We’re inching closer to the multi-day arguments set to happen before the SCOTUS regarding the constitutionality of the ACA, specifically, the individual mandate provision. A Kaiser Foundation tracking poll indicates that a third of all voters (respondents) think that the entire law will be revoked if the high court finds the plaintiffs’ assertions has cause. Perhaps what is more important is the fact that Americans remain divided over the issue of the existence of the law.

As the anniversary of the Affordable Care Act approaches on March 23, Americans remain as divided on the law as ever, with 37 percent in January saying they have a favorable view of it, and 44 percent having an unfavorable view. At the same time, the share of the public that favors expanding the law (31%) or keeping it in its current form (19%) remains larger than the share who would like to see the law repealed outright (22%) or repealed and replaced with a Republican-backed alternative (18%).

Mitt Romney, the probable GOP nominee for president, will have to exploit the differences between presiding over the initiation of the reform law’s progenitor in his home state of Mass. and Obama’s finished product — backed by the full faith and support of Big Insurance. | LINK to study PDF

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As 2011 fades into 2012 and the inevitable roll of “best of” lists begins to infiltrate the print, online, and broadcast media universe, healthcare policy is sure to be included. One of those bridging year-end/new year issues apprears to be headed in a more assured direction, as the House GOP and Senate Dems have agreed on a 2 month extension of the payroll tax cut — including the Medicare “doc-fix” provision. Here’s hoping GOP Speaker Boehner does the right thing and continues to push for a yearlong extension…

Of course, this saga is the first of many issues sure to keep the health policy flames ablaze in ’12. Concerns by states of rising Medicaid expenses as reform draws closer; more permanent solutions to incremental and programmatic Medicare reimbursements to be sought; continued legal challenges to the ACA (which the SCOTUS will be taking up in an unprecedented 3-day affair); and last — but certainly not least — the 2012 campaign itself. Will an Obama defeat mean the end of reform as we presently are getting to know it, or will a (narrow?) victory for the president bring greater sympathy for cause, establishing the type of legacy for his top domestic issue he so desperately desires after two terms in office? As always, stay tuned. Next year looks to be an exciting one.

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Honestly, these “clock-ticking countdowns” are getting a little irksome. The eleventh hour negotiations surrounding the legislative extensions of the payroll tax cuts for the middle class just hit another roadblock, outlets have reported. Cue the Senate showdown between the GOP and Dems. Closely tied into the GOP plan for the extension of the tax cut is the inclusion of the Keystone XL oil pipeline — a controversial project which President Obama had originally hoped to decide upon by 2013 its potential for environmental sustainability.

The Keystone pipeline pawn would force Obama to make a decision on its contruction by the end of this year.

With respect to healthcare, the inclusion of provisions to forestall cuts to Medicare payments for 2 years, preventing incremental threats to physician reimbursements (no permanent overhaul), would be the political gambit. It’s a political mixed bag for some healthcare entities. Hospitals would be better served by more long-term solutions to the so-called doc-fix problem. Providers would be spared more frequently intermittent threats to reimbursement. If passed, this payroll tax cut extension would eliminate the possibility of approximately 27 percent in cuts to Medicare payments.  | LINK

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He’s leaving his much embattled post, and he is not mincing words. Don Berwick will be stepping down as CMS head in lieu of what was sure to be a highly contentious Senate confirmation procedure next year. Calling much of what Medicare “does” as wasteful, the departing CMS chief sounded more like he was delivering a eulogy than offering up hopeful solutions to be implemented in his absence.

Dr. Donald M. Berwick, listed five reasons for what he described as the “extremely high level of waste.” They are overtreatment of patients, the failure to coordinate care, the administrative complexity of the health care system, burdensome rules and fraud. “Much is done that does not help patients at all,” Berwick said, “and many physicians know it.”

Berwick’s ascension came at a time in which President Obama was looking for a CMS chief who shared the same sense of analytical urgency in efforts to fix the nation’s ailing healthcare delivery system. Berwick sounded the clarion call for reform, but received very little cooperation from the GOP side of the ideological aisle, with those members of congress (and some Dems) essentially putting up a wall between him and any actionable improvements. Perhaps his own words project why he was essentially doomed from the start.

Berwick said he had not sought the job. Indeed, he said, “I did not even know if I was fit for it.” He took the post, he said, because he sensed that immense “tectonic shifts” were occurring in the health care delivery system.“I came with an agenda,” Berwick said. “I wanted to try to change the agency to be a force for improvement, covering one out of three Americans.”

Restating the obvious really does physicians he laments no good unless positive change, outside of obvious hyperbole, does occur. According to many pundits — including this one — his replacement offers more of the same, with true change occuring only if legislative control swings back to the Dems in 2012. | LINK

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With the SCOTUS set to take up the ACA and its constitutionality this term, more fuel to the fire has just been added to an otherwise white hot election ’12.

Although recent polls seem to dignify the usually staid Newt Gingrich with the flavor-of-the-campaign tiara at the moment, the sure bet is on the “electable” former governor of Massachusetts and originator of all things Universal Healthcare, Mitt Romney. For President Obama, it presents an interesting “problem” which will require appropriate strategies for the White House in keeping the president on message, as they say, over the next twelve months.

No matter how the SCOTUS rules on the matter before it, Obama has got the winds of the ACA behind him. The wheels have been in motion for the past year-and-a-half to the get the first provisions of the reform law into place. Issues such as coverage extensions  for adult children of policy beneficiaries and increased employer-based protections for workers practically guarantees and confirms widening of likes versus dislikes ratio with respect to the law. All of this cannot be ignored by the court as it hears arguments early next year.

Conversely, Mitt Romney could benefit from a negative ruling by the court. After signing into law an individual mandate provision in Mass’s. law as governor, Romney initially praised the action, calling it the “ultimate conservative idea”. Known as much for his flip-flops on this issue (because he is running for president, after all) as he is for his corporatist, milquetoast demeanor — a negative decision of the courts would give him immediate justification for blasting it.

Perhaps that’s why he is mum on the issue now. Further, Romney can make the repeal of the law a central campaign mantra, if the SCOTUS upholds it — “realizing” that individual states can have mandates if they so desire, but not at the direct imposition of the feds.

Regardless, the rhetoric on the constitutionality of the ACA will ramp into high gear next summer; and the ride will be a tumultuous one for both candidates. | LINK

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Grants in the total amount of over $1B will be targeted to healthcare orgs that work with federal agencies in an effort to increase the size of the overall healthcare workforce. The Obama administration is expected to announce today the availability of the funds to get initiatives started in as little as 6 months. I must admit, I was sent information on taking part in this effort.

“This will open the inbox for many innovators and organizations that have an idea to bring to the table,” Don Berwick, administrator for the Centers for Medicare & Medicaid Services, said in an interview. “We’re seeking innovators, organizations and leaders that have an idea to bring into further testing.”

Participating orgs with ideas brought to the table will be  grouped in the specially named CMS Center for Medicare & Medicaid Innovation. The initiative, praised by CMS head Don Berwick, is betting on using federal monies as an incentive to get the government involved in vetting other possible ways to spend more frugally ahead of reform and a pending physician shortage by decade’s end — two scenarios that will have to be met forcefully to ensure the onslaught of much needed healthcare delivery that won’t come cheap. | LINK

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Is it too early for this sort of news, or is a political agenda afoot? According to a new Gallup survey, the nascent reform law is still leaving a significant amount of uninsured without adequate coverage from employers. Ditto for the elderly and the government.

Some of the main components of the Affordable Care Act, such as tax credits for small businesses that provide health insurance to their employees, and the establishment of a pre-existing condition insurance plan, have done little to boost Americans’ health coverage, the survey found.

This report comes on the heels of a recent appeals court decision reaffirming the constitutionality of the law and its coverage mandates. It’s no secret, however, that the ACA is still struggling to get in the good graces of the majority of stalwart congressional Republicans and some Dems. Still a little early to say if the report will gain traction ahead of the first GOP primaries in less than two months; but, it represents another PR hurdle the law’s proponents must overcome on the road to reclaiming the White House in ’12. | LINK

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News comes today from a largely conservative appeals court, no less. (Does the ruling in support of the law by a solid conservative justice on the appeals panel nix the idea that ideology is controlling the judges’ votes on this very politically-charged and polarizing issue?)

The Obama administration prevailed Wednesday in the first appellate review of the 2010 health care law as a three-judge panel from the United States Court of Appeals for the Sixth Circuit held that it was constitutional for Congress to require that Americans buy health insurance.

All of this — as the SCOTUS prepares to consider this week whether to resolve conflicting rulings over the law’s requirement that all Americans buy health care insurance.

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The president will issue an executive order today requiring the FDA to act on potential drug shortages in the phrama marketplace. Previously, drug companies were only required to notify the agency if a preparation was to be discontinued. Any other notification would be completely voluntary on the part of the manufacturer. The executive branch action is only the latest maneuver^[1] by this administration to “get tough” in the way of roadblocks initiated by the GOP in the legislature to nix his jobs bill en toto.

Most preparations affected are used in the aucte setting: electrolyte mixtures, chemotherapeutics, and anesthetics. The FDA reported over 170 instances of shortages in 2010, with an increase projected for this year. President Obama also expressed his support for legislation that would require streamlining the notification process; pharma companies would have to notify the FDA of shortages six months in advance. All of this is good news for patients, who stand to benefit the most from timely intervention in acute medical treatments. | LINK

1. In the past week, Obama has issued orders creating relief for “underwater” homeowners and current college students with high tuition debt.

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Now that the GOP field fighting for the ’12 nod has been essentially set, political pundits and junkies alike will now settle in for the real race and issues to emerge. In the case of the media-anointed frontrunner, former Mass. Gov. Mitt Romney, it is his tenure with what has become the nation’s incubator for universal care coverage on a global scale — colloquially known as Commonwealth Care — that will either haunt him … or define him in the all-important run up to January^[1].

Not only does Romney have to meet issues of his faith and politics (Mormonism) and social conservatism (regarded as a moderate, esp. by Tea Party activists) head on, he now has to prove that his stance on healthcare delivery is actually a conservative one — in spite of the fact that the law guaranteeing care to all of Massachusetts’ citizens was signed on his watch. The bar on how Romney will position himself just became a little more precarious, with news breaking that the WH’s blueprint for the reform law, pejoratively known as Obamacare, was based upon Romney’s Mass. law more closely as a model than was previously thought.

“The White House wanted to lean a lot on what we’d done in Massachusetts,” said Jon Gruber, an MIT economist who advised the Romney administration on health care and who attended five meetings at the Obama White House in 2009, including the meeting with the president. “They really wanted to know how we can take that same approach we used in Massachusetts and turn that into a national model.”

The president even presided over one of those meetings himself in mid-2009. In an effort to diffuse the impact of this revelation, aides to Romney suggest that Gruber’s role was not central to the ultimate tone of the reform law. Good luck with that strategy.

Gruber was personally recognized by Romney for his role when he signed the health-care bill into law and was later appointed by Romney as a board member to the Connector Authority. (He also was given a photograph of the signing ceremony personally signed by Romney that read: “Jonathan, with deep appreciation and congratulations. A Triumph! Mitt Romney.”)

It will be interesting (and fun) to see how Romney can continue to make distinctions between the ACA and his personal stamp on Massachusetts’ model of universal coverage. | LINK

1. IA caucuses and FL primary will occur on the 3rd and 31st, respectively

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