Daily Health Policy Report

Tuesday, August 14, 2012

Last updated: Tue, Aug 14

KHN Original Reporting & Guest Opinion

Campaign 2012

Health Reform


Health Information Technology

Health Care Fraud & Abuse

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Health On The Hill: Romney's Choice Of Ryan Is Key To Politics Of Medicare Debate (Video)

Kaiser Health News staff writers Mary Agnes Carey and Marilyn Werber Serafini discuss how Medicare reforms could figure into November's presidential election now that presumptive GOP presidential candidate Mitt Romney has chosen Rep. Paul Ryan, R-Wis., to be his running mate (8/13). Watch the video.

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Insuring Your Health: Many People Would Like To Know Their Risk Of Developing Alzheimer's Disease

Kaiser Health News consumer columnist Michelle Andrews writes: "Alzheimer's disease can't be prevented or cured, and it ranks second only to cancer among diseases that people fear. Still, a study last year found that about two-thirds of respondents would want to know if they were destined to get the disease" (Andrews, 8/13). Read the column.

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U.S. Should Make 'Life-Long Homes' A Priority, Says Henry Cisneros

Reporting for Kaiser Health News, Judith Graham writes: "What will it take for Americans to age successfully in place? This question has immediate importance for policymakers and families as an estimated 10,000 Baby Boomers turn 65 years old every day. It's the subject of a new book, 'Independent for Life: Homes and Neighborhoods for an Aging America,' authored by more than a dozen leading aging and housing experts and co-edited by Henry Cisneros, a four-term mayor of San Antonio and former secretary of the U.S. Department of Housing and Urban Development" (Graham, 8/13). Read the interview.

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Capsules: Regulators Urged To Move Swiftly To Prevent 'Rate Shocks'

Now on Kaiser Health News blog, Julie Appleby writes: "Consumer groups on Monday said state and federal regulators should move quickly to set rules to protect Americans from health insurance premium 'rate shocks' and to prevent insurers from charging far higher rates in low income areas, when major provisions of the federal health law take effect in 2014" (Appleby, 8/13). Check out what else is on the blog.

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Political Cartoon: 'Elect-rifying Choice?'

Kaiser Health News provides a fresh take on health policy developments with "Elect-rifying Choice?" by Steve Greenberg.

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


Who is Paul Ryan?
When it comes to Medicare
the answer matters.

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

How Team Romney-Ryan Is Playing On The Campaign Trail

The Medicare plan advanced by Rep. Paul Ryan, R-Wis., who has been tapped by GOP presumptive presidential nominee Mitt Romney to be his running mate, almost immediately emerged as a campaign flashpoint.

The Associated Press: GOP Ticket Faces Growing Pains As Dems Attack
The newly shaped Republican presidential ticket is fighting growing pains amid charges from President Barack Obama's re-election team that challenger Mitt Romney favors his new running mate's controversial plans to overhaul Medicare and cut trillions of dollars from social programs (8/14).

The Washington Post: Both Camps Hit Trail Running In Race To Define GOP Ticket
President Obama, beginning a bus tour in Iowa, sought to use Ryan's seven terms in the House to lash the Republican ticket to dysfunction in Congress. In North Carolina, Vice President Biden deepened an assault on the GOP ticket over Ryan's proposal to slash the federal budget and overhaul Medicare. And the Republican team gave a glimpse of how it hopes to deploy the 42-year-old: as an energetic charmer at ease campaigning in his native Midwest. On Monday, he took the spotlight in front of thousands at the Iowa State Fair in Des Moines. Far from playing the part of a conservative ideologue, … he avoided any mention of his signature effort to reform domestic entitlement programs. But he was heckled by protesters over his budget plans nonetheless, quickly transforming his first solo appearance as a national candidate into a chaotic spectacle (Gardner and Helderman, 8/13).

The Wall Street Journal: Presidential Race Snaps Into Gear
The presidential candidates traded barbs on Medicare and the economy in three battleground states Monday, as the campaign for the White House sped into a sprint. The day mixed debate on the central fiscal issues facing Washington with traditional on-the-ground campaigning at venues including the Iowa State Fair in Des Moines, where Rep. Paul Ryan, in jeans and cowboy boots, made his first solo appearance since joining the GOP ticket. Across the state at a family farm in western Iowa, President Barack Obama, also in casual clothes, pledged aid to farmers suffering from a drought that has slashed crop yields (Murray, Lee and Nelson, 8/13).

The New York Times: Medicare Rises As Prime Election Issue
With Mitt Romney's selection of Representative Paul D. Ryan as his running mate, Florida quickly emerged on Monday as a critical test of the nationwide Republican gamble that concerns over the mounting federal debt can blunt potent Democratic attacks on conservative proposals to revamp Medicare (Nagourney, 8/13).

Los Angeles Times: In Florida, Romney Attacks Obama, Defends Ryan, On Medicare
From the moment Paul D. Ryan was picked as Mitt Romney's running mate, speculation mounted about whether the Wisconsin congressman's controversial proposal to reform Medicare would harm the ticket's prospects among seniors, notably in this battleground state. On Monday, as Romney campaigned on Florida's Gold Coast, he argued that Ryan and Republicans sought to protect the healthcare program for the elderly and that President Obama would gut it (Mehta, 8/14).

Miami Herald: Mitt Romney Returns To Florida With Medicare Back As Central Issue
Mitt Romney mentioned the word Medicare only twice Monday in his first Florida stop in St. Augustine after picking a running mate, but no one doubts it will be a central part of the campaign fight in this must-win state. "The president's idea for Medicare was to cut it by $700 billion," Romney said during a morning rally in St. Augustine. "That's not the right answer. We need to make sure we can preserve and protect Medicare." On his second stop in in West Miami-Dade at El Palacio de Los Jugos, the Republican presidential nominee was greeted by a large, enthusiastic crowd where he gave his standard stump speech — absent a single mention of Medicare (Smith, Caputo and Mitchell, 8/13).

CBS (Video): Romney Cautious About Medicare Stance In Fla.
Ryan backs that up with a serious plan to dramatically cut the budget, rein in spending, and reform entitlement programs like Medicare. But Romney, perhaps cautious of polls that show people like the current system, struck a more cautious and vague note on change. Romney's website says Ryan's plan "almost precisely mirrors Mitt's ideas." But pressed on Monday, Romney wouldn't even say that. "The items that we agree on I think outweigh any differences there may be," Romney said. "We haven't gone through piece by piece and said, 'Oh, here's a place where there's a difference'" (Crawford, 8/14).

Politico: In Florida, Mitt Romney Finds No Split On Paul Ryan Budget
Romney's decision to pick Paul Ryan as his No. 2 thrust the congressman's plans to overhaul Medicare, an entitlement program on which many seniors are dependent, into the spotlight. Given the politically explosive nature of that debate, especially in a place like Florida, Romney has said that while Ryan's plan is on the right track, he would propose his own budget as president. But the presumptive GOP nominee didn't answer how that plan might differ from Ryan's "Path to Prosperity" on Monday in Florida (Gibson, 8/13).

Bloomberg: Romney Campaigning In Florida Attacks Obama On Medicare
Presumed Republican presidential nominee Mitt Romney, moving aggressively to defend his running mate's budget blueprint, charged that President Barack Obama is weakening Medicare while his party is working to save it. Romney used a visit to Florida -- home to the nation's largest population of seniors -- to wade into a politically risky debate over the government health program for the elderly, citing the Medicare plan offered by his vice presidential pick, Representative Paul Ryan, as an example of the contrast between the Republican's vision and Obama's (Hirschfield Davis, 8/13).

Bloomberg: Romney Defends Medicare Proposal to Anxious Ohio Seniors
When Mitt Romney arrives in Ohio today, he’ll be facing undecided voters like Doug Phelps who worry the Republican presidential candidate and his newly chosen running mate will make big changes to a program they cherish. Without Medicare, Phelps, a 69-year-old barber from suburban Columbus, could never have afforded the $171,000 heart surgery he had last year -- his coverage combined with his wife's health insurance allowed them to pay less than $50 for the procedure. And Phelps wants to know more details about both Romney's and President Barack Obama's plans for Medicare (Niquette and Hirschfield Davis, 8/14).

Philadelphia Inquirer: Romney: Time To Be 'More Like America'
The GOP presidential candidate barely mentioned Medicare, the issue that has become a focus of the presidential race since he named as his running mate U.S. Rep. Paul Ryan (R., Wis.), the House Budget Committee chairman, who has proposed a partial privatization of the health-insurance program for seniors. The issue could bedevil the Republican ticket in two states that may hold the key to an Electoral College victory and have some of the highest percentages of voters who rely on Medicare and Social Security: Florida and Pennsylvania (Fitzgerald, 8/14).

The Associated Press/Washington Post: Dems Insist Romney Quietly Supports Ryan's Budgets
Led by President Barack Obama, Democrats claimed on Monday that Republican challenger Mitt Romney privately backs controversial plans to overhaul Medicare and cut trillions from social programs that his new vice presidential running mate has publicly proposed. Rep. Paul Ryan "has given definition to the vague commitments that Romney has been making," Vice President Joe Biden said as the Democrats welcomed the Wisconsin lawmaker to the race with a barrage of criticism (8/13).

Politico: GOP Memo: 'Don't Say Entitlement Reform'
It only took two hours after the Paul Ryan vice presidential announcement for Republican congressional candidates to get their talking points on how to spin the Ryan budget and Medicare attacks. "Do not say: 'entitlement reform,' 'privatization,' 'every option is on the table,'" the National Republican Congressional Committee said in an email memo. "Do say: 'strengthen,' 'secure,' 'save,' 'preserve, 'protect'" (Isenstadt, 8/13).

CNN: Labor Group To Target Ryan, Romney Over Medicare
Voters in Ohio and Nevada, the states which Mitt Romney and Paul Ryan will visit on Tuesday, may encounter a web ad or mailer hitting the Republican candidates on the issues of Medicare and Coal. Worker's Voice said it plans to spend $50,000 on web advertisements in Nevada which tie the Medicare plan proposed by Ryan to Romney and to Sen. Dean Heller. Romney is to campaign in Ohio on Tuesday and Ryan heads to Las Vegas in the evening after an afternoon event in Colorado (8/14).

Kaiser Health News: Health On The Hill: Romney's Choice Of Ryan Is Key To Politics Of Medicare Debate (Video)
Kaiser Health News staff writers Mary Agnes Carey and Marilyn Werber Serafini discuss how Medicare reforms could figure into November's presidential election now that presumptive GOP presidential candidate Mitt Romney has chosen Rep. Paul Ryan, R-Wis., to be his running mate (8/13).

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Under The Microscope: Ryan's Plans For Medicare, Medicaid And The Budget

News outlets examine how Medicare and Medicaid fare in the budget blueprint advanced by Rep. Paul Ryan, R-Wis., chairman of the House Budget Committee and GOP presidential hopeful Mitt Romney's vice presidential pick.   

Los Angeles Times: A Closer Look At Paul Ryan's Federal Budget Plan
Under Ryan's plan, which has passed the Republican-controlled House twice in slightly different versions, the Internal Revenue Service would tax the wealthiest Americans less, but many of the poorest ones more; Medicare would be transformed; Medicaid would be cut by about a third; and all functions of government other than those health programs, Social Security and the military would shrink to levels not seen since the 1930s (Lauter and Mascaro, 8/14).

The Associated Press: Ryan's Medicare Plan Would Be Tricky To Pull Off
The idea behind Paul Ryan's Medicare plan is to slow growing costs and keep the program more affordable for the long haul. But it's all in the details. The Republican-backed shift to private insurance plans could saddle future retirees with thousands of dollars a year in additional bills (Alonso-Zaldivar, 8/13).

The Fiscal Times:  No Matter Who Wins, Health Care Rationing Is Coming
Medicare has moved to the center of this year’s presidential campaign for a single overriding reason: shrinking the nation’s long-term government deficit demands dealing with health care costs. No one -- left, center or right -- disagrees with that analysis…But the debate is now focused on the government side of the ledger because Republican candidate Mitt Romney chose Rep. Paul Ryan, R-Wis., who has championed Medicare privatization, as his running mate. They are offering voters a stark choice on Medicare from President Obama and the Democrats. It can be distilled down to a single, simple question: Who will be on the hook if the health care delivery system fails to limit health care cost growth – individual seniors or the government (Goozner, 8/14)?

CQ HealthBeat: Ryan Prescription For Entitlement Costs Would Dramatically Remold Medicaid
Mitt Romney's selection of Rep. Paul D. Ryan as his running mate will mean sharper national scrutiny of his plan to remold Medicaid in addition to Medicare. Left-leaning analysts say millions more Americans would become uninsured under the changes he proposed to the health care program for the poor. Ryan says in his "Path to Prosperity" budget proposal that his plan would give states "greater flexibility to help recipients build self-sufficient futures for themselves and their families." It's the same plan that proposes to transform Medicare into a premium support program (Reichard, 8/13).

The Hill: Liberal Think Tank Says Ryan's Medicare Arguments Is Dishonest
Rep. Paul Ryan's (R-Wis.) budget proposal would keep the Medicare cuts in President Obama's health care law, the liberal Center for American Progress noted Monday. The political battle over Medicare has intensified yet again since Mitt Romney announced Ryan as his pick for vice president on Saturday. Ryan, the chairman of the House Budget Committee, is the author and champion of two budget plans that would dramatically overhaul Medicare (Baker, 8/13).

CQ HealthBeat: Premium Support Moves To Prime Spot In Policy Debate
Mitt Romney's choice of Rep. Paul D. Ryan as his running mate accelerates a national debate over a premium support-based overhaul of the Medicare program -- possibly teeing it up for prime consideration in Congress next year if the Republican ticket proves to be a winner with the voters. The premium support blueprint is controversial, to be sure. But it can't be laughed off as purely partisan, as doggedly as Democrats will try. It has proved to be attractive to such influential Democratic thinkers as former Congressional Budget Office (CBO) directors Alice Rivlin and Robert Reischauer. And it's an idea that has led pragmatic Democrats like Oregon Sen. Ron Wyden to think Medicare's core promise -- a guarantee of decent affordable health care during old age -- can be kept in a way that finds common ground with Republicans who insist that Medicare spending must be reined in sharply to defuse the debt crisis (Reichard, 8/13).

Des Moines Register: Iowans Look Anew At Medicare Ideas
Vice presidential candidate Paul Ryan’s plan to overhaul Medicare in an attempt to slow ballooning costs and keep the program affordable promises to cast a long shadow in Iowa, experts said. Past proposals to change the federal health insurance program for seniors have collapsed under deep public skepticism, but there are signs people in Iowa and across the nation are taking a more nuanced view this election cycle(Krogstad, 8/14).

Medpage Today: Romney VP Pick Could Mean Big Medicare Changes
Ryan's proposal for overhauling Medicaid involves the use of block grants. The federal government would cap the Medicaid spending in each state and let the states figure out funding rates themselves. Also on his website, Ryan says constant forestalling of changes to Medicare's Sustainable Growth Rate formula for physician reimbursement is unacceptable. "Physicians should not have to wait on Congress to act every year in order to prevent pay cuts that are arbitrarily determined by an outdated formula," he writes (Pittman, 8/13).

Medpage Today: Campaign: Ryan's Medicare Policies Draw Fire
Several health care groups are opposing the policy ideas of new Republican vice presidential candidate Paul Ryan, claiming his proposals for Medicare and Medicaid reform would do more harm than good. … The American Academy of Family Physicians (AAFP) opposes premium support. As health care costs increase, the fixed government contribution for premiums would prevent great increases in support, forcing beneficiaries to pay more, AAFP President Glen Stream, MD, noted in an interview with MedPage Today Monday. …The Center for Budget and Policy Priorities, a liberal think tank, says over time seniors would be able to purchase fewer benefits. The group's March analysis of Ryan's plan also states a premium-support proposal would increase health care costs because private insurance plans seniors would purchase provide higher payments to providers (Pittman, 8/13).

The Texas Tribune: Ryan's Plan For Medicaid, Medicare Mirrors Texas Bills
If Republican vice presidential hopeful Paul Ryan's controversial plan for reforming Medicaid and Medicare sounds familiar in Texas, it should. The Wisconsin congressman’s proposal bears strong similarities to bills that Texas Republicans advocated for -- and eventually passed -- during the last legislative session (Ramshaw, 8/14).

Meanwhile, Politico takes a look at Ryan's broader congressional voting record --

Politico Pro: Ryan's Record: Big-Spending Conservatism
Paul Ryan rose to the top of the political ranks on his reputation as a conservative budget hawk. But his voting record shows him to be far from a pure fiscal conservative. Ryan voted for the $700 billion bank bailout, the biggest Medicare expansion in U.S. history, a massive highway bill that included the "Bridge to Nowhere" and other big-ticket priorities when George W. Bush was president -- going to bat for a high-spending GOP agenda that the tea party base now looks on with regret (Restuccia and Kim, 8/13).

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Democrats Hammer GOP Candidates Over Ryan's Plan To Overhaul Medicare

Democrats running for seats in the House and Senate are spotlighting Republican plans to refashion the health insurance program for the elderly and disabled.

Politico: Warren Ties Brown To Ryan Plan
Over in Massachusetts, Elizabeth Warren is the latest Democratic Senate candidate to use Paul Ryan as a line of attack against her GOP opponent (Schultheis, 8/13).

St. Louis Beacon:  Akin Launches TV Ad That Attacks McCaskill For Attacking Him On Medicare, Social Security
Facing attacks on the ground and the airwaves, Republican U.S. Senate nominee Todd Akin is launching a counterattack with his first post-primary TV ad that his campaign contends "holds embattled Senator Claire McCaskill accountable for her desperate and misleading attacks..." The Akin ad is running statewide, his campaign said late Monday. It contends that recent ad attacks by McCaskill, D-Mo., and the national Democratic Senatorial Campaign Committee are "misleading, deceptive, false."  In particular, the TV spot asserts that Akin "fights to protect and strengthen Medicare and Social Security" (Mannies, 8/14).

Philadelphia Inquirer: Area Democrats Try To Use Ryan Against Congressional Incumbents
Using a South Philadelphia senior center as a backdrop, the Democrats hammered U.S. Reps. Mike Fitzpatrick, Jim Gerlach, and Patrick Meehan for their past votes in favor of Ryan's fiscal plan, his signature proposal. The plan includes a controversial call for overhauling Medicare by relying in part on private insurance. "Mitt Romney has made his decision; now Congressman Meehan's votes for the Ryan plan to privatize Medicare are all the more real, serious, and dangerous," said George Badey, who spoke alongside fellow congressional candidates Katherine Boockvar and Manan Trivedi (Tamari and Lai, 8/14).

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Health Reform

Obama Administration Urges States To Move Forward On Health Exchanges

Administration officials will "try to encourage reluctant states" to move forward with health exchanges, even as time appears to be running out, Reuters reports. Also in the news, consumer representatives from the National Association of Insurance Commissioners offered state and federal officials suggestions about how they should write regulations to implement the health law's key consumer protections.

Reuters: Obama Pushes For State Help On Health Exchanges
The Obama administration this week will try to encourage reluctant U.S. states to move forward with health insurance exchanges amid fears that time is running out for states to act on a reform provision meant to extend coverage to millions of low-to-moderate income uninsured Americans. The U.S. Department of Health and Human Services has scheduled four regional meetings this month to discuss the exchanges and other aspects of President Barack Obama's healthcare reform law with state officials and others (Morgan, 8/13).

Kaiser Health News: Capsules: Regulators Urged To Move Swiftly To Prevent 'Rate Shocks'
Consumer groups on Monday said state and federal regulators should move quickly to set rules to protect Americans from health insurance premium 'rate shocks' and to prevent insurers from charging far higher rates in low income areas, when major provisions of the federal health law take effect in 2014 (Appleby, 8/13). 

CQ HealthBeat: Protecting Consumers Means Mastering Fine Points Of Writing Health Law Regs, NAIC Reps Say
The consumer representatives to the National Association of Insurance Commissioners released a 51-page report Monday loaded with technical recommendations for how state and federal officials should write regulations to implement key consumer protections under the health care law. "We want to make sure that, as they implement these reforms, they're putting consumers front and center,' said Beth Abbott of Health Access California, one of the reps (Reichard, 8/13).

In addition -

Modern Healthcare/Crain’s New York Business: Health Reform Confusion Keeps Consultants Busy
The Affordable Care Act's long-term impact on employers is still uncertain. But one sector is already getting a boost from the law, recently upheld by the U.S. Supreme Court: Business is booming for benefits consulting firms. Whatever the new law will ultimately mean for the cost and quality of health care in the U.S., in the short term it has meant anxiety and paperwork for employers. Though some provisions will not take effect for years, others are already in place, with more to come in 2014 (Scott, 8/13).

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Simpson: Medicare On 'Auto-Pilot' To Squeeze Out The Rest Of Federal Domestic Spending

Bloomberg: Simpson Says Medicare to Squeeze Out Government Spending
Former U.S. Senator Alan Simpson, co-chairman of President Barack Obama's fiscal commission, said escalating Medicare costs stand to squeeze out the rest of domestic government spending. "Medicare is on automatic pilot. It will use up every resource in the government," the Republican former senator from Wyoming said in an interview today on Bloomberg Television. Asked about spending ranging from highway programs to the Federal Bureau of Investigation, Simpson said: "The things you just mentioned will be completely squeezed out" by Medicare (Fairchild, 8/13).

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Health Information Technology

Market For EHR Replacements Is On The Rise

Medscape:  Half Of EHRs Sold Are Replacements
Use of electronic health records is snowballing, and so is the number of unhappy users. Half of EHR systems sold to physician practices are now replacements, up from 30% last year, according to a recent study by research firm KLAS.  The leading reason for switching systems, cited by 44% of practices, is product issues. Service issues group consolidation — such as when a hospital converts newly hired physicians to a new EHR — are a distant second and third (Lowes, 8/13).

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Health Care Fraud & Abuse

Chicago, Blue Cross Blue Shield To Team On Health Care Fraud Task Force

Chicago officials will team with Blue Cross Blue Shield of Illinois on a new health care fraud task force.

The Associated Press: City, Blue Shield Team Up On Detecting Fraud
Chicago officials are teaming up with Blue Cross and Blue Shield of Illinois on health care fraud detection and prevention. A task force will be made up of representatives of the city and the health insurer. Members will work to assess potential health care fraud and instances of wasteful spending (8/14).

And two men -- a dentist in New York and a home health care provider in Virginia -- admit to Medicaid fraud --

The Associated Press/Wall Street Journal: Brooklyn Dentist Admits Fraud In Medicaid Probe
New York authorities say a Brooklyn dentist has pleaded guilty to fraud, admitting he paid recruiters to solicit homeless Medicaid patients with cash. Attorney General Eric Schneiderman and Comptroller Thomas DiNapoli say dentist Lawrence J. Bruckner of Plainview has also admitted failing to pay taxes on payments he received from other dentists who worked at his clinics (8/13).

The Associated Press/Sacramento Bee: Man Pleads To Health Care Fraud In VA
A North Carolina man has pleaded guilty to a health care fraud charge. Thirty-one-year-old Joseph T. Hackett of Asheville entered the plea Monday in federal court in Richmond. Federal prosecutors say Hackett owned Richmond-based Access Regional Taskforce, which contracted with Medicaid to provide in-home mental health services for youth and adolescents. Hackett was accused of collecting money from Medicaid for services that didn't meet the criteria for reimbursement (8/14).

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State Watch

Budgets, Exchanges And Rebates: States Consider Health Law's Moving Parts

States are considering what the different parts of the health law will mean for their budgets, their citizens' budgets and how their residents purchase and keep health insurance.

The Associated Press: State Economics Reviewing How Federal Health Care Overhaul Could Affect Florida's Budget
State economists are trying to determine how the federal health care overhaul could affect Florida's future budgets. Economists from the Legislature and Gov. Rick Scott's office are meeting Tuesday to consider the possibilities. Scott has opposed the federal law, even turning down federal money to help implement it. Florida also led a group of states that filed a legal challenge, but the U.S. Supreme Court upheld most aspects of the law including the insurance requirement (8/14).

California Healthline: Will Basic Health Program Hurt, Help Exchange?
An analysis of a proposed Basic Health Program and its impact on the Health Benefit Exchange offers a mixed bag of pros and cons for exchange leaders and legislators. The nascent Basic Health Program, if passed by the Legislature, would target a large percentage of possible exchange participants. So the question lawmakers have been wrestling with is: Would that be a good or a bad thing for the exchange, and for Californians? That's the question tackled by the exchange itself. On Monday, it released an independent analysis by the UC-Berkeley Labor Center and the UCLA Center for Health Policy Research, which was commissioned by the exchange board (Gorn, 8/14).

Houston Chronicle: Texans Get Nearly $167 Million In Health Insurance Rebates
Getting $795 in the mail is normally a good thing, but Katy Fernandez saw it as evidence of something she had long suspected. "We were being overcharged." Fernandez, her husband, Louis, and their daughter Sarah each received rebates for their individual health insurance policies last month, three of the 1.5 million Texans to benefit from a provision of the Affordable Care Act that requires insurance companies to return a portion of the premiums if they spend less than 80 percent on medical care. Texans received $166.9 million in rebates, more than residents of any other state (Kever, 8/14).

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State Roundup: Abortion-Rights Groups Mostly Silent On Fetal Pain Laws; Conn. Advocates Worry Over Medicaid Cuts

A selection of health policy stories from Arizona, Connecticut, Florida, Minnesota, Oregon, California, Tennessee, Kansas and Wisconsin.

Politico: Abortion-Rights Groups Absent On Pain Laws
When new limits on abortions are proposed, abortion-rights groups usually go all out to stop them. So why haven’t they gone all out against state fetal-pain laws, enacted in nine states since early 2010? These laws ban abortion after 20 weeks, based on the controversial assertion that the fetus can then experience pain. They're handing victories to anti-abortion groups, and so far there’s only one major challenge from an abortion-rights group: in Arizona, where the 9th Circuit Court early this month temporarily blocked the state law (Smith, 8/13).

CT Mirror: Health Care Advocates Remain Wary Of LIA Changes, Even As DSS Scales Back Restrictions
After advocates for mentally ill and disabled residents warned that a new plan to limit the number of people receiving state Medicaid benefits would hurt that population in particular, the state has somewhat modified its plan. DSS spokesman David Dearborn said the agency would revise its planned application to the U.S. Centers for Medicare and Medicaid Services regarding the Medicaid for Low Income Adults program, known as LIA (Phaneuf, 8/13).

Health News Florida/Kaiser Health News: Readmit Rates Cost FL Hospitals
Lower Medicare reimbursement rates are coming for hundreds of hospitals across the country and for 131 in Florida with "excess readmission" rates, according to analysis of CMS data by Kaiser Health News. … Nine hospitals around the state, including Florida Hospital in Orlando, will deal with a 1 percent gap caused by the penalty. Even though half of the 22 facilities in the Florida Hospital system will be penalized under the Hospital Readmissions Reduction Program, hospital officials said care won't be affected (8/13).

Minneapolis Star Tribune: Hospitals Face Penalties If Patients Quickly Return
Minnesota hospitals will lose an estimated $1.7 million in Medicare payments next year under a new program that penalizes hospitals for higher-than-average rates of readmission. The penalties are based on the 30-day readmission rates for Medicare patients with three common conditions -- heart attacks, heart failure and pneumonia -- between 2008 and 2011. The penalties, which will affect 29 Minnesota hospitals, will average about one-tenth of 1 percent of their annual Medicare payments, the Minnesota Hospital Association said (Lerner, 8/13).

Minnesota Public Radio: Careful Look At State Employees Health Benefits May Save Taxpayers Millions
The state of Minnesota is terminating health insurance coverage for about 3,100 family members of state employees. The action comes after the state conducted an audit to determine whether anyone was improperly receiving benefits. Supporters of the audit say it is proof the program is working, and that it could save the state millions of dollars (Scheck, 8/14).

The Oregonian: Hospital Error Reports Up Slightly In Oregon -- And That's Good News
Reports of errors in Oregon hospitals grew slightly last year, according to the Oregon Patient Safety Commission. But that might actually be good news. The commission relies on voluntary reporting, and has been struggling to persuade hospitals to improve their reporting. More reports will allow the state to better improve safety, says Bethany Higgins, the commission's executive director. "You can clearly see that there's improvement across the board with the quantity as well as the quality of the reports submitted, as well as the timeliness with which they are submitting them," she said, adding, "We have a long ways to go" (Budnick, 8/13).

HealthyCal: NPs On The Frontlines
Glide, situated in the heart of San Francisco's gritty Tenderloin neighborhood, is a haven for the homeless. Outside the shelter's door, though it is just before noon, a group of men and women line up to wait for a bed for the night or a hot meal. … Hints of the state-of-the-art health center on the top floors of the onetime hotel start inside the lobby, in the form of posters and flyers announcing services ranging from free HIV testing to tai chi classes. Patricia Dennehy, the director of Glide Health Services, has learned that low-income patients make better health decisions when providers focus on the entire person, not just the illness that landed them in the examining room. Challenges such as poverty, inadequate housing and unemployment can eventually wreak havoc on people's health (Ramirez, 8/14).

The Associated Press: Tennessee Nursing Job Market More Competitive
Health care experts say Tennessee's nursing job market has grown more competitive in recent years. According to the Tennessee Board of Nursing, there were more than 83,000 registered nurses in the state in 2011, and 21 new schools were added between 2000 and 2011 (8/13).

Reuters: Health Startups Learn To Compete In Silicon Valley
It may not sound as flashy as social media, but health care is becoming a new star in Silicon Valley. Driven by the promise of enormous payouts, entrepreneurs are using the latest technology and design to help save lives, and make money. But it's tough to grab a share from the big companies, which are dominant in certain fields in health care, such as Electronical Medical Records, or EMR, where doctors store and manage patients' digital health data (Tian, 8/14).

California Healthline: Designing A New Tier Of Dental Professional In California
About two million California kids will gain access to dental coverage over the next few years as a result of the Affordable Care Act and the state's decision to shift children from Healthy Families to Medi-Cal, California's Medicaid program. ACA also will provide more dental coverage for some adults. That's generally considered good news in the dental and children's health communities … but who's going to do the work? … The California Legislature this month will consider a bill aimed at improving dental care for underserved children. SB 694, by Sen. Alex Padilla (D-San Fernando Valley), would … launch a project to train a new level of oral health care professional in California -- people less educated than dentists but with enough training to perform some dental procedures (8/13).

Kansas Health Institute News: Changes Under Way For Determining In-Home Medicaid Services
State officials are changing the way they determine which in-home Medicaid services are provided to the frail elderly and people who are physically disabled. The new system will rely on a single agency or organization with a presence in each of the state's 105 counties to assess what services a person will receive. Currently, there are more than 30 organizations involved with the process. Some assess only the elderly. Others focus solely on the physically disabled (Ranney, 8/13).

Kansas Health Institute News: Kansas Looks To Wisconsin For ADRC Model
In Wisconsin, it's easy for frail seniors or people who are physically disabled to find out if they are eligible for the Medicaid services that could help them live at home and avoid or delay the move to a nursing home. All they have to do is call the Aging and Disability Resource Center (ADRC) in their county. They'll be hooked up with someone who can assess their conditions, figure out how to pay for the services and put them in touch with the providers who can make it happen (Ranney, 8/13).

Milwaukee Journal Sentinel: Mental Health Advocates Urge Abele To Fund Community Care
Advocates for community mental health services called on Milwaukee County Executive Chris Abele on Monday to reinvest savings from downsizing the Mental Health Complex into community services in his 2013 budget. Abele was reminded that he signed a resolution last year promising to do just that. However, the 2013 budget request by the county's Behavioral Health Division does not set aside for community services the $1.5 million in savings from closing an acute-care unit at the complex, shutting down part of another unit at the complex and privatizing some mental health services elsewhere (Schultze, 8/13).

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Editorials and Opinions

Viewpoints: Romney's Gamble; The Return Of 'Mediscare;' Klein And Roy Offer Competing Views On Differences In Ryan, Obama Plans

The Washington Post: Mitt Romney Chose Paul Ryan To Shift The Campaign Debate; Will The Gamble Pay Off?
It doesn't take a political genius to see where the contest between President Obama and Mitt Romney is heading. With Rep. Paul Ryan on the Republican ticket, the campaign is looking at a full-throated debate over the future of Medicare. Are Romney and Ryan ready? (Dan Balz, 8/13).

The Washington Post: The Dangerous Myths At The Heart Of Political Parties' Fiscal Policies
The Romney-Ryan approach fails to acknowledge the level of revenue required to sustain even the smaller government the candidates envision. The population is aging, and even with entitlement reform, health care costs will continue to grow. The world remains a dangerous place, which is why Mr. Romney says defense spending should consume 4 percent of gross domestic product. Yet the Congressional Budget Office has found Mr. Ryan's plan would whittle spending on everything but Social Security, health programs and interest on the debt to less than that. The country cannot afford to continue all the Bush tax cuts, at a cost of some $5 trillion over the next decade, let alone pile on trillions more from Mr. Romney's cuts (8/13).

The Wall Street Journal: The Forgotten History Of Ryan's Medicare Reform
In 2008, amid the poverty of ambition of the late Bush presidency, Mr. Ryan released "A Roadmap for America's Future," a 71-page document that was the first plan in years to take arithmetic seriously. The then-obscure Wisconsin congressman dropped by the Journal to sell his vision, no press secretary, no handlers. "I want to be the Paul Revere of the fisc," he said, according to my notes from the meeting. Mr. Ryan knew as everyone who knows the budget knows that the federal balance sheet can't be improved by zeroing out foreign aid to Mozambique and arts funding for off-off-off Broadway plays. Medicare is such a large share of spending, and growing so much faster than any other item, that fiscal reform must include the popular entitlement (Joseph Rago, 8/13).

The Wall Street Journal: Mediscare: The Sequel
It's the worst-kept secret in Washington that the Obama campaign and liberal Super Pacs are set to dust off those "Mediscare" TV ads showing Paul Ryan tossing grandma over the cliff. These attack campaigns are designed to undermine Republican plans to curtail the stampeding costs of Medicare. The ads have worked for Democrats in the past. It first started back in 1995 during the Newt Gingrich era when President Bill Clinton stymied GOP budget balancing plans (Stephen Moore, 8/13).

The New York Times: Let The Real Debate Begin
On the one hand, talk about limiting the federal government and shrinking the deficit has been central to Republican rhetoric for years. On the other hand, historically, most Republicans haven't really meant it. George W. Bush, for instance, pushed for a prescription drug benefit for Medicare recipients that added an estimated $300 billion to the federal deficit -- not to mention two budget-busting wars. Ryan, however, means it (Joe Nocera, 8/13). 

The New York Times: Paul Ryan's Fairy Tale Budget Plan
Mr. Ryan showed his conservative mettle in 2008 when he folded like a lawn chair on the auto bailout and the Wall Street bailout. But the greater hypocrisy is his phony "plan" to solve the entitlements mess by deferring changes to social insurance by at least a decade. A true agenda to reform the welfare state would require a sweeping, income-based eligibility test, which would reduce or eliminate social insurance benefits for millions of affluent retirees. Without it, there is no math that can avoid giant tax increases or vast new borrowing. Yet the supposedly courageous Ryan plan would not cut one dime over the next decade from the $1.3 trillion-per-year cost of Social Security and Medicare (David A. Stockman, 8/13).

The New York Times: Saving Private Ryan
The Romney gamble is huge because the line of Democrat attack against him and Ryan is so clear: They are the heartless would-be destroyers of Medicare, the health insurance program for retirees … and Medicaid; and they are the architects of a massive redistribution of income from bottom to top at a time when the top … is doing just fine. … The shape of the Republican counter-attack is equally apparent: Obama ... has no serious plan to stop Americans living on borrowed money. The economy is stalled, unemployment high. The country, to quote Clint Eastwood’s endorsement of Romney, "needs a boost." Behind this battleground a mountain stands. It is composed of debt (Roger Cohen, 8/13).

Los Angeles Times: Seniors Would Pay The Price Of Ryan's Plan To Overhaul Medicare
We've been hearing -- and will continue to hear -- a lot about how Paul Ryan's plan to overhaul Medicare and Medicaid would cripple the safety-net health care programs. Fair criticism? The answer, as Bill Clinton might say, depends on what your definition of "cripple" is (David Lazarus, 8/13).

The Washington Post: The Republican Ticket's Big Medicare Myth
Ryan's budget -- which Romney has endorsed -- keeps Obama's cuts to Medicare, and both Ryan and Obama envision the same long-term spending path for Medicare. The difference between the two campaigns is not in how much they cut Medicare, but in how they cut Medicare (Ezra Klein, 8/13)! 

Forbes: Yes, Obamacare Cuts Medicare More Than President Romney Would
I've long argued the same thing: that the way to understand the difference between Ryancare and Obamacare is not in the scale of the cuts to Medicare, which are roughly similar, but in the competing mechanisms used in reform (Avik Roy, 8/13).

Minneapolis Star Tribune: A Welcome Change In The Campaign
Many Medicare overhaul proposals -- such as Ryan's -- call for protecting those age 55 and older from any changes. This makes sense politically, since seniors are a mighty bloc of voters. But is it the fair thing to do? So far, few have asked that question, but it needs to be aired, particularly with Ryan in the race (8/13).

Modern Healthcare: Ryan Will Make Medicare Key Issue In Campaign
GOP presidential hopeful Mitt Romney's choice of Rep. Paul Ryan (R-Wis.) as his running mate sent a clear signal that Medicare will be a major issue in this presidential election, and President Barack Obama's remarks Sunday indicate he got the message. Ryan, the 42-year-old chairman of the powerful House Budget Committee, is the chief architect of a budget plan that made headlines in 2011 and 2012 for proposing a massive overhaul to the Medicare program (Zigmond, 8/13).

And on other topics --

San Francisco Chronicle: Medicaid Expansion Can Lift Health Care
States do not have to be forced to board a runaway Medicaid budget whose brakes have failed. By combining Medicaid expansion with federal funding designed to reward innovations in health care delivery, states can better manage care, improve the health of more of their residents and reduce costs. ... In 2010, the federal government approved a waiver for California that helped it to expand access to health care for the poor while improving the quality of care in safety-net hospitals. To help counties take advantage of this waiver, the foundation where I work made funds available to expand health insurance coverage to low-income adults. In the program's first nine months, more than 360,000 previously uninsured Californians gained health care coverage (Peter Long, 8/10).

San Jose Mercury News: Health Care Reform Needs Local Plans
Federal health care reform goes into effect on Jan. 1, 2014, but it won't be as simple as flipping a switch. State officials must take a number of steps to ensure the system works as intended, getting as many people as possible into affordable coverage. While the state took a huge step forward in 2010 by creating the California Health Benefits Exchange, ensuring that lower-income Californians will be able to afford basic benefits remains an unanswered challenge. That's why it's vital that California put in place a piece of President Obama's Patient Protection and Affordable Care Act known as the Basic Health Plan (John Ramey, 8/13).

Georgia Health News: A Simple, Fair Way To Reduce Health Costs
A study commissioned by Patients for Fair Compensation, released in July, showed that Georgia's economy could save $8 billion in health care costs annually if we eliminated the practice of defensive medicine within our borders. That is an astounding figure that should give pause to our governor and lawmakers as they brace for some more tough decisions about future budgets and budget cutting (Richard Jackson, 8/13).

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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.