Kaiser Health News - Marketplace

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).

Patient And Physician Prescribing Information A Powerful Aide In Drug Marketing

Fri, 17 May 2013 13:33:10 GMT

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).

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).

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).

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).

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).

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 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 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).

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: 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/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).

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Retiree Medical Expenses Fall, But They Still Exceed Most People's Expectations

Thu, 16 May 2013 13:43:00 GMT

A study released by Fidelity Investments estimated that a couple, who are enrolled in traditional Medicare and retiring in 2013, will need $220,000 to cover medical costs throughout their retirement.

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).

State Roundup: N.D. Abortion Clinic Sues To Stop New Law

Thu, 16 May 2013 13:42:00 GMT

A selection of health policy stories from North Dakota, Connecticut, California, Massachusetts, Texas, Oregon, Oklahoma and North Carolina.

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).

CT Mirror: Big Health Care Savings Help Counter Shrinking State Budget Revenues
State officials trying to close a last-minute hole in the next budget got some good news Wednesday in the form of major savings in health care costs for retired state employees. The Legislature’s nonpartisan Office of Fiscal Analysis issued a memo indicating it has reduced its projected cost of providing health care to retired state workers in the fiscal year that begins July 1 by $140.6 million, and in 2014-15 by $166.5 million. The nonpartisan office is boosting the projected health care costs for current employees by $46.7 million in the next budget and by $36.4 million in 2014-15, but the net savings over the next two years still totals $224 million (Phaneuf, 5/15).

HealthyCal: Counties Still Not Prepared To Offer Expanded Mental Health Care
More than one million people in California suffer from mental illness -- the largest number of any state. When the final phase of the new federal health care law starts in January of next year, more California residents than ever before will be able to seek help for problems ranging from depression, anxiety, and addiction to schizophrenia and bipolar disorder. But mental health providers in the state’s Central Valley are unprepared for an influx of thousands of patients (5/16).

Boston Globe: State Health Insurers Post Mixed Financial Results
The state’s biggest health insurers reported mixed first-quarter financial results Wednesday, with two notching income gains, one registering lower earnings, and one posting a loss. While all of the health insurance companies said they were working to hold down premiums as they rolled out new products and shifted doctors and hospitals to risk-sharing payments, each cited unique factors influencing financial performance in the three months ending March 31 (Weisman, 5/15).

Los Angeles Times: 13 Health Care Workers Arrested In Protest At UC Regents Meeting
Thirteen people were arrested Wednesday at the UC regents meeting during a sit-down protest by health care 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).

The Texas Tribune: Senate Backs Bill On Psychotropic Drugs For Foster Kids
Lawmakers in both chambers have now endorsed legislation that would require guardians of foster children to take greater caution before giving psychotropic drugs to the children. The Senate on Wednesday approved a version of the "informed consent" measure that is slightly different than the one approved by the House in April (Aaronson, 5/15).

Lund Report: Oregon House Passes Assessments For Hospitals And Nursing Facilities
The House passed assessment taxes on hospitals and long-term care facilities by a wide 54-5 margin Tuesday, ensuring Oregon’s health and human service budgets will raise over a billion dollars from providers in coming years and leverage $1.4 billion from the federal government next biennium for Medicaid. Hospitals are compensated for their assessments with higher reimbursements for the Oregon Health Plan while nursing homes are paid for the use of their beds by Medicaid patients. … House Bill 2216 extends an expanded hospital assessment of 5.32 percent for two years. A previous bill, House Bill 2056, was attached to that version, which extends the long-term care facility assessment for six years, while expanding it to include all nursing homes except the Oregon Veterans Home (Gray, 5/15).

Lund Report: Single-Payer Activists Keep Dream Of Universal Health Care Alive In Oregon
Wes Brain was uninsured last winter when a tonsillectomy showed signs of throat cancer. He qualified for the high-risk Oregon Medical Insurance Pool, which the state has administered through Regence BlueCross BlueShield. But gaining access to that insurance soon proved a big obstacle for the Ashland resident, when Regence erroneously told him he hadn't submitted his driver's license. … Eventually, his policy was approved. He paid $2400 -- three month’s premium. His doctor ordered a PET scan for March 1. But then Regence came back and told him no, he’d have to wait until March 1 to even begin authorization (Gray, 5/15).

Stateline: Oklahoma's "Life-Preserving" Law Raises Questions For Doctors
University of Tulsa law professor Marguerite Chapman has been studying end-of-life issues in Oklahoma for three decades and has come to a conclusion: "It's getting almost to the point that you need a government permit in order to die in this state." Certainly, dying has gotten a lot more complicated here, the result of a unique measure passed by the Oklahoma legislature and signed into law last month by Republican Gov. Mary Fallin. Modeled after legislation written by the National Right to Life Committee, the law says that patients who are disabled, elderly or terminally ill cannot be denied life-preserving treatments if they or their health proxies want it (Ollove, 5/16).

North Carolina Health News: Bill To Compel Insurers To Cover Autism Treatment Advances
For kids with autism in North Carolina, it’s possible to get insurance coverage for the process of diagnosing the developmental disorder. But for the bulk of those kids, getting an insurance company to cover treatment is another matter (Hoban, 5/15).

Oregonian: Mental Health Staff In Oregon Prison System Push For Big Raises
A group of unionized mental health workers in the Oregon state prison system wants a pay raise that even they acknowledge is big enough to cause a public relations problem. About 50 mental health specialists who handle inmates with addictions and other mental health problems want to be reclassified because their job descriptions have changed, including a requirement of a master's degree. Under their current proposal, they're seeking raises between 25 percent and 26 percent, which would result in a maximum salary of more than $80,000, according to a memo obtained by The Oregonian (Esteve, 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: 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 and the challenges she will face (5/15). Listen to the audio or read the transcript.

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 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).

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).

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 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 (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).

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).

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).

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89 Arrested In $223 Million Medicare Fraud Schemes

Wed, 15 May 2013 14:01:00 GMT

Doctors and nurses were among those charged in the bust that spanned eight cities and focused on bogus Medicare charges.

The Associated Press/Washington Post: Doctors And Nurses Among Nearly 100 Charged In $223 Million Medicare Fraud Busts In 8 Cities
Nearly 100 people, including 14 doctors and nurses, were charged for their roles in separate Medicare scams that collectively billed the taxpayer-funded program for roughly $223 million in bogus charges in a massive bust spanning eight cities, federal authorities said Tuesday. It was the latest in a string of similar announcements by Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder as federal authorities crack down on fraud that's believed to cost the program between $60 billion and $90 billion each year (5/14).

Reuters: U.S. Charges 89 People In $223 Million Medicare Fraud Schemes
Federal officials charged 89 people including doctors, nurses and other medical professionals in eight U.S. cities on Tuesday with Medicare fraud schemes that the government said totaled $223 million in false billings. In the latest big Medicare fraud crackdown, more than 400 law enforcement officers including FBI agents fanned out in Miami, Detroit, Los Angeles, New York and other cities to make arrests (Morgan, 5/14).

McClatchy: 89 Arrested In Crackdown By Medicare Fraud Strike Force
Doctors, nurses and other licensed medical professionals were among 89 people recently arrested in nine cities, accused of scheming to defraud the Medicare program of nearly $223 million in false billings, the Obama administration announced Tuesday. The defendants face charges of conspiracy to commit health care fraud, money laundering and violating federal anti-kickback statutes for submitting claims to Medicare for purchases, treatments and services that, according to federal officials, either were medically unnecessary or never provided (Pugh, 5/14).

The Hill: Feds Tout Medicare Fraud Bust
The Obama administration announced Tuesday that 89 people in eight cities have been charged with about $223 million in false Medicare billings. The action is part of a federal initiative against Medicare fraud that has yielded six "takedowns" since 2010, officials said (Viebeck, 5/14).

Hospitals: Calif. Bidding War Intensifies; Va. System Eyes Children's Facility

Wed, 15 May 2013 13:25:00 GMT

The business of hospitals makes news in California -- where sides are engaged in a bidding war to buy a famed Santa Monica hospital; Virginia -- where pediatricians eye a new children's hospital; and Oregon, where lawmakers passed a new hospital tax.

Los Angeles Times: St. John's Bidding War Escalates
A high-stakes bidding war has erupted for St. John's Health Center, a storied Santa Monica hospital, with a local billionaire teaming up with the Roman Catholic Archdiocese of Los Angeles on an unsolicited offer. The latest bid, expected to be formally announced Wednesday, comes from former drug-company executive and health care entrepreneur Patrick Soon-Shiong, who said in a statement the bid has the support of the archdiocese (Terhune, 5/15).

Richmond Times-Dispatch: Pediatricians Work Toward Children’s Facility
In the past three years, Bon Secours Virginia Health System has boosted the number of pediatric specialists in its physician network to 77, probably double what it was before, as its builds its St. Mary’s for Kids brand. … The "hope" he refers to is the prospect that Richmond will one day have an independently operated, free-standing children’s hospital that would consolidate most pediatric care in the region under that facility’s umbrella. For such an entity to stand a chance of financial success in Richmond, the major hospital systems -- Bon Secours, VCU Health System and HCA -- would have to stop offering most pediatric services at their hospitals (Smith, 5/15).

Oregonian: Oregon House Passes Hospital Tax, But It’s Still Part Of Senate PERS Debate
The Oregon House approved a major piece of the Oregon Health Authority’s budget Tuesday, including provisions extending taxes on hospitals and long-term care facilities, but the bill appears destined to be held up by Senate Republicans. The two taxes were drawn into a larger debate over taxes and public pension spending last week after Republicans cast protest votes against House Bill 2216 in the Legislature’s budget committee (Gaston, 5/14).

Angelina Jolie's Choice Underscores Screening And Treatment Costs

Wed, 15 May 2013 13:25:00 GMT

News outlets report on the cost of and questions surrounding Angelina Jolie's decision to have genetic testing and then to undergo a double mastectomy as preventive surgery.

Marketplace: The Cost Of Angelina Jolie’s Cancer Testing? More Than $4,000
Angelina Jolie wrote an Op-Ed in today's New York Times about her decision to have a double mastectomy. The actress didn't have breast cancer, but tests showed she had almost a 90 percent chance of developing it. The key was finding a mutation in a gene known as BRCA-1, and Jolie appealed for the test to be made more accessible to women around the world. At the moment, if you want to get tested for a mutation on your BRCA-1 or BRCA-2 genes, you will have to turn to Myriad Genetics. That's the company that discovered the link between those mutations and an elevated risk cancer -- and it patented the BRCA-1 and BRCA-2 genes. The price tag on a BRCA-1 and BRCA -2 test? More than $4,000 (Smith, 5/14).

Boston Globe: Angelina Jolie’s Preventive Surgery Shows Harsh Choices
Actress Angelina Jolie made a wrenching choice after a blood test detected a genetic defect that made breast cancer all but certain in her lifetime: She opted to have her breasts surgically removed. Her decision starkly highlights the less-than-ideal options available to women confronting a similar diagnosis. … Preventive surgery to remove the breasts and ovaries can dramatically reduce lifetime risk of getting these cancers to 5 percent or less. But those measures also mean an often long and painful recuperation from surgery as well as long-term consequences, such as reduced sexual pleasure and early menopause. … The $3,000 cost of the screening test may be an “obstacle for many women” without health insurance, as Jolie mentioned in her column, published Tuesday in The New York Times (Kotz, 5/15).

Kaiser Health News: Capsules: Angelina Jolie, Genetic Testing, And The ACA
Dr. Otis Brawley, the chief medical officer of the American Cancer Society, is on the record with a quick post on Angelina Jolie's startling announcement in a New York Times op-ed that she has had a prophylactic double mastectomy to cut her inherited risk of breast cancer. Jolie's mother, actress Marcheline Bertrand, died of cancer at age 56, and Jolie found through genetic testing that she carries the BRCA1 gene. Brawley, who has been an outspoken critic of overtesting, answers many important questions that Jolie's decision raises (Webber, 5/14).

Calif. Health Exchange Awards $37 Million For Health Law Education Efforts

Wed, 15 May 2013 13:24:00 GMT

The grants will go to 48 organizations to help the state explain benefits, show consumers how to access insurance and encourage small businesses to participate.

Los Angeles Times: California Health Insurance Exchange Announces Grants
Covered California, the state's health insurance exchange, announced $37 million in grants Tuesday to begin the massive task of educating millions of Californians about the new healthcare law. The grants will go to 48 organizations, including universities, nonprofit groups, health foundations and unions. They will help state officials explain the new benefits, show people how to access insurance, and encourage small businesses to enroll (Gorman, 5/14).

CQ HealthBeat: Health Insurance Exchange Helpers Prepare In California
When enrollment in the health care law’s new insurance exchanges opens in October, the prospects for success will turn on a crucial element: people who actually understand health insurance coverage and can explain it in plain language to consumers. Many Americans who will be signing up may never have had insurance in the past or aren’t fluent in English or might have trouble figuring out which plan will be best for their pocketbook and health condition (Norman, 5/14).

And in Maryland -

The Associated Press/Washington Post: State Officials Urge Faith Leaders To Spread Word About New Health Insurance Options
Maryland health advocates urged religious leaders on Tuesday to learn more about how federal health care reform will be implemented in the state so they can pass information on to uninsured congregants. About 150 leaders gathered for the first summit of its kind in the state (5/14).

State Roundup: Veto Of Medical Charity Tax Break Scrutinized In Ga.

Wed, 15 May 2013 13:23:00 GMT

A selection of health policy stories from California, Georgia, New York, Florida, California and Kansas.

Los Angeles Times: Gov. Jerry Brown Unveils Cautious Budget For Deficit-Free State
But Brown vowed to continue to resist pressure from fellow Democrats and interest groups to restore some money to adult dental care and to doctors who treat the poor. … Sacramento will oversee the expansion this year of Medi-Cal, California's health care program for the poor, to more than 1 million Californians who do not have health insurance now. Under Brown's plan, the newly insured would be offered the same benefits as those already covered by the public program, a shift from January. Then, the governor did not include stays in rehabilitation facilities and other long-term care for those who will become eligible for Medi-Cal for the first time next year (Megerian, 5/14).

Sacramento Bee: Gov. Jerry Brown Takes Cautious Approach On California Budget
Gov. Jerry Brown, dismissive of a surge in state tax revenue that stirred optimism at the Capitol, moved Tuesday to blunt appeals for increased spending, downgrading his budget proposal from January. The budget revision -- an annual exercise opening a month of negotiation with the Legislature -- threatened to strain Brown's relationship with Democratic lawmakers and with social service advocates who called Brown's estimates overly conservative and who are lobbying to restore programs cut during the recession (Siders, 5/14).

Georgia Health News: Veto Sidetracks Tax Break For Medical Charities
Among Gov. Nathan Deal’s five vetoes this year, probably the most surprising one targeted a bill that would have given sales tax breaks to charitable medical clinics, federally qualified health centers, food banks and other charities. The measure, House Bill 193, had overwhelming legislative support. It passed the House unanimously during the 2013 legislative session, and the Senate approved it 52-2. The legislation would have restored sales tax exemptions for community health centers and volunteer charity clinics – tax breaks that had sunset (expired automatically) in 2010 (Miller, 5/14).

The New York Times: Archbishop Presses Cuomo Over Abortion
Cardinal Timothy M. Dolan declined on Tuesday to say whether Gov. Andrew M. Cuomo was "a Catholic in good standing," as he ratcheted up his criticism of the governor's continued advocacy for abortion rights (McKinley, 5/14).

NPR: How A Florida Medical School Cares For Communities In Need
Brown helps direct FIU's Neighborhood HELP program. It's part of the school's curriculum that connects medical students with families in neighborhoods where medical care is scarce. Students visit families in their homes where they conduct examinations and provide basic care. But some things are better done in a clinic. So the medical school bought its own RV. "We're able to bring free basic primary care to our households relatively close to their community," Brown says (Allen, 5/15).

Health News Florida: Prescription Drug Deaths Drop In Tampa Bay
New data reveals the Tampa Bay area's prescription drug problem is on the decline. The number of accidental drug deaths in at least four local counties has dropped since 2010. Pinellas, Pasco, Hillsborough and Hernando counties have all seen a decline in drug overdoses over the last two years (Saleh, 5/15).

HealthyCal: Poor Health Care Moving From Prison To Jails
California’s sweeping criminal justice reform plan was meant to sharply reduce the state’s prison population. But the changes may have also had the unintended consequence of passing along to county jails the biggest problem associated with overcrowding -- poor health care. The reform, also known as prison realignment or AB 109, transferred authority for people convicted of certain non-violent felonies from the state to the counties in 2011 (Flynn, 5/15).

Kansas Health Institute: Kansas Drug Disposal Program Collects 6,000 Pounds Of Medications In First Year
Pharmacist Lori Murdock said she often heard the question even from people who weren’t her customers: How do we get rid of our old drugs? As the owner of Cedar Creek Pharmacy in this western Johnson County community, Murdock responded by signing up a couple months ago for the medication disposal program run by the Kansas Department of Health and Environment (Sherry, 5/14).

California Healthline: Stop-Loss Bill Heads For Senate Floor Vote
The Senate Committee on Appropriations yesterday approved a bill to ban a certain type of selection criteria when insurers issue stop-loss health care coverage to small employers. … The bill would end the practice of cherry-picking healthy employees from the pool of workers within small businesses by stop-loss insurers, said Beth Capell, legislative advocate for Health Access California (Gorn, 5/14).

Are The Health Law's Coverage Requirements Scaling Back Some Restaurants' Expansion Plans?

Wed, 15 May 2013 13:22:30 GMT

The Wall Street Journal: Health-Law Costs Slow Some Fast-Food Chains
Some restaurant operators are scaling back expansion plans because of uncertainty about the expense of insuring employees under the new federal health-care law. The concerns are especially acute among smaller operators who are more likely to be on the cusp of the Affordable Care Act's requirements for increased coverage of workers. The doubt is adding to anxiety over other rising costs for items like ingredients at a time when diners are cutting back on eating out (Jargon, 5/14).

Doctors Transform How They Practice Medicine

Wed, 15 May 2013 13:16:55 GMT

Kaiser Health News staff writer Ankita Rao reports: "The buzz, and anxiety, in the medical profession is palpable – trade magazines tout new coping strategies, doctor groups discuss the transformation of practices. Physicians are experimenting with business models and new practice techniques, hoping to find work that is both financially and personally rewarding" (Rao, 5/15). Read the story.

First Edition: May 15, 2013

Wed, 15 May 2013 11:33:15 GMT

Today's headlines include reports about how the latest Congressional Budget Office projections could further stall efforts to reach a grand bargain that includes changes to Medicare and other entitlement programs.

Kaiser Health News: Doctors Transform How They Practice Medicine
Kaiser Health News staff writer Ankita Rao reports: "The buzz, and anxiety, in the medical profession is palpable – trade magazines tout new coping strategies, doctor groups discuss the transformation of practices. Physicians are experimenting with business models and new practice techniques, hoping to find work that is both financially and personally rewarding" (Rao, 5/15). Read the story.

Kaiser Health News: Capsules: GOP Raises Concerns About 'Sebelius Shakedown'; Most Doctors Still Waiting On Medicaid Pay Raise; Angelina Jolie, Genetic Testing, And The ACA
Now on Kaiser Health News’ blog, Mary Agnes Carey reports on reactions from Republican lawmakers regarding health law fundraising activities: "Senate GOP leaders Tuesday took issue with Department of Health and Human Services Secretary Kathleen Sebelius for soliciting money from private groups to implement the law. Noting the Internal Revenue Service scrutiny of conservative political organizations, the Republicans also said the IRS can’t be trusted to implement the health law" (Carey, 5/15).

In addition, Phil Galewitz reports on the status of a much-awaited Medicaid pay raise: "Five months after primary care doctors who treat Medicaid patients were supposed get a big pay raise, most physicians have yet to see it. Only three states have implemented the pay raise — Nevada, Michigan and Massachusetts, according to the American Academy of Family Physicians" (Galewitz, 5/14).

Also on Capsules, Diane Webber reports on some questions and answers about genetic testing and inherited cancer risks: "Dr. Otis Brawley, the chief medical officer of the American Cancer Society, is on the record with a quick post on Angelina Jolie's startling announcement in a New York Times op-ed that she has had a prophylactic double mastectomy to cut her inherited risk of breast cancer. Jolie's mother, actress Marcheline Bertrand, died of cancer at age 56, and Jolie found through genetic testing that she carries the BRCA1 gene. Brawley, who has been an outspoken critic of overtesting, answers many important questions that Jolie's decision raises" (Webber, 5/14). Check out what else is on the blog.

The New York Times: U.S. Budget Deficit Shrinks Far Faster Than Expected
In revising its estimates for the current year, the budget office also cut its projections of the 10-year cumulative deficit by $618 billion. Those longer-term adjustments are mostly a result of smaller projected outlays for the entitlement programs of Social Security, Medicaid and Medicare, as well as smaller interest payments on the debt. The report noted that the growth in health care costs seemed to have slowed — a trend that, if it lasted, would eliminate much of the budget pressure and probably help restore a stronger economy as well. The C.B.O. has quietly erased hundreds of billions of dollars in projected government health spending over the last few years (Lowrey, 5/14).

Los Angeles Times: Federal Deficit Shrinks At Surprising Rate
Three major factors account for most of the long-term improvement: a better economy, a continued slowdown in the rate of medical inflation — which reduces the cost of Medicare and Medicaid — and higher taxes that Congress approved as part of the "fiscal cliff" deal in January, the budget office said. In addition, the automatic budget cuts that took effect this spring have reduced spending in the short term. … The numbers have an important political impact. Republicans have pushed for big reductions in government programs this year, arguing that the country could face a debt crisis if spending is not curtailed. The Obama administration and congressional Democrats have argued that big new reductions have less urgency because the budget picture is already getting better. The new figures from the budget office, which both parties rely on as a nonpartisan arbiter, will probably give more impetus to the Democrats' position (Lauter, 5/14).

The Washington Post: CBO Sees Brighter Economy With Budget Deficit To Plunge To $642 Billion This Year
After 2015, the CBO forecasts that deficits will gradually begin rising again as the baby-boom generation taps into Social Security and Medicare. Although borrowing will stabilize, the national debt will remain at historically high levels, the CBO said, stuck above 70 percent of the economy throughout the next decade. … Still, the improvement in the short-term forecast has removed the air of crisis that has hovered around the budget deficit since President Obama took office. On Tuesday, some analysts urged congressional Republicans to call an end to their fixation on budget cutting (Montgomery, 5/14).

The Wall Street Journal: Deficit Is Shrinking Quickly
A rapidly shrinking federal budget deficit is upending bipartisan talks to reach a federal budget deal, illustrating the conundrum Washington faces with an improving near-term fiscal outlook but continued longer-term pressures tied to aging baby boomers. … The White House and Republicans have been locked in a budget fight since 2011, leading to a number of piecemeal deals that have reduced the deficit by both raising taxes and cutting spending. White House officials have said they want more tax increases while Republicans have called for structural changes to Medicare and Medicaid, the two sprawling government health-care programs, while saying they won't back new tax increases. Earlier this year, a bipartisan effort was under way to lock in more deficit cuts, particularly later in the decade, but those talks have stalled in recent weeks, in part because of the shrinking deficit (Paletta, 5/14).

The Associated Press/Washington Post: Projected Lower Deficit This Year Could Further Slow Any Demand For Big Budget Deal
Now, the improving picture seems likely to make it more difficult for events to force Washington’s exhausted budget combatants closer to a deal. For starters, it means that the deadline for increasing the government’s borrowing cap has been postponed until October or November, the CBO said. It had been expected that lawmakers would have had to act this summer to increase the so-called debt limit, which could have been a catalyst for a broader budget deal (5/14).

The New York Times’ Political Memo: For Republicans, Incentives To Strike A Budget Deal With Obama
Ask around the White House and the Capitol, and you will quickly find reasons to doubt that Republicans will compromise with President Obama on a budget deal that includes more tax increases and spending cuts in social programs. … Delaying steps to rein in Social Security, Medicare and Medicaid, the subjects of Republican doomsday warnings for years, means delaying significant attempts to curb the size of the government. The longer the delay, the sharper and more immediate the changes Washington must eventually make to ease the long-term fiscal squeeze (Harwood, 5/14).

The New York Times: House To Vote Yet Again On Repealing Health Care Law
The 37th time won’t be the charm. But House Republicans are charging forward anyway this week on a vote to repeal President Obama’s signature health care overhaul, which will put the number of times they have tried to eliminate, defund or curtail the law past the three-dozen mark (Peters, 5/14).

The Washington Post’s Fact Checker: How Many Pages Of Regulations For 'Obamacare'?
Rep. Richard Hudson this week offered such an astonishing figure — 33,000 pages of "Obamacare" regulations! — that we immediately wanted to know more. But it turns out that Rep. Hudson got a little bit ahead of himself. An aide said that he misspoke and meant to say 13,000 pages. "Whether it is 13,000, 22,000 or 33,000, it is too many," the aide added. But then it turns out that Senate Minority leader Mitch McConnell (R-Ky.) has actually tweeted a photograph of this stack of paper. By his math, the Obama administration has issued 20,000 pages of regulations "associated" with the new law (Kessler, 5/15).

The Associated Press/Washington Post: Doctors And Nurses Among Nearly 100 Charged In $223 Million Medicare Fraud Busts In 8 Cities
Nearly 100 people, including 14 doctors and nurses, were charged for their roles in separate Medicare scams that collectively billed the taxpayer-funded program for roughly $223 million in bogus charges in a massive bust spanning eight cities, federal authorities said Tuesday. It was the latest in a string of similar announcements by Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder as federal authorities crack down on fraud that’s believed to cost the program between $60 billion and $90 billion each year (5/14).

The New York Times: Covering The Rising Cost Of Long-Term Care
A 2013 report by Genworth Financial, an insurance provider based in Waltham, Mass., estimates the national median daily cost of a private room in a nursing home at $230 a day, an increase of 3.6 percent over 2012 — some $6,900 per month. Sharing that room is only $27 less a day, according to the report (Kelly, 5/14).

Los Angeles Times: Gov. Jerry Brown Unveils Cautious Budget For Deficit-Free State
But Brown vowed to continue to resist pressure from fellow Democrats and interest groups to restore some money to adult dental care and to doctors who treat the poor. For upcoming contract negotiations with the state's big public-employee unions, the governor said the state "is aiming low." … Sacramento will oversee the expansion this year of Medi-Cal, California's healthcare program for the poor, to more than 1 million Californians who do not have health insurance now. Under Brown's plan, the newly insured would be offered the same benefits as those already covered by the public program, a shift from January. Then, the governor did not include stays in rehabilitation facilities and other long-term care for those who will become eligible for Medi-Cal for the first time next year (Megerian, 5/14).

Los Angeles Times: St. John's Bidding War Escalates
A high-stakes bidding war has erupted for St. John's Health Center, a storied Santa Monica hospital, with a local billionaire teaming up with the Roman Catholic Archdiocese of Los Angeles on an unsolicited offer. The latest bid, expected to be formally announced Wednesday, comes from former drug-company executive and healthcare entrepreneur Patrick Soon-Shiong, who said in a statement the bid has the support of the archdiocese (Terhune, 5/15).

The New York Times: Archbishop Presses Cuomo Over Abortion
Cardinal Timothy M. Dolan declined on Tuesday to say whether Gov. Andrew M. Cuomo was “a Catholic in good standing,” as he ratcheted up his criticism of the governor’s continued advocacy for abortion rights (McKinley, 5/14).

The Wall Street Journal: Lawmakers in Vermont Approve Assisted Suicide
Vermont is poised to become the third state in the nation to allow physicians to prescribe lethal drugs to terminally ill patients who want to die. State lawmakers on Monday night approved an assisted-suicide bill, which now awaits the signature of Gov. Peter Shumlin, a first-term Democrat who has said he would sign it, likely within a week. Once enacted, Vermont would be the first state to decriminalize assisted suicide through a legislative vote (Gershman, 5/14).

Politico: Vermont Oks Assisted Suicide Bill
The approval of an assisted suicide bill in Vermont brings to a close a 10-year battle in the state over the issue and delivers the third state-level victory for advocates seeking to advance the policy nationwide. But the national implications for the bill — which won legislative approval Monday night and allows doctors to prescribe lethal doses of drugs to some terminally ill patients — are tough to pinpoint (Cheney, 5/15).

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State Roundup: Ore. Health Co-Ops To Compete With Big Insurers

Tue, 14 May 2013 13:42:00 GMT

A selection of health policy stories from Oregon, Texas, Massachusetts, New York, Colorado and California.

Oregonian: Oregon's Upstart Health Co-Ops To Challenge Mainstream Insurers
Armed with hefty federal loans, two startup health insurers are jumping into a crowded and confusing Oregon market just as the biggest changes to U.S. health care in generations roll out this fall. Oregon's Health CO-OP and Health Republic aim to offer something different: a consumer-run experience. The two companies filed new policy details and proposed rates with the state, on oregonhealthrates.org. In October, they will go head-to-head with about a dozen established insurers to appeal to small businesses as well as more than 200,000 expected to buy their own insurance next year (Budnick, 5/13).

Dallas Morning News: Texas Lawmakers Find Funds For Mental Health, Women’s Care In Budget Talks
Lawmakers dickering over a two-year state budget met late into the night Monday making decisions that affect millions of vulnerable Texans. While the Legislature has rebuffed President Barack Obama’s proposed addition of more than 1 million poor adults to the state's Medicaid rolls, House and Senate budget negotiators approved more money for mental health, protection of abused children and women’s health care (Garrett, 5/14).

Bradenton Herald: Florida Lawmakers Pay Peanuts For Health Insurance
Florida House Republicans last month loudly and proudly rejected billions of dollars in federal money that would have provided health insurance to 1 million poor Floridians. Quietly, they kept their own health insurance premiums staggeringly low. House members will pay just $8.34 a month for state-subsidized health care next year, or $30 a month to cover their entire family (Mitchell, 5/14).

Boston Globe: Citing Backlog, State Health Agency Pleads For Funds
The Massachusetts Department of Public Health, reeling from years of budget cuts, has fallen significantly behind in investigating consumer complaints about medical facilities and lacks sufficient staff to conduct safety inspections of everything from summer camps to food manufacturers to housing for migrant farm workers. There’s a wait of more than five months for investigating problems reported in Massachusetts hospitals, nursing homes, dialysis centers, and clinics. Meanwhile, medical and biological waste from roughly 600 biotechnology firms is not being routinely monitored to ensure proper disposal (Lazar, 5/14).

The Wall Street Journal: Autism Center Is Set To Target Need
Children and adults with autism will begin arriving this month at a new autism center tucked into a 214-acre mental-health campus in Westchester County, [New York], which promises to help provide an answer to the piecemeal care currently available to many. The center, run by NewYork-Presbyterian Hospital and the medical schools at Cornell and Columbia universities, attempts to address what experts say is a significant challenge: autism rates are rising around the country but access to treatment lags well behind (Kusisto, 5/13).

Lund Report: Repeal Of Insurers' Unlawful Trade Practices Act Exemption Moves Into Senate
The bill to repeal the insurance industry’s one-of-a-kind exception to Oregon's chief fraud law has moved to the Senate Consumer Protection Committee, where it faces a less certain outcome than in the House. Sen. Chip Shields, D-Portland, bolstered his case for removing insurers' exemption from the Unlawful Trade Practices Act at the Wednesday hearing, inviting an economic analyst from the Washington State Insurance Commissioner's Office to testify on the impact of a 2007 Washington law that enhanced the private right of action (Gray, 5/13).

The Denver Post: Facility Fees Inflate Hospital Prices For Common Services
The first time Jeff Shellan got a cardiac stress test for his troubled heart, the retail price was $2,166. His insurance company agreed to a discounted price of $885, of which Shellan paid $364. When his doctor suggested a retest a year later, the charge was $8,078, the discounted rate was $3,755, and Shellan's share was $968. Same test. The only difference? Boulder Community Hospital bought the practice of Shellan's cardiologist and added a hefty "facility fee” (Booth, 5/14).

California Healthline: Health Information Sharing Deal Announced
The health information world in California is getting more connected. Many large and small HIE networks have signed an agreement to share information, state officials announced last week at the annual HIE Summit in Sacramento. … For instance, if a VA patient goes on vacation and has an accident and ends up in the emergency department out of the VA network, providers would be able to access critical health information to treat that patient properly (Gorn, 5/13).

California Healthline: $2-Per-Pack Tobacco Tax Clears First Of Legislative Hurdles
California lawmakers chose not to make smokers pay more for health insurance, but they may be more willing to make smokers pay more for cigarettes. A new bill proposing to raise the tax on tobacco by $2 per pack of cigarettes cleared its first two committee votes last week in predictably partisan votes. SB 768, by Sen. Kevin de León (D-Los Angeles), would raise the price of cigarettes to more than $8 a pack and generate about $1.4 billion a year. De León proposes the money be used to offset costs of medical care for tobacco-related diseases, anti-tobacco education and smoking-cessation programs (Lauer, 5/13).

Probe Of Medicare Advantage Leak Finds Wide Speculation On Deal

Tue, 14 May 2013 13:41:42 GMT

The Wall Street Journal: Health-Policy Move Widely Shared
More people than previously thought predicted a major change in U.S. health-care policy that led to a federal insider-trading probe, according to new documents assembled by congressional investigators. Justin Simon, a policy analyst with Height Securities, said in a previously unreported email that was reviewed by The Wall Street Journal that he heard about the policy change before it was made official from "like 30 people." Mr. Simon sent an alert to Wall Street traders just before markets closed April 1, sending health-insurance stocks on a tear. This and other emails indicate the extent to which Washington's insular world of health-care policy experts was buzzing about a possible deal that would result in the Centers for Medicare & Medicaid Services reversing course on previously announced Medicare funding cuts (Mullins and McGinty, 5/13).

Subsidiary Of Indian Drug Firm Pleads Guilty, Agrees To $500 Million Penalty

Tue, 14 May 2013 13:40:34 GMT

The Associated Press/Washington Post: Subsidiary Of Indian Drug Maker Agrees To Pay Record $500 Million US Penalty For Impure Drugs
A subsidiary of India's largest pharmaceutical company has agreed to pay a record $500 million in fines and penalties for selling adulterated drugs and lying to federal regulators in a case that is part of an ongoing crackdown on the quality of generic drugs flowing into the U.S. Federal prosecutors say the guilty plea by Ranbaxy USA Inc. represents the largest financial penalty against a generic drug company for violations of the Federal Food, Drug and Cosmetic Act, which prohibits the sale of impure drugs (5/13).