Medicare will encourage doctors, hospitals and other health care providers to team up to provide more coordinated care for patients, according to federal guidelines released Thursday.

The new draft regulations, which are part of the health care reform law, lay out how health care providers can join together in groups called “accountable care organizations.” The goal is to provide better care, at a cheaper price, by making sure that doctors, hospitals and other providers are talking to each other, sharing medical records and coordinating follow-up care. That, proponents say, could reduce medical errors that land patients back in the hospital and get rid of waste such as duplicate medical tests.

The ACO concept isn’t new. Well-regarded health systems such as Geisinger Health System in Pennsylvania work this way. But the healthcare reform law will ramp up the incentives for more providers to join together in ACOs by offering financial benefits through the Medicare system. Under the new rules, ACOs that can prove that they are improving patient care and saving money will get to keep a percentage of those savings.

“For too long, the federal government has been a bystander and in some cases a barrier, while others worked to improve health care delivery systems,” Health and Human Services Secretary Kathleen Sebelius told reporters Thursday. “With the new tools in the Affordable Care Act we’re putting our full weight behind efforts to improve care.”

Federal officials say that the program could save Medicare as much as $960 million over three years, though they caution that it is only an estimate and there’s a wide range of possible savings.

Although the ACO concept has been around a while, there is no one definition of what kind of organization qualifies as an ACO — and the six pages devoted to ACOs in the health reform law left much open to interpretation. The proposed rules released Thursday expand those six pages to 429, clarify the criteria organizations will have to meet in order to participate in the Medicare program, and explain how the financial incentives will work.

New ACOs — which will have to serve at least 5,000 Medicare beneficiaries — will be able to choose between two tracks. Organizations that are farther along in the process will be able to immediately join a program that will reward them for saving money and improving care, but will also penalize them if they don’t meet those goals. Organizations that aren’t yet ready to take the risk of penalties will be able to join a “reward-only” track, in which they’ll get to keep a smaller percentage of the savings for the first two years. Then, in the third year, they’ll accept the risk of penalties too.

Joining the ACO program will be completely voluntary for Medicare providers.

The two-phase program will allow more organizations to sign up, says Stuart Guterman, vice president for Payment and System Reform at the Commonwealth Fund.

“What [Centers for Medicare & Medicaid Services] is concerned about is getting folks in the program who really are going to be prepared,” Guterman says. “The object is not to put organizations at risk, it’s to get organizations to take responsibility for the care they provide patients, and the costs and outcomes.”

Not everyone agrees that accountable care organizations are an entirely good idea. Critics have charged that consolidating so many health care providers could lead to price-fixing and other competition problems, raising prices for consumers.

“In some markets, the dominant hospital is like the sun at the center of the solar system,” Elizabeth B. Gilbertson, chief strategist of a union health plan for hotel and restaurant employees, told The New York Times in November. “It owns physician groups, surgery centers, labs and pharmacies. Accountable care organizations bring more planets into the system and strengthen the bonds between them, making the whole entity more powerful, with a commensurate ability to raise prices.”

To address those concerns, the Federal Trade Commission and Justice Department released antitrust guidelines on Thursday as well. According to the guidelines, ACOs that control less than 30 percent of the market share in a given area would get less scrutiny, and larger proposed ACOs would be reviewed by federal regulators within 90 days.

The rules proposed Thursday are not quite final yet. Regulators will take comments and public feedback for 60 days and release a final regulation later this year. The program will begin in 2012.

The post Medicare Rules Will Guide Hospitals, Doctors Toward More Cooperation appeared first on PBS NewsHour.

File under “even when we agree, we disagree.” Perhaps the only aspect of health reform on which Republicans and Democrats concur is the “1099” provision — both parties say they want to repeal the unpopular measure that would burden small businesses with more tax-reporting paperwork. The Republican-led House passed its 1099 repeal bill Thursday, and the Democratic-led Senate passed a version last month.

But no final bill is in sight, because the two parties can’t agree on how to make up for the money that the government will lose if it repeals the measure. So until the two parties can agree on a plan, the 1099 provision will remain in the law.

Also this week:

The Federal government says that more than 5,000 employers are using the early retiree reinsurance program created under the health reform law. The program has given out $535 million so far to help employers provide health insurance for early retirees.

Senate Republicans are asking President Obama to withdraw his nomination of Donald Berwick to head the Center for Medicare and Medicaid Services. Berwick, who became a lightning rod for Republican criticism, has been leading the agency since last summer via a temporary recess appointment that bypassed the congressional approval process.

Insurers and patient groups met this week to discuss what medical treatments should be considered “essential benefits” under the health reform law. The Wall Street Journal explains.

Here are more stories we covered:

• U.S. District Court Judge Roger Vinson said that health reform implementation could go on while the government appeals his ruling that the law is unconstitutional.

• President Obama says that he supports an opt-out option for states that can achieve the goals of health care reform in a different way. But Republican governors say that that’s not enough flexibility.

• On the Hill, legislators hear that Medicare fraud is easy.

• Health insurance rate hikes are sparking anger in California.

The post Health Reform: Senate Passes 1099 Repeal, But Final Passage Not in Sight appeared first on PBS NewsHour.

Aghaegbune “Ike” Odelugo fraudulently billed Medicare for nearly $10 million worth of medical equipment between 2005 and 2008. On Wednesday, a repentant Odelugo spoke before a congressional subcommittee about how simple it was to commit his crime — and what Medicare could do to make it more difficult.

Odelugo, who was convicted in April and is cooperating with authorities while he awaits sentencing, spoke during a crowded day of three congressional hearings on Medicare fraud. He told members of the House Ways and Means Oversight subcommittee that it took him less than a month to put his fraud scheme into practice.

“[Medical equipment] fraud is incredibly easy to commit,” he said. “The primary skill required to do it successfully is knowledge of basic data entry on a computer.”

Medicare has no official estimate of the amount of money lost to fraud each year, but outside estimates put the number in the tens of billions — a “60 Minutes” estimated about $60 billion in 2009.

The issue has gained new prominence this year, as President Obama and others have emphasized that provisions in the health reform law that aim to curb Medicare fraud are a key money-saving part of the bill.

At the hearings Wednesday, the politics of health reform made an appearance.

Republican Rep. Charles Boustany of Louisiana, chair of the Ways and Means oversight subcommittee, said in his prepared remarks “While the Affordable Care Act included some new anti-fraud provisions, it left a lot of suggestions by the Office of Inspector General, Government Accountability Office, and Members of Congress from both parties on the cutting room floor. At the same time, the law created a host of new health care spending programs. The Congressional Budget Office estimates these new programs will cost $940 billion over the next ten years, and much more after that. CBO has estimated the Act’s anti-fraud provisions would save about $5.8 billion over the next ten years. That’s less than one percent of the expected fraud against federal health care programs during the same period.”

But Peter Budetti, director of the Center for Program Integrity at the Centers for Medicare and Medicaid Services, told the House Ways and Means Committee and the Senate Finance Committee that the law is already making a difference, allowing Medicare to move away from a “pay and chase” model of fighting fraud. Instead of paying claims and then later fighting to get that money back, Budetti said, Medicare is gaining more flexibility to keep fraudulent health care billing out of the system.

Health correspondent Betty Ann Bowser wrote a personal take on Medicare fraud last week.

Also on Wednesday, Sens. Charles Grassley, R-Iowa, and Ron Wyden, D-Oregon, introduced a bipartisan bill to allow public access to a Medicare claims database that details what every provider earns from Medicare.

“The bad actors might be dissuaded if they knew their actions were subject to the light of day,” Grassley said in a statement.

Courts have ruled against opening the database because of privacy concerns, the Wall Street Journal explains.

Find more health coverage on our Rx for Reform page.

The post Medicare Fraud Is ‘Incredibly Easy,’ Congress Hears appeared first on PBS NewsHour.

It’s one of the central debates around health care reform — in the end, will the reform law cost too much, or will it actually save money?

On Tuesday, Republican lawmakers and governors argued that it will cost too much — at least from the states’ perspective. In a hearing before the House Energy and Commerce Committee, Republican governors Haley Barbour of Mississippi and Gary Herbert of Utah testified that the Medicaid expansion included in the law will put a financial burden on states, and that states need more flexibility than the law allows to develop health systems that fit their needs.

Beginning in 2014, the reform law requires states to expand Medicaid eligibility to cover everyone who earns up to 133 percent of the federal poverty level — about $30,000 per year for a family of four. That will add tens of millions of people to states’ Medicaid rolls. The federal government will cover the entire cost of the new additions for the first three years. After that, it will gradually reduce its contribution to 90 percent by 2020, with states making up the rest.

Before the hearing, the Republican-led committee released a report that estimated that the Medicaid expansion would cost states $118 billion by 2023, nearly double the $60 billion that the nonpartisan Congressional Budget Office estimated that it would cost by 2021. The new estimate was based on state government cost projections, the report’s authors said.

“The only way we can afford to do this is going to be to cut from other programs […] or a big tax increase,” Gov. Herbert told the committee.

States are already facing a massive Medicaid budget crunch this year, as the NewsHour reported last month.

But the new report conflicts with projections that suggest that states will, on balance, save money under the health reform law, Nick Papas, a White House spokesman, told Bloomberg News. He said that a study by the Urban Institute (described here) found that states may save as much as $131.9 billion from 2014 to 2019, Bloomberg reported.

Barbour and Herbert testified at the House committee hearing, along with Democratic governor Deval Patrick of Massachusetts. All three were in Washington for the annual meeting of the National Governors Association.

The Republican governors also argued that the compromise President Obama endorsed Monday — to allow states to opt out of parts of the reform law if they could achieve the same coverage goals in other ways — didn’t go far enough.

“Of course the devil is in the details,” Barbour said. But, he argued, states would still be required to, for example, make insurers offer mandatory standard benefit packages that are higher than what they are now. “So if it doesn’t give us relief from that […] then it’s really not all that much help.”

Gov. Patrick defended the health reform law, which he said was similar to the 2006 Massachusetts law that was working well in his state.

“Today, thanks to effective implementation of reform, more than 96 percent of Massachusetts residents have insurance coverage,” he said.

But Barbour, who is considering a run for president in 2012, took a dig at a potential Republican rival — former Massachusetts governor Mitt Romney, who ushered in the state’s reform law. What works in Massachusetts is not right for Mississippi, he said.

“Massachusetts has a state health insurance program that they’re obviously happy with,” he said. “If that’s what Massachusetts wants, we’re happy for them. But we don’t want that. That’s not good for us.”

The post Republican Governors: Reform Law will Cost too Much appeared first on PBS NewsHour.

In the judicial back and forth over the health care reform law, the score is now three to two.

On Tuesday, Federal District Court Judge Gladys Kessler of Washington, D.C. said that the law is constitutional. She tossed out a lawsuit that challenged the law’s individual mandate — the requirement that nearly every American purchase health insurance beginning in 2014.

Kessler is the fifth federal judge to rule on the law since October. Three have said that it is constitutional, two have said that it is not. The decisions have fallen along party lines — all of the judges who have ruled in favor of the law were appointed by Democratic presidents, both of those who decided against it were appointed by Republicans.

See the score below:

The cases will make their way through appeals courts and will almost certainly be decided by the Supreme Court (most likely in the spring of 2012, Politico reported). But in the meantime, the growing number of decisions provide legal arguments for appeals courts to consider — and political fodder for supporters and opponents of the law.

On Tuesday, Kessler dismissed a lawsuit that had been brought by five individual plaintiffs, represented by the conservative legal group the American Center for Law & Justice. The wrinkle in this case was that three of the plaintiffs argued that they plan to use no medical services for the rest of their lives due to religious reasons, saying they believe that God will provide for their health. Two others said that they prefer holistic healing methods not covered by insurance.

Kessler rejected their arguments, ruling that Congress has a right to regulate health insurance under the Constitution’s commerce clause, and that the plaintiffs could choose to pay the fine specified in the law if they did not want to buy health insurance.

Appeals court arguments are scheduled for this spring and summer for the two Virginia cases and the Michigan case, but are not yet scheduled for the highest-profile lawsuit, the one brought by 26 states’ attorneys general.

The post D.C. Judge Upholds Health Reform Law as Cases Move Toward Supreme Court appeared first on PBS NewsHour.

Last week, in the largest nationwide bust of its kind ever, more than 700 federal agents fanned out from Miami to Los Angeles and rounded up 111 doctors, nurses, physical therapists and health company executives in nine cities. It was part of a massive federal government crackdown on fraud allegedly perpetuated by corrupt individuals that in recent years has cost Medicare and Medicaid more than $2.3 billion.

Since 2007, operations from these federal government strike forces have resulted in the apprehension of nearly 1,000 people by investigative teams from the Department of Health and Human Services’ Inspector General’s office.

Those arrested last week alone were charged with stealing $225 million. Investigators said they used fake billing schemes, kickback operations, money laundering and identity theft.

A podiatrist in Detroit allegedly billed Medicare $700,000 for performing partial toe nail removals which authorities said amounted to little more than toe nail clippings. A Brooklyn, N.Y., proctologist had billed Medicare $6.5 million for hemorrhoid removals which authorities said were mostly procedures that never took place. And in Miami, two doctors and several nurses were arrested after investigators found they had billed Medicare $57 million in physical therapy services which authorities said were little more than simple back rubs.

Don White, a spokesman for the Department of Health and Human Services Inspector General’s office, said these latest arrests are “just the tip of the iceberg.”

I followed all of this with great interest as the PBS NewsHour’s health correspondent, but also for a more personal reason.

In the months before my mother’s death last year, I had become increasingly disillusioned with a group of doctors who were under contract to her nursing home and wondered whether they were billing Medicare for services they did not perform.

In February 2010, my mother broke her leg while living in an assisted living facility. She was no longer able to dress herself. She could not get to and from the dining room on her own. She had reached the point where she needed the kind of care provided in a skilled nursing facility.

As a dual-eligible senior, meaning she had both Medicare and Medicaid, my mother was transferred to a local nursing home. It was neither the best nor the worst facility in the area. It was the closest place that had a qualified bed. And, as her only child with power of attorney, I watched with alarm as her medical condition began to deteriorate almost as soon as she entered the skilled nursing facility. Her dementia grew worse. Some days she thought she was on a trip to Chicago (a city she had never lived in). On one particularly bad day she insisted that she was in jail and that the nurses were actually guards who were assigned to keep her from hurting other inmates.

I repeatedly tried to contact the geriatric medical practice on contract to the nursing home but nobody called me back. Finally one day I reached a physician at the group who seemed irritated with me for bothering him and told me to talk to the nurses if I wanted information.

The nurses referred me back to the same doctors.

I tried to get help for my mother by contacting other primary care physicians, but after calling 14 different offices and being told they weren’t accepting any new Medicare or Medicaid patients, I gave up. All the while, I was receiving bills from the Centers for Medicare and Medicaid Services that showed these same nursing home doctors or their physician assistants who were allegedly visiting my mother once or twice a week were billing Medicare $130 per visit.

In frustration, I finally went to the nursing home on days when these physicians and their assistants were scheduled to see patients. I sat there for hours. But they never came. Once, when I asked about this, one nurse told me quietly “the doctors don’t actually see the patients. They check the charts and leave.”

About six weeks before Christmas my mother stopped eating. When I asked her why, she told me her mouth “hurt.” A care conference to talk about this problem never happened.

By December, my mother weighed just 80 pounds. By Christmas Eve, she was running a fever and coughing. When I put her in the hospital that day the admitting physician told me she had pneumonia and one of the worst cases of thrush he’d ever seen. Thrush is a condition commonly found in babies, HIV patients and elderly people who are malnourished. It is easily diagnosed by having a physician turn on a flashlight and look inside a patient’s mouth.

But there was no such diagnosis for my mother. That is, until it was too late.

In the hospital we tried antibiotics for awhile, but she got worse. Three days after Christmas I stopped all the intervention and moved her to a wonderful hospice where they sedated her. She died peacefully the next morning.

My mother was quite elderly. She was 90 years old. And yes, it is true she didn’t have much time left.

But with proper treatment she might have died from natural causes instead of pneumonia. I, of course, cannot prove that actual fraud was committed. All I know is that my mother wasn’t getting the attention she needed, and for which, I would hasten to add, the federal government was paying.

The post Medicare Investigation Prompts Reflections on a Mother’s Care appeared first on PBS NewsHour.

House Votes to Defund Health Reform

The House passed three amendments Friday that would block the government from spending money to implement the health reform law for the rest of this fiscal year. The amendments, which were attached to a federal spending bill, passed in a largely party-line vote in the Republican-controlled House. The defunding effort will face strong opposition, however, in the Democratic Senate and White House.

“If we are not successful this time we are going to try again and again and again until we have either a Senate that’s willing to pass it or a president that understands that we cannot do this to the American people,” said Rep. Danny Rehberg, R-Mont., one of the amendments’ sponsors, according to CNN.

Alaska Governor Says No to Reform

Alaska Gov. Sean Parnell said Thursday that his state will not implement the health reform law, citing a decision by Florida federal Judge Roger Vinson that ruled that a key part of the law is unconstitutional. The issue will almost certainly eventually be decided by the Supreme Court, but Parnell said that in the meantime the Alaska would not implement the law. The most immediate effect is that the state will not apply for a $1 million planning grant to begin developing health insurance exchanges.

On Thursday, the Obama administration asked Vinson to clarify his ruling. Justice Department spokeswoman Tracy Schmaler told the Wall Street Journal the government filed the motion “to confirm that the court did not intend to disrupt the many programs currently in effect.”

‘Early Innovators’ Get Funding to Develop Insurance Exchanges

Other states, meanwhile, moved ahead with reform. Seven states got $241 million in funding this week to develop the information technology infrastructure that they’ll need to run the state-based health insurance marketplaces that will go into effect in 2014, under the health reform law.

HHS Secretary Kathleen Sebelius said that the states will serve as “laboratories of innovation,” and that the methods they develop can later be used by other states. Find the list of states and grants here.

The post Health Reform Watch: House Votes to Defund Reform; Senate Hurdle Awaits appeared first on PBS NewsHour.

This week, Health and Human Services Secretary Kathleen Sebelius said that Arizona could drop 250,000 childless adults from the state’s Medicaid program. The decision is being watched closely in statehouses all over the country, where governors facing massive budget deficits are trying to find ways to cut costs. State funded programs from education to Medicaid are on the chopping block.

Thirty-three Republican governors and governors-elect recently signed a letter to the Obama administration complaining that the health care reform law‘s Medicaid provisions are unfair and impose crushing costs on them at a time when they’re desperately trying to deal with revenue shortfalls.

Over the past several years, recession-strapped states have seen their Medicaid rolls expand. Federal stimulus money has helped states shoulder the cost of increasing Medicaid populations during the long recession, but that money runs out at the end of June. Meanwhile, under the health care reform law, states are not allowed to tighten Medicaid eligibility requirements to cut people from the program.

So beginning in July, the states will face responsibility for bigger Medicaid case loads with less money coming from Washington.

The states are demanding financial relief from Washington, and that’s where Arizona enters the picture.

Arizona has the second-highest foreclosure rate in the country, some of the highest unemployment and a fast-growing Medicaid population fueled by people who have lost their jobs and then their health insurance. Because of the long recession and a dramatic one-third drop in revenues, the state’s budget has a giant hole that can only be filled by cutting programs across the board.

And like most states, Arizona is legally required to balance its budget.

Because Arizona is one of only a handful of states that provide Medicaid coverage to childless adults, Gov. Jan Brewer wrote to Secretary Sebelius to ask her to grant the state a waiver from the Medicaid requirement in the health reform law. Dropping more than a quarter-million adults, plus another 50,000 families that make more than about 50 percent of the poverty level, the governor argued, would bring the state $541 million it could use to cover part of its budget deficit.

Governors in 48 states facing huge budget deficits have been closely watching this situation and wondering — if Arizona got a waiver, might their states also be able to do the same?

Then, in a surprise move this week, Sebelius told Arizona that the state doesn’t need her permission to cut childless adults from Medicaid at all. She told officials they could eliminate at least 250,000 people from the program later this year when a different waiver that Arizona’s Medicaid program has been operating under expires.

Federal law does not require states to cover childless adults through Medicaid. In 2000, Arizona chose to expand its coverage to childless adults, an expansion made possible by a federal waiver that funded the expansion as a “demonstration program.” Sebelius said that because that waiver expires on Sept. 30, Arizona is free to drop most of the people in that category at that time.

“Arizona may choose to terminate its current demonstration,” and “either not pursue a new demonstration or pursue a different demonstration,” Sebelius said. She added that “any reduction in eligibility associated with the expiration” would not be considered a violation of the health care reform law’s provision regarding Medicaid eligibility.

Arizona Medicaid spokeswoman Monica Coury said “[Sebelius’s] promptness will allow the state to begin reviewing its options and determine the right approach for Arizona.”

The bottom line is that Arizona’s situation is unique and unusual.

Most of the buzz about this decision in the health policy community from both the left and the right has gone something like this: Secretary Sebelius is trying to appear sympathetic to the states’ plight and not present the federal government as “rigid” or “inflexible.”

Edmund Haislmaier of the conservative-leaning Heritage Foundation said “Secretary Sebelius has carefully avoided the core issue,” meaning that she did not rule on the issue of granting waivers to states to circumvent the Medicaid provision in the health reform law. And, Haislmaier said, she “did not give one inch” on the issue of allowing states to ignore the Medicaid eligibility provision of the law. “This is a dodging exercise,” he said. “They’re trying to have it both ways.”

Meanwhile, Ron Pollack, of the health care advocacy group Families USA, which supports the health reform law, said that the decision would be a “huge tragedy” for the people of Arizona who could lose their Medicaid coverage. However, he said, he does not think the decision will have much impact on Medicaid coverage in other states because “the Arizona situation is unusual.” Pollack said eligibility standards in most states were not established by waivers in the first place, and so this decision would not apply to them.

Len Nichols, Director of the Center for Health Policy Research and Ethics at George Mason University in Fairfax, Virginia, thinks the answer to the problem for states is “for Congress to come to it senses and extend Medicaid money in the stimulus bill” until 2014 when the full weight of the new health care kicks in.

But, Nichols says, the atmosphere in Washington right now around the budget deficit makes that almost impossible — so, he says, “We’re stuck.”

In the meantime, states can look toward some federal help in 2014, when most of the provisions in the health reform law take effect. At that time,16 million more Americans (everyone who earns below 133 percent of the federal poverty level) will qualify for Medicaid — including childless adults. But the new enrollees won’t cost the states money; instead, the federal government will pick up the tab for the expansion this for several years.

On Thursday’s NewsHour, we’ll have more perspectives from Arizona, and coverage of the Medicaid budget crunch that states are facing around the country.

The post As Ariz. Seeks Smaller Medicaid Rolls, Cash-Strapped States Look to Mimic appeared first on PBS NewsHour.

Updated 5:45 p.m. ET

A federal judge in Florida became the first Monday to declare the new health care law – in its entirety – unconstitutional.

It is the biggest challenge yet to the new law, with governors and attorneys general from more than half of the states signing onto the lawsuit.

Florida’s former Republican Attorney General Bill McCollum filed the lawsuit just minutes after President Obama signed the 10-year, $938 billion health care bill into law in March. Since then, 25 other states have joined, including Iowa, Ohio, Kansas, Wyoming, Wisconsin and Maine two weeks ago. Almost all the states suits have been brought by Republican governors and attorneys general.

In his 78-page ruling, U.S. District Judge Roger Vinson wrote, “Regardless of how laudable its attempts may have been to accomplish these goals in passing the Act, Congress must operate within the bounds established by the Constitution.”

At issue are two key aspects of the law.

The first centers around the “individual mandate,” which requires most Americans to buy heath insurance by 2014 or pay a fine. That fine would be $95 or 1 percent of their income, whichever is greater. By 2016, the penalty increases to $695 dollars, or 2.5 percent of income. By imposing such a mandate, the law exceeds the powers of the United States under the commerce clause of the Constitution.

Judge Vincent wrote: “Because the individual mandate is unconstitutional and not severable, the entire act must be declared void. This has been a difficult decision to reach, and I am aware that it will have indeterminable implications.”

The states also charge that the new law places an unfair financial burden on already cash-strapped states by adding 16 million people to Medicaid.

Ron Pollack, the Executive Director of Families USA, called the judge’s decision “radical judicial activism run amok.” He added, “The decision flies in the face of three other decisions, contradicts decades of legal precedent, and could jeopardize families’ health care security.”

So far, two federal challenges to the law have been struck down in separate lawsuits in Virginia and Michigan.

But, last month, a federal judge in Richmond, Va., ruled the law unconstitutional. At the time, Virginia Attorney General Ken Cuccinelli said “ordering Americans to buy health insurance, as the bill does, is beyond Congress’ power in the Commerce Clause.”

There are at least two dozen other pending cases filed in federal courts by states and private parties against the law.

Bill Wilson, President of Americans for Limited Government applauded today’s ruling, and said it’s time to go one step further. In a statement, he wrote: “Congress needs to act now to defund the regulation writing on this unconstitutional law to prevent further damage from being done to our nation’s health care system.”

The House of Representatives voted to repeal the healthcare reform law earlier this month. But, Senate Majority Leader Harry Reid, D-Nev., said he won’t bring it to a vote in the Senate.

The Obama administration announced they’ll appeal today’s ruling. In a statement, the Department of Justice said: “There is clear and well-established legal precedent that Congress acted within its constitutional authority in passing this law and we are confident that we will ultimately prevail on appeal.”

The White House also responded to the ruling in a blog post on its website.

White House officials called the decision “a plain case of judicial overreaching.” Stephanie Cutter, Assistant to the President and Deputy Senior Adviser, said the judge’s findings are “at odds with decades of established Supreme Court law” because Judge Vinson failed to preserve any part of the law in his ruling.

Another administration official called some of the judge’s reasoning “quite frightening” saying much of the decision was “unconventional” and built on “rhetorical conjecture.”

And officials said they did not expect today’s decision to slow down or stop implementation of the law, including a huge expansion of the Medicaid program for the poor in 2014, pending a ruling by the U.S. Supreme Court.

Find more coverage on Rx for Reform.

The post Florida Judge Strikes Down Obama Health Care Overhaul appeared first on PBS NewsHour.

After our conversation with Dr. Siddhartha Mukherjee about his new book, “The Emperor of All Maladies: A Biography of Cancer,” Dr. Mukherjee offered to answer some questions submitted by NewsHour viewers.

We received many questions on a variety of issues – his research, the disease and his hopes for his patients and a cancer cure. Dr. Mukherjee answers a few of those queries below.

If you had specific consultation requests about your condition, please visit New York Presbyterian Hospital or consult with your physician.

Carrie (Kensington, Md.): When a patient that was “in remission” has “recurrence” of cancer(same form), did the cancer actually return, or was it more likely really never totally cured?

Dr. Siddhartha Mukherjee: Typically, when cancer recurs in patients with a prior remission, it is because the original cancer was never cured. Occasionally, there can be really late recurrences, even up to a decade. Once in a while, though, a “recurrence” can be a truly new cancer, unrelated to the original cancer.

Jane (Germantown, Md.): You mentioned that when treated, many cancer survivors live more like those with chronic disease … what does that look like? What should we think about/listen to/act on if this is the case?

Dr. Siddhartha Mukherjee: For some cancers, such as breast cancer, prostate cancer, and some leukemias, patients can survive a prolonged period of time with the disease, even with advanced stage disease. This phenomenon is not merely restricted to breast, prostate and leukemias; there are patients with lung cancer, or even melanomas, that survive for decades without their disease being fully “cured.” Many of these patients return to their normal lives, although, of course, cancer remains very much a part of their lives.

Kathleen B: I have had 3 types of cancer, melanoma, papillary carcinoma (I think that is correct. Thyroid cancer)and invasive ductal carcinoma. Is it my immune system that isn’t functioning correctly and allowing these cancers to grow? Is there some relationship between these cancers that I had all three? Now that they’ve all been treated and seemingly in remission, what’s next? Some other form of cancer?

Dr. Siddhartha Mukherjee: It is difficult to tell whether a genetic link lurks behind these three types of cancer in your case. However, three cancers occurring in the same patient does raise the question of an unusual genetic predisposition or an unusual carcinogenic exposure. A genetic counselor might be able to advise you, in particular, by taking a careful family history. I hope that you don’t have another form of malignancy in the future.

Krista (Baton Rouge, La.): Has there been any success against the more aggressive leukemias, like acute myelogenous leukemia?

Dr. Siddhartha Mukherjee: Absolutely. We are using a variety of new drugs against acute leukemias, and many clinical trials are in advanced stages. Of particularly interest are drugs that are used to treat pre-leukemic diseases, such as certain forms of myelodysplastic syndrome.

Carol F.: You spoke of cancer as a disease, and if you interpret disease as “lack of ease,” it surely can be. However in the current medical usage of the word, does cancer strike you as more of a failure of the immune system? This would seem in keeping with your idea of a genetic origin.

Dr. Siddhartha Mukherjee: The relationship between cancer and the immune system is very complex, and only recently being discovered. Rather, I should say “rediscovered.” Scientists and doctors have known for a long time that certain cancers, such as melanomas, interact with the immune system. But recently, we have begun to understand this relationship in molecular terms, and to create medicines that activate the immune system. One such medicine happens to work against melanomas – a truly exciting advance. The notion of using the immune system to attack cancers will doubtless be a major focus of future research. I am very optimistic about this area.

Jennifer: Dr. Mukherjee, thank you for writing your book. As a breast cancer survivor diagnosed at age 31, my question is: why does it seem like younger and younger women are being diagnosed with breast cancer? Is it solely that we have more accurate diagnostic tools, or is there something else at work here?

Dr. Siddhartha Mukherjee: Some of the increased incidence of breast cancer is due to increased screening. Some of it, unfortunately, is the result of the usage of hormone replacement therapy – a practice that has mostly stopped. Some of it might be related to increased obesity, although this link is being investigated. A large part of this, though, is related to the overall aging of the population: breast cancer is very tightly linked to age.

No Name Provided: Does the doctor talk about Bone Marrow/Stem Cell Transplants, its history, and its future for treating blood type cancers and maybe other cancers in future?

Dr. Siddhartha Mukherjee: I cover some of this in my book. However, it is not possible to cover all aspects of BMT. I believe that BMT is a rich area of research, and is particularly successful at curing certain blood cancers. But it is a complex, toxic and expensive procedure that must be performed very carefully to get optimal results.

Jane (Germantown, Md.): If you could wave a magic wand, what would you tell us survivors not to worry about (or to keep in perspective) in order to live with confidence and joy?

Dr. Siddhartha Mukherjee: I would advise survivors to embrace everything that is positive in their lives. I would ask them to look to their loved ones, their families, their children, their friends for support and joy. I think it is impossible to “forget” the diagnosis of cancer; that would be asking too much. But it is also important to not let cancer invade every aspect of survivorship. I would tell survivors to try to restore the sanctity and dignity of their lives – to live beyond cancer as much as possible.

Find more health coverage on our Rx for Reform page.

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The House Ways and Means Committee announced Thursday that its first hearing will be next Wednesday, one day after President Obama’s State of the Union address. Among other tasks, Ways and Means is one of the committees charged with GOP-led efforts to offer a replacement for the health care reform bill signed last year.

Ways and Means Chairman Dave Camp, R-Mich., said the hearing will examine the full impact of what the Democratic-supported health care law is and how it impacts taxes. Camp appeared at a news conference with the other three committee chairmen who have jurisdiction over a possible dismantling the law: Michigan Rep. Fred Upton of Energy and Commerce; Minnesota Rep. John Kline of Education and Labor and Texas Rep. Lamar Smith of Judiciary.

All said that in each of their respective areas, the intention is to replace what they refer to as “Obamacare” with something better.

“Our goal is to produce legislation that is designed to bring down health care costs, expand access to coverage and maintaining the doctor-patient relationships,” Upton said. “We’ll be looking at some of the law’s harsh mandates” and “we intend to focus on a provision that would allow consumers to purchase insurance across state lines.”

“Why can you buy car insurance across state lines and you can’t do that for health insurance? We want to change that,” Upton said.

Camp said they are planting the seeds of cultivating a health care solution that will let Americans chose the health care plan they want without increasing the scope and size of the federal government. “Insuring more people is a goal, but we just want a different approach to health care,” Camp said. “What we have now is government-centered. We want it patient-centered. The tree branch is rotten and should be cut down, but if we can’t do all at once. We’ll prune it branch by branch,” he explained.

All committee chairs said they welcomed testimony from both sides of the aisle and that any proposed amendment or change that is bipartisan in nature would receive first priority.

No other dates for hearings were announced, but committee chairs said they would waste no time in tackling the issue and expect movement on the legislation in the coming weeks.

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The House of Representatives voted Wednesday to repeal last year’s landmark health reform legislation — a mostly symbolic vote since the Democratic-led Senate is unlikely to pass repeal and might not even consider the measure. The final House vote was 245-189.

All 242 Republicans voted to repeal the law, which aims to medically insure millions of Americans through an expansion of private insurance via government subsidies and Medicare. It also put new regulations on the health insurance industry.

In the final roll call, 189 Democrats voted against the repeal measure, while three chose to vote with Republicans: Rep. Dan Boren of Oklahoma, Rep. Mike McIntyre of North Carolina and Rep. Mike Ross of Arkansas.

The House spent all of Wednesday debating the proposal. Democrats largely focused on how many people will have insurance because of the health reform law as well as popular provisions, such as a ban on insurance companies rejecting people who have medical conditions.

Republicans repeatedly said that health care reform was hurting the country’s ability to create jobs and put government bureaucrats in charge of health care decisions.

Americans are still divided on whether to repeal the health care law: A Gallup Poll from Jan. 7 showed 46 percent want repeal, 40 percent do not, and 14 percent do not have an opinion.

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House Republicans are delivering on a campaign promise that helped fuel their many of election victories last year by debating a measure to repeal last year’s health reform law. A vote should come later Wednesday.

Here’s Betty Ann Bowser’s report on Tuesday’s debate, followed by Judy Woodruff’s discussion with two lawmakers on the move:

While the debate and vote (which you can watch in a live stream on C-SPAN) is expected to be more symbolic than substantial — a repeal proposal will most certainly fail in the Democratically-led Senate — we asked some experts to weigh on the change in tone from last year’s health care reform debate and what it tells us about the new Congress.

First up, Norm Ornstein, a congressional scholar at the American Enterprise Institute and a regular NewsHour analyst:

The change in tone in the health reform debate from last year to this is dramatic, and there is no doubt in my mind that it is because of the tragedy in Tucson and the public reaction to it.
Last year’s debate in the House was raucous, nasty, filled with rancor, bickering, outrageous and often false statements, fiery rhetoric and regular shots impugning the motives and basic character of the other side. Even when there were no charges of death panels or the like, the heat was sharply turned up, underscored by then-Minority Leader John Boehner’s peroration against the bill that was punctuated repeatedly by his yelling “hell no!” on the House floor.

This week’s debate on repeal of the Affordable Care Act has certainly had its moments of overblown rhetoric, but virtually all of it has been polite and focused on policy, not motives or outrageous charges. For example, Mike Pence of Indiana, a Tea Party favorite, went through a point-by-point explanation of why he believes that the provisions of the act are indeed “government takeover of health care.” The tone in general has been measured, voices have rarely been raised, and the focus has been on two different views of the bill.

To be sure, there have been some pointed comments. Steve Cohen, a Democrat from Tennessee, asked if any of the Republicans could answer a question about a provision in the bill that sent $250 checks to seniors on Medicare to ameliorate the donut hole costs of prescription drugs: would the repeal effort force those seniors to return the payments to the Treasury? Nobody responded, making Cohen’s polite, but barbed, question, a potent one.

It was also a substantive one about the impact of repeal, hitting highly popular provisions and unpopular ones alike, and leaving lots of questions about how you can in fact “repeal and replace” when there is no replacement plan and no roadmap for replacement on the table. Leading up to the House vote, the debate has not been ideal — it is less a debate with genuine give-and-take, and more a series of one- or two-minute speeches. That, unfortunately, is typical of House debate. I wish we had more scheduled, real debates in the House and Senate. But it has been substantive, civil and meaty. Keep your fingers crossed about how long we can sustain that tone in future weeks and months, as Tucson fades and the ingrained elements of our permanent campaign reassert themselves.

And from NewsHour health correspondent Betty Ann Bowser:

The one thing that is striking about today’s debate to repeal the health care law is this: It lacks passion. There are good reasons for the cool rhetoric. Tucson, after all, was less than two weeks ago. So as members have taken to the floor there have been no angry speeches about death panels, no name calling. It has been measured, polite and I have only heard the term “job killer” used once to describe the bill — and that came from a Democrat who said “some people call this law a job killer.”

The arguments for and against repeal have fallen along party lines. The Republicans have argued the health care law will discourage employers from hiring new people because they won’t be able to afford health insurance for them. Indiana Republican Mike Pence set out one of the GOP’s main complaints saying the law amounts to a government take over of health care. Another Republican argued it will be too expensive forcing the federal government to hire hundreds of bureaucrats and IRS agents to police the law.

On the other side of the aisle, Democrat Henry Waxman of California called the repeal effort a “story of Robin Hood in reverse….[taking] essential health benefits from struggling Americans.” Another California Democrat, George Miller, said repeal of the law would put American’s health care back in the hands of insurance companies, adding “nobody wants to go back there.”

In a few hours, when members vote to repeal the law, that will be that. The bill is going nowhere in the Senate. Democratic Majority Leader Harry Reid has made it clear he has no intention of scheduling a vote on it, period. So what happens now?

On Thursday, the House will instruct the four committees with jurisdiction over health care to get down to business and come up with an alternative health care reform plan. Speaker John Boehner said this morning he wants a “common sense reform that will bring down the cost of health insurance.” But what that will be is anybody’s guess, because many Republicans like a number of provisions in the very bill they are repealing today. Most agree insurance companies should not be allowed to cancel people’s insurance when they get sick or deny coverage to people with pre-existing conditions.

Republicans will also now be able to begin a series of oversight hearings, summoning various officials of the Obama administration to Capitol Hill to explain how they are implementing portions of the law. Fred Upton, who recently took over the House’s major oversight committee, recently suggested that Health and Human Services chief Kathleen Sebelius might want to get a permanent parking spot on the Hill, a hint at how many times his committee may call upon officials like her to explain the rule making that’s underway from the law.

The other thing the majority in the House will be able to do is refuse to fund certain provisions in the bill. For example, they can say no to funds to hire new IRS agents to police the law.

All of this is likely part of a strategy leading up to 2012, when Republicans hope they can use the health care law to propel one of their own into the White House. That’s when it’s possible the entire law could be repealed just as easily as the symbolic repeal that is taking place today.

The post Health Reform Debate Revisited: What’s the Tone in a New Congress? appeared first on PBS NewsHour.

On a day when debate began on the House floor over whether to repeal the health care law passed last year, Majority Leader Eric Cantor and Democratic Whip Steny Hoyer both met with the media in separate news conferences. Cantor used his forum to deride the policy already signed into law by President Obama.

“Obamacare did not lower costs and it will cost small business more money. More people will fall into government run health care and will therefore add to the debt. It’s a bill whose numbers just don’t quite jibe and it’s an unsustainable entitlement,” he said.

But Hoyer said that even though there is some division, repeal of the law is exactly what the American people don’t want.

“If we repeal health care, what we’ll do is in effect is repeal the Patient’s Bill of Rights, not letting the patients and doctors make their own decisions; repeal seniors’ help with their prescriptions and pre-existing conditions. This is inconsistent with what the American people want.”

House Democrats say further that Republicans are wasting their time trying to repeal health care because there are not enough votes to repeal the law in the Senate, where the process would die. But Cantor was up to that challenge.

“I don’t accept that. If Majority Leader Harry Reid feels he’s so confident in that body, then let him bring it up for a vote.

The post House Leaders Frame Next Steps for Round 2 of Health Reform Debate appeared first on PBS NewsHour.

Republicans officially take control of the House today, and a vote to repeal the health care reform law is at the top of their agenda. But with President Obama in the White House and a Democratic-controlled Senate, any House repeal vote will likely be symbolic — the repeal effort is unlikely to advance any further, and provisions of the law scheduled to go into effect this year will continue on course.

With that in mind, Hari Sreenivasan talks to Kaiser Health News reporter Mary Agnes Carey about some of the changes you might see in 2011. The reporters at Kaiser Health News wrote this detailed review of the upcoming changes. Highlights include:

Medicare Changes

Many of this year’s provisions affect Medicare recipients — and are designed to get them to see a doctor before small problems become big ones.

“There’s going to be a focus on making preventive health services more attractive to Medicare beneficiaries,” says Carey.

On January 1, Medicare started providing preventive care measures, including vaccinations and cancer screenings, for free, and also for the first time offering free annual “wellness exams.”

Many seniors will also be paying less for their prescription drugs this year, as Medicare continues to narrow the “donut hole” in which seniors pay out-of-pocket for drugs. This year, they’ll get a 50 percent off brand-name drugs.

But some seniors will be paying more for their pharmaceutical insurance. Medicare Part D, which covers prescription drugs, will for the first time link premium payments to income. Seniors who make more than $85,000 for individuals and $170,000 for couples will have to pay extra for their Medicare Part D coverage.

Medicare will also be making some changes to the way it pays its providers. To encourage more primary care doctors to see Medicare patients, the program will increase its reimbursement rates for primary care doctors by 10 percent.

This year also begins the reduction in payments to private Medicare Advantage plans — 2011 pay rates will be frozen at 2010 levels, and lower pay rates will begin phasing in in 2012. But next year, Medicare will also start offering bonuses to high-performing plans.

Calorie Counts

Diners will soon know exactly how many calories are in their burger, fries or salad — at least at chain restaurants. By March 23, 2011 (one year after the health reform law was signed), the Food and Drug Administration will issue its final rule specifying how restaurants have to implement a provision of the law that restaurants to post calorie counts and other nutrition facts.

The draft guidance is already available, and it says that restaurants with 20 or more locations will have to provide calorie counts on their menus. Consumers won’t see the changes show up immediately though — the FDA will let restaurants know how much time they have to begin complying with the new rules.

New Rules for Flexible Spending Accounts

If you have an FSA, there’ll be no more using it to buy Tylenol and other over-the-counter drugs — at least not without a doctor’s prescription. In the past consumers could use money set aside in an FSA to pay for both prescription and non-prescription drugs, as of January 1 the funds can only be used with a doctor’s prescription. Other rules remain the same — you can still use FSA money for co-pays, deductibles, and medical devices.

Insurance Rebates

As of January 1, health insurance providers are now required to spend a minimum amount of the money they collect in premiums on providing health care for their customers. For large-group plans, that minimum is 85 percent, for small group plans it’s 80 percent.
Plans that don’t meet the minimum requirement will have to give their customers rebates of the difference. The government has estimated that up to nine million people could be eligible for rebates.

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