May 5, 2006
The Washington Post reports that:
Based on nationwide data collected by the National Center for Health Statistics and other sources, the researchers found that from 1994 through 2001, the rate of unplanned pregnancies increased by almost 30 percent for women below the federal poverty line -- now defined as $16,000 annually for a family of three. For women in families comfortably above poverty, the rate of unplanned pregnancies fell by 20 percent during the same period.
The abortion rate also rose among poor women while declining among the more affluent.
"Clearly, something is changing, and it doesn't bode well in terms of unplanned pregnancies and abortions for poor women, in particular," said Heather Boonstra, one of the authors of the report.
Asked what was driving the trends, the authors noted that some state and federal reproductive health programs have been cut or made more restrictive in recent years. State and federal programs have increasingly focused on abstinence rather than contraception, and some analysts have argued that the shift is leading to less use of contraceptives and more unintended pregnancies.
Perhaps now would be the time to realize that the abstinence only programs do not seem to be working too well. [bm]
A Primer on the Insured and Uninsured
Kate Steadman from Healthy Policy will be leaving blogging (hopefully for only a little bit) but with her departure provides us with a helpful primer on the uninsured as well as a follow-up Insured Primer. Here are some of the interesting and rather discouraging facts that she reports in her Insured Primer:
• The average annual cost for insurance in 2004 was $3,695 for individuals and $9,950 for families.
• Employer-sponsored premiums are growing at an immense rate: 8.2% in 2000, 10.9% in 2001, 12.9% in 2002, 13.9% in 2003.
• The number of employers providing health insurance has dropped 9% in five years; from 69% in 2000 to 60% in 2005.
• The dollar amount of co-pays is increasing as well; for HMO participants the number paying at least $20 for office visits has increased from 1% in 1998 to 22% in 2004.
• The major problem with affordable health insurance right now is the total health spending increase, which is making premiums cost more and more every year. And as health expenditures are estimated to be $2.16 trillion in 2006, and are projected to rise to over $4 trillion in 2015, it's showing no signs of slowing. Per person health spending is $7,110 this year and is projected to increase to $12,320 by 2015. And unless you predict your wages will double during that time, be prepared to shell out more and more.
• Although many policy analysts encourage greater cost sharing in the form of higher deductibles and copays, the average insured person already pays 34% of their health costs out of pocket. Don't count on greater cost sharing to reign in the expected increase to solve our spending crisis. Americans can only afford so much more out of pocket without forgoing care altogether, which creates crises in worker productivity and absenteeism.
From in the Uninsured Primer:
• 41% of the uninsured adults reported skipping medical care because of cost last year. This number doesn't include the 20% of children who lack health insurance.
• 23% of uninsured adults report their health as "fair" or "poor," compared with 12% of insured adults.
That percentage will tick higher and higher while we distract ourselves from solving this problem with brave new explorations into the world of Health Savings Accounts. As health costs continue to outpace inflation markedly and wages remain stagnant, fewer and fewer of the uninsured will be able to afford any medical care. State and hospital funds that currently act as reimbursement for the cost of acute treatment will cover less and less.
May 4, 2006
Our Government and Avian Flu
The New York Times reports on our government's latest avian flu program. It states,
The 227-page plan estimates that a third of the population could become infected, two million people could die, 40 percent of employees might be absent from work during the height of the outbreak, and $600 billion in income could be lost nationwide.
If rioting broke out and overwhelmed the National Guard, the plan says, the president could call out the Army to establish order.
Dr. Josh Sharfstein, commissioner of the Baltimore Health Department, said the plan was welcome but offered "new expectations without new resources."
The plan asks local governments to deal with a flood of hospital patients, care for more patients at home and spend millions of dollars on antiviral drugs, Dr. Sharfstein said.
Congress has appropriated $3.8 billion to pay for preparations like drug and vaccine purchases. The Bush administration has spent $1.8 billion of that appropriation, although Ms. Townsend said that all the money would be spent by October.
Senator Tom Harkin, Democrat of Iowa, who advocated preparations for a pandemic, said the administration had been slow in implementing plans and spending money already appropriated.
A bill to provide another $2.3 billion for flu preparations is moving through Congress, and Ms. Townsend said the administration expected to ask for an additional $1 billion in 2008. . . .
Divided into nine chapters, the plan provides a list of actions federal departments must complete as a pandemic spread. . . .
Mary Selecky, secretary of health for Washington, said the administration plan would help her state align its efforts with those of the federal government. . . . .Like her counterparts in other states, she complained that the administration was not helping states to finance flu preparations. "They gave us a list of work that they expect us to do," Ms. Selecky said, "but they've only given us a little bit of one-time money. We need a sustained effort."
Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University, echoed the state officials' complaints, saying: "There's a disconnect between the rhetoric about what's needed and the resources on the table. This is the mother of all unfunded mandates."
Congress Considers Cutting Mammograms and other State Law Health Mandates
The American Cancer Society website has a call to action against proposed Senate Bill 1955 (Health Insurance Marketplace Modernization and Affordability Act of 2005) which would, among other things, extend ERISA's broad preemption to the small group insurance market, currently regulated at the state level. Many of these state insurance laws provide a significant source of patient protection by providing access to such items as mammograms and other essential diagnostic tools.
For more information about this bill, see the text here and some commentary on its impact on diabetes coverage here and here. Many health care providers and state attorneys generals oppose this legislation.
This doesn't look like a very good idea to me. Having these tests covered by insurance would seem to lead to a healthier citizenry, which would save money in the long run. I am not sure how much they cost, but it doesn't seem that coverage for these tests would force the insurance companies into bankrupty. Thanks to firedoglake for the heads up on this legislation. [bm]
May 2, 2006
Cover the Uninsured Week
Kate Steadman, writing at Ezra Klein's blog, reminds us that this is Covered the Uninsured Week, sponsoored by the Robert Wood Johnson Foundation. She posts some great commentary and reminds us to check the website for information on the unsinured and action items for this week. [bm]
Medicare Part D - More Woes
According to an article in USAToday, one out of five of the new enrollees in the Medicare Part D program may pay more for their prescription drugs than they did previously. USAToday reports,
They are poor or near-poor, old, disabled or both. Some have cancer or AIDS, schizophrenia or bipolar disorder, spinal cord injuries or multiple sclerosis. Others have lists of medications as long as the alphabet.
They're paying more for their drugs, perhaps as little as $1 per prescription, but often thousands of dollars a year. Some buy on credit without knowing how they'll pay it off. Others scrimp on food and utilities or rely on the charity of family and friends.
When things get really bad, they space out their pills or injections, risking medical setbacks. They lose weight or swell up or get nauseated. Some wind up in emergency rooms.
They are the people that Medicare's new prescription-drug program has hurt, rather than helped. Most of the program's beneficiaries have saved money since it began Jan. 1. But for others, perhaps about 20%, the much-heralded program has meant higher costs, and in some cases greater pain and more worry. . . .
Before Medicare, 6.4 million of them had drug coverage through Medicaid. Others had state help or free drugs from drug companies. "They had good coverage before this program began," says Ron Pollack of Families USA, a liberal health care advocacy group. Now, "there's a sizeable group that is actually worse off."
This program really isn't working well for the people who apparently needed it the most. Something tells me Congress won't be revisiting this anytime soon to help with these issues. Thanks to FirstDraft for the heads up on on this article. [bm]
AHA, Charity Care, and Community Benefit
As reported by Modern Healthcare today, the AHA board on Saturday approved charity-care guidelines for hospitals:
According to the criteria, hospitals must publicize financial-aid policies and provide free care to uninsured patients earning less than 100% of the federal poverty level. For patients earning from 100% to 200% of the poverty level, hospitals should bill no more than 125% of the Medicare rate or the price paid by public or private insurers.
The trade journal also reports that the AHA board addressed "'community benefit spending,' an umbrella term used to describe various activities from free and discounted care to public health education":
The association called for hospitals to undertake a periodic community-needs assessment; assign an employee to oversee community benefit plans; use benefit guidelines jointly drafted by the CHA [Catholic Health Association] and hospital alliance VHA [Voluntary Hospital Association]; and include the total with yearly Internal Revenue Service filings.
The AHA's outgoing president has written a letter to Sen. Charles Grassley (R-Iowa) in which he asked "for legislation to exempt hospitals from class-action lawsuits over uninsured care if the hospitals' charity-care policies meet or exceed criteria that was approved by the AHA board April 29." [tm]
May 1, 2006
Former Head of FDA Faces Criminal Investigation
So now we know why Dr. Crawford left his job at the FDA so suddenly. He is currently under criminal investigation by a federal grand jury for alleged financial improprieties and false statements to Congress. According to the New York Times, the timeline is as follows:
Dr. Crawford resigned in September, fewer than three months after the Senate confirmed him. He said then that it was time for someone else to lead the agency.
The next month, financial disclosure forms released by the Department of Health and Human Services showed that in 2004 either Dr. Crawford or his wife, Catherine, had sold shares in companies regulated by the agency when he was its deputy commissioner and acting commissioner. He has since joined a Washington lobbying firm, Policy Directions Inc.
The criminal investigation was disclosed at a court hearing in a lawsuit over the F.D.A.'s actions on the emergency contraceptive Plan B, a subject of bitter contention during Dr. Crawford's tenure as acting commissioner and commissioner. After the pill's maker, Barr Laboratories, applied three years ago to sell the pill over the counter, the agency repeatedly delayed making a decision on the application. . . .
An advocacy group, the Center for Reproductive Rights, sued the agency in federal court in New York over the delays. Many such suits are quickly dismissed, but a federal judge allowed the case to proceed, giving the center the right to interview top F.D.A. officials, including Dr. Crawford.
Dr. Crawford was scheduled to be questioned under oath on Thursday, but on Wednesday Ms. Van Gelder, who is his personal lawyer, asked for a delay, saying she would instruct him to invoke his Fifth Amendment rights. Dr. Crawford previously declined to answer questions from the Government Accountability Office about Plan B.
Ms. Van Gelder told Magistrate Judge Viktor V. Pohorelsky of the District Court for the Eastern District of New York on Thursday that Dr. Crawford had been represented by Justice Department lawyers in the reproductive rights center's suit.
According to the transcript, she said that Dr. Crawford was under criminal investigation and that the issue of his financial disclosures "is within the grand jury."
Should be an interesting case to watch! [bm]
AHA Issues Plan for Greater Pricing Transparency
Presumably in response to hearings in the House and the Senate, not to mention the class action suits filed all around the country over the last two years, the American Hospital Association has announced a plan to move the industry toward greater transparency in its pricing practices. Here's the blurb from this morning's Modern Healthcare Alert:
The American Hospital Association proposed a series of steps to make hospital prices more transparent. The plan includes federal requirements that states work with hospital associations to expand current efforts to publish hospital charges and that states work with insurers to make information on enrollees' out-of-pocket costs available to consumers before medical visits. In addition, the AHA proposed that the federal government lead a research effort to understand what pricing information consumers want and that the hospital industry work to create consumer-friendly language for the terms, definitions and explanations that are common on hospital bills. The AHA released the proposal at its annual membership meeting in Washington, saying it was ready to work with legislators to foster more "knowledgeable and empowered consumers."
Presumably something on this will appear soon in the AHA's Press Room. [tm]