States want flexibility in implementing the health care law, and President Obama told the National Governor’s Association yesterday that he supported a bipartisan bill that would allow states to apply for innovation waivers in 2014 instead of in 2017, as currently written into the health law. This bill, introduced last year by Sens. Ron Wyden (D-Ore.) and Scott Brown (R-Mass.) would allow states to opt out of major provisions like the individual mandate and pursue alternative routes to reform—as long as they meet the same coverage targets as the federal plan. Kathleen Sebelius, Secretary of the Department of Health and Human Services, called this action “another crucial step in empowering states to lead,” giving Vermont, for example, a chance to try a single-payer approach at the same time that Utah was developing a market-driven insurance exchange.

Meanwhile, Obama’s announcement was greeted far less enthusiastically by conservative critics of the health law who are intent on repealing the entire legislation, not making it more innovative. “Mandating many of the same requirements, this plan would treat states as agents of the very law these governors are running away from,” said Michael Steel, spokesman for Speaker John Boehner. “A better approach would be working with reform-minded governors to give states more flexibility to lower health care costs immediately by, for example, fixing costly federal regulations on Medicaid.” This chilly reception doesn’t bode well for the Wyden-Brown bill’s chances in the House.

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Gary Schwitzer writes on his blog “Health News Review” that he was “jolted” by a television commercial he saw recently for an artificial hip joint sold by medical device-maker Smith & Nephew.

The ad features athletic, fit, male body forms engaged in all sorts of strenuous pursuits; playing soccer, surfing, rock climbing up a craggy peak (!). The figures are rendered as stylized silhouettes but if I had to guess, I’d say they were designed with highly active men, age 40 to 50, in mind. Triatheletes and Ironmen wouldn’t be a stretch.

As Schwitzer notes, “it struck me that this younger demographic was the sole focus of the figures depicted in the commercial.”

Schwitzer would be right. The Smith & Nephew hip implant, called the Birmingham Hip Resurfacing System, is a newer kind of device that replaces just the damaged joint surfaces; not the complete joint. The femoral head is shaved down and covered by a metal cap and the hip socket is replaced with a metal cup. This procedure preserves some 3-4 inches more of the thigh bone than traditional total hip replacements. It’s being marketed as an alternative for active, younger patients (under 60) who are likely to outlive the implant and will need a total hip replacement 15 or 20 years down the road. By preserving more of the original joint, the theory is that the second surgery will be easier to perform and more successful. Two other companies now sell similar products; the Cormet Hip Resurfacing device (sold by Stryker) was approved by the FDA in 2007 and the Conserve Plus implant (sold by Wright Medical Group) got the nod in 2009.

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It’s open season in Congress on women’s reproductive rights. The Pence, Pitts and Smith trio of conservative Congressmen have been using gruesome depictions of abortion, charges of child-abuse (against fetuses), and other inflammatory tactics to help whip up support for their three separate pieces of anti-choice legislation.

Today, rhetoric grabbed the spotlight when the House voted 240-185 to pass Rep. Mike Pence’s (R-IN) amendment to specifically cut off all federal funding for Planned Parenthood, the 95-year-old women’s family-planning stalwart that he calls a “criminal enterprise.” The House vote is "a victory for taxpayers and a victory for life,” according to Pence who has had his sights on Planned Parenthood for years now. In fact, Pence’s amendment is a redundant, mean-spirited piece of legislation that is designed to not only block women’s access to a legal medical procedure, but is also aimed at preventing women from getting contraceptives, counseling, HIV testing and basic gynecological care.

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A vaccine or drug that can prevent healthy, yet high-risk people from developing the memory loss, confusion and other devastating cognitive problems that characterize Alzheimer’s disease is the Holy Grail for researchers, drug companies and patient advocates.

Interest in developing such a treatment is growing as it becomes increasingly clear that physiological changes occur in the brain years, even a decade, before patients experience the cognitive decline that we think of Alzheimer’s disease (AD). What was once deemed “early Alzheimer’s” is now recognized as a much later stage of the disease. And the truth is that dozens of drugs have failed to show efficacy in treating AD and the few available offer only modest benefits for alleviating symptoms. Frustration, paired with new research illuminating the molecular underpinnings and progression of Alzheimer’s is fueling a keen interest in devising drugs that can treat the “clinically silent” phase of the disease; years before cognitive symptoms become apparent. An oft-quoted analogy is heart disease, where preventing atherosclerosis is far more successful than treating heart failure.

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Last month I wrote about the Mental Health Parity law that requires insurers to provide equal coverage for both medical and mental health services. When health reform rolls out fully in 2013, many Americans with expanded access to private health insurance will have more equitable coverage for treatment of depression, attention disorders, addiction problems and other serious mental health ills. But parity laws that apply to private insurance will do little to advance the plight of the growing portion of our population that is seriously—and chronically—mentally ill, often homeless and increasingly showing up in the criminal justice system.

According to the Department of Justice, 14.5% of men and 31% of women recently admitted to jail have a serious mental illness. Applied to the 13 million jail admissions reported in 2007 (the most recent figure), the findings suggest that more than 2 million individuals with a serious mental illness may be locked-up annually. In many cases they cycle in and out of the criminal justice system; with a stop on the way to the emergency room or for hospitalization. It’s an expensive and futile exercise.

With all the emphasis on health reform and discussion centering on a vast overhaul of how we deliver, pay for and mandate medical care, the plight of the seriously mentally ill gets short-shrift. But that doesn’t mean there isn’t a real crisis in funding (especially at the state level) and treatment–or that there isn’t a wave of reform coursing through the mental health field. It’s just that without the loud voices of lobbyists from doctor, pharmaceutical and hospital organizations and powerful patient advocates, the mental health field is reform’s poor step-sister—beyond insurance parity, very few provisions in the Patient Protection and Affordability Act address chronic, serious, mental illness.

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Well, Wisconsin Attorney General, J.B. Hollen didn’t use those words exactly. But on Wednesday, his office released this brash statement; “for Wisconsin, the federal health care law is dead—unless and until it is revived by an appellate court. Effectively, Wisconsin was relieved of any obligations or duties that were created under terms of the federal health care law.”

Hollen was no doubt emboldened by this week’s ruling in Florida by district court judge Roger Vinson that the entire health care reform law is unconstitutional. This decision went beyond Judge Henry Hudson’s ruling in a Virginia court in December that found only the individual mandate to be unconstitutional. “This is a radical decision,” Timothy Jost, a law professor at Washington and Lee University School of Law writes in his analysis of the ruling in Health Affairs. “Judge Vinson has a clear vision of the limited federal government the founders intended that is very much in line with that espoused by the Tea Party Movement…He has thrown down the gauntlet.”

The ruling has emboldened others besides Wisconsin to swear off implementing reform. Florida Governor Rick Scott announced that he would wait for further court rulings before beginning to take any action to carry out the health law. And the Florida insurance commissioner Kevin McCarty wrote to federal officials on Tuesday letting them know that the state will return a $1 million grant intended to help it prepare for reform by setting up a system that would let consumers compare insurance plans. Wisconsin also announced it’s sending back the money. Finally, Minnesota’s Governor Tim Pawlenty issued an executive order barring state officials from participating in the ACA without express approval from his administration.

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The Mental Health Parity and Addiction Equity Act passed by Congress in 2008 was hailed as “a milestone in the quest for civil rights, an effort to end insurance discrimination and to reduce the stigma of mental illness.”

This law, which finally took effect in July 2010, prohibits large group insurance plans from placing coverage or treatment limits on mental health and substance abuse services that are more restrictive than those imposed on medical and surgical services. The Parity Act also prevents these plans from requiring patients to pay a larger share of mental health charges in terms of deductibles and co-payments. When the legislation first passed, federal officials predicted that some 113 million Americans would have better access to behavioral health services—82 million of those through their employer health plans.

Under the Patient Protection and Affordable Health Care Act, mental health parity is now set to be extended to millions more Americans. Most significantly, all insurance plans sold on the state exchanges in 2014—available to individuals and smaller companies with fewer than 50 employees who were exempt from the 2008 Parity Act—will have to offer coverage for mental health services that is on par with medical and surgical services. Some of the 32 million currently uninsured people who will newly qualify for Medicaid benefits will also have mental health parity—but only if they are enrolled in managed care plans.

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The government recaptured a record $4 billion last year from pharmaceutical companies, hospitals, doctors, nursing homes and other providers that defrauded federal health-care programs, the administration reported Monday. This is twice as much as was recouped in 2008, and funneled some $2.9 billion back into the Medicare Trust Fund.

This is a good start—Medicare and Medicaid fraud reportedly cost the government a whopping $54 billion last year—but we can do even better. In a new report from the Department of Health and Human Services and the Department of Justice, the success in recouping fraudulent payments is attributed to the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint effort between the two agencies created in 2009.

Earlier this week, new federal rules came into effect that HHS Secretary Kathleen Sebelius says will allow the government to be more proactive in preventing fraud in the Medicare, Medicaid and CHIP programs. These new rules (click here to see an overview) which are included in the Affordable Care Act,  require more rigorous screenings of providers and suppliers who participate in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP), levy larger fines for abuses, and also give HHS the power to immediately stop payment to providers who are being investigated for fraud. The goal of these new provisions is to prevent fraud rather than playing catch-up once the crimes have been committed.

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The war of words over health reform is increasingly focused on how the legislation will impact small business and employment. The day before the House voted—in a meaningless act of political theater—to repeal the “job-killing” health law, the White House hastily organized a conference call for reporters to speak with Karen Mills, administrator of the Small Business Administration and acting Deputy Commerce Secretary Rebecca Blank. During the call, the goal of which was to highlight how a repeal of health reform would negatively impact U.S. businesses, Mills announced that there’s already been a rise in the number of small businesses offering health coverage to their employees thanks to a new tax credit and other provisions of the law.

As evidence, Mills cited a survey conducted by the Kaiser Family Foundation that found that 59% of firms with three to nine employees offered health benefits in 2010, up from 46% the year before—a rise of 13%.

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The individual mandate to buy health insurance is clearly the most contentious aspect of health reform. More than two-dozen states have joined federal lawsuits seeking to have health reform repealed on the grounds that the mandate is unconstitutional. Most recently, just hours after being sworn in as Wisconsin’s new Republican governor, Scott Walker authorized the state's attorney general to join a federal lawsuit in Florida challenging the individual mandate.

Meanwhile, supporters of the Affordable Care Act argue that health reform cannot succeed without the mandate. Their rationale: The legislation prohibits health insurers from discriminating against applicants on the basis of health, either by charging higher premiums for sick people or by refusing to insure those with preexisting conditions. Without the mandate, many young, healthy Americans will opt to go without coverage, the insurance exchanges will be disproportionately utilized by older people, the chronically ill and other heavy users of care. As has happened in states that offer insurance through high risk pools, premiums will be driven higher, and even with government subsidies, all but the well-to-do will be priced out.

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