Kansas Health Institute

Blogs from here and there

Mayo, 22 other leaders encourage patient-centered reform

Feb. 23, 2010

In advance of the White House Summit on Health Reform this Thursday, Feb. 25, 2010, Mayo Clinic, along with 22 other organizations will run a full-page open letter Wednesday in Roll Call magazine to encourage Congress to come together on patient-centered reform. Our goal is to call attention to the issues that diverse interests have [...]

Payment Reform and Coverage for All a Step in the Right Direction

Feb. 11, 2010

We have been asked about the financial impact of health care reform bills on Mayo Clinic. We reiterate that both the House and Senate bills include important steps toward creating a more equitable and higher value health care system, consistent with the cornerstones of the Mayo Clinic Health Policy Center. We believe that reform provisions, [...]

Come Together on Patient-Centered Reform

Jan. 28, 2010

In his State of the Union address, President Obama urged Congress to continue to push forward and find a way to come together on health care reform. If we don’t act now, health care costs will continue to rise and more Americans will not have access to affordable, quality health care. The urgency for the [...]

Keep Patient-Centered Reform Moving Forward

Jan. 22, 2010

Reforming health care in America will not become easier with the passage of time. The status quo is not sustainable, and Mayo Clinic remains firmly committed to moving forward with patient-centered reform. We at Mayo Clinic encourage all stakeholders – government officials, patients, insurers, providers and employers – to work together to pass reforms that provide [...]

High Value, Affordable Care Will Benefit All Patients

Jan. 6, 2010

The Mayo Clinic Health Policy Center offers the following commentary in response to a Jan. 6, 2010 article in the Washington Post, “Health bills would shift Medicare money to Mayo and other ‘high-value’ hospitals.” We feel the primary goal of health care reform must be ensuring that all Americans have access to high quality, affordable care. Reforming [...]

OCR Update on Issuance of HIPAA HITECH Rulemaking

March 18, 2010

Update from Office for Civil Rights (OCR) on issuance of the Notice of Proposed Rulemaking (NPRM) implementing changes to HIPAA under the Health Information Technology for Economic and Clinical Health Act (HITECH). Health care organizations and health lawyers have been anxiously awaiting rules implementing and interpreting the changes because the effective date for many of the HITECH requirements was February 17, 2010. Of particular interest has been whether or not health care organizations are required to amend business associate agreement.The notice seems to indicate that the the date for compliance and enforcement may be delayed since it states that the NPRM "will provide specific information regarding the expected date of compliance and enforcement." However, covered entities and business associates need to weigh the risks of not complying with the new requirements while waiting for further clarification from OCR.The notice states:OCR will implement important privacy and security provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act through notice and comment rulemaking, as required by the Administrative Procedure Act. These provisions include: business associate liability; new limitations on the sale of protected health information, marketing, and fundraising communications; and stronger individual rights to access electronic medical records and restrict the disclosure of certain information. OCR continues work on a Notice of Proposed Rulemaking (NPRM) regarding these provisions. Although the effective date (February 17, 2010) for many of these HITECH Act provisions has passed, the NPRM and the final rule that follows will provide specific information regarding the expected date of compliance and enforcement of these new requirements.However, interim final rules implementing HITECH Act provisions in two areas have already been issued and are currently in effect: enforcement and breach notification. New civil money penalty amounts apply to HIPAA Privacy and Security Rule violations occurring after February 17, 2009. Covered entities and business associates must comply now with breach notification obligations for breaches that are discovered on or after September 23, 2009. OCR announced previously that it would use its enforcement discretion not to impose fiscal sanctions with regard to breaches discovered before February 22, 2010. Since that date has passed, OCR will enforce the Breach Notification Interim Final Rule, including with the possible imposition of sanctions, as it does with the HIPAA Privacy and Security Rule requirements.

West Virginia State Bar Issues Advisory Opinion 10-001 Clarifying Rule 8 Pro Hac Vice Admission

March 16, 2010

Today the West Virginia State Bar announced that the West Virginia State Bar's Unlawful Practice of Law Committee has released Advisory Opinion 10-001, relating to questions from attorneys regarding its interpretation of Rule 8 of the West Virginia Rules of Admission to the Practice of Law, relating to admissions pro hac vice.Advisory Opinion 10-001 addresses the following issues:1. Whether the requirement in Rule 8 of of admission pro hac vice extends to matters in which no action, suit or proceeding is pending;2. To what extent is the responsible local attorney required to participate in proceedings involving the attorney admitted pro hac vice;3. Whether presiding judicial officers can "excuse" local counsel form participation or "waive" the requirement of participating; and4. What limitations exist for attorneys seeking to be admitted pro hac vice, particularly their ability to be admitted on a frequent basis, or in multiple or consolidated actions.

AHLA Connections: Legal Implications of Health Care Social Media

March 10, 2010

The current issue of the American Health Lawyers Association's Connections magazine features an article I co-authored with fellow AHLA health lawyer, Jody Joiner, on the impact of social media use in health care.The article, Risky Business: Treating Tweeting the Symptoms of Social Media (PDF version), is featured in the March 2010 issue of AHLA Connections (Vol.14, No. 3, March 2010), a health lawyer magazine for the health and life sciences law community.We provide background context on the use of social media tools by health care providers, address why we think health lawyers need to understand social media, and explore some of the legal implications as social media and the law intersect. The article ends with practical guidance to health care providers and organizations on implementing policies emphasizing the appropriate use of social media.You can peruse the complete digital edition of the March 2010 AHLA Connections (Vol. 14, No. 3, March 2010). AHLA members should also check out the article in this issue on the recently launch Health Law Wiki. Great to see AHLA adding a wiki resource for members to share their expertise and experience in the complex and ever changing health care legal and regulatory world.Special thanks to the AHLA Connections staff for allowing Jody and I the opportunity to write the article and for their great editorial assistance.

Lesson for Hospitals and Health Care Providers: Photos of Shark Bite Victim

March 5, 2010

Martin Memorial too mum: Hospital staff violated privacy of shark victim, an article from the Palm Beach Post. The article highlights the impact ubiquitous mobile devices with cameras are having on our society and the potential liability risks associated with the use/misuse of these devices by health care employees.The article indicates that various hospital employees took photos of a shark bite victim when he arrived in the emergency room. The article discusses the action taken by the hospital in response to the incident. Another article indicates that the photos were emailed to others.This type of situation is a nightmare for hospital administration, the privacy officer and legal counsel. The effort and investigation that likely went into figuring out who took photos, where those photos went and the procedure for recapturing/removing the photos from the various sources was time consuming and expensive (both in $$ and reputation) for the hospital.As such, this incident provides a good example for training and reeducating health care employees on patient privacy issues. Health care employees and professionals must always remember to start from a framework of protecting the health and privacy of their patients. As the use of mobile devices with cameras and social media tools becomes more ingrained in our every day lives -- the ability for private information to be captured, transferred and spread in a viral fashion has become much easier. Caution must be used and this case highlights the importance of retraining staff and highlighting the importance of protecting your patient's privacy.

HITECH Law Blog

March 1, 2010

A warm welcome to fellow AHLA member and health law blogger, Kathie McDonald-McClure.I just ran across her blog, HITECH Law Blog. She focuses the blog on health information technology, privacy and security and the blog was named after the HITECH Act. Looks like a great addition to the health law blogosphere.Ms. McDonald-McClure is a member of the Health Care Services Team at Wyatt Tarrant & Combs, LLP in Louisville, KY.

Insurance Companies Cancelling Health Insurance of Sick Patients

Sept. 15, 2009

With President Obama’s speech to Congress last night outlining the details of his overhaul of healthcare in the United States, one interesting point popped up - the fact that Obama would guarantee that insurers could not reject people because of preexisting conditions. Health insurance companies are increasingly citing the failure to disclose preexisting conditions as a means to cancel policies and deny benefits to people in need of care. The term for this is "Post Claims Underwriting". What this means is that the insurance companies will not investigate someone for verification of entitlement to coverage until after they are sick and need the insurance. Of course, if they then determine the person is sick but not qualified they cancel the coverage and the sick consumer is left with no insurance. Insurance companies are using the term "rescission" to refer to the cancellation of insurance coverage due to a company being misled. Rather than trying to mislead companies, omissions of preexisting conditions seem to be honest mistakes by people filing out increasingly complex forms. There have been countless stories about how people have signed up for health insurance, only to have their policies later cancelled when they need care. No one knows how often policies are cancelled because of a variety of different state laws and policies in place, however, the practice has become rampant enough to result in numerous lawsuits and new regulations put in by states throughout the country. In the past year and a half, California has fined the five largest insurers in its state almost $19 million for cancelling the policies of individuals who became sick. One insurance company even admitted offering bonuses to employees who were able to find reasons to cancel policies. President Obama has been trying to gain support for his healthcare overhaul in part tapping into consumer dissatisfaction with the insurance industry, an industry that has never been popular among the American people. His plan for healthcare overhaul includes restricting insurance companies from screening for preexisting conditions, however, this still might not save people from having their policies cancelled. With new regulations, insurance companies might not necessarily cancel the policies of those individuals with undisclosed preexisting conditions, however, a company might institute further preauthorization requirements on services for certain patients, which might discourage such patients from renewing their policies. Lawsuits continue to be instituted against insurance companies who have cancelled policies. Rather than fight fraud, rescission has devolved into a backdoor route for insurance companies to stop paying the medical bills of people in their time of greatest need.

Coverage at the county level...

Aug. 19, 2009

Plenty has changed since 2006, the latest year that the uninsured of California was counted by the U.S. Census. But even then, many months before the current recession hit, the percentage of people living without health insurance in our state was startling. This week, the Sacramento Bee laid out the statistics, finding quite a disparity between those with health insurance and those without. Just in the five-county region The Bee covers, Yolo County posted an uninsured rate of 22 percent of people under 65, while the more prosperous Placer County -- with more employment-based coverage -- posted a 13.7 percent rate. That's quite a disparity, and the article by Phillip Reese and Anna Tong is worth reading. But the Bee doesn't limit information to its circulation area, it also posts online a comprehensive rundown of each of California's 58 counties' uninsured rate, along with an interactive map of the state and rollover charts. Here's a sampling of what the authors wrote: "The uninsured present an immense fiscal and public health challenge: 18,000 Americans die each year because they aren't covered, according to the Institute of Medicine, a nonprofit research organization. This is because having insurance is closely tied to health outcomes: The uninsured won't see a doctor regularly, and if they seek care it is likely to be inadequate or too late. Moreover, the uninsured are a cost for society: One economist recently estimated the tab at $56 billion per year, 75 percent of which is paid by governments. In cash-strapped California, that cost is critical: 6.6 million residents went uninsured in 2007, more than in any other state, according to the California Healthcare Foundation." You can bet that, with massive layoffs and small businesses closing since that Census count, the number of those among us -- members of our communities -- who are going without health insurance is a great deal larger. Factor in the Governor and Legislature's cuts in health and insurance programs for lower-income Californians, their children and the elderly, and you get an unimaginable sum of fellow Californians without access to affordable, quality health care -- notably, preventative health care, with better outcomes. This is what the conversation about health care reform boils down to, not pumped-up talking points and hyper-emotive protests based on misinformation. This is not a partisan issue. It is a people issue. And the bottom line is that the majority of Americans have already voted -- for substantive change for a better future for our country.

California Offers Lessons on Insurance Exchanges

Aug. 6, 2009

As Congress debates creating insurance "exchanges" as part of a health-care overhaul, the failure of a similar effort in California may offer important insights, former participants in the program say. From 1993 to 2006, small businesses in California could buy health insurance through an exchange run initially by the government, and later by a nonprofit group. The plan was undermined when some businesses with relatively healthy workers bought policies more cheaply directly from insurers, bypassing the exchange. That left the exchange with a shrinking pool of less-healthy workers, forcing rates higher and prompting many insurers to withdraw. Managers chose to shut the program in 2006 when one of three remaining insurers withdrew. "There are definite lessons to be learned," said John Ramey, who as former head of the Managed Risk Medical Insurance Board helped implement California's exchange. "We learned them the hard way out here." Among those lessons, he and others said: Employers and individuals who qualify must be required to obtain health insurance through the exchange. Failing that, John Grgurina, who ran California's exchange from 2002 until it ended, said government must impose rules governing rates and eligibility to protect the exchange from attracting a disproportionate share of high-risk people. An exchange aims to get better prices for coverage by banding together businesses and individuals. Insurers would have an incentive to join an exchange because they would gain access to more potential customers. Individuals and employees of businesses that participate in an exchange would be able to chose from the available plans and pay the same rate. Exchanges, either on a regional basis or a single national one, are likely to be a part of any final health-care legislation. Late Friday, the House Energy and Commerce Committee approved its health-care bill, though a full House vote won't come until the fall. President Barack Obama on Saturday praised the House committee's action and urged lawmakers to "build upon the historic consensus." The compromise proposal agreed to in the House Friday exempted more businesses from the mandate to provide coverage to their employees and offered subsidies to fewer individuals to buy insurance through an exchange, which would shrink the number of potential participants. Each of the three major bills -- one in the House and two in the Senate -- would create one or more exchanges. The specifics vary, but most of the proposals would impose more regulations than the failed California program, which analysts say would help the exchanges compete. Despite California's struggles, insurance exchanges are still the most effective way to expand coverage, said Elliot Wicks, a health-care consultant who wrote a report on the California program. The report, released last month, was commissioned by the California HealthCare Foundation, a private independent nonprofit. Veterans of the California effort said the ultimate effectiveness of any exchange would rest on details that have yet to be worked out. They said the pool of people in an exchange should be as broad as possible, to spread both risk and administrative costs. Click here for your free California health insurance now!

Public Health Insurance Would Be Too Good and We'd Like It Too Much

Dec. 17, 2008

A common thread is emerging in the right wing response to healthcare reform. Its opponents aren't claiming that public healthcare will be bad. Rather, they are terrified that the new system will be so good that no citizen would buy expensive private insurance--or vote for politicians who wanted to take public insurance away. The Obama team is sending clear signals that healthcare reform is a core economic issue, and the health insurance industry is becoming increasingly anxious by the future administration's determination to bring healthcare costs under control. Some Americans are seeing their healthcare premiums rising at four times the rate of inflation, if they have insurance at all. Healthcare reform is a pocketbook issue for all of us, according to the Obama team. In tough economic times it might be tempting to postpone healthcare reforms, but Obama is adamant that delay would be a false economy. In the American Prospect, Joanne Kenen and Sarah Axeen support claims about the high cost of doing nothing: A recent report by the New America Foundation's health-policy program estimates that the cost of doing nothing about health care, including poor health and shorter lifespan of the uninsured, is well above $200 billion a year and rising. That's enough to cover the uninsured and still have some left over for other public-health needs. If healthcare costs continue to rise at their current rates, it will cost $24,000/yr to insure a family of four by 2016, an 84% increase from today. At these rates, half of American households would have to spend at least 45% percent of their income to be insured. In the Nation, Willa Thompson describes how a bicycle crash made her appreciate the connection between healthcare and politics. Thompson was 21 years old when she suffered major injuries after a collision with a truck. Luckily, she was covered by her parents' medical insurance until she turned 22. She later realized that if she had been just a few months older when the accident happened, she wouldn't have been able to pay for her medical care. We all agree that something needs to be done. Let's briefly review the options that have been proposed so far. Obama wants to provide healthcare for all by requiring private insurance companies to cover everyone and creating a public health insurance plan to compete with private insurers. The second part of his plan is the public option that Republican opponents are so scared of. Click here for your free California health care quote now!

Why is single-payer health reform not viable?

Dec. 2, 2008

When it comes to health care reform in America, there is a relatively simple solution that will cover everyone's basic health care, control costs and save businesses, most people and the country a lot of money. It's called a single-payer health plan, where the government collects taxes to finance national health insurance. The government, which is the "single payer," covers all citizens and pays the bills when they visit private (or public) doctors, hospitals and other facilities for medical care. All would have basic coverage, regardless of whether they have a job, or where they work. Nobody gets billed for basic care. No-body goes broke because of medical bills. Yet this option has been declared "off the table" by Sen. Max Baucus, D-Mont., who's among those leading the charge for health care reform in America. Top Democrats who will be deciding policy in America in 2009, including Baucus and President-elect Barack Obama, say single-payer is "not politically feasible," because the public won't strongly support it. What they really mean is that when it comes to health care reform, they don't want a political fight with some of the nation's most powerful financial interests, which have the resources and the motivation to turn public opinion against meaningful reforms. These interests include the health insurance industry, pharmaceutical drug companies, some hospitals, highly paid medical specialists, medical suppliers and others who now profit handsomely from our current system - and who could no longer command those profits under a single-payer system or an alternative form of a national health plan. Californians, click here for your free health insurance quote now!

The Health Care Reform Reconciliation Bill

March 19, 2010

The House began its last step in the health reform legislative process early in the afternoon of Thursday, March 18, when it released HR 4872, the Health Care and Education Affordability Reconciliation Act of 2010. As this year’s health reform legislation has gone, this is a slender bill, weighing in at 153 pages, of which [...]

New Health Wonk Review Is Up

March 18, 2010

It’s March Madness, and over at the Robert Wood Johnson Foundation’s blog, “The Users’ Guide to the Health Reform Galaxy,” Minna Jung serves up the madness of both the basketball court and the health care reform process in this week’s Health Wonk Review. Copyright © 2010 Health Affairs Blog. This Feed is for personal non-commercial use [...]

CBO Gives Democrats Good News On Health Reform

March 18, 2010

Breaking news this morning provides some cheer for Democrats on health reform. The Congressional Budget Office reportedly will release this afternoon a preliminary analysis of the Senate-passed health reform bill as modified by a separate “reconciliation” measure, and the numbers look favorable for Democrats. According to reports, CBO estimates that the combined package will cost $940 billion over the first [...]

Individual Market Premium Increases: The Debate Continues

March 17, 2010

Editor’s Note: Anthem Blue Cross of California, the largest health insurance company in California, recently announced plans to increase insurance premiums by as much as 39 percent for people insured in their non-group health insurance plans. There are two competing narratives about this dramatic and unprecedented premium increase, wrote Jonathan Kolstad and Neeraj Sood in a [...]

Can Health Care Investments Stimulate the Economy?

March 16, 2010

Editor’s Note: In addition to Dr. Leighton Ku (photo and bio above), the authors of this post include Dr. Peter Shin, an Associate Research Professor and Director of the Geiger Gibson Program in Community Health Policy at the George Washington University School of Public Health and Health Services, and Brian Bruen, a Lead Research Scientist and Lecturer at [...]

HEALTH REFORM: Weekend Forecast

March 19, 2010

Sunny with a chance of ... comprehensive health reform? Steven Pearlstein in this morning's Washington Post predicts a great weekend. Not just because we are finally having nice weather in the nation's capital. Not even because of NCAA basketball. Pearlstein is excited for the same reason we are. We're about to make history. Better health care. A stronger economy. Maybe even a sign of a government that can govern. Read what he has to say: What strikes me about the lead-up to this weekend's health-care vote in the House is how quiet things actually are. If, as Republicans would have us believe, Americans are so up in arms about the prospect of "Obamacare," why aren't there angry hordes marching on the Mall or jamming the halls of the Rayburn Building? If the plan really represents a wholesale government takeover of one-sixth of the economy, why are so many associations representing private doctors, hospitals and drugmakers either supporting the legislation or staying relatively neutral? And if this Democratic version of health reform is such a threat to economic prosperity, why are stocks, bonds and the dollar all rising this week as odds of passage increase? One of the silliest Republican talking points is that Democrats are "ramming health-care reform down the throats of the American people." In fact, we've been talking about it, on and off, for decades, ultimately winding up with a solution that is not only remarkably centrist but also not all that different from the compromise nearly reached between Ted Kennedy and the Nixon White House in the early 1970s. Indeed, although you'd never know it from the overheated rhetoric, the remarkable thing about the final proposal is how little it would change things, at least initially, for most Americans. That's no accident -- in fact, it's by political design. This plan is more like a time-release tablet meant to reform the system slowly from the inside out rather than surgically from the outside in. [...] Over the past year, anyone following the health-care drama has been tempted, at various points, to question the judgment and the leadership of President Obama, his staff and the Democratic leaders in Congress. Should they succeed this weekend, however, there is no disputing that it will be a remarkable political achievement, the result of a combination of focus, determination, flexibility and patience not seen since the early Reagan years. Most of all, enacting health-care reform would be a desperately needed victory for a political system teetering on the verge of breakdown. Years of polarization, partisanship and stalemate have led to a widespread and cynical belief that Washington is simply incapable of solving any major problem. Passing a health-care reform bill would restore not only a measure of trust and confidence in our political process but also, more significantly, trust and confidence in ourselves. Looks like a pretty good forecast to us. Health Policy Program

HEALTH CARE: Reading List for the Ten Minutes This Week You Are Not Focused on the House..

March 18, 2010

(reposting this to fix the Pallimed links..) There are a couple of interesting health articles and studies floating around that we just haven't had time to focus on given all that's happening in DC. We were tempted to deem them read, but instead we'll reconcile ourselves to directing you to some other blogs that have smart things to say. 1) Pallimed, a terrific blog mostly by and for clinicans but accessible to anyone interested in palliative care and hospice, has done a good job of summarizing and interpreting the latest research on palliative care for patients living with -- not just dying from -- cancer. They also discuss why patients with advanced cancers end up in the ER. We were perhaps the first to write a major article in 2008 on palliative care for cancer in the outpatient setting, so the JAMA update was of interest. And our recent post on a cancer patient's unfortunate ER experience has generated a lot of discussion. 2) The Lucian Leape Institute at the National Patient Safety Foundation issued a very critical report on safety and med schools: Medical schools today focus principally on providing students with the knowledge and skills they need for the technical practice of medicine, but often pay inadequate attention to the shaping of student skills, attitudes, and behaviors that will permit them to function safely and as architects of patient safety improvement in the future. Specifically, medical schools are not doing an adequate job of facilitating student understanding of basic knowledge and the development of skills required for the provision of safe patient care, to wit: systems thinking, problem analysis, application of human factors science, communication skills, patient-centered care, teaming concepts and skills, and dealing with feelings of doubt, fear, and uncertainty with respect to medical errors. Maggie Mahar at Healthbeat blog and David Harlow at Healthblawg have more on the med school topic. Maggie addresses the culture of "shame and blame" in medical education, and Harlow notes that it's not enough to give a med student a course on safety, it must become "part of the basic fabric of training a physician, rather than an add-on." Health Policy Program

HEALTH REFORM: Sisterhood is Powerful

March 18, 2010

Michigan Democratic Rep. Bart Stupak says it's been "living hell" leading the fight against Senate abortion language. Wonder how he feels now that he's lost the nuns. The Catholic nuns, in a rare split with the bishops, believe the Senate language does the job -- and they don't want the abortion fight to hold up health reform that would cover 32 million Americans and crack down on insurance company abuses. Just a few days after the Catholic Health Association announced its support of the Senate health bill, a coalition of 59,000 Catholic nuns sent a letter to lawmakers encouraging them to pass the Senate health care bill. The letter was signed by the leaders of more than 50 Catholic women's orders and organizations. “While it is an imperfect measure, it is a crucial next step in realizing health care for all,” the letter reads. “And despite false claims to the contrary, the Senate bill will not provide taxpayer funding for elective abortions. It will uphold longstanding conscience protections and it will make historic new investments -- $250 million -- in support of pregnant women. This is the REAL pro-life stance, and we as Catholics are all for it.” (Read the full text below.) “We as sisters focus on the needs of people,” said Sister Simone Campbell, a spokeswoman for the group. “When people are suffering, we respond.”Retired Bishop John E. McCarthy of Austin agrees. He told the Associated Press on Wednesday that while he strongly opposes abortion, he is confident that the Senate bill would prevent taxpayer dollars from funding them. The church has been fighting for universal coverage for more than 40 years, and the President's bill is as close as the country has ever been to its realization. Lawmakers can improve on the legislation later, he says, "but let's not kill it at this crucial moment."The President deems this "a good sign." The support will hopefully provide the 12 wavering pro-life Democrats with some conciliation. As E.J. Dionne Jr. argued this morning in a Washington Post column, the bishops' opposition to the Senate bill could be deterimental to the reform effort. But fortunately, he explained, "major Catholic leaders -- most of them women in religious orders -- have picked up the flag of social justice ...  I suspect that many bishops would be quietly grateful. In their hearts, they know the nuns are right."Full text:Dear Members of Congress:We write to urge you to cast a life-affirming "yes" vote when the Senate health care bill (H.R. 3590) comes to the floor of the House for a vote as early as this week. We join the Catholic Health Association of the United States (CHA), which represents 1,200 Catholic sponsors, systems, facilities and related organizations, in saying: the time is now for health reform AND the Senate bill is a good way forward.As the heads of major Catholic women's religious order in the United States, we represent 59,000 Catholic Sisters in the United States who respond to needs of people in many ways. Among our other ministries we are responsible for running many of our nation's hospital systems as well as free clinics throughout the country.We have witnessed firsthand the impact of our national health care crisis, particularly its impact on women, children and people who are poor. We see the toll on families who have delayed seeking care due to a lack of health insurance coverage or lack of funds with which to pay high deductibles and co-pays. We have counseled and prayed with men, women and children who have been denied health care coverage by insurance companies. We have witnessed early and avoidable deaths because of delayed medical treatment.The health care bill that has been passed by the Senate and that will be voted on by the House will expand coverage to over 30 million uninsured Americans. While it is an imperfect measure, it is a crucial next step in realizing health care for all. It will invest in preventative care. It will bar insurers from denying coverage based on pre-existing conditions. It will make crucial investments in community health centers that largely serve poor women and children. And despite false claims to the contrary, the Senate bill will not provide taxpayer funding for elective abortions. It will uphold longstanding conscience protections and it will make historic new investments - $250 million - in support of pregnant women. This is the REAL pro-life stance, and we as Catholics are all for it.Congress must act. We are asking every member of our community to contact their congressional representatives this week. In this Lenten time, we have launched nationwide prayer vigils for health care reform. We are praying for those who currently lack health care. We are praying for the nearly 45,000 who will lose their lives this year if Congress fails to act. We are also praying for you and your fellow Members of Congress as you complete your work in the coming days. For us, this health care reform is a faith mandate for life and dignity of all of our people.We urge you to vote "yes" for life by voting yes for health care reform in H.R. 3590. Health Policy Program

HEALTH REFORM: What Comes When

March 18, 2010

Is it too early to say what would happen first if health care reform passes? We don’t think so. Better to be ready for something than to expect nothing, we always say. Understanding that we can’t be absolutely positive that the upcoming reconciliation process won’t change a thing or two, the somethings that will come first are: Insurance reforms: Within 6 months of enactment, elimination of pre-existing condition exclusions for children (and for everyone beginning in 2014, when the Exchanges are operational) Within 6 months of enactment, dependents may remain on their parents’ health insurance policy until age 26No lifetime limits on benefits, restricted use of annual limits and no rescissions $5 billion for high risk pools Re-insurance for employer health plans for early retirees New insurance plans required to offer free preventive care and immunizations without cost-sharing Development of uniform coverage documents will begin immediately to help people compare different insurance policies and creation of an internet portal for better health policy shoppingCreation of an appeals process and consumer advocate for insurance customers For Small Business: Tax credits beginning in 2010Tax credits of up to 35% percent of premiums will be immediately available to firms that choose to offer coverage Medicare Part D changes: If you fall into the Medicare Part D Drug Benefit coverage gap, dubbed the "donut hole," you will receive $250 to help pay for prescriptions in 2010Guarantee 50% price discounts on brand-name drugs purchased by beneficiaries in the coverage gap, beginning in 2011 Regular Medicare changes: Beginning on January 1, 2011, Medicare beneficiaries will receive a free, annual wellness visit and will have cost-sharing waived for certain prevention services. Health Policy Program

HEALTH REFORM: More Reconciliation Details

March 18, 2010

We're still digesting 25 pages of CBO analysis and 150 pages of legislative language, and we can't say we've mastered all the details of the Reconciliation language, but with a little help from our PDF search function and some smart Hill staffers, here's some of what we've learned:Changes in Medicare (particularly stopping overpayment to Medicare Advantage managed care plans) will add at least nine years to the Medicare trust fund.Medicaid will pay more to primary care doctors. As we have noted before, Jonathan Cohn, and Kevin Sack have all written about why this is so important, particularly as the health reform legislation will expand Medicaid.The donut hole (for Medicare patients with high prescription drug costs) will shrink with 50 percent discounts on brand name drugs starting in 2011. Even before that, this year, anyone on Medicare who hits the coverage gap will get a $250 rebate.Coverage will be more affordable for low income people -- (It's in Title I for those of you who want the detailed schedules).Current funding for the State children's Health Program will be maintained through fiscal 2015.Delays the "Cadillac tax" on high cost insurance plans until 2018 and raises the threshold ($10,200 for individual plans, $27,500 for families).The Nebraska "Cornhusker" deal, as expected is gone. As is the special break for Florida Medicare Advantage.Adult children (up to age 26) can stay on their parents' health insurance policy. (They don't have to wait until 2014 for this. They can't be on parents' plan if they have an option of getting coverage through their job.)Consumer protections (no discriminating on pre-existing conditions, caps. etc) will apply to group plans as well as plans offered in the new exchanges. The Senate bill had grandfathered the group plans (where some of these practices aren't as common as in the individual and small group market.)We haven't found any new language about alternative dispute resolution in medical malpractice -- even though President Obama has voiced support. Probably didn't fit into the strict reconciliation-deficit reduction rules. Also not included (because of the reconciliation rules) is Sen. Dianne Feinstein's idea about expanded federal review of insurance premium increases and Sen. Tom Coburn's super-popular idea about "mystery patients" aiming to detect medical fraud. We expect that these ideas may re-emerge in other legislative contexts in the future. Health Policy Program

Highlights from the Reconciliation Bill, and Maggie’s Comments on the Changes

March 19, 2010

Overall, the changes in the reconciliation bill will make the Senate bill more progressive—and fairer. My prediction: the bill will pass. Those who oppose universal coverage are becoming angrier, louder, more abusive, and more frantic. This is because they realize...

"Medicalizing" Life

March 17, 2010

How much medical care do we want in our lives? H. Gilbert Welch poses this question in his excellent op-ed piece for the LA Times entitled, “The Medicalization of Life” and tells us that the answer will be vitally important...

The Top Ten Immediate Benefits Americans Will Receive When Health Care Reform Passes

March 17, 2010

Today, the Democratic Caucus of the House listed the provisions of the health reform bill that will take effect “as soon as health care passes,” The legislation would: Prohibit pre-existing condition exclusions for children in all new plans; Provide immediate...

A Culture of Fear and Intimidation: Reforming Medical Education

March 16, 2010

Even as we set out to reform U.S. health care, we continue to train medical students as if they were going to work in the old, broken system. Today, everything about medical education needs to be re-thought, from how we...

Lots of Bark, Little Bite in State Efforts to Block Health Reform

March 16, 2010

Last week, Virginia became the first state in the nation to pass a law that aims to block the individual mandate for health coverage, a key element of President Obama’s health reform plan. Virginia has a history of defying federal...

MSNBC Giving Medical Advice?

March 19, 2010

Under this heading, “What not to do if you want to avoid the No. 3 killer in the U.S. [strokes],” MSNBC recommends: Not being a Southerner Not being black Not being female Not being unhappy Not being single Hint: There are better places to get medical advice.

Opinions in 35 Swing Congressional Districts

March 19, 2010

Source: The Wall Street Journal.

ObamaCare Insurance Exchange Could Cost States Health Insurance Tax Revenue

March 19, 2010

And some of their revenue to fund Medicaid and State Children’s Health Insurance Programs (SCHIP): Federal reform could cause more people to leave state-regulated private health insurance for…federally regulated private insurance… “This will result in reduced revenues for states charging premium taxes on state-regulated health insurance…” These revenues are most important in Nevada, Hawaii, New Mexico, [...]

The Cost of Daylight Savings, No Sitting Allowed, and One Woman Striving to Weigh 1,000 Pounds

March 19, 2010

The case against daylight savings time. At some British hospitals: No sitting allowed for friends and relatives of patients. Flowers are not allowed either. Woman holds the Guinness World Record as the world’s fattest mother. She is consuming 12,000 calories in a quest to become the world’s fattest woman.

Why Worry About Patient Satisfaction?

March 19, 2010

Studies from both the Annals of Internal Medicine and the British Medical Journal did not find a strong correlation between patient satisfaction and the quality of care. In other words, just because you’re satisfied with your doctor doesn’t necessarily mean he’s a competent physician. Full op-ed on the drawbacks of patient-satisfaction surveys. Can’t Get No Satisfaction

GlaxoSmithKline’s Evolving Business Model: For Profit and For Greater Good?

March 16, 2010

What is the modern business model? GlaxoSmithKline (GSK) CEO Andrew Witty is leading the front on modernizing pharmaceutical multinational companies (MNCs) with his recent announcement for a customized drug pricing scheme for emerging market economies like India. He outlined the new approach clearly in several interviews such as this one: “Our strategy is to grow our business [...]

Community Programming, the Final Frontier: Going Where No World Bank Evaluation Has Gone Before

March 4, 2010

On February 8th, the World Bank released a two-page summary of an evaluation underway to identify the effectiveness of the Community Initiatives component of the World Bank MAP, and how, if at all, it adds value to the national response. The evaluation—conducted in collaboration with DFID and the UK NGO AIDS Consortium—hopes to garner enough [...]

Death Toll from Haiti’s Earthquake in Perspective

Feb. 19, 2010

This is a joint post with Owen McCarthy. The January 12th earthquake in Haiti is the most lethal natural disaster of the past 20 years. On February 12th, the Associated Press reported that official Haitian government estimates of the dead had been revised upwards, now reaching 230,000 dead. Furthermore, the number could be much higher, since the [...]

FDA Goes Global: A New Approach to Food and Drug Import Safety

Feb. 12, 2010

Last week, I participated in an event at the Center for Strategic and International Studies (CSIS) in which U.S. Food and Drug Administration (FDA) Commissioner Margaret Hamburg announced a remarkable shift in the FDA’s thinking on food and drug import safety. If adequately supported by Congress and translated into concrete action, this change in strategy [...]

Daddy Healthbucks: How Will the Gates Foundation Leverage the New $10 Billion for Vaccines and Immunization?

Feb. 9, 2010

In announcing a $10 billion, decade-long commitment for vaccine development and immunization in poor countries, Bill Gates made no claims that the vaccine financing challenges are solved. Quite the contrary. He and many others have highlighted the need for other donors, industry and developing country governments to up their own ante to immunization. [...]

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