CMS Urged To Use Comparative Effectiveness Research To Determine Reimbursements.

CQ HealthBeat (10/6, Adams, subscription required) reports, "Medicare officials should base medical service payments on whether research shows that what they are paying for is an effective treatment for a particular ailment," Steven Pearson and Peter Bach wrote in Health Affairs. They "also suggest that Medicare could hold off for up to three years on reviewing any new service that is added to the benefit package for which there is no evidence that it is as good as current treatment." The authors wrote, "Just mentioning Medicare and comparative effectiveness research in the same sentence is enough to raise temperatures in Washington health policy circles," and noted that some consider the research a threat to patient choice, while "those who see it as a remedy for the nation's health care ills do not want a politically explosive link to Medicare."

        The Wall Street Journal (10/5, Hobson, subscription required) "Health Blog" reported that at present, Medicare covers any procedures that are considered "reasonable and necessary," without considering how they compare to other treatments. But, Pearson and Bach are suggesting a radical change to that policy. The authors pointed out, however, that "a shift in Medicare's fundamental approach to coverage and reimbursement decisions would require new legislative authorities, and would be highly contested by those with a vested interest in existing reimbursement systems."

        Writing for Kaiser Health News (10/5), Merrill Goozner, of the Fiscal Times, explained that the authors "say the time has come to rip the nameplate off new and higher-priced medical technologies that do not deliver better outcomes than older methods of care." Pearson said that their proposal is "a way for CMS to combine clinical effectiveness with cost effectiveness in a way that can work in the US." Notably, "the government poured $1.1 billion in stimulus funds into making comparisons between competing medical technologies. The Patient Protection and Affordable Care Act earmarked another half billion dollars annually for the effort over the next decade, and last week the Government Accountability Office appointed a 17-member board to oversee the research. The question now is how to make use of this information once it begins getting published in medical journals and government websites."

HHS Grants Waivers To One Million For Health Insurance Minimums.

Bloomberg News (10/6, Armstrong) reports, "Almost a million workers, a third of them members of New York's teachers union, were left out of a consumer protection in US health law meant to cap insurance costs after the government exempted their employers." Now HHS has granted waivers "so workers with minimum plans would keep coverage without major premium increases. The agency provided the list of exemptions." The largest "single waiver, for 351,000 people, was for the United Federation of Teachers Welfare Fund, a New York union providing coverage for city teachers." The plans "will be exempt from rules put in place this year intended to keep people from having to pay for all their care once they reach a preset coverage cap." The "waiver program is intended to provide continuous coverage until 2014, when new government-organized marketplaces will offer insurance subsidized by tax credits."

About 3.5 Million Californians Would Be Eligible For Health Reform Tax Credits.

The Los Angeles Times (10/6, Helfand) reports, "An estimated 3.5 million Californians would be eligible for federal tax credits to slash the cost of their health coverage when they begin buying policies through a new statewide insurance marketplace in 2014, a study released Tuesday found. Under the nation's healthcare overhaul, tax credits will be available to low- and middle-income people once insurers begin selling policies through state-based insurance exchanges like the one being set up in California." The data from Families USA show that "in California, working families stand to gain most from the tax credits," and the "researchers said that 94% of those who qualify would come from families that have at least one employed person."

Legal Challenges Of Healthcare Law Progressing.

USA Today /Kaiser Health News (10/6, Schmitt) reports, "A number of interest groups, state officials and ordinary citizens are seeking to have the health care law struck down in federal court, and action is heating up." For instance, "this week or next, a federal judge in Pensacola, Fla., is expected to issue a preliminary ruling on perhaps the most prominent lawsuit," which was "brought by the governors or attorneys general of 20 states," and "seeks to have the act declared unconstitutional." Meanwhile, "any day now, a judge in Michigan could act on a request by the Thomas More Law Center to issue an injunction blocking the government from taking any further action implementing the law." Even though "many scholars...argue that the law is on firm legal footing," ultimately the US Supreme Court may have to decide the outcome of the suits.

Article Weighs Potential Fate Of Individual Mandate In Healthcare Reform.

CQ HealthBeat (10/6, Reichard , subscription required) reports, "Time may be running out to sell the individual mandate -- never mind the fact that it doesn't take effect until 2014." The "fate of the mandate depends on who wins the race to put the most compelling image of the law in people's heads." Under the circumstances, when "seven times as many ad dollars are spent attacking the law as promoting it, negative images are building up in people's heads." Still, some experts argue that that "it wouldn't make sense right now for the White House to mount a big public education campaign specifically addressing the mandate." They "believe proponents of the law must do more to prepare the public for the eventual requirement," writes CQ.

Pataki Advocacy Group's TV Ads Target Democratic Supporters Of Health Reform.

The AP (10/6, Ramer) reports, "An advocacy group led by former New York Gov. George Pataki has begun running television ads in New Hampshire and New York attacking Democratic supporters of the new health care reform law." Those targeted include Rep. Carol Shea-Porter, "who is being challenged by Republican Frank Guinta" as "she seeks a third term in New Hampshire's 1st District." The "television ads claim the health care law Shea-Porter" voted for will "raise costs and take away an individual's right to choose his or her doctor." A spokeswoman for Shea-Porter said, "This is a classic example of an extreme outside organization trying to mislead New Hampshire voters."

Grassley Slams Dems On Impact Of Healthcare Law On Medicare Advantage Plans.

The Hill (10/6, Lillis) reports in its Healthwatch blog, "Sen. Charles Grassley (R-Iowa) on Tuesday slammed the Democrats over reports that Medicare Advantage (MA) plans are disappearing in Iowa," saying, "Seniors face fewer choices, fewer benefits and higher costs because of the partisan health care overhaul and previous changes to the Medicare program under Democratic leadership." Notably, the comment follows a report "indicating that roughly 21,000 seniors enrolled in MA will have to find new coverage next year because companies are discontinuing some of their plans." Meanwhile, HHS Secretary Kathleen Sebelius "this week defended the Democrats' policies," stating, "Any company that pulled out of the Medicare Advantage plan this year, my guess is that they had business plans to do that whether or not the president signed this law in March of 2010."

Columnist Says Real Problem In Implementing Health Reform Is The "Status Quo."

David Leonhardt writes in the Economic Scene on front page of the New York Times (10/6, B1) Business Day section that recently, the Wall Street Journal reported that McDonald's may stop providing health plans, which cap annual benefits at a paltry $2,000, to thousands of hourly workers if the company is compelled to adhere to new requirements in the healthcare law. Leonhardt says, "This episode was only the latest disruption that the health law seems to be causing" in the insurance industry, and "with each new disruption come loud claims -- some from insurance executives -- that the health overhaul is damaging American health care." He argues, "On the surface, these claims can sound credible," yet "when you dig a little deeper, you often discover the same lesson that the McDonald's case provides: the real problem was the status quo."

Public Option May Have Been Discarded Earlier Than Believed.

Writing for The Atlantic (10/6), Chris Good says, "Liberal senators and congressmen fought for the public option's inclusion in health care reform almost until the very end of the legislative process, adding signatures to a letter backing it in the weeks before the bill passed," yet "former Senate Majority Leader Tom Daschle, in an interview with ThinkProgress' Igor Volsky, seems to suggest that the public option was understood to be out of the picture much earlier." During the interview, Daschle stated, "I don't think it was taken off the table completely. It was taken off the table as a result of the understanding that people had with the hospital association, with the insurance (AHIP), and others. .. Lessons learned in past efforts is that without the stakeholders' active support rather than active opposition, it's almost impossible to get this job done."

Berwick, Other Officials Address Health Industry Concerns About ACOs.

Kaiser Health News (10/6, Galewitz) reports, "Federal Trade Commission Chairman Jon Leibowitz told a meeting of 300 health industry representatives Tuesday his agency would explore an 'expedited review process' for hospitals and doctors looking to determine if new partnerships they form to provide care would violate antitrust laws." Notably, "he was one of several top federal officials trying to address the concerns of hospitals and doctors" regarding "a key part of the new health law" which "encourages the development of 'accountable care organizations.'" CMS administrator Donald Berwick "promised the industry that the government agencies that oversee doctors and hospitals will work together to give unified guidance on how to form ACOs," saying "We will need a regulatory framework that nurtures cooperation, while it guards against the lingering threat of inappropriate practices." Meanwhile, HHS IG Daniel Levinson "promised 'fresh thinking' on how his agency enforces anti-fraud laws."

Candidates Have Differing Perceptions On What California Insurance Commissioner Position Entails.

The AP (10/6, Dillon), noting that the winner of California's insurance commissioner race will be "tasked with navigating the changes brought by federal health care reform on the state level," points out that the leading candidates have "wide ideological differences" on the post. According to Republican Mike Villines of Clovis, the job is about "protecting the consumer -- people should get what they pay for -- but we can also use it help the economy." In contrast, Democrat Dave Jones of Sacramento talks about "regulating the insurance market. ... 'Californians have been whacked with double-digit rate hikes as long as we can remember,'" he said. Jones cites his "record of sponsoring consumer-friendly legislation, including a ban on price discrimination against women in the personal insurance market. Villines voted against the bill because he said it would increase costs."

Insurers Notify 21,000 Iowans Of Intent To Drop Medicare Advantage Plans.

The AP (10/5) reported an Iowa "state agency says insurers have notified about 21,000 Iowans that they will no longer provide the Medicare Advantage plans in 2011." Under Medicare Advantage, "Iowa seniors get their health care insurance through a private company, not the government Medicare program." Those "who received notice can join a new Medicare Advantage plan or return to Medicare."

UPMC Expands Medicaid Product Into Central And Eastern Pennsylvania.

The Pittsburgh Business Times (10/5) reported, "UPMC Health Plan's Medical Assistance product -- UPMC for You -- and its Children's Health Insurance Program product -- UPMC for Kids -- are expanding into central and eastern Pennsylvania." Over "the past decade, membership in UPMC for You has increased more than 150 percent, making it the fastest growing Medical Assistance plan and the biggest of the three Medicaid managed care organization in western Pennsylvania."

Commentary: IPAB, NICE Stifle Innovation.

Tomas J. Philipson, chairman of the Manhattan Institute's Project FDA, writes in a Forbes (10/6) commentary, "Critics of the Obama administration's recent health care reform rightly focus on the $1 trillion cost of the legislation and fears that it will add to already unsustainable federal health care commitments for Medicare and Medicaid. Defenders point to the legislation's cost-saving provisions, like the Independent Payment Advisory Board (IPAB) which, starting in 2014, will recommend automatic Medicare spending cuts if costs grow faster than an average of the consumer price index and health care inflation." But, Philipson says that IPAB was modeled on the UK's National Institute for Health and Clinical Excellence (NICE), whose "decisions are routinely mired in controversy." He adds, "When governments effectively impose lower prices on drugs under the guise of 'cost-effectiveness' standards (through institutions like NICE or IPAB), they weaken patent protection and reduce incentives for innovation."

 

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