Daily Health Policy Report

Friday, May 25, 2012

Last updated: Fri, May 25

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Campaign 2012

Health Reform

Coverage & Access


Health Care Marketplace


Health Policy Research

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

States Encounter Obstacles Moving Elderly And Disabled Into Community

Writing for Kaiser Health News, in collaboration with McClatchy newspapers, Jenni Bergal reports: "A multi-billion dollar federal initiative to move low-income elderly and disabled people from long-term care facilities into the community has fallen far short of its goals, as many states have struggled to cobble together housing and other services" (Bergal, 5/24). Read the story.

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Capsules: Veterans Would Benefit Under Health Law, Study Says; Mass. Senate Skirts End-Of-Life Counseling Controversy

Now on the Kaiser Health News blog, Phil Galewitz writes: "If the 2010 health law is upheld by the Supreme Court, it would extend health coverage to thousands of the nation’s veterans, a new study says. The study, released Thursday, said about 630,000 uninsured veterans would likely qualify for Medicaid, the state-federal health insurance program for the poor, which would be expanded under the law. In addition, 520,000 uninsured vets could qualify for subsidized health coverage in new marketplaces, or insurance exchanges" (Galewitz, 5/25).

WBUR's Martha Bebinger, working in partnership with Kaiser Health News and NPR, reports: "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" (Bebinger, 5/24). 

Check out what else is on the blog.

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Political Cartoon: "Final Exam"

Kaiser Health News provides a fresh take on health policy developments with "Final Exam" By Signe Wilkinson.

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


Our childhood should be
A time of fun, simple joy
Not a cause of death
- Lauren Morelle

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

FDA Reauthorization Bill Sails Through Senate

Showing unusual bipartisan spirit, the Senate passed a massive FDA user-fee reauthorization bill Thursday designed to prevent drug shortages and speed federal approval of medicines, including lower-cost generic versions.

Politico: FDA User Fee Bill Passed By Senate
With little bickering and no effort to repeal the Obama administration's health reform law, the Senate passed the massive Food and Drug Administration Safety and Innovation Act on Thursday well ahead of schedule. ... The $6.4 billion, five-year reauthorization of FDA-industry user fee agreements partially funds the agency's review of drugs and medical devices, which would have expired at the end of September without action. Previous user fee authorizations have been contentious affairs. But notwithstanding the election-year and health care politics that dominate Congress, the bill sailed through with hardly a complaint (Norman, 5/24).

The New York Times: Senate Backs Bipartisan Bill To Speed Drugs And Avert Shortages
The Senate passed a major bipartisan bill on Thursday to prevent drug shortages and to speed federal approval of lifesaving medicines, including lower-cost generic versions of biotechnology products. A similar bill is on a fast track to approval in the House, perhaps as early as next week. President Obama, consumer groups and pharmaceutical companies strongly support the legislation (Pear, 5/24).

The Hill: Senate Passes FDA Reauthorization
Senate Majority Leader Harry Reid (D-Nev.) said the bill's passage was how all legislation should move through the Senate. "I know people are anxious to move on and I am too but I have to say just a word," Reid said after the vote. "I have already said in my caucus how much I appreciate the work of Sen. Enzi. He is a fine senator. He and Sen. Harkin have worked so well together on this. It's exemplary for what the rest of us should do" (Strauss, 5/24).

The Hill: Senate Republicans Criticize Obama As Drug Reimportation Amendment Fails
Republicans are slamming President Obama for his silence on drug reimportation legislation, claiming he has broken his campaign promise to allow seniors to buy cheaper medications from other countries. The pharmaceutical industry strongly opposes the idea, which failed again in the Senate on Thursday. Reimportation was kept out of the 2003 bill that created Medicare Part D and the 2010 healthcare law, though as a senator, Obama had co-sponsored a measure to allow it (Viebeck, 5/24).

Modern Healthcare: Senate OKs Measure To Reauthorize User-Fee Programs
The Senate easily passed a reauthorization of the Food and Drug Administration's drug and device user-fee programs and authorized new generic and biosimilar user-fee programs. The 96-1 vote to pass the measure followed a series of close votes that crossed partisan lines in which the chamber rejected a series on amendments, including one to allow the importation of pharmaceuticals from Canada (Daly, 5/24). 

MedPage Today: Senate Passes Drugmaker User Fee Bill
One piece of the massive FDA user fee legislation would reauthorize the Prescription Drug User Fee Act (PDUFA), the popular program that charges drug companies fees that help fund the FDA's drug approval programs. Since PDUFA was first passed in 1992, it has become the major revenue stream for the FDA's drug review programs, with user fees funding 62% of the agency's drug review expenses in 2010. Funding from PDUFA also has enabled the agency to hire more staff, and it has been hailed as a success by those who point to the shorter drug review times after PDUFA (Walker, 5/24).

Minneapolis Star Tribune: Congress Acts To Ease Shortages Of Vital Drugs In FDA Overhaul
Axel Zirbes' doctor said his leukemia required cytarabine, a standard chemotherapy drug that attacks cancers of the white blood cells…. That set the family on a nationwide scramble to find a dose -- a quest repeated by thousands of other families in Minnesota and around the country. It also touched off pleas for help to lawmakers like U.S. Sen. Amy Klobuchar, D-Minn., one of several who took up their case in legislation approved Thursday in the Senate. The provision, which requires drugmakers to issue warnings of looming drug shortages, also has been written into a bill expected to clear the House next week (Diaz and Spencer, 5/24).

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Dueling Student Loan Bills Stall In Senate

Neither measure reached the 60-vote threshold needed to delay an interest rate increase for 7.4 million students with college loans. Republicans want to pay for it by abolishing a preventive health program in the health care law; Democrats proposed raising Medicare and Social Security payroll taxes on high-income owners of some privately held companies.

The Associated Press: Senate Rejects GOP, Dem Plans On Student Loans
The Senate rejected dueling Democratic and Republican plans on Thursday for averting a July 1 doubling of interest rates on federal college loans for 7.4 million students, pushing back efforts to resolve the election-season showdown until next month. … Both measures rejected Thursday would delay the interest rate increase for a year at a cost of $6 billion, but each side's bill was paid for in a way the other couldn't tolerate. Democrats proposed raising Social Security and Medicare payroll taxes on high-earning owners of some privately held companies and professional practices, while Republicans would abolish an Obama preventive health program (Fram, 5/24).

The Washington Post: Senate Fails To Agree On Student-Loan-Rate Freeze
Republicans said the Democrats’ proposal amounted to a tax increase on those best positioned create jobs in the sluggish economy. They also argued that payroll taxes are earmarked to fund Medicare, and any new revenue should go to the retiree-health program. ... The Republican proposal would have paid for the loan-rate freeze by eliminating the preventative health-care fund created in the 2010 health-care act. Republicans call it a slush fund and have pointed to what they say are misuses in its spending (Helderman, 5/24).

Politico Pro: Senate Votes To Keep Prevention Intact
Sen. Tom Harkin's Prevention and Public Health Fund will live to see another day. The Senate on Thursday defeated a Republican-written bill, 34-62, that would have gutted the Affordable Care Act's investment in public health programs to offset the cost of keeping federal student loan interest rates from doubling in July (DoBias, 5/24). 

Meanwhile, in other congressional action -

The Associated Press: Senate Panel Approves $631 Billion Defense Bill
The (Armed Services) committee followed Obama's lead on overall spending, but broke with the administration and the Pentagon on several policies. The panel rejected a call for another round of domestic military base closings and rebuffed the Pentagon's plan to raise enrollment fees for the military's health care program (Cassata, 5/24).

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Campaign 2012

While GOP Pledges Austerity, Democrats Hesitant To Revamp Medicare, Medicaid

Health care continues to play a major role this political season. News outlets look at the parties' differences on spending, Sen. Baucus' early reelection calculations and a protest against Rep. Steve King.

The Fiscal Times: GOP Bets On Austerity To Lead Them To Victory
The Obama administration and Democratic congressional leaders have repeatedly called for a "balanced" approach to economic expansion and deficit reduction -- including targeted stimulus spending, overall government belt tightening and an increase in taxes on the wealthiest Americans -- to help contain the deficit in the coming decade.  While Democrats say they are open to discussing changes in Medicare, Medicaid and other entitlement programs for the elderly and poor, they are highly critical of anything that would alter the fundamental structure of the costly health care programs (Pianin, 5/24).

Politico: Baucus Faces The Biggest Campaigns Of His Career
Senate Finance Committee Chairman Max Baucus is about to launch two of the most daunting campaigns of his political career at once: first, to rewrite the U.S. Tax Code, then to win reelection in 2014 after having shepherded the controversial Democratic health care law to passage. ... The 70-year-old Baucus appears to be taking little for granted. ... Baucus sidestepped a fight over health care by punting on a confirmation hearing for Marilyn Tavenner, a nominee to head the Center for Medicare & Medicaid Services, which he said was unnecessary because of her lack of support (Raju and Bresnahan, 5/24).

National Journal: Nurses Endorse Obama
The American Nurses Association endorsed President Obama on Thursday. The group said the 2010 health reform law was the deciding factor. "Increasing access to care and transforming the American health care system from one that focuses on illness care to a system that emphasizes prevention, wellness, and care coordination have been ANA's priorities for more than two decades.  ANA remains committed to supporting President Obama's efforts to fully implement and fund the Affordable Care Act," ANA President Karen Daley said in a statement (5/24).

Des Moines Register: Man Calls Steve King A 'Professional Liar,' Is Removed From Event
A man who called Steve King a liar, homophobe and xenophobe at an event in Mason City today was escorted from the event by police. King, a U.S. Representative from western Iowa being challenged by Democrat Christie Vilsack, has consistently criticized federal health care reform for the past two years. He recently said it will result in fewer people being insured, which health care advocates say is inaccurate (Clayworth, 5/22).

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Health Reform

Health Law May Allow Some Limited Insurance Coverage

Politico Pro points out that the overhaul might not guarantee minimum standards in some specific cases. Another analysis finds that drug companies could be hurt if the Supreme Court strikes down some or all of the law.

Politico Pro: 'Skimpy' Plans May Satisfy Mandate
Think the individual mandate confuses people? Try linking the mandate to actuarial value. Many think the individual mandate means people have to pay a fine if they don't have health insurance that meets certain standards. But it's more complicated than that. There are several ways people can satisfy the mandate even with limited coverage. The law imposes many rules intended to get most insurance policies to cover at least 60 percent of expected health costs for a standard population, a measure known as actuarial value. All plans sold in the health insurance exchanges — the only place people can use federal subsidies — will have to meet that 60 percent threshold (Feder, 5/25).

Reuters: Analysis: Drugmakers Vulnerable If Health Law Revoked
Pharmaceutical companies, which were spared some of the more sweeping regulations in President Barack Obama's healthcare overhaul, could come under more pressure if the U.S. Supreme Court strikes down part or all of the 2010 law. Drugmakers agreed to pay about $100 billion over 10 years in excise taxes and discounts on medications under the law, but were expected to benefit overall as more than 30 million uninsured Americans get health coverage (Beasley, 5/24).

Another report notes a consumer benefit from the law that will become available this fall.

CQ HealthBeat: Report: Most Americans To Get Easily Understood Summaries Of Health Plans This Fall
Starting in September, 173 million Americans will get an easy-to-understand summary of the benefits and out-of-pocket costs of their health plans, says a report Families USA released Thursday. Mandated under a summary of benefits requirement in the health care law, the summaries may give the controversial law a bit of a boost in the eyes of a skeptical public. Insurer and employer groups lobbied hard to delay the eight-page explanations, saying they were too difficult to put together on time in an accurate way. But the Obama administration refused to postpone the release (Reichard, 5/24).

Rumors hit Washington Thursday about a court decision, but it turned out to be a case of the nerves.

National Journal: The Supreme Court Rumor Mill: Frenzied And Wrong
Rumors were flying around the Capitol this week that the Supreme Court would decide the health care cases on Thursday. They were wrong. Hill staffers, Health and Human Services Department employees, and think-tankers were all abuzz on Wednesday with speculation that the Supreme Court of the United States might issue its opinion on the Affordable Care Act case on Thursday, a month sooner than most court-watchers predict. If the rumors had been correct, they would have been surprising for two reasons: 1) It would have been an unusually accelerated timeframe for the Court to issue such an opinion, and 2) nothing ever leaks from the Supreme Court (Sanger-Katz and McCarthy, 5/24).

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Coverage & Access

Study: 10 Percent Of Veterans Go Without Health Insurance

Of the 1.3 million veterans who lack health coverage, the study says about 630,000 of them would likely qualify for Medicaid under the health law expansion, and as many as 520,000 could qualify for subsidized health coverage in insurance exchanges.

National Journal: Study: 10 Percent Of Veterans Lack Health Insurance
About 10 percent of U.S. veterans under the age of 65 lack health insurance and are not being cared for by the Department of Veterans Affairs, either, according to a study published on Thursday. The study estimated that 1.3 million veterans and nearly 950,000 members of their families lack health insurance. These uninsured military families account for 4.8 percent of the 47.3 million uninsured Americans, the Urban Institute and Robert Wood Johnson Foundation reported (Fox, 5/24).

Kaiser Health News: Veterans Would Benefit Under Health Law, Study Says
If the 2010 health law is upheld by the Supreme Court, it would extend health coverage to thousands of the nation’s veterans, a new study says. The study, released Thursday, said about 630,000 uninsured veterans would likely qualify for Medicaid, the state-federal health insurance program for the poor, which would be expanded under the law. In addition, 520,000 uninsured vets could qualify for subsidized health coverage in new marketplaces, or insurance exchanges (Galewitz, 5/25).

CQ HealthBeat: States With Little Action On Exchanges Also Home To Uninsured Vets
Some of the states that have made the least progress setting up health insurance exchanges also are home to many uninsured military veterans, according to an Urban Institute study released Thursday. In Texas, for example, there are an estimated 130,000 veterans without insurance, the largest number in the nation, the study said. And Texas also is included in a group of states that researchers said have done the least work in setting up a state benefits exchange (Norman, 5/24). 

Denver Post: Colorado Veterans Without Health Insurance At 41,000
America’s younger veterans -- 1.3 million of them -- do not have health insurance and don’t use Veterans Affairs health care, a new report says. That includes 24,000 non-elderly veterans in Colorado and 17,000 of their children and spouses, according to the research from the American Community Survey and released by the Robert Wood Johnson Foundation (Brown, 5/24).

Chicago Tribune: Disability Insurance Primer 
So, personal finance experts and consumer advocates try to hammer home the importance of long-term disability insurance, which pays a portion of your income if you're disabled either through illness or injury. Just over 1 in 4 of today's 20-year-olds will become disabled before age 67, according to the Social Security Administration. Although many people carry life insurance, you're three times more likely to become disabled for a year before age 65 than die, according to a recent report by Sun Life Financial (Gregory Karp, 5/25).

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School Districts, Hospitals Cut Nurses

Nurses, long a presence in many schools and the backbone of hospital care, are being cut back or stretched thin, according to several news organizations; Meanwhile, NPR reports on a poll that found three out of five patients feel their doctors rush through exams.

The Wall Street Journal: School Districts Cut More Nurses
School nurses, a fixture in many American schools for more than a century, are being cut from Philadelphia to San Diego, as public schools struggle to provide basic services while continuing to slash budgets. ... The cutbacks come as nurses are increasingly being pressed to serve a student body with a growing number of complex, chronic health problems -- from diabetes and life-threatening allergies to asthma and obesity, according to school officials, parents and nurses (Audi, 5/24).

NPR: Need A Nurse? You May Have To Wait
Nurses are the backbone of the hospital -- just ask pretty much any doctor or patient. But a new poll conducted NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health finds 34 percent of patients hospitalized for at least one night in the past year said "nurses weren't available when needed or didn't respond quickly to requests for help" (Neighmond, 5/25).

NPR: What's Up, Doc? When Your Doctor Rushes Like The Road Runner
To physician Larry Shore of My Health Medical Group in San Francisco, it's no surprise that patients give doctors low marks for time and attention. "There's some data to suggest that the average patient gets to speak for between 12 and 15 seconds before the physician interrupts them," Shore says. "And that makes you feel like the person is not listening." A doctor's impatience, though, is often driven more by economics than ego. Reimbursement rates for a primary care visit are notoriously low, and Shore laments the need to hustle patients in and out (Varney, 5/24).

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Health Care Marketplace

Hospital CEO Tied To Billing Collection Controversy Will Leave

Fairview Health Services of Minnesota opted not to renew the contract of CEO Mark Eustis after investigations into the role of bill collection company Accretive Health at the hospital.

Wall Street Journal: Hospital CEO Will Depart
A Minnesota health system that has come under scrutiny for its hiring of hospital contractor Accretive Health Inc. to handle billing and collections functions said its chief executive will leave at the end of July. The board of Fairview Health Services said Thursday that it decided in a special meeting not to renew the contract of CEO Mark Eustis, and that he will retire on July 31, when the contract expires. The Minneapolis-based nonprofit system, which includes seven hospitals and 42 primary-care clinics, didn't give a reason for the move (Wilde Mathews, 5/24).

Modern Healthcare: CEO Mark Eustis To Leave Fairview Health Services
Fairview Health Services, the Minneapolis-based system at the center of the controversy with billing and collections company Accretive Health, did not renew the contract of President and CEO Mark Eustis during a special meeting Wednesday. Eustis will retire July 31. Chuck Mooty, Fairview's board chairman, was named interim chief executive (Evans and Carlson, 5/24).

Minnesota Public Radio: Fairview Health CEO Leaves
The head of Fairview Health Services, a major Minnesota health system under investigation for bill collection practices, is leaving. The Fairview board held a special meeting Wednesday night and decided not to renew the contract of CEO Mark Eustis. He will retire at the end of July, after serving as head of Fairview for five years. The action comes as Minnesota Attorney General Lori Swanson pursues a highly critical review of Fairview's contract with its debt collector -- Accretive Health (Stawicki, 5/24).

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Auditors Find Medicare Lax On Overpayments; New MedPAC Members

Federal auditors say Medicare failed to collect about 80 percent of the more than $400 million that were identified as overpayments, Modern Healthcare reports.

Modern Healthcare: CMS Overpayment Collection Efforts Faulted
Though CMS officials often tout their aggressive efforts at fighting erroneous and fraudulent Medicare payments, federal auditors have found that the office failed to collect about 80 percent of the $416 million that was specifically identified as overpayments in prior audits. Furthermore, auditors said the CMS couldn't prove that the 20 percent said to be collected was actually received (Carlson, 5/24).

CQ HealthBeat: Five New Faces At MedPAC
The comptroller general on Thursday appointed five new members of the Medicare Payment Advisory Commission and reappointed the panel's chairman, Glenn Hackbarth. The independent commission advises Congress on Medicare and was established in 1997 to analyze issues including access to care, cost and quality of care. Gene L. Dodaro, comptroller general and head of the U.S. Government Accountability Office, said in a statement that the five appointees "bring impressive credentials to the commission" (5/24).

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Health Policy Research

Research Roundup: Do Mandatory Screening Laws Affect Disparities?; Mass. Health Law, 6 Years Later

Each week KHN reporter Christian Torres compiles a selection of recently released health policy studies and briefs.

The Kaiser Family Foundation: Massachusetts Health Care Reform: Six Years Later -- Since Massachusetts passed its own expansive health law, the state's uninsured rate has dropped and access to care has dramatically improved. But as this brief notes, two major issues remain. Massachusetts will have to find ways to contain health care costs -- now under discussion in the state legislature -- as well as align itself with the federal health law. In the process, other states "can draw on some of the state's early successes and challenges" (5/21).

Journal of Health Care for the Poor and Underserved: A Comparison Of Breast And Cervical Cancer Legislation And Screening In Georgia, North Carolina, And South Carolina -- The authors write: "We identified legislation (1989-2005) relating to breast and cervical cancer in Georgia, North Carolina, and South Carolina. ... The laws specifically intended to increase breast and cervical cancer screening were mandates requiring that insurance policies cover such screening; Georgia and North Carolina enacted such laws, but South Carolina did not. However, we were unable to demonstrate an effect of these laws on either screening rates or disparities. This may reinforce the importance of evidence-based health promotion programs to increase screening" (Miles-Richardson, Blumenthal and Alema-Mensah, May 2012).

The Kaiser Family Foundation: How Is The Affordable Care Act Leading To Changes In Medicaid Today? State Adoption Of Five New Options -- The health law is affecting Medicaid, even ahead of the expansion of coverage in 2014. "The options covered in the brief include incentives for states to get an early start on the Medicaid coverage expansion; increased federal funding to upgrade Medicaid eligibility systems; money to improve care for beneficiaries with chronic conditions by providing 'health home' services; special funding for chronic disease prevention; and help in developing service delivery and payment models that integrate care for beneficiaries who are dually eligible for Medicare and Medicaid" (5/18).

Genetics in Medicine: Association Between Health-Service Use And Multiplex Genetic Testing -- With the advent of genetic testing, there are concerns that patients will seek out unnecessary or inappropriate medical care due to their supposed risk for illness. In this study, researchers analyzed electronic health records for healthy individuals ages 25 to 40, some of whom took a test for risk of diabetes and other common conditions. The authors conclude: "Persons offered and completing multiplex genetic susceptibility testing used more physician visits before testing, but testing was not associated with subsequent changes in use. This study supports the supposition that multiplex genetic testing offers can be provided directly to the patients in such a way that use of health services is not inappropriately increased" (Reid et al., 5/17).

Here is a selection of news coverage of other recent research: 

Reuters: Tired Surgical Residents May Up Error Risk: Study
A small study suggests surgeons in training are still tired enough to raise their risk of making significant errors, despite new guidelines limiting their work hours. Researchers found that orthopedic surgical residents at two Boston-area hospitals were averaging five and a half hours of sleep a night, and so fatigued during waking hours that a quarter of the time their "impairment" was equivalent to being legally drunk. ... Based on the activity recordings, the researchers also determined that -- compared to data on a group of well-rested residents -- the study participants were only functioning at about 70 percent of their mental effectiveness during 27 percent of the time they were awake (Seaman, 5/21). 

MedPage Today: Program Cuts Use Of Restraints In Nursing Homes 
Nursing homes that took part in a multicomponent, guideline-based intervention made less use of physical restraints on their residents, according to German researchers. From baseline to 6 months after starting the program, the prevalence of physical restraint use dropped from 31.5% to 22.6% in the intervention group, compared with virtually no change in a control group (30.6% to 29.1%), Sascha Köpke, PhD, from the University of Hamburg, and colleagues reported in the Journal of the American Medical Association (Pal, 5/22).

MedPage Today: Intensivist Care At Night May Cut Mortality
Having an intensivist work the graveyard shift may save lives, but only in some circumstances, researchers reported. In a retrospective analysis, an intensivist working overnight in some ICUs was associated with a 28% reduction in risk-adjusted in-hospital mortality. ... But the benefit was seen only in ICUs where consultation with an intensivist was optional, Wallace and colleagues reported online in the New England Journal of Medicine and in a presentation at the annual meeting of the American Thoracic Society (Smith, 5/21).

Medscape: Many Teenagers Have at Least 1 CVD Risk Factor
Thirty-seven percent of normal-weight adolescents had at least 1 risk factor for cardiovascular disease (CVD), as did 49% of those who were overweight and 61% of those who were obese, according to a study published online May 21 in Pediatrics. ... Among all the adolescents in the study, the overall prevalence of risk factors was 14% for prehypertension or hypertension, 22% for borderline-high or high low-density lipoprotein (LDL) cholesterol, 6% for low high-density lipoprotein (HDL) cholesterol, and 15% for prediabetes or diabetes (DeVita-Raeburn, 5/21).

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Public Health & Education

CDC Report Finds States Spend Only A Fraction Of Tobacco Funds To Fight Smoking

The study says states collected $244 billion from tobacco settlement payments between 1998 and 2010, and used about $8 billion of that for anti-smoking campaigns.

HealthDay/Philadelphia Inquirer: States Use Only Fraction Of Tobacco Revenues To Fight Smoking, Study Finds
Only a small percentage of the billions of dollars states take in from tobacco revenues goes to anti-smoking efforts, a new federal report finds. Under the 1998 Tobacco Master Settlement Agreement, tobacco companies agreed to reimburse states for Medicaid costs related to tobacco use. … However, the new study finds that between 1998 and 2010, states collected a combined total of almost $244 billion in tobacco industry settlement payments and cigarette excise taxes, but have invested only about $8 billion in effective state anti-smoking, tobacco control programs (Preidt, 5/25).

Politico Pro: CDC: States Falling Short On Tobacco Control
States are using dwindling amounts of their tobacco settlement money to try to bring down smoking rates — despite ample evidence that investment in tobacco control pays off, according to a CDC report released Thursday. … The CDC report shows that between 1998 and 2010, states collected $243.8 billion from the settlement and tobacco taxes but spent only $8.1 billion of it — one dollar out of 30 — on smoking prevention and cessation. That's less than one-third of what the CDC recommended at the time. In addition, the share of settlement money used for tobacco control efforts has dwindled in recent years, according to the data released with the weekly morbidity and mortality update (Cheney, 5/24).

Meanwhile, in other news about public health -

The New York Times: Battle Brewing Over Labeling Of Genetically Modified Food
For more than a decade, almost all processed foods in the United States — cereals, snack foods, salad dressings — have contained ingredients from plants whose DNA was manipulated in a laboratory. Regulators and many scientists say these pose no danger. But as Americans ask more pointed questions about what they are eating, popular suspicions about the health and environmental effects of biotechnology are fueling a movement to require that food from genetically modified crops be labeled, if not eliminated (Harmon and Pollack, 5/24).

Reuters: Anti-Obesity Proposal Fails Again At McDonald's
McDonald's Corp investors soundly rejected a shareholder proposal that would have required the world's biggest fast-food chain to assess its impact on childhood obesity. ... The shareholder proposal, which also failed last year, returned amid growing concern over the social and financial costs of obesity in the United States and around the world -- not only in terms of healthcare-related expenses but also lower worker productivity and diminished quality of life (Baertlein, 5/24).

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State Watch

Illinois Legislature Passes Bill With Deep Medicaid Cuts

The $1.6 billion in budget cuts would also cut deeply into other Illinois health programs.

Chicago Tribune: Illinois Legislature Passes Deep Health Care Cuts
Hundreds of thousands of poor Illinoisans would lose health coverage, prescription drug discounts for seniors would be dropped and dental care for adults would be greatly curtailed as part of $1.6 billion in budget cuts lawmakers approved Thursday. The major Medicaid reductions ignited anger in some lawmakers who say the cutbacks will jeopardize the lives of the state’s most vulnerable residents (Long, 5/24).

Chicago Sun-Times: Illinois House Passes Bill To Cut $1.6 Billion From Medicaid
The Illinois House and Senate sent Gov. Pat Quinn a package of $1.6 billion in budget-driven Medicaid cuts that its sponsors say are necessary to avert the collapse of Illinois’ burgeoning health-care plan for the poor. "We believe this will save the Medicaid program," said Julie Hamos, director of the state Healthcare and Family Services department (McKinney, 5/24).

In other news, Medicaid budgets have other states considering their health care liabilities --

Reuters: State Budgets Spring New, Smaller Holes
For some U.S. states the new fiscal year will bring an old problem: shortfalls. Budget gaps totaling $54 billion emerged in state budgets for fiscal 2013, according to a the Center on Budget and Policy Priorities, a think tank that tracks state fiscal issues. … At the same time, states expect 5.6 million more people to become eligible for the Medicaid health insurance program for the poor, which states run with reimbursements from the federal government and which already takes up a third of some states' budgets (5/24).

Associated Press/Kansas City Star: Missouri Joins Settlement With Walgreen Co.
Missouri Attorney General Chris Koster says the state's Medicaid program will receive about $42,000 from a national legal settlement with Walgreen Co. The settlement resolves complaints that Walgreens Co. improperly tried to get people to switch their prescriptions to its pharmacies. The company has agreed to pay civil damages totaling $7.9 million to states and the federal government (5/24).

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Mass. Hospital Agrees To $750,000 Settlement Over 2010 Data Breach

The data breach compromised the personal information of more than 800,000 people.

Modern Healthcare: $750,000 Settlement In Data-Breach Suit
South Shore Hospital, Weymouth, Mass., has reached a $750,000 settlement agreement of a lawsuit over a 2010 data breach involving the records of 800,000 individuals, the hospital and the Massachusetts attorney general's office have announced. Under the settlement approved today by Suffolk Superior Court, South Shore agreed to pay a $250,000 civil penalty along with $225,000 that will go into a fund set up by Attorney General Martha Coakley to "promote education concerning the protection of personal information and protected health information," her statement said (Conn, 5/24).

Boston Globe: South Shore Hospital To Pay $750,000 To Settle Data Breach Charges
It will cost South Shore Hospital in Weymouth $750,000 to settle charges related to a 2010 data breach that compromised the personal information of more than 800,000 people. The settlement, approved Thursday in Suffolk Superior Court, included a civil penalty of $250,000 and $225,000 for a fund to be used by the office of Massachusetts Attorney General Martha Coakley to promote education on the protection of personal data. South Shore Hospital was also credited for $275,000 it spent on security measures following the breach (Bray, 5/25).

In other hospital news --

The Dallas Morning News: Parkland Memorial Hospital Extends Contract Of Interim Chief
Parkland Memorial Hospital’s governing board agreed Thursday to extend the contract of its interim chief executive after a behind-the-scenes lobbying campaign by Dallas powerbrokers to keep Dr. Thomas Royer in the top job. The unanimous vote to extend Royer’s contract by 90 days followed closed-door discussions among board members. It was at odds with concerns raised by federally installed safety monitors about Royer’s ability to steer the public hospital through a difficult transition (Moffeit, Egerton, and Dunklin, 5/24).

San Francisco Chronicle: 4 VA Health Facilities Cited For Violations
Four Department of Veterans Affairs medical facilities in Northern California have been cited for a total of 25 safety and health violations, ranging from overflowing trash cans of biohazardous waste to exposed syringes. The VA hospital in Mather and the outpatient clinic in Martinez were the biggest offenders with 10 serious violations and one minor violation each. The outpatient clinic in Oakland committed two serious violations and the outpatient clinic at the Travis Air Force Base in Fairfield committed one (Lee, 5/25).

Boston Globe: Partners’ Second-Quarter Earnings Fall On One-Time Charge
Taking a nearly $110 million write-off on an electronic health record system it will scrap, Partners HealthCare System Inc. reported Thursday that its second-quarter operating income dropped to $5.3 million from $71.2 million in the same period last year. Partners, the state’s largest hospital and physicians network, partly offset the decline through an increase in investment income (Weisman, 5/25).

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Insurance Refunds In Arizona; Mass. House Passes Dementia Care Standards

Arizona Republic: Health-Insurance Refunds On The Way For Arizonans
Arizona consumers and businesses can expect to collect more than $36 million in refunds this summer from health-insurance companies under new provisions of the nation's health care law, according to two reports. The reports show consumers who have purchased individual health-insurance plans will get $24.4 million in refund checks or credits to future premiums. Insurers also will refund $9.3 million to employers with small-group plans of fewer than 50 people and an additional $2.9 million to companies with larger plans of more than 50 people, according to reports by Consumers Union and Kaiser Family Foundation (Alltucker, 5/24).

Arizona Republic: Judge: MCSO Jail Conditions Better
The Maricopa County Sheriff's Office has sufficiently corrected jail deficiencies like overcrowding and poor sanitation to emerge in part from under a 35-year-old federal civil-rights lawsuit. … But attorneys representing a class of not-yet-sentenced inmates in the decades-old lawsuit say the county's health care system in the jails and the Sheriff's Office still have plenty of work to do to bring their facilities and programs into compliance with constitutional standards (Hensley, 5/24).

Boston Globe: House Passes Dementia Care Standards For State Nursing Homes
A loophole in Massachusetts law that allows nursing homes to advertise specialized Alzheimer’s and dementia care units, even though their workers may have no training in caring for such residents, is one step closer to being closed. A proposal that would establish minimum standards for such units was approved by the state House of Representatives on Wednesday and is headed for the Senate (Lazar, 5/24).

Houston Chronicle: Clinics Serve Families
A new pediatric health care clinic recently opened in the Bear Creek area is meeting a growing need for medical care among children and teenagers of families who have limited or no insurance. The Pediatric and Adolescent Health Center-Bear Creek is one of several community clinics being established throughout the greater Houston area by the Harris County Hospital District. … The Bear Creek and Cypress areas are rapidly growing to include more families who have no insurance as well as limited access to necessary health care, said Christina Mintner, administrative director of Pediatrics for Ambulatory Care Services with the Harris County Hospital District (Piña, 5/24).

California Healthline/KQED’s State of Health blog: Meet The New Costs, Same As The Old Costs
After more than a year of battling over eliminating and then restructuring adult day health care coverage for Medi-Cal beneficiaries, California's budget for delivering that care is similar to what it was before all the haggling started. The Community-Based Adult Services program grew out of a lawsuit challenging the state’s proposal and replaces the Adult Day Health Care program. CBAS will provide services to 80 percent of previous ADHC beneficiaries and is funded at a similar level to the original program (Gorn, 5/24).

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Editorials and Opinions

Viewpoints: Bill Could Make Universal Health Care Possible Via States; The Need To Change How Physicians Are Paid

Los Angeles Times: Legislation May Enable States To Offer Universal Health Care
Universal coverage, Medicare for all, single payer -- call it what you will. It's clear that conservative forces are determined to prevent such a system from ever being introduced at the national level. So it's up to the states. The catch is that to make universal coverage work at the state level, you'd need some way to channel Medicare, Medicaid and other federal health care funds into the system. At the moment, that's difficult if not impossible. But legislation quietly being drafted by Rep. Jim McDermott (D-Wash.) would change that (David Lazarus, 5/25).

JAMA: Sustainable Health Care Reform Requires Changing How Physicians Are Paid
With the passage of the Affordable Care Act, renewed attention is being given to reforming how health care is organized and delivered. But there's another element needed for sustainable health care reform: finding ways to deal with unsustainable increases in health care spending. And that will require developing a more rational way to reimburse physicians (Gail Wilensky, 5/24).

Boston Globe: Health Care Will Test Gov. Patrick's Skills
The state's congenial, consensus-oriented CEO has become a successful, well-regarded governor in tough times. But though it's no doubt a delight to be Deval these days, the governor also faces a ticklish policy problem in the weeks ahead. That's health care cost containment, an issue that involves a sector vital to the state's economy, includes an array of powerful stakeholders and energized activists, and will play out during a national campaign, in which Republicans can be expected to saddle Barack Obama, Patrick's presidential pal, with anything Massachusetts Democrats do (Scot Lehigh, 5/25).

The Wall Street Journal: The Liberal Legal Meltdown Over ObamaCare
In apparent panic at the tenor of the Supreme Court argument over the constitutionality of the Affordable Care Act (aka ObamaCare), liberal law professors have exploded with anticipatory denunciations of the court's conservative justices -- claiming that it would be "hypocritical" and "partisan" of them to invalidate legislation passed by Congress when they generally oppose "judicial activism" (Michael McConnell, 5/24).

The Wall Street Journal: Prostate Testing And The Death Panel
It's hard to avoid a political aside, so I won't try. A healthy market-driven free economy leads to innovation and the development of breakthroughs, like the PSA test. A highly taxed and highly regulated economy leads to "Death Panels," like the U.S. Preventative Health Service (Tom Perkins, 5/23).

Forbes: Why Closing Medicare's 'Donut Hole' Is A Terrible Idea
Many conservatives believe that George W. Bush betrayed their cause. Exhibit A, these conservatives say, is the Medicare Modernization Act of 2003. That law established Medicare's prescription-drug benefit plan without offsetting spending cuts or tax increases, adding $16 trillion to our unfunded liabilities. And yet, if media reports are to be believed, some of these very same conservatives want to shower the program with even more taxpayer money, for no other reason than because it "polls well" (Avik Roy, 5/23).

The Washington Post: Sen. Tom Coburn, Part 2: Reforming Health Care
Sen. Tom Coburn (R-Okla.) is a physician and the author of "The Debt Bomb: A Bold Plan to Stop Washington from Bankrupting America." This interview, which focuses on America’s health care system, is the second in a two-part series. ... Coburn: And my point is the best care I give is when the patient is active and questioning what I'm doing. Don't question the doctor? We can’t afford not to question doctors anymore. You need to know why you're getting a test, where you can get it cheaper, and what they can do about it. ... You have to invest some time. But you know how long it is before the average doctor interrupts the average patient for the first time? Seventeen seconds. Because we have a fixed-price system and they need to get to the next patient. So instead of me practicing the art and science of medicine, I'm practicing a scheduling-driven practice and ordering a bunch of tests to cover my rear end (Ezra Klein and Sen. Tom Coburn, 5/24).

The Washington Post: Kerrey’s Case For Entitlement Reform
Speaking by phone from the campaign trail in Nebraska, [Democratic Senate candidate Bob] Kerrey rattles off the statistics on fewer workers supporting the benefits of a larger number of retirees as federal entitlement spending squeezes out every other public investment in the general welfare. ... The main obstacle to entitlement reform, he told me, is the "presupposition that people older than 65 can't take the truth. People are afraid of them. . . . We need to get people over 65 to look at people under 40, who, right now, are going to get screwed. They are going to get less than they were promised. We need to ask the grandparents, does that bother them?" Not as much as it should. But it bothers Kerrey (Michael Gerson, 5/24).

Arizona Republic: Left Out Of Arizona's 'Moral' Majority
Thousands of single adults were eliminated from [the Arizona Health Care Cost Containment System] by (Gov. Jan) Brewer and the Republican majority in the Legislature, a move that opponents did not consider particularly moral. It was, however, a majority decision. At least among politicians. And as Brewer explained in her interview, "This is the arena in which this is all debated. And then we choose sides and there are winners and there are losers." That's politics. That's economics. But is it morality? (E.J. Montini, 5/25)

Philadelphia Inquirer: Onward, Christian Soldiers, Against Obama's Birth-Control Mandate
Finally, my church spoke truth to power, and fired a legal -- and most likely lethal -- shot against an oppressive, unconstitutional requirement that Catholics be forced to subsidize sin (Christine Flowers, 5/25). 

Chicago Sun-Times: Weighing Budget Cuts Vs. Cigarette Tax Hike
Pensions and Medicaid spending is gobbling up almost 40 percent of the state's budget. And if nothing is done right now, in just a few short years the mountain of overdue Medicaid bills alone will be higher than what the state spends on its annual budget. In other words, even with the income tax increase, there’s no money left to dig out from under that pile of overdue bills (Rich Miller, 5/24).

Milwaukee Journal Sentinel:  Hope And Help For Those With Mental Illness
Although the prevalence of mental illness is high, if social acceptance is broadened and those with mental illness receive targeted support and services, people living with mental health conditions can minimize future disability and achieve recovery. I cannot emphasize this enough: People with mental illness can and do recover, and treatment works. … While there will always be a need for inpatient care, the majority of the people we serve are residing in the community and working hard on their recovery (Hector Colon, 5/24). 

The Washington Post: The District Can Do More On Children's Mental Health
Children with unmet mental health problems suffer the effects. So do their families. But the consequences don't stop there: Many of these children will need costly special education, end up in the juvenile justice system, drop out of school and grow into adults who are unable to get work and will rely on public assistance. The cost to children, families and society is why it is so important that the D.C. government focus attention on improving its children’s mental health system (5/24). 

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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.