Winner Take All on Super Tuesday?

With a fifth of all delegates in play, the Super Tuesday primaries and caucuses promise to be a game changer for the men aiming to run against President Obama in November.

Republican voters in 10 states – Alaska, Georgia, Idaho, Massachusetts, North Dakota, Ohio, Oklahoma, Tennessee, Vermont, and Virginia – will head to the polls March 6, when a total of 437 delegates will be up for grabs. To win his party’s nomination, a candidate needs 1,144 delegates.

While health care has not been a central issue so far in the primaries and caucuses, it’s a pressing problem in almost every state. And the Affordable Care Act is not far off the campaign trail, with each of the Republican candidates vowing to repeal or replace the law. Attorneys general in many of the Super Tuesday states are parties to the Supreme Court litigation seeking to overturn the ACA.

The ACA appears to resonate deeply with voters, too, according to a USA Today/Gallup poll conducted Feb. 20-21. The random sample telephone survey of 1,040 adults found an even split on whether they favored (47%) or opposed (44%) a repeal of the ACA by a Republican president. Republicans, however, were overwhelmingly in favor of repeal (87%); Democrats overwhelmingly opposed it (77%). The researchers found that Republicans seemed to be more committed to their positions, with 56% strongly favoring repeal, while Democrats expressed fainter views, with only 39% strongly opposing repeal.

Even with a certain measure of voter animosity on health reform, another Gallup poll taken in late February showed that voters wouldn’t necessarily hold a candidate’s support of health reform against him. Only 21% of voters said they would be less likely to vote for former Massachusetts Gov. Mitt Romney in the general election because of his role in establishing that state’s health program.

Georgia (76 delegates)

At press time, Newt Gingrich was leading in this conservative-leaning state – he represented a Georgia district in Congress for 2 decades. Rick Santorum, former senator from Pennsylvania, was in second and Mr. Romney was polling third.

Medicare and Medicaid are important issues in Georgia. About 11% of the state’s 9.8 million residents are over age 65, compared with 13% of the nation. Fifteen percent of the state’s population is enrolled in Medicaid.

The state is currently looking at redesigning aspects of its Medicaid program, according to Donald Palmisano Jr., executive director of the Medical Association of Georgia (MAG). Pregnant women and children on Medicaid are currently served under a managed care framework; that may be extended to the disabled on the Medicaid rolls, Mr. Palmisano said.

Physician autonomy and medical liability reform are key issues for Georgia physicians, he said, adding that they are not happy with the lack of a permanent replacement for Medicare’s Sustainable Growth Rate formula.

Georgia doctors are closely watching ACA implementation. The medical association opposed the ACA, primarily because it considered the legislation to be financially unsustainable, Mr. Palmisano said. That is especially true when another 600,000 Georgia residents likely will be eligible for Medicaid when the ACA is fully in force, he said.

The MAG does not plan to endorse a GOP candidate in the primary. "We’re focused on state issues right now," Mr. Palmisano said, adding that a general election endorsement is not likely either.

Massachusetts (41 delegates)

Mr. Romney is currently projected to win the state. Thanks to the state’s 2006 health reform law, officially known as "An Act Providing Access to Affordable, Quality, Accountable Health Care," 98% of state residents have health care coverage, according to a report from the Massachusetts Health Connector, which administers the plan. The group also says that the plan has not been a budget-buster and that premium rates have been below those seen in the commercial market. There has been an increase in employers offering coverage, also, according to the Connector’s 2011 progress report.

But Dr. Richard Dupee, the governor of the Massachusetts chapter of the American College of Physicians, said the plan has not been entirely successful. While the vast majority of state residents now have health insurance coverage, the program "is too expensive," said Dr. Dupee, chief of the geriatrics service at Tufts Medical Center, Boston.

The state also continues to suffer from a shortage of primary care physicians, he said. That means patients are seeking care in the emergency department, which is more expensive than primary care. As a result, the state is looking into charging higher copays for nonemergent conditions that are treated in the ED, said Dr. Dupee.

Further, the state plan pays at rates lower than Medicaid and commercial plans, he said. Gov. Deval Patrick (D) is considering moving the entire state health plan to a global payment model. The ACP Massachusetts chapter has put together a wish list of things to be resolved before fee-for-service is left behind, Dr. Dupee said.

There is also concern that when fully implemented, the ACA will not be financially sustainable, Dr. Dupee said, adding that while the Massachusetts ACP supports broad coverage, the group also believes that the ACA needs tweaking. And, while the GOP candidates have said they will take a more aggressive approach to the law, their replacement plans have not really been made clear, said Dr. Dupee.

Ohio (66 delegates)

In terms of population, Ohio is the seventh-largest state in the country, with 11.5 million residents. Ohio is facing a skyrocketing Medicaid budget, expected to hit $6.3 billion this year. Fourteen percent of Ohio’s residents are over age 65.

At press time, Mr. Santorum was leading Mr. Romney in the state. Voters there made their displeasure with the ACA known in November, when they approved an amendment that would bar the individual mandate from being enforced in Ohio.

According to Tim Maglione, senior director of government relations at the Ohio State Medical Association, physicians in the state are concerned about how some of the ACA’s payment reforms will affect them. Care coordination will likely be a big aspect of the law – something that the state is already looking at for its Medicaid enrollees, Mr. Maglione said.

Medical liability reform law, which includes a cap on damages, has reduced malpractice premiums by 26% over the last 5 years, Mr. Maglione said. Physicians are not necessarily looking for new reforms, but to protect that law "and make sure the legislature doesn’t decide to repeal it or the court doesn’t jump in and try to overturn it," he said.

Virginia (49 delegates)

Mr. Gingrich and Mr. Santorum failed to collect enough signatures in time to get their names on the ballot, making Virginia’s primary election a two-way race between Mr. Romney and Rep. Ron Paul (R-Tex.). At press time, Mr. Romney had a substantial lead in the polls.

Virginia Attorney General Ken Cuccinelli (R) led the charge against the Affordable Care Act, filing suit in part to defend a Virginia statute signed into law by Gov. Bob McDonnell (R) in March 2010. That law makes it illegal to require a state resident to buy health insurance.

Dr. William Fox, an internist in Charlottesville, noted there is concern among Virginia physicians that the state will not be able to handle the Medicaid expansion envisioned by the ACA.

Talk by some GOP candidates of turning the program entirely over to states through a block grant is also a concern, according to Dr. Fox, chairman of the health and public policy committee of the Virginia chapter of the American College of Physicians, who added that it could lead to a reduction in coverage.

Medicare is also on the radar screen in the state. As is true nationally, Virginia physicians are backing a permanent replacement for the Medicare SGR. They also would like to see "the development of innovative health care delivery systems that reward quality and recognize care coordination rather than rewarding volume, maintaining funding for the training of primary care physicians and other specialists whose supply is not keeping up with demand, and improving the medical liability system," said Dr. Fox.

Virginia has been in the national news recently as a result of several controversial bills – one would have said that life begins at the moment of conception. The General Assembly has now postponed action on that bill, H.B. 1, until next year. Another bill would have required women to have a transvaginal ultrasound before getting an abortion.

The Medical Society of Virginia opposed the proposal because it would have dictated the practice of medicine, Dr. Fox said. The bill was amended to require an external ultrasound. That passed the state Senate and now goes back to the House, where it is expected to be approved.

With a fifth of all delegates in play, the Super Tuesday primaries and caucuses promise to be a game changer for the men aiming to run against President Obama in November.

Republican voters in 10 states – Alaska, Georgia, Idaho, Massachusetts, North Dakota, Ohio, Oklahoma, Tennessee, Vermont, and Virginia – will head to the polls March 6, when a total of 437 delegates will be up for grabs. To win his party’s nomination, a candidate needs 1,144 delegates.

While health care has not been a central issue so far in the primaries and caucuses, it’s a pressing problem in almost every state. And the Affordable Care Act is not far off the campaign trail, with each of the Republican candidates vowing to repeal or replace the law. Attorneys general in many of the Super Tuesday states are parties to the Supreme Court litigation seeking to overturn the ACA.

The ACA appears to resonate deeply with voters, too, according to a USA Today/Gallup poll conducted Feb. 20-21. The random sample telephone survey of 1,040 adults found an even split on whether they favored (47%) or opposed (44%) a repeal of the ACA by a Republican president. Republicans, however, were overwhelmingly in favor of repeal (87%); Democrats overwhelmingly opposed it (77%). The researchers found that Republicans seemed to be more committed to their positions, with 56% strongly favoring repeal, while Democrats expressed fainter views, with only 39% strongly opposing repeal.

Even with a certain measure of voter animosity on health reform, another Gallup poll taken in late February showed that voters wouldn’t necessarily hold a candidate’s support of health reform against him. Only 21% of voters said they would be less likely to vote for former Massachusetts Gov. Mitt Romney in the general election because of his role in establishing that state’s health program.

Georgia (76 delegates)

At press time, Newt Gingrich was leading in this conservative-leaning state – he represented a Georgia district in Congress for 2 decades. Rick Santorum, former senator from Pennsylvania, was in second and Mr. Romney was polling third.

Medicare and Medicaid are important issues in Georgia. About 11% of the state’s 9.8 million residents are over age 65, compared with 13% of the nation. Fifteen percent of the state’s population is enrolled in Medicaid.

The state is currently looking at redesigning aspects of its Medicaid program, according to Donald Palmisano Jr., executive director of the Medical Association of Georgia (MAG). Pregnant women and children on Medicaid are currently served under a managed care framework; that may be extended to the disabled on the Medicaid rolls, Mr. Palmisano said.

Physician autonomy and medical liability reform are key issues for Georgia physicians, he said, adding that they are not happy with the lack of a permanent replacement for Medicare’s Sustainable Growth Rate formula.

Georgia doctors are closely watching ACA implementation. The medical association opposed the ACA, primarily because it considered the legislation to be financially unsustainable, Mr. Palmisano said. That is especially true when another 600,000 Georgia residents likely will be eligible for Medicaid when the ACA is fully in force, he said.

The MAG does not plan to endorse a GOP candidate in the primary. "We’re focused on state issues right now," Mr. Palmisano said, adding that a general election endorsement is not likely either.

Massachusetts (41 delegates)

Mr. Romney is currently projected to win the state. Thanks to the state’s 2006 health reform law, officially known as "An Act Providing Access to Affordable, Quality, Accountable Health Care," 98% of state residents have health care coverage, according to a report from the Massachusetts Health Connector, which administers the plan. The group also says that the plan has not been a budget-buster and that premium rates have been below those seen in the commercial market. There has been an increase in employers offering coverage, also, according to the Connector’s 2011 progress report.

But Dr. Richard Dupee, the governor of the Massachusetts chapter of the American College of Physicians, said the plan has not been entirely successful. While the vast majority of state residents now have health insurance coverage, the program "is too expensive," said Dr. Dupee, chief of the geriatrics service at Tufts Medical Center, Boston.

The state also continues to suffer from a shortage of primary care physicians, he said. That means patients are seeking care in the emergency department, which is more expensive than primary care. As a result, the state is looking into charging higher copays for nonemergent conditions that are treated in the ED, said Dr. Dupee.

Further, the state plan pays at rates lower than Medicaid and commercial plans, he said. Gov. Deval Patrick (D) is considering moving the entire state health plan to a global payment model. The ACP Massachusetts chapter has put together a wish list of things to be resolved before fee-for-service is left behind, Dr. Dupee said.

There is also concern that when fully implemented, the ACA will not be financially sustainable, Dr. Dupee said, adding that while the Massachusetts ACP supports broad coverage, the group also believes that the ACA needs tweaking. And, while the GOP candidates have said they will take a more aggressive approach to the law, their replacement plans have not really been made clear, said Dr. Dupee.

Ohio (66 delegates)

In terms of population, Ohio is the seventh-largest state in the country, with 11.5 million residents. Ohio is facing a skyrocketing Medicaid budget, expected to hit $6.3 billion this year. Fourteen percent of Ohio’s residents are over age 65.

At press time, Mr. Santorum was leading Mr. Romney in the state. Voters there made their displeasure with the ACA known in November, when they approved an amendment that would bar the individual mandate from being enforced in Ohio.

According to Tim Maglione, senior director of government relations at the Ohio State Medical Association, physicians in the state are concerned about how some of the ACA’s payment reforms will affect them. Care coordination will likely be a big aspect of the law – something that the state is already looking at for its Medicaid enrollees, Mr. Maglione said.

Medical liability reform law, which includes a cap on damages, has reduced malpractice premiums by 26% over the last 5 years, Mr. Maglione said. Physicians are not necessarily looking for new reforms, but to protect that law "and make sure the legislature doesn’t decide to repeal it or the court doesn’t jump in and try to overturn it," he said.

Virginia (49 delegates)

Mr. Gingrich and Mr. Santorum failed to collect enough signatures in time to get their names on the ballot, making Virginia’s primary election a two-way race between Mr. Romney and Rep. Ron Paul (R-Tex.). At press time, Mr. Romney had a substantial lead in the polls.

Virginia Attorney General Ken Cuccinelli (R) led the charge against the Affordable Care Act, filing suit in part to defend a Virginia statute signed into law by Gov. Bob McDonnell (R) in March 2010. That law makes it illegal to require a state resident to buy health insurance.

Dr. William Fox, an internist in Charlottesville, noted there is concern among Virginia physicians that the state will not be able to handle the Medicaid expansion envisioned by the ACA.

Talk by some GOP candidates of turning the program entirely over to states through a block grant is also a concern, according to Dr. Fox, chairman of the health and public policy committee of the Virginia chapter of the American College of Physicians, who added that it could lead to a reduction in coverage.

Medicare is also on the radar screen in the state. As is true nationally, Virginia physicians are backing a permanent replacement for the Medicare SGR. They also would like to see "the development of innovative health care delivery systems that reward quality and recognize care coordination rather than rewarding volume, maintaining funding for the training of primary care physicians and other specialists whose supply is not keeping up with demand, and improving the medical liability system," said Dr. Fox.

Virginia has been in the national news recently as a result of several controversial bills – one would have said that life begins at the moment of conception. The General Assembly has now postponed action on that bill, H.B. 1, until next year. Another bill would have required women to have a transvaginal ultrasound before getting an abortion.

The Medical Society of Virginia opposed the proposal because it would have dictated the practice of medicine, Dr. Fox said. The bill was amended to require an external ultrasound. That passed the state Senate and now goes back to the House, where it is expected to be approved.

With a fifth of all delegates in play, the Super Tuesday primaries and caucuses promise to be a game changer for the men aiming to run against President Obama in November.

Republican voters in 10 states – Alaska, Georgia, Idaho, Massachusetts, North Dakota, Ohio, Oklahoma, Tennessee, Vermont, and Virginia – will head to the polls March 6, when a total of 437 delegates will be up for grabs. To win his party’s nomination, a candidate needs 1,144 delegates.

While health care has not been a central issue so far in the primaries and caucuses, it’s a pressing problem in almost every state. And the Affordable Care Act is not far off the campaign trail, with each of the Republican candidates vowing to repeal or replace the law. Attorneys general in many of the Super Tuesday states are parties to the Supreme Court litigation seeking to overturn the ACA.

The ACA appears to resonate deeply with voters, too, according to a USA Today/Gallup poll conducted Feb. 20-21. The random sample telephone survey of 1,040 adults found an even split on whether they favored (47%) or opposed (44%) a repeal of the ACA by a Republican president. Republicans, however, were overwhelmingly in favor of repeal (87%); Democrats overwhelmingly opposed it (77%). The researchers found that Republicans seemed to be more committed to their positions, with 56% strongly favoring repeal, while Democrats expressed fainter views, with only 39% strongly opposing repeal.

Even with a certain measure of voter animosity on health reform, another Gallup poll taken in late February showed that voters wouldn’t necessarily hold a candidate’s support of health reform against him. Only 21% of voters said they would be less likely to vote for former Massachusetts Gov. Mitt Romney in the general election because of his role in establishing that state’s health program.

Georgia (76 delegates)

At press time, Newt Gingrich was leading in this conservative-leaning state – he represented a Georgia district in Congress for 2 decades. Rick Santorum, former senator from Pennsylvania, was in second and Mr. Romney was polling third.

Medicare and Medicaid are important issues in Georgia. About 11% of the state’s 9.8 million residents are over age 65, compared with 13% of the nation. Fifteen percent of the state’s population is enrolled in Medicaid.

The state is currently looking at redesigning aspects of its Medicaid program, according to Donald Palmisano Jr., executive director of the Medical Association of Georgia (MAG). Pregnant women and children on Medicaid are currently served under a managed care framework; that may be extended to the disabled on the Medicaid rolls, Mr. Palmisano said.

Physician autonomy and medical liability reform are key issues for Georgia physicians, he said, adding that they are not happy with the lack of a permanent replacement for Medicare’s Sustainable Growth Rate formula.

Georgia doctors are closely watching ACA implementation. The medical association opposed the ACA, primarily because it considered the legislation to be financially unsustainable, Mr. Palmisano said. That is especially true when another 600,000 Georgia residents likely will be eligible for Medicaid when the ACA is fully in force, he said.

The MAG does not plan to endorse a GOP candidate in the primary. "We’re focused on state issues right now," Mr. Palmisano said, adding that a general election endorsement is not likely either.

Massachusetts (41 delegates)

Mr. Romney is currently projected to win the state. Thanks to the state’s 2006 health reform law, officially known as "An Act Providing Access to Affordable, Quality, Accountable Health Care," 98% of state residents have health care coverage, according to a report from the Massachusetts Health Connector, which administers the plan. The group also says that the plan has not been a budget-buster and that premium rates have been below those seen in the commercial market. There has been an increase in employers offering coverage, also, according to the Connector’s 2011 progress report.

But Dr. Richard Dupee, the governor of the Massachusetts chapter of the American College of Physicians, said the plan has not been entirely successful. While the vast majority of state residents now have health insurance coverage, the program "is too expensive," said Dr. Dupee, chief of the geriatrics service at Tufts Medical Center, Boston.

The state also continues to suffer from a shortage of primary care physicians, he said. That means patients are seeking care in the emergency department, which is more expensive than primary care. As a result, the state is looking into charging higher copays for nonemergent conditions that are treated in the ED, said Dr. Dupee.

Further, the state plan pays at rates lower than Medicaid and commercial plans, he said. Gov. Deval Patrick (D) is considering moving the entire state health plan to a global payment model. The ACP Massachusetts chapter has put together a wish list of things to be resolved before fee-for-service is left behind, Dr. Dupee said.

There is also concern that when fully implemented, the ACA will not be financially sustainable, Dr. Dupee said, adding that while the Massachusetts ACP supports broad coverage, the group also believes that the ACA needs tweaking. And, while the GOP candidates have said they will take a more aggressive approach to the law, their replacement plans have not really been made clear, said Dr. Dupee.

Ohio (66 delegates)

In terms of population, Ohio is the seventh-largest state in the country, with 11.5 million residents. Ohio is facing a skyrocketing Medicaid budget, expected to hit $6.3 billion this year. Fourteen percent of Ohio’s residents are over age 65.

At press time, Mr. Santorum was leading Mr. Romney in the state. Voters there made their displeasure with the ACA known in November, when they approved an amendment that would bar the individual mandate from being enforced in Ohio.

According to Tim Maglione, senior director of government relations at the Ohio State Medical Association, physicians in the state are concerned about how some of the ACA’s payment reforms will affect them. Care coordination will likely be a big aspect of the law – something that the state is already looking at for its Medicaid enrollees, Mr. Maglione said.

Medical liability reform law, which includes a cap on damages, has reduced malpractice premiums by 26% over the last 5 years, Mr. Maglione said. Physicians are not necessarily looking for new reforms, but to protect that law "and make sure the legislature doesn’t decide to repeal it or the court doesn’t jump in and try to overturn it," he said.

Virginia (49 delegates)

Mr. Gingrich and Mr. Santorum failed to collect enough signatures in time to get their names on the ballot, making Virginia’s primary election a two-way race between Mr. Romney and Rep. Ron Paul (R-Tex.). At press time, Mr. Romney had a substantial lead in the polls.

Virginia Attorney General Ken Cuccinelli (R) led the charge against the Affordable Care Act, filing suit in part to defend a Virginia statute signed into law by Gov. Bob McDonnell (R) in March 2010. That law makes it illegal to require a state resident to buy health insurance.

Dr. William Fox, an internist in Charlottesville, noted there is concern among Virginia physicians that the state will not be able to handle the Medicaid expansion envisioned by the ACA.

Talk by some GOP candidates of turning the program entirely over to states through a block grant is also a concern, according to Dr. Fox, chairman of the health and public policy committee of the Virginia chapter of the American College of Physicians, who added that it could lead to a reduction in coverage.

Medicare is also on the radar screen in the state. As is true nationally, Virginia physicians are backing a permanent replacement for the Medicare SGR. They also would like to see "the development of innovative health care delivery systems that reward quality and recognize care coordination rather than rewarding volume, maintaining funding for the training of primary care physicians and other specialists whose supply is not keeping up with demand, and improving the medical liability system," said Dr. Fox.

Virginia has been in the national news recently as a result of several controversial bills – one would have said that life begins at the moment of conception. The General Assembly has now postponed action on that bill, H.B. 1, until next year. Another bill would have required women to have a transvaginal ultrasound before getting an abortion.

The Medical Society of Virginia opposed the proposal because it would have dictated the practice of medicine, Dr. Fox said. The bill was amended to require an external ultrasound. That passed the state Senate and now goes back to the House, where it is expected to be approved.