Daily Health Policy Report

Friday, May 4, 2012

Last updated: Fri, May 4

KHN Original Reporting & Guest Opinion

Medicare

Health Reform

Campaign 2012

Health Care Marketplace

Public Health & Education

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

FAQ: Obama Vs. Ryan On Controlling Federal Medicare Spending

Kaiser Health News staff writer Marilyn Werber Serafini reports: "It may come as a surprise that President Barack Obama and Rep. Paul Ryan, the Wisconsin Republican who chairs the House Budget Committee, are pushing the same target rate for curbing annual federal spending on Medicare. Each would set it at half a percentage point higher than the growth rate of the economy – the gross domestic product" (Werber Serafini, 5/3). Read the story.

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Political Cartoon: 'Over The Top?'

Kaiser Health News provides a fresh take on health policy developments with "Over The Top?" by Lee Judge.

A BUDGET CHALLENGE FOR SUPER HEREOS

Could the Avengers
protect the safety net and
yet still find balance?
-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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Medicare

Reining In Medicare Costs: Lots Of Talk But Little Action

News outlets report on how efforts to control Medicare spending often get lost in political messages and campaign posturing.

The New York Times: The Caucus: For Republicans, Clear Approach To Medicare Has Many Sides
Among the Republican fiscal hawks, the 2012 election is supposed to be a stark choice between a Republican Party willing to make the tough spending decisions necessary to get the deficit under control and a profligate Democratic Party still relying on "Mediscare" tactics to avoid responsibility. Republican campaigns do not appear to be ready to embrace this message (Weisman, 5/3).

The Associated Press: Spin Meter: Lawmakers' Talk Of Cuts Is Just Talk
Presidents and lawmakers of every stripe have talked for years of needing to rein in Social Security and Medicare. They often campaign in ways to make sure it doesn't happen... In 2010, Republicans took control of the House after accusing dozens of Democrats of wanting to gut Medicare. The Democrats had voted for Obama's health care overhaul, which envisioned $500 billion in Medicare savings over 10 years. And liberals rebuked Obama last year for showing openness to reduced benefits for Social Security and Medicare in exchange for tax increases under a never-realized "grand bargain" with Republicans (Babington, 5/4).

Kaiser Health News: FAQ: Obama V. Ryan On Controlling Federal Medicare Spending
It may come as a surprise that President Barack Obama and Rep. Paul Ryan, the Wisconsin Republican who chairs the House Budget Committee, are pushing the same target rate for curbing annual federal spending on Medicare. Each would set it at half a percentage point higher than the growth rate of the economy – the gross domestic product (Werber Serafini, 5/3).

Politico: Feingold: Pelosi Wobbly On Social Security
Former Sen. Russ Feingold is going after House Minority Leader Nancy Pelosi for what he calls "a disturbing potential willingness to adopt a plan that could slash" Medicare, Medicaid and Social Security benefits. In an email to supporters of his group, Progressives United, Feingold … said Pelosi is the latest in a growing trend of Democrats who are wavering on defending Medicare. He even hints at a comparison of Pelosi with House Budget Committee Chairman Paul Ryan (Haberkorn, 5/3).

Meanwhile, in news from Capitol Hill -

Roll Call: Chris Van Hollen Pans GOP's Plan To Undo Sequester
House Budget ranking member Chris Van Hollen released a report this week skewering Republicans over their plans to replace mandatory spending cuts with reductions to entitlements, health care and other Democratic priorities. ... In particular, Van Hollen objected to cuts to food stamps, the Consumer Financial Protection Bureau, President Barack Obama’s 2010 heath care law and social services block grants, which help states fund programs for low-income people (Newhauser, 5/4).

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Health Reform

High Profile Judge Hints That Decision To Strike Health Law 'Would Be A Mistake'

The Wall Street Journal reports that Judge J. Harvie Wilkinson said the high court should "think twice" about overturning the law. In other health law news, the White House's under-the-radar effort to build support for the overhaul appears to be working.

The Wall Street Journal's Law Blog: Judge Wilkinson Hints That Overturning Obamacare Would Be A Mistake
And last month, receiving the Federalist Society's Lifetime Service Award at Georgetown University, Judge Wilkinson hinted that the high court he nearly joined should think twice before striking down the symbol of everything contemporary conservatives revile -- the health care overhaul President Barack Obama signed into law over near-unanimous Republican opposition (Bravin, 5/3).

The Hill: Obama's Below-The-Radar Push Builds Support For Health Care Reform Law
The Obama administration is employing an aggressive ground game to build support for its controversial health care law that often reaches beyond the Beltway. While President Obama doesn't mention health care much in his public appearances, the administration consistently touts its popular reforms to make the case for a law with an approval rating stuck just below 50 percent. In the two years since Obama signed the Affordable Care Act, the administration has released a deluge of positive reports, press releases and blog posts from the White House and the Health and Human Services Department (HHS) (Baker and Viebeck, 5/3).

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Campaign 2012

Poll Shows Obama Leading In Virginia Despite Mixed Views On Health Law

Virginia is viewed as one of the hot states in the presidential campaign. Also, because female voters continue to be considered an important force in the upcoming election, women's health issues are getting a lot of air time.

The Washington Post: Poll: Obama Leads Romney As Campaigns Converge On Virginia
The Democratic president has a key advantage in his bid for re-election: The coalition of Virginians that helped propel him to victory in 2008 — young voters, suburban Washingtonians, women and African Americans — is largely intact. Yet the survey shows that voters in the state are split on Obama's signature health-care reform law and that they remain deeply pessimistic about the way things are going in the country, creating a potential opening for Romney (Pershing and Cohen, 5/3).

The Hill: DNC Ad Keeps Pressure On Romney With Female Voters
President Obama already holds a big lead over presumptive Republican nominee Mitt Romney among female voters, and the Democratic National Committee is keeping the pressure on by attacking Romney for "turning back the clock on women's health" in a new Web video. The ad ties Romney to two of his high profile endorsers — Virginia Gov. Bob McDonnell, a potential vice presidential candidate, and former GOP presidential nominee Rep. Michele Bachmann (R-Minn.) — and their stances on women's health issues (Easley, 5/3).

iWatch News: FACT CHECK: A New Front In The 'War On Women'
Mitt Romney's senior adviser Ed Gillespie distorted some economic facts on "Meet the Press" when he accused President Obama of creating a U.S. economy that is "hostile" to women. ... Gillespie said "there are 2.7 million more women without health insurance today than when Barack Obama took office." True, but there are also 2.1 million more women living in the U.S. The percentage of uninsured women rose from 13.3 percent in 2008 to 14.8 percent in 2010. That’s lower than the percentage of uninsured men, which was 17.9 percent in 2010 (5/2). 

The New York Times: The Caucus: 'Julia' Becomes Vehicle For Obama's Messaging
Nearly 20 years ago, a multimillion-dollar ad campaign created a fictional couple — "Harry and Louise" — to dramatize the dangers of President Bill Clinton's health care reforms. Now, President Obama is trying to use the same Madison Avenue-style technique to demonstrate how his policies would be better for women than would Mitt Romney's (Shear, 5/3).

Politico: Conservatives Mock Obama's 'Julia'
For example, the slideshow suggests that at age 18, Julia would qualify for a college tax credit, one that would be allowed to expire under a Mitt Romney presidency. At age 65, Julia could enroll in Medicare -- something that Romney "could end as we know it." Conservatives were quick to lampoon the meme, criticizing the Obama campaign for viewing the life of a woman only in terms of her relationship with the government (Mak, 5/3).

Politico Pro: Bachmann Backs Romney, Avoids Health Care
Endorsing Gov. Mitt Romney for president, Rep. Michele Bachmann skipped one of her favorite topics: health care. During her foray into the presidential race, Bachmann constantly pounded at the health law. Or both health laws — President Barack Obama’s federal one and its precursor, then-Gov. Romney's Massachusetts one. And she helped turn it into a GOP signature issue (Smith, 5/3).

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Health Care Marketplace

HCA's Profits Up, Cigna's Down, As Patients Use More Services

News outlets pointed out that "after a long slump," patients have been seeking more care.

The Wall Street Journal: Cigna Profit Declines 10%, Full-Year View Raised
Earnings were slightly below the level analysts expected in the quarter, despite a boost from claims reserves that weren't needed in prior periods, although Cigna said it topped its own forecast. ... Like other insurers, Cigna has been projecting patients will start using health care services more after a long slump. The company in its release noted its latest guidance reflects, in part, an "expected increase in medical services utilization during 2012" (Kamp, 5/3).

MarketWatch: HCA Profit Soars On Higher Patient Volumes
HCA Holdings Inc.'s first-quarter earnings soared as the hospital operator saw revenue jump from an increase in patient volumes and adjustments related to Medicare payments. ... HCA, like other health-related companies, faces pressure from tighter government budgets and consumers who have been delaying doctor visits and medical procedures. But last month the company, which is the largest private-sector hospital operator in the U.S., said same-facility admissions were edging up, resulting in higher-than-expected first-quarter revenue (Jones, 5/3).

Los Angeles Times: Health Net Shares Tumble 25% As It Posts Loss, Lowers Forecast
The company surprised analysts and investors by disclosing an additional $67 million in medical claims that hadn't been reported in the fourth quarter because of errors in processing claims. Health Net said outside vendors that handle those claims for the company experienced problems with a new industrywide billing format (Terhune, 5/4).

MarketWatch: Health Net Swings To Loss As Claims Surge
The company had benefited from improved premium revenue and higher Medicaid enrollment, but its top line has declined in recent quarters on a sharp drop in government contract revenue. Health Net has also been on a buying spree of late in an effort to bulk up on senior-focused plans as baby boomers age (Warner, 5/3).

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Survey: First-Year Medical School Enrollment Expected To Increase

According to the Association of American Medical Colleges, the number of students entering medical school will show an increase of nearly 30 percent from its starting point in 2002 to projections for 2016.

Modern Healthcare: AAMC: First-Year Med School Enrollment On Track For 30% Boost
A new survey from the Association of American Medical Colleges predicts that by 2016, first-year enrollment in U.S. medical schools will nearly match the 30% increase in enrollment that the association called for in 2006. According to the AAMC's 2011 Medical School Enrollment Survey, first-year medical school enrollment will record a gain of 29.6% in the 14-year period from the 2002-03 school year to the 2016-17 school year (Selvam, 5/3).

The Fiscal Times: More Doctors on the Way, Higher Costs to Follow
The Association of American Medical Colleges (AAMC) unveiled a new survey Thursday showing the number of students entering the nation's 137 accredited medical schools will surge nearly 30 percent from 2002 levels to 21,376 in 2016, meeting a goal set in 2006 when it was widely believed an aging population would require far more physicians. ... Health care reformers say the increased enrollment has not addressed the ongoing shortage of primary care physicians, especially in poor and rural areas (Goozner, 5/4). 

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Public Health & Education

For U.S., Preventable Health Conditions A Gathering Storm

Georgia Health News: Largely Preventable Health Conditions Hamper U.S.
The current generation of American children may be the first not to live as long as their parents. Much of this projection is linked to the increase in obesity and health conditions. These and other medical deficits in the U.S. health system were highlighted Thursday at an Atlanta conference and in national media reports. Tyler Norris, a senior adviser on Total Health at Kaiser Permanente, cited the life expectancy warning as he spoke to an Atlanta audience about the burden of obesity and diabetes (Miller, 5/3).

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State Watch

Ore. Gets $1.9B To Launch Medicaid Coordinated Care Organizations

The federal support will help Oregon's Medicaid Coordinated Care Organizations as they try to cut health costs by 2 percent over two years using preventive care to keep patients healthy.

The Wall Street Journal's Health Blog: Oregon Gets Extra Funds To Test New Medicaid Method
Controlling costs is a major priority for virtually everyone involved in funding health care, including federal and state governments, employers and insurers. … One state, Oregon, reckons it can cut health costs by two percentage points within two years -- and improve health outcomes -- through a new way of delivering care under Medicaid, the state/federal program for the poor (Radnofsky, 5/3).

The Associated Press: Feds To Put Up $1.9B For Oregon Health Overhaul
The Obama administration is buying into an ambitious health care initiative in Oregon, announcing Thursday it has tentatively agreed to chip in $1.9 billion over five years to help get the program off the ground. Oregon hopes to prove that states can save billions on Medicaid without sacrificing the quality of health care. Gov. John Kitzhaber's plan would invest in preventive care to keep patients healthy so they don't need expensive hospitalizations (Cooper, 5/3).

Modern Healthcare: Ore. Coordinated Care To Receive $1.9 Billion From Feds
Oregon's plan to create a network of Medicaid Coordinated Care Organizations moved forward as the names of 14 applicants were released, and it also received a boost as the CMS announced preliminary approval to provide the program with $1.9 billion over five years (Robeznieks, 5/3).

Politico Pro: ACO Concept Reaches Oregon Medicaid
On Thursday, CMS and Oregon announced that they have reached an agreement on a $1.9 billion demonstration program to create Coordinated Care Organizations in the state's Medicaid program, which Oregon estimates will save $11 billion over 10 years (Feder, 5/3).

Oregon Statesman Journal: Oregon To Get $1.9 Billion From Feds To Pay For New Health Plan
Although lawmakers approved the overhaul in their February session, some expressed concerns that it would not result in the $239 million in budget savings projected for the year starting July 1. But Kitzhaber said he anticipated negotiating a deal with the federal government, such as the one announced today, that would produce more aid to cover any potential gap (Wong, 5/3).

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State Legislative News: Mass. Legislature Poised To Consider Cost Control Plan

Meanwhile, in Connecticut, the legislature approves a bill giving collective bargaining rights to home health care workers and goes against leadership to gut a bill that would loosen requirements for suing a health care provider.

Boston Globe: House Plans To Release Health Care Cost-Control Plan Friday
Legislative leaders said Thursday that they will release comprehensive plans to control health care costs in Massachusetts within the next week. The House has scheduled a press conference Friday afternoon at 2:30 ... The Senate plans to release its cost-control plan on Wednesday (Kowalczyk, 5/3).

Politico Pro: Massachusetts's Next Act: Payment Reform
What will the caps look like? A plan offered last year by Gov. Deval Patrick would have offered financial incentives for doctors and health care providers to keep their patients healthy. But now, House and Senate lawmakers intend to go further than the governor, imposing a growth target for all health care spending in Massachusetts (Cheney, 5/3).

The Connecticut Mirror: Labor Proposal Passes Senate, Heads For Malloy's Signature
A controversial proposal to give collective bargaining rights to certain home care workers and daycare providers is headed to the governor's desk (Levin Becker, 5/3). 

The Connecticut Mirror: In An Upset, It's Docs Over Lawyers, 74-69
You don't see this every day: The speaker, majority leader and minority leader all on the losing side of a 74-69 vote in the state House of Representatives. On a bipartisan vote, the House on Thursday gutted a bill aimed at loosening the requirements for bringing a medical malpractice lawsuit (Pazniokas, 5/3).

The Associated Press/San Francisco Chronicle: Bill Would Boost Indian Reservation Health Care
Lawmakers on Thursday passed AB1896, which would allow practitioners licensed in other states to work for tribal health care programs without obtaining a California license. Democratic Assemblyman Wes Chesbro of Arcata wrote the bill to address the chronic shortage of medical professionals in the state's 31 tribal health programs (5/3). 

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Romney Plan Could Hurt Mass. Medicaid; States Scramble Around Health Law

Mitt Romney hasn't released details of his health plan, but his views on Medicaid seem clear. Meanwhile, residents in Maine consider what the federal health law means for them and 90 Washington state women are suing their Republican attorney general.

Boston Globe: Romney's Plan May Undercut Mass. Law
A proposal by Mitt Romney to curtail Medicaid spending would dramatically undercut the way the Massachusetts health care overhaul law has achieved near universal coverage. Although the specifics of Romney’s plan are not public, his overall intent -- to rein in how much Medicaid money Washington sends to the states -- would probably cripple the Massachusetts health care law (Jan, 5/4).

PBS NewsHour: Health Reform On The Brink: Mixed Feelings In Maine 
As Jeff Aronson sees it, few things encapsulate the American health care dilemma as well as a car crash on the island of Vinalhaven, Maine. Not the shattering glass and twisting metal of impact, but the aftermath -- the ambulance ride, the hospital stay, and, eventually, the stacks of bills from both. ... It's fairly clear to Jeff that some type of health care reform is necessary. But, he said, "the Affordable Care law doesn't do anything for these issues" (Kane, 5/2).

The Seattle Times: McKenna Sued Over Challenge To Obama Health Care Law
Ninety women who say they've been helped by the federal health care overhaul sued Rob McKenna on Thursday, arguing the state's Republican attorney general breached his ethical duties by joining legal arguments to scrap the entire law while publicly saying he only wanted to eliminate its controversial individual mandate. The women, including several cancer survivors, are represented by attorney Knoll Lowney, a Democratic activist (Welch, 5/3). 

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Group Says It Has Kan. Clinic Abortion Records; Iowa Preps For Abortion Battle In Budget

An anti-abortion group says it has patient records of dozens of women and girls who sought treatment at a Kansas abortion clinic last month. In the meantime, Iowa lawmakers prepare to tackle the state's health spending, including whether victims of rape or incest may get abortions through its Medicaid program.

The Associated Press: Anti-abortion Group Says It Has Patient Records
An anti-abortion group says it has the patient records of dozens of women and girls who sought treatment at a Kansas City, Kan., abortion clinic last month -- a claim the clinic's attorney says is meant to scare off potential patients and would suggest a crime was committed. Troy Newman, the president of Wichita-based Operation Rescue, said a confidential informant delivered boxes to the group about two weeks ago that contained the records of 86 female patients who sought treatment at Central Family Medicine, also known as Aid for Women (Draper, 5/3). 

Des Moines Register: Lawmakers: Education Spending Settled, But Much Work Remains On Iowa State Budget
But even as spending levels shift slowly into focus, [Rep. David] Heaton said lawmakers haven't even begun to talk about the policy changes regarding abortion contained in the budget. The House version of the health and human services spending package removes language in current law that allows women who are the victims of rape or incest to obtain an abortion through Medicaid and adds wording elsewhere that could reduce state funding for Planned Parenthood. Senate Democrats oppose the changes (Noble, 5/3).

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State Highlights: Fla. Passed Up $200M Because It Comes From Health Law

News outlets report on health care policy news from California, D.C., Florida, Kansas, Massachusetts, Minnesota, Missouri, New York, Texas and Washington.

The Washington Post: D.C. Council Member Catania Comes Up With $20M For Health Coverage For Illegal Immigrants
D.C. Council member David A. Catania has found an additional $20 million in the budget to continue offering free health insurance to 19,000 undocumented immigrants, reversing a proposal by Mayor Vincent C. Gray (D) that could have restricted them from receiving emergency care. Catania (I-At Large) … has made full funding of the Alliance Insurance program a chief priority as the council prepares for final budget deliberations (Craig, 5/3).

The New York Times: Settlement Money Patched Nassau County Budget Gaps
The hundreds of millions of dollars in tobacco bonds issued by Nassau County, N.Y., illustrate both the perils in forecasting tobacco cash flows over decades and a reluctance to use the money for its original intent (Williams Walsh, 5/3).

(St. Paul) Pioneer Press: Twin Cities Postal Personnel Part Of Emergency Medication Delivery Test
In a simulated exercise, postal personnel will deliver empty medicine bottles to 37,000 residences in St. Paul and elsewhere as part of "Operation Medicine Delivery" on Sunday, May 6. The exercise will test the nation's plan to use postal personnel to deliver emergency medication in the event of a large-scale airborne anthrax attack, the Minnesota Department of Health said (Gervais, 5/3).

Health News Florida: FL Passed Up $200M For Kids
Over the past two years, Florida did such a good job of enrolling uninsured children in KidCare that the state could have qualified for as much as $200 million in federal bonuses – money that could have helped get more children into care. But the state did not take the steps required to get the money because the bonuses are part of the Affordable Care Act, which Florida Gov. Rick Scott and the Legislature oppose (Gentry, 5/4). 

The Texas Tribune: UT Regents Back Some Tuition Hikes, New Med Schools
UT regents today also committed to developing medical schools in Austin and South Texas. The plan to build an Austin-based medical school will receive up to $30 million a year from the state's Available University Fund, as long as UT-Austin can raise $35 million annually and continues to receive support from the Seton Healthcare Family, a Central Texas healthcare provider (Park, 5/3). 

Minnesota Public Radio: Investigation Finds Emotional Abuse, Neglect At Duluth Group Homes
State licensing officials are scrutinizing a Duluth company that runs four group homes for adults with mental illness, after a client turned over a 64-minute audio recording of an employee berating clients and a state investigation found the facility neglected two clients in the hours leading up to their deaths (Baran, 5/4). 

Boston Globe: Blue Cross Cuts Rate Request For Small Business, Individuals
Average base rate health insurance premium increases for small business and individual policies renewing in the third quarter have been revised to 0.7 percent -- even smaller than the 1.2 percent average reported earlier this week, Massachusetts regulators said Thursday. The downward revision came because Blue Cross Blue Shield of Massachusetts, the state's largest health insurance company, refiled its rate request in the so-called small-group market, which serves small companies along with self-employed and formerly uninsured individual policy holders (Weisman, 5/3).

Kansas Health Institute News: Money Will Help Counties Attack High Infant Mortality Rates
Two foundations will grant nearly $900,000 over five years to Kansas counties working to reduce infant mortality, members of the Blue Ribbon Panel on Infant Mortality were told today at their quarterly meeting. ... Kansas' death rate for all babies is 6.3 deaths per 1,000 live births. That's higher than the national average of 5.6. The state's death rate for black infants is the worst in the nation, at 19.6 per 1,000 live births (Cauthon, 5/3). 

KQED's State of Health blog: Rural California Hospitals Slow To Digitize
High in the Sierra in the town of Quincy, doctors at Plumas District Hospital are using iPads in the clinic. Technicians and nurses are also getting better acquainted with their new electronic health records (EHR) system. This 25-bed hospital has gone digital. ... but when it comes to the nitty-gritty of implementing an electronic system of medical records, change can be painful (Harris, 5/3). 

California Healthline: San Diego Barbershops Offer Shave, Haircut and Health Screening
In partnership with the San Diego Black Health Associates, the [Black Barbershop Health Outreach Program] will bring medical volunteers to African American-owned barbershops in Southeast San Diego, a community with the highest concentration of poverty and the largest percentage of ethnic minorities in the region. They will screen African American men for diabetes and high blood pressure, two diseases for which they are at higher risk than the general population (Zamosky, 5/3). 

Reuters/Fox News: Washington State On Track For Major Pertussis Epidemic
Public health officials in Washington state have confirmed more than 1,100 cases of whooping cough so far this year in what is on track to become the worst epidemic of the disease to hit the state in seven decades. … Governor Christine Gregoire made state emergency funds available on Thursday to help increase vaccinations against the disease and announced federal approval to redirect some funds to buy 27,000 more doses of vaccine for uninsured adults (5/4).

California Watch: Prime Hospital Cited For Violating Patient Confidentiality
The state Department of Public Health on Tuesday issued five "deficiencies" against Shasta Regional Medical Center for what were described as repeated breaches of patient confidentiality last year. At one point, the hospital CEO sent an e-mail to 785 people – virtually everyone who worked at the hospital – disclosing details from a 64-year-old diabetes patient’s confidential files, state investigators found (Williams, 5/4). 

The Associated Press/Kansas City Star: State Senator From St. Joe Blocks Prescription Drug Database
A Missouri senator who is a family physician succeeded Thursday in scuttling legislation that would have authorized a government database to track people's prescription drug purchases. Republican Sen. Rob Schaaf and his allies led an eight-hour filibuster against the legislation, soliciting supportive emails and faxes that they read aloud on the Senate floor. They outlasted other disinterested senators who went home and eventually triumphed over the bill's remaining backers. The result is that Missouri will remain one of just two states lacking the authorization for a prescription drug database (Lieb, 5/4).

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Health Policy Research

Research Roundup: Chronic Disease Interventions Could Save States Money

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

Urban Institute: Potential Savings Through Prevention Of Avoidable Chronic Illness Among CalPERS State Active Members -- California is one of many states in financial crisis, and according to this report, it could save millions of dollars on state employee health benefits by preventing chronic disease. Researchers write that of analyzed the cost burden of chronic diseases among active employees who are part of the California Public Employees' Retirement System (CalPERS) health program and found that of the "$1.6 billion spent
by CalPERS in 2008 on the health care services used by its State Active members, $362 million (22.4%)" was attributable to diabetes, hypertension, heart and kidney disease. They noted that with "well-designed and targeted interventions," the state could reduce disease prevalence by up to 15 percent and save as much as $54 million per year (Waidmann, Ormond and Spillman, 4/30).

Journal of Clinical Oncology: Treatment Outcomes In Black And White Children With Cancer: Results From the SEER Database and St Jude Children's Research Hospital, 1992 Through 2007 -- Cancer treatment outcomes are significantly worse for black children than white children. In this paper, national data were compared with outcomes at St. Jude Children’s Research Hospital - which, the authors write, "provides comprehensive treatment to all patients regardless of their ability to pay." Discrepancies persisted nationwide in the most recent time period, but there was no significant difference between black and white children at St. Jude, regardless of cancer type. “The most straightforward explanation is that both groups receive the same effective risk-directed therapy and supportive care” at the children’s hospital, researchers write (Pui et al., 4/30).

George Washington University: An Early Assessment Of The Potential Impact Of Texas' "Affiliation" Regulation On Access To Care For Low-income Women – Courts disputed this week whether Texas could exclude Planned Parenthood from the state Women’s Health Program. This analysis describes how Planned Parenthood centers "are the main source of family planning, cancer screening, and preventive health care for women in the WHP." An estimated 52,000 low-income women could lose access to services if the centers were excluded, and while community health centers could be an alternative source of care, they "will have to overcome significant provider shortages and funding gaps to substantially expand access" (Shin, Sharac and Rosenbaum, 5/2).

Circulation: Has the Time Come For A National Cardiovascular Emergency Care System? -- Organizing medical care into regional systems with centers of expertise -- for example, hospital trauma centers -- can help improve outcomes and better pool resources. The authors cite a model in Minnesota and propose regionalizing care for cardiovascular emergencies. Such a system "has the potential to improve clinical outcomes; to provide ongoing education for patients, providers, and the community; and to serve as a foundation for cost-effective care through cardiovascular accountable care organizations," they write (Graham et al., 4/24).

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

MedPage Today: More Proof CMS Infection Pay Policy Works
Hospitals have become more focused on preventing infections since the Centers for Medicare and Medicaid Services (CMS) has stopped paying for those it deems preventable, a survey found. Of 317 infection control specialists surveyed, 81% reported increased attention to hospital-acquired infections as a result of the CMS rule, according to Grace Lee, MD, MPH, of Harvard Medical School, and colleagues. Whether that increased attention has led to fewer infections is unclear, the researchers wrote in the American Journal of Infection Control, but, in April 2010, a CDC report documented a 32% decrease in the incidence of bloodstream infections related to central line insertion in hospital patients (Walker, 5/3). 

MedPage Today: Kids Overlooked For Inclusion In Drug Trials
Clinical drug trials have left pediatrics behind, with too few trials and too little industry funding given the disease burden, researchers found. For the 10 highest burden pediatric conditions, children accounted for 60% of patients but only 12% of the clinical trials, (P<0.001), Florence Bourgeois, MD, MPH, of Children's Hospital Boston, and colleagues reported at the Pediatric Academic Societies meeting in Boston. "This may be related in part to trial funding, with pediatric trials relying primarily on government and nonprofit organizations," the group noted (Phend, 4/28).

MedPage Today: Lower MI Death Risk Linked to Five Strategies
Mortality after myocardial infarction can vary considerably between hospitals. In a multivariate analysis, five strategies were significantly associated with lower mortality and, taken together, were associated with "clinically important" differences in the 30-day risk-standardized mortality rates. Specifically: Holding monthly meetings between hospital clinicians and staff who transported patients to the hospital ... Having cardiologists always on site ... Encouraging clinicians to solve problems creatively ... Avoiding cross-training nurses from intensive care units for the cardiac catheterization laboratory  ... Having physician and nurse champions rather than nurse champions alone (Smith, 4/30).

Medscape: Women, Minorities More Likely To Leave Surgery Career Path
Women and minority trainees in general surgery are more likely to fall short of board certification than their peers, according to a study published yesterday in the May issue of the Journal of the American College of Surgeons (JACS). In addition, female trainees who begin in general surgery are more prone than their male counterparts to end up board certified in another specialty, write lead author Dorothy Andriole, MD, and coauthor Donna Jeffe, PhD, both faculty members of the Washington University School of Medicine in St. Louis. ... These trends should worry a surgical specialty aiming for a larger, more diverse, and fully credentialed workforce, write Dr. Andriole and Dr. Jeffe (Lowes, 5/1). 

WBUR's CommonHealth blog: Study: Psych Patients' ER Waits In Boston Area Average 11 Hours
This just in from the American College of Emergency Physicians: a study led by Massachusetts General Hospital that offers some numbers to quantify the worsening problem of psychiatric patients waiting long hours in emergency rooms — significantly longer hours than other patients. The study included five hospitals in the greater Boston area, two academic medical centers and three community hospitals (Goldberg, 5/2).

Earlier, related KHN story: Emergency Rooms Provide Care Of Last Resort For Mentally Ill (Gold, 4/13/11).

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Editorials and Opinions

Viewpoints: Limited Choices For Prescriptions; Health Mandate Is About Liberty; VA Fails To Serve Vets' Mental Health Needs

Los Angeles Times: Insurers Limit Consumers' Choices For Getting Prescribed Drugs
Just a few years ago, so-called pharmacy benefit managers, or PBMs, like Medco would contract with most leading drugstore chains so people could fill their prescriptions almost anywhere they pleased. Then the PBMs realized they could operate more efficiently (and profitably) by limiting people's choices to a single drugstore — their own. So they laid down the law with consumers (David Lazarus, 5/4).

The Wall Street Journal: The Lonely Life Of Julia
Barack Obama has a new composite girlfriend, and her name is Julia. Her story is told in an interactive feature titled "The Life of Julia" on the Obama campaign website. Julia, who has no face, is depicted at various ages from 3 through 67, enjoying the benefits of various Obama-backed welfare-state programs. ... Obama is setting forward a vision contrary to the American tradition of self-sufficiency--a welfare state that runs from cradle to grave. And it's a dishonest vision, because it presents all of these benefits as "free," never acknowledging that they are paid for through coercive taxation (James Taranto, 5/3).

The Wall Street Journal: Wisconsin Recall Amnesia
Since last summer, unions have been throwing millions at defeating the man who reformed collective bargaining for government workers and required union members to pay 5.8% of their paychecks toward pensions and 12.6% of their health insurance premiums, modest contributions compared to the average in private business. As the May 8 Democratic recall primary nears to determine who will run against Mr. Walker on June 5, this should be their rhetorical moment ne plus ultra (5/3).

Bloomberg: Yes, The Health-Care Mandate Is About Liberty
As they await the Supreme Court ruling on the Affordable Care Act, legal critics of the law say their case is about liberty. If the government can instruct people to obtain health insurance, they keep asking, what’s to stop it from requiring them to buy broccoli? But the real threat to liberty in this case isn't a hypothetical broccoli law. It's the problem that the mandate remedies -- the failure of the health-insurance market -- and the long-standing national crisis of rising health-care costs that Congress finally found a way to address (Jonathan Cohn and David A. Strauss, 5/3).

Houston Chronicle: Texas Must Invest In Training More Primary Care Physicians
Our current medical education system is designed to underproduce the primary care physicians Texas desperately needs. Our system must change because if we always do what we've always done, then we'll always get what we've always gotten. In the case of Texas' physician work force, the viability of our health care delivery system and security of our economy, the status quo is simply not sustainable (Tom Banning, 5/3). 

The Seattle Times: VA Held Accountable For Limited Access To Mental-Health Care
A report released last week by the Department of Veterans Affairs' Office of Inspector General put a bright light on the bureaucratic games being played at the expense of those who need help. In 2011, the VA was claiming 95 percent of new patients received full evaluations for care within a 14-day period set by the department. Inspectors found only 49 percent met that standard, and the average wait was 50 days…. Failing to help those who step forward to serve their country is unconscionable. The nature of the wounds suffered has changed along with the nature of the battlefield (5/3).

San Jose Mercury News: Congress Must Keep Student Loan Rates Low -- And Address Problem Of College Affordability
If rates on subsidized Stafford loans are allowed to rise, as many as 7.4 million students will pay about $1,000 more this year; San Jose State estimates the rate hike will affect more than 8,000 of its students. This can't be allowed to happen. If the parties can't agree on how to pay the $6 billion cost of lower rates -- Republicans want to take it from preventive health care, while Democrats want to close a tax loophole benefiting the wealthy -- they should add it to the deficit (5/3).

JAMA: The Future Of Private Insurance
The overarching differences between the candidates on health reform and public programs like Medicare and Medicaid have received more attention, but they also envision divergent futures for private insurance. There's no one right way to create a fair insurance market, but different choices have consequences. How accessible will coverage be for people with preexisting health conditions? What benefits will insurance provide and at what cost to patients? (Larry Levitt, 5/4).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.