Daily Health Policy Report

Monday, June 17, 2013

Last updated: Mon, Jun 17

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch


Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Hospital CEO Bonuses Reward Volume And Growth

Kaiser Health News staff writer Jay Hancock, working in collaboration with ABC News, reports: "Like hospital leaders everywhere, the people running Valley Medical Center in Renton, Wash., talk frequently about the need to control soaring medical costs. … But even as Valley officials talk about change, they're paying hospital CEO Richard Roodman tens of thousands of dollars in bonuses for driving the kind of profits and expansion many say are no longer affordable for patients, employers and taxpayers" (Hancock, 6/16). Read the story and related components, including a chart tracking CEO compensation, a sidebar detailing what sometimes determines a CEO’s compensation, a look at some CEOs who shun bonus pay and an FAQ about the story. You can also watch the video.

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Panel Tells Congress Medicare Is Unfairly Penalizing Hospitals Serving The Poor

Kaiser Health News staff writer Jordan Rau, working in collaboration with The Washington Post, reports: "The financial penalties that Medicare imposes on hospitals with high rates of patient readmissions are too harsh for hospitals serving the poor and should be changed, according to a congressional advisory agency" (Rau, 6/14). Read the story.

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Your Smartphone Might Hold Key To Your Medical Records

Minnesota Public Radio's Elizabeth Stawicki, working in partnership with Kaiser Health News and NPR, reports: "How could a local doctor in Maryland access his dad's medical record in Boston? Through Medicare Blue Button, a computer program that allows patients to download their medical history into a simple text file on their smartphones and personal computers. Then third-party applications that you download help organize this information" (Stawicki, 6/17). Read the story.

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Political Cartoon: 'No-Go Pogo?'

Kaiser Health News provides a fresh take on health policy developments with "No-Go Pogo?" by Nick Anderson.

Meanwhile, here is today's health policy haiku:


High-end surgeries
bring hospital CEOs
hefty bonu$e$.

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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Health Reform

Health Exchanges: Choice Of Plans Will Vary Sharply From State To State

The New York Times reports that millions of people shopping in the new online marketplaces will discover their choices -- or lack thereof -- will depend on where they live. The Washington Post reports that many states are racing to have the online marketplaces ready to enroll people by Oct. 1. Also in the news, exchange developments from Wisconsin, California and Minnesota.

The New York Times: Choice Of Health Plans To Vary Sharply From State To State
When a typical 40-year-old uninsured woman in Maine goes to the new state exchange to buy health insurance this fall, she may have just two companies to choose from: the one that already sells most individual policies in the state, and a complete unknown — a nonprofit start-up. Her counterpart in California, however, will have a much wider variety of choices: 13 insurers are likely to offer plans, including the state's largest and best-known carriers (Abelson, 6/16).

The Washington Post: States Running Out Of Time On Health Insurance Exchanges
With the deadline for states to implement Affordable Care Act-mandated health insurance exchanges less than four months away, state governments will need to move fast. States are having to reevaluate their existing health insurance infrastructures to meet the act's requirements. They have already received nearly $4 billion in funding for the effort thus far — and can access more dollars through 2014 (White, 6/16).

Bloomberg: Obamacare Rollout Seen Slowed By Confusion Over Benefits
Judith Mayer Lynn, uninsured and battling breast cancer, should be a fan of the Affordable Care Act. Instead, she barely knows about it. The 56-year-old Nevada woman was unaware of subsidies in the law that will help people like her buy coverage in 2014, she said in an interview (Nussbaum and Wayne, 6/17).

MPR News: Advocates For Poor Say MNsure's 2-Tier Enrollment System Is Unfair
The state's new online health insurance marketplace, MNsure, is banking on community groups and other grass-roots organizations to help people sign up for health plans. MNsure will pay consumer assistants to help Minnesotans apply for and enroll in coverage. But MNsure has a two-tier payment system that advocates for low-income people call unfair (Stawicki, 6/17).

Milwaukee Journal Sentinel: More In State Must Shop For Health Care Coverage
Gov. Scott Walker rejected federal money to expand the state's Medicaid program because he would like more people to get coverage through commercial health plans instead of government programs. But the decision also means that tens of thousands more people will need to shop for a commercial health plan on the new marketplace known as an exchange. That, in turn, will put additional demands on people at hospitals, community health centers and community groups who are expected to do much of the work in helping people sign up for coverage (Boulton, 6/15).

In related news -

The Wall Street Journal: Aetna To Leave California Individual Insurance Market
The pullout is likely to draw attention as California has become a focus of national debate over the law's impact. Supporters, including President Barack Obama, who highlighted the state in a recent speech, argue that it has shown the success of the health overhaul in encouraging competition and pushing down prices (Mathews, 6/14).

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Health Law's Impact On Premiums Still A Question

Meanwhile, news outlets report on the Obama administration's challenge to educate a largely uninformed public about the law's benefits.

McClatchy: Obamacare's Big Decision: What Is It Going To Cost Me?
The cost of health coverage under Obamacare remains one the biggest mysteries of the nation’s health care overhaul. But nagging cost questions will slowly be answered this summer as insurers and state officials set 2014 health plan rates for people who buy coverage outside of work or purchase it through small employers. Those two coverage areas – the individual and small group markets – face the biggest rule and cost changes next year, when the main provisions of the Affordable Care Act finally kick in (Pugh, 6/17).

NPR: To Find Out How The Health Law Affects You, Ask The President
Call it the Affordable Care Act, call it Obamacare, call it whatever you want — it's coming. And soon. In less than four months people without health insurance will be able to start signing up for coverage that begins Jan. 1. A lot has been said about the law, most of it not that understandable. So starting now, and continuing occasionally through the summer and fall, we're going to try to fix that (Rovner, 6/17).

Milwaukee Journal Sentinel: Enrolling Uninsured In Obamacare Will Be A Challenge
Ray Bochas had little reason to learn about the details of the Affordable Care Act before February. That's when the InnoWare paper napkin and plate factory in Menomonee Falls shut down, and he lost his job and his health insurance. … He has heard that he's supposed to get health insurance next year but doesn't know what he and his wife will need to do. The Affordable Care Act's main goal of increasing the number of people with health insurance could hinge on reaching people like Bochas who will be eligible next year for coverage through Medicaid or through subsidized health plans sold on marketplaces known as exchanges (Boulton, 6/15).

The Wall Street Journal’s Law Journal: Want A Law Job? Learn The Health-Care Act
Some companies are warning that President Barack Obama's health-care overhaul will cost jobs. It won't be in their legal departments. Health-care companies racing to comply with the Affordable Care Act and other rules are calling in the lawyers, sparking a mini-boom for specialist attorneys who can backstop overloaded internal teams and steer clients through an increasingly crowded regulatory minefield (Smith, 6/16).

And here's the latest on how accountable care organizations are shaping up --

Medpage Today: Distribution Of ACOs Varies Widely
More than 40 percent of accountable care organizations (ACOs) formed under Medicare exist in only five states, leaving many states with one or none, according to an analysis by industry experts. Medicare ACOs are concentrated in states like Florida (32), California (22), and Massachusetts (18) but rural states -- like North Dakota, South Dakota, Utah, Wyoming, Oklahoma, and Kansas -- are devoid of them, according to the analysis by consulting firm MedeAnalytics in Emeryville, Calif. Others like Montana, Idaho, Mississippi each only have one Medicare ACO (Pittman, 6/14).

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Michigan Inches Toward Medicaid Expansion

Also in the news, Virginia remains undecided on the expansion as a legislative panel, called the Medicaid Innovation and Reform Commission, holds its first meeting, and The Arizona Republic details how Gov. Jan Brewer closed the deal in that state.

Politico: Michigan Moves Toward Medicaid Expansion
Another Republican-controlled state embrace of Medicaid expansion could be just around the corner. The Michigan Senate is expected to vote this week on a compromise reached in the lower chamber that would expand the program but limit how long beneficiaries can stay on it (Millman, 6/17).

Richmond Times Dispatch: Battle Lines Drawn In Va. Medicaid Overhaul
The Virginia Medicaid Innovation and Reform Commission will meet for the first time today to review a three-phased plan of reforms outlined in amendments to the state budget that will take effect July 1. The 10-member legislative commission would be able to authorize the expansion of Virginia’s Medicaid program under the Patient Protection and Affordable Care Act as early as the middle of next year if it finds those goals have been met – and that has opponents of the federal health care law crying foul. "This is a setup," said Del. Robert G. Marshall, R-Prince William, who vows to file suit to block the commission from allowing Medicaid expansion without action by the entire legislature. "This is a way to pave the way to say 'yes'" (Martz, 6/17).

Roanoke Times: Virginia Still Undecided On Medicaid Expansion
Casto, the Fieldses and Macauley-Cintron are among an estimated 376,000 to 400,000 people in Virginia who would benefit from a proposed expansion of Medicaid, the government insurance program for the poor and disabled. ... Many of the potential beneficiaries are the working poor. They might be the cashiers on the other side of a fast-food counter, the laborers at one of the Roanoke Valley’s many warehouses or the migrant workers harvesting apples or tobacco. ... Virginia is on the fence. A two-year budget approved by the General Assembly in March allows for the expansion, but only if major improvements are made to the program. As part of the budget bill, lawmakers created a commission that will oversee the reforms and, ultimately, decide whether to proceed. The panel is scheduled to meet for the first time Monday in Richmond. A decision is expected by year’s end (Hammack and Reck, 6/15).

The Associated Press/Washington Post: Va. Panel Established To Certify Medicaid Reforms And Approve Expansion Meets For First Time
The state panel responsible for verifying that a series of daunting reforms to Medicaid have been met as a condition for expanding access to the federal-state health care program meets for the first time (6/17).

The Arizona Republic: How Brewer Won The Day On Medicaid
Five months after her dramatic call to extend health insurance to thousands of low-income Arizonans, Gov. Jan Brewer closed the deal by pulling together a bipartisan coalition, harnessing the power of her office and emerging as the star of this year’s legislative session. Few would have predicted this from Brewer. ... But unlike in past sessions, when she was less involved with the legislative process, Brewer traveled the state, staged rallies, used her veto power to prod lawmakers into a budget deal, called a surprise special session and pieced together the bipartisan bloc that passed her top legislative priority (Sanchez, Reinhart and Rau, 6/16).

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Political Battles Congeal Around IRS Scandals, Implementation Questions

The Associated Press reports that the funding sought by the Obama administration for the Internal Revenue Service's health law activities could be in jeopardy as a result of recent scandals. Meanwhile, The Hill reports that GOP lawmakers are developing plans for handling constituents' questions about the health law.  

The Associated Press: IRS Scandals Threaten Funding For Health Care Law
Mounting scandals at the Internal Revenue Service are jeopardizing critical funding for the agency as it gears up to play a big role in President Barack Obama's health care law. Obama sought a significant budget increase for the IRS for next year, when the agency will start doling out subsidies to help people buy health insurance on state-based exchanges. Congressional Republicans, however, see management problems at the IRS as an opportunity to limit the agency's funding just as it is trying to put in place the massive new law (Ohlemacher, 6/15).

The Hill: GOP To Constituents: Questions On ObamaCare? Call Obama
Republican lawmakers say they anticipate a flood of questions in the coming months from constituents on the implementation of ObamaCare, which will pose a dilemma for the GOP. People regularly call their representatives for help with Medicare, Social Security and other government programs. ... Some Republicans indicated to The Hill they will not assist constituents in navigating the law and obtaining benefits. Others said they would tell people to call the Department of Health and Human Services (Viebeck, 6/17).

In other news, Senate Democrats in some "red" states are not stepping back from the overhaul -

The Associated Press: 2014 Senate Democrats Firm Up Health Care Support
Far from reversing course, Senate Democrats who backed President Barack Obama's health care law and now face re-election in GOP-leaning states are firming up their support for the overhaul even as Republican criticism intensifies. Mark Begich of Alaska, Mark Pryor of Arkansas, Mary Landrieu of Louisiana and Kay Hagan of North Carolina will face voters in 2014 for the first time since voting for the Affordable Care Act — also known as "Obamacare" — three years ago. They aren't apologizing for their vote, and several are pursuing an aggressive strategy: Embrace the law, help voters use it and fix what doesn't work (Barrow, 6/15).

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Capitol Hill Watch

Some GOP Lawmakers See Health Law As Means To Stall Immigration Reform Efforts

On Capitol Hill, immigration reform, sequester cuts and abortion issues continue to grab headlines.

The Washington Post: Republicans Trying To Use Health-Care Law To Derail Obama's Immigration Reform Efforts
After spending years unsuccessfully trying to overturn "Obamacare," Republicans are now attempting to use President Obama's landmark health-care law to derail his top second-term initiative — a sweeping overhaul of the nation's immigration system. Conservatives in both chambers of Congress are insisting on measures that would expand the denial of public health benefits to the nation's 11 million illegal immigrants beyond limits set in a comprehensive bill pending in the Senate (Nakamura and Somashekhar, 6/16).

The Associated Press/Washington Post: From Cancer Patients To Head Start, Impact Of Sequester Cuts Slowly Ripples Across Nation
The first warnings about the spending cuts were dire. In March, as the sweeping $85 billion reductions known as sequestration kicked in, President Barack Obama called them "stupid" and "arbitrary" and said they could thwart economic progress. Opponents said the administration was using scare tactics, predicting doom even though the cuts amounted to a tiny slice of the federal budget (6/15).

The Hill: House Rules Changes Abortion Bill To Allow Rape, Incest Exceptions
The House Rules Committee on Friday altered a controversial bill banning abortions after 22 weeks of pregnancy, in cases of rape, incest or when the life of the mother is threatened. The bill, from Rep. Trent Franks (R-Ariz.), was approved by the Judiciary Committee without this language. But on Friday, House Majority Leader Eric Cantor (R-Va.) hinted that this may change (Kasperowicz, 6/15).

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Report Examines Medicare Spending Issues, Geographic Disparities And Hospital Payments

The report from the congressional advisory group MedPAC assesses a variety of issues, including penalties that Medicare has recently begun imposing on hospitals and how that affects facilities largely serving poor patients.

CQ HealthBeat: MedPAC Report Tackles Premium Support, Bundling, Readmissions, Site Neutral Payment
This year's version of the Medicare Payment Advisory Committee's June report to Congress, released Friday, addresses a variety of problems in the program ranging from overall spending growth to wildly varying levels of outpatient therapy spending in different parts of the country. It's far from the mother lode of potential payment offsets that more often is found in MedPAC's other major report to Congress each March (Reichard, 6/14).

Kaiser Health News: Panel Tells Congress Medicare Is Unfairly Penalizing Hospitals Serving The Poor
The financial penalties that Medicare imposes on hospitals with high rates of patient readmissions are too harsh for hospitals serving the poor and should be changed, according to a congressional advisory agency (Rau, 6/14).

In other Medicare news -

CQ HealthBeat: CMS Tells States To Pay Cost Sharing For Duals
The Centers for Medicare and Medicaid Services is cracking down on state Medicaid programs that have not met their duty to reimburse medical providers for cost sharing for some low-income beneficiaries who also get Medicare. CMS officials said in a recent bulletin that "state Medicaid agencies have a legal obligation to reimburse providers for any Medicare cost sharing that is due" for those patients who are dually eligible for both Medicare and Medicaid (Adams, 6/14).

Roll Call: In Spending Debate, Baby Boomer Issue Remains A Headache For Legislators
When Congress created Medicare in 1965 to handle the health care needs of the older population, less than 10 percent of Americans were old enough to collect Social Security and the new medical benefit. Since then, the share of Americans 65 and older has soared, from 9.3 percent in 1965 to 13.7 percent in 2012 (Krawzak, 6/14).

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Health Care Marketplace

Patients Opt For Walk-In Clinics Because Of Price, Wait Concerns

Retail and urgent care clinics are gaining steam as a way for people to see a doctor without the long waits or higher cost of getting care in traditional settings. In the meantime, Kaiser Health News reports on CEO bonus pay and how some CEOs are rewarded for increasing patient volume.

Los Angeles Times: Walk-In Clinics Gaining Popularity
Nontraditional health care sites such as urgent care centers and retail clinics are gaining popularity with consumers looking to avoid the long waits and high prices of the doctor's office or emergency department. These sites, however, are not meant to replace a relationship with a primary care physician, and they're never a substitute for appropriate use of hospital emergency rooms (Zamosky, 6/14).

Kaiser Health News: Hospital CEO Bonuses Reward Volume And Growth
Like hospital leaders everywhere, the people running Valley Medical Center in Renton, Wash., talk frequently about the need to control soaring medical costs. … But even as Valley officials talk about change, they're paying hospital CEO Richard Roodman tens of thousands of dollars in bonuses for driving the kind of profits and expansion many say are no longer affordable for patients, employers and taxpayers (Hancock, 6/16). Related story components include a chart tracking CEO compensation, a sidebar detailing what sometimes determines a CEO’s compensation, a look at some CEOs who shun bonus pay and an FAQ about the story. You can also watch the video.

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State Watch

Federal Officials Give Final OK For Florida's Medicaid Managed Care Plan

Approval by the Obama administration was expected after it gave its initial go-ahead just hours before Florida Gov. Rick Scott announced his support for the health law's Medicaid expansion.

Politico: Florida Gets OK For Medicaid Managed Care
Obama administration health officials have officially approved a plan expanding Medicaid managed care throughout Florida. The move was widely anticipated after the Centers for Medicare & Medicaid Services gave its initial approval Feb. 20, a few hours before Gov. Rick Scott announced his support for the Medicaid expansion (Millman, 6/17).

The Associated Press: Medicaid Managed Care Gets Final OK
Federal health officials have given final approval to a plan to overhaul Florida’s safety net health insurance program. Gov. Rick Scott announced the decision on Friday, saying it would allow the state's Medicaid program to "to provide Medicaid users with quality, value-based and patient-centered care" (6/14).

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N.M. Project Aims To Electronically Connect Primary Care, Mental Health Providers

A new health care project in New Mexico -- with an eye on expanding the project nationwide -- will allow primary care doctors and mental health experts to connect electronically to provide better mental health care to the state's residents.

Politico: New Project Addresses Mental Health Care Gap
A new project seeks to bridge the U.S.'s mental health care gap by linking up primary-care doctors and mental health experts. Though it's not funded as part of Obamacare, the project fits in with several of the health care law's goals: coordinating physical and behavioral health care for better health outcomes, shoring up the primary-care workforce and lowering costs through preventive care. The initiative, which is starting in New Mexico but could eventually be scaled nationwide, is also being launched amid heightened concern about filling gaps in the mental health care system after a series of high-profile shootings like the one in Newtown, Conn. (Smith, 6/17).

Medpage Today: Project Expands Reach Of Mental Health Providers
A video teleconference system that connects specialists with community health providers to provide better care for patients in underserved areas is expanding to mental health, thanks to a grant announced Friday. The GE Foundation will provide $4.6 million to the University of New Mexico Health Sciences Center in Albuquerque to expand its Project ECHO to increase access to mental health and addiction services. The Project ECHO model -- ECHO is short for Extension for Community Healthcare Outcomes -- allows specialists at a center like the university's to electronically connect with community providers to discuss complex cases and help those providers better treat their patients (Pittman, 6/14).

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State Highlights: States Urge Using Life Insurance For Long-Term Care

A selection of health policy stories from California, Minnesota, Illinois and Oregon.

The Wall Street Journal: States Ease Use Of Life Policies For Elder Care
State lawmakers are encouraging elderly residents to use life insurance as a way to pay for long-term care -- and lower the Medicaid tab in the process. The strategy marks a tacit endorsement of so-called life settlements, a practice in which policyholders sell their policies at a discount in the secondary market and the buyer takes over premiums and consequently collects the death benefit (Greene, 6/16).

Los Angeles Times: California Lawmakers Finalize $96.3 Billion Budget
California lawmakers wrapped up their work on the state budget on Saturday, approving bills detailing plans for university tuition assistance, energy efficiency projects and the expansion of health care programs. The Legislature also renewed a $500 million tax on managed care plans, which was allowed to lapse last year, and approved a framework for boosting welfare grants in the coming years (Megerian, 6/15).

Los Angeles Times: S.F. Grudgingly Backs Kaiser Rate Hike For Public Workers
Officials who oversee the health care plans that cover San Francisco public employees this week excoriated Kaiser executives for failing to adequately explain a proposed rate increase but ultimately voted to back it. The city's public workers have seen their health care costs spiral while they have accepted pay cuts and furlough days at the bargaining table. In an unusual move, labor unions teamed up with San Francisco's Health Service System earlier this year to demand greater transparency from Kaiser (Romney, 6/14).

MPR News: Mayo Med School Receives $1M Grant In AMA Training Initiative
Mayo Medical School is one of 11 medical schools across the country to each receive a $1 million grant from the American Medical Association to help transform the way medical students are trained. Mayo's proposal will create a curriculum to prepare students to practice within patient-centered, community-oriented, collaborative care teams. The 11 schools will form a learning consortium to address gaps in the way medical students are trained now and the needs of 21st century medicine, said AMA president Jeremy Lazarus (Baier, 6/15).

Bloomberg: Chicago Hospital Accused Of Cutting Throats For $160,000
A surgeon at Chicago’s Sacred Heart Hospital cut a hole in Earl Nattee’s throat on Jan. 3, the day before he died. It’s not clear why. The medical file contained no explanation of the need for the procedure, called a tracheotomy, according to a state and federal inspection report that quotes Sacred Heart’s chief nursing officer as saying it happened "out of the blue" (Babcock, 6/15).

Oregonian: Dozens Of Lobbyists Tie Up Bill To Let Consumers Sue Insurance Companies
More than 40 registered lobbyists are fighting a bill that would give Oregonians the right to sue insurance companies. House Bill 3160 would add insurance companies to the state's Unlawful Trade Practices Act, allowing Oregonians to sue companies for not paying claims promptly, denying coverage for losses or medical bills, and other reasons. Insurance companies are the only industry exempt from the 1971 law after banks were added in 2010 in the wake of the recession (Zheng, 6/14).  

California Healthline: Bill Would Extend Private Plan Requirement To Cover Autism Therapy
The autism community got good news this week when the Assembly Committee on Health unanimously passed a bill extending what advocates described as critical behavioral health therapy for people with autism. SB 126 by Sen. Darrell Steinberg (D-Sacramento) would require California insurers to include applied behavior analysis -- known as ABA therapy -- as an essential benefit under the Affordable Care Act next year (Hart, 6/14).

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Editorials and Opinions

Viewpoints: Don't Change Course On Medicare Reforms On Medical Equipment Prices; Liberals' Agenda Depends On Cutting Entitlements; Making Hospital Prices Public

The Washington Post: Medicare Changes Must Be Implemented Now
Marilyn Tavenner has been administrator of Medicare and Medicaid officially for only about a month, but already she faces a policy challenge from Congress. A majority of the House, 145 Republicans and 82 Democrats, wrote to Ms. Tavenner on Wednesday, asking her to delay implementation of a Medicare cost-reduction initiative, scheduled to take full effect July 1, for six months. They complain that procedural irregularities threaten patient access to wheelchairs, oxygen tanks, beds and diabetes test strips -- known in Medicare parlance as "durable medical equipment, prosthetics, orthotics and supplies," or DMEPOS for short. In fact, these concerns are overblown. Ms. Tavenner should not postpone these overdue reforms to Medicare's DMEPOS program (6/15).

The Washington Post: Liberals Should Lead Entitlement Reform 
Social Security, Medicare and the other major health care programs will account for more than half of all federal spending 10 years from now, CBO says. That takes into account the recent good news of slower-than-expected growth in health care costs, and it assumes Medicare cuts that are unlikely to be implemented. The guts of these programs have to be preserved, as liberals rightly argue. Social Security keeps the elderly out of poverty. Medicare ensures that they get health care, and Medicaid and Obamacare should come close to extending that promise to all Americans. But while federal programs aimed at the young and the poor -- and at investments in the future -- are slated to dwindle, the entitlement programs are on track to give ever richer benefits to a growing older generation, some of whom don't need all that much help (Fred Hiatt, 6/16). 

Los Angeles Times: Human Gene Patenting Is A thing Most Of Us Aren't Ready For
In the course of our country's history, the U.S. Patent and Trademark Office has bestowed coveted protection on many strange and wondrous inventions: the three-legged pantyhose (in case one leg runs), the sealed, circular peanut butter-and-jelly sandwich, the motorized ice cream cone. And of course, the human gene (Robin Abcarian, 6/15).

The Wall Street Journal: Will Companies Stop Offering Health Insurance Because Of The Affordable Care Act?
We asked a panel to tackle the question: Will the Affordable Care Act, as the law is formally known, lead many employers to stop offering health insurance? Our panelists are Kevin Kuhlman, a manager of legislative affairs at the National Federation of Independent Business, a research and lobbying group for small business; Christine Eibner, an economist at RAND Corp. who has studied the possible effects of the law on health-insurance markets; and David Marini, managing director, strategic advisory services, at Automatic Data Processing Inc., who also has studied the law's effects (Thrum, 6/16). 

The Wall Street Journal: Should Physician Pay Be Tied to Performance?
We need to rethink how we pay doctors. That's one thing almost everyone can agree on. The question is, how? Currently, most doctors get paid for every service they perform. But one of the big ideas behind President Obama's health-care overhaul is paying doctors based on how well they do their job. … The idea of paying providers for their performance has found plenty of backers -- and opponents -- throughout the medical community (6/16). 

The Wall Street Journal: Should Hospital Residency Programs Be Expanded To Increase The Number of Doctors?
Bills have been introduced in Congress that would increase the number of spots. But some critics say that we have too many doctors already, and that this contributes to the current problems in health care. Arguing in favor of training more doctors is Atul Grover, director of legislative affairs for the Association of American Medical Colleges. His opponent, Elliott S. Fisher, endorses ways to make health care better while reducing the number of doctors. Dr. Fisher is a professor at the Geisel School of Medicine at Dartmouth, director of Dartmouth Institute for Health Policy and Clinical Practice, and co-director of the Dartmouth Atlas of Health Care (6/16). 

Boston Globe: Hospital Prices Should Be Published
Steven Sonenreich, chief executive of Mount Sinai Medical Center in Miami Beach, has pledged a move virtually unheard of in the health care industry: to publish what his hospital charges insurers for procedures. "We will post our prices relative to Blue Cross and Aetna, our contractual prices," Sonenreich said during a local radio appearance in May. He went on to challenge other hospitals to follow his lead, and they should (6/17).

USA Today: Target Obesity With Health Care Reform 
The Medicare Board of Trustees just released its latest report on the program's finances and the results are terrifying. Despite a decline in health care costs, the Medicare Trust Fund will be bankrupt in 2026. For the program to survive for future generations, innovation will be essential. The old medical paradigm of diagnosing and treating diseases must give way to a more holistic approach aimed at eliminating risk factors that lead to disease. The best place to start is by addressing the growing problem of adult obesity (Tommy Thompson and Kenneth Thorpe, 6/15). 

JAMA: The Medicare Trustees Report: Time For Reflection, Not Celebration
As I and others have cautioned, there has been an excess of exuberance about the recent slowdown in health care spending. The jury on that is still out on the degree to which the encouraging numbers are due to profound and lasting changes in the system rather than the recession. Now there is another round of excitement -- in this case misplaced rather than just excessive -- thanks to the recent Medicare Trustees Report (Stuart Butler, 6/17).

Milwaukee Journal Sentinel: The Cost Of Ignoring Alzheimer’s
Alzheimer's is one of the most feared of all diseases of aging. It is one of the top 10 causes of death in the U.S. There is no cure, and there are no effective treatments. No one has ever survived. The fiscal and human costs of Alzheimer's are intergenerational and will change our society if we ignore them. The Alzheimer's Association estimates that 5 million Americans have Alzheimer's and that the number of persons and families affected by this disease will increase by more than 50 percent over the next 20 years (Mark A. Sager, 6/15). 

Richmond Times-Dispatch: Malpractice
Officials in Maryland apparently have been so impressed with Obamacare's ability to take a bad health care system and make it worse that they want to see if they can do the same. Maybe that's why they are planning to switch from the state's long-running system of specific price controls to an even more onerous system of global price caps. Since the 1970s, Maryland has essentially dictated what its 46 hospitals can charge for various procedures. Doing so has enabled the state to boast the lowest average cost for hospital care in 2011 -- but only at a significant cost to everyone else. Years ago, Maryland worked a special deal with Washington that enables its hospitals to receive considerably higher payments from Medicare (6/17).

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Stephanie Stapleton

Andrew Villegas

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.