The House and Senate both have hefty health agendas Monday as they attempt to pass several remaining items before the new Congress takes over.

Delaying the SGR showdown … again: The House is expected to take up a one-month "fix" to the Medicare Physician Payment System under suspension of the rules this evening. If the House doesn't act, doctors face a 23 percent cut in Medicare payments starting Wednesday.

The Senate passed a bipartisan, $1 billion fix on Nov. 18. It's paid by cutting therapy service payments by 20 percent and using those savings to pay for the "doc fix" instead of redistributing them into the Medicare Physician Fee Schedule. http://bit.ly/cZd9fw

Food-safety bill includes 1099 provisions: The Senate may for the first time repeal a provision of Democrats' healthcare reform bill when it takes up food-safety legislation today.

According to Senate staff, the timeline should start with a cloture vote on the final bill, as amended by the small-farms exemption from Democratic Sens. Jon Tester (Mont.) and Kay Hagan (N.C.). The procedural motion will need 60 votes to pass.

This will be followed by a vote on four amendments, all requiring a 67-vote threshold: 

• Sen. Mike Johanns's (R-Neb.) amendment to repeal the 1099 provision (this is offset by unspent and unobligated federal dollars, to be identified by the Office of Management and Budget);

• Sen. Max Baucus's (D-Mont.) alternative amendment to repeal 1099 without paying for it (this would add to the deficit but at the same time lower the cost of repealing healthcare reform, a Republican priority);

• Sen. Tom Coburn's (R-Okla.) moratorium on congressionally directed appropriations; and 

• Coburn's food-safety substitute amendment, which is an alternate, stripped-down food-safety proposal.

The vote on amendments will be followed by a final vote on the food-safety bill, which will require a 51-vote threshold.

The House passed its version of the legislation in July 2009. It's not clear how the Senate and House versions would be reconciled.

Healthcare law repeal gains momentum in courts: A decision this week by a federal judge in Ohio marks at least the third time a legal challenge to Democrats' healthcare law has been allowed to go forward, underscoring the extent to which the legal push for repeal is gaining momentum.

While top-ranking Republicans have acknowledged that they won't be able to fulfill their campaign promise to “repeal and replace” the law so long as a Democrat sits in the White House, many see promise in the court fight against it. A number of Republicans have signed onto a 21-state challenge to the law that seems almost certain to end up at the Supreme Court. 

Newly elected governors in at least five states are also preparing to join the fray, even as advocates of the law push back. http://bit.ly/h1wESs

Administration says healthcare law can survive without mandate: Obama administration officials this week told a federal judge that even if the healthcare reform law's individual mandate is ruled unconstitutional, other parts of the law should be allowed to stand. http://bit.ly/g49YFA

Medicaid could be paying for unapproved drugs: A new report from the Health and Human Services Department's Office of Inspector General found that 38 percent of drugs paid for by Medicaid in 2008 did not have an approved application number in the National Drug Code (NDC) Directory or were not in the NDC directory at all.

"As a result, Medicaid could potentially pay for drugs that are not approved by FDA," the report found. "Without accurate approval and listing information, it is impossible to determine whether these drugs were paid for appropriately." http://bit.ly/dSZ14V

Task force created to protect agents and brokers: The National Association of Insurance Commissioners announced Wednesday the creation of a new task force to try to protect insurance agents and brokers from the side effects of Democrats' healthcare reform law. Some liberals say agents and brokers should go the way of the travel agent when state insurance exchanges with standardized offerings are up and running in 2014, but the NAIC says they will still serve an important function. http://bit.ly/eLBSMw

Kuwait disses U.S. model in pursuit of healthcare reform: According to Nadeem Al-Duaij, chairman of the nonprofit Kuwait Health Initiative that's helping reform the health sector in that country: "There currently exists no evidence to support the use of for-profit insurances to finance a nation's health care in a fair and cost-effective manner. Quite the contrary, such mechanisms have time and again resulted in poor health outcomes, in inequalities in health care access and delivery, and in an inability to contain rising health care costs. We believe in the need for health insurance to protect the individual from catastrophic health expenditures but this must be done through the adoption of a non-profit social health insurance or similar scheme that is supported by current health policy evidence." http://bit.ly/e28UIZ

A number of Republicans have signed onto a 21-state challenge that seems certain to end up at the Supreme Court.

That argument, known as severability, is crucial to the law's survival should a judge rule that the mandate is unconstitutional.

The National Association of Insurance Commissioners announced Wednesday the creation of a new task force to try to protect insurance agents and brokers from the side effects of Democrats' healthcare reform law. Some liberals say agents and brokers should go the way of the travel agent when state insurance exchanges with standardized offerings are up and running in 2014, but the NAIC says they will still serve an important function. 

"Health insurance is a complex product and experienced and licensed agents are a valuable resource for consumers," Florida Insurance Commissioner and task force chairman Kevin McCarty said in a statement. "We intend to work with the agent community and our colleagues at HHS to maintain that resource."

Creation of the task force comes after the NAIC in August adopted a resolution acknowledging the agents and brokers' role. The NAIC last month rejected agents' request that their fees be excluded from the medical-loss ratio calculation but has continued to advocate on their behalf in dealings with federal regulators.

Doing so would make the purchase of breast pumps and other breastfeeding supplies tax-deductible.

Health and Human Services Secretary Kathleen Sebelius and several of her staff met with national health reporters on Tuesday to discuss recent trends in healthcare coverage — and why the Democrats' law was necessary to stem the tide of rising prices. Sebelius said she hoped to start having "periodic" meetings with the media to put her department's work in context.

"I think the trends have been pretty alarming," she said — employer-sponsored coverage, for example, "we could say was on a slow death spiral before (the Affordable Care Act)."

The meeting comes as President Obama and prominent Democrats in Congress argue that their unpopular healthcare reform law was good policy but was poorly explained to the public. In particular, HHS officials pushed back against allegations that the new law was driving premiums up; they reminded reporters that actuaries inside and outside the government have linked the improved coverage required so far (insurers can no longer drop coverage for sick children, for example) to increases of at most 1 percent to 2 percent next year.

Sebelius recalled her experience as a Kansas legislator to point out that attempts by state lawmakers to mandate more generous coverage were inevitably met with united industry opposition, followed by dire warnings about skyrocketing premiums.

"Over and over again," she said, "those projections turned out to be wildly wrong."

GOP lawmakers under pressure to decline coverage: Congressional Republicans who assailed the Democrats’ healthcare law in the run-up to the midterm elections are facing pressure to decline government-provided coverage when they take office.

GOP Reps.-elect Bobby Schilling (Ill.) and Mike Kelly (Pa.), both opponents of the law, have already vowed to refuse government-backed health insurance when they come to Capitol Hill next year. http://bit.ly/e3UVUw

House Dem dares GOP on healthcare repeal: Rep. Gary Ackerman (D-N.Y.) is daring Republicans to make good on one of their top legislative priorities: repealing the healthcare law. 

Using a somewhat unusual tactic, Ackerman, a strong advocate for the healthcare reform law, vowed Tuesday to introduce a series of bills next week that would roll back some of the most popular provisions of the law. http://bit.ly/htWKQO

Nurse loses freedom of conscience suit: The Second Circuit Court of Appeals in New York ruled Tuesday that a private individual does not have the right to sue her employer after being forced to participate in an abortion.

Read the Americans United for Life amicus brief here: http://bit.ly/fs9F0C

Emergency departments decry surgeon shortage: Three quarters of emergency department directors responding to a new survey report inadequate surgical coverage, and nearly one-quarter report a loss or downgrade of their hospitals' trauma center designations. 

The report is prompting renewed calls for medical liability reform to help reverse the dearth of specialists. http://bit.ly/gUK6Vx

Ohio judge allows third healthcare reform challenge: A federal judge in Ohio has ruled a lawsuit against the healthcare reform can proceed, marking it at least the third challenge to get a green light. Two similar lawsuits have been dismissed.

Judge David Dowd of the U.S. District Court for the Northern District of Ohio issued a split ruling on Monday, dismissing three claims brought by the conservative U.S. Citizens Association but allowing one to move forward. Dowd agreed to hear arguments that the law's individual mandate — the requirement that people buy insurance — violates the Constitution's commerce clause. http://bit.ly/gsAgNV

Now this is funny: The Sons of Confederate Veterans awards a $35,000 medical fellowship for research into "non-union fractures." http://bit.ly/dH5T6y

Happy Thanksgiving. The morning roundup will resume on Monday, but if you have any news you want to draw attention to between now and then, please drop me a line at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

The majority of voters want opponents of the healthcare law to refuse coverage when they take office, a poll found.

Sen. Jay Rockefeller (D-W.Va.), chairman of the Senate commerce panel, will be holding a full committee hearing next week on low-value employer healthcare coverage. The hearing — titled "Are mini med policies really health insurance?" — comes after federal regulators on Monday announced new consumer-protection rules that temporarily offer special treatment to the mini-med policies.

Rockefeller said in a statement following the release of the medical-loss-ratio rules that he was "disappointed that limited benefit 'mini-med' plans continue to seek exceptions from these standards." He added that "they should know that their requests will be subject to close scrutiny."

The hearing has been scheduled for 2:30 p.m. on Dec. 1, in Room 253 of the Russell Senate Office Building.

Rep. Ackerman is introducing legislation rolling back the law's most popular provisions, and daring Republicans to vote for it.