Kaiser Daily Health Policy Report
Senate Launches Debate on Measure To Shift Class-Action Cases to Federal Courts; Amendments Could Slow Progress
Illinois Attorney General Sues 48 Pharmaceutical Companies Alleging Inflated Prices for Medicaid, Medicare
New Documents Raise Questions About Merck's Knowledge of Vioxx Risks; Mercury Levels in Vaccines
Consumers Union Asks States To Require Hospitals To Make Public Patient Infection Data
Bill Clinton Calls on Federal Government, Health Care Industry To Improve Access to Care
Gov. Pataki's Budget Could Cut Millions in Funding from New York Hospitals
Physicians File Lawsuit Against BCBS of Michigan Opposing Health Plan Fee Reductions
Editorials, Opinion Pieces Address Health Care-Related Proposals in Bush FY 2006 Budget
Administration News
President Bush's FY 2006 Budget Proposal Includes Medicaid Reforms, Modest Spending Increases for Health Care
[Feb 08, 2005]
President Bush on Monday sent to Congress his fiscal year 2006 federal budget proposal, which includes a 1.2% decrease in discretionary funds for HHS -- with "big cuts" for CDC and other agencies, a 17% increase in funds for Medicare and a plan to save $60 billion over 10 years in Medicaid funds through the removal of state reimbursement "loopholes" and tighter eligibility requirements, the Wall Street Journal reports (Lueck, Wall Street Journal, 2/8). The budget proposal would eliminate 150 domestic programs to save the federal government $20 billion annually (Dodge, Dallas Morning News, 2/7). HHS would receive a total of $642 billion under the budget proposal (Nesmith, Atlanta Journal-Constitution, 2/8). According to the AP/Las Vegas Sun, the budget proposal places HHS "squarely in the bull's-eye" and indicates "modest new spending at best on health insurance programs and encouraging states to find $45 billion in savings for Medicaid over a decade." The budget proposal includes no significant increase in funds for Medicare and Medicaid in addition to the amount required by federal law (Kellman, AP/Las Vegas Sun, 2/7). The Bush administration said that the budget proposal would eliminate "underperforming programs" at HHS, such as training programs for health care professionals and block grants administered by the Health Resources and Services Administration (Schuler [1], CQ Today, 2/7). However, several agencies "in the political crosshairs," such as FDA, were "spared" in the budget proposal, according to the Journal (Wilde Mathews et al., Wall Street Journal, 2/8). Congressional debate on the "leanest budget proposal of Bush's presidency" will begin on Tuesday, when Office of Management and Budget Director Joshua Bolten will testify before the House Budget Committee (Taylor/Schatz, CQ Today, 2/7). Medicare
The budget proposal would provide an estimated $340 billion for Medicare in FY 2006, about $50 billion more than in FY 2005. According to CQ HealthBeat, the increase in part would result from the new Medicare prescription drug benefit scheduled to begin on Jan. 1, 2006. The budget proposal also includes a $10 billion decrease in Medicare reimbursements to skilled nursing facilities, a $4.6 billion decrease in reimbursements to inpatient acute care facilities and an $860 million decrease in reimbursements to inpatient rehabilitation facilities. Under the budget proposal, the decreases in Medicare reimbursements would occur over a five-year period. The budget proposal does not include recommendations for reforms to the formula for Medicare reimbursements to providers (CQ HealthBeat, 2/7). Medicaid
The Bush administration also announced plans to work with governors to "chart far more sweeping changes" in Medicaid than those included in the budget proposal, which "gave a glimpse of how the administration wants to reshape Medicaid," the Journal reports (Lueck, Wall Street Journal, 2/8). The budgets for Medicaid and SCHIP under federal law will increase by 2.2% to about $198 billion for FY 2006 (AP/Las Vegas Sun, 2/7). HHS Secretary Mike Leavitt last Tuesday said that the federal government could save $60 billion in Medicaid funds over the next 10 years through the closure of "loopholes" that allow middle-class seniors to receive benefits, the ban of "accounting gimmicks" used by states to receive more federal matching funds and the reduction of spending on prescription drugs. Leavitt said that the administration will not limit federal expenditures for mandatory Medicaid beneficiaries. However, he did not directly address whether the administration would consider a limit on federal expenditures for optional Medicaid beneficiaries and services, which account for about two-thirds of Medicaid costs (Kaiser Daily Health Policy Report [1], 2/7). The Medicaid proposal, which is the "centerpiece" of efforts by the administration to address increased health care costs, would return about $15 billion of the $60 billion saved to the Medicaid and SCHIP programs for expanded coverage, CQ Today reports. The budget proposal also includes recommendations for long-term Medicaid reforms to establish a "more sustainable cost structure." Although the budget proposal includes few details, administration officials said that they hope to "build on the success" of SCHIP, which could indicate that the administration plans to implement a block grant system for Medicaid, CQ Today reports (Schuler [1], CQ Today, 2/7). According to the Journal, the budget proposal indicates that the administration might seek to provide states with more flexibility in Medicaid and "signals the administration may want to cap funding for certain categories of recipients" (Lueck, Wall Street Journal, 2/8). Tax Credit Plan
The budget proposal also includes a plan to help decrease the number of uninsured U.S. residents through tax credits (Kellman, AP/Las Vegas Sun, 2/8). The plan seeks $142 billion over 10 years to help 12 million to 14 million uninsured residents purchase health insurance. The plan calls for $74 billion in tax credits to help some residents without employer-sponsored or government-funded health insurance pay for high-deductible health coverage and contribute to health savings accounts or obtain traditional health insurance plans (Kaiser Daily Health Policy Report [2], 2/7). The plan would provide as much as $3,000 in tax credits to help low-income individuals and families purchase health insurance (Kellerman, AP/Las Vegas Sun, 2/7). VA
The budget proposal would require about two million higher-income veterans without service-related conditions to pay a $250 annual fee, as well as an $8 increase in copayments for prescription drugs, for FY 2006 (Dodge, Dallas Morning News, 2/8). Under the budget proposal, total funds for the Department of Veterans Affairs would increase to $68.2 billion, or by 1%. The budget proposal would eliminate federal funds for a program that provides long-term care for veterans and reduce funds for VA nursing home care by $351 million, which could lead to the elimination of about 5,000 nursing home beds administered by the department. VA officials said that the budget proposal would increase funds for long-term "noninstitutional" care by 18% to help shift more veterans from nursing home to in-home care but would not force veterans from nursing homes. According to CQ Today, the proposals for VA health care programs, which account for most of the discretionary budget of the department, likely would cause "the biggest debate" among lawmakers because they would "require some veterans to pay substantially more for their health care" (Plummer, CQ Today, 2/7). FDA
The budget proposal includes an increase in funds for FDA by 4.4% to $1.88 billion for FY 2006, with the additional funds used in part to finance more medical device reviews (Wilde Mathews et al., Wall Street Journal, 2/8). The budget proposal also "attempts to answer concerns about the safety of prescription drugs," according to CQ Today. Under the budget proposal, the FDA Office of Drug Safety, which monitors medications approved by the agency after they reach the market, would receive $33 million, a 24% increase from FY 2005 (Schuler [1], CQ Today, 2/7). However, the Journal reports, despite the proposed budget increase, "the office's funding remains a small share of the $556 million devoted to all drug oversight." According to the Journal, the budget proposal provides "an early look" at Bush administration plans for a "new drug-safety effort." The budget proposal calls for the FDA Office of Drug Safety to increase staff by 25, to 134 employees, and use the new workers to establish new policies on safety reviews and increase communications within the agency, as well as among other agencies. According to the Journal, "It isn't clear if the new drug-safety efforts," which the administration will formally release in the next several weeks, "will satisfy lawmakers focused on the FDA." The budget proposal also includes a $30 million increase in funds for FDA efforts to develop prevention and mitigation strategies in the event of contamination in the U.S. food supply (Wilde Mathews et al., Wall Street Journal, 2/8). Total funds for biodefense efforts would increase by 3.6% to $1.6 billion under the budget proposal (Schuler [1], CQ Today, 2/7). Research and Development
The budget proposal includes a total of $132.5 billion for research and development for FY 2006, an increase of less than 1% from 2005. The budget proposal also includes a 1% reduction in funds for basic research, no change in funds for applied research and a 2% increase in funds for "development." Under the budget proposal, NIH would receive $28.8 billion, or a 0.7% increase from FY 2005. Although funds for the 27 NIH centers would remain the same under the budget proposal, funds for biodefense would increase by 3.7% to about $1.8 billion, and the National Cancer Institute budget would remain at about $4.8 billion. The National Science Foundation budget would increase by about 2.4% to $5.6 billion under the budget proposal (Wysocki, Wall Street Journal, 2/8). CDC, Other Reductions
The budget proposal would reduce funds for CDC by 12% to about $4 billion for FY 2006 and decrease funds for mental health and substance abuse treatment programs by 1.6% (Kellman, AP/Las Vegas Sun, 2/7). The proposed $555 million reduction in the CDC discretionary budget "would be driven largely by what officials called a 'pause' in new construction in Atlanta and cuts in preventive health programs," the Atlanta Journal-Constitution reports. The budget proposal includes a $60 million reduction in funds for CDC management and a $59 million decrease in funds for prevention of chronic diseases. The budget proposal also would reduce funds for state and local government bioterrorism preparedness efforts by $130 million. CDC Chief Operating Officer William Gimson said that the agency would construct portable hospital units that could help in early responses to bioterrorist attacks (Atlanta Journal-Constitution, 2/8). In addition to CDC program, the budget proposal would eliminate: - The Department of Education Safe and Drug Free Schools state grants, which accounted for $437 million in FY 2005;
- The HHS Emergency Medical Services for Children, which accounted for $20 million in FY 2005; and
- The Homeland Security Department Metropolitan Medical Response System, which accounted for $30 million in 2005 (CQ Today, 2/8).
Bush Administration Reaction
Leavitt said, "The president has proposed a fiscally responsible budget that sets priorities and holds government programs accountable for real results. If we had an unlimited budget, we would spend more on many programs" (Atlanta Journal-ConstitutionΒΈ 2/8). CMS Administrator Mark McClellan praised the Bush administration Medicaid proposal, adding, "We can get more coverage and more assistance for the dollars we're spending and also relieve the burden on the states. ... This is not about saving money" (Lueck, Wall Street Journal, 2/8). Bolten said, "The Medicaid proposals do involve asking states to shoulder a more appropriate share of the burden" (Weisman, Washington Post, 2/8). Rita Reed, VA deputy assistant secretary for budget, said that proposed reductions to the department budget "were carefully thought out and part of an integrated plan, as opposed to simply reacting to resources available" (Plummer, CQ Today, 2/7). Lawmaker Reaction
Republicans and Democrats on Monday "challenged cuts that would hit Medicaid" and other health care programs and raised concerns about whether the Bush administration could significantly reduce the federal budget deficit over the next five years, the Dallas Morning News reports (Jackson, Dallas Morning News, 2/7). Lawmakers expressed "considerable skepticism" about the proposed budget reductions and said that "Congress was unlikely to accept many of the cuts," according to Pittsburgh Post-Gazette (Reston, Pittsburgh Post-Gazette, 2/8). According to CQ Today, the budget proposal "triggered discussion Monday" among lawmakers about the use of "some automatic mechanism to slow the rapid growth in mandatory spending" for programs such as Medicare and Medicaid "while minimizing political fallout" (Ota, CQ Today, 2/7). According to the New York Times, lawmakers expect "a bitter fight" over the proposed reductions in funds for Medicaid. Sen. Judd Gregg (R-N.H.) said, "Obviously, this is a budget which is going to create some significant angst amongst my colleagues, to be kind. But the fact is that everyone is probably going to be upset by it, because everybody's ox gets gored, including defense" (Hulse, New York Times, 2/8). Rep. Jeff Flake (R-Ariz.) said, "I am optimistic that the Congress is going to take [Bush] seriously, and because that is the case, I think he'll fare all right. But it still depends on the president. We've proven we can't control spending, and he's going to have to exert pressure" (Dinan/Lambro, Washington Times, 2/8). CQ Today reports that moderate Republicans "are lining up to oppose cuts in Medicaid." Sen. Lincoln Chafee (R-R.I.) said, "Instead of some of these spending cuts, I think we should put all the tax cuts on the table" (Ota, CQ Today, 2/7). Additional Reaction
House Minority Leader Nancy Pelosi (D-Calif.) called the budget proposal "a hoax on the American people." Sen. Dianne Feinstein (D-Calif.) said, "With the extraordinary costs of the war in Iraq and Afghanistan and making his tax cuts permanent, the only way President Bush can even provide an appearance of bringing the budget into balance is to make substantial and dramatic cuts in domestic spending." However, House Speaker Dennis Hastert (R-Ill.) said that the budget proposal is "a good starting point" and indicates that "there are tough fiscal challenges ahead" (New York Times, 2/8). Sen. Daniel Akaka (D-Hawaii), ranking member of the Senate Veterans' Affairs Committee, said of the proposals for VA health care programs, "Payroll and inflation increases for doctors, nurses and medications cost more than $1 billion, but the president has proposed to give VA only half of what it needed." Akaka added, "So far, 192,260 veterans have been turned away across the country, including 502 in my home state of Hawaii. This sends the wrong message to our troops overseas. They need to know that we are there for them when they return home" (Plummer, CQ Today, 2/8). Other Reaction
The National Governors Association said in a statement, "Governor's have little control over these two cost drivers and do not want to be in the position of having to choose between funding health care programs for grandparents or programs for their grandchildren" (Lueck, Wall Street Journal, 2/8). NGA said that Congress must "save both the states and federal government money, as opposed to shifting costs to the states through budget cuts, caps or other mechanisms." The Association of American Universities said that the proposed increases in funds for NIH "are so modest that the agencies would support less research next year than they do under the current budget" (Kellman, AP/Las Vegas Sun, 2/7). Daniel Smith, national vice president for federal and state government relations at the American Cancer Society, criticized proposed reductions in funds for CDC, adding, "Cancer doesn't understand budget deficits, and the research that is currently outpacing this disease has no layaway policy" (Atlanta Journal-Constitution, 2/8). Robert Greenstein, executive director of the Center on Budget and Policy Priorities, said, "If the question is how do low-income families fare under this budget, the answer is that they ultimately fare very poorly" (Dodge, Dallas Morning News, 2/7). Broadcast Coverage
NPR's "Morning Edition" on Tuesday reported on the Medicaid proposal and the funds included for health care programs in the budget proposal for FY 2006. The segment includes comments from George Hardy, executive director of the Association of State and Territorial Health Officials; Dan Hawkins, vice president for federal, state and public affairs at the National Association of Community Health Centers; Leavitt; and Rep. John Spratt Jr. (D-S.C.) (Rovner, "Morning Edition," NPR, 2/8).
 The complete segment is available online in RealPlayer.
An audio webcast of Leavitt's briefing to discuss the HHS budget is available online on kaisernetwork.org.
Capitol Hill Watch
Senate Launches Debate on Measure To Shift Class-Action Cases to Federal Courts; Amendments Could Slow Progress
[Feb 08, 2005]
The Senate on Monday began debate on a proposed amendment to a class-action lawsuit reform bill (SB 5), and consumer groups sought "to garner support for amendments they said would make an objectionable bill somewhat more palatable," the Washington Post reports (Harris, Washington Post, 2/8). The Senate Judiciary Committee on Thursday voted 13-5 to approve the legislation, which would shift more class-action lawsuits from state to federal courts. The bill seeks to prevent "forum shopping," a practice under which attorneys file lawsuits in jurisdictions that often favor plaintiffs. The legislation also would shift class-action lawsuits to federal court in cases in which more than $5 million is in dispute or in which plaintiffs and defendants reside in different states. In addition, the bill includes several provisions that would protect plaintiffs from settlements that are more beneficial to attorneys than plaintiffs (Kaiser Daily Health Policy Report, 2/4). One of the most "contentious" of the proposed amendments, introduced by Sen. Jeff Bingaman (D-N.M.), would allow federal judges to select which state laws to apply in multistate class-action lawsuits, the New York Times reports (Labaton, New York Times, 2/8). Federal judges often reject lawsuits in which several different state laws apply, and supporters said the amendment would "test whether the real point of changing the rules is to hear more cases in federal court or to guarantee that far fewer cases are ever heard," the Post reports (Washington Post, 2/8). Reaction
Consumer, environmental, civil rights and labor groups on Monday "blanketed Congress" to advocate for the amendment as business groups "lobbied hard to defeat it," the Times reports. Sen. Arlen Specter (R-Pa.), who sponsored SB 5, said that he supports the amendment, although Specter aides said that the senator would support the bill regardless of whether the amendment passes. "In moving cases to the federal courts, I do not want to see changes in the substantive rights of consumers and other class-action litigants," Specter said (New York Times, 2/8). Sen. Mary Landrieu (D-La.) said, "I think Bingaman has a very good amendment." Implications
The level of support for SB 5 is "thin enough that the defection of even a couple of Democrats could make the bill vulnerable to a filibuster," CQ Today reports. As a result, Senate Democrats on Monday began to draft an alternative to Bingaman's amendment to help "maintain the seemingly filibuster-proof margin of 60 supporters" for SB 5 and avoid "language that would push House Republicans to go ahead with their own bill (HR 516)" rather than the Senate version, according to CQ Today (Stern, CQ Today, 2/7). House Republican leaders last week said that they would expedite passage of the Senate version of the bill, provided that the legislation passed without amendments. The House in recent years has supported legislation that "would tighten rules on class-action lawsuits even more than the Senate," the Post reports (Washington Post, 2/8). John Feehery, a spokesperson for House Speaker Dennis Hastert (R-Ill.), last week called the amendment proposed by Bingaman a "deal killer" (Kaiser Daily Health Policy Report, 2/4). The House version of the bill likely would not pass in the Senate, CQ Today reports (CQ Today, 2/7).
Prescription Drugs
Illinois Attorney General Sues 48 Pharmaceutical Companies Alleging Inflated Prices for Medicaid, Medicare
[Feb 08, 2005]
Illinois Attorney General Lisa Madigan (D) on Monday filed suit against 48 pharmaceutical companies alleging that the companies defrauded the state and the public by overcharging for prescription drugs, the Chicago Tribune reports. Filed in Cook County Circuit Court, the suit accuses the pharmaceutical companies of defrauding the state's Medicaid program and Medicare beneficiaries out of "hundreds of millions of dollars" by "intentionally misreporting and inflating" the average wholesale price figures used to calculate reimbursement rates, the Tribune reports (Chase/Japsen, Chicago Tribune, 2/8). The suit cites one example in which Pharmacia -- now part of Pfizer -- reported an AWP for its breast cancer drug Adriamycin of $241.36 per month but actually charged other payers as little as $33.43 per month. The suit, which does not seek a specific dollar amount but asks for millions of dollars in restitution, is "the latest assault in a wave of attacks on the pharmaceutical industry," the Tribune reports. Attorneys in at least 19 other states have filed similar suits over the past two years to help address prescription drug price increases. According to congressional investigators, the pricing system used by pharmaceutical companies has resulted in public health programs overpaying by at least $800 million annually and U.S. consumers overpaying by as much as $200 million annually. State Officials Comments
In a statement, Madigan said, "Drug companies have manipulated the average wholesale prices" (Chicago Tribune, 2/8). Melissa Merz, a spokesperson for Madigan, said, "What distinguishes Illinois is the fact we're such a large state. Think of the numbers of Medicaid recipients alone (about 1.8 million), and you start to have a mental picture of how much this starts to cost" (Patterson/Fusco, Chicago Sun-Times, 2/8). Industry Reaction
Officials for the pharmaceutical companies named in the suit said they had not seen the complaint and could not comment. However, referring to similar charges made in lawsuits filed by other states, Baxter spokesperson Deborah Spak said, "Over the last several years, Baxter has been named together with dozens of pharmaceutical companies in a number of lawsuits involving average wholesale pricing. We have acted in a responsible, lawful and transparent manner and are vigorously defending these suits. It is important to keep in mind that we as a manufacturer do not determine the amount of reimbursement to health care providers." Abbott Laboratories spokesperson Jonathon Hamilton said, "Abbot has properly and lawfully provided information to the government and to the independent drug reporting services on which the government relies in setting reimbursement" (Chicago Tribune, 2/8). Broadcast Coverage
NPR's "All Things Considered" on Monday reported on attorneys general in at least 16 states who have filed suit against pharmaceutical companies for allegedly overcharging Medicaid programs. The segment includes comments from Richard Evans, a pharmaceutical stock analyst with Sanford Bernstein; Jim Frogue, director of the Health and Human Services Task Force at the American Legislative Exchange Council; Dee Miles, an attorney representing the state of Alabama; Nicholas Messuri, assistant attorney general for Massachusetts and president of the National Association of Medicaid Fraud Control Units; (Elliott, "All Things Considered," NPR, 2/7).
The complete segment is available online in RealPlayer.
New Documents Raise Questions About Merck's Knowledge of Vioxx Risks; Mercury Levels in Vaccines
[Feb 08, 2005]
Previously undisclosed documents show that Merck was preparing to conduct a large-scale cardiovascular study of its COX-2 inhibitor Vioxx in 2002 but canceled the trial as it was about to begin, the New York Times reports. The trial, which was slated to produce data by March 2004, "may have provided answers about Vioxx's risks even earlier if patients had shown ill effects," according to the Times. Merck pulled Vioxx from the market in September 2004 over concerns about cardiovascular effects. The study would have involved 20,000 patients with acute coronary syndrome, in which patients experience chest pain from cardiovascular disease. Although the plan was "briefly cited" in a 176-page document recently submitted to FDA, the company never disclosed how close the trial came to starting or how extensively it was planned, the Times reports. Documents reviewed by the Times show that by early 2002, Merck had contacted outside researchers to oversee the trial, approached AstraZeneca to supply anti-ulcer medication to ease possible side effects and prepared a 70-page protocol for trial conduct. However, in mid-March 2002, Merck executives halted the study days before researchers had planned to submit their protocol to FDA. Merck said in a statement on Monday that it decided not to conduct the trial because it involved "high-risk" patients. "[W]e continued to ask ourselves and our consultants whether this was the right study to definitively answer" the question of whether Vioxx increased cardiovascular risks, Merck said, adding, "We ultimately decided not to conduct that particular study." According to the Times, work on the planned trial was stopped at the same time that Merck and FDA were "concluding lengthy and heated negotiations" concerning Vioxx's label after an earlier trial indicated that the drug might increase risks for cardiovascular problems. However, Merck said that the talks had no bearing on its decision to not conduct the trial (Meier, New York Times, 2/8). Memo Shows Company Knew of High Mercury Levels
In related news, the Los Angeles Times recently obtained a seven-page 1991 Merck memo stating that six-month-old children who were given Merck vaccines on schedule would receive mercury doses up to 87 times higher than maximum daily consumption guidelines for mercury from fish. According to the memo, written by Dr. Maurice Hilleman to the president of Merck's vaccine division, "When viewed this way, the mercury load appears rather large." The memo continues, "The key issue is whether thimerosal, in the amount given with the vaccine, does or does not constitute a safety hazard. However, perception of hazard may be equally important." Thimerosal is an antibacterial compound that is nearly 50% ethyl mercury, a neurotoxin. In 1999, FDA released a report showing high-level mercury exposure from pediatric vaccines. By 2002, thimerosal -- which some contend is related to the development of autism in children -- had been eliminated from almost all vaccines. An Institute of Medicine committee in May 2004 concluded that evidence "favors rejection of a causal relationship" between vaccines and autism. The Merck memo was provided to the Los Angeles Times by James Moody, a lawyer who works with advocacy groups on vaccine safety issues. Moody said the memo provides "the first hard evidence the companies knew -- or at least Merck knew -- that the children were getting significantly more mercury" than guidelines recommended. Merck would not discuss the memo, citing pending litigation (Levin, Los Angeles Times, 2/8).
Coverage & Access
Consumers Union Asks States To Require Hospitals To Make Public Patient Infection Data
[Feb 08, 2005]
Consumers Union, which publishes Consumer Reports, has asked states to require hospitals to make public data on patients who develop infections during their stays, but "medical officials have been reluctant to do so out of concerns over cost and whether publicly releasing the data will fix the problem," the AP/Las Vegas Sun reports. Recent demand for greater hospital infection reporting has prompted four states -- Florida, Illinois, Missouri and Pennsylvania -- to require hospitals to make such data public, but the states have "fledgling reporting systems, as there is no industry standard," the AP/Sun reports. In addition, current Web sites that provide hospital infection data to consumers often are limited or difficult for consumers to use, or they do not provide data on specific hospitals, according to Lisa McGiffert, senior policy analyst for Consumers Union. According to CDC, two million health care-related infections occur annually. "It is a problem," McGiffert said, adding, "It affects the lives of 5% to 10% percent of hospital patients, who sometimes suffer debilitating long-term health consequences. We do want to give the system a little bit of a shove to take action." CDC Recommendations
CDC later this month plans to release recommendations on how states can work with hospitals to make public data on patient infections, with a draft of the guidelines scheduled for release on Tuesday at the meeting of the Association for Professionals in Infection Control and Epidemiology in Atlanta. "You want to have data ... so consumers can make decisions but also health care providers can use for improvement," Dr. Denise Cardo, director of the CDC division of health care quality promotion, said. However, according to hospital officials, the release of data on patient infections might not help address the problem. Nancy Foster of the American Hospital Association said that hospitals would have to validate data on patient infections, which is an expensive and difficult process. "We are very interested in sharing our data with the public to make them safe and to provide a higher quality of care," Foster said, adding, "But how do you do that credibly? We don't need another set of data graveyards" (Yee, AP/Las Vegas Sun, 2/7).
Bill Clinton Calls on Federal Government, Health Care Industry To Improve Access to Care
[Feb 08, 2005]
Former President Clinton on Monday in Raleigh, N.C., called the U.S. health care system "a crazy quilt pattern" of health insurers and said that the federal government, health insurers and pharmaceutical companies must partner to ensure that all U.S. residents have access to health care, the AP/Las Vegas Sun reports. According to Clinton, who delivered the keynote address at the two-day Emerging Issues Forum, the number of employers that provide health insurance to employees has decreased over the past few years, and the number of uninsured U.S. residents has increased. Clinton cited the medical care that he received when he underwent quadruple bypass surgery in September 2004 as a model (Beard, AP/Las Vegas Sun, 2/7). "I had the best health care in the world," he said, adding, "I knew where I was going. I knew who was going to take care of me. I knew they would get paid. I never had to give it a second thought. And if everybody in America knew that, we'd be better off." He added, "We are on course to have human misery that is unacceptable in a country as wealthy as ours." Blue Cross Blue Shield of North Carolina, Cisco Systems, IBM and other companies sponsored the forum (Ingram, Winston-Salem Journal, 2/8).
Gov. Pataki's Budget Could Cut Millions in Funding from New York Hospitals
[Feb 08, 2005]
New York Gov. George Pataki's (R) proposed fiscal year 2006 budget would result in more than $800 million in funding reductions and new taxes for hospitals across the state, according to an analysis released Thursday by the Greater New York Hospital Association and 1199 SEIU, the Syracuse Post Standard reports. Central New York hospitals alone would see funding reductions of more than $13.6 million under the proposed budget, the analysis said (Mulder, Syracuse Post-Standard, 2/4). Pataki last month proposed a $105 billion budget that includes a $1.1 billion reduction in state Medicaid spending, a proposed a tax increase for hospitals and nursing homes and a reduction of some public health program benefits, such as coverage for mental health services under the Family Health Plus program. The reductions are intended to help close a projected $4.2 billion state budget deficit (Kaiser Daily Health Policy Report, 1/19). "If these cuts go through, dozens of critically important hospitals across our state will close, and scores of other hospitals will have to curtail vital services and programs and lay off key staff," Kenneth Rasky, president of the GNYA, said in a statement. Meanwhile, a separate study released by the Healthcare Association of New York State, a trade group representing upstate hospitals, found that more than half of hospitals in the state lost money in 2003, and another 40% have profit margins too low to fund modernization and improvements in patient care (Syracuse Post-Standard 2/4).
Health Care Marketplace
Physicians File Lawsuit Against BCBS of Michigan Opposing Health Plan Fee Reductions
[Feb 08, 2005]
The Michigan State Medical Society and the Michigan Osteopathic Association have filed a lawsuit in a Lansing, Mich., circuit court against Blue Cross Blue Shield of Michigan challenging planned fee reductions by the health insurer intended to help reduce health costs for U.S. automakers, the Wall Street Journal reports. BCBS of Michigan in September 2004 agreed to a proposal by General Motors, Ford Motor Co. and Daimler Chrysler to eliminate 500 physicians, or about 5% of in-network physicians, from the network of a health plan with about 120,000 autoworker members. An additional 1,900 physicians withdrew from the plan voluntarily when told by BCBS of Michigan that payments for a range of medical services would be reduced. Dan Shulte, an attorney for MSMS, stated that BCBS of Michigan has no contractual right to limit physicians' fees. Shulte said that physicians should have been involved in negotiating their own fees and that the court should prohibit BCBS of Michigan from dismissing doctors who refuse to reduce their fees. Lisa DeMoss, a senior vice president and general counsel for BCBS of Michigan, said the changes were designed to remove "some practitioners with less cost-effective patterns of care" (Hawkins, Wall Street Journal, 2/8).
Opinion
Editorials, Opinion Pieces Address Health Care-Related Proposals in Bush FY 2006 Budget
[Feb 08, 2005]
Newspapers recently published editorials and opinion pieces addressing health care plans in President Bush's fiscal year 2006 budget proposal. Summaries appear below. Editorials
- Akron Beacon Journal: Bush's proposal to "slash funds for training doctors at children's hospitals" is "misguided," according to a Beacon Journal editorial (Akron Beacon Journal, 2/8).
- Albany Times Union: President Bush "received strong support" during his State of the Union address when he called for "every county in the nation to have a health clinic for the poor," but his budget would cut $94 million from the Healthy Communities Access Program and "gradually eliminate rural health grants," the Times Union writes in an editorial (Albany Times Union, 2/8).
- Boston Globe: Increasing the budget by 24% of the FDA Office of Drug Safety after products reach the market is a "sound proposal," but Bush's budget also would "scrap ... many meat-and-potatoes programs that advance the nation's security, health, education and long-term prosperity," including CDC's "ability to fight potential biological terrorism," the Globe writes in an editorial (Boston Globe, 2/8).
- Detroit News: Mandatory entitlements, including Medicare and Medicaid, mean that "more than 60% of the federal budget can't be touched by ... Congress or the president," a News editorial states. The News continues, "That should change," adding, "Congress should ... eliminate automatic spending hikes and subject their budgets to scrutiny and debate" (Detroit News, 2/8).
- Hartford Courant: A "host of federally funded services," including Medicaid, "are under the White House's budget-cutting knife," a Courant editorial states, adding, "Loss of money in such accounts will hurt, but the wild spending ride must come to a halt" (Hartford Courant, 2/8).
- Minneapolis Star Tribune: U.S. residents did not vote in 2000 and 2004 for a "plan that would ... eliminate health insurance for thousands of low-income families [and] reduce veterans' medical benefits," among other cuts to social programs, the Star Tribune writes in an editorial. The Star Tribune continues, "The president seems to think he can run a 21st-century nation on a Mamie Eisenhower budget, taking Americans back to a time before Medicare ... and other great strides of the last half-century." The editorial concludes that "it is a ruinous direction for" the 99% of people who do not benefit from Bush's tax cuts (Minneapolis Star Tribune, 2/8).
- New York Times: While proposed reductions in Medicaid funding are "fiercely unpopular with the states," they "deserve a close look" to determine whether states "game the system for more than their fair share," according to a Times editorial. However, the administration has "shied away from even starting to seriously address the financial problems in Medicare, which is far and away the most deeply troubled federal entitlement program," the Times writes (New York Times, 2/8).
- Pittsburgh Post-Gazette: "Sick people" are among those "who will bear the brunt of the spending cuts" in Bush's FY 2006 budget proposal, according to a Post-Gazette editorial. There are some "good things" in the spending plan, such as "more support for community health clinics," the Post-Gazette writes, adding, "But that's precious little compared to the damage that will be done across the landscape" (Pittsburgh Post-Gazette, 2/8).
- Seattle Post-Intelligencer: While the "deficit is a very real problem," the suggestion that Veterans Affairs health care services should be cut to fix it -- as proposed in Bush's budget -- "is cold-hearted fantasy," according to a Post-Intelligencer editorial (Seattle Post-Intelligencer, 2/8).
- Washington Post: The proposed "$45 billion over 10 years that is to be cut from Medicaid" is particularly "worrisome," the Post writes in an editorial, adding, "The administration and its allies depict" these cuts and others "as unhappy but inevitable." However, "this maddeningly blinkered mindset ignores the impact of the Bush tax cuts, which were at once unaffordable and tilted to the wealthiest Americans," the Post states (Washington Post, 2/8).
- Washington Post: Cuts to Medicaid spending would shift "more costs to states and ris[k] leaving more Americans with no insurance or inadequate coverage," according to a Post editorial. The Post adds that a "key test for lawmakers as the budget-writing process proceeds will be how the neediest are treated -- not whether they are lavished with government assistance but whether they endure a cruelly disproportionate share of the cuts" (Washington Post, 2/7).
Opinion Pieces
- Jesse Jackson, Chicago Sun-Times: Under Bush's proposed budget, "[t]hose with the greatest need" -- such as the "record" number of U.S. residents without health insurance and those covered by Medicaid -- "will lose out; those with the greatest clout will benefit," Jackson writes in a Sun-Times opinion piece. He continues, "Bush's budget essentially asks the poorest and weakest Americans to pay for the costs of his tax breaks to the wealthiest Americans," adding, "The immoral priorities of this budget are mirrored by the callous dishonesty that surrounds it" (Jackson, Chicago Sun-Times, 2/8).
- Paul Krugman, New York Times: Many of Bush's proposed spending cuts "won't make it through Congress," but he might "succeed in severely squeezing Medicaid," which is the "most politically vulnerable" of the "three great social insurance programs" for low-income U.S. residents, columnist Krugman writes in the Times. He also says, "And if Mr. Bush can take down Social Security, Medicare will be next" (Krugman, New York Times, 2/8).
- Chris Edwards/Alan Reynolds, Wall Street Journal: Congress "needs to start moving major programs" such as Medicaid, "back to the states," Edwards, director of tax policy at the Cato Institute, and Edwards, a senior fellow at the institute, write in a Journal opinion piece. They say that a "first step would be to turn Medicaid into a block grant and slow spending to at least the inflation rate" (Edwards/Reynolds, Wall Street Journal, 2/8).
- Sen. Arlen Specter (R-Pa.), Washington Post: "Strong advocacy for education, health care and worker safety will be indispensable if they are to get their fair share of President Bush's austere budget for the next fiscal year," Specter writes in a Post opinion piece. He states that he will "stay and fight" for such issues by remaining chair of the Senate Appropriations Subcommittee on Labor, Health and Human Services and Education "rather than switch[ing]" to another leadership position (Specter, Washington Post, 2/8).
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