KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

House Approves Permanent Fix For Medicare Doctor Payments

For more than a decade, doctors who treat Medicare patients have been threatened with pay cuts due to a faulty formula of how doctors are reimbursed. But in a rare bipartisan agreement, the House of Representatives overwhelmingly passed a deal to permanently end the problem and reward quality of care, not quantity. (3/27)

Some Face A Big Bill From Medi-Cal -- After They Die

California is one of the few states that charge the estates of deceased Medicaid beneficiaries for the cost of their health coverage. A bill is moving through the state legislature to stop the practice. (Lisa Aliferis, KQED, 3/27)

Political Cartoon: 'A Bigger Boat?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'A Bigger Boat?'" by Nick Anderson.

Here's today's health policy haiku:


No more doc fixes?
The end of kicking the can?
That's the House message.

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

House OKs Bipartisan Deal On 'Doc Fix'

The measure, which is being billed as the most significant bipartisan policy legislation to gain House passage since the GOP gained control of the chamber, would establish a new formula in the Medicare program for paying physicians. The Senate will take up the measure when it returns to work after its two-week recess. Without congressional intervention, doctors face a 21 percent pay cut.

The New York Times: House Approves Bill On Changes To Medicare
The House overwhelmingly approved sweeping changes to the Medicare program on Thursday in the most significant bipartisan policy legislation to pass through that chamber since Republicans regained a majority in 2011. The measure, which would establish a new formula for paying doctors, increase premiums for some Medicare beneficiaries and extend a popular health insurance program for children, has already been endorsed by President Obama and awaits a vote in the Senate. (Steinhauer and Pear, 3/26)

The Wall Street Journal: House Passes Medicare ‘Doc Fix’ Bill
Without congressional action, doctors would face a 21% cut in payments starting April 1. The formula, which dates back to a 1997 law designed to rein in the growth of Medicare’s costs, became politically untenable over the years, forcing Congress to override cuts through temporary patches. But lawmakers haven't been able to agree on a long-term fix until now. The agreement marks a shift for Mr. Boehner, who had eschewed dealing with Democrats in the interest of building a consensus with the most conservative members of his caucus. (Hughes, 3/26)

The Wall Street Journal: Senate To Take Up Medicare ‘Doc Fix’ Bill After Recess
The Senate will take up legislation to replace a formula for reimbursing doctors who treat Medicare patients when the chamber returns from a two-week recess, Senate Majority Leader Mitch McConnell (R., Ky.) said early on Friday. ... Dr. Robert Wah, the president of the American Medical Association, said his group was “extremely disappointed” that the Senate vote was delayed and said that physicians would face a “devastating” cut when the current patch expires just days from now. (Hughes, 3/27)

Reuters: U.S. Senate Delays Vote On Medicare Payment Fix For Two Weeks
The U.S. Senate will wait more than two weeks before acting on a bill to permanently fix the flawed formula for reimbursing Medicare physicians, after an April 1 deadline to start a 21 percent cut in payment rates. Senate Republican and Democratic leaders said early on Friday that they would take the bill up when they return on April 13 from an Easter/Passover break. (Lawder, 3/27)

NPR: Amazingly, Congress Actually Got Something Done
They said it couldn't be done. And for more than a decade they were right. But on Thursday, staring at a deadline that could have disrupted health care to millions of seniors, the House got something done. It voted to fix the flawed formula for compensating doctors who provide services to patients under Medicare. But this time it wasn't just a patch for a few months or years — like the ones Congress has done 17 times since 2003. (Elving, 3/26)

USA Today: House Passes Bipartisan 'Doc Fix' Medicare Bill
The bill would repeal the current Medicare payment formula for doctors and replace it with one that would increase payments to doctors by one-half of 1% every year through 2019. After that, doctors would receive bonuses or penalties depending on performance scores from the government. Their scores would be based on the value of the care they provide rather than on the volume of patients they see. (Kelly, 3/26)

Los Angeles Times: House Passes Compromise Package To Change How Medicare Pays Doctors
But prospects were dimming late Thursday that Senate leaders would take up the package to avert an automatic 21% cut in Medicare payments to physicians. Several Republican senators voiced concern about the bill's impact on the deficit, which could preclude Senate Majority Leader Mitch McConnell (R-Ky.) from bringing up the bill Friday in an expedited maneuver that under Senate rules requires unanimous consent. Democrats remain concerned that the legislation reauthorizes funding for the Children's Health Insurance Program, or CHIP, for only two years, rather than four, as many advocates and governors want. (Levey, 3/26)

Bloomberg: Doctors To Get Medicare Raise In Bipartisan Bill Passed By House
The bill, H.R. 2, would replace Medicare's cost-containment formula for physician payments in place since 1997. Congress has listened to warnings that physicians might stop taking Medicare patients and voted 17 times to prevent the formula from forcing cuts in doctor fees. The existing formula would cut doctors' pay by 21 percent starting April 1. The American Medical Association, the largest U.S. doctors' organization, has been lobbying for years to change the payment system. (House, 3/27)

Politico: Medicare Pay Fix Sails Through House
The bill now goes to the Senate, where Democratic-led opposition appears to be ebbing given the tsunami of support from a wide array of health care and children’s groups. In the last day, several key Senate Democrats — such as Sens. Claire McCaskill of Missouri and Dianne Feinstein of California — told reporters that they plan to support the measure. President Barack Obama said on Wednesday that he backs the legislation. (Haberkorn and Pradhan, 3/26)

NBC News: House Passes 'Doc Fix' For Medicare Doctors
Boehner and House Democratic leader Nancy Pelosi cooked up the bill together. It would cost $214 billion over 10 years, the Congressional Budget Office says, but $73 billion can be saved via spending cuts or new revenue. Boehner says it's cheaper than paying for one-year pay raises. (Fox, 3/26)

Kaiser Health News: House Approves Permanent Fix For Medicare Doctor Payments
For more than a decade, doctors who treat Medicare patients have been threatened with pay cuts due to a faulty formula of how doctors are reimbursed. But in a rare bipartisan agreement, the House of Representatives overwhelmingly passed a deal to permanently end the problem and reward quality of care, not quantity. PBS NewsHour’s Gwen Ifill learns more from Mary Agnes Carey of Kaiser Health News. (3/27)

The Wall Street Journal's Washington Wire: What Is The ‘Doc Fix’?
The House Thursday passed a bill to permanently change Medicare reimbursement formulas for doctors and other providers, and the Senate is expected to take up the bill sometime in the coming weeks. Passage represents a major bipartisan victory in a Congress that has otherwise been mired in gridlock. What is it and how did it come about? Here are some basics. (Radnofsky and Hughes, 3/26)

Kaiser Health News: FAQ: The House Passes A Bill To Fix Medicare’s Doctor Payments. What’s In It?
Kaiser Health News staff writer Mary Agnes Carey reports: "The troubled payment formula for Medicare physicians is one step closer to repeal. The House Thursday overwhelmingly passed legislation to scrap Medicare’s troubled physician payment formula, just days before a March 31 deadline when doctors who treat Medicare patients will see a 21 percent payment cut. Senate action could come this week as well, but probably not until the chamber completes a lengthy series of votes on the GOP’s fiscal 2016 budget package." (Carey, updated 3/26)

Who Voted Against It?

The Hill reports on the 37 lawmakers who voted against the House "doc fix" legislation. Also, The Fiscal Times details why some people are not happy with the agreement and the Connecticut Mirror notes that its two senators also have some questions.

The Hill: The 37 Lawmakers Who Opposed Medicare Deal
Thirty-three Republicans and four Democrats opposed the Medicare bill negotiated by Speaker John Boehner (R-Ohio) and House Minority Leader Nancy Pelosi (D-Calif.). The Republicans in opposition consisted of fiscal hawks who didn't want to vote for a measure that would add to the deficit. The Congressional Budget Office estimates the legislation would cost $214 billion over the next decade, with $73 billion of that total offset with spending cuts or new revenue. (Marcos, 3/26)

The Fiscal Times: Not Everyone Is Happy With Bipartisan Medicare Deal
A deal passed by the House of Representatives today with large margins from both parties would put an end to decades of last-minute patches to the Medicare payment system, a procedure that has happened so many times it gained its own nickname, the “Doc Fix.” Many are looking at the agreement, struck by House Speaker John Boehner (R-OH) and House Minority Leader Nancy Pelosi (D-CA), as a return to the way Congress used to do business. To some critics of the deal, though, that’s precisely the problem. (Garver, 3/26)

Connecticut Mirror: CT Senators Part Of ‘Doc Fix’ Hangup That Could Cut Medicare Fees
Fees paid to doctors who treat Medicare patients could drop sharply at the end of the month, the result of an impasse in the U.S. Senate over a bill that would prevent the 21 percent decline in payments. Connecticut's five House members voted Thursday for the legislation; but its Democratic senators, Richard Blumenthal and Chris Murphy, aren’t sold on the bill, objecting to its anti-abortion language and how the legislation would extend a children's health program. (Radelat, 3/26)

Medicare Pay Fix Bill Includes Higher Costs For Some Seniors

The measure includes a number of other provisions beyond its two big ticket items -- the repeal of Medicare's sustainable growth rate formula to pay doctors and the extension of the Children's Health Insurance Program.

Marketplace: Challenges Remain, Even After The 'Doc Fix' Gets Fixed
Another key provision would pay doctors more for high-quality care rather than the volume of care. Everybody loves that, says Harvard’s Dr. Ashish Jha. The trouble is it’s very hard to measure "quality." “We are going to focus on paying doctors for a lot of things. Some of which probably represent real quality and some of which clearly represent checking the box,” he says. (Gorenstein, 3/26)

Senate Passes Budget, Obamacare Repeal In All-Night Session

The budget is not binding, and House and Senate leaders will now meet to reconcile their versions of the spending blueprint, which is used to set funding levels for spending bills considered in the session. In the meantime, senators voted to reject an amendment to stop more than $1.2 trillion in Medicaid cuts.

The New York Times: Senate Approves Budget Of G.O.P. Wishes In All-Night Session
Emerging from an all-night session marked more by exhaustion than drama, Senate Republicans squeaked through a budget blueprint Friday morning that would repeal the Affordable Care Act, fundamentally remake federal health care for the poor and elderly, and push the federal deficit toward zero over the next decade. (Weisman, 3/27)

The Wall Street Journal: Republican-Controlled Senate Clears Budget Plan
The Senate passed a Republican budget for fiscal year 2016 early Friday morning after a grueling, round-the-clock marathon of amendment votes. ... Budgets are nonbinding and never become law, but they set the overall funding levels used to write spending bills considered later in the year. Top Republicans have said they plan to use spending bills to push GOP policies while avoiding the recent deadline-driven standoffs between Republicans and President Barack Obama. If both chambers can pass a unified budget, Republicans can also tap into procedural shortcuts enabling them to bypass Senate Democrats on some legislation, potentially including a repeal of the Affordable Care Act, though Mr. Obama would veto it. (Peterson and Crittenden, 3/27)

USA Today: Republican-Controlled Senate Approves Budget Plan
The ten-year fiscal blueprint achieves balance in ten years with deep spending cuts and no new taxes. It also calls for full repeal of President Obama's health care law and increased Medicare savings. The contours of the 2016 campaign season took shape throughout the lengthy Thursday debate, where senators powered through a marathon session of votes on politically charged amendments to the GOP's 10-year budget proposal. The voted concluded at 3 a.m. Friday. (Davis, 3/27)

Politico: Senate Passes Budget As Negotiations With House Loom Ahead
While that deadline has been routinely ignored in the past with little consequence, Republicans are eager to demonstrate they can govern, particularly when it comes to fiscal and budgetary issues. So it’s a good bet GOP leaders will work hard to try and meet that mid-April deadline. It won’t be easy to strike a deal that House Republican firebrands, defense hawks and Senate GOP moderates can all agree on. Hot button issues like the Pentagon budget, Medicare and Medicaid and domestic spending will all need to be resolved. Fiscal conservatives are angling for sharp cuts in government spending, while moderates are wary of going too far. And any budget that calls for major changes to entitlement programs like Medicare could be very risky. (Kim and Bade, 3/27)

The Associated Press: House, Senate GOP Budgets Have Differences And Similarities
Republicans controlling the House and Senate are pushing competing budget plans, though both nonbinding blueprints call for steep cuts to social programs like Medicaid and to federal subsidies under the Affordable Care Act as the chief means of achieving a small surplus within 10 years. The two plans would boost defense spending by the same level, but they take different approaches on Medicare. (3/26)

House Speaker Boehner Quiets Critics With Budget, Medicare Victories

His Democratic counterpart, Rep. Nancy Pelosi, annoyed some in her party by her deal-making with Republicans, but could yield political benefits for her party over the next two years. Also, former House Speaker Newt Gingrich says the GOP doesn't actually want to repeal Obamacare.

Politico: John Boehner Shows He’s Not Dead Yet
It wasn’t even a month ago some of John Boehner’s closest friends feared he was so weak that he might not last as speaker. Now, after big-ticket victories this week on the budget and entitlement reform, the Ohio Republican is about to depart Washington for the two-week Easter recess with the gavel planted firmly in hand. No one’s claiming Boehner suddenly has his fractious conference under his thumb or that his current good fortune will necessarily last once Congress returns to a host of other treacherous legislative challenges this year. (Sherman and Palmer, 3/27)

The Associated Press: Pelosi Irks Some Allies Over Bipartisan Bill With Boehner
House Democratic leader Nancy Pelosi bruised some longtime liberal allies when she worked with Speaker John Boehner to craft a rare bipartisan accord on Medicare. But lawmakers say it will enhance her stature as a dealmaker, and may help her party avoid being sidelined by majority Republicans over the next two years. Pelosi and her fellow Democrats disappointed friends in the abortion-rights lobby by backing a bill to avoid future cuts in Medicare physician payments. As Thursday's 392-37 House vote suggests, the bill was a compromise, with appeal to both parties. (3/27)

Meanwhile, in news from the Senate, Minority Leader Harry Reid announced that he wouldn't seek re-election -

USA Today: Senate Minority Leader Harry Reid To Retire
Reid's departure will set off a spirited battle for Democratic leader between his top two lieutenants, Illinois Sen. Dick Durbin and New York Sen. Charles Schumer. Showing off the combative streak that has been his signature as Democratic leader, Reid had a special message for Senate Majority Leader Mitch McConnell: "Don't be too elated. I am going to be here for 22 months ... doing the same thing I've done since I first came to the Senate." Reid has been a strong ally of President Obama and pushed hard as Democratic leader to pass the White House's agenda, including the Affordable Care Act, which was signed into law in 2010. Reid also helped Obama win Nevada, which has been trending Republican, in the 2008 and 2012 elections. (Camia and Kelly, 3/27)

Also in the headlines -

USA Today: Gingrich: GOP Really Doesn't Want To Repeal Obamacare
Former House Speaker Newt Gingrich doesn't think Obamacare should be repealed, and congressional Republicans who say they want to repeal it really don't want to either, he told a Washington, D.C. health conference Wednesday. Instead, he thinks more minor parts of the law that aren't working will be addressed because the core parts of the law have broader support than is often acknowledged. (O'Donnell, 3/26)

Health Law Issues And Implementation

Audit: Maryland Owes Feds $28M For State Exchange

Meanwhile, three Democratic governors took steps this month that could lead to the federal government assuming control of their state exchanges, and Tennessee's Republican governor continues to push for Medicaid expansion in his state.

The Baltimore Sun: Federal Audit Finds Accounting Problems With State Insurance Exchange
A long-awaited audit of Maryland's health insurance exchange has found that the state improperly billed the federal government $28.4 million as former Gov. Martin O'Malley's administration struggled to launch what would become one of the most troubled websites in the nation. Though the year-long probe by the Department of Health and Human Services inspector general found no fraud or criminal wrongdoing, auditors said the state lacked oversight and internal controls — and they recommended that Maryland refund what the federal government paid to subsidize the cost of signing people up for coverage. (Fritze and Cohn, 3/27)

Connecticut Mirror: ConnectiCare Takes Lead As Most Popular Insurer On Exchange
ConnectiCare Benefits Inc. was the most popular carrier among plans sold on the state’s health insurance exchange this year, capturing 42.3 percent of the 110,095 people who signed up for insurance through Access Health CT. Anthem Blue Cross and Blue Shield, the state’s largest insurer and last year’s exchange leader, received 39.8 percent of signups. HealthyCT raised its share from 3.2 percent last year to 15.6 percent this year, while UnitedHealthcare, in its first year of offering coverage through the exchange, captured 2 percent of customers. (Levin Becker, 3/26)

CQ Healthbeat: Blue State Governors Look To Feds After Exchange Snafus
Three Democratic governors have become so exasperated by flaws in their health law insurance exchange websites that they took steps this month that could lead to the federal government assuming control over all or part of their operation. More states may follow. Oregon Gov. Kate Brown signed a bill on March 6 that have her state’s Cover Oregon exchange use the same computers that run the federal government’s – after the state spent millions of dollars to fix the site and fired the contractor that built it. In a March 16 letter to lawmakers, Minnesota Gov. Mark Dayton wrote that he wants a task force to examine the long-term financial sustainability for the state’s MNsure exchange. (Evans, 3/26)

The Associated Press: Haslam Undaunted By Difficult Prospects For Insure Tennessee
Gov. Bill Haslam said Thursday that he is willing to risk a second defeat of his Insure Tennessee proposal to highlight the need for improving health standards in the state. The Republican governor told reporters after a prayer breakfast at Lipscomb University that the more often lawmakers take up his plan, the more chances his administration has to quell concerns about the proposal to extend health coverage to 280,000 low-income Tennesseans by drawing down $2.8 billion in federal Medicaid funds. (Schelzig, 3/26)

The Associated Press: Senate Rejects Medicaid Plan Freeze Proposal
An effort to stop signing people up for Arkansas' compromise Medicaid expansion has failed in the state Senate. The Senate voted 15-13 Thursday against the bill to require the state to seek approval from the federal government to freeze enrollment in the "private option," which uses federal funds to purchase private insurance for the poor. The program was crafted as an alternative to the Medicaid expansion envisioned under the federal health law. (3/26)


Report: Health Insurance Industry Doing Well Under ACA

The report from the Commonwealth Fund shows that industry profits remain nearly identical to before implementation of the Affordable Care Act. Meanwhile, experts predict the health care sector, like many others, will face pressure to raise wages as a result of tightening labor markets.

Marketplace: The Health Insurance Industry Looks ... Well, Healthy
On Thursday, a new report out from the Commonwealth Fund finds the health insurance industry is doing just fine, thank you very much. That’s contrary to the deep-seated fears of some as the Affordable Care Act launched back in 2010. But with three years’ worth of data on the books now, and insurers’ stock prices soaring, those fears have faded. (Gorenstein, 3/26)

Modern Healthcare: Tightening Labor Markets Pressure Health Care To Up Wages
Healthcare increasingly will face the type of wage pressure other sectors of the U.S. economy already have experienced, labor market experts predict. Signs of the building pressure already have begun to emerge. Health insurer Aetna said in January that all its employees will earn at least $16 an hour starting in April. That's more than double the federal minimum wage of $7.25, which has not been raised since 2009. (Herman, 3/26)

Public Health And Education

FDA Considers Regulating Homeopathic Remedies

Officials will review data on the safety and evidence behind the alternative therapies in a meeting next month. In the meantime, the Obama administration readies a plan to fight antibiotic-resistant bacteria and the Health and Human Services' inspector general advises labs that waive patient fees because of agreements with doctors that they could be violating anti-kickback statutes.

The Associated Press: FDA To Scrutinize Unproven Alternative Remedies
Federal officials plan to review the safety and evidence behind alternative remedies like Zicam and Cold-Eeze, products that are protected by federal law, but not accepted by mainstream medicine. The Food and Drug Administration says that it will hold a two-day meeting next month on regulations for homeopathic medicines, which have long occupied a place on the fringes of U.S. health care. Similar to dietary supplements, homeopathic products are not required to prove they are safe or effective before being sold on the market. But unlike supplements, homeopathic medicines state that they are designed to treat specific medical conditions. (Perrone, 3/26)

Veterans' Health Care

Narcotics Overprescriptions To Veterans Targeted By VA

Solutions are needed for lapses or practices at VA facilities that have resulted in opiate overprescribing, Veterans Affairs officials testified at a Senate hearing.

The Associated Press: VA Officials Say They Will Work To End Overprescribing
Department of Veterans Affairs officials are trying to put solutions in place to limit narcotic overprescribing practices in VA hospitals, they said Thursday, but lapses still happen. At a U.S. Senate hearing in Washington, Sen. Richard Blumenthal, D-Conn., called the VA system of prescribing narcotics "abysmally inaccurate" and prodded VA officials on how they would fix programs used to monitor such prescriptions. (Ferguson, 3/26)

In related news -

CQ Healthbeat: House Urged To Take Two-Pronged Approach To Opioid Abuse
House Energy and Commerce members on Thursday endorsed throwing more resources toward monitoring doctors who overprescribe prescription painkillers while addiction experts urged the lawmakers to also modernize laws that help addicts come clean. The Oversight and Investigations Subcommittee held a hearing into opioid abuse the same day lawmakers led by Edward Whitfield, R-Ky., introduced legislation to renew grants for states to implement prescription drug monitoring programs. (Zanona, 3/26)

State Watch

Indiana HIV Outbreak Declared A Health Emergency

With 71 cases identified, an HIV outbreak in southeastern Indiana prompted Gov. Mike Pence to announce a public health emergency and allow a temporary needle exchange program in one county.

The New York Times: Indiana Declares Health Emergency After H.I.V. Outbreak
Officials said that 71 cases of H.I.V. identified since mid-December have been traced to intravenous use of a prescription painkiller in Scott County north of Louisville, Ky. Nine more cases are still under investigation, and state health officials predicted that more would appear in coming weeks. The governor authorized a short-term exchange program that would provide drug users with access to sterile needles so that contaminated needles were less likely to be shared. (Schwarz and Smith, 3/26)

The Post-Tribune: Indiana Senator Asks Governor To Expand Needle Exchange Program In Light Of HIV/AIDS Crisis
An HIV outbreak in Southern Indiana caused Gov. Mike Pence to declare a health emergency on Thursday and authorize a needle-exchange program — a strategy a local legislator says should be instituted in Lake and Marion counties as well. Scott County, a rural area about 30 miles north of Louisville, Ky., has seen 79 new infections since December. On average, the county sees about five infections each year. All of the infections have been linked to needle sharing among drug users, particularly those who injected prescription painkillers, methamphetamine and heroin. (Nance Lazerus, 3/26)

State Highlights: Md., Va. State Budgets Advance; Wis. SeniorCare Proposal Stalls

A selection of health policy stories from Maryland, Virginia, Wisconsin, California, Indiana, Missouri, Texas, Arizona and Georgia.

The Washington Post: Maryland Senate Unanimously Approves Budget
The House Appropriations Committee restored the reductions in education spending and a 2 percent cost-of-living adjustment for state workers. But it also halved a $150 million additional payment to the state employees’ pension system. The committee made various reductions to Medi­caid and the Temporary Cash Assistance Program and saved $90 million by making changes to the local income tax reserve fund. (Wiggins, 3/26)

The Associated Press: McAuliffe Signs State Budget With Raises For State Workers
The GOP-controlled General Assembly did not include expanding Medicaid in its budget, which has been a top priority for McAuliffe and state Democrats. Medicaid expansion is a key part of the Affordable Care Act and about half of the states have implemented it. Democrats say the mostly federally funded expansion would help the poor and the state’s health care system, Republicans say Medicaid expansion is financially unsustainable. (Suderman, 3/26)

The Associated Press: Republican Says Walker's Proposal For SeniorCare Is Dead
Gov. Scott Walker's proposal to require enrollees in the popular SeniorCare prescription drug program to first sign up for Medicare Part D coverage is dead, the Republican co-chair of the Legislature's budget committee said Thursday. Walker's idea ran into bipartisan opposition in the Legislature, and the AARP and other groups representing senior citizens strongly disapproved of it. They feared the changes would increase costs for prescription drugs making it difficult for cash-strapped older people to make ends meet. (Bauer, 3/26)

Kaiser Health News: Some Face A Big Bill From Medi-Cal — After They Die
Catherine Jarett ran into a nasty surprise after she sent a form to Medi-Cal on behalf of her clients. An estate attorney, Jarett was hired by the sons of an elderly Vallejo woman who had died. For more than 20 years, the woman had been enrolled in Medi-Cal, as the state’s Medicaid insurance program for the poor is known. (Aliferis, 3/27)

The Wall Street Journal: The Push For ‘Right To Try’ Drugs For The Seriously Ill
A divisive measure called “right to try” is getting a tryout in Indiana. As Gov. Michael Pence deals with an outbreak of HIV in the state, his agenda also includes an unrelated health initiative about drug access. Earlier in the week, the governor signed a bill allowing people who are battling life-threatening conditions to gain access to experimental medicines. Known as a “right to try” law, the idea is to leapfrog a drug-development process that takes years before new treatments become available. (Silverman, 3/26)

Los Angeles Times: Kaiser Ordered To Pay Woman More Than $28 Million
A Los Angeles jury awarded more than $28 million to a woman who said Kaiser Permanente doctors wrongly delayed an MRI that could have detected an aggressive cancerous tumor that caused her to lose her right leg. Attorneys for 23-year-old Anna Rahm of Chatsworth argued that a cancerous tumor in her pelvis grew during the three months she and her mother tried to persuade Kaiser doctors to authorize an MRI. By the time the test was finally approved, doctors were forced to amputate Rahm's right leg, half of her pelvis and part of her spine. (Pfeifer, 3/26)

St. Louis Public Radio: Access To Mental Health Care A Challenge In Rural Areas
Every day, LaDonna Haley talks to patients who can’t find a psychiatrist or counselor who takes new clients in the St. Louis area. She estimates that 10 percent of those callers live in a rural county. The psychiatrists, counselors and therapists that are based in Missouri’s Warren, Jefferson and Franklin counties are often swamped with requests for appointments, Haley said. If someone can find a provider, they might pay out-of-pocket if their insurance plan doesn’t cover mental health. That can be an expensive investment, and driving all the way to St. Louis may not be feasible for everyone, she said. (Bouscaren, 3/26)

The Texas Tribune: Court Blocks Medical Leave Benefits For Same-Sex Couples
A federal court has temporarily blocked a federal rule change that would give medical leave benefits to certain same-sex couples, according to an announcement Thursday from Texas Attorney General Ken Paxton. In a lawsuit filed this month, Paxton challenged the Obama administration's change to the federal Family and Medical Leave Act, or FMLA, which would have granted paid time off to legally married same-sex couples, even if they live in a state like Texas that does not recognize gay marriage. The rule change was scheduled to go into effect Friday. (Ura, 3/26)

The Washington Post's Wonkblog: Arizona Is Moving To Block Abortion Coverage, Cutting Off Poor Women
Arizona could soon become the latest state to block women from purchasing insurance plans through the federal health-care exchanges that cover abortion. The trend started soon after the Affordable Care Act created the marketplaces, granting states the power to decide if and how Obamacare plans cover termination. Supporters argue Arizona’s controversial measure will stop taxpayer money from funding procedures some deem immoral. (Pacquette, 3/26)

The Associated Press: Cancer Hospital Fails To Get OK To Expand In Georgia
A bill to regulate home care for the elderly devolved Thursday into sarcastic debate in the state Senate when an effort was made to add an amendment that would have given an Illinois-based cancer treatment hospital chain part of what it tried unsuccessfully to get weeks ago. Senators passed a measure by Republican Sen. Greg Kirk to safeguard the elderly, but only after beating back three amendments, including one that would have allowed Cancer Treatment Centers of America to go back on part of the agreement with lawmakers that got it into the state in 2008. (Hendrick, 3/26)

Health Policy Research

Research Roundup: Effects Of Ending CHIP; Measuring Churn; Kids And Antipsychotic Drugs

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

Health Affairs: Many Families May Face Sharply Higher Costs If Public Health Insurance For Their Children Is Rolled Back
The potential for a significant rollback of public coverage for children [if the Children's Health Insurance Program is not funded] raises important policy questions regarding alternative pathways to affordable and high-quality coverage for low-income children. For many children at risk of losing eligibility for public coverage, the primary alternative pathway to coverage would be through their parents’ employer-sponsored insurance, yet relatively little is known about the cost and quality of that coverage. Our estimates, based on data from the Insurance Component of the 2012 and 2013 Medical Expenditure Panel Surveys, show that many families would face sharply higher costs of covering their children. In many cases, the only employer-sponsored coverage available would be a high-deductible plan. (Selden et al., 3/25)

Center on Budget and Policy Priorities: Lessons Churned: Measuring The Impact Of Churn In Health And Human Services Programs On Participants And State And Local Agencies
Public benefit programs for low-income individuals and families typically require households to apply, establish eligibility, and then, at subsequent regular intervals, to re-establish eligibility. ... the redetermination process can result in eligible households temporarily losing eligibility, experiencing a short period without benefits, and then reapplying — a phenomenon sometimes called “churn.” Churn entails costs for recipients — in lost benefits, short-term hardship, and effort reapplying — and also for state agencies, because processing a new application usually involves more resources. .... [This paper] defines churn and outlines its consequences, then explores approaches to measuring churn, and finally looks at possible approaches to reducing churn. (Rosenbaum, 3/20)

HHS Office of Inspector General: Second-Generation Antipsychotic Drug Use Among Medicaid-Enrolled Children: Quality-Of-Care Concerns
Second-generation antipsychotics (SGAs) are a class of drugs used to treat psychiatric disorders, such as schizophrenia, bipolar disorder, and psychotic depression. SGAs are widely used to treat children enrolled in Medicaid who have mental health conditions. However, SGAs can have serious side effects and little clinical research has been conducted on the safety of treating children with these drugs. ... We selected a sample of 687 claims for SGAs prescribed to children in California, Florida, Illinois, New York, and Texas. ... In the five States, 8 percent of SGAs were prescribed for the limited number of medically accepted pediatric indications. There are only five SGAs with medically accepted pediatric indications. It is not uncommon for doctors to prescribe, or Medicaid to pay for, SGAs for children for indications that are not medically accepted. (3/25)

American Journal of Managed Care: Decision Aids For Benign Prostatic Hyperplasia And Prostate Cancer
Our observational study is the largest to date of [using patient decision aids] in the context of quality improvement for elective surgical care. We found that implementing [video-based tools with accompanying booklets] for [benign prostatic hyperplasia patients] in a large, multi-site urology group practice setting was associated with a significant 32% lower rate of transurethral prostate procedures among men who had previously received pharmacological treatment .... Furthermore, we found that [using the video and booklets] for localized [prostate cancer] was associated with a significant 27% reduction in actively treating [the condition] ... Notably, implementing [the videos and booklets] was not associated with changes in healthcare costs. (Arterburn et al., 3/20)

The Kaiser Family Foundation: Medicare’s Income-Related Premiums: A Data Note
As part of this discussion [on replacing Medicare's formula for physician payments], some policymakers have proposed to increase Medicare premiums for higher-income beneficiaries — an idea that also has been raised in the context of proposals to reduce federal spending. ... This data note presents new information to help set a context for understanding the implications of proposed changes to Medicare’s income-related premiums. It describes current-law requirements with respect to the income-related premiums under Medicare Part B and Part D, including the number and share of Medicare beneficiaries who are estimated to pay income-related premiums and revenues raised from the income-related premium. (Cubanski and Neuman, 3/20)

Center for Medicare Advocacy/The Kaiser Family Foundation: Comparison Of Consumer March 2015 Protections In Three Health Insurance Markets
Medicare Advantage plans, QHPs and Medicaid MCOs provide coverage for an increasing number of people .... While many consumer protections between the markets are similar, differences could both cloud consumers’ understanding of their rights in the different programs and fragment oversight by government entities and administration by plan sponsors. Transitioning between types of coverage that have significantly different consumer protections raises issues of not only equity, but ease of administration, oversight and consumer understanding of how to use their insurance and exercise their rights. Whether these differences should be maintained warrants further review by policy makers. (Lipschutz and Pollitz, 3/19)

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

Reuters: Lack Of Insurance Bars Some From Hepatitis C Treatment
Survey data from 2001 to 2010 show that lack of insurance kept some people with hepatitis C virus from getting treatment. Recently, more effective and well-tolerated drugs have been developed to treat hepatitis C, removing many of the discouraging side effects of older drugs. The infection is curable and transmission can be prevented, researchers write in the American Journal of Gastroenterology. (Doyle, 3/24)

Reuters: Path To Breast Cancer Care Differs By Race, Ethnicity
Breast cancer patients of different races and ethnicities may not pick surgeons and hospitals in the same way, a new study suggests. For example, black and Hispanic women with breast cancer were less likely than white women to select surgeons and hospitals based on reputation, researchers found. The differences in how people select healthcare providers may help explain racial differences in use, delivery and quality of medical care, the researchers write in JAMA Oncology. (Seaman, 3/20)

Medscape: Reimbursement Key To Improving End-Of-Life Care
Giving physicians incentives — and compensating them appropriately — will be key to helping the nation improve end-of-life planning and care, said experts gathered at an Institute of Medicine (IOM) forum today. The National Action Conference on Policies and Payment Systems to Improve End-of-Life Care was held to discuss how to implement the recommendations in IOM's September report, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. (Ault, 3/20)

Reuters: Resuscitation Outcomes No Worse When Families Watch Doctors Work
Letting family members watch while doctors work to bring a loved one back from the brink of death may not hurt patients' odds of survival, a new study suggests. "Hospitals that have been hesitant to set policies that allow families to be in the room during resuscitation should be encouraged that this didn't lead to worse outcomes or errors," said Dr. Zachary Goldberger, the study’s lead author from the University of Washington Harborview Medical Center in Seattle. (Rapaport, 3/24)

Reuters: Cancer Patients Want More Info About CT Risks
Some cancer patients would like more information on the health risks of their radiology tests, a new study found. Most of the 30 patients questioned for the study said they looked online for information about the radiation hazards of tests like computed tomography (CT) scans, since their doctors did not explain the risks. (Doyle, 3/24)

Medscape: Most New Pediatricians Happy With First Job Choice
Most general pediatricians said lifestyle and family considerations influenced their first job choice, and 83% said the time allocated for specific duties in their current position was compatible with their career goals, according to a survey. ... Amid concerns about a mismatch between young general pediatricians' short- and long-term career goals and desired work responsibilities and the available jobs, the research team surveyed all 5210 clinicians who sat for the General Pediatrics Certifying Examination in 2012. ... 1190 (87%) were engaged in direct or consultative pediatric care. Within this group, 66% said lifestyle and family considerations were the most important factors in choosing their first position after completing training. Eighty-three percent said they spent their work time in the way they wanted. (Henderson, 3/23)

Time: This Map Shows The Deadliest Counties In The United States
Oglala Lakota County, South Dakota is the deadliest county in America, at least by one measure: It is the place where residents are most likely to die before the age of 75, which health experts consider premature death. The new edition of County Health Rankings from the University of Wisconsin Population Health Institute, places the county–which until very recently was called Shannon County–at the bottom of the class in the number of people who died before age 75, a common measure of public health. (Wilson, 3/25)

MinnPost: Antipsychotic Drugs Are Riskier For Older Dementia Patients Than Previously Thought
Physicians often prescribe antipsychotic drugs to older people with dementia to control non-memory related behavioral symptoms, including agitation, aggressiveness, delusions and hallucinations. But officials at the U.S. Food and Drug Administration (FDA) have never approved antipsychotic medications — such as haloperidol (Haldol), risperidone (Risperdal), olanzapine (Zyprexa) and quetiapine (Seroquel) — for that purpose. Indeed, these medicines come with a “black box” FDA warning that their use to control behavioral disturbances in people with dementia is associated with an increased risk of premature death. (Perry, 3/19)

Editorials And Opinions

Viewpoints: Why 'Doc Fix' Deal Was Done; Health Care Leaders Must Lead Change

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

The Washington Post's Plum Line: Don’t Expect A New ‘Kumbaya’ Era In Congress
A polar ice sheet lodged itself atop the entrance to Hell this afternoon, as the House of Representatives passed, by an overwhelming bipartisan margin of 392-37, a fix to the Medicare formula for reimbursing doctors, putting Congress on the brink of ending a saga that has been marked by punts and short term fixes for well over a decade. ... Don't expect it to last. (Greg Sargent, 3/26)

The Washington Post: Bipartisan Doc-Fix Passes The House: How Did Polarized Parties Do It?
How was such a deal possible in an otherwise polarized and seemingly deadlocked Congress? Granted, the Senate has yet to act, but the strong bipartisan vote and support from the president will make it hard for the Senate to block enactment. Given the rarity of the House vote, I suspect we’ll soon see a spattering of headlines declaring a thaw in Congress’s deep legislative freeze, and pointing to potential new agreements on the horizon. Perhaps. But closer inspection of deal-making on the doc fix points to a set of special circumstances that likely made a bargain possible. (Sarah Binder, 3/26)

Politico: House Should Reject Medicare Change
Medicare’s physician payment formula—the “sustainable growth rate” (SGR) in Washington speak—is another central-planning failure that puts bureaucrats and lobbyists ahead of patients and doctors. There is broad, bipartisan consensus that reform is desperately needed. However, the only thing worse than the SGR’s annual circus is repealing the SGR without solving the much bigger problems in Medicare. Unfortunately, the deal finalized in the House this week largely ignores those overarching problems and threatens to leave the next generation further in debt. (Sen. Ben Sasse, R-Neb., 3/26)

The Wall Street Journal's Washington Wire: In House ‘Doc Fix,’ An Unconservative Approach To Insurance Reform
Some of those changes aim to make Medicare more solvent by reducing the growth of program spending, a conservative goal, but it would achieve this by liberal means: prohibiting the sale of certain types of insurance policies. ... The issue involves Medigap supplemental insurance, which pays for beneficiary cost-sharing (deductibles, co-payments, and co-insurance) not covered by the traditional Medicare program. The most popular Medigap policies cover the Medicare Part B deductible, along with other forms of cost-sharing. Studies have shown that these types of policies—which allow seniors to visit medical providers without any out-of-pocket costs—encourage beneficiaries to over-consume care, raising taxpayer spending on Medicare. (Chris Jacobs, 3/26)

Bloomberg: Entitlement: Why The U.S. Can't Keep Costs Down
Here’s why it’s hard for the U.S. government to keep its costs down: Seniors and the very poor are entitled by law to almost half its money. Congress can trim other expenses, and automatic budget cuts and the cessation of two U.S. wars have slowed spending growth. But Social Security, Medicare and Medicaid are exempt from budget wrangling and are growing: from $1.7 trillion, or 48 percent of the fiscal 2014 budget to an estimated $3.2 trillion, or 53 percent of the U.S. budget, by 2024. (Toluse Olorunnipa and Roger Runningen, 3/26)

JAMA: Change From The Inside Out
Even as politicians and pundits continue to debate the merits of the Affordable Care Act (ACA), it is time to look beyond it to the next phase of US health care reform. Although many physicians contributed to the development and implementation of the ACA, the forces that have steered it so far have been primarily governmental. Leaders from within health care should now more firmly take the tiller. ... The challenge now is to follow through on such structural changes and ensure that they actually lead to improvement for patients and families. (Donald M. Berwick, Derek Feeley and Saranya Loehrer, 3/27)

The Kansas City Star: Sam Brownback's Dodge On Medicaid Expansion Is A New Low
All of a sudden, Gov. Sam Brownback is consumed with compassion for the more than 5,000 disabled Kansans who are pleading for services. This is new. Brownback didn’t give a rip about people with developmental and physical disabilities when he rammed through his massive tax cuts, which benefited wealthy Kansans and rendered the state unable to meet its most basic obligations. (Barbara Shelly, 3/26)

The Washington Post: The Next Epidemic
“Of all the things that could kill more than 10 million people around the world,” writes philanthropist Bill Gates in the New England Journal of Medicine, “the most likely is an epidemic stemming from either natural causes or bioterrorism.” Beginning with this blunt and clinical assessment, we are given a detailed picture of the specter that haunts Gates’s nightmares: the emergence of a highly infectious virus that would spawn global panic, overwhelm the supply of medical commodities, set off a desperate technological race against death, reduce global wealth by trillions of dollars and fill millions of graves. (Michael Gerson, 3/26)

New England Journal of Medicine: Health Care For Immigrants — Implications Of Obama's Executive Action
On November 20, 2014, President Barack Obama announced his intention to grant millions of undocumented immigrants a reprieve from the threat of deportation, along with the possibility of legal employment in the United States. ... The population affected by the policy is one that currently experiences major disparities in health care coverage and access. Immigrants are far more likely than native-born residents to be uninsured .... Although the President's policy does not explicitly address health care, it will most likely increase access to insurance among covered immigrants and members of their family through a variety of direct and indirect means. (Benjamin D. Sommers and Wendy E. Parmet, 3/26)

New England Journal of Medicine: Cutting The Gordian Helix — Regulating Genomic Testing In The Era Of Precision Medicine
In his 2015 State of the Union address, President Barack Obama announced a new Precision Medicine Initiative (PMI), a national investment in research on approaches to disease treatment and prevention that take into account individual variability in each person's genes, environment, and lifestyle. ... But scientific progress alone won't guarantee that the public reaps the full benefits of precision medicine — an achievement that, as [Francis] Collins and [Harold] Varmus note, “will also require advancing the nation's regulatory frameworks.” Nowhere are such advances more important than in the regulation of genomic testing. (Eric S. Lander, 3/26)

New England Journal of Medicine: Social Distancing And The Unvaccinated
If a state allows parents to obtain religious exemptions from vaccination requirements for school entry, can it temporarily exclude unvaccinated children from school during an outbreak of a vaccine-preventable illness without violating the family's constitutional rights? If parents refuse to vaccinate their children, what can physicians legally and ethically do to protect other patients in their practice from exposure to vaccine-preventable illnesses? ... Both questions invoke the legal and moral authority to use a classic public health measure known as social distancing to attempt to mitigate the spread of an infectious disease. ... Governments and physicians employing social distancing policies must give careful and systematic attention to the ethical and legal issues. (Y. Tony Yang and Ross D. Silverman, 3/25)