Daily Health Policy Report

Monday, November 5, 2012

Last updated: Mon, Nov 5

KHN Original Reporting & Guest Opinion

Campaign 2012

Health Reform


Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

As California Prepares To Expand Medicaid, Only The Poorest Will Benefit In Sacramento

Kaiser Health News: As California Prepares To Expand Medicaid, Only The Poorest Will Benefit In Sacramento
Capital Public Radio's Pauline Bartolone, working in partnership with Kaiser Health News and NPR, reports: "Midday on a Monday outside the Primary Care Center on Broadway and Stockton Boulevard in Sacramento, patients linger outside, waiting for services. Asked about their experiences at the clinic, they are eager to share – and many offer complaints" (Bartolone, 11/4). Read the story.

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Capsules: Health Issues On The Ballot In The States; Petition Calls For Hurricane Sandy First Responder Health Benefits

Now on Kaiser Health News' blog, NPR member station reporters working with KHN offer an examination of ballot issues in the states: "Sprinkled throughout ballots across the country are state initiatives that run the gamut from education to animal rights to marriage. And health care is well-represented, too. The National Conference of State Legislatures labels health a 'key issue' in this cycle's roundup of state ballot questions" (11/5).

Also on Capsules, Ankita Rao reports on Hurricane Sandy first responders' health benefits: "From leading evacuees through flooded streets to carrying a family pet out of a collapsing home, first responders have been dubbed the heroes of Hurricane Sandy. But not all of them had health benefits as they headed into the disaster zones this week" (Rao, 11/3). Check out what else is on the blog.

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Political Cartoon: 'Twister!'

Kaiser Health News provides a fresh take on health policy developments with "Twister!" by Daryl Cagle.

Meanwhile, here is today's health policy haiku:


Medicare: not the
Big issue Dems had hoped for
Good for GOP?

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

With Election Day Hours Away, Polls Show Deadlocked Race

The last round of polls shows the contest between President Barack Obama and GOP challenger Mitt Romney virtually tied. Meanwhile, news outlets report on how health issues are motivating some voters and what policies the winner might put in place.

The Wall Street Journal: Obama And Romney Deadlocked, Polls Show
The dueling assertions of success came as a new national Wall Street Journal/NBC News poll of likely voters found the two men caught in a dead heat. Mr. Obama led his rival by a whisker, 48% to 47%—a difference of seven voters among a pool of 1,475 surveyed. The poll has a margin of error is plus or minus 2.55 percentage points. Polls in many battleground states, from Virginia and Ohio to New Hampshire, Pennsylvania and even Michigan, also portrayed a race that is tightening down the home stretch (King and Meckler, 11/5).

USA Today: Final Swing States Poll: Fired-Up Voters Split, 48% to 48%
Voters in the nation's key battlegrounds have become as enthusiastic and engaged in the 2012 presidential election as they were in the historic contest four years ago, and they finally have made up their minds about President Obama and Mitt Romney (Page, 11/5).

Politico: Seniors Still Out Of Obama's Reach
Democrats hoped President Barack Obama would make inroads with seniors this year. ... for the most part, they just don't seem willing to give Obama a chance — despite their distrust of Ryan's budget and Medicare reforms. ... the president's health care reforms have made things even more difficult, pollsters say. There's an inherent distrust of any changes to the existing system, and continuing resistance to the underlying idea of universal health care, which many seniors fear will cut into their benefits (Tau, 11/4).

The Associated Press/Washington Post: Romney Pledges Bipartisanship In Final Push – And To Repeal Democrats' Priorities
In campaign stops in Iowa, Ohio and Pennsylvania, Romney reminded voters that on Day One, he would begin to repeal President Barack Obama's signature health care law. He also wants to weaken labor unions and overturn Democrat-backed legislation that overhauled the nation's financial system. But the polarizing priorities are not his focus at swelling rallies in the presidential contest's final hours (11/4).

The Wall Street Journal: In Its Final Lap, The President's Team Turns Nostalgic
Over the weekend, Mr. Obama sounded some of his successful themes from 2008, saying he would work with anybody from any party who is willing to move the nation forward. But he made clear there were lines he wouldn't cross, such as deep cuts to student aid and Medicaid. Along for the ride in the home stretch are many of Mr. Obama's senior advisers and closest friends, the people who helped engineer his rapid rise from state senator to president. His original speechwriting team, traveling with him aboard Air Force One, has employed a dose of superstition by vowing to not shave their beards until Election Day (Meckler, 11/4).

The New York Times' The Caucus: Ryan Says Obama Policies Threaten 'Judeo-Christian' Values
Representative Paul D. Ryan on Sunday accused President Obama of taking the country down a path that compromises Judeo-Christian values and the traditions of Western civilization. Mr. Ryan has previously criticized the Affordable Care Act for requiring church-run charities and institutions to include contraception in insurance plans for employees, a criticism widely echoed by conservatives. But this was the first time Mr. Ryan had used such strong language on the issue (Gabriel, 11/5).

The New York Times: Ryan, Quiet for Now, Is Said To Be Planning For An Active Role
Representative Paul D. Ryan may have largely disappeared from the national spotlight down the campaign homestretch, ceding attention to Mitt Romney. But if the Republican ticket prevails, Mr. Ryan plans to come back roaring, establishing an activist vice presidency that he said would look like Dick Cheney's under President George W. Bush.  Mr. Ryan would dedicate most evenings to dinners with senators and House members of both parties, aides said, as he steps into the role Mr. Romney promised: architect of a Romney administration's drive to enact a budget that shrinks the government and overhauls programs like Medicare (Gabriel, 11/3).

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In Fight For Control Of The House And The Senate, Status Quo Appears To Be Winning

News reports suggest that Republicans are likely to hold onto the majority in the House, despite Democrats' hopes around the impact of the Medicare issue, and that Democrats are likely to retain the Senate majority.

The Associated Press: GOP Likely To Hold House After $1B Campaign
In districts from one ocean to the other, Democrats have accused Republicans of trying to gut Medicare, the popular health insurance program for the elderly, and slice domestic programs like education while seeking tax cuts for the rich. They've also accused them of attacking women's rights with measures to curb abortion and cut funds for Planned Parenthood. ... The GOP has lambasted Democrats for supporting President Barack Obama's health care overhaul and other big spending programs like Obama's economic stimulus package. Democrats also are accused of cutting Medicare themselves and boosting taxes on the middle class (Fram, 11/3).

Los Angeles Times: Democrats' Hope Of Retaking House Fades In Polarized Campaign
Democratic hopes for a takeover have faded as races tightened in the final weeks. Underlying this election is a polarized political climate, as well as newly drawn congressional boundaries. The redrawn districts shored up Republican-held seats and largely ceded cities to Democrats, which has put the party on track to have the most diverse caucus ever, the first without a white-male majority (Mascaro, 11/4).

The Hill: Medicare Fades As 'Majority-Maker' Issue For House Dems
Attacking Paul Ryan's Medicare plan — once seen as the most potent weapon in House Democrats' campaign arsenal — is turning out to be a dud. Democratic leaders have hit Medicare harder than any other issue for more than a year, even calling Ryan's plan a "majority-maker." But with Election Day just around the corner, Democrats are looking at pickups in the single digits — far short of the 25 seats they would need to retake the House. Medicare simply hasn’t become the powerful tool that Democrats — and even many Republicans — expected (Baker, 11/3).

Politico: Dems' Drive To Retake House Falters
Nancy Pelosi has spent much of the past two years proclaiming that Democrats had a great shot at reclaiming the House and returning the speaker’s gavel to her hands. But her drive to regain the majority for Democrats is on the verge of a complete collapse. Democrats are expected to pick up five seats at best — a fraction of the 25 they need. On the eve of the election, some party officials are privately worried that Democrats might even lose ground and drop one or two seats to the Republican majority (Isenstadt, 11/4).

The CT Mirror: Differences Are In The Details For Hines, Obsitnik In Final Debate
In their last debate before next Tuesday's elections, 4th District Democratic Congressman Jim Himes and his Republican challenger, Steve Obsitnik, repeated the same messages they have throughout the campaign, and -- as in past debates -- struggled to define their differences. "I agree with Mr. Obsitnik on this point," was a phrase uttered a few times by Himes during the debate Friday, while Obsitnik, too, was caught more than once saying a version of "Congressman Himes said it right." The debate, sponsored by AARP, focused on Medicare and Social Security. The health care program for seniors has become a central part of the 2012 campaign across the country due to Republican vice presidential candidate Paul Ryan's controversial plan to turn it into a voucher program. But Obsitnik and Himes largely agreed Friday on how to ensure the long-term security of both Social Security and Medicare (Satija, 11/2).

The Associated Press/Washington Post: Control Of Senate Could Come Down To Maine's King, An Independent Who Won't Declare Preference
Add this to your set of Election Day unknowns: Control of the United States Senate could conceivably come down to an independent candidate from Maine who has resolutely refused to say which party he'd side with if voters send him to Washington. While it's commonly accepted that Angus King, a former Democrat who supports President Barack Obama, would align with Democrats, he has refused to say. That's generated suspense and, in theory, could translate to power for King if the Senate ends up close to a 50/50 split. If one party wins a decisive majority, King could find himself with less leverage than he hoped (11/5).

Politico: Senate Appears Destined To Remain In Democratic Hands
Coming out of the final weekend of the campaign, the GOP is still widely expected to fall short Tuesday night. The three- or four-seat gain it needs to make Harry Reid minority leader no longer looks to be in the cards (Catanese, 11/4).

Politico: Claire McCaskill On Brink Of Unlikely Comeback
This wasn’t how Claire McCaskill planned to spend the final weekend of a long and grueling Senate campaign: Laying to rest her 84-year-old mother, Betty Anne, who had blazed a path for her in politics and been by her side since her first run for the statehouse three decades ago. It was the latest show of resilience by a Democratic senator who three months ago had the look of a surefire loser — before she helped engineer a self-destructing Republican opponent and allowed for the most improbable comeback of the Senate election cycle (Wong, 11/4).

Milwaukee Journal Sentinel: Thompson Reverses Course On Raising Age For Medicare Benefits
U.S. Senate candidate Tommy Thompson is reversing course on whether he would raise the age at which future retirees receive Medicare benefits, saying he does not favor the idea just weeks after his campaign spokeswoman said that he did. Thompson spokeswoman Lisa Boothe issued a written statement last month that said Thompson was open to raising the age at which people receive Medicare and offering fewer benefits to those who have more money to help shore up the program. But in an interview with the Journal Sentinel on Thursday, Thompson said that was not his position and pointed to a different plan on Medicare he recently put forward (Marley and Stein, 11/2).

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Outcomes Of State Legislature Races To Play Big Role In Health Law's Future

Although the race for the top of the ticket claims the biggest headlines, news outlets report that the winners of governor and state legislative races will have a major effect on the health law's implementation.  

NBC: From Texas To Vermont, State Elections Decide Health Care's Future
As Mitt Romney and President Barack Obama pack in some last-minute campaigning before Tuesday's election, polls show voters are split just about down the middle on who they prefer: Romney, who has promised to do everything he can do repeal the 2010 health reform law, and Obama, who says its benefits are just beginning to take hold. But while the presidential race gets most of the attention, the choices voters make to fill governor’s mansions and state legislatures may have just as big an effect on what kind of health coverage they will have in coming years. That's in part because the Affordable Care Act sets it up that way, but even more so because the Supreme Court says it's up to states to decide whether and how to expand the Medicaid health insurance plan for the poor (Fox, 11/3).

USA Today: Control Of Legislatures Up For Grabs In 44 States
One of Tuesday's biggest election-night mysteries is whether Republicans can hold on to historic gains they made in state legislatures in 2010. Two years ago, Republicans won 700 extra seats nationwide and now have more state legislators than any time since 1928. The Republican tidal wave played a key role in conservative efforts to overhaul schools, limit union power, control spending and slow down the new federal health care law (Cauchon, 11/5).

The Associated Press: GOP Raises Specter Of Medicaid Expansion As Campaign Issue
Gov. Sam Brownback's allies have raised the potential expansion of the state's Medicaid program as a campaign issue in the days before Tuesday's election decides races for the Kansas Legislature, with conservative Republicans seeking to bind Democrats to President Barack Obama and the federal health care overhaul. The federal law enacted in 2010 contemplates an expansion of Medicaid to cover millions of uninsured Americans, and it promises that the federal government will pick up the full cost until 2016 and most of it afterward (Hanna, 11/5).

HealthyCal: What's At Stake For California On Tuesday
Whichever party controls the White House and Congress could have a profound influence on a number of policy fronts with huge implications for Golden State residents. Look no further than the future of the federal health reform adopted by Congress and President Obama in 2010. No state has been more aggressive than California in implementing the law, which expands access to government-subsidized care while overhauling the business practices of the health insurance industry (Weintraub, 11/4).

California Healthline: Health Care On California Ballot, Directly And Indirectly
Health care issues appear on California ballots next week directly and indirectly. Voters in several cities and counties will decide issues directly related to health care ranging from soda taxes to medical marijuana laws. Although statewide propositions on next week's ballot don't deal specifically with health care issues, several could have profound effects on California's health care system at the local and state levels. Proposition 30, Gov. Jerry Brown's (D) revenue-raising tax initiative, and Prop. 31, calling for changes in state and county government rules, probably have the most import for the state's health care system. Two other measures -- Prop. 32, calling for changes in political contribution laws, and Prop. 37, which would require labeling of genetically modified food -- also have the potential to affect health care policy and financing down the road (Lauer, 11/1).

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Both Candidates Use Abortion Issue To Turn Out Their Base

NPR takes a long look at how both candidates have put abortion "front and center," while the Los Angeles Times describes how the issue is galvanizing Catholic and evangelical Protestant voters in the swing state of Ohio. And then there are the robo-calls.

NPR: Why Abortion Has Become Such A Prominent Campaign Issue
Abortion isn't usually a major issue in presidential campaigns. But this year is different. Both President Obama and former Massachusetts Gov. Mitt Romney are putting the issue front and center, including official campaign-produced ads (Rovner, 11/5).

Los Angeles Times: Abortion Issue Galvanizes Voters In Battleground Ohio
[I]t's nearly impossible to spend time in Ohio this election year without noticing a surge of activity from Mitt Romney supporters and canvassers who say that values and abortion issues are paramount. ... Voters seem especially enraged about Obama's past positions on abortion and about a part of the Obama healthcare law that required Catholic-affiliated employers to pay for contraception coverage. ... Such excitement could energize voters in this crucial swing state, which is 21% Catholic and 24% evangelical Protestant, according to the Pew Forum (Semuels, 11/4).

The Hill: Fred Thompson Cuts Robocall Against Obama On Abortion
Former Sen. Fred Thompson (R-Tenn.) labels President Obama "the most pro-abortion president we've ever had" in a new robocall aimed at four million socially conservative voters. Thompson recorded the message for the Susan B. Anthony (SBA) List, which opposes abortion rights and is hoping to increase turnout for Mitt Romney on Election Day. "With only four days to go, we are leaving nothing on the table — voters must know this president’s extreme abortion record before casting their vote," SBA List President Marjorie Dannenfelser said in a statement (Viebeck, 11/2).

Politico: Citing Abortion, Robocalls Target Obama's Latino Support
Two conservative groups are hoping to peel away some of President Obama's strong support in the Latino community. Mexican actor and soap star Eduardo Verastegui is teaming up with Latino Partnership for Conservative Principles (an initiative of American Principles in Action) and Susan B. Anthony List on a robocall and web campaign that hits Obama on abortion and deportations — and encourages Latino voters to give Mitt Romney their votes. "President Obama and his friends in Congress say they care about Latinos, but then why are they attacking our values: life, family and faith –vida, familia, fe!. From day one they have worked to advance abortion at home and abroad. And they have unleashed an unprecedented attack on the Church and its freedom," the call script reads. "That's why we need Romney in the White House" (Tau, 11/2).

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Health Reform

Health Law Implementation Issues Expected To Loom Large Post-Election

News outlets reported on insurance exchanges, Medicaid expansion and how the law's employer mandate may already be affecting workers' hours.

The Wall Street Journal: Health-Care Law Spurs A Shift To Part-Time Workers
Some low-wage employers are moving toward hiring part-time workers instead of full-time ones to mitigate the health-care overhaul's requirement that large companies provide health insurance for full-time workers or pay a fee. Several restaurants, hotels and retailers have started or are preparing to limit schedules of hourly workers to below 30 hours a week. That is the threshold at which large employers in 2014 would have to offer workers a minimum level of insurance or pay a penalty starting at $2,000 for each worker (Jargon, Radnofsky and Berzon, 11/4).

Politico: Post-Election Flood Of 'Obamacare' Rules Expected
The once-steady stream of regulations and rules from the Obama administration — instructions for insurance companies, hospitals and states on how to put the law in place — has slowed to a trickle in recent months in an attempt to avoid controversies before the election. Many states, too, have done little public work to avoid making the law an election issue for state officials on the ballot. But work has been going on behind the scenes (Haberkorn, 11/5).

CQ HealthBeat: So Who's Running Exchanges At CMS? It's A Team
With two weeks to go before "declaration day" — the day states must say under the health law if they plan to open an insurance exchange — the Obama administration is relying on several officials to run the implementation of this key part of the health law. That's in contrast to the way exchange effort was run shortly after the health overhaul was passed, when Joel Ario was clearly the point person in his post as director of the Office of Insurance Exchanges at Health and Human Services (HHS) before the exchange office was folded into the Centers for Medicare and Medicaid Services (CMS) (Reichard, 11/2).

The Hill: Conflict-Of-Interest Concerns Raised As Obama Races To Implement Health Reform
The Obama administration is relying heavily on outside contractors to implement a core component of healthcare reform as it races to set up a federal health insurance marketplace before 2014. The fast-approaching deadline gives the administration little time to scrutinize private-sector partners for conflicts of interest. The purchase of one of these contractors, Quality Software Services, Inc. (QSSI), by UnitedHealth Group, a major healthcare conglomerate, has sparked concerns about a potentially uneven playing field (Bolton, 11/3).

Politico Pro: Hickenlooper: 'Uncertainty' On Medicaid Expansion
We've heard the argument from opponents and skeptics of the Affordable Care Act: States can't commit to expanding their Medicaid programs without more guidance from HHS. But Colorado Gov. John Hickenlooper, an avid surrogate for President Barack Obama and wholehearted supporter of the health law, offered a similar assessment in a budget he filed with his state's lawmakers this week. He didn't include Medicaid expansion at this time (Cheney, 11/2).

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Detailing Medicare's 2013 Doc Pay Schedules: Home Health Flat, Primary Care Up

Under Medicare's 2013 payment schedule, released late last week, home health agency payments will remain flat while primary care physicians can expect up to a 7 percent boost in payments.

Modern Healthcare: Medicare Home Health Payments To Remain Flat
Home health agencies can expect Medicare payments to drop by 0.01 percent next year, decreasing total payments in this segment by about $10 million from 2012 payments, the CMS announced Friday. The so-called market basket -- which adjusts for inflation -- called for a 1.3 percent payment increase to home health providers next year. Then the CMS applied an updated wage index that resulted in a 0.37 percent decrease, as well as a 1.32 percent decrease in the case-mix adjustment and an update to the fixed-dollar loss ratio used in outlier payments that led to an increase of 0.38 percent. Taken together, these adjustments result in a total decrease of 0.01 percent for 2013 payments, a CMS spokeswoman explained in an e-mail (Zigmond, 11/2).

Medpage Today: Medicare Sets 2013 Physician Fee Schedule
Family physicians will receive up to a 7 percent boost in Medicare payments in 2013, and other primary care providers will receive 3 percent to 5 percent more, under a final rule announced Thursday by the Centers for Medicare and Medicaid Services (CMS). Much of the increase in the physician fee schedule reimbursement will come from new added payments for coordinating a patient's care in the 30 days following a hospital or skilled nursing facility stay. Under the rule, providers will for the first time receive a separate payment to help a patient transition back to the community following a discharge. The American Medical Association (AMA) said it was pleased that the transition payments -- which were suggested by a work group that the association participated in -- had been adopted (Pittman, 11/1).

News outlets also look at one health plan's efforts to improve its Medicare rating and some of the unexpected beneficiaries of Medicare.

Health News Florida: $34M In Doctor Bonuses Led To Ratings Boost, Humana Says
Humana Gold Plus took a big leap in Medicare's quality ratings in just one year by paying bonuses to groups of doctors who produced results, the company said. The company paid $34 million in bonuses to more than 900 Florida primary-care physician practices that did the right things at the right time, documented what they did and got better outcomes for patients, spokesman Mitch Lubitz said. Health News Florida reported on Thursday that Humana Gold Plus, Florida's largest Medicare Advantage plan, was the only statewide plan to reach the level of 4.5 stars in a 5-star scale (Gentry, 11/2).

Marketplace: Medicare's Unexpected Beneficiaries
When you think of Medicare’s beneficiaries, you probably think of senior citizens. They account for more than 80 percent of the 49 million Americans on Medicare. Medicare beneficiaries also include younger Americans with disabilities and terminal kidney disease. But Medicare has helped millions of other Americans: the children and grandchildren of elderly parents. … Democratic Congressman John Dingell helped vote Medicare into law in 1965, and he remembers what elderly care used to be like, in the days before Medicare: "Well, it was pretty grim. Senior citizens were depending either on charity or on their kids in most instances." Back then, insurers wouldn't offer coverage to seniors because they were seen as too high a risk (Gura, 11/2).

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Public Health & Education

IOM Offers Assessment Framework For Community-Based Wellness Efforts

Modern Healthcare: Framework Offered For Measuring Community-Based Wellness Efforts
An Institute of Medicine committee released a report describing a framework to estimate the value of community-based, nonclinical prevention policies and wellness strategies. The goal of the report, called An Integrated Framework for Assessing the Value of Community-Based Prevention, is to make it easier to prevent disease, increase behaviors that improve health and well-being, slow or stop the progress of disease, and decrease disparities, all at the population level, according to a summary of the report (Barr, 11/3).

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State Watch

Petition Asks For Expanded Health Benefits For Superstorm Sandy First Responders

Superstorm Sandy is still affecting the health care of the medically vulnerable in New York and New Jersey as a new petition calls for expanded health benefits for Sandy first responders.

Kaiser Health News: Capsules: Petition Calls For Hurricane Sandy First Responder Health Benefits
From leading evacuees through flooded streets to carrying a family pet out of a collapsing home, first responders have been dubbed the heroes of Hurricane Sandy. But not all of them had health benefits as they headed into the disaster zones this week (Rao, 11/3).

CBS (Video): Disabled Residents In NY And NJ Weather Sandy
Superstorm Sandy wreaked havoc in the Northeast this week, and while many residents faced hardship, New York and New Jersey's disabled community faced the storm as one of the most vulnerable segments of society. Thousands of developmentally disabled people faced power outages and food shortages and their caregivers sacrifices their own needs in order to see the disabled through the storm. Kirsten Nataro is a health specialist at a group home for the mentally disabled on Long Island and she spoke with CBS News' Willem Marx about the impact of the storm at the home (11/3).

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State Roundup: Examining Health Issues On State Ballots

A selection of health policy stories from Massachusetts, Texas, Oregon, California, Colorado and Kansas.

Kaiser Health News: Health Issues On The Ballot In The States;
Sprinkled throughout ballots across the country are state initiatives that run the gamut from education to animal rights to marriage. And health care is well-represented, too. The National Conference of State Legislatures labels health a "key issue" in this cycle's roundup of state ballot questions (Girshman, 11/5).

Medscape: Will Physician-Assisted Suicide Spread To Massachusetts
A Massachusetts ballot proposition before voters next Tuesday pits traditional medical ethics against another creed anchored by a phrase that Hippocrates probably never uttered -- patient autonomy. The ballot proposition in question would legalize physician-assisted suicide, although supporters prefer the expressions "physician-assisted death" or "death with dignity." Regardless of the name, the proposed law would permit physicians to prescribe a lethal dose of oral narcotic to terminally ill patients who request it to end their suffering. Patients would swallow the medicine on their own, unlike the euthanasia that Dr. Jack Kevorkian illegally administered on occasion to willing patients. If the proposition passes, and polls suggest it could, Massachusetts would become the fourth state in which physician-assisted suicide is legal (Lowes, 11/4).

The Boston Globe: Hospitals Look To Lower Readmission Rates
Beth Israel Deaconess is one of hundreds of hospitals in the country that will lose money under a new federal program meant to force improvement in the overall care of some of the sickest seniors. Created under the Affordable Care Act, the program docks Medicare payments to hospitals whose patients are most likely to be readmitted within 30 days of treatment for pneumonia, heart failure, or heart attacks. Government officials say readmissions drive up health costs and can be a sign of inadequate care (Conaboy, 11/5).

The Oregonian: Hospital Charity Care In Oregon Sinks As Debate Over Standards Grows
In 2009 the recession was in full swing, and as the number of unemployed and uninsured shot up, Legacy Health System ratcheted free care to the needy in the Portland area to a new high. Legacy wrote off $67 million in area patients' bills last year, a nearly 25 percent jump since 2009, more than 6 percent of revenue. That may not have been a smart business move, but "we have a mission" to help others, says Dave Eager, chief financial officer of the nonprofit. Other tax-exempt hospitals in the state did not follow suit, according to newly released state records. From 2009 to 2011, 31 of Oregon's tax-exempt hospitals cut free care to the poor as a percent of revenue (Budnick, 11/3).

The Oregonian: Oregon's County Assessors Challenge Hospital Acquisitions' New Tax Breaks, Murky Law
Nonprofit hospitals in Oregon are increasingly pushing to take newly acquired property off public tax rolls, and assessors in cash-strapped counties are pushing back. Nationwide, hospitals are swallowing private practices, hiring their practitioners, absorbing their patients, and buying or leasing buildings and equipment. Counties have long granted charitable tax exemptions to nonprofit hospitals in exchange for their care for the poor. But health reform's coordinated care model along with changes to Medicare are driving mergers between hospitals and private practices to an all-time high. In Oregon, county assessors are fighting the trend. Douglas County recently denied Roseburg's Mercy Medical Center's request to extend its exemption to four properties worth $18 million. Hood River and Josephine counties, currently gathering information, may follow suit on similar requests, assessors there say (Budnick, 11/3).

The Texas Tribune (Video): Where The State Women's Health Program Stands
Women's health providers in Texas have had Nov. 1 marked on their calendars for months. It was supposed to be the day the state-funded Women's Health Program would launch. But it hasn't. And it won't until, according to Texas Health and Human Services Commission officials, the federal government stops funding it or a final court decision is rendered (Rocha, 11/2).

Kaiser Health News: As California Prepares To Expand Medicaid, Only The Poorest Will Benefit In Sacramento
Midday on a Monday outside the Primary Care Center on Broadway and Stockton Boulevard in Sacramento, patients linger outside, waiting for services. Asked about their experiences at the clinic, they are eager to share -- and many offer complaints (Bartolone, 11/4).

Health Policy Solutions (a Colo. news service): New Data Tool Finds Health Costs Vary Wildly
An MRI on your knee in Colorado could cost as little as $297 or as much as $1,261 depending on where you get it, according to the first release of health data from a powerful new tool aimed at improving health, bringing down costs and improving the quality of care. On Thursday, Colorado became the 12th state in the nation to unveil an All Payer Claims Database (APCD) with the debut of cohealthdata.org managed by the Center for Improving Value in Health Care (CIVHC). So far, the database includes about 40 percent of health data from 2009 to 2011, representing about 2 million people (all under 65) who were covered through both private and public health insurance programs in Colorado. By 2014, CIVHC managers hope to add data from Medicare patients along with claims from self-insured private employers to reflect about 90 percent of insured Coloradans (Kerwin McCrimmon, 11/1).

California Healthline: Healthy Families Notices Sent, Now Federal Approval Needed
The state late last week sent 415,000 notices to inform Healthy Families participants they will need to switch to Medi-Cal managed care plans on Jan. 1. At the same time, almost two dozen organizations, including the California Medical Association, sent a letter to lawmakers and state health officials asking for a delay in the conversion for 880,000 children in California. The 60-day notices went out on Thursday and Friday last week, according to officials at the Department of Health Care Services. That officially starts the clock ticking on the Healthy Families transition (Gorn, 11/5).

California Healthline: New Name, New Website For Exchange
California consumers will be able to get a strong picture of California Covered, the newly named package of health insurance offerings from the Health Benefit Exchange when the state launches a new website next month, according to exchange officials. "We've been targeting the new website by the end of this year, but I'm optimistic we're looking at Dec. 1 for the launch of that," said Oscar Hidalgo, director of communication and public affairs at the exchange. … The exchange eventually plans to launch a bigger web portal that can actually start people through the enrollment process, but that won't happen till the middle of next year, Hidalgo said (Gorn, 11/2).

Health Policy Solutions (a Colo. news service): Better Primary Care Saves Colorado $20 Million
An experiment to ensure that complex Medicaid patients have a regular doctor and care coordinators who can help them stay healthy has saved Colorado an estimated $20 million in its first year, according to a new report from Colorado's Medicaid managers (Kerwin McCrimmon, 11/2).

Kansas Health Institute News: Officials Gather To Evaluate State's Public Health System
Sixty officials from a variety of disciplines and from around the state gathered here today to grade Kansas' public health system by collectively answering a battery of 600 questions as part of the National Public Health Performance Standards Program. Kansas is one of 23 states to conduct the evaluation and first did so in 2008, a year after the program was started by the federal Centers for Disease Control and Prevention. Four years ago, however, only officials from the Kansas Department of Health and Environment participated, said Brenda Nickel, director of KDHE's Center for Performance Management (Cauthon, 11/2).

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Editorials and Opinions

Viewpoints: Romney, Obama Offer Details Of Their Plans; The 'Passionate Supply-Sider' Who Taught Paul Ryan; Medicare Plan Has Not 'Doomed GOP'

The Wall Street Journal: A New Direction For America 
All presidential elections matter. This one matters a great deal. It matters to the senior who needs medical care but, thanks to ObamaCare, can't find a doctor who is taking new Medicare patients. ... This election is about them. It is about all of us. ... It is about the education of our children, the value of our homes, the take-home pay from our jobs, the price of the gasoline we buy, the choices we have in our health care (Mitt Romney, 11/2).

The Wall Street Journal: Real Progress, But We're Not Done 
I've worked with Republicans to cut a trillion dollars of spending, and I'll do more. I'll work with anyone of any party to move this country forward. But I won't eliminate health insurance for millions of poor, elderly or disabled on Medicaid, and I won't turn Medicare into a voucher to pay for another millionaire's tax cut. That is surrender to the same philosophy that hurt middle-class families for too long (President Barack Obama, 11/2).

The New York Times: The Republican Id
The macroeconomics professor who helped shape Paul Ryan is a voluble, passionate supply-sider and self-described "hard-core libertarian" named William R. Hart. ... Hart's policy expectations for a Romney/Ryan regime are familiar from the campaign. ... They include entrusting health care for the poor, and as much else as possible, to the mercies of the states; requiring that Medicare compete in a voucher market; cutting marginal tax rates, of course. What is striking, talking to Ryan's mentor, is not the policies but the fervor and the deep suspicion of the other side's motives (Bill Keller, 11/4). 

The New York Times: What We Already Know
The second major development of the 2012 campaign has been the failure of Paul Ryan to emerge as the white hot ideological flash point that many on the left and right expected. Instead, from a purely political vantage point, Ryan has not only turned out to be an acceptable running mate – his home state, Wisconsin is unexpectedly in play — but his March 20, 2012 proposal to turn Medicare into a "premium support" (or voucher) plan has not, in and of itself, doomed Republican chances. ... the survey suggests that Democrats may have lost much of their overwhelming advantage among voters on the broad issue of health care, including Medicare (Thomas B. Edsall, 11/4).

The Wall Street Journal: Obama's Progressive Gamble
[W]ith a filibuster-proof Senate of 60 Democrats, (President Obama) began the Bataan death march to national health care—a new entitlement at a time when the current entitlement state is buckling and unaffordable. The Affordable Care Act is among the worst pieces of legislation ever passed, not least because Mr. Obama might have notched another bipartisan victory had he sought GOP input. When the bill ran into trouble with the public and even moderate Democrats, he plowed ahead anyway (11/4). 

Los Angeles Times: The Likely Winner -- Gridlock
Romney's professions of bipartisanship also collide with promises he has made to his own supporters — promises he could scarcely abandon even if he wanted to (and he says he doesn't). On "Day One" of his presidency, the GOP candidate says, he would begin the work of repealing Obama's healthcare law — something Senate Majority Leader Harry Reid has vowed to block. If a straightforward attempt to repeal Obamacare fails in the Senate, many Republicans want to undermine the law by blocking its implementation and funding (Doyle McManus, 11/4).

The Hill: Healthcare Law On The Ballot
If President Obama wins and Democrats hold the Senate, the Affordable Care Act will survive. If Mitt Romney wins and Republicans take the Senate, the law is dead. It is the starkest of differences. ... We will either move to a federally-dominated healthcare system, or we will step away from that precipice and pursue different reforms (David Merritt, 11/2). 

NBC's/The Grio: How Do We Solve A Problem Like Health Care Reform?
[President Obama] has brought encouraging changes to a health insurance system which to this point had been largely a voluntary endeavor. … [However,] the President did not deliver pharmaceutical price negotiation to Medicare Part D. This could still deliver significant cost savings to taxpayers as well as Medicare beneficiaries. ... Secondly, the President failed to include a Federal Employees Health Benefits Plan (FEHBP)-like public option in the Affordable Care Act’s health insurance exchanges. Not for lack of effort (Dr. Cedric Dark, 11/1).

The Wall Street Journal: A Referendum On ObamaCare And Liberty 
If President Barack Obama is re-elected, ObamaCare's controls over doctors, hospitals, pharmaceutical firms and other providers of medical care will be tightened, and the operations of private insurance companies will be progressively restricted. ... If Gov. Mitt Romney is elected, by contrast, ObamaCare's controls will be turned to promoting freer, more competitive markets, laying the groundwork for legislative "repeal and replace" (Christopher DeMuth, 11/4). 

San Francisco Chronicle: Mentally Ill Miss Out On Prop. 63 Funds
California voters passed the Mental Health Services Act in 2004 because they know how mental illness debilitates their families, destroys their friends and harms their communities. It is thus disturbing that the state agency overseeing Prop. 63 spending is ignoring the requirements of the law -- to spend the funds it raises on services to individuals with serious mental illness (11/4).

Health Policy Solutions (a Colo. news service): Data And Quality Measures Essential For Better Health
This week we saw the first presentation of the Colorado All Payer Claims Database, a project of the Center for Improving Value in Health Care (CIVHC) that is jointly funded by the Colorado Health Foundation and The Colorado Trust. We at The Trust believe that the claims and costs data collected through the APCD, as well as specific measures of quality, will provide an essential missing part of the spectrum of data needed to inform health care decisions by business leaders, policymakers, providers, payers and, of course, health care consumers (Dr. Ned Calonge, 11/2).

Health Policy Solutions (a Colo. news service): Medicaid Cuts Would Harm Children And Families The Most
Medicaid, not Medicare, is the real Obama-Romney divide. Medicaid is one of the most cost-effective programs by which Americans receive health insurance and is far better than private health insurance at holding down costs. In contrast, millions of people using the health care system without health insurance increases health care costs for everyone in an uncontrolled manner.  Covering people under Medicaid and its related health plan, Child Health Insurance Program (CHIP), improves the American health care system and saves money overall (Ballard Pritchett, 11/2).

The Arizona Republic: Phoenix Law Would Improve Access To Health Care
The Phoenix Access to Care Ordinance, crafted by our city's acute-care hospitals and city officials, led and championed by Mayor Greg Stanton, is a bold, financially sound measure to care for our uninsured and underinsured Phoenix residents who rely on emergency rooms when they are injured or ill. The ordinance will provide a new source of funds to keep those facilities fully operational in the midst of an economic downturn that is saddling hospitals with $540 million in uncompensated costs this year (Reginald M. Ballantyne III, 11/5).

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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.