Daily Health Policy Report

Thursday, October 4, 2012

Last updated: Thu, Oct 4

KHN Original Reporting & Guest Opinion

Campaign 2012

Health Reform

Medicare

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Denver Debate: Obama And Romney On 'Obamacare,' Medicare And Medicaid (Video Collection)

Kaiser Health News offers this video collection of excerpts from Wednesday night's presidential debate.

Obama And Romney On 'Obamacare': The bulk of Wednesday night's debate focused on the topic of health care. In this segment, President Barack Obama and former Mass. Gov. Mitt Romney discuss the 2010 health law. Watch Kaiser Health News' clip or read the transcript.

The Candidates Discuss Medicare: Medicare and how to rein in its rapidly growning costs was also a major focus in the face-off between the two presidential candidates. Watch KHN's video clip or read the transcript.

Medicaid As A Domestic Priority: The Medicaid program was not a major debate focus, but it was a topic of discussion as the two candidates laid out their domestic policy priorities. Watch this KHN video or read the transcript.  

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How Will The Election Change Medicaid?

Kaiser Health News staff writer Phil Galewitz, working in collaboration with the PBS Newshour, reports: "The future of Medicaid -- the state-federal workhorse of the nation's health system that provides health coverage to the poorest and sickest Americans -- hangs in the balance on Election Day. President Barack Obama and Republican nominee Mitt Romney have vastly different approaches to the program" (Galewitz, 10/3). Read the story or a watch the related video.

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Capsules: Breaking Down The Debate, Word-By-Word; Sebelius Touts Health Law Benefits For Older Hispanics

Now on Kaiser Health News' blog, a word-by-word breakdown of last night's debate. President Barack Obama and former Mass. Gov. Mitt Romney had plenty to say about health care. Here are they words they chose — with the most-frequently used words shown larger — during the discussions about health policy issues (10/4).  

Also on Capsules, Shefali S. Kulkarni writes about HHS Secretary Kathleen Sebelius speech to the National Hispanic Council on Aging: "Just hours before the first presidential debate, Health and Human Services Secretary Kathleen Sebelius delivered a message about the dire need to protect Medicare and Medicaid funding to a critical electoral constituency" (Kulkarni, 10/3). Check out what else is on the blog.

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Political Cartoon: 'Visting Hours?'

Kaiser Health News provides a fresh take on health policy developments with "Visting Hours?" by Chuck Asay.

Meanwhile, here are two health policy haikus: 

DEBATE CRITIQUE

Lehrer's "fair" question:
Obama: why not repeal?
Now I've heard it all.
-Alice Weiss

NOT TALKING POINTS

Watching the debates
I failed to hear new answers.
Dodge, distract, avoid...
-Julie Miller

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

First Presidential Debate Marked By Disagreements Over Taxes, Medicare And Health Issues

Many news outlets are reporting that President Barack Obama often found himself on the defensive as GOP presidential hopeful Mitt Romney launched attacks against his record.   

The New York Times: Obama And Romney, In First Debate, Spar Over Fixing The Economy
Both men argued that their policies would improve the lives of the middle class, but their discussion often dipped deep into the weeds. ... Even as (Romney) repeated his plans to repeal the president's health care plan, he happily embraced the plan he pushed into law in Massachusetts. ... an argument for bipartisanship animated much of Mr. Romney's message through the night. He said he had worked with Democratic legislators in Massachusetts. And he said that he would do the same thing on his first day in the Oval Office. The claim drew one of Mr. Obama's sharpest retorts of the night. "I think Governor Romney’s going to have a busy first day," he said, "because he’s also going to repeal 'Obamacare,' which will not be very popular among Democrats as you're sitting down with them" (Zeleny and Rutenberg, 10/3).

The Washington Post: Romney Goes On Offense, Forcing Obama To Defend Record
An energetic Mitt Romney launched a series of attacks against President Obama here Wednesday night, calling into question the president's record on the economy, health care and the deficit. ... Romney argued that (Obama's health law) would raise health-care costs and make it less likely that businesses would hire new workers. He accused Obama of establishing an unelected board to make health-care decisions for patients, and of cutting more than $700 billion from Medicare to help pay for the law. And he chastised the incumbent for "pushing through" legislation of such magnitude without a single Republican vote (Balz and Gardner, 10/3).

Los Angeles Times: In First Debate, Obama And Romney Politely Disagree Sharply
President Obama and challenger Mitt Romney differed sharply Wednesday night over taxes, Medicare and, especially, the record of the last four years in a pointed but largely polite debate. ... Romney repeatedly attacked "Obamacare" — a label Obama happily embraced with a smile — saying it would rob $716 billion from Medicare and make it more difficult for seniors to find doctors and hospitals willing to treat them. He said his overhaul proposal would protect current beneficiaries as well as those approaching retirement age. Obama shot back that Romney's promise was contradicted by the facts. Romney's plan to give future retirees a voucher to help subsidize their coverage would end up driving up their out-of-pocket costs and undermining Medicare for future generations, he said. He added that his Medicare cuts are aimed at providers and insurance companies and would not scale back care for seniors (Barabak, 10/3).

The Wall Street Journal: Candidates Spar Over Taxes
The way the candidates answered questions showed their core differences on the role of government in the economy, in particular on whether the government or the private sector can best provide health care for Americans. ... Seeking to exploit a potential weakness for the Republican ticket, Mr. Obama invoked his late grandmother as he said Mr. Romney's plans to overhaul Medicare would ultimately put the insurance program at risk by turning it into a voucher program. ... Mr. Romney said his plan would ensure a solvent future for Medicare and said there were merits to a private option (Lee and Murray, 10/4).

The Wall Street Journal: A Wonkfest With Few Zingers
Take, for instance, one provision of the Obama health-care law, which creates an independent board that can make recommendations for cuts to Medicare spending if the program grows too quickly. If lawmakers fail to act, the cuts take effect automatically. Mr. Romney brought up the board on his list of complaints with the law. "It puts in place an unelected board that's going to tell people, ultimately, what kind of treatments they can have. I don't like that idea," he said. Mr. Obama started to respond by explaining that he wants to reduce the cost of delivering health care. He said policy makers can either leave people uninsured or figure out how to reduce costs. From there, he was off to explain how the Cleveland Clinic is able to provide excellent care for less than average costs by having doctors work together. And then he shifted to a discussion of how providers are reimbursed for care (Meckler and Nelson, 10/4).

Bloomberg: Romney Puts Race Against Obama Back On Track In Debate
Mitt Romney aggressively challenged President Barack Obama in their first debate, seeking to recharge his campaign after weeks of setbacks, while a subdued incumbent largely passed up chances to attack a rival he said was hiding his full plans…. The president highlighted a provision in his health-care law that requires insurers to cover people with pre-existing health conditions, noting that Romney's plan wouldn't guarantee such coverage (Davis, 10/4).

McClatchy: Obama And Romney Clash Over Economy, Taxes, And Health Care
With the presidency hanging in the balance, President Barack Obama and Republican challenger Mitt Romney clashed sharply Wednesday in their first debate, trying to convince voters they're uniquely qualified to lead the country to full recovery from the worst economic downturn since the 1930s. The two men sparred from the opening minutes over their competing visions of government and whether it should help lead the way to a better economy or get out of the way. Each also repeatedly accused the other of promoting damaging policies on such issues as taxes, spending, health care and business regulation that made or would make things worse, not better (Lightman and Kumar, 10/3).

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Health Policy Challenges, Details Create Flashpoints For Candidates' Different Views

Although only a portion of Wednesday night's debate was supposed to focus on health issues, the presidential candidates sparred on Medicare, Medicaid and specific provisions of the health law throughout the entire 90-minute event.

The Associated Press/Washington Post: Romney, Obama Tangle Over Health Care Reform Law In First Presidential Debate
Republican Mitt Romney is vowing to repeal President Barack Obama's health care law, saying it adds costs to the health system and has led to Medicare cuts. Romney says in the first presidential debate that Obama spent his energy pushing through a massive health care law rather than trying to fix the struggling economy. … Obama says his administration worked on the health care law at the same time he was working to create jobs. He says the law has helped people with pre-existing conditions and those who have children under age 26. The president counters that he based the law on Romney's own plan when he was governor (10/3).

Reuters: Obama, Romney Debate Sheds Little Light On Healthcare Issues
President Barack Obama and his Republican challenger Mitt Romney agree that the $2.8 trillion U.S. healthcare system is broken, but neither candidate on Wednesday presented voters with a clear idea of how to fix it. Their comments about Medicare, Medicaid and healthcare in general dominated more than one-quarter of a presidential debate and gave both candidates a chance to articulate their policies for an estimated 50 million viewers (Morgan, 10/4).

National Journal: One Bright Spot For Obama In Debate: Medicare
In a tough debate for President Obama, Medicare may have been the high point. Obama made a strong case that the Medicare reform proposal offered by Mitt Romney could shift costs to seniors and potentially undermine the traditional government insurance program, even if the plan includes it as an option. Romney never fought back on Obama’s central assertion, that his plan amounted to a "voucher," even after moderator Jim Lehrer asked him if he supported "a voucher system" (Sanger-Katz, 10/3).

Medscape: Romney, Obama Hammer Each Other On Medicare In Debate
President Barack Obama and Republican challenger Mitt Romney hammered each other on the high-stakes issue of Medicare Wednesday night in the first of 3 presidential debates, with each candidate hitting his favorite hot buttons on the subject more than once. For Romney, one hot button was the figure of $716 billion — the amount of savings that the Affordable Care Act (ACA) extracts from Medicare over 10 years by cutting payment to Medicare Advantage plans, hospitals, and other providers. That spells trouble for patient access, he said. "Some 15% of hospitals and nursing homes say they won't take any more Medicare patients under that scenario," said Romney. "We also have 50% of doctors say they won't take any more patients" (Lowes, 10/3).

Roll Call: Mitt Romney Tweaks Plans, Lands Punches Against Barack Obama
Romney repeatedly sought to find the middle ground on health care, regulations and the like. He contended that his national health care plan to replace Obamacare would cover people with pre-existing conditions - but he hasn't detailed how beyond what current law allows. He defended his Massachusetts health care overhaul that Obama used as the template for his health care law, but he said that should be a model for states on a state level and not imposed at the federal level. ... The president said his policies would make sure insurance companies can't "jerk you around" and would give millions of people with pre-existing conditions access to affordable health insurance. And he said the Medicare plan proposed by Romney running mate Rep. Paul Ryan (R-Wis.) would ultimately hurt existing seniors as well (Dennis and Livingston, 10/3).

Politico Pro: Obama, Romney Clash Over Medicaid
The first health care clash between President Barack Obama and Mitt Romney during Wednesday's debate was not over Medicare or "Obamacare." Rather, it was over Medicaid. Obama argued that Romney's plan to let the states run Medicaid programs would result in a 30 percent cut to the program, meaning less care for seniors in nursing homes and children with disabilities. "That's not a right strategy to move forward," he said. Romney retorted that his proposal to give states more control over their Medicaid programs had bipartisan support from Republican and Democratic governors. He said his plan would provide states the same level of funding they currently get and link it to inflation plus 1 percent (Cheney, 10/3).

Kaiser Health News: How Will The Election Change Medicaid?
The future of Medicaid -- the state-federal workhorse of the nation's health system that provides health coverage to the poorest and sickest Americans -- hangs in the balance on Election Day. President Barack Obama and Republican nominee Mitt Romney have vastly different approaches to the program (Galewitz, 10/3).

Medpage Today: Health Care Takes Stage In First Debate
President Obama and Mitt Romney traded sharp jabs on healthcare in the first presidential debate Wednesday night, with each attacking the other's plans on health reform and Medicare. The first mention of the night for healthcare came in the first half-hour, when Romney said he'd cut "Obamacare" because it wasn't worth the cost. After Romney apologized for using the term Obamacare, the president said, "I like it." The former Massachusetts governor, unlike his earlier reticence on the subject, didn't shy away from his work to achieve universal coverage in his state. Instead, he said that work wasn't meant to serve as a model for the entire country, although it did seem to do that for the Affordable Care Act (Pittman, 10/3).

The Medicare NewsGroup: Medicare Takes Center Stage In First Presidential Debate
Misstatements about Medicare abounded during the first of the 2012 presidential debates, which aired Wednesday, October 3. President Barack Obama and GOP candidate Mitt Romney sparred repeatedly on Medicare, resurrecting sound bites that have featured prominently and consistently in their campaigns to date.  Romney repeatedly accused Obama of cutting $716 billion from Medicare through the Affordable Care Act and vowed to repeal the act on day one of his presidency. Obama defended his signature legislative achievement, saying it will drive innovative changes in Medicare and health care more broadly that will result in better care and lower costs (Szot, 10/3).

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Romney Embraces His Massachusetts Health Plan As Bipartisan Success

After months of distancing himself from the state health reforms he oversaw while governor of Massachusetts, GOP presidential pick Mitt Romney said that overhaul illustrates his ability to work with Democrats. President Barack Obama, however, countered that the Massachusetts plan was one of the models for the 2010 health law that has been a target of conservatives.

Los Angeles Times: Romney Shines Rare Spotlight On His Massachusetts Record
Romney has barely mentioned his stint as governor in his campaign advertising and rarely talks about it in public remarks. He has fought especially hard to avoid the subject of the landmark healthcare law that he signed as governor, lest he remind conservatives of its close resemblance to Obama's healthcare overhaul. So it was all the more noteworthy that Romney used the high-profile forum of a nationally televised presidential debate to contrast his work with Democrats on the Massachusetts healthcare law to Obama's party-line passage of the Affordable Care Act (Finnegan, 10/3).

The Washington Post: Romney Embraces His Health Care Plan
Mitt Romney embraced his role as the architect of Massachusetts's universal health care plan, an issue that has vexed him since he entered the race for president. During a segment of the debate devoted to health care, President Obama reminded the audience that the 2010 national health care overhaul that has made him a target among conservatives was inspired by a similar plan pioneered by Romney while he was serving as governor of Massachusetts (Somashekhar, 10/3).

Politico Pro: Romney Contrasts Romneycare, ACA
When Obama compared "Obamacare" … with Romney's Massachusetts health care plan, Romney drew distinctions between the two, arguing that Obama pursued a far different process to develop his law. "I like the way we did it in Massachusetts," Romney said, adding that his legislature was 87 percent Democratic and that the Massachusetts bill required bipartisan support. ... Romney also ticked through a list of differences between the plans. Obama's, he said, raised taxes, required some people to lose their coverage, cut Medicare and put together an "unelected board" to deny health care treatment. Obama defended his 2½ year old plan, which he said borrowed heavily from Romney's plan and Republican ideas. "The fact of the matter is we used the same advisers and they say its the same plan," he said, referring to public comments from MIT economist Jonathan Gruber and others, who worked on both plans. ... But Obama compared the two plans to knock down the Republican argument that the president's health plan is a "government takeover" of the health industry. He also questioned whether Romney is truly interested in providing health coverage to everyone (Haberkorn, 10/3).

The Washington Post: Romney's Federal Health Care Funding
Romney said he did not raise taxes to pay for the health care law that he implemented while serving as governor of Massachusetts. This claim deserves some context, because the federal government has provided substantial help in paying for the program (Hicks, 10/3).

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A Flood Of Post-Debate Fact Checking Follows Points And Counterpoints

News outlets examined a range of issues brought up during last night's presidential face-off, ranging from discussions of the $716 billion Medicare cut to talk of death panels and whether the health law promise of lower health insurance costs came true.

The Washington Post: Fact Check: The $700B Medicare Cut
Romney accused Obama of taking $716 billion from Medicare. This $700 billion figure comes from the difference over 10 years (2013-2022) between anticipated Medicare spending (what is known as "the baseline") and the changes that the law makes to reduce spending. The savings mostly are wrung from health-care providers, not Medicare beneficiaries — who, as a result of the health-care law, ended up with new benefits for preventive care and prescription drugs. While it is correct that anticipated savings from Medicare were used to help offset some of the anticipated costs of expanding health care for all Americans, it does not affect the Medicare trust fund. In fact, the Obama health-care law also raised Medicare payroll taxes by $318 billion over the new 10-year time frame, further strengthening the program’s financial condition (Kessler, 10/3).

Los Angeles Times: Fact Check: Romney's Charge On Obama's $716-Billion Medicare Cut
Mitt Romney repeated a somewhat misleading claim that President Obama cut $716 billion out of the Medicare program for current beneficiaries. The president's healthcare law does reduce future spending on Medicare, but those savings are obtained by reducing federal payments to insurance companies, hospitals and other providers, and do not affect benefits for people in the Medicare program (Levey, 10/3).

Los Angeles Times: Fact Check: Romney Repeats Erroneous Claims On Healthcare
Mitt Romney repeated a number of erroneous claims during Wednesday's debate about President Obama's healthcare law, including that it relies on a board that will decide "what kind of treatment" patients can get. This is a myth advanced repeatedly by critics of the Affordable Care Act and debunked consistently by independent fact-checkers (Levey, 10/3).

Los Angeles Times: Presidential Debate: It Always Comes Back To The 'Death Panels'
Just what to do with the nation's healthcare system has been argued time and again – but it always seems to come back to the "death panels." Such was the case at the debate in Denver on Wednesday night, when moderator Jim Lehrer asked the candidates whether Obamacare, one of the most contentious issues this election season, should be repealed (Semuels, 10/3).

Politico: Debate Fact Check: Analyzing Health-Care Statements
President Barack Obama and Mitt Romney had at it out over health care Wednesday night — providing some of the toughest, and wonkiest, moments of the night. Both candidates also showed they had done their research, citing studies to back their claims about Obama's health care law and how the other would cut Medicare spending — but they both managed to stretch the truth (Nather and Kenen, 10/4).

The Washington Post: About That Unelected Medicare Board
Just how will the IPAB work? Its powers kick in only if federal spending on Medicare exceeds yearly targets set by the law. At that point the board must propose spending cuts. Congress could overrule the panel, but only if it musters a super-majority in the Senate, or comes up with an alternate plan that saves at least as much (Aizenman, 10/3).

NPR: Romney Goes On Offense, Pay For It In First Wave Of Fact Checks
Has the president put in place a plan that would cut Medicare benefits by $716 billion? Romney says yes. The president says no. According to PolitiFact, Romney's charge is "half true." … In listing his objections to the Affordable Health Care Act, Romney said it "puts in place an unelected board that's going to tell people, ultimately, what kind of treatments they can have. I don't like that idea."  But the Times and National Journal have reported that the board in question wouldn't make treatment decisions, a point Obama made during the debate. National Journal called Romney's characterization of what this board would do "one of the biggest whoppers of the night" (Memmott and Montgomery, 10/4).

The New York Times: Check Point: Taking Stock Of Some Of The Claims And Counterclaims
Mitt Romney repeatedly questioned President Obama's honesty at Wednesday night's debate — likening the president and vice president at one point to his five sons repeating things that were not true — but he made a number of misleading statements himself on the size of the federal deficits, taxes, Medicare and health care (Cooper, Calmes, Lowrey, Pear and Broder, 10/4).

Los Angeles Times: Fact Check: 'Obamacare' Hasn't Yet Reduced Health Insurance Costs
President Obama reiterated a claim that his healthcare law will reduce costs, a promise he made when he started pushing for an overhaul as a candidate four years ago. Then, Obama said he would cut family health insurance premiums by $2,500 by the end of his first term. Today, this stands as one of the president’s biggest unfulfilled promises. In fact, the average employee share of an employer-provided health plan jumped from $3,515 in 2009 to $4,316 in 2012, an increase of more than 22%, according to a survey from the Kaiser Family Foundation and the Health Research & Educational Trust (Levey, 10/3).

CNN: Fact Check: Would Repeal Of Obamacare Hike Seniors' Drug Costs?
President Barack Obama said the repeal of Obamacare would cause seniors' prescription drug payments to rise. "We were actually able to lower prescription drug costs for seniors by an average of $600," Obama said during his debate with GOP challenger Mitt Romney. He went on to say that if Obamacare were repealed, "those seniors right away are going to be paying $600 more in prescription care." Nearly 5.4 million Medicare recipients saved more than $4.1 billion on prescription drugs as a result of the Affordable Care Act, Health and Human Services Secretary Kathleen Sebelius said in an August news release. "Seniors in the Medicare prescription drug coverage gap known as the 'donut hole' have saved an average of $768," she said. The law helps make Medicare prescription drug coverage more affordable (10/4).

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Senate Races: McCaskill Surges; Rehberg, Tester Spar In Montana

Meanwhile, Medicare is playing big in one Minnesota House race.   

The Kansas City Star:  McCaskill Surges In Polls As Akin's Abortion Comments Draw Fire
Two new polls Wednesday showed Democratic Sen. Claire McCaskill leading Republican U.S. Rep. Todd Akin by six points as Akin faced a new round of questions about four-year-old comments about abortion providers. In a 2008 speech on the House floor, Akin linked abortion providers to terrorists and suggested it was a "common practice" for those providers to give "abortions to women who are not actually pregnant." The remarks made the rounds on the Internet as Akin was in Washington raising money for his Missouri race against McCaskill. For Akin, the attention to the remarks was ill-timed as he struggles to emerge from the weeks-old shadow of his remarks about "legitimate rape" that were broadcast Aug. 19 on a St. Louis television station (Kraske, 10/3).

The New York Times: Tester And Rehberg Fight Over Outsider Label In Montana
The mustachioed Mr. Rehberg campaigns in cowboy boots and denim, telling stories about his family's old ranch and his days at Billings West High School. His speeches and advertisements are aimed at yoking Mr. Tester to President Obama, bailouts, deficits and health care reform — none of which are popular here. …Mr. Tester, sporting an $8 buzz cut, argues he is the real agrarian. His family runs an organic millet and alfalfa farm near Big Sandy, and in his campaign ads, he drives a red combine across his fields and talks about understanding the lives of farmers. He has dismissed Mr. Rehberg as a "mansion rancher" who converted much of his ranchland to housing developments (Healy, 10/3).

MPR: Cravaack, Nolan Battle Over Medicare
Republican Chip Cravaack and Democrat Rick Nolan are battling over Medicare in their campaigns for the 8th District congressional seat. Both candidates have aired new TV ads on the subject earlier this week to criticize the other over who would better protect health care for seniors. Cravaack started the Medicare campaign war this week with a television spot criticizing Nolan for supporting a proposal to cut the Medicare spending growth by nearly three-quarters of a billion dollars. In the television ad Cravaack says, "My opponent believes cutting $700 billion from Medicare won't have an impact on seniors. I disagree. I approve this message because Medicare is a commitment we made to our parents. It's a promise I plan to keep" (Zdechlik, 10/4).

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Have Attitudes On Health Law Shifted In N.H.?

Despite a beating two years ago for Democrats aligned with the health law, former President Bill Clinton and the Democratic gubernatorial candidate in New Hampshire rallied around the overhaul at a campaign appearance. Meanwhile, a conservative seniors group emerges to offer a competing view with that of AARP.

The Boston Globe: In NH, Bill Clinton Talks Up Obamacare
Is Obamacare now becoming an asset for Democrats? Two years ago, President Obama's health care overhaul looked like an albatross around the necks of Democratic candidates — nowhere more so than in the swing state of New Hampshire, where conservative opposition to the law helped propel the GOP to sweeping victories in 2010. Now, Democrats seem to be betting the tide has turned. At an Obama rally on the campus of the University of New Hampshire Wednesday afternoon, both former president Bill Clinton and New Hampshire Democratic gubernatorial candidate Maggie Hassan pointedly embraced the law (Wirzbicki, 10/3).

Politico: AARP Faces Conservative Competition
Looking to counter what they see as AARP's liberal slant, a new organization aims to rally conservative senior citizens. The National Association of Conservative Seniors says it will provide seniors "membership benefits while working together to protect conservative American values" — benefits that include "financial planning services, health and wellness offers, Medicare insurance plans and competitive pricing on auto insurance and roadside assistance," according to a release (Gavin, 10/3).

Also in the news -

NBC/Center For Public Integrity: Health Insurance Industry, Which Praised Obamacare, Gives To Kill It
The health insurance industry presented itself as a key ally of President Barack Obama's health care law while at the same time making hefty contributions to members of Congress who are trying to get rid of it, according to contribution records. Between January of 2007 and August of 2012, the political action committees of the 11 largest health insurance companies and their primary trade group gave $10.2 million to federal politicians, with nearly two-thirds of the total going to Republicans who oppose the law or support its repeal, according to the Center for Public Integrity's analysis of Federal Election Commission filings. The 11 top companies, according to the Fortune 500list, controlled 35 percent of the industry in 2011, according to data from the National Association of Insurance Commissioners. The top industry trade group is America's Health Insurance Plans. Much of the money rolled in as health insurance industry leaders lauded the Democrats' reform efforts (O’Brian, 10/4).

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Health Reform

What's New On Pre-Existing Condition Health Plans, The Medicaid Expansion

CQ HealthBeat offers a progress check on the health law's pre-existing condition insurance plan while the St. Louis Beacon explores the Medicaid expansion debate.

CQ HealthBeat: Enrollment Climbs In Pre-Existing Condition Insurance Plan
Enrollment in the Pre-Existing Condition Insurance Plan hit 82,000 as of July 31, an all-time high for a program that had a slow start following its creation in the health care law. But it’s still far from the 375,000 Americans who were expected to rush to sign up, based on early estimates by actuaries with the Centers for Medicare and Medicaid Services. One problem for the program has been that the plan premiums, while at market rates, are costly for people with moderate incomes (Norman, 10/3).

St. Louis Beacon: At Issue: Debate Over Medicaid Expansion Continues
Angela Pace gave up on getting $1,600 worth of medicine to shrink a tumor after she discovered that her insurer required her to cover 75 percent of the cost…. The two regard the proposed Medicaid expansion as one way to bring relief to working poor like themselves…. Whether Medicaid should be expanded to cover the near poor continues to be widely discussed in every state, with GOP leadership in some states, such as Missouri, reluctant to expand the program, while Democrats in states like Illinois are embracing the Medicaid changes (Joiner, 10/3).

Meanwhile, a new study questions an often repeated health reform proposal advanced by many Republicans -

The Hill: Study: Little Practical Interest In Selling Insurance Across State Lines
Efforts to sell health insurance across state lines haven't made much of an impact or galvanized much popular support, according to a new paper. Researchers at Georgetown University examined state laws that make it easier for insurance companies to sell plans across state lines — a hallmark of GOP healthcare plans, including the party's plan to replace President Obama's healthcare law. Only six states have passed laws to allow the sale of insurance policies from other states, and not a single insurance company has taken advantage of the expanded market, according to the research (Baker, 10/3).

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Medicare

Survey Finds Seniors Satisfied With Medicare Part D

The national survey of 2,363 seniors, which was conducted by Medicare Today, found 90 percent are satisfied with their Medicare prescription drug coverage.

CQ HealthBeat: Don't Mess With Medicare Part D, Say Analysts
Ninety percent of seniors are satisfied with the Medicare Part D prescription drug program, according to a new health care poll, and a trio of policy analysts whose views range from right-leaning to centrist said Wednesday that lawmakers should not change it. Representatives of the Healthcare Leadership Council, the Galen Institute and The Third Way said that they hope lawmakers will not pass adjustments such as allowing the Department of Health and Human Services to negotiate drug prices with manufacturers, a process now done by companies administering the plans, or imposing rebates used in Medicaid on the Medicare drug program (Adams, 10/3).

Politico Pro: Survey: High Satisfaction With Medicare Part D
The debate may be raging over Medicare in the race for the White House — but a new survey points out that one part of it, Medicare Part D, has both positive results and bipartisan support. And health experts from Third Way, the Galen Institute and the Healthcare Leadership Council say the program's success means that during sequester negotiations lawmakers should keep their hands off the Medicare prescription drug benefit. David Kendall, senior fellow for health and fiscal policy at Third Way, said on a call with reporters that the Medicare prescription drug benefit was a key example of successful bipartisanship because it was "enacted by Republicans and perfected by Democrats" (Smith, 10/3).

Modern Healthcare: Polls Find Seniors Happy With Part D
Seniors are as satisfied with the Medicare drug program as they have been at any point in the past six years, according to an annual tracking poll (PDF). A national survey of 2,363 seniors found 90% are satisfied with their Medicare Part D coverage, which matches the previous highest satisfaction level found by the annual survey conducted since 2006 by Medicare Today and KRC Research. Medicare Today is a nonprofit advocacy group that provides educational information to Medicare beneficiaries (Daly, 10/3).

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State Watch

Analysis: Health Costs Jump Nearly 5% Nationwide This Year

An analysis from benefits consulting group Aon Hewitt found health costs rose this year for employers and workers an average of 4.9 percent nationwide. In the midwest, two news outlets examine how this figure plays out locally.

Milwaukee Journal Sentinel: Health Benefits Costs Rise 5.2 Percent For Large Employers, 5.9 Percent For Workers
Large employers in the Milwaukee area will spend an average of $12,691 for each employee to provide health benefits this year, an increase of 5.2 percent from last year, according to an annual survey by Aon Hewitt, a benefits consulting company. In addition to the employer's cost, employees will spend an average of $5,238 this year for their share of the cost of insurance and out-of-pocket expenses, such as deductibles, or 5.9 percent more than last year. The survey also shows that costs remain higher in the Milwaukee area than the national average (Boulton, 10/3).

Chicago Sun-Times: Health Care Costs Jumping 9% For Chicago Workers, Report Estimates
Chicago area workers can expect their average health care costs to jump 9.2 percent next year from 2012, according to an analysis by Lincolnshire-based Aon Hewitt released Wednesday. Including employee contributions and out-of-pocket costs, health care costs are expected to rise to $5,595, up from $5,122 in 2012, the human resources and benefits consulting company said. Average employee premium contributions are expected to rise to $2,713 from $2,508, and average out-of-pocket costs are expected to rise to $2,882 from $2,614. This year companies and workers in Chicago saw higher cost hikes than were experienced nationally, compared with 2011. The average health care cost per employee in Chicago rose 5.7 percent to a cost of $10,616 this year, including employer and employee contributions, but excluding employee co-pays. That compares to the national average of a 4.9 percent increase (Knowles, 10/3).

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Prison Health Care: Healthy Inmates In Minn.

Prison health care is examined: In Minnesota, prison inmates are offered healthier lifestyles, even while incarcerated. In Wisconsin, in the meantime, some groups are calling for discipline for the Milwaukee County sheriff over medical care in prisons there.

Minneapolis Star Tribune: Behind Bars, But Health-Conscious
The 70 guys from Unit K-3 at Lino Lakes claim to be the prison's most physically fit inmates. But even they might have gotten a jolt Wednesday from the exhibition booths on view inside the prison clinic. … The health event is part of a Corrections Department campaign to instill better habits in a group that may be the unhealthiest population in Minnesota. With daunting chemical dependency problems and years of hard living, Minnesota's prisoners and ex-cons present the state with a medical challenge of sobering proportions (McEnroe, 10/3).

Milwaukee Journal Sentinel: Groups Want Clarke Found In Contempt Over Jail Medical Care
Milwaukee County Sheriff David A. Clarke Jr. should be found in contempt of court for "intentional disobedience" of a decade-old court decree on medical care in the county jail and County Correctional Facility-South in Franklin, according to plaintiffs in a long-standing lawsuit over jail conditions. The sheriff has violated the consent decree of 2001 by failing to fill key medical jobs at the two lockups, including a medical director, a chief psychiatrist and medical administrator, according to a motion filed in Circuit Court. The medical director post has been vacant for all but two months over the past two years and there's been no chief psychiatrist for more than four years, the motion states. The medical administrator job hasn't been filled in more than a year (Schultze, 10/3).

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State Roundup: Mass. Health Plans Lauded For Comprehensiveness

A selection of stories from Massachusetts, Kansas, Georgia, Oregon and California.

The Boston Globe: Mass. Health Plans Among Most Comprehensive In The Country
Health insurance plans offered in Massachusetts and analyzed by U.S. News & World Report were found to be among the most comprehensive in the country. The analysis included 67 plans from four Massachusetts insurers that are sold to individuals or families. Each earned at least four of five stars based on scope of coverage and cost to consumers. In other states, the portion of plans with the higher rankings ranged from 4 percent in Washington to 94 percent in New York (Conaboy, 10/3).

Kansas Health Institute News: KanCare Provider Manuals Still Not Finalized
State approval of the KanCare managed care companies' provider manuals is taking longer than initially expected, which means many Medicaid service providers are still holding off on signing KanCare network contracts in the face of looming deadlines. "We know that providers are eager to have the final versions," of the manuals said Miranda Steele, a spokesperson for the Kansas Department of Health and Environment (Ranney, 10/3).

The Associated Press: Ga. GOP Lawmakers Face Uncomfortable Tax Choice
Georgia Republican lawmakers could face the wrath of a GOP powerbroker who is warning them not to renew a hospital tax that supports care for poor patients. If they agree to end the tax, it would worsen the strain on an already stretched state budget and could burden hospitals and their emergency rooms with patients who lack insurance or don't have enough coverage to pay for their care (Barrow and Henry, 10/3).

The Lund Report: Oregon's Insurance Commissioner Speaks Out About Regence BlueCross BlueShield
Regence BlueCross BlueShield is in the hot seat again. This time actuaries from inside the Oregon Insurance Division are in the midst of conducting an in-depth financial review at Regence's headquarters in downtown Portland -- looking for any irregularities and whether the insurer has the financial stability to meet the needs of its policyholders. Oregon's insurance commissioner, Lou Savage, made it quite clear that Regence isn't being targeted because of any issues that have arisen in the past several months (Lund-Muzikant, 10/3).

California Healthline: Physicians, Nurse Practitioners At Odds Over New Roles
It's a time of celebration and indignation for Beth Haney, president of the California Association of Nurse Practitioners. Last week, Gov. Jerry Brown (D) signed into law a bill that will remove a six-month waiting period for new NP graduates to write prescriptions. However, earlier last week, the American Academy of Family Physicians came out with a policy paper that raised questions about the wisdom of expanding the scope of practice for nurse practitioners (Gorn, 10/3).

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Weekend Reading

Longer Looks: The Time Is Now For Community Health Workers

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

The Philadelphia Inquirer: Temple Hospital Trains Workers For The New Front Lines Of Health Care
(By) the time Frederick Pegues Jr. was resting in bed at Temple University Hospital, the irony struck him hard. Here, he had just finished a month-long course in being a community health worker, sponsored by Temple University Hospital. He had learned how to help patients navigate a complicated health system. Yet he himself had not been able to get the help he needed. Unwillingly, Pegues, 38, an unemployed and uninsured diabetic from North Philadelphia, had become Exhibit A for why people needed a community health worker. ... In the United States, these health workers have been an idea whose time, over the decades, is always coming but yet to fully arrive (Jane M. Von Bergen, 9/28).

The Atlantic: The Cost Of Assuming Doctors Know Best
Shared decision making is a process designed to ensure that patients are fully informed, and then use that information to get the treatment they want. A common though non-essential part of informing patients is a "patient decision aid." Decision aids can be videos, websites, or pamphlets, and they present the available medical evidence on all reasonable treatment options -- including the option to do nothing -- in a way that patients can understand. ... Here's the icing on the cake in terms of health care spending: Patients also tend to choose less invasive (and therefore less expensive) treatment options (Shannon Brownlee and Joe Colucci, 9/28).

Earlier, related KHN story: Study: Decision Aids Show Promise In Reducing Medical Procedures (Rao, 9/5)

Journal of the American Medical Association: Lack of Data
Right after the birth of our first child and during my final year of fellowship, I was diagnosed with an extremely rare and aggressive cancer. I could write many things about this: the difficulty of going from full-time physician to full-time patient and the loss of professional identity that comes with that. Knowing enough about what's going on medically to be terrified, but not enough to be able to sort through the data on my own. Dealing with insurance companies from the other end. ... I want to focus on an incredibly frustrating thing that the medical community can do something about: the "lack of data" regarding rare diseases, which now defines my life and care (Dr. Julie Maher, 10/3).

Slate: Why Is Romney Campaigning On Medical Quackery?
Let's play doctor. A patient comes to you with joint pain, difficulty concentrating, anxiety, poor attention, and mood swings. You might run a series of tests to rule out a persistent infection or other disorder. ... If you are a doctor who believes that the CDC and NIH have misrepresented carefully vetted clinical trial data about the diagnosis and treatment of Lyme disease, however, you might diagnose your patient with chronic Lyme disease and prescribe an intensive, long-term, side-effect-laden, mega-dose of antibiotics. And who would be the biggest supporter of your and your patient’s right to pursue a worth-testing-but-found-wanting treatment? Mitt Romney and Paul Ryan (Laura Helmuth, 9/29).

The Economist: An Incurable Disease
Health care expenditure in America is growing at a disturbing rate: in 1960 it was just over 5% of GDP, in 2011 almost 18%. By 2105 the number could reach 60%, according to William Baumol of New York University’s Stern School of Business. Incredible? It is simply the result of extrapolating the impact of a phenomenon Mr Baumol has become famous for identifying: "cost disease". His new book gives a nuanced diagnosis, offerings both a vision of a high-cost future and a large dose of optimism. The cost disease may be incurable, but it is also survivable—if treated correctly (9/29).

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Editorials and Opinions

Viewpoints: Romney's Surprisingly Strong Defense Of Mass. Health Plan; Challenger's 'Pretend' Proposal For The Nation

The New York Times: An Unhelpful Debate
The first debate between President Obama and Mitt Romney, so long anticipated, quickly sunk into an unenlightening recitation of tired talking points and mendacity. With few sparks and little clarity on the immense gulf that truly separates the two men and their policies, Wednesday's encounter provided little guidance for voters still trying to understand the choice in next month's election. ... On health care, Mr. Romney pretended that he had an actual plan to replace the Affordable Care Act, and that it covered pre-existing conditions. He has no such plan, and his false claim finally roused the president to his only strong moment of the evening. The country doesn't know the details, he said, of how Mr. Romney would replace Wall Street reform, or health care reform, or tax increases on the rich because Republicans don't want people to understand the hard trade-offs involved in these decisions (10/4).

The Wall Street Journal: Romney Takes Center Stage
Mr. Romney was also strong and fluent on health care, somewhat remarkably. The only major point Mr. Obama scored was noting the similarities between his plan and Mr. Romney's Massachusetts model, but the Republican brushed off those attacks by describing the broader harm ObamaCare will inflict on U.S. medicine and the abusive way Democrats jammed the bill through Congress over the objections of the American public. In particular he put Mr. Obama on the defensive about the so-called Independent Payment Advisory Board, the 15-member "expert" and unelected commission that will tell doctors how to practice and seniors the treatments they are allowed to receive. The President struggled to stick to his own talking points, perhaps because the damaging details speak for themselves. Mr. Obama was also on the backfoot on Medicare, which was supposed to have doomed Mr. Romney (10/4).

The Wall Street Journal: The Romney Reboot Arrives
(Obama's) references to what he would do with a second term were minimal. Instead, he had to spend most of the 90 minutes trying to defend his policies from Mr. Romney's critique. This was most notable on the biggest issue of all — the future of ObamaCare. Mr. Obama's defense of the 15-member review board came down to citing some process reforms at the Cleveland Clinic. Gov. Romney immediately turned that around as an example of a private institution experimenting its way toward new ideas—a difference of policy and philosophy. Not least, Mr. Romney has finally found his way to a workable defense of his Massachusetts health-care plan, emphasizing that whatever its merits, it was a major legislation that was passed on a bipartisan basis. Mr. Obama was left muttering that the Washington GOP should have taken cues from Massachusetts (Daniel Henninger, 10/3). 

The Washington Post: Romney's Personality Shift
Having hidden his Massachusetts health-care plan behind "Repeal Obamacare" rhetoric in the primaries, Romney warmly embraced his own plan — without explaining why repealing a national health-care system modeled on his plan would in any way be consistent with his sloganeering against the president's central achievement (E.J. Dionne Jr., 10/4). 

The Washington Post: The Audacity Of Romney
Health care has always required enormous audacity from Romney. While his attempt to distinguish his Massachusetts plan from Obamacare wasn't persuasive to someone like me, who has studied the details for years, I think it would have appeared perfectly reasonable to less wonky voters. I won't rehearse them all here, but Romney previewed his staccato talking points on this matter in the Republican primary debates, and I wrote then that (to my astonishment) he was on his way to a politically sufficient position. That Romney can not only pull this off but also go on offense while doing it (when in fact Romneycare is basically the same as Obamacare) takes remarkable dexterity (Matt Miller, 10/4). 

The Washington Post: Obama Didn't Come Ready To Play
To summarize: Romney won't raise taxes, he won't cut the budget for education, he'll increase military spending and he'll somehow balance the budget. The math doesn't work, but if the number of math teachers declines on his watch, perhaps fewer people will figure that out. ... Romney repeated attack lines and Obama declined to refute him the second or third time around — most particularly, on Romney’s assertion that Obama was gutting Medicare by more than $700 billion. Obama’s attack on Romney’s plan for Medicare, by contrast, was more nuanced, more complicated and fuzzier — and he did not repeat it anywhere near the number of times Romney repeated his own attacks (Harold Meyerson, 10/4).

The Washington Post: In Presidential Debate, Obama, Romney Evaded The Hard Truths
If anyone hoped that Wednesday night's debate between President Obama and Mitt Romney would shake the presidential candidates off their canned talking points, they would have ended the evening disappointed. The first of three encounters between the two men did underscore major contrasts between the two candidates: on keeping or repealing Obamacare, on financial regulation, on dealing with the deficit, on the fundamental role of government. Mr. Romney lauded "free people and free enterprises, doing things together," and derided Mr. Obama's approach as "trickle-down government" (10/3).

CNN: Romney Wasn't Stellar, But Obama Fell Short
Inevitably, the president was going to bring up Romney's health care program in Massachusetts during this face-off, so for debate-watchers it was just a question of how adequately Romney would defend himself. Thanks to his opponent, he got a little help right out of the gate. Obama's request of Romney that he "please elaborate" dripped with gratuitous sarcasm. ... Romney's defense of his Massachusetts record supplied the Republican nominee with one of his stronger moments of the night. He managed to spin Romneycare not as evidence of flip-flopping, but as an example of his ability to work in a bipartisanship fashion. Aimed straight at independents, this was a signal Romney needed to send, and the look on Obama's face suggests that he knew the governor had gotten the better of him (Alan Schroeder, 10/4).

The New York Times: Contraception And Religious Liberty
Leaders of the Roman Catholic Church, prominent Republicans and other social conservatives have spent the past year making inflammatory allegations that an Obama administration rule requiring employer health plans to cover birth control without a co-pay tramples on religious freedom. An important federal court decision issued Friday rejected that attack as without foundation (10/3).

New England Journal of Medicine: Moneyball And Medicine
In both medicine and baseball, advocates of evidence-based approaches argued for the enhanced vision of statistical techniques, which revealed what tradition or habit had obscured. The difference between an all-star and an average hitter, for example, works out to about one hit every other week. ... Early proponents of controlled medical trials similarly pointed to how difficult it was for an individual practitioner to determine a treatment's efficacy. ... The true relevance of moneyball to medicine, however, lies not just in the quantification of performance but in the appreciation of value (Christopher J. Phillips, Drs. Jeremy A. Greene and Scott H. Podolsky, 10/3).

Journal of the American Medical Association: The "Iron Triangle" Of Health Care: Access, Costs, And Quality
When I talk about health policy, I often refer to the iron triangle of health care. The 3 components of the triangle are access, cost, and quality. One of my professors in medical school used this concept to illustrate the inherent trade-offs in health care systems. His point was that at any time, you can improve 1 or perhaps even 2 of these things, but it had to come at the expense of the third. ... The lesson of the iron triangle is that there are inherent trade-offs in health policy. If we wanted to conduct the debates honestly, we would acknowledge these and allow the public to decide what they really want—and what they are willing to sacrifice to get it (Dr. Aaron Carroll, 10/3). 

Milwaukee Journal Sentinel: Mental Health Changes Overdue
In April 2011, the Milwaukee County Board adopted to redesign the county's Behavioral Health Division and integrate mental health care into our community…. It has been 18 months since the Redesign Task Force was created, yet no plan for implementing these desperately needed improvements has been written…. The problems have been identified, and solutions have been recommended. We must put the best interests of the patients before all else and see this redesign process through to a successful finish (Joe Sanfelippo, 10/3).  

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
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.