First Edition: March 13, 2012

Today's headlines include reports about the Obama administration's new rules for health insurance exchanges as well as the latest wrinkles in the federal budget process.  

Kaiser Health News: Off-Label Use Of Risky Antipsychotic Drugs Raises Concerns
Reporting for Kaiser Health News, in collaboration with The Washington Post, Sandra G. Boodman writes: "But these days atypical antipsychotics -- the most popular are Seroquel, Zyprexa and Abilify -- are being prescribed by psychiatrists and primary-care doctors to treat a panoply of conditions for which they have not been approved, including anxiety, attention-deficit disorder, sleep difficulties, behavioral problems in toddlers and dementia. These new drugs account for more than 90 percent of the market and have eclipsed an older generation of antipsychotics. Two recent reports found that children and adolescents in foster care, some less than a year old, are taking more psychotropic drugs than other children, including those with the severest forms of mental illness" (Boodman, 3/12).

Kaiser Health News: Rules For New Insurance Marketplaces Give Insurers Clout
Kaiser Health News staff writer Julie Appleby reports: "Insurers and other industry representatives will get to fill as many as half the seats on the governing boards for state health insurance exchanges, under final rules for the marketplaces issued today by the Department of Health and Human Services.  At least one seat must be reserved for a consumer representative. The long-awaited rules are likely to disappoint consumer advocates who would have preferred the governing boards 'be dominated by consumers,' said Timothy Jost, who speaks as a consumer advocate before the National Association of Insurance Commissioners and is a professor at the Washington and Lee University School of Law" (Appleby, 3/12).

Kaiser Health News: Insuring Your Health: Premium Rebates, Coverage Labels, Reduced Medicare Drug Costs Highlight 2012 Health Law Changes
In her latest Kaiser Health News consumer column, Michelle Andrews writes: "Two years after its passage, the sweeping health care overhaul remains deeply controversial, with both political parties trying to use it to their advantage in the upcoming elections. As GOP lawmakers constantly deride 'Obamacare' and threaten to repeal it, it's easy to forget that implementation marches on, and a number of notable changes will take effect for consumers this year" (Andrews, 3/12).

Kaiser Health News: Capsules: Winner And Losers In Medicare Advantage Extras: Avalere Report
Now on Kaiser Health News' blog, Marilyn Werber Serafini reports: "Medicare beneficiaries in private health plans throughout the country get significantly different levels of extra benefits, and that disparity will continue with the implementation of the 2010 health law, according to an analysis released Monday by the health care consultant Avalere Health. Moving forward, some extra benefits that seniors are getting in these plans are likely to diminish and some are likely to disappear altogether depending on where a senior lives, according to the report" (Werber Serafini, 3/12). Check out what else is on the blog.

The Associated Press/Washington Post: Ambitious Health Care Blueprint Stresses State Flexibility, Sets Up Huge Logistical Challenge
Democratic state officials are praising the flexibility in federal rules issued Monday, a long-awaited blueprint for state health insurance markets where millions of consumers will shop starting in 2014. States have a range of options for designing and running the new markets, called exchanges. … But Republicans say the health care law still amounts to a power grab by Washington. "Once again, the Obama administration has overpromised, oversold and under-delivered," said Bob McDonnell, Virginia's GOP governor (3/13).

Los Angeles Times: White House Relaxes Key Rule In New Healthcare Law
The administration moved to ease development of state-based insurance exchanges for Americans not covered by employers. States will get more flexibility in running the exchanges and may get help setting them up (Levey, 3/12).

Politico: Health Care Reform: States May Test HHS Power
If the Supreme Court upholds the health care reform law, can a state keep fighting its implementation? The law is very clear: The Department of Health and Human Services has the power to set up a federal health insurance exchange in states that don’t set up their own. But a federal exchange can’t function solo. It needs some help from a state's Medicaid program and insurance department (Feder, 3/12).

The Washington Post: The Fact Checker: Is The Health Law Already Running A Deficit
A reader asked us to fact-check these claims by Sen. Johnson, a trained accountant who won election in part on clever ads that played up his experience in the real world of budget numbers. ... Secretary Sebelius certainly appears to be a bit clueless as Johnson tosses a bunch of numbers at her, clearly trying to show that the Obama health care law is now projected to show a deficit. But he gets his own facts and figures mixed up, as we will demonstrate (Kessler, 3/13).

The New York Times: GOP Split Over A Bid To Revise Budget Deal
The House is bracing for a rancorous showdown over a 2013 budget plan that has already divided Republicans because of a push by conservatives to cut spending below the level both parties agreed to in last year’s deal to raise the federal deficit. … The budget blueprint for the coming fiscal year — to be unveiled next week — will also reignite the fight over Medicare, an election-year prospect that has both parties digging in (Weisman, 3/12).

The Wall Street Journal: States Keep Axes Sharpened
States are moving to cut jobs and other spending to close budget deficits, even though their protracted fiscal crisis is easing a bit in an improving economy. … But other economists more critical of government spending say the fiscal challenges of recent years helped states by forcing them to confront long-term problems, such as rising pension and health-care costs, that they had avoided for years. Some states have restructured their worker pension and health-care plans to reduce projected spending (Mitchell, 3/12).

The Washington Post: Doctors In Private Practices Are Now Joining Hospital Staffs
When a hospital buys out a practice and brings it into the institution’s system, it's like Wal-Mart coming into town. Corporate decisions are made about purchasing and staffing as well as oversight of medical care and quality, all of which impacts a patient’s experience when he comes for an office visit (Manoj Jain, 3/12).

The New York Times: Small-Picture Approach Flips Medical Economics
A.C.O.'s, as they are known, are collections of medical providers who band together under one business umbrella. The organization can include primary care doctors, specialists, social workers, pharmacists and nurses. The difference is in how these providers are paid: Instead of an insurance company or the government reimbursing each provider for each service provided to each patient, the A.C.O. is paid simply to care for a group of patients (Japsen, 3/12).

The Wall Street Journal's Washington Wire: Romney Isn't Signing Up For Medicare
The newly 65-year-old presidential candidate Mitt Romney isn’t enrolling in Social Security and he’s not signing up for Medicare, either, a campaign aide said Monday. Mr. Romney will keep his private health insurance plan, the aide said, without elaborating on whether he accessed that plan through a former employer or purchased it on the individual market (Radnofsky, 3/12).

Politico: Mitt Romney Won't Sign Up For Medicare
The decision puts Romney in a tiny minority. A vast majority of seniors choose to participate in Medicare. Nearly all seniors are automatically enrolled in Medicare Part A, which covers hospital care. But they can choose not to use it (Haberkorn, 3/12).

USA Today/Religion News Service: Bishop Hopes To Restart White House Contraception Talks
The Catholic bishop leading the push against the White House's contraception mandate says the bishops hope to restart contentious talks with the Obama administration, but cautioned that church leaders "have gotten mixed signals from the administration" and the situation "is very fluid" (Gibson, 3/12).

The Associated Press/Washington Post: Committee Considers Next Steps For Health Care Exchange, Vote On Legislation Could Come Friday
A House of Delegates committee is expected to vote on a bill to create the framework for a health insurance marketplace that is designed to provide coverage for the 700,000 uninsured people in Maryland. Health and Government Operations chairman Delegate Peter Hammen said the committee could vote on the cumbersome bill Friday afternoon (3/12).

Los Angeles Times: California Health Insurers And Doctors Attack Rate-Control Proposal
C. Duane Dauner, chief executive of the California Hospital Assn., said chronic under-funding of Medicare and Medi-Cal by federal and state governments was one of biggest reasons premiums keep climbing (Terhune, 3/13).

The Associated Press/Washington Post: Oregon Physician Behind Death With Dignity Dies At 83, Using Aid-IN Dying Law He Championed
Peter Goodwin fought for years to give terminally ill patients the right to die on their own terms. When he couldn’t fight anymore, that’s exactly what he did. The Portland physician died Sunday in his home after using lethal chemicals obtained under an Oregon law he championed. He was 83 (3/13).

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