Daily Health Policy Report

Wednesday, June 13, 2012

Last updated: Wed, Jun 13

KHN Original Reporting & Guest Opinion

Administration News

Health Reform

Campaign 2012

Capitol Hill Watch

Medicare

Health Care Marketplace

Quality

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Medicare Drug Discounts At Risk If Court Strikes Health Law

Reporting for Kaiser Health News, Susan Jaffe writes: "Billions of dollars in drug savings for Medicare beneficiaries may come to an end if the Supreme Court overturns the 2010 federal health law, a drug industry spokesman said Tuesday" (Jaffe, 6/12). Read the story.

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Kaiser Permanente's Ross: There's No Effective Substitute For The Mandate (Video)

In this Kaiser Health News video, Murray Ross, director of the Kaiser Permanente Institute for Health Policy, says he believes that the health law's requirement that most Americans have coverage by 2014 or pay a fine is necessary. By design, says Ross (who is also a vice president in the part of the company that sells health plans), the "individual mandate" would attract both the healthier and sicker individuals to balance risk and the cost of coverage. (Note: KHN is not affiliated with Kaiser Permanente). This interview is part of KHN's video series "Supreme Uncertainty: What's Next After The Court Rules," which solicits views from public officials and policy experts about the upcoming Supreme Court ruling on the health law and its implications for the future of health care (6/12). Watch the video.

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Taking A Risk To Secure Health Insurance

In this Kaiser Health News "first-person" story, California-based writer Randy Dotinga explains how he hopes to obtain health insurance by going without: "Last January, I cancelled my existing, very expensive individual coverage through California's state-run high risk plan and became insurance-free to gain eligibility for the federal alternative. That means that if I get a cancer diagnosis tomorrow, I'll end up with huge medical bills. I did this because I want to take advantage of the federal government's efforts to help people like me who have pre-existing conditions and no access to a group plan" (Dotinga, 6/12). Read the story.

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Capsules: Report: Health Spending Will Climb to Near One-Fifth Of GDP; Medicaid Costs Loom Over States’ Tepid Economic Recovery

Now on Kaiser Health News' blog, Christian Torres reports on new federal health spending estimates: "National health spending will account for nearly one-fifth of the U.S. economy in 2021, according to updated estimates from the federal government" (Torres, 6/12).

Also on Capsules, Sarah Barr reports on how Medicaid costs continue to be a drain on state budgets: "The economic outlook for the states is starting to brighten, but growth is slow and budgets still are tight, said the National Governors Association  and the National Association of State Budget Officers in their semi-annual fiscal survey of the states" (Barr, 6/12). Check out what else is on the blog.

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Political Cartoon: 'Sweet Land of Liberty'

Kaiser Health News provides a fresh take on health policy developments with "Sweet Land of Liberty" by John Darkow.

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

ENOUGH ALREADY! 

So many rumors
about d-day. Who can know
the high court's secrets?
-Anonymous

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

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Administration News

Health Care Costs To Reach Nearly One-Fifth Of GDP By 2021

New health care cost projections released Tuesday by the Centers for Medicare & Medicaid Services indicate that the nation's health care spending will keep outpacing economic growth despite a recent slowdown.

The Wall Street Journal: Steep Rise In Health Costs Projected
Economists have been puzzling over whether a three-year slowdown in the growth of health-care spending, prompted by the economy, portends a permanent change. Federal projections indicate that isn't the case (Radnofsky, 6/12).

The Associated Press: Gov't Report: Health Cost Relief Only Temporary
If only the economy were growing as fast. Despite a recent easing of medical costs, the nation's health care spending will keep outpacing economic growth for the foreseeable future, government experts said Tuesday in a forecast that signals more upheaval for Medicare and Medicaid, as well as private insurance. President Barack Obama's health care overhaul will add $478 billion in spending over the 2011-2021 period covered by the projections, expanding coverage to some 30 million uninsured people (Alonso-Zaldivar, 6/12).

Reuters: Government Forecasts Modest Health Spending Growth
The annual growth rate for U.S. healthcare spending will hover near historic lows in 2013 and rise at a modest pace for much of the next decade, even if the Supreme Court allows the expansion of coverage to millions more Americans to proceed, a government report said on Tuesday. The U.S. Centers for Medicare and Medicaid Services said healthcare spending will rise about 4 percent a year between now and 2014, when President Barack Obama's reform law takes full effect and provides coverage to more than 30 million uninsured Americans (Morgan, 6/12).

Kaiser Health News: Capsules: Report: Health Spending Will Climb To Near One-Fifth Of GDP
National health spending will account for nearly one-fifth of the U.S. economy in 2021, according to updated estimates from the federal government (Torres, 6/12).

Bloomberg: Health-Care Spending To Reach 20% Of U.S. Economy By 2021
An aging population, improving economy and President Barack Obama’s health-care overhaul will push spending on medical services to almost 20 percent of U.S. gross domestic product by 2021, the government projected. Spending on hospital visits, medications and other health care rose an estimated 3.9 percent in 2011 and consumed about 17.9 percent of GDP, the same as the previous two years, the Centers for Medicare and Medicaid Services said yesterday. The increases in such expenditures will continue to outpace economic growth projections, jumping 7.4 percent in 2014, when much of the insurance expansion created by the health law begins (Wayne, 6/13).

Politico: Projections: ACA Will Have Small Impact On Spending Growth
Health care spending will spike in 2014 as millions of people gain coverage, but the overall rate of annual growth for the decade ending in 2021 will average 5.7 percent — 0.9 percentage point faster than the economy, according to new Centers for Medicare & Medicaid Services projections released Wednesday (DoBias, 6/12).

CQ HealthBeat: The Overhaul's Impact On U.S. Health Spending: A Lot Or A Little?
Depending on who you talk to, the health care law either is a luxury the nation can't afford or a pretty good deal. Ten-year spending projections government economists issued Tuesday provide analysts on both sides of the debate with statistics they can cite to depict the overhaul the way they want. Those who think the law costs too much are likely to note that over the next few years national health spending is going to grow at unusually low rates, according to the projections issued by the Office of the Actuary at the Centers for Medicare and Medicaid Services But when coverage expansion kicks in fully under the health law in 2014 — assuming it takes effect — the growth rate will jump (Reichard, 6/12).

MedpageToday: ACA To Trigger Growth Spurt In Health Spending
Healthcare spending in the U.S. is expected to continue to grow slowly over the next year and a half, but then speed up in 2014 when a number of provisions of the Affordable Care Act (ACA) kick in, according to a report from economists and actuaries at the Centers for Medicare and Medicaid Services (CMS). And, by 2021, health care costs will equal 19.6% of the nation's gross domestic product (GDP), up from 17.9% in 2011, Sean P. Keehan, an economist in the CMS Office of the Actuary, told reporters at a Tuesday morning press conference (Walker, 6/12).

The Dallas Morning News: Health Care Law Trades Spending For Greater Insurance
Without the 2010 health care overhaul, the nation would spend $478 billion less over the next decade but leave 30 million Americans without health insurance, federal health economists projected Tuesday. The Supreme Court is expected to rule this month on the constitutionality of the law’s insurance mandate, and Republicans have vowed to repeal the entire act. Economists with the federal Centers for Medicare and Medicaid Services would not comment on the consequences of repeal. But they said the law increases health spending by an average of 0.1 percent a year (Landers, 6/12).

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Health Reform

Insurers, Politicians Girding For Supreme Court Health Law Decision

Insurance company executives tell news outlets they support the mandate to buy insurance or pay a fine, as Republicans try to refine their post-SCOTUS decision strategy.

The Wall Street Journal: Health Care Law Or Not, Insurance Is Set To Change
As the Supreme Court prepares to rule on the federal health overhaul, health insurers are in the spotlight. The law has been reshaping the health insurers' business -- requiring, for instance, that they spend a set share of premium dollars on health care, or send refunds to customers if they fall short -- and this month could see the law vanish or change markedly. … [Mark T. Bertolini, Aetna's] chief executive, says the new, more collaborative approach makes sense no matter what the court decides (Mathews, 6/12).

MarketWatch: Health Law Without Mandate May Hike Costs
So how important is the mandate? "It’s very important to the goals of making the private health-insurance market more viable and expanding coverage," said Paul Ginsburg, president of the Center for Studying Health System Change, a nonpartisan research group in Washington. ... The difference is about 12 million people and twice as much government spending per newly insured person if the mandate is eliminated, said Christine Eibner, a health economist at the Rand Corp (Gerencher, 6/13).

The New York Times: Navigating The Health Care Maze
[Peter Kim] and his wife resorted to catastrophic coverage, paying out of pocket for routine medical care -- until they discovered the health insurance exchange that Massachusetts set up in 2006. A linchpin of the state law passed under Mitt Romney as governor, which requires most residents to have health coverage, the exchange is an online marketplace meant to simplify buying insurance and thus help people find a plan they can afford. If the Supreme Court upholds [the law] ... proponents say that exchanges will be a crucial tool for extending insurance to most Americans (Goodnough, 6/12).

Kaiser Health News: Kaiser Permanente's Ross: There's No Effective Substitute For The Mandate (Video)
Murray Ross, director of the Kaiser Permanente Institute for Health Policy, says he believes that the health law's requirement that most Americans have coverage by 2014 or pay a fine is necessary. By design, says Ross (who is also a vice president in the part of the company that sells health plans), the "individual mandate" would attract both the healthier and sicker individuals to balance risk and the cost of coverage (Werber Serafini, 6/12).

Politico Pro: ACA In Trouble? Ben Nelson To The Rescue
President Barack Obama's health care law has found a savior -- a Senate Democrat who lashed out Tuesday against an "activist Supreme Court" that might strike it down.The name of the savior? Ben Nelson. Yes, that Ben Nelson. The one who held out for weeks in 2009 before he'd agree to vote for the law. ... [H]e put out a blistering press release Tuesday warning that the court could put sick kids at risk if it strikes down the law. And send millions of Americans' health insurance premiums soaring sky-high, too (Nather, 6/12).

Politico Pro: GOP Ready To Jump On Taxes, Health Care
Speaker John Boehner recently told Republicans in a private meeting to change their tone on health care and fast: stop using "job-killing" to describe the Obama health care law. Instead, emphasize that the law drives up costs and makes things worse for small businesses. Why? The job-killing message was polling poorly, sources said. The episode underscores both the GOP's recognition that it needs to be ready to respond to the Supreme Court's forthcoming decision on the health care law and the delicacy with which Republicans must fashion that response (Sherman and Allen, 6/12).

The Hill: Supreme Court Health Law Decision Could Be Trouble For Republicans
So far, the party has not come together around a set of policies to replace the health care law if it's struck down entirely. Republicans also haven't said how they would handle policies that are already in place, including discounts on prescription drugs for many seniors. ... Part of the law simply reauthorized existing programs, some of which had been in place for decades before the health care law was signed. When asked whether the GOP would move first to replace the law’s reauthorizations and other small-bore, generally agreed-upon items, [Rep. Tom] Price said such speculation was "premature" (Baker, 6/13).

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Health Law's Birth Control Mandate, Medicare's Doughtnut Hole Draw Headlines

Drug manufacturers may abandon the health law's provisions to close Medicare's so-called "doughnut hole" if the high court overturns the measure. Also, religious leaders press the Department of Health and Human Services to widen the religious exemption to the health law's birth control mandate.  

Kaiser Health News: Medicare Drug Discounts At Risk If Court Strikes Health Law 
Billions of dollars in drug savings for Medicare beneficiaries may come to an end if the Supreme Court overturns the 2010 federal health law, a drug industry spokesman said Tuesday (Jaffe, 6/12). 

Religion News Service/The Washington Post: Religious Leaders Ask HHS To Broaden Birth Control Exemption
A coalition of nearly 150 religious leaders, led by conservative Protestants, have petitioned the Obama administration to broaden the exemption that allows churches and some religious organizations to avoid a controversial new mandate that all health care insurers provide free contraception coverage (Gibson, 6/12).

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Campaign 2012

Romney Sees 'Consumer' Health Care In The Post-Health Law Landscape

As the country awaits the health law decision and President Barack Obama appears to be playing down campaign talk about the health law, GOP presidential candidate Mitt Romney took the opposite approach by offering his vision of health care in America when the law is undone.  

The Associated Press: Obama Doesn't Emphasize Issues He Fought Hard For
Fighting for re-election, President Barack Obama is playing down his historic health care overhaul and the multibillion-dollar recession-fighting stimulus -- two landmark efforts of his first three years in office. Those signature policies are unpopular, and voters clearly want the candidates to focus instead on jobs (Thomas, 6/12).

Los Angeles Times: Romney Touts Health Care Plans Ahead Of Supreme Court Ruling
With the Supreme Court on the verge of determining the fate of President Obama's health care overhaul, Mitt Romney sought to position himself Tuesday as a champion of affordable coverage for the middle class. In remarks to a few hundred supporters in the warehouse of an air-filter maker, Romney expanded on his pledge not just to repeal "Obamacare," but to replace it (Finnegan, 6/12).

The Washington Post: Romney Outlines Plan To Make Health Care System Like 'Consumer Market'
Addressing supporters in Orlando, Romney fleshed out a plan that he proposed earlier, one that would apply free-enterprise principles to the nation's health care system rather than operate it like a "government-managed utility," letting competition drive down prices and increase quality. He also vowed to divert federal Medicaid money and other federal funding to state governments, making them responsible for covering the uninsured. And he promised that his plan would help cover people with preexisting conditions, one of the more popular components of Obama's law (Rucker, 6/12).

Reuters: Romney Sees 'Consumer' Health Care After Obama Plan
Republican Mitt Romney on Tuesday laid out his vision for a "consumer market" health care approach to replace President Barack Obama's sweeping reform law, whether or not the U.S. Supreme Court overturns the legislation this month. The presumptive Republican presidential nominee told supporters in Orlando, Florida, that he would prevent people with pre-existing medical conditions with a history of health coverage from losing their insurance (6/12).

The Associated Press: Romney Health Care Vision Short On Detail
Anticipating the death of President Barack Obama's health care overhaul, Mitt Romney outlined his plans Tuesday to expand coverage to the nation's uninsured, while protecting at least one popular safeguard that would be eliminated should the Supreme Court strike down the law. The presumptive Republican presidential nominee promised to help maintain coverage for those with pre-existing health conditions and expand tax breaks to individuals wishing to purchase health insurance directly, instead of through their employer (Peoples, 6/12).

Bloomberg: Romney Outlines Health Care Plan As Supreme Court Weighs Law
Mitt Romney pledged to replace the U.S. health care overhaul with a plan relying on private markets to provide "access to good health care" for every American, as he revived attacks on President Barack Obama's signature achievement that the U.S. Supreme Court is preparing to rule on. The presumptive Republican presidential nominee told small- business owners in Orlando, Florida, that he would implement policies, including tax breaks, aimed at helping the private market care for the uninsured and those with preexisting medical conditions (Lerer and Runningen, 6/13).

National Journal: Romney Calls Obama Out Of Touch On Hiring Impact Of 'Obamacare'
Mitt Romney used President Obama's health care law on Tuesday to hammer him as out of touch with the economy, arguing that Obama is naively unaware of the impact of the Affordable Care Act on small businesses. "Now just yesterday the president said something else that shows just how much out of touch he is. He said he didn't understand that 'Obamacare' was hurting small business; he doesn't understand that Obamacare impacts small business, and you have to scratch your head about that," Romney told an audience of about 300 at Con Air Industries, a Florida HVAC product manufacturer and distributor (Huisenga and Kaplan, 6/12).

And, in election tallies --

Arizona Republic: Ron Barber Will Serve Out Gabrielle Giffords' Term
More than a year after the nation's attention was focused on critically injured then-U.S. Rep. Gabrielle Giffords and those killed and wounded alongside her, the spotlight returned Tuesday to southern Arizona as her former aide Ron Barber won the special election to serve out her remaining term. … [Democrats] hammered [Republican Jesse] Kelly on statements about privatizing Social Security, phasing out Medicare and opposing any corporate income tax (Sanders, 6/13).

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Capitol Hill Watch

Senate Panel Includes Funding For Implementing Health Law In Spending Bill

GOP members of the Senate appropriations subcommittee opposed the measure.

CQ HealthBeat: Despite GOP Objections, Health Care Law Funding Included In Draft Spending Bill
A Senate Appropriations panel on Tuesday approved a fiscal 2013 spending bill for labor, health and education programs that includes funding to implement provisions of the 2010 health care overhaul, despite Republican objections. The Labor-HHS-Education Subcommittee approved the draft measure along party lines, 10-7. According to the committee, the legislation would provide a total of $158.8 billion in discretionary funding, which is $2 billion more than fiscal 2012 levels and roughly equal to the president's request. The amount includes approximately $12.3 billion for the Labor Department, $71 billion for the Health and Human Services Department (HHS) and $68.5 billion for the Education Department (Khatami, 6/12).

The Hill: Dems, GOP Battle Over Health Care Law As 2012 Spending Bill Advances
Democrats and Republicans clashed Tuesday over President Obama's signature healthcare reform law as Democrats moved forward with a 2013 spending bill that funds it. The Labor, Health and Human Services appropriations bill passed out of a Senate Appropriations subcommittee by a vote of 10 to 7 with the GOP united in its opposition to increased funding for the Affordable Care Act. It heads for a full committee vote on Thursday. Protecting the ACA's funding could be tricky if part of the law is struck down by the Supreme Court later this month (Wasson, 6/12).

Politico Pro: Labor-HHS Bill Would Increase CMS Funding
CMS would see its operations budget soar 20 percent — in part to fund the implementation of the Affordable Care Act — under the Senate Labor-HHS spending bill approved by an appropriations subcommittee Tuesday (Cheney, 6/12).

Meanwhile, the House and Senate are working toward a July 4 goal for an FDA bill.

CQ HealthBeat: Lawmakers Set July Fourth Deadline For Clearing FDA User Fee Measure
House and Senate leaders are continuing to work toward a July Fourth goal of completing legislation to reauthorize the Food and Drug Administration’s authority to collect drug and device user fees. Even though the House is not in session this week, staff members and some lawmakers are meeting in an informal conference to work out the differences between the chambers' bills (Ethridge, 6/12).

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Medicare

Medicare Advantage Enrollment Goes Up As Premium Costs Decline

A report by the Kaiser Family Foundation found that the enrollment increases were also due in part to seniors' reduced access to supplemental coverage as well as greater comfort with managed care.

Bloomberg: Medicare Advantage Enrollment Rises 10% On Lower Premiums
Enrollment in U.S. government-backed Medicare plans run by insurers led by UnitedHealth Group Inc. (UNH) rose 10 percent to a record this year as lower premiums enticed people to sign up, a study shows. The average monthly charge for the 13.1 million people on Medicare Advantage fell $4 to $35, and is down from $44 in 2010, the Kaiser Family Foundation said today in a report (Wayne, 6/12).

The Hill: Report: Enrollment Up, Premiums Down For Medicare Advantage
The 2010 healthcare law contained cuts to Medicare Advantage that were strongly opposed by Republicans and insurance companies. The program offers care to seniors through private insurers that contract with the Medicare agency. ... The program now covers more than 13 million beneficiaries, or 27 percent of the Medicare population, the report stated. ... The law's cuts to the program are expected to save $136 billion over 10 years (Viebeck, 6/12).

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Health Care Marketplace

JAMA: Wage Gap Persists For Women Physician-Researchers

A study in the Journal of the American Medical Association found that the average salary for women doctor-researchers was 16 percent lower than men, even after accounting for speciality, hours, etc.

Reuters: Women Doctors Make Less Than Men: Study
Female doctor-researchers make an average of $12,000 per year less than their male counterparts, even after their work hours and area of specialty are taken into account, according to a study out Tuesday. The wage gap between men and women is nothing new, but among doctors in particular it wasn't clear if the disparity was due to different career choices and work habits in men and women that could have affected their pay (Pittman, 6/12).

Modern Healthcare: Female Doc-Researchers Have Lower Salaries: Study
For the men, the overall average salary was $200,433 or some 16.3 percent higher than the women, whose average salary was $167,669 (Robeznieks, 6/12).

MedPage Today: Salaries Lag For Women Docs In Research
Even after adjustment for differences in specialty, academic rank, leadership positions, publications, and research time, there remained an absolute difference of $13,399 per year between the sexes (P=0.001), the researchers reported in the June 13 issue of the Journal of the American Medical Association (Neale, 6/12).

JAMA: Gender-Based Pay Gap Persists Even for Top Medical Researchers
Lead author Reshma Jagsi, MD, DPhil, associate professor in the department of radiation oncology at the University of Michigan, discussed the results with news@JAMA: ... "I don’t think the pay disparity is the result of a conscious bias against women. I think it’s much more likely to be the result of unconscious biases. Studies show men and women are both more likely to hire a man than a woman and to give credit to a man. Employers may be thinking about a family wage, that a man needs to support a household. But it’s hard to justify the difference," [she said] (Kuehn, 6/12).

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Quality

Use, Overuse Of Imaging Tests Adds About $100 Billion To U.S. Medical Bills

The use of diagnostic imaging has nearly tripled since the mid-1990s, according to a new study, raising questions about whether the benefits outweigh the risks of increased radiation exposure.

Los Angeles Times: Use Of Imaging Tests Soars, Raising Questions On Radiation Risk
Advanced imaging adds about $100 billion to U.S. medical bills each year, said study leader Rebecca Smith-Bindman, a radiologist and epidemiologist at UC San Francisco. There is widespread agreement in the medical community that imaging tests are overutilized, particularly CT scans (Bardin, 6/12).

Reuters: Imaging Use Up In U.S. HMOs, Adds To Radiation Worry
Use of diagnostic imaging in the United States has doubled since the mid-1990s, raising fears that radiation exposure from technologies such as computed tomography (CT) scans may raise a person's lifetime cancer risk, researchers said on Tuesday. Previous research had shown rising usage in patients in the government's Medicare insurance program for the elderly. The new study showed use of imaging technologies rising by about the same amount in health maintenance organizations (HMOs) in the private sector, underscoring concerns about radiation exposure (Steenhuysen, 6/12).

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State Watch

R.I. Lawmakers Pass Federal Health Care Law Compliance Bill

Rhode Island and Connecticut moved forward on implementing the health law: Lawmakers in Providence approved legislation to bring state health insurance laws in line with the federal health care law. In Connecticut, the health insurance exchange board added a member.

Providence Journal: R.I. House Approves Legislation Bringing State In Line With Federal Health Care Overhaul
Over the strong objections of Republicans, the Rhode Island House of Representatives approved legislation Monday to bring the state's health insurance laws in compliance with President Obama's federal health care law.  House Republicans, by far the minority in the 75-member chamber, called on lawmakers to reject the proposal, as the U.S. Supreme Court is currently considering the constitutionality of certain key provisions on the federal Patient Protection and Affordable Care Act of 2010 (Marcelo, 6/11).

CT Mirror:  Panel Implementing Health Reform To Add A Voting Member
The composition of the board charged with implementing a key part of health reform -- creating a marketplace for individuals and small businesses to buy health care coverage -- is likely to change by a change in the status of the state's health care advocate. Victoria Veltri, now an ex officio board member, would become a voting member of the board (Thomas, 6/12).

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CalPERS Readies Nearly 10% Rate Hike; Blue Shield Of Calif. Faces Lawsuit

California's Public Employees' Retirement System premium increase is more than twice as large as last year's. Meanwhile, the lawsuit against Blue Shield alleges that the insurer is seeking to push customers into new options that offer less coverage.

Los Angeles Times: CalPERS Health Premiums Expected To Jump Average Of 9.6% In 2013
California Public Employees' Retirement System, the third-largest purchaser of health benefits in the country, said its health premiums next year are expected to increase 9.6 percent on average for nearly 1.3 million members. These recommended rates from the CalPERS pension and health benefits committee await full board approval Wednesday. If adopted, the rates for various health plans would take affect Jan. 1 (Terhune, 6/12).

Sacramento Bee: CalPERS To Raise Health Care Premiums 9.6 Percent
The California Public Employees' Retirement System plans to raise health care premiums to its members by an average of nearly 10 percent next year, one of the biggest increases in recent years. The increase of 9.6 percent would be more than twice as big as the rate hike that took effect for this year. It would have significant implications for health care affordability in California and beyond (Kasler, 6/12).

San Francisco Chronicle: Blue Shield Sued Over Insurance Policy Shifts 
When Blue Shield of California raised the rates for Robert Jeffrey Martin's family insurance policy by 23 percent, the health insurer offered him two options: Stay in his expensive old plan or switch to a policy that offered his family skimpier benefits with a higher deductible. … "I feel like I was being culled from the herd. It was like, 'Let's get rid of these people,' " said Martin, who believes he is part of scheme by the insurer to force policyholders out of older, more comprehensive individual plans into newer options that offer less coverage with higher out-of-pocket costs. Martin is a named plaintiff is a lawsuit filed Tuesday in San Francisco Superior Court against Blue Shield, a San Francisco company (Colliver, 6/13).

In New York, the attorney general announced a settlement among insurer Group Health, a medical practice and patients after balance billing accusations --

Modern Healthcare: Settlements Announced In Balance-Billing Cases
The New York attorney general's office announced actions against an insurer and a medical practice in Queens that were separately accused of underpaying patient bills and balance-billing patients for nearly $500,000 in three years despite a state law forbidding the activity. Group Health, a subsidiary of New York-based EmblemHealth, agreed as part of the settlement to reimburse patients who were affected when the company declined to pay out-of-network specialists at higher-than-standard rates that it agreed to in contracts (Carlson, 6/12).

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Conn. Children's Hospital, Insurer Reach Accord; San Francisco Nurses Plan Strike

A handful of articles look at developments at hospitals around the country.

The Connecticut Mirror:  Children's Hospital, Anthem Reach Agreement After Two-Month Standoff
Connecticut Children’s Medical Center and Anthem Blue Cross and Blue Shield announced today that they have reached a multi-year agreement, ending a two-month dispute that led to uncertainty and confusion for many patients and their families.  The hospital and the Connecticut Children’s Specialty Group had dropped the insurer April 16 after both sides failed to reach an agreement after a year of negotiations.  Under the deal, Anthem will immediately resume covering in-network costs (Merritt, 6/12).

San Francisco Chronicle: Oakland, UCSF Children's Hospitals May Merge
Children's Hospital Oakland, which has had its share of financial and other troubles in recent years, may soon be joining forces with UCSF's Benioff Children's Hospital. In a letter to the medical staff of the 190-bed Children's Hospital & Research Center Oakland last week, CEO Bertram Lubin said talks, initiated by UCSF, "have progressed with great enthusiasm and respect on both sides."  Neither side would disclose details of the talks (Ross, 6/13).

San Francisco Chronicle: 1-Day Strike For Nurses At Bay Area Hospitals
As many as 4,400 registered nurses at nine Bay Area hospitals operated by Sutter Health are set to walk off their jobs Wednesday as part of an ongoing labor dispute with the large Sacramento hospital chain. This will be the fourth strike since September organized by the California Nurses Association ... Labor leaders say sticking points include sick pay and reductions in employee benefits (Colliver, 6/13).

Modern Healthcare: R.I. Lawmakers OK Measure Allowing Steward Deal
The Rhode Island General Assembly passed legislation amending a state law that limits for-profit companies from buying more than one hospital every three years. The legislation also paves the way for the Boston-based Steward Health Care System to move forward with its purchase of Landmark Medical Center, a financially struggling 133-bed hospital in Woonsocket, R.I. (Lee, 6/12).

Kansas Health Institute News: Kansas Hospitals And Physicians To Launch Major Quality Initiatives
Groups representing Kansas hospitals and doctors on Thursday are scheduled to launch a major initiative aimed at reducing the number of patients who become infected or injured while hospitalized. Officials said collateral benefits of the effort would be fewer hospital readmissions and lower health care costs  (6/12).

Minnesota Public Radio: New Hires At VA To Boost Mental Health Care Services
The Minneapolis VA Medical Center is adding two-dozen new mental health staff positions. The St. Cloud Medical Center is adding five new mental health staffers. The hiring is part of a national effort to help returning war veterans with mental health needs (Mador, 6/12).

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Iowa Gov. Wants State Workers To Pay For Part Of Health Care

This pair of stories from the Des Moines Register, based on a meeting with Gov. Terry Branstad, details Branstad's plans for state employees' health benefits and efforts to develop a state alternative to the health law.

Des Moines Register: Branstad: State Employees Must Pay For Health Care; Predicts Obama Will Fail In Iowa
Iowa's state employees would be required to pick up 20 percent of their health care costs under a demand Gov. Terry Branstad will make during union negotiations this year, he said today in a meeting with The Des Moines Register. If successful, it would cost state workers roughly $46.3 million a year. Most state employees currently pay nothing in health care premiums (Clayworth, 6/12).

Des Moines Register: Branstad Working On 'Obamacare' Alternative
Gov. Terry Branstad said Tuesday that he has been working with leaders from the insurance and hospital industries to form an Iowa alternative to President Obama's health-reform plan. "We've had kind of a working group that's been looking at this for a long time," Branstad told Des Moines Register writers and editors. The governor said the state has several advantages, including that it has a history of providing high-quality, low-cost care and that relatively few of its residents lack health insurance (Leys, 6/12).

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State Roundup: Mass. Bill Seeking Alzheimer's Care Standards Moves Forward

Today's selection of health policy stories includes news from Massachusetts, Michigan, California, North Carolina and New York.

Boston Globe: Bill Seeking Alzheimer's, Dementia Care Standards Advances
A proposal to create minimum standards for Alzheimer's and dementia care in Massachusetts nursing homes is one step closer to becoming law. The state Senate Tuesday unanimously passed legislation that would require the Massachusetts Department of Public Health, which regulates nursing homes, to establish minimum standards for facilities with dementia care units. The House approved the proposal last month (Lazar, 6/12).

Boston Globe: Mass. House Health Care Leader Has Personal Experience With Medical Over-Testing
Representative Steven Walsh has attended 800 meetings with health care industry executives while researching the House’s health care cost-control legislation. But his personal experience as the father of a very sick infant has been eye-opening too. During a breakfast Tuesday sponsored by the Massachusetts Health Council, a non-profit group that promotes public health, Walsh said he witnessed overuse and denial of medical care for his 1-year-old twin son, who was born with a serious heart condition (Kowalczyk, 6/12).

Detroit Free Press: Emotions Flare As Abortion Bills Weighed
Emotions are running high on both sides of the abortion debate as the state House considers -- as early as today -- a package of bills to add the most sweeping restrictions on the procedure the Legislature has considered in decades. Abortion rights supporters say the bills could result in the closure of most Michigan clinics where abortions are performed. Abortion rights opponents say the bills are a remedy for abuses (Gray, 6/13).

San Jose Mercury News: Frail Seniors Program's Launch Brings Confusion, Delays For Californians
To save money, the state limited Medi-Cal coverage for such care to those with the most serious needs. ... The state this year found about 7,000 seniors ineligible out of 35,000 participants in a program originally meant to save money by keeping medically fragile people out of more costly nursing homes and high-cost emergency rooms. Some 1,800 … have appealed, and some centers, unwilling to leave people without services, are sagging under the financial pressure of keeping their doors open to people the state no longer pays for. The cutback is difficult but necessary, state health leaders say. "The unfortunate fact is that the state is in a very difficult budget situation," said Norman Williams, spokesman for the Department of Health Care Services (Kleffman, 6/12).

North Carolina Health News:  Advocates Plead With Senate To Restore Cuts Made In Health & Human Services
During a standing room only meeting this morning at the General Assembly, the full Senate Appropriations Committee discussed their proposed $20.2 billion budget for about 40 minutes, and then allowed about an hour of public input on the provisions included in it.  Sen. Richard Stevens (R-Cary) outlined the broad plan of the health and human services budget, which focuses on Medicaid and the program's $150 million deficit (Hoban, 6/13).

California Watch: Beverage Lobbyist Funds 'Community' Campaign Against Soda Tax
A powerful Washington, D.C., trade organization that represents PepsiCo, Coca-Cola and other major beverage companies is helping fund a Richmond group that is fighting a November ballot measure to raise taxes on soda and other sweetened beverages, interviews and records show (Harless, 6/13).

The Associated Press: NYC Health Board Likes Big Drink Ban Proposal
New York City's Board of Health signaled strong support Tuesday for the mayor's plan to fight obesity by banning the sale of large, sugary beverages at local restaurants. The proposal by Mayor Michael Bloomberg would prohibit licensed food service establishments in the city from using containers bigger than 16 ounces to serve high-calorie drinks like colas, lemonade and punch (Caruso, 6/12). 

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Editorials and Opinions

Viewpoints: Puzzling Slowdown In Health Spending; Court Decision Could Help End Businesses' Fears About Health Law

The Fiscal Times:  Recession's Upside:  Slowdown In Health-Care Spending
Economists will debate the causes of the great slowdown in health-care spending that’s now underway for a long time to come. ... And last year, preliminary government estimates released Tuesday showed, health care spending once again grew at just a 3.9 percent rate. If the economists at the Centers for Medicare and Medicaid Services (CMS) are correct, it will stay around that level for another two years and cause national health care expenditures to fall to 17.8 percent of GDP in 2013, the year before the reforms of the Affordable Care Act are due to kick in (Merrill Goozner, 6/13).

Roll Call: Court's Health Care Decision Could Help Backers And Foes
Besides giving its remaining Congressional backers a possible reprieve this November by putting voters in a less recriminative frame of mind, a Supreme Court torpedoing of the administration’s flagship social legislation could also help the president and his Congressional supporters on another issue, one where they need it most. The law’s passage spooked American business (Dan Weber, 6/12).

Boston Globe: Health Care System Needs More Freedom And Competition, Not Less
[The] orthodox view is that to shield people with serious medical needs from undue financial hardship, we must suppress the normal workings of a free market — supply and demand, competition, flexible prices. There's just one problem with this approach: It doesn't work. Six years after Romneycare became law, health insurance coverage in Massachusetts is all but universal. Yet a new statewide survey finds that those most in need of medical care are finding it harder than ever to pay for (Jeff Jacoby, 6/13).

Baltimore Sun: Insurers Do The Right Thing On Health Care
Singing the praises of major U.S. insurance companies is not a common pastime on these pages, but recent events require at least a stanza and perhaps even a chorus. Such is the tuneful news that several have decided that no matter how the U.S. Supreme Court rules, they intend to retain certain provisions of President Barack Obama's health care reform law. UnitedHealth Group, Inc. was the first to make that announcement and was later joined by Aetna and Humana. The move will allow policyholders to get certain kinds of preventive care without a co-payment, allow adult children up to age 26 to stay on parents' health plans, and avoid lifetime claims limits on individuals with chronic diseases, just as they would under the health care reform act (6/12).

KQED:  Why Is Mayor Bloomberg A 'Nanny'?
State of Health has followed the soda tax issue closely. Richmond voters will decide in November whether their city will be the first in California to levy a soda tax. The City Council voted to put the measure on the ballot only after hours of heated public debate.  Critics of the tax had many objections, not least of which was concern about an over-reaching government. So when New York Mayor Michael Bloomberg proposed limiting portion sizes on sugary drinks, I wasn't surprised when opponents of the idea labeled it a "nanny state" tactic. Then came the full page ad in the New York Times from the Center for Consumer Freedom. I shrugged and confess that I was a little amused (Lisa Aliferis, 6/12).

Miami Herald: Reason For Skepticism
WellCare continues to do business in Florida and other states, and there has been no hint that the "bad stuff" has been repeated. Given the depth of its experience in this arena, WellCare stands a good chance of continuing to do business here, but not so fast. No matter how reformed this company is, the state can't blithely give it a pass. Under a new state law, a company will lose other contracts if it stops providing services in one area. That's a start in accountability. Florida must monitor healthcare outcomes and audit WellCare's books to make sure taxpayers’ money is being spent on good care, not squandered — saving the millions promised.

Boston Globe: Access To Sleep Testing Will Make A Big Health Impact
The number of people in Massachusetts living with obstructive sleep apnea would fill Fenway Park 10 times over. Sadly, the majority of them don't know it and fewer still are being treated. … This is a shame, since addressing this disease, with its connections to the country's most expensive health conditions — obesity, diabetes and heart disease — reduces health care costs and improves the quality of life for millions (Dr. Michael Coppola, 6/12).

JAMA: The Cost Of Drug Coupons
Drug coupons raise two primary financial concerns. First, coupons can increase out-of-pocket spending for the coupon user in either the short or long term because co-pays may still be higher compared with therapeutic alternatives (ie, direct costs). Second, coupons can increase health care spending for coupon users and nonusers by increasing aggregate health spending and thus health insurance premiums (ie, indirect costs) (Dr. David Grande, 6/13).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Shefali Luthra

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