Daily Health Policy Report

Thursday, May 31, 2012

Last updated: Thu, May 31

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Care Marketplace

Campaign 2012



State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Oregon's $2 Billion Medicaid Bet

Oregon Public Broadcasting's Kristian Foden-Vencil, working in partnership with Kaiser Health News and NPR, reports: "Gov. John Kitzhaber, a Democrat and a former emergency room doctor, has convinced the federal government that he has a way to make Medicaid treatment better, and cheaper, by completely changing the way the sickest people in Oregon get health care" (Foden-Vencil, 5/30). Read the story.

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Psychiatric Patients Languish In Emergency Rooms

Colorado Public Radio's Eric Whitney, working in partnership with Kaiser Health News and NPR, reports: "Last fall Kathy Partridge got a phone call from a local emergency room, telling her that her daughter, Jessie Glasscock, was there -- and was OK. Glasscock had gone missing overnight.  She was away at college, and had a history of manic episodes. Police had found her in a dumpster and brought her to the ER for her own safety.  It was a huge relief for her mother – but she was completely surprised by what happened next" (Whitney, 5/31). Read the story.

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Capsules: Poll: 42% Of Women Take Action In Contraception Debates; Online One-Stop Shop For Navigating Patient Data Laws; Health Savings Account Membership Up 18 Percent

Now on Kaiser Health News' blog, Mary Agnes Carey reports on new poll findings: "More than four in 10 women have taken action, such as donating money or trying to change a friend's opinion, in response to recent controversies over women's reproductive health issues, according to a new survey" (Carey, 5/31).

Also on the blog, Shefali S. Kulkarni writes about a new one-stop shop for navigating patient data laws: "As more patient information goes digital, health providers, insurers and government officials are having a tougher time navigating the patchwork of state and federal laws that dictate what information can be shared without violating patient confidentiality" (Kulkarni, 5/30). 

In addition, Jay Hancock reports on health savings account membership: "HSA membership rose from 11.4 million in January 2011 to 13.5 million in January 2012, with most of the growth occurring in plans offered by large employers, according to an annual census by America's Health Insurance Plans, an industry lobby. Since 2008 HSA membership has more than doubled" (Hancock, 5/30). Check out what else is on the blog.

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Political Cartoon: 'Waiting Room'

Kaiser Health News provides a fresh take on health policy developments with "Waiting Room" by Randy Bish.

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


Hospital tactics  
to get patients to pay bills...
grab Franken's focus.
- Anonymous

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

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Capitol Hill Watch

Medical Device Tax Repeal Gains Ground

But the measure's supporters have not yet identified how they would make up for the lost revenue.

The Washington Post: Medical Device Tax Repeal Bill Gains Some Ground
Makers of medical devices are gaining some momentum in a vigorous campaign to persuade Congress to scrap a tax imposed on their industry by the 2010 health-care law. A bill to void the tax sponsored by Rep. Erik Paulsen (R-Minn.) will be marked up in the House Ways and Means Committee Thursday. Republican House leaders say a floor vote could be scheduled as soon as next week (Aizenman, 5/30).

Politico Pro: Device Tax Repeal Isn't Paid For, Yet
The House Ways and Means Committee is expected to punt on paying for the repeal of the medical device tax during its Thursday markup, leaving a $29 billion hole that likely won't get plugged until shortly before the bill moves to the floor next week, House aides said. Even so, the committee is expected to easily pass legislation — with Democratic support — that strikes the 2.3 percent excise tax created to help fund the Affordable Care Act, aides said. But whether Democrats stay on board as the bill speeds to a floor vote depends largely on how Republicans decide to pay for it (DoBias, 5/31).

Minneapolis Star Tribune: Taking Aim At Med Device Tax
Republican House members are not waiting for the long-sought decision of the U.S. Supreme Court next month on the constitutionality of President Obama's signature health care law. Spearheaded by Minnesota Republican Erik Paulsen, the GOP-led House is expected to vote next week to repeal an estimated $28 billion tax on medical device makers. While the tax is intended to help pay for the expansion of health care in the U.S., its repeal would provide relief to an industry with a major hub in the Twin Cities, home of pacemaker giant Medtronic (Spencer and Diaz, 5/30).

National Journal: AdvMed Ad Campaign Calls For Medical Device Tax Repeal
AdvaMed is launching a print and online ad campaign tomorrow urging Congress to repeal the health care reform law's medical device tax. The ad campaign, which is focused inside the Beltway, starts the day the House Ways and Means Committee is holding a markup on a bill from Rep. Erik Paulsen (R-Minn.) with over 200 cosponsors--the Protect Medical Innovation Act--that would do just that. AdvaMed argues that the tax, which is scheduled to go into effect in January 2013, hurts research and development and slows hiring (Joseph, 5/30).

Also on Capitol Hill, the House easily approves the Food and Drug Administration user fee bill -

Politico Pro: FDA User Fee Bill Cleared For Conference
Not even the House can slow down the FDA user fee bill this year. In what felt like a simple formality, the House passed its version of the bill Wednesday night on a 387-5 vote. It’s now bound for a conference committee to be merged with a very similar version of the bill that passed the Senate last week, 96-1. On the House floor Wednesday, hardly a complaint was registered as Republicans and Democrats praised the rare bipartisan jewel (Norman, 5/30).

The Hill: FDA Reauthorization Bill Approved By House
A bill reauthorizing and expanding a user-fee program for drugs and medical devices was approved by the House on Wednesday, sending the bill to a likely conference with the Senate. The House approved H.R. 5651, the Food and Drug Administration Reform Act, in a 387-5 vote. The bipartisan bill is similar to a Senate-passed bill that would extend the FDA's user-fee program for generic drugs and biosimilars (Kasperowicz, 5/30).

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House Set To Vote On Bill Banning Sex-Selection Abortions

The legislation would make it a federal crime to carry out an abortion based on the gender of the fetus. Anti-abortion advocates say the bill's sponsor, Rep. Trent Franks, R-Ariz., got the vote scheduled "as a concession" for agreeing not to try to attach it to the Violence Against Women Act.

The Associated Press: House To Vote On Sex-Selection Abortion Ban
Legislation coming up for a House vote would make it a federal crime to carry out an abortion based on the gender of the fetus. The measure takes aim at the aborting of female fetuses, a practice more common to countries such India and China, where there is a strong preference for sons, but which is also thought to take place in this country. The mainly Republican supporters of the bill characterized the vote as a sex-discrimination issue at a time when Democrats are accusing Republicans of waging a war on women (Abrams, 5/30).

The Associated Press/Washington Post: House To Vote On Whether To Make Abortions Based On Gender Of Fetus Illegal
Legislation coming up for a House vote would make it a federal crime to carry out an abortion based on the gender of the fetus. The measure takes aim at the aborting of female fetuses, a practice more common to countries such India and China, where there is a strong preference for sons, but which is also thought to take place in this country (5/30).

Politico: Bill Against Sex-Selective Abortion Comes To Vote
A vote Thursday on a bill to outlaw sex-selective abortion is the latest step in an awkward dance between the House Republican leadership and the large faction of passionate abortion opponents in the caucus. Anti-abortion bills percolate constantly in committee, but leadership has not been pushing to get them to the floor as they attempt to stay focused on an economic message, say sources close to anti-abortion Republican members. But for this bill, anti-abortion advocates say sponsor Rep. Trent Franks (R-Ariz.) got a vote scheduled as a concession when he agreed not to try to attach the measure to the Violence Against Women Act, which has been bogging down Republicans on a divisive social issue (Feder, 5/30).

CNN: House Debates Abortion Ban For Sex Of Fetus
The Prenatal Nondiscrimination Act would impose possible fines and prison sentences up to five years on doctors who knowingly perform abortions chosen on grounds based on sex. Abortion providers could also be subject to civil penalties, including punitive monetary damages, under certain circumstances. There is "evidence that the practice of sex selection abortion is demonstrably increasing here in the United States, especially but not exclusively in the Asian immigrant community," Arizona Republican Rep. Trent Franks, the bill's main sponsor, said Wednesday on the House floor (Silverleib, 5/31).

In related news -

Arizona Republic: Rep. Trent Franks Criticized For D.C. Abortion Bill
Washington's delegate to Congress called Rep. Trent Franks, R-Glendale, "a big bully" Tuesday for his proposal to restrict abortions in the District of Columbia. Delegate Eleanor Holmes Norton, a Democrat, made the remarks at a news conference with other city officials decrying what she called the "undisguised bullying tactics of the 112th Congress" when it tries to force its will on the city. The District does not have a voting member of Congress (Forsythe, 5/30).

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Senate Field Hearing Probes Whether Accretive Health's Bill Collection Practices Violated Patient Privacy

Sen. Al Franken, D-Minn., who convened the hearing, questioned whether thousands of Minnesotans who trusted their health records to Minnesota's Fairview and North Memorial hospitals, suffered privacy breaches. The hearing follows an investigation by Minnesota's attorney general into the relationship between Accretive Health and Fairview.

(St. Paul) Pioneer Press: Franken Grills Accretive, Fairview Officials
A U.S. Senate field hearing at the state Capitol in St. Paul has raised new questions -- and left others unanswered -- about the controversial work of a Chicago-based consultant on billing and collection matters at Fairview Health Services. Sen. Al Franken, D-Minn., convened the Wednesday, May 30, hearing and said a key moment came when a top Accretive Health official failed to explain why a company employee had so much patient data on his laptop computer when it was stolen last year in Minneapolis. The theft led to state Attorney General Lori Swanson's investigation of the relationship between Accretive Health and Fairview and her scathing report in April that alleged overly aggressive billing and collection techniques at the health system (Snowbeck, 5/30).

Minneapolis Star Tribune: Accretive Senior VP Apologizes, Defends Firm's Mission
An executive from Accretive Health Inc. apologized Wednesday to Minnesotans who were offended by aggressive debt-collection tactics at Fairview hospitals but offered the company's first public defense, saying its mission is to help patients pay their bills and help nonprofit hospitals improve their finances. Accretive Senior Vice President Greg Kazarian came under intense questioning at a field hearing in St. Paul called by U.S. Sen. Al Franken, D-Minn., who said he was troubled not only by the way patients were hounded for payment but by the possibility that Accretive violated the privacy of thousands of Minnesotans who trusted their personal health records to Fairview and North Memorial hospitals. The two-hour hearing included another revelation from Minnesota Attorney General Lori Swanson's 10-month investigation of the Chicago consulting firm (Kennedy, 5/31).

Minnesota Public Radio: At Franken’s Hearing, Patient Tells Grim Debt Collection Story
A former patient of embattled Fairview Health Services testified at a U.S. Senate hearing in St. Paul Wednesday about being hit up for payment while writhing in pain on an emergency room gurney. U.S. Sen. Al Franken called the hearing to examine whether the aggressive debt collection practices at Fairview Health Systems broke federal laws. Minnesota's Attorney General has accused Fairview's former debt collector, Accretive Health, of various law violations. Deb Waldin of Edina said last July she was curled up in a ball in excruciating pain from a kidney stone when a billing employee approached her for payment (Stawicki, 5/30).

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Health Care Marketplace

Report: Health Care Costs Expected To Increase 7.5 Percent In 2013

This projection is more than three times that of the expected rates for inflation and economic growth, according to PricewaterhouseCoopers. Still, it's the fourth year in which the cost increase is less than 8 percent.

Reuters: Healthcare Costs To Rise 7.5 Percent In 2013: Report
The cost of healthcare services is expected to rise 7.5 percent in 2013, more than three times the projected rates for inflation and economic growth, according to an industry research report released on Thursday. But premiums for large employer-sponsored health plans could increase by only 5.5 percent as a result of company wellness programs and a growing trend toward plans that impose higher insurance costs on workers, said the report by the professional services firm PricewaterhouseCoopers, or PwC (Morgan, 5/31).

Bloomberg: Pace Of Rising Health Costs May Slow For U.S., Study Says
Cheap walk-up health clinics, lower costs for drugs and medical supplies and state laws requiring hospitals to publish prices may be helping to reduce the increase in U.S. health costs, a study found. Health-care costs are expected to rise 7.5 percent in 2013, or 5.5 percent when accounting for changes in insurance benefits, such as higher deductibles and co-payments, PricewaterhouseCoopers said in its annual report on the nation's medical cost trend. It is the fourth year in a row the annual cost increase is less than 8 percent (Wayne, 5/31).

Also in the news -

National Journal: Report: Price Variation Makes Purchase Of Health Care Confusing
A new story from Consumer Reports highlights how extreme price variation and sketchy transparency can mean that even insured patients often end up on the hook for huge, unanticipated bills. The report homes in on two big themes: The broad range of prices that various providers charge for the same procedures, even if they are all considered in the network of a particular insurer; and changes in how plans calculate "usual and customary charges" mean that out-of-network reimbursements frequently cover a much smaller percentage of costs than patients typically realize (Sanger-Katz, 5/31).

And, in a separate Consumer Reports article -

Boston Globe: Consumer Reports Score Mass. Physician Practices
Consumer Reports magazine — long seen as an authority on the performance of automobiles, appliances, and air conditioners — is now rating a service commonly used but difficult to measure: your primary care doctor. The July issue, on stands Thursday, includes a special ­insert scoring 487 Massachusetts adult and pediatric practices on how well doctors communicate with patients and specialists, whether the staff is courteous, and other measures meant to judge patients' experience (Conaboy, 5/31).

WBUR's CommonHealth blog: Consumer Reports Rates Mass. Doctor Groups From Patients' Perspective
For the first time in its history, Consumer Reports, the trusty rater of cars and appliances, is publishing ratings of nearly 500 primary care physician groups in Massachusetts using data from Massachusetts Health Quality Partners. The first-in-the-nation ratings, which you can find here, include 329 adult practices and 158 pediatric practices around the state and are drawn from MHQP's statewide patient experience surveys, conducted every two years since 2006 (Zimmerman, 5/31).

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Health Savings Account Membership More Than Doubled Since 2008

The number of consumers signed up for high deductible health plans increased 18 percent in 2011, according to an annual census by the health insurance industry's trade group.

CQ HealthBeat: Use Of Health Savings Accounts On The Rise
The number of consumers signed up for high-deductible health plans rose by 18 percent in 2011, the health insurance industry's trade group reported Wednesday. America's Health Insurance Plans' annual census of health savings account (HSA) insurance plans found that 13.5 million people are covered by them as of January 2012, up from 11.4 million the previous January and 6.1 million in 2008. The fastest growing market was in large group plans, followed by small group plans (Norman, 5/30).

Kaiser Health News: Capsules: Health Savings Account Membership Up 18 Percent
HSA membership rose from 11.4 million in January 2011 to 13.5 million in January 2012, with most of the growth occurring in plans offered by large employers, according to an annual census by America's Health Insurance Plans, an industry lobby. Since 2008 HSA membership has more than doubled (Hancock, 5/30).

Modern Healthcare: HSA, High-Deductible Plans Growing: AHIP
The number of people covered by high-deductible health plans paired with health savings accounts increased 18.4% in 2012 to 13.5 million, according to a survey by Americas Health Insurance Plans, a trade group. In 2011, 11.4 million people had high-deductible health benefits with a health savings account. The survey, conducted by e-mail in January, included 97 responses from 97 health insurance companies and their subsidiaries (Evans, 5/30). 

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Campaign 2012

Planned Parenthood Targets Romney With New TV Ad

An ad buy in Florida, Iowa, Virginia and D.C. was announced at the same time the organization's action fund endorsed President Barack Obama. Meanwhile, the Boston Globe reports that the Obama campaign will increase its focus on GOP presidential hopeful Mitt Romney's Massachusetts record.

The New York Times: Planned Parenthood Ads To Target Romney
In the course of the Republican primary campaign, Mitt Romney took pains to convince socially conservative activists that he believes in them, understands their passions and would be an advocate for their causes in the Oval Office. Now, the Planned Parenthood Action Fund is unveiling one of its biggest-ever political advertising campaigns aimed at using Mr. Romney's own words to undermine his support among women — a critical voter group among whom he already trails President Obama (Shear, 5/30).

National Journal: Planned Parenthood Action Fund Endorses Obama
The Planned Parenthood Action Fund endorsed President Obama on Wednesday, marking only the third time the group has endorsed a presidential candidate. In announcing the decision, the group also launched an ad buy in Florida, Iowa, Virginia, and the District of Columbia with a 30-second spot that slams Romney for his "out of touch" and "harmful" positions on women's health (Vasilogambros, 5/30).

The Associated Press: Planned Parenthood Launches Anti-Romney TV Ad
Planned Parenthood is launching a TV ad campaign in three battleground states suggesting that women's rights would suffer if Republican Mitt Romney is elected president. The political arm of the women's health care organization has endorsed Democratic President Barack Obama for re-election. The group announced Wednesday, a day after Romney claimed the GOP presidential nomination, that it would spend $1.4 million to air its ad in Florida, Iowa and Virginia, as well as Washington, D.C. (5/30).

CNN: Planned Parenthood's New Ad Zones In On Romney
Backed by $1.4 million, the spot will run on broadcast and cable television in West Palm Beach, Florida, Des Moines, Iowa, northern Virginia and Washington, D.C., according to the political arm of the women's health care organization. The commercial uses the presumptive GOP nominee's own words and those of campaign officials to accuse him of wanting to deny women birth control, abortions and equal pay (Schwarz, 5/30).

Boston Globe: President Obama's Camp Targeting Mitt Romney's Mass. Record
In some ways, Obama campaign operatives must walk a tightrope in dealing with Romney's record in Massachusetts. For more than a year, they have heaped praise on him for passing a revolutionary health care plan. Romney had the skills to craft, negotiate, and work with Democrats on his signature accomplishment, their argument went, as they sought to remind Republican primary voters that Romney created the precursor for Obama's national health care law. But now they are attempting to shift that ample praise for health care into pointed criticism for nearly everything else (Viser, 5/31).

Meanwhile, the Missouri race for the U.S. Senate is heating up -

St. Louis Beacon: Brunner Shares Johnson's Call For A 'Meat Ax' To Cut Federal Spending
St. Louis businessman John Brunner, a Republican candidate for the U.S. Senate, is embracing much of the message from U.S. Sen. Ron Johnson, R-Wis., who told local Republicans that their party needs to "take a meat ax" to the federal budget should the GOP win control of the U.S. Senate this fall. Among other things, Johnson says that the rising costs of entitlements such as Social Security and Medicare need to be reined in for future retirees. Among the possible options: increasing the eligibility age and perhaps imposing means-testing, which would curb benefits for those with higher incomes (5/31).

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Poll: A Third Of Women Fear Efforts To Control Reproductive Rights

According to a poll conducted by the Kaiser Family Foundation, more than four in 10 women have taken action in response to recent dustups on women's reproductive health issues.

Reuters: U.S. Women See Assault On Reproductive Rights: Poll
About one-third of American women believe there is a broad effort under way to limit their access to reproductive services including contraception, family planning and abortion, according a poll released on Thursday. … But the survey of 1,218 adults, conducted by the nonpartisan Kaiser Family Foundation, said reproductive rights have not become a hot-button presidential campaign issue for women, who see the economy and jobs are far more important topics for Obama and his Republican rival Mitt Romney (Morgan, 5/31).

Kaiser Health News: Capsules: Poll: 42% Of Women Take Action In Contraception Debates
More than four in 10 women have taken action, such as donating money or trying to change a friend's opinion, in response to recent controversies over women's reproductive health issues, according to a new survey (Carey, 5/31).

National Journal: Women Fear Efforts To Control Reproductive Rights: Poll
Separately, the survey shows that fewer Americans support the 2010 health care reform law. The poll finds that more than 40 percent of women have taken action on reproductive health issues in the last six months, including trying to persuade others; donating money to a nonprofit organization that works on reproductive health issues; or contacting an elected official. Those numbers varied only a little by political ideology (Sanger-Katz, 5/31).

Politico Pro: Poll: Women Watch Contraception Battles
Guess who's been taking note of the "war on women." Women. And, for that matter, a fair number of men. According to a new poll by the Kaiser Family Foundation, 31 percent of U.S. women think the nation is witnessing a "wide-scale effort" to curtail women's access to services such as contraception and abortion — and most of them see that as a negative development. Another 45 percent say they think some groups are taking action to reduce choices in reproductive health, but stop short of thinking of it as "wide-scale" (Smith, 5/31).

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Feds Announce Effort To Slash Use Of Antipsychotics In Nursing Homes

An estimated 40 percent of nursing home residents with dementia receive the drugs, which are approved to treat schizophrenia and bipolar disorder.

Boston Globe: US Aims To Cut Use Of Drugs On Dementia Patients
Federal regulators announced a multiyear initiative on Wednesday to slash the inappropriate use of antipsychotic drugs on nursing home residents, saying that nearly 40 percent of residents with dementia were receiving the powerful sedatives though they did not have a condition that would warrant it. The US Centers for Medicare & Medicaid Services said it was aiming to reduce the use of antipsychotic drugs in nursing home residents by 15 percent by the end of this year, through training of nursing home staff and of state inspectors on alternatives to using antipsychotics to quell aggressive and agitated behavior among people with dementia (Lazar, 5/31).

HealthDay/Philadelphia Inquirer: U.S. Program Targets Antipsychotic Drug Use In Nursing Homes
According to CMS, overuse of antipsychotic drugs in nursing home patients suffering from dementia is a significant problem. CMS statistics indicate that in 2010, more than 17 percent of nursing home patients had daily doses exceeding recommended levels (Reinberg, 5/30).

Kansas Health Institute News: Initiative Aims To Reduce Use Of Antipsychotics To Treat Dementia
A national partnership is working to reduce use of antipsychotic medications for nursing home patients, officials from the Centers for Medicare & Medicaid Services announced today. The Partnership to Improve Dementia Care aims to reduce off-label antipsychotic use by 15 percent by the end of 2012. Treating dementia with antipsychotics is considered an off-label use of the drugs, which are approved to treat schizophrenia and bipolar disorder (Cauthon, 5/30).

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Medicare Official Sees Medicare Advantage Enrollment Continuing To Grow

CQ HealthBeat: Medicare Official Predicts Rising Enrollments In Medicare Advantage
A top Medicare official predicted Wednesday that the private Medicare Advantage program will continue to grow at double-digit rates, although payment reductions in the program are included in the health care overhaul law. "Despite the rhetoric you hear that the Affordable Care Act has killed the private plan side of Medicare that's contrary to the truth," deputy administrator and director of the Center for Medicare at the Center for Medicare and Medicaid Services, Jonathan Blum said (Norman, 5/30).

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State Watch

Mass. House Avoids Major Changes In Cost Containment Bill Update

The Massachusetts House has revised its health care cost containment bill, leaving several provisions intact -- including one directing the industry to cut spending growth in half by 2016.

Boston Globe: House Revises Health Care Bill
Massachusetts House leaders released a revised plan Wednesday to curb health care costs, keeping several key provisions intact, including a require­ment that the health care industry cut spending growth in half by 2016. The reworked proposal, which was the focus of intense lobbying by hospitals, businesses, and other groups, also retains a provision that would impose a luxury tax on certain expensive providers and would redistribute the money to struggling hospitals (Kowalczyk, 5/31).

WBUR's CommonHealth blog: Revised House Health Costs Bill Is Out
On Beacon Hill, the House has made few changes to a health care cost control bill despite intense pressure from hospitals and some business leaders. … The House makes one significant revision in the bill. The new entity that would set guidelines and monitor compliance with required changes would be within the Executive Office of Health and Human Services. But it would still be independent, as is the Group Insurance Commission (Bebinger, 5/30).

And the Massachusetts legislature's leaders were no-shows at a retirement for a key player in the bill's negotiations --

Boston Globe: House Speaker DeLeo, Senate President Murray Are No Shows At Partners Chief's Retirement Celebration
For a time today, some of the business leaders deeply involved in Beacon Hill's ongoing health care negotiations were expected to be rubbing elbows with the state's two most powerful legislators at a private dinner tonight at one of Boston's swankiest restaurants. House Speaker Robert A. DeLeo and Senate President Therese Murray were on the guest list to attend a small gathering at L'Espalier in honor of Jack Connors, the retiring chairman of Partners HealthCare, and a major player in the negotiations over the health care cost containment legislation (Phillips, 5/30).

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Health Law Jobs, Cost Controls And The Mandate Play In Minds Of State Leaders

Health law issues are reverberating in states around America as leaders consider what the law means for them -- especially if it stands after a Supreme Court review.

KQED's State of Health blog: New Health Care Jobs: How Healthy?
California stands to reap tens of thousands of jobs because of the federal health care overhaul -- according to a new report by the Bay Area Council Economic Institute (BACEI). Researchers compared the state's 2010 workforce to what it might have been if the Affordable Care Act had been fully implemented in that year. They concluded that once the ACA is fully in place in 2014 almost 99,000 new jobs will be created as a result of the law, most of them in Southern California. The Sacramento Valley will see the largest increase rate: a 1.3 percent boost in job opportunities. But ironically, health care jobs are not always healthy for the worker (Harris, 5/30).

Health News Florida: Health Law's Hidden Agenda Is Cost Control
Critics of the Affordable Care Act have focused on the "individual mandate" to buy health coverage. But industry leaders say the most far-reaching and incendiary part of the health law could be its shift in the way Americans pay for health care. Rewarding value -- good outcomes, cost-effective practices -- is likely to have the most potential long-term impact, say experts meeting in Orlando this week (Gentry, 5/30).

Denver Post: GOP Says Hick Opposes Health Mandates, But His Office Says Otherwise
Blasting Democrats as out of step with their own governor, the Colorado Republican Party on Wednesday said Gov. John Hickenlooper opposes the individual mandate, a key tenet of federal health care reform. The governor's office denies he said any such thing. The state GOP issued a press release Wednesday afternoon that said the Democratic governor "surprised Coloradans" by telling Ryan Warner, the host of Colorado Public Radio's "Colorado Matters," that Hickenlooper "opposes Obama's individual mandate" (Hoover, 5/31).

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Ill., Providence, R.I., Make Deals To Save Money On Retiree Pensions, Health Care

Officials report accords with public employees restricting pension increases in order to keep the programs solvent. Both deals also involve changes to retiree health care programs.

The New York Times: Rhode Island: Deal May Avert Bankruptcy
A tentative deal between the city of Providence and its workers and retirees will prevent the city from going into bankruptcy, Mayor Angel Taveras said Wednesday. Mr. Taveras announced that retirees, current safety officials and current municipal workers agreed to a 10-year suspension of cost-of-living increases for most pensions --and limitations thereafter -- and the migration of their health care plans onto Medicare (Bidgood, 5/30).

Chicago Sun-Times: Madigan Announces Possible Pension Reform Deal In Springfield
House Speaker Michael Madigan announced a possible breakthrough late Wednesday on a pension reform deal just hours after facing bitter GOP accusations of slashing juvenile diabetes funding to punish two Republican leaders with diabetic children. … The move came after a day of stalemate and acrimony over a pension deal, which is designed to right the state's massively underfunded pension systems by making current and retired state employees and teachers accept lower post-retirement pension increases in exchange for keeping state-subsidized health care as retirees (McKinney, 5/31).

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Medi-Cal Enrollees Have More Trouble Finding Docs Than People With Other Plans

In other Medicaid news: In Oregon, Gov. John Kitzhaber has convinced the federal government that he has a way to make Medicaid treatment better, and Georgia faces risks as it moves all of its Medicaid patients to managed care.

Los Angeles Times: Medi-Cal Works For Most Enrollees, Survey Finds
As California gears up for a major expansion of its publicly funded health program for the poor, a statewide survey released Thursday shows that Medi-Cal enrollees have more trouble finding doctors and use the emergency room more frequently than people with other health coverage (Gorman, 5/31).

San Jose Mercury News: Medi-Cal Users Struggle Ahead Of Expansion
As California's Medi-Cal program readies for an influx of 2 million to 3 million people when national health reforms kick in, major challenges lie ahead, including finding enough specialists who will see participants. The state's existing 7.5 million Medi-Cal recipients already have difficulty accessing specialists, according to a study by the California HealthCare Foundation. And adults on Medi-Cal are twice as likely to visit the emergency room as people with other coverage, the study reveals. This may be an indication of greater difficulty in seeing primary care doctors (Kleffman, 5/31).

Kaiser Health News: Oregon's $2 Billion Medicaid Bet
Gov. John Kitzhaber, a Democrat and a former emergency room doctor, has convinced the federal government that he has a way to make Medicaid treatment better, and cheaper, by completely changing the way the sickest people in Oregon get health care (Foden-Vencil, 5/30).

Georgia Health News: State Faces Risk In Medicaid Managed Care Switch
The potential state move of all Medicaid patients into managed care comes with a multimillion-dollar catch. Georgia could lose roughly $175 million to more than $220 million in federal funding annually for the program if it makes the managed care switch, based on figures for the last two fiscal years. The state, though, could seek federal permission to hold on to those "upper payment limit" (UPL) dollars. Texas sought and got federal approval in December to bring Medicaid beneficiaries into managed care and keep the funding, but only after the Lone Star State promised significant reforms to improve community health care (Miller, 5/30).

Also in the news -

Detroit Free Press: Lawyer Agrees To Temporarily Withhold Union Dues From Payments To Home Health Care Workers
A lawyer for the state of Michigan agreed today to temporarily continue withholding union dues from payments made to 41,000 home health care workers who provide services to low-income elderly and disabled residents under the state's Medicaid program. Assistant Attorney General Joshua Smith agreed to continue the collections after U.S. District Judge Nancy Edmunds expressed her willingness to issuing a temporary restraining order that would have continued the practice until she can sort out a legal dispute over the issue. The dues collections will continue at least until a follow-up court hearing on June 20 (Ashenfelter, 5/30).

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State Roundup: Judge Rejects Calif. Request To End Oversight Of Prison Health Care

A selection of health policy news from California, Kentucky, Massachusetts, Colorado, Utah, Wisconsin and Texas.

San Francisco Chronicle: CA Request To Take Over Inmate Health Care Denied
A federal judge rejected a request by California prison officials Wednesday to regain control of inmate health care, which has been under court-supervised receivership for six years, and said the state must first show it can provide adequate medical treatment. ... The current receiver, Clark Kelso, has reported improvements in the prisons' medical staff and facilities, and said a "turnaround plan" he proposed for the system in 2008 is about 80 percent complete (Egelko, 5/31).

The Associated Press: Judge Rejects Immediate End To Prison Oversight
A federal judge on Wednesday rejected California's call for an immediate end to federal oversight of medical care in state prisons, ruling that the state has yet to prove that it's ready to retake control. U.S. District Judge Thelton Henderson, of San Francisco, instead proposed a gradual transition back to state control. He set no deadline in the four-page ruling, which comes six years after he appointed a receiver to run inmate health care operations (Thompson, 5/30).

Reuters/Chicago Tribune: States Crack Down On Prescription-Drug "Doctor Shopping"
State databases such as one used in Kentucky are designed ... to alert prescribers that someone may be abusing drugs or diverting them for illegal sale. Forty-three states now have databases to keep track of who is getting prescriptions for powerful pain relievers such as oxycodone, Vicodin and Opana (Wisniewski, 5/30).

WBUR's CommonHealth blog: Study Finds 'Sunshine' Laws Have Little Effect On Prescribing
The Massachusetts 'gift ban,' barring drug- and device-makers from showering doctors with money and meals, was passed way back in 2008, but it remains a live controversy. The House, by my count, has now twice passed repeals of the ban, according to the State House News Service; and it sounds like last week, the Senate once again said no, no repeal, according to Health Care For All. So I figure this new study just out from the Colorado School of Public Health and Harvard will serve as fodder in the ever-swirling debate (Goldberg, 5/30).

California Healthline: Pre-Existing Condition Reform Passes
The Senate passed SB 961 yesterday on a 22-13 vote, largely a partisan split. One day earlier, the Assembly passed its version of the bill, AB 1461 by Bill Monning (D-Carmel) on a 50-27 vote. Both bills would require insurers to cover a minimum set of basic requirements and would forbid them from denying coverage based on pre-existing conditions. ... [Sen. Ed] Hernandez said the state Legislature has to move ahead based on current law, rather than what might or might not happen in the Supreme Court (on the federal health law)(Gorn, 5/31).

Los Angeles Times: Popular Medicare Drug Program Targeted In Utah GOP Primary Battle
As veteran Republican lawmakers are forced to defend their support for any government program in the face of tea-party-backed primary challenges, even Medicare, the popular insurance program for the elderly and disabled, is becoming campaign fodder in the intra-party GOP war. Utah Republican Senate candidate Dan Liljenquist has taken aim at six-term incumbent Sen. Orrin Hatch for supporting the creation of a drug benefit in Medicare in 2003, a top priority of then-President George W. Bush (Levey, 5/30).

Kaiser Health News: Psychiatric Patients Languish In Emergency Rooms
Last fall Kathy Partridge got a phone call from a local emergency room, telling her that her daughter, Jessie Glasscock, was there -- and was OK. Glasscock had gone missing overnight.  She was away at college, and had a history of manic episodes. Police had found her in a dumpster and brought her to the ER for her own safety.  It was a huge relief for her mother -- but she was completely surprised by what happened next (Whitney, 5/31). 

Modern Healthcare: Blue Shield of Calif., John Muir Announce ACO Plans
Blue Shield of California announced it entered into an accountable care organization with John Muir Health, a three-hospital system in Walnut Creek, Calif. The accountable care organization, Blue Shield's seventh, will include about 16,000 health plan members and continue for at least 36 months, according to a news release. The ACO will start July 1 but preliminary work is under way (Evans, 5/30). 

Milwaukee Journal Sentinel: Health Care System Vow Savings For Exclusive Contracts
Health systems in eastern Wisconsin are taking the first steps toward revamping the way they are paid, laying the groundwork for head-to-head competition on price and quality as well as sweeping changes in the health insurance market. Aurora Health Care is promising employers guaranteed savings if they offer a health plan that requires employees and their families to use only Aurora hospitals, doctors and other services. Froedtert Health, Wheaton Franciscan Healthcare and Columbia St. Mary's Health System are part of a partnership with other health systems in eastern and north-central Wisconsin and northern Illinois that plan to do the same. The initiatives are in the earliest stages. But over time, they could lead to the narrow networks common in the 1990s, when managed care remade the health insurance industry. That would force many patients to change doctors (Boulton, 5/30).

Texas Tribune: Should State Government Play Role in Family Planning? (video)
In Part 3 of our Fertile Ground series, we take a historical look at the role of government in funding family planning — a long-standing women's health initiative that has become entangled in the battle over abortion (5/31).

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Weekend Reading

Longer Looks: The Cost Of Dying; Insuring Fertility

Every week, KHN reporter Shefali S. Kulkarni selects interesting reading from around the Web.

Newsweek: Why Did Her Husband's End-Of-Life Care Cost So Much?
During those four days Terence had his blood drawn—eight times. Urine collected at least twice. There was a CT scan of his chest and an MRI of his brain. A physical therapist dropped by several times. A nutritionist talked about cancer fatigue, decompensation, and calorie needs. Over the stay, at least 29 professionals—nurses, physical therapists, a nutritionist, and nine M.D.s—attended to his needs...But until years later, when I read Terence's medical records, I didn't realize that they had prodded and X-rayed and scanned and tested him even though they thought he was dying. Soon. The discharge record after his four-day stay expresses regret that they could offer no more than "comfort care." Thirty-three days and one more hospitalization later, on Dec. 14, 2007, Terence died...And why, if all they could offer was "comfort care," was the total bill for that penultimate four-day hospital stay $33,382. (Amanda Bennett, 5/28).

New York Times Magazine: Mommy Wars: The Prequel
[Ina May] Gaskin, who is 72, has the spry, almost Seussian presence of someone much younger. Her gray hair, trimmed since the days when she wore it in thigh-length braids, was loose and a bit wild, and she wore jeans, gardening shoes and a homemade jacket. Gaskin, a longtime critic of American maternity care, is perhaps the most prominent figure in the crusade to expand access to, and to legalize, midwife-assisted homebirth. Although she practices without a medical license, she is invited to speak at major teaching hospitals and conferences around the world and has been awarded an honorary doctorate from Thames Valley University in England. She is the only midwife to have an obstetric procedure named for her. The Gaskin Maneuver is used for shoulder dystocia, when a baby's head is born but her shoulders are stuck in the birth canal... In 2001 the American College of Obstetricians and Gynecologists (ACOG) recommended C-sections as the best route of delivery for breech babies. Although ACOG modified that view in 2006, more than 90 percent of breech babies are now born by Caesarean, and the Farm is one of a dwindling number of places in the United States where practitioners still know how to perform vaginal breech delivery (Samantha M. Shapiro, 5/23).

TIME Magazine: A New Website Encourages Egg-Freezing For Women
It's a dream on ice, one of 11 eggs that [Brigitte] Adams froze last year at the age of 38, with babies on the brain but Mr. Right nowhere in sight...But Adams was the only one to feel so alone and confused throughout the process that she started a website for wannabe moms like her. It's called Eggsurance, which is both appropriate and tongue-in-cheek because just as with insurance, women who freeze their eggs hope they'll never have to use them; they'd much prefer to meet a man and go about the business of procreating in the more traditional way. But if that never happens — or if it does, and their natural egg supply is too old and finicky — at least they’ve got a stash of frozen gametes at the ready (Bonnie Rochman, 5/30).

The Economist: UnObamacare
So the Utah Health Exchange is decidedly not Romneycare or Obamacare. But what is it? At first glimpse, it is a snazzy web portal where four of Utah's five largest health insurance companies offer about 140 plans to about 6,600 employees of 285 small businesses. Each employer determines in advance how much he will contribute to an employee's insurance, as in a defined-contribution pension plan. The employee then filters the plans and selects his favourite—again, as he might choose mutual funds in his defined-contribution pension plan. As Patty Conner, the exchange's director, explains, this has advantages over traditional corporate health insurance. In the old system employers had no certainty about premiums, which often rise abruptly. And employees, offered little if any choice, often got stuck with inappropriate plans (5/26).

Salon.com: Listen Up, Doctors: Here's How To Talk To Your Patients
My doctor always walks into the exam room smiling. It's not necessarily the countenance you'd expect from a man who spends much of his time working with people with Stage 3 and Stage 4 cancers — the kind that haven't responded to other forms of treatment...A natively cheerful demeanor isn't a requirement for being a competent healer. But what is far too often lost in our grueling, impersonal and cost-driven healthcare system is the basic fact that a human being in the chaotic and scary world of injury or illness deserves sensitivity and compassion. That a shivering person in a paper dress deserves dignity. So if you're a doctor, nurse or technician, here's your reminder. And if you’ve ever been a patient, we'd love to read your own additions to the list (Mary Elizabeth Williams, 5/23).

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Editorials and Opinions

Viewpoints: Bishops' Request For Contraception Exemption May Push Legal Precedent; Maine's Experiment On Health Care

Los Angeles Times: For Contraceptives, A Catholic Exception? 
43 Roman Catholic organizations have filed lawsuits challenging a ... regulation that requires employers or their health insurers to offer birth control coverage to workers. The plaintiffs say that complying with the regulation would violate their religious freedom. ... A decision also could turn on the meaning of the 1993 Religious Freedom Restoration Act, which allows such exceptions unless restricting religious exercise is justified by a compelling government interest. In our view, increasing preventive care — including the provision of contraceptives, some of which have medical uses beyond birth control — is a compelling interest (5/30).

The Wall Street Journal: Church Is Still Not State
Surely someone inside the administration, perhaps Joe Biden (Archmere Catholic high school, '61), brought this matter up during the comment period preceding the January 20 statement by the Department of Health and Human Services (HHS) that religious institutions, primarily hospitals, would be required to extend insurance coverage to the widest definition of birth-control treatments. The Catholic bishops conference urged the Obama administration not to push them inside this mandate, citing religious belief as what one could call their conscientious objection to it. The backlash among Catholics to the HHS order, across the political spectrum, was an astonishing thing to witness (Daniel Henninger, 5/30).

The Fiscal Times: 5 Pitfalls That Could Block Obama's Reelection
No stumble has been as avoidable as the confrontation provoked by the Obama administration over the HHS contraception and sterilization coverage mandate.  Catholic bishops have pressed for universal health-care coverage in the US for almost a century, and were a natural ally for Obama’s social-justice initiatives.  All that changed when Obama and HHS Secretary Kathleen Sebelius decided that the federal government could define religious expression in such a way that Catholic hospitals, schools, and charities didn't qualify, and therefore could not opt out of the mandate – even when they self-insure, as many do (Edward Morrissey, 5/31).

The Washington Post: Clueless About Medicare
Medicare may be the most sacred government program in the United States — even 76 percent of tea-party supporters oppose cuts to it, a McClatchy-Marist poll found in November. Given its central role in our fiscal challenges, it makes sense to examine why this program is so popular (Bryan R. Lawrence, 5/30).

The Wall Street Journal: Political Diary: The Obama Spending Record
Where Senator Obama did oppose the spending patterns of the Bush years, it was often, as with Medicaid, because Mr. Obama wanted to spend more. Speaking of health care, and given all of this attention on the Obama spending history, it should not be forgotten that the big taxpayer bills generated by ObamaCare are still to come. Is federal spending really the issue that Barack Obama wants at the center of this campaign? (James Freeman, 5/30).

The Wall Street Journal: ObamaCare In Reverse
One tragedy of the Affordable Care Act is that we already know what its regulations will do to insurance markets, because the states have been conducting policy experiments since the 1990s. But we also know from the states that the damage is reversible, as shown by Maine's emerging insurance turnaround (5/30).

Philadelphia Inquirer: Should Pharma Grow, Shrink Or What?
What does it say about an industry when its leading competitors appear fundamentally at odds about whether they should grow bigger, smaller, more diversified or more focused? The rosy view is that the abundance of opportunities offers multiple paths to success and the various Big Pharmas are pursuing these divergent paths to profit. That view, however, is delusional, as a glance at the Big Cap pharma sector will show (Daniel R. Hoffman, 5/30).

Boston Globe: State Lawmakers Must Put Our Bloated Health Care System On A Diet
Despite the economic downturn over the past five years, health care costs in Massachusetts have continued to skyrocket. … The fault for excessive costs lies with everyone from hospitals to insurers, policymakers to consumers. The solutions aren’t simple but must be grounded in the principles of consumer transparency and empowerment, rather than continuing to cede control to the health care industry itself, or asking the government to figure it out (Jon B. Hurst, 5/30).

Boston Globe: Single-Payer Health Care Would Save Billions For Massachusetts
The House and Senate health care proposals would set imaginary limits for spending growth enforced by secret "improvement plans" and wrist slaps for hospitals that overcharge; establish tiered payment schemes to consign the poor and middle class to second-tier hospitals and doctors; push most residents of the Commonwealth into HMOs (oops, we forgot, now they're called "accountable care organizations," or ACOs); and wipe out small doctor’s offices by "bundling" their pay into ACO payments. Apparently the legislators' theory is that forcing health care providers to consolidate cuts costs. Oligopoly saves money? (David U. Himmelstein and Steffie Woolhandler, 5/30).

Minneapolis Star Tribune: Patients Lose When Care Isn't Top Goal
The Fairview Health Services CEO who hired an aggressive outside company to collect debts and lower medical care costs is leaving. But Accretive Health, the contractor brought in by Mark Eustis, and firms like it are only going to play a more prominent role in health care in years to come. ... hospitals across the nation will need to rely more on outside vendors to save on staffing costs and provide expertise in information technology ... That reality is why it is so important to intensely scrutinize what went wrong at Fairview (5/31).

New England Journal of Medicine: Residents' Response To Duty-Hour Regulations — A Follow-Up National Survey
We firmly believe that most residents support some form of duty-hour regulation and would not choose to revert to the Halstedian model (where medical trainees worked 362 days a year and lived in the hospitals in which they trained). However, a one-size-fits-all approach may not be adequate or appropriate for all trainees and training programs. Ultimately, the intended and actual effects of the 2011 ACGME duty-hours requirements may not be aligned (Drs. Brian C. Drolet, Derrick A. Christopher and Staci A. Fischer, 5/31).

New England Journal of Medicine: Home: Palliation For Dying Undocumented Immigrants
Federal funds for the care of undocumented immigrants are available only through emergency Medicaid. The vast majority of these funds are used for pregnant women and children. ... A disturbing problem arises in the care of terminally ill patients. Our hospital, Houston's county hospital, admits a startling number of terminally ill undocumented immigrants with organ failure or severe pain. These patients tend to present at a late stage of their illness and often receive many different regimens of chemotherapy paid for by county funds. But what happens when they are too weak to receive treatment? What happens when they are dying? (Dr. Ricardo Nuila, 5/31).

Healthy Cal: Aging With Dignity And Independence
While we all like to picture ourselves growing older in a healthy way, the reality is that 70 percent of people over the age of 65 will need help with daily activities at some point in their lives — for an average of three years. ... The first step is to build a plan that preserves your choices, dignity and independence, even when you need some help to do so. The second step is to start conversations with the people around you — family and friends, health care and social service providers, legal and financial experts, and others — about what you want and what is important to you in case the need arises. The SCAN Foundation recently produced a guide featuring 10 key areas with conversation starters that can help you (Victoria R. Ballesteros and Athan G. Bezaitis, 5/30).

MinnPost: Two Simple Changes Can Kickstart A Healthier Lifestyle, Study Suggests
Here's some hopeful news for people who are struggling to adopt a more healthful lifestyle: A new study has found that people who made two simple behavioral changes — eating more fruits and vegetables and cutting the amount of time they spend in front of a TV or computer screen — were more likely to experience another potentially healthful change (eating less food with saturated fat). Furthermore, they were highly likely to maintain those new habits months later (Susan Perry, 5/30). 

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Andrew Villegas

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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.