Healthcare Monday

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.

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.

"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?

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.

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.

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.

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

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

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.

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.

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.

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.