Health panels prepare for shake-up: As the House panels of jurisdiction over healthcare get ready for a switch in leadership, a number of Republicans are making their moves to claim top spots. 

Most of the attention has been on the Energy and Commerce Committee, where ranking member Joe Barton (R-Texas) hopes to overcome his government "shake-down" remark regarding BP to claim the chairmanship. Barton says the four years he was ranking member should not count against the six-year limit for chairmanships imposed by Republican rules, but the leadership seems to be taking a different view.

Rep. Fred Upton (R-Mich.) is seen as leadership's favorite to take over the panel, but some question whether he's conservative enough when the Tea Party is ascendant. On top of that, another GOP Michigander — Rep. Dave Camp — is all but certain to take over the other "A" committee, Ways and Means. Conservative Rep. John Shimkus (R-Ill.) has said he'll run for the spot if the Barton is denied a waiver. 

This week, Barton appealed directly to newly elected conservative Republicans to vote for him. "Over the past four years, as Ranking Member of the Committee on Energy and Commerce, I have led the charge against radical cap-and-trade legislation, fought the new entitlements and mandates that are the rotten core of President Obama’s health care law, and consistently applied free market principles to legislative decisions," he writes in his letter. "If this sounds like a speech, well, it is. One of the first major decisions waiting for you in Washington is deciding who will be the leaders of the next Congress. I’m supporting John Boehner for speaker. I also hope to participate, myself, as chairman of the Energy and Commerce Committee. I’ll need the support of people like you who are coming to Washington with change on their minds and determination in their hearts." http://bit.ly/aHn5v8

At least one member seems already to support Barton's bid. Oregon Rep. Greg Walden (R) was overheard at a GOP election night party telling Barton, "Come on backstage, Mr. Chairman!"

Shimkus or Upton could also take over the panel's powerful health subcommittee if they don't get the whole committee (Shimkus is currently the ranking member on health).

On Ways and Means, the only question is who gets the health subpanel. Rep. Wally Herger (Calif.) is the current ranking member and will automatically get to head the subcommittee if he so desires. There's been no indication that Herger would turn it down, but if he does sources say possible contenders include Reps. Charles Boustany (La.), Peter Roskam (Ill.) and Paul Ryan (Wis.). Conservative Rep. Tom Price (Texas), a doctor, is seen as likely to join the Ways and Means panel, but he probably wouldn't get the health chairmanship right off the bat.

Appropriations pulls the strings: While legislating panels will get much of the attention as they hold hearings on the healthcare reform law and debate repeal bills, the real power may well reside with appropriations panels. Already, Sen. Tom Harkin (D-Iowa) has warned that efforts to defund the bill will hit a brick wall in his Appropriations health subpanel. http://bit.ly/adIIai

But Republicans will still go full steam ahead with those efforts in the House. The health subpanel will seek a new chairman after ranking member Todd Tiahrt (Kan.) lost his primary to Jerry Moran. Several ranking members on lesser subpanels could have a shot, but some sources suggest Republicans might want a woman's touch as it makes the case for defunding healthcare reform and push-back against the inevitable accusations of heartlessness.

Possible contenders: Rep. Kay Granger (Texas), the ranking member on the subcommittee on state, foreign operations and related programs. And Rep. Jo Ann Emerson, the ranking member on the financial services and general government subpanel, can claim the to have the support of the 71 percent of Missourians who voted to reject the law's individual mandate in the August primary.

Healthcare reform lawsuit moves forward: Motions for summary judgments were filed Thursday night in the national lawsuit challenging the constitutionality of the healthcare reform law's individual mandate. The lawsuit was brought by 20 states and the National Federation of Independent Business; oral arguments will be held Dec. 16.

"Voters across the country signaled their distaste for the new healthcare law this week," Karen Harned, executive director of the National Federation of Independent Business's Small Business Legal Center, said in a statement. "They understand that it is fundamentally un-American for our government to force individuals to purchase a product from a private party against their will, and they strongly signaled that they don’t want the federal government to have this much power over their individual decisions. These are key issues at stake in the national lawsuit against the healthcare law brought by NFIB and 20 states. 

Separately, as many as six of the 11 states — including Wisconsin, Oklahoma and Wyoming —that switched to Republican governors Tuesday night are considering joining the lawsuit, reports The Wall Street Journal. It might be too late, though. http://on.wsj.com/9qarKN

Medicare premiums set: The Centers for Medicare and Medicaid Services (CMS) has set the Medicare premiums, deductibles and co-insurance amounts to be paid by Medicare beneficiaries in 2011. Premiums for about 10 percent of seniors will increase by 4.4 percent, explains Forbes. http://bit.ly/bkKBTG

Prevention regulations move forward: CMS released a final rule that implements portions of the healthcare reform law that provide greater access to Medicare’s coverage of preventive services. 

As a result of the new healthcare reform law, beginning on Jan. 1, people on traditional Medicare will no longer have to pay a co-pay, co-insurance or deductible to receive preventive services that are recommended with a grade A or B by the U.S. Preventive Services Task Force. The law does not require Medicare Advantage plans to cover these services without cost-sharing, but many plans already do so. 

The rule also implements an annual wellness visit, a new benefit under Medicare, for which Medicare consumers will pay nothing out of pocket. During this yearly visit, doctors can update a patient’s care plan, screen for cognitive impairments, and measure height, weight and blood pressure, as well as other needed measurements based on the person’s family and medical history. 

"To have preventive services available at no cost to people with Medicare is not only an improvement to the Medicare program, but also encourages both providers and patients to think about healthcare in a new way," said Joe Baker, president of the Medicare Rights Center. "By encouraging people to take steps to prevent illness, the law promotes efficient, higher-quality, patient-centered care."

Examples of Medicare-covered preventive services that will no longer require people to pay out of pocket include: screening mammographies, tests such as colonoscopies and barium enemas to screen for colorectal cancer, and Pap tests to screen for cervical cancer. http://bit.ly/a5gVTV

Rep. John Shimkus (R-Ill.) will seek the Energy and Commerce Committee chairmanship if Rep. Joe Barton (Texas) — the panel’s senior Republican — is denied the role when the GOP takes control of the House next year, an aide said.

“Yes, he [Shimkus] will pursue the chairmanship if Mr. Barton does not receive a waiver,” said Shimkus spokesman Steve Tomaszewski on Thursday. “He has started reaching out to members of the Steering Committee and he will be contacting his colleagues shortly.”

Barton’s bid is complicated by House GOP caucus rules that prevent members from serving more than three consecutive terms — or six years — in a top committee slot.

Enrollees in traditional Medicare will save more than $3,500 on average over the next 10 years, according to a new report released Thursday by the Department of Health and Human Services.

For seniors and people with disabilities who have high prescription-drug costs, savings should be even higher — as much as $12,300. Savings will be greatest for beneficiaries who reach Medicare's infamous prescription-drug "doughnut hole." 

Total savings per beneficiary enrolled in traditional Medicare are estimated to be $86 in 2011, rising to $649 in 2020. For those in the doughnut hole, estimated savings increase from $553 in 2011 to $2,217 in 2020.

The report does not cover the 11 million seniors who have private Medicare Advantage plans, however. Those beneficiaries, according to an analysis released last month by the program's chief actuary, can expect to see their out-of-pocket costs steadily increase until 2017, to a high of $923 that year, before falling to $873 in 2019.

"The Affordable Care Act makes Medicare stronger and reduces the burden of healthcare costs on some of our most vulnerable citizens," HHS Secretary Kathleen Sebelius said in a statement. "The law improves benefits for seniors and people with beneficiaries who rely on Medicare and ensures that Medicare will be there for current and future generations by extending the life of the Medicare Trust Fund. These benefits and savings are only possible with the continued implementation of the Affordable Care Act."

The White House does not think President Obama will have to veto legislation repealing his signature legislative accomplishments.

A well-placed Senate Democrat warned Thursday that efforts to scale back the new healthcare reform law will hit a brick wall in the upper chamber.

Sen. Tom Harkin (D-Iowa) — chairman of both the Senate Health Committee and the Appropriations health subpanel — said proposals to repeal or defund the reforms have little chance getting through the committees he heads.

“Republicans are seriously misreading this election if they claim a mandate to drag us back to the days of out-of-control health care spending and insurance company abuses and discrimination," Harkin said in a statement. "Ordinary Americans will not stand for it, and neither will I."

Coming from one of the architects of the healthcare law, Harkin's comments are no surprise. Still, they're a reminder that Republicans — who ran practically unanimously on a platform of repeal this election cycle — have a near-impossible road ahead to make good on that campaign promise.

Republicans are already acknowledging that full repeal is unlikely any time soon. 

Senate Minority Leader Mitch McConnell (R-Ky.) said Thursday that Republicans "may not be able to bring about straight repeal in the next two years, and we may not win every vote against targeted provisions, even though we should have bipartisan support for some.” But, he added, party leaders will force Democrats "to defend this indefensible health spending bill."

The comments are some concession that full repeal will likely never happen. Under the new law, different provisions take effect gradually over the next decade, but many of the patient protections were front-loaded to start this year and next. As more consumers experience those benefits first-hand, it will become that much harder for critics to take them away.

Democrats, for their part, appear to recognize the GOP's dilemma.

"It is sad that senior Republicans are saying their No. 1 priority is to repeal the new health reform law and put health insurance companies back in the driver’s seat," Harkin said Thursday. 

"Frankly, I don’t think working Americans will stand for a Republican crusade to take away the benefits and protections in the new health reform law."

Conservatives made the case for repealing healthcare reform at two separate think-tank events Thursday.

Several panelists at a Hudson Institute forum on whether Congress can repeal healthcare reform when the Senate and the presidency remain in Democrats' hands said it's important for House Republicans to make incremental changes to the bill to show voters what the GOP's solutions are. But they also urged Republicans to keep in mind that their eventual goal is repealing the bill.

"You don't want to improve the bill," said James Capretta, a former Office of Management and Budget staffer. "The bill is unredeemable."

Capretta said Republicans should be able to build bridges with centrist Democrats by proposing specific fixes. That could "isolate" the White House and make it harder to veto stand-alone provisions that have bipartisan support.

These could include: 

• Delaying cuts to Medicare Advantage until 2013, offset by delays to the subsidies for people to buy insurance;

• A straight repeal of the Independent Payment Advisory Board, which is charged with recommending cuts if Medicare costs grow too fast;

• Amending the law's language regarding Accountable Care Organizations by having seniors on Medicare consent to being assigned a specific managed-care type setting based on the pattern of care that they need; and 

• Giving states more flexibility in how to implement the law.

Meanwhile, Senate Minority Leader Mitch McConnell (R-Ky.) was invited to address the Heritage Foundation.

"Over the past week," he said in prepared remarks, "some have said it was indelicate of me to suggest that our top political priority over the next two years should be to deny President Obama a second term in office. But the fact is, if our primary legislative goals are to repeal and replace the health spending bill; to end the bailouts; cut spending; and shrink the size and scope of government, the only way to do all these things it is to put someone in the White House who won't veto any of these things. We can hope the president will start listening to the electorate after Tuesday's election. But we can't plan on it.

"On healthcare, that means we can — and should — propose and vote on straight repeal, repeatedly. But we can't expect the president to sign it. So we'll also have to work, in the House, on denying funds for implementation, and, in the Senate, on votes against its most egregious provisions."

Medicaid Health Plans of America on Thursday announced the launch of its Center for Best Practices, a nonprofit affiliate organization dedicated to research, quality improvement and dissemination of health plans’ best practices in the areas of both clinical and operational performance.

"MHPA’s members have already made great strides towards improving the health of the underserved," said Charlotte MacBeth, President and CEO of MDwise, an MHPA member non-profit plan and chairwoman of the Center for Best Practices. "The collection of their best practices in MHPA’s annual Best Practices Compendium is evidence of those strides. Given how valuable a resource the Compendium is, establishing the Center, which will have a more active role in educating the healthcare community in innovative best practices, is the logical next step in promoting our industry’s contributions to health care."

Post-election bipartisan cooperation is off to a rocky start.

The office of Senate Majority Leader Harry Reid (D-Nev.) is blasting Sen. Mitch McConnell (R-Ky.) over the GOP's plans to repeal the health-reform law. 

The Democrats are highlighting the notion that repeal would eliminate a long list of popular consumer protections included in the measure. Read more...

The health reform law's new discounts and rebates for prescription drugs in Medicare and Medicaid will have varying but limited effects on beneficiaries' pocketbooks, Congress's budget scorekeeper said Thursday. Older Americans who reach the infamous Medicare "doughnut hole," however, should benefit substantially.

The new law "requires manufacturers of brand-name drugs to provide new discounts and rebates for drugs purchased through Medicare and Medicaid, with the amount of those discounts and rebates based on the prices of the drugs," the Congressional Budget Office explains in a letter to House Budget Ranking Member Paul Ryan (R-Wis.), who requested the information. "Manufacturers thus have an incentive to raise those prices to offset the costs of providing the new discounts and rebates, although other forces will limit their ability to do so."

CBO estimates Medicare provisions will raise drug prices by about 1 percent, making "federal costs for Medicare’s drug benefit and the costs faced by some beneficiaries slightly higher." The 50 percent rebate in the Medicare "doughnut hole," meanwhile, should be so substantial that most seniors who reach that level should pay less overall for their drugs, even after factoring in the higher prices they'll pay for the portion of drugs consumed before reaching the doughnut hole. 

Medicaid, meanwhile, should pay less for drugs because of new rebates in that program.