Kaiser Health News - Health Reform

IRS Controversy Fuels Republican Health Law Opposition

Fri, 17 May 2013 14:01:00 GMT

Just as the House took its 37th vote to repeal the health law, largely along party lines, the Republicans held their first hearing on the IRS's tax-exempt and government-entities division. Several media outlets report that Sarah Hall Ingram, who led the division when the questioned operations began, is now in charge of the branch overseeing implementation of parts of the health law.

The New York Times: Congressional Hearings On IRS Scandal Set To Start
Joseph Grant, commissioner of the I.R.S.'s tax-exempt and government-entities division, announced Thursday that he, too, would be leaving in the next month. But Republicans jumped on news Thursday evening that Mr. Grant's predecessor, Sarah Hall Ingram, who led the division when the targeting operation began, is now in charge of the I.R.S. division overseeing implementation of parts of the president's health care law. Ms. Ingram's name did not appear anywhere in the inspector general's report of the program, nor had Republicans singled her out for criticism until now. But Republicans were eager to link the I.R.S. scandal with their opposition to the health care law (Weisman, 5/17).

Politico: Obamacare Repeal Now About The IRS
Republicans have hated Obamacare for years, and on their 37th repeal vote Thursday, they found a reason to hate it even more: the IRS. They've warned about its role in Obamacare before, but this time, they used its targeting of conservative groups as a fresh warning about how it might apply the law to the rest of the country. It’s the IRS, after all, that will enforce the individual mandate that most of the country already hates. And if the IRS can’t shake its image as a political tool of the White House, any conservatives who get hit with an Obamacare penalty are certain to cry foul (Samuelsohn and Cunningham, 5/16).

Fox News: IRS Official Who Oversaw Unit Targeting Tea Party Now Heads ObamaCare Office
The IRS official who led the tax-exempt organizations unit when Tea Party groups were targeted is now in charge of the IRS office responsible for ObamaCare, two Capitol Hill sources told Fox News. The acknowledgement comes after the administration announced that the official’s successor Joseph Grant -- who had only been on the job a few days -- would be retiring. And it fueled criticism of the agency, as the outgoing IRS commissioner prepared to face lawmakers’ questions at a hearing Friday morning (5/17).

The New York Times: House Votes Again To Repeal Health Law
For many Republicans, this was one of the major reasons for coming to Washington in the first place. And they were not going to miss their chance — whether it was their 37th time voting to repeal the 2010 health care overhaul, or their first (Peters, 5/16).

Los Angeles Times: House Republicans Repudiate Obama Healthcare Program - Again
House Republicans voted for the 37th time Thursday evening to repeal all or part of President Obama's healthcare law, underscoring once again the deep partisan divide over the landmark 2010 legislation. The bill to roll back the entire Affordable Care Act passed 229 to 195, with just two Democrats crossing the aisle to join the GOP. No Republicans voted against the legislation, which is assured of going nowhere in the Senate (Levey, 5/16).

The Hill: House Votes To Repeal ObamaCare
The House voted to repeal ObamaCare on Thursday for the third time since Republicans took over the chamber in 2011. Only two Democrats sided with Republicans in the party-line 229-195 vote — Jim Matheson (Utah) and Mike McIntyre (N.C.). All Republicans voted in favor of repeal (Kasperowicz, 5/16).

The Washington Post: House Votes To Repeal Obamacare For 37th Time
This vote does not put the Affordable Care Act in jeopardy. Thursday's repeal bill will probably meet the same fate as five others that would have eliminated the entire health-care law: It will die in the Democrat-led Senate. But for the GOP, the point was not to change the law. At least, not right away. Instead, the point was to refocus the House — and, hopefully, a swath of the American public — on a law that remains controversial three years after it was passed (Fahrenthold, 5/16).

The Wall Street Journal's Washington Wire: Freshman Republicans Get Chance To Vote Against Health Law
More than 70 freshmen Republicans had pushed House Speaker John Boehner to give them a chance to go on the record in opposing the 2010 law, and many of them made short speeches in the several hours of debate preceding the vote (Radnofsky, 5/16).

The Associated Press/Washington Post: House GOP Pushes Full Repeal Of Obama’s Health Care Law – 37th Vote To Scale Back Or Kill It
One more time, with feeling! The Republican-led House voted yet again Thursday to repeal President Barack Obama's health care law, knowing full well that won’t stop it. Only months away from the rollout of coverage for uninsured Americans, it was the 37th attempt in a little more than two years by House Republicans to eliminate, defund or partly scale back the Affordable Care Act. The Democratic-led Senate and the president will simply ignore the House action, which came on a virtual party line vote, 229-195 (5/16).

Reuters: U.S. House Votes To Repeal Obamacare In 37th Symbolic Act
The Republican-controlled U.S. House of Representatives voted to repeal President Barack Obama's healthcare reform law on Thursday in a symbolic move aimed as much at healing internal Republican rifts as demonstrating dogged party opposition to "Obamacare." The 229-195 vote occurred largely along party lines and marked the 37th time the House has voted to repeal or defund the 2010 Patient Protection and Affordable Care Act, which is now in the final months before full implementation on January 1 (Morgan, 5/16).

USA Today: Obamacare: 3 Years In, It Faces Steep Challenges
The Affordable Care Act is sure to survive the latest vote by the House of Representatives Thursday to repeal it — since the Senate doesn't plan to take it up and President Obama would veto a repeal bill if it somehow reached his desk — but the administration's signature legislative achievement still faces serious perils ahead (Page, 5/16).

The Washington Post's Wonk Blog: Yes, The 37th Obamacare Repeal Vote Matters
It's easy to write off these votes as pure political spectacle with no substantial meeting. Members of Congress can tell their constituents that they voted to repeal Obamacare and move on to other issues. But there's actually a compelling case on the other side, that these actions do really matter in a substantive way. This slew of three dozen repeal votes have changed both how the Affordable Care Act works and how the public perceives it (Kliff, 5/16).

Politico: John Boehner: No Timetable For Obamacare Replacement
House Speaker John Boehner was noncommittal on when — or even if — Republicans would put a bill on the floor to replace President Barack Obama’s health care law…Republicans offered replacements to the Affordable Care Act when they were in the minority. And the Pledge to America — their promises to voters when they took the majority in 2011 — clearly stated that they would “repeal and replace the government takeover of health care.” They’ve passed some bills that would do that (Sherman, 5/16).

Republicans Ask GAO To Probe Sebelius' Fundraising

Fri, 17 May 2013 14:00:00 GMT

GOP lawmakers seek an investigation of the Health and Human Services secretary's efforts to secure more funding for a private group that will help with the implementation of the health law. At the same time, an HHS spokesman offered more detail regarding whom she contacted.

Politico: GOP: GAO Should Investigate Kathleen Sebelius
A group of Republican lawmakers called on the Government Accountability Office to investigate Health and Human Services Secretary Kathleen Sebelius over her fundraising for a nonprofit supporting Obamacare. Republicans are criticizing news that Sebelius sought donations from health care companies for a group working to encourage more people to enroll in Obamacare programs (Gibson, 5/16).

Modern Healthcare: GOP Lawmakers Seek GAO Probe Of Sebelius’ Fundraising Efforts
Pressure continued to mount on the Obama administration Thursday as Republican leaders in the House and Senate asked the Government Accountability Office to investigate HHS Secretary Kathleen Sebelius' fundraising efforts for a private organization to help implement the healthcare reform law. House Ways and Means Committee Chairman Dave Camp (R-Mich.), Energy and Commerce Committee Chairman Fred Upton (R-Mich.), and Appropriations Subcommittee on Labor, HHS and Education Chairman Jack Kingston (R-Ga.), along with Sens. Lamar Alexander (R-Tenn.) and Orrin Hatch (R-Utah), the ranking members on the Senate Health, Education, Labor and Pensions and Senate Finance committees, respectively, sent a letter to Comptroller Gene Dodaro at the GAO asking Dodaro's office to examine Sebelius' efforts to solicit funds for Enroll America, a not-for-profit organization whose purpose is to help Americans learn about, enroll in and retain healthcare coverage (Zigmond, 5/16).

Bloomberg: Sebelius Limited Fundraising For Health Law To Two Calls
The U.S. health secretary's solicitation of money from companies to promote the Affordable Care Act ended after two phone calls, to H&R Block Inc. (HRB) and the Robert Wood Johnson Foundation, according to her spokesman. Enroll America, a nonprofit promoting the 2010 health law had asked Health and Human Services Secretary Kathleen Sebelius to help raise money from a longer list of companies. Sebelius solicited two for money, and only asked the others for technical advice and nonfinancial support because they were regulated by her department, said Jason Young a spokesman for the agency (Wayne, 5/16).

Meanwhile -

The Hill: CRS: Sebelius Can Take Place Of Controversial Medicare Board
If congressional Republicans succeed in blocking a controversial new Medicare board created in the Affordable Care Act, Health and Human Services Secretary Kathleen Sebelius can step in instead. GOP leaders have resisted the Independent Payment Advisory Board (IPAB), a 15-member panel tasked with slowing the growth in Medicare spending. The IPAB would make targeted cuts in Medicare's payments to doctors and other providers. ... But if Republican efforts to block the panel are effective, they could further empower Sebelius, the Congressional Research Service (CRS) said. CRS said in a memo to Sen. Tom Coburn (R-Okla.) that the law directs the HHS secretary to propose Medicare cuts if the IPAB doesn't (Baker, 5/16).

CBO: Cadillac Tax's Bark May Be Worse Than Its Bite

Fri, 17 May 2013 13:53:00 GMT

Bloomberg: Health Law's Cadillac Tax Bite on Companies Drops by $57 Billion
The U.S. health-care law’s projected tax bite on businesses with more generous health benefits is dropping as medical spending slows and employers look to rein in the cost of coverage. The 2010 Affordable Care Act's so-called Cadillac tax on high-premium health plans was initially projected to bring in $137 billion over the next decade. That estimate has now been trimmed to about $80 billion, a $57 billion decrease, the Congressional Budget Office said in a report this week (Nusbaum, 5/16).

Viewpoints: Health Law's Effect On Patient Safety; Angelina Jolie's Surgery Is The Ultimate 'Choice'

Fri, 17 May 2013 13:33:02 GMT

The New York Times: Learning From Litigation
Much of the discussion over the Affordable Care Act has focused on whether it will bring down health care costs. Less attention has been paid to another goal of the act: improving patient safety. Each year tens of thousands of people die, and hundreds of thousands more are injured, as a result of medical error (Joanna C. Schwartz, 5/16).

The New York Times: The Murky World Of Hospital Prices
Last week, the federal government made public a vast trove of information on the list prices charged by hospitals for a large array of procedures commonly performed on hospitalized patients. It was a good start toward providing greater transparency in hospital billing, which has long been shrouded in secrecy. But it fell short of providing full information that patients need to make informed decisions about which hospitals to use and which insurance to buy (5/16).

The Washington Post: Bill Gates: 'Death Is Something We Really Understand Extremely Well'
"I always use this chart of childhood death," Bill Gates says. "In 1960, 25 percent of kids died before the age of 5. And now we're down below 6 percent of kids dying before the age of 5." We're sitting in a bare conference room at his foundation’s D.C. headquarters. Gates is in town to talk to members of Congress about his top priority this year: Global health -- and, in particular, the total eradication of polio. He wants to drive that 6 percent even lower, and he believes he can. Wiping out a disease like polio sounds impossible. But it's actually, Gates tells me, completely achievable (Ezra Klein, 5/17).

Reuters: A Woman's Choice
We use that word so often: choice. It has become the code word for abortion, alas, and thus a lightening rod for activists on both sides of that continuing battle. But this week Angelina Jolie redeemed the word and the idea behind it -- that a woman has a right to choose what happens to her body, however tough that choice sometimes is (Anne Taylor Fleming, 5/16).

Philadelphia Inquirer: Angelina Jolie's Lesson For Obamacare
Angelina Jolie's announcement that she underwent a double mastectomy to protect against a genetic form of breast cancer inspired widespread surprise and admiration. With her op-ed revelation in the New York Times, she put herself forward as a role model for millions of women who face a similar dilemma. Such candor and forthrightness are rare among celebrities. Yet, she is extremely fortunate in one respect. She has the financial resources to afford both the testing that found her heightened risk and the consequent surgery. As she noted in her op-ed, many women do not (Robert Field, 5/17).

Tampa Bay Times: Politics And My Double Mastectomy
During the same week that Angelina Jolie announced that she had a preventive double mastectomy as a precaution against her genetic predisposition toward breast cancer, House Republicans are likely to vote for the 37th time to repeal or replace Obamacare. These two events have more in common than you think. That's because, for everyone except the mega-wealthy like a Hollywood star, having Jolie-like health care options depends on good, affordable health insurance. And having access to that kind of coverage depends on reasonable and caring leaders in Washington -- something the Republican caucus is missing, as proved by the anticipated vote (Robyn E. Blumner, 5/16).

Fox News/Washington Examiner: ObamaCare Is About Power
Members of the House of Representatives are scheduled to vote Thursday to repeal all of ObamaCare. Given that the House voted to repeal the law last year, some commentators and observers have questioned the need for another repeal vote. However, the scandals coming to light over the last week perfectly make the case for why Congress must eradicate the law from the statute books (Jim DeMint, 5/16).

New England Journal Of Medicine: Expanding The Role Of Advanced Nurse Practitioners – Risks And Rewards
As the 2014 expansion of coverage mandated by the Affordable Care Act (ACA) looms larger, one question with no ready answer is how health care providers, policymakers, and payers will cope with an expected surge in patient demand for services. A shortage of primary care physicians to treat newly insured persons is the most immediate health workforce issue, but when added to the nation's population growth and more aging patients who require treatment, finding a practitioner may become an even more daunting challenge (John Iglehart, 5/16).

Tampa Bay Times: Hypocrisy In The House
Republican state lawmakers on Tuesday didn't want to talk about 1 million of the state's poor who don't have health insurance. Or about how Floridians and their health care system inevitably absorb the cost when the uninsured are in crisis. They tried to change the subject when asked at a Suncoast Tiger Bay meeting in St. Petersburg about news reports that juxtaposed Republican House members' generous taxpayer-covered health insurance with their votes to reject federal Medicaid expansion dollars to cover 1 million uninsured -- and pump $51 billion into the state economy. Floridians shouldn't so easily dismiss the hypocrisy (5/14).

Orlando Sentinel: Costly Expansion Wouldn't Improve Floridians' Health
The state Legislature's decision this year to reject Medicaid expansion was the correct decision for Florida. There is little evidence that growing the health care program for the poor would improve the health of state residents. A recent study in the New England Journal of Medicine is all the proof that Sunshine State legislators needed to reject Medicaid expansion. Those lamenting the failed implementation of this part of the federal Affordable Care Act in Florida can look to Oregon to see that Floridians won't be missing out on much (Bob Williams, 5/17).

Orlando Sentinel: Misrepresentations Blocked Care For A Million Floridians
Despite the support of Gov. Rick Scott and the Florida Senate, the 2013 legislative session ended with the Florida House unilaterally blocking the extension of health coverage to more than a million low-income, uninsured Floridians. Approving "Medicaid expansion" (or a comparable Senate-backed alternative) would have provided low-wage workers, parents and patients priced out of coverage with desperately needed access to care and protection from financial ruin. It would have infused $51 billion of our tax dollars into the economy, created 120,000 private-sector jobs, saved the state more than it would cost, and enabled service-sector employers to avoid hundreds of millions in penalties. In short, a "win-win-win." The only remaining impediment was purely political (Greg Willowe, 5/17).

Cincinnati Enquirer: Kentucky Expands Medicaid, Why Not Ohio?
By virtue of Kentucky’s Medicaid laws, Gov. Steve Beshear was able to expand that state's program without going through the Kentucky General Assembly. Good for him and good for Kentucky. ... But in Ohio, the Republican-controlled General Assembly is taking a lifetime to ponder the issue (5/16).

State Highlights: State Medicaid Investigators Get More Money To Investigate Fraud

Fri, 17 May 2013 13:32:00 GMT

A selection of health policy stories from Texas, Kansas, Georgia, Wisconsin and California.

CQ HealthBeat: OIG Final Rule Allows Medicaid Investigators To Use Data Mining
State Medicaid fraud investigators will be able to get federal matching funds to electronically search for potential fraud, under a final rule to be published on Friday. The rule, which will be published by the Health and Human Services Office of Inspector General, is expected to save the federal government about $34.3 million from fiscal 2014 through fiscal 2023 in fraudulent claims that would have been paid (Adams, 5/16).

The Texas Tribune: End-Of-Life Bill Sparks Anger, Accusations
Political powerhouse Texas Right to Life is working overtime to try to defeat a compromise measure aimed at improving state laws governing "end of life" medical decisions. But with time running out to get Senate Bill 303 passed, the fight over the legislation has shifted from political to personal. Sen. Bob Deuell, R-Greenville, a family physician who has worked for years to craft legislation acceptable to faith-based groups, the disability community and medical professionals, said Texas Right to Life is acting like "the woman that went to Solomon and wanted the baby to be cut in two" (Aaronson, 5/17).

The Texas Tribune: House Backs Bill To Protect Medicaid Providers’ Rights
Medicaid providers would have clearer due process rights during fraud investigations under a measure the House gave tentative approval to on Wednesday. The bill would also codify the state's rules for withholding payments to providers during such investigations (Smith and Aaronson, 5/16).

Kansas Health Institute: Governor's Mental Health Initiative Panned At Manhattan Meeting
Karen McCulloh spent much of Wednesday afternoon listening to state officials explain how Gov. Sam Brownback's mental health initiative might work. She said she didn't hear much that she hadn't heard before. … Brownback has said his initiative, much of which remains undefined, is meant to "strengthen" the state's mental health system and better serve those most at-risk of hospitalization or incarceration (Ranney, 5/16).

Georgia Health News: Albany Hospital Merger Slowed By Latest Ruling
U.S. District Court Judge Louis Sands has issued a temporary restraining order against further moves by Phoebe Putney Health System to consolidate with the former Palmyra Medical Center in Albany. The ruling had been sought by the Federal Trade Commission. Phoebe Putney officials said in a statement that the judge's action won't alter day-to-day operations at the former Palmyra, which was purchased from HCA and has been renamed Phoebe North (Miller, 5/16).

Milwaukee Journal Sentinel: Uninsured, Low-Income Visits To Hospital
More than 1 million visits to Wisconsin's hospitals were by patients who were uninsured and low-income in 2011 -- an increase of more than 30 percent since 2006, according to the Wisconsin Hospital Association Information Center's annual Guide to Wisconsin Hospitals. The Wisconsin Hospital Association Information Center also reported that 70 percent of surgeries and procedures now done at the state's 148 hospitals don't require an overnight hospital stay and are done in outpatient departments. The figure shows that the traditional measure of inpatient stays no longer is a valid way to gauge a hospital's patient volume and size (Boulton, 5/16).

California Healthline: Increasing Medical Residencies Could Help Inland Empire
As the Inland Empire grapples with a shortage of primary care physicians, experts say the solution hinges on creating more medical residencies. New state legislation could help. AB 1176 proposes to increase the number of primary care medical residencies in underserved regions, such as the Inland Empire. The new slots would be funded by levying a fee on insurers (McSherry, 5/16).

CMS Examines Interaction Between Medicaid And Health Insurance Exchanges

Fri, 17 May 2013 13:31:40 GMT

Also in the news, developments on Medicaid expansion from Arizona, Ohio and Iowa.

CQ HealthBeat: At MACPAC, Discussion Of Interaction Between Medicaid And Exchanges
The Centers for Medicare and Medicaid Services has put out most of the rules to implement coverage changes under the health care law, but a top official said Thursday that the public should expect more guidance on such issues as outreach and the enrollment of lawmakers and their staffs into the new marketplaces that will start accepting people in October. Chiquita Brooks-LaSure, the deputy director for policy and regulations at the CMS Center for Consumer Information and Insurance Oversight, offered few new details in her wide-ranging remarks to the Medicaid and CHIP Payment and Access Commission (Adams, 5/16).

The Associated Press: Arizona Senate Passes Budget With Medicaid
The Republican-controlled Arizona Senate on Thursday passed an $8.8 billion state budget that embraces a signature part of President Barack Obama's health care overhaul, with a handful of Republican members teaming up with Democrats to push through Gov. Jan Brewer's top priority of the session. The Medicaid expansion proposal will add 300,000 Arizonans earning between 100 percent and 138 percent of the federal poverty level to the current 1.2 million people now on the state's insurance plan for the poor (Christie, 5/16).

Arizona Republic: Arizona Senate Backs Medicaid Expansion
The Arizona Senate on Thursday approved expanding the state’s Medicaid program, capping a rancorous debate that had split the Republican Party and had been building since January, when Gov. Jan Brewer issued a surprise call to increase Arizona’s health care program for the poor. A handful of Senate Republicans teamed with Democrats to approve the fiscal 2014 budget plan and overcome a flood of amendments intended to scuttle Medicaid expansion, pushing through the governor’s top legislative priority on a 19-11 vote after three hours of debate (Pitzl and Reinhardt, 5/16).

Columbus Dispatch: Legislators Mull Medicaid Changes Rather Than Expansion
Ohio Medicaid recipients could face time limits and work requirements under alternatives being discussed in the legislature to Gov. John Kasich’s proposed expansion of tax-funded health care for the poor and disabled. Republican leaders also are considering taking thousands of pregnant women, disabled workers and children off the Medicaid rolls and putting them into yet-to-be-established health exchanges (Candisky and Siegel, 5/17).

Des Moines Register: Medicaid Proposal Too Bitter A Pill For 27 States
Iowa Gov. Terry Branstad isn’t alone in scorning the Obama administration’s prescription for government health coverage for those who can’t afford private insurance, and he’s not alone in seeking another way to cover some of them. Iowa is one of the last states to decide, for this year, what to do about the hefty sums of federal money at stake for enlarging the pool of poor people eligible for Medicaid. More than half of the states have decided against a deal that the White House had thought they couldn’t refuse (Jacobs, 5/17).

Meanwhile, here's the latest on on the health exchange front in Colorado and California -

Health Policy Solutions (a Colo. news service): New Health Insurance Era Dawns With 19 Companies Competing
Coloradans hunting for health insurance will have 19 companies competing for their business with up to 1,000 different plans that could be offered through the state’s new health exchange and on the open market. Starting in 2014, for the first time, insurance companies selling to individuals won’t be able to exclude people with pre-existing health conditions. That’s one of the reasons consumers and competitors are eagerly awaiting plan details and costs, which Colorado authorities plan to unveil Wednesday. For now, Colorados Commissioner of Insurance Jim Riesberg says he’s pleasantly surprised that 19 health insurance companies want to vie for business here (Kerwin McCrimmon, 5/16).

California Healthline: How Exchange Hopes To Reach Enrollees
Covered California exchange officials on Tuesday awarded $37 million in outreach grants to 48 community-based organizations. Those groups all have a wide reach, and represent a much bigger bloc of community organizations, according to Peter Lee, executive director of the California Health Benefit Exchange, now known as Covered California. … Lee said applicants were encouraged to aim high, because the exchange wants to reach as many people as possible and so much of the target market -- a multi-cultural, low-income and multilingual population -- is difficult to reach (Gorn, 5/16).

Conservative Lawmakers Seek To Capitalize On Link Between Current 'Scandals' And Health Law

Fri, 17 May 2013 13:28:34 GMT

Rep. Michele Bachmann, R-Minn., was among the members of Congress linking the I.R.S. scandal to the repeal vote and even talk of impeachment.

Politico: Conservatives Link IRS Mess To Obamacare
Conservative lawmakers and tea party advocates Thursday sought to link the IRS scandal to efforts to repeal Obamacare, even acknowledging the potential of impeachment. Rep. Michele Bachmann (R-Minn.) made the leap from Benghazi to the IRS scandal to Obamacare, a progression she said was all related. At a packed press conference, she argued that the IRS will now be able to access individuals' health records because they are tasked with overseeing compliance with the new law (Gibson, 5/16).

The Associated Press: Bachmann Sprints To TV With Health Care Ad
Minnesota Rep. Michele Bachmann quickly launched a campaign-style television ad Thursday in hopes of capitalizing on the latest U.S. House vote to undo President Barack Obama's health care law. The Republican critic of the Affordable Care Act -- dubbed Obamacare by foes -- was to begin airing the ad Thursday night in Twin Cities market. She spent about $85,000 for the TV spot (Bakst, 5/16).

Research Roundup: Surgical Residents Not Happy With New Schedules

Fri, 17 May 2013 13:26:00 GMT

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

JAMA Surgery: Surgical Residents' Perceptions of 2011 Accreditation Council For Graduate Medical Education Duty Hour Regulations – In 2011, the organization that oversees medical student training instituted a new regimen to replace the traditional 24-hour call schedule for medical residents, to improve patient safety and the residents' health. Under this new policy, residents in their first year of post-graduate training get increased supervision and are limited to 16-hour shifts. Researchers interviewed more than 1,000 surgical residents and found nearly 66 percent of them disapproved. "Residents believe that the intended improvements in patient safety, resident quality of life, and education have not been borne out after implementation of the changes," the researchers write. "Furthermore, a concerning majority of surgical residents report noncompliance and falsification of duty hours. It may be difficult for residents, particularly in surgical fields, to learn and care for patients under the current ACGME regulations" (Drolet et al., 5/15).

JAMA Surgery: Effects Of Duty Hour Restrictions On Core Competencies, Education, Quality Of Life, And Burnout Among General Surgery Interns – Researchers aimed to measure the implications of the new work regulations by assessing the views and experiences of 213 surgical interns from 11 general surgery residency programs in July 2011 and May 2012. They found that half of the participants believed the new regulations decreased the coordination of patient care and the time they spent in the operating room while 70 percent felt it reduced their ability to achieve continuity with patients. The majority did not believe that the regulations decreased their fatigue. "The high rate of burnout among US surgeons appear to begin during residency training, even under the … reduced work hours," they conclude (Antiel et al., 5/15).

American Journal Of Public Health: The Impact Of Cigarette Excise Tax Increases On Purchasing Behaviors Among New York City Smokers – While tax increases on cigarettes have been shown to be effective in preventing and reducing smoking, many people respond to the hikes by buying their cigarettes in other jurisdictions with lower taxes, over the Internet, on the street or from Native Americans selling untaxed products. Researchers found that "Following the 2008 tax increase [in New York City], 21% of smokers reported buying more cigarettes from another person on the street. ...Tax increases should be paired with enforcement strategies that limit the flow of untaxed, cheap cigarettes into jurisdictions with high cigarette pack prices," they conclude (Coady et al., 6/2013).

Academic Emergency Medicine: National Growth In Intensive Care Unit Admissions From Emergency Departments In The United States From 2002 To 2009 – Patient admissions to intensive care units (ICUs) have been increasing with an aging population, the authors write. The authors analyzed records from more than 4,000 patients admitted to the ICU from emergency departments from 2002 to 2009. "Over the study period, ICU admissions from EDs increased from 2.79 million in 2002/2003 to 4.14 million in 2008/2009," they write. The largest growth was among visits by patients 85 years or older. Nonwhite and Medicaid-covered patients were also major contributors to higher ICU admissions. They suggest that growth trends should be considered as decisions are made in regards to ICU capacity and add that "an increased emphasis" on the link between the emergency department and intensive care unit as well as "critical care training for emergency providers may be warranted, as many patients stay in EDs for prolonged periods of time" (Mullins, Goyal and Pines, 5/2013).

Kaiser Family Foundation/Health Management Associates: Profiles Of Medicaid Outreach And Enrollment Strategies: Helping Families Maintain Coverage In Michigan – Looking ahead to the 2014 implementation of the health law, the authors write: "This brief provides insight into lessons learned from Medicaid and CHIP outreach and enrollment strategies by profiling a successful initiative of the Michigan Primary Care Association to facilitate coverage renewals through a systematic, technology-based reminder system coupled with one-on-one assistance." The authors assert that a critical challenge will be to help people stay enrolled. "Losses in coverage at renewal interfere with individuals' access to and continuity of care and create unnecessary administrative costs associated with re-enrolling eligible individuals into coverage" (Edwards, Rodin and Artiga, 5/14).

Political Cartoon: 'Cock-A-Doodle Don't?'

Fri, 17 May 2013 13:24:00 GMT

Kaiser Health News provides a fresh take on health policy developments with "Cock-A-Doodle Don't?" by Mike Luckovich.

Meanwhile, here is today's health policy haiku:

EGG ON YOUR FACE

The new public face
for Affordable Care Act
is the IRS.
-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.

First Edition: May 17, 2013

Fri, 17 May 2013 11:25:52 GMT

Today's headlines include reports about the GOP vote to repeal the health law -- for the 37th time -- as well as how the current IRS scandal is being connected to the health law's implementation.

Kaiser Health News: My Insurer Says It Paid Too Much. Do I Have To Reimburse Them? (Video)
Kaiser Health News consumer columnist Michelle Andrews answers a reader question about having to repay an insurer that says it reimbursed too much after the patient received care from an out-of-network provider (5/17). Watch the video or read the transcript.

Kaiser Health News: Capsules: CDC Takes A Closer Look At Kids' Mental Health
Now on Kaiser Health News’ blog, Capsules, Jenny Gold reports: "Somewhere between 13 and 20 percent of kids in the United States experience some sort of mental illness, according to a new report from the Centers for Disease Control and Prevention. That adds up to millions of children suffering from disorders like ADHD, depression, autism and illicit drug use" (Gold, 5/16). Check out what else is on the blog.

The New York Times: Congressional Hearings On I.R.S. Scandal Set To Start
Joseph Grant, commissioner of the I.R.S.'s tax-exempt and government-entities division, announced Thursday that he, too, would be leaving in the next month. But Republicans jumped on news Thursday evening that Mr. Grant's predecessor, Sarah Hall Ingram, who led the division when the targeting operation began, is now in charge of the I.R.S. division overseeing implementation of parts of the president’s health care law. Ms. Ingram's name did not appear anywhere in the inspector general's report of the program, nor had Republicans singled her out for criticism until now. But Republicans were eager to link the I.R.S. scandal with their opposition to the health care law (Weisman, 5/17).

Los Angeles Times: House Republicans Repudiate Obama Healthcare Program- Again
House Republicans voted for the 37th time Thursday evening to repeal all or part of President Obama's healthcare law, underscoring once again the deep partisan divide over the landmark 2010 legislation. The bill to roll back the entire Affordable Care Act passed 229 to 195, with just two Democrats crossing the aisle to join the GOP. No Republicans voted against the legislation, which is assured of going nowhere in the Senate (Levey, 5/16).

The Associated Press/Washington Post: Appeals Court In Va. Hears Christian University's Suit Against Obama Health Care Law
A Liberty University lawyer urged a federal appeals court to overturn the Obama administration's health care reform law Thursday, arguing that it violates the school’s religious rights by requiring it to provide insurance coverage for abortion-inducing drugs. Mathew Staver told a three-judge panel of the 4th U.S. Circuit Court of Appeals that the conservative Christian university founded by Jerry Falwell faces millions of dollars in penalties if it refuses to provide employee health insurance that violates its religious beliefs (5/16).

Politico: Liberty University Pivots In Health Law Challenge
Judges on the 4th Circuit Court of Appeals on Thursday appeared skeptical that Liberty University can challenge the Obama administration’s rule that most employers provide contraceptives in their employee health plans. But at least one of the judges suggested that the health reform law’s employer mandate could be at risk since last year’s Supreme Court health care ruling narrowed the Commerce Clause (Haberkorn, 5/17).

The New York Times: Pills Tracked From Doctor To Patient To Aid Drug Marketing
The information allows drug makers to know which drugs a doctor is prescribing and how that compares to a colleague across town. They know whether patients are filling their prescriptions — and refilling them on time. They know details of patients’ medical conditions and lab tests, and sometimes even their age, income and ethnic backgrounds (Thomas, 5/16).

The New York Times: New Jersey Hospital Is The Costliest In The Nation
The most expensive hospital in America is not set amid the swaying palm trees of Beverly Hills or the luxury townhouses of New York’s Upper East Side (Creswell, Meier and McGinty, 5/16).

Los Angeles Times: Cedars-Sinai Stands Out For Steep Pricing
When Medicare disclosed average charges from thousands of U.S. hospitals for 100 common procedures last week, only one hospital was near the top in every category: Cedars-Sinai Medical Center in Los Angeles. Be it a cardiac stent, a hip replacement or a pacemaker, Cedars-Sinai's list prices for these routine treatments ranked among the top 5% in the country (Terhune and Poston, 5/17).

The Washington Post: Psychiatry’s Revamped DSM Guidebook Fuels Debate
For ADHD, the definition is being broadened, meaning the disorder could be diagnosed in more children. In the case of autism, the opposite is true. The new criteria are among the changes that will be released with the publication this weekend of the long-awaited guidebook that psychiatrists and other mental health clinicians use to diagnose mental disorders. It’s the first major update in nearly 20 years. The 947-page tome by the American Psychiatric Association adds some new disorders, broadens criteria for existing ones and tightens them for other illnesses (5/17).

Check out all of Kaiser Health News' e-mail options including First Edition and Breaking News alerts on our Subscriptions page.

Tavenner Becomes Agency's First Confirmed Chief In 7 Years

Thu, 16 May 2013 14:10:00 GMT

In a 91-to-7 vote, the Senate approved President Barack Obama's pick to lead the Centers for Medicare & Medicaid Services. Tavenner, who has been the agency's acting administrator, was endorsed by Rep. Eric Cantor, R-Va.

The New York Times: Acting Chief Wins Confirmation To Run Medicare And Medicaid
The Senate on Wednesday approved President Obama's nominee to run Medicare and Medicaid, Marilyn B. Tavenner, providing the agency with its first confirmed chief in six and a half years. The 91-to-7 vote showed broad support for Ms. Tavenner, a former state health official in Virginia, who was endorsed by Representative Eric Cantor of Virginia, the House Republican leader (Pear, 5/15).

Kaiser Health News: Senate Confirms Tavenner To Head CMS
Kaiser Health News' Mary Agnes Carey talks with Jennifer Haberkorn of Politico Pro about the Senate's confirmation Wednesday of Marilyn Tavenner to head the Centers for Medicare and Medicaid Services (5/15).

Los Angeles Times: Senate Approves Obama Choice To Head Medicare
In an unusual break in the partisan warring over healthcare, the Senate on Wednesday confirmed President Obama's choice to oversee the mammoth Medicare and Medicaid health programs (Levey, 5/15).

The Associated Press/Washington Post: Senate Confirms Tavenner To Run Health Insurance Programs With Bigger Budget Than Pentagon
Together, the programs under the Centers for Medicare and Medicaid Services cover more than 100 million Americans, ranging from newborns in low-income families, to people with severe physical and mental disabilities, to patients under hospice care in their last days of life. Part of the Health and Human Services Department, the agency has a budget of about $850 billion that easily eclipses spending on national defense (5/15).

The Washington Post's Wonk Blog: Medicare Gets Its First Confirmed Leader In Nearly A Decade
Obama nominee Marilyn Tavenner received a 91 to 7 vote on the Senate floor to run an agency that, since 2006, has been without a confirmed leader. Her position, overseeing a $1 trillion agency that administers health benefits to millions, has long been considered too politically volatile to fill (Kliff, 5/15).

The Wall Street Journal: Senate Confirms Tavenner To Health Agency
Medicare and Medicaid have lacked a Senate-confirmed leader since 2006, when Republican appointee Mark McClellan left. Lawmakers from both sides of the aisle have said it is important to have a confirmed Medicare chief to implement the health law, which will allow currently uninsured Americans to sign up for health insurance starting in October. Coverage won't be effective until January (Dooren, 5/15).

Politico: Marilyn Tavenner Approved By Senate For CMS Post
The seven who voted no are Republican Sens. Mike Crapo and Jim Risch of Idaho, Ted Cruz of Texas, Ron Johnson of Wisconsin, Mike Lee of Utah, and Rand Paul and Minority Leader Mitch McConnell of Kentucky. McConnell said the CMS job has too much responsibility for implementing the health law (Haberkorn and Cunningham, 5/15).

Medpage Today: Tavenner Confirmed As Medicare Chief
The office of CMS administrator has been plagued by political turmoil for years, especially since President Obama took office and health reform began playing a more prominent role in public policy. Republicans blocked the nomination of Tavenner's predecessor, Donald Berwick, MD, following comments he made praising aspects of the British healthcare system. Tavenner, a Virginia native, has worked for the past 3 years as CMS' principal deputy administrator before becoming acting administrator following Berwick's departure (Pittman, 5/15).

The Hill: Senate Votes 91-7 To Confirm Tavenner To Head Medicare, Medicaid Services
The Senate confirmed President Obama's nominee to head the Centers for Medicare and Medicaid Services (CMS). On Wednesday, the Senate voted 91-7 for Marilyn Tavenner to lead CMS, which hasn’t had a Senate-confirmed administrator in seven years (Cox, 5/15).

Huffington Post: Marilyn Tavenner Confirmed As Medicare Chief
The Senate had declined to vote on Tavenner's nomination during Obama's first term and failed to vote on Obama's prior nominee, Donald Berwick, or Bush's nominee Kerry Weems. The Centers for Medicare and Medicaid Services already provide health care benefits to more than 100 million Americans and have a budget rivaling the Pentagon's. The agency's role is growing as the Obama administration implements the health care reform law, which will reduce the number of uninsured Americans by an estimated 25 million by 2023. As head of the agency, Tavenner is charged with carrying out key elements of Obamacare, including its expansion of Medicaid (Young, 5/15).

Repeal Votes Offer Important Campaign Trail Symbol For Some Republicans

Thu, 16 May 2013 14:09:00 GMT

Many GOP lawmakers see today's scheduled vote to repeal the health law as important to their campaign trail messaging.

The Washington Post: Voting To Repeal, Over And Over
Since Republicans took control of the House of Representatives in 2011, the House has voted 36 times to repeal either all, or part, of President Obama’s health care law. On Thursday, the House is scheduled to do it again, taking up another bill that would repeal the health care law in full. With number 37 on the way, here are the details of the first 36 votes (Fahrenthold and O’Keefe, 5/15).

Politico: Obamacare Repeal Central For GOP Primary Field
Republicans know their repeal votes on Obamacare are symbolic — but repeal remains a potent GOP message on the campaign trail for the 2014 midterm elections. GOP politicians running for Senate in states like Georgia and Louisiana have been burnishing their Obamacare repeal credentials for months. Some of the Senate candidates are trying to outdo primary opponents in showing how determined they are to roll back the unpopular law. Others hope anti-Obamacare sentiment will let them pick up seats in November that are now held by Democrats, like the one being vacated in Montana by retiring Senate Finance Committee Chairman Max Baucus, who helped write the 2010 health care law (Cunningham, 5/15).

The Hill: House Set To Vote On ObamaCare Repeal
The House will vote Thursday to repeal President Obama's healthcare law — a move Republicans hope will open the door to narrower votes to target specific parts of the law. GOP leaders scheduled the vote in a concession to conservative freshmen, who were not yet in Congress for the House's previous 36 votes to repeal or defund all or part of the Affordable Care Act (Baker, 5/16).

Appeals Court To Hear Liberty University Health Law Challenge

Thu, 16 May 2013 13:43:27 GMT

The 4th U.S. Circuit Court of Appeals in Richmond, Va., will hear arguments on Thursday related to the lawsuit brought by the Christian university.

The Associated Press/Washington Post: Appeals Court In Va. To Hear Christian University's Suit Against Obama Health Care Law
Liberty University's challenge to the Obama administration’s health care law is back before a federal appeals court in Virginia. A three-judge panel of the 4th U.S. Circuit Court of Appeals in Richmond hears arguments in the case Thursday. Liberty claims the health care law violates the school's religious freedoms. The Christian university is challenging the requirement that most people obtain health insurance or pay a penalty, as well as provision requiring many employers to offer health insurance to their workers (5/15).

Politico: Liberty Still Pushing Its Challenge To Obamacare
Liberty University's challenge to the health reform law will go back before the 4th Circuit Court of Appeals in Richmond, Va., on Thursday, with the school focused on getting Obamacare back before the Supreme Court. Liberty's lawsuit is the most wide ranging of the outstanding legal challenges to the health law, hitting everything from contraceptive coverage to the employer mandate (Haberkorn, 5/15).

And, from Texas -

The Texas Tribune: GOP Donor Releases Songs Opposing "Obamacare"
He's already a Houston physician, Republican campaign donor, radio talk show host and litigant in a federal lawsuit against the roll-out of "Obamacare." Now Dr. Steve Hotze may be adding aspiring pop star to that list. Hotze, an ally of top state leaders who has contributed hundreds of thousands of dollars to their campaigns, has cut two songs about his opposition to federal health reform (Ramshaw, 5/15).

In Many State Legislatures, The Medicaid Expansion Saga Continues

Thu, 16 May 2013 13:43:03 GMT

News outlets offer updates on the future of uncertain Medicaid expansion plans in Texas and Arizona as well as a progress report from California.

The Texas Tribune: An Update On Medicaid Expansion
We've highlighted Medicaid expansion in Texas a couple of times during the legislative session, from those hoping to pick up Medicaid coverage to lawmakers for and against Texas joining in the Affordable Care Act program. State Rep. John Zerwas, R-Simonton, worked this session to pass legislation that would let the state negotiate with the federal government on expansion. His final bill got out of committee but didn’t get to the House floor before last week’s deadlines (Philpott, 5/15).

The Texas Tribune: Budget Deal May Not Come Until Thursday
Budget negotiations stretched late into the night on Wednesday, but lawmakers said privately they didn’t expect to announce a deal until Thursday. House Appropriations Chairman Jim Pitts said earlier in the evening that lawmakers were working to resolve some "pending items" and that he hoped to secure a deal by midnight (Aaronson and Batheja, 5/15).

Arizona Republic: Senate Debates Brewer's Plan To Expand Health Care Program For Poor Today
Dueling rallies at the Capitol on Wednesday over expansion of Medicaid eligibility foreshadowed what’s expected to be a long, vitriolic fight today in the state Senate about the future of Arizona’s health care program for the poor. Gov. Jan Brewer’s Medicaid plan is expected to be offered as an amendment to a budget-related bill during debate on the fiscal 2014 spending plan, which is scheduled to begin this morning, officially putting the enormous health care policy package in play and moving the governor one step closer to realizing her top legislative priority (Reinhart, 5/16).

KQED/State Of Health: Brown Backs State-Run Medi-Cal Expansion
Gov. Jerry Brown’s revised budget plan is a mixed bag for health advocates and some county officials. Brown said the state would take the lead on a key provision of the federal health law — expanding Medi-Cal to more than one million Californians. Brown scrapped earlier plans to consider a more complicated, county-based system. But Brown anticipates recouping more than $300 million from the counties next fiscal year – money that pays for public health programs and care for the uninsured. Brown’s rationale? With the full implementation of federal health reform next year, more people will enroll in Medi-Cal and fewer people will show up to county emergency rooms (Kim, 5/15).

California Healthline: State Still Looks To Dun County Funds In Medi-Cal Expansion Proposal
The optional expansion of Medi-Cal will be administered using a state-based approach rather than the county-based plan being considered by California officials, the governor said yesterday when he proposed his May revise, the mid-year revision of the state budget. That comes as welcome news to county health officials who have cautioned for months that a county-based system would be more confusing and costly than a state-based approach (Gorn, 5/15).

California Healthline: What The Oregon Study Says (Or Doesn't) About Medicaid
The results of the so-called Oregon Health Study, which appeared in the New England Journal of Medicine earlier this month, prompted a firestorm of commentary from health care and health policy experts. Many health care blogs have weighed in on the study, and a deep gulf has emerged between those who think the findings confirm the mission of the Affordable Care Act to expand Medicaid and those who think the results are proof that the program is ineffective (Wayt, 5/15).

HHS To Pay $1 Billion For Ideas To Drive Down Health Costs

Thu, 16 May 2013 13:41:55 GMT

The availability of a second round of grants -- funded by the health law -- was announced to support approaches to reduce costs and improve care. The initial round, announced last year, funded 107 organizations.

CBS News: Gov't To Pay $1 Billion For Innovative Health Care Ideas
The U.S. government will award up to $1 billion in grants for innovative health care ideas that drive down medical costs, the Department of Health and Human Services (HHS) in conjunction with the Centers for Medicare & Medicaid Services (CMS) announced Wednesday. On a conference call with reporters, HHS secretary Kathleen Sebelius said the country has made strides in reducing medical costs, and national health care spending has fallen to a 50-year low. However, she said there is still more to do (Jaslow, 5/15).

CQ HealthBeat: Innovation Center Plans Second Round Of Grants
The Center for Medicare and Medicaid Services Innovation Center is preparing to distribute $1 billion in grants for projects designed to improve care and lower costs for federal health programs, agency officials said Wednesday. The second round of grants follows an initial round that was announced last year. At that time, 107 organizations received funding from a total pot of $895 million (Adams, 5/15).

Meanwhile, Medpage Today reports on ACOs -

Medpage Today: Doc-Led ACOs Better Model For Saving $
Physician-led accountable care organizations (ACOs) could have more opportunities to create savings in patient care with a little help from health insurers, a leading health reform expert said Wednesday. Doctor-centric ACOs can do a better job at controlling costs than hospital-led organizations, Paul Ginsburg, PhD, president of the Center for Studying Health System Change here, said at an ACO summit hosted by America's Health Insurance Plans. … Unlike in hospital-led ACOs, doctor-led ACOs aren't compromised financially by reducing hospital admissions and emergency department visits, he pointed out (Pittman, 5/15).

Weekend Reading: Volunteers In The Battle With Heart Disease

Thu, 16 May 2013 13:39:00 GMT

Every week reporter Ankita Rao selects interesting reading from around the Web.

The Atlantic: Lost In Medication
Psychiatrists who take time with their patients are not the norm. It's not because others don't care. Rather the system rewards efficiency, not empathy ... I treated a patient who had suffered from schizophrenia for years. He had finally achieved some stability on a cocktail of antipsychotic medications as he was passed along through the clinic, year after year ... One day, though, he showed up for his appointment looking completely different. His complaints had nearly disappeared; he was cheerful, optimistic. ... Inquiring about what had changed, I found out that with the assistance of the hospital work program, he had gotten a job for the first time in nearly 30 years. … In many places psychiatry has become a biological enterprise, with some psychiatrists even introducing themselves as "psychopharmacologists." In no other specialty does a physician define themselves by the medication that they use (Sarah Mourra, 5/10).

The New Republic: My Five Obamacare Anxieties
Conservatives are talking about the implementation of Obamacare in the same thoughtful way they talked about its enactment—that is, as an impending apocalypse. It won't be, as I've noted previously. Most Americans get insurance through employers, Medicare, and Medicaid, and that will still be the case on January 1, when Obamacare's big provisions take effect. But the minority who buy insurance on their own or have no insurance will see tremendous changes. And you don't have to be Rush Limbaugh to have real concerns about how those changes will play out (Jonathan Cohn, 5/13).

The Fiscal Times: Why The IRS Scandal Could Bring Down Obamacare
The Internal Revenue Service's scandalous targeting of Tea Party-themed and other conservative groups could severely damage President Obama – but it's not necessarily because anyone close to the White House sanctioned the allegedly independent actions by the tax collection agency. ... The real fallout could be that it will impede Obamacare, ... The IRS will largely administer this attempt at providing near-universal health insurance. It is responsible for overseeing the tax credits and tax increases in the law, and—most critically—ensuring that businesses and individuals comply with the individual mandate and other major provisions. Prominent Republicans are already connecting the unpopular insurance program to the questions swirling around the IRS (Josh Boak and Eric Pianin, 5/14).

The Weekly Standard: Eggs For Sale?
If you want to know what's going to go wrong in the culture, read the professional journals. A case in point: An article in the April 10 New England Journal of Medicine called for the creation of a commodities market for "made-to-order" human embryos. The authors, I. Glenn Cohen and Eli Y. Adashi—university professors, of course—treat embryos as the equivalent of a prize cattle herd. They note that sperm and eggs are already bought and sold for in vitro fertilization (IVF) and, further, that New York legalized buying eggs for use in biotechnological research a few years ago. Hence, "it is not clear" (an oft-used phrase in bioethical advocacy that frees the author from actually having to prove a point) why we should not also allow companies to make "made-to-order embryos" for profit, since that activity would be "more similar to the sale of gametes than the sale of children" (Wesley J. Smith, 5/14).

The New York Times: Seeking Clues To Heart Disease In DNA Of An Unlucky Family
Researchers have long known that a family history of early death from heart disease doubles a person's risk independently of any other factors. Family history is defined as having a father or a brother who were given a diagnosis of heart disease before age 55 or a mother or sister before age 65. Scientists are studying the genetic makeup of each member of the Del Sontro family, searching for telltale mutations or aberrations in the long sequence of three billion chemicals that make up human DNA. Until very recently, such a project almost certainly would have been futile. Picking through DNA for tiny aberrations was so costly and time-consuming that it was impractical to take on for an entire family (Gina Kolata, 5/12).

The New Yorker: Can We Patent Life?
On April 12, 1955, Jonas Salk, who had recently invented the polio vaccine, appeared on the television news show "See It Now" to discuss its impact on American society. Before the vaccine became available, dread of polio was almost as widespread as the disease itself. Hundreds of thousands fell ill, most of them children, many of whom died or were permanently disabled. The vaccine changed all that, and Edward R. Murrow, the show's host, asked Salk what seemed to be a reasonable question about such a valuable commodity: "Who owns the patent on this vaccine?" Salk was taken aback. "Well, the people," he said. "There is no patent. Could you patent the sun?" ... It took thousands of scientists and technicians more than a decade to complete the Human Genome Project, and cost well over a billion dollars. The same work can now be carried out in a day or two, in a single laboratory, for a thousand dollars—and the costs continue to plummet. As they do, we edge closer to one of modern science's central goals: an era of personalized medicine, in which an individual’s treatment for scores of illnesses could be tailored to his specific genetic composition. That, of course, assumes that we own our own genes (Michael Specter, 4/2).

The National Journal: How Much Big Insurance Paid A Small-Business Group To Fight A Premium Tax
The nation's leading health insurance industry group gave $850,000 to a top small-business trade association as part of a campaign to repeal a key provision of President Obama’s health care law, National Journal Daily has learned (Frates, 5/14).

Viewpoints: When A Doctor Should Keep Quiet; 2 Views Of Hospital Pricing; Stem Cell 'Snake Oil'

Thu, 16 May 2013 13:31:57 GMT

Los Angeles Times: For A Dying Patient, A Prescription Of Silence
In medical school, we were taught not to withhold information from our patients or to be "paternal" in making decisions for them. We internalized the idea that fully informed patients are better equipped to make treatment decisions. And with patients likely to die of their diseases, discussing the prognosis frankly would allow them to say goodbyes, get things in order and prepare advanced directives for what kind of interventions they did and didn't want. But Pedro's wife was adamant. "He will lose his will to live if he knows he has cancer. And he will then die even sooner" (Susan Partovi, 5/16).

USA Today: Hospital Pricing Gouges Patients: Our View
Shouldn't you be able to see the price of something before you buy it, so you can shop for value or simply figure out whether you can afford it? Before you roll your eyes and say, "Of course," think about the last time you bought medical care, especially in a hospital. See any price lists on the wall? Probably not. And, if you had, you might have fainted on the spot (5/15).

USA Today: Hospital Billing Too Complex: Another View
Many parts of America's health care delivery and financing systems urgently need updating, and the matter of "charges" ranks high on the list. Today's hospital bill is a symptom of a broken payment system. Hospitals deal with more than 1,300 insurers, each having different plans with multiple requirements for hospital bills. Decades of federal regulations have made a complex billing system even more complex and frustrating for everyone involved (Rich Umbdenstock, 5/15).

USA Today: Beware Of Stem Cell Therapy Claims
A stem cell transplant can help cure patients with acute myeloid leukemia, and research has shown incredible potential, from growing teeth to mending "unhealable" bone fractures. Still, stem cells are poorly understood. Despite this, as (Ferris) Jabr writes, many cosmeticians continue to claim that stem cells are a cure-all for "everything from wrinkles to joint pain to autism." Until we understand them better, stem cells are the new snake oil peddled by 21st century charlatans. Thankfully, the Food and Drug Administration is cracking down (Alex Berezow, 5/15).

JAMA: Accountable Care Organizations: Accountable For What?
Dr Robert Potenza and Dominica Potenza, partners in life and in work, are, respectively, a cardiologist and a registered nurse who have a cardiology/internal medicine practice in the Bronx. … In theory, continuity of care should be improving at Montefiore, one of 32 Pioneer Accountable Care Organizations (ACOs) that aim to become models for improving population health while lowering costs. Montefiore has been acquiring physicians' practices to expand its primary care capacity, but the Potenzas are reluctant to join, fearing they'll lose what control they have over the personalized care they give their patients (Diana Mason, 5/15).

Columbus Dispatch: Expanding Medicaid Would Help In Fight Against Breast Cancer
As a seven-year breast-cancer survivor, I know how important annual screening can be. I was diagnosed with Stage IIa breast cancer on a routine mammogram. ... I was lucky and had very adequate health insurance, yet my personal cost remained over $6,000. While expanding Medicaid in Ohio would seem counterintuitive as a cost-saving measure, we must sometimes view Medicaid dollars spent as a long-term investment in Ohio and enable Ohioans to realize the savings. Screening to capture cancer at the earliest possible stage reduces the costs of treatment and improves mortality (Tammy Weis, 5/16).

Bloomberg: U.S. Must Fight Harder Against TB
While USAID's TB budget is being slashed, public-health spending on tuberculosis in the U.S. is also being cut. On top of belt tightening from sequestration, the administration of Barack Obama has been pillaging money from the U.S. Department of Health and Human Services’ Prevention and Public Health Fund, which goes to efforts such as immunizations, health screenings and smoking prevention. ... Almost all TB specialists in the U.S. work in public clinics and hospitals. Many patients, being either uninsured or underinsured, have nowhere else to go for their treatment. Even after the Affordable Care Act is fully in place, public TB clinics will remain important safety nets for undocumented immigrants and legal immigrants who don’t yet qualify for public services. It's safe to assume that cuts in public health funding will have the same effect we saw in the early 1990s after earlier reductions: Many patients will be inadequately treated, allowing greater transmission of TB and the emergence of multidrug-resistant strains (Celine Gounder, 5/15).

Tampa Bay Times: Fight On Prescription Drug Abuse Not Over
Once local law enforcement and the Florida Legislature finally committed to addressing prescription drug abuse, it made a difference. The welcome news that prescription drug deaths in the Tampa Bay area are down 30 percent since 2010 is surely a result of a focus on unscrupulous pain clinics and easy access to pills. But there is more work to be done, and boosting the state's still-tepid commitment to a prescription drug database is the place to start (5/14).

New England Journal Of Medicine: The Role Of The NIH In Nurturing Clinician-Scientists
The awarding of the 2012 Nobel Prize in Chemistry to Robert Lefkowitz and Brian Kobilka, both M.D.s trained in cardiology, for their work on characterizing the structure and function of beta-adrenergic receptors, should remind us of the critical role that clinician-scientists have played in formulating the seminal concepts that govern modern biomedical science. Much has been written since the 1970s about the demise of the physician-scientist -- as evidenced by the declining share of RO1 grants that the National Institutes of Health (NIH) awards to physicians -- and the economic factors that have driven physicians away from the laboratory and research clinic into more remunerative clinical practice (Dr. Michael Gottesman, 5/15).

First Edition: May 16, 2013

Thu, 16 May 2013 11:20:00 GMT

Today's headlines detail the Senate confirmation of Acting Chief Marilyn Tavenner to run the Centers for Medicare & Medicaid Services.

Kaiser Health News: Capsules: Docs, Nurses Disagree Over Expanded Nurse Roles
Now on Kaiser Health News' blog, Alvin Tran reports: "As nurse practitioners lobby to expand their authority and scope of practice in many states, a New England Journal of Medicine study released Wednesday documents a deep chasm between doctors and nurses on that issue" (Tran, 5/15). Check out what else is on the blog.

The Washington Post: Voting To Repeal, Over And Over
Since Republicans took control of the House of Representatives in 2011, the House has voted 36 times to repeal either all, or part, of President Obama’s health-care law. On Thursday, the House is scheduled to do it again, taking up another bill that would repeal the health care law in full. With number 37 on the way, here are the details of the first 36 votes (Fahrenthold and O’Keefe, 5/15).

The Wall Street Journal: House Republicans Air Budget Ideas, Prepare For Fall Confrontation
The chairman of the House tax-writing committee has been laying the groundwork for advancing an overhaul of the tax code to scale back deductions and reduce rates. … Another idea gaining popularity among some Republicans is to delay implementation of the president's health-care law, which the House is expected to vote to repeal on Thursday. Rep. Steve Scalise (R., La.), chairman of the Republican Study Committee, an influential group of 171 conservative House lawmakers, said he liked the idea of delaying the implementation of health law's insurance exchanges and expansion of Medicaid for at least two years. ‪ … Other Republicans argued that the party should stick with its longstanding position that increases in the debt ceiling should be matched with spending cuts or by overhauling federal safety-net programs (Peterson and Hook, 5/15).

The Associated Press/Washington Post: Expected Retiree Medical Expenses Fall In 2013, But Still Outpace Many Americans’ Estimates
After years of increasing health care costs, the outlook is improving for seniors worried about paying their medical bills during retirement. For the second time in the last three years, estimated medical expenses for new retirees have fallen, according to a study released Wednesday by Fidelity Investments. A 65-year-old couple retiring this year would need $220,000 on average to cover medical expenses, an 8 percent decrease from last year's estimate of $240,000. The study assumes a life expectancy of 85 for women and 82 for men (5/15).

The Wall Street Journal’s Total Return: Retiree Health Costs Get Cheaper
Here’s a twist: Health-care expenses should cost 8% less for a 65-year-old couple retiring this year compared with last year, according to new research by Fidelity Investments. A 65-year-old couple retiring in 2013 is estimated to need $220,000 to cover medical expenses throughout retirement, assuming that they are enrolled in traditional Medicare coverage, Fidelity says (Greene, 5/15).

Los Angeles Times: For First Time, Stem Cells Are Produced From Cloning Technique
For the first time, scientists have created human embryos that are genetic copies of living people and used them to make stem cells — a feat that paves the way for treating a range of diseases with personalized body tissues but also ignites fears of human cloning. If replicated in other labs, the methods detailed Wednesday in the journal Cell would allow researchers to fashion human embryonic stem cells that are custom-made for patients with Alzheimer's disease, diabetes and other health problems (Healy, 5/15).

NPR: Cloning, Stem Cells Long Mired In Legislative Gridlock
The news that U.S. scientists have successfully cloned a human embryo seems almost certain to rekindle a political fight that has raged, on and off, since the announcement of the creation of Dolly the sheep in 1997. "The issue of legislation on human cloning is about to get hot again," says Hank Greely, director of the Center for Law and the Biosciences at Stanford Law School (Rovner, 5/16).

The New York Times: North Dakota’s Sole Abortion Clinic Sues To Block New Law
The running battle over the regulation of abortions entered a North Dakota courtroom on Wednesday, as the state’s sole abortion clinic sued to block a new law that it says could force it to shut down. The law, requiring doctors performing abortions to have admitting privileges at a nearby hospital, was promoted by anti-abortion legislators, who argued that it would mean better care for women who suffer medical emergencies (Eckholm, 5/15).

Los Angeles Times: 13 Healthcare Workers Arrested In Protest At UC Regents Meeting
Thirteen people were arrested Wednesday at the UC regents meeting during a sit-down protest by healthcare workers threatening to strike at the system's medical centers. The University of California regents left during the protest while UC police cleared the room, handcuffing the protesters and leading them out of the hall at the Sacramento Convention Center (Gordon, 5/15).

Check out all of Kaiser Health News' e-mail options including First Edition and Breaking News alerts on our Subscriptions page.