Daily Health Policy Report

Thursday, October 11, 2012

Last updated: Thu, Oct 11

KHN Original Reporting & Guest Opinion

Campaign 2012

Health Reform



Weekend Reading

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

FAQ: The Health Law Coverage For Immigrants

Kaiser Health News staff writer Julie Appleby reports: "The U.S. is home to more than 21 million immigrants who are not citizens, and for many of them, health coverage is a concern. That is partly because so many of these immigrants, both those who came here legally and those who do not have permission to live in the United States, work in lower wage jobs that don’t include health coverage" (Appleby, 10/11). Read the story.

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Capsules: Study: CMS Penalties Don't Change Hospital-Acquired Infection Rates; Adderall For Healthy Kids: A Cost Shift To Medicaid?; Seniors Overspend On Medicare Part D

Now on Kaiser Health News' blog, Julie Appleby reports on a development related to hospital-acquired infection rates: "A Medicare payment policy designed to push hospitals to cut their infection rates has had no effect in reducing two types of preventable infections among patients in intensive care units, researchers say in a study out Wednesday in the New England Journal of Medicine" (Appleby, 10/10).

Also on the blog, Jenny Gold reports on a development regarding Adderall and healthy kids: "Doctors in Georgia are prescribing ADHD medications to help low-income children struggling in elementary school, even when they do not have an attention deficit disorder, reports a front-page article in Tuesday's New York Times" (Gold, 10/11).

In addition, Ankita Rao reports on a study about seniors' Medicare Part D spending: "Seniors spent on average $368 more than they needed to on drug coverage through Medicare Part D plans in 2009 — their decisions complicated by the sheer volume of plans available and difficulties involved in determining what makes a plan a good choice, a Health Affairs study released Tuesday has found" Rao, 10/11). Check out what else is on the blog.

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Political Cartoon: 'Go Blue?'

Kaiser Health News provides a fresh take on health policy developments with "Go Blue?" by J.C. Duffy.  

Meanwhile, here is today's health policy haikus:


Policy details?
Or trip through the looking glass?
Voters will decide.

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

Medicare Sure To Be Hot Topic In Vice Presidential Debate

News outlets offer previews of tonight's prime time exchange between Vice President Joe Biden and his GOP opponent, Rep. Paul Ryan. 

The New York Times: Six Things To Watch For In Biden-Ryan Debate
Will Mr. Ryan be tempted to repeat a staple of his and Mr. Romney's stump speech, that the president has plundered $716 billion from Medicare to pay for "Obamacare?" There is danger there. Mr. Ryan incorporated the same $716 billion savings into his House budget this spring, and he has now renounced that plan because Mr. Romney promises to "restore" the money to Medicare. Mr. Biden would love to see Mr. Ryan, a self-described "numbers guy," get lost in the weeds of budget baselines and other details that he sometimes uses to explain this discrepancy. But the trap seems too easy (Gabriel, 10/10).

The Associated Press/Washington Post: 5 Things To Watch For Thursday Night In Biden-Ryan Vice Presidential Debate
Expect to hear lots about the House Republican budget plan written by Ryan. Biden's sure to criticize Ryan's spending cuts and Medicare proposal as too extreme. Even GOP presidential nominee Mitt Romney has distanced himself from some of Ryan's more controversial ideas (10/11).

Politico Pro: Ryan Plan's Bipartisan Roots Not Very Deep
Rep. Paul Ryan vaulted to national fame and the GOP ticket by styling himself as a visionary thinker and slayer of bloated entitlements. But at Thursday's vice presidential debate, don't be surprised if he portrays his blueprint for transforming Medicare as part of a bipartisan legacy with Clintonian roots. It's become part of Ryan's standard pitch. There's just one problem: The versions that actually had a modicum of bipartisan support are distant relatives of Ryan's Medicare plan. If they ever met on the street, they might not recognize each other. Ryan, in recent campaign appearances, and Mitt Romney, at last week's debate, both talked up the bipartisan aspects of "premium support." Both have alluded to connections to Bill Clinton’s presidency (Kenen, 10/11).

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Romney Takes Moderate Position On Abortion, Causes Stir On Both Sides Of Issue

GOP presidential hopeful Mitt Romney has shifted to more moderate policy positions on a number of issues, including health care and abortion.

The Washington Post: Romney Shifts To More Moderate Stances On Taxes, Immigration, Health Care, Education
The final weeks of the presidential campaign are bringing Mitt Romney full circle, back to a question that has tugged at him for nearly two decades: What does he really believe? Although he declared himself "severely conservative" during the Republican primaries, the former Massachusetts governor has been sounding more moderate in recent days. There may be room for argument as to whether Romney's positions are changing. But the emphasis and tone with which he describes them unquestionably are — on issues that include immigration, taxes, education and health care (Tumulty, 10/10).

The Washington Post: Romney Appears To Pivot On Abortion
Mitt Romney, buoyed by recent polls that show him ahead of President Obama after a strong debate performance, appears to have modified his stance on abortion, a key issue among social conservatives, a voting bloc that has been skeptical of the Republican nominee in the past. In an interview with the Des Moines Register, Romney seemed to back away from his antiabortion position, suggesting that he would not actively pursue legislation that would outlaw abortions, a key objective among social conservatives (Henderson, 10/10).

NPR: Romney's Remarks On Abortion Cause A Stir
Just how many abortion positions does Mitt Romney have? Once again, that answer is unclear. This time the confusion began Tuesday, during a meeting with the editorial board of the Des Moines Register. "There's no legislation with regards to abortion that I'm familiar with that would become part of my agenda," Romney said. … But the comment about not pushing abortion-restricting legislation surprised those on both sides of the abortion debate (Rovner, 10/10).

The New York Times' The Caucus: Obama Campaign Says Romney Is Misleading Voters On Abortion
President Obama's campaign on Wednesday accused Mitt Romney of "cynically and dishonestly" trying to hide his real position on abortion and contraception after the Republican presidential candidate said he could not think of any abortion-related legislation that would be part of his agenda in the White House. Speaking to reporters on a conference call, Stephanie Cutter, the deputy campaign manager for Mr. Obama, scoffed at those remarks, calling them a desperate attempt to mislead voters about his real intentions on the subject (Shear, 10/10).

Bloomberg: Romney Risks Base With An Appeal To Center On Abortion
Republican presidential candidate Mitt Romney pledged to be "a pro-life president," a day after an interview in which he said he doesn't intend to pursue anti- abortion legislation if elected. "I've said time and again, I'm a pro-life candidate, I'll be a pro-life president," Romney told reporters today in response to a question as he campaigned at Bun's Restaurant in Delaware, Ohio. He also said he’d eliminate funding for Planned Parenthood in his proposed federal budget and re-impose a policy banning use of U.S. foreign aid to fund abortions abroad (Talev and Lerer, 10/10).

Politico: Ryan: Romney And I Are 'Unified' On Abortion
POLITICO's Juana Summers reports from Florida: On the day before the Vice Presidential debate, Paul Ryan told reporters here in St. Petersburg, Fla. that he wasn't disappointed by statements that Mitt Romney made to the Des Moines Register, and that his position and Romney's are "unified." "Our position's unified. Our position is consistent and hasn't changed," Ryan told a reporter outside a local ice cream shop here when asked to describe the position between his beliefs and his running mate's. ... Ryan's personal position has been different than the one he has cited on the trail as Romney's, noting that the top of the ticket sets policy. But it is just one of many areas that Joe Biden is likely to highlight when the two debate tomorrow in Kentucky (Haberman, 10/10).

The Hill: Romney Vows To Be 'Pro-Life President'
Mitt Romney sought to reassure anti-abortion-rights groups that he is on their side on Wednesday as he vowed to be a "pro-life president" if elected. "I'm a pro-life candidate. I'll be a pro-life president," Romney said Wednesday during a campaign appearance in Ohio. Romney also promised to end public health funding for Planned Parenthood — a group conservatives oppose because it provides abortions — and to bar U.S. foreign aid from funding the procedures. According to Reuters, Romney said he would stop public funds for Planned Parenthood "immediately" upon entering office. Romney's forceful comments followed an earlier interview in which Romney suggested he would not seek to limit abortion rights through legislation (Viebeck, 10/10).

The Hill: Christie Backs Romney Over Abortion Remark Flap
New Jersey Gov. Chris Christie (R) said Mitt Romney is "pro-life and deeply committed to the issue," defending the GOP nominee from accusations that he misrepresented his abortion views this week. Romney received criticism Tuesday after saying abortion legislation was "not part of my agenda." The former governor has promised to back a variety of anti-abortion measures, and his campaign later clarified that he is "proudly pro-life and will be a pro-life president." For some conservatives, the flap could recall Romney's past as a supporter of abortion rights. But Christie said Wednesday that "there is no change in position for Gov. Romney" (Viebeck, 10/10).

The Hill: Obama Camp: Romney Trying To Hide His Real Views On Abortion
The Obama campaign on Wednesday accused Mitt Romney of trying to "cynically and dishonestly" hide his views on abortion rights after he told an Iowa newspaper that he would not act to restrict them if he wins the White House. Stephanie Cutter, Obama's deputy campaign manager, said that with 26 days left until the election, Romney has realized his positions "haven't been working for him" and is shifting his views to defeat the president (Parnes, 10/10).

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With Interest In Health Care High, Presidential Candidates Represent Stark Choice In Views

A study in this week's New England Journal of Medicine notes that one in five voters views health care as this year's highest priority issue -- that's more than in any election since 1992. Meanwhile, news outlets continue to examine the policies of President Barack Obama and GOP hopeful Mitt Romney.     

The New York Times: This Election, A Stark Choice In Health Care
When Americans go to the polls next month, they will cast a vote not just for president but for one of two profoundly different visions for the future of the country's health care system. With an Obama victory on Nov. 6, the president's signature health care law — including the contentious requirement that most Americans obtain health insurance or pay a tax penalty — will almost certainly come into full force, becoming the largest expansion of the safety net since President Lyndon B. Johnson pushed through his Great Society programs almost half a century ago (Goodnough and Pear, 10/10).

Politico Pro: Survey: Interest In Health Care Highest Since 1992
One in five voters view health care as their top priority in this year's presidential election, more than any contest since 1992, according to a study published Wednesday in the New England Journal of Medicine. Relying on a Harvard University poll that gauged 1,406 likely voters' views on issues, authors Robert Blendon, John Benson and Amanda Brule reveal that Americans who rate "health care and Medicare" as a top priority skew sharply in favor of the Affordable Care Act. In fact, 41 percent say they'd be less likely to vote for a candidate who favors repealing all or part of the law, compared to 14 percent who are more likely to back such a candidate. Unsurprisingly, most who rated health care as their top issue were Democrats (Cheney, 10/10).

California Healthline: Obama, Romney Health Care Differences Detailed In Study
Republican presidential candidate Mitt Romney would dismantle most of the federal Affordable Care Act and make sweeping changes to Medicare and Medicaid, according to a study released Wednesday by UCLA's Center for Health Policy Research. The side-by-side analysis of health care proposals in the 2012 presidential contest found stark policy differences between the former Massachusetts governor and President Barack Obama, said Shana Alex Lavarreda, the report's co-author and director of UCLA's Health Insurance Studies Program (Hart, 10/11).

The New York Times: Voters Give Romney Better Grades For Leadership, Polls In 3 States Find
Mitt Romney is seen by more voters in three battleground states as a strong leader after his dominant debate performance last week, but perceptions that the economy is improving remain a buttress for President Obama as the 2012 campaign comes down to its final weeks. … The president's support is built on strengths that have been evident for months. In the two states where he holds an advantage overall, Mr. Obama has consistently outperformed Mr. Romney on a series of issues, including international affairs, health care and Medicare (Shear and Thee-Brenan, 10/11).

California Healthline: 'No Debate,' Cleveland Clinic's Great. But How To Replicate?
Despite better judgment -- or previous advice -- "Road to Reform" didn't take its own medicine and watched last week's presidential debate. And unsurprisingly, there was little new news for health wonks; President Obama and GOP challenger Mitt Romney disagreed on many policies both in and out of health care. However, there was an unexpected moment: Both men found common ground on the Cleveland Clinic, agreeing that it's one of the nation's leading health systems -- even if they disputed how it got there.  Meanwhile, the Clinic seized on the moment. The health system quickly launched a new microsite … But there is debate over whether other systems can replicate the Clinic's model, and whether Obama's or Romney's reforms can help them get there (Diamond, 10/10). 

The Washington Post: Obama Vows More Aggressive Debate Approach Against Romney
Romney advisers have called Obama's questions about their candidate's honesty evidence that the president is unable to defend his record on job creation, health care and the management of the deficit. … In the radio interview, Obama said he expected the race to turn back his way, beginning Thursday night with the vice-presidential debate. He also dismissed the Democratic angst that has followed his performance in Denver as the same misplaced doubts that dogged his campaign four years ago (Wilson and Nakamura, 10/10).

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In Debates And Ads, House And Senate Candidates Face Off On Women's Health, Medicare And Health Law Issues

Campaigns are becoming increasingly feisty as candidates spar over these charged issues.  

The New York Times: A Feisty Debate Crystallizes Differences In Tight Massachusetts Race
Elizabeth Warren and Senator Scott P. Brown kept the pressure on each other throughout a feisty, hourlong debate here Wednesday night. … Asked where he would cut the government, Mr. Brown cited President Obama's health care law, which, he said, was crushing Massachusetts businesses. He said the law would remove $700 billion from Medicare, an assertion that Mr. Romney made in last week's presidential debate (Seelye, 10/11).

Los Angeles Times: Berman, Sherman Mix It Up – Again – In Congressional Race Forum
Both supported the Affordable Health Care Act and said Wednesday that it had already provided access to healthcare for thousands of uninsured people and was a good first step.  And each said he wanted "comprehensive" immigration reform, including securing borders, providing a path to legal residency for  otherwise law-abiding illegal immigrants and sanctions against employers who hire workers without proper documentation (Merl, 10/10).

The Washington Post: Kay Coles James Featured In New George Allen Ad
Republican Senate candidate George Allen on Wednesday released a new TV ad, the second featuring Kay Coles James, his secretary of health and human resource when he was governor. … Democrats have also questioned James as a surrogate in an election in which Kaine has sought to make women's health issues a focus. As director of public affairs for the National Right to Life Committee, James opposes abortion (Vozzella, 10/10).

The Hill: McCaskill Releases Series Of Attack Ads Featuring Sexual Assault Victims
Sen. Claire McCaskill (D-Mo.) is releasing a new set of ads featuring victims of sexual assault who criticize Rep. Todd Akin's (R-Mo.) position on contraception. McCaskill's reelection campaign announced Wednesday that it would release three new ads, each featuring a different testimonial from a sexual assault victim. The ads hit McCaskill's Senate challenger for saying that the female body has ways of terminating pregnancies that are the result of "legitimate rape" as well as Akin's opposition to emergency contraception. "I'm a Republican and a pro-life mother and a rape survivor. In the hospital, I was offered emergency contraception," Diana, one of the victims, says in one of the ads. "Because of my personal beliefs, I declined. Here's what else I believe: no woman should be denied that choice. What Todd Akin said is offensive, but what he believes is worse. He would criminalize emergency contraception. I've never voted for Claire McCaskill, but because of Todd Akin, I will now" (Strauss, 10/10).

The Hill: Allen West Slams Opponent For Medicare Cuts West Backed
Rep. Allen West (R-Fla.) is attacking his Democratic opponent for supporting $716 billion in Medicare cuts — the same cuts West backed when he voted for Rep. Paul Ryan's (R-Wis.) budget plans. In a new ad, West blasts Patrick Murphy for supporting President Obama's healthcare law, which cut Medicare spending by $716 billion. The 30-second spot features seniors calling Murphy "dangerous" to Medicare. But West voted for the same reductions when he supported Ryan's last two budget plans. Both sets of cuts are aimed at extending Medicare's lifetime (Viebeck, 10/10).

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Health Reform

States, Companies And Officials Worry Over Health Law Implementation

The medical device industry and other companies are concerned about how the health law's tax and compliance provisions are affecting their bottom lines and are strategizing new ways forward to avoid the monetary hit.

CQ HealthBeat: Device Companies Strategize About How To Eliminate Tax
For medical device companies, New Year's Day will probably not be a day to celebrate. That's when a 2.3 percent tax on their products goes into effect, unless the industry can convince the Senate to go along with House-passed legislation to repeal it. Device manufacturers are doing all they can to convince senators to get on board with a repeal of the tax, which was created by the 2010 health care law. They note that the final rule for the tax has not been published yet. Even if the rule is released soon, manufacturers say the short time left before the levy takes effect will make it difficult for companies, especially those without an in-house tax adviser, to comply (Adams, 10/11).

The Hill: Conservative Think Tank Says Health Law Compliance Has Cost $27 Billion
New regulations under President Obama have cost states and private companies more than $27 billion, the conservative American Action Forum said in a new analysis. The think tank, led by former Congressional Budget Office Director Douglas Holtz-Eakin, said the equivalent of 18,000 workers nationwide will be devoted to complying with the new law. About $20 billion in new compliance costs fall to private businesses, according to the AAF paper, and another $7.2 billion fell to state governments. States must undertake new initiatives such as planning for an insurance exchange, while the total for private employers includes healthcare requirements such as calorie labeling on restaurant menus (Baker, 10/10).

State leaders against the health law are also sounding off as Mississippi's and Kansas's governors lambast the law --

The Associated Press: Gov. Phil Bryant Believes Obamacare Is Hurting State's Economy
Republican Gov. Phil Bryant says the 2010 federal health care overhaul is slowing Mississippi's economy because business owners are confused about how much it will cost them to meet demands of the law. Bryant's comments came after he spoke to more than 200 business people who were at Mississippi College for a conference about the Patient Protection and Affordable Care Act. Bryant repeated his opposition to expanding Medicaid to people at 133 percent of the federal poverty level, which the U.S. Supreme Court said is optional under the law (Pettus, 10/10).

Politico Pro: States Prep For Quick Post-Election Call On Exchanges
Kansas Gov. Sam Brownback says he won’t lift a finger to implement the Affordable Care Act before the election — and then he’ll have just a little more than a week to decide if his state should take part in one of the law’s biggest pieces. The state insurance department, though, isn’t waiting around that long to start preparing. The office of Kansas Insurance Commissioner Sandy Praeger, a Republican who favors the ACA’s exchanges, has been planning an exchange for years and is working away on an exchange “blueprint,” an application states must file with HHS next month if they want to manage at least part of its health insurance exchange (Millman, 10/10).

Stateline: Accountable Care Explained: An Experiment In State Health Policy
The Affordable Care Act and state fiscal pressures have spawned an array of new Medicaid cost containment and quality improvement schemes. Among the most ambitious is a health care delivery system whose components are called accountable care organizations (ACOs). The phrase "accountable care organization" was coined in 2006 at Dartmouth University Medical School and then adopted by an advisory board to Medicare, the federal health plan for seniors. The idea -- that health care providers could be enticed to join forces to provide better care at lower costs, while taking financial responsibility for the health outcomes of their patients -- gained prominence during the 2009 congressional debate that led to passage of the federal health law (Vestal, 10/11).

Also, Atlanta's Catholic leadership has filed another lawsuit against the health law's birth control mandate and KHN looks at the law's coverage for immigrants --

The Atlanta Journal-Constitution: Archdiocese Files Suit Over Birth Control Mandate
The Roman Catholic Archdiocese of Atlanta has joined dozens of other religious institutions to have filed lawsuits seeking to overturn the so-called birth control mandate in the Patient Protection and Affordable Care Act. The archdiocese's suit, filed in U.S. District Court in Atlanta, said the institution seeks to vindicate one of the country's most fundamental freedoms -- the right to practice one's religion without governmental interference. The government is trying to penalize all Catholic entities that refuse to pay for or facilitate access to abortion-inducing drugs, sterilization and contraception, the suit said (Rankin, 10/10).

Finally, a look at how immigrants' health coverage fares under the law -  

Kaiser Health News: FAQ: The Health Law Coverage For Immigrants
The U.S. is home to more than 21 million immigrants who are not citizens, and for many of them, health coverage is a concern. That is partly because so many of these immigrants, both those who came here legally and those who do not have permission to live in the United States, work in lower wage jobs that don’t include health coverage (Appleby, 10/11).

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Medicare Penalties For Hospital-Acquired Infections Didn't Cut Infection Rate, Study Finds

The research, reported in the New England Journal of Medicine, looked at the effect of a 2008 change that cut payments to hospitals for treating infections that patients received while hospitalized.

The Wall Street Journal: Medicare Shift Fails To Cut Hospital Infections
A high-profile Medicare policy that sought to reduce certain hospital-acquired infections by cutting payments tied to treating them turned out to have no impact, according to a new study in the New England Journal of Medicine. The study, which looked at the effect of the 2008 payment change on bloodstream and urinary-tract infections related to catheters, found "no evidence" that the shift had any measurable impact on the infections, which were already decreasing before the change went into effect. The study follows other research that has cast doubt on the effectiveness of some efforts to tie reimbursement to quality-improvement efforts in health care, an approach that is being considerably ramped up under the federal health overhaul (Mathews, 10/10).

Kaiser Health News: Study: CMS Penalties Don't Change Hospital-Acquired Infection Rates
A Medicare payment policy designed to push hospitals to cut their infection rates has had no effect in reducing two types of preventable infections among patients in intensive care units, researchers say in a study out Wednesday in the New England Journal of Medicine (Appleby, 10/10).

Medscape: Preventable Hospital Infections Not Reduced By Disincentives
The Centers for Medicare and Medicaid Services (CMS) 2008 policy to discontinue payments for certain preventable hospital infections had no measurable effect on the rates of those infections, according to an assessment of data from 398 US hospitals and health systems (Tucker, 10/10).

Modern Healthcare: Nonpayment Policy Not Impacting Infection Rates: Study
In October 2008, the CMS stopped reimbursing hospitals for 12 hospital-acquired conditions, including patient falls, late-stage pressure ulcers, air embolisms and certain health care-associated infections. Using data gathered before and after the CMS' policy change, researchers found no evidence that nonpayment had lowered rates of central line-associated bloodstream infections or catheter-associated urinary tract infections. Rates of such infections were on a downward trend throughout the study period, the authors said, but those drops could not be attributed to the federal government's hospital-acquired conditions program (McKinney, 10/10).

Medpage Today: No-Pay Policy For In-Hospital Infection Fails
(There) had already been notable decreases in hospital-acquired infections before the financial disincentive program, possibly resulting from efforts by the government, accreditors, and quality improvement organizations to minimize these preventable events, according to the researchers. ... When it became apparent that the "pay for performance" approach of increasing payments when hospitals meet quality goals was having little effect, Congress directed CMS to begin using a more punitive approach, withholding payments for adverse outcomes (Walsh, 10/10).

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Will Growing Familiarity With Medicare's Private Choices Make Seniors More Open To Premium Support?

This question is explored in a new survey and policy brief. Meanwhile, a separate study finds that seniors overspend on Medicare Part D, and their experiences may provide lessons to consider in the development of the health law's insurance exchanges.  

CQ HealthBeat: Could Seniors' Familiarity With Private Medicare Choices Lead Them To Accept Premium Support?
A Kaiser Family Foundation survey released Wednesday said that 73 percent of seniors are aware there's an open enrollment period during which they can choose among private plan alternatives to the traditional fee-for-service Medicare. That could be a sign that many seniors would be comfortable with a Medicare approach that relies more heavily on private plan choices, a Kaiser brief speculated. Whether seniors could accept such an idea is one of the hottest issues in the presidential race between Republican Mitt Romney and Democratic President Obama (Norman, 10/11). (Kaiser Health News is an editorially independent program of the Kaiser Family Foundation)

Kaiser Health News: Capsules: Study: Seniors Overspend On Medicare Part D
Seniors spent on average $368 more than they needed to on drug coverage through Medicare Part D plans in 2009 -- their decisions complicated by the sheer volume of plans available and difficulties involved in determining what makes a plan a good choice, a Health Affairs study released Tuesday has found (Rao, 10/11).

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Weekend Reading

Longer Looks: Mitt Romney's Health Care Legacy; Young Doctors And Their Apps

Every week Shefali S. Kulkarni selects interesting reading from around the Web.

PBS Frontline: The Choice 2012
A journey into the places, people, and decisive moments that made the men who are competing for the presidency. ...As governor, Romney knew he needed what political pros called a “legacy issue” if he wanted to run for president one day. He devoted his energy towards reforming health care, an issue that Democrats had been grappling with and a problem that cost the state dearly as taxpayers bore the brunt of covering the uninsured. Romney’s solution was to require that all individuals obtain health insurance, a concept known as the "individual mandate," based on a sliding scale of affordability. Over the long term, he calculated, the plan would help reduce costs. His first challenge was to get the state legislature’s Democrats on board, a task he accomplished by reaching out across the aisle for cooperation (10/9).

The Atlantic: The Grim Consequences Of Closing Urban Hospitals
In 1995, Philadelphia had 19 hospitals with obstetric units, places where local women – about half of them on Medicaid – could go for prenatal care and, ultimately, to deliver their babies. … By 2005, nine of these 19 hospitals in the city had closed, a group accounting for more than 30 percent of all of the deliveries that had taken place in Philadelphia in the mid-90s. Now, some 15 years after the spate of closures started – brought on, by most accounts, because of financial pressure – we have some better sense of what this really meant for the city. A new study, published in the journal Health Services Research, concludes that Philadelphia's newborn mortality rate temporarily increased by nearly 50 percent in the first few years after the closures began (Emily Badger, 10/10).

The Miami Herald: Competition Launches Effort To Expand School Health Care In Miami Beach
Five-year-old Sydney suffers from a peanut allergy that caused her face to swell so badly when she was a toddler that her mother thought her throat would close and her heart would stop. But due to funding woes, her Miami Beach school has no nurse on staff to treat illnesses or even scrapes and bruises — much less anaphylaxis shock. ... Though experts say the rate of disorders, allergies, diabetes and other special needs is on the rise among students, increasing the importance of school healthcare and breadth of services needed, the days when an on-campus school nurse was a given are over. In Miami-Dade County, only 157 of the county’s roughly 335 public schools — excluding charters and private schools — has a daily on-campus healthcare professional (David Smiley, 10/5).

National Journal: Medicare: The Hard Issue Just Around The Corner
[Army veteran Herb] Randall, like many 69-year-olds, is torn between protecting a benefit he thinks he and other seniors earned — Medicare — and the taming of a soaring national debt that could one day cripple the government program. He’s not sure which presidential candidate offers the better solution. “The Republican position is nobody is going to have it if we don’t reverse the spending,” he said ... But a breath later, Randall expressed just as much anxiety about the plan by GOP nominee Mitt Romney and running mate Paul Ryan to convert Medicare into a premium support program for those younger than 55. … The debate over Medicare, which simmered quietly during much of September as the campaigns focused on taxes, is about to reemerge in the presidential campaign. Earlier this week, the Obama campaign released a new ad focused on it ... The future of Medicare also will likely play a major role on Thursday night during the sole debate between Vice President Joe Biden and Ryan (Alex Roarty, 10/10).

The New York Times: Redefining Medicine With Apps And iPads
[Dr. Alvin Rajkomar] came upon a puzzling case: a frail, elderly patient with a dangerously low sodium level. ... Rajkomar had been on call for 24 hours and was exhausted, but the clinical uncertainty was "like a shot of adrenaline," he said. ... With a tap on an app called MedCalc, he had enough answers within a minute to start the saline at precisely the right rate. ... The proliferation of gadgets, apps and Web-based information has given clinicians — especially young ones like Dr. Rajkomar, who is 28 — a black bag of new tools: new ways to diagnose symptoms and treat patients, to obtain and share information, to think about what it means to be both a doctor and a patient. And it has created something of a generational divide. Older doctors admire, even envy, their young colleagues’ ease with new technology. But they worry that the human connections that lie at the core of medical practice are at risk of being lost (Katie Hafner, 10/9).

Related, earlier KHN coverage: FDA Seeks To Tame Exploding Medical App Market (Gold, 6/26)

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State Watch

State Roundup: Minn. Says Health Exchange Will Cost $40 Million

News outlets provide a selection of health care news from Georgia, Illinois, Kansas, Massachusetts, Michigan, Minnesota and Oregon.

MPR: Minn. Estimates Health Insurance Exchange Costs At $40M
Minnesota budget officials estimate it could cost the state as much as $40 million to run its health insurance exchange in 2015. The state-based online insurance marketplaces are a cornerstone of the federal health care overhaul. State officials are trying to figure out how to come up with the money. ... So far, Minnesota has received about $70 million in federal money to build its exchange — everything from designing the exchange to hiring staff to making contracts with information technology vendors (Stawicki, 10/10).

CQ HealthBeat: Illinois Company Challenges HHS Birth Control Rule
Another private firm has filed a suit against a federal rule that requires employers to provide their workers with no-cost coverage of birth control in their health insurance policies. The suit was filed by Korte & Luitjohan Contractors, Inc., of Highland, Ill., which is represented by the American Center for Law and Justice, a legal organization opposed to abortion. The suit was filed in U.S. District Court for the Southern District of Illinois, and the company owners say the federal rule — required by the health care law — violates their Catholic faith (Norman, 10/11).

Kansas Health Institute News: Brownback Officials Continue Push For Jan. 1 KanCare Launch
With deadlines looming, including one for deciding if the three managed care companies (MCOs) are ready to go, officials in the administration of Gov. Sam Brownback continue their push toward a Jan. 1 launch for the package of Medicaid reforms they call KanCare. ... Officials are scheduled to decide Oct. 19 whether the new system is developed enough so that they can begin assigning Medicaid enrollees to the MCOs' health plans (Shields, 10/10). 

Reuters: Massachusetts Seeks Compliance Statements From Pharmacies
After a nationwide meningitis outbreak was tied to drugs shipped from a plant in Massachusetts, the state is requiring all pharmacy compounders to sign a statement saying they are complying with regulations on their work, officials said on Wednesday. The Massachusetts Department of Public Health also confirmed that compounder Ameridose LLC has agreed to close temporarily (Begley, 10/10).

Detroit Free Press: Tough Michigan Immunity Law For Drugmakers May Not Apply To Meningitis Cases, Experts Say
Michigan is the only state in the country where victims of faulty drugs can't sue the drugmaker, but experts say those affected by the recent outbreak of meningitis from a fungus-tainted steroid drug compound likely will have legal recourse. The reason: the compounding companies, such as the one that produced the steroid, don't need approval from the U.S. Food and Drug Administration. The immunity law only covers drugs approved by the FDA (Walsh-Sarnecki, 10/11).

Georgia Health News: New Pricing Puts Some 'Miracle' Drugs Out Of Reach
An increasing number of health plans have gone to different pricing for biologic drugs, causing patients' out-of-pocket costs to rise by hundreds of dollars per month. [Multiple sclerosis patient Caroline] Kulinski joined patient advocates, health care professionals, industry officials and others at a Wednesday forum at Emory University to promote awareness and an advocacy campaign to address the issue of biologic drug pricing. Their goal is to get action on the issue from the state Legislature (Miller, 10/10).

The Lund Report (an Oregon news service): Petition Delays Integration Of Dental Services Into CCOs
State officials had been preparing to integrate dental services into the coordinated care organizations (CCOs) on January 1, and had finalized a memorandum of understanding to seek approval from the Centers for Medicare and Medicaid Services. But when a petition signed by two prominent legislators surfaced on Monday, things came to a sudden halt. Sen. Alan Bates (D-Medford) and Rep. Tim Freeman (R-Roseburg) joined Mike Shirtcliff, DMD, president and CEO of Advantage Dental Services, asking for an administrative rules change (Lund-Muzikant, 10/11).

The Lund Report: Advocates Want Legislature To Spend Tobacco Agreement Funds On Prevention
The Tobacco Master Settlement Agreement, signed by Oregon and 45 other states in 1998, was supposed to help the state recover some of the states’ tobacco-related healthcare costs. According to the Oregon Partners for Tobacco Prevention, formerly known as the Tobacco Free Coalition of Oregon, the state has yet to use the Tobacco Master Settlement Agreement funds as they were intended ... the state has spent or committed the majority of its share of the settlement dollars, $1 billion to date, on debt service (Scharer, 10/11).

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Editorials and Opinions

Viewpoints: Does The GOP Plan Fix A 'Broken' Medicaid System Or Harm It?; Romney's Confusion On Abortion

The Wall Street Journal: Medicaid Is Broken – Let The States Fix It
Medicaid, America's safety-net program for more than 62 million low-income uninsured Americans, is broken. ... The best hope for Medicaid reforms that can improve care for low-income enrollees, reduce fraud, and put the program on a sustainable trajectory is to cap federal spending to the states by using block grants. Block grants would offer states a predictable source of federal funding in return for broad state flexibility in Medicaid administration, benefits and copays (Paul Howard and Russell Sykes, 10/10). 

Roll Call: Trying To Make The Math Add Up On Medicaid
Finding ways to restrain future growth in health care spending is an urgent priority. But Medicaid is already far more efficient than private health programs or Medicare, in large part because reimbursement rates to providers are ridiculously low. Cutting rates to providers would be counterproductive, and needs under the program, especially for the most sick among us, are likely to grow. Repealing the health care overhaul and making Medicaid a block grant are, at best, inadequate responses (Norman Ornstein, 10/11).

The New York Times: The Wrong Way To Help The Poor 
Most Americans understand that people enter poverty for many reasons and that we have an obligation to help them get out of it. A “conservative” path of just slashing budgets isn’t going to meet that obligation, but neither is the “liberal” path of embracing every program and spending more on each. We need a third way. The changes to spending on human services and Medicaid in Mr. Ryan’s budget proposal, if not a perfect template, could be a catalyst for starting the conversation. If only it would come up at tonight’s debate (Gary E. MacDougal, 10/10). 

The Boston Globe: A Health Care Disaster
I have had the privilege of interviewing both President Obama and former Massachusetts Governor Mitt Romney about health care reform. ... I found the two key elements in each of their plans — mandated insurance and insurance exchanges to make choices easier — to be almost identical in concept. ... We in Massachusetts are fortunate to have political, insurance, and medical leaders who are committed to quality and cost control. But that is not true in many other states. And simply letting each state design its own system would be a disaster: 50 legislatures subject to the pleadings of industry lobbyists, with the lives of patients potentially at risk as a result (Dr. Tim Johnson, 10/10).

New England Journal of Medicine: Health Care Policy Under President Romney 
His fundamental policy proposal is to undo the ACA, the nation's most consequential health care reform law. His replacement proposals would provide no meaningful security to people who would lose the law's coverage protections. His Medicare and Medicaid proposals would irrevocably transform these programs. His budget and tax proposals would threaten the country's basic health infrastructure as few in living memory have done. One can only hope that if elected President, Romney would surprise the United States as he did Massachusetts (Dr. Eli Y. Adashi, John E. McDonough and Kartik K. Venkatesh, 10/10). 

New England Journal of Medicine: The Shortfalls of "Obamacare"
What is needed are reforms that create clear financial incentives that promote value over volume, with active engagement by both consumers and the health care sector. Market-friendly reforms require empowering individuals, armed with good information and nondistorting subsidies, to choose the type of Medicare delivery system they want. ... If market-friendly Medicare reform is your aim, a good place to look is the plan proposed by Senator Ron Wyden (D-OR) and Representative (and vice-presidential candidate) Paul Ryan (R-WI) — not the ACA (Gail R. Wilensky, 10/10).

The New York Times' Taking Note: Romney's Confusing Abortion Comment
Yesterday, Mitt Romney told the editorial board of the Des Moines Register: "There's no legislation with regards to abortion that I'm familiar with that would become part of my agenda." It sounded like Mr. Romney was trying to distance himself from the anti-abortion position he took during the primaries. … Andrea Saul, a spokeswoman for Mr. Romney, later told the National Review Online that "Governor Romney would of course support legislation aimed at providing greater protections for life" (Andrew Rosenthal, 10/10).

Slate: Romney's Abortion 'Agenda'
If you want to understand what will happen to the no-legislation assurance Romney gave to the Register yesterday, look at what happened to the assurances he gave to voters in Massachusetts a decade ago. In 2002, as a candidate for governor, he repeatedly promised to "preserve and protect a woman’s right to choose." After he was elected, he reinterpreted that statement as a pledge not to “change our abortion laws either to restrict abortion or to facilitate it.” This allowed him to veto pro-choice legislation. Then, as he moved on from Massachusetts and began to court pro-lifers as a presidential candidate, he reinterpreted his no-change policy this way: “Every time I faced a decision as governor that related to life, I came down on the side of life" (William Saletan, 10/10).

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Stephanie Stapleton

Andrew Villegas

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.