FEHBlog

U.S. News and World Report announced today that “U.S. scientists [at the University of North Carolina, Chapel Hill] have decoded the structure of an entire HIV genome, a breakthrough which could improve understanding of how the virus infects humans and could lead to the development of new antiviral drugs.” It’s my expectation (hopefully not a pipe dream) that the decoding of the human genome and related developments such as this will lead to major healthcare advances before long. That’s why I hope that the health care reform being shaped by Congress promotes health care innovation.

AHIP President Karen Ignani came to the defense of the health care industry today. In pertinent part she said

The country is at a critical juncture. August will be the month when the country decides whether it supports reform and what shape it should take. It is crucial that the American people understand the broad consensus that exists on the essential building blocks for bipartisan reform. “With that in mind, there are five facts we believe all Americans should know:

• Health plans have proposed comprehensive health care reform to cover all Americans, make care more affordable, and improve quality.

• Health plans proposed health insurance reform last year.

• Health plans have proposed far-reaching initiatives to bend the health cost curve and make care more affordable for individuals, families, and employers.

• Health plans are advocating and advertising in support of bipartisan reform.

• Out of every dollar the nation spends on health care, one penny goes to health plan profits.

“Our community includes thousands of dedicated, conscientious Americans who are working hard across the country to try and improve health care. They are ordinary Americans from all walks of life who are raising their families and contributing to their communities. They do not deserve to be demonized or vilified as part of a campaign to distract attention away from the sinking support for a government-run program.”

My sentiments exactly.Preferred provider network vendor Multiplan announced today that it is acquiring Viant which owns the Beech Street preferred provider network. “The transaction is expected to close before the end of the year, subject to satisfaction of closing conditions including customary regulatory approvals. Financial terms were not disclosed.”

OPM has posted on the web its proposed 2010 – 2015 strategic plan. OPM currently is soliciting public comment on the plan. The plan assumes status quo for the FEHB Program.

HHS announced today that it is transferring HIPAA Security Rule enforcement authority from the Centers for Medicare and Medicaid Services to the HHS Office for Civil Rights. OCR currently enforces the HIPAA Privacy Rule. “Through a separate delegation, CMS continues to have authority for administration and enforcement of the HIPAA Administrative Simplification regulations, other than privacy and security of health information.”

Sen. Charles Schumer (D N.Y.) told reports today that “Senate Democrats won’t hesitate to forgo [the Senate Finance Committee efforts at] bipartisanship to pass a health-overhaul bill if negotiations fail in the next month.” according to a Wall Street Journal report. The Politico reports that “internal [Finance Committee] clashes about the government insurance [or public] option have begun to spill into the open — as Sen. John Rockefeller (D-W.Va.) has gone public with his case against consumer-owned health care cooperatives . . . .” The Hill reports that Sen. Charles Grassley (R Iowa), one of the Finance Committee negotiators, is predicting a final vote on health care reform in mid November, shortly before Thanksgiving.

Finally, Business Insurance reports that Aetna is buying an employee assistance program provider from Psychiatric Solutions, Inc., for $70 million. “he Wall Street Journal, citing people familiar with the matter, reported that Aetna’s PBM was being shopped by investment banks, and potential purchasers included CVS Caremark Corp., Medco Health Solutions Inc. or Express Scripts Inc.”

On Friday, the House Energy and Commerce Committee by a 31-28 vote cleared for floor consideration its version of the House health care reform bill (HR 3200). According to Modern Healthcare,

The deal, offered in a series of amendments, would ensure that public plans compete with other plans on a level playing field, allow the CMS to negotiate drug prices with pharmaceutical companies, and help lower premiums and increase subsidies for working families.

In addition, the bill’s public plan would use a drug formulary to control prices, and pharmacy benefit managers would be subjected to additional transparency requirements. * * *

A bipartisan amendment that would establish a 12-year patent exclusivity period for follow-on biologic products was approved, although [Committee Chairman Henry] Waxman didn’t support it.

The Committee rejected also by a 31-28 vote a a Republican amendment that would have opened the Federal Employees Health Benefits Program to the general public. The Chairman declined to consider on procedural grounds a proposed amendment that would have required all elected federal officials to participate in the public option created by the bill.On the Senate side, Senate Finance Committee Chairman Max Baucus advised that September 15 is the deadline for reaching agreement on a bipartisan measure according to a Politico report. “Baucus is also working to bring several governors to Washington next week to discuss the impact of expanding Medicaid on state budgets, according to a congressional source.”
While the House has recessed for the month of August, the Senate will be in session for another week to consider Judge Sonia Sotomayor’s Supreme Court nomination and the cash for clunkers extension. Kaiser Health News reports that the House majority and minority leadership sent their respective members home with talking points. The Speaker’s talking points build on her recent attack on the health care industry. The Politico reports that

“The glory days are coming to an end for the health insurance industry in our country,” Pelosi told reporters Friday afternoon. “This is about inoculating against misrepresentations and educating about what is in the bill,” she said. “We all want bipartisanship…but you’re either with the insurance companies or you’re for something new.”

The Office of Personnel Management announced today that the next federal benefits Open Season will be held from November 9 through December 14, 2009. The next step will be for OPM to announce 2010 FEHB plan premiums in mid-September. During the Open Season, federal and postal employees and annuitants can make enrollment changes in their FEHB plan coverage, FEDVIP coverage, and more.

Govexec.com reports that the Office of Management and Budget gave contracting guidance to federal agencies. The changes do not appear to impact FEHBP contracting.

The Associated Press reports that the Blue Dog Democrats and the House leadership reached a compromise today that permits the Energy and Commerce Committee to continue its mark up of HR 3200, the House health care reform bill.>

The agreement would allow a committee vote, preserving momentum on President Barack Obama’s top domestic priority.The deal calls for exempting more small businesses from a requirement to offer coverage, trimming subsidies to help people buy health insurance, and making any government-sponsored insurance plan negotiate payment rates with medical providers — instead of dictating them.

The Politico reports that liberal Democrats are upset with the deal which is at odds with the version of the bill cleared by the House Education and Labor and Ways and Means Committees. The House Rules Committee is responsible for reconciling conflicting versions of bills approved by different standing committees. No floor vote would occur until September.
Meanwhile the Wall Street Journal reports that

In the Senate, Finance Committee Chairman Max Baucus (D., Mont.) said his effort to build a bipartisan bill is advancing. He cited an estimate by the nonpartisan Congressional Budget Office that the bill in the Senate Finance Committee would cost less than $900 billion over a decade — less than other versions of the health legislation in the House and Senate — and ensure insurance coverage for 95% of Americans. Together, the developments suggested that Democrats are likely to avoid their worst-case scenario — a breakdown of talks before the August recess. But they are still far from agreement on the final contours of the legislation.

The AP reports that “Top House Democrats sought to minimize the impact of a near-certain missed deadline for health care legislation on Tuesday as the leadership struggled to ease the concerns of rank-and-file critics.”

The Government Accountability Office placed the Postal Service on its list of high risk government programs. The Federal Times notes that “GAO says the Postal Service must take a number of steps to remove itself from the high-risk list. One is reducing its labor costs, through some combination of early retirements and lower benefit costs; GAO notes that the Postal Service pays a higher percentage of employee health benefits, 80 percent, than most federal agencies, 72 percent.” What GAO evidently misses is that the Postal Service’s higher FEHBP contributions result from collective bargaining with the postal unions.

Govexec.com reports that OPM will be posting on the web its proposed strategic plan for public comment. OPM’s recent strategic plans are available here.

The FEHBlog was offline yesterday for the Weekend Update so I will try to catch up today.

Both the Hill newspaper and I misread Speaker Pelosi’s comment last Thursday about the month of August. We each thought that she, like Sen. Harry Reid, was throwing in the towel on passing the health reform legislation before the recess, but that was not the case. She continues to advocate for floor action but the House Energy & Commerce Committee mark up remains in limbo. Over the weekend, the CBO released a letter estimating that an approach to controlling Medicare costs favored by the White House and the Blue Dogs would only save $2 billion over ten years. Modern Healthcare reports that the Committee’s markup may resume on Wednesday.

The Wall Street Journal reports tonight that

In an effort to gain momentum, Democratic leaders Monday focused their
statements on insurance companies, saying insurers have made huge profits over
the last several years while Americans have been asked to pay more for their
health care. “The status quo is indefensible,” said House Majority Leader Steny
Hoyer (D., Md.).

According to Reuters, the House leadership also relied on on a CBO letter suggesting that the House bill would not have the harmful impact on employer sponsored coverage predicted by the Lewin Group study, which was updated today. Nevertheless, “[t]he latest CBO analysis also said the healthcare reform proposal would increase budget deficits in the long run.”

The Federal Times reports on the potential impact of the 1000+ page House bill on the FEHB Program. Most significantly, “Dan Adcock, legislative director for the National Active and Retired Federal Employees Association, * * * said that after a reform bill is passed, the government may have to extend FEHBP coverage to seasonal or temporary employees — who are currently ineligible for the plan — or contribute funds to cover the cost of those employees’ insurance.”

Meanwhile, the AP reports that the Senate Finance Committee continues to be engaged in a bipartisan effort.

[Anonymous officials] said any legislation that emerges from the talks is
expected to provide for a nonprofit cooperative to sell insurance in competition
with private industry, rather than giving the federal government a role in the
marketplace. The White House and numerous Democrats in Congress have called for
a government option to provide competition to private companies and hold down
costs.

One of the senators involved in the talks, Olympia Snowe, R-Maine,
confirmed that co-ops are the preferred approach. “The co-op is certainly one of
the prominent options that is on the table,” Snowe told reporters after the
group met Monday. “It’s safe to say that’ll probably remain in the final
document.”

Officials also said a bipartisan compromise would not subject companies to a penalty if they declined to offer coverage to their workers. Instead, these businesses would be required to reimburse the government for part or all of any federal subsidies designed to help lower-income employees obtaininsurance on their own.

Snowe said the idea is to discourage employers from dropping coverage because under the plan their workers could get government assistance to pay premiums. “We don’t want to undermine (employer coverage) or create a perverse incentive where employers potentially drop coverage because their employees can get subsidies,” she said.

In other Hill news, on Wednesday the Senate Homeland Security and Governmental Affairs Committee will mark up bill (S. 1507) to provide the U.S. Postal Service with financial relief from its obligation to pay employer contributions toward retiree coverage for FEHBP coverage. Govexec.com reports that Sen. Tom “Carper [(D Del.)] expects to pass the bill before Congress leaves for recess in August. The House Oversight and Government Reform Committee approved H.R. 22 on July 10, which also would afford the Postal Office some debt relief, though not as much as Carper’s bill.”

In legal news, last week Judge Patty Saris of the U.S. District Court for the District of Massachusetts approved the McKesson piece of the average wholesale price (“AWP”) fixing case, which creates a $380 million pot to be shared by third party payers, consumers, and of course lawyers. The appeal of Judge Saris’s earlier order approving the First Databank AWP rollback settlement in this case will be argued before the First Circuit tomorrow. I read the objector’s reply brief and I think that they have a strong case. Basically, the objecting pharmacies argue that the financial consequences of the rollback fall on them. Therefore, the plaintiffs were obligated by Rule 19, Fed. R. Civ. P. to join them as defendants in the lawsuit. The settlement fails because they weren’t so joined.

Senate Majority Leader Harry Reid announced today that the Senate will not consider health care reform legislation until September. This decision allows the Senate Finance Committee to complete its work. More suprising is the Hill newspaper’s report that House Speaker Nancy Pelosi “said Thursday that the House can go home for its August recess without passing a massive overhaul.” The Energy and Commerce Committee has not met since Monday to mark up the House reform bill due to Blue Dog Coalition concerns about the bill. The Wall Street Journal reports that “White House Chief of Staff Rahm Emanuel on Thursday met with House Democrats from the fiscally conservative “Blue Dog” coalition, which is delaying the [health care reform] bill’s passage over concerns about spending.”

This Politico article provides a good review of today’s health care reform action. In advance of the President’s news conference, Sen. Dick Durbin (D Ill.) remarked that the President’s August recess deadline for floor action on health care reform is infeasible in the Senate. To further complicate, the Senate Finance Committee’s activities, Republican Senator Orrin Hatch, of Utah dropped out of the bipartisan talks today, “saying they were going in a direction he just couldn’t support,” according to the Salt Lake City Tribune.

The Politico reports that “The new Democratic thinking is that Obama can legitimately claim progress if two Senate committees and three in the House approve bills by the August break. But even this goal is still not a foregone conclusion, as lawmakers continue to grapple over major issues.” Reuters reports that the Blue Dogs Democrats on the House Energy and Commerce Committee want Chairman Henry Waxman to hold off on a mark up of HR 3200 until the CBO scores the bill. Meanwhile, the Wall Street Journal reports that “Several senior House Democrats [including Rep. Pete Stark (D. Calif.)]voiced strong concern Wednesday with a [Blue Dog Democrat ] proposal [supported by the White House] to empower the executive branch to restrain Medicare spending.” As a wise man once said, “There are two things you don’t want to see being made—sausage and legislation.”

Modern Healthcare reports that the Senate Finance Committee is making progress on its bill. “Senate Finance Committee Chairman Max Baucus (D-Mont.) said that a bipartisan team of negotiators have locked down ‘two major issues’ that will be part of the broad framework for healthcare reform, but declined to provide details. ‘We’re making significant headway,’ Baucus told reporters.” America’s Health Insurance Plans, the trade association, issued a press release supporting a bipartisan approach.

The Wall Street Journal reports that “Democrats from the House Energy and Commerce Committee emerged from a meeting Tuesday with President Barack Obama saying no decisions had been made on new ways to cut the price tag of health-care legislation.” Reuters reports that “the House Ways and Means Committee, was to meet on Wednesday where it was expected to discuss taxes and other roadblocks to its version of the bill. Its plan to add a tax on the wealthy, to raise about $544 billion over 10 years, has come under fire.”

The American Medical Association has endorsed the House reform bill (H.R. 3200). The Lewin Group, working for the Heritage Foundation, projects that in 2015 the House reform bill will start to hit doctors where it hurts the pocketbook due to the expected growth of the public plan option. Not surprisingly, seventeen state medical societies, including the Texas Medical Association, have not jumped on the HR 3200 bandwagon. According to the Fort Worth Star Telegram, these groups also are concerned that the House bill does not attempt to control medical malpractice liability and the related costs of defensive medicine.

The Federal Times provided links to an interesting exchange of correspondence between the ranking minority member and chairman of the House Oversight and Government Reform Committee concerning the impact of H.R. 3200 on the FEHB Program.

Finally, the American Medical Association released its 2009 report card on major health plan claims processing. Happy Heal the Claims Process Week!