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FAQ: The Obama Administration's Compromise On Contraception Benefits

Mary Agnes Carey — Fri, 10 Feb 2012 20:22:00 GMT

The Obama administration, stung by fierce opposition from Catholic leaders to a new rule requiring that insurance plans offer free contraception, announced it is revising the regulations so that religious-affiliated groups don’t have to pay for the coverage. But President Barack Obama insisted that all women must still be covered. "No woman's health should depend on who she is or where she works or how much money she makes," he said in making the announcement.

Here are some common questions and answers from KHN that help explain the policy.

Q: What action did the president take and how is it different from earlier policy?

A: The announcement today shifts the responsibility for providing insurance coverage of birth control expenses for religious-affiliated organizations opposed to contraception. Last month, the administration announced that all insurance plans would be required to cover contraception as part of the list of free preventive services mandated by the 2010 federal health law. That regulation exempted houses of worship, like churches, from the requirement to provide contraceptive services at no cost to employees, but religious-affiliated institutions, such as universities and hospitals, would have to provide coverage for contraception.

Video: President Obama On New Contraception Rules

Some religious groups, including the United States Conference of Catholic Bishops, objected on the basis that it violated their religious freedom. The resulting furor quickly engulfed the White House and even some Democrats and Catholic groups that had supported the health law, such as the Catholic Health Association, turned against the policy.

The compromise detailed by the president stipulates that insurers – not the religious-affiliated employers -- would have to contact individuals directly about how to obtain contraceptive services, which would be provided at no cost, in accordance with the health care law. The administration will submit a regulation detailing specifics of the policy.

Q. What was the nature of the opposition to the initial rule?

A. Catholic religious leaders and Republican presidential candidates characterized the rule as an attack on religious liberty and another example of an overreach by the Obama administration. The U.S. Conference of Catholic Bishops led the opposition, with dozens of bishops all over the country making statements against it. Several bishops said that they would have no choice but to stop insuring employees altogether if the contraception mandate goes into effect.

How We Got Here

The following documents reflect imporant milestones as the issue moved from proposal, to regulation, to eventual compromise:

Fact Sheet: Women’s Preventive Services and Religious Institutions
-- The White House, Feb. 10, 2012
The HHS Mandate For Contraception/Sterilization Coverage
-- United States Conference Of Catholic Bishops, Feb. 2012
Key Facts On Birth Control Coverage Benefit
-- Planned Parenthood, Feb. 2012
More than Twenty Major Religious Leaders Issue Statement in Support of Current Policy
-- Catholics For Choice, Feb. 8, 2012
A Statement By Secretary Kathleen Sebelius
-- Department Of Health And Human Services, Jan. 20, 2012
U.S. Bishops Vow To Fight HHS Edict
-- United States Conference Of Catholic Bishops, Jan. 20, 2012
Insurance Coverage for Contraception Laws
-- National Council of State Legislatures, Aug. 2011
IOM Report Recommends Eight Additional Preventive Health Services to Promote Women's Health
-- Institute of Medicine, July 19, 2011

The Catholic opposition is rooted in a tenet of the faith that holds that life begins at conception and therefore anything that prevents conception is a sin. Though surveys have shown that as many as 98 percent of Catholic women have used birth control at some point, a more recent survey found that voters are split over the question of whether employers such as Catholic hospitals and universities should be required to provide contraceptive insurance coverage for employees.

Q: Wouldn't this mean that the religious institutions would still pay for birth control as part of the insurance they provide to their workers?

A: Administration officials say no. While birth control will be covered, by not requiring employers to pay anything additional or to tell employees how to get the services, the administration believes it has brokered a satisfactory compromise. White House officials said actuaries they consulted said that covering contraceptive services would not increase costs for employers and could actually save insurers money by preventing pregnancy. "Covering contraception saves money for insurance companies by keeping women healthy and preventing spending on other health services," according to the administration fact sheet. The document states that there was "no increase in premiums when contraception was added to the Federal Employees Health Benefit System and required of non-religious employers in Hawaii." The administration noted that one study found covering contraception lowered premiums by 10 percent or more.

The trade association for insurers, America's Health Insurance Plans, issued this statement from Press Secretary Robert Zirkelbach: “Health plans have long offered contraceptive coverage to employers as part of comprehensive, preventive benefits that aim to improve patient health and reduce health care cost growth. We are concerned about the precedent this proposed rule would set. As we learn more about how this rule would be operationalized, we will provide comments through the regulatory process."

Q. How does the new federal rule and religious exemption compare with contraceptive coverage laws currently on the books in states?

A. The big difference is that under the federal rule birth control will be available without the employee being responsible for a copayment. That is currently true in just a handful of states. Some 28 states have mandated coverage of birth control, and 20 of those have some sort of exemption for religious employers. According to a report by the Guttmacher Institute, the state exemptions range from very narrow definitions, such as only for churches, to broader exemptions, including religious elementary and secondary schools. The most expansive state exemptions allow religiously-affiliated colleges and hospitals not to provide birth control coverage.

The federal compromise announced Friday cleaves closely to laws on the books in Hawaii, Connecticut and West Virginia. In all of those states, insurers must cover contraceptives for employees of institutions who choose not to do so for religious reasons. The federal rule, though, is unlike state laws that require the religious employers to tell workers where contraception coverage is available.

Q. What is the initial reaction to this proposal?

The United States Conference of Catholic Bishops released this statement: "While there may be an openness to respond to some of our concerns, we reserve judgment on the details until we have them," said Cardinal-designate Timothy Dolan, president of USCCB. ... "Today’s decision to revise how individuals obtain services that are morally objectionable to religious entities and people of faith is a first step in the right direction,” Cardinal-designate Dolan said. "We hope to work with the Administration to guarantee that Americans’ consciences and our religious freedom are not harmed by these regulations."

"The Catholic Health Association is very pleased with the White House announcement that a resolution has been reached that protects the religious liberty and conscience rights of Catholic institutions," the group’s president, Sister Carol Keehan, said in a statement. The Catholic Health Association broke with the U.S. Conference of Catholic Bishops two years ago to support the health law, but had opposed the Jan. 20 rule.

Planned Parenthood President Cecile Richards said the administration had "reaffirmed its commitment to ensuring all women will have access to birth control coverage, with no costly co-pays, no additional hurdles, and no matter where they work."

Congressional Republicans said the compromise fell short, however. "This is about religious freedom, and anything short of a full exemption is no compromise," said Sen. Orrin Hatch, Republican of Utah. "The White House has shown time and time again that nothing will stand in the way of politics, and their actions on this mandate reflect that."

Concerned the fight would continue, several birth control advocacy groups said they planned to closely monitor implementation. "These groups and their allies in Congress want to take away contraceptive coverage from nurses, janitors, administrative staff and college instructors — and that agenda is out of touch with our country’s values and priorities," said NARAL Pro-Choice America’s Nancy Keenan.

Q: On Capitol Hill, Republicans have been pushing legislation to overturn the regulation. How might today's announcement affect those efforts?

A: Republicans in both chambers called the administration’s move a "gimmick" and said the policy still interferes with religious groups’ constitutional rights to refuse to pay for coverage of contraceptive services and they have promised legislative action to repeal it.

"Today’s announcement is not a compromise on policy – it simply pretends to shift costs away from religious employers, but it doesn’t fix the problem and is another call for individuals and institutions to compromise on principle," House Energy and Commerce Committee Chairman Fred Upton, R-Mich., said in a written statement. Upton had previously announced plans to introduce legislation to reverse the contraception rule.

In the Senate, Roy Blunt of Missouri, a member of the GOP leadership, said "it’s still clear that President Obama does not understand this isn’t about cost – it’s about who controls the religious views of faith-based institutions. President Obama believes that he should have that control. Our Constitution states otherwise." Sen. Joe Manchin, D-W.Va., who opposed the Jan. 20 rule, has introduced legislation with Sen. Marco Rubio, R-Fla., to repeal the health law’s requirement that employers cover contraception for employees.

While efforts in the House are still likely to pass, in the Senate Majority Leader Harry Reid has already rebuffed legislation to reverse the initial Jan. 20 rule. Today, he said "I will oppose Republican efforts to move the goalposts on this issue, including their extreme legislation that would allow any employer to deny coverage for a range of critical health services for women based on vaguely defined personal objections. American women have a right to make their own health decisions, and Democrats will fight to protect that right."

KHN's Diane Webber, Lexie Verdon, Carol Eisenberg and Karl Eisenhower contributed to this story.

Video: President Obama On New Contraception Rules

Fri, 10 Feb 2012 17:40:00 GMT

The president was joined by HHS Secretary Sebelius as he announced a revision of the rule requiring that insurance plans offer free contraception, so that religious-affiliated groups don’t have to take responsibility for the coverage.

>> FAQ: The Obama Administration's Compromise On Contraception Benefits

>> KHN's summaries of news coverage

>> The White House Fact Sheet On The Contraception Compromise

Here is a full transcript of President Barack Obama's remarks, as provided by the White House. He took no questions from the press corps.

THE PRESIDENT: Hello, everybody. (Laughter.) I was actually going to say good morning. But I guess it's afternoon by now.

As part of the health care reform law that I signed last year, all insurance plans are required to cover preventive care at no cost. That means free check-ups, free mammograms, immunizations and other basic services. We fought for this because it saves lives and it saves money –- for families, for businesses, for government, for everybody. That’s because it’s a lot cheaper to prevent an illness than to treat one.

We also accepted a recommendation from the experts at the Institute of Medicine that when it comes to women, preventive care should include coverage of contraceptive services such as birth control. In addition to family planning, doctors often prescribe contraception as a way to reduce the risks of ovarian and other cancers, and treat a variety of different ailments. And we know that the overall cost of health care is lower when women have access to contraceptive services.

Nearly 99 percent of all women have relied on contraception at some point in their lives –- 99 percent. And yet, more than half of all women between the ages of 18 and 34 have struggled to afford it. So for all these reasons, we decided to follow the judgment of the nation’s leading medical experts and make sure that free preventive care includes access to free contraceptive care.

Whether you’re a teacher, or a small businesswoman, or a nurse, or a janitor, no woman’s health should depend on who she is or where she works or how much money she makes. Every woman should be in control of the decisions that affect her own health. Period. This basic principle is already the law in 28 states across the country.

Now, as we move to implement this rule, however, we’ve been mindful that there’s another principle at stake here –- and that’s the principle of religious liberty, an inalienable right that is enshrined in our Constitution. As a citizen and as a Christian, I cherish this right.

In fact, my first job in Chicago was working with Catholic parishes in poor neighborhoods, and my salary was funded by a grant from an arm of the Catholic Church. And I saw that local churches often did more good for a community than a government program ever could, so I know how important the work that faith-based organizations do and how much impact they can have in their communities.

I also know that some religious institutions -– particularly those affiliated with the Catholic Church -– have a religious objection to directly providing insurance that covers contraceptive services for their employees. And that’s why we originally exempted all churches from this requirement -– an exemption, by the way, that eight states didn’t already have.

And that’s why, from the very beginning of this process, I spoke directly to various Catholic officials, and I promised that before finalizing the rule as it applied to them, we would spend the next year working with institutions like Catholic hospitals and Catholic universities to find an equitable solution that protects religious liberty and ensures that every woman has access to the care that she needs.

Now, after the many genuine concerns that have been raised over the last few weeks, as well as, frankly, the more cynical desire on the part of some to make this into a political football, it became clear that spending months hammering out a solution was not going to be an option, that we needed to move this faster. So last week, I directed the Department of Health and Human Services to speed up the process that had already been envisioned. We weren’t going to spend a year doing this; we're going to spend a week or two doing this.

Today, we've reached a decision on how to move forward. Under the rule, women will still have access to free preventive care that includes contraceptive services -– no matter where they work. So that core principle remains. But if a woman’s employer is a charity or a hospital that has a religious objection to providing contraceptive services as part of their health plan, the insurance company -– not the hospital, not the charity -– will be required to reach out and offer the woman contraceptive care free of charge, without co-pays and without hassles.

The result will be that religious organizations won’t have to pay for these services, and no religious institution will have to provide these services directly. Let me repeat: These employers will not have to pay for, or provide, contraceptive services. But women who work at these institutions will have access to free contraceptive services, just like other women, and they'll no longer have to pay hundreds of dollars a year that could go towards paying the rent or buying groceries.

Now, I've been confident from the start that we could work out a sensible approach here, just as I promised. I understand some folks in Washington may want to treat this as another political wedge issue, but it shouldn’t be. I certainly never saw it that way. This is an issue where people of goodwill on both sides of the debate have been sorting through some very complicated questions to find a solution that works for everyone. With today’s announcement, we've done that. Religious liberty will be protected, and a law that requires free preventive care will not discriminate against women.

We live in a pluralistic society where we're not going to agree on every single issue, or share every belief. That doesn’t mean that we have to choose between individual liberty and basic fairness for all Americans. We are unique among nations for having been founded upon both these principles, and our obligation as citizens is to carry them forward. I have complete faith that we can do that.

Thank you very much, everybody.

The White House Fact Sheet On The Contraception Compromise

Fri, 10 Feb 2012 17:03:00 GMT

This fact sheet was released by the White House in advance of President Barack Obama's Feb. 10 comments about mandated health insurance coverage for contraception.

THE WHITE HOUSE

Office of the Press Secretary

____________________________________________________________________

FOR IMMEDIATE RELEASE

February 10, 2012

FACT SHEET: Women’s Preventive Services and Religious Institutions

Thanks to the Affordable Care Act, most health insurance plans will cover women’s preventive services, including contraception, without charging a co-pay or deductible beginning in August, 2012. This new law will save money for millions of Americans and ensure Americans nationwide get the high-quality care they need to stay healthy.

Today, President Obama will announce that his Administration will implement a policy that accommodates religious liberty while protecting the health of women. Today, nearly 99 percent of all women have used contraception at some point in their lives, but more than half of all women between the ages of 18-34 struggle to afford it.

Under the new policy to be announced today, women will have free preventive care that includes contraceptive services no matter where she works. The policy also ensures that if a woman works for religious employers with objections to providing contraceptive services as part of its health plan, the religious employer will not be required to provide contraception coverage, but her insurance company will be required to offer contraceptive care free of charge.

The new policy ensures women can get contraception without paying a co-pay and addresses important concerns raised by religious groups by ensuring that objecting religious employers will not have to provide contraceptive coverage or refer women to organizations that provide contraception. Background on this policy is included below:

Section 2713 of the Affordable Care Act, the Administration adopted new guidelines that will require most private health plans to cover preventive services for women without charging a co-pay starting on August 1, 2012. These preventive services include well women visits, domestic violence screening, and contraception, and all were recommended to the Secretary of Health and Human Services by the independent Institute of Medicine of the National Academy of Science.
Today, the Obama Administration will publish final rules in the Federal Register that:

Exempts churches, other houses of worship, and similar organizations from covering contraception on the basis of their religious objections.

Establishes a one year transition period for religious organizations while this policy is being implemented.

The President will also announce that his Administration will propose and finalize a new regulation during this transition year to address the religious objections of the non-exempted religious organizations. The new regulation will require insurance companies to cover contraception if the non-exempted religious organization chooses not to. Under the policy:

Religious organizations will not have to provide contraceptive coverage or refer their employees to organizations that provide contraception.

Religious organizations will not be required to subsidize the cost of contraception.

Contraception coverage will be offered to women by their employers’ insurance companies directly, with no role for religious employers who oppose contraception.

Insurance companies will be required to provide contraception coverage to these women free of charge.

Covering contraception saves money for insurance companies by keeping women healthy and preventing spending on other health services. For example, there was no increase in premiums when contraception was added to the Federal Employees Health Benefit System and required of non-religious employers in Hawaii. One study found that covering contraception lowered premiums by 10 percent or more.

###

-----

Obama Announces Shift In Contraception Rule

Fri, 10 Feb 2012 16:05:00 GMT

CNN: Obama Announces Contraception Compromise
President Barack Obama announced a compromise Friday in the dispute over whether to require full contraception insurance coverage for female employees at religiously affiliated institutions. Under the new plan, religiously affiliated universities and hospitals will not be forced to offer contraception coverage to their employees. Insurers will be required, however, to offer complete coverage free of charge to any women who work at such institutions. Female employees at churches themselves will have no guarantee of any contraception coverage -- a continuation of current law (Silverleib, 2/10).

ABC News: Obama Blinks On Contraception Rule
"Religious organizations won't have to pay for these services and no religious institution will have to provide these services directly," the president announced from the White House briefing room. "Let me repeat: These employers will not have to pay for or provide contraceptive services, but women who work at these institutions will have access to free contraceptive services just like other women" (Bruce, 2/10).

Politico: Obama Offers Birth-Control Compromise
Catholic leaders had revolted on the issue, igniting an election year fight that pitted them against the many women concerned about reproductive choice who provide another core constituency for the president.Obama said he knew that the decision was being turned into a wedge issue, "But it shouldn’t be" (Budoff Brown and Epstein, 2/10).

The New York Times: After Outcry, Obama Shifts In Birth Control Fight
Casting himself as both "a citizen and a Christian" trying to balance individual liberty versus public health, Mr. Obama announced what administration officials called an "accommodation" that they said sought to demonstrate respect for religious beliefs. It will be similar to the path taken in several other states — particularly Hawaii — that have similar rules, but would require that insurance companies, and not religious institutions, offer contraceptive coverage at no cost (Cooper, 2/10).

The Wall Street Journal: Contraceptives Compromise Set Forth
Mr. Obama announced the policy change at the White House, a sign of how high-profile the issue has become. Health and Human Services Secretary Kathleen Sebelius was at his side but didn't make remarks. Her department will issue new regulations later Friday, people familiar with the decision said. Before the president made his statement, he telephoned Archbishop Timothy Dolan, head of the U.S. Conference of Catholic Bishops; Sister Carol Keehan, head of the Catholic Health Association; and Cecile Richards, head of Planned Parenthood, to discuss the shift, an administration aide said (Radnofsky, Meckler and Lee, 2/10).

The Washington Post: White House Compromise Still Guarantees Contraceptive Coverage For Women
A senior White House official said that the impact of the change on insurers would be cost neutral--and even potentially cost-saving--because on balance it would reduce the need to provide medical coverage related to unwanted pregnancies and other conditions that can be avoided with birth control (Nakamura, Wallsten and Aizenman, 2/10).

The Hill: Obama Retreats On Birth Control
Obama, who said he ordered officials to work out a compromise last week, said he was seeking a balance between the principle that all women should have access to affordable birth control, and the principle of religious liberty. "Whether you'e a teacher... or a nurse or a janitor. No woman's health should depend on who she is or where she works or how much money she makes. Every woman should be in control of the decisions that affect her own health. Period," Obama said (Strauss and Parnes, 2/10).

Politico Pro: Catholic Health Group Endorses Contraception Deal
The Catholic Health Association, which broke with the U.S. Conference of the the Catholic Bishops to support the health reform law, has endorsed the compromise contraception coverage policy announced Friday. "The Catholic Health Association is very pleased with the White House announcement that a resolution has been reached that protects the religious liberty and conscience rights of Catholic institutions," the group's president, Sister Carol Keehan, said in the statement (Feder, 2/10).

Here is the document: The White House Fact Sheet On The Contraception Compromise

KHN also has video excerpts of the president's remarks and a full transcript.

KHN's summaries of news coverage earlier today:

Obama Readies Compromise On Birth Control Mandate

New Contraceptive Rule Has Precedents In Federal, State Law

Birth Control Mandate Is A Rallying Cry In Presidential Campaigns

Senate Democrats Split From White House On Contraception Rule

Catholics Choosing Sides In Contraception Battle As Bishops Lead Fight Against Administration

Here is some of the key stories from major news organizations:

The New York Times: Bishops Were Prepared For Battle Over Birth Control Coverage
When after much internal debate the Obama administration finally announced its decision to require religiously affiliated hospitals and universities to cover birth control in their insurance plans, the nation’s Roman Catholic bishops were fully prepared for battle. ... the birth control mandate, issued on Jan. 20, was their Pearl Harbor. ... The conflict puts not just the White House, but also the bishops to the test. Will their flock follow their lead? (Goodstein, 2/9).

Politico: Obama Birth Control Battle: Bishop Checkmates The President
It was no secret inside the West Wing that Bill Daley, a Catholic with deep connections to the church hierarchy, vehemently opposed the administration’s proposal to require church-run hospitals and universities to give their employees free contraception. ... In early November ... Daley set up a four-man Oval Office meeting for himself, Obama, New York Archbishop Timothy Dolan and Vice President Joe Biden, who both shared the view that the policy would sink the president with Catholic voters (Thrush and Budoff Brown, 2/10).

NPR: Rules Requiring Contraceptive Coverage Have Been In Force For Years
Here's the rub: The only truly novel part of the plan is the "no cost" bit. The rule would mean, for the first time, that women won't have to pay a deductible or co-payment to get prescription contraceptives. In fact, employers have pretty much been required to provide contraceptive coverage as part of their health plans since December 2000 (Rovner, 2/10).

NPR: Catholics Split Over Obama Contraceptive Order
The conflict between the Catholic Bishops and the White House over contraceptive coverage has American Catholics narrowly support the White House position in polls. There are potential political consequences: In presidential elections, Catholics are swing voters. They supported Al Gore in 2000, President George W. Bush in '04 and President Obama in '08 (Gonyea, 2/10).

The Associated Press/Boston Globe: They're Back: Social Issues Overtake US Politics
Social issues don't typically dominate the discussion in shaky economies. But they do raise emotions important to factors like voter turnout. And they can be key tools for political candidates clamoring for attention, campaign cash or just a change of subject in an election year (Kellman, 2/10).

Coakley and Cuccinelli Debate The Health Law

Fri, 10 Feb 2012 15:21:27 GMT

Two prominent state attorneys general examined the health law case before the Supreme Court. Meanwhile, Reuters reports that some senators are pushing to get television cameras in the Supreme Court.

Kaiser Health News: Coakley v. Cuccinelli: Attorneys General Debate The Health Law
State attorneys general Martha Coakley and Ken Cuccinelli won't be arguing the constitutionality of the 2010 health law before the Supreme Court in late March, but they brought their opposing cases before the National Press Club in Washington on Thursday (Torres, 2/9). Video is also available.

Reuters: Senate Panel Approves Bill To Televise High Court
Justices have long opposed TV cameras in their courtroom, saying they would be disruptive. But backers say such coverage would help provide public scrutiny. On a vote of 11-7, the Judiciary Committee sent the measure to the full Senate for consideration. A similar bill was approved by the committee last year but failed to become law. Among other cases, the nine-member court is expected to decide later this year the legality of President Barack Obama's landmark overhaul of the U.S. health care system (2/9).

New Contraceptive Rule Has Precedents In Federal, State Law

Fri, 10 Feb 2012 15:17:34 GMT

NPR reports that not much has changed in the new regulation other than requiring coverage for contraceptives at no cost, while CNN reports on the escalating "rhetorical war" in Washington.

NPR: Rules Requiring Contraceptive Coverage Have Been In Force For Years
There's been no let-up in the debate about the Obama administration's rule requiring most employers to provide prescription birth control to their workers without additional cost. Here's the rub: The only truly novel part of the plan is the "no cost" bit. The rule would mean, for the first time, that women won't have to pay a deductible or co-payment to get prescription contraceptives. In fact, employers have pretty much been required to provide contraceptive coverage as part of their health plans since December 2000 (Rovner, 2/10).

CNN (Video): Contraception Controversy Consumes D.C., Campaign
Congressional Democrats and Republicans escalated their rhetorical war Thursday over a pending federal rule requiring religiously affiliated employers to provide full contraception coverage to women -- one day after hints emerged of a possible compromise between the White House and conservative religious critics. Numerous rank-and-file Democrats urged the White House not to back away from its support for the rule, while Republicans demanded a full retreat. "It is time for the extreme right wing to stop playing football with women's health," said Rep. Nita Lowey, D-New York. "My colleagues and I stand in solidarity with American women who have waited decades for equity in contraceptive coverage. We have fought for too long" (Silverleib, 2/10).

Viewpoints: Contraception As Obama's 'Gospel'; The Right Balance? Freedom At Risk?; Examining Medicaid Mandate

Fri, 10 Feb 2012 15:15:13 GMT

The Washington Post: A Rule That Protects Women And Respects Faith
These guidelines, which increase access to contraceptive services for women while upholding the religious liberty of churches, mosques and synagogues, strike the proper balance between respecting the religious beliefs of all Americans and protecting the health of American women and families. They will reduce health costs, end long-standing gender discrimination in prescription drug coverage and further enable women to lead healthier lives (Rep. Rosa L. DeLauro, 2/9).

The Washington Post: The Gospel According to Obama
Obama declares good works to be the essence of religiosity. Yet he turns around and, through Sebelius, tells the faithful who engage in good works that what they're doing is not religion at all. You want to do religion? Get thee to a nunnery. You want shelter from the power of the state? Get out of your soup kitchen and back to your pews. Outside, Leviathan rules (Charles Krauthammer, 2/9).

Chicago Tribune: 'Free' Birth Control For All, Right Here, Right Now
We should remove all employers and insurance companies from the equation and reimburse providers of contraceptive services with tax dollars. We already do so for many low-income patients via Medicaid without anyone squawking that it violates their religious rights, so expanding the offering to include the entire population could be done with minimal explosions of umbrage (Eric Zorn, 2/10).

Atlanta Journal-Constitution: All People's Freedom Is At Risk
This unwise and unjust mandate therefore should concern not only Catholics, but all Americans. This edict says mandating free contraception, sterilization and even some abortifacients is more important than the First Amendment, religious liberty and the consciences of Americans. It is a dangerous precedent that concerns many who do not share our teaching on contraception, but value religious ministries that serve the poor or believe that government does not have the power to decide what is religious and what is not (Wilton D. Gregory, 2/9).

Atlanta Journal-Constitution: Rule Strikes The Right Balance
I have worked very closely with the Catholic leadership on many projects that help people in our communities, and it is with this in mind that I respectfully disagree with the assertion that religiously affiliated employers in the U.S. should be able to claim an expansive exemption from the law. Under the Obama administration decision, individual employees can follow their own faith traditions, regardless of their employer's religious perspective. This is fair and just (Timothy McDonald III, 2/9).

The Dallas Morning News: Fairness For Both Employer And Employee
This newspaper agrees that an option needs to be found that will give more leeway to those religious objections. Federal policy must accommodate all religious organizations that object to providing coverage for contraceptives, while also ensuring that employees of those organizations have access to coverage (2/9).

San Francisco Chronicle: Contraception Rules Must Respect Religion, Health
It is also critical to note that neither those state laws, nor the Obama plan, force anyone to advocate or use contraception. Those states have made a reasonable, and constitutionally defensible, distinction between a church's religious and secular endeavors. These rules, and the Obama plan, strike a proper balance between respect for religious beliefs and assurance of an essential health care option for women who work in church-affiliated nonprofits (2/10).

Fox News: Liberalizing 'Morning-After' Pill Availability Sends Dangerous Message
When the public sees a push by government agencies to liberalize medications to be obtained without a prescription, they forget what they are putting into their bodies is a chemical that can have serious side effects and complications. ... The truth is, the 'morning-after' pill is a hormone, and for some people, it could have significant side effects and potentially hurt them. And while studies show it may be safe to take for most people, you can’t account for what could go wrong if it’s not taken properly under the guidance of an adult (Dr. Manny Alvarez, 2/9).

MSNBC: Catholic Bishops' Birth Control Stance Harms Employees, Bioethicist Says
Keep in mind the factual evidence for the value of contraception in preventing unwanted pregnancies, abortions and even diseases such as endometriosis is not in dispute. Disregard the fact that the majority of states already require contraceptive coverage by entities operated by the Catholic Church. Ignore the fact that the overwhelming majority of sexually active Catholic women ignore the church position on contraception and, following their conscience, use it regularly. Somehow making birth control affordable violates some unfathomable view of government-church-employer relations (Art Caplan, Ph.D, 2/9).

Politico: The Female Body As Battlefield
The abortion pushback has been going on since the Supreme Court decided Roe v.Wade almost four decades ago. Within three years, we had the Hyde amendment, barring any federal funding for abortion. Since then, there has been constant effort by the activists. They always had a rhetorical edge: the language of "life" versus the language of "choice." One sounded big, emotional, a matter of deep values, while the other seemed wimpy and selfish by comparison (Anne Taylor Flemming, 2/9).

The Minneapolis Star Tribune: Don't Surrender On Key Health Care Tool
Minnesota shouldn't give up on its first-in-the-nation attempt to publicly rank state hospitals and clinics by the quality and cost of the care they provide. Lawmakers need to make sure these comparisons are credible and accurate, but they also need to give this pioneering "health care report card" effort a chance to work through the challenges bound to accompany any complex, groundbreaking undertaking. Consumers and employers faced with mounting medical insurance premiums deserve to know where they're getting the best value for their dollars (2/9).

The Des Moines Register: Birth Control Shouldn't Be A Partisan Issue
This may be great campaign fodder, but fertility control shouldn’t be seen as a partisan issue. Employer-covered insurance is a workplace issue. Those who object to birth control shouldn’t use it, but nor should they get to prevent others’ access. As employers, religious institutions can certainly find ways to meet the law that acknowledge the individual values and needs of their employees (Rekha Basu, 2/9).

The Wall Street Journal/Reason: ObamaCare's Medicaid Mandate
Can a technically voluntary program also be coercive? The 26 states challenging the federal government's expansion of Medicaid called for by ObamaCare are going to the Supreme Court to argue that it can. ... Strictly speaking, states are allowed to opt out of the program. But the program's financial incentives are structured in such a way that the states feel they have no choice but to comply with the expansion, and the additional costs that come with it (Peter Suderman, 2/10).

Houston Chronicle: Texas Must Increase Access to Primary Health Care
During this interim period, our Senate Health and Human Services Committee will emphasize strengthening our primary-care infrastructure and removing underlying barriers to access. Specifically, we need to grow our primary-care residency slots. … We also need to examine how existing payment inequities between primary care physicians and specialists impact our primary-care work force (Jane Nelson, 2/9).

The Baltimore Sun: Insurance 'Prior Authorization' Wastes Time, Money
E-prescribing and the electronic ordering of procedures can cut costs by introducing much-needed efficiency to a system weighed down by paper and protocols. … However, according to a new report from the Maryland Health Care Commission (MHCC), one of the greatest impacts of e-prescribing and ordering procedures electronically could prove to be their potential to expedite a dysfunctional insurance company protocol called "prior authorization" (Gene Ransom, 2/9).

The Sacramento Bee: Vision Plans Should Be Included In Proposed Health Care Exchanges
The way things are currently defined, only qualified health plans and stand-alone dental plans will be able to offer coverage through the state exchanges. Other than dental, all other stand-alone plans – benefit companies that are not directly tied to a health plan – are excluded from the exchanges. Stand-alone plans that are able to demonstrate a value in continuing to be offered separately from a health plan should be given the same opportunity as dental (Thomas Fleischmann, 2/10).

Obama Readies Compromise On Birth Control Mandate

Fri, 10 Feb 2012 15:14:00 GMT

The Obama administration Friday morning signaled a new compromise on a rule that would require even most religious employer health plans to cover contraception at no cost to employees.

The New York Times: Obama Plans Shift in Birth Control Fight, Aides Say
The Obama administration, seeking to rein in a runaway political furor over birth control and religious liberty, is set to announce a possible compromise on Friday that is meant to calm ire from the right about a new administration rule that would require health insurance plans — including those offered by Roman Catholic hospitals, universities and charities — to offer free birth control to female employees (Cooper, 2/10).

Politico: Birth-Control Compromise To Be Announced By White House
President Barack Obama is scheduled to deliver a statement at 12:15 p.m. He is expected to announce that he wants insurance companies to pick up the cost of providing free contraceptives for religious employers, according to one source familiar with the announcement. White House officials briefed reproductive rights groups and Democratic lawmakers Friday morning on the expected announcement (Budoff Brown, 2/10).

ABC: White House To Announce 'Accommodation' For Religious Organizations On Contraception Rule
With the White House under fire for its new rule requiring employers including religious organizations to offer health insurance that fully covers birth control coverage, ABC News has learned that later today the White House — possibly President Obama himself — will likely announce an attempt to accommodate these religious groups. The move, based on state models, will almost certainly not satisfy bishops and other religious leaders since it will preserve the goal of women employees having their birth control fully covered by health insurance (Tapper, 2/10).

The Associated Press: Obama To Change Birth Control Rule
Obama was expected to make the announcement at the White House Friday. The shift is aimed at containing the political firestorm that erupted after Obama announced in January that religious-affiliated employers had to cover birth control as preventative care for women. Churches and houses of worship were exempt, but all other affiliated organizations were ordered to comply by Aug. 2013. Republican leaders and religious groups, especially Roman Catholics, responded with intense outrage, saying the requirement would force them to violate church teachings and long-held beliefs against contraception (Feller, 2/10).

The Washington Post: White House To Announce Adjustment To Birth Control Rule
But a senior administration official cautioned that the White House will stick to the principle of guaranteeing free contraception coverage for women. The current rule, proposed last summer and confirmed last month as part of Obama's health care overhaul law, requires employers to provide female employees the full range of contraceptive coverage, including birth control, the "morning-after pill" and sterilization services. The measure exempts churches but covers religiously affiliated colleges and hospitals, meaning that many Catholic-run institutions would have to offer insurance plans that church leaders say violate their teachings (Nakamura and Aizenman, 2/10).

The Wall Street Journal: Compromise On Contraception Expected
The Obama administration will announce a compromise Friday on its decision to require religious employers to cover contraceptives in employee health plans, a move the White House hopes will quell some of the political backlash to a decision last month requiring such institutions to pay for coverage, people familiar with the plan said. Details of the compromise position are unclear, but one person familiar with it said it will make sure religious institutions don't have to pay for contraceptives coverage for employees but that insurance companies do. The new mandate will come from the Department of Health and Human Services, this person said (Meckler and Lee, 2/10).

Politico: Obama Birth Control Battle: Bishop Checkmates The President
It was no secret inside the West Wing that Bill Daley, a Catholic with deep connections to the church hierarchy, vehemently opposed the administration's proposal to require church-run hospitals and universities to give their employees free contraception. ... In early November ... Daley set up a four-man Oval Office meeting for himself, Obama, New York Archbishop Timothy Dolan and Vice President Joe Biden, who both shared the view that the policy would sink the president with Catholic voters (Thrush and Budoff Brown, 2/10).

The Wall Street Journal: Biden Backs Birth Control Compromise
Vice President Joe Biden said he is confident the administration will find a way to require almost all health-insurance plans to offer free contraception without forcing Catholic institutions to act against their religious beliefs. His comments Thursday to a Cincinnati radio station came as the White House tried to defuse a growing controversy. ... A White House announcement of a compromise on the matter could come as early as Friday, two people familiar with the situation said (Meckler and Lee, 2/10).

Reuters: Biden Says Contraceptives Fight Can Be Worked Out
Vice President Joe Biden said on Thursday the White House was working to address concerns raised by the Catholic Church over a new rule on contraceptives, and he believed an escalating election-year battle over the issue would be resolved. … "I'm determined to see that this gets worked out and I believe we can work it out," Biden, who is Catholic, told Cincinnati's WLM radio station during a visit to Ohio (Whitesides and Ferraro, 2/9).

Politico: Joe Biden On Birth-Control Furor: 'We Can Work It Out'
In his first public comments on the decision, Biden told Cincinnati radio station WLW that he is "determined to see that this gets worked out, and I believe we can work it out." Biden, the nation's first Catholic vice president, was among the top aides who had warned President Barack Obama that the decision could be politically explosive, particularly with Catholics, Bloomberg reported Wednesday. "As a practicing Catholic, I am of the view that this can be worked out and should be worked out. And I know the president feels the same way," Biden said (Epstein, 2/9).

The Hill: Vice President Biden On Birth Control Rule: 'We Can Work It Out'
Biden has remained silent on the issue to date, at least publicly. But Bloomberg reported Wednesday that he tried to warn President Obama that the decision could become a politically divisive issue. Republicans — including GOP presidential frontrunner Mitt Romney — have railed against the decision, as have a handful of Democrats. The U.S. Conference of Catholic Bishops is also strongly opposed to the rule. But women's groups, a key constituency in an election year, have backed the president's decision (Parnes, 2/9).

Roll Call: Harry Reid To GOP: 'Calm Down' About Birth Control Rule
Senate Majority Leader Harry Reid (D-Nev.) blocked Republicans today from offering a proposal to repeal an Obama administration rule that requires religious-affiliated institutions to offer employees health insurance that covers birth control. Senate Republican Conference Vice Chairman Roy Blunt (Mo.) attempted to bring to the floor an amendment to a highway funding bill that would eliminate the proposed regulation, which was written by the Department of Health and Human Services as part of President Barack Obama's health care law. Reid objected, charging that the Republicans were trying to upend passage of the transportation bill that might otherwise have broad bipartisan support (Drucker, 2/9).

The Hill: State AGs Threaten To Sue Over Birth-Control Mandate
Three state attorneys general say they’ll sue the Obama administration over its controversial birth-control mandate unless the White House backs down on its own. "Not only is the proposed contraceptive coverage mandate for religious employers bad policy, it is unconstitutional," the attorneys general said in a letter to top administration officials Thursday. "It conflicts with the most basic elements of the freedoms of religion, speech and association, as provided under the First Amendment" (Baker, 2/9).

St. Louis Beacon: Federal Decision On Contraceptives Sparks Political Firefight In Missouri
Sen. Roy Blunt, R-Mo., told reporters Thursday that he does not see room for compromise with the White House. He predicted a Senate vote on the issue, but Senate Majority Leader Harry Reid, D-Nev., on Thursday blocked Blunt's initial effort to add an amendment to the highway bill that would reverse the birth-control rule. ... All three [Missouri] Republican candidates for the U.S. Senate are accusing Sen. Claire McCaskill, D-Mo., of siding with federal officials on the ruling or, at minimum, of exhibiting a "cavalier attitude'' (Mannies and Koenig, 2/9).

The Associated Press/Boston Globe: They're Back: Social Issues Overtake US Politics
All of a sudden, abortion, contraception and gay marriage are at the center of American political discourse, with the struggling — though improving — economy pushed to the background. Social issues don't typically dominate the discussion in shaky economies. But they do raise emotions important to factors like voter turnout. And they can be key tools for political candidates clamoring for attention, campaign cash or just a change of subject in an election year (Kellman, 2/10).

Examining Komen's History With Planned Parenthood; Rep. Blackburn Wants Expanded Planned Parenthood Investigation

Fri, 10 Feb 2012 15:14:00 GMT

ProPublica examines Komen's shifting history with Planned Parenthood. In other news, Planned Parenthood's services for men are examined and a Republican congresswoman is asking for a larger investigation of the organization.

ProPublica: Komen's Contortions: A Timeline Of The Charity's Shifting Story On Planned Parenthood
Starting last week in a head-snapping series of events, the Susan G. Komen for the Cure charity cut funding to Planned Parenthood, and after a wave of outcry, reinstituted the funding days later. Along the way it gave a string of seemingly contradictory explanations for its decisions. We break down exactly what Komen said, and how it's changed (Groeger, 2/9).

McClatchy: Defunding Planned Parenthood: Did You Know It Serves Men, Too?
Planned Parenthood performs 770,000 Pap smears annually, and more than four million tests for STDs (for men, too!). Three of four clients visit clinics for services to prevent unintended pregnancies, which helps reduce the need for abortion. … Maybe the trick is for Planned Parenthood to focus more on men's reproductive health and start performing vasectomies. Women's bodies are battlefields, but we never seem to argue about men (Heller, 2/9).

The Hill: Rep. Blackburn Urges 'Full-Scale' Planned Parenthood Investigation
Rep. Marsha Blackburn (R-Tenn.) is taking the lead in asking Congress to double down in its investigation of Planned Parenthood. In a letter to House Speaker John Boehner (R-Ohio), the Energy and Commerce Committee member is asking for a "full-scale series of congressional hearings to expose the damage Planned Parenthood has caused to our nation." The letter comes after an anti-abortion-rights group issued a report on Tuesday that accuses the nation's largest abortion provider of "waste, abuse and potential fraud." The report is aimed at fueling calls for investigatory hearings by the House Energy and Commerce Oversight panel, which launched a probe into Planned Parenthood last year (Pecquet, 2/9).

Health Spending, Insurance Profits Down

Fri, 10 Feb 2012 15:12:30 GMT

Health spending has declined, according to a new study, and it appears to be affecting insurance company bottom lines.

National Journal: Health Spending Grew Just 4.4 Percent In 2011, Study Says
U.S. health care spending grew at one of the slowest rates in 50 years last year, according to one analysis published on Thursday. Spending grew 4.4 percent from 2010 to 2011, for a total of $2.71 trillion, the nonprofit Altarum Institute reported. "This represents an increase over the government’s official estimate of spending growth in 2010 (3.9 percent) that was released last month," the report reads. This is the third slowest rate of growth since national health expenditures have been tracked, the group said (Fox, 2/9).

Reuters: Analysis: U.S. Health Care Stocks Face Obstacles After 2011 Run
After beating the market in 2011, health care stocks may struggle for a repeat performance this year as cash-strapped Americans keep putting off use of medical services and investors seek out faster growth stocks as the economy improves. So far this year, health care has underperformed the broader market: The Standard and Poor's Healthcare index, GSPA is up about 4 percent compared to a 7 percent increase for the S&P 500 index (Berkrot and Krauskopf, 2/9).

Meanwhile, one insurer is moving to a new payment model.

Bloomberg: UnitedHealth Overhauls Doctor Payments By Tying Them To Quality Of Care
UnitedHealth Group Inc. (UNH), the largest U.S. health insurer by sales, will pay doctors based on the quality of their care in a cost-cutting effort that also benefits the company's consulting business (Frier and Armstrong, 2/9).

President's Budget Not Expected To Tackle Entitlement Costs

Fri, 10 Feb 2012 15:11:06 GMT

The Wall Street Journal: Budget Ducks Big Benefit Cuts
President Barack Obama's budget proposal Monday will offer several measures to trim the federal deficit in the next 10 years. But it would leave largely unchanged the biggest drivers of future government spending: the Medicare, Medicaid and Social Security programs that are expanding rapidly as the baby boom turns into a senior boom. Calling for major changes in the popular programs would be politically treacherous in an election year because of fierce opposition from seniors, who vote in large numbers (Paletta, 2/10).

National Journal: Federal Budget Proposal Will Spare Entitlements--Report
President Obama’s budget proposal Monday will leave the Medicare, Medicaid, and Social Security programs largely unchanged, though will offer a slew of other measures to trim the federal budget deficit, the Wall Street Journal reports. The three programs represent an increasingly growing share of the federal budget (2/9).

Birth Control Mandate Is A Rallying Cry In Presidential Campaigns

Fri, 10 Feb 2012 15:08:00 GMT

CNN (Video): Santorum Says Opposition To Contraception Rule Doesn't Restrict Women's Rights
Rick Santorum said Thursday that arguments against a recent federal law requiring health insurance coverage for contraception were not ignoring the rights of women. "It's the churches' money, and forcing them to do something that they think is a grievous moral wrong, how can that be the right of a woman?" Santorum asked in an interview on CNN's "John King USA" (2/9).

McClatchy: As Obama's Political Fortunes Rise, Fight Over Contraception Mandate Casts A Cloud
Just as some analysts have begun to suggest a sunnier political outlook for the president's re-election prospects, the White House is engaged in a highly charged dispute ... pollsters and strategists say the controversy — and the push for contraceptive coverage for all women — is a political plus with at least one key target audience: young, female voters, a large portion of the electorate (Clark, 2/9).

WBUR’s CommonHealth blog: Dems: Romney Did Not Fight Contraception Mandate In Mass.
Contraception, with an exemption for churches, became a required benefit in Massachusetts in 2002, the year before Mitt Romney was sworn in as governor. Phil Johnston, who held top state health care and Democratic party positions, says Mitt Romney never tried to repeal the mandate. ... Romney aides say his original health coverage bill proposed eliminating all insurance mandates for individuals and small businesses covered through what would become the Health Connector (Bebinger, 2/9).

Some Senate Democrats Split From White House On Contraception Rule

Fri, 10 Feb 2012 15:07:00 GMT

Politico: Dems Push White House On Birth Control Rule
The White House on Thursday faced mounting pressure from Senate Democrats to amend its requirements that religious employers include contraceptives in their health insurance plans, as Republicans tried to force votes on the issue. Advocacy groups on both sides of the debate turned up the rhetoric, potentially hurting the chances of finding a compromise that both sides can live with. Sens. Tom Carper of Delaware, Bill Nelson of Florida, Ben Nelson of Nebraska and Claire McCaskill of Missouri on Thursday became the latest Democrats to indicate they want to see the administration go back to the negotiating table (Haberkorn, 2/9).

Bloomberg: Obama's Contraception-Coverage Rule Creates Split Among Senate Democrats
The Obama administration’s decision to issue a contraception-coverage rule without a broad exemption for religious groups is creating an election-year split among Senate Democrats, with some Catholics in the party joining Republicans in calls to modify or scrap it. Senator Joe Manchin, a West Virginia Democrat up for re-election in November, introduced a bill yesterday that would block the federal government from requiring health insurance plans to cover contraception if the purchaser opposes it for religious or moral reasons. ... Other Catholic Democrats in the Senate, including John Kerry of Massachusetts and Claire McCaskill of Missouri, said they want the administration to adjust its rule (Litvan and Wallbank, 2/10).

Associated Press: Obama Birth Control Policy Divides Democrats
Democrats are deeply divided over President Barack Obama's new rule that religious schools and hospitals must provide insurance for free birth control to their employees amid fresh signs that the administration was scrambling for a way out. "This is not only unacceptable, it is un-American," says Sen. Joe Manchin, D-W.Va., a Catholic who faces re-election in November in a state where Wednesday nights are reserved for church services. ... Several Democrats, including Senate candidate Tim Kaine in Virginia and Illinois Rep. Dan Lipinski, have been outspoken in assailing the recently announced administration mandate that has angered religious groups and unified Republicans in protest. In a reflection of the party split, Senate Majority Leader Harry Reid, D-Nev., on Thursday blocked a GOP effort to debate an amendment on religious freedom (Cassata, 2/9).

Catholics Choosing Sides In Contraception Battle As Bishops Lead Fight Against Administration

Fri, 10 Feb 2012 15:03:00 GMT

The New York Times: Bishops Were Prepared For Battle Over Birth Control Coverage
When after much internal debate the Obama administration finally announced its decision to require religiously affiliated hospitals and universities to cover birth control in their insurance plans, the nation’s Roman Catholic bishops were fully prepared for battle. Seven months earlier, they had started laying the groundwork ... the birth control mandate, issued on Jan. 20, was their Pearl Harbor. ... The conflict puts not just the White House, but also the bishops to the test. Will their flock follow their lead? (Goodstein, 2/9).

NPR: Catholics Split Over Obama Contraceptive Order
The conflict between the Catholic Bishops and the White House over contraceptive coverage has American Catholics choosing sides. Catholics narrowly support the White House position in polls. There are potential political consequences: In presidential elections, Catholics are swing voters. They supported Al Gore in 2000, President George W. Bush in '04 and President Obama in '08 (Gonyea, 2/10).

NPR: Bishops Stand Strong Against Birth Control Mandate
The Rev. Tom Reese of Georgetown University's Woodstock Theological Center says there's no reason for bishops to settle — they're are winning the public relations battle right now. ... According to Reese, they're under no pressure to compromise, particularly since they have a year before the rule takes effect. ... Reese says they also bristle at government pushing a religious entity to violate its beliefs (Bradley Hagerty, 2/9).

CBS: Report: Chicago Cardinal Joins Contraceptive Fight
The head of the Catholic church in the Chicago area has penned a letter, reportedly to be read out during church services this weekend, telling millions of American Catholics that church-affiliated employers "will not" comply with an Obama administration law requiring them to provide contraception as part of their health care plans for employees (2/10).

KQED: Interview: SF Archbishop George H. Niederauer on Obama Administration Contraceptive Rule
San Francisco Archbishop George H. Niederauer waded into the growing dispute between the Obama administration and U.S. Catholic leaders ... Q: California has a similar law in place, doesn't it? A: Twenty-eight states including California do. These states have found ways to let the church follow its tenets and still provide what is satisfactory health coverage according to the law. What bothers us quite a bit is that there were easy ways to get around this problem, but they decided to make the confrontation (Martin and Brooks, 2/9).

MSNBC (Video): Catholic TV Network Sues US Over Birth Control Mandate
Thursday, EWTN — a Catholic television network carried on thousands of cable systems in more than 100 countries — filed suit in U.S. District Court in Birmingham, Ala. ... "Under the HHS mandate, EWTN is being forced by the government to make a choice: Either we provide employees coverage for contraception, sterilization and abortion-inducing drugs and violate our conscience or offer our employees and their families no health insurance coverage at all. Neither of those choices is acceptable," [Michael Warsaw, president of EWTN, which stands for Eternal Word Television Network] said. On at least one point, Warsaw is wrong, said Erin Shields, HHS's top spokeswoman (2/9).

State Legislatures Face Tough Decisions On Long-Term Care, Abortion Rules, Pain Prescriptions, Coordinated Care

Fri, 10 Feb 2012 15:01:03 GMT

Milwaukee Journal Sentinel: Limits On State's Family Care Program Draw Critics
Cost-saving measures proposed by Gov. Scott Walker's administration to Family Care programs for frail elderly and people with disabilities are coming under fire ... [County Executive Chris Abele] said the county didn't have the staff to do "intensive prevention efforts" envisioned by the state reform ideas. ... The state's proposed sustainability modifications to the program include an emphasis on shifting clients from publicly financed help to "natural supports" - meaning a greater reliance on family members for care (Schultze, 2/9).

The Des Moines Register: Senate OKs Bill Allowing Resumption Of Care Facility Inspections
Iowa would legally resume periodic inspections at care facilities for the disabled under a bill that unanimously passed the Senate on Thursday. Lawmakers in 2010 removed the oversight designed to protect the nearly 4,600 disabled Iowans who live in the state’s 188 residential care facilities as a cost-cutting move. They imposed a one-year moratorium on the routine inspection of those facilities (Clayworth, 2/10).

The Kansas City Star: Kansas Abortion Hearing Gets Testy
A Kansas abortion debate turned nasty Thursday when the leader of a women’s group pulled out a rubber stamp and accused a House panel of routinely approving bills restricting the procedure. One lawmaker walked out in protest. The committee was concluding two days of hearings on new abortion restrictions ... At issue was a proposal that would require physicians to use handheld Doppler fetal monitors so pregnant women could hear the heartbeat of the unborn (Cooper, 2/9).

The Seattle Times: Doctors Want To Amend New Rules on Prescribing Pain Medications
Tougher state rules for prescribing pain medication — aimed at curbing abuse — are prompting some providers to abandon patients and avoid treating pain, patients and doctors told state lawmakers Thursday. ... The [Washington state Medical Association], with support of the Washington Osteopathic Medical Association, has formally asked the state's licensing authorities to amend the rules, which took effect last month (Ostrom, 2/9).

The Lund Report: Transformation Bill Headed for First Major Test in Joint Ways and Means Committee
After hours of discussions and countless meetings behind closed doors, legislators appear to have finished negotiating what might be the final version of Senate Bill 1580, which, if approved, would allow the Oregon Health Authority to begin soliciting proposals for coordinated care organizations (CCOs). ... Coordinated care organizations represent the backbone of the transformational reforms being to the Oregon Health Plan's delivery system (Waldroupe, 2/9).

Leavitt Says Exchanges Are Here To Stay

Fri, 10 Feb 2012 14:58:58 GMT

As efforts to implement the health law move forward, Politico Pro talks to Michael Leavitt about state exchanges, and KHN examines the administration's strategy for prevention funding.

Politico Pro: Leavitt: I'm For Exchanges, Not The ACA
Business is booming these days for former Utah Gov. Michael Leavitt, whose company, Leavitt Partners, has been advising states on how to best prepare their health insurance exchanges under President Barack Obama's health care law. ... "Exchanges are going to be part of the future no matter what," Leavitt told POLITICO as he was on his way to the "policy roundtable" fundraiser for Romney. "The Affordable Care Act didn't invent the exchange — we've been trying since the '70s to get the small and individual group markets to buy insurance like a larger group. That has always been the problem, and the exchange will always be the solution" (Nocera, 2/9).

Kaiser Health News: Will We Get The Biggest Bang From Health Law's Prevention Grants?
Backers of the health law's provision of $15 billion for prevention efforts believe it has the potential to improve health and reduce costs. But some question the administration’s decision to sprinkle money for community programs among dozens of groups testing different approaches, rather than channeling it to proven programs (Carey, 2/10).

Negotiations Stalled on House-Senate Package That Would Avert Medicare Pay Cuts for Doctors

Fri, 10 Feb 2012 14:53:00 GMT

The Republican plan to pay for the package, which includes extending a payroll tax cut, calls for a premium increase for upper-income Medicare patients that has been rejected by Democrats. Democrats have offered to trim unemployment benefits by six weeks.

The New York Times: Pessimism High, Republicans Warn Of Possible Expiration Of Payroll Tax Cuts
Congressional Republicans said Thursday that negotiations over extending a payroll tax cut were going so poorly that it was possible the tax break — along with added unemployment benefits — could expire at the end of the month. ... The committee was formed last year after the two parties were unable to agree on how to pay for a full-year extension of the benefits, as well as a measure to prevent a cut in fees for doctors who accept Medicare (Steinhauer, 2/10).

Reuters/Chicago Tribune: Republicans Push To Wrap Up Payroll Tax Talks
Republicans expressed frustration on Thursday at the slow pace of negotiations over extending a tax break for workers that expires at the end of the month, accusing President Barack Obama and Senate Democrats of blocking agreement. ... The tax cut package also includes extending jobless benefits for the long-term unemployed and the cost of averting a 27 percent pay cut for doctors treating elderly Medicare patients. Election-year politics have complicated the search for a deal on how to pay for the tax cut package. The Republican plan calls for a premium increase for upper-income Medicare patients that has been rejected by Democrats, who are likely to use protecting Medicare as a campaign issue (Smith, 2/9).

Bloomberg: Payroll Deadline Nears As Democrats Focus On Jobless Benefits
Congressional Democrats made their first proposal on one of the more contentious elements of the payroll tax cut package with an offer to trim maximum U.S. unemployment benefits by six weeks. ... Lawmakers are negotiating the benefits as part of a plan that would continue a payroll-tax cut for workers and prevent a drop in Medicare reimbursements to doctors. The proposal was the most substantial one offered by Democrats since a House-Senate negotiating panel began meeting Jan. 24. Republicans said the offer was inadequate (Sloan and Rowley, 2/10).

Associated Press: Democrats Propose 6-Week Cut In Jobless Benefits
House-Senate negotiations on extending jobless benefits and a two percentage point cut in the payroll tax remained stalled Thursday, despite a proposal in which Democrats urged a modest six-week cut in the maximum time unemployed workers can receive jobless benefits. The Democratic proposal would allow unemployed people to receive a maximum 93 weeks of benefits in states with the highest jobless rates, rather than the 99 weeks permitted now. Republicans want to cut 20 weeks from the maximum benefit, though as a practical matter, the benefit would drop to 59 weeks under their plan because falling unemployment rates mean enrollees would lose automatically 20 weeks under program eligibility rules (Taylor, 2/9).

State Roundup: Fraud Crackdowns, Searching For More Doctors, Immigrant Health Care

Fri, 10 Feb 2012 14:44:34 GMT

Chicago Tribune: Quinn To Obama: Illinois Moving Ahead On Medicaid Fraud Crackdown
Illinois Democrats running state government have waited more than a year to win federal approval for a new plan to fight fraud in the health program for 2.7 million of the state's poorest residents. Facing increasing Republican pressure to put reforms in place, this week Quinn’s team told the Obama administration that Illinois will wait no longer. ... [The] Healthcare and Family Services Department will start matching addresses of people enrolled in Medicaid against Illinois secretary of state driving records to ensure that care for the poor is going to people who actually live in Illinois (Long and Groeninger, 2/9).

KQED's State of Health blog: Medicare Fraud With A Twist
Two Los Angeles fraudsters, Eduard Aslanyan and Carolyn Vasquez, not only fraudulently used patient information, but also stole the identities of doctors themselves. ... Aslanyan and Vasquez submitted more than $18.9 million in fraudulent claims to Medicare (Aliferis, 2/9).

WBUR's CommonHealth blog: State Mobilizes To Restore Full Health Coverage For Legal Immigrants
The state is ready to resume full health coverage next month for the first group of legal immigrants who won a lawsuit in January. The state’s highest court said Massachusetts must offer low income legal immigrants the same insurance options it offers full citizens. Almost 13,000 residents who are on a limited coverage plan will be eligible for full coverage March 1st (Bebinger, 2/9).

San Francisco Chronicle: UCSF Still May Do Jesus Navarro Kidney Transplant
UCSF Medical Center officials on Thursday said they would perform a kidney transplant operation on an Oakland man who had accused the medical center of denying him a kidney transplant because of his immigration status. But the hospital said Jesus Navarro must prove he can pay for his medications and follow-up care after surgery. Navarro, a 35-year-old father and illegal immigrant suffering from kidney disease, has received national attention (Colliver, 2/10).

California Healthline: Health Care May Play Part in California Political Makeover
This year could bring a sea change in California politics. Reshuffled congressional districts, new election rules and some key retirements set the stage for potentially significant changes in Washington, D.C., and Sacramento. A couple of key health care issues -- a controversial Medicare proposal in Congress and a state ballot initiative to regulate health insurance premiums -- could play a part in how those changes come to pass if they become volatile campaign issues (Lauer, 2/9).

Los Angeles Times: Inmate Advocates Question State's Commitment To Prison Healthcare
The judge who once said California's dismal prison medical care constituted cruel and unusual punishment now says federal control could soon end. ... But advocates for inmates and some medical officials question whether the system will continue to improve without federal oversight (Megerian, 2/10).

The Texas Tribune: Key Players Drive Texas Medical Board's Stem Cell Rules
In draft rules floated in August and again in November, the [Texas Medical Board] suggested the [stem cell] treatment could only be offered if it was likely to have a favorable outcome. And it proposed patient consent forms listing the risks and benefits of the treatment ... But by last month, those elements had been stripped from the proposed rules ... What happened in between, records obtained from the medical board show, was an aggressive campaign by key industry leaders, an interested lawmaker and university researchers (Ramshaw, 2/9).

The Texas Tribune/The New York Times: Fighting For Austin Med School
(State Sen. Kirk) Watson told them he wants to build a full-fledged medical program in Austin within 10 years, part of a larger health-related initiative. And he has pursued an unconventional route to that goal, forming an organizing committee with community institutions to develop public-private partnerships. ... The Texas Medical Association has warned of a critical shortage of doctors available to treat the state’s fast-growing population (Tan, 2/10).

WBUR's CommonHealth blog: Why We Need More Minority Doctors
Dr. Alden Landry practices emergency medicine at Beth Israel Deaconess Medical Center, but he’s more than just a doctor — he’s helping lead the movement to diversify medicine. ... Later this month, Dr. Landry will join four other doctors, four medical students, a dentist, and a health professions advisor on a bus tour to five historically black colleges and universities in the South where he and the team will hold sessions about applying to medical school (Siddiqui, 2/9).

Kaiser Health News: Mass. Nurse-Midwives No Longer Need Physician OK To Practice
Under a new state law, nurse-midwives do not have to practice under a physician’s supervision. Instead, they will be required to practice within a health care system and have a clinical relationship with an obstetrician-gynecologist (Barr, 2/9).

Medscape: Court Overturns Georgia Law Limiting Assisted Suicide
The Georgia Supreme Court this week unanimously held that a law limiting some assisted suicides is unconstitutional because it violates free speech rights. The ruling means that criminal felony charges will be dropped against 84-year-old retired anesthesiologist Lawrence Egbert, MD, from Baltimore, Maryland, and 3 other members of the Final Exit Network, a group that offers support to people who want to end their lives (Crane, 2/9).

The Connecticut Mirror: Concerned About A Senior? Call The Gatekeepers
[The Gatekeeper Program] aims to connect seniors who need assistance with programs that could help them, including medical, social and mental health services. It relies on neighbors, family, mail carriers, hairdressers and others who encounter seniors to make referrals, then dispatches social workers to assess the situation and refer people to any services that are appropriate (Levin Becker, 2/9).

Health Insurance Exchanges Stall In Kansas And Georgia

Fri, 10 Feb 2012 14:28:04 GMT

Kansas Health Institute News: House Committee Votes To Halt Spending Of Health Reform Grant Funds
The House Appropriations Committee has voted to block Kansas Insurance Commissioner Sandy Praeger from spending any more federal grant dollars to plan for the implementation of the federal health reform law. ... The grants, which totaled about $2.3 million, were intended to help Kansas plan and develop a health insurance purchasing exchange and to educate consumers about the exchange (McLean, 2/9).

Georgia Health News: Health Exchange Idea Faces Uncertain Future
Early in January, the Republican leadership in the General Assembly declared the door was shut this year on any bill to set up a health insurance exchange in Georgia. The decision surprised many, because an advisory committee, appointed by Gov. Nathan Deal, had recommended in December that such an online insurance marketplace for small businesses be created. ... But Rep. Pat Gardner (D-Atlanta), a member of the exchange panel, sees no need to wait. She has introduced an exchange bill anyway (Miller, 2/9).

MarketWire: (Ill.) Small Business Advocacy Council Announces Introduction Of Health Care Cooperative Legislation
The Small Business Advocacy Council (SBAC) announced introduction of House Bill 3976, ... to authorize health care cooperatives in Illinois in an effort to stabilize health care costs for small business owners. A health care cooperative (coop - consumer owned and operated plan) is a state-chartered, nonprofit, membership organization comprised of individuals and small employers joined together to operate as a health insurance issuer (2/9).

Health Plans Must Provide Consumer-Friendly Health Plan Summaries

Fri, 10 Feb 2012 14:19:00 GMT

Moving to implement one of the new consumer protections in the health law, the Obama administration issued regulations Thursday requiring insurers to describe costs and benefits in clear, standardized language.

Los Angeles Times: New Rules For Health Plans Require Clear Summaries Of Benefits
Starting this fall, insurers and employers that offer health coverage will have to provide a six-page form that summarizes basic plan information, such as deductibles and co-pays, as well as costs for using in-network and out-of-network medical services (Levey, 2/10).

The Wall Street Journal: New Consumer Insurance Forms To Start In September
The Obama administration released finalized new rules for how health insurers describe what their plans cover Thursday, and told insurers that they have until September to prepare the documents for the new open enrollment season. ... The requirement, part of the health care overhaul law, is popular with consumers who hope they will be able to cut through pages of complicated small print and understand their coverage. But employers and insurers say that changing the way they explain insurance could be expensive and lead to more confusion (Radnofsky, 2/9).

Kaiser Health News: HHS Unveils Final Design For Insurance Labels
The Obama administration Thursday unveiled final regulations for new health insurance summaries that the federal health law requires plans to give to consumers to help them make informed coverage choices (Jaffe, 2/9).

Associated Press: Feds Require Consumer-Friendly Health Plan Brief
Don't have the slightest clue what your health insurance covers? The Obama administration says that's going to change. Officials announced Thursday that starting later this year private health plans will have to provide consumers with a user-friendly summary of what's covered, along with key cost details such as copays and deductibles. Just six pages long. No fine print. And because the summaries will use a single standard format, it will allow "apples to apples" comparisons among health plans that aren't possible now. That will help working spouses trying to pick between employer plans, as well as people who buy coverage directly from an insurance company (Alonso-Zaldivar, 2/9).

Detroit Free Press: New Rules Call For Simpler-To-Understand Group Health Insurance Benefits, Costs
Starting Sept. 23, group health insurance policies in America must provide consumers and employers with a simple, easy-to-understand summary of benefits and costs. The new rules, announced Thursday, aim to eliminate confusing and technical language in policies “the size of a small phone book,” said Marilyn Tavenner, acting administrator of the Centers for Medicare and Medicaid, in announcing the changes Thursday. She said insurers “can’t bury in fine print” any substandard coverage. The changes will help employers and consumers make apples-to-apples comparisons of their health plan, she said (Anstett, 2/9).