First Edition: May 10, 2011

Today's headlines include advance reports on today's appeals court action surrounding challenges to the health law and the latest on the budget debate.

Kaiser Health News: Millions Of Dollars In Consumer Rebates At Stake As States Seek To Soften Rule On Insurers' Profits
In a move that could absolve health insurers of paying more than $95 million in consumer rebates, nine states are pressing for relief from a federal rule limiting insurers' profits and administrative costs. State regulators say they fear insurers would flee their markets and leave some individuals without coverage options if the rule isn't eased. But consumer groups say there’s little evidence insurers would bail out (Appleby, 5/9).

Kaiser Health News: Insuring Your Health: The Old Practice Of House Calls Is Returning To Some Areas
In her latest Kaiser Health News consumer column, Michelle Andrews writes: "Nobody likes taking time out of a busy day to cool their heels in a doctor's waiting room. Now you may not have to. Some primary-care practitioners are bringing their black bags directly to home or office, in some cases for as little as $30 to $35 a visit" (Andrews, 5/10).

Kaiser Health News Guest Opinion: For The NAIC, A Consequential Decision On The MLR
In this Kaiser Health News column, a group of consumer representatives from the National Association of Insurance Commissioners write that the NAIC is considering whether to endorse legislation that would remove broker and agent commissions from the medical loss ratio. The final decision will have far-reaching implications for the reliability of the MLR as a measure of a health plan's value (5/9).

Los Angeles Times: Healthcare Law Showdowns Loom In Appeals Courts
President Obama's healthcare law faces a series of challenges in three appeals courts starting Tuesday as Republican lawyers from 27 states will urge the courts to strike down the law as unconstitutional. In a sign of the high stakes and the partisan divide, one case will feature a rare courtroom clash between the Obama administration's top appellate lawyer and his counterpart from the George W. Bush administration (Savage, 5/10).

The Washington Post: Virginia Suit Over Federal Health-Care Law Go Before Appellate Panel
A three-judge appellate court panel will hear oral arguments Tuesday morning over the constitutionality of the nation’s health-care overhaul as lawsuits challenging the federal law proceed up the legal ladder before most likely landing at the U.S. Supreme Court. More than 30 lawsuits have been filed across the country challenging the law. The U.S. Court of Appeals for the 4th Circuit will hear debate at a Richmond courthouse in two cases (Helderman, 5/9).

The Associated Press/Washington Post: Constitutionality Of Obama's Health Care Law To Be Reviewed By Federal Appeals Court In Va.
A three-judge panel of the 4th U.S. Circuit Court of Appeals in Richmond will hear two cases involving the legislation Tuesday. In one, the federal government is appealing U.S. District Judge Henry Hudson’s ruling striking down the law’s requirement that individuals buy health insurance or pay a penalty. In the other case, Liberty University is appealing U.S. District Judge Norman Moon’s ruling that the insurance mandate is a proper exercise of congressional authority under the Commerce Clause (5/10).

Politico: 2012 Battlefield: The Supreme Court
Despite a concerted drive by their ideological critics, two Supreme Court justices – Elena Kagan and Clarence Thomas – signaled late last month that they have no intention of recusing themselves from the court’s all but inevitable consideration of the Obama administration’s new health care law (Vogel and Raju, 5/10).

The New York Times: Boehner Outlines Demands On Debt Limit Fight
Speaker John A. Boehner said Monday that Republicans would insist on trillions of dollars in federal spending cuts in exchange for their support of an increase in the federal debt limit sought by the Obama administration to prevent a government default later this year. … Mr. Boehner also said the debt talks should include "honest conversations" about how to rein in the costs of the Medicare program, and he advocated fundamental changes. Other senior Republicans acknowledged last week that any changes to the health insurance program for older Americans are unlikely to incorporate the party's proposal to begin providing private insurance subsidies for future retirees (Hulse, 5/9).

Los Angeles Times: Boehner Demands Trillions In Cuts In Exchange For Debt Vote
House Speaker John A. Boehner said Monday that Republicans wanted trillions in budget cuts in exchange for their vote to increase the nation's borrowing limit and avoid default. … Boehner has been increasingly caught in a political squeeze. On one side, the Obama administration and its allies have demanded that GOP officials reassure markets that they won't gamble with U.S. debt obligations. On the other, "tea party" activists charged Monday that GOP leaders were selling out the nation's conservatives. Last week, GOP leaders backed away from the party's controversial proposal to overhaul and eventually privatize Medicare (Mascaro and Hennessey, 5/9).

The Washington Post: Boehner Demands 'Trillions' In Spending Cuts In Exchange For Lifting Debt Ceiling
Delivering a sermon on fiscal austerity to a Wall Street crowd clamoring for compromise on the debt limit, Boehner (Ohio) firmly rejected any effort to raise taxes. He also called on Democrats to engage in "honest conversations about how best to preserve Medicare," signaling that House Republicans remain committed to restructuring at least some portions of the program (Kane and Montgomery, 5/9).

The Associated Press: Despite Differences, Obama, GOP Eye Medicare Limit
Unlikely as it may seem, President Barack Obama and Republicans in Congress actually share some common ground on the need to curb Medicare costs to fight the spiraling federal debt. Although the House GOP plan to replace Medicare with a voucher-like system got shunted aside last week, that may not be the end of the story. Embedded in both the Republican plan and in Obama's counter-proposal is the idea of putting limits on the growth of the half-trillion-dollar-a-year program — and then enforcing them (Alonso-Zaldivar, 5/9).

Politico: Freshmen Split Over Entitlement Reform
Some freshmen, like Rep. Joe Walsh (R-Ill.), want an entirely separate debate on Medicare, meaning they would rather that fight not take place against the backdrop of an increase in the government's $14.3 trillion debt limit. … Yet other GOP freshmen insist that Republicans must hang onto the Medicare bargaining chip in the negotiations over the debt ceiling increase (Cogan and Bresnahan, 5/10).

The New York Times: As Special House Race Intensifies, Washington Sends Backup
While the district is dominated by Republican voters, Ms. Corwin, a state lawmaker, has seen her lead diminish in recent weeks, as the Democratic candidate, Kathy Hochul, has repeatedly warned that older residents, a key voting group, would be hurt by a deficit-cutting plan adopted by House Republicans that calls for overhauling Medicare (Hernandez, 5/9).

USA Today: Up To $49 Billion Unpaid By Uninsured For Hospitalizations
Uninsured Americans — including those with incomes well above the poverty line — leave hospitals with unpaid tabs of up to $49 billion a year, according to a government study released today. On average, uninsured families pay only about 12% of their hospital bills in full. Families with incomes above 400% of the poverty level, or about $88,000 a year for a family of four, pay about 37% of their hospital bills in full, according to the Department of Health and Human Services study (Kennedy, 5/10).

The New York Times: Antipsychotic Drugs Called Hazardous For The Elderly
Nearly one in seven elderly nursing home residents, nearly all of them with dementia, are given powerful atypical antipsychotic drugs even though the medicines increase the risks of death and are not approved for such treatments, a government audit found. More than half of the antipsychotics paid for by the federal Medicare program in the first half of 2007 were "erroneous," the audit found, costing the program $116 million for those six months (Harris, 5/9).

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