Kaiser Health News - Medicaid

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).

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).

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).

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).

House GOP Lays Groundwork For Fall Budget Face-Off

Thu, 16 May 2013 13:44:00 GMT

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).

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).

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).

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 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).

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Deficit Projections Likely To Reduce 'Grand Bargain' Pressure

Wed, 15 May 2013 14:02:00 GMT

The Congressional Budget Office reports the deficit is shrinking at a faster-than-expected rate this year. Medicare and Medicaid outlays are smaller than anticipated, and health care cost increases appear to have slowed. The numbers are expected to lessen the momentum to cut spending on Medicare and other entitlement programs.

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).

Modern Healthcare: CBO Projects Less Growth In Healthcare Spending
Noting the society-wide slowdown in healthcare spending, Congressional Budget Office analysts on Tuesday sharply lowered their projections for the next decade's outlays on Medicare, Medicaid and covering the uninsured under the healthcare reform law. The changes – sure to be welcomed by the White House and healthcare reformers – helped lower the CBO's overall projections for the government deficit by $618 billion through 2023 compared with estimates offered just three months ago (5/15).

National Journal: Are Health Care Costs Healing Themselves?
A mysterious shift in health spending patterns could have major implications for the fiscal policy debate—if only experts could figure out what’s behind it. The soaring cost of Medicare and other health programs is expected to be a key driver of the ballooning federal debt in coming years, thanks to the retirement of the baby-boom generation and fast-rising health costs (Chokshi, 5/15).

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).

Other CBO projections regarding the Medicare "doc fix" and health insruance coverage -

National Journal: Good News For Doctors And Budget Hawks
The price tag for repealing a flawed Medicare doctors' pay formula will remain near a recent record low, according to a new estimate from the independent Congressional Budget Office released on Tuesday. It's good news for the physicians and lawmakers who hope to see a permanent "doc fix" in 2013, and suggests the momentum behind achieving repeal is likely to continue this year. What's more, the CBO lowered its estimates Tuesday for Medicare spending between 2014 and 2023 by $85 billion (Hollander, 5/14).

Reuters: Two Million Fewer U.S. Uninsured To Gain Health Coverage: Congressional Researchers
President Barack Obama's landmark healthcare reform law will extend coverage to 2 million fewer uninsured Americans than expected only a few months ago, congressional researchers said on Tuesday. A new report from the nonpartisan Congressional Budget Office said 25 million people who currently lack insurance will obtain coverage through subsidized marketplaces or an expanded Medicaid program over the coming decade, down from a February CBO estimate of 27 million people (Morgan, 5/14).

Viewpoints: Controversy Taints IRS Efforts On Health Law; Another Chance To 'Gut' The Overhaul In The Courts; Salt Wrongly Accused

Wed, 15 May 2013 13:26:29 GMT

The Wall Street Journal: Your Next IRS Political Audit
Even as the politicized tax enforcement scandal expands, the Internal Revenue Service continues to expand its political powers thanks to the Affordable Care Act. A larger government always creates more openings for abuse, as Americans will learn when the IRS starts auditing their health care in addition to their 1040 next year (5/14).

The Washington Post's The Plum Line: Why Washington Scandal-Mania May Save Medicare And Social Security
Liberals who are dreading the scandal-mania that is taking hold should note that it contains a potential upside: It could make a Grand Bargain that includes cuts to Medicare and Social Security benefits even less likely than it already is. That's because when scandal grips Washington, a president actually needs his core supporters more than ever to ward it off, making it harder to do anything that will alienate them (Greg Sargent, 5/14).

New Republic: The Supreme Court Is About To Get Another Chance To Gut Obamacare
(Michael) Carvin's legal argument, which originated with CATO Institute economist Michael Cannon and Western Reserve law professor Jonathan Adler, is that, due to a drafting glitch in the ACA, only state-run exchanges, not federal ones, can provide tax credits and subsidies to enable lower-income individuals to afford ACA-mandated health insurance. ... So, could rejectionists have any basis for hoping to overturn Treasury's rule? Yes, they could. All the Obama administration's arguments, however well-founded, could be shoved aside, if the case reaches the Supreme Court, and the Court's conservative bloc deploys a "methodology," long touted by Justice Antonin Scalia, for interpreting statutes. Scalia's approach, which he calls "textualism," holds that judges must tease out the meaning of individual statutory words or phrases in isolation, rather than giving weight to the statute's overall structure, design, purpose, or legislative history (Simon Lazarus, 5/13).

The New York Times' Economix: Patterns Of Changes In Health Insurance
A number of industries can expect big changes in employee health insurance in the next year or two, while others will continue with business as usual (Casey B. Mulligan, 5/15).

Arizona Republic: Fiscal Risks Of Not Expanding Medicaid
Opponents of Gov. Jan Brewer's Medicaid expansion proposal are recklessly minimizing the risk to the (state) of not participating. Arizona is in an unusual position regarding this issue. Most states offer very little Medicaid coverage to childless adults. So, for them, expanding coverage to 133 percent of the federal poverty level is a very big step. And even the 10 percent of that expansion they will end up having to pay under Obamacare is a big bill (Robert Robb, 5/14).

Politico: Fixing The VA-DOD Health System Fiasco
As health care plans nationwide enter the home stretch of implementing electronic records under the framework of the Obama administration’s Affordable Care Act, and military service disability claims backlogs grow in size and attention, the Department of Veterans Affairs and the Pentagon need a much more coherent approach to modernize and deploy their electronic health record systems (Peter Levin, 5/15).

Medpage Today: Hospitals In Crisis: The Effects Of Obamacare
Under the Affordable Care Act's Hospital Readmissions Reduction Program, hospitals that readmit certain patients within 30 days of discharge could face significant penalties. Under the Affordable Care Act's Hospital Readmissions Reduction Program, hospitals that readmit certain patients within 30 days of discharge could face significant penalties. The question is whether hospitals really have that much control over factors leading to readmission and whether they are really at fault (Dr. Sreedhar Potarazu, 5/14).

The New York Times: Doubts About Restricting Salt
After years of warnings to cut sodium consumption to reduce heart attacks and strokes, it is disturbing to learn how little evidence exists that such reductions would actually be beneficial to health. There is even emerging evidence that some groups in the population could suffer harm from levels that are too low (5/14).

Los Angeles Times: Doctoring In A Family Way
New policies proposed in April by the Residency Review Committee for Family Medicine, or RRC, the group that outlines requirements for physician training programs nationwide, threaten to interfere with that comprehensive care and to decrease reproductive health access for women like Jennifer. The proposed RRC changes would eliminate the current requirement that family medicine residents learn full-scope reproductive healthcare. Instead, the decision to teach these skills would be up to the discretion of individual residency programs. Family doctors would no longer be required to learn how to prescribe birth control, place intrauterine devices or contraceptive implants, provide options counseling for women with unintended pregnancies or diagnose and manage miscarriages (Alison Block, 5/15).

USA Today: Angelina Jolie, Breast Cancer Fighter: Our View
While her message was brave and important, it's equally important to note that Jolie is among an extremely small percentage of women with an unusually high risk of breast cancer due to her family history and her gene mutation. Only about 1 percent of women test positive for mutations to the BRCA1 or BRCA2 genes that signal elevated risk for breast and ovarian cancer, and most women who develop breast cancer can be successfully treated with less radical treatment if the cancer is caught early (5/14).

Health Policy Solutions (a Colo. news service): The Ethically Slippery Slope Of Assisted Suicide
While New Mexico and other states are grappling with the question of whether to allow doctors to write prescriptions for drugs that terminally ill patients can take to commit suicide, countries such as Belgium and The Netherlands are pushing the envelope in distressing ways. For those who claim there is no evidence of a slippery slope in abuse of physician-assisted suicide once implemented, I offer several problems presented by the Belgium and Netherlands experiments. In these countries, it is legal for physicians to directly euthanize patients (Dr. Anthony Vigil, 5/14).

Health Policy Solutions (a Colo. news service): Making Sense Of Variation In Health Care Pricing
Some have been outraged by the seemingly pointless variation in charges the Medicare data shows. However, some variation in the base charges for hospital services does make sense. Facilities and providers alike need to charge differently depending on how sick and complicated their patients are, whether they have additional overhead costs because they are a teaching facility, number of patients receiving charity care, etc. The more important task, though, is to figure out where variation is not adding value and to identify opportunities to get health care spending under control (Phil Kalin, 5/15).

Miss. Dems Continue Work To Keep Medicaid Expansion Plans Alive; GOP Lawmakers Offer Proposals To Compete With Ariz. Gov.'s Expansion Vision

Wed, 15 May 2013 13:24:45 GMT

In addition, Florida health experts say that state's decision not to pursue the expansion is "bad for business."

The Associated Press: Dems Work On Miss. Medicaid Expansion
Democrats in the Mississippi Legislature say they're working on proposals to keep Medicaid alive and funded in the budget year that starts July 1. They say they're doing this in case Republican Gov. Phil Bryant calls a special session before the end of June. However, Bryant said last week he believes he can run Medicaid without legislative authorization — even with no budget in place (5/15).

Arizona Republic: 2 New Ideas For Medicaid In Arizona
After four months of pondering Gov. Jan Brewer’s plan to broaden Medicaid eligibility under the federal health-care overhaul, Republican leaders of the Arizona House and Senate released competing plans on Tuesday almost simultaneously. Neither is likely to pass muster with the governor, because one would not expand the state’s Medicaid program and the other sends the entire matter to the ballot. But the proposal from Senate President Andy Biggs, R-Gilbert, contained in his fiscal 2014 budget plan, set the legislative wheels in motion after months of inaction (Reinhart, 5/14).

Health News Florida: Health Experts On Medicaid Rejection: 'Bad For Business'
The Florida Legislature's decision against expanding Medicaid will saddle the state’s employers with higher health care costs and was "bad for business," health care experts told business leaders on Tuesday. Florida corporations have been "too quiet" about Medicaid expansion and other health care issues, and should make elected officials aware of their displeasure before the damage gets worse, said William Kramer, a national health policy leader in San Francisco who works with corporations (Lamendola, 5/15).

Medicaid: Lawsuit Alleges Conn. Application Backlog Breaks Federal Law

Wed, 15 May 2013 13:23:00 GMT

Medicaid doctors continue to wait for their pay raise -- five months after they were supposed to get it. In Connecticut, some allege a backlog of applications for the program breaks federal law, and are suing to stop it.

Kaiser Health News: Capsules: Most Doctors Still Waiting On 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).

CT Mirror: Suit Hammers Huge Medicaid Backlog, Long Waits
Every month, thousands of poor state residents go without health care coverage while their applications for Medicaid linger, without being approved or denied, for longer than federal law allows. The numbers "tell the whole story," attorney Sheldon Toubman said Tuesday at the start of a trial in Hartford centered on allegations that the state Department of Social Services doesn't have enough workers to handle Medicaid applications within federally required time frames (Becker, 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).

Administration Issues Proposed Rule On Medicaid DSH Payment Reductions

Tue, 14 May 2013 14:13:00 GMT

These payments, known as disproportionate share hospital payments, go to hospitals that treat a high number of uninsured patients.

Politico: W.H. Plans To Delay Medicaid DSH Payment Cuts
The Obama administration has proposed delaying a potentially painful decision on whether to penalize states that refuse to expand Medicaid coverage for low-income populations under Obamacare. The national health care law calls for a gradual reduction in special federal payments — known as Disproportionate Share Hospital or DSH payments — to hospitals that take care of large numbers of uninsured patients. The idea of reducing the DSH payments, which totaled $11.3 billion in 2011, was tied to the fact that the health law's coverage expansion would reduce the burden on hospitals. If more people get covered, the hospitals should have to provide less uncompensated care (Millman, 5/14).

Kaiser Health News: Capsules: CMS Won't Penalize Hospitals In States Slow To Expand Medicaid
That sigh of relief you heard Monday was from hospital administrators in nearly two dozen states, including Florida and Texas. That's because the Obama administration announced that for the next two years, it doesn't plan to penalize states that have yet to expand Medicaid coverage under the federal health law by targeting them for reduced Medicaid funding, according to a proposed rule unveiled Monday. That money goes to hospitals that treat large numbers of poor people (Galewitz, 5/14).

The Wall Street Journal: Health Officials Detail Payment Cuts For Uninsured
The Obama administration on Monday published a plan for cuts in payments for hospitals that treat many uninsured patients and said states that decline to expand their Medicaid programs under the 2010 health law won't get preferential treatment. The federal government currently sends about $11 billion a year to states to help cover the costs of uncompensated care. The health law called for cuts in those payments, assuming that most Americans would have insurance coverage after the law took effect (Radnofsky, 5/13).

Reuters: U.S. Proposes Rule On Medicaid Payment Cuts For Hospitals
The U.S. government on Monday issued a proposed rule for cutting payments to hospitals that treat a disproportionate share of the poor, including a $500 million reduction in fiscal 2014, as part of President Barack Obama's healthcare reform law. The Patient Protection and Affordable Care Act mandates annual reductions in Medicaid payments to hospitals through fiscal 2020 in exchange for increased insurance coverage options that are expected to reduce levels of uncompensated care (5/13).

Miami Herald: Jackson And Other Hospitals May Face Cuts In Pay For Uninsured, Under Healthcare Reform
Florida hospitals that treat many uninsured patients will lose millions of dollars in funding meant to offset those costs, according to a proposal unveiled Monday by federal health officials who had anticipated that more Americans would have access to insurance under the Affordable Care Act, reducing the amount of uncompensated care delivered by hospitals. In announcing the proposed cuts, federal health officials said they would not give preferential treatment, at least at first, to states that declined to expand Medicaid, such as Florida (Chang, 5/13).

Many Docs Reject Medicaid -- A Cause For Concern As The Expansion Approaches

Tue, 14 May 2013 13:50:00 GMT

McClatchy reports that projections highlight how the shortage of physicians in general as well as those who choose not to accept Medicaid patients could undermine the health law's intent. Also in the news, fits and starts surround this health law provision in Pennsylvania, Arizona, Texas, Louisiana, Ohio and Colorado.

McClatchy: Most Doctors Still Reject Medicaid As Program Expansion Nears
Because of the program's history of low payments, fewer than half of U.S. doctors and other health care professionals accept Medicaid patients, according to a recent study. For those that do, getting an appointment sometimes can take months because of the high demand, particularly among specialists. The problem is worse in rural areas such as Bonifay, in the Florida Panhandle. While 20 percent of Americans live in less-populated parts of the country, only 10 percent of U.S. doctors practice there. That's why 77 percent of the nation’s 2,000-plus rural counties are designated as health professional shortage areas, according to the National Conference of State Legislatures. Nationwide, the lack of doctors is a growing problem that will only worsen as some 27 million people get health coverage by 2016 as part of the Patient Protection and Affordable Care Act (Pugh, 5/15).

The Associated Press: Corbett Aide Doesn't Expect To See Pa. Medicaid Expansion In 2014
A top aide to Gov. Tom Corbett said expanding Medicaid eligibility in Pennsylvania under a sweeping federal health care law probably would not take effect before January 2015, even if the governor embraces the idea that would provide taxpayer-paid health care insurance to hundreds of thousands of residents. Beverly Mackereth, Corbett's Department of Public Welfare chief, told the Pittsburgh Post-Gazette on Friday that the administration would need until 2015 to negotiate with the federal government and create the program (5/13).

The Associated Press: Speaker Tobin Key To Medicaid Expansion Deal
Gov. Jan Brewer's proposal to expand the state's Medicaid program to 300,000 more poor Arizonans may pass or fail based on just one person in the Legislature: Republican House Speaker Andy Tobin. The trick for Brewer is figuring out just what Tobin wants in exchange for his support. And he's not making it easy (Christie, 5/14).

The Texas Tribune: Budget Rider Could Lay Out Terms For Medicaid Reform
The fate of Medicaid reform in Texas could rest solely on an up-or-down vote on the 2014-15 budget. State Rep. John Zerwas, R-Simonton, a member of the conference committee that is hashing out the differences between the House and Senate budget plans, said Monday he's relatively confident that a rider stipulating the Legislature's preferred Medicaid reform terms — like cost containment measures and private market reforms — for any deal with the federal government is "sticking" to the 2014-15 budget (Ramshaw and Aaronson, 5/13).

New Orleans Times Picayune: Federal Proposal For Cutting Safety-Net Money Supports Louisiana Decision To Decline Medicaid Expansion, State Says
A top Louisiana health agency official on Monday said a proposed federal rule cutting the money that funds the state's safety-net hospitals supports Gov. Bobby Jindal's decision to decline to expand the Medicaid program for the poor. The U.S. Department of Health and Human Services released a proposal for how the agency would cut "disproportionate share hospital" payments that finance hospital care for the uninsured. In Louisiana, this money is largely funneled to the LSU public hospitals that provide the bulk of the care for uninsured people. The Jindal administration and LSU are currently working on proposals to privatize operations of the public hospitals (Maggi, 5/13).

Cleveland Plain Dealer: Ohio Senate President Keith Faber Signals Hope For Medicaid 'Reform' But Not Kasich-Style Expansion
Ohio Senate President Keith Faber told a City Club of Cleveland crowd Monday that he expects state legislators to tackle Medicaid "reform" by the end of the year. But the Republican from Celina is not optimistic that a deal will reached before the June 30 deadline to pass the state's two-year budget. He also doubts the final product will resemble the Medicaid "expansion" Gov. John Kasich favors (Gomez, 5/13).

The Associated Press: Colorado Medicaid Expansion Signed Into Law
An expansion of Medicaid eligibility that's expected to add 160,000 adults to public health care assistance in Colorado was signed into law Monday. The expansion is part of the federal health care overhaul that 22 states and Washington, D.C., have accepted as of last week (Moreno, 5/13).