Daily Health Policy Report

Tuesday, May 1, 2012

Last updated: Tue, May 1

KHN Original Reporting & Guest Opinion

Health Reform

Campaign 2012

Health Care Marketplace

Coverage & Access

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

$18 For A Baby Aspirin? Hospitals Hike Costs For Everyday Drugs For Some Patients

Reporting for Kaiser Health News, in collaboration with USA Today, Susan Jaffe writes: "Sudden chest pains landed Diane Zachor in a Duluth, Minn., hospital overnight, but weeks later she had another shock – a $442 bill for the same everyday drugs she also takes at home, including more than a half dozen common medicines to control diabetes, heart problems and high cholesterol. … Even though her health plan covers medical and drug expenses, her policy did not pay the hospital drug bill because St. Luke's never formally admitted her. Instead, billed the visit as observation care, which is considered an outpatient service" (Jaffe, 4/30). Read the story.

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Insuring Your Health: Some Insurers Deny ER Coverage To People Who Have Been Drinking

In her latest Kaiser Health News consumer column, Michelle Andrews writes: "Up to half of the people who are treated at hospital emergency departments and trauma centers are under the influence of alcohol, experts say. That may be a sobering statistic, yet a recent study found that emergency departments can capitalize on this "teachable moment" to discourage problem drinking in the future. But laws in more than half the states permit insurers to deny payment for medical services related to alcohol or drug use and that can derail hospitals' best intentions, experts say" (Andrews, 4/30). Read the column.

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Political Cartoon: 'Butterflies Aren't Free?'

Kaiser Health News provides a fresh take on health policy developments with "Butterflies Aren't Free?" by Paul Fell.

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

Around The Bend For Health Costs? 

Cost curve perhaps bent?
Some say too soon, some say yes.
More than recession!
-Paul Hughes-Cromwick

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

House Republicans Divided Over How To 'Replace' Health Law

But they continue to target the law's co-op program, among other provisions.

Politico: GOPers Split Over How To Reform Health Care
Ask each of the 242 House Republicans what kind of health policy they'd like to enact instead of President Barack Obama's health care reform law and you might get 242 different answers. Even after three years of railing against Obama's plan, Republicans have coalesced around only a few basic tenets of health policy — let alone a full replacement plan (Haberkorn, 4/30).

Politico: House GOP Targets Nonprofit Health Co-Ops
The CO-OP faithful are vowing to plow ahead despite the friction they've been getting from the House lately, as Energy and Commerce Committee Republicans attack the initiative on two fronts — investigating its loans while trying to defund the entire program (Norman, 4/30).

Also in the news, reports and politics swirl around the overhaul, especially regarding medical-loss ratio rebates and prescription drug coverage - 

Modern Healthcare: 'Free Money' And Insurance Industry Warnings
Insurance coverage is nice but nothing beats free money. At least, that's the apparent political thinking that has elevated new estimates on expected rebate checks to the marquee position whenever senior Democrats—including the president—have commented on the healthcare law in recent days. An estimate released last Thursday concluded that $1.3 billion in rebates will go out this summer to more than 3 million policyholders from private health insurers that exceed new medical loss ratio limits. It quickly became a top healthcare line for Democrats (Daly, 4/30).

Politico Pro: Dropping Coverage Could Net Billions
The House Ways and Means Committee plans to release a report Tuesday that says 71 of the nation's top companies could save almost $30 billion in 2014 by dropping health insurance coverage for their employees. The report is the latest Republican effort to hammer the health care reform law for placing a greater burden on business. The committee surveyed 71 companies in the Fortune 100 and determined they could save more than $28 billion in 2014 alone by dropping insurance coverage and instead paying the $2,000-per-employee penalty. Savings over the following decade could be $422.4 billion (Feder and Haberkorn, 5/1).

The Hill: CMS: Obama Health Law Has Saved Seniors $3.4 Billion On Prescription Drugs
Seniors have saved $3.4 billion on prescription drugs because of President Obama's healthcare law, the Medicare agency said Monday. The Centers for Medicare and Medicaid Services (CMS) said seniors saved an average of $837 in the first three months of this year. CMS said more than 5 million seniors have benefited from the law's drug discounts — a provision that Democrats often highlight as they try to build public support for a law that remains stuck at about 50 percent approval (Baker, 4/30).

Exchanges, other health law provisions draw headlines at the state level -

The New York Times: In Fight Over Obama Health Law, A Front In Minnesota
With zeal, excitement and a meticulous attention to detail, the administration of Gov. Mark Dayton is trying to expand health insurance coverage and remake Minnesota's insurance market along the lines envisioned by President Obama (Pear, 4/30).

California Healthline: How Should California Respond if Part or All of ACA Is Struck Down?
We got responses from: Diana Dooley, Secretary, California Health & Human Services Agency. State Sen. Tom Harman (R-Huntington Beach), Vice-chair, Senate Committee on Health. State Sen. Ed Hernandez (D-West Covina), Chair, Senate Committee on Health. Betsy Imholz, Special projects director, Consumers Union. Bill Kramer, Executive director national health policy, Pacific Business Group on Health. Elizabeth Landsberg, Director of legislative advocacy, Western Center on Law and Poverty. Assembly member William Monning (D-Carmel), Chair, Assembly Health Committee. Anthony Wright, Executive director, Health Access California (4/30). 

Politico Pro: Exchange Week: Will Christie Say Yes Or No?
Vermont made huge progress toward an exchange last week when its Legislature approved a bill setting policy for the new marketplace — but it’s unlikely that any other Legislature will take such a monumental step before the Supreme Court makes its decision. In the near term, though, the biggest exchange decision to watch out for will be made by a Republican governor who at least seems receptive to the exchange concept (Millman, 4/30).

Meanwhile, Sen. Scott Brown, R-Mass., is taking advantage of a key health law provision although he has voted to repeal the law -

Boston Globe: Brown Says Daughter, 23, Insured Under Health Law
Senator Scott Brown, who won office vowing to be the 41st vote to block President Obama's health care law and who has since voted three times to repeal it, acknowledged Monday that he takes advantage of it to keep his elder daughter on his congressional health insurance plan. "Of course I do," the Massachusetts Republican told the Globe. Brown is insuring his daughter Ayla, a professional singer who is 23 years old, under a widely popular provision of the law requiring that family plans cover children up to age 26 (Johnson, 5/1).

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Campaign 2012

As Voters Weigh Candidates, Romney Seeks Support From Intra-Party Rivals

Although President Barack Obama and GOP presidential hopeful Mitt Romney offer voters "a distinct choice," Romney is still courting conservatives within his party who have been concerned about his past positions on things such as abortion and health reform.

The Associated Press: On Taxes, Health Care And Government's Role, Obama And Romney Offer Distinct Choices To Voters
Those differences surely exist. Obama and his Republican challenger are offering voters a distinct choice on taxes, a sharp disagreement over health care and a classic ideological divide on social issues that neither candidate seems eager to talk about (5/1).

The Associated Press: Santorum Wants Promises From Romney Before Backing
[Romney] signed a health care overhaul as governor that provided the groundwork for Democrats' national law that requires all Americans to buy insurance or face a fine. Romney's health care overhaul in Massachusetts required health care coverage. That's the primary issue Santorum plans to discuss Friday when he meets privately with Romney. "We want to make sure he doesn't replace it with any kind of mandate," Santorum adviser Hogan Gidley said (Elliott, 5/1).

At the state level, reports on Wisconsin's recall election and a new GOP ad in the special election to replace Rep. Gabrielle Giffords, D-Ariz. -

Chicago Tribune: Wisconsin's Walker Raises $13 Million For Recall Election
Walker enraged Democrats and unions representing government workers such as teachers when he pushed through the legislature last spring a measure drastically reducing their powers. The law forced them to pay a portion of the cost of health insurance and pensions, capped wage increases, and required unions to be recertified every year. … The first-term governor, who faces the expensive special election in June, raised that amount between January 17 and April 23, according to a finance report filed with the state (O'Brien, 4/30).

Roll Call: Arizona: NRCC Releases Ad Slamming Barber
The National Republican Congressional Committee upped its ante behind a new ad it is airing in the special election to replace former Rep. Gabrielle Giffords (D). Previously, the NRCC was putting $150,000 behind the ad buy. The group has since doubled that figure to $300,000. The buy will include broadcast television. It is a negative ad hitting the Democratic nominee, former Giffords staffer Ron Barber, on health care. ... the Democratic Congressional Campaign Committee, went up with a $150,000 ad buy of its own last week. Much like the NRCC, the Democrats ignore their own candidate and criticize the GOP nominee, veteran Jesse Kelly, on nationalized issues: Social Security, Medicare and lower taxes for the wealthy (Livingston, 4/30).

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Health Care Marketplace

Hospital Billing Collections Company Seeks Dismissal Of Minn. Lawsuit

The Minn. state attorney general lodged a suit against Accretive Health arguing that it violated privacy laws when an employee lost a laptop computer with medical data of 23,500 patients. In addition, Accretive is also lashing out at publicity about its efforts to get hospital patients to pay their bills.

(St. Paul) Pioneer Press: Accretive Health Fires Back Against Allegations
Accretive Health is firing back against Minnesota Attorney General Lori Swanson, saying her lawsuit against the bill collection company should be dismissed and alleging she has orchestrated a nationwide media campaign rather than litigate her concerns in court.  Until last week, the Chicago-based company was a consultant to the Minneapolis-based Fairview health system, but the relationship has fallen apart amid public scrutiny with a sweeping report released by Swanson that alleged overly aggressive collection tactics. Meanwhile, Fairview said Monday, April 30, that it recently stopped trying to collect on patients' old debts during emergency room visits for new medical problems -- a practice that Swanson criticized (Snowbeck, 4/30).

Minneapolis Star Tribune: Accretive Seeks Dismissal Of Suit Over Lost Laptop, Health Records
The consulting firm that lost a laptop computer with medical data on 23,500 Minnesotans last summer has asked a judge to dismiss a lawsuit by Minnesota Attorney General Lori Swanson alleging that the company violated health privacy laws and state consumer protections. Accretive Health Inc., the same company that came under fire last week with Fairview Health Systems for aggressive patient debt collection practices, said Swanson's lawsuit over the lost laptop should be thrown out because no consumers have been harmed and the suit's consumer fraud claims are baseless. In documents filed Monday in U.S. District Court in Minneapolis, Accretive also said it has temporarily halted debt collections in Minnesota under an order from the state Department of Commerce (Kennedy, 4/30).

Minnesota Public Radio: Accretive Asks Judge To Dismiss Attorney General's Lawsuit
The company that has helped Fairview Health Services and North Memorial Medical Center collect debts from patients has asked a court to dismiss a lawsuit filed by Minnesota Attorney General Lori Swanson. The lawsuit filed in federal court in January accuses Chicago-based Accretive Health of breaking federal and state health privacy and debt collection laws, including the Health Insurance Portability and Accountability Act (HIPAA). ... In the court documents, Accretive Health said it didn't violate privacy laws because there's no evidence the information on the laptop was compromised (Dunbar, 4/30). 

Modern Healthcare: Accretive Wants Minn. Lawsuit Dismissed
Accretive, a publicly traded company in Chicago, saw its stock drop last week after Swanson's office released a six-volume report on the company's collection efforts under its contract with Fairview. The report said Accretive pushed to collect payments from patients as they sought treatment in the hospital, including the emergency room. The Illinois attorney general has announced an inquiry and one congressman has called for a federal investigation (Evans, 4/30).

MedPage Today: Hospital Debt Collector Draws Scrutiny
Rep. Pete Stark (D-Calif.) is calling for a full-scale investigation into the reportedly questionable debt collection practices of a company accused of harassing patients in emergency rooms into paying their bills. Stark requested that if the practices of Accretive Health -- a company hired by hospitals to collect payments for medical care -- are found to violate the Emergency Medical Treatment and Active Labor Act (EMTALA), the federal government should issue a bulletin to hospitals informing them about the illegality of the behavior and of possible enforcement action (Walker, 4/30). 

The Hill: Medical Debt Collector, Under Fire From Lawmakers, Denies Pressuring Patients
One of the country's largest collectors of medical debt, under heavy criticism from lawmakers, hit back at allegations that it uses aggressive and potentially illegal tactics to get patients to settle up. In a statement, Accretive Health called reports that it puts "bedside pressure on patients" a "flagrant distortion of fact." … The response came after several lawmakers blasted Accretive for allegedly breaking federal law to collect debts on hospitals' behalf (Viebeck, 4/30).

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Coverage & Access

At-Home Caregiving Comes With Personal, Financial Costs

News outlets examine the costs of care-giving and a new initiative to help Medicaid enrollees stay at home rather than live in nursing homes.

NPR: Discovering The True Cost Of At-Home Caregiving
Few people want to turn over a loved one to institutional care. No matter how good the nursing home, it may seem cold and impersonal — and very expensive. But making the choice to provide care yourself is fraught with financial risks and personal sacrifices (Geewax, 5/1).

MedPage Today: HHS Announces Homecare Initiatives
The Department of Health and Human Services (HHS) has announced several Affordable Care Act initiatives aimed at keeping more chronically ill patients at home for care. HHS announced Thursday that it had issued a final rule for the Community First Choice program, which increases the federal Medicaid funding match by 6 percentage points for states that provide home attendants and other forms of support to Medicaid enrollees who would otherwise need to be in a nursing homes (Frieden, 4/30). 

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The Skills Of VA Nurses Under Examination After Patient Deaths

The competency of nurses at VA facilities is drawing scrutiny.

ProPublica: VA Nurses Scrutinized After Patient Deaths In Two States
Earlier this month, a broader review by the VA inspector general of 29 VA facilities found only half had adequately documented that their nurses had the needed skills. ... The April 20 IG report also noted that previous inspections had found nurse competency issues in "dialysis, mental health, long-term care, spinal cord injury, endoscopy procedure areas, the operating room and the cardiac catheterization laboratory and with reusable medical equipment (Weber and Ornstein, 4/30). 

Also in the news, a program that seeks to help veterans with post-traumatic stress disorder and other mental health issues -

PBS NewsHour: Combat Paper: Veterans Battle War's Demons With Paper-Making
The statistic is stark, heartbreaking and unacceptable. According to the Department of Veterans Affairs, 18 veterans commit suicide every day -- about one every 80 minutes. Many suffer from post-traumatic stress disorder, which plagues their thoughts, invades every aspect of their lives and disables some to the point where death is preferable to living through the nightmare. ... During the past five years, Combat Paper has helped many veterans make sense of their experiences in a constructive, safe and artistic environment. Now, Combat Paper has its first permanent East Coast home at the Printmaking Center of New Jersey, about 45 minutes west of New York City. Another project is underway on the West Coast (Till, 4/30).

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Public Health & Education

New Studies Restart Debate About Mammography For Women In Their 40s

Another study in today's news examines two eye drugs and finds they are comparable, a conclusion that could potentially save Medicare and other insurers millions of dollars.

NPR: Studies Reignite Mammography Debate For Middle-Aged Women
Should women in their 40s routinely get mammograms to detect breast cancer? Two studies released Monday aim to help resolve that question, which is one of the most intense debates in women's health. The studies identify which women in their 40s are most likely to benefit from routine mammograms (Stein, 4/30).

MedPage Today: Breast Screening In 40s Proposed Based On Risk
In a jointly conducted meta-analysis, extremely dense breasts (Breast Imaging Reporting and Data System [BI-RADS] category 4) or first-degree relatives with breast cancer at least doubled breast cancer risk for women age 40 to 49. The studies appeared in the May 1 issue of the Annals of Internal Medicine. ... All guidelines agree that women ages 50 to 74 should get mammographic screening, but recommendations for women in their 40s have been highly controversial (Phend, 4/30). 

The Wall Street Journal: Eye Drugs Roughly Equal, Study Says
The results of a closely watched study funded by the U.S. government show that the drugs Avastin and Lucentis are roughly equal at preserving vision in elderly people with a common eye disease, a finding that could potentially save Medicare and other insurers millions of dollars a year because Avastin is far less expensive than Lucentis (Whalen, 4/30). 

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Painkillers Create Quandary For Physicians

News outlets report on the hazards -- both in the ER and in maternity wards -- being brought about by painkiller use and abuse.

The New York Times: ER Doctors Face Quandary On Painkillers
Dental patients — mostly uninsured or indigent — are not unusual in emergency rooms. Poor patients may forgo preventive care and delay treatment until they face a medical crisis. In many states, adult dental benefits under Medicaid, the government insurance program for the poor, have been scaled back or eliminated. And dentists often don't accept Medicaid patients. But emergency physicians like Dr. Lobitz cannot know whether someone who claims to be in agony from dental issues is telling the truth — or simply plans, he said, to "go to the next emergency room, next town over, and get another 30 Vicodin" (Saint Louis, 4/30).

Reuters: More US Babies Born To Mothers Who Abuse Painkillers
The rate of American babies being born with symptoms of opiate withdrawal, typically caused by maternal drug abuse, tripled from 2000 to 2009, according to a study that underscores the growing problem posed by powerful prescription painkillers in the United States. ... The surge in the number of babies born to mothers using these drugs is causing not just health problems but an larger burden on the Medicaid federal-state health insurance program for the poor, the researchers found (Pittman, 4/30).

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State Watch

Judge Halts Texas Ban On Planned Parenthood Funding

The federal judge prevented Texas from enforcing the law, which banned Planned Parenthood from the state's health care program for women, until the legal challenge is concluded.

The New York Times: Texas: Judge Prevents Ban On Funds To Planned Parenthood
A federal judge in Austin on Monday prevented Texas from enforcing a rule that would have banned Planned Parenthood from participating in a health care program for low-income women (Fernandez, 5/1).

Los Angeles Times: Federal Judge Blocks Texas Funding Cuts To Planned Parenthood
In his ruling, U.S. District Judge Lee Yeakel in Austin cited evidence that the state rule banning Planned Parenthood from the program was unconstitutional. He imposed an injunction against enforcing the law until he can hear arguments in the case (Hennessy-Fiske, 4/30).

The Associated Press: Federal Judge Stops Texas Law On Women's Health
Texas Attorney General Greg Abbott appealed Yeakel's decision to the 5th U.S. Circuit Court of Appeals, asking that it remove the injunction (Tomlinson, 4/30).

The Hill: Federal Jude Halts Texas Law Against Planned Parenthood
The law under scrutiny prohibited Texas state funding for organizations that provide abortions, such as Planned Parenthood. It passed last year. Eight Planned Parenthood clinics in the state that do not provide abortions sued in response, arguing that the law punishes them for associating with segments of Planned Parenthood that do provide abortions (Viebeck, 4/30).

Reuters: Judge Halts Texas Ban On Planned Parenthood Funding
The ruling by U.S. District Judge Lee Yeakel in favor of Planned Parenthood means thousands of women enrolled in the Texas Women's Health Program who go to its clinics will not have to find new health care providers, at least for now (4/30).

The Texas Tribune: Judge: HHSC Must Keep Planned Parenthood in WHP for Now
Gov. Rick Perry's spokeswoman, Catherine Frazier, just issued the following statement following today's ruling: "Texas has a long history of protecting life, and we are confident in Attorney General Abbott’s appeal to defend the will of Texans and our state law, which prohibits taxpayer funds from supporting abortion providers and affiliates in the Women's Health Program. We will continue to work with the Attorney General to pursue all available legal options" (Tan, 4/30). 

Houston Chronicle: Texas Can't Bar Planned Parenthood From Program, Judge Rules 
"I find it particularly suspect that of all the different ways Governor (Rick) Perry could figure out to have a women's health program ... the only way he's interested in is a way that violates the United States Constitution," said Jeffrey Hons, president of the Planned Parenthood Trust of South Texas, which includes two affiliates in the lawsuit. "The question has to be asked, were you ever really interested in these women's health, or was this always a political game for you, where poor women were the weapon you were going to use to damage Planned Parenthood?" (Fikac, 4/30).

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Massachusetts On Edge Of Major Health Cost Control Effort

The next stage in the landmark 2006 health reform law is to scale back the growth in health care costs.

The Washington Post: Massachusetts Payment-Reform Bill Would Overhaul How Health-Care Providers Are Paid
In the next few months, Massachusetts is expected to take up legislation that would overhaul how doctors, hospitals and other providers are paid. The forthcoming payment-reform bill is expected to include many incentives for hospitals to accept "global payments," or a flat fee for all the care delivered for a specific person or group of people (Kliff, 4/30).

WBUR's CommonHealth blog: Glossary In Progress: Health Reform Terms For Coming 2012 Debate
Very soon, the topic of health reform is going to get white-hot again in Massachusetts. Legislative leaders will reveal their plans for the next stage, the part left out of the landmark 2006 law: How to cut costs. Gov. Deval Patrick laid out his own blueprint last February, and now, at long last, this next political shoe will drop. To prepare you and ourselves, we at WBUR are gathering a glossary of terms that it will help to know in the coming debate (Goldberg, 4/30). 

Earlier, related KHN coverage: Different Takes: How Massachusetts Can Control Health Care Costs (4/12).

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Okla. Court Keeps 'Personhood' Off Nov. Ballot; Minn. Gov. Vetoes Abortion Bill

Sooner state voters won't vote on the controversial proposal to label an embryo a person.

Reuters: Oklahoma Court Rejects Ballot Initiative On "Personhood"
The Oklahoma Supreme Court on Monday struck down a ballot initiative that sought voter approval of a so-called "personhood" amendment to the state constitution to define an embryo as a human being from the moment of conception (Olafson, 4/30).

The Associated Press: Okla. Court Halts 'Personhood' Rights For Embryos
The state's highest court ruled unanimously that a proposed amendment to the Oklahoma Constitution that would define a fertilized human egg as a person violates a 1992 U.S. Supreme Court decision involving a Pennsylvania case and "is clearly unconstitutional." Supporters of the personhood amendment are trying to gather enough signatures to put it before Oklahoma voters on the November ballot (Talley, 4/30).

The Hill: Oklahoma Court Tosses 'Personhood' Amendment
The personhood movement supports amending state constitutions to say that life begins at the moment of fertilization -- a definition that would likely impede women's access to contraception and in vitro fertilization (Baker, 4/30).

Politico Pro: 'Personhood' Move Struck In Oklahoma
When is a defeat a victory? When you're Personhood USA. Gualberto Garcia Jones, legislative director for the anti-abortion organization, said the Oklahoma Supreme Court's decision Monday to block a ballot initiative to extend full legal rights to the moment of conception will help his movement in the long run. The "momentary setback" will foment anger among the initiative's supporters, which will help build energy for their controversial strategy to overturn Roe v. Wade, he contended (Feder, 4/30).

Meanwhile --

Minneapolis Star Tribune: Dayton Issues Second Abortion Veto
Gov. Mark Dayton has issued his second veto of an abortion bill in as many weeks. The governor issued an expected veto Monday of a bill that would have required physicians to be physically present every time an abortion pill like RU-486 is prescribed, and again every time such a pill is swallowed (Brooks, 4/30).

(St. Paul) Pioneer Press: Dayton Vetoes Bill Requiring Doctors Be Present For Abortion Pill
Dayton also vetoed a bill that would allow Minnesota to join a group of other states in regulating health care within their states and to secure federal funding. "This bill would be a drastic departure from our current system of shared state and federal responsibility for delivering health care services,'' Dayton said (Lien, 4/30).

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Calif. Panel Considers Changes In Dental Program

As the state wrestles with budget problems, legislators consider how much coverage to give to children and adults.

California Healthline:  Subcommittee Approves Change For Sacramento County Dental Program
In fiscal year 2010-11, about 31% of the children eligible for dental care in Sacramento County actually saw a dentist (compared to a statewide average of about 50%). It is the only county in the state with a mandatory managed care dental program, which pays a per-person, capitated rate, whether beneficiaries  receive dental care or not. State legislators are considering changing that system to allow a voluntary option for beneficiaries to switch to fee-for-service. State health care officials are asking to keep the current system, with some major reforms to boost those low utilization rates (Gorn, 5/1).

HealthyCal: Community Clinics Try To Fill In Dental Care Gap
Roughly three million poor and disabled Californians had their coverage for dental services cut three years ago, and community dental clinics have struggled to cover preventative services ever since. "... Dental services aren't mandated under the federal Medicaid program and California, with a program called Denti-Cal, was one once of the few states to cover non-emergency services for adults. But with the state budget crisis, legislators cut the non-mandatory services (Shanafelt, 4/30).

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State Roundup: Mass. Premium Increases Muted

News outlets report on a variety of health policy stories from states including California, Georgia, Idaho, Illinois, Iowa, Kansas, Minnesota, Massachusetts, Texas and Washington.

Boston Globe: Mass. OK's Health Plan Increase Of Just 1.2%
State regulators on Monday approved third-quarter health insurance rates that will raise premiums an average of just 1.2 percent in the market serving small businesses and individuals, continuing a trend of more modest increases seen over the past three quarters. And several carriers, including Tufts Health Plan of Watertown and Fallon Community Health Plan, based in Worcester, will reduce their rates -- a rarity in Massachusetts health care -- according to data from the state Division of Insurance (Weisman, 5/1). 

Los Angeles Times: Insurance Rate-Hike Initiative Gains High-Profile Backers
Several high-profile business names, such as San Francisco hedge-fund manager Thomas Steyer and agribusiness magnate Stewart Resnick, have contributed to a proposed ballot measure seeking tighter regulation of health insurance rates, according to campaign finance records (Terhune, 5/1).

Los Angeles Times: California Agency Ripped Over Disparities In Autism Spending
California lawmakers and advocates for children with autism assailed the state Department of Developmental Services during a hearing Monday over the deep racial and ethnic disparities in how it spends money on the disorder (Zarembo, 5/1).

The Associated Press: Idaho Case Shows Midwife Tension With Hospitals
Midwives and doctors are longtime rivals in the politics governing where women should give birth: Home or hospital. But that tension, typically played out privately between pregnant women and their health care providers, was laid bare this month in the case of two Idaho midwives suspended by the state after three babies died during a 14-month period between 2010 and 2011 (Miller, 5/1).

Des Moines Register: Iowa Halts Payments To Des Moines Charity
The state of Iowa has suspended payments to a taxpayer-funded Des Moines charity that provides counseling for children and families. The charity, A New Beginning, was the subject of a March 29 Des Moines Register report that said the organization was the subject of examinations by the Iowa Medicaid Fraud Control Unit and the U.S. attorney’s office (Kauffman, 4/30).

Georgia Health News: Agency Urges Restricted Use Of Some Scarce Drugs
The Georgia Department of Public Health has asked EMS providers to reserve certain medications for the most critically ill patients, amid a shortage of drugs to treat people in emergency situations. ... A recent article in the Journal of Emergency Medical Services said the shortages first surfaced nationally in 2010, starting with epinephrine, which treats cardiac arrest, and dextrose, which replenishes bodily fluids and nutrients (Miller, 4/30). 

Minnesota Public Radio: Study: Disparity In Population With New Cases Of HIV/AIDS
A new report from the state health department shows wide disparities among people with HIV/AIDS in Minnesota, with more new cases in 2011 among communities of color, gay and bisexual men and people in their 20s than other groups. Overall, the number of new HIV cases reported in Minnesota last year fell slightly from the year before, with 292 new cases reported in 2011 (Mador, 4/30). 

Modern Healthcare: Safety Effort Targeting Handoffs Cut Errors 40%: Boston Hospital
Researchers at Boston Children's Hospital have developed a specialized set of protocols they say will improve patient handoffs and reduce the risk of adverse events. Using a number of bundled interventions, including team-based training and printed handoff instruction sheets, the initiative led to a 40% drop in medical errors during a three-month pilot study, the hospital said in a news release. The program is now being rolled out in 10 pediatric training programs (McKinney, 4/30).

The Atlanta Journal-Constitution: Aim Cuts Jail For One Class Of 'Criminals'
Georgia Bureau of Investigation director Vernon Keenan isn't known for being soft on crime, but he is working to keep one class of "criminals" out of jail. Keenan, like sheriffs statewide, contends law enforcement turns jails into asylums at huge human and financial costs. Now, a study in which the GBI is partnering with the Georgia chapter of the National Alliance of Mentally ill, shows how to keep people with schizophrenia, bipolar and other mental diseases out of jail, Keenan said (Visser, 4/30).

Houston Chronicle: Houston Hopes Mileage Fee Boosts Ambulance Revenue
A year and a half after raising the price of an ambulance ride from $415 to $1,000, Houston City Council is scheduled to consider Wednesday whether to charge for mileage, too. If the $13-per-mile charge passes, few people will pay it. The city does not collect a cent from the indigent uninsured who account for about 45 percent of the 131,000 ambulance rides the fire department's Emergency Medical Services units give annually. About a third of Harris County adults have no health insurance. The remainder of the rides are covered primarily by insurance, whether private or Medicaid or Medicare (Moran, 4/30).

San Francisco Chronicle: Nurses To Strike Sutter Health Hospitals Tuesday
As many as 4,500 registered nurses at 10 Northern California hospitals operated by Sutter Health are expected to walk off their jobs Tuesday for a one-day strike as part of a contract dispute with the Sacramento hospital chain.The California Nurses Association of Oakland and the hospitals have been in negotiations for more than a year. Union officials say the major points of contention are sick pay and reductions in employee benefits (Colliver, 5/1). 

Kansas Health Institute News: McPherson Doctor Leads In Recruiting, Training Of Rural Surgeons
After working 15 years at a large hospital in his native Dallas, [Dr. Tyler] Hughes picked up his family and moved 400 miles north to a Kansas town where he could be a "real surgeon," averting the administrative track he was on, he said. "I wanted to take care of patients and I felt there was a need out in the rural environment," Hughes said. That was 17 years ago. Since then, he has trained some 80 students, most of them through KU's program (Cauthon, 4/30). 

Earlier, related KHN story: Wanted: Mavericks And Missionaries To Solve Mississippi's Doc Shortage (Hess, 4/26).

The Lund Report (an Oregon news service): Court Ruling Denies CUP Injunction Request
Legislators representing Clark County are disappointed by a court ruling last week that will keep Columbia United Providers (CUP) out of Medicaid in Washington state starting July 1. The health plan ... had filed an administrative appeal with the state's Health Care Authority after contracts were awarded to Centene and Molina, two out-of-state, publicly-traded insurance companies (Jorgensen, 4/30). 

Minneapolis Star Tribune: Bipartisan Love Abounds For Health And Human Services Bill
Republicans and Democrats beat their swords into plowshares Monday as Gov. Mark Dayton ceremonially signed this year's health and human services budget measure…. The measure restores funding or delays cuts to funding for millions of dollars of programs slashed last year as part of the deficit-fixing budget. The restoration includes $4.7 million for the Emergency Medical Assistance program, which helps those who need dialysis and cancer treatment, and delays a $5.9 million cut to personal care attendants, who help people with disabilities with basic daily needs. It also delays a rate cut to long-term care facilities, which means paying out an additional $20.6 million and could give the state time to negotiate a deal with the federal government to make the cut unneeded (Stassen-Berger, 4/30). 

Associated Press/Chicago Sun-Times: Quinn Ties Cigarette Tax Hike To Health Benefits
Whether successful or not, Illinois governors repeatedly have aimed at the same target for additional money to address the state's financial gap — cigarette smokers. But for the first time, Gov. Pat Quinn has floated the idea of tying a cigarette tax hike to improving health care. The Democrat says a $1-per-pack increase would bring in nearly $700 million — including federal matching funds — to help close a $2.7 billion Medicaid shortfall, with the benefits going well beyond (4/30).   

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Editorials and Opinions

Viewpoints: Romney's Argument That Health Law Would Kill Free Enterprise; FDA's Delay In Cutting Use Of Antibiotics In Animals

Los Angeles Times: Who Says 'Obamacare' Will Kill Free Enterprise? Romney Does
In my column on Sunday, I quoted Mitt Romney's warning last week that President Obama's health reform law could doom the free-enterprise system in the United States. "With Obamacare fully installed," Romney said, "government will come to control half the economy, and we will have effectively ceased to be a free-enterprise society." Could that be true? Would "Obamacare," which relies mostly on free-enterprise health insurance companies, really turn America into a socialist state? (Doyle McManus, 4/30).

The Washington Post: Why Reform Conservatism Deserves A Chance
Reform Conservatism, in contrast, would seek to achieve federal goals in modern, market-oriented ways. It is less concerned about re-founding the country than making Medicare work. Its chief practitioner is Rep. Paul Ryan (R-Wis.), supported by a few policy experts of disproportionate creativity and influence (Michael Gerson, 4/30).

Minneapolis Star Tribune: Health Care Providers Have Lost Their Way
Replay history and you will see how some local hospitals have evolved from caring places into money machines…. Where does Fairview [Hospital] go from here [after a controversy about debt collections]? How does it and others like it recover the public trust that patients cling to for healing? First the board (especially the CEO and former board chair on whose watch the collection effort occurred) need to do more than say "sorry." That would be asking for cheap grace. Rather they need to articulate the values that guide the organization, and hence affect every employee. Then they need to assure us that the values are being practiced (Paul Olson, 4/30).

Politico: Antibiotics In Agriculture A Threat To Public Health
The Food and Drug Administration concluded in 1977 that feeding antibiotics daily to healthy livestock, chickens and hogs could promote antibiotic-resistant bacteria, capable of infecting people. ... the FDA dragged its feet for more than three decades. But a federal judge ruled in March that the agency must finally take action. The court ordered the FDA to withdraw approval for the use in animal feed of two antibiotics important for human health. This decision — in a case brought by consumer groups including the Natural Resources Defense Council and the Center for Science in the Public Interest — is a landmark victory in ending the misuse of antibiotics (Rep. Louise Slaughter, Robert Lawrence and Caroline Smith Dewaal, 4/30).

Des Moines Register: Special Deal For Cedar Rapids Doctor Is Wrong
Don’t like the law? Then write a check to state lawmakers and they might carve out an exception just for you. That is what the public probably is thinking after hearing about Dr. Lee Birchansky. The Cedar Rapids ophthalmologist wants to open an outpatient surgery center there. A state board has repeatedly denied him the needed certificate to do so, and the Iowa Supreme Court has agreed with the board. So Republicans in the Iowa House want to come to his rescue. They added an amendment to a state spending bill that would allow Birchansky's surgery center — and only his — to skirt a process known as the certificate of need (4/30).

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Stephanie Stapleton

Andrew Villegas

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.