It had all the trappings of a political football; a blue state’s extremely unpopular Republican governor — looking toward a possible presidential run a year after his term ends — used his partisan hardline to threaten veto of one of the most well-funded social programs for healthcare delivery to the state’s working impoverished, all the while setting the stage for a political attack on his character for all of the nation to see at the hands of the opposing party. The apparent newfound conciliatory stance taken by Minnesota governor and 2012 prez hopeful Tim Pawlenty concerning the threatened veto of GAMC headed this scenario at the pass, however, as the healthcare delivery safety net for thousands of the state’s working poor got a last-minute reprieve to continue being funded, albeit scaled back. Of course the negative PR surrounding a pending lawsuit by three beneficiaries of the program didn’t make eating crow any easier for the chief executive.

Though funding for the program was supposed to end on April Fools Day, the brokered change in funding commitment means that service providers will see less in reimbursements. Also,

[u]nder the agreement, hospitals will receive $71 million from the state’s general fund for the year starting July 1 and $131 million the following year. About 12 to 15 hospitals likely can start serving patients in the new program on June 1. For others not yet ready, $20 million will be set aside to pay for uncompensated care for six months.

The key is in acute care — often the first and only mode by which this underserved patient population will continue to receive care. With a decrease in monies to provide it — even with a grace period of sorts for charity care — the level of participation of acute hospitals is emblematic of both ongoing problems with funding (providing care) and simply surviving as they continue to operate in a program whose demand will only increase until reform is achieved on the national stage. | LINK

President Obama’s healthcare summit has come and gone. The mere fact that this meeting took place in front of cameras was reason enough to discount any potential for real bipartisanship to occur. The upshot? The Republicans stand firm on their ground to rally against any Obama proposal as the party brands itself on this issue ahead of a potentially gratifying November midterm.

Meanwhile, the White House and the Democrats will say that every effort is being made to “forge ahead” amid the apparent obstructionist natures of the GOP. The problem for both parties is that the American public is becoming tired of what it sees as a spectacle. According to a CNN poll [PDF], 86 percent felt that government is broken, with 14 percent saying it isn’t. Of that 86 percent, 81 percent say the government can be fixed, with 5 percent saying it’s beyond repair.

Whatever the ultimate effect this televised meeting had on patients, lawmakers, physicians, insurance companies, and other interested parties; one thing’s for certain: closed-door meetings are the only way anything can get done. Political theater for the world to see accomplishes nothing but shallow grandiosity on the bumpy road to an ultimate reform bill. | LINK

RELATED: The GOP’s proposals. | LINK

Pennsylvania and Hawaii are the only two states in the country that do not have a mechanism in place for the regulation of premium rates set forth by insurers as it applies to their small businesses — a demographic courted heavily by both Republicans and Democrats as players in the final direction of pivotal health reform. The Pandora’s Box cast wide open by the recent Anthem BC scandal is adding a new critical layer of scrutiny not only to Barack Obama’s reform trajectory, but also to the ways in which Insurance market fluctuations influence the overall cost of healthcare delivery and access.

Implications for the these two states are obvious, as government regulatory oversight could go a long way in keeping the relationship between small business and the insurance they purchase an open, transparent, and freely accessible system for consumers of healthcare (patients), giving states’ insurance commissioners added muscle. Alternatively, control of regulatory processes by the federal government could add just another layer of bureaucracy (read: increased administrative healthcare costs to the taxpayer and shifting rising costs to other entities — like Pharma) to an already overburdened HHS Dept. Over the next few days, the unfolding issue of federal gov’t Insurance regulation over state’s private insurance markets will become a hot-button one, adding some eleventh-hour drama to the health reform debate. | LINK

President Obama’s version of the reform bill (the one he is personally proposing and defending, come later this week) is getting a shot in the arm. Hoping to stoke public animus against the recent massively outrageous insurance premium hikes by Blue Cross in California and in other states, Obama will once again renew the call for a bill mostly on his terms.

Coming nearly a year after he put the push toward reform into overdrive, Obama will include the new provision that will allow the government (HHS) and states the power to bar or limit such increases — even demanding rebates for consumers of healthcare in such an environment. All of this is in anticipation for the bipartisan summit with senate Republican and Democratic leaders at which Obama will add previous provisions which include barring claims denials for pre-existing conditions, and a tax on HDHP (Cadillac plans).

Republicans are standing fast on their admonition to force Obama essentially to start from scratch, with a nod toward a more tepid bill with less obvious government funding. The showdown takes place later this week and will be televised. | LINK

UPDATE: The WH has posted Obama’s proposal summary. | LINK | At initial look, the president’s plan does not appear to repeal the antitrust exemption. | LINK [PDF] | Also, without public option language in the proposed bill (as expected), what’s next for each side? The heavily hyped bipartisan summit awaits this week. But what about afterwards? Assuming the Republicans stick to their guns, obliterating the WH’s strategy of forcing them to defend their antipathy toward the bill on fiscal grounds, will the party extend the drive for nay votes toward mditerms? Since the Dems are down by at least three votes, this could be likely. Perhaps, a protracted fight among both sides will be good for the bill’s ultimate passage on (mostly) Obama’s terms —  then, and only then, will the true transparency of the proposed bill’s language come to light as Americans may use November as a referendum on health reform.

Hot on the heels of Insurance hiking premiums among policyholders in California comes a warning of sorts from HHS Sec’y Sebelius: California is not immune. In fact, the spectre of recent burgeoning rates seen at the hands of a Blue Cross/Shield plan subsidiary in the Golden Gate State is only the tip of a rapidly moving iceberg in a healthcare marketplace within which Big Insurance says it must remain competitive.

RI, CT, and OR were three other states cited in Sebelius’s remarks. As healthcare reform moves at a more restrained pace in the run-up to an eventual bill, there is no denying the market is seeing the effects of an economy far from recovery. As millions jettison more expensive coverage for the bare minimum, costs for care delivery are beginning to reflect payouts to plans for the sicker and older portion of the risk pools, creating even more urgency for Obama and company for reform as he has seemingly moved on to his other top domestic priority — jobs. | LINK

Unemployment still sits at double digits (approx 10%) in the U.S. At the end of this month, the extension of COBRA benefits for the newly and longer-term jobless is set to expire — unless the Democrat-controlled legislature passes yet another extension based upon President Obama’s so-called “paygo” law.

Emergency spending would be exempt from typical tax increases or cuts amidst the backdrop of a national deficit. Centrist Democrats, under pressure from more left-leaning colleagues, will probably ask for discretionary spending under this statute — further stoking the ire of Republicans who voted against it in the first place, citing a slippery slope over what would be deemed “emergency spending”. | LINK

In the Massachusetts healthcare economy, the balance between employer, employee (policyholder, beneficiary), and health plan (insurer) is getting new scrutiny. Its chief executive, Gov. Patrick, filed a bill calling for the broadening of powers of the state’s insurance commissioner in capping rates for care delivery services by hospitals, doctor groups, imaging centers, and insurers. He cites the crippling effect of higher rates on employers and employees of small businesses.

Of course, in a state rocked by lowered reimbursement schedules, a diaspora of primary care physicians to other practice locales with a secondary shortage in those primary care services — the news of capped payments to docs is not generating a lot of support in that camp for Patrick’s plan. And what do the small businesses think? Cautious optimism rules the day. Smaller acute hospitals (who already are at the mercy of government whims with respect to Medicare and Medicaid payments) fear for their bottom lines amid the potential for layoffs and cuts in healthcare delivery services.

Insurance companies have no problem supporting the governor’s proposal, just as long as negotiations of rates with the other parties don’t cut into their bottom lines. | LINK

A year ago, this blog cited a study which detailed the difficulties cancer patients faced when navigating the byzantine nature of health plans which essentially made it difficult, if not impossible, to receive life-saving treatments. The paper [PDF] went on to describe the problems these patients would still face even when eligibility requirements for government assistance via Medicare or Medicaid were at least partially met.

Either through ignorance of policyholders’ plans limitations or via the inability for their out-of-pocket costs to cover the difference, cancer patients have continued to face significant challenges in accessing crucial care. The verdict may still be out on the finer points of President Obama’s goals for reform, but Insurance does not really seem to be waiting for his signature on legislation to react.

With respect to one insurer, news comes of a cancer patient’s current fight to obtain treatment oncologists thought could save his life. Relapsing neuroblastoma has sidelined a five year-old’s life right now; his insurer has refused a new treatment option it deems as expiremental — in spite of covering a cheaper treatment in 2007 that was also called such, resulting in a full remission. The child’s parents are suing the carrier.

Advocates for insurance reform have taken a backseat in the reform debate, which is not surprising. Although, Obama has described his reform plans are not a referendum on reform of Insurance in a strict sense, it is apparent that sound arguments based upon solutions in the way coverage is paid and delivered need to transcend the rather simple promise of non-discrimination based upon claims denials.

If Obama ever wished he could tell Insurance to just go and “take a hike”, I’m sure he wouldn’t mean it in a literal sense. A California-based insurance company’s decision to raise policyholders’ premium rates by as much as near 40% has prompted a state inquiry and the ire of HHS Sec’y Kathleen Sebelius. The attention the White House is giving this case at a time when reform efforts are rocky is somewhat of a balm for the president’s increasingly wounded pride on the effort to promise wider healthcare access and affordability as dictated during his campaign for the nation’s highest office. Why would an insurance company, even if it is for-profit, create such a negative PR issue for itself at a time when unemployment — and by extension, healthcare inaccessibility — in California and nationwide are at such cripplingly high levels?

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Obama is currently changing the focus of  his administration’s effort at domestic economic fixes from healthcare to jobs creation.  But he hasn’t completely abandoned healthcare lately — in spite of the recent media coverage hinting of the president’s pressuring Nancy Pelosi to just go with the Senate version pronto.

At an effort to keep health reform from the jaws of death, Obama has invited GOP leaders to discuss possible bipartisan compromises in a meeting slated for the end of this month.

Asked if he was willing to start from square one, the president said he wants “to look at the Republican ideas that are out there. And I want to be very specific. ‘How do you guys want to lower costs? How do you guys intend to reform the insurance markets so people with preexisting conditions, for example, can get health care?’”

Haven’t we been here before? Over a year into his presidency and his dreams of reform passage still the stuff of pipes — patients, providers, and pundits are probably growing as weary as the GOP (now that filibuster is not a possibility) watching this fight play on.

A White House statement Sunday said Obama repeatedly has made it clear “that he’s adamant about passing comprehensive reform similar to the bills passed by the House and the Senate.”

“He hopes to have Republican support in doing so, but he is going to move forward on health reform,” the statement said.

Obama hopes? For all of those wondering just how flawed the Democrats’ bipartisan strategy has been up to this point with respect to reform, it is unfortunately totally being laid bare now. The battle for reform on Obama’s terms is rapidly slipping away. | LINK

A couple of weeks ago, I interviewed the CEO of the EHR/PHR tech company MediConnect, Amy Rees Anderson. What follows is the second half of that interview here on Doctor Pundit.

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DP: How important is portability of the health record for patients beginning to benefit from EHR adoption?

Ms. Anderson: The cheapest way to facilitate the portability of the records is to have the doctors adopt electronic medical records at point of care. Once this occurs the ability to retrieve and transfer records will become substantially more affordable. Again, I don’t think we will see this adoption for doctors really start to boom until we incent the current providers to do so. I do, however, believe that the rising generation of physicians who grew up with their handhelds and tablet PCs will come right out of school using these systems already. But it’s the physicians who have been practicing for years that we need to incent to switch over. Without electronic health records we can still retrieve and digitize the paper records like MediConnect has been doing since 1996, it just comes at a higher cost than if we dealt with all electronic records.

DP: Do you see any immediate barriers to adoption with respect to hospitals, vendor interface, or broadband availability in resource-poorer regions of the country?

Ms. Anderson: I don’t think broadband availability is the barrier to adoption today. The majority of records are stored in offices in the metropolitan areas of the country where the highest numbers of people live anyway, which has ample availability for high speed. In the smaller areas, where the Internet is slower, the doctors can keep records on a local server that can connect and upload to secure online storage in batch mode, so it won’t prohibit them from the changeover to electronic records. With regard to vendors, I think it’s important to let doctors choose whatever electronic records software works best for them in their own practice. Trying to force everyone on to one system is just not practical. That said, every system should allow for the transmitting secure health data to other systems as requested by the patient controlling that data.

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All it took was an inch — as the GOP is going the whole mile, and then some. I’m talking about the stalemate in getting Obama’s reform bill passed. The election of Scott Brown to fill the seat once held by the legendary health reform stalwart Ted Kennedy seems to be only the beginning of an effort by the GOP to take over the parameters of what “reform” really means at this point.

The WaPo has an interesting analysis into the Democrats’ missteps leading to where the party finds itself today: a wounded warrior with very little to show in the way of valor in upholding Obama’s original plans for an overhaul.

Looking back, Obama and his congressional allies failed to appreciate the depth of frustration with Washington – people’s desire for health care legislation that would respond to their anxieties, not the clamor of interest groups.

There’s more. Some GOP lawmakers are upping the anti-reform rhetoric with fiesty language meant to energize its base and incite debate for their benefit. Invoking states’ rights arguments, a VA congressman calls reform measures at the hands of Democrats “mobster mandates”, and such issues “cross the line” as far as he’s concerned.

Del. Robert G. Marshall (R-13th District) has filed the “Virginia Health Care Freedom Act” (HB 10), which would “protect an individual’s right and power to participate or decline to participate in a health care system or plan,” according to a summary of the bill.

Mobsters and missteps. February is getting off to a rollicking start for the party that was supposed to have had a bill on Obama’s desk by now.

You know about the movie Avatar? Of course you do. It’s the new James Cameron movie which recently beat out that other Cameron flick Titanic to become the biggest worldwide and, shortly, domestic grossing film of all time — taking in a whopping $1.8B to date (almost $600M in the U.S.).

Now imagine the next Cameron vehicle surpassing Avatar by 33X. That’s the amount of public and private healthcare spending lost to fraud each year, according to remarks made by Atty. Gen. Eric Holder. Obama’s top lawyer was at the NIH yesterday pushing for a cabinet level commission designed to administer enforcements against healthcare fraud in both public and private sectors.

Will Congress listen? Just earlier this week, during his first SOTU address, Obama pledged a government spending freeze for three years — asking the legislature to pass a “pay as you go law” — requiring lawmakers to offset the cost incurred by the current tax cuts or incurred expenses due to programs like Medicare (which would be exempt from this law) with the increase in taxes. In essence, Obama would be keeping a ledger of the average budgetary effects of all legislation affecting mandatory spending.

According to Holder, public and private healthcare sectors need to embrace this new reality and the spending it will take to make it happen.

[O]ur ability to protect taxpayer dollars, to ensure the viability of our government health care programs, and to strengthen our national health care system depends on our ability to expand the discussion beyond the federal government…

LINK