IHA has been meeting in-person with each of the offices of Iowa’s congressional delegation and has drafted a delegation letter to CMS urging immediate action on this issue.  To date, Senator Tom Harkin, and Representatives Leonard Boswell, Steve King, Tom Latham, and Dave Loebsack have all confirmed their support on the issue and have agreed to sign onto the letter.  Staff from the offices of Senators Chuck Grassley and Harkin have also been in contact directly with CMS to outline their concerns and staff for Senate Finance Committee Chair Max Baucus have been in communication with CMS on this issue as well.

Earlier this week, CMS hosted a rural health open door forum conference call and spent most of the time discussing physician supervision.  CMS acknowledged the arising complications and encouraged hospitals to continue reaching out to help CMS understand the “real-world” impact of its policy.

CMS verbally qualified its position by stating that physicians or other allied professionals, recognized in the outpatient rule should be “fairly immediately available” and recognized that the rule doesn’t anticipate clinicians “hanging around the emergency department” with no knowledge of anticipated patient arrivals.  CMS stated that determination of “immediately available” is essentially at the discretion of the hospital.  CMS also acknowledged that this billing policy predominantly creates an issue with observation status, which is currently billed as a therapeutic service.  However, CMS stopped short of backing away from the rule as written, but confirmed that further written guidance will be provided on this topic.

IHA will continue working with Iowa’s Congressional Delegation, the Senate Finance Committee staff as well as the American Hospital Association to seek clarification and resolution of this issue.  Pending further guidance from CMS, IHA will survey Critical Access Hospital members to further refine its understanding of the scope of the problem and potential solutions.

Iowa News

Orange City auxiliary contributes $60,000 to health system
The Orange City Area Health System Auxiliary gifted a record $60,000 to the health system as its annual contribution for 2010. The money — which comes from auxiliary fundraising events and Gift Garden hospital gift shop sales — directly benefits patients and families. (Sioux City Journal)

Hancock hospital to receive Mercy skilled nursing patients
Skilled nursing patients from Hancock, Winnebago and Wright counties will soon be referred to Hancock County Memorial Hospital rather than Mercy Medical Center-North Iowa, Mercy officials announced. (Mason City Globe Gazette)

Flood warnings continue across Iowa
Ice jams along the Des Moines, Iowa, Winnebago, Shell Rock and Cedar Rivers and their tributaries may lead to flash flooding across north central Iowa through the early part of the weekend. Rapid fluctuations in stage levels are possible with little or no warning. Des Moines received .65 of an inch of rain by 7 a.m. today; Marshalltown .20 ; Denison .45 and Carroll .68. (Des Moines Register)

U.S. News

Senate-passed health care bill would cut deficit
Congressional budget referees say Senate legislation that’s now the foundation for President Barack Obama’s health care plan would cut the federal deficit by $118 billion over 10 years. The Congressional Budget Office says the $875 billion, 10-year plan would provide coverage to 31 million people who’d otherwise be uninsured. (Associated Press)

Employers plan to shift more health-care costs to workers, survey reports
Many employers say they may charge more to cover spouses, tighten eligibility standards for their health plans and dispense financial rewards or penalties based on the results of certain lab tests. At some companies, employees who are overweight could be excluded from the most desirable plans. (Washington Post)

Carrot-and-stick health plans aim to cut costs
Workers at a Portland, Ore., steel mill soon will be able to pick a new type of insurance that offers free care for some illnesses, such as diabetes or depression, but requires hefty extra fees for treatments deemed overused, including knee replacements, hysterectomies and heart bypass surgery. (Kaiser Health News)

Va. lawmakers 1st in US to pass bill banning mandatory health insurance coverage
Virginia’s General Assembly became the first in the nation Wednesday to approve legislation that bucks any attempt by President Barack Obama and Congress to implement a national health care overhaul in individual states. (Associated Press/Minneapolis Star Tribune)

Few drug studies meet comparative effectiveness definition
Comparing the effectiveness of different medical treatments, including their safety and their cost, is a cornerstone of health policy espoused by the Obama administration and funded by $1.1 billion in last year’s economic stimulus package. Two Cambridge Health Alliance doctors explored the state of current research to see how helpful drug studies might be to doctors trying to prescribe the best medications for their patients. (Boston Globe)

200 mental health jobs to be cut in Minnesota
The Minnesota Department of Human Services plans to cut 200 full-time positions from a program that provides direct care for people with mental illness, and will close mental health facilities in Cold Spring, Mankato and Eveleth. (St. Cloud Times)

Kentucky hospital cuts 500 jobs, citing declining patient load, rise in uninsured
Jewish Hospital & St. Mary’s HealthCare is eliminating 500 jobs, citing lower patient volume and a growing number of uninsured patients brought on by the lingering recession. The cuts announced Wednesday — which represent about 6 percent of the Jewish’s workforce of 8,100 — are the first large-scale job reductions in a Louisville hospital system since the economic downturn. (Louisville Courier-Journal)

The health care system in this country has really been more of a “sick care” system. Too much emphasis has been on mending bodies after health has left them. We have shielded folks from the true cost of health care through the proliferation and misuse of health insurance. The personal responsibility for maintaining optimal health has not been incented in the system. Although a growing number of Americans are health conscious, it is hard to deny the obvious epidemic of poor health. 

The “sick care” issue is at the foundation of health care reform.  It is one of the reasons health care and health insurance costs have risen.  We live in a very healthy society and most of us take it for granted, even though it was only 70 or 80 years ago that thousands of Americans were killed by accidents and diseases that scarcely exist today.  Advances in medicine, safety and nutrition keep people out of the hospital.  And when they go to the hospital, advances in treatment – like minimally invasive surgery – mean procedures are safer, recovery is faster and the likelihood of complications is greatly reduced. 

Our good health also comes with our good insurance coverage.  Since World War II, we have been a well-covered society.  On the up side, this has given broad access to the health care system and increased both the quantity and quality of life.  On the down side, as Todd notes, it has shielded health care users from the real cost of care and incented providers to offer more but not always better care. 

People don’t like going to the hospital and today they almost never have to.  But when they do go unexpectedly, it can be quite serious and very expensive.  For those with insurance, there is little incentive to prevent these occasions – the relatively low out-of-pocket cost and the fact that even very sick people are healed is what most of us see and remember.  For those without insurance, the result is often even more serious illness as they delay treatment. 

Certainly, we need to make sure as many people as possible are insured.  But how our society “uses” health care must also change and hospitals are helping make that happen with a focus on prevention and wellness.  This has been going at Grinnell Regional Medical Center in many ways and for several years, as Todd mentions.  In fact, every Iowa hospital provides services and programs that support prevention and advance wellness.  But hospitals are doing more than putting out the water and waiting for the horses to come around.  They are actively working to change our health care culture, to change our society’s mindset and put a focus on wellness. 

But cultural shifts don’t happen overnight.  It will take all of us, as health care consumers and providers, to create a true “health care” system.

Iowa News

FMCH to expand with rehab center
About a year from now, a new outpatient rehabilitation center will be serving patients of Fort Madison Community Hospital. FMCH has approved the construction of a 23,500-square-foot building, to be attached to the current northeast side of the hospital. (Fort Madison Daily Democrat)

Honoree Garcia-Padial followed father into medicine
The Alegent Health Foundation will honor four individuals from southwest Iowa for their professional and personal contributions to the community during the 2010 Heritage Dinner March 20 at Harrah’s Council Bluffs Casino & Hotel, 1 Harrah’s Blvd. Jorge Garcia-Padial, M.D., will be honored in the category of health and medicine. (Council Bluffs Daily Nonpareil)

Professor leads probe into rare eye disease
Vinit Mahajan has one very ambitious aspiration. “My mentors have invested their efforts into training me for one goal,” said the University of Iowa Hospitals and Clinics doctor. “Cure the blind.” (University of Iowa Daily Iowan)

Mercy Brain & Spine Center concentrates on complex cases
Mirza Baig, a neurosurgeon at the recently formed Mercy Brain & Spine Center, can easily rattle off three recent cases where the new team of surgeons, physical therapists, pain managers and other support personnel sprang into action to treat an injured or seriously ill patient with speed and efficiency. (Des Moines Register)

WHC offers sports enhancement program
Waverly Health Center Physical Therapy will offer a unique Sports Performance Enhancement Program for area athletes in conjunction with Wartburg College. (Waverly Democrat)

GRMC shows positive financial report
While many aspects of the economy continue to struggle and fall, the finances at Greater Regional Medical Center are looking up. The hospital’s financial report, which was updated by Greater Regional Healthcare Foundation and released last month, showed a good fiscal year for 2009. (Creston News Adverstiser)

U.S. News

Obama takes health care overhaul push to Missouri
The nation’s top health official challenged insurers on Wednesday to join President Barack Obama’s push to overhaul the medical system, arguing that if the effort fails it will hurt them as well as other Americans. Obama is to speak Wednesday in suburban St. Louis and then travel to northeastern Ohio on Monday, his third health care event in a week. (Associated Press)

Parliamentary hurdle could thwart latest health care overhaul strategy
The White House and Democratic Congressional leaders said Tuesday that they were bracing for a key procedural ruling that could complicate their effort to approve major health care legislation, by requiring President Obama to sign the bill into law before Congress could revise it through an expedited budget process. (New York Times)

Health care ad cyclorama to clog airwaves
It’s not quite election season, but President Obama is on the stump, pushing his health care bill. Now, millions of dollars in political ads aimed at swaying Congress are hitting the airwaves. (USA Today)

New tool lets patients call the shots at end of their lives
The document has an awkward name — Provider Orders for Life Sustaining Treatment, or POLST — but it seems to work. Where it is standard practice, most notably Oregon and La Crosse, Wis., far fewer people die in intensive care units hooked up to machines they didn’t want. (Minneapolis Star Tribune)

Group appointments give patients better access to physicians
Caring for multiple patients simultaneously has gotten a new boost as the nation urgently searches for sustainable models of health care. The group visit was cited as one of 10 trends to take seriously by the Future of Family Medicine Project, a national effort headed by the American Academy of Family Physicians looking for ways to improve the delivery of health care for both patients and their doctors. (Washington Post)

Mayors want health costs on ballot
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. (Boston Globe)

Cost of medical school rises in recession
A family is struggling to pay for their daughter’s medical school education. They know that the average doctor graduates with about $150,000 of student loans, and wonder how they’re ever going to pay it. (National Public Radio)

Iowa News

Medicare cuts could limit care, doctors say
Local health-care providers warn a proposed 21 percent reduction in their Medicare reimbursements could reduce care for the tri-state area’s older adults. (Dubuque Telegraph Herald)

Paradigm shift: Broadlawns builds for the future
“Our long-term goal, and we’ve talked about this at the board level, is really to be the best small public hospital in America, and I think we’re well on our way to doing that,” said Jody Jenner, CEO at Broadlawns Medical Center in Des Moines. (Des Moines Business Record)

Future is bright for Trinity Muscatine
Trinity Muscatine still offers convenient access to local health care with knowledgeable, yet familiar, physicians, nurses and staff. People can expect hometown care, but we are also able to tap into more specialized services that the Trinity system has a stellar reputation for providing. (Muscatine Journal)

VA’s decision on clinic site coming soon
In just a few weeks, Winneshiek Medical Center should know if the Veterans Administration plans to locate a community based outpatient clinic (CBOC) on its campus. According to WMC Chief Medical Officer Dan Werner, the VA has extended its application process by one day, for entities interested in submitted a proposal for a CBOC site. (Decorah Public Opinion)

Coalition seeks to address Iowa’s nurse shortage
As Iowa’s Baby Boomers get older, will there be enough nurses to provide care for them? If present trends continue, the nursing work force will fall far short of the increasing demand from the state’s aging population, say health-care experts. (Des Moines Business Record)

Employers expect to hire more
According to the latest Manpower Employment Outlook Survey, 14 percent of companies in the Cedar Rapids metropolitan area, which includes Iowa City and Johnson County, said they expect to hire more people from April to June. That is more than the 11 percent of area employers who said they planned to add more people from January through March. (Iowa City Press-Citizen)

U.S. News

Obama makes health care pitch
“We can’t have a system that works better for the insurance companies than it does for the American people,” Mr. Obama said. “We need to give families and businesses more control over their own health insurance.” House Minority Leader John Boehner (R., Ohio) characterized Mr. Obama’s speech as a rerun of past rhetoric. (Wall Street Journal)

Lights, camera, reconcile!
The yearlong debate over health care reform — a titanic contest involving big ideas, passionate convictions and lofty principles — is headed toward a highly unlikely endgame: a clash between parliamentary procedure attorneys. (Politico)

Anyone remember what’s in the health care bill?
Since the Senate passed its version of a health overhaul on Christmas Eve, most of the debate has focused on the politics of the effort. By now, many people have forgotten — if they ever knew — what the bill would actually do. So here’s a short refresher. (National Public Radio)

Lawsuit caps proposal could be headed to Illinois voters
In response to the Illinois Supreme Court’s decision last month overturning the state’s cap on medical malpractice awards, state Sen. Dave Luechtefeld, R-Okawville, has introduced a constitutional amendment that would prevent the state’s high court from overturning future medical malpractice reform laws. (Legal Newsline)

N.C. hospital infection data kept from public
Don Dalton, an N.C. Hospital Association spokesman, said public reporting is not mandated in North Carolina because the state isn’t ready. “The state recognizes that to put out inaccurate and insufficient data would be potentially as much harm to the public as much as a benefit to the public,” he said. But Dalton, as well as legislators and other health care officials, said he thinks N.C. hospitals will be required to report infection rates to the state government soon, possibly within the next two years. (Charlotte Observer)

Senate panel to investigate deaths at long-term care facilities
The Senate Finance Committee has opened an investigation into patient deaths and allegations of substandard treatment at long-term care hospitals, small specialty medical centers that treat chronically ill patients. (New York Times)

Iowa News

Look out for Iowans, not just insurers
Wellmark Blue Cross and Blue Shield raised premiums an average of 18 percent this year for Iowans who buy health insurance on their own. People are wondering how the company can justify this when it’s spending $250 million on a new headquarters and $2.4 million on its chief executive’s pay. Iowans have a lot of questions. So do state lawmakers. But getting satisfactory answers isn’t easy. (Des Moines Register)

Health premiums depend on cultural changes
The current health care crisis of double-digit rate increases by insurance companies, including Wellmark Blue Cross and Blue Shield in Iowa, was predictable. In fact, a statewide study warned six years ago that rising medical costs were on the brink of creating a financial crisis for Iowa employers. But little was done, and things got worse. (Des Moines Register)

Legislators split over how to handle the Iowa Power Fund
Democrats at the Statehouse are divided over a key component of the budget. They’re wrangling over how much money to invest in the Iowa Power Fund. The $25-million-a-year grant program was created in 2007 to support renewable energy projects across the state. The top two Democratic leaders in the senate say they want to protect it from the 10 percent budget cut applied to the rest of state government. (Radio Iowa)

This won’t hurt a bit
A physician talks about his experience as a hospital patient and how it changed the way he perceives patients and practices medicine. (Alegent Health Blog)

U.S. News

Healthcare overhaul comes down to Pelosi and Obama
The bill’s fate depends on whether the House speaker can land enough votes – and whether the president can take control of the debate, which Democrats say he has not done. (Los Angeles Times)

Under health reform, Medicaid would cover many childless adults
While Medicaid is the main government health insurance plan for the poor, the joint state-federal program has excluded Matthews and millions of other adults with no dependent children since the 1960s. Medicaid has been limited mainly to children in poor families, the elderly, pregnant women and the disabled. Some states have tried to fill the gap, but childless adults now comprise a majority of uninsured Americans. (Kaiser Health News)

How would health care overhaul help young people?
Critics warn that low-cost policies would leave young people financially vulnerable and reluctant to seek care. Supporters counter that the plans would help young people who otherwise might be uninsured. “Any coverage is always better than no coverage,” says Leslie Norwalk, acting administrator of the Centers for Medicare & Medicaid Services during the George W. Bush administration. (USA Today)

How Blue Cross became part of a dysfunctional health care system
The only solution is to prohibit all insurers from discriminating against the sick and to make sure that everybody is part of large, financially sound insurance groups in which there are enough healthy people to subsidize the cost of the sick. (Kaiser Health News)

Medical care vanishing in rural Wisconsin
Since 2001, several rural hospitals have cut services that typically lose money, according to an analysis of a Wisconsin Hospital Association database by the Rural Wisconsin Health Cooperative and the Wisconsin State Journal. (Wisconsin State Journal)

Costs of insuring the poor shift to Minnesota hospitals
About 30,000 poor Minnesotans will continue to receive health insurance coverage under a deal reached Friday by Gov. Tim Pawlenty and DFL legislative leaders. General Assistance Medical Care was scheduled to run out at the end of the month and supporters of the program were worried the state’s poorest would have no health coverage at all. (Minnesota Public Radio)

Lawmakers consider banning hospital advertising
After year upon year of struggling to rein in the ballooning cost of health care, a Vermont state legislator is unsure whether hospitals should be spending their money — or ratepayers’ money — that way. He has proposed legislation that would prohibit them from using money for advertising and marketing. (Burlington Free Press)

Miami’s Jackson Health System puts 2 hospitals on chopping block
With cash set to run out in May, Jackson Health System has announced plans to lay off 4,487 employees — more than a third of the work force — and close the system’s two satellite hospitals. (Miami Herald)

‘Speed-dating’ doctors woo patients
New in town, Brandy Preston reasoned that it was only lunch. She liked the fact that there were no strings attached. If she didn’t like the person, she could just say, “It was nice to meet you,” and leave. “I was surprised because it felt so comfortable and I wasn’t afraid to ask questions,” the 29-year-old said. “I mean, I’d finally met the right match. This gynecologist was exactly who I wanted.” (CNN)

Iowa News

Culver: Iowans should prep for floods
Spring flooding is all but inevitable this year, Gov. Chet Culver warned Thursday, urging Iowa residents to prepare for high water by assembling emergency kits and to consider buying flood insurance. The biggest dangers are in the basins of the Des Moines, Raccoon, Iowa and Cedar rivers, Culver said at a news conference. (Des Moines Register)

Orange City hospital developing new nursing home
Orange City is preparing for the future by developing a new senior care campus. The Orange City Area Health System purchased 37 acres to develop over the next few years. The 83-bed nursing home will be just west of the Landsmeer Ridge senior living community on the north side of the city. It will offer a village-style care center for the aging Baby Boomer generation. (KMEG)

Help for Haiti
Registered nurse Johnna Lindstrom of Oelwein, who works at Mercy Medical Center in Cedar Rapids, recently decided to take her life quest a step above and beyond her regular duties. Although she knows she helps people every day in her current profession, she felt she could do even more by extending her skills to the people of earthquake ravaged Haiti. (Oelwein Daily Register)

Iowa Health System launching scholarship
Iowa Health System is partnering with the Des Moines branch of the National Association for the Advancement of Colored People to offer scholarships for under-represented high school seniors pursuing careers in health care. Each year, one student will be selected based on an essay about his or her commitment to improving America’s health care system. (Des Moines Register)

Lab tech develops good swimmers
Get involved, the boss said. Make a difference in the community, the boss said. Not only did Robert Volpe comply to the request of his employer, Fort Madison Community Hospital, but he was able to help out in an area he is familiar with: swimming. “The hospital is very big on employees being involved with the community,” Volpe said. “This (being swim coach) was a chance to get involved.”

Sunshine circle working to brighten the day at Finley Hospital
If you often visit loved ones in the hospital, you may be very familiar with the hospital gift shop. But what you may not know is at Finley Hospital in Dubuque all the profits made in the gift shop are donated back to the hospital. More than $58,000 was donated to Finley hospital in 2009. (KCRG)

U.S. News

Obama intensifies health-care efforts
An aide to President Obama urged lawmakers on Thursday to make substantial progress on his health-care plan before he leaves on a foreign trip in mid-March, as Obama summoned wavering House Democrats to the White House for a private sales pitch. (Washington Post)

Pressure mounts for/against health care bill
As President Obama pushes for a prompt up or down vote on his health initiative, lobbyists and activist groups on both sides of the issue have launched grass-roots and high-dollar advertising campaigns on the roughly two dozen members of Congress who may be the final swing votes on the controversial issue. (Los Angeles Times)

I’m a Medicare doctor. Here’s what I make
When you think of low-paying jobs, doctor doesn’t usually come to mind. But with a 21 percent cut in Medicare payments slated to take effect later this month, physicians who say they are making an OK living may be reduced to income levels that no longer make their profession viable. That’s especially true for those still paying medical school costs and other training. (CNN)

How much fraud and abuse is there in U.S. health care
The regulations surrounding the rendering of health care services to the federal government are immensely complex. They seem to be based on the idea that every provider of these services is a latent crook. Other countries manage the process by exception. They go by the assumption that the bulk of providers of care are honest and then merely go after the statistical outliers. Far less money is spent on billing in those countries. (New York Times)

Minnesota residents sue to save expiring health plan
Three Minnesota recipients of General Assistance Medical Care filed a lawsuit against Gov. Pawlenty and other state officials Thursday to keep the subsidized health care program in place, at least temporarily. (Minnesota Public Radio)

Hospitals present 3.5 percent fee to raise TennCare funds
Tennessee Hospital Association leaders briefed state officials Thursday about their plan to raise $229.5 million from a 3.5 percent fee on hospitals. Hospital officials said the money — meant to offset many of Gov. Phil Bredesen’s proposed TennCare cuts — will be raised through what they are calling an “enhanced coverage fee” and would draw an additional $429.6 million in federal matching funds. (Chattanooga Times Free Press)

Health and care
Primary medicine may be on the decline in prestige and pay, but the fancy surgical specialties can’t offer the same daily dose of satisfaction, heartbreak, and connection. Judy Paley, a primary care doctor with a two-person practice and a load of bills in Denver, has started a blog brimming with what she calls “close encounters of the life-saving kind.’’ Reading it is good for what ails you. (Boston Globe)

Dr. Judy Paley

Anyone who spends enough time around health care and medicine knows there is no shortage of reading material.  More heavily regulated than the nuclear power industry, the sum of federal, state and local health care policies make the tax code look like a walk in the park.  The 2,400-page health care reform bill? Somewhat impressive, but far from unprecedented.

Outside the regulatory arena, the reading becomes somewhat more interesting. Journals and assorted periodicals cover every specialty.  Health care books could fill a whole aisle or more at Barnes & Noble, and they do.  Many of them are huge tomes by self-indulgent practitioners that leave one immediate impression: When did this guy have time to see patients? 

But there are treasures out there, and one of them is a blog by Judy Paley, a primary care doctor with a two-person practice in Denver.  And the Denver she works in is the one in Colorado, not in northwest Iowa.  That needs to be pointed out, because Dr. Paley sounds and writes like a small-town, patient-centered, community-loving doc.  Her “Medical Moments in 55 Words or Less,” as she calls her blog, have been described as health care haiku.  They are sad, funny, illuminating and the very definition of poignant. 

Give yourself a treat and check out what Dr. Paley so generously shares.

Iowa News

Grassley stands firm on health care bill
Iowa Sen. Charles Grassley said Wednesday that President Barack Obama was sincere in incorporating into health care legislation Grassley’s suggestion that Congress put more money into insurance programs for low-income Americans. But Grassley said the gesture was insufficient to win his support for the president’s bill. Grassley also noted the provision Obama suggested did not include Grassley’s proposed spending cuts to pay for it. (Des Moines Register)

Iowa surgeon featured on Discovery TV program
Dr. Dan Waters, cardiac surgeon at Mercy Heart Center in Mason City, will be featured on a Discovery Channel program today. Waters will appear in “Stone Cold,” one in a series of programs on “Surviving Death” being broadcast on the Discovery and Discovery HD Channels. The program will air at 8 and 11 p.m. tonight. (Waterloo-Cedar Falls Courier)

County delays building new ambulance facility
Budget cuts for fiscal 2011 led the Johnson County Board of Supervisors to propose holding off on pledging funds for a new building to house the ambulance and medical examiner facilities. By not immediately pledging money toward the building project and postponing other payments, the property-tax increase in 2011 will be 1.8 percent rather than 4.3 percent. (University of Iowa Daily Iowan)

U.S. News

Obama’s new game plan: Be more assertive
President Barack Obama will be more assertive with Congress after disappointing members in his first year with mixed signals during the healthcare debate, Democrats say. Obama made a crucial mistake not rallying the party behind a detailed healthcare reform proposal earlier in the debate, Democrats in both chambers broadly acknowledge. (The Hill)

Obama summons waffling Members to the White House to talk health care
Obama reached out to different factions of House Democrats on Wednesday night and asked them to meet with him this afternoon in two separate meetings. Several lawmakers who were invited said Obama didn’t tell them what the meetings were about, but that it was fairly obvious based on the guest list. (Roll Call)

Some small businesses see burden in ‘Cadillac’ tax
Higher-cost plans, dubbed “Cadillac” policies by some, often have generous benefits with low deductibles and co-payments, but this is not always the case. Premiums may also be high because customers are charged more because of their age, gender, geographic area or heath status. (Kaiser Health News)

21 District hospital workers fired for being blizzard no-shows
Washington Hospital Center fired eight more employees this week after they failed to show up for work during last month’s crippling snowstorms. The hospital announced that it has also rehired three of the 16 workers it had terminated. (Washington Post)

Concern over ‘metal on metal’ hip implants
Some of the nation’s leading orthopedic surgeons have reduced or stopped use of a popular category of artificial hips amid concerns that the devices are causing severe tissue and bone damage in some patients, often requiring replacement surgery within a year or two. (New York Times)

“I believe the United States Congress owes the American people a final vote on health care reform,” Obama said.  He continued by mentioning a myriad of other bills that were passed with a simple majority rather than the currently required “super-majority” of 60 votes needed in the Senate to pass legislation.

The Democrats held onto a 60 vote majority until the election of Republican Scott Brown in Massachusetts.

Republican lawmakers insist that using the reconciliation procedure would cause outrage in the public and further the intense partisan gridlock facing the Congress.  Regardless, Obama requested that Congress take action in the next few weeks.  The president also highlighted the Republican ideas that he has agreed to include in his proposal and again told Republicans that starting over is not an option.

IHA will continue to monitor the process along with the new budget numbers and coverage estimates that result from the president’s new proposal.