Daily Health Policy Report

Friday, April 5, 2013

Last updated: Fri, Apr 5

KHN Original Reporting & Guest Opinion

Health Spending And Fiscal Battles

Health Reform

Capitol Hill Watch

Women's Health

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Immigrant Docs Help Ease California's Primary Care Shortage

Kaiser Health News staff writer Jenny Gold, working in collaboration with NPR, reports: "When Jose Chavez Gonzalez moved to the United States from El Salvador, he took any job he could get — stocking warehouses, construction, cleaning houses and working in a meat processing plant. But unlike most of the other immigrants he worked alongside, Chavez, 38, was a doctor with eight years of medical training. He came to the U.S. in the mid-1990’s to be with his family, but like all doctors from other countries, he still had to pass the U.S. medical boards and go through at least three years of residency in order to practice here. The process can be both expensive and time consuming, so during the day he worked various menial jobs and at night he studied for the boards" (Gold, 4/4). Read the story.

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Insurers' Efforts To Delay Compliance With Health Law Could Affect Premiums, Benefits For Millions

Kaiser Health News staff writer Julie Appleby reports: "Regulators in several states are trying to prevent insurers from getting around the health law by extending potentially cheaper, but more limited policies for another year, but other states are giving the firms leeway to do so" (Appleby, 4/5). Read the story.

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Political Cartoon: 'Simpler Times?'

Kaiser Health News provides a fresh take on health policy developments with "Simpler Times?" by Nick Anderson.

Meanwhile, here is today's health policy haiku:

WHAT WILL HAPPEN NEXT?

Details emerging
for Obama's budget plan.
Will a deal follow?
-Anonymous

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

Obama Budget Will Propose Changes To Medicare

Previews of President Barack Obama's budget proposal, which is expected to be released next week, indicate that he will signal a willingness to compromise with Republicans by including trims to Medicare. The blueprint, though, reportedly will not make major dents in Medicaid.

The New York Times: Obama Budget Reviving Offer Of Compromise With Cuts
President Obama next week will take the political risk of formally proposing cuts to Social Security and Medicare in his annual budget in an effort to demonstrate his willingness to compromise with Republicans and revive prospects for a long-term deficit-reduction deal, administration officials say (Calmes, 4/4).

The Associated Press/Washington Post: Obama's Budget Will Avoid Deep Cuts In Medicaid As He Presses States To Expand Aid For Poor
President Barack Obama's budget next week will steer clear of major cuts to Medicaid, including tens of billions in reductions to the health care plan for the poor that the administration had proposed only last year. Big cuts in the federal-state program wouldn’t go over too well at a time that Health and Human Services Secretary Kathleen Sebelius is wooing financially skittish Republican governors to expand Medicaid coverage to millions who now are uninsured. That expansion in the states is critical to the success of Obama's health overhaul, which is rolling out this fall and early next year (4/4).

The Washington Post: Obama Budget Would Cut Entitlements In Exchange For Tax Increases
President Obama will release a budget next week that proposes significant cuts to Medicare and Social Security and fewer tax hikes than in the past, a conciliatory approach that he hopes will convince Republicans to sign onto a grand bargain that would curb government borrowing and replace deep spending cuts that took effect March 1. When he unveils the budget on Wednesday, Obama will break with the tradition of providing a sweeping vision of his ideal spending priorities, untethered from political realities (Goldfarb, 4/5).

CNN: Obama To Propose Changes To Medicare And Social Security In New Budget
President Barack Obama's upcoming budget will include proposed changes to Social Security and Medicare plus some new tax increases, changes that are an effort for the president to reach a deficit deal with Republicans, according to senior administration officials.The budget will include an offer Obama made to House Speaker John Boehner in December, officials said. That proposal included $400 billion in savings to Medicare over 10 years (Yellin, 4/5).

Politico: Obama Budget Includes Medicare, Social Security Cuts
President Barack Obama’s budget will include the final deficit reduction offer he made to House Speaker John Boehner in December, including cuts to both Medicare and Social Security, according to a senior administration official…The administration hopes including the cuts — adopting the chained CPI for Social Security and slashing about $400 billion from Medicare over the next decade — can persuade Republicans to roll back the cuts in the sequester and agree to further revenue hikes. In total, the president’s plan would reduce the deficit by $1.8 trillion over ten years (Robillard, 4/5).

Meanwhile, The Wall Street Journal reports on other specific Medicare plans being discussed -

The Wall Street Journal: Common Ground On Medicare Emerges
A long-standing idea of combining what consumers pay for their portion of Medicare hospital and doctor treatment costs is gaining new attention as lawmakers search for ways to slow the growth of what the government pays for the programs. The concept of merging the deductibles for Medicare Part A insurance, which covers hospital stays, and Part B, which covers doctors' services, is one of the few ideas that appeals to both parties (Radnofsky and Hook, 4/4).

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Health Reform

NAIC Offers States Ways To 'Mitigate' Expected Premium Increases

Also in the news, a report from InsuranceQuotes.com concluded that the vast majority of Americans don't know when they can start signing up for health exchanges.

The New York Times: Paper Offers Options On Limiting Higher Health Rates
State regulators are looking for ways to protect consumers against increases in health insurance rates that they expect to occur next year as major provisions of the new health care law take effect. A paper drafted by a panel of the National Association of Insurance Commissioners analyzes steps that states can take to "mitigate expected premium increases" (Pear, 4/4).

Marketplace: When Can You Join A Health Insurance Exchange? Few Know.
A new report by InsuranceQuotes.com finds 90 percent of Americans don’t know they can start signing up for insurance through health exchanges in October. The exchanges are websites that let people compare and buy insurance. The exchanges are also one of the key provisions of the Affordable Care Act, which was passed three years ago. By the end of 2013, people will have to join a plan to avoid penalties. "We want to make sure we do what can to inform consumers and give them the education that they need to make the right decisions," says Laura Adams, with InsuranceQuotes.com, which compares insurance rates for consumers (Carter, 4/4).

Other media outlets report on insurers' efforts to avoid some health law rules set to kick in next year-

Kaiser Health News: Insurers' Efforts To Delay Health Law Compliance Could Affect Premiums, Benefits For Millions
Regulators in several states are trying to prevent insurers from getting around the health law by extending potentially cheaper, but more limited policies for another year, but other states are giving the firms leeway to do so. The insurers' actions could affect the cost of health insurance and scope of benefits for millions of people who buy their own policies rather than getting them through their jobs. If enough relatively healthy people hold onto their old policies, the practice also has the potential to drive up insurance costs for those buying coverage in new online insurance marketplaces beginning next year (Appleby, 4/5).  

Huffington Post: Aetna Seeks To Avoid Obamacare Rules Next Year
One of the largest health insurance companies in the United States is advising insurance brokers on how to evade new mandates and benefits set to take effect next year under President Barack Obama's health care reform law. In an email sent to brokers, the insurance giant Aetna explains how they can renew customers' current health plans before Jan. 1, a strategy the Los Angeles Times reported this week is under consideration at other big health insurance companies (Young, 4/4). 

HealthBeat examines congressional reaction to the administration's decision to delay the health law's Small Business Health Options Program.

CQ HealthBeat: Delay On Choice In SHOP Exchanges Arouses Bipartisan Worry On The Hill
Members of Congress from both parties are signaling their unhappiness with a proposal by the Department of Health and Human Services to put off for a year a requirement that workers at small businesses in the exchanges be offered a smorgasbord of competing health plans. But as the Centers for Medicare and Medicaid Services works to ramp up a huge infrastructure for exchange enrollment beginning Oct. 1, CMS officials' comments in the proposed rule indicate they feel there's only so much they and insurers can manage in the first year of exchange operation in 2014 (Norman, 4/5).

And a proposed rule is released on tax-exempt hospitals and community needs assessments.

Modern Healthcare: Proposed Rule Offers Leeway On Community Needs Assessments
Tax-exempt hospitals that must conduct community needs assessments under the health reform law would get some leeway from penalties for minor missteps and got clarification about how to satisfy new rules under new draft regulations from the Obama administration. Julie Trocchio, senior director of community benefits and continuing care for the Catholic Health Association, said the trade group's membership welcomes the latitude to collaborate on needs assessments. She said the proposed rule appears to emphasize transparency and allows providers some welcome flexibility (Evans and Blesch, 4/4).

Meanwhile, in Kansas -

Kansas Health Institute: Report: Nearly 255,000 Kansans To Be Eligible For ACA Tax Credits
Nearly 255,000 Kansans will be eligible for tax credits to help purchase health insurance next year, according to a report released today. The credits are part of the Affordable Care Act, major provisions of which take effect Jan. 1, 2014 (Ranney, 4/4).

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Health Law Coverage Expansion Will Help Ex-Felons

Stateline reports that the health law's Medicaid expansion will make many newly released prison inmates eligible for coverage. Also in the news, reports on the latest Medicaid expansion developments in Texas, Florida and Iowa.

Stateline: Ex-Felons Are About To Get Health Coverage
Newly freed prisoners traditionally walk away from the penitentiary with a bus ticket and a few dollars in their pockets. Starting in January, many of the 650,000 inmates released from prison each year will be eligible for something else: health care by way of Medicaid, thanks to the Affordable Care Act. A sizeable portion of the nearly 5 million ex-offenders who are on parole or probation at any given time will also be covered (Ollove, 4/5).

The Texas Tribune: A Familiar Reluctance To Health Care Expansion In Texas
The wrangling over whether and how to expand Medicaid in Texas rings a bell. Proponents are emphasizing what it might do for the state's gigantic uninsured population. Opponents stress the dangers of a new federal entitlement program. A governor who might or might not have future political plans in mind is opposed (Ramsey, 4/5).

The Texas Tribune: House Backtracks On Medicaid Amendment
Hours after approving the measure, the Texas House backpedaled on an amendment to the 2013-14 budget that would have opened the door to negotiations on expanding Medicaid, a key provision of federal health care reform (Aaronson, 4/4).

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).

The Associated Press: More Details Released On Iowa Health Proposal
More details were released on Gov. Terry Branstad's health care proposal for low-income residents Thursday when the legislation for the plan was introduced in the Iowa House. Branstad's Healthy Iowa plan would cover an estimated 89,000 residents with incomes below the poverty line (Lucey, 4/4).

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Capitol Hill Watch

GOP SGR Plan Would Ease Docs Toward Medicare Pay-For-Performance Model

Under its new proposal to replace the Medicare physician payment formula, the House GOP plan would provide physicians with a stable, pre-set fee schedule to allow an eventual transition to alternate payment models. After that transitional period, payments would be linked to performance measures and other quality metrics.

Medpage Today: Congress Moves Forward On SGR Replacement
Physicians' Medicare payments in the future would be based in part on quality metrics relative to their peers, their own performance from previous years, and clinical improvement activities, according to an updated proposal from House Republicans. GOP lawmakers released on Wednesday a more fleshed-out proposal of their plan to repeal Medicare's sustainable growth rate (SGR) formula which determines physician payments and replace it with a plan to reward value and efficiency. … The plan still calls for providing physicians with a stable, predetermined fee schedule for a period of years -- which lawmakers still haven't specified -- to allow providers to transition to alternative payment models. But after that transition, payments would be based on performance measures, which the lawmakers provided more detail on (Pittman, 4/4).

Medscape: House Plan Would Ease Medicare Into Pay-For-Performance
Physician reimbursement in Medicare would gradually shift to a hybrid of fee-for-service (FFS) and pay-for-performance with an option for unspecified "alternative payment models" under a plan that leading House Republicans unveiled yesterday. The plan, not yet in the form of legislation, gives provider organizations such as medical societies the job of developing ways to measure physician performance (Lowes, 4/4).

In other news, Sen. Chuck Grassley has launched a probe into how a political intelligence firm learned about a major shift in Medicare policy before it was officially announced --

The Wall Street Journal: Probes Launched Into Leak of Health Care Policy Shift
A federal agency and a senior senator Thursday launched separate probes into whether news of an important government announcement was improperly leaked to traders about 30 minutes before it was made public. The leak, which was the subject of a Page One story in The Wall Street Journal, caused a run up in stocks of major health-insurance companies in the final few minutes of trading Monday (Mullins, 4/4).

The Hill: Grassley Probes Early Intel On Medicare Advantage Shift
Sen. Chuck Grassley (R-Iowa) is asking how a political intelligence firm learned about a major shift in Medicare policy before it was announced by the Obama administration. Grassley wrote to Medicare chief Marilyn Tavenner Thursday seeking to find out who knew, and when, that the administration would scrap its proposed cut to Medicare Advantage (Viebeck, 4/4).

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Women's Health

Judge Rules Morning-After Pill Must Be Available Over The Counter For All Ages

The ruling came in response to a lawsuit brought by reproductive-rights groups.

The New York Times: Judge Orders Morning-After Pill Available For All Ages
A federal judge has ruled that the United States government must make the most common morning-after pill available over the counter for all ages, instead of requiring a prescription for girls 16 and under (Belluck, 4/5).

Reuters: Judge Strikes Restrictions On 'Morning-After' Pill
The ruling by U.S. District Judge Edward Korman in Brooklyn, New York, comes in a lawsuit brought by reproductive-rights groups, which had sought to remove age and other restrictions on emergency contraception (4/5).

Politico Pro: Court: No Age Limit On OTC Emergency Contraception
The ruling is a blow to President Barack Obama and HHS Secretary Kathleen Sebelius, both of whom support restricting OTC access to "morning after pills" for anyone under age 17. Younger women had required a prescription (Smith, 4/5).

CBS News: Judge Strikes Age Restrictions For 'Morning-After' Pill
In 2011 the Food and Drug Administration had been prepared to lift a controversial age limit and make Plan B One-Step. ... Plan B was being sold only with a prescription to those 17 and older showing an ID with proof of age. But in December of that year Health and Human Services Secretary Kathleen Sebelius blocked the move. ... Sebelius said that while young girls are physically capable of bearing children, they might not properly understand how to use the emergency contraception without guidance from an adult (4/5).

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State Watch

Spate Of State Actions Worries Abortion-Rights Advocates, Divides Lawmakers

The advocates fear that a recent spate of measures, including one recently approved by lawmakers in Alabama, could roll back availability of abortions, while a debate in Virginia on the issue opens a chasm among lawmakers.

Los Angeles Times: Alabama Legislature OKs Abortion Limits; Kansas Clinic Reopens
Alabama this week moved to tighten the regulation of clinics and of medical personnel who perform abortions, the latest step in what abortion rights advocates argue is a campaign to use the regulatory power of government to limit a woman's right to an abortion. … Meanwhile, a Kansas abortion clinic that closed in 2009 after one of its doctors was murdered by an anti-abortion activist, reopened this week. The Wichita clinic has been closed since Dr. George Tiller was slain in a church in May 2009 (Muskal, 4/4).

The Washington Post: Abortion Debate Riles Virginia General Assembly
The Virginia General Assembly's decision Wednesday to prohibit insurers from offering abortion coverage in federally managed health-insurance exchanges under the Affordable Care Act has reopened an emotional debate along familiar partisan divides. But members of both parties agree that the measure's biggest impact will likely fall along class lines, landing hardest on some of the people the federal health care overhaul was designed to help: working women who barely get by on their incomes (Kunkle, 4/4).

And in Texas, an agreement on funding for women's health emerges --

The Texas Tribune: In Bipartisan Truce, House Members Pulling Amendments
While the Texas House began working through 267 amendments on the proposed budget Thursday morning, Democratic and Republican House members confirmed that potentially divisive amendments related to funding for women's health are being withdrawn as part of a bipartisan truce (Batheja, 4/4).

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State Highlights: Calif. Weighs Charity Minimum For Nonprofit Hospitals

A selection of health policy stories from California, Kansas, Nevada, Oregon, Georgia, Connecticut, Massachusetts and North Carolina.

The Wall Street Journal: St. Jude Hit By Suits
A raft of lawsuits filed Thursday against St. Jude Medical Inc. over an implanted heart device could challenge the broad liability protection that medical-device makers have enjoyed since a key Supreme Court ruling in 2008. The lawsuits, filed both in Los Angeles Superior Court and federal court in the Central District of California, claim that problems with the manufacturing and oversight of Riata defibrillator "leads" injured or killed more than 30 patients (Weaver and Smith, 4/4).

Kansas City Star: Kansas Agency's Promise Ends Dispute On AIDS Quarantine Ban Measure
A promise from Kansas' health department Thursday to continue protecting AIDS and HIV patients from being quarantined has resolved a dispute over a legislative proposal for helping medical personnel and emergency workers who may have been exposed to infectious diseases. State House and Senate negotiators agreed on the final version of a bill that still would repeal a 25-year-old law specifically banning state and local health officials from quarantining people with AIDS or the virus causing it (4/4).

The Associated Press/Washington Post: Jury: Health Management Group Liable For $24M In Las Vegas Hepatitis C Outbreak Case
A Nevada state court jury found the state’s largest health management organization liable Thursday for $24 million in compensatory damages to three plaintiffs in a negligence lawsuit stemming from a Las Vegas hepatitis C outbreak that lawyers called the largest in U.S. history (4/4).

Kaiser Health News: Immigrant Docs Help Ease California's Primary Care Shortage
When Jose Chavez Gonzalez moved to the United States from El Salvador, he took any job he could get -- stocking warehouses, construction, cleaning houses and working in a meat processing plant. But unlike most of the other immigrants he worked alongside, Chavez, 38, was a doctor with eight years of medical training. He came to the U.S. in the mid-1990’s to be with his family, but like all doctors from other countries, he still had to pass the U.S. medical boards and go through at least three years of residency in order to practice here. The process can be both expensive and time consuming, so during the day he worked various menial jobs and at night he studied for the boards" (Gold, 4/4).

The Lund Report: Cultural Competency Training Compromise Likely To Become Law
Oregon took a step toward acknowledging its increasing racial diversity when the House Health Committee passed a cultural competency bill for medical professionals that heads to the House floor next week. The committee voted 8-1 to allow the state’s medical licensing boards to require cultural competency courses for continuing education that health professionals must take to remain licensed. A separate amendment allows the state's community colleges and universities to require cultural competency training (Gray, 4/5). 

Georgia Health News: Rural Counties Ailing As Suburban Ones Thrive
A Georgia county-by-county ranking that combines health and economic statistics, released this week, shows suburban counties at the top and rural areas at the bottom. Oconee County, near Athens, placed first for the second straight year in the rankings, generated by Partner Up for Public Health, an advocacy campaign. Other counties in the top eight are Forsyth and Fayette near Atlanta; Columbia, near Augusta; and Cherokee, Cobb, Gwinnett and Coweta, also near Atlanta (Miller, 4/4). 

CT Mirror: Gun Restriction Irks Mental Health Advocates
Advocates for people with mental illness began this legislative session with trepidation. Would lawmakers, eager to pass a strong response to the mass shooting at Sandy Hook Elementary School, adopt restrictive measures against people with mental illness? Would the new law treat people with mental illness as sources of violence, even though they're more likely to be the victims? The gun violence, school security and mental health bill that passed this week with bipartisan support came as a relief to many advocates, who praised the thoughtfulness behind it (Becker, 4/4). 

The Associated Press: Mass. Gets Down To Business Of Medical Marijuana
In a packed conference room at the Sheraton Boston Hotel, the big sales pitch is on. About 300 people have gathered to get information on how to apply for a license to run a medical marijuana dispensary in Massachusetts. The pitch comes from Dr. Bruce Bedrick, the CEO of Medbox Inc., an Arizona-based company that offers consulting services and dispensing systems for medical marijuana that look and operate just like vending machines, though Bedrick cringes at that description (Lavoie, 4/5).

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 (Hoban, 4/4).

California Healthline: Five Bills Pass Health Committee
The state Senate Committee on Health yesterday approved ... bills designed to help alleviate California's shortage of physicians and nurses in underserved parts of the state. … The provider bills, SB 20 and SB 271 both authored by Sen. Ed Hernandez (D-West Covina), sailed through the health committee on 9-0 votes. "SB 20 directs funds from the Managed Risk Medical Insurance Board to help forgive physician education loans for those providers practicing in underserved area for three years," Hernandez said. ... To address the decade-long nursing shortage, particularly in underserved areas, SB 271 is based on a pilot program established in 2003 and expiring this year, he said (Gorn, 4/4).

California Healthline: Should Calif. Set Charity Minimum For Not-For-Profit Hospitals?
The California Legislature is considering a proposal to establish a minimum amount of charity care that private hospitals must provide to earn not-for-profit status and the tax benefits that go with it. AB 975 -- by Assembly members Rob Bonta (D-Oakland) and Bob Wieckowski (D-Fremont) -- would more tightly define charitable care and stipulate that private not-for-profit hospitals may not have operating revenue exceeding 10 percent of operating expenses, which includes charity care, community benefits and all other normal business expenses. State law currently requires not-for-profit hospitals to provide charity care, but because definitions of charity care are not specifically spelled out, minimum requirements are not clearly defined (4/4).

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Health Policy Research

Research Roundup: Looking At CHIP To Gauge Effect Of Health Law On Doctors

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

Medicare & Medicaid Research Review: The Effect Of The Children's Health Insurance Program On Pediatricians' Work Hours – In this study published by the Centers for Medicare & Medicaid Services, researchers analyzed the 1997 Children's Health Insurance Program (CHIP) to evaluate the potential changes in physicians' work hours in response to a large expansion in coverage. According to the authors, CHIP's coverage of almost one in five children is "roughly similar in magnitude to the expansion for adults that will occur under the Affordable Care Act." CHIP shifted millions of children into public coverage and substantially reduced out-of-pocket payments for medical services. The researchers found "that pediatricians in states with larger CHIP expansions substantially reduced their annual work hours relative to pediatricians in states with smaller expansions." They conclude that when trying to assess public insurance expansions, "it is important to not rely on a purely demand-driven model of physician behavior, but also to assess their effects on reimbursement rates and on physicians' work incentives" (He and White, 2013). 

The Commonwealth Fund: Insurers' Medical Loss Ratios And Quality Improvement Spending In 2011 –The federal health law requires insurers to pay out at least 80 percent of premiums for medical claims and quality improvements. If they don't meet that medical loss ratio (MLR), insurers are required to refund the difference to policyholders. The authors of this issue brief examined the spending of 947 health insurers, especially their "investment in quality improvement activities." They report, "In the aggregate, insurers paid less than 1 percent of premiums on either MLR rebates or quality improvement activities in 2011, with amounts varying by insurer type. Publicly traded insurers had significantly lower MLRs in each market seg­ment (individual, small group, and large group), and were more likely to owe a rebate in most segments compared with non–publicly traded insurers." The authors' findings suggest that "current market forces do not strongly reward insurers' investments" in quality improvements. (Hall and McCue, 3/22).

Georgetown University Law Center/The Kaiser Family Foundation: Updating The Ryan White HIV/AIDS Program For A New Era: Key Issues & Questions For The Future –The Ryan White HIV/AIDS program provides care and health services to millions of people – insured or uninsured –affected by HIV. The law is set to expire on Sept. 30, but Congress could reauthorize it  and “discussions about how best to structure the program in this new environment, including the timing of any changes, have already begun,” the authors of this report state. They highlight four broad areas of discussion: supporting people in all stages of treatment; building HIV treatment networks in underserved communities; integrating HIV care into mainstream health care; allocating Ryan White resources fairly. (Crowley and Kates, 4/3).

Trust For America's Health/Robert Wood Johnson Foundation: Investing In America's Health: A State-By-State Look At Public Health Funding And Key Health Facts – According to the authors "investing in disease prevention is the most effective, common-sense way to improve health – helping to spare millions of Americans from developing preventable illness, reducing health care costs, and improve the productivity of the American workforce so we can be competitive with the world." The authors say the nation's public health system has remained underfunded for decades and examine funding and key health facts in every state. They highlight several findings including inadequate federal funding for public health; cuts in states and local funding; wide variations in states' disease rates and other health statistics; and wide variations in health statistics within states. They conclude that "a sustained and sufficient level of investment in prevention is essential to improving health in the United States and that differences in disease rates will not be changed unless an adequate level of funding is provided to support public health departments and disease prevention efforts" (Levi, Segal, Laurent, and Lang, 4/2013).

Here is a selection of news coverage of other recent research:

Reuters: End-Of-Life Talks Lacking Between Doctors, Patients
Although many older patients in Canada have thought about end-of-life care and discussed it with family members, a new study suggests fewer have spoken with doctors and had their wishes noted accurately in their medical record. Many elderly people prefer to die at home instead of in the hospital - but that's not always the way it works out, researchers said (Pittman, 4/1).

MedPage Today: Kidney Outcomes Worse For Uninsured
Uninsured patients are more likely to progress to kidney failure and die from it than those who are covered by public or private insurance, researchers reported here. In adjusted models, uninsured patients were 82% more likely to die and 72% more likely to have kidney failure compared with insured patients (P<0.001 for both), Claudine Jurkovitz, MD, MPH, of Christiana Care Health System's Value Institute in Delaware, reported at the National Kidney Foundation meeting here (Fiore, 4/3). 

MedPage Today: Group Visits Ease Appointment Overload
A pilot program aimed at streamlining care of kidney stone patients allowed clinicians to see patients as a group and still provide individualized care, researchers reported. The "group visit" cut waiting time for office visits in half, yet the "satisfaction level attained with the shared medical appointments was very high as well," Allan Jhagroo, MD, assistant professor of medicine at the University of Wisconsin, Madison, told MedPage Today (Susman, 4/3).

The Hill: Study: Managed Medicaid Plans Handling More Prescriptions
Medicaid is quickly abandoning the traditional fee-for-service model when it comes to handling patient prescriptions, according to a new study. The IMS Institute for Healthcare Informatics reported Thursday that Medicaid managed care plans handled 19 percent of the program's prescriptions in September 2011 (Viebeck, 4/4).

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Editorials and Opinions

Viewpoints: A Doctor Finds Father's Hospital Care Frightening; Politicization Of Science Has Hurt Research Funding

WBUR: Cognoscenti: Even A Doctor Can't Keep His Father Safe In The Hospital
Three years ago, on a Friday afternoon, I received a frantic phone call from my mother. My active and healthy father was in the hospital with a suspected stroke. I immediately started driving to New Jersey, where they lived. I knew I had to be there to ensure that my dad would be safe. He had been taken to one of the most dangerous places in the world: a hospital. The story of my dad's three day stay in a major American teaching hospital is remarkably unremarkable (Ashish Jha, 4/5).

Journal of the American Medical Association: The Future of Biomedical Research
For decades the importance of biomedical research was a reliable pillar of bipartisan agreement, as evidenced by the continuous high levels of funding that both parties have sustained during the last 3 presidential administrations. ... This coming year, there will almost certainly be no increase in NIH funding. Moreover, sequestration means that the NIH will actually lose approximately 5.1% of its current level of funding, or about $1.55 billion. Bipartisan support has all but evaporated, and biomedical research is quickly becoming just another partisan issue. ... Four factors contribute to the erosion of support for the NIH. First, there is increasing politicization of science in general (Dr. Ezekiel J. Emanuel, 4/4).

Los Angeles Times: Blowing Smoke On Workplace Health
The best way to hire productive employees is to look for people with qualifications, talent, honesty and commitment. Now, however, a small but growing number of employers are looking for something else as well: job applicants who don't smoke. As much as we despair of the death and damage caused by tobacco, this new employment criterion strikes us as a lamentable and unwarranted intrusion into applicants' private lives — and one that should worry anyone in this country who has an elevated risk for any sort of injury or illness. In other words, most of us (4/4). 

The Washington Post: Obama Must Take The Lead On Medicare Reform
Reforming Medicare must be part of long-term deficit reduction. Alas, between House Budget Committee Chairman Paul Ryan's (R-Wis.) plan to replace Medicare with a "premium support" and President Obama's refusal to countenance it, Washington is hopelessly deadlocked. Or maybe not. There are ways to generate meaningful savings that don’t involve either abolishing Medicare "as we know it" or perpetuating the status quo (4/4). 

The Washington Post: The Politics Of Roe V. Wade And Gay Marriage
Arkansas last month enacted a law that bans abortion after 12 weeks. North Dakota went even further, banning abortion after six weeks. These blatantly unconstitutional statutes aren't the product of a 40-year-old Supreme Court ruling. They are the result of a sincere and intense belief — one I do not share — that abortion is the taking of a human life. They do not demonstrate the folly of the justices' intervention in Roe. They demonstrate its necessity (Ruth Marcus, 4/4).

The Washington Post: Let's Go Down The Aisle Toward Legalized Pot
Anytime now, Attorney General Eric Holder is expected to make an announcement about marijuana, one of the administration's trickier policy problems. In November, two states, Colorado and Washington, passed ballot initiatives — by strong margins — to legalize marijuana use. Both states established regulatory systems akin to those for alcohol, though Washington's is somewhat more stringent. And both states acted in defiance of federal marijuana policy: The 1970 Controlled Substances Act makes marijuana illegal and places it in the same class as heroin. How should the administration respond to this frontal challenge? The answer is: View it not as a threat but as an opportunity (Jonathan Rauch, 4/4).

Boston Globe: BC Should Work With Students To Resolve Issues Over Condoms
Boston College has taken action against a student group that dispenses condoms, intending to reinforce Catholic Church teachings in favor of marriage and against premarital sex. Administrators are certainly within their rights, as overseers of a private Catholic institution, to crack down. But it's still an unfortunate move: The administration and the student group coexisted respectfully for four years before the administration abruptly changed course. There's no reason to believe they can't do so again. And BC's leaders would earn the admiration of students by being mindful of their interests and needs — which might, in turn, make them more receptive to church teachings (4/5). 

Bloomberg: How To Finish the Last, Hard Path To Polio Eradication
The end of polio is in sight. Last year, there were fewer cases of the disease -- 223 -- in fewer endemic countries -- three -- than ever. Still, the eradication campaign can seem like Achilles' effort to outrun the tortoise in Zeno's paradox: There's always a little more ground to cover. The goal can be achieved only if health workers can find and inoculate the last unvaccinated children on earth. That's going to take an estimated $5.5 billion (in addition to the $9 billion spent so far), a huge commitment from endemic-country governments and a push by Muslim leaders to counter anti-vaccination extremists (4/3).  

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
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.