Florida's 14-member insurance advisory board has unanimously passed a resolution to seek a waiver from the health reform law's medical loss ratio.

An official with the Florida Office of Insurance Regulation tells The Hill that the board's vote means it's a "done deal" that the state will formally seek some kind of waiver but the board is gathering public input through Oct. 8. The resolution was adopted Friday during a hearing on the medical loss ratio, requested by Insurance Commissioner - and board chairman - Kevin McCarty.

Florida would become the third state to request a waiver, following Maine and Iowa. The health reform law requires health plans to spend at least 80 percent of premiums (85 percent in the large-group market) on care or give consumers rebates starting in 2012.

McCarty called the evidentiary hearing with the stated purpose of gathering ammunition for a formal waiver request. He said federal regulators demanded detailed testimony if they're going to entertain granting a waiver or phase-in.

"I am concerned that the Medical Loss Ratio requirements included in the Affordable Care Act could cause disruptions in the Florida health insurance marketplace," McCarty (R) said in a statement. "I am especially concerned about how the MLR requirements will affect the role of health care agents who are critically necessary to help consumers in this increasingly complicated health care landscape."

Representatives from Aetna, AvMed Health Plans, Golden Rule (a subsidiary of United Healthcare) and U.S. Health Plans testified, as did the agent trade group National Association of Insurance and Financial Advisors. The Florida Alliance for Retired Americans offered a lone voice of support for the medical loss ratio, defending it as an important tool to help control healthcare costs.

The House this week is scheduled to take up legislation to prevent paid medical debts from affecting consumers' credit scores.

Sponsored by Rep. Mary Jo Kilroy (D-Ohio), the proposal would prohibit credit-rating agencies from considering past medical debts when calculating those scores.

"People shouldn’t have their credit worthiness suffer because they got sick or injured,” Kilroy said in introducing the bill last year. "It is outrageous that bills for as little as a one-dollar dispute with insurance companies are driving up the mortgages of my constituents.”

Roughly 72 million working-age Americans (41 percent) owed medical debt in 2007, up from 34 percent just two years earlier, according to the Commonwealth Fund. 

On top of that, 7 million seniors were also paying accumulated medical debts that year, the researchers found. Although the trend affected low and moderate income families disproportionately, all income levels saw rising debts.  

More than 60 percent of the patients with debt were insured at the time they received treatments, the Commonwealth Fund reported.  

Kilroy's proposal is one of 63 bills on the House suspension calendar this week. 

A Senate companion bill, sponsored by Sen. Jeff Merkley (D-Ore.), is idling in the Banking Committee. 

The Department of Health and Human Services on Monday announced $68 million in grants to support community living for seniors and individuals with disabilities. The grants are funded through the healthcare reform law.

"The funds will be used to help seniors and individuals with disabilities and their caregivers make more informed decisions about their health and long-term care," according to HHS. "Specifically, the funds will be used to help families: understand their Medicare and Medicaid benefits, including coverage for preventive services; navigate options for long-term care including community-based services that can help individuals remain in their homes; and assist those transitioning from nursing or rehabilitation facilities back home to put the supports in place to make that transition successful."

The grants focus on four areas:

- Medicare outreach: 50 states and territories and 125 tribal organizations funded to provide outreach and assistance to Medicare beneficiaries on their benefits, including coverage for preventive services ($40 million). Additionally, $5 million goes to the National Center for Benefits Outreach and Enrollment for technical assistance;

- Counseling grants: 20 states funded to strengthen programs of the Aging and Disability Resource Centers for community-based health and long-term care services ($10 million);

- Transition grants: 24 state Medicaid agencies helped to transition individuals from nursing homes to community-based care ($10 million);

- Home-care grants: 16 states funded to coordinate and continue to encourage evidence-based care transition models that help older persons or persons with disabilities remain in their own homes after a hospital, rehabilitation or skilled-nursing-facility stay ($3 million).

Childhood nutrition fight looms: With the federal childhood nutrition program ending Thursday and just one week left on the House calendar, lawmakers will be under intense pressure all week to reauthorize the law. Children's advocates want the House to pass the Senate's $4.5 billion bill, but liberal Democrats and some anti-poverty advocates are balking at a $2 billion future cut in food stamps to pay for the bill. http://bit.ly/8ZbmLa

Late last week, the Society for Nutrition Education wrote to House Education and Labor Committee Chair George Miller (D-Calif.) to defend the reauthorization as a key tool to fight childhood obesity - the goal espoused by First Lady Michelle Obama in her Let's Move campaign.

"We strongly encourage the House to take action this week to pass this important legislation," reads the letter. "Not only will this bill increase access, it will improve the quality of meals in schools, set the stage for strong standards so that soda and candy are not readily available to school children in vending machines and schools stores, and, it will give local school agencies more tools and resources to strengthen school wellness policies to improve physical activity and nutrition education."

Margo Wootan, director of nutrition policy at the Center for Science in the Public Interest, argues that the bill does not cut but rather sunsets a temporary increase in the food stamp program five months earlier than anticipated (in October 2003 instead of March 2004). She points out that Democrats already advanced the sunset date by an entire three years to pay for state Medicaid aid in August.

"With the September 30 deadline quickly approaching, the House of Representatives is running out of time to pass child nutrition legislation and improve the health and well-being of our nation’s children," she told The Hill over the weekend. "If Congress resorts to an extension for the programs, important advances for child nutrition may be lost for good. Our kids simply can’t wait."

HHS updates guidance on children's policies: The Department of Health and Human Services has updated its guidance on regulations governing children's policies after several health plans announced they would no longer sell new policies because the health reform law bans them from turning down children with pre-existing conditions. Regulations already allow open enrollment periods, in compliance with state law, to prevent families from waiting until children are sick before enrolling them but HHS clarified Friday that it may adopt a nationwide policy. http://bit.ly/91zBmn

"To require a uniform open enrollment period for child-only policies would require a change in the existing regulations," reads the updated guidance. "The Administration would consider making such a change if it would result in issuers continuing to sell child-only plans."

The new guidance also clarifies that the following actions are not precluded by existing regulations:

- Adjusting rates for health status only as permitted by State law;

- Permitting child-only rates to be different from rates for dependent children, consistent with State law;

- Imposing a surcharge for dropping coverage and subsequently reapplying if permitted by State law;

- Instituting rules to help prevent dumping by employers to the extent permitted by State law;

- Closing the block of business for current child-only policies if permitted by State law; and

- Selling child-only policies that are self-sustaining and separate from closed child-only books of business if permitted by State law.

The guidance also states that the administration "would welcome" legislation being considered by some states requiring individual-market issuers that offer family coverage to also offer child-only policies.

Regulatory free-for-all: Insurance plans, patient advocates and the health industry will be preparing their comments throughout the week after having had time to digest the National Association of Insurance Commissioners' (NAIC) draft medical loss ratio regulations. The healthcare reform law mandates that health plans spend at least 80 percent of premiums on medical care (85 percent in the large-group market) and the state insurance commissioners are tasked with ironing out the details. Comments are due by Oct. 4.

The big questions: Will the insurance industry get some flexibility towards allowing aggregated ratio and counting fraud prevention and utilization review as medical expenses? Will House and Senate Democrats get the commissioners to change their minds and deduct only healthcare taxes when calculating the ratio? http://bit.ly/bV9qjD

Phase-in requested: Even as the health sector weighs in on state commissioners, the NAIC itself is trying to persuade federal regulators to allow a phase-in period for the individual market. Florida Insurance Commissioner Kevin McCarty held an evidentiary hearing Friday to help make the case for a phase-in by gathering oral and written testimony and affidavits from insurance companies as to how the medical loss ratio requirement would disrupt the market. http://bit.ly/clCdmG

Here to explain it all: Rep. Michael Burgess (R-Texas) invites Brian Webb of the NAIC and Janet Trautwein of the National Association of Health Underwriters (the industry group for insurance agents and brokers) to explain the medical loss ratio during Tuesday's meeting of his Health Care Caucus. http://bit.ly/dy1JAf

White House strategy: Meanwhile, the Obama administration continues to try to sell the health reform law ahead of the mid-term elections. Today, Health and Human Services Secretary Kathleen Sebelius will be in Henderson, Nev. promoting the law along with the state's two Democratic House members, Dina Titus and Shelley Berkley. http://bit.ly/c6K3cY

Titus, a first-term lawmaker, is running neck-and-neck with Republican challenger Joe Heck in the race for Nevada's 3rd District seat. http://bit.ly/bhLsia. Health reform is becoming a major factor less than six weeks before the election, with Heck calling for repeal of the law (http://bit.ly/d2MvpI) and Titus taking to her campaign Web site to defend health reform's consumer protections and deficit reduction (http://bit.ly/cOSuW2).

The race for the U.S. seat, meanwhile, is still a toss-up between Senate Majority Leader Harry Reid (D) and Sharron Angle (R). http://bit.ly/9pcp5Q

In other polling news: Voters who say the new health reform law was too conservative outnumber by 2 to 1 those supporting repeal, according to a poll released Saturday. About 40 percent of respondents said the law was too timid in overhauling the nation's healthcare system, while 20 percent said they'd like to see it scrapped, according to the survey, commissioned by the Associated Press. http://bit.ly/czR9Yc

Administration's response on antibiotics anticipated: Two senior Democrats are expecting answers from Agriculture Secretary Tom Vilsack after controversial comments regarding efforts to restrict the use of antibiotics in animal agriculture. Sen. Dianne Feinstein (D-Calif.) and Rep. Louise Slaughter (D-N.Y.) say Vilsack mischaracterized both their legislation and the position of his own department in comments he made about one of their bills to the National Cattlemen's Beef Association. http://bit.ly/c07eut

Fight over Medicare Advantage heats up: A quartet of Senate Republicans is calling on Medicare's top accountant to release the numbers behind his analysis of health reform's impact on the Medicare Advantage (MA) program. The lawmakers — Sens. Charles Grassley (R-Iowa), Jon Kyl (R-Ariz.), Orrin Hatch (R-Utah) and Mike Crapo (R-Idaho) — say the steep cuts to MA under the new reform law will cause many plans to fold, while many others will be forced to drop benefits to remain profitable. http://bit.ly/aCKcjK

College health plans under scrutiny: Many college health plans not only offer paltry coverage, reports the Wall Street Journal, but also managed to avoid many of the new regulations of the healthcare reform law - perhaps even permanently. http://bit.ly/dw0QiG

A quartet of Senate Republicans is calling on Medicare's top accountant to release the numbers behind his analysis of health reform's impact on the Medicare Advantage (MA) program.

The lawmakers — Sens. Charles Grassley (R-Iowa), Jon Kyl (R-Ariz.), Orrin Hatch (R-Utah) and Mike Crapo (R-Idaho) — say the steep cuts to MA under the new reform law will cause many plans to fold, while many others will be forced to drop benefits to remain profitable. 

In April, Richard Foster, chief actuary at the Centers for Medicare and Medicaid Services (CMS), issued a report that largely supported those claims. 

"The new provisions will generally reduce MA rebates to plans and thereby result in less generous benefit packages," the report stated. "We estimate that in 2017, when the MA provisions will be fully phased in, enrollment in MA plans will be lower by about 50 percent (from its projected level of 14.8 million under the prior law to 7.4 million under the new law)."

Currently, about 11 million seniors are enrolled in MA plans.

In a Sept. 24 letter to Foster, the GOP lawmakers requested all the internal number-crunching that resulted in those estimates. They've also asked for a breakdown of the effects on "rural versus urban areas," as well as "an estimate of how much less [MA] plans will be able to spend per member per month on reduced cost-sharing and extra benefits." 

The purpose, the senators wrote, is "to ensure that seniors are fully aware of how the health reform law will affect current and future Medicare Advantage enrollees."

The letter arrived just a few days after the Obama administration announced that enrollment in MA plans is projected to jump 5 percent next year, while average premiums will fall by 1 percent. Those figures, CMS officials said, belie the charges that the new law will cut benefits and hike costs. 

"Despite the claims of some, Medicare Advantage remains strong and a robust option for millions of seniors who choose to enroll or stay in a participating plan today and in the future," said CMS Administrator Donald Berwick.

The MA program — under which the government pays private insurance companies to cover Medicare patients — has been controversial since its creation in 2003. Enrollment in the program has skyrocketed, largely because many MA plans cover services, like dental and eye care, that traditional Medicare doesn't.

But the additional benefits have come with a cost. Despite initial promises that MA plans would eventually cost taxpayers less than the traditional program, the average MA patient costs roughly 14 percent more than the average senior under Medicare. 

The Medicare Payment Advisory Commission (MedPAC), an independent panel that suggests reforms to Congress, has been critical of the discrepancy, noting that a portion of the extra taxpayer cost “consists of funds used for plan administration and profits and not direct health care services for beneficiaries.”

MedPAC's analysis has fueled Democratic criticisms that MA is just a gift to insurance companies, and the new reform law cuts MA subsidies by roughly $145 billion over the next 10 years.

Next year, Medicare will freeze MA payments at current levels, before actual cuts take effect in 2012 and beyond. 

The Republicans have asked that Foster provide the information by Oct. 8.

The $4.5 billion bill was expected to come up this week, but liberals balked at cutting food stamps to pay for it.

Secretary of Labor Hilda Solis this week warned the mining lobby that worker safety is the industry's responsibility — and the White House won't tolerate offenders. 

"The law is clear," Solis told the executive board of the National Mining Association, an industry lobbying group. "Mine operators are ultimately responsible for the safety and health of everyone working in a mine. Period.

"We will not tolerate mines that cut corners on safety, put miners at risk, pay their fines, and view it as a cost of doing business," the California Democrat added. 

Solis was quick to note that many mine operators make worker safety the highest priority. For the others, she warned, "you need to change the way you approach mine safety — and you need to make those changes now."

The relationship between the mining industry and the White House — already chilly over the administration's steps to rein in mountaintop removal coal mining — have grown colder since April, when Massey Energy's Upper Big Branch (UBB) mine exploded in West Virginia, killing 29 workers.

Since that disaster, the Labor Department's Mine Safety and Health Administration (MSHA) has cracked down on safety violators, launching a series of surprise inspections and even shuttering several operations. 

Just this week, the agency tightened rock-dusting standards for coal mines — rules that aim to prevent the accumulation of highly combustible coal dust underground. 

Many in the industry, however, are pushing back against the new scrutiny. Just last week, for instance, Massey blamed its low production estimates on "increasingly stringent enforcement actions by MSHA."

Democrats are pushing legislation in both chambers that would install even more worker protections, hiking the penalties for safety violations, protecting whistleblowers who report hazards and empowering inspectors to close mines more easily.

Solis this week urged mine companies to get behind the reforms, rather than siding knee-jerk with the worst safety offenders in the industry. 

"It’s what we’ve seen repeated, time and time again – a disaster happens, the public is outraged, Congress and the regulators propose reform, and industry fights back," Solis said. "The problem with the 'industry-versus-the-government' approach, is that it lets the bad actors set the terms of the debate, and become the face of your industry.

"Any industry that tolerates bad actors," Solis said, "will ultimately find itself subject to regulations designed to target those bad actors."

Voters who say the law was too conservative outnumber by 2 to 1 those supporting repeal, according to a poll released Saturday.

Doctors in Maine are upset at their Florida colleagues' criticism of the American Medical Association for endorsing the healthcare reform law without getting enough in return.

The Maine Medical Association argues that Florida doctors' official expression of "no confidence" in the AMA's leadership risks weakening the organization's ability to "effectively advocate for physicians and the patients they serve."

"This action threatens the very principles that our AMA was founded upon," they argue.

"A football team whose members brawl among themselves will not win. A country whose elections are followed by secession attempts will not survive. A divided medical community will not be relevant," the Maine group's president and chairman write in a letter to Ardis Hoven, the chair of the AMA Board of Trustees. "The upcoming rulemaking process is an opportunity, which may not be seen again for decades. Now is not the time to squander our influence in petty bickering."

The Florida Medical Association considered splitting from the AMA over the summer because the national group wasn't able to make progress on two of its top priorities — overhauling the Medicare physician payment system and medical malpractice reform — despite endorsing the bill.

In the end, the FMA opted to send a sharply worded letter to share its "strong message of dissatisfaction with the AMA leadership" for supporting healthcare reform and its "serious reservations about the AMA's effectiveness and its ability to represent the physicians' interests."