Daily Health Policy Report

Wednesday, August 8, 2012

Last updated: Wed, Aug 8

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Campaign 2012

Administration News

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Q & A: Does My Travel Insurance Have Me Covered (Video)

Kaiser Health News:  Q & A: Does My Travel Insurance Have Me Covered (Video)
In her latest Kaiser Health News video, Insuring Your Health columnist Michelle Andrews answers a reader's question about travel insurance (8/7).

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Capsules: Group Health's 'Learning Health System' Keeps Innovations Moving; Four Want To Be Wash. State Insurance Commissioner

Now on Kaiser Health News' blog, Sarah Barr reports on Group Health's effort to make sure medical innovations are put to use: "They've adopted a strategy known as a "learning health system," which creates a feedback loop of sorts between the system's medical and research sides, including the Group Health Research Institute. In broad terms, researchers help doctors evaluate new ways of providing care, and doctors suggest areas where research is needed — meaning evidence and practice exist in a cycle" (Barr, 8/7).

Also on the blog, KUOW's Ruby de Luna, working in partnership with Kaiser Health News and NPR, writes about the Washington state race for insurance commissioner: "Voters in Washington will be filling out their Vote-by-Mail ballots Tuesday, and they will have a chance to do something that voters in just 10 other states do: elect an insurance commissioner. The primary field this year includes four candidates, and the top two vote getters, regardless of party, will face each other in the general election" (de Luna, 8/7). Check out what else is on the blog.

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Political Cartoon: 'Customer Care'

Kaiser Health News provides a fresh take on health policy developments with "Customer Care" by Chip Bok.

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


Jersey Medicaid... 
New patients ask the question:
Where are all the docs?

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

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Health Reform

Should 'Health Exchanges' Be Renamed?

The Wall Street Journal reports that the phrase confuses consumers in focus groups. Meanwhile, Papa John's CEO and founder John Schnatter, who is a fundraiser for Mitt Romney, told shareholders last week that the health care law is going to raise the company's costs, which he vowed to pass onto consumers.

The Wall Street Journal: Puzzling Over What To Call State Insurance Exchanges
Health-insurance exchanges are a central part of the Obama administration's health overhaul, serving as marketplaces for people to shop for coverage. But states trying to set them up are finding many people don't know what an exchange is and don't necessarily like the sound of it. … The word exchange "raises some suspicions of loopholes and fine print" and "implies current coverage may needed to be traded for something else," wrote communications company GMMB in a presentation to the Washington State Health Benefit Exchange. Part of the problem, GMMB said, was that the word was "perceived as a verb and unfamiliar as a noun" and reminded people of the New York Stock Exchange or military exchange stores (Radnofsky, 8/7).

KHN's earlier, related coverage: What's In A Name: Health Exchanges, Marketplaces ... Or Swap Meets (Jaffe, 5/10).

Politico: Papa John's: 'Obamacare' Will Raise Pizza Prices
Pizza chain Papa John's told shareholders that President Obama's health care law will cost consumers more on their pizza. On a conference call last week, CEO and founder John Schnatter (a Mitt Romney supporter and fundraiser) said the health care law's changes — set to go into effect in 2014 — will result in higher costs for the company — which they vowed to pass onto consumers (Tau, 8/7).

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Capitol Hill Watch

Outlets Analyze Health Spending, Sequestration Details

The Associated Press offers some of the specifics of which programs will feel the pinch of sequestration. CQ HealthBeat takes a look at the possible causes of the "deceleration in health spending." 

The Associated Press: The Nuts And Bolts Of The Sequester
Q: What programs would be spared? A: Social Security, Medicaid, supplemental security income, refundable tax credits, the children's health insurance program, the food stamp program and veterans' benefits. The White House said last week that President Barack Obama would exempt military personnel from the cuts. Q: What about Medicare? A: The government-run health care program for seniors would face a 2 percent cut in Medicare payments to providers and insurance plans. That works out to a reduction of $11 billion next year (Cassata, 8/8).

CQ HealthBeat: Deceleration In Health Spending: Is It Only The Weak Economy?
Government actuaries say the sharp downturn in health spending growth over the past few years stems from a weakened demand for services as Americans cut back on spending to cope with a weakened economy. But that may not be the whole story, some analysts say. They suggest fundamental changes in health care delivery also may be driving the slowdown. Others, however, dismiss such talk as wishful thinking. Prominent among those who see something broader at work is Peter R. Orszag, former head of the White House Office of Management and Budget in the Obama administration and former director of the Congressional Budget Office (CBO). ... Orszag said a big part of slower spending growth "is a weak economy but it's not all the economy. There are structural changes that are happening out there in the field that are helping to mitigate cost growth" (Reichard, 8/7).

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Campaign 2012

Buzz About Romney's Vice Presidential Pick Turns To Rep. Paul Ryan

News outlets examine what the House Budget Committee chairman and architect of a plan to curb spending for Medicare and other entitlement programs would bring to the  ticket.

Politico: Paul Ryan Veep Prospects Split GOP
As Mitt Romney's vice presidential selection nears and buzz about Rep. Paul Ryan's prospects builds, a split is emerging among Republicans about whether the choice of the House Budget chairman and architect of the party's controversial tax and spending plan would be a daring plus for the ticket or a miscalculation that would turn a close election into a referendum on Medicare (Martin, Sherman and Haberman, 8/8).

Los Angeles Times: Romney's Potential Running Mate: Paul Ryan
By naming Paul Ryan as his running mate, Mitt Romney would be gambling that he can buttress the Republican ticket's standing on the economy while suffering no harm from the Wisconsin congressman's controversial plan to curb spending on such popular programs as Medicare (Finnegan, 8/7).

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Female Voters Are Hot Commodity For Presidential Candidates

On the campaign trail, President Barack Obama continues his efforts to shore up support among women voters, as GOP presidential hopeful Mitt Romney vies for working-class voters.

The Associated Press/Washington Post: Obama And Romney Make Play For Female Voters, Working-Class Americans In Campaign Pitches
Republican candidate Mitt Romney and President Barack Obama are making hard sells to working-class and female voters while raising the volume on their criticism to fire up the party base and cast the other as an extremist. Romney's team thrust welfare into the campaign with an ad claiming that Obama planned to dole out taxpayer dollars to anyone, even those not trying to find work. For his part, Obama was set to appear Wednesday with Sandra Fluke, the Georgetown University student who became a flashpoint for women's health and, by proxy, abortion rights (8/8).

The Wall Street Journal's Washington Wire: Contraception Policy Advocate To Introduce Obama
President Barack Obama will draw fresh attention to his administration's decision to require most employers to offer free contraceptive coverage, when he's introduced in Denver Wednesday by Sandra Fluke, the young woman who came to prominence for supporting that policy (Meckler, 8/7).

ABC: Obama To Stoke 'War On Women' Debate In Colorado
President Obama kicks off a two-day campaign swing through Colorado today by stoking debate over an alleged Republican war on women. At his first stop here on a college campus, Obama will thrust the issue of women's health care back to center stage in the presidential race, casting rival Mitt Romney as out of touch with female voters and eager to "turn back the clock on decades of progress," according to his campaign. The president will emphasize provisions in his controversial health care law that benefit women, including the requirement that insurance companies cover a host of preventive health care services, such as contraception and breast cancer screenings, free of charge. Romney has said he would repeal the law and the expanded coverage rules, which took effect for the first time last week (Dwyer, 8/8).

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Super PACs, AARP And Catholic Church Among Groups Trying To Influence Candidates, Campaigns

A wide variety of groups seeks to shape the candidates' stances and drive the discussion around health issues.

Los Angeles Times: One Man's Anti-Romney Story, In Part
In an inflammatory new television spot, the pro-Obama "super PAC" Priorities USA Action attempts to link the closing of a Bain Capital-owned steel mill to the death of a wife of one of the former steelworkers, who lost his health insurance when he was laid off. … Meanwhile, CNN reported Tuesday that after Joe Soptic lost his job at the steel mill, his wife continued to have her own health insurance for a few years through her job at a local thrift store (Gold, 8/7).

The Associated Press/Wall Street Journal: Cardinal Suing Obama Invites Him, Romney To Dinner
The Archdiocese of New York is among more than 40 Catholic organizations, charities and schools that are suing over Obama's mandate that employers provide health insurance that covers birth control. Evangelical, Jewish and other religious leaders have joined U.S. bishops in pressing for a broader religious exemption, including for faith-affiliated hospitals, colleges and social service groups. As the head of the U.S. Conference of Catholic Bishops, Dolan has said the White House policy is "strangling" the church. Obama has offered an accommodation, but Catholic leaders and others have said the changes don't go far enough. The [Alfred E. Smith Memorial Foundation charity] dinner, in its 67th year, is a white-tie event at the Waldorf-Astoria that is customarily attended by presidents and candidates in an election year (8/7).

Roll Call: AARP Poll: Voters Over Fifty Dissatisfied, Anxious
A just-released survey from the seniors lobby AARP finds that older voters want candidates to better explain their plans for Social Security and Medicare. The poll also showed that Americans over age 50 are anxious about their retirement security and dissatisfied with politicians. "The message from voters 50+ is clear," AARP Executive Vice President Nancy LeaMond said in a statement. "In a razor-tight election, candidates have a major opportunity to reach key voters by speaking about their plans on Social Security and Medicare -- and they are making a huge gamble if they ignore them" (Ackley, 8/8).

In the meantime,  the GOP's conservative wing scored big in Kansas, winning primaries Tuesday over moderate GOP incumbents --

The Associated Press/Washington Post: GOP Conservatives Score Big In Kansas Primaries, Ousting Moderate State Senate Incumbents
Some GOP voters transferred their ongoing frustration with Democratic President Barack Obama and the federal health care law he championed to moderate GOP state senators. Some wanted the Senate to be more conservative and more in line with Kansas Gov. Sam Brownback and the state House’s right-leaning majority (8/8).

And in Ohio, a race there could help decide the fate of the health law in the U.S. Senate --

Gannett/Zanesville (Ohio) Times Recorder: Health Issues Point Of Contrast In Ohio Senate Race
The Supreme Court's decision upholding health care reform has not dulled the sharp political divisions over that law in Ohio's U.S. Senate contest, with Democrat Sherrod Brown vowing to protect the measure and Republican Josh Mandel gunning to repeal it. The outcome of this U.S. Senate race will go a long way to determining whether the law's popular consumer protections and its controversial insurance mandate survive in the next Congress. The winner of Ohio's high-stakes election also will have to grapple with a bevy of other urgent health policy questions -- starting with how to find savings in the Medicare and Medicaid programs amid an increasingly tough fiscal climate (Shesgreen, 8/8).

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Administration News

HHS Says Billing Rule Will Cut Red Tape For Doctors, Save Up to $9B

Officials say the interim rule, published Tuesday, will streamline electronic billing for doctors and save time and money.

CQ HealthBeat: HHS Says New Rule On Fund Transfers Will Cut Red Tape For Doctors
Doctors, hospitals and health insurance plans will be able to more smoothly coordinate electronic claims payments and adjustments under an interim final rule the Department of Health and Human Services announced Tuesday. HHS officials said that despite the proliferation of electronic payment transfers of funds throughout the business world, many doctor practices and hospitals continue to receive and deposit paper checks for paid claims from insurers and manually record the payments in their accounting systems. Making this into an electronic process will save money and administrative time, HHS officials said (Norman, 8/7).

The Hill: HHS: New Rules Will Save Up To $9 Billion
HHS said in a statement that the average doctor spends three weeks per year on billing and dealing with insurance companies. By streamlining those processes and making billing more efficient, HHS said, the new rules will save somewhere between $2.7 billion and $9 billion. "These new rules will cut red tape, save money and ensure doctors spend more time seeing patients and less time filling out forms," HHS Secretary Kathleen Sebelius said in a statement (Baker, 8/7).

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An Obama Administration Rule Modification Causes Angst For Home Health Workers

McClatchy Newspapers: Home Health Workers Sweat Obama Rule On Pay
An uneasy sense of deja vu is building among advocates for nearly 2 million workers who help the elderly and disabled live independently in their homes. Because of a 38-year-old amendment to the Fair Labor Standards Act, home health aides and personal care aides in many states can be paid less than the federal minimum wage – $7.25 an hour – and not receive overtime pay when they work more than 40 hours in a week. Enacted by Congress in 1974, the "companionship services exemption" was supposed to exclude baby-sitters and casual companions for the elderly from overtime and minimum wage requirements, not to waive federal pay guidelines for professional caregivers. So after years of failed efforts to change the guidelines, President Barack Obama in December announced plans to modify the exemption and extend overtime and minimum wage protections to home-care workers employed by private companies (Pugh, 8/7).

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Health Care Marketplace

Survey: In Health Care Marketplace, Consumers Value Friendliness, Convenience

The PwC Health Research Institute surveyed 6,000 consumers to find out what they thought of the health care sector compared with other service industries. Meanwhile, Group Health has put in place a strategy to ensure that innovations are put to work.  

Fox: What Patients Want, Expect From Health Care Providers
Whether it's friendly office staff or wireless Internet access, consumers are expecting the same amenities and customer services from their health-care provider as they would from a hotel, bank, airline or retailer, according to new research from The PwC Health Research Institute. The PwC Health Research Institute surveyed 6,000 consumers to gauge their opinions of health care as it compares with other service-based industries, and found that friendly staff and convenience are the top priorities for consumers when it comes to health care (Fuscaldo, 8/7).

Kaiser Health News: Capsules: Group Health's 'Learning Health System' Keeps Innovations Moving
They've adopted a strategy known as a "learning health system," which creates a feedback loop of sorts between the system's medical and research sides, including the Group Health Research Institute. In broad terms, researchers help doctors evaluate new ways of providing care, and doctors suggest areas where research is needed — meaning evidence and practice exist in a cycle (Barr, 8/7).

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CVS Profit Up On PBM Business, WellPoint Likely Sole Bid On Amerigroup

CVS Caremark's profit and outlook rise on its pharmacy benefits business while WellPoint may be alone in bidding for Medicaid insurer Amerigroup.

The Associated Press/Washington Post: CVS Caremark's 2nd-Quarter Profit Climbs 18 Percent; Outlook Rises For Drugstore Chain, PBM
CVS Caremark Corp.'s second-quarter net income jumped 18.4 percent, as its drugstores took business from rival Walgreen and an expansion of its pharmacy benefits management segment pushed revenue higher (8/7).

The Wall Street Journal’s Deal Journal: WellPoint Mostly Alone In Amerigroup Hunt
Ever since WellPoint announced plans to buy Medicaid insurer Amerigroup for $4.46 billion last month, analysts have wondered whether other big managed-care firms were also bidders (Kamp, 8/7).

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State Watch

State Roundup: Medical Malpractice Ideas Part Of Mass. Cost Control Law

A selection of health policy stories from Massachusetts, California, Oregon, Missouri, Minnesota and Michigan.

WBUR: Doctors, Lawyers Work Together On Med-Mal Reform
It may not seem like big news, but if you've followed the long-running, stubborn and mostly dug-in debate over reforming medical malpractice in the U.S., you know that when doctors and lawyers issue a joint news release, something is really going on. ... Formally, it's called "Disclosure, Apology and Offer" and it's a key provision of the new state health cost law. Massachusetts doctors and lawyers have agreed to work side by side on this less hostile (and potentially cost-saving) approach to dealing with medical errors and malpractice. It essentially boils down to disclosing mistakes, apologizing to the patient and family when appropriate and offering compensation as a way to avoid litigation when possible (Zimmerman, 8/7).

California Healthline: California's LIHP A Big Success
The Low Income Health Program, launched 20 months ago, already has more than 400,000 Californians signed up. Health care experts gathered in Sacramento yesterday to discuss one of the successes in California's health reform effort. … Only five states have formed a "Bridge to Reform" program like LIHP and none of them on the scale of California's effort, according to Diana Dooley, secretary of California's Health and Human Services Agency (Gorn, 8/8).

HealthyCal: Agency Offers In-Home, Palliative Care To Children
While there are many agencies that provide in-home help for adults with temporary, chronic and terminal illnesses, Margy Mayfield saw a gap in those services for children on the Central Coast. In the seven years since Coastal Kids Home Care was founded in Salinas, Mayfield said she still sees a too few services for children. … She and a partner decided to start Coastal Kids to dedicate themselves to offering all the services children might need at home, from helping new parents with complications from a premature birth to children requiring palliative care for a terminal illness. …They serve 500 to 600 families annually and make about 4,500 patient visits (Flores, 8/7).

The Oregonian: One In Three Oregon Third-Graders Have Tooth Decay
According to the National Center for Chronic Disease Prevention and Health Promotion, one in three third-grade students in Oregon have untreated tooth decay. ... At Oregon Health Authority, health unit manager Shanie Mason said many factors contribute to Oregon's high rate of tooth decay among children. "We don't prioritize it as an issue. There are a lot of dental issues in the state," Mason said. "It becomes a silent epidemic" (Ortiz, 8/7).

St. Louis Beacon: Group Wants Elderly To Talk About End-Of-Life Medical Care While Still Healthy
John G. Carney thinks it's time for Missourians to have more conversations about two issues they'd probably rather not discuss -- death and dying. He's president and CEO of Kansas City's Center for Practical Bioethics, which is running a pilot program in which the elderly spell out in more detail the kinds of medical interventions they want or don't want once they are seriously ill or near death (Joiner, 8/7).

Minneapolis Star Tribune: Blue Cross: Fighting Obesity Is Just A Walk In The Parking Lot
So you always thought the best parking spot was in the front row? Blue Cross and Blue Shield of Minnesota wants you to move back. Way back. The state's largest health insurer is taking over a handful of outlier parking spaces at shopping malls across Minnesota this month to encourage people to sneak in a few extra footsteps on the way inside (Crosby, 8/7).

Detroit Free Press: Same-Sex Couples Testify Against End Of Health Care Benefits
Kalamazoo resident Barbara Jean Ramber says she fears losing two things: her health care benefits and her eyesight. A new Michigan law could cost her both, Ramber testified Tuesday in U.S. District Court. She was among more than 60 people packed into Judge David Lawson's courtroom for arguments in a lawsuit filed on behalf of schoolteachers, city and county workers and their domestic partners who will lose their health insurance as a result of a new law prohibiting certain public employers from offering health care benefits to unmarried couples, including same-sex couples (Baldas, 8/8).

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Editorials and Opinions

Viewpoints: Dubious Ad On Romney's Role In Cancer Death; British Health Plan Has Problems Of Its Own

The New York Times' Campaign Stops: Fact-Checking Is Not Enough
He sits at a kitchen table, nursing a cup of coffee, talking about what happened after Bain Capital closed down his steel plant in 2001. He lost his job; his family lost its health insurance. His wife felt lousy but didn’t go to the doctor, to spare the family worry and expense. When she finally ended up in the hospital, the diagnosis was cancer. She had 22 days to live. ... That advertisement, paid for by the pro-Obama super PAC Priorities USA, was released on Tuesday morning. By midday the political press had subjected it to a fact-check and reported that not only was Romney no longer in charge of day-to-day decisions at Bain by the time the steel plant closed down, but the man's wife – his name is Joe Soptic, hers was Ranae – actually died in 2006, nearly five years after the original layoff (Ross Douthat, 8/7).

Los Angeles Times: Britain's Cherished, Lousy National Health System
In April, the British Medical Journal published an article about two studies conducted by the New York-based Commonwealth Fund. The studies compared the healthcare systems of 14 advanced countries, and on the 20 measures of comparison, Britain's centralized National Health Service performed well in 13, indifferently in two and badly in five. On several measures, the NHS came out the worst of all the systems examined (Theodore Dalrymple, 8/7).

The Seattle Times: If There Were A Health Olympics, The U.S. Wouldn't Even Medal
Close to half of our health is programmed in the first thousand days after conception. Stresses of the inequalities in modern life experienced by the mother, fetus and baby result in biologic adaptations that bring about many of our chronic diseases of aging…. Having the political will to support early life for all would produce the good health that we now lack, saving immense costs as we age in the form of fewer medical interventions (Dr. Stephen Bezruchka, 8/7).

The Wall Street Journal: ObamaCare's Phony Deficit Reduction
Defenders of President Obama's health law are flaunting a Congressional Budget Office claim that overturning the law would worsen the federal deficit. Repeal, said a CBO report late last month, would cancel $890 billion in new entitlement spending but eliminate revenues of even greater magnitude. Don't be bamboozled. Even if it were true that ObamaCare raises more money than it spends, that would hardly be reason to keep it (Betsy McCaughey, 8/7).

The Wall Street Journal: The FDA Wants To Regulate Your Cells
A recent decision by a federal trial court gave the Food and Drug Administration the latitude that the agency has long sought to regulate our cells as drugs. It could put the brakes on one of the most promising areas of medical research (Scott Gottlieb and Coleen Klasmeier, 8/7).

Politico: Baby Boomers' Economic Anxiety
These voters (age 50 to 64) have been whipsawed by disappearing pensions, rising health care costs and the financial and emotional stress of caring for elderly family members. ... The Great Recession has put many of these boomers in a downward spiral. When workers ages 55-plus lose their jobs, it typically takes a long time — more than a year on average — to find work again. Without a job or benefits, many are forced to raid their retirement savings or shortchange their health care, which increases the strain and lowers their retirement readiness in the long term. ... Americans ages 50 and older don't want a catalogue of platitudes. They want a dialogue on policies that will affect their health and retirement security (Nancy Leamond, 8/8).

Philadelphia Inquirer: Keep Health Info Coming
Buried in the road to cost reduction for the federal government, in Section 227 of the House Subcommittee on Appropriations Bill for Fiscal Year 2013, is a plan to defund the Agency for Healthcare Research and Quality (AHRQ). If this bomb goes off undetected, the nation will lose its greatest source for funding research on health-care quality, effectiveness, and patient safety (Jeffrey C. Lerner, 8/8).

Philadelphia Inquirer: Future Physicians Must Think About The Business Of Medicine
"There's definitely much greater awareness in training now on the costs of tests you order," (David Axelrod, the internist who teaches the course that delves into health-care reform at a practical level) explains, "on evidence-based medicine." So today's students will debate the economics of end-of-life care and the value of prescribing both lower doses and generic drugs. They'll even talk about the financial and physical impacts of referring patients to specialists. "Our students must think about the costs to society and the harm that can be done by excessive tests," Axelrod tells me (Monica Yant Kinney, 8/8).

San Jose Mercury News: California Health Reform Threatened By Bill For Basic Health Plan
California's work to create a more affordable and fair health care system is threatened by legislation in Sacramento that would create a Basic Health Plan. This plan poses a grave threat to the California Health Benefit Exchange, which is the linchpin of federal health care reform. When launched in 2014, the exchange will provide a new competitive marketplace for as many as 2 million consumers and business owners. Californians with incomes up to four times the federal poverty level — over $90,000 for a family of four — will receive subsidies to purchase insurance (Micah Weinberg, 8/7).

CNN: Long Wait At The Doctor's Office? Blame The Patients
Most of the time, I see my patients promptly. I hate running late. But like all doctors, every once in a while, I'm significantly behind schedule. And it's usually not my fault. So who's to blame if your doctor is running late? Blame the patients (Dr. Anthony Youn, 8/7).

Des Moines Register: Another View: What Iowa Conservatives Should Be Talking About
This week, conservative politicians and activists will gather for the Family Leadership Summit. … although the Family Leader tends to limit its focus to just a handful of hot-button social issues, I am hopeful that they might find some time to talk about other issues that have to do with our nation's families. ... They might be able to fit into their speeches that the Ryan budget ... would have a disastrous impact on vulnerable families by gutting programs they rely on to survive and thrive. … This budget plan would radically change Medicare for the worse, leaving seniors without the care they need, and it would slash funding for health insurance programs (Sister Simone Campbell, 8/8).

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Stephanie Stapleton

Andrew Villegas

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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.