First Edition: December 17, 2012

Today's headlines include weekend updates regarding the fiscal cliff negotiations as well as news regarding states' decisions on health exchanges.

Kaiser Health News: FAQ: Grandfathered Health Plans
In this Kaiser Health News FAQ, Sarah Barr writes, "If you get your insurance from your employer, there's a very good chance that you are in a 'grandfathered plan' and that means some of the changes do not affect you -; yet. ... Nonetheless, consumers should know the status of their plans since that may determine whether they are eligible for certain protections and benefits created by the health law" (Barr, 12/16).  Read the story.

Kaiser Health News: Capsules: Facing Deadline, Most States Say No To Running Their Own Insurance Exchanges; Med Students Switch Gears After Sandy KO's Training Hospitals; Tax Exclusion For Health Benefits Could Be Part Of 'Fiscal Cliff' Talks
Now on Kaiser Health News' blog, Phil Galewitz reports on the states' announcements of their plans to build or not build insurance exchanges: "The Obama administration will have to build and operate online health insurance markets for more than 30 states, something few expected when the federal health law was approved in 2010. ... Most experts thought only states with small populations such as Delaware or Montana would seek federal help. Instead, most will rely on the federal government -; including two of the most populous states, Texas and Florida, which together account for nearly 20 percent of nation's uninsured" (Galewitz, 12/14).

Also on Capsules, Alvin Tran looks into the impact on medical students of the closure of two New York City hospitals: "After completing a medical rotation in pediatrics, Hannah Kirsch was looking forward to starting another one in psychiatry at New York City's Bellevue Hospital – but then Hurricane Sandy hit. Kirsch is among about 170 third-year and fourth-year medical students at New York University who were required to change their plans after two of NYU's academic training hospitals, NYU Langone Medical Center and Bellevue, temporarily closed due to extensive flood damage" (Tran, 12/17).

Finally, Julie Appleby reports about how tax benefits for employee health insurance benefits factor into "fiscal cliff" negotiations: "As the deficit debate continues, some policy wonks think it's inevitable that negotiators will address a loophole that allows workers to avoid paying taxes on the value of their job-based health insurance" (Appleby, 12/14). Check out what else is on the blog.

The Associated Press/Washington Post: Movement Seen In 'Fiscal Cliff' Talks  As Boehner Offers Revenue Boost
In return, Boehner is asking for $1 trillion in spending cuts from government benefit programs like Medicare. Those cuts would defer most of a painful set of across-the-board spending cuts set to slash many domestic programs and the Pentagon budget by 8-9 percent, starting in January (12/17).

Politico: Fiscal Cliff Deal Still Faces Many Hurdles
House Speaker John Boehner jump-started the budget talks by offering to raise tax rates, but major differences on entitlements and revenue could prove difficult to bridge with only two weeks until the fiscal cliff deadline. … But proposed cuts to Medicare are now the key to any fiscal cliff deal. Boehner needs robust changes to the hugely popular seniors health program to sell any kind of tax-rate increase to his conservative-dominated Republican Conference (Sherman and Bresnahan, 12/16).

USA Today: Signs Of A Thaw Emerge In 'Fiscal Cliff' Talks
In talks with President Obama, Republican House Speaker John Boehner offered to back raising the income tax rates for people making $1 million or more if Obama agreed to significant cuts in entitlement program spending, according to two sources close to the negotiations. They spoke on condition of anonymity because they were not authorized to speak publicly. Obama rejected that offer, the sources said, but it was the first sign that Boehner was willing to endorse raising tax rates for anyone (Jackson, 12/16).

Bloomberg News/The New York Times: U.S. Fiscal Deal Unlikely Without Compromise
As the political tension mounts over the current fiscal deadlock -; which, unless a deal is reached by Dec. 31, would increase taxes for everyone and force some draconian spending cuts -; there will have to be trade-offs for any ultimate deficit-reduction deal. Congressional Republicans insist this will only be palatable if there are major cuts to entitlement programs, especially Medicare. There are clear indications that the White House, despite the objections of some Democrats, would go along with significant changes, perhaps including a form of means testing for Medicare benefits, altering the cost-of-living adjustments for entitlements and taxes (Hunt, 12/16).

Los Angeles Times: Fault Lines Also Appearing On Democratic Side In Fiscal Debate
White House officials insist nothing is off the table, tacitly acknowledging that the president is weighing potential changes to Medicare, Medicaid and Social Security as he negotiates with House Speaker John A. Boehner (R-Ohio). Although both sides have been reluctant to put details in writing, any deficit reduction deal will almost certainly require significant alterations to these entitlement programs. … The Democratic fault lines were apparent last week. More than 80 Democrats signed a letter to Obama urging him not to agree to a deal that would raise the eligibility age for Medicare. Obama had moved in that direction last year in a failed attempt to craft a "grand bargain" with Boehner, considering an increase phased in over time (Parsons, Memoli and Hennessey, 12/16).

Los Angeles Times: Many States Leaving Insurance Exchanges To Federal Government
Despite years of prodding and pleading by the Obama administration, close to half of the nation's governors will not take a critical step to implement the president's healthcare law next year, leaving the job of running new insurance markets for their residents to the federal government (Levey, 12/14).

The Washington Post: Setup For States' Health Insurance Exchanges Is Massive Job With Crucial Deadline
Oregon's health insurance exchange needs a 150-person call center. Maryland's wants a public relations agency. And the Colorado exchange seeks something even more basic: a name. ... Officials in the states that did receive approval this past week to run their own health insurance exchanges describe the effort as a huge undertaking, with much work still to be done (Kliff, 12/15).

Politico: Department Of Justice: Put A Hold On Contraception Suits
There's no reason to try legal challenges to the contraception mandate brought by religious employers who are now protected from it until HHS decides how it will try to accommodate them, government lawyers told federal appellate court judges Friday. Arguing in the U.S. District Court of Appeals for the District of Columbia, Department of Justice attorney Adam Jed said Health and Human Services will release a proposed rule on the contraception accommodation in the first three months of 2013 and finalize it by August before the safe-harbor protection expires. Since that rule is on the way, there is no cause for cases to move forward now, he said (Norman, 12/17).

The Wall Street Journal: Medicare To Cover More Home Care
For years, Medicare recipients with chronic conditions have had difficulty qualifying for home health services administered by nurses and therapists. Now, a legal settlement between consumer advocates and the federal government has paved the way for patients with chronic conditions to receive such services both at home and in skilled-nursing and outpatient facilities (Tergesen, 12/16).

The Wall Street Journal: Hospital Systems Branch Out As Insurers
A growing number of hospital systems are moving to start their own insurance plans, aiming to broaden their roles and prepare for the changes coming under the federal health-care overhaul. Piedmont Healthcare and WellStar Health System, both in the Atlanta area, are set to announce a jointly owned insurance arm, with the goal of marketing coverage to employers and Medicare recipients in 2014. They also will consider selling coverage on a health exchange, one of the online insurance marketplaces required in each state by the health-overhaul law (Wilde Mathews, 12/16).

Los Angeles Times: Advocacy Groups Coming Hat In Hand To A Less-Strapped Sacramento
The California Medical Assn. also wants more funding as the state prepares to enlarge healthcare coverage. David Ford, the group's associate director of medical and regulatory policy, said administrators will need more staff to process an influx of newly covered Californians. "We have to be ramping up," he said. Advocates worry that the new healthcare law will be undermined in California because the state's Medi-Cal cuts could make it harder for the poor to get care. A federal appeals court ruled Thursday that the state can reduce payments to doctors and others who care for Medi-Cal patients; provider groups say they will appeal (Megerian, 12/17).

Los Angeles Times: Healthcare Crisis: Not Enough Specialists For Poor
Many of the newly insured will receive Medi-Cal, the government plan for the needy as administered through the state of California. Clinics already struggle to get private specialists to see Medicaid patients because of the low payments to doctors. Last week, an appellate court decision that authorized the state to move forward with 10% cuts in Medi-Cal reimbursement, which could make finding doctors for those patients even more difficult (Gorman, 12/15).

NPR: Shooting Raises Issues Of Mental Health, Treatment
After a tragedy like the one in Newtown, people understandably want to know why someone would act with such extreme violence. Researchers have spent years trying to figure that out with mixed results (Martin, Hamilton, 12/16).

NPR:  Experts Argue Against Proposed Ban On Vaccine Preservative
The U.N. Environment Program is considering a ban on thimerosal, a vaccine preservative that is widely used in developing countries. The program expects to make a decision sometime after a final meeting on the issue in January. Thimerosal, which contains a form of mercury, was removed from most childhood vaccines in the U.S. and Europe more than a decade ago, amid public fear that it could cause autism. Several large studies later found no risk from the preservative and that removing it did nothing to change autism rates (Hamilton, 12/17).

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