanquished one of the biggest ghosts haunting his primary campaign: Romneycare. The homestretch before Tuesday’s vote coincided with the highly publicized Supreme Court hearings over President Obama’s health care overhaul, offering Romney's opponents the perfect opportunity to bash him over the comparable plan he championed as governor of Massachusetts. Rick Santorum tried. He took his cause from the campaign trail in Wisconsin straight to the steps of the high court, insisting that Romney could not credibly lead the charge against "Obamacare" in 2012 (Reinhard, 4/4).

Meanwhile, the Boston Globe reports that Obama remains popular among Jewish voters.

Boston Globe: President Obama Remains Popular Among Jewish Voters, Survey Shows
President Obama remains popular among Jewish voters, with more than six in 10 supporting his reelection, according to a Public Religion Research Institute poll released Wednesday... “The likely Republican nominee, Mitt Romney, is unpopular among most Jewish voters,” said Daniel Cox, the institute’s research director, “and the GOP’s signature campaign proposal — repealing the recent health care law — is opposed by nearly six in ten American Jews” (Borchers, 4/4).

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Health Care Marketplace

U.S. Spending On Prescription Drugs, Doctor Visits Levels Off

A study by the IMS Institute for Healthcare Informatics found that senior citizens in particular are filling fewer prescriptions as out-of-pocket costs increase.

The New York Times: Americans Cutting Back On Drugs And Doctor Visits
Patients cut back on prescription drugs and doctor visits last year, a sign that many Americans are still struggling to pay for health care, according to a study released Wednesday by a health industry research group (Thomas, 4/4).

NPR Shots Blog: Drug Spending Levels Off, But Not For The Usual Reasons
Greater use of generics had something to do with the leveling off. In 2011, according to IMS, 80 percent of dispensed prescriptions were generics and generic spending grew by $5.6 billion. But the bigger reason for the slow growth was a decline in actual use of prescription drugs, particularly by seniors, who are traditionally the biggest consumers of the products (Rovner, 4/4).

Bloomberg: Seniors Ration Spending On Drugs As Costs Rise In Weak Economy
U.S. senior citizens are filling fewer prescriptions for drugs as out-of-pocket costs rise in a weak economy, undercutting a record level of new product introductions by drug companies, industry researchers said. Dispensed prescriptions to patients 65 and older declined 3.1 percent in 2011, compared with a 2.7 percent dip in 2010, according to a study released today by the IMS Institute for Healthcare Informatics in Parsippany, New Jersey. For all age groups, prescriptions fell 1.1 percent last year. The economy and increased cost-sharing requirements are causing people to make fewer doctor visits and fill fewer orders for pills, IMS said (Armstrong, 4/4).

The Associated Press: U.S. Prescription Spending Again Nearly Flat
Spending on prescription drugs in the U.S. was nearly flat in 2011 at $320 billion, held down by senior citizens and others reducing use of medicines and other health care and by greater use of cheaper generic pills. Last year, spending on prescription drugs rose just 0.5 percent after adjusting for inflation and population growth, according to data firm IMS Health. Without those adjustments, spending increased 3.7 percent last year. The volume of prescriptions filled fell about 1 percent (Johnson, 4/4).

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Coverage & Access

Administration Budget Plan For Veterans' Health Care Riles Advocates

The budget proposal cuts defense spending in part by increasing health care cost-sharing for retired service members. Also in the news, USA Today reports that the Department of Veterans Affairs is short on psychiatrists as demand for mental health care continues to increase.

Politico: Hikes In Cost Of Veterans' Health Care Draw Fire
The Obama administration's budget proposal to cut defense spending, in part, by increasing the cost of health care for retired service members has riled veterans groups and members of Congress. "It's wrong to ask them to sacrifice more when Washington has not had the political courage to look at the big picture on the budget or the courage to address the big drivers of our debt," said Sen. Kelly Ayotte (R-N.H.), who sits on both the Senate Armed Services and Budget committees (Munsil, 4/4).

USA Today: VA Sees Shortfall Of Mental Health Specialists
As thousands of additional veterans seek mental health care every month, the Department of Veterans Affairs is short of psychiatrists, with 20 percent vacancy rates in much of the country served by VA hospitals, according to department data (Zoroya, 4/4).

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Public Health & Education

AP: Prescription Painkiller Sales Have 'Exploded,' Leading Experts To Fear 'Addiction Epidemic'

The Associated Press: Painkiller Sales Soar Around US, Fuel Addiction
Sales of the nation's two most popular prescription painkillers have exploded in new parts of the country, an Associated Press analysis shows, worrying experts who say the push to relieve patients' suffering is spawning an addiction epidemic. From New York's Staten Island to Santa Fe, N.M., Drug Enforcement Administration figures show dramatic rises between 2000 and 2010 in the distribution of oxycodone, the key ingredient in OxyContin, Percocet and Percodan. Some places saw sales increase sixteenfold (Hawley, 4/5).

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State Watch

Contraception, Abortion, Fetal Care Issues Flare Up In State Legislatures

Women's health issues continue to roil politics in Texas, Mississippi and Nebraska.

Reuters: Mississippi Bill May Cause State's Only Abortion Clinic To Close
The Mississippi state Senate passed a bill on Wednesday to impose new regulations on facilities providing abortions that supporters of the state's only abortion clinic said could force it to close. The measure, which previously passed in the state House of Representatives, ... requires physicians performing abortions to have admitting privileges at a local hospital and be board certified or eligible in obstetrics and gynecology (Ward, 4/5).

Kaiser Health News: Mississippi Legislature Passes Abortion Clinic Bill
The change could make staffing the state's sole abortion clinic very difficult, since most of the doctors who practice at Jackson Women's Health live out-of-state and admitting privileges at the nearest hospital are given only to local physicians. ... The clinic currently has a patient transfer agreement with a local hospital, according to Diane Derzis, one of the owners of Jackson Women’s Health (Hess, 4/4).

The Associated Press: Political Stress Erupting At Mississippi Capitol
[A]fter the Senate Public Health Committee approved a bill to put new restrictions on abortion clinics, a bill opponent glared at the committee members and called out: "Liars! You're all liars!" A security officer stepped between her and the committee members. Few lawmakers glanced her way, and no one responded (Pettus, 4/4).

The Associated Press: Prenatal Care Debate Divides Nebraska Republicans
The issues of illegal immigration and abortion have split Nebraska's Republican-dominated politics, with some conservatives supporting a plan to offer state aid to pregnant women in the country illegally and others arguing that doing so would violate a bedrock GOP belief. ... The measure would require the state to pay for prenatal care to low-income women who have entered the U.S. illegally (Schulte, 4/5).

The Dallas Morning News: Texas Democrats Say State Proposal On Women's Health Program Flawed
Democrats are warning that important welfare assistance could be harmed in the state's latest proposal to pay for the Women's Health Program, which lost almost all its funding after state Republicans bucked the federal government over Planned Parenthood. ... [Health and Human Services Commissioner Thomas Suehs' office] indicated that one possible source for refunding the Women's Health Program could be a Temporary Assistance for Needy Families block grant (Hoppe, 4/4).

The Texas Tribune/KUT: In Austin, Sex Ed Via Text Message
Officials in Austin, an area with one of the highest teen pregnancy rates in the state, have launched an effort to educate teens about sexual health using a familiar medium: their cellphones. Nathan Bernier of KUT News reports on how the effort compares to information students receive in school (4/5). 

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Medicaid News: Ore. Competitors Work Together; Calif. 'Duals' Project Launches

A selection of Medicaid news from California, North Carolina, Oregon, Utah and Colorado.

The Oregonian: Portland-Area Competitors Try Working Together To Cut Costs For Oregon Health Plan
A new push to reshape health care in greater Portland is reminiscent, its biggest booster says, of the race to land a man on the moon.  Erstwhile health care competitors hope to set aside their differences to care for the region's 200,000 Oregon Health Plan members, says Legacy Health CEO George Brown. The task is happening in a timeline -- Brown snaps his fingers -- "that's like that long. It's a moon shot for sure. What we're trying to do, to my knowledge, has not been attempted any place in the country" (Budnick, 4/4).

The Lund Report (an Oregon news service): Medicaid Collaborative Emerges To Create Coordinated Care Organization in Tri-County
"This is something we must do together," said Brown, CEO and president of Legacy Health System who's brought together leaders of five competing health plans to create the Tri-County Medicaid Collaborative – CareOregon, FamilyCare, Kaiser Permanente, Providence Health Plans and Tuality Health Alliance. On Monday, the collaborative filed its letter of intent with the Oregon Health Authority to become a coordinated care organization (Lund-Muzikant, 4/4). 

California Healthline: State Names Four Counties for Duals Project
California took a big step yesterday, officially unveiling the four counties that will kick off the three-year project to eventually convert 1.1 million dual eligibles -- Californians eligible for both Medi-Cal and Medicare -- to a Medi-Cal managed care program. The first four participants in the Coordinated Care Initiative are Los Angeles, Orange, San Diego and San Mateo counties (Gorn, 4/5). 

The Associated Press/Houston Chronicle: NC Medicaid Program Averts A Pair Of Fiscal Crises 
North Carolina's Medicaid program will dodge two immediate fiscal crises because federal regulators agreed Wednesday to extend the deadline to carry out new personal care service requirements and state officials outlined ways to close a projected $150 million shortfall. The Centers for Medicare and Medicaid Services wrote the state Medicaid office that it would have until January to enforce new regulations to ensure people living at home and residents of adult care homes receive comparable personal care services. The paid assistance helps people with disabilities, older adults and the mentally ill with activities such as bathing, dressing and cooking (Robertson, 4/4).

Reuters: European Hackers Suspected In Utah Medicaid Files Breach
A data security breach at the Utah Health Department, believed to be the work of Eastern European hackers, has exposed 24,000 U.S. Medicaid files bearing names, Social Security numbers and other private information, state officials said on Wednesday. The intrusion initially appeared to have affected claims representing at least 9 percent of the 260,000 clients of Medicaid in Utah (Nelson, 4/4). 

Denver Post: Colorado Pharmacy Board Denies Medicaid, Insurer Access To Prescription Drug Registry
Colorado Medicaid officials and a private insurer have quietly sought access to the state's prescription drug registry to help stop doctor-shopping and pharmacy-hopping for pain pills, but a state board denied them. The health care interests wanted access as part of wider efforts to slow an epidemic of painkiller overdoses and opioid misuse, which has resulted in a doubling of Colorado deaths and addicts seeking treatment (Booth, 4/5).

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State Roundup: New Vt. Law Overhauls Mental Health System

A selection of state health policy stories from Virginia, Vermont, Iowa, California, Georgia and Colorado.

The Associated Press/Washington Post: Advocacy Agency Backs Proposed Disabilities Settlement Between Virginia, Feds
A state agency that looks out for the rights of people with disabilities is advocating for a proposed settlement that would shift the care of Virginians with intellectual disabilities from state-run institutions (4/4).

The Associated Press: Vt. Governor Signs Mental Health Bill
Vermont Gov. Peter Shumlin has signed into law an overhaul of the state's mental health system. ... The package Shumlin signed calls for the 54-bed hospital in Waterbury to be replaced by a new 25-bed facility in Berlin, which could shrink to 16 beds depending on federal funding issues. The plan also calls for expanded psychiatric units in Brattleboro and Rutland and smaller and less restrictive community placements for people in need of mental health services around the state (4/4).

Des Moines Register: Mental-Health Compromise Offers Counties Flexibility, Power To Retain Property Taxes
Counties would continue to levy property taxes for mental-health services, and they could ask to be exempted from new regional mental-health authorities under a compromise reform plan agreed to by leading Democrats and Republicans in the [Iowa] Legislature. The Republican-controlled House is expected to pass the plan ... then send it to the Democrat-controlled Senate, where passage also is expected (Leys, 4/4).

Des Moines Register: Need A Doctorate Degree To Understand Your Health Bills? Iowa Senate Says 'Enough'
Complicated health bills that leave thousands of Iowans puzzled as to what they are truly being billed for would be tackled under a fast-moving plan approved by a Senate subcommittee this morning, advocates say. But the Republican on the three-member panel this morning waived a flag of warning: A proposal to address the problem comes with a cost of $500,000 to $2 million with no guarantee that premiums will lower (Clayworth, 4/4).

The Sacramento Bee: Aetna Mistakenly Tells 8,000 Customers Their Doctors Were Dropped From Coverage
Thousands of Aetna customers across the state, including many in the Sacramento region, were mistakenly sent letters this week telling them that their health care provider is no longer covered in the network and that they need to find new doctors. More than 8,000 Aetna customers were sent the form letters from the Hartford, Conn.-based health insurance company and have been receiving them in the mail over the past few days (Garza, 4/5).

KQED's State of Health blog: The Greatest Health Risk to Children? No, It's Not Drugs
Nearly half of people surveyed in a poll released today say an unhealthy diet combined with lack of physical activity are the greatest health risks facing California children today. In addition, almost three in four respondents to the Field Poll -- 73 percent -- said prevention efforts, while starting with the family, must extend to the broader community, including health care providers, schools, community organizations and beyond (Aliferis, 4/4). 

KQED: Glide Health Services
Glide Health Services, a community clinic in the heart of San Francisco's Tenderloin, provides primary care for some 3,000 patients a year. ... Pat Dennehy, the clinic's director, is gaining national attention for her innovative approach to providing low-cost, high quality care at a time when the state of California needs all the options it can get (Davis, 3/30). 

San Francisco Chronicle: California Health Exchange Moving Ahead
When the Patient Protection and Affordable Care Act, a.k.a. Obamacare, was signed into law, two years ago almost to the day, California quickly got the ball rolling. … The exchange has already received $40 million in federal seed money and is expecting additional funds this summer. No details, but the amount is "bigger than a breadbox," said the exchange's Executive Director Peter Lee. That assumes the U.S. Supreme Court doesn't throw the law out, in part or whole -- a distinct possibility that doesn't faze Lee. "California passed a law to have an exchange, and it's moving ahead on all cylinders. The commitment will be there no matter what," said Lee (Ross, 4/5).

California Healthline: 'We'll Deal With it Then': The State of Play if ACA is Struck Down
Twenty-eight states challenged the Affordable Care Act. And win or lose, all 50 will have to deal with the consequences. But are the states actually ready to respond? The answer is -- literally -- all over the map. ... Here's a look at how three states -- including California -- stand with respect to the ACA decision (Diamond, 4/4). 

Modern Healthcare: Ga. Cancer Centers To Pay $3.8 Million
A federal investigation sparked by whistle-blowers who used to work for a radiation oncology practice has resulted in a civil settlement in which the practice and its affiliates agreed to pay $3.8 million to settle fraud allegations. Radiotherapy Clinics of Georgia (Decatur), along with affiliates RCOG Cancer Centers, Physician Oncology Services Management Co., Dr. Frank Critz and Physician Oncology Services, were accused of overbilling Medicare for X-rays and simulations in preparation for radiation therapy and for consults and consult reports, according to a U.S. Justice Department news release (Robeznieks, 4/4).

Health Policy Solutions (a Colorado news service): Lack Of Access To Dental Care Endangering Health, Costing Colorado Millions
Every Thursday the [Kids In Need of Dentistry] clinic treats a steady stream of pediatric patients, many with a mouthful of problems. ... Untreated dental caries (the disease process that causes cavities) is the leading disease in children, occurring five times more often than asthma (Wolf, 4/4). 

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Weekend Reading

Longer Looks: Berwick Calls For Leaders To Rise Above 'Political Catechism'

Every week, reporter Jessica Marcy selects interesting reading from around the Web.

Rolling Stone: Don Berwick On The Fate Of 'Obamacare'
Between July 2010 and December 2011, Dr. Donald Berwick was head of the Centers for Medicare and Medicaid Services, the agency that runs the government's health insurance programs. In a sane world, he would be still. But Senate Republicans refused even to let his confirmation come up for a vote ... A pediatrician by training and a widely respected expert in health care policy, Berwick should have been a lock for the CMS job. But he was a backer of Obamacare; a believer in data and science; a proponent of universal health care  … Rolling Stone got him on the phone to talk about this week's healthcare hearings at the Supreme Court, the importance of Obamacare, and the future of reform (Julian Brookes, 3/30).

The Economist: Full-Court Press
When the arguments came to a close at the end of March 28th, Mr Obama faced one hopeful prospect—the court might uphold the mandate—and several nightmares. ... The Supreme Court is expected to issue its decision by the end of June. ... However the court rules, the political consequences will be huge. Even more important, for the long term, will be the court’s articulation of congressional power. Washington subsists on hyperbole. But this time it is all true (3/31).

The Atlantic: Legal Drug-Pushing: How Disease Mongers Keep Us All Doped Up
Pharmaceutical giants, like small-town pizza parlors, have two options for making more money: convince regulars to buy more of what they obviously like, or find ways to persuade more people that they will be happier with this drug or that thin crust with extra cheese. ... These "disease mongers" -- as science writer Lynne Payer in her 1992 book of that name called the drug industry and the doctors, insurers, and others who comprise its unofficial sales force -- spin and toil "to convince essentially well people that they are sick, or slightly sick people that they are very ill." Changing the metrics for diagnosing a disease is one reliable technique (John-Manuel Andriote, 4/3).

Outside: The Doctor Won't See You Now
Last year, 13 Americans died during running races, and another eight while competing in triathlons. ... the rising participation and the proportional death toll—especially in cases like (Peter) Hass's—highlight the need for quality medical care at these events. And usually that care comes from volunteer doctors. At least it used to. More and more doctors are refusing to donate their services, and it’s for one frustrating reason: they can’t get medical-malpractice insurance. Most doctors' insurers typically won't issue one-day policy riders for sporting events, and race organizers haven't stepped up to offer alternative coverage (Eric Beresini, 2/28).

The New Yorker: Dentists Without Borders
One thing that puzzled me during the American health-care debate was all the talk about socialized medicine and how ineffective it's supposed to be. ... my experiences in France, where I've lived off and on for the past thirteen years, have all been good. A house call in Paris will run you around fifty dollars. ... most of my needs are within arm's reach. There's a pharmacy right around the corner, and two blocks further is the office of my physician, Dr. Médioni. Twice I’ve called on a Saturday morning, and, after answering the phone himself, he has told me to come on over. These visits, too, cost around fifty dollars. ... I’ve gone from avoiding dentists and periodontists to practically stalking them, not in some quest for a Hollywood smile but because I enjoy their company (David Sedaris, 4/2).

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Editorials and Opinions

Perspectives: Obama's Initial Sharp Comments On Court Were Overbearing -- And So Was Appeals Court Response

The Washington Post: Disorder In The Court
I chided President Obama this week for his remarks on the Supreme Court and the role of "unelected" judges. The president, wisely, has since chosen to clarify his statement, and express his (correct) view -- that courts should be hesitant to overturn acts of Congress -- in a much more appropriate way. Now the problematic behavior is coming from the other branch, with a federal appeals court going out of it way to pick a fight with the president. Talk about judicial activism -- this is a judicial temper tantrum (Ruth Marcus, 5/4).

CNN (Video): Court's Obama Order A 'Hissy Fit'
The Fifth Circuit's homework assignment to the Department of Justice is a disgrace -- an embarrassment to the federal judiciary. Still, it's a useful window on the contemporary merger of law and politics. ... (Judge Jerry) Smith and his two colleagues -- all Republican appointees -- gave the Justice Department lawyers a homework assignment. They demanded a letter of "no less than three pages, single spaced," due on Thursday, explaining the president's remarks. This is not judging. This is a judicial hissy fit. The Supreme Court will determine the constitutionality of the health care law, and the president will, as he must, abide by that judgment whether he agrees with it or not. In the meantime, however, the president, like all Americans, enjoys the right to express himself on what the court should do in that or any other case (Jeffrey Toobin, 4/5).

The Wall Street Journal: Obama's Base Play
One theory is that (Obama is) trying to intimidate the justices into deciding the case his way. But if that's his aim, it would be odd to wait until after they've heard the case -- and, it is believed, after they've privately voted on it -- to begin the campaign. Moreover, while we'd say a politician's trash talk is unlikely to have any effect on the justices at all, the odds that it would influence them in his favor are surely minuscule. Judges jealously guard their independence, as the Fifth Circuit demonstrated yesterday. They're right to do so (James Taranto, 4/4).

The Wall Street Journal: The Supreme Court Lands In Oz
Many are saying the president should know Marbury v. Madison. He does. It doesn't matter. If something gets in his way, Barack Obama hammers it -- whether courts or Congress. The left likes that. It remains to find out if the rest of the country wants the judicial and legislative branches subordinated to a national leader (Daniel Henninger, 4/4). 

New England Journal of Medicine: Supreme Court Arguments On The ACA -- A Clash of Two World Views
Many legal scholars (including me) believed that this would be an easy case, because health insurance so obviously involves interstate commerce and the mandate is unquestionably central to many of the ACA's core unchallenged provisions. But these matters can be seen differently, as witnessed by the deep split among the lower courts.  ... [W]hen the Court confronts novel questions of constitutional principle, each justice's worldview understandably shapes his or her framing of the issues. Either way, it's remarkable how sharply these worldviews differ on the fundamental questions of health policy underlying the ACA (Mark A. Hall, 4/4).

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Viewpoints: Support For Drug Benefit Merger; Health Reform Comes Too Slowly For Some Patients; Pinpointing Romney's Views On Mandate

The New York Times: Costs, Benefits And Your Drug Plan
It seems counterintuitive, but the Federal Trade Commission has just decided that a $29 billion merger of two of the three largest companies that manage pharmaceutical benefits for employers and health plans — Express Scripts and Medco Health Solutions — would not substantially lessen competition. That judgment deserves credence because of the thoroughness of the F.T.C.'s eight-month inquiry and the willingness of the agency to oppose other mergers when the evidence warrants (4/4).

The New York Times: Down The Insurance Rabbit Hole
Were the Obama health care reforms already in place, my brother and sister-in-law's situation -- insurance-wise and financially -- would be far less dire. My brother's small employer -- he is the manager of a metal-fabrication shop -- does not offer health insurance, which was too expensive for them to buy on their own. Fortunately, my sister-in-law (who was paralyzed in a car accident) had enrolled in the Access for Infants and Mothers program, California's insurance plan for middle-income pregnant women. AIM coverage extends 60 days postpartum and paid for her stay in intensive care and early rehabilitation (Andrea Louise Campbell, 4/4). 

The Atlanta Journal-Constitution: Law Vital To Health System
Last week's Supreme Court arguments over the Affordable Care Act obscured a key fact: People in Georgia and nationwide are already getting better care under the law. Millions more will benefit in years to come if it stands. If it doesn't, we'll be right back where we started, trying to figure out how to care for Georgians without insurance and how to rein in soaring medical costs. We'll all be poorer for that (Timothy Sweeney, 4/4).

The Atlanta Journal-Constitution: Ruin Disguised As Reform
Clearly, the Affordable Care Act is yet another Obama scheme to grow government at every level and raise taxes. It will cost Georgians more than money. Our freedom to manage our own affairs and purchase what we want with what we earn is at stake (Virginia Galloway, 4/4). 

Georgia Health News: It's Not The Law, It's The Rhetoric
Physicians are professionally bound by the Hippocratic Oath of "do no harm." To perpetuate a health system that denies basic access to care for 50 million Americans is both harmful and unconscionable. It is time to repeal and replace the rhetoric of division and distraction. The ACA takes a major step forward in assuring that all Americans have access to affordable, high-quality health care (Dr. Harry Heiman, 4/4).

Chicago Tribune: Playing The Health Care Card
I have some questions. "Mitt, if you were still governor of Massachusetts, knowing what you know today, would you work to repeal the health care act you worked so hard to pass only a short while ago? If it's bad for the nation, how can it be good for Massachusetts? If it's good for Massachusetts, how can it be bad for the nation?" Those three questions are at the center of the Romney candidacy, even though we don't know it yet because the big show leading up to November has not yet started (Charles Madigan, 4/5).

Chicago Tribune: Obamacare Will Be Romney's Savior
The funny thing is: Even as they were saying he can't attack Obamacare, Romney was -- you guessed it -- attacking Obamacare. Romney has been attacking Obamacare since its inception. "I'll stop it in its tracks on day one!" he promises constantly on the stump (Jonah Goldberg, 4/5).

Chicago Tribune: Fear And Medicare, Round 2
We've seen this before. Last year, Democrats attacked (Rep. Paul) Ryan's Medicare proposal, raising fears the program would disappear. That "Mediscare" campaign was judged the "biggest political lie of 2011" by Politifact, the Tampa Bay Times' nonpartisan fact-checking website. It looks as if Mediscare 2 may claim the biggest-lie title for 2012 (4/5).

The Washington Post: Mitt's 'Marvelous' Misjudgment
What was unveiled with Obama's powerful speech is nothing less than a replay of Bill Clinton's reelection argument in 1996. Back then, a colorless GOP leader named Bob Dole was successfully lashed to revolutionary Newt Gingrich's budget, which Democrats argued would ravage Medicare, Medicaid, education and the environment. Dole was morphed into Gingrich at least 125,000 times in negative ads (according to Gingrich’s later tally for me), killing Dole with independents and sullying Gingrich's brand forever (Matt Miller, 4/4).

Politico: Bay State Not Buying 'War On Women'
Democrats turned public concern about the Obama administration's mandate that employers (including those with religious affiliations) must provide health insurance covering abortion-inducing drugs and sterilization into a national discussion of Republican attitudes regarding contraception. GOP missteps -- from failing to showcase women at prominent congressional hearings about religious liberty versus the mandate, recast by the left as being about women’s health, to conservative icon Rush Limbaugh, misled by an inaccurate report, insulting a Georgetown law student/contraceptive activist (for which he apologized, but by then the narrative was set) -- allowed Democrats to twist opposition to the unprecedented government mandate into a "GOP War on Women" (Carrie Lukas and Kellyanne Conway, 4/4).

Boston Globe: State Needs More Authority To Curb Abuses At 'Sober Houses'
The Massachusetts attorney general's office is wise to the operators of shady drug testing clinics and their kickback schemes with some so-called "sober houses’" inhabited by recovering addicts. But the absence of regulation in this area practically assures that abuses will happen time and time again. Sober houses fall somewhere between rooming houses and residential treatment centers. At their best, they provide a supportive, shared living environment for tenants who prove sobriety through random urine screenings. At their worst, operators of sober homes pocket the weekly rent as well as bribes for steering their indigent tenants to unethical testing labs, which pad Medicaid bills with frequent and unnecessary tests (4/5).

Minneapolis Star Tribune: Repayment Doesn't End HMO Concerns
A year of controversy over Minnesota health plan profits earned from taxpayer-paid medical programs has yielded a remarkable development: $73 million will soon be returned to state and federal coffers. … The $73 million windfall is momentarily reassuring, but serious questions remain about the repayment and, more importantly, about state and federal oversight of the Medicaid program. Problems in Minnesota may indicate inadequate Medicaid management in other states (4/4).

The Fiscal Times: Working Our Way Through Old Age
[T]his year's World Health Day is dedicated to healthy aging. The trajectory of population aging is entirely predictable. All over the world, we're getting older. It's time to do something about this demographic shift by realigning health, education, work-retirement, economic and financial policies to our current century's demographic truths (Michael Hodin, 4/5).

Journal of the American Medical Association: Choosing Wisely: Helping Physicians And Patients Make Smart Decisions About Their Care
To reduce unnecessary tests and procedures, physicians will need to play a leading role -- their decisions account for about 80 percent of health care expenditures. Yet physicians do not always have the most current effectiveness data. ... To help reduce waste in the US health care system and promote physician and patient conversations about making wise choices about treatments, 9 medical specialty societies ... developed a list of 5 tests, treatments, or services that are commonly used in that specialty and for which the use should be reevaluated by patients and clinicians (Dr. Christine K. Cassel and James A. Guest, 4/4).

New England Journal of Medicine: Building a Better Physician -- The Case for the New MCAT 
A 2004 Institute of Medicine report on "Improving Medical Education" and several years of evaluation identified a need to redesign the [Medical College Admission Test] to better reflect physicians' current challenges. ... Disparities in health outcomes among races and ethnic groups persist. The Los Angeles Department of Public Health, for example, reports a 17.5-year difference in life expectancy between African-American men and Asian-American women. ... Tomorrow's physicians will need to understand demographic changes, the effect of culture on adherence to medications, and the ways in which changes in incentives and payment systems will affect their practices (Robert M. Kaplan, Jason M. Satterfield and Dr. Raynard S. Kington, 4/5).

New England Journal of Medicine: Removing Legal Barriers to High-Quality Care for HIV-Infected Patients 
Remarkably, HIV infection has made the transition from death sentence to chronic condition in relatively short order. Laws that restrict the ability to collect, analyze, and appropriately share data on HIV-infected patients put them at risk for suboptimal care. HIV-positive patients should be treated in patient-centered, coordinated systems that ensure they receive all needed elements of care, for all their conditions. We believe it is time to remove special provisions for privacy that are based exclusively on HIV testing and diagnosis (Lara E. Szent-Gyorgyi, Dr. Sonali Desai, Daniel Kim, Dr. Paul E. Sax and Dr. Jeffrey O. Greenberg, 4/5).

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Stephanie Stapleton

Andrew Villegas

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Shefali Luthra

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