Daily Health Policy Report

Thursday, May 16, 2013

Last updated: Thu, May 16

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Health Care Marketplace

Public Health & Education

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Senate Confirms Tavenner To Head CMS

Kaiser Health News' Mary Agnes Carey talks with Jennifer Haberkorn of Politico Pro about the Senate's confirmation Wednesday of Marilyn Tavenner to head the Centers for Medicare and Medicaid Services and the challenges she will face (5/15). Listen to the audio or read the transcript.

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The IRS' Role In The Health Law Comes Under Scrutiny

Kaiser Health News staff writer Mary Agnes Carey talks to Joanna Kerpen, a partner at the law firm McDermott Will & Emery, about the role of the IRS in implementing and enforcing provisions of the health law after recent revelations the agency inappropriately targeted conservative groups that were seeking tax-exempt status (Carey, 5/16). Listen to the audio or read the transcript.

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Capsules: Docs, Nurses Disagree Over Expanded Nurse Roles

Now on Kaiser Health News' blog, Alvin Tran reports: "As nurse practitioners lobby to expand their authority and scope of practice in many states, a New England Journal of Medicine study released Wednesday documents a deep chasm between doctors and nurses on that issue" (Tran, 5/15). Check out what else is on the blog.

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Political Cartoon: 'Sky Is Falling?'

Kaiser Health News provides a fresh take on health policy developments with "Sky Is Falling?"by Rodrigo de Matos.

Meanwhile, here is today's health policy haiku:

IS IT ABOUT THE HEALTH LAW REPEAL, OR THE CAMPAIGN SEASON?

Will 37
be the lucky vote number?
Oh well... Not likely! 
-Anonymous

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

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Capitol Hill Watch

Tavenner Becomes Agency's First Confirmed Chief In 7 Years

In a 91-to-7 vote, the Senate approved President Barack Obama's pick to lead the Centers for Medicare & Medicaid Services. Tavenner, who has been the agency's acting administrator, was endorsed by Rep. Eric Cantor, R-Va.

The New York Times: Acting Chief Wins Confirmation To Run Medicare And Medicaid
The Senate on Wednesday approved President Obama's nominee to run Medicare and Medicaid, Marilyn B. Tavenner, providing the agency with its first confirmed chief in six and a half years. The 91-to-7 vote showed broad support for Ms. Tavenner, a former state health official in Virginia, who was endorsed by Representative Eric Cantor of Virginia, the House Republican leader (Pear, 5/15).

Kaiser Health News: Senate Confirms Tavenner To Head CMS
Kaiser Health News' Mary Agnes Carey talks with Jennifer Haberkorn of Politico Pro about the Senate's confirmation Wednesday of Marilyn Tavenner to head the Centers for Medicare and Medicaid Services (5/15).

Los Angeles Times: Senate Approves Obama Choice To Head Medicare
In an unusual break in the partisan warring over healthcare, the Senate on Wednesday confirmed President Obama's choice to oversee the mammoth Medicare and Medicaid health programs (Levey, 5/15).

The Associated Press/Washington Post: Senate Confirms Tavenner To Run Health Insurance Programs With Bigger Budget Than Pentagon
Together, the programs under the Centers for Medicare and Medicaid Services cover more than 100 million Americans, ranging from newborns in low-income families, to people with severe physical and mental disabilities, to patients under hospice care in their last days of life. Part of the Health and Human Services Department, the agency has a budget of about $850 billion that easily eclipses spending on national defense (5/15).

The Washington Post's Wonk Blog: Medicare Gets Its First Confirmed Leader In Nearly A Decade
Obama nominee Marilyn Tavenner received a 91 to 7 vote on the Senate floor to run an agency that, since 2006, has been without a confirmed leader. Her position, overseeing a $1 trillion agency that administers health benefits to millions, has long been considered too politically volatile to fill (Kliff, 5/15).

The Wall Street Journal: Senate Confirms Tavenner To Health Agency
Medicare and Medicaid have lacked a Senate-confirmed leader since 2006, when Republican appointee Mark McClellan left. Lawmakers from both sides of the aisle have said it is important to have a confirmed Medicare chief to implement the health law, which will allow currently uninsured Americans to sign up for health insurance starting in October. Coverage won't be effective until January (Dooren, 5/15).

Politico: Marilyn Tavenner Approved By Senate For CMS Post
The seven who voted no are Republican Sens. Mike Crapo and Jim Risch of Idaho, Ted Cruz of Texas, Ron Johnson of Wisconsin, Mike Lee of Utah, and Rand Paul and Minority Leader Mitch McConnell of Kentucky. McConnell said the CMS job has too much responsibility for implementing the health law (Haberkorn and Cunningham, 5/15).

Medpage Today: Tavenner Confirmed As Medicare Chief
The office of CMS administrator has been plagued by political turmoil for years, especially since President Obama took office and health reform began playing a more prominent role in public policy. Republicans blocked the nomination of Tavenner's predecessor, Donald Berwick, MD, following comments he made praising aspects of the British healthcare system. Tavenner, a Virginia native, has worked for the past 3 years as CMS' principal deputy administrator before becoming acting administrator following Berwick's departure (Pittman, 5/15).

The Hill: Senate Votes 91-7 To Confirm Tavenner To Head Medicare, Medicaid Services
The Senate confirmed President Obama's nominee to head the Centers for Medicare and Medicaid Services (CMS). On Wednesday, the Senate voted 91-7 for Marilyn Tavenner to lead CMS, which hasn’t had a Senate-confirmed administrator in seven years (Cox, 5/15).

Huffington Post: Marilyn Tavenner Confirmed As Medicare Chief
The Senate had declined to vote on Tavenner's nomination during Obama's first term and failed to vote on Obama's prior nominee, Donald Berwick, or Bush's nominee Kerry Weems. The Centers for Medicare and Medicaid Services already provide health care benefits to more than 100 million Americans and have a budget rivaling the Pentagon's. The agency's role is growing as the Obama administration implements the health care reform law, which will reduce the number of uninsured Americans by an estimated 25 million by 2023. As head of the agency, Tavenner is charged with carrying out key elements of Obamacare, including its expansion of Medicaid (Young, 5/15).

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Repeal Votes Offer Important Campaign Trail Symbol For Some Republicans

Many GOP lawmakers see today's scheduled vote to repeal the health law as important to their campaign trail messaging.

The Washington Post: Voting To Repeal, Over And Over
Since Republicans took control of the House of Representatives in 2011, the House has voted 36 times to repeal either all, or part, of President Obama’s health care law. On Thursday, the House is scheduled to do it again, taking up another bill that would repeal the health care law in full. With number 37 on the way, here are the details of the first 36 votes (Fahrenthold and O’Keefe, 5/15).

Politico: Obamacare Repeal Central For GOP Primary Field
Republicans know their repeal votes on Obamacare are symbolic — but repeal remains a potent GOP message on the campaign trail for the 2014 midterm elections. GOP politicians running for Senate in states like Georgia and Louisiana have been burnishing their Obamacare repeal credentials for months. Some of the Senate candidates are trying to outdo primary opponents in showing how determined they are to roll back the unpopular law. Others hope anti-Obamacare sentiment will let them pick up seats in November that are now held by Democrats, like the one being vacated in Montana by retiring Senate Finance Committee Chairman Max Baucus, who helped write the 2010 health care law (Cunningham, 5/15).

The Hill: House Set To Vote On ObamaCare Repeal
The House will vote Thursday to repeal President Obama's healthcare law — a move Republicans hope will open the door to narrower votes to target specific parts of the law. GOP leaders scheduled the vote in a concession to conservative freshmen, who were not yet in Congress for the House's previous 36 votes to repeal or defund all or part of the Affordable Care Act (Baker, 5/16).

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House GOP Lays Groundwork For Fall Budget Face-Off

The Wall Street Journal: House Republicans Air Budget Ideas, Prepare For Fall Confrontation
The chairman of the House tax-writing committee has been laying the groundwork for advancing an overhaul of the tax code to scale back deductions and reduce rates. … Another idea gaining popularity among some Republicans is to delay implementation of the president's health-care law, which the House is expected to vote to repeal on Thursday. Rep. Steve Scalise (R., La.), chairman of the Republican Study Committee, an influential group of 171 conservative House lawmakers, said he liked the idea of delaying the implementation of health law's insurance exchanges and expansion of Medicaid for at least two years. ‚Ä™ … Other Republicans argued that the party should stick with its longstanding position that increases in the debt ceiling should be matched with spending cuts or by overhauling federal safety-net programs (Peterson and Hook, 5/15).

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Health Reform

Appeals Court To Hear Liberty University Health Law Challenge

The 4th U.S. Circuit Court of Appeals in Richmond, Va., will hear arguments on Thursday related to the lawsuit brought by the Christian university.

The Associated Press/Washington Post: Appeals Court In Va. To Hear Christian University's Suit Against Obama Health Care Law
Liberty University's challenge to the Obama administration’s health care law is back before a federal appeals court in Virginia. A three-judge panel of the 4th U.S. Circuit Court of Appeals in Richmond hears arguments in the case Thursday. Liberty claims the health care law violates the school's religious freedoms. The Christian university is challenging the requirement that most people obtain health insurance or pay a penalty, as well as provision requiring many employers to offer health insurance to their workers (5/15).

Politico: Liberty Still Pushing Its Challenge To Obamacare
Liberty University's challenge to the health reform law will go back before the 4th Circuit Court of Appeals in Richmond, Va., on Thursday, with the school focused on getting Obamacare back before the Supreme Court. Liberty's lawsuit is the most wide ranging of the outstanding legal challenges to the health law, hitting everything from contraceptive coverage to the employer mandate (Haberkorn, 5/15).

And, from Texas -

The Texas Tribune: GOP Donor Releases Songs Opposing "Obamacare"
He's already a Houston physician, Republican campaign donor, radio talk show host and litigant in a federal lawsuit against the roll-out of "Obamacare." Now Dr. Steve Hotze may be adding aspiring pop star to that list. Hotze, an ally of top state leaders who has contributed hundreds of thousands of dollars to their campaigns, has cut two songs about his opposition to federal health reform (Ramshaw, 5/15).

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HHS To Pay $1 Billion For Ideas To Drive Down Health Costs

The availability of a second round of grants -- funded by the health law -- was announced to support approaches to reduce costs and improve care. The initial round, announced last year, funded 107 organizations.

CBS News: Gov't To Pay $1 Billion For Innovative Health Care Ideas
The U.S. government will award up to $1 billion in grants for innovative health care ideas that drive down medical costs, the Department of Health and Human Services (HHS) in conjunction with the Centers for Medicare & Medicaid Services (CMS) announced Wednesday. On a conference call with reporters, HHS secretary Kathleen Sebelius said the country has made strides in reducing medical costs, and national health care spending has fallen to a 50-year low. However, she said there is still more to do (Jaslow, 5/15).

CQ HealthBeat: Innovation Center Plans Second Round Of Grants
The Center for Medicare and Medicaid Services Innovation Center is preparing to distribute $1 billion in grants for projects designed to improve care and lower costs for federal health programs, agency officials said Wednesday. The second round of grants follows an initial round that was announced last year. At that time, 107 organizations received funding from a total pot of $895 million (Adams, 5/15).

Meanwhile, Medpage Today reports on ACOs -

Medpage Today: Doc-Led ACOs Better Model For Saving $
Physician-led accountable care organizations (ACOs) could have more opportunities to create savings in patient care with a little help from health insurers, a leading health reform expert said Wednesday. Doctor-centric ACOs can do a better job at controlling costs than hospital-led organizations, Paul Ginsburg, PhD, president of the Center for Studying Health System Change here, said at an ACO summit hosted by America's Health Insurance Plans. … Unlike in hospital-led ACOs, doctor-led ACOs aren't compromised financially by reducing hospital admissions and emergency department visits, he pointed out (Pittman, 5/15).

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In Many State Legislatures, The Medicaid Expansion Saga Continues

News outlets offer updates on the future of uncertain Medicaid expansion plans in Texas and Arizona as well as a progress report from California.

The Texas Tribune: An Update On Medicaid Expansion
We've highlighted Medicaid expansion in Texas a couple of times during the legislative session, from those hoping to pick up Medicaid coverage to lawmakers for and against Texas joining in the Affordable Care Act program. State Rep. John Zerwas, R-Simonton, worked this session to pass legislation that would let the state negotiate with the federal government on expansion. His final bill got out of committee but didn’t get to the House floor before last week’s deadlines (Philpott, 5/15).

The Texas Tribune: Budget Deal May Not Come Until Thursday
Budget negotiations stretched late into the night on Wednesday, but lawmakers said privately they didn’t expect to announce a deal until Thursday. House Appropriations Chairman Jim Pitts said earlier in the evening that lawmakers were working to resolve some "pending items" and that he hoped to secure a deal by midnight (Aaronson and Batheja, 5/15).

Arizona Republic: Senate Debates Brewer's Plan To Expand Health Care Program For Poor Today
Dueling rallies at the Capitol on Wednesday over expansion of Medicaid eligibility foreshadowed what’s expected to be a long, vitriolic fight today in the state Senate about the future of Arizona’s health care program for the poor. Gov. Jan Brewer’s Medicaid plan is expected to be offered as an amendment to a budget-related bill during debate on the fiscal 2014 spending plan, which is scheduled to begin this morning, officially putting the enormous health care policy package in play and moving the governor one step closer to realizing her top legislative priority (Reinhart, 5/16).

KQED/State Of Health: Brown Backs State-Run Medi-Cal Expansion
Gov. Jerry Brown’s revised budget plan is a mixed bag for health advocates and some county officials. Brown said the state would take the lead on a key provision of the federal health law — expanding Medi-Cal to more than one million Californians. Brown scrapped earlier plans to consider a more complicated, county-based system. But Brown anticipates recouping more than $300 million from the counties next fiscal year – money that pays for public health programs and care for the uninsured. Brown’s rationale? With the full implementation of federal health reform next year, more people will enroll in Medi-Cal and fewer people will show up to county emergency rooms (Kim, 5/15).

California Healthline: State Still Looks To Dun County Funds In Medi-Cal Expansion Proposal
The optional expansion of Medi-Cal will be administered using a state-based approach rather than the county-based plan being considered by California officials, the governor said yesterday when he proposed his May revise, the mid-year revision of the state budget. That comes as welcome news to county health officials who have cautioned for months that a county-based system would be more confusing and costly than a state-based approach (Gorn, 5/15).

California Healthline: What The Oregon Study Says (Or Doesn't) About Medicaid
The results of the so-called Oregon Health Study, which appeared in the New England Journal of Medicine earlier this month, prompted a firestorm of commentary from health care and health policy experts. Many health care blogs have weighed in on the study, and a deep gulf has emerged between those who think the findings confirm the mission of the Affordable Care Act to expand Medicaid and those who think the results are proof that the program is ineffective (Wayt, 5/15).

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Health Care Marketplace

Retiree Medical Expenses Fall, But They Still Exceed Most People's Expectations

A study released by Fidelity Investments estimated that a couple, who are enrolled in traditional Medicare and retiring in 2013, will need $220,000 to cover medical costs throughout their retirement.

The Associated Press/Washington Post: Expected Retiree Medical Expenses Fall In 2013, But Still Outpace Many Americans' Estimates
After years of increasing health care costs, the outlook is improving for seniors worried about paying their medical bills during retirement. For the second time in the last three years, estimated medical expenses for new retirees have fallen, according to a study released Wednesday by Fidelity Investments. A 65-year-old couple retiring this year would need $220,000 on average to cover medical expenses, an 8 percent decrease from last year's estimate of $240,000. The study assumes a life expectancy of 85 for women and 82 for men (5/15).

The Wall Street Journal’s Total Return: Retiree Health Costs Get Cheaper
Here’s a twist: Health-care expenses should cost 8% less for a 65-year-old couple retiring this year compared with last year, according to new research by Fidelity Investments. A 65-year-old couple retiring in 2013 is estimated to need $220,000 to cover medical expenses throughout retirement, assuming that they are enrolled in traditional Medicare coverage, Fidelity says (Greene, 5/15).

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Public Health & Education

Controversy Lurks As Cloning Technique Yields Embryos For Use In Stem Cell Therapies

Political and ethical fights over human cloning may follow the latest stem cell therapy advance after scientists created embryos that are genetic copies of living people in an effort to treat diseases such as Alzheimer's.

Los Angeles Times: For First Time, Stem Cells Are Produced From Cloning Technique
For the first time, scientists have created human embryos that are genetic copies of living people and used them to make stem cells — a feat that paves the way for treating a range of diseases with personalized body tissues but also ignites fears of human cloning. If replicated in other labs, the methods detailed Wednesday in the journal Cell would allow researchers to fashion human embryonic stem cells that are custom-made for patients with Alzheimer's disease, diabetes and other health problems (Healy, 5/15).

NPR: Cloning, Stem Cells Long Mired In Legislative Gridlock
The news that U.S. scientists have successfully cloned a human embryo seems almost certain to rekindle a political fight that has raged, on and off, since the announcement of the creation of Dolly the sheep in 1997. "The issue of legislation on human cloning is about to get hot again," says Hank Greely, director of the Center for Law and the Biosciences at Stanford Law School (Rovner, 5/16).

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State Watch

State Roundup: N.D. Abortion Clinic Sues To Stop New Law

A selection of health policy stories from North Dakota, Connecticut, California, Massachusetts, Texas, Oregon, Oklahoma and North Carolina.

The New York Times: North Dakota's Sole Abortion Clinic Sues To Block New Law
The running battle over the regulation of abortions entered a North Dakota courtroom on Wednesday, as the state’s sole abortion clinic sued to block a new law that it says could force it to shut down. The law, requiring doctors performing abortions to have admitting privileges at a nearby hospital, was promoted by anti-abortion legislators, who argued that it would mean better care for women who suffer medical emergencies (Eckholm, 5/15).

CT Mirror: Big Health Care Savings Help Counter Shrinking State Budget Revenues
State officials trying to close a last-minute hole in the next budget got some good news Wednesday in the form of major savings in health care costs for retired state employees. The Legislature’s nonpartisan Office of Fiscal Analysis issued a memo indicating it has reduced its projected cost of providing health care to retired state workers in the fiscal year that begins July 1 by $140.6 million, and in 2014-15 by $166.5 million. The nonpartisan office is boosting the projected health care costs for current employees by $46.7 million in the next budget and by $36.4 million in 2014-15, but the net savings over the next two years still totals $224 million (Phaneuf, 5/15).

HealthyCal: Counties Still Not Prepared To Offer Expanded Mental Health Care
More than one million people in California suffer from mental illness -- the largest number of any state. When the final phase of the new federal health care law starts in January of next year, more California residents than ever before will be able to seek help for problems ranging from depression, anxiety, and addiction to schizophrenia and bipolar disorder. But mental health providers in the state’s Central Valley are unprepared for an influx of thousands of patients (5/16).

Boston Globe: State Health Insurers Post Mixed Financial Results
The state’s biggest health insurers ¬≠reported mixed first-quarter financial results Wednesday, with two notching income gains, one registering lower earnings, and one posting a loss. While all of the health insurance companies said they were working to hold down premiums as they rolled out new products and shifted doctors and hospitals to risk-sharing payments, each cited unique factors influencing financial performance in the three months ending March 31 (Weisman, 5/15).

Los Angeles Times: 13 Health Care Workers Arrested In Protest At UC Regents Meeting
Thirteen people were arrested Wednesday at the UC regents meeting during a sit-down protest by health care workers threatening to strike at the system's medical centers. The University of California regents left during the protest while UC police cleared the room, handcuffing the protesters and leading them out of the hall at the Sacramento Convention Center (Gordon, 5/15).

The Texas Tribune: Senate Backs Bill On Psychotropic Drugs For Foster Kids
Lawmakers in both chambers have now endorsed legislation that would require guardians of foster children to take greater caution before giving psychotropic drugs to the children. The Senate on Wednesday approved a version of the "informed consent" measure that is slightly different than the one approved by the House in April (Aaronson, 5/15).

Lund Report: Oregon House Passes Assessments For Hospitals And Nursing Facilities
The House passed assessment taxes on hospitals and long-term care facilities by a wide 54-5 margin Tuesday, ensuring Oregon’s health and human service budgets will raise over a billion dollars from providers in coming years and leverage $1.4 billion from the federal government next biennium for Medicaid. Hospitals are compensated for their assessments with higher reimbursements for the Oregon Health Plan while nursing homes are paid for the use of their beds by Medicaid patients. … House Bill 2216 extends an expanded hospital assessment of 5.32 percent for two years. A previous bill, House Bill 2056, was attached to that version, which extends the long-term care facility assessment for six years, while expanding it to include all nursing homes except the Oregon Veterans Home (Gray, 5/15).

Lund Report: Single-Payer Activists Keep Dream Of Universal Health Care Alive In Oregon
Wes Brain was uninsured last winter when a tonsillectomy showed signs of throat cancer. He qualified for the high-risk Oregon Medical Insurance Pool, which the state has administered through Regence BlueCross BlueShield. But gaining access to that insurance soon proved a big obstacle for the Ashland resident, when Regence erroneously told him he hadn't submitted his driver's license. … Eventually, his policy was approved. He paid $2400 -- three month’s premium. His doctor ordered a PET scan for March 1. But then Regence came back and told him no, he’d have to wait until March 1 to even begin authorization (Gray, 5/15).

Stateline: Oklahoma's "Life-Preserving" Law Raises Questions For Doctors
University of Tulsa law professor Marguerite Chapman has been studying end-of-life issues in Oklahoma for three decades and has come to a conclusion: "It's getting almost to the point that you need a government permit in order to die in this state." Certainly, dying has gotten a lot more complicated here, the result of a unique measure passed by the Oklahoma legislature and signed into law last month by Republican Gov. Mary Fallin. Modeled after legislation written by the National Right to Life Committee, the law says that patients who are disabled, elderly or terminally ill cannot be denied life-preserving treatments if they or their health proxies want it (Ollove, 5/16). 

North Carolina Health News: Bill To Compel Insurers To Cover Autism Treatment Advances
For kids with autism in North Carolina, it’s possible to get insurance coverage for the process of diagnosing the developmental disorder. But for the bulk of those kids, getting an insurance company to cover treatment is another matter (Hoban, 5/15).

Oregonian: Mental Health Staff In Oregon Prison System Push For Big Raises
A group of unionized mental health workers in the Oregon state prison system wants a pay raise that even they acknowledge is big enough to cause a public relations problem. About 50 mental health specialists who handle inmates with addictions and other mental health problems want to be reclassified because their job descriptions have changed, including a requirement of a master's degree. Under their current proposal, they're seeking raises between 25 percent and 26 percent, which would result in a maximum salary of more than $80,000, according to a memo obtained by The Oregonian (Esteve, 5/15).

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Weekend Reading

Weekend Reading: Volunteers In The Battle With Heart Disease

Every week reporter Ankita Rao selects interesting reading from around the Web.

The Atlantic: Lost In Medication
Psychiatrists who take time with their patients are not the norm. It's not because others don't care. Rather the system rewards efficiency, not empathy ...  I treated a patient who had suffered from schizophrenia for years. He had finally achieved some stability on a cocktail of antipsychotic medications as he was passed along through the clinic, year after year ... One day, though, he showed up for his appointment looking completely different. His complaints had nearly disappeared; he was cheerful, optimistic. ... Inquiring about what had changed, I found out that with the assistance of the hospital work program, he had gotten a job for the first time in nearly 30 years. … In many places psychiatry has become a biological enterprise, with some psychiatrists even introducing themselves as "psychopharmacologists." In no other specialty does a physician define themselves by the medication that they use (Sarah Mourra, 5/10).

The New Republic: My Five Obamacare Anxieties
Conservatives are talking about the implementation of Obamacare in the same thoughtful way they talked about its enactment—that is, as an impending apocalypse. It won't be, as I've noted previously. Most Americans get insurance through employers, Medicare, and Medicaid, and that will still be the case on January 1, when Obamacare's big provisions take effect. But the minority who buy insurance on their own or have no insurance will see tremendous changes. And you don't have to be Rush Limbaugh to have real concerns about how those changes will play out (Jonathan Cohn, 5/13).

The Fiscal Times: Why The IRS Scandal Could Bring Down Obamacare
The Internal Revenue Service's scandalous targeting of Tea Party-themed and other conservative groups could severely damage President Obama – but it's not necessarily because anyone close to the White House sanctioned the allegedly independent actions by the tax collection agency. ... The real fallout could be that it will impede Obamacare, ... The IRS will largely administer this attempt at providing near-universal health insurance. It is responsible for overseeing the tax credits and tax increases in the law, and—most critically—ensuring that businesses and individuals comply with the individual mandate and other major provisions. Prominent Republicans are already connecting the unpopular insurance program to the questions swirling around the IRS (Josh Boak and Eric Pianin, 5/14).

The Weekly Standard: Eggs For Sale?
If you want to know what's going to go wrong in the culture, read the professional journals. A case in point: An article in the April 10 New England Journal of Medicine called for the creation of a commodities market for "made-to-order" human embryos. The authors, I. Glenn Cohen and Eli Y. Adashi—university professors, of course—treat embryos as the equivalent of a prize cattle herd. They note that sperm and eggs are already bought and sold for in vitro fertilization (IVF) and, further, that New York legalized buying eggs for use in biotechnological research a few years ago. Hence, "it is not clear" (an oft-used phrase in bioethical advocacy that frees the author from actually having to prove a point) why we should not also allow companies to make "made-to-order embryos" for profit, since that activity would be "more similar to the sale of gametes than the sale of children" (Wesley J. Smith, 5/14).

The New York Times: Seeking Clues To Heart Disease In DNA Of An Unlucky Family
Researchers have long known that a family history of early death from heart disease doubles a person's risk independently of any other factors. Family history is defined as having a father or a brother who were given a diagnosis of heart disease before age 55 or a mother or sister before age 65. Scientists are studying the genetic makeup of each member of the Del Sontro family, searching for telltale mutations or aberrations in the long sequence of three billion chemicals that make up human DNA. Until very recently, such a project almost certainly would have been futile. Picking through DNA for tiny aberrations was so costly and time-consuming that it was impractical to take on for an entire family (Gina Kolata, 5/12).

The New Yorker: Can We Patent Life?
On April 12, 1955, Jonas Salk, who had recently invented the polio vaccine, appeared on the television news show "See It Now" to discuss its impact on American society. Before the vaccine became available, dread of polio was almost as widespread as the disease itself. Hundreds of thousands fell ill, most of them children, many of whom died or were permanently disabled. The vaccine changed all that, and Edward R. Murrow, the show's host, asked Salk what seemed to be a reasonable question about such a valuable commodity: "Who owns the patent on this vaccine?" Salk was taken aback. "Well, the people," he said. "There is no patent. Could you patent the sun?" ... It took thousands of scientists and technicians more than a decade to complete the Human Genome Project, and cost well over a billion dollars. The same work can now be carried out in a day or two, in a single laboratory, for a thousand dollars—and the costs continue to plummet. As they do, we edge closer to one of modern science's central goals: an era of personalized medicine, in which an individual’s treatment for scores of illnesses could be tailored to his specific genetic composition. That, of course, assumes that we own our own genes (Michael Specter, 4/2).

The National Journal: How Much Big Insurance Paid A Small-Business Group To Fight A Premium Tax
The nation's leading health insurance industry group gave $850,000 to a top small-business trade association as part of a campaign to repeal a key provision of President Obama’s health care law, National Journal Daily has learned (Frates, 5/14).

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Editorials and Opinions

Viewpoints: When A Doctor Should Keep Quiet; 2 Views Of Hospital Pricing; Stem Cell 'Snake Oil'

Los Angeles Times: For A Dying Patient, A Prescription Of Silence
In medical school, we were taught not to withhold information from our patients or to be "paternal" in making decisions for them. We internalized the idea that fully informed patients are better equipped to make treatment decisions. And with patients likely to die of their diseases, discussing the prognosis frankly would allow them to say goodbyes, get things in order and prepare advanced directives for what kind of interventions they did and didn't want. But Pedro's wife was adamant. "He will lose his will to live if he knows he has cancer. And he will then die even sooner" (Susan Partovi, 5/16).

USA Today: Hospital Pricing Gouges Patients: Our View
Shouldn't you be able to see the price of something before you buy it, so you can shop for value or simply figure out whether you can afford it? Before you roll your eyes and say, "Of course," think about the last time you bought medical care, especially in a hospital. See any price lists on the wall? Probably not. And, if you had, you might have fainted on the spot (5/15).

USA Today: Hospital Billing Too Complex: Another View
Many parts of America's health care delivery and financing systems urgently need updating, and the matter of "charges" ranks high on the list. Today's hospital bill is a symptom of a broken payment system. Hospitals deal with more than 1,300 insurers, each having different plans with multiple requirements for hospital bills. Decades of federal regulations have made a complex billing system even more complex and frustrating for everyone involved (Rich Umbdenstock, 5/15).

USA Today: Beware Of Stem Cell Therapy Claims
A stem cell transplant can help cure patients with acute myeloid leukemia, and research has shown incredible potential, from growing teeth to mending "unhealable" bone fractures. Still, stem cells are poorly understood. Despite this, as (Ferris) Jabr writes, many cosmeticians continue to claim that stem cells are a cure-all for "everything from wrinkles to joint pain to autism." Until we understand them better, stem cells are the new snake oil peddled by 21st century charlatans. Thankfully, the Food and Drug Administration is cracking down (Alex Berezow, 5/15).

JAMA: Accountable Care Organizations: Accountable For What?
Dr Robert Potenza and Dominica Potenza, partners in life and in work, are, respectively, a cardiologist and a registered nurse who have a cardiology/internal medicine practice in the Bronx. … In theory, continuity of care should be improving at Montefiore, one of 32 Pioneer Accountable Care Organizations (ACOs) that aim to become models for improving population health while lowering costs. Montefiore has been acquiring physicians' practices to expand its primary care capacity, but the Potenzas are reluctant to join, fearing they'll lose what control they have over the personalized care they give their patients (Diana Mason, 5/15). 

Columbus Dispatch: Expanding Medicaid Would Help In Fight Against Breast Cancer
As a seven-year breast-cancer survivor, I know how important annual screening can be. I was diagnosed with Stage IIa breast cancer on a routine mammogram. ... I was lucky and had very adequate health insurance, yet my personal cost remained over $6,000. While expanding Medicaid in Ohio would seem counterintuitive as a cost-saving measure, we must sometimes view Medicaid dollars spent as a long-term investment in Ohio and enable Ohioans to realize the savings. Screening to capture cancer at the earliest possible stage reduces the costs of treatment and improves mortality (Tammy Weis, 5/16).

Bloomberg: U.S. Must Fight Harder Against TB
While USAID's TB budget is being slashed, public-health spending on tuberculosis in the U.S. is also being cut. On top of belt tightening from sequestration, the administration of Barack Obama has been pillaging money from the U.S. Department of Health and Human Services’ Prevention and Public Health Fund, which goes to efforts such as immunizations, health screenings and smoking prevention. ... Almost all TB specialists in the U.S. work in public clinics and hospitals. Many patients, being either uninsured or underinsured, have nowhere else to go for their treatment. Even after the Affordable Care Act is fully in place, public TB clinics will remain important safety nets for undocumented immigrants and legal immigrants who don’t yet qualify for public services. It's safe to assume that cuts in public health funding will have the same effect we saw in the early 1990s after earlier reductions: Many patients will be inadequately treated, allowing greater transmission of TB and the emergence of multidrug-resistant strains (Celine Gounder, 5/15).

Tampa Bay Times: Fight On Prescription Drug Abuse Not Over
Once local law enforcement and the Florida Legislature finally committed to addressing prescription drug abuse, it made a difference. The welcome news that prescription drug deaths in the Tampa Bay area are down 30 percent since 2010 is surely a result of a focus on unscrupulous pain clinics and easy access to pills. But there is more work to be done, and boosting the state's still-tepid commitment to a prescription drug database is the place to start (5/14).

New England Journal Of Medicine: The Role Of The NIH In Nurturing Clinician-Scientists
The awarding of the 2012 Nobel Prize in Chemistry to Robert Lefkowitz and Brian Kobilka, both M.D.s trained in cardiology, for their work on characterizing the structure and function of beta-adrenergic receptors, should remind us of the critical role that clinician-scientists have played in formulating the seminal concepts that govern modern biomedical science. Much has been written since the 1970s about the demise of the physician-scientist -- as evidenced by the declining share of RO1 grants that the National Institutes of Health (NIH) awards to physicians -- and the economic factors that have driven physicians away from the laboratory and research clinic into more remunerative clinical practice (Dr. Michael Gottesman, 5/15).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.