Daily Health Policy Report

Tuesday, April 9, 2013

Last updated: Tue, Apr 9

KHN Original Reporting & Guest Opinion

Health Spending And Fiscal Battles

Health Reform

Capitol Hill Watch


Public Health & Education

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insuring Your Health: Same-Sex Spouses Can Face Barriers On Health Care Under Federal Law

In her latest Kaiser Health News consumer column, Michelle Andrews writes: "Mike Bosia and Steven Obranovich, of Hardwick, Vt., were married three years ago after Vermont legalized same-sex marriage. As Bosia's spouse, Obranovich is entitled to health insurance through Bosia's employer, Saint Michael's College in Colchester. But that coverage comes at a cost" (Andrews, 4/9). Read the column.

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Capsules: Hospitals In 5 States Clamp Down On Delivering Babies Before 39 Weeks; Study: States Lag On Tracking Potential Obamacare Loophole

Now on Kaiser Health News' blog, Phil Galewitz reports on elective early deliveries: "A study published Monday in the journal Obstetrics & Gynecology showed a group of 25 hospitals in five states were able to cut their rates of elective early deliveries from nearly 28 percent to under 5 percent in one year. The March of Dimes, which partly funded the study and assisted the hospitals in setting up new policies and procedures, said the findings show hospitals can overcome cultural and economic barriers to lower their rates" (Galewitz, 4/8).

Also on Capsules, Jay Hancock reports how states are doing in tracking a potential health law loophole: "What if there were a way for even small employers to escape some Affordable Care Act rules blamed for driving up costs? Some see self-insurance for medical care, which is exempt from the law's taxes, benefit rules and price restrictions taking effect next year, as just such an opportunity" (Hancock, 4/8). Check out what else is on the blog.

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Political Cartoon: 'Four Out Of Five Politicians?'

Kaiser Health News provides a fresh take on health policy developments with "Four Out Of Five Politicians?" by Matt Wuerker.

Meanwhile, here is today's health policy haiku:


Sequester means what?
Small impact, large impact, none?
Lose own job - it's BIG!
-Team Haiku, Altarum

And for basketball and budget fans, here's a bonus haiku...


NCAA fun
is now over, but BUDGET
madness keeps rolling.

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

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Health Spending And Fiscal Battles

Obama Budget Likely To Reignite Talk Of Cost-Cutting Options

News outlets examine how the budget blueprint could address Medicare payments and also include other trims to the program.

The Associated Press/Washington Post: Obama Budget Plan Revisits Small-Bore Budget Cuts That Have Proven Difficult To Pass
Efforts for a "grand bargain" on the budget between Obama and Congress have proven elusive, however, and stand-alone attempts to advance the proposals — including cutting farm subsidies and overhauling the Postal Service — have bogged down as well. At issue are dozens of longstanding options to trim the federal budget. They include eliminating direct payments to farmers even if they don't produce a crop and curbing $30 billion worth of Medicare payments over a decade to hospitals to reimburse them for patients who don't pay deductibles and copayments (4/8).

The New York Times: Critical Week in Senate for Gun and Immigration Bills
On the fiscal front, President Obama's budget release on Wednesday will add a third set of tax-and-spending plans to a Republican version that has passed the House and a Democratic one that passed the Senate. That should kick off talks to try to find some common ground and reach a deficit deal that would encompass changes to entitlement programs like Social Security and Medicare and an effort to overhaul and simplify the tax code (Weisman and Steinhauer, 4/8).

NPR: The 'Hard-To-Change' Legacy Of Medicare Payments
The budget President Obama will send to Congress Wednesday is expected to include some $400 billion in reductions to Medicare and other health programs. And if the word around Washington is correct, it may also include a proposal aimed at winning some bipartisan backing – by changing the way Medicare patients pay for their care. But there have been previous efforts to streamline Medicare's antiquated system of deductibles and copayments. And none, so far, has been successful (Rovner, 4/9).

Roll Call: Health Advocates Push For Medicare Benefit Change
Health care stakeholders complain that some of Medicare’s benefit structure is still stuck in the 1960s, when the program was created. As lawmakers search for ways to reduce government spending, many are looking to find savings by bringing all of Medicare into the current century (Ethridge, 4/8).

Modern Healthcare: Medicare Cuts Expected In Obama Budget, But Not Big Structural Changes
Obama has signaled to federal lawmakers that he's open to making some significant Medicare policy changes to reduce the federal deficit, such as expanding means testing for higher-income individuals, combining hospital and physician services under one Medicare payment structure, or adding a surcharge to Medigap plans. But sources emphasize that the White House's openness to those structural-entitlement reforms are contingent upon congressional Republicans agreeing to tax increases in the broader deficit-reduction discussion (Zigmond, 4/8).

In related news -

The Wall Street Journal: Health-Care Costs: A State-By-State Comparison
Health-care spending in the U.S. averaged $6,815 per person in 2009. But that figure varies significantly across the country, for reasons that go beyond the relative healthiness, or unhealthiness, of residents in each state (Radnofsky, 4/8).

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Health Reform

Sebelius: 'Relentless' Politics Complicates Health Law's Implementation

Health and Human Services Secretary Kathleen Sebelius said she underestimated how long politics would dog the health law. Meanwhile, a regional official of the Centers for Medicare & Medicaid Services tells The Washington Post what's happening in the field.

Politico: Kathleen Sebelius: Much Confusion On ACA
Health and Human Services Secretary Kathleen Sebelius said she underestimated how long the politics of health reform would last and didn't anticipate how much confusion the slow rollout of the legislation would create. Sebelius said she had expected the Supreme Court ruling and President Barack Obama's reelection would tamp down some of the "relentless and continuous" politics. But the controversy goes on (Haberkorn, 4/9).

The Hill: Sebelius: Obamacare Rollout More Complicated Than Anticipated
Health and Human Services Secretary Kathleen Sebelius said Monday that she did not anticipate how complicated implementing the president's signature health care law would be…Speaking to students at the Harvard School of Public Health, Sebelius said implementation had been hampered both by the law's slow roll out and red-state governors and legislators who have rejected state-run insurance exchanges (Sink, 4/9).

The Washington Post: Rolling Out The Affordable Care Act In The Field
As the new features of the Affordable Care Act roll out between now and 2014, the Centers for Medicare & Medicaid Services (CMS) are developing new programs and tools to help healthcare providers deliver better care to the American public — and much of the work takes place outside the Beltway. Tom Fox spoke with a leader in the field about leading from the field. David Sayen is the CMS regional administrator for Arizona, California, Hawaii, Nevada and the Pacific territories. He has more than 30 years of federal service and experience in health and human services programs (Fox, 4/8).

Media outlets also report on specific health law provisions -

Richmond Times Dispatch: What is the 'Obamacare' Bronze Plan?
The open enrollment period begins for the new health plans created by the Affordable Care Act (a.k.a. Obamacare) on Oct. 1, yet most Americans couldn’t name one of the new health plans let alone describe all the services they cover. The Bronze Plan is the entry-level option of these new health plans. It is a private health plan, which means you will pay an insurance company to enroll in the plan rather than receiving the plan for free from the government. However, depending on your income level, you may qualify to receive a subsidy from the government to lower your monthly premium and lower the maximum amount of health care out-of-pocket costs you can pay in a year (4/9).

The Washington Post's WonkBlog: In Obamacare, Online Insurance Brokers See Potential Windfall
Online insurance brokers see a potential windfall when the federal government doles out billions in subsidies to buy help Americans buy health insurance. And they are asking state governments to help them score it (Kliff, 4/8).

Kaiser Health News: Study: States Lag On Tracking Potential Obamacare Loophole
What if there were a way for even small employers to escape some Affordable Care Act rules blamed for driving up costs? Some see self-insurance for medical care, which is exempt from the law's taxes, benefit rules and price restrictions taking effect next year, as just such an opportunity (Hancock, 4/8).

CQ HealthBeat: Deadline For Comment On Birth Control Proposal Sparks Fresh Debate
Opposing sides in the battle over birth control coverage under the health care law squared off anew Monday as the public comment period ended on a proposed Department of Health and Human Services rule. But, as even the secretary of Health and Human Services acknowledged, the issue is in the courts, and it’s likely that the issue will be decided by the Supreme Court, not by administration rule-making (Norman, 4/8).

Boston Globe: Mass. Businesses Don’t Like Insurance Decision
Massachusetts business leaders say they are disappointed with a federal decision to allow the state to phase in parts of the national health care law over three years, maintaining it doesn’t do enough to provide relief from expected insurance premium hikes. After state officials earlier this year objected to new rules stemming from the US health care overhaul -- arguing they would drive up costs for small businesses and their employees -- federal health officials told their Massachusetts counterparts Friday the state could take until 2016 to fully implement rules to bring it into compliance with national standards. But business leaders said Monday that the federal decision, while welcome, fell short of the waiver they had sought for regulations that conflicted with Massachusetts’ 2006 health care law, widely viewed as the model for the US Affordable Care Act (Weisman, 4/9).

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Missouri GOP State Senators Poised To Nix Medicaid Expansion

In addition, reports offer insights into how the debate over the health law's Medicaid expansion is playing out in Tennessee and Ohio.

St. Louis Beacon: State Senators To Nixon: No Deal On Medicaid Expansion This Session
One week after discussing Medicaid expansion with House Republicans, Gov. Jay Nixon will sit down Tuesday morning with Republican members of the Missouri Senate to talk about the issue. But the meeting may not go too smoothly. On Monday, the top Republican in the Missouri Senate indicated that Medicaid expansion may be dead for the session (Rosenbaum, 4/8).

Kansas Health Institute: Nearly Half Of Psychiatric Beds Could Be Cut Without Medicaid Expansion
Missouri could lose more than 40 percent of its hospital-based adult psychiatric beds if state lawmakers decide against expanding Medicaid, the director of the Missouri Department of Mental Health said Friday. Keith Schafer estimated that hospitals would eliminate roughly 500 adult psychiatric beds if the General Assembly does not expand Medicaid eligibility to 138 percent. The issue is pending before lawmakers (Sherry, 4/8).

The Associated Press: Faith Leaders Urge Use Of Medicaid Money In Tenn.
Faith leaders from across Tennessee gathered at the Capitol on Monday to speak out for the poor, while the governor and lawmakers consider initiatives affecting health insurance and welfare benefits. About 15 clergy delivered 133 baskets of loaves and paper fish to the offices of each legislator and Republican Gov. Bill Haslam, urging them to accept $1.4 billion in Medicaid money if the federal government doesn't approve an alternate plan for Medicaid expansion in Tennessee (Johnson, 4/8).

The Associated Press: Ohio House To Drop Medicaid Expansion
A Republican-controlled legislative panel will drop Gov. John Kasich's proposal to expand the Medicaid program from the state's two-year budget plan, The Associated Press has learned, as advocates for extending the health care coverage to thousands more low-income Ohioans prepared to rally against the move (Smyth and Sanner, 4/9).

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Mass., Vermont Pioneer Their Own Health Reforms

Efforts in Massachusetts and Vermont offer insight regarding cost controls and a state initiative to create a single-payer system.    

Stateline: After Expanding Coverage, Health Care Pioneer Seeks to Tame Costs
Seven years after its groundbreaking health reforms, which became the model for the Affordable Care Act, Massachusetts boasts an uninsured rate of less than 2 percent, compared to a national average of 16 percent. But the cost of health care in the state, the highest in the country before the reform law was passed, remains so. Nationwide, health care costs per person are higher in the U.S. than in any other country in the world (Vestal, 4/9).

WBUR CommonHealth: New England Journal Of Medicine: Lessons From Vermont's Single-Payer Plan
We devote a great many pixels to Massachusetts health reform, but of course it's really Vermont that's attempting the boldest state-level experiment, with its push toward a single-payer system. So how's it going? Very nicely indeed, according to a piece just out in the New England Journal of Medicine titled Lessons from Vermont's Health Care Reform (Goldberg, 4/8).

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Capitol Hill Watch

House GOP Leader To Introduce Tavenner At Nomination Hearing

Senators are planning to grill Marilyn Tavenner, the Obama administration's nominee to head the Centers for Medicare & Medicaid Services, but Rep. Eric Cantor, R-Va., has said she is "eminently qualified," and her confirmation is expected.

Politico: Eric Cantor Could Sway GOP For Marilyn Tavenner
House Majority Leader Eric Cantor will introduce President Barack Obama's nominee to run the Medicare and Medicaid agencies at Tuesday's Senate Finance Committee hearing to consider her nomination — a bipartisan boost that signals that she’s likely on course for confirmation. Cantor, who has known Marilyn Tavenner since he was in the state Legislature and she worked in Virginia, has called her "eminently qualified" to be administrator at the Centers for Medicare & Medicaid Services. That job also encompasses a lot of the implementation of the health care law (Haberkorn, 4/9).

Modern Healthcare: Tavenner Likely To Get Intense Grilling, But Confirmation Expected
Senators are planning a bipartisan policy grilling of Marilyn Tavenner this week, but they're likely to move her toward becoming the first confirmed CMS administrator since 2006. Tavenner, acting administrator since December 2011, is not expected to face the harsh political treatment that Democrats feared her predecessor Dr. Donald Berwick would get, according to congressional sources (Daly, 4/8).

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Moody's: Sequestration Increases Pressure On Non-Profit Hospitals

Also in the news, the Centers for Medicare & Medicaid Services has begun auditing some of the physicians who qualify for a Medicare EHR "meaningful use" bonus before they even receive a check -- a step that has triggered grumbling from organized medicine.

Reuters: New Medicare Cuts Threaten Non-Profit Hospitals – Moody's
Not-for-profit U.S. hospitals began confronting another threat to their shaky finances last week with the start of reductions to Medicare that are included in the universal federal spending cuts known as sequestration, Moody's Investors Service said on Monday (4/8).

Medscape: In Reversal, CMS Audits EHR Bonus Winners Before Payment
After panning the idea last fall, the Centers for Medicare & Medicaid Services (CMS) has begun auditing between 5% and 10% of physicians who qualify for a Medicare bonus for meaningful use of an electronic health record (EHR) system before they ever receive a check. The new audit, which comes on top of double-checking a similar percentage of physicians after they receive the bonus, has leaders of organized medicine grumbling about red tape and payment delays (Lowes, 4/8).

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Public Health & Education

Adults Younger Than 65 More Likely To Skip Meds To Save Money

A study by the Centers for Disease Control and Prevention concluded that adults younger than 65 were more likely than older Americans to skip medicines, or not take them as prescribed. Also, about 20 percent of adults, regardless of age, sought lower cost treatments from physicians.  

USA Today: Study: Younger Patients More Likely To Skip Medications
People younger than 65 are twice as likely to skip medications than older Americans, according to a study released today by the federal Centers for Disease Control and Prevention. The new CDC study found that about 13% of the Americans younger than 65 did not take their medications as prescribed to save money, while 6% of the older group skipped medications (Kennedy, 4/9).

Bloomberg: Adults Skipping Medicines To Save Money
Adults who haven’t reached retirement age were twice as likely as those who have to skip their prescribed medications to save money, a U.S. study found. About 20 percent of adults regardless of age have asked their doctors for a lower cost treatment, according to the study released today by the Atlanta-based Centers for Disease Control and Prevention. Spending on drugs is expected to increase an average of 6.6 percent a year from 2015 through 2021, the Kaiser Family Foundation has reported (Edney, 4/9).

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Health Care Marketplace

AP Analysis Reveals Big Jump In Compensation Package For Insurance Exec

The Associated Press/ABC News: Aetna Chairman, CEO Mark Bertolini Sees 2012 Total Compensation Climb 26 Percent
Aetna Inc. missed an earnings goal last year, so the health insurer chopped the performance-based bonus it awarded Chairman and CEO Mark T. Bertolini. But the executive’s total compensation still rose 26 percent in 2012. Bertolini, 56, received compensation valued at $13.2 million last year, according to an Associated Press analysis of the Hartford, Conn., company's annual proxy filing with the Securities and Exchange Commission. That's up from about $10.6 million in 2011 (4/8).

Earlier, related KHN story: Heads Of Largest Children's Hospitals Receive Big Salaries And Rich Benefits (Gaul, 9/27/11).

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Hospitals, Other Providers Increasingly Using 'The Cloud' To Store Images

The Wall Street Journal: Where Do You Keep All Those Images?
Health-care providers are starting to embrace the fast-growing area of technology known as cloud services, the model of shared computing in which data is stored on remote servers that hospitals can access via desktop, tablet or smartphone. Instead of big capital investments in their own storage, they are paying a relatively modest upfront charge and monthly usage fees for cloud services. ... About 600 million imaging procedures are performed each year by health-care providers in the U.S., including CT scans, X-rays, ultrasounds and MRIs (Landro, 4/8).

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State Watch

State Roundup: Ga. Smoker Surcharge Could Be Working

A selection of health policy news from Georgia, California, Maryland, Oregon, Minnesota, Kansas, Texas and New York.

Georgia Health News: Smokers' Surcharge May Be Having An Effect
State officials say the number of Georgians in the state employee health plan paying $80 more a month in insurance premiums due to smoking has dropped by 44 percent over the past six years. The goals of the surcharge in Georgia are to encourage people to quit smoking and to help cover their additional health costs, said Pam Keene, a spokeswoman for the Department of Community, which oversees the State Health Benefit Plan. From January 2007 to January 2013, the number of state workers paying the $80 fee because of smoking dropped from 46,459 to 25,850 (Miller, 4/8).

Kaiser Health News: Capsules: Hospitals In 5 States Clamp Down On Delivering Babies Before 39 Weeks
A study published Monday in the journal Obstetrics & Gynecology showed a group of 25 hospitals in five states were able to cut their rates of elective early deliveries from nearly 28 percent to under 5 percent in one year. The March of Dimes, which partly funded the study and assisted the hospitals in setting up new policies and procedures, said the findings show hospitals can overcome cultural and economic barriers to lower their rates (Galewitz, 4/8).

Health News Florida: Project Succeeds In Delaying Deliveries
A quality-improvement project carried out by hospitals in Florida and four other large states triggered a rapid and dramatic drop in early elective deliveries, according to a study published Monday. Unless there's a reason for concern, it's best to let pregnancies progress until labor occurs naturally -- usually in the 39th, 40th or 41st week of pregnancy, past research has shown (Gentry, 4/9).

California Healthline: Groups Calling For Pause In Transition
Children's advocates last week called for a pause in the transition of kids from the Healthy Families program to Medi-Cal managed care. At a legislative hearing Thursday, advocates said the state had promised a relatively seamless transition of 860,000 children to managed care, but that gaps in coverage have already occurred -- with the more-difficult phases of the transition yet to come. The outcry was prompted, in part, when the families of an estimated 207 children who were receiving autism services through the Healthy Families program recently were told their coverage had to be stopped because of the state's Healthy Families transition (Gorn, 4/8).

Baltimore Sun: Anti-Abortion Group Stirs Speech Debate At Hopkins 
A group of students at the Johns Hopkins University is reviving a campus anti-abortion group that members say will perform "sidewalk counseling" -- attempting to discourage pregnant women entering clinics from going through with the procedure. But critics worry that the tactics of Voice for Life will harm the vulnerable women the group says it is trying to help. On Tuesday, a panel of undergraduates will review a decision by the Hopkins Student Government Association to deny recognition to the group (Wenger, 4/8). 

Baltimore Sun: General Assembly Session Ends In Flurry Of Votes 
During the flurry of activity Monday, the Senate voted 40-4 to approve a medical marijuana program, making Maryland the 19th state to do so. The legislation calls for doctors and nurses to distribute the drug through academic centers that also must study the program's effects. The structure of the state's plan is relatively conservative compared to states that allow private companies to set up dispensaries (Cox and Dresser, 4/9). 

Reuters: Maryland Lawmakers Approve Medical Marijuana
The Maryland legislature approved the use of marijuana for medical purposes on Monday, and Governor Martin O'Malley has said he would sign the measure and make Maryland the 20th state to legalize medicinal cannabis (4/8).

The Oregonian: Medical Marijuana Shops Would Be State Sanctioned Under Oregon House Bill
Oregon lawmakers on Monday took up a bill that would create a statewide registry of medical marijuana retailers. Business owners would have to pass criminal background checks, document the amount of marijuana coming into their establishments and verify that it's from state-registered growers. The bill, sponsored by Rep. Peter Buckley, D-Ashland, also would require that marijuana sold by state-registered outlets be tested for impurities (Crombie, 4/8).

Minnesota Public Radio News: Attorney General Questions Proposed Fairview-Sanford Merger
Minnesota Attorney General Lori Swanson is raising concerns over the University of Minnesota's plan to acquire Minneapolis-based Fairview Health Services, which is also in merger talks with rural health care giant Sanford Health. ... Swanson has been wary of the potential merger between Sanford and Fairview for a number of reasons, especially because Fairview is a charitable institution whose net worth of $1.2 billion in assets was created by Minnesotans through tax breaks, donations, and land for the benefit of Minnesotans (Stawicki, 4/8).

Kansas Health Institute: KanCare Continuity Of Care Period Ends
The first 90 days of KanCare have passed, which means the transition period during which the state's 380,000 Medicaid beneficiaries could switch managed-care health plans this year is over. That is important -- for among other reasons -- because many KanCare enrollees may find themselves in situations where the medical providers they are accustomed to using are not in the network of the KanCare plan to which they were assigned or chose themselves before the changeover period ended April 4 (Shields, 4/8).

The Associated Press/Atlanta Journal Constitution: Central Texas Hospital Marred By Lab Deficiencies
At least a dozen deficiencies in lab testing procedures at a new Central Texas hospital resulted in several patients undergoing unnecessary procedures and emergency room patients having to wait up to five hours for test results. A report made by inspectors with the Texas Department of State Health Services at the request of the U.S. Centers for Medicare and Medicaid Services found deficiencies at the 100-bed, $210 million Lakeway Regional Medical Center, inaugurated last year, including poorly trained lab staff and a lack of policies and procedures (4/8).

California Healthline: Palliative Care Key Part Of Berkeley Forum’s Prescription
The Berkeley Forum, a task force of private and public sector health care leaders convened by UC-Berkeley's School of Public Health, is taking what it calls a new "bottom-up" approach to addressing health care costs and population health in California. … In a recently released report, the Forum suggested seven initiatives to help reduce health care spending in California by $110 billion over the next decade. Palliative care was a key area specifically highlighted by the Forum as having great promise in generating significant savings and improving the quality of care in California (Edlin, 4/8).

The Associated Press/Wall Street Journal: NY Doctor Convicted In Medicare Fraud Scheme
Authorities say a doctor has been convicted of participating in a $77 million Medicare fraud scheme. A jury in Brooklyn Monday convicted 50-year-old Dr. Gustave Drivas of Staten Island of health care fraud conspiracy and health care fraud following an eight-week trial. He was acquitted of kickback conspiracy (4/9).

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Editorials and Opinions

Viewpoints: Looking For The Budget's True Bottom Line; The Debate On Plan B Reignited; Medicare Cuts Have Impact

The Wall Street Journal: A Primer For Understanding Obama's Budget
President Obama will release his overdue budget on Wednesday. It will doubtless project a reduction in the federal budget deficit—a projection that journalists, commentators and policy makers should ignore. To do otherwise is to be complicit in fraud. Strong statement? Not really. … Fortunately, some years ago the CBO began to present "alternative scenario" budget projections, in which differences from current-law projections are explained in detail. In its early February update, one example is that the 25% cut in physician Medicare reimbursements scheduled for next Jan. 1 will not occur. That adjustment increases the projected deficit in 2023 by $16 billion, and cumulatively by $138 billion from 2014-23. Congress has overridden the scheduled cut in physician reimbursements every year since 2003, in a legislative provision known as the "doc fix" (William Poole, 4/8).

USA Today: If Plan B Goes OTC, Common Sense Suffers: Our View
Thanks to a federal judge's ruling last Friday, the Plan B One-Step emergency contraceptive pill could soon be available on drugstore shelves to everyone, no matter how young. That would be a mistake, and the Obama administration should appeal the judge's ruling (4/8).

USA Today: 'Plan B' Contraception Ruling Correct: Opposing View
As a mother, I can understand the visceral reaction of many parents to the idea of teens having direct access to emergency contraception. But as the leader of the reproductive rights organization that sought the elimination of limits on the over-the-counter sale of emergency contraception, I feel it's my duty to ensure that the broader point of this effort — to expand access to a safe and reliable means of preventing unintended pregnancy for women of all ages — does not get lost (Nancy Northup, 4/8).

Los Angeles Times: Don't Punish People Who Really Need Painkillers
But the biggest providers are well-meaning doctors who underestimate the hazards of dependence with commonly prescribed painkillers like Vicodin. "Doctors were led to believe the risk of addiction was low ... that you could prescribe these drugs safely," said drug expert Dr. Michael Von Korff. Now studies suggest that as many as 1 in 4 patients wind up abusing their opioid medication. What the research doesn't tell us, though, is how many people feel their lives are better because they take the drugs (Sandy Banks, 4/9).

The Medicare NewsGroup: Why Crude Medicare Cuts Will Quietly Kill Seniors
The recent news that thousands of seniors with cancer are being denied treatment with expensive chemotherapy drugs as a result of sequestration-mandated budget cuts raises the question of whether other patients being equally harmed, but less visibly. A careful study of the impact of past federal budget cutting suggests a troubling answer. That study, in a National Bureau of Economic Research Working Paper published in 2011 and revised last year, established an eerily direct link between slashing hospital reimbursement and whether Medicare patients with a heart attack live or die (Michael Millenson, 4/8).

PBS Newshour: Finding The Prescription For Improving U.S. And Global Health Care
Whenever I travel around the country -- or the world -- and people I meet learn that I am a journalist focused on health and health care, they often ask: What country do you think has the best health care system? Often they have their own ideas of what the right answer is. … As for me, when asked this question, I sigh. I've learned too much in my travels around the U.S. and the world, and spent too much time with people involved in their nation's health systems, to believe that any of them is perfect. Almost every system -- ours, England's, France's, Japan's, Germany's, Canada's, Israel's, you name it -- has its strengths and weaknesses. And right now, almost every one of them is in pursuit of the elusive Triple Aim (Susan Dentzer, 4/8).

The Washington Post: Planned Parenthood's Defense Of Infanticide
When Rep. Todd Akin made his outrageous comments about "legitimate rape" it was front page news — and rightly so. But when a representative of Planned Parenthood is caught on camera defending infanticide, it merits barely a mention in the mainstream media. Testifying against a Florida bill that would require abortionists to provide emergency medical care to an infant who survives an abortion, Planned Parenthood lobbyist Alisa LaPolt Snow was asked point blank: "If a baby is born on a table as a result of a botched abortion, what would Planned Parenthood want to have happen to that child that is struggling for life?" She replied: "We believe that any decision that's made should be left up to the woman, her family, and the physician" (Marc A. Thiessen, 4/8).

The Chicago Tribune: Utter Arrogance Of Obamacare
The Associated Press recently reported that Obamacare could price older smokers out of the insurance market because it "allows health insurers to charge smokers buying individual policies up to 50 percent higher premiums starting next Jan. 1." ... So much for the promise of lowering health insurance costs for all. ... So, I guess they would also agree that other high-risk behavior should require penalty-sized premiums. Single teenage girls who engage in unprotected sex should pay more to cover their prenatal and baby care — or abortions. And whatever else bureaucrats deem to be risks that should only be insured at a higher premium. It also sounds very Republican (Dennis Byrne, 4/9).

Sacramento Bee: Nevada Needs To Atone For Patient Dumping
Nevada authorities say they're sorry for how they treated James Flavy Coy Brown, who at age 48 has been battling mental illness for his entire adult life. But Nevada Gov. Brian Sandoval and the Nevada Legislature need to provide more than lip service, and U.S. Health and Human Services Secretary Kathleen Sebelius, whose underlings say they're investigating, must focus on the reasons behind Nevada's mistreatment of Brown and possibly many others. ... Nevada authorities housed Brown at the Rawson-Neal Psychiatric Hospital in Las Vegas. On Feb. 11, they sent him by Greyhound bus to Sacramento, a city where he had never been and had no relatives. To tide him over on the bus ride, Nevada supplied him with a three-day supply of antipsychotic medication, four bottles of Ensure and what he called "cheesy peanut butter crackers" (4/9). 

Sacramento Bee: Pérez Bill Could Add To Health Reform Costs
Assembly Bill 1263 by Speaker John A. Pérez seeks to improve and expand medical interpreter services for Medi-Cal patients. ... If all the bill did was improve testing, training and monitoring of health care interpreters, and push the state to draw down more federal funding available for their services, it might merit support. But nearly half the bill deals with setting up a process for interpreters, most of whom are private contractors now, to join a public employee union, pay dues and collectively bargain for wages, benefits and working conditions. It also sets a guaranteed minimum compensation of $60 an hour, more than what most interpreters earn now. ... Creating a new unionized work force within the health care field is certain to increase financial pressures in a system stressed by soaring costs (4/9). 

Sacramento Bee: Consumer Watchdog Should Know Better
Recently, Insurance Commissioner Dave Jones approved a grant worth up to $88,305 to the advocacy group Consumer Watchdog. Not surprisingly, Consumer Watchdog last week issued a report finding that Anthem Blue Cross is asking for too much in its latest rate request, as the Los Angeles Times reported. If Consumer Watchdog had stopped there, no one would be raising red flags. But in touting its taxpayer-funded findings about Anthem in a news release, the Santa Monica-based organization also promoted an initiative that will be on the 2014 ballot. Some federal taxpayers undoubtedly will be uneasy knowing their money is being used to help an advocacy group with one of its ballot campaigns (4/8). 

Health Policy Solutions (a Colo. news service): Looking Out For No. 1 In Health
In college basketball, being No. 1 means winning the Final Four. In cinema, it means taking home an Oscar. But when it comes to Colorado's health, being No. 1 could improve hundreds of thousands of lives and greatly benefit the local economy and business environment. Though Colorado already is No. 1 in certain measures (we have the leanest and most-active adult population of any state), the 2012 Colorado Health Report Card shows there's plenty of room for improvements. For example, we're No. 31 among other states in prenatal care and No. 38 in children's preventative dental care. And though our adult population is the leanest relative to other states, our obesity rate for adults and children has risen dramatically in recent years (Michelle Lueck, 4/8).

Milwaukee Journal Sentinel: State Right To Maintain Pressure On Complex
The testimony in recent weeks in the Oct. 6 death of Brandon Johnson at the Milwaukee Mental Health Complex was heartbreaking. And the report Saturday by the Journal Sentinel's Steve Schultze that state regulators are keeping up pressure over staffing concerns was certainly sobering. Both should serve as a reminder that a fundamental transformation of the delivery of mental health services deserves the highest priority from county and state officials. Gov. Scott Walker and Milwaukee County Executive Chris Abele have committed themselves, respectively, to providing more money and a deadline for moving to a new model (4/8).

Medpage Today: The Physician Pay Reform I'd Like To See
Look, here's my idea: stop redirecting the truth about what's really eating up the cost of health care.  It's time we address the excessive costs of all of these excessive middle management healthcare leeches.  If you want physician payment reform, stop creating ridiculous fronts called "National Commissions" of doctors that act as our modern-day Physician Inquisitors. Instead, pay us what we're each worth (trust me, it's not that hard to find out and it sure as heck doesn't take a year of meetings held at expensive hotels that results in just one white paper with 14 co-authors that carry innumerable conflicts of interest into the discussion) (Dr. Wes Fisher, 4/8).

Boston Globe: Medicalized Condition Doesn't Always Need Treatment
We doctors do this a lot, actually, this medicalizing of things that really aren't medical conditions. We're not so much doing it to sound smart or alarm people, it's just how we talk. And sometimes, making something a condition is easier for us because then we can offer tests and medical treatments, which is what we know how to do. The problem is, not all of those tests and treatments are necessary (Dr. Claire McCarthy, 4/8).

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Stephanie Stapleton

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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.