Finally Friday Edition

It's hot but it's Friday, so it's all good. Except maybe the news. Let's see:

Some reports indicate that the President and Speaker Boehner are close to a deal to cut spending and overhaul the tax system, cutting the debt by $3 trillion over 10 years, and raising the debt ceiling. There are big details remaining -- there would be a trigger if the tax overhaul didn't happen in 2012. President Obama wants the trigger to be a tax increase on the wealthy; Boehner wants the trigger to be a repeal of the individual mandate, the core of the health reform law. Both the Dems and the GOP hate it so far -- the GOP due to tax increases; the Dems due to entitlement cuts and the fact that there are no immediate revenue raisers -- it's a tax overhaul over the next year or so. The White House strenuously insists that there is no deal and no progress to report. But something has to happen -- and soon. States are already struggling with the uncertainty. Still, as much as I want a deal to avoid default, it sure does sound to me as though the President is giving up an awful lot, with cuts to Medicaid and Medicare but no new revenue -- how is this not the GOP plan that he rejected already? Apparently, a bunch of Dems are pretty upset and they let the President's budget director know it. It doesn't help when a GOP Senator brags that the President will cave in when the debt ceiling deadline comes upon him. And Speaker Boehner still has to sell it to House GOP, which won't be easy, either. Ezra Klein illustrates the problem -- many programs that could easily be cut are in the tax code, so they would be considered tax increases, which the House GOP won't support. But we are running out of time. Even now, it's really too late to draft legislation and vote on it by August 2, so there would probably be a short term extension of the debt ceiling. If we don't increase the debt ceiling, what happens to Medicaid and Medicare? Anyway, there will be a symbolic Senate vote today on the Tea Party plan to cut spending, cap spending, and create a balanced budget amendment -- something the Senate is likely to reject, and the President has already said he would veto.

And here's a new wrinkle in health reform implementation. There are no subsidies for employees who have employer-sponsored insurance that cost less than 9.5% of the employee's income. However, the Joint Committee on Taxation is saying that 9.5% limits applies only to the employee, not the family, so family plans can cost whatever and there's no subsidy. It's likely that the Administration will fix this through regulations making it clear that the 9.5% limit applies to the employee and dependents, which clearly was the intent of the legislation.

Hospital payments will soon reflect patient satisfaction, so one hospital sent its employees to Disney to learn patient satisfaction. Disney? Disney.

Meanwhile, the top health problem today is the heat. It can be very serious, so please listen to the experts, drink a lot, try to keep cool. Unfortunately, many states have cut energy assistance for the poor, making it harder for them to stay cool.

Going into the hospital is far riskier than flying! It would help a lot if everyone who cared for you would wash their hands, though.

Michelle Obama had a significant victory yesterday, getting a pledge from large chain stores to build in areas where there are no supermarkets and stocking them with fresh produce.

A nice piece on why anybody would choose to be a doctor.

The ExpressScripts take-over of Medco is progressing, creating a huge pharmacy benefit manager that might help drive down costs -- or it might be so big that it poses antitrust problems. But UnitedHealthcare is expanding its own Optum health unit, no longer using Medco as its pharmacy benefit manager, and creating a large book of business for itself. With CVS Caremark, you'd have three pharmacy benefit managers in charge of pharmacy benefits for most of the United States.

And here's a report on stem cell research underway here in Connecticut. Exciting.

And that's where we are this Friday morning. Have a great day! Jennifer

Insurance Premium Rate Issues

Connecticut's Governor, Dannel Malloy, vetoed a bill that would have allowed the Healthcare Advocate or the Attorney General to request a hearing any time an insurer proposed to increase their premiums by 10% or more. This morning, legislative leaders announced that, rather than holding a vote to override that veto, they have worked out a compromise with the Insurance Commissioner to allow up to 4 hearings per year on rate increases of 15% or more if requested by the Healthcare Advocate, Vicki Veltri.

In other news, the Oregon insurance Division rejected Regence Blue Cross Blue Shield's request for a rate hike of 22.1 percent, instead approving a 12.8 percent increase.

These actions taking place in the states demonstrate that we are moving -- albeit slowly -- in the right direction. Jennifer

Thursday Themes

Oh, boy, what a week. I feel like I'm running a five day marathon! But I can't stop now, so here's the news:

Wall Street is making contingency plans in case there's no deal on raising the debt ceiling, trying to reduce the risk of holding Treasury bonds. You really should read that article if you don't think raising the debt ceiling is important. Investors beg to differ. The plan proposed by the bipartisan "Gang of Six" is not going over well with conservatives in the House -- very disappointing because it seemed like the first hint of a way out. But Eric Cantor says it relies too much on raising revenue. They also don't like the plan B, Mitch McConnell's plan to give the President the ability to raise the debt ceiling. When did compromise become a dirty word? The GOP is taking a beating in the polls for being to recalcitrant, as well they should. The Federal Reserve is actively preparing for default as they try to figure out which government checks will be honored on August 3. You can't blame them -- there seem to be so many plans being discussed with little sense that issues are being narrowed down and that people are focused.

President Obama is doing all he can to bolster the Gang of Six plan -- a package of spending cuts and a tax overhaul -- even offering to raise the debt limit for only a few days, until this plan can be written up and votes taken. But he will only agree to a short-term deal if the parties are narrowing in on a deal. Here's the full text of the Gang of Six plan. Apparently, it was an agreement to make serious cuts to Medicaid and Medicare that have made this plan attractive to GOP Senators. And it eliminates the CLASS Act, a plan for long-term care insurance backed by the government.

Meanwhile, states are slashing budgets, which seems to involve health care cuts. For example, here in Connecticut, respite programs are being slashed, while substance abuse beds will be harder to find.

In other news, Express Scripts may be buying Medco, merging the two biggest pharmacy benefit managers -- I hope the antitrust lawyers in Washington take a hard look at whether this will harm consumers by eliminating any real competition in the market.

Calorie counts on restaurant menus may not always be accurate.

And there you have it, friends. Despite it all, have a great day! Jennifer

Hump Day Headlines

Yesterday, I posted the executive summary of the deficit reduction deal that's currently attracting so much attention. The President supports it. But the GOP led House of Representatives hasn't weighed in yet. Indeed, Politico reports that they oppose the deal because it involves restructuring the tax code. Instead, last night, they passed the cut, cap and balance bill that they like, imposing large spending cuts, spending caps, and a balanced budget amendment -- which the President has already said he will veto. Speaker Boehner says this new deal falls short. And it doesn't address raising the debt ceiling, so that thorny issue still has to be addressed. Harry Reid says they are still working on the McConnell plan, which transfers authority to raise the debt limit to the President. The general consensus seems to be that this legislation cannot be drafted and voted on before August 2. So they still have to vote to raise the debt ceiling. If they don't, not only will the US credit rating be down-graded, but so will that of five states. None of you will be surprised, of course, that even the conservative GOPers who want to slash spending drastically are not prepared to give up money coming into their home districts. Supposedly -- according to Politico -- the deal on the table involves reform of Medicare physician payments, ending the CLASS Act (long-term care), and malpractice reform. But there are these words "cuts to Medicaid and Medicare" that are vague -- I need to know the details, as I'm sure you do, too. Social Security appears to be on the table, as well.

The non-partisan Institute of Medicine has been asked to make recommendations about what treatments are "preventive," and, thus, free under the health reform law. Yesterday, they recommended that contraceptives be among the preventive, free care.

Kaiser Health News posts a round-robin discussion on curbing health costs.

Michelle Bachman has migraines. Does that mean she's unfit to be President? Be careful how you answer, those of you with chronic illnesses.

And that's the morning's news. I have a crazy day today, but if there are major developments, I'll do my best to update you. In the meantime, have a great day! Jennifer

Executive Summary of Debt Reduction Plan

Kaiser Health News has posted an executive summary of the debt reduction package that seems to be gaining momentum. It's very fuzzy; don't ask me to fill in the blanks because I don't know any more than this. But at least now you have everything that's out there. Hang in -- details will come as soon as I know them. Jennifer

Update on Debt Negotiations

It does appear that there is fairly widespread support for the bipartisan Gang of Six's compromise. However, new information states that the plan involves up to $100 billion in health care cuts, including cuts to Medicare and Medicaid. I cannot find anything more specific than that. It also would eliminate the CLASS Act, which was a long-term care insurance plan that was part of the health reform legislation.

I have a feeling this may be the path to a resolution -- and I have a feeling I'm not going to like it one bit. Jennifer

Breaking News: Movement?

Politico is reporting that the so-called Gang of Six -- six bipartisan Senators -- have reached an agreement on a plan that would involve $500 billion in cuts now (including a change to how COLAs for Social Security are calculated) immediately followed by a fast-track process that would result in a package of tax restructuring and spending cuts to total $3.7 billion in the next 10 years. President Obama has said that this is a useful, meaningful step towards resolving the crisis over the debt ceiling. The tax plan would involve more progressive tax brackets.

Now, will the House GOP agree? Jennifer