• Five Facts About Obama's Proposed Changes To Medicare Payroll Tax
• Political Cartoon: 'The Devil You Know'
• Obama Makes Final Public Push For Health Reform As Democrats Consider Timeline
• Abortion Holding Up Democrats' Endgame On Health Overhaul
• GOP Putting Strategies In Place To Thwart Dems On Reform
• Pro- and Anti-Health Reform Groups Wage Last Minute Attacks
• President Announces Plans To Crack Down On Health Care Fraud
• Lincoln, Kucinich Weigh In On Health Bill Votes
• Senate Poised To Pass COBRA Subsidy Extension, Medicare 'Doc Fix'
• California Rescission Settlement Benefits Few Consumers
• FDA Sponsoring Workshops To Increase Rare Disease Treatment Options
• Medical School Costs, Loan Rates Rise Sharply
• Pharmacy Franchises Sue Cardinal Health
• Non-Profit Operations Plugging Health Care Gap In Chicago
• Comparative Research Lags Far Behind Approval-Driven Evaluations
• States' Legislative Health Initiatives Stall
• Today's OpEds: Congressional Dealmaking, Cutting 'Honchos Pay,' Controlling Costs

President Obama is delivering his "closing argument" for health care reform in St. Louis today as Democratic leaders strategize on moving the bill through the House and Senate.

The Associated Press: "Obama is to speak Wednesday at St. Charles High School, his second health care address in three days. His speech comes as congressional Democrats stand on the brink of delivering the president a dramatic success with passage of his sweeping overhaul legislation — or a colossal failure if they can't get it done." Leaders are waiting for a final analysis from the Congressional Budget Office before they start counting votes "in earnest ... The two-step approach now being pursued calls for the House to approve a Senate-passed bill from last year, despite House Democrats' opposition to several of its provisions. Both chambers then would follow by approving a companion measure to make changes in that first bill" (Werner, 3/10).

The New York Times: Democrats are "bracing for a key procedural ruling [which] could come within days from the House and Senate parliamentarians, and could present yet another hurdle for Mr. Obama and Democratic leaders as they try to lock in support from skittish lawmakers in the House." The ruling considers if the president must sign the Senate bill after House passage before Congress can revise it through the reconciliation process.

"Meanwhile, Congressional leaders and top administration officials met in the offices of the House speaker, Nancy Pelosi, on Tuesday evening trying to resolve outstanding policy differences between the chambers." Senate Democratic Whip Dick Durbin said Tuesday that there's no timetable for a budget reconciliation bill (Herszenhorn and Pear, 3/9).

The Washington Post: "The sequence in which the Senate bill and the package of fixes would move is one of the key unresolved issues, much to the consternation of undecided House Democrats. They would prefer to pass the reconciliation bill first and force the Senate to accept their fixes before the House takes up the Senate bill. But reconciliation rules seem to indicate that the House will have to pass the Senate bill first."

Lawmakers who participated in the meeting in Pelosi's office "said that once the Congressional Budget Office delivers a final cost estimate on the fixes bill, possibly this week, Democratic leaders would begin lining up House and Senate votes" (Murray, 3/10).

CongressDaily: House Rules Committee Chairwoman Louise Slaughter,D-N.Y., "is weighing preparing a rule that would consider the Senate bill passed once the House approves a corrections bill that would make changes to the Senate version." She "has not taken the plan to Speaker Pelosi as Democrats await CBO scores on the corrections bill." In the meantime, House Energy and Commerce Chairman Henry Waxman said Democratic legislative leaders told White House Chief of Staff Rahm Emanuel at the meeting in Pelosi's office Tuesday night that they don't want deadlines assigned to them (Edney, 3/10).

The Hill: House Majority Leader Steny Hoyer "suggested the March 18 deadline recently set by White House press secretary Robert Gibbs was not endorsed by congressional leaders. … 'Our objective is to pass both [healthcare and the 2010 budget] before the Easter break [March 26],' Hoyer said. 'Is that going to be difficult? Yes. Is it a deadline? No. If we can, we can. If we can’t, we can’t,' Hoyer added" (Allen and Youngman, 3/9).

Roll Call: "Senate Finance Chairman Max Baucus (D-Mont.) said House and Senate leaders are moving 'as expeditiously as possible.' Pelosi likewise signaled optimism. 'These meetings now take us more quickly down the road of making good progress'" (Pierce and Newmyer, 3/9).

Reuters: Pelosi is facing her "biggest test" as speaker in trying to get to 216 votes. "If all Democrats voted as they did last year on an earlier version of the bill, Pelosi would reach 216. But many may switch from yes to no — or no to yes. … 'Every legislative vote is a heavy lift around here. You assume nothing,' Pelosi said" (Ferraro, 3/10).

McClatchy: Democrats "control 254 of 435 House seats, with four vacancies. When the House last voted on health care legislation in November, 39 Democrats voted no. Should that number hold, the bill would lose" (Talev and Lightman, 3/9).

Meanwhile, a new AP-GfK poll has found that a majority of Americans want a bipartisan health care overhaul, The Associated Press reports in a separate story. "More than four in five Americans say it's important that any health care plan have support from both parties. And 68 percent say the president and congressional Democrats should keep trying to cut a deal with Republicans rather than pass a bill with no GOP support."

"Half of all Americans say health care should be changed a lot or 'a great deal,' and only 4 percent say it shouldn't be changed at all." The telephone survey, conducted March 3-8 by GfK Roper Public Affairs & Media, has a margin of sampling error of +/- 4.2 percentage points (Babington, 3/9).

Politico: House Majority Leader Steny Hoyer "said Tuesday that the abortion fight 'has to be resolved.' The majority leader expressed confidence that the issue would be wrapped up, but he also cautioned reporters that he had not had any formal negotiations with Rep. Bart Stupak, the Michigan Democrat who authored the House abortion restrictions. ... 'Congressman Stupak has not reached an agreement on abortion funding in the health care legislation,' his spokeswoman, Michelle Begnoche, said Tuesday. 'Last Thursday, the congressman had meaningful discussions with [Energy and Commerce Committee] Chairman [Henry] Waxman and Majority Leader Hoyer. Congressman Stupak expects further meetings this week and remains optimistic that language can be worked out.'"  

"The problem at this point is that supporters of abortion rights, including many of the speaker's closest allies, have voted to oppose any bill that includes Stupak's restrictions. On the flip side, Stupak has said at least 10 colleagues will oppose a bill that doesn't include them. If both claims are true, that would make it almost impossible for party leaders in the House to get the 216 votes they need to pass the measure" (O'Connor, 3/10).

Roll Call: "Leadership aides are skeptical of Stupak's count and believe they can hang on to about half the number that the Michigan Democrat says are in his corner. … But already some Democrats have started pushing to punt the abortion debate with promises that the issue will be subject to future floor votes. Energy and Commerce Chairman Henry Waxman (D-Calif.) has floated putting off the issue — although to date both sides of the debate have rejected the idea. Under Waxman's idea, the Senate language would stand for now but be subject to future votes in the years before the insurance exchanges take effect" (Dennis and Newmyer, 3/10).

Roll Call in a separate story: "Rep. Dale Kildee (D-Mich.), a key supporter of Rep. Bart Stupak's (D-Mich.) anti-abortion language intended for the health care bill, said Tuesday night that he's satisfied the Senate abortion language prohibits federal funding of abortions and will likely vote for the bill. 'I think the Senate language keeps the purpose of the Hyde amendment,' Kildee told reporters. I’ll probably vote for it.' Kildee’s conversion undermines the position of Stupak, his fellow Michigan Democrat who has been demanding changes to the Senate bill" (Dennis, 3/9).

NPR interviews Father Thomas Reese of Georgetown University's Woodstock Theological Center who said that at "the beginning of the health care debate, there was kind of a gentlemen's agreement" about maintaining the status quo pm abortion. He added that many in the church really do want comprehensive health reform, but not at the expense of expanding access to abortion. The original intent of the bill was that it be abortion-neutral, NPR reports. A long-standing federal law has barred the use of federal money in abortion except in the cases of rape, incest and if the mother's life is in danger — the so-called "Hyde Amendment" (Inskeep and Rovner, 3/10).

Meanwhile, MSNBC fact-checks "Stupak on abortion," ask "is Stupak right -- that the Senate bill directly subsidizes abortions? The answer appears to be no" (Murray, 3/9). Stupak's office offered a response, which MSNBC reported in a separate story (Murray, 3/9).

The Boston Globe: "President Barack Obama said Tuesday he'll bring in high-tech bounty hunters to help root out health care fraud, grabbing a populist idea with bipartisan backing in his final push to overhaul the system. ... Obama's anti-fraud announcement was aimed directly at the political middle."

"Waste and fraud are pervasive problems for Medicare and Medicaid. ... Improper payments -- in the wrong amounts, to the wrong person or for the wrong reason -- totaled an estimated $54 billion in 2009. ... The bounty hunters in this case would be private auditors armed with sophisticated computer programs to scan Medicare and Medicaid billing data for patterns of bogus claims. The auditors would get to keep part of any funds they recover for the government" (Alonso-Zaldivar, 3/9).

Reuters: Regarding the White House's efforts, "[t]he action endorses Republican-backed proposals on cheats, in a gesture designed to highlight Obama's commitment to embrace opposition ideas alongside his own Democratic Party. The plan will offer private auditors a share of the money that they recoup in order to encourage them to dig deeper to uncover improper payments under Medicare and Medicaid" (Bull, 3/9).

The Wall Street Journal: "Mr. Obama will sign a presidential memorandum directing federal agencies to make more aggressive use of 'payment recapture audits,' in which private companies under contract scrub government books to find wrongful payments and are paid a portion of what they find. Under current law, only certain federal agencies are eligible to use this system. The president is also endorsing legislation to expand their use to other agencies and programs, including Medicaid" (Meckler and Hitt, 3/9).

The Washington Post: "Together, the announcements are intended to show the president's seriousness on two fronts: the willingness to incorporate Republican ideas into his overall plans for health reform, and his desire to confront fraud and waste in government. The announcement comes as part of an intensifying White House public relations campaign ahead of a legislative conclusion on the health care front, perhaps as early as next week" (Shear, 3/9).

The Associated Press reports on a new California state assembly report that found fewer than 200 people out of the more than 6,000 affected have taken advantage of benefits won by a settlement between state regulators and health insurers that dropped sick policyholders.

"More than 6,000 Californians were subject to rescissions by the five largest insurance companies between 2004 and 2008, according to settlement agreements between the regulators and the insurers." The settlements required the five insurance companies to "pay fines ranging from $50,000 for PacifiCare to $10 million for Anthem Blue Cross, and they required insurers to allow the policyholders to be reinstated under new policies" (Mohajer, 3/9).

San Francisco Chronicle: According to the Department of Managed Health Care's Assembly Committee on Accountability and Administrative Review, just five percent of consumers who were dropped accepted new coverage, and less than three percent went through the process of getting their money back. The committee will hold a hearing today on the issue. Critics say the "excessively bureaucratic" process of getting their money back barred many victims from taking advantage of what they were owed in the settlement (Colliver, 3/10).

Los Angeles Times: The report given to the committee overseeing the hearing today "was prepared by Bryan Liang, director of the Institute of Health Law Studies at the California Western School of Law, and based on data from the regulators. It concluded that so few eligible consumers obtained new coverage because the settlements were too complicated and because the cost of the new coverage was too high."

But Dept. of Managed Healthcare's spokeswoman Lynne Randolph says their actions have had positive effects: "As a result of DMHC actions, the number of rescissions industrywide has decreased significantly since 2005, millions of dollars have been assessed against health plans, thousands of consumers have been offered an opportunity to obtain coverage and reimbursement, and reforms have changed the practice of rescissions industrywide. It is difficult to know why many consumers chose not to participate" (Girion, 3/10).

Meanwhile, in other insurance company news, Business Week reports that Connecticut Attorney General Richard Blumenthal sent a letter to U.S. Secretary of Health and Human Services Kathleen Sebelius to inform the department of his investigation into Anthem Blue Cross & Blue Shield's "potentially anticompetitive practice that may raise rates." According to Business Week, Blumenthal claims that the insurer "may constrain competition through contracts that require that the insurer receives hospital discounts at least as favorable as any provided to a competitor."

"As a result of Anthem's practices, competitors are forced to pay more, hospitals are forced to accept less from Anthem -- and consumers are the ones paying," Blumenthal’s statement said. Anthem responded: "We have no reason to believe that any provision in our hospital contracts is in violation of applicable law" (Freifeld, 3/8).

The Wall Street Journal: FDA is putting on workshops for pharmaceutical manufacturers to increase the pool of applicants for approved "orphan drugs," that treat rare diseases. Currently, there are about 7,000 so-called orphan diseases in the U.S. that have few or no FDA-approved treatments.

"Getting an orphan-drug designation opens the door to incentives once the FDA approves a medicine for sale in the U.S., including seven years' marketing exclusivity and tax breaks. Last year, just 250 requests for orphan-drug designation were filed, and 160 received it." The workshops help companies through the application process by offering regulatory advice. The first, held last month in Claremont, Calif., attracted "29 potential sponsors, from major drug companies to academic centers, small biotechs and even some patient advocates. In a follow-up survey, 74% said they had never before filed an application for orphan drug designation" (Marcus, 3/10).

NPR reports on the high cost of medical school, focusing on one student, Sarah Rosen. The interest rate on her school loans "shot up to eight and a half percent, almost twice the rate [her parents] are paying after refinancing their mortgage."

"Tuition and fees at public medical schools, after all, have shot up 133 percent since 1990, according to the Association of American Medical Colleges. ... In survey after survey, the American Medical Students Association has found that the stress that comes from owing so much money absolutely influences students' decisions about what branch of medicine to pursue. .... Truth in lending requirements don't apply to federal student loans, they're not subject to bankruptcy protection. ... Education Department officials point out that under current law, medical students who owe hundreds of thousands of dollars don't have to pay more than 15 percent of their income. President Obama wants to lower that to 10 percent" (Sanchez, 3/9).

Medill Reports presents a story on community health centers in Chicago that try to fill access-to-care gaps for people too sick to get health care coverage or too poor to afford other care.

"Community health centers … are private, non-profit operations that fill a gap between for-profit health systems and free public health clinics. There are 36 of these federally qualified health centers in Illinois. Financial support comes from federal funds, Medicare, Medicaid, state programs, private insurance and philanthropies." Illinois community health centers served more than 1 million patients in 2008.

Many function as a "medical home" model of care — which serves as a sort of patient home base — that attract talented doctors. Health centers can face challenges when referring patients to specialty care, which "isn't an option" for federally-qualified centers.  And the nearby Cook County health system often has long waiting lists (Sullivan, 3/8).

The Boston Globe: "A group of Massachusetts mayors, fed up with what they say is legislative inaction on skyrocketing municipal health care costs, has launched a ballot initiative for 2012 aimed at giving cities and towns more flexibility in reducing expensive benefits for employees, retirees, and elected officials" (Murphy, 3/10).

The Associated Press/Bloomberg BusinessWeek: "An attempt by a Republican Louisiana lawmaker to nullify a federal health care overhaul before it's approved by Congress would be ridiculous and premature, the Democratic leader of the state House of Representatives said Tuesday. ... A bill filed by Republican Sen. A.G. Crowe asserts states' rights to refuse the federal mandates proposed in the congressional Democrats' health care legislation" (Deslatte, 3/9).

The (Douglas County, Minn.) Echo Press: "The Minnesota House upheld Governor Tim Pawlenty's veto of a health-care program for Minnesota's poorest residents last week, allowing negotiations on the subject to continue. Representatives sustained the veto 86-47, with 90 needed to override, but they immediately took another vote that leaves it available for future action" (Davis, 3/10).

Meanwhile, in other state news, The Associated Press/Miami Herald reports that "Republicans are touting Medicaid fraud-fighting legislation that's packed with political baggage. Republican Attorney General Bill McCollum joined GOP lawmakers at a news conference Tuesday to promote the bill (SB 8). He also disputed an allegation by Chief Financial Officer Alex Sink that he hasn't done enough to root out Medicaid fraud. ... The bill would strengthen the attorney general's Medicaid Fraud Control Unit and collocate it within the chief financial officer's department" (3/9).

Congressional Deals: Watching The Sausage Making Politico
Legislators need pork to make things happen, especially in an age when chronic obstruction has so weakened the legislative process that policy breakthroughs are almost impossible. This does not excuse all kinds of deal making, nor should we ignore that deals sometimes go too far (Julian E. Zelizer, 3/10).

Health Care Reform's Sickeningly Sweet Deals The Washington Post
Skipping through the Candy Land of the health-care bill, one is tempted to hum a few bars of "Let Me Call You Sweetheart." What a deal. For dealmakers, that is. Not so much for American taxpayers, who have been misled into thinking that the sweetheart deals have been excised. ... Regardless of what the CBO reports in the coming days, no one can claim the bill is as lean as it could be (Kathleen Parker, 3/10).

Sick Over The Health Honchos' Pay The Seattle Times
Controlling doctor and hospital bills is going to be the toughest challenge. Because it means eventually we'll all have to do something as Americans we're not very good at: Accept less. To get the hang of that, I vote we start with the guys getting the million-dollar bonuses (Danny Westneat, 3/9.)

Bending The Cost Curve – With A Crowbar The American Spectator
Having failed to excite the majority of American about covering 30 million of their fellow citizens at the expense of jeopardizing their own medical care, the Obama Administration has settled on an even more implausible reform argument -- extending these benefits will lower medical costs (William Tucker, 3/10).

Medicine In The Dark The Los Angeles Times
As medical science advances, clinical decision-making will only become more complex. Only by expanding public funding for comparative effectiveness research can we hope to put existing medical treatments and healthcare services to their best use. Doing so would ensure that national research priorities are determined by patient needs rather than by corporate agendas (Michael Hochman and Danny McCormick, 3/10).