Daily Health Policy Report

Tuesday, November 6, 2012

Last updated: Tue, Nov 6

KHN Original Reporting & Guest Opinion

Campaign 2012

Health Reform

Medicare

Health Care Marketplace

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Election Will Decide Health Law's Future

Kaiser Health News staff writer Jay Hancock reports: "The highest court in the country upheld most of the Affordable Care Act in June. But everybody knew it was only an overture. The law 'will fall in November by a vote of the American people,' Mississippi Gov. Phil Bryant pledged that day, speaking for many other Republicans. Democrats were more reluctant to paint the election as a referendum on what even they came to call 'Obamacare.' But privately they admitted the stakes" (Hancock, 11/5). Read the story.

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Employers Expected To Keep Some Of Health Law's Popular Provisions, Even If Obama Loses

Kaiser Health News staff writer Julie Appleby reports: "Employers will continue looking for ways to cap expenses, moving toward higher deductible policies, or placing limits on how much they pay toward their workers' premiums -- both trends that predate the federal health law, analysts say" (Appleby,11/5). Read the story.

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Health Care Stakes Are High In California

Kaiser Health News staff writer Sarah Varney reports: "More than any other state, California has wagered heavily on the Affordable Care Act: It has moved quickly to erect an insurance exchange and establish the high risk pool. It's also codified federal consumer protections into state law. In 2010, the state signed a $10 billion Medicaid waiver with the Obama administration that has allowed counties here – from Democratic Los Angeles to Republican San Diego – to enroll as many as 500,000 low-income adults into a 'Medicaid-lite' program years ahead of the law’s expansion of the federal-state program for the poor. Similar to the high risk pool, 'Medicaid-lite,' which is officially called the Low Income Health Plan, is envisaged as a temporary measure until January 2014. That’s when California would open up its Medicaid program to millions of poor people, an expansion paid for largely by the federal government" (Varney, 11/5). Read the story.

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Medicare Trying To Nudge Seniors Out Of Plans With Low Ratings

Reporting for Kaiser Health News in collaboration with USA Today, Susan Jaffe writes: "Medicare officials are trying a novel approach during this open enrollment season to gently nudge a half million beneficiaries out of 26 private drug and medical plans that have performed poorly over the past three years. It begins with letters informing seniors they are enrolled in a plan that received low ratings" (Jaffe, 11/5). Read the story or check out the related chart.

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Insuring Your Health: Dispelling Some Rumors About Medicare And The Health Law Limiting Care

Kaiser Health News consumer columnist Michelle Andrews answers questions from readers about provisions in the Affordable Care Act related to drugs and medical-care coverage under Medicare and high-risk insurance plans (11/5). Read the column.

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Capsules: Less Experienced Doctors Cost Health System More; Are ACOs Doomed To Fail?; Study: Depression A Leading Risk For Higher Health Spending

Now on Kaiser Health News' blog, Jenny Gold reports on a commentary on the future of ACOs: "Accountable care organizations are widely touted as one of the most effective cost-containing measures of the 2010 federal health law. Yet they have a great deal in common with the integrated delivery networks of the 1990s, leaving some wondering whether the bold experiment might come to the same disappointing end" (Gold, 11/5).

Also on Capsules, Jordan Rau writes about a new study finding that depression is a leading driver of health spending: "Depression was the most costly among 10 common risk factors linked to higher health spending for employees, according to a new study of seven companies. The study published in Health Affairs found that the 10 factors — which also included obesity, high blood sugar and high blood pressure — were associated with nearly a quarter of the money spent on the health care of the workers" (Rau, 11/6).

In addition, Alvin Tran reports on a study about the physicians who may cost the health system more:  A new study "found that doctors with less experience spend more money treating patients than their veteran colleagues" (Tran, 11/5). Check out what else is on the blog.  

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Political Cartoon: 'Tooth & Nail?'

Kaiser Health News provides a fresh take on health policy developments with "Tooth & Nail?" by Bob Englehart, The Hartford Courant.

Meanwhile, here is today's health policy haiku:

NO MORE ADS, JUST BALLOTS

Time to cast a vote.
There's a lot riding on this...
Make your voice be heard. 
-Anonymous

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

Obama, Romney Keep Up The Fight In Campaign Last Minutes

The Washington Post reported that President Barack Obama had a slight edge in the polls, but most analysts expect the election to be extremely close. GOP challenger Mitt Romney continued to hammer his anti-Obamacare message while other news outlets predict that whoever wins will face big challenges in dealing with the deficit.   

The Associated Press: No Rest In Final Campaign Hours For Obama, Romney
The White House the prize, President Barack Obama and Mitt Romney raced through a final full day of campaigning on Monday through Ohio and other battleground states holding the keys to victory in a tight race. Both promised brighter days ahead for a nation still struggling with a sluggish economy and high joblessness (Pace and Hunt, 11/5).

The Wall Street Journal: Obama And Romney Battle Down To Wire
After more than one million television ads, countless appearances and three contentious debates, the 2012 presidential election remained on a knife's edge with both candidates seeking to shore up support in states crucial to their chances Tuesday. … With the margin of victory for the winner expected to be narrow, a likely outcome is a political system as split as the country. It isn't clear either party would be positioned to emerge Wednesday with a clear mandate for tackling some the nation's biggest problems—including the looming tax increases and spending cuts known as the fiscal cliff (Meckler and Murray, 11/5).

The Washington Post: On Election Eve, President Obama Has A Slim Edge In Polls
President Obama held a slim advantage in national and battleground polls going into Election Day as the candidates made their last mad dashes across swing-state America and their campaigns braced for a day of intense battle — and the legal fights that may follow. A Washington Post-ABC News tracking poll showed Obama at 50 percent to Republican challenger Mitt Romney's 47 percent. That is Obama's best showing since July and a reversal of the three-percentage-point edge Romney held last month (Fahrenthold and Barnes, 11/5).

Politico Pro: Romney Hammers 'Obamacare' Message In Fla.
During his closing pitch at his last Florida campaign stop Monday morning, Mitt Romney made it clear one final time: "Obamacare" kills jobs and he'll do away with it. Romney didn't tread new ground, but  the GOP nominee mentioned "Obamacare" at least seven times, playing up familiar themes about how the health care law hurts the economy and creates burdensome regulations for small businesses. As Romney launched into attacks on President Barack Obama's record, the health care law was the first in a long list of complaints about how the Obama administration didn't live up to his campaign promises (Smith, 11/5).

The Wall Street Journal: Tough Calls On Deficit Await The Winner
If the winner of the presidential election wants to tackle America's groaning debt load, he will probably have to break a campaign promise or two. President Barack Obama and Republican challenger Mitt Romney have hammered at each other's plan for tackling the nation's growing debt. They are similar, though, in one key regard: Both offer prescriptions that largely exempt the vast middle class from the bitterest medicine (Paletta, 11/5).

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What Will The Election's Outcome Mean For The Health Law?

The stakes are high for the health law's future with the vote either sealing the measure's implementation or becoming its undoing. However, some of the changes it includes have already been internalized by the health care marketplace.  

Kaiser Health News: Election Will Decide Health Law's Future
The highest court in the country upheld most of the Affordable Care Act in June. But everybody knew it was only an overture. The law 'will fall in November by a vote of the American people,' Mississippi Gov. Phil Bryant pledged that day, speaking for many other Republicans. Democrats were more reluctant to paint the election as a referendum on what even they came to call 'Obamacare.' But privately they admitted the stakes (Hancock, 11/5).

Kaiser Health News: Employers Expected To Keep Some Of Health Law's Popular Provisions, Even If Obama Loses
Employers will continue looking for ways to cap expenses, moving toward higher deductible policies, or placing limits on how much they pay toward their workers' premiums -- both trends that predate the federal health law, analysts say (Appleby,11/5).

Los Angeles Times: Wall Street May Rally Regardless Of Presidential Election Winner
If nothing else, the end of the grueling presidential campaign will bring a long-awaited dose of certainty to the stock market. Given the divergent economic and fiscal policies of President Obama and Republican challenger Mitt Romney, investors have strained for months to divine who will win and how they should position their portfolios. … A second Obama term, for example, could boost shares of technology and alternative-energy companies. It also could help industries as varied as home builders, hospitals, fast-food chains and aluminum makers, analysts say. A Romney victory, by contrast, could lift financial-services firms, coal and other energy producers, high-end retailers and restaurants and dividend-paying companies. … Meanwhile, health care companies and their investors have been watching the campaign closely in light of Romney's repeated vow to repeal Obama's signature law, the Affordable Care Act. The federal health care overhaul imposes new rules on insurers and cuts reimbursements for many hospitals. But some experts think the net effect could be positive for many health care companies because the law expands coverage to an estimated 30 million Americans and requires most people to purchase health insurance (Hamilton, Terhune and Reckard, 11/6).

Kaiser Health News: Health Care Stakes Are High In California
More than any other state, California has wagered heavily on the Affordable Care Act: It has moved quickly to erect an insurance exchange and establish the high risk pool. It's also codified federal consumer protections into state law. In 2010, the state signed a $10 billion Medicaid waiver with the Obama administration that has allowed counties here -- from Democratic Los Angeles to Republican San Diego -- to enroll as many as 500,000 low-income adults into a 'Medicaid-lite' program years ahead of the law’s expansion of the federal-state program for the poor. Similar to the high risk pool, 'Medicaid-lite,' which is officially called the Low Income Health Plan, is envisaged as a temporary measure until January 2014. That’s when California would open up its Medicaid program to millions of poor people, an expansion paid for largely by the federal government (Varney, 11/5).

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Voters Will Make Choices In Tight Senate Races, Health Law Ballot Questions

The Wall Street Journal examines Democrats' fundraising successes in tight Senate races and how the health law is in a number of state ballot questions.    

The Wall Street Journal: Democrats Outraise GOP In Senate Tossups
In the battle for the Senate, which could determine the next president's room for maneuver, Democrats have built a surprising advantage: They have outraised Republicans. In the 11 Senate races considered tossups, Democratic candidates outraised their Republican opponents by a combined $45 million, according to an analysis by The Wall Street Journal (Mullins and Bendavid, 11/5).

The Wall Street Journal's Washington Wire: Health Care Appears On Some Ballots
When Florida voters cast their ballots, they will be asked to decide on a state constitutional amendment trying to block the federal health law's requirement that people purchase insurance or pay a penalty. …  Florida lawmakers had tried to get a similar measure on the ballot for 2010 elections but state courts nixed it, saying the language was misleading. Similar questions are on ballots in Alabama, Montana and Wyoming, all placed there by state legislators before the Supreme Court's ruling. Some 16 states already had provisions on the books that tried to block the health law (Radnofsky, 11/5).

Related, from KHN's Capsules blog: Health Issues On The Ballot In The States (KHN editors, 11/5)

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Health Reform

After Election Day, States Face Deadline On Health Exchanges

Under the health law, states are required to let the Department of Health and Human Services know by Nov. 16 if they plan to set up their own exchanges or enter into a state-federal partnership.

CQ HealthBeat: On Exchanges: For States, The Clock Ticks Down To Election Day — And Nov. 16
Should President Obama be re-elected, it's likely the health care law will remain intact and states will have to let the Department of Health and Human Services know by Nov. 16 if they intend to set up their own exchanges or enter into a state-federal partnership. Those states that opt to stay on the sidelines will have federally run exchanges in their states in 2014, though they could move to set up state exchanges in later years. If [Mitt Romney] wins, the fate of the health care law will be less certain and may also depend on the makeup of Congress, though the Nov. 16 deadline and the law will remain for now, and the exchanges may even survive (Norman, 11/5).

The Associated Press/Chicago Tribune: Illinois Moves Ahead On Health Insurance Exchange
Illinois officials are reviewing five bids to build the state's health insurance exchange -- a required component of the federal health care overhaul that Gov. Pat Quinn intends to implement regardless of who wins the presidency on Tuesday. ... The Illinois Department of Insurance has received proposals on the exchange contract from Infosys, CGI, Deloitte Consulting, Xerox and Cognizant Technologies Solutions (Johnson, 11/5).

In other health law implementation news -

MPR: Value Of Health Insurance Could Be Tough Sell To Some Uninsured
Going without a health plan is bad for your personal and financial health. ... The federal health care overhaul aims to drastically reduce the number of Americans who don't have insurance. But as Minnesota officials gear up to promote the importance of health insurance, market research indicates even subsidized health plans will be a tough sell with some people. You may wonder why states need to proactively sing the praises of health insurance. ... After all, the law provides free or low-cost coverage through government programs such as Medicaid and will include financial help through tax subsidies for many others (Stawicki, 11/6).

Los Angeles Times: Quiz: Test Your Healthcare Knowledge
Healthcare costs continue to climb, putting pressure on employers and consumers in a sputtering economy. In the past decade, U.S. health premiums have shot up 97%, three times as fast as wages and inflation nationwide, according to the Kaiser Family Foundation. Test your knowledge of healthcare costs and some of the changes under the federal healthcare law (Terhune, 11/5).

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Medicare

Medicare News: Young Workers' Benefits At Center Of Fiscal Debate

Although retirement may still be years away for these younger workers, key decisions could come in the looming debate on the nation's spending. Meanwhile, Medicare officials are sending letters to beneficiaries warning them that their plans are not meeting standards.

The Washington Post: Young Workers' Retirement Hopes Grow Bleaker Amid Economic Downturn
As Washington turns in the coming weeks from the presidential election to the long-term debt issues facing the nation, the discussions will center on whether the country can afford programs such as Social Security and Medicare in their current form (Fletcher, 11/5).

Kaiser Health News: Medicare Trying To Nudge Seniors Out Of Plans With Low Ratings
Medicare officials are trying a novel approach during this open enrollment season to gently nudge a half million beneficiaries out of 26 private drug and medical plans that have performed poorly over the past three years. It begins with letters informing seniors they are enrolled in a plan that received low ratings (Jaffe, 11/5).

Another news outlet examines a new twist in Medicare fraud -

The Miami Herald: Feds: Medicare Millions Moved To Cuba Through Canada, Trinidad And Mexico
A South Florida money-laundering network secretly transferred more than $30 million in illegal Medicare profits through a remittance firm with shell companies in not only Canada and Trinidad, but also in Mexico, according to court records filed Monday. Evidence of the widening network into Mexico surfaced in the federal plea agreement of a one-time Miami medical equipment provider who pleaded guilty Friday to his role in the money-laudering conspiracy (Weaver, 11/5).

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Health Care Marketplace

Lower 3rd Quarter Earnings For Health Net, Humana - But Optimism Still Reigns

And, a consulting firm measures the boom in retail clinics.

Los Angeles Times: Health Net Posts Plunge In Profit, Strikes Deal With California
Woodland Hills insurer Health Net Inc. said third-quarter net income plunged 71%, but its shares rose as the company resolved a dispute with California officials over reimbursement for government health programs. Health Net disappointed investors in August when it slashed its full-year profit outlook and reported higher-than-expected medical costs. On Monday, Chief Executive Jay Gellert ... cited a wide-ranging agreement with California healthcare officials as a major step forward (Terhune, 11/6).

The Associated Press: Humana Posts Lower 3Q Net, Hikes 2012 Earnings Forecast, Names CEO, Deal To Expand In Florida
Health insurer Humana Inc. said Monday that its third-quarter net income fell 4 percent as more premium dollars from its members went to pay for medical claims, offsetting continued growth in its lucrative Medicare Advantage business. But its earnings still beat analysts' expectations and the company raised its earnings forecast for the full year (Schreiner, 11/5).

The Wall Street Journal: Humana Brings Doctors In-House
Humana Inc.is accelerating its move into directly providing health care, with new deals and planned investments that are expected to expand the number of physicians under its umbrella to more than 2,600. ... The plans are the latest sign of how the lines between health-care providers and health insurers are blurring—a shift that is happening particularly fast in the Medicare sphere where the Louisville, Ky., company's business is focused (Mathews and Kamp, 11/5).

NPR: For Simple Care, Retail Clinics Are A Popular Choice
If you've got the sniffles or need a shot, do you go to the doctor or stop in at a clinic in a nearby drugstore? Lots of people are opting for the clinics, which are springing up inside grocery stores, big-box retailers and chain drugstores across the country. There are already 1,388 clinics like these in the U.S., according to data from Merchant Medicine, a consulting firm (Hensley, 11/5).

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Tyson Named CEO Of Kaiser Permanente

Bernard Tyson has been an executive with the giant HMO.

Los Angeles Times: Kaiser Permanente Promotes Longtime Executive To Be Next CEO
Kaiser Permanente's board said it would promote a veteran executive to be the next chairman and chief executive of the healthcare giant, effective next year. Bernard J. Tyson will replace George Halvorson, 65, ... Halvorson was instrumental in building Kaiser into the nation's largest nonprofit insurer and hospital system, with more than 9 million customers and nearly $50 million in annual revenue. It employs 17,000 physicians nationwide (Terhune, 11/6).

Modern Healthcare: Kaiser Permanente Taps Tyson For CEO Post
Halvorson has been CEO since 2002. "The board made an excellent choice," Halvorson said in the release. "Bernard has done an extremely good job as president and COO of Kaiser Permanente, and I am confident he will continue to perform at the same level as chairman and CEO." Tyson, 52, will replace Halvorson as CEO after a six-month transition period, and will take over as chairman of the board at the end of next year when Halvorson leaves (Selvam, 11/5).

Related, earlier KHN story: Halvorson: Premium Costs In The Exchanges Will 'Depend Entirely' On Participation – The KHN Interview (Appleby and Tran, 11/1) 

Bloomberg Businessweek: Kaiser Permanente Promotes Tyson to Take Over as CEO
[Tyson] take over as President Barack Obama’s health-care overhaul, the Affordable Care Act, is fully implemented at the beginning of 2014. New insurance marketplaces called exchanges are due to open in every state ... Kaiser expects to offer exchange plans in every state where it operates, Tyson said (Wayne, 11/5).

(KHN is not affiliated with Kaiser Permanente.)

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Public Health & Education

Previous Meningitis Outbreak Did Not Trigger Additional Oversight, Changes

The Washington Post reports that, despite an outbreak of fungal meningitis that took place 10 years ago and was linked to injections made by a compounding pharmacy in Massachusetts, not much has changed. Meanwhile, Politico adds that a recall of drugs related to the most recent round of illness could add to a critical drug shortage.

The Washington Post: Previous Fungal Meningitis Outbreak A Decade Ago Resulted In No Oversight Changes
First, David Brannon couldn't believe it. Then he couldn't stand hearing about it. Hundreds of people were ill with fungal meningitis they had contracted after getting pain-killing injections made by a compounding pharmacy in Massachusetts. Dozens were dead, and the numbers were still rising (Brown, 11/5).

Politico: Nationwide Drug Recall Likely To Deepen Shortages
The recall of all drugs from a Massachusetts manufacturer — in the latest response to the meningitis outbreak — will most likely exacerbate a critical shortage of at least six drugs that were already in short supply. Hundreds of products were recalled Wednesday by Ameridose, a sister company to New England Compounding Center that is at the center of the Food and Drug Administration’s investigation into the fungal meningitis outbreak that has killed 29 and sickened more than 400. The FDA recommended the recall after saying that it "could not assure the sterility" of Ameridose products but has offered no other details (Norman, 11/6).

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State Watch

Federal Appeals Court Begins Hearing Arguments On Ariz. Abortion Restrictions

A federal appeals court began hearing arguments Monday challenging Arizona's ban on abortions after 20 weeks of pregnancy -- sharply questioning lawyers arguing the case.

The Associated Press/Washington Post: Federal Appeals Court Begins Hearing Arguments For And Against Arizona's 20-Week Abortion Ban
A three-judge panel of the 9th U.S. Circuit Court of Appeal cast a skeptical eye Monday on the country's most-restrictive abortion law, which prohibits the procedure after 20 weeks of pregnancy unless there's a medical emergency. Even Judge Andrew Kleinfeld, a reliably conservative jurist appointed to the appeals court by former President George H.W. Bush, said Arizona's law appears to wrongly prohibit abortions before "viability," when the fetus can live outside the womb. Viability is generally considered to occur sometime after 23 weeks of pregnancy. The county's seminal Supreme Court 1973 abortion ruling, Roe v. Wade, said states cannot prohibit abortions outright prior to viability (11/5).

Reuters: Appeals Court Questions Arizona's Late-Term Abortion Ban
A federal appeals court panel on Monday sharply questioned lawyers defending an Arizona law that bans late-term abortions starting at 20 weeks of pregnancy except in medical emergencies, which opponents say is the toughest in the United States. In San Francisco, a three-judge panel of the 9th U.S. Circuit Court of Appeals heard the case after it blocked the Republican-backed Arizona law from going into effect earlier this year (Cohen, 11/5).

In Michigan, a federal judge blocked -- for one employer -- the health law's mandate that they cover contraception in their health plan.

The New York Times: Michigan Judge Temporarily Blocks Health Law Mandate On Birth Control
A federal judge has issued an order shielding a Michigan business from a requirement of the new health care law to provide insurance coverage for contraceptives at no charge to female employees (Pear, 11/5).

The Texas Tribune: Updated Interactive: Where Are The Women's Health Program Providers?
As Texas continues a legal battle with Planned Parenthood, the Women’s Health Program remains unchanged — for now. And so does the looming question: Will Texas have enough providers in its health care network for the Texas Women's Health Program if the state succeeds in court and ousts Planned Parenthood? In March, Perry pledged the state would forgo millions of federal dollars and launch the Texas Women's Health Program, so that the state could implement its "Affiliate Ban Rule," which lawmakers approved during the 2011 legislative session to bar clinics affiliated with abortion providers from participating in the program (Aaronson, 11/6).

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State Roundup: Ga. Considers Medicaid Managed Care 'Light' Touch

A selection of health policy news from Kansas, Georgia, Florida, Missouri and Texas.

The Associated Press: Kansas Shortens Waiting List For In-Home Medical Care
Kansas has updated its roster of disabled residents who have requested state-funded, in-home medical care and is now better equipped to provide that care more quickly and efficiently, officials in the governor’s office said Monday. The waiting list was cut by more than a third, from 3,423 to 2,197 people, after a company hired by the state spent the last few months trying to reach out to those on the lists, Lt. Gov. Jeff Colyer and Aging and Disability Services Secretary Shawn Sullivan said (Milburn, 11/5).

Kansas Health Institute News: 100 People To Come Off PD Waiting List, Officials Say
Top officials in the administration of Gov. Sam Brownback said today that they now have a list they accept as accurate of the 2,197 physically disabled persons who are awaiting home- and community-based Medicaid services. Armed with the updated information, they said, they are ready to begin providing services to 100 people currently on the list by the end of the year. "We now have a better handle on the waiting list and will be able to make better decisions about how to manage the waiting list and best utilize the funding provided by the Legislature for this program," said Shawn Sullivan, secretary of the Kansas Department for Aging and Disability Services (McLean, 11/5).

Georgia Health News: State Eyes Major Change In Medicaid
State officials, in an abrupt shift, are moving toward creating a case management system for hundreds of thousands of Medicaid beneficiaries who are "aged, blind and disabled."’ This summer, the Department of Community Health, citing the uncertainty about Medicaid's future, stepped away from a proposal to place beneficiaries residing in nursing homes, as well as those with disabilities, into managed care plans. But now, the Medicaid agency appears to envision a lighter form of managed care for those beneficiaries (Miller, 11/5).

Modern Healthcare: AMA Joins Friend-Of-The-Court Brief In Fla. 'Docs And Glocks' Case
The American Medical Association and nine other medical specialty societies have filed a friend-of-the-court brief opposing a Florida statute that prohibits physicians from asking patients and families about guns in their home and from noting a patient's gun ownership in his or her medical record. "Not only do physicians lose the right to express themselves freely, but their patients are deprived of the full range of medical care and professionalism that they could expect from their physicians," the brief stated. In July, a U.S. District judge in Miami blocked enforcement of the law. The state of Florida appealed this decision. The brief filed by the medical societies is in opposition to Florida's appeal (Robeznieks, 11/5).

Modern Healthcare: Mo. System To Pay $9.3 Million Settlement
Freeman Health System, Joplin, Mo., has agreed to pay $9.3 million to settle potential liabilities after it self-reported compensation arrangements with 70 doctors going back a full decade that may have created illegal financial incentives to refer patients to the hospital. According to the signed settlement agreement and a related news announcement from the Justice Department, the two-hospital system disclosed that between 1999 and 2009, it gave doctors incentive pay based on the Medicare revenue generated from their referrals for diagnostic testing and other health services at Freeman clinics (Carlson, 11/5).

The Dallas Morning News: AG Asked To Weigh In On Dallas County's Benefits For Partners
A state senator is asking the Texas attorney general to offer an opinion on whether Dallas County's decision to help unmarried and gay employees pay for their partners' individual health insurance violates the Texas Constitution. State Sen. Dan Patrick, R-Houston, wants Attorney General Greg Abbott to issue an official opinion on whether governmental agencies can legally offer such benefit programs. State voters in 2005 overwhelmingly voted to amend the state constitution to define marriage as a union between opposite-sex couples (Formby, 11/5).

Kansas Health Institute News: Aetna Acquisition Of Coventry Unopposed In Kansas
A top Aetna executive said Monday the health insurance company's planned acquisition of Coventry Health Care would benefit Kansas consumers by giving them more choices in the marketplace. Gregory Martino, an assistant vice president for governmental relations, made the comments in sworn testimony at a public hearing called by Kansas Insurance Commissioner Sandy Praeger. Martino said Coventry, which increased its Kansas footprint in 2010 when it acquired Wichita-based Preferred Health Systems, has "good market share" in the individual and small-group markets (McLean, 11/5).

Kansas Health Institute News: Building The Brownback Budget
Detailed spending proposals for the coming fiscal year prepared by officials at the state's three top health agencies outline how Gov. Sam Brownback's administration is planning to cap or cut spending on a broad range of health-related programs. The governor's formal budget recommendations for fiscal year 2014, which begins July 1, 2013, won’t be delivered to the Legislature until January when its new session begins. But agency chiefs were told as early as August by the governor to keep spending in check and to present alternatives for cutting 10 percent from each department's upcoming state general fund budget (Ranney and Shields, 11/5).

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Editorials and Opinions

Viewpoints: Fight For The Senate Will Impact GOP Effort To Void Health Law; Figuring Out Insurance Is Tough Even For Health Economist

The New York Times: The Battle For The Senate
For Republicans intent on unraveling President Obama's accomplishments, electing Mitt Romney has been only one part of the equation. Almost as important was installing a Republican majority in the United States Senate, where 50 votes (plus the vice president) would be necessary to repeal much of health care reform, roll back tax increases on the rich and gut social welfare programs. The party’s hopes, however, have been severely damaged in recent weeks (11/5). 

Fox News (Video): Romney Provides Common Sense, Not Cheap Talk, On Health Care
Four years ago, President Obama said all the right things about health-care reform.  He talked about "bending the curve" of government health-care spending.  He said that he would make health care more efficient and lower health insurance premiums for every American family.  He promised that health-care reform would be debated on C-Span, with no back room negotiations. Talk is cheap. What the President and Democrats in Congress finally delivered -- ObamaCare -- added more taxes, more expensive regulations, and more government spending.  And it was tailor made by lobbyists behind closed doors (Paul Howard, 11/5).

WBUR (Audio): Michael Dukakis: The Next President Should Defend 'Obamacare'
We recently heard from former Lt. Gov. Kerry Healey, who told us about a taxi driver she met on the campaign trail and how he was emblematic of middle class Americans whom she says would benefit under Mitt Romney's tax plan. ... Former Gov. Michael Dukakis disagrees. ... We speak with Dukakis about his stance (11/5).

Los Angeles Times: Anthem Clerical Error Adds Anxiety To Woman's Breast Cancer Fight
Ann Walton-Teter was diagnosed with breast cancer in September. About a month later, she was informed by her health insurer, Anthem Blue Cross, that her coverage had been canceled because of a missed payment. Anthem would eventually admit that it was mistaken. But Walton-Teter, 43, had to battle the insurance giant to have her coverage restored just as she was recovering from a double mastectomy and preparing for chemotherapy (David Lazarus, 11/6).

The Washington Post: Facing Brain Surgery, A Health Economist Finds The Health-Care Market Hard To Navigate
Whether it is President Obama praising the Affordable Care Act or critics of "Obamacare" describing their ideal system, such words as "choice" and "competition" figure greatly. The idea is that informed consumers shopping for health care will lower cost and improve quality. Yet my difficulties show how hard it is — even for someone who has studied health-care and insurance issues — to navigate the health-care marketplace, particularly when you have a serious medical condition (Dahlia K. Remler, 11/5).

California Healthline: Move Toward Openness In Health Care Pricing, Performance
The cost of health care -- from the most tangible of products and services to the most arcane high-deductible insurance policies -- is relatively opaque in California's health care system. … In California, a new state law takes a first step toward transparency by prohibiting health insurers and providers from including "gag clauses" in contracts that forbid the disclosure of pricing information. We asked stakeholders and experts if California should be actively pursuing pricing and performance transparency (11/5).

The Medicare NewsGroup: Taking A Deeper Look At Readmissions Causes
Is Medicare being too tough on hospitals with high readmission rates? … Hospitals, which lose a portion of their Medicare reimbursement when the penalties hit, are understandably unhappy with the new program. And a new meta-study by the Journal of General Internal Medicine suggests that Medicare may not be fully taking into account several important social factors when it makes its readmissions judgments (John Wasik, 11/5). 

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
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.