Daily Health Policy Report

Friday, June 8, 2012

Last updated: Fri, Jun 8

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Disparities

Public Health & Education

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Wallack On Vermont's Goal: 'Universal, Affordable Coverage' (Video)

Kaiser Health News' Marilyn Werber Serafini talks with Anya Rader Wallack, who is tasked with moving Vermont to a single payer health care system. She's confident the state would enact its own individual mandate requiring people to buy insurance even if the Supreme Court strikes down the federal mandate. But, she says, "We'll have to cover [people] without adding new resources to the system or raising taxes."  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 high court ruling (6/7). Watch the video or read the transcript.

This Story: Print | Link to | Top

Q & A: Will The Cadillac Tax Extend To Individual Plans Or The Self-Employed? (Video)

In this Kaiser Health News video, Insuring Your Health columnist Michelle Andrews responds to a reader's question about who will be affected by the health law's Cadillac tax, a 40 percent excise tax on high-cost plans set to start in 2018 (6/7). Watch the video.

This Story: Print | Link to | Top

Capsules: Rewarding Docs For Efficiency Reaps Savings For Insurer; Young Adults Don't Necessarily Fit 'Young Invincible' Stereotype

Now on Kaiser Health News' blog, Jay Hancock reports: "CareFirst BlueCross BlueShield..., which covers people in Maryland, Washington and Virginia, says its "patient-centered medical program" shaved $40 million — or 1.5 percent — off expected costs last year, its first in operation. Much of the savings came from reducing unnecessary hospital visits by patients with diabetes and other chronic illnesses, the company said" (Hancock, 6/8).

Also on the blog, Christian Torres reports: "Young adults' insurance coverage has significantly improved since the passage of the health law, but this trend could be derailed by the Supreme Court's much-anticipated ruling on the law, expected this month" (Torres, 6/8). Check out what else is on the blog.

This Story: Print | Link to | Top

Political Cartoon: 'Root Problem'

Kaiser Health News provides a fresh take on health policy developments with "Root Problem" by Gary Varvel.

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

Gloom or Bloom?

Entitlement woes 
Affordable Care Act stance
Fall election looms
-Shari Thomas 

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.

This Story: Print | Link to | Top

Health Reform

The Health Law Decision: How It Might Shake Out

News outlets continue to report on the various ways the court might rule on the health law and how those rulings could impact stakeholders and how various policymakers -- from the White House to Congress to state officials -- are preparing for the decision.

Politico: 3 Health Care Scenarios For The President
Chaos: Mandate struck down, other parts preserved. Many SCOTUS watchers think one of the most likely scenarios is that the court will toss out the individual mandate and keep the rest of the law. ... Clarity: The whole law goes down. It may seem paradoxical but losing the entire law is probably a more palatable political alternative for the White House than killing it in agonizing pieces. ... Miracle: Law is upheld. The notion that Chief Justice John Roberts will suddenly discover his inner Earl Warren isn't outside the realm of possibility (Haberkorn, Thursh and Samuelsohn, 6/8).

Kaiser Health News/USA Today: What Happens After Health Law Ruling?
Since President Obama's health care law passed in 2010, the federal government, states, insurers, doctors and hospitals have been building a complex scaffolding to extend insurance to 30 million more Americans. The question is: Will the structure be completed, or dismantled? (Rau, 6/7). 

Reuters: U.S. Administration Ready For Health Ruling: Sebelius
Health and Human Services Secretary Kathleen Sebelius said on Thursday the administration will be ready to respond if the Supreme Court strikes down all or part of the healthcare reform law in a landmark ruling expected this month. Speaking at a White House forum on the law and women's health issues, Sebelius said the administration remains "confident and optimistic" that the 2010 Patient Protection and Affordable Care Act will be upheld as constitutional (6/7).

Politico Pro: W.H. Ready But Not Planning Health Ruling
Ready. But not planning. That's the message coming from the Obama administration as it awaits the Supreme Court decision on the health law later this month. "We'll be ready for court contingencies," HHS Secretary Kathleen Sebelius told a White House women's health forum Thursday. But she and other administration officials have been saying ever since the case was argued in March that they are confident the Supreme Court will uphold the law and they are not working on any backup plans if parts are knocked down (Haberkorn and Feder, 6/8).

CQ HealthBeat: Whatever High Court Decides, GOP Still Committed Health Care Law Repeal, Boehner Says
House Speaker John A. Boehner on Thursday reiterated his party’s commitment to a full repeal of the 2010 health care law, but he didn’t rule out that the House GOP would take steps before the election to address some of the law’s popular benefits if the Supreme Court strikes down the entire overhaul. At a press conference Thursday, Boehner was asked if the law is thrown out what House Republicans would do to protect young adults from being kicked off their parents’ insurance plans, individuals with pre-existing conditions from losing coverage and seniors from falling into the coverage gap known as the doughnut hole (Attias, 6/7).

Des Moines Register: Hatch: State Leaders Should Huddle After Supreme Court Rules On Health Reform
An Iowa Senate Democrat is trying to organize a bipartisan summit meeting on health care, but he’s getting a cool reception from Republicans. Sen. Jack Hatch said Thursday that he wants Iowa leaders to get together soon after the Supreme Court rules on President Obama’s health-reform program. ... Hatch said at a press conference that Iowa leaders should move forward right away after the court announces its rulings (Leys, 6/7).

Kaiser Health News: Wallack On Vermont's Goal: 'Universal, Affordable Coverage' (Video)
KHN's Marilyn Werber Serafini talks with Anya Rader Wallack, who is tasked with moving Vermont to a single payer health care system. She's confident the state would enact its own individual mandate requiring people to buy insurance even if the Supreme Court strikes down the federal mandate. But, she says, "We'll have to cover [people] without adding new resources to the system or raising taxes."  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 high court ruling (6/7).

And in related news about what the public thinks about the health law -

The New York Times' The Caucus: New Poll: The Supreme Court And The Health Care Law
More than two-thirds of Americans hope the Supreme Court will overturn some or all of the 2010 health care law, according to a new poll conducted by The New York Times and CBS News. Just 24 percent said they hoped the court "would keep the entire health care law in place" (Liptak and Kopicki, 6/7).

National Journal: Poll: Most Americans Want All Or Part Of Health Law Overturned
The poll, conducted by the New York Times and CBS News, reveals that more respondents disapprove of the law than approve, 48 percent to 34 percent. That marks only a one-percentage-point uptick in those who disapprove of the law since the last poll was conducted, in mid-April, but a five-percentage-point drop in those who approve. The percentage of people saying they want the court to throw out the entire law rose four points, from 37 percent to 41 percent, since the last CBS News/New York Times poll was conducted. About a quarter in the new poll -- 24 percent -- said they want the whole law upheld. The court heard arguments on the law in March and a ruling is expected this month (Jaffe, 6/8).

The Hill: Poll Finds Strong Support For High Court To Strike Down Health Law, Mandate
Nearly seven in 10 Americans hope the Supreme Court will decide against all or part of President Obama's healthcare reform law, according to a new poll. The finding comes as the country braces for the court's decision. A ruling is expected by the end of June. The New York Times and CBS News found that 41 percent of those surveyed want the entire law overturned while 27 percent want its key provision — the individual mandate to buy health insurance — struck down (Viebeck, 6/7).

San Francisco Chronicle: Nancy Pelosi Concedes Health Care Law Unpopular
House minority leader Nancy Pelosi said Thursday that people are not aware of the many benefits they are receiving from health care law they stand to lose if the Supreme Court rejects the law in a decision expected this month.The San Francisco Democrat was a chief architect of the 2010 law known as Obamacare, and as House Speaker at the time, perhaps more instrumental than anyone, even President Obama, in its enactment.The Democratic strategy was to front load the law’s popular parts, such as allowing children up to age 26 to remain on their parents’ policies, while backloading its unpopular parts, chiefly the mandate on individuals to purchase insurance (Lochhead, 6/7).

This Story: Print | Link to | Top

Millions Of Young Adults Join Parents' Health Plans

While 6.6 million young people signed onto their parents' plans since the provision of the health law took effect, many still lacked coverage, according to a new Commonwealth Fund study. Cost, not a "young invincible" belief that they didn't need coverage, appears to be a key obstacle.

The Wall Street Journal: Millions Of Young Adults Join Parents’ Health Plans
About 6.6 million young adults signed up for health coverage through their parents' insurance plans in the first year after a new provision in the federal health law took effect, according to estimates in a study released Friday. As part of the law, most insurance plans offered by employers to their workers had to allow parents to enroll dependents on their plans up to the age of 26, starting in September 2010 (Radnofsky, 6/7).

Kaiser Health News: Survey: Young Adults Don't Necessarily Fit 'Young Invincible' Stereotype
Young adults' insurance coverage has significantly improved since the passage of the health law, but this trend could be derailed by the Supreme Court's much-anticipated ruling on the law, expected this month. ... The large number of enrollees shows that young adults are interested in health insurance as long as it is affordable, said Commonwealth Fund President Karen Davis (Torres, 6/8). 

Reuters: Young Americans Get Health Insurance, Still Have Debt: Study
Healthcare reform likely enabled about 6.6 million young adults to join their parents' health insurance plans last year, a report found on Friday, though problems with medical bills and debt remained an issue. ... The Commonwealth Fund, a nonprofit organization that analyzes healthcare issues, polled 1,863 adults between the ages of 19 to 25 and found 47 percent of them joined or remained on their parents' plans between November 2010 and November 2011 (6/8).

Politico Pro: Study: Despite ACA, Young Adults Uninsured
A popular part of the health care reform law has helped millions of young adults get insurance — but there are still big coverage gaps for this population, a new Commonwealth Fund report finds. The survey also found that cost — not a “young invincible” belief that they didn’t need insurance — was an obstacle to getting coverage. “There is considerable evidence that afford­ability, rather than a belief that they do not need insur­ance, prevents young adults from enrolling in a health plan,” the researchers wrote (Smith, 6/8).

This Story: Print | Link to | Top

States Hold Off On Insurance Exchanges; Medicare ACOs Confront Challenges

Marilyn Tavenner, the acting administrator for the Centers for Medicare & Medicaid Services, said Thursday that about 30 states will not move forward with state-based exchanges until after the Supreme Court rules and the November elections are finished. She also said her agency is working to streamline the process for early participants in Medicare ACOs.   

Modern Healthcare: Most States Holding Off On Insurance Exchanges, Tavenner Says
About 30 states will not move forward on creation of state-based exchanges until after both a U.S. Supreme Court decision on the federal healthcare overhaul and the November presidential election, according to the head of the CMS. Marilyn Tavenner, acting administrator of CMS, told a Washington gathering of accountable care organization advocates and experts on Thursday that the large number of states waiting for the court ruling and the election outcome before deciding whether to move forward with the insurance marketplaces required by the law is one of her leading concerns (Daly, 6/7).

Modern Healthcare: Medicare ACO Participants Hit Firewall
The earliest participants in Medicare's high-profile accountable care organization program have experienced problems accessing needed CMS data during their first six months of operations, according to the head of the agency. Marilyn Tavenner, acting administrator of the CMS, told ACO advocates, experts and providers at a Washington conference Thursday that the agency was working to streamline ACO participants' access to their Medicare enrollees' data after some of them experienced delays in receiving that information (Daly, 6/7).

In other implementation news -

CQ HealthBeat: HHS Invites States To Apply for Consumer Assistance Grants
Health and Human Services officials on Thursday announced the availability of up to $30 million in grants to beef up state programs that help consumers who are having difficulties with insurance coverage. The programs educate the public about consumer protections they have under the health care law and other statutes, officials said. The programs can also help consumers appeal insurance company claims denials or find out where to obtain coverage (Reichard, 6/7).

The Hill: HHS Says Grants Under Health Law Saved Consumers $18 Million
Consumers saved more than $18 million because of grants provided by President Obama's healthcare law, the Health and Human Services Department said Thursday. HHS touted its grants to Consumer Assistance Programs (CAPs), which help state-based agencies respond to consumers' questions about their coverage. CAPs help people find coverage, assist with appeals when coverage is denied and explain how certain policies work, according to HHS (Baker, 6/7).

Bloomberg: Health Insurer Tax Gives Nonprofits Advantage, Holtz-Eakin Says
Fees that health insurers will be required to pay the U.S. government starting in 2014 will give nonprofits such as Kaiser Permanente a market advantage over corporate competitors, said economist Douglas Holtz-Eakin. The fees -- starting at $8 billion and escalating each year based on the industry’s premium revenue -- aren’t tax deductible. While nonprofits don’t have an income tax, companies such as UnitedHealth Group Inc. (UNH) would effectively be paying taxes on the fees they’re handing over to the government, said Holtz-Eakin, chief economist of the White House Council of Economic Advisers during the Republican Bush administration from 2001 to 2003 (Wayne, 6/8).

This Story: Print | Link to | Top

Capitol Hill Watch

House Passes Repeal Of Tax On Medical Devices

The bill, which is likely to hit tough opposition in the Senate, would roll back a tax in the 2010 health law designed to help pay for the expansion of coverage to people who do not have insurance.

The New York Times: House Acts To Repeal Medical Device Tax
In another assault on President Obama's health care law, the House passed a bill on Thursday to repeal a new tax on medical devices (Pear, 6/7).

The Washington Post: House Votes To Repeal 'Medical Device Tax,' But Senate Unlikely To Agree
Launching a summer-long effort to chip away at the 2010 health-care reform law, the House voted Thursday to repeal a key funding source for the reforms. The Health Care Cost Reduction Act of 2012 would repeal a 2.3 percent excise tax on gross sales receipts in excess of $5 million for manufacturers and importers of certain medical devices, including defibrillators, pacemakers and prosthetic limbs. Congressional budget officials estimate that the tax set to take effect Jan. 1 would raise nearly $30 billion in revenue between 2013 and 2022 (O'Keefe, 6/7).

Reuters: House Votes To Kill Obama's Medical Device Tax
The Republican-led House of Representatives voted on Thursday to strike down a 2.3 percent tax on medical devices and other parts of President Barack Obama's healthcare law, although the effort is likely to hit a wall in the Democratic-led Senate. More than three dozen Democrats sided with Republicans to repeal the provisions, including the tax that the medical device industry has fiercely opposed. The vote was 270-146 (Dixon, 6/7).

Bloomberg: House Votes To Repeal Medical Device Tax In Health Law
Republicans in the U.S. House joined with 37 Democrats to pass a bill repealing a medical-device tax, chipping away at the 2010 health-care law in a victory for companies including Medtronic Inc. and Boston Scientific Corp. The Republican-led House voted 270-146 yesterday to pass the repeal measure. The 2.3 percent excise tax on sales, estimated to raise $29 billion over the next decade, is due to take effect in 2013. It applies to devices such as hip implants and coronary stents that aren’t sold directly to consumers (Rubin, 7/8).

The Fiscal Times: Medical Device Makers, GOP House, Renege On Tax
Ignoring threats of a presidential veto, House Republicans on Thursday repealed the medical device tax included in the 2010 health care reform law to help pay for coverage of the uninsured. ... Opponents of the 2.3 percent tax, which is slated to raise $29 billion over the next decade, argued the minor levy would slow innovation in the medical device field and cost jobs. During the debate over health care reform, device makers, like their counterparts in the pharmaceutical industry, had agreed with reform proponents' arguments that 30 million new paying customers would more than offset any tax losses or fees contained in the bill (Goozner, 6/8).

Politico: House Approves Bill To Repeal Medical Device Tax
Like the other targeted repeal efforts, this one has virtually no chance of getting a vote in the Democratic Senate, and the White House has threatened to veto it — even though there are Democrats who didn’t like the medical device tax to begin with. A Senate GOP aide, however, said that Republicans may try to force a Senate vote on the measure by bringing it up as an amendment — perhaps when a Democratic package of small-business tax breaks comes to the floor later this year (DoBias, 6/7).

The Hill: House Defies Veto Threat, Votes To Repeal Medical Device Tax
The House passed legislation Thursday that would repeal the healthcare reform law's tax on medical device manufacturers. ... To pay for the repeal, the bill would require all overpayments of health insurance subsidies provided in the healthcare law to be recaptured. Under current law, only some of these overpayments must be returned to the government. Overpayments of the subsidies are anticipated because they would be based on prior years' income, and if it is discovered later that a family's income increases, some repayment would be required (Kasperowicz, 6/7).

The Associated Press: House Approves GOP Bill Repealing Medical Tax
Scoffing at a White House veto threat, the House voted Thursday to repeal a tax on medical device makers that Republicans cast as a job-killing levy that would stifle an innovative industry. Lawmakers approved the measure 270-146, with 37 Democrats from states with a heavy presence of medical equipment makers like Minnesota, New York and California joining all 233 voting Republicans. Most Democrats said the bill was yet another GOP attempt to weaken President Barack Obama's health care overhaul, which created the tax to help pay for that law's expansion of health care coverage to 30 million Americans (Fram, 6/7).

This Story: Print | Link to | Top

Internists Press Lawmakers For Medicare Formula Fix

MedpageToday: Internists Lobby Congress For SGR Fix
Several hundred internists and medical students were on Capitol Hill Thursday, meeting with their members of Congress to advocate for issues facing internal medicine. Chief among them, not surprisingly, is a fix for the sustainable growth rate (SGR), the Medicare formula that, year after year, calls for steep cuts in Medicare reimbursement rates for physicians. … Before that fix expires, doctors' groups -- including the American College of Physicians (ACP), which represents internists -- as well as several lawmakers, have been pushing for bills to totally revamp the formula, which both Democrats and Republicans agree is flawed (Walker, 6/8).

This Story: Print | Link to | Top

Health Disparities

Study: U.S. Hispanics Fare Worse Waiting For Heart Transplants

Reuters: More US Hispanics Die Waiting For Heart Transplants: Study
Hispanic patients in need of a heart transplant are 50 percent more likely to die before they get one that white patients, according to a U.S. study. Previous studies found that black patients fared poorly after transplants compared to whites, but less was known about how different racial groups do while they are waiting for a donor organ (Grens, 6/7).

This Story: Print | Link to | Top

Public Health & Education

New Fetal Genetics Testing Technique Could Offer Less Risk, More Controversy

NPR: New Fetal Genetics Test: Less Risk, More Controversy
The full genetic code of a fetus has been cracked. The technique, used by scientists at the University of Washington, could offer parents safer and more comprehensive prenatal testing in the future. It also leaps into a debate over what information parents will eventually have — and use — to decide whether to have an abortion (Farrington, 6/7).

This Story: Print | Link to | Top

State Watch

La. Gov. Signs Bill Increasing Wait Time Between Mandatory Ultrasound, Abortion

The bill signed by Bobby Jindal would also require abortion providers to offer women the opportunity to listen to the fetal heartbeat. In other abortion news, a Michigan legislative panel endorses a bill that would ban abortions after 20 weeks of pregnancy.

New Orleans Times-Picayune:  Gov. Bobby Jindal Signs New Abortion Restrictions Into Law
Gov. Bobby Jindal signed bills Thursday increasing the waiting time between a mandatory ultrasound and an abortion, requiring abortion providers to describe the results of that procedure to the woman and offer to let her hear the fetus' heartbeat and prohibiting anyone who is not a physician from performing abortions.  The new restrictions add to requirements that are already considered some of the most stringent abortion regulations in the country, according to groups that support abortion rights (Adelson and Anderson, 6/7).

MLive:  Sweeping Abortion Legislation Would Affect Insurance And Doctors
A Republican-led Michigan House committee has approved broad proposals that would raise insurance requirements and increase regulations for some doctors performing abortions. The bills approved Thursday by the House Health Policy Committee also combine or expand upon many other bills that already have been sponsored recently in the Legislature. Those include proposals that prohibit abortions after 20 weeks of pregnancy except in cases where the mother’s life is in danger and make it a crime to coerce a woman into having an abortion (Martin, 6/7).

The Associated Press/Detroit Free Press: State House Panel Approves New Regulations For Abortions
A package of measures aimed at restricting and regulating abortion practices cleared a key hurdle Thursday in a Michigan House committee and could get a floor vote as early as next week. Proposals include requiring a doctor or assistant to do screening before an abortion to ensure a pregnant woman isn't being coerced, banning abortions after 20 weeks of pregnancy and enacting new regulations related to the disposal of fetal remains. The Republican-led House panel dealt with the bills that contain pieces of legislation that had been introduced or approved in the Legislature but was introduced in its current form only last week (Karoub, 6/8).

This Story: Print | Link to | Top

Bachmann Calls For Federal Audit Of Minnesota Medicaid Program

Rep. Michele Bachmann, R-Minn., is asking for a federal audit of her state's Medicaid program after a congressional probe found a year's worth of alleged overpayments. In other news, insurers Molina and Centene have won back Medicaid contracts in Ohio after initially being rejected. 

MinnPost:  Bachmann Calls For Audit Of Minnesota's Medicaid Program
U.S. Rep. Michele Bachmann has called for a federal audit of Minnesota's Medicaid management program. Bachmann sent a letter to the Center for Medicare and Medicaid Services on Thursday asking for an independent third-party audit of Minnesota's Medicaid billing practices in light of a congressional investigation into a year’s worth of alleged overpayments to the state's managed care organizations (Henry, 6/7).

Minnesota Public Radio: Bachmann Wants Independent Audit Of State’s Medicaid Program
Michele Bachmann is stepping up her campaign for federal officials to take a deeper look at how Minnesota's Medicaid managed care plans operate. Later today, the Minnesota Republican congresswoman will send a letter to Marilyn Tavenner, the head of the Center for Medicare and Medicaid Services, asking that the federal government conduct an independent, third-party audit of Minnesota's management of the federal-state health care program for the poor. Bachmann's request comes after a House hearing in April that paid particular attention to Minnesota's contracts with nonprofit managed care organizations and UCare's $30 million payment to the state in 2011 (Neely, 6/7).

(St. Paul) Pioneer Press: Minnesota: Bachmann Calls For Audit Of State Medicaid
U.S. Rep. Michele Bachmann, R-Minn., is calling for a federal agency to audit Minnesota's Medicaid program. In comments before a House of Representatives subcommittee on Thursday, June 7, Bachmann said she was sending a letter to the Centers for Medicare and Medicaid Services calling for "an immediate, independent third-party audit of Minnesota's books." "This situation needs immediate attention," Bachmann told the Oversight and Government Reform subcommittee, which was taking testimony on fraud in the federal Medicare and Medicaid health insurance programs (Snowbeck, 6/7). 

In other news, Molina and Centene have won back the right to do Medicaid business in Ohio after initially being rejected for renewal. Medicaid managed care makes news in Texas and Florida also --

The Wall Street Journal: Molina, Centene Win Back Ohio Medicaid Business
Medicaid health insurers Molina Healthcare Inc. and Centene Corp. won back business in Ohio after protesting their prior rejection for new contracts starting next year. The state, which had initially named Aetna Inc. a winner, dropped that insurer from its list of five Medicaid health plans that will serve starting Jan. 1. Meridian Health Plan, a nonprofit, was also dropped after initially being named a winner (Kamp, 6/7).

The Columbus Dispatch:  State Revises Which Health Plans Will Manage Medicaid Program Following Protests
Two months after shaking up which health plans get billions to manage Ohio’s Medicaid program, state officials are mixing it up again.  Two of the five companies awarded preliminary contracts -- Aetna Better Health of Ohio and Meridian -- were notified today that they have lost contracts for the work following a review of their bids by the state Department of Job and Family Services (Candisky, 6/7).

Market Watch: Molina Shares Plunge On High Costs In Texas Market
Shares of Molina Healthcare Inc. plunged Thursday after the Medicaid health insurer shelved its full-year earnings guidance due to Texas-size cost problems in the state's newly expanded Medicaid market. Fellow Medicaid insurers Centene Corp. and Amerigroup Corp., which joined Molina in recently winning new business in Texas, also came under pressure on worries about their potential exposure. The problem with unexpectedly high costs highlights a risk these companies face, even as they benefit from states turning to managed-care firms to handle the government health program for the poor (Kamp, 6/7).

Health News Florida: Medicaid Plan Wins $36M Contract
Medicaid patients and their doctors in 31 rural counties will soon get their first taste of real managed care -- the kind that requires permission to spend. The state has chosen the company that will be making the decisions:  Better Health, a Coral Gables-based firm that sponsors a provider-service network in Broward County.  It has signed a $36-million contract with the Agency for Health Care Administration. Better Health's task is to transform the Medicaid program known as MediPass into a standard managed-care program that requires "prior authorization" – permission -- for hospital stays and many other services (Jordan Sexton, 6/7).

And Arizona taxpayers could be paying millions for the care of patients who don't qualify for the Medicaid program --

Arizona Republic: AHCCCS Errors Could Be Costing Millions, Audit Shows
A new audit shows taxpayers could be losing up to $57 million a year paying for patients who should not have qualified for the state's indigent health-care program. Auditor General Debbie Davenport estimated that nearly 6 percent of applications for the Arizona Health Care Cost Containment System contained processing errors, such as understating income, and 1 percent were "at risk for being incorrect" (Reinhart, 6/7).

This Story: Print | Link to | Top

State News: Wis. Insurers Meet Health Law Medical Spending Requirements

A selection of health policy stories from Wisconsin, Oregon, Arizona, New York, Virginia, Texas, Massachusetts, Florida and California.

Milwaukee Journal Sentinel: State-Based Health Insurers Meet Federal Spending Requirements
All of the major health insurers based in Wisconsin and at least two of the large national health insurers in the state have met the new federal requirement that health plans spend at least 80 percent of premiums on medical care and quality initiatives (Boulton, 6/7).

The Lund Report:  Communication To Oregon Health Plan Patients Increases As Reform Nears
Communication to Oregon Health Plan patients about what the monumental changes to the Oregon Health Plan’s delivery system means to them is beginning in earnest as the August 1 start date for 11 organizations likely to become coordinated care organizations throughout Oregon nears.  The Oregon Health Authority is expected to send a 30-day notice letter to Oregon Health Plan patients that will receive care from coordinated care organizations starting August 1. A rough draft of that letter circulating among advocates stresses the fact that benefits paid for by the Oregon Health Plan are not changing (Waldroupe, 6/8).

Los Angeles Times: Prop. 29 Backers Hold Out Hope As Gap Narrows
Proponents of the tobacco tax initiative on Tuesday's state ballot, Proposition 29, refused to concede defeat Thursday as election officials continued to count ballots and the gap narrowed. The measure was losing by just under 53,000 votes as updated tallies continued to trickle in from county elections offices. On election night, that number was 63,000 (Wilson, 6/7).

Reuters: New York City Official Defends "Supersize" Drink Ban
New York City's top health official shot back on Thursday at critics who have blasted the city's plan to limit the sale of oversized sugary drinks such as soda, calling beverage industry opposition ridiculous. ... "It's not saying 'no' to people. It's saying, 'Are you sure? Do you really want that?'" Thomas Farley, New York City's health commissioner, said. "It's sending people a message while giving people the freedom to drink as much as they want" (Heavey, 6/7).

Richmond Times-Dispatch:  Emptying Training Centers Sparks Pivotal Hearing Today In Federal Court
A federal judge today will weigh a proposed $2 billion settlement between Virginia and the federal government that is a pivotal step toward erasing what the U.S. Department of Justice has alleged is the state's archaic and unconstitutional warehousing of disabled people. U.S. District Judge John A. Gibney Jr. in Richmond is expected to take most of the day to allow parties affected by the proposed closing of four of the state's five training centers for physically and intellectually disabled individuals to air their opinions about a settlement, which is described as either dooming or freeing for more than 1,000 institutionalized adults and their families (Mckelway, 6/8).

Modern Healthcare: Texas Devicemaker To Pay Over $34 Million In Kickback Case
A Texas-based medical-device company has agreed to pay more than $34 million to settle allegations that it improperly waived patient co-payments, received overpayments from the federal government and paid kickbacks to physicians. According to a news release from the Justice Department, Lewisville, Texas-based Orthofix "paid kickbacks to physicians and their staffs in the form of 'fitter fees,' referral fees and other comparable fees to induce the use" of the company's bone growth stimulator devices (McKinney, 6/7).

Modern Healthcare: NYU Langone, Continuum Health Explore Merger
The potential merger of NYU Langone Medical Center with Continuum Health Partners moved closer to a deal as the New York hospital operators signed a memorandum of understanding. Negotiations are expected to continue for another six months as the prospective partners compare strategic and operating plans, the not-for-profits said in a joint statement (Evans, 6/7).

Boston Globe: South Shore Hospital To Join Partners System
South Shore Hospital in Weymouth has agreed to become a member of the Partners HealthCare medical system in a deal that falls short of an outright merger, according to a memorandum of understanding released Thursday by the hospital, Partners HealthCare, and Brigham and Women’s Hospital. … South Shore Hospital, with 318 beds, serves a swath of Southeastern Massachusetts stretching from Quincy to Taunton to Cape Cod (Denison, 6/7).

Health News Florida: 'Report Card' Peeves Low-Scoring Hospital
Hospitals that got bad grades on this week's patient-safety report are fighting to reclaim their reputations. Florida hospitals, taken as a whole, scored several percentage points better than the national average when The Leapfrog Group released letter grades for 2,600 hospitals on Wednesday at www.HospitalSafetyScore.org. Only 5 percent of Florida hospitals received a "Grade Pending," which signifies a D or F. But that 5 percent includes some big names, including Jackson Memorial (Rabaza, 6/7).

California Healthline: Scrutiny Of Health Care Training Programs Increasing
As California gears up to increase an understaffed health care workforce, private schools training health care workers of the future are coming under more scrutiny on several fronts. … Common themes in the legislation, research projects and state oversight include the high costs of education compared with graduation rates and graduates' ability to find jobs. Most of the attention is trained on vocational training at private schools. The increased demand for a wide range of health care workers, from physician assistants to vocational nurses and dental assistants, has sparked an increase in private educational programs (Lauer, 6/7).

California Healthline: Long-Term Care Crisis Is Now, Report Says
By 2030, the number of Californians 85 and older will rise by 40 percent and the overall senior population will comprise about 18 percent of all Californians. That's the sobering news from a fact sheet released this week by the SCAN Foundation, a not-for-profit organization that tracks long-term care issues. … The fact sheet projects a population of 9 million seniors in California by the year 2030. [SCAN Vice President Gretchen] Alkema said state policies to encourage and facilitate the purchase of long-term care insurance will be important in the next few years (Gorn, 6/8).

This Story: Print | Link to | Top

Health Policy Research

Research Roundup: Savings From Electronic Health Records?

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

Journal of General Internal Medicine: Does Health Information Exchange Reduce Unnecessary Neuroimaging and Improve Quality of Headache Care in the Emergency Department? -- Researchers examined the records of 1,252 patients who visited Memphis-area emergency rooms at least twice or more because of severe headache to see if a health information exchange helped avoid duplicate tests and imaging. They concluded that this data-sharing system among providers was "associated with decreased diagnostic imaging and increased evidence-based guideline adherence in the emergency evaluation of headache, but was not associated with improvements in overall costs. ... ongoing federal support for HIE is warranted, but that funding should be tied to ongoing demonstration of meaningful HIE use” (Bailey et al., 5/31).

Health Affairs: Despite 'Welcome To Medicare' Benefit, One In Eight Enrollees Delay First Use Of Part B Services For At Least Two Years -- Medicare's Part B covers non-hospital medical services, and it includes a 'Welcome to Medicare" check-up visit at no cost to the patient. This analysis of national survey data found that about one in eight people did not use Part B services in the first two years. Researchers noted that "this delay reflected patterns of use before enrollment ... Men had a lower probability of using Part B services early than women; blacks and members of other minority groups were less likely to use services early than whites." They concluded that underuse of preventive care "may lead to more expensive care and a higher cost burden on Medicare in later years" (Sloan, Acquah, Lee and Sangvai, 6/5).

Annals of Internal Medicine: Effect Of The Medicare Part D Coverage Gap On Medication Use Among Patients With Hypertension and Hyperlipidemia -- Medicare Part D was introduced in 2006 to increase access to prescription medicines, but a gap in coverage known as the "doughnut hole" left seniors with 100 percent of cost between $2250 and $5100. Researchers looked at claims before and after Part D was implemented to see if the gap affected beneficiaries’ use of drugs for high blood pressure and high cholesterol. They concluded: "The Part D coverage gap was associated with decreased use of medications for hypertension and hyperlipidemia in patients with no gap coverage and generic-only gap coverage. The proposed phasing out of the gap by 2020 will benefit such patients; however, use of low-value medications may also increase" (Li et al., 6/5).

Health Affairs: Six Features Of Medicare Coordinated Care Demonstration Programs That Cut Hospital Admissions Of High-Risk Patients -- Coordinated care for seniors with chronic disease and frequent hospitalizations has the potential to improve health and reduce Medicare spending. The authors picked out six key practices from demonstration projects, which include "supplementing telephone calls to patients with frequent in-person meetings; occasionally meeting in person with providers; acting as a communications hub for providers; delivering evidence-based education to patients; providing strong medication management; and providing timely and comprehensive transitional care after hospitalizations.” These techniques did not reduce spending (Brown et al., 6/5).

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

Medscape Medical News:  Three Crucial Factors Link After-Hours Care To Primary Care
Primary care practices (PCPs) can better integrate after-hours care if they have adequate payer support and incorporate features such as shared electronic health records and systematic notification procedures to maintain continuity of care, according to a new analysis [published online June 1 in the Journal of General Internal Medicine]. ... The study also found that efforts to provide after-hours care often work best when adopted as part of a broader PCP strategy to improve access and continuity of patient care (Hitt, 6/6).  

MedPage Today: Therapy by Phone Good Against Depression
Receiving cognitive behavioral therapy (CBT) over the phone is just as effective in primary care patients as when counseling is done face-to-face, and phone CBT may keep patients in treatment longer (Fiore, 6/5).

Reuters: Therapy For Depression Can Work Over The Phone: Study
But while people may not drop out of therapy as much, such treatment in a traditional setting may still be slightly more helpful, according to findings published in the Journal of the American Medical Association(6/6).

This Story: Print | Link to | Top

Editorials and Opinions

Viewpoints: Bipartisanship On Medical Device Tax; 'Overreach' In Contraception Fight

The Wall Street Journal: A Bipartisan Tax Repeal
Bipartisanship arrived in Washington on Thursday, not that many in the media will hail it. That's because the sweet harmony involved a 270-146 House vote to repeal ObamaCare's 2.3% excise tax on medical devices. ... The Beltway wisdom is that the device tax repeal is dead on arrival in the Senate, but don't be so sure. The $30 billion the tax is supposed to steal will create unusual havoc due to its application on sales rather than profits, and even otherwise down-the-line liberals like Al Franken and Amy Klobuchar (Minnesota, again) realize it (6/7).

USA Today: Editorial: In Contraception Battle, Both Sides Overreach
The continuing battle between the Obama administration and the Catholic Church over birth control, almost 50 years after the issue was settled for virtually all women in the U.S., can be summed up in one word: overreach (6/7).

USA Today: Opposing View: Catholic Diocese Of Pittsburgh: ‘We Did Not Pick This Fight’
Last August, the Department of Health and Human Services issued a mandate requiring religious institutions to facilitate activities that violate their religious and moral convictions. The only church-sponsored organizations exempted are those that primarily employ and serve people of the same faith. This means that none of our social service agencies — hospitals, universities, free health clinics and soup kitchens — would be exempt (David A. Zubik, 6/7).

USA Today: Opposing View: HHS: ‘We Will Achieve Our Shared Goals’
For too long, many Americans couldn't afford the preventive care they needed to stay healthy. The 2010 health care law ensures millions of Americans won't pay an extra penny out of their own pockets for preventive services such as vaccines for children, critical cancer screenings and wellness visits for many seniors. And women won't have to pay more for preventive services — including contraception — that the respected Institute of Medicine says are important to protecting their health (Mary Wakefield, 6/7).

Philadelphia Inquirer: Bill Of Unhealth: State Rep’s Aim To Defund Planned Parenthood Will Hurt Many
The Whole Woman's Health Funding Priority Act essentially would defund Planned Parenthood from providing health services like screenings for cancer and sexually transmitted diseases, as well as contraception for 120,000 Pennsylvanians annually. Even though both state and federal law prohibit the use of any taxpayer money to be spent on abortions, Metcalfe insists that "They [Planned Parenthood] provide this testing to bring women in the front door, at the same time there is someone in the backroom performing abortions." Maybe Metcalfe didn't intend for this to be a factual statement, because it isn't (6/8).

Arizona Republic: Economy, Not Recall, Forces Pension Fix
In Wisconsin, Walker proposed to control government spending by reducing benefits for a subset of the electorate, government workers. The spending problem with the federal government isn't the benefits for government workers. It's the benefits for the rest of us. To his credit, Romney has proposed to rein in entitlement spending. … On Medicare, he supports changing it into a program that subsidizes insurance premiums rather than simply pays medical bills. To his discredit, Obama has made no meaningful proposals to get entitlement spending under control (Robert Robb, 6/8).

Denver Post: Improving Colorado Health Care
The Affordable Care Act was passed in large part because of recognition that our nation's health care system is not working. The act is not perfect, but it is a starting point, and we have been using it to improve the health of Coloradans. Colorado is undergoing a thoughtful, bipartisan reform process that makes our state a model for how to get this right. Many of the ideas that are in health reform are not new, and in fact were identified by Colorado's own Blue Ribbon Commission for Health Care Reform in 2008 (Gov. John Hickenlooper, 6/8).

This Story: Print | Link to | Top


EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Shefali Luthra

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