Daily Health Policy Report

Monday, May 13, 2013

Last updated: Mon, May 13

KHN Original Reporting & Guest Opinion

Health Reform

Women's Health


Coverage & Access

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Under-26 Coverage: Does It Matter If My Child Just Got Out Of Jail? (Video)

Kaiser Health News consumer columnist Michelle Andrews answers a reader question about keeping your children on your health plan until they turn 26, even if they were recently released from jail (5/13). Watch the video or read the transcript.

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Obama: 'The Law Is Here To Stay' (Video)

Kaiser Health News has a video clip from the speech President Barack Obama gave Friday on the health law, in which he emphasized his administration's commitment to moving forward with a full rollout of all the law's provisions (5/10). Watch the video or read the transcript. KHN also tracked news coverage of the speech (5/10).

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Oregon's Medicaid Lottery: A Participant's View

Kaiser Health News staff writer Jordan Rau, working in collaboration with The Washington Post, reports: "After winning the lottery, Mary Carson, 55, was accepted into the Oregon Health Plan, the state's Medicaid program, in 2011. She and her partner live with her three children. They earn about $1,000 a month by making and selling replicas of historic battle knives used in the Civil War and the two World Wars, doing odd jobs and providing respite care for people with cancer. Her comments on a popular blog about some of her own experiences on Medicaid have garnered some attention" (Rau, 5/10). Read the interview.

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Capsules: What A Hospital Charges Vs. What Medicare Pays; Competition Spurs Ore. Insurers To Lower Proposed Rates

Now on Kaiser Health News' blog, Alaska Public Radio's Annie Feidt, working in partnership with KHN and NPR, offers this report on hospital charges: "For the first time, the federal government has publicly shared what hospitals bill Medicare for the 100 most common diagnoses and treatments. The information shows hospitals across the country — and across Alaska — bill dramatically different prices for the same things" (Feidt, 5/13).

Also on the blog, Phil Galewitz reports on competition between insurers in Oregon: "Maybe competition among health insurance plans can lead to lower rates. As soon as Oregon this week became the fourth state to publicly list health insurers' proposed 2014 rates for individual and small group coverage, two plans moved to cut their suggested prices, the Oregonian reported Friday. Providence Health Plan and Family Care Health Plans sought to lower their rates when they noticed they were out of whack compared to competitors — five months before the health law's new online marketplaces even open for enrollment" (Galewitz, 5/10). Check out what else is on the blog.

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Political Cartoon: 'Hitting The Bull?'

Kaiser Health News provides a fresh take on health policy developments with "Hitting The Bull?" by Bob Englehart.

Meanwhile, here is today's health policy haiku:


Like the cidadas,
fundraising requests emerge
from under the ground.

 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

Sebelius Raises Eyebrows By Soliciting Big Donations For Health Law Outreach Campaign

Health and Human Services Secretary Kathleen Sebelius has asked businesses and charitable groups to make large donations to help underwrite the costs of public outreach associated with the overhaul. A GOP leader is questioning the legality of the efforts.

The New York Times: Cabinet Secretary Solicits Large Donations To Publicize Health Care Law
Kathleen Sebelius, the secretary of health and human services, has solicited sizable donations from the Robert Wood Johnson Foundation and H&R Block, the tax preparation service, as part of a multimillion-dollar campaign to ensure the success of President Obama's health care law, administration officials said Sunday, even as a leading Senate Republican raised questions about the legality of her efforts. The foundation is expected to contribute as much as $10 million, while H&R Block is expected to make a smaller donation of about $500,000, the officials said (Pear, 5/12).

The Washington Post: Budget Request Denied, Sebelius Turns To Health Executives To Finance Obamacare
Health and Human Services Secretary Kathleen Sebelius has gone, hat in hand, to health industry officials, asking them to make large financial donations to help with the effort to implement President Obama's landmark health-care law, two people familiar with the outreach said. Her unusual fundraising push comes after Congress repeatedly rejected the Obama administration's requests for additional funds to set up the Affordable Care Act, leaving HHS to implement the president's signature legislative accomplishment on what officials have described as a shoestring budget (Kliff, 5/10).

The Wall Street Journal: Sebelius Sought Industry Funds For Health Law
Because of the way the health law was written, Washington ended up with few resources to try to sign up uninsured people in the 33 states that refused to run their own insurance exchanges. The Obama administration has said before that it wants to try to make up for HHS' limited funding for public outreach work by tapping outside help (Radnofsky, 5/10).

The Associated Press/Washington Post: Senator Takes Issue With Fundraising Pitches By Health And Human Services Secretary
The administration has recently announced it would be directing $200 million to states, private groups and local health centers so that they can hire workers who can help consumers pick the insurance plan best for them. The fundraising pitches appear to be another step along those lines. Beginning Oct. 1, people can start signing up for coverage through new state and federal health exchanges. But Sen. Orrin Hatch, R-Utah, said that soliciting money from health care executives is absurd. "Moving forward, I will be seeking more information from the administration about these actions to help better understand whether there are conflicts of interest and if it violated federal law," Hatch said (5/10).

Reuters: Obama's Health Secretary Seeks Donation From Companies For Healthcare Law
Health and Human Services Secretary Kathleen Sebelius is asking companies for financial donations to help implement President Barack Obama's healthcare overhaul, months before it is due to take effect. In telephone calls that began around March 23, officials say, Obama's top healthcare adviser has been seeking assistance from companies in the healthcare field and other industries as well as from healthcare providers, patient advocacy groups, churches and other charitable organizations (Morgan, 5/11).

The Hill: HHS: Nothing Improper About Sebelius's ObamaCare Fundraising
The Health and Human Services Department (HHS) says there's nothing illegal or improper about soliciting donations to help promote President Obama's healthcare law. Republicans leapt at the news that HHS Secretary Kathleen Sebelius has been asking industry and community groups to donate to Enroll America, an outside organization created to promote the health law and encourage people to enroll in its new coverage options (Baker, 5/12).

Modern Healthcare: GOP Senator Says Sebelius’ Fundraising May Violate Federal Law
The ranking member of the Senate Health, Education, Labor and Pensions Committee on Saturday said HHS Secretary Kathleen Sebelius may be violating federal law in her fundraising efforts to help implement the 2010 healthcare overhaul. Recently Sebelius has asked businesses and charitable organizations to donate money to organizations that are helping to implement the Patient Protection and Affordable Care Act, but an HHS spokesman said in an e-mail the department has not solicited funds from entities that HHS regulates, such as hospitals, insurers and pharmaceutical companies (Zigmond, 5/11).

Politico: Kathleen Sebelius Pitches Health Industry On Obamacare Outreach
HHS Secretary Kathleen Sebelius has stepped up her pitch to health law stakeholders to chip in on Obamacare outreach and enrollment efforts, administration officials confirmed Friday…The Washington Post, which first reported Sebelius’s more aggressive pitch, suggested federal regulations prohibited the secretary from asking for funds from industry officials in her official capacity, that she could only solicit as a private citizen (Cheney and Norman, 5/10).

Also in the news -

Kaiser Health News: Obama: 'The Law Is Here To Stay' (Video)
Kaiser Health News has a video from a speech that President Barack Obama gave Friday, in which he emphasized his administration's commitment to a full rollout of all the health law's provisions (5/10).

Medpage Today: Obama: Don'Be 'Bamboozled' On Health Law
After months of prodding from Democrats on the Hill, President Obama is again taking to the bully pulpit to defend his landmark health reform law, which remains a mystery to many Americans more than 2 years after its passage. The president, speaking from the East Room of the White House, said opponents of the Affordable Care Act spread "misinformation," adding the law is "too important for political games." "Don't just read a blog or some commentary from some pedant that has a political agenda. Make sure you know what the facts are," Obama told the public (Pittman, 5/10).

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Drug Cost Disparities, Small Business Worries Continue To Surround Health Law's Implementation

The Associated Press reports on the emergence of concerns regarding the health law and drug cost disparities. Meanwhile, other news outlets report on how employers continue to have angst about the measure's price tag.

The Associated Press: Huge Drug Cost Disparities Seen In Health Overhaul
Cancer patients could face high costs for medications under President Barack Obama's health care law, industry analysts and advocates warn. Where you live could make a huge difference in what you'll pay. To try to keep premiums low, some states are allowing insurers to charge patients a hefty share of the cost for expensive medications used to treat cancer, multiple sclerosis, rheumatoid arthritis and other life-altering chronic diseases (Alonso-Zaldivar, 5/13).

The Washington Post: Health Insurance Tax 'Scares The Daylights' Out Of Some Small-Business Owners
Many small-business owners worry that a new tax on insurance providers in the health-care law will mean higher premiums for them, undermining the law’s capacity to lower their health-care costs. Starting next year, the federal government will charge a new fee on health insurance firms based on the plans they sell to individuals and companies, known as the fully insured market (Harrison, 5/12).

CT Mirror: Employers Told To Get Ready For The New Health Care Act Now
Speaking at a special seminar Friday, a panel of experts urged employers to start preparing now for implementation of the Affordable Care Act next year. Addressing some 400 business leaders at the Aqua Turf Club in Southington, the panelists explained who gets covered under Obamacare, what the penalties are and how to prepare employees for the change. The session was sponsored by The Connecticut Business & Industry Association. The panel explained that the 2,700-page law is complicated and daunting. Some aspects of the law have already taken effect, such as fees to help pay for implementation. But the bulk of the new regulations that affect Connecticut will kick in in 2014 (Merritt, 5/10).

Politico examines health care and immigration reform -

Politico: A Volatile Mix: Health Care And Immigration Reform
Politically, it's a no-brainer: People in the country illegally shouldn't get government health care benefits. It's such a nonstarter politically, in fact, that politicians don't even question whether it's smart policy to have millions of people remain uninsured for another decade or more, even if Congress does approve a pathway to their legalization (Cunningham, 5/12).

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White House Identifies Key Groups For Health Exchange Enrollment

Also, the Obama administration OKs Utah's dual health exchange while news outlets report on developments from South Carolina, Colorado and Connecticut.

CQ HealthBeat: White House Focuses Effort To Draw Healthy People Into Exchanges
The Obama administration has identified specific groups of people it would like to focus on as it promotes enrollment in the state health insurance exchanges next year. The administration plans a localized approach to reach 2.7 million healthy people who are 18 to 35 years old and without health insurance, according to information provided by senior administration officials (Ethridge, 5/10).

Politico: White House Gives Nod To Utah's Dual Exchange
Utah will be the only state in the country next year to run its own Small Business Health Options Program exchange — under a modified set of Obamacare rules — and let the federal government set up the exchange for the individual market. Republican Gov. Gary Herbert announced Friday that Utah had received a crucial nod from the White House that will allow the state to bend Obamacare’s exchange rules to accommodate the state’s small-business exchange (Cheney, 5/13).

The Associated Press/Washington Post: Feds Approve Utah To Become First State To Use Dual-Model Health Insurance Marketplace
The federal government has approved Utah to become the first state to have a dual-model health insurance exchange in which the state and the federal government divide responsibilities. The plan allows Utah to continue to run its existing health insurance marketplace for small businesses, a system that lets employees pick health care plans in an online exchange. The federal government will run the state’s individual exchange. The two marketplaces will operate independently of each other (5/10).

CQ HealthBeat: HHS Accepts Utah Proposal For Hybrid Exchange
The Department of Health and Human Services on Friday gave its blessing to yet another form of a health insurance exchange, this one a Utah creation that lets the state operate the small business market while the federal government oversees the sale of policies to individuals. In other developments regarding the health care law, Kentucky’s Republican governor announced that the state will expand its Medicaid program and GOP state legislators in Michigan moved that state a little closer to Medicaid expansion as well (Norman, 5/10).

Bloomberg: Haley Leaves Health Law To U.S. As Residents Remain Uninsured
South Carolina is upgrading its Medicaid system, the state-federal health insurance program for the poor, to interface with the new online marketplace. But officials are relying on the U.S. government to promote and run it, said Tony Keck, Haley’s director of the Health and Human Services Department (Niquette, 5/12).

Health Policy Solutions (a Colo. news service): Exchange Board Approves Bid For $125 Million
Colorado’s health exchange board approved a new federal grant request of $125 million on Friday that will include about $13 million to provide in-person assistance to the uninsured. Some board members tried but failed to boost the grant request even higher -- to between $133 and $135 million -- to ensure that Colorado will have enough money to reach out to people who may never have had health insurance and could need extensive help signing up for federal subsidies starting this fall. Now dubbed Connect for Health Colorado, the new exchange is slated to start signing up customers on Oct. 1 (Kerwin McCrimmon, 5/10).

CT Mirror: First Clue To Obamacare Insurance Cost Arrives
The much-anticipated first rate proposal for a health plan to be offered on the state’s new insurance marketplace is in. But that doesn’t mean it’s clear yet what a customer will have to pay to buy insurance once the major provisions of federal health reform kick in. For one thing, the proposal comes from HealthyCT, a new, nonprofit insurer that doesn’t yet do any business in the state. Its rates were created based on projections by the actuarial firm Milliman. Although the federal health reform law limits variations in how much people can be charged, there will still be differences in price based on a person’s age, location and the specific plan the person selects (Becker, 5/10).

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States Officials Wrestle With Medicaid Expansion And Related Issues

Media reports detail the latest on the debate in Mississippi, Michigan, Louisiana, Arizona, California and Iowa.

The Associated Press: Gov. Phil Bryant Gets Off Script In Medicaid Expansion Debate
Sometimes, someone veers from the script. That seemed to be the case last week when [Mississippi] Gov. Phil Bryant said he would try to run Medicaid even if the Legislature failed to pass bills reauthorizing or funding the program (5/12).

The Associated Press: Haveman Doubts Medicaid Time Limit
The Snyder administration's top health official on Friday was both receptive to and critical of Republican lawmakers' alternative plan to make more low-income uninsured adults eligible for Medicaid, expressing confidence that a deal will be reached within a month. [Michigan] State Department of Community Health Director James Haveman told The Associated Press he is a "glass half-full guy" despite having concerns with the legality of a proposed four-year cap on health insurance for nondisabled adults (Eggert, 5/10).

New Orleans Times Picayune: Health Clinics Urge Louisiana Lawmakers To Expand Medicaid Program
On Friday morning, McCree and St. Thomas officials held a news conference to urge Louisiana lawmakers to support bills that would expand health insurance coverage to low-income people through the Affordable Care Act. So far, legislators have rejected a proposal to expand the federal Medicaid program next year, but are still considering legislation that would tap federal Medicaid dollars to buy private insurance coverage (Maggi, 5/10).

Arizona Republic: Arizona House Speaker Tobin Takes On Medicaid Standoff
House Speaker Andy Tobin has emerged as the key player in getting Gov. Jan Brewer’s Medicaid expansion plan through the Legislature, and momentum may be shifting in the nearly dormant Capitol as he appears ready to negotiate. Tobin, R-Paulden, who opposes the Brewer plan as drafted, said he is working on an alternative that could include putting a time limit on the broadened eligibility and the hospital tax that helps fund it, stronger legislative oversight of the state’s Medicaid program and audits of hospital finances (Reinhart, 5/10).

Los Angeles Times: Healthcare Puts Jerry Brown, Capitol Democrats On Different Sides
With California's deficit wiped out and its economy starting to hum, this was to be a year when Gov. Jerry Brown was free of the budget logjams that have paralyzed the Capitol. But instead, the governor has a fight on his hands — with his fellow Democrats. He is on a collision course with them over how to reshape the state's sprawling, complicated healthcare system to conform with President Obama's national overhaul (York and Megerian, 5/10).

The Associated Press: Iowans Worry As Health Care Debate Continues
As negotiations drag out in the state Capitol over how to best provide health coverage for low-income residents, some Iowans are starting to worry about what the debate means for their doctor visits. Kyrie Borsay is one of about 66,000 residents enrolled in IowaCare, a limited benefit program funded by the state and federal governments and offered to people with low wages who don't qualify for Medicaid. She's heard conflicting information about what will happen to the program later this year (5/12).

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Women's Health

Catholic-Secular Hospital Mergers Further Complicate Abortion-Rights Battlefield

Mergers between Catholic and secular hospitals could mean wider restriction of abortion, even as lawmakers in many states consider tighter regulation or bans on the procedure.

The New York Times: Hospital Mergers Reset Abortion-Access Battle
Politicians seeking to restrict access to abortion, a marked trend this year from North Dakota to Arkansas, tend not to get much traction in [Washington state]. Washington is heavily Democratic, leaning left especially on social issues. A majority of voters even put into law a statutory right to abortion in 1970 -- the only state ever to do that. ... But now a wave of proposed and completed mergers between secular and Roman Catholic hospitals, which are barred by church doctrine from performing procedures that could harm the unborn, is raising the prospect that unelected health care administrators could go where politicians could not (Johnson, 5/12).

Elsewhere, a federal judge is refusing to drop his ruling that would allow women and girls of all ages over-the-counter access to emergency contraception --

The New York Times: Judge Refuses To Drop His Order Allowing Morning-After Pill For All Ages
A federal judge on Friday stepped up his criticism of the Obama administration, accusing the Justice Department of making "frivolous" and "silly" arguments in its attempt to delay making the morning-after emergency contraceptive pill available to women and girls of all ages without a prescription (Shear, 5/10).

Los Angeles Times: Judge Again Rejects Limits On Emergency Contraception
In yet another scathing critique of government health officials, a federal judge refused Friday to stay his order making emergency contraceptives available to consumers of all ages without a prescription. Calling government efforts to restrict the sale of drugs such as Plan B "frivolous and taken for the purpose of delay," U.S. District Judge Edward R. Korman of New York wrote that the medications would be available to all unless the 2nd Circuit Court of Appeals ruled otherwise by noon Eastern time on Monday (Morin, 5/11).

And a Supreme Court justice gives a surprising retrospective of Roe v. Wade --

The Associated Press: Ginsburg Says Roe Gave Abortion Opponents Target
One of the most liberal members of the U.S. Supreme Court, Justice Ruth Bader Ginsburg could be expected to give a rousing defense of Roe v. Wade in reflecting on the landmark vote 40 years after it established a nationwide right to abortion. Instead, Ginsburg told an audience Saturday at the University of Chicago Law School that while she supports a woman's right to choose, she feels the ruling by her predecessors on the court was too sweeping and gave abortion opponents a symbol to target. Ever since, she said, the momentum has been on the other side, with anger over Roe fueling a state-by-state campaign that has placed more restrictions on abortion (Keyser, 5/11).

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Medicare Lags In Detecting Hazardous Prescribing Patterns

An analysis by ProPublica and The Washington Post has found that Medicare does little to track doctor prescription patterns when they're prescribing potentially hazardous drugs.

ProPublica/Washington Post: Dangers Found In Lack Of Safety Oversight For Medicare Drug Benefit
An analysis of four years of Medicare prescription records shows that some doctors and other health professionals across the country prescribe large quantities of drugs that are potentially harmful, disorienting or addictive for their patients. Federal officials have done little to detect or deter these hazardous prescribing patterns (Weber, Ornstein and LaFleur, 5/11).

Elsewhere, prices that drugmakers charge for their medicines come under tighter scrutiny --

Reuters: Analysis: Drugmakers Face More Scrutiny Of Discordant U.S. Prices
The world's biggest drug makers have for years enjoyed rich premiums for their medicines in the U.S. market. Those days may be coming to an end. Companies like Pfizer Inc and AstraZeneca have grown dependent on higher U.S. prices to generate profits as generic rivals to their best-selling medicines enter the world market, Europe's government-run health plans clamp down on spending and sales growth in emerging markets stutters (Beasley, 5/10).

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Coverage & Access

Spending For Veterans' Care Delayed

Bloomberg reports that the U.S. Department of Veterans Affairs has put off more than $765 million in spending authorized for equipment and care. Meanwhile, the Los Angeles Times reports on how securing disability compensation has become a battle for many Vietnam Veterans.

Bloomberg: Agency Delays $765 Million In U.S. Veterans Care Spending
The U.S. Department of Veterans Affairs postponed purchases of cardiac monitors, radiological equipment and pain-medication pumps for patients last year. It didn't replace old surgical tools, oxygen-delivery systems or deteriorating operating-room stretchers. In all, the agency delayed more than $765 million it was authorized to spend, affecting veterans' medical care in some cases, according to VA documents obtained through a Freedom of Information Act (Miller, 5/13).

Los Angeles Times: Vietnam Veterans' New Battle: Getting Disability Compensation
(John) Otte is among hundreds of thousands of veterans from the Vietnam era filing for damages four decades after the war. They account for the largest share of the 865,000 veterans stuck in a growing and widely denounced backlog of compensation claims — some 37%. The post 9-11 wars in Afghanistan and Iraq account for 20%. The remainder are from the 1991 Gulf War, Korea, World War II and times of peace. Basic demographics explain some of the filing frenzy. Vietnam veterans are becoming senior citizens and more prone to health problems. Any condition they can link to their military service could qualify for monthly payments — and for many illnesses, it is easier for Vietnam veterans than other former troops to establish those links (Zarembo, 5/11).

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Health Care Marketplace

Medicare Reveals What Hospitals Charge For Many Procedures

News outlets continue plumbing newly released federal data that details for the first time what hospitals charge for some of the most common in-patient procedures.

Kaiser Health News: Capsules: The Dramatic Difference: What A Hospital Charges Vs. What Medicare Pays
For the first time, the federal government has publicly shared what hospitals bill Medicare for the 100 most common diagnoses and treatments. The information shows hospitals across the country -- and across Alaska -- bill dramatically different prices for the same things (Feidt, 5/13).

Arizona Republic: Huge Differences In Hospital Billing, Data Show
The federal government this week shed some light on one of the health-care industry’s most closely held secrets: how much hospitals charge for the most common procedures. Medicare released data for charges and payments for the 100 most common inpatient procedures in 2011, revealing a dramatic variance among hospitals in metro Phoenix and across Arizona. The data also show that Arizona hospitals generally charge more than the U.S. average (Alltucker and Hansen, 5/10).

In California, a patient sues Kaiser Permanente after the insurer granted his request to see a specialist and then declined to pay for his treatment  --

Los Angeles Times: Patient Is Out Of Network, Out Of Luck
A worrisome abdominal pain drove Jalal Afshar to seek treatment last year at health care giant Kaiser Permanente. ... Kaiser granted his request to see a specialist in Arkansas. But it ultimately declined to pay for his treatment there. By June, Afshar said, Kaiser was arranging for hospice care so that he could die at home. Afshar, 58, refused to accept that. Despite Kaiser's stance, he went back to Arkansas for six months of stem-cell transplants, chemotherapy and other treatments that he says saved his life. Now he owes $2 million for his care and is suing the company in state court for breach of contract and unfair business practices (Terhune, 5/10).

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Job Prospects For Nurses Not So Rosy

Georgia Health News: Nurses Without Jobs: A Sign Of The Times
Amber Tench did her homework before deciding to enter a two-year nursing program last year. She talked with nurses, met with career counselors and searched the Internet. Then she took the leap. … It’s true that the need for nurses will never disappear, and the U.S. Bureau of Labor Statistics has projected that 711,900 new nursing jobs will be created by 2020. But in the current economy, the job prospects for a nurse are surprisingly uncertain (Sellers, 5/11).

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State Watch

State Roundup: Texas Lawmakers Push To Modernize Medical Practices

A selection of health policy stories from New York, Tennessee, Oregon, North Carolina, Texas and California.

The New York Times: City Plans New Approach To Disciplining Mentally Ill Inmates
New York City will soon change the way mentally ill inmates are disciplined after breaking rules while in jail, creating alternatives to the more traditional approach of solitary confinement used for most inmates (Yee, 5/12).

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. Patients receiving cancer chemotherapy traditionally get their treatments via intravenous infusions or injections in their doctors' offices. But with new medications that are administered orally, patients don’t need to go to a doctor's office (Hoban, 5/10).

The Texas Tribune: Medical Association Backs Bills To Cut Red Tape
Health care providers in Texas could soon collect or verify patient information by swiping a driver’s license. The measure allowing such data collection is one of a handful that the Texas Medical Association is pushing this legislative session to help modernize medical practices (Aaronson, 5/13).

The Associated Press/Washington Post: Tenn. Hospital On Front Lines Of U.S. Pill Epidemic, Treating Babies Born Dependent On Drugs
He’s less than two weeks old, but he shows the telltale signs of a baby agitated and in pain: an open sore on his chin where he’s rubbed the skin raw, along with a scratch on his left check. He suffers from so many tremors that he’s been placed in a special area so nurses can watch him around the clock in case he starts seizing —or worse, stops breathing (Burke, 5/12).

Kaiser Health News: Capsules: Competition Spurs Ore. Insurers To Lower Proposed Rates 
Also on the blog, Phil Galewitz reports on competition between insurers in Oregon: "Maybe competition among health insurance plans can lead to lower rates. As soon as Oregon this week became the fourth state to publicly list health insurers' proposed 2014 rates for individual and small group coverage, two plans moved to cut their suggested prices, the Oregonian reported Friday. Providence Health Plan and Family Care Health Plans sought to lower their rates when they noticed they were out of whack compared to competitors — five months before the health law's new online marketplaces even open for enrollment" (Galewitz, 5/10).

Stateline: Cities, State Face Off On Mandatory Paid Sick Leave
Soon there will be fewer sick New Yorkers riding the subway, serving food in restaurants, or infecting their classmates, after the New York City Council decided last week to require local businesses to give workers time off if they are ill or have to care for a sick child. But mandatory sick leave, hailed as a progressive public health measure by its supporters, is sparking fierce opposition in several state legislatures (Maynard, 5/13).

Oregonian: Republicans Draw Oregon Hospital Tax Into Debate Over PERS
A tax on big city hospitals became the latest hostage in the fight over public pensions Friday, raising the stakes of ongoing budget negotiations between Democrats and Republicans in the Oregon Legislature. The hospital tax is a key component of the state's health care budget, bringing in as much as $1.3 billion in federal funds, but Senate Republicans said they wouldn't support the tax until an agreement on additional cuts to the Public Employees Retirement System can be reached (Gaston, 5/10).

California Healthline: 'So Many Moving Parts' To Fit Together
The Department of Health Care Services announced this week that the Cal MediConnect duals demonstration project will not start until at least January, 2014, a delay from its previous expected launch date in October, 2013. Advocates for seniors' health care yesterday praised the decision, saying the extra three months will go a long way toward pulling all of the disparate pieces of Cal MediConnect into place. … The Cal MediConnect duals demonstration program affects about 456,000 Californians who are dually eligible for Medicare and Medi-Cal coverage in eight demonstration counties (Gorn, 5/10).

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Editorials and Opinions

Medicaid Opinions: Several State Leaders Come In For Heat For Not Moving Toward Expansion

Editorials and columnists in several papers around the country pressed officials toward accepting a Medicaid expansion and offered suggestions about implementation. Also, comments continued about a recent study on Medicaid.

Los Angeles Times: A Public Health Compromise For California
The Legislature is poised to offer health insurance to millions of additional low-income Californians, with the federal government covering much of the cost. The expansion would be a boon to counties, which collectively spend billions of dollars caring for the indigent uninsured. One sticking point, though, is what to do with the more than $4 billion in sales taxes and vehicle license fees the state has been sending back to counties every year to help pay for public health programs -- and that the Brown administration wants to reclaim. Last week a group of nonprofits offered a sensible compromise, proposing that counties keep the funds if they spend them on a more efficient way to deliver care to the needy (5/12).

Boston Globe: A Trust Fund For New Medicaid Funding
In 2014, the federal government will send hundreds of millions of dollars to Massachusetts to help pay for an expansion of Medicaid under the terms of the Affordable Care Act. How we use those Medicaid funds will influence whether the state will have the financial resources to sustain that expansion over time. The first step in assuring the Medicaid funds are spent properly and as intended by Congress is to segregate them from the general funds of the state. This should be done by placing the new Medicaid revenues into a trust fund that would be dedicated to support Medicaid and other low-income health care programs. It is an idea that makes sense to many consumer, labor, business, and health care leaders (Lynn Nicholas, 5/11).

Lexington Herald-Leader: Medicaid Expansion Right For Ky.; Now Beshear Must Make It All Work
We could trot out other depressing indicators -- from frequency of diabetes to tooth decay -- to explain why Gov. Steve Beshear made the right choice -- the only choice, really -- by expanding Medicaid. ... But here's something that should be even more moving: Universal access won't make a significant difference in Kentuckians' health unless health care changes. Some good ideas are swirling around, but they won't take shape without strong leadership from the state, and that means Beshear. Much of Kentucky already suffers from shortages of primary care. Preparing a medical home for every Kentuckian will take hard work, from the loftiest medical faculty to the community and technical colleges, in order to create the capacity and work force to meet the new demand. The whole system must become more efficient and quality conscious (5/12).

The (Columbia, S.C.) State: Medicaid Madness
Democrats want free Medicaid for the working poor for the next three years; Republicans don't want it, and since Republicans are in complete control in our state, we won't get it, at least not the first year of it. ... when you listen closely to what opponents say, you realize that the opposition stems from their fear that our state couldn't accept just the three-year expansion and then return to the status quo before the federal government started sending us a bill. ... It's a political problem -- a political problem that Republican legislators and the governor have decided to throw away nearly $1 billion next year in order to avoid. They're worried that they won't be able to muster the political support to cut off the Medicaid spigot once it's turned on. ... Talk about not having much confidence in the strength of your own ideas (Cindi Ross Scoppe, 5/12).

Tulsa World: Medicaid Standoff A Disservice To Oklahomans
Does anyone else see the massive irony in Gov. Mary Fallin's latest attack on the Obama administration? She accused the president of not keeping his word and of "actively" seeking to toss 30,000 Oklahomans off a state-subsidized health-insurance program, when she has had it in her power for many months to singlehandedly provide health insurance for an estimated 180,000 residents by next year. Thanks to Oklahoma's inaction, the Insure Oklahoma program really is in jeopardy (5/13).

Cleveland Plain Dealer: Ohio Legislators Should Get Moving On Expanding Medicaid
If Ohio's skittish General Assembly keeps dawdling, voters themselves may be asked to extend Medicaid coverage to hundreds of thousands of Ohioans who now rely on expensive emergency care or care provided by Ohio taxpayers. Given the broad support for Medicaid expansion in Ohio, there shouldn't have to be an expensive referendum campaign to adopt it (5/11).

And in comments about the recent New England Journal of Medicine study of Medicaid in Oregon -

Forbes: Four Reasons Why The Oregon Medicaid Results Are Even Worse Than They Look
For years, lefty health policy wonks have insisted, against all the evidence, that expanding Medicaid would save hundreds of thousands of lives, and that, therefore, opponents of the Medicaid expansion are guilty of a form of mass murder. So it's been interesting to watch their reaction to the Oregon Medicaid study, which found that the $450 billion-a-year program "generated no significant improvement in measured physical health outcomes." They've desperately scoured the study to trumpet any silver lining they can find. But the reality is that the Oregon findings are even worse than they look. Here's why (Avik Roy, 5/11).

The New Republic: What Oregon Really Told Us About Medicaid
But the idea that this study all but blows away the case for the Medicaid expansion, as some Obamacare critics have suggested, still strikes me as wrong-headed. And that’s because these critics make two unfair claims: that the study "proves" Medicaid doesn’t improve health and that financial security, which Medicaid clearly provided its Oregon beneficiaries, was an afterthought in the health care reform debate (Jonathan Cohn, 5/13).

Tampa Bay Times: Medicaid's Benefits Not Easily Dismissed
A new study about the effectiveness of Medicaid in Oregon is being cited by opponents of expanding Medicaid in Florida and elsewhere, who complain the government health insurance program for the poor is a waste of taxpayer money. In fact, the results are more nuanced and suggest there are positive benefits as well as areas that need more study. The findings that Medicaid recipients enjoy lower rates of depression, increases in preventive health care and gains in financial stability should not be so easily dismissed (5/11).

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Viewpoints: Obama Took Risk On Budget Offer And Was Slammed By Rep. Ryan; Health Law Could 'Quash' Progress On Spending

Bloomberg: Obama's Budget Put The Onus On Ryan 
Obama took a risk and proposed a budget containing cuts to entitlements cherished by his party. House Budget Committee Chairman Paul Ryan, a Wisconsin Republican, and his cohorts were unmoved; they wouldn't give an inch on new revenue. Simpson and Bowles gave Obama a pat on the back and largely refrained from criticizing Ryan or House Speaker John Boehner, while corporate leaders ducked. Moreover, Simpson and Bowles have revised their plan and moved to the right, proposing proportionately more spending cuts and less in new revenue. Obama is playing ball, Ryan isn't, and the two deficit hawks, and their CEO supporters, are rewarding the guy who is stiffing them (Albert R. Hunt, 5/12).

Los Angeles Times: Mother Knows Best
There are two things you can do for your mother on Mother's Day. One is to say "thank you." (Over lunch, with flowers.) The other is to ask her for advice -- even if she's not convinced you really want it. ... [Lois Doyle McManus has] got some advice for Congress as it ponders taxes and spending: Go ahead and bite the bullet. Elderly voters aren't as naive, or as greedy, as you seem to take them for. "They're going to have to fix Social Security and Medicare. Those of us who are using it are aware of it. There's something terribly wrong with a medical system that spends as much money as this. We're willing to do our part" (Doyle McManus, 5/12).

The Wall Street Journal: The Health Spending Decline
To the surprise of both political parties and planners of all types, American health-care spending appears to be slowing down. The health growth rate has flattened out at about 3.9 percent over the last three years -- a record low since the 1960s and down from the old normal of 6.2 percent to 9.7 percent in the 2000s. This is rare good economic news, given that health cost growth sends federal entitlement spending soaring and erodes middle-class wage increases. Can this trend last? Maybe, though not with the Affordable Care Act looming to quash any progress (5/12). 

USA Today: The ObamaCare Train Wreck
When the Affordable Care Act was passed, opponents (mostly Republicans) warned that it would be a disaster. Few of us on Capitol Hill could have anticipated that we would later be joined by a raft of former Democratic proponents so eager to distance themselves from ObamaCare that they're using even harsher terms. Let's call these politicians the Train Wreck Club (Rep. Mike Pompeo, R-Kan., 5/10). 

Scripps Howard News Service: Today’s Hospital Pricing Shows A Sickening Disparity
Don’t feel bad if you don't understand the wide, sometimes huge, discrepancies in fees hospitals charge for the same procedure. Or if you don't understand the arithmetical magic the hospitals use to arrive at those fees. Neither does the federal government. Their officials are mystified, too (5/13).

WBUR: Cognoscenti: Complex, Flawed -- And Necessary: Here Comes ObamaCare
Just when you thought it was safe to go back into the news, the dorsal fin of Obamacare has sliced the water's surface. Diehard opponents vow to make next year's midterm elections a referendum on a law they've disparaged as socialist claptrap. Meanwhile, conservative pundit David Brooks spies logistical icebergs ahead as the hellishly complex reforms are implemented. Brooks's concern, based on interviews with experts pro and con, is legitimate but manageable. As for the socialism charge, remember this if nothing else: Mandatory national health insurance was the brainchild of an anti-socialist reactionary (Rich Barlow, 5/13). 

Houston Chronicle: Texas Should Restore Women's Health Care Funding
I would love to report that on this Mother's Day, women's health care is exactly where it should be in Texas: Regardless of her station in life, your mother, wife, daughter, sister or friend has access to the care she needs. But women's health care in Texas is in crisis. The safety net that's supposed to ensure women have access to preventive care and contraceptive services is in tatters, and it has been ever since the Legislature made deep and disproportionate cuts to the state's family planning program last session -- cuts that may soon be reversed (Janet Realini, 5/11).

Sacramento Bee: Steinberg Plan For Mental Health Has Real Merit
Important legislation is emerging that would significantly improve care for the most severely mentally ill people in California. Proposed by Senate President Pro Tem Darrell Steinberg, the package of bills warrants serious consideration by Gov. Jerry Brown, even though the measures would add to state costs, at least in the short run. Among his proposals, Steinberg is calling for construction or leasing of facilities that would provide 2,000 beds controlled by counties for individuals who are in the midst of crisis (5/11).  

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Stephanie Stapleton

Andrew Villegas

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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.