Daily Health Policy Report

Thursday, November 8, 2012

Last updated: Thu, Nov 8

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Campaign 2012

State Watch

Public Health & Education

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Maine May Warm To 'Obamacare' After Democratic Sweep

Kaiser Health News staff writer Phil Galewitz reports: "North of the Mason-Dixon Line, it's hard to find a state that has given more of a cold shoulder to President Barack Obama’s health law than Maine. ... But Maine's voters may have short-circuited further resistance Tuesday by initiating a Democratic sweep that flipped control of both houses of the State Legislature, and is now poised to challenge Gov. Paul LePage, a tea party Republican opposed to the law" (Galewitz, 11/8). Read the story.


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Post-Election, Insurance Exchanges, Other Health Care Issues Loom Large In States

Working in collaboration with Kaiser Health News, six public radio reporters -- Martha Bebinger (Mass.), Elizabeth Stawicki (Minn.), Sarah Varney (Calif.), Erika Beras (Penn.), Lynn Hatter (Fla.) and Elana Gordon (Missouri) -- talk about how ballot initiatives and state legislative elections could affect the future of the health law implementation and public health in their states.  Watch the video.

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Electoral Politics End; Legislative Season Begins

Jackie Judd talks to KHN's Mary Agnes Carey and Richard E. Cohen about what the new political landscape means for the health law and for federal budget negotiations. Watch the video or read the transcript


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Democrats’ Medicare Offensive Falls Flat Against GOP

Richard E. Cohen, writing for Kaiser Health News, reports: "At first glance, Tuesday’s election does not appear to have altered much the country’s health care politics: Many of the same key players and issues will dominate the congressional debate. Yet the temptation to claim a “status quo” outcome from the election ignores broader trends in this year’s health and Medicare debates, according to longtime congressional observers" (Cohen, 11/7). Read the story.

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Capsules: Health Care Issues On The Ballot: The Final Tally; State Political Shifts Likely To Affect Health Law

Now on Kaiser Health News' blog, Jenny Gold reports on ballot measures: "The rich variety of health issues at stake in Tuesday's election included the federal health law, abortion, medical marijuana and more" (Gold, 11/7).

Also on Capsules, Phil Galewitz writes about the election's effect on state governments: "In a power shift that could affect how the federal health law is carried out, Democrats took complete control of five additional state legislatures on Tuesday, while Republicans added a governorship and control of three additional state legislatures. All told, Republicans will have 30 governors and control 24 state legislatures next year, compared to 19 Democratic governors and 18 Democratic-controlled legislatures. The rest are split or tied" (Galewitz, 11/7). Check out what else is on the blog

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Hospitals Gamble On Urgent Care Clinics To Keep Patients Healthy

Kaiser Health News staff writer Jenny Gold reports: "When Stephen Wheeler realized he had an infected finger, he called his primary care doctor, who works for MedStar Health, a hospital and health care system. The doctor advised him to go to PromptCare, an urgent care clinic in a strip mall in the Baltimore suburbs. They are all about speedy service here at the urgent care center; Wheeler got in and out in 15 minutes. There's a timer outside of every exam room so the staff knows how long a patient has been waiting. Because Wheeler was already in the system, the clinic was able to pull up his electronic health records and find out if he was allergic to any medications or was due for any other care. Hospitals already own more than a quarter of the urgent care clinics in the U.S." (Gold, 11/8). Read the story.

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Political Cartoon: 'Between A Rock And A Hard Place?'

Kaiser Health News provides a fresh take on health policy developments with "Between A Rock And A Hard Place?" By Jimmy Margulies.

Meanwhile, here is today's health policy haiku:


Each and every state
finds its own path on health care:
That's federalism

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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Health Reform

Health Law Preparations Go Full Throttle

The re-election of President Barack Obama all but ensured the survival of the law, news outlets report. Now, a slew of regulations must be issued and political and financial and organizational obstacles overcome.

Reuters: Obama Wins Clear Health Law Hurdle, Challenges Remain
The 2010 Patient Protection and Affordable Care Act, the biggest overhaul of the $2.8 trillion U.S. healthcare system since the 1960s, aims to extend health coverage to more than 30 million uninsured Americans beginning in January 2014 (Morgan and Yukhananov, 11/7).

NPR: Obamacare Is Here To Stay – But In What Form?
President Obama's re-election and the retention of a Democratic majority in the Senate means the likelihood of a repeal of the Affordable Care Act has receded. So what now? "The law is here and we should at this point expect it to still be here Jan. 1, 2014," says Alan Weil, executive director of the nonpartisan National Academy for State Health Policy. Jan. 1, 2014, is the date the major parts of the law, like the new insurance policies available to individuals and small businesses, are supposed to become available (Rovner, 11/8).

Los Angeles Times: Obama's Win Means His Healthcare Law Will Insure All Americans
Tuesday’s results also present Obama with a new set of challenges as he tries to fulfill the promise of his signature legislative achievement, the biggest expansion of the social safety net since Medicare and Medicaid were created in 1965. Federal and state officials nationwide must create systems to handle millions of new insurance customers. ... And Obama will face renewed pressure to scale back the law as Congress tries to rein in federal budget deficits (Levey, 11/8).

The Washington Post: Obama’s Health-Care Law Still Faces Challenges After President’s Reelection
Among the tasks Obama officials still face: protecting the law from budget cuts Republicans are sure to demand during upcoming negotiations, wrangling wary governors into going along with the law’s expansion of Medicaid, and ensuring that the private insurance markets, or “exchanges,” at the heart of the law can be rolled out by the law’s 2014 deadline (Aizenman, 11/7).

Politico: Obamacare Survives -- Now What?
Now it has to work. If it does, more Americans might come to accept it — and even be glad it passed. If it doesn’t, Obama’s legacy will be tarnished. And Republicans will say “we told you so” for years to come. Either way, Americans will now see what the law — the Affordable Care Act — is supposed to look like. The big pieces, including coverage of pre-existing conditions and the hated individual mandate, won’t kick in until 2014. Until now, all Americans have seen are the warm-up acts — like letting young adults stay on their parents’ plans — that aren’t really central to the law (Nather, 11/7).

The Wall Street Journal: Election Removes Cloud From Health Law's Future
Also expected are rules spelling out the terms on which insurers must accept all customers regardless of their medical history, rules governing how insurers can vary premiums based on age and more information about new requirements on employers and individuals to buy insurance. ... Other industries in the health sector, including insurers, brokers, and medical-device-makers, were poised to lobby aggressively on regulations as they come out, and to redouble efforts to persuade Congress to amend particular aspects of the law in their favor (Radnofsky and Mathews, 11/7).

The Associated Press: Obama’s Health Care Overhaul Turns Into A Sprint
A steadying force within the administration is likely to be HHS Secretary Kathleen Sebelius. The former Kansas governor has said she wants to stay in her job until the law is fully enacted. "I can't imagine walking out the door in the middle of that," she told The Kansas City Star during the Democratic convention. Her office declined to comment Wednesday. Republicans will be leading more than half the states, so governors are going to be her main counterparts (Alonso-Zaldivar, 11/8).

National Journal: Major Regulations For Health Reform Coming Soon
While Congress wrangles over the fiscal cliff and scrambles to find money for the perennial “doc fix” payment formula problem, the professional staff at the Health and Human Services and Treasury departments are also expected to have a full plate, with legislative deadlines for implementing health reform looming and many of the political considerations that slowed regulatory release before the election now off the table. ... "I think it’s realistic to see a big bunch of regulations to be rolled out in the weeks following the election,” said Christine Pollack, a vice president for government relations at the Retail Industry Leaders Association, a trade group for big-box stores (Sanger-Katz, 11/7).

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States, Especially GOP-Controlled Ones, Facing Crucial Decisions On Health Insurance Exchanges, Medicaid

Stateline: Obama Win Means Big Health Care Decision For States
Since the day it was enacted, many of the Affordable Care Act’s opponents have preferred to treat it as provisional. ... there remain some significant uncertainties in the immediate future of the ACA, particularly in how Republican governors, who have vociferously opposed the law until now, will react in the wake of President Obama’s victory. The ACA is indeed the law of the land and will remain so for the foreseeable future, but that doesn’t mean that Republican governors have to be full participants (Vestal and Ollove, 11/8).

The Hill: Analysis: 20 States Will Run Their Health-Law Exchanges
Twenty states will operate their own insurance exchanges in 2014 under President Obama's healthcare law, according to a new analysis. Avalere Health released its estimate after Obama won a second term on Tuesday, ... Governors have a choice as to whether to implement the law's exchanges or leave the task to the federal government. A third option is a "partnership" model in which the state and federal government jointly manage the marketplace (Viebeck, 11/7).

Politico: States Face Swift Deadline On Health Exchanges
By Nov. 16, states must tell the Obama administration whether they plan to run at least part of their own health insurance exchanges, new state-based marketplaces that will provide subsidies for low- and middle-income individuals and small businesses to purchase coverage. Eventually, states also will have to decide whether they’ll accept a larger expansion of Medicaid, which comes with a generous match from the federal government but still requires states to pony up some of their own money (Millman 11/8).

Kaiser Health News: State Political Shifts Likely To Affect Health Law
Republicans will have 30 governors and control 24 state legislatures next year, compared to 19 Democratic governors  and 18 Democratic-controlled legislatures. The rest are split or tied. The Medicaid expansion and new insurance exchanges are the key ways the health overhaul expands coverage to as many as 30 million people starting in 2014. But the Supreme Court in June gave states the option to decide whether to expand Medicaid in 2014 (Galewitz, 11/7).

Kaiser Health News: Maine May Warm To 'Obamacare' After Democratic Sweep
North of the Mason-Dixon Line, it's hard to find a state that has given more of a cold shoulder to President Barack Obama’s health law than Maine. ... But Maine's voters may have short-circuited further resistance Tuesday by initiating a Democratic sweep that flipped control of both houses of the State Legislature, and is now poised to challenge Gov. Paul LePage, a tea party Republican opposed to the law (Galewitz, 11/8).

CQ HealthBeat:  After Election, Governors Face Medicaid Decision
So far, six GOP governors, all of whom remain in power, have said that they would not expand the health program for the poor (Adams, 11/7).

The Associated Press: Obama’s Win Forces Walker’s Hand On Health Care
President Barack Obama's re-election is forcing the hand of Wisconsin Gov. Scott Walker, who had stopped all efforts to implement the federal health care reform law in the hopes that Republicans would take over in Washington. ... Walker's administration and Republican leaders in the state Legislature are now scrambling to figure out their next move (Bauer, 11/7).

Milwaukee Journal Sentinel: Walker, Other Officials Have To Scramble On Obamacare Compliance
Walker decided late last year to stop planning to implement the health care law in the state, preferring instead to hold out for an Obama defeat and a repeal of the law (Stein, 11/7).

The Associated Press: Kan. Officials Ponder Next Health Care Step
Kansas officials are considering their next steps to implement the federal health care law now that the presidential election has been decided and deadlines are looming. The state has until Nov. 16 to tell the federal government whether it wants to be a partner in creating an online health insurance marketplace (Milburn, 11/7).

Kansas Health Institute News: Praeger Seeks Quick Insurance Exchange Answer From Governor
Kansas Insurance Commissioner Sandy Praeger said today that she wants to meet this week with Gov. Sam Brownback about how to move forward with implementation of the federal health reform law.  Specifically, Praeger said she wants to talk to Brownback about the state partnering with the federal government on a health insurance purchasing exchange (McLean, 11/7).

The Atlanta Journal-Constitution: Big Healthcare Decisions Loom For State In Election’s Wake
Two major decisions loom for [Georgia] Gov. Nathan Deal and other Republican governors who have put off key decisions tied to the law, hoping it would be repealed if Mitt Romney won election. One is whether they to accept billions of federal dollars to expand Medicaid, the government health program for the poor. Deal’s decision will determine whether hundreds of thousands of low-income Georgians get access to health coverage. To date Deal has said the state can’t afford the expansion longterm (Williams, 11/7).

Georgia Health News: Health Care Law Lives – And Ga. Faces Big Choices
Still, there may be a middle ground between states rejecting [Medicaid] expansion and fully pursuing it, Custer said. Some states have approached the federal government about a partial expansion, up to 100 percent of the federal poverty rate, rather than up to 138 percent ($15,415 for an individual; $26,344 for a family of three in 2012) as currently required (Miller, 11/7).

North Carolina Health News: In Wake Of Election, Questions About NC’s Implementation Of Health Reform
One of the questions that’s been open during this campaign season in North Carolina has been the fate of the state’s Medicaid program. ... Although some in the General Assembly have balked at the price tag, the political backlash of not covering a big chunk of North Carolina’s 1.5 million uninsured may be too great. And the state’s hospitals stand to lose big if a Medicaid expansion does not go forward (Hoban, 11/7).

Health News Florida: FL To Miss Exchange Deadline
[L]ike a kid who didn’t do his homework, the state’s about to miss an important deadline in implementation of the Patient Protection and Affordable Care Act. On Nov. 16 -- in just eight days -- states are supposed to turn in the applications and blueprints for their health insurance exchanges. ... Even if Gov. Rick Scott had a change of heart and wanted to send in an application, the Legislature hasn't given him the authority (Gentry, 11/8).

Richmond Times-Dispatch: Va. To Use Federal Health Exchange Option – For Now
[Gov. Bob] McDonnell said he would default to a federal exchange with the understanding that the state could change course later. … Defaulting to a federal exchange would reverse the position that McDonnell and the General Assembly took last year, when he signed a law giving him the authority to plan for implementing a state-based health benefits exchange under the Patient Protection and Affordable Care Act (Martz, 11/7).

MPR: Election Likely Removes Obstacles To Health Care Overhaul In Minn.
Democrats now control the capitol, led by Gov. Mark Dayton, who solidly supports the president's health care overhaul. ... Consultant Joel Ario, who formerly headed the U.S. Department of Health and Human Services' Office of Health Insurance Exchanges during the Obama administration, said Minnesota is well ahead of most other states. "I expect Minnesota will be one of the first states to be approved for a state-based exchange," Ario said (Stawicki, 11/8).

Health Policy Solutions (a Colo. news service): Now In Control, Colorado Democrats Want Medicaid Expansion
"We would like to push to get health care to as many people as possible because that’s going to reduce the costs for everyone,” said Rep. Mark Ferrandino, D-Denver, who is expected to take the reins of the Colorado House in January after Democrats recaptured control of it on Tuesday. Gov. John Hickenlooper is more circumspect. While he supports expansion of health care, Hickenlooper refused to say whether he’ll support Medicaid expansion (Kerwin McCrimmon, 11/7).

Los Angeles Times: California Speeds Revamp Of Health Insurance Market
With President Obama's reelection lifting a potential roadblock, California officials are rushing to implement the federal healthcare law and revamp the insurance market for millions of Californians starting next fall. ... Wednesday, California officials disclosed plans to spend nearly $90 million next year on marketing and outreach to millions of consumers who may become eligible for premium subsidies and other assistance under the federal law starting in 2014 (Terhune, 11/7).

California Healthline: December Special Session Now ‘Full Steam Ahead’
The nation's re-election of Barack Obama means California lawmakers will have a much busier and more productive special legislative session in December, according to state lawmakers. Gov. Jerry Brown (D) called for the December special session as a way to make sure California is fully on board with implementation of the Affordable Care Act. … Issues to address in the special session … include reform of the individual health insurance market (Gorn, 11/7).

California Healthline: Prop. 30 Could Stem Health Care Costs
Although revenues from Prop. 30 will help fund education, if it hadn't passed on Tuesday, the Legislature would be facing yet another massive budget shortfall and lawmakers would need to look at cutting many more millions of dollars. Health care programs and services would've been on the chopping block once again (Gorn, 11/8).

The Associated Press/Dallas Morning News: After Election Texas Legislature Faces Tough Issues Ahead
Texas Republicans will go into the 2013 legislative session with much of the same agenda as last year: tackle government spending, tighten immigration laws and discourage abortion. … The first order of business will be to make up for a $4.3 billion budget deficit by March, when funding will run out for Medicaid, the health care for the poor, elderly and disabled. Comptroller Susan Combs has forecast $5 billion in unexpected revenue this two-year budget cycle, so covering the tab should be relatively easy. The next two-year budget, though, will present a bigger challenge, with the Department of Health and Human Services expecting Medicaid costs to increase more than $7 billion (11/7).

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Republicans Consider Old, New Ways To Hinder Health Law Implementation

Some Republicans and religious leaders are following through with challenges to the law's contraception coverage mandate, looking for ways to repeal a Medicare cost-cutting board and trying further to delay implementation.

Politico Pro: With Contraception, ACA Not Done In Court
Dozens of lawsuits have been filed challenging the law's requirement that employers cover contraceptives in their health insurance policies, arguing that it's a violation of their right to exercise their religion without government interference. And in recent days, two new developments have emerged that show the challenge could get significant attention from the courts. Two district court judges have granted preliminary injunctions to block the mandate from going into effect for private, non-religious companies (Haberkorn and Smith, 11/8).

The Hill: Cantor Vows Bill To Repeal Health Law's Contentious Board
House Republicans will take aim at President Obama's divisive Medicare cost-cutting board during the new Congress, Rep. Eric Cantor (R-Va.) wrote Wednesday. The alert came in a letter from the House Majority Leader to his GOP colleagues lamenting Mitt Romney's presidential loss and outlining ways for Republicans to pursue tailored interests legislatively. Cantor said that repealing the health law's Independent Payment Advisory Board (IPAB) is one effort that could garner support in the Senate over the objections of Democratic Leader Harry Reid (Nev.) (Viebeck, 11/7).

CQ HealthBeat: GOP Will Continue To Look For Ways To Hinder Implementation Of Health Care Law
Republicans, especially those in the House, will be left to continue their campaign against the law in the form of funding fights, hearings, demands for documents and targeted legislation in the hope that something gains traction. ... One way to chip away at the overhaul would be through the annual appropriations process, a strategy that Republicans have already used with limited success (Attias, 11/7).

But there is also some rethinking of that strategy among Republicans --

The Hill: Conservatives Begin To Admit Defeat In Their 3-Year War Against 'ObamaCare'
[T]hough conservatives still say the law will be a disaster once it's fully implemented, they're finally acknowledging that it will, in fact, be fully implemented. "Repeal of the whole thing, I just don't see now how that's possible," said Grace-Marie Turner, president of the Galen Institute, a conservative health care think tank. The Wall Street Journal’s conservative editorial page also admitted defeat Wednesday. With Obama in the White House for another four years, the health care law "will spread like termites in the national economy," the paper wrote (Baker, 11/7).

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Health Law Confuses Small Business Owners; Stock Market, Industry Analysts Say Hospitals To Likely Gain

With the election over, the health care and other industries are taking stock of the health law's effects.

The Denver Post: Small Business Owners Don’t Understand Health Reform, Survey Says
It seems many small business owners were waiting until after the presidential election to take the time to understand national health reform. A recent survey by eHealthInsurance reveals widespread confusion. Some 78 percent of small business owners said they were not familiar with health insurance exchanges and how they could impact their business (Brown, 11/7).

Modern Healthcare: Insurance Mandate Seen Likelier With Obama Victory
The health care reform mandate that nearly everyone have health insurance would benefit hospitals and is now more likely to take effect after President Barack Obama won re-election, Moody's Investors Services said in a report. Moody's analysts said the mandate was "most at risk" in the campaign and its adoption is expected to increase demand for care from newly insured patients and reduce unpaid bills. But fewer write-offs from unpaid bills from the uninsured will not be enough to outweigh the Patient Protection and Affordable Care Act's scheduled Medicare cuts to hospital payments, which total $150 billion over a decade, Moody's said. The law also contains other provisions that will negatively impact hospitals' credit strength, including new penalties and payment models that will squeeze hospital revenue (Evans, 11/7).

Modern Healthcare: Health Care Industry Leaders React To Obama's Re-election
Modern Healthcare reporters are tracking health care leaders' reaction to President Barack Obama's re-election and what the election means for the health care industry, which finally has certainty that the bulk of the Patient and Protection and Affordable Care Act will be implemented yet little clue how the president and a still-divided Congress will treat health care programs in their quest to control federal spending (11/7).

Bloomberg: Obama Win Keeping Health Law Buoys Hospital Shares
HCA Holdings Inc. (HCA) and other hospitals will get more paying customers while insurers like UnitedHealth Group Inc. (UNH) will see profits squeezed as U.S. President Barack Obama moves to preserve the health-care overhaul he championed. Obama's re-election rallied shares of HCA Holdings Inc., the largest for-profit hospital company, by 9.4 percent today, while Community Health Systems Inc. (CYH) and Tenet Healthcare Corp. (THC) also gained on prospects for millions of newly insured patients being added to their admission rolls. UnitedHealth, the largest U.S. medical insurer, fell 3.8 percent, and WellPoint Inc. (WLP) and Humana Inc. (HUM) declined as the industry faces profit limits and new taxes to help pay for the coverage expansion (Armour and Nussbaum, 11/7).

Reuters: Hospital Shares Jump, Insurers Fall After Obama Win
Shares of hospitals and other healthcare companies that will benefit from President Barack Obama's health reform legislation jumped on Wednesday after his election victory, but health insurers fell as the law's costs became more certain. Obama's re-election has taken a Republican vow to repeal the health care reform off the table, though some industry executives said on Wednesday that some aspects of the law still may be changed or delayed (Humer, 11/7).

Modern Healthcare: Hospital Stocks Rise; Insurers Take Hit
Hospital stocks reacted with optimism to the news that President Barack Obama had won a second term -- as the fate of the health care reform law becomes even more certain. Companies like HCA, Nashville; Community Health Systems, Brentwood, Tenn.; and Tenet Healthcare Corp., Dallas opened Wednesday with clear gains even as the broader market showed less ebullience. The Dow Jones Industrial Index and the Standard & Poor's 500 were trading down about 1.9 percent in the first hour after the trading bell sounded, and closed the day down about 2.4 percent. Questions about how Obama would handle the looming fiscal cliff as well as ongoing concerns about the European markets led to the sell-off. Health care stocks on the whole were registering a loss of about 1.4 percent, with health insurers taking the brunt of the hit (Kutscher, 11/7).

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Capitol Hill Watch

Boehner, Obama Signal Willingness To Work Together On Fiscal Crisis

The House speaker says he would accept a deal that raises federal revenues, but not the top tax rates, if it also includes an overhaul of entitlement programs, such as Medicare and Medicaid.

The New York Times: Back To Work, Obama Is Greeted By Looming Fiscal Crisis
Newly re-elected, President Obama moved quickly on Wednesday to open negotiations with Congressional Republican leaders over the main unfinished business of his term -- a major deficit-reduction deal to avert a looming fiscal crisis -- as he began preparing for a second term that will include significant cabinet changes. ... Speaking for Republicans after a conference call with his Congressional colleagues, (Speaker John) Boehner said he was ready to accept a budget deal that raised federal revenues, but not the top rates on high incomes. And the deal, he said, also would have to overhaul both the tax code and programs like Medicare and Medicaid, whose growth as the population ages is driving projections of unsustainable future debt (Calmes and Baker, 11/7).

The Wall Street Journal: Obama Maps Out His Second Term 
People close to Mr. Obama said he was looking to send a message to congressional Republicans and to members of his own party, some of whom may see his re-election as a mandate for commitment to their own approach, that he is willing to reach compromises on major initiatives. ... But even beyond Mr. Obama's challenge in negotiating with Republicans, it's not clear how enthusiastically congressional Democrats will back his agenda, especially if it involves compromising with Republicans on longstanding positions on entitlement programs such as Medicare and Social Security (Lee and Nicholas, 11/7).

Los Angeles Times: House Speaker John Boehner Softens Tone On 'Fiscal Cliff'
House Speaker John A. Boehner (R-Ohio) made an opening offer Wednesday to avert an impending fiscal showdown, softening his party's confrontational tone one day after its electoral losses. But he stood by the GOP's core no-new-taxes pledge that has prevented a deal with the White House. The Republican shunned the bombastic approach favored by the GOP's tea party wing and sought to portray his House majority as ready to work with President Obama when Congress returns for what is expected to be an intense lame-duck session. ... Boehner suggested a stopgap measure that would buy time for negotiations to continue in 2013 on a broader deal to reform the tax code and entitlement spending, the so-called grand bargain that has eluded leaders (Mascaro, 11/7).

The Washington Post: After Obama's Re-election, Overtures From Republicans On Debt Negotiations
Less than 24 hours after the election, President Obama and congressional leaders moved with alacrity Wednesday to show flexibility in solving the nation's biggest economic problems and recast Washington's often divisive politics. With a sluggish economy facing major threats, House Speaker John A. Boehner (R-Ohio) opened the door to increased tax revenue as part of a bipartisan deal to tame the soaring national debt. Republicans are "willing to accept new revenues," Boehner said, suggesting he is willing to break with the orthodoxy of many influential Republicans out of a desire to "do what's best for our country." ... But a huge gap still remains, with the White House on Wednesday claiming an electoral mandate to pursue its tax policies and Republicans remaining opposed to any proposals for raising tax rates on the wealthy. Beyond tax policy, there are also divisions over what types of changes, if any, to make to federal entitlements such as Medicare and Social Security (Goldfarb and Montgomery, 11/7).

Kaiser Health News: Electoral Politics End; Legislative Season Begins (Video)
Jackie Judd talks to KHN's Mary Agnes Carey and Richard E. Cohen about what the new political landscape means for the health law and for federal budget negotiations.

The Wall Street Journal: Alan Simpson: Leaders Know What to Do, Now Do It
Former Wyoming Sen. Alan Simpson (R., Wyo.), who co-chaired the White House’s 2010 deficit-reduction panel, said Democrats and Republicans should pivot quickly from Tuesday's election and start forging a deficit-reduction deal to avoid sharp spending cuts and tax increases in 2013. "Move on, pull up your socks," the eternally loquacious Mr. Simpson said. "They've got nowhere to go between now and Dec. 31." Mr. Simpson said in an interview that he didn't care what deficit-reduction package lawmakers agreed to, as long as it was bipartisan and substantive (Paletta, 11/7).

Several news outlets examine how industry is reacting --

The Wall Street Journal: CEOs Vow To Work With Obama Team
Business leaders pledged cooperation with President Barack Obama on Wednesday, hoping to reset their relationship after a campaign season marked by White House criticism of corporations and the wealthy. As an overture to the re-elected president, some business leaders said their Republican allies in Congress will have to temper their expectations on some major issues that have divided the two parties. ... Even before the election, more than 80 chief executives had publicly called for a comprehensive deficit-reduction agreement that includes higher taxes and an overhaul of entitlements such as Medicare. Mr. Obama also proposes raising taxes as part of a deal, but many Republicans oppose the idea (McKinnon, Nelson and Mattioli, 11/8).

Modern Healthcare: Deficit Talks May Mean Big Cuts For Hospitals: Frist
Looming deficit-reduction negotiations coming soon after Tuesday's federal elections could result in larger-than-expected cuts to hospitals, some health leaders warned. Dr. Bill Frist, former Republican Senate Majority Leader, told attendees at a Washington health policy symposium that he expects a so-called grand bargain on deficit reduction within a few months with 2.5-to-1 ratio of spending cuts-to-tax increases. And hospital payments are the likely source of much of the coming federal spending cuts, due to the large share of Medicare and Medicaid spending they receive. "I don't think hospitals understand how deep these cuts are going to be in the grand bargain," Frist said at the World Healthcare Innovation and Technology Congress (Daly, 11/7).

Politico Pro: Medicare Wars; Fiscal Cliff Edition
A reckoning with the fiscal cliff is fast approaching, and while the rhetorical battle over the future of the seniors' health program may be fading from the airwaves, the real fight is just getting under way. Election jockeying over who would best "preserve and protect" the program aside, Obama already has put major concessions on the table -- concessions bound to incite liberal partisans who helped reelect him, not to mention the seniors and providers who may see cuts to benefits and payments sooner rather than later. Insurers, providers and Medicare advocates are girding to protect their interests as the fiscal cliff negotiations are almost certain to bring these proposals -- and possibly more -- back into play (Norman, 11/7). 

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Paul Ryan Assesses His Role In Congress; Dems Face Health Debates Without Rep. Stark

Ryan, who was the GOP vice presidential nominee, is in a tricky spot as a key negotiator between Congress and Capitol Hill on any possible fiscal deal. Meanwhile, Stark, one of the key health congressional care experts, was defeated. 

The Wall Street Journal: Ryan Plots His Next Steps In The House
(Paul Ryan) will have to decide whether to wade into what could be tense negotiations between Congress and the White House over tax and entitlements, where making compromises could risk a conservative backlash. ... The Wisconsin Republican joined the ticket as a polarizing figure, given his sharp disagreements with Mr. Obama and his plan to transform Medicare from an open-ended promise to a program more akin to subsidized private insurance. Those issues quickly moved to the back burner on the Romney campaign, particularly after an early blitz by Democrats on the Medicare overhaul. If the Obama-Romney race was a referendum on two visions of government -- as Mr. Ryan frequently said it was on the campaign trail -- the results were hardly a sweeping endorsement of Mr. Romney's view. But the campaign gave Mr. Ryan national campaign experience that few sitting House members ever get (O'Connor, 11/7).

In the meantime, Rep. Pete Stark's leadership on the Ways and Means health subcommittee may be most sorely missed by Democrats looking to push their health care agenda after his defeat --

CQ HealthBeat: Who's The Next Pete Stark? No One, Most Likely
The defeat of California Rep. Pete Stark leaves Democrats on Capitol Hill without perhaps their most expert member on Medicare -- just as the program faces a new round of potentially sharp cuts and other changes in coming months to offset the cost of a physician payment fix and reduce deficit spending. Other members will inevitably step in and fill the knowledge gap, lobbyists and former congressional aides say. But that may not happen right away, given Stark's many years of taking the lead on Medicare issues, both as chairman and ranking member of the House Ways and Means Health Subcommittee. And it may not be any one person who fills the void, considering the breadth of knowledge he has acquired over his 40-year career in Congress (Reichard, 11/7).

Politico: Pete Stark Defeated After 40 Years In Congress
Pete Stark, the top Democrat on the House Ways and Means Committee's Health Subcommittee, has been defeated in California, losing to a young challenger who convinced voters that Stark has outgrown his district. The 20-term Democrat lost to fellow Democrat Eric Swalwell 53.1 percent to 46.9 percent, with 100 percent of the vote calculated in the 15th district in California, according to The Associated Press. Stark built a reputation as a hard-charging advocate for progressive health reform in Washington, but in recent years was bogged down by a record of gaffes and personal insults to his colleagues (Haberkorn, 11/7).

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Campaign 2012

Dems, GOP Assess Campaign Shortcomings

Stories look at what went wrong for both parties in this week's elections: how comments about rape by two Republican Senate candidates fed a GOP gender gap, and how Democrats' offensive against a Republican plan to overhaul Medicare fell flat.

The New York Times: Senate Races Expose Extent Of Republicans' Gender Gap
Republicans, hoping to gain seats in the Senate, knew that their limited appeal among minorities would be a problem, as would party infighting. But they did not expect to be derailed by the definition of rape. Comments by two Republican Senate candidates concerning pregnancies that result from rape -- which came after months of battles in Congress over abortion, financing for contraception and a once-innocuous piece of legislation to protect victims of domestic violence -- turned contagious as one Senate candidate after another fell short of victory (Steinhauer, 11/7).

Kaiser Health News: Democrats' Medicare Offensive Falls Flat Against GOP
Republicans, for example, have exulted not only in their continuing House majority but also in their ability to withstand Democrats' harsh attacks on their budget blueprints, which called for major changes in Medicare. "There is no evidence that the Democrats’ message got through," said a senior House GOP leadership aide. "Our House Republican position has become stronger" (Cohen, 11/7).

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State Watch

Voters Decide Ballot Issues On Health Law, Assisted Suicide And Marijuana

A variety of news organizations assessed ballot initiatives in Florida, Massachusetts, Montana and Missouri, among other states.

Kaiser Health News: Post-Election, Insurance Exchanges, Other Health Care Issues Loom Large In States (Video)
Working in partnership with Kaiser Health News and NPR, six public radio reporters -- Martha Bebinger (Mass.), Elizabeth Stawicki (Minn.), Sarah Varney (Calif.), Erika Beras (Penn.), Lynn Hatter (Fla.) and Elana Gordon (Missouri) -- talk about how ballot initiatives and state legislative elections could affect the future of the health law implementation and public health in their states (11/7). 

Kaiser Health News: Health Care Issues On The Ballot: The Final Tally
The rich variety of health issues at stake in Tuesday’s elections included the federal health law, abortion, medical marijuana and more.  Here’s a round-up of state health initiatives and the results. ... Missouri voted against raising the state tobacco tax to fund tobacco control programs and public education. This was the third attempt in 11 years to raise taxes on tobacco (Gold, 11/7).

CQ HealthBeat: Voters Decide Controversial Ballot Measures
Missouri voters continued their assault on the health overhaul by choosing to prevent the state from building its own state-based health exchange. Almost 62 percent of the electorate voted for Proposition E, which blocks state officials from creating one of the new health benefits marketplaces under the health law. ... Florida voters also rejected, by 45 percent to 55 percent, a proposed constitutional amendment to ban the use of public funding for abortions. The amendment required 60 percent to pass (Adams, 11/7).

The Atlantic: No To Death With Dignity, Yes To Marijuana, No To GMO Disclosure: The Public Health Results
Decisions made yesterday by voters will have profound implications for public health. ... Do terminally ill patients have a right to terminate their lives, and should physicians be complicit? NO. Massachusetts' move toward "Death with Dignity" was narrowly defeated ... Massachusetts voted to permit [marijuana] for medical purposes, but a similar measure failed in Arkansas, with slightly more than half voting against it. ... Michigan voters ended up rejecting an amendment that would have limited the collective bargaining power of home health care workers and applied standards of quality to home care (Abrams, 11/7).

Medscape: Massachusetts Voters Reject Physician-Assisted Suicide
"Before this barrage of misleading, frightening ads, the polls showed the public was overwhelmingly in support," said Marcia Angell, MD, a senior lecturer in the Division of Medical Ethics at Harvard Medical School and a leading proponent of the ballot measure. "The ads implied there was something scary." Of course, opponents such as the Massachusetts Medical Society (MMS) contended that there indeed was something scary about physicians prescribing a lethal dose of a narcotic at the request of a terminally ill patient with less than 6 months to live (Lowes, 11/7).

WBUR (Audio): After Ballot Defeat, What’s Next For Assisted Suicide Supporters? 
To find out what the supporters of the ballot initiative plan to do next, WBUR’s All Things Considered host Sacha Pfeiffer spoke with the lead backer of the measure, Dr. Marcia Angell of Harvard Medical School. ... "We have had long experience now in Oregon and quite a bit of experience in Washington. We know that this law works. It works exactly as intended. And I think this is just a matter of state by state and maybe even country by country coming to accept this as just a good part of medical practice" (Pfeiffer, 11/7).

The Texas Tribune: Powers: Prop 1 Passage Huge Step For UT, Texas Health
The first University of Texas medical school class in Austin could be in place as early as 2015 or 2016, Provost Steve Leslie said Wednesday morning. Leslie, President Bill Powers and several college deans thanked Austin voters who approved Proposition 1 Tuesday night. The measure will raise property taxes to help fund a UT-Austin medical school. Those tax dollars will account for the last needed chunk of funding for the school (White, 11/7).

Reuters: Los Angeles Mandates Condoms For Porn Actors, Industry Threatens Suit
Los Angeles County voters passed a ballot initiative mandating that pornographic film actors wear condoms during sex scenes, prompting a trade group on Wednesday to threaten to sue and take production elsewhere. Measure B, which was sponsored by the group AIDS Healthcare Foundation, won approval on Tuesday by a margin of 55.85 percent to 44.15 percent, according to the Los Angeles County Registrar-Recorder's office (Whitcomb, 11/7).


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Roundup: Planned Parenthood Asks For Extended Ban On Texas Funding Cut; Election's Effect On Massachusetts Health Businesses

Bloomberg: Planned Parenthood Seeks To Extend Ban On Texas Funding Cuts
Planned Parenthood is asking a Texas judge to extend an order blocking the state from cutting funding to its clinics because the organization provides abortion services. Texas officials were blocked by an Oct. 26 temporary restraining order issued by Judge Amy Clark Meachum in Austin from eliminating public funds for the 49 Planned Parenthood clinics in the state that don’t provide abortions. The state ban will cost Planned Parenthood about $13 million a year in government reimbursements, force it to close some health centers, and interfere with health care for low-income women, the group said in court filings (Shannon, 11/8).

The Boston Globe: The Election's Effect On Massachusetts Business Sectors
The election results proved a mixed blessing for the state’s high-profile life sciences sector. While the state’s congressional delegation will continue to back the industry’s legislative agenda, biotechnology companies expect a fight over low-cost generics, and medical device makers face a tax on their products that will help fund President Obama’s health care overhaul. Combined, the two sectors have more than 800 companies in Massachusetts that employ nearly 70,000 people (Weisman, 11/8).

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Public Health & Education

Mass. Fires Head Of Board Overseeing Compounding Pharmacies

Officials say James Coffey did not investigate a complaint from Colorado about the center now tied to the meningitis outbreak.

The Wall Street Journal: Pharmacy Board Head Fired Over Meningitis
Massachusetts' health department said Wednesday that it has fired the director of its pharmacy board, after he failed earlier this year to investigate a complaint about the drug-mixing pharmacy recently implicated in a deadly meningitis outbreak. James Coffey, director of the Massachusetts Board of Pharmacy, failed to follow up on a complaint from the Colorado pharmacy board accusing New England Compounding Center of illegally selling medicines without a prescription, the Massachusetts health department said in a statement (Rockoff, 11/7).

Reuters:  Massachusetts Pharmacy Board Head Fired After Meningitis Outbreak
Authorities fired the director of the Massachusetts Board of Pharmacy after he failed to investigate a complaint against New England Compounding Center, the company at the center of a deadly U.S. meningitis outbreak, state officials said on Wednesday. NECC is linked to a meningitis outbreak that has infected more than 400 people and caused 31 deaths. ... Coffey was not immediately available for comment (McLaughlin, 11/7).

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Weekend Reading

Longer Looks: People With Mental Disabilities Have A Vote; Genome Sequencing Raises Hope - Also Anxiety

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

Bloomberg: My DNA Results Spur Alzheimer's Anxiety At $12,000 Cost
I may get Alzheimer’s disease, I was told after getting my DNA analyzed. I could suffer the consequences of an abnormal blood clot in my heart or my brain. Or perhaps I’ll suffer from a disease called primary myelofibrosis that’s caused by an overactive bone marrow. All of these were possible outcomes, based on my genetic profile. In each case, the test only gives an increased risk for disease, not a definitive diagnosis. In a few, Alzheimer’s for instance, there’s nothing I can do anyway. ... Robert Handin, a Harvard Medical School doctor who does genetic testing, [said]: "We're going through information overload. Everyone gets all this data and no one knows what to do with it." ... Yet mapping the genome is becoming a standard tool of medical care (John Lauerman, 11/6).

Time: What’s Making Adam Sick? A Contest to Sequence Three Kids’ Genomes
For more than a decade, doctors have been trying to figure out what’s behind the weakness and fatigue that caused 11-year-old Adam Foye to miss 60 days of school last year. His symptoms match up with centronuclear myopathy (CNM), a rare muscle disease, but genetic testing shows no signs of abnormalities in any gene linked to CNM. ... Traditionally, doctors have tried to figure out the cause of their illness by sequencing genes one by one or in small clusters. But for patients like Adam, the gene-by-gene approach is too time-consuming ... As the price of sequencing drops — it’s fallen from the billions to under $10,000 — many experts believe the test will become part of routine medical care. But before that happens, there are plenty of questions that still need to be addressed (Bonnie Rochman, 11/6).

The New York Times Magazine: Charmaine Yoest's Cheerful War On Abortion
Though she has helped usher in hard-hitting changes in women's health care, [Charmaine Yoest, head of Americans United for Life, a pro-life advocacy group] is especially good at sounding reasonable rather than extreme. ... For all her emphasis on women’s health, her end goal isn’t to make abortion safer. She wants to make the procedure illegal. She leaves no room for exceptions in the case of rape or incest or to preserve the health of the mother. She believes that embryos have legal rights and opposes birth control, like the IUD, that she thinks “has life-ending properties." Nor does Yoest advocate for reducing abortion by increasing access to birth control (Emily Bazelon, 11/2).

American Medical News: When The Rx Is An App
When Paul Mohabir, MD, noticed that more patients were arriving with smartphones in their hands, he thought some of the apps he used would be as valuable for them as they were for him. Since then, he has found smartphones to be a great tool to keep patients engaged and more compliant. He thinks the ways they are used are only going to grow. There has been so much buzz about the potential benefits of mobile health — known as mHealth in health IT circles — that several organizations have formed to promote mobile health solutions and study their efficacy and potential risks. Discussions are taking place in exam rooms across the country about how a $1 app could be a viable alternative to prescribing a medication and help patients monitor their health (Pamela Lewis Dolan, 11/5).

American Medical News: Clearing Up Confusion On Advance Directives
The patient was near death when emergency physician Ferdinando Mirarchi, DO, was called into a hospital room by frantic medical staff. The man was in cardiac arrest and needed to be shocked with a defibrillator. But because he had a living will, the health professionals at his side were uncertain how to proceed. ... They "assumed they shouldn't treat him. I came in and shocked the patient," [Dr. Mirachi said.] The man survived. However, such misinterpretations of end-of-life documents too often result in lost lives or unwanted care, said Dr. Mirarchi, medical director of the Dept. of Emergency Medicine at UPMC Hamot Medical Center in Erie, Pa. ... A series of surveys by QuantiaMD, an online physician learning collaborative, found that nearly half of health professionals misunderstood the components of living wills. Ninety percent of those surveyed were physicians (Alicia Gallegos, 10/29).

Mother Jones: Protecting The Voting Rights Of People With Mental Disabilities
Arizona is one of 14 states that categorically bar people who are under guardianship or are judged to be mentally "incompetent" or "incapacitated" from voting, according to the Bazelon Center for Mental Health Law. Although all but 11 states have disability-related voting restrictions, laws that impose uniform bans on people who are under guardianship or judged to be incompetent disproportionately target adults with disabilities or mental illness, including veterans with traumatic brain injury, seniors with dementia, and people with autism. These laws are "inherently biased" and violate constitutional guarantees of equal protection and due process, says Lewis Bossing, a senior staff attorney at the Bazelon Center (Deanna Pan, 11/5).

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Editorials and Opinions

Viewpoints: Bowles Urges 'Deficit Deal Now;' A Doctor's Take On Health Law; Preparing N.Y. Hospitals For Future Storms

The Washington Post: Make A Deficit Deal Now
Going over the fiscal cliff would mean allowing a massive and immediate cut to nearly every major government agency and activity, including those vital to our national security or economic growth. ... What does that alternative look like? We already have the blueprints. It’s the type of bipartisan package toward which the fiscal commission I co-chaired with former senator Alan Simpson, the Domenici-Rivlin group, the Senate's "Gang of Six" and the Obama-Boehner negotiations all worked. It’s a package large enough to put the debt on a clear downward path, relative to the economy, and designed well enough to promote, rather than disrupt, economic growth. It’s a package that includes real spending cuts and structural entitlement reforms to make Social Security solvent while slowing the growth of federal health spending while protecting vulnerable populations. And it’s a package that institutes fundamental tax reform that simplifies the code and encourages economic growth by cutting spending in the tax code to reduce rates and generate additional revenue for deficit reduction (Erskine Bowles, 11/7).

The Wall Street Journal: Obama's Divided Nation
Assuming anyone could survive the GOP's clown-car selection process, one of the most attractive alternatives would have been Mr. Romney's running mate, Rep. Paul Ryan. A Ryan campaign would have consisted of a principled articulation of the case for reforming Medicare and Social Security before they collapse the national fisc, a simpler tax system and a bipartisan compromise on the deficit (Daniel Henninger, 11/7).

The New York Times: Hospital Evacuations For Future Storms
One of the big lessons of Hurricane Sandy is that New York’s hospitals are not as well prepared as they need to be. ... In light of this disaster, hospital administrators clearly need to re-examine their evacuation planning and re-assess how decisions were made before the storm. Hospitals also will need to bolster their defenses (11/6).

San Diego Union Tribune: Long-Term Care A Growing Concern
San Diego is home to some of the most beautiful beaches in the nation, yet a coming wave threatens the financial security of many who live here. Four of 10 middle-aged voters say a close family member is likely to need long-term care in the next five years, yet most don't know where they will turn for help, according to a poll on long-term care by The SCAN Foundation and the UCLA Center for Health Policy Research. These findings beg for greater awareness and action by state and local policymakers (Bruce A. Chernof, 11/2).

Health Policy Solutions (a Colo. news service): VA System Inadequate To Meet Veterans' Health Needs
The sacrifices they and our family made are real, and a real testament to their commitment to our country.  As we come together to celebrate Veterans Day it is important that we consider how we might repay this commitment with a promise of our own: The promise of access to high-quality, affordable health care. Understanding the health and particularly mental health needs of our Colorado veterans is the first step toward doing that. ... A recent analysis of national data, estimates over 16 percent of all veterans report having limitations in their health such as trouble getting around and living independently, or problems with their vision or hearing (Gretchen Hammer, 11/7).

The Medicare NewsGroup: The Post-Election Climate: Common Ground On Medicare Reform
While President Obama's win won’t establish a clear path forward on Medicare, it is highly unlikely to lead to a radical restructuring of the program. There is quite a bit of middle ground that policymakers, think-tank experts and academics have agreed to explore. Although they haven't yet penetrated the partisan fog on Capitol Hill, there are several ideas that may gain currency in the coming year, with some involving market-based approaches and items contained in conservative agendas. At the epicenter of a third way on Medicare reform is a growing realization that Medicare is not only part of the larger health care cost debate but that it can be reformed incrementally. Part of that strategy revolves around both a gradual departure from the fee-for-service model and a dissection on how health care is provided (John Wasik, 11/7).

Fox News: What Obama's Victory Means For Your Health Care -- A Doctor's Take
Tuesday night's win in the presidential contest for President Obama was a win for ObamaCare, the president's signature legislation from his first term. ObamaCare will now continue to be implemented. This future means that we will continue to be faced with rising insurance premiums, as our current insurance expands to cover all patients regardless of pre-existing condition, age, or how many times they've already used the policy ... Federal regulations in the form of Medicare's Independent Payment Advisory Board as well as ObamaCare's many other committees will restrict my choices for my patients. I will have more patients with more red tape and less time to spend with them. Since ObamaCare does not effectively address the doctor shortage, you will see more nurse practitioners and physicians assistants, who are quite competent, but have different training than I have treating patients (Dr. Marc Siegal, 11/7).

Baltimore Sun: The Key Role Of Nursing Homes
Many people think of nursing homes as places to go to die. But here in Maryland, skilled nursing and rehabilitation centers are in fact places people go to live. They are a big part of the solution to the state's health care challenges, providing quality and cost-effective transitional, rehab, long-term and high-acuity care to those in need. With the impending implementation of the Affordable Care Act in Maryland, we have an opportunity to identify and pilot ways in which Maryland's skilled nursing and rehabilitation centers can be essential to providing expanded care to people and families in need and deploying center‐based resources into the community for public health challenges. Nursing centers in Maryland have valuable roles to play in effectively integrating care across all settings, connecting the dots among family caregivers, primary care doctors and nurses and hospital-related care to provide better focus and integrated care to address such things as chronic heart disease, diabetes and obesity (Joe DeMattos, 11/7).

Kansas City Star: Deal With Reality: Obamacare Stays
For GOP leaders in Missouri and Kansas, the time for wishful thinking is past. Mitt Romney will not have the chance to repeal "Obamacare," as he promised in his campaign. So states must make important decisions about their participation in the Affordable Care Act. And quickly. Governors face a Nov. 16 deadline to inform the U.S. Department of Health and Human Services about their level of involvement in state-based insurance exchanges. Because of their own missteps, it is too late for Kansas and Missouri to create their own exchanges and have them operational by January 2014, as called for in the health care law. Their choice now is to partner with federal officials or accept an exchange designed by Washington (11/7).

The Wall Street Journal: Organizing to Battle Drug-Resistant TB
Extensively drug-resistant TB -- a deadlier form of the airborne disease, one that can overpower nearly all available drugs -- first emerged in South Africa in 2008. It has since been discovered in 84 countries, including the United States and much of Europe. With a concerted and coordinated response from governments, the mining industry, international development partners and civil society, we can stop this disease in its tracks. The way to start is by strengthening efforts to detect and treat TB in southern Africa's mines (The Rev. Desmond Tutu, 11/7).

New England Journal of Medicine: 'If I Had Only Known' -- On Choice and Uncertainty in the ICU
The way one views patients' initial choices to undergo advanced or high-risk interventions -- as decisive acts of buy-in or as decisions made with limited information, to be revisited and reevaluated over time -- sets the stage for one's approach to subsequent decisions regarding pursuit of life-sustaining or palliative care. For patients like ours, explicit examination of such distinctions represents an important step toward confronting and understanding the regret that can occur in the ICU (Drs. Jesse M. Raiten, and Mark D. Neuman, 11/8).

New England Journal of Medicine: Compounding Errors Compounding pharmacies are businesses that produce important products for patients. These patients, however, do not have the means to check the clinical indications for the use of the products, to ensure the accuracy of the compounding, and to verify the sterility of the delivered products. The FDA has the technical expertise and drug-evaluation experience to do so and should have this authority, and there needs to be a mechanism to ensure that the funding is in place to exercise it effectively (Drs. Jeffrey M. Drazen, Gregory D. Curfman, Lindsey R. Baden, and Stephen Morrissey, 11/7).

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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.