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Daily Women's Health Policy Report
Bush Signs $555B Omnibus Spending Bill, Criticizes Earmarks
President Bush Vetoes Defense-Policy Bill That Had Veterans Health Funding
EEOC Says Employers Can Eliminate, Reduce Health Benefits for Retirees Older Than 65
Presidential Candidates Debate Health Care Proposals in Preparation for Iowa Caucuses
Small Businesses Could Have Major Influence on Next President's Health Care Plan
JAMA Study Shows Racial Disparities in Emergency Department Pain Relief Prescriptions
States Struggled To Enact Health Care Reform in 2007, Uncertainty for Reforms Remains
Judge Rules San Francisco Health Care Program Violates ERISA; City Appeals Decision
Efforts To Increase Medical School Enrollment Could Place Financial Burden on U.S. Health Care System, Experts Say
AP/USA Today Examines Efforts To Offer Health Care Services to Low-Income and Uninsured U.S. Residents in Gathering Places
Health Industry Develops Medical Credit Score
Health Insurers Must Review Applications for Accuracy Before Issuing Policies, California Appeals Court Rules
UAW Looks to Influence Health Care Debate; VEBA Might Be Model for Other Companies
Schwarzenegger, Núñez Submit Ballot Initiative for Health Care Reform Proposal
Number of Uninsured Louisiana Residents Declines
U.S. Judge Repeals Maine Law Prohibiting Access to Prescribing Information
Kentucky's Low-Income Residents Lack Dental Insurance, Dental Care, NYT Reports
Washington Post Examines 'Winners,' 'Losers' Among Lobbyists in 2007
The Latest Reports in Health Policy
Study Looks at Effect of Medicare on Previously Uninsured Adults; Perspectives Examine Physician-Efficiency Comparisons, Physician-Performance Programs
Editorial Urges Federal, State Agencies To Curb Medicare Advantage Plan Abuses, Eliminate 'Unjustified Subsidies'
Physicians Should Follow Professional Standards, Editorial States
Administration News
President Bush Signs SCHIP Extension, Provides Funds Through March 2009
[Jan 02, 2008]
President Bush on Saturday signed legislation that will provide funding for SCHIP through March 2009, the AP/Houston Chronicle reports. The extension is expected to provide enough funds to cover children currently enrolled in the program. White House spokesperson Tony Fratto said, "We're pleased that the program will be extended and that states can be certain of their funding."
Democrats, who were unable to reach a compromise with Republicans on a long-term reauthorization of the program, have said that they will continue to negotiate with GOP leaders. House Speaker Nancy Pelosi (D-Calif.) said that Democrats will not stop "until 10 million children receive the health care coverage they deserve" (Feller, AP/Houston Chronicle, 12/29/07). States Unlikely To Expand SCHIP Programs Under Stopgap Funding Measure
Republican and Democratic lawmakers say that when they return to Congress in January 2008, they will try to reach a compromise on a long-term reauthorization of SCHIP, the AP/Lexington Herald-Leader reports. However, while "[d]ifferences over who should get coverage have clearly narrowed over the past months, ... differences over how to pay for expansion remain considerable," according to the AP/Herald-Leader.
Congress last month approved a continuing resolution that will maintain coverage for current beneficiaries, after Bush twice vetoed large spending increases proposed by Democrats. The "modest spending increase" has "scuttled" plans by several states that had planned to expand health coverage, the AP/Herald-Leader reports. "Few expected such a result when 2007 began," according to the AP/Herald-Leader.
Democrats also were unable to rescind guidelines issued by the Bush administration in August 2007 that require states to enroll at least 95% of eligible low-income children before expanding eligibility to children in families with higher incomes. The policy directive will impact about half the states. Cindy Mann, executive director of the Center for Children and Families at Georgetown University, said that the rule is "definitely a step backward from where we started in 2007," adding, "We would have seen growth in the program. We're not going to see that growth, and by August, we'll start to see a ratcheting down" (Freking, AP/Lexington Herald-Leader, 12/26/07).
Bush Signs $555B Omnibus Spending Bill, Criticizes Earmarks
[Jan 02, 2008]
President Bush on Dec. 26, 2007, signed into law a $555 billion omnibus spending bill but criticized Congress for including nearly 10,000 earmarks, worth about $10 billion, the Washington Post reports (Gardner, Washington Post, 12/27/07). The package includes the fiscal year 2008 Labor-HHS-Education appropriations bill and the 10 other FY 2008 appropriations bills, as well as $11.2 billion in emergency funds and $70 billion in additional funds for the wars in Iraq and Afghanistan. The Labor-HHS-Education section of the package includes $600.1 billion in total spending and $145.1 billion in discretionary spending. The package in large part meets the overall spending levels of the $932.8 billion requested by Bush but shifts billions of dollars to health care and other priorities supported by Democrats (Kaiser Daily Health Policy Report, 12/21/07).
Bush in a statement said, "I am disappointed in the way the Congress compiled this legislation, including abandoning the goal I set early this year to reduce the number and cost of earmarks by half" (Marre, The Hill, 12/26/07). He said, "These projects are not funded through a merit-based process and provide a vehicle for wasteful government spending."
Bush praised the bill for not including any new taxes and for providing adequate funding for the wars in Iraq and Afghanistan without "arbitrary timelines for withdrawal" from Iraq (Washington Post, 12/27/07). Bush added that there "is still more to be done to rein in government spending" and noted that his fiscal year 2009 budget proposal will "once again restrain spending, keep taxes low and continue us on a path towards a balanced budget" (Feller, AP/Boston Globe, 12/27/07).
White House spokesperson Scott Stanzel said that Bush expects Office of Management and Budget Director Jim Nussle to examine the earmarks to determine where cuts can be made (Washington Post, 12/27/07).
President Bush Vetoes Defense-Policy Bill That Had Veterans Health Funding
[Jan 02, 2008]
President Bush on Dec. 28, 2007, vetoed a $696 billion defense-policy bill (HR 1585) that included improvements to veterans' health care benefits and pay increases for servicemembers, the Wall Street Journal reports (Pullizi, Wall Street Journal, 12/29/07).
The bill would have included nearly $950 million for military health care in fiscal year 2008. The bill included four amendments, including one that would have barred most personality-disorder discharges from the military until the Pentagon submits a report on such discharges and another that would have ensured wounded veterans receive transitional care from the military for 180 days from the time the servicemember is separated from active duty. The third amendment would have extended for one year current prohibitions on raising military health care fees and prescription drug copayments, while the final amendment would have permitted National Guard and Reserve members who have served two years of active-duty service to receive accelerated G.I. Bill educational benefits (Kaiser Daily Health Policy Report, 10/2/07).
In a statement released by the White House, Bush said the bill contained a provision that would have placed the U.S. in a position to face liability lawsuits linked to actions that occurred under former Iraqi leader Saddam Hussein's rule (Wall Street Journal, 12/29/07). According to the New York Times, the veto "surprised and infuriated Democratic lawmakers and even some Republicans, who complained the White House had failed to raise its concerns earlier." White House officials said the administration will collaborate with lawmakers to restore dozens of new military and veterans programs when Congress reconvenes this month (Myers/Herszenhorn, New York Times, 12/29/07). TRICARE
S. Ward Casscells, assistant secretary of defense for health affairs, said he believes enrollment fees, copayments and deductibles for military retirees and dependents covered under TRICARE will "begin to gradually go up" within "the next year or two," the Newport News Daily Press reports. The Task Force on the Future of Military Health Care has proposed that higher fees and copays for retirees younger than age 65 and their families be phased in over four years and that TRICARE Standard beneficiaries, the fee-for-service plan, pay higher deductibles. Congress for the last two years has worked to block the increases, saying that Department of Defense officials had "options to constrain the growth of health care spending in ways that don't disadvantage" retirees.
Casscells on Dec. 13, 2007, told reporters that the task force "just made so much sense" because 12 years of frozen fees can have an "adverse" effect on TRICARE benefits. Casscells said that military retirees who continue to work and shift from employer-based health plans to TRICARE are raising system costs, adding, "TRICARE has gotten so popular that if we subsidize it artificially, we will do so at the detriment to our military treatment facilities."
According to Casscells, the higher fees proposed by the task force are "being discussed now" in the Pentagon and with the White House Office of Management and Budget, and they likely will be endorsed in some form in the president's fiscal year 2009 defense appropriations bill (Newport News Daily Press, 12/30/07). Editorial
Congress in December 2007 "took a big step in making amends" for "the disgraceful way" the U.S. has "treated its returning war wounded" by incorporating the Wounded Warrior Act into the 2008 National Defense Authorization Act and appointing a new Department of Veterans Affairs secretary, a Washington Post editorial states. According to the Post, these efforts "aimed at fixing and upgrading the military health care system" are "important developments in righting the wrongs against America's soldiers."
The legislation calls for "improvements in health care and benefits and the beginning of disability reform," the editorial states. It adds, "Most significant, the measure sets in place an overarching policy that requires [VA] and the Defense Department to work together -- not at cross-purposes -- on comprehensive reforms."
The Post continues, "Still on the to-do list is the big issue of how to restructure the disability system." The editorial concludes, "No one questions the need for fixes, but how to carry out reform is proving to be a thorny issue, one that requires the continued attention of Congress if it wants to support the troops" (Washington Post, 12/22/07).
Medicare
EEOC Says Employers Can Eliminate, Reduce Health Benefits for Retirees Older Than 65
[Jan 02, 2008]
The Equal Employment Opportunity Commission last week announced that employers can legally eliminate or reduce health benefits for retirees when they reach age 65 and become eligible for Medicare while retaining benefits for retirees younger than age 65, the New York Times reports. The ruling, published in the Federal Register, allows employers to create two classes of retirees -- those younger than age 65 and those older than 65 -- and offer different benefits to each group. In addition, the ruling allows employers to eliminate or reduce benefits provided to spouses or dependents of retirees older than 65 (Pear, New York Times, 12/27/07).
EEOC proposed the rule in response to a 2000 U.S. Court of Appeals decision that required benefits to be offered at the same level for Medicare-eligible retirees and those younger than 65 (Armour, USA Today, 12/28/07). However, according to Dianna Johnston, an EEOC lawyer, many employers and labor unions told the commission that "if they had to provide identical benefits for retirees under 65 and over 65, they would just drop retiree health benefits altogether for both groups."
The rule creates an explicit exemption from age-discrimination laws for employers that reduce benefits for retirees ages 65 and older. The preamble to the new regulation states, "The final rule is not intended to encourage employers to eliminate any retiree health benefits they may currently provide" (New York Times, 12/27/07). According to a statement by commission Chair Naomi Earp, "EEOC seeks to preserve and protect employer-provided retiree health benefits which are increasingly less available and less generous." Earp added, "Millions of retirees rely on their former employer to provide health benefits, and this rule will help employers continue to voluntarily provide and maintain these critically important benefits in accordance with the law."
EEOC said its decision is supported by the Society for Human Resource Management, the AFL-CIO, the American Federation of Teachers, the National Education Association, the American Benefits Council, and other groups (AP/Seattle Times, 12/28/07). Reaction
The ruling was "welcomed" by some employer and labor groups, who believe it will allow employers to provide more comprehensive benefits to retirees under 65, but others "said it will deprive older people of coverage to supplement Medicare," the Wall Street Journal reports. "If the regulation did not come about, it could have very well spelled the death knell for retiree health care," Mike Aitken, director of government affairs for SHRM, said.
According to James Klein, president of the benefits council, the new rule "validates what employers and unions for years have understood to be the appropriate policy: namely to allow employers to focus health care coverage on early retirees who would otherwise not have coverage." Many experts note that some companies already have established different benefits for retirees who are eligible for Medicare (Maher et al., Wall Street Journal, 12/28/07).
AARP attorney Christopher Mackaronis said, "This rule gives employers free rein to use age as a basis for reducing or eliminating health care benefits for retirees 65 and older. Ten million people could be affected -- adversely affected -- by the rule" (New York Times, 12/27/07). David Certner, legislative policy director for AARP, said, "This policy is a civil rights and economic fiasco," adding, "It is a wrong-headed move to legalize discrimination, allowing employers to back off their health care commitments based on nothing more than age" and to shift more of the cost onto retirees and taxpayers (Rose, Chicago Tribune, 12/28/07).
 The final rule is available online.
 American Public Media's "Marketplace" on Thursday reported on the ruling. The segment include comments from Henry Aaron, an analyst at the Brookings Institute; Anna Burger, secretary-treasurer of the Service Employees International Union; and Klein (Marshall Genzer, "Marketplace," American Public Media, 12/27/2007). Audio and a transcript of the segment are available online.
Election 2008
Presidential Candidates Debate Health Care Proposals in Preparation for Iowa Caucuses
[Jan 02, 2008]
Presidential candidates have debated their health care proposals in preparation for the Iowa caucuses on Thursday, the Chicago Tribune reports (Pearson/Chase, Chicago Tribune, 12/31/07).
Democratic presidential candidate Sen. Barack Obama (Ill.) on Monday at a Perry, Iowa, community center defended his proposal against claims made by rival former Sen. John Edwards (D-N.C.). In response to claims by Edwards that Obama should not negotiate with health insurers and pharmaceutical companies, Obama said, "I'd have a big table, and everybody would be invited." He added, "Yes, I'd invite the drug companies and the insurance companies and the HMOs. They'd have seats. They just wouldn't be able to buy every chair." He also said that C-SPAN would televise the negotiations to increase the influence of the public and reduce the influence of special interests. According to Obama, "That's how you get things done, not by shouting" (Eichel, Philadelphia Inquirer, 1/1).
Edwards on Sunday in northern Iowa addressed questions by the Obama campaign about comments he made last year about the role of special interests in health care reform. In comments made in a story on the Web site www.mydd.com, Edwards said that he would "try to bring everybody to the table" on health care reform, although during his campaign he has said that he would not negotiate with special interests. Edwards on Sunday said that he meant health insurers would continue to play a role in the health care system under his proposal. He said, "What I was talking about then was what we needed to do to actually bring about universal health care and the difference between single-payer, government-run health care and what I'm proposing." Edwards added, "I don't eliminate insurance companies from the health care fix. ... People have choice in my health care proposal between a private plan and a government-run plan" (Chicago Tribune, 12/31/07). On Friday during a campaign event in Dubuque, Iowa, Edwards "tried to distinguish himself from his Democratic rivals" on health care and other issues, the New York Times reports (Bosman/Luo, New York Times, 12/29/07).
Drew Altman, president and CEO of the Kaiser Family Foundation, said that health care is "not a wedge issue" and is not "emerging as a pivotal distinguishing issue" in the presidential primaries. However, Altman said, "We're in the early stages of health care re-emerging as a top national issue. It's the next great debate" (Feder Ostrov, San Jose Mercury News, 12/25/07). Additional Developments
- Sen. Hillary Rodham Clinton (D-N.Y.): Clinton on Wednesday plans to launch a television ad in Iowa that will ask voters to "take the first step" in efforts to address health care and other issues through their support for her in the caucuses. In the ad, Clinton says, "As we start this new year, America is at a crossroads," with "47 million people without health care." She adds, "All the men and women across the state who have whispered their health care problems to me -- bills they can't pay, parents they can't afford to care for, insurance companies who refuse to help" have "welcomed me into your hearts and your homes" (Glover, AP/Kansas City Star, 1/2). In related news, Clinton on Dec. 23 during an appearance at the Iowa Veterans Home reiterated her promise to provide adequate health care and other benefits to U.S. troops who return from the wars in Iraq and Afghanistan. Clinton said that "no one has given more to our country than our country's veterans." She added, "I believe that when you sign up to serve our country, our country must serve you with the health care, the compensation and the support that you so richly deserve" (Lorentzen, AP/Lexington Herald-Leader, 12/25/07).
- Former New York City Mayor Rudy Giuliani (R): The New York Times on Friday examined consultant work provided by Giuliani to Purdue Pharma in efforts to defend against federal allegations that the company misled the public about the potential addictiveness of the pain medication OxyContin. According to the Post, Giuliani participated in two meetings between Purdue Pharma officials and the Drug Enforcement Administration acting administrator, and, as a "celebrity, Mr. Giuliani helped the company win several public relations battles." In addition, Giuliani "became the public face" of Rx Action Alliance -- a group of pharmaceutical companies, physicians and law enforcement authorities that seeks to fight prescription drug abuse, the Post reports (Meier/Lipton, New York Times, 12/28/07).
- Obama: Obama on Friday launched a television advertisement in Iowa that promotes his health care proposal over those announced by Edwards and Clinton. According to the Washington Post "The Trail" blog, the ad "misrepresents some newspaper assessments" of the Obama proposal. The ad cites a St. Paul Pioneer Press article that said the Obama proposal "guarantees coverage for all Americans" but omits the end of the statement: "but does not require all to have it." The ad also cites an Iowa City Press-Citizen article that praised the Obama proposal as "the best." However, the ad fails to indicate that the article involved a comparison of the proposal to a single-payer health care system, not the plans announced by Clinton and Edwards. In addition, the ad cites a Post article that states the Obama proposal would save "$2,500 for the typical family," although the article attributed the figure to Obama aides without outside verification (Kurtz, "The Trail," Washington Post, 12/29/07). On NBC's "Meet the Press" on Sunday, Obama "sidestepped whether his spot was a stretch" on whether his proposal would expand health insurance to all U.S. residents, the Chicago Sun-Times reports (Sweet, Chicago Sun-Times, 12/31/07). In related news, Obama last week in Mason City, Iowa, promised to not "play politics" on the issue of health care for veterans. Obama said that he would seek to improve health care for veterans and provide them with mental health screenings. According to Obama, "We have to fund all the services that have been promised to our veterans. We can't play politics with it" (AP/Arizona Daily Star, 12/27/07).
Polls
Almost two-thirds of U.S. residents support a health care system "in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers," according to a recent poll commissioned by AP/Yahoo! News. The poll, conducted over the Internet by Knowledge Networks, included telephone contacts with more than 1,800 residents followed by online interviews. The poll also found that 64% of respondents cited concerns about the possibility of unexpected major medical expenses (Kuhnhenn/Tompson, Associated Press, 12/28/07).
In related news, a recent Boston Globe poll of likely voters in the Jan. 8 New Hampshire primary found that 80% of Democratic respondents believe the federal government should provide health insurance, compared with 30% of Republican respondents (Mooney, Boston Globe, 12/26/07). Opinion Pieces
Summaries of several recent editorials and opinion pieces related to health care in the presidential election appear below. - Edwards, Boston Globe: "I am running for president to make sure that every child can have the same opportunities in life that I've had," and one "thing we need to do is create universal health care in America," Edwards writes in a Globe opinion piece. "Not only are health care costs putting a huge strain on American families and our competitiveness in the global economy, but our broken health care system that leaves 47 million Americans without health care is also a moral disgrace," Edwards writes, adding, "I have proposed a health care plan that calls for shared responsibility among people, businesses, and the government, and will ensure that every man, woman, and child in America has access to affordable, quality coverage" (Edwards, Boston Globe, 12/28/07).
- Los Angeles Times: "A sick America can't be a working America," and "changes to the health care system will be necessary to keep us in good health," according to a Times editorial. The editorial states, "The Congressional Budget Office reported this month that rising medical costs, which far outstrip inflation, pose the No. 1 threat to the country's ability to balance federal budgets in the future." The editorial, which recommends a health care "plan that would achieve universal coverage through an individual mandate, requiring every American to buy health insurance," states that most Democratic presidential candidates "line up with our approach" and "seek to expand coverage and to create new purchasing pools to expand choice." However, the "GOP candidates prefer market-based solutions such as health savings accounts, tax refunds for those who buy individual coverage ... and boosting citizens' ability to spend wisely by requiring greater transparency on prices and outcomes from health care providers," all of which are "appealing ideas in theory" but "will not improve care for all Americans," the editorial states (Los Angeles Times, 12/28/07).
- Paul Krugman, New York Times: The Democratic presidential candidates are "offering strongly progressive policies on taxes, health care and the environment," Times columnist Krugman writes. However, Republican presidential candidates support "Bushonomics," although the "public is very unhappy with the state of the economy ... with a declining fraction of Americans receiving health insurance from their employers," he writes (Krugman, New York Times, 12/31/07).
- David Leonhardt, New York Times: The only difference between Clinton and Obama "on any domestic policy that has received much attention" is the issue of a health insurance mandate, which Clinton has included in her health care proposal but Obama has not included in his plan, Times columnist Leonhardt writes. "Outside of health care, the campaigns -- and we in the media -- have focused on more exalted concepts, like experience, change and judgment," but "there really are some other important differences between the candidate," such as "policies as a whole" and "competing economic philosophies," Leonhardt writes, adding, "The fight over health insurance is just one part of their disagreement." According to Leonhardt, "Mrs. Clinton and Mr. Edwards favor a mandate because -- as they point out -- there will never be universal health care without one," and "skepticism about government tinkering" raised by Obama "helps explains his stance on a health care mandate." He adds, "Obama is right that some people would ignore a health care mandate. But some wouldn't. As any good behavioral economist knows, there really are people who can afford health insurance and who would like to have it -- but who haven't gotten around to getting it. A mandate would nudge some of them to do so, and the whole health care system would be better off as a result" (Leonhardt, New York Times, 1/2).
- Jacob Sunshine, Seattle Post-Intelligencer: "There are many reasons physicians and people in health care are lukewarm about John Edwards' presidential candidacy," and none "is bigger probably than his professional past," Sunshine, a student at the University of Washington School of Medicine, writes in a Post-Intelligencer opinion piece. Sunshine writes, "In the '80s and '90s, he amassed a fortune as a trial attorney, in no small part through malpractice cases against OB/GYNS in North Carolina," and "this makes some people in health care uneasy." However, "no matter how you feel about Edwards' past, of all the candidates seeking the presidency, he is the one most committed to improving the public's health, in addition to health care," based in part on his "having the most progressive universal health plan" and his focus on poverty, Sunshine writes. He adds, "Make no mistake; those measures will not be easy. But by focusing on poverty, in addition to his health plan, Edwards is in a position to do a tremendous amount to improve our country's collective health" (Sunshine, Seattle Post-Intelligencer, 1/2).
- Washington Post: "When it comes to health care, the way policy makers define the problem determines the answer they produce," as "Democratic presidential candidates tend to focus on the uninsured" and Republicans candidates tend to focus on "rising costs," a Post editorial states. According to the editorial, "Both are important: The unaffordability of health insurance won't be addressed without tackling health-care costs, but reducing cost growth alone won't solve the insurance problem." A health care proposal announced by presidential candidate Sen. John McCain (R-Ariz.) is the "most detailed and thoughtful of the Republican proposals" but "does not put enough emphasis on dealing with the uninsured," the editorial states. In addition, McCain "puts too much emphasis on the ability of consumers, once they are aware of and responsible for health-care costs, to drive down prices," and his "plan is weakest on the underlying problem with the health-insurance market, in which insurers have every incentive to cherry-pick the healthiest purchasers," the editorial states. However, according to the editorial, "his suggestions for constraining costs and reforming the irrational tax treatment of health insurance merit serious consideration by whoever is elected." The editorial states, "The McCain plan represents an important improvement on a dead-on-arrival proposal from President Bush earlier this year," adding, "Getting rid of the tax preference would be a good step toward achieving a more rational system, one that does not favor some purchasers of health insurance over others and does not encourage spending on gold-plated health care plans" (Washington Post, 12/23).
Broadcast Coverage
 "Meet the Press" on Sunday included a discussion with Obama about his health care proposal and other issues (Russert, "Meet the Press," NBC, 12/30). Video of the complete program is available online. A transcript of the complete program also is available online. Forum
PBS's "NewsHour with Jim Lehrer" last week reported on the latest in a series of health policy forums in Washington, D.C., organized by Families USA and the Federation of American Hospitals. Democratic presidential candidates Sen. Joe Biden (Del.); Clinton; Edwards; Rep. Dennis Kucinich (Ohio); and New Mexico Gov. Bill Richardson participated in the forum (Dentzer, "NewsHour with Jim Lehrer," PBS, 12/25/2007). Republican candidate Sen. John McCain also has participated in the forum.
The Kaiser Family Foundation hosts the forums in its Barbara Jordan Conference Center in Washington, D.C. Kaiser is webcasting the forums live through kaisernetwork.org, its health policy news and information service. Susan Dentzer of "NewsHour" will moderate the forums, and additional panelists will include journalists from NPR, Wall Street Journal and ABC News. Live and archived webcasts of the six forums held to date, as well as additional information about them, are available on a dedicated Web site, http://presidentialforums.health08.org. The forums are being funded by The California Endowment and the Ewing Marion Kauffman Foundation (Kaiser Daily Health Policy Report, 11/20).
The "NewsHour" segment includes comments from Biden; Clinton; Edwards; Kucinich; Richardson; Laura Meckler, a reporter for the Journal; David Muir, a correspondent for ABC News; and Julie Rovner, a correspondent for NPR ("NewsHour with Jim Lehrer," PBS, 12/25/2007).
Audio and a transcript of the segment are available online.
Small Businesses Could Have Major Influence on Next President's Health Care Plan
[Jan 02, 2008]
The Los Angeles Times last month examined how the "verdict of small business owners could lift or sink the next president's health care reform plan." Small businesses are "at the core of both the policy problem and the thorniest political challenge" to reducing the number of uninsured U.S. residents, the Times reports.
While most large employers offer coverage, many small companies find the cost prohibitive. Nearly two-thirds of the working uninsured and about 40% of all U.S. workers are employed by companies with fewer than 100 employees, the Times reports. "So in terms of policymaking, it will be almost impossible to reduce the number of uninsured substantially without involving those who work for small firms," according to the Times.
Small businesses traditionally have been "a solid GOP constituency," but they are "being wooed by the Democratic candidates, who are offering to tweak their health care plans to make them more appealing," according to the Times. However, the Times reports that small businesses "are a powerful lobbying force, and winning their support for significant changes may not be easy." Denny Dennis, research director for the National Federation of Independent Businesses, said, "The politicians' problem is coverage. Ours is cost," adding, "If they can't help us with cost, how can we help them with coverage?"
A survey by the federation showed that 9% of its 350,000 members said expanding coverage was the most important issue related to health care, while 74% named health care costs as the most important issue. The survey also found that 57% of federation members said they would support an individual health insurance mandate, while 40% said they would oppose it. An individual coverage mandate "is a cornerstone of universal coverage plans" proposed by Democratic candidates Sen. Hillary Rodham Clinton (N.Y.) and former Sen. John Edwards (N.C.).
Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health, said, "The individual mandate is attractive in that it sounds like it could get their employees coverage, and it wouldn't require (employers) to contribute very much" (Alonso-Zaldivar, Los Angeles Times, 12/23/07).
Prescription Drugs
JAMA Study Shows Racial Disparities in Emergency Department Pain Relief Prescriptions
[Jan 02, 2008]
Emergency department physicians are prescribing more narcotics to patients who say they have pain, but minority patients are less likely than whites to receive such drugs, according to a study published on Wednesday in the Journal of the American Medical Association, the AP/Houston Chronicle reports. The government-funded study, which was conducted by researchers at the University of California-San Francisco, used data from a federal survey to analyze more than 150,000 ED visits for all types of pain at 500 city and rural U.S. hospitals from 1993 to 2005.
According to the study, narcotic prescriptions by ED physicians increased from 23% in 1993 to 37% in 2005. The study found that opioid narcotics were prescribed in 31% of pain-related visits involving whites, 28% involving Asians, 24% involving Hispanics and 23% involving blacks. In addition, the study found that in more than 2,000 visits for kidney stones, whites received narcotics 72% of the time, Hispanic patients received the drugs 68% of the time, and Asian and black patients received the drugs 67% and 56% of the time, respectively. Minorities were slightly more likely than whites to receive aspirin, ibuprofen and similar pain medications, according to the study. The study found racial disparities in ED narcotic prescriptions in both urban and rural hospitals.
Study co-author Mark Pletcher said that the "gaps between whites and nonwhites have not appeared to close at all." According to the study's authors, physicians might be less likely to see signs of pain medication abuse among white patients or might be undertreating pain in minorities. Pletcher said that patient behavior also might play a role, adding that minorities "may be less likely to keep complaining about their pain or feel they deserve good pain control" (Johnson, AP/Houston Chronicle, 1/2).
An abstract of the study is available online.
Coverage & Access
States Struggled To Enact Health Care Reform in 2007, Uncertainty for Reforms Remains
[Jan 02, 2008]
"A year that began with great ambition for major expansions of health insurance" in California and other states, ended "with considerable uncertainty, as a second wave of change runs headlong into a darkening economy and political divisions over how to apportion the cost," the New York Times reports. California, Illinois and Pennsylvania each proposed wide-ranging health care proposals, but none "finish[ed] 2007 with bills passed and signed," according to the Times. The Times reports that the proposals "confronted entrenched opposition from insurance and other business lobbies that made it far more difficult to build a consensus for change" in these large states than in the smaller New England states that have been successful with reform.
For example, in California, Republican Gov. Arnold Schwarzenegger and Democratic state Assembly Speaker Fabian Núñez (D) were successful in crafting a plan that aims to achieve near universal coverage in a state with one of the country's highest rates of uninsured residents. The state Assembly approved the measure, but state Senate President Pro Tempore Don Perata (D) has expressed concern about the cost of the plan at a time when the state faces a massive budget shortfall (Sack, New York Times, 12/25/07).
Despite potential problems in the California bill's final passage, the health proposal impressed some experts "by finding compromises where earlier efforts ended in logjams," according to the Washington Post. Karen Davis, president of the Commonwealth Fund, said, "For a long time, [health care reform] was seen as too big, too complicated, too costly, too many interest groups," adding, "Where you get action by a major state like California that has a very high level of the uninsured, it just becomes realistic and pragmatic: This is doable. What is really needed is leadership" (Vick, Washington Post, 12/22/07).
According to the Times, in 2008 the "focus may shift to the presidential campaign, where the leading candidates for the Democratic nomination have each proposed major overhauls." Larry Levitt, a vice president of the Kaiser Family Foundation, said, "It's significant that what they've been talking about in California is similar to what many of the leading Democratic presidential candidates are talking about as well," adding, "There seems to be some convergence at least on the part of those supporting universal health care on how to get there." The result of the overlap, however, is that some state leaders "may be tempted to wait out the year to gauge whether the next president will push for a national health plan that might subsume state efforts," the Times reports (New York Times, 12/25/07).
Judge Rules San Francisco Health Care Program Violates ERISA; City Appeals Decision
[Jan 02, 2008]
A U.S. District judge on Dec. 26, 2007, ruled that a provision of a San Francisco law requiring employers to meet minimum contribution levels to employee health insurance benefits or help fund a city program violated the 1974 federal Employee Retirement Income Security Act, the San Francisco Chronicle reports (Egelko/Knight, San Francisco Chronicle, 12/27/07). However, city officials said they would move forward with plans to expand health services for uninsured residents while appealing the decision (Engel, Los Angeles Times, 12/31/07).
The program is intended to ensure access to health care services at San Francisco clinics and the city's public hospital for San Francisco's 82,000 uninsured residents. Under the law establishing Healthy San Francisco, private employers with at least 20 employees and not-for-profit groups with at least 50 employees must provide health care benefits at a cost that meets minimum spending levels or help cover the cost of the Healthy San Francisco program. Other funding comes from tax revenue and member premiums. Lawsuit, Ruling Details
The Golden Gate Restaurant Association challenged the employer contribution provision of the law, arguing that it violated ERISA, a federal law that governs employer-sponosred health benefits. City attorneys maintained that Healthy San Francisco does not violate ERISA because employers can comply without establishing new health plans (Egelko/Knight, San Francisco Chronicle, 12/27/07).
However, U.S. District Judge Jeffrey White in the decision wrote, "By mandating employee health benefit structures and administration, those requirements interfere with preserving employer autonomy over whether and how to provide employee health coverage, and ensuring uniform national regulation of such coverage" (Leff, AP/Contra Costa Times, 12/27/07).
In lieu of the employer mandate, the restaurant association has proposed a quarter-cent sales tax increase to help fund Healthy San Francisco, but Mayor Gavin Newsom and labor leaders say such a funding mechanism would encourage employers to stop providing health care benefits for employees. Appeal
City Attorney Dennis Herrera requested an emergency stay of the ruling from the Ninth U.S. Circuit of Appeals on Thursday, a move that would permit the employer mandate to take effect while San Francisco appeals the decision (Knight/Egelko, San Francisco Chronicle, 12/28/07). Herrera argued that the ruling ignores past decisions that allowed state and local governments to regulate employee benefits as long as they do not require employers to create new health plans.
However, the Ninth U.S. Circuit Court of Appeals declined to take immediate action on Monday and said it would hold a hearing on the case later this week. It is unlikely that the city's appeal would be decided before next summer at the earliest, the Chronicle reports (Egelko, San Francisco Chronicle, 1/1). Implications
Beyond San Francisco, the ruling raises concerns about the viability of similar health care programs under consideration by city and county governments across California, as well as a health care coverage expansion backed by Gov. Arnold Schwarzenegger (R) and Assembly Speaker Fabian Núñez (D-Los Angeles), according to the Chronicle (San Francisco Chronicle, 12/27/07).
The text of the ruling is available online (.pdf).
Efforts To Increase Medical School Enrollment Could Place Financial Burden on U.S. Health Care System, Experts Say
[Jan 02, 2008]
Efforts to train more physicians to serve an aging U.S. population might increase health care costs, as well as expenses for Medicare, according to researchers at Dartmouth Medical School, the Washington Times reports.
The Association of American Medical Colleges recommends that by 2015 medical schools increase their enrollments by 30%, or 5,000 students annually. According to the Council on Graduate Medical Education, the class of 17,800 students who enrolled in medical schools in 2007 is the largest in U.S. history and represents a 2.3% increase from 2006. AAMC President Jordan Cohen said, "Given the extensive time it takes to educate and train tomorrow's doctors, efforts to increase enrollment must get under way as soon as possible to ensure that the health care needs of the nation in 2015 and beyond are met."
However, David Goodman, a professor of pediatrics and family medicine at Dartmouth Medical School, said, "Calling for more doctors, like prescribing more drugs, for an already overmedicated patient, may only makes things worse." He said, "We already have a crisis in Medicare, we know that. We don't know how to pay for future Medicare expense at present, and no one has considered the implication of adding a large number of physicians," adding, "The physicians' fees are expensive, but once they enter the medical marketplace, no one has estimated the cost of the decisions they make. They order tests, prescribe medications, they really control health care cost in the U.S."
In addition, Goodman said, "There are not enough incentives in the market for doctors to go where they are needed most," adding, "More doctors does not mean the aging population will get the care it needs" (Lopes, Washington Times, 1/2).
AP/USA Today Examines Efforts To Offer Health Care Services to Low-Income and Uninsured U.S. Residents in Gathering Places
[Jan 02, 2008]
AP/USA Today on Tuesday examined efforts by health officials and specialists nationwide "to address glaring disparities in U.S. health care" by expanding health screenings and lifestyle education programs to places where uninsured and low-income residents most often gather. A number of states are conducting education programs for barbers and beauticians to help them teach their clients about stroke symptoms and the importance of screenings, while many churches are hosting blood pressure exams and health education fairs.
The Medical College of Wisconsin in a partnership with Columbia St. Mary's Hospital in Milwaukee recently launched a nine-month study to determine whether chronic disease management services offered at food pantries can improve the health of patrons, according to AP/USA Today. The $450,000 charity-sponsored project will continue for three years and will target common chronic ailments including diabetes, obesity and high blood pressure. It aims to offer screenings to 2,500 patients.
Patients will be required to pay for a part of the services and medications, and those who are seriously ill will be referred for advanced care. Jim Sanders of MCW said that for $4 or $5, patients can receive a month's supply of low-cost generic hypertension or cholesterol drugs. Health care officials also will register qualified patients for Medicaid and other health care programs, AP/USA Today reports.
Georges Benjamin of the American Public Health Association said, "The most important principle here is going where the people are," adding, "There no reason you can't do immunizations there, no reason you can't do nutritional counseling there. ... It makes a lot of sense" (Neergaard, AP/USA Today, 12/25/07).
Health Care Marketplace
Health Industry Develops Medical Credit Score
[Jan 02, 2008]
The health technology firm Healthcare Analytics is creating a new credit score -- called medFICO -- that would rate an individual's ability to pay medical bills, the McClatchy/Baltimore Sun reports. The score could be introduced as early as this summer in some hospitals. MedFICO would reflect on-time medical bill payments and would include only billing data, not information indicating the reason for treatment. Hospitals would check the score after a patient is discharged to help officials to decide whether a patient can afford to pay bills or whether hospitals should write the debt off as uncollectible.
Development of the score is funded by Fair Isaac, Tenet Healthcare and North Bridge Venture Partners. A sense of the extent of uncollectible bills would help hospitals determine whether to invest in new projects and more accurately balance expenses against gross income, according to McClatchy/Sun.
However, consumer advocates are concerned that the scores might lead lower-income patients with lower scores to receive poorer quality health care than those with higher medFICO scores. Linda Foley, founder of the Identity Theft Resource Center, said, "How much assurance do I have that they're not going to look at this medFICO first, before they decide whether to treat or not?" Consumer advocates also say that given the problems associated with the current Fair Isaac credit score, such as identity theft and inaccurate scoring data, it should not be used as a basis for a medical credit score.
Stephen Farber, chair and CEO of Healthcare Analytics, said, "We only come into play once the patient has been treated and discharged, and the bill already exists," adding, "We help figure out what sort of relief a hospital should grant the patients" (McClatchy/Baltimore Sun, 1/2).
Health Insurers Must Review Applications for Accuracy Before Issuing Policies, California Appeals Court Rules
[Jan 02, 2008]
A panel of the 4th District Court of Appeals in Santa Ana, Calif., last week ruled unanimously that health insurers are responsible for reviewing applications before issuing policies and should not wait until beneficiaries run up large medical bills, the Los Angeles Times reports. The court also ruled that insurers cannot rescind a health insurance policy unless they show that the policyholder willfully misrepresented his or her health or that the insurance company had investigated the application before issuing coverage.
In the case, Blue Shield of California is accused of inappropriately terminating an individual health insurance policy after authorizing more than $450,000 in medical services for a member. A lower court dismissed the case without a trial, but the appeals court overturned that decision and declared that insurers are obliged to verify information included in health insurance applications before extending coverage.
According to the decision, the facts of the case "raise the specter that Blue Shield does not immediately rescind health care contracts upon learning of potential grounds for rescission but waits until after the claims submitted under that contract exceed the monthly premiums being collected." The court ruled that a health plan "may not adopt a 'wait-and-see' attitude after learning of facts justifying rescission," adding that a company cannot continue to "collect premiums while keeping open its rescission option if the subscriber later experiences a serious accident or illness that generates large medical expenses." Blue Cross is considering an appeal of the decision.
The ruling sets the stage for similar cases against insurers to move forward in trial courts. Insurers and attorneys for policyholders say that courts previously have dismissed such lawsuits without trials, making it possible for health insurance companies to settle claims privately out of court (Girion, Los Angeles Times, 12/25/07).
UAW Looks to Influence Health Care Debate; VEBA Might Be Model for Other Companies
[Jan 02, 2008]
United Auto Workers' "gamble that it can manage the health care costs of up to 700,000 people" through a voluntary employees' beneficiary association "comes with a side wager over how much the union can boost its influence in the health care debate in Washington," which "will be key to whether the union can contain health care costs enough to keep its $52 billion fund for retiree health care solvent," the Detroit Free Press reports. The VEBA agreement between UAW and the Big Three automakers -- Ford Motor, General Motors and Chrysler Group -- also includes a $30 million pledge to form a new think tank, the National Institute for Health Care Reform.
Although "the sheer scope of the UAW's health care plan will make it one of the largest buyers of health care" in the U.S., "experts say its sway over future health care reform may hinge more on which party wins the White House in 2008," according to the Free Press. While the union continues to support "some form of a national health care system" during the Bush administration -- which is "steadfastly opposed to any such move" -- UAW has focused its recent lobbying efforts on other health care issues such as cost control, expanding Medicare and obtaining government aid for automakers' retiree health care costs, the Free Press reports. Many of its positions have placed the union in opposition of insurers and drug companies.
UAW has been a presence on the political scene for nearly two decades, donating more than $2 million in every election cycle since 1990 to the Democratic Party. Karen Davenport, director of health policy at the Center for American Progress, said UAW might face challenges in attempting to influence the health care debate. "Even with the new roles, along with other stakeholders, [UAW is] at the mercy of health care costs trends -- and more so as a payer," she said (Hyde, Detroit Free Press, 12/24/07). VEBAs Considered by Other Industries
"[L]ooming retiree health care costs have pushed" a number of unions and companies to turn to VEBAs before "things go from bad to worse," the Free Press reports. Companies see VEBAs as a way to unload "massive health care liabilities," while unions see them as "a chance to secure at least some health benefits in the face of uncertain futures," according to the Free Press, which notes that VEBAs also became "one option for dealing with health care expenses as companies and employee groups became involved in lawsuits or bankruptcy proceedings over who should pay for these benefits."
Chip Kerby, a partner who specializes on employee benefits at the Washington, D.C.-based law firm McDermott Will & Emery, said turning to VEBAs is not "a new thing." He added, "It's a thing that's being utilized now because the parties that are facing each other across the table in these situations of economic distress have decided that it is maybe the last, best shot for preserving some of the benefits that the union retirees have been expecting."
According to the most recent IRS statistics, there are 9,193 VEBAs in the U.S. While VEBAs have been in existence since 1928, their usage became more widespread in the 1980s when public companies under new accounting rules had to disclose estimated liabilities for future health care expenses. "Absent some major move on national health care, VEBAs likely will be a topic of discussion for years, especially with the new, massive VEBAs in the auto industry," according to experts, the Free Press reports (Collier, Detroit Free Press, 12/23/07). VEBA Solvency
In related news, experts maintain that the VEBAs managed by UAW might become insolvent earlier than the 80 years promised by union President Ron Gettelfinger, the Detroit Free Press reports. According to experts, the VEBAs leave unfunded about $36 billion in retiree health care liabilities and assume that the health care inflation rate will decrease to 5% by 2013 and remain at the same level, although the rate has averaged almost 10% in recent decades.
UAW members and outside experts maintain that the VEBAs likely will not remain solvent for 80 years unless the federal government implements a national health care system within 5 to 15 years. Lance Wallach, a VEBA consultant, said that UAW has made "ridiculous assumptions on health care costs." He added, "Unless they make drastic changes to the way they treat health care, I'd be surprised if the money lasts 20 years" (Merx, Detroit Free Press, 12/23/07).
State Watch
Schwarzenegger, Núñez Submit Ballot Initiative for Health Care Reform Proposal
[Jan 02, 2008]
California Gov. Arnold Schwarzenegger (R) and state Assembly Speaker Fabian Núñez (D) on Friday submitted to the state attorney general a proposed ballot initiative for the November 2008 elections that would provide the funding mechanism and other changes necessary to enact their plan to overhaul the state's health care system, the Los Angeles Times reports. The submission "sets the stage for what is expected to be a costly and contentious battle pitting the two state leaders and their allies against some powerful opponents," according to the Times (Rothfeld, Los Angeles Times, 12/29/07).
The proposal, approved by the California Assembly last month, would require most state residents to obtain health coverage. Under the bill, residents with incomes up to 250% of the federal poverty level would receive state subsidies for coverage, and residents with incomes up to 400% of the poverty level would receive tax credits to ensure that health care premium costs do not exceed 5.5% of their incomes. Insurers would be prohibited from denying coverage to residents because of pre-existing medical conditions (Kaiser Daily Health Policy Report, 12/21/07).
The ballot initiative submitted by Schwarzenegger and Núñez would ask voters to approve about $9 billion in fees and taxes to partially fund the $14 billion plan. The remaining funding would come from the federal government, consumer premiums and copayments (Chorneau, San Francisco Chronicle, 12/29/07). The initiative would nearly double the state tax on cigarettes to $1.75 per pack, from 87 cents per pack, in mid-2009. The initiative also includes an employer requirement that ranges from 1% to 6.5% of their payrolls, depending on the level of payroll. Funds raised by this fee would go into a new California Health Care Trust Fund to assist state residents who find insurance unaffordable. The initiative specifies that funds directed to the health care trust fund only could be used for the specified purpose.
In addition, the initiative would:
- Specify the process by which programs would be suspended if the state encounters insufficient funding;
- Levy new fees on hospitals; and
- Approve a $25 million loan from the state's general fund to provide funding to families with children who will be dropped from city or county health care programs during the transition to the state program (Los Angeles Times, 12/29/07).
Process
Submitting the measure to the attorney general "is the first step" in qualifying it for the ballot, according to the Chronicle. The attorney general has seven weeks to review the initiative, assign it a formal title and write a summary that can be distributed to voters. Schwarzenegger and Núñez likely will need signatures from more than one million registered voters.
In addition to approval of the ballot measure, supporters of the health care proposal need to pass legislation (AB1X) that would make changes to the state and local government to allow the new health care system to operate. State Senate Pro Tempore Don Perata (D) has delayed a vote on the bill until mid-January, after a financial analysis is completed. If the bill is amended in a "substantial way, a new initiative would have to be drafted and the attorney general would have to begin his review again -- costing backers of the plan precious time," according to the Chronicle. The Chronicle reports that for supporters of the reform proposal, "time is running short to qualify the measure for the ballot and then effectively campaign for its passage" (San Francisco Chronicle, 12/29/07). Problems With ERISA
The Christian Science Monitor on Monday examined how California leaders "are pushing forward with a health care reform effort ... despite an ominous legal ruling last week" that found that a San Francisco health care program violated the 1974 Employee Retirement Income Security Act by requiring employers to spend a specified amount of money on health programs for their employees. ERISA prevents state and local governments from meddling with employer-provided benefits. The ruling "reiterates the almost Sisyphean nature of health care reform at anything but the national level," and the submission of the ballot initiative by Schwarzenegger and Núñez "signal[s] they are still willing to try to push the boulder back up the hill," the Monitor reports (Arnoldy, Christian Science Monitor, 12/31/07).
Number of Uninsured Louisiana Residents Declines
[Jan 02, 2008]
The number and percentage of uninsured Louisiana residents declined last year compared to 2005 before Hurricane Katrina, according to the 2007 Louisiana Health Insurance Survey, the New Orleans Times-Picayune reports. According to the Louisiana Department of Health and Hospitals, the post-Katrina population loss accounts for part of the decline, but the biggest factors are the state's strong economy and a low unemployment rate that has resulted in more residents having employer-sponsored health coverage.
The survey found that 64,355 Louisiana children, or 5.4%, lacked insurance in 2007, compared with 97,403, or 7.6%, in 2005. The decline was attributed mainly to increasing enrollment in LaCHIP, the state's version of SCHIP. The percentage of uninsured adults decreased from 23.4% in 2005 to 21.2% this year, according to the survey. The survey found 546,348 adults in the state were uninsured in 2007 -- a decrease of 108,381 over two years (New Orleans Times-Picayune, 12/26/07).
Meanwhile, new U.S. Census Bureau data show that an increasing number of pre-Katrina residents are returning to Louisiana, the AP/Washington Post reports. According to the AP/Post, 250,000 state residents left Louisiana after the hurricane, and while 50,000 people returned to the state in the fiscal year ending July 1, 2007, "the state is far from returning to its pre-Katrina population level of 4.5 million" (Dunbar, AP/Washington Post, 12/27/08).
The Louisiana Health Insurance Survey is available online (.pdf).
U.S. Judge Repeals Maine Law Prohibiting Access to Prescribing Information
[Jan 02, 2008]
U.S. District Judge John Woodcock last week overturned a Maine law that would have restricted medical data companies' access to physician prescribing information, the AP/Wall Street Journal reports (AP/Wall Street Journal, 12/24/07). Lawsuits were filed by Connecticut-based IMS Health, Pennsylvania-based Wolters Kluwer Health and Verispan. The companies were seeking to block Maine from enforcing its law, which was set to take effect Jan. 1.
According to the complaints, the law was unconstitutional and violated the First Amendment by prohibiting the transfer of legally obtained information and the 14th Amendment by impeding interstate commerce. The complaint also said the law went against a national trend toward greater health care transparency. A similar law in New Hampshire was overturned in April 2007 by U.S. District Judge Paul Barbadoro, who ruled that it placed unconstitutional restrictions on free speech (Kaiser Daily Health Policy Report, 8/31/07).
In his 42-page decision, Woodcock wrote that the law would prohibit "the transfer of truthful commercial information" and "violate the free speech guarantee of the First Amendment." Woodcock also cited the April 2007 ruling by Barbadoro.
Maine Assistant Attorney General Thomas Knowlton said Attorney General Steven Rowe (D) is "disappointed by the judge's conclusion," adding, "We obviously believed the New Hampshire statute is very different than Maine's." Maine state Rep. Sharon Treat (D), who sponsored the law, said she anticipates an appeal of the decision (AP/Wall Street Journal, 12/24/07).
Kentucky's Low-Income Residents Lack Dental Insurance, Dental Care, NYT Reports
[Jan 02, 2008]
Kentucky is "among the worst states nationally in the proportion of low-income residents served by free or subsidized dental clinics, and less than a fourth of the state's dentists regularly take Medicaid, according to 2005 federal data," the New York Times reports in a look at dental health among state residents. Kentucky has the highest proportion of adults under 65 without teeth, and about half of state residents lack dental insurance, according to the Times.
Until August 2006, the state had one of the lowest Medicaid reimbursement rates nationwide, which contributed to a shortage of dentists in low-income and rural areas. Julie Watts McKee, the state's dental director, said that in 2006, Medicaid reimbursements for children's dental services were raised by about 30%. However, despite the increase, which was funded by cutting orthodontic benefits, reimbursement rates still are about 50% below the market rate, according to Ken Rich, the state's dental director for Medicaid. Reimbursement rates for adult dental care are about 65% below the market rate, Rich said.
One of the leading causes of missed school days for Kentucky children is pain caused by dental problems, according to state health officials, and nearly half of the state's children ages two to four have untreated cavities, while about 10% of state residents are missing all of their teeth, according to 2004 federal data.
Edwin Smith -- a dentist who runs Kids First Dental Care, a free mobile clinic in Kentucky, and who provides no-cost care to about half of the patients at his private practice -- "has seen the extremes of neglect," according to the Times. Smith said, "The level of need is hard to believe until you see it up close" (Urbina, New York Times, 12/24/07).
Capitol Hill Watch
Washington Post Examines 'Winners,' 'Losers' Among Lobbyists in 2007
[Jan 02, 2008]
The Washington Post on Tuesday examined the "winners" and "losers" among lobbyists in 2007. According to the Post, among the winners in 2007, a partnership between AARP and the American Medical Association -- "two of Washington's most potent pressure groups" -- "eked out a victory that was barely noticed by the general public at the end of the year but was pivotal to doctors." The groups lobbied Congress to delay by six months a scheduled 10% reduction in Medicare physician reimbursements.
However, the groups "did not succeed every time," as they failed to lobby lawmakers to pass legislation to reauthorize and expand SCHIP that included a 61-cent increase in the federal cigarette tax, the Post reports. The SCHIP bill "was defeated by two of the other winners of the year: the tobacco lobby and America's Health Insurance Plans," according to the Post.
Pharmaceutical companies, among the losers in 2007, "were major targets of Congress's Democratic majority," the Post reports. According to the Post, pharmaceutical companies "fended off the strongest assaults," such as a "proposal to force them to negotiate prescription drug prices under Medicare," but they "did come out on the short end in one legislative skirmish -- the drive to alter the nation's patent laws," as an "alliance that represents tech companies steered a bill that it likes -- and drug companies oppose -- through the Senate Judiciary Committee and the full House" (Birnbaum, Washington Post, 1/1). Democratic Congress
NPR's "Morning Edition" on Thursday reported on Democrats' attempts to pass health care legislation in 2007. According to "Morning Edition," at the start of the year, Democrats "had big plans for health care," including giving the federal government authority to negotiate prescription drug prices under Medicare, increasing federal funding for embryonic stem cell research and expanding SCHIP. At the close of the year, Democrats "have accomplished none of those things," "Morning Edition" reports. Democratic-backed measures on mental health parity and genetic discrimination also are yet to reach the president. The segment includes comments from Drew Altman, CEO and president of the Kaiser Family Foundation; President Bush; Sen. Tom Coburn (R-Okla.); and Democratic Caucus Chair Rahm Emanuel (Ohio) (Rovner, "Morning Edition," NPR, 12/27/2008).
Audio of the segment is available online.
The Latest Reports in Health Policy
Study Looks at Effect of Medicare on Previously Uninsured Adults; Perspectives Examine Physician-Efficiency Comparisons, Physician-Performance Programs
[Jan 02, 2008]
- "Health of Previously Uninsured Adults After Acquiring Medicare Coverage," Journal of the American Medical Association: The study evaluates how gaining Medicare coverage affected the health of previously uninsured adults. According to the authors, Medicare coverage improved self-reported health for previously uninsured adults, particularly those with cardiovascular disease or diabetes (McWilliams et al., JAMA, 12/26/07).
- "Comparing Physicians on Efficiency," New England Journal of Medicine: In the article, Arnold Milstein, chief physician at Mercer Health and Benefits and medical director of the Pacific Business Group on Health, and Thomas Lee, network president for Partners HealthCare in Boston and an associate editor of NEJM, discuss issues surrounding the use of physician-efficiency assessments by consumers and purchasers. According to Milstein and Lee, "Knowledge about physicians' efficiency could be helpful to patients who increasingly struggle to afford premiums, deductible, and coinsurance," and it also could "motivate physicians to lead urgently needed efforts to improve efficiency" (Milstein/Lee, NEJM, 12/26/07).
- "Is Quality Improvement Improving Quality? A View From the Doctor's Office," New England Journal of Medicine: In the NEJM perspective, Mark Vonnegut -- a pediatrician in Quincy, Mass. -- discusses efforts by the health care industry to evaluate physician care and performance. Vonnegut also examines whether these programs have a positive or negative impact on patients' health. Vonnegut says he suspects that such programs will be more beneficial to insurers than physicians and patients, adding that doctors should work harder to determine whether performance-assessing programs truly improve care before the health care industry changes the way medical care evolves and is delivered (Vonnegut, NEJM, 12/26/07).
Opinion
Editorial Urges Federal, State Agencies To Curb Medicare Advantage Plan Abuses, Eliminate 'Unjustified Subsidies'
[Jan 02, 2008]
Many Medicare Advantage plans "are continuing to prey on elderly Americans despite state, federal and industry efforts to stop them," which is "yet another reason to rein in these operations by eliminating their unjustified subsidies," a New York Times editorial states. The editorial says that these private MA plans are "an ethical horror" and "a financial drag ... as the government pays them about 12% more, on average, than the same services would cost in the traditional Medicare program."
The editorial notes that under business practices recently examined by the Times, "unscrupulous insurance agents have tricked people into dropping traditional Medicare coverage and enrolling instead in private plans that do not meet their needs." It continues, "Although federal officials claim the number and severity of sales abuses have declined, they remain a dark stain on the ethical performance of private plans."
The editorial concludes, "Federal and state agencies need to redouble their efforts to root out abuses, and Congress ought to eliminate the unjustified subsidies that give private plans a competitive advantage over traditional Medicare" (New York Times, 12/26/07).
Physicians Should Follow Professional Standards, Editorial States
[Jan 02, 2008]
A recent survey that "sought to measure attitudes toward a 'charter on professionalism' that has been embraced by many medical organizations" raises "doubts about physicians' willingness to meet their medical and societal responsibilities," a New York Times editorial states. Researchers "found a disturbing reluctance among doctors to report incompetent colleagues or serious mistakes by their peers," and "[a]lthough an overwhelming majority of some 1,600 doctors acknowledged that they should make such reports to hospitals, clinics or other relevant authorities, they often flinched when the occasion arose," according to the Times.
In addition, "Almost half of those who had direct knowledge of impaired or incompetent colleagues, or who knew of significant medical errors, had failed to report them at least once over the last three years," the editorial states. The editorial continues, "In addition to raising questions about misplaced loyalties, several findings suggest that doctors could become an impediment to much-needed efforts to rein in health care costs." According to the Times, "To their credit, fewer than 1% of the doctors said they had lied to a patient in the last three years, and three-quarters reported delivering free care to patients who couldn't pay."
The editorial continues, "The charter is a valuable attempt to define a doctor's obligations -- not only to individual patients but also to the health care system as a whole." The Times concludes, "It is comforting that a vast majority of physicians seem to accept the standards. Now they need to start adhering to them" (New York Times, 12/24/07).
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