Daily Health Policy Report

Wednesday, October 31, 2012

Last updated: Wed, Oct 31

KHN Original Reporting & Guest Opinion

Campaign 2012


Capitol Hill Watch


State Watch

Swing State Trailmix

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insurance Policies Favoring Compounded Drugs For High-Risk Pregnancies Draw Scrutiny

Kaiser Health News staff writer Julie Appleby reports: "When a brand-name drug to help prevent premature births was approved last year, its $1,500-a-dose-price alarmed state and private sector insurance officials. Many restricted use of the FDA-approved Makena in favor of $20- to $40-a-dose versions that had been made for years by pharmacies, saying that would give more women access to the treatment. Federal officials, sympathetic to such arguments, allowed the pharmacies to continue making the unapproved drugs" (Appleby, 10/30). Read the story

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Capsules: Poll: Romney Narrows Gap With Obama On Medicare Issue

Now on Kaiser Health News' blog, Phil Galewitz writes: "As the race for the White House has tightened, President Barack Obama has seen his advantage on several key health issues narrow significantly among likely voters, according to a Kaiser Family Foundation poll released Wednesday" (Galewitz, 10/30). Check out what else is on the blog.

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Political Cartoon: 'What're You Wearing?'

Kaiser Health News provides a fresh take on health policy developments with "What're You Wearing?" by Nate Beeler.  

Meanwhile, here is today's health policy haiku:


I had not heard of 
compounded drugs before now.
What should I fear next? 

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 Still In The Campaign Trail Mix

How is Medicare playing among the ever-important bloc of Florida senior citizens as the two presidential candidates vie for their votes? Similarly, it's also a hot topic in the Montana Senate race, which is one of the most intensely watched in the country.  

The Wall Street Journal: Medicare Fails To Sway Senior Votes
None of the current proposals to bolster Medicare changes benefits for the current generation of senior citizens. But the 88-year-old Republican [Leonard Yordon] and many other retirees of both parties speak of little else when talk here turns to the presidential election. Senior citizens are a coveted voting bloc in Florida, where they make up about a quarter of the electorate in this highly contested swing state. ... Polls now show Mr. Romney leading among the state's elderly voters by 6% to 12%—a sign he may be weathering reasonably well the charges by Democrats that he and running mate Paul Ryan would undermine Medicare (Campo-Flores, 10/29).

(Montana) KULR8: Tester Talks Medicare and Social Security
[Democratic] Sen. Jon Tester joined forces with the state's Republican Lt. Gov. John Bohlinger to criticize Congressman Dennis Rehberg for supporting what they call "irresponsible changes" to the programs. Tester said he wanted to set the record straight on Medicare and Social Security and how he and Rehberg differ. Bohlinger joined Tester saying the Democrat will protect benefits for Montana's seniors (Chen 10/30).

All the while, as high profile celebrities and surrogate speakers are appealing to last-minute voters, health policies often come up -  

USA Today: Pearl Jam Guitarist Asks Voter To Back Health Care Law
Pearl Jam guitarist Mike McCready may seem like an odd poster-child for President Obama's health care law. But the musician, 46, has Crohn's disease, an incurable gastrointestinal disorder. He says he was denied health insurance coverage twice because of his condition and needed the help of a patient advocate to navigate the bureaucracy to get his treatment (Camia, 10/30).

The Hill: Celebs Back Obama In 'Yes We Plan' Video
Celebrities have cut a video for Planned Parenthood's political arm to encourage votes for President Obama. The two-and-a-half minute "Yes We Plan" video echoes will.i.am's much-viewed "Yes We Can" video backing Obama's 2008 presidential campaign. The new film does not mention GOP presidential nominee Mitt Romney or specific policy debates, but alludes to disagreements between Romney and Obama over abortion rights and the mandate that most employers cover birth control for free in their health plans (Viebeck, 10/30).

The Hill: Romney Surrogate Says Roe v. Wade Won't Be Overturned
Former Sen. Norm Coleman (R-Minn.) told voters in the crucial swing state of Ohio Monday that Roe v. Wade is not in danger of being overturned. Coleman, a surrogate for Mitt Romney, is Jewish and opposes abortion rights. He made his comment during a town hall with Jewish voters in Beachwood, a suburb of Cleveland. "The reality is that choice is an issue for a lot of people, an important issue. President Bush was president eight years; Roe v. Wade wasn't reversed" (Vieback, 10/30).

And physician-led PACs are making their voices heard in key House and Senate races -

Politico Pro: Physician PACs Step Up Spending
Several of the most prominent physician-led political action committees are on track to spend more on the 2012 election than they did in 2008 and 2010. The most notable increase comes from the American College of Obstetricians and Gynecologists, which is on pace to nearly double its tally of political spending in 2008 and 2010. The group has spent $1.1 million so far on the 2012 race. ... The group has given money to some key Democratic races (Haberkorn, 10/31).

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KFF Poll: Obama Lead On Health Issues Lessens

The latest Kaiser Family Foundation health care tracking poll -- the last one that will be released before the election -- found that President Barack Obama's advantage on several health issues has diminished.    

Kaiser Health News: Capsules: Poll: Romney Narrows Gap With Obama On Medicare Issue
Most troublesome for Obama is that, among likely voters, GOP candidate Mitt Romney has pulled nearly even with him on which candidate would do a better job with Medicare — an issue that resonates in battleground states with large elderly populations like Florida and Pennsylvania. ... While the economy remains voters' most important issue, the poll found over a third of likely voters polled say the Affordable Care Act and Medicare are ''extremely important" to their vote. The law appears to be motivating supporters and opponents of the law about equally (Galewitz, 10/30).

Los Angeles Times: Obama Edge Over Romney On Healthcare Issues Shrinking
More likely voters still trust Obama to do a better job than his Republican challenger in handling the Medicare and Medicaid programs, lowering healthcare costs and determining the future of the healthcare law he signed in 2010. But Romney has cut the president’s lead in half on most issues and nearly eliminated it entirely on Medicare, the Kaiser survey found, compared with a similar poll taken in September (Levey, 10/31).

Politico Pro: Kaiser: Obama's Lead On Health Issues Drops
[J]ust 46 percent of likely voters now say they trust Obama over Mitt Romney, while 41 percent say they prefer Romney. That's a sharp drop from the 52 percent-36 percent lead Obama had over Romney in the September poll. And even though 72 percent of seniors opposed a premium support system for Medicare — the overhaul Romney and Paul Ryan are proposing — they actually trust Romney more than Obama on the future of Medicare. Forty-eight percent of those age 65 or older said they trust Romney more, while 43 percent say they prefer Obama (Smith, 10/31).

(KHN is an editorially independent program of the Kaiser Family Foundation.)

In related news, the Los Angeles Times takes a look at what Mitt Romney might do about the health law if he wins -

Los Angeles Times: Romney Says He'll Undo Obama Healthcare Reform On Day 1. Can He?
Mitt Romney has pledged to do away with President Obama's healthcare reform law if he wins next week's election. But would he — or any other president — have the power to do so? Not exactly, according to two Georgetown University professors writing this week in the online version of the Journal of the American Medical Assn. But there are some things President Romney would be able to do if he won ... The ACA does allow the president to issue waivers to the states, but only so that they can implement alternatives to the law that are better, not worse, write John D. Kraemer and Lawrence O. Gostin. In any case, those waivers won’t be available to states until 2017 (Kaplan, 10/30).

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Medicare News: Health Spending On Seniors Grew Faster In U.S. Than Canada

A new study finds that U.S. spending grew nearly three times faster since 1980 than Canada's spending on a similar population group.

Medpage Today: U.S. Bill For Senior Care Higher Than Canada's
Medicare spending in the U.S. has grown nearly three times faster since 1980 than spending on a similar population group in Canada, a study has found. Spending per Medicare enrollee rose in the U.S. from $1,215 in 1980 to $9,446 in 2009. In Canada, per capita spending on elderly patients in the country's national health care system grew from $2,141 to $9,292, David Himmelstein, MD, and Steffie Woolhandler, MD, at the School of Urban Public Health at City University of New York, reported online in the Archives of Internal Medicine. Adjusted for inflation, those figures translate to a 198.7 percent growth rate in the U.S. compared with 73 percent in Canada (Pittman, 10/30).

Another new study takes a look at how hard it is to find savings in programs for those who qualify for both Medicare and Medicaid --

The Hill: Kaiser: Savings Hard To Find In Programs For Dual-Eligibles
Everyone agrees that people who receive both Medicare and Medicaid generate significant expenses for the federal government -- but controlling those costs might be harder than it seems. A new paper from the Kaiser Family Foundation says efforts to better coordinate care for "dual eligible" seniors have produced only modest savings. Dual-eligibles make up a relatively small share of all Medicare and Medicaid recipients, but they make up an outsized portion of spending within both programs. Dual-eligibles are among the oldest, sickest and poorest patients in the country — which makes their care some of the costliest. There is broad support in Washington for reducing spending through better care coordination between the two programs, but the Kaiser Family Foundation review says big savings will be hard to find (Baker, 10/30). (Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.)

Another study sees some successful strategies in Medicare programs --

CQ HealthBeat: Payoff Seen From Obesity Measures, Medicare Advantage Pay-For-Performance System
So often the strategies that policy wonks prescribe to get better value for the health care dollar prove disappointing. But health plan quality measures and pay-for-performance systems might be a different story. A study released Tuesday by the leading national group that evaluates health plans draws two main conclusions: that Medicare's program for making higher payments to health plans based on performance is reaping dividends, and that, prodded by quality measures, doctors are stepping up efforts to identify and counsel obese patients (Reichard, 10/30).

Health News Florida: Medicare Sends Warning To Seniors In Low-Rated Plans
In a week or two, seniors enrolled in certain Medicare health plans and drug plans will get a letter from the federal government. It is not good news. The Centers for Medicare and Medicaid Services (CMS) letter will say their plan is, frankly, substandard, "rated 'poor' or 'below average' for at least the last three years." It continues: "We encourage you to compare this plan to other options in your area and decide if it is still the right choice for you." Hint, hint (Gentry, 10/30).

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Capitol Hill Watch

New Track-And-Trace Proposal Would Combat Drug Counterfeiting, Gray Market

Politico Pro reports on a draft legislative proposal released last week.

Politico Pro: Track And Trace Draft Could Address Drug Counterfeiting
The bipartisan track and trace draft legislation released last week would allow drugs to be authenticated throughout the supply chain, which could help combat counterfeiting as well as the so-called gray market that's been highlighted in the drug shortage crisis, Democratic staffers who worked on the draft said. The legislation would initially establish only a lot -- or batch -- level drug pedigree requirement. But it requires every bottle of pills or vial of drugs contained in a lot to be labeled with a unique identifier of its own. That can be traced back to the manufacturer lot and confirmed as authentic (Norman, 10/30).

Meanwhile, CQ HealthBeat reports that another coalition, this one made up of HIV and AIDS advocates, is urging Congress to take a balanced approach to deficit reduction efforts that would not include the automatic cuts called for as a result of the sequester.

CQ HealthBeat: Big Coalition Urges Hill Against AIDS-Related Automatic Cuts
A coalition of 118 organizations involved in the care of people with HIV and AIDS is urging congressional leaders to raise revenues as part of a "balanced approach" to deficit reduction that would prevent automatic cuts Jan. 2 under sequester provisions of the budget control law. "Sequestration cuts, scheduled to take place in just a few weeks, will reverse efforts to prevent HIV in our country and severely disrupt the system of lifesaving care and treatment that today serves over 500,000 low-income people with HIV/AIDS," the Oct. 26 letter said (Reichard, 10/30).

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Study Compares Mortality Rates At Magnet And Non-Magnet Hospitals

Medscape: Magnet Hospitals Show Lower Mortality For Surgery Patients
Magnet hospitals had 14% lower odds of mortality in surgery patients compared with non-Magnet hospitals in a 4-state area during a 2-year period, according to a study published online October 7 in Medical Care. However, the better patient outcomes are attributable to more than just better nursing care. The American Nurses Credentialing Center's Magnet Recognition Program was established in the 1990s. Today, almost 400 hospitals are recognized as "Magnet" hospitals — meaning they have been identified as good places for nurses to work — representing about 8% of hospitals nationwide. Many of the Magnet hospitals in this study are large, nonprofit, teaching, and high-tech hospitals (Hand, 10/30).

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State Watch

NYU Hospital Loses Power And Evacuates 215 Patients During Storm

Industry officials described the failure of the backup generator at the Manhattan medical center as an unusual incident, not a warning of systemic flaws in hospital preparedness plans.

NPR: Superstorm Sandy Takes Toll On New York Hospitals
When a storm hits, people count on the local hospital to be ready — no matter what. But when Sandy slammed into New York City, one of Manhattan's biggest hospitals buckled. After the power went out in Lower Manhattan, New York University Langone Medical Center's backup power generators failed, too (Hensley, 10/30).

The New York Times: Patients Evacuated From City Medical Center After Power Failure
The medical center, NYU Langone Medical Center, a sprawling complex in the low 30s near the East River, began transporting all 215 patients at the hospital to other facilities on Monday evening, They were still being transported to other nearby hospitals, including Sloan Kettering and Mount Sinai, early on Tuesday, a spokeswoman for the hospital said (Goodman and Moynihan, 10/30).

Politico Pro: Hospital Officials: Evacuation Not A Warning Sign
The failure of a backup power generator at a New York City hospital — forcing the evacuation of hundreds of patients during the ferocious peak of Hurricane Sandy — startled the medical world Tuesday morning. But hospital industry officials and experts suggest that the mid-storm evacuation by New York University's Langone Medical Center was an unusual incident, and not a warning of widespread flaws in disaster plans at hospitals around the country. … Marie Watteau, a spokeswoman for the American Hospital Association, said hospitals "proactively develop a hazard vulnerability analysis to identify potential vulnerabilities and to inform their emergency management planning." That analysis, she said, considers a disruption in the power supply (Cheney and Norman, 10/30).

Medpage Today: Storm Damage: When Patients Must Be Moved
As flood waters rose in lower Manhattan, backup generators at NYU Langone Medical Center failed -- an outage that shut down not just lights, but phones and email. The hospital, which rises alongside the East River at 1st Avenue and E. 33rd Street, had an inpatient census of 215 when the lights went out and the decision was made to evacuate all patients, according to news reports that quoted hospital spokesperson Lorinda Klein. The patients, carried or helped down from as high as the 17th floor, were transported to neighboring hospitals that included Mount Sinai and Memorial Sloan Kettering Cancer Center. As of midday Tuesday MedPage Today's attempts to reach NYU officials were unsuccessful (Peck, 10/30).

ABC: Superstorm Sandy Tests Hospital Preparedness
When superstorm Sandy slammed into New York and New Jersey, it tested the emergency preparedness of hospitals housing some of the region's most vulnerable residents. Despite all the hospitals' preparations, the storm's high winds and flooding forced a handful of hospitals in New York and New Jersey to evacuate all patients, including those that were in critical condition. In New York City, NYU Langone Medical Center was forced to evacuate 300 patients after losing power in the historic storm. Among the evacuees were roughly 45 critical care patients and 20 babies, who were carefully carried down dark stairways as the 18-story hospital's elevators stood still (Moisse and Lupkin, 10/).

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Calif. Insurers Competing To Be Part Of State Health Insurance Exchange

More than 30 plans are expected to seek to be part of the exchange, or new marketplace. Meanwhile, a small business health coverage exchange in Massachusetts -- a model for those called for by the health law in other states -- struggles.

Los Angeles Times: Health Insurers Line Up To Compete In California's Exchange
California's health insurance exchange said more than 30 plans are expected to vie with one another for spots in the state-run marketplace opening next fall. State officials, and those in other states, are eager to flex their purchasing power under the federal health care law by selecting only certain individual and small-business health plans for 19 different regions across California (Terhune, 10/31).

CQ HealthBeat: Massachusetts Exchange Program For Small Businesses Has Struggled. Why?
One of the major assumptions about health insurance exchanges is that they'll be attractive to the smallest businesses that have struggled to provide affordable health insurance to their workers. Problem is, in Massachusetts at least, it hasn't worked out that way, according to a new study. And Massachusetts is the model for the national health care overhaul. The Health Connector in Massachusetts "has not made major inroads" into the employer market, according to a paper from a group called Changes in Health Care Financing and Organization. "To date, the Connector’s small-group component clearly has failed to meet its goals," it says (Norman, 10/30).

In the meantime, Blue Shield says it will rebate $50 million to customers -- part of a pledge to limit profit.

Los Angeles Times: Blue Shield Of California Will Return $50 Million To Customers
Health insurer Blue Shield of California said it would return $50 million to customers by year-end as part of its pledge to limit its annual profit to 2 percent of revenue. The San Francisco company said most customers would receive credit on their December bills. It said the average credit would be about $25 for an individual customer and roughly $75 for a family of four, depending on their premiums. ... Separately, Blue Shield issued nearly $11 million in rebates to customers earlier this year as part of new requirements under the federal healthcare law for a minimum amount of premiums to be spent on medical care (Terhune, 10/31).

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Calif. Health System Ends Pursuit Of Ore. Hospital Amid Community Concerns

A California health system formerly tied to the Roman Catholic Church has ended its bid to acquire a community hospital in Oregon amid concerns over access to abortion and assisted suicide services. Meanwhile, two of Michigan's largest hospital groups are expected to announce plans Wednesday to pursue a merger.

Modern Healthcare: Dignity Health, Ore. Hospital End Acquisition Talks
Dignity Health has broken off negotiations to acquire Ashland (Ore.) Community Hospital, the first hospital with which Dignity announced it was in talks after rebranding itself in early 2012 and setting its sights on expanding nationwide. Neither side said why talks deteriorated, citing a confidentiality agreement. A six-month exclusive negotiating window between the hospital and Dignity, a San Francisco-based Catholic health system, began in April. However, according to a Dignity news release, "the two organizations were not able to reach an agreement on the final closing conditions for the merger and have decided to end negotiations" (Selvam, 10/30).

The Ashland Daily Tidings: Dignity Health Ends Deal With ACH
Dignity Health has dropped plans to merge with Ashland Community Hospital, a decision that a local hospital official said stemmed at least in part from community resistance. Despite the setback, ACH still hopes to have an alliance formed with a new hospital system by the end of 2012, said Doug Gentry, chairman of the hospital board. "We are very disappointed that negotiations with Dignity could not move forward … we felt Dignity was a strong, good fit for the hospital and community," Gentry said. "We wanted to keep negotiations open … but we're quite sure they mean what they say" (Wheeler, 10/30).

The Associated Press/San Francisco Chronicle: California System Drops Bid For Ashland Hospital
Amid concern in the community over access to abortion and assisted suicide services, a California hospital system once tied to the Roman Catholic Church has dropped plans to take over the Ashland Community Hospital. The Ashland Daily Tidings reports that Dignity Health of San Francisco didn't cite specific reasons in a letter halting negotiations, other than "residual resistance" in the community and uncertainty about being able to conclude the deal. The hospital has been losing money -- $2.5 million in the last fiscal year (10/30).

In the meantime, two large hospital groups in Michigan prepare to merge --

Detroit Free Press: Henry Ford, Beaumont Health Systems To Announce Merger Talks In Blockbuster Deal
In a blockbuster deal to combine two of Michigan's largest hospital groups, Henry Ford Health System and Beaumont Health System are expected to announce Wednesday that they have signed letters of intent to pursue a merger. A press conference is to be held at 11 a.m. at William Beaumont Hospital in Royal Oak, with CEOs of both groups present, several sources told the Free Press. News of the deal, which is contingent on further discussions and due diligence, began to circulate among industry and civic leaders Tuesday afternoon, following a meeting where Beaumont trustees approved it, according to sources who requested anonymity because the discussions were confidential. Henry Ford’s board met last Friday and voted to pursue the merger (Walsh, 10/30).

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State Roundup: Federal Judge Says Milwaukee Can Raise Retiree Contribution

A selection of health policy stories from California, Texas, Michigan, Minnesota, Wisconsin, Kansas and Oregon.

The Dallas Morning News: Commissioners Approve Health Care Stipend For Gay, Unmarried Employees
Dallas County will give a stipend to unmarried and gay employees who provide health care benefits to their partners. County commissioners approved the new program in a narrow 3-2 vote, which was split along party lines. Democratic commissioners hailed the move as a way to attract and retain talent, embrace the county’s diversity and compete against private companies who already provide domestic partner benefits. Republican commissioners said the move, which is estimated to cost taxpayers $100,000 a year, made bad economic sense and was an end-run around state and federal laws barring gay marriage (Formby, 10/30).

Milwaukee Journal Sentinel: Federal Judge Rules Milwaukee County Could Shift Some Health Costs To Retirees
Milwaukee County's move to charge its retirees for some health care costs - a change made in 2012 that shifted millions of dollars in costs from taxpayers to retirees as well as active employees - was upheld in federal court Tuesday. U.S. District Judge William E. Callahan Jr. ruled against Esther Hussey, who retired from the county in 1991 after 35 years and said she was promised free health insurance. She worked primarily in the register of deeds office. Callahan sounded sympathetic to Hussey, 85, comparing her case to another in which Pabst Brewing retirees felt "an element of betrayal" over losing health benefits (Schultze, 10/30).

HealthyCal: Permanent Housing Offers Stability For Those With Mental Illness
The Mental Health Services Act approved by voters as Proposition 63 in 2004 provides more funding to county-based mental health programs. The funding from a 1 percent tax on personal income in excess of $1 million was expected to fund the implementation of treatment, prevention and early intervention programs for those with serious mental illness. Still, the cost of not serving the needs remains high. An experiment in Los Angeles, started in 2008, concluded that giving homeless residents permanent housing with no strings attached provides a savings to taxpayer (Flores, 10/31).

The Texas Tribune: Senate Panel Takes Aim At Prescription Drug Abuse
Speaking Tuesday at a Senate panel hearing on prescription drug abuse, doctors and law enforcement officials touted the importance of agencies sharing information to more effectively look for pharmacies and doctors involved in the usage of prescription drugs outside of medically sanctioned purposes (Chammah, 10/30).

The Dallas Morning News: Officials Unveil Plan To Eliminate Childhood Obesity In Dallas By 2020
Community leaders met Tuesday to unveil a plan to eliminate childhood obesity in Dallas by 2020. The plan, named Charting the Course for a Healthy Future, was introduced at Texas Scottish Rite Hospital for Children after nearly two years of planning by a coalition of more than 60 organizations and community leaders. "Reducing childhood obesity will have a profound impact on the health and quality of life for all North Texans," said Susan Hoff, chief strategy officer of United Way of Metropolitan Dallas (Fancher, 10/30).

(St. Paul) Pioneer Press: Watchdog: U Students Say New Health Insurance Process Causing Headaches
Some students at the University of Minnesota say they are being charged for the university health care plan, even though they have private insurance and notified the U of their coverage when they registered for class last spring. The problem appears to be related to a change in the university's health insurance verification process. The new system uses electronic verification when students register for classes to confirm that students are covered by a private insurance provider. The glitch is that the system recognizes only five major providers: Blue Cross and Blue Shield, HealthPartners, Medica, MinnesotaCare, and Preferred One (Tritschler, 10/30).

Kansas Health Institute News: Advocates Of Mid-Level Dental Care Prepare For Legislature
Hays dentist Melinda Miner is one of a handful in her profession who publicly support licensing a new type of mid-level dental provider as a way to increase Kansans' access to oral health care. She's also among the relative few who will see Medicaid patients. "Only 25 percent of us see the problems," Miner said. "Most dentists live in a different world. Their patients pay cash and can afford the expensive treatments. They don't see the dental decay and the problems in people who can't pay." Miner was among about 25 people who met today in Topeka as part of the Kansas Dental Project, a coalition of advocacy groups seeking to improve dental care for children, the elderly and the medically underserved (Cauthon, 10/30).

California Healthline: Payments Delayed To CBAS Centers
California centers that offer adult day services are having trouble getting reimbursed for services provided to Medi-Cal beneficiaries under the state's new Community Based Adult Day Services program launched on Oct. 1. "We are not getting paid. And I don't know when we will get paid. I'm not expecting anything at this point," said Manooch Pouransari, who runs the Grace Adult Day Health Care center in Santa Clara. "My experience is similar to many other centers," he said. "We haven't been told who to bill, where to bill, how to bill. And we found the same thing on their side, the MCOs (managed care organizations), they don't know any of that, either" (Gorn, 10/31).

The Lund Report: Member Insists OEBB Overpays For Prescription Drugs
Tamara Weaver questions why the Oregon Educators Benefit Board (OEBB) is paying more for prescription drugs through its mail order company than at Costco, her local retail pharmacy. OEBB is responsible for selecting the health plans for the majority of Oregon's public school teachers, community colleges and state universities (Scharer, 10/30).

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Swing State Trailmix

Swing State Highlights: Ohio's Provisional Ballots; Sandy's Impact On Voting

KHN's Sarah Barr samples campaign news coverage each week from swing states to see how health policy developments, and other political issues, are playing.

The Cleveland Plain Dealer: Provisional Ballots Could Keep Ohio's Presidential Outcome In Doubt For Days After Election
As the presidential race narrows in Ohio, the Buckeye State runs the risk of preventing the United States from calling a winner for days after the Nov. 6 election. A wild card in declaring a winner on Election Night could be thousands provisional ballots. Provisionals are given to voters when their eligibility is in question, often because of address changes or discrepancies. Election boards hold the ballots 10 days to determine eligibility (Spector, 10/30). 

Also in the news, last-minute ad buys in Pennsylvania -

Philadelphia Inquirer: Romney Backers Buying Ads In Pennsylvania
Two Republican super PACs are making a late play to try to crack Democratic-leaning Pennsylvania, spending a combined $3.2 million to air TV commercials across the state in support of Mitt Romney. Restore Our Future, the pro-Romney super PAC run by former aides to the Republican nominee, is spending $2.1 million over the campaign's final week to attack President Obama in the state, including $1 million devoted to the expensive Philadelphia media market. That's on top of $1.1 million in airtime purchased by Americans for Job Security (Fitzgerald and Warden, 10/30).

Pittsburgh Post-Gazette: Obama, Romney Have Bypassed Pennsylvania In Advertising War -- Until Now
"We are going to win Pennsylvania, but we're not taking anything for granted, which is what good campaigns do," Obama campaign manager Jim Messina said in a conference call with reporters.
Pennsylvania has not been the key presidential battleground it has been in years past, which is partially reflected in the lack of network television advertising: Through last week, the Obama and Romney campaigns spent $100 million in Ohio compared with just $5 million next door in Pennsylvania (McNulty, 10/30).

Meanwhile, various newspapers also offered local coverage of how Mega-Storm Sandy is affecting early voting and campaign appearances in key states -

Pittsburgh Post-Gazette: Corbett Extends Deadline For Absentee Ballots In Some Counties
Monday's closures of county courthouses across the state has led Gov. Tom Corbett to allow some counties to extend today's deadline for applying for an absentee ballot. ... The governor announced Monday night that counties could extend that deadline by one day for each day their courthouse is closed this week as a result of storm damage (Olson, 10/30).

The Tampa Bay Times: Superstorm Sandy Upends Presidential Campaign
Superstorm Sandy forced the presidential race into a unpredictable spin Monday as rain and high winds pummeled the East Coast, causing both campaigns to cancel events with a week left in a battle that remains bitterly close. President Barack Obama skipped a rally with Bill Clinton in Orlando on Monday and an event in Wisconsin today ... The campaign has been intensely close for weeks, each side feeling bursts of momentum only to be dragged back into a dead heat, and the storm injected a powerful sense of unease and limbo (Leary, 10/30). 

The Cincinnati Enquirer: Buckeye Political Strategies Set Askew
The storm’s power outages could linger until Election Day in some parts on the East Coast. The campaign suspension holds risks for both men, experts say. ... It was unclear late Monday whether Obama would still make a planned Cincinnati campaign stop Wednesday. Vice President Joe Biden canceled campaign appearances through Thursday. ...“If the storm has half the impact that’s predicted, its hurts both candidates,” said Hiram College political science professor Jason Johnson. Obama benefits from the national spotlight on his leadership role, but curtailed early voting could help Romney win the battleground state of Virginia, he said (Coolidge, 10/30).

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Editorials and Opinions

Viewpoints: Dukakis On Keeping 'Obamacare'; Are Medicare Patients Being Pressured Into Concierge Medicine?

WBUR: Advice To The Next President: The Future Of 'Obamacare' 
The United States is the only industrialized nation that doesn't guarantee access to health care for all its citizens. ... That's what Obamacare is designed to fix. ... That's why the next president – whether it is Barack Obama or Mitt Romney — should defend Obamacare and make sure it's fully implemented. Despite what he's said on the campaign trail, Gov. Romney knows this is the responsible thing to do because of what has happened in Massachusetts since the passage of "Romneycare" (Michael Dukakis, 10/31).

The Wall Street Journal: ObamaCare's Cost To The Working Class
It is time to move past the debate over whether ObamaCare was a good or a bad idea. I count myself as an ObamaCare supporter, but this doesn't blind me to the law's flaws. Regardless of who wins the presidential election, bipartisan compromise will be necessary to reform health care in a constructive way (David Gamage, 10/30).

The Wall Street Journal: 'Concierge' Medicine, ObamaCare And The End Of Empathy
Those of us who have spent our careers in the cottage industry of medical practice and working in America's single-payer health-care system known as Medicare hear only this nowadays: "Get ready, changes are coming." The talk is all wonky babble about "primary care medical homes," "accountable care organizations," "service bundling" and "resource-based relative value units." Through the din, one thing is clear: The single practitioner will be unable to survive without joining some much larger entity, or by transforming into a concierge model (Dr. Jerald Winakur, 10/29).

Kansas City Star: Ladies, Claim Your Rights
Lesley Gore recorded the hit "You Don't Own Me" in 1964. Now, almost 50 years later, the song is back in a viral video featuring such celebrities as HBO's "Girls" mastermind Lena Dunham and actress Tracee Ellis Ross singing along. It's a PSA to remind women to protect their bodies and their rights and vote. Politicians have taken aim at reproductive rights, women's healthcare, equal pay and the definition of rape. As Election Day nears, women's rights are in the spotlight, and Hollywood is front and center (Jeneé Osterheldt, 10/30).

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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.