Policy & Practice Podcasting Archives

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NARR: Doctors weigh in on the big health care question. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: The American Medical Association's House of Delegates wrapped up its annual meeting, but not without a few floor fights. Here's Alicia Ault with more.

AULT: As anticipated, the most contentious issue was whether the AMA should continue its current support of the individual mandate - that is, the notion that all individuals should be required to buy health insurance. Hours of debate early in the meeting were followed by a later floor vote that reaffirmed the AMA's stance. The House also took up issues as diverse as the safety of full-body scanners at airports and the ethics of accepting industry support for continuing medical education. Obesity was another much talked about topic. Finally, delegates also fretted over the AMA's declining membership.

NARR: Lots more details of the AMA House of Delegates meeting are available at internalmedicinenews.com.

NARR: While the AMA debated...the Obama administration implemented. HHS officials announced they will no longer allow bare-bones health plans to get exemptions from the Affordable Care Act. These so-called mini-med plans won't be able to maintain their restrictions on annual coverage limits, sometimes as low as 10,000 dollars. After September 22nd, the government won't accept any more waiver applications or requests for extensions. And in May 2014, the health law will ban annual limits on all plans. But Steve Larsen, who oversees the mini-med waivers at HHS, said the government hasn't granted that many exemptions.

LARSEN: "To date, these waivers have been granted to a tiny percent, about 2 percent of all privately insured Americans. It's a very, very small percentage of the market because most plans comply with the annual limit restrictions."

NARR: The feds also rolled out a new effort to promote the free preventive services that are available to seniors under the Affordable Care Act. The campaign comes as a new government report shows that only one in six Medicare beneficiaries eligible for the free services are taking advantage of them.

NARR: And meanwhile on Capitol Hill, the debate over the Republicans' budget proposal rages on. You know it as the Ryan plan, the one that proposes changing Medicare into a premium support system. GOP members at one recent hearing of the Ways and Means Committee hailed it as a way to save Medicare for future generations. But Democrats continued to hammer away on the Ryan plan, calling it a voucher program that would disenfranchise poor seniors. And Democratic leaders are making it clear: the Ryan plan is polling miserably, all but four Republicans voted for it, and that will be an election issue.

NARR: We'll be taking a break next week for the Fourth of July holiday. So join us again on July 11th for all the latest political, legal, and policy developments in health reform. And that's the Policy and Practice Podcast. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: Physician payment reform is back in the news. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: Medicare's Sustainable Growth Rate formula is under scrutiny again. The Congressional Budget Office says that when the current SGR fix ends this year, physician pay will be cut by 30% for 2012. Here's Alicia Ault with more:

AULT: The budget office estimate is not a surprise. But the potentially deep cut has policy experts and physicians thinking out loud again on how to overhaul the SGR. The Medicare Payment Advisory Commission calls the SGR "flawed" in its just-released June report to Congress. The MedPAC members lay out several alternatives…and say that the SGR must be permanently fixed soon because the periodic short term fixes are eroding patients' and physicians' confidence in Medicare. Meanwhile, the American Medical Association is asking organized medicine to back its effort to include an SGR repeal in a bill to raise the nation's debt limit.

NARR: Turning now to Medicaid.... many Republican governors oppose the program's expansion under the Affordable Care Act. Now, some of them have come up with their own Medicaid fix. The Republican Governors Association issued seven principles that give the states more flexibility. The plan includes the use of block grants and more control over determining who's eligible. The governors' proposal follows a bill introduced by Utah Senator Orrin Hatch-- the top ranking Republican on the Finance Committee. Senator Hatch's plan gives states the power to cut Medicaid spending and enrollment without losing federal matching dollars.

NARR: Meanwhile, the early Republican presidential contenders are making their health care views known. The nation got a first look at the seven candidates who have declared so far at a debate in New Hampshire. The candidates seemed to all agree on one thing … repealing the Affordable Care Act. And former governor Mitt Romney found himself defending the health system overhaul he signed in Massachusetts. Romney's been under attack from fellow Republicans who call his plan a clone of Obamacare. But Romney argued that his plan was not the same as the federal health reform plan.

ROMNEY: "If it were perfect (and it's not perfect; it's terrible) we can't afford more federal spending. Secondly, it raises 500 billion dollars in taxes. We didn't raise taxes in Massachusetts. Third, Obamacare takes 500 billion dollars out of Medicare and funds Obamacare. We, of course, didn't do that. And finally, ours was a state plan, a state solution. And if people don't like it in our state they can change it."

NARR: Politics and medicine will be a potent mix at the American Medical Association House of Delegates meeting, under way in Chicago. We'll be covering that meeting as well as health reform in the next edition. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: The Affordable Care Act in court and in organized medicine's house. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: A three-judge panel heard oral arguments this week in yet another challenge to the President Obama's health care law. Here's Frances Correa with more

CORREA: This time, they grappled with the precedent set by the individual mandate. If all Americans can be required to purchase health insurance, what other products could they be required to purchase in the future? The judges noted the unique nature of health insurance in that everyone will eventually need to use it, and that those who purchase it end up bearing the costs for those who don't. Acting U.S. solicitor general Neal Kumar Katyal argued that the individual mandate is constitutional based on the commerce clause. A ruling in the case, brought by 26 states, is not expected for several months.

NARR: And there a new roadblock standing in the way of establishing Accountable Care Organizations, or ACOs. The Center for Medicare and Medicaid services has pushed back.. .by about a month… its deadline for the first round of ACO participants. That's after feedback from stakeholders and sparse interest from potential applicants. Even some of the health providers that are best positioned to become ACOs have complained about the process and the lack of incentives. Internist William Golden explains that CMS probably had to make the modification to attract more participants.

GOLDEN AX: "And so if the early adopters are not indicating interest it's probably a wise decision to perhaps rethink or to at least potentially modify what the requirements may be so that there would be greater participation."

NARR: The agency wouldn't want to find itself alone in the ACO enterprise, says Dr. Golden, a professor of medicine at University of Arkansas.

GOLDEN AX: "I think they want to have a large party and uh, and they don't want to have a sparsely attended party."

NARR: Dr. Golden and his colleagues from across medicine are getting ready for the annual House of Delegates meeting at the American Medical Association. Dr. Golden heads up the delegation from the American College of Physicians. Here's Denise Fulton:

FULTON: Dr. Golden says health reform will be a hot topic, with debate expected over whether organized medicine should support the law's individual mandate as well as some healthy discussion about how doctors should be paid under the new health system. Also controversial: several resolutions backing a physician's right to counsel patients about gun safety. That is in reaction to a Florida law that bans doctors from inquiring about guns at all.

We, too, are sending a delegation to cover the AMA meeting. Look for coverage of that and more in our next edition. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

Doctors up in arms over the government's plan for accountable care organizations. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: The public comment period on proposed rules for accountable care organizations, or ACOs is winding down. And doctors and hospitals are not thrilled. Groups like the AMA and the American College of Physicians have told Medicare officials the proposal is too restrictive and doesn't offer enough financial incentives. They said the proposal will discourage small physician groups from participating. Even the Cleveland Clinic - a health system that experts say is in a good position to be an ACO - has a problem with the plan. Congress has also voiced some criticism. A group of 7 republican senators told Medicare's Dr. Donald Berwick that he should scrap the proposal and start over. Dr. Berwick said the comments will help shape the final product.

BERWICK AX: "So it was a try to get it right. The input we're going to get now is going to help us get it righter and I am fully confident that when the final rule is issued it will be better because of the input from those senators and others and that's our commitment."

NARR: Meanwhile, another federal health initiative has been retooled. The Pre-existing Condition Insurance Plan, part of the Affordable Care Act, so far has not attracted very many enrollees. Just 18,000 have signed up. Contrast that number with the estimated 100,000 Americans the Administration said lacked coverage due to pre-existing illness. Now, HHS says it is cutting premiums by 40 percent and waiving a rule that said patients had to be denied commercial insurance before they can join. HHS will also reward private insurance brokers who recruit new enrollees. Not all the hurdles are gone though: Patients must still must be uninsured for six months before they can apply.

NARR: And the affordable care act continues to face legal challenges. A three-judge panel in Cincinnati just heard a case filed by the Thomas More Law Center on behalf of members who said they should not be forced to buy health insurance. The government argued that the case was moot because at least one of the members now has employer-provided health coverage. One observer said the appellate panel seems to be leaning in favor of the government's position that it can require people to buy health insurance. Here's Families USA Executive Director Ron Pollack.

POLLACK AX: "I think the uh most promising thing about this argument is that all three judges at different points during the argument understood full well there is something different about the health market than exists for any other kind of product."

NARR: Mr. Pollack would not venture to predict the outcome of the case, however

NARR: This week another court in Atlanta will hear appeals arguments in a ruling that went against the Administration. In that case, a Florida District Court judge said that the Affordable Care Act should be thrown out. We'll report on that hearing and update you on other news next week. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

The Obama Administration tries some new rules to get providers on board. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: There are complaints coming from doctors, hospitals, and others who want to be part of new Accountable Care Organizations. Why? They say that proposed federal rules don't give them much leeway in building the new systems called ACOs. Well, now the government has offered some new alternatives it hopes will satisfy some of those critics. One lets pioneers who already have a solid ACO-style infrastructure in place make the leap to an ACO in the fall, instead of waiting until January. Another offers education on how to become an ACO. And finally, money: Another possible plan could see the government offer upfront payments to those who want to become an ACO but lack the resources. CMS Administrator Don Berwick said the agency wants to balance providers' needs with good treatment.

Berwick: "The ground rules for ACOs have to strike very careful balances in a number of dimensions. For example, they have to give providers incentives to achieve savings and tools to help coordinate and improve care. But we also need to make sure that providers don't stint on care or withhold care when it's needed, in pursuit of those incentives."

NARR: The public comment for those HHS rules ends on June 6th.

NARR: Meanwhile, the Administration is also moving forward with another part of the Affordable Care Act. That's insurance reform. HHS Secretary Kathleen Sebelius unveiled new rules aimed at slowing the rise in health insurance premiums by boosting scrutiny of rate hikes. The new regulation applies to most health plans in the small and individual insurance market and goes into effect in September. Plans that increase rates by 10 percent or more have to first get reviewed by state or federal officials. If those officials find the increases to be unreasonable, plans have to justify the rate hike in public. Insurers call the ten percent threshold arbitrary. Their lobbying group, America's Health Insurance Plans, said that setting a standard at ten percent just tells reviewers that anything more than ten percent is by definition unreasonable. HHS plans to set state-specific rules beginning in September 2012.

NARR: Meanwhile, on the legal side of the Affordable Care Act, the Administration has submitted its latest defense of the law in a brief with the Eleventh Circuit Court of Appeals. Alicia Ault has more.

AULT: The government is appealing a lower court judge's decision in Florida vs. HHS. That judge ruled that the requirement that individuals buy insurance is unconstitutional. And, he said, that provision could not be separated from the rest of the law, so the whole law should be struck down. In what some legal experts are calling a departure, the Administration is now in some ways agreeing that the Act cannot be separated into pieces. But it still is arguing that the law is valid. The feds get a chance to make their argument on June 8 in that case.

NARR: Just a week before the Eleventh Circuit hearing, the government will be in appeals court in Cincinnati as well. In that case, a lower court judge upheld the Affordable Care Act. We'll report on those proceedings after a week's break for Memorial Day. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: Hospitals...on the way to pay for performance. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: Payment is about to change. Starting October 2012, hospitals will see part of their Medicare payments, depending not by how MUCH care they deliver, but by how WELL they deliver it. The new program-- mandated by the Affordable Care Act-- takes one percent of the Medicare payments normally delivered to hospitals and uses it to reward quality and patient satisfaction. The Hospital Value-Based Purchasing program will make about 850 million dollars in quality payments in the first year. Dr. Donald Berwick, who runs Medicare, said the program should improve quality for patients while bringing down costs.

BERWICK: "So this is one of those areas where improvement of quality and reduction in cost go hand-in-hand. And my feeling continues to be that the best way for us to arrive at sustainable costs for the health care system is precisely through the improvement of quality of care."

NARR: Federal officials also want to improve quality with the new electronic health record incentive program. One person who will play a large role in shaping that program is the new national coordinator for health IT: Dr. Farzad Mostashari (Most-ah-shah-ree). He is the fourth person to hold the post and replaces Dr. David Blumenthal, who left earlier this year. Speaking at a small gathering in Washington, D.C., Dr. Mostashari said there's hard work ahead as the country enters an intense period of implementation of health IT programs.

MOSTASHARI: "But I think something bigger is afoot here than just the incentive payments. I think that I'm optimistic about where we are, about where we're going, because the wind is at our backs in a very important way. We are approaching a virtuous cycle where what providers need to do to succeed in the new era of health care financing requires better information."

NARR: The information, Dr. Mostashari said...could help further fuel the movement toward paying for quality.

NARR: Meanwhile, the Obama Administration won a victory in the legal battle over the health reform law. The U.S. Supreme Court denied a petition by Virginia's Republican Attorney General to expedite review of the Affordable Care Act. Attorney General Kenneth Cuccinelli (Koo-chih-nelly) had sought a quick hearing on his state's challenge to the law's constitutionality. A state judge ruled in Cuccinelli's favor, but the federal government has appealed. The High Court made no comment in denying the Virginia petition. But Cuccinelli's suit will be heard by a Fourth Circuit appeals court judge next week, on May 10th. Legal experts still expect that at least one of the many reform suits will make it to the Supreme Court by the fall, with a decision by next spring - just as the 2012 presidential election gets into full swing.

NARR: Join us next week for news on an upcoming vote on federal funding of abortion and more on health reform implementation. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

Lawmakers - and the President -- spar over the future of Medicare and Medicaid. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: Just 12 days after passing a compromise budget plan for this year, House lawmakers turned their attention to 2012. Frances Correa has more.

CORREA: In a party-line vote, the House passed a controversial budget plan authored by Paul Ryan, a Republican from Wisconsin. The Ryan plan would significantly alter Medicare and Medicaid-- essentially privatizing Medicare for everyone who is under 55 today. It would also convert the federal share of Medicaid to block grants for the states. Supporters say the changes are critical to cutting the deficit, but President Obama has declared the plan dead on arrival.

NARR: Now soon after the Ryan plan was introduced, the President unveiled a deficit-cutting proposal of his own. And he said it would get the country back on track within 12 years. The $4 trillion in reductions in the President's outline do come out of Medicare and Medicaid. The plan has a ways to go though. Congress first has to agree to it. Some details released so far are sure to make the physician community nervous. For instance, the President said he'd give greater powers to the newly-created Independent Payment Advisory Board, to hold Medicare costs down. He also envisions $340 billion in Medicare and Medicaid savings on top of the $1 trillion already expected to come from provisions in the new health care law. But the President also made it clear that he would not support a block grant concept for Medicaid.

NARR: That is not likely to stop the nation's Republican governors. They're preparing a report that's expected to back block grants. After a task force shares the Medicaid report with all the Republican governors, the aim will be to get Congress on board, said Mississippi Governor Haley Barbour.

BARBOUR AX: "We look forward to trying to have for the Congress, during the month of May, a series of recommendations about Medicaid. About how to improve Medicaid and how to control the costs consistent with the Ryan budget, which we believe we can do.

NARR: Barbour is mulling a presidential run in 2012. He said the Republican governors have also been developing health policies with an aim to repeal and replace the Affordable Care Act.

NARR: Congress, meanwhile, is taking a break over the next two weeks. There were a few more controversial votes before the members left Washington. The House took aim at the Affordable Care Act, voting to eliminate the law's Prevention and Public Health Fund. House Republicans members also passed a resolution to defund the health care law and to strip federal funding from Planned Parenthood. Those two measures failed in the Senate, however. And the Senate has yet to take up the Prevention and Public Health Fund provisions.

We'll be taking a break also, but will be back on May 2nd. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

Lawmakers avoid a government shutdown. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Mary Ellen Schneider.

NARR: The federal government is open for business today, thanks to a last-minute deal hammered out just before Friday's midnight deadline. Here's Frances Correa with more:

CORREA: Lawmakers passed a short-term budget resolution to keep government operating through Thursday. They will vote shortly on a bill funding the government for the rest of the fiscal year. While much of the negotiations centered around billions in federal spending cuts, Democrats and Republicans also got hung up over funding for Planned Parenthood. The GOP negotiators wanted the 2011 budget to stop funding the well-known abortion provider. Democrats objected. They said federal funds don't go toward abortions and that cutting off Planned Parenthood would hurt women's health since those clinics mainly provide mammograms, pap smears, and family planning services. The final deal kept Planned Parenthood funding intact but took away federal abortion subsidies for the District of Columbia.

NARR: With this year's budget under control, Congress will now take up the 2012 budget. And there won't be any easy agreements there either. House Budget Committee chairman Paul Ryan of Wisconsin has unveiled the GOP blueprint, which makes big changes to Medicare and Medicaid. The plan would convert the federal share of Medicaid funding into block grants for the states. It would also privatize Medicare for everyone who is 54 or younger today. Congressman Ryan said the changes will save Medicare from bankruptcy.

RYAN: "Americans are ready for honest talk. They're ready to be spoken to like adults. They're ready for a fact-based conversation without budget gimmicks, accounting tricks, and all the rest, about what is really needed to save this country. And what this plan shows you is that this country can still be saved."

NARR: Not surprisingly Democrats are opposed to these changes. And in their response to the plan, they pointed out what they see as another flaw-- the GOP budget proposal doesn't fix the Medicare physician payment formula. Ryan's plan does call for a 10-year solution but Democrats say it's all talk. He doesn't specify how he would pay for the fix, which would cost around 300 billion dollars.

NARR: Ryan's plan also calls for repealing the Affordable Care Act.

NARR; Meanwhile, tempers flared as the House Energy and Commerce Committee took up a Republican-sponsored malpractice reform bill that physicians widely support. Both Democrats and Republicans said they wanted tort reform, but the hearing made it clear that they are far apart on how to overhaul the system. Democrats said that the states should take the lead on reform, not the feds, as HR 5, proposes. Florida neurosurgeon Troy Tippett disagreed.

TIPPETT: "A number of states have made significant gains in reducing medical lawsuit abuse but as personal injury lawyers work state by state to overturn liability reforms and expand areas open to litigation, it's clear that medical liability remains a national problem that requires a comprehensive federal solution."

NARR: HR 5 was approved by the House Judiciary Committee in March. But the Senate has not taken any action on a companion bill.

NARR: Stay tuned as we follow the 2012 budget negotiations and their impact on health reform implementation. And that's the Policy & Practice Podcast. I'm Mary Ellen Schneider.

Physicians get some answers on Accountable Care Organizations. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: Medicare officials have finally issued their proposals on how doctors and hospitals can form accountable care organizations or ACOs. The proposal allows providers to band together to care for patients and then share any money Medicare saves on their care. The proposal lays out two possible tracks for ACOs. In track one, ACOs could share in Medicare savings for the first two years and then assume risk in the third year. That means that they would potentially pay penalties if they dont provide cost-effective care. In track two, ACOs assume risk immediately but with the potential to earn a bigger share of the savings. Dr. Don Berwick, who heads the Center for Medicare and Medicaid Services explained:

BERWICK: "The policy aim here is to offer ways for organizations, as I said, at different levels of maturity and capability to get into the world of accountability and seamless care that we're looking forward to."

NARR: The ACO rule was widely criticized by Republicans. They called it another example of health reform's burdensome bureaucracy. Former House speaker Newt Gingrich -- widely expected to run for President in 2012 - echoed that sentiment.

GINGRICH AX: "It's one more step of centralizing decisionmaking and centralizing reporting which actually makes it more expensive to innovate."

NARR: On Capitol Hill, Democrats and Republicans also sparred over whether the Affordable Care Act would reduce the deficit or add to it. At house hearings, Democrats portrayed the law as the biggest deficit-cutting measure in years. Republicans said it would add to the nation's spending and drive many companies right out of business. Both parties pointed to estimates by the Congressional Budget Office to support their contentions. CBO Director Doug Elmendorf said the law is now likely to cost $1.1 trillion, not the $900 billion originally estimated. But, he also said this.

ELMENDORF AX: "According to our latest comprehensive estimate of the legislation the net effect of all the changes in direct spending and revenues is a reduction in budget deficits of $210 billion over the 2012 to 2021 period."

NARR: Elmendorf's conclusions were supported by Medicare's chief economist, who also testified at the hearing.

NARR: Meanwhile, several Republican members of the House Ways and Means Committee accused AARP of seeking to profit from its support of health reform. Representatives Wally Herger (her-gur), Dave Reichert (Reikert) and Charles Boustany (boostahnee) said that a year-long investigation showed that AARP stands to make millions of dollars from increased sales of the Medigap insurance policies it endorses. The report also lambasted AARP for reaping hundreds of millions in royalties while cutting its budget for core programs for its senior citizen members. The lawmakers have asked the IRS to look into AARP's tax-exempt status. Congresssman Boustany said the investigation was not politically-motivated.

BOUSTANY AX: "This is about seniors, this is about fairness. It's about whether or not this entity is misrepresenting itself to seniors. This is about whether a nonprofit or an entity purported to be a nonprofit is in fact abusing that tax exempt status."

NARR: AARP maintains that royalty payments are necessary to keep dues affordable and to keep advocacy programs running.

NARR: Elsewhere on the Hill, Democrats and Republicans are attempting to set aside differences. They have to broker an agreement on the fiscal 2011 budget by Friday or the government will be forced to shut down. Look for more on that next week. And that's the Policy & Practice Podcast. I'm Mary Ellen Schneider.

NARR: MedPAC delivers a warning on physician payment. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: The Medicare Payment Advisory Commission- or MedPAC- has recommended a one percent increase in physician fees for 2012. That came in its March report to Congress. The non-partisan group advises Congress on Medicare payment rates to physicians, hospitals, and other health care providers. Now MedPAC members will shift their focus to finding a fix to the Sustainable Growth Rate formula or SGR. That's the equation used to determine physician fees under Medicare. Under the SGR, payments to doctors are scheduled to be cut by nearly 30 percent next year. MedPAC's chairman Glenn Hackbarth said now is the time to tackle the perennial SGR problem:

HACKBARTH: "For a long time, I've been able to sit before this subcommittee and say that SGR is a problem but we don't see an imminent threat to access. We think we're getting loser to that tipping point."

NARR: MedPAC could have recommendations for an SGR fix later this year.

NARR: Well here's some March madness. Medical school seniors around the country just learned where they'll spend their residencies. It's the annual March ritual known as Match Day. The day brought good news not just for students but also for primary care. The latest figures from the National Residency Matching Program show that 11 percent more U.S. medical school seniors chose residencies in family medicine this year. And 8 percent more chose internal medicine. Leaders in those specialties say the health reform law may have played a role by drawing attention to the importance of primary care. This is the second year in a row that primary care residencies have attracted more U.S. medical school seniors to their ranks... that's after years of flat or declining numbers.

NARR: Back on Capitol Hill now, Republicans on the Senate Finance Committee applied what they called a "full court press" on Health and Human Services Secretary Kathleen Sebelius. For almost two years, congressional Republicans complained that they were shut out of the process that resulted in the Affordable Care Act. Since the bill has become law, they've been asking the White House for details on how it was all put together. Those requests have largely gone unheeded, according to Utah Republican Orrin Hatch.

HATCH: "There have been at least 52 congressional requests for information regarding implementation of the health law submitted to your department since the middle of last year and to date 67 percent of those requests are still awaiting responses. Now your department has also still not responded to questions for the record submitted by members of this committee from when you last testified over a month ago. Now this ongoing failure to provide information to us relating to the implementation of the new law and to respond to congressional inquiries directly undermines Congress' ability to conduct oversight and assess the impact that this law is having on patients, employers, states and taxpayers."

NARR: Ms. Sebelius said the department was already working on responding to the various requests and that it would try to get details to Congress as quickly as possible.

NARR: The Secretary also told Senators that HHS expects to issue rules on accountable care organizations by the end of this month. The rules are widely anticipated and will tell physicians, hospitals, and insurance companies how they can band together to deliver more efficient care. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: The first anniversary of the health care overhaul ... but not everyone is celebrating. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: It's been one year since the Affordable Care Act became law...and the Obama administration is still trying to sell it. President Obama's cabinet has been fanning out. They said the health law could help with some burdens in rural areas like high rates of uninsurance and provider shortages. The patients' bill of rights, the state-based health insurance exchanges, and tax credits to small businesses would all help. That's according to Agriculture Secretary Tom Vilsack.

VILSACK: "With this law in place I think we can make a stronger case to encourage young adults that rural America is still a great place to live, work, and raise their own family."

NARR: Health reform's anniversary was also a chance for critics to renew their attacks. A small group of Republican health analysts has released a new book with a title that says it all-Why ObamaCare is Wrong for America. And House Speaker John Boehner continues to call for the full repeal of the law. Barring that, the GOP majority will seek to strip the law's funding, one piece at a time.

NARR: The American Medical Association backed up the White House on health care and still does. AMA President Dr. Cecil Wilson said the group's leaders are happy to see increased coverage and insurance reforms in the law. Now they are working with Congress to fix the pieces left undone like malpractice reform and a replacement of the Medicare physicians' fee schedule. The AMA is also trying to influence regulations that put the law into practice. Dr. Wilson explained the group's role in formulating upcoming regs on Accountable Care Organizations:

WILSON: "We have been involved over the last 5 or 6 months providing physician input to the Centers for Medicare and Medicaid Services, to the White House to say that these regulations need to be crafted in a way that will allow physicians to be involved in leadership roles in order to make this new way of delivering care work and be effective. So we've been involved with a lot of resources and time in trying to affect the outcome of that."

NARR: Americans, meanwhile, remain divided and confused about the health law. That's according to a recent poll by the Kaiser Family Foundation. Americans are nearly split when it comes to supporting or opposing the law. Half say they are confused about how the law would benefit them. And their political affiliation is still the strongest factor in whether they have a favorable or unfavorable view. Seniors remain more skeptical than other groups, believing that Medicare will be worse off under the Affordable Care Act.

NARR: And finally, embattled Medicare chief, Dr. Donald Berwick, is getting some support. Dozens of health care leaders and some primary care organizations sent a letter to President Obama urging him to push for Dr. Berwick's confirmation. Berwick currently holds the post because of a recess appointment and faces hefty Republican opposition in the Senate. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: The legal battle over health reform continues ... this time... with a reprieve. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: The same Florida judge who tossed out the Affordable Care Act in January now says that the government can keep implementing it. Here's Mary Ellen Schneider with more.

SCHNEIDER: Judge Roger Vinson initially ruled that the requirement that individuals buy health coverage is unconstitutional. He also invalidated the entire law because he said there was no way to carve out that individual mandate requirement. The administration said it would appeal and forged ahead on implementing the law. Now Judge Vinson has issued a clarification of his previous ruling. It turns out he had meant for the Administration to halt its actions on the law. But since it didn't.... he is now granting them a reprieve from his original decision. His terms: the government can continue to implement health reform, but it must appeal his decision within seven days. The goal is to get the case to the Supreme Court sooner rather than later.

NARR: The implemention of health reform rolls along. It's controversial, and now, President Obama has offered an olive branch to states. Governors complain that health reform's Medicaid requirements will bankrupt their states. The President said the White House would support a congressional proposal to let states try experimental Medicaid programs in 2014 -- three years sooner than the law now allows. The offer was panned by Republicans. Mississippi Governor Haley Barbour said states should be given free rein now. One of his proposals is to let states take Medicaid money from the federal government in a lump sum and make their own choices -- instead of having to share spending decisions with the feds.

BARBOUR AX: "I'll tell you what, most governors would take that in a heartbeat. And we would make Medicaid better. We would also make Medicaid less expensive."

NARR: Utah Republican Senator Orrin Hatch said the President's flexibility plan did not address his main concerns.

HATCH AX: "It does nothing to address the law's major structural flaws. Now this date shift gimmick does nothing to address the fundamental failure of Obamacare - reducing skyrocketing health care spending."

NARR: Meanwhile, fraud was the buzzword on Capitol Hill. Both the House and Senate held hearings last week looking at how easy it is to exploit Medicare ... and how much money the government could save if it did a better job of preventing fraud in the first place. With so much focus on the deficit, fraud prevention is being eyed by both parties as a potential revenue source. The President also wants to go after fraud as a source of money to pay for part of a two-year fix to the Sustainable Growth Rate formula. That proposal was in his 2012 budget.

NARR: And finally, Congress managed to reach an agreement to keep the federal government funded-- but just for two more weeks. Stay tuned to see if lawmakers can reach a longer term deal and what that will mean for health reform implementation. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: States sound an alarm in Washington over health reform. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: Is health coverage expansion colliding with harsh fiscal realities in the states? According to some governors, the answer is yes.. .and they're trying to raise the alarm in Washington.

The Affordable Care Act broadens health coverage... largely by expanding Medicaid. That's while some governors -- already struggling with tight budgets -- are trying to trim Medicaid eligibility and thus cut costs. The Obama Administration says the law gives states enough flexibility and financial support so they don't have to go broke expanding coverage. But that's not enough for some state officials. Take Louisiana. The state ranks 49th overall in health and has a large number of uninsured. It has done a lot to cover its citizens but the burden of health reform will be great, says state Secretary of Health and Hospitals Bruce Greenstein (GREENSTEEN):

GREENSTEIN AX: "We predict that we'll go from 27-percent of the state's population to as much as 48-percent of the state's population on Medicaid. That's too much reliance on a system that no one would agree is working very well. It's a broken system that needs structural reform as it is and reliance on that as the catalyst for coverage is not in the right direction."

NARR: Greenstein cautioned there's a lot of uncertainty among the state's physicians.

GREENSTEIN AX: "Most of the physician community doesn't know nearly enough what the impact would be of health care reform and those that do understand it believe that there's not enough capacity in the physician community to supply quality care for the number of new people that will join the health insurance rolls."

NARR: Meanwhile, a federal judge in Washington DC upheld the constitutionality of the reform law. That brings to three the number of judges who have ruled in favor of the law. Two others have said that the law's individual mandate is unconstitutional. Judge Gladys Kessler ruled against the five individuals who alleged that the requirement they buy health insurance violated their rights and their religious freedom.

NARR: The efforts to repeal the law in Congress and to overturn it in the courts seems to have confused a large number of Americans. A Kaiser Family Foundation poll found that 22 percent of respondents thought that the law had already been revoked. Another quarter said they weren't sure whether the law was still standing.

NARR: Elsewhere in Washington, the Medicare Payment Advisory Commission, or Medpac, is considering an issue near and dear to doctors - how to fix the Sustainable Growth Rate formula. Here's Alicia Ault with more.

AULT: Medpac is preparing its annual spring report to Congress. Commission members at its latest meeting wrestled with what advice they should give lawmakers on replacing the SGR. The annual cuts called for by the formula cause uncertainty for doctors and have led some to stop seeing Medicare patients. And putting off the cuts each year is adding to the deficit. The Medpac members are considering several SGR alternatives. But there would be a trade-off. In exchange for the fix, physicians might have to agree to curb the volume of services or meet stricter quality goals.

NARR: Congress is now back from its recess and is trying to reach a dal to avoid a government shutdown. Members are working on a short-term bill to keep the government operating for a few weeks. Republicans are still talking about making deep cuts in a longer-term package to fund the rest of the fiscal year. We'll report back on their efforts next week. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: The President puts his 2012 budget on the table…and gets a cold reception. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: President Obama presented his 3.7 TRILLION dollar budget to Congress, but both Democratic and Republican critics say it doesn't take on the real deficit monster: entitlement programs like Social Security and Medicare. Making the rounds on Capitol Hill, the White House budget director called the document a first step towards cutting the deficit. First: a proposed ten-year plan to fix Medicare's Sustainable Growth Rate, or SGR. The total cost would be 370 billion dollars. Administration officials say they'll cover the cost through fraud-fighting efforts and adjustments to payments for Medicaid and pharmaceuticals. It remains to be seen whether the fix will actually happen. Here's the C-M-S Administrator Dr. Donald Berwick:

BERWICK: "This is the first step that these two years are covered. But the main idea here is to continue to work with Congress as hard as we possibly can to get a permanent and solid fix in place and we're committed to that."

NARR: Congress is also trying to agree on a workable federal budget for the current fiscal year. The House put a lot of hours into debating hundreds of amendments to a bill that would fund the federal government through the end of September. In the end, they approved a bill that cut 61 BILLION dollars in spending, including reductions to Community Health Centers, the National Health Service Corps, and the Maternal and Child Health Block Grant. The bill also cut all federal funds to Planned Parenthood facilities and blocked funding for federal agencies to implement the Affordable Care Act. The bill now goes to the Senate.... but time is running out. The current of federal funding expires March 4th.

NARR: Meanwhile, sensing that the time is right, Republicans are also trying -- yet again -- to move a malpractice reform bill through Congress. Here's Alicia Ault with more.

AULT: President Obama has expressed support for some kind of change to the nation's medical liability laws. But the bill sponsored by Republican Phil Gingrey of Georgia did not attract a single Democratic vote as it was approved by the House Judiciary Committee. The Democrats objected to the caps on non-economic compensatory damages and also on punitive damages that were called for in Gingrey's bill, the HEALTH Act of 2011. The bill now goes on to the House Energy & Commerce Committee. It has also been introduced in the Senate, but has yet to see any action there.

NARR: The Administration continues to implement its health reform law despite congressional attempts to circumvent it. The President's budget calls for 465 million dollars to carry out various aspects of the law in 2012. And the White House just issued a 241-million-dollar grant for seven states first out of the gate in establishing health insurance exchanges. Look for more from the White House this week, even as Congress takes a Presidents' Day recess. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

Doctors descend on Washington.... looking for answers about health reform. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: Health reform dominated... as the American Medical Association just held its National legislative Conference here in Washington. But while doctors seemed hungry for insight.... federal leaders mostly just recited the timeline for health reform implementation. Washington insiders did a little more prognosticating. Chip Kahn of the Federation of American Hospitals doesn't foresee a lot of changes to the law:

KAHN: "I think other than 1099, the probability of any kind of even minor modifications in the ACA-the health reform process-- is very low."

NARR: Here's analyst Dan Mendelson of Avalere Health.:

MENDELSON: "I tend to think that really everything related to coverage is going to be debated very actively over the next couple of years."

NARR: Also a big topic... the future of the individual insurance mandate. And on that, Chip Kahn had a warning:

KAHN: "At the end of the day though, my experience with this is the politics of this are bad and if we lose this mandate, we ain't never gonna recover anything comparable."

NARR: The fate of the individual mandate is in the courts for now.... with the Supreme Court likely to decide the constitutionality of the mandate in the next year or two.

NARR: Meanwhile, across town, Congress was once again taking on the contentious issue of abortion. In hearings in the House, lawmakers squared off on how to best ensure federal funds- in particular those doled out through the Affordable Care Act-- are not used for abortion coverage. Now the idea is nothing new-- Congress approves restrictions on federal funding for abortions each year in the form of the Hyde Amendment. But the new GOP majority in the House is pushing to have the restrictions put permanently into law. One such bill-- the Protect Life Act-- would bar the use of tax credits awarded through the new health reform law from being used to pay for any insurance plan that covers abortion. But abortion rights supporters are crying foul. They say the law creates a marketplace where it wouldn't make sense for an insurer to offer abortion coverage even if a woman paid for it with her own money.

NARR: Well, this week the President unveils his new budget. We'll bring you all the details on the proposals and how they're received on Capitol Hill. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: Opponents challenge health reform in the courts...and on Capitol Hill. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: Another federal judge has struck down President Obama's health reform law. At the center of the fight-the requirement that individuals buy health insurance. Judge Roger Vinson ruled that the so-called individual mandate is an inseparable part of the law and that if the mandate is struck down, then the whole law should be struck down with it. Obama administration officials responded. The Justice department plans to appeal the decision. Meanwhile, White House staffers noted that Judge Vinson's ruling would not affect the law's implementation and they expect the Supreme Court to ultimately uphold the law. But it could take awhile for the case to reach the high court. Democratic Senator Bill Nelson wants to speed up the process.

NELSON AX: "Why don't we just expedite the matter, and why don't we express our intent to have an expedited review by the Supreme Court? Well, I have filed such a sense of Congress, a resolution, and its passage might prevent people from arguing back and forth over this law for the next several years and everybody in this country that's going to be affected would have an answer and they deserve an answer."

NARR: Virginia's Republican attorney general is also pushing for the Supreme Court to take the case sooner rather than later. A Virginia judge ruled in December that the law is unconstitutional.

NARR: Meanwhile, some hearings in the Senate Judiciary Committee could be a preview of how parties on both sides of the health reform law might argue its constitutionality before the high court. Republicans at the hearing derided what they called an unprecedented government mandate that Americans buy certain goods or services. Democrats countered that such mandates exist throughout American life. They argue Republicans are trying to continue a lost political battle in the courts. Legal experts invited to testify at the hearing were divided on whether the law follows the Constitution's original intent.

NARR: Also in the Senate, Republicans have attempted to push through a full-scale repeal of the Affordable Care Act, they're following in the footsteps of their House Republican colleagues. The Senate effort failed 47 to 51 during a procedural vote. Now while full repeal of the law seems unlikely due to the Senate's Democratic majority, there appears to be common ground for tweaking the law. Senators overwhelmingly supported an amendment stripping a provision that forces businesses-including physician's practices-to file a 1099 tax form for all vendor payments of more than 600 dollars in a year. Senator Debbie Stabenow, a Democrat from Michigan, said this is a clear point of agreement.

STABENOW AX: "So, this is an area where we can come together, where Democrats and Republicans on both sides of the aisle who care passionately about small business can come together, eliminate red tape and burdensome IRS reporting provisions. Get that off the table. Make it clear now to small businesses that there is no intent or actuality that this is going to happen and we can do that together."

NARR: Stay tuned for more on repeal efforts... and progress on implementation. The Centers for Medicare and Medicaid Services is expected to release regulations on Accountable Care Organizations soon. We'll bring you those details and a lot more. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: The President opens the door to medical liability reform. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: Could tort reform be back on the table in Washington? Well, maybe. In his State of the Union address last week, President Obama said more needs to be done to cut health costs and one solution he'll consider.... limiting malpractice lawsuits.

OBAMA: "I'm willing to look at other ideas to bring down costs, including one that Republicans suggested last year: medical malpractice reform to rein in frivolous lawsuits."

NARR: The American Medical Association praised the President for those remarks. The AMA and 100 other medical groups have already endorsed a bill pending in the House. HR 5-- the so-called HEALTH Act-- would cap non-economic damages and limit attorneys' fees. The bill is modeled after California's medical liability law, which has been in place for 30 years. It's not clear whether the bill will see much support in the Democratic-controlled Senate, however. And while doctors are encouraged by President Obama's mention of tort reform, they aren't sure exactly what it means. The President spoke to doctors in 2009 at the AMA's national meeting and sympathized with them but said he didn't favor capping damages.

NARR: The American College of Physicians says it, too, would like some movement on liability reform. It's calling on Congress and the White House to look for bipartisan compromise on the health law. ACP officials strongly condemned the Republicans' repeal effort, but also chastised Democrats for engaging in a partisan and polarized debate. The Affordable Care Act should not be scuttled. But it could use some tinkering, they said. Finally, the ACP called for a frank discussion of how to allocate the nation's limited health dollars.

NARR: And public opinion on the health reform law is changing. A new poll shows that nearly half of Americans now oppose reform - that's up almost 10 percent from December. But the poll, by the Kaiser Family Foundation, also shows that a majority of Americans are opposed to cutting off funding for the law. And most don't want to see reductions in Medicare, Medicaid or Social Security. Another not-so-surprising finding: three in four Republican voters want the health law repealed, while half of Democrats want to expand it. Kaiser President Drew Altman offered a bird's eye view of the poll:

ALTMAN AX (00:36) "The bigger picture that we see in our polling, is a picture of stability and not change in public opinion on health reform. And what the picture shows is that the public is split along conventional, partisan and ideological lines, and it's a picture that hasn't changed in quite some time. It's a public that has been split before the legislative debate, it was split during the legislative debate, and guess what, it's split today."

NARR: That poll was conducted before the House passed a bill to repeal the law. We'll bring you news on repeal efforts and more in our next edition. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

The House votes to repeal health reform ... but what's next? Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: As expected, the new GOP-led House has passed legislation repealing the Affordable Care Act. They followed that with a resolution directing committees to draft an alternate law. Passing the repeal bill was important to Republicans who campaigned hard against the health reform bill last year. But repeal...or even significant changes ... are unlikely as long as Democrats control the Senate and the White House. But don't expect the debate to go away -- Republicans have already scheduled hearings to examine the economic effects of the law.

NARR: And there was unexpected good news for physicians hidden in the repeal efforts. As part of the resolution to rewrite health reform, House Republicans also directed their committees to find a permanent fix for the dreaded Medicare physician fee schedule.

NARR: Cost, once again, has emerged again as a major sticking point on health reform. Conservatives are blasting estimates out of the nonpartisan Congressional Budget Office. Those estimates say the law will reduce the budget deficit. But many Republicans say the C-B-O is constrained by rules that force it to accept assumptions from Congress that just ... well...don't make sense. Douglas Holtz-Eakin, former C-B-O director, explained:

HOLTZ-EAKIN: "The bottom line is real simple. The C-B-O has to take at face value what is in the law that Congress sends it and is not allowed to question in any way how the law will evolve. So an analogy is, if Congress sets down a schematic of a pig with wings, C-B-O would be forced to rule that it could fly. The trouble is pigs don't have wings and the trouble with this law is that it doesn't save money."

NARR: Health reform supporters say that attacks on C-B-O's estimates are incorrect and there is also a larger issue at play. Bob Greenstein of the Center for Budget and Policy Priorities explains:

GREENSTEIN: "At a time when a nation faces serious long-term fiscal challenges, the notion of Congressional leaders rejecting nonpartisan CBO estimates that they find politically inconvenient and promoting their own partisan estimates instead has troubling implications."

NARR: Meanwhile, the administration continues to implement the Affordable Care Act. HHS announced that states can begin applying for grants to help defray the costs of setting up health insurance exchanges. These exchanges are the much-celebrated one-stop-shop for insurance slated to open in 2014. In remarks announcing the new grants, HHS Secretary Kathleen Sebelius called the House repeal vote "unfortunate."

SEBELIUS: "At a time when there's so much important work to be done to restore freedom and health security to consumers across the country, it would be a huge mistake to undue the progress that's already been made and go back to the crumbling market that continues to fail consumers."

NARR: And finally, the American Medical Association was on the Hill last week making its case for medical liability reform. The AMA favors caps on non-economic damages-- like in Texas and California. It also wants federal funding for states to explore new ideas. Incidentally, Republicans in Congress say that will be part of their new reform effort. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: Health reform returns to the forefront. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: While Congress spent the last week largely silent on health reform, state officials have been showing their displeasure with the law. Here's Mary Ellen Schneider with more:

SCHNEIDER: Last week alone, Republican officials in Kansas, Maine, Ohio, Wisconsin, and Wyoming said they plan to join the multi-state health reform lawsuit now being considered by a Florida judge. That suit challenges the constitutionality of the law on two counts-- the individual mandate and the massive expansion of Medicaid. Now, fully half of the states are a part of this challenge. The judge in the case is expected to render his decision shortly. But whatever the outcome, experts continue to predict that the fate of the law will ultimately be decided by the Supreme Court perhaps as soon as next year.

NARR: Meanwhile, in Washington, Medicare's Payment Assessment Commission, known as Medpac, recommended that physicians' fees should be raised by a scant 1 percent in 2012. The increase would not offset the 25 percent cut called for by Medicare's SGR formula. But Medpac members also called for revamping the SGR, they said it's causing too many headaches for physicians and patients alike. Some observers had predicted that Medpac would no longer be influential after health reform became law. But Medpac Chairman Glenn Hackbarth emphasized that the panel would continue to play an important role advising Congress on Medicare policy.

NARR: Another pressing concern for physicians is whether to participate in a new government program offering bonus payments for implementing electronic health records. If new survey data from the Centers for Disease Control and Prevention are any indication, many physicians will be signing up. The poll found that 41 percent of office-based doctors plan to seek federal dollars for implementing electronic records. And 80 percent of those will do so in the next two years. This level of interest is a major shift after years of sluggish adoption rates. Dr. David Blumenthal, the federal government's health information technology czar, offered his thoughts on the reasons for the uptick in a recent message to doctors.

BLUMENTHAL: "Why are providers choosing to go now? Availability of incentive payments is one reason. Availability of federally-supported technical assistance is another. The guidance provided through the meaningful use process, which provides clarity regarding how to use electronic health records, and assurance that certified electronic health records will support those uses. And leadership by the nation's clinical and hospital professional organizations are a very important element."

NARR: Registration for the new incentive program began on January 3rd. Doctors can earn up to 44,000 dollars under Medicare and nearly 64,000 dollars under Medicaid through the program.

NARR: Well, stay tuned for more next week as we bring you details on the House debate on whether to repeal health reform law. Lawmakers are expected to vote on the repeal on Wednesday. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: The politics of health reform set aside as the nation mourns. This is Policy and Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: Congressional leaders are calling for civility and putting politics on hold...for now...following the shooting of Congresswoman Gabrielle Giffords and several others outside a Tucson, Arizona supermarket over the weekend. Here's Mary Ellen Schneider with more:

SCHNEIDER: The tone in Washington changed dramatically as lawmakers learned that Democratic Congresswoman Gabrielle Giffords had been shot in the head while greeting constituents. House Republicans were planning to vote to repeal the health care reform law later this week. Instead, hearings and votes are suspended for the week. The timetable for considering health reform repeal is uncertain. Lawmakers will be in Washington this week in a show of unity, while also being briefed on new security measures.

NARR: Now even while the nation comes to grips with the tragedy, some efforts to implement health reform are going forward. The Centers for Medicare and Medicaid Services has put out a proposal to revamp how hospitals are paid. The reform law required the new payment system. It aims to link pay to performance. The so-called value-based purchasing program will reward hospitals that do well on meeting certain quality measures. Payments tied to improved performance will begin in fiscal 2013. There could still be some changes to the payment plan though, because the proposal is open for comment until mid-March.

NARR: The value-based pay system also aims to cut costs. But new figures show that national health spending actually slowed in 2009 without any reform-related help, that's thanks largely to the recession. The United States still spent 2.5 trillion dollars on health care, but there were some notable reductions. Among them: spending on doctors' visits. With less money and less insurance coverage, Americans saw their doctors less often -- especially their primary care doctors. Here's federal statistician Aaron Catlin.

CATLIN AX: "In 2009, um, the trend in physician spending is one that we listed as one of the major contributors to the slow down in overall health spending. Um, physician spending increased 4 percent in 2009 which was the slowest rate since 1996. And that comes off a rate of growth of 5.2 percent in 2008."

NARR: The analysts couldn't say whether these trends continued into 2010. But the data are likely to lend support to health reform. It also showed that the faltering economy led to shrinking private insurance coverage and a huge spurt in Medicaid enrollment.

NARR: And other health reform developments are on the horizon. A Florida judge is expected to rule soon on the multi-state challenge to the requirement that all individuals buy insurance. The new Republican Governor of Wisconsin joined the suit at the last minute. Look for more on that and the resumption of the health repeal effort in our next edition. That's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: A last-minute maneuver settles Medicare physician fees for the coming year. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: Well, doctors got at least one item on their Christmas wish list: An end, for now, to the sporadic threat that their Medicare fees will be cut substantially. Here's Mary Ellen Schneider with more.

SCHNEIDER: Acting on doctors' pleas to stop the roller coaster ride, Congress passed a one-year fix to Medicare's Sustainable Growth Rate formula. President Obama is expected to sign the bill, which extends current Medicare payment rates through 2011. There's no cut, but no increase, either. Doctors are not pleased with the pay freeze. And, they are expected to start lobbying early next year for a permanent replacement for the SGR.

NARR: The new year is also expected to yield details on accountable care organizations, or A-C-Os. Look for officials at the Centers for Medicare and Medicaid Services to issue a proposed rule outlining the new care delivery model in mid-January. For now, the only sure thing about A-C-Os is that no one knows exactly how they will work or if they'll even succeed. Erik Johnson of Avalere Health says the recent upheaval in Washington, the complicated regulatory environment, and the bad economy all add up to uncertainty.

JOHNSON AX: "It makes this a highly uncertain bet for most providers to contemplate-one that by no means is one that every health system or physician group should make, frankly."

NARR: Meanwhile, HHS Secretary Kathleen Sebelius continues to make the case that the health reform law will improve quality and make the health system more rational. Right now, the United States spends roughly 700 billion dollars a year on health care services that don't necessarily improve patient care. That's almost 30 percent of health care spending. But the Affordable Care Act should help stop that trend, according to the secretary. Among the initiatives in the law-- a 10 billion dollar innovation center at CMS that will experiment with new care delivery and payment models-Models like those A-C-Os we were just talking about. The administration is also touting an effort to deliver coordinated care at Federally Qualified Health Centers and for patients who are eligible for both Medicare and Medicaid.

NARR: And in some late breaking news... a federal judge in Virginia has ruled that a key part of the health reform law is unconstitutional. The ruling strikes down the individual mandate... that's the part that says individuals must buy health insurance or pay a penalty if they don't. Other courts have ruled the other way... making it highly likely that this case is going to the Supreme Court.

NARR: Well, the lame-duck Congress is still in session voting on big issues...like your taxes. Stay tuned to see what they do before Republicans take control of the House in January. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: Physicians get short term relief from Medicare fee cuts. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: President Obama signed a bill giving physicians a reprieve from a looming Medicare fee cut. The one-month extension of current pay rates avoids a 23 percent reduction that would have slammed doctors on December 1. But that stay from the tyranny of the Sustainable Growth Rate is only good until the end of the month unless Congress acts again. The on-again, off-again pay cut continues to frustrate physicians, who want a more permanent fix. That may be hard to do with Congress' new focus on the deficit. But Republican House member Michael Burgess says that the SGR fix is a must-do item..

BURGESS: "The money's already been spent. This is Bernie Madoff accounting. We should all go to jail for what we've done with the SGR. Don't quote me on that, but...should there be pay-fors and most of my conference will tell you yes, we don't want to just expand the deficit. This is too big a number...280... 380 billion dollars, wherever it shakes out, so we'll have to pay for it."

NARR: Meanwhile, the health reform law - or at least its goals - were tacitly endorsed by the President's deficit commission panel last week. Eleven of the 18 panelists approved the plan, which calls for $4 trillion in spending cuts over the next ten years. The lack of a super-majority vote means the deficit proposal won't go to Congress for its formal approval. Three Republicans on the panel who voted against the plan said it was too supportive of the Affordable Care Act. But some commission members who are also Members of Congress said they'd use the plan to guide their budget-cutting attempts.

NARR: And the health reform fight continues in the courts, where judges in several states have been hearing challenges to one of the law's central provisions, the individual insurance mandate. Naseem Miller has more.

MILLER AX: The outcomes of the legal battles are very unclear right now. A U.S. District Court judge in Virginia just ruled against Liberty University's argument that the mandate was unconstitutional. And federal judges in Michigan and California have upheld portions of the law. But broad challenges in Florida and Virginia are moving forward. The oral arguments in Florida are set to begin by December 16, and the Virginia judge has promised to rule by the end of the year.

NARR: Meanwhile, Republicans - and some Democrats - in Congress are still pursuing their own challenges of the law. A bid to repeal a section that would have required employers to file a greater number of 1099 tax forms has failed. But proponents of that effort say they'll be trying again. We'll report on that and more in our next edition. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: A deficit panel backs health reform. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: President Obama's budget deficit reduction commission released an early draft proposal. In it: how to cut nearly four-trillion-dollars off the projected deficit through 2020. The bipartisan commission was charged with finding savings in all areas of government. When it came to health care, the proposal backs many principles of the Affordable Care Act. Among its reforms to Medicare are pay cuts for doctors. The commission called for replacing the cuts required by the Sustainable Growth Rate formula with modest physician pay reductions through 2015, while the feds establish a new payment system.

NARR: Some Washington watchers say the document is dead on arrival, in part because of the sweeping tax proposals, but also because it supports health reform. Here's lobbyist Dean Rosen, a former health policy adviser to Republican Senators and Congressmen:

ROSEN AX: "It probably won't make it out of the commission. But the one thing to keep our eye on is that just because it doesn't get a supermajority vote doesn't mean these ideas are dead forever."

NARR: Well, Congress will have plenty of work to do now that it is back for a lame duck session. There will be jockeying for leadership posts in the House as well as initial informal Republican conference meetings to lay the groundwork for the next Congress. Political commentator Norm Ornstein of the American Enterprise Institute counsels the new Republican majority to proceed cautiously.

ORNSTEIN AX: "I think what you're going to find is that republicans in the process of trying to block or discredit the Obama plan have boxed themselves into a little bit of a corner in terms of what alternatives they can pursue without creating a very significant blowback."

NARR: Ornstein says the GOP will have a particularly hard time scaling back or repealing the reform law, given its many popular benefits.

NARR: Meanwhile, the White House is continuing to issue regulations to implement the Affordable Care Act. The Centers for Medicare and Medicaid Services has proposed rules that would strengthen requirements for private Medicare Advantage plans and Medicare Part D drug plans. The goal is to make the plans more transparent and consumer-friendly. When made final, the requirements could help the Administration bolster public support for health reform.

NARR: This week, though, the White House will be under intense scrutiny as President Obama's recess-appointed Medicare chief, that's Don Berwick, goes before Congress for the first time. We'll report on that and more in our next edition. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

Narr: Health reform challenges in the media, in the courts, and soon, the ballot box. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

Narr: Can they say that? That's been a common refrain in Washington lately. First, it was about Mayberry's finest, that's Andy Griffith, and his public service announcements for Medicare open season. In a thirty-second ad, Sheriff Andy says,

Griffith AX (from 00:14-00:28 in the file): "With the new health care law, more good things are coming -- free checkups, lower prescription costs, and better ways to protect us and Medicare from fraud. See what else is new. I think you're going to like it."

Narr: Now, while the PSAs are free, Medicare paid to place it on several channels, causing Republican congressmen Darrell Issa and Dave Camp to call them government propaganda, which is illegal. Well, the nonpartisan Government Accountability Office ruled that, no, old Andy was not being purely political or offering puffery -- the ads, the GAO said, were factual enough.

Narr: Then, two more Republican congressmen wrote to HHS Secretary Kathleen Sebelius, saying that she appeared to be threatening unruly insurance companies. Texas Congressmen Lamar Smith and Joe Barton said Sebelius was dangling the prospect of exclusion from future health insurance exchanges … over insurance companies that are hiking up premiums. Barton and Smith call that a potentially unconstitutional assault on free speech. As the lawmakers' letter said, the health reform act remains a highly controversial law.

Narr: Opponents are also challenging health reform in the courts. A federal judge gave the go-ahead to a suit from the Commonwealth of Virginia. It claims the federal government can't make people buy health insurance, or any other product. It was a similar story in Florida a few days earlier, where 20 states are making the same claim. But those decisions are opposite another U.S. District Court in Michigan. In that case, the judge ruled that buying and selling health insurance is commerce that the government can regulate...and that the government can penalize people for not buying insurance. Out went that lawsuit, at least until appeal. About a dozen more legal challenges have been filed. Lawyers involved say no final decision will come until one or several cases wind up in the Supreme Court.

Narr: With all the election year yelling over health reform, you might not think any of it has bipartisan appeal. But one experts says health insurance exchanges might. Washington and Lee University law professor Timothy Jost who has just written a book on health law told reporters in Washington that the idea of exchanges basically comes from free market advocacy groups and it's not a radical left-wing idea:

JOST AX (00:15): "This is one idea that I haven't seen a huge amount of resistance to in the states. I think that a lot of states think that the market, the non-group and small group markets are not working terribly well and this might be one idea to improve them... So I think this is not an idea that goes down on November third depending on who wins most states houses or seats in Congress."

Narr: So far, only Massachusetts, Utah, and California have started setting up exchanges. Federal law requires the states to set up their exchange by January 2014, but if some states have difficulty by January 2013, the federal government will step in to help.

Narr: Well, the mid-term elections are just about here. What will it mean for health reform? We'll cover that, and more, next week. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

Narr: Affordable Care Act money starts flowing, while Recovery Act money dries up. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

Narr: Last week, federal government announced a hefty boost for the nation's primary care workforce. Health and Human Services Secretary Kathleen Sebelius announced 320-million dollars in grants designed to expand training programs for health professions.

Sebelius AX (00:20 runtime): "The communities don't need just doctors. They need mental health providers, dentists, physician assistants, and nurse practitioners. And while the shortage has been looming for decades, President Obama and the Congress and those of us here at HHS working with our partners are committed to closing this gap as soon as possible."

Narr: More than half the money goes to primary care training programs to boost the number of residents in general pediatrics, general internal medicine, and family medicine.

Narr: Meanwhile, the feds also released the first start-up funds for the health insurance exchanges that are supposed to form the core of health reform. Starting in 2014, these state-based programs are supposed to let individuals and small businesses compare health insurance options. They're also designed to help consumers pool their purchasing power. Ms. Sebelius announced that 49-million-dollars already gone out to 48 states and Washington, D.C. The money is for computer systems, community outreach and research, and to hire the first staffers. Minnesota and Alaska said no thank you to the new money; politicians there favor less of a federal involvement in health care.

Narr: So the money begins flowing from the Affordable Care Act.... And from the economic stimulus...soon so start drying up. A new survey by the Kaiser Family Foundation shows the impact the recession and high unemployment are having on Medicaid. Heavy new enrollment this year has caused spending to increase, leading to the highest rate of growth in state Medicaid programs in eight years. While federal Recovery Act money has been helping states pay their Medicaid bills since 2008, that money is scheduled to stop flowing in 2011. States have already started to restrict benefits and cut payments to providers. According to study author Vern Smith:

Smith AX (00:18 runtime): "The most difficult rate cut for a state to take is for doctors. But last year, 20 states cut payment rates to physicians; it's a very significant action when a state does this because of its implications for access and participation in the provider community."

Narr: Well, Congress has adjourned for now and headed home to campaign ahead midterm election. But don't worry, we'll keep you up to date on health reform news and be standing by, ready to report when Congress returns for a lame duck session in November. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: The fraud detectives are out for Medicare. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: Sweeping new anti-fraud rules for physicians, hospitals, and other health providers who bill Medicare, Medicaid and the Children's Health Insurance Program. Here's CMS Chief Dr. Don Berwick

BERWICK: "These are important new tools that are provided by the Affordable Care Act that'll help us move from pay and chase approach, the reactive approach that we've been using, to one that makes it hard to commit fraud in the first place. The new tools that we're proposing are going to give us the ability to prevent fraud on the front end by keeping out unscrupulous people who pose as providers and prey on our beneficiaries and our programs."

NARR: The proposed rules give the new Center for Program Integrity the power to fight fraud on several fronts. The rule stops federal health payments to a provider based on a credible allegation of fraud. The feds are making easier to weed out bad buys by tightening the process of enrolling as a Medicare or Medicaid provider. And, the new rule makes it easier for state Medicaid and Children's Health Insurance programs to work together across state lines to fire providers guilty of fraud. Right now, the rule is open for public comment. Want some input? Register your thoughts at regulations-dot-gov.

NARR: Meanwhile some health insurance companies, or at least their trade and lobbying group, started getting down to the details of implementing a potentially powerful health reform tool. They are called accountable care organizations and the question is, exactly how can they lower costs while raising quality? America's Health Insurance Plans says ACOs, as they're known, might pay providers for shared savings while steering clear of antitrust violations. Now that could be tricky. But AHIP put out a position paper advising the government to follow market innovations health plans have already implemented.

NARR: Physicians are taking a closer look at what the mid-term elections might mean for them and for health reform. Leaders in cardiology and internal medicine recently said that they see it as increasingly likely that the Republicans could regain the majority, at least in the House of Represented. If so, they could use their power to delay or change health reform. One tactic the GOP might use? Holding up the money needed to implement parts of the law. Here's Dr. John Tooker, executive vice president and CEO of the American College of Physicians:

Tooker: "To me this is a very normal process about what the opposition to a given piece of legislation would do in order to try A, to try to change or amend the legislation or decrease its impact on an annual basis."

NARR: Dr. Tooker said he thinks it is unlikely that the next Congress would be able to repeal the Affordable Care Act.

NARR: Well as the elections near, physicians are also beginning to fret about whether a lame duck Congress will step up in time to avert yet another Medicare physician fee cut based on the sustainable growth rate. That legally mandated cut in the SGR is slated to take effect December 1st, and no action to reverse it is likely before the election. That leaves a just tiny window when Congress returns in November. We'll keep an eye on that, and more, in the coming weeks. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: The White House tries to sell its health care victory to increasingly skeptical voters. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: Primary season came to a close with voting in Hawaii over the weekend. Upsets in Alaska and Delaware and elsewhere by Tea Party candidates and strong challenges by Republicans in many races indicate an increasingly bleak mid-term picture for Democrats. Here's Alicia Ault with more.

AULT: Mainstream Republican candidates and their Tea Party cousins have run this election season on promises to undo the Democrats' stimulus program and health care overhaul. Whether primary victories translate to election night parties is far from clear. And, even if the opposition party regains the House, the Senate, or both, President Obama is likely to veto any bill that repeals the landmark Affordable Care Act.

NARR: Meanwhile, the Census Bureau says that the number of uninsured rose steeply in 2009, to about 51 million people. More people lost employer-sponsored coverage, and more had to get insurance through public programs like Medicaid. The report was issued last week and it could provide new ammunition to the Obama White House as they spend the next few weeks trying to convince voters that health reform is crucial.

NARR: President Obama's new chief of Medicare and Medicaid, Dr. Don Berwick, tried to enlist the help of the insurance industry last week in implementing reform. Here's Naseem Miller with more.

MILLER: In his first national speech since taking the helm at CMS, Dr. Berwick dismissed critics who have said he favors rationing of care. He said his goal as the head of the Centers for Medicare and Medicaid Services is to bring Americans better care, better health and lower costs. Dr. Berwick called health reform a historic opportunity and asked for the industry's support. Responding after the speech, the industry's top lobbyist said that insurers would work with CMS to "get it right."

NARR: And in a bit of health reform cheerleading, the advocacy group Families USA is touting tax breaks that won't be available until 2014. Some 30 million people could benefit, getting up to $110 billion in immediate premium discounts or tax credits. Families USA Executive Director Ron Pollack said that his group is talking up the credits now to dispel lingering myths about health reform and to spread the word that benefits are just around the corner.

NARR: The first benefits kick in this week. Health plans that start on or after September 23 won't be able to drop coverage for any policy holders, or deny coverage to children based on pre-existing conditions. Lifetime limits on coverage are out and there are new restrictions on annual limits. Plus, parents can keep their young-adult children on their policies longer--up to age 26. We'll keep an eye on how the White House makes the pitch on these and other health issues over the next few weeks. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: Health care reform - it all comes down to money and doctors. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: New cost estimates are out for the next decade of the U.S. health care system and the numbers are not exactly what the Obama administration must have wanted when they pushed for health reform. Actuaries at the Centers for Medicare and Medicaid Services say health care spending will actually grow a bit faster over the next decade than it would have if reform had never been enacted. The more than 30 million people who have no health insurance today will get it, but still the projections seem to mean that the number crunchers in the government are waving goodbye to the idea of lower health care costs, at least in the near term. Here's CMS economist Andrea Sisko:

SISKO AX: While the estimated net impact of the Affordable Care Act and other legislative and regulatory changes on national health spending are moderate, the underlying effects of these changes on coverage and financing are more pronounced.

NARR: The actuaries estimate that spending will grow zero-point-two percent faster under health reform than without. But if all goes as expected, 93 percent of U.S. residents will have health coverage by 2014 and see their out-of-pocket costs drop a bit - one-point-one percent overall. In total, health care spending will consume one-fifth of the country's gross domestic spending by the end of 2019.

NARR: Well, covering 30 million new people is great, but who is going to treat them? Boosting the supply of primary care physicians is a huge issue in health reform and a new Dartmouth University report agrees. Naseem Miller has more:

MILLER: For almost 20 years, researchers at the Dartmouth Atlas of Health Care have studied Medicare data to learn about the efficiency and effectiveness of our health care system. Their most recent findings show that having more primary care providers doesn't necessarily mean better outcomes for patients. While it's important to get more providers into areas where there aren't enough, if patients' needs aren't matched to that supply, then having more doctors is not really going to help. Researchers said what's more important is improving services and coordinating care with specialists and other providers.

NARR: And finally, the death panels are back ... at least in the minds of many senior citizens. Although formal end-of-life care reviews for Medicare beneficiaries didn't make it into the health reform law, a poll conducted by the Kaiser Family Foundation found that more than a third of seniors believe they did. The foundation has been tracking Americans' beliefs about health reform since before the law was passed. This time around, fully half of seniors said they believed that the new law would cut their benefits. Even more said the law will cut payments to their doctors. Foundation President Drew Altman pointed out that elderly people are more negative toward health reform than the rest of the public. But don't count younger Americans as big supporters either. While 38% of the Medicare crowd says it's favorable toward the law, only 53% of adults under 65 back the reform law so far.

Well, come back next week for more news on the implementation of health reform and what Congress is doing about it. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: Health reform tax breaks kick in for employers. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: Employers big and small will soon reap the tax benefits created by the Affordable Care Act. And the White House hopes those tax breaks will lead to better coverage for workers.

NARR: The Administration is trying to bring relief to employers through the Early Retiree Reinsurance Program. The 5 billion dollar program will reimburse participating employers for some of the claims costs for retirees who are older than 55, but not yet eligible for Medicare. Health and Human Services Secretary Kathleen Sebelius said the Administration was stepping in to help plug a gap in coverage.

SEBELIUS: "So what we're saying to employers is we know covering early retirees has never been easy. It's expensive, but it's extremely important, and many employers want to continue to do the right thing. So if employers are willing to cover retirees between ages 55 and 65, if they're willing to make that investment, then we're going to help make it happen and keep it steady until 2014."

NARR: So far, HHS has approved 2,000 employers to participate. More will be approved in the coming months. But Ms. Sebelius said it was difficult to predict whether 5 billion dollars will cover all the claims until 2014. That's when the Early Retiree program ends and is essentially replaced by the health insurance exchanges created by the new law.

NARR: Tax breaks for small companies also kick in this year. They're designed to keep small employers from dropping insurance coverage for 3.4 million workers, according to a Commonwealth Fund analysis. The incentives are supposed to offset the cost of health insurance premiums. While millions will keep coverage as a result of the tax breaks, some 13 million other workers won't see a change, at least initially, according to the analysis. The incentives just might not be attractive enough to lure some small employers to add coverage for previously uninsured workers.

NARR: Meanwhile, outside Washington, Americans remain divided on health reform. Here's Mary Ellen Schneider with more:

SCHNEIDER: The latest tracking poll from the Kaiser Family Foundation shows that 43 percent of Americans have a favorable view of the health reform law, down from 50 percent in July. And 45 percent now oppose the law. So what does this mean for the midterm elections? With just 8 weeks to go, about a third of registered voters say they are more likely to oppose a candidate who supported health reform. Another third say they would be more likely to vote for a candidate because he or she backs health reform. The rest say it doesn't matter either way.

NARR: Stay tuned to see if the Obama administration can turn public opinion in favor of health reform in time to help maintain Democratic majorities in the House and Senate. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: Coverage and controversy in women's health. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: The new health reform law could have a big impact on health coverage for women. That's according to a new analysis by The Commonwealth Fund. Women are as likely as men to be uninsured, but pregnancy and childbirth make them more vulnerable to higher health care costs. But the Affordable Care Act means as many as 30 million women could be removed from that vulnerable category. Study author Sara Collins explains.

Collins AX: "Most women who are uninsured and underinsured will gain access to comprehensive health insurance beginning in 2014 under the new law. But early provisions, many of which go into effect this year or have already gone into effect, will provide important transitional relief for millions of women."

NARR: The authors also said the law will encourage doctors to stay in primary care and keep seeing Medicare and Medicaid patients.

NARR: Well, it's hard to talk health reform...and women's health... without some controversy. A new preexisting condition coverage plan is going into effect...and Republicans say the Obama administration hasn't ensured that federal dollars won't pay for abortions. The White House says that's just not the case. Abortion is only covered in the case of rape, incest or where a woman's life is endangered, according to the Obama Administration. But don't expect that to be the final word. Congressman Chris Smith, who's a Republican from New Jersey and a staunch abortion opponent, has introduced a bill that would permanently ban federal funding of abortion...and if you're confused and thought that federal funding of abortion is already banned. You're right. That's the Hyde Amendment, and it's still in effect.

NARR: Meanwhile, Congress is moving to spend the money needed to implement health reform. Not surprisingly, partisan politics is playing a role in that too. Alicia Ault has more.

AULT: The Senate Appropriations Committee voted along party lines to approve a massive 170 billion dollar labor, health and education spending bill. That figure included funds to train more primary care physicians and to create new medical home projects. The panel also moved to start paying for the 750 million dollars in spending on disease prevention called for by the Affordable Care Act. It appropriated 688 million dollars for a public health program to prevent and reduce obesity-related disease. The funds still have to be approved by the Senate and the House.

NARR: Well, Congress is now headed into its August recess. Health care is going to remain on the political agenda though. The state of Missouri is voting on a ballot initiative to ban the individual insurance mandate. Other states are planning the same thing...which means the health reform law will be a big issue for the fall campaign. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: What was old is new again. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: If you cast your mind back to last fall, you might remember when the public option died...as part of the health reform debate. Well, now Congressman Pete Stark of California and some of his fellow House Democrats have introduced a bill to bring it back. Here's Mary Ellen Schneider with more:

SCHNEIDER: The bill would create a government-run insurance plan to compete alongside private plans in the health insurance exchanges that are set to launch in 2014. The Congressional Budget Office estimates that adding the public option could save the government 68 Billion dollars from 2014 to 2020. Consumers would save too, the CBO said, with a public plan offering lower premiums than others in the exchange. But the chances for success don't seem too strong. The midterm elections are just a few months away and Democrats are likely to lose seats this year.

NARR: Another hot topic from last year was comparative effectiveness research. Unlike the public option, comparative effectiveness research or C-E-R did make into the health reform law. Senate Finance Committee Chairman Max Baucus is touting the C-E-R institute that's created under the law. While the criticism on C-E-R is that it could lead to rationing and interfere with the doctor-patient relationship, Baucus said the opposite is true. And he says the new Institute will have strong oversight.

BAUCUS AX: "I will use the full powers of the Finance Committee to see that the new Institute and health reform are implemented as Congress intended. Over the next years, we will hold hearings, engage stakeholders, and monitor the administration. And we will employ oversight agencies like the GAO to monitor and guide their progress as well."

NARR: Meanwhile, the feds aim to make it easier for consumers to appeal decisions made by their health insurance plans. New federal regulations set the standards both for internal appeals and appeals to independent third parties. The new rules mean that health plans must do these reviews faster, making decisions in 24 hours in urgent cases. And those who process appeals for insurance companies must avoid conflicts of interest. So plans can't reward employees with better pay or more vacations for denying claims. That's according to the U.S. Department of Labor.

NARR: And finally, stay tuned to see if Republicans get their wish-a chance to question the new head of the Centers for Medicare and Medicaid Services. Of course, that's Dr. Don Berwick. Even though the White House skipped the usual confirmation hearings with a recess appointment, GOP members of the House Energy and Commerce Committee have asked that committee's chairman to schedule a hearing with Dr. Berwick. They want to hear more about his plans for health reform implementation. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: Free mammograms, colonoscopies, and well-child visits...all early benefits of health reform. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: While most provisions of the Affordable Care Act don't take effect until 2014, millions of Americans will begin getting free preventive screenings next year. The Obama administration laid out rules requiring all new health plans to cover preventive care without copays or deductibles, as long as the care is recommended by a set of government advisory groups. In an event at the White House, First Lady Michelle Obama said eliminating cost sharing will improve access. But as doctors know, she said, it's up to the patient to embrace prevention.

OBAMA AX: "Ultimately each of us needs to be a part of the solution on this one. Each of us needs to take responsibility for our own health. And each of us needs to use all the tools available to us to ensure that our kids get every possible chance to lead happy, healthy lives."

NARR: Physicians may be providing more preventive care next year, and that's not the only big change. 2011 is the first year doctors can get bonus payments from the government for using electronic health records. The feds issued so-called meaningful use rules and there's some good news. The requirements are easier to meet compared to proposals they floated earlier this year. But doctors will still need an electronic record that can document vital signs, demographics, send electronic prescriptions, and report on quality measures. Now for Medicare physicians who meet the standards in the first year, the payout is about 18,000 dollars...and up to 44,000 dollars over 5 years.

NARR: Meanwhile, the new CMS administrator Dr. Don Berwick was on hand in Washington to tout the new meaningful use rules. He was officially sworn in last week and says he's getting right to work. Likely to be on the top of the agenda--- working with Congress to sort out Medicare physician payments. Texas Republican Congressman Michael Burgess, who is an ob.gyn., said next year may be the time to fix this problem for good.

BURGESS AX: "You've got to be ready to do this because people have waited long enough. I've even heard the statement that this is one of the reasons that we lost the majority in 2006 was because we didn't tackle tough problems like this. Well, if we're going to show that we're different as a governing body in a new majority, after the first of the year, we've got to fix this."

NARR: Join us again next week to hear how health care could affect the mid-term elections. And that's the Policy & Practice Podcast. I'm Todd Zwillich.

NARR: Health reform implementation rolls on... without Congress. Welcome to Policy & Practice, the weekly podcast from Global Medical News. I'm Todd Zwillich.

NARR: It's been a hot and humid summer in the Nation's Capital but that weather pales next to how steamed up Republicans are over the recess appointment of Dr. Don Berwick. He's the pediatrician and quality expert who President Obama nominated to be head the federal Center for Medicare and Medicaid Services. Now because Berwick was named while Congress was on Independence Day recess, the job is now his--without having to be confirmed by the Senate...without even a hearing. But Dr. Kavita Patel, who heads up the health policy program at the New America Foundation, said Dr. Berwick can repair a damaged relationship with lawmakers.

PATEL AX: "There will be some members of both the Democratic and Republican caucus that never got a chance to really to talk to Don and get to know him. So the downside is that that process that happens as a result of a hearing, and the questions during and after a hearing, is not going to take place. But I do think that Don and those of us who have worked with him and know him, we're very confident that he will establish those relationships in the very near future and will make up for that time that was lost in the questioning process."

NARR: It's not just personnel matters that are keeping the administration busy. Officials at the Health and Human Services department just launched healthcare.gov. It's where the public can find a range of coverage options. And the government rolled out a Pre-existing Condition Insurance Plan -that's a state-by-state program to cover U.S. residents who haven't been able to get insurance because of pre-existing conditions. In addition, some 300,000 Medicare beneficiaries who have entered the Part D donut hole will soon find $250 rebate checks in their mailboxes.

NARR: But for doctors, a big concern remains what will Congress do about Medicare payments come the end of November. The temporary 2.2 percent pay increase expires November 30, just after the mid-term elections. At that point Congress will have to act to make sure the required 21 percent cut does not go into effect. House Republican Dr Michael Burgess said it's unlikely that legislators will give physician fees much thought during that so-called lame duck session.

BURGESS AX: "That's generally a fairly contentious time... people are generally still mad at each other about the elections and it's very doubtful that... at least in my mind -- I'm just speaking for myself - it's very doubtful that a meaningful long term policy can be crafted in that tight little window after the election before November 30th."

NARR: Burgess said he expects another temporary patch to the physician pay problem until the next Congress convenes in January. But the congressman, who is also an ob.gyn., added that after that, it'll be time for Congress to fix the Medicare pay formula once and for all.

NARR Be sure to stay tuned all summer as we track the implementation of health reform and physician pay. And that's the Policy & Practice Podcast. I'm Todd Zwillich.