Daily Health Policy Report

Wednesday, June 6, 2012

Last updated: Wed, Jun 6

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Campaign 2012


Coverage & Access

Public Health & Education

Health Disparities


State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Michigan Medicaid Director: 'A Struggle' To Meet Deadlines If Law Upheld (Video)

Kaiser Health News' Mary Agnes Carey talks to Michigan Medicaid Director Steve Fitton about how it will be a "struggle" for his state to be ready to implement the health law on schedule if the Supreme Court upholds the measure. 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 (6/5). Watch the video or read the transcript.

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Health On The Hill: Ahead Of Elections, GOP Readies Vote On Repealing Parts Of Health Law

Kaiser Health News' Mary Agnes Carey talks with Jackie Judd about two measures from the health law that the House GOP will attempt to roll back in votes this week. Republicans want votes on repeal now, Carey says, to make an economic argument ahead of elections (6/5). Watch the video or read the transcript.

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Capsules: Lots of 'C's As Hospitals Get Graded For Patient Safety; Leavitt Talks Obesity Prevention, But Not Politics

Now on Kaiser Health News' blog, Jordan Rau reports: "For 2,651 hospitals, Leapfrog created a single letter grade out of 26 different measures collected by Leapfrog or Medicare officials. They included hospitals’ adherence to safe practices, such as entering physician orders into computer records to avoid penmanship errors and removing catheters promptly to minimize the risk of infections. The grade was also based on hospitals’ records of mishaps, such as bed sores, infections and punctured lungs" (Rau, 6/6).

Also on the blog, Shefali S. Kulkarni reports: "Just a few days after he was tapped to be a part of presidential-hopeful Mitt Romney's transition team, Michael Leavitt Tuesday took on a very different mission: obesity. Leavitt was one of four former cabinet officials presenting a report on the economic impact of the obesity epidemic at the Bipartisan Policy Center in Washington" (Kulkarni, 6/5). Check out what else is on the Capsules.

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Political Cartoon: 'Freedom Of Choice'

Kaiser Health News provides a fresh take on health policy developments with "Freedom Of Choice" by Signe Wilkinson.

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


The clock keeps ticking.
Will the Supreme Court choose doom,
Joy, or confusion?
- 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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Health Reform

Worrying About The Court's Much-Awaited Health Law Decision

Elected officials, policy-makers and advocates discuss the possible twists and turns that could result from a high court ruling. News outlets also report on how the decision could impact a variety of health programs, including Medicare, Medicaid and disease prevention efforts.

The Hill: House GOP Concedes 'Mess' Will Result From Partial Health Care Repeal
House Republicans conceded on Tuesday that they will have a "mess" to deal with if the Supreme Court rules portions of the president's health care law are unconstitutional. All eyes on Capitol Hill are focused on the high court as lawmakers await the much anticipated ruling, which is expected by the end of the month. The court could come down with several positions — it could uphold the 2,700-page law passed by a Democratic-controlled Congress, or it could toss it out completely. Another possibility is that the court will rule the mandate that consumers buy insurance is unconstitutional, but that the mandate is "severable" from the rest of the law, which can then stand on its own (Hooper, 6/5).

Roll Call: GOP Mulls Health Care Tacks
While nothing is certain until the justices release their decision, the implications are undeniable: No matter which way the court decides, it is sure to unleash a firestorm of political posturing and punditry that will propel the somewhat dormant issue of health care forcefully back into the election year messaging fray. From House Republicans’ perspective, the first step is clear: If the law is upheld fully or even partially, GOP leaders plan to pass a full repeal. "We are, I think, united that if there is not a full overturn of the law, that we will put a repeal measure on the floor to totally repeal Obamacare," Majority Leader Eric Cantor (R-Va.) told reporters today (Newhauser, 6/6).

MedPageToday: Supreme Court: Decision Nears On 'Obamacare'
The Supreme Court is expected to announce its ruling on the Affordable Care Act (ACA) this month, and with the countdown started speculation about the impact of that decision is heating up on both sides of the "Obamacare" debate. And both sides predict disaster for doctors -- massive disruption if the law is struck down -- or if it is upheld. If the court decides to go with something in between, confusion is likely to be the short-term result. Health policy experts generally list five possible scenarios for how the Supreme Court might rule (Walker, 6/5).

National Journal: Poll: No Blame If Court Nixes Health Care Law
Even though President Obama fought for passage of the landmark 2010 health care law, very small minorities say their attitudes about him would change one way or the other should the Supreme Court strike down the law that is so often referred to as "Obamacare." Two-thirds of those surveyed in a new public-opinion poll said that their respect for Obama would be unchanged if the Supreme Court struck down his signature legislative achievement. Fourteen percent said they would respect Obama more under such a scenario, while 15 percent said they would respect him less (Sanger-Katz, 6/5).

Politico Pro: State Worry Cuts Could Hurt Implementation
In Washington, a sneeze by Chief Justice John Roberts might generate a three-day story about its implications for the Affordable Care Act. But in state capitals around the country, the fate of President Barack Obama's health care law — and its impact on his presidency — is among a slew of potentially grave threats to their health programs. Whether the Supreme Court upholds, eliminates or strikes portions of the 2010 law, the drama will be far from over for state agencies tasked with implementing it (Cheney, 6/6).

Kaiser Health News: Michigan Medicaid Director: 'A Struggle' To Meet Deadlines If Law Upheld (Video)
Kaiser Health News' Mary Agnes Carey talks to Michigan Medicaid Director Steve Fitton about how it will be a "struggle" for his state to be ready to implement the health law on schedule if the Supreme Court upholds the measure. 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 (6/5).

Reuters: Health Care Court Ruling Could Paralyze Medicare
Opponents of President Barack Obama's health care law have been predicting dire consequences for seniors on Medicare ever since the legislation was signed last year. The warnings are mostly political spin, but there could be real problems if the U.S. Supreme Court strikes down the Affordable Care Act this month. … Important improvements to Medicare would disappear if the high court decides to toss out the entire law. The decision could paralyze the Medicare system because the act lays out the benefits, payment rates and delivery systems. Some of the changes already have been implemented, and others are works in progress (Miller, 6/5).

CQ HealthBeat: Public Health Lobby: Throwing Out Health Care Law Wouldn't End All Its Prevention Provisions
A number of the provisions of the health care law that relate to preventing disease could continue to be implemented even if the U.S. Supreme Court throws out the entire health care law, according to Trust for America's Health. The group says, for example, that President Obama has already used an executive order to create the National Prevention, Health Promotion, and Public Health Council required by the law (Reichard, 6/5).

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Capitol Hill Watch

CBO: Ballooning Health Care Costs Will Continue As A Key Driver In Nation's Debt

A new Congressional Budget Office report offers a bleak view of the future if current tax and spending policies are not adjusted.  

The Washington Post: CBO: Taxmageddon Would Bring Tax Pain But Debt Relief
And the choices would not be easy. So far, lawmakers have focused their deficit-reduction efforts on a relatively abstract portion of the budget known as discretionary spending. But future spending growth is driven almost entirely by popular entitlement programs for the elderly, the CBO said, whose numbers are soaring as the baby-boom generation ages. The graying of America will push federal spending on programs such as Medicare and Social Security to more than 16 percent of the economy over the next 25 years, the CBO said. By comparison, total federal spending has averaged 18.5 percent of GDP over the past 40 years. Without significant changes to federal health and retirement programs, taxes will have to rise to historically high levels or the nation will sink inevitably into the red (Montgomery, 6/5).

Los Angeles Times: Rising U.S. Debt Could Trigger A Downturn, Agency Warns
Amid election year barbs over taxes and spending comes a jolt: A new report says that a U.S. debt crisis could hit soon and imperil the economy if Washington fails to staunch the red ink. … The bleak fiscal outlook throws into stark terms the politically difficult choices facing lawmakers and the next president: Allowing the debt level to continue unchecked would lower the nation's economic output and increase the possibility of a fiscal crisis in the years to come, the budget office warned. But taking sudden action to ease the debt load — by imposing new taxes or making deep cuts in federal spending or both — could slam the brakes on economic growth, pitching the nation into a recession in the first half 2013 (Mascaro, 6/6).

CQ HealthBeat: CBO: Health Care Will Eat Up An Increasing Share Of GDP
The aging population and high cost of health care will result in federal health care spending almost doubling its share of the economy by 2037 if current policies remain in place, according to the Congressional Budget Office. In its annual long-term budget outlook, the CBO said that the debt held by the public will increase sharply if current policies are extended. It also found that federal health care spending will take up more and more of the gross domestic product (GDP). In addition, per-capita spending for health care will likely continue to grow faster than such spending on other goods and services (Ethridge, 6/5).

Reuters: Unchanged Tax, Health Policies To Balloon US Debt-CBO
U.S. public debt would balloon to twice the size of its economy in 25 years if current tax and spending policies are extended, Congress' budget referee said on Tuesday, delivering fresh fodder for a year-end budget brawl. … The CBO report finds, as it has in past years, that the biggest source of growth in federal spending will come from [Medicare and Medicaid]. By 2037, if no health care changes are enacted, federal health care spending would double to around 10 percent of gross domestic product compared to around 5 percent in 2010, it said (Lawder, 6/5).

Modern Healthcare: Healthcare Likely To Be Major Budget Buster: CBO
Likely future healthcare spending is a primary federal budget buster under projections released Tuesday by the Congressional Budget Office. The annual CBO projections concluded that federal debt would fall to 61% of the nation's economy in 10 years from 73% now, if current law is unchanged. However, the government's debt is more likely to accelerate to 93% of the entire economy within 10 years under an "alternative fiscal scenario" that used projections based on more likely actions by federal representatives, including key healthcare policy changes (Daly, 6/5).

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Medical Device Tax Repeal Effort Creates Dilemma For Some Democrats

The House is scheduled to vote on this measure this week. It is one of two repeal-related proposals currently moving in that chamber.  

Bloomberg: U.S. Medical Device Backers Face Tough Health Care Vote
Senate Democrats from states including Minnesota and Pennsylvania are caught between their support for medical-device industries and their party's reluctance to make major changes to the 2010 health-care law. The U.S. House of Representatives is scheduled to vote this week to repeal a 2.3 percent excise tax for medical devices. To Senate Majority Leader Harry Reid, a Nevada Democrat, the vote is part of a Republican attack on the health law. To Senator Amy Klobuchar, a Minnesota Democrat seeking a second term, the repeal is necessary to prevent harm to an industry that provides jobs in her state (Rubin and Hunter, 6/6).

Kaiser Health News: Health On The Hill: Ahead Of Elections, GOP Readies Vote On Repealing Parts Of Health Law
Kaiser Health News' Mary Agnes Carey talks with Jackie Judd about two measures from the health law that the House GOP will attempt to roll back in votes this week. Republicans want votes on repeal now, Carey says, to make an economic argument ahead of elections (6/5).

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House GOP Spending Plan Aims To Reduce Funding For Health Overhaul

News outlets report that House Republican appropriators are working to undo parts of the health law by advancing steep funding cuts.

The New York Times: House Bill Takes A Scythe To Spending
Financial regulators would lose hundreds of millions of dollars needed to implement the new Wall Street regulatory law. The Internal Revenue Service's budget would not be increased, with a prohibition on cash transfers to implement the health care law. … Quietly, the House Appropriations Committee is working hard to undo much of the president's first-term ambitions — or at least provoke a showdown with the White House ahead of the fall election (Weisman, 6/5).

CQ HealthBeat: Spending Plan Targets Health Care, Financial Regulatory Overhauls
House Republicans, renewing their attack on major Obama administration initiatives, released a spending plan Tuesday that would sharply reduce backing for the 2010 health care and financial regulatory overhauls. The House Appropriations Committee fiscal 2013 draft of a $21.2 billion Financial Services bill has many of the same funding limitations and policy restrictions GOP lawmakers previously sought, almost certainly setting up a fight with Democrats. The Financial Services Appropriations Subcommittee is set to consider the measure Wednesday (Weyl, 6/5).

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Campaign 2012

Sebelius Talks The Health Law Talk In Virginia -- A Battleground State

As the campaign for women's votes spreads, HHS Secretary Kathleen Sebelius meets with women in Richmond, Va., to discuss how the health law helps them. Meanwhile, Planned Parenthood attacked GOP presidential hopeful Mitt Romney as he visited Texas, where support of the organization is a hot issue.  

The Associated Press/Washington Post: Obama Secretary Sebelius Appeals To Women In Battleground Of Virginia With Health Care Message
President Barack Obama's Health and Human Services secretary brought a defense of the administration's health reforms to the electoral battleground of Virginia Tuesday with a direct appeal to women. In a stage-lighted living room chat with a half dozen women, Kathleen Sebelius heard stories Tuesday of how Obama's embattled Affordable Care Act had benefitted middle class women and children, an indirect complement to the Democrats' focus on women (6/5).

Richmond Times-Dispatch: Sebelius Talks Health Care In Richmond
Kathleen Sebelius, surrounded by a half dozen women in a West Avenue living room, listened to them share their personal health care stories — from mothers worrying about insurance for their children, to a nurse struggling to cover her medication costs. … Attorney General Ken Cuccinelli, who filed a challenge to the law the day that President Barack Obama signed the bill in March 2010, said in a statement Tuesday that Sebelius should "explain why they have put a cadre of unelected bureaucrats like her in charge of determining what is and what isn't sufficient health insurance for each and every American" (Meola, 6/6).

Los Angeles Times: Women Push To Make History Again In Election
Women's votes are particularly sought-after this year. … On Tuesday, Senate Democrats tried to advance paycheck equity legislation, which would prohibit private companies from retaliating against workers who share pay and salary information. … The outcome of the day's vote produced another entry in the Democratic narrative that Republicans are engaged in a "war on women." First there was the Republican-led attack on President Obama's new contraceptive rules under the healthcare law. Then there was the all-male panel that was convened to discuss the issue by House Republicans and the GOP-led vote in the Senate against the contraceptive regulations (Mascaro, 6/5).

The Hill: Planned Parenthood: Romney Would Slash Women's Health Funds
Planned Parenthood attacked presumptive Republican nominee Mitt Romney on women's health issues Tuesday as he visited Texas, a state embroiled in a court battle with the group. Texas's dispute began when conservative officials barred public health funds for all of the state's Planned Parenthood clinics, whether they provide abortions or not.  Planned Parenthood Action Fund President Cecile Richard said Tuesday that the move foreshadows what Romney would do in the White House (Viebeck, 6/5).

Texas Tribune: A Closer Look At UT-TT Poll On Planned Parenthood
As the fight between Texas and Planned Parenthood continues this week in the 5th U.S. Circuit Court of Appeals, public opinion of the reproductive health organization and abortion provider remains fiercely split along partisan lines, according to a recent University of Texas/Texas Tribune poll. The poll also showed favorability splits for Planned Parenthood based on race and gender (Tan, 6/6).

The New York Times: Abortion Qualms On Morning-After Pill May Be Unfounded
Labels inside every box of morning-after pills, drugs widely used to prevent pregnancy after sex, say they may work by blocking fertilized eggs from implanting in a woman’s uterus. Respected medical authorities, including the National Institutes of Health and the Mayo Clinic, have said the same thing on their Web sites. Such descriptions have become kindling in the fiery debate over abortion and contraception (Belluck, 6/5).

In related news -

Des Moines Register: Dave Loebsack Beats Fellow Democrat Joe Seng
U.S. Rep. Dave Loebsack fended off fellow Democrat Joe Seng in the 2nd District. … Seng said he decided to run against Loeback because Seng took offense to elements of the federal health care law that required religious institutions to offer insurance plans that provide birth control (Jacobs, 6/5).

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Romney's Recent Health Policy Decisions Leading Some Conservatives To 'Scratch Their Heads'

The pick of Mike Leavitt, former Utah governor and Health and Human Services secretary, is chief among the actions that are triggering questions.

WBUR: Romney's Health Care Prescription Gives Some Conservatives Heartburn
GOP presidential candidate Mitt Romney insists that when it comes to health care, his first priority is the full repeal of the 2010 Affordable Care Act. But some of his actions of the past few days have conservatives scratching their heads. First, there was the appointment of Mike Leavitt, a former Utah governor and Health and Human Services secretary, to lead a potential Romney transition team (Rovner, 6/5).

Politico: Mike Leavitt Pick May Be Signal On Exchanges
The selection of Mike Leavitt to lead Mitt Romney's transition team doesn't mean the Affordable Care Act's health insurance exchanges are here to stay. But it is a reminder of how some Republicans, regardless of the ACA, have already been circling behind the exchange concept. It also gives the health care world an idea of how exchanges could look under a Romney administration. In all likelihood, they'd be portals -- the way Leavitt's home state of Utah did them -- and not much like the more active marketplaces of the Affordable Care Act (Millman, 6/5).

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Gov. Walker Wins Wisconsin Recall Vote

The final tally is being described as a blow to public-sector unions. The state's labor groups sought to recall Walker because of his efforts to eliminate most collective bargaining for public employees.    

The Washington Post: Gov. Walker Survives Recall In Wisconsin
Wisconsin Gov. Scott Walker won a vote to keep his job on Tuesday, surviving a recall effort that turned the Republican into a conservative icon and his state into the first battleground in a bitter, expensive election year (Fahrenthold and Weiner, 6/5).

Milwaukee Journal Sentinel: Public-Sector Unions Are Clear Losers In Walker Victory
Voters dealt a stinging blow to the nation's public-sector unions Tuesday in the state that first granted them broad bargaining power more than a half-century ago. In the first recall in U.S. history in which an incumbent governor retained office, Wisconsin chose to keep Gov. Scott Walker, who sparked the recall by eliminating most collective bargaining for most public employees, as well as their ability to collect dues through payroll deductions. Though public unions will not disappear as a result, they were the clear losers in a race that confirmed Walker as a national celebrity for Republicans (Stein, 6/5).

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Hospitals Get Graded For Patient Safety

The grades, compiled by a nonprofit safety group from 26 different measures, reflect patient injuries, infection rates and frequency of medical and medication errors.

Politico Pro: Leapfrog Grading Hospitals For Safety
Hospital executives are about to find out if they make the grade under a new rating system developed by the Leapfrog Group that debuts online Wednesday — and some are not happy about it. Under Leapfrog’s Hospital Safety Score initiative, hospitals are given a letter grade — A, B, C, D or F — on how safely they treat patients. The grade reflects patient injuries, infection rates and the frequency of medical and medication errors (DoBias, 6/6).

Kaiser Health News: Lots of 'C's As Hospitals Get Graded For Patient Safety
The cities of New York and Los Angeles grade their restaurants on cleanliness and the precautions they take to avoid making customers sick. Now hospitals are getting similar assessments for their patient safety records from the Leapfrog Group, a nonprofit devoted to patient safety. For 2,651 hospitals, Leapfrog created a single letter grade out of 26 different measures collected by Leapfrog or Medicare officials (Rau, 6/6).

Meanwhile, one of the leading medical journals reports on efforts to reduce unnecessary procedures.

JAMA: Materials Educate Patients to Make Wise Choices On Tests And Procedures
As multiple organizations step up efforts to encourage physicians to more wisely use clinical resources and reduce health care costs, professional organizations and consumer groups are conducting a parallel campaign to educate patients about testing and procedures that involve more cost than value. Over the past few years, several professional organizations and publications have launched efforts to eliminate wasteful or potentially harmful medical practices (Kuehn, 6/6).

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Coverage & Access

Army To Examine If It Shortchanged Vets On Mental Health Compensation

The Army will examine 190,000 files to see if it failed to give veterans the proper pension compensation for mental health problems. In Calif. one in 10 vets are uninsured.

USA Today: Army Review To Look At Mental Health Compensation
The Army says it will pore through -- in less than 90 days -- about 190,000 medical files of current and former soldiers dating to 2001 to see whether any were shortchanged on retirement compensation for mental health problems (Aoroya, 6/6).

KQED:  One In Ten California Veterans Are Uninsured
Ten percent of California veterans don't have health insurance or don't use Veterans Affairs (V.A.) care. That's just slightly below the 10.3 percent rate among veterans around the country.  That's according to a report by the Urban Institute. Co-author Jennifer Haley says there are 108,000 uninsured vets in the state, second only to the number in Texas (Dornhelm, 6/5).

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Public Health & Education

Disney To Ban Junk Food Ads In Obesity Fight

The change from the children's entertainment company got a prominent backer Tuesday as first lady Michelle Obama offered her praise for the move.

Denver Post: Disney Junk Food Ad Ban Guided By CU Nutrition Center
Disney's highly-touted junk food ad ban was guided in large part by consultations with the CU Center for Human Nutrition at Anschutz, which calls the move a "game-changer" for kid health. The University of Colorado center has one of the longest-running national studies of people who lose weight and keep it off, and director James Hill has been a key paid consultant to Disney on its health efforts (Booth, 6/5).

CBS: Disney To Cut Junk Food From Its Platform
Mickey Mouse and the Disney family want their fans to grow up to be healthy adults, and are stepping up their fight against childhood obesity. The Walt Disney Company announced on Tuesday that it will be enacting several new regulations in order to promote healthy eating habits. The company detailed the plan during a Washington news conference with Michelle Obama, who has focused on fighting childhood obesity during her tenure as First Lady (Castillo, 6/5).

Marketplace:  Disney Kicks Junk Food Out Of The Magic Kingdom
The Walt Disney Company made two big announcements this morning. It's banning junk food ads on cartoons and other kid shows. That starts in 2015. And in just a few months, it will launch the Mickey Check.  Yeah, that Mickey. The mouse symbol will be slapped on foods in the grocery aisle that Disney approves as nutritious: Only so much sugar and salt and fat.  Obesity expert Vicky Rideout says it could provide a single standard that helps parents sort through the health claims on packages (Warner, 6/5).

The Associated Press: Disney's New Diet For Kids: No More Junk Food Ads
There won't be any more candy, sugary cereal or fast food on TV with the morning cartoons. The Walt Disney Co. on Tuesday became the first major media company to ban ads for junk food on its television channels, radio stations and websites, hoping to stop kids from eating badly by taking the temptation away. First Lady Michelle Obama called it a "game changer" that is sure to send a message to the rest of the children's entertainment industry (Choi and Hirsch, 6/5).

The Associated Press: First Lady Walks Fine Line On NYC Drink Proposal
First lady Michelle Obama says banning big servings of sugary drinks isn't anything she'd want to do at the federal level, but she offered some kind words Tuesday for New York Mayor Michael Bloomberg's effort to do just that. She later issued a statement backing away from taking a stand on New York's controversial proposed ban (Benac, 6/6).

In the meantime, new reports outline the economic impact of obesity and new nutritional guidelines for children --

Kaiser Health News: Capsules: Leavitt Talks Obesity Prevention, But Not Politics
Now on Kaiser Health News' blog, Shefali S. Kulkarni reports: "Just a few days after he was tapped to be a part of presidential-hopeful Mitt Romney’s transition team, Michael Leavitt Tuesday took on a very different mission: obesity. Leavitt was one of four former cabinet officials presenting a report on the economic impact of the obesity epidemic at the Bipartisan Policy Center in Washington" (Kulkarni, 6/5). Check out what else is on the blog.

CQ HealthBeat: Obesity Report Recommends Nutritional Guidelines For Babies, Toddlers
Recommendations in a new report on obesity issued Tuesday reach all the way down to babies and toddlers, as policy makers increasingly seek ways to prevent childhood obesity before it begins. Two former Health and Human Services secretaries and two former Agriculture secretaries teamed up to back the report by the Bipartisan Policy Center that offers what its Democratic and Republican authors termed possible "real life" solutions to the very difficult problem of how to curb obesity in the United States. The 105-page report is titled "Lots to Lose" (Norman, 6/5).

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Health Disparities

Life Expectancy Gap Narrows Between Blacks And Whites

The life expectancy gap between blacks and whites has narrowed thanks to fewer black deaths due to AIDS and heart disease, a new study finds.

Los Angeles Times: Life Expectancy Gap Narrows Between Blacks, Whites
The gap in life expectancy between black and white Americans is smaller than it has ever been, thanks largely to a decline in the number of deaths resulting from heart disease and HIV infection, a new analysis has found. … Blacks have higher rates of obesity, diabetes and hypertension. … Studies have documented that blacks are treated less aggressively than whites for heart problems, said Dr. James McPherson, medical director of the Los Angeles Cardiovascular and Thoracic Surgery Group and a spokesman for the American Heart Assn. Blacks are also less likely to have health insurance, so they are apt to be treated later in the course of heart disease than those with regular access to care (Mestel, 6/5).

Reuters: U.S. Racial Gap In Life Expectancy Shrinks: Study
Whites in the United States have typically lived longer on average than blacks, but a new study released on Tuesday suggests that gap in life expectancy may be shrinking. The shift appears to be because fewer African Americans are dying of AIDS and heart disease, but also because more whites are dying in early and mid-adulthood from unintentional injuries - mainly poisonings, including prescription drug overdoses, researchers said (Pittman, 6/5).

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ACOs Find Traction In Medicaid

CQ HealthBeat: ACO-Type Models Growing In Medicaid
For the past couple of years, health policy makers have been developing new ways of delivering care in Medicare, most notably accountable-care organizations. But less attention has been given to similar models that are a growing trend in Medicaid. Within the next week or so, the Center for Medicare and Medicaid Innovation is expected to announce a round of "innovation awards" that could support Medicaid demonstration projects that test out methods of coordinating care in a manner similar to accountable-care organizations (ACOs). Medicare ACOs require medical providers to coordinate care for patients. They then share in any savings from this new model of care and, depending on the amount of risk a group is willing to assume, they could face penalties for not meeting savings goals (Adams, 6/5).

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State Watch

State Roundup: Mass. Insurance Mandate Examined

A selection of health policy stories from Massachusetts, California, New York, Iowa, Illinois, New Hampshire, Kansas and Oregon.

San Francisco Chronicle: Prop. 29: Dollar-Per-Pack Cigarette Tax Passing
Tobacco companies poured nearly $47 million into defeating Proposition 29, a $1-a-pack tax hike on cigarettes, but the measure was narrowly leading in early returns Tuesday despite the hard-fought campaign. The tax increase would raise $810 million a year for cancer research and smoking cessation programs, and it would give California -- which currently has a lower tobacco tax than 32 other states -- the 16th-highest cigarette tax in the nation. … The vote would be a huge win for the public health groups that sponsored the measure, including the American Cancer Society (Lagos, 6/6).

Politico: California Cigarette Tax Too Close To Call
A Lance Armstrong-backed initiative in California to raise taxes on cigarettes for the funding of cancer research remained deadlocked Tuesday morning, reports the Associated Press. Just a few months ago, a statewide poll showed that Proposition 29 -- to hike taxes $1 per pack -- would pass with two-thirds support -- but the morning after the polls closed, the vote remains too close to call (Mak, 6/6).

The Associated Press: Calif. Voters Split On Tax Targeted By Big Tobacco
A high-profile California cigarette tax initiative backed by cycling legend Lance Armstrong that once seemed like a sure thing teetered on the brink of defeat Wednesday, a testament to the efficacy of a $50 million campaign backed by Big Tobacco. A blizzard of industry-financed radio and television advertisements over the last two months closed the gap on an effort to impose an additional $1-per-pack tax on cigarettes to fund cancer research (Dreier, 6/6).

The Associated Press: In Mass., Individual Mandate Sparks Little Outcry
It's the single most contentious element of President Barack Obama's health care law: the requirement that nearly everyone have insurance or face a financial hit. But in Massachusetts, the only state with a so-called individual mandate, the threat of a tax penalty has sparked little public outcry since the state's landmark health care law was signed in 2006 by the governor, Mitt Romney (LeBlanc, 6/6).

The New York Times' City Room: Ruling Delayed On Adding Cancer To 9/11 Fund Illnesses
An eagerly awaited federal ruling on whether to include cancer among the illnesses that will be treated and result in compensation using money set aside by Congress for victims of the Sept. 11 attack on the World Trade Center has been delayed by several days, federal officials said Tuesday (Hartocollis, 6/5).

Des Moines Register: Wellmark Agrees To Pay Genesis Hospitals For Keeping Patients Well
A Quad Cities hospital-and-clinic system has joined a national movement that aims to reward health-care providers for keeping patients healthy instead of just treating them when they’re sick. Genesis Health System announced today that it has signed a contract with Wellmark Blue Cross/Blue Shield to set up an accountable-care organization (Leys, 6/5).

Modern Healthcare: No Negative Credit Impact From Illinois Legislation: Fitch
Legislation in Illinois that would link hospital property taxes to charity-care levels is not expected to have a negative effect on not-for-profit providers in the state, according to Fitch Ratings. … Fitch described the legislation as providing "long overdue clarity" on how to define charity care and said it is consistent with the standard used in other parts of the country (Kutscher, 6/5).

Modern Healthcare: CMS Claims 'Inaccurate,' N.H. Official Says
The New Hampshire Department of Health and Human Services is disputing claims that it has not submitted detailed information to the CMS about Medicaid reimbursement rate reductions. In a May 23 letter, released Monday, CMS Deputy Administrator Cindy Mann requested the state health department supply specific data and analysis about Medicaid reimbursement rates within 30 days (Lee, 6/5).

Kansas Health Institute: Kansas Asks To Withdraw Medicaid 1115 Waiver Request 
Kansas officials today announced they have asked that the so-called 1115 Medicaid waiver application they submitted with fanfare to federal authorities in April be withdrawn pending consultation with two Native American health centers. The Governor's Office issued a statement today saying the administration intends to resubmit the waiver application in July. The statement included a copy of the email sent by Kari Bruffett, director of the state's Health Care Finance Division, to Victoria Wachino of the Centers for Medicare & Medicaid Services, notifying the federal agency of the state's intentions (Shields, 6/6).

WBUR: Mass. House Begins Debate On Sprawling Health Cost-Cutting Plan
Debate is now underway in the Massachusetts House on the health care cost-cutting bill, a sprawling proposal to save $150 billion over 15 years by re-focusing medical care on prevention, changing the incentives and methods for paying doctors and hospitals, linking health-care spending to the state economy, and more. Debate is expected to run through today and pick up again tomorrow (Zimmerman, 6/5).

The Oregonian: Rural Oregon Women And Men Often Missing Out On Cancer Screening
Women and men in rural Oregon often go for years without receiving recommended cancer screening tests, researchers report in the journal Cancer. Among rural women age 55 or older, only 30 percent were up-to-date for cervical cancer screening and 37 percent for mammography. The statewide average rate for both screening tests is about 75 percent. ... Patricia Carney and others at Oregon Health & Science University based the findings on medical chart reviews of four primary care practices in two rural Oregon communities (Rojas-Burke, 6/5).

HealthyCal:  Clinics Prepare For Onslaught Of Patients
As federal health care reform promises insurance for tens of thousands of Santa Clara County residents, local health clinics are scrambling to prepare for the expected onslaught in demand.  For the soon-to-be-insured poor, health care reform is an opportunity to take care of aches and pains many have ignored for years, doctors said. As a result, demand for primary care doctors is expected to surge around Santa Clara County. These family physicians are the first stop for most patients, to help them identify the roots of their problems (Bookwalter, 6/6).

California Healthline: Bill Aims to Expand Number of Residency Slots
Most of the health care reform expansion effort has focused on the logistics of adding coverage for up to 3 million more Californians, but that's just the start, according to Senate member Michael Rubio (D-Shafter). Those millions of health insurance cards won't be worth their weight in plastic if you don't make sure the state has the providers to take care of all of those people, he said. … Rubio spoke on the Senate floor last week on behalf of his bill to expand the number of residency slots in California, a plan with the potential to significantly increase the number of providers in the state, he said. Setting up the infrastructure to accept private contributions for residency expansion creates an opportunity to add providers in California without using any more general fund dollars, Rubio said (Gorn, 6/6).

Boston Globe: Mass. Hospitals Receive Top Marks
Using the model of letter grades posted in New York to steer ­diners away from the dirtiest restaurants, a prominent health quality group is grading U.S. hospitals on safety, giving ­Massachusetts medical centers the highest overall scores in the nation. The Leapfrog Group planned to post the assessments online Wednesday morning, at hospitalsafetyscore.org (Conaboy, 6/6). 

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Editorials and Opinions

Viewpoints: Wis. Vote Cements Walker Plan To Raise State Workers' Health Costs; Treating Addiction; Obama's Silence On Insurance Mandate

Chicago Tribune: Wisconsin Speaks. Again.
Many of those voters also expect that, going forward, the dividends for Wisconsin residents, their school districts and other governments will continue to grow. As old labor contracts expire, public officials will write into the new contracts the other Walker-inspired personnel provisions — such as higher (but still relatively inexpensive) employees' contributions to their pension and health plans — that have lowered government expenses. New labor pacts, that is, should keep reducing government costs across Wisconsin (6/6).

The New York Times: The D.S.M. Gets Addiction Right
When we say that someone is "addicted" to a behavior like gambling or eating or playing video games, what does that mean? Are such compulsions really akin to dependencies like drug and alcohol addiction — or is that just loose talk? This question arose recently after the committee writing the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (D.S.M.), the standard reference work for psychiatric illnesses, announced updated definitions of substance abuse and addiction, including a new category of "behavioral addictions" (Howard Markel, 6/5).

The New York Times: Evolution's Sweet Tooth
Of all the indignant responses to Mayor Michael R. Bloomberg’s plan to ban the sale of giant servings of soft drinks in New York City, libertarian objections seem the most worthy of serious attention. People have certain rights, this argument goes, including the right to drink lots of soda, to eat junk food, to gain weight and to avoid exercise. If Mr. Bloomberg can ban the sale of sugar-laden soda of more than 16 ounces, will he next ban triple scoops of ice cream and large portions of French fries and limit sales of Big Macs to one per order? Why not ban obesity itself? (Daniel E. Lieberman, 6/5).

The New York Times: Disney Takes On Obesity
The Walt Disney Company deserves applause for its plan to impose strict standards on food advertising aimed at young children on Disney-owned television channels, radio stations and Web sites. The standards, based on federal guidelines, should eliminate junk-food ads on children’s programs and could set an example for other companies and advertisers to follow (6/5).

Chicago Tribune: Gulp! Another Intrusion By The Nanny State
There are things the law cannot do. And if that seems a self-evident observation, well, you may want to think again in light of last week's headlines out of New York: It seems the mayor wants to ban the Big Gulp (Leonard Pitts, 6/6).

The Washington Post: The Rise Of Noodge Government
Judging the wisdom of New York Mayor Michael Bloomberg’s (I) ban on super-size sugary sodas depends on where you draw the line between nudge government and noodge government. Nudge government makes sense. It harnesses human nature to steer citizens to smarter -- choices (Ruth Marcus, 6/5).

The Washington Post’s Post Partisan: Yep, The CBO's Debt Numbers Are Still Scary
Hordes of retiring boomers would take their toll on the Treasury, but the big budget-killer would be rapid per-patient health-care cost inflation, which has outpaced economic growth by an average of 1.6 percentage points every year since the mid 1980s. In other words, unless Congress enacts truly massive tax increases, something about how the government delivers health care must change (Stephen Stromberg, 6/5).

The Wall Street Journal: Why Obama Strikes Out In Court
As the world awaits the Supreme Court's ruling on ObamaCare, there's a larger story that the pundits are missing: the court's rejection of the Obama administration's increasingly extreme claims on behalf of unlimited federal power. … If the government loses in the health-care or immigration cases, it won't be because its lawyers had a bad day in court or because the justices ruled based on their political preferences. It will be because the Obama administration continues to make legal arguments that don't pass the smell test (Ilya Shapiro, 6/5).

Politico: Speak Out To Defend Your Agenda, Mr. President 
Indeed, if anything, the president has been far too reluctant to talk to the American people. Consider the Affordable Care Act. If the individual mandate is lost, the president’s failure to talk enough about the health care law over the past 2½ years will be a leading cause. ... If the president had seized the initiative, the legal challenge to the individual mandate would have been far less likely to succeed. It would certainly have been far more difficult for the central argument against the mandate to break into the legal mainstream (William Yeomans, 6/5).

Baltimore Sun: Planning For The Worst
We Americans cherish our freedom of choice. In light of our ardent individualism, it's puzzling that so few of us make decisions about something almost all of us will face: medical care at the end of our lives. Only about a third of Americans have completed advance directive forms, even though the forms are straightforward, free and legal in every state. While we generally think of an advance directive as a responsibility of the elderly, it is just as essential for younger people. The leading cause of death in those under 35 is accidents and injuries that can trigger complex medical situations (remember Terri Schiavo?), including potential organ donation (Morhaim, 6/6).

Boston Globe: Birth Control Fight Is Still Being Fought
Thursday marks the 47th anniversary of the Supreme Court’s decision to make birth control legal in the United States, but the case is still being argued. … Living in a time when the basic definitions of "life" and "death" are increasingly less fixed, it becomes all the more essential that a woman and her doctor are guaranteed the freedom to seek, and to offer, the best possible care (Alexandra Marshall, 6/6).

Boston Globe: Without Patient-Centered Health Plans, Mass. Is Using The Same Tired Script
As the next act of the Massachusetts health care drama plays out on Beacon Hill, the same characters return to the stage with a tired script. The ostensible hero of the production, the patient, is left to watch the tragedy from the back row. Legislation being debated on Beacon Hill ignores patient-centered health plans and health savings accounts, or HSAs, which are lower-premium insurance plans that direct pre-tax dollars into a bank account to cover an individual’s current health care and save money for future medical expenses (Josh Archambault, 6/6).

Boston Globe: Hospitals Need To Coordinate Better To Deliver The Best Care — And Save Money
Leaders on Beacon Hill should know that one of the key factors driving up health care spending is poorly managed and uncoordinated care delivery. Too often, patients are getting treatment from multiple providers that don’t talk to each other and lack any incentive to work together to keep costs down. This raises the overall price tag, and doesn’t result in better care (Mike Coyne, 6/5).

JAMA: If Accountable Care Organizations Are the Answer, Who Should Create Them?
Who is most able to create and manage this type of organization that can effectively implement both medical and insurance functions? Employers? They would like to bring costs under control while maintaining quality, but most employers have not demonstrated sustained interest or capacity to manage health care for their employees. This task requires knowledge and skills far different from those present in the typical firm (Victor R. Fuchs and Leonard D. Schaeffer, 6/6).

JAMA: Why Accountable Care Organizations Are Not 1990s Managed Care Redux
Many people are concerned that accountable care organizations (ACOs) and other delivery system reforms in the Affordable Care Act will simply bring back the managed care days of the 1990s. These skeptics suspect that payment reforms to control high and increasing costs will simply lead to gate keeping and service denial rather than the promise of care redesign and coordination that removes unnecessary cost and delivers better outcomes (Ezekiel J. Emanuel, 6/6).

Health Policy Solutions (a Colo. news service): Seniors Reap Benefits From Affordable Care Act
Opinions may not change overnight, but the fact is, more and more seniors are benefiting from the law. New figures show that thousands of seniors and disabled Americans are improving their health thanks to expanded preventive care services and saving money on prescription drug prices because of a shrinking "donut hole." It is especially important that seniors learn about the benefits of the ACA because they have been the victims of some of the most egregious misrepresentations about the law (Bob Semro, 6/5).

MinnPost:  Overdiagnosis – And How We Need To Stop Harming The Healthy
The problem of medical overdiagnosis is getting increasing attention — and not a moment too soon, as noted in a commentary paper published last week in the journal BMJ.  "A burgeoning scientific literature is fueling public concerns that too many people are being overdosed, overtreated, and overdiagnosed," writes Australian journalist and academic researcher Ray Moynihan, Australian epidemiologist Jenny Doust, and Dr. David Henry, CEO of the Institute for Clinical Evaluative Sciences in Toronto, Canada (Perry, 6/5).

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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.