Daily Health Policy Report

Monday, June 4, 2012

Last updated: Mon, Jun 4

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Campaign 2012

Health Care Marketplace

Health Care Fraud & Abuse

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

The New Normal In Health Insurance: High Deductibles

Kaiser Health News staff writer Jay Hancock, working in collaboration with The Washington Post, reports: "Angela Wenger calls herself a self-reliant 'German Midwesterner' who hates to complain. But the Wisconsin mom was dismayed when husband Dan's employer switched to an insurance plan that increased the family's medical expenses tenfold" (Hancock, 6/3). Read the story.

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As Patients' Records Go Digital, Theft And Hacking Problems Grow

Kaiser Health News' David Schultz, working in collaboration with The Washington Post, reports: "Keeping records secure is a challenge that doctors, public health officials and federal regulators are just beginning to grasp. And, as two recent incidents at Howard University Hospital show, inadequate data security can affect huge numbers of people" (Schultz, 6/3). Read the story.

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Debt Collectors In The ER

Minnesota Public Radio's Elizabeth Stawicki, working in collaboration with Kaiser Health News and NPR, reports: "Former patients as well as top executives from Fairview and its former debt collector, Accretive Health, testified before a U.S. Senate hearing Wednesday in St. Paul, called by Sen. Al Franken" (Stawicki, 6/1). Read the story.

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Capsules: Report Offers Glimpse Of Health Law's Impact On Washington State

Now on Kaiser Health News' blog, KUOW's Ruby de Luna, working in collaboration with KHN and NPR, writes: "Washington State Insurance Commissioner Mike Kreidler is weighing in on the fate of the Affordable Care Act with a report released this week about what's at stake for Washingtonians if the law is overturned by the Supreme Court" (de Luna, 6/1). Check out what else is on the blog.

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Political Cartoon: 'An Open Letter To The Supreme Court About Health Insurance'

Kaiser Health News provides a fresh take on health policy developments with "An Open Letter To The Supreme Court About Health Insurance" by Jen Sorensen.

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


Long-term care matters.
And yes, it will break the bank.
A debacle looms...
- 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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Capitol Hill Watch

GOP Schedules Repeal Votes To Bring Attention To Health Law

One of the highest profile efforts involves the repeal of the health law's medical device tax, and one proposal also includes language that would trim the measure's insurance subsidies for low- and middle-income taxpayers.

The Hill: GOP Plans To Call Attention To Health Care Law With Tax Repeal Votes Next Week
With a Supreme Court decision on healthcare fast approaching, House Republicans are doubling down on efforts to bring attention to President Obama's signature legislative issue. The effort, which includes votes on several measures to repeal taxes under the law, is intended to highlight unpopular aspects of the landmark bill as the presidential campaign between Obama and Republican Mitt Romney heats up (Hooper, 6/2).

The Associated Press: GOP Plays Offense In Medical Device Tax Fight
For Republicans, it's an irresistible trifecta: A bill that gives them an election-season chance to say they're fighting to protect jobs and cut taxes, even as it erodes financing for President Barack Obama's health care overhaul they despise. So though it is destined to die in the Democratic-run Senate, GOP leaders plan to push legislation through the House this week to repeal an excise tax on the makers of medical devices sold in the U.S. sales (Fram, 6/4).

Minneapolis Star Tribune: It's Health Subsidies Vs. Tax On Med Technology
U.S. House Republicans are proposing to trim health insurance subsidies for low- and middle-income taxpayers to pay for a bill sponsored by Minnesota Republican Erik Paulsen that would repeal a new tax on medical device makers under President Obama's health care overhaul. The plan could be a breakthrough for the two-term congressman, who has defined himself as a champion for the state's medical technology sector. But it could also open a new front in the ongoing battle over the federal health care law, which is now under review by the U.S. Supreme Court (Diaz, 6/3).

Minnesota Public Radio: Minn. Democrats Torn Over Medical Device Tax
A bill sponsored by Republican U.S. Rep. Erik Paulsen to eliminate a planned tax on medical devices like those made by Medtronic and other Minnesota companies has put Democrats on the state's congressional delegation in a bind. At issue for the Democrats is whether to support a key state industry or support the federal health care overhaul. The 2.3 percent device tax provides $29 billion in funding for the health care law over the next decade -- a vital stream of money. Paulsen, who represents Minnesota's 3rd District, introduced his first bill to repeal the tax on pacemakers, stents and other medical devices in 2010, not long after Congress -- with the House and Senate under Democratic control -- passed the health care bill (Neely, 6/4).

In other news from Capitol Hill -

CQ HealthBeat: Some Democrats Say They Will Not OK Medicaid Offset For Student Loan Measure
In an attempt to move forward on student loan legislation, Republicans are floating a Medicaid offset that Democrats have proposed in the past — but some Democrats say they won't accept that plan this time around. The idea — to limit how states can tax Medicaid providers as a way to increase their share of the federal matching payments — has popped up in some Democratic deficit reduction plans. But state health provider groups oppose the idea, and now some Democrats are saying they won't support the new GOP proposal (Ethridge, 6/1).

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Health Reform

Fate Of Pre-Existing Condition Insurance Pools, Health Exchanges May Hinge On High Court Ruling

News outlets report on what might become of programs such as high risk pools and health exchanges if some or all of the health law is overturned by the Supreme Court.

Reuters: Looming Court Ruling Worries Some With Health Woes
PCIP is a temporary government program set up to run until 2014, when the Obama healthcare law is due to take full effect and prevent insurance companies from the common practice of denying people coverage due to pre-existing medical conditions. About 60,000 Americans already are receiving medical coverage through the program, according to the Obama administration. As the U.S. Supreme Court prepares to rule in the next few weeks on whether to overturn the law considered to be Obama's signature domestic policy achievement, [Sam] Lovett said the choice is very clear for him and others unable to get insurance without the statute's provisions. "Without this, you're going to die," Lovett said in an interview arranged by the Consumers Union organization, which supports the law" (Morgan, 6/3). Also, Reuters has a related factbox.

CQ HealthBeat: On Exchanges: What If The Mandate Does Survive The Supreme Court?
Many policy analysts are focused on the impact of a possible U.S. Supreme Court ruling in June that finds the individual coverage mandate in the health care law unconstitutional. But what will happen if the high court leaves the mandate unscathed and states are then under the gun to open exchanges by 2014 as the overhaul requires? Two things: more states may be ready to open their own exchanges than doomsayers say. And the coverage that these new marketplaces offer may be very pricey (Reichard, 6/1).

Meanwhile, advisors offer insights regarding how the high court's decision could impact the health industry, and federal officials offer more information regarding essential benefits - 

Milwaukee Journal Sentinel: Red Granite Adviser Prepped For Health Care Changes
The Supreme Court's decision on health care reform may have far-reaching implications for investors in the industry. Even if the court were to strike down only the individual mandate, that could topple the entire plan, which relies on everyone paying in order to fund the additional patient load, said Jeffrey L. Holmes, partner and research director at Red Granite Advisors, which is part of Ziegler Lotsoff Capital Management LLC … Holmes' study of how such changes might affect these companies has yielded a number of names that are expected to hold up well, no matter what happens (Gallagher, 6/3).

Modern Healthcare: Proposed Rule Outlines Data Needed For Defining Essential Benefits
A proposed HHS rule outlines a data-collection process for determining the minimum scope of many future health insurance plans. The proposed regulation, posted by the Office of the Federal Register, outlines the data HHS officials plan to collect from certain issuers to help define so-called essential health benefits. The 2010 federal healthcare overhaul required all non-grandfathered small-group and individual insurance market plans nationwide to cover a core group of services, known as an essential benefits package, starting in 2014 (Daly, 6/3).

And on student health plans -

The Wall Street Journal: Big Changes In College Health Plans
Some colleges are dropping student health-insurance plans for the coming academic year and others are telling students to expect sharp premium increases because of a provision in the federal health law requiring plans to beef up coverage (Radnofsky, 6/3).

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Campaign 2012

Former Utah Gov. Mike Leavitt Picked To Lead Romney Transition Team

So far, Leavitt has acted as a "low-profile advisor" to GOP presidential hopeful Mitt Romney. Meanwhile, advisors to President Barack Obama and Romney spar over issues of job creation and the health law. News outlets also report on how some religious leaders and scholars who backed Obama in 2008 are now skeptical.   

Boston Globe: Mitt Romney Picks Former Utah Governor Mike Leavitt To Lead Transition Team
Mike Leavitt, the former governor of Utah and health and human services secretary under President George W. Bush, has been charged with leading presumptive Republican presidential nominee Mitt Romney's transition team. Leavitt has acted as a low-profile adviser to Romney during the campaign, and the two have been close since Leavitt, as governor, courted Romney to run the 2002 Winter Olympics in Salt Lake City (Borchers, 6/3).

Reuters: Obama, Romney Campaign Advisers Trade Blame On Job Creation
Advisers to President Barack Obama and presumptive Republican presidential nominee Mitt Romney squared off on Sunday over job creation in a debate which, following Friday's weak jobs report, promises to be a deciding factor in the November vote. Ed Gillespie, a senior adviser to Romney, citing Obama's healthcare reform law and a decision to put a major oil pipeline on hold, said on "Fox News Sunday" that Obama's policies have put a damper on job creation (6/3).

The Associated Press: Democratic Faithful See Waning Support For Obama
But some religious leaders and scholars who backed Obama in 2008 are skeptical. They say the Democrats have, through neglect and lack of focus, squandered the substantial gains they made with religious moderates and worry it will hurt Obama in a tight race against Republican Mitt Romney. … Catholic bishops have filed a dozen lawsuits nationwide challenging a Department of Health and Human Services mandate that most employers, including religious groups, provide insurance that covers birth control (Zoll, 6/4).

The Associated Press: Obama Win Could Cost Romney $5M In Personal Taxes
Under his own proposal, Mitt Romney would pay half what he would under President Barack Obama's tax plan. For a man of Romney's means, that could save almost $5 million a year. … Obama's health care law, already in place, also raises Medicare taxes on the wealthy, especially big investors, starting in 2013. That could cost Romney more than $800,000 (Cass, 6/4).

And in campaign news related to gubernatorial and congressional races -

Politico Pro: ACA May Shadow Wash. Gubernatorial Race
Washington State's Rob McKenna might be the Mitt Romney of gubernatorial candidates — but in reverse. Romney, the presumptive GOP presidential nominee, has railed against federal health reform despite having signed into law a similar plan while governor of Massachusetts. Washington state gubernatorial contender McKenna has said that he doesn't want the entire federal health reform law struck down — even though in his current position, state attorney general, he signed onto the multi-state lawsuit asking the Supreme Court to do exactly that (Feder, 6/1).

Denver Post: Colorado's First-Ever June Primary Creates Little Statewide Excitement
The top Republican race to watch is the battle for House District 19 between Rep. Marsha Looper of Calhan and Rep. Amy Stephens of Monument, who were drawn into the same House district during legislative redistricting last year. Looper is being backed by Tea Party activists and others angry with Stephens over her support for establishing a state health- insurance exchange, one of the key tenets of the federal health- care-reform law, called "Obamacare" by conservatives (Hoover, 6/3).

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Health Care Marketplace

High-Deductible Health Plans Pick Up Steam

Seventy percent of large companies participating in a recent survey said they'll offer high-deductible insurance by 2013 combined with accounts that let patients buy medical services with pre-tax dollars.  

Kaiser Health News: The New Normal In Health Insurance: High Deductibles
Angela Wenger calls herself a self-reliant 'German Midwesterner' who hates to complain. But the Wisconsin mom was dismayed when husband Dan's employer switched to an insurance plan that increased the family's medical expenses tenfold" (Hancock, 6/3). 

Minneapolis Star Tribune: More Minnesotans Driven To Choose High-Deductible Health Insurance 
Jim Voigt has health insurance, but he can't afford to go to the doctor. … He's one of nearly half a million Minnesotans with high-deductible policies, which offer lower premiums but higher out-of-pocket expenses. According to a new survey, the state ranks second in the nation in the percentage of insured people carrying high deductible policies (Spencer, 6/2).

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Walgreen, Express Scripts Dismiss Claims Against Each Other

Reuters: Walgreen, Express Scripts Drop Claims Against Each Other
Walgreen Co said on Friday that it and drug benefits manager Express Scripts Holding Co had dropped claims against each other stemming from a September 2011 lawsuit, but said the dismissals did not mean they were any closer to reaching a new deal. Walgreen, the largest U.S. drugstore chain, stopped filling prescriptions in January for members of Express Scripts, which manages prescription drug benefits for employers and other clients, after the two companies failed to agree on terms to renew their contract (6/1).

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Health Care Fraud & Abuse

CMS Turns To Contractors To Help Fight Health Care Fraud

The Centers for Medicare & Medicaid Services will rely on local contractors as part of a two-pronged effort to uncover fraudulent claims. Meanwhile, the dean of the University of Missouri's medical school steps down amid a federal investigation into potential Medicare billing fraud by two radiology professors.

The Washington Post: Agency Taps Two Contractors In Fight Against Fraud
Under pressure to reduce fraud, the Center for Medicare & Medicaid Services is turning to local contractors to manage a two-pronged approach to rooting out sham claims (Censer, 6/3).

The Associated Press: MU Medical Dean To Leave Amid Billing Fraud Probe
The University of Missouri's medical school dean is stepping down amid a federal investigation into potential Medicare billing fraud by two radiology professors. The university health system announced Friday that Dr. Robert Churchill, a 25-year university employee and former radiology department chairman, will retire in October. The university also fired the two radiologists at the center of the federal probe (Zagier, 6/1).

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Public Health & Education

Bloomberg's Proposed Super-Size Soda Ban Is Latest Attack In War Against Obesity

New York City mayor seeks to limit the size of sugary beverages, but the plan draws scorn from the soft drink industry and heightens the debate about how involved government should be in efforts to "steer individual behavior in the name of health."

The Washington Post: New Tactic In War On Obesity: Attack Portion Size
This past week, New York Mayor Michael Bloomberg (I) tried a new tactic: He proposed limiting sugary drinks sold by restaurants, cinemas, street vendors and stadiums in his city to 16 ounces. (Grocery stores would be exempt.) … The move intensified the debate over how far government should go to steer individual behavior in the name of health and drew immediate scorn from the $75 billion-per-year soft drink industry (Vastag and Aizenman, 6/2).

The New York Times: Soda Industry Maps Strategy To Defeat Bloomberg Plan To Ban Super-Size Drinks
The industry was blindsided this week when Mr. Bloomberg introduced a totally new tactic in his campaign: an outright ban on sales of large-size sweetened beverages at virtually all of the city's restaurants, street carts and theaters. Now the industry's army of lobbyists and researchers, who have proven adept at combating other government regulatory efforts, find themselves unexpectedly scrambling to find the right counterattack to this new front in a growing national debate over the health of their products (Grynbaum, 6/2).

The Hill: Mayor Bloomberg's Hard Line On Soft Drinks Has Beverage Industry Shook Up
New York City Mayor Michael Bloomberg’s proposed ban on large sodas put big beverage companies back on the defensive this week — an increasingly familiar spot for the industry. Anti-obesity advocates have homed in on soft drinks over roughly the past five years, and Bloomberg described his proposal as a way for the city to take immediate action to curb obesity. He wants to ban sodas larger than 16 ounces at restaurants and movie theaters (Baker, 6/2).

Reuters: NY Mayor Blasts Sugar Ban Critics: 'That's A Lot Of Soda"
New York City Mayor Michael Bloomberg offered a full-throated defense of his proposed ban on large-size sugary sodas on Friday, calling criticism of the proposal "ridiculous" and saying his city is again leading the way in taking on critical health issues. "I look across this country, and people are obese, and everybody wrings their hands, and nobody's willing to do something about it," Bloomberg said on his weekly radio show (Francescani, 6/1).

Denver Post: New York Soda Ban Will Boost Colorado Efforts
Colorado eliminated the sales tax exemption for candy and soda in 2010, at the urging of then Gov. Bill Ritter, who couched it more as a budget balancing act than a food crusade. But that alone was highly controversial, and brought a renewed round of debate about whether the "nanny state" had once again gone too far. This year, legislators debated a ban on trans fat in school foods (Booth, 6/1).

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State Watch

States Eye Health Law Changes -- Consider Next Moves In Implementation

State officials in Minnesota, California and Washington are among those moving ahead regardless of the Supreme Court's ruling.

Minneapolis Star Tribune: As Nations Waits For High Court, State Pursues Health Care Fixes
The world of health care is changing dramatically -- whether the controversial law mandating universal coverage survives or not. … And no matter what the Supreme Court ultimately decides, reforming the health care system -- one way or another -- will remain in the forefront of public policy in Minnesota and the country, health care professionals and regulators say. "We'd be derelict in our duty to say we'll stop and let things ride for a while," Minnesota Health Commissioner Ed Ehlinger said (Crosby, 6/2).

Los Angeles Times: California Health Insurance Exchange Awards Operational Contract
California's new health insurance exchange awarded a contract worth nearly $360 million to create a website and enrollment system to help Californians shop for health coverage and determine whether they are eligible for subsidies under the federal health care law starting late next year (Terhune, 6/1).

Kaiser Health News: Capsules: Report Offers Glimpse Of Health Law's Impact On Washington State
Washington State Insurance Commissioner Mike Kreidler is weighing in on the fate of the Affordable Care Act with a report released this week about what's at stake for Washingtonians if the law is overturned by the Supreme Court (de Luna, 6/1). 

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Mass., Calif. Insurers Will Pay Millions In Rebates To Their Customers

Nationally, insurers are expected to return about $1.3 billion.  

Boston Globe: Four Massachusetts Health Insurers To Rebate $46 Million
Four health insurers will return $46 million to Massachusetts customers in the coming weeks because the companies spent too much money collected as premiums on administrative costs and surpluses in 2011. Tufts Health Plan will return the most — about $25 million. About 5,000 members who have an individual Tufts plan will get an average rebate of $260. About 14,000 small businesses will receive an average rebate of $1,700 (Conaboy, 6/2).

WBUR's CommonHealth blog: $45 Million In Insurance Rebates Headed Your Way
State law says health insurers in Massachusetts must spend at least 88% of every premium dollar on medical services. Last year, members used less care than insurers had collected money to cover, so most of the state's largest health plans are returning the difference. Nationally, health plans are expected to return $1.3 billion (Bebinger, 4/1).

Los Angeles Times: Health Insurers Owe Rebates To Many California Policyholders
Anthem Blue Cross owes some California policyholders nearly $40 million in rebates and nonprofit rival Blue Shield of California owes about $11 million under a requirement of the federal healthcare law (Terhune, 6/2).

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Medicaid News: Ga. Working On Reshaping Program

News outlets look at a variety of Medicaid issues in California, Florida, Georgia, Kansas and Wisconsin.

The Atlanta Journal-Constitution: Reshaping Medicaid Care To Affect Many
Georgia is reshaping its Medicaid program, a complex lifeline for 1.7 million vulnerable people that consumes $21 million in state and federal dollars every single day. The state is widely expected to announce a plan this summer that would dramatically expand the use of for-profit insurance companies in a new approach to managing Medicaid. … A consultant's report in January strongly recommended relying on private companies to manage Medicaid. In the months since, the state has quietly convened task forces of key health care providers and advocates to debate the various options, from maintaining the status quo to letting hospitals and doctors manage the care (Teegardin and Williams, 6/3).

The Atlanta Journal-Constitution: Medicaid More Than Medical Aid
People like Francel Kendrick once spent most of their lives locked inside state hospitals. … Medicaid isn’t just a health plan for low-income people. These days, it’s a job training program, relief for a mom with an autistic son and crisis teams to help someone with schizophrenia live a stable life in the community. State health officials who are redesigning the state’s $7.8 billion Medicaid program face an especially tricky task in dealing with recipients who rely on this broad spectrum of services (Williams and Teegardin, 6/4).

Politico Pro: CMS, Walker Fight Over Care Funding
As Wisconsin Gov. Scott Walker's recall vote approaches on Tuesday, he's causing a big headache at CMS. Walker's administration is in a protracted fight with the agency over the renewal of federal funding for a popular long-term care program -- and whether it should reimburse beneficiaries who were shut out for nine months. The program Family Care, operates under a home and community-based services Medicaid waiver and aims to keep elderly and disabled people out of nursing homes. As part of the cost-cutting drive that put Walker in the national spotlight, Wisconsin began severely limiting Family Care enrollment last July (Smith, 6/4).

News Service of Florida/Baltimore Sun: Florida's AHCA Looks At How State Will Recoup Medicaid Costs
With hundreds of millions of dollars at stake, local officials from across Florida are seeking changes as the state moves forward with new plans for collecting Medicaid payments from counties. The issue has become highly controversial, after lawmakers in March required that the Agency for Health Care Administration recoup disputed Medicaid charges to the counties going back more than a decade. As of this past week, 53 counties had joined a pending lawsuit that challenges the constitutionality of the Legislature's move (Saunders, 6/2).

Stateline: Medicaid Fraud Busters Learn From Experience
Nationwide, the federal government estimates it lost $22 billion of its share of Medicaid funding last year to what it calls "improper payments," according to its payment accuracy survey. This suggests that the loss to state treasuries was also in the tens of billions. How do flagrant violations of Medicaid procedure go unnoticed by federal and state regulators for so long?  The answers are not simple. ... As fraudsters' schemes grow bigger and more elaborate, state Medicaid agencies are forced to create equally elaborate schemes to thwart them. But the more paperwork and audits they require from doctors, dentists, pharmacists and other health care providers who serve the needy, the more Medicaid officials worry they will have trouble attracting enough providers willing to accept Medicaid's low fees (Vestal, 6/4).

KQED's State Of Health blog/Center For Health Reporting: Confusion For Parents, Providers Over Sign Up For Dental Managed Care
There's a lot of confusion related to getting on --  and staying on -- Medi-Cal dental managed care in Los Angeles County, where parents have a choice. In Sacramento County, the only other county in the state that offers Medi-Cal dental managed care, the program is mandatory. Several dentists, children’s advocates and parents told me that dental plans play a role in signing patients up for their services (Bazar, 6/1).

Kansas Health Institute News: Governor Signs Budget Bill, Sine Die
Gov. Sam Brownback has signed the budget bill into law but vetoed about a dozen line items, including a temporary bump in the rates paid to payroll agents for home- and community-based services. … In the budget bill it approved, the Legislature had signed off on a temporary increase in the rates paid to payroll agents for those who receive home- and community-based services through the state's Medicaid program. The rate boost would have taken the $115 per client per month currently paid to the agents to $125. Supporters of the increase said it would help the payroll agents transition to a new system launched late last year by the Kansas Department on Aging and the Kansas Department of Social and Rehabilitation Services (Shields, 6/1).

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$25 Million Grant Announced To Improve States' Care For Frail Elderly

Stateline reports on a new HHS grant to help low-income adults with mental and physical disabilities remain in their communities. Meanwhile, California submits a plan to federal officials for the transition of dual eligibles to managed care.

Stateline: New Federal Grants For Aging And Disability Resource Centers
The U.S. Department of Health and Human Services has announced a $25 million grant to help states improve and develop more Aging and Disability Resource Centers (ARDC), which help low-income adults remain in their communities by using local home health care services. The centers are part of a national effort to help more frail elders and those with mental and physical handicaps maintain their independence, while reducing the cost per person of Medicaid long-term care (Vestal, 6/4).

CaliforniaHealthline: Duals Project Goes To CMS For Approval
The project is the Coordinated Care Initiative, also known as the duals demonstration project, and the document is the project's final plan, which was submitted late last week to CMS. ... Stakeholder committees continue to meet and plan for the transition of dual eligibles -- Californians eligible for both Medicare and Medi-Cal -- to managed care. Committees focus on specific issues such as provider outreach (Gorn, 6/4).

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Mo. Gov. Faces Defining Choice On Abortion Bills

Missouri's governor faces tough choices on a pair of abortion bills awaiting his signature or veto -- moves that could have national implications. In the meantime, Louisiana lawmakers have approved a bill banning abortions after 20 weeks of pregnancy.

Kansas City Star: Contraceptive Health Insurance Bill Awaits Nixon's Decision
The fate of a bill allowing employers in Missouri to refuse to provide health insurance coverage for contraception, sterilization or abortion is in the hands of Gov. Jay Nixon, who over the years has managed to sidestep taking a stand on abortion legislation. Two anti-abortion bills have been sent to the desk of the Democratic governor during his first term, and both times he took no action. Instead of signing or vetoing the bills, on both occasions he let a constitutional deadline pass that allowed them to become law without his signatures. This time, however, the issue could have implications on the national stage (Hancock, 6/2).

Reuters: Louisiana House Approves Bill Banning Abortions After 20 Weeks
The Louisiana state House of Representatives on Friday unanimously approved a bill that would prohibit abortion beyond 20 weeks after fertilization unless the mother's life is in danger. Georgia a month ago became the seventh state to ban most or all abortions after 20 weeks. Alabama, Idaho, Indiana, Kansas, Nebraska and North Carolina also have such restrictions (Finn, 6/1).

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Roundup: Cracking The Cost-Savings Code In Mass.; Va. Releases Abortion Clinic Regs

A selection of health policy stories from Massachusetts, Virginia, Wisconsin, California, Minnesota, Oregon, Arizona, Illinois, Connecticut and North Carolina.

Politico: Massachusetts Bogged Down With Health Care Challenge
Gov. Deval Patrick wants Massachusetts to "crack the code" on health care costs, a punchy slogan he uses when he's promoting nationally the Bay State's cost-containment efforts. But transforming his ambition into policy has produced some messy sausage-making in his state Legislature. Key stakeholders aren't sure whether the springtime rush to craft a state approach to health care costs will create a national model -- much the way Massachusetts's 2006 coverage expansion signed by Gov. Mitt Romney helped create a framework for President Barack Obama's 2010 national health law. In fact, some are wondering whether the cost-savings effort will even work in Massachusetts (Cheney and Millman, 6/3).

Washington Post: Va. Health Dept. Releases Proposal Of Regulations For Abortion Clinics
The Virginia Health Department has released its proposed regulations governing abortion clinics -- rules that opponents say could put the clinics out of business. Emergency regulations have been in effect since Jan. 1. The state Board of Health will vote on the permanent regulations June 15. The proposed regulations are similar to the emergency regulations, which are considered some of the toughest in the country. They regulate the size of exam rooms and hallways and the number of parking spaces; and address requirements for inspections, medical procedures and record-keeping (6/2).

Milwaukee Journal Sentinel: Pair Sues State Over Health Insurance Aid 
Two Milwaukee residents have sued the state Department of Health Services for freezing enrollment in a program that provides basic health insurance for people with low incomes who are not eligible for other coverage. The program -- known as BadgerCare Plus Core -- covers about 26,000 people compared with 65,265 in January 2010. The BadgerCare Plus Core plan now has an estimated waiting list of 130,000 people (Boulton, 6/1).

Los Angeles Times: Traditional Dentistry Wary Of Dental Therapists
[Crystal Ann] Baker, who treats low-income patients in St. Paul, Minn., is among the nation's first dental therapists -- an innovative and controversial health position intended to fill socioeconomic and geographic gaps in dental care. With nearly 17 million children nationwide lacking dental care and health reform expected to increase demand, California and other states are exploring similar models to expand the dental workforce, setting the stage for a series of battles with dentist organizations that warn that patient safety is at stake (Gorman, 6/3).

WBUR's CommonHealth blog: Are We Lowering Health Costs Or Just Shifting Them To Consumers?
Why are premiums down and why are hospitals able to take a lower increase than in recent years? I haven’t seen much firm evidence that answers this question. But the latest report from the state's Division of Health Care Finance and Policy has some important analysis on the premiums question. Take a look at the far right column on this chart and note the premium increase in 2010 when "adjusted for benefits." If you put back all the costs that have shifted to members (higher co-pays, deductibles, co-insurance, etc.), premiums in 2010 would be rising at almost the same rate they have for the last decade or so. In health care-speak, this is called "benefit buydown." The market is producing lower premiums, but it is because patients are paying more health care costs on their own (Bebinger, 6/4).

Boston Globe: Cambridge Health Alliance CEO Aims To Improve Care Delivery
The new chief executive of Cambridge Health Alliance says he wants to improve the way medical care is delivered and paid for at the system’s three so-called safety net hospitals, but is also open to forging partnerships that may fall short of outright mergers. Patrick R. Wardell, 59,  who arrived here in mid-March from Michigan State University’s Hurley Medical Center in Flint, Mich., said he plans to spend the first six months working with his board on a plan to strengthen the finances of Cambridge Health Alliance, which serves a large population of low-income and immigrant patients (Weisman, 6/2).

Kaiser Health News: Debt Collectors In The ER
Former patients as well as top executives from Fairview and its former debt collector, Accretive Health, testified before a U.S. Senate hearing Wednesday in St. Paul, called by Sen. Al Franken (Stawicki, 6/1).

Arizona Republic: KidsCare II Open To Arizona's Uninsured Children
David Campos, 14, is among more than 100,000 Arizona children on a waiting list for KidsCare, the state health-insurance program for children whose parents earn too much to qualify for Medicaid but not enough to afford traditional insurance. A new, temporary version of the program opened May 1, and so far the state has enrolled about 2,500 kids. There's room for 21,700 children, and they will be covered through January 2014 (Reinhart, 6/2).

The Oregonian: For The Sickest Patients, Medicare Tests Home-Based Primary Care In Portland
In a given year, 10 percent of the people covered by Medicare account for nearly 60 percent of spending. A pilot project starting today in Portland aims to show that providing home-based primary care to Medicare patients with multiple chronic conditions can improve their health -- and save money. Housecall Providers, a Portland-based nonprofit, is one of 16 medical groups chosen from more than 130 applicants to participate in the Independence at Home demonstration. … A home-based primary care program started by the Department Veterans Affairs health system appears to have saved significant money. The VA says the program lowered the average annual cost of care for a patient with multiple chronic conditions from $38,168 to $29,036 (Rojas-Burke, 6/1).

Chicago Sun-Times: Nurse To Feds: State Grants Went To Politicians Campaigns
"Thousands of dollars" in state grants awarded to bolster health care in minority communities instead went to pay campaign workers for former state Sen. Rickey Hendon and Democratic candidates Hendon supported, a Chicago nurse has told investigators. The nurse, Tonja Cook, 44, detailed her allegations in four interviews with state and federal authorities between October 2010 and May 2011, records show (Fusco and McKinney, 6/4).

Modern Healthcare: Conn. AG Clears Yale-New Haven's Purchase Of St. Raphael
Yale-New Haven (Conn.) Hospital's bid to buy the Hospital of St. Raphael won clearance Connecticut's attorney general. The 959-bed Yale-New Haven Hospital reached a definitive agreement to purchase the 406-bed Hospital of St. Raphael in September 2011 (Evans, 6/2).

Modern Healthcare: Setting A Standard
For decades, most hospitals around the country have avoided paying taxes under a hazy set of standards without strong public oversight -- a state of affairs staunchly supported by hospital lobbyists and executives at the state and national level. But in Illinois, hospital officials were among the most ardent cheerleaders for new laws that will define, for the first time in the Land of Lincoln, precisely how not-for-profit hospitals qualify for their exemptions from taxes. Gov. Pat Quinn has vowed to the sign the bills, which are headed to his desk (Carlson, 6/2).

North Carolina Health News: Legislators Of Two Minds About Tobacco Cessation Programs 
Leaders in North Carolina’s House of Representatives can’t seem to decide whether they like smoking cessation programs, or not. On the same day the House passed a budget that would significantly cut funds [for] tobacco cessation, the House also adopted a resolution marking COPD Awareness day at the General Assembly (Hoban, 6/4). 

HealthyCal: Far From Cities, Children Lack Specialized Care
Local health care is virtually non-existent for children with special needs living in rural California.  Few doctors who are trained to treat the complex conditions that afflict these children practice in remote parts of the state. Traveling to major cities where physicians are more plentiful is often a day-long journey. Families often find that the multiple doctors their children see don’t have a system for communicating with each other, and parents must coordinate their child’s care themselves. But for many of these families, there is no alternative (Shanafelt and Gilligan, 6/4).

HealthyCal: Distance From Specialized Care Takes Toll On Parents, Too
Instead, most of [Crystal De Witt's] energy is spent getting Jace the ongoing medical attention he needs while keeping up with her fulltime work running an in-home daycare. His list of doctors is as long as his list of health problems and includes a gastroenterologist, audiologist, plastic surgeon, orthopedic surgeon and more, all specialists in pediatric care. Meeting these needs can become a fulltime job for any parent. But the task is even harder for people who live in the rural areas of California (Gilligan, 6/4).

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Editorials and Opinions

Viewpoints: Bloomberg Defends Stand Against Sugary Drinks; Charging Higher Insurance Premiums To The Obese Misses Mark

Several outlets offer opinions on obesity issues and on the New York City mayor's proposal to curb the sale of sugary drinks.

USA Today: Big Sugary Drinks Yield Big Waistlines
Bold actions to protect the public's health always stir controversy at first. Smoke-free bars and restaurants, trans fat restriction and calorie posting in restaurants were all met with skepticism, but are now widely popular in New York City. They are also saving many lives each year, and life expectancy in New York City is outpacing that of the United States (Michael R. Bloomberg, 6/3).

USA Today: Editorial: New York Soda Cap Wouldn't Beat Obesity
If Mayor Michael Bloomberg gets his way, which he usually does, New Yorkers will soon no longer be able to buy sugary drinks in servings larger than 16 ounces. And Bloomberg sees his idea as a national model in the fight against obesity (6/3). 

The Washington Post: Slurping Less Soda In New York
Sugary drinks have been the largest single contributor to the increase in Americans' caloric consumption over the past three decades. Soft drinks deliver roughly half the added sugar in the average American's diet. ... So, policies aimed at discouraging overconsumption of sugary soft drinks can make sense, as long as they are part of a broader, comprehensive anti-obesity effort to improve eating and exercise habits (6/2).

Los Angeles Times: Life, Liberty And The Pursuit Of Doughnuts And Big Gulps
Can Americans have their doughnuts and their Big Gulps too? It seems a timely question, what with Friday being National Donut Day -- and coming on the heels of New York Mayor Michael Bloomberg's proposal to limit the sale of super-size sugary drinks (Paul Whitefield, 6/1).

Denver Post: Obesity And Health Care: Prevention And Support, Not Penalties
Singling out obese individuals for higher insurance premiums based only on their weight is fundamentally unfair and will do little to improve the nation's health. A more productive approach would be to require insurance companies to provide at least minimal coverage for obesity treatment (Adam Gilden Tsai and Daniel Bessesen, 6/3).

Denver Post: Obesity And Health Care: Taxing "Bad" Food Is Offensive To Liberty
In a distortion of science right up there with the attempts of grant-seeking climate scientists to eradicate the Medieval Warm Period, money-grubbing governments are trying to convince Americans that there is a lot of unhealthy eating going on out there. Some people even claim that preserving good health requires giving government more money and power by letting it tax and control "bad" food and overweight people (Linda Gorman, 6/3).

Denver Post: Obesity And Health Care: Coloradans Still Gaining Weight
The good news: a growing number of Coloradans can correctly identify what obesity looks like and understand it is not someone else's problem; it's their own. Consequently, they want to improve their health, and are increasingly realistic about their lackluster levels of physical activity and the inadequate amount of healthy foods they eat. ... Now the bad news: Coloradans are still gaining weight (Maren Stewart, 6/3).

The Atlanta Journal-Constitution: Obesity Fight Is An Obligation
While the tide of obesity exceeds the power of any individual physician to defeat, all of us on the medical front lines need to engage in this fierce battle. Sadly, that is not happening. … We have a responsibility never to quit. Talking and persistence are sometimes the most powerful medicines for both doctor and patient (Dr. Damon Tweedy, 6/1). 

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Viewpoints: The High-Stakes Of Wisconsin Recall; One Entrepreneur's Fears That Health Law Will Be Overturned

A selection of editorials and opinions on health care policy from around the country.

The Wall Street Journal: The Wisconsin Recall Stakes
A single election rarely determines a democracy's fate, but some matter more than others. Tuesday's recall election of Wisconsin Governor Scott Walker is one that matters a great deal, because it will test whether taxpayers have any hope of controlling the entitlement state and its dominant special interests (6/3).

Philadelphia Inquirer: Consequences Of Striking Down Affordable Care Act
The Republican Party made obstruction of the health-care bill a central political strategy during the first two years of Barack Obama's presidency. After the bill passed, Republicans then objected that the minimum-coverage provision — originally promoted by Republican politicians and conservative think tanks — was unconstitutional, in an effort to secure the victory in court they couldn't obtain in politics. This strategy flouts traditional conservative arguments for judicial restraint. ... Striking down the ACA would amount to the most consequential — and least justified — invalidation of a federal law on federalism grounds since the Great Depression (Neil S. Siegel, 6/3).

The Hill: Repealing Healthcare Reform -- A Risk We Can't Afford
Before I started my business, I worked in corporate America for 13 years. One of the biggest surprises I faced when I decided to start my own business was how little we got in health care benefits for almost twice the dollars. Even now, businesses our size are still too small to have any bargaining power. The ACA’s state insurance exchanges are finally going to change that. A state exchange will give me the opportunity to band together with thousands of other small businesses across Washington State to get better health care at better rates (Jody Hall, 65/31).

Philadelphia Inquirer: Mandate For Health Services Touches Full Religious Spectrum
Last month, Catholic archdioceses and institutions across the nation filed lawsuits against the Department of Health and Human Services for its overreaching mandate announced earlier this year. ... Opposition to this radical mandate is not limited to the Catholic Church and Catholic organizations. Priests, rabbis and pastors, as well as ministry and faith leaders across the spectrum, are speaking out against this policy. The mandate impacts people of all faiths (Joe Watkins, 6/3).

Boston Globe: Fifty Shades Of Obamacare
And in some circles, the contraception rule has become a stand-in for the ills of Obamacare, a complaint issued with Victorian-era disdain: "Why should I have to pay for your recreational sex?" But that's a highly distorted way of looking at health insurance. We engage in all sorts of recreational pursuits that carry all sorts of consequences; if pregnancy is a potential outcome of recreational sex, then knee surgery is a potential outcome of recreational skiing (Joanna Weiss, 6/3).

The Wall Street Journal: Treating You Better For Less
There is some good news about the overly costly, underperforming American health care system. A growing number of hospitals, doctors, employers and health insurers are finding ways to reduce the cost of delivering medical care while maintaining or improving quality. If enough providers adopt their already proven techniques, this grass-roots movement could transform the entire system in ways that will benefit all Americans (6/2).

JAMA: Primary Care: Rebuilding a Foundation For Reforming Health Care Delivery
In the next few weeks, the Supreme Court is expected to issue a decision that will clarify the future of the ACA. If the court completely strikes down the law, this will deliver a major blow not only against coverage expansion, but also to a set of reforms that are built on a foundation of primary care. Clearly, it will take more than the ACA's provisions for primary care to overcome policies set in motion long ago that promoted excessive physician specialization in the United States (Andrew Bindman, 6/1). 

Bloomberg: How 'Death Panels' Can Prolong Life
How do you persuade fellow citizens to accept limits on their right to consume health-care resources? The trick, we think, is to ask them when they're healthy, not when they're sick. If you think a $200,000 operation is going to give you a few more years to live, it's going to be hard to convince you that it's not worth the cost. But before then, when your odds of needing that expensive operation are the same as everybody else's, you might well choose a system that offers a higher life expectancy, even though it costs less (6/3).

Los Angeles Times: Free Markets Vs. Family Values
To compare the health, education, emotional and material well-being of children in 21 economically advanced nations, an international team of researchers looked at such indicators as whether children ate dinner with the family, had someone to talk to, were susceptible to accidents. They reported the highest ratings of well-being among children living in the Netherlands, Sweden, Norway and Denmark — nations that, far more than we, tax the rich, regulate industry and provide such public services as paid parental leave, art subsidies and excellent public schools. The lowest overall rank went to nations pursuing the strongest free-market agenda: the U.S. and Britain (Arlie Russell Hochschild, 6/3).

Los Angeles Times: Medicine You Can't Trust
When you take medicine, there's a good chance you're getting a dose of modern global business practices as well. Eighty percent of the active ingredients in the medications that Americans use are produced overseas. In a single drug, it's quite possible that the individual components came from several countries and were assembled in yet another before arriving on U.S. shores. This diffuse manufacturing operation increases the opportunities for chicanery (5/31).

The New York Times: Let's (Not) Get Physicals
For decades, scientific research has shown that annual physical exams — and many of the screening tests that routinely accompany them — are in many ways pointless or (worse) dangerous, because they can lead to unneeded procedures. The last few years have produced a steady stream of new evidence against the utility of popular tests. ... So why do Americans, nearly alone on the planet, remain so devoted to the ritual physical exam and to all of these tests, and why do so many doctors continue to provide them? (Dr. Elisabeth Rosenthal, 6/2).

Philadelphia Inquirer: Bad Bill Threatens Women's Health
Republicans in Harrisburg have launched another misguided attack on women's reproductive health care with a bill to defund Planned Parenthood in Pennsylvania. ... The bill's chief sponsor, Rep. Daryl Metcalfe (R., Butler), claims overall public funding for women's health services would not be reduced, but that the bill would prioritize funding so that hospitals, health centers, and other clinics would receive money first. But the intent behind this bill supported by antiabortion groups is blatantly obvious. Health-care providers that offer abortion services would go to the back of the bus for state funding (6/4).

San Jose Mercury News: Community Must Help Those With Mental Illness
More than half of persons housed in the U.S. correctional system have a mental health problem. The correctional system is the number one provider of mental health services in this country. Incarcerated individuals have rates of mental illness that are two to four times greater than the general population. People with mental health needs comprise 56 percent of state, 45 percent of federal, and 64 percent of the jail populations in the United States. As 93 percent of incarcerated people return home, we need to plan for their care and successful reintegration (Bonnie Sultan, 6/3).

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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.