First Edition: May 15, 2013

Today's headlines include reports about how the latest Congressional Budget Office projections could further stall efforts to reach a grand bargain that includes changes to Medicare and other entitlement programs.

Kaiser Health News: Doctors Transform How They Practice Medicine
Kaiser Health News staff writer Ankita Rao reports: "The buzz, and anxiety, in the medical profession is palpable – trade magazines tout new coping strategies, doctor groups discuss the transformation of practices. Physicians are experimenting with business models and new practice techniques, hoping to find work that is both financially and personally rewarding" (Rao, 5/15). Read the story.

Kaiser Health News: Capsules: GOP Raises Concerns About 'Sebelius Shakedown'; Most Doctors Still Waiting On Medicaid Pay Raise; Angelina Jolie, Genetic Testing, And The ACA
Now on Kaiser Health News' blog, Mary Agnes Carey reports on reactions from Republican lawmakers regarding health law fundraising activities: "Senate GOP leaders Tuesday took issue with Department of Health and Human Services Secretary Kathleen Sebelius for soliciting money from private groups to implement the law.  Noting the Internal Revenue Service scrutiny of conservative political organizations,  the Republicans also said the IRS can't be trusted to implement the health law" (Carey, 5/15).

In addition, Phil Galewitz reports on the status of a much-awaited Medicaid pay raise: "Five months after primary care doctors who treat Medicaid patients were supposed get a big pay raise, most physicians have yet to see it. Only three states have implemented the pay raise -; Nevada, Michigan and Massachusetts, according to the American Academy of Family Physicians" (Galewitz, 5/14).

Also on Capsules, Diane Webber reports on some questions and answers about genetic testing and inherited cancer risks: "Dr. Otis Brawley, the chief medical officer of the American Cancer Society, is on the record with a quick post on Angelina Jolie's startling announcement in a New York Times op-ed that she has had a prophylactic double mastectomy to cut her inherited risk of breast cancer. Jolie's mother, actress Marcheline Bertrand, died of cancer at age 56, and Jolie found through genetic testing that she carries the BRCA1 gene. Brawley, who has been an outspoken critic of overtesting, answers many important questions that Jolie's decision raises" (Webber, 5/14). Check out what else is on the blog.

The New York Times: U.S. Budget Deficit Shrinks Far Faster Than Expected
In revising its estimates for the current year, the budget office also cut its projections of the 10-year cumulative deficit by $618 billion. Those longer-term adjustments are mostly a result of smaller projected outlays for the entitlement programs of Social Security, Medicaid and Medicare, as well as smaller interest payments on the debt. The report noted that the growth in health care costs seemed to have slowed -; a trend that, if it lasted, would eliminate much of the budget pressure and probably help restore a stronger economy as well. The C.B.O. has quietly erased hundreds of billions of dollars in projected government health spending over the last few years (Lowrey, 5/14).

Los Angeles Times: Federal Deficit Shrinks At Surprising Rate
Three major factors account for most of the long-term improvement: a better economy, a continued slowdown in the rate of medical inflation -; which reduces the cost of Medicare and Medicaid -; and higher taxes that Congress approved as part of the "fiscal cliff" deal in January, the budget office said. In addition, the automatic budget cuts that took effect this spring have reduced spending in the short term. … The numbers have an important political impact. Republicans have pushed for big reductions in government programs this year, arguing that the country could face a debt crisis if spending is not curtailed. The Obama administration and congressional Democrats have argued that big new reductions have less urgency because the budget picture is already getting better. The new figures from the budget office, which both parties rely on as a nonpartisan arbiter, will probably give more impetus to the Democrats' position (Lauter, 5/14).

The Washington Post: CBO Sees Brighter Economy With Budget Deficit To Plunge To $642 Billion This Year
After 2015, the CBO forecasts that deficits will gradually begin rising again as the baby-boom generation taps into Social Security and Medicare. Although borrowing will stabilize, the national debt will remain at historically high levels, the CBO said, stuck above 70 percent of the economy throughout the next decade. … Still, the improvement in the short-term forecast has removed the air of crisis that has hovered around the budget deficit since President Obama took office. On Tuesday, some analysts urged congressional Republicans to call an end to their fixation on budget cutting (Montgomery, 5/14).

The Wall Street Journal: Deficit Is Shrinking Quickly
A rapidly shrinking federal budget deficit is upending bipartisan talks to reach a federal budget deal, illustrating the conundrum Washington faces with an improving near-term fiscal outlook but continued longer-term pressures tied to aging baby boomers. … The White House and Republicans have been locked in a budget fight since 2011, leading to a number of piecemeal deals that have reduced the deficit by both raising taxes and cutting spending. White House officials have said they want more tax increases while Republicans have called for structural changes to Medicare and Medicaid, the two sprawling government health-care programs, while saying they won't back new tax increases. Earlier this year, a bipartisan effort was under way to lock in more deficit cuts, particularly later in the decade, but those talks have stalled in recent weeks, in part because of the shrinking deficit (Paletta, 5/14).

The Associated Press/Washington Post: Projected Lower Deficit This Year Could Further Slow Any Demand For Big Budget Deal
Now, the improving picture seems likely to make it more difficult for events to force Washington's exhausted budget combatants closer to a deal. For starters, it means that the deadline for increasing the government's borrowing cap has been postponed until October or November, the CBO said. It had been expected that lawmakers would have had to act this summer to increase the so-called debt limit, which could have been a catalyst for a broader budget deal (5/14).

The New York Times' Political Memo: For Republicans, Incentives To Strike A Budget Deal With Obama
Ask around the White House and the Capitol, and you will quickly find reasons to doubt that Republicans will compromise with President Obama on a budget deal that includes more tax increases and spending cuts in social programs. … Delaying steps to rein in Social Security, Medicare and Medicaid, the subjects of Republican doomsday warnings for years, means delaying significant attempts to curb the size of the government. The longer the delay, the sharper and more immediate the changes Washington must eventually make to ease the long-term fiscal squeeze (Harwood, 5/14).

The New York Times: House To Vote Yet Again On Repealing Health Care Law
The 37th time won't be the charm. But House Republicans are charging forward anyway this week on a vote to repeal President Obama's signature health care overhaul, which will put the number of times they have tried to eliminate, defund or curtail the law past the three-dozen mark (Peters, 5/14).

The Washington Post's Fact Checker: How Many Pages Of Regulations For 'Obamacare'?
Rep. Richard Hudson this week offered such an astonishing figure -; 33,000 pages of "Obamacare" regulations! -; that we immediately wanted to know more. But it turns out that Rep. Hudson got a little bit ahead of himself. An aide said that he misspoke and meant to say 13,000 pages. "Whether it is 13,000, 22,000 or 33,000, it is too many," the aide added. But then it turns out that Senate Minority leader Mitch McConnell (R-Ky.) has actually tweeted a photograph of this stack of paper. By his math, the Obama administration has issued 20,000 pages of regulations "associated" with the new law (Kessler, 5/15).

The Wall Street Journal: Health-Law Costs Slow Some Fast-Food Chains
Some restaurant operators are scaling back expansion plans because of uncertainty about the expense of insuring employees under the new federal health-care law. The concerns are especially acute among smaller operators who are more likely to be on the cusp of the Affordable Care Act's requirements for increased coverage of workers. The doubt is adding to anxiety over other rising costs for items like ingredients at a time when diners are cutting back on eating out (Jargon, 5/14).

Los Angeles Times: California Health Insurance Exchange Announces Grants
Covered California, the state's health insurance exchange, announced $37 million in grants Tuesday to begin the massive task of educating millions of Californians about the new healthcare law. The grants will go to 48 organizations, including universities, nonprofit groups, health foundations and unions. They will help state officials explain the new benefits, show people how to access insurance, and encourage small businesses to enroll (Gorman, 5/14).

The Associated Press/Washington Post: State Officials Urge Faith Leaders To Spread Word About New Health Insurance Options
Maryland health advocates urged religious leaders on Tuesday to learn more about how federal health care reform will be implemented in the state so they can pass information on to uninsured congregants. About 150 leaders gathered for the first summit of its kind in the state (5/14).

The Associated Press/Washington Post: Doctors And Nurses Among Nearly 100 Charged In $223 Million Medicare Fraud Busts In 8 Cities
Nearly 100 people, including 14 doctors and nurses, were charged for their roles in separate Medicare scams that collectively billed the taxpayer-funded program for roughly $223 million in bogus charges in a massive bust spanning eight cities, federal authorities said Tuesday. It was the latest in a string of similar announcements by Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder as federal authorities crack down on fraud that's believed to cost the program between $60 billion and $90 billion each year (5/14).

The New York Times: Covering The Rising Cost Of Long-Term Care
A 2013 report by Genworth Financial, an insurance provider based in Waltham, Mass., estimates the national median daily cost of a private room in a nursing home at $230 a day, an increase of 3.6 percent over 2012 -; some $6,900 per month. Sharing that room is only $27 less a day, according to the report (Kelly, 5/14).

Los Angeles Times: Gov. Jerry Brown Unveils Cautious Budget For Deficit-Free State
But Brown vowed to continue to resist pressure from fellow Democrats and interest groups to restore some money to adult dental care and to doctors who treat the poor. For upcoming contract negotiations with the state's big public-employee unions, the governor said the state "is aiming low." … Sacramento will oversee the expansion this year of Medi-Cal, California's healthcare program for the poor, to more than 1 million Californians who do not have health insurance now. Under Brown's plan, the newly insured would be offered the same benefits as those already covered by the public program, a shift from January. Then, the governor did not include stays in rehabilitation facilities and other long-term care for those who will become eligible for Medi-Cal for the first time next year (Megerian, 5/14).

Los Angeles Times: St. John's Bidding War Escalates
A high-stakes bidding war has erupted for St. John's Health Center, a storied Santa Monica hospital, with a local billionaire teaming up with the Roman Catholic Archdiocese of Los Angeles on an unsolicited offer. The latest bid, expected to be formally announced Wednesday, comes from former drug-company executive and healthcare entrepreneur Patrick Soon-Shiong, who said in a statement the bid has the support of the archdiocese (Terhune, 5/15).

NPR: How A Florida Medical School Cares For Communities In Need
Brown helps direct FIU's Neighborhood HELP program. It's part of the school's curriculum that connects medical students with families in neighborhoods where medical care is scarce. Students visit families in their homes where they conduct examinations and provide basic care. But some things are better done in a clinic. So the medical school bought its own RV. "We're able to bring free basic primary care to our households relatively close to their community," Brown says (Allen, 5/15).

The New York Times: Archbishop Presses Cuomo Over Abortion
Cardinal Timothy M. Dolan declined on Tuesday to say whether Gov. Andrew M. Cuomo was "a Catholic in good standing," as he ratcheted up his criticism of the governor's continued advocacy for abortion rights (McKinley, 5/14).

The Wall Street Journal: Lawmakers in Vermont Approve Assisted Suicide
Vermont is poised to become the third state in the nation to allow physicians to prescribe lethal drugs to terminally ill patients who want to die. State lawmakers on Monday night approved an assisted-suicide bill, which now awaits the signature of Gov. Peter Shumlin, a first-term Democrat who has said he would sign it, likely within a week. Once enacted, Vermont would be the first state to decriminalize assisted suicide through a legislative vote (Gershman, 5/14).

Politico: Vermont Oks Assisted Suicide Bill
The approval of an assisted suicide bill in Vermont brings to a close a 10-year battle in the state over the issue and delivers the third state-level victory for advocates seeking to advance the policy nationwide. But the national implications for the bill -; which won legislative approval Monday night and allows doctors to prescribe lethal doses of drugs to some terminally ill patients -; are tough to pinpoint (Cheney, 5/15).