Health Care remains part of political conversations at all levels. This week HHS secretary Sebelius appeared before the House Ways and Means Committee.  The Secretary defended the health law and indicated the administration was vetting candidates for the Independent Payment Advisory Board, (IPAB) as covered by Kaiser Health News.

Meanwhile, the House Energy and Commerce Health subcommittee voted in support of repealing the IPAB provision of the reform law, according to HIMSS and others. The full committee is scheduled to vote on the proposed legislation on March 5. That vote, is anticipated by many as putting pressure upon the Senate to vote on the same issue. Most political analysts suggest that with a Democrat majority, it is unlikely the legislation would win approval there. The role of the IPAB remains contentious as critics object to decisions being made by a non-elected group, as voiced within this Forbes article.

The administration's preparations for defending the health reform law before the Supreme Court are featured in this Politico feature, which considers strategies that may be employed for framing arguments before the high court.  The Medication Therapy Management Benefits Act, H.R. 891 is getting some press as representatives are urging colleagues to support the legislation as highlighted in this article in Drug Topics. Finally, seven groups will receive low interest federal loans worth $638 million to be used for establishing consumer-governed health insurance plans in eight states. Kaiser covers the topic further.

This week the Supreme Court denied a request to exclude Justice Elena Kagan from the upcoming debate over the legality of the Affordable Care Act. Actually, groups have called for recusal of Kagan as well as Justice Clarence Thomas. Kagan's participation is being challenged because she served as Solicitor General at the time the law was passed, and calls for Thomas to step away from the case are based upon the work of his wife, opposing the law.

Multiple News sources cover the matter and Kaiser Health News offers summaries of some of news articles. In the meantime, the Patient Centered Outcomes Research Institute commenced its work, with its first publication being released; a draft priorities and research agenda. The PCORI Draft National Priorities and Research Agenda, released early this week managed to avoid some controversy by not focusing upon any diseases, treatments or procedures in particular. Public Comment on the document is being accepted at the PCORI survey site through March 15.

Analysts reflecting on the minimal mention of health care in this week's State of the Union address view the inattention as reflecting anything  an effort to save discussion for the Supreme Court to, overconfidence in the outcome of the proceedings, to frustration with dynamics in Washington.  Every perspective's been offered, and readers might review one perspective in this Medscape article or other links available through this Kaiser Health News article which highlights a variety of news sources coverage on the subject.

In 2012 the Supreme Court will be hearing the lawsuit challenging the individual mandate provision of the Affordable Care Act.

Presently, the National Federation of Independent Business is seeking the court's approval to add two additional plaintiffs to the suit. The case, originally built upon the premise that the mandate may create a hardship for small business owners, may be impacted by the recent closure of the original plaintiff's business. Read more on this in Kaiser Health News.

In the meantime, The Hill reports the court has set aside 3 days to hear arguments and is likely to issue its ruling in June, at a time many consider to be critical in terms of the 2012 presidential race. There's progress and still generally favorable reactions to the new Accountable Care Organization guidelines released late last year and 32 medical groups were named by CMS as "Pioneer" organizations as reported by First Report Now, Modern Health Care, and Kaiser Health News.

Last week's announcement that the Supreme Court will review the Affordable Care Act's individual mandate (Bloomberg, Washington Post, New York Times ) was expected by most health policy analysts. It's a surprise to some supporters, however, that the Court will also consider whether the law's impact upon the expansion of Medicaid is an unconstitutional coercion of states (Washington Post.)

The intended timing, hearing arguments in March with a ruling in June, will make health reform a major issue in the 2012 presidential elections (Politico.) C-Span has, according to the Washington Post and Associated Press asked for special permission to deviate from the Court's customary policy and permit the broadcast of the five and a half hours of scheduled arguments. It's noteworthy that the Court has scheduled this amount of time, as an hour is all that is typically allowed. Ultimately, the court could issue a ruling or may determine that it will offer no decision after hearing arguments. Many stakeholders contend that regardless of the outcome, changes to health delivery systems in the U.S will endure, as discussed in this New York Times article. Activity within the deficit reduction or super committee is being monitored closely.

There's evidence that the groups reached a stalemate as characterized by the Washington Post. Party leadership is becoming involved and according to Politico, with the deadline a week away, the committee is seeking a "Plan B."  The House Energy and Commerce Health Subcommittee approved legislation to repeal the Community Living Assistance Services and Supports Act or CLASS Act, according to Modern Healthcare.  That legislation is currently suspended following announcements by HHS of concern for the program's viability and sustainability.

Finally, Managed Health Care Executive explores two University of Michigan health care programs recommended by the Institute of Medicine to HHS. The programs are described as innovative by IOM in that they remove barriers to health care services and engage the public in setting healthcare priorities.

It's reported that the Supreme Court will be making a decision regarding whether it will be reviewing the health reform act on November, 10.

While it's relatively clear that all parties would like the court to rule, there's speculation as to how some legal considerations that will play into the Court's decision. Specifically, there remains an issue with the manner in which fees related to the law are defined. In short, the administration contends that Americans who are asked to pay a fee because of the lack of health insurance coverage are actually paying a tax, not a fine. If this is the case, then the review of the law's legality and implementation must be considered within specific parameters.

There is a federal law known as the anti-injunction act that prohibits the courts from blocking taxes before they have gone into effect. So, if the penalty is viewed as a tax, the court is legally unable to overturn the tax. Since, the administration is encouraging the court to rule, there's been some contradiction in how this has been framed and will be handled. Read more on this in The Hill. In the meantime, there's been an amicus brief filed by   AHIP (America's Health Insurance Plans) asking that a ruling on the individual mandate's legality by the 11^th Circuit Court of Appeals be reviewed.  The actions of the debt reduction, super committee continue to attract attention, and speculation. As time grows short for the group to reach consensus, news sources are increasingly focusing upon positions, comments, alliances and other developments surrounding the committee and its objectives.

Finally, the release of revised Accountable Care Organization rules continues to receive favorable reactions from stake holders. Some of these responses are characterized in this article in the Washington Post.

The emphasis this week has been on reviewing the newly released ACO rule. Meanwhile, the administration's announcement of plans to cease working on the implementation of the controversial CLASS act remains a source of controversy in legal and health care circles. The final ACO rule is generally receiving a favorable response as it's been significantly changed based on input obtained during the comment period. Read more on this below, in the CMS section. 

As for the Community Living Assistance Services and Supports or CLASS Act, controversy continues. HHS Secretary Kathleen Sebelius announced last week that she sees no viable means of implementing CLASS. The Congressional Budget Office has since weighed in; stating the elimination of the program would not adversely affect the projected savings anticipated as a result of the implementation of health reform. The political implications of acting to repeal the provision continue to stir controversy. This article in The Hill considers the divergent positions being taken regarding CLASS and Kaiser Health News reflects upon early statements that indicated CLASS is being shut down. The Institute of Medicine's recent guidance to HHS on essential benefits continues to elicit comments as analysts point out the report directs HHS to balance health benefits and costs.

The lack of emphasis in the IOM report on the handling of prescription drugs has some experts speculating that little will change in the way of pharmacy benefits in the near future. That observation is characterized in this AIS Health News column. Finally, lobbying and monitoring of actions being taken by the debt super committee continues. The potential implications, in terms of automatic cuts that would be implemented if the group fails to reach its objectives, are considered in this news story , collaboration between the Washington Post and Kaiser Health News.

HHS moved toward identifying "essential benefits" when the Institute of Medicine, a federal advisory board, released its report this week. The IOM outlined criteria, but HHS is ultimately responsible for defining essential benefits. America's Health Insurance Plans (AHIP) praised the report for focusing upon cost and efficacy.

The New York Times, The Hill and other sources indicate the guaranteed benefits are aligned with the "scope and design of packages offered by small employers."  A release date for HHS' defined "essential benefits" has not been announced, but a period of public comment is planned. The guidelines are widely anticipated as it's expected that in addition to their influence on health insurance exchanges they will guide commercial insurers in the same manner Medicare coverage decisions have. On that note, the US Preventive Services Task Force, is releasing a draft recommendation that healthy males 50 and over no longer receive a P.S.A. blood test to screen for prostate cancer.

Although the recommendation may ultimately impact health coverage, early indications are that advocacy groups will object and coverage and payment guidelines are unlikely to undergo immediate revision.  In 2009, the task force triggered controversy by suggesting limiting routine mammography screening. The Washington Post is among many news sources covering this issue. The debate over the Supreme Court's review of the Accountable Care Act continues. While it appears inevitable that the Court will rule, it's unclear when that will occur and which judges will participate. More is written on this subject in news stories published by Reuters and the Associated Press.

Meanwhile, as some aspects of the health reform law are being implemented, experts are keeping an eye on Accountable Care Organization antitrust guidelines. The issue here is based on an FTC and Department of Justice proposal that potential ACO's be alerted if their organization's size would create an antitrust issue. The issue revolves around when antitrust action is warranted. ACO's, left unchecked, would have the potential to impact pricing and drive costs in a particular market. Inside Health Policy explores the issue and there's speculation that the FTC and DOJ are working on a scaled down version of the original proposal, which has insurers concerned. Debate over the future of the CLASS act, the controversial long term care insurance program defined in the health law continues as explored by Kaiser Health News and The Hill.

Finally, Kaiser Health News and other sources focused upon troubling disparities in access to care and outcomes that were quantified in the Center for Disease Control's Healthy People 2010 report. Review the full report or executive summary.

This week both the groups supporting and opposing the health reform law reached an agreement. Both "sides" requested the Supreme Court to rule on the validity of the law.

The request by the federal government represents a departure from earlier indications that it would first seek to exhaust the lower court appeals process. The plan was viewed by many as a means of avoiding a Supreme Court ruling immediately prior to the 2012 presidential elections, according to the Washington Post. Other legal action regarding the reform law also made news this week. The Hill reports on a House proposal that would de-fund the health reform law, the text of that proposal to the House Appropriations Committee is available for review here; House Democrats are seeking a judicial ethics investigation into whether Justice Clarence Thomas should be part of the ruling on the health law (citing conflicts of interest for both the Judge and his wife), as reported by The Hill; and Kaiser Health News reports the National Federation of Independent Business, a small business advocate organization, is seeking to have the entire health law overturned.

On a related subject, there's speculation from all sides regarding how the office charged with implementing a controversial aspect of the reform law, the Community Living Assistance Services and Support Act,  would fare. It's been acknowledged that a review of the feasibility of the CLASS Act will be released in mid October. There was controversy when it was announced that staff at the office would be reassigned while the program is reviewed, according to The Hill. It's become increasingly difficult for stakeholders to believe that CMS will launch the Accountable Care Organization program before its January 1 deadline. The final rule for the program was scheduled for release during September. Currently there's no indication of when that rule can be expected.

Meanwhile, the Institute of Medicine announced it will releasing its essential benefits report on October 7, just a week after its self imposed deadline, according to Reuters. The IOM report will be used to help in the establishment of criteria for insurance exchanges. The report is not intended to provide specific benefit standards. Rather, the report is intended to offer methods and criteria to support HHS in defining the essential benefits package.

A $3 trillion deficit reduction plan presented by the President includes cuts of $248 million from Medicare and of $72 billion from Medicaid.

Some analysts suggested the plan spares the health care sector deeper cuts. Others speculate the proposal may be undermining efforts of the "super committee," as the bipartisan Joint Select Committee on Deficit Reduction has come to be known. Amongst recommended cuts, the plan would trim payments to providers in underserved areas. Currently compensated at slightly higher levels than their contemporaries, these providers would stand to lose "add-on payments" intended to offer incentives to physicians and hospitals in some outlying areas.

Other aspects of the proposal include increased Part B and Part D contributions as well as higher Part B deductibles for higher income Medicare beneficiaries; adjusting Medicare Part D rebates from drug makers; shorter market exclusivity for biologics; and a surcharge to Part B premiums when subscribers purchase a MediGap policy. That fee is intended to discourage seniors from becoming high consumers of costly health care services due to generous coverage benefits. CQ HealthBeat reports on efforts by insurance commissioners to oppose that proposal. Stakeholders opposed the aspect of the proposal that strengthens the role of the Independent Payment Advisory Board (IPAB.) That group was developed by the health reform law to keep Medicare spending growth to within 1% of the growth rate of the gross domestic product.

The President's proposal would limit spending growth to 0.5% of the GDP.  The American Medical Association voiced support for the aspect of the plan that addressed cuts to physician's payments for care provided to Medicare services. Those cuts, rolled back each year since the introduction of the sustainable growth rate formula, have accumulated. If enacted as the SGR formula would direct, physicians would incur a pay cut of nearly 30%, as of January 1, 2012 (more on this below in the CMS section.) Analysts note two groups offered differing suggestions regarding the nature of cuts to health spending that may be considered.

A proposal offered by drug makers, hospitals, pharmacies, and academia (The Healthcare Leadership Council or HLC) suggested a four point plan which it suggested could account for $410 billion in savings. However, it was not lost on observers that the president's plan includes more elements of suggestions included within a proposal offered by a pharmacy benefit managers or PBMs. That group, the Pharmaceutical Care Management Association, recommends increasing generic drug utilization, increased use of mail order pharmacy, shorter exclusivity periods on biologics, and price negotiations for drugs purchased for Medicare Part D. Review the Obama plan here. Further information and perspectives are available in the Pharmaceutical Executive Blog.