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Senate Committee Advances Budget Resolution; Debate Remains Over Whether To Use Reconciliation To Fast Track Health Reform
Hoyer To Coordinate Committees on Health Care Legislation Process
Senate Measure Would Allow Generic Versions of Biotechnology Drugs After Five Years
Senate Panel Hears From Witnesses Detailing Insurer Practices That Limit Transparency of Payment Rates
Congressional Hearing Explores Stronger Regulations for Independent Institutional Review Boards Certifying Patient Clinical Trials
Kennedy, Hutchison Introduce Bill To Overhaul 1971 National Cancer Act
HHS Secretary-Nominee Sebelius' Confirmation Vote Could Be Conducted Before April Recess, Grassley Says
President Obama Discusses Health Reform During Internet Town Hall Meeting
Florida Senators Introduce Bill To Prevent Medicaid Fraud
Kaiser Daily Health Policy Report Examines State Budget Developments in Kansas, Tennessee
Iowa House Committee Cuts Provisions From Health Reform Bill
Kaiser Daily Health Policy Report Feature Highlights Recent Blog Entries
Recent Releases in Health Policy
Health Affairs Papers Examine California Health Reform Efforts
Capitol Hill Watch
Senate Committee Advances Budget Resolution; Debate Remains Over Whether To Use Reconciliation To Fast Track Health Reform
[Mar 27, 2009]
The Senate Budget Committee on Thursday voted 13-10 along party lines to approve a $3.5 trillion fiscal year 2010 budget resolution that does not include budget reconciliation instructions for comprehensive health care reform legislation, CQ Today reports (Clarke et al., CQ Today, 3/26). The House Budget Committee on Wednesday approved its version of the resolution, which totaled $3.45 trillion. The Senate measure provides for a deficit-neutral health care reserve fund.
The committee also approved an amendment, sponsored by Sen. Ben Cardin (D-Md.), that would assure Medicare reimbursements for outpatient treatment (Kivlan, CongressDaily, 3/26). In addition, the committee voted 13-10 to reject an amendment sponsored by committee ranking member Judd Gregg (R-N.H.) that would have required pay/go rules to apply to health care reform legislation (Sanchez, CongressDaily, 3/27). According to committee Chair Kent Conrad (D-N.D.), the Senate resolution would already subject such a bill to pay/go and require costs to be offset within 11 years. The committee also voted 12-11 to reject an amendment sponsored by Sen. Mike Enzi (R-Wyo.) that would have required hospitals and physicians groups to pay a 25% share of the cost of Medicare-funded projects to improve health information technology.
Both chambers are expected to consider the respective resolutions next week. Conrad on Thursday said the Senate will begin debate on its resolution on Thursday with a final vote expected on Thursday or Friday (CongressDaily, 3/27). According to the Washington Post, "Democrats expect the blueprints to easily win approval of the full House and Senate next week" (Montgomery, Washington Post, 3/27). Republican Alternative
House Republicans on Thursday released an 18-page outline of their FY 2010 budget proposal that includes providing tax incentives to help people purchase health coverage, CQ Today reports. According to the outline, the proposal would expand access to health care "through policies that will provide tax incentives for millions more working families and small-business owners to obtain access to coverage" (Krawzak, CQ Today, 3/26).
According to the Washington Times, "On issues such as health care, energy, the deficit and national debt, the Republican document was little more than a statement of broad principles" (Rowland, Washington Times, 3/27). The full alternative budget, including spending and revenue numbers, will be released next week, CQ Today reports (CQ Today, 3/26). Reconciliation
House and Senate Democrats on Thursday debated over whether to use budget reconciliation, which requires only 51 votes in the Senate to avoid the threat of a filibuster instead of the normal 60, to pass comprehensive health care reform legislation, Politico reports. Currently, the House's pending budget resolution includes health care reconciliation instructions while the Senate bill does not. Reconciliation could be included in the compromise bill.
House Speaker Nancy Pelosi (D-Calif.) said in her weekly press conference "I believe it's absolutely essential that we come out of this year with a substantial health care reform," adding, "I believe that is best served by having reconciliation in the package." Senate Finance Committee Chair Max Baucus (D-Mont.) on Thursday warned that using reconciliation would prompt a partisan battle that would undermine the policy and lead to a weaker legislation (Raju/Isenstadt, Politico, 3/26). "We'll get a much better chance at getting better, more meaningful health care reform," with bipartisan support, which is "better accomplished by not going to reconciliation," Baucus said (Lengell, Washington Times, 3/27). Baucus noted that "many, many Democrats in the Senate do not think it's a wise move." Sen. Ben Nelson (D-Neb.) said that he would not vote for the legislation if budget reconciliation is used.
A number of Senate moderates, including Sens. Judd Gregg (R-N.H.) and Susan Collins (R-Maine), have suggested that Pelosi is using the threat of reconciliation as a bargaining strategy (Politico, 3/26). Senate Minority Whip Jon Kyl (R-Ariz.) said that House leadership was using reconciliation to "sneak through" health reform, calling reconciliation, "a special rule that was never intended to create energy or health care policy for our country -- issues so significant that our regular order should prevail" (Washington Times, 3/27).
Meanwhile, Senate Majority Leader Harry Reid (D-Nev.) on Thursday said that he was not ruling out the possibility of using the budget reconciliation process to advance health care reform, CQ Today reports. Reid added that the decision on whether to use reconciliation, which is included in the House's version of the resolution, will be decided in conference committee. He said, "We're taking nothing off the table," adding, "We're going to work during the (April) recess ... to see what we're going to do about having a (budget resolution) conference report that is going to be passed over here and passed in the House" (CQ Today, 3/26). Editorial
For Obama's FY 2010 budget proposal "to work," he and Congress must "scale this vision back and accomplish some things, such as entitlement and health care reforms, that have proved politically impossible in the past," a Portland Press Herald editorial states. While Obama has said that he is "open to stripping some measures out" of his proposal, one "exception is Obama's commitment to health care reform," according to the Press Herald. The editorial continues, "Out-of-control health costs do create a brake on economic growth and a disadvantage for U.S. companies" and "burden Medicare and Medicaid ... straining the budget and adding to deficits."
While "[i]t may be impossible to complete health care reform in one year ... there is a unique opportunity that should not be missed to get started on a plan," according to the Press Herald (Portland Press Herald, 3/26). Opinion Piece
The 57% of U.S. residents who believe Obama is "doing too much" by attempting to address the economy, health care, education and energy do so based on a "flawed assumption -- that fixing the economy can be separated from health care, education and energy," syndicated columnist Froma Harrop writes in a Providence Journal opinion piece. She continues, "If Obama ever has to throw any of them off the agenda island, he must ensure that health care reform [remains] a survivor," as the "inability to afford needed medical treatment is among Americans' most primal economic fears."
Harrop writes, "In the bigger picture, soaring health care costs are busting federal and state budgets" and are putting "Americans at a comparative disadvantage to foreign companies whose governments curb medical spending." For the U.S. to close the health care gap, the government "can curtail unnecessarily expensive care," in part by funding comparative effectiveness research, she writes.
Harrop continues, "The challenge for reformers will be gaining the trust of Americans happy with their coverage" and that many U.S. residents "fear that a national plan would compromise the quality of care they've come to expect." She adds, "The time to establish their trust is right now, while the Obama administration is still young and enjoying much good-will."
Harrop writes, "In sum, the president's push for health care reform amid economic crisis is not a symptom of any attention-deficit disorder," adding, "It is making good use of political momentum while it lasts" (Harrop, Providence Journal, 3/26).
Hoyer To Coordinate Committees on Health Care Legislation Process
[Mar 27, 2009]
House Majority Leader Steny Hoyer (D-Md.) on Thursday announced that he will coordinate the efforts of the House Energy and Commerce Committee, the House Ways and Means Committee and the House Education and Labor Committee in drafting a comprehensive health reform bill, The Hill reports.
According to The Hill, Hoyer's actions indicate that House Democrats have "internalized one of the lessons learned" during the health overhaul effort under the administration of former President Clinton, "when committee and subcommittee chairman squabbled over jurisdiction." Hoyer said, "I intend to spend a lot of time working with the various committees who have already made a determination they're going to work together" adding that the role "is to coordinate rather than impose my view" (Young, The Hill, 3/26). Hoyer said, "I think you are going to find mandates [requiring U.S. residents to buy health insurance] will be part of the plan." He added that "a public option clearly is going to be necessary" (Smith, Reuters/Boston Globe, 3/26).
Hoyer said, "We are hopeful that health care is done in the House prior to the August break," adding that it is "not a deadline, but it's a target" (O'Connor, Politico, 3/26). He noted that budget reconciliation is a "fallback position," and not the "preferred option," which is building bipartisan support (Dennis, Roll Call, 3/26). Editorials
- Los Angeles Times: The announcement this week that most health insurers would halt basing premiums on a patient's medical history if all U.S. residents were required to retain coverage "removes one of the hurdles facing lawmakers as they struggle to overhaul the system" because health insurers were "[o]nce the main opponents of sweeping reforms," a Times editorial states. "The mandate sought by the insurers has its own set of problems," which indicate that policymakers "still have a long way to go in crafting a health care plan that can attract broad support," the editorial continues. The editorial concludes that "the industry's concessions have at least advanced the debate" (Los Angeles Times, 3/27).
- Wall Street Journal: The White House and Congress are now seeking to "inflict on the entire country" a plan similar to one put in place three years ago by former Massachusetts Gov. Mitt Romney (R), a Journal editorial states. The Journal continues that current Massachusetts Gov. Deval Patrick (D) and other Democrats are "starting to move down the path that government health plans always follow when spending collides with reality -- i.e., price controls," whose "inevitable results are coverage restrictions and waiting periods." The editorial continues, "Obama and Congressional Democrats are about to try their own Bay State bait and switch: First create vast new entitlements that can never be repealed, then later take the less popular step of rationing care when it's their last hope to save the federal fisc." The Journal concludes, "The real lesson of Massachusetts is that reform proponents won't tell Americans the truth about what 'universal' coverage really means: Runaway costs followed by price controls and bureaucratic rationing" (Wall Street Journal, 3/27).
Opinion
- Stuart Butler, Washington Times: "Rather than stack the deck with a public plan in a new health system, Congress could learn from the basic" Federal Employee Health Benefits plan, "with its selected private plans acting as safe-harbor options," Butler, vice president for domestic policy at the Heritage Foundation, writes in a Times opinion piece. "Today there is a refreshing desire to find common ground in the health care debate" but "the public plan proposal is fatally divisive" and "threatens to explode any potential right-left coalition because it would push the country decisively toward a government-run system," Butler continues. He concludes, "By looking first at its own health system, Congress can find a better way" (Butler, Washington Times, 3/26).
- David Grande, Philadelphia Inquirer: "[W]e shouldn't let the insurance companies' fears" -- that a public plan might be cheaper and more effective than their own -- "get in the way of health reform," Grande, a senior fellow at the University of Pennsylvania's Leonard Davis Institute of Health Economics, writes in an Inquirer opinion piece. He continues that "everyone knows" the U.S. health care system is "broken," adding that "competition and choice, including an affordable public insurance option, will go a long way toward fixing it." Grande concludes, "We can't let 'nameless, unreasoning, unjustified terror' get in our way" (Grande, Philadelphia Inquirer, 3/26).
Senate Measure Would Allow Generic Versions of Biotechnology Drugs After Five Years
[Mar 27, 2009]
Sens. Charles Schumer (D-N.Y.) and Susan Collins (R-Maine) on Thursday introduced legislation (S 726) that would allow FDA to approve generic versions of biotechnology drugs after a five-year period of brand-name patent exclusivity, the New York Times reports. President Obama has emphasized the need for generic competition in the biotech industry and has estimated that it could save $9.2 billion over 10 years, which could be used to finance his health care reform plan. A similar bill passed by the Senate Health, Education, Labor and Pensions Committee last year would have given biotech products 12 years of exclusivity, but it died without being voted on by the full Senate.
The bill would allow FDA to determine on a case-by-case basis whether generic biotech drugs require additional testing before they can be marketed. It also would grant an additional three years of exclusivity if modifications are made to a biotech product. A similar House bill (HR 1427) was introduced two weeks ago by House Energy and Commerce Committee Chair Henry Waxman (D-Calif.) (Harris, New York Times, 3/27).
Schumer said, "It's past time we created a way for generic versions of these expensive drugs to come to market," adding, "We have a bipartisan plan that we know consumers will support and we believe the president will, too" (Perrone, AP/Miami Herald, 3/26). AARP Vice President Nancy LeaMond said, "The crushing cost of biologic drugs is leaving far too many Americans without access to life-saving treatments for devastating illnesses like multiple sclerosis and cancer" (New York Times, 3/27).
The AP/Herald reports that Senate HELP Committee Chair Edward Kennedy (D-Mass.) is the lawmaker "best positioned to hammer out an agreement"' on exclusivity. A Kennedy aide on Thursday said the senator would not endorse the five-year window and instead would seek a 12-year exclusivity period (AP/Miami Herald, 3/26). Industry Reaction
Biotech firms have criticized the legislation, saying it could result in the sale of unsafe medicines, fewer cures for diseases and fewer jobs in the industry, the Times reports. Jeff Joseph, a spokesperson for the Biotechnology Industry Organization, said, "It's a shortcut that would jeopardize patient safety and undermine our ability to develop future cures and therapies." Genzyme CEO Henri Termeer said, "For a tiny little bit of savings, we are giving up the potential to come up with treatments for Parkinson's and Alzheimer's, and it's just not very sensible" (New York Times, 3/27).
Pharmaceutical Research and Manufacturers of America in a statement said, "Developing biologic cures is a complex and difficult undertaking," and such an exclusivity period would not allow firms to recoup the investments required to develop these products. It added, "Congress needs to approach any changes in this arena carefully" (AP/Miami Herald, 3/26).
Senate Panel Hears From Witnesses Detailing Insurer Practices That Limit Transparency of Payment Rates
[Mar 27, 2009]
Witnesses at a Senate Commerce, Science and Transportation Committee hearing on Thursday discussed the need for increased consumer protections that would limit the practice of insurers underpaying for out-of-network medical services, CQ HealthBeat reports.
Among the witnesses was Linda Lacewell, counsel for economic and social justice in the office of New York State Attorney General Andrew Cuomo (D), which has conducted investigations and settled resulting lawsuits against 11 insurers operating in the state that had been using a database known as Ingenix. The database, operated by UnitedHealth Group, is intended to calculate market rates for care provided by out-of-network doctors. However, Ingenix had been accepting claims information from insurers, which it uses to identify average out-of-network rates, without verifying or questioning the data, Lacewell said. The low payments rates calculated by Ingenix led to patients being charged for differences of as much as 28% between real market rates for payments and those generated by the database.
She said, "Ingenix is nothing more than a conduit for rigged information that is defrauding consumers of their right to fair reimbursements for their out-of-network health care costs." Insurers have said they would provide about $95 million for the creation of a new, independent database that will be available to insurers nationwide and could be operational within a year. Lacewell also noted other "deceptive industrywide practices" that are "staggering in scope and impact" (Adams, CQ HealthBeat, 3/26). Committee Chair Jay Rockefeller (D-W.Va.) said Cuomo's efforts should provide a national model for increasing the transparency of out-of-network payments.
American Medical Association President Nancy Nielson also testified before the panel. Nielsen said, "If you elect to go out of network, (patients) should know what the charges are, and they have the right to know what they are going to be reimbursed (by the insurance companies.) That's really the issue," adding, "Otherwise, it's price-fixing." She said her group's members have a "strong ethic against overcharging" for care and rebuffed insurers' argument that they intended to control costs for consumers. Sen. Olympia Snowe (R-Maine) said, "There is very little competition in the insurance market," adding that five of the nation's largest insurers comprise 75% of the market, while in some states, the top five make up almost 90% of the market. "This is deeply troubling ... leaving consumers with nowhere else to go," Snowe said (Goto, CongressDaily, 3/26).
Rockefeller said he favored including transparency requirements in health care overhaul legislation, but did not discuss a specific proposal. He said, "I want to make sure exactly what it is we need to do." Consumers Union Programs Director Chuck Bell also spoke at the hearing.
Insurance executives will appear before the panel on Tuesday (CQ HealthBeat, 3/26). The witnesses will include the CEOs of UnitedHealth and Ingenix (CongressDaily, 3/26).
Congressional Hearing Explores Stronger Regulations for Independent Institutional Review Boards Certifying Patient Clinical Trials
[Mar 27, 2009]
Independent institutional review boards, or IRBs, could be facing more stringent regulations following the release of a recent investigation that revealed flaws in the system, the Wall Street Journal reports. As a requirement for FDA approval, drug and medical device manufacturers must appoint IRBs to monitor the safety of clinical trials for their products (Mundy, Wall Street Journal, 3/26). IRBs traditionally have been housed at academic institutions, but IRBs unaffiliated with such institutions have played an increasingly large role in research, the AP/Minneapolis Star Tribune reports (Abrams, AP/Minneapolis Star Tribune, 3/26). A House Energy and Commerce Subcommittee on Oversight and Investigations hearing examined the issue on Thursday (Edney, CongressDaily, 3/26).
In an investigation of IRBs, the Government Accountability Office in 2008 contacted three separate IRBs in Arizona, Colorado and Illinois to oversee a study of Adhesiabloc, a fake surgical product developed by Device Med-Systems, a fictitious Virginia-based company made up by GAO investigators (Wall Street Journal, 3/26).
According to GAO officials who testified at the hearing, Coast Independent Review Board in Colorado Springs, Colo., was the only company that agreed to monitor the study (AP/Minneapolis Star Tribune, 3/26). Coast IRB learned that Adhesiabloc and Device Med-Systems were fake five months after the company approved a patient clinical trial for the product, the Journal reports (Wall Street Journal, 3/26). According to the New York Times, Coast IRB over a five-year period has reviewed 356 study proposals and rejected just one (Meier, New York Times, 3/27).
As part of the investigation, the Energy and Commerce Committee and GAO also successfully registered a fictitious IRB, which had a fake CEO named after a dog, with HHS. About 6,350 IRBs nationwide are registered with the department, according to the Journal (Wall Street Journal, 3/26).
Subcommittee Chair Bart Stupak (D-Mich.), Energy and Commerce Committee ranking minority member Joe Barton (R-Texas) and Subcommittee ranking member Greg Walden (R-Ore.) all agreed that regulatory standards for IRBs, especially for initial approval required to launch one, need to be strengthened (CongressDaily, 3/26). Testimony
In his presentation of the GAO report, GAO Forensic Audit and Special Investigations Unit Managing Director Gregory Kutz declined to say if he believed that Coast IRB's oversight failure was indicative of a larger problem. However, he noted, "It's hard to believe that anybody could be comfortable with the integrity of the current system" (CongressDaily, 3/26). The GAO report stated that the system "is vulnerable to unethical manipulation, particularly by companies or individuals who intend to abuse the system or to commit fraud" (AP/Minneapolis Star Tribune, 3/26).
Coast IRB CEO Dan Dueber during his testimony said, "The GAO perpetrated an extensive fraud against my company," adding, "You pulled the wool over our eyes -- congratulations" (Wall Street Journal, 3/26). In recent media releases Dueber accused the government of trying to embarrass IRBs. He said, "I cannot believe that my government did this to me and my company," adding, "It is unconscionable" (New York Times, 3/26). "We got hoodwinked," he said.
Stupak said, "You didn't get hoodwinked," adding, "You took the bait, hook, line and sinker" (AP/Minneapolis Star Tribune, 3/26). "Lives could have been lost as a result of your company's action and all you do is complain that you got caught," Stupak added (CongressDaily, 3/26).
Jerry Menikoff, director of the Office for Human Research Protections at HHS, told the panel that HHS' registration process does not mean the agency approves IRBs, adding, "Right now we think we have a well-functioning system," though there still is room for improvement (AP/Minneapolis Star Tribune, 3/26).
Kennedy, Hutchison Introduce Bill To Overhaul 1971 National Cancer Act
[Mar 27, 2009]
Sen. Kay Bailey Hutchison (R-Texas) and Senate Health, Education, Labor and Pensions Committee Chair Edward Kennedy (D-Mass.) on Thursday introduced a bill (S 717) that would overhaul the 1971 National Cancer Act, the Boston Herald reports (Boston Herald, 3/27). The bill would:
- Provide funding for cancer research on early detection and supply grants for screening and referrals for cancer treatment;
- Require some private insurers to provide coverage of routine cancer care for patients enrolled in clinical trials;
- Make law the current Medicare policy that reimburses patients for routine care while they are enrolled in clinical trials;
- Require states to pay for tobacco cessation medication and counseling to pregnant women who are Medicaid beneficiaries;
- Encourage the use of biomarker tests, which might provide early detection of cancer;
- Create a demonstration project to provide limited regional coverage for biomarker tests;
- Establish procedures for independent research entities to assess the efficacy and cost-effectiveness of biomarkers; and
- Direct NIH to devote more resources to childhood cancer.
Hutchison said, "We must bring renewed focus and vigor to this fight." Kennedy said, "Americans still live in fear that they or someone they love will be affected" by cancer, adding, "This bill will renew our efforts to make progress in the battle against cancer, and to give patients and their families a renewed sense of hope." Hutchison and Kennedy said they expect that the Senate will pass the measure this year ( CQ HealthBeat, 3/26). Opinion Piece
If the current trend of cancer diagnoses and deaths continues, one in every two men and one in every three women will be diagnosed with cancer during their lifetime and cancer will become the leading killer of U.S. residents, Hutchison and Kennedy write in a Houston Chronicle opinion piece. They continue, "The solution isn't easy, but there are steps we should take now if we hope to see the diagnosis rate decline substantially and the survival rate increase." They write, "To do so, we must identify and remove the numerous barriers that obstruct our progress in cancer research and treatment." Hutchison and Kennedy outline five steps that can be taken to help this effort. They are: diagnose cancer "at an initial, curable stage"; expand health coverage to ensure that all U.S. residents have access to routine screening; "adopt a more coordinated approach to cancer research"; improve cancer treatment for current patients; and "improve patient survivorship through comprehensive care planning services" (Hutchison/Kennedy, Houston Chronicle, 3/25).
Administration News
HHS Secretary-Nominee Sebelius' Confirmation Vote Could Be Conducted Before April Recess, Grassley Says
[Mar 27, 2009]
Kansas Gov. Kathleen Sebelius (D), President Obama's HHS Secretary-nominee, could receive confirmation approval from the Senate Finance Committee next week, committee ranking member Chuck Grassley (R-Iowa) said Wednesday, CQ HealthBeat reports (Adams, CQ HealthBeat, 3/25). Sebelius is scheduled to undergo a "courtesy hearing" before the Senate Health, Education, Labor and Pensions Committee on Tuesday (AP/Kansas City Star, 3/26). The Finance Committee, which ultimately votes on her nomination, will hear Sebelius testify on Thursday, Roll Call reports (Brady, Roll Call, 3/26).
Grassley said that Sebelius was expected to provide responses to several outstanding questions from committee members on Wednesday, which then would facilitate the committee's vote. Grassley said the questions are "not serious things." Democratic and Republican Senate aides late Wednesday confirmed that Sebelius had furnished the committee with her responses and they are being processed as quickly as possible, according to CQ HealthBeat. Grassley said, "We think that when we get answers to these questions, that'll close it up," adding, "It's possible she could be done before we go home for the next recess, and then you're assuming that she is not going to be held up on the floor of the Senate. But if everything goes forward ... we can move on it before we go home" for April recess (Adams, CQ HealthBeat, 3/25). Roll Call reports that "Sebelius' confirmation is expected to move smoothly through the Senate" (Roll Call, 3/26).
President Obama Discusses Health Reform During Internet Town Hall Meeting
[Mar 27, 2009]
President Obama on Thursday fielded questions from U.S. residents on a range of topics, including health care, at a town hall meeting that was broadcast on the Internet and cable news channels, Politico reports (Gerstein, Politico, 3/26). When asked why the U.S. could not implement a health care system similar to those of European countries, Obama said that the U.S. has a tradition of employer-based coverage that has met the needs of a lot of individuals for some time (AP/Kansas City Star [1], 3/26). He signaled that he opposes such a single-payer system because it would be too drastic a change from the current system, Politico reports. According to Obama, "It may not be the best system if we were designing it from scratch, but that's what everybody's accustomed to" (Politico, 3/26).
He said that he intends for Congress to find a system that works for the U.S. and that an overhaul needs to occur now rather than waiting for decades (AP/Kansas City Star [1], 3/26). He added, "I think we can accomplish [reform]. Whether we do it exactly the way European countries do it or Canada is a different question. There are a variety of ways to get to universal coverage" (Politico, 3/26). In addition, he said that Medicare and Medicaid are the leading causes of the nation's growing long term-deficit (AP/Kansas City Star [1], 3/26).
Obama also stressed the importance of nurses to the health care system and said they should have a key role in setting the nation's health policy. He also noted the shortage of nurses at a time when the country's unemployment rate is atypically high (AP/Kansas City Star [2], 3/26).
 A video of the town hall meeting is available online. A transcript is also available online.
Medicaid
Florida Senators Introduce Bill To Prevent Medicaid Fraud
[Mar 27, 2009]
Florida Senate Health Regulation Committee Chair Don Gaetz (R) and state Senate Health and Human Services Appropriations Committee Chair Durell Peaden (R) at a news conference on Wednesday "expressed confidence" that lawmakers will pass legislation (SB 1986) aiming to prevent and detect Medicaid fraud, the Tallahassee Democrat reports. Medicaid fraud has become a considerable issue in Southeast Florida, where home health care clinics open quickly and operate with little to no regulation or accountability, according to Gaetz and Peaden. Miami alone has twice as many home health providers than all of California, they noted.
The two lawmakers, who were joined at the conference by state Agency for Health Care Administration Secretary Holly Benson, said the measure would require that all home health services be deemed medically necessary by a physician who has no ties to the agency providing the services. The bill also would increase to 25% the share of recovered money that whistleblowers would be eligible to receive. Peaden said money recovered from fraud would be redirected by his panel "into health care for the truly needy."
The bill also would target companies' recruiting of patients and the practices of filing claims for non-existent patients and ordering unneeded devices and treatments. Gaetz said Florida would work with federal and local agencies to create a database that would prevent operators of fraudulent companies from re-incorporating new clinics or home services and allow regulators to prevent fraudulent companies from renewing their operating licenses. Peaden said a companion bill is being worked out in the state House (Cotterell, Tallahassee Democrat, 3/26).
State Watch
Kaiser Daily Health Policy Report Examines State Budget Developments in Kansas, Tennessee
[Mar 27, 2009]
Summaries of developments related to state budget plans in Kansas and Tennessee appear below.
- Kansas: The Kansas program that oversees coverage for child Medicaid and CHIP beneficiaries would receive $1.2 million to expand coverage under budget proposals approved by the state House and tentatively agreed to by the state Senate on Tuesday, Kansas Health Institute News reports (KHI News, 3/24). The $13.4 billion House plan includes about $13 million in spending that would allow the state to avoid creating waiting lists for the children's health care program, known as HealthWave, and other programs (Klepper, Kansas City Star, 3/24). The funding would allow HealthWave to expand eligibility to children in families with incomes up to 250% of the federal poverty level. The Kansas Health Policy Authority said about 4,500 additional children could be enrolled in the fiscal year that begins July 1, and that as many as 8,000 more could be enrolled by the end of FY 2011, which would cost the state $3.2 million. Kansas would pay 28% of HealthWave's costs this year with the federal government funding the remainder, and the state's share could be offset in FY 2010 and FY 2011 using money included in the federal economic stimulus package. State House and state Senate negotiators will meet this week to work out differences in the two chambers' plans (KHI News, 3/24).
- Tennessee: Tennessee Gov. Phil Bredesen (D) last week proposed a $29.3 billion FY 2010 budget plan that would tax health maintenance organizations to fund TennCare, the Tennessean reports. TennCare provides Medicaid coverage to some state beneficiaries through HMOs. The tax -- which would be between 2% and 5.5%, the most allowable under law -- would raise about $139 million annually for TennCare. The proposed budget would decrease overall state spending by 1.5%, compared with the current fiscal year, the Tennessean reports. Spending on TennCare would increase only as much as funds from the federal stimulus package allow (Sisk, Tennessean, 3/24).
Iowa House Committee Cuts Provisions From Health Reform Bill
[Mar 27, 2009]
The Iowa House Human Resources Committee on Wednesday rejected a plan that would have established a commission to help uninsured residents find affordable coverage, the Des Moines Register reports. The plan was part of a larger health reform bill (SF 389) that the state Senate approved last week. The House committee also voted to drop from the bill proposed limits on drug company gifts or payments to physicians. The bill still contains a provision that would expand health coverage to about 30,000 uninsured Iowa children (Leys, Des Moines Register, 3/26).
Blog Watch
Kaiser Daily Health Policy Report Feature Highlights Recent Blog Entries
[Mar 27, 2009]
"Blog Watch" offers readers a roundup of health policy-related blog posts
The American Prospect's Ezra Klein points to a report that Howard Dean might campaign for the inclusion of a public plan option in health reform legislation. Klein says, "Though I'm glad to see progressives fighting for it, it shouldn't become the be-all, end-all determinant of success."
Louise of Colorado Health Insurance Insider looks at a Colorado bill proposing to ban insurers from charging men and women of similar health status different premiums and says, "While I can see the point of the legislation in terms of fairness, it doesn't seem fair to penalize men by making them pay more for their health insurance even when as a group they seek medical care less often."
Trudy Lieberman of the Columbia Journalism Review's Campaign Desk looks at media coverage of an announcement that insurers would be willing to end the practice of charging different premiums based on individuals' health status and says that "there's more that reporters eager to explore the story should know." Insure Blog's Bob Vineyard says the "bad news is that EVERYONE pays a higher premium."
Hygeia of Disruptive Women in Health Care posts "10 Things You Need to Know About the Health Care Stimulus."
John Goodman of his eponymous blog links to a literature review where he and colleagues found "public policy articles in the leading health journals (especially the health policy journals) tend to cite poorly done studies over and over again."
Bob Laszewski of Health Care Policy and Market Place Review examines Obama's proposed funding for part of health reform legislation and says, "Since there aren't any extra dollars elsewhere in the budget, it's a good assumption any cuts to pay for health care reform are going to have to come from the health care budget itself." Laszewski estimates that an additional $1.2 trillion dollars in funding is necessary.
Avery Comarow of Newsweek's Comarow on Quality asks whether health information technology spending is worth the stimulus investment of $30 billion and considers some unknowns of health IT.
Anthony Wright on the New Republic's The Treatment continues the conversation about Massachusetts health reform as a model for national reform, drawing from his experience with health overhaul legislation in California. Wright says that "the nation's needs dictate a policy solution that is bigger and bolder, and just simply different."
Don McCanne of Physicians for a National Health Program says there is no longer a national debate about comprehensive health reform because it is now about adding "one more plan, a public plan, to our dysfunctional, fragmented, multi-payer system that costs so much and serves us so poorly."
Recent Releases in Health Policy
Health Affairs Papers Examine California Health Reform Efforts
[Mar 27, 2009]
"Affording Shared Responsibility For Universal Coverage: Insights From California," Health Affairs: In the paper, Rick Curtis, president of the Institute for Health Policy Solutions, and Ed Neuschler, a senior program officer at IHPS, examine California's recent experience in developing a universal health coverage plan with "shared responsibility" among individuals, employers and governments. The authors discuss the differences between California's and Massachusetts' approaches to providing affordable health coverage. In a second paper, titled "Designing Health Insurance Market Constructs For Shared Responsibility: Insights From California," Curtis and Neuschler discuss how California's reform plan tried to safeguard against "adverse selection," in which insurers select only relatively healthy members with low-risks, and the tendency of residents to purchase minimal insurance coverage when they are healthy and more comprehensive coverage after they become sick (Health Affairs release, 3/26).
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