Daily Health Policy Report

Friday, October 12, 2012

Last updated: Fri, Oct 12

KHN Original Reporting & Guest Opinion

Campaign 2012

Capitol Hill Watch

Health Care Marketplace

Health Policy Research

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

VP Debate: Two Visions For Medicare (Video)

In this Kaiser Health News video clip, Vice President Joe Biden and Rep. Paul Ryan laid out their parties' competing visions for Medicare at the vice presidential debate in Danville, Ky. Watch the video or read the transcript.

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VP Debate: How Faith Informs The Candidates On Abortion (Video)

In this Kaiser Health News video clip from last night's vice presidential debate, Biden and Ryan talked about how their Catholic faith informs their stances on abortion. Watch the video or read the transcript.

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Chris Christie Considers New Medicaid Math

WNYC's Fred Mogul, working in partnership with Kaiser Health News and NPR, writes: "As a way to reduce the number of uninsured, states are being encouraged to set more generous income limits for Medicaid as part of the Affordable Care Act. If states comply, they can get 100 percent federal funding in the first three years, declining to 90 percent funding over time. Typically, states and the federal government share the burden at a ratio that's closer to 50-50" (Mogul, 10/11). Read the story.

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Capsules: Medicare, Medicaid, CHIP All Targets For Fraud

Now on Kaiser Health News' blog, Alvin Tran reports: "When it comes to health care fraud, medical facilities and hospitals are the top two offenders. That's according to a new Government Accountability Office report released this week" (Tran, 10/12). Check out what else is on the blog.

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Political Cartoon: 'Til Death (Or Co-pays) Do Us Part?'

Kaiser Health News provides a fresh take on health policy developments with "Til Death (Or Co-pays) Do Us Part?" By David Fitzsimmons.  

Meanwhile, here is today's health policy haiku:

ROMNEY'S ANSWER FOR THE UNINSURED

Question continues...
Where's care without insurance?
It's in the ER.
-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

In Vice Presidential Debate, Biden And Ryan Clash On Health Issues

In this face-off, the two candidates outlined very different sets of policies and perspectives on issues ranging from their respective Medicare plans to the uninsured and abortion.  

Los Angeles Times: Vice Presidential Debate Gets Prickly On Healthcare
As the candidates for vice president parried, Ryan accused the Obama administration of "getting caught with its hand in the cookie jar," and Biden charged that the plans proposed by Ryan and former Massachusetts Gov. Mitt Romney would privatize Medicare and wind up cutting benefits for younger people as they approached retirement age (Landsberg, 10/11).

The Wall Street Journal: Understudies Give Viewers A First-Rate Performance
But once the debate got to the differences between the two parties on spending, entitlements and taxes, the sparks flew. The two men couldn't agree any more than their parties have over the past four years. The vice president portrayed Republicans as opposed to the crown jewels of the Democratic Party, Social Security and Medicare. … He found ways to repeatedly drive home the fact that he has been around a lot longer than his 42-year-old Republican opponent. He invoked his dealings with Ronald Reagan, and with the late House Speaker Tip O'Neill. He charged that Republicans put two wars on a credit card. Through it all, Mr. Ryan stood his ground and gave back without flinching, giving as good as he got. He marshaled facts and figures and the details he has mastered as the Republicans' budget wunderkind (Seib, 10/12).

The New York Times: Night Of Withering Ripostes, Mostly Delivered By Biden
It was a sharp and spirited debate, with both candidates delivering some lacerating blows, but Mr. Ryan at times seemed disconcerted by the sheer blowhard intensity Mr. Biden brought to the night. Mr. Ryan tried to be respectful, listening to the vice president with a tilted head, choirboy smile and puppy-dog eyes, but he showed his irritation when Mr. Biden kept interrupting to attack his policy on Medicare. "I know you're under duress," he told the vice president, prompting another belly laugh (Stanley, 10/12).

The New York Times: Biden Vs. Ryan: No Shy People Onstage
On critical issues, Mr. Ryan did not shy from his and his party's plans to fundamentally alter Medicare. And while Mr. Romney had played down the benefit of the ticket's tax plan for the wealthy, his running mate fell back on Republican orthodoxy, defending "small businesses" and rich households from what he suggested was the rapacious reach of President Obama. …  Mr. Biden was equally steadfast, accusing Mr. Ryan of shifting a health care burden borne for decades by the government onto the elderly, and playing the populist on taxes (Weisman, 10/11).

The Associated Press: Biden, Ryan Focus On Health Care, Economy
At odds early and often, Joe Biden and Republican Paul Ryan squabbled over the economy, taxes, Medicare and more Thursday night in a contentious, interruption-filled debate. "That is a bunch of malarkey," the vice president retorted after a particularly tough Ryan attack on the administration's foreign policy. "I know you're under a lot of duress to make up for lost ground, but I think people would be better served if we don't interrupt each other," Ryan said later to his rival, referring to Democratic pressure on Biden to make up for President Barack Obama's listless performance in last week's debate with Mitt Romney (10/12).

Meanwhile, news outlets examined the number Ryan used regarding how many people could lose their health insurance once the health law kicks in -  

The Wall Street Journal's Washington Wire: Inside Paul Ryan's Health Insurance Number
Ryan's closing statement included a claim that 20 million people are projected to lose their health insurance once the Obama health law takes effect. That figure likely comes from a possible scenario mentioned deep into this March 2012 set of estimates by the non-partisan Congressional Budget Office that contemplates what employers might do after 2014 when many will be penalized for not providing insurance but can also look to new options such as subsidies towards the cost of premiums for private insurance or Medicaid coverage for low-income workers (Radnofsky, 10/11).

The Washington Post: Fact Check: Losing Health Insurance
What does Ryan mean when he says 20 million Americans will lose their health insurance under Obamacare? … The CBO cautions that there is a "tremendous amount of uncertainty" about how employers and employees will respond to the legislation. "One piece of evidence that may be relevant is the experience in Massachusetts, where employment-based health insurance coverage appeared to increase after that state's reforms," the CBO noted. Mitt Romney, as governor, ushered in health-care legislation that served as a model for Obama's health plan (Kessler, 10/11).

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VP Candidates Spar Over Medicare Plan Specifics

During last night's face off, Vice President Joe Biden and GOP vice presidential hopeful Paul Ryan offered different plans, visions and, sometimes, even numbers for Medicare's future.  

The New York Times: Bipartisan Spin On Medicare Plan
As Representative Paul D. Ryan debated Vice President Joseph R. Biden Jr. on Thursday night, he sometimes seemed to be defending his own past budget and Medicare proposals as much as his running mate's plans — sometimes in misleading ways (Cooper, Weisman and Schmitt, 10/12).

Politico: Medicare Cage Match: Biden Vs. Ryan
Joe Biden and Paul Ryan say they want the same thing for seniors: to make sure Medicare and Social Security are still around for future generations. ... In their vice presidential debate Thursday night, Biden accused Ryan and Mitt Romney of trying to dismantle the companion retirement programs. Ryan countered that Biden and President Barack Obama would let them die from neglect. Their hot exchanges lit up the debate hall and illuminated just how hard the two campaigns are fighting over the votes of senior citizens, particularly in swing states, like Florida and Ohio, where their votes could be crucial on Election Day (Allen, 10/10).

NPR: Biden, Ryan Bent The Truth At Times, Fact Checkers Say
As expected, Vice President Biden and GOP vice presidential nominee Paul Ryan both crossed through some heavily disputed territory. They argued over the $716 billion in reduced Medicare spending that's part of the affordable health care law. And they traded barbs over whether the Republican ticket's plan for overhauling Medicare is a "voucher" program that would effectively replace the guaranteed benefit (Memmott and Montgomery, 10/ 11).

Los Angeles Times: Fact Check: Ryan Misrepresents Effect Of His Medicare Plan
Rep. Paul D. Ryan claimed inaccurately that the Medicare plan he and Gov. Mitt Romney have proposed would preserve seniors' access to the current Medicare program and would not affect  current retirees (Levey, 10/11).

Politico Pro: What Biden And Ryan Said, And What They Meant
What Ryan said: "If you reform these programs for my generation, people 54 and below, you can guarantee they don't change for people in or near retirement, which is precisely what Mitt Romney and I are proposing." Why he said it: Romney and Ryan need seniors to feel protected from any changes to the Medicare benefits they're already enjoying. Romney also needs to preserve the power of his other charge: That unlike his plan, President Barack Obama does cut Medicare for current seniors. What he didn't say: If future retirees start switching to private plans ... some analysts have warned that seniors in traditional Medicare will have trouble finding doctors. ... What Biden said: "We cut the cost of Medicare. We stopped overpaying insurance companies, doctors and hospitals. The AMA supported what we did. AARP endorsed what we did." Why he said it: The best defense against Ryan's attacks on Obama's Medicare cuts is to point out that two respected nationwide groups ... supported the health care law. What he didn't say: AARP has asked the Obama administration to stop using its name to promote the law (Nather, 10/11).

National Journal: What AARP Has To Do With Vice Presidential Debate Between Biden And Ryan
There are two things to know about one of Washington's biggest advocacy groups, AARP, and tonight's vice presidential debate. First is that the organization doesn't endorse presidential candidates. Second is that AARP is a sponsor of tonight's clash between Joe Biden and Paul Ryan at Centre College in Danville, Ky. So, the advocacy group that represents nearly 37 million members doesn't have a horse in this race? Not exactly. "Our goal is to get these candidates to really talk about these issues a little more fully than they have in the past," AARP Senior Vice President John Hishta told the Alley (Catalini, 10/11).

Modern Healthcare: Medicare Heats Up Biden-Ryan Debate
Medicare was one of the biggest flashpoints during the election's first and only vice presidential debate Thursday night. The Medicare segment of the debate included some of the most frequent interruptions by both Vice President Joe Biden and Republican vice presidential candidate Rep. Paul Ryan (R-Wis.) in a testy debate as each took turns bashing the other side's impacts on the program. Ryan blasted the Patient Protection and Affordable Care Act for cutting $716 billion from Medicare's growth over the next 10 years and for creating the Independent Payment Advisory Board to reduce future Medicare growth (Daly, 10/11).

Politico Pro: Biden, Ryan Clash Over Medicare
Vice President Joe Biden used Thursday night's debate to tell seniors to judge for themselves whether they have more benefits under the health care law, dismissing Paul Ryan's criticism of the law as the same thing he heard from Sarah Palin four years ago. "Any senior out there, ask yourself, do you have more benefits today? You do," Biden said. "If you're near the doughnut hole, you have $600 more to help your prescription drug costs. You get wellness visits without co-pays. They wipe all of this out, and Medicare becomes insolvent in 2016." Medicare and the health care law sparked some of the feistiest arguments in the vice presidential debate Thursday night (Haberkorn, 10/11).

Medscape: Biden, Ryan Come Out Swinging On Medicare In Debate
In their one and only debate, Vice President Joe Biden and Republican vice presidential nominee Paul Ryan (R-WI) tonight tried to portray each other as Medicare wreckers, and themselves as Medicare saviors. ... For his part, Ryan remained cool and firm despite Biden's rhetorical fire, interruptions, and good-natured cackling. ... Ryan repeated the Romney charge that the Affordable Care Act (ACA) cut $716 billion from Medicare to pay for "Obamacare." Biden countered that the cuts did not affect seniors' benefits, which he said have grown under the law. "Do you have more benefits today," he asked, looking at the television camera. "You do." He cited lower costs in the Medicare Part D drug program and free wellness visits as examples (Lowes, 10/12).

The Hill: Biden On Medicare: 'Who Do You Trust?'
Vice President Biden and Rep. Paul Ryan (R-Wis.) clashed Thursday night over Medicare, as Biden charged that Republicans have never cared much for the program. "These guys haven't been big on Medicare from the beginning," Biden said. Ryan, the architect of House Republicans' controversial plan to partially privatize Medicare, sought to personalize the issue, and opened with an assault on the $716 billion in Medicare cuts in President Obama's healthcare law. "Medicare and Social Security are going bankrupt. These are indisputable facts," Ryan said (Baker, 10/11).

The Washington Post: Fact Check: That Medicare Debate
While it is correct that anticipated savings from Medicare were used to help offset some of the anticipated costs of expanding health care for all Americans, it does not affect the Medicare trust fund. Ryan, as House Budget Committee chairman, probably knows he's playing a rhetorical game here. Federal budget accounting is so complex that it is easy to mislead ordinary Americans — a tactic used by both parties (Kessler, 10/11).

Medpage Today: Biden, Ryan Trade Barbs And Claims
Dueling plans for the future of Medicare took stage Thursday night in the only vice presidential debate, with the candidates' words mostly reflecting their campaigns' messages thus far. Vice President Joe Biden denounced the Republican plan to transform Medicare into a premium-support model for those 54 and younger, saying it would shift the escalating costs of healthcare away from the government and onto beneficiaries. Rep. Paul Ryan (R-Wis.) countered by charging that the Obama-Biden approach is bankrupting Medicare (Pittman, 10/11).

The Medicare NewsGroup: Biden, Ryan Debate The Best Fix For Medicare's Future
Medicare heated up the October 12 vice presidential debate as Vice President Joe Biden and Congressman Paul Ryan sparred over the best way control Medicare costs, extend the program's life, and protect the benefits of future beneficiaries. Ryan repeated the often-heard claim that the Obama administration cut Medicare by $716 billion through the Affordable Care Act (ACA). Biden defended the law—the Obama administration’s signature domestic achievement--saying it extends the life of Medicare by guaranteeing solvency through 2024 while giving seniors enhanced benefits such as wellness visits, certain cancer screenings and shrinking out-of-pocket costs for prescription drugs. Ryan said the best way to protect Medicare is by reforming the program for future beneficiaries (Szot, 10/11).

The Medicare NewsGroup: Timeline: The History Of Premium Support
Although premium support is currently a point of heated debate between Democrats and Republicans, the concept has a history of bipartisan collaboration. The timeline below shows how the premium support concept progressed from a bipartisan reform approach to a deeply partisan issue (10/11).

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Biden, Ryan Face Questions About Abortion And Faith

Both candidates explained how their Catholic background helped to shape their policy views, including on abortion. News outlets reported that, based on answers from Vice President Joe Biden and GOP vice presidential pick Paul Ryan, it was clear that both were aiming to the larger, much sought-after audience of female voters.   

The Washington Post: On Abortion, Paul Ryan Articulates Position Different From Earlier One
An exchange at the end of Thursday night's vice presidential debate illustrated the complex — and, at times, difficult-to-reconcile — positions taken by the Republican ticket on the issue of abortion. Moderator Martha Raddatz asked Rep. Paul Ryan (Wis.), the GOP vice-presidential nominee, how a Mitt Romney administration would handle that issue: "Should those who believe that abortion should remain legal be worried?" (Fahrenthold, 10/12).

Los Angeles Times: Abortion: A Brief Quiet Moment In The Vice Presidential Debate
The exchange neatly summarized part of the debate roiling within the Roman Catholic Church in the U.S., with the men landing on opposite sides. Biden stressed his concern for caring for the vulnerable -- the Catholic social doctrine -- while Ryan held firm to his belief that life begins at conception. But it was clear the candidates were aiming to reach far beyond Catholic viewers. Female voters are in a position to decide the victor in November, and both men were playing for those votes as they cast their positions as middle-of-the-road (Hennessey, 10/11).

The Washington Post: Biden, Ryan Talk Abortion, Catholic Social Teaching In Vice-Presidential Debate
During their only debate this campaign season Thursday night, Vice President Joe Biden and Congressman Paul Ryan (R-Wis.) discussed how their Catholic beliefs have shaped their views on abortion (Hunter, 10/11).

The Hill: Biden, Ryan Spar Over US Abortion Rights
The next president's Supreme Court appointments could determine whether abortion remains legal, Vice President Biden said Thursday night. "The next president will get one or two Supreme Court nominees, that's how close Roe v. Wade is," Vice President Joe Biden said. His opponent, Rep. Paul Ryan (R-Wis.), did not directly answer a question from debate moderator Martha Raddatz about whether abortion-rights supporters should be "worried" about a Romney-Ryan administration. The Republican vice presidential nominee reiterated that he opposes abortion rights except in cases of rape, incest and when the life of a pregnant woman is at stake (Baker, 10/11).

Politico Pro: Fact Check: Biden, Ryan Off On Contraception Rule
Joe Biden and Paul Ryan clashed on the Obama administration policy on contraception coverage — and neither one of them was totally accurate in describing the current state of play in the controversy. Ryan asserted that churches, religious hospitals and institutions would be required to cover birth control in their employee health plans, even if they objected on moral grounds (Kenen, 10/11).

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Romney Hints At Plan For Pre-existing Conditions, Lack Of Health Coverage

During a meeting with the Columbus Dispatch, GOP presidential hopeful Mitt Romney offered a comment about people who lack insurance which is being characterized by some news outlets as "controversial." Romney plans to repeal the health law but says uninsured people could still visit an emergency room and that people with preexisting conditions could keep their insurance. On this point, however, he has yet to provide specifics, news outlets report.

NPR: Romney: People Don't Die For Lack Of Insurance
Another day, another editorial board, another controversial remark for Republican presidential nominee Mitt Romney. On Wednesday, it was abortion. On Thursday, health care. … But Romney was talking about something slightly different in Ohio: the idea that the U.S. doesn't have people who become ill or die because they don't have insurance. That, however, is belied by a large and growing body of academic studies, starting with a landmark study from the nonpartisan Institute of Medicine in 2002 that found 18,000 people died in the year 2000 because they lacked health insurance (Rovner, 10/11).

Los Angeles Times: Romney Offers Clue On Coverage For Pre-existing Conditions
Romney has never said what he would do with people who did not have continuous coverage, but he offered a new clue in an interview that was published Thursday. "Romney, in a meeting with The Dispatch's editorial board, said those who currently don't carry insurance would have a chance to make a 'choice' to be covered without fear of being denied," according to the Columbus (Ohio) Dispatch. But, according to the paper, he did not elaborate on how these people would gain coverage (Mehta, 10/11).

The Hill: Romney Defends Plan To Repeal Obama Health Care Law
Repealing President Obama's health care law would not keep people from getting insurance or quality care, GOP presidential nominee Mitt Romney said Wednesday. In an interview with the editorial board of the Columbus Dispatch, Romney defended his plans to repeal the health care law, saying the uninsured could still visit an emergency room and that people with preexisting conditions could keep their insurance. "We don't have a setting across this country where if you don't have insurance, we just say to you, 'Tough luck, you're going to die when you have your heart attack,'" Romney said. "No, you go to the hospital, you get treated, you get care, and it's paid for, either by charity, the government or by the hospital," he said…The comment drew criticism from the Obama campaign, which said it showed Romney did not understand the struggles of middle-class families that lack insurance (Viebeck, 10/11).

President Barack Obama delivered a high-energy campaign speech amidst his preparation for the next debate --  

The New York Times: After Fiery Florida Rally, Obama Focuses On Debate Work
Mr. Obama, when he wants, is light years more effective on the stump than he is in a debate hall. At the University of Miami, the president was energized, displaying the fire that he did not show during the debate. He worked the audience, making people laugh and cheer. And he directed zinger after zinger at Mr. Romney. Mr. Romney, the president charged, "is trying to go through an extreme makeover."  … He chuckled. "Suddenly, he loves the middle class. Can't stop talking about them. He loves Medicare, loves teachers. He even loves the most important parts of Obamacare," he said, referring to the health care overhaul (Cooper and Gabriel, 10/11).

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Women's Health, Medicare And The Health Law Mark Tight Races In Various States

The fireworks continue in Senate and House races in Massachusetts, Connecticut, Nevada, Florida and New York.

The New York Times: A Feisty Debate Crystallizes Differences In Tight Massachusetts Race
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. "That's the same playbook that Mitt Romney used a week ago tonight," Ms. Warren said. "It was wrong then, it’s wrong tonight." But generally, Ms. Warren did little to link Mr. Brown to Mr. Romney or to the Republican Party (Seelye, 10/11).

CT Mirror: Round Two: McMahon, Murphy Stick To The Familiar
With well-practiced moves and occasional flashes of spontaneity, Democrat Chris Murphy and Republican Linda McMahon counter-punched over each other's character, intellectual depth and commitment to women's reproductive health Thursday night in their second U.S. Senate debate. Murphy scored the only applause line of the night when McMahon launched into an ill-timed attack on his ethics: At the time, she was responding to a question about whether personal attacks are crowding out issues. … Murphy countered by tying the issue of reproductive health care to the economy -- and to her status as an independently wealthy woman who can afford to spend an estimated $75 million so far on two runs for U.S. Senate (Pazniokas, 10/11).

The Associated Press: Heller, Berkley Spar On Health Care, Immigration
Republican Sen. Dean Heller and Demo­cratic challenger Rep. Shel­ley Berkley quarreled over health care, immigration and tax breaks for oil companies in the second debate of their acrimonious campaign Thursday night. The encounter began with Heller proposing the candidates treat each other "respectfully" -- a notable request after millions of dollars of slashing, personal attack ads and a contentious first debate in Reno last month (Riccardi, 10/12). 

Newshour (Video): Medicare Is Battle Cry For Both Sides In Tight House Races In Fla., N.Y.
In our new Battleground Dispatches series, Todd Zwillich of Public Radio International's "The Takeway" reports from Florida and New York, where Medicare is not only a hot topic in the general election, but crucial to clinching some close congressional races (10/11).

In addition, the Los Angeles Times offers a profile of Elizabeth Emken, the GOP candidate challenging Democratic Sen. Diane Feinstein in California --  

Los Angeles Times: Autism Activism Led Elizabeth Emken To Become GOP Senate Candidate
Recent opinion polls show Feinstein, who has held her seat for two decades, leading the little-known Republican Emken by more than 20 percentage points. Feinstein, who has declined to debate her opponent, also is winning the campaign finance contest, having raised $12.7 million to Emken's $389,000 in the most recent filing period. But Emken, who after years as a parent advocate launched the lobbying arm of a national group called Autism Speaks, is persisting. "It's what I do," she said. "I take on daunting tasks" (Romney, 10/12).

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Capitol Hill Watch

Capitol Hill Fights Over Health Law, EHR Doc Payments Continue

Lawmakers on Capitol Hill sound off on the Obama administration's "meaningful use" payments to doctors as the fight over parts of the health law and its oversight and D.C's insurance exchange continue.

Medscape: House GOP Urges Halt To EHR Bonuses
Federal bonuses for "meaningful use" of electronic health records (EHRs) have become a political football, with House Republicans calling for their immediate suspension and health care groups rising to their defense. Last week, four powerful House Republicans told US Department of Health and Human Services (HHS) Secretary Kathleen Sebelius in a letter that "insufficient standards" for EHR meaningful use have left physicians and other providers with systems that cannot "talk with one another." They urged Sebelius to suspend incentive payments until HHS issues "universal interoperable standards." ... The letter from the GOP congressmen provoked a rebuttal the next day from the Healthcare Information and Management Systems Society (HIMSS), a large trade organization for professionals and vendors in that field (Lowes, 10/11).

The Hill: Waxman Protests 'Partisan' GOP Oversight Of Health Law
Rep. Henry Waxman (D-Calif.) charged Thursday that House Republicans haven't been fair with their investigations into part of President Obama's health care reform law. Waxman, the top Democrat on the powerful Energy and Commerce Committee, criticized GOP investigations into contracts with public-relations firms to help raise awareness of new benefits stemming form the legislation. Former President George W. Bush also spent millions of dollars on Medicare-related advertising, and House Republicans were silent, Waxman said (Baker, 10/11).

Politico Pro: Johnson Questions D.C. Exchange Rules
A Senate Republican responsible for oversight of the District of Columbia says the city's new exchange format goes beyond the scope of the health law and restricts residents' right to keep their insurance. "The decision to force individuals and small groups into a government-run exchange violates their freedom to negotiate, contract and retain their current health insurance plan," Sen. Ron Johnson, the top Republican on the Senate Homeland Security and Governmental Affairs Committee's D.C. subcommittee, wrote in a letter Thursday to D.C. Mayor Vincent Gray. The D.C. exchange could prove to be a new battleground in the political fight over the health reform law. The District is pursuing an aggressive model of the health reform law, but frequently finds itself confined by a Congress that controls its pocketbook (Haberkorn, 10/11).

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Health Care Marketplace

Wal-Mart Expanding Program For No-Cost Employee Surgeries

Wal-Mart announced this week that it will expand a program that ends out-of-pocket procedure and travel costs for employees seeking some heart and spine surgeries if they go to hospitals across the country that have agreements with the retailer.

Reuters: Wal-Mart To Pay For Heart And Spine Surgery For U.S. Employees
Wal-Mart Stores Inc is offering its U.S. employees and their families free heart and spine surgeries at six major health centers at no cost to the retailer's workers, as it tries to find better ways to cover costly, complicated procedures. Starting in January, workers and dependents enrolled in Wal-Mart's medical plans will receive free consultations and care for certain heart and spinal procedures along with travel, lodging and food for the patient and a caregiver (Wohl, 10/11).

Cleveland Plain-Dealer: Wal-Mart To Send Employees To Cleveland Clinic For Heart Care
As the cost of medical care continues to rise across the country, the nation's largest employer, Wal-Mart Stores Inc., is hoping to turn the tide by seeking out the best medical deals for its workforce across the country. And for heart care, many of their employees will be headed to the Cleveland Clinic (Zeltner, 10/12). 

The Dallas Morning News: Wal-Mart Turing To Medical Tourism To Lower Employee Health Costs
Wal-Mart Stores Inc., the nation's largest employer, will jump into medical tourism next year by offering insured employees no-cost heart and spine surgeries at Temple's Scott & White Memorial and seven other hospitals across the country. Health care cost pressures are pushing companies toward narrowing the number of physicians and hospitals covered by their insurance policies. Since 1996, for example, Wal-Mart has urged employees and their dependents to use the Mayo Clinic's three hospitals for organ transplants (Landers, 10/11).

Modern Healthcare: Walmart Expands Program For Workers' Out-Of-Pocket Costs
Walmart said it would expand a program that eliminates out-of-pocket costs and covers travel expenses for its workers who seek care at certain hospitals. Walmart, which first launched the program in 1996 for transplant surgery, said it expanded the effort to include certain heart and spine surgeries. "In providing this service at no cost to its enrolled associates, Walmart has worked with these Centers of Excellence health systems to provide exclusive and unique bundled pricing arrangements for these types of procedures," the company said in a news release. Mayo Clinic locations in Rochester, Minn., Scottsdale, Ariz., Phoenix and Jacksonville, Fla., will offer transplants under the program (Evans, 10/11).

See related Kaiser Health News coverage: Latest Destination For Medical Tourism: The U.S. 

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Health Policy Research

Research Roundup: Medicare Open Season Awareness

KHN reporters Ankita Rao and Alvin Tran compiled a selection of recently released health policy studies and briefs.

Cancer Epidemiology, Biomarkers, & Prevention: Boston Patient Navigation Research Program: The Impact Of Navigation On Time To Diagnostic Resolution After Abnormal Cancer Screening – Researchers tested the effectiveness of using patient navigation programs with women who have abnormal breast or cervical cancer screenings. These programs aim to facilitate treatment by such things as arranging financial support, transportation to appointments, child care or interpreter services.  Researchers found that women with abnormal cervical or breast cancer screenings who received patient navigation had a significant decrease in time to diagnosis. They conclude: "Patient navigation may address cancer health disparities by reducing time to diagnosis following an abnormal cancer-screening event" (Battaglia et al., 10/2012).

Archives Of Internal Medicine: Variation In Use Of High-Cost Diabetes Mellitus Medications In The VA Healthcare System – To determine if the Veterans Affairs (VA) hospital system "may serve as a model of efficient use of prescription drugs," researchers "examined national VA data for over 1 million outpatients with diabetes mellitus (DM) to understand how prescribing of high-cost medications varies across facilities." They found substantial variations across 139 facilities. According to the authors, factors specific to each VA facility may be the root of the variations in the use of high-cost drugs (Gellad et al., 10/8).

Georgetown University Health Policy Institute/The Commonwealth Fund: Child-Only Coverage And The Affordable Care Act: Lessons For Policymakers -- The authors of this analysis write: "The Affordable Care Act prohibited insurers from denying or limiting coverage for children under the age of 19 in 2010. In response, some insurers ceased to offer coverage to children in need of individual health insurance, known as a 'child-only' policy." They found that 22 states and the District of Columbia have taken action to promote child-only coverage.  Kentucky, for example, saw 268 children enrolled in child-only coverage in 2012 after requiring insurers to offer the policies during open season. The authors say the findings "suggest the need for meaningful regulatory incentives to avoid market disruption in successfully implementing broader reforms in 2014" (Keith, Lucia and Corlette, 10/2012).

The Kaiser Family Foundation: Senior’s Knowledge And Experience With Medicare’s Open Enrollment Period And Choosing A Plan -- Researchers surveyed seniors about Medicare's 2013 open enrollment period, Oct. 15 - Dec. 7. "During this time, the Medicare program encourages beneficiaries to review their benefits and coverage options, including traditional Medicare, private Medicare Advantage plans, and Medicare Part D prescription drug plans." They found that "one in four seniors say they are unaware of this annual opportunity to review and change their Medicare coverage, with even larger shares who say they unaware of Medicare's open enrollment period among blacks and Hispanics and those seniors in fair or poor health, with low incomes, and without a high-school diploma" (Cubanski and Damico, 10/10).

Here is a selection of news coverage of other recent research:

Medscape: Racial Disparity in HIV Mortality Hits Less Educated Hardest
Blacks with a high school education or less continue to die from HIV at much higher rates than whites of any education level, despite the emergence of treatment that has reduced overall mortality, according to a study published online October 8 in the Archives of Internal Medicine. Edgar P. Simard, PhD, MPH, senior epidemiologist, Surveillance Research Program, American Cancer Society, and colleagues looked at National Vital Statistics System records of 91,307 HIV deaths among people aged 25 to 64 years between 1993 and 2007 (Laidman, 10/8).

Medscape: Obesity Medicine Certification Needed, Endocrinologists Say
The American Association of Clinical Endocrinologists (AACE) has released a position statement in which it calls for specialized education in obesity medicine, a certification program, and shared strategies to combat obesity. Jeffrey I. Mechanick, MD, a clinical professor of medicine, endocrinology, diabetes, and bone disease at the Mt. Sinai Hospital in New York City, and colleagues presented the position statement in an article published online October 9 in Endocrine Practice. More than simply an excess of body fat, obesity is a primary disease state, the authors write (Brown, 10/10).

Medpage Today: Hospital Scores: Change Formula, Change Rank
Hospital rankings on readmissions and early deaths are strongly influenced by the calculation methods that are used, researchers found. Changing just two key factors -- adjustment for patient case mix and number of admissions per patient included -- led to a variation in individual hospital rankings by an average 29% of the total score, Carl van Walraven, MD, MSc, of the Ottawa Hospital Research Institute and University of Ottawa in Ontario, and colleagues reported online in CMAJ (Phend, 10/11).

Medpage Today: Post-Hospital Choice Can Save Medicare Billions
Directing Medicare beneficiaries into the most cost-efficient setting possible after a hospital stay could save the program $35 billion to $100 billion over the next decade, the Alliance for Home Health Quality and Innovation, a home care trade association, reported Wednesday. "This isn't a silver bullet to fix Medicare but it could make a difference," Rep. David McKinley (R-W.Va.) said at a press conference where the report was issued. "Better post-acute care leads to less frequent hospital readmissions, plain and simple" (Frieden, 10/10).

Reuters: Climate Linked To California ER Visits
The risk of heading to the emergency room for certain conditions, such as heart disease, diabetes, stroke, kidney disease and low blood pressure rises slightly as temperature and humidity increase, according to a new study from California. Researchers also found that for a few conditions, including aneurysm and high blood pressure, higher temperatures were tied to a drop in ER visits (Grens, 10/5).

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State Watch

State Highlights: N.J.'s Medicaid Decision; La. Hospitals Seek Care Gap Agreement

A selection of health policy stories from New Jersey, Texas, Louisiana, Minnesota and California.

Kaiser Health News: Chris Christie Considers New Medicaid Math
WNYC's Fred Mogul, working in partnership with Kaiser Health News and NPR, writes: "As a way to reduce the number of uninsured, states are being encouraged to set more generous income limits for Medicaid as part of the Affordable Care Act. If states comply, they can get 100 percent federal funding in the first three years, declining to 90 percent funding over time. Typically, states and the federal government share the burden at a ratio that's closer to 50-50" (Mogul, 10/11). Read the story.

The Texas Tribune: Study: Women To Lose Care If State Nixes Planned Parenthood
Women's access to affordable health care will be reduced if the state follows through with its plan to eschew federal funding for the Women's Health Program and create a state program instead, according to a new study from George Washington University. The study, a follow-up to a May report from the university on Texas women's health, examines the impact of excluding Planned Parenthood from the state Women's Health Program in Bexar, Dallas, Hidalgo, Lubbock and Midland counties (10/11).

The Associated Press: Louisana DHH Seeks Agreements To Fill Gaps In Hospital Services
A week after $152 million in cuts were levied across the LSU public hospitals, Health and Hospitals Secretary Bruce Greenstein said Thursday that no new, formal arrangements have been reached with private hospitals to pick up the care. But Greenstein and LSU hospitals chief Frank Opelka said in a joint interview that they're having solid discussions with private health care facilities to identify ways they might collaborate on services and medical training programs or possibly take over management of a university hospital (10/11).

Minneapolis Star Tribune: Minnesota Hospitals Are Testing Ways To Reduce Return Trips
Ruth Ratajczak knew that the elderly man was in trouble. … For more than a year, Allina and other hospitals throughout Minnesota have been experimenting with ways to smooth those transitions as part of a statewide collaborative called RARE (Reducing Avoidable Readmissions Effectively). And they're making progress: Since January 2011, Minnesota hospitals collectively have reduced readmissions by about 2,600, according to the Minnesota Hospital Association (Lerner, 10/11).

California Healthline: How Should Exchange Handle Vision And Dental Coverage?
Along with medical coverage, state-run health insurance exchanges under the Affordable Care Act have the option of offering vision and dental coverage. This summer, the California Health Benefit Exchange elected not to offer stand-alone vision plans. That brought a chorus of criticism and now the exchange is planning to revisit that decision. The Affordable Care Act provides some guidelines for vision and dental coverage -- guidelines that differ for children and adults. But as it does with medical coverage, the ACA leaves the details pretty much up to state officials. We asked stakeholders and consumers how the California Health Benefit Exchange should handle dental and vision coverage (10/11).

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Editorials and Opinions

Viewpoints: Debate Provided 'Meaty' Political Conversation; Looking For Obama's Plan On Medicare

The New York Times: A Debate With Clarity And Fervor
Thursday night's vice-presidential debate was one of the best and meatiest political conversations in many years, showing that real differences on public policy can be discussed with fervor, anger, laughter and real substance. In contrast to the dismal meeting last week between President Obama and Mitt Romney, this debate gave voters a chance to evaluate the positions of the two tickets, in part because Representative Paul Ryan’s nonanswers were accurate reflections of his campaign (10/12). 

USA Today: Biden, Ryan Put On A Partisan Show
It was for all immediate purposes a draw ... Nowhere were their differences more stark than on the issue of Medicare. Biden attacked Ryan's plan to end the traditional program and have the government write checks to people to buy private insurance. Ryan fired back that Obama's health care overhaul took too much money out of the program for seniors. What neither of them was willing to say is that sacrifices will be needed no matter what approach is taken and who is elected president. They also sparred over abortion rights, with Biden making a point that has gone largely unremarked during this campaign -- that the next president could determine the future of Roe v Wade through Supreme Court appointments (10/12).

The Wall Street Journal: The Bully Vs. The Wonk
Mr. Ryan was stronger on domestic issues, calmly laying out the facts of Mitt Romney's proposals on taxes, Medicare and job creation. Even here, though, the debate devolved into an exchange between Mr. Ryan's policy details and Mr. Biden's free-association appeals to emotion and class solidarity—"Who do you trust on this?" On nearly every specific issue on which Mr. Biden attacked, he was demonstrably wrong. The Administration's Medicare actuary really does say that 15% of hospitals will take on operating deficits as a result of ObamaCare's cuts in payments to Medicare providers (10/12). 

The Washington Post: The Biden-Ryan Show: Good TV But A Dull Debate
But Mr. Biden, too, dodged and obfuscated, particularly on entitlement spending and the debt. "They haven't put a credible solution on the table," Mr. Ryan said of the Obama-Biden ticket on entitlement reform, and he was correct. "Their ideas are old and their ideas are bad, and they eliminate the guarantee of Medicare," Mr. Biden said of the Republicans (10/11).

Los Angeles Times: Vice Presidential Debate: Biden's Mission Accomplished
Still, Biden had one mission, and he accomplished it: to stanch the Democrats' near-panic after Obama's lackluster performance in Denver last week. With a steady diet of old-fashioned Democratic talking points, the vice president did just that. It wasn't subtle; he brought up Romney's dismissal of 47% of the American public as moochers no fewer than four times. For the liberal base, Biden's traditional defenses of Medicare, Social Security and taxing the rich were pure catnip. For undecided voters, they may have been less convincing (Doyle McManus, 10/11).

The Washington Post: VP Debate: Biden Seemed Real, Ryan Plastic
Biden's great triumph was in his effort to show concern. He came out of his corner as the champion of the great and sacrosanct middle class. He cited his mother several times – a bit of a George M. Cohan number, if you ask me – but he pulled it off. He would defend Social Security to the death; Medicare and Medicaid, too (Richard Cohen, 10/11).

The Washington Post: Joe Biden And The 'Seniors Enigma'
Watching Joe Biden hammer Paul Ryan on Medicare before looking into the camera and saying "listen to your instincts, folks," I couldn't help thinking – if Democrats have their classic case well in place on Medicare (and Social Security), why did the last Pew poll have Romney beating Obama 58-37 among seniors? (Matt Miller, 10/12).

The Wall Street Journal: Filiblustering Joe
The judgment of the late-night pundits was that Mr. Biden had done well for his party, and helped to right the Obama ship. Note, however, that Mr. Biden didn't get those accolades because he had made a better case to Americans on jobs or entitlement reform or deficit-cutting. Mr. Biden barely offered any positive argument for how the administration he serves would revive a dismal economy, or reform the Medicare or Social Security programs that are going bankrupt, or fix soaring deficits (Kimberley A. Strassel, 10/12).

Kansas City Star: Yes, Mr. Romney, Americans Die For Lack Of Health Insurance
Poor Mitt Romney. In trying to be all things to all people on health care, he has found himself stuck in a time warp. The Republican presidential nominee, supposedly a new man after his sparkling debate performance last week, has not completely abandoned his clueless ways ... Romney amazingly and wrongly said that Americans don't die for lack of health insurance. ... Oh yes we do, Mr. Romney. This nation has millions of people who become ill because they can’t afford preventive medicine. We have sick people who can’t get well because they can’t afford medications (Barbara Shelly, 10/11).

The New York Times: Multiple Choice Romney
I don't think people expect consistency any longer. It’s considered quaint. ... As for Romney, the best summation of his flip-flopping was provided by Ted Kennedy in a 1994 debate in Massachusetts: "I am pro-choice," Kennedy said, before adding of Romney, "My opponent is multiple-choice." The subject then was abortion and Romney declared, "I believe that abortion should be safe and legal in this country." In response to Kennedy's jibe, he shot back, "You will not see me wavering on that or being multiple-choice." The subsequent wavering has, of course, been more of a volte-face. Romney is now pro-life (Roger Cohen, 10/11).

JAMA: Reproductive Freedom And The 2012 Presidential Election
With the 2012 presidential election just weeks away, there can be little doubt that reproductive freedom hangs in the balance. For one, the next president will be selecting ideologically compatible nominees to a Supreme Court that has repeatedly restricted abortion rights in the last few years. For another, the next president, working with the legislative branch, could well reorder the status quo. President Obama has spoken through his actions over the last 4 years. Far less clarity exists as to Governor Romney’s positions, in light of lingering ambiguities and influence from a resurgent Tea Party (Dr. Eli Y. Adashi and I. Glenn Cohen, 10/11).

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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.