Health and Human Services Secretary Kathleen Sebelius has told lawmakers that she cannot guarantee greater transparency in health care reform negotiations in spite of President Obama's  repeated statements about providing greater transparency into the negotiations. 

 

"I am not a principal in the negotiations," Ms. Sebelius said in testimony before the Senate Finance Committee. "Nor is my staff."

 

Ms. Sebelius said administration officials provided "technical support" to Congress, but did not control the negotiations.

 

Her comments came about five hours after President Obama affirmed the need for openness in efforts by the administration and Congress to finish work on a health bill intended to expand coverage and rein in costs.

 

In the rush to pass legislation in December, Senate leaders and White House officials did much of their work behind closed doors, and Mr. Obama said Wednesday that the perception of secrecy may have undermined public trust.

 

For the full story in the New York Times, click here

 
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The Puget Sound Business Journal reports that The state Health Care Authority (HCA) said it plans to ask private insurers to help it create a coverage option that anyone in the state could buy for about $100 a month.  The agency will issue a request for proposals to the insurers asking how much they would charge for a benefit package outlined by the agency.  Based on the bids, the agency would determine what premium insurers may charge for the package. Insurers who figure the premium would not cover their claims and administrative expenses could choose not to participate.

 

Washington State has an estimated 875,000 uninsured people that the HCA is hoping to open up coverage for.  Opponents of the proposal say that state regulations deny private insurers the right to offer comparable policies to the HCA plan and would destroy the individual insurance market.  Some lawmakers have introduced legislation to changes these regulations but legislative observers expect this legislation to run into stiff opposition from Democrats who control both the House and the Senate. 

 

For the full story, click here.

 

Health Leaders Media reports that one segment of health care reform may go ahead with or without a comprehensive reform package:


While Congress may not have approved healthcare reform legislation yet, one of the more well-discussed--and sometimes controversial--areas included in the reform bills was included in President Obama's proposed fiscal 2011 budget: comparative effectiveness research (CER).


However, a scan of the proposed budget will detect no references to "CER;" its new name is instead: "patient-centered health research."


In the Department of Health and Human Services (HHS) budget, no explanation is given for the name change. The fiscal 2011 budget request provides a total of $286 million--which included $273 million for research and $13 million for related program support--targeted in part for the Agency for Healthcare Research and Quality (AHRQ) to support new research projects.


A central tenant to President Obama's health care reform proposals has been comparative effectiveness research.  Comparative effectiveness research compares similar treatments in terms of both the relative medical benefits and risks of each option, and also the costs and the benefits of those options.  Comparative effectiveness is increasingly being viewed as a viable way to help drive down spiraling health care costs while continuing to provide quality care. Roughly $700 billion each year goes to health-care spending that can't be shown to lead to better health outcomes, according to the non-partisan Congressional Budget Office.


For the full story click here.  For the CBO report on comparative effectiveness research, click here.

 
pharmaadmodel.jpgThere has been a conversation about a conversation going on for some time now, namely how the pharma industry can (i.e. regulatory perspective) and should (i.e., effectiveness perspective) engage with physicians in the new and largely-uncharted world of online social media.  This is one focus of the upcoming ePharma Summit happening in Philadelphia February 8 - 10.  The event will bring together major players in the digital marketing space together with some the some of the nation's leading pharma brand teams.

The marketing landscape has changed a lot over the past few years as new regulatory constraints, changing behaviors of physicians and attitudes of administrators around access issues have turned the traditional pharma marketing model upside down.  With physicians spending more and more time online and gaining more and more control over the kinds of conversations they are willing to have, pharma is intent on figuring out how to engage physicians online in a way that supports both sides of the conversation.  What we hear from physicians is that they want, neigh demand, that their engagement with pharma must be "value-add", e.g.:

  • efficient use of time
  • simple engagement tools
  • high-quality, relevant and timely information
Online research tools, eDetailing, eSampling and virtual conferences are examples of services that can be delivered in an effective way through online media channels and each offers the potential for pharma to add value to physicians' lives.  The regulatory issues surrounding these online engagements are non-trivial and the vagueness of the FDA has been a barrier; but online media companies (including iMedExchange) pursuing innovative solutions will arrive at useful, value-add conversations between pharma and physicians.

Given that the technical and regulatory challenges are resolved, the next question for physicians is: "if pharms wants to talk... do you want to listen?"
 
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Politico is reporting that House Speaker Nancy Pelosi is proposing a two track approach to health care reform:  less controversial incremental changes now with more sweeping changes tabled until a later date when the political climate improves.

 

"We believe that it's possible to have comprehensive health care reform as we go forward, but at the same time, it can be on another track where some things can just be passed outside of that legislation, and we'll be doing both," Pelosi said in an interview with POLITICO.

 

Though the Democrats' loss of Ted Kennedy's old Senate seat has complicated efforts to get the 60 votes they need for a sweeping health care bill, Pelosi insisted that comprehensive reform is still on the agenda.

 

"We have to get it done," the speaker said. "What the process is doesn't matter. The outcome is what is important, and what it means to working families in America."

 

For the complete story including video of the interview, click here.

 
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The Congressional Budget Office (CBO) cites federal healthcare spending as "the single greatest threat" to the United States' budget stability in its new report, The Budget and Economic Outlook: Fiscal Years 2010 to 2020. Under current law, Medicare spending will reach $1,038 billion in 2020, with Medicaid spending coming in at $458 billion.  In 2009, higher unemployment drove up Medicaid spending by 9 percent ($18 billion). For the previous 10 years, the program's average annual growth rate had held at 7 percent. Medicare outlays also rose faster than average, jumping by 10 percent ($39 billion).

 

For an article summarizing the report, click here and for the CBO report, click here.

 

Broadening our scope

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The mission of VitalSigns is to bring you, our physician readers, relevant and valuable information tailored to your unique needs.  Our primary focus over these past months has been health care reform legislation because it is so vital to your profession.  There are still some miles to travel down that road and we will continue to keep you informed, but we'll also begin broadening the scope of VitalSigns to include other areas of interest to physicians.  For example, we'll bring you news on the latest technologies that may have an impact on your practice, physician strategies for navigating the economic crisis, and profiles of your physician colleagues who are making a difference for you and the rest of the world.  And when your colleagues are talking inside iMedExchange about topics that we think you'll find especially interesting we'll let you know so you can join the conversation if you like. 
 

The election of Republican candidate Scott Brown to fill Ted Kennedy's senate seat last week was viewed by some as a referendum on health care reform.  The Kaiser Family Foundation did some polling on this election and found that the driving forces behind Brown's election to be much more nuanced: 

 

First, while health care policy did top the list of voting issues, the economy and general discontent with Washington also were significant factors for Brown voters. Second, and perhaps more importantly, Brown voters' top complaint about health reform was not about the substance of the legislation itself or its perceived impact on them or their families, but about a policymaking process that they seemed to think had gone badly wrong ... For Brown voters health reform became a reflection of, and in some ways a proxy for, deeper concerns about how Washington works today. 

 

For the full story, click here.

 
nejm.jpgThe January 27 edition of the New England Journal of Medicine has a detailed article by Dr. Mark Pauly on health insurance reform, specifically on how to deal with higher risk individuals.

 

All U.S. health insurance reform proposals currently being discussed now include changes in the way insurers treat some people with above-average health risks. In most states, insurers who sellpolicies directly to individuals now charge premiums based to some extent on characteristics thought to predict the risk of high-cost conditions; insurers also exclude some or all preexistingconditions from coverage and simply refuse to cover some people. Without such "risk rating" and coverage exclusions, insurers would be subject to substantial adverse selection -- that is, consumers would seek them out primarily if and when they became ill and therefore represented higher risks to insurers -- which could lead insurers needing to cover their costs to charge premiums so high they would drive lower-risk consumers to choose minimal coverage or forgo insurance altogether.

 

Some states have decided that adverse selection is a lesser evil than people being left uninsured and have passed regulations that require insurance companies to charge the same premiums to everyone in a certain geographic area ( a practice called "community rating.")  Dr. Pauly suggests an alternative approach: the guaranteed renewability policy.  He argues that these policies, that already exists in today's insurance markets, are the best way to wring efficiency an efficacy from the system.   In a nutshell,  these policies charge a small premium for the right of the insured to continually renew his or her policy at the standard class rate even if they develop a high risk or chronic condition.   The insured person benefits from the security of knowing that their insurance will not be cancelled or their rates raised because of serious illness and the insurance company benefits because people will purchase these policies while they low risk (young and healthy). 

 

To read the article in its entirety, please click here

 

President Obama devoted relatively little time to health care reform in Wednesday night's state of the union address.    The topic of health care did not appear until thirty minutes into the address, a sign, according to The New York Times, "of how imperiled [the health care bill] had become:"

 

Mr. Obama's speech did nothing to resolve differences between the House and the Senate or to clarify the way forward. Just 20 weeks ago Mr. Obama stood in the same place and made an urgent plea to a joint session of Congress. "The time for bickering is over, the time for games has passed," he said on Sept. 9.  "Now is the time to deliver on health care," he said then.

 

But on Wednesday health care was wedged into a catalog of presidential priorities, which included jobs, the economy, education, bank regulation, energy independence, deficit reduction and the war in Afghanistan.  The change highlighted the risks for Mr. Obama in staking more of his political capital on legislation whose fate in Congress is uncertain -- a bill that divides the Democratic caucus, that is reviled by Republicans and that makes many independent voters nervous.

 

President Obama went on to state in his address that he had not clearly explained the benefits of health care reform to the public and blamed special interests, industry lobbyists and partisan politics for sidetracking healthcare reform.  He stood by the health care reform bills that and urged both parties to take another look at the bill after "temperatures cool"

 

For the full story in the New York Times, click  here . 

 

5 questions

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Yesterday Politico covered 5 key health reform questions, saying that 'before Democrats can resuscitate their yearlong push for near-universal health coverage, it's time for a gut check'. Their questions are:
  • If you don't have 60, how about 51?
  • How close will the House come to the Senate?
  • Can you actually do a scaled-down bill, given how interconnected the legislation is?
  • How many "yeses" have turned to "nos"?
  • How hard will Obama push?

  • Read the full story here.
     

    What now?

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    Now that Brown has won, what are the democrats going do? That is unclear right now. According to the Wall Street Journal...

    Party members clashed openly over what to do next. Sen. Max Baucus, a top Senate Democrat, appeared to throw cold water on a bill that would focus only on stiffer insurance regulations. Rep. Charles Rangel, chairman of the House Ways and Means Committee, scotched another idea, a complicated parliamentary maneuver to usher a bill quickly to the president's desk.

    In an interview with ABC News, President Obama said he would be open to scaling back the legislation in order to salvage it. "I would advise that we try to move quickly to coalesce around those elements in the package that people agree on," Mr. Obama said. White House Communications Director Dan Pfeiffer said later the president would prefer Congress to pass the comprehensive package, and hasn't given up on that option.

    Read the full story here.
     

    What the MA vote means

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    ScottBrown.jpgThe results of yesterday's vote in Massachusetts have given Republicans 41 seats in the senate. This is a critical number because 41 votes allows them to block a new bill. It was expected that the health reform bill would need to be edited and passed through the senate again, since there were several issues that face opposition within the Democratic voters. 
     
    To compensate for this opposition, there is a proposal that the House would then pass a second measure making changes to the Senate bill. That measure could then pass through the upper chamber at a later date under special budgetary rules known as reconciliation, which allow legislation to pass with a simple majority.

    Since Democrats and allied independents still control 59 seats, strategists believe it would be relatively easy to pass a second measure that would contain compromises reached between Senate and House negotiators, such as a limit on the tax imposed on high-cost insurance plans.
     
    But Democratic lawmakers were split Tuesday evening over the prospect of passing the Senate bill and hoping for a later fix.

    Read the full story here, on The Hill.
     
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    Today is the Massachusetts election that's being watched around the country. Politico summarizes the pressure being felt by the democrats...

    Ever since health care reform flamed out in the 1990s, Democrats thought lots of things might derail their longtime dream this time around. Losing a Senate seat in liberal Massachusetts was not on the list.

    But that is the harsh reality sinking in among Democrats -- that a Republican victory could spell the end of health reform because there is no good option to rescue the plan from this latest brush with political death.

    Publicly, the White House and top Democrats held firm to their stance that health care reform will pass this year. And Speaker Nancy Pelosi (D-Calif.) said Monday that Democrats will need to figure out a way to proceed if Republican Scott Brown wins, "but that doesn't mean we won't have a health care bill."

    "Let's remove all doubt that we will have health care one way or another," Pelosi told reporters in San Francisco.

    But privately, Democrats are getting cold feet about pushing ahead full bore on health care. Moderate Democrats who have long been skeptical of the administration's focus on the issue could begin to peel away in the face of a convincing loss for Democrat Martha Coakley, dealing a fatal blow to legislation that had no room for error in either chamber. 

    Read the full story here.
     
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    Since 2006, when Mitt Romney required all residents to purchase health insurance, Massachusetts has been a state to watch in health care reform. Scott Brown is running in Massachusetts' special election to fill Tedd Kennedy's open seat

    As the underdog GOP nominee in one of the most Democratic states in the nation, the state senator's message has been simple: If he upsets Democratic state Attorney General Martha Coakley in the Jan. 19 election to fill the seat once held by the late Sen. Ted Kennedy, he will provide the critical vote to halt the Democrats' health care bill once the final version is negotiated.

    "If you feel that Washington and the health care bill that they're proposing is systemic of the problems in Washington and the failure to understand average people anymore, then you vote for me because as the 41st senator I can stop a lot of this stuff in its tracks," Brown told POLITICO. "I can actually force them to go back to the drawing board."

    Read Politico's coverage here.

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