Kaiser Health News - Medicare

As Hill Panels Focus On Medicare, Marketplace Examines How Part D Changed The Pharmaceutical Industry

Wed, 22 May 2013 13:14:18 GMT

Medicare is a topic of conversation on Capitol Hill as a Senate committee holds a hearing on the Medicare Part D drug program. Meanwhile, on the House side, members of the Ways and Means Health Subcommittee heard testimony on patient cost-sharing that triggered a broad discussion of health care incentives within the program.

Marketplace: How Medicare Part D Changed The Drug Industry
Later today, a U.S. Senate committee is scheduled to hold a hearing on the prescription drug benefit program for seniors known as Medicare Part D. The program has been around now for 10 years. And it has meant tens of millions of new customers for pharmaceutical companies says Mark Duggan, an economist at the University of Pennsylvania. … Yale economist Fiona Scott Morton says the emphasis on cheaper drugs has pushed companies to be more innovative if they want a big payday (Gorenstein, 5/22).

MedPage Today: Focus On Medicare Cost Drivers, Congress Told
A congressional hearing on increasing patient cost sharing as a mechanism for Medicare reform turned into a call for broad changes to provider incentives in the program. Health policy experts told lawmakers Tuesday that payments need to move away from a volume-based fee-for-service if policymakers want to generate savings in Medicare. The House Ways and Means Health Subcommittee called the hearing to examine bipartisan proposals for Medicare reform. Specifically, they wanted to discuss increasing the Part B deductible, increasing Part B and D premiums for wealthier seniors, and establishing a copay for home health services, subcommittee chair Kevin Brady (R-Texas) said. But experts called before the subcommittee called the proposals short-sighted and said they wouldn't do much other than cause beneficiaries to pay more (Pittman, 5/21).

Also in the news, the Medicare NewsGroup takes a look at how slowing health care costs impact Medicare -

The Medicare NewsGroup: Does Slow Health Care Cost Growth Matter For Medicare?
Medicare spending has generally increased at a rate faster than growth in the economy and national health expenditures, and it is expected to continue to do so according to the Medicare Board of Trustees 2012 report. From 2007 to 2011, a timespan that includes the U.S economic recession, the GDP grew at an average of 1.8 percent, national health expenditures grew at an average of 4.1 percent and aggregate Medicare spending grew at an average rate of more than 6 percent (Vahlkamp, 5/21).

First Edition: May 22, 2013

Wed, 22 May 2013 11:20:17 GMT

Today's headlines include reports about how the Medicaid expansion is shaking out in Virginia and Texas, as well as a report about the role health care is playing as the House attempts to negotiate an immigration reform measure.

Kaiser Health News: Capsules: Survey: Even In Southern States, Medicaid Expansion Is Popular; Accuracy of Blood Glucose Meters Draws Scrutiny
Now on Kaiser Health News' blog, Karl Eisenhower reports on a poll of public opinion in southern states and the health law: "Alabama, Georgia, Louisiana, Mississippi and South Carolina have a lot in common: The summers are hot and the political climates are conservative. These are states where Mitt Romney handily beat Barack Obama in the 2012 presidential election, so it's not surprising to learn that the president's signature health law is unpopular there. But despite the law's unpopularity, its expansion of Medicaid is supported by almost two-thirds of adults in these states, according to a survey by the Joint Center for Political and Economic Studies, a left-leaning think tank" (Eisenhower, 5/21).

Also on Capsules, Phil Galewitz reports on the accuracy of blood glucose meters: "Blood glucose meters, which millions of diabetics rely upon to regulate their blood sugar, have become less costly and easier and less painful to use. But they haven't become more accurate, a top Food and Drug Administration official said Tuesday at a meeting of researchers analyzing studies that show wide variation in the performance of the machines used to measure blood glucose levels" (Galewitz, 5/21). Check out what else is on the blog.

The New York Times: For Tea Party Groups, Shades Of 2010
Leaders of the Tea Party movement hope outrage over the I.R.S. inquiry will rekindle grass-roots activism that in many places went dormant after big Republican electoral defeats of November 2012. They aim to link the current scandal to other government programs they consider overweening — principally the rollout of the health care overhaul law — and generate a Republican wave in the 2014 midterm elections reminiscent of 2010's (Gabriel, 5/21).

The Associated Press/Washington Post: Major Savings Reform Va. Demanded To Expand Medicaid Gets Approval From Federal Officials
Federal officials approved a four-year Virginia cost-saving experiment intended to simplify and consolidate health care coverage for about 78,000 Virginians who are eligible for both Medicaid and Medicare, a major change Gov. Bob McDonnell set as a condition for expanding Medicaid (5/21).

The New York Times/Reuters: Texas: House Votes to Ban Medicaid Expansion
The Texas House passed a measure on Tuesday that would prevent the state from expanding its Medicaid program as outlined by President Obama's health care law (5/21).

USA Today: Market, Insurers Will Keep Premiums Low, Analysts Say
Market forces and an impetus to attract younger, healthier people into the insurance market will help keep health insurance premiums lower as the 2010 health care law takes effect on Jan. 1, industry analysts and insurance officials say. "If they price too high, young people won't buy insurance, and that's going to hurt the companies," said Jay Angoff, who led initial implementation of the law for HHS. "They need these people to come in. It's an industry problem" (Kennedy, 5/21).

Politico: Courts To Hear Birth Control Mandate Lawsuits
Obamacare’s birth control mandate will go before four different appeals courts over the next three weeks as private businesses that object to the policy on religious liberty grounds bring a barrage of lawsuits that opponents hope to get before the U.S. Supreme Court as soon as this fall. On Wednesday, two for-profit companies will ask the 7th Circuit Court of Appeals to strike the requirement that they provide employees with insurance coverage that includes birth control and other drugs that they say can cause abortion. Three other companies will present oral arguments in different appeals courts by early June (Smith and Haberkorn, 5/22).

The Wall Street Journal: Electronic Health Data Gaining Favor
More than half of U.S. doctors have switched to electronic health records and are using them to manage patients' basic medical information and prescriptions, according to federal data set to be released Wednesday. The Department of Health and Human Services says it has reached a tipping point as it seeks to steer medical providers away from paper records (Radnofsky, 5/22).

The Washington Post: The End Of Health Price Secrecy May Be Starting In Miami
Spurred by the release of the Medicare data, the chief executive of Mt. Sinai Medical Center in Miami has now pledged to release those negotiated rates that tend to be kept secret. Via MedCity News: Steve Sonenreich, chief executive of Mount Sinai Medical Center in Miami Beach, made a public pledge Monday to divulge the contractual rates the hospital pays private insurers for diagnoses and treatments (Kliff, 5/21).

Politico: House Immigration Talks Hang On Health Care
House immigration negotiators have given themselves until the end of the week to hash out language on what kind of health benefits should be available to undocumented immigrants seeking U.S. citizenship, a crucial issue for the talks. If they can’t resolve this issue, the four-year immigration negotiations could come to a crashing halt (Sherman and Bresnahan, 5/21).

The Associated Press/Washington Post: House GOP Panel Approves Agency Budget Cuts Far Deeper Than Those Approved In March
Republicans controlling the House pressed ahead Tuesday with slashing cuts to domestic programs far deeper than the cuts departments like Education, Interior and State are facing under an already painful round of automatic austerity. Veterans Affairs, Homeland Security and the Pentagon would be spared under the plan approved by the House Appropriations Committee on a party-line vote, but legislation responsible for federal firefighting efforts and Indian health care would absorb a cut of 18 percent below legislation adopted in March (5/21).

The New York Times: Arizona Law On Abortions Struck Down As Restrictive
A federal appellate panel struck down Arizona's abortion law on Tuesday, saying it was unconstitutional "under a long line of invariant Supreme Court precedents" that guarantee a woman’s right to end a pregnancy any time before a fetus is deemed viable outside her womb — generally at 24 weeks (Santos, 5/21).

The Wall Street Journal: Appeals Court Strikes Down Arizona Abortion Law
Arizona is among a number of states that have tried to restrict the practice in recent months, while other states have weighed laws that would strengthen abortion rights. For instance, a bill recently proposed by New York Gov. Andrew Cuomo, a Democrat, would expand women's access to late-term abortions (Jones, 5/21).

The Associated Press/Los Angeles Times: Arizona Abortion Ban Struck Down
A three-judge panel of the court said the law violated a woman's constitutionally protected right to terminate a pregnancy before a fetus can survive outside the womb. "Viability" is generally considered to begin at 24 weeks. Normal pregnancies run about 40 weeks (5/21).

Los Angeles Times: Strike At UC Medical Centers Continues; More Picketing Wednesday
As the afternoon wore on, the number of union members on the picket lines at the University of California medical centers started to thin. But hundreds of workers concerned about staffing levels and pension reforms planned to continue striking throughout the evening. Union spokesman Todd Stenhouse said that the decision to strike was a difficult one for many (Gorman and LaGanga, 5/21).

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Some GOP Lawmakers Target HHS Secretary Sebelius For Fundraising

Tue, 21 May 2013 13:17:52 GMT

The members of Congress are questioning Sebelius' efforts to solicit funds for Enroll America, which is trying to help get people signed up for benefits under the federal health law.

Reuters: Analysis: Some Republicans See New Scandal In Sebelius Fundraising
With the White House already reeling from three major controversies, some Republican lawmakers are zeroing in on what they perceive is another possible scandal tied to President Barack Obama's landmark health reform law just as it nears implementation. On top of the troubles the administration is facing over its handling of the attack on the Benghazi mission, the Internal Revenue Service's targeting of conservative groups, and the Justice Department's seizure of Associated Press phone records, Republicans hope to target Health and Human Services Secretary Kathleen Sebelius. They are questioning her soliciting of funds on behalf of a non-profit group, called Enroll America, from two private entities, a practice which if not unprecedented is at the very least unusual (Morgan, 5/21).

Also in the headlines -

The Wall Street Journal: Tip Puts Lobbyist's Career On Hold
Mark Hayes was a Washington policy wonk on a long and steady ascent: a senior Senate health-care aide, a role writing President Barack Obama's health-care overhaul and a spin through the revolving door to a lobby firm where he banked 20 years of contacts. A series of emails to a client was all it took to put that carefully crafted career on hold (Mundy and Mullins, 5/20).

New Analysis Finds More Seniors Living In Poverty

Tue, 21 May 2013 13:15:00 GMT

The estimate, which takes health spending and other factors into account, concluded that 1 in 7 seniors lives in poverty. Projections indicate that number could go up if certain Medicare reforms took effect.

Politico: Report: More Seniors Are Living In Poverty
An alternative census estimate shows that more of America's seniors than originally thought are living in poverty -- and that means the poverty rate could spike under certain Medicare reforms, a new analysis finds. The estimate, which takes into account health spending and regional cost of living, finds 1 in 7 seniors lives in poverty. It was previously thought that just 1 in 10 did (Smith, 5/21).

The Washington Post: Senior Poverty Is Much Worse Than You Think
But under the [supplemental poverty measure], you'd count as poor as $15,000 – $10,000 = $5,000, which is below the relevant SPM threshold. And despite having Medicare, many seniors struggle with out-of-pocket medical bills. As my colleague Michelle Singletary pointed out over the weekend, the Employee Benefit Research Institute has found Medicare only pays for about 60 percent of seniors' total health costs. Sarah has written about how out-of-pocket costs tend to pile up particularly at the end of seniors' lives. Due in part to such burdens, a new Kaiser Family Foundation report finds that the SPM poverty rate for senior citizens is actually higher than the official rate: 15 percent vs. 9 percent. And when you include people living within 200 percent of the poverty line, the picture under SPM looks even worse (Matthews, 5/20).

First Edition: May 21, 2013

Tue, 21 May 2013 11:23:54 GMT

Today's headlines include stories examining how the approaching implementation of some health law provisions is highlighting key policy questions.

Kaiser Health News: How Will The 'Unbanked' Buy Insurance On The Exchanges?
Kaiser Health News staff writer Sarah Varney, working in collaboration with NPR, reports: "When movie stars become unbankable, they’re no longer a slam dunk at the box office. When investments become unbankable, they’re relegated to the junk pile. For ordinary Americans deemed unbankable, those who don’t have a traditional checking or savings account, it can be hard to simply pay bills. And that is about to become a big problem for those who also lack health coverage -- and for the health insurance companies trying to sell them coverage. After all, how do you sell a product to a customer who has no way to pay you?" (Varney, 5/20). Read the story.

Kaiser Health News: Texas' Rio Grande Valley Presses for Medicaid Expansion
Kaiser Health News staff writer Sarah Varney, working in collaboration with NPR, reports: "When the sun rises over the Rio Grande Valley, the cries of the urracas – black birds – perched on the tops of palm trees swell to an unavoidable cacophony. That is also the strategy, it could be said, that local officials, health care providers and frustrated Valley residents are trying to use to convince Gov. Rick Perry and state Republican lawmakers to set aside their opposition and expand Medicaid, a key provision of the federal health law" (Varney, 5/21). Read the story.

Kaiser Health News: Insuring Your Health: Some Individual Policies Offer A Way To Shrink Deductibles
Kaiser Health News consumer columnist Michelle Andrews writes: "There is no free lunch. As more people buy high-deductible health plans, they're discovering that while premiums for such plans are more affordable, the trade-off can be high out-of-pocket costs before coverage kicks in. However, some plans sold on the individual market offer a way for healthy people to shrink their deductibles. Under these so-called deductible-credit plans, the deductible diminishes year by year for policyholders who don't spend a lot on health care" (Andrews, 5/21). Read the column.

The Wall Street Journal: Role Of Health-Law 'Navigators' Under Fire
Lawmakers across the country are tussling over the Obama administration's plans to create a small army of assistants to guide millions of Americans as they sign up for new health-insurance options available this fall. Backers of the health-care overhaul face an uphill battle to spread the word about the law, in the face of consumer research that suggests most uninsured people know little about it and are skeptical about the value of health insurance generally. Some Democrats have openly worried that the administration is doing too little to make sure the enrollment process goes smoothly (Radnofsky, 5/20).

The New York Times: Overruns Forcing Lower Payments To Some Providers In Stopgap Health Program
The Obama administration said Monday that it was cutting payments to doctors and hospitals after finding that cost overruns are threatening to use up the money available in a health insurance program for people with cancer, heart disease and other serious illnesses (Pear, 5/20).

Los Angeles Times: Some Could Have Gaps In Medical Coverage Under New Law
When the national healthcare law takes full effect next year, millions of Americans risk disrupted health coverage because of common life events: getting married or divorced, having children or taking on a second job. As their family incomes change, so too will their eligibility for public insurance programs. And if nothing is done, policymakers warn, many low-income patients will lose access to their doctors and medications during this massive game of health coverage pingpong. Policymakers and healthcare industry leaders across the nation are paying close attention to the issue and working to close the coverage gaps before Jan. 1, said Alan Weil, executive director of the National Academy for State Health Policy (Gorman, 5/20).

Politico: Report: More Seniors Are Living In Poverty
An alternative census estimate shows that more of America’s seniors than originally thought are living in poverty — and that means the poverty rate could spike under certain Medicare reforms, a new analysis finds. The estimate, which takes into account health spending and regional cost of living, finds 1 in 7 seniors lives in poverty. It was previously thought that just 1 in 10 did (Smith, 5/21).

The Washington Post: Senior Poverty Is Much Worse Than You Think
But under the [supplemental poverty measure], you’d count as poor as $15,000 – $10,000 = $5,000, which is below the relevant SPM threshold. And despite having Medicare, many seniors struggle with out-of-pocket medical bills. As my colleague Michelle Singletary pointed out over the weekend, the Employee Benefit Research Institute has found Medicare only pays for about 60 percent of seniors’ total health costs. Sarah has written about how out-of-pocket costs tend to pile up particularly at the end of seniors’ lives. Due in part to such burdens, a new Kaiser Family Foundation report finds that the SPM poverty rate for senior citizens is actually higher than the official rate: 15 percent vs. 9 percent. And when you include people living within 200 percent of the poverty line, the picture under SPM looks even worse (Matthews, 5/20).

The New York Times: E.R.'s Account For Half Of Hospital Admissions, Study Says
Emergency rooms account for about half of the nation’s hospital admissions and accounted for virtually all of the rise in admissions between 2003 and 2009, according to a study released on Monday. Although emergency rooms are widely considered expensive places for diagnostic care, physicians are increasingly relying on them to determine whether a patient needs to be hospitalized (Abelson, 5/20).

The Washington Post: Health-Care Training And Data Storage Innovations Featured At Silicon Valley Conference
This year’s HealthBeat conference continues through Tuesday in San Francisco, with health technology innovators gathering to offer their take on what’s challenging, what’s working and what’s next in innovation for the health care industry (Kolawole, 5/20).

The Wall Street Journal: Forget To Take Medicine? These Pills Will Tell Your Doctor
Startup companies are coming up with new technologies aimed at getting people to take medicine only as directed. Taking medication haphazardly—skipping doses, lapsing between refills or taking pills beyond their expiration date—has been linked to health complications and hundreds of millions of wasted dollars for insurers and hospitals (Hay, 5/20).

The Washington Post: Federal Faces: David E. Vollman, VA Ophthalmologist
There are more than 50,000 cataract surgeries performed at Department of Veterans Affairs health facilities every year and more than 3 million throughout the country, but there has never been a system to collect detailed patient outcomes on a national level. Vollman, 34, in only his second year working at St. Louis VA Medical Center, helped organize and implement a pilot project to track cataract surgery results (5/20).

Los Angeles Times: Patient Care Workers Set To Start Walkout At Five UC Hospitals
Respiratory therapists, nursing aides, surgical technicians and other patient care workers plan to stage a walkout starting Tuesday morning at five University of California medical centers. More than 12,000 workers from the American Federation of State, County and Municipal Employees are expected to participate in the two-day strike over staffing, pay and pension reform, union officials said. An additional 3,400 workers from the University Professional and Technical Employees union plan a one-day sympathy strike (Gorman, 5/21).

The Wall Street Journal: Minnesota To Allow Home Day-Care Workers To Unionize
Minnesota is set to allow unions to organize workers who provide home day-care services and other home care, giving organized labor a rare victory at the state level. The state House, by a vote of 68 to 66, passed legislation Monday that allows unions to negotiate on behalf of providers whose clients receive government subsidies—including through Medicaid, the federal health program for low-income and disabled people (Peters and Maher, 5/20).

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CBO: Obama's Budget Would Reduce Medicare Spending By $364B

Mon, 20 May 2013 13:33:00 GMT

The Congressional Budget Office estimated Friday that President Obama's budget would reduce Medicare spending by $364 billion over the next decade and would reduce future budget deficits. The White House and Congress will likely soon need to work on a long-term budget solution as the nation again hits its debt limit.

Los Angeles Times: Obama Budget Would Cut Deficits, Report Says
President Obama's proposed mix of tax hikes and spending cuts would reduce future budget deficits more quickly than under current laws, according to a report issued Friday that could rekindle the dormant budget wars in Washington. The outlook from the nonpartisan Congressional Budget Office comes as the government is set to reach its debt limit on Saturday, forcing the White House and Congress back to the negotiating table to work out a long-term budget plan that raises taxes, cuts spending -- or some combination of the two (Mascaro, 5/17).

Modern Healthcare: CBO's Medicare Estimates On Par With White House Figures
Falling closely in line with the Obama administration's analysis last month, the nonpartisan Congressional Budget Office estimates that the policies in President Barack Obama's fiscal 2014 budget proposal would reduce Medicare spending by about $364 billion over 10 years, compared with the administration's estimate of $371 billion. Released Friday, the CBO's analysis said the president's budget proposal for next year would total $5.2 trillion in deficits between 2014 and 2023, or about 2.4 percent of the country's Gross Domestic Product projected for that period (Zigmond, 5/17).

The Hill: Obama Budget Would Cut $364 Billion In Medicare Spending
President Obama's budget proposal would save the Medicare program $364 billion over the next decade, according to the Congressional Budget Office (CBO). The CBO largely concurred with the White House's estimates, which pegged the budget's Medicare savings at $370 billion (Baker, 5/17).

First Edition: May 20, 2013

Mon, 20 May 2013 11:26:54 GMT

Today's headlines include reports about the policy and political issues currently surrounding the health law's implementation.

Kaiser Health News: With High Deductible Health Plans, It Pays To Shop Around For Care
Reporting for Kaiser Health News, in collaboration with The Philadelphia Inquirer, Michelle Andrews writes: "When Maria and Vadim Brodsky's then 7-year-old daughter needed an MRI two years ago to examine a tumor in her head, they took her to a hospital in their health plan’s network and were dismayed to receive a $4,500 bill. The couple had a $6,000 deductible on their family plan. And even though the bill was reduced to $3,000 — the price the provider and insurer had agreed to by contract — the Brodskys had to cover all of it" (Andrews, 5/20). Read the story.

Kaiser Health News: Feds Make It Easier For States To Enroll Poor Under Health Law
Kaiser Health News staff writer Phil Galewitz reports: "The Obama administration is making it easier for states to sign up the poor for health coverage – and to help those people stay covered. On Friday, it informed state officials that they could simplify enrollment in Medicaid, the federal-state program for the poor, to handle the onslaught of millions of anticipated enrollees next year when the health care law expands coverage. The administration said the changes are geared to states that are expanding their programs, but they may also be adopted by others" (Galewitz, 5/18). Read the story.

Kaiser Health News: Capsules: Audio: 42 Percent Of Americans Unaware Health Law Exists (Audio)
Kaiser Health News staff writer Mary Agnes Carey joined NPR's "Tell Me More" Friday afternoon to discuss the state of the health law and other health policy issues – including a new poll saying 42 percent of Americans don't know that the Affordable Care Act actually still stands (5/17). Check out what else is on the blog.

Kaiser Health News also tracked weekend news coverage, including reports that Republicans are pressing the link between the health law and the IRS scandal (5/19).

The New York Times: Potential Donors to Enroll America Grow Skittish
The Obama administration's efforts to raise private money to carry out the president's health care law have provoked such a strong partisan uproar that potential donors have become skittish about contributing, according to several people involved in the fund-raising program (Pear, 5/19).

Los Angeles Times: Medicaid Opposition Underscores States' Healthcare Disparities
Republican opposition in many statehouses to expanding Medicaid next year under President Obama's healthcare law — opposition that could leave millions of the nation's poorest residents without insurance coverage — will likely widen the divide between the nation's healthiest and sickest states (Levey, 5/18).

The Associated Press/Washington Post: Republicans Seek To Link IRS Scandal And Tax Agency's Role Implementing Obama Health Overhaul
Political scandals have strange ways of causing collateral damage, and Republicans are hoping the furor over federal tax enforcers singling out conservative groups will ensnare their biggest target: President Barack Obama’s health care law. There is a link, but it may only be coincidence. No one appears to have connected the dots factually, and it’s unclear whether they will (5/18).

The Wall Street Journal: Employers Eye Bare-Bones Health Plans Under New Law
Employers are increasingly recognizing they may be able to avoid certain penalties under the federal health law by offering very limited plans that can lack key benefits such as hospital coverage. Benefits advisers and insurance brokers—bucking a commonly held expectation that the law would broadly enrich benefits—are pitching these low-benefit plans around the country. They cover minimal requirements such as preventive services, but often little more. Some of the plans wouldn't cover surgery, X-rays or prenatal care at all. Others will be paired with limited packages to cover additional services, for instance, $100 a day for a hospital visit (Weaver and Mathews, 5/19).

Politico: Obamacare Allies Eye Ballot Initiatives
Obamacare backers stymied by conservative legislatures in red states may have a new approach: letting the voters break logjams with state ballot initiatives in 2014. Frustrated by conservative opposition to extending Medicaid even in states where Republican governors have embraced it, the president's allies are strategizing about asking voters to do what their elected leaders have not: accept billions of federal dollars to cover millions of poor people under Obamacare (Cheney and Millman, 5/19).

The Washington Post: McConnell Predicts Obamacare Will Be 'Biggest Issue' Of 2014 Election
The Senate's top Republican predicted Sunday morning that President Obama's health care law will be the biggest issue of the 2014 midterm elections (Sullivan, 5/19).

Los Angeles Times: Anthrax Drug Brings $334 Million To Pentagon Advisor's Biotech Firm
Over the last decade, former Navy Secretary Richard J. Danzig, a prominent lawyer, presidential advisor and biowarfare consultant to the Pentagon and the Department of Homeland Security, has urged the government to counter what he called a major threat to national security. Terrorists, he warned, could easily engineer a devastating killer germ: a form of anthrax resistant to common antibiotics. … Danzig did this while serving as a director of a biotech startup that won $334 million in federal contracts to supply just such a drug, a Los Angeles Times investigation found (Willman, 5/19).

Los Angeles Times: City Of San Francisco, Worker Unions Protest Kaiser Premium Hike
It's a trend many public employees can relate to: Health insurance premiums climb year after year, while at the bargaining table workers have agreed to kick in more for pensions, take salary cuts and sign on to furlough days. But when Kaiser Permanente — which insures 45,000 public workers here — proposed another hike for 2014, San Francisco's Health Service System teamed up with labor unions to say "no more" (Romney, 5/19).

Politico: Virginia Pick Compared Planned Parenthood To KKK
E.W. Jackson, a black minister and activist nominated for lieutenant governor Saturday, posted a four-minute video on YouTube last fall exhorting African-Americans to vote Republican. In the video message, he accused the "civil rights establishment" of selling out their Christian values in order to support Democratic policy positions on gay marriage and abortion. ... "The Democrat Party has created an unholy alliance between certain so-called civil rights leaders and Planned Parenthood, which has killed unborn black babies by the tens of millions. Planned Parenthood has been far more lethal to black lives than the KKK ever was," Jackson says in the video (Burns, 5/19).

Los Angeles Times: St. John’s Picks Providence Health & Services In Bidding War
After months of controversy, the owner of St. John's Health Center said it plans to sell the landmark Santa Monica hospital to Catholic chain Providence Health & Services. The hospital has been at the center of an intense competition that featured bids from UCLA Health System, other Catholic hospital chains and Los Angeles billionaire Patrick Soon-Shiong (Terhune, 5/17).

Los Angeles Times: Judge Temporarily Delays 12-Week Abortion Law In Arkansas
An Arkansas law that bans most abortions after 12 weeks of pregnancy was temporarily blocked by a federal judge on Friday. In a ruling from the bench, U.S. District Court Judge Susan Webber Wright in Little Rock granted a preliminary injunction preventing the Arkansas law from going into effect as scheduled, a member of the court staff said by telephone. It was scheduled to start Aug. 16 (Muskal, 5/17).

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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).

Some Hospitals Under The Microscope For Steep Pricing

Fri, 17 May 2013 13:33:00 GMT

The New York Times and Los Angeles Times report on specific hospitals that have been shown to be among the most expensive in the nation. Meanwhile, Modern Healthcare reports on interest from some senators in overhauling Medicare's hospital payment system.

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 percent in the country (Terhune and Poston, 5/17).

Modern Healthcare: Senators Seek Overhaul Of Hospital Payment System
When it comes to Medicare hospital payment systems, the exceptions are the rule. Congress' nonpartisan investigative arm reported Thursday that 91 percent of hospitals paid by Medicare receive some dispensation or add-on to the program's standard payment system. The Inpatient Prospective Payment System was designed to maximize "cost-control, efficiency and access" when it was launched 30 years ago, according to the Government Accountability Office report. But Congress has piled an accumulating number of exemptions and carve-outs for various types of hospitals (Daly, 5/16).

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).

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).

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).

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).

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).

Political Cartoon: 'Bloc On Wood?'

Wed, 15 May 2013 13:40:21 GMT

Kaiser Health News provides a fresh take on health policy developments with "Bloc On Wood?" by Chris Weyant.

Meanwhile, here is today's health policy haiku:

GO AHEAD, KICK THAT CAN!

CBO numbers
suggest shrinking deficit...
Stalls a grand bargain.
-Anonymous

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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).

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’ 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 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).

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).

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).

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).

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).

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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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).