Daily Health Policy Report

Monday, August 13, 2012

Last updated: Mon, Aug 13

KHN Original Reporting & Guest Opinion

Campaign 2012

Health Reform

Medicare

Quality

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Medicare To Penalize 2,211 Hospitals For Excess Readmissions

Kaiser Health News staff writer Jordan Rau reports: "More than 2,000 hospitals — including some nationally recognized ones — will be penalized by the government starting in October because many of their patients are readmitted soon after discharge, new records show" (Rau, 8/13). Read the story and the sidebar detailing where the data came from as well as a related story about hospitals that treat the poor. Also, look at charts detailing the penalties by region or by state.

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FAQ: How Paul Ryan Proposes To Change Medicare

Kaiser Health News staff writer Marilyn Werber Serafini reports: "Wisconsin Republican Paul Ryan, GOP presidential hopeful Mitt Romney's choice for vice president, has provoked consternation from Democrats and anxiety among some congressional Republicans with his proposals to reshape Medicare" (Werber Serafini, 8/11). Read the story. Also, check out Kaiser Health News' essential reading page on the Ryan Medicare plan.

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Political Cartoon: 'New Math?'

Kaiser Health News provides a fresh take on health policy developments with "New Math?" by Rina Piccolo.

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

SHAKING UP THE ELECTION-YEAR DISCOURSE?

Romney's Ryan pick
puts Medicare in front of
Bain in voters' minds. 
-Anonymous

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Campaign 2012

Mitt Romney Taps Paul Ryan As His V.P. Pick

The selection of the fiscal conservative puts the size and scope of the federal government -- and especially the future of Medicare and other entitlement programs -- at the center of the election debate. Ryan's views on social issues, such as abortion, are also explored by media outlets.

The Wall Street Journal: Ryan Pick Jolts Race
Mr. Ryan has become a favorite of fiscal conservatives for his plans to rein in spending through budget cuts and changes to Medicare and other entitlement programs. The Romney campaign said enthusiasm over the pick brought in $3.5 million in online donations in the 24 hours after he was named to the ticket Saturday morning (O'Connor and Murray, 8/13).

The New York Times: Both Sides Focus On The Republican Ticket's New Face
In North Carolina and at an evening rally in Wisconsin, Mr. Romney praised his running mate for conservative vision and courage. But with Mr. Ryan's introduction to a national audience defined by his plan to reshape Medicare and slash spending for nearly all government programs outside the military — policies that Democrats have spent years using to generate opposition to Republicans — campaign aides pointedly noted that it was a Romney-Ryan ticket, not Ryan-Romney (Zeleny and Barbaro, 8/12).

The New York Times: As Ryan Looks To Focus On Economy, Spotlight Shines On His Views
In nearly 14 years as a Republican congressman from Wisconsin, Mr. Ryan has not only voted for legislation that would cut off federal money for Planned Parenthood and the Title X family planning program, but also backed bills to establish criminal penalties for certain doctors who perform the procedure known as partial-birth abortion (Pear, 8/12).

Politico Pro: Ryan's Anti-Abortion Record Appeals To Right
Paul Ryan's budget-cutting zeal isn't the only stance that has conservatives fired up. His anti-abortion record can energize social conservatives who had been slow to embrace Mitt Romney. "We are thrilled with this pick," Marjorie Dannenfelser, president of the Susan B. Anthony List said of Ryan. "He has a pristine pro-life voting record and will be an asset to Gov. Romney’s campaign.” During the primary season, social conservatives were skeptical of Romney’s more moderate record on abortion and family planning while running for Senate and governor of Massachusetts. But they see the young Wisconsin Republican running mate, a Catholic, as one of their own (Kenen, 8/12).

Los Angeles Times: Many See Ryan As More Wisconsin Than Washington
In Washington, Ryan is chairman of the House Budget Committee. His relentless drive to reduce the deficit, cut taxes and trim spending — including for entitlements such as Medicare, Medicaid and Social Security — has turned him into an intellectual hero to some, and to others an ideologue intent on dismantling the social safety net. But to his Janesville neighbors, Ryan is a Green Bay Packers devotee, a camper and an avid bowhunter, known to rise before dawn during deer season and return at night after a day alone in the woods (Hennessey, Semuels and Mascaro, 8/12).

Kaiser Health News tracked weekend news coverage of GOP presidential hopeful Mitt Romney's pick of House Budget Committee Paul Ryan to be his running mate and analyzed the Ryan Medicare plan.

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On '60 Minutes,' Romney And Ryan Defend Medicare Plan

The GOP presumptive presidential nominee and his choice for a running mate also went on the offensive by criticizing the Obama administration for cutting Medicare spending. 

CBS News: "60 Minutes": Romney, Ryan Answer Critics Of Medicare Position
Romney answered critics who say Ryan's Medicare plan will hurt the ticket's chances, especially in Florida. "There's only one president that I know of in history that robbed Medicare, $716 billion to pay for a new risky program of his own that we call Obamacare," Romney said. ... Ryan added, "My mom is a Medicare senior in Florida. Our point is we need to preserve their benefits, because government made promises to them that they've organized their retirements around. In order to make sure we can do that, you must reform it for those of us who are younger. And we think these reforms are good reforms. That have bipartisan origins. They started from the Clinton commission in the late '90s" (Delargy, 8/12). CBS also posted a text of the interview.

USA Today: Romney, Ryan Defend Medicare Plan On '60 Minutes'
Mitt Romney and Paul Ryan defended their stance on Medicare, saying Ryan's plan to overhaul the health insurance program for seniors won't hurt them in Florida. ... "What Paul Ryan and I have talked about is saving Medicare, is providing people greater choice in Medicare, making sure it's there for current seniors," Romney said, according to the 60 Minutes excerpts. Romney said the plan would not make any changes for seniors currently enrolled in the government-run health insurance program. "But looking for young people down the road and saying, 'We're going to give you a bigger choice' " (Camia, 8/12).

The Hill: Romney Defends Ryan, Says Obama 'Robbed' Medicare To Fund Health Reform
GOP presidential candidate Mitt Romney on Sunday came to the defense of his running mate Rep. Paul Ryan's proposals to reform Medicare, denying they would gut the program, as Democrats allege. "There's only one president that I know of in history that robbed Medicare, $716 billion to pay for a new risky program of his own that we call 'ObamaCare,'" said Romney hitting back at President Obama in an interview with CBS's "60 Minutes" scheduled to air Sunday night (Mali, 8/12).

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Ryan's Medicare Plan Comes Under Greater Scrutiny

As Rep. Paul Ryan, R-Wis., moves to the national stage as GOP presidential hopeful Mitt Romney's running mate pick, his proposals to reshape Medicare, Medicaid and other safety net programs emerge as political lightning rods.

The Wall Street Journal: Selection Sets Off Debate On Government
Until now, in a 2012 campaign bristling with negative attacks and accusations about the character of the two candidates, big policy choices have been eclipsed. That changes with the selection of Mr. Ryan, author of detailed conservative budget plans that call for major changes to many social programs, offering voters a choice: Are welfare services a safety net, or can they breed dependency? Is Medicare a social contract with the elderly, or unsustainable and in need of repair? And will cuts in government spending hurt economic growth, or foster a more robust private sector? (Hook and Paletta, 8/12).

Milwaukee Journal Sentinel: Ryan's Medicare Plan Mired In Controversy
U.S. Rep. Paul Ryan's proposals to revamp Medicare confront an economic reality: The rise in health care spending threatens the country's fiscal future. Ryan's approach - which has evolved in recent years - is the most controversial provision in his broad plan for reining in federal spending and lowering the budget deficit…. Ryan and others contend that competition among health plans will slow the rise in spending by forcing hospitals, doctors and other health care providers to become more efficient. Many economists, however, question whether that would happen (Boulton, 8/11).

The Associated Press: GOP's VP Picks' Medicare Plan Back In Spotlight
Republican Paul Ryan's blueprint for Medicare could prove as polarizing in the campaign as President Barack Obama's health care overhaul has been. Even Mitt Romney may not want to go there. Romney's new running mate has built a strong reputation on Capitol Hill for bold ideas to restrain health care costs and federal spending overall. His centerpiece idea is to steer future retirees into private insurance plans, with a fixed payment from the government that may or may not cover as much of a retiree’s costs as does the current program (8/13).

Bloomberg: Ryan Plan to Revamp Medicare With Private Choices Draws Skeptics
Paul Ryan's Medicare plan wouldn’t, as Democrats charge, end the program as Americans know it. It likely would increase costs or reduce benefits for many seniors. ... "No question" it will raise costs, said Uwe Reinhardt, a health-care economist at Princeton University, dismissing the claim that the market can solve the problem. "You can tell me that, and you can also tell me communism works if properly practiced. But show me the goods, show me that you could do that" (Faler, 8/13).

The Washington Post: With Paul Ryan As Romney's VP Pick, Democrats Pounce On GOP Budget Plan
If Romney is betting that his selection of Ryan will rally his conservative base in a nip-and-tuck election, Democrats are counting on its having the same effect on their side. For months, the Obama campaign has been trying to tie Romney to Ryan's Republican House budget proposal, which the president in April called "social Darwinism" that would pit the poor against the wealthy. Ryan has proposed major cuts to spending and entitlement programs in an effort to curb the spiraling national debt (Nakamura, 8/12).

Kaiser Health News: FAQ: How Paul Ryan Proposes To Change Medicare
Wisconsin Republican Paul Ryan, GOP presidential hopeful Mitt Romney's choice for vice president, has provoked consternation from Democrats and anxiety among some congressional Republicans with his proposals to reshape Medicare (Werber Serafini, 8/11).

The Associated Press/Washington Post: Fact Check: Romney-Ryan Team Debut Leaves Some Facts In The Dust, On Budget, Medicare And More
In his debut as Mitt Romney's running mate, Paul Ryan promised "America's comeback team" won't duck tough budget issues, although the man standing next to him has kept his head low so far. Romney vowed the duo would "preserve" Medicare, an eye-popping claim considering Ryan wants to transform the program from the ground up (8/12).

NPR: Medicaid Fight Reinvigorated With Political Light On Health Care
The addition of Rep. Paul Ryan to the GOP ticket is certain to elevate health care as a campaign issue this fall. Most of the debate is likely to be about Medicare, and Ryan's controversial plan to transform the popular program for the elderly and disabled. But some of the attention is likely to focus on Medicaid, the health care program for those with low incomes, as well (Rovner, 8/13).

CNN Money: Romney-Ryan Would Aim To Overhaul Medicaid
Ryan, currently a House Republican and picked this weekend to be Romney's running mate, wants to turn Medicaid and food stamps into block grants and make recipients work for certain benefits, according to his budget proposal unveiled in March. ... Here's how Medicaid and food stamps would work under the proposal: The federal government would give states a set amount of funds to cover their Medicaid recipients in the form of a block grant. States would also be given more flexibility to tailor the program's requirements and enrollment criteria. Ryan says his plan would curtail Medicaid spending by $810 billion over 10 years. In 2022, federal Medicaid funding would be about 34% less than states would receive under current law, according to an analysis by the Center on Budget and Policy Priorities (Luhby, 8/13).

Also from Kaiser Health News, a list of essential reading on Ryan's Medicare proposals.

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Romney-Ryan Team Hits The Campaign Trail

GOP presumptive presidential nominee Mitt Romney will make campaign appearances Monday in Florida, the senior-rich state where Medicare is a key voter concern, and where some predict Paul Ryan's budget proposals could have a negative impact. Meanwhile, the newly anointed Romney vice presidential pick will be in Iowa.

Los Angeles Times: Romney-Ryan Ticket Gets Hero's Welcome In Wisconsin
The reaction since the Saturday announcement underscored that Romney and his campaign are navigating a familiar path for candidates whose running mates are popular with the party base: trying to harness the enthusiasm without being utterly usurped by the newcomer. In Romney's case, there was an added desire to create some distance from some of the more controversial positions held by Ryan, who gained notice for a budget plan that pushed Medicare toward privatization for younger Americans (Mehta, 8/13).

The Washington Post: In Key Swing State Florida, Paul Ryan A Virtual Unknown
And so, TV and radio advertising in Florida for the next three months is likely to be relentless: President Obama's campaign will cast Ryan's proposal as the death knell of Medicare, and Romney will cast it as the program's only salvation. For Romney, the process launched Sunday, when he and Ryan, whose mother is on Medicare in Florida, appeared on CBS's "60 Minutes" and introduced Ryan's proposal as one that will save Medicare for future generations (McCrummen, 8/12).

The Wall Street Journal: Some Seniors Worry Over Ryan Selection
The news that Mitt Romney picked Rep. Paul Ryan, who has suggested changing Medicare, as his running mate sparked worries over the weekend among some residents at the Stella Maris retirement community in Miami Beach—concerns that could reverberate among seniors nationwide. Mr. Ryan has proposed overhauling Medicare and Social Security—including introducing private accounts for Social Security and giving future retirees the option to choose a privately run health insurance plan (Campo-Flores, 8/12).

The Wall Street Journal's Washington Wire: In Senior-Rich Florida, Ryan Will Discuss Medicare
Rep. Paul Ryan (R., Wis.), Mitt Romney's newly announced running mate, will head to central Florida next weekend and likely confront questions about his proposal to overhaul Medicare for future seniors (Paletta, 8/12).

Reuters: Ryan Pick Could Hurt Romney In Crucial Fight For Florida
In Florida last month, President Barack Obama worked up the crowd as he assailed a Republican plan to slash the federal budget deficit while also cutting taxes for millionaires by "squeezing more money out of our seniors." He was referring to a plan proposed by congressman Paul Ryan to get elderly Americans to pay more out of pocket for their healthcare by changing the government-run Medicare program for seniors (Brown, 8/12).

Miami Herald: Ryan Could Be A Drag On Romney In Florida
Ryan, a Wisconsin congressman, is the architect of the Ryan budget plan that makes big changes to Medicare and Medicaid and could allow for some privatization of Social Security. And that's widely seen as a politically risky stance in Florida, a must-win state for Republicans (Caputo, 8/11).

CNN: Democrats Hit Ryan Medicare Proposals As Romney Heads To Florida
Democrats followed through on a pledge Monday to peg presumptive GOP nominee Mitt Romney to the budget plan advanced by his running mate Paul Ryan, releasing web video calling the House Budget chairman's proposals to change Medicare an assault on the middle class. President Barack Obama's campaign released a spot focusing on Florida residents, who say in the video that Ryan's proposed voucher system for Medicare would amount to ending the health care system designed for senior citizens (Liptak, 8/13).

NBC (Video): Campaign Battle Focuses On Ryan's Medicare Redesign
The day after Mitt Romney's selection of House Budget Committee Chairman Paul Ryan of Wisconsin as his running mate, it was clear in the debate on Sunday talk shows that Ryan's plan to redesign Medicare for future retirees will be a primary focus of the campaign. ... According to analyses by the Congressional Budget Office and the chief Medicare actuary, Obama’s health care overhaul will reduce future Medicare spending by between $400 billion and $600 billion in its first ten years. The Medicare provisions in the Affordable Care Act are designed to squeeze savings out of Medicare by pressing hospitals, hospices and other providers to become more efficient and by reducing spending on Medicare Advantage plans (Curry, 8/12).

The Associated Press/Washington Post: Obama Targets Ryan Medicare Plan In New Video
President Barack Obama's campaign is already targeting Paul Ryan in a new online video, just two days after the Wisconsin congressman became Mitt Romney's vice presidential pick (8/13).

Also in the news, Sen. Ron Wyden, D-Ore., has found himself caught in the fray because of his past policy partnerships with Ryan.

The Washington Post: Liberal Wyden's Partnership With Ryan Becomes A GOP Talking Point
In his proud pursuit of creative, if politically implausible, policy initiatives, Wyden has in the past teamed up with the likes of Rep. Paul Ryan of Wisconsin, the newly anointed Republican vice presidential candidate. Their collaboration on a Medicare reform proposal helped cement Wyden's reputation as a "King of Policy Wonks," as he is sometimes dismissively referred to within his caucus. And it also has given Republicans some cover on the campaign trail (Horowitz, 8/12).

Roll Call: Ron Wyden Takes Issue With Mitt Romney Linking Him To Paul Ryan
At a Saturday campaign stop with his new vice presidential pick, Rep. Paul Ryan (Wis.), Romney praised the House Budget chairman's work with Democratic Sen. Ron Wyden (Ore.) to develop a Medicare overhaul plan. "This man said, 'I'm going to find Democrats to work with.' He found a Democrat to co-lead a piece of legislation that makes sure we can save Medicare," Romney said in Ashland, Va. (Lesniewski, 8/12).

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Health Reform

IRS Rule Could Keep Working-Class Families From Affordable Coverage

An IRS rule could mean some working-class families may not be able to afford employer-sponsored insurance nor qualify for federal subsidies under the health law, leaving a key part of America uninsured. Childless adults, however, are in line for significant health insurance coverage gains under the health law's Medicaid expansion.

The New York Times: Ambiguity In Health Law Could Make Family Coverage Too Costly For Many
The new health care law is known as the Affordable Care Act. But Democrats in Congress and advocates for low-income people say coverage may be unaffordable for millions of Americans because of a cramped reading of the law by the administration and by the Internal Revenue Service in particular. Under rules proposed by the service, some working-class families would be unable to afford family coverage offered by their employers, and yet they would not qualify for subsidies provided by the law (Pear, 8/11).

The Hill: Report: Medicaid Expansion Would Help Childless Adults
Single adults without children would benefit significantly from the Medicaid expansion in President Obama's health care law, according to new research. The report, written by the Urban Institute and the Robert Wood Johnson Foundation, says roughly 82 percent of the people newly eligible for Medicaid do not have a dependent child (Baker, 8/10).

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Medicare

Boomers Face Dearth Of Home Caregivers; Medicare Expands Home-Care Pilot Project

As baby boomers age, the U.S. will face a challenge trying to fill more than 1 million new home care positions to meet their needs, The Associated Press reports. In the meantime, Medicare is adding more groups to a pilot program aimed at lowering costs for Medicare beneficiaries by providing them with home-based care.

The Associated Press: Aging Baby Boomers Face Home Health Care Challenge
Demand for home health care workers is soaring as baby boomers -- the 78 million Americans born between 1946 and 1964 -- get older and states try to save money by moving people out of more costly nursing homes. But filling more than 1 million new home care positions over the next decade will be a challenge (Seewer, 8/12).

Modern Healthcare: CMS Adds Medical Practices To Home-Care Pilot Program
Three groups of medical practices were added to an eight-month-old Medicare pilot program that aims to test methods for reducing unnecessary beneficiary hospitalizations. The pilots aim to test whether primary-care services delivered in the home by multidisciplinary teams can improve care and reduce costs for beneficiaries with chronic conditions and forestall the need for institutional care. They require 24-hour availability by providers who also use electronic health information systems, remote monitoring and mobile diagnostic technology (Daly, 8/13).

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Quality

First Hospital Penalties For High Readmissions Detailed

KHN examines new penalties hospitals face under the health law. Meanwhile, Medpage Today reports on the American College of Physicians' new recommendations on government rules about doctors' interactions with patients.

Kaiser Health News: Medicare To Penalize 2,211 Hospitals For Excess Readmissions
More than 2,000 hospitals -- including some nationally recognized ones -- will be penalized by the government starting in October because many of their patients are readmitted soon after discharge, new records show (Rau, 8/13). Also, look at charts detailing the penalties by region or by state.

Kaiser Health News: Hospitals Treating The Poor Hardest Hit By Readmissions Penalties
Medicare's new crackdown on readmissions will hit hospitals that treat large numbers of low-income patients especially hard, a Kaiser Health News analysis shows. The debate over whether readmissions penalties would fall most heavily on safety-net hospitals has been a flash point since penalties were included in the 2010 health law (Rau, 8/13).

Minnesota Public Radio: Some Minn. Hospitals Penalized For Readmission Rate
At least two dozen Minnesota hospitals will have to forfeit a small fraction of their Medicare funding because patients had to be readmitted soon after discharge. The federal health care law considers readmissions a sign that a hospital could do a better job at coordinating and following up on patient care and reducing costs as a result. No Minnesota hospital faces the highest penalty of 1 percent of their Medicare funds. Mayo Clinic's Health System in Fairmont was the highest at 0.81 percent. Sanford Medical Center in Worthington and Fairview Ridges Hospital in Burnsville both face penalties of 0.43 percent (Stawicki, 8/10).

Meanwhile, Medpage Today reports on the doctor-patient relationship --

Medpage Today: ACP Tackles Government Intrusion In Doctor-Patient Relationship
In light of recently passed laws, the American College of Physicians (ACP) has released a statement of principles regarding the role of government in regulating the doctor-patient relationship. The statement offers seven recommendations, including the notion that physicians shouldn't be barred from discussing risk factors with their patients, and that laws shouldn't mandate the content of what physicians can say to patients. … Several states have proposed or enacted laws that prohibit doctors from asking their patients about risk factors, require them to provide tests that aren't supported by evidence, or limit the information they're allowed to disclose to patients. Specifically, proposed legislation in Alaska would allow patients and families to override a physician's do-not-resuscitate order, and women seeking an abortion in Arizona must have an ultrasound at least 24 hours before the procedure (Fiore, 8/10).

And in other quality news --

CQ HealthBeat: Quality Forum Recommends Measurements On Cancer, Care Coordination And Disparities
The National Quality Forum endorsed several quality measures Friday on cancer treatment, care coordination and health care disparities. The standards on disparities are the first comprehensive set of measures targeting the problem of health disparities among different populations. The forum is a voluntary consensus standards-setting organization. Medicare officials consider NQF-endorsed measures when setting federal policies. Individuals or groups that disagree with any of the standards can request reconsideration of them by submitting an appeal no later than Sept. 10 (Adams, 8/10).

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State Watch

Some Mass. Health Premiums To Rise; Blue Shield Of Calif. CEO Pay Down Slightly

The increase in Massachusetts' small business and individual health care insurance premiums is down from increases of 5.5 percent on average last year.

The Boston Globe: Insurance Costs Rise Modestly
Small businesses and individuals whose annual health insurance policies renew on Oct. 1 will see average premium base rate hikes of 2.1 percent in Massachusetts, increases that are more modest than the 5.5 percent average boost in base rates they absorbed a year ago. But despite the trend of moderating increases in the past two years, the new rate hikes ticked up from the 0.7 percent average increases on policies that renewed July 1, according to data filed Friday by the state Division of Insurance (Weisman, 8/11).

Meanwhile, in California -

Los Angeles Times: Blue Shield Top Executives' Pay Changed Little In 2011
Nonprofit insurer Blue Shield of California said its outgoing chief executive earned $4.6 million last year, off slightly from a year earlier, as all insurance companies faced new government rules on how customer premiums are spent (Terhune, 8/11).

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Medicaid Expansion Would Have Major Effect On State Economy

The Atlanta Journal-Constitution examines issues surrounding the expansion of Medicaid coverage under the health law and notes that the extra federal money coming into the state would have a $72 billion economic impact over 10 years.

Atlanta Journal-Constitution: Medicaid: Flood Of Funds Awaits OK In Georgia
Viewing the Medicaid expansion from a business perspective makes it harder to reject, some economists argue, especially at a time when Georgia's economy needs every boost it can get. The federal dollars would cycle through the state's economy and have an overall economic impact of $72 billion between 2014 and 2023, said Jeff Humphreys, director of the University of Georgia's Selig Center for Economic Growth. That computes to $16 in impact from federal dollars for every $1 from state coffers, Humphreys projected (Teegardin and Williams, 8/12). 

The Atlanta Journal-Constitution: Medicaid: Projection At Issue
Budget gurus and health officials in every state are trying to project the costs and benefits of the Affordable Care Act. Georgia is no exception. As state officials try to decide whether Georgia will agree to expand its Medicaid program, putting a price tag on that decision has been the first order of business. Some experts who have reviewed the numbers say the state's projections may overstate the likely costs (Teegardin, 8/12).

The Journal Constitution also offers a look at governors' views on Medicaid block grants and what other states have decided on expansion.

The expansion also makes news in Arizona --

The Arizona Republic: Brewer Advisers Form Health Pact To Push To Expand Medicaid
Two key advisers to Gov. Jan Brewer are attempting to create a coalition of hospitals, insurance plans, providers and other players to push Arizona to expand Medicaid under federal health-care reform. Last week, the board of a statewide group of human-services providers agreed to hire Chuck Coughlin and Peter Burns, and the state's largest hospitals and health plans are considering signing on (Reinhart and Wingett Sanchez, 8/12).

In other Medicaid news --

The Atlanta Journal-Constitution: Judge Orders Drug For Premature Birth To Be Covered By Medicaid
A judge has ordered the state to halt a policy that made it difficult for women to get Medicaid coverage for a pricey drug that prevents premature births. U.S. District Judge Charles Pannell granted a victory to K-V Pharmaceutical Co., which had accused the Department of Community Health of preventing pregnant women from getting its drug, Makena. State officials had argued that a readily available custom-compounded drug costs far less and has no major safety issues (Rankin, 8/10).

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State Roundup: Fla. Groups Ask Gov. For Essential Benefits Hearings

A selection of health policy stories from Massachusetts, Florida, Ohio, Texas, Colorado and Washington state.

Medscape: Ban On Industry-Provided Meals To Docs Lifted In Massachusetts
In a reversal of a law passed 4 years ago, physicians in Massachusetts will now be allowed to accept "modest" meals and refreshments provided by pharmaceutical or medical device companies. When he approved the state budget, Gov. Deval Patrick last month repealed part of the Massachusetts Pharmaceutical and Medical Device Gift Ban and Disclosure Law that banned such meals to physicians and other health professionals. The meals for physicians must happen "in a venue and manner conducive to informational communication," essentially outside the physician's office, the new law says (Crane, 8/10).

Health News Florida: Groups Ask Scott To Hold Hearings On Health Benefits
A coalition of Affordable Care Act supporters is asking Gov. Rick Scott to hold hearings on the issue of which health benefits should be covered on all insurance policies to be offered as of 2014. The federal government allows each state to design the minimum-benefit package, called "Essential Health Benefits," as long as such items as preventive care, childbirth and hospitalization are included. In a letter released today, the groups say that if Florida continues to ignore the law, the federal government will determine which benefits citizens in the state will be able to choose when the coverage takes effect (8/10).

The Associated Press: Tea Party Evolves, Achieves State Policy Victories
Tea party activists in Georgia helped kill a proposed sales tax increase that would have raised billions of dollars for transportation projects. In Pennsylvania, tea partyers pushed to have taxpayers send public school children to private schools. In Ohio, they drove a referendum to block state health insurance mandates. Activists in Ohio forced the ballot initiative on health care by gathering more than 400,000 signatures and hiring consultants to get 100,000 more. Chris Littleton, a former tea party organizer, led the effort without the tea party label. The measure prevailed 2-to-1, he said, partly because the tea party name didn't drive debate (Barrow, 8/12).

The Texas Tribune: Looking To Mexico For Alternative To Abortion Clinics
In this Roman Catholic stronghold, where abortion is deeply stigmatized, reproductive health providers tell stories of women going to pharmacies across the border in Mexico, in search of a drug they hope will terminate unwanted pregnancies. But the providers say that the pharmacies, which are largely unregulated, often fail to give proper instructions for the drug, misoprostol, and that it does not always give the women the result they seek (8/12).

The Denver Post: Colorado CREATE Program Helps Health Care Students Fill Gap In Care
CREATE Health Scholars, part of an initiative funded by the Colorado Health Foundation, already has aided about 140 over the past three summers. It's not so much that there is a statewide shortage of health care professionals -- it's that a relatively small percentage of them practice in rural areas, said Amy Downs, senior director for policy and analysis for the Colorado Health Institute (Simpson, 8/12).

The Seattle Times: Cancer-Screening Program Reaches Out To Pacific Islander Women
Wearing a black T-shirt that reads, "I am on the clock: end breast cancer by Jan. 1, 2020," Fa'amaile Frost spends Monday afternoons at the Filipino Community Center in Seattle urging women to schedule regular mammograms and Pap smears. Frost, who works with International Community Health Services (ICHS), reaches out to Pacific Islander women -- often skeptical or unaware of the importance of these tests — at her physical-activity and diabetes-awareness classes, and in churches and community centers. If they agree, she refers them to free or low-cost providers. Frost is Samoan, and in sharing a similar cultural thread, she's able to gain the women's trust (Araya, 8/12).

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Editorials and Opinions

Choice Of Ryan Energizes Campaign--For Both GOP And Dems

Many outlets offer views of Rep. Paul Ryan after GOP presidential contender Mitt Romney named him as his vice presidential choice.

Bloomberg: Romney-Ryan Could Be Just The Ticket For A Useful Debate
By choosing U.S. Representative Paul Ryan as his running mate, Mitt Romney has added some verve to what had been a tedious presidential contest. ... Now we have the potential at least for a true contest of ideas: What is the optimum size and role of government? What is the best way to reduce trillion-dollar annual deficits and $15 trillion in total debt? With a rapidly graying population and entitlements that eat up most of the federal budget, can Medicare’s growth be stopped without impoverishing senior citizens? Is it time to raise taxes, even on the middle class (8/12)?

USA Today: Why The Ryan Selection Draws Smiles On Both Sides
Republicans — particularly those in the vanguard of the movement to radically reduce the role of government — are thrilled. Ryan is not just one of their own; he's the intellectual leader of the House insurrection against big government and the architect of a controversial budget plan that would rein it in. He also could be the most personally appealing advocate for it — smart, affable and a natural politician. By putting Ryan on the ticket, Romney effectively adopted his plan, turning an election he once cast as a referendum on President Obama into a test of conflicting visions.The Democrats, meanwhile, had been quietly hoping for months that Romney would pick Ryan over less controversial choices (8/12).

The Wall Street Journal: The Ryan Choice
Mr. Obama has always shied away from directly debating Mr. Ryan on health care and spending. He changed the subject or moved on to someone else. The President knows that Mr. Ryan knows more about the budget and taxes than he does, and that the young Republican can argue the issues in equally moral terms (8/11).

The Wall Street Journal: Why Romney Chose Ryan
Mitt Romney did much more this weekend than announce a running mate. He unveiled a significant change in strategy. The 2012 election is now a choice, not just a referendum (Kimberley A. Strassel, 8/12).

The New York Times: Mr. Ryan's Cramped Vision
As House Budget Committee chairman, Mr. Ryan has drawn a blueprint of a government that will be absent when people need it the most. ... And it will be silent when the elderly cannot keep up with the costs of M.R.I.'s or prescription medicines, or when the poor and uninsured become increasingly sick through lack of preventive care (8/11).

The New York Times: The Romney-Ryan Plan For America
Most voters know little about Mr. Ryan. Those who have heard of him are probably most familiar with his Medicare plan, which would turn the program into a voucher system that would pay beneficiaries a fixed amount for their medical care, leaving them on their own if the voucher did not cover their costs. This notion so alarmed the public last year that Mr. Ryan was forced to backtrack and leave the existing Medicare system as an option. Even so, the plan would leave older Americans on average with $6,400 in extra costs by 2022, according to the Congressional Budget Office (8/12).

Los Angeles Times: The Paul Ryan Choice
Rep. Paul Ryan (R-Wis.) is Mitt Romney's Al Gore, a policy wonk who brings legislative experience and seriousness of purpose to the ticket. He is, in other words, no Sarah Palin. But Ryan is also the symbol of something more: a commitment to a particularly conservative vision of a smaller federal government, a scaled-back safety net and a lower tax burden. ... By choosing Ryan, Romney answered the critics (particularly on the right) who questioned whether his campaign had a vision for the future. If there were voters who harbored any doubt about the magnitude of the choice they face in November, they should no longer (8/12).

Bloomberg: Paul Ryan Is Thoughtful, Handsome and Misguided
Ryan's approach to health care is somewhat akin to a doctor observing that an arm is finally showing some signs of healing -- and then deciding to amputate it. Over the past several years, health-care costs have decelerated dramatically -- suggesting our broken arm may slowly be starting to heal. But rather than reinforcing that progress, Ryan would chart a drastically different course, one that would not only shift substantial risk to beneficiaries but also, according to the Congressional Budget Office, actually raise health-care costs (Peter Orzag, 8/11).

The Washington Post: Understanding The Ryan Plan
The striking thing about Paul Ryan's ascent is the gulf between his proposals and the way the media have characterized them. Since Mitt Romney named Ryan to the ticket on Saturday, the news has been filled with talk of the "fiscal conservative" (NPR) "intent on erasing deficits" (New York Times) who has become "the intellectual heart of the Republican Party's movement to slash deficits" (The Post). All of this is demonstrably false. Ryan's con has succeeded largely because Democrats haven't sensed the political salience of assailing his plans from the right; instead, they've chosen to slam only Ryan's regressive priorities and Medicare scheme (Matt Miller, 8/12).

The Washington Post: Paul Ryan Could Inspire Meaningful Debate
The selection of Paul Ryan — chairman of the House Budget Committee — as Mitt Romney's vice presidential candidate has the potential to turn this dreary presidential campaign into a meaningful debate over the size and role of the federal government. It could also (sadly) litter the debate with so many exaggerations, distortions and falsehoods that Americans end up less informed and less able to make sensible choices (Robert J. Samuelson, 8/12).

Baltimore Sun: With Paul Ryan, Romney Bets On The Wrong Vision For America
Mitt Romney said he wanted to select a vice presidential candidate who had a vision for America, and that he did. In fact, Wisconsin Rep. Paul Ryan likely beats out his prospective boss in the vision department, having provided the most concrete and detailed expression of how ultra-fiscal conservatism would actually transform our government. Unfortunately, the vision is the wrong one. Mr. Ryan's proposals for the federal budget would end Medicare as we know it and decimate safety net programs for the poor, all while offering huge tax breaks for the wealthy and failing to meaningfully address the budget deficit (8/11).

San Francisco Chronicle: Romney Reaches To Right With Paul Ryan
President Obama and his supporters will find it tempting to exploit Ryan's willingness to take on deficits and the growth of entitlement programs. No question, some of Ryan's government-shrinking ideas go beyond the comfort zone of Americans who accept a basic role of government to provide a safety net for the poor and retirement security for the elderly. Still, there is peril for the Obama camp in trying to demonize Ryan's fiscal hawkishness. Many younger voters -- including some who voted for Obama in 2008 -- are justifiably nervous about the debt this nation is incurring and the long-term sustainability of entitlement programs (8/12).

NBC Latino: Paul Ryan's Policies, If Implemented Will Have Deep Consequences For Latinos
Just to give you one example, Medicare reform will have a great impact on the future wellness of Latinos.  Latinos make up a young population with a median age of 27 years, while the median age of non-Hispanic whites is 42 years old. This means that the vast majority of the population that is retired is non-Hispanic white, and by extension, the vast majority of Medicare recipients are also non-Hispanic white. Yet, any tinkering of Medicare will have the greatest impact on the benefits of future participants, not current ones (Stephen A. Nuño, 8/12).

Boston Globe: The Romney-Ryan $700B Disagreement
Even in Washington, $700 billion is a lot of dough, so it's worth focusing on the fact that Republican Presidential nominee Mitt Romney and his chosen running mate, Cong. Paul Ryan (R-WI) disagree about $700 billion in Medicare reductions included in the Affordable Care Act (aka: ACA, ObamaCare). This difference is important and compelling from both policy and political vantage points (John McDonough, 8/12).

iWatch News:  Rep. Ryan's Budget Plan Is A "Path To The Poorhouse"
If Americans who are embracing Rep. Paul Ryan's "Path to Prosperity" — and that now includes Mitt Romney — spent a few minutes reviewing a few recent research reports, they just might conclude that the Wisconsin Republican's plan to reduce the deficit might better be renamed the "Path to the Poorhouse" because of what it would mean to the Medicare program and many senior citizens (Wendell Potter, 8/11).

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Health Law Critically Important To Women; Expanding Medicaid Could Spur State Education Cuts; Misuse Of Antipsychotics In Dementia Patients

The Arizona Republic: Health-Care Law Will Help Boost Women's Access
If we can set aside the political wrangling and focus on the benefits of the Affordable Care Act, what becomes obvious is its critically important impact on women's health. The fact is while women are the primary coordinators of health care for families and comprise the majority of U.S. health-care workers, they also put their own health-care needs behind those of their children. Cost is too often the reason (Brenda Thomas, 8/12).

Philadelphia Inquirer: Obamacare's Opponents Just Won't Stop
Will they ever give up? House Republicans have devised yet another plan to try to undermine the health reform law. This one is an attempt at an end-run around the Supreme Court ruling that upheld it. The Court found that the law's individual mandate to maintain health insurance is constitutional. It reasoned that the penalty for failure to comply with it functions in the same way as a tax. As such, Congress has broad power under the Constitution to impose it. The end-run takes that form of an amendment to the law introduced by Rep. Raul Labrador (R-Idaho) to "clarify" that the penalty shall not be construed as a tax. The measure has four Republican co-sponsors. What's the point? (Robert I. Field, 8/10).

Baltimore Sun: The False Promise Of Dementia Drugs
Federal officials are working to place compassion at the center of how our nation aims to treat elderly patients suffering from dementia. The Centers for Medicare and Medicaid Services (CMS) has announced that they'll coordinate an effort to dramatically reduce the use of antipsychotic drugs among dementia patients in nursing homes. The agency's plan acknowledges that these powerful pharmaceuticals are often overused — and represents a valuable first step toward improving the way we treat people with this condition. But government alone shouldn't dictate how we deal with dementia. Families and caregivers must also recognize when medication is appropriate — and when it's not (Dr. Cheryl Phillips, 8/13).

San Francisco Chronicle: As Medi-Cal Soars, Higher Education Loses
Now Medicaid is split between states and the federal government. And although the federal government will pay the entire cost of the expansion beginning in 2014, three years later states will have to begin sharing the cost. That might leave less money than ever for higher education. The result: higher tuition and fees as academic institutions scramble for ever-scarcer dollars from state budgets (Maura J. Casey, 8/10).

The Orlando-Sentinel: Medicaid Expansion: An Ounce Of Prevention Well Worth It
"An ounce of prevention is worth a pound of cure," Benjamin Franklin wrote in "Poor Richard's Almanack." Gov. Rick Scott should heed the advice of Franklin and accept the Affordable Care Act expansion of Medicaid. In this instance, federal funding serves as the "ounce of prevention," as it will prevent death, serious injury and medical debt. The "pound of cure" offered by Scott is higher insurance premiums and rising public costs. ... the expansion would provide health insurance to low-income working-class people who don't have insurance through their employers (Michael Vaghaiwalla, 8/11).

Sacramento Bee: Mental Health Spending Needs An Honest Audit
Two Republican legislators have requested an audit of the billions raised by the Proposition 63 tax on wealthy Californians to pay for mental health services. The request came late in the session, and the committee that decides whether to order audits is not scheduled to meet until a new Legislature is sworn in. But the Democratic-controlled Legislature should find a way to meet this request. Over the years, there have been many accounts of Proposition 63 money being misspent. The issue is too important to let slide (8/10).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.