KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

HHS Pledges To Quicken Pace Toward Quality-Based Medicare Payments

As part of their effort to improve quality while cutting costs, federal officials announced Monday that they want programs such as accountable care organizations and bundled care to account for 50 percent of traditional Medicare spending by the end of 2018. (Jordan Rau, 1/26)

Political Cartoon: ‘Shaking Like A Leaf?’

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: ‘Shaking Like A Leaf?’" by Bob and Tom Thaves.

Here's today's health policy haiku:


The health law puts tax
preparers in the hot seat...
They break the bad news.

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.


Medicare Officials Announce Major Shift To Pay For Quality

The goal, officials say, is for the health care program for the elderly and disabled to pay providers based on quality and frugality. HHS officials say 50 percent of all Medicare pay would be made this way by 2018.

The Associated Press: Gov't To Overhaul Medicare Payments To Doctors, Hospitals
Medicare will change the way it pays hospitals and doctors to reward quality over volume, the Obama administration said Monday, in a shift that officials hope will be a catalyst for the nation's $3 trillion health care system. "It is in our common interest to build a health care system that delivers better care, spends health care dollars more wisely and results in healthier people," said Health and Human Services Secretary Sylvia M. Burwell. (Alonso-Zaldivar, 1/26)

The Wall Street Journal: Medicare To Rework Billions In Payments
The effort faces a long climb ahead amid potential resistance from health-care providers and skepticism from beneficiaries and lawmakers. Medicare, which covers more than 50 million Americans, started to pay some doctors and hospitals on the basis of their performance as part of a provision in the 2010 Affordable Care Act. Currently, around 20 percent of payments are made in this way, and the federal government said Monday it will aim to get that share to 30 percent by the end of 2016 as an interim goal. (Radnofsky and Beck, 1/26)

Kaiser Health News: HHS Pledges To Quicken Pace Toward Quality-Based Medicare Payments
The Obama administration Monday announced a goal of accelerating changes to Medicare so that within four years, half of the program’s traditional spending will go to doctors, hospitals and other providers that coordinate their patient care, stressing quality and frugality. The announcement by Health and Human Services Secretary Sylvia Burwell is intended to spur efforts to supplant Medicare’s traditional fee-for-service medicine, in which doctors, hospitals and other medical providers are paid for each case or service without regard to how the patient fares. Since the passage of the federal health law in 2010, the administration has been designing new programs and underwriting experiments to come up with alternate payment models. (Rau, 1/26)

Los Angeles Times: Medicare To Transform How It Pays Doctors And Hospitals
Most experts believe that this shift is crucial to improving the quality of care that patients receive, while also restraining costs at a time when millions of baby boomers will be entering the nation's primary insurance program for the elderly. Under the goals announced Monday, Medicare will make 30% of its direct payments to doctors, hospitals and other providers through alternative payment models by next year, up from nearly nothing four years ago. (Levey, 1/26)

The Washington Post's Wonkblog: The Obama Administration Wants To Dramatically Change How Doctors Are Paid
Rather than pay more money to Medicare doctors simply for every procedure they perform, the government will also evaluate whether patients are healthier, among other measures. The goal is for half of all Medicare payments to be handled this way by 2018. Monday’s announcement marks the administration’s biggest effort yet to shape how doctors are compensated across the health-care system. As the country's largest payer of health-care services, Medicare influences medical care generally, meaning the changes being initiated by the administration will likely be felt in doctor's offices and hospitals across the country. (Millman, 1/26)

USA Today: Feds Step Up Changes To Hospital Payments
Health care, including for Medicare patients, has traditionally used the "fee for service" model that pays providers for each individual treatment rather than for the overall treatment of a patient or group of patients. That is, they are paid for making people better; not just for trying. For consumers, the end result of HHS' push should be better health care, but it may not seem that way to some. (O'Donnell, !/26)

Marketplace: Big Changes For Medicare
The Department of Health and Human Services has announced a plan to move Medicare away from the current fee-for-service system and toward a quality-based payment system. (Ryssdal, 1/26)

Politico Pro: HHS Steps Up Medicare Shift To New Payment Models
HHS has outlined a sharp acceleration of its efforts to move Medicare away from traditional fee-for-service and tie provider reimbursements to quality, setting an ambitious goal of having half of payments in alternative pay models by the end of 2018. (Pradhan, 1/26)

Modern Healthcare: Medicare's Payment Reform Push Draws Praise And Fears
By 2018, half of Medicare spending outside of managed care will be paid under contracts with incentives to manage quality and costs, federal officials said Monday. The goal was broadly greeted with enthusiasm but also with warnings that the effort will be wasted if the new models are too weak or tied to flawed measures. (Evans and Demko, 1/26)

Politico Pro: Will Health IT Help Or Hinder Medicare Pay Policies?
A big leap of faith lies at the center of Monday’s HHS announcement that Medicare will move dramatically away from traditional fee-for-service payments. The efficient use of technology is crucial to the plan to pay doctors and hospitals on the basis of care quality rather than volume. To date, the tech hasn’t been ready to support quality-based payments in most health care systems. On the other hand, quality-based pay hasn’t been important enough to incentivize good use of technology, experts say — creating a chicken-and-egg problem. (Pittman, 1/26)

Capitol Hill Watch

CBO: Though Now At A Low Point, Deficit Projected To Rise As More Baby Boomers Enroll In Medicare, Social Security

The Congressional Budget Office forecasts that the red ink will start flowing again in 2017, and by 2025, deficits could again top $1 trillion.

The Wall Street Journal: CBO: Deficit To Narrow, Then Widen In ’18
The CBO’s report showed that discretionary spending, after excluding interest costs and major safety-net programs such as Medicare and Social Security, is set to fall by 2019 to its lowest level as a share of the overall economy since comparable data reporting began in 1940. ... Monday’s report also revised down by 7% from its last forecast, released in August, the projected costs to the government from the Affordable Care Act that Mr. Obama signed into law five years ago. Health-insurance spending for the 2015-19 period is now 20% lower than when the CBO issued its first estimates for the law in March 2010. (Timiraos, 1/26)

The New York Times: Budget Forecast Sees End To Sharp Deficit Declines
The federal budget deficit will continue to inch downward through next year, but even with the economy on an upward trajectory, the government’s red ink will begin to rise in 2017 and expand with an aging population, the Congressional Budget Office said Monday. The new budget projections effectively signal the end of the steep decline in deficits as the economy climbed out of the recession. Lawmakers now face a familiar and politically vexing problem: What to do about increases in Medicare, Medicaid and Social Security spending that reflect the nation’s demographics, not its economic health? (Weisman, 1/26)

The Associated Press: CBO: Deficit To Shrink To Lowest Level Of Obama Presidency
For future years however, CBO issued a warning: Beyond 2018, deficits will start rising again as more baby boomers retire and enroll in Social Security and Medicare. By 2025, annual budget deficits could once again top $1 trillion, unless Congress acts. At that point, Social Security benefits would account for one-quarter of all federal spending, said CBO Director Douglas Elmendorf. "The underlying point is that we have a handful of very large federal programs that provide benefits to older Americans," Elmendorf said. "And with the rising number of older Americans and a rising cost of health care, those programs get much more expensive." (1/26)

USA Today: Federal Deficit Falling To Lowest In Obama Presidency
CBO also projects the unemployment rate will fall further -- to 5.3% by 2017 -- as more people are encouraged to enter or stay in the workforce. The budget agency estimates that the number of U.S. residents without health insurance will drop from 42 million last year to 36 million this year, largely because the Affordable Care Act. ... While the deficit is projected to hold steady through 2018, CBO projects the gap between spending and revenues will continue to grow due to the retirement of Baby Boomers and healthcare costs associated with an aging population, as well as rising interest rates on the federal debt. (Davis, 1/26)

The CBO also forecasts that the health law's cost could be as much as 20 percent less over the next decade than previously projected -

The New York Times: Budget Office Slashes Estimated Cost Of Health Coverage
The Congressional Budget Office on Monday significantly lowered its estimate of the cost of providing health insurance coverage to millions of Americans under the Affordable Care Act. Douglas W. Elmendorf, the director of the budget office, said the changes resulted from many factors, including a general “slowdown in the growth of health care costs” and lower projections of insurance premiums that are subsidized by the federal government. (Pear, 1/26)

Los Angeles Times: Obamacare Cost To Be 20% Less Than Forecast, Budget Office Says
President Obama's healthcare law will cost about 20% less over the next decade than originally projected, the Congressional Budget Office reported Monday, in part because lower-than-expected healthcare inflation has led to smaller premiums. So far, the number of uninsured Americans has dropped by about 12 million. By the end of 2016, 24 million fewer Americans will lack insurance, the nonpartisan budget office forecast. Excluding immigrants in the country illegally, who are not eligible for coverage under the law, only about 8% of Americans under age 65 will lack insurance by the time Obama leaves office, the budget office's latest report on the law estimates. (Lauter, 1/26)

Reuters: Obamacare's Insurance Subsidies May Cost Less
Obamacare will cost 7 percent less than expected over the next decade for federal subsidies to help lower-income people pay for private health insurance, congressional researchers said Monday. A report by the nonpartisan Congressional Budget Office (CBO) said insurance coverage would cost $964 billion from 2015 to 2024, $68 billion below its April 2014 projection, because of factors including lower-than-expected enrollment in federal and state insurance exchanges set up under the Affordable Care Act. (1/26)

The Washington Post's Wonkblog: CBO: Interest On Federal Debt Will Triple Over Coming Decade
Meanwhile, the CBO said that the cost of the Affordable Care Act continued to come in substantially below the March 2010 estimates. Because the program gets more expensive over time, the 10-year cost estimates have risen. But costs compared year by year remain lower. In March 2010, the CBO and Joint Committee on Taxation projected that the ACA would cost the federal government $710 billion during fiscal years 2015 through 2019. The newest projects put the cost at just $571 million over those years, about 20 percent lower than the original estimates, the CBO said in its report. The latest projections for the cost in 2019 are $132 billion, or 23 percent less than the original projection. (Mufson, 1/26)

Federal Employees Would Get Paid Parental Leave Under House Democrats' Bill

The measure, which was introduced Monday, follows a call by President Barack Obama during his State-Of-The-Union address to take such action. In other legislative news, the Senate Finance Committee is scheduled this week to consider a bipartisan veterans' bill that would create incentives to hire veterans. It also includes a health law tweak that would allow companies to exempt vets who get health care through the Veterans Health Administration from the health law's employer mandate calculations.

The Washington Post: Democrat Bill Would Give Federal Workers Paid Parental Leave
Federal employees would be eligible for six weeks of paid leave for purposes related to the birth or adoption of a child, under legislation introduced Monday by a group of House Democrats. President Obama two weeks ago called on Congress to enact that benefit–which would be paid “administrative” leave that would not be charged against either sick leave or annual leave time–while separately ordering agencies to advance up to six weeks of paid sick leave for those purposes under existing authority. (Yoder, 1/26)

The Hill: Senate Finance To Consider Veterans Bill
The Senate Finance Committee will consider its first piece of legislation of the new Congress on Wednesday, marking up a bipartisan measure to incentivize the hiring of veterans and tweak Obamacare. The House passed the Hire More Heroes Act roughly three weeks ago by a 412-0 vote, in its first vote dealing with President Obama’s health care law this year. (Becker, 1/26)

Also happening on Capitol Hill -

CQ Healthbeat: Plot Against Boehner Puts Mental Health Back In Spotlight
The recent indictment of a former Ohio country club bartender for allegedly threatening to shoot or poison House Speaker John A. Boehner is one more example that Rep. Tim Murphy uses to buttress his legislation for more aggressive mental health treatment. The bartender, Michael R. Hoyt,had a history of mental problems; country club members told the Dayton Daily News that Hoyt’s demeanor had changed since he suffered a concussion when he was mugged two years ago, and he had been fired by the club last fall. (Attias 1/26)


High Court Ruling Chips Away At Health Benefits Promised To Union Retirees

In what's being viewed as a victory for corporate America, the Supreme Court unanimously ruled Monday that "ambiguous" provisions of union contracts shouldn't necessarily be interpreted in workers' favor.

The New York Times: Supreme Court Rules Against Retirees in Union Health Benefits Case
The Supreme Court on Monday ruled that a chemical company may be able to cut the health benefits of its retired workers, unanimously reversing an appeals court ruling that said the benefits had vested for life. “Courts should not construe ambiguous writings to create lifetime promises,” Justice Clarence Thomas wrote for the court, adding that “retiree health care benefits are not a form of deferred compensation.” (Liptak, 1/26)

The Wall Street Journal: Supreme Court Rules Against Union Retirees In Benefits Case
The Supreme Court on Monday ruled ambiguous provisions in union contracts shouldn’t automatically be interpreted in favor of workers, giving a chemical manufacturer another chance to terminate lifetime health-care benefits for retirees. ... The retirees and their dependents filed suit, and the Sixth U.S. Circuit Court of Appeals in Cincinnati found the company had reneged on the contract, saying it was “unlikely that [the union] would agree” to such a deal “if the company could unilaterally change the level of contribution.” (Bravin, 1/26)

Health Law Issues And Implementation

Ohio's AG Sues Over Health Law Tax On State, Local Governments

The Republican state official is also challenging a provision that allows some tax money to go directly into Treasury Department coffers. Other stories examine medical device makers' assertion that a health law tax has devastated them, a watchdog report that asserts that several health law programs do the same thing, and how Maryland residents still struggle to get mental health services.

The Associated Press: Attorney General Sues Over Health Care Law
Applying a tax aimed at helping keep premiums affordable under the federal health care law to state and local governments is unconstitutional, Ohio Attorney General Mike DeWine claimed in a lawsuit filed Monday. The complaint argues there's no precedent for the collection of $6.25 million for 2014 from government entities and nothing in the health overhaul law that allows such a tax. (Welsch-Huggins, 1/26)

Kaiser Health News: ‘Orthopedic Capital Of The World’ Is Still Hiring Despite Health Law Tax
Tom Till eyes the morning’s email to see who’s angling to hire his students: A local employer, which had already hired 23 people in less than a year, says it needs three more to help make the artificial hips, knees and other devices manufactured here in the self-proclaimed 'Orthopedic Capital of the World.' 'Everyone is going gangbusters,' said Till, who oversees an advanced manufacturing program at Ivy Tech Community College in this lake-dotted region two hours north of Indianapolis. Till’s bullish view of the medical device industry – he says he can’t crank out graduates fast enough — contrasts sharply with what industry lobbyists are telling lawmakers in the nation’s capital. They say a 2.3 percent tax on the sale of medical devices put in place two years ago by the Affordable Care Act has already cost more than 30,000 jobs and is stifling innovation. (Appleby, 1/27)

The Fiscal Times: $1 Billion A Year In Redundant Obamacare Programs
The Health and Human Services Department is shelling out billions of dollars on three new federal programs that essentially do the same thing. The Affordable Care Act provides funding toward new initiatives aimed at improving the quality of care. But a new report from the HHS Inspector General found that at least three other programs that serve essentially the same purpose are being used by many of the same hospitals. (Ehley, 1/26)

The Baltimore Sun: Health Reform Highlights Shortage Of Mental Health Workers
National health reform was supposed to open the doors to mental health services for hundreds of thousands of people who couldn't previously afford to get treatment, but Maryland patients are finding there aren't enough doctors. A study released Monday by the Mental Health Association of Maryland found that consumers who buy private plans on a state exchange under health reform are supposed to have access to 1,154 psychiatrists. But when researchers tried to call these doctors, they found that only 14 percent were accepting new patients and available for an appointment within 45 days. (Daniels, 1/26)

3.2 Million Newly Eligible Adults Enrolled In Medicaid In Early 2014, CMS Reports

The findings by the Centers for Medicare & Medicaid Services do not include every state that expanded Medicaid but they are the first federal effort to define how many enrollees are new to the program. Also in the news, the latest from Arkansas and Tennessee regarding expansion plans in those states.

Modern Healthcare: 3.2 Million Newly Eligible Adults Joined Medicaid In Early 2014
In the first three months of last year, 3.2 million new adults joined [Medicaid under the expansion provision of the Affordable Care Act], the CMS said in a report posted Jan. 23. Even though the agency has been releasing monthly reports on Medicaid enrollment for some time, those figures did not give a nuanced look at what effect the ACA was having on enrollment because they included children and re-enrollees. The report only tracks enrollment in states that expanded Medicaid as of March 2014, so Michigan, New Hampshire and Pennsylvania were not included. Also not included in the report were California, Washington, D.C., and North Dakota because the agency was still reviewing their data for accuracy. (Dickson, 1/26)

The Associated Press: Proposal Filed To End Arkansas' Private Option Compromise Medicaid Plan
A group of Republican lawmakers wants to terminate Arkansas' compromise Medicaid expansion by the end of the year, despite Gov. Asa Hutchinson wanting to continue the program through 2016. Republican Sen. Linda Collins-Smith and six other GOP senators co-sponsored legislation filed Monday that would end the state's "private option" on Dec. 31. Under the private option, Arkansas uses federal funds to purchase private insurance for low-income residents. (1/26)

The Associated Press: Opponent Of Insure Tennessee Proposal To Hold Senate Hearing
Republican Gov. Bill Haslam's proposal to extend health coverage to 200,000 low-income Tennesseans is getting its first hearing in a legislative committee on Tuesday, though the panel won't have the authority to vote the measure up or down. Senate Judiciary Chairman Brian Kelsey has called the meeting to study what he describes as legal issues surrounding the governor's Insure Tennessee proposal. (1/27)

New Surgeon General Talks Up Obamacare

Vivek Murthy, who was confirmed last month, is going on a cross-country tour, "reminding community leaders of the February 15th deadline" for enrollment in health law plans, reports The Hill. Meanwhile, about 800,000 California households received $3.2 billion in Obamacare premium subsidies, according to state officials.

The Hill: New Surgeon General's First Job: Boosting ObamaCare Signups
The first task for the new surgeon general will be driving up enrollment for ObamaCare – an issue that threatened to derail his confirmation a month ago. Vivek Murthy, who was appointed the U.S. Surgeon General last month, is spending two months meeting with local officials and health leaders in 20 cities, in part to remind them that the last day to sign up for ObamaCare is Feb. 15. (Ferris, 1/26)

Los Angeles Times: Californians Received $3.2 Billion In Obamacare Premium Subsidies
Californians received $3.2 billion in Obamacare premium subsidies during the rollout of the federal health law last year. That federal aid went to about 800,000 California households, state officials said Monday. Those individuals and families paid $1.1 billion in premiums themselves, meaning for every dollar they spent the federal government paid an additional $3 to their health insurer. Nearly 90% of enrollees in the Covered California exchange qualified for financial help based on their income. The average monthly subsidy was $436 per household, according to the state. (Terhune, 1/26)

Administration News

Administration Seeks More Money To Combat Antibiotic-Resistant Bacteria

The White House wants to double the amount of federal funding dedicated to combating the resistant bacteria. Meanwhile, the Veterans Affairs department is creating five service regions as part of a major reorganization, and the FDA taps a Duke cardiologist for a top post.

The Associated Press: VA To Create Unified Framework With 5 Service Regions
The Veterans Affairs Department said Monday it is creating a single regional framework that divides the sprawling agency into five clearly marked regions. The new framework is part of a larger reorganization that VA leaders say will bring a singular focus on customer service to an agency that serves 22 million veterans, including more than 6 million who receive health care each year from the VA's 970 hospitals or clinics. (1/26)

CQ Healthbeat: FDA Taps Duke Cardiologist For Top Post
The Food and Drug Administration has attracted a leader in American medical research to serve in an agency post overseeing medical products and tobacco regulation. Robert Califf, currently vice chancellor of clinical and translational research at Duke University, will step into the vacant position of Deputy Commissioner for Medical Products and Tobacco in late February. (Gustin, 1/26)

State Watch

State Highlights: New Mass. A.G. Steps Into Fray Over Partners HealthCare Deal; Emergency Overdose Treatment To Cost Cities Less

A selection of health policy stories from Massachusetts, Wisconsin, Georgia, Kansas, New York, California, New Mexico, Missouri and Illinois.

The Boston Globe: Healey Opposes Deal With Partners HealthCare
Newly elected Attorney General Maura Healey put pressure on a Superior Court judge Monday to reject a controversial deal that would allow Partners HealthCare to take over three community hospitals, saying in a court filing that she would sue to stop the mergers if the opportunity arises. (McCluskey and Weisman, 1/26)

The New York Times: Treatment Of Overdose Will Cost Cities Less
The Clinton Foundation on Monday announced that it had negotiated a lower price for an emergency treatment that can prevent overdoses with a company that makes it. The soaring cost of the treatment has constrained its widespread use by municipalities across the country. Naloxone is a medication that reverses the effects of prescription painkiller or heroin overdoses. Doctors and paramedics give it to people who have stopped breathing or lost consciousness. In the past it was used mostly in medical settings like hospitals, but in recent years its use has spread to homes or on the streets, where overdoses commonly occur, a trend experts say can improve the chances of saving a person’s life. (Tavernise, 1/26)

The Badger Herald: Wisconsin Lawmakers To Push Mental Health Care This Session
Mental health care in Wisconsin may be receiving more attention in the upcoming legislative session, Assembly Speaker Robin Vos, R-Rochester announced late January. Vos introduced a committee in an earlier session that has carried out assessments of mental health needs in Wisconsin. Vos also recently created a new Assembly committee to instigate mental health care development, which will begin this fall. (Saxena, 1/26)

Georgia Health News: School Bus Driver: I Work For The Benefits
[Gov. Nathan] Deal’s budget plan would eliminate health coverage for 11,500 “non-certificated’’ school personnel who work fewer than 30 hours a week, including school bus drivers and cafeteria workers. The proposal has generated broad concern among lawmakers and health advocates. (Miller, 1/26)

The Associated Press: Ex-Executive Seeks To Toss Medicaid Suit Extortion Claims
A former executive who sued a firm managing part of the privatized Medicaid program in Kansas asked a judge Monday to toss out counterclaims accusing her of trying to extort $3 million, calling those claims a "not so thinly-veiled campaign of retaliation." The latest legal dustup comes in the federal lawsuit filed against Sunflower State Health Plan Inc. and parent Centene Corporation by former Sunflower Vice President Jacqueline Leary. Her lawsuit, filed in October, contends she was wrongfully fired after protesting potentially improper cost-cutting moves for the Kansas Medicaid program. (Hegeman, 1/26)

Pittsburgh Tribune-Review: Emergency Room Visits Decline As Navigators Steer Patients To Proper Medical Care
Three hospitals in Western Pennsylvania have found a way to blunt these problems by connecting patients with people in their communities. Known as navigators, they help patients schedule doctor appointments, find transportation, pick up medications and make sure they're sticking to discharge instructions after a hospital stay. Navigators are not medical professionals or social workers. They're more like a trusted neighborhood problem solver trained to help patients overcome obstacles to getting the care they need. During a nine-month-long pilot program, Jameson Health System in New Castle, Saint Vincent Hospital in Erie and Allegheny Valley Hospital in Natrona Heights found that navigators were effective in getting patients to access medical care more efficiently, according to consulting firm Accenture, which ran the program, and the Highmark Foundation, which funded it. (Nixon, 1/26)

The New York Times: Joan Rivers’s Daughter Files Malpractice Suit Against Manhattan Clinic
Ms. Rivers went into cardiac and respiratory arrest during the procedure on Aug. 28 and died several days later. There has been no official determination of exactly what it was that killed her, though federal health investigators found a number of errors, including a failure by those treating Ms. Rivers to notice that her vital signs were dropping, which the lawsuit said contributed to the death. The lawsuit also said the closing of Ms. Rivers’s vocal cords was a cause. The defendants include Dr. Korovin; the clinic; Renuka Bankulla, the anesthesiologist; and Dr. Cohen, who stepped down as the clinic’s medical director. (Hartocollis, 1/26)

Bay Area News Group: Kaiser Nurses Ratify Contract
Northern and Central California nurses have overwhelmingly approved a three-year contract with Kaiser Permanente. Registered nurses and nurse practitioners voted on the agreement last week in membership meetings from Santa Rosa to Fresno. The nurses are members of the California Nurses Association/National Nurses United representing some 18,000 Kaiser nurses. (Parr, 1/26)

The Albuquerque Journal: Judge Calls For Hearing On Health Dept. Case Against Nonprofit
A state district judge ruled Friday that the state Human Services Department likely violated the due process rights of a northern New Mexico behavioral health nonprofit in a case involving questioned Medicaid billings. District Judge Francis Mathew called for a full hearing on the agency’s evidence against Easter Seals El Mirador, the nonprofit that sued HSD in August to obtain about $671,000 in Medicaid reimbursements it claims it is owed. (Boyd, 1/26)

The Chicago Sun-Times: Trial To Begin In Ghoulish Medicare Fraud Case
He’s been free for nearly two years after posting an astonishing $10 million bond. But most of the patients who ended up at Ed Novak’s West Side hospital weren’t so fortunate. Poor, elderly and vulnerable, many found themselves driven by ambulance across the city, past countless better hospitals, to Sacred Heart, the maggot-infested, substandard Sacred Heart Hospital where some of them died, federal prosecutors say. Their doctors would never have sent them to Sacred Heart if Novak, who owned the hospital and acted as its CEO, wasn’t dishing out illegal kickbacks so that he could reap millions of dollars in Medicare and Medicaid payments, the feds say. (Janssen, 1/26)

Editorials And Opinions

Viewpoints: Medicare's Cost Cutting; Paying For Obamacare; Warren Misguided In Pharma Plan

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

Bloomberg: The Cost-Cutting Power Of Medicare
The Department of Health and Human Services' action today to set a timetable for moving Medicare away from fee-for-service payments is commendable and timely. ... Why is this important? Because after years of slow cost growth, health care is reaching a crucial tipping point. In fiscal year 2014, inflation-adjusted Medicare spending per beneficiary actually declined compared with the previous year. Yet the next year or two will determine whether the recent era of slow cost growth becomes the new normal, or instead is reversed. (Peter R. Orszag, 1/26)

The Wall Street Journal's Washington Wire: Spending Debate: Partisan Divide On Deficit Problem Signals More Tension Ahead
In its annual economic outlook, the nonpartisan [Congressional Budget Office] said the federal budget deficit will shrink this year to its lowest level since 2007 .... Then, the kind of bad deficit news that has been the norm in recent years kicks back in. As a result of Baby Boomers leaving the work force and snapping up federal retirement benefits, as well as CBO estimates that long-term economic growth will remain weak by historic standards, the estimated deficit starts to climb again in 2017. ... In the latest Wall Street Journal/NBC News poll, released just last week, there was a stark partisan difference in the importance attached to making further deficit reductions. Among Republicans, 84% cited cutting the deficit as one of their absolute top priorities for this year .... Among Democrats, though, cutting the deficit further is a much lower priority. Only 53% of Democrats cited it as an absolute priority this year. That put it below creating jobs, defeating the Islamic State, reducing income inequality, increasing the minimum wage and fixing and keeping the new health-care law. (Gerald Seib, 1/26)

The Wall Street Journal's Washington Wire: Why Data On Health-Care Price Variation Doesn’t Itself Solve The Problem
The Blue Cross and Blue Shield Association (BCBSA) last week put out one of the best reports I have seen on price U.S. in health services. The report documents “extreme price variation” across the country for knee and hip replacements. It called for arming consumers with more price information but stopped there; it did not suggest there was anything large insurers—such as Blue Cross–could do about the problem themselves or call for greater government action. The association examined hip and knee replacements in 64 markets across the country and found more than a threefold difference in the average cost of knee and hip replacements across markets. Perhaps even more startling, the analysis found that prices within markets can vary by as much as 313%. (Drew Altman, 1/27)

The Wall Street Journal's Washington Wire: Who’s Going To Pay For This Obamacare Wish List?
I wrote in this space last June that supporters of the president’s health-care law had not made many specific suggestions about how to amend or otherwise change the Affordable Care Act. Last week, the advocacy group Families USA attempted to change that, releasing its “Health Reform 2.0” agenda of how to expand on Obamacare. But the paper also raises an important question for the law’s supporters—including presidential candidates running in 2016: How to pay for the myriad promises that liberal groups want to add to the health-care agenda? (Chris Jacobs, 1/26)

Los Angeles Times: This Conservative Op-Ed Confirms The Immorality Of Repealing Obamacare
Rarely do conservative opponents of the Affordable Care Act acknowledge the real human consequences of their campaign to overturn the healthcare reform law. But an astonishing op-ed published Friday by the Washington Post does just that. Its author, Michael R. Strain of the American Enterprise Institute, argues that even though the result of repeal is that some Obamacare beneficiaries may die from losing their insurance, that outcome is moral. As the Post's editors succinctly and accurately headlined the piece: "End Obamacare, and people could die. That's okay." (Michael Hiltzik, 1/26)

The Wall Street Journal: ‘Ordinary Contract Principles’
Sometimes the Supreme Court’s most important contribution resembles the job of a baseball catcher who stops wild pitches from heading to the stands. An example came Monday when the High Court unanimously blocked an attempt to rewrite a contract to make retiree health benefits a lifetime obligation. In M&G Polymers v. Tackett, retired employees and their union claimed that the company that had taken over their previous employer couldn’t renegotiate the terms of retiree health care even after the collective-bargaining deal expired. The Sixth Circuit Court of Appeals sided with the retirees based on an expansive interpretation of contract law that Justice Clarence Thomas took apart piece by piece. (1/26)

Bloomberg: Big Pharma Is A Pointless Target For Warren
Senator Elizabeth Warren has a modest proposal for pharmaceutical companies that get fined by the Food and Drug Administration for rule violations: a sort of "swear jar" that will require them to give money to the National Institutes of Health every time they break the FDA's rules .... There are a few problems with Warren's proposal, starting with the fact that it seems to assume that the NIH is the ultimate source of all those Big Pharma profits, which is why some of those profits should be transferred to the NIH to fund "the next generation of medical research." In fact, academic research -- most of it presumably NIH-funded -- accounts for only about a quarter of new drugs. The majority are discovered by pharma or biotech firms. (Megan McArdle, 1/26)

The Wall Street Journal: Fear Measles, Not Vaccines
A measles outbreak traced to the Disneyland theme park in California has infected nearly 70 people since December. Even before this alarming episode, 2014 saw the worst U.S. measles outbreak in two decades. What else happened last year? More than 13,000 parents nationwide claimed on forms that vaccinating their children from preventable diseases like measles violated their “personal beliefs.” (Marc Siegel, 1/26)

The Baltimore Sun: A Risky Cut To Medicaid
Of all the major spending cuts Gov. Larry Hogan proposed in his budget, the easiest one for him politically may be the $160 million he's seeking to trim out of the Medicaid program. The reason is not just the cynical one, that Medicaid is a Democratic issue and that the people who rely on it probably didn't vote for him anyway, though there may be some truth to that. Rather, the reason Mr. Hogan isn't taking much heat for it so far is that he's merely continuing a cut former Gov. Martin O'Malley enacted through the Board of Public Works earlier this month. Even the state medical society, while opposed to the policy, is holding its fire where Mr. Hogan is concerned and pinning the blame on his predecessor. But it's one cut that could prove penny wise, pound foolish. (1/26)

The Denver Post: Leadville Hospital Needs A Savior
St. Vincent, Leadville's only hospital, is dying. Most medical services have been eliminated, although the emergency room, three patient rooms and ambulance services are still functioning, according to Karen Reinhart, hospital director of community relations. The boiler and pipes have been breaking, and staff members have left. Without some miracle, St. Vincent will disappear, leaving Lake County without a hospital and forcing residents to drive 33 dangerous mountain miles to the nearest hospital in Frisco. (Tom Noel, 1/26)

JAMA: Mandatory Use Of Prescription Drug Monitoring Programs
The United States is in the midst of a prescription opioid overdose and abuse epidemic. The rate of fatal prescription drug overdoses involving opioids almost quadrupled from 1.4 deaths/100 000 people in 1999 to 5.4 deaths/100 000 people in 2011. ... Prescription drug monitoring program mandates are a proliferating policy tool. It will be critical to strike a balance between addressing legitimate practitioner concerns and retaining features fundamental to mandate efficacy. System imperfections, such as the lack of real-time, interstate data and lack of full integration into clinical workflow, are important drawbacks that should be addressed. However, these limitations do not render PDMPs useless, nor should they block mandates altogether. (Rebecca L. Haffajee, Anupam B. Jena and Scott G. Weiner, 1/26)