HealthLawProf Blog

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]

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]