Daily Health Policy Report

Friday, May 3, 2013

Last updated: Fri, May 3

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Spending And Fiscal Battles

Women's Health

Coverage & Access

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Advocates Head To Court To Overturn Medicare Rules For Observation Care

Reporting for Kaiser Health News, in partnership with USA Today, Susan Jaffe writes: "Advocates for seniors say the distinction is not fair to patients. They are taking their argument to federal court in Hartford, Conn., Friday for the first hearing on a lawsuit seeking to have Medicare eliminate the observation label. Government lawyers argue in court filings that Medicare considers observation care an outpatient service and if elderly patients think they should have been admitted to the hospital, they should file an appeal" (Jaffe, 5/3). Read the story.

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Medicare Seeks To Limit Number Of Seniors Placed In Hospital Observation Care

Reporting for Kaiser Health News, in collaboration with The Washington Post, Susan Jaffe writes: "Medicare officials have proposed changes in hospital admission rules that they say will curb the rising number of beneficiaries who are placed in observation care but are not admitted, making them ineligible for nursing home coverage. 'This trend concerns us because of the potential financial impact on Medicare beneficiaries,' officials wrote in an announcement April 26. Patients must spend three consecutive inpatient days in the hospital before Medicare will cover nursing home care ordered by a doctor" (Jaffe, 5/3). Read the story.

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Colorado Weighs Reopening A Psychiatric Hospital To Serve The Homeless

Colorado Public Radio's Eric Whitney, working in partnership with Kaiser Health News and NPR, reports: "Last summer's mass shooting at the movie theatre in Aurora, Colo., led Gov. John Hickenlooper to call for stricter gun control and big new investments in mental health care. Several significant gun bills passed, and a package of mental health reforms are moving forward, but there may not be enough support to win funding for 300 new in-patient psychiatric beds" (Whitney, 5/2). Read the story.

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Letters To The Editor: Better Wages For Home Health Aides; Nurse-Staffing Laws; Physician-Owned Hospitals; Actuaries And 'Rate Shock'

This periodic Kaiser Health News feature offers a variety of reader comments on recent stories (5/2). Read the letters.

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Political Cartoon: 'Off Track?'

Kaiser Health News provides a fresh take on health policy developments with "Off Track?" by Steve Kelley.

Meanwhile, here is today's health policy haiku:


Confucius might say:
"Governors block Medicaid.
May have head in sand."
- Beau Carter

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

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Health Reform

Medicaid Expansion: Sparring Puts Some Red States In Limbo

News outlets report that several Republican governors who came out in favor of the expansion are battling with conservative lawmakers as legislative sessions wind down.

The Washington Post: In Several States, Medicaid Expansion Remains In Limbo As Time Runs Short
In the closing days of their legislative sessions, lawmakers in more than a dozen states are struggling with whether to expand Medicaid under the federal health-care law, with many of them leaning against participating in a program that is key to President Obama’s aim of extending coverage to 30 million uninsured Americans. Twenty states and the District of Columbia have signed on to the expansion, and 14 are planning to decline. But 16 remain in limbo as lawmakers clash in the final days and weeks of the legislative calendar, when many must come to a decision in time for the provision to kick in next year (Somashekhar, 5/2).

The Wall Street Journal: GOP Clashes Stymie Medicaid Expansion
Several Republican governors who defied their conservative bases to support Medicaid expansion under the federal health-care law are running into a brick wall: their states' GOP-led legislatures. The latest clash is unfolding in Florida, where Republican Gov. Rick Scott, an ardent opponent of the 2010 health-care law, shocked many observers by announcing his support for Medicaid expansion in February (Campo-Flores, 5/2).

Politico: Medicaid Expansion Stalls In Red States
Conservative state legislators have thwarted Republican governors who broke with their base in favor of Obamacare’s massive expansion of Medicaid. Governors such as John Kasich in Ohio, Rick Scott in Florida and Jan Brewer in Arizona spent political capital but saw their Medicaid expansion plans stall, the latest glitch in implementing the sweeping 2010 health law (Cheney and Millman, 5/2).

Miami Herald: Tick, Tock: With Deadline Looming, House Gets Moving
After spiraling into near-chaos late Wednesday, the Florida House returned to normal Thursday. ... Representatives got an unexpected visit from Gov. Rick Scott, who briefly appeared on the floor to show gratitude for the approval of a sales tax break for manufacturing equipment. Democrats, however, wanted to talk about health care. Scott agrees with Democrats on the need to expand Medicaid in Florida, including accepting $51 billion in federal money. House Democrats have been wearing lapel stickers that say "Health Care for Florida Families." ... Scott dodged questions on whether he would call lawmakers back for a special session on health care if, as expected, they fail to reach a deal this week. "As you know, there’s still time left in session ... We’ll see what happens," Scott said. "I’ve said 'yes' to making sure we take care of the uninsured and the Legislature said 'no'" (Olorunnipa and Bousquet, 5/2).

Meanwhile, West Virginia Gov. Earl Ray Tomblin decides to pursue the expansion -

The Associated Press/Washington Post: W. Va. Governor Decides To Expand Medicaid; Analysis Says Additional 92K Likely To Be Covered
West Virginia will expand Medicaid under the federal health care overhaul through a plan announced Thursday by Gov. Earl Ray Tomblin, which would extend coverage to an estimated 91,500 uninsured low-income residents (5/2).

CQ Health Beat: West Virginia Governor Pushes for Medicaid Expansion
Tomblin made his announcement surrounded by hospital officials, including UnitedHealth System President Tom Jones and Thomas Health System CEO Steve Dexter, at St. Francis Hospital in Charleston. Sen. Jay Rockefeller, D-W.Va., was also by the governor's side. Tomblin said that "although we may not agree with every provision of the ACA," he had concluded after commissioning a study on the issue that "fully expanding Medicaid is the best choice for West Virginia" (Adams, 5/2).

Modern Healthcare: W.Va. Governor To Push Medicaid Expansion
One of the last undecided Democratic governors has opted to expand Medicaid. West Virginia Gov. Earl Ray Tomblin announced his intention to urge funding of the expansion by the Democratic-led Legislature after considering it for nearly a year. The expansion to the full limit allowed by the Patient Protection and Affordable Care Act—all residents earning up to 138% of the federal poverty level—would add 91,500 enrollees to the 350,000 now in the program, according to state estimates (Daly, 5/2).

Bloomberg: West Virginia Governor Backs Medicaid Expansion For Poor
West Virginia Governor Earl Ray Tomblin said for the first time that he will expand Medicaid under President Barack Obama's health care law. About 91,500 low-income residents will be added to Medicaid, the Democrat told reporters today in Charleston. The governor has the power to expand the program without approval from the legislature, Amy Goodwin, a Tomblin spokeswoman, said in an e-mail (Newkirk and Niquette, 5/2).

The Hill: West Virginia Governor Back Medicaid Expansion
West Virginia Gov. Earl Ray Tomblin (D) embraced ObamaCare's Medicaid expansion on Thursday, another win for the Obama administration. Tomblin is the 26th governor to back expansion of the low-income health program, though only about 20 states have actually pushed it through their legislatures. Tomblin said the Medicaid expansion makes sense for his state — as long as the federal government lives up to its end of the bargain (Baker, 5/2).

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Big Insurers Are Tentative About Health Law's Marketplaces

Reuters reports that some of the nation's largest insurers are wary about jumping into the online marketplaces slated to open for enrollment in October. Meanwhile, CQ Health Beat tracks worries from some officials about consumer outreach.

Reuters: Analysis: Big Insurers Wary Of Entering New Obamacare Markets
The nation's largest health insurers are far from leaping at the chance to join new state health insurance exchanges under President Barack Obama's reform law, making it likely that some markets will have little or no competition next year. … But health insurers, some of whom fought the law before it was passed and continue to lobby to reverse parts of it, are wary. In recent days, executives at the four largest U.S. health insurers say they are likely to sell insurance plans on less than a third of the exchanges, reluctant to venture out beyond the states where they already offer coverage (Humer, 5/2).

CQ Health Beat: Federal Exchange Unlikely to Slim Down Soon
The 33 states that have left it to federal officials to operate part or all of their health law insurance marketplaces in 2014 are unlikely to change their minds in 2015 or soon after, experts suggested on Thursday (Reichard, 5/2).

CQ Health Beat: State Exchange Officials Worried About Outreach
Even as state officials overseeing state exchanges say they know their marketplaces won't be perfect on Oct. 1, they added their voices Thursday to those in and out of government who have been saying they’re particularly worried about the lack of federal publicity about how to enroll (Adams, 5/2).

In addition, news from Minnesota -

MPR News: The Daily Circuit: Accessing New Health Exchanges In Minnesota's Tribal Nations (Audio)
Gov. Mark Dayton this week named members of the board that will oversee the state's new health insurance exchange, which is scheduled to go live on Oct. 1. The exchange, an online marketplace and a major component of the Affordable Care Act, is designed to help individuals and small businesses in Minnesota find coverage online (Weber, 5/2).

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Subsidies And Federal Exchanges At Heart Of New Health Law Court Challenge

News outlets report on a variety of health implementation issues, including the latest lawsuit filed by the law's opponents. Other stories detail cost and coverage wrinkles and advances.

The Wall Street Journal's Washington Wire: Obamacare Gets New Court Challenge
Opponents of the health-care overhaul have filed a new lawsuit Thursday against the federal government on behalf of four individuals and three employers in the U.S. District Court for the District of Columbia. The complaint focuses on the law's distribution of federal subsidies for Americans to purchase insurance, and whether people can get them if they live in one of the 33 states that have refused to set up their own insurance exchanges and have left that task up to the federal government (Radnofsky, 5/2).

Reuters: Health Care Law Opponents Sue Obama Officials Over IRS Rules
A group of individuals and businesses filed a lawsuit against the Obama administration's health care overhaul on Thursday, hoping to stop the law in states that have not set up new insurance exchanges. The complaint filed in the Washington federal court challenges federal rules issued in 2012 for implementing the president's 2010 healthcare law which goes into full force in January 2014. The 12 challengers, ranging from a hospital chain to a restaurant franchise, argue that Internal Revenue Service rules issued last year should be invalidated because they contradict what Congress originally intended. A court win for the challengers could cast doubt over the IRS's ability to enforce the healthcare law's new tax penalties (Temple-West, 5/2).

Bloomberg: Obama Health Care Law Challenged In Suit Over Tax Subsidy
Opponents of the Obama administration’s health care overhaul sued the U.S. over an Internal Revenue Service rule that extends tax subsidies to individuals in states that declined to set up insurance exchanges authorized under the law. … By providing the subsidies in the 33 states that declined to set up exchanges, the healthcare overhaul, known as the Affordable Care Act, makes insurance “less unaffordable,” according to the complaint. It subjects some people to “a requirement to purchase costly, comprehensive health insurance that they otherwise would forgo,” the plaintiffs claimed (Zajac, 5/2).

The Hill: Lawsuit Accuses IRS Of ‘Flagrantly Illegal’ Actions In Rollout Of Obamacare Aid
The businesses said they shouldn't have to provide health insurance to their employees — and that their employees also shouldn't be able to get a subsidy from the government to help afford coverage on their own. It's not the first time critics have accused the IRS of illegally implementing the health care law's subsidies, but the latest challenge focuses on small businesses in an effort to advance the issue in the courts. The businesses have enlisted some high-profile legal help for their ObamaCare challenge — they're represented by Michael Carvin, who argued part of the case against the law's individual mandate at the Supreme Court last year (Baker, 5/2).

In other implementation news -

Los Angeles Times: Part-Timers To Lose Pay Amid Health Act's New Math
Many part-timers are facing a double whammy from President Obama's Affordable Care Act. The law requires large employers offering health insurance to include part-time employees working 30 hours a week or more. But rather than provide healthcare to more workers, a growing number of employers are cutting back employee hours instead. The result: Not only will these workers earn less money, but they'll also miss out on health insurance at work (Terhune, 5/2).

NPR: Political Battle Over Health Law Starts Next Chapter
In the three years since the Affordable Care Act became law, public opinion has remained deeply divided, with as many Americans opposing the law as supporting it. When Americans begin signing up for health insurance under the act, opinion may finally begin to shake loose. Some people without access to insurance gain it and others encounter new bureaucracies (Liasson, 5/3).

KQED/State Of Health: Hey, Small Business Owners – Obamacare Tax Credits Available Now
With less than a year to go before the full rollout of Obamacare, many business owners are still scratching their heads over what it will mean for them. In fact, most still wrongly believe they’ll have to offer health insurance to their employees, according to a recent eHealth survey. While businesses with 50 or more full time employees will have to pay a $2,000 penalty per worker if they do not offer health insurance, there is no penalty for smaller businesses (Weiss, 5/2).

From the state-level -

Fox News: South Carolina Bill Would Make It A Crime To Implement ObamaCare
The Supreme Court may have ruled ObamaCare is constitutional, but implementing the controversial federal law would become a crime in South Carolina if a bill passed by the state House becomes law. The bill, approved Wednesday by a vote of 65-39, declares President Obama's signature legislation "null and void." Whereas the law that Obama pushed and Congress passed is known as the Patient Protection and Affordable Care Act, South Carolina's law would be known as the Freedom of Health Care Protection Act (5/3).

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Reid Adds To Capitol Hill Dems' Health Law Implementation Concerns

Senate majority leader becomes the latest prominent Democrat to express concerns about the rollout of the law, placing blame on the Obama administration and on Republicans for resisting adequate funding. 

CBS News: Reid: Obamacare Could Be "Train Wreck" Without More Money
Senate Majority Leader Harry Reid, D-Nev., warned Thursday that Obamacare -- the health care reform law that he played a key role in shepherding through Congress -- risks becoming a "train wreck" because Republicans have resisted adequately funding several key provisions. Reid's comments echoed Sen. Max Baucus, D-Mont., who warned last month during a hearing with Health and Human Services Secretary Kathleen Sebelius that he sees a "huge train wreck coming down" as Congress works to set up the health insurance exchanges, a key pillar of the law's expansion of health care coverage (Miller, 5/2).

The Washington Post's Post Politics: Harry Reid Concerned About Obamacare Implementation
Senate Majority Leader Harry Reid (D-Nev.) expressed fresh concerns Wednesday about the implementation of the federal health care reform law, while a second congressional Democrat also chimed in with some worry. Reid said he agrees with Sen. Max Baucus (D-Mont.), one of the law’s chief architects, who has expressed concerns about potential problems with implementing some of the law's key components. Baucus recently said he sees a "huge train wreck coming down" the road in the implementation process (Sullivan, 5/2).

The Hill: Rep. Bera 'Concerned' About Obamacare Implementation
Rep. Ami Bera (D-Calif.) is the latest potentially vulnerable Democrat to say he's "concerned" about how the Obama administration is implementing its signature healthcare law. One senior Democrat told The Hill this week that a botched ObamaCare rollout would be a threat to the party in 2014. And Bera, already a top target for Republicans, is clearly worried about the effects of a messy implementation process (Baker, 5/2).

Meanwhile -

NPR: Congress, Staffers Caught Up In Health Act's Sticky Political Situation
Members of Congress have found themselves in another awkward situation when it comes to the federal health law. They wrote the law to require that members and staffs participate in the new health exchanges starting in 2014. But a glitch could stick them with huge out-of-pocket costs. And, as NPR's Julie Rovner tells David Greene, attempts to fix it could be seen as providing special treatment (Greene and Rovner, 5/3).

Also, the Republican National Committee and tea party activists are positioning themselves to use these developments -

The Hill: RNC Launches Petition Drive Against ObamaCare
The Republican National Committee (RNC) is doubling down against ObamaCare this week with a new petition drive against the law. The GOP is preparing to deliver signatures of people who want ObamaCare "exemptions" to federal Health Secretary Kathleen Sebelius. The campaign also mentions allegations that congressional Democrats have tried to exempt Capitol Hill from the law (Viebeck, 5/2).

The Hill: Tea Party Looks To Obamacare For New Life In 2014 Election Cycle
Tea Party leaders have been watching closely as President Obama and other prominent Democrats predict glitches in the law's implementation. Conservative activists see these concessions as a major boon for Tea Party candidates in 2014 as Republicans seek to hold the House and take the Senate. … The law's implementation is "reinvigorating the movement," said Jenny Beth Martin, national coordinator of the Tea Party Patriots (Viebeck, 5/2).

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Capitol Hill Watch

Sen. Grassley Pushes On In Medicare 'Political Intel' Probe

The Wall Street Journal writes that the Iowa Republican, who is looking into how investors got advance word of a Medicare financial policy decision, is also asking about comments by his Utah colleague's staffer.

The Wall Street Journal: Probe Into Medicare Tips Grows
Sen. Charles Grassley is expanding his investigation into how investors got advance word of a market-moving Medicare policy decision, a development that could shine a spotlight on the office of one of the senator's own colleagues. Mr. Grassley (R., Iowa) is seeking information about whether a top aide to Sen. Orrin Hatch (R., Utah) divulged non-public information about the Medicare change during a conference call with investors two weeks before the government's decision was made public, according to people familiar with the matter (Mullins and McGinty, 5/2).

CQ Health Beat: Grassley Not Satisfied With Access on Medicare Advantage Probe
Grassley's staff has already twice interviewed Mark Hayes, a former Grassley staffer who now works for Greenberg Traurig, a lobby firm, about the April 1 announcement by the Centers for Medicare and Medicaid Services that it would increase rates for Medicare Advantage plans. That decision was a reversal from an earlier suggestion by the agency that rates would be reduced. Before that announcement was made public after the markets closed, Height Securities, a Greenberg Traurig client that Hayes worked with, alerted its clients to the impending announcement and health insurance stocks soared. Greenberg Traurig and Hayes have since said they did not provide any advance information to Height (Bunis, 5/2).

The Washington Post: Intel For Investors: What's Going On Behind Closed Doors In Washington
The Washington-based firm Height Securities is a small player in a burgeoning financial field where companies seek to acquire valuable information about even the most minor of federal actions and provide it to investors. Yet a stock brokerage with only $7 million in reported annual revenue, a pittance by Wall Street standards, was apparently able to provoke a major surge in market trading. After Height Securities alerted clients to a pending government decision favoring health-care insurers, trading spiked in the shares of major health-care firms. With a federal investigation underway into these events, the activities have gained public attention (Markon and Yang, 5/2).

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Health Spending And Fiscal Battles

Obama Plan For Medicare, Social Security Draws Ire From Liberal Groups

McClatchy: Obama's Bid To Squeeze Social Security Enrages His Core Backers
Liberal groups angered by President Barack Obama's proposed Social Security cuts say they'll take a page from conservatives' campaign playbook and work to oust Democratic lawmakers who go along with the plan. … As part of his budget plan now before Congress, Obama wants to slow the inflation calculator for Social Security benefits and payments to some military veterans, their survivors and college students. He's also asking affluent Americans to pay higher Medicare premiums (Rosen, 5/2).

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Women's Health

Obama 'Comfortable' With Morning-After Pill Sales At 15

President Barack Obama said he is "very comfortable" with the Food and Drug Administration rule announced this week to make the so-called morning-after pill available without a prescription to women and girls who are at least 15 -- younger than the current policy of 17. He also defended the Justice Department's decision to appeal a judge's ruling to make the Plan B pill available to all ages.

Los Angeles Times: Obama 'Very Comfortable' With Age Restriction On 'Morning After' Pill
President Obama says he's "very comfortable" with a Food and Drug Administration ruling that maintains age restrictions on females who can buy the so-called morning after pill without a prescription. The rule announced this week prohibits girls younger than 15 from buying the drug, known as Plan B, over the counter. The decision was made by the FDA and Secretary of Health and Human Services Kathleen Sebelius, Obama said, pushing back against women's groups that have suggested the White House has interjected its political concern about a touchy subject into the rule process (Hennessey, 5/2).

Politico: President Obama Defends Plan B Appeal
President Barack Obama on Thursday defended his administration's decision to appeal a judge's ruling that the Plan B morning-after pill should be available to women and girls of all ages, saying he was "very comfortable" with the Food and Drug Administration's current rule. Obama said the agency was likely to conduct an additional review, but would go forward with the appeal nonetheless (Epstein, 5/3).

The Associated Press: Obama OK With Morning-After Pill Sales At Age 15
President Barack Obama said Thursday he was comfortable with his administration's decision to allow over-the-counter purchases of a morning-after pill for anyone 15 and older. The Food and Drug Administration on Tuesday had lowered the age at which people can buy the Plan B One-Step morning-after pill without a prescription to 15 - younger than the current limit of 17. The FDA decided that the pill could be sold on drugstore shelves near condoms, instead of locked behind pharmacy counters (Pace, 5/3).

Los Angeles Times: Plan B One-Step Debate Continues
Confused by the wrangling in federal court over the Plan B One-Step emergency contraceptive? You're not the only one. As U.S. attorneys work hastily to halt a federal judge's order regarding the sale of the so-called morning-after pill, medical and reproductive rights groups weighed in on the hot-button controversy, which mixes issues of drug safety, social mores and politics (Morin, 5/2).

National Journal: After the Obama Administration's Morning-After Pill Decision
The administration’s decisions—to fight a judge’s ruling that would make the drug called Plan B freely available, while approving a new application that would allow girls as young as 15 to buy it over the counter—may appear to be a good political compromise. But it has infuriated reproductive rights activists, and groups of doctors and scientists, who feel that drug policy should not be influenced by political considerations (Sanger-Katz, 5/2).

Reuters: Obama Comfortable With FDA Decision To Let 15-Year-Olds Buy Morning-After Pill
President Barack Obama said on Thursday he is comfortable with a U.S. government agency's decision to allow over-the-counter purchases of a morning-after pill for anyone 15 and older. Some critics have complained girls that young should not be allowed to purchase the pills without a doctor's approval. But Obama told a news conference in Mexico City that the decision was based on "solid scientific evidence” (Holland, 5/2).

The Hill: Obama ‘Very Comfortable’ With Lowered Age For ‘Morning-After’ Pill
Obama said he understood that there was "solid scientific evidence" that the contraception was safe for girls of that age. "I think it's very important that women have control over their healthcare choices and when they are starting a family," Obama said. The president also defended the Justice Department's decision, announced late Wednesday, to appeal a federal court ruling that made the pill available to girls of all ages without a prescription. Obama maintained that both the appeal and the FDA rule were decisions made without the involvement of the White House (Sink, 5/2).

Reuters: Most Women Back Over-The-Counter Birth Control Pill
Close to two-thirds of women favor making contraceptive pills available over the counter, according to a new nationally-representative survey. In addition, about 30 percent of women using either no birth control or a less effective method - such as condoms - said they would likely take the Pill if it was sold without a prescription, researchers found. … About 31 percent of participants each said they were "strongly" or "somewhat" in favor of women being able to buy birth control pills without a prescription, according to findings published in the journal Contraception (Pittman, 5/2).

Miami Herald: FDA Rule On Morning-After Pill Draws Strong Reaction
On Tuesday the Food and Drug Administration ordered retailers to offer the emergency contraceptive Plan B One-Step as an over-the-counter option — the latest ruling in a long battle, both legal and social, about the rights of women to have access to the drug. Before now, the pill, which is used after sexual intercourse to help prevent pregnancy, was available to women ages 17 and older without a prescription, but the medication was kept behind drugstore counters. The FDA’s decision came weeks after a federal judge ordered that over-the-counter emergency contraception be made available to females of any age — a ruling the Obama administration is appealing. Even with many practical questions still unanswered and the specter of more court rulings looming, reaction has been passionate on both sides of the issue (Burch, 5/2).

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Coverage & Access

Pentagon Scolds UnitedHealth For Delays In Military Families' Treatment

Bloomberg: Pentagon Blames UnitedHealth For Failures Under Contract
The Pentagon rebuked UnitedHealth Group Inc., the nation's largest insurer, after military families began experiencing long delays getting medical-care referrals from the company. The backlogs occurred almost as soon as Minnetonka, Minnesota-based UnitedHealth took over a contract, valued as much as $20.5 billion, from TriWest Healthcare Alliance Corp. It assumed responsibility on April 1 for the western region of the military's health-care system, known as Tricare. UnitedHealth's "failure to meet contractor requirements" has prevented a large number of beneficiaries in one Tricare health plan from obtaining timely access to specialty care, Jonathan Woodson, assistant secretary of defense for health affairs, said in a memo yesterday to other military leaders (Miller, 5/2).

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State Watch

State Highlights: New Health Care Oversight Laws In Md.

A selection of health policy stories from Maryland, Texas, New York, New Jersey, Colorado, California, Oregon, Florida and Massachusetts.

The Washington Post: Three New Md. Health Laws Offer More Patient Protection
Maryland Gov. Martin O’Malley signed three laws Thursday that will give more protection for patients. The measures provide more state oversight of cosmetic surgery centers, pharmacies that make sterile medications and staffing agencies that find temporary jobs for health care professionals (Sun, 5/2).

Texas Tribune: Public, Private Hospitals To Negotiate With Dewhurst
Officials from more than a dozen hospital systems -- some private, some public -- will gather at the Capitol with Lt. Gov. David Dewhurst on Friday afternoon to try to iron out a solution to how they are reimbursed for uncompensated care. ... The House version of the budget includes a rider private hospitals support: It calls for the state to fully maintain the Disproportionate Share Hospital program, or DSH, under which the state’s large public hospital systems use local taxpayer dollars to draw down federal matching money to cover indigent care at both public and private hospitals. The Senate version of the budget, preferred by the public hospitals, does not contain such a measure (Ramshaw, 5/2).

Kaiser Health News: Colorado Weighs Reopening A Psychiatric Hospital To Serve The Homeless
Last summer's mass shooting at the movie theatre in Aurora, Colo., led Gov. John Hickenlooper to call for stricter gun control and big new investments in mental health care. Several significant gun bills passed, and a package of mental health reforms are moving forward, but there may not be enough support to win funding for 300 new in-patient psychiatric beds (Whitney, 5/2).

The New York Times: Park Slope Food Co-op Takes Up New Cause: Saving A Hospital
In a letter written "on behalf of the 16,000 members" of the co-op, its general manager, Joseph Holtz, and a member, Dr. Saul Melman, call on Gov. Andrew M. Cuomo to "take a leadership role" in developing a plan to save the money-losing hospital, known as LICH, which serves a large swath of food co-op territory from its perch in Cobble Hill in northern Brooklyn (Hartocollis, 5/2).

The Associated Press/Washington Post: NJ Gov. Signs Good Samaritan Bill to Help Overdose Victims; Bon Jovi Says It Will Be Lifesaver
The New Jersey law seeks to assure timely medical treatment for overdose victims by encouraging people to seek help without fear of being arrested for drug possession (5/2).

The Associated Press: CA Prison Mental Health Spends More On Anti-Psychotic Meds Than Other States
California's prison mental health system has been spending far more on anti-psychotic drugs than other states with large prison systems, raising questions about whether patients are receiving proper treatment. While the amount has been decreasing in recent years, anti-psychotics still account for nearly $1 of every $5 spent on pharmaceuticals purchased for the state prison system, according to figures compiled by The Associated Press (Thompson, 5/2).

The Lund Report: Nurse Practitioners And Chiropractors Want More Workers' Comp Patients
People who suffer an injury on the job will get better access to a nurse practitioner or their favored chiropractor under a Senate bill that should become law. Senate Bill 533 extends the time that a nurse practitioner can provide services to an injured worker from 90 days to 180 days; it also allows injured workers to use their regular doctor or chiropractor, even if the provider is not a member of the worker’s assigned managed care organization (Gray, 5/2).

Texas Tribune/KUT News: Bill Would Give Foster Kids a Say in Medication Use (Audio)
Texas lawmakers are weighing a bill that would allow some teenagers in foster care to refuse medication. The legislation comes amid reports that despite recent reforms, rates of psychotropic drug use among Texas foster children remains high (Zaragovia, 5/2).

Health News Florida: Hospital Chain Under SEC Investigation
Fast-growing Health Management Associates has received a subpoena from the Securities and Exchange Commission, the Naples-based hospital company told  investors on Thursday. HMA was already under investigation by the Justice Department, a probe announced last summer that allegedly involved emergency room admissions. Now the SEC wants information on the chain's accounting practices. The agency asked for documents related to Medicare, Medicaid and private insurance, the company said in a news release (Gentry, 5/3).

Boston Globe: Beth Israel Deaconess, Cambridge Health To Partner
Beth Israel Deaconess Medical Center, a Boston hospital aggressively courting health providers in the suburbs, has formed a partnership with Cambridge Health Alliance, the two hospital systems announced Thursday. The collaboration gives doctors with the Cambridge health system greater bargaining power with health insurance companies and a formal relationship with a major teaching hospital that provides many services they do not, such as advanced cancer care and neurosurgery (Conaboy, 5/3).

California Healthline: Committee Votes To Repeal Medi-Cal Cut
AB 900 would reverse the Medi-Cal provider rate cuts imposed in 2011. Cuts have not been implemented, pending a federal court decision in a lawsuit challenging them. Because of the delay in implementation, providers in California face the prospect of retroactively paying back two years' worth of 10 percent reductions. If the cuts are approved in federal court, the retroactive clawback would amount to 5 percent a year over four years, making the Medi-Cal provider rates dip by 15 percent for four years (Gorn, 5/2).

California Healthline: Reform May Improve Access To Pediatric Specialties
Children with special health care needs in Los Angeles County should not be treated as "small adults," according to pediatric specialists who see health care reform as a golden opportunity to design tailored systems of care for children with complex, chronic and rare health conditions. … More than one million California children age 17 and younger have special health care needs, according to a new policy note from the UCLA Center for Health Policy Research. California has 1,700 pediatric subspecialists, or one for every 5,454 children age 17 and under, lower than the national average of one to 4,373, according to the report (Stephens, 5/2).

Reuters: Los Angeles Launches Probe Of Alleged 'Patient Dumping' By Nevada
Nevada health officials acknowledged on Thursday that a state-run hospital improperly bused 10 newly discharged psychiatric patients out of the state with deficient plans for their care, while Los Angeles launched a criminal probe into the alleged "patient dumping." Rawson-Neal Psychiatric Hospital has been under fire since last month, after a Sacramento Bee investigative series reported that hospital staff gave as many as 1,500 patients one-way Greyhound bus tickets from Las Vegas to California and 46 other states over the past five years (Cohen, 5/2).

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Health Policy Research

Research Roundup: Surgical Care At Critical Access Hospitals

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

JAMA Surgery: Utilization And Outcomes Of Inpatient Surgical Care At Critical Access Hospitals In The United States – During the past 15 years, the number of critical access hospitals (CAHs) – those with fewer than 25 acute care beds that receive higher reimbursements and other considerations from Medicare to help sustain them – has increased substantially, representing a quarter of all U.S. acute care hospitals in 2011. But there is also growing interest in the quality of care and the costs. Using surgical data from 2005 to 2009, researchers found that "compared with non-CAH facilities, CAHs are less likely to provide inpatient surgical care in specialty fields" and that "in-hospital mortality for common low-risk procedures is indistinguishable between CAHs and non-CAHs." Although patients at CAHs were less likely to have a prolonged stay, the costs at CAHs were 9.9% to 30.1% higher than at non-CAHs. They conclude: "The higher costs associated with surgical care at CAHs identify potential opportunities for cost savings" but worry that "changes in payment policy for CAHs could diminish access to essential surgical care for rural populations" (Gadzinski et al., 5/1). 

Annals Of Emergency Medicine: Owning The Cost Of Emergency Medicine: Beyond 2% – Emergency room care is often cited as overused and one of the drivers of the increasing health spending. However, emergency room physicians have countered that argument, estimating that ER costs make up just 2 percent of the nation's health care spending. But: "We have presented calculations demonstrating that aggregate ED expenditures are higher than previously published," the authors write. "A conservative estimate is approximately 5% of national health expenditures, although it could be as high as 10%. These results may invite further criticism that the expense of emergency care represents unnecessary, inefficient care. However, we offer a more sanguine interpretation: the high share of spending affirms the importance of emergency medicine." They suggest current estimates are based on outdated models and suggest instead that researchers use activity-based cost accounting, which involves mapping patients' entire clinical, administrative and diagnostic encounters. "Rather than minimizing the issue of cost, we should recognize the economic and strategic importance of the ED within the health care system and demonstrate that costs are commensurate with value," the authors conclude (Lee, Schuur and Zink, 4/26).

Rand Corp.: Oral Health In The District Of Columbia: Parental And Provider Perspectives – Many areas in the District of Columbia suffer from a shortage of dentists and other barriers to oral health care, especially those with a large low-income population, according to this study.  Researchers interviewed parents, dentists, pediatricians, and school health nurses to assess the barriers to better oral health in the city. Health providers said they felt parents did not view their children's oral health as a priority. Parents, on the other hand, told researchers they felt the care provided by clinics serving Medicaid patients was lower in quality and they had trouble getting access to that care. The researchers recommended providing incentives to encourage dentists to accept Medicaid patients to expand their clinic hours. They add that there is "a need to expand health promotion in schools and in the greater District metropolitan area to better educate parents about the importance of preventive care" and that "such promotion should include community-based and culturally and linguistically appropriate media campaigns" (Blanchard, Towe, and Donald, 4/26).

Dartmouth Atlas Project/California HealthCare Foundation: End-Of-Life Care In California: You Don't Always Get What You Want -- The report presents research findings from 2003 to 2010 which show that end-of-life care for Medicare patients varied widely across California. "Most striking is the increase in intensity of care in some regions and hospitals but not others," the author notes. She writes that on some measures, care more closely matches patient preferences than it did in 2003: dying patients spend less time in the hospital and were more likely to receive hospice care. However, the findings also show an increase in the percentage of patients seeing more than 10 physicians during the last six months of life and the days spent in the intensive care unit during that time. Compared to the rest of the country, the state of California had a higher percentage of patients dying in the hospitals, patients with more days spent in the ICU, and patient deaths that involved an ICU stay. "The disparate findings point to the important role of the local delivery system in determining the care patients receive," she concludes (Brownlee, 4/2013).

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

CBS News: Lying To Doctors Could Be Harmful For Patients
Telling a white lie to a friend is not always the best idea. Telling one to your doctor could lead to serious health problems, but many still seem to do it. CBS News medical contributor Dr. Holly Phillips told "CBS This Morning: Saturday" that people go into their doctor's office with a problem and do not always tell the whole truth simply because they do not want to feel criticized. "Research shows that, again, people don't want to feel judged. It is a reflex," she said. "When you're in an interview setting, you want to make a good impression, but ultimately it's not about that." According to a study conducted with the Cleveland Clinic, 28 percent of patients say they "lie or omit facts" when visiting their health care providers (Davis, 4/27).

Reuters: MedEvac Cost Effective With Modest Use Improvements
Emergency helicopter transport is expensive, but could become cost effective if it's used mainly for cases where it will make a measurable difference in trauma patients' survival or long-term disabilities, according to a new analysis. "For the routine use of helicopter emergency medical services to be considered good value for our health care dollars, there needs to be a modest reduction in mortality or some reduction in disability among patients who are flown out with serious injuries," said study author Dr. Kit Delgado, an instructor of emergency medicine at Stanford University Medical School (Stokes, 5/2).

MedPage Today: Doc Pay: More $$$ For Primary Care
The pay disparity between primary care physicians and their specialty counterparts -- which is often cited as a reason for the shortage of primary care providers -- is lessening, according to a survey. Primary care physicians reported a first-year guaranteed compensation of $180,000 in 2012, up from $175,000 in 2011. Meanwhile, the average first-year compensation of all specialists combined dropped over that same time from $255,000 to $247,437, according to the MGMA Physician Placement Starting Salary Survey: 2013 Report Based on 2012 Data (Pittman, 5/2).

Reuters: Healthcare Costs To Negate State, Local Budget Improvements: Outlook
State and local governments can expect ever-widening budget gaps through 2060, as rising healthcare costs for both citizens and public employees surpass recent improvements in their revenue, the Government Accountability Office said on Monday. Closing the gap may require drastic action (Lambert, 4/29).

Reuter: Task Force Calls For Routine HIV Testing For All Adults
An influential U.S. panel is calling for HIV screening for all Americans aged 15 to 65, regardless of whether they are considered to be at high risk, a change that may help lift some of the stigma associated with HIV testing. The new guidelines from the U.S. Preventive Services Task Force (USPSTF), a government-backed panel of doctors and scientists, now align with longstanding recommendations by the U.S. Centers for Disease Control and Prevention (Steenhuysen, 4/29).

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Editorials and Opinions

Viewpoints: Liberals Refuse To Acknowledge Evidence Of Oregon Medicaid Study; Politics Is Roiling Science In Emergency Contraception Decisions

The Wall Street Journal: The Oregon Trial
A familiar critique of liberal governance is that the results always matter less than its grand social ambitions. The latest evidence of this truth comes in the reaction to disappointing new findings from one of the most important public-policy experiments since the 1970s. A team of varsity health economists, mostly at Harvard and MIT, is studying the relationship between health outcomes and health insurance delivered by Medicaid (5/2). 

The New York Times: Putting Politics Ahead Of Science
The move to appeal the court ruling came just a day after the F.D.A. staked out a new position, setting the age restriction on nonprescription access to the most well-known brand of emergency contraception — Plan B One-Step — at 15 years old and telling pharmacies to stock the product on display shelves rather than behind the counter. It also said purchasers would have to prove their age by showing a driver's license, birth certificate, passport or other official form of identification. The compromise guidelines are a step in the right direction but still inadequate. There is no good reason to limit the product to those 15 and older. And the ID requirement represents a significant barrier for a time-sensitive drug. Many teenagers don't have any kind of ID (5/2). 

The Washington Post: The Legal Mess On Emergency Contraception
When U.S. District Judge Edward Korman ruled last month that the government had to allow unrestricted, over-the-counter access to the emergency contraceptive Plan B, it seemed as though the Obama administration had stumbled its way out of a political quandary. Scientists say that the drug is safe for over-the-counter sale; in fact, the judge noted, it would be among the safest of over-the-counter drugs. But many parents — President Obama included, by his own account — are queasy about children being allowed to buy emergency contraceptives without oversight. The court forced the government to act on evidence, not queasiness (5/2). 

USA Today: FDA Decision On Plan B Is Good, Still Barriers
The Obama administration's decision earlier this week to make emergency contraception more widely available is an important step forward for preventing unintended pregnancy -- a persistent problem in the United States that most people agree should be addressed more aggressively. However, access should be expanded further (Cecile Richards, 5/2).

Bloomberg: The Morning After Pill Should Be Available To All Ages
Few parents are comfortable with the thought of young teenagers using emergency contraception. That shouldn't make us insensitive to the fact that girls this age might need to. Because the drug blocks fertilization best if taken within 24 hours of unprotected sex, it is counterproductive to require the user to delay taking it in order to see a doctor first. ... The court was right to side with science, leaving parents to establish their own moral guidelines. The administration should obey his ruling and remove the age limit without delay (5/2).  

The New York Times: The Importance Of Testing For H.I.V.
An expert advisory group has recommended that Americans ages 15 to 65 be voluntarily screened for H.I.V., the virus that causes AIDS, and that many of those found infected receive antiviral drugs even before symptoms develop. This authoritative advice reinforces similar recommendations from the Centers for Disease Control and Prevention. It is a reminder that doctors and clinics need to test and treat patients as early as possible (5/2). 

Baltimore Sun: Plan B Restrictions – Better, But Not Best
In the United States of 2013, any youngster can walk into a store and buy a bottle of aspirin, acetaminophen, ibuprofen or some other pain reliever without showing any identification, parental consent or a doctor's order. They don't have to be 15 or 17 or even old enough to know how to make exact change if the cashier will help them out. So what's the big deal about a bottle of a common analgesic, you may ask? Well, it may be the most dangerous over-the-counter drug available. Each year, poison control centers across the nation get thousands of calls from people who have overdosed on painkillers, particularly acetaminophen, which some people deliberately take to commit suicide, as it can cause acute liver failure if consumed in sufficient quantity. About 50 people die of acetaminophen overdoses each year in this country (5/2).

Politico: Twinkie Insanity Hits The House
Rep. Aaron Schock (R-Ill.) argued in POLITICO April 17 that it should be illegal for the U.S. government's public health guardian — the Centers for Disease Control and Prevention — to point out to children and their parents that Twinkies and sugar-laced sodas are bad for health. In his op-ed, Schock expresses concern that federal money is being used by local health agencies to "attack … Americans' freedom of choice" when they point out that such products have little nutritional value, and contribute to the exploding rates of diabetes and other chronic disease. His solution: Muzzle the CDC and the community agencies they support. ... This bill ignores some basic realities (Marion Nestle, Larry Cohen and Rob Waters, 5/3).

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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.