Daily Health Policy Report

Monday, July 9, 2012

Last updated: Mon, Jul 9

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Campaign 2012


Health Care Marketplace


State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Q & A: Concierge Care And Choosing A Doctor (Video)

Kaiser Health News "Insuring Your Health" columnist Michelle Andrews answers a reader question about doctors who charge extra fees for more personalized care (7/9). Watch the video.

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Political Cartoon: 'Hope He Has Insurance'

Kaiser Health News provides a fresh take on health policy developments with "Hope He Has Insurance" by Chris Weyant.

And here's today's health policy haiku:


Hopkins, Geisinger,
Mayo - models of high-end
Care. Bargains? Really?

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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Capitol Hill Watch

Health Law Debate Returns To Center Stage In House

With lawmakers returning to Washington this week after the July 4 break, Republican leaders in the House have scheduled a vote -- the 31st such attempt -- to repeal the health law. The effort is not expected to get any traction in the Democrat-led Senate.

The Associated Press: Analysis: Compromise In Congress Very Unlikely
Republicans and Democrats in Congress who congratulated themselves for passing relatively routine legislation before July 4 are returning to the Capitol for a summer stocked with political show votes and no serious role for bipartisanship. … the House Republican leadership intends to force a vote this coming week on a repeal of President Barack Obama's health care law, recently upheld by the Supreme Court in a ruling that said the law imposes a tax on anyone who fails to purchase insurance (Espo, 7/9).

NPR: GOP To Make 31st Attempt To Repeal Obamacare Act
The House Rules Committee takes up a bill Monday called the "Repeal of Obamacare Act." And just like it says, the bill would wipe away the president's Affordable Care Act. A vote of the full House is planned for Wednesday (Keith, 7/9).

The Hill: GOP Seeks To Rebound As Democrats Hit Reset On Health Care Reform Debate
The Supreme Court ruling on healthcare reform has upended the parties' messaging war, and led to a series of adjustments on both sides of the aisle. Republicans, still reeling from the conservative-leaning court's decision to uphold President Obama's signature law, are looking to regain their political legs. Democrats, who were pummeled by the GOP over the last couple of years on healthcare, are going on offense. House GOP leadership officials have scheduled a floor vote on repealing the law next week in what will represent the opening of a new chapter in the intense message battle. Throughout the 2009 and 2010 debate on the bill, Democrats were divided on what direction to pursue on healthcare. Republicans, meanwhile, were united in their opposition (Viebeck, 7/7).

Roll Call: Fight Over Health Law Resumes
President Barack Obama's health care reform law will be center stage again this week, as Republicans look to put coordinated bicameral pressure on Senate Democrats to take up a full repeal of the controversial law. House Republicans pledged for months to offer a full repeal if the law was upheld by the Supreme Court, and on Wednesday they will do just that when they vote on a measure sponsored by Majority Leader Eric Cantor (R-Va.). … Unlike in the House, where Republicans can schedule repeal votes at will, Senate Republicans will have to use procedural maneuvering or amendments to work the issue onto the Senate's agenda, which is dictated by Majority Leader Harry Reid. The Nevada Democrat has scheduled a test vote for Tuesday on a package of tax breaks designed to promote hiring and new equipment purchases by small businesses. Senior Democratic aides indicated Friday that Republicans are not expected to block the measure from coming up, but they are concerned that GOP Senators will try to use the bill as a vehicle for their own agenda (Newhauser and Lesniewski, 7/9).

Los Angeles Times: Obama Says 'More To Do' On Jobs As GOP Vows Healthcare Repeal
President Obama touted the newly-signed highway bill as a potential economic booster, while a Republican congresswoman called for the repeal of the healthcare reform law in dueling addresses on the economy Saturday (Memoli, 7/7).

Politico: Dems Face Month Of Perilous Votes
The carefully planned effort, detailed by Republicans inside and outside the Capitol, has buy-in from Mitt Romney's campaign, aides say. Outside political groups, which by law cannot coordinate with lawmakers, intend to pounce on the upcoming votes with advertising, robocalls and mailings. House Republicans will kick off the effort this week with another quixotic attempt to repeal Obama's health care law. Next week, they will turn to defense, passing the Defense Department's funding bill while trying to put the Obama administration on record as having no plan to avoid deep cuts to the Pentagon next year. After that, Republicans intend to take up a slew of regulatory relief bills. And before the House breaks in August for its monthlong recess, GOP leaders plan to hold a vote on tax rates and principles for future tax reform. Republicans have spent much of 2012 on these very themes (Sherman and Min Kim, 7/8).

Meanwhile, other longer-term strategies to undo the health law are percolating -

Politico: Health Care Reform: 5 Ways To Kill 'Obamacare' Without Repealing
Even conservatives admit Mitt Romney's promise to repeal President Barack Obama's health care law with an executive order might not work — but that doesn't mean he's out of luck. Romney could still begin to gut the law immediately by taking some more passive-aggressive steps — a jumbo-sized version of a strategy Obama has embraced on issues ranging from immigration to education (Feder, 7/7).

Houston Chronicle: Senate Republicans Eye Budget Tactic To De-fund Health Care Law
With some powerful Texans in the vanguard, Republican lawmakers return Monday to a deeply divided Capitol Hill and tenacious election-year tactics to get rid of President Barack Obama's health care plan….In the Democratic-led Senate, where leaders dismiss the upcoming House action as "just a show vote," Texas Sen. John Cornyn and other Senate GOP leaders are looking for added Republican senators in the fall elections and an arcane legislative tool known as budget reconciliation to help target Obama's health care blueprint early next year (Powell, 7/9).

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Health Reform

Could Insurance Rules Survive If GOP Goes After Health Law Through Budget Reconciliation?

Politico explores what might become of this element of the health law if Republicans win control of Congress and the White House and attempt to unwind the law through the same budget reconciliation process that Democrats used to pass it. Other parts of the law under GOP attack include the online insurance markets where individuals and small businesses could buy coverage and the provision of federal subsidies to help some people buy coverage.

Politico: Insurance Rules Might Stay Even If ACA Repealed
GOP Hill aides are still working through the details of what they can rip out of the Affordable Care Act through budget reconciliation — the same complex process used more than two years ago to usher through final passage of the health law. There's broad agreement Republicans could use the legislative maneuver to go after the law's individual mandate. … Health policy analysts are split on what else can stay under reconciliation and what can go. There's uncertainty, in particular, on what would happen to the new insurance rules. … The Senate parliamentarian — Congress's rule maker — will be at the center of any decision (Millman and Dobias, 7/8).

The New York Times: Brawling Over Health Care Moves To Rules On Exchanges
Critics of the new health care law, having lost one battle in the Supreme Court, are mounting a challenge to President Obama's interpretation of another important provision, under which the federal government will subsidize health insurance for millions of low- and middle-income people. ... At issue is whether the subsidies will be available in exchanges set up and run by the federal government in states that fail or refuse to establish their own exchanges. Critics say the law allows subsidies only for people who obtain coverage through state-run exchanges. The White House says the law can be read to allow subsidies for people who get coverage in federal exchanges as well (Pear, 7/7).

Kansas City Star: Kinder Vows To Sue Over Missouri Health Care Exchanges
Republican Lt. Gov. Peter Kinder is once again taking his opposition to the federal health care law to court, this time promising a lawsuit challenging the language that will appear on Missouri’s Nov. 6 ballot. The language — crafted by Democratic Secretary of State Robin Carnahan — attempts to summarize a measure passed by the Republican-dominated General Assembly that would allow voters to decide whether the governor should be allowed to set up an online marketplace for patients to shop for insurance policies (Hancock, 7/6).

The Associated Press: The Tax Man Cometh To Police You On Health Care
The Supreme Court's decision to uphold most of President Barack Obama's health care law will come home to roost for most taxpayers in about 2½ years, when they'll have to start providing proof on their tax returns that they have health insurance. That scenario puts the Internal Revenue Service at the center of the debate, renewing questions about whether the agency is capable of policing the health care decisions of millions of people in the United States while also collecting the taxes needed to run the federal government (Ohlemacher, 7/8).

The Hill: Health Law Mandate Isn't 'Largest Tax' Despite GOP Claims
To hear Republicans tell it, the individual mandate to buy health insurance that the Supreme Court has now declared to be a tax is the "largest tax in America's history." Yet even when considered as a revenue-raising tax, the mandate at the center of President Obama's signature legislation is not even the largest tax increase in the 2010 healthcare law, much less in the history of the republic. The Congressional Budget Office projects that the penalty, or tax, for not buying health insurance will bring in just about $4 billion a year and a total of $17 billion by the end of the decade. Taken either as a whole or as a percentage of the overall economy, that pales in comparison to many tax increases in recent decades (Berman, 7/8).

The Fiscal Times:  Employer-Based Health Care Plans On Slippery Slope
Will any of the 160 million Americans who receive health insurance from their employers lose that coverage because of the Affordable Care Act? Former Massachusetts Gov. Mitt Romney, the presumptive Republic nominee, has repeatedly challenged the President Obama's assertion that no one who likes their current plan will lose it. "Up to 20 million Americans . . . will lose the insurance they currently have, the insurance that they like and they want to keep," he said shortly after the Supreme Court decision upholding the law was announced. The claim is based on a 2011 McKinsey & Co. online survey of 1,329 corporate executives where 9 percent said they would "definitely" drop coverage (Goozner, 7/9).

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For States, High Court's Medicaid Ruling Creates Choices, Makes Waves

States are responding to the court's decision in varying ways. Some interpretations are leading states to pare back their existing Medicaid programs, according to the Wall Street Journal. Others find themselves in limbo.   

The Wall Street Journal: States Interpret Ruling To Cut Medicaid Now
Some cash-strapped states have seized on a section of the Supreme Court's health-law decision to pare their existing Medicaid programs, saying the ruling lifts the March 2010 law's ban on such cuts. The court, which upheld most of the law, struck down penalties for states choosing not to expand Medicaid. A few states are also trying to go farther, arguing that the ruling justifies cuts to their existing programs (Weaver and Radnofsky, 7/6).

Atlanta Journal Constitution: Georgia Health Care In Limbo
Georgia hospitals were depending on the health care law to ease the burden of treating hundreds of thousands of uninsured patients each year for free. But that relief may never come. While upholding the law, the U.S. Supreme Court ruled states could reject the massive expansion of the Medicaid program that is a cornerstone of the Patient Protection and Affordable Care Act. For hospitals, not expanding the health program for poor and low-income Georgians would mean having to treat almost as many uninsured patients as ever while facing significant cuts to their reimbursements (Williams and Teegardin, 7/8). 

Georgia Health News: ACA's Impact On Public Health: Changes And A Choice
Georgia Gov. Nathan Deal has taken a wait-and-see approach on Medicaid expansion. Georgia has about 2 million uninsured residents, or roughly 20 percent of the state's population. The more who get coverage, either through Medicaid or the health insurance exchanges that the ACA will create, the better for public health in the state, health experts say (Miller, 7/8).

Bloomberg: Hospital Bills Unpaid As S.C. Shuns Medicaid Expansion
Shirley Johnson gets her medical care at Palmetto Health Baptist hospital's emergency room in Columbia, South Carolina. ... Johnson, as a 49-year-old with no dependents, isn’t eligible for Medicaid, the joint state-federal health program for the poor, which covers about 20 percent of the state’s residents. And in two years, when President Barack Obama's health-care overhaul allows the expansion of Medicaid to cover 17 million more Americans, she may still be left behind (Newkirk and Selway, 7/9).

Greenville (S.C.) News: Clyburn Goes After Haley On Health Care
The state's top Democrat says Gov. Nikki Haley's rejection of expanded Medicaid under the federal Affordable Healthcare Act shows South Carolina's GOP leaders "don't seem to care" about the health of 700,000 South Carolinians. U.S. Rep. Jim Clyburn, the state's top elected Democrat and a top ranking Democrat in Congress, told GreenvilleOnline.com that he was not surprised at Haley's decision to reject the idea of creating a state-based insurance exchange under the new law, following a decision by the U.S. Supreme Court last week to uphold the law's constitutionality (Smith, 7/7). 

Richmond Times Dispatch: PolitiFact: McDonnell Claim About Medicaid Mandate Rated Pants On Fire
After the Supreme Court's ruling on the health care act, McDonnell repeatedly said states still face a "mandate" to take part in Medicaid expansion provisions in the law. Actually, the court's ruling had the opposite effect. It took away Washington's ability to punish states that don't take part in the expansion by eliminating their federal Medicaid subsidies. The court ruled states must have "a genuine choice" whether to take part in the expansion (Gorman, 7/8). 

Texas Tribune: Perry: TX Won't Implement Key Elements Of Health Reform
Texas will not expand Medicaid or establish a health insurance exchange, two major tenets of the federal health reform that the U.S. Supreme Court upheld last month, Gov. Rick Perry said in an early morning announcement. "I stand proudly with the growing chorus of governors who reject the Obamacare power grab," he said in a statement (Ramshaw, 7/9).

Houston Chronicle: Perry: No Medicaid Expansion, No State Health Exchange
Gov. Rick Perry says Texas has "no intention" of implementing a state health insurance exchange or expanding Medicaid now that the federal health care law has been upheld.  Here’s an excerpt from his statement. His office says more will come Monday: "If anyone was in doubt, we in Texas have no intention to implement so-called state exchanges or to expand Medicaid under Obamacare, I will not be party to socializing healthcare and bankrupting my state in direct contradiction to our Constitution and our founding principles of limited government" (Fikac, 7/9).

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Campaign 2012

Romney's Stance On The Health Law Tax Is Blasted By Democrats, Scrutinized By GOP

GOP presidential hopeful Mitt Romney's reversal on whether the mandate is a tax has made him the target of intense Republican and Democratic scrutiny as the Supreme Court ruling on the health law proves a boon for the campaign bankrolls of both Romney and President Obama.

Reuters: Romney Campaign's Missteps Have Some Republicans Grumbling
The anxiety over Romney's campaign has been heightened this week by its conflicting messages over his position on a key part of the Supreme Court's ruling that upheld Obama's health care overhaul. But it was only the latest example of message problems from a campaign that even some Republicans say is being outmaneuvered by Obama's team (Holland, 7/6).

San Francisco Chronicle: Romney Faces Fallout After Fumble On Health 'Tax'
The seemingly simple concept of an individual mandate to buy health insurance has mutated into a complex political controversy that has tied Mitt Romney's presidential campaign in knots and has diverted attention from the Republican presidential candidate's relentless focus on the weak U.S. economy. ... The fumbling response has caused some prominent conservatives to publicly second-guess the quality of Romney's campaign and its ability to deal with adversity (Dunham, 7/7).

Reuters: Obama Chides Romney For Flip-Flopping On Health Care
President Barack Obama accused Republican rival Mitt Romney of kowtowing to conservatives when he changed his position on what to call the health care reform provision that requires people to buy insurance. Obama said Romney had defended the "individual mandate" as a penalty when he backed it as part of health care reform in Massachusetts as governor, but changed his tune on the national health care law after criticism from fellow Republicans (Mason, 7/6).

The Associated Press: Obama, Romney Use Ruling To Rally Core Backers
President Barack Obama and Mitt Romney both are using the Supreme Court decision upholding the federal health care insurance requirement, loved by liberals and hated by conservatives, to rally core supporters in the most competitive states in the presidential race. Yet while each side may be benefiting from groundswells of volunteers and money, the ruling seems unlikely to sway the legions of undecided voters who are focused heavily on the economy -- not on the health care debate that has raged in this country for years (Beaumont, 7/6).

NewsHour: Romney Rakes In Campaign Cash As Health Care Battle Rages On
Mitt Romney, the $100 million dollar man. The presumptive GOP presidential nominee and the Republican National Committee are expected to announce Friday a combined June haul of $100 million, nearly $5 million of that coming in the 24 hours following the Supreme Court's ruling on health care. RNC political director Rick Wiley taunted President Obama's top political aide Thursday with the news: .@Messina2012, check this out bro, we raised north of $100 million in June. I'm assuming u & Axe will need beers 2night bro. David Axelrod offered his congratulations and maintained that the Obama campaign always thought it would be outspent by the Republicans (Bellantoni, 7/6).

Los Angeles Times: Health Care Ruling Triggered Millions In Campaign Donations
The long-term political consequences of last week's Supreme Court ruling on the health care law remains unclear. But early indications show that as a fundraising tool, the 5-4 decision is a boon for both parties. ... After 24 hours, more than 47,000 donors had contributed a total of $4.6 million (to Mitt Romney). The Obama campaign, which also hit up supporters for post-decision donations, declined to specify how much it raised, though a spokesman said it was more than what the Romney campaign said its effort drew (Memoli, 7/6).

The New York Times: Delicate Pivot As Republicans Blast Rivals On Medicare Cuts
"Obamacare cuts Medicare -- cuts Medicare -- by approximately $500 billion," Mr. Romney has told audiences. That is a reprise of Republicans' mantra of the 2010 midterm elections, which gave them big gains at both the state and federal levels and a majority in the House. Yet the message conflicts not only with their past complaint that Democrats opposed reining in Medicare spending, but also with the fact that House Republicans have voted twice since 2010 for the same 10-year, $500 billion savings in supporting Mr. Ryan's annual budgets (Calmes, 7/6).

The ruling also has other polticians getting in on the act --

Politico: Health Care Ruling Could Tip Races
Former Democratic Rep. Dan Maffei lost in 2010 after facing heat over his health care vote and he'd like to just move on as he tries to regain his seat in 2012. GOP Rep. Ann Marie Buerkle beat Maffei by running on an anti "Obamacare" platform and she's more than happy to keep talking about the Supreme Court ruling from last week. ... It's a theme that's sure to play out in swing districts across the country. Democrats will argue that the Supreme Court has spoken on the health care law, and try (to) turn the conversation toward improving the economy. Republicans will say the law — even though parts of it are popular — tramples on individual freedoms and is a burdensome regulatory juggernaut (Nocera, 7/7).

National Journal: Durbin: Romney Is Obamacare's Daddy
At least one Senator on Sunday made it clear that health care reform will still be used as a cudgel to beat Mitt Romney, even as his campaign attempts to brush the candidate's connection to Obamacare aside following the Supreme Court ruling that upheld the law. "Mitt Romney is the Obamacare daddy. He gave birth to this baby up in Massachusetts and now he doesn't recognize it, he can't pick out any strains in the hereditary chain there that look like anything that he did in Massachusetts," said Sen. Dick Durbin, D-Ill., on CBS's Face the Nation (Jaffe, 7/8).

Politico: Health Care Remarks Haunt Tommy Thompson
Those 2009 comments have come back to bite Thompson in his Wisconsin Republican Senate primary in which his conservative opponents are trying to make him the first real political victim of the landmark Supreme Court ruling upholding the Affordable Care Act. The Wisconsin attacks will test the continued potency of the issue among GOP base voters and may offer a measure of whether the tea party still has the power in Republican primaries to purge more moderate candidates in swing states (Raju, 7/8).

National Journal: McConnell Tries Out 'Mandate Tax' And 'Penalty Tax'
Republicans have tied themselves up in rhetorical knots since the Supreme Court upheld the individual mandate at the heart of President Obama's health care law. GOP lawmakers said the mandate to buy insurance was a new tax. The Romney campaign said it wasn't a tax, and then reversed itself. On Sunday, Senate Minority Leader Mitch McConnell worked to square the circle. The requirement that uninsured Americans buy insurance, he told CNN’s State of the Union, was a "mandate tax" and a "penalty tax" (Dreazen, 7/8).

Finally, in a new ad, Obama is attacking Romney's abortion stance as well.

Fox News: Obama Attacks Romney On Abortion Stance, Campaign Calls New Ad False
The 30-second spot titled "Troubled" is airing in Virginia and seven other swing states. "Every woman who believes decisions about our bodies and our health care should be our own is troubled Mitt Romney supports overturning Roe v. Wade," says a female voice at the beginning of the ad (7/7).

Politico: Polling Memo: Planned Parenthood's Anti-Romney Ads Leave A Mark
Women are far more likely to support President Obama and voice doubts about Mitt Romney after being exposed to the Planned Parenthood Action Fund's recent anti-Romney ad campaign, according to a survey commissioned by the women's health and abortion rights group. The poll, conducted by Hart Research Associates and shared with POLITICO, tested female voters in West Palm Beach, Fla., and Des Moines, Iowa, to gauge the impact of the PPAF ads. The group announced at the end of May that it was spending over $1 million on an initial wave of commercials hitting Romney in Florida, Iowa and Virginia (Burns, 7/9).

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Proposed Medicare Fee Schedule Includes Pay Increase For Primary Care, Family Docs

The proposed rule also would provide payment for care that helps patients make the transition back into the community following a discharge from a hospital or nursing facility.

Medscape:  CMS Proposes Primary Care Raises Funded With Specialist Cuts
Medicare would reduce reimbursement for many types of specialists to fund sizable raises for primary care physicians in 2013, according to a proposed fee schedule that the Centers for Medicare and Medicaid Services (CMS) released today.  These reductions and raises are apart from the huge pay cut — now put at 27% — set for January 1, 2013, that is triggered by Medicare's sustainable growth rate formula, and likely to be postponed by Congress (Lowes, 7/6).

Modern Healthcare: CMS Proposes 7% Pay Hike For Family Docs
In a proposed rule released late Friday, the CMS included a slew of potential changes to the physician-fee schedule for 2013, including a 7% payment increase for family physicians and smaller increases for other primary-care doctors. The proposed pay hike for family physicians comes from a plan to reimburse such providers separately for providing successful follow-up care after a patient's hospital or nursing-home stay, the CMS said (McKinney, 7/6).

Medpage Today: CMS Proposes Primary Care Pay Raise For 2013
The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule that would give family physicians a 7 percent pay boost in 2013. The proposal released Friday also would increase Medicare payments to other primary care practitioners by between 3 percent and 5 percent. "Helping primary care doctors will help improve patient care and lower healthcare costs long term," CMS Acting Administrator Marilyn Tavenner said in a press release (Walker, 7/6).

In related news -

The Wall Street Journal: Medicare Tries To Cut The Cost Of Its Most Complex Patients
Medicare is trying new tactics to cut costs for complex patients and keep them healthier, although some health-policy observers say they don't go far enough (Adamy, 7/6). 

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Health Care Marketplace

Airline Files Suit To Stop Providing Health Benefits To Current Retirees

The Associated Press: AMR Sues Retired Workers Over Health Benefits
American Airlines and its parent company are suing to stop providing health care and life insurance benefits to current retirees. AMR Corp. and American filed the lawsuit Friday as part of their bankruptcy case in federal court in New York. The airline wants the bankruptcy judge to rule that it can end the benefits as a way to cut costs in "sound business judgment." American says it never promised benefits to last the retirees' entire lives, and it reserved the right to change the benefits plan (Koenig, 7/6).

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Nurses Complain About Underemployment

Marketplace:  Finding A First Job Not Easy For New Nurses
Ever found yourself stuck in a hospital bed, pushing that little "help" button and then waiting... waiting... waiting for a nurse? That's when all the headlines about a "nursing shortage" in this country hit home, right?  And if the forecasts are right, we could be short hundreds of thousands of nurses in the next decade. So you might be surprised to hear some nurses complaining about underemployment right now.  We asked reporter Annie Baxter to examine that seeming contradiction -- and here's her diagnosis (Baxter, 7/6).

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Consumer Reports Investigates Hospital Safety

The magazine offers its rankings of the safest and most dangerous hospitals based on six criteria.

Consumer Reports: How Safe Is Your Hospital? Our New Ratings Find That Some Are Riskier Than Others
Infections, surgical mistakes, and other medical harm contribute to the deaths of 180,000 hospital patients a year, according to projections based on a 2010 report from the Department of Health and Human Services. Another 1.4 million are seriously hurt by their hospital care. And those figures apply only to Medicare patients. What happens to other people is less clear because most hospital errors go unreported and hospitals report on only a fraction of things that can go wrong (August 2012).

CBS (Video): Consumer Reports Ranks Most Dangerous, Safest Hospitals
For the first time, Consumer Reports magazine has investigated hospital safety - and the results will probably surprise you. Dr. John Santa, director of the Consumer Reports Health Ratings Center, says the magazine used six criteria: Infections; Communications about safety issues; The degree to which you come right back in the hospital after you've been discharged; Situations in which too many imaging tests that expose you to radiation are being done; Common complications in unsafe hospital; and Death rates for several conditions. The lowest-rated hospital in the country, he told "CBS This Morning: Saturday" co-hosts Rebecca Jarvis and Anthony Mason, was Sacred Heart Hospital in Chicago (7/7).

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State Watch

Federal Judge To Decide Wednesday On Miss. Abortion Law

The Republican-appointed judge is expected to rule this week whether to block a law that could effectively shutter the state's only abortion clinic. Abortion politics could also affect the availability of services in Indiana and D.C.

Stateline: New Anti-Abortion Strategy Pays Off
By the end of this week, Mississippi may be the only state in the nation to have no abortion clinic within its borders. A federal judge will decide on Wednesday whether or not to continue blocking a new law that would effectively shut down the one such clinic remaining. The law, signed by Governor Phil Bryant in April, requires doctors performing abortions to be board-certified OB-GYNs and to have admitting privileges at local hospitals. That is a condition that the Jackson Women’s Health Organization says it cannot meet (Wiltz, 7/9).

The Associated Press: Miss. Abortion Case Heard By GOP-Appointed Judge
Although restricting abortion has long been a conservative goal in Mississippi, the Republican-appointed judge considering the constitutionality of the state's stringent new abortion law doesn't play politics in the courtroom, according to those who know him. U.S. District Judge Daniel P. Jordan III temporarily blocked the new law that, if enforced, could shut down the state's only abortion clinic (Pettus, 7/8).

The Associated Press: Medicaid Official Rules Against Ind. Abortion Law
Indiana's decision to deny Planned Parenthood Medicaid funds because it performs abortions denies women the freedom to choose their health care providers, a federal hearing officer said. The state had asked the Centers for Medicare and Medicaid Services in Chicago to reconsider its June 2011 ruling that found changes in Indiana's Medicaid plan unacceptable. But a hearing officer recommended in documents released Friday that a CMS administrator uphold the agency's initial decision (Wilson, 7/8).

Politico Pro: 'Personhood' Movement Not Quitting
The "personhood" anti-abortion movement isn't quitting. But it might be revising its timetable by a few years. Last week the anti-abortion group Personhood USA, which seeks to ban abortion by giving full legal rights to an embryo, fell short of collecting enough signatures in Ohio to get a state constitutional amendment on the ballot this November. The group did not get enough signatures to get on the ballot in Nevada or California. The abortion rights group NARAL Pro-Choice America sees limits to Personhood’s reach (Smith, 7/9).

Roll Call: D.C. Abortion Measure Set For Markup
For the past several months, a bill that would ban abortions after 20 weeks in the District of Columbia has been a centerpiece of the rhetoric of anti-abortion forces, abortion-rights proponents and D.C. autonomy activists. The talk turns into action Tuesday, when the House Judiciary Committee is scheduled to consider the measure. "We will continue to press this issue … building towards ultimate enactment," National Right to Life Committee Legislative Director Douglas Johnson said. "We will counter them every step of the way," NARAL Pro-Choice America spokesman Ted Miller said. …The legislation, sponsored by Rep. Trent Franks (R-Ariz.), is based on the argument by some medical experts that 20 weeks is the threshold after which a fetus can begin to feel pain (Dumain, 7/9).

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Medicaid News: La. Preps Managed Care Cuts; Fewer Texas Docs Accept New Patients

The Medicaid program in Louisiana is preparing to cut payments to providers who run its managed care program. In Texas, only 31 percent of doctors take new Medicaid patients, a survey says.

New Orleans Times Picayune: Louisiana Officials Sketch Out Medicaid Payment Cuts
The Louisiana health agency late Friday afternoon detailed Medicaid payment cuts, expected as part of implementing the state operating budget that went into effect July 1, to a range of health care providers and the private insurers that run Bayou Health, the managed-care portion of the giant government insurance program for the poor. For most entities, the cuts range from 1.5 percent to 3.7 percent, though a handful of providers and services take a bigger hit, particularly ambulance services (Barrow, 7/6).

The Associated Press/Houston Chronicle: Texas Docs Cut Back On Poor Patients
The number of Texas doctors willing to accept government-funded health insurance plans for the poor and the elderly is dropping dramatically amid complaints about low pay and red tape, showed a survey by the Texas Medical Association provided to The Associated Press on Sunday before its Monday release. Only 31 percent of Texas doctors said they were accepting new patients who rely on Medicaid, the health insurance program for the poor and disabled. In 2010, the last time the survey was taken, 42 percent of doctors accepted new Medicaid patients. In 2000, that number was 67 percent (Tomlinson, 7/8).

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Roundup: Calif. Insurers To Lower Rate Hikes For Small Businesses

A selection of health policy stories from California and Massachusetts.

Los Angeles Times: Health Insurers To Reduce Rate Hikes For California Small Firms
Tens of thousands of small businesses in California collectively will save $48 million on their health insurance bills starting this month now that three insurers have agreed to reduce pending rate hikes (Lifsher, 7/7).

Boston Globe: Students, Doctors Protest Easing Of Gift Ban
Governor Deval Patrick is scheduled to sign a new $32.5 billion state budget Sunday that would probably loosen a ban on gifts to doctors from drug and medical device companies. The proposed measure scales back restrictions imposed in 2008 and would now allow companies to pay for "modest" meals and refreshments for doctors as part of informational sessions about their products (Shen, 7/6).

Modern Healthcare: Mass. Governor Backs Easing Of Industry Gift Ban
Massachusetts Gov. Deval Patrick said in a letter this week that he will support amendments to the state's law banning drug and medical-device companies from giving gifts to health care providers. Legislation banning gifts to providers was passed in 2008. The Massachusetts Public Health Council later issued related regulations in March 2009 (Lee, 7/6).

HealthyCal: Low-Income Patients Want Closer Connection To Health Providers
Low-income Californians want closer relationships with their doctors' offices -- but not only with their doctor, according to a new poll that plumbed the needs and desires of a population that will be at the heart of federal health reform. The survey, released Monday, found that most low-income patients would be happy to have a "team approach" to treatment that included not just a doctor but nurses, medical assistants, dieticians and health outreach workers (Weintraub, 7/9).

HealthyCal: Free Clinic Struggles To Meet Surge In Demand
Lestonnac, a free health clinic in Orange County, is struggling to keep up with increasing demand. Clinic resources can no longer cover the needs of patients, 60 percent of whom are from Santa Ana. People who lost jobs that once provided them with decent health policies, and do not qualify for Medi-Cal, the insurance program for the poor, now rely on free and low-cost health care services at the clinic. Undocumented workers also turn to the clinic as their only option. Sometimes, it saves their lives (Afrasiabi, 7/9).

San Francisco Chronicle: Romney Aides Gave Advice On State Health Care Law
California officials are moving quickly to deliver services to millions of people as a result of crucial legislation signed two years ago by former Republican Gov. Arnold Schwarzenegger. Here's the twist: Schwarzenegger consulted with advisers to Mitt Romney, the former Massachusetts governor and presumptive GOP presidential nominee, before signing a package of seven health care bills after Congress passed the federal Affordable Care Act. Among other things, the 2010 legislation made California the first state to establish a health insurance exchange aimed at giving residents more affordable choices (Marinucci, 7/6).

San Francisco Chronicle: Hospitals See Pros And Cons To Health Care Law
Hospital administrators in the state said they largely support the federal health care reform legislation upheld by the Supreme Court last month, but many are apprehensive about major pieces of the law, including the possible expansion of the state's Medicaid program. … Locally, hospital executives said they've been preparing for the onset of the reforms, mainly through administrative changes, such as moving to electronic medical records expected to streamline the health care process. But most added that there are significant unanswered questions about how health care reform will affect their business and the patients they serve (Cuda, 7/8).

Boston Globe: Curbing Health Care Costs May Cost State $40 Million A Year
The state will have to spend money to save money on health care costs, according to preliminary estimates from Governor Deval Patrick's administration. The cost to the state of imple­menting cost-control legislation being finalized by House and Senate leaders could be $20 million to $40 million a year, the governor's staff said yesterday (Kowalczyk, 7/7).

Boston Globe: Thousands In Massachusetts Still Forgo Health Care Insurance, Pay Penalty
Massachusetts had the nation's highest rate of health coverage even before passage of a pioneering 2006 law requiring most residents to have insurance. Yet tens of thousands of people like [Francisco] Machado go uncovered each year and pay a fine. Starting in 2014, when much of the national ­Affordable Care Act kicks in, millions of other Americans could face a similar fine, putting Massachusetts in the spotlight as a possible indicator of what lies ahead for the country (Conaboy, 7/6).

California Healthline: Kaiser, State Close On Healthy Families Pact
Officials from Kaiser Permanente and the state Department of Health Care Services are finalizing a deal to enable Kaiser's participation in the state's planned elimination of the Healthy Families program. That is welcome news for the 193,000 Kaiser-enrolled children in Healthy Families -- almost one-fourth of all children in the program. Up till now, it looked like the state and Kaiser were at an impasse over Kaiser's participation in the conversion of Healthy Families to Medi-Cal managed care (Gorn, 7/9).

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Editorials and Opinions

Viewpoints: Daschle Says Health Law Still Has 4 Hurdles; Commentators From States Such As Calif., Texas And Florida Wrestle With Options

Philadelphia Inquirer: GOP Is Refusing Good Medicine
The GOP-controlled U.S. House plans to hold what can only be called symbolic votes on repealing the sweeping reforms they deride as "Obamacare." Meanwhile, at least 15 governors are said to be leaning toward refusing to expand state Medicaid programs -- a key part of the reform's strategy to provide some form of health insurance to the 32 million people now going without coverage. Refusing to expand Medicaid is a bad option that should be rejected by these holdout governors. It certainly isn't the right course for Govs. Corbett or Christie (7/9).

Politico: Obama's 4 Major ACA Hurdles To Go
The Obama administration has cleared a transformational hurdle now that the Supreme Court has ruled the health care individual mandate constitutional. The mandate's importance to meaningful insurance reform and expanded insurance coverage for millions of Americans can’t be overstated. ... Yet four major additional hurdles must still be overcome before President Barack Obama and his administration can consider themselves clear of danger. Like the legal hurdle, these too, if not successfully addressed, could substantially undermine the law's future viability (Tom Daschle, 7/8).

Bloomberg: A Penalty Or A Tax?  It's Both
"Penalty" and "tax" are just words. They don't have some kind of essence that can settle any arguments about their meanings if only it can be discovered. … However much a fee may resemble a penalty, it can still be a tax, and vice versa. Arguing about whether it is one or the other is like arguing about how many angels can dance on the head of a pin (7/8).

Boston Globe: When Mitt Romney's Campaign Struggles, Don't Blame The 'Boston Boys'
When it comes to framing a strong rebuttal to the Supreme Court's Obamacare decision, Mitt Romney's biggest problem isn't Eric Fehrnstrom or anyone else in his Boston brain trust. His problem is Romneycare. Under the health care reform law that Romney championed as governor, Bay Staters must have health insurance. If they don't have it, they must pay what Romney mostly characterized, back then, as a penalty. Similarly, under Obamacare, Americans who don't have health insurance also have to pay what President Obama also characterizes as a penalty (Joan Vennochi, 7/8).

Journal of the American Medical Association: The Supreme Court's Medicaid Surprise
Whatever the outcome, Medicaid will continue to be a major part of the nation's system of financing health care, so careful attention must be paid to measuring performance of states and holding them accountable, just as states and private payers hold their health plan partners accountable. This will require states to embrace greater transparency, as Medicare recently has. It will also require more Medicaid participation in multipayer initiatives to analyze data, improve quality, and change the incentives to foster health care that is more longitudinal and less episodic (Dr. Mark D. Smith, 7/6).

Raleigh News & Observer/McClatchy Newspapers: 'Obamacare' And The Voice Of 'The American People'
The GOP strategists are using "Obamacare” as a device to raise money and stir up opposition to the president. The people buying their pitch don't like President Obama, for various reasons. Health care reform seems like a hook on which to hang their feelings against the president. So after the high court ruling, let’s take a breather and consider what "Obamacare" doesn't do: It’s not a government takeover of health care. The insurance system still is in place, but most everyone will have to have it. Over time that ought to lower the cost for others (Jim Jenkins, 7/6).

iWatch News:  Health Care's Community-Based Beginnings
Back during the debate on the Clinton health care reform proposal, insurance executives tried to convince lawmakers that they were on the same side of health care reform as consumers were, so they embraced the idea of "community rating" in which insurers charge everyone in a given community the same premium regardless of age, gender or health status. ... Fast forward nearly two decades and you'll find that insurance executives have changed their tune, now that they’re actually being required to go back to the good old days when community rating was the norm. Today's health insurers want nothing to do with it. There's just not enough profit in it (Wendell Potter, 7/9).

Arizona Republic: Was Justice Roberts' Decision Really Worth Potential Damage?
The so-called individual mandate -- now, officially, a tax -- is not the Affordable Care Act's only unaffordable element. Altogether, the law creates 20 other new taxes intended to raise a half-trillion dollars. That includes a 3.8 percent surtax on investment income, which may come on top of the investment-income hikes created by ending the George W. Bush-era tax cuts. And which, in many states, will come on top of local soak-the-rich tax increases (Doug MacEachern, 7/8).

Los Angeles Times' Capitol Journal: 'Affordable' Care Act? Not So Much For Sacramento
In Washington, it's called the Affordable Care Act. In Sacramento, it could be become known as another budget buster. Obamacare -- as it's pugnaciously tagged by the political right -- may not be affordable at all for California state government (George Skelton, 7/9). 

Sacramento Bee: State Insurance Exchange Can Learn From Big Employers
California leaders have signaled their intention to move full speed ahead with building a state health insurance exchange that has the potential to provide coverage to millions of Californians beginning in 2014. But if the California Health Benefit Exchange simply becomes another website where Californians can go to purchase health insurance, we will have missed a colossal opportunity to improve health care in the Golden State (Bill Kramer and David Chase, 7/8).

The Raleigh News and Observer: The Southern Side Of Health Coverage
As the Supreme Court upheld the health care bill's mandated coverage, seven justices placed ample constraints on the program's massive Medicaid expansion. They ruled that Congress had exceeded its authority by coercing states to participate through the threatened loss of existing federal payments. Accordingly, states can now choose to forgo new dollars, and new strings, without abandoning Medicaid coverage (and funding) altogether -- a prospect none could realistically abide. States have a choice whether to assist in providing additional health care services to their poorest citizens. The resulting political donnybrook may be a daunting one (Gene Nichol, 7/7). 

Spartanburg, S.C., Herald-Journal: We Need To Use S.C. Solutions For S.C. Health Care Issues
South Carolina advocates for better health, lower health care costs and limited government have little to cheer about after the U.S. Supreme Court ruling upheld much of Obamacare. Instead of providing real solutions, the law simply hides our problems from public view by pouring hundreds of billions of government subsidies into a broken health care system, allowing Washington to declare "victory" while continuing to ignore the real health care challenges facing Americans (Gov. Nikki Haley and Anthony Keck, 7/6). 

Des Moines Register: Branstad's Medicaid Stance Is Unreasonable
For decades this nation has left millions of our people without health insurance. One of Congress’ main goals with the health reform law was to finally get them coverage. Unfortunately, Gov. Terry Branstad appears to want to make sure they remain uninsured (7/8).

Des Moines Register: State Workers Faced With Tough Decision On Whether To Voluntarily Pay For Health Insurance
More than 20,000 state employees face a decision in the coming days: Should they make a monthly contribution to the state treasury or not? Last week, the Iowa Department of Administrative Services informed them that they would be "good stewards of taxpayer dollars" if they volunteer to pay 20 percent of the cost of their health insurance premiums. The Register's editorial board has repeatedly argued that state workers should pay a portion of the cost of their insurance. ... But such cost-sharing should be sorted out in negotiations between employees' unions and state officials. It should be part of a thoughtful process ensuring that the amount paid is not plucked out of politically-charged thin air and that all workers are paying their fair share, rather than just some (7/6).

Tacoma News Tribune/McClatchy Newspapers: Health Care View Depends On Where You Sit
How you reacted to the pretty darned historic U.S. Supreme Court ruling on the Affordable Care Act might depend upon the lens you look through. Is it a primarily a constitutional issue, a political issue or a public policy issue? (Peter Callaghan, 7/9).

Fort Worth Star-Telegram/McClatchy Newspapers: Health Care Law Will Benefit Small Businesses
In this marketplace, the sharpest dividing line between the haves and have-nots hinges on the size of your employer. Among Texas companies with at least 50 workers, 95 percent offer health insurance to employees. Among smaller companies, 31 percent offer coverage. That means that most small employers don't even try to compete on this benefit. And after the Supreme Court upheld the Affordable Care Act last week, they won't have to. This is one of the great breakthroughs of health reform: By 2014, everyone gets access to health insurance, whether employers are on board or not -- and whether they're sick or healthy (Michael Schnurman, 7/8).

Boston Globe: Obamacare: A Windfall For Massachusetts
Even though the state already has near-universal health coverage, Obamacare -- if all goes well -- will reduce the financial pressure on Massachusetts and give the state some room to make its economy more competitive. The challenge to Beacon Hill is to use this opportunity wisely (Josh Barro, 7/9).

Baltimore Sun: Obamacare: Constitutional But Contemptible
The majority opinion was a win/win for the president; his mandate to purchase health insurance survives. If the costs borne by those now forced to buy insurance are construed as a tax (as I and many others believe they should be), they join with the other 18 (mostly) progressive Obamacare taxes to form the largest tax increase in American history. Lost among most of the analysis was another surprising result: Obamacare's attempt to cover more people under Medicaid was significantly limited; those states that refuse to extend coverage to new beneficiaries will no longer face the prospect of losing their existing federal payments. A small victory for the taxpayers on an otherwise bad day (Robert L. Erlich, Jr., 7/8).

MinnPost:  Why Americans Want To Spend More On Health Care
Last week, the Supreme Court upheld the Affordable Care Act (ACA). Now, the battle moves from the courts to electoral politics, with arguments about whether or not the ACA will reduce health care costs compared to what they would have been without it, or whether repealing the ACA and substituting alternatives such as health care vouchers would encourage increased efficiency and lower costs.  However, such debates are fundamentally flawed. The economic fact is that the amount we spend on health care as a percentage of national income will continue to rise over the next 50 years (Louis D. Johnston, 7/6).

Houston Chronicle: Care Act Will Benefit Children
The U.S. Supreme Court's decision to uphold the Affordable Care Act (ACA) marks a giant step forward for millions of Texas children and families who can now get the health care coverage they need. Because of our state's highest-in-the-nation rates of uninsured, Texas stands to benefit from this decision more than any other state. … Now that the law's legality has been affirmed, our state leaders must get to work on implementing the law effectively for all Texans (Anne Dunkelberg; Eileen Garcia; and Laura Guerra-Cardus, 7/6).

The Seattle Times: Medical Reform, Act II -- How Best To Deliver Care
We should feel great urgency to move forward with our now firmly constitutional health care, while recognizing it is only one piece of a much larger solution still in the making. This solution, which we must shape locally, needs to accomplish three goals. … First is to increase access to health care -- to expand coverage to nearly 200,000 King County residents through the individual mandate and Medicaid-expansion provisions of the act. … Second is to implement payment reform to curtail spending. … And third is to increase our investment in community programs that create health (David Fleming, 7/7).

The Seattle Times: Update From Health Insurer Only Good News, In His View
According to a Rasmussen Reports poll done after the Supreme Court's ruling, 52 percent of Americans still want the entire law repealed, but it's difficult to see which of the above amendments cause such ire. Greater support of preventive care? Increased allowance for essential benefits? Surely not the coverage of pre-existing conditions in children, which UnitedHealth pledged to revoke if the court allowed. I'm grateful that provision stands. As the father of a toddler with type 1 diabetes, I struggle to pay out-of-pocket for preventive care, but for years, I couldn't opt for a better plan -- surely, the best benefit of a free-market system -- without a lapse in coverage  (Dan Newman, 7/6).

Minneapolis Star Tribune: Medicaid Expansion: Good For Minnesota
Many of those newly eligible for Medicaid are already eligible for or are receiving MinnesotaCare, a program that costs state taxpayers more money and offers fewer benefits than Medicaid. The bottom line: Expanding Medicaid is a greater value for Minnesotans at a lower cost to the state, a deal few could pass up (Tony Lourey, 7/8).

Minneapolis Star Tribune: GOP's Unfinished Health Care Work
Now that the U.S. Supreme Court has mostly upheld the Affordable Care Act, it's time for Minnesota's Republican legislative majority to take care of some important unfinished business: passing enabling legislation and working with Gov. Mark Dayton's administration to make the state's online "health exchange" marketplace a reality. … Exchanges will likely be part of the health care landscape no matter which party dominates next fall (7/7).

Detroit Free Press: All Eyes On What Happens Next With Health Care
The U.S. Supreme Court ruling on health care reform does not make adequate health insurance a fait accompli. Serious work remains, particularly at the state level. There are steps at the federal level, too, that could improve the new system even before it gets fully under way, regardless of who holds sway in Washington next year. The most crucial initial decisions will be made in state capitals, and at least some of them need to be made quickly. For Michiganders, that means urging state lawmakers and the governor to take full advantage of the provisions of the Affordable Care Act (7/8).

Kansas City Star: The Sick, Like Me, Should Speak Up
As long as this legislation stands, I do not have to face rejection for health insurance when my COBRA coverage runs out. If it is repealed, my options will be to accept public assistance (something I’ve resisted despite being irrefutably qualified for disability insurance), deplete my parents’ security, or move to one of the nearly 50 countries with universal health coverage. Many people can’t wrap their minds around the fact that lots of conditions do not have cures and that diagnostic criteria and treatment guidelines change regularly as more is learned about the body and that which thwarts it. Few understand the feeling of futility and isolation when one is on a quest for an answer or remedy that doesn’t yet exist (Brooke Tourtellot, 7/6).

Miami Herald: On Affordable Care Act, Gov. Scott Should Get To Work
Since early 2010, when Congress passed health care reform, Florida Republican leaders have been obsessed with its overthrow. Defeating it was the priority of Gov. Rick Scott. Our last two attorneys general have led the charge in the courts. And the state Legislature did all it could to thwart its implementation. So now that the most conservative Supreme Court in our nation's recent history has ruled that the Affordable Care Act is constitutional, perhaps it is time to redirect a little of that negative energy used to obstruct reform toward implementing the law and solving Florida’s healthcare crisis (Dan Gelber, 7/8).

Richmond Times-Dispatch: Reform Is Dependent On An Adequate Work Force
Health care is a service industry and labor represents approximately 65 percent of its costs. Without a sufficient work force, transformation of health care will be unattainable. And yet, health care may be the only industry in America where one business is expected to train the work force for its competitors. Academic health centers like the VCU Health System educate and train the preponderance of health professionals for the nation, while still competing in the marketplace (Dr. Sheldon M. Retchin, 7/8).

Chicago Sun-Times: You Can Cover Long-Term Care With 'Combo' Products
The long-term care insurance industry seems to be throwing in the towel -- deciding it can't afford to give you extensive insurance coverage at a price you can afford. That's a shame because the scariest part of retirement planning is not the possibility of a stock market crash, or even outliving your money. You can adjust your investments and withdrawals for those possibilities. The truly scariest part of retirement is the need for long-term, non-skilled health care -- a cost that can easily wipe out all your retirement savings in a few years (Terry Savage, 7/8).

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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.