In response to my question about pharmaceutical cuts being included in the debt ceiling negotiations, The Hill’s Julian Pecquet reports that Republicans and Democrats may both agree on a provision to extend Medicaid drug rebates to dual eligibles:

By demanding that the rebates count as revenue raisers rather than spending cuts, Republicans would be able to say they’re meeting Democrats halfway — without actually having to raise taxes, which is anathema to conservatives. The proposal would extend Medicaid drug rebates to the nation’s 9 million “dual eligibles,” who are on both Medicaid and Medicare but aren’t currently covered by the rebates.

“This way [Republicans] can look like they’re going along with something that raises funds,” said a well-placed health policy consultant.

The source points out that there’s some precedent for that claim, since part of the drug lobby’s contribution to the healthcare reform law came in the form of rebates for seniors who reach the Medicare “doughnut hole.” And since drug rebates are already offered in the Medicaid program, Republicans could claim they’re simply extending current law into Medicare’s Part D drug benefit.

Back in 2003, the Medicare part D legislation moved the 6 million Americans who were eligible for both Medicare and Medicaid into the Medicare part D program, thus creating a windfall for the industry. Whereas Medicaid obtained an average discount of about 34 percent from pharmaceutical companies that participated in the Medicaid program, “the average discount obtained by the Part D plans was 14 percent,” according to a report issued by Rep. Henry Waxman (D-CA). As he put it, “The drug companies are making the same drugs. They are being used by the same beneficiaries. Yet because the drugs are being bought through Medicare Part D instead of Medicaid, the prices paid by the taxpayers have ballooned by billions of dollars.” CBO estimates that if drug manufacturers provided the Medicare Part D program with the same prices that Medicaid receives, the government could save $112 billion over 10 years.

One Washington investment analyst tells Pecquet, “PhRMA is scared, and I think they have reason to be.”

Back in 2007, President George W. Bush’s Center for Medicare and Medicaid Services (CMS) “initiated a secret shopper program that would secretly monitor the practices of various health plans offering Medicare Advantage and prescription drug plans” to ensure that payers were complying with CMS marketing guidelines. The program was so successful that “CMS decided to continue the secret shopping through the 2008 Open Enrollment period for Medicare Advantage.” In 2004, the Government Accountability Office (GAO) relied on secret shoppers to examine the effectiveness of Medicare’s help line.

Flash forward a few years, and President Obama’s Department of Health and Human Services proposes assembling a team of “mystery shoppers” to pose as patients at primary care doctor offices “to see how doctors responded to prospective patients’ requests for an appointment, depending on whether they are privately insured or government-insured (Medicaid or Medicare recipients).” Republicans — who didn’t have a problem with Bush’s programs — now stand outraged, even after the administration backed down from its proposal. Rep. Tim Price (R-GA) has just sent out this fundraising plea:

As a physician, I know from personal experience that a doctor’s primary focus should be on providing the highest quality of care to his or her patients. Instead, doctors would have to worry whether the bureaucrats behind Obamacare were spying on them. I, along with dozens of my House Republican colleagues, immediately called on President Obama to put an end to this half-baked proposal.

Then, just days later, the Department of Health and Human Services — home of the unelected bureaucrats President Obama wants in charge of our health care — said they were abandoning their proposal to spy on doctors.

This episode illustrates a critical fact: The Conservative Republican Majority in the House is the only thing standing between you and the out-of-control Obama Administration.

In 2010, we saw a new wave of principled conservatives sweep into Washington, and together, we immediately began the roll-back of President Obama’s agenda. Your support of the House Conservatives Fund means these strong, conservative voices can fight back against the attacks of the left.

And so it’s unclear what the administration won in abandoning the program: Republicans are still hitting them over the head with it and will undoubtedly continue to raise fears about limited access to physicians and blame Obama for failing to take their concerns seriously.

I’ve recently been told that liberal groups and blogs are eager to pounce on the administration for not living up to certain progressive principles but rarely highlight instances of accomplishment. And so, it’s in an effort to correct the imbalance that I point to the government’s efforts to reduce health care premiums in the federally-run, high-risk insurance pools — temporary coverage programs for uninsured people who can’t find coverage in the individual market — and encourage more uninsured Americans to sign up:

Uninsured sick people got some good news recently, or some of them did, anyway. Starting July 1, the Obama administration reduced the premiums by up to 40 percent in special high-risk insurance plans that the federal government is running in 17 states and the District. [...]

On the low end, Mississippi will reduce premiums by 2 percent. Several states will cut monthly rates in the 15 to 25 percent range, including the District , which will reduce premiums by 18 percent. Six states, including Virginia, will reduce their premiums by 40 percent.

The change means that a 55-year-old District resident who would have owed $551 per month under the old rates for the standard plan will now owe $450. In Virginia, the same person’s premium would now be $297 monthly, compared with $498 before.

The premium rates in the 23 states where the federal government runs risk pools will now more closely resemble the “rates for individual policies in each state,” which, while lower than what those pools had been charging, are still prohibitive for many of the individuals who would quality for coverage.

Still, a recent report from the Commonwealth Foundation found that high premiums aren’t solely responsible for pools’ relatively low enrollment rates. “[P]eople with preexisting conditions who have been uninsured for a long time may have stopped looking” for coverage, the government has conducted limited outreach efforts (due to the relatively fast implmentation schedule), and given the multiple court challenges to reform and the media’s taste for covering negative verdicts, Americans may simply be confused about the status of the law, the report found.

This M.B. Pell article in the Atlanta Journal-Constitution points to a trend that’s now all too common in corporate America:

Hospitals across the region are cutting staff, elected officials are considering slashing Medicaid and Medicare funding and medical bills are driving an increasing number of Georgians into bankruptcy.

But the six- to seven-digit compensation packages for the chief executives who lead metro Atlanta’s taxpayer-subsidized hospitals remain untouched and in most cases are growing.

Five of these CEOs made more than $1 million in the fiscal year ending in 2009, the last tax records available.

Edward Bonn of Southern Regional Health System, which operates Southern Regional Medical Center and two affiliated facilities, made $2,610,175 in fiscal 2009. Bonn left the system that year and received his pay of $421,822 plus $2.2 million from a retirement plan. Hospital CEOs commonly receive extra pay from retirement plans when they leave.

Bonn did not receive a bonus because the hospital system lost $12 million that year, the hospital said.

So as hospital CEOs are still taking home hefty paychecks, tax exempt hospitals — which also receive millions in government grants — are cutting staff and their associations are lobbying the government against including any additional Medicare cuts in the debt ceiling negotiations. In fact, the American Hospital Association “spent nearly $4.1 million in the first three months of the year lobbying the federal government on the health care overhaul and several bills tied to it,” Forbes recently reported.

The fact still is that any additional cuts will be felt by patients first and executives last — a situation that screams for greater regulation of the CEO compensation packages of tax-exempt institutions and points to some of the access in the health care system.

Politico’s Dan Nather has this handy guide of the health care cuts that could be included in the debt ceiling negotiations. He writes that industry groups that were shielded from reductions in the Affordable Care Act may be particularly vulnerable to seeing cuts now, since Democrats have promised to avoid direct benefit reductions. Some cuts that may already be part of the deal, via New York Times’ Robert Pear:

— Gradually eliminate Medicare payments to hospitals for bad debts that result when beneficiaries fail to pay deductibles and co-payments. Medicare reimburses hospitals for 70 percent of such debts after the hospitals make reasonable efforts to collect the unpaid amounts.

– Reduce Medicare payments to teaching hospitals for the costs of training doctors, caring for sicker patients and providing specialized services like trauma care and organ transplants. Medicare spends $9.5 billion a year for its share of those costs.

– Reduce the federal share of payments to health care providers treating low-income people under Medicaid and the Children’s Health Insurance Program. The administration wants to establish a single “blended rate” for each state. The federal government now reimburses states at different rates for different groups of people and different services in the two programs.

Obama’s blended rate proposal is basically a cost shift to the states and beneficiaries, and is possibly the most troubling of the three provisions. As for the first two: the hospitals have launched a massive ad buy to forestall the cuts, but it’s difficult to feel much sympathy for providers who will see an increase of revenue as a result of the coverage provisions in the Affordable Care Act.

Thomas Scully, who ran CMS from 2001 to 2004, has argued that “hospitals are probably the biggest winners” from health reform — “They got hardly touched and got a lot of new money.” The Tennessee Hospital Association’s (THA) concluded that even after accepting $155 billion in cuts in the Affordable Care Act, hospitals will net about $16 billion from reform. “The breakdown estimates that the industry will receive additional money of about $171 billion over those same 10 years as a result of reimbursements for newly insured patients…In other words, the hospitals would give up $155 billion in cost cuts, but take in $171 billion in new money — a net gain of $16 billion,” the association estimated.

Big Pharma also did well — recall that they put $80 billion on the table to help pay for the Affordable Care Act but successfully forestalled measures that would have allowed Medicare to bargain for cheaper drugs and extended drugmakers’ Medicaid rebates to the “dual eligibles.” If Pear’s article is any indication of what the current deal looks like, pharma still isn’t providing any additional savings.

A federal judge has temporarily blocked Kansas from enforcing new licensing regulations against its three abortion providers, but that doesn’t mean that the state is letting up in its effort to outlaw abortions across the state. To the contrary, Gov. Sam Brownback’s (R) administration plans to enact new permanent regulations that may be identical to the temporary rules being challenged in court:

The Kansas Department of Health and Environment already had plans for a new set of rules even as it finished regulations that would have taken effect Friday. The agency described the first set as temporary, which allowed it to avoid taking public comments and get the rules in place within weeks, though they could remain in effect afterward for only four months. The next set of rules would be considered permanent and require public comment. [...]

Robert Moser, secretary of health and environment and a Brownback appointee, said his department respected the ruling and would “follow the law.”

But Moser added: “Judge Murguia’s ruling is narrowly tailored and does not prevent KDHE from moving forward to establish permanent licensing regulations.” [...]

Department officials have said their proposed permanent rules are identical to the temporary ones blocked by Murguia. Cheryl Pilate, an attorney for the Aid for Women clinic in Kansas City, Kan., said if the department makes few or no changes, providers will challenge the next set “for the very same reasons.”

“Those would certainly be taken up into the lawsuit,” she said.

The licensing rules — which are far more stringent and specific than what the state currently requires of hospitals and ambulatory surgical centers — had shut down two of Kansas’ three abortion clinics. One provider, Planned Parenthood of Kansas and Mid-Missouri clinic, received an abortion license last Thursday — “after being initially denied and undergoing a second inspection.” All three clinics will now be allowed to operate until the lawsuit against the regulations are resolved.

Proponents of the new regulations argue that stricter licensing standards would help improve women’s safety, a notion the judge challenged before issuing a stay of the regulations. Indeed, as RH Reality Check’s Jodi Jacobson argues, “[s]uperfluous regulations put in place to delay or deter women from obtaining abortions–along with stigma, discrimination, and clinic harassment–only push them later. The later a termination is performed, the more risks are involved. While second trimester abortions are both relatively rare and relatively safe, especially early on in that phase, they involve higher risks than do first trimester abortions.” Additionally, she adds, “But causing delays and obstacles are what Kansas legislators are all about.”