Kaiser Daily Health Policy Report
Insurers Remove Medical Restrictions, Prior Authorization Requirements for Those Injured in Attacks
Blood Donors Nationwide Overwhelm Centers, Asked to Come Back Next Week
HHS Reports That Relief Efforts Continue; Service, Reimbursement Through CMS Uninterrupted
FAA Grants Flight Clearance to UNOS, Other Medical Transport Teams, While Drug Distribution Remains Grounded
Smoky Air Near WTC Poses Health Risks
Aftermath of Terrorist Attacks Disrupts Health Care for Colorado Springs Area Military Retirees
AMA Says Slow Economy May Reduce Medicare Payments
Tax Credits Would 'Do Little' to Help Young and Healthy Gain Insurance Coverage, Families USA Study Finds
Virginia Commonwealth University Health System Improves Finances, Receives Full Funding from State for Indigent Care
Two Colorado Counties Seek Funding for Programs for Mentally Retarded
America's Response: Day Two
Attacks Reshape Congressional Budget Priorities; Many Health Care Issues Likely to be Postponed Until Next Year
[Sep 13, 2001]
Although "as recently as" Sept. 10 health issues such as patients' rights and a Medicare drug benefit appeared "likely to play a central role in the end-of-year budget battle this fall," they are "among items now headed for the back burner" considering the Sept. 11 attacks, CongressDaily/AM reports. Sen. Byron Dorgan (D-N.D.) said, "Everything's a lower priority. All the other little issues seem less important to debate" (Rovner, CongressDaily/AM, 9/13). Among the lower priorities are budgetary issues, including the "sudden disappearance of the debate on preserving the Social Security surpluses," the Washington Post reports (Broder/Eilperin, Washington Post, 9/13). Several health-related hearings were cancelled this week, including a Senate Finance Committee hearing on Medicaid's "upper payment limit"; a Senate Appropriations subcommittee hearing on embryonic stem cell research; a House Ways and Means subcommittee hearing on Medicare contractor reform; a joint House Energy and Commerce subcommittee hearing on Medicare drug reimbursement; and separate Senate Health, Education, Labor and Pensions Committee hearings on protections for human research subjects and genetic discrimination. A senior Senate committee aide said, "We're taking things moment by moment." A House committee aide added, "Positions haven't changed, but the world has." Families USA Executive Director Ron Pollack expressed concern about the fate of a bill to provide coverage to the uninsured, saying, "It was in trouble before. This certainly can't help." In addition to Congress, other groups delayed action on various health issues (CongressDaily/AM, 9/13).
Insurers Remove Medical Restrictions, Prior Authorization Requirements for Those Injured in Attacks
[Sep 13, 2001]
Several health plans with consumers in the New York and Washington, D.C., regions have suspended their restrictions on care following Tuesday's attacks, the AP/Houston Chronicle reports. Injured members of Cigna Corp. do not need to obtain prior authorization for hospital care in the two cities (AP/Houston Chronicle, 9/12). Aetna Inc. and Oxford Health Plans have also said that consumers injured in the attacks should not worry about authorizations or referrals (Lau, Investor's Business Daily, 9/13). "This is an emergency situation, and we expect our members to go directly to seek emergency medical care, and we expect them not to worry about referrals," Aetna spokesperson Dave Carter said (AP/Houston Chronicle, 9/12). Aetna has "added resources and extended hours" in four of its service centers in order to process benefit payments more quickly (Investor's Business Daily, 9/13). Empire Sets Up Temporary Centers
Empire BlueCross BlueShield, whose headquarters were located in the World Trade Center, established temporary command centers yesterday at its New York offices in Albany, Staten Island and Melville, according to Geoff Taylor, a spokesperson for the New York State Conference of Blue Cross and Blue Shield Plans. Taylor said that the company did not know how many of its 1,800 employees escaped before the collapse of the twin towers. Bloomberg reports that the loss of Empire's office will "affect the company's processing of Medicare claims and the operation of its health plan for Medicare beneficiaries." However, a hotline operator at the Centers for Medicare and Medicaid Services said, "Empire processed about 55,000 claims [Tuesday] night, and we expect them to proceed under normal working conditions" (Bloomberg, 9/12).
Blood Donors Nationwide Overwhelm Centers, Asked to Come Back Next Week
[Sep 13, 2001]
With thousands of people across the country waiting in lines for hours to donate blood in the wake of the Sept. 11 terrorist attacks, America's Blood Centers is urging donors to wait to donate, saying the "national blood supply for [the] victims is at capacity," USA Today reports (Manning, USA Today, 9/13). At five Bonfils Blood Centers in the Denver area, 2,000 pints of blood were collected on Sept. 11, and on Sept. 12 the waiting rooms at donation centers were "filled with hundreds" who had registered to donate. On Tuesday night, 300 pints were loaded onto a Lear jet headed to New Jersey's Teterboro Airport (Janofsky, New York Times, 9/13). In the Washington D.C., area, waits to donate lasted up to six hours, and more than 2,000 donors were turned away because the staff members were "overwhelmed." The Red Cross Greater Potomac and Chesapeake region deployed hundreds of extra volunteers to keep up with the "incessant flow" of donors (Honawar, Washington Times, 9/13). However, Brooke Doherty, a spokesperson for America's Blood Centers, said that many donors "mistakenly believe" that blood can be stored indefinitely for later use. Whole blood has a shelf life of 42 days, but platelets must be used within three to five days. She added, "There's going to be an overload of blood in these blood banks that isn't going to be used. People need to understand that standing in line at these blood banks may make them feel good, but if they really want to help they can do that by giving in the weeks and months to follow" (USA Today, 9/13). The Spokane Spokesman-Review reports that the Inland Northwest Blood Center is also asking that people "come back next week" to make donations (Craig, Spokane Spokesman-Review, 9/13). Red Cross Calls For More Donations
Meanwhile, the American Red Cross, at the urging of President Bush, is continuing to encourage donations now and later. Red Cross President Bernadine Healy said, "We have an obligation ... to continue to maintain our blood supply and keep inventories up." The Red Cross currently has 120,000 units, or a four-day supply, on hand and is developing technology to allow blood to be stored for longer periods of time. The Red Cross has decided to donate up to 30,000 units to hospitals treating victims of the attack. Healy added that the blood drives help people "console" each other. Healy said, "This is wounded America. This is the spirit of giving. We don't want to turn that off" (USA Today, 9/13). The New York Times reports that many donors are "acting out of compassion" as well as satisfying a need to do something. Steve Benson, a carpenter from Flagler, Colo., said, "Giving blood is the only thing I can do at the moment because there are people in need in my country" (New York Times, 9/13). To schedule a donation, call 1-800 GIVE LIFE or to make a financial contribution to the Red Cross, call 1-800 HELP NOW.
HHS Reports That Relief Efforts Continue; Service, Reimbursement Through CMS Uninterrupted
[Sep 13, 2001]
HHS on Sept. 12 continued to respond to the aftermath of Tuesday's terrorist attacks on the World Trade Center in New York City and the Pentagon in Arlington, Va. In an address yesterday to the department's 63,000 employees, HHS Secretary Tommy Thompson said that the department will "go the extra mile to help those in need." He added, "The Department of Health and Human Services has begun the healing process in America, and we must see it through." According to an HHS press release, the department's response as of mid-Wednesday includes: - The HHS Office of Emergency Preparedness has deployed 328 medical staff members from disaster readiness teams and 270 mortuary services staff members to New York City and the Washington, D.C., area.
- HHS has sent five Disaster Medical Assistance Teams and four Disaster Mortuary Operational Response Teams to the New York area and three disaster medical teams and three disaster mortuary teams to the Washington, D.C., area.
- HHS has placed the PHS Commissioned Corps, which includes 5,700 staff members, on readiness alert.
- The CDC sent four epidemiologists and two laboratory experts to New York City to help determine "medical needs and capacity" in area hospitals.
- The CDC sent 11 technical service staff members to help distribute medical supplies and an emergency response specialist to help the New York City Department of Health coordinate emergency efforts.
- The CDC activated the Health Alert Network, which provides rapid information to state and local health departments, and issued a precautionary advisory to state and local health departments "to be alert to any unusual disease symptoms."
- The Centers for Medicare and Medicaid Services sent five staff members to help in the Edison, N.J., response center established by the Federal Emergency Management Agency.
- HHS has continued to help major blood centers to ensure that they have "adequate" supplies.
- HHS has also continued "uninterrupted services and reimbursement" through the Centers for Medicare & Medicaid Services (CMS)(HHS release, 9/12).
FAA Grants Flight Clearance to UNOS, Other Medical Transport Teams, While Drug Distribution Remains Grounded
[Sep 13, 2001]
Despite closures of U.S. airports after the Sept. 11 attacks in New York City and Washington, D.C., the nation's organ transplant system and other organizations transporting blood and emergency medical supplies have received a "green light" for air travel in the form of a special waiver from the Federal Aviation Administration, the Contra Costa Times reports (Krishnan, Contra Costa Times, 9/13). The United Network for Organ Sharing has delivered 24 organs since receiving air clearance on Sept. 11, with deliveries coordinated by regional organ procurement organizations. Anne Paschke, a spokesperson for UNOS, said the four-to-six hour lifespan of hearts and lungs intended for transplant makes "[q]uick delivery ... especially crucial." For organs such as kidneys and pancreases, viable recipients are determined based more on "tissue-matching than need," and therefore must usually travel longer distances, the AP/Nando Times reports (AP/Nando Times, 9/12). Yesterday, the San Francisco Chronicle reported that a Sept. 11 liver transplant operation for a girl at Stanford University's Lucile Packard Children's Hospital was cancelled because the liver could not be flown from New Mexico after the nation's air transport system was shut down (Raine, San Francisco Chronicle, 9/12). On Sept. 12, officials at the FAA cleared planes to fly for "emergency medical purposes" after blood centers "were left scrambling" to ship vials of donor blood to testing sites. With only 72 hours available to "get the most accurate results" in testing the blood for HIV, hepatitis B and other infectious diseases, "urgency is key," the Contra Costa Times reports. Although blood centers used alternate transportation routes, such as military planes and ground transportation, in the past few days, the FAA gave clearance late Tuesday night for two planes in San Diego to drop off test vials in Portland (Contra Costa Times, 9/13). Pharmaceutical Companies Take to the Road
Meanwhile, the country's pharmaceutical industry has not received FAA clearance, prompting firms to respond to "contin[uing] demand" for drugs and supplies by operating solely on ground transportation, the Bloomberg News/Detroit Free Press reports. Companies are "trucking drugs that would ordinarily be flown" to distributors and hospitals to ensure products arrive where they are needed. Mark Grayson, spokesperson for PhRMA, said, "There is an average 90-day supply of each drug in the U.S. and plans made in preparation for possible disruptions with the Year 2000 changeover are helping companies allocate those products." Representatives from Pfizer, the world's largest drugmaker, said "the grounding of air traffic isn't expected to lead to shortages" (Richter, Bloomberg News/Detroit Free Press, 9/13).
Smoky Air Near WTC Poses Health Risks
[Sep 13, 2001]
People with chronic lung diseases such as asthma and emphysema may experience attacks up to two days after exposure to "smoke and grit" from the collapsed World Trade Center, and those who have already been treated for smoke inhalation could see their symptoms get worse before they get better, the AP/Washington Times reports. Breathing smoky air "would be enough to set off somebody who has lung disease," Dr. Mark Siegel, an assistant professor of medicine at the Yale School of Medicine, said, adding that even those who were not in the immediate area surrounding the Trade Center are at risk. Those already treated for smoke inhalation may see their symptoms -- which can include shortness of breath, coughing and chest pain -- worsen over the next four days as their lungs become inflamed by rising fluid, Siegel said. He added that those who "are OK now are probably going to stay that way." People with heart disease or who were otherwise already in "frail" health also face an increased risk of heart attacks or congestive heart failure from the debris. Those in the immediate area during the collapse could also develop pneumonia or an "asthma-like syndrome" within 24 hours, Dr. Neil Schachter, medical director for respiratory care at New York's Mount Sinai Hospital, said. He added that the condition is possibly fatal, but is more likely to lead to a "chronic condition resembling asthma." Asbestos
Other than the smoke, asbestos is the "primary environmental concern," EPA Administrator Christie Whitman said. Three asbestos tests conducted by the EPA found "minimal or no" airborne asbestos in the area surrounding the collapsed buildings; a fourth test did find "significant" levels of asbestos, Whitman said. She said that the agency will continue testing. Asbestos-related cancer is usually caused by prolonged exposure to the material, although a large one-time exposure can lead to a type of cancer known as mesothelioma. The EPA said it does not foresee any permanent environmental damage as a result of the collapse. Water Supply Safe
Experts also said yesterday that germs that may result from any decomposing bodies under the debris do not threaten the safety of Manhattan's water supply. Manhattan gets its water from outside of the island. "As long as people use normal sanitary precautions in handling the corpses and normal sanitation of clean water and food, there is no infectious risk related to the corpses," Dr. Richard Forthingham of Duke University and the Veterans Affairs Medical Center in Durham, N.C., said (AP/Washington Times, 9/13).
Aftermath of Terrorist Attacks Disrupts Health Care for Colorado Springs Area Military Retirees
[Sep 13, 2001]
Tens of thousands of military retirees and family members in Colorado Springs, Colo., have found obtaining medical care and prescriptions at area military hospitals and clinics "difficult to impossible" in the aftermath of the Sept. 11 terrorist attacks on the World Trade Center and the Pentagon, the Colorado Springs Gazette reports. Many military retirees receive medical care and medications at Evans Army Community Hospital, the Air Force Academy Hospital and the Peterson Air Force Base Clinic under TriCare, the U.S. military health insurance program. However, in recent days, "getting care is just too difficult to attempt," some military retirees said, citing restricted access to area facilities and "hours-long traffic jams" at entrance gates. The three facilities have canceled most routine doctor visits, and the Peterson clinic has stopped filling prescriptions. On average, the clinic fills more than 800 prescriptions daily. According to advocacy groups, many military retirees have "given up waiting in long lines" to receive their prescriptions and have decided to "wait out the heightened security crisis." Master Sgt. Debbie Grant, a spokesperson for Peterson Air Force Base, also said that many military retirees have used the Air Force Academy Hospital pharmacy. The pharmacy, which fills about 500 to 1,000 prescriptions daily, has filled more than 2,000 per day in recent days. In addition, Grant said that most local pharmacies will refill existing TriCare prescriptions. "We have an agreement where local pharmacists may call the clinic here to OK refills," Grant said. Refills cost $3 for generic and $9 for brand-name drugs. The Gazette reports that some larger area pharmacy chains have had a "substantial increase" in business from military employees and retirees (Gonzales, Colorado Springs Gazette, 9/13).
Health Care Marketplace
AMA Says Slow Economy May Reduce Medicare Payments
[Sep 13, 2001]
Bloomberg News on Sept. 10 reported that the American Medical Association said that the slowing U.S. economy may reduce Medicare and private insurer reimbursements for physicians and affect the number of Medicare beneficiaries that they treat. Medicare determines the payments for doctors each year through a formula that "depends partly" on changes in the gross domestic product. In March, the government predicted that the GDP would increase 1.5% this year, down from a 4.2% jump last year. The economic slowdown could lead to a 3% reduction in Medicare reimbursements for physicians this year, the AMA said in an Aug. 29 letter to Centers for Medicare and Medicaid Services Administrator Thomas Scully. Last year, physicians received a 4.5% boost in Medicare payments. The increase allowed doctors to negotiate higher reimbursement rates from private health plans, which "generally follow" rates set by Medicare. By Nov. 1, CMS will publish final changes to Medicare physician payments, which will take effect Jan. 1. The AMA urged CMS officials to "reconsider their estimates" and increase reimbursements for physicians, which does not require congressional approval. This year, Medicare will spend about $40 billion on payments to doctors (Bloomberg News, 9/10).
The Uninsured
Tax Credits Would 'Do Little' to Help Young and Healthy Gain Insurance Coverage, Families USA Study Finds
[Sep 13, 2001]
Tax credits, such as those proposed by President Bush, would "do little to help" the uninsured obtain coverage, a study released yesterday by Families USA says (Rovner, CongressDaily/AM, 9/13). Under Bush's proposal, low-income uninsured individuals would receive tax credits of up to $1,000 and low-income uninsured families would receive tax credits of up to $2,000. In the report, Families USA analyzed insurance plans offered in 25 states, using two hypothetical applicants, a 25-year-old woman and a 55-year-old woman who both were healthy and did not smoke. Researchers sought information about two types of plans; one type that cost about $1,000 and the second that was based on the most popular plan offered under the Federal Employees Health Benefits Program and is comparable to health insurance plans provided by many mid- and large-size employers. According to the report, in many states, $1,000 plans were not available and when they were, they "generally provided incomplete coverage, had high deductibles and required high coinsurance or copayments." Although standard plans were "more widely available," they also were more expensive than $1,000 and "would consume a significant portion of annual income for the low-income people eligible for the tax credit." For 25-year-old women, $1,000 plans were not available in six of the 25 states the report studied and coverage under available plans was "substandard." Deductibles for $1,000 plans for 25-year-old women ranged from $500 to $5,000, out-of-pocket costs were "very high" and coverage was "limited." For 55-year-old women, $1,000 plans were not available in 18 of the studied states, and like plans for 25-year-olds, available $1,000 plans for 55-year-olds had "substandard" coverage. Standard Plan Information
For 25-year-old women, standard plans were not available in four of the studied states; the same is true for 55-year-old women. Standard plan premiums for 25-year-old women averaged $2,395, and premiums were more than $3,000 in six states. For 55-year-old women, premiums averaged $4,734 and were higher than $5,000 in eight of the states (Families USA, "A 10-Foot Rope for a 40-Foot Hole: Tax Credits for the Uninsured," September 2001). Families USA Executive Director Ron Pollack said, "The costs of individual health insurance are far more expensive than the cash value of pending tax-credit proposals. They are like throwing a 10-foot rope to a person at the bottom of a 40-foot hole" (CongressDaily/AM, 9/13).
Behavioral Health
Virginia Commonwealth University Health System Improves Finances, Receives Full Funding from State for Indigent Care
[Sep 13, 2001]
The Virginia Commonwealth University Health System, which finished the fiscal year ending June 30 with a "small profit," is "showing a better bottom line" and will request "only slight" increases in funding for indigent care programs for the next budget cycle, the Richmond Times-Dispatch reports. Dominic Puleo, VCU executive vice president for corporate finance, said, "We are looking at level funding. What we are looking at is not to get any new dollars except for what we call medical inflation related to supplies, salaries, et cetera. That is anticipated to be 4.7%." VCU Health System runs Medical College of Virginia Hospitals, which provide nearly one-third of the indigent care in the state. The Times-Dispatch reports that until this year, the health system had "spent more on caring for poor and uninsured people than it was being reimbursed by the state through Medicaid" and other state programs. State officials have funded $102.5 million in indigent-care costs for the system in the fiscal year that will end June 30, 2002. In return, the state asked the health system to "trim its costs." The health system plans to "cut" some staff and services, and Puleo said the health system is "really aggressively controlling [its] costs." In addition, the health system has announced plans to "broaden its reach" throughout the state by increasing enrollment in Virginia Premier, a Medicaid managed care plan in central Virginia, by as much as 60,000 people. The plan has 28,000 beneficiaries (Smith, Richmond Times-Dispatch, 9/11).
Two Colorado Counties Seek Funding for Programs for Mentally Retarded
[Sep 13, 2001]
Developmental Pathways, the not-for-profit agency designated by Colorado to serve the mentally retarded populations in Arapahoe and Douglas counties, is facing a $1.4 million deficit in its budget, along with a waiting list of approximately 1,400 of the counties' residents, the Denver Post reports. John Meeker, executive director of Developmental Pathways, said Medicaid covers 85% to 90% of the program's $24 million budget but added that the funds are "no longer enough." The program also receives about $750,000 per year from Arapahoe County and up to $300,000 from Aurora County, as well as money from state and private entities. Developmental Pathways is asking both counties for a tax levy to help reduce the agency's deficit and waiting list. Last week, the commissioner boards in Arapahoe and Douglas counties last week voted to "ask voter permission to raise taxes." Although several other Colorado counties "have been subsidizing housing, transportation and other services for the mentally retarded," taxpayers in Arapahoe and Aurora counties have "never had a special tax dedicated" to programs for the mentally retarded. According to the Post, if approved, the levy could generate $2.7 million for Douglas County and $6.5 million for Arapahoe County. The Post reports that even if voters approve the levy, there is no "guarantee" the funds will go to Developmental Pathways, only that they money "will be used to support programs for mentally retarded residents" in the counties (Rouse, Denver Post, 9/10).
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