Healthcare Friday

Let the tax war begin: The National Association of Insurance Commissioners (NAIC) on Thursday issued a long-awaited draft proposal defining what exactly qualifies as a medical cost under the Democrats' new health reform law.

Of interest, the group is proposing to count most federal and state taxes as medical costs (though "federal income taxes on investment income and capital gains" will be excluded). 

That concept runs at least partly counter to the wishes of leading Democrats on Capitol Hill, who wrote last month to HHS Secretary Kathleen Sebelius that the intent of the law was to count only those taxes and fees "that relate specifically to revenue derived from the provision of health insurance coverage that were included in [the bill]."

Signing that letter were Sens. Max Baucus (Mont.), Tom Harkin (Iowa) and Chris Dodd (Conn.), as well as Reps. Sander Levin (Mich.), Henry Waxman (Calif.) and George Miller (Calif.). http://bit.ly/aNNsrF

The Democrats are trying to force the insurers to spend more of their revenues directly on patient care, while the insurance lobby is fighting to maximize profits by urging a broader definition of what constitutes a medical cost.

Specifically, the new healthcare law requires insurance companies to dedicate at least 85 cents of each premium dollar to actual medical expenses in the large-group market. For the small-group and individual markets, the requirement drops to 80 cents. Plans that don't meet those thresholds are required to give rebates to their customers, beginning in 2012.

NAIC is accepting comments on its draft proposal through Oct. 3. http://bit.ly/btzh41

A compromise on Avandia: The Food and Drug Administration (FDA) on Thursday issued a much anticipated decision on the fate of Avandia, stipulating that the blockbuster diabetes drug is suitable only for patients with Type 2 diabetes who don't respond to other medications. 

The decision brought cheers from Baucus — who said the "tough new restrictions … will help protect patients" — and from Harkin, who said he's "pleased that the FDA carefully considered the new data about cardiovascular risks and took action."  

Some consumer advocates think otherwise. Sidney Wolfe, health research director at Public Citizen, issued a statement Thursday saying the FDA "again caved to industry pressure." 

"Although the FDA has made progress highlighting the risks of using Avandia by severely restricting the drug, it did not go far enough," Wolfe said. "Too many people could still be exposed to this dangerous product."

The group has advocated for an outright ban on the drug. http://bit.ly/cNM8jq

Part D rates projected to skyrocket: Seniors enrolled in some of the leading Medicare prescription drug plans should prepare to switch plans or be hit with double-digit premium hikes, according to an analysis released Thursday by Avalere Health. 

"Beneficiaries are going to need to be savvy consumers and shop around to find the plan that’s best for them," Avalere CEO Dan Mendelson said in a statement. http://bit.ly/cjstce

A Pledge short on solutions: To much fanfare, House Republicans on Thursday unveiled their "Pledge to America," a 21-page document outlining the GOP's plans to shrink the government and rein in deficit spending. A glaring omission from that blueprint, however, is how the party intends to control entitlement costs, which happen to be the single most significant driver of federal deficits.

Asked about the omission Thursday, House Minority Leader John Boehner (R-Ohio) punted the fix to an unspecified future.

"I don't have all the solutions," Boehner said. "But I believe that if we work with the American people, the American people will want to work with us to come to grips with these challenges that face our country.

"It's about having that adult conversation in an honest, open way that'll get us the answers to lay out the plan that will solve this problem once and for all." http://bit.ly/d7g5Kg

Dems celebrate launch of Patient's Bill of Rights: The insurance reforms at the heart of the new healthcare law started to take hold Thursday, and Democrats missed no opportunity to mention it. 

"Today is the day that the worst abuses of insurance companies come to an end in America,” Health and Human Services Secretary Kathleen Sebelius said Thursday on Capitol Hill. "It’s long overdue for millions of Americans who now will have some peace of mind." 

Beginning this week, insurers will no longer be able to deny coverage for sick kids, set lifetime coverage limits or use technical errors to drop patients when they get sick. The law will also allow young adults to remain under their parents' coverage up to age 26, and require all new plans to cover a minimum set of preventive care services. http://bit.ly/cyVKNu

Clean out your medicine cabinet: The Drug Enforcement Agency this weekend is sponsoring a drug "Take Back" campaign, designed to prevent prescription drug abuse by offering thousands of sites nationwide where folks can drop their expired, unused or unwanted pharmaceuticals. 

Sen. Robert Casey (D-Pa.) will host a press call Friday to introduce the event.