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Kaiser Daily Health Policy Report
Election 2008
'Harry and Louise' Advertisements Return, Advocate for Health Care Reform
[Aug 19, 2008]
Several consumer advocacy and business groups on Tuesday at the National Press Club in Washington, D.C., plan to announce a multimillion-dollar national television advertising campaign that will feature "Harry and Louise" and seek to promote health care in the presidential election, the Detroit Free Press reports. The American Cancer Society Cancer Action Network, the American Hospital Association, the Catholic Health Association, Families USA and the National Federation of Independent Business will sponsor the ads, which will air during Sunday morning news programs, as well as on national cable networks and Comedy Central, through the Democratic and Republican national conventions (Spangler, Detroit Free Press, 8/18). In addition, the ads will appear on the Web site harryandlouisereturn.com (Frates, The Politico, 8/18).
In 1994, health insurers launched an ad campaign that featured "Harry and Louise" to help defeat the health care plan of former President Bill Clinton, but the new campaign will ask the two major presidential candidates to make health care their top domestic priority. In the latest ads, Louise raises concerns about an individual who has cancer and lacks health insurance, and Harry says that "too many people are falling through the cracks." Louise adds, "Whoever the next president is, health care should be at the top of his agenda, bring everyone to the table and make it happen."
According to the AP/Kansas City Star, the new ad campaign "shows a shifting political landscape for overhauling the nation's health care system," with consumer advocacy and business groups "working together to stress that changes have to be made to deal with rising costs and the growing number of uninsured," but the "coalitions could prove fragile once candidates get beyond their campaign blueprints" (Freking, AP/Kansas City Star, 8/18). Opinion Piece Looks at Candidates' Positions on Prescription Drug Reimportation
Both presumptive Democratic presidential nominee Sen. Barack Obama (Ill.) and presumptive Republican presidential nominee Sen. John McCain (Ariz.) have said that they support prescription drug reimportation, and that "illustrates how out of touch they are" because, "in the real world, no one is seeing it as much of a solution to anything anymore," Greg Scandlen, president of Consumers for Health Care Choices, writes in a Chicago Sun-Times opinion piece.
According to Scandlen, prescription drug reimportation programs established in Montgomery County, Md.; Illinois; and other states in large part have failed, in part because the changes in the exchange rate made "Canadian drugs ... a whole lot more expensive." In addition, he writes, all of the other concerns about prescription drug reimportation -- such as safety and liability issues, as well as the effect on the development of new medications -- remain.
He concludes, "Let's hope the Obama and McCain camps are listening" (Scandlen, Chicago Sun-Times, 8/19). Broadcast Coverage
 NPR's "Morning Edition" on Tuesday examined how, although Medicare is typically a big issue in presidential campaigns, the major presidential candidates are playing down the issue this year. Both candidates argue that Medicare should be put on "firmer fiscal footing," according to NPR (Rovner, "Morning Edition," NPR, 8/19).
Administration News
HHS Office Resolves More Than Half of HIPAA Complaints Without Investigation
[Aug 19, 2008]
An HHS office has resolved more than half of complaints about possible violations of the medical privacy rule issued after the passage of the Health Insurance Portability and Accountability Act without investigation, according to a Des Moines Register review of state and federal records. Since the rule took effect in 2003, 38,000 U.S. residents have filed complaints with the HHS Office for Civil Rights, and the office has resolved 56% of those complaints without investigation, the review found. The review also found that OCR has referred only 437 complaints, less than 2% of the total, to federal prosecutors. Abner Weintraub of the HIPAA Group said, "There are no HIPAA cops out there looking for violations," adding, "Enforcement at the Office for Civil Rights is virtually nonexistent. Technically, they've still not issued a single fine -- not even down to the $100 level, and they could toss those around like candy, if only to wake people up about the seriousness of compliance."
According to Weintraub, one of the main problems with enforcement of the rule is that health care providers do not have to report internal violations. "This is a tremendous loophole," he said, adding, "Enforcement is left to the health care community to sort of self-police itself, and to the Office of Civil Rights, which has done virtually nothing." Deborah Peel, head of Patient Privacy Rights, also said that the rule does not include adequate restrictions on cases in which providers can share the medical records of patients without their consent. Under the rule, "there is no real privacy right to be violated," she said, adding, "That's why we're not seeing any prosecutions." OCR Response
According to Susan McAndrew, deputy director of health information privacy at OCR, the office has resolved 6,800 complaints through corrective action orders. She said, "We have found that this is the most effective way to obtain industry compliance with the privacy rule." In addition, McAndrew said, "OCR has investigated complaints against many different types of entities, including national pharmacy chains, major medical centers, group health plans, hospital chains and small-provider offices" (Kauffman, Des Moines Register, 8/17).
American Public Media's "Marketplace" on Friday examined companies that can sell medical records online despite the rule (Henn, "Marketplace," American Public Media, 8/15).
Health Care Marketplace
WellCare Agrees To Pay $35.2M in Medicaid Fraud Investigation
[Aug 19, 2008]
WellCare has agreed to pay $35.2 million as part of a Medicaid fraud investigation, but the payment does not settle nor limit the investigation, the health insurer wrote in a filing with the Securities and Exchange Commission on Monday, the St. Petersburg Times reports (St. Petersburg Times, 8/18).
Federal authorities raided WellCare's Tampa Bay, Fla., headquarters on Oct. 24, 2007, to search for records of "any monetary overpayments," according to the search warrant. WellCare, which provides Medicare and Medicaid managed care plans to about 2.3 million beneficiaries nationwide, in 2006 received nearly $4 billion in revenue from government sources.
Federal authorities during the raid seized thousands of documents, copied data from dozens of hard drives and took several laptops, including one used by company CEO Todd Farha. One day after the raid, a former WellCare fraud investigator filed a sealed whistle-blower lawsuit in Tallahassee, Fla. (Kaiser Daily Health Policy Report, 11/20/07).
The payment includes $24.5 million in estimated Medicaid repayments related to "behavioral health" claims from 2002 to 2006. The claims were filed with two WellCare subsidiaries, WellCare of Florida and HealthEase of Florida. The remaining $10.7 million will be put in escrow while federal investigators continue the probe.
The payment does not prevent the federal government or the state of Florida from making additional claims in their continuing investigations. WellCare wrote in the filing, "We do not know whether other areas of the investigations might lead to fines, penalties, operating restrictions or disqualifications, or other material adverse impaction on the company or the company's previously issued financial statements" (St. Petersburg Times, 8/18).
N.J.'s Largest Insurer Filing for For-Profit Status; Change Could Result in $1B Charitable Foundation
[Aug 19, 2008]
Horizon Blue Cross Blue Shield, New Jersey's largest health insurer, on Friday filed to become a publicly held for-profit company, which could potentially provide the state $1 billion to spend on health care, the Philadelphia Inquirer reports. The insurer covers 3.6 million people, or about four in every 10 New Jersey residents, and is the largest insurer participating in the state's Medicaid program.
According to the Inquirer, Gov. Jon Corzine (D) has suggested that the move could help fund the expansion of public health programs, which both Corzine and the state Legislature support. The Inquirer reports that the value of the insurer in the open market -- which Horizon President and CEO William Marino estimated at $1 billion -- would go toward a charitable foundation that current law mandates would provide care for low-income residents. Marino in a conference call with reporters said, "We're optimistic that the benefit of creating a foundation of $1 billion or more and the benefits that that can provide the underserved population -- in other words, the good that that can do -- will be easily understood." Marino said converting to a for-profit company would raise capital and allow for competition with other insurers. However, Michael Kornett, chief executive officer of the Medical Society of New Jersey, said, "The emphasis will go from patients and employers right to the shareholders." He added, "Their whole mission is going to change."
Horizon's application will be reviewed by the state Department of Banking and Insurance, which is required to hold a series of public meetings on the plan. Marino said he hopes a decision will be handed down during the first half of 2009 (Tamari/Burling, Philadelphia Inquirer, 8/16).
Hartford Courant Examines 'Growing Competition' in Individual Health Insurance Market
[Aug 19, 2008]
The Hartford Courant on Monday examined the "growing competition" in the individual health insurance market, in which health insurers have begun to offer a "dizzying array of policies" in a "broader spectrum of prices." As part of increased competition, health insurers have sought to make individual health insurance policies more affordable through elimination or limitation of certain benefits and higher deductibles for policyholders. Health insurers have targeted consumers of all ages for individual health insurance policies, with a focus on early retirees and "young invincibles" -- adults in their 20s and early 30s who often believe that they do not require health insurance and do not have access to coverage through their employers. According to the Courant, health insurers continue to reject applications from consumers with pre-existing medical conditions or require them to pay premiums 25% to 50% higher than standard rates, but, "rather than wait for health care reform as efforts lurch forward and back, some consumers could benefit by taking a second look at individual policies."
Patrick Quirk, product director for individual markets at Anthem Blue Cross and Blue Shield in Connecticut, said, "There is definitely more competition, more players entering into the market and more products available than ever before." Stephen Jewett, a spokesperson for ConnectiCare, said, "We are in a mature insurance market, and some of the biggest potential is in the individual market." He added that "all the insurers recognize that." Ellen Andrews, executive director of the Connecticut Health Policy Project, said, "I'm very skeptical of individual markets," adding, "It may be better, but it's so bad that they've got a long way to go before it gets to what we have in the small group market" (Levick, Hartford Courant, 8/18).
Coverage & Access
Maryland Trauma Patients Over Age 65 Less Likely To Be Brought to Trauma Centers, Study Finds
[Aug 19, 2008]
Trauma patients over age 65 are less likely than younger patients to be taken to Maryland trauma centers, according to a report published Tuesday in the Archives of Surgery, the Baltimore Sun reports. For the study, researchers from Johns Hopkins University School of Medicine and Bloomberg School of Public Health, led by surgery professor David Chang, analyzed data taken from the Maryland Ambulance Information System for about 26,000 trauma patients in the state between 1995 and 2004. They also interviewed 166 emergency medical and trauma center personnel. Researchers found that 50% of patients older than 65 were not taken to trauma centers, compared with 18% of younger patients. Although the disparity was notable for patients older than 65, researchers found that it began at age 50, the Sun reports.
Researchers discovered through the interviews that lack of training, unfamiliarity with transportation protocol and possible age bias were the biggest factors in the discrepancy. Chang said, "We use the word bias in certain areas of our study. But we also talk about blind spots," adding, "People are operating on assumptions of what old is and what elderly patients need." Researchers found that in some cases, EMS workers reported not being welcomed by trauma officials when arriving with an elderly patient, and that younger trauma doctors might perceive an elderly patient's fall as "less exciting" than a gunshot wound, although the injuries can be equally severe, the Sun reports. Comments
Chang said, "Trauma is often seen as a disease of the young," but "that's changing. You have a fairly active aging population that is playing sports, being active and getting injured." Chang noted that by 2050, about 39% of trauma patients will be 65 or older. Robert Bass, executive director of the Maryland Institute of Emergency Medical Services, who helped analyze the report, said, "[W]e want to share [the results] with other states and EMS systems because if it's happening in Maryland, it's likely happening everywhere." According to the Sun, MIEMS in the past year included age as a factor in its guidelines for when to take patients to trauma centers after the change was advised by the American College of Surgeon's Committee on Trauma (Brewington, Baltimore Sun, 8/19).
 An abstract of the study is available online.
Blog Watch
Kaiser Daily Health Policy Report Feature Highlights Recent Blog Entries
[Aug 19, 2008]
While mainstream news coverage is still a primary source of information for the latest in policy debates and the health care marketplace, online blogs have become a significant part of the media landscape, often presenting new perspectives on policy issues and drawing attention to under-reported topics. To provide complete coverage of health policy issues, the Kaiser Daily Health Policy Report offers readers a window into the world of blogs in a roundup of health policy-related blog posts. "Blog Watch," published on Tuesdays and Fridays, tracks a wide range of blogs, providing a brief description and relevant links for highlighted posts.
Michael Cannon of Cato@Liberty argues that presumptive Republican presidential nominee Sen. John McCain's (Ariz.) proposed plan to provide tax credits to consumers who purchase private coverage would not amount to a net tax increase, as some advisers to presumptive Democratic nominee Sen. Barack Obama (Ill.) have charged.
Trudy Lieberman of the Columbia Journalism Review's Campaign Desk posts two parts (here and here) of a series examining how the presidential candidates' health care proposals would affect "ordinary people." According to Lieberman, the media has not been covering the campaign from this angle.
Maggie Mahar of the Century Foundation's Health Beat Blog explains the methodology behind Medicare's physician fee schedule, calling the schedule "physician-centered" and saying that it fails to account for the value of care to patients.
Richard Reece on The Health Care Blog outlines what he sees as a "paradigm shift" in primary care that he says "will fundamentally change" the delivery of U.S. health care.
The Healthcare Economist's Jason Shafrin examines the presidential candidates' health plans.
Michael Miller of the Health Policy and Communications blog discusses the globalization of health care and its implications for the U.S. economy, as well as shortcomings of "medical tourism" and problems with prescription drug importation.
Paul Testa of the New America Foundation's New Health Dialogue writes that "the case for health reform only grows stronger during an economic downturn," in response to a new survey that found 22% of respondents have reduced the number of times they visit their physician because of the current economic climate.
The New Republic's The Plank points to an online article by Jonathan Cohn assessing the Obama campaign's contributions to the Democratic Party's proposed health care platform and what they signal about the candidate's commitment to health reform.
Anna Wilde Matthews of the Wall Street Journal's Health Blog reports on new results from a pilot project administered by CMS on incentive payments for doctors.
Opinion
Congress Should Pass Health IT Legislation To Help Reduce Costs for U.S. Manufacturers, Opinion Piece States
[Aug 19, 2008]
"Health care reform is a divisive issue in Washington, but there is wide agreement on one solution to lower costs and improve care": health care information technology, Drew Greenblatt, president and owner of Marlin Steel Wire Products and a member of the board of the National Association of Manufacturers, writes in a Baltimore Sun opinion piece. According to Greenblatt, with health care IT, "all medical records are stored electronically and available worldwide," and physicians can "instantly access medical information" for their patients.
Greenblatt writes, "Obviously, the benefits of health IT go far beyond patient convenience" because "something as simple as another doctor's illegible handwriting or an improperly transcribed note can cause a patient to get less than ideal care." In addition, he writes that a "balance is required between protecting patient privacy and giving health care professionals access to patient medical information" and that health care IT "offers better security for private medical information through high-tech firewalls and secure data encryption."
Greenblatt adds that the "increased efficiency in treatment made possible by health IT will also help contain rising health care costs," an issue that has become "a major concern for business owners, like me, who offer health care coverage." U.S. "manufacturers who provide health coverage spend an average of $2.38 per worker per hour on health care costs," or "more than double what foreign competitors pay," Greenblatt writes, adding, "Spiraling health care costs have forced many manufacturers to tighten their budgets, making it difficult or impossible to expand" their businesses or provide more jobs.
"If Congress doesn't act to rein in these costs, American companies will be forced to either scale back on health benefits or shift manufacturing jobs overseas in order to compete," he writes, concluding, "We need Congress to act -- now" (Greenblatt, Baltimore Sun, 8/18).
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