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Over 100 Patient And Provider Groups Push For Affordable Care For People With Disabilities In Final Health Reform Bill

Over 100 members of the Coalition to End the Two-Year Wait for Medicare, a group of patient and provider organizations dedicated to health care access for people with disabilities, sent a letter to Senate Majority Leader Harry Reid and House Speaker Nancy Pelosi on January 11 to urge that the final health reform legislation ensure affordable coverage for people with disabilities. "This letter makes clear that there is broad support for provisions that will make sure that the new coverage options for people with disabilities have premiums and copays that they can afford, " said Medicare Rights Center President Joe Baker. "The coverage the final bill will provide for people with disabilities who are waiting for Medicare will be an important test of whether this historic health care reform works for all Americans, including the most vulnerable.

Labor Leaders Confront Obama On 'Cadillac' Tax Proposal

Labor leaders were invited to the White House to discuss negotiations to merge the House- and Senate-passed health overhaul packages. The Washington Post : "The final bill will not include the House's government-run insurance plan, or 'public option'; it will probably include the Senate's new tax on high-cost health plans that could affect many union members; and its penalties for employers who do not provide insurance coverage will probably be closer to the more lenient terms in the Senate bill." Earlier in the day, AFL-CIO President Richard Trumka warned at the National Press Club that Democrats risk a replay of the "Democratic blowout in the 1994 elections, when, after the passage of NAFTA and other disappointments to unions, "'there was no way to persuade enough working Americans to go to the polls when they couldn't tell the difference between the two parties'" (MacGillis, 1/12).

Medical Specialists Petition Congress To Preserve Access To Care For Millions Of Medicare Patients

The American Association of Clinical Endocrinologists (AACE) sent a petition to Congress signed by 1, 325 AACE members, non-AACE member physicians, allied health professionals and patients opposing a new Medicare policy, which would eliminate consultation codes for specialists. Overturning this policy would preserve access to care for millions of Medicare patients seen by a medical specialist. The Centers for Medicare & Medicaid Services' (CMS) new policy, which went into effect on January 1, 2010, no longer allows endocrinologists and other cognitive specialists to bill for consultations provided for patients referred to them by primary care physicians.

ACP Joins 118 Groups Supporting Equality Of Medicaid Medicare Rates For Primary Care

The American College of Physicians (ACP) today was one of 118 organizations that joined to send a letter to House and Senate leaders supporting equality of Medicaid and Medicare rates for primary care services. The co-signers include national and state organizations representing physicians, nurses, hospitals, and other health care providers; and consumer, labor, and other patient advocacy groups. Sent to Majority Leader Reid, Speaker Pelosi and chairmen Rangel, Waxman, Miller, Baucus, Dodd and Harkin, the letter urged the legislators to "ensure meaningful access to care under the proposed Medicaid expansion by adopting [in a final House-Senate health reform agreement] the House provision to bring Medicaid reimbursement rates for primary care in line with comparable Medicare rates within four years.

States Threaten Lawsuit Over Nebraska's Medicaid Deal In Senate Health Bill

Several news outlets report on a possible lawsuit against the Medicaid compromise for Nebraska that Sen. Ben Nelson, D-Neb., brokered with Senate leaders. "South Carolina Attorney General Henry McMaster is threatening to file a constitutional challenge to Congress's healthcare reform effort unless a special provision favoring Nebraska at the expense of all other states is stripped from the law, " The Christian Science Monitor reports. "In a news conference at the National Press Club Wednesday, Attorney General McMaster said he has the support of 14 other attorneys general who agree that the Nebraska amendment raises significant constitutional concerns. Democratic leaders inserted a special measure into the Senate healthcare bill in December that would exempt Nebraska from having to pay its usual share for coverage of new Medicaid participants.

Budget Woes Prompt Health Cuts In Some States

The Salt Lake Tribune : "Utah's Medicaid program isn't providing enough oversight of its managed care plans, a problem that is costing the state as much as $19 million, according to a Legislative audit released Tuesday" (Rosetta, 1/19). Lexington Herald-Leader : "Facing exploding growth in the government-run health insurance program for the poor and disabled, Gov. Steve Beshear's proposed budget calls for spending an additional $782 million on Medicaid over the next two years." However, Beshear is also calling for $108 million in cuts to the program over two years, and 2-percent nearly-across the board cuts to Cabinet for Health and Family Services programs (Spears, 1/20).

States Struggle With Budget Cuts, Increased Medicaid Pressure

News outlets look at developments in Medicaid issues. The Associated Press/ABC News reports on Louisiana: "Sen. Mary Landrieu defended the Senate's version of health care overhaul legislation - and language in it that provides up to $365 million in Medicaid money for Louisiana - as she discussed what her fellow Democrats should do after losing a crucial Senate seat to a Massachusetts Republican." Landrieu said she supports continuing efforts to reach a consensus on reform. Landrieu's support for the Senate health overhaul, which came after the provision for Medicaid money for Louisiana was added, led to criticism from opponents that Democratic leaders bought her vote (McGill, 1/20).

Obama Signals Interest In Reducing The Protections For Biologic Drugs

Lobbyists for generic biologic drugmakers are fighting to undercut a provision in the proposed health overhaul that would protect brand-name pharmaceutical companies from lower-cost, generic competition over new products for 12 years, the Associated Press reports. The generic companies have friends in high places: "White House officials and Rep. Henry Waxman, D-Calif., chairman of the House Energy and Commerce Committee, are trying to reduce the curbs against competition to 10 years or less" (Fram, 1/14). The move surprised the drug industry Thursday, Politico reports: "Industry took a quiet victory lap earlier this year once it was clear that both bills would include a 12-year window of protection from competition by generics.

Academy Posts Video Explaining Health Care Reform Provisions

AMCP has posted a two-part video on explaining provisions in the House and Senate health care reform bills that would affect the practice of managed care pharmacy. Part 1 explains provisions related to the Medicare Part D drug benefit, including government negotiations of drug prices, protected therapeutic classes on formularies and medication therapy management. Part 2 explains other provisions relevant to managed care pharmacy, including comparative effectiveness research, the public insurance option, insurance marketplace transparency, follow-on biologics and generic drugs. The programs also provide AMCP's positions on these issues.

Can Medicare Advantage Plans Buck The Downward Trend?

Medicare Advantage plans reported enrollment of 10, 971, 598 for January 2010, down -2.8% from one month ago. Meanwhile, stand-alone prescription drug plans (PDPs) gained 70, 195 members between December 2009 and January 2010 for a total of 17, 664, 256 enrollees as of January 1, 2010. The latest reports from the Centers for Medicare & Medicaid Services (CMS) are the first true indication of open enrollment results. "The downward trend for Medicare Advantage is troublesome, " said Debra A. Donahue, VP of Market Analytics for Mark Farrah Associates (MFA). "Though year-over-year enrollment is up 5.2%, sustaining Medicare Advantage levels with reimbursement cuts on the way has been challenging for plans nationwide.

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