PR Newswire -

Sept. 23: San Francisco - As part of its ongoing commitment to providing high quality affordable health care, Blue Shield of California announced today that it is awarding $29.5 million in performance bonuses to medical groups and IPA’s in California.

Nearly half of the payments are part of the Integrated Healthcare Association (IHA) pay-for-performance program, which rewards providers for the quality of their health care services, including clinical care, patient experience and use of information technology.

This year, in accordance with IHA criteria, Blue Shield will pay medical groups and IPA’s based on attainment and improvement for clinical and patient experience measures, with 80% of the payout related to performance and 20% to improvement.

Blue Shield uses the IHA standards to track and reward physician organization performance on a range of clinical factors, including childhood immunizations, diabetes management, cholesterol management, and use of appropriate medications by those with asthma. This year, Blue Shield is also helping medical groups that ranked in the bottom 25th percentile of the IHA pay-for-performance program to identify steps to improve their clinical scores.

“Paying for performance leads to better quality health care,” said David Joyner, Blue Shield’s senior vice president, network management. “We are committed to encouraging best practices by paying physicians more for following proven medical guidelines.”

Since the launch of the pay-for-performance programs in 2003, the most notable clinical impacts for Blue Shield members have been in the areas of breast cancer screening, cervical cancer screening, Chlamydia screening and control of HbA1c levels for patients with diabetes.
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Knight Ridder Washington Bureau -

Sept. 25: Washington - Premiums for job-based health insurance are up 5 percent in 2008 and have more than doubled since 1999, a growth rate that far outpaces inflation and the increase in workers’ wages over the same period, according to an annual survey of employers.

Meanwhile, a growing number of workers at smaller firms are getting less coverage for their money as health plans with high deductibles and fewer benefits become more prevalent.

The portion of workers with single coverage who pay a deductible of at least $1,000 has jumped from 10 percent to 18 percent in the past two years. Among smaller firms with three to 199 employees, the rate has more than doubled from 16 percent to 35 percent.

“We may be seeing the tip of the iceberg of a trend towards less comprehensive, skimpier insurance with higher out-of-pocket payments for working people,” said Drew Altman, president and CEO of the Kaiser Family Foundation. “That’s bad news at a time when workers are being by hit other economic pressures from declining 401(k)s to higher food and gas prices and problems paying the rent and mortgage.”

On average, workers now pay $3,354 about 27 percent toward the $12,680 annual cost for family coverage, according to the survey of 1,927 public and private companies by the Kaiser foundation and the Health Research and Educational Trust.

Workers with single coverage pay about $721 a year, or about 16 percent of the $4,704 annual cost of their coverage. Both rates are up about 5 percent from 2007, which is the slowest annual growth rate since the survey began in 1999.

However, soaring health-care costs continue to hurt both employers and workers. The overall cost of family coverage has increased 119 percent since 1999; that’s roughly four times faster than the rate of inflation 29 percent over the same period. It’s more than three times faster than workers’ earnings, which have increased 34 percent in the last nine years.

About 158 million people are covered by employer-sponsored health plans. Most large companies with more than 200 workers provide health coverage and 62 percent of smaller firms do.

IM Construction, a Sacramento, Calif., homebuilder with 135 employees, is typical of smaller companies that are cutting their health insurance costs by switching to consumer-directed plans with high deductibles.

The company provided health coverage for each employee plus one additional person. But two years ago, they began covering only the employee, said company controller, Jason de Lemos.

The company also switched their coverage from a Health Maintenance Organization to cheaper, high-deductible Health Reimbursement Accounts. In HRAs, employers provide money to help employees pay medical expenses. Once the money has expired, the employee picks up the additional charges.

IM pays employees’ $2,000 HRA deductible, and workers pay $15 a month toward the premium a cost-cutting move implemented last year. The changes have helped cut their health costs, both in terms of premiums and utilization, de Lemos said.

“The idea was to increase the level of cost-sharing, so that people only go to the doctor when they need to. In doing that, we were able to reduce our rates considerably, especially since we haven’t seen a rate decrease in eight years,” de Lemos said.

No coverage changes are planned for next year, but with the housing industry in the worst decline since the Great Depression, de Lemos said he’s glad the coverage changes were made two years ago.

“Because if we were doing it right now, it would be even harder on everybody because the industry we’re in is just having a hard time,” he said.

Other key findings from the survey include:

–31 percent of large companies with 200 or more employees provide retiree health benefits, down from 66 percent in 1988.

–14 percent of firms are “very likely” to raise employee premiums next year and 12 percent are “very likely” to raise deductibles.

–58 percent of covered workers are in Preferred Provider Organizations, 20 percent are in HMOs, 12 percent are in point-of-service plans, 8 percent are in consumer-directed plans and 2 percent are in conventional indemnity plans.
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The Philadelphia Inquirer -

Sept. 28: Barack Obama and John McCain present voters with starkly different visions of how to change the nation’s troubled health-care system. Obama wants more people to have health insurance. He would require insurance for children, create new options for uninsured adults, and reduce price discrimination against people with health problems.

McCain wants to make insurance more affordable. He would weaken incentives for employer-sponsored insurance the value of benefits would be taxed as income while giving people tax credits to help them buy insurance on their own.

But don’t expect the election to hinge on health care, political and health-care experts said last week. The Wall Street debacle has grabbed the spotlight for the foreseeable future. More important, it’s grabbing billions of dollars, and that likely will constrain reform efforts by either candidate once the election is over.

“The top three issues in the election are the economy, the economy and the economy,” said David L. Cohen, a Comcast executive who chairs the board that governs the University of Pennsylvania Health System and who was a top aide to Gov. Rendell when he was Philadelphia’s mayor.

“I think everything is past tense now,” said Joseph Antos, a health-policy expert with the American Enterprise Institute who has critiqued Obama’s proposal. “I don’t think any of this is going to happen.”

Nonetheless, Jay Khosla, a McCain health-policy adviser, said last week that “health-care reform is going to be a very important priority for McCain.”

Obama, whose campaign did not respond to a request for information last week, said he might have to delay some domestic initiatives. Cohen said he believed health care would continue to resonate with voters. “There’s nothing that scares people more,” he said, “than losing their health insurance.”

And everyone agrees the problems are not going away. Forty-six million people in this country lack insurance, and costs are rising for the people who have it. The Henry J. Kaiser Family Foundation said last week that the average family plan now costs $12,680, up 5 percent from last year.

In Quinnipiac University polling earlier this month in four battleground states, 7 percent to 11 percent of voters listed health as the single most important issue in the election. (More than half chose the economy.) “As you get closer to the election, the economy and national security always become the issue,” said Peter Brown, assistant director of Quinnipiac’s polling institute. “That’s just the way it is.”

Political challenges aside, the plans reveal important differences in philosophy. Obama would expand government coverage by creating a Medicare-like option that younger people could join. He also would make it easier for individuals and small employers to buy insurance through bigger groups. All children would have insurance. He would require greater oversight of insurers, prohibiting them from charging more to people who have health problems. He also would make employers above a certain size provide health insurance or pay an unspecified tax. His campaign estimates the cost of his plan at up to $65 billion a year.

McCain takes a more market-centered approach. He would do away with the tax advantage of having employer-sponsored insurance, substituting tax credits of up to $2,500 for individuals and $5,000 for family plans. The subsidies would make it easier for people to afford buying their own private insurance, which would allow them to keep coverage when they change jobs. Policies could be sold across state lines. There would be no effort to prohibit discrimination against people with a history of illness, so young, healthy people likely would pay less. McCain has a subsidized option for the sick people private insurers don’t want. He does not put a price tag on his plan.

Both senators say they’ll save money by encouraging greater use of information technology and better management of care, savings that health experts say are likely to be lower than the campaigns estimate.
Health experts say cost likely will be Obama’s biggest obstacle, especially in light of the Wall Street mess.

Antos says small businesses in particular might choose to pay Obama’s tax rather than buy insurance for employees. The extra cost could lead to lower wages or fewer jobs. And, he said, the plan calls for generous health benefits, which could drive up overall costs.

The Urban Institute, which analyzed both plans, said Obama’s would cover about two-thirds of the uninsured, while McCain’s would have little effect.

Critics of the McCain approach say it would weaken employer-sponsored insurance without giving low-paid people enough money to buy health plans on their own. Thomas Buchmueller, a health economist at the University of Michigan, estimates that 20 million people would lose work-provided insurance, a number the McCain plan disputes. McCain would not require employers who drop coverage to give workers higher pay instead, though economists think competition for employees would keep pay up.

The size of McCain’s tax credit is indexed to overall inflation, not the price of health care, which has been rising faster. McCain’s plan would throw workers, who benefit now from their employers’ ability to negotiate lower group rates, into the more costly individual health market.
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PR Newswire -

Sept. 29: Washington - With states confronting a weakening economy, enrollment in Medicaid began to rise last year with states expecting even larger increases for fiscal year 2009, according to a new 50-state survey released today by the Kaiser Family Foundation’s Kaiser Commission on Medicaid and the Uninsured (KCMU). With the increased enrollment, Medicaid spending is also rising more rapidly than in the recent past, raising the potential for program cutbacks as states confront the combined impact of more enrollees and fewer available resources.

The survey finds that Medicaid enrollment across the country grew 2.1 percent in fiscal year 2008, more than erasing a slight decline in enrollment experienced the previous year. States also experienced spending growth of 5.3 percent, up significantly from the previous two years. For fiscal year 2009, states expect to see even larger increases in Medicaid enrollment (3.5 percent) and spending (5.8 percent).

The survey comes as states face serious financial constraints, with 30 states having confronted significant budget shortfalls as they prepared their fiscal year 2009 budgets. Looking ahead, two thirds of state Medicaid directors say that there is at least a 50-50 chance that they will face a shortfall in their Medicaid budgets during the current year. Such shortfalls could force mid-year changes to control costs, potentially including cuts in eligibility and outreach efforts.

“We’re just beginning to see the impact of the economic slowdown, as growing Medicaid enrollment and shrinking revenues pose new threats for health coverage,” said Diane Rowland, executive vice president of the Kaiser Family Foundation and Executive Director of KCMU.

Medicaid directors attributed the growth in enrollment and spending to the weakened economic outlook facing their states. During economic downturn, as unemployment rises people may lose employer-based coverage and incomes decline, making them potentially eligible for a state’s Medicaid program. Ongoing state efforts to address the uninsured such as expanding Medicaid eligibility, improving outreach and simplifying enrollment procedures also played a role in the growth.

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Dept of Insurance -

Sept. 29: Sacramento - Insurance Commissioner Steve Poizner today issued the following statement regarding Governor Arnold Schwarzenegger’s signing of Senate Bill (SB) 1145 (Machado, D-Linden) and Assembly Bill (AB) 1874 (Coto, D-San Jose), which help reform the State Compensation Insurance Fund (SCIF), one of the largest workers’ compensation insurance companies in the country and California’s workers’ compensation insurer of last resort,.

“California’s employers and employees both depend on a healthy workers’ compensation insurance marketplace, and reforming SCIF is key to helping maintain that competitive marketplace,” said Commissioner Poizner. “SCIF was cooperative during this process and has been diligently working with CDI to address a number of concerns as we help them restructure for the 21st century.”

After working with SCIF on this legislation, the California Department of Insurance (CDI) urged the Governor to sign SB 1145 and AB 1874. Copies of the letters are attached.

CDI has been heavily involved in improving the performance of SCIF, including a top-down review of the institution. These bills are part of that larger effort.

SB 1145 would facilitate the transformation of SCIF into a modern operation with the executive talent necessary to run such an establishment. SB 1145 reforms SCIF by allowing the appointment of additional executive staff to provide expertise needed for its effective, efficient management. The bill also subjects SCIF board meetings to the Bagley-Keene Open Meeting Act and the California Public Records Act, recognizing it as a public enterprise.

AB 1874 introduces significant changes to SCIF’s board of directors, which is still structured as it was when it was established 70 years ago. AB 1874 increases the number of board members, commensurate with similar-sized organizations, to allow for appropriate governance. It also requires reasonable qualifications for board members and provides for remuneration consistent with those qualifications and time commitment to the organization.

The bill brings greater accountability to the SCIF board by establishing training requirements for board members, and requiring board members to take active governing roles or be subject to replacement. Finally, AB 1874 creates conflict of interest requirements for board members.

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Los Angeles Times -

Sept. 29: Sacramento - Garrett Warren, 14, needs braces to fix the gaps in his teeth caused by a severe cleft lip and palate that have already required seven operations. But his family’s insurance plan won’t pay for them, though Warren’s doctors say the braces are necessary before they can begin a final round of surgeries.

“It’s so important for his whole treatment,” said his mother, Becky. “Just because you hear the word braces or teeth doesn’t mean it’s dental.”

As insurers try to limit their payouts and new treatments become available, patients are finding more gaps in what their medical policies will cover. As he considers 10 bills passed by the Legislature that would expand what insurers are required to pay for, Gov. Arnold Schwarzenegger must balance improved medical coverage for those who have it with the risk of driving costs so high that people can’t afford it.

The new health coverage requirements include maternity services; tests for the HPV virus, which can cause cervical cancer; and treatment for most mental health and substance abuse problems. The broadest would enhance existing medical coverage for 18 million Californians. The narrowest would help a few hundred patients.

For example, about 300 people a year would benefit from the proposal that insurers cover orthodontia needed for cleft palate patients, increasing monthly premiums by a third of a cent.

But together, the new mandates would increase premiums by $383 million a year, or 0.5% of the $74 billion employers and individuals now pay to insurers each year, according to the California Health Benefits Review Program, a University of California office that analyzes such proposals for the Legislature. The premium increases affecting maternity and mental health mandates alone would prompt 3,200 people to drop their coverage, UC experts estimate.

Other proposals would require insurers to pay for screening for HIV in people without symptoms and for the cost of special formulas and foods for people whose digestive tracts can’t absorb nutrients because of a rare genetic disorder. Two bills would compel insurers to offer the option of purchasing extra coverage for hearing aids for children and durable medical equipment such as wheelchairs.

Another bill would bar insurers from refusing to pay for the treatment of people who sustained injuries because they were impaired by drugs or alcohol. And one measure, to cover acupuncture, was vetoed by the governor last month.

Daniel Zingale, Schwarzenegger’s senior advisor on healthcare, said the governor is looking at the bills warily after the Legislature rejected his proposals for overhauling the state’s healthcare system, including Schwarzenegger’s ideas for keeping costs down.

“There were hopes we would have a comprehensive package of prevention and cost-containment measures,” Zingale said. California already requires insurers to offer 44 benefits, more than most other states. They include various types of cancer screening and diagnosis and care for chronic diseases, including osteoporosis.

Not every policy has to include all 44. Although managed care plans are required to cover all medically necessary procedures, pared-down insurance plans that offer only catastrophic coverage to young, healthy adults have been proliferating in recent years.

Maternity coverage, for instance, has dwindled since 2004, when Schwarzenegger vetoed legislation to require that it be included in plans sold directly to consumers (group plans are compelled to offer it). In his veto message, Schwarzenegger cited its wide availability in that market.

But today only 26% of people with individual, rather than group, policies are covered for prenatal care and delivery. About 147,000 women of child-bearing age have insurance that lacks it.

Taxpayers sometimes have to pick up the costs for treatment that insurers refuse to pay for. The state has public healthcare programs for low- and moderate-income pregnant women and for children with serious health conditions whose family’s income is less than $40,000.

“If health insurance doesn’t cover this, then the taxpayers end up paying for it,” said Beth Capell, a lobbyist for Health Access California, a nonprofit consumer group.

But adding maternity coverage to all policies that lack it would lead to premium increases of between 1% and 13%, depending on the age of the consumer, according to a UC report. It estimated that increased premiums would cause about 2,300 people primarily people in their 20s to drop their coverage and join California’s 5 million uninsured.

In addition, the UC experts predicted that even if maternity coverage were required of all insurers, some women eligible for state pregnancy care would opt for it to avoid the deductibles and co-pays of private plans.

Medical providers say insurers can afford to absorb some of the costs of expanded coverage, given their large profits. But “the insurers oppose anything that costs money,” said Dr. William Hoffman, chief of plastic surgery at UC San Francisco Medical Center and an early proponent of the bill to require coverage of cleft palate correction.

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San Francisco Chronicle -

Sept. 29: Facing a Tuesday night deadline, Gov. Arnold Schwarzenegger continued to work his way through a stack of legislation on his desk Sunday, vetoing twice as many measures as he signed.

The governor vetoed 131 bills Sunday, bringing his total for 2008 to 278.

With 341 bills remaining to be dealt with, Schwarzenegger has a good chance of surpassing the 311 vetoes he handed out in 2004.

The governor is putting much of the blame for his nay-saying on the Legislature’s nearly three-month delay in getting a budget passed.

Schwarzenegger signed only a single bill during that time and put the heat on the lawmakers by threatening to veto every bill passed by the Legislature.

But since he approved the state budget on Sept. 23, the governor has been forced to scramble to clear up the logjam of bills, because any he doesn’t veto by Tuesday will automatically become law without his signature.

The looming deadline has forced Schwarzenegger to use boilerplate veto language on dozens of the rejected bills, with the governor saying only that given the historic delay in passing this year’s budget, “I am only signing bills that are the highest priority for California. This bill does not meet that standard.”

A half-dozen bills the governor vetoed Sunday would have added a variety of new subjects to the state Board of Education’s academic content standards. 

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Business Wire -

Sept. 30: Orange, Ca – CHOICE Administrators®, a division of The Word & Brown Companies, today announced the launch of HSA California – a new program that offers employers with 2-50 employees a way to minimize insurance costs and offer staff excellent medical benefits, federal tax-advantaged opportunities to pay for qualified medical expenses, and the ability to save on a federal tax-free basis for the future.

“HSAs are becoming more and more popular for employers and employees looking for ways to reduce insurance costs,” said Ron Goldstein, president of CHOICE Administrators. “HSA California is unique in the marketplace because it allows employers to offer HSA-compatible benefits through two health plans Health Net and Kaiser Permanente and pay only one monthly insurance premium.”

Health Savings Accounts (HSA) were established by the federal government in 2004 to give employers and individuals a way to lower health insurance premiums and save for future health care expenses – tax-free. HSAs allow people to contribute pre-tax money to special interest-earning or investment accounts if they are enrolled in a high-deductible health insurance plan.

These HSA funds can be used to pay for qualified out-of-pocket medical expenses such as medications, doctor visits, hospital stays, eyeglasses, and even weight-loss programs.

HSAs are great savings tools because contributed funds rollover year after year, unlike Flexible Spending Accounts (FSA). After age 65, funds can even be used to pay for non-medical expenses and are taxed at an individual’s regular income tax rate. With HSA California, employers and employees enjoy these benefits and more.

Employers pay only one monthly bill for all services and can apply the money they save on insurance premiums to employees’ HSA accounts. They even receive free access to online human resources support.

Employees benefit from HSA California because they can choose from Health Net and Kaiser Permanente health plans at different deductible levels and purchase dental, vision, life, and section 125 benefit plans. They receive prescription discounts, participation in a free hearing program, and access to wellness360™ – an online health and wellness tool that financially rewards people for utilizing the site.

Employers and employees can also create self-managed HSA accounts through Bancorp Financial Center, making it easy for participants to set-up, fund, and manage everything online.

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San Jose Mercury News -

Sept. 27: Sacramento - Gov. Arnold Schwarzenegger spent more than a year pursuing a radical overhaul of a health care system that leaves millions uninsured and virtually everyone else struggling with ever-growing costs for skimpier coverage.

Today, sweeping health care reform appears all but dead in California. But the state is considering changes to the system that would provide real relief, though only to a small portion of the population.

Bills passed by the Legislature this session and awaiting the governor’s signature or veto take aim at what critics call some of the most egregious, but still relatively rare, practices in the health care system: insurers that cancel a patients’ coverage after they get sick, hospitals and doctors that stick patients with huge bills while they’re haggling with insurers for payment and insurance companies that use customer premiums to pad profit margins instead of to pay for medical care.

Other bills would mandate that all insurance plans cover maternity care and all diagnosable mental illnesses, and boost fines on hospitals and other providers for medical errors. Schwarzenegger has until Tuesday to decide the measures’ fates.

Few expect a renewed push for sweeping health care reform in California soon, even though if anything the problem has grown worse. The state’s fiscal woes threaten to remove hundreds of thousands of children from a state health insurance program and lower reimbursements to doctors who treat the poor.

Still, the next big push for reform is more likely to come in Washington, after the next president takes office. “People are going to be looking to the new administration and Congress to see what they’re going to do,” said E. Richard Brown, director of the UCLA Center for Health Policy Research. “If it doesn’t happen there, the focus might shift back to California.

“This is a big come down from ‘Let’s fix the health care system’ to ‘Let’s fix a handful of problems caused by the health care system,’”‰” Brown added.

One problem that’s received heavy media attention and delivered a black eye to the insurance industry is known in health care speak as “rescissions.’

The practice occurs when an insurer retroactively cancels a patient’s policy after the person becomes ill and files claims. Insurers say the practice is often justified in cases when a patient lied on his or her insurance application, for example, by not disclosing a pre-existing condition. But many unjustified cases have also come to light.

An estimated 4,000 to 6,000 health care rescissions have occurred in California in recent years. Schwarzenegger highlighted one case in his annual State of the State address this year. He spoke of a 51-year-old San Diego man named Todd who bought an insurance policy on his own, and later developed lymphoma, a form of cancer.

Soon after he was diagnosed, the governor said, the man’s insurance company canceled his coverage. Schwarzenegger said the firm cited a reason unrelated to his illness: that he failed to disclose a prior knee injury on his insurance application. Months later, the man died.

“We are taking action so what happened to Todd will not happen to any other Californian,” Schwarzenegger said in his January speech. But it’s unclear whether the governor will embrace the bill, AB 1945, designed to fix the problem. The measure, sponsored by Assemblyman Hector De La Torre, D-South Gate, says that a policy could be rescinded only if a patient intentionally misrepresented or omitted information on an insurance application. An independent board would have to approve any attempts to rescind coverage.

The proposal has widespread backing among pro-consumer groups that believe the insurance industry has invited such oversight with its own misdeeds. But insurance firms says the bill would force them to prove that someone intentionally lied before they could drop coverage an impossibly high standard in their view.

Another measure takes aim at what critics call the “excessive profits’ of insurers. The bill, SB 1440 by Sen. Sheila Kuehl, D-Santa Monica, would require that insurance companies spend 85 percent of revenues from patient premiums on medical care, as opposed to administrative costs and profits. The proposal would also force insurers to disclose, on a plan by plan basis, the percentage of premium dollars going toward health care.

Schwarzenegger included a similar initiative in his health care proposal last year, saying it would boost accountability and rein in costs. But he also emphasized that the proposal was part of a comprehensive reform package, so it remains to be seen whether he will back the idea on its own.

One other high-profile bill is an attempt to prevent situations in which patients get trapped in the middle of billing disputes between health care providers and insurers after, say, a visit to an hospital emergency room that’s not part of the person’s insurance network. The bill, SB 981 by Senate President Pro Tem Don Perata, D-Oakland, would ban a practice called “balance billing” when an emergency room physician seeking payment from an insurer bills the patient in the meantime.

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Kaiser Daily Health Policy Report -

Sept. 15: Advocates of reauthorizing and expanding SCHIP “are warily training their eyes on next year with a mix of anticipation and anxiety” as it seems unlikely that there will be another vote on the legislation during the current congressional session, CongressDaily reports (Edney, CongressDaily, 9/15). Congressional Democrats recently said they will not hold a vote on SCHIP legislation this year, citing an inability to override a promised veto by President Bush (Kaiser Daily Health Policy Report, 9/8). In January, the House fell 15 votes short of overriding Bush’s veto of SCHIP legislation, CongressDaily reports.

Ron Pollack, president of Families USA, said the group has urged Democratic leaders to avoid scheduling an SCHIP vote if there is not enough time also to schedule a veto override.

According to a GOP aide, “Republican staff still anticipates a politically driven SCHIP vote in the next few weeks.” While discussions of an SCHIP vote came about after Republicans joined with Democrats to override Bush’s veto of Medicare legislation, Democrats do not expect a similar situation with SCHIP, CongressDaily reports.

“Whether SCHIP’s time comes sooner or later,” one of the measures advocates are expected to support is a provision that would eliminate a five-year ban on documented immigrant children enrolling in the program, CongressDaily reports. The House had included such a measure in its SCHIP bill, but lawmakers thought the issue was too controversial to include in compromise legislation.

Comments

First Focus President Bruce Lesley said, “This is really unfinished business of this Congress,” adding, “We should just get SCHIP done and then really focus on national health reform.” Other advocates said that SCHIP should be separate from overall health system changes, CongressDaily reports.

Edwin Park, a senior fellow on health policy at the Center on Budget and Policy Priorities, said that with the future of SCHIP uncertain after funding expires in March 2009, some states “may decide to forgo expansion and even more modest changes like making enrollment easier” when planning their budgets (CongressDaily, 9/15).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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