Kaiser Daily Health Policy Report
Group of House Democrats Propose Medicare Drug Benefit for Low-Income Beneficiaries
Sen. Grassley Meets With Bush To Address Geographic Disparities in Medicare Payments
Frist Says Senate Will Address Medical Malpractice Issue After Spring Recess
Denver Health Medical Center Residency Policy Limiting Access to Care for Homeless
United Auto Workers Would Reject Any New Contract That Would Increase Workers' Health Costs, President Says
Federal Judge Blocks Connecticut Plan To End Medicaid Coverage for Adults, Some Children
Philip Morris, State AGs Expected To Request Illinois Court To Lower Bond
Robert Wood Johnson Foundation Names Lumpkin Senior Vice President and Director of Health Care Group
The Latest Reports in Health Policy
Capitol Hill Watch
House Appropriations Committee Approves FY 2003 Supplemental Spending Bill, Including Funds for Smallpox Compensation Program
[Apr 02, 2003]
The House Appropriations Committee on April 1 approved on a 59-0 vote a $77.9 billion fiscal year 2003 supplemental appropriations plan, which would fund the war against Iraq and homeland security issues, including the smallpox vaccine compensation program that failed to pass the full House on March 31, the AP/Philadelphia Inquirer reports (Fram, AP/Philadelphia Inquirer, 4/2). Under the smallpox compensation bill, sponsored by Rep. Richard Burr (R-N.C.), people who become disabled or die as a result of the smallpox vaccine or their survivors would receive a lump sum of $262,100. The legislation also would compensate participants for 66% of lost wages after they missed five days of work for illnesses related to smallpox vaccination or 75% of lost wages for workers with dependents, up to $50,000 per year, or up to $262,100 total, the maximum benefit for death or permanent disability (Kaiser Daily Health Policy Report, 4/1). The House FY 2003 supplemental plan would allocate $165 million for bioterrorism and public health efforts, including $50 million for the smallpox vaccine compensation program, $94 million to help state and local health authorities with the costs of the civilian smallpox vaccination program and $16 million for the CDC to research Severe Acute Respiratory Syndrome, known as SARS (House Appropriations Committee release, 4/1). The House plan also would allocate $2.2 billion for first responders to a disaster, $700 million of that total for "high-density, high-threat urban areas" and the rest for states, CongressDaily reports (Ghent, CongressDaily, 4/1). The Senate Appropriations Committee on April 1 approved a $78.8 billion FY 2003 supplemental appropriations bill, but the measure does not include funds for smallpox vaccine compensation, CongressDaily/AM reports (Ghent/ Fulton, CongressDaily/AM, 4/2). The Senate Health, Education, Labor and Pensions Committee is expected to mark up a smallpox vaccine compensation bill April 2, CongressDaily/AM reports (Rovner, CongressDaily/AM, 4/2). Both the full House and Senate are expected to approve their versions of the supplemental appropriations measure "within days" and send President Bush a reconciled bill by April 11, the Los Angeles Times reports (Simon, Los Angeles Times, 4/2). Drop Objections to Smallpox Compensation Plan, Editorial Says
The action by some House members to vote against Burr's smallpox compensation plan on March 31 "was a sop to union leaders who are holding out for more money and scaring their health care industry members," a Wall Street Journal editorial states. While some lawmakers and others have said that Burr's bill "is too stingy," the Journal states that it would give the "same amount the Justice Department pays firefighters or policemen injured or killed on duty." The editorial adds, "Does anyone think cops and firemen are worth less than hospital workers?" Further, the Journal says that "most workers already have access to insurance and workers' comp for minor reactions" to the smallpox vaccine and notes that military statistics show that only 3% of troops vaccinated have required sick leave, with average time off of 1.5 days. While there has "been alarm over three people who died of heart attacks after vaccination ... [t]he reality is that for well-screened, healthy adults, the risks of vaccination are minuscule," the Journal states. "The Bush administration is taking bioterror[ism] seriously," the editorial concludes, adding, "Is it too much to ask that Congress and unions do their part?" (Wall Street Journal, 4/2).
Group of House Democrats Propose Medicare Drug Benefit for Low-Income Beneficiaries
[Apr 02, 2003]
A group of about 20 moderate House Democrats on April 1 proposed a Medicare prescription drug benefit that would be added to the existing program and would only apply to beneficiaries with low incomes or high drug costs, the New York Times reports. Under the plan, sponsored by Reps. Cal Dooley (D-Calif.) and Rahm Emanuel (D-Ill.), Medicare would pay 80% of the cost of each prescription after a beneficiary has incurred $4,000 in drug costs in a year. Further, the plan calls for the federal government to cover a percentage of drug costs for beneficiaries with annual incomes less than 200% of the federal poverty level, or $17,960 for an individual, on a sliding scale based on income. For instance, the government would cover 80% of drug costs for beneficiaries with the lowest incomes and a decreasing portion as beneficiaries' incomes rise. The $4,000 deductible would not apply to beneficiaries with incomes below 200% of the poverty level. Dooley and Emanuel said the drug benefit, which would have no extra premium, could be delivered through HMOs, group health plans for retirees, private insurance polices or state drug assistance programs. According to the Congressional Research Service, almost 50% of seniors have annual incomes of less than 200% of the federal poverty level, and the Congressional Budget Office says that 17% of seniors will have drug expenses higher than $4,000 this year, the Times reports. The bill also calls for the government to negotiate medication discounts with drug companies and then create drug discount cards that could save beneficiaries 15% to 30%. The bill would cost $400 billion over 10 years, the same amount that President Bush has requested for Medicare reform and a drug benefit in his fiscal year 2004 budget outline. 'Fiscally and Politically Realistic'?
Dooley said that other Medicare drug benefit proposals by Republicans and Democrats have "serious shortcomings" because the drug benefits they propose generally would be optional and would charge beneficiaries additional premium costs. He said that such approaches would attract a disproportionate number of sick people who will need a large number of prescription drugs. Dooley and Emmanuel said that Democrats should support their plan because it would not privatize Medicare or require "sweeping changes" in the program's structure and that Republicans should support it the plan because its cost is limited and it would not "lavish aid" on the wealthy, the Times reports. "Our proposal is fiscally and politically realistic," Dooley said. Howard Bedlin, vice president of the National Council on the Aging, said, "This is not the ultimate solution, but it would be a good start, a potential compromise, that could attract bipartisan support if we find there's not enough money to provide more comprehensive drug benefits." Members of both parties said that Congress might eventually support such a plan if legislators cannot agree on a plan to give a drug benefit to all Medicare beneficiaries, the Times reports (Pear, New York Times, 4/2).
Sen. Grassley Meets With Bush To Address Geographic Disparities in Medicare Payments
[Apr 02, 2003]
Senate Finance Committee Chair Charles Grassley (R-Iowa) met with President Bush, Vice President Dick Cheney and other members of the administration on April 1 to discuss so-called geographic "inequities" in Medicare payments to providers, the Des Moines Register reports (Norman, Des Moines Register, 4/2). Medicare provider reimbursement rates are based partly on data such as local wages and costs, a system that some people say has led to disparities in payments for providers in rural areas, such as Iowa (Kaiser Daily Health Policy Report, 3/26). During the 40-minute meeting, Bush made a commitment to have his staff work with Grassley's staff to develop "ways to reduce [the] disparities," Grassley said. Grassley said that Bush spoke "very sympathetically" about the geographic payment disparities, particularly after Grassley showed the president recent editorials and articles about the issue in the Register. The paper has reported that Iowa has one of the lowest Medicare spending per beneficiary rates in the nation (Des Moines Register, 4/2). Grassley's meeting with Bush comes after the Senate last week on a 49-49 vote defeated an amendment to the fiscal year 2004 budget resolution that would have allocated $25 billion to address the disparities. The amendment, sponsored by Sen. Tom Harkin (D-Iowa), would have transferred $25 billion from funds allocated for a tax cut to Medicare reform (Kaiser Daily Health Policy Report, 3/26). More information on states' Medicare spending per beneficiary is available online at State Health Facts Online.
Frist Says Senate Will Address Medical Malpractice Issue After Spring Recess
[Apr 02, 2003]
Senate Majority Leader Bill Frist (R-Tenn.) on April 1 said that a Senate version of the medical malpractice bill (HR 5) passed in the House last month will not likely reach the floor for debate until later this spring, CongressDaily/AM reports (CongressDaily/AM, 4/2). The House bill, sponsored by Rep. Jim Greenwood (R-Pa.), would cap noneconomic damages in medical malpractice lawsuits at $250,000. The legislation would allow punitive damages of $250,000 or twice the amount of economic damages, whichever is higher. The measure applies to lawsuits filed against physicians, HMOs, pharmaceutical companies and medical device companies. In addition, the bill would allow state governments to increase or decrease the cap; the legislation would not limit economic damages, which include medical costs and lost wages. Frist had scheduled debate time on a Senate version of the bill last month. However, Sen. Dianne Feinstein (D-Calif.) last week withdrew support from a compromise Senate bill after the American Medical Association and the California Medical Association expressed opposition to the legislation. The compromise bill would cap noneconomic damages in malpractice lawsuits at $500,000 (Kaiser Daily Health Policy Report, 3/27). Frist said that he would continue to work with Feinstein and other Democrats to reach a compromise on medical malpractice, which has stalled in the Senate over the past 10 years (CongressDaily/AM, 4/2).
Coverage & Access
Denver Health Medical Center Residency Policy Limiting Access to Care for Homeless
[Apr 02, 2003]
As a result of Denver Health Medical Center and its clinics beginning to "strictly enforce" a rule that only Denver residents can receive treatment at its facilities, many homeless people are "struggling to get medical care," the Denver Post reports. Denver Health, which receives funding from the city, always has officially limited charity care to Denver residents; however, the hospital last April began requiring patients to show two forms of identification with their name and Denver address before being admitted, the Post reports. More recently, the hospital stopped accepting shelter addresses as proof of residency, leaving thousands of homeless people without care, according to social workers, the Post reports. People who require emergency care do not have to show any identification. Dr. Michael Earnest, director of quality management at Denver Health, said the hospital began enforcing the residency rule because the slowed economy is causing an increase in the number of uninsured seeking charity care. Earnest said the city gave Denver Health $26 million last year for charity care, much less than the $210 million the hospital provided in charity care. He added, "We must preserve our resources for providing services to the residents of the city and county." But John Parvensky, president and chief executive of the Colorado Coalition for the Homeless, said that the new policy is "disconcerting," adding that there is no other place to send indigent people for care, the Post reports. "The homeless community is very much reliant on [Denver Health]," Brad Meuli, president of Denver Rescue Mission, said (Austin, Denver Post, 3/30). Denver Health CEO Responds
In a letter to the editor of the Denver Post, Deborah Gabow, CEO and medical director at Denver Health, notes that the hospital cared for 3,723 homeless patients in 2002, providing $20.2 million in services for such patients. She disputes the Post's report that the hospital is declining care for homeless people unable to prove Denver residency, saying that the hospital system's facilities accept documentation from homeless shelters to prove residency. Gabow states that the any patient seeking care at Denver Health facilities first sees a registration clerk and then is referred for enrollment screening and medical screening. Patients who are determined to be homeless through the screening process can receive free services and prescriptions if their annual incomes are below 40% of the poverty level. Patients seeking emergency care are treated immediately, Gabow writes (Gabow, Denver Post, 4/3).
United Auto Workers Would Reject Any New Contract That Would Increase Workers' Health Costs, President Says
[Apr 02, 2003]
United Auto Workers President Ron Gettelfinger announced March 31 that the union will not accept a new labor contract proposed by Detroit auto manufacturers for 300,000 hourly workers if it would transfer rising health care expenses to workers, the Detroit News reports. In 2001 health care costs increased 14%, to $8.2 billion, for General Motors, Ford and Chrysler to provide health care for 2.1 million employees, dependents and retirees. "Shifting costs onto the backs of workers is not the answer," Gettelfinger said, adding that he supports a national health insurance plan administered by the government. He said, "You can't fix the health care crisis in America at any one bargaining table, with any one employer or within any one industry." The workers' current contracts with GM, Ford, Chrysler, Delphi and Visteon expire in September (Hudson, Detroit News, 4/1).
State Watch
Federal Judge Blocks Connecticut Plan To End Medicaid Coverage for Adults, Some Children
[Apr 02, 2003]
U.S. District Court Judge Robert Chatigny on March 31 issued a temporary restraining order blocking scheduled changes to the HUSKY program, Connecticut's Medicaid program, that would have eliminated coverage for 23,000 adults and 7,000 children, the Hartford Courant reports. Chatigny delivered the verbal order "just hours" before the 30,000 beneficiaries would have lost their medical coverage (Keating, Hartford Courant, 4/1). Last month, the state Department of Social Services sent letters to 23,000 adults informing them that their HUSKY health coverage would be eliminated because of budget cuts. The state expected to save $12 million this fiscal year and $50.7 million next fiscal year because of the cuts, David Dearborn, a spokesperson for the department, said (Kaiser Daily Health Policy Report, 3/19). Lawyers representing seven beneficiaries who would lose coverage argued that the plaintiffs' medical conditions would be "worsened" if the state went through with the cuts. Marc Ryan, budget director for Gov. John Rowland (R), said, "If the [temporary restraining order] isn't lifted, it could mean a $5 million problem this year, and more importantly, a $54 million problem next year." But Lucy Potter, an attorney with Greater Hartford Legal Aid, said, "The abrupt termination of coverage for these parents and children is a violation of federal law. You can't balance the state budget by breaking federal law" (Hartford Courant, 4/1).
Philip Morris, State AGs Expected To Request Illinois Court To Lower Bond
[Apr 02, 2003]
Philip Morris on April 2 is expected to file a court motion seeking to reduce a $12 billion bond that an Illinois state court said the tobacco company must pay to appeal a recent court decision, the New York Times reports (Fuerbringer, New York Times, 4/2). The company must pay the bond to appeal a decision reached last month in a class-action case filed on behalf of about one million Illinois smokers. Illinois Circuit Court Judge Nicholas Byron ruled that Philip Morris misled consumers about the health risks of "light" cigarettes and ordered the company to pay $10.1 billion in damages (Kaiser Daily Health Policy Report, 3/31). Philip Morris has said that it cannot afford to pay the bond and that the company could face bankruptcy if it is forced to pay the full amount (New York Times, 4/2). The expected court motion follows the company's warning that it might not be able to pay $2.5 billion in settlement money to 46 states by April 15 because of the bond order, the Wall Street Journal reports. Philip Morris is responsible for about 50% of the annual settlement payment to the states that won a $246 billion lawsuit against the tobacco industry in 1998. Washington state Attorney General Christine Gregoire (D), who has said that the large bond "could deal a significant, unnecessary financial blow to the states," is expected to join other state attorneys general in filing a formal motion to urge the Illinois court to lower the bond. Although the national tobacco lawsuit sought funds for public health costs and smoking prevention programs, many states have used the settlement money to address budget shortfalls, the Journal reports. "These dollars are becoming more and more important," Lee Dixon, who researches health policy for the National Conference of State Legislatures, said (Fairclough/O'Connell, Wall Street Journal, 4/2).
 PRI's "Marketplace" on April 1 included a report on the Philip Morris bond payment. The segment includes comments from Morningstar tobacco analyst David Kaplan and George Washington University Law School professor John Banzhaf (Eaton, "Marketplace," PRI, 4/1). The full newscast is available online in RealPlayer.
People
Robert Wood Johnson Foundation Names Lumpkin Senior Vice President and Director of Health Care Group
[Apr 02, 2003]
Dr. John Lumpkin has been named the senior vice president and director of the health care group at the Robert Wood Johnson Foundation, foundation officials announced March 31. Lumpkin, the former director of the Illinois Department of Public Health, is a member of the Institute of Medicine's Committee on Minority Health Statistics and chair of the National Committee on Vital Health Statistics. He previously was a member of the National Advisory Council on Maternal, Infant and Fetal Nutrition, a member of the Advisory Committee to the Director of the CDC and the past-president of the Association of State and Territorial Health Officials. Lumpkin will lead the foundation's health care group in promoting access to health care for the nation's estimated 41 million people without health insurance and improving the quality of health care services. "Dr. Lumpkin is an exceptionally talented physician/administrator who brings a unique perspective to the foundation. His deep hands-on experience, as both an 'in-the-trenches' national and state public health leader and an emergency care provider, will serve the Foundation and philanthropy well as we continually work toward improving health care and health care for all Americans," foundation President and CEO Dr. Risa Lavizzo-Mourey said (RWJF release, 3/31).
New Releases
The Latest Reports in Health Policy
[Apr 02, 2003]
- "Physician, Public and Policymaker Perspectives on Chronic Conditions," Partnership for Solutions: The report, released by Partnership for Solutions, a project from the Robert Wood Johnson Foundation and Johns Hopkins University, analyzes survey information from physicians, policymakers and the public on their opinions of the chronic care system. According to the report, by Gerald Anderson, national program director for the partnership, the public is the most positive about the current system, and policymakers are the least positive. The report recommends that the system respond to the concern of providers, the public and policymakers that the current system does not address the needs of those with chronic conditions (Anderson, Archives of Internal Medicine, 2/24).
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