A new federal regulation issued Tuesday defines “unreasonable” health insurance premiums under the healthcare reform law.

Ground Zero first responders will make a return visit to Washington on Tuesday to build support for a bill that will provide them with health benefits and compensation for illnesses suffered in the aftermath of the Sept. 11, 2001, terrorist attacks.

First-responders will plead their case in the Capital Visitors Center at noon Tuesday in what may be their final attempt to sway Republican lawmakers to assist workers who fell ill working at the Ground Zero site in New York City.

Senate Democrats are pushing to hold another vote before the end of the lame-duck session, but prospects are uncertain because Senate Republicans already rejected a cloture vote and it's still unknown if Democrats can secure a handful of Republican votes for passage.

Over the weekend, in an attempt to gain Republican support, Senate Democrats cut the bill’s cost from $7.4 billion to $6.2 billion and changed the funding mechanism. The new bill will shave $108 million from the deficit through 2020, according to the Congressional Budget Office score released Monday.

Sen. Charles Schumer (D-N.Y.) was confident Monday morning that Republicans will support the new bill.

“We now have the votes, we’ve made some modifications that some of our Republican colleagues requested and if no one does undue delay, just stands up and delays and delays and delays, we will get this done,” Schumer said on “Good Morning America” on Monday.

However, all it takes is one senator to hold up the bill, and the clock may be running out. Monday night, House Majority Leader Steny Hoyer (D-Md.) told The Hill that the Senate must work quickly to send the bill to the House because Democratic leaders do not want to call back lawmakers after Christmas.

Democrats say they'll use the repeal debate to attack Republicans for wasting time and money.

Because of GOP objections, funding for the healthcare reform law is noticeably absent from a bill keeping the government running.

The healthcare reform law’s new Medicaid drug rebate formula will provide more accurate reimbursements to pharmacists, according to a Government Accountability Office (GAO) report released Monday.

Medicaid programs receive federal matching funds for generic drug reimbursements up to a maximum amount — the federal upper limit (FUL). The FULs, designed to contain costs, historically were calculated as 150 percent of the lowest published price for generics.

The industry successfully sued to block implementation of a 2005 law that based the FUL formula on average manufacturer price (AMP) rather than compendia prices, which are typically higher than AMPs. Retail pharmacies argued that the new formula would not provide sufficient reimbursement to cover their costs for acquiring outpatient prescription drugs.

Under the reform law, the Centers for Medicare and Medicaid Services will determine FULs based on no less than 175 percent of the weighted AMP — which will be calculated according to utilization — rather than using an AMP based on the cheapest version of the drug.

The GAO report said the new formula also reduces overpayment for the drugs while still ensuring that pharmacists are reimbursed at fair rates.

“This is a great example of the important improvements made possible through the healthcare reform law,” said House Energy and Commerce Committee Chairman Henry Waxman (D-Calif.) in a statement. “The law averted massive payment cuts to pharmacists for generic drugs under Medicaid, and did so in a responsible way for taxpayers.”

Industry also hailed the GAO’s findings.

“GAO’s analysis confirms that the bipartisan provision included in the health reform law regarding Medicaid generic drug reimbursement strikes the right balance,” said National Community Pharmacists Association CEO Kathleen Jaeger. “The policy helps state and federal officials grappling with rising Medicaid costs, while preserving patient access and avoiding the draconian cuts that were previously enacted.”

House Democratic leaders are trying to drum up support for a bill that would give the Food and Drug Administration (FDA) more resources to regulate the global drug marketplace.

More and more drugs are produced overseas, presenting an “alarming” risk to consumer safety, said Democratic Reps. John Dingell, (Mich.), Henry Waxman (Calif.), Frank Pallone (N.J.) and Bart Stupak (Mich.), who sponsored the bill.

According to a joint statement, the bill:

•    creates an up-to-date registry of all drug facilities — both foreign and domestic — serving American consumers;
•    generates funding for increased Good Manufacturing Practices inspections for brand and generic drugs;
•    requires parity between foreign and domestic inspections;
•    prohibits entry of drugs coming from domestic and foreign facilities that limit, delay or deny FDA inspections;
•    prohibits the entry of drugs into the U.S. lacking documentation of safety;
•    requires manufacturers to know their supply chain, identify and mitigate risk throughout their supply chain, and to document measures taken to secure their supply chain;
•    prohibits false or misleading reports to FDA;
•    provides strong new enforcement tools, including mandatory recall authority, increased civil and criminal penalties, and new FDA authority to subpoena records related to possible violations;
•    provides protection for whistleblowers that bring attention to important safety information; and
•    requires unique identification numbers for drug establishments and importers to improve the ability of the FDA to more quickly identify parties involved in a crisis situation.

For first time since enactment, Rasmussen survey shows most voters think healthcare law will be repealed.

Funding for the new healthcare reform law is noticeably absent from a bill to keep the government running through March 4, after Republicans objected to an earlier proposal because they said it funded reform.

The continuing resolution (CR) provides a small increase of $1.16 billion over fiscal 2010 levels, but does not fund reform law measures included in an earlier, comprehensive spending proposal.

Republicans had singled out measures in the failed 2,000-page proposal that would have funded a new Prevention and Public Health Fund, an “adjustment” to the Centers for Medicare and Medicaid Services’s Program Management account, an increase to the Health and Human Services Department (HHS) to enforce new mandates and regulations, and a national healthcare workforce commission. Senate Majority Leader Harry Reid (D-Nev.) scrapped the proposal last week when Republicans raised concerns about reform funding and earmarks included in the bill.

The new 36-page CR mentions only one HHS program, which ensures that the department designates the same amount for Low Income Home Energy Assistance Program funding as it did during the same period during fiscal 2010.

The Senate is expected to vote on a procedural motion Tuesday morning to advance the CR to a final vote. The government is currently running on a three-day CR that will expire Tuesday.

A left-leaning public policy group issued new recommendations Monday morning on how to structure accountable care organizations (ACOs), promoted by the new healthcare reform law, to deliver better quality at lower costs.

Under the reform law, an ACO is a group of physicians and hospitals collaborating to provide efficient and quality care for a certain group of patients.

The Center for American Progress (CAP) report said ACOs should follow three major principles:

• "On payment reform, we encourage the development of physician-led accountable care groups alongside hospital-led organizations. The Centers for Medicare and Medicaid Services can encourage these organizations by tying financial rewards to reduction of preventable inpatient and emergency care, as well as providing organizational and technical support to physician-led organizations.

• "On payment incentives, we suggest a payment system that first optionally and then as a requirement leads providers to share in the financial risks of overspending as well as in the savings from underspending, relative to spending targets.

• "On rights and responsibilities, we believe that consumers should be active partners in improving the quality of their care. That means consumers should decide whether to join an ACO, and if they do, they should be able to count on rules for consumer protection and creative ways to benefit financially from seeking quality care at lower costs."

To help ACOs reach full potential, CAP said, healthcare providers must gather the right data on what patients need and how to best deliver those services. The estimated $30 billion for health information technology in last year’s stimulus package will help ACOs better share information, the CAP report said. Further, payment incentives must change to reward better care instead of paying for more services.

The CAP echoed concerns voiced by the Medicare payment advisory body earlier this month that ACOs might receive the same public backlash experienced by managed care organizations in the 1990s. 

The Department of Health and Human Services is expected to issue regulations on ACOs early next year.