Daily Health Policy Report

Friday, July 20, 2012

Last updated: Fri, Jul 20

KHN Original Reporting & Guest Opinion

Campaign 2012

Health Reform

Capitol Hill Watch


Health Care Marketplace

Public Health & Education

Administration News

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Hospitals' Readmissions Rates Not Budging

Kaiser Health News staff writer Jordan Rau, working in collaboration with The Washington Post, reports: "The nation's hospitals are making little headway in reducing the frequency at which patients are readmitted despite a campaign by the government and the threat of financial penalties, according to Medicare data released Thursday" (Rau, 7/19). Read the story.

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Political Cartoon: 'Acting Up?'

Kaiser Health News provides a fresh take on health policy developments with "Acting Up?" by Jerry King.

And here's today's health policy haiku:


Talk about health care?
Or Bain? What's best for campaign?
Medicare plays well

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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Campaign 2012

In Florida, Obama Attacks Romney On Medicare Plan

Drawing on traditional Democratic campaign themes, President Barack Obama criticized GOP plans to transform Medicare into a "voucher program" and to repeal the 2010 health law.

The New York Times: Obama Visits Florida To Win Over Older Voters
After weeks of focusing on Mr. Romney's private-sector business deals, Mr. Obama turned to another front by attacking Republican plans to repeal his health care law and transform Medicare into a voucher program. Democrats have long used Medicare as an issue to galvanize older voters in Florida against Republicans (Baker and Gabriel, 7/19).

Miami Herald: As Thrill Fades, President Barack Obama Fires Up Supporters On Medicare, Tax Cuts
But Obama steered clear of attacks on Romney's business record and instead tailored his message toward seniors and the middle class on the first day of a two-day campaign swing in the nation's biggest battleground state. He stops in Fort Myers and Orlando on Friday. The president warned that Romney's proposal to repackage Medicare as a fixed benefit is a "voucher" system "will end Medicare as we know it" as it forces seniors to purchase private health insurance. He said his health care reforms have helped seniors receive discounted prescription drugs and get access to free preventive care (Klas and Caputo, 7/19).

Los Angeles Times: In Florida, Obama Attacks Romney Over Medicare
President Obama broadened his attack on Mitt Romney on Thursday, using Medicare to draw a sharper contrast on key issues in this swing state. With an eye on seniors, Obama warned that Romney would undermine their federal healthcare entitlement program. In a speech after the early-bird dinner at a retirement community, he linked the program's fate to Romney's position on taxes, building on his campaign's assertion that Romney would "end Medicare as we know it to help pay for his tax cuts for the wealthiest" (Memoli and Mehta, 7/20).

The Associated Press: Obama, Romney Tangle On Health Care, Jobs
President Barack Obama is warning Florida retirees that Republican challenger Mitt Romney would undercut the new health care law and alter Medicare, a play for voters in one of the nation's top swing states. Obama wraps up a two-day trip to Florida on Friday with stops in Fort Myers and suburban Orlando, where he is pressing the case that retirees would be hurt by Romney's opposition to the health care law and by Republican-led efforts to turn Medicare into a "voucher program” (Thomas, 7/20).

The Wall Street Journal: Florida Poses New Worry For Obama
President Barack Obama revived his attack Thursday on Republican plans to overhaul Medicare, as he opened a two-day swing through Florida, a state he won in 2008 but which his aides say is now more of a challenge. The sour economy and housing market are creating problems for Mr. Obama in the state (Lee and Campo-Flores, 7/19).

Bloomberg: Obama Appeals for Votes In Florida By Hitting Romney On Medicare
President Barack Obama took aim at Mitt Romney on taxes and Medicare in making an appeal to voters in Florida, the biggest swing state prize, while the Republican candidate pressed his case that Obama is hostile to business. Obama yesterday began a two-day trip through Florida, twinning criticism of Romney's support for tax cuts to benefit the top earners with a warning that the Republican’s proposals would force those 65 and older to pay more for health care (Brower, 7/20).

ABC News: President Obama In Florida: Mitt Romney's Medicare Plan Leaves Seniors 'Out Of Luck'
President Obama slammed Mitt Romney's Medicare plan today, telling seniors in the battleground state of Florida that his rival's proposal would force them to fend for themselves and hurt them financially. "He plans to turn Medicare into a voucher program," the president told a rowdy crowd at Century Village. … The president is hammering his opponent's plan during his two-day tour of the Sunshine State, where seniors make up roughly 17 percent of the population (Bruce and Dwyer, 7/19).

CBS News: Obama Kicks Off Fla. Visit By Criticizing Romney On Medicare
Making his 19th visit to Florida since taking office and his 7th visit this year, the president used his kick-off speech to reach out to the politically significant population of senior citizens. He said Mitt Romney threatens their Medicare coverage by advocating it be turned into a voucher program. "If that voucher isn't worth enough to buy health insurance that's on the market - you're out of luck," said the president, eliciting groans and boos from the audience (Knoller, 7/19).

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Health Reform

CRS: Medicaid 'Maintenance-Of-Effort' Requirement Not Touched By High Court's Medicaid Expansion Decision

According to a Congressional Research Service memo, the Supreme Court's recent health law decision only touches the new Medicaid expansion provision of the health law, not penalty requirements associated with the existing program. Meanwhile, Politico Pro offers a list of states to watch as the expansion efforts continue.  

CQ Healthbeat:  CRS Analysts Say Supreme Court Decision Didn't Strike Down 'MOE' Rule
Contrary to arguments by Maine Governor Paul R. LePage, the Supreme Court's June 28 health care law ruling did not strike down the measure's "maintenance of effort" requirement that blocks states from reducing Medicaid eligibility before coverage expands in 2014. That's the finding of a July 16 Congressional Research Service memo that analyzes some of the practical implications of the high court's ruling for Medicaid officials (Reichard, 7/19).

National Journal: CRS: Governors Can't Change Medicaid Enrollment Yet
Bad news for governors hoping that the Supreme Court could lighten their current Medicaid load: Congress's independent experts say that states can't kick people off their Medicaid rolls, despite the Court's ruling (McCarthy, 7/19).

Politico Pro: 5 States To Watch On Medicaid
The Supreme Court decision making health care reform's Medicaid expansion optional has created a high-stakes guessing game about which states sign up. A handful of governors who most emphatically refused to implement the Affordable Care Act grabbed the early attention after the court decision. Yet an overwhelming majority of the states aren't ruling it out. And Medicaid advocates are still counting on most of the states to come on board, if not by 2014 then soon after (Millman, 7/20).

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HHS Issues Final Rule On Essential Health Benefits Data Collection

Meanwhile, new research from the Center for Studying Health System Change indicates that more small businesses may be self-insuring -- a step that will reduce their participation in the health law's insurance exchanges.

CQ Healthbeat:  Final Rule On Data Collection For Essential Health Benefits Unveiled
The Obama administration on Wednesday disclosed the contents of a final rule dealing with information that insurers must provide as part of the health law's standard health benefit package, less than two weeks after the comment period for the proposed regulation ended. The speed with which the rule was rolled out is an indication of how quickly federal officials are moving now that the Supreme Court upheld the health overhaul law and deadlines loom for implementation of health benefits exchanges and the formation of the plans they will offer. While the rule is not a major piece of how essential health benefits will be administered, in its proposed form it nonetheless stirred objections among insurers who said it went too far by asking them to describe not only the services they cover, but how they plan to limit access to covered services (Norman, 7/19).

Modern Healthcare: Reform May Spur More Small Firms To Self-Insure: Report
Small employers with fewer than 100 workers could see incentives to self-insure under the healthcare reform law, a paper by the Center for Studying Health System Change says. Self-insured employers, which accept the risk of workers' healthcare costs, are exempt from new rules under health reform for fully insured products, including state review of premium rate increases, community rating for premiums and essential health benefits, according to the report (Evans, 7/19).

Politico Pro: Self-Insurance Trend Could Hurt Exchanges
An increasingly attractive self-insurance market could undermine a central aim of the Affordable Care Act: generating savings by having  small businesses move into state-based insurance exchanges. Research by the Center for Studying Health System Change suggests that more small firms are self-insuring. That had traditionally been more typical of large businesses with stable workforces that use a more predictable amount of health care (Cheney, 7/19).

Politico Pro: Mass. Eyeing ACA Rules For Small Businesses
Massachusetts's 2006 health care law may have been the philosophical inspiration for the Affordable Care Act, but the state will be forced to revisit central components — including rules for small businesses  — as it moves toward compliance with the federal legislation. In particular, state policymakers must decide whether to backpedal on some of the penalties and fines imposed on small businesses that don’t cover their workers, double down and increase them or find a middle ground (Cheney, 7/19).

In other health law implementation news -

Modern Healthcare: HHS Announces Innovation Initiative For States
HHS on Thursday announced that it will provide about $275 million from the healthcare reform law in a competitive program for states to design and test multi-payer payment and delivery models. Called the State Innovation Models Initiative, the program from the CMS Innovation Center will provide up to $50 million for up to 25 states in "model design awards" and up to $225 million over three to four years for up to five states in "model testing awards" (Zigmond, 7/19).

California Watch: New Health Care Groups Look To Cut Costs And Improve Quality
Across the country, doctors, hospitals and insurers are forming new health care entities to increase the efficiency and quality of health care, and lower the cost of it. Called accountable care organizations, these groups are gaining ground, even though critics consider them a repackaging of HMOs – some of which have given managed care a bad name. An ACO is a group of health care providers such as doctors, hospitals and others, including insurance companies, who agree to work together to provide overall care to their patients (Graebner, 7/20).

The Hill: HHS: Health Law Project Will Cut State Costs In Major Programs
The federal Health secretary said a new project under the Affordable Care Act will improve care and cut spending in three major federal health programs. The initiatives will reward states for working with healthcare stakeholders to better coordinate care and cut "unnecessary spending" in Medicare, Medicaid and the Children's Health Insurance Program, according to the announcement. Health and Human Services (HHS) Secretary Kathleen Sebelius said the effort will lead to better practices in the three programs, referring to her time as governor of Kansas. "As a former governor," she said, "I've seen states in action and know what great laboratories they are for innovations we can put into practice nationwide" (Viebeck, 7/19).

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Capitol Hill Watch

Reid Blocks Latest GOP Effort To Repeal Health Law

Senate Republicans had advanced the repeal effort as an amendment to the Bring Jobs Home Act. Meanwhile, House conservatives, who have also pressed to undo the health law, say state lawmakers now may be on the frontlines of the fight.

The Hill: Reid Blocks GOP Amendment To Repeal Affordable Care Act
Senate Majority Leader Harry Reid (D-Nev.) again blocked a Senate vote on repealing the Affordable Care Act. Republicans had offered it as an amendment to the Bring Jobs Home Act, which has a procedural vote Thursday afternoon. Reid said Republicans aren't taking the "insourcing" bill seriously based on the amendments they've offered. "The only amendments I've seen are three in number — the Republicans have suggested to do away with the Affordable Care Act, to re-establish the Bush tax cuts and the Hatch tax measure," Reid said. "Those have absolutely nothing to do with outsourcing" (Cox, 7/19).

Politico Pro: House Conservatives To States: Kill Reform
House conservatives said they still want to take shots at President Barack Obama's health care law but concede that the best opportunity to repeal it rests with state lawmakers. "I think the onus is now on state governments to not create state health care exchanges," Rep. Justin Amash (R-Mich.) said. "That's the real path to bringing down Obamacare at this point, at least during this Congress" (Dobias, 7/19).

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HHS Report: Hospitals Fall Short In Meeting Error Reporting Requirements

The government report says the failure to report medical errors hampers providers' ability to identify and fix preventable problems. Meanwhile, new Medicare data shows hospitals are making little progress in reducing preventable readmissions.

USA Today: HHS: Hospitals Ignoring Requirements To Report Errors
Hospitals are ignoring state regulations that require them to report cases in which medical care harmed a patient, making it almost impossible for health care providers to identify and fix preventable problems, a report to be released today by the Department of Health and Human Services inspector general shows (Kennedy, 7/20).

Kaiser Health News: Hospitals' Readmissions Rates Not Budging
The nation's hospitals are making little headway in reducing the frequency at which patients are readmitted despite a campaign by the government and the threat of financial penalties, according to Medicare data released Thursday (Rau, 7/19). 

Also, the Centers for Medicare & Medicaid Services has updated its Nursing Home Compare and Hospital Compare websites -

Boston Globe: Federal Websites Updated With Data On Hospital Imaging, Use Of Antipsychotics In Nursing Homes
Federal regulators Thursday unveiled long-awaited updates to websites that allow consumers to search more detailed information about thousands of hospitals and nursing homes across the country. The revisions to the US Centers for Medicare & Medicaid Services' Nursing Home Compare and Hospital Compare sites include measures that show potential health risks of imaging services in hospitals, detailed findings from nursing home inspections, and specifics about each nursing home's use of antipsychotic medications (Lazar, 7/19).

CQ Healthbeat: Medicare Updates Hospital, Nursing Home Information Sites
The Centers for Medicare and Medicaid Services have rolled out two redesigned websites officials said will make it easier for people to find the information they need to decide which hospital or nursing home they should go to…  One site is dedicated to information about hospitals, the other focuses on nursing home information. According to CMS, both sites contain important data on how well these facilities perform on quality measures — such as the frequency of infections that develop in the hospital, how often patients have to be readmitted to the hospital, and the percentage of nursing residents who report having moderate to severe pain while staying in the nursing homes (Staff, 7/19).

Modern Healthcare: CMS Updates Hospital Compare, Nursing Home Compare Websites
The CMS announced it has updated its Hospital Compare and Nursing Home Compare consumer websites with new quality measures, easier-to-use navigation and mobile-ready capabilities. Hospital Compare, which the CMS says has drawn more than 1.2 million visitors so far this year, now includes hospital-specific data on two new quality measures related to hospitals' use of imaging: outpatients who received cardiac imaging stress tests before low-risk outpatient surgery, and outpatients with brain CT scans who got a sinus CT scan at the same time (McKinney, 7/19).

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Health Care Marketplace

UnitedHealth: Higher Earnings Despite Pressuers On Medicare, Medicaid Business

The Minnesota-based insurer said second-quarter earnings rose 5.5 percent but stock falls on the company's report of tough rate environment.

The Wall Street Journal: UnitedHealth Posts Higher Profit, Lifts Outlook
UnitedHealth Group Inc.'s second-quarter earnings rose 5.5% amid rising membership in government-based health plans and signs that patients are still using health-care services sparingly following the recession. The company—the biggest managed-care firm in the U.S. by revenue and membership—raised its full-year earnings outlook as the quarterly results exceeded expectations (Kamp, 7/19).

Los Angeles Times: UnitedHealth Reports Solid Second-Quarter Results But Shares Dip
UnitedHealth Group Inc. reported solid second-quarter results and raised its full-year profit outlook, but shares slipped in midday trading after the company projected a tough rate environment for its Medicare and Medicaid plans (Terhune, 7/19).

Reuters: UnitedHealth Sees Pressures Even As Profit Beats
Insurer UnitedHealth Group Inc on Thursday signaled that pressures on its health plans would not ease anytime soon as the government reins in reimbursement for Medicaid and Medicare and tough competition persists among plans serving employers. … It was the first report from a health insurer since the U.S. Supreme Court late last month upheld President Barack Obama's healthcare law, which more tightly regulates the industry and adds new fees while also adding millions of potential new customers by expanding coverage to the uninsured (Krauskopf, 7/19).

Bloomberg: UnitedHealth CEO Says Profit Pressures Squeezing Plans
UnitedHealth Group Inc., the biggest U.S. health insurer, declined after Chief Executive Officer Stephen Hemsley said profit margins are being squeezed in its Medicare and Medicaid plans. ... While UnitedHealth raised its 2012 profit forecast, the company is still coping with "minimal" rate increases in Medicare, the U.S.-backed plan for the elderly and disabled, Hemsley told analysts today on a conference call. He said the Minnetonka, Minnesota-based insurer may also consider pulling out of Medicaid markets in states where rates "aren't sustainable" (Nussbaum, 7/19).

Market Watch: UnitedHealth Q2 Net Rose 5.5%; Lifts Year View
UnitedHealth Group Inc.'s second-quarter earnings rose 5.5% as the health insurer's revenue improved at its UnitedHealthcare insurance business and Optum, its information- and technology-based health-services business. … UnitedHealth, the biggest managed-care company by revenue and membership, is the industry's first to report quarterly results, making its view of health-cost trends and patient traffic an important barometer (Warner, 7/19).

In related news -

The New York Times' Deal Book: After Health Care Ruling, Centene Is Cast As Takeover Target
Since the Supreme Court upheld President Obama's transformative health care law last month, Wall Street has been wondering whether the decision would set off a fresh round of consolidation in the industry. One analyst says the Centene Corporation, a health care services company focused on Medicaid, could be a takeover target (Morrissey, 7/19).

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Walgreen, Express Scripts Reach Deal To Renew Relationship

Walgreen and Express Scripts will again do business together, allowing hundreds of thousands of Express Scripts customers to get prescriptions from Walgreens, starting again in September. In other news, Johnson & Johnson has agreed to pay as much as $2.2 billion to resolve a marketing investigation.

The New York Times: Walgreen And Express Scripts Reach Deal
Walgreen, the nation's largest drugstore chain, agreed on Thursday to renew its relationship with the prescription benefit manager Express Scripts, opening the door for hundreds of thousands of customers to return in September for discounts and related benefits from their Express Scripts drug cards (Japsen, 7/19).

Reuters: Express Scripts, Walgreen Settle Pharmacy Spat
Walgreen Co will soon be able to fill prescriptions for Express Scripts Holding Co patients after the two corporate giants settled their long-running dispute, removing a concern that has weighed on the drugstore chain's shares for a year. Walgreen, the largest U.S. drugstore chain, will be part of the broadest network of drugstores available to clients of pharmacy benefit manager Express Scripts, as of September 15, the companies said on Thursday (Krauskopf and Wohl, 7/19).

Bloomberg: Walgreen Gains After Renewing Pact With Express Scripts
Walgreen Co. (WAG), the largest U.S. drugstore chain, surged the most since 2008 after renewing a contract to provide Express Scripts Inc. customers with prescriptions, ending a dispute that contributed to an 11 percent decline in the retailer's quarterly profit…. Walgreen will become part of the network of pharmacies available to Express Scripts clients as of Sept. 15, the companies said today in a statement. Terms weren't disclosed. The agreement ends a standoff that centered on reimbursement rates and caused Walgreen to lose customers to CVS Caremark Corp. (CVS), Wal-Mart Stores Inc. (WMT) and other drugstore rivals (Burritt, 7/19).

The Associated Press: Walgreen, Express Scripts Sign New Agreement
The Walgreen pharmacy chain will begin filling prescriptions from customers in the Express Scripts network again starting in September under a new multiyear contract that ends a costly impasse between the companies. The agreement announced Thursday follows a series of disputes between Walgreen and Express Scripts that ended with the discontinuation of the contract between the drugstore operator and the pharmacy benefit manager last year (Seaman, 7/19).

In other news, a Johnson & Johnson penalty over its marketing practices could total $2.2 billion --

The Wall Street Journal: J&J Penalty May Total $2.2 Billion
Johnson & Johnson and federal prosecutors have reached a deal that would settle investigations into the company's marketing practices for as much as $2.2 billion, including a roughly $400 million criminal fine for the illegal promotion of the antipsychotic Risperdal, according to people familiar with the matter (Rockoff and Lublin, 7/19).

The Associated Press: Report: J&J Will Pay $2.2B In Risperdal Settlement
Johnson & Johnson has agreed to pay as much as $2.2 billion to resolve an investigation into its marketing of the anti-psychotic drug Risperdal, according to a published report. The Wall Street Journal, which reported the settlement Thursday, said the settlement will include a $400 million criminal fine and that the final amount will depend on how many states accept the settlement (7/19).

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When Checks And Balances In The Pharmaceutical Marketplace Fall Short

The Washington Post explores how a trio of very expensive anemia drugs became "superstars" in the marketplace. Also, The Wall Street Journal tracks the process by which certain fake cancer drugs found their way into the United States.

The Washington Post: Anemia Drugs Made Billions, But At What Cost?
For years, a trio of anemia drugs known as Epogen, Procrit and Aranesp ranked among the best-selling prescription drugs in the United States. … Even compared with other pharmaceutical successes, they were superstars. For several years, Epogen ranked as the single costliest medicine under Medicare: U.S. taxpayers put up as much as $3 billion a year for the drugs. The trouble … is that for about two decades, the benefits of the drug -- including "life satisfaction and happiness" according to the FDA-approved label -- were wildly overstated, and potentially lethal side effects, such as cancer and strokes, were overlooked (Whoriskey, 7/19).

The Wall Street Journal: How Fake Cancer Drugs Entered U.S.
From the outskirts of Winnipeg, Kris Thorkelson's Canada Drugs grew to become a vital link for American consumers stung by high drug prices. The Internet pharmacy had by the middle part of the last decade filled millions of U.S. prescriptions with low-cost, Canadian supplies of everything from Pfizer Inc.'s cholesterol pill Lipitor to GlaxoSmithKline PLC's asthma treatment Advair. But as Mr. Thorkelson's company grew into a larger enterprise spanning three continents, so did the risks of counterfeit drugs. In the final months of 2011, companies controlled by Mr. Thorkelson's Canada Drugs Group of Cos. sold two batches of fake Avastin, a cancer drug, to U.S. doctors (Weaver and Whalen, 7/19).

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Public Health & Education

Washington - Site Of Global Conference - Focuses On Testing For HIV, Fights Stigma

PBS NewsHour: In Washington, A Focus On Testing And Fighting Stigma In The Fight Against HIV
Next week's global AIDS conference marks the first time it's been held in the U.S. in more than two decades. But when tens of thousands of people descend on the nation's capital, they will be visiting a place that's more than just a host city. Many neighborhoods in Washington, D.C. have felt the pain of AIDS acutely. And experts are looking for ways to turn the epidemic around (Suarez, 7/19).

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Administration News

Details Emerge Regarding Personalities Involved In FDA Flap

The Wall Street Journal: Scientist Behind FDA Flap Sued Prior Employees
An FDA scientist whose complaints about the agency's approval process for medical devices led to a controversial email monitoring program had filed lawsuits against two hospitals where he worked and also sued a dozen medical-device companies (Burton, 7/19).

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State Watch

State Roundup: Texas Medicaid Fraud Probes Use Controversial Tool

A selection of health policy stories from Texas, Michigan, Oregon, Georgia, Massachusetts, Maine, Ohio and Colorado.

Texas Tribune: In Medicaid Fraud Investigations, A Controversial Tool
When it comes to finding cost savings in the state’s unwieldy Medicaid program, the Health and Human Services Commission’s Office of Inspector General gets high marks. … But OIG’s dollar-recovery strategy -- which includes an increased reliance on a rule that allows investigators to freeze financing for any health provider accused of overbilling -- has enraged doctors, dentists and other providers who treat Medicaid patients (Ramshaw, 7/20).

Detroit Free Press: State To Block Preferential Hospital Pricing By Insurers
Michigan Insurance Commissioner Kevin Clinton today issued an order saying the state will prohibit the use of preferential hospital pricing policies by insurers unless he approves them. The decision is effective February 1. It applies to all health insurance companies operating in Michigan. These preferential pricing policies -- known in the hospital and insurance industries as most favored nation clauses -- go to the heart of a 2010 landmark suit filed by the United State Justice Department against Blue Cross Blue Shield of Michigan. The federal government contends the policies unfairly cause hospitals to charge other insurance companies more to offset big discounts they give to the Blues. Aetna, one of the nation's largest health insurers, also filed a lawsuit last year with similar allegations (7/19).

Oregonian: Targeting Wasteful Health Care Spending In Oregon
Wasted spending isn't the biggest driver of health care costs, but it is a glaringly obvious target for improvement. For instance, a new report by the Oregon Health Care Quality Corporation suggests the state could save more than $26 million a year by preventing unnecessary visits to hospital emergency rooms (Rojas-Burke, 7/19).

Georgia Health News: Health Insurance Rebates On Their Way For Many
A new rule on health insurer spending will deliver nearly $20 million in policy rebates to Georgians by Aug. 1. Several other states, including Tennessee and Florida, have much higher rebate totals. But in the small-employer market, the rebates in Georgia for 4,614 consumers will average $811 -- a higher average payout than in any other state. The next highest is Ohio, with an average of $783. No other state is close to those figures. The Georgia insurance department said Thursday that the high rebates in small-group plans were due from only two health insurers -- John Alden Life Insurance Company and Nippon Life Insurance Company of America (Miller, 7/19).

Boston Globe: Massachusetts Lawmakers To Draft A 'Sober Homes' Bill
A leader of the Legislature’s substance abuse committee said Thursday that she and her colleagues will draft a bill to try to weed out the growing numbers of private group homes for recovering addicts that are triggering neighborhood complaints about drug overdoses and reckless partying (Wen, 7/20).

Modern Healthcare: Cigna Adds To ACO Count In Maine, Ohio
Cigna on Thursday announced that its tally of accountable care programs nationwide stands at 32 following the signing of agreements for new ACOs in Maine and Ohio. The Bloomfield, Conn.-based insurer's contracts with Martin's Point Health Care and Mercy Health System in Maine and Mount Carmel Health Partners in Ohio follow Cigna's announcement on Wednesday of accountable-care partnerships in California, Colorado, Texas and Vermont (Evans, 7/19).

Modern Healthcare: Colo. Court Says Nurses Can Administer Anesthesia
A Colorado state appellate court in Denver upheld a lower court decision today to allow nurse anesthetists to administer anesthesia without physician supervision in the state's critical-access and rural hospitals. The case has pitted the state's doctors against the governor, hospitals and nurses in what has turned into a scope-of-practice fight in 16 states -- including California, where the state Supreme Court last week also ruled in the nurses' favor (Robeznieks, 7/19).

California Healthline: Moving 'Almost A Million Children' To Medi-Cal
The Managed Risk Medical Insurance Board, which oversees the state's Healthy Families program, yesterday took a long look at the first outline of a plan to facilitate the state-ordered shift of an estimated 873,000 children enrolled in the HF program to Medi-Cal managed care. The conclusion was, the current time frame to make such a big change is too tight, said Janette Casillas, executive director of MRMIB. … Dealing with that kind of complicated transition could be hard, she said, when you multiply all of that by 415,000 -- the number of children slated for transition to Medi-Cal on Jan. 1, 2013. That's almost half the kids in Healthy Families (Gorn, 7/19).

Detroit Free Press: State Is Taking Bids To Privatize Prison Health Care
The State of Michigan has called for bids in what could be the largest privatization of state government services in Michigan history. Proposals are due Aug. 29 for a massive deal to provide medical services -- physical and mental -- to all 43,000 inmates held in Michigan prisons. Services include wound care, treatment of heart disease and diabetes, dental care, optometry and sex offender treatment. The contract could replace the work of 1,300 state employees, Department of Corrections spokesman Russ Marlan said Thursday. Prison medical and mental health services cost the state $306 million in 2011, and the state wants to test the waters through competitive bidding to determine how much or whether it can reduce that, he said (Egan, 7/20).

Bloomberg: Silicon Valley Surgeons Risk 'Moral Authority' For 200% Returns
The anesthesiolgists’ ball in December 2010 was already raging when Dr. Thomas Elardo and his wife arrived. … By rejecting the discounted contracts that participating in-network providers sign with insurers, the surgery centers bill insurance companies at their own out-of-network rates, which are 5 to 35 times as much as the in-network facilities charge, and make a killing. … The company pays profits to some 60 surgeon-partners at rates of return that often exceed 200 percent a year (Waldman, 7/19).

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Health Policy Research

Research Roundup: Gastric Bypass Costs, Paying For Psychotherapy

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

Archives of Surgery: Health Expenditures Among High-Risk Patients After Gastric Bypass and Matched Controls -- A few studies have shown that bariatric surgery can help reduce health care spending by obese patients, particularly those with conditions such as diabetes. This latest study looked at 847 patients who received bariatric surgery through the Veterans Affairs medical system. Inpatient and outpatient spending both before and after surgery were compared to 847 obese patients who did not have the operation. Researchers found that there was no significant difference in patients' health care expenditures after three years. Despite that, the authors add that "many patients may still choose to undergo bariatric surgery given the strong evidence of significant reductions in body weight and comorbidities and improved quality of life" (Maciejewski et al, 7/17).

Health Services Research: Impact of Deductibles On Initiation And Continuation Of Psychotherapy For Treatment Of Depression -- An increasing number of insurance plans have high deductibles, which are expected to reduce overall costs by making patients pay more attention to the care they choose. But these plans could also discourage patients from necessary services. In this study, researchers looked at the effect of a range of deductibles on patients seeking psychotherapy for depression. Among patients who had met their deductible, there was no significant effect from deductible size on whether they began or continued psychotherapy. However, those patients who hadn't yet met between $100 to $500 of their deductible were significantly less likely to make an initial visit (Fishman et al, August 2012).

Annals of Emergency Medicine: A Novel Approach To Identifying Targets For Cost Reduction In The Emergency Department -- Policymakers frequently recommend reducing emergency department visits for minor and preventable illness as one way to reduce health care spending. Authors of this paper, however, propose a different strategy, based on a new framework for analyzing ED visits. The researchers divide visits into three categories -- emergencies, intermediate/complex conditions and minor injury/illness -- and based on federal data they estimate that the middle category accounts for the greatest share of costs. Intermediate/complex conditions, the authors write, "have the most potential for substantial cost savings, mainly through reduced admissions yet also to a lesser degree from streamlined ED evaluations" (Smulowitz, Honigman and Landon, 7/16).

Health Services Research: Medicaid, Hospital Financial Stress, And The Incidence Of Adverse Medical Events For Children -- Initiatives to encourage better hospital care will likely adjust Medicare or Medicaid payment based on factors including the rate of adverse events. This study uses federal data and a survey by the American Hospital Association to look at how the stress of Medicaid reimbursement might correlate with the rate among children of adverse events, such as hospital-acquired infections, accidental lacerations or after-surgery respiratory failure. Researchers found that children at community hospitals with a heavy reliance on Medicaid were 62 percent more likely to experience an adverse event than at other hospitals. The authors write that "adverse events may be in part due to factors outside the control of hospital management and medical staff and that Medicaid itself may be playing a contributing role in the occurrence of some of these events" (Smith et al, August 2012).

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

The Associated Press: CDC: Whooping Cough Rising At Alarming Rate In US
The U.S. appears headed for its worst year for whooping cough in more than five decades, with the number of cases rising at an epidemic rate that experts say may reflect a problem with the effectiveness of the vaccine. Nearly 18,000 cases have been reported so far — more than twice the number seen at this point last year, the Centers for Disease Control and Prevention said Thursday. At this pace, the number for the entire year will be the highest since 1959, when 40,000 illnesses were reported (Stobbe, 7/19).

Medscape: Millions of US Women Lack Adequate Healthcare
A new Commonwealth Fund report shows that women in the United States are in much worse shape, healthcare-wise, than women in 10 nations that have universal healthcare. Even insured American women are more likely to go without needed healthcare because of the cost and difficulty paying medical bills. The report was published online July 13 (Brown, 7/13).

Boston Globe: Surgery Offers No Advantage For Early Prostate Cancer, Study Finds
The vast majority of men ­diagnosed with early-stage prostate cancer have surgery or other harsh treatments that can cause permanent side effects, but a study published Wednesday found that men in their 60s who had surgery did not live significantly longer than those whose cancers were merely monitored. The clinical trial, performed at Massachusetts General Hospital and elsewhere, could be a turning point, shifting doctors toward more conservative treatment of men who are diagnosed with prostate cancer that has not spread beyond the gland, the authors said (Kotz, 7/18).

Medscape: Program For Preventing Stroke, Dementia In Primary Care A special prevention program that encouraged primary care doctors to identify and treat vascular risk factors in their older patients successfully reduced the need for long-term care dependence, according to a new study published in the Journal of the American Heart Association (Lowry, 7/18). 

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Editorials and Opinions

Views On Health Reform: U.S. Not Getting Value For Its Spending; Cutting Doctors' School Debt To Curb Costs

Los Angeles Times: How To Cure U.S. Healthcare
When it comes to healthcare, Americans are not getting a lot of value for their money. The United States spends 17.6% of its gross domestic product, nearly twice the average of the nations in the Organization for Economic Cooperation and Development. But life expectancy in the United States in 2010, at 78.7 years, is below the OECD average of 79.8 years. The U.S. infant mortality rate is higher than in most developed countries — it is higher than the rates in Greece, Hungary and Slovakia (Dalibor Rohac, 7/20).

The Wall Street Journal: Doctor Pay And Social Priorities
There is no scarcity of reasons for the growth of health-care expenditures. ... Yet another factor was left out of the equation. The United States is alone among Western nations in launching its medical school graduates into the world carrying sizable debt—$158,000 in 2011, according to the American Association of Medical Colleges. Whatever we may yet do to reshape health care, this debt and the need of individual physicians to repay it will inevitably affect the system. If we are moving inevitably toward more and more "socializing" of how doctors are compensated for their usually exemplary professional labors, the question arises: Should we "socialize" the costs of creating the skills they bring to those labors? (John Schnapp, 7/19).

Arizona Republic: Doctor Treats Victims Of Health Care Politics
Politicians get to condemn sick people to death without ever looking them in the eye. Dr. Randy Oppenheimer doesn't have that luxury. "Most people have no idea," Dr. Oppenheimer told me. "Even medical people. They have no idea what the people I see are going through. I'm sure the governor has no idea what she did to all these people by kicking them off of AHCCCS. (The state's Medicaid program.) It's a death sentence. And it's not necessary. Even if you just look at the economics" (E.J. Montini, 7/19).

Denver Post: Health Care Reform, The Colorado Way
Whether the Affordable Care Act should be upheld, tweaked or repealed, the U.S. Supreme Court's decision on the matter isn't the first or last word on reforming health care in Colorado. In recent years, Colorado organizations and policymakers have explored many innovative approaches to improve Coloradans' health, health coverage and health care — both in tandem with and independent of the Affordable Care Act. In many respects, our state is already ahead of the curve in health and health care (Anne Warhover, 7/20).

Boston Globe: Municipal Health Reform Yields Huge Savings
A million dollars goes a long way in a small city like Haverhill, and when officials announced this spring that the city had reached an agreement with its unions to save $1.1 million by moving employees and retirees into a cheaper health plan, it was a big victory for a municipality that had been forced to cut back services and furlough workers to pay for skyrocketing insurance costs. Stories like Haverhill's have played out in dozens of towns across Massachusetts over the last year, thanks to municipal health insurance reforms pushed by House Speaker Robert DeLeo and signed by Governor Patrick (7/20).

Boston Globe: A Word Of Caution On Massachusetts Health Cost Reform
The idea of legislators attempting to fix any kind of market should come with caution flags. A government plan to influence one of the biggest segments of the state's economy — a last-minute compromise hatched behind closed doors — makes me very nervous. There are certainly elements of a plan everyone can agree upon. Greater transparency in the incredibly opaque world of medical costs has to be a good idea. The list of agreeable details goes on, but not for too long (Steven Syre, 7/20).

CNN: Take Another Look At Health Care Act
I have argued many times that I don't think the Affordable Care Act does enough to contain costs. I still believe that's true. But let's not ignore the fact that it does a lot. ... You may not like these types of efforts. ... But there's a difference between arguing that you want different measures and pretending those measures don't exist (Aaron E. Caroll, 7/19).

Miami Herald: Medicaid Expansion Benefits Florida's Children
Of course, if Florida does not to expand its Medicaid coverage, $20 billion in federal funds will be diverted from Florida to other states over the next ten years. This is money paid by Floridians through federal income taxes that will go to residents of other states if our state government rejects Medicaid expansion. Over two million children in Florida participate in Medicaid or the Child Health Insurance Program (CHIP) also known as Florida KidCare. The vast majority of individuals enrolled in and benefitting from Florida's Medicaid program are children from families who work at low-income jobs. How much would it cost our state to expand health insurance coverage to low-income children and families, children with disabilities and children with serious chronic health problems? (Peter A. Gorski, 7/19).

Des Moines Register: Branstad's Puzzling Disaster Push
Even a governor cannot persuade Mother Nature to drop some rain, but [Terry] Branstad vowed to do what he can: Push to get the federal government to declare Iowa counties agricultural disaster areas. That paves the way for federal aid. That’s commendable. But you can see why that request might confuse some Iowans. Only a few weeks ago, Branstad expressed concerns about the state accepting federal money. He said he was reluctant to expand Medicaid under the new health reform law because he doesn’t think Washington can afford it. He wants federal money to help Iowa farmers but not uninsured, low-income Iowans? (7/19)

Des Moines Register: Obama Represents Good Catholic Values
As a lifelong Catholic, I have dedicated my life to care of my fellow human beings and tending to the needs of the poor and vulnerable in line with the tenets of the Catholic Church. I believe in President Obama's commitment to provide health care for all citizens. As a nurse and health care administrator for many years, I can say unequivocally our old health care system that left so many people without care and uninsured needed to be reformed (Sister Patricia Miller, 7/19).

Journal of the American Medical Association: Gaming Out The New Medicaid Option
The most important policy implications from the Supreme Court’s decision on the Affordable Care Act (ACA) pertain not to the individual mandate but to Medicaid. Although the court seems to have left the states with 2 options—accept or decline the 2014 expansion—without any implications for current program funding, the available range of options is potentially larger than that, and implications vary (Austin B. Frakt, 7/19).

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Viewpoints: Creating An HIV-Free Generation; Postal Service's Struggle Over Retiree Health Benefits

Politico Pro: The Next Steps To An HIV-Free Generation
HIV forces us to deal with so much: sex, drugs, poverty, racism, homelessness, homophobia, sexism, illness and death. While our nation's response has been imperfect, we have gotten a lot right. And we are now at a pivotal moment where science has led us to imagine the possibility of an HIV-free generation. But how do we turn hope into reality? There is no easy path to ending HIV. Here at home, however, a rare convergence of factors is making more progress possible than ever before (Jeffrey S. Crowley, 7/20).

Politico: Does Homophobia Impact AIDS Funding?
HIV/AIDS remains one of the biggest health issues that the U.S. is confronting today. Hundreds of millions of dollars in private and public funding go to combat the disease each year. But to be effective, far more must be allocated to the specific populations at greatest risk. One reason we are falling short is that homophobia still channels HIV prevention funding away from the group that most needs it: gay men (Sean Cahill, 7/20.)

Politico: U.S. Indispensable In AIDS Fight
The good news is that the fight against AIDS has shifted radically in the past two decades. Thanks largely to support from Americans of all stripes – Democrats, Republicans, religious leaders, college students, public health officials and the business community – 8 million HIV-positive people around the world now have access to life-saving treatment. Before Bush’s historic commitment to fighting HIV/AIDS through the creation of The President’s Emergency Plan for AIDS Relief – and Obama’s support and expansion of the program – that number was just 300,000 a decade ago (Tom Hart, 7/20).

The Washington Post: The Postal Service Is Struggling, But Not Because Of The Mail
There is indeed red ink, but the reasons are unrelated to the mail. In 2006 Congress required that, within the next decade, the Postal Service pre-fund future retiree health benefits for the next 75 years — a burden no other agency or company faces. That accounts for 85 percent of all of the agency's red ink since — and more than 90 percent of the $6.46 billion shortfall from the first half of fiscal 2012. Before pre-funding began in 2007, the Postal Service had annual profits in the low billions. It's this unaffordable payment that the Postal Service is "simply not capable of making" next month, a spokesman said this week (Fredric Rolando, 7/19).

Philadelphia Inquirer: Merger's Failure Is Good Medicine
The decision by Abington Health and Holy Redeemer Health System to call off their short-lived plans for a merger is positive news for women's health care in the Philadelphia region. ... But what was most striking about the merger ... was that it held out the prospect of immediately reducing vital services for women (7/20).

The New York Times: Abortion In D.C.
House Republicans didn't do away with purely symbolic legislation all together, however. Bills with absolutely no chance of becoming law, introduced only to express ideology (as opposed to appreciation), are rampant. Take, for instance, a bill the House Judiciary Committee approved today that would ban abortion in the District of Columbia after 20 weeks of pregnancy, with no health exception. It will advance to the full House for a vote, but will never pass the Democratic-controlled Senate (Juliet Lapidos, 7/19).

Los Angeles Times: CVS Should Require Signatures For Automatic Prescription Refills
All businesses want people as repeat customers. And when it comes to drugstores, that means they want you to keep refilling prescriptions. But you'd think they'd ask first before signing you up for automatic refills and billing your insurer. In the case of CVS Pharmacy, the country's second-largest drugstore chain, after Walgreens, the official policy is that customers' approval is always sought before people are enrolled in the company's ReadyFill program. But B.G. Stine, 52, of Torrance had a decidedly different experience (David Lazarus, 7/20).

Baltimore Sun: The Hidden Health Risks Of Fracking
Imagine you are a nurse working in an emergency room, and a worker on a gas fracking well comes in covered in chemicals used in the drilling process. You call the gas company to find out what chemicals are being used to help in your assessment of possible health risks to your patient, and even yourself, but find out they don't have to disclose this information. … As nurses, we strongly support our right to know in order to protect the health of our communities and the environment. That's why the American Nurses Association House of Delegates last month passed a resolution highlighting the important role nurses play in advocating for the health of their patients and communities when faced with fracking (Kate Huffling, 7/19).

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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.