Daily Health Policy Report

Friday, August 3, 2012

Last updated: Fri, Aug 3

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Administration News

Health Care Marketplace

Campaign 2012

Public Health & Education

Health Information Technology

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Nursing Schools Struggling To Find Professors

Virginia Public Radio's Sandy Hausman, working in partnership with Kaiser Health News and NPR, writes: "There have been lots of parties this year at the University of Virginia School of Nursing, but Dean Dorrie Fontaine is in no mood to celebrate. So far, eleven professors have retired, a full 25 percent of the whole faculty. The health law is predicted to boost demand for nurses to take care of the newly-insured, especially in primary care. 'I need faculty to teach the practitioners that are going to take care of these uninsured,' she says" (Hausman, 8/3). Read the story.

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Baltimore Center Brings Hope To Homeless Struggling With Mental Illness

According to this Kaiser Health News story, written by Philip Merrill College of Journalism students Matt Birchenough, Alissa Gulin and Kandyce Jackson: "Catering to mentally ill homeless individuals and staffed by workers who have struggled with the same problems, the HOPE Wellness and Recovery Center is providing a critical safety net in Baltimore" (Birchenough, Gulin and Jackson, 8/2). Read the story.

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Capsules: Vermont Wields New Power Over Hospital Budgets; Economists Say Market Approaches Will Curb Costs Best

Now on Kaiser Health News' blog, Vermont Public Radio's Bob Kinzel, working in partnership with Kaiser Health News and NPR, reports on developments related to Vermont hospitals: "Vermont's Green Mountain Care Board, established by state law in May 2011 and given new powers last spring, is taking over responsibility for virtually every aspect of health care in the state. This month's project for the new regulatory board: How much hospital budgets should go up on an annual basis" (Kinzel, 8/2). Read the story.

Also on the blog, Sarah Barr reports on a paper published in the New England Journal of Medicine: "A market-based effort to control health care spending would provide Medicare beneficiaries with fixed subsidies, rather than the current system's open-ended ones, a trio of conservative health economists said Wednesday" (Barr, 8/2). Check out what else is on the blog.

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Political Cartoon: 'Doctor's Orders'

Kaiser Health News provides a fresh take on health policy developments with "Doctor's Orders" by Ann Telnaes.

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

PUNDITS, POLLSTERS, POLITICOS PONDER

Will your Medicare
affect November vote? Too
many ways to ask...
-Anonymous

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

IRS Faces GOP Criticism On Health Care Tax Credits

During a Capitol Hill hearing Thursday, House Republican lawmakers grilled the director of the Internal Revenue Service on his agency's ruling allowing qualified individuals to get tax credits to buy health insurance in federal health insurance exchanges.

The Associated Press: Republicans Grill IRS Commissioner On Health Care
House Republicans on Thursday grilled the head of the Internal Revenue Service on the agency's decision to apply the health care law's tax credits in states that decide not to carry out a key provision of the statute. Commissioner Douglas Shulman defended the IRS rule that applies the tax credits to federal insurance exchanges, which are the bodies that will be developed to allow those without health insurance to buy it. He testified at a House hearing (Margasak, 8/2).

The Hill's Healthwatch: IRS Defends Against GOP Charges Of 'Illegal' Healthcare Tax Credits
Republicans and conservative policy experts say the IRS has gone too far in implementing the Affordable Care Act, specifically its subsidies to help people buy private insurance (Baker, 8/2).

CQ HealthBeat: Hearing Highlights Dispute Over Subsidies For Federal Health Insurance Exchanges
House Republicans expressed support for the argument that the health care overhaul does not authorize subsidies for individuals in exchanges set up by the federal government at a Thursday hearing that featured dueling witnesses on the issue. The controversy centers on an Internal Revenue Service rule finalized in May that allows the federal government to provide subsidies to help eligible individuals buy health insurance through state and federal exchanges created under the law beginning in 2014 (Attias, 8/2).

Politico Pro: IRS Chief Defends Federal Exchange Ruling
Opponents of the health law argue that the statute specifically provides tax credits to purchase insurance only through exchanges established by the states. A recent 70-page paper released by Case Western Reserve University’s Jonathan Adler and the Cato Institute’s Michael Cannon argued that it wasn’t a drafting error, but an intentional decision by Congress to incentivize states to build their own exchanges. Cannon, who testified at the hearing, and Adler contend that the IRS is flying in the face of congressional intent by issuing a rule allowing federal-run exchanges to issue tax credits the same as state-run exchanges. "It's quite literally taxation without representation," Cannon told the committee (Millman, 8/2).

In other news from the Hill -

The Associated Press: Gov't Report: Tax Cheats Getting Paid By Medicaid
Thousands of Medicaid health care service providers still got paid by the government even though they owed hundreds of millions of dollars in federal taxes, congressional investigators say. A legal technicality is making it harder for the IRS to collect. In a report being released Thursday, the Government Accountability Office says Medicaid payments to doctors, hospitals and other providers aren't technically considered federal funds, since they're funneled through state health care programs (Alonso-Zaldivar, 8/2).

CQ HealthBeat: Senators Want To Halt Medicaid Reimbursements To Providers Who Owe Taxes
Senators called for additional steps to stop health providers from collecting Medicaid reimbursements while they owe federal taxes, citing a report that found that providers who owed $791 million in taxes received $6.6 billion in Medicaid payments. Currently, health care providers who owe federal taxes are not prohibited from participating in the Medicaid program. Five senators requested a report from the Government Accountability Office (GAO) as part of efforts to track funds from the 2009 economic stimulus measure, which boosted the federal share of Medicaid funding (Ethridge, 8/2).

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Bipartisan Group Of House Lawmakers To Push Lame-Duck Passage Of 'Simpson-Bowles' Debt Plan

A bipartisan group of lawmakers will make a lame-duck push at passing a previously released deficit reduction plan.

Politico Pro: House Group To Push 'Simpson-Bowles Plus'
Retiring Rep. Steve LaTourette (R-Ohio) said Thursday that a bipartisan House group will try to launch a lame-duck effort to reform Medicare, part of what he called a "big deal" to reduce the federal deficit by trillions of dollars. At a press conference outside the Capitol, LaTourette -- joined by Reps. Charlie Bass (R-N.H.), Robert Dold (R-Ill.) and Daniel Lipinksi (D-Ill.) -- said that on Nov. 7, the day after the election, a bipartisan group would file "Simpson-Bowles Plus," modeled on the debt reduction plan proposed by President Barack Obama’s fiscal commission (Cheney, 8/2).

In the meantime, Wal-Mart is backing a plan released recently by nearly two dozen Democrats - including former Obama and Clinton administration officials - to control health care spending --

Reuters: Wal-Mart Backs Democratic Plan To Cut Health Care Costs
Wal-Mart Stores Inc, the largest private employer, endorsed a new Democratic proposal for controlling health care spending that would seek to keep the rising cost of medical services in line with wage growth. The giant retailer said on Thursday that the plan co-authored by former Obama and Clinton administration officials contained "innovative methods" that could help slow health care spending and improve the quality of health care delivery (Morgan, 8/2).

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Another Senate Vote To Repeal The Health Law? Harry Reid Says No.

Roll Call: Harry Reid Rejects Another Health Care Vote
Senate Majority Leader Harry Reid (D-Nev.) this evening rejected a plan offered by Senate Minority Leader Mitch McConnell (R-Ky.) to set up a vote on repealing the 2010 health care law before the end of September. "Our Republican friends are hopelessly stuck in the past," Reid said before objecting to a GOP unanimous consent request. "They continue to want to fight battles that are already over." Reid noted that the Supreme Court deemed the law constitutional last month, after it was challenged by several Republican attorneys general (Sanchez, 8/2).

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Administration News

Obama Administration Promises New Money To Help Vets Become PAs

The Obama administration has announced $2.3 million in grants to help veterans become physician assistants -- helping ease their transition back into civilian life.

The Hill: HHS Grants To Help Veterans Become Physician Assistants
The federal Health department will devote $2.3 million to helping train new physician assistants, focusing on veterans who want civilian jobs in health care. "If you can save a life on the battlefield in Afghanistan, you can save a life here at home," said Health and Human Services Secretary (HHS) Kathleen Sebelius in a statement. "These grants will help ensure veterans who served our country can use their military medical training and get good jobs serving patients" (Viebeck, 8/2).

CQ HealthBeat: Primary Care Training Grants Key On Vets
Twelve colleges and universities will share in $2.3 million in Health and Human Services grants to train primary care physician assistants, with a particular emphasis on helping veterans use their medical training in the service to help them transition to civilian life. That theme has come up in various ways this year, including at a recent House hearing where a bipartisan team of lawmakers said they want to pursue legislation to make it easier for military medics to get licensed as civilian emergency medical technicians (8/2).

In other news related to the health care workforce --

Kaiser Health News: Nursing Schools Struggling To Find Professors
There have been lots of parties this year at the University of Virginia School of Nursing, but Dean Dorrie Fontaine is in no mood to celebrate. So far, eleven professors have retired, a full 25 percent of the whole faculty. The health law is predicted to boost demand for nurses to take care of the newly-insured, especially in primary care. 'I need faculty to teach the practitioners that are going to take care of these uninsured,' she says" (Hausman, 8/3).

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Health Care Marketplace

Generic Drugs Saved U.S. $1T Over 10 Years, Industry Study Finds

Generic drug makers released a study Thursday that found generic pharmaceuticals have saved the U.S. -- through private prescriptions as well as Medicare and Medicaid -- more than $1 trillion over 10 years.

The Hill's Healthwatch: Study: Generic Drugs have Saved U.S. $1 Trillion
Generic drugs have saved the health care system more than $1 trillion over the last decade, according to research released Thursday by the generics industry. The industry is pushing for expanded use of generics in Medicare and Medicaid, and the new research suggests that generics have helped control the government's spending on prescription drugs (Baker, 8/2).

CQ HealthBeat: Generic-Drug Study Touted In Effort To Reduce Health Care Costs
Generic drugs saved consumers more than $1 trillion over 10 years and offer a prime area in which to find savings in health care, the generic drug industry and Democrats said Thursday. A study by the IMS Institute for Healthcare Informatics, a market research company, showed that savings from generic drugs amounted to $1.07 trillion between 2002 and 2011, including $193 billion in 2011 alone (Ethridge, 8/2).

Medpage Today: Industry: Generics Saved $193 Billion
The General Pharmaceutical Association (GPhA) is spotlighting the savings in an effort to encourage policymakers to protect and spur use of their products through an upcoming critical budgetary debate. "As government leaders in Washington and across the country look for ways to cut health care costs, this new analysis details the remarkable savings achieved through the use of generic medications," states the fourth annual Generic Drug Savings analysis (Pittman, 8/2).

The Associated Press: Report: Generic Drugs Saved $193 Billion In 2011
The fourth annual report, produced for the Generic Pharmaceutical Association, found use of generic prescription drugs in the U.S. saved about $193 billion last year alone. That amount was up 22 percent from the $158 billion in savings from generics in 2010, and was more than three times the $60 billion in savings in 2002, the report states (Johnson, 8/2).

In other news related to drug costs --

Reuters: Cash Rewards Keep People On Their Medications
Weekly rewards of as little as $5 could keep people on track with their medications, says a new study. … For the new study, Dr. Nancy Petry and her team at the University of Connecticut looked at 21 studies that offered incentives to people taking medication for tuberculosis, substance abuse, HIV, hepatitis, schizophrenia and stroke prevention (Sheriff, 8/2).

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Self-Insurance For Small Businesses Goes Under The Microscope

Politco Pro describes the growing focus on this part of the insurance marketplace as a "sleeper battle to watch." Meanwhile, Reuters reports that a growing number of people are signing up for supplemental insurance coverage.  

Politico Pro: Focus On Self-Insurance For Small Businesses
In a summer dominated by health care fights, self-insurance is emerging as a sleeper battle to watch. Amid signs that more small businesses may self insure — which could effectively let them avoid complying with aspects of national health reform — the nation's insurance commissioners are wrestling with new guidelines for stop-loss insurance that would mean small businesses would have to bear more of the self-insurance risk. California's crusading insurance chief is leading a high-profile effort to significantly raise the bar for self-insuring in his state while the Obama administration examines federal limits on self-insurance (Millman, 8/2).

Reuters: Supplementary Insurance Fills New Gaps
A convergence of trends in insurance costs is driving up the number of people who are signing up for supplemental insurance - overall sales rose 11 percent between 2011 and 2012, with critical illness sales jumping by 23 percent and accident plans by 21 percent, according to industry analyst, LIMRA. One big reason for that increase? The 13.5 million-plus people now enrolled in a high-deductible health plan paired with a health savings account (HSA) (Zamosky, 8/2).

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Outsourcing Trend Emerging In Health Care Industry

California Healthline: Outsourcing May Grow As Health System Evolves
Outsourcing, an established but fairly static practice in the U.S. health care industry, may grow in scope as the country experiences major shifts in health care delivery. The health care industry is no stranger to outsourcing. Administrative work -- billing, collections, enrollment, eligibility -- as well as clinical work -- radiology, laboratory tests, physical therapy -- are often done by contractors outside the health system providing coverage and care. In some systems, insurers and hospitals routinely outsource specific kinds of specialized care, such as intensive pediatric care, neurosurgery and burn care. With pressure mounting from several directions, health care systems may be looking outside more often and with a wider lens, according to some experts (Lauer, 8/2).

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Campaign 2012

Obama Pushes Record On Women's Issues

President Barack Obama's talking points on the campaign trail highlight his positions on women's health issues including his support for Planned Parenthood.

Politico: Obama: Women Make Up 80 Percent Of My Household
President Obama touted his record on women's issues and stressed the women in his personal story as he addressed a major gathering of women bloggers on Thursday. "Women's issues are front and center as they should be. But the conversation has been oversimplified a bit," he told the BlogHer conference in New York, speaking live via video from Orlando, Fla. "Women are not a monolithic bloc, not an interest group.” … Though he listed the Lilly Ledbetter Fair Pay Act, education reform and his support for Planned Parenthood -- among other issues -- as accomplishments, much of his speech focused on his own relationships with women (Epstein, 8/2).

The Hill: Planned Parenthood Officials Greet Obama In Orlando
Officials with Planned Parenthood welcomed President Obama in Orlando Thursday as he visited for a campaign event, underscoring the group's support for his reelection. The two women, Jenna Cawley Tosh and Nancy Wolf, were part of a group that greeted Obama on the tarmac as he stepped off Air Force One. Obama "spent time talking with each" before moving on to work a rope line, according to a White House pool report. Tosh and Wolf are President/CEO and Board Chairwoman of Planned Parenthood of Greater Orlando, respectively (Viebeck, 8/2).

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Public Health & Education

Komen Ads Overstate Benefits Of Mammograms, Professors Charge

Two Dartmouth health policy experts criticize the national breast cancer charity for using misleading statistics to promote breast cancer screening.

Medpage Today: BMJ OpEd Says Komen Ads False
The world's largest breast cancer charity used misleading statistics and deceptive statements about mammography to promote breast cancer awareness and screening, authors of an opinion piece asserted. In promotional material for the 2011 Breast Cancer Awareness Month, Susan G. Komen for the Cure suggested large differences in breast cancer survival among women who undergo screening mammography and those who do not. Specifically, the advertisement stated a 5-year survival of 98% when breast cancer is caught early and 23% when it is not. … "This benefit of mammography looks so big that it is hard to imagine why anyone would forgo screening. She'd have to be crazy," Steven Woloshin, MD, and Lisa M. Schwartz, MD, of the Department of Veterans Affairs Medical Center in White River Junction, Vt. and the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H., wrote in an article published online in BMJ (Bankhead, 8/2).

CNN: Professors: Komen Overstating Benefits Of Mammograms
A national breast cancer charity is being accused of using misleading statistics to convince women to have mammograms, according to a paper published Thursday in the British Medical Journal. Susan G. Komen for the Cure's mammography campaign during breast cancer awareness month last October has come under fire from professors Steven Woloshin and Lisa Schwartz at the Dartmouth Institute for Health Policy and Clinical Practice, who say the foundation overstated the benefits of the procedure and totally ignored the risks. "The ad implies that mammograms have a huge effect, but the only evidence that they use is the five-year survival rate for breast cancer when caught early is 98% and when it's not, 23%," Woloshin said. "The problem is that in the context of screening survival, statistics are meaningless" (Young, 8/3).

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Health Information Technology

Power Outage Points Out How Technology Can Undermine Patient Care

Los Angeles Times: Patient Data Outage Exposes Risks Of Electronic Medical Records
Dozens of hospitals across the country lost access to crucial electronic medical records for about five hours during a major computer outage last week, raising fresh concerns about whether poorly designed technology can compromise patient care. Cerner Corp., a leading supplier of electronic health records to hospitals and doctors, said "human error" caused the outage July 23 that it said affected an unspecified number of hospitals that rely on the Kansas City, Mo., company to remotely store their medical information (Terhune, 8/3).

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State Watch

Ariz. Delays Medicaid Expansion Decision, States Make Other Health Law Implementation News

Arizona Gov. Jan Brewer won't say until January if her state will expand Medicaid. In the meantime, advocates worry about whether health care for kids in Texas could be cut.

The Associated Press/Arizona Republic: Brewer Decision On Medicaid Expected In January
Gov. Jan Brewer apparently won't say until January whether Arizona should expand the state's Medicaid program under the federal health care overhaul. That's the word from Brewer administration officials who briefed reporters on Thursday about funding and policy considerations being weighed by the governor, her staff and agency officials (8/2).

Texas Tribune: Video: Texans Worry About CHIP Amid Health Care Overhaul
The Affordable Care Act requires states to maintain eligibility requirements for Medicaid and the Children's Health Insurance Program through 2019. But Gov. Rick Perry and the Republican Governors Association oppose the provision, and some families in Texas fear children's health care could be in jeopardy (Barnes, 8/2).

State implementation of exchanges, ones both to buy insurance and to store patient information, are also making news --

Georgia Health News: Mississippi Gets A Jump On Creating Exchanges
"Thank God for Mississippi." That phrase, when uttered by public health experts elsewhere in the South, is seldom a compliment. When contemplating the poor health statistics in their own states, they've been known to take some comfort that the Magnolia State fared worse. But when it comes to the issue of building a health insurance exchange, those comparisons are turned on their head. While other Southern, Republican-dominated states such as Georgia have put the idea of a health insurance exchange on hold -- or have dismissed it entirely, due to its connection to the Affordable Care Act (ACA) -- Mississippi has forged ahead in creating its own such online marketplace in 2014 (Miller, 8/2).

WBUR: State Wins $17M To Build New Health Care Portal A La Online Banking
WBUR's Martha Bebinger reports that Massachusetts has secured $17 million to begin building the country’s first health care portal that will work much like online banking. The new Health Information Exchange is a program through which doctors, hospitals and labs can log in from any location to share notes, converse and post patient records. Health and Human Services Secretary JudyAnn Bigby says connecting a patients providers will save money and improve care (Zimmerman and Bebinger, 8/3).

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Summer Camp Pairs 'Smores And Anti-Abortion Activism

State news on abortion focuses on a summer camp that trains anti-abortion activists and charges against a Kansas City Planned Parenthood that is accused of performing illegal late-term abortions.

Texas Tribune: Summer Camp Focuses On Fight Against Abortion
In its third year, Reveal summer camp is organized by Texas Right to Life, a statewide anti-abortion advocacy organization based in Houston. For $240, high school students can attend a two-week overnight camp that along with the plentiful icebreakers and 'smores, teaches them how to become activists. So far, a spokeswoman said, the only reason the organization turned down a student is because of age, and typically a spot is offered to every student who applies (Smith, 8/3).

The Associated Press: 26 Charges Against Kan. Abortion Clinic Dismissed
A Kansas judge on Thursday dismissed 26 misdemeanor charges against a Kansas City-area Planned Parenthood clinic, honoring a prosecutor's request to further narrow a criminal case over allegations the clinic performed illegal late-term abortions. Johnson County District Attorney Steve Howe confirmed Thursday night that District Judge Stephen Tatum signed an order late in the afternoon at Howe's request (Hanna, 8/3).

Meanwhile -

Politico Pro: U.S. Company Overreaches On Contraception
The federal government says that the Colorado HVAC company granted a temporary reprieve as it fights the Obama administration's contraceptives policy is now overreaching in its request for further action from the court. After U.S. District Judge John L. Kane awarded the three month temporary injunction, he said the case would move forward quickly. His ruling focused on the company's argument that the policy violates employers' religious freedom, and that's what the DOJ said should be the central issue. But the company that brought the suit has made several other arguments (Haberkorn, 8/2).

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State Highlights: Report: Mass. Medicaid Managed Care Doesn't Reduce Fees

A selection of health policy stories from Massachusetts, California, Colorado, Maryland, Vermont, Georgia, Minnesota and Oregon.

Boston Globe: Medicaid Managed Care Program Doesn't Reduce Fees, Report Says
Insurers that contract with the state to manage the care of low-income Medicaid patients are expected to save money, in part by negotiating lower prices with health providers. But a new report by the state inspector general found that the plans pay higher fees to many hospitals and doctors than the traditional Medicaid program pays for the same services. In the 2011 fiscal year, the higher payments cost taxpayers $328 million, the ­report said (Conaboy, 8/3).

California Healthline: State Delays Not-For-Profit Requirement For Adult Day Centers
The Department of Health Care Services extended the not-for-profit deadline for potential providers of the Community Based Adult Services program. Organizations providing adult day health care services now have until Jan. 1, 2013 to become not-for-profit, a new stipulation by the state to be eligible to receive Medi-Cal funding. The previous deadline was July 1, 2012. The six-month delay in establishing not-for-profit status was done, in part, because the state will need a substantial number of former Adult Day Health Care providers to become CBAS providers. The department has granted eligibility to approximately 80% of former ADHC beneficiaries -- roughly 28,000 frail and elderly Californians (Gorn, 8/3).

USA Today: Colorado Theater Shooting Victims Face Bills With Wounds
Like many victims, Moser, whose daughter was killed in the shooting and who suffered a miscarriage from her injuries, will face mental and physical trauma that will lead to a lifetime of medical costs. Her family and others will have to sort through dozens of victim funds and find their way through a maze of medical bills (Alcindor and Welch, 8/2).

Kaiser Health News: Baltimore Center Brings Hope To Homeless Struggling With Mental Illness
Catering to mentally ill homeless individuals and staffed by workers who have struggled with the same problems, the HOPE Wellness and Recovery Center is providing a critical safety net in Baltimore (Birchenough, Gulin and Jackson, 8/2).

Kaiser Health News: Capsules: Vermont Wields New Power Over Hospital Budgets
Vermont's Green Mountain Care Board, established by state law in May 2011 and given new powers last spring, is taking over responsibility for virtually every aspect of health care in the state. This month's project for the new regulatory board: How much hospital budgets should go up on an annual basis (Kinzel, 8/2).

The Atlanta Journal-Constitution: More Budget Cuts Ahead For State Universities
Gov. Nathan Deal is making it clear that the era of state budget cutting isn't over, asking state agencies to find another $553 million in reductions through June 2014. About half of that would come from higher education and from public health -- $108 million from the University System of Georgia and $170 million from the Department Community Health, which handles Medicaid and PeachCare -- while most k-12 school funding is exempt. Agencies are still weighing their responses to the order, issued last week, but some will consider layoffs (Salzer, 8/2).

(St. Paul) Pioneer Press: Mayo Clinic Pays $1.26 M To Settle Federal Lawsuit
The Mayo Clinic and three related entities have agreed to a $1.26 million settlement of a federal whistleblower lawsuit, according to the U.S. Attorney's Office in Minnesota. Originally filed in 2007, the lawsuit claimed that the Rochester, Minn.-based clinic submitted false claims for payment to the government for pathology services that Mayo did not provide, according to a news release Thursday, August 2 from the U.S. Attorney's Office. … Karl Oestreich, a spokesman for the clinic, said Mayo corrected the error before it knew of the Justice Department's lawsuit and voluntarily refunded $262,975 to the government. Mayo Clinic then agreed to settle with the Justice Department for an additional $1 million "because we believe the prolonged legal process would have been more costly than the settlement itself," Oestreich said in a statement (Snowbeck, 8/2).

The Oregonian: Doctors, Lawyers Join At Oregon Medical Liability Reform Meeting
The Aug. 2 meeting was the first of three by a state advisory group Gov. John Kitzhaber has asked to present a recommendation to the 2013 Legislature. Kitzhaber outlined a potential compromise last month requiring earlier notification of injuries and the potential for a confidential apology as well as pretrial mediation before a lawsuit may proceed. The proposal calls for better sharing of medical error information as well. Key leaders of Oregon Medical Association as well as Richard Lane, a frequent representative of the Oregon Trial Lawyers Association, presented the Kitzhaber-backed proposal jointly at the meeting, held in Portland. OMA generally supports the effort; a trial lawyer spokeswoman said her organization is withholding judgment until details are worked out (Budnick, 8/2).

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Health Policy Research

Research Roundup: Mass. Health Reform; Race, Insurance And Kidney Transplants

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

Journal of General Internal Medicine: Access to Care After Massachusetts’ Health Care Reform: A Safety Net Hospital Patient Survey -- Policy analysts have long said that Massachusetts and its 2006 health reform law provide great insight into the federal health law and how its expansion of insurance coverage will play out. In this study, 431 patients at a Massachusetts safety net hospital were interviewed about their access to health care since the state's coverage expansion. Researchers found that publicly and privately insured patients now had similar access to a usual source of care; they also utilized health care services at a similar rate. Publicly insured patients were significantly more likely, however, to report delaying or not seeing a specialist, or not getting a medication or test, because of cost sharing under their health plan. The authors write that policymakers at the state and federal level "should carefully evaluate the impact of various levels of cost sharing on access to care, and should design and offer forms of insurance that will not discourage the receipt of useful health care services" (McCormick et al, 7/25).

Medicare & Medicaid Research Review: Financial Performance of Health Plans in Medicaid Managed Care -- An increasing number of states are moving toward Medicaid managed care as a way to handle the financial burden of the Medicaid program. This study compares the financial health of 170 Medicaid managed care plans and finds that companies focused on Medicaid, rather than Medicare or a commercial plan, spent significantly less on medical care and had higher operating profit margins. The author writes that plans not specializing in Medicaid are often losing money from the venture, partly because these plans "may not have invested in the medical management programs to reduce inappropriate emergency room use and avoid costly hospitalization" (McCue, 7/26).

Journal of General Internal Medicine: "Did I Do as Best as the System Would Let Me?" Healthcare Professional Views on Hospital to Home Care Transitions -- For providers, better coordinating the transition from hospital to home is important for reducing readmissions and improving the quality of care. In this study, researchers conducted focus groups and interviews with several health care providers involved in those transitions: physicians, nurses, case managers and others. Many pointed to poor communication between each type of provider, as well as a lack of standardization, as causes of poor transitional care. The authors recommend that hospitals establish better protocols for discharge and require further training for all providers involved in care transitions (Davis et al, 7/25).

Clinical Journal of the American Society of Nephrology: Association of Race and Insurance Type with Delayed Assessment for Kidney Transplantation among Patients Initiating Dialysis in the United States -- Previous research has shown that black patients are less likely than white patients to receive kidney transplantations. This study looks at both race and insurance status to determine how those factors might affect whether or not a patient has received an assessment for transplantation -- one of many steps in the process. Researchers used a national database of more than 420,000 patients with kidney disease and found that black patients were 5 percent more likely to report not having been assessed, while patients on Medicaid were 33 percent more likely. This insurance disparity was even more pronounced among younger patients, who might have the most to gain from a transplant, the authors note. They recommend changes to the transplant system, including making the start of dialysis, rather than formal assessment and admission, the patient's start time on the transplant wait list (Johansen, 7/27).

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

Reuters: Price Of Life-Saving Allergy Injections Has Spiked
The cost of self-administered epinephrine injections, which are used to stop life-threatening allergic reactions, has more than doubled over the past 25 years, according to a new analysis. The researchers found that the average cost - adjusted for inflation - of one injection increased from about $36 in 1986 to about $88 in 2011. The analysis, however, cannot say why the cost is going up (Seaman, 7/31).

Reuters: More U.S. Women Choosing IUDs For Birth Control: Study
A growing number of U.S. women appear to be opting for intrauterine devices (IUDs) as their birth control method, with the number more than doubling in just two years in one study. Researchers, whose findings were published in the journal Fertility & Sterility, said this is good news, since IUDs and contraceptive implants are the most effective forms of reversible birth control. But in the United States they are still far from popular, with use lagging well behind birth control pills and condoms (8/2).

Reuters: Black Arthritis Patients Get Fewer Potent Drugs
Black people with rheumatoid arthritis are less likely than whites to be on powerful drugs that ward off further joint damage and disability, according to a new study from California. … Dr. Kenneth Saag, an immunologist from the University of Alabama at Birmingham, called the findings "unsettling." He said black people with rheumatoid arthritis may know fewer members of their community who are on biologic DMARDs, and so aren't as comfortable trying them. Or, doctors could have misconceptions about arthritis not being as severe in certain types of patients (Pittman, 8/2).

Reuters: Program Cuts Medically Unnecessary Scheduled Births
A quality improvement program can cut by 60 percent the number of deliveries scheduled a few weeks before the due date, according to a new study. "To me this (study) is a success story on how to do it," said Dr. Kenneth Leveno, the chair in obstetrics and gynecology at UT Southwestern Medical Center, who was not involved in the research (Grens, 8/2).

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Editorials and Opinions

Viewpoints: Romney's 'Repeal And Replace' Pledge; 'Socialized Medicine' In The U.S.; Pros And Cons Of Expanding Medicaid

The Washington Post: Romney Still Peddling Phony 'Repeal And Replace'
Greg Sargent already took a crack at Mitt Romney’s new “Plan for a Stronger Middle Class,” but one thing that he didn’t get to shouldn't be ignored: Romney is apparently still campaigning on a “repeal and replace” plan on health care reform (Jonathan Bernstein, 8/2).

The New York Times Economix blog: Where ‘Socialized Medicine’ Has A U.S. Foothold
Remarkably, Americans of all political stripes have long reserved for our veterans the purest form of socialized medicine, the vast health system operated by the U.S. Department of Veterans Affairs (generally known as the V.A. health system). If socialized medicine is as bad as so many on this side of the Atlantic claim, why have both political parties ruling this land deemed socialized medicine the best health system for military veterans (Uwe E. Reinhardt, 8/3)?

JAMA: The Middle Class Tax Break Hardly Anyone Is Talking About
There has been no shortage of attention focused on the scheduled expiration of tax cuts for middle class and wealthy Americans at the end of this year. That’s likely to continue to be the case through the election and a potential lame duck session of Congress following it. Yet there’s been surprisingly little discussion of the details of the substantial middle class tax break built into the Affordable Care Act (ACA) (Larry Levitt, 8/2).

The Washington Post: HHS Mandate: President Obama’s Broken Promise
First, a major misconception must be cleared up. Specifically, American citizens need to understand that the mandate that became law is the mandate that was originally proposed by the Obama administration. This original version requires employers to provide and pay for contraception, sterilization, and abortion-causing drugs in their health-care plans, regardless of religious objection (Ashley E. McGuire, 8/2).

Los Angeles Times: Republican Plan To Cut Medicaid Is Just Plain Mean
Republican leaders are determined to protect rich people from paying higher taxes. Now they also want to reduce health coverage for the poor. You've really got to wonder about these guys (David Lazarus, 8/2).

Health Policy Solutions (a Colo. news service): The Costs Of Expanding (Or Not Expanding) Medicaid
The cost of the expansions should be measured in three ways: the number of lives saved, the number of lives improved, and the bottom-line cost in dollars and cents.  All of these numbers are very hard to calculate. ... What we can say with more certainty, though, is that insurance coverage both improves and saves lives. We may argue over numbers, but the benefits for people are undeniable (Bob Serno, 8/2).

Houston Chronicle: Texas Is Falling Short In Looking Forward
[Gov. Rick Perry’s] intransigence will deprive Texans of generous, and sorely needed, federal funding over the next decade. Meanwhile, our state lawmakers have targeted some of the most vulnerable Texans whom the [Affordable Care Act] seeks to aid, slashing funding for mental health, women's health services and other programs. ... We still have enormous deficits to make up before we can serve the increased numbers with coverage, but we'd be better equipped to face them if our elected state officials would support, rather than decimate, our existing programs (8/2).

Boston Globe: Closed-Door Dealings Yield Big Bills, But Little Scrutiny
The strengths and weaknesses of Massachusetts’s single-party-dominated Legislature were on display in the closing days of the session, as House and Senate leaders compromised with each other and Governor Deval Patrick to arrive at reasonable legislation to curb health care costs, even as they rejected his sensible efforts to add more judicial flexibility to the “three-strikes” crime bill. … On the other hand, in a more balanced Legislature there would almost certainly have been more time devoted to open debate on policies with major implications for criminal justice, health care, and the economy — and citizens could feel more confident that all angles and consequences had been appropriately explored (8/3).

Boston Globe: It’s Not Perfect, But New Health Law Is A Start
Now what happens? We finally have a new health care cost-control law this week — after 17 numbing months of talking, lobbying, and debating. The fact that the Legislature passed a 350-page compromise bill just 24 hours after it was hatched — a measure that purports to influence one of the most important cylinders in the state’s economic engine for the next 15 years — should make you shudder (Steven Syre, 8/3).

Arizona Republic: Health-Care Lessons From Colorado?
According to published reports, three of the five hospitals treating those wounded in the Colorado theater shooting have pledged to reduce or eliminate the victims' medical bills. Not only that, but millions have been donated to defray the costs. ... It's a little different for people who have the bad luck simply to get sick (E.J. Montini, 8/3).

Minneapolis Star Tribune: Health Exchange Questions Linger
For all of the daunting information technology challenges this project involves, creating buy-in from the consumers and businesses who will purchase coverage through the exchange beginning in 2014 is the most important task of all. ... While department officials deserve credit for setting up advisory groups and holding meetings around the state, important details have yet to be finalized or communicated clearly. It's understandable that with scant months before the November deadline, the chamber and other stakeholders are growing anxious (8/2).

Bloomberg: When A Mammogram Is Riskier Than Cancer
What we know is that screening helps women older than 40, with greater benefit for those over 50. Yet women of all ages should be made aware of mammography’s risks. Doctors who favor screening should not be afraid to discuss its limitations openly and honestly. Patients expect it and will thank us for it (Handel Reynolds, 8/2).

The New York Times: Was This Death Really Unavoidable?
An article in The Times on Sunday recounted in jarring detail the tragic death of a young woman, an aspiring novelist named Sabrina Seelig, at a hospital in Brooklyn five years ago. Ms. Seelig’s family is convinced she was a victim of medical lapses and errors, and troubling details emerged during a malpractice trial this spring. Nevertheless, the trial jury decided that neither the hospital nor an emergency room doctor or nurse had been negligent (8/2).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
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.