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Week In Review: Berwick Nomination Still Drawing Fire; Regulations For Health IT And Preventive Care; A New AIDS Policy; New PhRMA Chief

Jul 16, 2010

This week, news outlets covered the Obama administration as it began implementing parts of the new health law and also unveiled a  national HIV/AIDS strategy. And, Capitol Hill is still reacting to the president's recess appointment of Dr. Donald Berwick to head the agency overseeing Medicare and Medicaid.

Berwick was sworn in as the administrator for the Centers for Medicare and Medicaid Services (CMS) Monday, The Boston Globe reported (Rowland, 7/12).

Senate Republicans are furious, and reprised concerns that Berwick is a supporter of a British-style government-controlled health care system. The 10 Republican members of the Finance Committee, which "has jurisdiction over the post," sent a letter to Chairman Max Baucus, D-Mont., arguing "that Berwick needs to answer questions raised about his qualifications — namely, questions they have regarding his statements in support of the British health care system and rationing," Politico reported. The White House continued to defend the recess appointment, saying that "calling Berwick to a hearing would give Republicans an opportunity to reopen the bitter politics of the health reform debate" (Haberkorn, 7/14).

Roll Call reported that Minority Leader Mitch McConnell, R-Ky., "offered a lengthy objection that he said was based on Obama's use of a recess appointment to install Donald Berwick as administrator of the Centers for Medicare and Medicaid Services, as well as previous Democratic objections to judicial nominees to the 4th Circuit made by President George W. Bush," as he blocked consideration of two nominees to the 4th U.S. Circuit Court of Appeals (Drucker, 7/14).

House Republicans also protested. CQ Politics reported that 15 Republicans on the House Ways and Means Committee sent a letter to Chairman Sander Levin, D-Mich., asking for a hearing, saying "their concerns with Berwick were heightened because some Medicare spending faces cuts under the overhaul law" (7/14).


For more detailed news summaries regarding Berwick's appointment, read KHN's Morning Edition on July 12, July 13 and July 15. KHN also has a Resource Guide to Berwick's speeches and coverage about his appointment. 

Key Regulations Geared Toward Health Care System Overhaul

Berwick made his first official appearance at an HHS press briefing Tuesday, where new regulations defining the "meaningful use" of electronic medical records were released. If doctors and hospitals qualify under those standards, they can get help to pay for their digital transition from a $27 billion (over 10 years) incentive fund.

"Berwick opened his brief speech with forward-looking remarks, reminding the audience of President Obama's goal to have electronic health care records available to all Americans by 2014. 'What we have at stake is the future of health care itself,' said Berwick. 'The benefits of a modernized health information technology help everyone. It’s a win-win, right across the board,'" The Boston Globe reported (Vallejo, 7/13).


The New York Times noted that the "rules significantly scale back proposed requirements that the health care industry had denounced as unrealistic." Some groups said they still were not sure they could meet the requirements, but the incentives are there: "a doctor can receive up to $44,000 under Medicare and $63,750 under Medicaid, while a hospital can receive millions of dollars, depending on its size" (Pear, 7/13).

The American Hospital Association's vice president of policy told Kaiser Health News, "The requirements may still be out of reach for many American hospitals" (Galewitz, 7/13).

Another set of regulations – those laying out how insurance companies will treat preventive services in new health plans – were released the following day by First Lady Michelle Obama, HHS Secretary Kathleen Sebelius and Jill Biden, the wife of the vice president. 

"Under the new health care overhaul law, insurers will be required to pay fully for services that get an "A" or "B" recommendation from the U.S. Preventive Services Task Force, a volunteer group made up of primary care and public health experts." according to Kaiser Health News and The Washington Post.  But, it will also open the door to lobbying by disease groups, physicians and companies that have an interest in seeing services covered. That may create conflicts for the scholarly group that has so far endeavored to avoid the political process (Weaver, 7/15).


"The rules will eliminate co-payments, deductibles and other charges for blood pressure, diabetes and cholesterol tests; many cancer screenings; routine vaccinations; prenatal care; and regular wellness visits for infants and children," the New York Times reported (Pear, 7/14).


The Wall Street Journal points out that the "regulations don't address a different slate of covered preventive services for women, which won't be determined until August 2011. The Planned Parenthood Federation of America is pushing for birth control to be included in that segment of the regulations" (Adamy, 7/15).

Abortion An Issue - Again

The issue of government funding of elective abortions came up again this week, USA Today reported: "The National Right to Life Committee is citing language on government websites in two states — Pennsylvania and New Mexico— suggesting that new federally funded high-risk insurance pools for patients with pre-existing conditions such as diabetes will cover 'elective' abortions for residents of those states" (Hall, 7/14).


The administration, which struck a deal with some anti-abortion Democrats to get the health bill through Congress, reacted quickly, reiterating "that funding for President Obama's health care legislation would only pay for abortions in cases of rape, incest and when the life of the mother is at risk,"
according to ABC News (Tapper, 7/14).


Abortion is part of the discussion about state insurance "exchanges," The Hill reported. Missouri on Wednesday became "the fifth state to ban health plans from offering abortion coverage on its health insurance exchange. ... The legislation has exemptions for rare cases where the mother's life is in danger from 'a physical disorder, physical illness, or physical injury' including 'a life-endangering physical condition caused by or arising from the pregnancy itself'" (Pecquet, 7/14).

AIDS Strategy

President Obama fulfilled a campaign promise this week when administration officials announced a new national strategy to reduce the number of HIV/AIDS cases in the United States. "Fighting HIV/AIDS in America and around the world will require more than just fighting the virus," Obama told supporters at the White House Tuesday, The Associated Press reported. "It will require a broader effort to make life more just and equitable'"(Pace, 7/14).

USA Today detailed the goals: "By 2015, the White House seeks to: Reduce new HIV infections by 25%; Cut the rate of the virus' spread by 30%, from five people a year infected by every 100 living with HIV to 3.5 per 100; Increase from 79% to 90% the percentage of HIV-positive people who know they're infected with the virus so they can get treatment" (Sternberg, 7/13).

The new policy also will direct new prevention efforts at high-risk populations, including gay and bisexual men and African American communities.

Some advocacy groups compained that the effort was too little, too late. "Michael Weinstein, president of the Los Angeles-based AIDS Healthcare Foundation, told CNN in an interview that 'when you see what this administration has done on AIDS, you have to give them very low grades.' Obama has 'consistently underfunded AIDS' programs, Weinstein said" (Silverleib and Uliano, 7/14).

Kaiser Health News posted the president's introductory letter, the full National HIV/AIDS strategy and the Implementation Plan (7/13), and KHN has more details in a news summary July 14.

Washington Watch

--CBS News released a new poll that showed support for the new health reform law has dropped seven percentage points in the past two months, though it remains higher than when the law was first signed in March. "Forty-nine percent of Americans now disapprove of the health care reform measure, according to the poll, which was conducted July 9-12. Thirty-six percent support the law. In a May CBS News poll, 47 percent disapproved of the new laws, while 43 percent approved. While the new poll shows a recent drop in support, the numbers have still improved overall since March, when 53 percent of Americans disapproved of the new laws and 32 percent said they approved of them" (Condon, 7/13).



--In the meantime, according to The Wall Street Journal, the Republicans are renewing their request that Supreme Court nominee Elena Kagan recuse herself from consideration of a challenge to the health reform law if such a question comes before the high court (Meckler, 7/13).

--The Pharmaceutical Research and Manufacturers of America has a new president: John Castellani, who spent nine years representing CEOs as president of Business Roundtable. He succeeds "Billy Tauzin, a Washington insider who had represented Louisiana in Congress for 26 years. Mr. Tauzin resigned in February after promoting a compromise in the health care overhaul," according to The New York Times. Tauzin had "caught flak from some business interests" for trying to compromise on health reform by offering tens of millions of dollars in television advertising and promising drugmaker discounts that will reduce pharmaceutical spending in the United States by $80 billion during the next 10 years. "In Mr. Castellani, the drug makers get another insider with deep connections, though mostly from the lobbying world rather than inside Congress. He was named president of the roundtable in 2001 and credited with re-energizing the group" (Wilson, 7/13).

PhRMA's heath reform deal with the Obama administration, Reuters reported, "was seen as a small price for the $315 billion drug industry to pay in exchange for potentially 30 million more insured customers." Some analysts said, however, that that the deal created disharmony among PhRMA's leaders and led to Tauzin's resignation (Morgan, 7/13).

--In another transition, Obama announced that he is nominating Jacob Lew to replace Peter Orszag as head of the Office of Management and Budget. The Fiscal Times notes that "Lew faces a grueling challenge. … Now, the administration faces trillion-dollar deficit projections in the coming years. Obama has pledged to slash the deficit to 3 percent of gross domestic product by 2015, and his fiscal commission may recommend painful policy changes that would be difficult to get through Congress" (Pianin, 7/13).

--The Department of Veterans Affairs announced a new rule Monday that aims to make it easier for troops who return from battle to get the post traumatic stress disorder support they need. NPR explained, "Veterans will no longer have to prove that a certain attack, bomb explosion or event in a combat zone triggered post-traumatic stress. It's a change that most agree has been a long time coming. 'The new regulation will potentially benefit all veterans, regardless of their period of service, and it is not limited to veterans with direct combat experience,' VA Undersecretary for Benefits Michael Walcoff said Monday during a news conference" (Martin, 7/12).

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