Daily Health Policy Report

Thursday, May 17, 2012

Last updated: Thu, May 17

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Campaign 2012

Health Care Marketplace

Health Information Technology

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Q & A: Can I Pay Negotiated Rates When I Pay Out Of Pocket? (Video)

In this Kaiser Health News video, Insuring Your Health columnist Michelle Andrews responds to a reader's question about how to get the negotiated rates insurers pay even when paying for a medical procedure directly (5/16). Watch the video.

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Capsules: Senate Panel Looks At Innovative Health Care Strategies; States Must Submit Plans For Insurance Marketplaces By Nov. 16; Targeting Diabetes Prevention Among Medicare Beneficiaries; D.C. Health Program For Illegal Immigrants Avoids Cuts

Now on Kaiser Health News' blog, Mary Agnes Carey reports on Wednesday's Senate Health, Education, Labor and Pensions hearing: "No matter how the Supreme Court rules next month on the challenges to the 2010 health care law, there will be a continued focus on making the health care system more efficient, and senators looked at some promising options Wednesday" (Carey, 5/17).

Julie Appleby reports: "States must provide details to the federal government by Nov. 16 – just 10 days after the presidential election – on how they will run online insurance marketplaces, according to guidance released Wednesday" (Appleby, 5/16).

In addition, Shefali S. Kulkarni reports on diabetes prevention efforts: "Recent studies might suggest an increase of Type 2 diabetes among children and young adults, but the real low hanging fruit, according to diabetes and policy experts, may be among the Medicare population" (Kulkarni, 5/16).

Also on the blog, Sarah Barr reports on a D.C. health program for illegal immigrants: "A public health insurance program that primarily serves illegal immigrants in the District of Columbia avoided the chopping block Tuesday under a budget compromise approved by the D.C. Council" (Barr, 5/16). Check out what else is on the blog.

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Alaska Targets An Old Foe: Tuberculosis

Alaska Public Radio Network's Annie Feidt, working in partnership with Kaiser Health News and NPR, reports, "Until 1950, TB was the No. 1 cause of death in Alaska. That legacy means that a large number of Alaskans still carry the bacteria that can cause the disease. They have no symptoms and they aren't contagious, but full-blown TB can flare up at anytime and then spread" (Feidt, 5/17). Read the story.

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Political Cartoon: 'Full Coverage?'

Kaiser Health News provides a fresh take on health policy developments with "Full Coverage?" by Bill Day.

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

STATE HEALTH EXCHANGE: MOVING FORWARD OR FALLING BACK?

November 16:
The new fed exchange deadline.
Now it's up to states...
-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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Health Reform

HHS Sets Deadline For State Health Exchange Proposals

The Department for Health and Human Services released guidelines detailing the requirements states must meet in their proposals if they want to gain federal approval to operate these insurance markets.

The Wall Street Journal: Bid To Coax States On Health Exchanges
The Obama administration on Wednesday made a fresh bid to coax reluctant governors to work with the federal government to help enact the health-overhaul law. The move centers on new marketplaces that sell health insurance, a key plank of the law that states are supposed to open by 2014. Republican governors, who lead 29 of the 50 states, are divided over whether to set up the exchanges, which would allow consumers to shop for insurance plans if they don't receive affordable coverage through an employer (Radnofsky, 5/16).

Reuters: U.S. Sets Deadline For Proposals On State Healthcare Exchanges
The Obama administration forged ahead with healthcare reforms on Wednesday, announcing a November 16 deadline for state governments to submit proposals showing how they intend to operate health insurance exchanges in 2014. The Department for Health and Human Services released a detailed blueprint of the legal and operational requirements states must meet in their proposals if they expect to win federal approval to begin operating regulated insurance markets, in whole or in part, by January 1, 2014, when the 2010 law is scheduled to come into full force (5/16).

Kaiser Health News: Capsules: States Must Submit Plans For Insurance Marketplaces By Nov. 16
States must provide details to the federal government by Nov. 16 – just 10 days after the presidential election – on how they will run online insurance marketplaces, according to guidance released Wednesday (Appleby, 5/16).

CQ HealthBeat: HHS Seeks To Re-Energize Exchange Creation Via New Grants, Guidance
Six states will get grants totaling $181 million to help them establish health insurance exchanges under the health care law, Health and Human Services officials announced Wednesday. That makes 34 states and the District of Columbia that have received such federal assistance. Officials also released a guidance document detailing how they will work with states to establish a "federally facilitated exchange" (FFE) for those that elect not to create their own such marketplace (Reichard, 5/16).

Modern Healthcare: Insurance Exchanges Could Mean Savings For Some, Researcher Says
People who purchase health insurance policies on the individual market may save an average of $280 annually under the healthcare overhaul's coming insurance exchanges, according to projections by a federal researcher. Steven Hill, a senior economist in the Center for Financing, Access and Cost Trends at the Agency for Healthcare Research and Quality, analyzed costs for the 11 million beneficiaries in the individual insurance market in recent years and projected their future costs under the Patient Protection and Affordable Care Act (Daly, 5/16).

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GOP Makes Plans To Pursue After The High Court Rules On The Health Law

If the law is upheld, Republicans plan to take to the floor to "tear out" the law's most controversial provisions, Politico reports. Meanwhile, in related news, Reuters reports on the questionable fate of lesser known, but still controversial, aspects of the health law -- billions of dollars in new taxes.  

Politico: Health Care Reform: GOP Preps Plan For Ruling On Law
House Republican leaders are quietly hatching a plan of attack as they await a historic Supreme Court ruling on President Barack Obama's health care law. If the law is upheld, Republicans will take to the floor to tear out its most controversial pieces, such as the individual mandate and requirements that employers provide insurance or face fines (Sherman and Haberkorn, 5/16).

Reuters: Taxes Lurk Behind Court Test Of Obama Health Law
While Supreme Court watchers focus on the controversial insurance requirement in President Barack Obama's health care law, lesser known is that the court's ruling next month will also decide the fate of billions of dollars in new taxes. The 2010 law includes a 3.8-percent boost in taxes on investment income and a 0.9-percent increase in the Medicare payroll tax, both hitting people who earn more than $200,000 a year (Dixon, 5/16).

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Capitol Hill Watch

Budget Politics And Posturing Continues At Both Ends Of Pennsylvania Avenue

Even as congressional leaders met with President Barack Obama on budget matters, the Senate voted on -- and rejected --  a series of budget proposals. Meanwhile, House Speaker John Boehner draws a line in the sand regarding the next vote to raise the federal debt limit.

Los Angeles Times: Congress' Partisan Fight Persists Despite High-Level Overture
As President Obama welcomed congressional leaders for a White House chat over hoagies about setting aside differences to improve the economy, a far different scenario was unfolding at the other end of Pennsylvania Avenue. Republicans in the House and Senate were conducting a series of partisan maneuvers Wednesday on legislation that has no chance of reaching the president's desk. The votes in the Senate on budget measures, which would slash social programs and revamp Medicare, were designed to underscore the GOP's alternatives to Obama's policies in advance of the November election (Mascaro, 5/16).

The Fiscal Times: Boehner to Dems: We Won't Blink First on Debt Deal
The political fault lines and tensions between the two parties heading into the crucial fall presidential and congressional elections were on full display yesterday during the third annual fiscal summit sponsored by the Peter G. Peterson Foundation. "When the time comes, I will again insist on my simple principle of cuts and reforms greater than the debt limit increase," [House Speaker John] Boehner said in the closing speech of the day (Pianin, 3/16).

The Washington Post: Senate Rejects Obama Budget, Republican Alternatives
Among the Republican plans advanced on the floor was the spending plan authored by House Budget Chairman Paul Ryan (R-Wis.). It would balance the budget over the next three decades, in part by cutting deeply into social safety network spending and revamping Medicare. Like Obama’s budget, it failed to garner adequate votes to continue to a full debate. Republicans forced the series of budget votes to highlight Democrats' failure to advance their own plan. The Senate rejected Obama’s budget on a 0 to 99 vote (Helderman, 5/16).

The New York Times' The Caucus: Senate Republicans Engineer Rebuke On Budget
Republicans charged that Democrats have been derelict in their statutory duty to bring forward a budget. No long-term solution to the nation's fiscal problems can be reached, they say, unless both parties are willing to agree on their visions for spending and taxes, then go to the table to negotiate. Democratic leaders have made it clear that they do not want to subject their members to the politically difficult votes Republicans would spring on them if they brought a budget to the floor (Weisman, 5/16).

The Associated Press: Senate Democrats Reject House GOP Budget Plan
Democrats controlling the Senate rejected for the second year in a row Wednesday a budget plan passed by House Republicans. The 58-41 vote against the GOP budget came after a daylong debate in which Democrats blasted Republicans for refusing to consider tax increases as part of a solution to trillion-dollar deficits, and Republicans in turn attacked Democrats for not offering a budget at all (Taylor, 5/16).

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A Senate Panel Contemplates Innovations For The Health Care System

At a Wednesday hearing, members of the Senate Health, Education, Labor and Pensions Committee considered various strategies to make the health system more efficient.

Kaiser Health News: Capsules: Senate Panel Looks At Innovative Health Care Strategies
No matter how the Supreme Court rules next month on the challenges to the 2010 health care law, there will be a continued focus on making the health care system more efficient, and senators looked at some promising options Wednesday (Carey, 5/17).

CQ HealthBeat: Whitehouse Touts Rhode Island Group Practice As Model For Health Care Redesign
Sen. Sheldon Whitehouse has taken on the role in Congress of showcasing new forms of health care delivery that save money without undermining quality or access, and of touting the role the 2010 health care overhaul plays in incubating that innovation. But Republican statements at a hearing Wednesday by the challenged the notion that the government can play an effective role in fostering redesign of health care delivery (Reichard, 5/16).

Modern Healthcare: Lawmakers Target Geographic Payment Variations
Creating a new Medicare payment modifier that increases or decreases hospital reimbursements based on their quality and costs would help rein in geographic variations in the program, according to two Democratic senators. Sens. Al Franken (D-Minn.) and Sheldon Whitehouse (D-R.I.) said at a Wednesday hearing on improving healthcare quality and controlling costs by the Health, Education, Labor and Pensions Committee that they support the creation of a hospital version of the new physician payment modifier included in the 2010 healthcare overhaul (Daly, 5/16).

In other Capitol Hill news, media outlets report on two ongoing investigations: a Senate inquiry into a dental management services company and a probe by House Republicans regarding drug industry support for the health law -

Bloomberg: Dental Abuse Seen Driven By Private Equity Investments
Isaac Gagnon stepped off the school bus sobbing last October and opened his mouth to show his mother where it hurt. ... Isaac’s case and others like it are under scrutiny by federal lawmakers and state regulators trying to determine whether a popular business model fueled by Wall Street money is soaking taxpayers and having a malign influence on dentistry (Freedberg, 5/17).

Bloomberg: Republicans Probe Drugmaker Political Support For Health Law
House Republicans are probing whether the White House and Democrats in Congress were promised political support from drugmakers in exchange for limiting what the industry would be asked to contribute under the 2010 health-care overhaul, according to a memo. Those involved in negotiating the law’s passage are being interviewed by a House Energy and Commerce subcommittee, people familiar with the investigations said this month. The probe, led by Republicans Michael Burgess of Texas and Cliff Stearns of Florida, has included companies such as Pfizer Inc. (PFE) and the Washington-based Pharmaceutical Research and Manufacturers of America, a trade group (Armstrong, 5/16).

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Campaign 2012

Ad Charges President Obama With Using The Health Law To Raise Taxes

News outlets report on the details of the ad campaign, which is being paid for by Crossroads GPS, and also provide fact checking regarding some of its assertions.

Los Angeles Times: Crossroads GPS Fires Back At Obama With $25-Million Ad Buy
The 2012 campaign air battle grew more intense Wednesday with the news that Crossroads GPS, the cash-flush conservative advocacy group, is pouring another $25 million into television ads castigating President Obama for "broken" promises. The massive ad buy matches the $25 million that Obama's reelection campaign announced last week it would be spending on a month of TV airtime. … The commercial charges Obama with, among other items, raising taxes through his health care reform plan and failing to meet his pledge to cut the deficit in half (Gold, 5/16).

The Associated Press: Ad Attacks Obama Health Care, Tax, Debt Promises
Obama's promise that if people like their health care plan, they will be able to keep it, is also questionable. Employers sponsor coverage for most families, and they'd be free to change their health plans in ways that workers may not like, or drop insurance altogether. Few are predicting a stampede by employers — especially major companies — to drop coverage. But some could avoid the hassle of dealing with insurance companies and take advantage of new financial assistance from the government their workers may qualify for (Miga, 5/16).

Boston Globe: Conservative Nonprofit Makes $25m Ad Buy
Countering the Obama campaign’s massive ad buy of last week, the independent conservative group Crossroads GPS on Wednesday announced a plan to spend $25 million airing an attack ad in 10 swing states. The 60-second ad accuses the president of breaking promises to assist struggling homeowners, hold down taxes for households making less than $250,000 per year, let people keep private health insurance plans they like, and cut the federal deficit in half (Borchers, 5/16).

The Washington Post's The Fact Checker: Obama: Broken Promises On Taxes And Health Care?
The Republican-aligned Crossroads GPS has scheduled a massive $25 million ad buy, starting with this hard-hitting ad that purports to list a bunch of "broken promises" by President Obama. We are not going to quibble with some of these claims. The president, for instance, certainly has not met his pledge to cut the budget deficit in half. But we were interested in exploring more carefully the two health care-related items (Kessler, 5/17).

Meanwhile, Jill Biden, the "Second Lady," makes a campaign trail appearance in Iowa -

Des Moines Register: Jill Biden Pitches Reasons Why Iowa Women Are Better Off With Obama
The call, the first official campaign event for the Second Lady, was meant to underscore the importance of women to Obama's re-election. ... Thanks to the Affordable Care Act, she said, insurance companies can no longer deny women coverage on pre-existing conditions such as breast cancer, and they must cover cancer screenings and mammograms. Soon, they must cover contraception and domestic violence screening and counseling, she said. In Iowa, 229,000 women on Medicare now can get mammograms and flu shots with no copay or deductible, she said (Jacobs, 5/16).

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Despite Bishop's Disapproval, Sebelius Will Speak At Georgetown University

The Health and Human Services secretary was invited in January to address graduates of the Public Policy Institute at the Jesuit institution.

The Associated Press: Sebelius To Address Georgetown Grads Amid Flap
A planned graduation speech by U.S. Health and Human Services Secretary Kathleen Sebelius at Georgetown University is going forward, despite criticism from the Archdiocese of Washington that Sebelius is an inappropriate choice for the Jesuit school. The Archdiocese said in a statement Tuesday that Sebelius' actions as a public official "present the most direct challenge to religious liberty in recent history" (5/16).

The Wall Street Journal: Georgetown Defends Sebelius Invitation
Ms. Sebelius is set to speak at an awards ceremony at the Georgetown Public Policy Institute immediately after its commencement event. Students at the school said that they picked Ms. Sebelius as their speaker in January because of her career in public service (Radnofsky, 5/17).

The New York Times: New Fight On A Speaker At A Catholic University
As a two-term governor of Kansas, Ms. Sebelius was told by her bishop that she should be denied communion at Mass because of her support for abortion rights. As health secretary, she has been vilified for upholding the mandate in the health care overhaul that requires even religiously affiliated institutions to provide birth control coverage to their employees (Goodstein, 5/16).

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Decision In N.Y. Case On Access To Emergency Contraception Could Impact Politics

Politico looks at how a court decision to make emergency contraception accessible to women younger than age 17 could put both President Barack Obama and GOP candidate Mitt Romney on the spot.

Politico: Contraception Lawsuit Puts Obama On The Spot
A ruling to strike the age 17 limit on "Plan B" — which, based on the judge's tone in a recent hearing, seems likely — could again force attention to reproductive politics at a time when both parties might prefer to focus on the economy. Throwing Plan B back in the spotlight has a risk for Mitt Romney, who is under fire from some anti-abortion groups because the chairman of Teva Pharmaceuticals, which makes Plan B, was set to host a fundraiser for him  Wednesday. But the stakes may be higher for President Obama, who would have to decide whether to appeal — possibly before November (Feder, 5/16).

Two other outlets also explore some reproductive health issues that may have an impact on the campaign.

The Hill: Poll: Voters Would Approve Of Ban On 'Sex-Selective' Abortions
Americans would support a ban on abortions that are performed solely because of the child's gender, according to a new poll from the anti-abortion-rights Susan B. Anthony List. SBA List just recently launched a new research arm, the Charlotte Lozier Institute, which it framed as a counterweight to the abortion research Guttmacher Institute (Baker, 5/16).

Modern Healthcare: Bishops To Sue Over Birth-Control Coverage Rule
The United States Conference of Catholic Bishops, which sets official Catholic healthcare policy in the U.S., says it has no choice but to sue the federal government if Congress fails to rescind a rule that forces insurers for religious employers to offer contraception coverage. The Washington-based bishops' conference submitted a 21-page letter this week in response to a call for public comments on a revised HHS policy that calls for commercial health plans to offer contraception services free of charge as part of a requirement to provide preventive health services in the Patient Protection and Affordable Care Act (Carlson, 5/16).

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Health Care Marketplace

WellPoint: Protestors Push For More Disclosure Regarding Insurer's Political Giving Habits

The Associated Press/Washington Post: Protestors Seeking More Political Disclosure Disrupt Insurer WellPoint's Annual Meeting
WellPoint Inc. shareholders rejected a call for more disclosure about the health insurer's political contributions Wednesday during a shout-filled, contentious annual meeting. Union representatives and other protesters repeatedly interrupted Chairwoman and CEO Angela Braly after she opened the meeting and introduced proposals for shareholder voting (5/16).

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Health Information Technology

Doctors Trade Prescription Pads For Electronic Options

The Associated Press: More Doctors Are Ditching The Old Prescription Pad
Doctors increasingly are ditching the prescription pad. The latest count shows more than a third of the nation's prescriptions now are electronic... Surescripts, the largest network for paperless prescribing, found 390,000 doctors were e-prescribing at least some last year, and more are signing up fast. Some 36 percent of all prescriptions were electronic in 2011 (Neergaard, 5/17).

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State Watch

State Budgets Aim At Health Programs, Medicaid To Bridge Shortfalls

Medicaid and other health program cuts are on the minds of state lawmakers around the nation. In Maine, the governor signed Medicaid cuts into law Wednesday, and California and Kansas are weighing similar cuts as they struggle to balance their budgets.

The Associated Press/Boston Globe: Maine Budget-Balancing Bill Signed By Governor
Even though Governor Paul LePage signed a bill Wednesday to make up for an $80 million budget shortfall largely through Medicaid cuts, the debate is far from over. Maine voters can expect the cuts to become an issue in this year’s legislative election. ... Democrats say the budget cuts will take health care services from more than 24,000 Mainers. They had supported a proposal they said would have used surplus funding to blunt the impact on seniors, children, and working families (Adams, 5/17).

California Healthline: Healthy Families, Seniors Initiatives Questioned
In the governor's May budget revision released this week, in addition to $2.5 billion in new cuts to health care in California, there were a couple of proposals that raised big red flags for many health care advocates. In particular, two budget items took a lot of heat: the effort to move about 1 million dual-eligible Californians into managed care programs; and the state's plan to move 870,000 children out of the Healthy Families program and into Medi-Cal care. In both cases, advocates said the state is taking on way too much, too quickly -- putting the two most vulnerable populations in California at real risk (Gorn, 5/17).

Kansas Health Institute News: Legislature Ends Day 95 Without Budget Accord
Among the things tentatively agreed to on Wednesday: The House agreed to drop its budget proviso that would have barred the Kansas Insurance Department from spending federal grant dollars associated with the Affordable Care Act, which Kansas, along with 25 other states, is challenging in the U.S. Supreme Court. The department had about $800,000 of a $1.9 million grant remaining as of April 18, according to legislative staffers. Negotiators agreed to spend $3.6 million in the coming fiscal year to help reduce waiting lists for home and community based Medicaid services for the disabled; $1.8 million would be earmarked for the physically disabled and $1.8 million would be for the developmentally disabled (Shields, 5/16).

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Legislatures Push Health Care Changes In Disabled, Immigrant Care, Medical Boards

State lawmakers grapple with health care issues including establishing a new monitor for disabled care in New York, avoiding cuts for undocumented immigrant care in D.C. and a Massachusetts revamp of the state medical board.

The New York Times: Senate Passes Bill Creating Monitor For Disabled Care
The State Senate unanimously passed Gov. Andrew M. Cuomo's legislation to protect developmentally disabled and mentally ill New Yorkers on Wednesday, but some high-profile advocates have been unnerved by what they perceive as flaws in the bill. Assembly Democrats have said that they intend to pass the bill, but will negotiate some changes before the legislative session ends on June 21 (Hakim, 5/16).

Kaiser Health News: Capsules: D.C. Health Program For Illegal Immigrants Avoids Cuts
A public health insurance program that primarily serves illegal immigrants in the District of Columbia avoided the chopping block Tuesday under a budget compromise approved by the D.C. Council (Barr, 5/16).

Boston Globe: Mass. Senate Approves Revamp Of State Medical Board
The drive to revamp the discipline reporting system for doctors in Massachusetts continued this week on Beacon Hill, with the Senate approving a measure that would make that system more transparent. As part of its health care cost reduction bill, the Senate approved an amendment Tuesday that would require the state Board of Registration in Medicine to provide a public database that would include any felony or serious misdemeanor convictions doctors may have, as well as any disciplinary measures taken against them by the board (Andersen, 5/17).

In the meantime, Oklahoma and Tennessee are the latest to require potential welfare recipients have drug tests --

Stateline: More States Pass Drug Testing For Welfare Recipients
Oklahoma and Tennessee are the latest states about to require drug tests of those applying for welfare benefits. While such proposals are popular in statehouses this year, their legality is still unclear. ... Lawmakers in at least 28 states this year have proposed drug testing or screening for public assistance applicants or recipients, according to a state-by-state map from the National Conference of State Legislature. So far this year, Utah has passed legislation requiring applicants to complete a written questionnaire screening for drug use while Georgia passed legislation requiring drug tests for all applicants for the Temporary Assistance for Needy Families, commonly known as welfare, NCSL says (Prah, 5/17).

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D.C. Abortion Bill To Get Hearing; Mo. Considers Allowing Employers To Opt-Out Of Contraception Coverage Mandate

The House is considering a bill that would ban abortions in the District of Columbia after 20 weeks of pregnancy. Elsewhere, Missouri lawmakers consider allowing businesses to opt-out of a federal mandate to cover contraception in their health plans, and another Catholic university -- this one in Florida -- considers dumping its health plan instead of complying with the mandate.

Politico: Norton Refused Testimony In Anti-Abortion Hearing
House Republicans pushing a bill to ban abortions after 20 weeks in the District of Columbia aren't allowing Del. Eleanor Holmes Norton to testify at a hearing Thursday. The bill's lead sponsor, Arizona Republican Trent Franks, chairs the House Judiciary Subcommittee on the Constitution. Norton, a Democrat, wrote a letter to Franks last week asking to testify. But Republicans aren't repeating the mistake they made earlier this year, when a male-heavy panel during a hearing on contraception prompted Norton and other Democrats to walk out in protest. Christy Zink, a George Washington University professor who was forced to have an abortion late in her pregnancy due to complications, will testify (Robillard, 5/17).

The Hill: NARAL Vows To Blitz GOP Over DC Abortion Bill
The head of a leading abortion-rights groups promised to "flood" the offices of some House members with messages of opposition to a bill that would criminalize abortions after 20 weeks in the District of Columbia. The message came ahead of a hearing on the bill, sponsored by Rep. Trent Franks (R-Ariz.), that is scheduled for Thursday afternoon. "The politicians behind this bill, who claim to support smaller government, are obsessed with attacking choice and willing to override locally elected officials to undermine the doctor-patient relationship," NARAL Pro-Choice America President Nancy Keenan said in a statement (Viebeck, 5/16).

St. Louis Beacon:  Missouri Legislators Close To Approving Bill To Curb Coverage On Contraception, Sterilization
The Missouri General Assembly appears to be on its way to approving a measure to allow businesses to decline to provide coverage for "abortion, contraception or sterilization." The bill would allow any medical professional to decline to be involved in such procedures. Pharmacies also could decline to stock any drug or device (Mannies, 5/16).

Fox News: Florida Catholic School Considers Dropping Student Health Plan, On Heels Of Ohio Decision
On the heels of an Ohio school's decision to abandon its student health insurance plan, another Catholic university in Florida is considering whether to follow suit over concerns about premium costs associated with the federal health care overhaul, FoxNews.com has learned.  The school, the private Ave Maria University, is voicing both moral and economic concerns. ... Ave Maria officials are opposed to the so-called contraceptive coverage mandate (Berger, 5/17).

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State Roundup: Poverty, Disparities Create Public Health Issues

A selection of state health policy news from Massachusetts, California, Kansas, Florida, Pennsylvania, Minnesota, New York, Georgia and Alaska.

Boston Globe: Area Cities Adopt Changes To Curb Health Costs
Amesbury, Chelsea, and Newburyport have adopted union-backed changes to their employee health insurance plans that they say will bring much-needed savings. The changes in Amesbury and Newburyport, to take effect July 1, involve moving from a Blue Cross Blue Shield of Massachusetts plan with no deductibles to one that has deductibles and higher copayments (Laidler, 5/17). 

The Miami Herald: Miami Has Highest Health Care Costs In Country For Private Insurance
The Miami area continues to have the highest health care costs in the country, according to the latest edition of the Milliman Medical Index. The average annual cost of an employer-sponsored, preferred provider organization (PPO) for a family of four runs $24,965 in the Miami area, the highest of 14 cities surveyed by Milliman, the national consulting firm. The total includes all employer and employee costs (Dorschner, 5/16).

Health News Florida: FL Institute Is Part Of New Alzheimer's Trial
Florida will be "deeply involved" in the national initiative to prevent Alzheimer's Disease by the year 2025, and not only because nearly half a million residents have been diagnosed with the irreversible, progressive brain disease. The USF Health Byrd Alzheimer's Institute will be one of the sites conducting a test of an insulin nasal spray for patients with early-stage disease, one of two major clinical trials announced on Tuesday (Gentry 5/16).

Related, earlier KHN Capsules blog story: Obama Administration: A Plan To Prevent Alzheimer’s By 2025  (Torres, 5/15)

Kaiser Health News: Alaska Targets An Old Foe: Tuberculosis
Until 1950, TB was the No. 1 cause of death in Alaska. That legacy means that a large number of Alaskans still carry the bacteria that can cause the disease. They have no symptoms and they aren't contagious, but full-blown TB can flare up at anytime and then spread (Feidt, 5/17). 

Georgia Health News: A Forgotten Scourge, TB Still A Problem In Ga.
The U.S. rate of TB has been declining. Last year, a total of 10,521 new tuberculosis cases were reported in the U.S., an incidence of 3.4 cases per 100,000 people. That's the lowest rate recorded since national reporting began in 1953, the CDC says. But Georgia's tuberculosis rate, though dropping, is still higher than the national average. Georgia reported 347 TB cases (3.5 cases per 100,000 population) in 2011, a 16 percent decrease from 2010 (Miller, 5/16).

Healthy Cal: Life And Health In A Low-Income Neighborhood
[E]merging research continues to highlight the connection between place, lifespan and quality of life. ... The poorest counties in California have the worst health, while the richest, generally, have the best. This series of info-graphics looks at the stressors identified by residents in one low-income, high-crime area in the city of Hayward in Alameda County. ... The numbers of teenagers feeling sad, hopeless or contemplating suicide were shocking to the research teams (Jones and Flynn, 5/16).

Kansas Health Institute News: New Stevens County Facility To Address 'Mexican Mennonite' Health Needs
The population of Stevens County is less than 5,800, but its health department has more than 7,000 patients, and it's out of space. Many of those patients are so-called Low German Mennonites, or Mexican Mennonites, said Paula Rowden, administrator of the health department ... they have come to Kansas from Mexico, looking for jobs on farms, feed lots, or in meat packing plants. "They seem to be at the greatest risk. They're the ones that are utilizing the emergency room for medical care," Rowden said (Cauthon, 5/16).

Minneapolis Star Tribune: 8 Twin Cities Hospitals, Workers Reach Tentative Contact
Workers at eight Twin Cities hospitals reached a tentative contract agreement Wednesday, averting a potential strike later this month. Hospital negotiators and the Service Employees International Union Healthcare Minnesota, which represents 3,500 nursing assistants, technicians and support staff, have been negotiating a contract since January. The current contract had been extended several times (Smith, 5/17).

(St. Paul) Pioneer Press: Threatened Twin Cities Hospital Strike Averted With Contract Deal
Hospitals said they were seeking contract changes that would allow for more flexibility while letting medical centers be "good stewards of our limited resources." Union officials said the changes proposed by hospitals would mean less for workers who three years ago agreed to a wage freeze (Snowbeck, 5/16). 

The Philadelphia Inquirer: Philadelphia-Area Hospitals Report Higher Profit Margins
Profitability at hospitals in Philadelphia and its Pennsylvania suburbs improved slightly last year, but the revenue growth rate continued sliding, according to an annual report by the Pennsylvania Health Care Cost Containment Council. ... The report, which is appearing as hospital interests are lobbying hard in Harrisburg to undo funding cuts proposed by Gov. Corbett in February, showed that the overall operating profit margin at 41 area for-profit and nonprofit hospitals edged up to 4.4 percent from 4.3 percent (Brubaker, 5/17).

The New York Times: U.S. Expected To Retry Ex-Senator On 4 Unresolved Charges
Federal prosecutors will try to recover nearly $500,000 that Pedro Espada Jr., a former Democratic state senator from the Bronx, was convicted this week of stealing from a nonprofit health care network, as they seek a retrial for Mr. Espada and his son (Hu, 5/16).

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Weekend Reading

Longer Looks: Music As A Means Of Treatment For PTSD

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

The Associated Press: Iraq Veteran Uses Rap To Treat His PTSD
On one of the many days Leo Dunson wanted to die, the Iraq veteran put a gun to his temple and pulled the trigger. The loaded weapon misfired. For the troubled former soldier, it was another inexplicable failure, like his divorce or inability to make friends after returning from the war. In a Las Vegas recording studio, Dunson rapped about his life: "What's wrong with me? Got PTSD. These pills ain't working, man, I still can't think." ... The use of music to heal war wounds is part of an emerging field of alternative treatment being embraced by military officials eager to help veterans suffering from PTSD. In Wisconsin, New Jersey, California and other states, government doctors in recent months have launched experimental music therapy programs that rely on the smoothing sounds of classical or acoustic music to help veterans get well (Christina Silva, 5/15).

Forbes: Pills Still Matter; So Does Biology -- Managing Expectations About Digital Health
I read a tweet recently asserting that physicians may soon prescribe health apps as an alternative to medications; my initial reaction: good luck with that one. It's certainly easy enough to envision how magical thinking about the power of health apps will soon be replaced by disappointment as app developers realize something drug makers have known for years: it's hard to improve health, and it can be very difficult to get patients to stick with a treatment long enough to make a difference. At the same time, it's clear there are profound opportunities in digital health; I imagine the most effective applications will find a way to complement and enhance traditional therapeutics, rather than position themselves as "alt apps" – the alternative medicines of the digital age (you can just see the eBook now: "Health Apps 'They' Don't Want You To Know About") (David Shaywitz, 5/14).

The Atlantic: Women And Ob-Gyns Need Reliable Medical Justice
Ob-gyns are among the most frequently sued medical specialists. According to a 2009 survey, 90 percent of board-certified members of The American College of Obstetricians and Gynecologists (ACOG) have been sued. ... Rather than reflecting rampant negligence and maltreatment of patients, these numbers reflect that even the best care cannot guarantee a perfect birth outcome. Ob-gyns get sued for less-than-perfect outcomes--instances in which no one may be at fault but family medical costs can quickly skyrocket. Our current medical liability system fails to provide appropriate and timely compensation to persons injured, fails to deter real negligence, and impedes efforts to correct medical errors and improve patient safety. Under the current system, medical justice is unreliable for both patients and physicians, and patient care is harmed (Dr. Al Strunk, 5/15).

The Atlantic: Your Heart On Air Pollution: An Olympic Case Study
U.S. Olympic distance runner Amy Yoder Begley, who had previously visited Beijing, declared air quality "better than expected" upon arriving for the 2008 games. The IOC was pleased too. "I think, objectively, we can say that the Chinese authorities have done everything that is feasible and humanly possible to solve the situation or to address the situation," Olympic Committee chief Jacques Rogge reported during a press conference. "What they have done is extraordinary." ... Although the period of blue skies in Beijing may have been fleeting, researchers from the University of Southern California (USC) and colleagues have found that even such a small window of cleaner air may have proved useful for residents' cardiovascular health (Nadja Popovich, 5/16).

Huffington Post: The W Connection: Support For Widows By Widows
Dawn Nargi, a New Yorker, lost her husband, Norman Ferren, just two months after she gave birth to their son William. Dawn is one of 11 million widows in America today. There will be 1 million more by the end of 2012. ... When she lost her husband, Dawn herself was at a loss. Who to turn to? Who would understand? Who would help her through the maze of questions she had, from the deeply personal to the very practical? As it turned out, she found very few social service agencies that could help; and what information she did find was dispersed among several resources. It was this frustrating experience that motivated her and Ellen Kamp, a former colleague at Morgan Stanley, where Dawn is an IT vice president, to establish the W Connection. The W Connection calls itself "a one-stop Internet-based resource center and a national network of community-based organizations run by widows" (Perry Garfinkel, 5/14).

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Editorials and Opinions

Viewpoints: Drug Shortages Scare Consumers; Georgetown Was Right To Invite Sebelius; N.Y. Judge Makes Plea For Pot

USA Today: Editorial: Why Do Drug Shortages Persist?
Though the Food and Drug Administration has found better ways to alleviate [drug] shortages and some makers are providing the FDA with earlier warnings, the problem persists. This year, there have been 42 shortages. Although that's fewer than at this time last year, if you're the patient who needs an unavailable medication, the decline is of little consolation (5/16).

USA Today: Generic Pharmaceutical Association: We're Stepping Up
As the manufacturers of 80% of the prescription drugs dispensed in the U.S., the generic pharmaceutical industry is committed to providing patients with the safe and effective medicines they need at a price they can afford. This commitment has never been more evident than in our work to address shortages of critically needed medications (Ralph G. Neas, 5/16).

The Washington Post: Georgetown Gets It Right On Invitation To Kathleen Sebelius
The archbishop of Washington finds it "shocking" that Georgetown University President John J. DeGioia would defend the university's decision to have Health and Human Services Secretary Kathleen Sebelius participate in a commencement event in the aftermath of the furor over the Obama administration's rule on contraceptive coverage. What we find shocking is Cardinal Donald Wuerl's failure to credit the proper role of a university and the importance of vigorous, open debate, even — or perhaps especially — involving matters of intense controversy and religious disagreement (5/16).

The New York Times: A Judge's Plea For Pot
Three and a half years ago, on my 62nd birthday, doctors discovered a mass on my pancreas. It turned out to be Stage 3 pancreatic cancer. I was told I would be dead in four to six months. Today I am in that rare coterie of people who have survived this long with the disease. But I did not foresee that after having dedicated myself for 40 years to a life of the law, including more than two decades as a New York State judge, my quest for ameliorative and palliative care would lead me to marijuana (Gustin L. Reichbach, 5/16).

The New York Times: Room For Debate: How To Address Alcoholism On Indian Reservations
How can tribes, states, the federal government and local communities deal with alcoholism on and around reservations? If the beer companies and liquor stores are following the law, do they have a further responsibility to their communities? (5/16).

Boston Globe: Mass. Health Care Debate Pits Cost Vs. Quality — And Young Vs. Old
We have to rethink the balance we've struck between young and old — which means more than just investing in education. The state's much-discussed health care mandate also creates an implicit transfer from young to old. When young healthy people are forced to buy health care insurance, they pay rates that don't adjust fully for age. Even though they generally earn less, younger people subsidize older people with typically greater health care needs. Restraining health care spending will make room for other priorities, such as education, that address young people's needs more directly (Edward J. Glaeser, 5/17).

Boston Globe: Leading The Way In Accountable Care
We are as anxious as anyone to see how these ACOs begin to better coordinate care for their Medicare populations. But the truth is the real pioneers in providing coordinated care and coverage for seniors have been the Senior Care Options and Program for All Inclusive Care for the Elderly, which are thriving in Massachusetts. In fact, they are setting the example for the rest of the country (Lois Simon and Tom Reiter, 5/16).

JAMA: Tea Leaves Are For Drinking: Health Reform After The Supreme Court Ruling
Regardless of whether the Affordable Care Act (ACA) is upheld, overturned entirely, or stripped of key features, health care reform is already happening, and will continue, no matter what the Court decides. The bill is massive. Some of its features have already been altered—the long-term care program (the CLASS Act), for example—and others are sure to change in the process of implementation. But in in the midst of uncertainty about the future of the ACA, it's worth contemplating changes in the delivery system in response to spiraling costs of care, wider concerns about the Federal budget, and thus in anticipation of the ACA or something like it—something has to give (Dr. Mark D. Smith, 5/16).

The New York Times: The Power Of Nursing
In 2010, 5.9 million children were reported as abused or neglected in the United States. If you were a policy maker and you knew of a program that could cut this figure in half, what would you do? What if you could reduce the number of babies or toddlers hospitalized for accidents or poisonings by more than half? ... These and other striking results have been documented in studies of a program called the Nurse-Family Partnership, or NFP, which arranges for registered nurses to make regular home visits to first-time low-income or vulnerable mothers, starting early in their pregnancies and continuing until their child is 2 (Bornstein, 5/16).

Denver Post: Colorado Can't Fall Prey To Anti-Vaccination Nonsense
The whooping cough epidemic in Washington state offers some important public health lessons for places such as Colorado where vaccination opt-out rates are unacceptably high. Washington has about 1,280 cases reported and more expected. While it may seem a comfortable distance away in the Pacific Northwest, make no mistake: It could happen here (5/16).

MinnPost: Nursing Homes Deserve The Fees That Would-Be Heirs Often Want
According to some in the business, Minnesota's nursing-home system is in financial trouble in large part because people seem to think that no matter what their net worth, when it comes time for long-term care, they have a right to go on the dole. "Well," they say as they set up a way to hide their assets, "if we don't do something, it'll all just go to the nursing home!" Since when is it unfair to expect a person to use their assets to pay for their own care? (Eric Bergeson, 5/17).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Ankita Rao
Marissa Evans

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2012 Kaiser Health News. All rights reserved.