KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

Political Cartoon: ‘Bill Of Health?’

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: ‘Bill Of Health?’" by Chip Bok, Akron Beacon Journal.

Here's today's health policy haiku:

WILL THAT BE ALL?

I'll take a dark roast,
with soy milk, and the cheapest
silver plan you have.

If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Capitol Hill Watch

GOP Lawmakers Won't Preserve Health Subsidies If The High Court Strikes Them From Law

This signal from congressional Republicans ups the ante regarding the legal challenge to the Affordable Care Act that will be argued at the Supreme Court in March. Meanwhile, some GOP House members are also starting to work on a bill to replace the ACA.

The Wall Street Journal: Republicans To Block Legislative Fix To Health-Care Law
Congressional Republicans say they won’t move to preserve consumers’ health insurance tax credits if the Supreme Court strikes them down, raising the stakes in the latest legal challenge to the Affordable Care Act. The high court is set to consider in March whether the wording of the 2010 health law means people can only get tax credits to lower their health premiums if they live in one of the handful of states running its own insurance exchange. A decision is expected by June. (Radnofsky, 1/29)

The Associated Press: Republicans: House To Begin Work On Health Care Alternative
The House will vote next week to repeal the health care law Republicans have vowed to undo. They'll also direct work to start on a replacement bill the GOP promised more than four years ago. The House voted more than 50 times in the past two years to repeal the law in whole or in part. Next week's vote will be the first for such a bill in the new Congress. It will also be the first time the legislation will go to a Republican-controlled Senate. (1/29)

At the same time, Democrats vow to do better in explaining "their vision" while the medical device tax continues to draw attention.

The Associated Press: House Democrats Vow To Explain Their Vision Better In 2016
[Rep. Steve] Israel's new role is to oversee messaging for House Democrats. He told reporters his colleagues will stick to the party's well-known priorities: a higher minimum wage, tax increases on the rich, and advancing the president's health care law and other measures largely associated with Obama. This time, they're counting on Obama's rising popularity — and fading headlines on Ebola and terrorist beheadings — to help persuade voters they'd be better off with a Democratic-run Congress. (Babington, 1/30)

Politico Pro: Lobbying Push Puts Obscure Tax At Top Of Obamacare Repeal Agenda
A lot of things about Obamacare rile up Americans, but the medical device tax isn’t one of them. Yet this relatively obscure piece of the law’s financing has risen to the top of Republicans’ health care agenda and may have the best chance of any Obamacare repeal bill of actually getting through Congress this year. (Norman, 1/29)

Senate Panel Questions Whether Wellness Programs Clash With Disability Laws

In other Capitol Hill action, two Republican senators set out goals for overhauling federal policies regarding the National Institutes of Health and the Food and Drug Administration.

The Hill: Murray: EEOC Regs On Wellness Programs Coming Soon
The top Democrat on the Senate Health, Education, Labor and Pensions Committee said Thursday that federal guidance is forthcoming to help employers administer worker wellness programs so that they comply with both ObamaCare and the Americans with Disabilities Act. Sen. Patty Murray (D-Wash.) raised concerns in a committee hearing that some employers are going too far with their wellness initiatives and are ultimately discriminating against certain workers based on their health status. (Viebeck, 1/29)

CQ Healthbeat: Senators Question If Wellness Programs Run Afoul Of Disability Laws
Employers and health experts are pressing the Equal Employment Opportunity Commission for greater clarity on how workplace wellness programs should comply with anti-discrimination and disability laws. Lamar Alexander, chairman of the Senate Health, Education, Labor and Pensions Committee, suggested during a Thursday hearing that legislation may even be appropriate and invited witnesses to submit their suggestions to the panel afterwards for review. (Zanona, 1/29)

CQ Healthbeat: Senators Lay Out Goals For FDA, NIH Overhaul
The top senator overseeing health policy is setting an ambitious target for overhauling federal policies governing medical research and regulation with an aim of getting products to market faster. While Health, Education, Labor and Pensions Chairman Lamar Alexander, R-Tenn., kicked off the effort with Sen. Richard M. Burr, R-N.C., he said he intends to collaborate closely with Patty Murray of Washington, the ranking member of HELP, and other committee Democrats. Alexander also noted that the White House has been calling for a more intense effort to translate genetic knowledge into new treatments, a field referred to as precision medicine. (Young, 1/29)

And artificial intelligence technology is part of a lobbying push -

Bloomberg: Doctor Watson Will See You Now, If IBM Wins In Congress
Watson, an artificial intelligence technology that IBM wants to sell to help doctors diagnose diseases, will largely escape the oversight of U.S. regulators if the computer giant wins a two-year Washington lobbying push. IBM Corp.'s argument to Congress is that its supercomputer, famed for victory on quiz show "Jeopardy!," isn't a medical device like a cardiac pacemaker and shouldn't need lengthy clinical trials to prove it's safe and effective. A draft bill released Tuesday backs that position, and could speed the use of Watson and other decision support technologies. (Edney, 1/29)

Health Law Issues And Implementation

Final Push Underway For Obamacare Sign-Ups

With two weeks until the deadline, the White House is joining forces with advocacy groups to boost enrollment of Asian-Americans. In California, Anthem leads in sign-ups, but Kaiser Permanente is gaining, while in Colorado, a glitch cancels 3,615 insurance plans that should have been renewed. And in Florida, some prefer using free clinics to getting coverage -- even when they qualify for big subsidies.

Milwaukee Journal-Sentinel: Final Push Underway For Obamacare Sign-Up
Roughly two weeks remain to sign up for health insurance on the marketplace set up under the Affordable Care Act, and this year the penalty for not having coverage will have a bit more bite. The minimum penalty will be $325, up from $95 for last year, and most people will face higher penalties. (Boulton, 1/29)

Los Angeles Times: Obamacare Enrollment In California: Anthem Leads, Kaiser Draws Closer
Insurance giant Anthem Blue Cross leads Obamacare enrollment in California, but Kaiser Permanente is gaining on its archrival. Anthem Inc., the nation's second-largest health insurer, has signed up 353,635 people, or 29.1 percent of Covered California enrollment through Jan. 15. That figure includes 2014 renewals and new enrollees since November. (Terhune, 1/29)

Kaiser Health News: Insurance Choices Dwindle In Rural California As Blue Shield Pulls Back
After the insurance exchanges set up under the Affordable Care Act first went live in late 2013, Lori Lomas started combing the website of Covered California on a hunt for good deals for her clients. Lomas is an agent at Feather Financial, in the Sierra Nevada mountain town of Quincy, California; she’s been selling health policies in rural communities for more than 20 years. But in 2013, she noticed a troubling change that surprised her: For many clients, insurance options decreased. (Bartolone, 1/30)

Health News Florida: Free Clinics Beat Subsidies For Some
With open enrollment for health insurance ending in just two weeks, the push is on to get everyone who qualifies signed up. But some of the uninsured are balking, and it’s not only the so-called “young invincibles” who think they don’t need it. Gary Babcock of Clearwater, for example, is neither young nor invincible. He’s 55, with diabetes so severe he has to give himself daily insulin shots and he could choose from several Affordable Care Act plans with no premium, fully subsidized. But he didn’t sign up last year and won’t enroll this year either, he said, because he gets everything through the St. Petersburg Free Clinic – drugs, supplies, checkups and classes on diabetes management. (Gentry, 1/29)

In Florida, meanwhile, business leaders are leading the push for Medicaid expansion  -

Health News Florida: Business Driving Florida Expansion Push
Florida's Legislature has twice turned down proposals to provide health insurance for nearly 1 million state residents. And the new House Speaker on Wednesday said he had “no plans” to expand Medicaid for the people caught in the so-called coverage gap. But still state business leaders – and some mayors – continue to rally and aim to take another swing at it when the Legislature convenes March 3. (Shedden, 1/29)

Administration News

Obama To Unveil Biomedical Research Initiative

President Barack Obama plans to ask Congress for $215 million for what is being called a "precision medicine initiative," including plans to collect genetic data, so that scientists can learn how to target treatments.

The Associated Press: Obama Proposes 'Precision Medicine' To End One-Size-Fits-All
President Barack Obama is calling for an investment to move away from one-size-fits-all-medicine, toward an approach that tailors treatment to your genes. The White House said Friday that Obama will ask Congress for $215 million for what he's calling a precision medicine initiative. The ambitious goal: Scientists will assemble databases of about a million volunteers to study their genetics — and other factors such as their environments and the microbes that live in their bodies — to learn how to individualize care. (Neergaard, 1/30)

Medicare

Scrutiny Given To Surgeries To Relieve Blockages In Arms, Legs

Some are questioning the necessity of these treatments, which can be done in doctors' offices and are very lucrative. Meanwhile, federal regulators say they will ease up on an electronic health records program in response to complaints from doctors' groups and medical homes show mixed results after one year.

The New York Times: Medicare Payments Surge For Stents To Unblock Blood Vessels In Limbs
At a time of increasing scrutiny of procedures to open blocked heart arteries, cardiologists are turning to — and reaping huge payments from -- controversial techniques that relieve blockages in the arms and legs. Unlike heart procedures, which must be done in a hospital or outpatient facility, where oversight is typically more intense, the opening of the peripheral arteries and veins of the arms and legs can be done in a doctor’s office. (Creswell and Abelson, 1/29)

The Hill: Feds To Ease Up On Electronic Health Records Program
Federal regulators announced their intention Thursday to ease up on the meaningful use electronic health records (EHR) program, one week after a coalition of 35 medical societies called for major changes. In a blog post, senior Centers for Medicare and Medicaid Services (CMS) official Patrick Conway said the agency is working on "multiple rulemaking tracks" to adjust the program based on provider feedback. (Viebeck, 1/29)

Kaiser Health News: Mixed Results For Obamacare Tests In Primary-Care Innovation
Medical homes are a simple, compelling idea: Give primary-care doctors resources to reduce preventable medical crises for diabetics, asthmatics and others with chronic illness — reducing hospital visits, improving lives and saving money. But it’s not so easy in practice. New reports show that two big experiments run by the health law’s innovation lab, known as the Center for Medicare & Medicaid Innovation, delivered mixed early results in enhancing primary care. The programs reduced expensive hospital visits in some cases but struggled to show net savings after accounting for their cost. (Hancock, 1/30)

Veterans' Health Care

Commission Urges Change In Military Health And Pension Plans

The congressionally mandated commission recommended doing away with the centerpiece of the military health system and instead giving military families and retirees a choice of private-sector plans.

The Wall Street Journal: Commission Recommends Changes To Military Benefits
A special commission looking at Pentagon spending called Thursday for scrapping the centerpiece of the military health-care system and trimming guaranteed retirement benefits for career officers, as part of a broad plan that could save the Defense Department billions of dollars. After 18 months of research, the independent commission concluded that the Pentagon’s pay and benefit system “is fundamentally sound and does not require sweeping overhaul.” But the 280-page report lays out a series of politically charged changes that are certain to face strong resistance in Washington. (Nissenbaum, 1/29)

Bloomberg: Military 401(k) and Cheaper Health Plans Proposed by U.S. Panel
Future U.S. military families and retirees should be given a choice of health-insurance plans and help paying the premiums, according to an independent commission that looked at ways to update benefits and slow the growth of personnel costs. The Military Compensation and Retirement Modernization Commission also suggested adding 401(k)-style retirement accounts to the mix of military benefits. (Tiron, 1/29)

Also in the news, more from the Inspector General on veterans' health -

Public Health And Education

Measles Outbreak Tally Continues To Grow

NPR reports that some health experts say this is a critical time in efforts to control the spread of this outbreak. Meanwhile, The Washington Post highlights an anti-vaccine physician.

The Washington Post: 2015 U.S. Measles Outbreak Already At 84 Cases, More Than In A Typical Year
The 2015 measles outbreak already has spread to 84 people, more than health officials typically see in an entire year, the Centers for Disease Control and Prevention reported Thursday. Most of the cases are traceable to an outbreak at Disneyland and another theme park in Southern California that began in late December and now has spread to six other states, including Utah, Washington, Oregon and Colorado. In all, measles has reached 14 states, according to Anne Schuchat, director of the CDC’s National Center for Immunization and Respiratory Diseases. (Berstein, 1/29)

NPR: Rise In Measles Cases Marks A 'Wake-Up Call' For U.S.
After a few cases here and there, measles is making a big push back into the national consciousness. An outbreak linked to visitors to the Disneyland Resort Theme Parks in Orange County, Calif., has sickened 67 people in California and six other states according to the latest count from the Centers for Disease Control and Prevention. So far this year there have been 84 measles cases in 14 states. That's already more cases than the U.S. typically sees in a year, the CDC's Dr. Anne Schuchat told reporters on a conference call Thursday. "This is a wake-up call to make sure measles doesn't get a foothold back in our country." (Hensley, Rizzo and Hurt, 1/29)

The Washington Post: Amid Measles Outbreak, Anti-Vaccine Doctor Revels In His Notoriety
It’s 6:30 p.m. in eastern Arizona, and an energetic doctor who has gained notice due to his disdain for vaccinations has just gotten home. It’s been a busy day. He’s already spoken to USA Today. He just did a segment on CNN. And he’s closely monitored his Facebook page, which has collected 4,000 “likes” in the span of 48 hours. But Jack Wolfson always has time to discuss vaccinations — his hatred of them and his abhorrence of the parents who defend them. (McCoy, 1/30)

State Watch

State Highlights: In Mass., Judge Rejects Partners' Hospital Acquisition Deal; Iowa Physician Assistants Seek To Have Oversight Rule Eased

A selection of health policy stories from Massachusetts, Iowa, Mississippi, Georgia, Florida, New York, Kansas and Maryland.

WBUR: Judge Rejects Partners Deal To Acquire 3 Hospitals
The state health care market is reverberating with the aftershocks of a major court decision Thursday which rejected a deal that would have let Partners HealthCare, the state’s largest hospital network, acquire three more hospitals. (Bebinger, 1/29)

The Boston Globe: Partners’ Deal To Acquire Three Hospitals Rejected
A Superior Court judge on Thursday dealt a devastating blow to Partners HealthCare’s plans to expand its dominance across Eastern Massachusetts, rejecting a controversial deal that would have allowed Partners to acquire three community hospitals and add hundreds of doctors to its network. (McCluskey and Weisman, 1/29)

The Des Moines Register: Physician Assistants Want Oversight Rule Eased
Ed Friedmann is the top health care provider on most days in this Dallas County town of 876 people, where he has worked for 29 years as a physician assistant. He owns his red-brick clinic, which once was a small hospital but hasn’t had a full-time physician in decades. He can prescribe most medications. He can stitch up a cut leg or remove a wayward fish hook from a finger. Friedmann’s work is overseen by a physician 19 miles away in Dallas Center. A state regulation requires the doctor to travel to the Redfield clinic at least every other week to go over cases. But Friedmann is helping lead an effort to get rid of the state requirement that such reviews be done in person. (Leys, 1/29)

Health News Florida: Tampa-area Hospitals Face $151M Cut
Hillsborough County hospitals are scheduled to lose more than $151 million a year in funds for care of the uninsured beginning June 30, according to a report released Thursday. Statewide, the coming annual loss will be $2.1 billion, estimates co-author Charlotte Cassel. The Tampa Bay area report strongly urges that Florida accept the federal funds provided through the Affordable Care Act for states that expand Medicaid expansion to people under the poverty level who are not covered now. That includes close to 1 million uninsured Floridians. (Gentry, 1/29)

The New York Times: As New York Moves People With Developmental Disabilities To Group Homes, Some Families Struggle
For John Cosentino, 50, an intellectually disabled adult with profound autism and self-injurious behavior who does not speak, this routine has been his refuge. He has lived at the sprawling, state-run center in East New York off the Belt Parkway since he was a teenager. Sometime this year, however, his routine will abruptly end, and he, like the other remaining residents of the institution, will probably enter a group home. (Robbins, 1/29)

The Kansas Health Institute News Service: Mental Health Providers Wary Of Effort To Regulate Use Of Behavioral Health Drugs
The Kansas Department for Aging and Disability Services is attempting to head off opposition to a bill being crafted to allow the state to regulate the use of prescription mental health drugs. Kansas Mental Health Coalition made it clear they would likely continue to oppose any proposal aimed at limiting Medicaid patients’ access to brand-name antipsychotic drugs. (Ranney, 1/29)

The Kansas Health Institute's News Service: Kansas Pushes For Savings Accounts For Children With Disabilities
On a day when Congressman Kevin Yoder testified before a Kansas House committee, it was a 15-year-old Olathe South High School freshman who stole the show. Rachel Mast, who has Down syndrome, ebulliently encouraged the Children and Seniors Committee to approve a bill to allow tax-exempt savings accounts for Kansas children with disabilities that would not jeopardize their Medicaid benefits. Yoder said with federal bill’s passage in December Kansas should now act quickly to become the first state to take advantage of it. (Marso, 1/29)

The Kansas Health Institute's News Service: Legislators Consider Allowing Access To Drugs In Early Testing Phase
Legislators heard emotional testimony Thursday from an Emporia woman about a bill to allow access to drugs in preliminary federal testing. They also heard questions about whether the “Right to Try” legislation is sound policy or an ideological quest that will give terminal patients false hope. Versions of “Right to Try” have passed in Colorado, Arizona, Michigan, Missouri and Louisiana. (Marso, 1/29)

The Baltimore Sun: After Delay, Hogan To Implement Regulation Banning LGBT Discrimination
Gov. Larry Hogan will allow implementation of three health care regulations his administration had previously flagged for further review, including one that bans discrimination against Medicaid patients based on sexual orientation and gender identity. Hogan's withholding of the regulation, which also prevents discrimination based on religious affiliation, had riled advocates for the lesbian, gay, bisexual and transgender community. (Rector, 1/29)

Health Policy Research

Research Roundup: Patient Costs And Medicaid; ER Co-Payments

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

JAMA Internal Medicine: The Effect Of Emergency Department Copayments For Medicaid Beneficiaries Following The Deficit Reduction Act Of 2005
To provide states with flexibility in administering [Medicaid] while containing costs, the Deficit Reduction Act of 2005 (DRA) gave states the authority to impose cost-sharing strategies, including emergency department (ED) copayments for nonurgent visits. ... [The researchers compared] trends in ED use among Medicaid beneficiaries from January 2001 to December 2010. Eight states with ED copayments for nonurgent ED visits (copayment states) were compared with 10 states with zero ED copayments (control states). ... [They] detected no statistically significant change in annual ED admissions per Medicaid enrollee in copayment states compared with control states following the DRA. There was also no change in the rate of outpatient medical provider visits or in annual inpatient days per Medicaid enrollee. (Siddiqui, Roberts and Pollack, 1/26)

Health Affairs: The Two-Midnight Rule
Medicare pays for inpatient services and outpatient services under separate and very different payment systems, which can produce substantially different payment amounts for similar patients receiving similar services. The cost-sharing implications for beneficiaries under the two systems can also vary significantly. ... In 2013 CMS announced the so-called two-midnight rule to clarify when it expected a patient to be designated to inpatient status. Under this rule, only patients that the doctor expects will need to spend two nights in the hospital would be considered as hospital inpatients. This brief describes the perceived need by CMS for the two-midnight rule, how it would work, and the implications for Medicare payment. It also reviews the heated response to the rule. (Cassidy, 1/22)

The New England Journal of Medicine: Cost-Effectiveness Of Hypertension Therapy According To 2014 Guidelines
We projected the cost-effectiveness of treating hypertension in U.S. adults according to the 2014 guidelines. ... The full implementation ... would result in approximately 56,000 fewer cardiovascular events and 13,000 fewer deaths from cardiovascular causes annually, which would result in overall cost savings. ... treatment of patients with existing cardiovascular disease or stage 2 hypertension would save lives and costs for men between the ages of 35 and 74 years and for women between the ages of 45 and 74 years. The treatment of men or women with existing cardiovascular disease or men with stage 2 hypertension but without cardiovascular disease would remain cost-saving even if strategies to increase medication adherence doubled treatment costs. (Moran et al., 1/29)

The Kaiser Family Foundation: Federal And State Standards For "Essential Community Providers" Under The ACA And Implications For Women's Health
Congress established general requirements to assure that [safety-net providers, such as community health centers and family planning clinics] have the opportunity to participate in the health plans that are offered through the [health law's] Marketplaces. These safety net clinics and hospitals are referred to as Essential Community Providers (ECPs) .... there is considerable variation across the country in both the categories of providers included as ECPs as well as the standards required for inclusion in plan networks. This brief reviews the definition of ECP, examines the federal and state rules..., identifies the variation from state to state, and discusses the particular importance of these rules and providers for women’s access to care. (Jade Peña, Sobel, and Salganicoff, 1/23)

Brookings: Medicare Physician Payment Reform: Securing The Connection Between Value And Payment
Last year, Congress reached agreement in principle on legislation that would move Medicare’s payment of physicians and other clinicians away from fee-for-service (FFS), which pays based on the volume and intensity of services they provide. Instead, Medicare would begin paying clinicians for providing better care, keeping patients healthy, and lowering overall costs – a “pay for value” approach. ... we believe that some specific modifications to the legislation would enable it to do more to support better care and more value in Medicare. (McClellan, Berenson et al., 1/27)

The Robert Wood Johnson Foundation: State-Level Trends In Employer-Sponsored Health Insurance
[C]oncerns have been raised that the ACA could have unintended consequences that would cause declines in ESI [employer sponsored insurance]. To provide a baseline for understanding the impacts of the ACA on ESI, this report examines and compares trends during two time periods: a period before and including the recession (2004/2005 to 2008/2009), and a period including and since the recession (2008/2009 to 2012/2013). While the majority of nonelderly Americans with health insurance are covered by employer-sponsored insurance (ESI), the percentage of the U.S. population with ESI has been declining for more than a decade. (Planalp, Sonier and Fried, 1/29)

The Kaiser Family Foundation: The HPV Vaccine: Access And Use In The U.S.
Vaccination rates have remained mostly static for the two vaccines that protect young people against infection by certain strains of the human papillomavirus (HPV), the most common sexually transmitted infection (STI) in the United States. The vaccines were originally recommended only for girls and young women and were subsequently broadened to include boys and young men. This factsheet discusses HPV and related cancers, use of the HPV vaccines for both females and males, and insurance coverage and access to the vaccines. (1/26)

Here is a selection of news coverage of other recent research:

Medscape: Headache-Related Imaging, Referrals Almost Doubled
Contrary to practice guidelines, clinicians treating patients with headache are increasingly ordering costly imaging tests and referring patients to other physicians, and they're doing less counseling on lifestyle changes, authors of a new review suggest. The researchers found an almost doubling of the use of computed tomography (CT) and MRI in a recent 10-year period. Although given the nature of the study they couldn't determine which referrals or imaging studies weren't appropriate, the trend toward a doubling of these tests is concerning, said lead study author, John Mafi, MD, fellow, general internal medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. (Anderson, 1/26)

Medscape: To Meet Demand For Pediatric NPs, System Must Change
Pediatric nurse practitioner (PNP) programs in the United States will need to increase in number and size, promote the pediatric specialization better, and better prepare students to pass the certification exam to meet the coming demand, a new study finds. Without changes, the shortage, based on a prediction model for admissions into PNP programs, is expected to last 13 years or more. (Putre, 1/26)

Medscape: Tiered Care Centers Proposed For High-Risk Pregnancies
A new consensus document proposing the establishment of levels of care for perinatal and postnatal women has been developed by the American College of Obstetricians and Gynecologists and the Society for Maternal Fetal Medicine. The document was published in the February issue of Obstetrics & Gynecology. (Brown, 1/29)

Medscape: PCPs Should Be Consultants On Hospitalists' Team, Experts Say
To better coordinate primary care and hospitalists' care in the inpatient setting, internal medicine researchers from Massachusetts General Hospital in Boston have proposed a collaborative model. Allan Goroll, MD, and Daniel Hunt, MD, say that under their plan, the primary care provider (PCP) would become a consultant to the hospitalists' team. The PCP would visit patients within 12 to 18 hours of admission to give support and counseling and recommend a care plan. (Frellick, 1/26)

Editorials And Opinions

Viewpoints: Misguided Efforts On Medical Device Tax; Tighten Vaccine Regs; Abortion Switch

A selection of opinions on health care from around the country.

The Washington Post: Bipartisan Efforts To Repeal The Medical Device Tax Are Galling
Once again, Congress seems set to prove it can be bipartisan — when the challenge involves caving in to special interests. Republicans and Democrats look set to repeal the Affordable Care Act’s medical device tax, a 2.3 percent excise on manufacturers of everything from sutures to pacemakers to MRI machines. The winners would be an influential lobby and rank hypocrisy. The loser would be the country. (1/29)

The New York Times: No Case For Killing The Medical Device Tax
In seeking to dismantle the Affordable Care Act piece by piece, congressional Republicans have placed a high priority on repealing a tax on medical devices that would raise some $29 billion over the next 10 years to help ensure that health reform will not increase the deficit. Repealing the tax is a terrible idea that has been given a veneer of respectability by support from liberal Democrats in states with large concentrations of device manufacturers. They include Senator Elizabeth Warren of Massachusetts, Senators Amy Klobuchar and Al Franken of Minnesota and Representative Ron Kind of Wisconsin, among others. President Obama ought to veto any bill that eliminates the tax. (1/30)

Bloomberg: Are Republicans Ready For A Post-Obamacare World?
Millions of Americans could find their health-insurance plans endangered if the Supreme Court rules this summer that President Barack Obama's administration has broken the law in subsidizing them. The administration created this problem by pushing through a poorly written statute and lawlessly implementing it. But congressional Republicans nonetheless should step up and solve the problem -- and they should do it in a way that hastens the end of Obamacare. ... Republicans could, for example, offer to authorize the subsidies everywhere, but only through the end of this presidency and in return for some changes to the law. Or they could offer a health-insurance alternative of their own that enables the people affected to get affordable coverage. (Ramesh Ponnuru, 1/29)

Tampa Bay Times: Excuses Are Running Low For Florida Lawmakers Who Won't Expand Medicaid
Indiana's plan to use Medicaid expansion funds was approved by the federal government on Tuesday, bringing the total number of participating states to 28. ... Once upon a time, former House Speaker Will Weatherford complained about the federal government's inflexibility. Well, it turns out D.C. is quite flexible on this issue. Arkansas, Indiana, Iowa and Michigan have all gotten waivers to use federal funds for health coverage outside the traditional Medicaid model. So now, incoming House Speaker Steve Crisafulli, R-Merritt Island, is saying the House is philosophically opposed to expanding a broken system. Yet, once again, federal officials have allowed states to use funds to create their own health care systems. (John Romano, 1/28)

news@JAMA: Medicaid At 50: Time For Major Overhaul
It’s understandable that attention is heavily focused these days on imagining alternative futures for the Affordable Care Act (ACA) after the US Supreme Court renders its decision in King v Burwell, expected this June. (This case challenges the legality of making tax subsidies available for people to buy health insurance through the federal exchange in states that have decided not to run their own exchanges.) But it’s also time to look hard at Medicaid, the joint federal-state program for lower-income Americans. Whatever happens to the ACA, Medicaid needs urgent attention—and some basic rethinking. (Stuart Butler, 1/29)

JAMA: Health CO-OPs Of The Affordable Care Act
At this time, the future of the existing CO-OP program remains promising if uncertain. According to this view, some CO-OPs may falter. The recent default of CoOpportunity Health, the CO-OP serving the states of Iowa and Nebraska, is supportive of this outlook. Other CO-OPs may experience a significant growth spurt replete with the related attendant benefits. The latter outcome hinges on the appeal of the CO-OP construct, functional online exchanges, and priced-to-compete multiyear products. Growth by way of entry into the mid-size and large group markets must also be considered. In the final analysis, the CO-OPs will have to prove their effectiveness and value in the marketplace. (Allan M. Joseph and Eli Y. Adashi, 1/29)

The New York Times' Opinionator: For V.A. Hospitals (And Patients), A Major Health Victory
Earlier this month, the Centers for Disease Control and Prevention announced that the United States is making modest progress in bringing down rates of hospital-acquired infections. Progress is good, but modest is not. Hospital-acquired infection is one of the country’s leading causes of death, killing 75,000 people per year — more than car accidents and breast cancer combined. As antibiotic resistance increases, we are already seeing infections no drugs can cure. And these infections are preventable. Still, one in 25 patients who goes into the hospital without an infection will get one there. (Rosenberg, 1/30)

The Baltimore Sun: Medicare 'Quality Indicators' Diverge From Quality Care
Health and Human Services Secretary Sylvia Burwell announced this week that, through the Affordable Care Act (ACA), Medicare would be taking drastic steps to assure that doctors are paid not for visits and procedures, but rather for the value of their work. The truth is that we cannot measure quality. Medicare's quality indicators often diverge sharply from true quality geriatric care, yet it is our compliance with those numbers that will now determine our salary. Rather than having time to talk to my patients, I often find myself madly typing notes into a computer and filling out reams of paperwork to comply with Medicare's regulations, and ordering tests and using drugs to comply with Medicare's quality indicators. (Andy Lazris, 1/29)

The New York Times' Taking Note: Tim Ryan’s Switch On Abortion Rights
Representative Tim Ryan, an Ohio Democrat who previously opposed abortion rights, has officially changed sides. He’s very welcome in the pro-choice camp. With reproductive freedom under attack in the Republican-led Congress and in G.O.P.-controlled state legislatures around the country, the embattled cause needs all the new supporters it can get. (Dorothy J. Samuels, 1/29)

Los Angeles Times: Measles: How Legislators Can End 'Personal Belief' Waivers On Vaccination
If there's a silver lining in the ongoing outbreak of measles linked to infected and unvaccinated visitors to Disneyland during the holidays, it's that the crisis may spur state lawmakers to reverse the trend expanding exemptions from mandatory childhood immunizations. Two public health experts have just weighed in with a timely look at the legislative landscape and lawmakers' options. Y. Tony Yang of George Mason University and Ross. D. Silverman of Indiana University, writing in the Journal of the American Medical Assn., report that until recently, legislative initiatives across the country have tended toward expanding exemptions from vaccination mandates. (Michael Hiltzik, 1/29)

Los Angeles Times: It's Time To Tighten The Rules On E-Cigarettes
As more information begins to emerge about e-cigarettes, they are looking less and less like benign alternatives to traditional smoking. Teenagers are apparently taking up the so-called vaping habit in droves, and now we're also learning that the exhaled vapor contains multiple harmful chemicals. That is reason enough for California to follow the lead of many municipalities by prohibiting vaping in workplaces, restaurants and other indoor gathering places, and to take stronger steps to prevent teens from buying e-cigarettes. (1/29)

Reuters: What Precision Medicine Is, And How It Might Save Your Life Some Day
The term “precision medicine’’ is one that most Americans had likely never heard before President Barack Obama’s State of the Union address, but it is an area of exciting promise in biomedical research that will eventually improve health outcomes and potentially reduce healthcare costs. The concept revolves around understanding the specific genetic changes that underlie such diseases as cancer, diabetes and cystic fibrosis. (Carlos Moreno, 1/30)