Daily Health Policy Report

Friday, August 10, 2012

Last updated: Fri, Aug 10

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform


Campaign 2012

Health Care Marketplace

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Medicare Seeks To Cut Number Of Seniors Denied Nursing Home Coverage After Hospital Stays

Reporting for Kaiser Health News, in collaboration with The Washington Post, Susan Jaffe writes: "Concerned that a growing number of seniors have been unexpectedly forced to pay thousands of dollars for nursing home care after a stay in a hospital, Medicare has launched a pilot project to test whether relaxing its hospital payment rules could help beneficiaries" (Jaffe, 8/10). Read the story.

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Colorado Pursues Insurance Exchange – But Keeps Fighting About It

Colorado Public Radio's Eric Whitney, working in partnership with Kaiser Health News and NPR, reports: "A special legislative committee gave Colorado the green light on Thursday to continue working on its health insurance exchange by allowing it to apply for a $43 million federal grant. But first the lawmakers had to fight about it" (Whitney, 8/9). Read the story.

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Capsules: 3 House Republicans Ask For GAO Report On CMS Spending; Baby Boomers Worry About Medicare's Future, Want More Detail From Candidates

Now on Kaiser Health News' blog, Mary Agnes Carey reports on a request by three GOP lawmakers for a GAO report on CMS spending: "Three House Ways and Means Committee Republicans have asked the Government Accountability Office to review money spent by the Centers for Medicare & Medicaid Services on programs not related to Medicare and Medicaid" (Carey, 8/10).

Also on the blog, Ankita Rao reports on an AARP survey: "The organization asked registered voters, including an oversample of people age 50-plus, about their five top financial concerns to measure what they call an 'Anxiety Index.' Health expenses ranked fourth on the list of concerns after rising prices, taxes and financial security in retirement" (Rao, 8/9). Check out what else is new on the blog.  

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Letters To The Editor: Readers' Thoughts On Tennessee Medicaid's Long-Term Care Benefits; Hospital Readmissions; And The Nursing Professor Shortage

In this periodic feature, Kaiser Health News shares readers' comments and reactions to our reporters' recent original stories.

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Political Cartoon: 'Vertigo?'

Kaiser Health News provides a fresh take on health policy developments with "Vertigo?" by Nick Anderson.

Meanwhile, here's today's health policy haiku:


Do health policies
play a role in V.P. choice?
Only time will tell...

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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Capitol Hill Watch

House GOP Seeks Details On Administration Health Spending

Members of the House Ways and Means Committee and the Energy and Commerce Committee are following the spending trail of Obama administration health programs.

The Hill: House Republicans Ask For Details On Health Care Implementation Spending
House Republicans on Thursday asked government auditors for a detailed accounting of the money being used to implement President Obama's healthcare law. Republican leaders on the Ways and Means Committee asked the Government Accountability Office (GAO) to investigate how much money the Obama administration has spent implementing the law — and how much it expects to spend through 2014, when most of the major provisions take effect (Baker, 8/9).

Kaiser Health News: 3 House Republican Ask For GAO Report On CMS Spending
In January 2011, Department of Health and Human Services Secretary Kathleen Sebelius announced that the Office of Consumer Information and Insurance Oversight, one of several agencies charged with implementing the health law, would be moved from her office into CMS. The reorganization,  Sebelius wrote, was done to improve implementation of the health law and to create "administrative savings and organizational efficiencies."  The agency was renamed the Center for Consumer Information and Insurance Oversight, or CCIIO. In their letter Thursday, the House Republicans suggested a different motive for the shift. "We suspect what precipitated this reorganization was the desire by Obama Administration officials to tap into the significant financial resources at CMS’ disposal" (Carey, 8/10).

CQ HealthBeat: Republicans Concerned About Use Of Funds For Health Insurance Oversight Office
Top House Ways and Means Committee Republicans on Thursday requested a financial analysis of money spent on a health care oversight center, saying the Obama administration may have diverted funds from Medicare and Medicaid. Three GOP lawmakers asked the Government Accountability Office to audit all the money allocated to the Center for Consumer Information and Insurance Oversight (CCIIO), which was created under the 2010 health care law (Ethridge, 8/9).

The Hill: GOP Wants More Records On $8B Medicare Program
House Republicans say the Obama administration hasn't fully answered questions about a controversial Medicare program. Republican leaders on the Energy and Commerce Committee wrote to the Health and Human Services Department on Thursday to request more information about the $8 billion program, which is under fire from lawmakers as well as the nonpartisan Government Accountability Office. GAO has said HHS should simply end the demonstration program, which gives bonus payments to Medicare Advantage plans that meet certain quality standards (Baker, 8/9).

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Health Reform

Health Insurer Rebates: Where Has The Money Gone?

The New York Times reports that many consumers who get health coverage through their employers wonder what happened to the insurer rebates that were part of "the great health insurance giveback" under the health law. Also in the news, The Associated Press details who will be hit the hardest by the health law's tax provisions.

The New York Times: Health Insurer Refunds May Stall In Employers' Hands
It was the great health insurance giveback: $1.1 billion in premiums returned to policyholders under the Affordable Care Act. But while many people who buy their own insurance found a check in the mail last week, millions insured through employers are still wondering what is happening with the money (Bernstein, 8/9).

The Associated Press/Washington Post: Health Care Law's Big Tax Hikes Hit The Wealthiest 2 Percent – Others Also Caught In The Net
Who gets thumped by higher taxes in President Barack Obama's health care law? The wealthiest 2 percent of Americans will take the biggest hit, starting next year. And the pain will be shared by some who aren't so well off — people swept up in a hodgepodge of smaller tax changes that will help finance health coverage for millions in need (8/9).

Crain's Business Insurance/Modern Healthcare:  Healthcare Reform Drives interest In Captive Insurers
The Patient Protection and Affordable Care Act has increased middle-market employers' interest in captives to fund medical stop-loss for their self-funded health benefit plans, captive experts say.  Similar to captive property/ casualty programs, medical stop-loss captives allow self-funded employers to pool part of their excess medical claims costs with other like-minded companies and then purchase commercial stop-loss coverage at higher attachment points (Wojcik, 8/9). 

In other news, Politico Pro reports on the future of long-term care insurance and the next possible iterations of the CLASS Act -              

Politico Pro: Talks Under Way On Long Term Care Steps
Months after the Obama administration said it shut down efforts to implement the fiscally unstable CLASS Act, federal officials have participated in closely guarded, multi-stakeholder conversations about ways to finance long-term care. In the aftermath of the Obama administration's decision to shut down the troubled health care reform program, policy experts have quietly huddled to ponder policy prescriptions for boosting long-term care coverage. Those discussions, which have explored possible fixes to the CLASS Act, have been attended by federal officials, as well as long-term care advocates, insurance company representatives, actuaries and policy experts, according to participants (Millman, 8/9).

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Medicare Payments For Anemia Drug Too High

News outlets report on these Medicare policy developments.

The Washington Post: Medicare Overspending On Anemia Drug
The U.S. health-care system is vastly overspending for a single anemia drug because Medicare overestimates its use by hundreds of millions of dollars a year, according to an analysis of federal data. The overpayment to hospitals and clinics arises because Medicare reimburses them based on estimates rather than the actual use of the drug (Whoriskey, 8/9).

Kaiser Health News: Medicare Seeks To Cut Number Of Seniors Denied Nursing Home Coverage After Hospital Stays
Concerned that a growing number of seniors have been unexpectedly forced to pay thousands of dollars for nursing home care after a stay in a hospital, Medicare has launched a pilot project to test whether relaxing its hospital payment rules could help beneficiaries (Jaffe, 8/10).

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Anxiety Index: Survey Examines Baby Boomers' Concerns About Medicare

The AARP found that health expenses ranked fourth on the list of concerns.

Los Angeles Times: High Anxiety: Half Of Baby Boomers Doubt They Will Ever Retire
Worries about health care, inflation, taxes, nest eggs and more have boomers scoring a 70% on AARP’s anxiety index, compared to 59% of younger voters and 46% of people ages 65 or older (Hsu, 8/9).

Kaiser Health News: Capsules: Survey: Baby Boomers Worry About Medicare's Future, Want More Detail From Candidates
The organization asked registered voters, including an oversample of people age 50-plus, about their five top financial concerns to measure what they call an 'Anxiety Index.' Health expenses ranked fourth on the list of concerns after rising prices, taxes and financial security in retirement (Rao, 8/9). 

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Campaign 2012

Pressure Builds On Presidential Nominees On Health Care Issues

The presidential race picks up with conservatives pushing presumptive GOP nominee Mitt Romney to pick Rep. Paul Ryan, R-Wis., as his running mate while Romney's latest TV ad accuses President Obama of using his health law to "declare war" on religion.

The New York Times: Romney Faces Pressure From Right To Put Ryan On Ticket
In rallying around Mr. Ryan, a champion of cutting government spending and reining in the costs of programs like Medicare and Medicaid, conservatives are calling for Mr. Romney to select someone who can push their fiscal agenda, but they also are setting the stage for a possible letdown on the right if Mr. Romney chooses someone else in his race against President Obama. A strongly worded Wall Street Journal editorial on Thursday urged Mr. Romney to pick Mr. Ryan, saying he "best exemplifies the nature and stakes of this election" (Shear and Gabriel, 8/9).

The Associated Press: Ad Watch: Latest Romney TV Ad Accuses Obama Using Health Care Law To 'Declare War' On Religion
This latest ad by Romney's campaign and the Republican National Committee is the former Massachusetts' governor's most direct bid yet for religious voters. Obama's health care overhaul split religious groups, with Catholic bishops and conservative Protestants strongly opposed to provisions that permitted women to buy insurance coverage for abortion, provided they used their own money. But liberal Protestant denominations supported the law, as did many religious orders of Catholic nuns, and the trade group representing Catholic hospitals (8/9).

Politico: Obama Camp Acknowledges Knowing Man's Story
Obama campaign spokeswoman Jen Psaki acknowledged Thursday that the campaign was no longer pleading ignorance about the story of a man who has appeared in both a super PAC ad and a campaign ad. … Missouri steelworker Joe Soptic starred in an Obama campaign ad and participated in a conference call with the campaign in May, as Politico reported Wednesday. He resurfaced this week in a Priorities USA Action super PAC ad, charging that his wife died of cancer after Mitt Romney's former private equity firm laid him off (Tau, 8/9).

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Health Care Marketplace

Hospital Debt, Financial Practices Draw Investors' Attention

Also in the news, The Wall Street Journal reports that consumers may be returning to the doctor after a period during which the difficult economy appeared to keep them away.  

The Wall Street Journal: Hospitals' Debt Gets A Checkup
Hospitals are doling out a dose of bitter medicine in the form of riskier bonds. Investors hungry for higher yields in an environment of near-zero interest rates are clamoring for the municipal bonds issued by hospitals and other health-care facilities. Borrowers are capitalizing on this rising demand by dispensing with standard investor protections on their bonds (Nolan, 8/9).

Reuters: U.S. Hospital Companies Seen Under Microscope As Costs Targeted
Investors in U.S. hospital companies can expect more scrutiny of billing practices and the medical need for expensive treatments as the federal government faces greater pressure to recoup billions in fraudulent claims, analysts said. HCA Holdings Inc, the largest for-profit hospital operator in the United States, said earlier this week that federal authorities were investigating whether heart procedures performed at some of its facilities were medically necessary (Kelly, 8/9).

The Wall Street Journal: It May Be Time To See A Doctor
Years of economic drag have had some profound effects on Americans. One big one: They stopped going to the doctor as much as they used to. Now people may be starting to head back for checkups and other medical procedures. Any shift has important implications for the health-care sector and the broader economy, since the drought has helped restrain spending growth (Mathews and Kamp, 8/9).

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State Watch

States Set Standards, Continue Health Insurance Exchanges Fight

State officials in California are moving to define standards for insurers hoping to participate in the insurance exchanges, while a legislative committee in Colorado gives the state permission to continue building its exchange.

California Healthline: Standards Open Exchange Doors For Qualified Health Plans
Exchange board, Executive Director Peter Lee hefted a 263-page tome about qualified health plans in one hand, for effect, and then set it down on the table with a plop. "The qualified health plan issue," Lee said, "is a big issue." Big in many ways: Health care reform experts have said the health plans participating in the exchange are crucial to its success. Andrea Rosen, staff counsel for the Department of Insurance who is on loan to the exchange, helped write the hundreds of pages of rules, requirements and standards that describe just how insurers can participate in the exchange, set to open for business in January 2014 (Gorn, 8/9).

Kaiser Health News: Colorado Pursues Insurance Exchange – But Keeps Fighting About It
A special legislative committee gave Colorado the green light on Thursday to continue working on its health insurance exchange by allowing it to apply for a $43 million federal grant. But first the lawmakers had to fight about it (Whitney, 8/9).

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State Officials Seek Medicaid Savings In Cuts, Payment Methods, Managed Care

Facing budget pressures, state officials in Georgia, Minnesota, Kansas and West Virginia are among those making cuts and switching to new payment methods as well as to managed care to cut the cost of the state-federal health care program for the poor and disabled.

Georgia Health News: Medicaid Cuts Loom; State To Extend Insurer Pacts
State officials say proposed budget cuts to Georgia Medicaid and PeachCare would total $170 million in state funds through the next fiscal year. And with the matching federal funds generated by that state spending, the reductions would have a more than $500 million impact on the two health insurance programs. The cuts would come on top of a current shortfall in the two programs that the Department of Community Health's budget director estimates at about $300 million (Miller, 8/9).

Minnesota Public Radio: New Medicaid Payment Method Will Save Money, MN Officials Say
Minnesota is the first state in the nation to receive federal approval for a new way of paying for health care in its Medicaid program. Minnesota will pay some hospitals and clinics based on how well their patients do medically and their ability to cut costs. Right now Medicaid pays HMOs to provide coverage or pays medical clinics directly by the procedure or test. Experts say that "fee-for-service" approach does nothing to rein in costs. But under the "shared savings" program, the state will contract directly with clinics. Minnesota Human Services Commissioner Lucinda Jesson said if those clinics meet quality standards, patients get healthier, and cut costs, they'll be able to share any cost savings with the state (Stawicki, 8/9).

Kansas Health Institute News: KanCare: Ready Or Not?
Less than five months from now, the Kansas Medicaid program is scheduled to convert to a privatized system called KanCare. In January, three for-profit, managed-care organizations will take over the federal/state program that pays for health care for low-income children, seniors and people with disabilities. State officials have been conducting meetings across the state to help people prepare for the change (Thompson, 8/9).

In the meantime, West Virginia plans to audit its Medicaid program to look for savings --

The Associated Press: W. Va. Plans Audit Of Health Care Programs
West Virginia is planning an audit of eight state health care agencies and Medicaid with the goal of improving programs with existing or fewer resources. The Governor's Office has awarded a $390,000 contract to Pennsylvania-based Public Works to conduct the audit, the Charleston Daily Mail reported Thursday. Public Works recently completed an audit of the state's education system (8/10).

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State News: Mammogram Rates Did Not Rise Under Expanded Mass. Coverage

News outlets report on health care news in California, Kansas, Massachusetts, Michigan, Minnesota, South Carolina, Texas and Wisconsin.

The Dallas Morning News: Leadership Failures Tied To New Cases Of Patient Harm At Dallas' Parkland Hospital
Federal safety monitors produced a harsher critique of Parkland Memorial Hospital's reform efforts than recently portrayed by the hospital, finding ongoing dangers to patients from a botched surgery, medication errors and emergency care failures. Those problems, cited in a June compliance report obtained by The Dallas Morning News, were not disclosed in a Parkland summary released to The News two weeks ago. Nor did the summary reveal the monitors' finding that such problems flow from weak leadership (Moffeit and Egerton, 8/8).

The Dallas Morning News: Texas Left False Information About Women's Health Program In Legal Documents
State officials have allowed an outdated and false assertion about how they intend to pay for the Women’s Health Program to stand uncorrected in several legal documents, including those submitted to the public and an appeals court.  State health officials in the published notice of the program's proposed rules stated that the federal government would pick up the annual cost of the program, estimated to be about $30 million, starting in 2014 through the Affordable Health Care Act. The attorney general's office submitted that same language to the U.S. 5th Circuit Court of Appeals on July 9, the same day that Gov. Rick Perry and Health and Human Services Commissioner Tom Suehs said the state would reject funding under the Affordable Health Care Act (Hoppe, 8/9).

The Associated Press: House Speaker: SC To Likely Get Sued, Lose
House Speaker Bobby Harrell said Thursday he expects South Carolina to be sued over a panel's decision to disregard the state budget and increase employees' health insurance costs anyway. And he expects the state to lose. Harrell, R-Charleston, said the Budget and Control Board likely lacked the authority to split the cost of premium hikes between workers and employers after the Legislature passed a budget that fully funded the increases (Adcox, 8/9).

Reuters: Mass. Health Reform Hasn't Boosted Mammography Rates
The 2006 Massachusetts health overhaul didn't boost the state's mammography rates or lead to more breast cancers being caught early, despite rising insurance rates, new research shows. Researchers had expected to see an increase in breast cancer screening as the number of insured women went up, because earlier work had suggested women without insurance were less likely to get mammograms (Joelvin, 8/9).

WBUR: Study: Maybe Mass. Doesn't Know It All On Health Reform
(A) new report just out from the Beacon Hill Institute at Suffolk University suggests that perhaps we should be a bit less provincially, pridefully myopic. ... The report reviewed several health-reform policies in other states and concludes that there is much worth emulating (Goldberg, 8/9).

Minneapolis Star Tribune: Patient Transport Switch A Worry
The Department of Health Services expects some glitches next month when a new company begins providing transportation to doctors and other health care providers for people covered by state health programs, such as BadgerCare Plus, in southeastern Wisconsin. That concerns advocates given the complaints raised about the service provided by the new company, LogistiCare, in the state over the past year. "We would have liked to see them slow down" the transition to LogistiCare, said Barbara Beckert, director of the Milwaukee office of Disability Rights Wisconsin (Boulton, 8/9).

California Watch: Report: Major Cities Not Prepared For Growing Retiree Health Costs
Most major California cities are failing to address the growing health care costs of government retirees, which have ballooned to more than $1 billion in some areas and soon could threaten municipalities' ability to pay other expenses, according to a recent financial analysis by a nonprofit research group. Eleven of 20 California cities with the biggest budgets do not set aside funds for future health care costs, the study by California Common Sense found (Johnson, 8/10).

Crain's Detroit Business/Modern Healthcare:  Three Detroit-Area Hospitals Improve Emergency Care Under National Program
DMC Sinai-Grace Hospital, St. Joseph Mercy Oakland and McLaren Macomb improved care in their emergency departments through a national program made possible by the Greater Detroit Area Health Council.  Here are the highlights: DMC Sinai-Grace decreased average length of stay in its emergency department by nearly one hour over a six-month period; St. Joseph Mercy Oakland decreased ambulance diversion hours from 41 to zero in a four-month period and cut the percentage of patients who left its emergency department without being seen from 4 percent to 1 percent. Ambulances are diverted from ERs because of overcapacity issues; McLaren Macomb reduced the average time between patients' arrival in its ER to admission by 19 minutes (Greene, 8/9). 

California Healthline: Including PACE In Dual Eligible Options
Legislators are about to weigh in on one detail of the state's dual-eligible pilot program known as the Coordinated Care Initiative:  An Assembly bill calling for the inclusion of a popular program for Californians at-risk of nursing home care is up for a vote on the Senate floor. AB 2206 by Toni Atkins (D-San Diego) would require the Department of Health Care Services to include  PACE  -- the Program of All-Inclusive Care For The Elderly -- as one of the alternatives to Medi-Cal managed care in the eight counties where the CCI pilot is starting (Gorn, 8/10).

Kansas Health Institute News: Pilot Project Would Speed DD Program Exposure To KanCare
The Kansas Department for Aging and Disability Services has begun the process for putting together a pilot project aimed at letting programs for the developmentally disabled contract with the KanCare managed care companies next year instead of waiting until 2014. Earlier this week, the agency issued a formal 'request for information' on how the project might work (Ranney, 8/9).

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Health Policy Research

Research Roundup: Unnecessary Heart Tests; Americans Hit The Walkway

News outlets reported this week on a variety of studies dealing with health care policies.

Medpage Today: White Kids May Get Too Many Head CTs
Among children who suffered minor blows to the head, whites were more likely to receive unneeded cranial CT scans in the ED than were blacks or Hispanics, researchers found. In a national network of pediatric emergency centers, scans were performed in 84.1% of the high-risk white children compared with 79.8% of the black and Hispanic children combined, reported JoAnne E. Natale, MD, PhD, of the University of California Davis, and colleagues (Gever, 8/7).

Medpage Today: Employers Still Support Workers' Weight Loss
More than 70% of large employers will cover weight-loss surgery in 2013 -- a rate similar to past years, according to a survey by the National Business Group on Health. The group's Large Employers' 2013 Health Design Survey found 79% plan to cover gastric bypass surgery and 70% laparoscopic adjustable gastric banding. And 40% will cover physician-recommended obesity treatments for children, up slightly from 35% 2 years ago (Pittman, 8/8).

Medpage Today: QI Program Can Cut Unneeded Cardiac CT
Inappropriate coronary CT angiography (CCTA) exams can be curtailed if physicians are educated as to when the test should be ordered, researchers found. Follow-up after physicians underwent a 2-year continuous quality improvement program revealed a significant 60.3% decrease in inappropriate orders for CCTA tests (14.5% to 5.8%, P<0.0001), reported Kavitha M. Chinnaiyan, MD, from William Beaumont Hospital in Royal Oak, Mich., and colleagues (Kaiser, 8/9).

Medpage Today: Americans Step Up Their Walking
More Americans are walking for physical fitness now than they were 5 years ago, but they spend less time doing so, government researchers said. Between 2005 and 2010, the proportion of the population that reported walking at least 10 minutes a day rose from 55.7% to 62%, Dianna Carroll, PhD, of the CDC, and colleagues reported in a Vital Signs report in Morbidity and Mortality Weekly Report. But the mean time spent walking daily fell from 15 minutes (105 minutes per week) to 13 minutes (90.8 minutes) during that time, the reasons for which are unclear, the researchers wrote (Fiore, 8/7).

Medscape: Falls Prevented With Novel Exercise Program For Older People
Embedding balance and strength movements into everyday activities such as "carrying the groceries from the car to the porch while walking sideways" may help older people prevent falls and improve overall strength and balance, according to a study published online Aug. 7 in the British Medical Journal (Hand, 8/8).

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Editorials and Opinions

Viewpoints: Democrats Must Get Tough On Entitlements; Fla. Gov. Scott Says Feds Should Stay Out Of State Medicaid Decisions

Politico: Tough Love: Why Democrats Must Cut Entitlements
Democrats nurtured entitlements, which provided a bedrock of security for Americans. But we never said no to entitlement expansion or benefit increases. We haven't supplied enough discipline, and they are out of control. Conversely, we've ignored the New Frontier investment programs, bragging about them but meting out only subsistence rations. They're now stunted and need higher rations. We have one more chance. The fiscal cliff was designed to force tough choices. For Republicans, those tough choices are about taxes. For Democrats, it must be about entitlements. We have defended them to the hilt. We have made their success our legacy. But they are eating us out of house and home (Gabriel Horowitz and David Kendall, 8/9).

The Washington Post: The Case Against Reelection
Obama's ideology — and the program that followed — explains the failure of these four years. ... (Among the examples, Obama's) radical reform of health care that would reduce its ruinously accelerating cost: "Put simply," he said, "our health-care problem is our deficit problem" — a financial hemorrhage drowning us in debt. Except that Obamacare adds to spending. The Congressional Budget Office reports that Obamacare will incur $1.68 trillion of new expenditures in its first decade. To say nothing of the price of the uncertainty introduced by an impossibly complex remaking of one-sixth of the economy — discouraging hiring and expansion as trillions of investable private-sector dollars remain sidelined (Charles Krauthammer, 8/9). 

The Wall Street Journal: A Nation That Believes Nothing
The pro-Obama Super PAC ad that essentially blames Mitt Romney for a woman's death from cancer is over the line, and if it's allowed to stand the personal attacks that have marked the presidential campaign will probably get worse. If the president rebukes the PAC and renounces the ad—and he should, and he'd look better doing it than not doing it—then we'll all know there's an ethical floor below which things can't sink (Peggy Noonan, 8/10).

Christian Science Monitor: Health Care Reform: Has Team Romney Embraced The Individual Mandate?
Has Team Romney endorsed the individual mandate, the central pillar of President Obama’s health-care law that the GOP otherwise loves to hate? A Romney official seemed to indicate that Wednesday. Commenting on the harsh ad just released by a pro-Obama "super PAC," in which an ex-steelworker basically blames Bain Capital for his uninsured wife’s death, spokeswoman Andrea Saul told Fox News that "if people had been in Massachusetts, under Governor Romney’s health-care plan, they would have had health care" (Peter Grier, 8/9).

The Wall Street Journal: The Ryan Express
The Romney camp has not-so-discreetly floated the trial balloon (that Rep. Paul Ryan may be the vice presidential pick) in recent days to prominent conservative leaders to get instant feedback. Most conservatives I caught up with in recent days were enthusiastic about a Ryan veep nomination. ... One big reservation for the Romney team is that putting Mr. Ryan on the ticket further exposes Mr. Romney to the Mediscare campaign that the Obama team is dying to roll out in the fall (Stephen Moore, 8/9).

Miami Herald: Medicaid Expansion Could Save Over 5,000 Lives
To those who control Florida health policy, discussions about Medicaid are exclusively about dollars and cents. Gov. Rick Scott calls the health-insurance program for certain low-income groups a budget-buster, even though Florida has one of the lowest Medicaid costs per patient in the nation. He refuses to consider the expansion of Medicaid to low-income adults who are uninsured, even though the federal government pays the whole tab until 2017 and at least 90 percent after that. He speaks only of future costs, without looking at savings that could accrue to hospitals and without looking at economic benefits of a healthy, productive population. Now, it's time to talk about human suffering and early deaths (Carol Gentry, 8/9).

Miami Herald: Medicaid Expansion Bad For States
History has repeatedly shown the costs of many government healthcare programs far exceed early projections. Why does anyone expect the expansion of Medicaid would be any different? ... Medicaid expansion is bad for states because it would put a tremendous strain on state budgets and increase dependency on government programs. We don't need to expand a big-government program to provide for everyone’s needs. What we need is to shrink the cost of healthcare and expand opportunities for people to get a job so more people can afford it (Florida Gov. Rick Scott, 8/9).

Milwaukee Journal Sentinel:  Health Care Law Boosts Costs, Worsens Care
The best course of action now is for the entire health care law to be repealed and replaced with a real solution to our nation's health needs: market-oriented solutions that foster competition between providers, instead of a larger and more invasive role for the federal government. That's what will bring down costs and make care more affordable and accessible, so that all Americans can enjoy the quality and access to care that we have in Wisconsin (Luke Hilgemann, 8/9).

Milwaukee Journal Sentinel: Health Care Access And Education Are Vital
Access to affordable reproductive health care, not just for prospective mothers but for fathers as well, is a crucial but sometimes invisible piece of the infant mortality puzzle. ... The bottom line is that improved awareness about and access to birth control and the early diagnosis and treatment of STDs (a serious risk factor for preterm births) before pregnancy improves birth outcomes (Teri Huyck, 8/9).

Bloomberg: Make It Hard For Parents To Deny Their Kids Vaccines
With more than half of parents expressing concern about vaccine safety in one survey, however, abolishing all nonmedical exemptions now could lead to a backlash. ... Instead, parents -- two parents, if both are legally responsible for the child -- should be required to visit a pediatrician for counseling on the risks of vaccination versus leaving a child unprotected (8/9).

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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.