Daily Health Policy Report

Tuesday, October 2, 2012

Last updated: Tue, Oct 2

KHN Original Reporting & Guest Opinion

Campaign 2012

Health Reform

Capitol Hill Watch

Medicare

Coverage & Access

Quality

Health Care Marketplace

Health Information Technology

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Drug Coupons: A Good Deal For The Patient, But Not The Insurer

David Schultz, reporting for Kaiser Health News in partnership with The Washington Post, writes: "A magazine ad for the testosterone drug AndroGel shows a discount card that allows consumers to pay 'as little as $10 per month' for the medicine. Drugmaker GlaxoSmithKline announces in another magazine that it offers discount coupons for the popular inhaler Advair. And a TV commercial for Nexium notes that if consumers can't afford the heartburn drug, its manufacturer, AstraZeneca, 'may be able to help'" (Schultz, 10/1). Read the story.

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Insuring Your Health: Insurance Dependents Can Face Special Challenges On Privacy

In her latest Kaiser Health News consumer column, Michelle Andrews writes: "Elizabeth Nash was 21 and just finishing her junior year at the College of William & Mary when she had a miscarriage. She planned to tell her parents about it in person, but her insurer beat her to it when, as a matter of routine, it mailed them a form that described the medical treatment she'd received" (Andrews, 10/1). Read the column.

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Capsules: For Patients, What A Difference A Note Makes

Kaiser Health News: Capsules: For Patients, What A Difference A Note Makes
Now on Kaiser Health News' blog, Jenny Gold writes: "Doctors are required by federal law to provide patients with a copy of their medical notes upon request, but few patients ask and doctors generally don't make the process easy" (Gold, 10/2). Check out what else is on the blog.

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Political Cartoon: 'J'Accuse!'

Kaiser Health News provides a fresh take on health policy developments with "J'Accuse!" by Adam Zyglis.

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

ODE TO THE WASHINGTON NATIONALS

Nats win NL East.
For a sec, even we wonks
focus on baseball!
-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

Debate Primer: 'A Mere 15 Minutes' Set Aside To Cover Lots Of Differences On Health Policies

News outlets set the scene for some of the tough health policy questions the two presidential candidates might face during tomorrow night's debate. And new ads about the health law and women's health issues have been unleashed.  

Medscape: Obama-Romney Debate: Readers Pose Tough Questions
The first presidential debate of 2012 between Republican challenger Mitt Romney and President Barack Obama, scheduled for tomorrow night, allots a mere 15 minutes to the subject of healthcare … A number of Medscape readers asked Romney what he would substitute for the ACA if he became president and delivered on his promise to repeal the law. "Be specific!!!!!!" one physician demanded. Other readers wanted him to explain why he opposed the ACA even though it was modeled after the healthcare reform he enacted in Massachusetts when he was governor (Lowes and Berry, 10/2).

The MedicareNewsGroup: Debate Primer: Get Up To Speed On Obama, Romney And Medicare Reform
[W]ith health care and economics on the list of discussion topics Medicare will possibly take center stage. ...  Here's a round-up of MNG content that will tell you all you need to know about Romney, Obama, vice presidential candidate Paul Ryan and their plans to revamp Medicare (10/1).

CNN: Romney Ties Obama To Pelosi In New Ad
Mitt Romney's campaign and the Republican National Committee aligned President Barack Obama with House Democratic Leader Nancy Pelosi in a new television ad Tuesday, one day before the year's first presidential debate (Killough, 10/2).

The Hill: Romney Ad: Obama Health Law Raised Taxes On The Middle Class
"Who will raise taxes on the middle class?" a narrator asks, as a picture of President Obama and House Minority Leader Nancy Pelosi (D-Calif.) pans across the screen. "Barack Obama and the liberals already have. To pay for government-run healthcare, you’ll pay higher taxes and more for your medicine" (Sink, 10/2).

The Hill: Planned Parenthood Launches Anti-Romney Blitz In Colorado
Planned Parenthood Action Fund (PPAF) and Planned Parenthood Votes (PPVotes) are planning a slew of anti-Romney messaging efforts with a special focus on Denver, the location for the domestic-policy debate. The groups have been actively involved in this year's presidential race, endorsing President Obama and running ads against Romney, who has promised to end Planned Parenthood's public funding (Viebeck, 10/1).

Meanwhile, coverage also details how Medicare proposals could play in the swing states, as well as some  cost and coverage numbers associated with Mitt Romney's health proposals.

The Hill: Ryan: Medicare Reform Proposal Won't Hurt Ticket In Swing States
The Medicare reforms proposed in a budget plan by Paul Ryan won't hurt the Republican presidential ticket in swing states, the Wisconsin lawmaker said Monday. Ryan's comments come as recent polling shows Mitt Romney and Ryan trailing President Obama on Medicare in key swing states. A Gallup poll from late September found that in 12 battleground states more voters felt Obama's healthcare reform law would better handle the problems facing Medicare (Strauss, 10/1). 

Politico Pro: Report: Romney Plan Leaves 72M Uninsured
Mitt Romney's health care plan wouldn't just insure fewer people than "Obamacare" — it would make the uninsured problem worse than it would have been if the law had never passed ... The analysis by the Commonwealth Fund, a New York-based health care research foundation, found that under Romney's health care plan, the uninsured population would soar to 72 million by 2022 — 12 million higher than if nothing had been done at all. ... [the] report is based on research by MIT economist Jonathan Gruber, who worked on both the federal and Massachusetts health reform laws (Norman, 10/2).

NBC: Romney Health Plan Would Cost US, Group Says
If President Barack Obama stays in office, just 27 million will go without insurance and costs will fall, the group predicts. There are a lot of caveats in the report issued Tuesday by the group, which does research in support of a “high-performing” health system. Romney would also need a friendly (read Republican-dominated) Congress to roll back health reform, and he hasn’t given very many details of his health plan (Fox, 10/1).

NewsHour (Video): What's At Stake In The Candidates' Different Visions For Medicaid
The firestorm over how to make Medicare more sustainable has consumed the health care debate this election season, but Medicaid, its counterpart for low-income, disabled and elderly Americans, actually covers more people. Hari Sreenivasan looks at how the candidates' two drastically different proposals offer reform (10/1). 

Politico Pro: Mass. Dems Sent To Praise 'Romneycare'
Two Massachusetts Democrats, at the urging of the Obama campaign, will hit the trail this week to talk up Romney’s proudest achievement as governor: the near-universal health care law he signed in 2006. ... Massachusetts House Majority Leader Ron Mariano and State Rep. Steven Walsh are headed to Nevada Wednesday and Thursday to shower praise on the law. The pair plans to contrast Romney's work on the state health law with his clarion call to repeal the ACA and to expand the role of private insurers in Medicare (Cheney, 10/1).

Meanwhile, health issues are playing in a gubernatorial race - 

The Associated Press: N.H. Gov. Candidates Debate Health Care
Though similar parental and professional experiences guide their views, the candidates for New Hampshire governor take very different approaches when it comes to health care policy. Democrat Maggie Hassan has an adult son with severe disabilities and has served as legal counsel for several hospitals. Republican Ovide Lamontagne has an adult foster son with special needs and also has represented numerous hospitals as a business lawyer. Both cited those backgrounds Monday during an hour-long debate (Ramer, 10/2).

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Health Reform

Obama Administration Urges States To Pursue Health Law Medicaid Expansion

Even as federal officials push states to expand Medicaid programs, at least a dozen states are not ready or not willing to set up state-based health exchanges -- another aspect of the health law that is key to expanding insurance coverage.  

The New York Times: Administration Advises States To Expand Medicaid Or Risk Losing Federal Money
The Obama administration is putting pressure on states to expand Medicaid, telling them they may lose federal money if they delay. But at the same time, federal health officials have also told states that if they choose to expand Medicaid, they are free to reverse the decision at any time (Pear, 10/2).

The Washington Post: Many States Not Prepared For Health-Care Law
More than three dozen states could be unprepared or unwilling to set up the insurance marketplaces called for under the 2010 health-care law, leaving at least part of the task up to the federal government, according to a new report. But many of the rest of the states are behind in their planning or have decided not to operate exchanges on their own, according to a report from the Health Research Institute (Somashekhar, 10/2).

Meanwhile, various news outlets report on developments related to essential health benefits -

Politico Pro: EHB Drug Coverage Bests ACA Minimums So Far
Patient advocates and House Democrats have complained the skimpy one-drug-per-class standard HHS pitched in December's EHB bulletin falls short of the Affordable Care Act's promise for comprehensive coverage. But an Avalere analysis of eight of the plans already submitted to HHS showed that states’ benchmarks cover a much broader scope of drugs than the administration's minimum requirement (Millman, 10/1).

The Associated Press/Register-Herald: W. Va. Questions HHS On Essential Benefits
West Virginia officials are questioning another major provision of the federal health care overhaul, this one calling on states to set basic levels for 10 categories of services that many insurance policies must cover. Gov. Earl Ray Tomblin wrote U.S. Health and Human Services Secretary Kathleen Sebelius on Friday, posing seven questions regarding benchmarks for essential health benefits (Messina, 10/1).

Related, earlier KHN story: States Move Ahead On Defining 'Essential' Health Insurance Benefits (Galewitz, 9/30)

And a California report forecasts a not-so-positive view of the future -

California Healthline: Millions Will Fall Though ACA Cracks In California, Report Predicts
As many as four million Californians could remain uninsured after all national health reforms are in place, and about half of them will be eligible for subsidized coverage but not enrolled, according to a new report.  National reform will bring health coverage to millions of previously uninsured Californians through the expansion of Medi-Cal and creation of subsidized insurance through the new Health Benefit Exchange. However, millions still will fall through the cracks, say authors of a joint report from the UC-Berkeley Center for Labor Research and Education and the UCLA Center for Health Policy Research (Lauer, 10/1).

St. Louis Beacon: At Issue: Two Years After ACA Becomes Law, Debate Over Costs And Responsibility Continues
[The] ACA hasn’t been popular in Missouri. On August of 2010, voters across the state gave strong support to Proposition C, in effect repudiating a federal mandate that people buy health insurance or be fined. ...Two sessions ago, a bill to set up an affordable insurance exchange won bipartisan approval in the Missouri House. But the measure never came up for a vote in the Senate. In November, voters will have a chance to have their say once again on the exchange issue (Joiner, 10/1).

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Liberty University Hopes To Revive Health Law Challenge

The school says its suit raises questions not answered by the Supreme Court in its June decision and is asking the high court to order an appeals court to hear the case. 

Politico: 'Obamacare' Lawsuit Tries to Set Up Path To SCOTUS
Is President Barack Obama's health care law headed back to the Supreme Court? Not now — but one of the law's opponents could be trying to set up a path to allow the court to take up some unfinished business. Liberty University is asking the Supreme Court to order a federal appeals court to hear the issues it has raised in its own lawsuit — issues it says weren't resolved when the Supreme Court upheld the law this summer (Haberkorn and Cheney, 10/1).

The Hill: Supreme Court Asks DoJ To Weigh In On Reviving Health Care Suit
The Supreme Court is weighing whether it should revive a religious university's lawsuit over President Obama's healthcare reform law. Liberty University is trying to revive its lawsuit against the Affordable Care Act. The Supreme Court declined to hear an appeal in that case after its landmark healthcare ruling this summer, but Liberty says its case presents different issues and should get a new hearing in a lower court (Baker, 10/1).

Medpage Today: Supreme Court May Look At ACA Again
The Supreme Court began its new term Monday, and the Affordable Care Act (ACA) -- the subject of the decision that so dramatically wrapped up its last term -- is still on its agenda. The court has given both the Obama administration and Liberty University 30 days to file responses in the case known as Liberty University v. Geithner. In that case, two of the plaintiffs -- Michele Waddell and Joanne Merill -- have decided not to buy health insurance, a decision that would require them to pay a penalty beginning in 2014 under the ACA's so-called individual mandate (Frieden, 10/1).

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Capitol Hill Watch

Senate Leaders Working On Post-Election Plan To Avoid 'Fiscal Cliff'

The New York Times reports that a bipartisan group is trying to find a path to a deficit reduction deal, but Democrats and Republicans still remain far apart on details.

The New York Times: Leaders At Work On Plan To Avert Mandatory Cuts
Senate leaders are closing in on a path for dealing with the "fiscal cliff" facing the country in January. ... First, senators would come to an agreement on a deficit reduction target -- likely to be around $4 trillion over 10 years -- to be reached through revenue raised by an overhaul of the tax code, savings from changes to social programs like Medicare and Social Security, and cuts to federal programs. Once the framework is approved, lawmakers would vote on expedited instructions to relevant Congressional committees to draft the details over six months to a year (Weisman, 10/1).

Meanwhile, several members of Congress are scrutinizing an HHS plan as well as reports about overpricing on Medicare drugs --

Politico Pro: GOP Docs Knock Error-Reporting Plan
Several Republican physicians are pushing back on a new HHS proposal that would allow people to self-report medical errors, arguing that the policy doesn't consider that people can't always identify what is or is not an error. "While it is important to understand the subjective patient experience of care, it would be inaccurate to use this information as an objective standard of care," the lawmakers wrote in a letter to Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality. ... The letter was signed by Sens. Tom Coburn and John Boozman and Reps. Bill Cassidy, Ron Paul, Phil Gingrey, Paul Broun, John Fleming and Phil Roe (Haberkorn, 10/1).

CQ HealthBeat: Grassley Scrutinizes North Carolina Hospitals' Use Of Medicare Outpatient Drug Program
The Senate Judiciary Committee's top Republican, Charles E. Grassley, is pressing North Carolina hospitals to answer questions about whether they are abusing the 340B Medicare outpatient drug program, which is intended to lower drug prices for the uninsured poor. Grassley, of Iowa, wrote to Carolinas Medical Center, Duke University Health System and the University of North Carolina Hospital after newspaper reports said they were inflating prices on chemotherapy drugs. The investigation by The News & Observer in Raleigh and The Charlotte Observer found that hospitals "mark up prices on cancer drugs two to 10 times or more over cost," according to a Sept. 22 article (Adams, 10/1).

Modern Healthcare: Grassley Seeks Answers From Hospitals On Drug-Discount Program
Sen. Charles Grassley (R-Iowa) requested information from two hospitals and a health system in North Carolina about how they are using the 340B federal drug discount program. The request is in response to media reports that the providers -- 402-bed Carolinas Medical Center in Concord, 786-bed University of North Carolina Health Care in Chapel Hill and the three-hospital Duke University Health System in Durham – have charged more for certain cancer drugs, compared with prices charged by community oncologists (Lee, 10/1).

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Medicare

Study Finds Medicare May Favor Skilled-Nursing Facilities Over Hospice

According to findings published in the Archives of Internal Medicine, almost a third of Medicare beneficiaries getting end-of-life care use their benefits to pay for nursing home services.

Reuters: Do Seniors Turn To The Right Places At The End Of Life
A new study says almost one third of Medicare's beneficiaries use the program to pay for end-of-life care at nursing homes, which may not be equipped to treat or prevent pain and suffering. Those palliative care services are usually associated with hospice care, while nursing homes are typically for rehabilitation and long-term care (Seaman, 10/1).

Modern Healthcare: Medicare Benefit Structure May Favor SNFs Over Hospice Care, Study Finds
The benefit structure of Medicare and Medicaid may encourage post-hospitalization Medicare beneficiaries to go into skilled-nursing facilities instead of hospice, even though hospice may be more appropriate, according to a study published online by the Archives of Internal Medicine. The study of more than 5,100 Medicare patients found that of patients who lived in the community and had used Medicare's SNF benefit, 42% died in a nursing home, while of those patients who lived in the community and hadn't used the SNF benefit, only about 5% died in a nursing home (Barr, 10/1).

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Coverage & Access

Post Office's Retiree Health Benefits Hole Gets Deeper

The New York Times: Distress Deepening, Postal Service Defaults On $5.6 Billion Benefits Payment
The Postal Service sank deeper into debt on Monday after the agency defaulted on a $5.6 billion payment due at the end of September, the second time it has missed a deadline this year to set aside money for its future retiree health benefits (Nixon, 10/1).

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Quality

Census Reports Americans Go To The Doctor Less Often

A study of working-age people found that the average number of doctor appointments dropped from 4.8 visits a year in 2001 to 3.9 visits in 2010.

The New York Times: Doctor Visits Dropping, New Census Figures Show
Americans of working age are going to the doctor less frequently than they were 10 years ago, according to a new report by the Census Bureau. In 2010, people age 18 to 64 made an average of 3.9 visits to doctors, nurses and other medical professionals, down from 4.8 visits in 2001, said the report, which was released on Monday (Tavernise, 10/1).

Houston Chronicle: Strapped Americans Skipping Doctor Visits
Buffeted by the sluggish economy and rising insurance co-payments and deductibles, working-age Americans are visiting the doctor less frequently. New U.S. Census Bureau data released on Monday showed that non-retired adults made an average of 3.9 visits to doctors or other medical providers in 2010, down from 4.8 in 2001. The decline was reflected in those insured and uninsured, in excellent health and poor health, and in all surveyed ages, ethnicities and sexes (Ackerman, 10/1).

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Study Finds Access To Doctors' Notes Helps Patients Manage Their Health

Consumers are more likely to understand health issues and maintain medication schedules.

The Wall Street Journal: Access To Doctors' Notes Aids Patients' Treatment
Patients who have access to doctor's notes in their medical records are more likely to understand their health issues, recall what the doctor told them and take their medications as prescribed, according to a study published Monday (Landro, 10/1).

Kaiser Health News: For Patients, What A Difference A Note Makes
Doctors are required by federal law to provide patients with a copy of their medical notes upon request, but few patients ask and doctors generally don't make the process easy (Gold, 10/2).

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Health Care Marketplace

Washington Post Buys Major Stake In Celtic Healthcare Inc.; Tenet Plans Buybacks

News outlets report on these health business developments.

The Wall Street Journal: Washington Post Branches Into Health Care
Post Co. said Monday it would buy a majority stake in Celtic Healthcare Inc., a closely held provider of hospice and home health care in Pennsylvania and Maryland. Terms of the deal weren't disclosed, although one analyst, Sheryl Skolnick of CRT Capital Group, said average valuations suggests the deal could have been worth at least $50 million. That is a drop in the bucket for Post Co., which has a market capitalization of $2.7 billion (Hagey, 10/1).

The Wall Street Journal: Hospital Operator Tenet Plans Buybacks
The Dallas-based company plans to offer $800 million in new debt to fund deals and repay other borrowings. Tenet—which aims to add acute-care hospitals, outpatient facilities and business-process services—said its near-term acquisitions are expected to total about $400 million (Kamp, 10/1).

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Health Information Technology

Clouds And Venture Capital: Both Sides Of Health Technology News

NPR reports on how cloud computing is changing the health care industry, as Reuters notes that venture capital funding for health technology is getting harder to raise.   

NPR: Cloud Computing Saves Health Care Industry Time And Money
The cloud's vast computing power is making it easier and less expensive for companies and clinicians to discover new drugs and medical treatments. Analyzing data that used to take years and tens of millions of dollars can now be done for a fraction of that amount. ... when information is stored on the cloud, it's easier for researchers to collaborate (Kaufman, 10/1).

Reuters: Venture Capital For Medical Technology Harder To Come By: Report
Venture capitalists, long the lifeblood of medical technology firms, are growing cautious on the sector after seeing their returns squeezed in a time of growing cost pressures for healthcare, a report by Ernst & Young said. While venture capital investment levels have stayed fairly steady over the past five years, those funds were mostly raised before the financial crisis (Kelly, 10/2).

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State Watch

State Roundup: AP Probes Va. Hospital's Actions In Woman's Death

A selection of health policy stories from Nebraska, Missouri, Virginia, California, Kansas and Minnesota.

The Associated Press/Washington Post: Investigation Of Woman's Care At Va. Hospital Mired In Bureaucracy, Confusing Reports
An Associated Press examination of her care highlights the dizzying array of federal, state and private agencies charged with regulating hospital care, and the differing standards they use when investigating the most serious cases of possible neglect. In addition, an investigation report filed by Virginia regulators appears to have been altered to delete parts of the report that substantiated most of the family's complaints. That prompted a former top federal regulator to say the case warrants further investigation (10/1).

The Associated Press/Washington Post: Supreme Court Won't Hear Challenge In Nebraska Abortion Case
The Supreme Court won't reconsider a decision stopping a Nebraska anti-abortion group from fighting for an abortion law that requires health screenings for women seeking abortions (10/1).

Politico Pro: Missouri Employer To Appeal Contraception Ruling
A Missouri company plans to file an appeal Monday after a district court judge dismissed its lawsuit against the Obama administration's contraception requirement, according to a lawyer for the company. On Friday, District Judge Carol E. Jackson found that requiring employers to cover contraception imposes no substantial burden on religious exercise for plaintiffs Frank O'Brien and O'Brien Industrial Holdings LLC, which mines and distributes refractory and ceramic materials (Smith, 10/1).

Kansas Health Institute News: AAAs To Take On Assessments Of In-Home Medicaid Needs
Officials at the Kansas Department for Aging and Disability Services today signed a contract with the Southwest Kansas Area Agency on Aging, putting the organization in charge of determining which Medicaid-funded services are needed to keep the state's low-income frail elderly, physically disabled or brain-injured out of nursing homes. Southwest Kansas AAA Executive Director Dave Deist said the agency intends to subcontract for the same services with the other 10 AAAs throughout the state (Ranney, 10/1).

California Healthline: Access, Capacity Concerns For CBAS
California's Community Based Adult Services program officially launches today, the culmination of a long and contentious effort to first eliminate and then replace the Adult Day Health Care program. There were roughly 36,000 recipients of ADHC services when the governor first proposed eliminating it as a Medi-Cal benefit in January 2011. ... According to Department of Health Care Services officials, about 80 percent of former ADHC beneficiaries now can receive CBAS benefits (Gorn, 10/1).

Minnesota Post: Feds Give $21 Million For Phase 2 Of Minnesota Veterans Home Upgrade
The Department of Veterans Affairs in Washington will spend $21 million to help build a 100-bed skilled-nursing facility at the Minnesota Veterans Home. Work on the project -- which is Phase 2 of a major update of the Veterans Home in Minneapolis -- will start in the spring. The first phase of the project, a new skilled-nursing facility and an adult day center, was completed in August. A third phase will add even more modern care facilities (Kimball, 10/1).

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Editorials and Opinions

Viewpoints: David Brooks' 'Brutal Truth;' What To Ask The Candidates At Their First Debate; Putting Medicare On A Budget

The New York Times: The Opening Statement
The third big problem is Medicare and rising health care costs, which are bankrupting this country. Let me tell you the brutal truth. Nobody knows how to reduce health care inflation. There are two basic approaches, and we probably have to try both simultaneously. The first, included in Obamacare, is to have an Independent Payment Advisory Board find efficiencies and impose price controls. The problem is that that leaves the painful cost-cutting decisions in Washington, where Congress rules. … The second approach, favored by me, is to scrap the perverse fee-for-service incentives and use a more market-based approach. … I'm willing to pursue any experiment, from any political direction, that lowers costs and saves Medicare (David Brooks, 10/1). 

Medpage Today: What I'd Ask Obama And Romney
If I were the moderator of Wednesday night's first presidential debate -- scheduled to be devoted to domestic issues including health care -- the single question I would most want to ask of both candidates is this one: How is it possible that the U.S., which is the richest country in the world, is the only developed country on this planet that has not figured out how to provide basic health insurance to all its citizens? It certainly is NOT because we don't spend enough money on healthcare (Dr. Timothy Johnson, 10/1).

The New York Times: Mr. Romney's Government Handout
The biggest beneficiaries of government largess are not those who struggle along on Social Security payments, Medicare or Medicaid benefits, or earned-income tax credits, despite what Mitt Romney has told his donors. Rather, they are those at the highest end of the income scale: government contractors, corporate farmers and very rich individuals who have figured out how to exploit the country's poorly written tax code for their benefit (10/1). 

The Washington Post: Paul Ryan's Budget Flimflam
The Republican ticket says it could pay for its tax cut by eliminating loopholes. But the biggest loopholes are popular: the exclusion from taxation of employer-sponsored health insurance and the deductions for mortgage interest, charitable contributions and state and local taxes. Pressed by the assiduous Mr. Wallace about which of these Mr. Ryan would limit, the nominee pleaded a lack of time. "It would take me too long to go through all of that," he said (10/1). 

The Hill: Medicare's Status Quo: No We Can't
Politicians have promised Medicare benefits worth $37 trillion over the next 75 years. But that huge amount of benefits isn't paid for, and so those promises will not be kept. That is why Republicans and Democrats agree -- albeit usually in private -- that a major reform of this health care program for the elderly is necessary. And on one narrow point, there is bipartisan consensus: Medicare must be put on a budget (Robert E. Moffit, 10/1).

Bloomberg: The Flaws That Will Bring Down Obama's Health Care Plan
Obama's plan makes tax credits available to people who get health insurance from exchanges set up by state governments. If states don't establish those exchanges, the federal government will do so for them. The federal exchanges, however, don't come with tax credits: The law authorizes credits only for people who get insurance from state-established exchanges. And that creates some problems the administration didn't foresee, and now hopes to wish away (Ramesh Ponnuru, 10/1).

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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.