Daily Health Policy Report

Friday, September 28, 2012

Last updated: Fri, Sep 28

KHN Original Reporting & Guest Opinion

Campaign 2012

Health Reform

Coverage & Access

Capitol Hill Watch

Health Care Fraud & Abuse

Health Information Technology

Health Care Marketplace

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Capsules: Study: States, Feds Recover Billions In Medicaid Drug Fraud Settlements; Not Your Typical Presidential Debate Forum For Obama, Romney

Now on Kaiser Health News' blog, Mary Agnes Carey reports on states and the federal government recovering funds from Medicaid drug fraud settlements: "Eager for revenues, states are settling more cases than ever — and at record amounts — with drug makers accused of defrauding Medicaid programs, according to a new analysis from the consumer group Public Citizen" (Carey, 9/27).

Also on the blog, Peggy Girshman writes about two essays currently appearing in the New England Journal of Medicine: "There's nothing unusual about the way The New England Journal of Medicine displays the 'Perspective' section this week: In dueling columns, under an original article on a 'novel androgen-receptor blocker' for prostate cancer. But the authors of two of the perspectives are far from typical: B. Obama and M. Romney" (Girshman, 9/27). Check out what else is on the blog.

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Political Cartoon: 'The Introduction'

Kaiser Health News provides a fresh take on health policy developments with "The Introduction" by Dave Coverly.

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

GOP LAWMAKER AND A MEDICARE ADVANTAGE CONSPIRACY 

Issa wants answers.
And he'll use a subpeona.
Who's got Advantage?
-Anonymous

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

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Campaign 2012

Obama, Romney Spar Over Medicare, Health Reform Policies

News outlets offer a variety of coverage on these issues - including how Medicare is playing in the polls and what motivates senior voters. And a new Families USA study offers a critical assessment of Mitt Romney's health policies.   

The Washington Post: Medicare Working To Boost Obama In Swing States, Poll Finds
Voters in three critical swing states broadly oppose the far-reaching changes to Medicare -associated with the Republican presidential ticket and, by big margins, prefer President Obama to handle the issue, according to new state polls by The Washington Post and the Kaiser Family Foundation. For seniors in Florida, Ohio and Virginia, Medicare rivals the economy as a top voting issue (Aizenman, Cohen and Craighill, 9/27).

The Associated Press/ABC News: Older Voters Look Beyond Medicare, Social Security
Who wins the trust of seniors … will be a deciding factor in the presidential election. That should be good news for Mitt Romney, because those 65 and older have backed the Republican candidate in both of the last two presidential elections. But President Barack Obama has been pounding Romney and his running mate, Rep. Paul Ryan, on their plan for Medicare. Those attacks are starting to bear fruit for Obama, who is gaining ground among seniors in two key battlegrounds: Florida and Ohio. Still, Romney has the edge nationally among seniors — in no small part thanks to seniors’ concerns about Obama's handling of the economy (Lederman, 9/27).

The New York Times: Obama Fills In Blanks Of Romney's Plans, And GOP Sees Falsehoods
The Obama campaign has run advertisements charging that Mitt Romney's Medicare plan "could raise seniors' costs up to $6,400 a year" ... The outdated charge that future Medicare beneficiaries could face $6,400 in higher costs comes from an analysis of an old proposal by Mr. Romney’s running mate, Representative Paul D. Ryan, that has since been revised (Cooper, 9/27).

Politico: What Obama Isn't Saying About Medicare
As Woodward explains in "The Price of Politics," Obama was willing to make significant changes to the cherished federal health care plan for seniors last year as part of a grand bargain with congressional Republicans. And 2011 was hardly the first time Obama considered confronting the costly and popular program; it's also highly likely it won’t be the last if he’s reelected (Martin, 9/27).

Los Angeles Times: Obama And Romney Campaigns Take Battle To Virginia
Both candidates are heavily targeting women in Virginia, particularly in the northern suburbs of Washington, where Romney campaigned Thursday. Democrats are accusing Republicans of waging a "war on women" by targeting reproductive rights. They point to a measure that failed in the Virginia Legislature this year that would have required trans-vaginal ultrasounds before a woman could have an abortion. … Outside groups are also weighing in, airing ads that feature Romney's vow this year to eliminate funding for Planned Parenthood (Mehta, Reston and Memoli, 9/27).

CQ HealthBeat: Families USA Report Says Americans Would Pay More, Be Less Likely To Have Coverage Under Romney
Tens of millions more people would be uninsured and Americans would pay thousands of dollars more each year for their coverage under Mitt Romney's health proposals than under President Obama's health care law, according to a report released Thursday by Families USA, the left-leaning group that strongly backs the overhaul. Entitled "ObamaCare versus RomneyCare versus RomneyCandidateCare," the report compares the health care law with the Massachusetts overhaul passed when Romney was the state's governor and to proposals he has laid out as the Republican candidate for president (Bunis, 9/27).

The Hill: Study: Families Would Pay More For Health Care Under Romney
Families would pay nearly twice as much for non-group health insurance under a President Romney than under President Obama, according to a new report from the liberal advocacy group Families USA. The study found that Mitt Romney's pledges to repeal the 2010 healthcare law, create a health insurance tax deduction and block-grant Medicaid would result in higher coverage costs and more uninsured Americans (Viebeck, 9/27).

Health News Florida: Economists Prefer Former Romney 
In Florida, the number of uninsured would grow by 500,000 by the end of Romney's first term, instead of dropping by 2.5 million if President Barack Obama is re-elected and the Affordable Care Act takes full effect, they said. The [Families USA] report was written by economists who helped design or implement the Massachusetts Health Insurance Law, signed by then-Gov. Romney in 2006 (Gentry, 9/27).

Also in the news -

Los Angeles Times: Paul Ryan Does Not Need To Be Unmuzzled, Paul Ryan Says
[T]he Wisconsin congressman pointed out that he has concentrated his efforts on interviews with regional reporters … But Ryan has not avoided places where he is likely to encounter hostile crowds. Last week, he gave a speech to the national AARP convention in New Orleans, where he was booed for advocating the repeal of the president's healthcare law and the restructuring of Medicare for future retirees (Abcarian, 9/27).

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Health Policies Bubble Up In House And Senate Races

The Associated Press reports on how the top of the ticket could affect some down-ballot races, and other news outlets report on how Medicare is playing in Virginia, Nevada and Wisconsin races.

The Associated Press: Coattails A Factor In Some Senate And House Races
[Romney's comment] that 47 percent of Americans think they are "victims" entitled to government help and that he doesn't worry about "those people," sent Republican Senate candidates scrambling. … There are, after all, a lot of Republicans in that 47 percent — seniors, for example, who depend on government programs like Medicare and Social Security after paying into them for decades. ... Democrats, meanwhile, are left to defend Obama on broader issues ... his health care overhaul that struck even some in his own party as a too-big government power grab (Jackson, 9/27).

The Washington Post: Kaine Ad Hits Allen On Medicare, Social Security
Timothy M. Kaine upped the ante Thursday in the battle over seniors in Virginia, launching a new ad hitting George Allen for his record on Social Security and Medicare. As Allen (R) and Kaine (D) duel for the seat of retiring Sen. James Webb (D), both former governors are eyeing older voters as a key constituency (Pershing, 9/27).

The Associated Press/U.S. News: Tight Nevada Senate Race Despite Ethics Issues
Rep. Shelley Berkley ended her speech at a recent gathering of union members and retirees here by bringing up a potentially risky subject — her husband, Dr. Larry Lehrner. Lehrner was supposed to be an albatross in the seven-term congresswoman’s attempt to replace Republican Dean Heller in the U.S. Senate, because his involvement in a kidney transplant program that Berkley pushed to save sparked a House Ethics Committee investigation of the congresswoman. But Berkley focused instead on health care, luck and love (Riccardi, 9/27).

The Hill: DSCC Hits Thompson On Medicare Lobbying Ties
A new ad from Senate Democrats' campaign arm hammers Tommy Thompson, the GOP candidate in Wisconsin, over Medicare. The new ad, which the Democratic Senatorial Campaign Committee released Thursday, criticizes Thompson for supporting GOP proposals to overhaul Medicare. It also casts him as a well-connected Washington insider disconnected from Wisconsin voters (Baker, 9/27).

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Health Reform

Republican Governors Push HHS For Health Law Implementation Details

Virginia Gov. Bob McDonnell, the chairman of the Republican Governors Association, demanded information from the Obama administration. Also HHS announced $224 million in health-exchange grants to five states. 

Politico Pro: RGA To HHS: Seriously, We Need Some Answers
The chairman of the Republican Governors Association sent yet another letter to the Obama administration on Thursday, demanding answers to detailed questions the states have about implementing of the federal health care law. And while he was at it, Virginia Gov. Bob McDonnell took the opportunity to hammer the law on its shortcomings. "While [we] believe the best option is to fully repeal and replace the PPACA, states continue to confront numerous deadlines and face major policy decisions in the wake of the Supreme Court decision," McDonnell wrote (Norman, 9/27).

Modern Healthcare: $224 Million In Exchange Grants Awarded
As a Nov. 16 deadline approaches for states to submit their health insurance exchange plans, HHS announced that the total number receiving implementation funds has reached 34. The latest round of about $224 million in so-called establishment grants went to Arkansas, Colorado, the District of Columbia, Kentucky, Massachusetts and Minnesota, according to the HHS tracking site (Daly, 9/27).

CQ HealthBeat: HHS Awards A Quarter-Billion Dollars More For Exchange Grants
Each of the entities except one — Arkansas — has notified HHS that they intend to operate their own exchange to offer coverage options to uninsured Americans and small businesses under the health care law. The awards bring to $2.2 billion the amount of money HHS has granted to states under the health care law for exchanges (Reichard, 9/27).

An example of local coverage of the grant awards -  

(St. Paul) Pioneer Press: Minnesota Gets $42.5M To Help Develop Health Insurance Exchanges 
With the new grant, the state has received a total of $71 million so far for its health exchange, which is intended to be a new marketplace for individuals and small business to buy coverage starting late next year. ... The process in Minnesota has proved contentious, with business groups criticizing the administration of Democratic Gov. Mark Dayton this summer for not releasing more details about the cost and governance of the marketplace (Snowbeck, 9/27).

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Coverage & Access

Employers Offer Buffet Of Health Care Coverage Choices -- But With Limits

Some companies are offering employees a set amount to spend during the next open enrollment period for health insurance and making the employees choose coverage themselves -- instead of offering one or two plans to them.

The Wall Street Journal: Some Firms' Workers Will Choose From Array Of Benefits
Is health insurance just the beginning? A handful of employers may go even farther than Sears Holdings Corp. and Darden Restaurants Inc., which plan to give workers a set sum of money next year to use in choosing among health plans (Mathews, 9/27).

Chicago Sun-Times: Sears To Overhaul Health Insurance Benefits
Sears Holdings Corp. and Aon P.L.C. are radically shifting the way their employees choose their health care coverage -- letting employees decide their level of coverage and how much of their employer’s contribution to spend. Employees will go to an online Web portal to make their selections, starting Jan. 1. More companies are expected to adopt the model as health care reform gets under way and as they face higher health care coverage expenses as long as they run their own medical insurance programs (Guy and Knowles, 9/27).

In the meantime, a report says employer coverage is declining as government health coverage increases --

CQ HealthBeat: For U.S. Workers, Employment-Based Health Insurance Continues To Decline, Report Says
When it comes to health insurance coverage for those under 65 in the United States, research released on Thursday shows the trends are like two trains rushing past one another: Coverage in public programs is growing, while traditional private insurance through employers is contracting. That will continue, predicts a report written by Paul Fronstin, of the nonpartisan Employee Benefits Research Institute (EBRI), who dove deep into recently released census numbers. "Until the economy gains enough strength to have a substantial impact on the labor market, a rebound in employment-based coverage is unlikely," the report said (Norman, 9/27).

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Capitol Hill Watch

Issa Threatens To Subpoena HHS Medicare Advantage Documents

Rep. Darrell Issa, R-Calif., chairman of the House Oversight and Government Reform Committee, alleges that the Department of Health and Human Services is using an $8 billion Medicare bonus payment demonstration project to mask the health law's cuts to Medicare Advantage plans in advance of the election.  

The Hill: Rep. Issa Threatens To Subpoena HHS Over Medicare Bonuses
Rep. Darrell Issa (R-Calif.) said Thursday that he's willing to subpoena documents from the Health and Human Services Department (HHS), alleging a conspiracy to hide the impact of President Obama's health care law. Issa, as chairman of the House Oversight and Government Reform Committee, is investigating an $8 billion demonstration project in which Medicare pays bonuses to certain private Medicare Advantage plans based on quality. The congressman has suggested that HHS is using the bonus payments to mask the health care law's cuts to Medicare Advantage plans ahead of the election. Issa and Rep. James Lankford (R-Okla.) requested documents about the bonus payments in August. They said Thursday that they haven't gotten a response and said they "will consider the use of compulsory process" if HHS doesn't turn over the documents by Oct. 5 (Baker, 9/27).

CQ HealthBeat: Issa Threatens To Force CMS To Turn Over Medicare Advantage Documents
The chairman of the House Oversight and Government Reform Committee is threatening to force Centers for Medicare and Medicaid Services officials to turn over documents relating to their authority to issue bonus payments to Medicare Advantage plans under a CMS demonstration program. Rep. Darrell Issa, R-Calif., said in a letter to Health and Human Services Secretary Kathleen Sebelius that he wants the documents by Oct. 5. "If the Department continues to ignore the Committee's request, we will consider the use of a compulsory process," Issa wrote (9/27).

In other Capitol Hill news --

The Hill: Dems Warn Implanted Medical Devices Prone To Hacking
Democratic lawmakers are sounding the alarm on a new hacking threat -- to your pacemaker. In a statement Thursday, three House Democrats called on the Food and Drug Administration (FDA) to scrutinize implantable medical devices more carefully. The lawmakers cited government research showing devices such as cardiac defibrillators and insulin pumps can be vulnerable to tampering because of their wireless capabilities. "Even the human body is vulnerable to attack from computer hackers," said Rep. Anna Eshoo (D-Calif.). "The demonstrated security risks require a renewed emphasis by the FDA and manufacturers to identify, evaluate and plug the potentially rare but serious security holes that exist in these devices" (Viebeck, 9/27).

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Health Care Fraud & Abuse

Report: States, Feds Collected $30B In Fraud Settlements In 20 Years

A new report finds federal and state authorities have collected more than $30 billion from drug company fraud settlements in the last 20 years.

The Associated Press/Washington Post: Public Citizen Advocacy Group Tracks Rise In Pharmaceutical Settlements With State Governments
Federal and state prosecutors have collected more than $30 billion from drug companies for alleged fraud and illegal marketing over the last 20 years, according to a new report by consumer advocacy group Public Citizen (9/27).

Kaiser Health News: Capsules: Study: States, Feds Recover Billions In Medicaid Drug Fraud Settlements
Now on Kaiser Health News' blog, Mary Agnes Carey reports on states and the federal government recovering funds from Medicaid drug fraud settlements: "Eager for revenues, states are settling more cases than ever -- and at record amounts -- with drug makers accused of defrauding Medicaid programs, according to a new analysis from the consumer group Public Citizen" (Carey, 9/27).

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Health Information Technology

Patients, Physicians Face Health IT Divide

Medpage Today: Patients, MDs Divided By IT Chasm
When it comes to consumer use of health information technology, demand seems to be outstripping supply and it's creating a great healthcare chasm. Results of a new survey show that, while three out of four patients are eager to access health records online through EMRs and more than 60 percent want to communicate with their doctor via email or other Internet technology, only 40 percent of physicians said they had the capability to interact with patients through email or give them access to their online health records. This despite the fact that 70 percent of surveyed physicians said they had basic electronic medical records capability within their organizations (Parmar, 9/27).

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Health Care Marketplace

Counterfeit Drugs For Sale: FDA Issues Warning Regarding Online Pharmacies

The Associated Press: FDA Warning Public Of Risks Of Online Pharmacies
The Food and Drug Administration is warning U.S. consumers that the vast majority of Internet pharmacies are fraudulent and likely are selling counterfeit drugs that could harm them. The agency on Friday launched a national campaign, called BeSafeRx, to alert the public to the danger, amid evidence that more people are shopping for their medicine online, looking for savings and convenience (Johnson, 9/28).

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State Watch

Maryland Sets Insurance Marketplace Plan Benchmark; Other State Health Law News

In Maryland, a board sets a state employee health plan as the benchmark for others in the marketplace. In the meantime, New Mexico examines what it has to gain from a Medicaid expansion, and Virginians give a thumbs down to the health law.

The Associated Press/Washington Post: Md. Health Reform Panel Approves State Health Plan As Benchmark In Health Care Reform
A Maryland panel working on implementing federal health care reform voted Thursday to use the state employee health plan as a benchmark for other plans that will be available to small businesses and individuals for two years, starting in 2014 (9/27).

The Associated Press: Report: NM Gains Initially With Medicaid Expansion
New Mexico's costs of expanding Medicaid under the federal health care overhaul will be offset initially by additional tax revenues because of increased spending on medical services, according to a legislative committee analysis released Thursday. The Legislative Finance Committee released its staff projections as lawmakers began to consider what will be one of the biggest issues confronting Gov. Susana Martinez and the Legislature next year (Massey, 9/27).

Politico Pro: Poll: Virginia Opposes Health Care Law
Virginia voters are poised to deliver a photo-finish on Election Day, but they're decisive about one thing: the Affordable Care Act is a bad deal for the Old Dominion. A Suffolk University poll released Thursday shows that 51 percent of Virginians call the law "generally bad," while just 38 percent believe it's "generally good." Eleven percent remain undecided. By the same token, 50 percent of Virginians oppose a law signed by Republican Gov. Bob McDonnell requiring women seeking an abortion to undergo an ultrasound. Just 33 percent support that measure and 15 percent were undecided, according to the poll (Cheney, 9/27).

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Liberal Christians Protest Hobby Lobby Lawsuit Over Contraception Coverage Mandate

A group of liberal Christian activists are protesting Hobby Lobby's decision to sue the Obama administration over its contraception coverage mandate in the health law.

The Associated Press/Washington Post: Liberal Oklahoma Pastors Protest Hobby Lobby Suit Challenging Coverage Of Morning-After Pill
Christian activists attempted Thursday to deliver a petition to Hobby Lobby criticizing its challenge to a portion of the new federal health care law, but guards at the company's headquarters turned them away. … Schmitz said more than 80,000 people had signed copies of a petition circulated nationwide by Faithful America, an online Christian group, and UltraViolet, which promotes women's rights. Schmitz said he intends to mail the petition to the company. Lawyers representing Hobby Lobby this month sued the federal government claiming it should not be forced to provide workers with health insurance that covers the morning-after and week-after pills (9/27).

Elsewhere, fallout from Texas' budget cuts for family funding services has forced several clinics to close --

Houston Chronicle: Family Planning Clinics Hard Hit By Budget Cuts
About 15 percent of Houston-area clinics that received state funding for family planning services closed their doors because of budget cuts last fiscal year, and another 30 percent have reduced service hours, according to a study published this week. Following a political firestorm in the 2011 legislative session, state family planning funds were cut from $111.5 million to $37.9 million for the biennium, cutting services to as many as 180,000 women in Texas a year, according to state health department officials. The number of clinics funded by the Texas Department of State Health Services has dropped from 300 to 136 since the Legislature slashed funding, state officials said (Radcliffe, 9/27).

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State Highlights: Free Calif. Health Care Clinic A Big Draw

A selection of health policy stories from California and North Carolina.

Los Angeles Times: Free Health Care Clinic At LA Sports Arena Draws 4,800
Many of the 4,800 people seeking care at the annual massive free clinic this weekend will become eligible for health insurance in 2014 when the national law takes effect. Organizers said raising awareness about the health care changes is crucial (Gorman, 9/27).

San Francisco Chronicle: Law May Encourage Mammogram Alternatives
A new law that will require California doctors to tell women if they have highly dense breast tissue is expected to increase demand for alternatives to mammography to screen patients for breast cancer. The potential market is huge: About 40 percent of women have tissue that is dense enough that cancer may be missed through conventional mammography. The law says that beginning in April, patients must be told a "range of screening options" are available, but it does not specify those methods or require health insurers to cover them (Colliver, 9/27).

California Healthline: New Attention To End-Of-Life Care
Partnership HealthPlan of California, a health insurer covering roughly 200,000 Medi-Cal beneficiaries in six Northern California counties, has decided to offer the optional benefit of palliative care to its members. … The state doesn't currently offer the enhanced benefit, in part due to budget concerns, but [Partnership HealthPlan’s medical director] said the cost of palliative care is offset by less necessity to provide other types of care that may not actually benefit the patient or the family, he said (Gorn, 9/28).

North Carolina Health News: Public Health Workers Express Frustration With New Law
With the passage of a new law this past year, county public health agencies could look very different -- and some public health professionals are making their unhappiness about it known. At a meeting of the N.C. Public Health Association last week at the New Bern Convention Center, state Sen. Fletcher Hartsell (R-Cabarrus) was forced to defend a bill he shepherded through during this year’s legislative session that allows county boards of commissioners to disband local boards of health and assume their powers. The new law also allows for county commissioners to consolidate public health and social services agencies, and creates incentives for smaller counties to join together to provide services across county lines (Hoban, 9/27).

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Health Policy Research

Research Roundup: Saving Money With Hospital Observation Units

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

Health Affairs: Making Greater Use Of Dedicated Hospital Observation Units For Many Short-Stay Patients Could Save $3.1 Billion A Year
The authors write: "Using observation units in hospitals to provide care to certain patients can be more efficient than admitting them to the hospital and can result in shorter lengths-of-stay and lower costs. However, such units are present in only about one-third of US hospitals. ... Using a systematic literature review, national survey data, and a simulation model, we estimated that if hospitals without observation units had them in place, the average cost savings per patient would be $1,572, annual hospital savings would be $4.6 million, and national cost savings would be $3.1 billion" (Baugh et al., 9/26). 

Journal of the American Medical Association: Total Knee Arthoplasty Volume, Utilization, and Outcomes Among Medicare Beneficiaries, 1991-2010
"Between 1991 and 2010 annual primary [total knee replacement] volume increased 161.5% from 93,230 to 243,802," according to this study which specifically evaluated trends in the Medicare population. The cost of the procedure is approximately $15,000 and succeeds in “safely reducing pain and improving functional status”. Researchers found that increases in "TKA volume have been driven by both increases in the number of Medicare enrollees and in per capita utilization. We also observed decreases in hospital [length of stay] that were accompanied by increases in hospital readmission rates" (Cram et al., 9/26).

Archives of Internal Medicine: Geographic Variation in Outpatient Antibiotic Prescribing Among Older Adults
By examining Medicare Part D records, researchers found a significant relationship between location and antibiotic use. The rate of patients using antibiotics per quarter was highest in the South, 21.4 percent, compared to 19.2 percent in the Midwest and 17.4 in the West. The drugs had been primarily prescribed for bacterial pneumonia, acute nasopharyngitis, and other acute respiratory tract infections. The Northeast, which had the highest prevalence of bacterial pneumonia, had the lowest rates antibiotic use. The authors concluded: "Areas with high rates of antibiotic use may benefit from targeted programs to reduce unnecessary prescription. Quality improvement programs can set attainable targets using the low-prescribing areas as a reference" (Zhang, Steinman and Kaplan, 9/24).

The Milbank Quarterly: Fundamental Causes of Colorectal Cancer Mortality: The Implications of Informational Diffusion
Colorectal cancer deaths, which will claim an estimated 52,857 lives this year, can be prevented through removing polyps, radiation and chemotherapy if identified through timely screening. But researchers found that there are socioeconomic disparities in mortality rates. By examining death and "diffusion of information" data in counties from 1968 to 2008, they found that southern states tend to have the worst outcome, because of their lower socioeconomic demographics. The authors noted that the "impact of socioeconomic status (SES) on colorectal cancer mortality is substantial and its protective impact increases over time." The disparity is attributed to access to information that authors said could be mitigated through “aggressive colorectal cancer screenings, better treatment protocols” and publicizing screening recommendations (Wang et al., 9/2012). 

The Commonwealth Fund: As CareFirst Tweaks The Medical Home, Doctors Flock and Costs Dip
CareFirst BlueCross BlueShield launched one of the country’s largest medical home programs in January 2011. Now they are targeting small clinics, especially in rural areas, to join a network. Doctors in the CareFirst model are grouped together, sometimes across several practices, to communicate about screening, access and effectiveness and controling costs. If one medical home is prescribing more tests than another, they are "educated about community norms." CareFirst has recorded a 1.5 percent drop in medical expenses, or a $40 million savings, of which roughly $22 to $23 million is to be paid back to providers (Schilling, 9/25).

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Editorials and Opinions

Viewpoints: Obamacare A 'Big Plus'?; What Happened To GOP Anger Over Health Law?

The New York Times: Not The Election They Were Expecting
How did that happen? Partly it's because this has become such an ideological election — much more so than 2008. … And let me add a speculation: I suspect that in the end Obamacare is turning out to be a big plus, even though it has always had ambivalent polling. The fact is that Obama can point to a big achievement that will survive if he is reelected, perish if he isn’t; health insurance for 50 million or so Americans (30 million from the ACA, another 20 who would lose coverage if Romney/Ryan Medicaid cuts happen) is enough to cure people of the notion that it doesn’t matter who wins (Paul Krugman, 9/27).

The Washington Post: Where Is Republican Anger Over Obama's Health-Care Law?
What ever happened to the political power of Republican anger over President Obama's health-care reform? GOP candidates used anxiety over changes to the nation’s health-care system — which they derisively called "Obamacare" — to win big in the 2010 midterm elections. Earlier this year, it was conventional wisdom that Obama could not withstand the political rage against health-care reform in a general election (Juan Williams, 9/27).

USA Today: Contraception Is An Economic Issue
Republican state legislatures passed a record-setting number of abortions restrictions in 2011 and 2012, and Congress spent inordinate amounts of time passing go-nowhere abortion bans and contraception restrictions, and trying to gut Planned Parenthood's budget, even threatening twice to shut down the government rather than continue providing contraception subsidies. But should anyone try to make political hay out of these attacks on women, they are immediately accused of trying to distract the voters from the real issues. For women, having their full rights isn't a distraction, it is a real issue (Amanda Marcotte, 9/27).

The Wall Street Journal: ObamaCare's Tax Raid On Medical Devices
The Supreme Court decision in June upholding the Affordable Care Act leaves in place a tax on medical devices that threatens thousands of American jobs and our global competitiveness. It will also stifle critical medical innovation in the industry that gave us defibrillators, pacemakers, artificial joints, stents, chemotherapy delivery systems and almost every device we depend on to save lives (Evan Bayh, 9/27).

The New York Times: A Duty Of Health Care Workers
Health care workers should know better than anyone that it is important to get vaccinated against the flu virus to protect their own health and prevent the possibility of infecting patients. There were some encouraging signs in an analysis issued Thursday by the Centers for Disease Control and Prevention that doctors and nurses are beginning to get the message. But other health care workers — a broad group that includes clinical personnel like nurse practitioners and physician assistants and various nonprofessional aides and assistants — show remarkable indifference to performing what ought to be considered their civic duty (9/27). 

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
Lisa Gillespie
Shefali Luthra

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