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."

Sen. Dianne Feinstein (D-Calif.) and Rep. Louise Slaughter (D-N.Y.) want Agriculture Secretary Tom Vilsack to "clarify" comments he made about their bill.

The Obama administration on Friday said it will delay a controversial rule designed to prevent students at for-profit colleges from defaulting on their federal loans.

The Department of Education had initially set a Nov. 1 deadline for finalizing its so-called "gainful employment" rule — which would hinge eligibility for federal financial aid on the debt-to-earnings ratio of recent graduates. Instead, the agency will push the timeline to "early 2011" — a response to the tens-of-thousands of public comments the proposal attracted.

The effective date of the provision remains unchanged: July of 2012.

"We want to be as thoughtful as possible as we move forward," DOE Secretary Arne Duncan said in a statement.

"We're taking additional time to analyze all the feedback we've received to help us strike the right balance between holding these programs accountable to protect students and taxpayers from abuse and making sure we keep whole those programs that are doing a good job." 

The decision will come as welcome news to scores of Capitol Hill lawmakers, who had registered their opposition to the gainful employment proposal in letters to Duncan earlier this month. 

Even some lawmakers fully behind of the controversial rule said they're supportive of the delayed finalization. Sen. Tom Harkin (D-Iowa), chairman of the Senate education panel, said he's "encouraged" by the agency's "commitment to the implementation of a strong gainful employment regulation." 

Proposed last July, the gainful employment rule would require for-profit programs to demonstrate that graduates' annual loan payments don't exceed 8 percent of their starting salaries. The idea is to ensure that professional students can make enough money in their fields to pay back the debt they accrue during training — an issue of importance to taxpayers, who provided about $24 billion in federal loans and grants to career college students last year. 

Under the proposal, those programs failing to meet the standard could lose access to the federal aid.

The proposal is largely a response to the rising default rate among students receiving certificates and degrees from the nation's exploding career college industry. But it also follows a series of reports suggesting that aggressive recruiting, shady marketing practices, and even fraud are common tactics within the industry.

The gainful employment proposal is the most controversial of 14 rule changes put forth by the DOE this summer in response to those reports. The agency said it still intends to finalize the other 13 guidelines by Nov. 1, allowing them to take effect July 1, 2011. 

Moreover, DOE is pushing to finalize some elements of the gainful employment rule by the original Nov. 1 deadline.

One element of that rule the agency hopes to have in effect next summer would require for-profit schools to reveal each program's graduation and job placement rates to prospective students.

This post was updated at 3:01 pm and 3:50 pm.

A pair of House lawmakers this week introduced legislation designed to improve regenerative medical practices — the field that aims to create living tissue to repair and replace damaged tissues and organs.

Reps. Mike Castle (R-Del.) and Diana DeGette (D-Colo.) said their proposal, which would authorize $850 million toward regenerative medicine research, will help tackle some of the country's most pressing healthcare troubles, including the perennial shortage of organs available for transplant.

"From diabetes to spinal cord injuries and ALS to cancer, regenerative medicine has the potential to help solve some of our most troubling medical conditions, and the need for new products for patients has never been greater," the lawmakers said in a joint statement.

Specifically, the bill would:

• Require the government to report what steps it is taking to improve regenerative medicine.

• Create a panel to devise a national strategy for improving regenerative medicine.

• Create two grant programs through the National Institutes of Health to (1) encourage research collaboration between industry and academia and (2) offer funding to private companies "for basic research, pre-clinical studies and clinical trials."

• Offer grants through the Food and Drug Administration for "regulatory research."

"By fostering a national strategy for regenerative medicine," Castle and DeGette said, "this bill will provide new grant opportunities for academic-industry collaboration in this important field, and help ensure the United States is a leader in medical innovation."

The House passed four more healthcare bills on Thursday. They were part of a group of more than a dozen bills brought up under suspension on Wednesday that were postponed after roll-call votes were requested.

The bills are:

- The Training and Research for Autism Improvements Nationwide Act. The bill, sponsored by Rep. Mike Doyle (D-Pa.), authorizes $55 million in grants over five years for training to improve autism services. It passed 393-24.

- The Emergency Medic Transition Act of 2010. Sponsored by Rep. Jane Harman (D-Calif.), the bill authorizes grants worth $25 million over five years to help state entities provide for the expedited training and licensing of military veterans as emergency medical technicians. The bill passed 412-5.

- The Family Health Care Accessibility Act of 2010. The bill, sponsored by Rep. Tim Murphy (R-Pa.), extends federal liability protections to volunteers at Community Health Centers. It passed 417-1.

- The National All Schedules Prescription Electronic Reporting Reauthorization Act of 2010. Sponsored by Rep. Ed Whitfield (R-Ky.), the bill fosters the establishment of state-administered controlled substance monitoring systems. It passed 384-32.

Healthcare plans are raising several concerns with draft medical loss ratio regulations released Thursday, reports The Wall Street Journal.

The healthcare reform law requires small-group and individual market plans to spend at least 80 percent of premiums on medical care (85 percent in the large-group market) or offer customers rebates. The requirement begins in 2011, with rebates starting in 2012.

While insurers are satisfied that the draft allows them to deduct most taxes when calculating the ratio — congressional Democrats are pushing for a more restrictive definition — the plans have several concerns.

The industry had been pushing for an aggregated ratio reflecting all of a company's business units — some with high ratios, others with lower ones — the Journal reports; instead, the National Association of Insurance Commissioners' draft requires insurers to account for the ratios separately for every business unit in every state.

The draft also bars health plans from counting measures to combat fraud and review medical use as medical expenses. Spending on some non-medical costs, such as wellness activities, can be counted as medical expenses, however.

The NAIC is accepting comments on the regulations until Oct. 4 and hopes to adopt the regulation at its fall meeting later that month.

Let the tax war begin: The National Association of Insurance Commissioners (NAIC) on Thursday issued a long-awaited draft proposal defining what exactly qualifies as a medical cost under the Democrats' new health reform law.

Of interest, the group is proposing to count most federal and state taxes as medical costs (though "federal income taxes on investment income and capital gains" will be excluded). 

That concept runs at least partly counter to the wishes of leading Democrats on Capitol Hill, who wrote last month to HHS Secretary Kathleen Sebelius that the intent of the law was to count only those taxes and fees "that relate specifically to revenue derived from the provision of health insurance coverage that were included in [the bill]."

Signing that letter were Sens. Max Baucus (Mont.), Tom Harkin (Iowa) and Chris Dodd (Conn.), as well as Reps. Sander Levin (Mich.), Henry Waxman (Calif.) and George Miller (Calif.). http://bit.ly/aNNsrF

The Democrats are trying to force the insurers to spend more of their revenues directly on patient care, while the insurance lobby is fighting to maximize profits by urging a broader definition of what constitutes a medical cost.

Specifically, the new healthcare law requires insurance companies to dedicate at least 85 cents of each premium dollar to actual medical expenses in the large-group market. For the small-group and individual markets, the requirement drops to 80 cents. Plans that don't meet those thresholds are required to give rebates to their customers, beginning in 2012.

NAIC is accepting comments on its draft proposal through Oct. 3. http://bit.ly/btzh41

A compromise on Avandia: The Food and Drug Administration (FDA) on Thursday issued a much anticipated decision on the fate of Avandia, stipulating that the blockbuster diabetes drug is suitable only for patients with Type 2 diabetes who don't respond to other medications. 

The decision brought cheers from Baucus — who said the "tough new restrictions … will help protect patients" — and from Harkin, who said he's "pleased that the FDA carefully considered the new data about cardiovascular risks and took action."  

Some consumer advocates think otherwise. Sidney Wolfe, health research director at Public Citizen, issued a statement Thursday saying the FDA "again caved to industry pressure." 

The Food and Drug Administration on Thursday decided to restrict the use of the diabetes drug Avandia to patients with Type 2 diabetes who cannot control their diabetes on other medications. The decision comes in response to studies linking the GlaxoSmithKline drug to elevated risks of cardiovascular events such as heart attacks and strokes.

Senate Finance Committee Chair Max Baucus (D-Mont.), who along with ranking member Charles Grassley (R-Iowa) led a two-year inquiry into the drug, applauded the decision.

"Patients and doctors have a right to know the risks of the medicines they use and prescribe," Baucus said in a statement. "Our investigation into Avandia exposed major safety risks and showed that information is the most important tool the FDA has to protect American consumers. The FDA’s tough new restrictions on the drug will help protect patients. We will continue watching closely and working with the FDA to make sure patients and doctors are aware of the risks associated with Avandia and all drugs so they can make safe and informed decisions when choosing their medicines."

The consumer group Public Citizen wasn't satisfied.

"By failing to ban the dangerous diabetes drug, Avandia, generic name rosiglitazone, the Food and Drug Administration (FDA) again caved to industry pressure," Health Research Group Director Sidney Wolfe said in a statement. "Although the FDA has made progress highlighting the risks of using Avandia by severely restricting the drug, it did not go far enough. Too many people could still be exposed to this dangerous product. Rather, the FDA should have acted with its European counterpart and outright banned Avandia from the market."

The European Medicines Agency - the European Union's FDA equivalent - decided to suspend the drug on Thursday.

“Our primary concern continues to be patients with type 2 diabetes and we are making every effort to ensure that physicians in Europe and the US have all the information they need to help them understand how these regulatory decisions affect them and their patients,” Ellen Strahlman, GSK’s Chief Medical Officer, said in a statement.