Daily Health Policy Report

Monday, October 1, 2012

Last updated: Mon, Oct 1

KHN Original Reporting & Guest Opinion

Campaign 2012

Health Reform

Medicare

Capitol Hill Watch

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

States Moving Ahead On Defining 'Essential' Health Insurance Benefits Under Federal Law

Kaiser Health News staff writer Phil Galewitz reports: "California and Washington state will require coverage of acupuncture. Arkansas wants prevention counseling for women at high risk of breast cancer but not coverage of expensive infertility treatment" (Galewitz, 9/30). Read the story.

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Eyes Turn To Arkansas' Bold Effort To Cut Medicaid Costs, Add Transparency

Kaiser Health News staff writer Shefali S. Kulkarni reports: "On Monday, Arkansas will kick off a program to reduce its Medicaid costs and improve care through a partnership with its largest private insurance companies -- Arkansas Blue Cross Blue Shield and QualChoice. If successful, experts say the state's Medicaid program could save about $4.4 million in FY 2013 and $9.3 million in 2014" (Kulkarni, 9/30). Read the story.

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Capsules: Medicare's Pay For Performance Effort Begins, Targeting Quality And Readmissions

Now on Kaiser Health News' blog, Jordan Rau writes: "Monday is the start of the federal fiscal year, and with it begins Medicare's biggest effort yet at paying for performance. Starting Oct. 1, Medicare is withholding 1 percent of its regular hospital reimbursements in the new Value-Based Purchasing Program, which was created by the 2010 health care law" (Rau, 10/1). Check out what else is on the blog.

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Political Cartoon: 'Patriotism?'

Kaiser Health News provides a fresh take on health policy developments with "Patriotism?" by Harley Schwadron.

Meanwhile, here's today's health policy haiku:  

THE BIGGEST EFFORT YET TO PAY FOR PERFORMANCE

Pay for performance?
That's Medicare's latest thing.
Will it do the trick?
-Anonymous 

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Campaign 2012

Campaign Issues And Answers: Health Coverage, Costs, Quality

Policy positions related to the future of the nation's health system have taken on significance for presidential candidates, as have issues related to women's health, entitlement spending and deficit reduction.

The Associated Press: Why It Matters: Issues At Stake In Election
America's health care system is unsustainable. It's not one problem, but three: cost, quality and coverage.
The U.S. has world-class hospitals and doctors. But it spends far more than other advanced countries and people aren't much healthier. And in an aging society, there's no reliable system for long-term care (Alonso-Zaldivar, 9/29).

The Associated Press/Washington Post: Why It Matters: Fight Over Birth Control And Abortion Rages On National And State Levels
The issue: Whether women have access to abortion services and birth control is a longstanding and divisive issue in politics, and it has flared up from time to time in this campaign despite the candidates' reticence to dwell on such hot-button topics (10/1).

Politico: Big 'Romneycare' Secret: It Didn't Rein In Costs
It's one of the greatest stories never told. An ambitious Republican governor passes a revolutionary health reform plan that promises health insurance coverage for everyone but fails to reduce health costs or the growing reliance on the state's overburdened hospitals — and depends heavily on the financial support of the federal government (Haberkorn and Cheney, 9/30).

The Associated Press: Analysis: Candidates' Deficit Plans Don't Add Up
Here's the rap on the presidential candidates' plans for cutting federal deficits: Mitt Romney's is too bold and the numbers don't add up, while President Barack Obama's is too timid and his numbers don't add up, either. ... The Republican nominee promises to balance the budget in eight years to 10 years, but he also offers a mix of budgetary contradictions. ... Obama claims more than $4 trillion in deficit savings over the coming decade. But it you peel away accounting tricks and debatable claims on spending cuts, it's more like $1.1 trillion. Republicans say it's even less because of creative bookkeeping used to mask spending on Medicare reimbursements to doctors (Taylor, 10/1).

Meanwhile, The Washington Post offers some suggested questions for this week's debate -

The Washington Post: Some Debate Questions For Obama And Romney To Lob At Each Other
All too often, neither (President Barack Obama nor GOP nominee Mitt Romney) has been directly challenged about his misleading statements. So here are some questions we would like to see. ... Obama to Romney: You keep saying that health-insurance premiums have gone up by $2,500, as if "Obamacare" had anything to do with it. You know that most provisions of that law have not gone into effect yet, so experts say only a small portion of the increase is due to the law. ... Romney to Obama: You keep claiming that health-care premiums will go down for people in the individual and small-group markets. But isn't it correct that, because of a variety of provisions in the law, premiums are going to go up for young Americans and healthier individuals? (Kessler, 9/30).

CNN: Romney Mail Piece Takes Aim At 'Obamacare'
A new mailer from the Romney campaign portrays "Obamacare" in a particularly harsh light, claiming that President Barack Obama’s health care law would send jobs overseas and force millions off Americans off their existing coverage. The mail piece, which landed in Virginia mailboxes late last week, says Republican nominee Mitt Romney would "take immediate steps to repeal and replace Obamacare" on the first day of his presidency (Hamby, 10/1).

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Missouri, Wisconsin Senate Races Grab Headlines

News outlets report on the Missouri Senate race pitting Democratic Sen. Claire McCaskill against GOP challenger Todd Akin and the Wisconsin contest between Democratic Rep. Tammy Baldwin and former Gov. Tommy Thompson. In both cases, themes of the health law are playing an important role. 

Los Angeles Times: Stalwart Missouri Conservatives Stick With Todd Akin For Senate
This land of Harry Truman has an increasingly Republican tilt. ... The race remains a challenge for (Democratic Sen. Claire) McCaskill, whose unfavorable ratings could still pose political problems. McCaskill was an early supporter of Obama's first campaign for president, but the nation's new healthcare law, his top domestic achievement, was overwhelmingly rejected by voters in a statewide referendum. (GOP challenger Todd) Akin is running a TV ad showing McCaskill in Obama's embrace (Mascaro, 9/30).

Politico (Video): Akin Speaks About Old Arrest Abortion Clinic
Missouri Senate candidate Todd Akin disclosed Friday that he was arrested more than two decades ago at an anti-abortion protest. His remarks came after Right Wing Watch, an arm of the liberal People for the American Way, circulated a video in which Akin is talking to a group of people about the arrest. The video was captured in 2011, the organization claimed (Kim, 9/28).

Roll Call: Health Care Takes Center Stage In Wisconsin Senate Debate
The Democrats' signature health care law helped cost three-term Wisconsin incumbent Russ Feingold his seat in 2010. Rep. Tammy Baldwin (D) made clear tonight that she thinks her support of the law will help her secure victory over former Gov. Tommy Thompson (R). The debate between the two candidates revealed what campaign spots in recent days had already been hinting at: There is likely no statewide race in the country where health care is playing a more crucial role in candidates distinguishing themselves for voters (Shiner, 9/28).

Milwaukee Journal Sentinel: Senate Race Focus Turns To Health Care
In an increasingly competitive U.S. Senate race, the candidates and their allies are turning to health care to attack each other and highlight the differences between them. Republican Tommy G. Thompson and his allies - hoping to offset Thompson's slide in the polls - are using Democrat Tammy Baldwin's support of the new health care law to portray her as a big spender and too liberal for Wisconsin. Meanwhile, Baldwin and her supporters are drawing on the new law and Medicare reform to paint Thompson as a Washington insider who wants to dismantle health care coverage for the elderly (Bergquist and Marley, 9/29).

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Health Reform

Health Exchanges, Essential Benefits Issues Central To Health Law Implementation

News outlets are reporting on states' efforts to define "essential benefits" as lawmakers and state officials press for information about how health exchanges will be created.

Kaiser Health News: States Moving Ahead On Defining 'Essential' Health Insurance Benefits Under Federal Law
With a Monday target for submitting their lists of "essential health benefits" to the federal government, 15 states and the District of Columbia have made their choices and 17 more states are expected to do so in the next few weeks, according to consulting firm Avalere Health. The health law lists 10 broad categories of essential benefits, including preventive care, emergency services, maternity care, hospital and doctors’ services, and prescription drugs (Galewitz, 9/30). 

Politico Pro: Lawmakers Question HHS On Exchange Grants Oversight
Two top Republicans on Friday demanded that the Obama administration explain what they call "inadequate or non-existent" oversight of the money being given out to states to implement the health reform law's insurance exchanges. Sen. Chuck Grassley (R-Iowa) and House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) say there have been few restrictions on the more than $1 billion that has already been distributed (Haberkorn, 9/28).

Minnesota Public Radio: In New Health Exchange, Human Element Of Customer Service Is Up For Debate
If you lack health insurance, or have coverage through an individual or small group policy, it's likely you will be using a so-called insurance exchange in early 2014 ... Would you know how to evaluate an array of different premiums, co-pays and deductibles? The software that will run the insurance exchange is supposed to make it easy to compare health plans side by side, much like Expedia or Orbitz provide a list of flights by price and departure time (Stawicki, 10/1).

Minnesota Post: GOP Rep. Gottwalt Has (A Long List Of) Questions About Health Insurance Exchange
Following word Thursday that Minnesota state officials have received another $42.5 million to help plan the state health insurance exchange, Republican state Rep. Steve Gottwalt, chair of the House Health and Human Services Reform Committee, has lots of questions. In a letter today to Mike Rothman, state Commerce commissioner, ... has more than 70 specific questions about where the exchange is headed, and says he wants the answers by Oct. 1, "so Minnesotans have some time to review and understand them before the November 16th federal deadline to file for preliminary approval" (Kimball, 9/28).

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Medicare

Medicare Begins Latest Pay-For-Performance Effort; Hospital Readmissions Among Program Targets

Medicare is beginning to withhold funding if hospitals readmit too many patients within 30 days of their release. It's part of a broader federal push to improve health care quality.   

Kaiser Health News: Capsules: Medicare's Pay For Performance Effort Begins, Targeting Quality And Readmissions
Monday is the start of the federal fiscal year, and with it begins Medicare's biggest effort yet at paying for performance. Starting Oct. 1, Medicare is withholding 1 percent of its regular hospital reimbursements in the new Value-Based Purchasing Program, which was created by the 2010 health care law (Rau, 10/1).

The Washington Post: Hospitals In DC, Va. To Lose Millions From Medicare
Hospitals in the District and Northern Virginia will lose millions of dollars in Medicare funding over the next year because too many of their patients were re-admitted to a hospital within weeks of being released, according to Medicare data and interviews with hospital officials (Sun, 9/30).

The Associated Press: Medicare Fines Over Hospitals' Readmitted Patients
If you or an elderly relative have been hospitalized recently and noticed extra attention when the time came to be discharged, there's more to it than good customer service. As of Monday, Medicare will start fining hospitals that have too many patients readmitted within 30 days of discharge due to complications. The penalties are part of a broader push under President Barack Obama's health care law to improve quality while also trying to save taxpayers money. About two-thirds of the hospitals serving Medicare patients, or some 2,200 facilities, will be hit with penalties averaging around $125,000 per facility this coming year, according to government estimates (Alonso-Zaldivar, 10/1).

Politico: Reform Law Seeks Savings In Hospital Operations
Two major but little discussed programs in the 2010 health care law take effect Monday, part of the law's efforts to deliver better medical care in addition to more insurance. Both programs are part of an effort to leverage the financial might of Medicare to reward hospitals for providing more efficient and higher quality care and penalize those that don't (Norman, 10/1).

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Capitol Hill Watch

House Republicans Criticize Efforts To Get Health Law A Starring Role In TV Shows

House Republican lawmakers criticize efforts to enlist a PR firm to pitch TV shows on ways to address the health law in story lines. Meanwhile, one House Democrat introduced legislation to increase the number of government-supported medical residencies as a way to address the nation's looming doctor shortage.

The Hill: Republicans Blast California's Move To Hype Health Care Law On TV Shows
Republican lawmakers want to know why California hired a PR firm to promote the Affordable Care Act law on popular television shows such as "Modern Family" and "The Biggest Loser." The Golden State made headlines when its insurance exchange — created by the healthcare law — hired Ogilvy Public Relations to pitch TV shows on story lines involving President Obama's signature law. On Friday, Rep. Fred Upton (R-Mich.) and Sen. Chuck Grassley (R-Iowa) pushed the Obama administration on whether the $900,000 Ogilvy contract is the right use of taxpayer dollars (Viebeck, 9/28).

The Hill: House Dem Floats Bill To Ward Off Doctor Shortage
One House Democrat wants to increase the number of government-backed hospital residencies to fight the looming doctor shortage. A new bill from Rep. Joseph Crowley (D-N.Y.) would up the number of Medicare-supported residencies by 15,000 over five years to about 102,000 positions total. The cap on Medicare residency positions has not been lifted in 15 years, Crowley said. "We face a cruel irony: retiring baby boomers and the newly-insured, now covered through the Affordable Care Act, will be accessing our health care system in greater numbers, but we won’t have nearly enough doctors on-the-ready to deliver the healthcare services they’ll need," the Queens-based representative said in a statement. "A doctor shortage is something we just can't ignore" (Viebeck, 9/28).

In addition, a question of whether it's about policy or politics -

Medpage Today: CDC On Obesity: Public Health Or Politics?
The CDC has operated generally with bipartisan support for several decades regardless of who was in the White House or which party controlled Congress. Campaigns targeting the issues the CDC has championed -- such as tobacco cessation and obesity prevention -- were funded and backed with little objection. Its hallmark issues have varied little with the political ideology of whichever party controlled Washington. But now, projects the CDC funds are gaining increased attention from Republicans in Washington, who are saying the CDC's latest efforts are blurring the line between lobbying and what a federal agency can support (Pittman, 9/29).

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Public Health & Education

New Films Focus On 'Ailing' American Health Care System

Several new films being released examine the American health care system. One being released in theaters this week includes a look at the nation's for-profit system and proposes greater use of alternative healing.

Los Angeles Times: Filmmakers Turn Cameras On America's Ailing Health Care System
Health care reform is the focus of three new documentaries that explore the explosive issue through different lenses. "Doctored," which opened Thursday, focuses on the benefits of seeing chiropractors, while examining a wide range of medical, political and insurance topics. "The Waiting Room," which arrived Friday, provides an unflinching look at the uninsured trying to get health care at a big city hospital. "Escape Fire: The Fight to Rescue American Healthcare," opening Oct. 5 in theaters and on video on demand, looks at ways to help cure the ailing system, including greater use of alternative healing (King, 9/30).

Marketplace: Former Health Care Executive Pushes Critical Film
The documentary "Escape Fire" will be in theatres around the country this week, making a case that the country's profit-driven health care system isn't necessarily making people healthier. "When medicine became a business, we lost our moral compass," says Dr. Steven Nissen, head of cardiology at Cleveland Clinic, in the film. "I think we've gotten into a great deal of trouble because of that." One of the film's unlikely backers is an entrepreneur in Nashville who made a fortune in the health care industry. "I'm pointing fingers at myself almost," says Clayton McWhorter, one of the wealthiest businessmen in Tennessee and a former executive with Hospital Corporation of America (Farmer, 10/1).

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State Watch

Abortion Laws Causing Confusion, Consternation

In Indiana, abortion rights advocates are trying to change a law restricting abortions induced by prescribing a pill. Also in the news, a deadline nears for Planned Parenthood in Texas.

The Associated Press: Legal Language Pivot Of Ind. Abortion Drug Fight
A legal loophole could become the latest weapon in the fight over abortion rights as opponents push Indiana to rewrite a law that defines abortion clinics so it includes facilities offering the procedure without surgery by prescribing a pill. As many as eight other states could face similar battles over semantics. The move would potentially affect women's health providers that previously have been untouched by laws meant to limit access to abortions (Wilson, 9/28).

Bloomberg: Texas Women Ponder Next Steps As Law Cuts Health Options
Losing access to a Fort Worth, Texas, health-care clinic affiliated with Planned Parenthood has Alexis Lohse worried. She's just one among more than 126,000 low-income women who may face the same dilemma by Nov. 1. That’s when funding for services by Planned Parenthood affiliates will end because other operations tied to the nonprofit group offer abortions. ... lawmakers previously cut state family-planning aid by two- thirds, or $73 million, leading dozens of providers to close or reduce hours (Warbelow, 10/1).

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State Roundup: Pittsburgh Health System Merger Falls Apart

A selection of health policy news from Arkansas, New York, California, Pennsylvania, Arizona, Massachusetts, Montana and Georgia.

The New York Times: California Is First State to Ban Gay 'Cure' For Minors
California has become the first state to ban the use for minors of disputed therapies to "overcome" homosexuality, a step hailed by gay rights groups across the country that say the therapies have caused dangerous emotional harm to gay and lesbian teenagers (Eckholm, 9/30).

The Wall Street Journal: Pittsburgh Health Merger Collapses
Pittsburgh's West Penn Allegheny Health System broke off its agreement to be acquired by Highmark Inc., saying the insurer had breached the deal's terms and was demanding the hospital operator file for bankruptcy. Highmark, for its part, said it "categorically denies" that it violated the terms of the deal and "continues to believe that an affiliation" is in the best interest of both companies and the community (Mathews, 9/28).

The Arizona Republic: Arizona Seeking Help For Medicaid Program
Arizona is seeking federal approval to continue its Medicaid program for childless adults, which lawmakers capped last year to help balance the budget. Without a federal extension, the program will expire next year. At the same time, state Medicaid officials hope to convince the federal government that Arizona deserves additional funding to insure that group of low-income adults. The goal is to prevent thousands of Arizonans from getting kicked out of the Arizona Health Care Cost Containment System, the state's Medicaid program, and to give Arizona policy makers additional incentive to expand government-paid insurance under federal health care reform (Reinhart, 9/30).

Kaiser Health News: Eyes Turn To Arkansas' Bold Effort To Cut Medicaid Costs, Add Transparency
On Monday, Arkansas will kick off a program to reduce its Medicaid costs and improve care through a partnership with its largest private insurance companies -- Arkansas Blue Cross Blue Shield and QualChoice. If successful, experts say the state's Medicaid program could save about $4.4 million in FY 2013 and $9.3 million in 2014 (Kulkarni, 9/30).

The New York Times: After Decades In Institutions, A Bumpy Journey To A New Life
Once viewed as outcasts to be shunned and isolated in institutions, hundreds of Georgia's most disabled citizens are taking their first tentative steps back into society. Their fledgling journeys, marked by uncertainty, jubilation and some setbacks, are unfolding as officials embark on an ambitious plan to profoundly reshape the lives of the cognitively and physically impaired. It is a new strategy for Georgia, one of several states responding to mounting pressure from the Justice Department, which in recent years has threatened legal action against states accused of violating the civil rights of thousands of developmentally disabled people by needlessly segregating them in public hospitals, nursing homes and day programs (Swarns, 9/29).

The Arizona Republic: Arizona Fines Provider Of Prison Health Care
The Arizona Department of Corrections has levied a $10,000 fine against Wexford Health Sources Inc., a new private medical-care provider for inmates that is accused of improperly dispensing medicine and wasting state resources. The DOC called on Wexford to fix staffing problems, properly distribute and document medication for inmates, show a sense of urgency and communicate better with the state when problems occur. Wexford was fined over the actions of a nurse who caused a hepatitis C scare in August at the Arizona State Prison Complex-Lewis in Buckeye, and for failing to properly report the problem to authorities (Harris, 9/28).

Boston Globe: Partners HealthCare Will Give Centers $90M
Partners HealthCare plans to award community health centers $90 million over the next 15 years under a new grant program, part of a broad push to strengthen Massachusetts primary care providers. The state's largest hospital and physician organization is launching the initiative with its newly acquired insurer, Neighborhood Health Plan, and is scheduled to announce it Monday. In the first round of grants, it will give $4.25 million to 49 community health centers across the state to help them adopt immediate improvements, such as upgrading technology that tracks patients' health and redesigning office procedures so caregivers can spend more time with patients (Kowalczyk, 10/1).

Reuters: Montana Governor Sees Big Savings With New State Health Clinic
Montana, looking to cut down on state health care costs, has opened the nation's first government-run clinic for state employees in a program the Rocky Mountain state's governor says could ultimately cover a much broader range of people. Democratic Governor Brian Schweitzer says the primary care clinic in the state capital Helena will keep the area's 11,000 state workers and their dependents healthier while saving the state $20 million over five years (Boyce, 9/29).

Georgia Health News: Mental Health Agency OKs Tight 2014 Budget
The state Department of Behavioral Health and Developmental Disabilities has approved a fiscal 2014 budget that includes reductions to service providers, the closing of a nursing home and probable job cuts. Like other state agencies, DBHDD is required to cut its budget 3 percent under orders from Gov. Nathan Deal’s Office of Planning and Budget. The state has been struggling with sluggish tax revenues amid a slow economy (Miller, 9/28).

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Editorials and Opinions

Viewpoints: A Need For Sacrifice On Health Care; Health Law's Conservative Heritage; HSAs Foster Competition

The New York Times: How Insurers Can Help
Private insurance companies should be leading the way in the struggle to control health care costs. They know about every contact a patient has with the health care system and can see how much is wasteful or redundant. By altering the way they pay doctors and hospitals, they can potentially push providers to reduce costs, improve quality and even transform the whole culture of American medicine (9/30). 

The New York Times: The Real Referendum
Yet there is a sense in which the election is indeed a referendum, but of a different kind. Voters are, in effect, being asked to deliver a verdict on the legacy of the New Deal and the Great Society, on Social Security, Medicare and, yes, Obamacare, which represents an extension of that legacy. Will they vote for politicians who want to replace Medicare with Vouchercare, who denounce Social Security as "collectivist" (as Paul Ryan once did), who dismiss those who turn to social insurance programs as people unwilling to take responsibility for their lives? (Paul Krugman, 9/30). 

Philadelphia Inquirer: Mitt Romney Continues His Strange Health Care Dance
The sad truth is that constructive health-care reform could have been Mitt Romney's route to reaching a moderate majority of the electorate -- if he hadn't instead taken a ride on the Tea Party Limited. Now, he seems almost schizophrenic on the topic -- heralding his Massachusetts health-care reform while promising to repeal Obamacare, its national doppelganger, if he wins (Jeff Gelles, 9/30).

The New York Times: Three Muffled Syllables
We revere the Americans who lived through World War II and call them the "greatest generation" precisely because of the sacrifices they made. But we seem more than content to let that brand of greatness pass us by. ... Those of us with health insurance are encouraged not to fear any negative consequence from the attempt to universalize coverage, rather than being told that such a goal is worth some giveback — which it is. All of us are assured that the cost of Medicare can be contained without the program's beneficiaries' feeling a significant impact. Really? (Frank Bruni, 9/29). 

The New York Times: The Conservative Case For Obamacare 
[T]he architecture of the Affordable Care Act is based on conservative, not liberal, ideas about individual responsibility and the power of market forces. This fundamental ideological paradox, drowned out by partisan shouting since before the plan's passage in 2010, explains why Obamacare has only lukewarm support from many liberals, who wanted a real, not imagined, "government takeover of health care." It explains why Republicans have been unable since its passage to come up with anything better (J.D. Kleinke, 9/29).

Minneapolis Star Tribune: Unhealthy And Unjust
The Obama administration received much-deserved praise in June for granting a temporary reprieve from fear of deportation to qualified undocumented immigrants who, through no fault of their own, were brought to the United States as children. But in a seeming contradiction, the Department of Health and Human Services is denying health benefits to recipients of the "deferred deportation status." ... Denying recipients' health coverage is pure politics (9/30).

The Wall Street Journal: Can A Young Democrat Liberate America From Pete Stark?
The young challenger isn't running to Mr. Stark's right. He supports ObamaCare, opposes Republican entitlement reforms ... Still, the octogenarian Mr. Stark hopes to ride to re-election on his reputation as a liberal scourge. He helped drive the ObamaCare legislation left and has lambasted Paul Ryan's budget and entitlement-reform plans (Allysia Finley, 9/28).

San Francisco Chronicle: HSAs Force Health Providers To Compete
Recently, however, more and more employers are encouraging their employees to shop for health care the way they shop for groceries. To encourage that activity, employers are allowing their employees to manage more of their own health care dollars by means of a health savings account. ...  When health care dollars are in the hands of the patient, those on the supply side of the market -- doctors, hospitals and labs -- compete for those dollars by reducing price, increasing quality and making care more accessible (John C. Goodman, 9/29).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Ankita Rao
Marissa Evans

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2012 Kaiser Health News. All rights reserved.