Daily Health Policy Report

Friday, May 7, 2010

Last updated: Fri, May 7

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Care Marketplace

Public Health & Education

Quality

Health Information Technology

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Groups Vie For A Piece Of Health Law's $15 Billion Prevention Fund

Kaiser Health News staff writer Julie Appleby reports: "If you had $15 billion to spend on preventing disease in the U.S., where do you think it would do the most good? Fighting obesity? Smoking? Maybe encouraging exercise? There's a sharp divide on the answer to the question of how to spend a prevention fund over the next 10 years" (Appleby, 5/7). Read entire story.

This Story: Print | Link to | Top

Health Reform

Health Overhaul Proving To Be Difficult Issue For Democrats And Republicans

Politico: Regardless of a candidate's party, "health care reform is treacherous campaign territory. A series of polls from the Quinnipiac University Polling Center, testing voter opinion on lawsuits challenging the constitutionality of the new law, underscore the difficulties of the issue for both Democratic and Republican candidates."

The polls "conducted in three states [Ohio, Florida, Pennsylvania] across the past month, all find likely voters to have complex and contradictory views on these repeal lawsuits as well as health care reform itself. By a slight majority, likely voters tend to oppose the health care reform law. But they also tend to oppose the repeal lawsuits as a 'bad idea' that would, for a sizeable portion of voters, make them 'less likely' to support a given candidate" (Kliff, 5/6).

The Washington Times: Some Republicans are saying that the 10th Amendment "dictates that initiatives such as the health care reform law and other massive government programs are the business of state governments, not Washington." The Republican Study Committee has created a task force to "work, it says, to 'educate' Congress and the public about the importance of maintaining a proper balance between state and federal governments" (Lengell, 5/7).

Seizing on anger over health reform, the candidate challenging Arkansas Sen. Blanche Lincoln in the Democratic primary, raised nearly twice as much money as Lincoln in April, The Associated Press reports. Lt. Gov. Bill Halter raised nearly $580,000 last month. Lincoln has "become one of the most vulnerable politicians in Washington, facing anger from both the right and the left. Republicans have condemned her for supporting the health care overhaul, while groups on the left have criticized her for opposing a government-run insurance option."

"Halter entered the race March 1, and was immediately embraced by groups on the left. Labor unions that have backed him, including the Service Employees International Union and the Communication Workers of America, have been airing radio and television ads around the state to help his bid" (DeMillo, 5/6).

This Story: Print | Link to | Top

States Consider Action On Health Care Reform

State leaders around America are considering their options in complying with or challenging the new health law.

The Baltimore Sun: In Maryland, a governor-appointed task force said yesterday that the state needs to begin acting right away on health reform. "Some provisions, such as how the state will administer high-risk pools, which offer insurance for people with pre-existing conditions who can't get coverage, kick in later this year and require immediate attention. Others are up to state leaders. For instance, Maryland may decide if it wants to expand Medicaid coverage to more low-income people than it does now in advance of a 2014 deadline." The task force, a 12-member council, started discussing the considerations Thursday. "The group made no decisions Thursday, but rolled out a timeline, which includes submitting a report to the governor by July 15, identifying the most critical state needs" (Brewington, 5/6). 

The (Peoria, Ill.) Journal Star: Lawmakers in Illinois have passed a bill that will monitor and study the new health reform law with a new task force. "The group would consist of 29 members — five will be appointed by Gov. Pat Quinn and six will be appointed by each of the legislative leaders — will represent health care professionals, the insurance industry, labor leaders, business interest and others and ensure the state complies with federal health care legislation" (McDonald, 5/6).

The Salt Lake Tribune: Utah and Rhode Island "remain the only states undecided about whether to set up temporary high risk insurance pools for the uninsurable as mandated under the new federal health overhaul. The decision is of little consequence to consumers since the task of running the pools will, by default, fall to the federal government. But it has political ramifications for Utah Republican Gov. Gary Herbert who, under a tight deadline and with limited information, must weigh what's best for the state while appeasing members of his own party who are pushing to opt out of health reform altogether." Lawmakers and others in Utah are pressuring the governor to either opt out or begin making decisions about implementation (Stewart, 5/6).

In a separate story, The Salt Lake Tribune reports that "Sixty-nine percent of registered and active Utah voters oppose the law, compared with 57 percent in November when Congress was still debating competing versions of President Barack Obama's health care fix. A slim majority would support Utah opting out of the new federal system, even if it greatly cost the state. And 64 percent favor Utah's move to challenge parts of the law as unconstitutional, according to a poll conducted last week by Mason-Dixon Polling and Research Inc., of Washington, D.C.," which was commissioned by the Tribune (Stewart, 5/6).

The [Carson City] Nevada Appeal: "Consultants told the Public Employee Benefits Program board Thursday that no one yet knows the impact the federal health care reform bill will have on the state program. Tim Nimmer of Aon Consulting said there are a couple of changes that will come in about a year but that guidelines for implementing other changes mandated by the legislation haven't been drafted yet" (Dornan, 5/7).

This Story: Print | Link to | Top

Capitol Hill Watch

House Panel May Slow Action On Health Pricing Disclosure Bills

CongressDaily: Proposals to make the price of health care services and products more transparent to consumers has attracted bipartisan support on a House panel, but the subcommittee's chairman, Rep. Frank Pallone, D-N.J., would not say whether he would allow such legislation to move forward. Having just passed the health overhaul legislation, Pallone said he thought Congress should devote energy to initiatives "outside of health care" (McCarthy, 5/7).

Modern Healthcare: The committee reviewed three related bills Thursday, which Pallone described as "a critical first step." He said, "We also would like to compare the three bills and see what kind of support there is" before moving forward. "One bill, introduced by Rep. Steve Kagen (D-Wis.), also a physician, requires hospitals, doctors, nurses, pharmacies and a range of manufacturers and vendors to openly disclose prices." Another, introduced by Rep. Joe Barton, R-Texas, the Energy and Commerce committee's ranking member, "requires public and private health plans to make known what services they cover, any restrictions in that coverage and the cost-sharing requirements that are also involved" (DoBias, 5/6).

The Hill: Politics isn't the only reason for delaying the legislation. "'The concern I guess is about the unintended consequences of too much transparency,' Pallone said, pointing to a Congressional Budget Office report that suggests that increasing transparency in highly concentrated markets could lead to higher prices because providers can see what the others are charging" (Pecquet, 5/6).

This Story: Print | Link to | Top

House Committee To Investigate Johnson & Johnson After Kids' Tylenol Recall

A House committee is looking at Johnson & Johnson after the company announced a recall of children's medicines. "Lawmakers requested information on Thursday from regulators about Johnson & Johnson's recall of Children's Tylenol and other over-the-counter pediatric medicines, saying the company's repeated recalls 'point to a major problem' with production," Reuters/The New York Times reports. "The House Committee on Oversight and Government Reform has opened an investigation after Johnson & Johnson recalled 40 widely used children's pain and allergy medications, saying some might have a higher concentration of their active ingredients, while others might be contaminated. In an F.D.A. report issued Tuesday, inspectors said they had found thick dust, grime and contaminated ingredients at the plant that produces Children's Tylenol and dozens of other products recalled last week" (5/6).

USA Today adds that McNeil Consumer Healthcare plant in Fort Washington, Pa., which manufactured the recalled drugs, "has been on a stepped-up inspection schedule by federal regulators since 2008. ... On average, because of limited resources, the FDA inspects domestic drug plants only about once every two to three years, [Douglas] Stearn [an assistant director for compliance at the FDA] said" (Young, 5/6).

This Story: Print | Link to | Top

Health Care Marketplace

Hospitals' Financial Woes Cause Shake-Ups In Three Cities

The Wall Street Journal: "Some doctors from St. Vincent's Hospital in Manhattan fear they won't be covered for malpractice insurance for care they provided while on staff before the hospital's demise. They believe the failed institution has a legal obligation to continue to provide the coverage. The doctors fear they may have to buy their own medical malpractice coverage for the next several years, policies they say can cost $40,000 a year when purchased individually" (Sataline, 5/7).

The Boston Globe: "The private-equity firm proposing to purchase Boston's six Catholic hospitals intends to maintain the hospitals' religious identity, but has also negotiated an escape clause that would allow the firm to end the religious affiliation in exchange for a $25 million donation to charity." The holding company created by Cerberus Capital to manage the hospital could go secular if "complying with Catholic ethical guidelines for hospitals is 'materially burdensome'" in the firms view (Wangsness and Healy, 5/7).

The Wall Street Journal's Bankruptcy Beat Blog: "The financial woes that pushed a poverty-stricken Washington neighborhood's only general hospital into bankruptcy protection several years ago are rearing their head again, resulting in a battle for control of the facility. Washington officials are seeking a receiver to take control of the troubled United Medical Center, which the city took over last month to 'stabilize' after its owner defaulted on loans." The hospital was once known as Greater Southeast Community Hospital (Palank, 5/6).

This Story: Print | Link to | Top

Physicians Saying No More Often To Drug Reps

The Wall Street Journal: A report out Thursday on the accessibility of doctors to pharmaceutical reps showed that fewer physicians are letting reps visit them. "The number of physicians who were 'rep-accessible,' defined as meeting with at least 70% of salespeople who come calling, dropped by 18% from last year, according to sales and marketing consultants ZS Associates." The report noted that now 58 percent of prescribing doctors are considered rep-friendly, and those who see 30 percent or less of reps who come calling are up to 9 percent of all prescribing doctors (Hobson, 5/6).

Pharma Times: "The study looked at the sales rep-related interactions of more than 500,000 physicians, nurse practitioners and other pharmaceutical prescribers in the USA and both the planned and completed calls of more than 41,000 reps — about half of all those operating in the country" (Grogan, 5/7).

This Story: Print | Link to | Top

Public Health & Education

President's Cancer Panel Focuses On Environmental Chemicals

The Washington Post: "An expert panel that advises the president on cancer said Thursday that Americans are facing 'grievous harm' from chemicals in the air, food and water that have largely gone unregulated and ignored. The President's Cancer Panel called for a new national strategy that focuses on such threats in the environment and workplaces. 

"Epidemiologists have long maintained that tobacco use, diet and other factors are responsible for most cancers, and that chemicals and pollutants cause only a small portion -- perhaps 5 percent. … The presidential panel said that figure has been 'grossly underestimated' but it did not provide a new estimate. … About 80,000 chemicals are in commercial use in the United States, but federal regulators have assessed only about 200 for safety" (Layton, 5/7).

The New York Times: "Children are especially vulnerable, the panel says. It urges the government to strengthen research and regulation, and advises individuals on ways to limit exposure to potential threats like pesticides, industrial chemicals, medical X-rays, vehicle exhaust, plastic food containers and too much sun."

Some scientists thought the report was based too heavily on hypothesis. "Dr. Michael Thun, an epidemiologist from the [American Cancer Society], said in an online statement that the report was 'unbalanced by its implication that pollution is the major cause of cancer,' and had presented an unproven theory — that environmentally caused cases are grossly underestimated — as if it were a fact" (Grady, 5/6).

Reuters: The American Cancer Society, also said "the report downplayed known risks that cause most cases of cancer including tobacco, obesity, alcohol, infections, hormones and sunlight." However, according to Reuters, the report "delighted environmental groups that have been pressing for more regulation of chemicals." It also pleased lawmakers that have been pushing for stricter regulation on chemicals, like New Jersey Democratic Sen. Frank Lautenberg. "My Safe Chemicals Act will require testing of all chemicals, and take substances off the market if the manufacturer cannot prove they are safe," he said (Fox, 5/6).

MedPage Today/ABC News: "The President's Cancer Panel was established by the National Cancer Act of 1971, when then President Richard Nixon declared war on cancer. The panel is required to submit an annual report to the president describing the status of the 'war' and identifying both progress and barriers to continued advances. … The singling out of environmental causes for cancer in this year's report is considered a major -- and some said welcome -- departure from previous reports, according to a number cancer specialists contacted by ABC News and MedPage Today."

"And while the report issued a call for increased emphasis on dialing down the radiation exposure with CT, the government may actually be out in front on this issue; the FDA recently proposed new safety requirements for manufacturers of CT scanners and fluoroscopic devices. The report included had to do with radiation exposure during CT scans" (Walker, 5/6).

This Story: Print | Link to | Top

Quality

VA Plans To Limit Surgeries At Some Of Its Facilities

The Department of Veterans Affairs will limit the kinds of surgeries at some hospitals after a review of surgical deaths at a hospital in southern Illinois, The Associated Press reports. "Under a new system, the VA has given each hospital a 'surgical complexity' level. Because of that, hospitals in at least five states — Louisiana, West Virginia, North Carolina, Illinois and Washington state — will now only perform less-complicated surgeries. The VA will pick up the tab for patients who have surgeries performed elsewhere" (Hefling, 5/6).

Army Times: "VA officials are imposing a new grading system on its 112 in-patient treatment facilities that will rank their abilities to do complex, intermediate or standard procedures" and that the move will force some patients to travel farther for surgery. "Grading for medical centers takes into consideration medical staffing, both for the operating room staff and surgical consultants who are available, plus equipment and diagnostic capabilities." The VA does about 357,000 surgeries a year, and of the 112 in-patient surgical facilities, 66 of which have been approved for complex procedures, Army Times reports. Thirty-three have been approved for intermediate procedures.

"The initiative is VA's response to criticism of problems with surgical care at the medical center in Marion, Ill. The issues at that hospital, since resolved, involved physician credentialing, standards of care, peer review and quality management. A review ordered in September 2007 found problems at other VA medical centers as well" (Maze, 5/6).

This Story: Print | Link to | Top

Health Information Technology

IBM To Analyze Best Way To Cut Childhood Obesity

The Wall Street Journal: IBM "will put computer models to work analyzing the reams of available data on the different factors that might affect obesity – things such as consumer behavior, the location of grocery stores, the availability of physical activity facilities and even community transportation options – and see how those factors interact. ... By running computer simulations, the scientists hope to bring policymakers some guidance on which levers to pull to most effectively influence obesity. ... The project will roll out over the next year or so; IBM says potential collaborators include MIT's Sloan School of Management and the NIH's Office of Behavioral and Social Sciences" (Hobson, 5/6).

Contra Costa Times: "The goal, [IBM mathematician Pat] Selinger said, is to help answer the question: 'If you have extra money to spend, would it be better to spend it on building another park, or having more physical education in schools, or improving school lunch programs?' The research could also shed light on the effectiveness of food labeling or economic incentives for retailers to open grocery stores that are located near public transit stops, IBM said in a statement. ... While there is no immediate business plan for the research, Maglio said, it fits with IBM's broader evolution from a predominantly hardware company into a company that draws most of its revenue from selling software and providing a range of technology services to other corporations and public agencies" (Bailey, 5/7).

This Story: Print | Link to | Top

State Watch

Texas CHIP Program Faces Budget Uncertainties While Arizona Governor Restores Funds For Health Care Programs For The Poor

Dallas Morning News: "Seven years ago, state leaders working to close a $9.9 billion budget gap took a hatchet to government health insurance for children of the working poor. Thousands of children paid the price when officials tightened eligibility rules and whacked dental, vision and mental health benefits. Gradually, benefits were restored to the Children's Health Insurance Program and, this month, enrollment reached roughly the same level as in 2003. But CHIP proponents fear the program could be on the block again as lawmakers face an even bigger shortfall – maybe $15 billion – as they write the next two-year budget in their upcoming session. The new federal health care law has limited the state's ability to cut too deeply into CHIP. If state leaders again tightened eligibility rules, they would put at risk the entire $14 billion to $15 billion a year of federal Medicaid and CHIP funds that Texas receives, said Anne Dunkelberg, associate director of the Center for Public Policy Priorities, a strong supporter of the program" (Garrett, 5/7). 

KENS 5 TV / Texas Tribune: "Dr. William Jones spent years losing money on Medicaid and Medicare patients — until he stopped seeing them. … Jones is still the exception, not the rule. But his decision is becoming increasingly common. The proportion of Texas doctors accepting all new Medicaid patients has tumbled in the last decade — falling from 67 percent to 42 percent, according to a Texas Medical Association survey. Medicare acceptance took a similar spill in that study, dropping from 78 percent to 64 percent. ... With health care reform expected to place up to 1 million more Texans on state rolls in the next several years, experts predict an almost certain surge in low-income Texans seeking long-overdue doctors appointments." Because reimbursements for these programs are "well below private-payer rates," experts worry more physicians to opt out (Ramshaw, 5/6).

Arizona Daily Star: "Arizona will continue to fund its health-care programs for the poor at current levels, at least for the time being. Without comment, Gov. Jan Brewer on Thursday signed legislation restoring funds that had been taken from the Arizona Health Care Cost Containment System, the state's Medicaid program. The move, designed to save money, would have dropped more than 310,000 people from the program effective Jan. 1. The new law also reauthorizes and finances the KidsCare program" (5/7).

The Chicago Tribune: "House lawmakers unanimously approved legislation Thursday that would sharply raise the standards of care and safety in Illinois' troubled nursing homes." The bill is expected to be approved by the Senate and Gov. Pat Quinn has said he "views the bill 'favorably.' The proposal would require nursing homes to increase staffing levels, meet higher standards before admitting patients with serious mental illness and segregate the most dangerous residents in secure units where they would receive more intensive monitoring and treatment." The goal of the measure is to move many mentally disabled people out of the homes and into community treatment programs (Garcia, 5/6).

Milwaukee Journal Sentinel: "Home care workers who provide services to people in Medicaid programs, such as Family Care, have voted to be represented by the Service Employees International Union. The vote could result in a minimum wage being negotiated with the state for the more than 5,000 people who independently provide home care services in Medicaid programs. The programs are designed to help people remain in their homes instead of moving to an assisted living center or nursing home" (Boulton, 5/6).

The Sun-Sentinel: "Tens of thousands of South Florida seniors are passing up as much as $3,900 a year in Medicare help paying for their prescription drugs because they are eligible but have not applied. What's more, the government changed the law this year to make it easier to qualify. So this week the Social Security Administration chief for the nation's Southeast urged seniors to fill out the form to get the 'extra help.' … The program, known as the low-income subsidy, covers all or part of what seniors pay for drug coverage, from monthly premiums of their drug plans to annual deductibles to drug co-payments" (LaMendola, 5/6).

The Los Angeles Times: "Serious questions have emerged about whether Olive View-UCLA Medical Center in Sylmar has continued treating critically ill babies long after state officials said the hospital lacked the doctors to do so properly and told the facility to transfer such high-risk patients." According to state officials, the county hospital's neonatal intensive care unit, or NICU, was downgraded in late 2008. "Since then, Olive View has been required to transfer babies needing a ventilator for more than four hours to a hospital that could provide a higher level of care, according to California Department of Health Care Services officials. ...  Williams said the state acted on Nov. 20, 2008, because the hospital had only one neonatologist who met state requirements and some of the doctors working in the unit were not board-certified in pediatrics. Los Angeles County officials, informed of the state's timeline of events, expressed shock Thursday, saying they became aware of the downgrade only in January. Even after that date, however, the hospital appears to have continued to treat babies who spent far more than four hours on a ventilator" (Hennessy-Fiske and Lin II, 5/7). 

This Story: Print | Link to | Top

Editorials and Opinions

Today's Opinions And Editorials: Health Reform's Paperwork And Accountability In Medicare

Why The AMA Wants To Muzzle Your Doctor The Wall Street Journal
Without the support of the AMA it is quite possible that the health-care reform initiative would have failed. So why the effort to silence other doctors? (Hal Scherz, 5/7).

Digitize Medical Records; Waiting Puts Lives At Risk The Boston Globe
Even with the incentive of billions of federal dollars to cover much of the cost of the transition, doctors and hospitals have been slow to take even the first steps toward conversion (5/7).

Health Bill Floods Business In Paper The Atlanta Journal-Constitution
Almost every day we discover some new little gem hidden in the 2,500-page, 400,000-word redesign of the American health care system. Regulations we hadn't heard about, new costs, new taxes, new mandates; it's a bad bill that just keeps getting worse (Michael Tanner, 5/6).

Accountability Is Crucial To The Future Of Medicare The Des Moines Register
If left untouched, Medicare's costs will continue to spiral out of control, comprising an ever-greater share of the economy and undermining growth (Robert Blancato, 5/7).

Obamacare's Hidden Time Bomb Forbes
Section 2718, at a mere 802 words, goes into effect first thing next year. ... It is the section that converts private insurers into regulated utilities by effectively placing a ceiling on their already-low profit margins (Avik Roy, 5/7).

The Party's Over On Health Insurance Premiums The (Mobile, Ala.) Press-Register
For the first time in 27 years, teachers and education employees will pay higher premiums for individual health insurance coverage (5/7).

This Story: Print | Link to | Top


EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.