Daily Health Policy Report

Friday, April 6, 2012

Last updated: Fri, Apr 6

KHN Original Reporting & Guest Opinion

Administration News

Campaign 2012


Health Reform

Health Care Marketplace

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Q & A: Should You Have Access To Your Lab Results?

Kaiser Health News' "Insuring Your Health" columnist Michelle Andrews answers a question from a reader who wants to get his lab results sent directly to him. Andrews points out that federal officials are weighing a rule that would allow that but there are concerns from medical professionals (Andrews, 4/6). Watch the video.

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Capsules: Health Care Hiring Boom Projected To Continue, Regardless Of Law

Now on Kaiser Health News' blog, Jay Hancock writes: "Health-care employment will continue to grow much faster than employment generally, with the number of jobs in home care and other ambulatory settings projected to jump more than 40 percent by 2020, a new study suggests. New figures from the Labor Department highlight an expected hiring shift away from hospitals, as the system puts greater emphasis on preventive care and reduced admissions, said Jean Moore, director of the Center for Health Workforce Studies at the State University of New York at Albany" (Hancock, 4/6). Read the blog.


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Political Cartoon: "The Writing On The Wall"

Check out KHN's lighter side, featuring today's cartoon and health policy haiku.

Kaiser Health News provides a fresh take on health policy developments with "The Writing On The Wall" by Rick McKee.

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


States and plans waiting
Like geeks for a new iPhone
SCOTUS, please decide
- Don Amsel

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

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Administration News

DOJ Reaffirms Court's Power To Review Health Law Case But Urges Caution

In response to a demand from a federal appeals court judge, Attorney General Eric Holder says the Supreme Court has the power to review whether the health law is constitutional, but he also urged the court to show "deference."

The New York Times: Administration Concedes Courts' Review Power
The Obama administration stipulated the incontestable to a disgruntled federal court on Thursday, formally declaring that "the power of the courts to review the constitutionality of legislation is beyond dispute." Attorney General Eric H. Holder Jr., bowing to an unusual demand of the United States Court of Appeals for the Fifth Circuit, in New Orleans, made official the backpedaling of the past few days over remarks by President Obama about the Supreme Court's coming ruling on the constitutionality of his health care overhaul. Mr. Obama said on Monday that it "would be an unprecedented, extraordinary step" for the court to overturn the law (Cushman, 4/5).

Wall Street Journal: Attorney General Defends Obama's Court Critique
Attorney General Eric Holder said Thursday that the Justice Department recognized the authority of judges to overturn laws, but he defended comments on judicial review by President Barack Obama earlier this week, attempting to quell a political storm over the remarks. ... "The power of the courts to review the constitutionality of legislation is beyond dispute," Mr. Holder wrote, citing the 1803 Marbury v. Madison decision that established the principle of judicial review. But he also echoed Mr. Obama's argument that courts should act with restraint (Perez, 4/5).

Los Angeles Times: Obama Respects Supreme Court's Power, Attorney General Writes
Attorney Gen. Eric H. Holder Jr. told a federal appeals court that President Obama respects the Supreme Court's power to rule on the constitutionality of the nation's laws, a statement that a week ago would have seemed obvious but on Thursday appeared aimed at ending days of White House stumbling over the tricky politics of the high court (Hennessey, 4/6).

The Washington Post: In Letter To Judge, Holder Defends Obama's Comments Urging Supreme Court To Uphold Health-Care Law
Attorney General Eric H. Holder Jr. Thursday defended President Obama's comments urging the Supreme Court to uphold the health care law, telling a panel of federal judges that courts should show "deference" to the "legislative judgements of Congress." ... But the attorney general, citing a series of Supreme Court and other cases, said acts of Congress are presumed to be constitutional and should be overturned only sparingly (Markon, 4/5).

Houston Chronicle: Feds Respond To Houston Judge Questioning Obama On Health Care
In responding to the request of a federal appeals judge in Houston, U.S. Attorney General Eric Holder on Thursday affirmed his department's belief in the time-honored concept of judicial review and said nothing in President Barack Obama's recent comments on a pending Supreme Court decision should be interpreted otherwise (Tolson, 4/5).

CBS (Video): Did Obama Misspeak On Health Care And Supreme Court?
CBS News White House correspondent Bill Plante and White House spokesman Jay Carney on Thursday discussed whether President Obama made a mistake or misspoke when he said it would be "unprecedented" for the Supreme Court to overturn his health care law (4/5).

Politico Pro: Hospital Group Says DOJ Memo Went Too Far
The hospital association at the center of the dispute between President Barack Obama and a federal appeals court judge says Attorney General Eric Holder wrongly dismissed the merits of its lawsuit. In a letter to the 5th Circuit Court of Appeals late Thursday, Physician Hospitals of America and Texas Spine & Joint Hospital Ltd., which are suing over the health law's limits on physician-owned hospitals, said Holder went beyond just responding to the judge and called their lawsuit's claims "insubstantial" — which they say is not true (Haberkorn, 4/5).

Obama's comments also riled the top Republican in the Senate:

McClatchy: Obama Vs. Supreme Court Is Latest Episode In Recurring Rivalry
Barack Obama got off to a bad start with the Supreme Court the very moment he was sworn in as president, and it's not getting any better. On Thursday, seizing on Obama's comments Tuesday about the high court and health care, Senate Republican leader Mitch McConnell of Kentucky declared that the president "crossed a dangerous line this week" when he complained about unelected judges overturning laws (Doyle and Lightman, 4/5).

The Hill: McConnnell: Obama 'Crossed A Dangerous Line' With Rhetoric On Supreme Court Case
Senate Minority Leader Mitch McConnell (R-Ky.) slammed President Obama on Thursday for his earlier comments about the Supreme Court, accusing the president of an "intolerable" assault on the Judicial Branch. Obama said Monday that a decision overturning his health care law would be "unprecedented" and would demonstrate a "lack of judicial restraint." Republicans seized on the comments, saying the president is questioning the legitimacy of an entire branch of government just because one ruling might not go his way (Baker, 4/5). 

Market Watch: McConnell Says Obama Trying To 'Intimidate' Court
Sen. Mitch McConnell, speaking in his home state of Kentucky, said Thursday President Barack Obama was trying to "intimidate" the Supreme Court into upholding health-care legislation. ... "With his words, he was no longer trying to embarrass the Court after a decision; rather, he tried to intimidate it before a decision has been made. And that should be intolerable to all of us," said McConnell, the top Republican in the upper chamber (Goldstein, 4/5).

Meanwhile, some news outlets offered new analyses of the health law case before the court:

Reuters: Analysis: Justice Kagan -- Giving Liberals A Rhetorical Lift
During three days of arguments over the Obama health care plan, Supreme Court Justice Elena Kagan put on a display of rhetorical firepower, reinforcing predictions that the newest liberal justice is best equipped to take on the conservative, five-man majority controlling the bench. The strong views and persuasive tactics of the administration's former top lawyer could affect the fate of the health care overhaul, as well as decisions in other ideologically charged issues that will come before the court, such as same-sex marriage (Biskupic, 4/5).

CNN: Turn-Of-Century Baker Invoked In Health Care Law Debate
Though the Lochner ruling was overturned in 1937, President Barack Obama mentioned the case this week as he sought to defend his administration's Affordable Care Act, a health care reform bill intended to provide coverage to tens of millions of uninsured people. ... From 1905 until 1937, the Lochner case was commonly employed to strike down progressive era laws, including several New Deal programs penned by then-President Franklin D. Roosevelt (Ariosto, 4/6).

WBUR: What Went Wrong With The Supreme Court And The Health Law?
On Wednesday, the Health Law, Bioethics & Human Rights Department at Boston University School of Public Health posed the question many of us had been asking ourselves: "The Supreme Court and the Affordable Care Act: What Went Wrong?" A panel of three legal scholars from the department -- George Annas, Wendy Mariner and Leonard Glantz -- reflected on last week’s Supreme Court proceedings and explained what the arguments really were addressing (Siddiqui, 4/5).

California Healthline: Where Would Consumers, Insurer Land If ACA Is Struck Down?
California officials have been quick and confident in their assertions that the state should move forward with health care reform no matter what the Supreme Court decides about the Affordable Care Act. But what about insurers? The reform law promised up to 30 million new customers for health insurance -- more than six million in California. If the Supreme Court rules that requiring citizens to have insurance is unconstitutional, where will that leave insurers? (Lauer, 4/5). 

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Campaign 2012

Obama And Romney Campaigns Assail The Other's Budget Plans

Each casts the other's plans for entitlement programs, such as Medicare, as dangerous.

The Washington Post: Obama vs. Romney, Part 2
On the surface, (Mitt) Romney’s attack (on President Barack Obama) appeared contradictory, because a few moments after attacking the president for not having a plan for solving the entitlement crisis, he faulted Obama's proposals for reining in spending on Medicare as part of his health care law. ... Obama is betting that his health care law will help restrain the growth in health care spending over time, thus easing the budgetary pressure of Medicare and Medicaid. But a plausible case could be made that the proposed Medicare cuts will never occur or cause serious problems for providers — that is what the Medicare chief actuary has warned — and thus the budgetary savings will not materialize. In fact, without anticipated savings, costs could skyrocket, as often happens with new entitlements (Kessler, 4/6).

Reuters: White House Casts Republican Budget As Bad For Women
The White House said on Thursday that budget cuts proposed by congressional Republicans would hurt American women more than men, tailoring criticisms from President Barack Obama to one of his key voting demographics. ... Senior administration officials said the deficit blueprint that Republicans, including the party's likely 2012 presidential nominee Mitt Romney, would put teachers out of work, take away funds for violence prevention and cut medical care for millions of poor and elderly women (4/5).

The Washington Post: The Political Deadlock Over National Debt
Rep. Paul Ryan (R-Wis.) accused President Obama last week of setting the nation on an "unsustainable" path that would endanger "our kids and grandkids." Obama, in turn, alleged this week that Ryan and Republican front-runner Mitt Romney were trying "to impose a radical vision on our country . . . thinly veiled Social Darwinism." ... The reason neither man has found the sweet spot — which both stabilizes the debt and preserves key programs — has in part to do with political taboos. Obama has yet to put forward a plan that fully addresses the long-term costs of Medicare, a primary driver of the nation’s debt. ... Ryan, Romney and many Republicans, however, refuse to raise taxes at all (Goldfarb, 4/5). 

Meanwhile, earlier work of a new Romney adviser raises eyebrows.

The Hill: Report: Romney Adviser Lobbied For Individual Mandate
Mitt Romney's newest adviser lobbied for a national mandate that everyone have insurance two years before President Obama embraced the idea, The Washington Examiner reported Thursday. The revelation that former Republican National Committee Chairman Ed Gillespie was hired by the Coalition to Advance Healthcare Reform to lobby for the mandate in 2007 could further hurt Romney's popularity with conservative voters. Romney has tried to distance himself from Obama's healthcare reform law by arguing that the mandate he imposed as governor of Massachusetts was a state solution, but his ties to Gillespie could make that harder (Pecquet, 4/5).

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Gingrich's Health Care Consulting Firm Declares Bankruptcy

GOP presidential hopeful Newt Gingrich's health care consulting company filed for bankruptcy Thursday. The Center for Health Transformation charged up to $200,000 annually to drugmakers, insurers and hospitals for Gingrich's advice and may have suffered after he stepped down to seek the GOP nomination for president, reports say.

The New York Times: A Company Gingrich Founded To Offer Health Care Advice Files For Bankruptcy
A consulting company founded by Newt Gingrich filed for bankruptcy on Thursday, an apparent casualty of Mr. Gingrich's stepping down from the business to run for the Republican presidential nomination. The company, the Center for Health Transformation, charged up to $200,000 annually to big drug makers, insurance companies and hospitals for Mr. Gingrich's advice, including what he had to say about working the corridors of Washington power, although Mr. Gingrich has insisted he was not a lobbyist (Gabriel, 4/6).

The Wall Street Journal: Gingrich Health Care Group Files For Bankruptcy.
Newt Gingrich’s well-known health care think tank has filed for Chapter 7 bankruptcy, according to federal court filings, shuttering the most profitable of Gingrich’s former enterprises and potentially putting a big piece of his net worth in jeopardy (Yadron and McKinnon, 4/5).

The Washington Post: Gingrich Health Care Think Tank Files For Bankruptcy Protection
The once high-flying health care think tank that Republican presidential hopeful Newt Gingrich started nearly a decade ago has filed for bankruptcy, its fortunes having sunk rapidly last year as its compelling leader turned his energies to the political campaign trail. The Center for Health Transformation had promoted private-sector solutions to America's skyrocketing health-care costs. It also became a source of significant cash for Gingrich and his wife, Callista. The Washington Post reported that the center took in $37 million in donations, primarily from big pharmaceutical and health care corporations, in its eight years in business (Leonnig, 4/5).

National Journal: Newt's Health Care Think Tank Goes Bankrupt
Much like Newt Gingrich's presidential campaign, his multi-million dollar Washington consulting empire is also crumbling. The Center for Health Transformation, Gingrich's health care think tank, filed for bankruptcy today, the Atlanta Business Chronicle reports. The center's website is down and a spokeswoman has not returned a call. Newt Inc. appears dead. If Gingrich was still in the hunt for the GOP nomination this would be big news. But with his campaign on life support, it’s unlikely to matter much. For the campaign's part, it's already pointing out that Gingrich divested himself from the center in May and had nothing to do with its operations since. But that, of course, raises questions about how well the center was run to begin with if it couldn't survive a year without him (Frates, 4/5).

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Advisory Panel Urges New Fee On Medigap Plans, Cap On Out-Of-Pocket Costs

The Medicare Payment Advisory Commission made recommendations to Congress for changes to the program. It's not clear if Congress will accept the proposals.

Modern Healthcare: MedPAC Urges New Fee For Medigap Plans
Congress should add a new charge for Medicare beneficiaries who buy supplemental insurance, according to a recommendation from its advisory panel. The size of the fee for Medigap plans was not specified but left up to the secretary of HHS, according to a unanimous recommendation by the panel. Medicare Payment Advisory Commission members and other health policy experts have frequently criticized such plans as cost drivers for Medicare because they often cover all out-of-pocket costs for beneficiaries, which critics contend leads to overutilization of health care services (Daly, 4/5).

CQ HealthBeat: MedPAC Backs Cap On Out-of-Pocket Costs, Fee On Supplemental Insurance
Medicare beneficiaries would be protected from never-ending out-of-pocket costs under a recommendation the Medicare Payment Advisory Commission approved on Thursday. Funding for capping catastrophic expenses would come partly from an additional charge on supplemental insurance plans, such as Medigap policies. Most seniors have some supplemental insurance to pay for medical costs that Medicare doesn't cover (Adams, 4/5).

Meanwhile, a new study finds that Medicare coverage has improved but still doesn't match employer-based plans:

CQ HealthBeat: Medicare Coverage Not As Generous As Large-Employer Plans
Medicare coverage has gotten better in the past few years with the addition of prescription drug coverage, but it’s still not as generous on average as the private employer-sponsored insurance offered by large companies or the federal government, according to a new study by the Kaiser Family Foundation. The average value of Medicare is almost as good as the Blue Cross/Blue Shield standard option plan offered to federal workers, with Medicare's benefits worth about 97 percent of the value of the federal plan, the report says. The typical large-employer preferred provider organization (PPO) is better than both. Medicare's coverage equals about 93 percent of the typical big-company PPO benefits (Adams, 4/5).

(Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.)

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Health Reform

Cost Of Preventive Exams Varies As Much As 700%, Report Finds

The health law seeks to make preventive screening and procedures available to more people, but it could come at a high cost.

USA Today: Costs Of Many Preventive Medical Exams Vary As Much As 700%
A new report shows costs vary as much as 700 percent for some preventive examinations, and as the federal health care law increases demand for those procedures, it can mean an increase in premiums if employees don't pay attention to those costs (Kennedy, 4/6).

Chicago Tribune: Report: Health Care Law 'Medical-Loss Ratio' Provision Would Have Generated Over $100 Million In Customer Rebates In Illinois
An Illinois resident with individual health insurance would have received an average rebate of $159 last year if a provision of the new federal health care law had been in effect, according to a new report. The health care law's provision, called the medical-loss ratio, took effect in 2011. It requires that insurers spend at least 80 percent of patient premium revenues on medical services or issue customers rebates for the difference (Frost, 4/6).

Meanwhile, a new report looks at U.S. health costs in comparison to other countries:

The Hill: Think Tank: Long-Run Deficit 'Entirely Due' To Health Care Costs
The United States would be looking at long-term budget surpluses rather than deficits if only health care costs per person were on par with the rest of the world, the nonprofit Center for Economic and Policy Research demonstrates with a new online calculator. The think tank's "Health Care Budget Deficit Calculator" allows users to change the course of the nation's fiscal outlook by swapping health care costs with those of other industrialized nations, all of which have longer life expectancies than the United States. Simply by adopting Australian health care prices, the calculator shows, the deficit would be eradicated by 2040 (Pecquet, 4/5).

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Md. Passes Health Exchange Legislation; Ore., Mass. Prepare Their Own Reforms

Maryland is moving aggressively to implement health reform as it passes legislation creating health insurance exchanges. In other news, Oregon and Massachusetts officials make plans to overhaul their state-based health care systems, and Washington state's attorney general is talking positively about the law's Medicaid expansion after previously criticizing it.

The Baltimore Sun: Legislation Passed To Create Health Exchanges
Maryland continued its aggressive implementation of health care change Thursday despite uncertainty surrounding the issue nationally, as the General Assembly passed legislation to create open markets where people will buy insurance. The law to set up the health benefit exchanges was sent to Gov. Martin O'Malley, who supports the legislation (Walker, 4/5).

Modern Healthcare: Proposals Laid Out For Ore. Health Overhaul
No corner of Oregon would be left behind from sweeping changes to the Oregon Health Plan under proposals by groups that want a part of a redesigned health care system for low-income patients.The preliminary plans, laid out in letters to the state released this week, also show that some companies see Oregon's health overhaul as an opportunity to expand into new territories (4/5).

The Seattle Times: McKenna Talks Up Medicaid Expansion, Despite Lawsuit
When Republican Attorney General Rob McKenna joined the lawsuit challenging President Obama's 2010 health care overhaul, he criticized the "massive expansion" of Medicaid as a budget buster for states. In media interviews over the last few years, he has frequently sounded similar alarms about the Medicaid provision -- once even likening it to "creeping socialism." ... So it's been a bit jarring to hear McKenna speak positively about the law's Medicaid provision in recent weeks (Brunner, 4/5).

Meanwhile, two reports out of Massachusetts look at trying to control health costs.

Boston Globe: Attorney General Martha Coakley Circulating Plan To Control Health Care Costs
Attorney General Martha Coakley's office is quietly circulating a proposal to more tightly regulate hospitals and doctors and the prices they are paid to care for patients. Coakley's staff has drafted legislation and has briefed providers, business leaders, key legislators, and the governor’s office on the plan to contain health care spending. Providers and insurers would have to provide detailed price information to patients before they undergo a test or treatment, and the Division of Insurance and Department of Public Health would have new authority to limit the prices and market power of providers under Coakley’s proposal (Kowalczyk, 4/6).

WBUR: Budgeting Care For One Of America's Most Expensive Patients
[One Massachusetts patient] recently signed up with an agency that will try to improve her health while working under a budget, sometimes called a global payment. (We'll track [the patient, Sue] Beder's care for her first year in this plan.) As more and more patients are covered by global payments, Beder represents the future of health care in Massachusetts. And, if health care on a budget doesn’t work for high-cost patients such as Sue Beder, it may not make sense for any of us (Bebinger, 4/6).

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Health Care Marketplace

Advice For Getting Coverage For An ER Visit; Accessing Lab Results

In health care marketplace news, outlets examine coverage for emergency room visits and patients' efforts to get direct lab reports. Also, a new study finds that the health care workforce is continuing to grow.

Los Angeles Times: When A Health Insurer Won't Pay For An ER Visit
According to Dr. David John, an emergency room physician in Stafford Springs, Conn., and former chair of quality and patient safety for the American College of Emergency Physicians, it's quite typical for a patient to enter the ER with symptoms indicating a serious medical condition but leave with a diagnosis that sounds anything but urgent. ... By law, health plans are required to pay for emergency room visits for medical situations in which an average person believes his or her health or life is threatened (called the prudent layperson standard), according to John. Your ultimate diagnosis cannot influence whether your emergency room visit is paid for by your insurer (Zamosky, 4/5).

Kaiser Health News: Q & A: Should You Have Access To Your Lab Results?
Federal officials are weighing a rule that would allow patients to get direct access to their lab results, but there are concerns from medical professionals (Andrews, 4/6).

Kaiser Health News: Capsules: Health Care Hiring Boom Projected To Continue, Regardless Of Law
Health-care employment will continue to grow much faster than employment generally, with the number of jobs in home care and other ambulatory settings projected to jump more than 40 percent by 2020, a new study suggests. New figures from the Labor Department highlight an expected hiring shift away from hospitals, as the system puts greater emphasis on  preventive care and reduced admissions, said Jean Moore, director of the Center for Health Workforce Studies at the State University of New York at Albany (Hancock, 4/6).

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State Watch

Calif. Regulator Calls Aetna Rate Hike 'Unreasonable'; Ariz. County Raises Premiums For Stealth Smokers

California Insurance Commissioner Dave Jones used authority, granted under a year-old state law, to call out the rates as unreasonable. In Arizona, Maricopa County raised premiums on hundreds of county workers who either failed a saliva testing for nicotine or refused to take it.

Los Angeles Times: Aetna Raises Health Insurance Rates For Small Employers
Aetna Life Insurance Co. raised health insurance rates for small employers by an average of 8% a year beginning April 1, a hike that California Insurance Commissioner Dave Jones called  unreasonable. Jones said Thursday that he'd asked Aetna to withdraw its increase in quarterly rates, affecting 77,000 employees and dependents of small employers (Lifsher, 4/5).

The Wall Street Journal: California Regulator Criticizes Aetna Rate Increase As ‘Unreasonable’.
A California insurance regulator ruled that an Aetna Inc. health-insurance rate increase was “unreasonable,” in the latest salvo of a long-running debate in the state over the cost of coverage (Wilde Mathews, 4/5).

Arizona Republic: Maricopa County Employees Who Fibbed About Smoking To See Hike In Premium
Hundreds of Maricopa County employees caught fibbing to their health insurer about their smoking or who refused nicotine testing will now pay higher health-insurance premiums under a new county policy. As a result, the county will collect an additional $327,360 in health-insurance premiums, with the money going into an employee-benefits fund (Lee, 4/5).

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Miss. Senate Passes Bill That Could Shut Abortion Clinic; Ariz. Lawmakers Get Knitted Uteruses As Protest

The Mississippi bill, which would require doctors working at abortion clinics to have admitting privileges to a local hospital, passed the House last month and is expected to be signed by the governor. Meanwhile, 32 Republican lawmakers in Arizona received knitted uteruses as part of a national protest against government regulation of women's health.

The Associated Press: Miss. Passes Abortion Bill That Could Shut Clinic
The Mississippi Senate has given final passage to a bill that could close the state's only abortion clinic. The bill would require doctors working at abortion clinics to be certified as obstetrician-gynecologists and to have admitting privileges to a local hospital. The clinic's owner told The Associated Press that all of its physicians are OB-GYN's, but only one has admitting privileges (Tillman, 4/5).

Arizona Republic: Contraception Bill To Be Revived In Amended Form
Legislation to allow businesses to opt out of providing contraception health-care coverage will likely be revived next week, but the sponsor plans to amend it so that it applies to only religious-based employers such as St. Vincent de Paul. House Bill 2625 in its current form would allow any business or insurance company to opt out for religious reasons. The business or insurance company would still have to cover any contraception prescribed for reasons other than to prevent pregnancy or cause an abortion. In such cases, the patient would cover the cost and submit a reimbursement request to the insurance company (Rau, 4/5).

The Associated Press: Feds Receive Kan. Abortion Complaint
A federal agency has received a civil rights complaint about a former Kansas abortion provider's disposal of hundreds of patients' medical records in a recycling bin, an official said Friday. Meanwhile, a state regulatory board is working on an agreement on the permanent custody of other files still in his possession. Leon Rodriguez, director of the Office for Civil Rights in the U.S. Department of Health and Human Services, said it received a complaint March 26 about Krishna Rajanna's handling of confidential patient files (Hanna, 4/5).

Arizona Republic: State GOP Lawmakers Get Unique "Gift:" Knitted Uteruses
Thirty-two Republican lawmakers at the state Capitol received an unusual gift on Thursday: knitted uteruses. Peggy Tinsley delivered the craft uteruses as part of a national knitting project that aims to take a stand against government regulation of women's bodies, including restrictions to contraception health-care coverage (Rau, 4/5).

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State Roundup: Health Costs Cloud Budget Forecasts; Minn. To Use HMO Refund On Personal Care

Reuters: Outlook Still Grim For US State, Local Budgets-GAO
U.S. state and local governments' fiscal situations have improved recently but will still deteriorate through 2060, the Government Accountability Office said on Thursday. ... The outlook remains gloomy for the future, with healthcare costs, both for public employees and for the Medicaid insurance program for the poor, swelling and weighing on budgets, GAO said. "Specifically, state and local expenditures on Medicaid and the cost of healthcare compensation for state and local government employees and retirees are projected to grow more than GDP (gross domestic product)," it said (4/5).

(St. Paul) Pioneer Press: Senate Passes Health Bill Restoring Pay For Some Personal Care Attendants
The Senate passed a health and human services bill Thursday, April 5, that includes about $22 million in new spending based on an expected repayment of funds from the state's nonprofit HMOs. On Tuesday, Gov. Mark Dayton announced that health plans would repay $73 million to the state and federal governments this summer because of a 1 percent cap on HMO profits during 2011. The cap applied to health plan earnings on their business managing care for patients in the state's largest public health insurance programs. Legislators expect the federal government - which jointly funds the state programs - will get $38 million of the total (Snowbeck, 4/5).

The Associated Press/Denver Post: Colorado Health Department Offering Remote Tests
Colorado health officials are offering Medicaid patients the option of doing routine health checks from home. ... State officials say the program will save money by reducing the number of unnecessary emergency room and hospital visits (4/5).

The Sacramento Bee / California Watch: Neglect, Health Concerns Envelope Poor County Areas In California
"It's like people are living in colonies of the United States," said Miguel Donoso, a longtime Latino community advocate in Stanislaus County. "Living in a Third World country, that's close to what you see here today." Statewide, PolicyLink, an Oakland-based public policy research and advocacy institute, estimates that 1.8 million low-income and often Spanish-speaking Californians live in such communities, many without the infrastructure that would curb gastrointestinal illnesses, respiratory disease symptoms, and other public health and safety risks (Yeung, 4/6).

Boston Globe: Primary Care Physician Groups Rated On Preventive Care In New Report
Massachusetts Health Quality Partners, a non-profit organization that has tracked physician performance for 8 years, released its latest ratings of physician practices on Thursday. The report shows how well primary care doctors do at providing their patients with preventive care, such as colon cancer screening, and treating chronic disease care such as diabetes. The group found that Massachusetts primary care physicians continue to provide high-quality care overall, although notable differences in quality exist (Kowalczyk, 4/5).

WBUR: Report Finds 40% Differences In Mass. Primary Docs’ Quality
Attention, primary care patients, which means just about all of us. A new study from Massachusetts Health Quality Partners finds that the state remains a great place to be a patient, and it’s getting even better. But there are some major disparities among medical groups in performance as measured by MHQP’s quality indicators, from testing for strep throat before prescribing antibiotics to using scans to diagnose lower back pain (Goldberg, 4/5).

Minneapolis Star Tribune: Minnesota Legislature Approves Tougher Elder-Abuse Bill
Minnesota lawmakers gave final approval Thursday to a measure that would, for the first time, punish abusive caregivers with prison time and significant fines if they severely neglect elderly and vulnerable adults. The bill, which has the support of Gov. Mark Dayton, creates a felony provision in state law that would target caregivers who intentionally deprive vulnerable adults of food, clothing, shelter, health care or supervision. Elder advocates and prosecutors say it will close a gaping loophole that for years left vulnerable people without proper protection (Schrade, 4/5).

The Associated Press: Nevada Working To Curb Backroom Doctors, Dentists
Nevada state health officials are trying to cope more effectively with phony providers. A former Nevada state attorney general is heading a task force examining the issue, and the Latino Research Center at the University of Nevada, Reno, has been commissioned to document reports of unlicensed care in the state's Hispanic community. The goal is to provide recommendations in June for the state Legislature (Silva and Ritter, 4/5).

The Associated Press/Houston Chronicle: No Viral Infections Found In Clinic’s Patients
Mississippi health officials say none of the nearly 300 cancer patients they tested from a defunct clinic have contracted viral blood infections such as HIV because of care at the facility, which is suspected of diluting chemotherapy drugs and using old needles. The Mississippi Health Department closed Rose Cancer Center in Summit in July because of "unsafe infection control practices" after 11 patients were hospitalized with the same bacterial infection. Health Department spokeswoman Liz Sharlot told The Associated Press that the department sent out two rounds of letters to former patients advising them they could come in for tests (Mohr, 4/5).

Associated Press/Minneapolis Star Tribune: Prenatal Care Proposal For Illegal Immigrants Divides Nebraska Lawmakers, Frustrates Governor
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 has made opponents of typical allies, with Republican Gov. Dave Heineman pushing hard against the proposal, even while noting his strong opposition to abortion. The Republican speaker of the Legislature, Mike Flood, has taken the opposite position, supporting the measure while stating that he has always been against illegal immigration (Schulte, 4/5).

Detroit Free Press: AARP: Michigan Too Quick To Put Elderly In Nursing Homes
When it comes to long-term care, Michigan is too quick to place its elderly in nursing homes, according to a new report by the AARP Michigan. In fact, 35 states spend fewer Medicaid dollars — the bulk of the funding for long-term care — on nursing homes, instead finding ways to help seniors age in place, said Lisa Dedden Cooper, author of the report (Erb, 4/5).

Health News Florida: WellCare Ready To Roll, Analysts Say
WellCare Health Plans has spent the past five years in the doghouse, trying to live down evidence of massive Medicaid fraud against Florida and eight other states. Now, the Tampa-based company has a clear field ahead, Wall Street analysts say. Criminal charges that have been pending since 2009 have been dropped, and a settlement of $137.5 million for governments and whistleblowers is now official. Florida's share of the settlement will be more than $54 million, Attorney General Pam Bondi announced on Wednesday (Gentry, 4/5).

The Wall Street Journal: Outbreak Of Rabies Puts City On Edge
Rabid skunks are causing a stink in Carlsbad, N.M. After 15 years without a confirmed case of rabies, the southeastern New Mexico county where Carlsbad is the county seat has seen about 30 skunks test positive for rabies since December. ... Rabid skunks have tangled with dogs, cats and sheep in the area, requiring more than 30 pets and farm animals to be euthanized, Dr. (Paul) Ettestad said. A dozen people in the county have received rabies shots as a precaution, but no humans have exhibited symptoms of rabies, a virus that typically is fatal in humans if not treated quickly (Koppel, 4/5).

Modern Healthcare: Utah Reports Breach Of 24,000 Medicaid Claims
Hackers believed to be operating out of Eastern Europe gained access to around 24,000 Medicaid claims housed on a Utah Technology Services Department server, according to the state's health department. The Utah Health Department stated in a news release that the state's tech services department, which operates the server containing the Medicaid claims, gave notice of the breach on Monday evening. The breach itself appears to have occurred Friday, according to the release (Conn, 4/5).

CT Mirror: Supreme Court Health Care Decision Likely To Spark Fight In Connecticut Senate Race
The Supreme Court's decision on the constitutionality of the health care act will put the justices on the front lines of political campaigns this summer and likely fire up Connecticut's Senate race. The Supreme Court will issue a ruling, probably in late June, that would uphold the Affordable Care Act, toss out the whole law, or reject its mandate to buy health insurance. But no matter what the justices' decision is, analysts say the outcome will be political fodder for Republican candidates like Linda McMahon and former Rep. Chris Shays, who are running for the seat of retiring Sen. Joe Lieberman (Radelat, 4/5).

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Health Policy Research

Research Roundup: Effects Of Health Exchanges; Improving Provider Performance

Every week, KHN reporter Shefali S. Kulkarni compiles a selection of recently-released health policy studies and briefs.

Urban Institute: The Coverage And Cost Effects Of Implementation Of The Affordable Care Act In New York State -- Authors analyzed the cost and coverage implications of various scenarios of the health insurance exchanges that are called for in the health law. They predicted that about 1 million uninsured people in the state would get insurance through the exchanges and said that premiums in the small group and individual market would be lower than if the health law was not in effect. They added: "The state will reap substantial savings under the ACA due to the higher federal matching rate that it will receive on Medicaid coverage for adult non-parents" (Blavin, Blumberg, Buettgens and Roth, 3/31).

Health Affairs: In A California Program, Quality And Utilization Reports On Reproductive Health Services Spurred Providers To Change -- Researchers examined a statewide family planning and reproductive health program in California to see if performance reports altered providers’ behavior. The researchers reported that for “five of the six indicators among private providers and three of the six indicators among public providers, there was a significant change over time. We believe the evidence suggest that providers changed their behavior when they were presented with performance reports that used administrative and claims data to compare them with their peers” (Watts et al., 3/28).

The Kaiser Family Foundation: Governors' Budgets for FY 2013 -- What is Proposed for Medicaid? -- This report notes that state revenues "have not rebounded to pre-recession levels, unemployment rates are still high, and some states continue to face budget shortfalls. ... Governors have proposed a wide range of Medicaid cost containment measures, including significant cuts in eligibility and benefits for some groups, increased use of care management, and greater use of technology to streamline enrollment processes and find efficiencies. At the same time, many states are preparing for the Affordable Care Act coverage expansions and implementation of state Exchanges and are taking advantage of opportunities for federal financial support to make changes" (Snyder, Stephens and Rudowitz, 3/27).

Archives of Pediatric and Adolescent Medicine: Parental Recall Of Doctor Communication Of Weight Status – This study used data from the National Health and Nutrition Examination Survey, 1999 through 2008, and found that the "percentage of parents who reported that a doctor or health professional told them that their child was overweight was relatively unchanged during the 1999-2006 period but increased in the 2007-2008 period." Researchers concluded: "Fewer than one-quarter of parents of overweight children report having been told that their child was overweight. While reports of notification have increased over the last decade (perhaps because of [1] revised definitions of overweight and obesity, [2] increased concern about children with BMIs in the 85th to 95th sex- and age-specific percentiles, or [3] improved recall by parents), further research is necessary to determine where and why communication of weight status breaks down" (Perrin, Skinner and Steiner, April 2012).

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

Kansas Health Institute News: Study: Untreated Mental Illness Costs Kansas More Than $1 Billion Yearly
The financial toll of untreated mental illness in Kansas is $1.17 billion annually, according to new research released today by the Health Care Foundation of Greater Kansas City.  In the KC metro area, the cost is $624 million per year — about $287 million of which is also included in the statewide Kansas tally. About one in 10 adults in Kansas and Kansas City has at least one of the serious mental illnesses considered in the research: major depression, anxiety disorder, schizophrenia and bipolar disorder, said Jessica Hembree, the foundation's policy officer. About 40 percent of those go untreated, she said (Cauthon, 4/4).

MedPage Today: Lawsuit Defense Still Costly When Doctor Wins
Clinicians spend more money defending themselves when malpractice suits involve a payment to the patient, researchers found, but winning cases remains expensive. Mean defense costs were significantly higher in cases in which indemnity payments were made ($45,070 versus $17,130, P<0.001), Apum Jena, MD, PhD, of Massachusetts General Hospital in Boston, and colleagues reported in a letter to the editor in the New England Journal of Medicine (Fiore, 4/4).

Medscape: Nutrition Report Reflects Race And Sex Differences 
Data from the latest National Health and Nutrition Examination Survey (NHANES), just released by the US Centers for Disease Control and Prevention (CDC), also suggest that ethnicity is a factor in measures of vitamin D deficiency, as well as in measures of heart-healthy polyunsaturated fatty acids at beneficial levels. The Second National Report on Biochemical Indicators of Diet and Nutrition in the US Population states further that iron deficiencies and excesses can be associated with age, ethnicity, and sex (Franklin, 4/4).

MedPage Today: EMR Pop-Ups Can Lead To 'Alert Fatigue'
A VA point-of-care study found that medication alerts generated by the electronic medical record system were frequently frustrating to prescribers because they were numerous, contained extra information, and did not apply to the patient. ... Some alerts don't give enough information and others contradict common clinical practice, according to Alissa Russ, PhD, of the Richard L. Roudebush VA Medical Center in Indianapolis, and colleagues. One result may be that practitioners distrust the value of the system, Russ and colleagues argued in the April issue of the International Journal of Medical Informatics (Smith, 4/3). 

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Editorials and Opinions

Viewpoints: An 'Easy' SCOTUS Case?; Is Painkiller Addiction Really An Epidemic?

The New York Times: 'Embarrass the Future'?
Nothing in the Supreme Court arguments in the health care case last week, or in the subsequent commentary, has changed my opinion that this is an easy case. It’s the court that made it look hard (Linda Greenhouse, 4/4).

The Wall Street Journal: The Dissent That Wasn't
One way of understanding the liberal left's response to ObamaCare's constitutional infirmities is through Elisabeth Kübler-Ross's five stages of grief. We've seen examples of denial (of course ObamaCare is constitutional, only crazy people think otherwise), anger (the Supreme Court loves insurance companies and hates poor people) and depression (what a train wreck!). (James Taranto, 4/5)

The Washington Post: Obama v. SCOTUS
Obamacare passed the Congress without a single vote from the opposition party -- in contradistinction to Social Security, the Civil Rights Act, the Voting Rights Act, Medicare and Medicaid, similarly grand legislation, all of which enjoyed substantial bipartisan support. In the Senate, moreover, Obamacare squeaked by through a parliamentary maneuver called reconciliation that was never intended for anything so sweeping. The fundamental deviation from custom and practice is not the legal challenge to Obamacare but the very manner of its enactment (Charles Krauthammer, 4/5).

The New York Times: Toward Universal Health Coverage
Two recent events underscore the disparity between the United States and the rest of the world on health coverage. Last week, American reactions to the Supreme Court hearings showed how deeply divided the nation is on the subject. This week, at an international forum in Mexico City, country delegates from around the globe made clear that they are not only aiming for universal coverage but also rapidly getting there (David de Ferranti and Julio Frenk, 4/6).

The New York Times: That Other Obama
Then the president turned to Ryan’s Medicare proposal. The Ryan plan, he charged, "will ultimately end Medicare as we know it." In 2011, when Ryan first proposed a version of this budget, Politifact, the truth-checking outfit, honored this claim with its "Lie of the Year" award. Since then, the Ryan Medicare proposal has become more moderate and much better. Obama’s charge is even more groundless (David Brooks, 4/5).

Los Angeles Times: Painkiller Addiction: Is It Really An Epidemic?
Prescription painkillers are growing in popularity in new parts of the country, according to a new Associated Press analysis that has experts sounding alarms of a new addiction epidemic. "Pharmacies, hospitals and physicians dispensed the equivalent of 69 tons of pure oxycodone and 42 tons of pure hydrocodone in 2010," according to the study. "That’s enough to give 40 5-mg Percocets and 24 5-mg Vicodins to every man, woman and child in the United States" (Alexandra Le Tellier, 4/5).

The Fiscal Times: Obama And Paul Ryan's Conflicting Budget Visions
Perhaps the biggest disagreement between the president and Ryan is over how to reform the entitlement programs that are driving this country toward bankruptcy. Ryan would restructure Medicare for those under age 55 to give recipients a choice between the traditional program and a voucher that would allow them to purchase private insurance. ... The president makes no significant changes to Medicare, relying instead on expansion of changes contained in the new health care law to save a projected $364 billion over the next 10 years (Michael Tanner, 4/6).

The Atlanta Journal-Constitution: Law's Unjust Consequences
House Bill 954 hinges its basis for a challenge to the U.S. Constitution on the notion that a growing baby inside the womb feels pain at 20 weeks. Although all recent research from the American Medical Association and the American College of Obstetricians and Gynecologists refutes this rationale, its proponents pressed on. … Why? Because HB 954 was really not about fetal pain. … When laws include unintended consequences, care suffers. Georgia’s pregnant women and their doctors are now left with the consequences (The Infertility and Perinatology Consortium of Georgia (4/6).

The Atlanta Journal-Constitution: State Guards Babies In Utero
The law will protect children who have reached 22 weeks from the mother’s last menstrual period from elective termination, at a time when the baby can experience pain and even survive the delivery. … Babies who have reached this gestational age deserve the protection of the state (Kathleen M. Raviele, 4/5).

Fox News: Medicaid's Cruel Status Quo
It turns out that Medicaid’s profoundly inefficient design leads to hundreds of billions of dollars in waste and fraud. As a result, fewer funds are left over to care for actual Medicaid patients. Medicaid pays physicians, on average, about half of what they get from private insurers. Indeed, a study by two MIT economists found that nearly 60 percent of doctors gained more revenue from the uninsured than from Medicaid patients, because many uninsured patients pay out-of-pocket for their care. And you don’t have to fill out any government forms when your patient pays you in cash. Medicaid's paltry payments, in many cases, amount to less than what it costs to care for these patients. As a result, doctors are faced with two choices: caring for Medicaid patients and going broke, or shutting their doors to the poor (Avik S. A. Roy, 4/5).

The Philadelphia Inquirer/The Philadelphia Daily News: Hush, Doctors: Gas Industry Gags Physicians
Act 13, the hydraulic fracturing law passed in February, already qualified as a major corporate giveaway to the natural-gas industry, giving companies the right to overturn local zoning laws and pretty much drill anywhere. But buried in the law, which goes into effect April 14, is a gag order on doctors. If physicians want to learn the exact chemicals being used in fracking they must sign a nondisclosure agreement that prevents them from sharing what they know with their patients or other doctors (4/6).

San Jose Mercury News: This Time, Truth In Mammograms Law Must Succeed
We're still not entirely sure why Gov. Jerry Brown vetoed Sen. Joe Simitian's bill last year to make doctors tell women when their breast tissue is too dense for mammograms to be effective. But the Democrat from Palo Alto is trying again, this time with more evidence that the law will save lives. It should easily pass the Legislature again, and this time the governor needs to get on board (4/5).

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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.