Issues ranging from plans to cap or cut Medicaid spending to voting positions on the Medicare prescription drug program are among the policies being tossed about as candidates jockey for tea party votes and conservative credentials.

The New York Times: In Tightening Race, Top GOP Candidates Race To Capture 2 Battleground States
In the brilliant sunshine of Arizona, Rick Santorum aggressively challenged Mitt Romney in a state where the Tea Party is strong and the politics of immigration are poised to take center stage at a debate on Wednesday night. Speaking to about 500 people at the Maricopa County Lincoln Day luncheon, Mr. Santorum tipped his hat to the Tea Party movement, many of whose members had packed into the large Shriners' hall to hear him speak. "We need to take everything from food stamps to Medicaid to housing programs to education training programs," he said. "We need to cut 'em, cap 'em, freeze 'em, send 'em to the states and say that there has to be a time limit and a work requirement," he said, the rest of his words drowned out by thunderous applause (Shear and Zeleny, 2/21).

Los Angeles Times: Ron Paul's 'Groovy' New Ad Calls Santorum A Fake Conservative
If the enemy of my enemy is my friend, Mitt Romney and Ron Paul are best buds these days. As Romney fights to stave off a potentially debilitating loss in Michigan's Feb. 28 primary, Paul is taking to the airwaves there with an ad that reinforces Romney's message that Rick Santorum betrayed conservative principles on spending when he served in Congress. … It says Santorum voted to raise the debt ceiling, doubled the size of the Education Department, and "supported the biggest entitlement expansion since the '60s," referring to the Medicare prescription drug plan (Memoli, 2/21).

The Associated Press/Washington Post: Gingrich Asks Oklahoma Lawmakers For Input On Getting 'Federal Government Out Of Your Hair'
The former House speaker said he'd focus most on regulations he thinks are hindering energy development and on giving states greater flexibility to implement Medicaid programs for the poor. Gingrich praised House Budget Committee Chairman Paul Ryan's ideas for turning more Medicaid funds into block grants to states. Gingrich drew conservative blowback last May for suggesting Ryan's plan for Medicare for seniors constituted "right-wing social engineering" (2/21).

In Friday action, the House and Senate OK'd legislation that prevented a 27.4 percent reduction in Medicare physician pay, which was scheduled to kick in on March 1.

Modern Healthcare: Congress OKs Measure Averting Doc-Pay Cut
The House and Senate approved a payroll tax package that includes a provision to stave off a 27.4% cut in Medicare physician payment rates scheduled for March 1 and freezes rates at their current level until Dec. 31, 2012. House members voted 293 to 132 to approve the legislation, which received support from 146 Republicans and 147 Democrats. Meanwhile, 91 Republicans and 41 Democrats voted against it. Reps. Phil Gingrey (R-Ga.) and Michael Burgess (R-Texas), both physicians, did not vote in favor of the bill (Zigmond, 2/17).

Kaiser Health News: FAQ: The 'Doc Fix' Dilemma
Now that Congress has passed legislation to avert drastic payment cuts to physicians who treat Medicare patients, attention is turning to what will happen when the temporary solution expires at the end of this year (Carey, 2/17).

Reuters: U.S. Congress Ends Bitter Tax Battle With Bill Passage
The U.S. Congress ended a three-month battle on Friday by passing legislation to extend a tax cut for 160 million workers, a boon for both the economy and Democratic President Barack Obama in this election year. The outcome for Republicans and House of Representatives Speaker John Boehner is far more murky. While Boehner has put behind him a bill that has been nothing but political heartache, nearly 40 percent of his rank-and-file voted against the measure he advanced by compromising on a core Republican cause - deficit reduction (Cowan and Smith, 2/17).

Market Watch: Congress Approves Extension Of Payroll-Tax Cut
In a rare show of bipartisanship, House and Senate lawmakers voted Friday to extend a two-percentage-point payroll-tax cut for the rest of the year, sending legislation to President Barack Obama nearly two weeks before a tax hike would have gone into effect for about 160 million Americans (Schroeder, 2/17).

The Hill: Congress Approves Payroll Tax Cut Extension, Sending Bill To Obama
The House and Senate quickly approved the payroll tax cut bill on Friday, sending the legislation to the White House for President Obama's signature. Both chambers easily approved the measure. In the House, the measure was approved in a 293-132 vote that split both parties. The vote was 146-91 among Republicans, and 147-41 among Democrats. The Senate acted less than an hour later and approved the bill in a 60-36 vote. Senate Republican and Democratic leaders agreed the bill would not require a 60-vote super majority for passage, a move intended to allow more Republicans to vote against the measure. In the end that procedural maneuver didn't matter (Kasperowicz and Ryan, 2/17).

In the background -

California Healthline: Polarization Evident at National Health Policy Conference
The annual AcademyHealth National Health Policy Conference offered more than 800 policy wonks a varied overview of the industry at the start of what many feel will be a pivotal year in the evolution of the nation's health care system. ... Republicans and Democrats representing committees and leadership from the House and Senate were predictably partisan -- and sometimes brisk (Lauer, 2/17). 

Federal officials said  Friday that the trend toward relatively low premium charges and stable benefits will likely continue.

Reuters: Government Issues Medicare Advantage Guidelines
The Obama administration on Friday issued 2013 payment and policy guidelines for U.S. health insurers that participate in the Medicare Advantage program, saying the proposed changes would bring lower premiums and stable or improved benefits. But the documents did not include an official preliminary estimate for the net average percentage change in reimbursements, leaving insurers and financial markets in the dark about the guidelines' potential impact on the industry (2/17).

CQ HealthBeat: CMS: Trend Toward Low Premiums, Stable Benefits To Continue
Relatively low premium charges and stable benefits have been a hallmark of the private health care plans and prescription drug plans in the Medicare program of late, and that trend will continue, federal officials said Friday. Officials released a "growth percentage" for per capita expenditures in Medicare and said it will be used to set 2013 rates for Medicare Advantage plans, the private managed care health plans in Medicare. The figure — 2.47 percent — "will help ensure that beneficiaries maintain a choice of plans without significant increases in premiums or decreases in benefits," said a CMS news release. CMS will publish a rate announcement for 2013 on April 2 (Reichard, 2/17).

Politico Pro: CMS Releases Medicare Advantage Guidance
CMS posted its 2013 payment guidance for Medicare Advantage and Part D plans late Friday, projecting an estimated annual growth rate of about 2.5 percent for the private Medicare plans. The document lays out guidance for insurance plans that want to participate in the programs in the coming year. It’s open for public comment, and final rates will be published April 2. CMS will again exercise the authority granted by health reform to deny bids from plan sponsors that propose “too significant” an increase in beneficiary cost-sharing or a decrease in benefits, according to a release announcing the guidance (Norman, 2/17).

Modern Healthcare: CMS Seeks Input On Payment, Policy Updates For Advantage, Prescription-Drug Plans
The CMS announced it is accepting public comments on the agency's proposed payment and policy guidance for Medicare Advantage and prescription drug plans in 2013. According to the Advance Notice and draft Call Letter for 2013, the CMS proposes that it will again use its authority under the Patient Protection and Affordable Care Act to deny bids if the agency decides the bid proposes too high of an increase in cost sharing or a decrease in benefits (Zigmond, 2/19).

The Washington Post: Our Unrealistic Attitudes About Death, Through A Doctor's Eyes
For all its technological sophistication and hefty price tag, modern medicine may be doing more to complicate the end of life than to prolong or improve it. ... When families talk about letting their loved ones die "naturally," they often mean "in their sleep" — not from a treatable illness such as a stroke, cancer or an infection. ... While it's easy to empathize with these family members' wishes, what they don't appreciate is that very few elderly patients are lucky enough to die in their sleep (Dr. Craig Bowron, 2/1).

Los Angeles Times: Mixing Medicare And Mudslinging
It's going to be a campaign issue, but the problem with that is that a heated, polarized election race isn't the best forum to debate complex, competing proposals for bringing down health care costs (Doyle McManus, 2/19).

Los Angeles Times: Payroll Tax Cut Undermines Social Security’s Security
The accepted response to the economic deal reached in Congress last week, extending the Social Security payroll tax holiday and unemployment insurance and maintaining reimbursement levels for Medicare doctors, is huzzah! Finally Congress got something important done with a minimum of brinkmanship and posturing, and more than a few minutes before the deadline. A threat to the embryonic economic recovery was averted, and the extensions even pushed any subsequent fracas over the same issues to the end of this year, safely past the presidential election (Michael Hiltzik, 2/19).

The Washington Post: Ideological Hypocrites
Why do they criticize "entitlements" and "big government" while promising today's senior citizens — an important part of the conservative base — never, ever to cut their Medicare or Social Security? Why do they claim that they want government out of the marketplace while not only rejecting cuts in defense but also lauding large defense contracts that are an enormous intrusion in the operation of the "free market"? (E.J. Dionne Jr., 2/19).

The Fiscal Times: Health Care: A Penny-Wise, Pound Foolish Doc-Fix 
Would you sell your home's storm doors to pay for this winter's heating bills? That's what Congress did Friday to pay for part of a 10-month "doc fix." ... "We're robbing from the one place in the Affordable Care Act where we can really do something about prevention," lamented Kenneth Thorpe, director of the Partnership to Fight Chronic Disease and a professor at Emory University (Merrill Goozner, 2/17).

iWatch News: ANALYSIS: Taking The Initiative In A Struggle Against Excessive Rate Increases
The biggest applause line Senator Dianne Feinstein (D-Calif.) got at a gathering of Democratic Party activists last week came when she endorsed a ballot initiative to give the California Insurance Commissioner power to reject excessive health insurance rate increases. Consumer advocates there decided to go the ballot initiative route after the insurance industry's friends in the legislature blocked a bill last year that would do the same thing (Wendell Potter, 2/20).

The Philadelphia Inquirer: Shortage Of Nurses In Philadelphia Schools Costs Everyone
Yet, since the summer, the Department of Public Welfare has removed 25,000 city children from the medical assistance rolls, kids whose family incomes are believed to still fall within the qualifying guidelines. For these now-uninsured children - and every other child who attends the city public schools - the district's layoff of 47 school nurses means that the children's health and educational prospects have taken a step backward. The result - predicted a school nurse who barely escaped losing her job - will be "more chaos" added to an already overburdened system of no-fee health services that acts as a safety net (Sid Holmes, 2/21).

USA Today: Prescription Drugs Deaths Demand Attention
While Xanax and similar drugs are less notorious than narcotic painkillers such as OxyContin and Vicodin, they're addictive, widely prescribed and, combined with alcohol, can be just as dangerous. They cause 373,000 overdoses a year, almost as many as the narcotic painkillers. Collectively, the two classes of drugs kill about 70 people a day, according to estimates by the Prescription Monitoring Program Center of Excellence at Brandeis University (2/20).

Politico Pro: Nursing Homes Can't Take More Cuts
Medicare funding for nursing homes is scheduled to be reduced by more than $125 billion over the next decade. At the same time, Medicaid has restricted or frozen reimbursements in 29 states in the fiscal year that just ended. These state budget shortfalls make it likely this trend will continue. If further reductions in Medicare are imposed — like those recommended by the Medicare Payment Advisory Commission — it will be difficult for facilities to continue using Medicare to help make up for the underpayment of Medicaid for long-stay patients (Vincent Mor and Gail Wilensky, 2/21).

Des Moines Register: Lawmakers Are Right To Intervene
In the summer of 2010, this state opened a new "high risk pool" to provide health insurance to Americans with health problems. It was created by the federal health reform law and funded with $35 million from Washington. As the editorial page has reported, Iowa's program has enrolled hundreds fewer people than projected. It has spent a higher percentage of its money on administration than most other states. And it is one of the few states prohibiting “third parties” from paying premiums for enrollees (2/19).

Denver Post: Why Obamacare Is Good For America
Decisions about our health care are too personal and important to be left to insurance companies. The Affordable Care Act, dubbed Obamacare, is putting all of us back in the driver's seat when it comes to our own health care. While full implementation of reform is being phased in over several years, health care reform has already helped hundreds of thousands of Coloradans access the health care they need (Dede de Percin, 2/19).

Denver Post: Why Obamacare Works: Four Reasons
Now that Obamacare is making preventive care available with no co-pays or cost-sharing, Coloradans can get advice they need to stay healthy and the screenings they need to halt a serious disease at an early, more treatable, and more affordable stage. Preventive care has given me the opportunity to live a long and full life; I urge every insured Coloradan to take advantage of this key benefit so you can, too (Kathy Leinz, David Taft, Sonji Wilkes and Chris Crigler, 2/19).

Houston Chronicle: Remaking Medicaid's Complicated, and Important
At this early, confusing stage, it's not clear yet how many regional partnerships there will be, or which counties will belong to which partnership - much less what rules each region will play by. And yes, that stuff matters. In the short term, we need to make sure of three things. … That counties forge regional partnerships that make sense. … That counties (and to a lesser extent, other local-government health care entities, such as medical schools) ante up their share of the money needed to pull down the enormous federal match. … That hospital districts, hospitals and other health-related entities in each region share the sandbox nicely.

The Dallas Morning News: You Might Not Choose Parkland But It's Still Your Problem
Wealthy, poor, homed or homeless, no one in America deserves such horrific basic care. For another, if you own property in Dallas County, you're paying for it. Shouldn’t you expect more? And your safety cushion of choice might disappear at your most critical moment of need (2/20).

Modern Healthcare: Health Care's Waffle House
Health policy in this country lacks direction because of a shortage of decisive leadership in both the public and private health care sectors. The past few weeks have witnessed an unprecedented amount of waffling on important health care topics that only feeds the belief that if you just shout loud enough, the object of your ire will back off their position rather than stand firm. The fact that this is an election year only makes things worse (Burda, 2/18).

Boston Globe: Big Savings For Small Business In New, Innovative Health Plans
For years now, small businesses have complained about the big annual premium increases they faced for health insurance. Two years ago, state policymakers agreed to let small companies form purchasing cooperatives to bargain for better rates. Now that experiment is paying off. New health plans announced last week will allow members of the first such cooperative to save at least 20 percent, and in some instances double that, on premiums. Those small businesses have every reason to be pleased, but they should share some of the new savings with their employees (2/19).

Kansas City Star: Give Raises To KC Police For Joining Health Plan
Members of Kansas City's police force are paying extremely close attention to proposed changes in their health insurance. But they also need to do the math when it comes to the possibility of getting pay raises in 2012. … That’s a strong reason the Board of Police Commissioners next Tuesday should approve a unified health insurance program. That would give the department enough money to hand out raises of $1,000 or more a year to most officers and civilian employees (2/20).

The Wall Street Journal: Payroll-Tax Cut Pact Clears Congress
Congress quickly passed a deal to extend the payroll-tax-cut through year-end, continue unemployment benefits and avoid a steep cut in Medicare doctors' fees, moving on from a fight that tied up legislators for months. By 293-132, the House voted to pass the measure. The Senate quickly followed with a 60-36 vote (Hughes, 2/17).

The New York Times: Congress Acts to Extend Aid to Jobless and Payroll Tax Cut
Republicans who said they supported the deal said they had won several important concessions during the talks, like imposing new conditions and limits on unemployment compensation and making a significant cut in the preventive-health spending called for in the health care overhaul that Democrats pushed through Congress in 2010. Representative Renee Ellmers, Republican of North Carolina, called that cut “the most dramatic blow to Obamacare yet" (Cushman Jr. and Pear, 2/17).

Earlier news coverage noted the details of the final deal:

Modern Healthcare: Details Of SGR Deal Released
[The bill] would prevent a 27.4% cut in Medicare physician payment rates scheduled for March 1 and would freeze current payment rates through Dec. 31, 2012. The provision also requires that the Government Accountability Office and HHS submit reports to help Congress develop a long-term replacement of the existing Medicare physician payment system (Zigmond, 2/16).

The Associated Press: How Parts Of Payroll Tax Cut Package Are Paid For
The approximately $20 billion cost of preventing payment cuts to Medicare doctors would be paid for with cuts in other areas of health care. All these cuts and savings would be achieved from 2012 through 2022. ... President Barack Obama sought similar cuts in his proposed 2013 budget (2/17).

Kaiser Health News: Health On The Hill: Congressional Leaders Reach Deal On 10-Month 'Doc Fix'
Five billion dollars comes from the health law’s prevention fund, and this would be over the next 10 years. $2.5 billion comes from additional Medicaid money for Louisiana that was contained in the health law. And there’s also an extension of a phasing-down of Medicaid payments to hospitals that take a lot of lower-income folks. Those reductions would be extended for another year (Carey and Judd, 2/16). Listen to the audio or read the transcript.

KQED's State of Health blog: Money From Prevention Is First To Go In 'Doc Fix'
The goal of the Prevention Fund is to provide communities around the country with billions of dollars over the next ten years to invest in effective prevention efforts against heart attacks, cancer and strokes and to reduce tobacco use as well as prevent obesity. And if you’re wondering if prevention money is well spent, the most recent research says it is (Aliferis, 2/16).

Politico: Tom Harkin Rips 'Devil's Deal' On Payroll Tax
Sen. Tom Harkin (D-Iowa) unleashed fury at President Barack Obama and fellow Democrats over the deal to extend the payroll tax holiday, ripping the agreement apart as a "devil’s deal." ... Harkin, who chairs the Senate Health, Education, Labor and Pensions Committee, took particular aim at one component: that will slash about $5 billion from the Prevention and Public Health Fund - a program created by the health care law that Harkin has championed (Kim, 2/16).

Kaiser Health News Capsules blog: Reid Vows Health Prevention Fund Will Be Replenished, Eventually 
Reid said, "We put into law that this fund grows. … This program is going to grow at the rate of about $2 billion a year in the next few years." But if the conference report to stop the Medicare physician pay cut becomes law, the fund’s growth would be significantly slowed, and supporters say that will hurt its ability to finance programs (Carey, 2/17).

NPR: Doctors 'Disgruntled' And Frustrated By Looming Medicare Cuts
[The fix] isn't permanent. It only extends to the end of the year. And then, if Congress doesn't act again, the cut it is expected to be in the neighborhood of 32 percent. ... while Congress mostly hasn't let the scheduled cuts take effect, it also hasn't given doctors a raise, either (Rovner, 2/16).