Daily Health Policy Report

Friday, June 1, 2012

Last updated: Fri, Jun 1

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Coverage & Access

Health Care Marketplace

Campaign 2012

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Ex-Medicare Administrator: Premium Support 'Is Going To Have To Happen'

Kaiser Health News staff writer Marilyn Werber Serafini interviewed Thomas Scully, senior counsel at Alston & Bird, and a former Medicare administrator under President George W. Bush. Scully urged Democrats and Republicans to set aside partisan differences and take a closer look at the controversial premium-support model, which would give beneficiaries a set amount of money to purchase coverage (Werber Serafini, 5/31). Read the story or watch the related video.

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An Open Letter To The Supreme Court About Health Insurance (A Multi-Page Comic)

In this speicial, Kaiser Health News multi-page cartoon, Jen Sorensen illustrates the thoughts and opinions – and even her own experiences - she hopes the Supreme Court will consider as the justices finalize their decision on the health law (Sorenson, 6/1). Check out the multi-page comic

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Capsules: Feds Seek To Reduce Disparities In Childhood Asthma Rates

Now on Kaiser Health News' blog, David Schultz reports on a new federal task force and action plan designed to eliminate the racial and ethnic gap among children suffering from asthma: "The task force's purpose is to pool the knowledge and resources of these various federal entities to ultimately lower asthma's sizeable public health costs. The Centers for Disease Control and Prevention estimates the total cost of asthma to the public, in both medical costs and lost school and work days, is $56 billion a year" (5/31). Check out what else is on the blog.

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Health Reform

House GOP Releases White House Emails Detailing Health Law Deals

The communications, which were gathered by the House Energy and Commerce Committee, offer an inside look at how the White House struck a deal with the pharmaceutical industry to win support for the health care law.

The Associated Press: House GOP Releases Documents On Health Care Deals
The White House played political hardball with drug industry honchos to get a 2009 deal that helped keep health care overhaul legislation from bogging down in Congress, according to internal emails released Thursday by House Republicans. Obtained from the industry by the House Energy and Commerce Committee, the emails and documents shed light on the saga of President Barack Obama's health care overhaul as its fortunes shifted back and forth in Congress (Alonso-Zaldivar, 5/31).

The Wall Street Journal's Washington Wire: Emails Describe Deal-Making On Obama Health Bill
Newly released emails give an inside look at how the White House struck a deal with the pharmaceutical industry in 2009 to get support for the health bill that ultimately passed the next year (Mundy, 5/31).

Politico: Report: W.H. Pushed Hard For PhRMA Health Reform Deal
The Obama administration aggressively pursued the pharmaceutical industry to make a deal in support of health care reform legislation in mid-2009, according to a series of emails released Thursday by Republicans on the House Energy and Commerce Committee (Haberkorn, 6/1).

CQ HealthBeat: GOP Report Details PhRMA-White House Dealmaking Over Health Law
A 12-page memorandum House Energy and Commerce Committee Republicans released on Thursday offers a detailed look at 2009 closed-door negotiations between the White House and the drug industry that culminated in it supporting the health care law and agreeing to $80 billion in discounts and other givebacks to help fund the measure. Republicans said their account of the negotiations, pieced together from emails exchanged between officials at the Pharmaceutical Research and Manufacturers of America (PhRMA) and the White House, contradicts claims President Obama made during the 2008 election campaign that he would conduct health overhaul negotiations in the open (Reichard, 5/31).

The Hill: GOP Releases New Documents On White House Deal With PhRMA
House Republicans released a detailed account Thursday of the negotiations over healthcare reform between the White House and the pharmaceutical industry. Republicans on the Energy and Commerce Committee have been investigating the $80 billion deal among the Obama administration, Senate Democrats and the drug industry's leading trade group, Pharmaceutical Research and Manufacturers of America (PhRMA) (Baker, 5/31).

Roll Call: House GOP Releases Documents From Health Care Probe
The documents reveal new details about a pact that is widely known, but they offer a close look at the transactional process of legislative sausage-making. The documents primarily come from the point of view of employees and lobbyists at the Pharmaceutical Research and Manufacturers of America, and they largely consist of PhRMA's impressions of what White House officials were doing to pressure them into an agreement. For instance, White House officials told PhRMA that Obama would announce support for a policy opposed by the pharmaceutical industry in his weekly radio address, and internal emails suggested the White House might be dangling that possibility as a way to pressure the sector to agree to a deal more quickly, according to a June 10 email from Bryant Hall, a top lobbyist for the industry (Strong, 5/31).

Bloomberg: Drugmakers Vowed To Campaign For Health Law, Memos Show
Drugmakers led by Pfizer Inc. agreed to run a "very significant public campaign" bankrolling political support for the 2010 health-care law, including TV ads, while the Obama administration promised to block provisions opposed by drugmakers, documents released by Republicans show. The internal memos and e-mails for the first time unveil the industry's plan to finance positive TV ads and supportive groups, along with providing $80 billion in discounts and taxes that were included in the law. The administration has previously denied the existence of a deal involving political support (Armstrong, 5/31).

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A Lot At Stake In Supreme Court Health Law Decision For Insurers, Providers

News outlets report on how various players are braced for the ruling. Meanwhile, President Barack Obama tells donors he may have to revisit the law in a second term depending on what the court decides.

Market Watch: Best Outcome For Health Stocks? Uphold Law
If the Supreme Court strikes down any part of the Affordable Care Act, it's likely that health insurers and hospitals will see their stock prices tumble. And expect just the opposite if the high court leaves the 2010 reform measure — often known as "Obamacare" — alone (Britt, 6/1).

Also, House Minority Leader Nancy Pelosi, D-Calif., offers her prediction about the outcome of the high court's deliberations -

Los Angeles Times: Pelosi Expects Court To Vote 6-3 In Favor Of Obama Healthcare Law
As Washington awaits the Supreme Court's ruling on President Obama's healthcare law, Rep. Nancy Pelosi (D-San Francisco) said the Affordable Care Act would withstand the constitutional challenge before the court and be upheld. "I know the Constitution – this bill is ironclad," Pelosi, the House minority leader, said Thursday. "It is ironclad" (Mascaro, 5/31).

And President Barack Obama offers a vision of future health care fights to donors -

Bloomberg: Obama Tells Donors Health-Care Fight May Loom After Court Rules
President Barack Obama is confiding to Democratic donors that he may have to revisit the health-care issue in a second term, a position at odds with his publicly expressed confidence that the U.S. Supreme Court will uphold the Affordable Care Act, according to three Democratic activists. As he previewed his agenda for donors at a May 14 fundraiser, Obama said he may be forced to try to revise parts of his health-care plan, depending on how the court rules later this month, said one activist, who requested anonymity to discuss the president’s comments (Nichols, 5/31).

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Health Law's Medicaid Expansion, Employer Coverage Requirements Drawing Expert Analysis

At a meeting this week, some state Medicaid directors expressed concern that their programs will not be able to handle the scheduled 2014 surge in enrollment because of challenges like outdated technology and the uncertainty of what will happen with the Supreme Court and November elections. Meanwhile, a committee of the National Association of Insurance Commissioners will offer recommendations on how to close a potential loophole in the law's employer coverage requirements.

CQ HealthBeat: 2014 Medicaid Expansion A Challenge, Say State Directors
With a year and a half to go before Medicaid is supposed to be expanded to cover an additional 16 million people under the health care law, on Thursday Medicaid directors said they are worried that they will not be ready to handle the surge in enrollment. Most states face budget constraints that make it hard for them to expand enrollment in a phased-in way in preparation of the huge surge in the program in 2014 under the law. They have outdated technology that they must decide whether to replace or try to build on. And they face huge uncertainty about whether the expansion will actually take place or be derailed by a Supreme Court decision expected next month or a change in administrations after the November elections (Adams, 5/31).

Politico Pro: NAIC Subgroup To Examine Potential Loophole
A committee of the National Association of Insurance Commissioners will weigh recommendations for closing a potential loophole in the health care reform law's employer coverage requirements in a conference call scheduled for next Wednesday. The NAIC's Self-Insurance (B) Subgroup will look at whether some small employers could buy generous stop-loss insurance policies and choose to self-insure. That would allow them to exit the small-group health insurance market and avoid many of the rules that apply to small-business health plans. The Obama administration is considering imposing national rules to prevent this (Feder, 5/31).

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Capitol Hill Watch

GOP Puts Medicaid Payments On The Table In Student Loan Plan Debate

In an effort to pay for an extension of current student loan interest rates, Republicans leaders targeted Medicaid payments to states as a way to bridge the impasse.

Los Angeles Times: Republicans Make New Offer In Student Loan Stalemate
Under the proposal, Republicans suggested raising the amount federal employees contribute toward their retirements, a proposal Obama had included in his budget for the coming fiscal year, but is unlikely to get broad support from Democrats, who have argued that government workers have already seen their benefits trimmed and pay frozen for the last several years. Republicans also suggested a second option that would cut off the loan subsidy – and allow interest to start accruing – for students who attend college part-time or take longer to finish college. The second option would also adjust Medicaid payments to the states (Mascaro, 5/31).

The Washington Post: New GOP Proposal On Student Loans
Congressional Republicans on Thursday outlined new ways to break the political impasse that threatens to drive up student loan rates July 1. … Two alternatives were offered for paying for the student loan freeze. In one, the costs would be offset by increasing the amount paid by federal employees for their retirement. In the other, a freeze on loan rates would be paid for through a combination of items: shortening the period during which part-time students would be eligible for federally subsidized loans; limiting the ability of states to recoup Medicaid costs through taxes on providers, which would lead to a slight reduction in Medicaid use and, therefore, lower costs to the federal government. ... (Helderman, 5/31).

The Associated Press: Hill GOP Leaders Make New Offer On Student Loans
Top congressional Republicans made a new offer to President Barack Obama on Thursday in their fight over heading off a doubling of interest rates on federal college loans for 7.4 million students, proposing fresh ways to cover the effort's $6 billion cost. … House Speaker John Boehner, Senate Minority Leader Mitch McConnell and other top Republicans made their proposals in a letter to Obama. They included savings from making it harder for states to collect some federal Medicaid reimbursements (Fram, 5/31).

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House Panel Nixes Two Health Law Provisions

The House Ways and Means Committee voted to eliminate a 2.3 percent tax on medical devices and to end a ban on the use of pretax flexible spending accounts to buy nonprescription medicines. These measures, though, are not expected to advance in the Senate even if they pass the full House.

Reuters: U.S. House Panel Backs Medical Device Tax Repeal
A Republican-controlled congressional panel voted on Thursday to repeal a tax on medical devices, a key revenue provision in President Barack Obama's 2010 healthcare reform law, but the measure was not expected to become law. Approval in the House, which is dominated by Republicans, was viewed as probable, possibly as soon as next week. But the measure faced an uphill climb in the Democrat-controlled Senate, where parallel legislation lacks bipartisan sponsors (Temple-West, 5/31).

Bloomberg: Republicans Attempt To Repeal Taxes For U.S. Health Law
Efforts to repeal taxes imposed by President Barack Obama’s health-care law advanced in Congress as Republicans sought to save medical-device makers $29 billion in levies and consumers $4 billion in out-of-pocket drug costs. The U.S. House Ways and Means Committee voted 23-11 to eliminate a 2.3 percent tax on hip implants, pacemakers and other devices sold to hospitals; and voted 24-9 to end a ban on the use of pretax flexible spending accounts to buy nonprescription medicines such as Johnson & Johnson’s Tylenol (Edney, 5/31).

CQ HealthBeat: House Panel Backs Repeal Of Medical-Device Tax, Changes To Account Rules
Republican-backed efforts to scrap two of the 2010 health care overhaul law's tax-related provisions advanced in the House on Thursday. The Ways and Means Committee approved, 23-11, legislation that would repeal the law's tax on medical devices. The panel also voted, 24-9, to back a bill that would do away with the overhaul's restrictions on using tax-preferred accounts to pay for over-the-counter drugs. Speaker John A. Boehner said Thursday that House Republicans plan to make repeal of the law's 2.3 percent tax on medical devices a centerpiece of their economic program and their attack on President Obama’s management of the economy. The bill is expected to receive floor votes next week (Khatami and Phenicie, 5/31).

Modern Healthcare: House Panel OKs Device-Tax Repeal, Bills To Expand HSA Use
A House panel advanced measures to roll back two unpopular provisions of the 2010 healthcare overhaul and also approved two other bills that aim to expand the use of health savings accounts. The Ways and Means Committee voted 23-11 to repeal the 2.3% excise tax set to go into effect Jan. 1 on medical devices that are generally available for purchase only by healthcare providers. The measure has garnered some bipartisan support, including two Democrats voting for it in the committee and 11 Democrats among its 239 co-sponsors (Daly, 5/31).

Minnesota Public Radio: Medical Device Tax Repeal Advances In The U.S. House
A committee hearing over legislation introduced by 3rd District Republican Congressman Erik Paulsen to repeal a tax on medical devices turned heated Thursday as Republicans and Democrats took turns re-litigating the fight over the 2010 health care law. While many Democrats on the panel said they were uncomfortable with the tax and would be happy to see it reduced or eliminated, in the end only Democratic Reps. Ron Kind of Wisconsin and Shelley Berkley of Nevada joined all of the Republicans present to vote 23-11 in favor of eliminating the tax (Neely, 5/31).

In other news from Capitol Hill -

The Associated Press: House Passes Veterans Funding Bill
The Republican-controlled House approved legislation Thursday to boost health care spending for veterans and provide more money to compensate record numbers of Iraq and Afghanistan war veterans claiming service-related disabilities as they return home. The 407-12 vote reflected the traditional bipartisan support for veterans in Congress and efforts by Republicans to exempt veterans' programs from cuts felt by other domestic programs (Taylor, 6/1).

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Sex-Selective Abortion Ban Rejected By House

The House on Thursday voted down a bill that would have banned abortions based on the sex of a fetus. Republicans, however, said they achieved a strategic goal of forcing Democrats to vote against it.

The New York Times: House Rejects Bill To Ban Sex-Selective Abortions
The House on Thursday rejected a measure that sought to impose fines and prison terms on doctors who perform abortions on women who are trying to select the gender of their offspring -- a practice known as sex-selective abortion (Steinhauer, 5/31).

The Washington Post: Bill Banning 'Sex-Selection Abortions' Fails In The House
A measure to ban abortions based on the sex of a child failed Thursday after proponents were unable to earn enough support in the House, but GOP abortion opponents said they achieved their strategic goal of forcing Democrats to vote against it (O'Keefe, 5/31).

The Associated Press: House Rejects Sex-Selection Abortion Ban
The House on Thursday fell short in an effort to ban abortions based on the sex of the fetus as Republicans and Democrats made an election-year appeal for women's votes. The legislation would have made it a federal crime to perform or force a woman to undergo a sex-based abortion, a practice most common in some Asian countries where families wanting sons abort female fetuses (Abrams, 5/31).

McClatchy Newspapers: Republican Effort To Ban Abortions Based On Gender Fails In House
House Republicans provoked a fresh confrontation in the ongoing battle over women's health care rights, but failed Thursday to win approval for a bill designed to outlaw abortions based on gender. The bill, aimed at families trying to avoid unwanted daughters, attracted the support of a majority of representatives, but failed because it was considered under a procedure normally used for uncontroversial measures. It needed the votes of two-thirds of the House (Duncan, 5/31).

Reuters: U.S. House Rejects Sex-Selection Abortion Ban
The U.S. House of Representatives on Thursday rejected Republican legislation banning abortions based on the sex of the fetus in a vote that keeps the election-year spotlight on an emotionally charged issue. The "Prenatal Nondiscrimination Act," would have subjected doctors to a five-year prison term if they performed abortions intended to select gender. Medical and mental health professionals also would have had to report suspected violations to authorities or face a one-year sentence (Lawder, 5/31).

National Journal: House Fails To Pass Sex-Specific Abortion Bill
The House on Thursday failed to pass a bill that would have outlawed abortions performed because of the sex of the fetus, thrilling abortion-rights advocates. House members voted 246-168 to approve the bill, which was short of the two-thirds majority needed under an unusual procedure used to get the vote to the floor. The Prenatal Nondiscrimination Act, sponsored by Rep. Trent Franks, R-Ariz., would have made it it a federal offense to perform, solicit funds to perform, or coerce a woman into a sex-selection abortion (Fox, 5/31).

The Hill: House Rejects Bill Penalizing Doctors For Sex-Selective Abortions
The House on Thursday rejected a Republican bill that would impose fines and prison terms on doctors who perform abortions for the sole purpose of controlling the gender of the child, a practice known as sex-selective abortion. The Prenatal Nondiscrimination Act (PRENDA), H.R. 3541, was defeated in a 246-168 vote. While that's a clear majority of the House, Republicans called up the bill under a suspension of House rules, which limits debate and requires a two-thirds majority vote to pass. In this case, it would have required more support from Democrats (Kasperowicz, 5/31).

Roll Call: House Shoots Down Ban On Sex-Selective Abortions
Seven Republicans voted against the GOP measure, which was first introduced by Rep. Trent Franks (R-Ariz.) three years ago and would punish doctors with up to five years in prison for performing an abortion if the doctor knows it "is sought based on the sex or gender of the child." Speaker John Boehner said it is an important vote. "Ours Members feel strongly about it, "the Ohio Republican told reporters before the vote. "This is an important issue to the American people. This type of sex-selection most Americans find pretty repulsive" (Newhauser, 5/31).

If a ban on sex-selective abortions ever succeeded, it could lay the groundwork for a challenge to Roe vs. Wade, some say --

Politico Pro: Abortion Opponents See New Challenge To Roe
If Congress someday manages to pass a ban on sex-selective abortions, it could be an ideal vehicle for bringing the next direct challenge to Roe v. Wade, legal experts argued Thursday at a forum sponsored by Americans United for Life. That's because, according to University of St. Thomas law professor Michael Paulsen, "It turns on its head this perverted notion that abortion rights are needed to protect equality of the sexes" — which was one of the principles used to uphold Roe in the landmark 1992 case Planned Parenthood v. Casey (Feder, 5/31).

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Coverage & Access

Federal Appeals Court Strikes Down Law Barring Gay Marriage

Massachusetts officials had argued to the three-judge panel that the law could deny gay married couples federal benefits such as Medicaid.

Boston Globe: Federal Court In Boston Rules US Marriage Law Unconstitutional
In a groundbreaking ruling on gay rights, a US appeals court in Boston on Thursday struck down the heart of a federal act that defines marriage as a union solely of a man and a woman. … [Attorney General Martha] Coakley had argued that the law dictated the way the state could administer federally funded programs, forcing the state to discriminate against the type of marriages that it already approved. According to the marriage act, for instance, under some circumstances, gay couples could be denied Medicaid and the state could not bury the same-sex spouse of a war veteran in federally funded cemeteries (Valencia, 5/31).

The Associated Press: Gay Married Couples Look To High Court On Benefits
In California, two federal judges have found this year that the (Defense of Marriage Act) violates the due-process rights of legally married same-sex couples. In the most recent case, a judge found the law unconstitutional because it denies long-term health insurance benefits to legal spouses of state employees and retirees. The judge also said a section of the federal tax code that makes the domestic partners of state workers ineligible for long-term care insurance violates the civil rights of people in gay and lesbian relationships (Lavoie, 6/1).

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Health Care Marketplace

UnitedHealth Offers Rebate To Calif. Small Business; Humana On The Lookout For Medicare Deals

This summer, United Healthcare will share $3.5 million in rebates with California small businesses as a part of a requirement of the health law - if it indeed is in effect.  

Los Angeles Times: UnitedHealth To Rebate $3.5 Million To California Small Businesses
Nearly 4,400 small businesses in California will share in $3.5 million in rebates from insurance giant UnitedHealth Group Inc. this summer as insurers nationwide prepare to return millions of dollars to customers as a key benefit of the federal healthcare law kicks in (Terhune, 5/31).

Meanwhile, Humana remains a potential buyer for Medicare-plan providers -

The Wall Street Journal: Humana Remains On The Lookout For Medicare Deals
Health insurer Humana, which has boosted its already-large roster of Medicare Advantage-covered patients with a couple of recent purchases of Medicare-plan providers, remains a potential buyer (Kamp, 5/31).

In addition, NPR offers the following report about consumers' cost consciousness -

NPR: More Americans Are Checking Prices Before Getting Health Care
Do you shop around for the best price on a visit to the doctor, a CT scan or surgery at a hospital? If so, it looks like you've got a little more company (Hensley, 5/31).

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Campaign 2012

N.Y. Catholics Split On Bishops' Lawsuit Over Contraception Rule

In political developments, a new poll shows a significant divide among Catholics but little support among general voters in New York for the church's complaints about the Obama administration rule. Also, in Minnesota, a new candidate opens his campaign for Congress and criticizes the state's handling of Medicaid funds.

Politico: Poll: Catholics Split On Suit Vs. White House
New York Catholics are sharply divided over the lawsuits filed by Catholic organizations opposed to the Obama Administration’s mandate on birth control, according to a new survey. A new Quinnipiac poll shows that New York Catholics only approve of the lawsuit led by the state's Archbishop, Cardinal Timothy Dolan, 51 percent to 45 percent. Meanwhile, a majority of New York voters in general disapprove of the lawsuit, 55 percent to 38 percent (Mak, 5/31).

St. Paul Pioneer Press: Allen Quist Files, Will Face Mike Parry In Primary
Former state Rep. Allen Quist filed to run for U.S. Congress on Wednesday, May 30. Earlier this month, Quist called for an immediate, third-party audit of Minnesota's handling of the Medicaid program. The release said Quist estimates the government is overcharging every taxpayer approximately $500 a year to pay for inflated Medicaid expenses (5/31).

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State Watch

States Taking Sides On NYC Sugary Soda Restrictions

A plan by New York City Mayor Michael Bloomberg to limit the sale of large sugary drinks is being met by apprehension by the food industry as other states' leaders consider what example the restrictions could provide for them.

Reuters: Coke, McDonald's Slam New York City Bid To Ban Big Soda Cups
Coca-Cola Co and McDonald's Corp slammed Mayor Michael Bloomberg's proposed ban on large soft drinks in New York City, arguing for freedom of choice and saying it would not effectively curb obesity. "New Yorkers expect and deserve better than this. They can make their own choices about the beverages they purchase," Coca-Cola said in a statement on Thursday (Geller, 5/31).

The Associated Press: NYC Soda Ban Another Blow For Drink Makers
Is the Big Gulp to blame for obesity in the Big Apple? New York City Mayor Michael Bloomberg thinks so. But Bloomberg's proposal Thursday that the city prohibit restaurants, delis and movie theaters from serving large cups of sodas and other sugary drinks is a bitter twist for companies that make beverages like Coke, Dr Pepper and Pepsi. The ban, which would be the first of its kind in the nation, comes at a time when soda consumption has been declining (Choi, 5/31).

MedPage Today: Bloomberg Wants Super-Sized Soda Ban in NYC
New York City Mayor Michael Bloomberg wants to put the lid on super-sized sugary drinks. The mayor announced plans to cap the size of sodas and other sugary drinks that can be sold at city restaurants, movie theaters, and stadiums at 16 fluid ounces -- about the size of a "Grande" drink from Starbucks, and smaller than the typical 20-oz bottles in which sodas are sold (Fiore, 5/31).

NewsHour (Video): Bloomberg Could Buy The World A Coke, But He’d Make It A Small
New York City Mayor Michael Bloomberg announced Thursday his aim to ban the sale of large, sugary drinks at restaurants, movie theaters, sports venues and street carts to help fight obesity. Judy Woodruff speaks with New York Health Commissioner Dr. Thomas Farley and Andrew Moesel of the New York State Restaurant Association (5/31).

Other leaders are considering what it means for similar efforts to curb obesity in their states --

Baltimore Sun: Md. Leaders Watching New York's Ban Of Large Soda Containers
Baltimore Mayor Stephanie Rawlings-Blake will remain focused on a controversial plan to increase the tax from 2 to 5 cents on sugary drinks and alcohol. It was meant to generate millions in public school construction funds, but was formulated with health effects in mind, said Ryan O’Doherty, her spokesman. "The mayor's proposal encourages healthy choices because the tax completely exempts milk and dairy substitute containers and beverage containers with at least 10 percent juice contents," he said. But he added, "Congratulations to Mayor Bloomberg for standing-up to the big, powerful beverage industry on behalf of city youth" (Cohn, 5/31).

Des Moines Register: Gulp! Iowa Gives New York City Soda Plan Chilly Reception
Relax, Iowa pop guzzlers. Your state is unlikely to follow New York City’s lead and try to impound your Big Gulps. … Iowa Gov. Terry Branstad shares Bloomberg’s concern about Americans’ ballooning waistlines, and he’s pushing hard to make our state the healthiest. But he’s not about to seize anybody’s super-sized soda. If the only physician you see regularly is Dr Pepper, that will remain your right (Leys and Eller, 6/1).

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State Roundup: How Health Law Could Harm Mass. Exchange

A selection of health policy stories from Massachusetts, California, North Carolina, Illinois, Texas, Michigan, Kansas and Wisconsin.

Politico: How ACA Could Hit Massachusetts 
Here's a health policy paradox that'll make you think: Is it possible that President Barack Obama's health law means bad news for the centerpiece of the Massachusetts health reform? No state is a bigger cheerleader than Massachusetts for the Affordable Care Act; the state's 2006 coverage expansion was a model for the federal law enacted two years ago. But if most of the ACA is implemented in 2014, there's real concern in the Bay State about the viability of the Massachusetts Health Connector, the state's health insurance exchange (Millman, 6/1).

California Watch: Health Care District Reforms Are On Hold
An effort to impose spending restrictions on California's taxpayer-funded health care districts is on hold until next year. Assemblyman Rich Gordon, D-Menlo Park, said he plans to introduce a bill in January requiring more "transparency" and more "accountability" from those districts. The new legislation would mandate how much tax revenue districts must spend on community health care programs. The state's 74 health care districts were created to provide medical care to low-income and rural communities, but a recent Bay Citizen investigation found about 30 of those districts no longer run hospitals. Instead, some districts are managing real estate, stockpiling cash and pouring millions of taxpayer dollars into dubious projects at the expense of community health care programs (Gollan, 6/1).

Healthy Cal: State To Award Computer Contract For Health Insurance Marketplace
California's new Health Benefit Exchange -- the online consumer portal that will be at the center of federal health reform -- took a major step Thursday toward implementing the controversial law that could extend insurance coverage to millions of Californians. The Exchange announced its intent to award a $360 million contract to Accenture LLC to design and maintain a web site that will allow consumers to shop for insurance, choose their plan and enroll (Weintraub, 5/31).

North Carolina Health News: Questions Linger On Resolving Housing Problem For Mentally Ill
The budget proposed by the House Republican majority contains $50 million designated for a new "transitions to community living" program for people with mental health disabilities. Twenty percent of the funds go to creating community resources for people who need housing this year, while the other 80 percent of the money goes to owners of adult care homes, and to providing personal care services for residents. "This is a backwards approach," said Fred Waddle, chief policy officer for the state chapter of Easter Seals/ UCP. "There's $10 million to transition people to community settings, but then they’re spending $40 million to refurbish or change adult care homes" (Hoban, 5/31).

Bloomberg: Illinois Hospitals Escape Taxes With Big Dose Of Lobbying
The Illinois Hospital Association took no chances as state lawmakers debated in recent weeks whether nonprofit hospitals should pay property taxes. It unleashed a self-described media blitz. "My baby is sick -- anyone help, please!" screamed an actress portraying a mother in radio ads aired in Chicago and 41 other markets starting in early May. A baby wailed, an ambulance siren blared and a voiceover asked what the terrified parent would do if no hospital were around. The blitz worked. The Illinois General Assembly this week handed hospitals a long-sought victory: a sweeping legislative antidote to a recent state Supreme Court decision that threatened to slap many hospitals with potentially millions of dollars in tax liabilities just as they say they’re struggling to survive (Kazel, 6/1).

Modern Healthcare: Calif. Senate OKs Bill Pushing Health Worker Vaccinations
The California Senate passed a bill requiring all health care workers to be either vaccinated against influenza or wear a mask in patient-care areas during flu season. The bill, which would go into effect Jan. 1, 2015, is supported by a number of state health care organizations, including the California Hospital Association and the California Medical Association. The bill is opposed by a number of labor groups, including the California Nurses Association (Barr, 5/31). 

KUT News/Texas Tribune: In Central Texas, Cases of Elderly Neglect on the Rise (audio)
Last year, almost 30,000 elderly Texans were victims of abuse, neglect or exploitation. As Matt Largey of KUT News reports, the problem is especially pronounced in Central Texas, where the elderly population is growing rapidly (Largey, 6/1).

Chicago Sun-Times: Pension-Reform Package Collapses In Illinois House
A hulking pension reform package pushed by Gov. Pat Quinn and House Minority Leader Tom Cross collapsed late Thursday, leaving the last big issue of a productive spring legislative session a casualty of partisan bickering and a heavy union pushback. ... Aimed at fixing the nation’s most underfunded pension system, the package sought to erase more than $80 billion in unfunded liabilities by having current and retired state workers, Downstate and suburban teachers, university and community college employees and state legislators accept less generous annual pension increases. If workers and retirees agreed to relinquish an automatic 3-percent cost-of-living increase each year, they could keep state-subsidized health insurance as retirees, and current workers could continue to have future pay increases factored into their pensions (McKinney and Maloney, 5/31).

San Jose Mercury News: Public Hospitals Target Of New State Cash Grab
Arrowhead Regional Medical Center, the county's hospital, stands to lose millions of dollars, if proposals under Gov. Jerry Brown's revised budget become reality, county officials said. Board of Supervisors Chairwoman Josie Gonzales said the proposals are "horrendous" because they could end up causing some to be denied care at a time when they need it most, after losing health insurance because they had become unemployed in the sagging economy (Steinberg, 5/31).

Detroit Free Press: Gov. Snyder Calls For Better Management, Long-Term Planning In Michigan
Gov. Rick Snyder called for better management of state government and long-term planning in a keynote address today to the Detroit Regional Chamber Mackinac Policy Conference. … Once the state's liabilities for long-term costs such as retirement health care are fully funded, the additional cash flow generated can be used to cut taxes or invest in programs, Snyder said (Egan, 5/31).

Bloomberg: Republicans Hit Dental Bill That Private Equity Hates
The likes of Jeb Bush, William Frist, Tommy Thompson and Haley Barbour aren't typically heard from in the office of Thom Tillis, the Speaker of the North Carolina House of Representatives. Yet the four Republican Party stalwarts, none of them a Carolina resident, have contacted Tillis's office over a little- known bill to toughen state regulation of dental companies. They've been joined by Grover Norquist, the Tea Party favorite and anti-tax crusader who heads the Washington, D.C.-based Americans for Tax Reform. ... Their interest marks the Tar Heel State as the front line in a national struggle over dental management companies (Freedberg and Kelly, 5/31).

CHCF Center For Health Reporting/San Jose Mercury News: Legislators Say Changes In Dental Care For LA County’s Poor Children Must Be Made
Southern California legislators are demanding changes to Los Angeles County's managed care dental program for poor children after reports revealed that fewer than one in four saw a dentist last year. ... Of the roughly 900,000 children with Medi-Cal in Los Angeles County, about 154,000 receive their dental care from a managed care plan. State data show that they are among the least successful in California at obtaining dental care. In fiscal year 2010-2011, 23 percent of them saw a dentist, compared with about 31 percent in Sacramento -- the only other county with Medi-Cal dental managed care -- and about half of all Medi-Cal kids statewide (Bazar, 6/1).

Kansas Health Institute News: Program Trains Underemployed Hispanics As Bilingual Health Care Staff
The program was launched with a $10,000 grant from the National Council of La Raza and assistance from local partners. The goal is to produce much-needed bilingual health care staff by training underemployed or unemployed Hispanics for those positions. ... The program’s early coursework focused on training students to become certified nursing assistants. Preparados operates at an accelerated pace to get the pupils into the workforce rapidly -- and to establish a quick foundation for further studies (Sherry, 5/31).

Milwaukee Journal-Sentinel: Clarke Seeks Permission To Use Firm For Jail Medical Care
Milwaukee County Sheriff David A. Clarke Jr. wants to fire a court-appointed overseer of jail conditions and hire an outside company to take over inmate medical care. Clarke filed a motion in Circuit Court on Thursday seeking to end a key provision of a 2001 settlement agreement over allegations of inadequate inmate care. Those problems have been remedied, according to Clarke, who added that jail monitor Ronald Shansky's oversight is no longer needed (Schultze and Kissinger, 5/31).

San Francisco Chronicle: Mayor Ed Lee Presents S.F.’s 1st 2-Year Budget
San Francisco's new annual city budget will top $7 billion for the first time, a massive figure but one with merit, Mayor Ed Lee said Thursday. The first citywide, two-year spending plan restores funding for local HIV and AIDS services targeted for federal cuts, includes additional money for public schools, and ups funding for employment and small-business programs. ... This year's total reflects significant responsibilities being shifted to the city by the state and federal governments, city officials said, including the diversion of low-level criminals to county jails, increasing roles for local public health systems under federal health care reforms and absorbing the responsibilities of the local redevelopment agency after Gov. Jerry Brown dissolved the organizations statewide (Gordon, Coté e, 5/31).

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Health Policy Research

Research Roundup: ACOs For Medicaid

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

Archives of Internal Medicine: Multiple Behavior Changes In Diet And Activity -- Mobile technologies have been touted for their potential benefits to health and wellness. Researchers in this study gave 204 individuals a dieting and exercise regimen. They also gave each person a handheld device to record adherence and receive remote coaching. Patients could earn a financial reward for meeting their goals, and many did so after three weeks of treatment and at a five-month follow-up. "This study demonstrates the feasibility of changing multiple unhealthy diet and activity behaviors simultaneously, efficiently, and with minimal face-to-face contact by using mobile technology, remote coaching, and incentives," the authors write (Spring et al, 5/28).

Journal of General Internal Medicine: Evaluation Of The Effectiveness Of Making Weight Watchers Available To Tennessee Medicaid (TennCare) Recipients -- Since 2006, Tennessee's Medicaid program has offered enrollment in local Weight Watchers programs at a substantially reduced cost. This study looks at nearly 1,200 participants over three years and finds that 21 percent experienced at least a 5 percent loss of body weight, which the authors describe as clinically significant. This benefit came even with poor meeting attendance among some Medicaid beneficiaries, and the researchers conclude that state-private partnerships like this one "may provide a valuable weight management tool" for low-income populations (Mitchell et al, 5/23).

Mathematica Policy Research/Kaiser Family Foundation: Emerging Medicaid Accountable Care Organizations: The Role of Managed Care -- Accountable care organizations, in which doctors and hospitals agree to share responsiblity for the care of patients, are rapidly spreading through both private and federal efforts, including the Medicare pilots initiated by the health law. This brief looks at efforts in some states to establish ACOs in Medicaid programs and finds that "most Medicaid ACOs are currently at an early stage of development, as states engage in relatively lengthy planning and implementation processes." Federal regulations and concerns about how to address Medicaid patients who are also eligible for Medicare have complicated efforts to develop Medicaid ACOs. Five states -- Colorado, Utah, Oregon, Minnesota and New Jersey -- have ACO initiatives and only Colorado has one operating. "Promoting transformation in the way services are delivered in Medicaid is not straightforward, and the time and investment required may run counter to states' fiscal imperatives," the authors write (Gold, Nysenbaum and Streeter, 5/29).

The Urban Institute: Best Practices in SHAP Outreach, Eligibility, and Enrollment Activities
Much of the health law's expansion of insurance coverage will depend on individual states' ability to reach out to communities and enroll people in programs like Medicaid. This brief looks at the efforts of five states -- Colorado, Kansas, Minnesota, New York and Oregon -- that received grants from the State Health Access Program to improve outreach and enrollment processes. States showed success by working with community partners, coordinating with fellow agencies and streamlining online enrollment systems. These "experiences under the SHAP grant offer important insights for other states as they consider how to best prepare for the major coverage expansions that will occur in 2014," the authors conclude (Courtot and Coughlin, 5/23).

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

JAMA: Author Insights: Home Telemonitoring Does Not Reduce Hospitalizations or Emergency Department Visits for Seniors
A telemonitoring device in the home that can measure and transmit information about indicators of health such as blood pressure and oxygen saturation coupled with videoconferencing can allow a health care team to assess a patient's condition remotely and discuss ongoing treatment plans with the patient. Proponents of telemonitoring suggest that it has the potential to improve patient outcomes, but recent studies suggest such optimism may be premature. New findings appearing in the May 28 Archives of Internal Medicine found that telemonitoring of older adults with multiple health issues did not reduce hospitalizations and emergency department visits (Mitka, 5/29).

Reuters: Doctors Sometimes Over-Treat Blood Pressure: Study
A new study suggests veterans hospitals are following guidelines when it comes to treating patients with diabetes and high blood pressure -- but some diabetics with healthy readings may also be getting intensive blood pressure treatment that won't do them much good. … Doctors have gotten very good at making sure everyone at risk gets treated with blood pressure medications, [lead author Eve Kerr] added. But some patients who needed blood pressure medications to begin with might end up not needing them later on (Pittman, 5/29).

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Editorials and Opinions

Viewpoints: Supporting Abortion Rights For Women Soldiers; If We Ban Big Sodas, What About Cheesesteaks?

The New York Times: The Rights Of Female Soldiers
Republicans — even a small number of them — joining with Democrats on Capitol Hill to protect women’s reproductive rights is a rare and welcome sight. Last week, Senators John McCain of Arizona, Scott Brown of Massachusetts and Susan Collins of Maine voted with nearly all the Democrats on the Armed Services Committee to lift a cruel and insulting law that requires female service members who are victims of rape or incest to pay for abortion care they receive at military facilities (5/31).

The New York Times: Opinionator: Do The Bishops Have A Case Against Obama?
Religion often comes alive in the face of persecution. Recently, Daniel Jenky, the bishop of Peoria, Ill., did not hesitate to play the persecution card in the dispute with the Obama administration over required health insurance coverage of birth control (Gary Gutting, 5/31).

The Washington Post: The Real War On Women
It is a sad day in America when the president of the United States endorses sex-selection abortion by opposing the Prenatal Nondiscrimination Act. It is no less sad that this bill did not pass the House — although a significant majority, 246 members, did vote for it — given its laudable aim of outlawing this egregious assault on baby girls. Sex-selection abortion is cruel, it's discriminatory and it's legal (Rep. Christopher H. Smith, R-N.J., 6/1).

Philadelphia Daily News: Ban Big Sodas? Nanny State Amok In Bloomberg's NY
I asked our mayor’s office if Green Genie Nutter wanted a piece of this misguided idea. Nutter’s idea to tax sugar drinks — following (New York Mayor Michael) Bloomberg’s lead — got euthanized in Council. "The health commissioner will take a look at this proposal and will focus on whether it could have an impact on obesity," said mayoral spokesman Mark McDonald. Well, it "could" have an impact on obesity, but so would banning cannolis and cheesesteaks. That would never be contemplated. Or would it? Hard to say in this brave new world of government concern for the "masses" (Stu Bykofsky, 6/1).

Philadelphia Daily News: Why New York's Soda Ban Is A Good Idea
Bloomberg's proposal won't ban all sugary drinks. Nor will it have an impact on diet drinks or fruit juices. But it will help control the amount that diners and restaurant-goers are served in certain venues. If that goes even a little bit toward curing New York’s obesity epidemic, it would be a good thing. Here’s hoping Philly follows suit (Jenice Armstrong, 6/1).

CNN: Big Gulp? Meet Big Brother
Bloomberg justifies his nanny-state interventions by pointing to the social costs of obesity, but there is no direct causal link between obesity and 20-ounce sodas with sugar in them, and neither would it be anyone's business at all except for the increasing government control and subsidies for health care. Bloomberg's insistence on dictating consumer choices has a more direct connection to an assumption that government should control our access to health care than obesity has to a couple of Big Gulps (Edward Morrissey, 6/1).

The Washington Post: Post Partisan: When Republicans Attack On Health Care
There is, of course, something deeply cynical about a Republican Party that blasts Obama and the Democrats for cutting Medicare in health-care reform at the very same time (sometimes in the same sentence!) as they attack Obama and the Democrats for refusing to cut ("reform") Medicare. And then there's the constant Republican carping about "Mediscare" — the idea that Democrats supposedly unfairly attack Medicare cuts, a complaint that hardly squares either with GOP support for the Medicare-cutting Paul Ryan budget or with the Medicare-based attacks on the ACA (Jonathan Bernstein, 5/31).

Boston Globe: Choosing Politics Over Kids
Each party's plan to pay for the [student loan] subsidies would make a different problem worse. Republicans' desire to plunder the health care funds reflects a general hostility to the Obama health care overhaul. Meanwhile, the Senate Democrats' desire to close Medicare and Social Security tax loopholes makes sense, but the futures of the two major entitlements are cloudy enough that any proceeds should be put aside to strengthen and reform those plans (6/1).

Los Angeles Times: A Sports Injury Leads To A Big Foul In Medical Billing
It's amazing how easily the smallest healthcare mix-up can spin out of control and leave the patient on the hook for thousands of dollars in medical bills (David Lazarus, 6/1).

Baltimore Sun: The High Cost Of Waiting
A physician's time is perhaps the scarcest resource in our health care system and needs to be utilized optimally. Doctors play a noble role in our society — they save lives and relieve pain. Their time is valuable. And it is preferable if the patient waits rather than the doctor. But what about my time (Ritu Agarwal, 5/31)?

Boston Globe: The Perils Of Health Care Price Controls
So lawmakers and the governor need to identify the specific purpose for passing a new price-control system now. Is it to rebalance pricing power across the health care industry? Should it redistribute money and other assets from the rich to the poor in the medical world? In a word, no. The purpose of a new health care cost-control law should be simply to control the future growth of medical costs in the best way possible (Steven Syre, 6/1).

Des Moines Register: Prostate Test Push-Back Is Out Of Line
The screenings cost money and lead to unnecessary, even harmful, follow-up tests and treatments that can cause impotence and incontinence. The bottom line: Decisions about routine medical care should be made based on evidence, not tradition. That is particularly important when this aging country needs to make the best use of its limited health care money. And the task force is not part of some conspiracy to strip people of health care services (5/31).

Chicago Sun-Times: Pension Reform Poses Difficult Financial Questions For State Retirees
Despite the impasse in Springfield, pension reform will come, and when it does state employees will be asked to make a very tough choice: Should they forego the 3 percent annual compound inflation adjustment in the pension benefit? Or should they keep the inflation protection and give up retiree medical benefits? … And one more question: If you choose the health insurance over the inflation protection, who’s to say the state won't renege on parts of this promise, too (Terry Savage, 5/31)?

Arizona Republic: Arizona's Anti-Abortion Czar ... For D.C.?
You can take the zealot out of Arizona, but you can't take the Arizona out of the zealot. Just ask the good folks of Washington, D.C., who can't figure out why an obscure congressman from 2,000 miles away wants to tell them how to live their lives. Trent Franks, the long-time representative of Arizona’s second congressional district, is pushing legislation that would ban abortions in the district after 20 weeks of pregnancy (E.J. Montini, 6/1).

Minneapolis Star Tribune: Patients Lose When Care Isn't Top Goal
Faced with thinning patient-care margins and mounting pressure to cut costs, hospitals across the nation will need to rely more on outside vendors to save on staffing costs and provide expertise in information technology. ... That reality is why it is so important to intensely scrutinize what went wrong at Fairview and what the lessons are for other hospitals. Sen. Al Franken of Minnesota continued this much-needed postmortem at a U.S. Senate field hearing on Wednesday in St. Paul (5/31).

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Stephanie Stapleton

Andrew Villegas

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Shefali Luthra

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