OVERNIGHT HEALTH: Battle over rate review begins

Battle lines formed over rate review regulations: Health insurers are squaring off against providers and consumer advocates as regulators debate how to structure the healthcare reform law's rate review requirement.

In comments due Tuesday, the American Medical Association and Consumer Watchdog both pressed regulators to make as much rate information as possible public so consumers can review the rates. Health plans, however, argue that "release of confidential and competitive information into the marketplace jeopardizes competition and innovation."

It's the prices, stupid: America's Health Insurance Plans (AHIP) counters that regulators would be ill-advised to inflexibly limit rate increases when insurance costs only amount to 4 percent of national health expenditures.

"Health plan solvency is threatened if these costs continue to grow unabated, but actuarially justified rate increases are not allowed to go into effect," AHIP says.

Specifically, AHIP is asking regulators to:

• Delay the July 1 deadline by which states must put in place "effective review" programs or risk the Department of Health and Human Services taking over;

• Rethink the idea of establishing a specific rate increase (10 percent, for example) as the trigger for review. Doing so, AHIP argues, fails to capture geographic variations, risk and adverse selection, medical inflation and the costs of compliance with the new law; and

• Delete subjective criteria such as the requirement that states conduct "an effective and timely review."

Not so fast: And then there's the libertarian viewpoint. Americans for Limited Government argues in its unusual comments that the regulation itself is misguided, especially after a federal judge ruled that the whole law is unconstitutional.

"The current administration, to foster its ideological belief that a 'benevolent' government is needed to oversee corporations presumed to be evil, must have tools it can use to propagate its ideology to the public," the group said. "This proposed regulation is merely a propaganda tool for those who believe in more government control."

GOP targets heparin again: Republicans on the Energy and Commerce panel are relaunching their 2008 investigation into the Food and Drug Administration's handling of contaminated heparin from China that caused dozens of deaths. Committee Chairman Fred Upton (R-Mich.) is giving FDA Commissioner Margaret Hamburg two weeks to turn over FDA documents on heparin inspections. Read The Hill story.

Lining up for bonuses: The Centers for Medicare and Medicaid Services on Wednesday cited early interest in the agency's electronic health record incentive program. About 21,000 providers have signaled their interest, and 11 states have launched Medicaid programs, CMS said. Read The Hill story. 

Shadegg joins Heritage Foundation: Former Rep. John Shadegg (R-Ariz.) is joining the conservative think tank to focus on healthcare reform alternatives, Healthwatch's Julian Pecquet writes.

Drug makers want theft protections: Citing a rise in the theft of drugs and medical devices, a group of the nation's largest pharmaceutical firms is pushing for stronger medical product theft laws. The new Coalition for Patient Safety and Medicine Integrity is trying to bring attention to an issue that the Food and Drug Administration (FDA) last year called "very concerning," Healthwatch's Jason Millman writes.

White House makes economic case for healthcare reform: Council of Economic Advisers Chairman Austan Goolsbee devotes 14 pages of his 2011 Economic Report of the President to the new law. His shocking takeaway: "Broadly, the Affordable Care Act controls costs and improves quality."

Abortion foes arrested in Longworth: Anti-abortion protesters, pushing efforts to block federal funding to Planned Parenthood, were arrested outside House Speaker John Boehner's (R-Ohio) Longworth office. Though the House voted to do so in the seven-month continuing resolution, Senate Democrats aren't expected to include such a measure in their version. Read The Hill story.

Thursday's agenda:

The Medicare Payment Advisory Commission (MedPAC) holds its second day of meetings at the Ronald Reagan Building.

At 9 a.m., commissioners tackle the issue of care coordination for dual-eligibles enrolled simultaneously in the Medicare and Medicaid programs. The Medicare agency had required that the privately run dual-eligible special-needs plans that cater to these "dual eligibles" submit "models of care" describing their care coordination activities, and MedPAC commissioners will consider the issues identified in a staff analysis of those submissions.

Later, commissioners discuss policy options for using Medicare to "motivate and support" healthcare quality improvement. One of the goals of Democrats' healthcare reform law is to shift the U.S. healthcare system away from paying for tests and procedures and toward paying for quality of outcome; Medicare, the single biggest healthcare payer — it spent $502.3 billion in 2009, or 20 percent of national health expenditures — has "a responsibility to exercise its policy levers to accelerate improvement," according to MedPAC.

Suggestions include: pay-for-performance, medical homes, penalties for high rates of hospital readmissions and bundled payments.

Rural Health: HHS Secretary Kathleen Sebelius will speak to the National Advisory Committee on Rural Health and Human Services about the healthcare reform law. The advisory panel will also discuss the role of rural health in new insurance exchanges opening in 2014.

Reading list:

House Republicans' stopgap budget bill would "increase the number of abortions, raise federal healthcare costs and swell the welfare rolls," columnist Ruth Marcus writes in The Washington Post.

Tennessee's state Senate approved a bill allowing residents to opt out of healthcare reform, The Associated Press reports. 

An adviser to New York Gov. Andrew Cuomo (D) is working as a paid consultant to major healthcare players, The New York Times reports. 

Pennsylvania will close a state health plan for low-income adults, Kaiser Health News reports. 

Virginia will vote Thursday on a bill that would make it the first state to regulate first-trimester abortion clinics, The Washington Post reports.

What you might have missed on Healthwatch: 

Efforts to curtail abortion rights are flaring up in states across the country.

The House is tentatively scheduled to take up legislation repealing healthcare reform's 1099 tax reporting requirement next week.

A third federal judge ruled that Democrats' healthcare reform law is constitutional. 

Comments / complaints / suggestions? 

Please let us know:

Julian Pecquet: This e-mail address is being protected from spambots. You need JavaScript enabled to view it / 202-628-8527

Jason Millman: This e-mail address is being protected from spambots. You need JavaScript enabled to view it / 202-628-8351