Weekend update / Miscellany

  • In Thursday’s FEHBlog post about the White House health care summit, I noted that the the individual mandate found in Sen. Baucus’s health care reform plan conflicted with President Obama’s campaign proposal. The New York Times and Modern Healthcare report that at the end of the conference the President signalled his willingness to compromise. However, the question that provoked this statement was raised by Sen. Charles Grassley who wanted to know whether the President would stick to his guns on the campaign plan to create a public health plan option to private health plan coverage.

    All along Obama has called for the creation of a public health insurance plan that would provide low-cost coverage options to potentially millions of Americans. Republican lawmakers and private payers, however, have said that such an option would siphon away members. Sen. Chuck Grassley (R-Iowa), the senior Republican on the Senate Finance Committee, raised the issue with the president, saying “there’s a lot of us that feel that the public option—the government—is an unfair competitor and that we’re going to get an awful lot of crowd out.” Obama acknowledged the concern—as well as the political realities that could make such a proposal a sticking point. “I think it’s a serious one and real one, and we’ll make sure that it gets addressed,” he said

    Under these circumstances, it’s less surprising that the Washington Post reports that opponents of Hillarycare in the early 1990s are supporting this health care effort.

    In the room [at the White House summit on Thursday] was Rep. Joe L. Barton (R-Tex.), who proudly reminded the crowd of 150 that he was instrumental in killing “Hillarycare” in the 1990s. Yesterday, he announced that he supported the principles that have been outlined by Obama.Also at the summit was Chip Kahn, who 15 years ago, as an insurance lobbyist, helped mastermind the iconic “Harry and Louise” ads that attacked the health-care overhaul proposed by President Bill and first lady Hillary Rodham Clinton. Kahn, who now represents hospitals, said Obama has “successfully launched the process we need to achieve health reform, which we all want, and brought together congressional Democrats and Republicans with stakeholders to begin to forge a consensus.”Karen Ignagni, who runs the nation’s leading insurance association, told Obama, “You have our commitment to play, to contribute and to help pass health-care reform this year.”

    I think that this quote from the Washington Post story sums it up the best:

    U.S. Chamber of Commerce President Thomas Donohue said, “We know where everyone stood. But they don’t stand there anymore,” adding, “We’re going to get some kind of an agreement here, whether it’s two-thirds of what everybody wants or three-quarters of what everybody wants or who knows. If you don’t get in this game … you’re not on the menu”

  • The Financial Times reports that the Wellpoint, which provides Blue Cross coverage to 35 million Americans, plans to auction off its inhouse prescription benefits management operation.

    The three dominant companies in prescription healthcare services – ExpressScripts, Medco and CVS Caremark – are independent, free-standing companies. Several others are embedded within managed care providers such as WellPoint, Aetna, Cigna and UnitedHealth, the largest US health insurer.WellPoint paid 67.5m ­prescriptions in the fourth quarter of last year, an increase of 5.6 per cent from the same period a year earlier.Its PBM business is likely to attract interest from CVS Caremark, Medco and ExpressScripts, and the sale process has been under way for months, according to people close to the matter. WellPoint did not have any immediate comment.Expectations have risen that insurers with in-house PBMs might consider selling them or spinning them off as the political and economic environment surrounding the healthcare industry grows more challenging.

  • HHS made the following announcement on interest to HIPAA covered entities —

    On January 15, the U.S. Department of Health and Human Services released
    two final rules that will facilitate the United States’ ongoing transition
    to an electronic health care environment through adoption of an updated set
    of diagnosis and procedure codes and updated standards for electronic
    health care and pharmacy transactions.

    In accordance with the White House Chief of Staff’s memorandum of January
    20, 2009 entitled “Regulatory Review,” a determination has been made that
    the effective date will not be extended and the comment period will not be
    reopened for either of these rules.

    The first rule finalizes new code sets to be used for reporting diagnoses
    and procedures on health care transactions. This final rule replaces the
    ICD-9-CM code sets, developed nearly 30 years ago, with greatly expanded
    ICD-10 code sets. The second final rule adopts updated versions of the
    standards governing electronic transactions under the authority of the
    Health Insurance Portability and Accountability Act of 1996. The updated
    versions replace the current standards and will promote greater use of
    electronic transactions. In response to public comments suggesting that
    more time would be needed for effective industry implementation, the final
    rules include later compliance dates. More specifically, the final rules
    provide compliance dates of Jan. 1, 2012, for the transaction standards and
    Oct. 1, 2013, for the ICD-10 code set.