Daily Health Policy Report

Monday, April 9, 2012

Last updated: Mon, Apr 9

KHN Original Reporting & Guest Opinion

Health Reform

Medicare

Campaign 2012

Capitol Hill Watch

Health Care Marketplace

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

In Kansas, No Consensus On How To End 'Dental Deserts'

Kansas Public Radio's Bryan Thompson, working in collaboration with Kaiser Health News and NPR, reports: "In an ongoing disagreement over how to solve dental care access problems in Kansas, there is one thing no one disputes: the great need" (Thompson, 4/8). Read the story.

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Kaiser Health News: Capsules: Arizona Gets OK To Expand Health Coverage To Kids; Obama Ties Women's Economic Future To Health Law

Now on Kaiser Health News' blog, Phil Galewitz reports: "Nearly 22,000 poor kids in Arizona will gain health insurance coverage under a Medicaid deal the state has reached with the Obama administration, federal officials said Friday" (Galewitz, 5/6). Also on the blog, Christian Torres reports: "President Barack Obama brought together Friday two of his biggest campaign issues, health care and the economy, in an appeal to women voters, who have favored the president over GOP rivals in recent polls. During remarks at a White House forum on women and the economy, Obama described how provisions of the 2010 health law have helped break barriers for women in the workforce" (Torres, 4/6). Check out what else is on the blog.

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Political Cartoon: 'Scout's Honor?'

Kaiser Health News provides a fresh take on health policy developments with "Scout's Honor" by Clay Bennett.

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

Goldilocks Redux

EKG needed?
Too few: Too much heart disease
Too many: Waste cash
-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 Reform

Debate Continues About Obama And The High Court

News outlets analyze President Barack Obama's recent comments on the Supreme Court's consideration of the health law, looking at historical references, the politics in play and precedents. Reports also take a look at what some judges are saying.

National Journal: With Health Care, Obama Joins Presidents Who Have Commented On Court
Despite some awkward wording, were Obama's comments that unusual? Not really, several experts told National Journal. There is a rich history of presidents on both sides of the aisle commenting on the Supreme Court's role. President Reagan "talked regularly about the need for unelected judges to respect the wishes of the elected branches of government,"said Jeff Shesol, a former Clinton administration speechwriter and the author of Supreme Power: Franklin Roosevelt vs. the Supreme Court, in an interview (McCarthy, 4/6).

The Washington Post: Health-Care Arguments Recall A Supreme Court Case That Is An Equal-Opportunity Offender
Those who are not historians or recent law school graduates might miss the reference. So it is time to brush up on Lochner v. New York, a 1905 decision reviled enough to lend its name to an era of discredited Supreme Court rulings. Some supporters of the Affordable Care Act saw an apparition in the Supreme Court’s arguments on the act, and recalled the days when the court struck down progressive economic regulations (Barnes, 4/8).

The Washington Post: The Fact Checker: Obama's Selective Memory Of Supreme Court History
President Obama made these remarks during a series of high-profile news conferences last week, taking the unusual step of commenting on a Supreme Court case — the challenge to the Affordable Care Act, in this case — while the justices are still deliberating. … Still, we don't know whether the president's factual error was a mere slip-up or a purposeful attempt to mislead, and we generally don't beat people over the head for off-the-cuff remarks. Let's take a look at the president's message in light of his clarifying remarks to see whether it holds up any better under scrutiny (Hicks, 4/9).

The Associated Press: Allies: Judge Upset By Obama Remarks Not Political
A federal judge who called out President Barack Obama for saying it would be "unprecedented" for the Supreme Court to strike down a law like his administration's health care overhaul is a conservative voice on what may be the nation's most conservative appeals court. But those who know Judge Jerry E. Smith from his years on the 5th U.S. Circuit Court of Appeals in New Orleans and earlier days in Texas politics paint a more complex portrait of someone who isn't afraid to buck the party line (Kunzelman, 4/6).

National Journal: Justice Thomas Comments On Health Care Case
Clarence Thomas, the Supreme Court justice famous for almost never asking questions at oral arguments, defended his desire to stay mum during the recent marathon health care arguments, the Associated Press reports. In a talk at the University of Kentucky on Thursday night, Thomas said that the questions are a waste of time, because they interfere with the advocates' ability to argue their cases. "I don't see where that advances anything," he said (Sanger-Katz, 4/6).

Also in the news, efforts to parse what the public thinks about the law and the Supreme Court -

Medpage Today: Readers: ACA Stays, Court Supported Or Not
Just slightly more than half (51%) of readers who responded to our poll last week said the Affordable Care Act should not be repealed regardless of what the Supreme Court rules. However, out of the 2,700 votes, 45% were in favor of repealing the Affordable Care Act (ACA) in some form -- 34% in whole and 11% in part -- depending on the how the high court deals with the individual mandate. Less than 5% of our readers weren't sure what to do, indicating that the bulk of our readers who cast their votes as either "yes" or "no" are either well informed, have strong opinions, or both (Kaiser, 4/7).

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White House Moves $500 Million To IRS For Health Law Implementation

The funds were diverted to the Internal Revenue Service outside the normal appropriations process to help the agency implement the overhaul. Meanwhile, other news outlets report on developments related to accountable care organizations and primary care payment issues.  

The Hill: White House Has Diverted $500M To IRS To Implement Health Care Law
The Obama administration is quietly diverting roughly $500 million to the IRS to help implement the president's healthcare law. The money is only part of the IRS's total implementation spending, and it is being provided outside the normal appropriations process. The tax agency is responsible for several key provisions of the new law, including the unpopular individual mandate (Baker, 4/9).

Modern Healthcare: Blazing A Trail
For federal health officials, a couple of payment alternatives allow policymakers to offer participants some flexibility and experiment with the hope of identifying the best models. "It's meeting people where they are," said Dr. Richard Gilfillan, director of the Center for Medicare and Medicaid Innovation, which has oversight of the effort, known as the Medicare Pioneer ACO Model program. Participants were named in December, and each selected one of five payment models with varying degrees of potential risk and reward (Evans, 4/7).

Politico Pro: Specialists Want Cut Of Primary Care Cash
Step one: The health reform law boosts Medicaid pay for primary care physicians for two years. Step two: Everyone wants to be primary care physicians. Specialty physician groups are pressing CMS for a more expansive definition of primary care services, saying a broader definition is more consistent with the intent of the health care law, if not the actual legislative text. Lobbyists for the American Academy of Pediatrics and the American Congress of Obstetricians and Gynecologists have urged CMS to include them under an Affordable Care Act provision that will allow primary care doctors to receive Medicare-level rates when they treat Medicaid patients (DoBias, 4/6).

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Medicare

Medicare, Entitlements: Key Political Sparring Points

Although congressional Democrats and President Barack Obama hope to make electoral hay out of the GOP budget's Medicare revamp, GOP Republican presidential hopeful Mitt Romney is proving to have appeal. During the primary season thus far, Romney has fared well with older voters in swing states.

The Wall Street Journal: Both Parties Wooing Seniors
President Barack Obama and Democrats are counting on regaining support from older voters who switched to the GOP in 2008 and 2010 by attacking Republican plans to revamp Medicare. But Mitt Romney is proving to be a formidable competitor in this battle (Hook, 4/8).

Politico: Durbin To Mitt: What's Your Plan On Entitlements?
Senate Majority Whip Dick Durbin (D-Ill.) said Sunday that Republican presidential candidate Mitt Romney has no plan to deal with the millions of seniors reaching retirement (Tau, 4/8).

In other Medicare news --

NewsHour: Medicare 'Less Generous' Than Private Plans, Study Finds
Pick your adjective: wildly popular, unsustainable, politically convenient, endangered. At a time when politicians of all stripes are considering drastic changes to "Medicare as we know it," the Kaiser Family Foundation has another way to describe the program: "less generous." On average, Medicare recipients receive less coverage than the typical elderly employee of a large company, according to a new report from the foundation. That's even after the program's drug coverage benefits are factored in (Kane, 4/6).

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Campaign 2012

On The Campaign Trail, It Seems Everyone Has Critics

According to reports, the Obama administration continues to face stiff criticism from Catholic leaders over its contraception policies. Meanwhile, GOP presidential hopeful Mitt Romney has among his health policy advisers two people who are on the record in their opposition to the health law he signed while governor of Massachusetts.  

The Washington Post: Catholic Leaders Remain Critical Of Obama Administration
Catholic Church leaders said Sunday that the institution's dispute with the Obama administration over contraception policy continues, with Cardinal Timothy Dolan saying, "We didn't ask for the fight, but we're not going to back away from it" (Thompson, 4/8).

The Hill (Video): Cardinal Dolan Criticizes Obama Contraception Policy As 'Radical Intrusion'
Cardinal Timothy Dolan, the archbishop of New York, said Sunday the Obama administration's policy on contraception was "a dramatic radical intrusion of government bureaucracy in the internal life" of the Catholic Church and vowed to continue to fight the ruling. In an interview on CBS's "Face the Nation," Dolan reiterated that he remained unsatisfied with the administration's policy requiring that employees of religious organizations, including Catholic groups, have access to contraception (Berman, 4/8).

Politico Pro: Some Romney Advisers Don't Like His Law
If Mitt Romney needs any reminder of how unpopular his Massachusetts health care plan is with conservatives, he need only look at his closest health advisers. Two of the five members of Romney's recently announced Health Care Policy Advisory Group have a record of opposition to his Massachusetts health care reform plan. Paul Howard, a senior fellow at the Manhattan Institute and a new addition to Romney's advisory team, wrote in late 2010 that Romney's plan has resulted in a dramatic increase in insurance costs for small businesses (Haberkorn, 4/9).

In other campaign news, the political arm of Planned Parenthood has made an endorsement in the Massachusetts Senate race.

Boston Globe: Planned Parenthood Endorses Elizabeth Warren
The political arm of Planned Parenthood has endorsed Elizabeth Warren in her challenge of Senator Scott Brown, providing timely support in what political analysts say is a crucial, competitive contest for women voters. ... [Dianne Luby, president of the Planned Parenthood Advocacy Fund in Massachusetts] cited Warren's recent opposition to the so-called Blunt amendment in the decision to endorse her over Brown (Valencia, 4/9).

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Health Law Key To Obama Campaign's Outreach To Women Voters

Late last week, the president and his deputies were linking parts of the health law and economic opportunities as part of their effort to draw support from women voters. At the same time, The Associated Press reports on the challenges GOP presidential hopeful Mitt Romney faces in his attempts to bridge the gender gap.

The Hill: Obama Touts Health Care Law As Part Of Outreach To Women
President Obama is making his health care reform law a centerpiece of his outreach to women voters ahead of November's election. The president and his lieutenants repeatedly referred to provisions of the health care law during Friday's White House Forum on Women and the Economy, hoping to draw a sharp distinction against the Republican presidential candidates who have all vowed to repeal the law. Obama commands far more support from women than Mitt Romney -- he leads Romney by 18 percent among female voters in 12 key swing states, according to a USA Today/Gallup poll released this week -- and the administration has kept up its attacks against a so-called "Republican war on women" since controversy over the law's contraception mandate erupted in February (Pecquet, 4/6).

Kaiser Health News: Capsules: Obama Ties Women's Economic Future To Health Law
President Barack Obama brought together Friday two of his biggest campaign issues, health care and the economy, in an appeal to women voters, who have favored the president over GOP rivals in recent polls. During remarks at a White House forum on women and the economy, Obama described how provisions of the 2010 health law have helped break barriers for women in the workforce (Torres, 4/6).

Politico Pro: ACA Will Help Level The Playing Field
HHS Secretary Kathleen Sebelius told a roundtable of women supporters of health reform Friday that the Affordable Care Act will level the health insurance playing field for women -- and defended the contraception coverage mandate as a critical step toward that goal. In a breakout session at the White House forum on Women and the Economy, Sebelius said that being a woman will "no longer be a pre-existing condition" (Norman, 4/6).

The Associated Press: Challenges Facing Romney In Wooing Female Voters
Mitt Romney is starting to hone his appeal to female voters, acutely aware as he turns to the general election that he has little choice but to narrow President Barack Obama's commanding lead among this critical constituency. ... Romney must overcome history, political math and the missteps of a party that picked a fight over one provision of Obama's health care law and ended up on the defensive over access to birth control. Romney also has work to do with female voters after inconsistencies or misstatements on issues such as abortion and the future of Planned Parenthood (Kellman, 4/7).

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Capitol Hill Watch

During The Congressional Break, Voters Air Their Frustrations

Reuters: Congress' Spring Break A Time For Voters To Vent
At a time of high unemployment and home foreclosure rates, frustration with Congress and rising anxiety over how to deal with the national debt without gutting programs such as Medicare health insurance for the elderly and the Social Security retirement program, such meetings aren't always comfortable for lawmakers. But they can offer a vivid picture of voters' feelings, as Republicans and Democrats start gearing up in earnest for presidential and congressional elections on November 6 (Jacobs, 4/8).

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Health Care Marketplace

Kodak Withdraws Plan To End Health Benefits For Medicare-Eligible Retirees

In the midst of bankruptcy proceedings, Kodak withdrew a motion to end these health benefits and will instead create a retirees committee to examine issues of medical and survivor benefits. Meanwhile, AT&T contract negotiations continue -- with health care premiums and copayments among the issues in play.

The Associated Press: Kodak Proposes Bonuses, Withdraws Benefits Cut
Eastman Kodak Co. is seeking permission to pay about 300 executives and other employees a total of $13.5 million in bonuses to persuade them to stay with the company as it reorganizes under bankruptcy protection. ... Also this week, Kodak told retirees it has withdrawn for now its motion to end supplemental health care benefits for about 16,000 Medicare-eligible retirees. The company will instead create a retirees committee to examine the issues of medical and survivor benefits (Thompson, 4/6).

The Associated Press: Contracts Expire For Many At AT&T; Talks Continue
About 40,000 AT&T landline workers are staying on the job this week without a contract, their union said Sunday... At issue in the negotiations are job protection clauses and health care premiums and co-payments. AT&T says it wants employees to shoulder more of their growing health care costs and more leeway to downsize its shrinking landline operations (4/8).

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What's The Prize In The Wellness Games?

News reports track the latest trends regarding how insurers are using digital gaming methods to encourage wellness and how patients increasingly are being urged to ask questions about the cost of care.  

The Wall Street Journal: Playing For Wellness
Your health insurer wants to play games with you—and they might involve actual prizes. As insurers try to get members to take better care of themselves, they are turning to tactics from the world of digital gaming. They're using methods including team competitions forged through online communities, virtual and real-world rewards for those who make moves to improve their health and the potential for raffle-style prizes. In addition, they're working with games for consoles such as Microsoft's Xbox Kinect that involve physical activity (Mathews, 4/7).

Arizona Republic: Patients Urged To Ask About Cost Of Health Care
Most people have little idea what a doctor or lab will charge before they slip on a patient gown for an examination or roll up a shirtsleeve for a blood sample. But as the cost of health care continues to spiral, that is changing. In what could be a major shift in how Americans choose medical care, consumers are being encouraged to ask questions about the price of medical treatments, especially those their insurance plans might not cover (Alltucker, 4/7).

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Study Questions Whether FDA Is Too Tough On Online Pharmacies

NPR: FDA's Stance On Online Pharmacies May Go Too Far, Study Says
The Food and Drug Administration has warned people about the many dangers of buying medications from foreign pharmacies over the Internet. While some sites might offer high-quality medicines, there are plenty that sell bogus and potentially dangerous products. But a recent economic analysis suggests that while there's good reason for the safety warnings, the FDA's stance on the matter might go too far. Many Americans don't fill their prescriptions because they can't afford to, the study says, and some legitimate foreign pharmacies may offer medicines at prices lower than those of verified U.S. suppliers (Vedamtam, 4/6).

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Public Health & Education

Prescriptions On The Rise For Strongest Pain Pills

The New York Times: Tightening The Lid On Pain Prescriptions
High-strength painkillers known as opioids represent the most widely prescribed class of medications in the United States. And over the last decade, the number of prescriptions for the strongest opioids has increased nearly fourfold, with only limited evidence of their long-term effectiveness or risks, federal data shows (Meier, 4/8).

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State Watch

Medicaid: Ariz. Gets Fed's OK To Expand Kids' Coverage; Docs Want To Share Minn. Rebates

States around the nation are grappling with Medicaid issues ranging from expanding coverage and making deals with new managed care providers to sharing insurer rebates, forging budget cuts, waiting on court action and admitting large data breaches.

Arizona Republic: Feds Approve Plan To Restore Kids' Health Coverage
The state will add nearly 22,000 low-income Arizona children to its health-insurance program under a deal that won federal approval Friday. The deal also will provide three large hospital groups with federal funding to care for uninsured patients. In total, the new agreement brings in more than $400 million in local and federal money to cover low-income, uninsured Arizonans through January 2014. No new state funding is involved (Reinhart, 4/6).

Kaiser Health News: Capsules: Arizona Gets OK To Expand Health Coverage To Kids
Nearly 22,000 poor kids in Arizona will gain health insurance coverage under a Medicaid deal the state has reached with the Obama administration, federal officials said Friday (Galewitz, 5/6).

Boston Globe: N.H. Taps HealthNet For Role In Medicaid
New Hampshire officials have chosen Boston Medical Center's HealthNet Plan as one of three insurers to manage care for low-income and disabled residents, if a proposal to overhaul the state's Medicaid program gets the necessary approvals from the governor's executive council and federal authorities. ... The plan -- and the Boston insurer's interest in it -- reflects growing competition in the Medicaid market, which historically has not been thought of as a fruitful area for business (Conaboy, 4/9).

Stateline: Connecticut Revisits Old-School Medicaid Financing
But after more than 15 years of struggling with troubled managed care arrangements (in its Medicaid program), Connecticut is retreating. State officials say the system was no longer saving the state money and patients were not getting the care they need -- just the opposite of what managed care organizations promise. So to regain control of its health care programs, the state cut its ties with managed care organizations and started over (Vestal, 4/9).

California Healthline: Medi-Cal Cuts Face Another Preliminary Injunction
The Department of Health Care Services has been on the losing end so far of four court cases over the 10 percent cut in Medi-Cal provider rates. … Now it's adult day service providers' turn for a judicial ruling. A decision is expected today from federal judge Christina Snyder on a request for another preliminary injunction. This one is from adult day health providers who worked under the Adult Day Health Care program before it was terminated and replaced by the Community Based Adult Services program, or CBAS (Gorn, 4/9).

Minnesota Public Radio: Senate Passes Health Services Bill, Restoring Some Cuts
The Minnesota Senate has passed its health and human services spending bill. The legislation got a boost this week after the announcement that the state will receive an estimated $35 million from four managed-care plans that administer the state's Medicaid and MinnesotaCare programs. Republican leaders want to spend nearly $22 million of that on additional health and human services programs, some of which had been cut as part of last year's budget agreement. However, some DFL senators argued lawmakers should restore even more of the cuts. Sen. Roger Reinert, DFL-Duluth, said the state should spend another $6 million on programs that pay for doctors' residency programs in rural Minnesota (Dunbar, 4/6).

Minnesota Public Radio: Minn. Doctors Want Share Of Health Funds
The state's largest physician group, the Minnesota Medical Association, says doctors and clinics that treat Medicaid and MinnesotaCare patients should get a share of an estimated extra $35 million coming into the state's coffers this summer. The money is part of a deal the Dayton administration made with four large HMOs to return profits from the government programs above 1 percent of revenue (Stawicki, 4/6).

Modern Healthcare: Utah Officials: Medicaid Records Breach Worse Than First Thought
Utah's Medicaid records breach is worse than initially reported. Utah Health Department officials are now saying that approximately 181,604 Medicaid and Children's Health Insurance Program recipients had their records exposed in a breach that reportedly occurred March 30 and was disclosed by the state on April 4.  At first, Utah officials reported that the hackers -- reportedly from Eastern Europe -- accessed about 24,000 records, which may have included recipients' names, addresses, dates of birth, Social Security numbers and procedure codes as well as their physicians' names, addresses and tax and national provider identification numbers (Conn, 4/6). 

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States Count Health Law Dollars, Brace For Back-Ups If Overhaul Struck Down

In health law implementation news, Iowa gets federal grants for home care workers to visit families with children while Minnesota lawmakers brace for losing Medicaid dollars.

Des Moines Register: Health Reform Program Grants $6.6 Million To Iowa For Visits To Young Families' Homes
Iowa will receive $6.6 million in federal grants to expand a program that sends health care workers to the homes of families with young children. The money, announced this week, comes from the federal health-reform law passed last year. Iowa is one of 10 states to receive such grants, which help pay for visits by nurses, social workers or other professionals to the homes of families struggling with poverty or other factors that can complicate child-rearing (Leys, 4/6).

Minnesota Public Radio: Legislators: State Should Have Backup Plan For Health Care Law
Some Republican state lawmakers want the Minnesota human services commissioner to have a contingency plan in place if the federal health care law's Medicaid expansion is either struck down or repealed. Minnesota would lose about $2 billion in federal money between January 2014 and July 2015 if that part of the law doesn't survive. … Minnesota House Majority Leader Matt Dean, R-Dellwood, authored the bill that he said would minimize disruption for people on Medicaid (Stawicki, 4/8).

Meanwhile, in other news -

Modern Healthcare: Iowa Providers' Collaboration Plans Include ACO
Two of Iowa's largest health care providers -- University of Iowa Health Care in Iowa City and Mercy Medical Center in Cedar Rapids -- announced plans to form an accountable care organization as part of a wider collaboration. A statement from UI Healthcare said the two organizations are planning to coordinate patient care and decrease costs through the formation of a Medicare ACO, which would focus on improving disease screening, delivery of acute care, and population-based health management through integrated delivery networks (Carlson, 4/6).

Palm Beach Post: Health Law Aims To Close Gender Gap
Florida women who don't get health insurance through an employer can forget about finding a single comprehensive medical plan that will pay for their care while they deliver a baby. It's one of 25 states in which there are no health plans that include maternity coverage on the individual market. ... Expanded access to maternity insurance is one of the provisions tucked into the 2,700-page law that is the Affordable Care Act. Maternity care grabbed few headlines as Congress spent 18 months wrangling over the legislation and when 26 states, led by Florida, challenged the law. But now the fate of that rule as well as dozens of others is unclear as the U.S. Supreme Court decides whether to strike down the law, which requires virtually every American to buy health insurance (Green, 4/7).

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States Roundup: Aetna Goes Ahead With Small Biz Coverage Hike

A selection of health policy stories from around the U.S.

The Sacramento Bee: Aetna Proceeds With Health Insurance Hike For Small Businesses
Despite criticism from the state insurance commissioner and several statewide consumer groups, Aetna said Thursday it's going ahead with a recent hike in health care premiums for small businesses. Aetna's new increases, which average 8 percent annually and took effect April 1, were deemed "unreasonable" this week by state Department of Insurance Commissioner David Jones (Buck, 4/6).

The California Report: Insurance Commissioner Calls Aetna Rate Hike "Unreasonable"
If you were a California business making nearly 28 percent profit, would you change your business strategy if someone asked you nicely? Probably not. In a nutshell, that's what's going on between California's Department of Insurance and the health care insurer Aetna (Menghrajani, 4/6).

The Associated Press/Houston Chronicle: 1.2 Million Texas Children Still Without Insurance
More than 1 million Texas children remain without health insurance, and those kids are not getting the care they need. The startling condition of the state's children came into vivid focus last week with the release of the annual Kids Count survey. The analysis of official state and federal data by the non-partisan Center for Public Policy Priorities found that 1.2 million Texas children have neither private nor public health insurance (4/8).

Houston Chronicle: Medical Board's Proposed Stem-Cell Policy Under Fire
Texas' proposed adult stem-cell regulations, up for approval this week, are under fire for circumventing the Food and Drug Administration and making the experimental therapy commercially available before it's been proven safe and effective. The criticism of the Texas Medical Board draft policy, developed in the aftermath of Gov. Rick Perry receiving stem-cell treatment for his back problems, is coming from a host of pre-eminent scientists and institutions, including the influential scientific journal Nature and the International Society for Stem Cell Research (Ackerman, 4/9).

The Associated Press/Boston Globe: Immigrants Begin To Join Health Care Plan
The agency overseeing the state's landmark health care law has begun enrolling thousands of legal immigrants into the subsidized insurance program after the state's highest court ruled that lawmakers unconstitutionally denied the benefit to foreign-born residents who have been in the country for less than five years. State lawmakers voted in 2009 to cut funding for low-income immigrants enrolled in Commonwealth Care because the federal government does not reimburse states for dental, hospice, skilled-nursing care, and other costs incurred by foreign-born residents living in the country for less than five years (Ngwoi, 4/7).

Kaiser Health News: In Kansas, No Consensus On How To End 'Dental Deserts'
In an ongoing disagreement over how to solve dental care access problems in Kansas, there is one thing no one disputes: the great need (Thompson, 4/8).

Arizona Republic: Maricopa Agency For Inmate Care Regains Credentials
The Maricopa County agency that treats jail inmates has earned back its national accreditation for its quality of care at all six county jails after losing the status three years ago. County officials said better documentation, improved communication between the health-care organization and Sheriff's Office, and more staffing helped Correctional Health Services get reaccredited (Lee and Hensley, 4/7).

Arizona Republic: Critics Cast Doubt On New Ariz. Prison Health-Care Contractor
The private contractor taking over health care in Arizona's prisons promises significant improvements in care while saving money, in effect saying it will do more with less. But critics charge that Wexford Health Sources' record elsewhere suggests that sometimes it fails to live up to its promises and may do less with less. Arizona's Department of Corrections, fighting a federal lawsuit that accuses it of providing grossly inadequate health care, issued a contract to Wexford this week as part of the state Legislature's attempts to save money by privatizing prison health care (Ortega, 4/6).

Los Angeles Times: Task Force Seeks To Change California's Mental Health Commitment Law
California's pioneering Lanterman-Petris-Short Act, passed in 1967, gave legal rights to those who previously could have been locked up indefinitely and treated against their will. But the task force -- made up of family members, mental health professionals, judges and public defenders -- contends that the law has failed those unable or unwilling to seek help. They are calling for sweeping changes that would allow the involuntary commitment of those deemed incapable of making treatment decisions, expand the use of conservatorships, lengthen involuntary hospital stays and standardize the checkerboard way the law has been applied from county to county (Romney, 4/8).

Des Moines Register: Health Care Jobs Surge During Recession
Iowa's health care industry is about as close to being recession-proof as you can get. Despite continuing structural and financial changes, it was the only Iowa industry to add significant numbers of new jobs during the recession. ... Although health care continues to add jobs, the types of jobs are changing as the industry is pulled and pushed by shifting demographics, new technology and cuts in government funding (Elbert, 4/7).

(St. Paul) Pioneer Press: Mayo Supporters: Lab-Tax Exemption Means More Money For Research
Every day, thousands of medical specimens are flown in from around the country - and even from around the world - for analysis at a lab in Rochester, Minn….Currently, the lab must pay a 2 percent tax on all out-of-state samples analyzed in Rochester because of the state's health care provider tax. Mayo Clinic officials are seeking a tax break for these samples, saying the tax is putting their lab at a competitive disadvantage (Snowbeck, 4/8).

The Miami Herald: Pediatric Specialists A Huge Issue At Jackson Health System
The departures of the two doctors -- University of Miami faculty members in the field of pediatric cardiac anesthesiology -- led to an informal agreement between UM and Jackson that seemed to benefit both. … As the two Miami-Dade institutions try to forge a new, more formal agreement -- not just for anesthesiologists but for all doctor services -- the case of the pediatric anesthesiologists illustrates the problems that have dogged the complicated relationship for years (Dorschner, 4/8).

Florida Sun Sentinel: Up To One-Third Of Patients Don't Fill Prescriptions
South Florida has a larger-than-average problem with patients who skip medications, refuse to take them or take them incorrectly, according to health officials involved in the issue. Nationally, several studies since 2010 show that between one-quarter and one-third of patients never fill new prescriptions from their doctors, because they can't afford them, fear them, don't think they work or don't think they are necessary (LaMendola, 4/8).

The Lund Report (an Ore. news service): Intersection Of Public Health And CCOs Discussed During Public Health Week
A panel discussion about public health's role in coordinated care organizations stressed the need for public health departments to use concrete, factual and evidence-based arguments to help define their roles within those organizations. "The challenge for public health…is to really make sure we can deliver things that matter to the people making the decisions about how resources are distributed," said Rep. Mitch Greenlick (D-Portland), a panel participant who had a career in public health before being elected (Waldroupe, 4/6).

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Editorials and Opinions

Viewpoints: Doctors' Efforts To Cut Unnecessary Procedures Is A Good First Step

Several news outlets look at the initiative by nine physicians' groups to identify medical procedures which are frequently unneeded and could even be harmful.

The New York Times: Do You Need That Test?
If health care costs are ever to be brought under control, the nation's doctors will have to play a leading role in eliminating unnecessary treatments. By some estimates, hundreds of billions of dollars are wasted this way every year. So it is highly encouraging that nine major physicians' groups have identified 45 tests and procedures (five for each specialty) that are commonly used but have no proven benefit for many patients and sometimes cause more harm than good (4/8).

Huffington Post: "Choosing Wisely": Physicians Step To The Front In Health Care Reform
Silver linings are in short supply, but one appeared last week in the form of a new initiative called "Choosing Wisely," catalyzed by the American Board of Internal Medicine Foundation. Its goal is to identify medical interventions -- like tests, procedures, drugs, and even surgery -- that are often overused without benefit to patients, and, in their words, "whose necessity should be questioned and discussed" between physicians and their patients. … (Dr. Donald M. Berwick, 4/8).

The Sacramento Bee: To Cut Health Costs, Doctors, Hospitals Must End Unneeded Medical Procedures
The federal health care reform law will face monumental hurdles to be successfully implemented. The biggest of these is its cost. … If we don't get a handle on rising health care costs the answer to that more important question is an emphatic "no." And that's what makes last week's announcement by physicians representing nine medical specialties so welcome. The physicians have identified 45 specific medical tests and procedures, five within each specialty, which they think are either overused or misused (4/8).

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Viewpoints: Health Law Seeks To Remedy Broken Insurance Market; Overhaul Was Sunk By Its Complexity

Commentators look at some of the underlying issues of the health law which is being considered by the Supreme Court.

The Washington Post: What Makes Health Care Different
As best as I can tell, the recent arguments at the Supreme Court did not touch on a critical part of the discussion about government's role in health care: the broken market for private insurance. And I think I know why. A key assumption underlying the arguments, questions and answers was that all uninsured people are uninsured by choice. ... It was as if the court forgot that the private insurance market does not function as a normal market. If you are not employed and you want to purchase insurance in the private market, you cannot unilaterally decide to do so. An insurer has to accept you as a customer. And quite often, they don't (Donna Dubinsky, 4/6).

The New York Times: Romney's Health Care Plan
Mr. Romney and others on the right abhor the idea that the federal government will force a "one size fits all" solution on the country, instead of allowing experimentation. But just how long should this period of experimentation, actually more like a period of throwing everything at the wall, last? Especially when we know from the experience of Western Europe and Canada that universal coverage is possible, and sustainable, if the central government takes control (Andrew Rosenthal, 4/6).

The Wall Street Journal: Complexity Is Bad For Your Health
The Supreme Court has long had the role of declaring what the law is. That's becoming a harder and harder task thanks to the White House and Congress concocting laws so complex that no one knows their meaning before, during or after they're passed. In an era when people expect transparency and abhor complexity, three days of skeptical Supreme Court hearings on the president's health law showcased a complex law collapsing under its own weight. Information is supposed to flow freely, but consumers of health care operate in the dark, including without any understanding of how the law is supposed to work (L. Gordon Crovitz, 4/8).

Politico: Health Care Reform Supreme Court Case: Is This Conservative Judicial Activism?
Obama alleged that the court would be guilty of "judicial activism" if it struck down "Obamacare." He specifically called out "conservative commentators" who have made the same charge in other cases. Conservatives, however, have criticized "judicial activism" where judges resorted to novel legal theories to invalidate acts passed mostly by state legislatures (Frank Donatelli, 4/6)?

Bloomberg: Facts Are First Casualty Of Health-Care Fight
In the Supreme Court's historic argument over President Barack Obama's health-care law, the Republicans claimed the high ground on principle, Democrats on the politics. Both positions are tenuous…. No matter how the court rules, Team Obama will remind voters of the Republican inconsistency -- they will tag it hypocrisy -- in the fall campaign. Their task would be easier if they had mustered public support (Albert R. Hunt, 4/8).

The Washington Post: Obama Levels Straight Shots At Supreme Court And Ryan Budget
Conservatives are not accustomed to being on the defensive. … So imagine the shock when President Obama decided last week to speak plainly about what a Supreme Court decision throwing out the health-care law would mean, and then landed straight shots against the Mitt Romney-supported Paul Ryan budget as "a Trojan horse," "an attempt to impose a radical vision on our country," and "thinly veiled social Darwinism" (E.J. Dionne, 4/8).

The Wall Street Journal: Providential Design
In his parade of Republican horribles, President Obama poured special scorn this week on the idea of handing Medicaid to the states with a fixed annual federal payment. He says it wouldn't save money without hurting "poor children" and "middle-class families who have children with autism and Down's Syndrome." Someone needs to tell Mr. Obama about the results of Medicaid reform in Rhode Island (4/6).

Boston Globe: Taking Back 'Obamacare'
Will the turnaround on "Obamacare" pay off this campaign season? We could look at previous reclamation projects for some clues. The idea of turning a hurtful word into a positive or neutral term might be most familiar to us from the realm of identity politics--for instance, how "queer" has been reclaimed by the gay community. But there's a long legacy of this verbal repositioning in party politics, too (Ben Zimmer, 4/8).

Modern Healthcare: Time For A Restraining Order
While there's clearly no end in sight for speculation over the ultimate fate of the healthcare reform law, here's hoping for some judicious restraint in a couple of areas as the legal debate lingers. First, how about a restraining order on any further comparisons of broccoli to health insurance? We get the point intended, but also contend, along with many economists, that it's a flawed, ridiculously simplified argument (David May, 4/7).

Modern Healthcare: Healthcare Matchup
While an insurance card doesn't clear emergency rooms overnight or miraculously manage chronic diseases, it does begin to change the way we experience healthcare. Health reform focuses on wellness and prevention, which is a shift in how care is delivered. More individuals and families will be connected to primary care. Hospitals can help patients beyond discharge by ensuring needed prescriptions are taken and necessary follow-up appointments are scheduled and attended. Ultimately, reform will help all Americans access the services they need (Dr. Bruce Siegel, 4/7).

JAMA: Battle Lines Surrounding Health Care Take Shape In Presidential Race
The long and short of it is that under the Republican House budget, anyone who turned 55 years or older in 2012 would continue to experience Medicare as we know it today, a program that receives overwhelmingly positive ratings by its beneficiaries and typically higher ratings than any other form of health insurance. However, those of us foolish enough to have been born on or after January 1, 1958, would get a decidedly watered-down version of the program that would start later and offer less financial protection against the historical rises in health care costs (Andrew Bindman, 4/6).

iWatch: Why The Insurance Industry Needs Obamacare To Stay In Business
If there is a group of people more anxious about how the Supreme Court will rule on the health care reform law than President Obama and the millions of Americans who are already benefiting from it, it is health insurance executives (Wendell Potter, 4/9).

The Baltimore Sun: A Health Care Reform Backup Plan
President Barack Obama's Affordable Care Act (ACA) could be struck down by a sharply divided court when it rules in June. If that happens, insurance will continue to be priced beyond the means of many. It is therefore prudent to look at possible alternatives for these Americans. Fortunately, a proven model exists today in Howard County: the Healthy Howard Health Plan (Ken Ulman and Peter Beilenson, 4/8).







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Viewpoints: Scarcity Of Dental Care; Surprise Budget Buster Awaiting States On Retiree Health Costs

The New York Times: Dental Insurance, But No Dentists
We know that too many Americans can't afford primary care and end up in the emergency room with asthma or heart failure. But in the debate over health care coverage, less attention has been paid to the fact that too many Americans also end up in the emergency room with severe tooth abscesses that keep them from eating or infections that can travel from decayed teeth to the brain and, if untreated, kill (Louis W. Sullivan, 4/8). 

Chicago Tribune: Surprise! You Owe Another $54 Billion
A second, often overlooked time bomb merrily ticking for governments nationwide is the cost of health insurance for all those retirees. That number, too, is hard to gauge, because health care costs -- like future investment returns -- are unknowable. Yet governments typically don't put aside money for future health care, as they do for future pensions. The culture is to pay-as-you-go (4/8).

Chicago Tribune: Saving Medicaid
Gov. Pat Quinn has called for $2.7 billion in Medicaid cuts in next year's budget. This week, the governor is likely to unveil the details of how he plans to make those cuts in the state's $14 billion Medicaid program. Along with pension reform, curbing the rising cost of Medicaid is essential to restoring the state's financial footing (4/9).

McClatchy/The Rock Hill Herald: S.C. Gov. Haley Got It Wrong On Contraception
(Gov. Nikki) Haley volunteered: "Women don't care about contraception. They care about jobs and the economy and raising their families ..." … (But) it's worth noting that if women care about jobs and raising their families, they're also likely to care about family planning. ... The unwillingness of Haley and other Republicans to acknowledge the importance of contraception to female voters and the failure to recognize their distaste for a host of state bills requiring unnecessary and often invasive medical procedures before qualifying to get an abortion have hurt the party (James Werrell, 4/8).

Boston Globe: A Darwinian Campaign Season
The most pronounced signifier that emerged from the GOP free-for-all is birth control, and its contentiousness points right back to a lingering unease with, well, Charles Darwin. Abortion and gay marriage have long been hot-button issues, but when birth control tops the fight card, something odd is happening (James Carroll, 4/9).

The Atlanta Journal-Constitution: How Health Curves Affect Cost
If we are going to deal with the drivers of increasing health care costs, we need to decrease the number of people with expensive chronic health conditions. The U.S. has gotten away with its pay-for-failure strategy for many years because its economy was growing steadily and funds were available for rescue programs. But this kind of policy stance condemned many children to never reaching their biological, health and educational potential (Neal Halfon, 4/6).

Des Moines Register: Equitable Mental Health Care Is Key Concern For Legislature
For the last several years the concerns of mental health delivery have grown to a crisis level in Iowa, especially for those families trying to work their way through a challenging system of service delivery. ... Last year the Legislature provided the necessary funding to remove the wait lists for services, and started a massive reform effort of the mental health system so that Iowans can depend on consistent and equitable care -- and that the new system will result in no Iowan ever again waiting for delivery of mental health services. Legislators working on redesigning Iowa's mental health delivery system moved closer to completion last week as the House prepared to debate the redesign bill (Iowa state Rep. Scott Raecker, 4/7).

Detroit Free Press: Mental Care Shouldn't Be Police Work
As Michigan's mental health care system broke down over the past two decades, police officers, instead of mental health workers, became first responders to mentally ill people. When that happens, random stops and minor offenses can turn into prison or jail sentences (4/8).

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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.