March 23: Health Care Reform News
House delivers health care bill
Even as the raucous argument continued after the House's passage of a health-care reform bill late Sunday, many Americans on Monday were considering how the sweeping legislation will affect their own health care…
Mayo Clinic took a highly visible role during the health-care reform debate, pushing for provisions ensuring that providers are paid for value, rather than number of procedures. "We're certainly happy that many of the provisions of the legislation were aligned with our principles," said Randy Schubring, a spokesman for the Mayo Clinic Health Policy Center, this morning. Those values include paying for value and "coverage for all," he said.
Post-Bulletin, by Jeff Hansel, 3/22/10
Minnesota sizes up payoffs from the health care bill
Kelly Grivauval met the news of the passage of the federal health care bill with joy. As the CEO of a small Pine City company that recycles fluorescent lights, Grivauval has seen her insurance costs go up 16 percent in 2009 and 19 percent this year, despite having employees who are all under 35 and appear to be in good health…
Payment reform was a high priority for leaders of the Mayo Clinic, along with expanding insurance access. While the reform legislation isn't as aggressive in addressing the payment system, Mayo's Jeff Korsmo called it "a good first step."
Pioneer Press, by Jeremy Olson, 3/22/10
Additional HCR coverage:
Chicago Sun-Times, San Francisco Chronicle, WEAU TV, AP, KTTC, BusinessWeek, MinnPost
Top stories
Obama to Sign Health Bill, Celebrate With Allies
AP/The Washington Post
March 23, 2010
President Barack Obama's yearlong health care overhaul drama featured dozens of speeches, contentious debate and a televised summit with lawmakers before a divided Congress passed the bill. An elaborate White House signing ceremony kicks off the next act: selling the sweeping changes to a skeptical public.
Republicans Mobilize Health Care Opposition
The Los Angeles Times
March 23, 2010
Conservatives plan procedural maneuvers to drag out the debate before the final bill is cleared in the Senate. A dozen states pledge to fight the bill in court. Related: Health Measure’s Opponents Plan Legal Challenges, The New York Times
Health-Care Vote Looms as Big Issue for November Elections
The Washington Post
March 23, 2010
President Obama scheduled a Tuesday White House signing ceremony for landmark health-care legislation that passed the House on Sunday, as Democrats and Republicans began shifting their focus to November elections that seem certain to become a referendum on the most significant social legislation enacted in half a century.
Health Reform Hits the Spin Cycle
Politico
March 23, 2010
On Monday, with the House votes behind them and the protesters gone from the Capitol grounds, both sides in the bitter health reform debate proclaimed victory — with the confidence of actors who still have a final climactic act in which to sway the audience.
'Fix-It' Bill: Final Fight on Health Care Front
USA Today
March 23, 2010
Senate Democrats vowed to start debate today on a series of changes to President Obama's landmark health care legislation, launching the final battle in the year-long effort to revamp the nation's health insurance system.
Government Focus Now Turns to Implementation (subscription required; full text below)
The Wall Street Journal
March 23, 2010
With the health bill passed, the focus now turns to enacting the most-massive changes to the health system in more than four decades. That task will be made difficult by a tight window for launching the first provisions of the bill, and a contentious relationship between government and industry.
Insurance
First Wave of Health-Care Changes Will Target Insurers With New Rules
The Washington Post
March 23, 2010
The new healthcare legislation will set in motion a fundamental shift across the industry, with insurers facing an expanded list of restrictions and hospitals and doctors confronted with new incentives to practice more-efficient care. By far, the most direct effect will be on insurers.
Industry Groups Say Premiums Will Rise With New Healthcare Bill
The Hartford Courant
March 23, 2010
In response to the health reform bill President Obama is expected to sign today, health insurance industry groups warned that premiums will rise and the chief executive of CIGNA Corp. said the sweeping measure does nothing to rein in medical costs.
Healthy San Francisco Expected to Continue
The San Francisco Chronicle
March 23, 2010
When San Francisco launched its first-of-its-kind universal healthcare program in 2007, city officials said they hoped the program would someday be irrelevant because the federal government would provide healthcare for all. But Mayor Gavin Newsom and Public Health Chief Mitch Katz have announced they are dedicated to ensuring the viability of Healthy San Francisco because major holes in the national plan, if signed to law, will leave out thousands of city residents.
Transparency/Safety
Hospital Safety Info Shielded From Public
The Seattle Post-Intelligencer
March 23, 2010
A nationwide Hearst Newspapers investigation found that state and federal governments collect a treasure trove of [hospital] safety information, but the public can't see it. Even after years of clamor for reform, the data-collection system is a mess and the government hides key information from researchers.
Wellness/Chronic Care
Georgetown Joins Campaign to Bring a Healthier Menu to Nation's Hospitals
The Washington Post
March 23, 2010
Georgetown is the first hospital in Washington to sign on to the Balanced Menus Challenge, an initiative of the advocacy group Health Care Without Harm that calls on health-care institutions to reduce meat purchases by 20 percent over a 12-month period. Twenty-nine other health-care institutions in the United States have made that commitment. Click here for more information on the challenge.
State news
Ohio: Tort Reform Hasn't Cut Health Costs
Fierce HealthCare
March 23, 2010
In the absence of national legislation for comprehensive tort reform, efforts are under way in several states to implement changes in medical liability laws. However, those efforts might not reap the expected monetary savings. Five years after enacting tort reform in Ohio, the state's healthcare costs haven't diminished.
Medicare/Medicaid
Medicare Steps Up Efforts To Monitor Seniors' Prescriptions
Kaiser Health News
March 23, 2010
Medicare is expanding a program to make sure that some older adults use the right drugs and take them correctly to prevent harmful side effects or interactions.
Reform efforts
Senate Democrats Get Favorable Ruling
Politico
March 23, 2010
A ruling by Senate parliamentarian Alan Frumin handed Democrats a major victory Monday night, beating back a GOP push to declare a key tax proposal in the health care bill out of order.
How Obama Revived His Health-Care Bill
The Washington Post
March 23, 2010
When the Democrats lost Kennedy's Senate seat to a Republican, the president feared his signature policy issue had arrived at its moment of defeat.
The Washington Post - editorial
March 23, 2010
The most important variable will be whether reform does, as promised, "bend the curve": whether it slows the rate of growth of health-care costs, which on their current trajectory will bankrupt the country.
A New Era in American Health Care
The Commonwealth Fund
March 23, 2010
In a blog post, Commonwealth Fund President Karen Davis writes about the impact of passing comprehensive health reform legislation.
Employers
Small-Business Owners Unclear on Health Care Impact
USA Today
March 23, 2010
Not understanding what health care reform really means to a business seems the common reaction from small-business owners. In a nation of more than 29.6 million small businesses with about 58 million employees, it seems less a matter of being for it or against it and more a matter of not understanding what it means for them.
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Government Focus Now Turns to Implementation
The Wall Street Journal
March 23, 2010
With the health bill passed, the focus now turns to enacting the most-massive changes to the health system in more than four decades. That task will be made difficult by a tight window for launching the first provisions of the bill, and a contentious relationship between government and industry.
After the White House spent months sparring with insurers, government health officials must seek their cooperation to put in place the overhaul. Insurers, meanwhile, are hoping the implementation process will offer them an opportunity to influence the overhaul of their industry.
The biggest changes don't take effect until 2014, when states will launch new exchanges to sell insurance and subsidies to help people afford plans. But a batch of provisions takes effect between now and within six months, including covering children with pre-existing conditions and removing lifetime limits on coverage. For those provisions, the government is under the gun.
"It's going to be a bear to implement," said Donna Shalala, the Health and Human Services secretary during the Clinton administration. That is made worse by the fact that the top job at the Centers for Medicare and Medicaid Services has been vacant for more than three years .
The trickiest part, according to former top health officials and people who developed the legislation, will be creating a new system of high-risk pools designed to make it less expensive for sick people without employer plan to buy insurance until the insurance exchanges are up-and-running less than four years from now. The bill sets aside $5 billion for the pools but they might not have enough money to offset their higher costs , and at least 15 states that don't have pools will need to start from scratch.
"We've never been able to make local high-risk pools work," Ms. Shalala said.
Insurers are looking for ways to press their case that the bill doesn't address cost issues well enough and doesn't contain a strong enough mandate on individuals to purchase insurance. They complain that they can't put in place many of the changes that the bill calls for in the first year. For one, 2011 product designs in many cases have already been submitted for regulatory approval.
That's what happened at Group Health Cooperative, a coordinated care system in Washington that insures 600,000 people. The health plan just submitted its 2011 rates to state regulators two weeks ago. Diana Birkett, executive director of public policy there, said the company has launched a series of meetings with legal, regulatory and product teams to decide whether the new legislation will necessitate redesigning and refilling the plans.
Another concern for insurers is the medical-loss ratio, a measure of how much companies spend on medical care versus profits and administration. The industry is concerned because plans will need to comply with mandatory medical-loss ratios next year. The National Association of Insurance Commissioners is working to uniformly define what counts as a medical versus an administrative expense.
"Insurers are nervous and want to make sure they are able to provide input," said Sandy Praeger, the Kansas Insurance Commissioner who chairs the group's health committee. "They recognize this is not business as usual."
Another point of tension will be how the premium tax of some $70 billion is shared among insurance companies. Cigna Corp.'s vice president of public policy, G. William Hoagland, said his company is trying to shape how the regulations define what counts as premium dollars. "You can't change the overall amount. But how much of that is borne by an Aetna, a Cigna or a Humana is a function of what goes into calculating the net premium," he said.
This year, the bill gives the government new powers to regulate insurance premiums. "Defining what's excessive, defining the process, creating a national framework for that, I would say, is going to be pretty contentious and challenging," said John McDonough, a former Democratic Senate committee aide who helped draft the bill.
Insurers are still not giving up on last-minute opportunities to shape the overhaul itself, since a package of changes still needs to pass through the Senate. America's Health Insurance Plans, the industry's trade group, is in talks with lawmakers about ways to make the reconciliation package more to the industry's liking, including lessening the cuts on the privately administered Medicare Advantage plans and moving the mandated medical-loss ratio from next year to 2014, a spokesman said.
Cigna's Mr. Hoagland was making his health plan's case on Capitol Hill that the requirement for individuals to buy health insurance could be toughened by amendments to the reconciliation bill—though he wasn't holding out much hope.
"Healthcare reform is not over simply because the president signs this bill," said Mr. Hoagland. He said other measures in the future—such as appropriations or authorization bills —could address some of the cost-savings measures it says are needed to contain premium increases.
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