Daily Health Policy Report

Friday, May 10, 2013

Last updated: Fri, May 10

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Spending And Fiscal Battles

Coverage & Access

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Colorado Exchange Board Spars Over Federal Funding

Colorado Public Radio's Eric Whitney, working in partnership with Kaiser Health News and NPR, reports: "Here's the question making the rounds in Colorado: Is the state asking for enough start-up money from the federal government for its online health insurance marketplace? Consumer advocates are worried the answer is 'no.' Statehouse Republicans, on the other hand, think it’s asking for far too much. Colorado exchange CEO Patty Fontneau is playing Goldilocks, saying the $125 million federal grant request she wants to send to Washington is just right" (Whitney, 5/10). Read the story.

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Capsules: Community Health Centers Get $150 Million To Boost Exchange Enrollment; Boehner Says GOP Will Not Make Nominations For Medicare Cost Control Panel; Four States That Snubbed Health Law Gaining Jobs From It

Now on Kaiser Health News' blog, Jenny Gold reports on a boost in community health center funding: "Once upon a time, there were the navigators, then the in-person assisters, and the certified application counselors. Now, add community health centers to the list of individuals and organizations available to help consumers sign up for the new health insurance marketplaces scheduled to open Oct. 1. On Thursday, the Obama administration pledged $150 million to help community health centers provide in-person enrollment assistance to uninsured patients" (Gold, 5/9).

Also on the blog, Mary Agnes Carey writes about the latest on the GOP and IPAB: "Note to the Obama administration: Don't wait by the phone for those GOP nominations to the Independent Payment Advisory Board, a panel created in the health law to make recommendations to Congress on how to control Medicare costs. House Speaker John Boehner, R-Ohio, made it clear Thursday that neither he nor Senate Minority Leader Mitch McConnell, R-Ky., would be sending in any names for consideration" (Carey, 5/9).

In addition, Phil Galewitz reports on how four states that chose not to pursue a key parts of the health law are still gaining jobs from the overhaul: "Four states that have snubbed the federal health law by defaulting to the federal government to build new online insurance marketplaces and not agreeing to expand Medicaid are getting new jobs at call centers that will help consumers understand their new coverage options this fall" (Galewitz, 5/10). Check out what else is on the blog.

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Political Cartoon: 'No Kidding?'

Kaiser Health News provides a fresh take on health policy developments with "No Kidding?" by Gary Varvel.

Meanwhile, here is today's health policy haiku:


Who needs crystal ball
when you have a direct line
to Capitol Hill

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

Community Health Centers Get $150M To Help Uninsured Enroll In New Coverage

The funding is to hire staff, train existing staff and perform outreach and educational activities. The idea is to help consumers sign up for coverage sold through new online insurance marketplaces that are scheduled to open on Oct. 1 under the Affordable Care Act.

Los Angeles Times: Obama Administration Moves To Get More Enrolled In Health Insurance
The Obama administration announced Thursday that it would provide millions of dollars to community health centers to help them enroll Americans in health insurance programs next year under the president's health law. The move comes as the administration faces growing pressure from Democrats and other supporters of the 2010 Affordable Care Act to show how it will get Americans into health plans, a key goal of the landmark legislation (Levey, 5/9).

The Associated Press/Washington Post: Health Centers Get $150 Million To Help The Uninsured Navigate New Coverage Options
The money addresses concerns from Congress and advocacy groups that many consumers will have a hard time navigating the health coverage options available to them next year as a mix of government programs and tax credits for private insurance kicks in (5/9).

Kaiser Health News: Capsules: Community Health Centers Get $150 Million To Boost Exchange Enrollment
Once upon a time, there were the navigators, then the in-person assisters, and the certified application counselors. Now, add community health centers to the list of individuals and organizations available to help consumers sign up for the new health insurance marketplaces scheduled to open Oct. 1. On Thursday, the Obama administration pledged $150 million to help community health centers provide in-person enrollment assistance to uninsured patients (Gold, 5/9).

Here's how the news is playing in a sampling of states -

Health News Florida: Community Clinics To Offer Obamacare Enrollment
Four dozen community health centers in Florida are eligible to share $8 million in federal grants to become enrollment centers for uninsured people who need to sign up for subsidized insurance coverage under the Affordable Care Act, the Obama administration announced Thursday (Gentry, 5/10).

Kansas Health Institute: Safety-Net Clinics Eligible For $1.7 Million In Federal Marketplace Grants
Federal official today announced that 16 safety-net clinics in Kansas are eligible for more than $1.7 million in grants to help enroll the state’s uninsured and underinsured residents in affordable health insurance plans…The insurance plans will be available through the federally administered health insurance marketplace, which is scheduled to be up and running on Oct. 1, with coverage starting Jan. 1, 2014 (Ranney, 5/9).

CT Mirror: Community Health Centers Getting Money To Help People Get Covered
Connecticut’s community health centers are eligible to receive an estimated $1.55 million in federal funds to enroll people in health insurance, federal officials announced Thursday. The funds are part of $150 million being awarded to health centers across the country as part of the federal health reform law, the Affordable Care Act. The money is expected to be used to hire new staff, train existing staff and perform outreach and educational activities. The idea is to help consumers understand what coverage is available to them, determine what they’re eligible for, and help them get enrolled (Becker, 5/9).

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Obama To Talk Health Law's Benefits For Women, Families

In an effort to rally public support for the overhaul, President Barack Obama will talk about provisions that benefit women as part of a Mother's Day-themed event.

The Associated Press/Washington Post: Obama Launches New Effort To Sell Health Care As Law's Main Components Near Implementation
President Barack Obama is launching a new effort to rally the public around his hotly disputed health care law, a strategy aimed at shoring up key components of the sweeping federal overhaul and staving off yet another challenge from Republicans. The president will specifically target women and young people, groups that backed him overwhelmingly during his presidential campaigns. During a Mother's Day-themed event at the White House on Friday, Obama will promote the benefits of the law for women, including free cancer screenings and contraceptives, and ask moms to urge their uninsured adult children to sign up for the health insurance "exchanges" that open this fall (5/10).

The Hill: Obama To Tout Health Law's Benefits For Women At Friday Event
President Obama will make a public defense of his signature healthcare law Friday, using Mother's Day as a backdrop. Obama will highlight popular pieces of the healthcare law, such as the provision allowing children to stay on their parents' insurance policies through age 26, a White House official said. He'll be flanked by "women and families" who have benefitted from the law (Baker, 5/9).

CNN: President To Tout Obamacare Benefits
The Affordable Care Act, enacted in 2010 but still the focus of intense Republican scorn, will get a boost from its champion President Barack Obama on Friday at an event singling out the law's benefits for women. His remarks, to be delivered at the White House, will be made alongside women and families the White House says are already benefiting from the measure, which has become known as Obamacare. The event is pegged to Mother's Day (Liptax, 5/9).

House Minority Leader Nancy Pelosi is also hailing the health law--

The Hill: Pelosi: Dems Eager For 'Remarkable' Reforms Coming In ObamaCare
House Minority Leader Nancy Pelosi (D-Calif.) on Thursday hailed the implementation of healthcare reform as "remarkable" and said Democrats are "very pleased" the central elements of the law are soon coming into force. Some Democratic leaders have expressed worry that any glitches in the law's implementation will provide Republicans with easy attack lines heading into the 2014 midterms (Lillis, 5/9).

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Feds Offer Positive Signals About Progress On Health Exchanges

USA Today reports that federal officials say the government is meeting deadlines, testing systems and putting the infrastructure in place to get these online insurance marketplaces up and running. Also, Modern Healthcare reports that the National Association of Health Underwriters is urging extensive training for the exchange navigators.

USA Today: U.S. Says It's On Track To Make Health Exchanges Work
The federal government has met its deadlines, tested its system and collected insurance plan information critical to rolling out the 2010 health care law, White House and other federal officials say, despite the rumors of train wrecks, delays and bare-bones health care exchanges rocking Washington (Kennedy, 5/9).

Modern Healthcare: Reform Update: More Training, Certification Urged For Navigators
Individuals who act as navigators assisting consumers in applying for health coverage through state insurance exchanges should have extensive training and exam-based certification, the trade association for brokers and agents has told the CMS. In comments submitted May 6 regarding a proposed CMS rule on standards for navigators and other assistance personnel, National Association of Health Underwriters Senior Vice President of Government Affairs Jessica Waltman writes that navigators will also need recertification and that appropriate steps must be taken to guard against conflict-of-interest issues impacting navigators' work (Block, 5/9).

Kaiser Health News: Capsules: Four States That Snubbed Health Law Gaining Jobs From It
Four states that have snubbed the federal health law by defaulting to the federal government to build new online insurance marketplaces and not agreeing to expand Medicaid are getting new jobs at call centers that will help consumers understand their new coverage options this fall" (Galewitz, 5/10). Check out what else is on the blog.

In addition, news from California, Maryland, Idaho and Colorado -

Sacramento Bee: California Health Exchange Poised To Hand Out Millions In Outreach Grants
Tens of millions of dollars in outreach grants are set to be awarded next week in a massive campaign to persuade uninsured Californians to buy coverage as a linchpin in the looming health care overhaul. Applicants include community-based nonprofits, social service centers, huge labor unions and school districts - including Los Angeles Unified School District and Service Employees International Union, one of the state's largest health care unions (Sanders, 5/9).

The Associated Press/Washington Post: Maryland To Allow Health Exchange Information Requests, Confidential, Financial Info Protected
Maryland will make information related to its health benefit exchange available through public information requests. But the state’s Public Information Act does prevent disclosure of confidential commercial or financial information. Rebecca Pearce, executive director of the Maryland Health Benefit Exchange, says information that could cause substantial harm to the competitive position of the contractor would not be subject to the state’s public information laws (5/9).

Politico: Idaho Ready To 'Beg, Borrow, Steal' For Exchanges
Can a state actually build an Obamacare health insurance exchange in six months? Idaho’s about to find out — with a little help from the feds. The newly formed Idaho exchange board and the federal exchange office have been talking about ways the state can remain in control of its exchange while borrowing pieces of the federal exchange's infrastructure. As interim Chairman Stephen Weeg puts it, Idaho is looking to "beg, borrow and steal" its way to the Oct. 1 start of open enrollment (Millman, 5/10).

Kaiser Health News: Colorado Exchange Board Spars Over Federal Funding
Here's the question making the rounds in Colorado: Is the state asking for enough start-up money from the federal government for its online health insurance marketplace? Consumer advocates are worried the answer is 'no.' Statehouse Republicans, on the other hand, think it’s asking for far too much. Colorado exchange CEO Patty Fontneau is playing Goldilocks, saying the $125 million federal grant request she wants to send to Washington is just right (Whitney, 5/10).

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In States That Opt Against Medicaid Expansion, Rural Areas Could Miss Out

Also in the news, updates from Kentucky, where Gov. Steve Beshear announced he will proceed with the expansion; Michigan, where lawmakers advance a plan to expand Medicaid -- with conditions; and California, where a compromise proposal continues to be a hot topic.

Marketplace: How Some Rural Areas Are Being Pinched By Lack Of Medicaid Expansion
An expansion of Medicaid under the Affordable Care Act is supposed to cover more of the working poor and balance out cuts that were made to already-struggling hospitals. But Republican-led states have been opting out or at least holding out, and outlying areas in states like Tennessee may be the hardest hit. … Partners for Healing in Tullahoma, Tenn., offers care solely to the working uninsured, and there are plenty of them in this town of 18,000. There’s no shortage of studies showing rural Americans are more likely to have low-wage jobs, and thus have no insurance (Farmer, 5/9).

Reuters: Kentucky Governor Announces Medicaid Expansion Under Obamacare
Kentucky Democratic Governor Steve Beshear said on Thursday he will expand Medicaid coverage under President Barack Obama's healthcare reform law, a move that will cut the state's uninsured population almost in half. The expansion will extend coverage to adults earning up to 133 percent of the federal poverty line, providing public health assistance to more than 300,000 people (Humer, 5/9).

The Associated Press: Michigan House GOP Backs Expanded Medicaid, With Conditions
Snyder and others pushing for Medicaid expansion under the federal health care law, though, credited GOP lawmakers for putting forth a House bill for discussion. Senate Republicans met behind closed doors to talk about the plan and reached no consensus. It was crafted by a GOP workgroup of two representatives and two senators (Eggert, 5/10).

California Healthline: Budget Revision May Bring Medi-Cal Expansion To A Head
Hoping to end a stalemate in California's debate over how to expand Medi-Cal, a health advocacy group has come up with a compromise proposal. Health Access California proposes a time frame and percentages for the state and counties to share $1.4 billion in savings when Medi-Cal coverage is expanded through the Affordable Care Act next year. State and county officials have been wrangling behind closed doors about how the windfall should be divided (Gorn, 5/9).

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Capitol Hill Watch

GOP Leaders Refuse To Name Candidates For Medicare Cost Control Board

House Speaker John Boehner tells reporters that he and Senate Minority Leader Mitch McConnell will not nominate anyone to serve on the Independent Payment Advisory Board.

The Associated Press/Washington Post: GOP Leaders Say They Won’t Name Candidates to Health Care Advisory Board
House and Senate Republican leaders told President Barack Obama Thursday that they will refuse to nominate candidates to serve on an advisory board that is to play a role in holding down Medicare costs under the new health care act (5/9).

Kaiser Health News: Capsules: Boehner Says GOP Will Not Make Nominations For Medicare Cost Control Panel
Note to the Obama administration: Don't wait by the phone for those GOP nominations to the Independent Payment Advisory Board, a panel created in the health law to make recommendations to Congress on how to control Medicare costs. House Speaker John Boehner, R-Ohio, made it clear Thursday that neither he nor Senate Minority Leader Mitch McConnell, R-Ky., would be sending in any names for consideration (Carey, 5/9).

In that same press conference, Boehner talked about the upcoming vote on repealing the health law -

Politico: John Boehner: Health Care Law Repeal Vote Is For New Lawmakers
House Speaker John Boehner said Thursday that next week's vote to repeal the health reform law is being held to provide new lawmakers a chance to vote on it. "We've got 70 new members who have not had an opportunity to vote on the president's health care law," Boehner said. "Frankly they've been asking for an opportunity to vote on it" (Haberkorn, 5/9).

And health insurance was a flashpoint at a Capitol Hill hearing -

CQ HealthBeat: Health Insurance Tax's Effect On Farms, Small Businesses Criticized
Even the farmers are getting riled up about the new health insurance tax. At a hearing Thursday before a House small business subcommittee, the president of the New York Farm Bureau was among the witnesses who blasted the tax, which will be levied on insurers beginning in 2014. The tax is intended to generate billions in revenue for implementation of the health care law from insurers, who will benefit from more people enrolling in their plans for coverage (Norman, 5/10).

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Senate Bill On FDA Oversight Of Compounding Pharmacies Gets Broad Backing As Hearings Move Closer

A bill to give the FDA greater authority over compounding pharmacies like the one behind a deadly meningitis outbreak gets broad -- including bipartisan -- backing, and a key committee chairman readies a hearing on the legislation.

Politico: Senate FDA Oversight Bill Has Bipartisan Backing
A Senate panel continued to build the case Thursday for giving the Food and Drug Administration broad authority to crack down on compounding pharmacies like the one behind the deadly fungal meningitis outbreak, pledging to pass a bill before Memorial Day (Norman, 5/10).

Medpage Today: Senate Bill On Compounding Coming Closer
The Senate appears ready to move on a bill that aims to provide greater oversight to large-scale compounders like the one at the center of last fall's fungal meningitis outbreak. Lawmakers received feedback Thursday on how they can fine-tune a draft bill that creates a new class of compounding pharmacies for those who act more like manufacturers. Stakeholders -- including the FDA, a public-policy think tank, and pharmacy groups -- were generally supportive of the draft senators released late last month. "Just from the general tone of what I hear, I think we're very, very close to having what we need," Sen. Tom Harkin (D-Iowa), chair of the Senate Health, Education, Labor, and Pensions Committee, said at a hearing on the issue (Pittman, 5/9).

Stateline: State Pharmacy Regulators Back Senate Bill On Drug Compounding
The organization representing state pharmacy regulators Thursday endorsed federal legislation that would give the Food and Drug Administration authority over large compounding pharmacies, including the Massachusetts company whose tainted drugs last year sickened or killed 741 people in 20 states. A rare form of fungal meningitis was traced to contaminated steroids made and sold by the New England Compounding Center in Framingham (Ollove, 5/9).

In other news, Iowa Sen. Chuck Grassley wants closer scrutiny of firms that dig around Capitol Hill for information to use in financial market dealings --

The Washington Post: Sen. Grassley: 'Political Intelligence' Firms Need More Transparency, Disclosure
Sen. Charles E. Grassley, the Iowa Republican who has been leading an inquiry into "political intelligence" firms, said this week that he is not seeking to dismantle such firms or vilify the actions of Capitol Hill staffers who have communicated with them. These firms hire armies of consultants to scour Washington for bits of information on federal actions that could influence the financial markets, and then sell the information to Wall Street investors. The industry was thrust into the spotlight in April, when a Washington brokerage called Height Securities revealed a key Medicare funding decision to its clients before the administration formally announced it, triggering a surge in health care stocks (Hamburger and ElBoghdady, 5/9).

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Health Spending And Fiscal Battles

Older Americans Fare Well With Budget Impasse Regarding Medicare, Other Entitlements

The Associated Press/Washington Post: Entitlement Programs Thrive Amid Gridlock, Shifting Money From Younger Generations To Older
With Congress increasingly unable to resolve budget disputes, federal programs on automatic pilot are consuming ever larger amounts of government resources. The trend helps older Americans, who receive the bulk of Social Security and Medicare benefits, at the expense of younger people. This generational shift draws modest public debate. But it alarms some policy advocates, who say the United States is reducing vital investments in the future (5/10).

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Coverage & Access

Who Is Responsible For Retired Football Players' Medical Costs?

The Washington Post: Do No Harm: Who Should Bear The Costs Of Retired NFL Players' Medical Bills?
Who should bear the costs of football-related medical problems that arise years after retirement? This question is at the heart of Williams’s case — and scores of others like it. The average NFL player’s career lasts just 3.3 seasons. Studies show that one in four retirees will need a joint replacement, they suffer arthritis at five times the rate of their peers and are four times as likely to suffer neurodegenerative diseases, such as Alzheimer’s or ALS (Jenkins and Maese, 5/9).

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State Watch

State Highlights: Feds Sue Fla. Senate President's Former Co. Over Medicare Billing

A selection of health policy news from Florida, Oklahoma, California, North Carolina and Oregon.

The Associated Press/Washington Post: Florida Senate President's Former Hospice Company Sued By Feds For Alleged Medicare Fraud
Department of Justice is suing the hospice company founded by Florida's Senate president, accusing it of submitting tens of millions of dollars in fraudulent Medicare claims for more than a decade, including while Don Gaetz was vice chairman of the board (5/9).

The Associated Press: Consulting Firm Says State Medicaid Board Should Consider Expanding Insurer Oklahoma Program
A consulting firm hired by Oklahoma to help answer the question of how to insure 200,000 people without health coverage told the state's Medicaid board Thursday that an existing program could be used to build a broader system by 2015. Utah-based Leavitt Partners gave the Oklahoma Health Care Authority Board its preliminary report at Thursday's regular monthly board meeting (Holtmeyer, 5/9).

San Jose Mercury News: Barbara Lee Bill Would Push States To Roll Back Criminal HIV Laws
California and other states would be pressured to amend or repeal criminal laws that single out HIV-positive people under a bipartisan bill co-authored and introduced this week by Rep. Barbara Lee. Lee, D-Oakland, said 32 states and two U.S. territories have laws that criminalize exposing another person to HIV even if the virus isn't actually transmitted. And 36 states have reported at least 350 cases in recent years in which HIV-positive people have been arrested or prosecuted for consensual sex, biting and spitting, according to the Center for HIV Law and Policy (Richmond, 5/9).

North Carolina Health News: Cancer Drug Parity Bill Passes House
A bill aimed at reducing the cost burden for people with cancer who take oral medications made it through a vote on the floor of the state House of Representatives Thursday afternoon, getting it one step closer to law (Hoban, 5/10).

North Carolina Health News: State, Feds Move to Increase Hospital Price Transparency
By coincidence, a proposed N.C. bill to increase hospital transparency moves through committee on the same day the federal government releases data on hospital pricing (Hoban, 5/9).

Oregonian: Two Oregon Insurers Rethink 2014 Premiums As State Posts First-Ever Rate Comparison
This is what competition looks like: One health insurer wants to charge $169 a month next year to cover a 40-year-old Portland-area non-smoker. Another wants $422 a month for the same standard plan. The new health insurance marketplace envisioned by federal health reforms doesn't formally kick in until fall. But it already is taking shape -- and consumers for the first time can compare, premium by premium, identical plans by different insurers. Soon they'll be able to compare benefit-by-benefit as well (Budnick, 5/9).

California Healthline: Provider Cut Repeal Talk Turns To Veto Override
Two bills repealing the 2011 Medi-Cal provider reimbursement rate reductions have sailed through California legislative committees so far in an unusual way: They've been approved with unanimous votes in both houses from both parties. But all those Yes votes could fail on a single No vote if Democratic Gov. Jerry Brown vetoes the bills. He has 50 million reasons every month to use his veto stamp. The savings to the state from the 10 percent across-the-board Medi-Cal provider rate cut amounts to an estimated $600 million a year (Gorn, 5/9).

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Health Policy Research

Research Roundup: Out-Of-Pocket Costs On Individual Market

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

Health Affairs: Some Families Who Purchased Health Coverage Through The Massachusetts Connector Wound Up With High Financial Burdens – Since many of the people who will gain insurance under the federal health law will likely get such individual plans through the state-based online marketplaces, or exchanges, researchers sought to identify the effects on vulnerable populations, some of whom with incomes above 400 percent of the poverty level and thus will not qualify for Medicaid or receive subsidies. After surveying families who participated in "unsubsidized plans offered in the Massachusetts Commonwealth Health Insurance Connector Authority" - the state's exchange - they found that those with lower incomes, increased health care needs and more children will be at greater risk for financial burden and higher-than-expected out-of-pocket costs. They concluded: "In implementing the Affordable Care Act, policy makers will need to develop strategies to mitigate financial burden and facilitate discussion between patients and providers about the value of health care choices" (Galbraith et al., 5/6).

Health Affairs: Federal Spending On Behavioral Health Accelerated During Recession As Individuals Lost Employer Insurance – In the recent recession, many Americans who became unemployed lost their health insurance coverage. Using data from the Substance Abuse and Mental Health Services Administration, researchers found that: "(The) average annual growth in spending for behavioral health treatment slowed during the recession, from 6.1 percent in 2004-07 to 4.3 percent during 2007-09." In contrast, the federal behavioral health spending growth went from 7.2 percent in 2004-07 to 11.1 percent during the recession, providing a "critical safety net," the authors write. "The Medicaid expansions in eligibility and health insurance marketplace subsidies made available through the Affordable Care Act will relieve some of the budget pressures faced by state mental health and substance abuse authorities in funding behavioral health treatment services," they conclude (Levit et al., 5/6).

JAMA Internal Medicine: Cognition And Take-Up Of Subsidized Drug Benefits By Medicare Beneficiaries –While many low-income beneficiaries are eligible for subsidies to help cover their out-of-pocket costs for prescription drugs in the Medicare Part D program, enrollment has been low.  Researchers analyzed 2006, 2008, and 2010 survey data from the nationally representative Health and Retirement Study and found that "Older age, poorer cognition, and poorer numeracy strongly and consistently predicted these apparent failures to take up fully subsided drug benefits." They offer several options for policymakers to improve participation in the subsidies and suggest broader implications as federal officials consider structural changes to the Medicare program: "This evidence suggests that policies that rely on seniors' choices to support efficient competition among plans may be less effective when not coupled with government efforts to regulate choice sets and guide beneficiaries to the best available options" (Kuye, Frank, and McWilliams, 5/6).

Urban Institute/Robert Wood Johnson Foundation: Limiting The Tax Exclusion Of Employer-Sponsored Health Insurance Premiums: Revenue Potential And Distributional Consequences – As officials seek to stabilize the federal budget and lower the deficit, one proposal often mentioned is to tax employer-provided health insurance coverage. The authors write: "In this brief, we provide estimates of the revenue potential and distributional consequences of limiting the exclusion from income and payroll taxes at the 75th percentile of 2013 premiums, indexing by GDP. The policy would produce $264.0 billion in new tax revenues over the coming decade while preserving 93 percent of the tax subsidies available under the current policy." While that tax threshold "would affect public-sector employers to a greater extent," they conclude that "limiting the tax exclusion for employer-sponsored insurance could be an important component of a broad-based federal debt-reduction package, while having minimum impacts on those with lower incomes" (Clemans-Cope, Zuckerman and Resnick, 5/8).

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

MedPage Today: Hospitals Move to Shut Down Elective Deliveries
Nearly two-thirds of all U.S. hospitals have instituted policies to eliminate non-medically indicated deliveries prior to 39 weeks' gestation and those policies may be having a positive impact on fetal outcomes, according to a pair of studies presented here at the annual meeting of the American Congress of Obstetricians and Gynecologists (Laino, 5/9).

Reuters: Insurance Law Tied To More Breast Reconstruction
Many more breast cancer patients had breast reconstruction following a 1998 federal law mandating insurance coverage for the procedure, according to a new study. … As a percentage of all the women treated for breast cancer in a given year, the number who got reconstructions rose from roughly 13 percent in 2000 to 36 percent in 2009, the team reports in the medical journal Cancer (Grens, 5/3).

Medscape: Little Benefit in Routine Imaging After Benign Breast Biopsy
Routine imaging studies that are conducted less than a year after a benign breast biopsy are unnecessary, according to a new study. "Our data do not support the routine use of interval imaging following benign concordant breast biopsy," said study author Demitra Manjoros, MD, a breast fellow at Bryn Mawr Hospital in Pennsylvania, during a press briefing at the 14th Annual Meeting of the American Society of Breast Surgeons, held in Chicago, Illinois (Nelson, 5/3).

Medscape: Pediatricians: Fewer Malpractice Claims, Equivalent Payments
Pediatricians have much lower rates of malpractice claims and indemnity payments than other physicians, but similar rates of payments that exceed $1 million, according to an analysis of the malpractice claims of 40,916 physicians (1630 pediatricians) from 1991 to 2005. Anupam B. Jena, MD, PhD, an assistant professor of health care policy and medicine at Harvard Medical School and an assistant physician and professor in the Department of Medicine at Massachusetts General Hospital in Boston, and colleagues present their findings in an article published online May 6 in Pediatrics (Brown, 5/6).

Reuters: Religious Support Tied To Intensive End-Of-Life Care
People with advanced cancer tend to get more aggressive care at the end of life and spend more time in the intensive care unit if they receive spiritual support from their religious communities, according to a new study [in JAMA Internal Medicine]. The report's lead researcher said in that finding was "quite the opposite" of what her team was expecting -- in part because of evidence that spiritual support coming from within a patient's medical team leads to less aggressive care and more use of hospice (Pittman, 5/7).

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Editorials and Opinions

Viewpoints: The Threat From 'Contagion Exhaustion;' An Economist Sees Humor In Hospital Pricing

The New York Times: The Next Contagion: Closer Than You Think
There has been a flurry of recent attention over two novel infectious agents: the first, a strain of avian influenza virus (H7N9) in China that is causing severe respiratory disease and other serious health complications in people; the second, a coronavirus, first reported last year in the Middle East, that has brought a crop of new infections. While the number of human cases from these two pathogens has so far been limited, the death rates for each are notably high. Alarmingly, we face a third, and far more widespread, ailment that has gotten little attention: call it "contagion exhaustion" (Michael T. Osterholm, 5/9).

The New York Times: The Next Pandemic: Not If, But When
Terrible new forms of infectious disease make headlines, but not at the start. Every pandemic begins small. Early indicators can be subtle and ambiguous. When the Next Big One arrives, spreading across oceans and continents like the sweep of nightfall, causing illness and fear, killing thousands or maybe millions of people, it will be signaled first by quiet, puzzling reports from faraway places — reports to which disease scientists and public health officials, but few of the rest of us, pay close attention. Such reports have been coming in recent months from two countries, China and Saudi Arabia (David Quammen, 5/9). 

Los Angeles Times: Is $1,721.75 The Bill You'd Expect For Treating A Cut? 
Medical costs are often inexplicably high and are almost always kept hidden from patients until the bill arrives. Health insurance, meanwhile, is frequently coverage in name only. The federal government released data this week showing that hospitals nationwide charge wildly differing amounts for the same procedure. ... Medicare and private insurers routinely pay less than what a hospital bills, and different insurers will cut different deals with healthcare providers. The bottom line is that, even with this rare look at medical pricing nationwide, consumers are still in the dark about how much treatments actually cost. All we know for sure is that the prices we pay are typically way above the hospital's true expenses (David Lazarus, 5/10).

The New York Times’ Economix Blog: American Health Care As A Source Of Humor
It is not that I inject humor into our otherwise august debate on health policy. Rather, the health system in the United States is in many ways so risible that it comes across as droll even when a dour German-born economist describes it. One of those risible moments occurred this week when the Centers for Medicare and Medicaid Services of the Department of Health and Human Services delivered a giant spreadsheet on hospital charges and payments (Uwe E. Reinhardt, 5/10). 

Los Angeles Times: For Wal-Mart, Should Healthcare Be A Cost Of Doing Business?
Big employers beware -- some California lawmakers want to pressure you to extend health insurance to virtually everyone who lands on your payroll, even part-timers who work less than two hours a day. That's one of the effects that a bill by Assemblyman Jimmy Gomez (D-Echo Park) would have on companies and nonprofits that employ 500 or more people in the state. But it's not the one that Gomez, a former labor leader, emphasizes when talking about the measure, which the Assembly Health Committee approved on a party-line vote April 30 (Jon Healey, 5/9).

The Washington Post: The Successes Of Obamacare
For more than 100 years, leaders from both parties struggled to bring affordable health care to all Americans. When President Obama took up the fight, many people predicted defeat. Three years, 34 repeal votes, one Supreme Court decision and a presidential election later, some are questioning whether government is capable of implementing the historic law. Concern is understandable: The Affordable Care Act (ACA) transforms a health-care system that accounts for one-sixth of the U.S. economy and is central to our lives. But recent history shows that big changes in health-care policy can be implemented (Nancy-Ann DeParle, 5/9).

The Washington Post: Why Obamacare Is Oversold
It's the great moral imperative behind the Affordable Care Act ("Obamacare"): People should not be denied health care because they can't afford insurance. Health status and insurance are assumed to be connected, and opponents have often been cast as moral midgets, willing to condemn the uninsured to unnecessary illness or death. The trouble is that health status and insurance are only loosely connected. This suggests that Obamacare may result in more spending and health services but few gains in the public's health (Robert J. Samuelson, 5/9).

Sacramento Bee: Big Issues Await State In Prepping For Health Reform
We have fewer than five months until the October enrollment launch when uninsured Californians will be able to apply for coverage through the state. Depending on their income, uninsured individuals can either buy insurance in the state's exchange, called "Covered California," or get coverage from expanded Medi-Cal, the joint state-federal insurance plan for lower-income people. Yet some big issues remain unresolved. The state needs to decide them quickly so providers, insurers, community groups, state agencies and counties can prepare for the October enrollment period, with insurance coverage to begin in January (5/9). 

Boston Globe: Student Health: Fighting Abuse Of Stimulants
Student health centers are a necessity to college life. On-campus medical staffs treat students, many living away from home and their regular doctors, for conditions that range from the common cold to severe depression. An increasing number of clinics, however, are opting out of diagnosing attention deficit hyperactivity disorder among their students or are tightening rules on prescribing the much-misused stimulant medications used to treat it. This is a fair decision as long as schools refer students with legitimate needs to trusted off-campus providers (5/10).

Louisville Courier Journal: Dental Decay A Public Health Crisis
Dental disease continues to be one of Kentucky's worst public health crises but gets scant attention in a state already struggling with high rates of cancer, diabetes, heart disease, obesity and a host of other health problems. Yet it afflicts Kentucky at alarming rates — causing pain and infection in the state's youngest children, some of whom arrive in kindergarten having never had a dental screening and many with rotted baby teeth (5/9).

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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.