Health care Tuesday

“The current regime,” DeBofsky will say, “cries out for Congressional reform aimed at correcting the means by which most abuses arise:

– Abolish the right given insurers to grant themselves a deferential review and allow claimants the ability to present witnesses and evidence in open court;

– Provide for jury trials;

– Preclude courts from “remanding” benefit claim disputes to the insurers; and

– Permit awards of statutory or other damages in appropriate cases.

The American Council of Life Insurers and America’s Health Insurance Plans will testify that the system works well now. Their testimonies both point out that insurers paid out more than $8.95 billion in long-term disability benefits in 2009 and that 82 percent of claimants said they were satisfied with their policies in an 2008 Harris Interactive poll.

Another health reform vote? Sen. Mike Enzi (R-Wyo.) could get a vote this week on his resolution of disapproval repealing the grandfathering clause of the healthcare reform law. The provision exempts existing employer-sponsored plans from a number of provisions in the new law, such as having to offer benefits without cost-sharing, but business groups say complying with it is too onerous. http://bit.ly/aKD7zK

“A vote on a motion to proceed to this could come up before we leave,” a Senate leadership aide tells The Hill, “and would be a simple majority vote on both the motion to proceed and final passage.”

U.S. Chamber weighs in: In a new letter to senators, executive vice-president R. Bruce Josten asks for support and warns that the Chamber “may consider votes on, or in relation to, this issue in our annual How They Voted scorecard.”

“Rather than allowing plans to continue operating in the manner they are accustomed to, the regulation specifies numerous ways by which such plans would lose grandfathered status,” the letter states. “Thus, many existing plans would be forced to change in order to comply with an array of new mandates. In our view, this regulation violates Congressional intent, and does not live up to the promises of proponents of the new law.”

Medicare innovation chief named: Expect reactions today from stakeholders as word spreads that Richard Gilfillan has agreed to serve as Acting Director of the health reform law’s Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services.

“As the Acting Director of CMI, Rick will be working closely with the CMS Deputy group and me to develop and implement innovative programs that will help improve and update the nation’s health care delivery systems under the provisions of the Affordable Care Act,” CMS Administrator Don Berwick said in a staff email Monday.

Gilfillan, a family physician by training, currently heads performance-based policy at CMS. Before that, he was a consultant for healthcare systems regarding innovative care delivery and financing and president and CEO of Geisinger Health Plan from 2005 to 2009.

Food safety still stalled: A Senate leadership aide tells The Hill that Majority Leader Harry Reid (D-Nev.) may again ask for unanimous consent this week on food safety legislation, but Sen. Tom Coburn (R-Okla.) appears to still be blocking blocking the bipartisan bill. Reid is not expected to file cloture before the Senate recesses, making it unlikely the legislation will pass this session.

Coburn wants the bill to fix the overlap between the U.S. Department of Agriculture and the Food and Drug Administration. He filed a one-page legislative alternative last week requiring them to work out their jurisdictions. Ironically, a fact sheet for the bill unintentionally makes Coburn’s oft-repeated point about the unintentional effects of legislation by promising that the bill “reduces government efficiencies in order to ensure the safety of our food supply.” http://bit.ly/dixgyf

Daschle tells all: Former Senate Majority Leader and Health and Human Services Secretary nominee Tom Daschle (D-S.D.) is sure to get tongues wagging with his new book on health reform, “Getting It Done,” advance copies of which are circulating ahead of the its Oct. 12 release date.

In the book, Daschle reveals skepticism within the White House as President  Obama decides to tackle health reform despite the deteriorating economy. In particular, National Economic Council Director Larry Summers argued for delay and even Vice-President elect Joe Biden in December 2008 “at one point … began to think it would be wiser to delay the health care effort.”

Daschle also details Obama’s daily calls to Senate Finance Chairman Max Baucus (D-Mont.) as the “Gang of Six” talks with Republicans Charles Grassley (Iowa), Mike Enzi (Wyo.) and Olympia Snowe (Maine) dragged on for months. “Although it was a worthy goal that had a brief chance of success,” Daschle writes, “it went on too long and allowed opponents to mobilize, just as they did with the Clinton health care plan.”

Eensy-weensy bill: Daschle also reveals how close the White House came to dropping comprehensive health reform after Republican Scott Brown’s victory in the Massachusetts Senate race and instead adopting Chief of Staff Rahm Emanuel’s plan to cover children – an option derided as “eensy-weensy spider” and “Kiddiecare” by House Speaker Nancy Pelosi.

Grassley audit sparks reaction: The trade group representing the middle-men who purchase medical products for hospitals are taking issue with Sen. Charles Grassley’s (R-Iowa) interpretation of a new Government Accountability Office study. http://bit.ly/9MqKbs

“With so many votes of confidence affirming the value of GPOs, and 98% of all hospitals reliant on GPO low-cost contract pricing, the market has spoken loudly and the facts are clear,” Curtis Rooney, president of the Health Industry Group Purchasing Association, said in a statement. “We urge people to read the GAO report for themselves to get unbiased, non-political information proving that GPOs operate in a competitive market that is working and bending the healthcare cost curve.” http://bit.ly/aCaXoh

Physician food fight: The American Medical Association’s support for health reform prompted Florida doctors to voice their displeasure, prompting Maine physicians to criticize Florida, prompting the Florida Medical Association to issue the following five-point rebuttal: 

– The Maine Medical Association is entitled to its opinion and we would hope that they would respect the right of other state medical associations to express their opinions … The AMA should use this as an opportunity to get better rather than circling the wagons and attempting to squash a dissenting point of view;

– The medical community in Maine is homogeneous… By contrast, the FMA represents a diverse group of physicians who practice in many different settings;

_ Maine Medical Association represents around 2,000 physicians. With all due respect, we have several counties in Florida that have more physicians than the entire State of Maine;

_ The facts speak for themselves – the AMA was unable to leverage their endorsement of the Federal health care reform bill into any substantial victories for physicians;

_ The FMA’s letter does not weaken the AMA – the organization is already less effective than it has been in years past.