Daily Health Policy Report

Thursday, September 13, 2012

Last updated: Thu, Sep 13

KHN Original Reporting & Guest Opinion

Coverage & Access

Campaign 2012

Capitol Hill Watch

Health Reform

Administration News

Public Health & Education

State Watch

Swing State Trailmix

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Health On The Hill: On Capitol Hill, Frustration At Administration's Regulatory Pace (Audio)

Kaiser Health News staff writers Mary Agnes Carey and Jay Hancock talk with Jackie Judd about separate House and Senate hearings in which Obama administration officials got an earful from members of Congress and industry and consumer representatives, who want more clarity about regulations called for in the health law (9/13). Listen to the discussion.  

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Census: Uninsured Numbers Decline As More Young Adults Gain Coverage

Kaiser Health News staff writer Phil Galewitz reports: "The closely-watched census report found that 48.6 million Americans were uninsured during all of 2011, compared to 49.9 million in 2010. The rate of uninsured dropped to 15.7 percent from 16.3 percent, the biggest percentage drop since 1999" (Galewitz, 9/12 - updated). Read the story.

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The Great Fluoride Debate

Oregon Public Broadcasting's Kristian Foden-Vencil, working in partnership with Kaiser Health News and NPR, reports: "Over jeers and cheers from the audience, commissioners on the Portland, Ore., City Council voted Wednesday to add fluoride to the city's drinking water starting in 2014. Portland is the largest American city that doesn't add fluoride to its drinking water. But some groups have raised questions about the possible risks from fluoridation and oppose its use" (Foden-Vencil, 9/12). Read the story.

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Capsules: Health Care Jobs Report: A Dire Warning To Congress; How Is Your Medicare Drug Plan Like Your Cable Company?;Family, Community Ties Key To Fighting Chronic Disease Among Latinos, Officials Say

Now on Kaiser Health News' blog, Shefali S. Kulkarni writes about a report from health care groups that details the impact of upcoming automatic federal spending cuts: "The report, funded by the American Hospital Association, the American Medical Association and the American Nurses Association, predicts that the 2 percent cuts to Medicare providers included in the 'budget sequester' beginning in January will cause as many as 766,000 health care and health-related jobs to disappear by 2021. An estimated 496,000 jobs will be lost during the first year of the automatic cuts" (Kulkarni, 9/12).

Also on Capsules, Jay Hancock reports on the "lock in" effect related to Medicare drug plans: "Economists have long chronicled the 'lock in' effect – the ability to attract shoppers with low prices and then sock them with increases once they’ve stopped paying attention. Think car insurance or bank fees. Consumers often stay put even when they notice the higher bills, deciding that the hassles of switching represent an even greater cost. Boston University economist Keith M. Marzilli Ericson finds the same thing going on in Medicare prescription drug plans" (Hancock, 9/12).

In addition, Ankita Rao reports on efforts to address chronic disease among Latinos: "During a panel discussion Wednesday, she joined Rep. Lucille Roybal-Allard, D-Calif., and other health care experts to speak about 'Diabetes and Obesity In The Latino Community, Reversing The Trend' as part of the Congressional Hispanic Caucus Institute’s public policy conference in Washington, D.C. They said that public health officials need to take into consideration family and community dynamics as they tackle broad health care issues" (Rao, 9/13). Check out what else is on the blog.

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Political Cartoon: 'Healing Waters?'

Kaiser Health News provides a fresh take on health policy developments with "Healing Waters?" by John Deering.

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

INFORMED DECISION-MAKING

Posting calories
at McDonald's... Do we want
fries? Or just knowledge?
-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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Coverage & Access

Number Of Uninsured Americans Drops By 1.3 million

New census data shows that for the first time since 2007, the number of Americans without health insurance declined. However, high rates of poverty persisted.

The Washington Post: Number Of Uninsured Americans Drops By 1.3 Million, Census Report Shows
One spot of good news in the census data released Wednesday was on the health-care front: For the first time in three years, the share of Americans without health insurance declined, with the number of uninsured dropping by 1.3 million people from 2010 to 2011. A major factor was an influx of newly insured young adults, many of whom benefitted from a provision in the 2010 health-care law requiring insurers to let parents keep adult children on their plans up to age 26 (Aizenman, 9/12).

NewsHour: More Americans Insured: What's Behind The Numbers?
According to data released Wednesday by the U.S. Census Bureau, about 48.6 million people were uninsured last year, down from 49.9 million in 2010. The rate fell, too, from 16.3 percent of the U.S. population uninsured in 2010 to 15.7 percent in 2011. That's the biggest percentage drop since 1999. Why the coverage increase? For the fifth consecutive year, there was an upswing in the number of people covered by government health insurance -- primarily the Medicare and Medicaid programs -- rose from 31.2 percent in 2010 to 32.2 percent last year. The rate of private health insurance remained stable in 2011, not declining for the first time in the last decade. And the percentage of young adults between the ages of 19 and 25 fell 2.2 percent, from 29.8 percent in 2010 to 27.7 percent in 2011. That's the second consecutive year that the uninsured rate for the age group has fallen by more than 2 percent. Democrats attribute the latter to the Affordable Care Act, which requires insurance companies to allow young adults to stay on their parents' health plans through their 26th birthday (Kane, 9/12).

The Associated Press/Washington Post: US Poverty Rate At 15 Percent In 2011; Record Numbers Of Poor Persist
The share of Americans without health coverage fell from 16.3 percent to 15.7 percent, or 48.6 million people. It was the biggest decline in the number of uninsured since 1999, helped in part by increased coverage for young adults under the new health care law that allows them to be covered under their parents' health insurance until age 26. The number of people covered by employment-based health plans also edged up from 169.4 million to 170.1 million, the first time in 10 years that the rate of private insurance coverage did not fall. Meanwhile, government health insurance including Medicaid, Medicare and the Children's Health Insurance Program increased for the fifth consecutive year, adding coverage to more than three million people (9/12).

Kaiser Health News: Census: Uninsured Numbers Decline As More Young Adults Gain Coverage
Surprising some experts and giving President Barack Obama a potential boost eight weeks before Election Day, the number of people without health insurance fell for the first time since 2007, the Census Bureau said Wednesday (Galewitz, 9/12).

The Wall Street Journal: Household Income Sinks To '95 Level
Other measures of well-being in the report were more positive. The poverty rate, which had risen in the past four years, held steady in 2011, and the number and share of people without health insurance fell. The shift in health coverage is in large part due to more Americans getting covered by government programs, such as Medicare. … Health care is one area where Americans on the whole notched gains in 2011. However, the rise in insurance coverage is likely to fuel the debate about the government's growing role in health care and the expanding budget deficits that have accompanied increases in entitlement spending (Dougherty and Mathews, 9/12).

The New York Times: U.S. Incomes Dropped Last Year, Census Bureau Says
There was a bright spot for President Obama. The share of 19- to 25-year-olds who were uninsured declined by 2.2 percentage points in 2011, a decrease that administration officials are likely to promote as an early success of its health care law (Tavernise, 9/12).

Reuters: Wider Health Coverage Spurred By Reform, Income Decline
Some 1.3 million more Americans had health insurance in 2011, as healthcare reform helped blunt a decade-long decline in private coverage and government safety nets expanded to cover growing numbers of the poor, elderly and disabled. Census Bureau data released on Wednesday showed that the number of uninsured shrank to 48.6 million people from 50 million in 2010, leaving 15.7 percent of the U.S. population without the most reliable means to pay for doctors, hospitals and life-saving procedures including cancer screenings (Morgan, 9/12).

Politico: W.H. Takes Credit For Health Coverage Boost
According to new Census Bureau numbers released Wednesday, the rate of Americans without health insurance decreased to 15.7 percent last year, down from 16.3 percent in 2010. The number of people without coverage also decreased to 48.6 million in 2011, down from 50 million in 2010, the office reported. That’s partly because of an increase in coverage through federal programs. But the Census Bureau also says that about 40 percent of young adults, ages 19 to 25, who were newly covered over the past two years gained that through their parents’ health plans. Young adults experienced a 2.2 percent decrease in the uninsured rate. The rate also decreased among seniors. And for the first time in the past decade, the rate of private health insurance didn’t decrease last year. In a White House blog post, the Obama administration said the new figures prove the Affordable Care Act is working (Millman, 9/12).

Bloomberg: Americans Without Health Insurance Decline, Census Says
The number of Americans without health insurance fell for the first time since 2007, as many younger than age 26 took advantage of a new law allowing them to stay on their parents’ plans.  About 540,000 more young people were insured in 2011, helping reduce the proportion of uninsured people to 15.7 percent, the Census Bureau said today in a report. About 48.6 million people were uninsured last year, compared with 49.9 million in 2010, the largest numerical drop since at least 1999, according to Census data (Wayne, 9/12).

Medpage Today: More People Had Health Insurance Last Year
The percentage of Americans without health insurance fell from 16.3 percent in 2010 to 15.7 percent in 2011, the Census Bureau reported Wednesday. That equates to 48.6 million uninsured Americans in 2011, down from 2010's record high of 49.9 million. The agency noted that the largest -- and statistically significant -- declines were among those ages 19 to 25 (-2.2 percent), 35 to 44 (-0.9 percent), and 65 and older (-0.3 percent). The decline in uninsured status among 19-to 25-year-olds "can be attributed to children being on their parent's plan," noted David Johnson, PhD, of the Census Bureau, on a conference call with reporters. A provision of the Affordable Care Act, which took effect in late 2010, allows children to stay on their parents' health plans until they reach age 26 (Petrochko, 9/12).

Meanwhile, here is a sampling of local coverage regarding the Census Bureau's findings -

Kansas Health Institute News: Kansas Uninsured Rate Climbs While Nation's Declines
The number of Kansans without health insurance continued to increase last year but the number of Americans who lacked coverage declined for the first time since the start of the recession. According to data released Wednesday by the U.S. Census Bureau, approximately 365,000 Kansans were uninsured in 2010-2011 compared to about 350,000 in 2009-2010. The increase was enough to bump the state’s uninsured rate up to 13.1 percent from 12.8 percent (McLean, 9/12).

Health Policy Solutions (a Colo. news service): Rates Of Uninsured Drop, Insurance Premiums Rise Modestly
The number of Americans without health insurance fell to 48.6 million last year, or 15.7 percent of the population, the first drop since 2007, according to new U.S. Census numbers released today. At the same time, a report from the Kaiser Family Foundation has found that health insurance premiums for employer-sponsored family health coverage reached $15,745 this year. That’s up 4 percent over last year, but a more modest increase than in previous years when health costs far outpaced earnings. The average family pays nearly $4,500 a year for its share of health insurance costs, according to the 2012 Employer Health Benefits Survey. The costs for individuals rose by 3 percent. Since 2002, premiums have increased 97 percent, three times as fast as wages, which rose 33 percent, and racing ahead of inflation, which rose 28 percent in the same period (Kerwin McCrimmon and Kaiser Health News, 9/12).

The Dallas Morning News: U.S. Report: Texans’ Income Rises, But Large Percentage Still Poor, Uninsured
Texas families squeaked out a tiny increase  in real income last year, defying a downward national trend. But Texas still had the dubious distinction of having the highest share of its people lacking health insurance, the Census Bureau reported Wednesday….As was true nationally, the percentage of Texans without health insurance coverage decreased, from 24.6 percent in 2010 to 23.8 percent last year. But that was not a big enough decline for Texas to shake its longtime No. 1 ranking as the state with the biggest share of its people uninsured. It was followed by Nevada, at 22.6 percent; Louisiana, 20.8 percent; and Florida, 19.8 percent (Garrett, 9/12).

(St. Paul) Pioneer Press: Minnesota's Uninsured Rate Rises To 9.5 Percent, Below National Average
The share of Minnesotans lacking health insurance grew to 9.5 percent during the two-year period that ended last year, with declines in employer-sponsored coverage apparently outpacing gains in government-backed insurance. The rate increased by 1.3 percentage points over the state's uninsured rate during 2008-2009, according to the U.S. Census Bureau's annual report on income, poverty and health insurance, released Wednesday, Sept. 12….Since the 2000-2001 period, the share of Minnesota residents who lack health insurance has grown by nearly 3 percentage points, said Christina Wessel, deputy director of the Minnesota Budget Project, a St. Paul-based nonprofit group that studies budget and tax issues (Snowbeck, 9/12).

Georgia Health News: Ga. Uninsured Rate Remains High; U.S. Number Dips
The U.S. Census Bureau reported Wednesday that the estimated number of Americans without health insurance in 2011 fell from almost 50 million, or 16.3 percent,  to 48.6 million, or 15.7 percent. It’s the first drop in that uninsured number since 2007. Georgia’s three-year average of uninsured, meanwhile, has hit 19.7 percent, the fifth-highest rate in the country, the Census Bureau figures showed (Miller, 9/12).

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Campaign 2012

New Ads, Campaign Appearances Deepen Political Lines In The Sand

As former President Bill Clinton concludes his two-day Florida campaign tour for President Barack Obama, he continued to hammer domestic themes including the importance of the health law and to criticize GOP statements regarding Medicare.

The New York Times' The Caucus: Clinton Sticks To Domestic Issues While Campaigning For Obama
Instead, much as he had on Tuesday in Miami before 2,300 people, Mr. Clinton defended and promoted Mr. Obama's health care law, his initiatives to make college more affordable and his response to the economic crisis that Mr. Obama inherited in 2009 despite what Mr. Clinton characterized as constant obstructions from Republicans (Calmes, 9/12).

Los Angeles Times: Bill Clinton Focuses On Economy, Ignores Libya
Based on audience responses at his initial post-convention appearances on Obama's behalf, it's clear that several other bits of that Charlotte speech have become a lasting part of the 2012 campaign lexicon, including his use of "arithmetic" to deride Mitt Romney's economic policies and his broadside at Romney running mate Paul Ryan's "brass" for attacking Obama over the $716 billion in Medicare cuts that were also in Ryan's House GOP budget (West, 9/12).

As the Obama campaign unveils a new Medicare ad in Virginia, the Romney camp releases a Spanish language TV ad that tackles Medicare issues -    

The Washington Post: New Obama Ads In Virginia Hit Romney On Taxes, Medicare
One, titled "Won't Say," criticizes Republican presidential candidate Mitt Romney for not releasing more of his income tax records. … The second ad, titled "Guide," is based on the American Association of Retired Persons guide. It goes after Romney based on changes to Medicare that his running mate, Rep. Paul Ryan of Wisconsin, has proposed (Vozzella,  9/12).

The Hill (Video): Romney Spanish-Language TV Ad Hits Obama On Medicare
Republican presidential nominee Mitt Romney's campaign accused President Obama of cutting funding to Medicare in a Spanish-language television ad unveiled Wednesday. The ad, titled "Yo Pagué," claims that the president took billions of dollars from Medicare to pay for his signature healthcare legislation, which has been bashed by Republicans. ... The ad goes on to tout Romney's plan as protecting and strengthening Medicare "for future generations" (Sands, 9/12).

CNN: Romney Hits Obama On Medicare In Spanish Language Ad
Mitt Romney's campaign pushed its Medicare attack in a new Spanish language television ad released Wednesday. The ad, "Yo Pagué," is a Spanish version of a spot it released last month, "Paid in," which makes the widely-criticized claim that the president cut more than $700 billion from Medicare in his health care reform. When Romney's team released the English version last month, Obama's campaign called the ad "dishonest and hypocritical." "The savings his ad attacks do not cut a single guaranteed Medicare benefit, and Mitt Romney embraced the very same savings when he promised he'd sign Paul Ryan's budget," said Obama campaign spokeswoman Lis Smith (Killough, 9/12).

Also in the news, House Minority Leader Nancy Pelosi, D-Calif., rolls out a video that assails the budget written by GOP vice presidential pick Paul Ryan as a document that would gut Medicare and give tax breaks to millionaires -

Politico Pro: Dems Greet Ryan With Open Fire On Budget
Democrats seem even more thrilled than Republicans about Paul Ryan's homecoming to Congress on Thursday. The Wisconsin Republican returns to the Capitol for the first time since presidential hopeful Mitt Romney tapped him as his running mate. …Using their megaphone on Capitol Hill, Democrats are reintroducing Ryan's budget to voters as a dangerous document that guts Medicare, cuts funding for education and infrastructure, and includes tax policies that favor millionaires. House Minority Leader Nancy Pelosi (D-Calif.) will make those points Thursday morning when she rolls out a video titled "Welcome Back, Mr. Ryan." It will feature TV clips of Ryan explaining his proposals for Medicare and taxes (Wong, 9/12).

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Capitol Hill Watch

Kohl, Grassley Press CMS On Long-Delayed Physician Payment Sunshine Rule

In other hearings, Republican lawmakers pressed the IRS about the regulatory costs of the health law and criticized the requirement that all insurance plans cover birth control.

Politico Pro: No Answers For Kohl, Grassley On Sunshine
Sens. Herb Kohl and Chuck Grassley are demanding to know when CMS will come out with a long-delayed rule to require manufacturers to disclose financial relationships with doctors. But CMS isn't giving many answers, except that it's complicated. Niall Brennan, director of the Policy and Data Analysis Group at the agency, was on the hot seat at a roundtable convened by the senators Wednesday. But if he knew when the rule would come out, or when it would require companies to start collecting data, he wasn't saying. As soon as possible is as far as he would go. Grassley (R-Iowa) referred to rumblings that the agency had completed a final rule and sent it to the Office of Management and Budget but that OMB planned to withhold the rule until after the election (Norman, 9/12).

CQ HealthBeat: Senators Want CMS To Move On Sunshine Requirements
Senators on Wednesday afternoon pressed Department of Health and Human Services officials for faster action on a section of the health care law designed to increase the transparency of financial relationships between drug makers, device makers and doctors. The health care law provision sought to decrease the influence of marketing on the prescriptions written by doctors, including direct payments, drug samples, gifts and meals. The idea is to develop a reporting system to disclose the doctor-business relationships to the public (Norman, 9/12).

CQ HealthBeat: Lawmakers Question IRS Experts About Regulatory Costs Of Health Care Law
House Republicans expressed concern Tuesday that the IRS's implementation of the health care overhaul would cause a significant burden on taxpayers in the amount of time they would need to devote to complying with the law. Louisiana Republican Charles Boustany Jr., chairman of the House Ways and Means Oversight Subcommittee, said taxpayers would have to spend a total of nearly 80 million hours each year to deal with the regulations the IRS has published so far. A chart distributed by committee staff during a panel hearing on Tuesday showed that more than 40 million of those hours would be spent on the law’s small-business tax credit, which was designed to help employers provide health insurance for their workers (Attias, 9/12).

Modern Healthcare: Dems Defend Birth Control Coverage Mandate
Democrats defended the Obama administration's requirement that Catholic hospitals cover birth control services as comparable to federal efforts to desegregate Southern hospitals, during a Wednesday congressional hearing. The hearing on a range of actions by the administration that Republicans criticized as "abuses" partly focused on the requirement that all insurance plans—including self-insured plans frequently used by religious employers—cover various types of birth control (Daly, 9/12).

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Automatic 2 Percent Medicare Cut Would Hurt Health Industry, Groups Warn

Health care provider organizations have joined forces to urge Congress to avert Medicare cuts and spare jobs.

Kaiser Health News: Capsules: Health Care Jobs Report: A Dire Warning To Congress
The report, funded by the American Hospital Association, the American Medical Association and the American Nurses Association, predicts that the 2 percent cuts to Medicare providers included in the 'budget sequester' beginning in January will cause as many as 766,000 health care and health-related jobs to disappear by 2021. An estimated 496,000 jobs will be lost during the first year of the automatic cuts (Kulkarni, 9/12).

Medscape: Automatic 2% Medicare Cut Will Cost 767,000 Jobs, Study Says
The cut, which will affect physicians, hospitals, and other providers, but leave enrollee benefits untouched, is scheduled to take effect January 1, 2013, unless Congress acts to nullify it. The AMA and 124 other medical societies urged lawmakers in a letter today to spare physicians this 2% reduction as well as a 27% pay cut next year that is mandated by Medicare's sustainable growth rate formula (Lowes, 9/12).

Medpage Today: Medicare Cuts Will Cost 500,000 Jobs, Groups Say
The model for the new study, conducted by Pittsburgh-based consultant Tripp Umbach, projected cuts of $10.7 billion in 2013 using baseline spending impacted by Medicare payments. Job losses include those involved in direct patient care as well as support roles. Not only will health sector jobs be lost, but a slowdown in spending by health entities will lead to job losses in companies and organizations whose clients are health-related (Pittman, 9/12).

CQ HealthBeat: Groups Lobby Congress To Avoid Sequester Cuts
A variety of health-related interest groups are releasing reports and doing all they can to pressure Congress to stave off cuts affecting their industry that are scheduled to hit on Jan. 2. Last year's budget deal requires $1.2 trillion over a decade in automatic across-the-board cuts for some federal programs to take effect unless Congress finds an alternative. Most policy analysts expect lawmakers to get more serious about funding and tax decisions after the November elections (Adams, 9/12).

The Hill: Medical Coalition Urges Congress To Avert 'Devastating' Medicare Cuts
"We believe the Congress should not abdicate its responsibility to deliberate and make policy decisions on what is important and needs to be funded," the letter tells lawmakers, referring to the automatic, across-the-board cuts ordered by the sequestration (Viebeck, 9/12).

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Health Reform

Report: Risk Pools Extend Insurance Coverage Now, But Are 'Unsustainable' As Alternative To Health Law

Politico Pro: Report: Risk Pools Won't Work Scaled Up
The health reform law's high-risk insurance pools, one of the first pieces of the law to be enacted, are operating at a loss and prohibitively expensive — but they also provide needed coverage to a small group of people, according to a new report out Thursday. The Commonwealth Fund report found that the Pre-Existing Condition Insurance Plans are providing a solid "bridge" to extend insurance coverage until the health insurance exchanges and other pieces of the law are set up in 2014. But the report's authors warn that Republican proposals to set up more widespread high-risk pools would not work (Haberkorn, 9/13).

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Administration News

Sebelius Found To Have Violated The Hatch Act

The U.S. Office of Special Counsel concludes that HHS Secretary Kathleen Sebelius violated the federal law that governs government officials' political actions.

The Associated Press: HHS Secretary Sebelius Found To Have Violated Law That Restricts Political Activity
Health and Human Services Secretary Kathleen Sebelius violated a federal law that restricts political activity by government officials, a federal ethics office said in a report Wednesday. Off-the-cuff remarks by Sebelius during a speech earlier this year to a gay rights group in North Carolina violated the Hatch Act, the U.S. Office of Special Counsel said in a report to the White House (Alonso-Zaldivar, 9/12).

The Wall Street Journal: Health Secretary Broke Law That Limits Campaigning
The agency forwarded its report to the White House for possible disciplinary action. A White House spokesman said Wednesday that Ms. Sebelius wouldn't be penalized, and that she and her department have already taken steps that put the matter to rest. The Democratic National Committee said on Wednesday that it has reimbursed taxpayers for the $2,515 cost of Ms. Sebelius's trip, a standard remedy for such violations (Nicholas, 9/12).

Politico: HHS Secretary Kathleen Sebelius's Comments Violated Hatch Act, OSC Concludes
The special counsel's office said it "found no evidence that Secretary Sebelius made any other political statements in her official capacity." During a speech to the Human Rights Campaign Gala in North Carolina in February, Sebelius said North Carolina Lt. Gov. Walter Dalton “needs to be the next governor of North Carolina” (Haberkorn, 9/12).

Also in the news, The Wall Street Journal reports on some of the considerations in the mix as advisers to GOP presidential nominee Mitt Romney look for candidates to lead HHS, if he wins the presidency. 

The Wall Street Journal: Romney Team Preps To Fill A Cabinet
Mike Leavitt, the former Utah governor who is overseeing the Romney transition team, briefed campaign donors on the planning process during the GOP convention in Tampa. Participants said his description was reminiscent of a corporate takeover. ... The transition team is looking at the Department of Health and Human Services with an eye toward fulfilling Mr. Romney's promise to repeal the president's health-care law. ... The team's goal is ... also to evaluate which policy changes require congressional support and which Mr. Romney could put in place with executive powers (Murray and Paletta, 9/11).

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Public Health & Education

McDonald's To List Calorie Counts On Menu Boards

News outlets describe the fast-food restaurant's move to provide this menu information both in its restaurants and drive-thrus across the country as part of an effort to get ahead of federal menu-labeling requirements.

Los Angeles Times: McDonald's To Post Calorie Count In Restaurants Nationwide
Calorie counts will be posted alongside images of juicy burgers on McDonald's menu boards nationwide starting next week, much as they have been in California for more than a year (Hsu, 9/12).

The Wall Street Journal: Highest-Calorie Menu Item At McDonald's? Not A Burger
The push is part of an effort to get out ahead of federal menu-labeling requirements. There is a market need to it too -- McDonald's want to convey to customers that it’s not just selling junk food. The company last year added apples to all of its kids' meals and made the servings of fries smaller (Jargon and Tomson, 9/12).

USA Today: McDonald's To Post Calories For Items On Menu Boards
In an action likely to rock the fast-food industry, McDonald's Wednesday said it will post calories for all items on its menu boards and drive-thru menus in the U.S. The move by the world's largest fast-food chain comes as consumers, regulators and activists are pressuring the industry to improve food quality and share more nutritional information with consumers (Horovitz, 9/12).

Reuters: U.S. McDonald's To Put Calorie Counts In Lights
A Big Mac and large fries? They'll cost you 1,050 calories, and beginning next week, McDonald's will tell its customers that in bright lights on its fast-food menus. The world's No. 1 hamburger chain said on Wednesday it is going to start listing calorie information on menus in some 14,000 U.S. restaurants and drive-throughs - ahead of a national rule that will require larger restaurant chains to make such disclosures (Baertlein, 9/12).

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State Watch

Mo. Lawmakers Override Veto Of Bill Limiting Contraceptive Coverage

Gov. Jay Nixon had argued that state law already provided protections.

Kansas City Star: Missouri Lawmakers Override Gov. Nixon's Birth Control Bill Veto
Missouri lawmakers voted Wednesday to override Gov. Jay Nixon's veto and allow employers to refuse to provide health insurance coverage for birth control if doing so violates their religious convictions. But almost immediately after the vote, a Kansas City firefighter and the Greater Kansas City Coalition of Labor Union Women filed a lawsuit asking a judge to throw the new law out (Hancock, 9/13).

St. Louis Beacon: Lawmakers Override Nixon On Contraception, Skip Vehicle Tax
(Missouri state) Sen. John Lamping's bill stated that employers could not be required to provide insurance coverage for abortion, contraception or sterilization if such coverage violated their religious or ethical beliefs.  The bill went on to say that no employees could be required to pay for such coverage in a group plan, if they held similar objections. Nixon vetoed the bill in July, arguing that state law already "provided strong religious protections" that allow employers to decline to provide coverage for abortion or contraceptives (Rosenbaum, 09/12). 

Also, a religiously oriented business files suit against the Obama administration policy requiring employers to cover contraceptives.

The Associated Press/Washington Post: Hobby Lobby Sues Over Morning-After Pill Coverage Requirement In Health Reform Law
Christian-oriented Hobby Lobby Stores Inc. filed a federal lawsuit Wednesday challenging a mandate in the nation's health care overhaul law that requires employers to provide coverage for the morning-after pill and similar drugs. The lawsuit by the Oklahoma City-based chain claims the government mandate is forcing the company's owners "to violate their deeply held religious beliefs under threat of heavy fines, penalties and lawsuits" (9/12).

Reuters: Hobby Lobby Sues Government Over Healthcare Mandate
Hobby Lobby, an arts and crafts retailer founded by evangelical Christians, sued the Obama administration on Wednesday to stop a mandate under the federal healthcare reform law to provide drugs such as the morning-after pill to employees through their health insurance. The lawsuit, filed in District Court in the Western District of Oklahoma, seeks a permanent injunction against the government on behalf of Hobby Lobby and other companies that have religious convictions against abortion (Olafson, 9/12).

Abortion issues are also making news in Virginia and Alabama --

Richmond Times-Dispatch: Board Of Health Takes Up Abortion Clinic Regulations Friday
The state Board of Health is scheduled to vote Friday on regulations that would require Virginia's existing abortion clinics to comply with standards for new hospital construction — an upgrade that abortion-rights proponents say is politically motivated, unnecessary and entails costs that jeopardize the clinics' ability to stay open. The meeting is the first since the board voted 7-4 on June 15 to approve the new regulations with an amendment that grandfathered the state's 20 existing clinics from having to comply with the building requirements. After the vote, Virginia Attorney General Ken Cuccinelli's office refused to certify the amended regulations as part of the executive review process. It said the new rules were not in compliance with a law the Virginia General Assembly passed regulating the clinics like hospitals (Nolan, 9/13).

The Associated Press: Rejected By Alabama, Woman Promises Continued Fight To Reopen Birmingham Clinic For Abortions
A woman said Wednesday she's not giving up on reopening a Birmingham clinic that performs abortions, even though she was dealt another setback in her attempt to get a license. A state hearing officer has ruled against Kelley Rain-Water in her appeal of the state health department's denial of her license application to reopen the New Woman All Women Health Care (9/12).

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New Efforts To Improve Medicaid in California, Colorado

Advocates caution that California's ambitious program for dual eligibles could be problematic, while Colorado's effort to move Medicaid patients into medical homes is showing savings.

California Healthline: Promise, Peril Of Duals Program
Advocates see potential for improvement but also are concerned about consumer protections in the transition of roughly 1.1 million Californians into Medi-Cal managed care. The state is launching a managed care pilot project for beneficiaries who are dually eligible for Medicare and Medi-Cal, California's Medicaid program (Gorn, 9/12).

CQ HealthBeat: California Official Expects Hospitals To Be Paid Medicare Rates In Duals Demonstration
The next high-profile demonstration project agreement affecting people who are dually eligible for Medicare and Medicaid will probably be completed in California within a month. A top state official said Wednesday that Medicare providers who care for dual-eligibles should assume that they will receive rates as high as those they now get under the health program for seniors and the disabled (Adams, 9/12).

The Denver Post: Key Medicaid Reform Effort In Colorado Shows Promising Savings
Colorado's key Medicaid-reform effort — matching thousands of state-supported patients to "medical homes" and careful case management — is showing promising savings, health officials will report to the legislature this fall. More than 128,000 Medicaid clients are enrolled in seven case management regions, and preliminary data for the first six months of billing shows a 14 percent drop for inpatient hospital stays among children, state officials said (Booth, 9/12).

The Lund Report: Governor Kitzhaber Seeks To Expand Coordinated Care Organizations
With coordinated care organizations – better known as CCOs -- in full swing for the Medicaid population, Governor John Kitzhaber is setting his sights on the next targets – people on Medicare, the state's public employees and the private business sector. "The biggest challenge with Medicare is that it's not a sustainable model," the governor told Beaverton residents last week at a town hall meeting hosted by Sen. Mark Hass (D-Beaverton). Why not allow people on Medicare to participate in a CCO on an "experimental basis," he suggested (Lund-Muzikant, 9/12).

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Roundup: Fla. Officials Probe Report On Disabled Children In Nursing Homes

News outlets report on a variety of health issues in California, Colorado, Florida, Kansas, Massachusetts, Minnesota and Oregon.

Kaiser Health News: The Great Fluoride Debate In Portland
Over jeers and cheers from the audience, commissioners on the Portland, Ore., City Council voted Wednesday to add fluoride to the city's drinking water starting in 2014. Portland is the largest American city that doesn't add fluoride to its drinking water. But some groups have raised questions about the possible risks from fluoridation and oppose its use (Foden-Vencil, 9/12).

Miami Herald: State Denies Forcing Disabled Kids Into Nursing Homes
Florida healthcare administrators will visit hundreds of medically fragile children living in geriatric nursing homes, and speak with their parents, to determine whether families are being forced to abandon their youngsters in institutions, as federal civil rights lawyers are claiming. Almost a week after the U.S. Justice Department's Civil Rights Division released a grim report that accused the state of warehousing sick and disabled children in adult nursing homes, the leaders of two state health agencies insisted the state was in "full compliance" with federal laws that require governments to house and treat disabled people in community settings, whenever possible (Marbin Miller, 9/12).

The Associated Press: Fla. Health Officials Denounce Allegations
Florida health officials are sending staff to visit more than 200 disabled children living in nursing homes, days after federal investigators accused the state of unnecessarily sending medically needy kids to adult facilities. Florida Agency for Health Care Administration Secretary Liz Dudek said she dispatched staff Tuesday to visit the nursing homes and will also meet with parents to make sure they feel the child is in the best place (Kennedy, 9/12).

The Associated Press: Florida Will Privatize Nearly 3,000 Prison Jobs
Florida is moving ahead with a plan to privatize nearly 3,000 (health care) jobs in the state's prisons despite a promise by one of the state's main unions to ask a court to block the move. A legislative panel on Wednesday approved a proposal by the administration of Gov. Rick Scott to spend nearly $58 million in order to privatize prison health care operations by January (Fineout, 9/12).

Miami Herald: Panel Okays Privatizing Inmate Health Care
A union for state workers is racing to sue Florida after lawmakers cleared the way Wednesday to privatize health care in prisons. ... The lawsuit could be filed as early as Thursday, said Doug Martin, spokesman for the American Federation of State, County and Municipal Employees, known as AFSCME. About 2,600 state workers who provide prescriptions, mental health and other medical services to prisoners find their jobs and benefits in limbo over the deal (Davis, 9/13).

Related KHN coverage: States Efforts To Outsource Prison Health Care Come Under Scrutiny

Minneapolis Star Tribune: Fairview Violated Federal Laws With Billing Practices
Strong-armed billing practices at the University of Minnesota Medical Center violated federal patient-protection laws, regulators have concluded after reviewing a range of incidents involving emergency room patients and others in fragile medical condition. The findings, which stem from Fairview's relationship with a Chicago-based consulting firm, put the hospital at risk of being terminated from Medicare and Medicaid, the ultimate penalty the federal government can impose. But a state official who is still investigating on behalf of the federal agency that runs Medicare said the Fairview-owned university hospital has ample time to correct its deficiencies and avoid sanctions (Kennedy, 9/13).

Crain's Business Insurance: Massachusetts Boosts Surcharges On Hospital Bills
Massachusetts regulators have slightly increased the surcharge on services received at hospitals and ambulatory surgical centers in the state. The surcharge, which applies to bills paid on or after Oct. 1, will be 1.87%, up from 1.75%. The surcharge increase, announced by the Massachusetts Division of Health Care Finance & Policy, is imposed on third-party claims administrators, health maintenance organizations, preferred provider organizations and self-insured employers that administer their own health care plans (Geisel, 9/12).

Kansas City Star/Wichita Eagle: Kansas Lawmakers Fume Over Official's Silence On Disability Waiting Lists
Kansas lawmakers bristled Wednesday over a top official's refusal to answer questions about the growing list of people with disabilities who are waiting for in-home or community-based services. Gary Haulmark, commissioner of community services and programs in the Department for Aging and Disability Services, said a state lawyer told him not to discuss the waiting lists because of pending litigation. The lists have led to a federal civil rights inquiry and the potential for the U.S. attorney's office to sue the state (Wistrom, 9/12).

Health Policy Solutions (a Colo. news service): Ill-Equipped College Students Flood Counseling Centers
(At) Colorado campuses and universities across the country, deans, researchers and behavioral health experts have been seeing spikes in recent years in visits to counselors and mental health facilities. Incoming students are arriving in poor emotional health aggravated by academic and financial pressures. … Dean's research and surveys from the American College Health Association have found that 75 percent of students reported experiencing stress; nearly half said they were dealing with anxiety; and 25 percent said they had been depressed in the last year (Kerwin McCrimmon, 9/12).

California Healthline: Legislative Help For Long-Term Care?
The SCAN Foundation today released results of a survey on long-term care readiness in California. It wasn't pretty: Roughly half of the poll respondents said they will need long-term care for a close family member within the next five years. About half of the poll respondents said they cannot afford even one month of nursing home care. Almost two-thirds of the registered voters in the poll said they're worried about being able to afford long-term care. A whopping 88% of those polled said legislators should make affordable long-term care a high or moderate priority (Gorn, 9/13).

Kansas Health Institute News: KHIE Board Turns Over Regulatory Duties To State
The board responsible for overseeing the digital exchange of Kansans' health records today unanimously approved transferring its duties to a state agency within a year, provided the Legislature acts to make the transfer legal. If the Legislature amends the law, as is now expected, the functions of the Kansas Health Information Exchange would be transferred to the Kansas Department of Health and Environment by October 2013 (Cauthon, 9/12).

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Swing State Trailmix

Weekly Campaign Highlights: Races In Penn., Iowa, Miss. And Mich.

As election day approaches, Kaiser Health News' Sarah Barr will sample news coverage each week from swing states around the country – how health policy developments, and other political issues, are playing in this year's vote.  

For instance, news outlets report on a hotly contested House race in Iowa where Medicare has become a flashpoint, as well as recent reports from the Senate races in Michigan and Missouri: 

Des Moines Register: In Campaign Fight Over Medicare, U.S. Rep Bruce Braley Looks To Bill Clinton For Backup
Medicare has become a flashpoint in the race for Iowa's first congressional district, with incumbent Democrat Bruce Braley and Republican challenger Ben Lange each accusing the other of undermining the popular health-care program. Lange accuses Braley of "gutting" the program by supporting the Affordable Care Act, which cuts $716 billion in future Medicare spending. Braley, in turn, highlights Lange's support for GOP vice presidential candidate Paul Ryan's plan to offer subsidies for the purchase of private health insurance, and suggests such a "voucher" program could raise costs and reduce benefits for seniors. Over the weekend, Braley called in reinforcements (Noble, 9/10).

Detroit Free Press: Hoekstra Launches New Campaign Ads Calling Stabenow Michigan's 'Worst Senator Ever'
Pete Hoekstra's launching a new attack against incumbent U.S. Sen. Debbie Stabenow with an online ad campaign calling her Michigan's worst senator ever. Hoekstra, a former congressman from west Michigan, is the Republican nominee running against Stabenow, a Democrat, who is vying for third 6-year term and appears to have a solid lead, according to several polls. Hoekstra's campaign held a conference call with reporters Monday afternoon to unveil his ad campaign, which can be viewed at www.worstsenator.com (Spangler, 9/10).

St. Louis Post-Dispatch: McCaskill, Akin Push Outside Strategy
Republican Todd Akin asks supporters to help him fight the GOP's "corrupt party bosses." Democrat Claire McCaskill says she's "strong enough to tell the president to go fly a kite when I think he's wrong." In recent weeks, both candidates in Missouri's fast-changing U.S. Senate race have fashioned themselves as outsiders willing to go against their own party's establishment (Pistor, 9/8).

Philadelphia Inquirer: Pennsylvania's Eighth House District A Closely Watched Swing Zone
On the increasingly polarized political map, Pennsylvania's Eighth District is a true swing district. ... According to the website OpenCongress, (Republican Mike) Fitzpatrick broke with GOP leadership on 18 percent of his votes in the current session, sixth-most among House Republicans.... Democrats argue that inside the percentages, though, are votes for key pieces of a right-wing agenda. Fitzpatrick voted to repeal President Obama's health-care overhaul and back Paul Ryan's budget, which would increase tax breaks, largely for the wealthy and corporations, slash spending on programs for the poor, and, most controversially, overhaul Medicare. "I voted to secure Medicare for today's seniors and to strengthen it for the future," Fitzpatrick said, adding that (Democrat Kathy) Boockvar would side with Nancy Pelosi, the Democratic leader in the House, to "raid" Medicare. He pushed back against criticism that Ryan's plan would cost future seniors thousands of dollars, saying the savings would preserve the program. Boockvar also cited Fitzpatrick's votes to strip funding from Planned Parenthood and his cosponsorship of a bill restricting federal funding for abortion (Tamari, 9/4).

Meanwhile, in the post-convention atmosphere, Florida continues to be a key battleground for both presidential campaigns:  

Tampa Bay Times: Crowds And Post-DNC Poll Numbers Buoy Obama In Florida
President Barack Obama — buoyed by higher poll numbers after his Democratic Party's convention — journeyed to Florida for a two-day swing, bouncing from Tampa Bay to Central Florida on Saturday, and then the Space Coast and West Palm Beach on Sunday. In his wake, former President Bill Clinton [stumped] Tuesday in Miami and then in Orlando on Wednesday, the same day that Republican presidential candidate Mitt Romney's wife, Ann, [headed] to the Tampa Bay area. As the Nov. 6 elections draw near, expect the visits to get even heavier and rhetoric to get sharper — specifically regarding Medicare and the economy, two key issues in a senior-heavy state menaced by high home foreclosures and unemployment rates (Caputo, 9/10).

Other reports detail how voter access issues are emerging as an important election-year dynamic: 

Richmond Times-Dispatch: Study Gives Virginia Mixed Reviews On Voter Protections
Virginia gets mixed reviews in a study of how well the election laws of 10 swing states protect voters from discrimination and intimidation when they try to cast a ballot. The study — "Bullies at the Ballot Box: Protecting the Freedom to Vote Against Wrongful Challenges" — was released Monday by the nonpartisan voting rights groups Common Cause and Demos. The report concludes that Virginia "offers unsatisfactory protections for voters from wrongful challenges to their right to vote before Election Day, but better protections against wrongful challenges on Election Day and good protections for voters from intimidation by partisan poll watchers on Election Day, inside and outside the polls" (Nolan, 9/11). 

Pittsburgh Post-Gazette: Voter ID Case Goes To Pa. Supreme Court On Thursday
Challengers seeking to stop the new voter ID law from taking effect for the November elections will make their case Thursday before the Pennsylvania Supreme Court. It is the final venue for the lawsuit under the state Constitution after a lower court in August declined to halt the requirement that voters show certain forms of photo identification at the polls. The Pennsylvania law is only one example of the heightened voter identification requirements that have gained traction nationwide, but it has attracted notice for its location in a populous state that has been treated as a swing vote in presidential elections (Langley, 9/10).

Philadelphia Inquirer: Pennsylvania Supreme Court Faces Key Question On Voter ID Appeal
Many opponents of the state's voter ID law, like Bea Bookler of Devon, were shocked when Commonwealth Court Judge Robert E. Simpson Jr. upheld the law in a ruling last month. "My first reaction was unprintable," Bookler, 94, one of the plaintiffs trying to get the law overturned, said in a telephone interview. "My second reaction was to get in bed and say I don't want to be alive in a world where people are prevented from voting" (Warner, 9/11).

The Plain Dealer: Ohio Secretary Of State Jon Husted Rescinds Order Blocking Early Voting Hours, Asks Court For Stay During Appeal
Ohio Secretary of State Jon Husted on Friday rescinded a directive that blocked boards of election from setting in-person early voting hours for the final three days leading up to Election Day. But the Republican secretary still hopes to forestall a federal court's order that he set hours for voting during that run-up period to Nov. 6, asking to hold off at least until the state's request to appeal is decided.  Husted's action came in response to federal Judge Peter C. Economus, who ... ordered Husted to appear in his courtroom on Sept. 13 to explain why he issued a directive that appears to ignore Economus' recent court ruling (Fields, 9/7).

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Weekend Reading

Longer Looks: The Smells To Treat PTSD; Nudging Healthy Choices

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

The Miami Herald: Bringing The Smells Of War Home, Via Virtual Reality
On an Orlando college campus, veterans and active duty soldiers suffering from post-traumatic stress disorder inhale the unmistakable smell of burning tires, rotting garbage and Middle Eastern spices as part of a virtual reality treatment for the psychological wounds of war. Participants sit in a chair wearing a head-mounted display and video goggles connected to a computer system and a scent machine that puffs out the odors, recreating their memories of war. ... The Trauma Management Therapy program, now available to South Florida active duty soldiers and veterans with PTSD who volunteer, is part of a clinical study at the University of Central Florida that uses sights, sounds and smell to help ease the episodes of anxiety, sleeplessness and nightmares. With new waves of soldiers returning as American forces withdraw from Iraq and Afghanistan, researchers are hoping the combination of traditional therapy and virtual-reality simulation — with an emphasis on smell — to help decrease post-traumatic symptoms (Audra D.S. Burch, 9/9).

The New York Times: Door To Door In The Heartland, Preaching Healthy Living
Like a missionary, Michael Bailey, a county health worker, spends his days driving his beat-up Nissan around (Okalahoma City's) poorest neighborhood, spreading the word in barber shops and convenience stores about the benefits of healthy diet and exercise. "Look at the kids," he said. "Overweight, huffing and wheezing. Their lives will be miserable if this doesn't change." Mr. Bailey believes that food is slowly killing his community here, and signing people up for a program to prevent heart disease is his way of saving souls. Local governments across the country are creating dozens of such experiments with money from the Obama administration's Affordable Care Act. It is part of a broad national effort set in motion by the law to nudge a health care system geared toward responding to illness to one that tries to stop people from getting sick in the first place. To that end, the law created the $10 billion Prevention and Public Health Fund, the largest-ever federal investment in community prevention (Sabrina Tavernise, 9/10).

The New York Times: How My Mother Disappeared
In 2005, as my mother began the torturous process of disappearing in plain sight, I retreated to my kitchen, trying to reclaim her at the stove. Picking up a pot was not the instant panacea for illness and isolation and despair that I wanted it to be. But it helped. When I turned to my mother’s recipes, I felt grounded in her rules, and they worked every time. I could overcook or undercook the meatloaf, and it still tasted the same. ... A CT scan ... showed that she had suffered ministrokes, transient ischemic attacks. The scar tissue the strokes left in Mom’s brain was anything but mini; because of its location, it was not only impairing her memory but ensnaring her in a state of depression (Alex Witchel, 9/7).

The Atlantic: The Fallacy Of Treating Health Care As An Industry
On September 6 the well-respected Institute of Medicine (IOM) released its report, "Best Care at Lower Cost." Its authors argue that the U.S. health-care system is falling far short of its potential and continuing to rack up unsustainable cost increases. ... The solution, they argue, is for the health care system to adopt practices already in use by other industries. ... One problem with a patchwork approach to reforming healthcare is the danger that we may produce a sort of Frankenstein, a monstrosity made up of parts that look strong when viewed in isolation but turn out not to fit well together. We cannot merely mix up two-thirds of a cup of banking, a quarter cup of manufacturing, and two tablespoons of airline policies and procedures and expect to produce well-integrated patient care. No matter how good each of the individual ingredients that go into preparing a meal are, if the components are not mixed in the appropriate combinations and proportions, the result is more likely to prove stomach churning than appetizing (Dr. Richard Gunderman, 9/10).

Los Angeles Times: The Doctor-Patient Relationship Is Evolving
(This story is part of a series of health care stories in a special section of the Los Angeles Times called The Future Of Healthcare)  
Until now, doctors have pretty much called the shots in the doctor-patient relationship. But change is on the way. Patients, say ahhhhh — it's about to be all about you. The new approach is called patient-centered care, and it's a very good thing, according to Dr. James Rickert, the founder and president of the Society for Patient Centered Orthopedics in Bedford, Ind. "It will mean better outcomes, more satisfied patients and lower costs," he says. Here are just a few ways your relationship with your doctor may evolve in the not-too-distant future:Your doctor won't be the boss of you. "Physicians are experts on likely outcomes, likely effects and side effects," says Dr. Elliott Fisher, a professor of community and family medicine at Dartmouth's Geisel School of Medicine in Hanover, N.H. "But patients are experts on their preferences"...You and your doctor will spend more time on the Internet. That's because e-visits will replace some traditional kinds of appointments. "It's so easy," says Dr. Redonda Miller, an associate professor at the Johns Hopkins University School of Medicine in Baltimore. "Patients love it — 50% of what we do in the office could by done by email" (Karen Ryan, 9/13).

Journal of the American Medical Association: A Path To Wholeness
My communications with Len and Lorraine allowed me to envision this loving young couple as they embarked on establishing Len's first church in Hardin, Montana, after seminary in 1952. Lorraine was glowing as she was about to give birth to their firstborn, starting their family and new life. A much-dreaded experience befell them on October 13, 1952, when physicians in Billings discovered that Deborah had a life-altering condition at birth: spina bifida. ... In 1952, the expectations and values imposed by social standards and framed through the advice of both nurses and physicians—"You cannot care for this infant." "Do not bond." "Pass her on to an institution for care. You cannot do it." and insisting that Lorraine should "Stop that crying" whenever she was seen expressing emotion—were in marked contrast to those deafening proclamations coming from Deborah's parents: This is our daughter. How can we not care for her and love her? Our very souls have been as one with hers from the moment of intention, to conception, to birth, to death and beyond (Dr. Jay M. Milstein, Lorraine B. Kovar, Leonard J. Kovar and Debora A. Paterniti, 9/11).

The New York Times: The Caregiver
I was driving through Kansas, taking the kids back to college, when my cellphone buzzed. It was my sister-in-law letting me know that Juanita Hawkins had died. An aching sensation — grief — filled my chest and swelled into my throat. Juanita was my mother’s caregiver for more than 35 years. She was at every Passover, every Thanksgiving, for as long as I could remember, sitting at the table, smiling at the jokes, partaking in the closeness of family. They were an unlikely pair: my mother, raised in Chicago by Russian Jewish parents, her high school’s valedictorian and a gifted pianist before multiple sclerosis attacked in her early 20s. And Juanita, a black woman, the second of 10 children from Pine Bluff, Ark. A modest woman who never went to college, married or had children. A committed churchgoer. They had nothing in common, these two, except decades of living together and being bound inextricably by my mother's illness and the rhythms of their daily life (Judith Graham, 9/11).

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Editorials and Opinions

Viewpoints: Medicaid's Role In Lowering Uninsured Rate; Need To Protect Physicians 'Compelled By Conscience' To Provide Abortions

The New York Times: Fewer Uninsured People
The number of Americans who lack health insurance declined last year, the first drop since 2007. This is, in large part, the result of the health care reform law and better coverage under public programs like Medicaid. This also shows why repealing the health care law or revamping and shrinking Medicaid, as many Republicans want to do, would be disastrous moves (9/12). 

The Wall Street Journal: Grim Census 'Progress'
The share of the population without health insurance did fall modestly ... which liberals are attempting to use as evidence that the Affordable Care Act is working, though the law doesn't kick in until 2014. But even if these claims were true, the problem is that the gains came largely by government crowding out private insurance. Some 3.9 million people on net joined the public rolls, led by a jump in Medicaid enrollment of 2.3 million, while the number of individuals with normal insurance rose by about 800,000 (9/12).

Journal of the American Medical Association: Outcome Of 2012 Election Will Likely Affect Medicaid Far More Than Medicare
Medicaid covers more people than Medicare does. ... It’s important to remember that although the focus is often on “block granting,” the savings projected to come from Medicaid in the Republican proposal are a result only of this drastically reduced spending. There’s no “innovation” driving them. They will have real consequences, and they’re not hard to predict (Dr. Aaron Carroll, 9/12).

The Denver Post: Preventive Care Is The Key
Recent news about the number of people in this country who have out-of-control high blood pressure was astonishing — some 36 million Americans. That condition poses terrible risks for cardiovascular disease, but the real shame in the numbers is that 89 percent of those people reported having regular access to health care. The statistic is one of many that points out the need for better preventative care and a greater awareness of the risks of not seeking treatment and changing their lifestyles. And let's be candid: This is about cost, too (9/13).

New England Journal of Medicine: Recognizing Conscience In Abortion Provision
The exercise of conscience in health care is generally considered synonymous with refusal to participate in contested medical services, especially abortion. This depiction neglects the fact that the provision of abortion care is also conscience-based. The persistent failure to recognize abortion provision as "conscientious" has resulted in laws that do not protect caregivers who are compelled by conscience to provide abortion services, contributes to the ongoing stigmatization of abortion providers, and leaves theoretical and practical blind spots in bioethics with respect to positive claims of conscience (Dr. Lisa H. Harris, 9/12). 

New England Journal of Medicine: There Is More To Life Than Death
Physicians and patients alike crave certainty. ... In clinical decision analysis, the outcome that is generally measured is death. ... Basing decisions on the outcome of death ignores vital dimensions of life that are not easily quantified. There are real complexities and uncertainties that we all, patients and physicians alike, confront in weighing risk and benefit. Wrestling with these uncertainties requires nuanced and individualized judgment. It is neither ignorant nor irrational to question the wisdom of expert recommendations that are sweeping and generic (Drs. Pamela Hartzband and Jerome Groopman, 9/12).

New England Journal of Medicine: Punishing Health Care Fraud — Is The GSK Settlement Sufficient?
On July 2, 2012, the Department of Justice announced the largest settlement ever in a case of health care fraud in the United States. GlaxoSmithKline (GSK) agreed to plead guilty to three criminal counts and settle civil charges brought under various federal statutes; the company will pay a total of $3 billion to the federal government and participating states. ... Despite the size of the fine and civil settlements, it would be a mistake to assume that GSK was an outlier in the global pharmaceutical and medical-device industries. ... questions remain about the efficacy of fines and corporate integrity agreements in deterring corporate misbehavior (Kevin Outterson, 9/12).

Detroit Free Press: Don't Ignore All The Empty Hospital Beds
Challenges occasionally arise to Michigan's Certificate of Need process for new medical facilities, which has worked well for decades. It's no surprise that with term-limited lawmakers, the challenges are likely to become more frequent. ... "If you build it, they will come" is not the appropriate mantra for reining in health care costs in this country (9/13).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
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.