OVERNIGHT HEALTH: Ryan under assault on two fronts

• Most elderly people would pay more for their healthcare than they would pay under the current Medicare system;

• Even with more flexibility under Medicaid block grants, states would still probably have to decrease payments to Medicaid providers and reduce eligibility and coverage; and

• A private health insurance plan covering the standardized benefit would be more expensive than the current Medicare system.

The report had a bit of positive news for Ryan: Mandatory healthcare spending would be about just 6 percent of GDP in 2030 and 2040 and about 5 percent in 2050. 

A nonstarter?: For all the hoopla over Ryan's Medicare proposal, even he admitted his proposals won't gain much traction with Senate Democrats and the White House. "Something tells me when we repeal ObamaCare, [President Obama is] not going to sign that bill into law," Ryan joked.

Dueling governors: Four Republican governors on Tuesday signed a letter applauding Ryan's proposal to transform Medicaid into a block-grant program.

"Medicaid reform is welcome and the Republican Governors overwhelmingly support the creation of a Medicaid block grant program," reads the letter signed by Govs. Rick Perry (Texas), Bob McDonnell (Va.), Haley Barbour (Miss.) and Chris Christie (N.J.). "This well established approach will give states the freedom to innovate, share best practices, and create cost-effective ways to deliver quality health care to our most vulnerable populations."

The letter comes a day after 17 Democratic governors (from 16 states and the Virgin Islands) warned lawmakers that the block-grant proposal would "shift costs and risk to states" and "severely undercut our ability to provide health care to our residents and adequately pay providers."

Just had to be different: New York Gov. Andrew Cuomo (D) sent his own letter to Congress Monday opposing a "congressionally-mandated block grant of federal Medicaid spending." New York wants to redesign its Medicaid program, and the governor did not want to hamstring the state by criticizing block grants in general.

Meanwhile, in Florida...: Efforts to change the Sunshine's State Medicaid program into a managed care model have had questionable results, researchers at Georgetown University argue in a new report.

1099 moves closer to repeal: The Senate voted overwhelmingly to eliminate an onerous IRS reporting requirement included in the Democrats' healthcare law, even amid concern that the bill's payment mechanism would discourage participation in the reform law's new state-run health insurance exchanges. The White House said it was "pleased" that repeal of the 1099 requirement was approved, and it looks forward "to improving the tax credit policy in this legislation to ensure we protect small businesses and middle-class families." Check out The Hill's story

Competitive bidding delay: The Centers for Medicare and Medicaid Services announced it will delay by six months the second round of a controversial competitive bidding program for durable medical equipment. The program went into effect in nine metro areas earlier this year, and round two – now slated for summer 2013 – expands it into 91 more. Pennsylvania Reps. Jason Altmire (D) and Glenn Thompson (R) are spearheading an effort repeal the competitive bidding program, citing industry concerns that it will push small businesses out of the market and diminish care quality. 

Better coordination needed for kids in Medicaid, CHIP: Almost half (45 percent) of children in Medicaid and the Children's Health Insurance Program need care-coordination services, according to a new Government Accountability Office report. Of that group, 37 percent did not receive it, according to the study, which was based on 2007 data.

Mission accomplished: The White House, through a Tuesday executive order, officially shuttered the Office of Health Reform. However, Republicans may not be through with the office. Earlier this year, the House Energy and Commerce Committee requested detailed information from the White House about the office's closed-door meetings with special interests during the healthcare reform debate.

Wednesday's agenda:

Budget madness continues: The House Budget Committee will mark up the budget Wednesday morning. Meanwhile, members of the Congressional Progressive Caucus will hold a press conference to weigh in on the GOP's budget proposals for Medicare. The House Democratic Caucus Seniors Task Force follows that up with a press conference about the budget's impact on seniors. Spoiler alert: They're not big fans. 

Tort reform: The Energy and Commerce health subcommittee will take up a bill that would dramatically change the nation's medical liability laws. H.R. 5, which already passed out of the House Judiciary Committee, puts a cap on non-economic damages and sets new timing requirements for raising lawsuits against care providers. Check out the subcommittee's background memo.

Defense heath: The Senate Appropriations defense subcommittee holds a hearing on defense health programs.

Reading list:

Massachusetts Gov. Deval Patrick (D) is renewing efforts to lower healthcare costs, the Boston Globe writes.

Supreme Court Justice Anthony Kennedy, seen as the key swing vote on healthcare reform, tipped his hand on how he'll rule, the Christian Science Monitor editorial board writes.

A new Health Affairs policy brief looks at healthcare reform's mandatory review of "unreasonable" rate increases.

The Susan B. Anthony list has spent more than $500,000 to convince lawmakers to defund Planned Parenthood, The Wall Street Journal reports.

Lobbying registrations (since Friday):

  • Corley Consulting / Creative Solutions in Healthcare (Medicare and Medicaid)
  • Roy Ramthun / Council for Affordable Health Insurance
  • Thorn Run Partners / Long Term Care Pharmacy Alliance
  • W Strategies, LLC / MedImmune, LLC (Biotechnology pharmaceutical company)

What you might have missed on Healthwatch:

Ryan compares his Medicare overhaul to the program's popular prescription drug plan. 

A one-week continuing resolution unveiled by Republicans late Monday night includes language to block abortion funding in Washington, D.C.

Comments / complaints / suggestions?

Please let us know:

Julian Pecquet: jpecquet@thehill.com / 202-628-8527

Jason Millman: jmillman@thehill.com / 202-628-8351