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Newsletter, What's Going On, February 22, 2011

There’s a class at MIT’s Sloan School called “"Economics of the Health Care Industries."   Last weekend the students were given the assignment to prepare a paper dealing with this subject: What methodology would you propose for the allocation of an annual global payment, to divide it up among primary care doctors, community hospitals, tertiary hospitals, specialist doctors, nursing homes, etc. -- all of whom are involved in caring for a given population of patients? How would you make the transition from the current fee-for-service approach?  They had all of one weekend to write it.   

The Wonkbook: The spending bill passed by the House strips funding to implement health care reform, reports David Nather: "The House voted Friday to block funding for the health care law in several ways...As expected, lawmakers approved Rep. Denny Rehberg’s amendment to the continuing resolution, which bars all payments to 'any employee, officer, contractor, or grantee of any department or agency' to implement the law...But they also gave unexpected victories to Steve King of Iowa, approving broader measures to deny any implementation funds in the continuing resolution and block salaries to enforce the entire law. And another measure by Jo Ann Emerson of Missouri to block funding for the Internal Revenue Service to enforce the individual mandate - the wildly unpopular requirement for everyone to get health coverage starting in 2014 -- was also approved." 

American Independent:  The House voted Friday, 240-185, to block all federal funding to Planned Parenthood, and to go one further, to defunding Title X entirely.   “……All of the funding blocked, ironically, is Title X funding--contraceptive and family planning assistance to low and moderate income individuals. You know, the education and means by which to prevent unwanted pregnancies, and thus, reducing abortion. Apparently so as not to single out Planned Parenthood, the resolution actually eliminates the entire Title X program. Other parts of the Title X program include breast and cervical cancer screenings, HIV prevention education, pregnancy diagnosis and counseling.” 

POLITICO Pulse: Reproductive health advocates are anxious they won't be able to strip the Pence amendment to defund Planned Parenthood from the Republicans' continuing resolution - and with good reason. To do so, Democrats would have to muster a 60-vote supermajority. And on a contentious issue of reproductive health - one that lead to a three-hour long debate on the House floor - can they peel off seven Republicans?  "Since it's a base bill, I'm very concerned that it might stay there," Rep. Diana DeGette, co-chairwoman of the Congressional Pro-Choice Caucus, told us. "I'm concerned that some of these restrictions on reproductive health are going to whip through Congress and people aren't going to see it coming."

However, The Hill: Senate Dems present united front on GOP abortion fight.  A handful of Senate Democrats are presenting a united front against new reproductive-rights restrictions being pushed by House Republicans.

Common Dreams: HHS Repeals Portions Of Health Care Denial Rule That Threatened Women’s Health. Last Friday the Department of Health and Human Services modified a regulation originally issued by the Bush administration that was designed to allow insurance companies, hospitals and other health care providers to refuse to offer basic reproductive health services, including birth control and life-saving abortions. The American Civil Liberties Union welcomed the changes, while urging the administration and lawmakers to oppose ongoing efforts in the House of Representatives to place politics over women’s health.

POLITICO Pulse: Republicans are seizing on Obama's new conscience clause regulations - which rolled back Bush-era provisions - to make the case for the Protect Life Act, which strengthens providers' rights to not perform abortions. "Without legal protection, we can certainly expect even more bureaucratic assaults on the conscience of medical workers," Energy and Commerce subcommittee chairman Joseph Pitts said in a Friday statement. 

Daily Kos: The GOP continuing resolution would decimate community heath centers. How big is the cut? On paper, House Republicans propose to reduce clinic funding from current levels by $1 billion, or roughly a third of their total federal funding.  From best estimates it sounds like more than 100 clinics could close and more than 1000 clinics could reduce services, leaving around 3 million people without a regular source of affordable health care.  The cuts would also cost an estimated 178,000 jobs.  Community clinics were initially created with bipartisan support. 

Austin Frakt.  Incidental Economist.  Truth and Health Care.  …” What would real action on health look like? Well, it might include things like giving an independent commission the power to ensure that Medicare only pays for procedures with real medical value; rewarding health care providers for delivering quality care rather than simply paying a fixed sum for every procedure; limiting the tax deductibility of private insurance plans; and so on.  And what do these things have in common? They’re all in last year’s health reform bill.”

Kevin Pho at KevinMD: Integrating doctors and hospitals may worsen cost control in health reform  Health reformers propose the proliferation of integrated health systems, like the Mayo Clinic or Kaiser Permanente, which, according to the Dartmouth Atlas, lead to better patient care and improved cost control.  To that end, Accountable Care Organizations have been a major part of health reform, changing the way health care is delivered.  Never mind that patients may not be receptive to the new model, but the creation of these large, integrated physician-hospital entities that progressive policy experts espouse comes with repercussions.  Monopoly power.  To prepare for the new model of health care delivery, physician practices have been consolidating.  In many cases, they’re being bought by hospitals.  But with consolidation comes a tilt in market power.  Health insurers, desperate to control costs, are finding it more difficult to negotiate with hospital-physician practices that dominate a market.  And patients are going to side with the hospital — insurers that leave out popular doctors and medical facilities face a backlash from patients.  Witness the power that Partners Healthcare has in the Boston market that’s mostly driven by patient demand for big-reputation, high-cost Massachusetts General Hospital and Brigham and Women’s Hospital. 

And, Merrill Goozner at Fiscal Times: Monopolies Threaten Health Care Cost Control.  Consolidation in California actually raised prices.  A lot.  

Maggie Mahar at Health Beat called attention to the two preceding posts.  Her comments are worth reading.  

Daily Kos: The legislation proposed in Wisconsin that has generated national uproar would seriously imperil that state’s Medicaid program, among other provisions.  Jonathan Cohn at The New Republic comments on the Medicaid peril, too. 

The Harvard Crimson: Report Finds Flaw in Health Care Legislation  Millions of Americans could temporarily be left without insurance coverage under the recent health care reform legislation, according to a study co-authored by Benjamin D. Sommers, an assistant professor at the Harvard School of Public Health.  Under the new law, monthly fluctuations in income will cause low-income families to move back and forth between Medicaid and subsidized insurance coverage obtained through federally-mandated state exchanges. Some people may have to wait several weeks after their Medicaid coverage ends for their exchange insurance to take effect or vice versa.  The study is published in Health Affairs.  The Wonkline. 

Wonkbook: GOP state governments are experimenting with ways of blocking health care reform, report N.C. Aizenman and Amy Goldstein: "With battles over the president's signature health legislation underway in the courts and on Capitol Hill, a third line of attack is forming in the states: Practically every week, a Republican governor or lawmaker announces a new effort to kill the health-care law or undercut its implementation. Some have returned federal funding to prepare for the rollout and halted early planning work. But others are moving forward even as they pursue efforts to overturn the law... After a federal judge in Florida not only struck down the health-care law but suggested that his judgment was the 'functional equivalent of an injunction,' officials in three of the 26 states party to the suit - Alaska, Florida and Wisconsin - declared the law 'dead.'"

Kaiser Daily Health Policy Report: States Pushing Managed Long-Term Care For Elderly And Disabled Medicaid Patients.  Kaiser Health News staff writer Phil Galewitz, in collaboration with USA Today, reports, "Desperate to rein in rising Medicaid costs, Tennessee last year became the sixth state to require its frailest and costliest patients -- the elderly and disabled who need long-term care -- to enroll in managed care plans. At least 10 other states, including Florida, Maryland, New Jersey and Rhode Island, are considering introducing or expanding the use of managed long-term care. The trend is sparking opposition from the nursing home industry and raising some concerns from AARP and other patient advocates (Galewitz, 2/21). 

Not Running a Hospital: Have you heard the one about the backlash to Accountable Care Organizations (ACOs)? Actually, there’s no such thing...yet. But there could be, suggests Pauline Chen in her latest “Doctor and Patient” column, if ACOs take off without fully appreciating that patients have to buy into the concept. And that won’t happen if they’re not part of the discussion and the design, and offered more than legal lingo.

There is a very serious, very cynical argument that Chief Justice Roberts will write the opinion upholding the constitutionality of the Affordable Care Act.  The Wonkroom.

New York Times Opinion: Money Won’t Buy You Health Insurance.  A corporate CEO denied insurance because of a pre-existing condition: a corn on her foot for which a podiatrist had recommended an in-office procedure. 

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Thursday, February 24, 2011. 8 PM.  CST  PNHP Leader/Activist Conference Call.  Call me for the number and access code. 

Wednesday, March 2, 2011. Please join NAHA (North Alabama Healthcare for All), for a fun lunch with no agenda, just some good discussion. 

Location in March to be determined.  .  Wednesday before each monthly meeting.

Sunday, March 6, 2011  7PM CDT. Healthcare-NOW monthly activist phone call. Please use this Dial-in Number 1-218-862-1300 and Conference Code 441086. To mute and unmute the line, please hit *4.

Monday, March 7, 2011  5:30 PM.  North Alabama Healthcare for All Monthly Meeting —Huntsville/Madison County Public Library, 901 Monroe Street  (downtown).  The meeting is in Room AB, on the first floor. After you enter the library’s front door, turn right towards the auditorium.

Thursday, March 10, 7:00 PM.  Health Care for Everyone-Alabama meeting, Community Meeting Room, Emmet O’Neal Library, 50 Oak Street, Mountain Brook.  We’ll combine a drop-in health care study group, this month starting with the ‘Individual Mandate’; talk about recent goings on in health care reform and plans for what to do next.  All invited.  

Thursday, March 17, 2011.  @5:30 PM.  Third Thursday happy hour (social gathering), at The Scene, restaurant and lounge, upstairs at Monaco, 370 The Bridge Street, Huntsville.  Rob Kilpatrick would appreciate knowing you’re coming.  rob2020@mac.com

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