By Richard Rubin and Kathleen Hunter - 2012-06-06T04:01:43Z

Senate Democrats from states including Minnesota and Pennsylvania are caught between their support for medical-device industries and their partys reluctance to make major changes to the 2010 health-care law.

The U.S. House of Representatives is scheduled to vote this week to repeal a 2.3 percent excise tax for medical devices. To Senate Majority Leader Harry Reid, a Nevada Democrat, the vote is part of a Republican attack on the health law. To Senator Amy Klobuchar, a Minnesota Democrat seeking a second term, the repeal is necessary to prevent harm to an industry that provides jobs in her state.

Senator Klobuchar is faced with a difficult choice between voting the kind of narrow particularistic interest of industry in her state versus voting her personal and partisan platform, said Lawrence Jacobs, a political scientist at the University of Minnesota.

Klobuchar, first elected in 2006, has been a knight in shining armor for a home-state industry that includes St. Jude Medical Inc. and Medtronic Inc. (MDT), Jacobs said. Medtronics employees have been the seventh-largest contributors to Klobuchars campaign this election cycle, according to the Center for Responsive Politics.

Device companies have been lobbying to undo the tax, and the House repeal bill sponsored by Minnesota Republican Erik Paulsen is co-sponsored by more than 55 percent of the House.

Congress included the tax in the 2010 health-care law as a way to help pay for expansion of health insurance coverage. The 2.3 percent excise tax will be levied on devices such as coronary stents and hip implants that arent sold directly to consumers.

Similar fees and taxes were levied on health insurers, pharmaceutical companies and the indoor tanning industry. The law passed without a single Republican vote, and the party has been trying to undo it since, even as the Supreme Court considers its constitutionality.

Efforts to pick apart the health-care legislation are finding favor with some Democrats who agreed to the measure despite misgivings about individual provisions.

Senator Orrin Hatch, a Utah Republican, said hes looking for ways to force a vote on the issue.

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U.S. Medical Device Backers Face Tough Health Care Vote

His long hair, goatee and mutton-chop sideburns hint at his years in rock bands in the 1980s, but Erny Papay hardly fits the stereotype of the irresponsible, risk-taking musician. Now in his 50s, his main gigs are quite wholesome: playing kids' songs at preschools, old-time tunes for retirees, and contemporary worship music at a Lutheran church. He and his wife, Karen, live in Monroeville, and have two grown sons, one of whom is also a professional musician.

Papay also juggles 60 students, teaching piano, guitar and bass. It takes a lot of lessons to cover the couple's health insurance premiums, which total $1,400 every month. He's considered taking the risk of not having health insurance. "But one of us seems to end up in the hospital each year," Papay says he calls it "the $10,000 visit to the spa.'"

Whether they're piano teachers or punk rockers, part-time or full-time, musicians have a tougher time than most when it comes to finding health insurance. According to a survey by the Future of Music Coalition, one in three musicians is uninsured nearly twice the 17 percent national average.

Like many lifelong musicians, Papay held a regular job for many years; as a chemist, he received healthcare benefits through his employer. When the company eliminated his position in 2001, music became his full-time job. For 18 months, he relied on COBRA, a federally mandated program that allows people to continue with their group health plan temporarily after leaving a job. Eventually, though, he had to look elsewhere.

Papay's current policy, through UPMC, is an improvement over earlier plans inferior coverage that cost him $2,000 each month. But the Papays cut corners where they can, passing up dental insurance, for example.

Papay's experience is not unique, suggests research by the FMC, a Washington, D.C.-based advocacy group. Its survey of 1,451 musicians found that most of those with insurance obtained it through employment outside their musical activity. And the more working hours you devote to your music, the less likely you are to have insurance. Of survey respondents who earn more than half of their income from music, four in ten are uninsured.

In some ways, a musician's challenges resemble those of any freelancer trying to obtain adequate, affordable coverage in a health-care system geared toward those with full-time employment. The FMC suggests musicians face "structural barriers" to obtaining coverage. Musicians often work on contract, "performing or composing for specific events, albums or projects." Without a steady employer, "[T]hey must seek out individual health insurance policies." And those are frequently far more expensive than insurance obtained through a group plan.

Kevin Erickson, a spokesperson for the group, says the group may take up the issue again, depending on how the Supreme Court rules on President Obama's health-care overhaul.

Even full-time, "professional" musicians are affected: 35 percent are uninsured. But for the most part, these are the lucky ones, members of a group that includes symphony musicians and others with relatively high, union-negotiated salaries and benefits. It's a group that also includes Erny Papay's 32-year-old son, Jeremy.

Jeremy Papay has spent nearly four years on the road playing drums for the Ringling Bros. and Barnum and Bailey Circus. Living in an RV, he drives to a new town each week to play several shows. The circus musicians carry a union card, and their employer provides competitive salaries, health insurance and other benefits.

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Health-care Blues

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BOSTON As the Massachusetts House of Representatives debates a bill that some are touting as a way to rein in health care costs, one conservative-leaning think tank has raised concerns over its projected savings.

State representatives began their debate Tuesday on a bill that House leaders have said will save the state's economy more than $160 billion over the next 15 years.

The bill is designed to even out disparities in the costs of hospital services by requiring hospitals that charge more than 20 percent above the state median price for a service to pay a 10 percent surcharge into a fund to help support hospitals serving the poor and most vulnerable.

Among many things, it also would reduce premiums for patients who show they're committed to maintaining their health and overhaul medical malpractice laws by letting doctors apologize without fearing a lawsuit. It also sets guidelines for the size of "accountable care organizations" - health care networks that take a coordinated approach to medicine. There are already five such organizations in Massachusetts.

Joshua Archambault, the director of Health Care Policy at the Pioneer Institute in Boston, said much of the bill's expected savings is contingent upon other factors.

According to his analysis, only 40 percent of Massachusetts residents would be directly affected by the bill, as they are fully covered by traditional private insurance companies. Meanwhile, 60 percent of residents would not be affected because they receive coverage through Medicare, self-insured companies, are federal employees or are already on MassHealth, the state's Medicaid program.

He said while the bill aims to lower health care costs by an average of around $10 billion a year, publicly available data suggests health care costs for patients who would be affected by the legislation average around $13 billion a year. That means that either those patients would need to nearly eliminate their health care costs, or more self-insured companies would need to join the state's plan or another one affected by the legislation, in order for the plan to work, he said.

Because of this, he called the House's proposal a "faith-based initiative," adding that he believes bill increases spending through provisions like the one-time hospital surcharge for the distressed hospital fund, which he said would cost consumers millions of dollars.

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House begins health care bill debate

BOSTON, June 6, 2012 /PRNewswire/ -- The U.S. faces major obstacles in taking advantage of "value-based health care"one of the most promising developments in health care, according to a new study by The Boston Consulting Group (BCG).

(Photo: http://photos.prnewswire.com/prnh/20120606/NY19587 )

BCG assessed the progress of 12 developed-world countries in adopting value-based health care, an approach to better controlling health care costs by improving health outcomes at the same or lower cost. The results of the assessment appear in a report titled Progress Toward Value-Based Health Care: Lessons from 12 Countries, which is being released today.

The assessment evaluates national health systems along two dimensions. The first is the degree to which key supports of value-based health care are in place at the national levelfor example, common national standards and IT infrastructure, national legal and consent frameworks, the ability to link health outcomes with costs, and high engagement on the part of clinicians and policymakers. The second is the quality of a country's existing disease registries (institutions that track selected health outcomes in a population of patients with the same diagnosis or who have undergone the same medical procedure), both in terms of the richness of the data and the sophistication of the medical community's use of the data.

"When it comes to implementing value-based health care, Sweden is the most advanced country of the 12 we studied, followed by Singapore, Canada, and the U.K.," said Neil Soderlund, a BCG partner and coauthor of the report. "By contrast, Germany and Hungary have the furthest to go."

The U.S. health system, which has the highest per capita costs of the 12 nations studied and spends 17.6 percent of GDP on health care, is also one of the laggards in the group. "The U.S. has some successful national disease registries, such as the Cystic Fibrosis Foundation Patient Registry, the Society for Thoracic Surgeons' STS National Database, and the American College of Cardiology's CathPCI Registry," said Peter Lawyer, a BCG senior partner and coauthor of the report. "And some integrated players such as Kaiser Permanente have made considerable progress in using clinical outcomes in their own patient populations to identify and disseminate best practices across their centers."

However, the fragmented nature of the U.S. health-care system has seriously limited the collection and use of national health-outcome data. "Reporting standards and clinical outcome metrics differ substantially across the system, even within the same speciality," said Lawyer. "There currently exists no national mechanism for compelling providers to report outcomes to disease registries. Nor is there a unique patient identifier in place that would enable research to combine data across different disease states to examine the effect of complex comorbidities."

Detailed International Comparisons

The report is one of the most detailed international comparisons of progress toward value-based health care, combining a top-down assessment of national enablers with a bottom-up assessment of data quality and use at existing disease registries across 12 major health conditions. It uses 35 specific assessment criteria developed on the basis of previous BCG research in the field, a comprehensive survey of the medical literature, and 139 interviews with representatives of national health departments and with international health-outcome experts.

"We learned that a number of countries have begun to build the infrastructure and processes to support a value-based approach, but some are significantly farther along the learning curve than others," said Stefan Larsson, MD, a BCG senior partner and coauthor of the report. "Despite this differential in development and despite major differences in the structure and organization of national health-care systems, there is much to learn from each country."

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U.S. Faces Obstacles to Improving Health Care Value

It's the single most contentious element of President Barack Obama's health care law: the requirement that nearly everyone have insurance or face a financial hit.

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In Mass., individual mandate sparks little outcry