Daily Health Policy Report

Wednesday, September 19, 2012

Last updated: Wed, Sep 19

KHN Original Reporting & Guest Opinion

Campaign 2012

Capitol Hill Watch

Health Reform

Public Health & Education


Coverage & Access

Health Information Technology

State Watch

Swing State Trailmix

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Medicare Battle Heats Up California House Race

Kaiser Health News staff writer Sarah Varney, working in collaboration with Politico, reports: "When Republican Rep. Dan Lungren faced a crowd of tea party supporters and Democratic detractors at a recent town hall meeting here, the arguments showed how explosive the Medicare debate can get in the hottest races in the country" (Varney, 9/18). Read the story and watch a related video about a Pennsylvania House race.

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Capsules: Joint Commission Praises 620 Hospitals For Quality; Family Physicians Reject Suggestions To Have Nurses Lead Practices; Unchecked Rise In Obesity Will Be Costly To States, Report Says

Now on Kaiser Health News' blog, Jordan Rau reports on a list released by the Joint Commission: "The Joint Commission, the nation’s major hospital accreditation board, is releasing its annual list of hospitals that have excelled at adhering to basic procedures for treating common illnesses such as heart attacks and strokes" (Rau, 9/19).

Also on Capsules, Ankita Rao reports on a report released Tuesday by the American Academy of Family Physicians: "With a shortage of primary care providers looming, the idea of using nurses and physician assistants to fill the gap often appears to be gaining traction. But according to a report released Tuesday by the American Academy of Family Physicians, having more nurse practitioner-led medical practices is not a viable solution" (Rao, 9/18).

In addition, Rao reports on a new analysis of obesity trends: "A new report analyzing obesity trends warns that health care costs will increase alongside U.S. waistlines if current rates are left unchecked. It calls for mobilizing public health efforts and expanding funding to help adults and children become leaner" (Rao, 9/18). Check out what else is on the blog.

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Political Cartoon: 'Status Quo?'

Kaiser Health News provides a fresh take on health policy developments with "Status Quo?" by Joel Pett.

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


Waistlines are growing.
Illness rates, health costs follow.
It's time to diet. 

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

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Campaign 2012

Romney's '47 Percent' Fuels Talk Of Who Gets Tax Breaks, Aid

Some news outlets report how the remarks underscore different views of the role of government by President Barack Obama and GOP challenger Mitt Romney. Meanwhile, Romney attempts to deflect criticism by going on the offensive, saying his comments help define the choice before voters.

The Associated Press/Washington Post: Analysis: Romney Describes Government's Role As Dramatically More Limited Than Obama's View
Republican Mitt Romney, in describing nearly half of Americans as being docile dependents of the state, and saying it's a "foreign concept" for government to redistribute income, is outlining a philosophy that's not only sharply at odds with President Barack Obama's views. It's also difficult to square with the facts of how Social Security, Medicare, the tax code and scores of other institutions work. Romney's claim that 47 percent of Americans won't take "personal responsibility" … instantly crystallized his philosophical differences with Obama when the remarks came to light Monday (9/18).

The New York Times: Romney Says Remarks On Voters Help Clarify Position
Mr. Romney, who on Monday called the remarks inelegant, suggested on Tuesday that it was time for a full debate about dependency, entitlements and what his campaign characterized as a long history of Mr. Obama's support for "redistributionist" policies. But despite the effort by Mr. Romney to take the offensive, his campaign spent the day working to keep the episode from becoming a turning point in a campaign that until now has remained neck and neck, and trying to minimize the damage from the disclosure of another set of remarks from the fund-raiser, in which he suggested that a two-state solution for peace between the Israelis and Palestinians — longstanding United States policy — was not feasible (Rutenberg and Parker, 9/18).

Politico Pro: Romney Push For Medicaid Funds Back In Spotlight
Republican presidential nominee Mitt Romney may complain about the nation's dependence on government largesse, but his own Massachusetts health care plan depended on a big infusion of Medicaid funds — and Romney led the charge for it, according to his former Bay State adversaries. Romney stunned the political order Monday when a four-month-old video emerged showing the candidate contending that 47 percent of Americans feel "entitled" to government programs — from health care to housing to food stamps. But as governor, Romney led the drive to expand publicly subsidized health insurance that depended on a massive infusion of federal funds to Massachusetts. Without those funds, the state's 2006 health law ... would not have been possible, backers say (Cheney, 9/18).

The Associated Press/Washington Post: Romney's 47 Percent: His Math Is Correct, But Much Federal Aid Goes To The Middle Class, Too
While it's true most of those nonpayers are poor, the numbers include many others who got tax breaks because they are old, have children in college or didn't owe taxes on interest from state and local bonds. And of those who didn't write checks to the IRS, 6 in 10 still paid Social Security and Medicare payroll taxes, and more than that paid federal excise taxes on items such as gasoline, alcohol and cigarettes, said Roberton Williams, who analyzes taxes at the center (9/18).

The Wall Street Journal: Raw Data Support – And Undercut – Romney Take On Who Gets Benefits
Federal benefits include those going to low-income Americans, such as food stamps and Medicaid, the health-care program for the poor. Other benefits from programs such as Medicare and Social Security flow to older Americans who, in most cases, paid taxes for decades before they qualified (Paletta and McKinnon, 9/18).

Politico Pro: Romney Backlash Begins With Call On Veterans' Health
Americans United for Change hosted a call for reporters Tuesday afternoon — "Faces of Romney's 47 Percent" — featuring a veteran, Mike Evans, who talked about Veterans Administration health care and vocational rehabilitation that allowed him to become a public school teacher in Missouri. It also featured Leon Burzynski , a senior citizens advocate with the Wisconsin Alliance for Retired Americans, who claimed that he was proud to enjoy the retirement security of Medicare and Social Security after paying into the programs for decades. He blasted Romney and Rep. Paul Ryan for wanting to "roll back that promise." None of the speakers said that he or she did not pay federal income tax, but Romney's surreptitiously recorded remarks blurred the line between those who don’t pay income taxes and those who receive any government benefit (Norman, 9/18).

Politico: Biden Avoids Talk Of Mitt Video, But Defends Government Assistance
Vice President Biden hasn't commented on the videos showing Mitt Romney saying President Obama's supporters consider themselves "victims," but he launched into a defense of Medicaid spending here, telling a crowd that Republicans would end aid to needy senior citizens in nursing homes. With each time he mentioned Medicaid, Biden emphasized the program’s final syllable, ensuring the mostly college-aged crowd of 718 understood he meant the health insurance program for the poor rather than Medicare, which provides insurance for older people (Epstein, 9/18).

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Polls Offer Windows Into Campaign Challenges, Dynamics

A new round of polls indicates that, with seven weeks left of campaigning, President Barack Obama appears to be edging out GOP candidate Mitt Romney. However, the findings also highlight the political forces that could work for and against each candidate.

The New York Times: Wisconsin Offers Window Into Challenges Confronting Romney
Rob Jankowski, an independent voter who supported Mr. Obama four years ago but has been disappointed by his economic leadership and disapproves of his health care plan, is among the 3 percent of voters in the survey who say they are still undecided. He said he did not feel loyalty to Mr. Obama simply because he supported him last time, but he said Mr. Romney had not made his case. … The New York Times, in collaboration with Quinnipiac and CBS News, is tracking the presidential race with recurring polls in six states (Zeleny and Connelly, 9/19).

The Washington Post: Obama Up 8 Points Over Romney In Virginia
With just seven weeks of campaigning left before the November election, President Obama holds a clear lead over Mitt Romney in Virginia, buoyed by growing optimism about the state of the country and fueled by a big gender gap working in his favor, according to a new Washington Post poll (Vozzella, Balz and Cohen, 9/18).

In other presidential campaign news -

The Associated Press: Celebrities To Attend AARP Conference in N.O.
More than a dozen celebrities are participating in talks and activities for aging Americans at the national conference of the AARP this week in New Orleans. It will also be a presidential campaign stop for Republican Mitt Romney's running mate, Wisconsin Rep. Paul Ryan. President Barack Obama is expected to address attendees via satellite. Both are speaking Friday about Social Security, Medicare, jobs and finances (9/18).

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Capitol Hill Watch

House Panel To Consider Health Law Change That Would Help Brokers

A House committee is preparing a bill that would change the health law's medical loss ratio provision to exclude brokers' fees from counting as administrative costs.

The Hill: House Panel Readies Bill To Alter Health Law's Medical Loss Ratio
A feature of President Obama's healthcare law often touted by Democrats would change under a House bill now ready for mark-up. The measure (H.R. 1206) from Rep. Mike Rogers (R-Mich.) would alter the law's medical loss ratio (MLR) by excluding insurance brokers' fees from counting as administrative costs under the requirement. The medical loss ratio mandates that insurers spend no less than about 80 percent of their premiums on medical care rather than administrative costs or profit, or rebate the difference to policyholders. Democrats and the Obama administration have praised the policy for producing more than $1 billion in consumer rebates this year (Viebeck, 9/18).

Meanwhile, a Senate subcommittee releases a report questioning the oversight of disability benefits - 

The Hill: Report: Disability Benefits Wrongly Awarded
Lax oversight is leading the government to approve disability benefits for people who can't prove that they're disabled, according to a report released Tuesday by a Senate subcommittee. The report, spearheaded by Sen. Tom Coburn (R-Okla.), says more than a quarter of disability claims are approved despite inadequate or conflicting information. That doesn't necessarily mean all of those claims should have been rejected, Coburn said at a hearing Tuesday — but some unfounded approvals are surely slipping through the cracks of an inadequate review process. The report does not address people who might have been wrongly denied disability benefits (Baker, 9/18).

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Health Reform

HHS Rule Limits Access To Exchanges, Insurance Subsidies For Young Immigrants Who Are Exempt From Deportation Proceedings

The Wall Street Journal: Health-Law Limits Cloud Democrats' Push For Hispanic Vote
The Department of Health and Human Services issued rules last month that said the young people wouldn't be allowed to shop for insurance policies through newly established health exchanges or receive federal subsidies toward the cost of premiums starting in 2014. They are also not eligible to enroll in the federal-state Medicaid program for low-income Americans, the department has said. The rules were first reported by the New York Times on Tuesday (Radnofsky, 9/18).

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Public Health & Education

Report: Obesity Rates Will Continue To Grow, Health Care Costs Will Follow

The Robert Wood Johnson Foundation and Trust for America's Health concluded that, based on current trends, most Americans could be obese by 2030.

Politico: Study: Obesity Rate To Jump By 50% By 2030
The Robert Wood Johnson Foundation and the Trust for America's Health released a new report Tuesday projecting America's obesity rates through 2030. If current obesity rates continue, every state could have an obesity rate above 44 percent by 2030, and most states could have rates higher than 50 percent, the report found (Smith, 9/19).

Kaiser Health News: Capusles: Unchecked Rise In Obesity Will Be Costly To States, Report Says
A new report analyzing obesity trends warns that health care costs will increase alongside U.S. waistlines if current rates are left unchecked. It calls for mobilizing public health efforts and expanding funding to help adults and children become leaner (Rao, 9/18).

The Hill: Study: US Will Have 39 'Majority-Obese' States By The Year 2030
The Robert Wood Johnson Foundation (RWJF) and Trust for America's Health partnered on the report out Tuesday. It projects a massive rise in cases of type 2 diabetes, heart disease and other weight-related disorders as Americans gain substantial weight. Report authors argue the crisis merits federal intervention to promote healthier school lunches and more physical education for children — controversial recommendations amid current political debates over the right role of government. "Policy changes can help make healthier choices easier for Americans in their daily lives," said Jeff Levi, executive director with Trust for America's Health (Viebeck, 9/18).

The Fiscal Times: Unchecked Obesity Could Bankrupt Nation
Obesity rates have doubled over the past two decades and will almost double again over the next two decades unless the public comes to grips with its swelling waistlines, a new study says. The rising tide of obesity threatens to send health care costs soaring. Already, the nation spends an estimated $147 billion to $210 billion per year on obesity-related diseases including Type 2 diabetes, hypertension, heart disease, and arthritis. Unless the projections are altered dramatically, additional medical costs associated with treating preventable, obesity-related diseases could swell by another $48 billion to $66 billion by 2030, the report said (Goozner, 9/19).

Medpage Today: Red Or Blue Most States Are Fat
If obesity rates continue to follow current trends, more than half the population of almost 40 states will be obese in 2030, health groups said. In 13 states six of every 10 residents will be obese, and all 50 states would have rates topping 44 percent, according to a report by Trust for America's Health and the Robert Wood Johnson Foundation. … The report estimates that in 2030, Mississippi could have the highest obesity rate at 66.7 percent, while Colorado would have the lowest at 44.8 percent. Currently, obesity rates top out at 34.9 percent in Mississippi and bottom out at 20.7% in Colorado, according to the CDC (Fiore, 9/18).

ABC: Most Americans May Be Obese By 2030, Report Warns
The annual report looks at the state of the obesity epidemic, as well as ways to address it. This year, for the first time, it includes new data on how obesity could impact the health and wealth of the U.S. over the next 20 years. Using a prediction model published in The Lancet last year, analysts estimated that if adult obesity rates continue on their current path, all 50 states could have rates above 44 percent by 2030 (Braun, 9/18).

CNN: Health Care Costs To Bulge Along With U.S.
It also projects that the health of the country -- and the dollars spent on the health care system -- would benefit from even a 5% reduction in the average body mass index. ... The U.S. Centers for Disease Control and Prevention found, in data published in August, that Mississippi is the country's leader in adult obesity, at 34.9%. That number could rise to 66.7% by 2030, the new report found. The new analysis also projected that obesity rates in 13 states could rise above 60% among adults by 2030 (Landau, 9/18).

NBC: If You Think We're Fat Now, Wait Till 2030
In August, the Centers for Disease Control and Prevention reported that 12 states have an adult obesity rate over 30 percent. Mississippi had the highest rate of obesity at 34.9 percent. On the low end, 20.7 percent of Colorado residents are obese. CDC projections for obesity resemble those in Tuesday's report - it projects 42 percent of adults will be obese by 2030. The problem isn't just cosmetic (Fox, 9/18).

Some news outlets examined what the report projects for their states -

Los Angeles Times: More Than 45% Of Californians May Be Obese By 2030, Report Says
If you think America is fat now, just wait 20 years. So says a state-by-state projection of the nation's future obesity rates that has arrived at some terrifying results: By 2030, every state in the nation may well have obesity rates above 44%, with most having rates above 50% (Bardin, 9/18).

The Dallas Morning News: Texas Is On A Path To 57% Obesity By 2030, And That Would Be Costly
At the current rate of weight gain, by 2030, 57.2 percent of Texans will be obese. That could lead to 13 million more cases of chronic diseases like diabetes, heart failure and stroke, arthritis and cancer. The projections by the Trust for America's Health  were released Tuesday. ... The state's current obesity rate is 30.4 percent, according to self-reported weight and height measurements gathered in surveys by the U.S. Centers for Disease Control and Prevention (Landers, 9/18).

San Francisco Chronicle: Heavy Toll Seen In Health Habits: Obesity
Nearly half of Californians will be obese by 2030 if they don't change their eating habits and start exercising, according to a report released Tuesday that offers a state-by-state analysis of the country's weighty future. That would mark a significant increase from the state's 2011 obesity rate of 23.8 percent but, even with that, California's ranking as the 46th fattest state in the country is not expected to change (Colliver, 9/18).

Minnesota Public Radio: Obesity Could Double In Minnesota If Patterns Hold
Anyone who thinks Minnesota has a serious obesity problem now should look ahead 20 years. It could get a whole lot worse. A new analysis of government health data suggests that Minnesota's obesity rate could climb to a staggering 54.7 percent by 2030 if the state's current weight-related trends don't change. Currently 25.7 percent of Minnesota adults are obese (Benson, 9/18).

Milwaukee Journal Sentinel: State Could Save $12 Billion In Health Costs If Residents Slim Down, Report Says
Every little bit counts, whether it's increasing physical activity in schools and workplaces, making fresh fruits and vegetables more affordable, or losing 10 pounds through exercise and better eating. The ultimate payoff for Wisconsin could add up to $11.96 billion in health care savings if the average resident trimmed just 5% from his or her body mass index by 2030, according to a state-by-state report released Tuesday by Trust for America's Health and the Robert Wood Johnson Foundation. Combating obesity helps reduce costly chronic obesity-related diseases, such as type 2 diabetes - a disease of considerable concern for aging baby boomers (Herzog, 9/18).

Detroit Free Press: How Fat Is Michigan? New Obesity-Rate Ranking Puts Us Behind Just These 4 Other States
Three of 5 Michiganders could be obese by 2030 and its healthcare costs could soar if the state doesn’t start shedding pounds, according to a new report this morning. Michigan jumped to 5th fattest state in the nation as the number of obese adults expanded from 30.5% to 31.3%, according to the annual F as in Fat report by the Trust for America Health. The report is financed by the Robert Wood Johnson Foundation, a Princeton, N.J.-based philanthropy focused on health issues. More than 12% of Michigan’s high school students are obese as well, according to the report (Erb, 9/18).

In related news -

Reuters: Wal-Mart, Humana Reward Healthy Food Purchases
Wal-Mart Stores Inc, the world's largest retailer, is joining with healthcare insurer Humana Inc to trim the cost of healthy foods for some customers. More than 1 million members of Humana's healthy rewards program will get a 5 percent credit on about 1,300 healthy food items at U.S. Walmart stores starting on October 15, the companies said. The credit can be used against future Walmart purchases (Humer, 9/19).

Medpage Today: NYC Health Chief Urges Others To Act On Obesity
The chief of New York City's health department, which just passed a ban on super-sized sugary drinks, has called on other governmental bodies to champion food policy that will have an impact on obesity. "To do nothing is to invite even higher rates of obesity, diabetes, and related mortality," Thomas Farley, MD, MPH, the city's health commissioner, wrote in a commentary in a special issue of the Journal of the American Medical Association dedicated to obesity. Farley argues that government has a long history of passing policies that protect public health, including restaurant inspections to prevent foodborne disease and seat belt laws that blunt the impact of car crashes -- even though none of these are as deadly as obesity, Farley said (Fiore, 9/18).

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Joint Commission Offers Ranking Of Hospitals On Quality, Patient Safety

The hospital accreditation board recognized 620 hospitals as top performers based on 45 measures. The rankings reflect performance in 2011.  

Modern Healthcare: Joint Commission Ranks 620 Hospitals As Top Performers On Quality Measures
The Joint Commission has recognized 620 hospitals as top performers in quality and patient safety, up 53 percent from 405 hospitals last year. The designation is based on hospitals' performance during 2011 across 45 accountability measures in areas such as pneumonia care, heart-failure care and inpatient psychiatric services. To make the list, hospitals had to receive a composite score of 95 percent or above on all of the accountability measures it reported to the Oakbrook Terrace, Ill.-based organization (McKinney, 9/19).

Kaiser Health News: Capsules: Joint Commission Praises 620 Hospitals For Quality
The Joint Commission, the nation's major hospital accreditation board, is releasing its annual list of hospitals that have excelled at adhering to basic procedures for treating common illnesses such as heart attacks and strokes (Rau, 9/19).

Miami Herald: HCA Facilities Lead Top Hospital List In South Florida
Five hospitals in the HCA chain are among 11 in South Florida that received top scores from the Joint Commission, the nonprofit group that accredits the nation’s hospitals. The Memorial Healthcare System in South Broward had three on the list. Baptist Health South Florida had two in a report scheduled to be released Wednesday. The 11 hospitals all received top scores in four key quality treatment measures for 2011: for heart attack, heart failure, pneumonia and surgical care, as measured by data collected by the Joint Commission (Dorschner, 9/19).

In other news about health care quality --

Medscape: Best Hospital-To-Primary-Care Procedures Remain Unclear
A systematic review of 36 randomized controlled trials of interventions aimed at improving handovers between hospital and primary care providers at hospital discharge failed to establish any firm conclusions about which interventions have positive effects on quality of care. Gijs Hesselink, MA, MSc, from the Scientific Institute for Quality of Healthcare at Radboud University Nijmegen Medical Centre in the Netherlands, and colleagues published their findings in the September 17 issue of the Annals of Internal Medicine. According to the researchers, studies suggest that poorly managed hospital discharges can lead to increased rehospitalizations and decreased quality in continuity of care. With the increased movement of patients between various health care institutions, the emphasis on delivery of care in the community, and the move toward shorter hospital stays, there is a greater need for effective discharge and transfer of patients (Hitt, 9/18).

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Coverage & Access

Report: Medical Home Model Should Have Physician At The Helm

A report issued Tuesday by the American Academy of Family Physicians urges the concept of medical homes as a solution to the looming primary care shortage, but argues that such practices should still be led by doctors.

Politico Pro: Primary Care Docs Don't Want Bigger Role For Nurse Practitioners
Primary care physicians know they're in short supply -- but that doesn't mean they want nurse practitioners stepping up to fill the void. A new report from the American Academy of Family Physicians discounts the idea that nurse practitioners practice medicine independently to treat patients. It embraces the patient-centered medical home as a solution for improving care, but only if physicians are at the head. In a call with reporters Tuesday, AAFP Board Chair Roland Goertz said the discussion about team-based care in a medical home and the discussion about nurse practitioners stepping up to fill the void are at odds with each other (Smith, 9/18).

Kaiser Health News: Capsules: Family Physicians Reject Suggestions To Have Nurses Lead Practices
With a shortage of primary care providers looming, the idea of using nurses and physician assistants to fill the gap often appears to be gaining traction. But according to a report released Tuesday by the American Academy of Family Physicians, having more nurse practitioner-led medical practices is not a viable solution (Rao, 9/18).

Kansas Health Institute News: Physicians, Not Nurses, Should Lead Care In Medical Home Model, Says Report
As states adopt so-called patient-centered medical homes, family physicians -- not nurse practitioners -- should be at the helm of the health care team, even in areas facing doctor shortages, according to a white paper released today by the American Academy of Family Physicians. "We recognize that primary care physician shortages are a reality," said AAFP board chair Roland Goertz. But "granting independent practice to nurse practitioners would be creating two classes of care -- one with physician-led teams and one guided by less qualified professionals." As the shortage of primary care doctors grows, particularly in rural areas, 16 states have granted authority to nurses with more training to diagnose patients and prescribe treatment or medications (9/18).

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Health Information Technology

Are Electronic Medical Records Leading To Higher Medical Bills?

The Center For Public Integrity: Growth Of Electronic Medical Records Eases Path To Inflated Bills
Electronic medical records, long touted by government officials as a critical tool for cutting health care costs, appear to be prompting some doctors and hospitals to bill higher fees to Medicare for treating seniors (Schulte, 9/19).

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State Watch

Minn. Governor Moves Forward On Insurance Exchange, Shifts Oversight

Minnesota Gov. Mark Dayton is shifting responsibility for a key part of the federal health overhaul in his state -- a health insurance exchange -- to a different state agency. He's also moving forward on implementing the exchange, he said Tuesday.

Minnesota Public Radio: Citing Potential Conflicts Of Interest, Dayton Moves Insurance Exchange To Budget Office
Gov. Mark Dayton is changing the leadership of the administration's work on a key part of the federal health care law in Minnesota -- the insurance exchange. The governor is shifting the project's oversight from the Department of Commerce to the state Management and Budget office. The move follows complaints that the Commerce Department was too secretive in developing an the health insurance marketplace, and questions of possible conflict of interest for the department (Stawicki, 9/18).

Minneapolis Star Tribune: Dayton Moving Ahead On Health Insurance Exchange
Gov. Mark Dayton told legislative leaders Tuesday that he will seek federal approval to move forward on a Minnesota-made health insurance exchange, but he sought to assure Republican opponents that he will defer important policy decisions until after the November election. Dayton also said he was shifting responsibility for leading the "next phase" of the exchange to a new state agency. The actions are a sign of continued movement to set up a state-run exchange, a key component of President Obama's health care law. The exchanges are scheduled to launch nationwide in 2014 and aim to be competitive marketplaces for individuals and small businesses to comparison shop for health insurance (Crosby, 9/18).

(St. Paul) Pioneer Press: Minnesota Health Exchange Planning Shifted To New Agency
The Dayton administration is shifting responsibility for creating Minnesota's health insurance exchange to a new state agency. The move by Democratic Gov. Mark Dayton follows weeks of criticism from business leaders that they couldn't get enough information about the project from the Commerce Department. The planning job will now fall to Minnesota Management and Budget Commissioner James Showalter, according to a Tuesday, Sept. 18, letter from Dayton to legislative leaders (Snowbeck, 9/18).

And in California --

California Healthline: Exchange Narrows Name List To Four
At yesterday's meeting of the state's Health Benefit Exchange board, Chris Kelly, the exchange's senior advisor for marketing and outreach, presented the four finalists in the project to pick a new name for the exchange -- the name that will be used to market the exchange's choices and services. "We brought forward about 13 names last time [at the Aug. 23 board meeting]," Kelly said, "including Wellquest and, of course, Avocado -- that is still a crowd favorite." Kelly prefaced his presentation by reiterating that each proposed name includes a marketing package with a unique logo and tagline -- "a voice of its own," as Kelly put it (Gorn, 9/19).

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Wis. Officials Say Medicaid Funding Will Need To Rise $650M Over Two Years

The Wisconsin Department of Health Services in a request to Gov. Scott Walker said Tuesday that the increase was needed because of rising health care costs, higher program enrollment and lower federal funding. 

Milwaukee Journal Sentinel: Taxpayers Need To Pay Nearly $650 Million More In Medicaid Costs
Taxpayers need to chip in about $650 million more toward state health care programs for the poor and elderly during the next two-year budget cycle, Gov. Scott Walker's administration said Tuesday. The additional sums are needed because of rising health care costs, more people joining the programs, increased use of services by those in the programs and a lowering aid rate from the federal government. The funding request is for Medicaid programs, which are paid for jointly by state and federal taxpayers and cover nursing home stays and programs such as BadgerCare Plus for low-income people and Family Care for the elderly and disabled (Marley, 9/18).

In the meantime, Oregon's governor looks for ways to stem Medicaid spending growth --

CQ HealthBeat: Bequeath To Future Generations Health Spending That’s Under Control, Kitzhaber Urges Boomers
Can Oregon Gov. John Kitzhaber nudge his fellow Democrats closer to embracing an approach that caps Medicaid spending growth? One might think so judging by his remarks Tuesday at a forum sponsored by the left-leaning Center for American Progress, which showcased his state's new law to tackle runaway Medicaid spending by retooling its health care delivery system. Kitzhaber, who is a doctor, was outspoken and impassioned in a way few of his fellow Democrats are right now about the moral imperative to chop Medicaid and Medicare spending growth and to not pour money into a broken health care system. He said fixing health care costs is something baby boomers must take on and get done for future generations (Reichard, 9/18).

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State Roundup: Ore. Insurance Co-Op Readies Coverage

A selection of health policy stories from New Jersey, Oregon, California, Wisconsin, Georgia, Minnesota, New York, Texas, Kansas, North Carolina and Indiana.

The Lund Report: Freelancers CO-OP Of Oregon Partners With Providence Health System
Independent workers -- artists, journalists, information technology professionals, craftsmen and even those who earn their living buying and selling on eBay -- will soon have the ability to buy health coverage without having to dicker with a privately-run insurance company such as Regence BlueCross BlueShield. ... people can sign up when enrollment opens for the health insurance exchange in October 2013. The CO-OP anticipates having up to 40,000 members by the end of 2015, and has entered into a partnership agreement with Providence Health System to provide the network of physicians and hospitals throughout the state and handle claims administration and medical management (Lund-Muzikant, 9/18).

The New York Times: Christie's Budget Faulted As Fiscal Outlook Is Called Weak
The ratings agency said it lowered its outlook because it believed the governor’s revenue projections for the current fiscal year were overly optimistic, warning that the budget was structurally unsound. In particular, the agency took note of the administration’s reliance on one-time transfers of money to fill gaps in the state's $32 billion budget. At the same time, it noted that the state will have to spend more in the coming years to meet pension and Medicaid obligations (Zernike, 9/18).

The Associated Press/Washington Post: Wisconsin Attorney General Appeals Union Law Ruling, Asks Judge For Stay
Wisconsin’s attorney general on Tuesday appealed a court ruling repealing major parts of Gov. Scott Walker’s law effectively ending collective bargaining for most public workers. … The law as passed by the Republican-controlled Legislature in 2011 applied to all public employees except police, firefighters, local transit workers and emergency medical service employees. It limits collective bargaining on wage increases to the rate of inflation. Other issues, such as workplace safety, vacation and health benefits, were excluded from collective bargaining (9/18).

Los Angeles Times: Brown Signs Bill Revamping Workers' Compensation Insurance
Approved by the Legislature on the last night of the legislative session, the package would boost payments to permanently disabled victims of on-the-job accidents by about $740 million a year and hand employers a major break on workers' compensation insurance premiums (Castellanos, 9/19).

Georgia Health News: Hemophilia Program Could Get The Budget Ax
Through a state contract, Hemophilia of Georgia is helping dozens of patients get or keep health insurance and lifesaving medication for the inherited bleeding disorder. The money "saves lives and saves money," said Jeff Cornett of Hemophilia of Georgia. He noted Tuesday that an uninsured patient with hemophilia can run up huge emergency room bills. But the state's Department of Public Health, in budget recommendations released last week, would eliminate that hemophilia funding next fiscal year (Miller, 9/18).

(St. Paul) Pioneer Press: Blue Cross Forms New Insurance Option With Allina Health System
Health insurers in Minnesota are jumping on the ACO bandwagon. … On Tuesday, Eagan-based Blue Cross and Blue Shield of Minnesota announced a similar product in conjunction with the Minneapolis-based Allina Health System. Blue Cross didn't use the term "ACO" in describing its product -- called Blue Choice featuring the Allina Health Network -- but the description makes sense, said Garrett Black, the company's senior vice president of health management (Snowbeck, 9/18).

Modern Healthcare: Montefiore Forms ACO With Empire Blues In N.Y.
Montefiore Medical Center, New York, has entered into an accountable care agreement with Empire Blue Cross and Blue Shield, New York, the organizations announced. The accountable care agreement will cover fully insured Empire enrollees in New York's Bronx and Westchester counties and Montefiore's employees, according to a news release. Montefiore will be eligible to receive shared-savings payments tied to quality and efficiency targets and a capitated care management fee, said John Caby, vice president of provider engagement and contracting for Empire (Evans, 9/18).

The Dallas Morning News: One-Day Free Clinic At Convention Center Will Serve Dallas-Area Uninsured
For one day next week, hundreds of medical volunteers hope to see and treat some of the thousands of uninsured Dallas-Fort Worth area residents at a free clinic at the Dallas Convention Center. How many people they help depends on how many volunteer health care workers they can round up between now and then. "We have the ability to put their minds at ease," said Nicole Lamoureux, executive director of the National Association of Free and Charitable Clinics. "Just getting them connected to a doctor and to the help they need takes so much worry off their shoulders" (Rosales, 9/18).

Kansas Health Institute News: Kansas REC To Be Spun Off As Independent Non-Profit, Synovim
The regional extension center created two years ago to help Kansas health care providers implement electronic patient records is to be spun off over the next year by its parent organization, the Kansas Foundation for Medical Care. The new non-profit consulting firm -- called Synovim -- will absorb all 15 staff members from the Kansas Regional Extension Center by the time the REC's federal funding runs out September 30, 2013, said REC director Michael Aldridge. Aldridge, who has been named Synovim's chief executive, said that setting up a firm that’s wholly independent of KFMC will allow his staff to collect fees for its services without putting KFMC in a position of receiving payments from providers that it’s charged with monitoring (Cauthon, 9/18).

North Carolina Health News: Opening Doors To Housing For The Mentally Ill
Four years ago, Nancy ended up in the hospital with pneumonia. While there, she received steroids to reduce the fluid accumulation in her lungs. The steroids made her psychotic, a common side effect. ... Last week, the Housing Subcommittee of the Blue Ribbon Commission on Transitions to Community Living met for the first time to start the work of creating, over the coming decade, more than 3,000 housing units throughout the state for people with mental health problems. Those housing units will need to be accompanied by more community programs to help people with mental health problems stay out of the hospital (Hoban, 9/18).

The Associated Press: S. Ind. Physician Sentenced For Health Care Fraud
A Bloomington physician has been sentenced to 3 1/2 years in prison after pleading guilty to federal charges of unlawful drug distribution and health care fraud. Kamal Tiwari was also sentenced Tuesday to three years of probation and ordered to pay $1.3 million in restitution to Medicare, Medicaid and Anthem Blue Cross (9/18).

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Swing State Trailmix

Weekly Campaign Highlights: News From Florida, Iowa, Pennsylvania And Virginia

As election day approaches, Kaiser Health News' Sarah Barr samples 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, The Tampa Bay Times outlines how polical dynamics in one key Florida county:  

The Tampa Bay Times: Volusia County May Predict The Future For Obama And Romney
What do Rick Scott and Barack Obama have in common? Very little, except that they both carried Volusia County. If you want to see who wins Florida in November, you can't find a better county to watch than this perplexing mix of leather-clad bikers, rural fern growers, retirees, struggling mom and pop business owners, and working class suburbanites commuting to and from Orlando. Volusia has long been one of Florida's ultimate bellwether counties, probably because, for good or ill, it so mirrors Florida and America: a disorderly mix of cultures, interests and geography (Smith, 9/17). 

In other news, contests in Iowa, Virginia and Pennsylvania draw more attention:

Des Moines Register: King, Vilsack, Deal Blows In Third Debate
Democratic challenger Christie Vilsack and U.S. Rep. Steve King sniped repeatedly at each other during a debate on Monday night, exchanging pointed shots over the president's federal health care plan, the federal deficit, voter fraud and other issues. Vilsack, a southeast native who moved to Ames to oppose the Republican incumbent, berated King as an ineffective congressman who has seen the federal deficit balloon from $6 trillion to $16 trillion during his decade of service in Washington, D.C. ... The contrasts between Vilsack and King couldn't have been more clear than when they discussed President Barack Obama's health care plan (Petroski, 9/18).

Richmond Times-Dispatch: Kaine, Allen Emphasize Work Across Aisle
Entering the homestretch of Virginia's pivotal U.S. Senate race, it's clear that short of a campaign implosion, the battle between former Govs. George Allen and Timothy M. Kaine will be a squeaker. While numerous recent polls have shown President Barack Obama with an advantage in Virginia, the Kaine-Allen race has — with a few rare outliers — been deadlocked for more than a year. As a result, the battle for undecided, independent voters is reaching critical mass, with both candidates seeking to strike a distinctly bipartisan tone while continuing to pick apart each other's record (Hester, 9/18).

Pittsburgh Post-Gazette: Pennsylvania Races In House Could Tip The Balance In Congress
Democrats, battered in congressional elections two years ago, are struggling to reverse the tide that gave Republicans control of the U.S. House. The year 2010 emerged as the third consecutive cycle of House elections to produce an unusually large turnover in the chamber, and Pennsylvania seats formed a big part of each of those waves. This year, with nearly two months to go to the election, the Pennsylvania scene appears more stable. And, while some leading Democrats predict that they can make the net gain of 25 seats needed to switch control of the House, Republican campaign officials contend that they will actually gain still more seats Nov. 6 (O'Toole, 9/16).

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Editorials and Opinions

Viewpoints: Romney Says Citizens 'Do Need Help From Government;' One Retiree Suggests Sacrifices On Medicare; Entitlements Would Be Used To Prop Up Rich

A selection of editorials and opinions on health care from around the nation.

USA Today: Editorial: Romney's 47 Percenters Blur Facts, Message
Government benefits are heavily skewed towards seniors, nearly all of whom paid Social Security and Medicare taxes for decades to earn them. Judging by the polls, both they and low-income workers are likely to give Romney respectable levels of support in November, unless they feel he is insulting them or cannot relate to their situation (9/18).

USA Today: Opposing View: I'll Deliver Recovery, Not Dependency
Government has a role to play here. Right now, our nation's citizens do need help from government. But it is a very different kind of help than what President Obama wants to provide. My experience has taught me that government works best when it creates the space for individuals and families to pursue success and achieve great things (Mitt Romney, 9/18). 

The Wall Street Journal: What Romney Might Have Said
Mitt Romney has been taking a beating for his remarks, taped at a May fundraiser, that 47% of Americans would automatically vote for President Obama because they are "dependent" on government. We could pile on, but instead we can report that we've been leaked pages of draft remarks that Mr. Romney might have delivered on the same subject but curiously didn't. Maybe he'll deliver them some time before Election Day (9/18). 

The New York Times: Mitt Romney, Class Warrior
Everything about Mr. Romney's characterization of this mythical slice of lazy, shiftless Americans was wrong. A vast majority of Americans pay federal taxes, either income tax or payroll taxes for Social Security and Medicare — or both — as well as other federal fees. They also pay state and local taxes and sales taxes. The government's revenue problem does not start with the poor but with the richest people, through the Bush tax cuts and other changes (9/18). 

Los Angeles Times: We, The Parasites
My husband and I, recently retired, are among the people that Mitt Romney described with such disdain in the fundraiser video revealed Monday. ... our federal income taxes are a fraction of what we paid as full-time workers. ... conservatives would like to steeply cap, cut or cap and privatize entitlements. Medicare, in one of their schemes, would ultimately become a voucher system for the benefit of for-profit companies. Only one entitlement, the capital gains tax cap, would be vastly expanded. ... Thus Americans who in Romney's view "believe the government has a responsibility to them, who believe they are victims, who believe they are entitled to healthcare, to food, to housing" would help fund the yachts of billionaires through reductions in their food stamps or child care credits. Others of us might pay for their luxuries through limits on and fees for our Medicare (Judy Dugan, 9/19).

Los Angeles Times: Debunking Romney's Attack On Americans Who Don’t Pay Income Taxes
The key number he cited is that 47% of Americans "pay no income tax." ... In fact, its shock value derives from the legerdemain of focusing solely on the federal income tax. This misleads Romney and his audience into thinking that the group in question is mostly people on a lifelong dole. The truth is that the vast majority are people who are working or who have worked in the past. Their ranks include millions of Americans who are now retired, living on Social Security and Medicare benefits they paid for throughout their working lives. Many others are those who were booted into culverts by the economic crisis and are today struggling to get back on the road (Michael Hilzik, 9/19).

The Washington Post: Mr. Romney's '47 Percent' Fantasy
There is a wisp of a serious argument in Mr. Romney’s comments bemoaning the half of the country that pays no income tax. Conservatives have worried for years that Americans who don't pay taxes have no incentive to restrain spending. Government payments to individuals have risen dramatically, and beneficiaries become an interest group that makes reform of health and pension programs difficult. But here's why it's only a wisp (9/18).

Roll Call: Improve Housing Policy, Improve Health Care
With the expansion of Medicaid under the 2010 health care law, states have an unprecedented opportunity not just to improve people's health, but also to boost the effect of other federal safety-net programs. In an era of tightening budgets, a few common-sense changes to housing policy could help federal programs improve the health of some of society's sickest and most vulnerable. For vulnerable populations such as the elderly, people with disabilities and people with complex health needs, housing and health are intricately linked (Jill Khadduri and Gretchen Locke, 9/19).

Politico: The 80/20 Rule: Commissions Vs. Health Premiums
This summer, 12.8 million Americans received more than $1.1 billion in rebates from their insurers. Small businesses received $321 billion — money they can use to reduce their employees' health insurance costs and expand their businesses. For many Americans, this is the most concrete evidence so far that health care reform is working for them. These rebates were paid out under the act's medical loss ratio — or 80/20 — rule, which requires insurers in the individual and small group market to spend 80 percent of their premiums on actual enrollee health care claims and programs to improve health care quality. ... Yet Congress looks likely to eviscerate this rule to help a special interest group (Timothy Stoltzfus Jost, 9/18).

Modern Healthcare: Slipshod Approach To Security Should Concern IT Leaders
A million and a half dollars here, a million and a half dollars there, and pretty soon, you're talking real money—even in the healthcare industry. The privacy and security enforcers at the OCR, after a long, long period of quiescence, appear to be stepping up their enforcement efforts and availing themselves of the stiffer penalties that Congress provided in the American Recovery and Reinvestment Act's revisions to the Health Insurance Portability and Accountability Act's privacy and security rules (Joseph Conn, 9/18).

Bloomberg: Ryan's Proposal Would Shrink Medicare's Doctor Pool
Doctors see Medicare patients, despite the relatively low payments they receive for doing so, partly because Medicare represents such a large share of the health-care market. If a substantial number of beneficiaries moved out of Medicare and into private plans, as (Rep. Paul) Ryan proposes, doctors would have much less incentive to see Medicare patients. And the elderly who want to remain in traditional Medicare would risk being stranded. The evidence suggests that, in time, this problem could well affect a large share of Medicare beneficiaries (Peter Orszag, 9/18).

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Views On Obesity: Difficulty Changing Eating Habits; Huge Changes In The Food Marketplace

The New York Times and the Journal of the American Medical Association offer opinions on the U.S. battle against obesity.

The New York Times: Classifying Calories
Starting this week, McDonald’s is posting calorie information for all items on its menus across the United States, part of a movement to improve diets and reduce obesity by providing nutritional data. New York City has mandated that chain restaurants post calories since 2008, and the federal health care law adopted in 2010 will eventually require fast-food restaurants across the United States to do so. While the alarm over obesity is fairly recent, the notion of using "scientific" knowledge to guide the dietary habits of ordinary people — particularly the less well off — is not. The fate of earlier campaigns suggests that it will take much more than calorie information to change food ways (Bruegel, 9/18). 

Journal of the American Medical Association: The Role of Government in Preventing Excess Calorie Consumption
As the obesity epidemic has mounted during the last few decades, Americans' genes have not changed, but the "food environment" has changed markedly. Food has become increasingly ubiquitous, convenient, calorie-dense, offered in large portion sizes, and heavily marketed. Many foods contribute to excess calorie intake, but sugary drinks have drawn particular blame because of the near-tripling of consumption since the 1970s and their association in epidemiologic studies with obesity, weight gain, diabetes, and markers of cardiovascular disease. The increase in portion sizes of these beverages is important because studies consistently show that when people are offered larger portions they simply consume more without recognizing it and without compensating for the increased consumption by decreasing intake later (Dr. Thomas A. Farley, 9/19).

Journal of the American Medical Association: The Next Generation of Obesity Research: No Time to Waste
The obesity epidemic is not the first major health crisis that the United States has faced. In recent decades, progress has been made against such daunting challenges as tobacco use, infant mortality, and HIV/AIDS. However, obesity may pose the most significant challenge yet because it involves changing approaches to 2 fundamental aspects of daily life: food consumption and physical activity (Dr. Griffin P. Rodgers and Dr. Francis S. Collins, 9/19).

Journal of the American Medical Association: FDA Approval of Obesity Drugs: A Difference in Risk-Benefit Perceptions
Given the obesity epidemic, patients and physicians are in need of safe and effective treatments. Companies are responding with significant investment in drug development. Drugs provide an important therapeutic option when lifestyle modifications are insufficient for achieving weight loss goals and when surgery is not desired or warranted. However, in the last decade, 3 obesity drugs were removed from the US market, and until last month, only 1 new obesity drug has been approved since 1999 (Elaine H. Morrato and David B. Allison, 9/19).

Journal of the American Medical Association: Progress In Obesity Research: Reasons For Optimism
Treating obesity has also proven elusive. Changing lifestyle is difficult and usually ineffective. Few drug options for weight loss exist, and bariatric surgery, while effective, is reserved for the morbidly obese. Thus, it is tempting to consider obesity an intractable problem and walk away from it. Fortunately, many dedicated researchers, clinicians, and policy makers have not given up. ... Prevention is the best treatment. Successful prevention requires disentangling the factors responsible for the obesity epidemic (Dr. Edward H. Livingston and Dr. Jody W. Zylke, 9/19).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

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