Daily Health Policy Report

Thursday, September 20, 2012

Last updated: Thu, Sep 20

KHN Original Reporting & Guest Opinion

Health Reform

Campaign 2012

Coverage & Access


Health Care Marketplace

Public Health & Education

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Q & A: Keeping Your Young Adult Child On Your Health Plan (Video)

In this Kaiser Health News video, "Insuring Your Health" consumer columnist Michelle Andrews answers a reader's question about keeping an under-26-year-old on a parent's health plan. Much of the time, even if the child is financially independent and has a job with insurance, the young adult can stay on the family plan (9/20). Watch the video.  

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Capsules: Insurance Coverage Improves In 20 States, Census Shows; HHS Touts Growth In Medicare Advantage Plans, Drop In Premiums

Now on Kaiser Health News' blog, Phil Galewitz reports on Census Bureau data regarding insurance coverage rates: "The percentage of people without health insurance fell in 20 states last year with Oregon, Rhode Island and Vermont seeing the biggest declines, according to an analysis of data released Thursday by the Census Bureau" (Galewitz, 9/20).

Also on Capsules, Mary Agnes Carey reports on Medicare Advantage news: "Just days away from a House hearing where Republicans are likely to charge that the 2010 health law’s cuts to Medicare Advantage plans will cause insurers to leave the program and seniors to pay more for coverage, the Obama administration said Wednesday that as a result of the law seniors now have more of these private plans to choose from and that coverage is less expensive" (Carey, 9/19). Check out what else is on the blog.

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Political Cartoon: 'Rear View?'

Kaiser Health News provides a fresh take on health policy developments with "Rear View?" by Christopher Weyant.

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


Mitt seems to embrace
role as health law "grandfather."
Shake that etch-a-sketch?

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

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Health Reform

CBO: More People Than Expected Will Face Health Law's Penalty

The Congressional Budget Office now estimates that nearly six million people will face penalties for not getting health insurance as a result of the 2010 health law's individual mandate.

USA Today: CBO: Health Care Penalty To Hit 6M People
That's a 2 million increase over a previous estimate. The average penalty is estimated at nearly $1,200. The requirement that nearly all Americans buy some form of health insurance goes into effect starting in 2014 (Jackson, 9/19).

The Associated Press/NBC News: More Expected To Face Penalty Under Health Law
The new estimate amounts to an inconvenient fact for the administration, a reminder of what critics see as broken promises. The numbers from the nonpartisan Congressional Budget Office are 50 percent higher than a previous projection by the same office in 2010, shortly after the law passed. ... That's still only a sliver of the population, given that more than 150 million people currently are covered by employer plans. Nonetheless, in his first campaign for the White House, Obama pledged not to raise taxes on individuals making less than $200,000 a year and couples making less than $250,000 (Alonso-Zaldivar, 9/19).

Reuters: Six Million Americans Likely To Pay Healthcare Tax In 2016
The 50 percent increase was likely to draw fire from Republicans on the campaign trail who want to repeal President Barack Obama's signature healthcare law and who reject the penalty as a government intrusion into the lives of individuals. ... The law requires most Americans to have some form of health insurance - known as the individual mandate. The law stipulates that those who do not acquire health coverage will face a penalty (Dixon and Morgan,9/20).

The Hill: CBO: 6M People Will Pay Penalty Under Health Law's Mandate
The penalties paid will add up to about $8 billion per year, CBO said. The penalty for going uninsured will be start off at either $695 or 2.5 percent of household income, whichever is greater. It will increase over time (Baker, 9/19).

Bloomberg: CBO Says 6 Million In U.S. To Face Penalty For Lacking Insurance
[T]he CBO said it foresees higher unemployment, which translates into more people without employer-sponsored coverage. It’s also a result of the U.S. Supreme Court decision in June striking down the law’s requirement that states expand their Medicaid programs, which will leave more uninsured Americans subject to the penalty, CBO said (Faler, 9/19).

The Fiscal Times: Six Million Uninsured Will Pay Penalty
The law is projected to provide insurance for about 30 million people, either through plans purchased with subsidies on state-based exchanges or through joining state Medicaid programs. A number of Republican-led states are balking at signing up for the program. Over half the 30 million who will remain uninsured after the law goes into effect won’t be subject to the penalty because they are unauthorized immigrants (Goozner, 9/19).

CNN Money: Two Million More Expected To Pay Penalty Under Obamacare
[T]he penalty will be waived for people with very low incomes who don't have to file tax returns, those who are members of certain religious groups, or people who face insurance premiums that would exceed 8% of family income even after including employer contributions and federal subsidies. Penalty payments collected in 2016 are expected to total $7 billion, about $3 billion more than previously estimated (O’Toole, 9/19).

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Administration Touts Thriving Medicare Advantage Under Health Law

Enrollment in the private plans is projected to increase 11 percent next year, while premiums hold steady, officials say, disproving predictions made by critics of the health care law.

The Associated Press/Washington Post: Premiums Inching Higher For Popular Medicare Advantage Plans; Strong Rise In Enrollment
Monthly premiums for popular private insurance plans through Medicare are only inching up next year, the Obama administration said Wednesday, trumpeting good news for skeptical older voters on a closely watched election-year issue (9/19).

Politico: Medicare Advantage Shrugs Off Cuts
The Obama administration is declaring a small victory on Medicare: The private Medicare Advantage plans haven't been hurt by "Obamacare" after all. In fact, they’re thriving, according to administration estimates released Wednesday (Norman, 9/20).

Reuters: Medicare Advantage Enrollment Projected To Grow 11 Percent
Enrollment in Medicare Advantage, the private insurance segment of the popular U.S. healthcare program for the elderly, is expected to grow 11 percent next year while premiums remain steady, government health officials said on Wednesday. The U.S. Centers for Medicare and Medicaid Services estimated that 14.5 million people will enroll in Medicare Advantage plans in 2013, based on insurance industry expectations. That is up from 13.1 million people this year (Morgan, 9/19).

The Hill: HHS: Health Law Strengthened Medicare Advantage
Enrollment is up and premiums are down in Medicare Advantage (MA) as a result of the healthcare law, the federal health department reported Wednesday. Health and Human Services (HHS) Secretary Kathleen Sebelius issued projections that MA enrollment will increase by 11 percent over the next year while premiums hold steady. Sebelius attributed a 28 percent rise in MA enrollment and 10 percent drop in MA premiums since 2010 to the Affordable Care Act, which remains politically divisive (Viebeck, 9/19).

Kaiser Health News: Capsules: HHS Touts Growth In Medicare Advantage Plans, Drop In Premiums
Just days away from a House hearing where Republicans are likely to charge that the 2010 health law's cuts to Medicare Advantage plans will cause insurers to leave the program and seniors to pay more for coverage, the Obama administration said Wednesday that as a result of the law seniors now have more of these private plans to choose from and that coverage is less expensive (Carey, 9/19).

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Indiana Braces For The Costs Of Health Law's Expanded Coverage

In addition to questions about costs from the health law's Medicaid expansion, states are also wrestling with issues related to the creation of health exchanges and questions regarding essential benefits.  

The Associated Press: Daniels' Health Care Team Says Answers Pending
Gov. Mitch Daniels' team of federal health care overhaul leaders told state lawmakers Wednesday that even without clear answers on the new law, it will cost the state hundreds of millions more in the coming years. A new report this week assumed that if Medicaid isn't expanded, Indiana would still pay a combined $612 million over the next seven years as more residents who qualify for the program come out of the "woodwork" because of the health care law (LoBianco, 9/19).

The Associated Press/Washington Post: Virginia's Top Health Official To Discuss Federal Health Care Overhaul
Virginia's top health official will discuss the federal health care overhaul that was upheld over the summer and tell legislators what it will mean for Virginia. Virginia Secretary of Health & Human Resources Bill Hazel will address the Senate Finance Committee on Thursday (9/20).

The Lund Report: Tribal Members Given Assurances About Health Insurance Exchange
Once the health insurance exchange gets up and running next October, the 30,000 tribal members likely to participate won't have to worry about their rights being violated, according to Rocky King, executive director. "The intent is for insurers – qualified health plans – to have contracts with tribal clinics throughout the state so people can get services, and I've not heard of any major barriers," he said (Lund-Muzikant, 9/20).

Minnesota Post: Minnesota's Health-Insurance-Exchange Planners Change Agencies
Minnesota's fledgling health insurance exchange has quickly outgrown its first home. In a letter to legislative leaders Tuesday, Gov. Mark Dayton announced the exchange would move from the auspices of the Department of Commerce to Minnesota Management and Budget, an agency with experience leading multi-departmental projects. The move, though, also is aimed at removing the exchange from a potential conflict of interest within the Commerce Department — an agency that, with the exchange, would have both administered and regulated health insurance (Nord, 9/19).

CQ HealthBeat: No Sign Of Essential Benefits Proposal, But Some Say States Can Progress Anyway
Despite indications that it might be out by now, a proposed rule setting minimum standards for the benefits that insurers must provide under the health care law has yet to emerge – and the Obama administration may be skittish about releasing it before the approaching election. Insurers, states and health care law supporters all say that with enrollment in insurance exchanges set to begin in a little more than a year, that having a proposed rule is key. Insurers have to be able to craft the benefit packages they will offer in the exchanges, among many other tasks they must accomplish to prepare for the exchanges, which will begin to operate in 2014 (Reichard, 9/19).

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New Okla. Challenge To Health Law Zeros In On Tax Penalties And Subsidies

In a new legal challenge, the state's attorney general is asking a federal court to rule that the law's requirement that most people purchase insurance or face a tax penalty is inoperative in his state.

The Wall Street Journal: Oklahoma Challenges Health Law In New Suit
Oklahoma's attorney general on Wednesday filed a fresh legal challenge to the federal health-overhaul law, zeroing in on penalties that employers in the state would face if they didn't offer affordable health coverage to their workers. ... The new complaint filed by Oklahoma faces long odds. It focuses on the law's distribution of tax credits for low-income Americans to purchase insurance (Radnofsky, 9/19).

Bloomberg: Oklahoma Attorney General Revises Health-Care Lawsuit 
Oklahoma Attorney General Scott Pruitt, who initially filed a legal challenge to Obama's Patient Protection and Affordable Care Act in January 2011, asked in a revised complaint yesterday for a federal judge to rule that the part of the law mandating people purchase insurance or face a tax penalty is inoperative in his state. Oklahoma amended its constitution by popular vote in November 2010, eight months after Obama signed the health care law. The amendment prohibited any rule or law forcing a person, employer or health care provider to participate in a health care system (Harris, 9/20).

Politico Pro: Okla. Targets Federal Exchange Subsidies
Oklahoma is challenging an IRS rule allowing federal-run health insurance exchanges to provide subsidies to help individuals purchase coverage. Critics of the Affordable Care Act have spent the summer trying to build a legal case against the IRS rule, and Oklahoma Attorney General Scott Pruitt appears to the be first to bring it to federal court. Pruitt, who had a standing lawsuit in federal court against the ACA's individual mandate, had been asked by the court to either drop the case or change his argument in light of the June Supreme Court decision upholding the law (Millman, 9/19).

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Campaign 2012

Romney Touts His Health Care Credentials

During a forum hosted by Univision, the GOP presidential nominee embraced his role as the "grandfather of Obamacare." Elsewhere on the camapign trail, the Service Employees International Union launches a Medicare attack ad against the Romney-Ryan campaign and other Republicans. 

The Wall Street Journal's Washington Wire: Romney Softens Tone At Univision Forum
Mitt Romney appeared to embrace his role as the "grandfather of Obamacare," while also disavowing President Barack Obama's health-care law, as the Republican softened his tone on a host of hot-button issues Wednesday evening. "I have experience in health-care reform," Mr. Romney said in a candidates forum hosted by Univision, the Spanish-language network. "Now and then the president says I'm the grandfather of Obamacare. I don't think he meant that as a compliment but I'll take it" (Murray, 9/19).

The Associated Press/Washington Post: Romney Says Being Called The 'Grandfather Of Obamacare' Is A Compliment He'll Accept
Mitt Romney says it's a compliment to be called the grandfather of Obamacare, the health care law championed by President Barack Obama and scorned by Republicans — including Romney himself. Obama has said the health care law Romney backed while governor of Massachusetts is the basis of the federal Affordable Care Act, enacted in 2010 (9/19).

CBS (video): Romney: I'm the Grandfather Of 'Obamacare'
Mitt Romney said Wednesday at Univision's "Meet the Candidates" forum in Coral Gables, Fla., "The president says I'm the grandfather of 'Obamacare' -- I don't think he meant that as a compliment, but I'll take it."

ABC: New Union Ads Hit Romney, Republicans On Medicare
The Service Employees International Union is going after Mitt Romney and two freshman House Republicans on Medicare, with a flight of ads airing in three states. The union plans to make health care a central theme in its ads this fall. "You're going to see a lot of stuff on Medicare, Medicaid and the Affordable Care Act in multiple races," said SEIU spokesman Mark McCullough. In Florida, a new statewide radio ad blasts Romney and VP nominee Paul Ryan for their Medicare plan. In it, a nervous-sounding mother calls her son asking about Medicare and the GOP ticket, confused by TV ads on the topic (Good, 9/20).

The Boston Globe: Romney-Ryan Medicare Plan Dependent On Effective Competition
The success or failure of Mitt Romney and Paul Ryan’s plan to overhaul Medicare depends largely on the answer to one key question: Would competition among private insurers hold down insurance costs? If the answer is yes, then the Republican ticket's proposal — to issue premium support payments to future seniors, who would use the vouchers to purchase private insurance — could work (Borchers, 9/20).

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Presidential Campaigns Vie For Specific Voting Blocs

The New York Times reports that young adults  are up for grabs in several key states. Meanwhile, both candidates are courting Hispanics. The Washington Post reports that President Barack Obama is hoping women voters give him the edge in Virginia.

The New York Times: Struggling Young Adults Pose Challenge For Campaigns
Millions of struggling working-class young adults, many in battleground states like Florida, Colorado and Wisconsin, are up for grabs in this election, making up what experts call one of the most potentially powerful but often overlooked voting blocs (Saulny, 9/19).

The Washington Post: To Claim Virginia, Obama's Hopes Rest On Women
This year, however, ginning up female support has become an imperative for Obama in his reelection bid. Across the electoral map, the Obama campaign is banking on women to offset an expected loss to Romney among men. In few places, if any, does that effort appear to be succeeding as well as it is in the Old Dominion. That is in part a reaction to heavy-handed Republican moves on reproductive issues, but it also reflects an apparent affinity that women feel with Obama on economic concerns (Tumulty and Clement, 9/19).

Politico: Emily's List Super PAC Raises $2 Million
Schriock said the quality of women candidates this year combined with the Republican agenda to defund Planned Parenthood and ban abortion in all cases has the group’s energies up this year (Parti, 9/19).

The Associated Press/Washington Post: Hispanics The Focus Thursday As Obama Pushes To Keep Romney On Defensive
Battling the perception that he's not working hard enough, Romney on Thursday announced plans to launch a three-day bus tour across Ohio next week. His campaign also released a new ad featuring Florida Sen. Marco Rubio … promoting Romney's plans to overhaul Medicare. The candidates' personal attention to Hispanic voters, backed by millions of dollars in targeted advertising, is designed to influence a group likely to play a critical role this fall — and for years to come (9/20).

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Coverage & Access

New Census Data Show Insurance Coverage Expands In 20 States

Oregon, Rhode Island and Vermont saw the biggest expansions, while Missouri and Montana saw declines in coverage. The biggest increases occurred among young adults between the ages of 19 and 25.   

NPR's The Two-Way: Census: In 2011, Number Of Poor Americans Increased
Young Americans are one of the first to feel the effects of the Affordable Care Act. … According to the Census, once young Americans aged 19 to 25 could be added to their parents' plans, there was a 3.5 percent increase in the number insured. The Census compared that number to to those aged 26 to 29, who saw a decline of almost 1 percent in the number of those insured during the same period (Peralta, 9/20).

Kaiser Health News: Capsules: Insurance Coverage Improves In 20 States, Census Shows
The percentage of people without health insurance fell in 20 states last year with Oregon, Rhode Island and Vermont seeing the biggest declines, according to an analysis of data released Thursday by the Census Bureau (Galewitz, 9/20).

Politico Pro: Census Details Youth, Insurance Trends
Young adults in Vermont saw the biggest increase in private health insurance coverage from 2009 to 2011 — 10.5 percent — while 13 states saw no gains at all, according to a Census Bureau report released Thursday. Drawing on the bureau’s 2011 American Community Survey — an annual demographic assessment of the United States — the report takes a state-by-state look at the change in the insurance rate among adults aged 19 to 25 since the Affordable Care Act mandated that they could remain on their parents’ insurance plans. To gauge the effects of the law, the bureau examined the difference in the rates for 19-to-25-year-olds and 26-to-29-year-olds, two groups that track closely. Private insurance coverage fell by 1.9 percent in the older group but rose 2.7 percent in the younger one (Norman, 9/19).

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CMS Eyes Improper Medicare Payments For Power Wheelchairs

A Centers for Medicare & Medicaid Services official testified on Capitol Hill Wednesday that 80 percent of this type of fee-for-service Medicare claim should not have been paid.

CQ HealthBeat: CMS: Medicare Improperly Paid Half-Billion Dollars For Power Wheelchairs
"Although CMS recognizes that many improper payments are not the result of willful fraud, this error rate represents over $492 million in estimated improper payments," said Deborah Taylor, chief financial officer at CMS. Taylor said Medicare spent about $700 million last year for power wheelchairs. Taylor testified at a Senate Aging Committee hearing on Medicare payments for "power mobility devices," which include both power wheelchairs and power scooters (Reichard, 9/19).

The Associated Press: Wheelchair Suppliers Say Crack Down On Medicare Fraud Goes Too Far; Insurer Applauds Effort
Wheelchair suppliers raised concerns Wednesday about a new government program that requires Medicare contractors to sign off before power wheelchairs can be delivered to elderly and disabled consumers. ... The new program began on Sept. 1 and requires providers in seven states to get confirmation from a government contractor that Medicare will pay for the device before they deliver it. Michael Clark, general counsel for the SCOOTER Store, says the pilot project goes too far and every claim his business has submitted under the new program has been denied (Freking, 9/19).

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Health Care Marketplace

Drug Co. Execs Say Cost-Containment Pressures Undermine Medical Innovation

Executives such as the Bayer CEO said this kind of pressure could hamper efforts to bring new meds to market.  

Reuters: Bayer CEO Decries Pressure To Lower Drug Prices
Pressure from governments to lower drug prices risks undermining medical innovation, Bayer AG's chief executive said on Wednesday, echoing complaints of other drug company executives. Speaking at the Boston College Chief Executives' Club, Marijn Dekkers said there was "tremendous pressure" on drugmakers to lower prices (Krasny, 9/19).

The Boston Globe: Executives Say Global Push To Contain Health Costs Threatens Innovation
The push to contain spiraling health costs around the world could hamper the ability of drug makers to bring new medicines to market, two biopharmaceutical executives warned Wednesday. Marijn Dekkers, chairman of German drug giant Bayer AG, sounded the alarm at a luncheon hosted by the Boston College Chief Executives' Club of Boston, saying the global economic downturn has intensified pressure to restrict reimbursements for therapeutics (Weisman, 9/19).

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Public Health & Education

N.Y. Times Examines Why Many Kidneys Available For Transplant Are Discarded

In each of the past five years, more than 2,600 kidneys were recovered and discarded, according to government data.

The New York Times: In Discarding Of Kidneys, System Reveals Flaws
Last year, 4,720 people died while waiting for kidney transplants in the United States. And yet, as in each of the last five years, more than 2,600 kidneys were recovered from deceased donors and then discarded without being transplanted, government data show. ... many experts agree that a significant number of discarded kidneys — perhaps even half, some believe — could be transplanted if the system for allocating them better matched the right organ to the right recipient in the right amount of time (Sack, 9/19).

The New York Times: After Death, Helping To Prolong Life
If the deceased is not registered as a donor, next of kin are presented with the decision, and families in LifeSource’s region decline consent about a third of the time, said Meg Rogers, the agency’s director of procurement. They may resist on moral or religious grounds, or simply because they are uncertain what their loved ones wanted. Exhaustion and pain may have drained their strength to wrestle with the choice (Sack, 9/19).

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Study Finds Drug May Aid Some Autism Patients

Los Angeles Times: Experimental Drug May Help Some Autism Cases, Researchers Say
An experimental drug can improve sociability in patients with fragile X syndrome and may be helpful as a treatment for autism, according to the authors of a new study. Fragile X is a rare genetic disorder that affects about 1 in 4,000 boys and 1 in 8,000 girls, according to the National Institutes of Health. It usually results in mental retardation and — in about half of cases — some form of autism (Zarembo, 9/20).

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State Watch

Alabama Voters Approve Moving Money From State Trust Fund To Balance Budget

Medicaid officials say the vote results will help prevents massive cuts that had been forecast.

The Associated Press: Final Tally: Alabama Voters Approve Budget Rescue 2-To-1
Alabama voters decided by a 2-to-1 margin Tuesday to avoid dramatic cuts in state government by withdrawing $437 million from a state trust fund to help balance the General Fund budget for the next three years. State Health Officer Don Williamson, who oversees the state Medicaid program, said it will still have to make $20 million to $40 million in cuts to live within the new year's budget, but that will be much less painful than the massive cuts that were forecast (9/19).

The Associated Press: State's Medicaid Costs Could Rise $600M
The state of Indiana's Medicaid costs could rise by as much as $600 million over the next seven years, as the deadline for the new federal health care law approaches. That's according to new numbers presented to legislators by the state's Family and Social Services Administration (Kehoe, 9/19).

Meanwhile, in other Medicaid news -

The Associated Press: Medicaid Health Records Available Online In Fla.
Florida Medicaid recipients can now access their personal health records online. State health officials said Wednesday that beneficiaries can use the My Florida Health eBook to track information about their doctor's visits, procedures, medications and immunizations. They can also update the records with notes about allergies and chart personal health information such as their weight, blood pressure and blood sugar levels (9/20).

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Layoffs Hit Group Health in Washington and Boston Children's Hospital

Group Health Cooperative, a leader in innovations, insures about 600,000 in Washington state.

The Seattle Times: Group Health Announces Layoffs, Cuts
Group Health Cooperative, recognized as a leader in health-care innovations and patient satisfaction, says it must cut $250 million over the next 16 months through layoffs, better cost control and some reorganization at the top. As part of those changes, Richard Magnuson, executive vice president and chief financial and administrative officer, will soon leave the organization. CEO Scott Armstrong says he intends to create a new CFO position focused solely on financial targets. Group Health, which insures about 600,000 people in Washington and has annual revenues of $3.5 billion, is aiming to climb back up to a 3 percent operating margin, Armstrong said in a Friday memo to staff, first reported by the Puget Sound Business Journal (Ostrom, 9/19).

Also, in Boston -

WBUR: Boston Children's Hospital Cuts 255 Jobs, Lays Off 45 Staffers
WBUR's Martha Bebinger reports that top management at Boston Children’s Hospital sent word to employees today that the hospital was cutting a total of 255 positions, most through attrition but 45 through elimination. Savings total $89.5 million, for a 3% margin (Bebinger, 9/19).

The Boston Globe: 45 Workers To Lose Their Jobs At Boston Children's Hospital
Children’s has been moving aggressively to reduce expenses over the past two years since it was identified by state Attorney General Martha Coakley as one of the most expensive hospitals in Massachusetts. It has cut fees to private insurers and Medicaid managed care programs by lowering charges for lab tests, doctor appointments, imaging, surgery, and hospital admissions (Weisman, 9/19).

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State Roundup: HCA Fined For Kickbacks; Minn. Rural Health Care Investigation

A roundup of health policy news from Tennessee, Oregon, Connecticut, Massachusetts, Washington state, Minnesota and Tennessee.

Politico Pro: HCA To Pay $16.5 Million In Kickback Case
The Hospital Corporation of America will pay $16.5 million to settle claims that its subsidiaries had paid a diagnostics firm for referrals, violating federal anti-kickback rules, the Justice Department announced Wednesday. HCA subsidiary Parkridge Medical Center and HCA Physician Services, both provided "financial benefits" to a physician group, Diagnostic Associates of Chattanooga, for referrals to the HCA facilities (Norman, 9/19).

The Boston Globe: Ban Is Lifted On Free Meals For Massachusetts Doctors
Drug and medical device makers once again can treat Massachusetts doctors to meals and drinks in restaurants, ­under new regulations that weaken the state's strict ban on gifts to health care providers. The change drew strong criticism from the state's major consumer advocacy group, but was applauded by the pharmaceutical industry's national trade organization (Kowalczyk, 9/19).

The Lund Report: Providence Severs Contract With Health Net Just As Employers Consider Option For 2013
The leading healthcare systems in Portland -- Legacy and Providence -- are embroiled in a competitive battle, and the victor could end up controlling a much larger slice of the market. ... Right now Providence Health & Services appears to be in command (Lund-Muzikant, 9/20).

The CT Mirror: Helping Children With Substance Issues: Are Insurance Companies Not Covering Treatment?
Kelli Belardi wishes her son had just been diagnosed with cancer. "At least then he would receive treatment," the Rocky Hill resident said of her year-long battle with her insurance company to cover in-patient treatment to treat her son's drug abuse problems. ... although mental illness and substance abuse parity laws are on the books, the Office of the Healthcare Advocate reports that hundreds of parents have approached the office seeking help to appeal insurance denials (Thomas, 9/19).

Minnesota Public Radio has a special project on rural health care:

Minnesota Public Radio: Rural Minnesota Retools Health Care In Wave Of Hospital Mergers
The Queen of Peace hospital in New Prague wasn't in financial trouble when it sold to Mayo Clinic Health System just over a year ago. ... But the healthcare field is changing dramatically, partly because the federal Affordable Care Act requires expensive electronic medical record systems and seeks to impose a new reimbursement model based on a cooperative approach to care. ... Hospitals in Minnesota are experiencing a new wave of consolidation (Vogel, 9/20). 

Minnesota Public Radio: Let’s Make A Deal: Lessons Learned From Hospital Mergers
Ron Osladil, chair of the North Pine Area Hospital District board in Sandstone, said he woke up one day and realized the hospital in his community, long run by Essentia, had been left behind. ... It's a pressing issue right now because increasingly, independent hospitals in rural Minnesota are joining bigger systems--Sanford Health, Essentia Health, Mayo Clinic Health System and others. According to the Minnesota Hospital Association, 16 hospitals have joined systems since 2005. Of 148 hospitals in the state, only 42 remain independent (Vogel, 9/20). 

Minnesota Public Radio: Trying To Go It Alone In Rural Healthcare
"I strongly still believe in being totally independent," said Tim Rice, president of Lakewood Health System in Staples. "We want to maintain our culture and our ability to make our decisions ourselves about what we want for our community and our patients. That is the key thing that we do not want to give up."  Rice's determination stands out in a climate where more rural hospitals are joining larger health system just to survive (Vogel, 9/20).

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Weekend Reading

Longer Looks: A 'Renegade' Bill Frist?; The Pharmacist's Expanding Role

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

Politico: The Bill Frist Rx
Meet former Sen. Bill Frist, a renegade "Obamacare"-loving Republican who is in the mood for some real bipartisanship. Yes, the same Frist who as Senate majority leader led an army into the culture wars over Terri Schiavo and whose efforts in 2004 to unseat his then-rival, Minority Leader Tom Daschle, led to a nasty — and personal — Washington battle royal. Now, Frist is pushing for a national conversation on end-of-life care and dismissing "caricatured" talk of death panels. He's committing Republican heresy in endorsing elements of the loathed Affordable Care Act (Brett Norman, 9/16).

Fox Business: Secret Weapon In Health Care: Your Pharmacist
With primary care physicians in short supply, doctors' schedules on overload and about 30 million people scheduled to enter the health care system by 2014, patients may start to feel neglected. But experts say consumers often overlook the skills and expertise of their pharmacists ... Medication adherence is a priority for improving outcomes and containing individual and system costs, experts say. According to the National Association of Chain Drug Stores, the overall spend resulting from poor medication adherence is approximately $290 billion per year (Barbara Mannino, 9/13).

The Atlantic: How The Catholic Church Misunderstands Death With Dignity
My father, a lifelong atheist, died at 91 in a Catholic hospice center. He received excellent, compassionate care from his nurses and from a doctor who willingly administered the morphine needed to ease his suffering -- although, she advised, it would hasten his death. Did she violate the doctrine of a church actively opposing a Death with Dignity proposal now on the ballot in Massachusetts? The medical team was administering palliative care, not assisting in a suicide. ... sometimes, palliative care involves not just "the risk of shortening life" but the knowledge that it will shorten life. What if the only way to ease pain is to shorten life? (Wendy Kaminer, 9/17).

The New York Times: Life Went On Around Her, Redefining Care By Bridging A Divide
The story of Lia, the severely brain-damaged daughter of Hmong refugees who had resettled in California, became the subject of (Anne) Fadiman's first book, "The Spirit Catches You and You Fall Down," published in 1997. ... Ms. Fadiman’s book is a cautionary tale about the cultural chasm between Lia’s family, with its generations-old animist beliefs, and her rationalist American doctors. ... That cultural divide — despite the best intentions of both sides, Ms. Fadiman wrote — may have brought about Lia's condition, a consequence of a catastrophic seizure when she was 4. ... Lia Lee died in Sacramento on Aug. 31. ... Lia's story, as few other narratives have done, has had a significant effect on the ways in which American medicine is practiced across cultures, and on the training of doctors (Margalit Fox, 9/14).

Detroit Free Press: Michigan Patients Receive Free Flights To Get Them To The Care They Need
(Elaine Jerry), who moved to the remote area in the Upper Peninsula 18 years ago, needed to get to Ann Arbor to have surgery on her right eye. ... Getting to and from Munising -- population 2,355 -- can be time-consuming and expensive, especially when driving isn't an option. Volunteer pilots such as Richard (Dick) Lawrence make it possible for Jerry and others in similar financial and geographic situations to get where they need to go for specialized medical treatment. Dozens of organizations nationwide -- several of them based in Michigan -- coordinate thousands of flights for people in need each year (Elisha Anderson, 9/17).

The American Interest: Fixing Health Care Calls for Evolution, Not Intelligent Design
It’s true that central direction and planning can sometimes be what’s needed to reach a specific, identifiable goal, like winning a war or landing a man on the Moon. But spurring innovation in the organization and delivery of health care is like constantly improving our education system or ensuring that American industry is always continuously creative. It is about a process and not about achieving a specific, known result. And it cannot be centrally directed because it is about encouraging creativity without knowing what the best future should or will look like (Stuart Butler, 9/17).

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Editorials and Opinions

Viewpoints: Romney's Comments Point To Entitlements' Role As Big Part Of 'Budget Paralysis;' Kristof Says Candidate Inflated 'Underlying Truth'

The Washington Post: Romney's Chance to Challenge The Welfare State
Stigmatizing almost everyone with a federal benefit is not just bad politics. It's the worst sort of social stereotyping. But beyond (GOP presidential candidate Mitt) Romney's bluster lies a genuine problem. The fact that roughly half of Americans receive some government payment to which they feel morally entitled is a big part of our budget paralysis. It's an inconvenient fact, but it’s still a fact. ... In 2011, Social Security had 49.6 million recipients and Medicare 45.6 million, most of them overlapping. There were 5.2 million Americans with unemployment compensation and 3.2 million with veterans' benefits. An estimated 107.2 million people received "means-tested" benefits available to those with low incomes. Medicaid had 80.5 million beneficiaries, food stamps 48.3 million and WIC (Women, Infants, and Children) 23.1 million (Robert J. Samuelson, 9/19). 

The Wall Street Journal: Time For An Intervention
As for those workers who don't pay any income taxes, they pay payroll taxes—Social Security and Medicare. They want to rise in the world and make more money. They'd like to file a 1040 because that will mean they got a raise or a better job. They too are potential Romney voters, because they're suffering under the no-growth economy. So: Romney's theory of the case is all wrong. His understanding of the political topography is wrong. And his tone is fatalistic. ... That's too small and pinched and narrow. That's not how Republicans emerge victorious (Peggy Noonan, 9/18). 

The New York Times: It Takes One To Know One
Romney is a smart man and, his friends say, a pragmatist rather than an ideologue, so what possessed him to say these things? There’s an underlying truth there — we do have a problem with entitlements and with freeloaders — and he inflated it beyond recognition. Perhaps he has passed so much time in a Republican primary bubble, hearing moans about the parasitic 47 percent, that he didn’t appreciate how obtuse and arrogant such comments appear (Nicholas Kristof, 9/19).

The Hill: Republicans' Premium Support Long Game
Medicare's future — thanks to the Affordable Care Act — is promising. The law extends the life of the trust fund, improves prescription drug coverage and eliminates copayments for critical preventive services. And the Affordable Care Act also takes important steps to change how Medicare and the rest of our health system pay for care — moving the system from one that rewards volume of care to one that rewards quality of care. More still needs to be done to lower overall healthcare costs, but the Affordable Care Act set the groundwork for future reform. But even though Medicare is heading in the right direction, it faces an enormous threat from Republicans who want to turn the program into a voucher system (Maura Calsyn, 9/19).

Journal of the American Medical Association: To Serve Patients Better and Lower Costs of Care, Respect End-Of-Life Wishes
The election debate has focused on warring narratives about whose approach to reforming Medicare is more harmful, as Democrats and Republicans promote competing solutions to lower Medicare spending. But outside of Washington, there is general agreement on one way to serve patients better and lower the costs of care: respect patients' end-of-life wishes (Dr. Mark D. Smith, 9/19).

The New York Times: Happy (Un)constitution(al) Day
The Affordable Care Act decision marked the first time the Supreme Court had ever invalidated any law enacted under the Congressional spending power. Justice Ruth Bader Ginsburg, in dissent, called the decision all the more "unsettling" because the case for constitutionality appeared, to her and Justice Sonia Sotomayor, so simple. What, exactly, was the problem with the bargain Congress attempted to strike with the states? Did it simply go too far and threaten too much? If so, when considering the next case, how far would be too far? How close a connection must there be between the desired behavior — honor the Constitution — and the threat — lose your federal money? (Linda Greenhouse, 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.