OVERNIGHT HEALTH: House, including Ryan, to vote on welfare waivers

Republican vice presidential nominee Paul Ryan will return to Capitol Hill Thursday as the House votes to block the Obama administration's divisive welfare waivers. Ryan's (R-Wis.) vote, likely to be his last before the November election, comes as the GOP defends its criticism of the welfare policy, which has become a flashpoint in the race for the White House. In a feisty speech on Wednesday, Sen. Orrin Hatch (R-Utah) told the Heritage Foundation that the media and its fact-checking groups have "leaned on partisan talking points" and refused to question President Obama's motivations in releasing waivers Republicans say will "gut" the program's work requirement.

"The motives of the Obama administration have been unexamined. The language they have used to describe their waiver scheme has been taken at face value," Hatch said. 

Back on Capitol Hill, the welfare fights continued as Sen. Ben Cardin (D-Md.) blocked a Hatch measure to block the waivers, House Republicans used a Government Accountability Office report to blast Obama on the policy, and House Democrats accused the GOP of previously supporting broad waivers that would apply to welfare.

Read more about the waivers, the debate and tomorrow's vote — which Heritage Action for America will score — at Healthwatch.

Maligning MLR bill: The liberal group Health Care for America Now (HCAN) wrote to members of Congress Wednesday slamming a bill that would exclude insurance brokers' fees from the healthcare law's medical loss ratio. HCAN Executive Director Ethan Rome said that the Access to Professional Health Insurance Advisors Act would "undermine important consumer and small-business protections against price gouging by health insurance companies" by carving out an exemption for insurance agents' commissions. The bill would "raise premiums and erase the protections that keep wasteful spending by insurers in check," Rome wrote.

The measure responds to longtime complaints from the insurance industry that the current medical loss ratio (MLR), which mandates that insurers spend 20 percent or less on administrative costs, including brokers' fees, threatens their business. H.R. 1206 will see a vote in the House Energy and Commerce Committee Thursday, where ranking member Henry Waxman (D-Calif.) opposes it. Read more about the bill at Healthwatch.

Mandate math: Congress's budget office says 6 million people will have to pay the individual mandate's tax penalty — 2 million more than the last estimate. The Congressional Budget Office released updated figures Wednesday, saying the 6 million people who pay the fine will end up paying the IRS about $8 million per year after 2016. The mandate requires people to either get insurance or pay a penalty, though many low-income households will be exempt. The Hill has more on the CBO's latest estimates.

Protecting pregnant women: A new bill from Sens. Bob Casey Jr. (D-Pa.) and Jeanne Shaheen (D-N.H.) would strengthen protections for pregnant women in the workplace by mandating that employers provide expectant mothers with "reasonable accommodations" such as those given to disabled workers. The bill, the Pregnant Workers Fairness Act, would also make it illegal for employers to fire or place on unpaid leave pregnant women who need small job modifications to stay healthy.

The National Women's Law Center (NWLC), a group that supports the bill, says it would help protect women who are unfairly dismissed from their jobs for habits related to pregnancy. In one legal case, the NWLC said, a pregnant woman was fired from Wal-Mart for carrying a water bottle on the job — her doctor said she needed water throughout the day, but carrying the bottle contradicted company policy. Read the Healthwatch story here.

Antibiotics in ag: More than 200 farmers and scientists, in partnership with advocates at Keep Antibiotics Working, released statements Wednesday condemning the "imprudent use of antibiotics in animal agriculture," which the scientists warned is "linked to human diseases increasingly impervious to antibiotic treatment." The calls to action targeted the Food and Drug Administration (FDA) and Congress to create stringent rules to reduce the widespread use of antibiotics in livestock and poultry feed, where they promote faster growth.

"The FDA recently announced a policy calling on the animal drug industry to voluntarily surrender label claims for growth promotion and other production uses of veterinary drugs," the scientists wrote in their statement. "While we support the effort to renounce drug approvals for injudicious uses, we cannot support a voluntary approach."

Standardizing D-SNP data: Reps. Henry Waxman (D-Calif.) and Pete Stark (D-Calif.) released a government report calling for greater disclosure of quality and performance measurements for Medicare Dual Eligible Special Needs Plans. So-called D-SNPs cover about 9 percent of the dual-eligible population, but more information is needed to compare their effectiveness with other Medicare Advantage plans or traditional Medicare, the members said.

"Special Needs Plans are serving the vulnerable Medicare and Medicaid eligible individuals, particularly those that have disabilities," Stark said in a statement. “However, it remains unclear whether they are worth the extra money that we pay." The report, which urges greater transparency, is available here.

Thursday's agenda

Advocates with United for Medical Research and Research!America will roll out a poll on medical research and the sequester. Reps. Ed Markey (D-Mass.) and Brian Bilbray (R-Calif.) will speak at the groups' press conference.

The Energy and Commerce Committee will continue its markup of H.R. 1206, the Access to Professional Health Insurance Advisors Act, and H.R. 1063, the Strengthening Medicare and Repaying Taxpayers Act.

The House Oversight subcommittee on Healthcare will hold a hearing on Medicaid overpayments and the Obama administration’s failure, in Republicans' view, to “prevent and end” them.

The Pew Health Group will unveil a report on best practices in prescription drug monitoring programs at a Capitol Hill briefing will Rep. Hal Rogers (R-Ky.). 

Sens. Bernie Sanders (I-Vt.), Mark Begich (D-Alaska), Al Franken (D-Minn.) and others will discuss Social Security and budget deficits at a news conference. 

State by state

California could lose $61 billion Medicare pay. Does it matter?

Gov. Kitzhaber pitches Oregon's health care plan to influential DC audience

Alabama voters approve tapping trust fund for budget fix


Lobbying registrations

Upstream Consulting / Reata Pharmaceuticals

Upstream Consulting / American Enterprises

Upstream Consulting / Sterling Biotech Limited

FaegreBD Consulting / City of Minneapolis

Martin & Seibert / Express Scripts

Holland & Knight / Erlanger Health System

The Arnold Agency / Adena Health Foundation

Capitol Counsel / Hilton Worldwide


Reading list

Wal-Mart, Humana reward healthy food purchases

Dental insurers look for sense of regs and market come 2014

Blue Cross CEO: Cooperation, innovation needed to cut health costs

Quarter million Americans have been infected by West Nile Virus

Hospital shootings are rare occurrences, study finds [reg. req'd]

Study: Cancers are on the rise in pregnant women


What you might have missed on Healthwatch

HHS: Health law strengthened Medicare Advantage


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