Daily Health Policy Report

Wednesday, July 14, 2010

Last updated: Wed, Jul 14

KHN Original Reporting & Guest Opinion

Health Information Technology

Health Reform

Capitol Hill Watch

Administration News

Health Care Marketplace


State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

A New Practice: The Doctor Will See You Today

Catherine Arnst, writing for Kaiser Health News in collaboration with The Boston Globe, reports: "Dr. Dennis M. Dimitri, a family physician, runs a pretty unusual office. Few appointments are accepted in advance. Instead, patients call in the morning and are assigned a time slot later that day. Some patients walk in without calling ahead" (Arnst, 7/14). Read entire story.  

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HHS Relaxes Some Rules For Doctors, Hospitals To Get Aid For Electronic Health Records

Kaiser Health News staff writer Phil Galewitz reports: "The federal government is making it easier for health care providers to get bonus money for using electronic health records starting next year, but the hospital industry said it still had concerns that too few facilities would qualify" (Galewitz, 7/14). Read entire story.

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Health Information Technology

Final Rules Unveiled For Docs, Hospitals To Tap E-Health Funding

The federal government has issued new regulations defining the "meaningful use" of electronic medical records, a requirement doctors must fulfill in order to gain funds from a $27-billion pot set aside in the 2009 stimulus law, The New York Times reports. "A doctor can receive up to $44,000 under Medicare and $63,750 under Medicaid, while a hospital can receive millions of dollars, depending on its size." These final rules are significantly less stringent than an early proposed version, but the president of the American Hospital Association said most hospitals may still struggle to surmount them (Pear, 7/13).

The AHA's vice president of policy told Kaiser Health News, "The requirements may still be out of reach for many American hospitals." Under the final rules, "doctors will have to meet 15 objectives, and at least five from a list of 10 more. Hospitals will have to meet 14 objectives, and at least five more goals." Objectives include things like recording whether patients smoke and incorporating medication lists into records. The earlier draft version required doctors to meet 25 objectives and hospitals to meet 23 (Galewitz, 7/13). 

The Dallas Morning News: The payments are scheduled to begin in May of next year. "Providers that don't participate will see their Medicare payments reduced by 1 percent, beginning in 2015. In later years, the penalty grows to 3 percent." Many do not have records in place now. "Despite years of technological development, most hospitals and physician offices, including in North Texas, cannot electronically share information or even record patient data. As a result, patients who move between doctors, or between hospitals, have trouble coordinating their care" (Michaels, 7/14).

The Associated Press: "As lawyers pored over the [hundreds of pages of] text of the regulations, the American Medical Association said it was withholding judgment. … Federal officials said they tried to address doctors' complaints that the initial draft of the rule asked them to do too much, too quickly. More than half of family doctors practice in groups of four or fewer. A majority of small and medium offices have opted not to adopt electronic records because of costs and unresolved questions, according to the American Academy of Family Physicians" (Alonso-Zaldivar, 7/13).

Modern Healthcare: What does the public get out of these investments? "The goals behind meaningful EHR use are said to be improving the quality, safety and efficiency of healthcare services; reducing healthcare disparities; engaging patients and their families; improving the coordination of care; improving population and public health; and ensuring the privacy and security of personal medical information" (Robeznieks, 7/13). 

The Boston Globe: The unveiling of the regulations was presided over by Donald Berwick, the newly appointed director of the Medicare agency, which will distribute the stimulus funds. "Berwick opened his brief speech with forward-looking remarks, reminding the audience of President Obama's goal to have electronic health care records available to all Americans by 2014. 'What we have at stake is the future of health care itself,' said Berwick. 'The benefits of a modernized health information technology help everyone. It’s a win-win, right across the board'" (Vallejo, 7/13).

NPR: Berwick himself is a fan of electronic records. He also said, "I never had to go hunting for a missing piece of paper with a lab test written on it that I needed. … All the results were there, right there, as soon as the lab that produced the result." NPR adds, "And if he sent a child to see a specialist, there was 'no phone tag after that, wondering what happened. The specialist notes were there for me, and the family, just as soon as the specialist prepared those notes'" (Rovner, 7/13).

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Health Reform

Rules For Free Preventive Services Requirement Announced

During a Wednesday news conference, the Obama administration unveiled regulations for implementing provisions of the new health that will require insurers to fully pay for some preventive services.

The Associated Press: "From counseling for kids who struggle with their weight, to cancer screenings for their parents, preventive health care will soon be available at no out-of-pocket cost under consumer rules the Obama administration unveiled Wednesday. That means no copays, deductibles or coinsurance for people whose health insurance plans are covered by the new requirements. The Obama administration estimates that 41 million Americans will benefit initially, with the number projected to rise to 88 million by 2013. Many large company plans, which usually offer solid preventive benefits, will be exempt from the requirements for the time being" (Alonso-Zaldivar, 7/14).

Reuters: "'Unfortunately, too many Americans don't get the preventive care they need to stay healthy and keep health care costs down for all of us,' said Kathleen Sebelius, the secretary of health and human services. The rules will go into effect in September, six months after Congress passed the health care overhaul" (Lentz, 7/14).

The Washington Post: First Lady Michelle Obama, in announcing the new regulations, said, "Getting access to early care and screenings will go a long way in preventing chronic illnesses like diabetes, heart disease, and high-blood pressure." Obama, Sebelius and Jill Biden, wife of Vice President Joseph Biden, made the announcement at George Washington University Hospital.
"And good preventative care will also help tackle an issue that is particularly important to me as First Lady and as a mother - and that is the epidemic of childhood obesity in America today. These are important tools, and now it's up to us to use them," Obama said (Henderson, 7/14).

The Wall Street Journal: "Cancer screenings, including mammograms and colonoscopies, as well as obesity prevention services, immunizations, blood pressure screenings and tobacco cessation services are among those that will be available to consumers without a copayment or other direct costs for consumers on new health plans after Sept. 23." The Journal later updated the story to says that "birth control will not qualify as preventive." However, Planned Parenthood is advocating to get it covered (Adamy, 7/14).

In other health reform policy news, Maine has asked the federal government to exempt it temporarily from adhering to health reform law rules governing medical-loss ratios, saying it could force one of the state's health plans out of business in the state, according to The Wall Street Journal, in a separate story. "At issue are tougher rules governing the so-called medical-loss ratio, a measure of how much insurers spend on medical care compared with their administrative expenses and profits. Under the new law, insurers must pay out at least 80% of the premiums collected from individuals on medical care. Regulators at the National Association of Insurance Commissioners are drafting rules to determine what insurers can count as medical expenses and what protections might help smaller plans stay afloat."

Maine's insurance superintendent said the rule, if implemented too quickly, could force HealthMarkets Inc. to stop doing business in the state, leaving just WellPoint's Anthem Blue Cross & Blue Shield the sole option for consumers. "The law allows HHS to grant exemptions if the requirement will upend markets. HHS has received the letter, which is the first from a state regulator, and it will be establishing the process for reviewing such requests in regulations that it plans to issue, said an HHS spokeswoman" (Johnson, 7/14).

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Support For Health Overhaul Down; GOP Asks Kagan If She Would Recuse Herself From Cases On New Law

CBS News: Support for the new health reform law has dropped seven percentage points in the last two months, though it remains higher than when the law was first signed in March. "Forty-nine percent of Americans now disapprove of the health care reform measure, according to the poll, which was conducted July 9-12. Thirty-six percent support the law. In a May CBS News poll, 47 percent disapproved of the new laws, while 43 percent approved. While the new poll shows a recent drop in support, the numbers have still improved overall since March, when 53 percent of Americans disapproved of the new laws and 32 percent said they approved of them." Most Republicans and independents disapprove of the overhaul while most Democrats support it (Condon, 7/13).

The Wall Street Journal: In the meantime, GOP senators have asked Supreme Court nominee Elena Kagan to recuse herself from consideration of a challenge to the health reform law if such a question comes before the high court. "Kagan, the solicitor general, represents the Obama administration before the Supreme Court. She has said she would decline to participate in deciding cases that she worked on but has not said whether that includes a challenge to the health care law. Constitutional questions about the health care law, including its requirement that most Americans obtain insurance or face a fine, were raised in the months before President Barack Obama nominated Kagan to the court. Several states have filed suit to try and stop it." Kagan has said she has not expressed an opinion on the merits of the health reform legislation (Meckler, 7/13).

Roll Call: Republicans also are considering "retaliatory measures in response to President Barack Obama's decision to use a recess appointment to install Donald Berwick as administrator of the Centers for Medicare and Medicaid Services. ... Minority Leader Mitch McConnell called the appointment of Berwick during the July Fourth recess period a 'truly outrageous' political move. The Kentucky Republican declined to specify what Republicans might do in retaliation, but Senators in his inner circle suggested some action was forthcoming." Republicans also took to the Senate floor again Tuesday to express criticism of the appointment (Drucker, 7/14).

In other political news, CQ HealthBeat reports that Health and Human Services Secretary Kathleen Sebelius "rejected charges by Republicans that a Medicare brochure mailed out to beneficiaries earlier this year was inaccurate and misleading." The brochure, Sebelius said, helped inform Medicare recipients of changes to the health system in health reform. In a letter to eight Republican senators, Sebelius said the brochure was an important "educational tool" (Norman, 7/13). 

Retiring Rep. Bart Stupak, D-Mich., has given money to colleagues running for office "who helped him in his high-profile push for restrictions on abortion funding in the health care bill," Politico reports. "Since announcing his retirement in April, Stupak has cut campaign checks for Ohio Rep. Steve Driehaus, Indiana Reps. Joe Donnelly and Baron Hill and Pennsylvania Reps. Chris Carney and Kathy Dahlkemper — all of whom joined Stupak in negotiating with leadership for tighter limits on federal support for abortion. Stupak also donated to West Virginia Rep. Alan Mollohan, another abortion opponent who lost reelection in a May Democratic primary. That whole group of Democrats eventually voted for the health care reform bill, after President Barack Obama agreed to sign an executive order clarifying that no federal money would be used for abortion procedures under the law" (Isenstadt, 7/13).

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Capitol Hill Watch

PhRMA Names Business Roundtable Head As New President, Looks To New Influence

John Castellani was named president of the Pharmaceutical Research and Manufacturers of America Tuesday, bringing his clout and lobbying power to the post after spending nine years representing CEOs as president of Business Roundtable.

The New York Times: "Castellani starts work in September for the Pharmaceutical Research and Manufacturers of America, succeeding Billy Tauzin, a Washington insider who had represented Louisiana in Congress for 26 years. Mr. Tauzin resigned in February after promoting a compromise in the health care overhaul." Tauzin had "caught flak from some business interests" for trying to compromise on health reform by offering tens of millions of dollars in television advertising. Tauzin also promised drugmaker discounts that will reduce pharmaceutical spending in the United States by $80 billion during the next 10 years. "In Mr. Castellani, the drug makers get another insider with deep connections, though mostly from the lobbying world rather than inside Congress. He was named president of the roundtable in 2001 and credited with re-energizing the group." PhRMA spent $26 million lobbying last year (Wilson, 7/13).

Reuters: PhRMA's pledge was "to pay $80 billion over 10 years in price cuts and other concessions as part of a deal with the Obama administration and top Senate Democrats last June. The cost was seen as a small price for the $315 billion drug industry to pay in exchange for potentially 30 million more insured customers." Some analysts said, however, that that the deal had created disharmony among PhRMA's leaders and led to Tauzin's resignation (Morgan, 7/13).

Politico: "Castellani comes to PhRMA well-positioned for Washington in 2010, as something of a hedge depending on what happens in the November midterms — on good terms with the Obama White House, but also set up nicely in case Republicans take over the House of Representatives. … Still, Castellani will have to operate in the midst of growing tensions between some business leaders and Obama. Castellani said he will focus on successfully implementing health care reform, including closing the gap in prescription drug coverage for seniors. And he said his group will continue fighting an independent Medicare payment advisory board, which would essentially force cost-cutting measures on lawmakers, limiting the ability of outside groups like PhRMA to lobby the outcome" (Frates, 7/13).

Dow Jones Newswires/The Wall Street Journal: He said he want to ensure "quick and smart implementation of the [health reform] law's so-called doughnut hole closure." Regarding the Independent Payment Advisory Board, which also was established in the law, "Castellani said he is concerned this advisory board will have 'overly broad powers which could potentially enact sweeping Medicare changes not authorized by Congress.' He wants to make sure the board is responsible, and has appropriate authority and appropriate oversight" (Loftus, 7/13).

The Washington Post: "As head of the Business Roundtable — an association of chief executives of major U.S. companies — Castellani has opposed most Democratic legislative initiatives, including the health-care overhaul. But he has managed to do so without alienating adversaries. … Ranked Washington's third-largest lobbying entity in 2009 behind the U.S. Chamber of Commerce and Exxon Mobil, PhRMA spends more than $2 million a month on behalf of drug conglomerates such as Pfizer and Merck, and could wield considerable influence on such issues" (Aizenman and Eggen, 7/14).

Roll Call: "'This is an industry and this is an association that has a history — as I have a history — of working with both sides of the aisle,' … Castellani said in a conference call on Tuesday. 'My style and PhRMA's style will be to be politically relevant, not to be partisan.' … 'We're not a rubber stamp for either of the political parties,' Castellani told reporters on Tuesday" (Murray, 7/13).

CongressDaily: The decision to hire Castellani "might help the organization win back Republicans angry with the group after they worked with Democrats on the healthcare overhaul, while retaining the moderate approach needed to work with whichever party is in power. … Ipsita Smolinski, a senior health policy analyst at consulting firm Capitol Street, said PhRMA's decision to hire Castellani largely came from Pfizer CEO and Chairman Jeff Kindler, who also serves as PhRMA's chairman and contributed to President Obama's campaign in the 2008 general election. Pfizer is also a member of the Business Roundtable" (McCarthy, 7/14).

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Administration News

After Releasing New HIV Strategy, Obama Says Efforts Against The Disease Require 'More Than Just Fighting The Virus'

HHS Secretary Kathleen Sebelius, Assistant Secretary Dr. Howard Koh, White House AIDS Policy Director Jeffrey Crowley and domestic policy advisor Melody Barnes at the briefing on the National HIV/AIDS Strategy Tuesday in Washington. (Photo by Chip Somodevilla/Getty Images)

The Associated Press: "President Barack Obama said Tuesday a new strategy for combating HIV and AIDS fulfills America's obligation to stopping the spread of the virus and rooting out the inequities and attitudes on which it thrives. The strategy sets a goal of reducing new infections by 25 percent over the next five years; getting treatment for 85 percent of patients within three months of their diagnosis; and increasing education about the virus, even in communities with low rates of infection. 'Fighting HIV/AIDS in America and around the world will require more than just fighting the virus,' Obama said at a White House reception honoring the work of those in the HIV and AIDS community. 'It will require a broader effort to make life more just and equitable'"(Pace, 7/14).

The Washington Post: "Noting that the number of new infections in the United States has been static -- and that the number of people living with HIV is growing -- the new policy would direct more resources toward African Americans and gay and bisexual men. Latinos and substance abusers should also be a priority, the report says. … The new HIV/AIDS policy has been summarized in a 60-page report that credits the Bush administration for its efforts to address the disease but also laments the country's general lack of concern" (Kornblut, 7/14).

USA Today: "By 2015, the White House seeks to: Reduce new HIV infections by 25%; Cut the rate of the virus' spread by 30%, from five people a year infected by every 100 living with HIV to 3.5 per 100; Increase from 79% to 90% the percentage of HIV-positive people who know they're infected with the virus so they can get treatment" (Sternberg, 7/13).

Reuters: In his remarks, Obama said, "'We need to make sure all our efforts are coordinated within the federal government and across state and local governments.' The plan directs government agencies to work together more closely to focus spending where it is most needed and identify where new spending would do the most good. ... Julie Scofield, executive director of the National Alliance of State & Territorial AIDS Directors, said she would welcome better coordination on the federal level. 'Right now state health departments and community-based organizations really have so many disparate requirements and rules and reporting that it really ties them up in knots more than it should,' Scofield said" (Colvin and Fox, 7/14).

CNN: "Federal officials are also seeking to combat a growing sense of complacency about the disease, partly by reducing the percentage of infected Americans who are unaware of their status. ... The White House's goal, according to Health and Human Services Secretary Kathleen Sebelius, is to make new infections rare while ensuring that those who are infected have an 'unfettered access to high quality life-extending care free from stigma and discrimination. ...'"

"One leading HIV/AIDS activist, however, was sharply critical of the administration's strategy. Michael Weinstein, president of the Los Angeles-based AIDS Healthcare Foundation, told CNN in an interview that 'when you see what this administration has done on AIDS, you have to give them very low grades.' Obama has 'consistently underfunded AIDS' programs, Weinstein said" (Silverleib and Uliano, 7/14). 

Kaiser Health News posted the president's introductory letter, the full National HIV/AIDS strategy and the Implementation Plan (7/13).

The Los Angeles Times: "Obama's strategy includes broad goals as well as dozens of directives for the Centers for Disease Control and Prevention, the Agency for Healthcare Research and Quality, and other federal agencies. Those steps include developing standards to evaluate care, investigating community programs to see whether they're effective and simplifying grant applications. The Bureau of Prisons would expand HIV screening of inmates, and the Justice Department would fast-track investigations of discrimination involving those with HIV. … David Munar, vice president of the AIDS Foundation of Chicago, praised it as a potentially 'seminal moment' in the country's efforts to combat HIV/AIDS" (Levey, 7/13). 

The Washington Times: "But some groups dedicated to fighting the epidemic were critical of the fact it took officials a year and a half to come up with a plan. One such group, the AIDS Healthcare Foundation, hit Mr. Obama for what they described as a 'laggard approach' on the issue" (Rowland, 7/13).

NPR's "The Two Way" blog: "Charles King, president and chief executive officer of Housing Works which tries to ameliorate the problem of AIDS and homelessness, was disappointed. ... 'Unless [President Obama] commits significant new resources intended to make major inroads against the spread of HIV, he will be regarded as a leader who did next to nothing about the most devastating epidemic of our time.' [King said in a written statement]" (James, 7/13).

And, in earlier coverage, KHN reported: The HHS announcement comes "as state programs that provide AIDS drugs to patients with HIV grapple with growing waiting lists for the drugs. More than 2,000 patients are on the waiting lists. HHS Secretary Kathleen Sebelius announced July 8 that she will provide $25 million to states to help pay for the drug treatments, which average more than $12,000 a year. Even so, some advocacy groups said the aid 'falls short' of the need. … The administration's announcement also corresponds with the 2010 International AIDS Conference" in Vienna, Austria (Steadman, 7/13).

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Lew Chosen For OMB Post As Federal Deficit Tops $1 Trillion

President Obama's pick to replace Peter Orszag to run the Office of Management and Budget is inheriting a federal deficit that has topped $1 trillion with three months left in the federal government's fiscal year.

The Associated Press: "In its monthly budget report, the Treasury Department said Tuesday that through the first nine months of this budget year, the deficit totals $1 trillion. That's down 7.6 percent from the $1.09 trillion deficit run up during the same period a year ago." In the meantime, Republicans are blocking extra spending on unemployment benefits and job creation bills. "Another failed effort would have provided cash-starved states with money to help avoid layoff of public employees and finance the Medicaid program for the poor and disabled" (Crutsinger, 7/13).

The Fiscal Times, a reported column: Jacob Lew, who will take over OMB, will likely have tough choices to make to mitigate the debt. "Lew faces a grueling challenge — the exact mirror image of his last tenure at OMB. Back then, tax revenues were flooding in so fast that surpluses were piling up even though Congress and the White House were ignoring pay-as-you-go restrictions. Now, the administration faces trillion-dollar deficit projections in the coming years. Obama has pledged to slash the deficit to 3 percent of gross domestic product by 2015, and his fiscal commission may recommend painful policy changes that would be difficult to get through Congress" (Pianin, 7/13).

The Washington Post: Lew "'handed the next administration a record $236 billion budget surplus,' [President Obama] said, and called on his new appointee to 'use his extraordinary skill and experience to cut down that deficit and put our nation back on a fiscally responsible path.' … In the job of OMB chief, Lew would be responsible for drawing up a budget plan by February to reduce the federal deficit to 3 percent of the size of the economy by 2015. The current deficit is $1.3 trillion — more than 9 percent of the economy. To meet the goal, he probably would have to entertain the possibilities of tax increases and cuts to popular entitlement programs such as Social Security and Medicare" (Kornblut and O'Keefe, 7/14).

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Health Care Marketplace

Health Insurers Confront Dual Uncertainties Of Recession, Overhaul

Health insurers' Wall Street prospects remain uncertain as details of the health overhaul have yet to be mapped out, according to a Dow Jones Newswires/The Wall Street Journal brief. "While the federal overhaul of the health-care system could add millions of new members to companies' rolls, it also places new taxes and restrictions on the industry. Unresolved details in the new law add uncertainties, such as a potential requirement for insurers to spend a certain percentage of premiums on medical costs. The changes come as health insurers deal with declining membership rolls due to companies cutting jobs and benefits" (Xu, 7/13).

Meanwhile, "Blue Cross and Blue Shield of North Carolina plans to slash its administrative costs by 20 percent by 2014, as the state's largest medical insurer adapts to health reform and the economic slump," The Charlotte (N.C.) Observer reports. The company's strategy is aimed at improving financial results and keeping premiums down. Blue Cross raised rates for individual members an average of 12 percent this year, but gave some consumers much higher increases" (Wolf, 7/14).

Also, Blue Cross and Blue Shield of Oklahoma has announced it will slash 29 marketing and other administrative jobs by consolidating its support operations for the Southwest region in Texas, the Tulsa World reports. BCBS companies in Texas, Oklahoma and New Mexico are operated by the Chicago-based firm Health Care Services Corp. A company executive said, "While it is never easy to make decisions that affect staffing levels, this move will help us reduce administrative costs and provide our customers with enhanced services during a challenging economy and in the wake of a newly reformed health care environment" (Winslow, 7/13).

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Doctors Reluctant To Report Colleagues For Being Impaired, Incompetent

The Associated Press: "Your doctor could be drunk, addicted to drugs or outright incompetent, but other physicians may not blow the whistle. A new survey finds that many American physicians fail to report troubled colleagues to authorities, believing that someone else will take care of it, that nothing will happen if they act or that they could be targeted for retribution. A surprising 17 percent of the doctors surveyed had direct, personal knowledge of an impaired or incompetent physician in their workplaces, said the study's lead author, Catherine DesRoches of Harvard Medical School. One-third of those doctors had not reported the matter to authorities such as hospital officials or state medical boards." The findings appeared in Wednesday's Journal of the American Medical Association (Johnson, 7/13).

The Los Angeles Times: "About 70% of physicians said they feel prepared to report impaired physicians, and 64% said they were prepared to report incompetent ones. But more than one-third, 36%, said they do not feel obligated by professional commitment to do so. Physicians with less experience, 10 years or fewer, were most willing to report impaired or incompetent colleagues. Those with greater experience, 20 years or more, were less likely to feel that it was their responsibility to do so. … Pediatricians and family practice doctors were the least likely to say they felt prepared to deal with impaired or incompetent colleagues; anesthesiologist and psychologists apparently felt most prepared" (Schiewe, 7/13).

Reuters: "The most common reason for not reporting a colleague was that the doctor thought someone else was addressing the problem, but doctors also worried that either nothing would happen or the colleague would be punished too strictly if they reported their concerns. Doctors in solo and two-person practices were the least likely to have reported a colleague -- only 44 percent of those who knew a colleague was impaired or incompetent told authorities" (7/13).

The Wall Street Journal Blog: "There are a few different options for how a doc would go about reporting a colleague, including licensing boards, medical societies, clinical supervisors and hospital peer-review groups, according to the AMA, whose code of ethics requires reporting impaired, unethical or incompetent physicians" (Hobson, 7/13).

Bloomberg BusinessWeek reports that DesRoches said "'self-regulation is our best alternative, but these findings suggest that we really need to strengthen that. We don't have a good alternative system'" (Gardner, 7/13).

ABC News includes a video segment about the issue (7/13).

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State Watch

Florida Medicaid Recipients Make Fewer Trips To Doctors; Calif. Payments To Health Clinics In Jeopardy; Texas Addresses Nursing Shortage

Florida Times-Union: "Northeast Florida's Medicaid recipients are making fewer trips to the doctor for chronic illnesses since state officials outsourced the government-subsidized health insurance program to private managed care companies. But it remains unclear from the analysis performed by the Florida Agency for Health Care Administration, which oversees the state's Medicaid program, whether they're healthier for it. Medicaid reform was launched in 2006 in Duval and Broward counties to test whether HMOs could rein in the state's Medicaid spending. Baker, Clay and Nassau counties were added a year later. A University of Florida analysis last year suggested that medical costs were rising in reform counties at a slower rate compared with other parts of the state. But critics quickly lined up to attribute those savings to patients being denied care or being forced into bureaucratic tangles by the managed-care contractors" (Cox, 7/14).

The Los Angeles Times: "Health clinics that serve hundreds of thousands of California residents face the prospect of not being paid as the state lurches toward a third week of a budget stalemate — despite assertions by the state controller and Gov. Arnold Schwarzenegger's administration that providers of healthcare for the poor would be immune from missed payments. Without a spending plan in place, California cannot legally pay all its bills. But the controller said in June that all institutional health providers would be paid this year because of provisions in the federal stimulus act. Turns out, that was wrong. Officials now say that only hospitals and nursing homes will be paid in full" (Goldmacher, 7/14).

Dallas Morning News: "Tens of thousands of qualified applicants have been turned away from nursing schools for at least five years because there aren't enough teachers to conduct classes or enough clinical sites where students can get hands-on experience. Across the country, experts predict a shortage of more than 260,000 nurses by 2025. … The average age of a nurse faculty member in Texas is 54. Almost 57 percent of all nursing faculty will reach age 65 within seven years, according to the Texas Nurses Association. In Texas, one solution is to create more nurses in its own backyard rather than import them from elsewhere. The state tripled its appropriations for nursing education. The Legislature appropriated $14.7 million for the 2008-09 biennium but provided $49.7 million for the current biennium. Texas business leaders, through regional chambers of commerce, worked with the health sector to create a pay-for-performance plan" (Roberson, 7/13).

Milwaukee Magazine: "In the coming weeks, about 100,000 low-income families in Southeastern Wisconsin will receive packets of information in the mail asking them to choose from an array of new health care plans funded by the state's BadgerCare Plus insurance program. The state Department of Health Services has overhauled the program, signing new contracts with private health care providers which include new quality controls to address complaints the companies were under-performing.
The first third of the mailings, which will eventually be sent to all BadgerCare Plus members belonging to the Standard and Benchmark programs, are expected to go out next week. … Wisconsin's Badger Care uses federal Medicaid funding plus supplementary state funding to extend more medical care to families than in many other states" (Hrodey, 7/14).

Sacramento Bee: "State health insurance regulators are cracking down on insurance brokers who prey on elderly consumers confused by new federal health insurance rules. On Tuesday, the Department of Managed Health Care took steps to bar a Folsom insurance agent from selling Medicare Advantage plans after she allegedly defrauded at least 12 capital-area seniors, who then incurred thousands of dollars in unexpected medical bills." The agent [Nadia King] "is one of two dozen agents across the state getting legal scrutiny because of what officials said was deceptive marketing aimed at seniors" (Calvan, 7/14).

The Wall Street Journal: "The California Supreme Court reinstated a lawsuit in which retail pharmacies accused major drug makers of conspiring to set prices at artificially high levels. The pharmacies' lawsuit alleges Pfizer Inc. and AstraZeneca PLC as well as numerous other drug makers acted to restrain importation into the U.S. of their lower-priced foreign drugs and to restrict price competition from cheaper generic drugs. The suit claimed that as a result drug prices were 50% to 400% higher than for the same drugs sold outside the U.S. The antitrust lawsuit had previously been dismissed after a trial court and appeals court concluded that the pharmacies lacked standing because they passed on the alleged overcharges to consumers and thus sustained no damages. But in a ruling Monday, the California Supreme Court decided that drug makers couldn't use this defense and remanded the suit to lower court for further proceedings" (Loftus, 7/14).

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Editorials and Opinions

Today's OpEds: The Advantages Of Electronic Health Records; The Free Market And Health Care; And The Obama Administration's HIV Strategy

Finding My Way To Electronic Health Records The New England Journal Of Medicine
Having lost the Bayou Clinic three times, I knew we had to have a better way of practicing. I needed to find a way to deliver high-quality health care to people who didn't have a lot of money. From the experiences with the hurricanes and the fire, I knew we had to be able to evacuate the clinic quickly, while still safeguarding the vital patient information. Whereas I had previously decided against installing an EHR system because I couldn't afford one, I now realized I couldn't afford not to have one. … Until the day we turned on our EHR system, I was still using pens with waterproof ink. It is a very good thing — for both me and our patients — that my fellow physicians and I don’t need to use those pens anymore (Surgeon General Regina Benjamin, 7/13).

Health Experts Who May Decide Whether You Live Or Die Forbes
What worries some is the potential for new government attempts to pick therapeutic winners and losers to get combined into rules of the government run-exchanges that will sell insurance to people who can't get it elsewhere. If the two ideas are combined, private HMOs may only be able to offer coverage for government-greenlit procedures. This would reduce choice for patients, much like NICE does in Britain (David Whelan, 7/14).

No, The 'Free Market' Will Not Fix Health Care The Baltimore Sun
Free markets are wonderful. They have brought millions of humans out of poverty. But there are large problems when applying markets to 21st century health care (Jay Hancock, 7/13).

Health Care Suit Exercises Freedom, But Argument Is No Win The Missourian
I had a conversation last weekend about our lieutenant governor's decision to sue the United States of America concerning the Patient Protection and Affordable Care Act. ... I am glad he is suing. He may have valid point. However, I am also scared his lawsuit will destroy the Missouri Democratic Party, the Democratic National Committee and the Obama administration (David Rosman, 7/14).

Obama's AIDS Strategy A Test Of Will San Francisco Chronicle
This country has a better record on fighting AIDS overseas than it does at home. … President Obama wants to change this disparity with his own domestic AIDS plan. It keys on testing, sending federal money where it's needed most, and setting a goal to cut infection rates by 25 percent (7/14).

He's Playing You The American Spectator
The Obamacare socialized medicine takeover legislation doesn't even go into effect until 2014, and he is saying now in 2010 just 3 or 4 months after its passage, hey, look around, where are all those scary results they told us about? … He is thinking that enough of us are too stupid to know that his socialized medicine bill doesn't go into effect until 2014, and that he can play us for fools with this kind of shameful, manipulative, abusive rhetoric (Peter Ferrara, 7/14).

Stopgap, High-Risk Health Coverage Still Costly The [Litchfield County, Conn.] Register Citizen
A major provision of the health care legislation passed by Congress in March was to have taken effect last month. It will provide federally subsidized health care to the uninsured with pre-existing conditions. It is intended as a stopgap until 2014, when insurers will no longer be able to reject individuals from coverage because of a pre-existing condition. … In fact, many states, including Connecticut, have discovered health care will still be costly and out of reach for many (7/14).

Tough Calls Ahead For Deficit Commission CNN
Medicare, Medicaid and Social Security are exploding. Already, [commission co-chairman Erskine] Bowles said, their costs equal all the tax revenues coming into Washington. The commission knows that Medicare is the biggest, toughest nut to crack, and it will almost certainly recommend reopening and revising the health care bill passed last year in order to bring down costs (David Gergen, 7/13).

The Results Problem The New York Post
In just 20 months, Obama got an $800 billion stimulus bill; partly nationalized the US auto industry, and muscled through a health-care reorganization that will cost anywhere between $1 trillion and $3 trillion. … Phase Two is "making it all work." By front-loading so much activity in his first 18 months, Obama has set himself a nearly insuperable managerial and executive task (John Podhoretz, 7/14).

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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.