Daily Health Policy Report

Monday, May 20, 2013

Last updated: Mon, May 20

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch


Public Health & Education

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

With High Deductible Health Plans, It Pays To Shop Around For Care

Reporting for Kaiser Health News, in collaboration with The Philadelphia Inquirer, Michelle Andrews writes: "When Maria and Vadim Brodsky's then 7-year-old daughter needed an MRI two years ago to examine a tumor in her head, they took her to a hospital in their health plan’s network and were dismayed to receive a $4,500 bill. The couple had a $6,000 deductible on their family plan. And even though the bill was reduced to $3,000 — the price the provider and insurer had agreed to by contract — the Brodskys had to cover all of it" (Andrews, 5/20). Read the story.

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Feds Make It Easier For States To Enroll Poor Under Health Law

Kaiser Health News staff writer Phil Galewitz reports: "The Obama administration is making it easier for states to sign up the poor for health coverage – and to help those people stay covered. On Friday, it informed state officials that they could simplify enrollment in Medicaid, the federal-state program for the poor, to handle the onslaught of millions of anticipated enrollees next year when the health care law expands coverage. The administration said the changes are geared to states that are expanding their programs, but they may also be adopted by others" (Galewitz, 5/18). Read the story.

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Capsules: GOP Fears About IRS’ Access To Medical Records Disputed; Audio: 42 Percent Of Americans Unaware Health Law Exists (Audio)

Now on Kaiser Health News' blog, Mary Agnes Carey reports on the IRS and access to medical records: "Listening to recent statements from some congressional Republicans, you might think that the 2010 health law allows the Internal Revenue Service to have access to your medical records. Not so, says the Department of Health and Human Services. 'The Affordable Care Act maintains strict privacy controls to safeguard personal information. The IRS will not have access to personal health information,' said agency spokeswoman Erin Shields Britt" (Carey, 5/20).

Also on the blog, Carey joined NPR's "Tell Me More" Friday afternoon to discuss the state of the health law and other health policy issues – including a new poll saying 42 percent of Americans don't know that the Affordable Care Act actually still stands (5/17). Listen to the conversation or check out what else is on the blog.

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Political Cartoon: 'This Won't Hurt A Bit?'

Kaiser Health News provides a fresh take on health policy developments with "This Won't Hurt A Bit?" by Chip Bok.

Meanwhile, here is today's health policy haiku:

 THE 37th VOTE

'It's the law of the
land,' Mister Speaker said. But
2014 looms.

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

IRS Scandal, HHS Fundraising Stir The Health Law Political Pot

The Obama administration's efforts to raise money from private sources for the health law have led some likely donors to become "skittish." Meanwhile, as GOP lawmakers seek to link the Internal Revenue Service issues to the health law, media outlets examine the IRS's reach in this regard.

The New York Times: Potential Donors to Enroll America Grow Skittish
The Obama administration's efforts to raise private money to carry out the president's health care law have provoked such a strong partisan uproar that potential donors have become skittish about contributing, according to several people involved in the fund-raising program (Pear, 5/19).

The Associated Press/Washington Post: Republicans Seek To Link IRS Scandal And Tax Agency's Role Implementing Obama Health Overhaul
Political scandals have strange ways of causing collateral damage, and Republicans are hoping the furor over federal tax enforcers singling out conservative groups will ensnare their biggest target: President Barack Obama’s health care law. There is a link, but it may only be coincidence. No one appears to have connected the dots factually, and it’s unclear whether they will (5/18).

National Journal: Explaining The Connection Between Obama's Health Care Law And The IRS
Even before news organizations confirmed that Sarah Hall Ingram, who headed the tax-exempt division of the IRS, would lead agency's implementation of the ACA, Republicans wasted no time trying to link the scandal to the law. As the investigation into the IRS' targeting of conservative groups begins, here's an explainer to answer the role that the tax-collecting agency plays in the health care law's implementation (Catalini, 5/18).

Kaiser Health News: Capsules: GOP Fears About IRS' Access To Medical Records Disputed
Listening to recent statements from some congressional Republicans, you might think that the 2010 health law allows the Internal Revenue Service to have access to your medical records. Not so, says the Department of Health and Human Services. "The Affordable Care Act maintains strict privacy controls to safeguard personal information. The IRS will not have access to personal health information," said agency spokeswoman Erin Shields Britt (Carey, 5/20.

News coverage also included political reports from both the state and national level -

Politico: Obamacare Allies Eye Ballot Initiatives
Obamacare backers stymied by conservative legislatures in red states may have a new approach: letting the voters break logjams with state ballot initiatives in 2014. Frustrated by conservative opposition to extending Medicaid even in states where Republican governors have embraced it, the president's allies are strategizing about asking voters to do what their elected leaders have not: accept billions of federal dollars to cover millions of poor people under Obamacare (Cheney and Millman, 5/19).

The Washington Post: McConnell Predicts Obamacare Will Be 'Biggest Issue' Of 2014 Election
The Senate's top Republican predicted Sunday morning that President Obama's health care law will be the biggest issue of the 2014 midterm elections (Sullivan, 5/19).

Modern Healthcare: Reform Update: ACA Foes, Supporters Trade Volleys
Democrats and Republicans played another game of political tennis this week when House Republicans served up another vote to fully repeal the Patient Protection and Affordable Care Act and Democrats returned a litany of reasons why the 2010 law is good for Americans. Hours before the House of Representatives voted 229-195 to approve overturning the entire Affordable Care Act for a third time in a little more than two years, House Speaker John Boehner (R-Ohio) used a tower of the law's regulations—rising more than 7 feet tall—as a prop to emphasize the GOP view that the incredibly complex law is damaging the economy, hurting patients' access to care, and preventing job growth (Zigmond, 5/17).

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Employers Eye Limited Plans To Avoid Health Law Penalties

The Wall Street Journal reports that "bare-bones" health plans may help some employers avoid the law's fines. Meanwhile, the Journal Sentinel explores how investors are assessing winning or losing stocks as a result of the law's implementation.

The Wall Street Journal: Employers Eye Bare-Bones Health Plans Under New Law
Employers are increasingly recognizing they may be able to avoid certain penalties under the federal health law by offering very limited plans that can lack key benefits such as hospital coverage. Benefits advisers and insurance brokers—bucking a commonly held expectation that the law would broadly enrich benefits—are pitching these low-benefit plans around the country. They cover minimal requirements such as preventive services, but often little more. Some of the plans wouldn't cover surgery, X-rays or prenatal care at all. Others will be paired with limited packages to cover additional services, for instance, $100 a day for a hospital visit (Weaver and Mathews, 5/19).

Journal Sentinel: New Health Law Offers Opportunities For Investors
Three years after the passage of the Patient Protection and Affordable Care Act, and less than a year before some of ObamaCare's key measures take effect, there are still many unanswered questions about its impact. Obamacare has raised concerns about increases in health insurance premiums, doctor shortages and any number of issues. It has also created debate among investors about which stocks will benefit and which will suffer (Gallagher, 5/18).

Also in the news, small businesses looking for a way out of complying with the health law get no help from Congress, and the new CMS chief plans a busy implementation schedule --

The Hill: Despite Talk, No Effort In Congress To Change ObamaCare’s Employer Mandate
Small businesses looking for a break from President Obama’s healthcare law aren’t getting any help from Congress. The law’s critics spend a lot of time talking about its potential effects on employers, and small businesses in particular. But there hasn’t been a real effort on the Hill to address the provisions that will have the most immediate impact on small businesses (Baker, 5/19).

CQ HealthBeat: Newly Confirmed As CMS Administrator, Marilyn Tavenner Eyes A Summer Of Change
There’s something about Marilyn Tavenner that the White House could use a whole lot of right now as it absorbs successive waves of Republican criticism of its implementation of the health care law. She clearly has the ability to engage opponents of the overhaul and to earn their good will, as Wednesday’s overwhelming Senate vote confirming her as Centers for Medicare and Medicaid Services administrator attests (Reichard, 5/17).

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State Rejections Of Medicaid Expansion Likely To Widen Health Disparities

The Los Angeles Times reports that states opting against expanded eligibility -- among them, some of the nation's unhealthiest -- could fall even further behind as the Affordable Care Act is implemented.  News outlets also offer reports from Arizona, Michigan, Wisconsin, Ohio, California, Florida and Virginia.

Los Angeles Times: Medicaid Opposition Underscores States' Healthcare Disparities
Republican opposition in many statehouses to expanding Medicaid next year under President Obama's healthcare law — opposition that could leave millions of the nation's poorest residents without insurance coverage — will likely widen the divide between the nation's healthiest and sickest states (Levey, 5/18).

The Associated Press: Brewer Wrestled With Decision On Medicaid Expansion
The weekend before Arizona Gov. Jan Brewer made her State of the State address in January, she practiced two versions of her speech: one with a Medicaid expansion and one without. The Republican governor ended up announcing during her Jan. 14 address that she wanted to expand the state's Medicaid program - known as the Arizona Health Care Cost Containment System - bucking many conservatives in her party to embrace Medicaid expansion (5/20).

Arizona Republic: Arizona Gov. Jan Brewer Staking Legacy On Medicaid
Inside a Sun City West clubhouse one recent afternoon, Republican Gov. Jan Brewer stood before fellow Republicans, many of whom she once represented as a state lawmaker or county supervisor. She was there to explain why she had bucked many conservatives in her party to embrace Medicaid expansion, a signature piece of Democratic President Barack Obama’s health-care overhaul. It was a tough sell for some in this crowd — just as it has been with many GOP state legislators, who are divided on whether to accept billions in federal funds under the Affordable Care Act to provide health coverage to tens of thousands of uninsured Arizonans (Wingett, 5/19).

Arizona Republic: Medicaid Q&A With Arizona Gov. Jan Brewer
Gov. Jan Brewer, amid the most important policy debate of her governorship, spoke with The Arizona Republic last week about why she wants to expand Medicaid in Arizona. Question: Why are you fighting so hard for Medicaid expansion? Answer: This is something I had great difficulty with — I was such an opponent of “Obamacare.” I did everything … within my power to fight it. And we lost. Elections have consequences: Obama won, and the Supreme Court upheld the health care, so it’s here. Medicaid is just a small portion of Obamacare, and that’s what I keep trying to tell people — and the voters of Arizona have voted twice for expansion (Wingett Sanchez, 5/19).

CQ HealthBeat: On Medicaid: One State Moves Closer To Expansion, One Stalls
Arizona senators moved Medicaid expansion one step closer to reality in that state this week while the effort fell short in Michigan. Both states are led by Republican governors who announced earlier this year that they support expansion (Adams, 5/20).

Journal Sentinel: Taxpayers Will Pay More Under Scott Walker Health Plan, Study Says
Gov. Scott Walker's proposed rejection of a federally funded expansion of state health programs would add some $50 million in costs to state taxpayers over the next two years, according to the Legislature's nonpartisan budget office. The new report from the Legislative Fiscal Bureau immediately became part of the debate over Walker's budget proposal for Medicaid programs, which is currently before lawmakers on the Joint Finance Committee. The budget panel is rewriting Walker's bill and will send it to the Assembly and Senate early next month for their consideration (Stein, 5/17).

Sacramento Bee: Big Capitol Fight On Medi-Cal Looms Among Democrats
As he presented his revised 2013-14 budget to the Legislature last week, Gov. Jerry Brown warned against expanding spending beyond his administration's conservative revenue estimates. Citing darkening economic and revenue forecasts, Brown called on fellow Democrats in the Legislature to restrain themselves – and indirectly threatened to veto anything he considers to be too expansive (Walters, 5/20).

PolitiFact/Tampa Bay Times: Weatherford Overreaches With Claim That Medicaid Expansion Drives Deficit
The Florida House did the nation a favor by refusing to expand subsidized health insurance to 1 million low-income Floridians, argues Speaker Will Weatherford. ... Does the Medicaid expansion drastically raise the deficit? PolitiFact Florida wanted to check it out (Sanders, 5/19).

Columbus Dispatch: Medicaid Expansion Could Be On Ballot In 2014
As supporters of Medicaid expansion in Ohio grow increasingly impatient with legislative inaction, talk, both publicly and privately, is turning toward alternatives such as a 2014 ballot issue. “In the balance is health care for hundreds of thousands of Ohioans and the jobs that would be attached to those,” said Anthony Caldwell, spokesman for Service Employees International Union District 1199. The SEIU is part of a broader coalition, the Ohio Alliance for Health Transformation, whose leaders still hope for legislative action before lawmakers pass the two-year budget in late June. Gov. John Kasich proposed expanding Medicaid to cover about 275,000 Ohioans who earn up to 138 percent of the federal poverty level (Siegel and Candisky, 5/18).

Richmond Times-Dispatch: Hospitals Face Anxious Period On Medicaid
Virginia hospitals face an anxious summer and fall as state lawmakers begin to take a hard look at reforming — and potentially expanding — the state’s Medicaid program for the poor, elderly and disabled. Next month, a new legislative commission will meet for the first time to review Medicaid reforms required under the state budget that will take effect July 1. Accomplishment of those reforms will determine whether the Medicaid Innovation and Reform Commission agrees to extend the program to hundreds of thousands of uninsured Virginians — many of whom now go to emergency rooms for care that ultimately is paid for by taxpayers (Martz, 5/19).

In related news, Kaiser Health News reports on how the Obama administration is encouraging states to streamline enrollment of adults in Medicaid -

Kaiser Health News: Feds Make It Easier For States To Enroll Poor Under Health Law
The Obama administration is making it easier for states to sign up the poor for health coverage – and to help those people stay covered. On Friday, it informed state officials that they could simplify enrollment in Medicaid, the federal-state program for the poor, to handle the onslaught of millions of anticipated enrollees next year when the health care law expands coverage. The administration said the changes are geared to states that are expanding their programs, but they may also be adopted by others (Galewitz, 5/18).

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Health Law's Insurance Exchanges Are Not Mirror Image Of Mass. Version

Some of the state's features that advocates say helped consumers make their insurance-purchasing decisions were not included in the the federal health law.

Boston Globe: U.S. Won't Mirror Mass. On Health Exchanges
When millions of Americans around the country sign up for insurance under President Obama's sweeping health care law in October, the system they encounter will lack some of the key protections and cost controls that Massachusetts consumers receive. Massachusetts, the first state in the nation to implement near-universal health coverage, served as the model for major aspects of the groundbreaking health care overhaul law. But under lobbying pressure from the insurance industry, the Obama administration has decided not to adopt features of the Massachusetts plan that advocates say have helped consumers more easily make cost-effective choices (Jan, 5/20).

In Minnesota, a glitch pushed back the deadline for its online health insurance marketplace --

MPR News: Glitch Pushes Back MNsure Deadline
A computer glitch at the Centers for Medicare and Medicaid has forced the postponement of a state deadline Friday connected to Minnesota's new online health insurance marketplace, called MNsure. Insurers now have an extra week to submit health insurance policies for approval to sell them on MNsure. The state is already under a tight time crunch to complete the massive project by the Oct. 1 deadline to be up and running. But the state Commerce Department says a computer system problem at the federal level means insurers can't complete all the required steps in time to meet the state deadline (Stawicki, 5/17).

MPR News: MNSURE Board Picks Ex-CEO As Chairman
The former head of a health care software company will lead a powerful board that is playing a major role in shaping the state's new online health insurance marketplace, MNSURE. The seven-member board chose Brian Buetner, former CEO of Minneapolis-based mPay Gateway, to chair the MNSURE board of directors. Buetner is a former executive with health insurance Giant UnitedHealth Group. The board also chose a vice chairman, Peter Benner, a former AFSCME executive director (Stawicki, 5/19).

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Capitol Hill Watch

CBO: Obama's Budget Would Reduce Medicare Spending By $364B

The Congressional Budget Office estimated Friday that President Obama's budget would reduce Medicare spending by $364 billion over the next decade and would reduce future budget deficits. The White House and Congress will likely soon need to work on a long-term budget solution as the nation again hits its debt limit.

Los Angeles Times: Obama Budget Would Cut Deficits, Report Says
President Obama's proposed mix of tax hikes and spending cuts would reduce future budget deficits more quickly than under current laws, according to a report issued Friday that could rekindle the dormant budget wars in Washington. The outlook from the nonpartisan Congressional Budget Office comes as the government is set to reach its debt limit on Saturday, forcing the White House and Congress back to the negotiating table to work out a long-term budget plan that raises taxes, cuts spending -- or some combination of the two (Mascaro, 5/17).

Modern Healthcare: CBO's Medicare Estimates On Par With White House Figures
Falling closely in line with the Obama administration's analysis last month, the nonpartisan Congressional Budget Office estimates that the policies in President Barack Obama's fiscal 2014 budget proposal would reduce Medicare spending by about $364 billion over 10 years, compared with the administration's estimate of $371 billion. Released Friday, the CBO's analysis said the president's budget proposal for next year would total $5.2 trillion in deficits between 2014 and 2023, or about 2.4 percent of the country's Gross Domestic Product projected for that period (Zigmond, 5/17).

The Hill: Obama Budget Would Cut $364 Billion In Medicare Spending
President Obama's budget proposal would save the Medicare program $364 billion over the next decade, according to the Congressional Budget Office (CBO). The CBO largely concurred with the White House's estimates, which pegged the budget's Medicare savings at $370 billion (Baker, 5/17).

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Findings Examine Work-Hour Restrictions, Impact Of Hospitalists' Workloads

A survey found surgeons-in-training often skirt limits on work hours. Meanwhile, a new study concluded that the length of inpatient hospital stays increased when hospitalists' workload went up.

Reuters: Surgeons-In-Training Dislike New Work Hours: Survey
Most surgeons-in-training dislike new rules that limit how many hours they can work, according to a new study that also found the majority said they skirt the restrictions. Researchers surveyed 1,013 surgical residents - who train for years alongside more senior surgeons - and found that about two of every three said they disapproved of the 2011 regulations, which aimed to improve patient care as well as the residents' education and quality of life (Seaman, 5/17).

Medpage Today: Hospitalists Work Longer, Patients Stay Longer
In a less busy hospital, inpatient hospital stays increased as physician workload went up, Daniel Elliott, MD, hospitalist with Christiana Care Health System in Wilmington, Del., found in a retrospective, cohort study. … However, as the hospital got busier, the length of stay was less responsive to changes in workload, he said at a session on hospitalist workload (Pittman, 5/17).

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Public Health & Education

New Psychiatric Diagnostic Manual Released

Long-awaited update of "the psychiatrist's bible" has stirred controversy.

Marketplace: How Much Is The DSM-5 Worth?
Controversy has dogged the new DSM-5, what people like to call "the psychiatrist's bible," and it won't even be officially released until this weekend. Really, the book is a manual clinicians use to diagnose and classify people with mental illness. While it sounds pretty dry, there's a whole lotta drama around this book. The federal government has questioned its value. ... some practitioners are boycotting it and there are charges that it's not ready for prime time. Before I say anything more about the DSM-5, here are a couple of facts about the DSM IV. It's 19 years old and it still brings in about $4-5 million a year (Gorestein, 5/17).

Reuters: Psychiatrists Unveil Their Long-Awaited Diagnostic 'Bible'
The long-awaited, controversial new edition of the bible of psychiatry can be characterized by many numbers: its 947 pages, its $199 price tag, its more than 300 maladies (from "dependent personality disorder" and "voyeuristic disorder" to "delayed ejaculation," "kleptomania" and "intermittent explosive disorder") (Begley, 5/17).

Medpage Today: APA Leaders Defend New Diagnostic Guide
The fifth edition of the "psychiatrist's bible" was officially released here in all its 947-page glory, with its developers offering a spirited rebuttal to their critics. Known as DSM-5, the new version of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders was launched at a press briefing to kick off the organization's annual meeting. Most of the changes from the previous edition had already been made public, at least in general outline (Gever, 5/18).

McClatchy: Child Mental Health Disorder Rising, Cost Society $247 Billion Annually
Up to one in five American youngsters – some 7 million to 12 million by one estimate – experience a mental health disorder each year, according to a new report billed as the first comprehensive look at the mental health status of American children. And the rate is increasing, said the U.S. Centers for Disease Control and Prevention, which produced the study, released Thursday (Pugh, 5/16).

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Health Care Marketplace

Pentagon Advisor's Biotech Firm Reaps Millions For Anthrax Drug

Los Angeles Times: Anthrax Drug Brings $334 Million To Pentagon Advisor's Biotech Firm
Over the last decade, former Navy Secretary Richard J. Danzig, a prominent lawyer, presidential advisor and biowarfare consultant to the Pentagon and the Department of Homeland Security, has urged the government to counter what he called a major threat to national security. Terrorists, he warned, could easily engineer a devastating killer germ: a form of anthrax resistant to common antibiotics. … Danzig did this while serving as a director of a biotech startup that won $334 million in federal contracts to supply just such a drug, a Los Angeles Times investigation found (Willman, 5/19).

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State Watch

GOP Nominee For Va. Lt. Gov. Likened Planned Parenthood To KKK; Ark. Judge Halts Abortion Ban

A man nominated Saturday for lieutenant governor of Virginia made comments last year that likened Planned Parenthood to the KKK. In Arkansas, a judge delayed a law that would ban most abortions there after 12 weeks of pregnancy.

Politico: Virginia Pick Compared Planned Parenthood To KKK 
E.W. Jackson, a black minister and activist nominated for lieutenant governor Saturday, posted a four-minute video on YouTube last fall exhorting African-Americans to vote Republican. In the video message, he accused the "civil rights establishment" of selling out their Christian values in order to support Democratic policy positions on gay marriage and abortion. ... "The Democrat Party has created an unholy alliance between certain so-called civil rights leaders and Planned Parenthood, which has killed unborn black babies by the tens of millions. Planned Parenthood has been far more lethal to black lives than the KKK ever was," Jackson says in the video (Burns, 5/19).

Los Angeles Times: Judge Temporarily Delays 12-Week Abortion Law In Arkansas
An Arkansas law that bans most abortions after 12 weeks of pregnancy was temporarily blocked by a federal judge on Friday. In a ruling from the bench, U.S. District Court Judge Susan Webber Wright in Little Rock granted a preliminary injunction preventing the Arkansas law from going into effect as scheduled, a member of the court staff said by telephone. It was scheduled to start Aug. 16 (Muskal, 5/17).

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State Roundup: Okla. Gov. Pushes Funding Fix To Cover 9,000 On Medicaid

A selection of health policy stories from Oklahoma, Texas, California and Massachusetts.

The Associated Press: Fallin Urges Last-Minute Health Care Fix
Gov. Mary Fallin proposed a last-minute legislative change Friday to the state's Insure Oklahoma program that would direct $50 million in state tobacco taxes to pay for more than 9,000 people who are expected to lose their health insurance under the program. Insure Oklahoma currently uses federal Medicaid funding, state tobacco tax revenue and payments from workers and employers to provide health insurance to about 30,000 low-income Oklahomans, but the federal government notified Oklahoma last week that the program must change in order to qualify for federal funding (Murphy, 5/18).

The Associated Press: Legislators Devote New Funding To Mental Health
For the first time since (Texas) state lawmakers made historic budget cuts a decade ago, legislators are dedicating hundreds of millions more dollars to mental health care. (Haven for Hope in Bexar County) serves as a model of the services and success they aim to accomplish. ... As Republicans and Democrats in the Texas House and Senate hash out the details of the state’s 2014-15 budget — there are fights over water, roads and education — one issue they are not arguing about is support for mental health. "One thing we could all agree on was mental health was, to a large extent, a driver of crime," said state Rep. John Zerwas, R-Simonton (Grissom and Rocha, 5/19).

The Texas Tribune: House OKs Bill To Expand Mental Health In Managed Care
Managed care plans would be required to offer more mental health services to Medicaid recipients under a bill tentatively approved by the House on Friday. … The majority of mental health services -- such as medication management and counseling -- are already provided to Medicaid recipients through managed care (Aaronson, 5/17).

Los Angeles Times: City Of San Francisco, Worker Unions Protest Kaiser Premium Hike
It's a trend many public employees can relate to: Health insurance premiums climb year after year, while at the bargaining table workers have agreed to kick in more for pensions, take salary cuts and sign on to furlough days. But when Kaiser Permanente -- which insures 45,000 public workers here -- proposed another hike for 2014, San Francisco's Health Service System teamed up with labor unions to say "no more" (Romney, 5/19).

Los Angeles Times: St. John's Picks Providence Health & Services In Bidding War
After months of controversy, the owner of St. John's Health Center said it plans to sell the landmark Santa Monica hospital to Catholic chain Providence Health & Services. The hospital has been at the center of an intense competition that featured bids from UCLA Health System, other Catholic hospital chains and Los Angeles billionaire Patrick Soon-Shiong (Terhune, 5/17).

The Texas Tribune: Texas On Track To Restore Cancer Research Funding
The Legislature is on track to restore financing for the Cancer Prevention and Research Institute of Texas. In an effort to restore public trust in the beleaguered agency, budget negotiators made the agency's financing for 2014-15 biennium -- $595 million -- contingent upon the passage of Senate Bill 149, which the House tentatively approved on Friday (Aaronson, 5/17).

Medpage Today: No Hike In Mass. Hospital Use Post Health Reform
Health care reform in Massachusetts did not increase overall use of inpatient resources, but other states may not be so lucky, researchers found. Before and after a reform, the average number of quarterly admissions per hospital was 1,502 and 1,557, respectively -- translating into a nonsignificant net change of 0.3 percent when compared with controls, according to Amresh D. Hanchate, PhD, an economist at the Veterans Affairs Boston Healthcare System, and colleagues (Kaiser, 5/17).

California Healthline: Assembly Approves Race, Ethnicity In Quality Reporting
The Assembly yesterday passed a bill that requires state officials to include race and ethnicity when compiling health care quality data. AB 411 by Assembly member Richard Pan (D-Sacramento) would not create any kind of difficulty for state officials, since that data already exists, according to Pan. The point is to make state officials use it, Pan said. … The information is already being collected by the state Department of Health Care Services so it's not really much more work to mine that data for health disparities by race or ethnicity, Pan said (Gorn, 5/17).

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Editorials and Opinions

Viewpoints: Sebelius' 'Ethical Line'; As Tricky Phase Of Health Law Approaches, Concerns About Exchanges Opening On Time

The Washington Post: Kathleen Sebelius Dances On An Ethical Line
One of the biggest questions hanging over the health-care system is how many young Americans will sign up for coverage once the Affordable Care Act begins to phase in this October. If too few buy insurance on the markets that the government is creating, insurance companies would be stuck covering primarily the old and the sick. They would have to pay out more per customer. Their customers, in turn, would have to pay more to those companies for coverage. The stakes for the Health and Human Services Department, which is overseeing the transition, are tremendous. But they are not high enough to justify HHS Secretary Kathleen Sebelius dancing around serious ethical lines (5/18). 

The Washington Post: Obamacare's Tricky Next Phase
Thought you had seen the last of the fighting over the Affordable Care Act, also known as Obamacare? Since its passage in 2010, after all, it has survived Supreme Court review, innumerable challenges from House Republicans and Mitt Romney’s unsuccessful campaign to evict its author from the White House. Nonetheless, with the heart of the reform set to take effect next year, its most contentious days may lie ahead (5/19).

The Wall Street Journal: Navigating The ObamaCare Maze
On Oct. 1, millions of Americans are supposed to be able to go online and acquire health insurance on electronic exchanges in the states where they live. But here is a question that is being increasingly asked by people in the insurance industry: What happens if the exchanges aren't ready on time? (John C. Goodman, 5/19).

The Washington Post: Is The Health Care Spending Slowdown For Real?
We all know that Stein's Law will someday apply to health-care spending, which has risen from 5 percent of the economy (gross domestic product) in 1960 to almost 18 percent now. What we don't know is how and when its share of the economy will stabilize. Will this result from spending controls imposed by Washington; or from delivery-system "reforms" that spontaneously cut "waste"; or from rationing, which limits spending by denying people treatment; or by some combination of these? As for when, could it be now? (Robert J. Samuelson, 5/19).

Tampa Bay Times: Paying For Benefits, Getting None
Economists like myself are accustomed to seeing politicians act in ways that don't make economic sense. That being said, the decisions many are making about health care policy are truly dumbfounding. Florida recently failed to pass a budget that included the expansion of Medicaid that is part of the Affordable Care Act (Obamacare) and will be implemented on Jan. 1, 2014. In so doing, Florida joins 24 other states that are "opting out" of expanding Medicaid. Not surprisingly, most of the South is in that group. The economic consequences of opting out are likely to be large (Alan Green, 5/19).

Austin American Statesman: A Texas Solution For The Affordable Care Act
Because the governor is hesitant to expand Medicaid, the legislature will probably adjourn without taking full advantage of the dollars available to Texas to cover the uninsured through the Affordable Care Act. Fortunately there is more than one way to skin a cat, which in this case means a way to pull down all the dollars in the affordable care act through a market solution rather than by expanding traditional Medicaid, and it can be done before the legislature meets again in 2015 (Anne Dunkelberg, 5/19).

Bloomberg: Oregon's Radical Health Overhaul Blazes New Trail
The past few years have seen two remarkable health-care experiments in the Beaver State. One is the Oregon Health Insurance Experiment, the first randomized, controlled trial comparing Medicaid -- or any kind of health insurance -- with being uninsured. The other is (Gov. John) Kitzhaber's effort to rebuild the state's Medicaid program around community health rather than individual fee-for-service treatments. The health-insurance experiment has gotten all the attention. But it's the Medicaid reforms that really matter (Ezra Klein, 5/17).

Oregonian: Getting More Doctors, Nurses Into Rural Oregon Should Win Legislature's Support
Oregonians living in rural settings can have a hard time finding adequate and prompt medical care. It's either far away, too expensive or both. Finding an available doctor or a trained nurse practitioner close to home in Grant or Tillamook counties, to name just two of more than a dozen Oregon counties rated by the U.S. government as medically underserved, could be more of a trial than the runaway fever in need of attention (5/19).

Arizona Republic: Refusing Medicaid Expansion Means Abandoning Neighbors 
But when (Timothy Leffler) lost his position at the Arizona State University School of Music because of state budget cuts, he faced dire circumstances. Leffler has type 2 diabetes. As a single adult without children, he narrowly qualified for Arizona Health Care Cost Containment System coverage just before the state froze enrollment. Soon after, he was diagnosed with severe hereditary neuropathy, which started in his feet and moved to his hands and arms. It's a very painful disease with no cure. He will need medication for the rest of his life. And he will be one of 60,000 Arizonans to lose such coverage on Dec. 31, if the state Legislature refuses Medicaid restoration (John Linder and Martha Seaman, 5/19).

Star Tribune: Minnesota Program Cuts Costs For Poor -- Compassionately
Ezekiel Allen's weary voice and his long list of medical challenges -- schizophrenia, a back injury, bipolar condition, high blood pressure, brain polyps, dental troubles, migraine headaches -- make him sound far older than his 45 years. Homeless for a number of years, Allen didn't see a doctor regularly for far too long. When the pain of his conditions became overwhelming, the Minneapolis man would get medical care from one of the costliest venues — an emergency room (5/19). 

The New York Times: Angelina Jolie's Disclosure
Very few women fall into such a high-risk category. But for those who do, the test may be lifesaving. ... The health care reform law requires private insurers to cover genetic counseling and, if appropriate, BRCA testing, without a co-payment, in recently issued policies. ... Generally, neither private nor public insurance will cover the tests for women whose family history does not suggest increased risk, and that makes good sense (5/17).

Los Angeles Times: Health Care For Angelina Jolie -- And Everyone Else
We applaud Times columnist Robin Abcarian for shining the light on the inequities in our healthcare system in response to Angelina Jolie’s recent announcement about her prophylactic mastectomy. When Jolie made her medical decision, she had at her disposal the resources to pay for the procedures and the best doctors; not everyone has the same ability. At the Cancer Legal Resource Center (CLRC), our attorneys hear from individuals who experience great difficulty undergoing the same procedures as Jolie because they fear discrimination based on the results of genetic tests, and because their insurance won't cover the care they need (Anya Prince and Jen Flory, 5/18). 

Los Angeles Times: A Birth Control Double Standard
In the uproar about making the morning-after contraceptive known as Plan B available to our daughters, there has been no similar outcry about condoms and our sons. Anyone of any age can walk into a drugstore -- as well as most grocery and big-box stores -- and buy condoms. If you want to remain anonymous, you can pay cash; no ID is required. If you're too embarrassed to face the checkout clerk, use the self-check aisle or, for $17.97, get a box of 100 -- flavored or with "added sensations," even -- delivered to your door in a plain brown box (Meg White Clayton, 5/20).

Des Moines Register: Dental Board's Actions Protect Dentists, Not The Public
Some licensing boards are obviously important to protect public safety by ensuring workers have certain minimum education and training. Yet the licensing boards, often composed largely of industry insiders, may limit competition. ... Among the most egregious examples of this: In 2009, the Legislature approved an amendment to Iowa law that ensured only dentists can provide teeth-whitening services. ... That’s right. You can whiten your own teeth with a mouth tray and gel purchased at a drugstore. You can go online and buy exactly the same products dentists use in their offices. And if you lived in most other states, you could set up a business offering this cosmetic procedure to the public -- and many people have. But not in Iowa  (5/19).

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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.