Daily Health Policy Report

Friday, October 5, 2012

Last updated: Fri, Oct 5

KHN Original Reporting & Guest Opinion

Campaign 2012

Health Reform

Health Care Fraud & Abuse

Public Health & Education

Health Care Marketplace

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insurers Get Ready For Exchanges, But Exchanges May Not Be Ready For Them

Kaiser Health News staff writer Jay Hancock, working in collaboration with The Atlantic, reports: "The attraction of the 2010 health law for insurance companies is obvious: Millions of new customers and billions in new spending. Those dollars will flow through state exchanges, online marketplaces where customers can shop for insurance" (Hancock, 10/5). Read the story.

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Capsules: Berwick: Debate Underscores Challenge Explaining Health Law; Highmark Files Suit Against West Penn Allegheny In Pittsburgh

Now on Kaiser Health News' blog, Phil Galewitz reports on what one expert describes as the "challenges" related to explaining the health law: "More than two and a half years after he signed the most far reaching health care legislation into law, President Barack Obama showed in his Wednesday debate with Mitt Romney that explaining the law is still no easy job" (Galewitz, 10/5).  

Also on the blog, Essential Public Radio's Erika Beras, working in partnership with Kaiser Health News and NPR, reports on a market development: "The Pennsylvania insurer Highmark has filed suit in the Allegheny County Court of Common Pleas to prevent West Penn Allegheny Health System from forming alliances with other entities. Last year, Highmark said it was purchasing the financially struggling hospital system. Last week, West Penn Allegheny announced it was breaking ties with Highmark and searching for other fiscal partners, because the insurer wanted the health care provider to file for bankruptcy, which they said amounted to a breach of contract" (Beras, 10/4).Check out what else is on the blog.

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Letters To The Editor: Readers' Thoughts On Hospital Readmissions Penalties; Arkansas’ Health Care Payment Improvement Initiative; And Drug Coupons

Kaiser Health News' coverage of Medicare's penalties for hospitals that fail to meet targets for reducing readmission rates draws a lot of reader attention. So did recent stories about drug coupons and about a new Arkansas initiative to reduce Medicaid spending while adding a new level of transparency to the state's health care payment system. Here's a sample.

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Political Cartoon: 'Turnabout'

Kaiser Health News provides a fresh take on health policy developments with "Turnabout" by Paul Fell.

Meanwhile, here is today's health policy haikus: 


Fraud and abuse sweep
could net feds some big money.
National takedown!

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Campaign 2012

Debate Coverage, Cont.: Questions Emerge About Health Care Facts

News outlets offer more analysis of Wednesday night's debate, including examinations of plans and proposals about Medicare and pre-existing conditions.

The New York Times: Entering Stage Right, Romney Moved To Center
[H]e praised the Massachusetts health care bill, calling it a "model for the nation." ... This week, he pivoted to the center, as many political analysts had long expected him to do, seeking to appeal to more centrist general election voters. In doing so, Mr. Romney used striking new language to describe his policy proposals on taxes, education and health care in ways that may assuage independent voters — but which may be sowing confusion about how Mr. Romney would govern. ... his [health care] plan could exclude millions of people (Cooper, Kocieniewski and Calmes, 10/4).

The New York Times’ The Caucus: On Health Care, Two Visions With Their Own Set Of Facts
If there was one area where Mitt Romney and President Obama sometimes seemed to inhabit parallel universes at their debate on Wednesday night — with separate sets of assumptions, beliefs and even facts — it was on the question of health care and government's role in providing it (Cooper, Goodnough and Pear, 10/4).

The New York Times: Debate Praise For Romney As Obama Is Faulted As Flat
Voters sometimes surprise the pundits by coming to different conclusions about the outcome of a presidential debate. And Mr. Obama's top strategists predicted that some of Mr. Romney's answers — in particular, his admissions about the need for a voucher system for Medicare — would deepen the concern in some communities about Mr. Romney's policies (Shear, 10/4).

The Associated Press/MSN: Romney's Medicare Plan Raises Cost Questions
Mitt Romney's Medicare plan won't try to control costs by limiting the payments that future retirees would use to buy private health insurance, aides say, adding detail to a proposal from the GOP presidential nominee that has both intrigued and confused many Americans. ... Independent experts say they doubt that Romney's Medicare plan can succeed without some kind of hard spending limit; Romney campaign officials say the savings will come through competition among health insurance plans (Alonso-Zaldivar, 10/5).

The Wall Street Journal’s Washington Wire: Debate Blurs Role Of Medicare Cost Board
In defending a cost-control board in his health law, President Barack Obama during Wednesday's debate cited the Cleveland Clinic as an example of how better health care is actually cheaper. But it's unlikely the Medicare cost-control board would adopt many of the practices that have lowered costs at the renowned clinic, located in the electoral battleground of Ohio (Burton and Radnofsky, 10/4).

Los Angeles Times: Obama And Romney Both Strayed From Facts In Debate
Obama, whose 2008 pledge to reduce insurance premiums is unfulfilled, continued to overstate the impact of the new healthcare law, claiming erroneously that premium increases had slowed in recent years. 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% (10/4).

The Hill: DNC Hits Romney On Pre-Existing Conditions
Democrats launched a new Web video Thursday arguing that people with pre-existing conditions would be "out of luck" under a President Romney. Mitt Romney said in Wednesday night's presidential debate in Denver that he has a plan to guarantee insurance coverage to people with pre-existing conditions. But Romney did not mention important caveats to his proposal. The Democratic National Committee's Web video shows media fact-checkers rating Romney's debate rhetoric as "mostly fiction" (Baker, 10/4).

Politico Pro: Axelrod: We May Call Out Romney More
[Axelrod] pointed to Romney's pledge to repeal "Obamacare" and provide coverage for people with pre-existing conditions. Axelrod said it was “an assertion that was so audacious that the Romney campaign has to send someone into the spin room after the debate to say he really can’t do that” (Haberkorn, 10/4).

CNN: Romney Adviser Fields Questions On Pre-Existing Conditions
Eric Fehrnstrom, a top aide to Mitt Romney, suggested in a Thursday interview with CNN that the GOP presidential candidate's health plan may achieve his goal of covering individuals with pre-existing conditions through "state initiatives and money." ... When pressed whether Romney would require states to include a pre-existing conditions stipulation in their legislation, Fehrnstrom answered: ... "But, of course, we'd like them to see them continue that pre-existing band for those who have continuous coverage" (Wallace, 10/4).

Modern Healthcare: Healthcare Leaders Weigh In On Debate
Families USA, a liberal healthcare consumer group and champion of the Patient Protection and Affordable Care Act, accused Romney of "breathtaking falsehoods and misleading statements" ... But analysts at the Heritage Foundation, a conservative think tank on Capitol Hill, said the premium-support model is no more a voucher than is current law (Zigmond, 10/4).

In other news -

Politico: Simpson-Bowles Make Their Comeback
Fifty-eight million Americans saw President Barack Obama and Mitt Romney tangle over former Sen. Alan Simpson (R-Wyo.) and former White House Chief of Staff Erskine Bowles's deficit reduction plan. .... Now, Simpson and Bowles are looking to retool their deficit reduction package to decrease the amount of revenue it raises — to address those concerns from the right regarding tax increases. And they’re zoning in on increased tweaks to health care programs and want to bolster social safety net protections for low-income Americans — to address concerns from the left (Sherman, 10/4).

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New Medicare, Health Law Ads Emerge In Congressional Races Across The U.S.

While Connecticut GOP candidates appear to be distancing themselves from the Medicare plans being advanced by their presidential candidate Mitt Romney, the U.S. Chamber of Commerce has expanded its advertising targeting Democrats who voted in favor of the health law.  

CT Mirror: Connecticut Republicans Run From Romney On Medicare
They embrace Mitt Romney's bid for the White House, but Connecticut Republicans part ways with him on his controversial plan for Medicare. At the first presidential debate Wednesday night, GOP presidential nominee Romney promoted a plan his vice presidential pick, Wisconsin Rep. Paul Ryan, has proposed to keep the Medicare system solvent. According to government projections, beginning in 2024 the popular health care plan for seniors would pay out more in medical bills than it collects in Medicare taxes. The Romney-Ryan plan -- part of a larger budget cutting proposal --would keep the current Medicare system in place for everyone who is 55 years old or older today. But people now age 54 or younger would be able to receive a fixed payment from the government, adjusted for inflation, to pay for either private insurance or a government plan modeled on Medicare (Radelat, 10/4).

National Journal: Chamber Expands Ads Into New York, Utah And Georgia
The U.S. Chamber of Commerce will launch a new round of advertisements in nine House districts beginning tomorrow, including on behalf of six New York Republicans and two conservative Democrats seeking re-election this year. The Chamber's new advertising will focus on President Obama's health care law. Advertisements are running against Reps. Tim Bishop, Bill Owens and Louise Slaughter and ex-Rep. Dan Maffei, four New York Democrats who voted for the law; Rep. Kathy Hochul, who entered Congress after the law passed; and Democratic candidate Sean Patrick Maloney, who is running against Republican Rep. Nan Hayworth. But lest someone accuse the Chamber of only backing Republicans, the group is launching its first advertising on behalf of a few conservative Democrats. Both Reps. Jim Matheson (D-Utah) andJohn Barrow (D-Ga.) -- both of whom voted against the health care law -- will get advertising on their side… Now, a Democratic source sends along the totals of the buys so far, which add up to about $1.9 million. (Wilson, 10/4).

Politico Pro: Chamber Targets Dems Over ACA Votes
Health care is at the heart of a new U.S. Chamber of Commerce ad blitz aimed at unseating Democrats or defeating Democratic candidates in New York. A slate of ads that will begin running Thursday in six New York House districts feature unflattering images of the candidates, ominous music and a reminder that they voted for the Affordable Care Act. Two of the ads -- airing in Rep. Kathy Hochul’s western New York district and Bill Owens’s northern district -- focus exclusively on health care (Cheney, 10/4).

And, Politico highlights possible upsets --

Politico: 5 Potential Dem House Upsets
For Democrats to reach the 25-seat magic number to seize control of the House, they'll need to score more than a few upsets on Nov. 6. So party strategists are starting to look beyond the lineup of races they've long focused on to a handful of longer shot contests in which they might find success if things break just right (Isenstadt, 10/5).

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Health Reform

States, Feds Confront Health Law P.R. Challenges, Exchange Implementation

States are dealing with the ramifications of the health law's federally or state-run health insurance exchanges and the essential health benefits. Also, officials confront the challenge of educating the public on the health law's provisions.

The Washington Post: Small Businesses Push Back On DC Insurance-Exchange Mandate
The District's small businesses may have to buy their employee health insurance through a city-run exchange come 2014, following a controversial vote by a city board. The D.C. Health Benefit Exchange Authority, charged with implementing the federal health care overhaul, voted Wednesday evening to accept a recommendation that all health-insurance plans sold in the city for 50 members or fewer must be purchased through the exchange (DeBonis, 10/4).

Politico Pro: Louisiana May Try To Stop EHB In Its Tracks
Plenty of states, almost exclusively Republican-led, say they don’t have enough guidance from the feds to select an essential health benefits benchmark plan. But they seem willing to accept the federal default plan taking effect in their states. Louisiana, however, is taking it one step further. The state -- at the front lines of opposing the Affordable Care Act -- is looking to stop the EHB from taking effect within its borders (Millman, 10/4).

Kaiser Health News: Capsules: Berwick: Debate Underscores Challenge Explaining Health Law
More than two and a half years after he signed the most far reaching health care legislation into law, President Barack Obama showed in his Wednesday debate with Mitt Romney that explaining the law is still no easy job (Galewitz, 10/5).

Politico Pro: Panelists Agree: ACO Push Likely To Survive
The political winds are at the back of accountable care organizations, no matter who wins the election, and economic pressure to make "integrated care" work will continue to push the health care system away from fee-for-service, panelists agreed at a Politico Pro briefing Thursday. Bruce Fried of SNR Denton compared the health care system to a "battleship" that may not be able to turn around in time to achieve the savings Medicare needs -- making it that much more urgent to double down on ACO-like reforms (Norman, 10/4).

In the meantime, the Department of Health and Human Services has hired a PR firm to educate the public about the federal health insurance exchanges --

CQ HealthBeat: Federally-Paid PR Firm To Help Market Federal Exchanges
The Centers for Medicare and Medicaid Services has hired public relations firm Weber Shandwick to help promote the health insurance exchanges the administration will operate in states in 2014. With the $3.1 million contract, the New York City-based firm will help with a strategic plan to raise awareness about the exchanges, educate consumers and conduct outreach. "This will help our educational effort to ensure more Americans have access to quality, affordable health insurance," said a CMS spokesperson. States have until Nov. 16 to tell the administration about whether they will operate the insurance exchanges on their own, run a hybrid model with federal assistance, or rely on the federal government to operate the exchange (Ethridge, 10/4).

The Hill: HHS Signs $3 million PR Contract To Promote Federal Exchange
The new $3.1 million award is tied to the fallback exchange that the Health and Human Services Department will operate in states that don't set up their own exchanges. Only a handful of states have taken concrete steps to set up an exchange, and some states that want to handle the task themselves won't be ready by the Jan. 1, 2014, deadline (Baker, 10/4).

And in other health law news --

St. Louis Beacon: Appeals Court Affirms Decision To Dismiss Kinder Suit Against Health Care Law
The 8th Circuit Court of Appeals has upheld a lower court decision to dismiss Lt. Gov. Peter Kinder’s challenge to the Affordable Care Act.The Republican officeholder, who is seeking re-election Nov. 6, filed a federal suit against President Barack Obama's signature domestic achievement in 2010, taking particular aim at the mandate requiring most Americans to buy health insurance. A lower federal court earlier threw out the suit, stating that Kinder didn't have standing because he has health insurance (Rosenbaum, 10/4).

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Health Care Fraud & Abuse

91 Charged With $430 Million Medicare Billing Fraud

The nationwide sweep involved arrests of doctors, nurses and other licensed medical professionals.

Los Angeles Times: Feds Charge 91 Healthcare Providers With Billing Fraud
A federal healthcare strike force has charged 91 doctors, nurses and other licensed medical professionals in a nationwide sweep in connection with fraudulently billing the government nearly $430 million. Those charged included a group in Los Angeles that ferried patients for ambulance rides that were never medically necessary (Serrrano, 10/4).

Reuters: Authorities Charge 91 In $430 Million Medicare Fraud
Ninety-one people including doctors, nurses and other medical professionals were charged criminally in a new sweep of Medicare fraud involving seven U.S. cities and $430 million in alleged false billing, officials said on Thursday. It was the government's second big raid in recent months after a similar effort in May alleged $452 million in fraud in Medicare, the U.S. health program for the elderly and disabled (Ingram and Morgan, 10/4).

Bloomberg: U.S. Charges 91 Over Millions In False Medicare Bills
U.S. authorities charged 91 people with Medicare fraud in a nationwide crackdown, alleging schemes involving $429.2 million in false billing, Attorney General Eric Holder said. Doctors, nurses and other medical professionals were among those who billed Medicare for unnecessary services and paid kickbacks to acquire patient information for fraudulent bills, Holder said today at a news conference in Washington (Mattingly, 10/4).

CQ HealthBeat: Medicare Fraud Operation Results In Charges Against 91 In Seven Cities
Attorney General Eric H. Holder Jr. and Health and Human Services Secretary Kathleen Sebelius announced the nationwide operation at a Thursday afternoon news conference with law enforcement and HHS officials who participated in the strike force effort. ... Together, those indictments charge more than $230 million in home health care fraud; more than $100 million in mental health care fraud; more than $49 million in ambulance transportation fraud; and millions more in other frauds (10/4).

Politico Pro: DOJ Announces $430M In Medicare Fraud
The Medicare Fraud Strike Force has arrested 91 people in seven cities for Medicare fraud schemes totaling approximately $430 million, Attorney General Eric Holder announced Thursday. "Over the last 24 hours, Medicare Fraud Strike Force operations in seven different cities have conducted one of the largest health care fraud takedowns on record," Holder said. ... He said defendants were charged in Miami, Los Angeles, Dallas, Houston, New York City, Chicago and Baton Rouge, La., for schemes including home health care, mental health care and ambulance fraud (Smith, 10/4).

Houston Chronicle: FBI Arrests Historic Houston Hospital’s CEO, Son, 5 Others
After 30 years as CEO of one of Houston's most historic hospitals, Earnest Gibson III, along with his son and five others, was arrested on Thursday -- part a national Medicare fraud sweep involving $430 million in bogus billings and 91 health care providers in seven states. If the allegations against the 68-year-old Gibson are true, that he and others at the hospital bilked the Medicare program of $158 million over a period of more than seven years, it could prove lethal for Riverside, once the primary hospital for the city's black population. Gibson and his son Earnest Gibson IV, 35, were charged with 13 counts: conspiracy to commit health care fraud; conspiracy to defraud the United States and pay and receive health care kickbacks; one count of money laundering and ten counts of violating the anti-kickback statute (Langford, 10/4).

CNN Money: Medicare Fraud Case: 91 Professionals Arrested
The Justice Department announced criminal charges Thursday against 91 people who allegedly received about $430 million through wide-ranging Medicare fraud. ... Among those arrested by the FBI Thursday was Ernest Gibson, the president of Riverside General Hospital in Houston, along with his son, who is also an employee of the hospital, and four others associated with the hospital. "We are going after people, whatever their positions, whatever their level," said Holder (Isidore, 10/4).

Medpage Today: Medicare: Feds Charge 91 In Fraud Sweep
In Dallas, 14 individuals -- including two doctors and two registered nurses -- were charged for their alleged involvement in $103.3 million in false billings. In one case involving a home healthcare company, Joseph Megwa, MD, signed roughly 33,000 prescriptions for more than 2,000 beneficiaries from 2006 to 2011; many beneficiaries had primary care physicians who never certified home healthcare services for them. ... In Brooklyn, 15 people, including one doctor, were charged in various fraud schemes costing Medicare $23.2 million, including paying cash for physical therapy that was never provided in some cases (Pittman, 10/4).

Meanwhile, in other news -

Reuters: FDA Cracks Down On Websites Selling Bad Drugs
The U.S. Food and Drug Administration said it has cracked down on thousands of online pharmacies for selling potentially unsafe, unapproved or fake medicines, including the erectile dysfunction drug Viagra and antiviral Tamiflu. The FDA, working with international regulatory and law enforcement agencies from about 100 countries, said on Thursday that it took action against more than 4,100 Internet pharmacies, bringing civil and criminal charges, removing offending websites and seizing drugs worldwide (Sherman and Berkrot, 10/4).

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Public Health & Education

Study: Free Birth Control Lowered Abortion, Teen Birth Rates

A new study that gave free birth control to low-income teens and women in St. Louis has found that the free contraception dramatically lowered rates for teen births and abortions.

USA Today: Free Birth Control Project Cuts Teen Births, Abortions
An experimental project that gave free birth control to more than 9,000 teen girls and women in one metropolitan area resulted in a dramatic decrease in abortions and teen pregnancies, a new study shows (Painter, 10/5).

The Associated Press: Study: Free Birth Control Leads To Fewer Abortions
Free birth control led to dramatically lower rates of abortions and teen births, a large study concludes. The findings were eagerly anticipated and come as a bitterly contested Obama administration policy is poised to offer similar coverage. The project tracked more than 9,000 women in St. Louis, many of them poor or uninsured. They were given their choice of a range of contraceptive methods at no cost -- from birth control pills to goof-proof options like the IUD or a matchstick-sized implant (Neergaard, 10/5).

Medpage Today: Free Birth Control Slashes Abortion Rates
Providing women with free and long-acting contraception was associated with significantly lower rates of unintended and teen pregnancies and dramatically lower abortion rates. Compared with regional and national data, St. Louis adolescents and women given free long-acting reversible contraceptive (LARC) methods had nearly four times fewer abortions -- a proxy measure of unintended pregnancies -- than the regional rate (4.4 versus 17.0 per 1,000 women), and and nearly five times fewer abortions than the national rate (4.4 versus 19.6 per 1,000 women) in 2008, according to Jeffrey Peipert, PhD, and colleagues (Petrochko, 10/4).

NBC: Free Birth Control Cuts Abortion Rate Dramatically, Study Finds
A dramatic new study with implications for next month's presidential election finds that offering women free birth control can reduce unplanned pregnancies -- and send the abortion rate spiraling downward. When more than 9,000 women ages 14 to 45 in the St. Louis area were given no-cost contraception for three years, abortion rates dropped from two-thirds to three-quarters lower than the national rate, according to a new report by Washington University School of Medicine in St. Louis researchers. From 2008 to 2010, annual abortion rates among participants in the Contraceptive Choice Project -- dubbed CHOICE -- ranged from 4.4 abortions per 1,000 women to 7.5 abortions per 1,000. That’s far less than the 19.6 abortions per 1,000 women nationwide reported in 2008, the latest year for which figures are available (Alexander, 10/4).

CNN: Free Contraception May Prevent Abortions
Contraception includes condoms and birth control pills, but there are other, longer-term methods that are effective and reversible: Intrauterine devices and implants. A new study in the journal Obstetrics & Gynecology set out to see what would happen if these methods were given out at no cost. The study incorporated more than 9,000 girls and women at risk for unintended pregnancy. Researchers found that teen births within the group of women who were part of this program was 6.3 per 1,000, which is much lower than the national rate of 34.1 per 1,000 (10/4).

In related news -

The Associated Press: Oklahoma To End Planned Parenthood Contracts
Oklahoma is withdrawing federal funding to three Planned Parenthood clinics in Tulsa that for 18 years has allowed them to provide food and nutritional counseling to low-income mothers -- a decision that mirrors efforts in other conservative states to defund the group and one its director described Thursday as a "short-sighted political maneuver." The State Department of Health notified Planned Parenthood of the Heartland CEO Jill June in a letter last week that it would be terminating its contracts with the Tulsa facilities at the end of December (Murphy, 10/4).

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Health Care Marketplace

Kaiser Permanente CEO Plans To Retire In 2013

After 10 years as the insurer's chairman and chief executive officer, George Halvorson announced his plans to retire in December 2013.

Los Angeles Times: Kaiser Permanente CEO George Halvorson To Retire
The longtime chairman and chief executive of Kaiser Permanente, George Halvorson, plans to retire in December 2013, and the nonprofit health system is searching for a new leader (Terhune, 10/5).

CQ HealthBeat: Kaiser Permanente Chief Will Retire In 2013
George Halvorson, chairman and chief executive officer of Kaiser Permanente since 2002, announced Thursday that he will retire in December 2013. Kaiser Permanente, which was founded in 1945, is one of the nation’s largest not-for-profit health plans. The company is an integrated system that now covers more than nine million people and has about 173,000 employees (Adams, 10/4).

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State Watch

Medicaid News: Texas Transition To Managed Care Plan Hurts Caregivers

Meanwhile, California develops plans to move 875,000 kids from its Healthy Families program to the state's Medicaid rolls.

The Texas Tribune/New York Times: Medicaid Patient Shift Squeezes Home Caregivers
The abrupt exodus of thousands of South Texas Medicaid patients from one managed care health plan is putting a financial strain on home health providers already struggling to stay in business after the state's transition to Medicaid managed care (Aaronson, 10/4).

The Associated Press: 65,000 SC Children To Be Enrolled In Medicaid
South Carolina's Medicaid agency announced Thursday that 65,000 children in the state's poorest households will be automatically enrolled in the government insurance program by month's end. The state Department of Health and Human Services is enrolling children whose parents receive food assistance or welfare payments through the Department of Social Services, meaning their children are well under eligibility limits for Medicaid. The agency is informing parents of the enrollment in letters, starting this week in Richland County. All 65,000 children should be signed up by month's end (Adcox, 10/4).

California Healthline: Ambitious Transition Plan For Health Families
State officials this week submitted a four-phase strategic plan to eventually move 875,000 children from the Healthy Families program into Medi-Cal managed care plans. Health care advocates have expressed some reservations and concerns about the transition. State officials have said they're confident they're ready to meet the deadlines that have been set for it. The new plan hopes to simultaneously improve quality of care for children and save the state money. It will happen quickly. On Jan. 1, the state plans to launch the first phase of the transition, shifting 415,00 of the Healthy Families kids to a managed care plan (Gorn, 10/4).

California Healthline: Why The Future Of Health Care May Be On The Line With Prop. 30
There is a hidden risk buried inside Proposition 30 that goes far beyond cuts to education, according to Hope Richardson, policy analyst for the California Budget Project. … According to a report from the Health and Human Services Network of California, the state has cut $15 billion from health and social service programs in just the past three years. That does not include the budget reductions made this summer, including the planned conversion of Healthy Families to a Medi-Cal managed care program and another $2.5 billion in social service cuts, said Michael Herald, a public benefits advocate for the Western Center on Law and Poverty. Medi-Cal is California's Medicaid program (Gorn, 10/4).

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State Highlights: Kansas Court Decision On Malpractice Cap Expected Today

News outlets report on a variety of health care topics in Georgia, Illinois, Kansas, Minnesota, Pennsylvania and Oregon.

The Philadelphia Inquirer: Pennsylvania Health Secretary Avila Quits Corbett Cabinet
Pennsylvania Health Secretary Eli N. Avila, who became known in the Capitol for a dispute over an egg sandwich and other episodes, has quit his $146,500-a-year post in Gov. Corbett's cabinet. The governor announced the departure Thursday in a news release that said Avila, 52, was leaving to pursue "other interests" and was looking forward to spending more time with his family in New York (Couloumbis, 10/5).

Kansas Health Institute News: Court To Issue Long-Awaited Decision On Medical Malpractice Cap
Court officials today said the Kansas Supreme Court will issue (Friday) its long-awaited decision in a case challenging the constitutionality of a law capping the amount of jury awards to people harmed by medical malpractice.  Justices first heard the case of Miller v. Johnson in October 2009 and took the unusual step of rehearing it again in February 2011. At issue is a 25-year-old state law that limits damage awards for pain and suffering to no more than $250,000 (10/4).

Georgia Health News: Building Health Communities—For A Lifetime
By 2030, one of every five people in metro Atlanta will be 60 or older. It’s a statistic that has helped spark an initiative by the Atlanta Regional Commission (ARC) to bring more housing and transportation options – and healthy lifestyle features – to area communities. The goal is to make it possible for individuals to "age in place"’ – to stay in their communities throughout their lifetimes if they so desire (Miller, 10/4).

Chicago Sun-Times: Emergency Room Wait Times Down At Cook County Hospital
A trip to Stroger Hospital's ER might be a little less painful, now that staff there have cut the average wait time to see a doctor by about one third. In 2011, the average wait used to be nearly 3 hours, but this year it's down to almost 2 hours, according to Cook County Board President Toni Preckwinkle's office (Esposito and Dudek, 10/5).

(St. Paul) Pioneer Press: Minnesota Medicare Clients Could See Some Changes Going Into Enrollment Season
About 13,000 Minnesota Medicare beneficiaries might need to do some shopping in the coming weeks because of changes in the lineup of Medicare health and drug plans being offered in the state. The annual open enrollment season for Medicare health plans begins Oct. 15, and it's not unusual for some beneficiaries to face changes in health plan offerings, said Jean Wood, executive director of the Minnesota Board on Aging. The number of beneficiaries in Minnesota needing to shop for a new plan is up from last year, Wood said, but down from 2010 (Snowbeck, 10/4).

The Lund Report: Kaiser Bolsters Position As Oregon's Largest Insurer
Kaiser Permanente has bolstered its newly won lead as the state's top health insurer at the same time as long-time leader Regence BlueCross BlueShield has continued its slide. And while No. 3 PacificSource still has half the members of Kaiser and Regence, it enrolled more new members than anyone else in the state, according to reports on the first half of 2012 filed with the Oregon Insurance Division (Sherwood, 10/4).

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Health Policy Research

Research Roundup: Limited Savings Found From ACOs

Each week KHN reporter Ankita Rao compiles a selection of recently-released health policy studies and briefs.

Health Affairs: A Simulation Shows Limited Savings From Meeting Quality Targets Under The Medicare Shared Savings Program -- The health law rewards accountable care organizations (ACOs), groups of health care providers working together to save money and increase quality. Those providers then share in the savings. Using CMS guidelines, researchers simulated an ACO targeting Type 2 diabetes Medicare patients. They concluded that a 10 percentage point improvement in performance would prevent up to 4.1 percent of adverse events, such as cardiovascular complications. But they note that would reduce Medicare costs only "by up to about 1 percent. After the costs of performance improvement, such as additional tests or visits, are accounted for, the savings would decrease or become cost increases." To save more, they say, ACOs would "have to lower costs by other means, such as through improved use of information technology and care coordination" (Eddy and Shaw, 10/3).

The New England Journal Of Medicine: The Prevention And Treatment Of Missing Data In Clinical Trials -- Despite FDA regulations, missing data in clinical trials is a "serious problem that undermines the scientific credibility of causal conclusions." They note that a key cause of missing data is when study participants discontinue their treatment which can result in researchers simply inflating "the required sample size in the absence of missing data to achieve the same sample size under the anticipated dropout rate, estimated from similar trials." The authors suggested improvements for limiting missing data, such as allowing a flexible treatment regimen and shortening the follow-up period. (Little et. al., 10/4).

The Kaiser Family Foundation:  Putting Men's Health Care Disparities On The Map: Examining Racial and Ethnic Disparities at the State Level – The authors write that "men of color in almost every state continue to fare worse than white men on a variety of measures of health, health care access and other social determinants of health. ... the persistence of such disparities between white men and men of color -- and among different groups within men of color -- [were found] on 22 indicators of health and well-being, including rates of diseases such as AIDS, cancer, heart disease and diabetes, as well as insurance coverage and health screenings." The authors also link to an earlier, companion report about women (James, Salganicoff, Ranji, Goodwin and Duckett, 9/27).

Health Affairs: The Supreme Court And Health Reform -- This policy brief explores the implications of the Supreme Court ruling on the federal health law, especially the decision to limit the law's mandated Medicaid expansion which "dealt a blow to a major element of the government's strategy to expand health insurance coverage to millions of uninsured Americans. It is unclear how many states will now move forward with the expansion, or what options they have to undertake partial expansions." The brief also notes: "The Supreme Court's decision upholding the Affordable Care Act makes moot almost all of the trial and appellate court cases that had been moving through the judicial system" (Goldman, 9/27).

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

Reuters: Drop In Hospital Visits Seen With Lower Drug Copay
After Pitney Bowes Inc cut copayments for two essential heart drugs, employees at the Stamford, Connecticut-based company began filling their prescriptions more regularly, according to a new report. They also were less likely to visit the doctor, end up in the ER or be admitted to a hospital, slashing their out-of-pocket expenses beyond the copay reductions, researchers found (Joelving, 10/3).

Medscape: Makers of Antipsychotics Targeting Medicaid Psychiatrists
Manufacturers of antipsychotic medications are targeting high levels of their marketing dollars toward psychiatrists in the Washington, DC, area, with a special emphasis on those who are Medicaid prescribers, new research suggests. The study was conducted by researchers from the George Washington University School of Public Health and Health Services (SPHHS), with results released in a report by the DC Department of Health (DOH). The investigators found that in 2010, more than $25 million was spent on marketing antipsychotics in the DC area (Brauser, 10/3).

Medscape/Reuters: Race Influences Surgical Residency Experience
Compared with white general surgery residents who responded to a recent survey, minority residents reported feeling less positive about their fit with the program and their relationships with faculty and peers. "We believe that residency programs should establish mentorship between faculty and trainees based on shared interests, culture and background, if possible," Dr. Julie A. Sosa from Yale School of Medicine, New Haven, Connecticut, who led the study, told Reuters Health. "Since the number of minority faculty is small, programs should commit to fostering cultural competence among all its faculty and trainees..." (Boggs, 10/1).

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Editorials and Opinions

Viewpoints: Romney's Shifts Back To Moderate?; His Misleading Comments On Pre-Existing Conditions; Debate's Half-Truths

The New York Times: Moderate Mitt Returns!
Far from being a pitchfork-wielding populist who wants to raze Washington, Romney said he would work with the people he finds there. ... He bragged that in his old job as governor, he met with Democrats every week. He boasted about his bipartisan health care bill. ... he gave us a hint of a strong center-right pragmatic approach. It starts with 1986-style tax reform and Wyden-Ryan Medicare reform and then offers a glimpse of experimental pragmatism on most everything else. ... Democrats call it hypocrisy; I call it progress (David Brooks, 10/4). 

The New York Times: Romney's Sick Joke
"No. 1," declared Mitt Romney in Wednesday's debate, "pre-existing conditions are covered under my plan." No, they aren't — as Mr. Romney’s own advisers have conceded in the past, and did again after the debate. ... Also, many Americans have health insurance but live under the continual threat of losing it. Obamacare would eliminate this threat, but Mr. Romney would bring it back and make it worse (Paul Krugman, 10/4). 

Journal of the American Medical Association: The First Debate: Adjudicating Health Care
Most pundits appear to have concluded that Romney won on style; I have little basis to judge that. But I can judge the health care policy statements, and based on those, I reached the opposite conclusion of the pundits. Romney made a variety of bold statements related to health care, but they don’t stand up to scrutiny (David Cutler, 10/4). 

The Wall Street Journal: Informed Independents Cool To ObamaCare
One of the debate's major topics was health care, about which it is assumed the public has also largely made up its mind, either for or against ObamaCare. ... Independent Women's Voice, an educational advocacy organization that runs the Repeal Pledge calling for the elimination of ObamaCare, believes that opinions about health care can be changed (Heather R. Higgins and Hadley Heath, 10/4).

Los Angeles Times: Presidential Debate: Dueling Half-Truths
When asked why he wanted to repeal Obamacare, Romney said one reason was that "it puts in place an unelected board that’s going to tell people ultimately what kind of treatments they can have." He repeated that assertion five times as the evening went on. Romney was referring to the Independent Payment Advisory Board ... However, the law constrains the board in a way that seems to preclude dictating which medical procedures are and are not available (Jon Healey, 10/4).

The Wall Street Journal: No Easy Answers In Effort To Curb Health Spending
My book about the federal budget, which emphasizes the fiscal significance of rising health spending (it was 10% of federal spending in 1960, is 25% today and is headed to 33% within a decade), has many readers asking: Isn't it true that we spend huge sums on people who are in their last year of life, and isn't finding a socially acceptable way to stop doing that the best way to slow health-care spending? The short answer: Yes to the first part, no to the second (David Wessel, 10/4).

The Sacramento Bee: Supreme Court Allows States To Opt Out Of Medicaid Expansion; They Should
[E]xpanding Medicaid was a central tenet of the Patient Protection and Affordable Care Act. ... States are already having difficulty finding enough physicians willing to accept Medicaid patients, largely because of the program's low reimbursement rates. Expanding patient rolls by a third will only exacerbate this problem (Nina Owcharenko, 10/4).

Los Angeles Times: Don't Need That Drug Refill? Here It Is Anyway
You already knew that our healthcare system is screwy. But you probably didn't know that at least some pharmacists at CVS, the nation's second-largest drugstore chain, were refilling prescriptions and submitting claims to insurers without patients' approval (David Lazarus, 10/5).

CNN: Health Care Act's Glaring Omission: Liability Reform
Although not a panacea for the health problems in the United States, the need for physicians to practice defensive medicine in order to avoid potential litigation has far-reaching consequences. ... In [Massachusetts] alone, an estimated $281 million in unnecessary physician costs and more than $1 billion in excessive hospital costs was due to the practice of defensive medicine. Across the country, doctors are ordering tests and consultations as a way to protect themselves from potential liability (Dr. Anthony Youn, 10/5).

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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.