Daily Health Policy Report

Thursday, September 27, 2012

Last updated: Thu, Sep 27

KHN Original Reporting & Guest Opinion

Campaign 2012

Health Care Marketplace

Health Reform

Capitol Hill Watch

Medicare

Health Information Technology

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Lawmaker Pitches New FDA Office Of Mobile Health

Kaiser Health News staff writer Jenny Gold reports: "There are already tens of thousands of mobile health applications available for download on smart phones and tablets, allowing consumers to do anything from count calories to monitor their blood sugar level and fight depression. But it can be hard to know which ones actually deliver on their health claims and provide accurate information" (Gold, 9/26). Read the story.

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Poll: Younger Americans More Receptive Than Seniors To GOP Medicare Plan

Kaiser Health News staff writer Jordan Rau reports: "The Republican proposal to change Medicare that has been championed by GOP vice presidential candidate Paul Ryan remains unpopular with Americans, although younger people are more receptive to it than older ones, according to a new poll" (Rau, 9/27). Read the story.

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Capsules: Md. Blues Chief Blasts Plan To Shift Hospital Costs To Insurers

Now on Kaiser Health News' blog, Jay Hancock reports: "Negotiations to avert a breakdown in Maryland's unique system of regulating hospital prices have deteriorated into a stalemate between the state's largest insurer and the Maryland Hospital Association. CareFirst BlueCross BlueShield CEO Chet Burrell, speaking out for the first time about the talks, blames hospitals for their proposal to shift hundreds of millions in costs to CareFirst and other private insurers in an attempt to control rising Medicare spending" (Hancock, 9/27). Check out what else is on the blog.

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Analysis: Access To Health Care Beginning To Look Like Airline Travel

In this Kaiser Health News analysis, Michael L. Millenson writes: "The old axis of access in U.S. health care – insured or uninsured – is being replaced by the kind of gradations and complexity in determining who-gets-what-when-for-what-price for which the airline industry has become famous" (Millenson, 9/26). Read the analysis.

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Political Cartoon: 'Price Conscious'

Kaiser Health News provides a fresh take on health policy developments with "Price Conscious" by Marty Bucella.

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

EXPLORING OPTIONS: AVOCADO, MARKETPLACE, QUICK SHOP?

On alternative
names for state health exchanges
,
how about Healthport?
-Ron Hammerle

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

Talk On The Trail: Romney Praises His Own Mass. Health Reforms, Denounces The 2010 Health Law

In what The Washington Post describes as "political flexibility," GOP presidential nominee Mitt Romney touted the state health law he signed while Massachusetts' governor as proof of compassion and empathy, while also sharply criticizing the federal health law, which is viewed as President Barack Obama's signature legislative achievement.

Los Angeles Times: Romney Cites His Healthcare Law As Proof Of His Compassion
Mitt Romney, while campaigning in Ohio on Wednesday, highlighted the healthcare law that he passed while governor of Massachusetts as proof of his empathy for people. … The healthcare law is controversial among conservatives because it included a mandate that nearly every state resident purchase the insurance or be fined; it served as the model of the federal healthcare law that is Obama's signature act as president, and that is an anathema to many Republicans (Mehta, 9/26).

Politico: Romney Hits 'Obamacare' In Ohio
Facing falling poll numbers in Ohio, Mitt Romney reconfigured his stump speech here, ratcheting up his attack on President Barack Obama's health care law and returning to his once-abandoned talking points about the Founding Fathers and the debt clock. ... Instead of simply vowing to repeal the health care overhaul, Romney spoke more about the danger it poses to American freedoms (Gibson, 9/26).

The Boston Globe: Mitt Romney Praises Mass. Health Law, Denounces Obamacare
Mitt Romney cited his record on Wednesday in shepherding through the Massachusetts health care law as a sign of his empathy for all people, talking far more openly than usual about a law that has caused him so much strife with conservative Republicans. Romney cited his health care plan as a sign of his empathy a week after a video emerged showing Romney dismissing nearly half of the electorate, telling donors at a May fund-raiser that 47 percent of voters considered themselves victims and were too dependent on government to consider voting for him (Viser, 9/27).

The Washington Post: Romney Shows Political Flexibility On Health Care
Over the course of a half hour on Wednesday evening, Mitt Romney put on a vivid display of his political flexibility on the lightning-rod issue of health care. As his surrogates were warming up a crowd of 3,600 at the SeaGate Convention Centre in downtown Toledo, Romney sat backstage for an interview with NBC News, during which he fully embraced the health care overhaul he signed into law as governor of Massachusetts. … Then, just minutes later, Romney stepped out to rally his supporters here with a sharp critique of Obama's national health-care overhaul, calling the federal law "Exhibit No. 1" of Obama's liberal view of government, even though it is very similar to Romney's own Massachusetts law (Rucker, 9/26).

CNN: Health Reform Law An Example Of Compassion, Romney Says
Republican presidential nominee Mitt Romney pointed Wednesday to the Massachusetts health reform law he signed – and particularly its coverage of children – when asked about his compassion for middle class people. Romney raised the law in an interview with NBC News. Conservatives have criticized Romney for supporting the law, which is similar to the health reform law signed by President Barack Obama. Romney has said his law was constitutional and appropriate in Massachusetts, but was not meant to be implemented nationally (Wallace, 9/26).

Bloomberg: Romney Touts His State's Health Law While Bashing Obama Overhaul
Republican Mitt Romney cited a Massachusetts health-care law he backed as showing his "empathy," then later reiterated his pledge to repeal national legislation modeled after the state's measure as he and President Barack Obama crisscrossed Ohio yesterday. Republican Mitt Romney cited a Massachusetts health-care law he backed as showing his "empathy," then later reiterated his pledge to repeal national legislation modeled after the state's measure as he and President Barack Obama crisscrossed Ohio yesterday (McCormick and Nichols, 9/27).

The New York Times: Romney Ad Reaches Out To Working Class
Mitt Romney stepped up his efforts to repair the damage from his "47 percent" comments, releasing a new television ad on Wednesday. ... In an NBC News interview on Wednesday, Mr. Romney, explaining why he could relate to middle-class voters, talked about the health care law he championed as governor of Massachusetts but rarely mentions on the campaign trail. "Don't forget — I got everybody in my state insured," he said. "One hundred percent of the kids in our state had health insurance. I don't think there's anything that shows more empathy and care about the people of this country than that kind of record" (Parker, 9/26).

National Journal: Romney's New Message: I Care
Although the message may not have been written on a cue card, the Romney campaign took a page out of the 1992 playbook of George H.W. Bush on Wednesday, launching a new charm offensive meant to appeal directly to those who were turned off by his comments at a private fundraiser about "the 47 percent."  The message: I care. Faced with his own image problems in 1992, the first President Bush made a now-infamous gaffe on the campaign trail when he mistakenly read out loud the stage directions on cue cards given to him (Huisenga, 9/27).

Politico Pro: Romney, Obama Duel Over Health Care In NEJM
President Barack Obama's health care law fails to control costs that will bankrupt the country and his $700 billion in cuts to Medicare are not viable, Mitt Romney writes in a New England Journal of Medicine essay published Wednesday. In a dueling essay, Obama reiterates his call for "additional steps" to fix the nation’s health care system in a second term, including a "permanent fix to Medicare's flawed payment formula that threatens physicians’ reimbursement." He blasts Romney for having "a radically different vision for the future of our health care system — even if it means running from his past as the architect of health reform in Massachusetts." The essays are a chance for each man to make his case without the constraints of a 30-second TV spot (Norman and Cheney, 9/26).

Medpage Today: Obama Vs. Romney On Health Care In NEJM
Less than a week after they co-starred on TV's "60 Minutes," President Barack Obama and Governor Mitt Romney delivered another "showdown" with dueling commentaries on the Affordable Care Act, published online Wednesday by the New England Journal of Medicine. The statements came in response to a request from NEJM editors asking the candidates to "describe their healthcare platforms and their visions for the future of American healthcare." Not surprisingly, the statements were long on sound bites and light on details (Peck, 9/26).

In other campaign news -

Politico: Todd Akin Still Had Shot In Senate Race
Senior Republicans and leading pundits quickly declared Todd Akin's "legitimate rape" comments a mortal blow to his Senate candidacy, writing off the conservative congressman’s campaign in one of the country's most important races. But a month after his comments set the political world on fire, there's a different feeling on the ground here among operatives, voters, activists and officials in both parties: Akin can still win. ... The fact that Akin is still a contender has unnerved Democrats here and put Republican leaders in Washington in an increasingly awkward position after they slammed the congressman and vowed not to spend a dime in the state if Akin refused to drop out — a decision that some Republicans fear could cost their party the majority (Raju, 9/26).

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Polls: Obama Scores Higher In Trust On Medicare

A new Kaiser Family Foundation tracking poll found that 52 percent of the public trusts President Barack Obama over GOP presidential pick Mitt Romney to do a better job with Medicare's future, although young people were more receptive than seniors to GOP Medicare proposals. Meanwhile, a survey by AP-GfK found substantial belief in the widely challenged idea that the law includes "death panels."

Kaiser Health News: Poll: Younger Americans More Receptive Than Seniors To GOP Medicare Plan
The Republican proposal to change Medicare that has been championed by GOP vice presidential candidate Paul Ryan remains unpopular with Americans, although younger people are more receptive to it than older ones, according to a new poll (Rau, 9/27).

Politico Pro: Poll: Obama Better For Medicare's Future
Fifty-two percent of the public says Obama is the one they "trust to do a better job" in determining Medicare's future, according to a poll released Thursday by the Kaiser Family Foundation. That's compared with 32 percent who pick Mitt Romney. Obama has made significant gains since July, when the spread in the Kaiser poll was just half that. At that time, 44 percent chose him and 34 percent chose the Republican presidential nominee (Haberkorn, 9/27).

Politico: Swing-States Polls: President Obama Tops Mitt Romney On Medicare
And that's despite weeks of Republican attacks that the president is taking $716 billion from Medicare to pay for "Obamacare." In Florida, Obama is up by 15 percentage points on the question of who would do a better job on Medicare, 55 percent to 40 percent. ... Obama leads 55 percent to 39 percent in Ohio, and 55 percent to 39 percent in Pennsylvania (Norman, 9/27).

The Hill: Poll: Four In 10 Believe In Obama Health Care Law 'Death Panels'
About four in 10 U.S. adults believe that President Obama's healthcare reform law will create "death panels" to decide patients' fitness for care, according to a new Associated Press-GfK survey. Support for the widely challenged claim has remained steady since 2010, when 39 percent believed "death panels" would result from the healthcare law. Today, 41 percent say the same is true. Overall, most people believe the law will go into effect in spite of Republican pledges to repeal it (Viebeck, 9/26).

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Health Care Marketplace

Big Employers Change The Way They Provide Health Benefits

The Wall Street Journal reports on developments related to the health benefits provided by two large employers. Also, The Associated Press reports on how making smart decisions will be eaiser during the current open enrollment season.

The Wall Street Journal: Big Firms Overhaul Health Coverage
Two big employers are planning a radical change in the way they provide health benefits to their workers, giving employees a fixed sum of money and allowing them to choose their medical coverage and insurer from an online marketplace. Sears Holdings Corp. and Darden Restaurants Inc. say the change isn't designed to make workers pay a higher share of health-coverage costs. Instead they say it is supposed to put more control over health benefits in the hands of employees (Mathews, 9/26).

Earlier, related KHN story: Some Employers Already Sending Workers To Exchanges to Buy Health Insurance (Appleby, 4/29). 

The Associated Press/Boston Globe: How To Maximize Your Savings Through Smart Health Care Benefit Decisions
All too often this open-enrollment period has required combing through pages and pages of confusing insurance terms. But this year workers will receive help translating that jargon thanks to a new requirement that insurers provide a user-friendly coverage summary of all health plans. Combined with innovative wellness plans that reward employees for staying health, experts say millions of workers should be able to make smarter benefit decision and save money in the process (Perrone, 9/26).

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Health Reform

HHS To States, Lawmakers: Federal Exchange Will Be Ready On Time

A pair of stories from CQ HealthBeat examines emerging issues in the implementation of health exchanges. 

CQ HealthBeat: HHS Reiterates Federal Exchange Will Be Ready After Hatch Presses For Details
Senate Finance Committee Chairman Orrin G. Hatch of Utah is pressing federal officials to give states more details about how a federal health exchange will work as the states confront a Nov. 16 deadline for telling the Health and Human Services Department whether they will operate an exchange on their own. HHS said Wednesday that it is reviewing the letter from the Utah Republican and declined further comment on the federal exchange other than to say it will be ready on time (Adams, 9/26).

CQ HealthBeat: OPM Working To Attract Interest In Multistate Plans
The Office of Personnel Management, in an effort to persuade a variety of large health plans to provide multistate exchange proposals, is offering to allow insurers to cover only part of a geographic area at first when the option begins in January 2014. The OPM revealed new details about the plans when it invited comments, which are due by Oct. 22, on a 20-page draft application for participation. The agency appears to be interested in making it as easy to participate as possible (Adams, 9/26).

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Capitol Hill Watch

Politico: GOP Budget Plan In The Red Without Ryan Cuts

Politico: Without Paul Ryan Medicare Ax, GOP Budget Still In Red
Call it Paul Ryan's 0.5 percent solution. In a little-noticed but vital change last spring, the House Budget Committee chairman cut half a point from the annual growth rate he had allowed for Medicare spending. It gave him the extra margin needed to pay for tax cuts and still placate the right by getting to balance in 2040. But it meant breaking with Ryan's fellow Medicare reformer, Sen. Ron Wyden (D-Ore.), and raised this question that echoes now in the presidential campaign: Did Ryan cut corners with seniors to pay for tax cuts just as he accuses President Barack Obama of doing to finance health care reform? Indeed, calculations by POLITICO — drawn from a Congressional Budget Office analysis commissioned by Ryan in March — show that without the half-point cut, the House Republican budget would still be in the red in 2040 (Rogers, 9/26).

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Medicare

Inspector General: Medicare Wrongly Paid Millions For Refills On Restricted Prescriptions

The Associated Press/Washington Post: Inspector General: Medicare Wrongly Paid For $25M In Refills On Painkillers, Other Drugs
Medicare routinely refilled pain pills and other restricted medications that are barred by federal law from renewal without a fresh prescription, government inspectors said in a report Thursday (9/27).

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Health Information Technology

FDA, Docs, Consumers Scrutinizing Medical Apps

Consumers are increasingly relying on mobile applications to monitor their own health as some question whether the FDA can evaluate the apps fast enough.

Fox Business: Just What The Doctor Ordered: Medical Apps To Improve Care, Health
In the face of rising health-care costs, consumers are looking for any assistance to reduce medical expenses and stay healthy. At the same time, doctors are seeking ways to improve their communications with patients, increase patient adherence to drug regimens and care plans and overall improve the quality of care. Both parties are turning to the same tool: mobile health. ... In the past, patients relied on their own memory to remember previous weights or past illnesses (Mannino, 9/26).

Kaiser Health News: Lawmaker Pitches New FDA Office Of Mobile Health
The Food and Drug Administration, the agency in charge of regulating mobile health apps, has evaluated a few apps so far, but it still has not made clear which [mobile health applications] will require approval. Some app developers have raised concerns about whether the FDA can keep up with the fast-paced innovations of Silicon Valley (Gold, 9/26).

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State Watch

Medicaid: Ariz. Expansion Savings Detailed; Kan. Prepares For Managed Care Approval

In Medicaid news, a report details how an expansion there would save Arizona money. And a Kansas official says a planned move of recipients to managed care is likely to be approved by federal authorities.

The Arizona Republic: Report: Medicaid Boost Would Save Arizona Money
Expanding Medicaid under federal health reform would save state tax dollars, create thousands of jobs and provide government-paid health care to hundreds of thousands of low-income Arizonans, according to a new report from a bipartisan think tank. Research from the Grand Canyon Institute, whose board includes former Republican and Democratic state lawmakers, shows that with a $1.5 billion investment over the first four years the state would collect nearly $8 billion in federal funding and insure an additional 435,000 people by 2017 (Reinhart, 9/26).

Kansas Health Institute News: Federal Officials Likely To Approve KanCare Plan, KDHE Official Says
A top official at the Kansas Department of Health and Environment today assured a legislative panel that efforts to secure federal approval for Gov. Sam Brownback's plan for privatizing almost all of the state's Medicaid programs appear to be going well. "I don't see it being rejected," said Kari Bruffett, KDHE's director of health care finance, testifying before the Joint Committee on Home and Community Based Services Oversight. Brownback's plan for remaking the state's Medicaid program is called Kancare (Ranney, 9/26).

Kansas Health Institute News: KanCare Benefit Packages Outlined
State officials today released a side-by-side comparison of the "value-added" packages being offered by the KanCare managed care companies. … The packages, [Bruffett] said, include different incentives aimed at promoting preventive dental care for adults, wellness checks, prenatal and postnatal doctor's office visits, smoking cessation, weight loss and exercise (Ranney, 9/26).

Modern Healthcare: Fla. Agency Rejects Feds' Claims About Care Of Disabled Kids
Florida's Agency for Healthcare Administration is defending itself against U.S. Justice Department allegations that it forced families to send their disabled children to nursing homes when they couldn't afford their care. "Florida cares about kids," agency Secretary Elizabeth Dudek said in a statement Tuesday evening. "Medicaid has a comprehensive medical service package that can accommodate any family who chooses to have their child at home..." (Kutscher, 9/26).

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Texas Budget Cutting Causes Closure Of 50 Clinics Offering Family Planning Services

Cuts to Texas' budget have caused more than 50 clinics that provide family planning services to close, a new study in the New England Journal of Medicine reports.

The Texas Tribune: Report: Family Planning Cuts Caused 53 Clinics To Close
More than 50 clinics that provide family planning services have closed as a result of state budget cuts, according to a report published Wednesday by the New England Journal of Medicine. State lawmakers cut funding for family planning services by two-thirds in the last legislative session, dropping the two-year family planning budget from $111 million to $37.9 million for the 2012-13 biennium (Aaronson, 9/26).

Politico Pro: The Impact Of Cutting Family Planning Funding In Texas
What happens when states say goodbye to federal family-planning funding? A new analysis in The New England Journal of Medicine, focusing on Texas, finds it leads to decreased access to preventive services, clinics turning away women who can't pay and far fewer resources in impoverished areas. "We are witnessing the dismantling of a safety net that took decades to build and could not easily be recreated even if funding were restored soon," authors Kari White, Daniel Grossman, Kristine Hopkins and Joseph E. Potter write (Smith, 9/26).

In the meantime, Missouri has fined Aetna $1.5 million for failing to allow employers to opt-out of contraception coverage in their plans, and Virginia's Attorney General approves new regulations on abortion clinics --

St. Louis Beacon: State Department Of Insurance Fines Insurer For Offering Contraceptive Coverage
The Missouri Department of Insurance has announced that it has levied its largest fine in state history -- $1.5 million -- against an insurer who failed to comply with state law regarding coverage, or lack of, for autism treatment, contraception and elective abortions. Among other things, Aetna Life Insurance Co. "provided coverage for contraceptives without allowing employers to opt out of this coverage," the department says. A department spokesman noted that the provisions in question were in an 11-year-old state law, and not part of the new state law regarding abortion, contraceptive and sterilization coverage put in place following the General Assembly's action earlier this month to override Gov. Jay Nixon’s veto (Mannies, 9/26).

Richmond Times-Dispatch: Cuccinelli Approves Abortion Clinic Regulations
Attorney General Ken Cuccinelli's office Wednesday gave its stamp of approval to new abortion clinic regulations that will compel existing clinics to retrofit their facilities to meet standards for new hospital construction. Cuccinelli's certification of the regulations, approved by the state Board of Health Sept. 14, advances them to Gov. Bob McDonnell for further review. If McDonnell approves the regulations, they will be subject to a 60-day public comment period before returning to the Board of Health for final consideration, which is expected next year. The Board of Health voted 13-2 on Sept. 14 to adopt regulations that require existing abortion clinics in Virginia to be regulated like new hospitals (Nolan, 9/27).

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State Roundup: Pharmacies Struggle With New Drug Controls

A selection of health policy news from Maryland, Florida, Massachusetts, California, Kansas and Oregon.

Kaiser Health News: Capsules: Md. Blues Chief Blasts Plan To Shift Hospital Costs To Insurers
Negotiations to avert a breakdown in Maryland's unique system of regulating hospital prices have deteriorated into a stalemate between the state's largest insurer and the Maryland Hospital Association. CareFirst BlueCross BlueShield CEO Chet Burrell, speaking out for the first time about the talks, blames hospitals for their proposal to shift hundreds of millions in costs to CareFirst and other private insurers in an attempt to control rising Medicare spending (Hancock, 9/27).

The Wall Street Journal: Making The 'Pharmacy Crawl'
The clampdown by Florida and at least seven other states has left some pain-sufferers struggling to get their medicine. That has put drug-enforcement and public-health officials at odds with some doctors and patients legitimately prescribed the pills. Several states now make doctors criminally liable and revoke their licenses for writing prescriptions for painkillers that lead to overdoses, prompting many to stop prescribing them at all. Other states have tightened regulation of pain clinics, forcing so-called pill mills to close but leaving people in need of pain medications with fewer doctors (Martin, 9/26).

The Boston Globe: Mass. Insurance Plans Again Earn Top Ranking On Member Satisfaction, Improvement Process
Health insurance plans in Massachusetts again earned top rankings in an analysis of member satisfaction, clinical quality, and improvement processes by the National Committee of Quality Assurance. The results, released last week, put Harvard Pilgrim Health Plan in the no. 1 slot among private plans for the ninth consecutive years. Tufts Health Plan's products were ranked at no. 2 and no. 4 on the list (Conaboy, 9/26).

The Associated Press/Washington Post: Md. Health Reform Panel To Vote On State's Benchmark Health Benefit Plan
A Maryland panel working on implementing federal health care reform is planning to take a vote on the state's benchmark health benefit plan. The Maryland Health Care Reform Coordinating Council is scheduled to meet Thursday in Annapolis (9/27).

Modern Healthcare: Calif. Looks To Speed Health Data Exchange
A new program in California will use health information exchange technology to facilitate the flow of data between health care providers. The California Health eQuality, or CHeQ, program, will be led by Dr. Kenneth Kizer, director of the UC Davis Health System's Institute for Population Health Improvement (Robeznieks, 9/26).

Kansas Health Institute News: Waiting-List Investigation 'Not Formal,' Says KDADS Official
Kansas Department for Aging and Disability Service Secretary Shawn Sullivan today said federal officials are not actively investigating complaints that years-long waiting lists for community-based services for the physically and mentally disabled constitute violations of the Americans with Disabilities Act. "There is no formal investigation into Olmstead," Sullivan said, adding that he was uncomfortable saying much more. Sullivan was testifying before a meeting of the Joint Committee on Home and Community Based Services Oversight (Ranney, 9/26).

The Lund Report: Coordinated Care Organizations Could Advance Public Health Priorities
The new coordinated care organizations provide enormous opportunities to further the state’s public health agenda, but the new organizations are more likely to be successful in counties with strong existing public health departments, the state's top public health officer told The Lund Report. Oregon Public Health Director Dr. Mel Kohn said that it's too early to say if public health considerations are playing a key role in the new organizations, but he singled out Lane County as very forward thinking, in part due to the strong leadership shown by the county's public health officer, Pat Luedtke (Widman, 9/26).

The Miami Herald: Pediatricians: Florida State Officials Refuse To Meet To Talk About Implementing Obamacare
With the clock ticking on Florida's ability to control how it applies the federal Patient Protection and Affordable Care Act, pediatricians say they've been trying to meet with the agency that oversees the state's Medicaid program --- to no avail. The Agency for Health Care Administration last month declined a request from the Florida Pediatric Society to discuss how the state will implement those aspects of the federal health-care overhaul that relate to children. "Whatever program is ultimately designed, there are risks where children could fall through the cracks in a system that's really oriented to adults," said former state lawmaker Sam Bell, a lobbyist for the pediatricians' group (Menzel, 9/27).

California Healthline: Is Quality Key To Cutting Long-Term Cost?
National health care reform presents an opportunity to improve the way California delivers and measures the quality of long-term care and save money along the way, according to organizers of a long-term care conference last week in Sacramento. The long-term care population -- often elders with multiple chronic conditions, multiple providers and sometimes dozens of medications -- is an expensive one to treat. According to Lisa Shugarman, director of policy at the SCAN Foundation, which sponsored the conference, national reform gives California a chance to change the way it handles long-term issues (Gorn, 9/27).

California Healthline: FTC, Calif. AG Put Pressure on M&A – And Confuse Providers
The [FTC] has deepened its pressure on hospital deal-making -- scrutinizing dozens of mergers, filing motions to block several acquisitions and even examining whether hospitals' purchases of physician groups may be anti-competitive. And federal regulators' efforts are trickling down to the state level. As reported in California Healthline last week, Golden State's attorney general has launched her own study of whether hospital-physician consolidation is leading to higher health care costs. Industry leaders say that the regulators' timing couldn't be worse, or more confusing (Diamond, 9/26).

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Weekend Reading

Longer Looks: Brains Are Saved As High School Football Season Begins

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

ABC News: 'Waiting Room': Hundreds A Day Seek Hospital Of 'Last Resort'
Eric Morgan, in his 20s and planning to get married, arrives at Highland Hospital's emergency room, shaken that he has been diagnosed with a testicular tumor that is likely cancer. Surgeons at a private hospital have turned him away for lack of insurance but tell him it's "urgent" he get care. ... A provocative new documentary, "The Waiting Room," is a snapshot of Highland Hospital in Oakland, Calif., one of the nation's busiest safety-net hospitals, which is stretched to the limit with 241 patients a day, mostly uninsured, who need medical care they can't afford. The film, directed by Peter Nicks and getting Oscar buzz, opens at the IFC Center in New York City on Wednesday, Sept. 26 (Susan Donaldson James, 9/25).

The New York Times: Seeking Cures, Patients Enlist Mice As Stand-Ins
Megan Sykes, a medical researcher, has a mouse with a human immune system — her own. She calls it "Mini-Me." There are also mice containing a part of 9-year-old Michael Feeney — a cancerous tumor extracted from his lungs. Researchers have tested various drugs on the mice, hoping to find the treatment that would work best for Michael. In what could be the ultimate in personalized medicine, animals bearing your disease, or part of your anatomy, can serve as your personal guinea pig, so to speak. ...  "The mice allow you the opportunity to test drugs to find out which ones will be efficacious without exposing the patient to toxicity," said Colin Collins, a professor at the University of British Columbia. ... while the models are mainly being used for research, companies are beginning to commercialize them for use in drug development and medical treatment as well (Andrew Pollack, 9/25).

Atlanta Journal-Constitution: A Push To Get More African-Americans Involved In Alzheimer's Research
In mid-August, Dr. Christa-Marie Singleton said a final goodbye to her father, a retired high school physics and chemistry teacher who in her estimation was a scientific genius. Fred H. Singleton Jr. died at age 81 of Alzheimer's disease, a form of dementia that strikes African-Americans twice as often as it does whites and often leaves their caregivers emotionally and financially drained. For those reasons alone, Singleton said her family made the decision to donate her father's brain to the Registry for Remembrance, an initiative started in 2009 by the Emory Alzheimer's Disease Research Center … 21.3 percent of African-Americans age 71 and older have Alzheimer's or other forms of dementia, according to the Alzheimer's Association. That compares to 11.2 percent of whites in the same age bracket (Gracie Bonds Staples, 9/18).

Reuters: High School Football Saving Brains As Game Goes On
In the small northeast Ohio town of Massillon, a few miles from the National Football Hall of Fame, some 20,000 fans pack into a high school stadium, drowning out the roar of a real tiger mascot on the sidelines. Football is akin to religion in Massillon and, like a religion, it can be resistant to change. ... Between 2009 and 2011, 33 states plus the District of Columbia passed laws aimed at preventing concussions in youth sports, and another 15 states have introduced legislation this year, according to the National Conference of State Legislatures. Only Montana and Arkansas have yet to act. Many were inspired by the case of Zackery Lystedt, who suffered a life-threatening brain injury and permanent disability when at age 13 in 2006 he was sent back into the second half of a game after suffering a concussion (Daniel Trotta and Jo Ingles, 9/20).

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Editorials and Opinions

Viewpoints: Obama, Romney Pitch Health Care Plans In NEJM

New England Journal Of Medicine: Securing the Future of American Health Care
Because of you, America is blessed with the world's most talented health care professionals, who do a heroic job serving and saving our citizens. But for years you have faced a health care system that was increasingly fractured. ... But after a century of trying, a broad coalition of doctors, nurses, hospitals, businesses, AARP, and patients helped me sign into law the Affordable Care Act. Supporters and detractors alike refer to the law as Obamacare. I don't mind, because I do care. And because of Obamacare we're moving forward toward a health care system that broadly provides health security (Barack Obama, 9/26).

New England Journal Of Medicine: Replacing Obamacare with Real Health Care Reform
President Obama's 2700-page federal takeover does not solve our problems. His $1 trillion in tax increases hits the middle class hard and drives medical innovation overseas. His $700 billion in Medicare cuts "will not be viable," according to the program's trustees, jeopardizing access to care for senior citizens and throwing millions of beneficiaries off the coverage they rely on. ... If elected President, I will repeal Obamacare and replace it -- not with another massive federal bill that purports to solve all our problems from Washington, but with common-sense, patient-centered reforms suited to the challenges we face (Mitt Romney, 9/26).

JAMA: Expanding Health Care Coverage As A Step Toward Cost Control
President Obama’s federal health reform through the Affordable Care Act (ACA) is designed to significantly expand health insurance coverage. When it was initially passed in March 2010, the Congressional Budget Office (CBO) estimated that 32 million uninsured Americans individuals would gain coverage as a result, half through private insurance and half through expansion of Medicaid. The Supreme Court decision on June 28, 2012, largely upheld the ACA but rendered the expansion of Medicaid less certain by removing financial penalties on states that choose not to participate (Dr. Andrew Bindman, 9/26).

Kaiser Health News: Analysis: Access To Health Care Beginning To Look Like Airline Travel
The old axis of access in U.S. health care -- insured or uninsured -- is being replaced by the kind of gradations and complexity in determining who-gets-what-when-for-what-price for which the airline industry has become famous (Michael Millenson, 9/26).

The New York Times: Opinionator: For Veterans, A Surge Of new Treatments For Trauma
Anyone who undergoes trauma can experience post-traumatic stress disorder -- victims of rape and other crimes, family violence, a car accident. It is epidemic, however, among soldiers, especially those who see combat. People with PTSD re-experience their trauma over and over, with nightmares or flashbacks. They are hyperaroused: the slam of a car door at home can suddenly send their minds back to Iraq. And they limit their lives by avoiding things that can bring on the anxiety -- driving, for instance, or being in a crowd (Tina Rosenberg, 9/26).

Modern Healthcare: HHS Aims To Assess Effort To End Health Disparities
HHS' Office of Minority Health is seeking to evaluate the success of the National Partnership for Action to End Health Disparities, which was launched in April 2011 to create a community-driven and sustained approach to combating health disparities, according to a filing in the Federal Register. The evaluation would consist of four parts, according to a request for permission from the Office of Management and Budget to collect the necessary data for the evaluation (Andis Robeznieks, 9/26).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
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.