Daily Health Policy Report

Thursday, May 10, 2012

Last updated: Thu, May 10

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Medicaid

Medicare

Health Reform

Health Care Marketplace

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Medicare Spotlights Hospitals With Especially Costly Patients

Kaiser Health News staff writer Jordan Rau reports: "The government has identified hundreds of hospitals whose Medicare patients are incurring especially high bills, a first step toward using bonuses and penalties to encourage more efficient care" (Rau, 5/9). Read the story. Check out the interactive charts detailing Medicare spending by state and Medicare spending at individual hospitals.

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Lawsuit Challenges Medicaid Managed Care Decision In Missouri

KCUR's Elana Gordon, working in partnership with Kaiser Health News and NPR, reports: "Molina Healthcare is suing the state arguing that Missouri changed the rules in the midst of a competitive bidding process. Molina is one of five companies currently managing care for about 430,000 of the state's Medicaid beneficiaries, who are mainly low-income children and pregnant women" (Gordon, 5/9). Read the story.

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Health On The Hill: Federal Budget: Health Care Politics Trumps Policy (Video)

Kaiser Health News staff writer Mary Agnes Carey and Jackie Judd discuss the congressional wrangling over the federal budget and what’s ahead for the automatic cuts scheduled for December (5/9). Watch the video or read the transcript.

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Capsules: Study: Privately Insured Kids Get More Care In ED

Now on Kaiser Health News' blog, Jenny Gold writes: "Insurance coverage may play a major role in the kind of care a patient receives, according to a study published in the most recent edition of The Journal of Pediatrics" (Gold, 5/10). Check out what else is on the blog.

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Political Cartoon: 'Sing-Along?'

Kaiser Health News provides a fresh take on health policy developments with "Sing-Along?" by R.J. Matson.

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

CLOUDY DAYS

Sunshine delayed on
industry pay for doctors... 
Grassley not happy.
-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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Capitol Hill Watch

House Vote Likely Today On GOP Budget Plan

House Republicans want to stave off $55 billion in automatic cuts to the Pentagon budget by paring back key provisions of the health law and cutting Medicaid and other safety net programs, restarting an emotional debate about the nation's spending priorities.

NPR: House To Vote On GOP Bill Framed As Guns Vs. Butter
Republicans who control the House want to block some $55 billion worth of automatic cuts to the Pentagon budget next year. Instead, they want to cut funding for social programs such as food stamps, Medicaid and Meals on Wheels. The Obama administration has threatened to veto the legislation. But the president is willing to leave the Pentagon cuts in place for now, in hopes of bringing Republicans back to the bargaining table (Horsley, 5/10).

The Associated Press: GOP Plan Cuts To Social Programs To Protect Pentagon
Moving to protect the Pentagon, Republicans controlling the House are pressing cuts to food stamps, health care and pensions for federal workers as an alternative to an automatic 10 percent cut to the military come January. The automatic spending cuts, totaling $98 billion next year in a new estimate, are punishment for the failure of last year's deficit-reduction "supercommittee" to strike a deal (Taylor, 5/10).

The Washington Post: House To Vote On GOP Plan That Would Forestall Pentagon Cuts
The House is expected to vote Thursday on a Republican plan that would spare the Pentagon from the deep across-the-board spending cuts envisioned as part of last summer's debt-ceiling agreement, reviving what has been an emotional debate in Washington about the best ways to reduce the federal budget deficit. … To forestall the defense hit, the GOP proposal would cut funding for food stamps, eliminate key pieces of the federal health-care law and slash funding designed to help the government better monitor the financial sector (Helderman, 5/9).

The Fiscal Times: Student Loan Bill Caught In A Web Of Politics
House Republicans on April 27 passed a version that would cut into preventive care funds for women and children in the Obama health care reform program to offset the projected $7 billion of income the Treasury would forego if the interest rate on Stafford student loans remained the same for another year ... Senate Democrats are proposing to offset the cost of holding the interest rate steady by closing a tax loophole used by some wealthy individuals to avoid Medicare payroll taxes (Pianin, 5/9).

The Fiscal Times: Surveys Say Cut Defense, Not Domestic Programs
The "no new taxes" part of the Republican Party platform, when isolated from other issues, remains popular with voters. But the latest opinion surveys suggest the broad public is ready for a shift in spending priorities after a decade of war and fast-rising military spending, which more than doubled in the past decade (Goozner, 5/10).

Meanwhile, on the Senate side, more fighting words -

The Associated Press/Washington Post: Top Senate Democrat Reid Stands Behind Automatic Defense Cuts to Pressure GOP On Budget
President Barack Obama's top Democratic ally in the Senate said Wednesday that he won't block much-feared automatic spending cuts to the Pentagon and Medicare providers from taking effect unless Republicans show more flexibility on cutting the budget deficit (5/9).

Politico: Harry Reid: No Rollback Of Automatic Budget Cuts
In his strongest words yet, Senate Majority Leader Harry Reid warned Wednesday that he is not prepared to stop automatic spending cuts in January unless Republicans accept a more "balanced" approach to deficit reduction including revenues (Rogers, 5/9).

Kaiser Health News: Health On The Hill: Federal Budget: Health Care Politics Trumps Policy (Video)
Kaiser Health News staff writer Mary Agnes Carey and Jackie Judd discuss the congressional wrangling over the federal budget and what's ahead for the automatic cuts scheduled for January (5/9).

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Steps Toward A Permanent Medicare 'Doc Fix'?

Rep. Allyson Schwartz, D-Pa., and Rep. Joe Heck, R-Nev., introduced the latest bill Wednesday aimed at reforming how Medicare pays health care providers and preventing a scheduled, Jan. 1, 2013 cut to physician reimbursement rates. The bipartisan measure would replace Medicare's current pay formula.

The Wall Street Journal's Washington Wire: Progress Made On How Medicare Pays Doctors
A Democratic congresswoman and Republican congressman made a small move forward in an effort to change the way Medicare pays doctors Wednesday, introducing a bill that would end regular congressional scrambles to stave off physician pay cuts by tapping savings from winding down the war in Afghanistan (WSJ Staff, 5/9).

The Hill: Lawmakers Propose A Permanent 'Doc Fix'
Reps. Allyson Schwartz (D-Pa.) and Joe Heck (R-Nev.) introduced a bill Wednesday to reform how Medicare pays healthcare providers and to avoid a cut to reimbursement rates on Jan. 1. The bipartisan measure would repeal Medicare's current reimbursement formula and replace it with a new system of payment models. It would also give doctors small boosts in payment rates for four years (Viebeck, 5/9).

CQ HealthBeat: House Democrat Tries Again At Overhauling Medicare Payments To Physicians
Democrat Allyson Y. Schwartz and Republican Joe Heck introduced draft legislation Wednesday in the House that they hope will create a path toward solving the nagging problem of how to pay physicians who treat Medicare patients (Ethridge, 5/9).

Medscape: Bill Would Repeal SGR, Phase Out Medicare Fee-for-Service
The Schwartz-Heck bill lays out a complicated timetable for reforming Medicare's system for paying physicians: In 2013, reimbursement rates would remain at 2012 levels. From 2014 to 2017, Medicare would raise rates by an annual 2.5% for primary care, preventive, and care-coordination services. Rates for all other physician services would increase by 0.5% annually (Lowes, 5/9).

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House Lawmaker Offers Amendment To Block DOJ From Defending Health Law

Rep. Marsha Blackburn, R-Tenn., has offered this amendment to the appropriations bill that provides funding to the Department of Justice and other agencies. It's part of the GOP's ongoing effort to target the health law. Also, during a House hearing, Republicans questioned spending levels at the Department of Health and Human Services.

Politico Pro: House Amendment Would Stop DOJ From Defending Health Law
The House of Representatives took up an amendment Wednesday afternoon that would bar the Justice Department from using funds to defend the health reform law. The amendment by Rep. Marsha Blackburn (R-Tenn.), which is being offered to the appropriations bill for the Commerce and Justice departments and science and related agencies, is the latest in a series of GOP appropriations riders that have targeted the health reform law (Feder, 5/9).

Politico: GOP Grills HHS On Rising Payroll, Travel Costs
Too-big-to-fail banks? Meet "too-big-to-control" government. That's the label House Republicans slapped on the Department of Health and Human Services on Wednesday during a hearing on the agency's spending (Chaney, 5/9).

But the Republican plan to replace the health law still appears in flux --  

The Hill: GOP Shies Away From Offering Health Care Reform Alternative
Republicans might not offer a comprehensive plan to replace President Obama's health care law if the Supreme Court strikes it down this summer. House Republicans had said they would have a health care bill ready to go by the time of the ruling to present a clear alternative to the Democrats' Affordable Care Act. But now, with the high court's ruling just weeks away, some conservatives are urging the party to abandon that strategy, fearing voters will recoil from another sweeping revamp of the health care system (Baker, 5/10).

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Drug Manufacturers Draw Attention For Politics And Pain Killers

Politico examines the relationship between industry-group PhRMA and congressional Republicans in the post-health-reform-debate landscape.

Politico: Republicans Find Lots To Love In PhRMA
If Republicans are mad about PhRMA's betrayal during the health reform debate, they sure have a funny way of showing it. Even though the pharmaceutical trade group was the first industry group to make a deal with the Obama administration to support health reform, Republicans are working hard to fast-track the passage of the industry's top legislative priority -- the reauthorization of the Food and Drug Administration "user fee" bill that regulates drug approvals (Feder, Norman and Dobias, 5/9).

Meanwhile, the Senate Finance Committee is investigating connections between drug makers, medical groups and physicians who advocate the use of certain narcotic painkillers.

Modern Healthcare: Baucus, Grassley Probe Drugmakers' Ties
Citing a spike in the number of deaths from narcotic painkillers, two senators have started an investigation into the connections between three drug manufacturers and the medical groups and physicians who advocate the use of these drugs. In letters to Purdue Pharma, Endo Pharmaceuticals, Johnson & Johnson and seven organizations, Senate Finance Committee Chairman Max Baucus (D-Mont.) and Sen. Chuck Grassley (R-Iowa), the committee's senior member, said it's clear that the "United States is suffering from an epidemic of accidental deaths and addiction resulting from the increased sale and use of powerful narcotic painkillers such as Oxycontin, Vicodin and Opana" (Zigmond, 5/9).

CQ HealthBeat: Senate Finance Probing Ties Between Drug Makers, Nonprofits
The chairman and top Republican on the Senate Finance Committee launched an investigation Wednesday into the financial ties between three manufacturers of powerful painkillers and what the senators say are "supposedly independent" medical groups and associations that have distributed studies favorable to painkiller use (Norman, 5/9).

MedPage Today/Everyday Health: MedPage Today/Milwaukee Journal Sentinel Series Triggers Senate Investigation
The U.S. Senate Committee on Finance has opened a wide-ranging investigation into questionable financial relationships between companies that make narcotic painkillers and various nonprofit organizations that advocate for the treatment of pain. Citing investigative reports by MedPage Today/Milwaukee Journal Sentinel, the committee is seeking financial and marketing records from three companies that make opioid drugs such as Oxycontin and Vicodin as well as seven national organizations that advocate for the treatment of pain (Fauber, 5/9).

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Medicaid

HHS Announces Big Pay Boost For Some Medicaid Docs

HHS says the increase, required by the health law, would raise primary care doctors' payments for treating Medicaid patients, on average, 34 percent.

The Washington Post: Medicaid Payments To Primary Care Doctors Will Rise Under New Regulation
Primary care doctors could get a pay raise next year for treating Medicaid patients, under a rule announced by the Obama administration Wednesday. ... The pay raise is one of several attempts in the law to address a fundamental challenge in U.S. health-care: Because primary care doctors focus on preventive care, they offer the best hope of curbing the nation's health spending. Yet they are paid far less than specialists (Aizenman, 5/9).

The Associated Press: Pay Boost For Doctors Treating Low-Income Patients
But it may not last long. The boost under President Barack Obama's health care overhaul is good only for the next two years, even if the Supreme Court upholds the law (5/9).

Modern Healthcare: Primary-Care Docs To See Increase In Medicaid Rates
The provision, released Wednesday, would increase average Medicaid primary care payments by 34%, according to one estimate cited by CMS (Daly, 5/9).

The Hill: HHS: Health Law To Raise Medicaid Service Fees
Acting administrator for the Centers for Medicare and Medicaid Services Marilyn Tavenner noted that the payment increase will help prepare primary care networks for "increased enrollment as the healthcare law is implemented" (Viebeck, 5/9).

National Journal: HHS To Send States $11 Billion For Medicaid Pay Rise
"It's nonsensical to think a temporary, two-year bump in pay will actually attract and retain doctors to the Medicaid program unless the White House thinks Congress will keep extending these higher payment rates in perpetuity," grumbled Sen. Orrin Hatch, R-Utah, who is ranking member on the Senate Finance Committee (Fox, 5/9).

Medscape: Medicaid Raise For Primary Care Could Include Subspecialists
Medicaid managed care plans that contract with states also are obligated to pay out the extra money. Physicians working in Federally Qualified Health Centers or Rural Health Clinics would not receive the raise, however. If Congress does not avert a 30% cut to Medicare reimbursement scheduled for 2013, Medicaid rates would be raised to Medicare rates that were effective in 2009. The federal government would give state Medicaid programs 100% of the funds needed to make the raise possible in 2013 and 2014 (Lowes, 5/9). 

MedPage Today: Medicaid Pay Going Up For Primary Care
Although Medicaid rates vary from state to state, they are generally about 66% of Medicare rates for the same service, although in some they're just a third, according Roland Goertz, MD, chairman of the board of the American Academy of Family Physicians (Walker, 5/9). 

Politico Pro: Medicaid Payment Rule Leaves Out OB-GYNs
Pediatricians and their sub-specialists would be allowed to recoup higher Medicaid payments that are on par with Medicare rates — but obstetricians are barred from doing so — under a closely watched payment rule released by CMS on Wednesday (Dobias, 5/9).

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Medicare

Feds Pinpoint $5.6 Billion In 'Suspect' Medicare Billings From Pharmacies

This report from the Health and Human Services inspector general concluded that corner drugstores are vulnerable to fraud.

The Associated Press: Suspect Billings At 2,600 Drugstores
Medicare paid $5.6 billion to 2,600 pharmacies with questionable billings, including a Kansas drugstore that submitted more than 1,000 prescriptions each for two patients in just one year, government investigators have found. The new report by the inspector general of the Health and Human Services department finds the corner drugstore is vulnerable to fraud, partly because Medicare does not require the private insurers that deliver prescription benefits to seniors to report suspicious billing patterns (Alonso-Zaldivar, 5/10).

In other Medicare news, the government has identified hospitals where Medicare patients incur very high bills, and the Obama administration is expected to announce today a plan to regularly review rules, including outdated hospital reporting requirements, that could result in big savings.

Kaiser Health News: Medicare Spotlights Hospitals With Especially Costly Patients
The government has identified hundreds of hospitals whose Medicare patients are incurring especially high bills, a first step toward using bonuses and penalties to encourage more efficient care (Rau, 5/9).

The Associated Press: Obama To Require Regular Reviews Of Federal Rules
The Obama administration is changing or eliminating a handful of regulations -- from uniform street sign requirements to outdated hospital reporting rules -- that it says could have cost the economy $6 billion over five years, part of a regulatory overhaul that will require agencies to periodically scrub their rule books in search of unnecessary mandates. ... Among the five finalized rule changes that are to be announced Thursday, some of the biggest saving come in changes that do away with unnecessary reporting requirements by hospitals that treat Medicare and Medicaid patients (Kuhnhenn, 5/10).

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Health Reform

Small Businesses Miss Out On Health Law's Tax Credit, Report Finds

According to a report from Families USA, millions of businesses with fewer than 25 employees failed to take advantage of a tax credit that would help them provide health coverage to their workers. 

The Hill: Report: Millions Of Employers Fail To Claim Health Care Tax Credit
Millions of small businesses failed to claim tax credits they could have received under President Obama's healthcare law, according to a new report from the advocacy group Families USA. The report says more than 3 million businesses were eligible for the new healthcare credit in the 2011 tax year. The White House, however, has estimated that only 360,000 businesses received the credit (Baker, 5/9).

CQ HealthBeat: Millions Of Small Businesses Qualify For Premium Tax Credit, According To Families USA
Seventy percent of small businesses with fewer than 25 employees are eligible for tax credits to help them provide insurance for their workers, according to a study released Wednesday by Families USA and the Small Business Majority. ... The report estimates that the credit would affect 19.3 million Americans employed by small companies and that the total value of the tax credits in 2011 is more than $15.4 billion (Bristol, 5/9).

Mississippi Public Broadcasting: Health Insurance Tax Credit Could Help 26-Thousand Mississippi Businesses
A new study finds a tax credit could help pay for the health insurance of 177-thousand Mississippi workers. ... A new study by the pro-health care reform group Families U-S-A found that 26-thousand small businesses in Mississippi are eligible for health care tax credits which are currently available as part of the 20-10 health care reform law (Hess, 5/9).

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Health Care Marketplace

Accretive Lowers Forecast, Promises To Release Its Own Report On Minn. Probe

The billing and collection company has denied allegations by the Minnesota attorney general that it used overly agressive tactics on patients.

The New York Times: After Questions On Tactics, Accretive Cuts Forecast
Despite a surge in revenue in the first quarter, Accretive Health on Wednesday lowered its earnings estimate for 2012 because of the loss of an important contract amid accusations that the medical debt-collection company had used overly aggressive tactics (Silver-Greenberg, 5/9).

Reuters: Accretive Health Revenue Beats, Shares Rise
Accretive Health Inc's quarterly revenue topped market expectations as the company increased its customer base even as it faces allegations that it violated patient privacy and debt collection laws, sending its shares up as much as 20 percent on Wednesday (Siddiqui, 5/9).

Modern Healthcare: Accretive CEO Rejects Allegations; Company Revises Financial Outlook
Accretive Health's chief executive said no other state attorneys general have contacted the company following a scathing report by Minnesota's attorney general. Accretive CEO Mary Tolan, speaking in a conference call with analysts, rejected allegations brought by Minnesota Attorney General Lori Swanson that Accretive may have violated privacy and consumer protection laws (Evans, 5/9).

Minnesota Public Radio: Accretive Health Faces Questions After AG Begins Probe
Meanwhile, [Tolan] said the company plans to release more detailed information about the case on Friday in response to questions raised by Sen. Al Franken, D-Minn. (Dunbar, 5/9).  

(St. Paul) Pioneer Press: Accretive Health To Answer Franken's Questions, CEO Says 
Last month, Franken sent Accretive Health a lengthy set of questions based on Swanson's investigation and followed up Tuesday with a letter scolding the firm for not yet providing answers. Fairview [health system] cut its final contractual tie with Accretive Health in the wake of Swanson's report (Snowbeck, 5/9).

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When To Retire? Health Costs Enter Into The Decision

The New York Times: Working Late, By Choice Or Not
With the value of many 401(k)'s and homes taking a beating during the recession and with energy and health care prices climbing, many who dreamed that retirement was just around the corner have reluctantly kicked their retirement plans down the road (Greenhouse, 5/9).

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State Watch

Republican Govs Like Insurance Exchanges But Skewer 'Obamacare'

Many governors find themselves in an awkward spot since opposing the health care law is GOP orthodoxy. In the meantime, Iowa lawmakers approved a bill requiring licensure of advisers who help people navigate health insurance options.

The Wall Street Journal: Health Exchanges Vex GOP
The controversy over President Barack Obama's sweeping health-insurance law is putting the nation's 29 Republican governors in an awkward position. On one hand, opposition to "Obamacare," as opponents derisively dub it, is now doctrine among Republicans and a winner among many voters. On the other, a pillar of the Affordable Care Act, as it is formally known, is the creation of exchanges, online state marketplaces where individuals and small business can shop for coverage from competing private insurers. A lot of Republican governors like the concept (Wessel, 5/9).

Des Moines Register: Did The Iowa Legislature Just Approve An Illegal Act?
The required licensure of new public advisers to help Iowans and employers compare health insurance options is a backdoor way to give an unfair advantage to insurance agents or brokers and is likely illegal, health advocates said today. The House Tuesday and the Senate today approved a budget bill that includes language setting out the qualifications for the so-called "navigators" that will work as public advisors in implementing the federal health care reform act that opponents often called "Obamacare" (Clayworth, 5/9).

In California, advocates consider what to do if the health law mandate is overturned, while one group says the implementation of the law is going well there -

California Healthline: If Individual Mandate Is Overturned, States Still Have Lots of Options
If the Supreme Court decides that Congress does not have the authority to require an individual mandate, then the health care reform effort could be hampered by an inability to get a pool of participants large enough to make the system work.  But there are a number of ways around that problem, and state health officials are busy examining those options and working out a Plan B to implement health care reform (Gorn, 5/9). 

KQED's State of Health blog: Advocacy Group Says State (Mostly) Doing A Good Job 
State health agencies' call centers are doing a pretty good job, according to survey. ... Health Access conducted a survey with an eye toward 2014 when the federal health care overhaul rolls out. Potentially millions of people will access health insurance for the first time and state health agencies are likely to be swamped with calls (Aliferis, 5/9). 

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Medicaid: Bidding Lawsuit In Mo.; Conn. Raises Adult Qualification Bar

States deal with Medicaid issues, including illegal transportation of poor children to Medicaid services in Texas and a lawsuit challenging bidding rules in Missouri. In Connecticut, lawmakers have raised the bar for low-income adults to qualify for the program.

Houston Chronicle: Officials Investigate Kids' Illegal Medicaid Rides To Therapy 
Millions of public dollars have been spent for the transportation of poor and unaccompanied children, some as young as 3, to rehabilitation clinics in the Rio Grande Valley even though the rides have been illegal for years. "With no parent on the ride or service, there's little in the way of checks and balances to let the state know if there were problems or if the ride or therapy session even happened," said Stephanie Goodman, spokeswoman for Texas Health and Human Services Commission (HHSC), which oversees both Medicaid and the van service (Langford, 5/9).

Kaiser Health News: Lawsuit Challenges Medicaid Managed Care Decision In Missouri
Molina Healthcare is suing the state arguing that Missouri changed the rules in the midst of a competitive bidding process. Molina is one of five companies currently managing care for about 430,000 of the state's Medicaid beneficiaries, who are mainly low-income children and pregnant women (Gordon, 5/9).

Reuters: Connecticut OKs $20.5 Billion Budget, Closes Deficit
The Connecticut legislature has approved a $20.5 billion budget for the next fiscal year, which closes a $200 million deficit and adds $100 million in spending on education without increasing taxes, officials said on Wednesday. The budget, enacted late on Tuesday by lawmakers, includes savings of around $75 million focused on Medicaid, the federal-state health plan for the poor, raising the bar for low-income adults to qualify (5/9).

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Iowa Legislature Approves State Mental Health System Revamp

The Iowa plan had been held up by funding concerns. In other news on mental health issues, North Carolina is also weighing major changes in its system.

Des Moines Register: Mental Health Compromise OK'd
The Iowa House and Senate finally found compromise Wednesday on a plan to remake the state's mental health care delivery system. Lawmakers had been in agreement on the policy provisions of the redesign for weeks, but Senate Democrats and House Republicans repeatedly clashed on how to fund the transition from the current system to the new one. A joint committee of House and Senate lawmakers resolved their differences and approved a final plan Wednesday morning, leading to final votes in both chambers in the afternoon. The Senate passed the redesign package on a 30-16 vote, followed by the House on a 66-31 vote (Noble, 5/9).

The Texas Tribune: Officials Testify About Gaps In Mental Health Services
State health officials delivered a sobering assessment of mental health treatment in Texas, telling a Senate committee Wednesday that waiting lists for services have increased by 642 percent since September 2004 and that there is a severe shortage of psychiatrists and mental health workers available to treat patients (Tan, 5/9).

North Carolina Health News: Everybody Is Watching As NC Transforms Mental Health System
Without a doubt, North Carolina is taking a gamble in transforming all of the state's mental health local management entities into managed care organizations. If the effort succeeds, North Carolina stands to become a national leader in solving the problem of Medicaid financing for mental health services. If the effort fails, it could cost billions to fix it (Hoban and Wilson, 5/10). 

Minnesota Public Radio: State Investigating Security Hospital's Handling Of Missing Patient, Stabbing
State human services officials are investigating the Minnesota Security Hospital's handling of two incidents Tuesday in which one patient was missing for nearly 22 hours and another patient was arrested after allegedly stabbing his mother at a nearby park. ... [Anne Barry, deputy commissioner of the Minnesota Department of Human Services] said the department may decide to bring in other agencies and state experts to determine whether either incident at the state-run facility was preventable (Baran, 5/9). 

California Healthline: Laura's Law Advocate Objects To Plan
The Assembly Committee on Health on Tuesday approved a proposal designed to change the way some counties handle people who are having a mental health crisis.  "Consumers, mental health professionals, law enforcement and others are working side-by-side developing ways to de-escalate crisis situations, while reaching out to consumers and providing much-needed mental health services," said Wesley Chesbro (D-Arcata) (Gorn, 5/10).

The Lund Report (an Oregon news service): FolkTime Looks To Expand Peer Support Services for Veterans
FolkTime, a 26-year-old nonprofit providing community socialization for people with mental illness, has just signed a contract with Clackamas Behavioral Health to start providing peer support services – including job coaching, arts activities and support groups – to veterans with mental health challenges (McCurdy, 5/9).

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Ariz., Iowa Republicans Tweak Abortion, Contraception Bills

GOP legislators have backed down from some of the anti-abortion and anti-contraception coverage measures they wanted.

The Associated Press/Arizona Republic: Brewer Now 'More Favorable' On Contraception Bill
Arizona Gov. Jan Brewer says a contraception coverage bill now on her desk was improved in the time since she voiced reservations about an earlier version ... As passed by the Republican-controlled Legislature, the bill would generally allow employers formally identifying themselves as religiously oriented organizations to opt out of the state's decade-old requirement that health plans generally cover contraception. ... The bill originally would have let any employer opt out of providing health plan coverage of contraception for birth control (Davenport, 5/9).

Des Moines Register: Abortion Restrictions Removed To Let DHS Bill Pass
[I]n the end, Republicans agreed to drop the abortion language, which would have eliminated state funding to abort pregnancies resulting from rape or incest and perhaps limited state funding for Planned Parenthood, the women's health organization whose services include abortion (Noble, 5/9).

The Texas Tribune: Video: Texas Vs. Planned Parenthood
In part two of "Fertile Ground," our occasional series on the battle over family planning, we go to West Texas to look at a fight that has centered on Planned Parenthood (Tan, 5/10).

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State Roundup: Ill. House Wants State Retirees To Pay Part Of Their Health Care

News organizations report on state health care policy issues in Alabama, California, Colorado, Illinois, Massachusetts and Oregon.

Chicago Sun-Times: Illinois House Votes To End 'Free' Health Care For State Retirees
The Illinois House voted Wednesday to yank "free" taxpayer-funded health insurance from nearly 80,000 retired state workers, university employees, lawmakers and judges. The measure, which was approved by a 74-43 vote and now moves to the Senate, takes aim at an $876 million annual subsidy that had been one of the most lucrative perks of public employment. … Indeed, the health-care decision represents the first of several painful fiscal votes lawmakers face this month, when they are expected to impose $2.7 billion worth of Medicaid cuts and dramatically trim state and possibly city pension benefits (McKinney and Maloney, 5/9).

Los Angeles Times: California Medical Spending Grew In 2009, But Rate Slowed
Californians spent less per person for health care in 2009 than residents of all but eight other states. But the total tab is mounting, according to a new report from the California HealthCare Foundation. Total spending for health care in California was $230 billion, nearly triple the level in 1991 (McMahon, 5/9).

The Wall Street Journal: Massachusetts Is Closer To Controlling Health Costs
Just days after the House introduced a long-awaited proposal that set a target growth rate for health spending and establish a new authority to oversee it, the Senate on Wednesday afternoon released its own bill that sets similar, albeit less-aggressive, goals (Levitz, 5/9).

The Associated Press: Military Stop Brings Health Care To Rural Alabama
An Air Force dentist pulls teeth in the oil-stained garage where the town's fire truck normally parks. A reservist in camouflage dispenses free medicine in the police department lobby. The doctoring Wednesday was part of a military program to provide free health care in poor areas of the South and whose latest mission came to one of Alabama's most impoverished regions, where the teams have treated more than 12,000 people in less than two weeks. The work helps fill a gap in an area with few doctors and a multitude of medical problems, many of them linked to the obesity that is rampant in the state (Reeves, 5/10).

Modern Healthcare: Calif. Report Highlights EHR Milestones
In a biennial report, the California Health Information Partnership and Services Organization, a not-for-profit group focused on electronic health-record adoption, said it has reached a number of milestones to expand EHRs in the state. The report on its first two years highlights significant milestones it has accomplished, such as developing the infrastructure that could help thousands of providers implement EHRs in their practices (Kutscher, 5/9).

The Lund Report (an Oregon news service): Cascade Comprehensive Care And Klamath County Commissioner Engage In Public Dispute
What started as a steady stream of e-mails between Cascade Comprehensive Care and Klamath County Commissioner Cheryl Hukill relating to the managed care organization's interest in becoming a coordinated care organization turned into a testy public spat (Waldroupe, 5/9).

Health Policy Solutions (a Colorado news service): Health Rights At The Core Of Dead Civil Unions Bill, Hickenlooper Calls Special Session
Colorado's civil unions bill -- which died after a vitriolic showdown on the House floor Tuesday night but will come back to life in a special session starting as soon as Friday -- would have had far-reaching health policy implications for families with same sex partners. ... So what was lost when the bill died Tuesday? Security and automatic recognition by medical institutions for gay and lesbian partners and parents will have to wait. And, experts on health insurance say a civil unions bill would have a dramatic effect on reducing the number of uninsured people in Colorado (Kerwin McCrimmon, 5/9).

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Weekend Reading

Longer Looks: More 20-30 Somethings Are Taking Care Of Elderly

Every week, Kaiser Health News reporter Shefali S. Kulkarni selects interesting reading from around the Web.

ABC News: Early Burdens: Eldercare Falls on Young Shoulders
At 30, Suzette Armijo cares for her widowed 86-year-old grandmother, a retired National Park Service ranger in the final stages of Alzheimer's disease, while holding down a fulltime job, a part-time job and raising a 4-year-old son. "This was nothing that I had planned for," says Armijo, who moved her grandmother Elizabeth Armijo into a nearby six-bed assisted living home because veterans' benefits "wouldn't pay for her to live with me." ... Armijo is among a generation of young adult caregivers, the majority of whom are women, navigating tough turf without a roadmap. ... As they try to tap into resources to help an ailing grandmother, Mom or Dad, these 20-somethings and 30-somethings are often on a lonely road (Jane E. Allen, 5/4).

The Atlantic: Can a Sense of Purpose Slow Alzheimer's?
Medical professionals have also found correlations between a person's sense of purpose and their physical health and survival. As far back as 1946, the Austrian psychiatrist Victor Frankl, who spent several years in concentration camps during WWII and lost his entire family in the Holocaust, found that the people who survived the concentration camps best were those who believed they had a reason, mission, or purpose that required their survival ... [But now] it appears that a sense that your life has purpose, and that what you do matters, may actually protect your brain from the clinical effects of Alzheimer's disease (Lane Wallace, 5/9).

Newsweek: Why The Campaign To Stop America's Obesity Crisis Keeps Failing
Most of my favorite factoids about obesity are historical ones, and they don’t make it into the new, four-part HBO documentary on the subject, The Weight of the Nation. ... the government efforts to curb obesity and diabetes avoid the all-too-apparent fact, as Hilde Bruch pointed out more than half a century ago, that exhorting obese people to eat less and exercise more doesn’t work, and that this shouldn’t be an indictment of their character but of the value of the advice (Gary Taubes, 5/7).

The Root: On Blacks And Fat: Will Allen
Obesity is more common in African Americans than in other ethnic groups. But when it comes to black people and weight, that's where the agreement seems to end. Is food the culprit? Is exercise the solution? Is there even a real problem to begin with, or should we be focusing on health -- or even self-acceptance -- rather than the number on the scale? Against the backdrop of the first lady's mission to slim down the nation's kids, black celebs getting endorsements after shedding inches and a booming weight-loss industry, The Root will publish a series of interviews with medical professionals, activists and fitness enthusiasts that reveal the complexity of this issue and the range of approaches to it. For the fifth in the series, The Root talked to Will Allen, author of the Good Food Revolution: Growing Healthy Food, People and Communities (Jenée Desmond-Harris, 5/9).

Charlotte Observer: Nonprofit Hospitals Thrive On Profits (5 part series/major investigation)  
Hospitals in the Charlotte region have margins among the highest in the U.S. They also have billions in investments and real estate. Experts say they could do more to lower patients' costs. ...To understand what’s happening nationally, one need look no farther than Charlotte’s Dilworth neighborhood, where North Carolina’s largest hospital system got its start. Carolinas HealthCare System began in 1943 with a 325-bed hospital called Charlotte Memorial, which struggled financially for decades. Its leaders decided they needed to grow to survive. They built a system that could attract paying patients while continuing to care for the uninsured. It worked. Over the past 30 years, they have transformed it into a juggernaut (Ames Alexander, Karen Garloch and Joseph Neff, 4/21).

Medscape: New AMA Head on Membership, the ACA, and Medicine's Future
Dr. [James] Madara: We support coverage for the uninsured; health insurance reforms, which include allowing children to remain their parents' plans until age 26; and eliminating the lifetime cap on insurance policies. But, like any complex law, the Affordable Care Act is not perfect. For example, the Independent Payment Advisory Board, a nonelected board that could set Medicare pricing independently without accountability, is something we would not encourage (interviewed by Dr. John Reed, 5/9).

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Editorials and Opinions

Viewpoints: Can Medicare Taxes Really Fund Student Loans?; Daschle On Diabetes And Kids

Los Angeles Times: Student Loans And Social Security Taxes: A Poor Fit
In the case of the student loans, the Democrats' bill would require certain Americans -- high-income partners in small businesses that provide professional services, such as engineering or lobbying -- to pay payroll taxes on their share of the firm's profits. That's a long way of saying the bill would eliminate a tax-avoidance strategy that some small firms use to reduce their contributions to Social Security and Medicare (Jon Healey, 5/9).

The Washington Post: Taxing Jobs Out Of Existence
Congress, ravenous for revenue to fund Obamacare, included in the legislation a 2.3 percent tax on gross revenue — which generally amounts to about a 15 percent tax on most manufacturers' profits — from U.S. sales of medical devices beginning in 2013. This will be piled on top of the 35 percent federal corporate tax, and state and local taxes. The 2.3 percent tax will be a $20 billion blow to an industry that employs more than 400,000, and $20 billion is almost double the industry's annual investment in research and development (George F. Will, 5/9).

Politico: Type 2 Diabetes In Kids Not Child's Play
If ever we needed a wake-up call on the state of American children's health, consider the growing proliferation of Type 2 diabetes in our youth, as detailed in a study recently published in The New England Journal of Medicine. These findings, which warn of many children and adolescents' alarming future of poor health, are yet another reminder of the serious challenges we face in health care today. ... The U.S. rates of childhood obesity are staggering. So it's no coincidence that we now find Type 2 diabetes — closely linked to obesity — is escalating at unforeseen rates in the same population, demanding the attention given to any other preventable threat to our youth (Tom Daschle, 5/9).

Reuters: The Real Reason Romney Is Struggling With Women Voters
Back in February, things started to look dire for the Romney campaign's ability to attract female voters. Every day brought another story about Republican attacks on reproductive rights: attacks on insurance coverage for contraception, transvaginal probes, all-male panels called in Congress to discuss contraception. ... The Romney campaign responded by trying to change the subject, to jobs and the economy. But if Romney wants to close the gender gap, he should rethink that strategy (Amanda Marcotte, 5/9).

JAMA: Medicare And The Year Ahead: Opportunities For Reform
When the Affordable Care Act (ACA) was signed into law in March 2010, it ushered in significant changes to Medicare. ... However, it's clear from the presidential campaign rhetoric, as well as the legislative and political calendar, that Medicare could face additional, potentially dramatic changes in the coming year. The most likely engine for change to Medicare is a confluence of statutory deadlines that some observers think could lead to a bipartisan "grand bargain" (Austin B. Frakt, 5/9).

Sacramento Bee: Doctors Are Often In The Dark About Costs
Commercial Internet sites have some important lessons to offer for the practice of medicine. When shopping online, each time you select an item for purchase – say from Amazon or Lands' End – you place the item in an electronic shopping cart. As you go along, you can monitor the total for your purchase. If the cost is too high, you can eliminate an item or two. You are informed of your cost as you shop. ... [In medicine] there is no "shopping cart total" (Michael Wilkes, 5/10).

Chicago Tribune: More Like This, Please
The Illinois House voted 74-43 to end a generous retirement benefit for state and public university workers, General Assembly members and judges. Sponsored by House Speaker Michael Madigan, the legislation would force about 78,000 retirees to pay more toward their health care costs. The state pays all the premiums for most retirees, costing taxpayers about $800 million a year. Illinois can't afford that (5/10).

Chicago Sun-Times/Herald-News: Reform Plans Overburden The Poor
The state budget and the Medicaid and public pension systems in Illinois must be "reformed" (i.e., receive sharp spending cuts) to achieve fiscal balance. We get that. It's necessary. But we're also sureĀ­ that when the dust settles and the cliches recede, the poorest people in Illinois will suffer the most. They always do. … The working poor are suffering in Illinois, largely because the easiest taxes to raise — excise and sales taxes on gasoline, cigarettes and alcohol, for example — hit the poorest harder than everyone else (5/9).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
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.