Dems, consumer groups welcome Patient's Bill of Rights: Six months ago tomorrow the Democrats passed their healthcare reform bill into law — an anniversary most significant for the arrival of many of the insurance reforms that were central to the mammoth bill.

On Wednesday, President Obama will mark the imminent anniversary by meeting with a handful of patients benefiting from the changes, including a previously uninsured New Hampshire woman with non-Hodgkin's lymphoma who's now enrolled in a high-risk insurance pool.

The White House this week also plans to release reports indicating how the reforms will affect each state, and to launch an overhauled website (www.WhiteHouse.gov/HealthReform) detailing the changes.

The reforms taking effect Thursday will:

• Ban insurance companies from denying coverage for kids based on preexisting conditions. (In 2014, this rule will be expanded to apply to patients of all ages.)

• Prohibit insurers from using unintentional application errors to drop coverage when patients get sick.

• Allow young adults to remain on their parents' health plans until age 26.

• Prohibit plans from setting lifetime dollar limits on coverage. (In 2014, annual limits will be banned as well.)

• And require all new health plans to cover a minimum set of preventive care services.

All but the last provision apply to all insurance plans, even those in existence when the law was enacted in March.

Good news for MA patients, taxpayers: Tuesday's news that Medicare Advantage (MA) plans will offer more benefits next year at a lower cost to patients brought cheers from a group that's been critical of the program since its inception seven years ago: liberal Democrats.

"Medicare Advantage beneficiaries will actually get more benefits from their plans, not less," Rep. John D. Dingell (D-Mich.) said in a statement. "And the insurers are not suffering because of the changes – they are gaining new enrollees."

The figures fly in the face of reform critics who'd warned that requiring MA plans to cover additional benefits would inevitably cause premiums to jump. Instead, Medicare officials were able to leverage the bulk-purchasing power of more than 11 million MA beneficiaries to negotiate lower costs for the same folks. Read more...

President Obama will drop by an administration meeting with state insurance commissioners on Wednesday ahead of his comments on the six-month anniversary of healthcare reform. Topics under discussion will include health insurance rate review, the definition of what constitutes "unreasonable" rate increases and the medical loss ratio, senior administration officials said.

The medical loss ratio conversation could be especially important, one policy analyst notes, because the National Association of Insurance Commissioners subpanel tackling the issue is expected to release draft legislation by Monday. The NAIC is set to vote on the regulation next month following a public comment period.

The administration does not want to publicly override the commissioners, the analyst said, so it makes sense to iron out any differences before the commissioners send their product to the secretary of Health and Human Services for certification. Last month, the chairmen of the House and Senate committees of jurisdiction over healthcare said only that taxes pertaining to the healthcare reform law should be excluded when calculating the ratio; the NAIC is leaning in the direction of excluding many more taxes, which means health plans wouldn't have to spend as much on care to meet their medical loss ratio requirements under the new law.

But NAIC President Jane Cline tells The Hill that the administration has not weighed in on the tax piece of the ratio. Cline, the West Virginia insurance commissioner, added that she does not expect the White House to do so Wednesday.

Administration officials, she said, "have been very respectful of our work."

"They recognize that it's important that we get the medical loss ratio definitions to them as soon as possible so that they have the opportunity to put forward their regulations and the industry knows what is expected of them," she said.

Under the health reform law, large group plans must spend at least 85 percent of premium dollars on care; plans in the small group and individual market have an 80 percent requirement. The provision applies to plan years starting in 2011, with rebates to consumers beginning in 2012.

Senate Finance Committee Chair Max Baucus (D-Mont.) has scheduled a hearing titled "Do Private Long-Term Disability Policies Provide the Protection They Promise?". The hearing will take place Tuesday.

The announcement comes a few days after House Energy and Commerce health Chair Frank Pallone (D-N.J.) vowed to launch an investigation into the skyrocketing cost of long-term health insurance.

Witnesses scheduled to testify include an actuary and a judge.

Senate Majority Leader Harry Reid (D-Nev.) on Tuesday offered to allow Sen. Tom Coburn to offer an amendment to pending food-safety legislation, but the Oklahoma Republican turned him down.

"If the Majority Leader wants the bill to advance he should pay for it," Coburn spokesman John Hart said. "Dr. Coburn isn't responsible for the Majority Leader's failure to write offsets into the base bill."

The legislation would give FDA the power to recall tainted food, quarantine geographical areas and access food producers’ records.

Coburn has been holding up the bill out of concerns over its $1.4 billion price tag over five years, not including $230 million directly offset by new fees. In the absence of guaranteed future appropriations, Coburn writes on his Web site, "at best we are just passing it for a press release, and at worse, we shackle the FDA with unfunded mandates."

Reid on Tuesday asked for unanimous consent allowing that, after consultation with the Republican leader, the Senate take up the bill with only three amendments in order: 

- An amendment by Sen. Jon Tester (D-Mont.) exempting small farms; 

- Sen. Dianne Feinstein's (D-Calif.) amendment restricting the use of the Bisphenol A chemical; 

- A Coburn amendment regarding "offset for cost of bill."

The Senate health committee released a bipartisan food-safety manager's amendment during the first week of the August recess. The House passed its bill in July 2009.

Sen. Tom Coburn, a physician, said he's stopped delivering babies because malpractice insurance "is too expensive."

The healthcare reform law falls far short of reforming a healthcare payment system that is bankrupting the nation, but progress remains possible, lawmakers and physicians agreed Tuesday at a panel on payment reform.

Sen. Tom Coburn (R-Okla.) launched the discussion, hosted by The Hill and sponsored by the American College of Cardiology, by acknowledging "we have designed exactly the tragedy that we have" — namely, a payment system, largely driven by Medicare, that pays for quantity rather than quality of care. That argument was repeated throughout the healthcare reform debate, but Coburn, a family physician, advocated for specific steps: 

• encourage physicians to spend more time with their patients by changing billing codes to consider time, skills sets and outcomes;
• create pilot programs in federal health programs that reward physicians who order fewer tests without decreasing the quality of care they provide; and 
• address the issue of medical liability.

Rep. Brian Baird (D-Wash.), a clinical psychologist, repeated his call for ending Medicare and Medicaid. His alternative would cover everyone by replacing the unwieldy array of federal and state health insurance programs with a needs-based voucher system.

Baird held out on supporting the healthcare reform law until the last minute because it fails to overhaul the existing programs. But he defended several provisions of the new law, particularly comparative effectiveness research he said is vital to rewarding quality care and keeping costs under control.

"Sadly," he said, "it is easy to sometimes demagogue that and say, 'Well, somebody wants to tell your doctor what they can do for you.' Well, if the doctor isn't doing what is right for you, maybe somebody ought to tell them that."

The House Oversight Committee wants the Food and Drug Administration (FDA) to testify later this month on its role in the "phantom recall" of Motrin in 2008.

In that under-the-radar episode, Motrin manufacturer Johnson & Johnson hired private contractors to buy up defective pills directly from retailers' shelves.

ABC News reported Monday that e-mails sent between J&J executives suggest that some FDA officials knew of the strategy, but didn't take steps to force a broader recall until months later.

The news didn't escape Rep. Darrell Issa (Calif.) — the senior Republican on the House Oversight Committee told ABC the FDA needs to answer to the allegations.

“Johnson and Johnson’s not off the hook," Issa told ABC Monday, "but neither is the FDA for being too cozy with industry and not forthcoming with Congress."

In response, Oversight Chairman Edolphus Towns (D-N.Y.) on Monday requested that FDA Principal Deputy Commissioner Joshua Sharfstein testify at a previously scheduled Sept. 30 hearing on the Motrin recall.

Towns has also asked the FDA "to provide the committee with copies of its records relating to Johnson & Johnson’s phantom recall of Motrin, including all communications between Johnson & Johnson/McNeil employees and employees of the FDA from January 2009 to June 2009," according to a statement.

Johnson & Johnson CEO William Weldon is also scheduled to appear.

Enrollment in the controversial Medicare Advantage (MA) program will increase by 5 percent in 2011, while average premiums will drop by 1 percent, the Obama administration announced Tuesday.

White House health officials said the numbers indicate that — despite threats from conservatives and the insurance industry that the new healthcare reform law will cripple MA plans at the expense of seniors — both patients and taxpayers will benefit from the reforms.

"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," Donald Berwick, head of the Centers for Medicare and Medicaid Services (CMS), said in a statement. “The Affordable Care Act gave us new authority to negotiate with health plans in a competitive marketplace. As a result, our beneficiaries will save money and maintain their benefits."

The MA program — under which the government pays private insurance companies to cover Medicare patients — has been a lightening rod of controversy since its creation in 2003. Seniors have flocked to MA plans because many of them cover services, like dental and eye care, that Medicare doesn't.

But the extra care hasn't come cheap. Despite promises that private plans operating under MA could eventually save money, the cost to treat the average MA patient is roughly 14 percent higher than the cost to treat the average senior under traditional Medicare. 

The Medicare Payment Advisory Commission, an independent panel that suggests reforms to Congress, has noted that part of the additional cost “consists of funds used for plan administration and profits and not direct health care services for beneficiaries.”

Such statements have fueled criticisms from patient advocates and consumer groups that MA is just a giveaway to insurance companies. Many Democrats tend to agree, and the new reform law cuts MA subsidies substantially over the next decade.

As part of that effort, Medicare will freeze payments to MA plans next year, before actual cuts take effect further down the line.

The freeze has done little to discourage plan participation, CMS said Tuesday, largely crediting the insurance companies themselves. 

"The plans are making very strong commitment to their programs," Jonathan Blum, director of CMS’s Center for Medicare, told reporters in a phone call. "We're seeing better value for beneficiaries and for taxpayers."

Among the other revelations Tuesday: 

• About 5 percent of MA enrollees will have to choose new plans in 2011, largely resulting from MA reforms enacted in 2008. Of those seniors, all but 2,300 will have the option of choosing another MA plan; 

• 99.7 percent of Medicare beneficiaries will have access to an MA plan in 2011;

• Of the roughly 2,100 MA plans submitting 2011 bids, CMS identified 300 that had proposed to hike premiums or other cost sharing on seniors, while also increasing their profit margins. After CMS threatened to deny those plans, all but seven plans reworked their bids to the benefit of seniors.

"Plain and simple, insurance companies can't be trusted," Ways and Means health panel Chair Pete Stark (D-Calif.) said Tuesday in the latest salvo after health plans announced they were dropping their children's coverage.

Several major insurance companies — including WellPoint, Cigna and CoventryOne — have decided to stop issuing children's policies just days before the start of new rules forbidding them from turning down sick children. The prohibition is among several provisions of the healthcare-reform law that kick in Thursday and that Democrats plan to highlight ahead of the midterm elections.

Democrats are especially galled by the announcement because the industry's lobbying arm, America's Health Insurance Plans, had appeared to support the measure.

"Six months ago, the insurance industry trade association promised that their members would 'fully comply' with the provision in the health reform law outlawing discrimination against children with pre-existing conditions, " Stark said in a statement. "Now with this consumer protection about to go into effect, we find out they didn't really mean it. The insurance industry has once again shown their reckless disregard for the well-being of consumers, which is why we need the health reform law that holds them accountable."