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2006-02-14 Kaiser Daily Health Policy Report - Tuesday, February
14, 2006
 Feb 14, 2006 09:19 PST 

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Tuesday, February 14, 2006

1. Several Health Programs Slated To Be Cut Under Bush's FY 2007
Budget Proposal

2. Medicare Drug Plans Requirements, Restrictions Sometimes
Delay Beneficiaries' Access to Medications

3. Kaiser Daily Health Policy Report Highlights State Actions
Related to Medicare Rx Drug Benefit

4. Newspapers Examine Health Savings Accounts, Consumer-Driven
Health Plans

5. Black Box Warnings Deter Few Physicians From Prescribing
Medications, Study Says, Wall Street Journal Reports

6. Former President Clinton Announces New Initiative To Address
Childhood Obesity

7. Hawaii Considering New Children's Health Insurance Program

8. Massachusetts Attorney General Investigates Overbilling of
State Uncompensated Care Pool After Audit Finds Excessive

9. FDA Panel Made 'Brave Effort' To Urge Risk Warning on ADHD
Medications, New York Times Editorial States

10. Editorials, Opinion Pieces Address President Bush's Budget



1. Several Health Programs Slated To Be Cut Under Bush's FY 2007
Budget Proposal

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The fiscal year 2007 budget proposal that President Bush
announced last week would eliminate six HHS programs, for a
savings of $866 million, and reduce spending by about $1 billion
for five additional programs, CQ HealthBeat reports. The
proposal would save $630 million though the elimination of the
community services block grant, which funds "Community Action
Agencies" that offer employment, housing, nutrition and health
care for low-income individuals. In addition, the proposal would
eliminate the CDC Preventive Health and Human Services Block
Grant -- which funds chronic disease prevention, immunization,
injury reduction programs and sex-offense prevention programs --
for a savings of $99 million. The proposal also would save $39
million through the elimination certain categories of funding
under the $693 million Maternal and Child Health Small
Categorical Grant program. According to the Office of Management
and Budget, the programs that the proposal would eliminate have
not established long-term goals or indicated improvement. The
proposal also would eliminate the Urban Indian Health Program,
which funds primary, preventive and behavioral health care for
the 60% of American Indians and Alaska Natives that reside in
urban areas, for a savings of $33 million. OMB said that health
care providers who receive funds through the program receive 60%
of their operating funds from other sources, adding that many
individuals served by the providers can obtain care at community
health centers. In addition, the proposal would save $25 million
through the elimination of Real Choice System Change Grants. HHS
said the grants are no longer necessary because of funding to
move individuals with disabilities into home and community-based
care programs. The proposal also would reduce spending for:

*The Children's Hospital Graduate Medical Education Payment
Program, which subsidizes children's hospitals, from $297
million to $99 million;

*Health Resources and Services Administration Health Professions
Programs, which direct health care professionals to underserved
communities, from $295 million to $159 million;

*HRSA Rural Health Programs -- which fund rural health care
facilities, state offices of rural health and the establishment
of rural provider networks -- to $27 million, for a savings of
$133 million; and

*Poison control centers, from $23 million to $13 million,
(Reichard, CQ HealthBeat, 2/10).HHS Secretary Mike Leavitt said,
"We had to make hard choices, hard choices about very
well-intentioned programs."

Additional Comments

Stephen McConnell, vice president for public policy at the
Alzheimer's Association, criticized the budget proposal, which
he said would eliminate $12 million in state grants for
community-based Alzheimer's care, in addition to a $1.6 million
"Maintain Your Brain" campaign. He said, "It costs Medicare
three times as much to take care of somebody with Alzheimer's
disease than not," adding, "If we could even just slow the
progression of this disease, we could reduce the cost
substantially." However, HHS CFO Charles Johnson defended the
spending reductions included in the budget proposal and said
that the proposal has "a very substantial amount of funding
going into Alzheimer's." Sen. Edward Kennedy (D-Mass.) said the
Bush administration included "tax cuts for the wealthy and
giveaways for the drug industry" in the proposal. Vinay
Nadkarni, a spokesperson for the American Heart Association,
criticized a provision in the proposal that would eliminate a
$1.5 million program that provides defibrillators to rural
communities and trains local personnel to use them. He said,
"Coronary heart disease is the No. 1 killer in the United
States. This is actually something we can arm ourselves with"
(Connolly, Washington Post, 2/14).

Cancer Research Spending Reductions

The budget proposal also includes the first spending reductions
for cancer research in 10 years. The proposal would reduce
spending for the National Cancer Institute by 0.8%, or $39.4
million, to $4.75 billion. In addition, the proposal would
reduce spending for the CDC cancer prevention programs by 1% to
$304.7 million. The proposal also would reduce spending for the
National Breast and Cervical Cancer Early Detection Program for
low-income women by $1.4 million and reduce spending for the CDC
Office of Smoking and Health by $2.1 million. Sen. Tom Harkin
(D-Iowa), ranking member of the Senate Appropriations
Subcommittee on Labor, HHS, Education and Related Agencies,
said, "Instead of funding a war on cancer, the president' budget
is funding a retreat." Rep. Clay Shaw (R-Fla.) said, "When you
are so close you don't jog, you sprint" (Cohn, CongressDaily,

Veteran Fee Increases

The budget proposal also would require veterans younger than age
65 to pay more for TRICARE, the military health care program,
the San Diego Union-Tribune reports. The proposed fee increases
would affect about 3.1 million military retirees and their
families nationwide. Annual enrollment fees for TRICARE Prime,
the managed care program, currently are $230 for an enlisted
retiree or retired officer and $460 for a family. Under the
proposal, the fees would increase to $325 for a junior enlisted
retiree and $650 for a family; $475 for a senior enlisted
retiree and $950 for a family; and $700 for a retired officer
and $1,400 for a family. The fees are based on retirement income
levels (Fitzsimons, San Diego Union-Tribune, 2/14). In addition,
under the proposal, copayments in the TRICARE retail pharmacy
network would increase to $5 from $3 for generic medication and
to $15 from $9 for brand-name treatments (Tacoma News Tribune,
2/11). Defense Department analysts have estimated that, without
increased fees, TRICARE expenses could reach $64 billion, or 12%
of the estimated department budget, by 2015. Under the proposal,
the fee increases would "be phased in over two years beginning
in October 2007," the Union-Tribune reports (San Diego
Union-Tribune, 2/14).

Broadcast Coverage

WAMU's "The Diane Rehm Show": The NPR-syndicated program on
Monday included a discussion with Senate Finance Committee Chair
Chuck Grassley (R-Iowa) about provisions in the budget proposal
related to Medicare and Medicaid (Rehm, "The Diane Rehm Show,"
WAMU, 2/13). The complete segment is available online in


2. Medicare Drug Plans Requirements, Restrictions Sometimes
Delay Beneficiaries' Access to Medications

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The New York Times on Tuesday examined how some physicians and
pharmacists maintain that many medications covered by Medicare
prescription drug plans are "not readily available" to
beneficiaries because of prior authorization requirements.
Medicare prescription drug plans require prior authorization --
or preapproval from the plan sponsors -- as a prerequisite for
coverage of many medications. Medicare prescription drug plan
sponsors maintain that prior authorization requirements prevent
unnecessary prescriptions and encourage the use of
less-expensive medications. However, some physicians and
pharmacists maintain that prior authorization requirements used
by Medicare prescription drug plans are excessive and could
prevent access to some medications for beneficiaries. According
to the Times, a Medicare prescription drug plan might have "25
or 30 forms" for prior authorization for different medications.
The forms often require laboratory test results, "all office
notes" and other data to demonstrate need for medications, the
Times reports.


Steven Levenson, president-elect of the American Medical
Directors Association, said, "We have seen signs that Medicare
drug plans are using management controls to deter access to
medically appropriate drugs, including drugs on their own
formularies." David Bernauer, chair of Walgreen, said, "It is
impossible for pharmacists to keep track of all these
formularies" and prior authorization requirements. Bernauer said
that the federal government "should use its leverage to promote
greater standardization of policies and procedures." Francis
Soistman, executive vice president of Coventry Health Care, said
that prior authorization forms are necessary because "each drug
requiring prior authorization has unique clinical criteria that
must be met." In addition, he said, prior authorization forms
"serve as a checklist of necessary information needed for our
review." Soistman said that prior authorization requirements
reduce the use of medications with potential for abuse; limit
safety problems; prevent overuse of expensive medications; and
help ensure that "equally effective, less expensive agents are
used first." Daniel Lyons, senior vice president of Independence
Blue Cross, said that he supports efforts to "simplify and
standardize the prior authorization process." Babette Edgar, a
former CMS official, said that agency officials analyzed the
prior authorization requirements of Medicare prescription drug
plans when they approved formularies for the plans last year
(Pear, New York Times, 2/14).

Leavitt Comments on Dual Eligibles

In other Medicare news, HHS Secretary Mike Leavitt on Monday
said that the percentage of dual eligibles who continue to
experience problems with the prescription drug benefit has
decreased from about 10% to between 3% and 5%, CQ HealthBeat
reports. Many dual eligibles --- beneficiaries who are eligible
for both Medicare and Medicaid -- have experienced problems with
access to medications under the prescription drug benefit
because of incorrect enrollment information in computer
databases and other issues. Leavitt said that problems with the
Medicare prescription drug benefit are "still too heavy on the
duals" and that the issues are "the kind of thing you go through
when you implement a large systems change." He added, "We will
not quit worrying about this until every Part D participant has
connected with their plan. Once people have connected with their
plan, things go smoothly." Leavitt said that a proposed
extension of the May 15 deadline for enrollment in the Medicare
prescription drug benefit without penalty "is a policy decision
that Congress will have to make," adding that "the value of a
deadline is people get busy and take care of it." He said, "The
good news is millions of people have drug coverage today who did
not (before). We make no excuses here. The system gets better
every day and it will continue to" (Carey, CQ HealthBeat, 2/13).

Effect of Rx Drug Benefit on Midterm Elections Examined

The AP/Long Island Newsday on Tuesday examined how the
experience that Medicare beneficiaries have with the
prescription drug benefit could affect how they vote in midterm
elections this fall. In the 2004 presidential election, voters
ages 65 and older supported President Bush over Sen. John Kerry
(D-Mass.) by a 52% to 47% margin. In the 2004 House races, 51%
of voters ages 65 and older voted for Republican candidates,
compared with 45% who voted for Democratic candidates. Pollsters
maintain that the opinions of Medicare beneficiaries on how
lawmakers and the Bush administration respond to problems with
the prescription drug benefit could affect their votes in the
midterm elections. Whit Ayres, a Republican pollster, said, "A
lot of it depends upon how the program evolves over the next few
months," adding "The real question is not what seniors think of
the program today as much as what they think of it at the end of
the enrollment period." Celinda Lake, a Democratic pollster,
said, "If the Democrats are smart, they will play this thing
until it's completely overhauled" (Freking, AP/Long Island
Newsday, 2/14).

3. Kaiser Daily Health Policy Report Highlights State Actions
Related to Medicare Rx Drug Benefit

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Summaries of state actions related to the Medicare prescription
drug benefit appear below.

*Minnesota: An emergency order issued last month by Gov. Tim
Pawlenty (R) to cover the cost of medications for some
low-income Medicare beneficiaries will expire on Friday without
action by the state Legislature, which is not in session, the
St. Paul Pioneer Press reports (Olson, St. Paul Pioneer Press,
2/13). On Jan. 14, Pawlenty issued a five-day emergency order
that said the state would cover the cost of medications for
beneficiaries eligible for both Medicare and Medicaid who
experience problems with access under the prescription drug
benefit (Kaiser Daily Health Policy Report, 1/18). His executive
council later extended the emergency order by 30 days. An
additional extension requires action by the state Legislature
(Kaiser Daily Health Policy Report, 1/19). Dawn Simonson,
executive director of the Metropolitan Area Agency on Aging,
said that many dual eligibles continue to experience problems.
However, Kevin Goodno, commissioner of the state Department of
Human Services, said that the number of claims for the state to
cover the cost of medications for dual eligibles has decreased
from 9,000 daily in mid-January to 3,000 to 4,000 currently and
should continue to decrease (St. Paul Pioneer Press, 2/13). In
other Minnesota news, a group of Democratic state lawmakers last
week introduced a bill that would allow the state to negotiate
discounts on prescription drugs for Medicare beneficiaries whose
annual medication costs reach the so-called "doughnut hole" in
the prescription drug benefit. Under the Medicare drug benefit,
beneficiaries must cover annual medication costs between $2,250
and $5,100. The bill would extend the power Minnesota currently
uses to negotiate discounts on prescription drugs for prisoners
and mental health facilities, according to state Rep. Tony
Sertich (D), a co-sponsor of the legislation. The bill could
allow the state to obtain discounts of as much as 25% to 33% on
the cost of prescription drugs. The legislation also would apply
to uninsured state residents (Olson, St. Paul Pioneer Press,

*New Jersey: State officials have asked CMS to extend the
deadline for the federal government to reimburse states that
have covered the cost of medications for dual eligibles who
experience problems with access under the prescription drug
benefit, the Newark Star-Ledger reports (Campbell, Newark
Star-Ledger, 2/13). The federal government has agreed to provide
reimbursements to states through Feb. 15 (Kaiser Daily Health
Policy Report, 2/10). However, state officials maintain that
problems with the Medicare prescription drug benefit continue
and that the state must continue to cover the cost of
medications for some dual eligibles. Anthony Coley, a
spokesperson for Gov. Jon Corzine (D), said, "We want assurances
that the problems are resolved." CMS spokesperson Jeffrey Hall
said that the agency will consider the request to extend the
deadline. Since Jan. 6, New Jersey has paid $37.9 million to
provide 415,000 prescriptions for dual eligibles and $55 million
to provide medications for beneficiaries in the state
Pharmaceutical Assistance to the Aged and Disabled program,
which provides assistance to 190,000 low-income state residents
(Newark Star-Ledger, 2/13).


4. Newspapers Examine Health Savings Accounts, Consumer-Driven
Health Plans

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Several newspapers recently published articles that examined
health savings accounts. Summaries appear below.

*Knight Ridder/Austin American-Statesman: Knight
Ridder/American-Statesman on Sunday examined how "Bush's
proposed expansion of health savings accounts is based on a
premise that some research shows is questionable: that Americans
want more financial choices in their lives." According to Knight
Ridder/American-Statesman, "many Americans already feel
overwhelmed by financial options," and research into "Americans'
behavior with retirement savings plans suggests they don't" want
"to shop for a cheaper doctor, X-ray or blood test" (Hall,
Knight Ridder/Austin American-Statesman, 2/12).

*Long Island Newsday: Newsday on Sunday examined the "theory
behind health savings accounts ... that people will shop around
more for medical treatment if they are paying for it." According
to Newsday, the "reality ... may be very different, critics say,
with Americans forgoing care because of cost or getting lost in
the health care maze." Surveys of individuals enrolled in HSAs
indicate that "people with health problems more often skimped on
care because of cost and that many enrollees were not satisfied
with their policies," Newsday reports (Luhby, Long Island
Newsday, 2/12).

*St. Louis Post-Dispatch: The Post-Dispatch on Sunday examined
how the "ideas" on which health savings accounts are founded
"could foretell the future of American health care and its
cost," although most experts "agree it's unlikely
consumer-driven health plans ... will dramatically shrink the
nation's health care bill." According to the Post-Dispatch,
consumer-driven health plans, such as HSAs, could provide all
patients with access to wellness programs and the ability to
compare the cost and quality of health care services, or the
"race to save money could push them aside and leave employees
with higher costs and fewer benefits" (Feldstein, St. Louis
Post-Dispatch, 2/12).


5. Black Box Warnings Deter Few Physicians From Prescribing
Medications, Study Says, Wall Street Journal Reports

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Many patients are prescribed drugs with "black box" warnings --
the strictest warning FDA can administer -- even if the drugs
are not appropriate for their medical needs, according to a
study published Tuesday in the Archives of Internal Medicine,
the Wall Street Journal reports. Researchers led by Cambridge
Health Alliance and Harvard Medical School examined the health
records of 324,548 outpatients from Boston-area medical clinics
who were given at least one prescription from Jan. 1 to Dec. 31,
2002. They found that 33,778 patients were prescribed a
medication that had a black box warning. The warnings -- often
found at the top of a drug's label and featured in the
Physician's Desk Reference guide -- emphasize important drug
guidelines, such as cautioning against a drug being prescribed
with certain other drugs or advising against prescribing a drug
to patients with particular medical conditions. Of the 33,778
prescriptions, researchers found that 2,354 were written in
violation of a black box warning. About 90% of the violations
involved instances where a medication was prescribed for a
person with a condition for which the drug was not recommended.
About 1,000 patients were taking other medications that could
have interacted with the drug listing the black box warning.
Researchers said that in some cases, physicians intentionally
might have chosen to override a black box warning. They found
that patients who were female and older than 75 and who took
several medications were more likely to be given a drug in
violation of a black box warning. Although the overall number of
patients who received a drug in violation of a black box warning
is relatively small, researchers said that when compared with
the total number of outpatient prescriptions dispensed in the
study, "the absolute number of outpatients at risk is
substantial." Researchers said that one solution to decrease
medical errors would be for the FDA to "make these warnings more
specific so they are more readily understandable by providers"
(Corbett Dooren, Wall Street Journal, 2/14). An abstract of the
study is available online.


6. Former President Clinton Announces New Initiative To Address
Childhood Obesity

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Former President Bill Clinton, along with the Robert Wood
Johnson Foundation, on Monday announced a new campaign that aims
to improve the health of school-aged children by promoting
healthier food and more exercise, the AP/Minneapolis Star
Tribune reports. The initiative is part of the year-old Alliance
for a Healthier Generation campaign, a joint effort by Clinton's
foundation and the American Heart Association. According to the
AP/Star Tribune, obesity rates in children ages six to 19 have
tripled over the past 40 years, which raises their risk of type
2 diabetes and other diseases. The pilot phase of the campaign,
which will begin next fall, will give 285 schools in 13 states
the resources to improve the nutritional value of cafeteria food
and vending machine products, increase physical activity among
students, provide health education and promote staff wellness.
Clinton said, "What we want to do is to create a national
recognition program shining a spotlight on schools that have
done a good job, with concrete, innovative steps to create
healthier learning environments for children and healthier work
environments for staff." RWJF President Risa Lavizzo-Mourey
said, "This is one of those moments when we have a chance to
shape the history of a future generation. The question we have
to ask ourselves is, could these children be the first
generation of Americans who live sicker and die younger than the
previous ones?" (Matthews, AP/ Minneapolis Star Tribune, 2/13).


7. Hawaii Considering New Children's Health Insurance Program

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The Hawaii House Health Committee on Thursday approved a bill
(HB 3116) that would establish a three-year pilot program to
provide no cost health insurance to children in families that do
not qualify for the state's QUEST program and cannot afford
private insurance, the Honolulu Star-Bulletin reports. Under the
proposed Keiki Care Plan, a mutual benefit society would partner
with the program, and the Hawaii Medical Service Association's
children's health plan would be a model for the pilot program.
State Rep. Josh Green (D) said the goal of the program is to
provide health insurance to all of Hawaii's children. The Hawaii
Uninsured Project estimated there are 16,000 uninsured children
in the state. Keiki Care would cover preventive services,
immunizations, physician visits, diagnostic tests, dental
services, mental health benefits and limited prescription drug
coverage. Green said the program originally was expected to cost
the state and a private partner about $4 million, but CMS
earlier this month approved state-proposed expansions of QUEST
and Medicaid programs that would allow about half of Hawaii's
uninsured children to qualify for Medicaid and about 3,000 to
receive coverage under the QUEST expansion. That would leave
about 5,000 children who could be covered under Keiki Care, and
the program would cost about $2 million (Altonn, Honolulu
Star-Bulletin, 2/10).

8. Massachusetts Attorney General Investigates Overbilling of
State Uncompensated Care Pool After Audit Finds Excessive

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The office of Massachusetts Attorney General Thomas Reilly (D)
is investigating excessive billing of the state's Uncompensated
Care Pool by hospitals, the Boston Globe reports. According to
Reilly's office, the investigation is related to an audit by
state Inspector General Gregory Sullivan that found several
hospitals were overbilling the pool. The audit report, which was
made public in November 2004, said overcharges to the pool
result in "tens of millions of dollars a year" in excessive
payments to hospitals. The audit, which did not identify
hospitals, did not allege any illegal activity. According to the
audit, hospital officials said they inflated charges to the pool
to compensate for shortfalls in Medicaid reimbursements. Beth
Stone, a spokesperson for Reilly, said the attorney general's
office is investigating allegations of improper billing of the
pool to determine "whether health care funds are being used
properly and efficiently." The pool is made up of federal
Medicaid funds, $160 million in tax revenue from the state's
hospitals and $160 million in tax revenue from insurance
companies and large employers with their own insurance plans.
According to Sullivan, a major problem with UCP is that there is
no system to scrutinize claims submitted to the pool. The rate
of spending growth in the pool decreased to 3.7% in 2005 from
29% in 2004, when hospitals became required to screen
underinsured patients for Medicaid eligibility and enroll them
in the program, the Globe reports. Gov. Mitt Romney (R) has
proposed eliminating the pool as part of a plan that would
require all state residents to have insurance coverage (Rowland,
Boston Globe, 2/11).


9. FDA Panel Made 'Brave Effort' To Urge Risk Warning on ADHD
Medications, New York Times Editorial States

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An FDA advisory panel's recommendation last week that black box
labels for some attention deficit hyperactivity disorder drugs
should warn about potential cardiovascular risks "is best
understood as a response to an alarming upsurge in use of
stimulants that many have deemed unwarranted," a New York Times
editorial states. The recommendation was a "brave effort" by the
panel "to slow the drug promotion juggernaut that frequently
drives use beyond reasonable bounds," the editorial says.
According to the editorial, some FDA officials and psychiatrists
were concerned the recommendation would "scare people away from
potentially beneficial therapy" if the panel "issue[d] too
strong a warning based on uncertain evidence." However, the
editorial says, "[T]he prime function of a strong warning label
is to force doctors to think twice before prescribing," and
"[t]hat is presumably salutary even if it does depress drug
sales a bit." The editorial concludes, "The renegade advisory
panel was right to throw its weight against this trend" (New
York Times, 2/12).

10. Editorials, Opinion Pieces Address President Bush's Budget

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Several newspapers recently published editorials and opinion
pieces related to the fiscal year 2007 budget proposal that
President Bush announced last week and other Bush health care
proposals. Summaries appear below.


*Akron Beacon Journal: Bush "deserves credit for plunging
(again) into the thorny matter of slowing the rise of
entitlement spending," but "his proposed savings in Medicare
miss the mark, taking aim at hospitals, failing to reconfigure
eligibility based on means," a Beacon Journal editorial states,
adding, "Regarding Medicaid, he would shift costs to the
states." According to the editorial, the "truth is, the nation
won't put its fiscal house in order until it addresses its
largest social spending programs," and the "money necessary to
close the gap doesn't reside in relatively small, worthy and
compassionate programs for the poor. It exists in tax cuts the
country cannot afford" (Akron Beacon Journal, 2/10).

*Atlanta Journal-Constitution: The budget Bush has proposed
"contains no solution to the coming crises in Medicare and
Social Security, when there will not be enough to pay promised
benefits," and includes "no call to reverse the illogical ban on
the federal government negotiating with manufacturers for the
best deal on Medicare drugs," a Journal-Constitution editorial
states. The editorial adds, "Clearly, changes in the structure
and finances of Medicare and Social Security are needed," but
"increases in federal revenue, not simply cuts in social
services, must be part of the process" (Atlanta
Journal-Constitution, 2/12).

*Des Moines Register: A proposal by Bush to expand health
savings accounts would benefit only "those wealthy enough to
pack away the bucks; insurance companies that now have a new
product to sell; and financial institutions positioning
themselves to manage these accounts," a Register editorial
states. The editorial concludes, "HSAs could be a windfall for
investment companies. But what about making health care more
affordable for Americans?" (Des Moines Register, 2/14).

*Lincoln Journal Star: "Unfortunately the prospects for
old-fashioned thrift don't look too bright," a Journal Star
editorial states, adding that the spending reductions for
Medicare and other programs Bush included in his budget proposal
are "all potential congressional minefields." The editorial
concludes, "With congressional elections coming this year,
Washington politicians will be doing their best to gain public
confidence for their fiscal prudence. They have a lot to prove"
(Lincoln Journal Star, 2/13).

*Richmond Times-Dispatch: "[E]ntitlements continue to grow like
kudzu" -- Medicare currently accounts for 14% of the federal
budget, and Medicaid and other health care programs account for
10% -- and, although the "Bush budget makes some minor
adjustments by ... trying to slow the rate of growth in
Medicaid," that "didn't work last year" and "probably won't work
this year," a Times-Dispatch editorial states. The editorial
adds, "Congress lacks the discipline to rein in the entitlements
that everyone recognizes must be curtailed sooner or later.
Congress always prefers later" (Richmond Times-Dispatch, 2/12).

*San Jose Mercury News: "Bush might deserve credit for proposing
cuts -- albeit modest ones -- to entitlement programs such as
Medicare and Social Security, which are the real long-term
budget busters," but such proposed spending reductions should
"be part of an overall reform effort, instead of piecemeal," a
Mercury News editorial states. The editorial adds, "Bush's
earlier attempts to tackle entitlements have fallen flat," and
the "chance of these unpopular cuts passing in an election year
is virtually nil" (San Jose Mercury News, 2/12).

Opinion Pieces

*Adam Searing, Charlotte Observer: Some proposals that Bush has
made to reduce health care costs are "new income tax deductions
for out-of-pocket medical expenses," but many "very low-income
families are paying most of their federal taxes in payroll taxes
for Medicare and Social Security -- not income taxes," Searing,
project director of the Health Access Coalition at the North
Carolina Justice Center, writes in an Observer opinion piece.
"These deductions then mean little or nothing to most uninsured
North Carolinians but will be generous new deductions to people
in upper income brackets who already have health insurance,"
Searing adds (Searing, Charlotte Observer, 2/10).

*David Francis, Christian Science Monitor: "President Bush's new
federal budget has received a much tougher reception than his
earlier ones did," Monitor columnist Francis writes in an
opinion piece. "Both left and right agree that the costs of
Medicare and Medicaid are a major problem," Francis adds
(Francis, Christian Science Monitor, 2/13).

*Richard Bookman/Milica Bookman, Miami Herald: Bush has "offered
some proposals to control costs in the American health care
system by unleashing market forces" under the "basic idea ...
that we can better control costs if American health care dollars
are spent wherever U.S. consumers want to spend them," Richard
Bookman, associate dean at the University of Miami Miller School
of Medicine, and Milica Bookman, professor of economics at St.
Joseph's University, write in a Miami Herald opinion piece.
However, under such a system, U.S. consumers likely would "turn
to high-quality, low-cost global providers," which could "damage
the financial and human foundations of the U.S. health care
system," they add (Bookman/Bookman, Miami Herald, 2/13).

*Jason Furman, New York Daily News: A proposal by Bush to expand
HSAs "threatens the way most Americans get insurance" -- through
their employers -- because the plan "would eliminate the tax
advantages that support the employer-based system," Furman, a
senior fellow at the Center on Budget and Policy Priorities,
writes in a Daily News opinion piece. Furman adds that tax
breaks for individuals included in the proposal "would be worth
10 to 20 times as much to affluent families -- those who least
need help -- as to moderate income families" (Furman, New York
Daily News, 2/12).

*John Goodman, New York Daily News: HSAs "will empower patients
and turn them into true consumers of care" and will "strengthen
the doctor-patient relationship, allowing doctors to become
agents of their patients rather than agents of employers and
insurance companies," Goodman, president of the National Center
for Policy Analysis, writes in a Daily News opinion piece.
According to Goodman, studies "show that with a modest amount of
training, some patients can manage their own health care -- and
achieve results at least as good and at lower cost than
traditional care" (Goodman, New York Daily News, 2/12).

*Arthur Benavie, Raleigh News & Observer: Bush "promised" to
"make inroads into the budget deficit," and his budget proposal
would "cut spending on low-income programs like Medicaid,"
Benavie, an economics professor at the University of North
Carolina at Chapel Hill, writes in a News & Observer opinion
piece. However, "two tax reductions quietly took effect" on Jan.
1 that will "more than offset ... the budget bill," he writes,
adding that future "presidents and Congresses will have to
undertake the dirty work of raising taxes to re-establish our
government's financial soundness" (Benavie, Raleigh News &
Observer, 2/13).

*Froma Harrop, Seattle Times: "Heads up, Americans. The Bush
administration is now greasing the skids for employers to drop
your health coverage. This is a biggie," syndicated columnist
Harrop writes in a Times opinion piece. Harrop writes,
"Demonically, the Bush proposal gives employers new reasons not
to offer traditional health coverage or any medical benefits at
all. Indeed the new health savings accounts could do to the
traditional health plan what the 401(k) plan did to the
traditional pension: Kill it off." Harrop concludes, "Americans
would do well to go Code Red on this new potential threat to
their economic security, or what's left of it" (Harrop, Seattle
Times, 2/12).

*Alan Reynolds, Washington Times: The Bush administration "has
exhibited an unhealthy appetite for bankrolling FARI -- the
False Alarm Research Industry -- which continually fabricates
lucrative scare stories with one chance in a zillion of actually
happening" in health care and other areas, Reynolds, senior
fellow at the Cato Institute, writes in a Times opinion piece.
According to Reynolds, health care "can always be described as
in a state of crisis," a word with "no meaning at all" except
that the health care industry "always use[s] that pitch to beg
for more federal loot" (Reynolds, Washington Times, 2/12).


The Kaiser Daily Health Policy Report is published for
kaisernetwork.org, a website of The Henry J. Kaiser Family
Foundation. (c) 2006 Advisory Board Company and Kaiser Family
Foundation. All rights reserved.

Jill Braden Balderas, managing editor, kaisernetwork.org
Beth Liu, web writer, kaisernetwork.org
Simone Vozzolo, web producer, HealthCast
Francis Ying, web producer, HealthCast
Amanda Wolfe, senior editor, Kaiser Daily Health Policy Report
Evonne Carroll Young, senior web writer, kaisernetwork.org
Shari Lewis, online communications associate, Kaiser Family
Sahar Neyazi, online communications assistant, Kaiser Family
Robin Sidel, communications officer, online activities, Kaiser
Family Foundation
Larry Levitt, editor-in-chief, kaisernetwork.org; vice
president, Kaiser Family Foundation
DAILY REPORTS PHONE: 202-266-6312; FAX: 202-266-5700; E-MAIL:
For questions and further information about kaisernetwork.org:
in-@kaisernetwork.org or 202-347-5270
kaisernetwork.org is a website of the Kaiser Family Foundation.
For access to the Foundation's policy research, analyses,
reports and fact sheets, and media partnerships, visit the
Foundation's main website at http://www.kff.org.
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