WASHINGTON — A Democratic senator, Ron Wyden of Oregon, and a Republican member of the House, Paul D. Ryan of Wisconsin, unveiled a bipartisan plan on Wednesday to revamp Medicare and make a fixed federal contribution to the cost of coverage for each beneficiary. The lawmakers aim to reshape the debate over the giant health insurance program by addressing concerns that have provoked fierce opposition to similar ideas in the past. Just as important as the details of their proposal was the fact that the two were working together on an issue that both parties have exploited for political advantage.

The proposal would make major structural changes in Medicare and limit the government’s open-ended financial commitment to the program. Under the proposal, known as premium support, Medicare would subsidize premiums charged by private insurers that care for beneficiaries under contract with the government.

Congress would establish an insurance exchange for Medicare beneficiaries. Private plans would compete with the traditional Medicare program and would have to provide benefits of the same or greater value. The federal contribution in each region would be based on the cost of the second-cheapest option, whether that was a private plan or traditional Medicare.

Read more on the Wyden-Ryan Medicare proposal from the New York Times here.

The managed care industry’s growing role in Medicaid got a boost Monday when the Obama administration approved Texas’ plan to shift one million additional recipients into private health plans by 2013.

The approval is the latest signal the administration will give broad leeway to states to expand managed care in Medicaid if they meet performance measures showing they are improving care. Currently, about half the 60 million people in Medicaid, the state-federal program for the poor, are covered by private managed care plans that have promised to coordinate care and hold down spending.

The Centers for Medicare and Medicaid Services (CMS), which oversees the program, has been pushing to make states and hospitals more accountable for how they use federal Medicaid dollars.

The agency is targeting the dollars “to improve care rather than just giving it to hospitals to use as they see fit,” said James Verdier, a senior fellow at Mathematica, a nonpartisan think tank.

“CMS is doing exactly the right thing,” said Sara Rosenbaum, a health policy professor at George Washington University.  “I think other states will follow.”

Read more on efforts to link the Medicaid managed care expansion to performance from Kaiser Health News here.

More than 2.65 million Medicare recipients have saved more than $1.5 billion on their prescriptions this year, a $569-per-person average, while premiums have remained stable, the government plans to announce today.

That’s because of the provision of the health care law that put a 50% discount on prescription drugs in the “doughnut hole,” the gap between traditional and catastrophic coverage in the drug benefit, also known as Part D.

And, as of the end of November, more than 24 million people, or about half of those with traditional Medicare, have gone in for a free annual physical or other screening exam since the rules changed this year because of the health care law.

Get more details at USA Today.

WASHINGTON — The National Academy of Sciences said Thursday that the federal government should explicitly consider cost as a factor in deciding what health benefits must be provided by insurance plans under President Barack Obama’s health care overhaul, and it said the cost of any new benefits should be “offset by savings” elsewhere in the health care system.

Moreover, it said, in defining “essential health benefits,” the government should try to guarantee that the average premium would not exceed benchmarks that would be set by the secretary of health and human services.

Read more on the discussion of weighing costs in health coverage from the New York Times.

The Obama administration on Monday cleared the way for the U.S. Supreme Court to decide in its 2011-12 term the president’s signature healthcare law that requires Americans to buy insurance or face a penalty.

A Justice Department spokeswoman said it decided against asking the full U.S. Appeals Court for the 11th Circuit to review the August ruling by a three-judge panel of the court that found the requirement unconstitutional.

The decision not to seek review by the full appeals court will likely speed up consideration of the matter by the high court in its 2011-12 term that begins next week. A ruling could come by late June, in the middle of the presidential campaign.

The Supreme Court has long been expected to have the final word on the legality of the individual mandate, a cornerstone of President Barack Obama’s healthcare law. A big uncertainty has been over when the court would decide the issue.

The law’s fate before the nine-member court, closely divided with a conservative majority and four liberals, could come down to two Republican appointees, Chief Justice John Roberts and Justice Anthony Kennedy, legal experts have said.

Find out more from Reuters.

The grants come on the heels of new rules that require insurers to post on their websites explanations of premium increases exceeding 10% and to justify the hikes to state and federal regulators, who also will post them starting this year.

The grants continue the administration’s efforts to step up regulation of health insurance markets by bolstering state regulators, who retain responsibility for overseeing the industry.

“We absolutely expect for this … to help have a moderating influence on premiums,” said Steve Larsen, who oversees the insurance efforts at the Department of Health and Human Services.

Some states, such as Oregon and Rhode Island, have the power to block rate hikes they deem excessive. But 30 states still don’t have this authority in both the individual and small-group markets, according to a 2010 survey by the nonprofit Kaiser Family Foundation. The federal government doesn’t have the power to reject premium increases.

The Obama administration has urged states to pass legislation giving them veto authority over rates.

President Obama’s plan to require individual Americans to obtain health insurance or pay a penalty, a key pillar of his health-care legislation, is unconstitutional, a federal judge ruled Tuesday in Harrisburg.

U.S. District Judge Christopher C. Conner said in a 53-page opinion that the federal government’s power to regulate commerce did not give it the authority to compel individual citizens to purchase products against their will.

The lawsuit was filed by a married couple from Etters in York County against Health and Human Services Secretary Kathleen Sebelius, asking that the law be overturned. The couple, Barbara Goudy-Bachman, 48, and Gregory Bachman, 56, said they dropped their health-care coverage because of the expense – more than their monthly mortgage payments.

The couple, who operate a bait-and-tackle and marine engine-repair shop, said they preferred to pay for their health care out of pocket.

“The nation undoubtedly faces a health-care crisis . . . and the costs to all citizens are measurable and significant,” Conner said. “The federal government, however, is one of limited enumerated powers, and Congress’ efforts to remedy the ailing health-care and health-insurance markets must fit squarely within those powers.”

The case is one of several dozen lawsuits playing out in various jurisdictions challenging the constitutionality of Obama’s Patient Protection and Affordable Health Care Act, which seeks to provide health-insurance coverage to the 40-plus million Americans without insurance.

Check out the rest of the article to learn more, including the broader implications of this and similar lawsuits across the country.

Kansas is returning a $31 million grant to help implement the federal healthcare reform law.

Gov. Sam Brownback (R) announced Tuesday that his state would return its “early innovator” grant. Tea party activists have criticized Brownback for accepting the money, saying his decision validated the healthcare law and undermined the lawsuits against it.

“Every state should be preparing for fewer federal resources, not more,” Brownback said in a statement. “To deal with that reality Kansas needs to maintain maximum flexibility. That requires freeing Kansas from the strings attached to the Early Innovator Grant.”

The healthcare reform law directs states to set up insurance exchanges — new marketplaces for buying coverage. And it provides early innovator grants for a handful of states to begin building the logistical systems to run an exchange and share that progress with other states.

Brownback defended the grant just last month. He said Kansas didn’t have to use the money to implement the healthcare law.

For more on the issue, go to The Hill

State legislators are concerned that a new program in the healthcare reform law will reopen a series of problems that states tackled years ago.

The National Conference of Insurance Legislators is worried about the law’s new long-term-care insurance program, known as CLASS.

NCOIL President George Keiser, a Republican state lawmaker in North Dakota, said the group is worried that the U.S. Health and Human Services Department eventually will have to raise premiums for the CLASS program significantly, driving people away from buying long-term-care insurance.

CLASS is slated to begin collecting premiums before it pays out benefits, to help ensure it has enough money on hand to cover claims for long-term care, such as nursing-home stays. But Keiser said HHS hasn’t done enough to make sure that CLASS’s premiums will be high enough to cover its costs.

For the rest of the story, read The Hill

The Supreme Court was asked on Wednesday to hear a challenge to the health care overhaul law, raising the possibility that the justices could rule on the matter by next summer, just months before the presidential election. Similar requests are likely to follow, and it is not clear which if any of them the court will agree to hear.

The petition submitted Wednesday was an appeal from a divided decision last month by a three-judge panel of the United States Court of Appeals for the Sixth Circuit, in Cincinnati. The decision was the first appeals court ruling on the constitutionality of the law, the Patient Protection and Affordable Care Act.

The decision was also notable because Judge Jeffrey S. Sutton, a prominent conservative judge who had served as a law clerk to Justice Antonin Scalia, joined the majority in upholding the law. Additional decisions on the constitutionality of the law are expected soon from other federal appeals courts, including ones in Atlanta and Richmond, Va.

The Sixth Circuit case was brought by several individuals and the Thomas More Law Center, which describes itself as a defender of “America’s Christian heritage and moral values.” They argued that a provision of the law, which requires the purchase of insurance in some circumstances, exceeds the powers granted to Congress by the Constitution.

For the rest of the story, read The New York Times