Daily Health Policy Report

Friday, September 21, 2012

Last updated: Fri, Sep 21

KHN Original Reporting & Guest Opinion

Campaign 2012

Health Care Marketplace

Health Reform

Capitol Hill Watch

Public Health & Education

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Is A Competitive Health Care Model All It's Cracked Up To Be?

Reporting for Kaiser Health News, in collaboration with The Atlantic, Julie Appleby and Marilyn Werber Serafini write: "Republican vice presidential nominee Paul Ryan says his proposal to overhaul Medicare would use market competition to tame costs in the government health program relied on by almost 50 million people. As models, he often cites the health program for federal employees – including members of Congress -- and Medicare's prescription drug program" (Appleby and Werber Serafini, 9/20). Read the story.

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Capsules: Romney Adviser's Firm Says Most States Will Expand Medicaid — If Obama Is Re-Elected; Bipartisan Report Focuses On Issues Driving Up Health Care Costs

Now on Kaiser Health News' blog, Phil Galewitz reports on a report about the prospects for the health law's Medicaid expansion by Leavitt Partners: "The consulting firm headed by the man planning Mitt Romney’s White House transition –should there be one — says most states eventually will expand Medicaid under the health law, if President Barack Obama is re-elected" (Galewitz, 9/21).

Also on Capsules, Julie Appleby writes on the factors a think tank as identified as driving the nation's health care costs: "Among the reasons behind the nation's seemingly inexorable rise in medical spending are the practice of rewarding doctors and hospitals for volume rather than efficiency of care and the tax break given to consumers for their job-based health insurance, according to a report out Thursday from the Bipartisan Policy Center, a think tank in Washington" (Appleby, 9/20). Check out what else is on KHN's blog.

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Political Cartoon: 'Auction Block?'

Kaiser Health News provides a fresh take on health policy developments with "Auction Block?" by Jeff Danziger.

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


Obama, Ryan
both to speak -- now wait for it --
about Medicare.


 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

USA Today/Gallup Poll Shows Obama More Trusted On Medicare

Other polls indicate President Barack Obama is faring well in some swing states. GOP nominee Mitt Romney's campaign hopes to shift the focus to federal spending and Medicare issues as Obama and GOP vice presidential nominee Paul Ryan speak today to the AARP. 

USA Today: Romney Fights On Medicare But Obama Retains Advantage
President Obama remains more trusted to address Medicare's challenges, the latest USA TODAY/Gallup Poll of Swing States shows, even as Mitt Romney challenged him over the issue Thursday in retiree-rich Florida (Page, 9/20).

The Wall Street Journal: Headwinds For Romney In Latest Poll Results
The three state surveys come amid a broader set of challenges for Mr. Romney, among them the release of his videotaped comments at a Florida fundraiser. The Romney campaign moved Thursday to shift its focus to federal spending and its proposal to overhaul Medicare, the popular health-care program for seniors and the disabled. Rep. Ryan speaks to seniors' lobby AARP in New Orleans on Friday. Mr. Obama will address the group by satellite (O'Connor and Hook, 9/20).

Politico: Paul Ryan To Hit 'Obamacare' At AARP
In a speech Friday to a powerful senior citizens' interest group, Paul Ryan will again go on the offense on Medicare, addressing an issue that many say is among his biggest liabilities on the GOP ticket. According to excerpts provided by the campaign ahead of his speech to the AARP national conference in New Orleans, Ryan will attack in detail President Barack Obama's health care plan, and argue that "the first step to a stronger Medicare is to repeal Obamacare" (Summers, 9/21).

CBS: Ryan To Challenge Obama On Medicare At AARP
Republican vice presidential nominee Paul Ryan, whose plans for Medicare are under attack by President Obama and other Democrats, will promise an honest conversation on entitlements in a speech at an AARP conference Friday in New Orleans, just after Obama addresses the group by satellite. "You're right to worry that years of empty promises by both political parties are threatening the security of your golden years. And you're right to demand honest answers from those asking for your vote. Mitt Romney and I share your concerns," Ryan will tell the say, according to excerpts of his speech. "And we respect you enough to level with you. We respect all the people of this country enough to talk about the clear choices we face on Medicare, Social Security, the economy, and the kind of country our children will inherit" (Kaplan, 9/21).

CNN: Paul Ryan To Seniors: Obamacare Threatens Medicare
In a speech to seniors on Friday, Republican vice presidential candidate Rep. Paul Ryan will warn them about the threat of Obamacare when he appears at the AARP conference after President Barack Obama addresses the group via satellite. Mitt Romney’s running mate will speak at the AARP Life@50+ conference, held in New Orleans, at 12:30 p.m. ET. President Barack Obama is scheduled to speak live, via satellite, at 11:45 a.m. ET. Members of AARP – a nonprofit organization and a powerful lobbying group that boasts of having more than 37 million members – were encouraged to submit questions to the nominees on their website (Shepard, 9/21).

The Associated Press: Obama Medicare Plan: No Voucher But Maybe A Bill
He'll never turn Medicare into a voucher, but if you are lucky enough to be financially comfortable in retirement, odds are you'll pay higher premiums under President Barack Obama's plan. It's not just the 1 percent who'll feel the pinch. And take note, baby boomers: The Medicare you get won't be quite as generous as what your parents' generation enjoys. A higher deductible here, a new co-payment there, and the tweaks add up (Alonso-Zaldivar, 9/20).

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Health Law, Medicare Both Hot Issues In House And Senate Races

News outlets examine how health issues are playing out in a House race in Pennsylvania and a Senate race in Massachusetts.

NBC/PhillyBurbs: Fitzpatrick Cites CBO Report As Broken Health Care Promise
Pouncing on a government report that says nearly 6 million Americans will face a tax penalty under President Barack Obama's health overhaul, Congressman Mike Fitzpatrick on Thursday said "we're on the road to a government takeover of our health care system." Fitzpatrick, who has voted to repeal the Affordable Care Act, called the Congressional Budget Office's new estimates "sobering" and said the "cost of Obamacare was underestimated by a Congress anxious to push it through." Those penalized — mostly middle class Americans — would be hit with the tax for not having insurance. The revision, 50 percent higher than a previous projection of 4 million in 2010, amounts to a broken promise, Fitzpatrick said (Weckselblatt, 9/21).

WBUR: Brown And Warren On Health Care: Two Views Of The Problem
He doesn't want to turn Medicare into a voucher program (like many of his GOP colleagues) — neither does she. He wants to cut "waste, fraud and abuse." She wants to cut costs. WBUR's Martha Bebinger offers this portrait of the two U.S. Senate candidates from Massachusetts — Republican Sen. Scott Brown and Democrat Elizabeth Warren — and their differing views on health care: Brown does not support the Romney-Ryan plan to turn Medicare into a premium support (some call it a voucher) program with seniors buying coverage on their own. Nor does Warren, who says the main problem with Medicare "is the rise in health care costs, and we’ve got to bring health care costs under control for everyone. And so the question is how we provide needed medical care for all our people at a price we can afford" (Zimmerman and Bebinger, 9/20).

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Health Care Marketplace

Targeting Companies That Cut Health Care Costs

Reuters reports that the health care sector will be "a focal point" for years to come and looks at investments in companies that are likely to make money by helping to reduce costs. Meanwhile, Kaiser Health News examines whether competitive health care models like Medicare Part D and the Federal Employees Health Benefits program are taming costs as effectively as supporters suggest.

Reuters: Targeting The U.S. Healthcare Market
No matter what the outcome of the U.S. election, healthcare looks to be a focal point in the economy for years to come. The United States spent 17.9 percent of its gross domestic product on healthcare in 2010 - more than double what other wealthy nations spend on a per-person basis. In one sign of the growing importance of healthcare to the economy, S&P Dow Jones Indices added health insurer UnitedHealthcare to the Dow Jones industrial average, replacing Kraft Foods (Randall, 9/20).

Kaiser Health News: Is A Competitive Health Care Model All It's Cracked Up To Be? 
Republican vice presidential nominee Paul Ryan says his proposal to overhaul Medicare would use market competition to tame costs in the government health program relied on by almost 50 million people. As models, he often cites the health program for federal employees – including members of Congress -- and Medicare's prescription drug program (Appleby and Werber Serafini, 9/20).

Meanwhile, news outlets report that FEHBP premiums will rise about 4 percent next year -

The Washington Post: FEHBP Premiums To Rise About 4 Percent On Average
Premiums in the health insurance program for federal employees and retirees will rise by just under 4 percent on average in 2013, although rates will hold virtually steady in the largest plan, government officials said Thursday (9/20).

The Hill: Federal Workers' Health Care Premiums To Rise 3.4 Percent
Members of Congress and other federal workers will see only a modest increase in their healthcare premiums next year. The average premium for federal employees will rise 3.4 percent next year, the Office of Personnel Management (OPM) announced Thursday. The increase translates to an extra $2.75 per paycheck for individuals, or $6.39 for families. Federal workers' premiums went up 3.8 percent this year — slightly less than the 4 percent increase seen in the private sector (Baker, 9/20).

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Bipartisan Report Details Health Care Cost Drivers

The Bipartisan Policy Center issued a report yesterday detailing the reasons behind the nation's spiralling health care costs.

Kaiser Health News: Capsules: Bipartisan Report Focuses On Issues Driving Up Health Care Costs
Among the reasons behind the nation's seemingly inexorable rise in medical spending are the practice of rewarding doctors and hospitals for volume rather than efficiency of care and the tax break given to consumers for their job-based health insurance, according to a report out Thursday from the Bipartisan Policy Center, a think tank in Washington (Appleby, 9/20). 

Politico Pro: BPC Tackles Health Cost Challenge
[The report] includes the usual suspects of soaring health care costs — the fee-for-service reimbursement system and tax treatment of health insurance, lack of transparency about cost and quality, dual eligibles — as well as others that are less tangible, like cultural norms that drive Americans to pursue expensive treatments with little evidence of benefit. ... The staff is interviewing stakeholders in the health care industry and doing shuttle diplomacy between their political leadership, whose backing they think is key to both giving the final report some weight in Congress, but also navigating ideological differences ahead of time for areas of agreement (Norman, 9/20).

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Health Reform

Jindal, Campaigning For Romney, Says Health Law Will Penalize 6 Million People

The Louisiana governor denies ties between Romney's health law in Massachusetts and the national overhaul championed by President Barack Obama.

The Wall Street Journal's Washington Wire: Gov. Jindal Slams Obama Health Law
Mitt Romney might joke about accepting the role as the "grandfather" of President Barack Obama's health-care law, but Louisiana Gov. Bobby Jindal didn't take the bait. "I can't speak to the governor's sense of humor," Mr. Jindal said in a conference call,  organized by the Romney campaign, in which he decried Mr. Obama's health-care law (Murray, 9/20).

Politico Pro: Jindal: CBO Mandate Report Proof Of Broken Promises
Gov. Bobby Jindal said Thursday that the difference between Gov. Mitt Romney's state and national health plans is that the Republican presidential contender has "consistently" been against a national mandate. On a press conference call for the Romney campaign, the Republican governor of Louisiana pushed back on comparisons between the national plan and Romney's Massachusetts health reform plan, saying President Barack Obama's health reform law led only to a series of broken promises. Jindal said the Congressional Budget Office report released this week, which found that nearly 6 million Americans will have to pay a penalty for not obtaining health insurance, is the latest example of the broken promises in the law (Haberkorn, 9/20).

In other news related to states and the implementatioin of the health law -

The Associated Press/Washington Post: Virginia's Top Health Official Discusses Federal Health Care Overhaul
Many unknowns still exist regarding what the federal health care overhaul that was upheld over the summer will mean for Virginia, the state's top health official told legislators Thursday. Virginia Secretary of Health & Human Resources Bill Hazel told the Senate Finance Committee that Virginia faces deadlines this fall on determining which benefits will be required in basic health insurance plans sold to individuals and small businesses in the state (9/20).

The Associated Press/The Seattle Times: Inslee Would Embrace Medicaid Expansion As Governor
(Washington) Democratic gubernatorial candidate Jay Inslee is fully embracing the expansion of Medicaid health coverage, saying Thursday he believes it is one of the transformational parts of President Obama's health-care law. In outlining his health-care plans, Inslee said the Medicaid expansion will have financial benefits by covering all the uncompensated care that occurs in hospitals. The federal government will cover all the costs of the newly eligible enrollees, with the state picking up some of the tab eventually (9/20).

Politico Pro: Mississippi Revisits Medicaid Expansion
Mississippi Gov. Phil Bryant has sworn off the health law's Medicaid expansion. So how come state lawmakers are still talking about it? Members of the Mississippi Joint Legislative Budget Committee said they'll be discussing the potential expansion in 2014 in budget hearings Thursday afternoon — even though most of them already think the state can't afford it. Dr. David Dzielak, executive director of the state's division of Medicaid, said that even though the governor is dead set against the expansion, "technical bills and how we operate are really the purview of the Legislature" (Smith, 9/20).

Georgia Health News: Backers Planning Push For Medicaid Expansion
Since the Supreme Court ruling on the health reform law, many Georgians involved in health care have been hyper-interested in the state's decision whether to expand Medicaid. ... If the state expands its Medicaid program, more than 600,000 lower-income people will become eligible for coverage.That represents a "huge impact" in terms of numbers of people, Judith Solomon of the Washington-based Center on Budget and Policy Priorities told consumer advocates and health care officials Thursday at an Atlanta event hosted by Healthcare Georgia Foundation (Miller, 9/20).

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Administration: Health Law Led Medicare Beneficiaries To Save $4.5B On Rx Drugs

USA Today reports the Obama administration is annoucing that, because of provisions in the health law Medicare's prescription drug doughnut hole, Medicare beneficiaries experienced considerable savings.

USA Today: Medicare Recipients Save $4.5 Billion On Prescriptions
Medicare beneficiaries have saved a total of about $4.5 billion on prescription medications because of the 2010 health care law since January 2011, the Department of Health and Human Services plans to announce today. … The announcement comes two days after the Congressional Budget Office found that about 2 million more people than expected would be paying an average $1,200 penalty for not purchasing insurance as required by the law beginning in 2014. The number affected is significantly higher than the 4 million the CBO had estimated would pay a penalty in 2010, shortly after the bill passed (Kennedy, 9/21).

In other health law news -

The Denver Post: Health Care Battle Has Plenty Of Fight Left, Denver Panel Show
A key architect and a sharp opponent of national health care reform clashed in a debate Thursday over how much "Obamacare" limits consumer choice and holds hope of cutting costs. The Affordable Care Act strips exactly the kind of freedom consumers need to make better care choices and reduce costs, health economist Linda Gorman argued at a panel sponsored by The Denver Post and the University of Denver (Booth, 9/21).

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Capitol Hill Watch

Broker Bill Gets House Energy And Commerce Committee OK

The House panel approved legislation that would modify the health law's medical loss ratio provision to protect the earnings of insurance brokers and agents.

CQ HealthBeat: Health Insurance Broker, Secondary Payer Bills Advance In House
A House panel signed off on controversial legislation Thursday that would modify a consumer protection provision in the 2010 health care overhaul. The measure, which the Energy and Commerce Committee approved 26-14, would amend the law's provision on medical loss ratios (MLR) in an effort to protect the earnings of insurance brokers and agents. John Barrow of Georgia was the lone Democrat to vote in favor of the bill, while all of the panel's Republicans supported it (Khatami, 9/20).

Politico Pro: Energy And Commerce OKs Broker Bill
In the end, Rep. John Barrow found himself all out on his own. Barrow (D-Ga.), the co-sponsor of a bill shielding agent and broker commissions from the health care law's medical loss ratio requirement, was the only Democrat on the House Energy and Commerce Committee who voted to advance the bill Thursday. The committee approved the bill on a 26-14 vote. But it's likely to have much more Democratic support if it gets to the full House floor. The agent and broker groups say their livelihoods are threatened by the ACA's limits on what insurers can spend using premium dollars, besides the actual cost of medical care. By lumping in broker commissions with insurers’ administrative spending, the groups say their members have seen their revenue cut between 20 and 50 percent and have suffered job losses as a direct result (Millman, 9/20).

Also, a House oversight committee takes a long look at alleged Medicaid overpayments to the state of New York --

The Wall Street Journal: State Accused Of $15 Billion Fraud Scheme
A congressional oversight committee on Thursday accused New York of overbilling Medicaid by billions of dollars by inflating reimbursement payments to its state-run institutions for the mentally disabled. In a scathing report, the Republican-led House Oversight and Government Reform Committee said New York overcharged taxpayers by $15 billion since 1990 (Gershman, 9/20).

CQ HealthBeat: Medicaid Official Defends Work To Limit Overpayments In New York
Republicans who called a hearing planning to grill an Obama administration official about Medicaid overpayments to New York State instead ended up praising the Democratic administration's work. Medicaid has grossly overpaid New York to house developmentally disabled beneficiaries, and that money has not yet been recouped. However, lawmakers from both sides of the aisle seem satisfied at the House Oversight and Government Reform subcommittee hearing that Obama's Medicaid officials are dealing with the issue, which predated this administration (Adams, 9/20).

In other news, National Journal reports that health lobbyists are working hard to persuade lawmakers to delay the automatic $1.2 trillion in automatic cuts generated by last year's debt ceiling deal. Meanwhile, The Washington Post reports on a delay in the Senate regarding a vote on the short-term spending bill to keep government operating.  

National Journal: Health Lobbyists Swarming On The Hill
The impending sequestration cuts are not lost on health care lobbyists, who are undertaking an intense effort to persuade Congress to stop them, National Journal Daily reports today. … Although most of Washington expects that Congress will delay the automatic $1.2 trillion in cuts to government spending before the end of this year, health lobbying groups from myriad industries are taking the threat seriously. And they are letting lawmakers and their staff know about the consequences of letting the automatic cuts hit--making their case directly to politicians, rather than to the voters who will decide whether to keep them in office. One point that bolsters the lobbyists' argument? Jobs (McCarthy and Catalini, 9/20).

The Washington Post: Senate Delays Votes On Short-Term Spending Bill
There appears to be no doubt on the final passage of a bill to provide funding for government agencies when the fiscal year ends Sept. 30. Federal spending would be capped at $1.047 trillion, a limit agreed to last summer as part of the bipartisan debt ceiling negotiations. The bill cleared a key procedural vote Wednesday. But Senate Majority Leader Harry M. Reid (D-Nev.) began threatening to hold votes on final passage this weekend after Republicans objected to his plans to hold a vote on Paul's proposal (O’Keefe, 9/20).

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Public Health & Education

Smoking, Obesity, Lack Of Insurance May Be Shortening Some Americans' Life Spans

The New York Times reports that the nation's life-expectancy trend has reversed by four years since 1990 for the country's least-educated whites.

The New York Times: Reversing Trend, Life Span Shrinks For Some Whites
The reasons for the decline remain unclear, but researchers offered possible explanations, including a spike in prescription drug overdoses among young whites, higher rates of smoking among less educated white women, rising obesity, and a steady increase in the number of the least educated Americans who lack health insurance (Tavernise, 9/20).

In other news -

Bloomberg: Alzheimer's Leaves Patients, Caregivers Feeling Isolated
Patients with Alzheimer's disease, the most common form of dementia, and their caregivers say the illness leaves them feeling isolated and apart from family, friends and life's typical connections, a report shows. About a quarter of people with dementia hide or conceal their diagnosis because of the stigma surrounding the disease and 40 percent say they are excluded from everyday life, according to the World Alzheimer Report 2012 released today by London-based Alzheimer's Disease International. About 36 million people worldwide are living with dementia and the numbers will more than triple to 115 million by 2050, according to the report (Ostrow, 9/20).

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State Watch

State Highlights: Big Changes Ahead For Mich. Blue Cross

Health policy news from Texas, Maryland, California, Wisconsin, Oregon, Kansas and Michigan.

The Associated Press/Crain's Detroit Business: Mich. Panel Discusses Blue Cross Overhaul Plan
The Michigan Legislature took its first steps Wednesday toward tackling a proposed overhaul of the state's largest health insurer, Blue Cross Blue Shield of Michigan. Senate Insurance Committee Chairman Joe Hune introduced bills that would end the nonprofit health insurer's tax-exempt status and align it with competitors. ... [Republican Gov. Rick Snyder] said last week he aims to "level the playing field" for insurers and modernize the only Michigan company that has to provide insurance coverage regardless of a customer's health status (Karoub, 9/20). 

Milwaukee Journal Sentinel: Wisconsin Medical Society Wants Planning For End-Of-Life
The Wisconsin Medical Society is launching a statewide initiative to make advance care planning -- including the sensitive and often difficult conversations about end-of-life care -- a standard part of patient care. The initiative -- Honoring Choices Wisconsin -- is modeled after a communitywide initiative in La Crosse that has drawn national attention as well as a similar initiative by the Twin Cities Medical Society in Minnesota (Boulton, 9/20).

The Oregonian: Oregon End-Of-Life Care Program Spreads, Report Finds
An Oregon effort to ensure people near the end of life receive the care they want continues to spread across the country, according to a new report. The Oregon Physicians Orders for Life Sustaining Treatment (POLST) program, created two decades ago and put into state law by the Legislature in 2009, has been adopted by 15 states and is under consideration in 28 others, according to the report (Budnick, 9/20).

Related, earlier KHN story: Oregon Emphasizes Choices At Life's End (Foden Vencil, 3/8)

Kansas Health Institute News: Dentist Shortage Proposal Not Funded In Regents' Recommended Budget
Proposals for dealing with the state's dentist shortage did not make the cut today when the Kansas Board of Regents approved recommending a $47 million budget increase for state universities…. Board chair Tim Emert said that funds are clearly not available to begin a dental school — and temporarily securing seats from other schools came at the expense of other programs (Cauthon, 9/20).

The Texas Tribune: Better Hepatitis Treatment Costly For Prisons
Prison health officials estimate that as many as 50,000 of the state's more than 150,000 inmates could be infected with hepatitis C. The cost to treat Texas inmates with hepatitis C is expected to soar by as much as 380 percent next year, a result of the growing prevalence of the disease among inmates and a more effective, but more expensive, treatment protocol. Legislators, already facing a strained budget, will have to find millions more dollars to pay for this care (Grissom, 9/21).

The Texas Tribune: Interactive: Mental Health Treatment At State-Funded Centers
Texas has a severe shortage of mental health professionals: 202 out of 254 counties do not have enough psychiatrists, clinical psychologists, social workers, psychiatric nurse specialists and family therapists to treat the needs of the population, according to the U.S. Department of Health and Human Services (Aaronson, 9/20).

The Baltimore Sun: Health Officials Consider Increasing Plastic Surgery Center Oversight
Maryland health officials may ask state lawmakers for permission to oversee plastic surgery centers, a move inspired in part by the death of a Lochearn woman after liposuction. ... Surgical centers currently are subject to state inspection only if they meet certain criteria in how they bill insurance companies, (Secretary Joshua Sharfstein) said (Dance, 9/20).

Los Angeles Times: Gov. Jerry Brown Signs Bill To Overhaul Disabled Access Law
The disabled are being promised better wheelchair access to businesses at the same time that business owners are gaining some protection against expensive, "predatory" lawsuits under legislation just signed by Gov. Jerry Brown. ... [The bill prohibits] lawyers from sending "demand for money" letters to owners of restaurants and other high-traffic businesses (Lifsher, 9/20).

The Washington Post: Johns Hopkins, Other Major Area Hospitals Left Off Top-Performer List
When the nation's main hospital accreditation group released a list of top-performing hospitals last year, Johns Hopkins got a nasty surprise: It wasn't included. Instead, Holy Cross Hospital in Silver Spring — a much smaller institution that lacks the global reputation of the Baltimore-based behemoth — was the only area hospital to make the cut (Sun, 9/20).

The Associated Press/Wall Street Journal: NY Pushes Insurer To Explain Coverage To Members
New York regulators say they've fined an insurer $665,000 for failing to explain health plan coverage to members, including ways to challenge claims they believe were improperly denied. Superintendent of Financial Services Benjamin Lawsky says Oxford Health was cited for approximately 300,000 instances of not providing required statements about service plans and appeals from 2001 to 2008 (9/21).

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Health Policy Research

Research Roundup: 'Early' Cost-Control Lessons From Mass.

Each week KHN reporter Ankita Rao compiles a selection of recently-released health policy studies and briefs. 

Health Affairs: The New Era Of Payment Reform Spending Targets, And Cost Containment In Massachusetts: Early Lessons For The Nations
On Aug. 8, Massachusetts' third health care cost control bill became law. It "sets annual state spending targets, encourages the formation of accountable care organizations, and establishes an independent commission to oversee health care system performance." The authors write that the state's "experience provides several lessons for state and federal policy makers. First, implementing near-universal coverage, as is planned under the Affordable Care Act for 2014, will increase pressure on government to begin controlling overall health care spending. Second, introduction of cost control measures takes time." They note that the legislation "while lacking strong mechanisms to enforce the new spending goals, creates a framework for increased regulations if spending trends fail to moderate" (Mechanic, Altman and McDonough, 9/19).

Archives of Internal Medicine: Impact Of The 2008 US Preventive Services Task Force Recommendation To Discontinue Prostate Cancer Screening Among Male Medicare Beneficiaries
In 2008, the U.S. Preventive Services Task Force recommended against routine PSA (prostate-specific antigen) screening for men 75 and older because the test did not reduce mortality for prostate cancer. The researcher compared the prevalence of screening tests before and after the recommendations and found that men between the age of 66 and 74 increased their use of the test by 0.5 percent – rising from 33.9 percent to 34.4 percent of the sample. Men older than 75 decreased their use of the screening by 1.6 percentage points, a probable result of the 2008 recommendation (Ross, et al, 9/10).

Kaiser Family Foundation/American Cancer Society/National Colorectal Roundtable: Coverage of Colonoscopies Under The ACA’s Prevention Benefit
The health law requires that health insurers cover preventive services, such as screenings, that warrant an A or B recommendation from the U.S. Preventive Services Task Force. Colorectal cancer screening, which received an A, could prevent the third most common cancer in the country. But patients sometimes pay out-of-pocket for the test, which can cost $1,000 to $2,000, when it comes to follow-up or preemptive measures. The authors write: "confusion over whether colon cancer screenings are preventive care or treatment means patients sometimes receive unexpected bills for the procedure," and conclude: "In the absence of federal guidance, the new preventive care benefit may continue to be inconsistently applied for at least some procedures" (Pollitz, Lucia, Keith, Smith, Doroshenk, Wolf and Weber, 9/19).

University of Mass./National Academy of Social Insurance/Robert Wood Johnson Foundation:  Establishing The Technology Infrastructure For Health Insurance Exchanges Under The ACA
Under the health law, federal regulators "have created unprecedented resources" for planning for state-based insurance exchanges. The authors of this analysis call the exchanges a "major technology challenge" for governments who will "need to conduct major updates or complete replacements of their legacy IT systems and create new interfaces to link individual eligibility and enrollment data among Medicaid, CHIP and the state's Exchange." They conclude that "states would be well advised to seek out the 'Early Innovators' and other advanced states for their lessons learned" (Tutty and Himmelstein, 9/2012).

Here is a selection of news coverage of other recent research:

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 (Hitt, 9/18).

Medscape: Remediation Rate High for Surgical Residents
Almost one third of general surgery residents required remediation to successfully complete their program, according to a retrospective analysis of 11 years of training at 6 US medical schools. The study, published in the September issue of the Archives of Surgery, showed that most of the residents required remediation to fill gaps in medical knowledge, but were not prompted by poor performance to leave surgery. Attrition rates did not differ significantly between remediated and nonremediated residents, and more than 96% of those leaving did so voluntarily for personal reasons (Waknine, 9/17).

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Editorials and Opinions

Viewpoints: AARP's Agenda On Health Law; Cuccinelli 'Demeaning' Va. AG's Office; Government's Health Care Role

Politico: AARP Sells Out Seniors For 'Obamacare'
President Barack Obama is scheduled to speak Friday via satellite to a convention sponsored by AARP. ... here are five facts you're unlikely to hear from the president, or AARP, about how each treats seniors: First, while AARP poses as a disinterested senior advocate, it functions as an insurance conglomerate, with a liberal lobbying arm on the side. AARP depends on profits, royalties and commissions to make up more than 50 percent of its annual revenues (Sen. Jim DeMint, R-S.C., 9/21).

The Wall Street Journal: The Love Song Of AARP And Obama 
How can that lobby claim to speak for American seniors given its partisan role in passing ObamaCare? Thanks to just-released emails from the House Energy and Commerce Committee, we now know that AARP worked through 2009-10 as an extension of a Democratic White House, toiling daily to pass a health bill that slashes $716 billion from Medicare, strips seniors of choice, and sets the stage for rationing (Kimberley A. Strassel, 9/20).

Los Angeles Times: Anthem's Tip For Better Health: Try This Ice Cream 
Hoping to inspire better diets among its members, the insurance giant Anthem Blue Cross is sending out money-saving coupons. But it's pushing processed sandwich meat, mayonnaise and even ice cream. ... If you're going to promote wellness, why not go all-in? Provide incentives to buy fresh fruits and vegetables, or fresh meat and fish (David Lazarus, 9/20).

The Washington Post: Ken Cuccinelli Bullies A State Board Into Surrender
In three years as Virginia's attorney general, Ken Cuccinelli II (R) has demeaned his office by using it as a blatantly partisan bully pulpit to attack Obamacare, illegal immigrants, homosexuals and climate-change scientists. Now he has managed to bully Virginia's Board of Health into a stance — unprecedented in state history — that could force most of the commonwealth’s 20 or so abortion clinics to close (9/20).

Journal of the American Medical Association: The Role of Government: To Help The People Who Need Our Help The Most
The ACA is resulting in new regulations that some clinicians and institutions find concerning. But the law was passed in part because the private sector was unable to address the nation's escalating health care costs and comparatively poor outcomes. If the nation depends on a healthy citizenry for economic success, then strategies for reducing the number of uninsured people and improving access to safe, quality, equitable health care are imperative. The ACA lays the foundation for achieving both by expanding and reforming health insurance coverage. And it does more (Diana Mason, 9/20).

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Stephanie Stapleton

Andrew Villegas

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Shefali Luthra

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