Health reform implementation

Sen. Jay Rockefeller (D-W. Va.) is joining the chorus of healthcare reform allies calling on the nation’s insurance commissioners to oppose draft legislation that would exempt insurance agents from new restrictions on administrative spending. 

Under the healthcare reform law, health plans must spend an average of at least 80 percent of premiums on care or send a rebate check to customers for the difference. A Health and Human Services regulation lumps insurance agents and brokers into administrative expenses, but the National Association of Insurance Commissioners (NAIC) has proposed legislation that would count them toward care dollars.

Rockefeller urged the NAIC to keep the “medical loss ratio” (MLR) rule as is.

“I cannot support a proposal that would allow agents, brokers and health insurance companies to retain the estimated $1 billion in benefits that American consumers will receive next year thanks to the healthcare reform law,” Rockefeller wrote in an 11-page letter.

A number of liberal groups made the same plea to the NAIC on Tuesday.

A group of liberal groups is urging state insurance commissioners to oppose legislation that would reduce how much insurers have to spend on medical care under the healthcare reform law by exempting insurance agents and brokers' fees.

The effort, they write in a letter sent Tuesday to the National Association of Insurance Commissioners, would "undermine the medical loss ratio, raise premiums and deny consumers of anticipated rebates."

Under the law, health plans have to spend at least 80 percent (85 percent in the large group market) of premiums on care on average, or give consumers a rebate starting next year. Agents and brokers want their commissions and other costs to be excluded when calculating that threshold instead of counting as administrative costs, and an NAIC panel has proposed legislation that would make those changes.

Republicans on a powerful House committee are bringing the so-called "death panel" controversy back to life.

The House Energy and Commerce Committee Republicans are demanding that President Obama’s health department explain why a provision rewarding doctors for end-of-life care consultations was recently tucked into a massive Medicare regulation.

A provision of the rule, which would have incentivized Medicare doctors to hold end-of-life discussions with seniors during new annual wellness visits, was uncovered by The New York Times in December, weeks after the regulation was issued. End-of-life care became a political lightning rod for the administration during the healthcare reform debate, with some conservatives accusing the administration of trying to withhold life-saving treatment from seniors because of the cost.

A November letter from Rep. Earl Blumenaeur’s (D-Ore.) office urging healthcare reform advocates not to publicly celebrate the inclusion of end-of-life counseling in the regulation bolstered the GOP’s claims that the administration abused the regulatory process to sneak in failed legislation.

The original House healthcare reform bill included a Medicare provision reimbursing doctors for advising patients on end-of-life care, but was dropped from the final bill after some conservatives said it could have led to government-run “death panels.” The fact-checking website Politifact labeled that claim its “lie of the year” in 2009.

The administration withdrew the Medicare rule in January amid public scrutiny.

“It is clear that end-of-life regulations would not make it through Congress or survive a public debate during the rulemaking process, and were dropped into the final rule without allowing the public any opportunity to comment,” Energy and Commerce Republicans wrote to Health and Human Services Secretary Kathleen Sebelius.

There is “no persuasive reason” to fast-track Virginia’s challenge of the healthcare reform law to the Supreme Court, the Obama administration has argued to the nation’s top court. 

Virginia Attorney General Ken Cuccinelli (R), who successfully challenged the law’s requirement for individuals to purchase insurance by 2014, had asked the Supreme Court to let the administration’s appeal skip over appeals court and go directly to the high court.

Noting that the so-called individual mandate does not go into effect until 2014, Acting Solicitor General Neal Katyal said the courts are in no rush to make their decision.

“There will be ample time before 2014 for this court to decide whether to grant review in the normal course and, if it does so, to issue a decision,” Katyal wrote for the administration in a late Monday filing.

Sen. Mike Johanns (R-Neb.) is confident he has enough votes to tack on a repeal of the 1099 provision included in the healthcare law to a small business bill under consideration in the Senate.

Johanns, who has been pressing for months to eliminate the provision that requires businesses to file paperwork to every vendor with which they purchase at least $600 in goods and services, will offer the House-passed 1099 repeal legislation, which uses an offset that has caused angst among some Democrats. 

"I'll run it and I think we'll get plenty of votes to pass the amendment," he told The Hill on Monday.  

Healthcare reform dodges the budget ax again: The House is scheduled to vote on yet another stopgap spending bill that again avoids cutting big-ticket healthcare items, including the reform law and Planned Parenthood. The $6 billion in cuts outlined in the three-week spending measure includes two healthcare cuts backed by the administration: $276 million in pandemic flu funding and $75 million from State Health Access Grants.

Conservatives growing impatient: The short-term spending measures keep pushing back fights over funding for healthcare reform and Planned Parenthood, and conservatives are growing restless over what they see as another missed defunding opportunity. GOP Reps. Michele Bachmann (Minn.) and Steve King (Iowa) circulated a letter on Friday demanding that the next continuing resolution withhold $105 billion in the reform law's mandatory spending as well as any funds for implementing the law. On Monday, the anti-abortion Susan B. Anthony List said failure to include Rep. Mike Pence's (R-Ind.) amendment blocking funds to Planned Parenthood would show the House is "not serious about cutting spending."

Golden years: Medicare improperly paid $3.1 million over two years for Viagra and other erectile-dysfunction drugs, says a new report by the Health and Human Services Office of Inspector General. Jason Millman has the story.

Bipartisan duo drops bill to terminate medical equipment bidding: Reps. Glenn Thompson (R) and Jason Altmire (D) have introduced legislation ending the Medicare competitive bidding program for durable medical equipment. Read the Healthwatch post.

Supporters of the Democrats' healthcare reform law are calling on all lawmakers to disclose whether they receive congressional health benefits, part of an ongoing effort to portray Republican opponents as hypocrites for receiving government-subsidized care.

A handful of House Democrats are backing a resolution that would require all members of Congress to disclose whether they receive health insurance through the Federal Employees Health Benefits Program. A number of high-profile Democrats, including Sen. Charles Schumer of New York, and progressive groups have routinely hammered House Republicans for accepting government health benefits while opposing the reform law.

"As Republicans continue their efforts to repeal and defund the health care law, the public has a right to know if members who are trying to take away the American people’s access to high-quality, affordable health insurance are, in turn, taking taxpayer-subsidized health benefits for themselves," write Reps. Joseph Crowley (N.Y.), Donna Edwards (Md.), Tim Ryan (Ohio) and Linda Sanchez (Calif.).

More than a dozen of the 87 House freshmen have declined congressional health insurance.
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The one-year anniversary of the healthcare reform law is fast approaching, giving both supporters and critics a high-profile opportunity to debate the impact of the overhaul.
 
The Senate Finance Committee on Wednesday holds a hearing on lessons learned during the first year of the law’s implementation. That hearing will feature testimony from Health and Human Services Secretary Kathleen Sebelius. On Thursday, the Senate Health, Education, Labor and Pensions Committee will explore how states have moved forward on implementing health insurance exchanges and other parts of the reform law.
 
Meanwhile, a coalition of conservative groups is hosting a pizza party in the Capitol Visitor Center Monday to hash out their opposition to the law. Sen. Tom Coburn (R-Okla.) and Rep. Tom Price (R-Ga.) are scheduled to attend.
 
As Senate Democrats celebrate the law, House Republicans will scrutinize one of its most troubled programs: The CLASS Act. On Thursday, the Energy and Commerce Committee's Health subpanel holds a hearing on the new long-term-care program taking effect in 2012. The president’s fiscal commission called for repealing or reforming the CLASS Act, and Sebelius has already signaled the administration will take up the reform recommendation.

The House Oversight Committee's Health subpanel will probe waivers granted by the administration for a provision of the healthcare reform law on Tuesday. Republicans cite the 1,000-plus waivers granted as evidence that the law doesn’t work, and have accused the administration of rewarding Democrats’ union allies.

'Mini-med' plans don't end until state insurance exchanges open in 2014.

An influential Tea Party group is pressuring Republicans to oppose the next continuing resolution unless it eliminates $105 billion in mandatory spending included in healthcare reform.

Republicans over the past week have blasted the reform law’s long-term mandatory spending, claiming that it had been “hidden” in the law enacted almost a year ago. The Tea Party Patriots now say the next spending bill to keep the government running past March 18 must strip away the funds.

“Urge [Republican representatives] to pledge to vote ‘NO’ on the next CR unless it contains a provision to defund Obamacare of the billions that were secretly and fraudulently appropriated by the old Democratic Congress,” the group wrote to members. “If this is not done now, this funding will be self-perpetuating into the future."

A long-term CR approved by the House last month blocks funds for agencies to implement healthcare reform, but the Democratic-controlled Senate has rejected the measure. Insistence now on also slashing the long-term mandatory spending could add a new wrinkle to the challenged budget negotiations.