Our guest blogger is Lindsay Rosenthal, Special Assistant for Health Policy and Women’s Health and Rights at the Center for American Progress.

In order to combat an impending budgetary crisis related to spending on Medicaid, Oregon will take the lead on implementing a model that the Affordable Care Act has invested in at the Federal level. Yesterday, the Gov. John Kitzhaber (D-OR) and the Obama Administration announced a Federal-State Partnership for a coordinated care initiative that is projected to save $11 billion dollars in Medicaid spending over the next decade. These savings offer reason to celebrate, given the burden rising health care costs have placed on the economy. But perhaps more important than the savings alone is the way that they will be achieved: by investing in increased quality of patient care.

Effectively implementing this reform will require a fundamental shift in the way we pay for care, which Kitzhaber has explicitly proposed to his legislature. A cornerstone of the coordinated care effort is a change in the way that the doctors are paid for their services, away from the current fee-for-service system that incentivizes quantity and towards an integrated payment system that incentivizes quality. The concept is simple: If we want a doctor’s goal to be controlling diabetes, then we should pay her for controlling diabetes, not the number of tests she runs or medications she prescribes. We should pay her to collaborate with her peers and to communicate with her patients to track improvement, not to sign a higher volume of referrals and prescription slips. Read more

The Kansas House is considering HB 2598, a 69-page, extreme anti-abortion bill that would force doctors to warn women that abortions cause breast cancer — even though scientific studies have disputed the claim — define a fetus as a human being, and require women to hear the fetal heartbeat prior to undergoing an abortion. In February, before a House committee approved the bill, a Planned Parenthood of Kansas official described it as “the largest and most sweeping overhaul we’ve seen to date.”

But in a state where the attorney general has already spent more than half a million dollars defending an anti-abortion law that severely limits the availability of insurance coverage for abortions, this bill is just one more harmful restriction on abortion services that state lawmakers have added:

– EXPANDED ‘CONSCIENCE MEASURE: Earlier this week, the state Senate aproved a bill that offers additional legal protection to Kansas health care providers who refuse to participate in abortions. The House had already approved the measure, and it is likely that Gov. Sam Brownback (R) will sign it. But critics of the bill worry the “conscience” measure goes too far, and that it would allow pharmacists to refuse to dispense birth control “allow a doctor to refuse to provide chemotherapy to a pregnant cancer patient because it might end her pregnancy,” according to the Associated Press.

– PREVENTING LICENSES FOR PROVIDERS: Last year, the legislature approved licensing regulations that specifically targeted the state’s three abortion providers, potentially making Kansas the first state where a woman could not access abortion services. But when a judge temporarily blocked the regulations from going into effect, Brownback’s administration planned to enact the exact same regulations to skirt around the court’s ruling.

– DEFUNDING PLANNED PARENTHOOD: Lawmakers signed off on a law last year to ban Planned Parenthood clinics in Kansas from receiving federal funds, endangering health care for at least 5,700 patients. A judge blocked the law from going into effect, but the state has spent hundreds of thousands continuing to defend the law.

And each of these overreaching regulations are in addition to other measures, like preventing abortions after 20 weeks and requiring women to wait 24 hours before an abortion procedure. By limiting women’s access to abortion services — and potentially other forms of care — Kansas is is denying women choice and undermining their health.

Obesity is a growing health concern in the United States. A projection earlier this year estimated that 75 percent of Americans will be overweight or obese by 2020, higher than any other country surveyed. That, in turn, is expected to grow health care costs considerably.

Now, experts are warning that those kinds of preventable health conditions could make the current generation the first to live shorter lives than their parents. At a conference in Atlanta yesterday, health professionals talked about health problems like obesity, why they are becoming more prevalent, and what needs to be done to encourage Americans to live healthier lives:

Tyler Norris, a senior adviser on Total Health at Kaiser Permanente, cited the life expectancy warning as he spoke to an Atlanta audience about the burden of obesity and diabetes. [...] Of course, it’s partly what Americans eat. Many people consume too many ‘’cheap, empty calories,’’ [Kaiser Permanente health advisor Tyler] Norris told the Connections conference, sponsored by Healthcare Georgia Foundation. Lack of exercise and the increase in sedentary jobs are other major factors contributing to obesity.

Norris presented several ideas to reduce to the problem, including providing more biking and walking routes; promoting breastfeeding; and serving better food in school cafeterias.

In one case, another expert noted, two communities in New Orleans had dramatically different life expectancies, with one at 55 and another at 80. According to Brian Smedley, director of the Health Policy Institute of the Joint Center for Political and Economic Studies, much of the difference can be attributed to things like “food deserts,” or areas with many fast-food restaurants and few nutritious options, and a lack of parks or recreational facilities.

Unfortunately, Republicans in Congress have publicly rejected the idea that prevention programs, which have already started to help communities get healthier using those same actions, are worth funding, despite the fact that many of their constituents have a lot to gain from them.

-Zachary Bernstein

Mitt Romney’s proposal to transform Medicaid into a block grant program could reduce access to health care for lower income Americans and jeopardize the health care reform he signed into law as governor of Massachusetts, the Boston Globe reports. “As governor, Romney worked closely with the late Democratic Senator Edward M. Kennedy to secure hundreds of millions per year in federal aid to realize their shared goal of access to health care for all. Expanding Medicaid coverage – and the flow of federal money that came with it – was a key underpinning of the state’s 2006 law”:

“It would have been impossible for Massachusetts to do what it did without increased federal Medicaid support,’’ said John McDonough, a major architect of the state’s health care overhaul law and now director of Harvard University’s Center for Public Health Leadership.

“What he’s proposing is in direct opposition to what he did as governor,’’ said Amy Whitcomb Slemmer, executive director of Health Care for All in Massachusetts, citing the Bay State’s 98 percent coverage rate, the highest in the nation. “That kind of expansion would not have been possible under a block grant program,’’ as Romney has proposed.

Indeed, Romney funded his 2006 health care expansion by re-appropriating state funds and relying on additional federal Medicaid funding he secured from the Bush administration. As Romney himself explained to Bill O’Reilly in April of 2010, “[F]rom the beginning the plan was a 50/50 deal between the federal government and the state government. The Feds fund half of it, they have from the very beginning.” The Boston Globe notes that “approximately 56 percent of the gain in coverage was related to increased federal Medicaid support” in Massachusetts, and of the newly insured, “18 percent gained coverage through Medicaid, and another 38 percent gained coverage through Commonwealth Care, a program that federal Medicaid dollars pay half of.”

As a presidential candidate, however, the former governor has argued that he could lower federal spending on Medicaid by transferring control of the program to the states and transforming the current matching-rate funding structure into block grants that would pay states pre-determined funding amounts. The “blocks” would not increase with health costs or automatically rise during economic downturns.

According to a Congressional Budget Office (CBO) analysis of Rep. Paul Ryan’s (R-WI) Medicaid block grant proposal — which is very similar to Romney’s — federal expenditures on the program would be “49 percent lower in 2030 than current projected federal spending.” “[T]he magnitude of the reduction in spending relative to such spending in the other scenarios means that states would need to increase their spending on these programs, make considerable cutbacks in them, or both,” the Office concluded. “Cutbacks might involve reduced eligibility for Medicaid and CHIP, coverage of fewer services, lower payments to providers, or increased costsharing by beneficiaries—all of which would reduce access to care.”