Daily Health Policy Report

Tuesday, May 22, 2012

Last updated: Tue, May 22

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Quality

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insuring Your Health: Trained Interpreters Can Help Avoid Medical Mishaps

In her latest Kaiser Health News consumer column, Michelle Andrews writes: "A visit to the emergency department or a physician's office can be confusing and even frightening when you're trying to digest complicated medical information, perhaps while you're feeling pain or discomfort. For the 25 million people in the United States with limited English proficiency, the potential for medical mishaps is multiplied" (Andrews, 5/21). Read the column.

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Political Cartoon: 'Wash It Down?'

Kaiser Health News provides a fresh take on health policy developments with "Wash It Down?" by Nick Anderson.

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

A HEALTH BENEFITS RIDDLE...

A no-brainer for
Corporate America
But hard for Congress
-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

Catholic Groups Sue To Stop Birth Control Coverage Rule

In total, 43 Catholic groups -- including archdioceses in D.C. and New York, and Catholic universities such as Notre Dame -- brought suits in a dozen federal courts against a provision of the health law that requires they cover birth control in most of their health plans.

Los Angeles Times: Catholic Institutions Sue Over Contraceptive Rule
The battle between the Obama administration and some prominent Catholic institutions intensified Monday when 43 Catholic groups, including the archdioceses of Washington, D.C., and New York,  and Notre Dame and Catholic universities, filed suit across the country challenging a federal mandate requiring them to provide contraception to their employees (Duncan, 5/21).

NPR Shots Blog: Catholic Groups Sue Obama Administration Over Birth Control Rule
So much for compromise. A total of 43 Catholic educational, charitable and other entities filed a dozen lawsuits in federal court around the nation Monday, charging that the Obama Administration's rule requiring coverage of birth control in most health insurance plans violates their religious freedom (Rovner, 5/21).

The New York Times: Catholics File Suits On Contraceptive Coverage
In an effort to show a unified front in their campaign against the birth control mandate, 43 Roman Catholic dioceses, schools, social service agencies and other institutions filed lawsuits in 12 federal courts on Monday, challenging the Obama administration's rule that their employees receive coverage for contraception in their health insurance policies (Goodstein, 5/21).

The Wall Street Journal: Catholics Sue Over Health Mandate
The University of Notre Dame, the Archdiocese of New York and 41 other Roman Catholic institutions sued the Obama administration in federal court Monday, the latest push against a requirement in the health care overhaul law that employers cover contraception in workers' health plans (Radnofsky, 5/21).

The Associated Press: Catholic Dioceses, Colleges Sue Over Obama Mandate 
Roman Catholic leaders opened a new front against the Obama administration mandate that employers provide workers birth control coverage, filing federal lawsuits Monday on behalf of dioceses, schools and health care agencies that argued the requirement violates religious freedom. Among the plaintiffs is the University of Notre Dame, which in February had praised President Barack Obama for pledging to accommodate religious groups and find a way to soften the rule. Notre Dame president, the Rev. John Jenkins, said the school had since decided to sue because "progress has not been encouraging" in talks with administration officials (Zoll, 5/21).

Chicago Tribune: Illinois Dioceses, Other Catholic Groups Sue Over White House Insurance Mandate
The Roman Catholic dioceses of Springfield and Joliet have joined 41 other religious institutions filing simultaneous lawsuits that challenge the Obama administration's mandate that many religious employers have their health insurance cover the cost of birth control for employees. Catholic Charities programs in both dioceses also filed simultaneous lawsuits in U.S. District Court on Monday (Brachear, 5/22).

Politico: Notre Dame, Other Groups File New Lawsuits Against Contraception Rule
The groups say the administration's policy is a violation of their right to freedom of religion. The Obama administration has said it would give religious-affiliated institutions, such as Notre Dame, a one-year reprieve from the policy, which goes into effect Aug. 1. During that time, the administration has said it would work on a compromise. But the plaintiffs say that there is no way to compromise on the matter and that the administration has not yet delivered any new policy (Haberkorn, 5/21).

Reuters: U.S. Catholic Groups Sue To Block Contraception Mandate
The University of Notre Dame and dozens of other Catholic institutions sued President Barack Obama's administration on Monday to block a government regulation that requires employers to provide health insurance coverage for contraceptives to employees. The regulation, which is part of the president's health care reform law, has sparked a nasty fight between the administration and the Roman Catholic Church, which opposes artificial contraception. Some 43 Catholic groups including Notre Dame, Catholic University of America and the Archdiocese of New York filed 12 different suits across the country (Baynes, 5/21).

Bloomberg: Catholic Church Attacks Birth-Control Mandate In Court
The Catholic Church and related universities, charities and health-care groups sued the Obama administration in a bid to overturn a requirement that their health plans cover birth control. Forty-three Catholic organizations, including the archdioceses of Washington and New York, the University of Notre Dame and Catholic University of America, filed 12 suits yesterday in courts around the country, saying the mandate violates religious freedom and free-speech rights. They asked federal judges to bar the mandate's application to religious institutions or overturn it altogether (Forden, 5/22).

National Journal: Major Catholic Institutions Sue Over Birth Control Rule
"For the first time in this country's history, the government's new definition of religious institutions suggests that some of the very institutions that put our faith into practice—schools, hospitals, and social service organizations—are not 'religious enough,'" Cardinal Donald Wuerl, Archbishop of Washington, said in a statement. Religious groups are exempted from the rule if they employ primarily people of their faith (McCarthy, 5/21).

The Hill: Planned Parenthood: Contraception Suit 'Unbelievable'
"It is unbelievable that in the year 2012 we have to fight for access to birth control," said Cecile Richards, president of Planned Parenthood Federation of America. "Yet this lawsuit would make it harder for millions of women to get birth control." The lawsuits and the response from Planned Parenthood mirror the political debate over the birth-control mandate. Critics, most notably the U.S. Conference of Catholic Bishops, see the policy as a question of religious freedom. But the mandate's supporters say it's about women's health, not religion (Baker, 5/21).

NewsHour (Video): Catholic Groups Sue Over Contraception Coverage
A group of Roman Catholic leaders and institutions sued the Obama administration over the federal mandate to provide birth control to employees, saying it violated religious freedom. Gwen Ifill and The Wall Street Journal's Janet Adamy discuss the lawsuit (5/21).

McClatchy: Catholic Employers Sue Over Contraceptive Rule
At issue is a rule in the Obama 2010 health-care law requiring contraception coverage, including the morning-after pill, at no cost. Under rules released last August, churches, mosques and other places of worship would be exempt, but not religiously affiliated groups, such as hospitals and universities. But that did not satisfy some prominent Catholic officials. In response, the administration softened the rule earlier this year so that religiously affiliated employers could shift the requirement for paying for contraceptive coverage onto their insurers (Duncan, 5/21).

Fox News (Video): Catholic Organizations Across The Country File Suit Against Contraception Mandate
Some of the most influential Catholic institutions in the country filed suit against the Obama administration Monday over the so-called contraception mandate, in one of the biggest coordinated legal challenges to the rule to date. Claiming their "fundamental rights hang in the balance," a total of 43 plaintiffs filed a dozen separate federal lawsuits challenging the constitutionality of the requirement. Among the organizations filing were the University of Notre Dame, the Archdiocese of New York and The Catholic University of America (5/21).

The Hill (Video): Obama Adviser Defends Contraception Mandate
Senior Obama campaign adviser David Axelrod defended the health care law's mandate on contraception Monday shortly after a lawsuit was filed against it by Catholic institutions. "These institutions don't have to pay for it, they don't have to sponsor it and I think most people agree that’s an appropriate compromise," Axelrod said in an appearance on MSNBC (Altman, 5/21).

The Hill: Dem Law May Be Downfall Of Mandate
The biggest legal threat to the White House’s birth control mandate could come from a decades-old law that was championed by liberal Democrats, according to legal experts. The Religious Freedom Restoration Act (RFRA) has been mentioned in nearly all of the more than 30 lawsuits pending against President Obama's administration over the mandate. One, filed by the University of Notre Dame on Monday, cited RFRA’s protections in the first paragraph (Viebeck, 5/22).

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GAO: Health Law's Tax Credit For Small Businesses Underperforms

A Government Accountability Office report found that only about 17 percent of the businesses that would otherwise be eligible for the maximum tax credit offered health insurance to employees.

The Hill: GAO: Tax Credit In Health Care Law Underperforms
Only about 17 percent of the businesses that would otherwise be eligible for the maximum tax credit offered health insurance, according to government data cited in the GAO report. The tax credits are administered on a sliding scale, covering up to 35 percent of a company's healthcare costs. "While some small employers could be eligible for the credit if they began to offer health insurance, small business group representatives and discussion group participants told us that the credit may not offset costs enough to justify a new outlay for health insurance premiums," GAO said (Baker, 5/21).

Politico Pro: GAO: Small Businesses Skip Tax Credit
Republicans pounced on the news to paint the ACA as an unworkable and confusing thicket of regulation. "The failure of these small business tax credits goes to the heart of what's wrong with ObamaCare: It's confusing, expensive, and burdensome for the families and businesses that have to comply with it," U.S. Sen. Orrin Hatch (R-Utah) said in a statement (Cheney, 5/21).

CQ HealthBeat: GAO: Small-Business Tax Credit Is Chump Change For Effort Involved
The credit, designed to encourage small businesses to purchase coverage for their employees, was claimed by 170,300 employers in tax year 2010, a small portion of the 1.4 million to 4 million participants government agencies and small business advocates expected, GAO said. Most of the claims, 83 percent, were for partial credits rather than the full 35 percent available. The average credit amount claimed in 2010 was $2,700 (Bristol, 5/21).

Modern Healthcare: Few Businesses Claiming Health Insurance Tax Credit: GAO
Depending on the estimate, 4% to 12% of small businesses eligible for health insurance tax credits claimed them in 2010, according to a new report. The tax credit was included in the Patient Protection and Affordable Care Act to induce small businesses to offer health benefits but failed to do so, the Government Accountability Office said (Evans, 5/21).

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Progress Report On Health Law's Risk Adjustment Rule, State-Based Exchanges

News outlets offer updates regarding state progress related to developing the health law's insurance exchanges, the timing for risk adjustment rules and the release of the final federal rule on the health insurance premium tax credit. 

Politico: Few States Set For Health Exchanges
When health insurance exchanges open in 2014, it is now clear that the federal government will be playing the lead, not the understudy. Many insurance experts and health policy consultants predict only a dozen or so states will be ready to run exchanges on their own -- and a few say that projection may be too sunny (Feder and Millman, 5/21).

Politico Pro: CCIIO: Risk Adjustment Rules Due By Fall
CCIIO officials told state officials Monday that draft rules on risk adjustment will not be issued till the fall, according to sources participating in a three-day conference on exchanges held this week in Washington. The CCIIO officials also said that final rules may not be available until December or January (Feder, 5/21).

Modern Healthcare: Feds Issue Final Rule On Consumer Tax Credit
The federal government has released a final rule cementing many of the details of the health insurance premium tax credit. Mandated by the health care reform law, the credit applies to individuals and families who are enrolled in insurance exchanges and whose income is between 100 percent and 400 percent of the federal poverty level. The Treasury Department, which published the rule May 18, estimates the tax credit will help provide coverage for nearly 20 million middle-income Americans (McKinney, 5/21).

In other health law news, the Department of Health and Human Services signs a $20 million PR contract to get the word out about the overhaul --

The Hill: HHS Signs $20M PR Contract To Promote Health Care Law
The Health and Human Services Department has signed a $20 million contract with a public-relations firm to highlight part of the Affordable Care Act. The new, multimedia ad campaign is designed to educate the public about how to stay healthy and prevent illnesses, an HHS official said (Baker, 5/21).

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Capitol Hill Watch

Tavenner Confirmation Hearing Not In The Senate's Plans

The Wall Street Journal reports that, after months of speculation, Senate Democrats have indicated they aren't planning a confirmation hearing for Centers for Medicare & Medicaid Services acting administrator Marilyn Tavenner.   

The Wall Street Journal's Washington Wire: No Confirmation Hearing Planned For Marilyn Tavenner
Senate Democrats have said they aren't planning a confirmation hearing for Marilyn Tavenner, the acting top official at the Centers for Medicare and Medicaid Services, ending months of speculation over whether they would try to get the agency its first permanent leader since 2006 (Radnofsky, 5/21).

Other Capitol Hill news includes reports about continuing efforts to address the Medicare physician payment problem and about the results of the GOP investigation into White House efforts to pass the health law -

CQ HealthBeat: Pursuing A Permanent Payment Patch
The medical industry is hoping this will be the year when Congress fixes, once and for all, the recurring problem of the formula that dictates how much Medicare reimburses physicians. For almost a decade, Congress has overridden the reductions in payment rates dictated by the Sustainable Growth Rate, a 1997 formula designed to keep Medicare costs under control. But lawmakers have never come up with a way to handle the problem permanently. In the past few weeks, however, they have started to talk about possible solutions in a way they haven't before (Ethridge, 5/21).

Roll Call: Health Care Probe May Ensnare Jim Messina
House Republicans are preparing to unveil results of an investigation into deals the White House made to help pass the health care overhaul, and the findings might saddle Jim Messina, President Barack Obama's campaign manager, with unwanted distractions. Rep. Michael Burgess told Roll Call that Messina's name was "the one that came up most consistently" in emails and other documents about the deals. The Texas Republican, a member of the Energy and Commerce Subcommittee on Oversight and Investigations, said Messina might have violated the Presidential Records Act by using a personal email account to discuss official White House business (Strong, 5/22).

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Quality

Federal Task Force Recommends Dropping Routine Prostate Cancer Test

The U.S. Preventive Services Task Force finds scant evidence that the PSA blood test saves lives and instead says unneeded treatment leads to serious problems, including impotence and incontinence.

The Washington Post: Government Task Force Discourages Routine Testing For Prostate Cancer
Men should no longer receive a routine blood test to check for prostate cancer because the test does more harm than good, a top-level government task force has concluded in a final recommendation that immediately became controversial (Vastag, 5/21).

The Associated Press: Final Advice: Panel Against Routine Prostate Test
Healthy men shouldn't get routine prostate cancer screenings, says updated advice from a government panel that found the PSA blood tests do more harm than good. Despite strenuous protests from urologists, the U.S. Preventive Services Task Force is sticking by a contentious proposal it made last fall. A final guideline published Monday says there's little if any evidence that PSA testing saves lives — while too many men suffer impotence, incontinence, heart attacks, occasionally even death from treatment of tiny tumors that never would have killed them (Neergaard, 5/21).

The Wall Street Journal: Men Should Skip Common Prostate Test, Panel Says
The recommendations can influence coverage decisions by Medicare and other insurers, though under current law, Medicare must cover annual PSA testing (Dooren, 5/21).

Los Angeles Times: PSA Test For Prostate Cancer Should Be Dropped, Task Force Says
The PSA test should be abandoned as a prostate cancer screening tool, a government advisory panel has concluded after determining that the side effects from needless biopsies and treatments hurt many more men than are potentially helped by early detection of cancers. At best, one life will be saved for every 1,000 men screened over a 10-year period, according to the U.S. Preventive Services Task Force. But 100 to 120 men will have suspicious results when there is no cancer, triggering biopsies that can carry complications such as pain, fever, bleeding, infection and hospitalization (Mestel, 5/22).

NPR Shots Blog: All Routine PSA Tests For Prostate Cancer Should End, Task Force Says
There they go again — those 17 federally appointed experts at the U.S. Preventive Services Task Force are telling American doctors and patients to stop routinely doing lifesaving tests. Or at least that's the way some people look at the task force's latest guidelines on prostate cancer screening, which say doctors should stop doing routine PSA tests on men of any age (Knox, 5/21).

Reuters: U.S. Task Force: End Routine Prostate Cancer Screening
The reaction was fast and furious. Screening advocates warned that the recommendation will cost lives, but critics of PSA testing said thousands of men will be spared impotence and incontinence as a result of needless cancer treatment (Begley, 5/21).

Bloomberg: Prostate-Cancer Test Not Worth Risk, Advisory Panel Says
The government-sponsored task force is an independent medical advisory group that drew criticism in 2009 for questioning the value of breast-cancer screening in women younger than 50. ... While doctors are still free to suggest PSA tests, they should be prepared to discuss the potential downsides, the report said. Community- or employer-offered mass screenings should be discontinued, the group said. ... The findings won the endorsement of the American Cancer Society in an accompanying editorial (Nussbuam, 5/22).

Medscape Today: Final USPSTF Guidelines: No To Routine PSA Testing
It's final. The US Preventive Services Task Force (USPSTF) now officially recommends against routine prostate-specific antigen (PSA)–based prostate cancer screening for healthy men, regardless of age. ... The USPSTF last published recommendations on prostate cancer screening in 2008. At that time, researchers concluded that there was no evidence to support PSA testing for men older than age 75. Now this recommendation extends to all men (Mulcahy, 5/21). 

MedPageToday:  USPSTF Turns Thumbs Down On PSA Testing
Healthy men should no longer have PSA measurements as a screening test for prostate cancer, according to a final recommendation from the United States Preventive Services Task Force (USPSTF). The so-called grade D recommendation applies to men of all ages but does not apply to the use of PSA testing for monitoring patients after a prostate cancer diagnosis or treatment (Bankhead, 5/21).

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Health Care Marketplace

Billion-Dollar DaVita Deal Highlights Movement Toward Mergers, ACOs

This particular deal, in which DaVita will acquire HealthCare Partners, will enable the dialysis services provider to offer a more integrated group of services that fall under the ACO model that the government is trying to encourage. 

Los Angeles Times: HealthCare Partners to Be Bought By DaVita In $4.42 Billion Deal
HealthCare Partners, the Torrance owner of physician groups in Southern California, Nevada and Florida, agreed to be acquired in a $4.42-billion deal by dialysis chain DaVita Inc., as large healthcare companies continue snapping up doctor groups and clinics. … Nationally, much of the merger activity stems from Medicare, which is moving away from fee-for-service payments that encourage volume rather than quality care or efficiency. Instead, Medicare is adopting new payment methods that reward medical providers that keep patients healthy and curb excessive spending. If those so-called accountable-care organizations succeed at managing their pool of patients, Medicare allows them to share in the savings and boost their profits (5/22).

The Wall Street Journal: Dialysis Firm Bets On Branching Out
In striking the deal, DaVita is wagering that American health care is changing significantly—moving away from a fragmented world in which individual doctors and hospitals get fees for each service, and toward large integrated providers that coordinate all patients' medical needs and get paid in ways that reward quality and efficiency. HealthCare Partners gets much of its payment in so-called capitated flat fees that are supposed to cover nearly all of a patient's care, an arrangement that puts a provider at risk of losing money if the person requires many pricey services (Mathews and Athavaley, 5/21).

Reuters: DaVita Looks To New Healthcare Model With $4.42 Billion Deal
DaVita Inc, the biggest U.S. operator of dialysis clinics, sought to better align itself with government efforts to cut healthcare costs with a $4.42 billion deal to buy HealthCare Partners, an operator of physician practices. The deal will allow DaVita to offer a more integrated group of services that the government is looking to incentivize through its accountable care organizations (ACO) model (5/21).

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The Details Of Direct Primary Care

The New York Times examines the emergence of direct primary care in the health care marketplace and links this concept back to concierge medicine. In a separate New York Times story, one health industry expert offers his take on how to control costs while improving access to care -- it comes down to thinking like an investor.

The New York Times: More Care Up Front For $54 A Month
Direct primary care derives from an unlikely source: the so-called concierge practices that began appearing a decade ago, catering primarily to the affluent. Concierge practices generally do not accept insurance, either; instead, members are charged thousands of dollars annually for unlimited access to their doctors (Japsen, 5/21).

The New York Times: A Long View On Health Care: Think Like An Investor
Could health care costs be reined in by improving access to preventive care? It's an idea that appeals to policy makers and many public health experts, but the evidence for it is surprisingly hard to pin down. … We put some of these questions to Dana Goldman, director of the Schaeffer Center for Health Policy and Economics at the University of Southern California and founding editor of the Forum for Health Economics and Policy. What follows is an edited version of our conversation (Kolata, 5/21).

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Humana Will Pay $45M To Settle Dispute Over Military Care Reimbursements

Humana is set to pay $45 million to five health systems to resolve a reimbursement dispute with the group of hospitals over the insurer's military health care business.

Fox News: Humana Expects Costs Of $45 Million For Hospital Settlement
Health insurer Humana Inc. said Monday it will pay about $45 million to resolve a five-year-old lawsuit filed a group of hospitals that had alleged breached agreements by Humana's military health-care business. … The lawsuit was filed in 2007 by several hospitals, including ones run by Sacred Heart Health System Inc. and Tenet Healthcare Corp. The hospitals' lawsuit included allegations that Humana Military Healthcare Services Inc. breached network agreements with hospitals in six states that contracted for reimbursement of outpatient services for people covered by a military health plan, Humana said in its annual filing with the Securities and Exchange Commission (5/21).

Modern Healthcare: Humana Set To Pay $45 Million To Settle Reimbursement Feud
Humana, Louisville, Ky., expects to pay $45 million in the second quarter to resolve a 2007 lawsuit filed by a number of health systems against its military benefits arm. ... Humana Military Healthcare Services, which administers Tricare benefits, came under fire in the U.S. District Court for the Northern District of Florida for allegedly breaching its network agreements with a class of hospitals in six states (Kutscher, 5/21).

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State Watch

Expansion Of Colo. Medicaid Program Slower Than Expected

Also in state Medicaid news is a report on a proposal to cut Illinois' costs and the controversy over funding in Minnesota's program.

Stateline: Life After the American Community Survey?
The U.S. Senate is expected to vote next month on an appropriations bill that could end the U.S. Census Bureau's survey of state and local population, income, health and other data. Known as the American Community Survey, the federally funded program continuously samples about 3.5 million households each year to produce crucial data used to divvy some $400 billion in government money to states and localities. ... Medicaid is the biggest federal program that relies on American Community Survey data to shift funding when states' average incomes rise or fall (Vestal, 5/22).

Denver Post: Colorado Medicaid Expansion Goes Slower Than Expected
Colorado Medicaid's expansion to adults without dependent children has gone slower than expected, with thousands of slots in the long-sought program still available. ... Colorado can afford only 10,000 adults in the joint federal-state funded program, while health officials calculated 50,000 would be eligible. The state set up a lottery system to handle the expected flood of demand. Instead, as the first group of clients gets enrolled for care, about 6,000 have finished the application process (Booth, 5/21).

The Associated Press/Chicago Sun-Times: Medicaid Proposal Makes Nearly $1.4 Billion In Cuts
Illinois moved closer to drastic Medicaid cuts Monday with proposed legislation that could excise nearly $1.4 billion from the state's program by shrinking benefits, such as regular adult dental care, and cutting payments to most hospitals and nursing homes. The measure, backed by Gov. Pat Quinn, falls short of the $2.7 billion in cuts that Quinn originally said would be needed to prevent the health care program for the poor and disabled from collapsing. … The measure, filed as a House amendment to a Senate bill, includes $240 million in payment rate cuts to hospitals and nursing homes. But it spares doctors from rate cuts, along with 51 rural community hospitals and about 20 urban hospitals that care for poor patients (Johnson, 5/21).

(St. Paul) Pioneer Press: Minnesota Medicaid Funding Questioned By Republicans In U.S. House
Republicans in the U.S. House of Representatives are asking more questions about federal funding for Minnesota's Medicaid program.  In a May 15 letter, three Republicans on the House's committee on oversight and government reform ask the state's human services commissioner to respond to a series of questions about whether Minnesota wrongly shifted excess federal funds in the Medicaid health insurance program to a state insurance fund (Snowbeck, 5/21).

Texas Tribune: State's Medicaid Chief Retiring
Billy Millwee, who oversees the state's giant Medicaid and Children's Health Insurance programs, will retire in August. … It's a complicated time for Medicaid. Whether the U.S. Supreme Court upholds federal health reform legislation will largely determine the future of the program, and how many more Texans will be added to the state's already staggering rolls. In 2011, facing a massive budget shortfall, lawmakers had to take the ax to Medicaid programs to balance the budget (Ramshaw, 5/21).

California Healthline: Healthy Families Conversion Slowing Down
California health officials need to go a little slower in their plan to move 875,000 children out of the Healthy Families program and into Medi-Cal managed care, according to a Senate budget subcommittee that voted yesterday to reject the state's full plan. It did endorse the transition of about 200,000 Healthy Families "bright line" children to Medi-Cal -- those beneficiaries at or below 133% of federal poverty level. The Affordable Care Act requires that those children be moved to Medi-Cal by 2014, so California would get a head start on that effort, according to John Bacigalupi from the state Department of Finance (Gorn, 5/22).

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State Roundup: Health Law Could Create Calif. Jobs; What's Driving Mass. Health Costs

A selection of health policy stories from Massachusetts, Georgia, California, Texas, Oregon, Maryland and Minnesota.

Politico Pro: Gruber: Mass. Not Sure What's Driving Costs
As Massachusetts wrestles with ambitious legislation to contain health care costs, MIT economist Jonathan Gruber raises one major problem: The state has no idea what's driving the growth in health care costs. In fact, it's not even close to figuring it out, Gruber says. "We don't know the answer, we don't know how to fix it now," said Gruber, who helped design the state's 2006 health reform and the national law. "We have to experiment and be more patient" (Millman, 5/21).

The Atlanta Journal-Constitution: Lax Enforcement In Personal Care Homes
Deficiencies in care, living conditions and record-keeping have piled up in scores of Georgia personal care homes, with the state rarely shutting down violators or levying heavy fines, The Atlanta Journal-Constitution has found. An analysis of five years worth of inspections, violations and enforcement actions revealed that many frequent violators have faced nothing more than a fine of a few hundred dollars. ... About half of the state's 2,000 licensed personal care homes are in metro Atlanta, and they provide more than 12,000 beds for some of the region's most fragile residents — those who are disabled, elderly or mentally ill (Schneider and Simmons, 5/22).

Market Watch: Health Reform To Create California Jobs: Study
Health care reform will create nearly 99,000 jobs in California, according to a study released Monday. The Bay Area Council Economic Institute's report said a ripple effect will result from the $4.4 billion that will come to the state's economy via the 2010 Affordable Care Act in coming years (Britt, 5/21).

Houston Chronicle: School Programs Lead Fight Against Childhood Obesity
Inside E.A. Jones Elementary School, the battle against childhood obesity is being fought with fresh ingredients. … The classes are one component of Activate for Kids, a health and fitness pilot program developed by UnitedHealthcare and the United Health Foundation. The program, which kicked off this year in six school districts in Texas, Florida and Georgia, is among a growing number using a more holistic approach to tackle the childhood obesity epidemic (Rhor, 5/21).

Boston Globe: Harvard Pilgrim Expands Health Coverage
Harvard Pilgrim Health Care, expanding a seven-year-old partnership with United HealthCare Services Inc., will use the national health insurer’s network to offer Harvard Pilgrim health coverage to employers with offices outside Massachusetts, New Hampshire, and Maine. Under the joint program, called Access America, multistate businesses based in the three New England states where Harvard Pilgrim does business will be able to offer their workers at plants, sales offices, or satellite sites across the country the same Harvard Pilgrim insurance products that employees in their home offices receive (Weisman, 5/22).

Statesmen Journal (Oregon): Quick Medical Care Given Free To State Workers
Any state worker feeling poorly in the Salem area now has quick access to a free medical consultation via secure video conferencing, under a new program by Providence Health & Services. Providence Health eXpress is an innovative attempt to reduce health care costs by providing quick treatment in the workplace for routine ailments, Providence spokeswoman Patti Atkins said. … The service is available to all state workers enrolled in a Public Employees’ Benefit Board health insurance plan, even folks who are signed up with Kaiser Permanente. It’s a joint program being offered by PEBB and Providence (Thompson, 5/21).

The Baltimore Sun: Health Care Spending Rising In Maryland
Marylanders spent $44.5 billion on personal health care in 2010 as costs in the state continued to outpace the nation, according to a new report. Spending on services including hospital care, prescription drugs and long-term care increased 3.5 percent compared to 2009, according to the report by The Maryland Health Care Commission. On average a Maryland resident spent $7,698 on health care in 2010, 9 percent higher than the national average of $7,066 (Walker, 5/21).

McClatchy/The Sacramento Bee: California Sees Sharp Rise In Million-Dollar Hospital Bills
The number of Northern California hospital stays resulting in charges of $1 million or more rose sevenfold in the past decade, from 430 in 2000 to almost 3,000 during 2010, according to a Bee review of new data from the Office of Statewide Health Planning and Development. Most of those bills will be lowered significantly -- up to 80 percent -- following negotiations between hospitals and insurers. Even then, they will usually still cost more than a typical Sacramento home.

Minnesota Public Radio: Hospital Support Workers Vote On New Labor Contract
Health care workers will vote today and Wednesday on a new labor contract with eight metro-area hospitals. Union leaders representing about 3,500 nursing assistants, food service workers, clerks and maintenance and warehouse staff reached a tentative agreement with the hospitals last week (Benson, 5/22).

Georgia Health News: Pickens Vs. Murray: A Tale Of Two Counties
Murray and Pickens comprise one of five pairs of neighboring counties with markedly different health profiles, based on both Partner Up and University of Wisconsin data.  The other pairs are Pike and Upson, Glynn and Wayne, Lee and Terrell, and Houston and Twiggs. With the other four pairs, however, the reasons for the differences in health status are more obvious. … In each of the other pairs of counties, big enough differences in demographics would explain the health disparities. For Pickens and Murray, it’s not as clear cut (Toledo, 5/12).

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Editorials and Opinions

Viewpoints: Taunting Justice Roberts; The Bishops And Religious Freedom; Romney's Choices On Health Care Tax

The Wall Street Journal: Targeting John Roberts
You can tell the Supreme Court is getting closer to its historic ObamaCare ruling because the left is making one last attempt to intimidate the Justices. The latest effort includes taunting Chief Justice John Roberts that if the Court overturns any of the law, he'll forever be defined as a partisan "activist" (5/21).

The Wall Street Journal: Why The Bishops Are Suing The U.S. Government
This week Catholic bishops are heading to federal courts across the country to defend religious liberty. On Monday they filed 12 lawsuits on behalf of a diverse group of 43 Catholic entities that are challenging the Department of Health and Human Services' (HHS) sterilization, abortifacient and birth-control insurance mandate. Like most Americans, the bishops have long taken for granted the religious freedom that has enabled this nation's diverse religions to flourish in relative harmony (Mary Ann Glendon, 5/21).

McClatchy: States Show Outlook For Women's Health Under Romney
Romney said in November that he wants to eliminate the nation's family planning program, which was signed into law by President Richard Nixon in 1970 and provides essential preventive health services to over 5 million people a year, the vast majority of whom are poor and uninsured. Beyond the millions of people who are helped by this health-care program, investing in family planning saves the government money -- for every dollar spent on family planning, experts say taxpayers save around $4. … This isn't about abortion. These health-care programs provide blood pressure and cholesterol monitoring, flu shots, breast cancer screenings, Pap tests and birth control. Planned Parenthood is the only medical care many women receive all year (Cecile Richards, 5/21).

Des Moines Register: Feds Can Be A Savior, Not Just A Demon
To hear some politicians tell it, "government run" health care is destroying this country. President Ronald Reagan, himself a conservative, challenged that assertion. He recognized that when government coverage works the way it is supposed to, it is a Godsend that saves and extends the lives of vulnerable Americans. That was the case with Katie Beckett, a Cedar Rapids woman, whose disabilities led to changes in Medicaid that changed the course of the future for people with disabilities. Her story is a reminder that the government can be a savior, not a demon, when it comes to health care (5/21).

Bloomberg: Romney Is About To Make Bush's Health-Care Blunder
Mitt Romney, so long bedeviled by the politics of health care, may be about to make another serious mistake. He is on the verge of spelling out a plan to replace President Barack Obama's health plan. Romney’s advisers, both inside and outside the formal campaign, want the main component of his alternative to be a change in the tax code's treatment of health care. But there are two versions on the table, and Romney is leaning toward the one that would offer much less help to the uninsured (Ramesh Ponnuru, 5/21).

Milwaukee Journal Sentinel: Study Shows Kids Need Healthier Eating Habits
A study released Monday in the journal Pediatrics contained alarming news about the nation's teenagers: Half of those who are overweight are putting themselves at risk for heart attacks or other cardiac problems down the road because of unhealthy blood pressure, cholesterol or blood sugar levels…. The study should be a wake-up call that much more needs to be done to ensure that kids enter adulthood free of the long-term health problems that will only cost them -- and society -- so much down the road (5/21).

Archives of Internal Medicine: Invited Commentary—Oncologists Responding To Grief
Since death and loss are intrinsic aspects of oncologists' practice, grief is common, whether it be over the physical absence of a patient or the more abstract surrender of a meaningful joint struggle. Unaddressed grief over time can clearly contribute to burnout, which is an occupational hazard for physicians in general and oncologists in particular. ... One suggestion ... to ameliorate the adverse effects of grief is to provide education on recognizing and working through the grief process, along with learning strategies that emphasize self-care, starting in the training years and continuing throughout their careers (Dr. Michelle Shayne and Dr. Timothy E. Quill, 5/22).

Medscape: Smile! Your Handwashing Is On Candid Camera
This study shows us several things. First, there should be considerable question about the validity of routine hand-hygiene observations; second, hand-hygiene compliance is probably much lower than most visual observations would predict; and third, through use of electronic or camera monitoring with feedback, hand-hygiene rates can be improved and sustained (Dr. William R. Jarvis, 5/21).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
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.