Daily Health Policy Report

Thursday, September 29, 2011

Last updated: Thu, Sep 29

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Coverage & Access


Campaign 2012


State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Capsules: Fla. CHIP 'Treading Water'; N.C. Insurer Invests $15 M In Docs' Health IT; HHS Offers New Push For Coordinated Care

Now on Capsules, KHN's news blog, Christian Torres writes about a new federal coordinated care initiative: "If the Department of Health and Human Services has its way, hundreds of physician practices will follow the money and take up a coordinated model of health care. The Comprehensive Primary Care Initiative, announced Wednesday, will increase Medicare payments to primary care providers who adopt a coordinated care model. A four-year demonstration, overseen by the Centers for Medicare and Medicaid Services, begins next year in several health care markets."

Phil Galewitz reports on enrollment in Florida's Children's Health Insurance Program: "Despite the tough economy, Florida’s Children’s Health Insurance Program added just 2,000 children in the year ended June 30, for a growth rate of less than 1 percent. Among school-age kids, the program added just 700 children. Before last year, the Florida CHIP progam was growing by about 8 percent a year. It now has about 275,000 kids enrolled."

Also on the blog, Christopher Weaver, reporting on an announcement by Blue Cross and Blue Shield of North Carolina about their cash infusion to help arm physicians with state-of-the-art electronic medical records, writes: "Blue Cross, the dominant financier of the state's health system with 54 percent of the insured on its rolls, stands to benefit if the electronic records help doctors practice a more efficient style of medicine. For instance, the computer can prompt doctors to do blood tests or other follow-ups with patients." Check out what else is on the blog.

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Building Ambitions: The Big Money World Of Kids' Care

Reporting for Kaiser Health News, in collaboration with McClatchy, Gilbert M. Gaul examines the business of children's hospitals in this three-part series. Check out the series.

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Political Cartoon: 'Alternate Realities'

Kaiser Health News provides a fresh take on health policy developments with "Alternate Realities" by Rob Tornoe.

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Health Reform

Obama Administration Asks High Court To Rule On Health Law

The Justice Department's formal appeal puts to rest speculation about the administration's legal strategy. In addition, Republican state attorneys general separately asked the Supreme Court for a verdict early next year. Many observers say the new timeline will make the court's ultimate finding a factor in the presidential election.

The New York Times: Supreme Court Is Asked To Rule On Health Care
The Obama administration asked the Supreme Court on Wednesday to hear a case concerning the 2010 health care overhaul law. The development, which came unexpectedly fast, makes it all but certain that the court will soon agree to hear one or more cases involving challenges to the law, with arguments by the spring and a decision by June, in time to land in the middle of the 2012 presidential campaign (Liptak, 9/28).

Los Angeles Times: U.S. Seeks Supreme Court Review Of Health Care Law
The Obama administration is asking the Supreme Court to rule on the constitutionality of the federal health care overhaul sooner rather than later, with the Justice Department announcing that it will file a petition Wednesday asking the court to take the case. … Earlier this week, the department declined to seek review of the full appeals court of that decision, signaling that it was ready for the case to be heard by the justices. Technically, the administration had several weeks before it had to file its petition to the high court and the accelerated timetable suggests that it's eager for a final determination on the legality of the controversial law (Oliphant, 9/28).

The Associated Press: Election-Year Ruling Looms For Health Overhaul
The health care law affecting virtually every American is sure to figure prominently in President Barack Obama's campaign for re-election. Republican contenders are already assailing it in virtually every debate and speech. The administration on Wednesday formally appealed a ruling by the federal appeals court in Atlanta that struck down the law's core requirement that Americans buy health insurance or pay a penalty beginning in 2014. The administration said the appeals court decision declaring the law's central provision unconstitutional was "fundamentally flawed" (Sherman, 9/29).

The Wall Street Journal: Health Overhaul Heads To Justices
The administration's move puts an end to months of speculation about its strategy in the case. … While the likely mid-campaign timing of the decision may not be ideal for the White House, any attempt to push the ruling back into 2013 would have been risky, too. Opponents of the law were already calling for a quick Supreme Court ruling, so a slow-walking strategy would have made the administration look less confident — and the Supreme Court might have chosen to take the case quickly anyway (Kendall and Meckler, 9/29).

Los Angeles Times: Fight Over Health Care Law Heads Toward Supreme Court
The constitutional clash over President Obama's national health care law moved closer to the Supreme Court on Wednesday, when both the administration and Republican state attorneys separately asked the justices to hand down a verdict early next year. … Now that both sides have asked the high court to decide the Florida lawsuit, the justices are almost certain to vote to hear the case early next year (Savage, 9/28).

Politico: Obama's Health Reform Law Rests With The Supreme Court
It could be one of the smartest political moves the Obama administration has made — or a historic mistake that could kill not just the health care reform law but the president's chances for reelection, too. By asking the Supreme Court to rule so quickly on the constitutionality of the Affordable Care Act, the administration is taking a huge risk that the justices will rule against the law right in the middle of the 2012 race — either striking down the whole law or just slicing out the requirement for nearly all Americans to buy health coverage (Nather, 9/28).

The Washington Post: Justice Dept. Asks Supreme Court To Review Health Care Law
The administration said it was confident the act would be upheld as a valid exercise of federal power, just as Social Security and the Civil Rights Act were. If the court agrees to hear the case in the term that begins Monday, it would almost certainly render its decision by the end of deliberations in June (Barnes, 9/28).

NPR: Early Supreme Court Review Of Health Care Law Could Impact 2012 Race
The Affordable Care Act always promised to be a hot-button issue in the 2012 presidential campaign. But it could loom even larger, now that the Obama administration has asked the Supreme Court to take the case, making very likely a high-court decision in June only months before Election Day (James, 9/28).

Bloomberg: Obama Lawyers Appeal To U.S. High Court For Ruling On Health Care Overhaul
President Barack Obama’s administration asked the U.S. Supreme Court to review last year's landmark health care law, a move that may lead to a ruling months before the 2012 presidential election. Calling the issue "a matter of grave national importance," administration lawyers today appealed a lower court ruling that declared part of the law unconstitutional. Earlier in the day, 26 states filed their own appeal, saying the lower court should have gone further and voided the whole statute, which was championed by Obama (Stohr, 9/28).

Reuters: Obama's Health Care Law Appealed to Supreme Court
The Obama administration on Wednesday asked the U.S. Supreme Court to back the centerpiece of Barack Obama's sweeping health care overhaul — the requirement that all Americans have health insurance. The appeal was largely expected as a high court ruling against the law could be a fatal blow to the president's signature domestic policy achievement and could have major implications for his re-election bid (Vicini, 9/28).

Modern Healthcare: Justice Department, Critics Appeal Reform Law to Supreme Court
The Justice Department joined 26 state governments, a national employers' rights group and two private citizens in asking the U.S. Supreme Court to rule on the constitutionality of the Patient Protection and Affordable Care Act. A total of three competing writs of certiorari were filed Wednesday with the high court — two from groups that want the health care reform law thrown out, and one from the Justice Department arguing that Congress had the power to pass the sweeping law in March 2010 (Carlson, 9/28).

McClatchy: Obama Asks Supreme Court To Settle Constitutionality Of Health Care Law
The Obama administration on Wednesday formally asked the Supreme Court to review its controversial health care law, a move that's likely to set up a blockbuster election-year decision. Hot on the heels of an appellate court defeat, the Justice Department late Wednesday afternoon filed the 34-page petition urging the court to uphold the law's ambitious mandate that individuals be covered by insurance (Boyle, 9/28).

The Atlanta Journal-Constitution: Georgia, Other States Appeal Health Care Ruling To High Court
Georgia, 25 other states and three other plaintiffs have asked the U.S. Supreme Court to hear a challenge to the national health care overhaul law, state Attorney General Sam Olens said Wednesday. In August, the 11th U.S. Circuit Court of Appeals, in a 2-1 decision, struck down the law's individual mandate provision. But the court also left the rest of the sweeping reform law intact, and that is what the states are appealing to the high court. The Obama administration recently decided not to ask the entire 10-member 11th Circuit to reconsider the three-judge panel's ruling (Rankin, 9/28).

CNN: White House Is Confident Supreme Court Will Uphold Health Care Law
The Obama administration is putting on a confident face when it comes to the debate being waged in federal courts over the health care law. In a blog post explaining why the Justice Department is formally asking the Supreme Court to take up the matter this term, Deputy Senior White House Advisor Stephanie Cutter writes she is confident the high court will overturn a recent federal court’s decision that held the law’s mandate unconstitutional (Mooney, 9/28).

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Analyzing The Health Law's Tax Credits And The CLASS Act's Future

This round-up of health law implementation news also includes a report that the comment period for state health exchanges has been extended and news that Catholic organizations have stepped-up their opposition to the measure's requirement that contraceptive services be covered.

CNN Money: Health Care Tax Credits: Many Left Wanting
The health reform passed last year included tax credits to help ease the burden of surging health care costs for small businesses. But many small firms are ineligible. Four million small businesses would qualify for the credit if they provide health insurance to their employees, estimates the White House Council of Economic Advisors. Of those, only 30 percent — or about 1.2 million businesses — would be eligible for the full tax credit, according to research from the Families USA and the Small Business Majority. Only the smallest companies will qualify for the maximum amount. The tax credit refunds small businesses for a portion of the money they spend on health care premiums. However, the size of the business and the average salary can disqualify a business. Therefore, a lot of small businesses that are struggling with the growing expense of providing their employees with health insurance don't qualify (Clifford, 9/28).

Politico Pro: HHS: Expect CLASS Decisions Mid-October
Amid growing speculation that Congress may repeal the CLASS Act, Assistant Secretary of Aging Kathy Greenlee said HHS will make recommendations after reviewing various legal, policy and actuarial reports. "We are looking at the CLASS program from every angle. We are doing our due diligence," she wrote on the HHS blog. Actuarial experts have been working on various scenarios to structure the program to make it fiscally sound. Many on the Hill, however, regard the voluntary long-term care program as an unworkable fiscal time bomb. It's been a rough month for the CLASS Act. A congressional Republican report slammed the program and said "officials at HHS may have ignored" warnings the program was financially unsustainable. CLASS actuary Bob Yee sent an email to colleagues, that spread like wildfire around health policy circles, that the CLASS office was closing. Finally, the Senate Appropriations Committee cut funds for the planning and implementation of the program in a recently passed spending bill that funds HHS (Nocera and Millman, 9/28).

Modern Healthcare: CMS Extends Comment Period on Exchanges
The CMS has extended the public-comment period deadline for proposed rules on state insurance exchanges to Oct. 31, a month later than the original deadline of today. The agency issued proposed rules on the exchanges in July and then followed with another set in mid-August. This recent announcement means that public comments for both sets of rules are now due in late October (Zigmond, 9/28).

The Wall Street Journal: Catholics Fight Health Rules
Catholic organizations have ramped up opposition to new federal health care requirements to cover contraceptive services, saying the rules may prompt them to drop insurance or shut down. Beginning next August, employers have to provide coverage for contraception and other preventive services for women such as screening for gestational diabetes and domestic-violence counseling under the Patient Protection and Affordable Care Act, part of the federal health care law passed in 2010 (Maher, 9/29).

The Associated Press/(Minneapolis-St. Paul, Minn.) Pioneer Press: ND President Protests Birth Control Inclusion
President Barack Obama's health care overhaul should be changed so that religious schools such as the University of Notre Dame aren't required to go against their beliefs and provide birth control to students and employees, the school president says.  The Rev. John Jenkins wrote a letter Wednesday to Kathleen Sebelius asking the Obama administration to broaden the definition of religious employer currently under consideration to ensure the school can continue its provide health care without going against the teachings of the Roman Catholic Church (Coyne, 9/28).

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Initiative Pays Primary-Care Docs For Coordinating Medicare Patients' Care

The Department of Health and Human Services announced Wednesday a new initiative created by the health law that will ask physicians to focus on patients with chronic conditions. The program will be tested in five to seven markets across the country.

The Hill: Medicare Launches A Primary-Care Initiative
Medicare announced a new initiative Wednesday that will give primary-care doctors extra payments for better coordinating their patients' care. Participating doctors will receive bonus payments averaging $20 per patient per month. After two years, they'll be able to share in the savings the program generates for Medicare. Many studies suggest that more efficient primary care helps lower costs in the long run by emphasizing prevention and cutting down on redundant or unnecessary procedures. The new Medicare initiative will ask doctors to focus on patients with chronic diseases, work closely with patients' families and help coordinate among specialists. Medicare intends to test the voluntary program in five to seven parts of the country (Baker, 9/28).

Modern Healthcare: Care-Coordination Initiative Announced
The CMS will pay primary-care doctors to better coordinate care under a pilot program that would require other public and private insurers to make a similar investment. Primary-care doctors will receive an average of $20 per month for each Medicare fee-for-service enrollee to coordinate care in five to seven communities where most other insurers also agree to take part (Evans, 9/28).

Kaiser Health News: Capsules: HHS Announces Coordinated Care Initiative
The Comprehensive Primary Care Initiative, announced Wednesday, will increase Medicare payments to primary care providers who adopt a coordinated care model. A four-year demonstration, overseen by the Centers for Medicare and Medicaid Services, begins next year in several health care markets. Providers in HHS-supported accountable care organizations, which also promote coordinated care, will not be able to participate (Torres, 9/28).

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Capitol Hill Watch

States Join Forces To Fend Off Medicaid Cuts

Reuters: Analysis: States Lobby Against Medicaid Cuts in Congress
With billions of dollars in Medicaid spending at risk in Congress, states are forming a loose confederacy to oppose any federal cuts that could damage state budgets already awash in red ink. The "red" and "blue" states that mark America's political divide between conservative and liberal sympathies are often far apart on issues involving health care, including Medicaid, the $420 billion-a-year program for the poor. But lobbyists say governors, legislators and other state officials, Republican and Democrat alike, have found common ground in a push to convince a special congressional deficit panel that White House-backed Medicaid cuts totaling $41 billion will only weaken a system that already struggles to deliver care to 60 million beneficiaries (Morgan, 9/29).

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Coverage & Access

Military Benefits Face Same Cost Challenges As Social Security, Medicare

USA Today: Military Retirees Say Benefits Hard-Earned
The federal government last year spent a record $275.2 billion on benefits for retired federal workers, two-thirds of it for military retirees. What's driving up costs: Congress has expanded benefits frequently and Baby Boomers are living longer, collecting pension checks longer and consuming more health care — the same issues challenging Social Security and Medicare (Cauchon, 9/28).

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IOM Offers Additional Ideas To Revamp System Of Geographic Adjustments To Medicare Payments

Modern Healthcare: IOM Offers More Ideas On Geographic Adjustments
The Institute of Medicine supplemented its earlier list of ideas for overhauling the system of geographic adjustments to Medicare payments with four more suggestions today. The latest recommendations, which do not replace the IOM's ideas released in June for improving Medicare's calculation of geographic practice cost indexes, focused on methods of setting the work adjustment, calculating the labor portion in the practice expense and using cost-share weights (Daly, 9/28).

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Campaign 2012

Gingrich Issues New 'Contract With America'; Includes Health Insurance Proposal

Des Moines Register: Register Exclusive: Newt Gingrich Releases '21st Century Contract With America'
Republican Newt Gingrich, who has positioned himself as the idea guy in this presidential campaign, will today call for Americans to have new choices in how they buy health insurance, pay their income taxes and save for retirement. In his '21st Century Contract with America' that he shared with The Des Moines Register and will officially release Thursday in Iowa, Gingrich says people should to be able to choose either a tax credit or the ability to deduct the value of their health insurance up to a certain amount (Jacobs, 9/28).

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Hospital Readmission Rates Reflect Problem In Addressing Hospital Failures

News outlets continue their coverage of a report by the Dartmouth Atlas Project.  

The Wall Street Journal's Health Blog: How One Hospital Reduced Its Readmission Rate
If you're a Medicare patient admitted to the hospital, the odds are about one in six that you’ll end up back in the hospital within a month. And there was very little progress made in reducing that rate between 2004-09. That's the not-so-good news from a new report by the folks at the Dartmouth Atlas Project, which tracks variations in medical care across the U.S. The report also found that more than half of Medicare patients who left the hospital didn't see a primary-care doctor within two weeks of discharge — identified as a contributing factor to the revolving-door problem (Hobson, 9/28).

The Hill: Report: Hospitals Across The Country Failing Patients After Discharge
Hospitals across the country are doing a dismal job making sure their patients stay healthy after they have been discharged, according to a new report released Wednesday. Readmission rates have actually increased nationally for some conditions over the past five years, according to the Dartmouth Atlas Project, which tracks regional variations in care. The new data come as hospitals with high readmission rates will start seeing Medicare reimbursement cuts under the health care reform law, starting in October 2012. "The report highlights widespread and systematic failures in coordinating care for patients after they leave the hospital," lead author David Goodman said in a statement accompanying the report. "Irrespective of the cause, unnecessary hospital readmissions lead to more tests and treatments, more time away from home and family, and higher health care costs" (Pecquet, 9/28).

In other hospital news  —

The Associated Press: Dementia Patients Suffer Dubious Hospitalizations
One-fifth of Medicare nursing-home patients with advanced Alzheimer's or other dementias were sent to hospitals or other nursing homes for questionable reasons in their final months, often enduring tube feeding and intensive care that prolonged their demise, a new study found. Nursing homes may feel hospital care is warranted when a frail, elderly patient develops swallowing problems, pneumonia or a serious infection, but researchers suspect a different motive for many transfers: money. After a patient is hospitalized for at least three days, Medicare pays about three times the normal daily rate for nursing homes to take patients back — three times the rate paid by Medicaid, which funds such long-term care for many (Marchione, 9/28).

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State Watch

Jails Are Holding Increasing Numbers Of Mentally Ill

The Atlanta Journal-Constitution reports that in Georgia more mentally ill people are locked away than are treated in state psychiatric hospitals. In other state news about mental health, Florida seeks to recoup $4 million from company that managed Medicaid mental health services, and Milwaukee considers bolstering services.

The Atlanta Journal-Constitution: Mentally Ill Languish In Local Jails
Detention Officer Terroyanne Harris considers the inmates she oversees on 3 North as much patient as prisoner. They suffer from schizophrenia, bipolar disorder, post-traumatic stress and other mental illnesses. Some walk aimlessly around their cell block. Some are lost in hallucinations…. Jails have become the new asylums. In Georgia, more mentally ill people are locked away than are treated in all the state psychiatric hospitals combined. And it's costing county taxpayers millions (Visser, 9/29).

News Service of Florida/Sunshine State News: Mental-Health Firm, State Battle Over $4 Million
Contending that not enough money was spent on patient care, the state Agency for Health Care Administration is trying to recoup $4 million from a firm that manages Medicaid mental-health services (Saunders, 9/28).

Milwaukee Journal Sentinel: Proposed Milwaukee County Mental Health Funding Up
Milwaukee County Executive Chris Abele's 2012 budget includes a $3 million increase to bolster community mental health care and lay the groundwork for a future downsizing of the Mental Health Complex. Abele said Wednesday that about $1.4 million will go toward subsidizing one or two new 16-bed Crisis Resource Centers on the north side of town that would be privately operated and modeled after an existing center on the south side. The centers provide short-term care to stabilize someone at a cost that's a fraction of what emergency care at the complex costs (Schultze, 9/28).

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Medicaid Payments In N.Y., Kentucky Questioned

New York auditors says nursing homes were overpaid, while a Kentucky state senator says doctors at the University of Louisville misused Medicaid funds.

The Associated Press/Wall Street Journal: NY Audit Notes $42 M In Medicaid Overpayments
New York auditors say the state Health Department has overpaid nursing homes about $42 million in Medicaid over a 44-month period because many are not collecting money from their clients' income as required (9/29).

Louisville Courier-Journal: Medicaid Funds Allegedly Misused: U Of L Doctors Used $4.8 Million In Medicaid Money For Bonuses, Shaughnessy Says
Doctors at the University of Louisville medical school used about $4.8 million in state Medicaid funds to pay themselves "financial bonuses" — money that was supposed to be used for indigent care, state Sen. Tim Shaughnessy says. And they used another $5.2 million for an electronic records system that would make U of L doctors eligible for additional bonuses from the federal government, according to new details of a controversial transaction that Shaughnessy said he recently obtained from Attorney General Jack Conway's office (Yetter, 9/29).

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State Roundup: Mass. Doctors Not Keen On New Payment Methods

News outlets report on a variety of state health policy options.

Boston Globe: Doctors: We Aren't Ready For Global Payments
A new survey from the Massachusetts Medical Society reveals interesting divisions among doctors over plans to hold down health care spending -- and perhaps some words of warning for lawmakers. More than half -- 58 percent -- of the 1,100 doctors who responded to the society's survey this year said they would not voluntarily agree to treat patients under so-called global payments (Kowalczyk, 9/28).

WBUR's CommonHealth blog: Survey Finds MA Doctors 'Hesitant' On Payment Reform, Particularly Specialists
For the past 10 years, a random selection of Massachusetts doctors have been surveyed on how they're feeling about certain aspects of their profession. This year, for the first time, they were asked about new payment models and health care delivery strategies. More than 1,070 practicing physicians responded, and here, according the 2011 Massachusetts Medical Society Annual Physician Workforce Survey, is what they said … Primary care physicians (61.4%) are more likely to participate in a voluntary global payment system than specialists (32.2%). ... Of all respondents, 49 percent said they were likely, and 51 percent said they were not likely to participate in a voluntary ACO (Zimmerman, 9/28).

California Healthline: Legislative Hearing Looks At Rural Health
The list of rural health issues is a long one, according to Steve Barrow of the California State Rural Health Association. But it can be summed up by one statistic, he said. "In the rural areas, we have 30% of the state's Medi-Cal patients, and we have 10% of the state's population," Barrow said. … That high concentration of Medi-Cal patients, Barrow said, translates into a lack of primary care physicians, specialists and other providers for all rural residents, and he said that's the driving concern in rural medicine (Gorn, 9/28).

(Arizona) Cronkite News: Arizona Education Organizations Hoping Lawsuit Will Block New Law
The Arizona School Boards Association and Arizona Education Association have sued to block a new law that provides publicly funded scholarships that allow children with disabilities to attend private schools (Ingram, 9/27).

Chicago Sun-Times: Preckwinkle, Hospital Board Still $35 Million Apart On Budget
The independent governing board of Cook County's health and hospital system gave first-round approval Wednesday to an $827.6 million spending plan for 2012 that isn't exactly getting the seal of approval from Cook County Board President Toni Preckwinkle. That's because the health system is asking for $283 million in county taxpayer money, and Preckwinkle and the County Board hold those purse strings. But Preckwinkle has told the governing board she's only willing to consider, at most, a $248 million subsidy to help cover costs at the health system, which includes two hospitals and 16 clinics that serve the poor and uninsured (Donovan, 9/28).

Connecticut Mirror: Insurance Department Reduces Anthem's Rate Hike
The Connecticut Insurance Department has turned down a request by the state's largest health insurer to raise premiums by 12.9 percent for more than 25,000 individual-market policies, instead granting the company a 3.9 percent increase. Anthem Blue Cross and Blue Shield had said that the higher increase was needed to account for rising claims costs, increased use of services by members, and state and federally mandated benefit changes (Levin Becker, 9/28).

Arizona Republic: Arizona Seeks Court's OK To Trim Health Benefits To State Workers
Arizona is asking that the full 9th U.S. Circuit Court of Appeals allow the state to go forward with a plan to eliminate health-care benefits for domestic partners of state workers. Gov. Jan Brewer filed the petition Tuesday, less than a month after a three-judge panel of the appellate court upheld a temporary injunction blocking a 2009 state law from taking effect (Rough, 9/29).

Milwaukee Journal Sentinel: Jail Health Care Change Denounced
Milwaukee County Sheriff David A. Clarke Jr.'s planned privatization of medical care for jail inmates is inadequate and should be stopped, according to the court-appointed overseer of the jail. "Dramatically reduced staffing" under the privatization plan would likely result in "further deterioration" of services at the jail, said Ronald Shansky, who has served as court monitor for the jail under a settlement of a 1996 lawsuit over crowding and other problems at the jail (Schultze, 9/28).

Kaiser Health News: Capsules: N.C. Insurer Invests $15 M In Doc's Health IT
Blue Cross and Blue Shield of North Carolina planned to announce Wednesday that the insurer will spend $15 million to arm as many as 750 physicians in the state with state-of-the-art electronic medical records (Weaver, 9/28).

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Weekend Reading

Longer Looks: A Surgeon Examines His Professional Development

Every week, reporter Jessica Marcy selects interesting reading from around the Web.

The New Yorker: Personal Best
I've been a surgeon for eight years. For the past couple of them, my performance in the operating room has reached a plateau. I'd like to think it's a good thing—I've arrived at my professional peak. But mainly it seems as if I've just stopped getting better. During the first two or three years in practice, your skills seem to improve almost daily. It's not about hand-eye coördination—you have that down halfway through your residency. As one of my professors once explained, doing surgery is no more physically difficult than writing in cursive. Surgical mastery is about familiarity and judgment. … As I went along, I compared my results against national data, and I began beating the averages. My rates of complications moved steadily lower and lower. And then, a couple of years ago, they didn't. It started to seem that the only direction things could go from here was the wrong one (Atul Gawande, 10/3).

MedPage: Why Do Doctors Cling To Continuous Fetal Heart Monitoring?
Nearly all American mothers are monitored during labor, and bad fetal heart strips are an important cause of high cesarean section rates. A recent report detailed the dizzying increases: Almost one in three babies was delivered by cesarean in 2007, the most recent year for which data are available. That rate has grown by more than 50 percent in a decade. I have performed hundreds of cesarean sections during residency, and many were the result of bad heart-rate strips. … No test is perfect. But almost every time we whisked a mother back to the operating room, and I cut through skin, fat, fascia, and finally the muscle of the uterus, expecting a blue, floppy baby, the child I delivered emerged pink, healthy, and a little bit angry. Were we saving lives and averting disaster? Or were we performing unnecessary surgery? (Alexander Friedman, 2011). 

Harvard Business Review: How To Solve The Cost Crisis In Health Care
U.S. health care costs currently exceed 17% of GDP and continue to rise. Other countries spend less of their GDP on health care but have the same increasing trend. Explanations are not hard to find. … But few acknowledge a more fundamental source of escalating costs: the system by which those costs are measured. To put it bluntly, there is an almost complete lack of understanding of how much it costs to deliver patient care, much less how those costs compare with the outcomes achieved. Instead of focusing on the costs of treating individual patients with specific medical conditions over their full cycle of care, providers aggregate and analyze costs at the specialty or service department level. Making matters worse, participants in the health care system do not even agree on what they mean by costs. … Poor costing systems have disastrous consequences (Robert S. Kaplan and Michael E. Porter, September, 2011).

The Atlantic: Why Mitt Romney's Health Care Record Won't Stop Him
In his new Washington Examiner column, Tim Carney runs through the conventional argument that GOP candidate Mitt Romney is uniquely ill-suited to challenging President Obama in 2012 (including that) "Obamacare was the catalyst for the GOP electoral victory in 2010. … So it's hard to imagine a worse leader for this fight than Mitt Romney. Romneycare in Massachusetts not only looks a lot like Obamacare, it literally was a model for Obamacare." It's true that a lot of conservatives think that way about a Romney candidacy, but their reasoning is unpersuasive for several reasons. Most obviously, there is every reason for the GOP nominee to run a campaign that revolves around the economy. It would be foolish indeed to run primarily against Obamacare, especially since the average American voter, whatever he or she thinks about the legislation, isn't exactly eager to trust the Republican Party's approach to health care, if the GOP can even be said to have a coherent approach. Do Republicans really want to pit Rick Perry's record on health care against Obama's record, have them discuss the merits a few times on debate stages, and have those exchanges determine the winner of the presidential election? (Conor Friedersdorf, 9/28).

American Medical News: Making Part Time Work
More physicians are figuring out ways to practice part time to raise children, achieve a work-life balance, pursue other interests or extend working years beyond expected retirement age. Thirteen percent of physicians worked part time in 2005, according to the 2010 Physician Retention Survey by Cejka Search and the American Medical Group Assn. This grew to 21% in 2010. When broken down by gender, 7% of male physicians worked part time in 2005, a rate that nearly doubled to 13% by 2010. With female doctors, 29% worked part time in 2005, and 36% did so in 2010. Physicians with part-time positions say the key to making it work is knowing what you want and having firm boundaries but being willing to be flexible. ... Some medical practices are finding that accommodating part-time requests can be to their advantage, particularly with a physician shortage that is only expected to get worse (Victoria Stagg Elliott, 9/26).

Columbia Journalism Review: Meet The Bay State's Uninsured
Last week the Census Bureau released new numbers showing that 5.6 percent of the population in Massachusetts remained without health insurance coverage. That's a 42 percent drop in the number of the state's uninsured since the law took effect in 2006. A new study by the Cambridge Health Alliance, one of the state's safety net providers, showed who was left out, putting a human face on those without insurance. The findings are illuminating given that the Bay State’s health law is the model for the national law, which takes full effect in 2014, and the Romney-Perry feud often flares up around the topic of health reform in the state. (Trudy Lieberman, 9/26).

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Editorials and Opinions

Viewpoints: Rising Health Costs And The Health Law

Los Angeles Times: Healthcare's Rising Costs
Even a slow economy can't stop healthcare costs from rising. A new report by the Kaiser Family Foundation and the Health Research & Educational Trust shows that the cost of employer-provided insurance rose 9% this year — even as workers and their families were cutting back on trips to the doctor's office — and has more than doubled over the last decade. The data buttress the arguments in favor of AB 52, a California bill that would give state regulators the authority to reject unreasonable increases in health insurance premiums. But they also show that policymakers must do even more to slow the growth of healthcare costs (9/29). 

USA Today: Health Premiums Jump, But Don't Blame 'ObamaCare'
No sooner had the Kaiser Family Foundation, in its annual survey of health insurance, found that the average premium rose a whopping 9% this year to $15,073 for an employer-sponsored family plan, than the usual partisans began pointing fingers. Spare us the simplistic explanations. These latest increases are just further evidence of deep, long-standing flaws in the U.S. health care system that are only modestly impacted by the new law (9/29). 

Denver Post: Editorial: Pointing Fingers Over Health Costs
When critics insist the growth of this nation's health care burden is unsustainable, this is what they mean: The average cost of an employer-provided family insurance plan soared by 9 percent in 2011. That's far higher than the rate of inflation or the average growth of wages. ... In a word, it's a looming disaster. And yet our political leaders mostly still refuse to come to terms with it (9/29).

San Francisco Chronicle: Health Care Taxing America's Workers
On Tuesday House Budget Committee Chairman Paul Ryan gave a talk at Stanford's Hoover Institution on what should become the Republican template behind its bid to "repeal and replace" Obamacare. Ryan cited the unintended consequences that employer-paid health care plans have delivered: "The system that shields us from the cost of services has actually left us paying much, much more" (Debra J. Saunders, 9/29).

Kansas City Star: Health Care Reform Needed, Stat
Unemployment hovers above 9 percent. Home values remain depressed. Small businesses can't gain traction for growth. Politics and life are so unsure the U.S. credit rating has been downgraded from AAA status. But against this backdrop, a new report indicates that health insurance rates on the average family plan this year increased 9 percent, three times the rate of inflation. Insurance companies blame an increase in the cost of care. The news is compelling evidence for why we need health care reform (9/28).

San Francisco Chronicle: Right Cure For Shortcoming Of S.F. Health Care Law
There ought to be a warning sign at City Hall for whenever the San Francisco Board of Supervisors starts tinkering with economic and social policy: "First, do no harm." That admonition certainly should apply to the efforts to close a loophole in the city's requirement that businesses provide health care coverage for their workers (9/29).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.