Daily Health Policy Report

Wednesday, October 10, 2012

Last updated: Wed, Oct 10

KHN Original Reporting & Guest Opinion

Campaign 2012

Capitol Hill Watch

Health Reform

Coverage & Access

Quality

Medicare

State Watch

Swing State Trailmix

Editorials and Opinions

KHN Original Reporting & Guest Opinion

In New Health Exchange, Human Element Of Customer Service Is Up For Debate

Minnesota Public Radio's Elizabeth Stawicki, working in partnership with Kaiser Health News and NPR, reports: "If you have health insurance through your employer, imagine what it would be like to choose a health plan without a human resources staffer to explain the choices. Would you know how to evaluate an array of different premiums, co-pays and deductibles?" (Stawicki, 10/9). Read the story.

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Capsules: Revealing Angioplasty Outcomes Didn't Improve Patient Mortality; Schumer: 'A Lot Of Opposition' To Raising Medicare Age; Docs Say Concerns About ER 'Frequent Flyer' Use Are Overblown

Now on Kaiser Health News' blog, Jordan Rau reports on a new study about the impact of some health care outcomes reporting: "In the 23 years since New York State began publishing hospital death rates of coronary artery-bypass graft patients, the number of publicly reported outcome measures has proliferated. There are now 258 public reports on health care quality available around the country, according to the Robert Wood Johnson Foundation" (Rau, 10/9).

In addition, Mary Agnes Carey reports on signals sent by Sen. Charles Schumer, D-N.Y., about what might be on the table for a grand bargain: "Democrats have said they are willing to overhaul entitlements if Republicans agree to new tax revenues as part of a 'grand bargain' to reduce the deficit, but don't expect the Medicare eligibility age to be increased as part of any deal, Sen. Charles E. Schumer, D-N.Y., said Tuesday" (Carey, 10/10).

Also on Capsules, Ankita Rao writes about research dismissing the notion that frequent ER use drives up health care costs: "When Mitt Romney advised uninsured Americans to head to the emergency room for care, analysts were quick to point out the burden of high ER costs and the danger of abusing a safety net system. But emergency departments only account for 2 percent of health care spending, according to research presented by the American College of Emergency Physicians, a proportion they say reflects good value for the acute care delivered to 50 percent of the patients at hospitals" (Rao, 10/10). Check out what else is on the blog.

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Political Cartoon: 'Trick Or Treat?'

Kaiser Health News provides a fresh take on health policy developments with "Trick Or Treat?" by Mike Luckovich.

Meanwhile, here is today's health policy haikus:

WHAT'S THE VEGAS LINE?

Expectations soar
For V.P. debate - Will THE
"V" Word be uttered?
-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 Buzz: Obama, Romney Vie For Swing Voters

In the background, news outlets break down some of the policy specifics in play regarding Medicare and other health issues -- and how candidates' efforts to control the debate are playing among voters.

The Wall Street Journal: Romney Targets Obama Voters
Mitt Romney is putting a new emphasis on visiting counties that voted for President Barack Obama in 2008, as he urges Republicans in swing states to help him push the president's supporters to switch sides. … As Mr. Romney tweaks his message to appeal to more centrist voters, he must contend with positions he took as he fought for the Republican nomination, such as his vows to defund Planned Parenthood and his plan to restructure Medicare. At one point this year, Mr. Romney told voters that he had been a "severely conservative" governor of Massachusetts (Nelson and O’Connor, 10/9).

The New York Times: Obama Campaign Tells Supporters: Steady On
Big Bird was part of a broader effort by Mr. Obama and his team to reassure supporters — many of whom were confident a week ago that the election was all but assured — that his campaign had not lost its intensity or focus. By later in the day, Mr. Obama was delivering a spirited campaign appearance in Columbus, Ohio, his aides were reaching out to big donors with a calming message that they had always expected a tight finish, and the campaign had released new ads in battleground states on issues like potential cuts to Medicaid (Rutenberg and Zeleny, 10/9).

And on Medicare policies and how they are playing -

CQ HealthBeat: The Medicare Conundrum
The future of Medicare lines up with the economy as one of the hottest topics in this year's presidential campaign. Republican nominee Mitt Romney accuses President Obama of stealing money from the program to pay for parts of his 2010 health care law. Obama says the GOP plan would "end Medicare as we know it." ... The two men are courting voters 65 and older with essentially the same message: "The other guy wants to change your Medicare. I won't do that. Vote for me." In fact, both candidates do want to change Medicare, recognizing that something needs to be done to address the financial crisis facing the half-century-old health care program for the elderly and disabled. At the same time, neither wants to mess with the benefits so dear to the hearts of a demographic group that has a reputation for showing up at the polls (Ethridge, 10/9).

The Medicare NewsGroup: Cutting Through The Political Fog: Romney, Ryan, Obama And Medicare's Fiscal Future
Politicians and policy specialists alike are debating whether instituting a premium support system (Romney’s plan) or maintaining the current system and finding other ways to reduce costs and make health care delivery more efficient (Obama’s plan) would be more advantageous for the economy and beneficiaries. However, health care experts seem to agree that the political debate is clouding the issue at best (Adamopoulos, 10/9).

The Boston Globe: Future Seniors May See Benefits Tied To Means Testing
Mitt Romney wants to save Social Security and Medicare partly by cutting benefits for higher-income recipients. President Obama also sees wealthy Americans as part of the solution but suggests instead raising their premiums or payroll taxes. The fact that both presidential candidates back some form of so-called "means testing" suggests that millions of future seniors will probably end up paying more, or getting fewer benefits — no matter who wins the White House (Kranish, 10/10).

Politico: Paul Ryan Plan Not The Weapon House Dems Had Expected
Democrats could barely contain their glee when Mitt Romney selected Paul Ryan as his running mate in August. The Wisconsin congressman's controversial Medicare plan would be an anvil around the necks of Republicans nationwide, they insisted — a "majority maker" for the party, in the words of Democratic Congressional Campaign Committee Chairman Steve Israel. Two months later, that's turned out to be mostly wishful thinking (Isenstadt, 10/9).

WNYC: NJ Poll Shows Mixed Views On Health Care Issues
A majority of New Jersey voters supports President Barack Obama's health care reforms, wants Medicare to stay as is and wants the state to expand Medicaid, according to a new poll commissioned by WNYC's The Brian Lehrer Show. The poll conducted by the Eagleton Center for Public Interest Polling at Rutgers University found nearly six in 10 voters support the Supreme Court's decision upholding "Obamacare." Even larger numbers of New Jerseyans support Medicare, with only 25 percent supporting the kind of privatization that Republican challenger Mitt Romney supports (Solomon, 10/10).

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Romney Says Abortion Issues Not Part Of His Presidential Agenda

In what is being cast by many reports as a move to the center, GOP presidential hopeful Mitt Romney told the Des Moines Register that, if elected, he would not pursue specific legislation targeting abortion. Opponents say this is a marked difference from his comments earlier in the campaign.

The Washington Post: Romney: No Abortion Legislation On His Agenda
Republican presidential nominee Mitt Romney told the Des Moines Register Tuesday that legislation regulating abortion would not be a part of his agenda, prompting the Obama campaign to suggest he was trying to confuse women voters about his position on the emotionally charged issue (Williams, 10/9).

The Associated Press/Washington Post: Romney Promises No Abortion Legislation Will Be Part Of Presidential Agenda
Wading into an explosive social issue, Republican Mitt Romney on Tuesday said he would not pursue any abortion-related legislation if elected president. "There's no legislation with regards to abortion that I’m familiar with that would become part of my agenda," he told the Des Moines Register in an interview posted on the newspaper's website (10/9).

Reuters: Romney Says Won't Pursue New Abortion Laws
Republican presidential nominee Mitt Romney, in an apparent fresh move toward the political center, said on Tuesday if elected he would not pursue specific legislation targeting abortion. "There's no legislation with regards to abortion that I'm familiar with that would become part of my agenda," Romney told the Des Moines Register's editorial board during a campaign visit to Van Meter, Iowa (Holland, 10/10).

National Journal: Romney: Abortion Not On My Agenda
Mitt Romney said on Tuesday that he has no plans for abortion legislation if elected president, a statement that is more moderate than ones he's made on the issue in the past. "There's no legislation with regards to abortion that I’m familiar with that would become part of my agenda," Romney told the Des Moines Register editorial board (Huisenga, 10/9).

ABC: Romney Appears To Shift To Center On Abortion Legislation Plans
Democrats and abortion rights activists have seized on Mitt Romney's recent comment to the Des Moines Register that he would not pursue any new restrictions on abortion rights as president, an apparent change from what he has said earlier in the campaign and during the Republican presidential primaries (Wolf, 10/9).

The Hill: Celebs Lambaste GOP Over Abortion
A slew of film and television stars are pushing back against GOP efforts to ban abortion and stop President Obama's birth-control mandate. Meryl Streep, Kevin Bacon, Kyra Sedgwick, Amy Poehler and others mounted an online push for a "Bill of Reproductive Rights" on Tuesday in collaboration with an international abortion-rights group. The campaign does not target Republicans or the GOP by name, but its message clearly echoes the "war on women" charge leveled at the right. "Every day, the opponents of our fundamental reproductive rights are passing laws designed to take those rights away," Streep says in a video for the campaign (Viebeck, 10/9).

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Obama Campaign Unleashes Ads On Medicaid, Link Between Medicare And Romney's 47 Percent Comment

According to news reports, these ads are part of the Obama campaign's more urgent approach since last week's debate performance.

The Hill: Obama Hits Romney On Medicare, '47 Percent'
The Obama campaign tied Mitt Romney's Medicare plan to his controversial "47 percent" comments in a new ad Tuesday. The television spot quotes comments in which the GOP presidential nominee said 47 percent of the country pays no income tax and is dependent on government programs. That statistic includes seniors who receive Medicare and Social Security benefits. " 'Victims,' 'dependent,' that's what Mitt Romney called 47 percent of Americans, including people on Medicare," the ad says. It goes on to criticize Romney's Medicare plan, under which seniors would receive a fixed payment to help buy insurance on their own, either from a private insurer or the existing Medicare program (Baker, 10/9).

The Washington Post: Ad Watch: Obama Ad Ties '47 Percent' To Medicare Vouchers
What it says: "Victims. Dependent. That's what Mitt Romney called forty-seven percent of Americans. Including people on Medicare. But what about his plan for you? Romney would replace guaranteed benefits with a voucher system. Seniors could pay six thousand dollars more a year. A plan AARP says would undermine Medicare. You're no victim … you earned your benefits. Don't let Mitt Romney take them away" (Jennings, 10/9).

The Hill: Obama Ad Hits Romney On Medicaid
President Obama's reelection campaign hit Mitt Romney's proposed Medicaid cuts in a new television ad Tuesday. ...The ad focuses on Medicaid's coverage of nursing-home stays. "For many middle-class families, Medicaid is the only way to afford the care," the Obama ad says. "But as a governor, Mitt Romney raised nursing home fees eight times. And as president, his budget cuts Medicaid by one-third and burdens families with the cost of nursing-home care." Romney has proposed converting Medicaid into a block grant to the states. Such an approach would give the states more flexibility to set their own eligibility standards (Baker, 10/9).

CNN: Obama Ad Hits Romney Over Medicaid
Pivoting from a sarcastic Big Bird ad released Tuesday morning, President Barack Obama's campaign put out a more serious television spot in the afternoon, this time painting Mitt Romney as a threat to nursing homes. The 30-second commercial, "Only Choice," attacks Romney's plan to block-grant Medicaid and allow states to manage the system, rather than the federal government. Juxtaposed against a series of images of seniors in nursing homes, the ad's narrator points to fees on nursing home beds that Romney enacted as Massachusetts governor (Killough, 10/9).

Los Angeles Times: Obama Campaigns More Urgently In Response To Debate Setback
Another spot released Tuesday reinforced in a more serious way the Obama camp's concerns about Romney's new momentum. That ad, airing in swing states, links Romney to running mate Rep. Paul D. Ryan's proposal to cut back spending on Medicaid. The cuts would "burden families with the cost of nursing home care," the ad said, picking up on a line of attack former President Clinton stressed when he made the case for Obama at the Democratic National Convention. The ad also indicated that the Obama campaign views Thursday's vice presidential debate as an opportunity to get back on track (Memoli and Reston, 10/10).

In other campaign messaging news -

The Hill: DNC Chief Cites Past Breast Cancer To Fundraise Against Romney
The head of the Democratic National Committee (DNC) called Mitt Romney's healthcare claims "personally offensive" to her as a breast cancer survivor in a bid for campaign funds Tuesday. The fundraising email from Rep. Debbie Wasserman Schultz (Fla.) came on the heels of a new Gallup survey finding Romney leading President Obama 49 to 47 percent nationally among likely voters. Pollsters have attributed Romney's sudden lead to his highly successful debate performance last week. But Wasserman Schultz was quick to criticize the former governor for "say-anything dishonesty" on the issue of health insurance for people with pre-existing conditions — a group she joined when she was diagnosed with breast cancer (Viebeck, 10/9).

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As Election Day Approaches, Acrimony Highlights Many House And Senate Races

The Associated Press and Politico report on some of the nastiest races across the country.

The Associated Press/Washington Post: In Tight Senate And House Races, Tempers Flare While Attacks Get Snarky And Personal
Short on time and tempers, House and Senate candidates in tight races are turning snarky and personal in their attacks on their opponents. … Across the land, candidates are launching incendiary attacks on each other in the final, fretful days of an election year colored by margin-of-error races that have refused to budge (10/10).

Politico: 10 Nastiest House Races
If you thought the presidential race was veering off the rails with small-ball attacks and Big Bird, the ugliest House races around the country take it to a whole new level. House races are more local, less polished and the candidates often know each other -- and have built up a personal hostility palpable in the campaign (Kim and Nocera, 10/9).

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Capitol Hill Watch

Schumer Offers Views On How Deficit Talks Should Tackle Entitlement, Tax Reform

Sen. Chuck Schumer, D-N.Y., noted that, among Democrats, there is a lot of opposition to raising Medicare's eligibility age but also interest in overhauling entitlements as part of the push to reach a grand bargain.

The Wall Street Journal's Washington Wire: Schumer: New Tack On Taxes
Sen. Charles Schumer, the Senate’s third-ranking Democrat, will offer a tax rewrite that includes tightening tax breaks – but no across-the-board rate cuts – in exchange for an overhaul of entitlement programs. ... he says that Republicans should be drawn to such a deal by the prospect of a bipartisan bargain that also includes changes to improve the sustainability of entitlement programs. Those programs – such as Social Security and Medicare – are expected to run substantial shortfalls in the future, adding dramatically to budget deficits (McKinnon, 10/9).

The New York Times: Schumer Shakes Up Deficit Talks With Call To Raise Taxes On The Rich
But some Democrats involved in the negotiations say Mr. Schumer's position could prove helpful by demarcating the left's opening position on tax cuts for the rich and by opening a new avenue for negotiation over entitlement programs. Mr. Schumer said Republicans would be drawn to the table by the prospect of making changes to Medicare and other entitlements. While he did not specify what changes he would accept, Republicans in deficit talks have demanded the restructuring of entitlements in exchange for added revenues (Weisman, 10/9).

The Washington Post: Schumer: Tax Reform Should Cut Deficits, Not Tax Rates
(Some) Democrats worry that opening with an offer to lower the top rate will push the final number far lower than Democrats are willing to go. "Simpson-Bowles is a compromise, not the starting point," said one House aide. In that regard, Schumer may be planting the Democratic flag at 39.6 percent not to thwart compromise but to encourage a deal closer to 35 percent than to the lower GOP targets. Instead of lower rates, Schumer said, "the lure for Republicans to come to the table around a grand bargain should be the potential for serious entitlement reform" — including major changes to Medicare, the biggest driver of projected deficits. But Democrats have so far rejected structural changes to the program. On Tuesday, Schumer declined to say what new revisions Democrats were willing to contemplate (Montgomery and Khimm, 10/9).

Kaiser Health News: Schumer: 'A Lot Of Opposition' To Raising Medicare Age
Democrats have said they are willing to overhaul entitlements if Republicans agree to new tax revenues as part of a 'grand bargain' to reduce the deficit, but don't expect the Medicare eligibility age to be increased as part of any deal, Sen. Charles E. Schumer, D-N.Y., said Tuesday (Carey, 10/10).

Modern Healthcare: Tackle Medicare During Lame Duck Session, Schumer Says
The short post-election congressional session needs to include an entitlement reform package that cuts "hundreds of billions of dollars" from Medicare, a senior Senate Democrat said Tuesday. Sen. Charles Schumer (D-N.Y.), the third-ranking Democrat in the Senate and a senior member of the powerful Finance Committee, urged the Medicare cuts as part of a "grand bargain" that produces at least $4 trillion in deficit reduction. The package also should increase taxes on high income earners while maintaining current rates for taxpayers with incomes below $250,000. Other Democrats and Republicans have urged delaying any entitlement talks until the next Congress is seated, but Schumer said a deal is more likely to occur if it is attempted to during the lame-duck session (Daly, 10/9).

Meanwhile, news outlets also offer details on the efforts underway by a group of senators to reach a bipartisan deficit reduction agreement.

Los Angeles Times: Group Of Senators Seeks Bipartisan Deficit Reduction Deal
As a lofty political debate over taxes and spending plays out on the presidential campaign trail, a more practical one is unfolding this week in Virginia as eight senators try to strike a bipartisan deficit reduction deal (Mascaro, 10/9).

Politico: Senators Throw Elbows For Seats At Fiscal Table
There's nothing on the table yet from anyone. But these moves illustrate the furious, power-driven scramble under way right now to shape the real negotiations on the nation’s fiscal future immediately after the election. It's a drive to lay down markers on taxes, spending and deficit reduction before the real talks begin (Raju and Sloan, 10/9).

The New York Times' Economix: Q & A: Understanding The Fiscal Cliff
In the first two days of 2013, large tax cuts passed in 2001 and 2003 will expire and across-the-board cuts to defense and nondefense programs in the government will begin a drastic and sudden hit to the economy — a so-called fiscal cliff — that both parties say could be damaging to the unsteady recovery. Here is a primer on the tax increases and program cuts and their potential impact on the economy (Weisman, 10/9).

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Health Reform

Restaurant Chain Considering End Run Around Health Law

Darden Restaurants, whose companies include Olive Garden, is considering adding more part-time workers to avoid the insurance coverage mandate in the health law.

Politico Pro: Darden Tests Part-Timers To Avoid ACA
Warning of the looming cost of the Affordable Care Act, Darden Restaurants -- the parent company of Olive Garden, Red Lobster and LongHorn Steakhouse -- is experimenting with the use of more part-time workers to ease the sting of the law. The catch: They have to find out if they can shift people to part-time hours without forcing customers to suffer agonizingly long waits for their mezzaluna ravioli or seafood-stuffed flounder. But if the restaurant chain likes what it sees in the test -- and expands the use of part-timers throughout the country -- the law's critics are bound to cite Darden as proof that the health care law is forcing low-wage workers to lose hours and benefits (Cheney, 10/9).

The Associated Press: To Limit Health Care Costs, Olive Garden Parent Tests Keeping More Workers On Part-Time Status
Under the new health care law, companies with 50 or more workers could be hit with fines if they do not provide basic coverage for full-time workers and their dependents. Starting Jan. 1, 2014, those penalties and requirements could significantly boost labor costs for some companies, particularly in low-wage industries such as retail and hospitality, where most jobs don't come with health benefits. Darden, which operates more than 2,000 restaurants in the U.S. and Canada, employs about 180,000 people. The company says about 75 percent of its employees are currently part-timers (Choi, 10/9).

In other news, it's open season and workers are choosing plans --

Reuters: What To Expect When You Choose A Health Plan
Make way for open enrollment season, the time of year when those wordy benefits packages stuff your inboxes. Once again, workers face higher health care costs, but what else can employees expect from insurance plans? Tracy Watts, a partner with benefits giant Mercer, explains what's new for employees in 2013, including the impact of healthcare reform. ... While the main provisions of the new law won't go into effect until 2014, we've already seen companies expand coverage for dependents (Young, 10/9).

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Two Texas Baptist Universities Join Challenge To Health Law's Contraception Coverage Mandate

News outlets report on various developments related to the implementation of the health law.

CQ HealthBeat: Two Baptist Universities In Texas Sue Against Contraception Requirement
Two Baptist universities in Texas on Tuesday became the latest to join in a series of lawsuits challenging an Obama administration rule on coverage of birth control. East Texas Baptist University in Marshall and Houston Baptist University said in court filings that they are Christian liberal arts institutions whose religious beliefs "forbid them from participating in, providing access to, paying for, training others to engage in, or otherwise supporting abortion" (Norman, 10/9).

Politico: PCORI Urged To Pick Up The Pace On Research
The Patient Centered Outcomes Research Institute seems to be lacking the sense of urgency to tackle specific, high-impact clinical questions fast, which is what it needs to do if it is to survive past 2019, according to a new article in Health Affairs. Harold Sox, who co-chaired the 2009 Institute of Medicine panel on comparative effectiveness research, argues that given the slow pace of clinical research, and the slower pace of changing clinical practice, PCORI needs to move quickly for it to have a chance of being reauthorized beyond the sunset date of September 2019 set by the Affordable Care Act (Norman, 10/9).

CQ HealthBeat: Medicare Board Still A Long Way Off
A statutory board of 15 advisers charged with keeping Medicare costs in check doesn't actually exist yet, but that hasn't stopped Republicans from making it a target on the campaign trail. GOP presidential nominee Mitt Romney repeatedly used the Independent Payment Advisory Board last week to help make his case against President Obama’s signature health care overhaul during the first presidential debate. Without mentioning it by name or even by its widely used acronym, IPAB, Romney cited the panel as his third reason for repealing the 2010 law. ... Obama hasn't nominated any of its members, and when he does they will need Senate confirmation -- something Republicans are likely to block (Attias, 10/9).

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Coverage & Access

Military Families Who Want To Keep Adult Kids On Tricare Face Higher Fees

The Wall Street Journal reports on how military families who wish to keep their adult children on their health plans are facing higher costs than those in the regular insurance market. Also, ABC News reports on research findings that compare the health of military veterans with current military and civilians.

The Wall Street Journal: Military Families Balk At Health Fee
A provision in the national health care law that lets young adults stay on their parents' insurance plan is popular with many families -- but not ones in the military. Families covered by Tricare, the health program for active and retired members of the military, must pay as much as $200 a month to let an adult child stay on their plan until age 26. Most families in private plans now pay no fee to extend such coverage. Military families are starting to complain about the disparity, saying they can't afford those premiums and have let their children go uninsured (10/9).

ABC News: Veterans Report Poorer Health Than Active Military, Civilians
Military veterans have poorer health compared with current servicemen as well as civilians, according to a new study by researchers at the VA Puget Sound Health Care System in Seattle. They surveyed 53,000 veterans, 3,700 Guard and Reserve members, 2,000 active duty servicemen and 110,000 civilians about their health and access to health care. Veterans as well as active duty servicemen reported higher rates of diabetes, alcohol consumption and tobacco use compared with civilian men. In some ways, the findings, which were published Tuesday in the American Journal of Preventive Medicine, are not so surprising given that current active duty, National Guard and Reserve service members are given routine physical screenings (Salahi, 10/9).

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Quality

Study Finds Reporting Heart Procedure Results Can Limit Use

The research in the Journal of the American Medical Association shows that in states that report outcomes from procedures to open blocked arteries, patients are less likely to get the treatment. However, they found no differences in patient survival.

Los Angeles Times: For Heart Patients, Medical Disclosure Can Limit Treatment
Heart attack patients in states that require healthcare providers to report the outcomes of procedures to open blocked arteries are less likely to receive those live-saving treatments than similar patients in states without public reporting mandates, according to a new study. The disparities in care, however, appeared to have little effect on patient survival rates. The analysis, based on nearly 100,000 Medicare patients in 10 states, comes amid a nationwide push for greater transparency in how doctors and hospitals measure up against one another (Zarembo, 10/9).

Reuters: Fewer Heart Stents In U.S. States Reporting Outcomes
In what might be an unintended consequence of health care improvement efforts, older heart attack patients seem less likely to get stents in the U.S. states that require hospitals to report the outcomes of such procedures, according to a new study. Some believe public reporting allows patients to pick the best hospitals while encouraging hospitals to perform better, according to the researchers. But some fear such reporting also discourages doctors from performing risky but necessary procedures (Seaman, 10/9).

Healthday/Philadelphia Inquirer: State Regulations Tied To Drop In Common Heart Procedure
If you suffer a serious heart attack, your medical treatment could depend on where you are when you have it. If you're in a U.S. state with mandatory hospital public reporting, you may be less likely to get angioplasty to treat a blocked artery than if you were in a state without such data collection, a new study suggests (10/9).

Kaiser Health News: Revealing Angioplasty Outcomes Didn’t Improve Patient Mortality: Study
In the 23 years since New York State began publishing hospital death rates of coronary artery-bypass graft patients, the number of publicly reported outcome measures has proliferated. There are now 258 public reports on health care quality available around the country, according to the Robert Wood Johnson Foundation. Researchers are still studying what impact this transparency movement has had. The latest such effort, published Tuesday by the Journal of the American Medical Association, looked at three states that publicly report the results of heart attack patients receiving angioplasties, stents and other percutaneous coronary interventions (Rau, 10/9).

Another journal also takes a look at how medical practice is affected by research into effectiveness.

Medpage Today: Effectiveness Research Slow To Change Practice
Comparative effectiveness research is slow to change clinical practice, and separate papers published in the October issue of Health Affairs seek to explain why. Financial barriers such as fee-for-service models, biases, and limited use of tools to aid in treatments better aligned with evidence all prevent more cost-effective, results-driven treatments from taking root, wrote Justin Timbie, PhD, a health policy researcher at the RAND Corporation in Arlington, Va., and colleagues. … In the second paper, [researchers] examined the correlation between the publication of two large clinical trial results showing arthroscopic debridement and lavage don't benefit patients with arthritis of the knee, and changes in the frequency of the procedure. While the number of procedures dropped after the first data were published in 2002, results found arthroscopic debridement and lavage dropped also when payers stopped covering the procedure (Pittman, 10/9).

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Medicare

Medicare Beneficiaries Who Are Victims Of Identity Theft Face Difficulties Getting New IDs, Accessing Health Care

USA Today: Medicare Won't Issue New IDs To Identity-Theft Victims
More than a quarter-million Medicare beneficiaries are victims of identity theft and hampered in getting health care benefits because the government won't issue new IDs, according to an investigation report released today (Kennedy, 10/10).

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State Watch

Some State Officials Grappling With Health Law's Insurance Exchanges

State leaders in Mississippi, Idaho and Minnesota pore over their options on establishing the health law's health insurance exchanges -- or allowing the federal government to do it.

Bloomberg: Mississippi Fights Over Health Law As States Resist Key Element
In Mississippi, where one in five people lack health insurance, two Republican elected officials are fighting over the best way to resist President Barack Obama’s health care overhaul. Insurance Commissioner Mike Chaney, 68, is proceeding with a key requirement -- creating health-care exchanges to help people without employer-provided coverage get policies -- saying he wants the least burdensome requirements. Governor Phil Bryant, 57, asked him to stop late last month, saying the state shouldn't advance any part of the Obama-backed law (Newkirk, 10/9).

The Associated Press/Houston Chronicle: Expert: Idaho Has No Time For State Exchange
Idaho has run out of time to establish a state-run insurance exchange that's required by President Barack Obama's health care overhaul, meaning working with the federal government on an alternative is virtually unavoidable. That's according to a consultant advising a 13-member panel organized by Gov. C.L. "Butch" Otter to gather information on what Idaho should do. At this point, it's too complicated and risky to launch a state-run exchange, like neighboring states Washington and Oregon plan, said Robert Mitchell, a Denver-based consultant with KPMG LLC hired to help the state make its choice (Miller, 10/9).

Kaiser Health News: In New Health Exchange, Human Element Of Customer Service Is Up For Debate
Congress envisioned exchanges as one-stop shopping for people who need coverage either from a government program like Medicaid or from a commercial health plan. But there's a general concern that for a lot of people, the new marketplaces will be daunting no matter how well the exchange software is designed. "Not everybody is going to be able to independently hop on an online program," said Joan Cleary, who heads the Minnesota Community Health Worker Alliance (Stawicki, 10/9).

States are also considering Medicaid expansion and kids' care decisions provisioned in the health law --

The Associated Press/Las Vegas Review-Journal: No Medicaid Decision Until After Elections
[Nevada] Gov. Brian Sandoval said Tuesday he won't decide whether expanding Medicaid eligibility as called for under the federal health care reform law will be part of his budget proposal until after the elections and state revenue projections are made later this year. Speaking to reporters Tuesday, the Republican governor said his administration is still awaiting guidance from the federal government on aspects of the law (Chereb, 10/10).

California Healthline: Study: Pediatric Vision, Dental ACA Coverage In Limbo
California has yet to resolve several key questions about how insurers will provide pediatric dental and vision benefits under the federal Affordable Care Act, according to a new study from the California Health Benefits Review Program. Recent state legislation helps define essential health benefits for children's dental and vision care, "but does not clarify which ages are 'pediatric,' and thus eligible to use these benefits," according to the study (Hart, 10/10).

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State Roundup: Filling The Health Care Void In NYC's Greenwich Village

A selection of health care policy stories from New York, Alaska, Massachusetts, Texas, California and Georgia.

The New York Times: New Style Of Health Care Emerges To Fill Hospital's Void
The demise of St. Vincent's Hospital in Greenwich Village two years ago has led to a struggle for health care supremacy in some of New York's most distinctive neighborhoods, offering a glimpse, in the process, at what might be the future of urban medicine (Hartocollis, 10/9).

Anchorage Daily News: Judge: Parents Must Be Notified Before Teen's Abortion
An Anchorage Superior Court judge has upheld as constitutional a state law requiring parents to be notified before a teen's abortion. But the issue may not be resolved. Both sides expect it will wind up before the state Supreme Court. Judge John Suddock, in a 65-page decision issued Monday, said the legal requirement does not violate a teenager's right to privacy. Nor, the judge ruled, does it violate provisions to treat people equally even though a pregnant teen generally cannot receive an abortion without her parents' knowing, but could get prenatal care. The law applies to Alaska teenagers age 17 and younger. It says abortion providers must generally inform parents before performing an abortion. Girls can get around the requirement by going to a judge or providing the doctor with notarized statements attesting to abuse at home. Pro-choice advocates say that's a lot to ask of a girl in crisis (Demer, 10/9).

The Boston Globe: Partner's Financial Health Turns On Complex Plans
When Partners HealthCare, the big Boston hospital group, announces its financial results each quarter, what often stands out are not the gains and losses for providing medical services. It’s the investment and debt portfolios. With $7.5 billion in assets under its watch -- more than at most community banks -- Partners feels the swerves of the stock market in a big way. And there's another significant factor in the quarterly swings: a complex hedging strategy on Partners’ debt. Together, these are often the tail that wags the dog (Healy, 10/10).

The Texas Tribune: Lawmakers Discuss Mental Health Challenges For Veterans
Seeing a recent increase in suicides by military veterans returning from Iraq and Afghanistan, Texas lawmakers are looking for ways to address mental health challenges faced by soldiers as they come back to the state. "With so many of our own becoming veterans, it's going to be an ongoing issue," state Rep. Joe Pickett, D-El Paso, said Tuesday at a hearing of the House Defense and Veterans Affairs Committee (Chammah, 10/9).

The Texas Tribune: Joint Task Force Tackles Medicaid Dental Fraud
Through a new joint task force, the Texas attorney general's office and the office of the Inspector General at the Health and Human Services Commission have teamed up to strengthen investigations of fraud and abuse in the state's Medicaid dental program for children. And because the task force allows the agencies to coordinate limited resources, state officials say, the state can advance investigations and recover misused taxpayer funds more quickly (Aaronson, 10/10).

California Healthline: Study: Nurse Ratio Law Has Mixed Results On Quality Of Care
Authors of a new study contend that California's 2004 law mandating minimum nurse-to-patient ratios in hospitals has had mixed results on quality of care for patients. California Nurses Association officials said the study's findings do not support the authors' conclusions. The nurses association was the driving force behind the ratio law and now is lobbying to get other states to adopt similar legislation. The study, "California's Minimum Nurse Staffing Legislation: Results From a Natural Experiment," was published last month in Health Services Research (Lauer, 10/9).

Georgia Health News: Push For Babies' Safe Sleeping Reaches State Capitol
Dr. Evelyn Johnson was overcome by a "sense of emptiness" when she got the call from the coroner about an infant's death. … She told the story of the infant's death at a news conference at the state Capitol on Tuesday. The event was held to promote safe sleeping practices for babies: that they should always sleep alone, on their backs, and in a crib (Miller, 10/9).

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Swing State Trailmix

Swing State Highlights: Focus On The Middle Class; GOP Momentum In Michigan?

As election day approaches, KHN's Sarah Barr samples news coverage each week from swing states around the country – how health policy developments are playing in this year's vote. In Iowa, for instance, both presidential campaigns are vying for middle-class votes.

Des Moines Register: Middle Class Is Focal Point As Election Nears
[Tony] Swanson, 53, of rural Ottumwa, for years was the manager of the landfill in Wapello County. ... But a few years ago, he had a heart attack and began to suffer from other illnesses. His wife’s health deteriorated, too. ... He lost his job when his health problems forced him onto disability. Then he lost his home. Swanson's story is personal, but is representative of the struggles facing many Americans. ... Both [presidential] candidates ... have put middle-class concerns at the center of their candidacies and built their rhetoric, advertising, campaign appearances and multipoint policy plans around solutions to middle-class hardships (Noble, 10/6).

Detroit Free Press: Poll Shows Mitt Romney Closing Gap With Barack Obama In Michigan After Debate
Republican presidential nominee Mitt Romney's performance in his first debate with President Barack Obama helped him trim Obama's lead in Michigan by seven percentage points and put the state back in play, according to a poll released Monday to the Free Press. ... Obama actually widened his lead among voters 50 or older, a statistic [pollster Bernie] Porn attributes to concerns over the Medicare voucher plan that has been espoused by U.S. Rep Paul Ryan of Wisconsin, Romney's running mate (Egan, 10/9).

Detroit News: Ryan: GOP Has 'Good Chance' To Win In Michigan
In his second trip to Michigan as the GOP vice presidential pick, Paul Ryan told thousands of cheering Republicans on Monday night that the GOP ticket can win the state. "It's getting closer in Michigan," Ryan said. "… You can deliver this. We can do it here." The push through Michigan comes as two new polls released on Monday showed Obama's double-digit lead in the state had been cut to 3 percentage points (Shepardson and Schultz, 10/9).

Other highlights include news about swing-state registration and early voting in Ohio, Pennsylvania and Nevada. 

Pittsburgh Post-Gazette: Jill Biden Emphasizes Registration Deadline
The wife of Vice President Joe Biden urged campaign volunteers Monday to continue their efforts as (Tuesday's) voter registration deadline approached, emphasizing that they also need to spread the word about the voter ID decision. "We've got to get the news out that people do not need a photo ID," Jill Biden told a crowd of about 180 people  ... She highlighted efforts to increase funding for college Pell grants, steps to end the war in Iraq, passage of the federal health care act and Friday's decrease in the national unemployment rate (Olson, 10/9).

Cincinnati Enquirer: Ohio Early Voting To Stay, Appeals Court Says
A federal appeals court Friday handed the Obama campaign a major legal victory, ruling that Ohioans may cast early in-person absentee ballots during the final three days before the Nov. 6 election.  ... A major factor in its unanimous decision, the court said, was evidence suggesting that early voting restrictions would be especially harmful to women, minorities, older voters and those with lower incomes and less education (Horstman, 10/6).

Cleveland Plain Dealer: Ohio Secretary John Husted To Appeal Early Voting Decisions to The U.S. Supreme Court
Ohio's elections chief said today he will appeal to the U.S. Supreme Court a federal appellate court ruling last week that permitted early voting the weekend before the Nov. 6 election. … The availability of in-person early voting the weekend before the Nov. 6 election is a crucial issue for Democrats, who four years ago marshaled thousands of voters to the polls in that time frame to help President Obama to victory (Guillen, 10/9).

Cleveland Plain Dealer: In Deep-Blue Cuyahoga County, Republicans Outpacing Democrats In Early Ballot Requests (But Democrats Returning Them At A Higher Clip)
Some numbers to chew on after nearly a week of early voting in Ohio: In the Democratic stronghold of Cuyahoga County, 36 percent of registered Republicans had asked for absentee ballots as of Sunday afternoon, compared with 32 percent of registered Democrats, according to the elections board. ... For the GOP, this is ... about holding down President Barack Obama's margins in what could be a close race in an electoral battleground (Gomez, 10/8).

Cleveland Plain Dealer: Analysis Of Cuyahoga County Voting Finds Cutback On In-Person Balloting Hits Minorities Most
Restrictions on early in-person voting in Ohio would discriminate against black voters, an analysis of voting patterns concludes. The study examined voting in Cuyahoga County in 2008 using elections records and census data. It found that black voters and white voters cast early ballots at similar rates in 2008, but that blacks -- who accounted for about 29 percent of the overall vote -- cast more than 77 percent of the in-person early ballots (Feran, 10/6).

Las Vegas Sun: Democrats Expand Voter Registration Lead In Clark County
Democrats in Clark County have a 119,000 voter registration advantage over Republicans at the closing online voter registration. ... Individual voters can still register in person by Oct. 16. Democrats have been consistently outpacing Republicans in voter registrations statewide, and particularly in Clark County, the state's Democratic stronghold and largest county (Schwartz, 10/8).

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Editorials and Opinions

Viewpoints: Wis. Senate Candidates Thompson, Baldwin Offer Competing Views Of Health Law; 'Disturbing Lack' Of Oversight Of Compounding Pharmacies

The New York Times: Out-Of-Control Compounding Of Drugs
The meningitis outbreak that has sickened at least 119 people and killed 11 of them has laid bare a disturbing lack of regulatory oversight of pharmacies that mix drug compounds and ship them around the country. Unless Congress passes legislation to strengthen the hand of the Food and Drug Administration, the public will continue to be at risk from contaminated products (10/9).

The Washington Post: Stopping The Next Outbreak
The outbreak raises broader policy questions. In 1997, Congress passed legislation establishing state and federal regulation of compounding pharmacies. But the federal role was challenged by some pharmacies in the courts, and it has been caught up in legal wrangling for years. The FDA has attempted to keep watch with “policy guidance” instead of law (10/9).

Los Angeles Times: Romney's Big Bounce 
[O]nce the two candidates met on an equal footing in Denver, many voters were amazed to meet a Romney who seemed like an earnest businessman looking for ways to fix the economy — a Romney who insisted that, contrary to his previously stated positions, he didn't want to cut taxes for the wealthy, abandon healthcare reform or reduce education spending (issues that polls find especially important to female voters) (Doyle McManus, 10/10).

The Washington Post: What Women Voters Want
Thanks to certain outspoken members/supporters of the GOP, the Democratic Party has been able to capitalize on a fiction created by the Obama campaign — the alleged "war on women." ... While these incidents and anecdotes provide handy faces for dart practice, they constitute a war on women only if all women find these positions reprehensible. And only if all women care more about contraception and reproductive rights above all other issues, which is not the case (Kathleen Parker, 10/9).

Politico: Election Could Erase Medical Device Tax
Just recently, Cook Medical announced it is scrapping its plans to build five plants that would have created hundreds of jobs because of this new tax in Obamacare. Now as more companies report potential layoffs and plans to outsource good-paying jobs due to this disastrous law, some supporters of Obamacare are changing their tune. A few weeks ago, Indiana's former Senator Evan Bayh called on Congress to repeal the medical device tax even though he was the 60th vote needed to pass the president's health care law that created this tax in the first place (Sen. Dan Coats, 10/10).

The (Madison, Wis.) Capital Times: Moving America's Health Care Reform Forward
Middle class families should have the peace of mind knowing they will have access to quality, affordable health care, regardless of any pre-existing condition. That is just one of the reasons I fought to pass President Obama's Affordable Care Act. It is the right thing to do to allow millions of young people to stay on their parents' health care coverage until age 26 ... I believe seniors should continue to have access to free preventive care, as well as affordable access to prescription drugs under Medicare. About 33 million Americans have already benefited from free preventive health care benefits thanks to Obamacare (Rep. Tammy Baldwin, 10/10).

The Capital Times: Reform Health Care With Wisconsin Common Sense 
Our nation can afford neither Obamacare nor the prior policy, both of which will cause deficits to balloon, businesses to suffer, and families to fear the loss of affordable care. My plan addresses four fundamental flaws of our current system: 1. Over-regulation. 2. The disconnection of economic realities and consumer choices. 3. The lack of coverage for those with pre-existing conditions. 4. The lack of market-based solutions (Tommy Thompson, 10/10).

The New York Times' Economic Scene: Cutbacks And The Fate Of The Young
But the nation’s growing debt is not the only threat to our children’s future. … Right now, the next generation is getting shortchanged all around, with children too often treated as an afterthought in policies meant to appeal to their elders. The United States tolerates the highest rate of child poverty in the developed world. Yet federal expenditures on children — including everything from their share of Medicaid and the earned-income tax credit to targeted efforts like child nutrition and education programs — fell 1 percent last year and will fall an additional 4 percent this year, to $428 billion, according to estimates by the Urban Institute based on the Congressional Budget Office’s projections (Eduardo Porter, 10/9).

Los Angeles Times: More On Pete Peterson, Deficit Panic And Washington Influence 
Fix the Debt is chaired by former Pennsylvania Gov. Ed Rendell, a democrat, and former Sen. Judd Gregg of New Hampshire, a Republican -- this sort of D.C. garden-party bipartisanship being a hallmark of the Peterson style. The group is encouraging D.C. lawmakers to cut "entitlements" in return for a modest tax increase. ... In case you've forgotten, entitlements are Social Security and Medicare, to which you're entitled because you've paid for them during most of your working life (Michael Hiltzik, 10/9). 

Politico Pro: What Does Health Care Worker Certification Have To Do With Quality?
Escalating health care costs have appropriately focused the attention of both parties on the quality of care Americans receive — resulting in the increasingly intensive scrutiny of medical treatments and the health care workers who prescribe or deliver them. ... As we've pushed harder on quality metrics, however, we've made an important discovery: All metrics aren't created equal (David A. Shaywitz, 10/10).

Health Policy Solutions (a Colo. news service): The Places We Live, Work And Play: What's Health Got To Do With It?
Though personal responsibility is a major contributing factor to health, it’s difficult to live healthy lives when communities lack infrastructure and facilities that encourage physical activity. That's one of the many reasons the Colorado Health Foundation has joined a growing number of health-oriented groups in promoting and supporting ... a number of projects and initiatives to promote places where it is easier to engage in physical activity and make the healthy choice is the easy choice (Kelly Dunkin, 10/9).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.