Daily Health Policy Report

Wednesday, October 3, 2012

Last updated: Wed, Oct 3

KHN Original Reporting & Guest Opinion

Campaign 2012

Health Reform

Capitol Hill Watch


Health Care Marketplace


Swing State Trailmix

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Medicare Revises Hospitals' Readmissions Penalties

Kaiser Health News staff writer Jordan Rau reports: "Medicare's new readmission penalties for hospitals just got a bit tougher. The Centers for Medicare & Medicaid Services has discovered errors in its initial calculations in August. As a result, 1,422 hospitals with comparatively high readmission rates will lose slightly more money than they were expecting, according to a Kaiser Health News analysis of the revised penalties. Fifty-five hospitals will lose less than were previously told" (Rau, 10/2). Read the story.

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Hospitals Need Networks To Prevent Readmissions

Colorado Public Radio's Eric Whitney, working in partnership with Kaiser Health News and NPR, reports: "A paradox of American health care is that hospitals are sometimes rewarded for doing things badly. Patients who are discharged, for example, shouldn't have to come right back because their conditions get worse when they go home. But if they do come back, hospitals benefit, because they can fill an empty bed and bill for more care" (Whitney, 10/2). Read the story.

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Capsules: Study: Newly Insured Patients Are Likely To Be Healthy; States Requiring Broader Drug Choices Than Skimpy Federal Limit; Medicaid Stars In New Obama Campaign Ad; Some 'Bingo' Fun For Debate Season

Now on Kaiser Health News' blog, Julie Applebly reports on a new study regarding the health law's newly insured: "Good news for insurers: 88 percent of people new to health coverage after the health law fully goes into effect will be in relatively good health.  That means providers won't be overwhelmed, at least initially, says a report out today by PricewaterhouseCoopers" (Appleby, 10/2).

Also on the blog, Phil Galewitz reports on how states are handling certain minimum benefit rules set by the federal government: "When the Obama administration set initial rules last December to determine what minimum benefits insurers must offer in plans sold to individuals and small groups starting in 2014, one provision stood out: Insurers selling small group and individual policies would have to provide at least one drug per class of drug. In other words, insurers could cover just one drug for cholesterol, one for high blood pressure or one drug for attention deficit disorder" (Galewitz, 10/2).

In addition, Galewitz reports on a new Obama campaign ad: "At last, Medicaid is getting some respect. Medicaid, not Medicare, is the subject a new television campaign advertisement for President Barack Obama.The 30-second ad is being broadcast in five election battleground states — Colorado, Virginia, Nevada, Iowa and Ohio. It accuses GOP presidential nominee Mitt Romney of supporting the plan passed by the GOP-led House of Representatives that cuts $800 billion from Medicaid, the state-federal health insurance program for the poor and disabled, over the next 10 years" (Galewiz, 10/3).

And, in anticipation of tonight's presidential debate, Kaiser Health News offers a way enhance debate with a health policy version of BINGO: "Kaiser Health News feels your pain (so to speak).  And we're here to help.  Jim Lehrer, the moderator of the debate, has promised to devote a segment to health policy issues.  There's no better way to help you stay focused on the questions and answers than with a good, old fashioned game of BINGO.  Or in this case, DEBATE-O" (10/2). Check out what else is on the blog.

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Political Cartoon: 'Take Two Tablets And Call Me In The Morning'

Kaiser Health News provides a fresh take on health policy developments with "Take Two Tablets And Call Me In The Morning" by Arend van Dam.

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


How to stay awake
during the Denver debate?
-KHN Editors

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

Health Policies Will Play Role In Debate's Political Theater

As new polls show a narrow margin separating them, President Barack Obama and Mitt Romney will face questions on their plans for Medicare, Medicaid and overhauling the health system during tonight's debate. The focus will be on domestic policy, and at least 15 minutes will be dedicated to health care.   

The Wall Street Journal: Race Tightens In 2 States As Ohio Gap Widens
Biting into President Barack Obama's lead over the past three weeks, Mr. Romney trails the president by a single percentage point among likely voters in Florida and by two points in Virginia, the new Wall Street Journal/NBC News/Marist Poll surveys show. Both races are statistical dead heats, as Mr. Obama's leads fall within the surveys' margin of error. But Mr. Romney trails by eight percentage points among likely voters in Ohio (Murray, 10/3).

The New York Times: Claims Likely To Surface In Debate And Facts Behind Them
Both candidates agree that the health care program for older Americans, the single-biggest contributor to projected deficits, cannot continue growing at current rates. They disagree on how, and how much, to curb it. Mr. Romney favors shifting from the open-ended, fee-for-service Medicare program to one giving each beneficiary a fixed annual amount to buy private insurance or a Medicare option. … Mr. Obama, who says Mr. Romney would "voucherize" the program, instead backs marginal changes, including lower payments to providers of health care like doctors and insurers (Calmes and Harwood, 10/2).

The Associated Press: First Debate Sets Up Moment Of High-Risk Theater
The central role of the economy in this election is evident in the topics selected for the first three of the night's six debate segments: The Economy I, The Economy II and The Economy III. The last three segments will focus on health care, the role of government and governing (Hunt and Benac, 10/3).

On the lighter side -

Kaiser Health News Capsules blog: “Health Savings Accounts”? I Have Bingo!
There’s no better way to help you stay focused on the questions and answers than with a good, old fashioned game of BINGO. Or in this case, DEBATE-O. The game card below is filled with terms that the two candidates might use to describe their own plans and to attack their opponent’s plans. Each time you hear a word or phrase that’s on your game card, click on it (10/2).

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Parsing Health And Medicare Plans Amid Campaign Promises

News outlets analyze the presidential candidates' proposals for tackling Medicare and Medicaid costs, as well as how these differing ideas are playing among voters.  

CNN Money: Election 2012: Tackling Medicare Costs
Because of demographic changes and rising health care costs, the program's spending is projected to balloon from 3.7% of the economy today to 6.7% in 25 years, according to the nonpartisan Congressional Budget Office, making it the biggest driver of America's long-term budget gap. ... As House budget chairman, Ryan made his name with sweeping proposals to change Medicare, and Romney says his approach will be similar. Obama's health reform law lays out a very different blueprint for restraining costs. Analysts at the Urban Institute calculate that lifetime Medicare benefits will be worth over $500,000 for a mid-career couple today (Regnier, 10/2).

The Hill: Democrats Feel Campaign Focus On Medicare Is Paying Election Dividends
The Democrats' shifting strategy to make Medicare a central focus of the 2012 campaign appears to be paying dividends, as polls show voters — particularly in key swing states — are wary of Republican plans for the popular seniors' healthcare program. Democratic leaders had spent most of the 112th Congress focused on jobs and the economy — even downplaying Medicare's significance after the issue propelled a Democrat to a surprise House victory in a New York special election last year (Lillis, 10/2).

NPR: Democrats And Republicans Differ On Medicaid Fix
Medicaid is already the nation's largest health insurance program in terms of number of people covered: It serves nearly 1 in 5 Americans. ... Medicaid is likely to undergo a major change regardless of whether President Obama is re-elected or replaced by Republican Mitt Romney. Democrats support a much bigger program. Republicans have plans to scale it back (Rovner, 10/2).

The State (South Carolina): Election Could Impact South Carolina's $6-billion Medicaid Program
In South Carolina, the program is immense – both in dollars and impact. ... The program covers 1.1 million people, nearly a quarter of the state's population. About 58 percent of those covered are children. ... Medicaid contracts with 78 percent of the state's nursing homes and pays for 70 percent of the people in those homes. ... President Barack Obama and Republican candidate Mitt Romney both want to spend less on the program – but in different ways (Beam, 10/2).

The Associated Press: Governor Candidates Clash Over Health Care
New Hampshire's candidates for governor continue to spar over how to fund health care reform and the best approach to job growth in a state where employment opportunities have become stagnant. Republican Ovide Lamontagne and Democrat Maggie Hassan met Tuesday for their fourth debate at the Capitol Center for the Arts, in a 90-minute gathering sponsored by the New Hampshire Center for Nonprofits (Tuohy, 10/3).

Also in the news, the Commonwealth Fund issued a report critical of Romney's health positions - 

The Hill: Study: Obama Health Law Would 'Outperform' Romney Proposals
Mitt Romney's healthcare proposals would dramatically increase the uninsured population compared to the Affordable Care Act, according to a new study. The Commonwealth Fund, a nonprofit research foundation that supports President Obama's signature reform law, evaluated the candidates' healthcare policies and found Obama's proposals "outperform" Romney's when it comes to expanding coverage and lowering costs (Viebeck, 10/2).

Medpage Today: Foundation Slams Romney Health Proposals
But the Romney campaign is discrediting the report, saying many of the assumptions used by Commonwealth are flawed. ... The report makes a set of assumptions on two key Romney proposals -- transforming Medicaid into a block grant program and providing tax advantages to people buying insurance on their own -- because details haven't been fleshed out. Because of his turning Medicaid into a block grant system, Romney's plan would actually increase the number of uninsured by 12 million by 2022, the Commonwealth Fund study found (Pittman, 10/2).

And a small business group decries what it views as the health law's very heavy tax burden -

Richmond Times-Dispatch: Small Businesses To Be Hit By Health Tax, Group Says
Small businesses will bear the brunt of a tax on insurance companies aimed at helping to pay for the Patient Protection and Affordable Care Act, better known as Obamacare, members of a national business group said Tuesday at two informal meetings in the Richmond area. The Health Insurance Tax, scheduled to go into effect in 2014, looks like it will penalize health insurance companies, said Nicole Riley, state director of the National Federation of Independent Business. "But frankly, it will just be a pass through" to employers and then consumers, Riley said (Blackwell and Martz, 10/3).

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Obama Spending More Than Romney On TV Advertising, New Ad Stars Medicaid

Meanwhile, GOP vice presidential nominee Paul Ryan, who is also seeking reelection to his congressional seat, unveils a new health care ad in his district.   

The New York Times: Obama Outspending Romney On TV Ads
In Florida, the disparity was greater. The number of pro-Obama ads outnumbered pro-Romney ads by almost 50 percent — some 13,000 of them accusing Mr. Romney of outsourcing jobs to China, trying to gut Medicare and hiding his tax returns from the public. The story was the same in most of most of the other battlegrounds. In Ohio and in Iowa, in Norfolk, Va., and on the Boston stations that feed New Hampshire, Mr. Obama out-advertised his rival after the parties' nominating conventions, according to data compiled by the political advertising monitoring firm Kantar Media/CMAG (Rutenberg and Peters, 10/2).

Kaiser Health News: Medicaid Stars In New Obama Campaign Ad
At last, Medicaid is getting some respect. Medicaid, not Medicare, is the subject a new television campaign advertisement for President Barack Obama.The 30-second ad is being broadcast in five election battleground states — Colorado, Virginia, Nevada, Iowa and Ohio. It accuses GOP presidential nominee Mitt Romney of supporting the plan passed by the GOP-led House of Representatives that cuts $800 billion from Medicaid, the state-federal health insurance program for the poor and disabled, over the next 10 years (Galewitz, 10/3).

CNN: New Ryan Reelection Ad On Health Care
Republican vice presidential candidate Paul Ryan is out with a new ad Tuesday – one supporting his bid for reelection to the House of Representatives. The seven-term Wisconsin congressman's new spot, "Patient Centered Solutions," shows him fielding a question from a Wisconsin woman about his plans to reform the health care system. "We should get insurance and government bureaucrats out of the way and force health care providers to compete for our business," Ryan says in response to the question. "That way we can cut costs, improve quality, and make health care accessible for everyone" (Bohn and Wallace, 10/2).

The Hill: Paul Ryan Runs Health Care Ad For Wis. Congressional Race
Republican vice presidential candidate Paul Ryan is launching a TV spot on healthcare issues for his U.S. House bid. Rep. Ryan is running for an eighth House term in Wisconsin and the vice presidency at the same time, as permitted by Wisconsin law. On Tuesday, his congressional campaign released a new ad, "Patient Centered Solutions," in which Ryan lays out principles for reforming U.S. healthcare (Viebeck, 10/2).

Also, in campaign ad news -

The Hill: Anti-Abortion Group Launches Super-PAC Against Obama
The Susan B. Anthony List has launched a new super-PAC to oppose President Obama and give the abortion debate a higher profile in the presidential election. The new Women Speak Out PAC aims to "amplify the voices of women opposed to President Obama and his extreme abortion record," the SBA List announced Tuesday. "The most pro-abortion president our nation has ever seen resides in the White House and is seeking a second term," said SBA List President Marjorie Dannenfelser in a statement (Viebeck, 10/2).

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Health Reform

States Ask, Answer Questions On Health Law Implementation

Even as some states didn't meet the target set by the Department of Health and Human Services for submitting their "benchmark" plans regarding the health law's essential health benefits, others offered specifics about what would be covered and what plans would be their choice.

Politico Pro: Dem Governors Fail To Pick EHB Plans
It's not just Republican-led states that didn't turn in their homework when the teacher asked for it -- a handful of states with Democratic governors didn't meet HHS's suggested target for submitting their essential health benefit benchmark plans, either. HHS said Monday wasn't a hard deadline for states to make their EHB picks known, but plenty of red states opposed to the law certainly treated it that way. They used it as a day to blast the Obama administration for dumping the EHB decision in their laps without issuing formal rules, and a number of Republican state executives made it clear they didn't think they had enough information from the feds to set a benchmark plan in their state (Millman, 10/3).

Kaiser Health News: States Requiring Broader Drug Choices Than Federal Limit
When the Obama administration set initial rules last December to determine what minimum benefits insurers must offer in plans sold to individuals and small groups starting in 2014, one provision stood out: Insurers selling small group and individual policies would have to provide at least one drug per class of drug. In other words, insurers could cover just one drug for cholesterol, one for high blood pressure or one drug for attention deficit disorder (Galewitz, 10/2).

The Associated Press/Wall Street Journal: NY Picks Oxford Plan As Exchange Benchmark
New York's Health Department has selected a health care plan offered by Oxford as the benchmark for the state's health insurance exchange, which is intended to help extend coverage to the uninsured and reduce costs for individuals, small businesses and local governments. The New York Health Benefit Exchange Gov. Andrew Cuomo established by executive order is a federally required and subsidized marketplace scheduled to start in 2014 (10/2).

The Associated Press: Hawaii Sets Insurance Minimums For Health Care
Hawaii has set minimum standards for health care insurance plans that can be sold in Hawaii under new federal guidelines. Hawaii Gov. Neil Abercrombie announced the minimums at a press conference on Monday. Abercrombie says the minimums will help Hawaii lead the nationwide health care transition (10/2).

CQ HealthBeat: Nebraska Raises A Question: What's The Future Of HSAs In The Exchanges?
An announcement by Nebraska Gov. Dave Heineman that his state is proposing a benchmark plan for essential health benefits coverage that's also a high-deductible plan combined with a Health Savings Account raised an intriguing question Tuesday: Could such increasingly popular plans find a home in state insurance exchanges? The answer from experts on the health care law appears to be that it's possible that the plans could be offered in the exchanges if they met other requirements in the law. That might be tough, though, since the deductibles for such plans -- frequently offered by employers trying to trim their health care costs -- tend to run higher than the $2,000 limit for individuals and $4,000 limit for families the law sets for small group plans (Norman, 10/2).

CQ HealthBeat: California Asks Insurers For Input Into Exchange
Insurers that want to participate in the California health care exchange have until Oct. 12 to submit letters of intent, according to state officials who were poised to release a notice about the process late Tuesday. California was the first state to establish a health benefits exchange after the 2010 health care law passed. A spokesman said that California officials expect between 1.8 million and 2.1 million people to obtain subsidized coverage through the exchange with another 2.1 million Californians purchasing unsubsidized coverage in the exchange, which the law says should be up and running in 2014 (Adams, 10/2).

The Associated Press: Officials Raise Questions About Health Care Law
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, 10/2).

Meanwhile, Medicaid also gets state attention --

Stateline: Maine Seeks To Cut Medicaid Eligibility
Under the Affordable Care Act , beginning in 2014 every state is supposed to expand Medicaid coverage to all adults and children in households earning 133 percent or less of the federal poverty level. But in June the Supreme Court struck down that provision, making Medicaid expansion optional. LePage, like at least six other Republican governors, has already declared that Maine will opt out of the expansion. But he’s the only governor who is taking his opposition to the federal health law even further by attempting to scale back his state's Medicaid enrollment. Other states, particularly those led by Republicans, are watching closely to see whether LePage's proposed cuts, which will likely be reviewed by a federal court, are upheld (Ollove, 10/3).

Politico: Red-State Counties Back Off Medicaid Expansion Talk
Texas counties made waves this summer after reports surfaced that they were interested in moving forward on their own with a Medicaid expansion at the local level -- without Gov. Rick Perry's signoff. But now, they're backing off (Smith, 10/3).

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Report: Overhaul Will Bring New Customers, Challenges To The Insurers

A report released Tuesday by the health care consultant PricewaterhouseCoopers outlines how various changes put in place by the 2010 health law will change the insurance industry.

Reuters: Future U.S. Healthcare Customers Challenge Insurers: Report
U.S. health insurers will face challenges over the next decade as they expand their marketing to individuals who in many cases will be less educated and poorer than their current policyholders, according to a report released on Tuesday. As a result of the Patient Protection and Affordable Care Act, 30 million Americans are expected to gain access to health insurance through regulated exchanges in each state, more plans from employers, and an expansion of the federal Medicaid program for the poor (10/2).

The Associated Press: Health Care Overhaul Seen As Boon To Insurance Industry
The health care overhaul is poised to pour billions of dollars into an insurance industry thirsty for customers, according to health care consultant PwC. The massive federal law aims to cover millions of uninsured people and will take a major step toward that goal in 2014, when the government starts offering tax credits to help many Americans buy coverage through online exchanges. Those exchanges will act as virtual marketplaces for customers to comparison shop for the right coverage (10/2). 

Kaiser Health News: Study: Newly Insured Patients Are Likely To Be Healthy
Good news for insurers: 88 percent of people new to health coverage after the health law fully goes into effect will be in relatively good health.  That means providers won't be overwhelmed, at least initially, says a report out today by PricewaterhouseCoopers (Appleby, 10/2).

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Capitol Hill Watch

'Gang Of 8' Working Toward Resolution Of Debate Surrounding The Fiscal Cliff

Politico: Gang Of 8 Plots Secret Retreat
The group came together in the summer of 2011 to try to hammer out a deal to solve the debt ceiling crisis but failed to reach an agreement in the end. Yet it’s jumped into the latest debate over the fiscal cliff — the expiration of the Bush tax cuts and a dramatic cut to federal spending, including for the Pentagon — to see try to see if the bipartisan fever catches widely (Bresnahan and Sherman, 10/2).

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CMS Revises Readmissions Penalties; How Hospital Networks Play Into Equation

Kaiser Health News examines readmissions at hospitals, including how CMS has revised up penalities on hospitals who readmit patients too soon and how hospital networks play into the readmissions equation.

Kaiser Health News: Medicare Revises Hospitals' Readmissions Penalties
Medicare's new readmission penalties for hospitals just got a bit tougher. The Centers for Medicare & Medicaid Services has discovered errors in its initial calculations in August. As a result, 1,422 hospitals with comparatively high readmission rates will lose slightly more money than they were expecting, according to a Kaiser Health News analysis of the revised penalties. Fifty-five hospitals will lose less than were previously told (Rau, 10/2).

Kaiser Health News: Hospitals Need Networks To Prevent Readmissions
A paradox of American health care is that hospitals are sometimes rewarded for doing things badly. Patients who are discharged, for example, shouldn't have to come right back because their conditions get worse when they go home. But if they do come back, hospitals benefit, because they can fill an empty bed and bill for more care (Whitney, 10/2).

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Health Care Marketplace

Court Approves Abbott Settlement For Wrongly Marketing Depakote

The pharmaceutical company will pay $1.5 billion for marketing the drug for non-approved uses.

The Associated Press/Washington Post: Federal Court In Va. Approved $1.5B Abbott Laboratories Settlement Over Depakote
A federal court in Virginia on Tuesday approved a settlement in which Abbott Laboratories agreed to pay $1.5 billion over allegations that it promoted the anti-seizure drug Depakote for uses that were not approved by the Food and Drug Administration ... Depakote is an anti-seizure and mood-stabilizing drug prescribed for bipolar disorder (10/2).

The Wall Street Journal: Court Sentences Abbott For Off-Label Promotion Of Antiseizure Drug
Abbott was ordered to pay a criminal fine of $500 million, forfeit another $198.5 million, and pay $1.5 million to the Virginia Medicaid Fraud Control Unit for marketing the drug for patients with dementia and schizophrenia. The drug manufacturer will also be subject to a five-year term of probation (Jones, 10/2).

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An Expanded Role For Some Nurses?

The Wall Street Journal: Nurses Seek Expanded Role
A federal agency is weighing whether to reimburse a specialized type of nurse for giving chronic-pain treatments, a move opposed by some doctors and one that critics say could complicate the battle against prescription painkiller abuse. By Nov. 1, the Centers for Medicare and Medicaid Services is expected to decide whether nurse anesthetists should be directly reimbursed by Medicare for evaluating, diagnosing and treating pain with epidural injections or prescription painkillers called opioids. Medicare is the federal health program for the elderly and disabled (Martin, 10/2).

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Swing State Trailmix

Swing State Highlights: The Latest On Political Ads, Appearances And Polls

As election day approaches, KHN's Sarah Barr samples news coverage each week from swing states around the country – how health policy developments are playing in this year's vote.

Highlights include the scoop on the start of early voting -

The Columbus Dispatch: Early Voting Starts Today, As Do The Rallies
Early in-person voting begins [today] in each of Ohio's 88 counties at 8 a.m. while the first of more than 922,000 absentee ballots will begin to be mailed today by county boards of elections. ... There's a lot at stake with early voting, particularly among Democrats seeking to pump up turnout to return Barack Obama to the White House amid the heated contest with Republican Mitt Romney for must-win Ohio. ... Early voters tend to vote Democratic (Ludlow, 10/2).

Charlotte Observer: GOP, Conservatives Put Greater Focus On Mail Absentee Ballots In North Carolina
Five weeks before Election Day, about 14,000 North Carolina voters already have cast absentee ballots – a total equal to President Barack Obama's margin of victory in 2008. The number is etched into the minds of conservatives who are placing a greater emphasis than ever this year on absentee voting by mail, suggesting it could make the difference in another tight election contest (Frank, 10/2).

The Detroit News: Both Parties Pushing For Absentee Votes
Unlike other states, Michigan doesn't have early voting, but already votes are being cast here from the comforts of home. About 20 percent of ballots are expected to be cast absentee. ... A recent Michigan Republican Party mailer includes an absentee ballot application already addressed to the local city clerk. It's a pitch for seniors with a picture of a bed: "Don't take Obamacare lying down" (Schultz, 10/1).

In Colorado, young voters may be swayed by the first presidential debate of the season, which will be held in Denver -

Denver Post: Young Coloradans Toggle Between Economy, Social Issues In Election
[F]irst-time voter Tyler Antikainen, a politically in-tune 19-year-old sophomore at Metropolitan State University of Denver ... believes Republican presidential nominee Mitt Romney's business background is an asset. On social issues — particularly support of same-sex marriage — he's in lock step with President Barack Obama. ... At college stops, the president touts his policies that affect young people — such as health-care reform that allows them to stay on their parents' insurance plans until age 26 (Lee, 10/2).

Meanwhile, local news outlets offer the latest on political advertising, campaign appearances and polls -

Charlotte Observer: The Mitt And Barack Show: TV Blitz Hits Charlotte
A torrent of money is flooding Charlotte TV stations as President Barack Obama and Mitt Romney battle for the 6 percent of North Carolina voters deemed undecided in the presidential race. With the campaigns approaching the clubhouse turn, $7.6 million has been spent since August on presidential TV ads in Charlotte alone, or about $73 for every undecided voter. And despite the video assault ... there appears to be little or no effect on voter attitudes (Washburn, 10/1).

Des Moines Register: New TV Ad By U.S. Rep. Steve King Criticizes Obama' Health Care Plan
U.S. Rep. Steve King, a Kiron Republican, today released his fourth television advertisement, titled "Truth." A press release from King's campaign says the 30-second advertisement highlights the truth about Medicare – ObamaCare cuts it by $716 billion, according to the nonpartisan Congressional Budget Office. King is seeking reelection in Iowa's 4th Congressional District against Democratic candidate Christie Vilsack (Petroski, 10/2).

The Associated Press/The Virginian-Pilot: Political Ads In Va. Hit Diminishing Returns
The bitter back-and-forth of political ads by candidates and allied super PACs has reached a point of diminishing returns with Virginia voters. Voters, political professionals and media experts say that with political attacks coming at them in the mail, the phone, television and radio, the Internet and even illegal text messages, many people have started shutting down and tuning it out (Lewis, 9/30).

Des Moines Register: In Dubuque, GOP Vice Presidential Candidate Paul Ryan Courts Catholic Voters Republican Vice Presidential candidate Paul Ryan's visit Monday night to a Catholic college in this historically Catholic city underscores the competition in this presidential race over a religious group whose political views cross party lines in key areas. ... The Obama administration’s actions on setting mandates for insurance coverage of contraception upset the Catholic Church and associated institutions, and led religious leaders and Republicans to accuse Obama and Democrats of infringing on religious liberty (Noble, 10/1).

Pittsburgh Post-Gazette: U.S. Congressional Candidates Have Spirited Exchange
Republicans running in two congressional races on the outskirts of Pittsburgh hammered Obama administration policies at a forum in Greensburg Thursday, while their Democratic opponents called for more bipartisanship in Washington, D.C. U.S. Rep. Tim Murphy, R-Upper St. Clair, and fellow Republican Keith Rothfus, who is challenging in the 12th District, repeatedly criticized Mr. Obama's health care legislation and regulatory policies affecting the coal industry. ... His Democratic opponent, U.S. Rep. Mark Critz of Johnstown, showed his conservative stripes as well, noting he ... would have voted against the full "Obamacare" bill (McNulty, 9/28).

St. Louis Post-Dispatch: McCaskill Internal Poll Shows Her Beating Akin By 9 Points
Sen. Claire McCaskill, D-Mo., is up by 9 percentage points over Republican challenger Todd Akin, according to an internal pollster for her campaign. The results of pollsters Kiley & Company show the same overall lead found in a Post-Dispatch poll in August, shortly after Akin's campaign was rocked by his controversial suggestion that "legitimate rape" seldom causes pregnancy. Prior to that, Akin was widely thought to be leading in the race (McDermott, 10/1).

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State Watch

State Roundup: Ind. Mandate Back On Fla. Ballot; Ga. Hospital Tax Fight Rages On

A selection of health policy stories from Florida, Massachusetts, Georgia, Ohio, Alaska, Texas, Vermont, California and Connecticut.

The New York Times: GOP Aims To Remake Florida Supreme Court
In a bid to remake Florida's judiciary, Republicans are asking voters to oust three state Supreme Court justices and give the Legislature greater power over Supreme Court appointments. ... In Florida, the issue is not same-sex marriage but another politically divisive matter: President Obama's health care law. In a 2010 ruling, the Florida Supreme Court removed from the ballot a nonbinding amendment allowing Floridians to refuse to buy mandatory health insurance. The justices ruled that the required ballot summary contained "misleading and ambiguous language" and asked the Legislature to fix it. Lawmakers did, and it is back on the ballot this year (Alverez, 10/2).

The Boston Globe: Mass. Medical Society Survey: More Doctors Embracing New Payment Models
Doctors in Massachusetts may be looking a bit more favorably on new payment methods created under state and federal laws, according to a survey of 1,095 practicing physicians by the Massachusetts Medical Society. About 49 percent of respondents said they are likely to participate in a voluntary global payment system, in which doctors are paid a fixed rate to manage the care of a group of patients (Conaboy, 10/2).

Georgia Health News: Hospitals Respond To Norquist Letter On Provider Tax
The battle over Georgia's hospital tax suddenly heated up last week, ignited by the attention-grabbing entrance of national anti-tax leader Grover Norquist. The Washington-based activist, in a letter to Georgia legislators, said renewing the hospital fee, which raises money for the state's Medicaid program, would kill jobs and raise health costs. … Now, some major Georgia hospital organizations have fired back at Norquist and come out strongly in support of the tax, which expires in July (Miller, 10/2).

The Associated Press: Judge Ends Oversight Of Ohio Prisons' Health Care
A federal judge on Tuesday ended the court's oversight of Ohio's prison medical system after finding that health care and services for the nearly 50,000 inmates have greatly improved over the last seven years. U.S. District Court Judge Sandra Beckwith had overseen the prisons' medical system since a 2005 settlement of a lawsuit brought by Ohio Justice and Policy Center, a Cincinnati-based prisoner rights group (Welsh-Huggins, 10/2).

The Associated Press: Health Care Jobs To See Highest Rate Of Job Growth
The health care and social assistance industry is expected to see the largest rate of job growth in Alaska this decade. That's according to the employment forecast for 2010-2020, released by the state labor department on Monday. It estimates that Alaska will add nearly 40,000 jobs during that period, an increase of 12 percent, with nearly all sectors gaining (10/2).

Houston Chronicle: Supporters Celebrate Felony Mental Health Court
State District Judge Jan Krocker's voice cracked as she talked Tuesday about a Hispanic teenager in jail persuading a grizzled and tattooed former white supremacist to get mental health help earlier this year. Krocker and others celebrated the official opening of Harris County's felony mental health court, which started putting mentally ill defendants on probation instead of sending them to jail in May. Krocker has been working to get a special court to oversee felony cases of defendants diagnosed with schizophrenia, bipolar disorder and severe depression since 2009 (Rogers, 10/2).

The Associated Press: Vt. Board Approves Hospital Budgets
A Vermont board says budgets for Vermont's 14 hospitals for the next fiscal year are not on a sustainable path. The Green Mountain Care Board said Tuesday that it approved budgets that will result in 5.1 percent increase in hospital net patient revenue for fiscal year 2013. The board had set a target increase of 3.75 percent (10/2).

HealthyCal: Orange County Clinics Pilot Patient Centered Care
Orange County has gotten an early start on health care reform with a pilot program testing a new approach to care for the low-income and uninsured in three clinics. The Coalition of Orange County Community Clinics (COCCC) is piloting a program for patient-centered care with UCI Family Health Center, Serve the People and The Vietnamese Community of Orange County's Asian Health Center clinics. The initiative's goal is for local safety-net providers and local health plans to partner together to coordinate care for their patients (Afrasiabi, 10/2).

The CT Mirror: Blumenthal, Advocates For Elderly Target 'Chemical Restraint' Abuse At Care Facilities
Calling it a form of chemical restraint, Sen. Richard Blumenthal and advocates for the elderly Tuesday blasted the practice of prescribing antipsychotic drugs for dementia patients in nursing homes and other long-term care facilities. "It is a form of elder abuse. It's chemical restraint -- no less pernicious and insidious than physical restraint of patients -- and it should be stopped," Blumenthal said. During a press conference at the Capitol, Blumenthal announced that he has introduced a bill to crack down on the overprescription of these off-label drugs (Merritt, 10/2).

California Healthline: Governor Nixes Long List Of Health Bills
Gov. Jerry Brown (D) vetoed a number of health care bills over the weekend. They ranged from a program designed to improve flu vaccinations among health care workers, to a proposal to define and promote patient-centered medical homes, to a regulation on hospital-nurse staffing ratios. The governor had a variety of reasons he gave for the different vetoes, but at least one of those explanations didn't make much sense, according Assembly member Henry Perea (D-Fresno). Perea is the author of AB 1000, a measure designed to make oral chemotherapy more affordable and accessible for Californians. "While I support the author's efforts to make oral chemotherapy treatments more affordable for the insured, this bill doesn't distinguish between health plans and insurers who make these drugs available at a reasonable cost and those who do not," Brown wrote in his veto message (Gorn, 10/2).

Los Angeles Times: LA Billionaire Teams With Insurer On Personalized Medicine
Los Angeles billionaire and health care entrepreneur Patrick Soon-Shiong reached an agreement with insurer Blue Shield of California aimed at accelerating medical breakthroughs to doctors and patients to improve care and reduce costs. Soon-Shiong, a former UCLA surgeon and drug-company executive, announced the deal Tuesday between his NantHealth company and Blue Shield, a nonprofit insurer with 3.3 million customers in California (Terhune, 10/2).

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Editorials and Opinions

Viewpoints: Key Issues For Romney, Obama To Address In The Debate; Peter G. Peterson's Mission To Cut Entitlements

Los Angeles Times: 8 Direct Debate Questions For Obama And Romney
With the U.S. population aging, Social Security and Medicare are projected to account for a growing share of the federal budget and the economy. To accommodate that change, should federal spending (and revenue) amount to a larger share of the economy than it has historically? If not, how does Washington make ends meet? … In its ruling upholding most of the 2010 health care law, the Supreme Court said Washington could not compel states to expand their Medicaid programs to cover more of the impoverished and working poor. What, if anything, should Washington do to help this group obtain affordable health care? (Jon Healey, 10/2). 

The Washington Post: A Prime-Time Chance For Candidates To Discuss The Future
The president-elect will inherit a sputtering economy, with unacceptably high rates of unemployment and imperceptible growth. He will face, in less than two months, a barrage of scheduled tax increases and spending cuts that, if unaltered, would knock the country back into recession and endanger national security. He also will confront, again if policies are unaltered, the longer-term specter of national bankruptcy, as health costs rise, the baby-boom generation retires and tax revenue is swallowed by interest on the swelling debt (10/2).

Los Angeles Times: Unmasking The Most Influential Billionaire In U.S. Politics
Who's the most influential billionaire business figure in national politics? If you answered one of the Koch brothers (Charles or David) or George Soros, you're wearing your partisan blinders. The former are known for their devotion to conservative causes, the latter to liberal. In either case, you're wrong. The most influential billionaire in America is Peter G. Peterson. ... He isn't content merely to express concern about the federal deficit. His particular targets are Social Security, Medicare and Medicaid, which he calls "entitlement" programs and which he wants to cut back in a manner that would strike deeply at the middle class (Michael Hiltzik, 10/2). 

The New York Times' Economic Scene: Health Care As Income For The Poor
As a nation, we devote almost one-sixth of our spending to health care, twice the share of 30 years ago. Medical bills for the elderly are climbing, threatening to blow up the budget in a few decades. Politicians from both parties are consumed by how to pay for it all. Yet we cannot quite agree on how valuable government health care benefits are to Americans (Eduardo Porter, 10/2).

Bloomberg: Life-Span Gap Skews Entitlements Toward The Well-Off
Since better-educated, higher-income Americans are living longer than everyone else and therefore collecting benefits longer, Medicare and Social Security are becoming less progressive on a lifetime basis. Fortunately, there are ways to offset this gap. … If Medicare were shifted to a premium-support program -- a change that would create other problems, as I have explained -- the widening divide in life expectancy would justify a much larger annual subsidy for people at the bottom of the income distribution than for those at the top. Given how the program is structured now, however, policy makers should look for still more ways to link copayments to income, as is already done for Medicare Part B and Part D premiums (Peter Orszag, 10/2).

Journal of the American Medical Association: Challenges At The Intersection Of Team-Based And Patient-Centered Health Care
Implementing patient-centered, team-based care requires overcoming several challenges, but health care that meets the promise of "nothing about me without me" is worth pursuing. Bringing patients into the orchestra of team-based care requires not only new skills and tools but wholly reframing how clinicians and patients view roles (including leadership) and accountability -- even the language describing the care patients "receive" and other team members "provide" (Dr. Matthew K. Wynia, Dr. Isabelle Von Kohorn and Pamela H. Mitchell, 10/3). 

Journal of the American Medical Association: A New Model For Medical Education: Celebrating Restraint
Policy makers recognize that physicians play a central role (in controlling health costs), with some estimates suggesting that physicians control 80% of health expenditures. ... we suggest complementing health care cost control initiatives by transforming the current approach used in medical education that primarily rewards meticulousness of clinical investigation to one that also celebrates appropriate restraint (Dr. Allan S. Detsky and Dr. Amol A. Verma, 10/3). 

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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.