Saturday, February 13, 2010
Massachusetts now has at least some form of health coverage for most of its citizens. The next step is to try to figure out what to do about the rapid rise of health costs. Jacob Goldstein of the WSJ Health Blog reports that
[t]he latest proposal comes from the state’s governor, Deval Patrick, who yesterday proposed a bill that would give the state the power to review — and, in some cases, reject — rate increases by doctors and hospitals.
Here’s a key paragraph from the bill:
Any contract under which provider payments increase by an amount in excess of the applicable Consumer Price Index for Medical Care Services shall be presumptively disapproved. The division may conduct a hearing on any contract that is presumptively disapproved and will approve or disapprove the contract based on its findings following the hearing.
The bill would also allow the state to prevent health-insurance plans sold to small businesses from raising premiums by more than 1.5 times the rate of medical inflation, and impose a two-year moratorium on lawmakers mandating new health benefits that plans must cover (those mandates drive up costs).
The Boston Globe said reaction “was mixed, with small business groups expressing cautious optimism, insurers saying the measures do not go far enough, and health care providers worrying that smaller hospitals could be disproportionately harmed and that some might have to lay off caregivers.”
Friday, February 12, 2010
A new call for proposals (CFP) from the Robert Wood Johnson Foundation's Public Health Law Research Program (PHLR) has been released today. The CFP is available at www.publichealthlawresearch.org
While PHLR funds studies that mainly focus on the intersection of law and public health, researchers from other disciplines, such as medicine, economics, sociology, psychology, public policy and public administration are encouraged to be part of multi-disciplinary teams of applicants. Research teams that include government agencies, community organizations, and advocacy and policy related groups are especially encouraged to apply.
This year's CFP will have about $3.5 million available for funding studies at two levels. Short-term studies will be funded up to $150,000 each for up to 18 months, while complex and comprehensive legal and public health studies will be funded up to $450,000 each for up to 30 months. The deadline for submitting brief proposals is April 14, 2010.
A press release can be found at:
Thursday, February 11, 2010
Scientists report that they have created a new way of preventing harmful plasticizers such as phthalates -- the source of long-standing human health concerns -- from migrating from one of the most widely used groups of plastics called polyvinyl chloride (PVC) plastics. This new generation of PVC plastics could be safer than those now used in packaging, medical tubing, toys, and other products. According to ScienceDaily
Helmut Reinecke and colleagues note that manufacturers add large amounts of plasticizers to PVC to make it flexible and durable. Plasticizers may account for more than one-third of the weight of some PVC products. Phthalates are the mainstay plasticizers. Unfortunately, they migrate to the surface of the plastic over time and escape into the environment. As a result, PVC plastics become less flexible and durable. In addition, people who come into contact with the plastics face possible health risks. The U.S. Consumer Product Safety Commission in 2009 banned use of several phthalate plasticizers for use in manufacture of toys and child care articles.
The scientists describe development of a way to make phthalate permanently bond, or chemically attach to, the internal structure of PVC so that it will not migrate. Laboratory tests showed that the method completely suppressed the migration of plasticizer to the surface of the plastic. "This approach may open new ways to the preparation of flexible PVC with permanent plasticizer effect and zero migration," the article notes.
The new study is published in the American Chemical Society's bi-weekly journal called Macromolecules at Navarro et al., Phthalate Plasticizers Covalently Bound to PVC: Plasticization with Suppressed Migration.
Wednesday, February 10, 2010
THE CENTER FOR HEALTH LAW STUDIES announces the 22nd Annual Health Law Symposium
Pandemic Preparedness: Lessons Learned & Future Challenges
Friday, March 5, 2010
9:00 a.m. to 4:00 p.m.
Saint Louis University School of Law
William H. Kniep Courtroom
5.9 CLE Credits (MO)
Public health officials and policy makers have focused on "preparedness" since 9/11, and the results of that work were tested during the recent H1N1 outbreak. Are we prepared for the next pandemic? If not, where are the weaknesses of our system? What must we anticipate to be prepared for tomorrow's threats? This symposium will gather leading experts from fields including law, public health, medicine, and ethics to discuss these questions and the evolving state of pandemic preparedness.
Assessing the Impact of Federal Law on State and Local Public Health Preparedness
Benjamin E. Berkman, JD, MPH
Faculty, Department of Bioethics (Clinical Center)
Deputy Director, National Human Genome Research Institute Bioethics Core
The Hidden Epidemic: Assessing the Legal Environment Underlying
Mental and Behavioral Health Preparedness in Public Health Emergencies
James G. Hodge, Jr., JD, LLM
Lincoln Professor of Health Law and Ethics,
Director, Public Health Law & Policy Program
Fellow, Center for the Study of Law, Science, & Technology
ASU Sandra Day O'Connor College of Law
Assessing the Public Health Response During
and After the Emergency: Lessons from the HIV Epidemic
Zita Lazzarini, JD, MPH
Director, Division of Public Health Law and Bioethics
Department of Community Medicine and Health Care
University of Connecticut School of Medicine
Cross-Border Legal Preparedness: A Comparative Review
of Selected Public Health Emergency Legal Authorities in Canada and Mexico
Daniel Stier, JD
Public Health Analyst
Public Health Law Program, Centers for Disease Control
Wendy E. Parmet, JD
Matthews Distinguished University Professor of Law
Northeastern University School of Law
Stewart Simonson, JD
Vice President, Government Affairs, SRA International, Inc.
and former Assistant Secretary for Public Health Emergency Preparedness,
U.S. Department of Health and Human Services
Symposium schedule and registration
call: Mary Ann Jauer (314) 977-3067
The Journal of Food Law & Policy just announced that it is seeking submissions for placement in the Spring 2010 issue, to be published in June 2010. This unanticipated need presents an opportunity for an author to place an article and see it in print in a very short period of time.
Articles may be submitted via email to firstname.lastname@example.org or mailed to:
Journal of Food Law and Policy
University of Arkansas School of Law
107 Waterman Hall
Fayetteville, AR 72701
A special health insurance program for low-income adults in Washington State is set to close later this year, ending coverage for about 65,000 low income people who do not qualify for Medicaid, unless lawmakers come up with $160 million in new funding. This program is not alone. USA Today reports that
[t]he troubled economy is forcing Washington and other states to pare back health insurance programs for low-income people, even as growing joblessness boosts demand for help. Five of six states that use state funds to assist adults not covered by Medicaid are considering cuts, barring new enrollment or raising fees.
The more than 250,000 people in the state programs are adults who don't qualify for the joint federal-state Medicaid program, either because they don't have children or earn more than the tight limits states impose on Medicaid eligibility. They represent a tiny fraction of people who get government health insurance, yet the state programs are often their sole option for coverage.
"They're not offered insurance through their jobs," says Rebecca Kavoussi of the Community Health Network of Washington state, which runs clinics and an insurance plan.
The U.S. Senate passed a health bill that includes some funding for the state programs. That bill and one the House of Representatives passed would also expand Medicaid and offer federal subsidies to help low- and middle-income Americans buy insurance. The fate of the bills is uncertain as Democrats regroup after recently losing a key Senate seat to Republican Scott Brown of Massachusetts.
[t]he state has asked insurers to submit bids for a program that would include coinsurance payments of 30% for inpatient treatment, and pay out a maximum of $75,000 a year ....That may sound like a lot, but people who are really sick or seriously injured can easily run up far higher costs. Current state regulations don’t allow insurers to sell policies like this ....
A few years back, Tennessee put in place a somewhat similar plan with an even lower annual cap ($25,000). As of 2007, the premium was about $150 a month.
Tuesday, February 9, 2010
Annual government projections have U.S. health care spending reaching $2.5 trillion in 2009--up an estimated 5.7 percent since 2008, despite a projected decline in the gross domestic product (GDP) in the same period. Health Affairs explains that, as a result,
health care's share of the economy grew 1.1 percentage points in 2009, to a projected 17.3 percent. This represents the largest one-year increase in GDP share since the federal government began keeping track in 1960.
For 2009 through 2019, health spending is expected to grow at an average annual rate of 6.1 percent--1.7 percentage points faster than GDP, the CMS analysts say. During that time, public spending (7.0 percent average annual growth) is projected to continue increasing faster than private spending (5.2 percent average annual growth). Researchers predict that public payers will be paying for slightly more than half of the health care purchased in the U.S. by 2012, compared to 47 percent in 2008.
The 11-year health care spending projections, prepared annually by economists at the Centers for Medicare and Medicaid Services (CMS), reflect the substantial influence of the economic recession on both public and private health care spending as more Americans lose their private health insurance and as federal and state governments face projected increases in Medicaid enrollment and spending.
Sunday, February 7, 2010
Impact on Insurance Coverage of Decision that Gender Reassignment Surgery is a Deductible Medical Expense?
Hat tip to Paul Caron at Tax Prof Blog for the following story that raises a follow-up question -- what impact will the Tax Court's decision have on health insurance coverage?
In a long-awaited decision, a fractured (8-5-3) Tax Court today ruled in O’Donnabhain v. Commissioner, 134 T.C. No. 4 (Feb. 2, 2010), that male-to-female gender reassignment surgery qualifies as a deductible medical expense under § 213, reversing the IRS's position in Chief Counsel Advice 200603025. The 8-judge majority held that:
- TP's gender identity disorder is a “disease” within the meaning of § 213(d)(1)(A) & (9)(B).
- TP's hormone therapy and sex reassignment surgery were for the treatment of disease within the meaning of § 213(d)(1)(A) & (9)(B), and thus not “cosmetic surgery” excluded from the definition of deductible “medical care” by § 213(d)(9)(A).
- TP's breast augmentation surgery was directed at improving her appearance did not meaningfully promote the proper function of her body or treat disease within the meaning of § 213(d)(9)(B), and thus was “cosmetic surgery” excluded from the definition of deductible “medical care” by § 213(d)(9)(A).
Judge Gale wrote the 69-page majority opinion, joined by Judges Cohen, Colvin. Marvel, Morrison, Paris, Thornton, and Wherry. Judge Halperin (12 pages), Judge Holmes (joined by Judge Goeke) (23 pages), and Judge Goeke (joined by Judge Holmes) (6 pages) wrote separate concurring opinions. Judge Foley (joined by Judges Gustafson, Kroupa, Vasquez, and Wells) (8 pages) and Judge Gustafson (joined by Judges Foley, Kroupa, Vasquez, and Wells) (21 pages) wrote separate opinions concurring in part and dissenting in part.
Prior TaxProf Blog coverage:
- IRS Denies Medical Expense Deduction for Costs of Gender-Reassignment Surgery (Jan. 23, 2006)
- Tax Court to Decide Deductibility of Sex-Change Operation (July 18, 2007)
- IRS: Why Cost of Gender Reassignment Surgery Is Not a Deductible Medical Expense (Oct. 2, 2007)
- Tax Court to Decide Deductibility of Sex-Change Operation (Oct. 2, 2007)
- NPR on Deductibility of Sex-Change Operation (Oct. 17, 2007)
The CMS “five-star” nursing home rating system gives nursing homes participating in Medicare and Medicaid programs a star rating that varies from 1 to 5.
Hat tip to Peter Leibold of the AHLA LTC List who passed the following on from Ric Henry of Pendulum LLC:
[The five star rating system] is derived from three data sources: health survey inspections, quality measures, and the nurse staffing information from the most recent health survey inspection. The tables below show the separate star ratings under each of these domains.
These tables are produced using data files currently available on Nursing Home Compare, and are updated monthly. The latest update is: Jan. 21, 2010.