Daily Health Policy Report

Wednesday, May 15, 2013

Last updated: Wed, May 15

KHN Original Reporting & Guest Opinion

Health Spending And Fiscal Battles

Health Care Fraud & Abuse

Health Reform

Capitol Hill Watch

Health Care Marketplace

Coverage & Access

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Doctors Transform How They Practice Medicine

Kaiser Health News staff writer Ankita Rao reports: "The buzz, and anxiety, in the medical profession is palpable – trade magazines tout new coping strategies, doctor groups discuss the transformation of practices. Physicians are experimenting with business models and new practice techniques, hoping to find work that is both financially and personally rewarding" (Rao, 5/15). Read the story.

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Capsules: GOP Raises Concerns About 'Sebelius Shakedown'; Most Doctors Still Waiting On Medicaid Pay Raise; Angelina Jolie, Genetic Testing, And The ACA

Now on Kaiser Health News' blog, Mary Agnes Carey reports on reactions from Republican lawmakers regarding health law fundraising activities: "Senate GOP leaders Tuesday took issue with Department of Health and Human Services Secretary Kathleen Sebelius for soliciting money from private groups to implement the law. Noting the Internal Revenue Service scrutiny of conservative political organizations, the Republicans also said the IRS can’t be trusted to implement the health law" (Carey, 5/15).

In addition, Phil Galewitz reports on the status of a much-awaited Medicaid pay raise: "Five months after primary care doctors who treat Medicaid patients were supposed get a big pay raise, most physicians have yet to see it. Only three states have implemented the pay raise — Nevada, Michigan and Massachusetts, according to the American Academy of Family Physicians" (Galewitz, 5/14).

Also on Capsules, Diane Webber reports on some questions and answers about genetic testing and inherited cancer risks: "Dr. Otis Brawley, the chief medical officer of the American Cancer Society, is on the record with a quick post on Angelina Jolie's startling announcement in a New York Times op-ed that she has had a prophylactic double mastectomy to cut her inherited risk of breast cancer. Jolie's mother, actress Marcheline Bertrand, died of cancer at age 56, and Jolie found through genetic testing that she carries the BRCA1 gene. Brawley, who has been an outspoken critic of overtesting, answers many important questions that Jolie's decision raises" (Webber, 5/14). Check out what else is on the blog.

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Political Cartoon: 'Bloc On Wood?'

Kaiser Health News provides a fresh take on health policy developments with "Bloc On Wood?" by Chris Weyant.

Meanwhile, here is today's health policy haiku:


CBO numbers
suggest shrinking deficit...
Stalls a grand bargain.

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

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Health Spending And Fiscal Battles

Deficit Projections Likely To Reduce 'Grand Bargain' Pressure

The Congressional Budget Office reports the deficit is shrinking at a faster-than-expected rate this year. Medicare and Medicaid outlays are smaller than anticipated, and health care cost increases appear to have slowed. The numbers are expected to lessen the momentum to cut spending on Medicare and other entitlement programs.

The New York Times: U.S. Budget Deficit Shrinks Far Faster Than Expected
In revising its estimates for the current year, the budget office also cut its projections of the 10-year cumulative deficit by $618 billion. Those longer-term adjustments are mostly a result of smaller projected outlays for the entitlement programs of Social Security, Medicaid and Medicare, as well as smaller interest payments on the debt. The report noted that the growth in health care costs seemed to have slowed — a trend that, if it lasted, would eliminate much of the budget pressure and probably help restore a stronger economy as well. The C.B.O. has quietly erased hundreds of billions of dollars in projected government health spending over the last few years (Lowrey, 5/14).

Los Angeles Times: Federal Deficit Shrinks At Surprising Rate
Three major factors account for most of the long-term improvement: a better economy, a continued slowdown in the rate of medical inflation — which reduces the cost of Medicare and Medicaid — and higher taxes that Congress approved as part of the "fiscal cliff" deal in January, the budget office said. In addition, the automatic budget cuts that took effect this spring have reduced spending in the short term. … The numbers have an important political impact. Republicans have pushed for big reductions in government programs this year, arguing that the country could face a debt crisis if spending is not curtailed. The Obama administration and congressional Democrats have argued that big new reductions have less urgency because the budget picture is already getting better. The new figures from the budget office, which both parties rely on as a nonpartisan arbiter, will probably give more impetus to the Democrats' position (Lauter, 5/14).

The Washington Post: CBO Sees Brighter Economy With Budget Deficit To Plunge To $642 Billion This Year
After 2015, the CBO forecasts that deficits will gradually begin rising again as the baby-boom generation taps into Social Security and Medicare. Although borrowing will stabilize, the national debt will remain at historically high levels, the CBO said, stuck above 70 percent of the economy throughout the next decade. … Still, the improvement in the short-term forecast has removed the air of crisis that has hovered around the budget deficit since President Obama took office. On Tuesday, some analysts urged congressional Republicans to call an end to their fixation on budget cutting (Montgomery, 5/14).

The Wall Street Journal: Deficit Is Shrinking Quickly
A rapidly shrinking federal budget deficit is upending bipartisan talks to reach a federal budget deal, illustrating the conundrum Washington faces with an improving near-term fiscal outlook but continued longer-term pressures tied to aging baby boomers. … The White House and Republicans have been locked in a budget fight since 2011, leading to a number of piecemeal deals that have reduced the deficit by both raising taxes and cutting spending. White House officials have said they want more tax increases while Republicans have called for structural changes to Medicare and Medicaid, the two sprawling government health-care programs, while saying they won't back new tax increases. Earlier this year, a bipartisan effort was under way to lock in more deficit cuts, particularly later in the decade, but those talks have stalled in recent weeks, in part because of the shrinking deficit (Paletta, 5/14).

Modern Healthcare: CBO Projects Less Growth In Healthcare Spending
Noting the society-wide slowdown in healthcare spending, Congressional Budget Office analysts on Tuesday sharply lowered their projections for the next decade's outlays on Medicare, Medicaid and covering the uninsured under the healthcare reform law. The changes – sure to be welcomed by the White House and healthcare reformers – helped lower the CBO's overall projections for the government deficit by $618 billion through 2023 compared with estimates offered just three months ago (5/15).

National Journal: Are Health Care Costs Healing Themselves?
A mysterious shift in health spending patterns could have major implications for the fiscal policy debate—if only experts could figure out what’s behind it. The soaring cost of Medicare and other health programs is expected to be a key driver of the ballooning federal debt in coming years, thanks to the retirement of the baby-boom generation and fast-rising health costs (Chokshi, 5/15).

The Associated Press/Washington Post: Projected Lower Deficit This Year Could Further Slow Any Demand For Big Budget Deal
Now, the improving picture seems likely to make it more difficult for events to force Washington’s exhausted budget combatants closer to a deal. For starters, it means that the deadline for increasing the government’s borrowing cap has been postponed until October or November, the CBO said. It had been expected that lawmakers would have had to act this summer to increase the so-called debt limit, which could have been a catalyst for a broader budget deal (5/14).

The New York Times' Political Memo: For Republicans, Incentives To Strike A Budget Deal With Obama
Ask around the White House and the Capitol, and you will quickly find reasons to doubt that Republicans will compromise with President Obama on a budget deal that includes more tax increases and spending cuts in social programs. … Delaying steps to rein in Social Security, Medicare and Medicaid, the subjects of Republican doomsday warnings for years, means delaying significant attempts to curb the size of the government. The longer the delay, the sharper and more immediate the changes Washington must eventually make to ease the long-term fiscal squeeze (Harwood, 5/14).

Other CBO projections regarding the Medicare "doc fix" and health insruance coverage -

National Journal: Good News For Doctors And Budget Hawks
The price tag for repealing a flawed Medicare doctors' pay formula will remain near a recent record low, according to a new estimate from the independent Congressional Budget Office released on Tuesday. It's good news for the physicians and lawmakers who hope to see a permanent "doc fix" in 2013, and suggests the momentum behind achieving repeal is likely to continue this year. What's more, the CBO lowered its estimates Tuesday for Medicare spending between 2014 and 2023 by $85 billion (Hollander, 5/14).

Reuters: Two Million Fewer U.S. Uninsured To Gain Health Coverage: Congressional Researchers
President Barack Obama's landmark healthcare reform law will extend coverage to 2 million fewer uninsured Americans than expected only a few months ago, congressional researchers said on Tuesday. A new report from the nonpartisan Congressional Budget Office said 25 million people who currently lack insurance will obtain coverage through subsidized marketplaces or an expanded Medicaid program over the coming decade, down from a February CBO estimate of 27 million people (Morgan, 5/14).

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Health Care Fraud & Abuse

89 Arrested In $223 Million Medicare Fraud Schemes

Doctors and nurses were among those charged in the bust that spanned eight cities and focused on bogus Medicare charges.

The Associated Press/Washington Post: Doctors And Nurses Among Nearly 100 Charged In $223 Million Medicare Fraud Busts In 8 Cities
Nearly 100 people, including 14 doctors and nurses, were charged for their roles in separate Medicare scams that collectively billed the taxpayer-funded program for roughly $223 million in bogus charges in a massive bust spanning eight cities, federal authorities said Tuesday. It was the latest in a string of similar announcements by Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder as federal authorities crack down on fraud that's believed to cost the program between $60 billion and $90 billion each year (5/14).

Reuters: U.S. Charges 89 People In $223 Million Medicare Fraud Schemes
Federal officials charged 89 people including doctors, nurses and other medical professionals in eight U.S. cities on Tuesday with Medicare fraud schemes that the government said totaled $223 million in false billings. In the latest big Medicare fraud crackdown, more than 400 law enforcement officers including FBI agents fanned out in Miami, Detroit, Los Angeles, New York and other cities to make arrests (Morgan, 5/14).

McClatchy: 89 Arrested In Crackdown By Medicare Fraud Strike Force
Doctors, nurses and other licensed medical professionals were among 89 people recently arrested in nine cities, accused of scheming to defraud the Medicare program of nearly $223 million in false billings, the Obama administration announced Tuesday. The defendants face charges of conspiracy to commit health care fraud, money laundering and violating federal anti-kickback statutes for submitting claims to Medicare for purchases, treatments and services that, according to federal officials, either were medically unnecessary or never provided (Pugh, 5/14).

The Hill: Feds Tout Medicare Fraud Bust
The Obama administration announced Tuesday that 89 people in eight cities have been charged with about $223 million in false Medicare billings. The action is part of a federal initiative against Medicare fraud that has yielded six "takedowns" since 2010, officials said (Viebeck, 5/14).

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Health Reform

Miss. Dems Continue Work To Keep Medicaid Expansion Plans Alive; GOP Lawmakers Offer Proposals To Compete With Ariz. Gov.'s Expansion Vision

In addition, Florida health experts say that state's decision not to pursue the expansion is "bad for business."

The Associated Press: Dems Work On Miss. Medicaid Expansion
Democrats in the Mississippi Legislature say they're working on proposals to keep Medicaid alive and funded in the budget year that starts July 1. They say they're doing this in case Republican Gov. Phil Bryant calls a special session before the end of June. However, Bryant said last week he believes he can run Medicaid without legislative authorization — even with no budget in place (5/15).

Arizona Republic: 2 New Ideas For Medicaid In Arizona
After four months of pondering Gov. Jan Brewer’s plan to broaden Medicaid eligibility under the federal health-care overhaul, Republican leaders of the Arizona House and Senate released competing plans on Tuesday almost simultaneously. Neither is likely to pass muster with the governor, because one would not expand the state’s Medicaid program and the other sends the entire matter to the ballot. But the proposal from Senate President Andy Biggs, R-Gilbert, contained in his fiscal 2014 budget plan, set the legislative wheels in motion after months of inaction (Reinhart, 5/14).

Health News Florida: Health Experts On Medicaid Rejection: 'Bad For Business'
The Florida Legislature's decision against expanding Medicaid will saddle the state’s employers with higher health care costs and was "bad for business," health care experts told business leaders on Tuesday. Florida corporations have been "too quiet" about Medicaid expansion and other health care issues, and should make elected officials aware of their displeasure before the damage gets worse, said William Kramer, a national health policy leader in San Francisco who works with corporations (Lamendola, 5/15).

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Calif. Health Exchange Awards $37 Million For Health Law Education Efforts

The grants will go to 48 organizations to help the state explain benefits, show consumers how to access insurance and encourage small businesses to participate.

Los Angeles Times: California Health Insurance Exchange Announces Grants
Covered California, the state's health insurance exchange, announced $37 million in grants Tuesday to begin the massive task of educating millions of Californians about the new healthcare law. The grants will go to 48 organizations, including universities, nonprofit groups, health foundations and unions. They will help state officials explain the new benefits, show people how to access insurance, and encourage small businesses to enroll (Gorman, 5/14).

CQ HealthBeat: Health Insurance Exchange Helpers Prepare In California
When enrollment in the health care law’s new insurance exchanges opens in October, the prospects for success will turn on a crucial element: people who actually understand health insurance coverage and can explain it in plain language to consumers. Many Americans who will be signing up may never have had insurance in the past or aren’t fluent in English or might have trouble figuring out which plan will be best for their pocketbook and health condition (Norman, 5/14).

And in Maryland -

The Associated Press/Washington Post: State Officials Urge Faith Leaders To Spread Word About New Health Insurance Options
Maryland health advocates urged religious leaders on Tuesday to learn more about how federal health care reform will be implemented in the state so they can pass information on to uninsured congregants. About 150 leaders gathered for the first summit of its kind in the state (5/14).

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Are The Health Law's Coverage Requirements Scaling Back Some Restaurants' Expansion Plans?

The Wall Street Journal: Health-Law Costs Slow Some Fast-Food Chains
Some restaurant operators are scaling back expansion plans because of uncertainty about the expense of insuring employees under the new federal health-care law. The concerns are especially acute among smaller operators who are more likely to be on the cusp of the Affordable Care Act's requirements for increased coverage of workers. The doubt is adding to anxiety over other rising costs for items like ingredients at a time when diners are cutting back on eating out (Jargon, 5/14).

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Capitol Hill Watch

House Slated To Vote On Health Law Repeal -- For The 37th Time

House Republicans have scheduled a vote to undo the health law. This vote marks the 37th time the chamber has considered legislation to repeal, defund or strike all or part of the measure. Meanwhile, The Washington Post fact checks how many pages of regulations exist regarding Obamacare. Also, House and Senate lawmakers continue questioning Health and Human Services Secretary Kathleen Sebelius on her search for private funds for the health law's implementation.

The New York Times: House To Vote Yet Again On Repealing Health Care Law
The 37th time won't be the charm. But House Republicans are charging forward anyway this week on a vote to repeal President Obama's signature health care overhaul, which will put the number of times they have tried to eliminate, defund or curtail the law past the three-dozen mark (Peters, 5/14).

The Washington Post's Fact Checker: How Many Pages Of Regulations For 'Obamacare'?
Rep. Richard Hudson this week offered such an astonishing figure — 33,000 pages of "Obamacare" regulations! — that we immediately wanted to know more. But it turns out that Rep. Hudson got a little bit ahead of himself. An aide said that he misspoke and meant to say 13,000 pages. "Whether it is 13,000, 22,000 or 33,000, it is too many," the aide added. But then it turns out that Senate Minority leader Mitch McConnell (R-Ky.) has actually tweeted a photograph of this stack of paper. By his math, the Obama administration has issued 20,000 pages of regulations "associated" with the new law (Kessler, 5/15).

Kaiser Health News: Capsules: GOP Raises Concerns About 'Sebelius Shakedown'
Senate GOP leaders Tuesday took issue with Department of Health and Human Services Secretary Kathleen Sebelius for soliciting money from private groups to implement the law. Noting the Internal Revenue Service scrutiny of conservative political organizations, the Republicans also said the IRS can’t be trusted to implement the health law (Carey, 5/15).

Fox News: House Committee To Probe Sebelius Soliciting Money For ObamaCare Signups
House Republicans are starting a probe into Health and Human Services Secretary Kathleen Sebelius soliciting donations from companies her agency might regulate, to help sign up uninsured Americans for ObamaCare. Sebelius in recent weeks has asked various charitable foundations, businesses executives, churches and doctors to donate money to nonprofit organizations, such as Enroll America, that are helping to implement President Obama's health care overhaul (5/14).

The Hill: GOP Senators Join Sebelius Investigation
Republicans on the Senate Finance Committee raised questions Tuesday about Health and Human Services Secretary Kathleen Sebelius's push to raise money for a group promoting the Affordable Care Act. Sebelius has asked healthcare stakeholders to contribute to Enroll America, a non-profit group formed to promote the healthcare law and encourage people to sign up for its new coverage options (Baker, 5/14).

National Journal: Search For 'Obamacare' Funding Angers Lawmakers
With money and time running out to implement the president’s health care law, administration officials are looking for funding wherever they can find it—and angering members of Congress along the way. Republicans in Congress are fuming about recent reports that Health and Human Services Secretary Kathleen Sebelius has been calling private companies—including some that her department regulates—and asking them to help with private efforts to educate the public about the Affordable Care Act (Sanger-Katz, 5/15).

Modern Healthcare: Not-For-Profit Systems Back Support For ACA
If HHS Secretary Kathleen Sebelius was indeed calling healthcare executives to solicit donations, she didn't dial the leaders of some of the largest not-for-profit hospital systems or their national trade group. She didn't need to. Republican lawmakers are gunning for Sebelius over reports that she contacted health industry executives to raise funds for organizations campaigning on behalf of the Patient Protection and Affordable Care Act's insurance expansion. Richard Umbdenstock, the American Hospital Association's president and CEO, said federal health officials did "not call us and didn't have to," because the trade group has separately encouraged hospitals to support Enroll America, an organization created two years ago to promote the Affordable Care Act's coverage push (Evans, 5/14).

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Health Care Marketplace

Hospitals: Calif. Bidding War Intensifies; Va. System Eyes Children's Facility

The business of hospitals makes news in California -- where sides are engaged in a bidding war to buy a famed Santa Monica hospital; Virginia -- where pediatricians eye a new children's hospital; and Oregon, where lawmakers passed a new hospital tax.

Los Angeles Times: St. John's Bidding War Escalates
A high-stakes bidding war has erupted for St. John's Health Center, a storied Santa Monica hospital, with a local billionaire teaming up with the Roman Catholic Archdiocese of Los Angeles on an unsolicited offer. The latest bid, expected to be formally announced Wednesday, comes from former drug-company executive and health care entrepreneur Patrick Soon-Shiong, who said in a statement the bid has the support of the archdiocese (Terhune, 5/15).

Richmond Times-Dispatch: Pediatricians Work Toward Children’s Facility
In the past three years, Bon Secours Virginia Health System has boosted the number of pediatric specialists in its physician network to 77, probably double what it was before, as its builds its St. Mary’s for Kids brand. … The "hope" he refers to is the prospect that Richmond will one day have an independently operated, free-standing children’s hospital that would consolidate most pediatric care in the region under that facility’s umbrella. For such an entity to stand a chance of financial success in Richmond, the major hospital systems -- Bon Secours, VCU Health System and HCA -- would have to stop offering most pediatric services at their hospitals (Smith, 5/15).

Oregonian: Oregon House Passes Hospital Tax, But It’s Still Part Of Senate PERS Debate
The Oregon House approved a major piece of the Oregon Health Authority’s budget Tuesday, including provisions extending taxes on hospitals and long-term care facilities, but the bill appears destined to be held up by Senate Republicans. The two taxes were drawn into a larger debate over taxes and public pension spending last week after Republicans cast protest votes against House Bill 2216 in the Legislature’s budget committee (Gaston, 5/14).

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Coverage & Access

Angelina Jolie's Choice Underscores Screening And Treatment Costs

News outlets report on the cost of and questions surrounding Angelina Jolie's decision to have genetic testing and then to undergo a double mastectomy as preventive surgery.

Marketplace: The Cost Of Angelina Jolie’s Cancer Testing? More Than $4,000
Angelina Jolie wrote an Op-Ed in today's New York Times about her decision to have a double mastectomy. The actress didn't have breast cancer, but tests showed she had almost a 90 percent chance of developing it. The key was finding a mutation in a gene known as BRCA-1, and Jolie appealed for the test to be made more accessible to women around the world. At the moment, if you want to get tested for a mutation on your BRCA-1 or BRCA-2 genes, you will have to turn to Myriad Genetics. That's the company that discovered the link between those mutations and an elevated risk cancer -- and it patented the BRCA-1 and BRCA-2 genes. The price tag on a BRCA-1 and BRCA -2 test? More than $4,000 (Smith, 5/14).

Boston Globe: Angelina Jolie’s Preventive Surgery Shows Harsh Choices
Actress Angelina Jolie made a wrenching choice after a blood test detected a genetic defect that made breast cancer all but certain in her lifetime: She opted to have her breasts surgically removed. Her decision starkly highlights the less-than-ideal options available to women confronting a similar diagnosis. … Preventive surgery to remove the breasts and ovaries can dramatically reduce lifetime risk of getting these cancers to 5 percent or less. But those measures also mean an often long and painful recuperation from surgery as well as long-term consequences, such as reduced sexual pleasure and early menopause. … The $3,000 cost of the screening test may be an “obstacle for many women” without health insurance, as Jolie mentioned in her column, published Tuesday in The New York Times (Kotz, 5/15).

Kaiser Health News: Capsules: Angelina Jolie, Genetic Testing, And The ACA
Dr. Otis Brawley, the chief medical officer of the American Cancer Society, is on the record with a quick post on Angelina Jolie's startling announcement in a New York Times op-ed that she has had a prophylactic double mastectomy to cut her inherited risk of breast cancer. Jolie's mother, actress Marcheline Bertrand, died of cancer at age 56, and Jolie found through genetic testing that she carries the BRCA1 gene. Brawley, who has been an outspoken critic of overtesting, answers many important questions that Jolie's decision raises (Webber, 5/14).

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The Challenge Of Increasing Long-Term Care Costs

The New York Times: Covering The Rising Cost Of Long-Term Care
A 2013 report by Genworth Financial, an insurance provider based in Waltham, Mass., estimates the national median daily cost of a private room in a nursing home at $230 a day, an increase of 3.6 percent over 2012 — some $6,900 per month. Sharing that room is only $27 less a day, according to the report (Kelly, 5/14).

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State Watch

Vermont Lawmakers OK Doc-Assisted Suicide

The state will become the first to use a legislative vote to legalize physician-assisted suicide after the governor, who has expressed his support for the measure, signs the bill.

The Wall Street Journal: Lawmakers in Vermont Approve Assisted Suicide
Vermont is poised to become the third state in the nation to allow physicians to prescribe lethal drugs to terminally ill patients who want to die. State lawmakers on Monday night approved an assisted-suicide bill, which now awaits the signature of Gov. Peter Shumlin, a first-term Democrat who has said he would sign it, likely within a week. Once enacted, Vermont would be the first state to decriminalize assisted suicide through a legislative vote (Gershman, 5/14).

Politico: Vermont OKs Assisted Suicide Bill
The approval of an assisted suicide bill in Vermont brings to a close a 10-year battle in the state over the issue and delivers the third state-level victory for advocates seeking to advance the policy nationwide. But the national implications for the bill -- which won legislative approval Monday night and allows doctors to prescribe lethal doses of drugs to some terminally ill patients -- are tough to pinpoint (Cheney, 5/15).

Medpage Today: Vermont Passes Assisted Suicide Bill
Vermont will soon become the fourth state to allow physician-assisted suicide now that state lawmakers there have passed a bill allowing the practice. The bill, the Patient Choice and Control at End of Life Act, next heads to the desk of Gov. Peter Shumlin (D), who is expected to sign the bill into law, having previously expressed his support for it. Taking effect July 1, the law would absolve healthcare professionals licensed in the state of civil or criminal liability if a terminally ill patient self-administers a lethal dose of a drug meant to treat their condition. The physician is required to have examined the patient, who must be expected to live no more than 6 months (Pittman, 5/14).

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Medicaid: Lawsuit Alleges Conn. Application Backlog Breaks Federal Law

Medicaid doctors continue to wait for their pay raise -- five months after they were supposed to get it. In Connecticut, some allege a backlog of applications for the program breaks federal law, and are suing to stop it.

Kaiser Health News: Capsules: Most Doctors Still Waiting On Medicaid Pay Raise
Five months after primary care doctors who treat Medicaid patients were supposed get a big pay raise, most physicians have yet to see it. Only three states have implemented the pay raise -- Nevada, Michigan and Massachusetts, according to the American Academy of Family Physicians (Galewitz, 5/14).

CT Mirror: Suit Hammers Huge Medicaid Backlog, Long Waits
Every month, thousands of poor state residents go without health care coverage while their applications for Medicaid linger, without being approved or denied, for longer than federal law allows. The numbers "tell the whole story," attorney Sheldon Toubman said Tuesday at the start of a trial in Hartford centered on allegations that the state Department of Social Services doesn't have enough workers to handle Medicaid applications within federally required time frames (Becker, 5/14).

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State Roundup: Veto Of Medical Charity Tax Break Scrutinized In Ga.

A selection of health policy stories from California, Georgia, New York, Florida, California and Kansas.

Los Angeles Times: Gov. Jerry Brown Unveils Cautious Budget For Deficit-Free State
But Brown vowed to continue to resist pressure from fellow Democrats and interest groups to restore some money to adult dental care and to doctors who treat the poor. … Sacramento will oversee the expansion this year of Medi-Cal, California's health care program for the poor, to more than 1 million Californians who do not have health insurance now. Under Brown's plan, the newly insured would be offered the same benefits as those already covered by the public program, a shift from January. Then, the governor did not include stays in rehabilitation facilities and other long-term care for those who will become eligible for Medi-Cal for the first time next year (Megerian, 5/14).

Sacramento Bee: Gov. Jerry Brown Takes Cautious Approach On California Budget
Gov. Jerry Brown, dismissive of a surge in state tax revenue that stirred optimism at the Capitol, moved Tuesday to blunt appeals for increased spending, downgrading his budget proposal from January. The budget revision -- an annual exercise opening a month of negotiation with the Legislature -- threatened to strain Brown's relationship with Democratic lawmakers and with social service advocates who called Brown's estimates overly conservative and who are lobbying to restore programs cut during the recession (Siders, 5/14).

Georgia Health News: Veto Sidetracks Tax Break For Medical Charities
Among Gov. Nathan Deal’s five vetoes this year, probably the most surprising one targeted a bill that would have given sales tax breaks to charitable medical clinics, federally qualified health centers, food banks and other charities. The measure, House Bill 193, had overwhelming legislative support. It passed the House unanimously during the 2013 legislative session, and the Senate approved it 52-2. The legislation would have restored sales tax exemptions for community health centers and volunteer charity clinics – tax breaks that had sunset (expired automatically) in 2010 (Miller, 5/14).

The New York Times: Archbishop Presses Cuomo Over Abortion
Cardinal Timothy M. Dolan declined on Tuesday to say whether Gov. Andrew M. Cuomo was "a Catholic in good standing," as he ratcheted up his criticism of the governor's continued advocacy for abortion rights (McKinley, 5/14).

NPR: How A Florida Medical School Cares For Communities In Need
Brown helps direct FIU's Neighborhood HELP program. It's part of the school's curriculum that connects medical students with families in neighborhoods where medical care is scarce. Students visit families in their homes where they conduct examinations and provide basic care. But some things are better done in a clinic. So the medical school bought its own RV. "We're able to bring free basic primary care to our households relatively close to their community," Brown says (Allen, 5/15).

Health News Florida: Prescription Drug Deaths Drop In Tampa Bay
New data reveals the Tampa Bay area's prescription drug problem is on the decline. The number of accidental drug deaths in at least four local counties has dropped since 2010. Pinellas, Pasco, Hillsborough and Hernando counties have all seen a decline in drug overdoses over the last two years (Saleh, 5/15).

HealthyCal: Poor Health Care Moving From Prison To Jails
California’s sweeping criminal justice reform plan was meant to sharply reduce the state’s prison population. But the changes may have also had the unintended consequence of passing along to county jails the biggest problem associated with overcrowding -- poor health care. The reform, also known as prison realignment or AB 109, transferred authority for people convicted of certain non-violent felonies from the state to the counties in 2011 (Flynn, 5/15).

Kansas Health Institute: Kansas Drug Disposal Program Collects 6,000 Pounds Of Medications In First Year
Pharmacist Lori Murdock said she often heard the question even from people who weren’t her customers: How do we get rid of our old drugs? As the owner of Cedar Creek Pharmacy in this western Johnson County community, Murdock responded by signing up a couple months ago for the medication disposal program run by the Kansas Department of Health and Environment (Sherry, 5/14).

California Healthline: Stop-Loss Bill Heads For Senate Floor Vote
The Senate Committee on Appropriations yesterday approved a bill to ban a certain type of selection criteria when insurers issue stop-loss health care coverage to small employers. … The bill would end the practice of cherry-picking healthy employees from the pool of workers within small businesses by stop-loss insurers, said Beth Capell, legislative advocate for Health Access California (Gorn, 5/14).

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Editorials and Opinions

Viewpoints: Controversy Taints IRS Efforts On Health Law; Another Chance To 'Gut' The Overhaul In The Courts; Salt Wrongly Accused

The Wall Street Journal: Your Next IRS Political Audit
Even as the politicized tax enforcement scandal expands, the Internal Revenue Service continues to expand its political powers thanks to the Affordable Care Act. A larger government always creates more openings for abuse, as Americans will learn when the IRS starts auditing their health care in addition to their 1040 next year (5/14).

The Washington Post's The Plum Line: Why Washington Scandal-Mania May Save Medicare And Social Security
Liberals who are dreading the scandal-mania that is taking hold should note that it contains a potential upside: It could make a Grand Bargain that includes cuts to Medicare and Social Security benefits even less likely than it already is. That's because when scandal grips Washington, a president actually needs his core supporters more than ever to ward it off, making it harder to do anything that will alienate them (Greg Sargent, 5/14).

New Republic: The Supreme Court Is About To Get Another Chance To Gut Obamacare
(Michael) Carvin's legal argument, which originated with CATO Institute economist Michael Cannon and Western Reserve law professor Jonathan Adler, is that, due to a drafting glitch in the ACA, only state-run exchanges, not federal ones, can provide tax credits and subsidies to enable lower-income individuals to afford ACA-mandated health insurance. ... So, could rejectionists have any basis for hoping to overturn Treasury's rule? Yes, they could. All the Obama administration's arguments, however well-founded, could be shoved aside, if the case reaches the Supreme Court, and the Court's conservative bloc deploys a "methodology," long touted by Justice Antonin Scalia, for interpreting statutes. Scalia's approach, which he calls "textualism," holds that judges must tease out the meaning of individual statutory words or phrases in isolation, rather than giving weight to the statute's overall structure, design, purpose, or legislative history (Simon Lazarus, 5/13).

The New York Times' Economix: Patterns Of Changes In Health Insurance
A number of industries can expect big changes in employee health insurance in the next year or two, while others will continue with business as usual (Casey B. Mulligan, 5/15). 

Arizona Republic: Fiscal Risks Of Not Expanding Medicaid
Opponents of Gov. Jan Brewer's Medicaid expansion proposal are recklessly minimizing the risk to the (state) of not participating. Arizona is in an unusual position regarding this issue. Most states offer very little Medicaid coverage to childless adults. So, for them, expanding coverage to 133 percent of the federal poverty level is a very big step. And even the 10 percent of that expansion they will end up having to pay under Obamacare is a big bill (Robert Robb, 5/14). 

Politico: Fixing The VA-DOD Health System Fiasco
As health care plans nationwide enter the home stretch of implementing electronic records under the framework of the Obama administration’s Affordable Care Act, and military service disability claims backlogs grow in size and attention, the Department of Veterans Affairs and the Pentagon need a much more coherent approach to modernize and deploy their electronic health record systems (Peter Levin, 5/15).

Medpage Today: Hospitals In Crisis: The Effects Of Obamacare
Under the Affordable Care Act's Hospital Readmissions Reduction Program, hospitals that readmit certain patients within 30 days of discharge could face significant penalties. Under the Affordable Care Act's Hospital Readmissions Reduction Program, hospitals that readmit certain patients within 30 days of discharge could face significant penalties. The question is whether hospitals really have that much control over factors leading to readmission and whether they are really at fault (Dr. Sreedhar Potarazu, 5/14).

The New York Times: Doubts About Restricting Salt
After years of warnings to cut sodium consumption to reduce heart attacks and strokes, it is disturbing to learn how little evidence exists that such reductions would actually be beneficial to health. There is even emerging evidence that some groups in the population could suffer harm from levels that are too low (5/14). 

Los Angeles Times: Doctoring In A Family Way
New policies proposed in April by the Residency Review Committee for Family Medicine, or RRC, the group that outlines requirements for physician training programs nationwide, threaten to interfere with that comprehensive care and to decrease reproductive health access for women like Jennifer. The proposed RRC changes would eliminate the current requirement that family medicine residents learn full-scope reproductive healthcare. Instead, the decision to teach these skills would be up to the discretion of individual residency programs. Family doctors would no longer be required to learn how to prescribe birth control, place intrauterine devices or contraceptive implants, provide options counseling for women with unintended pregnancies or diagnose and manage miscarriages (Alison Block, 5/15).

USA Today: Angelina Jolie, Breast Cancer Fighter: Our View
While her message was brave and important, it's equally important to note that Jolie is among an extremely small percentage of women with an unusually high risk of breast cancer due to her family history and her gene mutation. Only about 1 percent of women test positive for mutations to the BRCA1 or BRCA2 genes that signal elevated risk for breast and ovarian cancer, and most women who develop breast cancer can be successfully treated with less radical treatment if the cancer is caught early (5/14). 

Health Policy Solutions (a Colo. news service): The Ethically Slippery Slope Of Assisted Suicide
While New Mexico and other states are grappling with the question of whether to allow doctors to write prescriptions for drugs that terminally ill patients can take to commit suicide, countries such as Belgium and The Netherlands are pushing the envelope in distressing ways. For those who claim there is no evidence of a slippery slope in abuse of physician-assisted suicide once implemented, I offer several  problems presented by the Belgium and Netherlands experiments. In these countries, it is legal for  physicians to directly euthanize patients (Dr. Anthony Vigil, 5/14).

Health Policy Solutions (a Colo. news service): Making Sense Of Variation In Health Care Pricing
Some have been outraged by the seemingly pointless variation in charges the Medicare data shows. However, some variation in the base charges for hospital services does make sense. Facilities and providers alike need to charge differently depending on how sick and complicated their patients are, whether they have additional overhead costs because they are a teaching facility, number of patients receiving charity care, etc. The more important task, though, is to figure out where variation is not adding value and to identify opportunities to get health care spending under control (Phil Kalin, 5/15).

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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.