Daily Health Policy Report

Tuesday, May 8, 2012

Last updated: Tue, May 8

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Campaign 2012

Coverage & Access

Health Care Marketplace

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Health Care Increasingly Out Of Reach For Millions Of Americans

Kaiser Health News staff writer Phil Galewitz reports: "Having trouble finding a doctor? You're not alone. Tens of millions of adults under 65 — both those with insurance and those without — saw their access to health care dramatically worsen over the past decade, according to a study released Monday" (Galewitz, 5/7). Read the story.

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Insuring Your Health: Patients' Share Of Expensive Specialty Drugs Is Rising

In her latest Kaiser Health News consumer column, Michelle Andrews writes: "While most drugs are made from chemicals and can have generic as well as brand-name versions, a typical specialty drug is biologic -- that is, derived from living organisms -- and has no substitute. In addition to treating MS, these drugs are used for such complex, serious conditions as cancer, rheumatoid arthritis and Crohn's disease. Growth in spending on specialty drugs is far outpacing spending on traditional drugs, and many new ones are in the pipeline" (Andrews, 5/7). Read the column.

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Capsules: Grand-Aides Could Offer 'Family-Style' Health Care Help; Small Pharmacists Seek Big Clout In Negotiating With Benefit Managers; Even Small Reductions In Obesity Would Generate Major Savings

Now on Kaiser Health News' blog, Mary Agnes Carey reports a health care approach known as grand-aides: "Assuming the 2010 health law survives its Supreme Court challenge, about 32 million more people are expected to be eligible for coverage in 2014 through the law's Medicaid expansion or new health insurance exchanges. If the law is struck down, the number of uninsured will continue to increase. With experts warning of physician shortages and rising health expenditures, how can all those people get medical care without costs going through the roof? Dr. Arthur Garson Jr. has a plan" (Carey, 5/7).

Also on the blog, Carey reports on the latest push by small pharmacists to gain clout with benefit managers: "It's highly unlikely that during a heated election season House Republicans would want to wade into a debate over antitrust law. But that isn't stopping independent pharmacists from trying" (Carey, 5/7).

Judith Graham reports on a new study and its findings on obesity: "Cut the growth in rates of obesity by just 1 percent a year over the next two decades, and you’ll slice health care costs by $85 billion. Keep obesity rates at their current levels – which is well below a 33 percent increase being projected — and you'll save nearly $550 billion during the same time frame" (Graham, 5/7).

In addition, Phil Galewitz reports on findings from a new study measuring access to health services across the United States: "Adults in nearly every state saw their access to health services worsen during over the past decade, with Tennessee, Florida and Georgia having the greatest increase in people reporting having an unmet medical need, according to a study released Tuesday. The three states had at least a 9 percentage point jump in the proportion of adults under 65 who said they had unmet medical needs due to cost, according to the report released by the Robert Wood Johnson Foundation, which was conducted by researchers at the Urban Institute" (Galewitz, 5/8). Check out what else is on the blog.

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Political Cartoon: 'Bedside Manner?'

Kaiser Health News provides a fresh take on health policy developments with "Bedside Manner?" by Piero Tonin.

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

THE ACO OUTLOOK: CAUTIOUSLY OPTIMISTIC

Value, not volume.
Can ACOs deliver?
A cautious maybe.
- David Harlow

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

House GOP Bill Cuts Medicaid To Protect Military Spending

The budget plan, developed by House Budget Committee Chairman Paul Ryan, R- Wis., targets a number of Obama administration domestic initiatives. It trims an estimated $261 billion in domestic spending over the next decade and undoes elements of the health law.

The New York Times: House Bill Offers Aid Cuts To Save Military Spending
The Republican-led House this week will lay bare the choice between social programs and Pentagon spending in an age of austerity when it takes up legislation to slice $261 billion from food stamps, Medicaid, social services and other programs for struggling Americans over the next decade to stave off more than $50 billion in military spending cuts scheduled to take effect next year (Weisman, 5/7).

The Washington Post: Republicans Seek To Add More In Defense Spending
Another issue to watch is the Obama plan for increasing fees for military retirees, both for working retirees' health-care programs and for their drug purchases. The authorizers would bar any increases or new fees but propose a pilot program on pharmacy purchases. Some $1 billion is involved, and the GOP appropriators have yet to decide the issue (Pincus, 5/8).

The Wall Street Journal: House Bill Shields Defense From Cuts
House Republicans, seeking to prevent defense-spending cuts at the end of the year, advanced a plan that would instead reduce spending on health-care programs, food aid and other major domestic initiatives of the Obama administration. The bill developed by House Budget Committee Chairman Paul Ryan (R., Wis.) would cut about $261 billion in domestic spending over the next decade and roll back portions of the 2010 health-care law and the Dodd-Frank financial overhaul (Hook and Paletta, 5/7).

Politico: GOP: Shield Pentagon, Cut Poverty Programs
The bill reported by the House Budget Committee on Monday evening is the most serious Republican attempt yet to forestall those cuts for defense but only by substituting alternative domestic savings. … Lashing back at Obama, Republicans have targeted his health care and financial markets reforms as major targets in the new savings package, totaling over $310 billion over 10 years. But tens of billions would also come from food stamps, Medicaid and child tax credit refunds — a major shift of resources from the social safety net to the Pentagon (Rogers, 5/7).

Politico Pro: Lawmakers Debate Cuts To Kids' Health
Early debate over the House Budget Committee’s markup of its plan to replace the sequester was dominated by the way the package would affect children’s enrollment in health insurance. The debate suggested that Democrats may be eyeing the effect on kids’ coverage as another line of attack on the GOP budget as the election approaches. Democrats say the sequester replacement plan would lop 300,000 kids off the Medicaid and CHIP rolls within three years, while the sequester protects children’s enrollment…Last month, the Congressional Budget Office estimated that repeal of health reform's maintenance of effort requirements — included in the GOP reconciliation plan — would reduce Medicaid and CHIP enrollment by about 300,000 people in 2015 (Cheney and Millman, 4/7).

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Senate's Student Loan Skirmish Will Include Health Law Funding Fight

Although both Democrats and Republicans agree on the idea of extending the current interest rate for student loans, they want to pay for it differently. Democrats would raise Medicare payroll taxes for some high-earning stock holders. Republicans would use health law funds. Pundits predict a showdown.

Los Angeles Times: Congress Returns To Fight For The Presidency
Democrats will seek to portray Republicans as protecting the wealthy at the expense of the middle class. Republicans will use the sluggish economy and Obama's healthcare law as prime examples of big government failures. … The fight over student loan interest rates, which will resume Tuesday with a vote in the Senate, is the first skirmish: Senate Democrats will highlight Obama's plan to extend the lower rate by paying for it with a new tax on wealthier Americans. Republicans will counter with a proposal to divert money from a fund that is part of the president's healthcare law (Hennessey and Mascaro, 5/7).

The Associated Press: Senate Heads Toward Showdown Vote On Student Loans
The Senate is steaming toward a showdown on a Democratic proposal to keep student loan interest rates from doubling for 7.4 million students. In a measure of how the upcoming election is driving work in Congress these days, it's a vote Democrats won't terribly mind losing — which is probably what will happen... Republicans say they favor freezing student loan interest rates but oppose how Democrats would finance the $6 billion bill: by raising Social Security and Medicare payroll taxes on high-earning stock holders of some privately owned corporations (Fram, 5/8).

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Campaign 2012

Polls: Though Numbers Are Tight, Voters Give Obama Edge Over Romney On Medicare, Health Care Policies

Voters had more confidence in how GOP challenger Mitt Romney would handle the economy. Meanwhile, Rick Santorum, who previously had been a candidate in the Republican presidential primary, offered a late-night e-mail endorsement to Romney.  

Los Angeles Times: Polls: Obama, Romney Neck And Neck Six Months Ahead Of Election
Still, at this early point in the campaign, voters appeared to prefer Obama over Romney on a host of other issues aside from the economy. Obama holds a 23-percentage-point lead over Romney (58% to 35%) on the question of who would better stand up for the middle class. He also leads Romney on "sharing your values" and on who would better handle foreign policy, taxes, healthcare, jobs, and Social Security and Medicare. The only category in which Romney performed better than Obama was when voters were asked who would better handle the economy. Romney won 48% to Obama's 45% (Geiger, 5/7).

The Associated Press: Santorum Endorses One-Time Rival Romney
Romney visited Santorum for more than an hour on Friday at the Pittsburgh office of Santorum's longtime strategist. The session covered many of Santorum's concerns about Romney's campaign, especially the sincerity of his vow to repeal Democrats' national health care law that was modeled on one Romney signed into law as Massachusetts governor. Those worries, it seems, were assuaged during their private session that ended without Santorum's public backing (Elliott, 5/8).

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Coverage & Access

Federal Appeals Court Reverses Ruling On VA Mental Health Care

The court dismissed a lawsuit brought by veterans' groups on the basis that courts do not have authority to order such changes in how the Department of Veterans Affairs system delivers care.

Reuters: US Court Reverses Itself On Veterans Healthcare Overhaul
A federal appeals court has reversed a ruling that the U.S. Department of Veterans Affairs must overhaul how it cares for veterans with combat-related mental health care illnesses. By a 10-1 decision, a panel of the 9th U.S. Circuit Court of Appeals in San Francisco said it could not conclude that the VA's treatment of veterans, which sometimes causes health care claims to remain unaddressed for several years, was unconstitutional (Stempel, 5/7).

San Francisco Chronicle: Court Dismisses Vets' Suit On Mental Health
Claims of systematic delays and neglect in mental health care for the nation's military veterans are beyond the power of courts to address, a federal appeals court in San Francisco ruled Monday in ordering dismissal of a 5-year-old suit by veterans groups…. Declaring that "the VA's unchecked incompetence has gone on long enough," a panel of the Ninth U.S. Circuit Court of Appeals ruled 2-1 a year ago that vets groups could ask a federal judge to order changes in the system.  But at the Obama administration's request, the full appeals court granted a new hearing before a larger panel, which ruled Monday that courts lack authority to order system-wide changes in veterans' health care (Egelko, 5/8).

San Jose Mercury News: 9th Circuit Tosses Lawsuit Over VA Mental Health Care
In a major setback for suffering combat veterans, a federal appeals court Monday found that Congress, not the courts, is responsible for fixing the VA's troubled mental health care system, overturning a previous court that found the program riddled with "unchecked incompetence." In a 10-1 decision, the 9th U.S. Circuit Court of Appeals rejected a lawsuit that sought to force the Veterans Affairs Department to overhaul the treatment program and reversed an earlier ruling that would have forced the government to speed up treatment requests and benefit claims (Mintz, 5/7).

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Health Affairs: Access To Care Declining, Study Says

The May issue of Health Affairs examines access to care issues, high-deductible health plans, the relationship between hospitals' size and costs, among other important topics.  

Kaiser Health News: Health Care Increasingly Out Of Reach For Millions Of Americans
Having trouble finding a doctor? You're not alone. Tens of millions of adults under 65 — both those with insurance and those without — saw their access to health care dramatically worsen over the past decade, according to a study released Monday (Galewitz, 5/7).

Reuters: Healthcare Access To Erode If Law Struck Down: Study
Most Americans have seen a decade-long erosion in access to medical services that is likely to continue if President Barack Obama's healthcare law is struck down by the Supreme Court or repealed in Congress, a study released on Monday shows. The study ... says access to health care deteriorated for U.S. adults aged 19 to 64 between 2000 and 2010, even among those with private health insurance (Morgan, 5/7).

Politico Pro: Report: Access To Care 'Deteriorating'
[T]he gap in care is worst in states where the political leaders oppose implementation of the Affordable Care Act. Researchers from the Urban Institute looked at three key questions asked in surveys of American adults in each state: Did they get a routine check-up over the past year? Did they go to the dentist during that time? Were they not dealing with certain medical needs because of cost? They found that between 2000 and 2010, almost every single state population experienced a decrease in health care access in one of those three key areas (Smith, 5/8).

Milwaukee Journal Sentinel: Access To Health Care Declines In Wisconsin, Nationwide 
An estimated 13% of the adults under 65 in Wisconsin reported not seeking health care because of the cost in 2010, according to the study. That was up from 8.5% in 2000 (Boulton, 5/7).

Baltimore Sun: Harder For Americans To Get Health Insurance, Report Says
In Maryland, the number of people who found it too expensive to get care increased 5.1 percentage in the decade to 15.4 percent. About 530,000 adults in the state could not meet their medical needs (Walker, 5/8).

Another study focused on consumer-directed health plans -

Reuters: Consumer-Directed Health Plans Show Mixed Results
Employer-sponsored health insurance plans with low premiums and high deductibles could cut healthcare costs significantly but not without potential risks for workers, according to a study published on Monday. A Rand Corporation study, published in the May issue of the journal Health Affairs, said so-called "consumer-directed" health plans would cut healthcare costs for the nonelderly by 4 percent, or $57 billion a year, if they accounted for half of all employer-sponsored health insurance (5/7).

MarketWatch: Higher Health Deductibles May Save Billions: Study
[B]y giving consumers more “skin in the game,” according to Rand Corp., higher deductibles could help push for greater transparency in medical costs, as well as force caregivers to keep charges more in line with normal inflation (Britt, 5/7).

The Associated Press: Study: Savings And Risks In Health Insurance Trend
It's the hottest trend in job-based health insurance: plans that give you a personal savings account for medical bills but also require you to pay a hefty share of costs before coverage kicks in. ... But there's a warning flag, a risk that workers will forgo needed care, even preventive services covered at no extra cost to them. Some consumers were apparently unsure that prevention was covered (Alonso-Zaldivar, 5/7).

National Journal: Consumer-Directed Plans Save Money, But At What Cost?
 About a third of the time, the savings came from reduced spending at each encounter with a health care provider. Families in consumer-directed plans used fewer brand-name drugs, used specialists less often, and had fewer elective hospital procedures than those in different plans. But people did skip screenings, such as blood tests for diabetes and Pap smears to check for cervical cancer (Fox, 5/7).

The Hill: Study: Market-Driven Plans Could Lower Healthcare Costs
The question remains whether the plans' cutbacks in care would lead to poorer health and higher costs later, study authors said. The RAND study was the most comprehensive to date looking at consumer-directed health plans, which account for about 13 percent of all healthcare coverage provided by employers (Viebeck, 5/7).

Related, earlier KHN story: Quick Facts About High-Deductible Health Plans (Kulkarni, 4/27)

Another study examined hospital mergers -

Politico: Study: Bigger Hospitals Drive Cost Increases
For everyone out there worried that President Barack Obama's health reform law will spur monopolies and make it easier for hospitals to raise their prices, a new study says it's already happening, and it's not because of the health law. ... “What we found is that the leverage of some hospitals is growing,” said Paul Ginsburg, president of the Center for Studying Health System Change and a co-author of the report. “That’s a contributor to rising health care spending" (DoBias, 5/7).

And, a look at "difficult" patients and a new model for delivering care -

Modern Healthcare: Patients Fear Being Seen As 'Difficult': Study
Patients have a strong desire to engage in shared decisionmaking with their physicians but this wish is often stymied by "authoritarian" doctors or patients' fears of being perceived as "difficult," according to a study by the Palo Alto (Calif.) Medical Foundation Research Institute published by Health Affairs... The researchers wrote that they uncovered four main themes from the participants' responses: Patients feel compelled to conform to "socially sanctioned roles" when speaking with their doctor; physicians can be authoritarian; patients work to fill information gaps; and patients feel the need to bring social support to consultations with their physician (Robeznieks, 5/7).

San Francisco Chronicle: Patient's Fear Of Being 'Difficult' May Hurt Care
Hugo Campos doesn't view himself as a difficult patient. But he senses his doctors' exasperation with him because of his insistence he be given all the medical information they have about him. ... In the study, 48 Bay Area patients recruited from Palo Alto medical practices said they feared that challenging their physicians or asking too many questions might result in lower-quality care or strain their relationship (Colliver, 5/7).

Finally --

Kaiser Health News: Capsules: Grand-Aides Could Offer 'Family-Style' Health Care Help
Assuming the 2010 health law survives its Supreme Court challenge, about 32 million more people are expected to be eligible for coverage in 2014 through the law's Medicaid expansion or new health insurance exchanges. If the law is struck down, the number of uninsured will continue to increase. With experts warning of physician shortages and rising health expenditures, how can all those people get medical care without costs going through the roof? Dr. Arthur Garson Jr. has a plan (Carey, 5/7).

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Health Care Marketplace

Abbott Agrees To $1.6B Settlement With States, Feds

Abbott Laboratories will pay the federal government and 45 states a total of $1.6 billion after admitting to marketing its anti-seizure drug Depakote for off-label uses over 10 years.

The Washington Post: Abbot Laboratories Agrees To $1.6 Billion Settlement Over Marketing Of Depakote
Global pharmaceutical giant Abbott Laboratories has agreed to pay federal and state governments $1.6 billion in criminal and civil fines for illegally promoting unapproved uses of its drug Depakote, including to sedate elderly patients in nursing homes, officials announced Monday (Aizenman, 5/7).

The New York Times: Abbott Settles Marketing Lawsuit
The pharmaceutical company Abbott Laboratories said on Monday that it had reached an agreement with the federal and nearly all state governments to pay $1.6 billion in connection with its illegal marketing of the anti-seizure drug Depakote (Schmidt and Thomas, 5/7).

Los Angeles Times: Abbot Labs Agrees To Pay $1.6 Billion To Settle Depakote Cases
Abbott will pay $800 million to resolve civil allegations split among federal and state governments, $700 million in criminal penalties and $100 million to states to resolve consumer protection matters, the Abbott Park, Ill., company said Monday (Frost, 5/7).

The Associated Press: Abbott Labs Agrees To Pay $1.5B Over Depakote
Abbott Laboratories has pleaded guilty and agreed to pay $1.5 billion over allegations that it promoted the anti-seizure drug Depakote for uses that were not approved by the Food and Drug Administration. The case includes a criminal fine and forfeiture of $700 million and civil settlements with the federal government and states totaling $800 million. Deputy Attorney General James Cole said Monday the settlement reflects the determination by government "to hold accountable those who commit fraud” (Yost, 5/7).

Chicago Sun-Times: Abbott Labs Pleads Guilty, Will Pay $1.6B Over Drug Claims
North Chicago-based pharmaceutical company Abbott Laboratories has pleaded guilty and agreed to pay $1.6 billion over allegations that it promoted the anti-seizure drug Depakote for uses that were not approved by the Food and Drug Administration. ... Depakote is an anti-seizure and mood-stabilizing drug prescribed for bipolar disorder. The company admitted that it marketed the drug for unapproved uses, including treatment of schizophrenia, agitated dementia and autism (5/7).

CNN: Abbott Laboratories To Pay $1.6 Billion Over Misbranding Drug
Abbott Laboratories has pleaded guilty and agreed to pay $1.6 billion to resolve its criminal and civil liability arising from the company's unlawful promotion of the prescription drug Depakote, the U.S. Justice Department said Monday. Acting Associate Attorney General Tony West said it was case of Abbott putting "profits ahead of patients." ... Abbott pleaded guilty to a criminal misdemeanor for misbranding Depakote. Separate from the DOJ settlement, Abbott agreed to pay 45 states a total of $100 million to resolve liability under the state consumer-protection laws (Frieden and Watkins, 5/7).

Massachusetts and Connecticut news organizations detail the part of the settlement their states will receive from the settlement -

Boston Globe: Mass. To Get $19.8m In Abbott Deal
Massachusetts will get $19.8 million as part of a pair of multistate settlements with Illinois drug company Abbott Laboratories, which agreed to pay a total of $900 million and plead guilty to violating a federal drug law to resolve charges of illegal off-label marketing. The accords revolve around Abbott's promotion of the antiseizure medication Depakote for off-label uses over 10 years. In one, Abbott will pay the states and US government $800 million in civil damages and penalties to compensate Medicaid, Medicare, and other federal health care plans to settle a suit filed under the False Claims Act (5/7).

The Connecticut Mirror: Prescription Monitoring Program Gets Funding Reprieve 
The state program that allows doctors and pharmacists to track controlled substance prescriptions has gotten something of a reprieve, at least for now. Money for the Prescription Monitoring Program had been slated to run out later this year, but a settlement between states and the drug maker Abbott Laboratories will provide Connecticut with $150,000 to bolster the program (Levin Becker, 5/7). 

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Home Health And Long-Term Care Issues And Trends

USA Today reports on the profitability of home health care businesses while NPR examines long-term care insurance.

USA Today: Home Health Care Is One Of The Most Profitable Franchises
A new report lists home health care as one of the top five most profitable franchises in the U.S., even as the industry fights new Department of Labor rules calling for mandatory overtime and minimum wage requirements for home health employees (Kennedy, 5/7).

NPR: Long-Term-Care Insurance: Who Needs It?
Americans routinely buy all sorts of insurance — for cars, homes, health and even pets and boats. But when it comes to long-term-care insurance, relatively few sign up. Out of more than 313 million Americans, only about 8 million have any such protection, according to the American Association for Long-Term Care Insurance. The low participation rate largely reflects the high cost of long-term-care insurance (Geewax, 5/8).

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Public Health & Education

Report Notes Rise In Obesity Slowing, But Still Huge Health, Cost Problem

Bloomberg: More Than 40% Of U.S. May Be Obese By 2030, Study Says
The obesity rate may rise to 42 percent from about a third of the U.S. population by 2030 if nothing changes, according to a report. Preventing that increase may save about $550 billion in medical costs over the next 20 years, Eric Finkelstein, the study author and an associate research professor at Duke University, said during a press briefing (Lopatto, 5/7).

The Fiscal Times: The Obesity Epidemic: Another $550B in Costs by 2030
Let's start with the good news, because, frankly, there isn't all that much of it: The rate of increasing obesity in America has apparently flattened out some in recent years. After more than doubling from the late 1970s to 2008, the rate of expansion in America's waistlines has been shrinking, at least among some groups (Rosenberg, 5/7). 

Kaiser Health News: Capsules: Even Small Reductions In Obesity Would Generate Major Savings, Report Finds 
Proven interventions are now available. “We know more than ever about the most successful strategies that will help Americans live healthier, more active lives and reduce obesity rates and medical costs,” said Dr. William H. Dietz, director of the CDC’s division of nutrition, physical activity and obesity, in a prepared statement (Graham, 5/7). 

National Journal: Could America's Fat Curve Be Flattening Out?
People who are obese – more than 20 percent above their ideal weight – have higher rates of heart disease, cancer, diabetes, stroke, arthritis, back pain, and other chronic, expensive conditions. “The cost of obesity is $150 billion a year or almost 10 percent of the annual health care budget,” Dietz said. Besides the 34 percent of Americans who are obese, an additional one-third are overweight (Fox, 5/7).

CQ HealthBeat: Sebelius: Obesity Threat Warrants Sustained Prevention Efforts
Health and Human Services Secretary Kathleen Sebelius on Monday called for maintaining momentum on multiple fronts to address the problem. "We've seen over and over again — whether it's TB or HIV/AIDS or tobacco — there's no such thing as inevitable progress," Sebelius said at the Centers for Disease Control and Prevention's Weight of the Nation conference in Washington. "The second that our focus shifts or our resources move elsewhere, the threat can return and our health will suffer once again" (Bristol, 5/7).

McClatchy: Study: Soaring Obesity Rate Will Slow Over Next Two Decades But Remain High
Previous projections based on historical trends in obesity had suggested that more than half the nation - perhaps even 70 percent - could be obese by 2030, said Eric Finkelstein. ... He and his fellow researchers, though, tried to sharpen the picture by considering an array of variables that have shown correlation with obesity, such as trends in unemployment, the price of fast food and even access to the Internet (Price, 5/7).

MedPage Today: New Model Sees Smaller Uptick in Obesity Rates
The uptick in severe obesity, defined as a BMI of ≥40, would be even greater, rising to 11% by 2030, an increase of about 130%, they reported. Their figure is actually higher than the 9% predicted for 2030 by earlier estimates, they noted (Fiore, 5/7).

CBS: Obesity To Affect 42% Of Americans By 2030 With $550 Billion In Costs, Say Researchers
The "Weight of the Nation" meeting is part of a nationwide awareness campaign that involves experts from numerous organizations discussing strategies for the prevention and control of obesity. Partners in the campaign include the CDC, National Institutes of Health, and Institute of Medicine, and HBO - which will air a four-part documentary series by the same title starting May 14 (Jaslow, 5/7).

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State Watch

Legislatures Twist And Turn On Health Budgets, Autism Coverage And Abortion

States confront a bevy of health issues including finding funds for health services, taking control of Medicare and Medicaid programs, mandating coverage for autism and limiting abortions.

Des Moines Register: Iowa Legislative Stalemate Broken; Key Budget Agreements In The Works
Iowa lawmakers are today on track to approve compromise agreements on most of the key budget bills, a major step in wrapping up this year’s legislative session. ... The remaining areas include the state's health and human services budget, which is a $1.6 billion piece that includes controversial measures such as further abortion restrictions (Clayworth, 5/7).

Arizona Republic: Brewer Signs Budget Approved By Legislature
Gov. Jan Brewer has signed into law an $8.6 billion budget for next fiscal year that includes increases for certain education, public-safety and health programs but also puts $450 million into a "rainy-day fund" … There is an additional $39 million for the seriously mentally ill (Rau, 5/7).

The Kansas City Star: Missouri Budget Debate Puts Health Care For The Blind In Jeopardy
If the Senate fails to approve a plan to fund Missouri's veterans' nursing homes, it could mean the end of a health care program for the blind, Republicans negotiating the state budget said Monday. But as of late Monday night, a group of senators was blocking a vote on the bill. … First on the chopping block could be a $28 million program that provides health care to roughly 2,800 blind Missourians who earn more than $9,495 a year -- too much to qualify for Medicaid -- but have less than $20,000 in assets besides their homes (Hancock, 5/8).

The Associated Press/Houston Chronicle: NH Senate Voting On Health Compact Bill 
The Senate is considering whether New Hampshire should form an interstate compact to assume control for health care within state boundaries. The House passed the bill in March that proposes that New Hampshire join with other states in delivering health care to its residents. Under the bill, the states would receive block grants from the federal government and would take over Medicare and Medicaid. Congress would have to approve the compact for it to take effect (5/7). 

The Lund Report (an Oregon news service): Legislators Begin Working On Insurance Coverage For Autism 
Although Oregon's next legislative session is 10 months away, work is already beginning on legislation to establish requirements for health insurance coverage of autism spectrum disorders and streamline the process of obtaining care (Joregensen, 5/7). 

The Kansas City Star: Bill Passed By Kansas House Makes Abortion A Tax Issue
The tax code is becoming the new weapon in the war against abortion with Kansas pioneering the way. The Kansas House passed a bill Monday that would further restrict abortion by rewriting state tax law. … The measure is patterned after a similar bill pending in Congress. The Kansas bill, approved on an 88-31 vote, would prohibit taxpayers from deducting money spent on an abortion or for supplemental health insurance to cover the procedure (Cooper, 5/7).  

Des Moines Register: Iowa Campaign Targets Synthetic Drugs
Iowa officials are hoping a pairing of legislation and education will produce progress in dealing with the growing issue of synthetic drugs. As legislators at the state Capitol discussed a bill expanding the list of banned substances, officials representing law enforcement, public health and drug control policy presented a new public education campaign designed to warn both teenagers and parents of the products' dangers (Zilbermints, 5/7).

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States Push Feds To Include 3 Million 'Dual Eligibles' In Pilot Program

Though only designed for 2 million beneficiaries, states want the federal government to open a pilot program on dual eligibles -- those who qualify for both Medicare and Medicaid -- to 3 million. In the meantime, California is shifting its dual eligibles to managed care.

Modern Healthcare: Dual-Eligibles Pilot Program Faces Rush From States
States want to include more than 3 million dual-eligible beneficiaries in a CMS pilot program to overhaul their care and payments.  The number is 1 million more than the program was designed for and represents about a third of all that category's beneficiaries, whose care is one of the biggest drivers of the growth in Medicaid costs (Daly, 5/7).

California Healthline: Risks, Rewards Higher for Managing Dual Eligibles 
The state is working to shift older, low-income Californians eligible to receive Medi-Cal and Medicare -- known as dual eligibles -- into managed care plans, hoping to coordinate and improve care, as well as save money. The state also is shifting Medi-Cal beneficiaries participating in the Multi-Purpose Senior Services Program into managed care. ... About 60 percent of the 7.6 million people covered by Medi-Cal are in managed care plans. ... The most-expensive Medi-Cal beneficiaries, many of them older with multiple chronic conditions, are still in fee-for-service plans (Lauer, 5/7).

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State Roundup: Calif. Prison Health Care Reverts To State; Fla. To Redo IT System

Media outlets report on a variety of health policy issues in Arizona, California, Colorado, Connecticut, D.C., Florida, Georgia, Louisiana, Massachusetts, Missouri and Texas.

New Orleans Times-Picayune: Health And Hospitals, Higher Education Face More Budget Cuts
The cuts were announced Monday afternoon. ... Overall the [Louisiana] health agency is looking at $57 million in reductions in state revenue, which will require the state to forgo about three times that much in federal revenue. ... Department of Health and Hospitals Sec. Bruce Greenstein said in addition to those reductions, the budget for hospitals run by LSU will face $21.5 million in cuts. ... Among the changes proposed by the department are further cuts to the rates for Medicaid providers (Adelson, 5/7).

Health News Florida: FL Hates Law, But Plans For It
The Agency for Health Care Administration today will answer questions from companies that have shown an interest in competing for a $700,000 study on creating a modern Medicaid information system. The IT system needs to be able to handle not just the current job, but the health insurance exchange called for under the federal health law. Answers to the questions will help guide whether the companies will respond to the bid by the May 22 deadline (Sexton, 5/7).

Arizona Republic: OB/GYN, Aetna Cost Dispute May Affect 5,000 Patients
About 5,000 metro Phoenix women covered by Aetna could be forced to switch doctors or medical practitioners next week because of a dispute between the insurance company and a large East Valley obstetrics and gynecology practice. Drs. Goodman and Partridge OB/GYN said Monday that it will no longer contract with Aetna effective May 15 over disagreements about the health insurer's administrative practices and reimbursement rates (Alltucker, 5/7).

Sacramento Bee: Sacramento's Threadbare Medical Network For Poor Getting Thinner
Getting primary medical care when you're poor or uninsured is challenging everywhere. In some places in California, people can at least tap into extensive county services and flourishing networks of federally financed community clinics. But not in Sacramento County. Health care leaders here describe the county's network of primary care for the poor and uninsured – including people who don't get health insurance through their employers or can't afford it on their own – as "fragmented," "frayed" and two to three decades behind the times (Rubenstein, 5/8).

The Washington Post: Sale Of D.C. Health-Care Firm In Works
D.C. Chartered Health Plan is weighing offers from buyers in an effort to keep $350 million in District government business that officials have said it could lose if the company remains in the hands of owner Jeffrey E. Thompson (Stewart and DeBonis, 5/7).

The Associated Press/Washington Post: Court Hearing Scheduled In Lawsuit Against Conn. Governor Over Unionization Of Care
Opponents to unionization of certain daycare and personal care workers are going to court after Connecticut lawmakers sent legislation to Gov. Dannel P. Malloy allowing the employees to collectively bargain over wages and benefits. Fergus Cullen, executive director of the Yankee Institute conservative think tank, said the legislation does not affect the institute's lawsuit challenging the legality of an executive order signed by Malloy last year. It created a process for the workers who are paid through the state's Medicaid program, to select a union to represent them in non-binding talks with the Department of Social Services (5/7).

Boston Globe: As Legislative Debate Begins, Partners HealthCare Ad Campaign Touts Its Cost-Cutting
The debate over the next stage of the state’s health care overhaul is in full swing now, reflected on the pages of the Boston Globe in more ways than one. ... Today, in the Globe’s Metro section, Partners HealthCare ran a full-page advertisement touting its efforts to control costs. Partners, which owns Massachusetts General Hospital and Brigham and Women's Hospital, is often pointed to as a high-cost system with tremendous power to negotiate with health insurers (Conaboy, 5/7).

NPR: As Texas Cuts Funds, Planned Parenthood Fights Back
Planned Parenthood has filed a lawsuit in federal court, claiming these new Texas rules violate the organization's constitutional rights to free association and free speech. ... Texas already cut its support statewide for women's health clinics by two-thirds in 2011, eliminating access to family planning services for nearly 300,000 poor and working-class women. ... The Texas Legislative Budget Board estimates those cuts will result in roughly 20,000 additional unplanned births. ... But for abortion opponents, the issue is not about money but about keeping Planned Parenthood out of the Texas Women's Health Program (Goodwyn, 5/7). 

Georgia Health News: Two Shots In The Arm For Georgia Medicaid
First, technology giant HP said in a news release that federal officials have recently certified Georgia's Medicaid information system. The accreditation by [CMS] ensures that Georgia will receive maximum federal funding for the system's implementation and operations. ... Also Monday, state Attorney General Sam Olens announced that Georgia has joined with other states and the federal government to reach an agreement with Abbott Laboratories to settle civil and criminal allegations that the company illegally marketed the anti-seizure drug Depakote (Miller, 5/8). 

California Healthline: Will FQHCs Get Lower Adult Health Rate?
A federal judge last week heard arguments for and against issuing a temporary restraining order against the state's plan to reduce payments for adult day health services. The California Primary Care Association filed suit on behalf of federally qualified health centers. U.S. District Court judge James Ware heard the case last week. He has 30 days to issue a ruling. In a similar case last month filed by the Adult Day Health Care Association, a federal judge declined to issue a preliminary injunction against the state (Gorn, 5/8). 

KQED/The California Report: Prisoner Health Care To Revert To State Control
Seven years ago, one state prison inmate a week died from inadequate health care. Now the federal judge who put the system under receivership says the care has improved enough to transition control back to the state (Small, 5/7). 

Colorado Public Radio: Health Care Law Means Uncertainty For Doctors
The president of the Colorado Medical Society, Dr. Brent Keeler says nobody knows what will happen if the Supreme Court strikes the [health] law down. But if it upholds it, the future isn't exactly clear, either. "A lot of the Affordable Care Act has not actually started to happen, and so we don't know for sure how it's going to affect physicians, patients, the public, government. We don't know how it's going to have an effect in all those areas, because not all of it has unfolded yet" (Whitney, 5/7).

KCUR in Kansas City: Patients, Providers, Companies Await Medicaid Ruling
A main part of Missouri's Medicaid program is at the center of a lawsuit right now. A company that's long contracted with the state to manage Medicaid services for several thousand enrollees alleges the state inappropriately chose new contracts. A Cole county circuit court could rule on the case any day now, with one potential outcome creating problems for the Medicaid program and its enrollment (Gordon, 5/8).

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Editorials and Opinions

Viewpoints: Taking Aim At 'Superbugs'; Friending Organ Donations; Ariz. And Kansas Abortion Efforts Hurt Women

Bloomberg: Squash 'Superbugs' With Fast-Track Antibiotics Approval
In the battle between humans and infectious bacteria, humans have had the advantage, at least since antibiotics were introduced into our arsenal 70 or so years ago. Now, however, our weapons appear to be turning against us as germs have found ways to outfox antibiotics…. A second challenge is to keep a steady stream of new antibiotics in the pipeline, and this is where the big pharmaceutical companies based in Europe and the U.S. come in…. The FDA is considering a high-speed pathway for some new antibiotics, which would allow for limited approval based on only a small clinical trial, rather than the two large ones usually require (5/7).

Bloomberg: Facebook's Organ Donation Success Needs Follow-Up
Facebook Inc. took a momentous action last week [with] ... the company's invitation to users to register to become organ donors…. As a result, online state donor registries experienced a remarkable 23-fold surge, according to Donate Life America, a nonprofit alliance of national donor advocate organizations…. What's needed to complement Facebook's breakthrough are rewards for living donors. These could take many forms -- perhaps a contribution to a retirement fund, an offer of lifetime health insurance, a tuition voucher or a large charitable contribution in the donor's name (Sally Satel, 5/7).

Politico: Obama Plays Politics With College Grads
To cover the cost of a temporary rate freeze [on student loans] both parties want, Democrats propose to divert $6 billion from Medicare and raise taxes on small business — damaging the very companies we’re counting on to hire young workers. Republicans have been crystal clear that this fix is no fix at all if it weakens entitlements or harms small business in the process. ... For our part, Republicans propose to cover the cost of the interest rate freeze by ending an "Obamacare" slush fund that Democrats and the president himself have already drawn from to cover expenses unrelated to health care (Sen. Mitch McConnell, 5/7).

Roll Call: Model Programs After VA’s Home-Based System
The VA's home-based primary care program — developed in 1972 as a way to serve chronically ill veterans with comprehensive, interdisciplinary care in patients' homes — has enabled the delivery of skilled, coordinated and cost-effective services in a challenging fiscal environment. This focus on providing clinically advanced care in the home setting has yielded unprecedented outcomes that should serve as a model for America's health care system. In addition to providing veterans with high-quality care in the setting most patients prefer, this system of encouraging home care for long-term chronic disease management saves money (John Rowan and Tom Berger, 5/8).

Arizona Republic: Lawmakers' Shot Misses Planned Parenthood, Hits Poor Women
Gov. Jan Brewer, along with the Tea Party contingent of the legislature and the anti-abortion Center for Arizona Policy want to put Planned Parenthood out of business. Their reasoning is simple: Planned Parenthood provides abortion services. Those services aren't close to everything that Planned Parenthood does, but it's enough for Brewer and the others to want to shut them down (E. J. Montini, 5/7).

The Kansas City Star: A Lack Of Concern
In the process of passing bills to make abortion less accessible, Kansas lawmakers have potentially restricted women's ability to access other services and undermined the University of Kansas Medical Center…. This bill is disrespectful and dangerous. The Senate must stop it from getting to Gov. Sam Brownback, who never lets offensive and even unethical provisions deter him from signing a bill limiting abortions (5/7).

The New York Times: Monitoring Care For The Disabled
Gov. Andrew Cuomo has finally come up with a comprehensive plan to monitor thousands of New York's private and public facilities. The legislative package he released this week would create a new agency to oversee homes for about a million people who are disabled or mentally ill. It is a sensible, straightforward proposal that legislators and unions should support (5/7).

The New York Times: Room For Debate: Women, Weight And Wellness
A New York Times Op-Ed by Alice Randall calls for black women to "commit to getting under 200 pounds." But in February, a Washington Post/Kaiser Family Foundation survey revealed that heavier black women have much higher self-esteem than average-sized white women. What's more important, a positive body image, whatever your size, or a fit physique that proportionately puts you at less risk for diabetes and other ailments? (5/7).

WBUR’s CommonHealth blog: Blue Cross Painkiller Policy Risks Hurting Patients
It is wonderful that Blue Cross Blue Shield of Massachusetts is concerned about pain reliever abuse and that the company has consulted with some physicians about ways to curb it. But it is extremely likely that the policy the company is set to put in place July 1, which allows patients to fill a 15-day prescription and one additional 15-day supply, will end up doing more harm than good, becoming yet another barrier for legitimate pain patients who need opioid medications  (Judy Foreman, 5/7).

Medscape: Our Challenge In Healing Health Care
[Atul] Gwande traces the evolution of the 'good doctor' from the autonomous craftsman of the late 1930's - somebody who could set a bone, identify the cause of a lobar pneumonia and treat congestive heart failure by bleeding, providing digitalis and oxygen- to the contemporary specialized physician with 6,000 drugs and 4,000 operations to choose from. The cowboy who valued autonomy has morphed into a good leader who recognizes the need for pit crews. ... The challenge for our generation is to identify systems that work and the first step is to understand where we fail (Dr. Lidia Schapira, 5/6).

Archives of Pediatrics & Adolescent Medicine: Why Feed Breast Milk From A Bottle?
One hypothesized mechanism by which breastfeeding might protect against obesity is that feeding from the breast prevents overfeeding (feeding the infant beyond satiety), suggesting that breastfeeding, rather than breast milk, protects against later obesity. ... Pediatricians should be wary of how well-intentioned encouragement of breastfeeding may be placing added pressure on mothers living in a culture that does not support paid parental leave. ... Pediatricians should deliver their expert advice with empathy, being mindful of the gap that always exists for parents between doing what is ideal for their children and doing what is possible (Drs. Robert C. Whitaker and Jeffrey A. Wright, 5/8).

Archives of Pediatrics & Adolescent Medicine: Public Policy To Improve Child Nutrition And Health: Challenges and Opportunities
With passage of the federal Healthy, Hunger-Free Kids Act of 2010, schools are required to adhere to new standards to improve the quality of school meals. ... Beginning with the 2012-2013 school year, the USDA-reimbursable school lunch will need to include more fruits and vegetables, whole grains, and reduced-fat milk. ... USDA is required to establish nutritional standards for all other foods and beverages (ie, competitive foods) served or sold in schools at any time during the day throughout the school campus, including vending machines, school stores, and à la carte in the cafeteria. ... However, as was demonstrated in developing the new nutritional standards for school lunch and breakfast, the interests of industry and advocates can influence the interpretation of science, translation into specific rules, and implementation time frames (Dr. Barbara A. Dennison, 5/8).

Archives of Pediatrics & Adolescent Medicine: Who Is Minding The Virtual Alcohol Store?
Seventeen years ago, a public health colleague of mine ordered a case of beer over the Internet in his then 10-year-old daughter's name. The case duly arrived, left at the door without any requirement of signature or age verification. ... the problem my colleague identified years ago has blossomed like a hothouse flower in a long-forgotten greenhouse. [A new study looking] for Internet alcohol vendors found an industry with sales of $2.4 billion per year. ... Underage purchases at these sites were far too easy: 45 of 100 attempts were successful (David H. Jernigan, 5/8).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Marissa Evans

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.