Health Reform Weekly Digest

August 17 – August 27 | 2010 Issue 13

FEDERAL REGISTER NOTICES

• Health Resources and Services Administration Statement of Organization, Functions and Delegations
of Authority
http://edocket.access.gpo.gov/2010/pdf/2010-20425.pdf
• Centers for Disease Control and Prevention (CDC) Expanded Human Immunodeficiency Virus (HIV)
Testing for Disproportionately Affected Populations (funding from PPACA)
http://edocket.access.gpo.gov/2010/pdf/2010-20572.pdf
• Draft Guidance for Industry: Questions and Answers Regarding Implementation of the Menu Labeling
Provisions of Section 4205 of the Patient Protection and Affordable Care Act of 2010; Availability
http://edocket.access.gpo.gov/2010/pdf/2010-21065.pdf
• Guidance for Industry: Questions and Answers Regarding the Effect of Section 4205 of the Patient
Protection and Affordable Care Act of 2010 on State and Local Menu and Vending Machine Labeling
Laws; Availability
http://edocket.access.gpo.gov/2010/pdf/2010-21065.pdf
• Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B
for CY 2011; Corrections
http://edocket.access.gpo.gov/2010/pdf/2010-21255.pdf
• Availability of Interim Procedures for Federal External Review and Model Notices Relating to Internal
Claims and Appeals and External Review under the Patient Protection and Affordable Care Act; Notice
http://edocket.access.gpo.gov/2010/pdf/2010-21206.pdf
• Medicare Program; Listening Session Regarding the Implementation of Section 10332 of the Patient
Protection and Affordable Care Act, Availability of Medicare Data for Performance Measurement
http://edocket.access.gpo.gov/2010/pdf/2010-21369.pdf

BE ON THE LOOK OUT:

• August 27th: Comments are due for rules relating to Medicare and Medicaid Programs: Changes to the
Hospital and Critical Access Hospital Conditions of Participation To Ensure Visitation Rights for All
Patients
• August 27th: Comments are due for rules regarding Preexisting Condition Exclusions, Lifetime and
Annual Limits, Rescissions, and Patient Protections it is also the date they become effective
• August 31st: Comments are due for rules regarding the Medicare Program; Proposed Changes to the
Hospital Outpatient Prospective Payment System and CY 2011 Payment Rates; Proposed Changes to
the Ambulatory Surgical Center Payment System and CY 2011 Payment Rates; Proposed Changes to
Payments to Hospitals for Certain Inpatient Hospital Services and for Graduate Medical Education
Costs; and Proposed Changes to Physician Self-Referral Rules and Related Changes to Provider
Agreement Regulations
• September 1st: Applications are due for the Exchange State Planning and Establishment Grants
• September 7th: Comments are due for the notice for the Disclosure of Nutrient Content Information for
Standard Menu Items Offered for Sale at Chain Restaurants or Similar Retail Food Establishments and
for Articles of Food Sold From Vending Machines
• September 10th: Comments are due for the request for comment on Current State Practices Related to
Payments to Providers for Health Care-Acquired Conditions
• September 20th: listening session to receive comments regarding implementation of section 10332 of
the Patient Protection and Affordable Care Act (the Affordable Care Act), which amended section 1874
of the Social Security Act: Availability of Medicare Data for Performance Measurement
• Only 27 days until September 23rd

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Prepared by HELP and Finance Republican Committee Staff
LETTERS TO THE ADMINISTRATION
• August 26: CMS Administrator Donald Berwick sent a letter to Sen. Grassley responding to Sen.
Grassley's July 29 letter to Dr. Berwick regarding potential conflicts of interest. The letter did not
comply with Senator’s Grassley request that Berwick disclose information regarding the donors who
funded the Institute for Healthcare Improvement (IHI) during Dr. Berwick’s time as its CEO. See the
Grassley press release for more information.
• August 25: Senator Coburn response to Secretary Sebelius response to the August 3rd letter regarding
the Andy Griffith Medicare promotional advertising campaign. (CQ Article on this issue)
• August 3: Senators Coburn, Barrasso, Burr, McCain, and Thune sent a letter to Secretary Sebelius
regarding the Medicare promotional advertising campaign
• August 3: Senator Ensign sent a letter to Secretary Sebelius, Secretary Geithner, and Secretary Solis
regarding the Interim Final Rules For Group Health Plans and Health Insurance Issuers Related to
Coverage of Preventative Services under the Patient Protection and Affordable Care Act.
• August 2: Senator Grassley sent a letter to Mr. Berry of the U.S. Office of Personnel Management
(OMP) regarding the OPM’s decision to forgo the retiree drug subsidy included in the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003.
• July 22: Senators Grassley and Enzi sent a letter to Secretary Sebelius requesting additional
information on the Secretary’s claim that premiums would rise by less than one percent as a result of
the new health law.
• July 28: Senators Enzi, Coburn, and 9 other Republican members sent a letter to Secretary Sebelius
regarding federal funding for abortions in the new high-risk pools established under the new health law.
The letter follows the release of a Congressional Research Service report indicating that neither current
law (Hyde Amendment), nor the health care law, nor the Executive Order signed by the President, nor
HHS’ contract solicitation for the high-risk pool program specifically prevent federal funds from being
used to finance abortion coverage in state high-risk pools. A response was received the next day.
• July 29: Senator Grassley sent a letter to Dr. Berwick regarding potential conflicts of interest and
information requested by the Finance Committee.

ADMINISTRATION MATERIALS
• WH blog posts
o The health insurance finder tool at healthcare.gov
o Seniors Already Seeing Lower Prescription Drug Costs
o An Unexpected Answer on the Affordable Care Act and the Deficit
o Protecting Medicare Benefits and Offering Clear Choices for Seniors
• Healthcare.gov blog posts:
o The Affordable Care Act & Mental Health by Pamela S. Hyde, J.D., Administrator, SAMHSA
o What is a preexisting condition? by Jay Angoff
o Making Sure Your Premiums Pay for Care by Secretary Sebelius
o Reining in Excessive Health Insurance Premium Increases by Jay Angoff
• Healthcare.gov web chats
o Creating a fairer insurance market with HHS Secretary Kathleen Sebelius, Jay Angoff, and Liz
Fowler
• Health and Human Services Press Releases
o New Insurance Finder Tool
o Announcement of $32 million to support rural health priorities
• Web Portal
o Training materials
• Secretary Sebelius Response to Senator Coburn’s letter asking about funding on the Andy Griffith
Medicare & Mayberry ads.
• Annals of Internal Medicine Article: The Affordable Care Act and the Future of Clinical Medicine: The
Opportunities and Challenges by Robert Kocher, MD; Ezekiel J. Emanuel, MD; and Nancy-Ann M.
DeParle, JD
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CMS HILL NOTIFICATIONS
(For additional information on these please contact Finance staff)
• August 27: Rural Community Hospital Demonstration Expanded
• August 26: Medicare Imposes Stronger Protections on Medical Equipment Suppliers
• August 25: HHS Announces Expanded Medicare Coverage of Tobacco Cessation Counseling
• August 24: CMS Issues Reminder about January 2011 Target for Testing Transaction Standards
• August 20: CMS Releases Guidance on Operational Changes to the Payment Error Rate
Measurement (PERM) Program
• August 18: CMS Announces the 2011 Average Part D Premium Estimate and the 2011 Part D
Benchmarks
• August 17: Guidance on States' Access to HIT Incentive Payment Administrative Match

CBO REPORTS
• CBO Letter to Sen. Crapo regarding certain health care provisions and the “net deficit impact would be
if certain provisions of PPACA and the Reconciliation Act that were estimated to generate net savings
were eliminated”
• CBO Budget and Economic Update
• CBO August Baseline- Medicare (attached)

UPDATED CRS REPORTS

• Individual Mandate and Related Information Requirements under PPACA
• Health Care: Constitutional Rights and Legislative Powers
• PPACA Regulations Issued During the First Four Months of the Act’s Implementation
• Temporary Federal High Risk Health Insurance Pool Program
• Preexisting Exclusion Provisions for Children and Dependent Coverage under the Patient Protection
and Affordable Care Act (PPACA)
• Grandfathered Health Plans Under the Patient Protection and Affordable Care Act (PPACA)

RESOURCES
• NAIC’s special section on their website on Health Care Reform Implementation
• August Issue of Health Affairs
o Robert Wood Johnson Foundation policy brief on High Risk pools
• American Action Forum: Operation Health Care
• Operation Health Care Poll: Health Care Law Opposed by Midwest Voters
• National Business Group on Health Survey
• Thompson Reuters Health Care Sentiment Index
• New England Journal of Medicine: Underinsurance among Children in the United States
• Annals of Internal Medicine: Comparative Effectiveness Research

IN THE NEWS
Politics of Implementation
In the next few days a massive ad campaign, aimed at countering anti healthcare efforts will be unveiled,
according to a story in the LA Times. This, “effort is up against an intense Republican campaign that has
painted the healthcare bill as a symbol of all that's wrong with Democratic-dominated Washington.” Politico has
a story on the Administration’s efforts to take the focus away from the cost associated with the Unaffordable
Care Act. The story reports that, “Key White House allies are dramatically shifting their attempts to defend
health care legislation, abandoning claims that it will reduce costs and deficit and instead stressing a promise
to "improve it.”

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States
As states work to implement health care reform; The Wall Street Journal reports that, “California passed
legislation creating a health-insurance marketplace, a move set to be echoed across the country as states take
steps to implement federal law.” Inside Health Policy examines the recently passed legislation.

The Governor of Nebraska released statement saying, that after analysis, “the new federal health care law that
predicts the cost to the State of Nebraska will be between $526 million and $766 million over the next 10 years
in new state funding for Medicaid programs.” In the release he also states, “The results of this analysis are
staggering…This unfunded and unparalleled expansion of Medicaid is an unfair and unsustainable mandate on
Nebraska and other states. This analysis confirms that the federal health care law is an extraordinarily large
and excessive unfunded mandate for states. It is potentially devastating to our state budget.”

Inside Health Policy reports that HHS held a seminar to, “discuss ideas about the structure and operation of
the health insurance exchanges mandated to go into effect by 2014…The main focus of the half-day event --
kicked off by the White House's Nancy Ann DeParle -- was to “walk through” the application process for the
$51 million in planning grants announced before the meeting, but it also helped advance initial conversations
about the details of the exchanges, officials said.”

MLR
The Chicago Sun Times has a story on the MLRs and how last week NAIC Commissioners, “approved a
proposed financial disclosure form that insurance companies must file, beginning next year, outlining what
health plans can classify as a medical service.” Politico and The Hill also have stories on the medical loss ratio
decision.

Premiums
Business Week has a story saying that due to higher health premiums, “About 63 percent of businesses plan
to make employees pay a higher percentage of their premium costs in 2011, said the Washington-based
National Business Group on Health, which surveyed 72 companies that employ more than 3.7 million people.”

High Risk Pools

According to a story in Kaiser Health News, “an unexpectedly small number of people to sign up for the
program, which was touted by the Obama administration as an early benefit of the new health overhaul law…
About 3,600 people have applied and about 1,200 have been approved so far in state plans that started in the
beginning of July, according to data from the states and federal government.”

Health Care Confidence

A number of articles were published examining national health care confidence. Both Reuters and the AP
have stories examining the state of national health care confidence and how, according to Reuters “Americans'
confidence in their ability to pay for and access healthcare has fallen by 5 percent since December 2009.”

Implementation
Politico reports that, “Secretary Kathleen Sebelius could find herself pitted between top Democrats on Capitol
Hill and state insurance commissioners over a key section of the health care overhaul.” The article goes on to
say, “NAIC’s work isn’t done yet, so HHS isn’t giving any hints on what it will do. Sebelius, who served as NAIC
president when she was the Kansas insurance commissioner, wrote in a blog entry last week that the series of
Medical Loss Ratio regulations will simply ‘build on the NAIC recommendations.’”

The Hill and the Flathead Beacon have stories with Senator Baucus stating, “I don’t think you want me to
waste my time to read every page of the healthcare bill,” Baucus said, according to the Flathead Beacon. “You
know why? It’s statutory language. ... We hire experts.”

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Medicare
An AP article examines “A new analysis by a leading private research firm estimates that more than 3 million
beneficiaries will see their current drug plan eliminated as Medicare tries to winnow down duplicative and
confusing coverage, in order to offer consumers more meaningful choices. Instead of 40 or more plans in each
state, beneficiaries would pick from 30 or so.”

Prevention
Secretary Sebelius and Assistant Secretary for Health Koh article on PPACA and Prevention in the New
England Journal of Medicine stating, “we believe that the Act will reinvigorate public health on behalf of
individuals, worksites, communities, and the nation at large— and will usher in a revitalized era for prevention
at every level of society.”

Business News

1099s
The US Chamber submitted a letter to Congress with 1,099 signatories stating their fervent support of a repeal
of the 1099 reporting provision. Here is the US Chamber’s press release.

Small Business
Business Week examines the small business tax credit for health care and states, “The response has been
tepid, according to insurance brokers who sell small-group policies. The reason, they argue, is that the credit
starts to phase out for companies that pay average annual wages of more than $25,000 or employ more than
25 workers.”

Cost
Some businesses are providing on site physician services in anticipation of increasing health care costs and a
continuing primary care physician shortage. The Wall Street Journal looks at how, “Interest in such facilities
may intensify as some 32 million uninsured Americans are poised to gain coverage in the next few years under
the new health overhaul, exacerbating what many experts see as a growing U.S. physician shortage that can
hinder access to good medical care and lengthen waits to see a doctor.”

Editorials
New York Times: Come Again
Washington Post: The Medicare reform illusion (Former Secretary Leavitt)
Kaiser Health News: Health Care Reform: Here We Go Again (Douglas Holtz-Eakin and Michael Ramlet)
Wall Street Journal: Big Foot on Campus, Why colleges want a waiver from ObamaCare
Wall Street Journal: ObamaCare’s tax on taxes, the latest gambit to punish for profit health insurers

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Prepared by HELP and Finance Republican Committee Staff