Daily Health Policy Report

Tuesday, July 30, 2013

Last updated: Tue, Jul 30

KHN Original Reporting & Guest Opinion

Administration News

Health Reform

Capitol Hill Watch


Public Health & Education


State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

HHS Inspector General Scrutinizes Medicare Observation Care Policy

Reporting for Kaiser Health News, Susan Jaffe writes: "Medicare patients' chances of being admitted to the hospital or kept for observation depend on what hospital they go to -- even when their symptoms are the same, notes a federal watchdog agency in a report to be released today, which also urges Medicare officials to count those observation visits toward the three-inpatient-day minimum required for nursing home coverage" (Jaffe, 7/30). Read the story.

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Insuring Your Health: Benefits On Health Marketplace Plans Will Be Similar But Costs Will Vary

Kaiser Health News consumer columnist Michelle Andrews writes: "As the state health insurance marketplaces, also called exchanges, get set to launch in October, many people have questions about the coverage that will be offered there. Here are a few that were posed to me recently" (Andrews, 7/30). Read the column.

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Capsules: KHN Reporters Answer Health Law Questions

Now on Kaiser Health News' blog, KHN reporters Mary Agnes Carey, Jay Hancock and Sarah Varney talked about a variety of issues related to the health law's implementation on C-SPAN's Washington Journal Monday morning (7/29). Watch the video.

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Political Cartoon: 'Pick Your Battles?'

Kaiser Health News provides a fresh take on health policy developments with "Pick Your Battles?" by Steve Sack.

Meanwhile, here is today's health policy haiku:


Tune in on Monday
and the Monday after that.
We'll keep you informed.

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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Administration News

Obama Administration Touts Slower Health Care Cost Increases

According to USA Today, personal health care costs rose at the slowest rate in the last 50 years, based on statistics for the past year ending in May.

USA Today: White House Touts Slow Increase In Health Care Costs
Personal health care costs rose in the 12 months ending in May at the slowest rate in the last 50 years, as spending on hospital and nursing home services declined, the White House announced Monday (Kennedy, 7/29).

Meanwhile, the White House also is pointing to the latest economic statistics to dismiss opponents' health law criticisms --

Reuters: White House Takes Aim At Obamacare Opposition's Economic Claims
The White House on Monday shot back at critics who claim Obamacare is leading to higher health care costs, slower job growth and rising numbers of part-time workers, saying the latest economic statistics show none of those effects. Nearly one-third of the sharp rise in part-time workers seen in employment numbers for June was due to federal employee furloughs caused by automated spending cuts, rather than employers shifting to part-time workers due to concern about President Barack Obama's signature health care law, a senior administration official said (7/29).

CQ HealthBeat: White House Says Health Law Helping, Not Impeding Economic Growth
The White House released its own set of statistics Monday to make the case that the health care law is setting the stage for a strong economy, not dragging it down, an attempt by the Obama administration to counter a swelling chorus of Republican complaints about the impact of the overhaul on economic growth and jobs. A senior administration official said at a background briefing with reporters that the health law is not fueling an increase in part-time work at the expense of full-time employment, something that critics of the overhaul are increasingly contending (Reichard, 7/29).

Also in the news -

CBS News: HHS: Obamacare Reduces Medicare Drug Costs
Over six million people with Medicare have saved $7 billion under the Affordable Care Act, the Health and Human Services Department announced Monday. Reducing individual prescription drug costs by $1,061, Obamacare has begun to reduce the existing gap in this coverage for seniors. With a $250 check to those in the "donut hole" -- those without full prescription coverage -- the Affordable Care Act began to reduce this discrepancy, which is set to close by 2020 (Haven, 7/29).

The Hill: HHS: Seniors Have Saved $7 Billion On Drugs Thanks To Obamacare
President Obama's signature health care law has saved seniors more than $7 billion on prescription drugs, the Health and Human Services Department said Monday. The department highlighted the savings ahead on Medicare's 48th anniversary. HHS touted new benefits the law made available to seniors, as well as savings on prescription drugs (Baker, 7/29).

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Health Reform

Lawmakers' Aides Fret Over Requirement To Buy Obamacare Coverage

The New York Times explores how congressional staffs are anxious about a health law provision requiring them to buy coverage in online insurance markets because the federal government may no longer pay a share of their premiums. Meanwhile, The Hill reports on a request to audit Enroll America, a nonprofit that is encouraging people to enroll in new coverage. CQ Healthbeat looks at how the law's definition of a full-time employee is affecting some businesses.

The New York Times: Wrinkle In Health Law Vexes Lawmakers' Aides
As President Obama barnstorms the country promoting his health care law, one audience very close to home is growing increasingly anxious about the financial implications of the new coverage: members of Congress and their personal staffs (Pear, 7/29).

CQ HealthBeat: Definition Of Full-Time Worker Continues To Roil Health Care Law
White Castle might stop making full-time hires because of costs associated with requirements in the health care overhaul, an executive with the hamburger chain recently told a House panel. The testimony from Jamie Richardson was one of the latest examples of an employer citing the law’s definition of a full-time employee as a major problem, and highlighted an ongoing debate over whether a revision is needed (Attias, 7/29).

The Hill: Watchdog Requests IRS Review Of Group That Is Promoting ObamaCare
A watchdog group is asking the IRS to review the tax-exempt status of an organization crucial in helping to promote ObamaCare. Cause of Action has asked the IRS to investigate Enroll America, a nonprofit that is encouraging people to enroll in new coverage options under the healthcare law (Baker, 7/29).

Politico: Mythbusters: Obamacare Edition
There are a lot of wild stories about Obamacare that make the debate sound like a fact-free zone. No, the IRS isn’t going to be posting your medical tests all over the Internet. No, people’s premiums aren’t doubling in the crucial swing state of Ohio (Nather, 7/30).

Modern Healthcare: Reform Update: Aug. 1 Brings Deadline To Report Physician Payments
While much attention was given to the decision to delay the Patient Protection and Affordable Care Act's employer mandate by one year, another ACA deadline quietly arrives this week. As of Aug. 1, group purchasing organizations and drug and medical-device manufacturers will have to report any "transfers of value" of $10 or more they make to doctors and teaching hospitals (Robeznieks, 7/29).

Contra Costa Times: Concord: Half Of Affordable Care Act Call Center Jobs Will Be Part-Time
Earlier this year, Contra Costa County won the right to run a health care call center, where workers will answer questions to help implement the president's Affordable Care Act. Area politicians called the 200-plus jobs it would bring to the region an economic coup. Now, with two months to go before the Concord operation opens to serve the public, information has surfaced that about half the jobs are part-time, with no health benefits -- a stinging disappointment to workers and local politicians who believed the positions would be full-time (Gafni, 7/25).

Fox News: Workers At ObamaCare Call Center Angry After Being Offered Jobs Without Health Benefits
A soon-to-be-opened call center meant to help teach the public about ObamaCare is under fire for offering many of its new employees part-time positions — in turn denying them benefits under the very law they are helping to implement. The Contra Costa Times reports the call center, which is set to be opened Oct. 1, attracted about 7,000 applicants for 200 jobs after the county won the right to operate it earlier this year. Many workers and local politicians say they believed that the majority of the positions at the center would be full-time with benefits (7/29).

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Uninsured People In Rural Areas Could Benefit Big Under The Health Law

MedPage Today reports on how rural residents could gain as a result of the overhaul, while other news outlets offer reports from a variety of states regarding the health law's implementation.

MedPage Today: ACA Likely To Deliver Bigger Bang In Rural Areas
The rural uninsured may reap a bigger benefit from the Affordable Care Act than their city-dwelling counterparts, which prompted health policy experts to call for a ramped-up campaign to publicize ACA in rural communities. More rural residents than urban dwellers (10.7 percent versus 9.6 percent) can receive tax subsidies under the ACA to purchase private insurance and more uninsured are eligible for an expanded Medicaid program (9.9 percent versus 8.5 percent), Keith Mueller, PhD, director of the Rural Policy Research Institute's Center for Rural Health Policy Analysis in Iowa City, said (Pittman, 7/29).

Des Moines Register: Health Care Advocates Want Program To Be Understandable
Advocates for various health care groups said Monday that they want to ensure Iowa's new insurance program for poor adults is as straightforward and understandable as possible. "Misinformation is abundant and anxiety is very high," Susan Whitty, public-policy chairwoman for the Iowa Nurses Association said at a public hearing in Des Moines (Leys, 7/29).

Health Policy Solutions (a Colo. news service): Health Law Alone Won't Reverse Inequities
The Affordable Care Act may leave many of the poor and people of color behind. That's the view of this year's president of the American Public Health Association, Dr. Adewale Troutman, who spoke in Denver last week. … While the Affordable Care Act, which goes into full effect next year, will help millions of people get health insurance, it does not guarantee that they’ll get decent care. Nor does it go far enough to reverse disparities that cost lives every day, Troutman said. For instance, health inequities cause more than 83,000 excess deaths among African Americans each year, Troutman said. He cited a study titled "What if We Were Equal?" that he and others did for the journal Health Affairs in 2005 (Kerwin McCrimmon, 7/29).

California Healthline: California Businesses Welcome ACA Delay
California business groups applauded the Obama administration's decision to delay for one year a provision in the Affordable Care Act that requires businesses with 50 or more employees to provide health insurance for full-time workers. Delaying the mandate until January 2015 will give businesses more time to deal with new data gathering and reporting requirements, according to analysts. "For the larger business community, particularly in the Bay Area, this isn't going to have a huge impact because the majority of them already offer health insurance to their employees," said Micah Weinberg, a senior policy adviser for the Bay Area Council, a business group based in San Francisco (Hart, 7/29).

Palm Beach Post: Individual Health Insurance Rates To Rise 30-40% Next Year Under New Law, Florida Insurance Chief Says
Health insurance rates in Florida will rise by 5 to 20 percent in the small-group market, and 30 to 40 percent in the individual market, as the Affordable Care Act's guaranteed coverage rule takes effect next year, Florida's insurance commissioner said Monday. It’s a measure of how tough Florida’s insurance market has been for adults with pre-existing conditions that the state’s rates will rise so much for individuals, Insurance Commissioner Kevin McCarty said in an interview with The Palm Beach Post. McCarty said the impact on people with large-group insurance will be negligible (Singer, 7/30).

Columbus Dispatch: Tea Party Targeting Sears For Medicaid Stance
The most outspoken House Republican supporter of Medicaid expansion (not much competition for that distinction) has attracted attention from the Toledo Tea Party, which is actively seeking a candidate to challenge her in the 2014 primary. Rep. Barbara Sears of Sylvania, a member of the House GOP leadership team and considered one of the most knowledgeable members on Medicaid and health care, has backed Gov. John Kasich’s effort to expand Medicaid. ... The Toledo Tea Party quotes Linda Bowyer, spokeswoman for Conservative Coalition: "NWOCC supporters are very upset with Rep Sears and her continuing efforts to implement Obamacare Medicaid Expansion." She added: "We've been interviewing candidates throughout northwest Ohio. Our supporters have made it clear to us that we need to support candidates who will actively work to oppose Obamacare, and oppose any candidate that is working to implement Obamacare” (Siegel, 7/29).

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Capitol Hill Watch

Vote To Defund Health Law On Congress' To-Do List Before August Break

The vote, which will mark the House of Representatives' 40th effort to undo all or part of the health law, is scheduled for Friday afternoon. This time around, the effort is causing friction within the Republican caucus. Meanwhile, budget issues are gaining attention in the Senate.  

The New York Times: At The 11th Hour, A Languid Congress
But the House's marquee moment before adjourning until Sept. 9 will come on Friday with its 40th vote to cripple President Obama's health care law. House members preparing their vacation plans have been assured that the last vote will be no later than 3 p.m. In the Senate, a glimmer of hope has appeared for a bipartisan deal to end the automatic across-the-board spending cuts known as sequestration and shift some of those savings to entitlement programs like Medicare and Social Security. But even optimistic negotiators do not suggest that an agreement between Senate Republicans and the White House is in reach before the break (Wesman, 7/29).

Politico: Tom Cole: Obamacare Shutdown 'Suicidal Political Tactic'
House Deputy Whip Tom Cole thinks shutting down the government to defund Obamacare is a "suicidal political tactic." … Cole said he has voted multiple times to repeal Obamacare and called defunding the health care law an "admirable goal," but said shutting down the government is the wrong way to do it (Arkin, 7/29).

Roll Call: Obamacare Defunding Fight Could Threaten Boehner Leverage, Message
The effort by conservatives in the House and Senate to threaten a government shutdown over Obamacare could force Speaker John A. Boehner into the arms of House Democrats. With 60 Republicans already pushing the Ohio Republican to defund Obamacare in any spending bill, the speaker may not be able to cobble together a House majority on a bill that President Barack Obama would sign without Democratic votes (Dennis and Fuller, 7/29).

NBC News: Cruz: Republicans Not Willing To 'Stand Up' To Defund Obamacare
The conservative plan to use the resolution that funds the government to cripple the president's health care law has a problem, according to GOP Sen. Ted Cruz: other Republicans. "The problem right now is we don't have Republicans willing to stand up and do this," Cruz said Monday on The Andrea Tantaros Show, a conservative radio program. "We need 41 Republicans in the Senate or 218 Republicans in the House, to stand together, to join me, to join Mike Lee, to join Marco Rubio, all of whom have said, we will not vote for a single continuing resolution that funds even a penny of ObamaCare" (Hunt, 7/3).

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HHS Inspector General Raises Concerns About Medicare Policy On Observation Care

The report also finds that policies on admitting patients or keeping them under observation -- a distinction that can have dramatic financial impact on the patients -- varies substantially among hospitals.

Kaiser Health News: HHS Inspector General Scrutinizes Medicare Observation Care Policy
Medicare patients' chances of being admitted to the hospital or kept for observation depend on what hospital they go to -- even when their symptoms are the same, notes a federal watchdog agency in a report to be released today, which also urges Medicare officials to count those observation visits toward the three-inpatient-day minimum required for nursing home coverage (Jaffe, 7/30).

Meanwhile, the observation issue leads to a financial penalty at one major hospital.

Boston Globe: Beth Israel Deaconess Settles With US For $5.3m
Faced with government allegations of improper billing, Beth Israel Deaconess Medical Center paid $5.3 million Monday to settle claims that it overcharged Medicare by admitting patients who should have been treated less expensively as outpatients. The allegations involved patients who were admitted to the Harvard teaching hospital for brief stays between 2004 and 2008 and who were suffering from congestive heart failure, chest pain, gastroenteritis, and nutritional and metabolic disorders, federal officials said in a written statement (Kowalczyk, 7/30).

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Public Health & Education

Task Force Recommends Annual CT Scans For High-Risk Smokers

The U.S. Preventive Services Task Force has recommended that high-risk current and former smokers get an annual CT scan to look for cancer. If the draft recommendation becomes final, insurers will likely have to cover the scan at no co-pay cost to consumers.

The New York Times: Task Force Urges Scans for Smokers at High Risk
The recommendation by the United States Preventive Services Task Force, still in draft form, could change medical practice by making annual CT screening the standard of care for the highest-risk smokers. And because insurers cover procedures strongly recommended by the task force, eligible patients would no longer have to bear the cost themselves. Under President Obama's health care law, those who are eligible for the scan would have no co-pay. The procedure's average price is about $170, according to the Advisory Board Company, a health care research firm in Washington, which polled oncology professionals (Tavernise, 7/30).

The Washington Post: Older Smokers Should Get CT Scans For Lung Cancer, Panel Recommends
Patient advocates welcomed the task force's decision to give its recommendation a "B" rating, which, under the terms of the Affordable Care Act, would require insurance companies eventually to cover the tests without co-payments from patients. The average national cost of the procedure is about $750, though prices vary widely, according to Castlight Health, which analyzes price and quality data for health-care services (Bernstein, 7/29).

The Associated Press/Washington Post: Panel Backs Lung Cancer Screening For Heavy Smokers; Insurers Likely To Pay For Scans
For the first time, government advisers are recommending screening for lung cancer, saying certain current and former heavy smokers should get annual scans to cut their chances of dying of the disease. If it becomes final as expected, the advice by the U.S. Preventive Services Task Force would clear the way for insurers to cover CT scans, a type of X-ray, for those at greatest risk (7/29).

The Wall Street Journal: Influential Federal Panel Backs CT Scans For Lung Cancer
The federal preventive-services task force, which consists of private physicians appointed by the U.S. Department of Health and Human Services, acknowledged risks but concluded that low-dose computed tomography, or CT, imaging "reduced lung cancer mortality by 20 percent and all-cause mortality by nearly 7 percent." Its findings are being published Tuesday in the Annals of Internal Medicine. "We believe the benefits do outweigh the harms," said Michael LeFevre, co-vice chairman of the task force. He said the decision was largely based on a 2011 study sponsored by the National Cancer Institute. The task force recommended that people consider screening for lung cancer if they are current or former smokers between the ages of 55 and 79, and have smoked the equivalent of a pack of cigarettes a day for 30 years and have smoked within the past 15 years. Lung screening is already available at some hospitals and often costs in the range of $100 to $300 a test (Burton, 7/29).

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Study Finds Doctors Not Following Medical Guidelines On Back Pain

Researchers report that physicians are often overly aggressive by prescribing addictive narcotics to patients instead of other recommended drugs and are too often using surgery and unneeded imaging tools.

Los Angeles Times: Back Pain: Doctors Increasingly Ignore Clinical Guidelines
Doctors have increasingly ignored clinical guidelines for the treatment of routine back pain by prescribing powerful and addictive narcotics instead of other recommended painkillers and by recommending unwarranted diagnostic imagery, according to a new study. Researchers at Massachusetts' Beth Israel Deaconess Medical Center and Harvard Medical School based their conclusion on an examination of roughly 24,000 cases of spine problems in national databases from 1999 to 2010. Their findings appeared online Monday in JAMA Internal Medicine (Morin, 7/29).

Fox News: Doctors Don't Follow Back Pain Guidelines, Study Finds
A new study has found that many physicians are not following expert recommendations for the treatment of back pain. By not doing so, they are subjecting patients to unnecessary imaging tests, ineffective surgeries and unnecessary exposure to addictive narcotics, say the authors of the study published in JAMA Internal Medicine. Several guidelines for back pain stress a more hands off approach, largely because more aggressive treatments have not been shown to improve the pain and subject patients to risks (Tarkan, 7/30).

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State Watch

N.C. Governor Signs Law Tightening Abortion Clinic Regulations

Critics say the new law -- and stricter standards -- will force most abortion clinics to close.

The Associated Press/Washington Post: NC Gov. McCrory Signs Abortion Clinic Bill That Critics Say Will Force Most To Close
North Carolina Gov. Pat McCrory on Monday signed into law a measure directing state officials to regulate abortion clinics based on the same standards as those for outpatient surgical centers, a change that critics say will force most to close (7/29).

Reuters: North Carolina Governor Signs Tougher Abortion Clinic Rules
North Carolina Governor Pat McCrory signed into law on Monday new requirements for clinics performing abortions that supporters say will protect women's safety and opponents say will restrict access to the procedure (Brooks, 7/30).

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State Highlights: Mandatory Treatment For Mental Illness Working In N.Y.

A selection of health policy stories from Montana, New York, Oregon, California, South Carolina and Wisconsin.

NPR: Montana's State-Run Free Clinic Sees Early Success
A year ago, Montana opened the nation's first clinic for free primary health care services to its state government employees. The Helena, Mont., clinic was pitched as a way to improve overall employee health, but the idea has faced its fair share of political opposition. A year later, the state says the clinic is already saving money (Boyce, 7/30).

The New York Times: Program Compelling Outpatient Treatment For Mental Illness Is Working, Study Says
For some people with severe mental illness, life is a cycle of hospitalization, skipped medication, decline and then rehospitalization. They may deny they have psychiatric disorders, refuse treatment and cascade into out-of-control behavior that can be threatening to themselves or others. Now, a study has found that a controversial program that orders these patients to receive treatment when they are not hospitalized has had positive results (Belluck, 7/30).

The Lund Report: Insurance Division Knocks Off $69 Million In Rate Review
The Oregon Insurance Division reduced insurance rates in the individual and small group markets by $69 million for 2014, but significant savings continued to be lost, as some insurers ignored slowing medical inflation and failed to factor reductions in uncompensated care as fewer people go without insurance under the Affordable Care Act. An Oregon State Public Interest Research Group report released last week showed the Insurance Division cut more than half of the waste, $38 million, from just two of the state’s major insurance carriers -- Kaiser Permanente and Providence Health Plan (Gray, 7/29).

Los Angeles Times: L.A. Seniors Confident About Aging, Yet Many Don't Manage Health
Ninety percent of Los Angeles seniors are confident they will keep up the quality of their lives as they age, a new survey shows. Yet experts warn that only a fraction are taking steps to manage their health. For many seniors battling chronic conditions such as diabetes and arthritis, "they're gliding toward a very distressing future," said Richard Birkel, senior vice president for health at the National Council on Aging, which helped conduct the survey. If seniors don't take action, "they will see their world begin to shrink" (Alpert, 7/29).

Modern Healthcare: Molina Adds S.C. To Its Medicaid Managed-Care Portfolio
Molina Healthcare is entering the South Carolina Medicaid managed-care market by acquiring the medical-home membership in the state from Community Health Solutions of America -- assuming the state phases out its medical homes program and transfers those enrollees into full-risk managed care.  St. Petersburg, Fla.-based Community Health Solutions' South Carolina Solutions, which serves about 150,000 Medicaid enrollees, is one of three medical-home networks doing business with the state's Medicaid program (7/29).

Milwaukee Journal Sentinel: Wisconsin A Model For Country, Scott Walker Says
Detroit would not be bankrupt and Chicago public schools would be flourishing if those cities operated under Wisconsin's public union laws, Gov. Scott Walker said Monday in what amounted to a national stump speech -- and came days before he hosts the National Governors Association conference in Milwaukee. ... Walker said Wisconsin was able to turn a $3 billion deficit at the time he took office into a $75 million surplus as of June 30 by passing legislation that repealed most collective bargaining for most public employees. In addition, the law required most public employees to pay more for their pension and health care benefits (Stanley-Becker, 7/29).

California Watch: Lax Oversight Leaves California Drug Rehab Funds Vulnerable To Fraud
Next to a smoke shop deep in the San Fernando Valley, employees at Able Family Support pull back the metal gates and open the doors to catch an unfettered flow of government money. The clinic, reimbursed by taxpayers for each client it sees, offers in-person drug and alcohol counseling (Jewett and Evans, 7/29). 

California Healthline: State Has Paid More Than $1 Million In Penalties For Late Hearings; Total Will Rise
The Department of Health Care Services has sent more than $1 million in penalty checks to some beneficiaries in the Community Based Adult Services program due to long delays in appeal hearings over beneficiaries' eligibility status, according to DHCS officials. About $1.2 million in penalties has been paid to 486 appellants and there are another 670 checks waiting in the queue. … The state has 90 days to process fair hearings for CBAS eligibility appeals. If  the ruling finds the appellant eligible for the program, the state must pay $100 a day for each day past the 90-day limit (Gorn, 7/29).

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Editorials and Opinions

Viewpoints: How Much Power Should The AMA Have To Set Medicare Prices?; GOP's 'Disastrous' March To Defund Health Law

The New York Times: Don't Give Up On Health Care Cost Control
S.G.R. More than 99 percent of Americans have no idea what these three letters stand for. And yet they are extremely valuable: worth about $140 billion. This week, a House committee will finally take up the issue. The S.G.R., or the Sustainable Growth Rate formula, was enacted as part of the Balanced Budget Act of 1997 to restrain the inevitable increase in Medicare's annual spending on physician services. ... Nice idea in theory. Never worked out in practice (Dr. Ezekiel J. Emanuel and Topher Spiro, 7/29). 

USA Today: When Doctors Set Their Own Pay: Our View
Some of the most important players in setting the rates that Medicare and private insurers pay doctors are — surprise — doctors themselves. And — no surprise — certain procedures end up costing more than they should. ... The time has come to either supervise the AMA committee's work more aggressively or have Medicare do the work itself (7/29). 

USA Today: AMA: Medicare Gains From Physicians' Advice
The success of Medicare depends on accurately assessing the impact of constant advances in science and technology on patient care. There is simply no substitute for physicians' clinical expertise when gauging how much work and resources go into one medical service compared with another. No one knows more about what is involved in providing services to Medicare patients than the physicians who care for them (Dr. Ardis Dee Hoven, 7/29). 

Bloomberg: Who Should Set Medicare Prices?
[H]ere’s what I didn't see the outraged critics explain: what should replace the American Medical Association committee. If we take the power of the doctors away, who will set prices, and how? ... We’ve spent the 50 years since [Medicare] was founded complaining that providers were charging too much and implementing reforms that didn’t fix that fundamental problem, as the Official Blog Spouse has extensively documented. That’s no reason not to try again, of course. But we probably shouldn’t expect too much in the way of fixes (Megan McArdle, 7/29).

The New York Times' Economix blog: The Question Of Taxing Employer-Provided Health Insurance
The exclusion for employer-provided health insurance is far and away the largest tax expenditure. In part this is because it, like all such exclusions, reduces payroll taxes as well as income taxes; it is as if the worker never received the income it represents, although employers may deduct the cost of health insurance as a business expense. In contrast to exclusions, individuals' tax deductions, exemptions and credits reduce only income taxes (Bruce Bartlett, 7/30). 

Los Angeles Times: No, Howard Dean, Obamacare Doesn't Ration Medicare
Republicans have said hyperbolic things about the 2010 healthcare law's Independent Payment Advisory Board so many times -- e.g., former Alaska Gov. Sarah Palin's declaration that it's a "death panel" -- that I've gotten inured to it. Nevertheless, it was a little startling to see some of the same facts-be-damned assertions coming from a liberal Democrat on the op-ed page of the Wall Street Journal. Former Democratic Party Chairman Howard Dean took to the Journal on Monday to attack the IPAB with the same blatant mischaracterizations that have been the hallmarks of the GOP attacks (Jon Healey, 7/29).

The Washington Post's Post Partisan: Ignoring The Obamacare Spin
To the extent it matters to voters — and very few people will ever vote on just one issue, health care included — there's no election where Obamacare could make a difference for over a year. What will matter is what actual, real consumers find when they think about signing up for health insurance. If those eligible for the exchanges like what they see (and if the interface works, and if they find out about the availability of the marketplaces in the first place), then they're going to buy insurance, and the system will work pretty well. If not, not (Jonathan Bernstein, 7/29). 

Baltimore Sun: GOP's Obamacare Obsession Is Starting To Look Like Political Suicide
Many present-day Republicans seem bent on making "Backward, Christian Soldiers" their marching song in their relentless determination to "repeal and replace Obamacare," even to the point of repeating their lemming-like plunge over the cliff of another government shutdown. More than 60 of them in the House and about a dozen in the Senate have signed letters by conservative GOP Sen. Mike Lee of Utah and Rep. Mark Meadows of North Carolina pledging to vote to defund President Barack Obama's Affordable Care Act, despite some party warnings of likely political suicide (Jules Witcover, 7/29).

Bloomberg: Drop The Disastrous Plan To Defund Obamacare
One possible outcome of this debate is that the Republican House passes a government-funding bill that doesn’t include money for Obamacare, but then gives in to the Democratic Senate on the issue. At that point the conservative groups that are pushing for defunding will say Republican leaders have again betrayed them, and get back to the vital work of raising donations off that idea. That won’t be the happiest of endgames for Republicans, but it would still be better than a shutdown or default that failed to achieve their goals ... The repeal of Obamacare is a worthy and potentially popular cause, but it won’t be accomplished through sheer willpower (Ramesh Ponnuru, 7/26).

The Washington Post: A Setback On Polio
Only a few months ago, there was great optimism that polio was on the verge of eradication. The world saw only 223 cases in 2012, the lowest level in history, and the Global Polio Eradication Initiative, an umbrella group, unveiled a major strategy to wipe out the disease over the next five years. Those hopes now seem clouded by a poliovirus outbreak in Somalia and Kenya. This year, there have been 81 cases in these two countries, more than the 59 cases in the three countries where polio remains endemic: Afghanistan, Pakistan and Nigeria (7/29).

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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.