First Edition: December 4, 2012

Today's headlines include coverage of the GOP counteroffer in the fiscal talks, as well as the White House reaction to it. 

Kaiser Health News: Health Plans Gear Up To Sell Directly To Consumers
Kaiser Health News staff writer Julie Appleby, working in collaboration with USA Today, reports: "All this is happening in anticipation that an estimated 9 million people will buy their own insurance in 2014 -- about 50 percent more than do so now. That's when the law goes into full effect and virtually all Americans will be required to have health insurance. Those not covered through their jobs will be able to buy policies online, through so-called exchanges that will be run by the states or the federal government" (Appleby, 12/3). Read the story.

Kaiser Health News: Specialists Work To Reduce Kids' Fears In The Hospital
Kaiser Health News staff writer Jenny Gold, working in collaboration with The Washington Post, reports: "There are more than 4,000 child life specialists across the country. Every pediatric hospital in the country has a child life program, according the Children's Hospital Association, as do many general hospitals with large pediatrics units. The specialists must have a college degree, with classes in child development, psychology and similar subjects. They must also complete an internship of at least 12 weeks" (Gold, 12/3). Read the story and watch the related video.

Kaiser Health News: Insuring Your Health: Weighing  A State Mini-Cobra Plan; Premiums Must Be Based On Pay
In her latest Kaiser Health News consumer column, Michelle Andrews answers readers' questions about picking an insurance plan when leaving a job, small-business health insurance coverage requirements under the Affordable Care Act and salary-based premiums (Andrews/12/3). Read the column.

Kaiser Health News: Capsules: Patients Often Don't Realize Preventive Care Is Free; Hospice Rules May Keep Patients Away
Now on Kaiser Health News' blog, Jay Hancock reports on a study examining what patients realize about the costs of preventive care: "A survey of hundreds of Californians enrolled in health savings accounts, one type of high deductible plan, showed that fewer than one member in five understood that preventive care was free or almost free. A fifth of those surveyed said they had avoided preventive examination or treatment because of cost" (Hancock. 12/3).

Also on Capsules, Jordan Rau reports on new findings related to hospice enrollment policies: "Hospice is one of the fastest growing segments of Medicare, and many health policy experts laud it as a humane and cheaper way to care for people in the last half-year of life. But in surveying hospices, the new study warns Medicare's method of paying a fixed daily fee to hospices may be discouraging many from taking on patients with expensive needs" (Rau, 12/3).

In addition, Susan Jaffe writes about the idea of insurance "rate shock" for young people: "If young adults can't afford health insurance policies available in 2014 under the health care law, state insurance officials are worried they won't buy them.  And that could drive up the cost of insurance for the mostly older, sicker people who do purchase it. That's a potential problem even in states like California and Rhode Island, which are moving ahead to carry out the law, state officials told representatives of the Obama administration Friday at a meeting of the National Association of Insurance Commissioners" (Jaffe, 12/4). Check out what else is on the blog.

The New York Times: Initial Deficit Cuts Are Sticking Point In Negotiations
For all the growing angst over the state of negotiations to head off a fiscal crisis in January, the parties are farthest apart on a relatively small part of the overall deficit reduction program — the down payment. President Obama and the House speaker, John A. Boehner, are in general agreement that the relevant Congressional committees must sit down next year and work out changes to the tax code and entitlement programs to save well more than $1 trillion over the next decade. But before that work begins, both men want Congress to approve a first installment on deficit reduction in the coming weeks (Weisman, 12/3).

The New York Times: Republicans Make Counteroffer In Fiscal Talks
The counteroffer represented an acknowledgment by Republicans that they had to issue their own proposal to head off around $600 billion in automatic tax increases and spending cuts next year, a fiscal combination that could send the economy back into recession. They said that their approach was a move toward the center rather than sticking to a position established last year with the passage of the House Republican budget, which included contentious changes to Medicare and Medicaid and deep domestic spending reductions (Weisman, 12/3).

Los Angeles Times: Republicans Counter With Their Own 'Fiscal Cliff' Plan
Under pressure from the White House to make a specific deficit reduction proposal, House Speaker John A. Boehner on Monday countered with one that rejects higher tax rates for the wealthy and deeply cuts Medicare, Social Security and other safety net programs. The offer from the Republican leader was swiftly dismissed by the White House as not meeting the "test of balance." President Obama, seemingly confident that the public is on his side, has insisted that the nation can no longer afford to continue tax breaks for the wealthy (Mascaro and Memoli, 12/3).

The Washington Post: Boehner, House GOP Leaders Offer 'Fiscal Cliff' Counterproposal
That framework aims to raise new revenue through an overhaul of the tax code. It also calls for slicing $600 billion from federal health programs, in part by increasing the Medicare eligibility age from 65 to 67, and saving $200 billion by applying a less generous measure of inflation to all federal programs, including Social Security benefits, according to GOP aides. For the first time, Boehner managed to get his entire leadership team …  to publicly sign on to a plan that explicitly calls for new tax revenue. … But Democrats said the proposed cuts to social safety-net programs would outweigh higher taxes. And they said Republicans have not made clear how they would raise the additional tax revenue without imposing new burdens on the middle class (Montgomery, 12/3).

Los Angeles Times: White House spurns Republican Offer On 'Fiscal Cliff' Negotiations
The White House on Monday dismissed a Republican counteroffer to avert the so-called fiscal cliff as failing to "meet the test of balance" by resisting higher tax rates for the wealthy, a point that remains a key hurdle in the impasse over spending and revenues. … Republicans greeted the White House response as a demonstration of "how unreasonable it has become" (Memoli, 12/3).

The Wall Street Journal: GOP Makes Counteroffer In Cliff Talks
The GOP offer was immediately rejected by the White House, but it provides the most detailed statement to date of what Republicans are willing to concede for now. It comes days after the White House put forward its opening bid in the high-stakes deficit talks. With both sides now having made preliminary offers, the parameters for future negotiations between Republicans and the White House are becoming clearer (Hook, Lee and Paletta, 12/4).

Politico: GOP Cliff Offer Is No Deal-Maker
Boehner didn't pitch the plan with a personal phone call to the president or even with much advance warning to the White House. In a sign of how distant the parties remain, White House aides received the offer via email shortly before 2 p.m. — just as Boehner's staff began briefing reporters, a senior administration official said. House Republicans touted their offer as a middle-ground option outlined during a congressional hearing last year by Erskine Bowles, a Democrat who led the president's debt-reduction committee. But Bowles himself disavowed the GOP characterization (Sherman and Budoff Brown, 12/4).

The Associated Press/Washington Post: GOP Plan Would Raise Medicare Age, Lower Social Security COLAs, While Raising $800B In Revenue
Republicans are proposing a "fiscal cliff" plan that revives ideas from failed budget talks with President Barack Obama last year, calling for raising the eligibility age for Medicare, lowering cost-of-living hikes for Social Security benefits and bringing in $800 billion in higher tax revenue. The counter to a White House plan last week relies more on politically sensitive spending cuts and would raise half the $1.6 trillion in revenue proposed by Obama over the coming decade (12/4).

USA Today: GOP's $4.6T 'Fiscal Cliff' Counterproposal Rebuffed
The Republicans' proposal is based on a framework outlined last year by former Clinton White House chief of staff Erskine Bowles, who co-chaired Obama's debt commission, and included an increase in the eligibility age for Medicare benefits. Republicans did not offer specific language on raising the age in their proposal, but Bowles has supported raising the age to 67. Boehner called it a "la-la land offer" on Monday (Page, 12/3).

The Washington Post's The Fact Checker: Geithner's Fuzzy Math On Entitlement 'Spending Cuts'
Eager to rebut Republican claims that the administration was not serious about reining in entitlement programs such as Medicare and Medicaid, Geithner insisted the administration did have "a detailed plan of spending cuts," totaling $600 billion, in what he described as "mandatory programs" or "entitlement programs." But his language is a bit slippery. Let's explore what's going on (Kessler, 12/4).

The Washington Post: AARP Lobbies Against Medicare Changes That could Hurt Its Bottom Line
As Washington debates whether to cut federal retirement programs as part of a deal to tackle the nation's debt, one of the most powerful advocates for preserving them could have millions of dollars riding on the outcome. AARP, the highly influential lobby for older Americans, is fiercely opposing any Medicare or Social Security cuts and emphasizes that it is fighting for the good of its members. But the proposals for changing Medicare also could affect AARP's bottom line (Markon, 12/3).

The Associated Press/Wall Street Journal: AARP: Benefit Changes Could Harm New Yorkers
With the "fiscal cliff" looming, AARP is warning that changes being considered for Social Security and Medicare could harm older New Yorkers. The clock is ticking closer to the end-of-year deadline to avert the fiscal cliff, which is a combination of the expiration of Bush-era tax cuts and automatic, across-the-board spending cuts. Some economists say the combination could send the economy back into recession (12/4).

The Washington Post: Some Health Exchange Plans To Mirror FEHBP
Health-care offerings to be available in multiple states through the Affordable Care Act's insurance exchange system would parallel those of the Federal Employees Health Benefits Program in many ways, although the two programs would not affect each other directly, under rules to be proposed on Wednesday (Yoder, 12/4).

NPR: The (Huge And Rarely Discussed) Health Insurance Tax Break
What's the largest tax break in the federal tax code? If you said the mortgage interest deduction, you'd be wrong. The break for charitable giving? Nope. How about capital gains, or state and local taxes? No, and no. Believe it or not, dollar for dollar, the most tax revenue the federal government forgoes every year is from not taxing the value of health insurance that employers provide their workers (Rovner, 12/4).

USA Today: Medicare Beneficiaries Reach $5 Billion In Drug Savings
Since passage of the health care overhaul two years ago, 5.8 million Medicare patients have saved $5 billion from prescription drug discounts, and the government can now predict lower health care costs based on increased use of these cheaper drugs (Kennedy, 12/3).

The Wall Street Journal: UMass Memorial Tests Software To Curb Hospital Readmissions
Stung by a multimillion-dollar penalty for failing to meet new patient readmissions standards set by Medicare, UMass Memorial Health Care is using transaction analytics software to reduce frequent and costly readmissions for patients with heart attacks, heart failure and pneumonia (Boulton, 12/3).

The New York Times: Ruling Is Victory For Drug Companies In Promoting Medicine For Other Uses
In a case that could have broad ramifications for the pharmaceutical industry, a federal appeals court on Monday threw out the conviction of a sales representative who sold a drug for uses not approved by the Food and Drug Administration. The judges said that the ban on so-called off-label marketing violated the representative's freedom of speech (Thomas, 12/3).

The Wall Street Journal: Medicare Fraud Is Charged
A Tennessee-based nursing-care company systematically defrauded Medicare of millions of dollars by pressuring therapists to perform expensive, unnecessary treatments, according to a recently unsealed federal complaint. The filing against Life Care Centers of America Inc. is part of an investigation by the Office of Inspector General of the U.S. Department of Health and Human Services into high-priced nursing care. The inspector general reported last month that Medicare loses about $1.5 billion annually from overbilling by skilled-nursing facilities (Burton, 12/3).

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