Daily Health Policy Report

Wednesday, May 23, 2012

Last updated: Wed, May 23

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Campaign 2012

Coverage & Access

Health Care Marketplace

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Minnesota Seeks Bridge Across 'Affordability Gap'

Minnesota Public Radio's Elizabeth Stawicki, working in partnership with Kaiser Health News and NPR, reports: "Under the 2010 health law, millions of Americans will gain access to affordable health insurance. But in Minnesota, many are concerned that an affordability gap will leave about 100,000 low-income Minnesotans struggling to pay for health care" (Stawicki, 5/23). Read the story.

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Political Cartoon: 'On The Record?'

Kaiser Health News provides a fresh take on health policy developments with "On The Record?" by Eric Allie.

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


The DaVita deal... 
a hint that the market sees 

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

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Capitol Hill Watch

CBO: Recession Ahead If Congress Fails To Resolve Impasse

The Congressional Budget Office reported Tuesday that the nation's economy could fall back into a recession if President Barack Obama and Congress fail to come to terms on tax and spending issues. However, Democratic and Republican leaders appeared unwavering in their positions.

The New York Times: Recession Possible If Impasses Persists, Budget Office Says
The economy could relapse into a recession if President Obama and Congress remain at an impasse and allow several big tax increases and spending cuts to take effect at the start of 2013, the Congressional Budget Office reported on Tuesday. … Among the changes that will take effect if the White House and Congress do not act: … Reimbursements to doctors who treat Medicare patients will be cut significantly, taxes will increase for wealthy taxpayers to help pay for health insurance for more Americans and temporary business tax cuts, part of stimulus measures, will expire (Calmes, 5/22).

The Associated Press: Top Senate Dem To GOP: No Tax Cuts For Rich
Republicans will have to drop their insistence on retaining tax cuts for the rich and plans to reshape Medicare before there can be a bipartisan deal on controlling federal deficits and averting a wide-scale tax increase in January, the Senate's top Democrat said. In a letter to GOP senators released Tuesday, Senate Majority Leader Harry Reid blamed congressional Republicans' "strict adherence to tea party ideology" for the two sides' failure to reach such a deal (Fram, 5/22).

Politico: Paul Ryan: I Expect Mandate For GOP
House Budget Committee Chairman Paul Ryan predicted Tuesday that November's elections could bring a broad mandate for the Republican Party to enact aggressive reforms to the nation's finances. … Ryan said he and the Republican Party would "welcome" a debate with Obama on Medicare and taxes – believing that the GOP has an upper hand on the issue. In a question-and-answer session after his speech, Ryan said House Republicans will bring tax legislation to the floor in about a month that would extend the current rates for another year. That's intended to give lawmakers time to work through complicated budget and tax issues, instead of squeezing them in a lame-duck session (Kim, 5/22).

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HHS $20 Million PR Contract Draws GOP Ire

Sen. Rob Portman, R-Ohio, sought additional information from Health and Human Services Kathleen Sebelius while Senate Minority Leader Mitch McConnell, R-Ky., took to the Senate floor to criticize the arrangement.  

Roll Call: Rob Portman Seeks Answers On Health And Human Services Spending
Sen. Rob Portman (R-Ohio) today sent a letter to Health and Human Services Secretary Kathleen Sebelius asking for more information on a $20 million public relations contract to tout the president's health care law. Portman, the top Republican on the Homeland Security and Government Affairs Subcommittee on Contracting Oversight, launched a broader inquiry earlier this year with Sen. Claire McCaskill (D-Mo.) asking 11 federal agencies to provide an accounting all "contracts for the acquisition of public relations, publicity, advertising, communications, or similar services" dating back to the fall of 2008, before President Barack Obama took office (Shiner, 5/22).

Politico: Mitch McConnell Rips Obama Ad Campaign
Minority Leader Mitch McConnell blasted the Obama administration on the Senate floor Tuesday for signing a $20 million contract for an advertising campaign to promote wellness benefits from the health reform law. This money is "$20 million of taxpayer money to promote a bill most Americans want to see repealed," McConnell (R-Ky.) said. "Let me suggest that the president spend a little more time trying to do something about the spending, debt and gas prices and a little less time trying to spin the unpopular things he's already done — it might require a little more work, but it's what we need" (Feder, 5/22).

In other news, Democratic Virginia Senate hopeful Tim Kaine offered some criticisms of his own aimed at Senate Democrats.

Politico: Kaine Calls For Tavenner Hearing
Virginia Senate hopeful Tim Kaine is blasting Senate Democrats for not planning a confirmation hearing for Marilyn Tavenner, President Barack Obama's nominee to run the Centers for Medicare & Medicaid Services and a former top health official in his state (Haberkorn, 5/22).

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Health Reform

Strategies, Views On The Health Law's Future Vary Depending On Politics

Congressional Republicans continue to appear divided over what their strategy should be if the Supreme Court strikes down all or part of the health law. More immediately, though, Sen. Orrin Hatch, R-Utah, is targeting the measure's device tax as part of the Senate's consideration of a bill that would reauthorize the Food and Drug Administration user fees.

The Wall Street Journal: GOP Mixed On Health Moves
Congressional Republicans are divided over what to do if the Supreme Court strikes down all or part of the health-care overhaul next month. House Republican freshmen from moderate districts say they need to have credible alternatives to present to their constituents if the court—or lawmakers—eliminate the law. They are eager to find ways to replicate popular provisions of the law, such as those requiring coverage for people with pre-existing conditions and allowing young adults to stay on their parents' insurance plans until age 26 (Radnofsky, Bendavid and Murray, 5/22).

Modern Healthcare: GOP Targeting Reform Law's Device Tax
The latest effort by Republicans to repeal components of the 2010 healthcare law is expected later this week during Senate consideration of a bill that would reauthorize FDA user fees. Sen. Orrin Hatch (R-Utah) plans to offer an amendment to the Food and Drug Administration Safety and Innovation Act to repeal a medical-device tax included in the Patient Protection and Affordable Care Act (Daly, 5/22).

Meanwhile, other articles report on the parts of the health law that appear to be taking hold even as the Supreme Court's pending decision causes some uncertainty.

The New York Times: Gains In Health Seen As Lasting By Some
The new health care law is already transforming the way care is delivered, and the changes will continue regardless of how the Supreme Court rules on the mandate for most Americans to carry health insurance, a Democratic senator and an Obama administration official said Tuesday (Pear, 5/22).

National Journal: Panelists: Health Care Law's Innovations Taking Hold Despite Supreme Court Case
[Dr. Richard Gilfillan, director of the Innovation Center at the Health and Human Services Department’s Centers for Medicare and Medicaid Services] cited as an example "the incredible response" his office received -- some 3,000 applications from private health care providers nationwide -- to a CMS grant offer soliciting models for interpreting data on the cost savings from bundling medical-care payments.  (Clark, 5/22).

And the Fiscal Times reports on how the Court's decision could affect health care costs.

The Fiscal Times: SCOTUS Decision Could Raise Health Care Costs
Spending on health care is slowing down – a much-needed development since the nation's long-term deficit problem is largely tied to projections that spending on Medicare and Medicaid will remain out of control. … The Supreme Court in the next few weeks could rule the entire health care reform law unconstitutional, which would be a blow to cost-control efforts since at least some of the recent slowdown is being attributed to delivery system changes sparked by the law (Goozner, 5/23).

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Innovation Center To-Do List Could Include Medicaid; PCORI Announces Grant Application Deadlines

In a pair of articles, CQ HealthBeat reports on the role the Innovation Center could play in reshaping Medicaid and the latest on the timeline for grants from the Patient Centered Outcomes Research Institute.

CQ HealthBeat: MACPAC Commissioners Nudge Innovation Center Official On Medicaid Policies
Sean Cavanaugh, a top official at the Center for Medicare and Medicaid Innovation, confirmed for members of a government commission Tuesday that some demonstration projects that could reshape Medicaid could be expanded nationally. At the meeting of the Medicaid and CHIP Payment and Access Commission (MACPAC), which is charged with advising Congress and government officials on best practices for the programs, Cavanaugh said the innovation center might be willing to test some of the policy changes that the commissioners advocate (Adams, 5/22).

CQ HealthBeat: PCORI Sets First Round Grant Deadline
The Patient Centered Outcomes Research Institute, a nonprofit that awards grants for such projects as comparative effectiveness studies, announced Tuesday that the application deadline for $96 million in an initial round of grants is July 31. The grants will be awarded for four topic areas including research that would: pit one type of treatment against another for the same disease; improve the health care system; better communicate the results of research; or address ethnic and other disparities among different populations (Adams, 5/22).

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Campaign 2012

Political Ads Stake Out Presidential Candidates' Philosophies On Government

Meanwhile, President Barack Obama's campaign will air a new ad aimed at seniors who are on Medicare and will continue efforts to connect with the women's vote. 

The New York Times: Political Memo: In One Corner, A Champion Of Government. In The Other, Its Foe.
An Obama campaign video shows the president's national political director, Katherine Archuleta, tearfully crediting Mr. Obama with having saved her daughter's life. She portrays the president as a hero of government whose health care law assures her daughter, a cancer survivor, insurance coverage forever. A video by a political committee backing Mr. Romney follows a nearly identical tack: evocative music and a tearful description of Mr. Romney as "the man who helped save my daughter." But the testimonial, from a former partner at Bain Capital, depicts Mr. Romney as a hero of business who once shut down his firm to aid search efforts until the partner’s missing teenager was found (Harwood, 5/22).

The Associated Press: Obama Airing Ads On Veterans, Seniors
President Barack Obama's re-election campaign is airing two new ads, one focusing on his work with veterans returning home from wars in Iraq and Afghanistan and another aimed at seniors dependent on Medicare. ... The ad on Medicare notes that Obama was raised by his grandparents and cites his administration's efforts to root out health care fraud (5/23).

CNN: Obama Campaign Highlights Medicare And Veterans In Two New TV Ads
President Barack Obama's re-election campaign is out with two new TV ads Wednesday that tout what they say are the president's commitment to preserving Medicare and his pledge to honor the country's veterans. The campaign says the commercials are part of their previously announced ad buy of $25 million to run spots this month in many crucial battleground states (5/23).

The Associated Press: Ad Aimed At Women Takes On Obama's Economic Record
Some headlines that flash by in the ad probably need an asterisk or two. One says, "Survey: Health insurance costs surge in 2011," while the narrator blames the new health care law for making premiums more expensive. Actually, Kaiser Family Foundation analysts who prepared the survey in question said the health care law was only responsible for between 1 and 2 percentage points of a 9 percent increase (Alonso-Zaldivar, 5/22).

In addition, a poll examines shifting opinions on abortion rights -

Politico: Poll: Record Low Are 'Pro Choice'
The percentage of Americans who identify themselves as "pro-choice" is at the lowest point ever measured by Gallup, according to a new survey released Wednesday. A record-low 41 percent now identify as "pro-choice," down from 47 percent last July and one percentage point down from the previous record low of 42 percent, set in May 2009. As recently as 2006, 51 percent of Americans described themselves as "pro-choice" (Mak, 5/23).

Meanwhile, a report about the North Dakota Senate race -

The Associated Press: Competitive Senate Race Shaping Up In North Dakota
Heidi Heitkamp, a former state attorney general with ties to the energy industry and a one-time candidate for governor, is perhaps the state's only Democrat who can prevent the seat being vacated by Democratic Sen. Kent Conrad from flipping to the GOP in November. ... Republicans say Heitkamp's tough talk on Obama is an election-year conversion and predict her past support for his health care overhaul and candidacy in 2008 will be her undoing. The latest Crossroads ad, for instance, targets her support of Obama's health care plan (Wetzel and Jackson, 5/23).

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Coverage & Access

Report: Employer-Based Health Insurance Shows Decline

A new report from the Employee Benefit Research Institute finds that employment-based health coverage has taken steps back after a brief uptick. 

The Wall Street Journal's Total Return: Employment-Based Health Coverage Is Waning
Bad news for workers: The "brief uptick" in employer-based health coverage right after the recession "has not endured," according to a new report from the Employee Benefit Research Institute. Between December 2007 and June 2009, the percentage of workers with health coverage in their own name fell to 56% from 60.4%. Coverage rose by almost 1 percentage point by the end of 2009, and then fell to 55.8% by April 2011 (Greene, 5/22).

Modern Healthcare: Rise In Worker Coverage Short-Lived: Report
The percentage of workers with employer-based health insurance coverage edged up briefly after the last recession but dropped during the first half of last year, according to a new Employee Benefit Research Institute report. "After August 2009, there appears to be what might be the beginning of a recovery in the percentage of workers with employment-based coverage," said the report authored by Paul Fronstin, director of health research and education program with the institute (Evans, 5/22).

In related news -

NPR Shots Blog: Health Insurance Cutbacks Squeeze The Insured
Amber Cooper and her husband were doing OK. They both had jobs. A healthy 5-year-old son, a house in Riverbank, Calif., and health insurance from her job in the accounting department of a small manufacturing company. But then one day everything changed (Stein, 5/23).

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Health Care Marketplace

Tenn. Doctors, Blue Cross and Blue Shield Agree To Bundle Payments For Knee, Hip Replacements

In other insurance company news, BlueCross Blue Shield of Illinois will pay $25M to settle coverage denial claims.

Modern Healthcare: Tenn. Blues, Doc Practices To Bundle Payments
Four Tennessee orthopedic practices have inked an agreement with Blue Cross and Blue Shield of Tennessee to establish a bundled-payment system for total knee and hip replacements. ... The payment model, expected to debut on Oct. 1, will provide a set fee for the entire episode of care, from surgery to postoperative care and physical therapy, according to a Tennessee Blues news release (Kutscher, 5/22). 

Chicago Sun-Times: BlueCross BlueShield To Pay $25M To Settle Coverage Denial Claims
A Chicago-based insurance company will pay $25 million to settle claims that it illegally terminated insurance coverage to sick children in need of in-home nursing care to shift the costs of their treatment to Medicaid. The U.S. Attorney's office and Illinois Attorney General's office on Thursday announced the settlement with BlueCross BlueShield of Illinois over allegations that it fraudulently denied coverage for nursing care to children and other technologically-dependent patients to shift the high cost of their care to the program funded by the state and federal governments (5/23).

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Is Access Problem Preventing Generic Drug Makers' Progress?

The Washington Post: Generic-Drug Makers' Complaints Over Brand-Name Access Prompt Investigations
Some drugmakers assert they are unable to create cheaper generic versions of drugs because their rivals are exploiting a legal loophole. It all comes down to process: To get a generic drug approved for sale, a company has to test a sample of the brand-name version and show regulators that the generic version is essentially identical and as effective (ElBoghdady, 5/22).

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Public Health & Education

CMS Sticks With Medicare Coverage Of PSA Test

The federal government is not changing coverage plans "at this time." Meanwhile, a number of urologists and other medical specialists raise concerns that new recommendations against prostate cancer screening will hurt men's health.

CQ HealthBeat: Medicare 'At This Time' Will Continue to Cover Prostate Cancer Screening
The U.S. Preventive Services Task Force may have issued a controversial final recommendation against routine prostate cancer screening for men, but the move appears unlikely to affect Medicare coverage —— at least in the short term. In letters to members of Congress in February, Health and Human Services Secretary Kathleen Sebelius said that "while the department has discretion to modify or eliminate coverage for the PSA test based on the Task Force's recommendation, I do not intend to eliminate coverage of this screening test under Medicare at this time." A Centers for Medicare and Medicaid Services spokeswoman said Tuesday that the secretary’s statement stands (Norman, 5/22).

Health News Florida: Florida Rejects Advice To Scrap Routine PSA Tests
Leading urologists in Florida say they're disappointed with a government panel's advice against routine prostate-cancer screening.  "That's the wrong message,” objects Dr. Johannes Vieweg, chair of the urology department at University of Florida. The president of an association for Florida urologists said he felt the same way. … Florida's disapproval of the Task Force guidelines is actually official; it came out in November in a report by the Florida Prostate Cancer Advisory Council, which Vieweg chaired.  The council began work when the federal task force's interim guidelines were published, showing where things were headed (Gentry, 5/23).

STL Beacon: Cancer Expert Decries Recommendation To End PSA Screening For Healthy Men Over 50
Dr. Gerald Andriole, chief of urologic surgery at the Siteman Cancer Center and the Washington University Medical School, cautions that a blanket end to the screening would send men back to the time when one-third of prostate cancers had advanced and were incurable by the time they were diagnosed. … Andriole is the principal investigator of the National Cancer Institute's prostate, lung, colorectal and ovarian (PLCO) screening trial. He favors leaving the decision on PSA screening to patients and their doctors (Joiner, 5/22).

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State Watch

Mass. Senate Approves 'End-Of-Life' Discussion Mandate; Kan. Tax Cuts Bill Signed

News from state houses around the United States includes legislation requiring end-of-life discussions in Massachusetts, adding a step to vaccine opt-outs in California, approving tax cuts in Kansas and debating licensure of insurance advisers in Iowa.

WBUR: Mass. Senate Skirts End-Of-Life Counseling Controversy
With no debate, and a quick call of the ayes and nays, the Massachusetts Senate approved a requirement last week that all doctors and nurses talk to dying patients about their end-of-life options. In passing the amendment, legislators avoided a minefield that exploded repeatedly during the national health care debate. Senate aides who knew what was coming held their breath as Senate President Therese Murray asked the clerk to read amendment No. 121 known as "Palliative Care Awareness" (Bebinger, 5/23).

KQED: Bill Would Make 'Opt-Out' A Little Tougher
California is one of 20 states that allows parents to "opt out" of vaccines for their children simply by signing a form. It's called a "personal belief exemption." But AB 2109 would change that. The bill has cleared the Assembly and is starting its path through Senate committees. If the bill becomes law, parents who wish to refuse vaccines would first need to receive counseling from a licensed health professional about the risks and benefits of skipping immunizations for their children (Aliferis, 5/22).

Kansas Health Institute News: Governor Signs Tax Cuts Into Law
Gov. Sam Brownback today signed into law a package of tax cuts that many supporters and most critics of the plan agree will mean deep future cuts in state spending. Legislative analysts project the law will cost the state treasury up to $2.9 billion in foregone revenues over the next five years and put Kansas government in the hole by about $829 million come July 1, 2014. … "We aren't going to cut people off Medicaid," he said. "We're going to fund our schools. The roads will get built” (Cauthon, 5/22).

Des Moines Register: Insurance Adviser Licensure Opposed
Gov. Terry Branstad should veto a requirement in a budget bill mandating that advisers who help Iowans compare health insurance options be licensed, an advocacy group said in a letter to the governor on Tuesday. The Legislature this month passed a bill that includes language setting the qualifications for the so-called "navigators" who will act as public advisers in implementing the federal health care reform act that opponents often called Obamacare (Clayworth, 5/23).

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Mass. Safety-Net Hospitals Slated To Get $628M To Better Coordinate Care

Safety net hospitals in Massachusetts are slated to get $628 million to help them focus on coordinating care for patients instead of on which tests and treatments will earn them the most pay. In the meantime, two hospitals in North Carolina are settling their differences over transparency and indigent care.

Boston Globe: Funding For State 'Safety Net' Hospitals Approved

Seven Massachusetts hospitals that primarily serve low-income patients will receive up to $628 million over three years to change how they care for patients, with the goal of improving quality and cutting costs, state officials announced Tuesday. The Patrick administration is pushing hospitals to change so that they can focus on keeping patients healthy, rather than on the tests and treatments for which they are paid. But doing that requires investing in improved communication between providers and better monitoring the needs of large groups of patients (Conaboy, 5/23).

Modern Healthcare: $628 Million Marked For Mass. Safety Net Hospitals
Massachusetts Gov. Deval Patrick said that the Obama administration approved a plan to provide $628 million in incentives to the state's safety net hospitals to encourage investment in integrated care and alternative payment models. The governor's office said in a news release that the administration approved Massachusetts' "master plan" for Delivery System Transformation Initiatives, a program that the CMS authorized in December as part of the state's Medicaid waiver (Lee, 5/22).

North Carolina Health News: WakeMed & UNC Health Care Put Aside Differences, Rex Hospital To See Changes
In a resolution to the bitter dispute between Wake County's two largest health care providers, leaders from both WakeMed Hospital and the UNC Health Care system announced an agreement ending their public squabbling Tuesday at the legislative building in Raleigh. The agreement extracts many of the things WakeMed wanted from UNC subsidiary Rex Hospital: more transparency about Raleigh-based Rex’s finances, and a commitment by UNC to have Rex to provide more indigent care. The agreement also obligates UNC to provide mental health services in Wake County, and creates changes in the governance of UNC Health Care (Hoban, 5/23).

In Dallas, Parkland Memorial Hospital is behind schedule on federally mandated patient safety requirements, and the area deals with a physician shortage --

The Dallas Morning News: Parkland Behind Schedule On Two Critical Patient Safety Requirements
Parkland Memorial Hospital is behind schedule on two critical government safety mandates -- ensuring enough psychiatrists are on duty and developing ways to track the supervision of doctors-in-training. Both problems rank among federal regulators' top priorities for eliminating dangers at the troubled public hospital as part of a sweeping reorganization. Under the government-imposed plan, Parkland must meet 400 initiatives to remove systemic safety risks to patients over the next year to keep hundreds of millions of dollars in Medicare and Medicaid funding (Moffeit, 5/22). 

The Dallas Morning News: Report: Dallas-Fort Worth Lacks Primary Care Doctors, Specialists to Meet Population Demands
North Texas lacks enough primary-care doctors and medical specialists to meet the demands of a growing population suffering from chronic diseases, according to a new analysis of local health care needs. The report by the Dallas-Fort Worth Hospital Council represents the most comprehensive assessment of the region's medical services in several years. … By 2016, when the area’s population is expected to pass the 5 million mark, the shortage of such doctors, including family practitioners, internists and pediatricians, could reach 50 percent, the report said (Jacobson, 5/22).

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State Roundup: Labor Unions Continue Wis. Governor Recall Push

A selection of health policy news from Wisconsin, Minnesota, California, Minnesota, Kansas and Connecticut.

Reuters/Chicago Tribune: Labor Union Hopes Of Ousting Wisconsin Governor Fade
Democrats and unions hoping to turn Wisconsin Governor Scott Walker out of office over his efforts to tame the power of organized labor are finding it tough going with only two weeks to go before a historic recall election. … Walker pushed through the legislature a law requiring public sector union members to pay part of the cost of health insurance and pensions, limited pay rises, made paying union dues voluntary and forced unions to be recertified every year (5/22).

Kaiser Health News: Minnesota Seeks Bridge Across 'Affordability Gap'
Under the 2010 health law, millions of Americans will gain access to affordable health insurance. But in Minnesota, many are concerned that an affordability gap will leave about 100,000 low-income Minnesotans struggling to pay for health care (Stawicki, 5/23).

California Healthline: Kaiser Balks At Joining Healthy Families Conversion To Medi-Cal
The planned switch of Healthy Families children into Medi-Cal could leave as many as 43,000 children looking for new health care providers if the state can't convince Kaiser Foundation Health Plan to join the effort. That number would grow to 189,000 children if the state eventually converts all Healthy Families children to the Medi-Cal program.  On Tuesday, the Senate budget subcommittee for Health and Human Services rejected a plan to move the entire Healthy Families population of 875,000 kids to Medi-Cal all at once, instead starting with a pool of roughly 200,000 "bright line" children -- beneficiaries who are at or below 133 percent of federal poverty level (Gorn, 5/23). (Kaiser Health News is not affiliated with Kaiser Permanente.)

HealthyCal: Removing The Stigma From Mental Illness
(Ron) Oden recently recalled his Felicia's battle with paranoid schizophrenia at a Summit on Mental Illness hosted by the Coachella Valley Health Collaborative (CVHC) at Cal State San Bernardino's Palm Desert campus. The Mental Health Summit is the first part of a campaign funded by a $100,000 grant from Riverside County to improve awareness of mental health issues, increase access to treatment, and reduce stigma (Potter, 5/23).

HealthyCal: Service Offers Low-Cost Rides To Seniors, Visually-Impaired
Judy Daniels, a Salinas senior, doesn’t drive anymore. Her family members live out of the area and she doesn’t like to impose on friends to drive her to the grocery store, doctors’ appointments or to do other errands. But her options for getting around her town increased recently with a nonprofit transportation service that allows seniors, the visually-impaired or others with limited mobility to get from point A to point B at a low cost. Independent Transportation Network Monterey launched in January and by March had tripled the number of rides they gave to members their first month (Flores, 5/22).

Minneapolis Star Tribune: Team Care Slicing Medial Costs
More than 2 million Minnesotans now get care in medical clinics that aim to improve treatment and reduce costs by offering a coordinated team approach to health care -- especially for those patients with difficult medical conditions -- the state Department of Health said Tuesday. The model, known as a "health care home,'' represents a core element of a sweeping 2007 state law designed to reform Minnesota's health care system by raising quality, controlling costs and improving accountability. While still a new effort, the health care home system has resulted in a 5 percent reduction in costs for patients whose care is paid for by Medica, said Dr. Jim Guyn, medical director of provider relations at the state's second-largest health insurer (Wolfe, 5/22).

Kansas Health Institute News: KanCare Work Groups Proposed
Administration officials on Monday announced plans for forming four stakeholder work groups to ensure a smooth transition to KanCare, Gov. Sam Brownback’s plan for remaking the state's Medicaid program. "We'll be bringing stakeholders to the table - whether they be advocates, providers, or professional associations – to engage in some of the nitty-gritty details of what we'll be dealing with," said Kansas Department on Aging Secretary Shawn Sullivan, addressing the second meeting of the 20-member KanCare Advisory Council (Ranney, 5/22).

CT Mirror: Seniors Wait For Home Care While Their Applications Linger In 'Black Hole'
People involved in the home care system say delays in handling applications at [Department of Social Services] have left hundreds of seniors in similar positions, waiting months for services they've been deemed qualified for, services that could be critical to keeping them safe and healthy. … DSS officials have acknowledged the challenges they face in processing applications for all the programs the department runs. The number of eligibility workers is down more than 30 percent in the past decade, despite rising demand for services (Levin Becker, 5/22).

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Editorials and Opinions

Viewpoints: The Promise And Perils Of Prostate Screening; Presidential Candidates Shy Away From Frank Discussion Of Spending

CNN: Prostate Cancer Screening's False Promise
After an exhaustive process, the U.S. Preventive Services Task Force has announced its final recommendation on PSA-based prostate cancer screening. It finds that the known harms of screening outweigh the potential benefits for men who have no cancer symptoms. It notes that all screening studies have demonstrated considerable harms associated with screening, but only one major study found evidence that screening saves lives -- and that study has some internal inconsistencies. It showed screening saves lives in the Netherlands and Sweden, but not in five other European countries. Even the positive parts of that study did not show a considerable increase in lives saved (Dr. Otis W. Brawley, 5/22).

USA Today: Editorial: Skipping Prostate Test Can Kill
If you have undetected cancer, the average outcome is irrelevant. Skipping the test can kill you. That logic seems lost on the U.S. Preventive Services Task Force, which recommended Monday that because of its findings, the PSA test should no longer be routinely given to men over 50, as it generally has been for the past two decades (5/22). 

USA Today: Opposing View: Make Informed Decisions On PSA
Amid the many messages you are hearing and reading about screening for prostate cancer, I hope this one stands out most prominently: At best, there is a very small potential benefit from the PSA test and there are substantial known harms (Virginia A. Moyer, 5/22).

Los Angeles Times: It's The Fiscal Future, Candidates
The current generation of American elected officials is preparing to pass along the bill for its profligate spending to our children and grandchildren — a shameful shifting of the tax burden to people with little or no say in the matter. And what is by far the greatest chunk of our spending? Social Security and Medicare, which already account for more than $46 trillion in liabilities and unfunded promises. ... My hope is that, as the presidential campaign unfolds, Obama and Romney will do something that would be truly radical for politicians: speak the full truth about the financial challenges the country faces and what it will take to solve them (David M. Walker, 5/23).

The Washington Post: The Public Trial Of Justice Roberts
Novelist John Grisham could hardly spin a more provocative fiction: The president and his surrogates mount an aggressive campaign to intimidate the chief justice of the United States, implying ruin and ridicule should he fail to vote in a pivotal case according to the ruling political party's wishes. If only it were fiction. The justice is, of course, John Roberts and the case involves the Affordable Care Act (ACA), a.k.a. Obamacare, which would be affordable only if the Supreme Court upholds the individual mandate requiring all Americans to buy health insurance (Kathleen Parker, 5/22).

Reuters: Who Truly Speaks For Small Businesses?
Everyone knows that small businesses hate President Obama's historic healthcare reform law, right? At least that's what the nation's leading small-business advocacy group would have you believe. Joining 26 states, the National Federation of Independent Business challenged the law all the way to the U.S. Supreme Court in March... Yet while the NFIB claims its multimillion-dollar lawsuit is on behalf of job creators and small businesses everywhere, it's unclear whether small businesses genuinely support the NFIB position (John Stoehr, 5/22).

The Wall Street Journal: ObamaCare Vs. The First Amendment
Maybe the president can recast ObamaCare as a jobs program. So lengthy, complex and intrusive a law cannot help but create massive amounts of work for lawyers. Catholic institutions filed a series of lawsuits yesterday seeking to vindicate their rights under the First Amendment and the Religious Freedom Restoration Act. At issue is the regulation mandating that all employer-provided insurance policies cover birth control, including sterilization procedures and abortifacient drugs, in violation of church teachings (James Taranto, 5/22).

The Wall Street Journal: Catholics In Court
The 12 federal lawsuits filed Monday by 43 Catholic plaintiffs against the Obama Administration's birth-control mandate are a big political and Constitutional moment. The nation's most prominent Catholic institutions are saying that the same federal government they have viewed for decades as an ally in their fight for social justice is now a threat to their religious liberty (5/22).

Arizona Republic: Study Offers Some Hope
Alzheimer's disease is a formidable foe. A terrifying enemy that can take everything you know and leave behind only confusion. That's the human level. On a public-policy level, this disease is equally fearsome. ... So it was a good thing that Congress passed the National Alzheimer's Project Act, which the Obama administration used to develop a plan that includes a $16 million grant from the National Institutes of Health. ... The study will test whether a Genentech-developed drug can prevent onset of Alzheimer's in population genetically predisposed to the disease (5/23).

The Hill: Passing FDA Bill Will Save Lives
This legislation also helps reduce prescription drug costs for consumers by speeding the approval of lower-cost generic drugs. By providing FDA with additional resources to review and approve new generic versions of popular drugs, including expensive biologic products, competition will increase and costs will go down. These provisions will also help FDA address recent problems with drug shortages, allowing it to inspect and approve new manufacturing facilities on an expedited basis and improve FDA’s access to information about potential shortages before they happen (Sen. Tom Harkin, D-Iowa, and Mike Enzi, R-Wyo., 5/22).

Philadelphia Inquirer: Pennsylvania Women At Risk Due To Gender Bias, Study Finds
Pennsylvania ranks 32nd among states in women's health, according to a 2010 study. Our numbers are dreadful in terms of breast cancer death rate (sixth), high blood pressure (ninth), diabetes (12th), and smoking (14th). Who knows what will happen to everyone's health if the commonwealth doesn't get serious about environmental regulations related to fracking (Karen Heller, 5/23).

Philadelphia Inquirer: A Healthy Partnership When Traditional Medicine Can't Do It All
At St. Christopher's Hospital for Children, and in similar offices throughout the country, many of the resources our patients need to be healthy are not under physicians' direct control. I can easily write a prescription for an asthma-controller medication but cannot write a prescription to rid the child's home of the many toxins that contribute to a child's worsening asthma. I can refer a child to a mental-health provider but cannot write a prescription to decrease a child's exposure to toxic stressors such as interpersonal violence, bullying, and poverty (Daniel Taylor, 5/23).

Chicago Sun-Times: GOP Should Back Cigarette Tax
Some House Republicans are willing to support another central element of the Medicaid package: a higher cigarette tax. Without it, Illinois will face even more devastating cuts to the state's health-care safety net. Despite that, Senate Republicans remain opposed to the cigarette tax. It's time for them to join the team backing a healthier and more humane Illinois (5/22).

JAMA: Retail Clinics And Drugstore Medicine
Easy access to medical clinics in retail settings is gaining momentum in the United States. While criticized in some quarters, these clinics are successful as measured by patient satisfaction and quality scores. Retail clinics hold potential for a uniquely US solution to the problem of access to primary care. Although questions remain about their future, evidence suggests that retail clinics may have an important role in US health care (Christine K. Cassel, 5/23).

JAMA: Assessing Value In Health Care Programs
Although asking about return on investment might seem to make sense given concerns about health care cost and value, asking about return on investment is the wrong question when assessing whether a health care program is successful. What would happen if the rule were applied to every health care decision that is made? Besides childhood vaccination and flu shots for the elderly, few health care services save money. The positive return-on-investment criterion is not applied to most health care services because almost nothing satisfies it (Dr. Kevin G. Volpp, George Loewenstein, Dr. David A. Asch, 5/23).

JAMA: The Journey Across The Health Care (Dis)Continuum For Vulnerable Patients
Older adults with hip fracture and multiple chronic conditions illustrate the challenges facing vulnerable patients as they move through the health care system. Their journey highlights recent policies that both facilitate and impede attempts to provide appropriate care and suggest gaps that need to be filled to ensure better care and outcomes (Drs. Grace Jenq and Mary E. Tinetti, 5/23).

JAMA: Deciphering Harm Measurement
Improvement in health care quality and safety can be notable when measurement criteria are clear, evidence is strong, and policy and interventions are focused. Despite this potential, progress in reducing patient harm in hospitals has been slow (Gareth Parry, Amelia Cline and Dr. Don Goldmann, 5/23).

Medpage Today: Jim Crow, Old Crow, Al Capone, And Richard Nixon
Recognizing full well that our society has not done a good job regulating either tobacco or alcohol, and that marijuana is not harmless, I nonetheless believe that cannabis cultivation, possession, marketing, sale, and use should now be made legal, regulated, and taxed in all 50 of these United States (Dr. George Lundberg, 5/14).

Medscape Today: A Forthcoming Diabetes Epidemic In Teens?
The National Health and Nutrition Examination Survey (NHANES) is the oldest and largest nationally representative continuous survey of the health and nutritional status of the US population. ... a recent analysis concluded that the prevalence of prediabetes and diabetes in American teens had more than doubled in the 10-year study period, increasing from 9% to a staggering 23%. Medscape spoke with Ashleigh L. May, PhD, from the Division of Nutrition, Physical Activity, and Obesity at the Centers for Disease Control and Prevention (CDC), lead author for this study, about the implications for practice (May and Scudder, 5/22).

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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.