Senate begins budget ‘markup’ – Sign of a damaged Congress – ACA SCOTUS ruling could bring chaos – SCOTUS rules on generics – Ways and Means targets exchange subsidies

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TODAY: SENATE BUDGET BEGINS ‘MARKUP’ — The Senate’s top budget guru on Tuesday said he’s introducing the so-called “Simpson-Bowles” deficit report with hopes of building a bipartisan consensus before the end of the year. The committee will begin a markup on the plan today. Senate Budget Committee Chairman Kent Conrad said he’ll release the National Commission on Fiscal Responsibility and Reform’s report ( as a chairman’s mark. But it will be a “markup” in name only. Conrad said there will be time for opening statements and a vote won’t be planned for months. The North Dakota Democrat said that’s the time required to work through the “geeky” budget resolution and have bipartisan negotiations with the Simpson-Bowles document as a starting-off point. He also admitted that any budget vote is unlikely before the November elections. The POLITICO Pro story:

CONRAD BUDGET: TELLTALE SIGN OF A DAMAGED CONGRESS — When Conrad reclaimed the Budget Committee gavel in 2007, he set out to tame the federal debt and turn staggering deficits into a surplus in five years. But as he rolls out the final budget of his career on Wednesday, it’s clear none of those goals has been realized. And the frustration and futility that’s marked his tenure as chairman may serve as a metaphor for what has broken and politically polarized Congress, POLITICO’s Scott Wong reports. The POLITICO story:

Good Wednesday morning and welcome to PULSE, where we’re still a little giddy about the Discovery flyover yesterday. Maybe Congress will take a cue from the early days of the space program and be more awesome.

“When I played my hand, I looked like a joker. Turn around, fate must have woke her. Cause lady luck, PULSE was waiting outside the door.”

IF SCOTUS STRIKES HEALTH LAW, CHAOS ENSUES — If the Supreme Court pulls the plug on health care reform, winding it down could be almost as contentious as building it up in the first place. And the hundreds of federal employees in the agencies created or expanded by the health care law could find themselves at the center of a new round of fighting. J. Lester Feder has the story:


…THE SCOTUS VERDICT IS IN, AND IT’S UNANIMOUS! That is, in its decision to support generic drugmakers’ right to challenge overly broad patent claims by brand-name competitors. The POLITICO Pro story:

… The ruling was a relief to the Generic Pharmaceutical Association, as you would expect. And Rep. Henry Waxman, who had filed an amicus brief in the case, said today’s Supreme Court decision on brand-name drug patents should lead to lower prices for consumers. “While the issues in the case may seem arcane, the fact of the matter is that allowing brand companies to exaggerate the breadth of their patent protections in their listings with FDA served as a real block to generics,” Waxman said in a statement.

GOP INVESTIGATION OF ACA MESSAGING GOES ON – Republicans on the House Energy and Commerce Committee said Tuesday that the White House messaging strategy behind the health care reform law is more expansive than publicly known and most of the law was crafted behind closed doors. The POLITICO Pro story:

A RETURN TO THE FAMILIAR – The House Judiciary Committee re-opened old battles on Tuesday — and with the same expected results — as members began what could be a lengthy markup of legislation it already passed. The committee returned to a version of a medical liability overhaul bill it cleared last month, which caps noneconomic damages — think pain and suffering — at $250,000. But this time it’s different. Sort of. The latest markup is a procedural move required under budget reconciliation orders. It’s needed in order to count the legislation’s $41 billion in savings. Still, members of the committee picked up where they left off, battling over an amendment that would strip the insurance industry of its antitrust protections and another that would have given states the right to set their own awards for medical injury. The markup continues today at 1.30 p.m.

HAPPENING TODAY: The House Energy and Commerce Subcommittee on Health holds a hearing on FDA user fees and “innovation” at 10:15 a.m., featuring testimony from the agency’s head of drug review, Janet Woodcock …  The Senate Special Committee on Aging has a post-CLASS hearing on “The Future of Long-Term Care” at 2 p.m. … And Deputy CMS Administrator and Director of the Center for Medicare Jonathan Blum holds a conference call with reporters at 12:30 p.m. to discuss “important news” about Medicare’s competitive bidding program for durable medical equipment.

ALSO TODAY: WAYS AND MEANS TARGETS EXCHANGE SUBSIDIES — The House Ways and Means Committee will mark up legislation that would cut $44 billion from the Affordable Care Act’s insurance exchange subsidies, House aides confirmed to POLITICO. The markup starts at 9:30 a.m., and the committee also plans to find savings from the Social Services Block Grant program, which funds a number of state-based child and adult health care programs. The legislation is posted on the committee website:

HEALTH WONKS CARRY THE DAY – At POLITICO Pro’s trivia night Tuesday, the Part A Team from AHIP took the prize. Congrats! You make PULSE proud.

ELIZABETH WARREN WANTS TO REPEAL (A PIECE OF) HEALTH REFORM — The candidate running against Scott Brown for his Massachusetts Senate seat came out Tuesday with an editorial calling for the repeal of health reform’s 2.3 percent excise tax on medical devices. The industry is lobbying hard against the tax, and device makers are major players in Massachusetts, employing 24,000 people and responsible for 13 percent of the state’s exports, Warren writes in an essay for Warren, an otherwise strong supporter of health reform, calls for “an appropriate offset” to help expand coverage of Americans and writes that the tax can be repealed without fighting “the whole health care battle all over again.”  You may remember Brown, a Republican, voted against health reform, and he’s been fighting to repeal the device tax. Warren also points to the FDA’s increased time for device review and urges the agency to move faster and provide clearer guidance to the industry.

SENATORS INTRODUCE CHILDREN’S HEALTH BILL – The Better Pharmaceuticals and Devices for Children Act of 2012 would reauthorize and strengthen some provisions in three laws that require stricter drug labeling and testing for children and incentivize the development of pediatric medical devices. It was introduced Tuesday by Sens. Jack Reed (D-R.I.), Lamar Alexander (R-Tenn.), Patty Murray (D-Wash.) and Pat Roberts (R-Kan.). The American Academy of Pediatrics and the Elizabeth Glaser Pediatrics AIDS Foundation praised the bill, which would be included with the must-pass FDA user fee legislation this year. “Children are not just small adults; the therapeutics we use to care for children should not only be safe and effective, but should also work specifically for them,” AAP President Robert Block said in a release. “The bill introduced in the Senate [Tuesday] recognizes the unique needs of children by renewing three laws whose success has led to valuable pediatric drug dosing information, new data on how drugs work in children, and the development of several new medical and surgical devices that treat rare childhood diseases.”

TIME TO FROWN AT DRUG COUPONS — A new survey from the National Coalition on Health Care says as many as 2 million seniors might be using coupons to get discounts on brand-name prescription drugs, even though the practice is banned under Medicare. Why does the coalition care? Because, the group says, it’s a marketing tool that helps brand-name makers keep out the generics. “Consumers might see lower costs for brand-name drugs, but their health plans still end up paying more to the brand-name manufacturer.  That means higher costs for everyone,” coalition president and CEO John Rother said in a statement. The survey:

OBAMA TO NOMINATE NEW HHS GENERAL COUNSEL – The White House announced Tuesday that it will nominate William Shultz, the acting general counsel at HHS, to be the actual general counsel. Schultz has a long history in Washington. He was a deputy assistant attorney general at the Department of Justice and deputy commissioner for policy at the FDA from 1994 to 1999. Before that, he was counsel for the Energy and Commerce Subcommittee on Health and the Environment under Waxman from 1990 to 1994. Before joining HHS, Shultz was a partner at Zuckerman Spaeder LLP from 2001 to 2011.

WOULD DOWNFALL OF ACA BE BOON TO DRUGMAKERS? Perhaps in the case of Bristol Myers Squibb, according to a report Tuesday in Investor’s Business Daily. The company estimates “Obamacare” cost the company 24 cents a share in 2011. The story duly notes that health reform’s expansion of coverage could eventually boost Bristol-Myers’ sales, though the company says that won’t happen until 2014 or later, which is, of course, when the coverage expansions kick in.

HHS WINS CASE AGAINST PHYSICIAN PRACTICE FOR HIPAA VIOLATION – Phoenix Cardiac Surgery in Arizona agreed Tuesday to pay HHS $100,000, after an agency investigation found that the practice was posting clinical and surgical appointments for its patients on an Internet-based calendar that was publicly accessible and was not taking steps to safeguard patient data. The HHS release:

What we’re reading, by Joanne Kenen

Two studies question whether there is, after all, any link between so-called food deserts and obesity. The article:

The New York Times editorial page praised Gov. Cuomo for moving ahead with an executive order to establish an exchange by 2014. The editorial:

USA Today and Kaiser Health News look at quality measurement and trends in community health settings. The report:

Joshua Archambault at Pioneer Institute does some Massachusetts math and comes up with a bigger price for reform than that much-quoted $91 million annual number from the Massachusetts Taxpayers Foundation. His conclusion:

ProPublica, following up on its series on dialysis, updates its dialysis facility tracker. The data:

Susan Desmond-Hellmann, oncologist, former drug co. exec and UCSF chancellor, tells The Wall Street Journal health blog about a new social contract for medical research — how to make sure that the people who participate in the research also get some benefits. The conversation:

Also seen in Politico.