Daily Health Policy Report

Tuesday, October 9, 2012

Last updated: Tue, Oct 9

KHN Original Reporting & Guest Opinion

Campaign 2012

Health Reform

Capitol Hill Watch


Health Information Technology

Coverage & Access

Administration News

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insuring Your Health: Federal Retiree Weighs Whether To Keep FEHB Or Switch To Medigap

In her latest Kaiser Health News consumer column, Michelle Andrews writes: "Many readers have contacted me with questions about Medicare, which has strict coverage rules and payment provisions that can sometimes be confusing. Here are responses to two recent inquiries" (Andrews, 10/8). Read the column.

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Capsules: Study: Health Insurance Costs To Fall For Businesses Under 50 Employees; Physicians Are Healthier Than Nurses, Other Workers, Says Survey

Now on Kaiser Health News' blog, Mary Agnes Carey writes about a new study measuring how the health law, once  implemented, could impact employers' heatlh care costs: "Once fully implemented, the 2010 health care law will increase employer-sponsored insurance coverage and reduce the cost small businesses pay for employee health coverage, according to an Urban Institute study released today" (Carey, 10/9).

Also on Capsules, Shefali S. Kulkarni reports on how physicians' health stacks up against that of other professionals: "Are doctors following the same health and wellness advice they give to their patients? Based on new Gallup data, physicians appear to be in better health than other members of the workforce – even nurses– which could set a good example for patients" (Kulkarni, 10/9). Check out what else is on the blog.

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ICYMI: Critical Decisions Await Patient, Family Members When Medicare Deadline Looms

In case yesterday's federal holiday kept you away from your daily installment of KHN original news, Kaiser Health News staff writer Sarah Varney, working in collaboration with NPR, offered this report: "When a spouse or parent signs up for Medicare, it is often perplexing – and unnerving – for the rest of the family who may have grown used to cushy employer-sponsored coverage. For example, young adults up to age 26, who were covered under their parent's insurance, are no longer covered when their parent moves to Medicare" (Varney, 10/8). Read the story.

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Political Cartoon: 'Out Of This World Coverage'

Kaiser Health News provides a fresh take on health policy developments with "Out Of This World Coverage" by Dave Coverly.

Meanwhile, here is today's health policy haikus:


Last week, Jerry Brown
signed laws to prepare his state
for health law changes.

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

Poll: Obama's Lead On Health Care Issues Narrows Post-Debate

Overall, the Pew Research Center for the People and the Press poll found that GOP presidential pick Mitt Romney wiped out President Barack Obama's advantage and took the lead by four percentage points.  

The Wall Street Journal's Washington Wire: Romney Leaps Past Obama In Pew Poll
While the Pew poll shows notable gains for Mr. Romney, it still reflects a very close race. Messrs. Romney and Obama are tied among registered voters. Mr. Obama is still viewed as better able to connect with ordinary people, according to the survey. By small margins, the president is seen as the better candidate to deal with Medicare, health care and foreign policy. And more than half of voters – 53% — say that "It's hard to know what Romney really stands for" (Nelson, 10/8).

Politico Pro: Pew: Obama's Health Care Lead Narrows After Debate
Despite the enduring unpopularity of Obama’s health care law, voters in September believed he would do a better job on health care than Romney, 52 percent to 39 percent. That lead has now shrunk to 47 percent to 44 percent in favor of Obama in the days following the Oct. 3 debate. The same goes for Medicare (Millman, 10/8).

The Hill: Poll Shows Obama's Lead On Healthcare Shrinking
Medicare is a central line of attack for the Obama campaign, especially in the pivotal swing state of Florida. Romney and Ryan want to partially privatize Medicare, offering seniors a fixed amount of money to put toward either private insurance or traditional Medicare. Democrats say the plan would "end Medicare as we know it" (Baker, 10/8).

Meanwhile, McClatchy contrasts the different paths the two candidates have chosen on Medicare and Social Security -

McClatchy: Obama, Romney Offer Different Paths On Medicare, Social Security
Medicare is the nation's biggest buyer of health care, spending $550 billion last year to provide care for 48.7 million Americans. The problem is that the taxes paid by workers and employers to finance the program aren't covering the full cost, and the government since 2008 has been drawing off its trust fund to make up the difference. Barring changes, the trust fund runs out in 12 years – 2024 – and the government would have to raise taxes or cut services. ... President Barack Obama and Republican presidential nominee Mitt Romney offer vastly different approaches to putting both popular programs on sound financial footing (Pugh, 10/8).

And look who is popping up on the campaign trail -

Politico: Experts: Sebelius Can Visit Ryan's District
When HHS Secretary Kathleen Sebelius visited Paul Ryan's district Sunday on behalf of President Barack Obama's reelection bid, she was careful to follow the rules: The campaign paid for the trip, not the government, and campaign officials said she was just there as a supporter, not as HHS secretary. So is that enough to make it OK? Legally, yes, experts on government ethics rules say. It doesn't look great, according to some ethics lawyers — but they insist that's the system we have (Nather and Cheney, 10/8).

Politico Pro: GOP Sends Doctors On 'Repeal' Tour
It's time to call in a doctor. The House Republican physicians are fanning out across the country this month, doing health-oriented campaign and fundraising events for Mitt Romney and other House members. It's part of a Republican strategy that's been in place since the debate over the health law started: Have the doctors talk about the problems in "Obamacare" and make the case for its repeal. It's playing out in this election cycle as physician-lawmakers travel around the country to co-host town halls with candidates, participate in fundraisers or visit with state medical groups (Haberkorn, 10/9).

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Romney's Pre-Existing Conditions Plan Questioned

News outlets examine this aspect of GOP presidential candidate Mitt Romney's health care policies and report that it would only help a fraction of the country's uninsured.   

The Associated Press: Big Gaps In Romney Plan On Pre-Existing Conditions
Republican presidential candidate Mitt Romney says he has a plan to help people with pre-existing medical conditions get health insurance. But there's a huge catch: You basically have to be covered in the first place. If you had a significant break in health insurance coverage an insurer still could delve into your medical history, looking for anything — from a bad back to high blood pressure — that could foreshadow future claims. They'd be able to turn you down (Alonso-Zaldivar, 10/9).

Bloomberg: Romney's Pre-Existing Conditions Vow Puts 36M At Risk
Health-policy specialists say Romney’s plan echoes such protection already in a 1996 U.S. law and doesn’t show how it would help at least 36 million sick people at risk of being denied coverage. “It’s a complete mystery what he’s talking about,” said Joe Antos, a health-care economist at the American Enterprise Institute, a Washington policy group. "He’s clearly asserting that he’s got a new policy, but he hasn’t said what it is" (Faler, 10/8).

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Senate Candidates Spar Over Medicare, Health Policies

Campaign debates in Virginia and Michigan focus on Medicare and health issues while the GOP candidate in Ohio says he has not yet signed on to Republican plan to revamp Medicare.  

The Washington Post: Virginia Senate Debate: George Allen, Tim Kaine Face Off In Richmond
In their second televised debate Monday night, former governors George Allen and Timothy M. Kaine clashed over health care, women's issues and Social Security as they sought to contrast how each would represent Virginia in the U.S. Senate (Haines, 10/8).

The Associated Press/Washington Post: In First Televised Prime Time Va Senate Debate, Kaine And Allen Target Money, Women's Issues
Democrat Tim Kaine and Republican George Allen drew sharper contrasts Monday between themselves in a televised primetime U.S. Senate debate on the issues of entitlements seniors have paid all their lives, with Allen backing higher retirement age and Kaine promising to protect Social Security "to my last breath." The fourth of five debates between the former Virginia governors and the first before a statewide broadcast audience ranged from abortion and contraception to looming military cuts to a Supreme Court case over racial diversity initiatives on college campuses (10/8).

Politico: George Allen Struggles On Abortion Questions
When asked about proposals in the GOP-led General Assembly's this year to require an ultrasound before women could get an abortion and to codify that life begins at conception — so-called "personhood" legislation — Allen punted and pivoted. "Some of those issues are state issues on informed consent," Allen replied, before shifting to contraceptive access, which was not brought up in the question (Catanese, 10/8).

The Associated Press/Washington Post: In Ohio, GOP Senate Hopeful Mandel Challenged By Dems As A Kid Who Hasn't Done His Homework
(Josh) Mandel uses his presentation to the Ross County group, many of them seniors, to promise to protect Social Security and Medicare. In a follow-up, he declined to back GOP vice presidential candidate Paul Ryan's plan to turn Medicare into a voucher system for those 55 and younger. "When I go to Washington, I will work in a bipartisan way to save Social Security and Medicare. Thus far I have not endorsed anyone's specific plan," Mandel said in an interview (10/9).

The Associated Press: Hoekstra, Stabenow Senate Campaigns Spar Over Medicare
Democratic U.S. Sen. Debbie Stabenow and Republican challenger Pete Hoekstra swapped accusations Monday of favoring policies that would undermine Medicare, the health care program for seniors that has become a focal point of congressional and presidential campaigns. Hoekstra, the acknowledged underdog trying to unseat a two-term incumbent, made Medicare the subject of his first post-nomination television ad (Flesher, 10/8).

And news from one high-profile House race -

Politico Pro: Ryan Releases Medicare Ad For House Race
Paul Ryan is up with a new ad explaining his Medicare reform plan, but this one isn't for the vice presidential race. This one is for his House race — where he's still running for reelection in case the veep thing doesn't work out. The ad, targeted at his southeastern Wisconsin congressional district, hammers the Ryan message that his Medicare reform plan won't impact anyone over the age of 55 — a message that Gov. Mitt Romney could also benefit from in the swing state (Haberkorn, 10/8).

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Health Reform

Report: Health Law Will Benefit Many Firms, But Mid-Size Would See Costs Rise

According to an Urban Institute study, the health-coverage costs carried by small businesses will likely fall if the 2010 health law is completely implemented, but companies with 101 - 1,000 employees could experience a jump in their costs. 

The Hill: Study: Costs Will Rise On Mid-Size Firms From New Healthcare Law
President Obama's healthcare law won't erode employer-based health insurance — but it will raise some companies' costs by nearly 10 percent, according to a new analysis from the Urban Institute. ... Mid-sized businesses — firms that have between 101 and 1,000 employees — would have seen a 9.5 percent jump in their total healthcare costs if the Affordable Care Act had been fully in place this year, the paper says. (Many of the law's key provisions don't take effect until 2014.) Small businesses would have seen their costs fall by 1.4 percent. Firms with more than 1,000 workers would have seen a 4.3 percent increase (Baker, 10/8).

Kaiser Health News: Capsules: Study: Health Insurance Costs To Fall For Businesses Under 50 Employees
[The analysis] says that if all provisions of the health law were implemented this year, the number of Americans covered by employer-sponsored insurance would increase by 2.7 percent and costs-per-person for small businesses (fewer than 50 workers) would decrease by 7.3 percent (Carey, 10/9).

Kansas Health Institute News: New Report: ACA Will Benefit Most Employers
Two factors — expanded enrollment and penalties levied on an anticipated 5 percent of mid-size companies that are still not expected to offer coverage — could lead to an increase in overall spending of 9.5 percent for this [mid-sized business] group of employers, according to the report (10/8).

Also in the news -

Medpage Today: HHS Watchdog Has ACA In Sights For 2013 Review
Some aspects of the Affordable Care Act will get special attention in the coming year from the Department of Health and Human Services' (HHS) Office of Inspector General (OIG). Among other things, the agency's independent watchdog will review the use of grants to establish the necessary insurance exchanges that are a backbone of the Affordable Care Act (ACA). ... Investigators are already looking into states' willingness to comply with requirements for the exchanges and for eligibility for Medicaid, the Children's Health Insurance Program, and health subsidy programs, according to the OIG's 2013 work plan, which was released last week (Pittman, 10/8).

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Capitol Hill Watch

In Congress, Deal-Making Mood May Emerge From Budget Issues

The New York Times reports that, as lawmakers on Capitol Hill face "so many potentially calamitous tax and budget issues," necessity may bring consensus.  

The New York Times: Weighing The Effect Of An Exit Of Centrists
But Congress is facing so many potentially calamitous tax and budget issues that another theory is brewing: a combination of Democrats, once averse to changes to social welfare programs, and senior Republicans may form some sort of new deal-making consensus through sheer necessity to avoid large tax increases and significant military cuts. "If Republicans think by embracing the Tea Party it is a loser politically," said Senator Charles E. Schumer of New York, the No. 3 Democrat, "it may strengthen the hands of the mainstream conservatives" to make deals with the 10 or so moderate Democrats in the Senate who are interested in reforming Medicare and other programs (Steinhauer, 10/8).

Meanwhile, in related news, states consider cost-containment strategies as congressional leaders wrestle with the prospects for a long-term deal that could include Medicare and Medicaid --

Politico Pro: States Taking New Look At Cost Containment Strategies
Will states buckling under surging health care costs be scared straight by the fiscal cliff? Any long-term deal to head off fiscal disaster is likely to feature efforts to control the growth of Medicare and Medicaid, and in some scenarios, states could be left without billions of dollars in federal support. As a result, some experts say states will begin warming to proposals aimed at slowing health care costs within their borders, if only to get ahead of a likely gut-punch from Washington. "The prospect of what the federal government is going to do on Medicare and Medicaid is scaring the heck out of people," said Harvard University economist David Cutler. "They think, 'They're just going to kill us and they're going to do it in some awful way. One way or the other, we are going to get slammed.' What they don't want is what Washington always gives them, which is just payment cuts." Cutler and a group of mostly left-leaning health care experts recommended last month that states consider setting "global targets" to help pressure their "fragmented health care systems" to reduce costs (Cheney, 10/8).

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New Rating System To Focus On Patient Data Provided By Electronic Health Records

Modern Healthcare: AHRQ Developing Consumer Info Rating System
HHS' Agency for Healthcare Research and Quality is developing a rating system for the growing amount of health information directed at patients. The agency's Health Information Rating System, discussed in a Federal Register posting, will focus especially on patient data provided by electronic health records. The agency's notice stated that health education materials delivered by EHRs "are rarely written in a way that is understandable and actionable for patients with basic or below basic health literacy," which includes about 77 million people (Daly, 10/8).

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Health Information Technology

Telemedicine: Nantucket Hospital's Example Demonstrates Telemedicine's Utility

The New York Times: With Telemedicine As Bridge, No Hospital Is An Island
When Sarah Cohen's acne drove her to visit a dermatologist in July, that's what she figured she’d be doing — visiting a dermatologist. But at the hospital on Nantucket, where her family spends summers, Ms. Cohen, 19, was perplexed (Belluck, 10/8).

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Coverage & Access

Decrease In Doctor Appointments, Preventable Hospital Visits Draw Scrutiny

Medpage Today offers a pair of stories exploring Census findings regarding doctor visits in 2010 as well as MedPAC's interest in "preventable" hospital visits.

Medpage Today: Census: Doc Visits In 2010 Fewer, Farther Apart
Nearly 73 percent of Americans visited a medical provider in 2010, but they went significantly less often than they did 10 years ago, the Census Bureau reported. A new report of census data examined relationships between Americans' health statuses, insurance coverage, demographic characteristics and use of health care services using data from the Survey of Income and Program Participation. It found that the average adult between the ages of 18 and 64 went to a medical provider an average of 3.9 times in 2010, compared with the 4.8 times the average adult went in 2001. … Reduced visits to the doctor most likely have to do with rising health care costs that have affected both insured and uninsured Americans (Pogorelc, 10/8).

Medpage Today: MedPAC Eyes 'Preventable' Hospital Visits
A quarter of all initial hospital admissions and roughly 60 percent of all walk-up emergency department (ED) visits are potentially preventable, the nonpartisan Medicare Payment Advisory Commission (MedPAC) said Friday. Those rates translate to roughly 94 admissions and 158 visits per 1,000 beneficiaries per year, staffers told commissioners on the second day of their 2-day meeting here. Heart failure was the most frequent reason for a preventable admission, and upper respiratory tract infection was the most frequent reason for a preventable ED visit (Pittman, 10/8).

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Administration News

New Limits On Death Record Access Could Hamper Hospital Safety

The New York Times: Researchers Wring Hands As U.S. Clamps Down On Death Record Access
A shift last year by the Social Security Administration to limit access to its death records amid concerns about identity theft is beginning to hamper a range of research, including federal assessments of hospital safety and efforts by the financial industry to spot consumer fraud (Sack, 10/8).

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Public Health & Education

Meningitis Outbreak Fuels Calls For More Oversight

According to the Centers for Disease Control and Prevention, eight people have died and 105 people in nine states have been sickened by a type of fungal meningitis they were exposed to when they received tainted spinal steroid injections.

The Wall Street Journal: Outbreak Spurs Calls For New Controls
As many as 13,000 patients may have been exposed to fungal meningitis from tainted spinal steroid injections, authorities said Monday, as some lawmakers called for bringing certain specialized pharmacies under greater regulatory scrutiny. The oversight of compounding pharmacies, which create customized versions of medicines, is gaining greater attention as the death and illness tolls in the outbreak continue to rise. On Monday, the Centers for Disease Control and Prevention said eight people had died and 105 people in nine states had been sickened by fungal meningitis, a rare but potentially deadly inflammation to the brain or central nervous system (Martin, Burton and Dooren, 10/8).

Also in the news, an examination of safety issues associated with fast-track drugs --

Medpage Today: Safety Issues Seen With Fast-Track Drugs
About a quarter of new drugs introduced to the Canadian market over a 15-year period developed serious safety issues, a researcher said. The probability of a New Active Substance -- the Canadian equivalent of a New Molecular Entity -- acquiring a serious safety issue between 1995 and 2010 was 23.7 percent, Joel Lexchin, MSc, MD, of the University of Toronto, reported in a research letter in the Archives of Internal Medicine. That figure is similar to previous American analyses that have put the probability of new drugs being slapped with a black box warning or being withdrawn from the market at 20 percent over a 25-year period. That should make clinicians cautious about prescribing certain new drugs, Lexchin wrote (Zalenznik, 10/8).

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State Watch

State Roundup: Labor Activist's Work For Blue Shield Raises Conflict Concerns

A selection of health policy stories from California, Kansas, Minnesota, New Jersey and Rhode Island.

Los Angeles Times: Blue Shield's Union Ties Raise Concerns About Conflicts
At a time when public-sector unions across the country are fighting to hold on to generous retirement and health benefits, one of the loudest voices standing up for their rights is Dave Low. A longtime labor activist, Low carries considerable clout as executive director of the California School Employees Assn., a 215,000-member union that represents bus drivers, custodians and other school workers. He also leads a broader group of 1.5 million government employees, including firefighters, police and teachers, called Californians for Health Care and Retirement Security. But Low had another job as well until recently. He was a consultant for Blue Shield of California, which has secured lucrative health insurance contracts that cover many of the same public workers that Low represents (Terhune, 10/9).

Modern Healthcare: R.I. Mandates Flu Vaccinations For Health Workers
Flu vaccines are now mandatory for Rhode Island health care workers who have direct contact with patients in healthcare facilities in the state. The policy, proposed by the Rhode Island Department of Public Health (PDF), gained approval despite objections from the American Civil Liberties Union and SEIU Healthcare No. 1199 New England, which represents health care workers in Rhode Island and Connecticut. The SEIU circulated petitions in favor of vaccinations, but opposed making them required. The Rhode Island policy would require flu vaccines for all health care workers, including nurses, volunteers and physicians. The American Nurses Association supports only mandatory policies if they meet certain criteria, spokesman Adam Sachs said. Ensuring the policy covers all workers is one of the requirements, Sachs noted (Selvam, 10/8).

MPR: 'Safety Net' Hospitals Brace For Potential Cuts
Hennepin County Medical Center and other so-called "safety net" hospitals are preparing for a decline in federal funding due to the national health care overhaul. These hospitals are typically large urban hospitals that provide a significant amount of care to people who cannot afford to pay for it. The health care overhaul is reducing federal subsidies those hospitals have relied on for more than 20 years. At the Hennepin County Medical Center about 50 men and women are wedged in cubicles, talking on headsets. The scene looks like a telemarketing boiler room, but here the employees aren't making the calls; they are taking calls from people who wish to see a doctor (Stawicki, 10/9).

Kansas Health Institute News: Health Departments Brace For Loss Of STD Funds
State health officials are raising concerns about the future of a federally funded program that helps county health departments prevent infertility in women by testing for the sexually transmitted diseases of chlamydia and gonorrhea. "There hasn't been an official announcement, but it certainly appears that the funding will be going away after January of 2014," said Jennifer VandeVelde, who runs the Kansas Infertility Prevention Project at the Kansas Department of Health and Environment. "The assumption is that with the Affordable Care Act everyone will have insurance so we won't need the funding we have now."… The mandatory coverage provisions in the federal health reform law are scheduled to take effect Jan. 1, 2014 (Ranney, 10/8).

Kansas Health Institute News: Kansas Medicaid HIT Incentives Total $252 Million
Nearly $25.2 million in Medicaid incentive payments have been awarded to 463 Kansas doctors and 31 hospitals for implementing electronic health record systems in the first six months of a federal program, officials at the Kansas Department of Health and Environment announced today. … The incentive payments were made available by the federal economic stimulus law passed in 2009 for health care providers whose electronic health record systems meet certain federal standards (Ranney, 10/8).

California Healthline: Could Reform Initiative Affect Health Care?
Proposition 31 on California's November ballot has some health advocates alarmed. They say it could hinder development of health programs, especially senior care options, and make existing programs more vulnerable to large cuts. … Supporters of the measure, who did not immediately respond to requests for comment, contend the measure will control government spending by requiring performance-based budgeting (Gorn, 10/9).

Crain's Detroit Business: Competition Among Health Information Exchanges Slows Development Of Michigan System
A plan intended to foster interconnected health information exchanges across the state has gone awry as companies providing the services compete for hospitals, physicians and market share. The health information exchanges -- not to be confused with the health insurance exchanges under health care reform -- are intended to help make it easier for hospitals and physicians to exchange patient information, thereby achieving lower costs and higher quality by better coordinating care and reducing service duplication. The problem is the two exchanges with the biggest market share, Okemos-based Great Lakes HIE and Grand Rapids-based Michigan Health Connect, use different information systems that cannot exchange data with providers that select other exchanges (Greene, 10/8).

MSNBC/ Philly.com: NJ Senate Approves Health Insurance Exchange, Other Measures
Legislation to create a state-run health insurance exchange was approved by the New Jersey Senate last week. ... The health insurance exchange bill would establish an online and telephone marketplace where individuals and businesses can shop for coverage, including some subsidized plans. Creating these user-friendly markets in each state is considered a key component of the national health care reform law, known as the Affordable Care Act, and its objective of extending health care coverage to millions of uninsured residents. ... Earlier this year, Republican Gov. Chris Christie vetoed a bill passed by the Democrat-controlled Legislature to create a state-run exchange, citing the imprudence of taking action before the U.S. Supreme Court ruled on the federal law’s constitutionality. The governor now is saying he wants to consider all his options before committing to a state exchange (Levinsky, 10/8).

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Editorials and Opinions

Viewpoints: David Brooks' Praise For Ryan Plan; Medicaid Overlooked In Presidential Debate; Romney Proposal Effective For Pre-Existing Conditions

The New York Times: The Policy Verdict I
In Thursday night's debate, Vice President Joe Biden will almost certainly go after Representative Paul Ryan's Medicare plan. And why shouldn't he? It's unpopular. But I'd like to make a case for that plan. It's the best thing the Romney-Ryan campaign has going for it (David Brooks, 10/8).

The Boston Globe: Making Medicaid A Block Grant Would Curb Vital Services
Of all the federal programs discussed in last week's presidential debate, an important one got short shrift: Medicaid. And it's more pressing than many other health care issues, because so many elderly people rely on it as virtually their only source of funds for long-term care. There are stark differences in how the two candidates would approach Medicaid, the federal health program for the poor that also covers 60 percent of the Americans living in nursing homes. Mitt Romney aims at much larger savings, but would sharply reduce the number of people with health coverage (10/9). 

Forbes: Why Mitt Romney's Plan For Pre-Existing Conditions Is Better Than Obamacare's
Obamacare's approach to pre-existing conditions, in summary, may help a tiny minority with pre-existing conditions to gain coverage in the short term, but the law will drive up the cost of insurance for everyone else, leading to adverse selection and higher premiums for all. And the price of Obamacare is steep: the individual mandate; trillions in new spending and taxes; deep cuts to Medicare providers. The Romney approach is, over the mid-to-long term, the far superior one. Romney's plan liberates Americans to own their own health insurance, continuously, as opposed to remaining dependent upon their employers. In addition, his plan would reduce the cost of insurance, making it more affordable for Americans to maintain their coverage (Avik Roy, 10/9).

Milwaukee Journal Sentinel: Romney Still Running Away From Massachusetts Plan
Romney had the right idea in Massachusetts, but the hard right turn taken by his party forced him to put that idea back on the shelf and pick from an old Republican wish list. What he's left with is a bag full of stale ideas. Obamacare is far from perfect. It expanded coverage massively without fully dealing with health care's cost beyond theoretical arguments. Nonetheless, the best approach is to salvage the Affordable Care Act -- not throw it out (10/8).

Medpage Today: Obama And Romney Ignored The Key Issue
I wasn't really surprised when Jim Lehrer did not use my suggested question on health care in last week's first presidential debate. For those who didn't read that column, or don't remember the question, here it is: How is it possible that the U.S., the richest country in the world, is the only developed country on this planet that has not figured out how to provide basic health insurance for all its citizens? However, I was truly surprised that this issue did not come up at all (Dr. Timothy Johnson, 10/8).

The New York Times: The Ups And Downs Of Electronic Medical Records
The case for electronic medical records is compelling. … Small wonder that the idea has been promoted by the Obama administration, with strong bipartisan and industry support. The government has given $6.5 billion in incentives, and hospitals and doctors have spent billions more. But as health care providers adopt electronic records, the challenges have proved daunting, with a potential for mix-ups and confusion that can be frustrating, costly and even dangerous (Milt Freudenheim, 10/8).

Los Angeles Times: CVS Customers Say Prescription Refills Weren't OKd
George Engelke manages his CVS prescriptions online. If he needs more of a medicine, he orders it. If he's going to be away from his Corona del Mar home, he tells the pharmacy where to send the shipment. He's never asked CVS to automatically refill his prescriptions. Engelke, 76, recently returned from a vacation in Montana. ... He got a call from the drugstore the other day informing him that they'd taken the liberty of sending another batch of supplies to the Montana address. "I never asked them to do that," Engelke told me (David Lazarus, 10/9). 

The Medicare NewsGroup: Why Are Medicare Advantage Premiums Dropping?
As a private offering within the larger public fee-for-service program, the Medicare Advantage Plan (Part C) program is a bit of an odd duck. Designed to give beneficiaries more insurance choices, costs have been coming down while the number of plans have been increasing. While it's too early to say if these trends will continue, it's important to dig into how Part C plans are structured and financed to understand the recent numbers in context. These cost savings may not continue and the recent news has been highly politicized (John Wasik, 10/8).

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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.