HealthLawProf Blog

Doctors, Insurers and Business React to Senate Bill

The Wall Sreet Journal's Health Blog provides comments on H.R. 3590, The Patient Protection and Affordable Care Act, from key interest groups, including those which represent doctors, insurers and business. "The short version: The AMA, drug industry and AARP backed the bill; health insurers and the Chamber of Commerce did not."

AHIP, the health insurance trade group:

Health plans support legislative changes that would provide guaranteed access to all Americans, with no pre-existing condition limitations and no health-status-based premiums. … At the same time, specific provisions in this legislation will increase, rather than decrease, health care costs; reduce coverage options; and disrupt existing coverage for families, seniors and small businesses – particularly between now and when the legislation is fully implemented in 2014.

AMA:

The AMA supported passage of the bill because it contains a number of key improvements for our health care system, which currently is not working for far too many patients or the physicians who dedicate their lives to patient care. Important issues that need to be resolved in the House-Senate conference committee include the scope, authority, accountability and transparency of a payment advisory board. The details of several cost control and quality improvement initiatives also need to be refined so that they do not have unintended consequences for patients and physicians. (full statement)

PhRMA, the drug industry trade group:

In the final analysis, we believe the Senate bill provides the best blueprint for reform. It offers the kind of change that will benefit patients today without putting medical progress at risk in the future. Today, we believe the Senate voted with America’s best interests and future in mind. (full statement)

AdvaMed, the medical device trade group:

The tax on medical devices and diagnostics present significant challenges for our industry, but we are committed to working constructively on a number of important refinements to implementation. These include a start date of 2013 to allow companies reasonable time to prepare for the tax, protections for small companies, and ensuring that the tax is deductible.

AARP:

The bill passed by the Senate makes needed progress to prevent coverage denials due to health status and limit insurance companies from charging older Americans much more for coverage because of their age. It also begins to close the dangerous gap in Medicare drug coverage known as the doughnut hole, and Senate leaders have committed that a final bill will close the gap entirely by 2019, in keeping with the President’s pledge. (full statement)

U.S. Chamber of Commerce:

The business community has been consistent in calling for health care reform, but the bill that was passed by the Senate today is counterproductive, does little to lower the cost of health care, and it is not reform. It implements crippling new taxes, and hurts our ability to create jobs at the worst possible time for the economy. (full statement) 

Christmas Cholesterol Epiphany: 'Myrrh' May Have Cholesterol-Lowering Properties

The "myrrh" of the Christmas story may have cholesteral lowering properties. "Myrrh" is a resin that comes from certain trees in the middle east. According to a recent ScienceDaily story "research published in the Journal Food Safety, Nutrition and Public Health discusses the hypocholesterolemic effects of myrrh and other plant products."

Myrrh is a rust-coloured resin obtained from several species of Commiphora and Balsamodendron tree, native to the Middle East and Ethiopia. It is perhaps best known as one of the gifts of the Magi offered to the infant Jesus, along with gold and frankincense. At the time, myrrh was revered as an embalming ointment and is also an ingredient in incense. Nadia Saleh Al-Amoudi of the Department of Nutrition and Food Science, at the King Abd Al-Aziz University, in Jeddah, Kingdom of Saudi Arabia, explains that myrrh is known to have medicinal properties, including antibacterial and anti-inflammatory effects.

Al-Amoudi also points out that myrrh has been used in a wide range of traditional remedies over the centuries as a mouthwash, for treating sore threats, bronchial congestion, as well as an antiseptic astringent, for soothing cuts and burns, and for various other less well-convincing purposes, such as calming emotions.

Al-Amoudi has now investigated the potential of myrrh together with other plant materials to see whether they have any demonstrable hypocholesterolemic effect. Esparto grass leaves, halfa, fenugreek seed powder, myrrh resin (from Commiphara myrrh) and various blends of each were tested on laboratory rodents with high cholesterol. She fed the animals various combinations of the plants as part of their normal daily diet and measured blood concentrations of total cholesterol, LDL (low-density lipoprotein) and VLDL (very-low-density lipoprotein), together with TG (triglycerides). She also recorded HDL (high-density lipoprotein).

The concentrations of LDL (known colloquially as "bad cholesterol"), VLDL, and TG all decreased on this diet, while the HDL levels, so-called "good cholesterol" fell.

Senate Passes H.R. 3590, Patient Protection and Affordable Care Act, by a 60-39 Vote

As reported by Joe Hodnicki over at Law Librarian Blog:

The health care reform bill was passed in the Senate [yesterday] and sent to conference with the House. All 39 Republicans who were present voted "no." See Donny Shaw's report on OpenCongress and for more information including the full text of the bill, news and blog coverage visit the OpenCongress H.R. 3590, Patient Protection and Affordable Care Act page.

American Health Lawyers Association Launches New Web Site Covering Health Care Reform

Hat tip to Ed Richards for calling attention to the launch by the American Health Lawyers Association (“AHLA”) of a new web page called Health Care Reform Essentials. The goal of this new web site is to provide a “one-stop” source for the latest news on health care reform with analysis and comment from its members. The AHLA has a mission to serve as an educational resource and foster dialogue on key issues affecting the health law community. 

Surveys Show More Pandemic Flu Vacccine Available But Fewer Takers

In spite of the growing amount of H1N1 vaccine becoming available, two surveys indicate that over one-half of American adults report that they are not interested in becoming vaccinated. In addition, many parents will not be getting their children vaccinated. According to a Washington Post story by David Brown

[a]s of this week, 111 million doses of vaccine against the pandemic strain of H1N1 flu have been released to states and cities. Not all of it has been used. There have been no unusual or unexpected vaccine side effects reported.

As of Dec. 12, 11 states reported "widespread" flu activity (as measured by office visits, hospitalizations and other indicators), down from 14 the week before. During the last two weeks of October, in comparison, 48 states reported widespread activity. Speaking to reporters, Anne Schuchat, director of the Centers for Disease Control and Prevention's National Center for Immunization and Respiratory Diseases, urged people to get vaccinated even though the flu outbreak is waning in many places. "There are a lot of unknowns, but the one thing we do know is that getting vaccinated will reduce the chance of you getting sick, and reduce the chance of the country going through a third wave" of H1N1 spread, she said.

A survey done a week ago by researchers at the Harvard School of Public Health found that 38 percent of children and 22 percent of adults who are pregnant, chronically ill or caring for young infants had gotten the vaccine. Both groups are in the "high priority" category established by the CDC. About 44 percent of high-priority adults, and 55 percent of all adults, said they did not intend to get the vaccine. About 35 percent of parents said they would not get it for their children. About 60 percent of parents cited the vaccine's safety as their main concern. Among high-priority adults, 38 percent mentioned safety as the reason they would pass on flu shots, with the belief they were not at risk or that the infection was less serious than anticipated as the main reason.

People who wanted the vaccine, however, were having an easier time finding it. In a survey taken at the start of November, only one-third of parents seeking vaccine for a child found it. In mid-December, three-quarters of parents who sought vaccine found it. As of last week, slightly more than half of adults seeking vaccination got it.

U.S. Food Safety System In Serious Disrepair

More than 50% of food manufacturers are unaware of their legal obligation to provide the FDA with updated contact information that the FDA relies on to deal with emergencies, such as Salmonella or other forms of food contamination. According to a Report released yesterday by The Department of Health and Human Services, Office of Inspector General, federal auditors found that approximately 48% of surveyed manufacturers failed to provide the FDA with accurate contact information and approximately 25% provided no emergency contact information at all.

The GAO Report explains:

Each year, more than 300,000 Americans are hospitalized and 5,000 die after consuming contaminated foods and beverages. In the event of an outbreak of a foodborne illness, FDA is responsible for finding the source of the contamination and helping to remove the contaminated food products from the food supply chain. Recent outbreaks of foodborne illness involving peanut butter, peppers, and spinach have raised serious questions about FDA’s ability to protect the Nation’s food supply.

The Public Health Security and Bioterrorism Preparedness and Response Act of 2002 requires certain food facilities to register with FDA. The purpose of registration is to provide FDA with sufficient and reliable information about food facilities. This information enables FDA to quickly locate facilities during an outbreak of foodborne illness and to locate these facilities for inspection.

FDA requires each domestic food facility to provide information for the registry, including (1) contact information (i.e., name, full address, telephone number, and all trade names under which the facility conducts business); (2) contact information for the parent company; (3) contact information for the owner or operator of the facility; and (4) an emergency contact telephone number. If there is a change in a facility’s information, such as a new name or address, the facility must provide FDA with the updated information within 60 days. The information provided by facilities is stored in a database called the FDA Unified Registration and Listing System .....

Hat tip: Bill Marler at Marler Blog.

Senate Stalled Over Drug Importation Proposal

A bipartisan proposal to allow the importation of less expensive drugs from Canada (and some other countries) has stalled the Senate debate over health care reform. A story in the New York Times by Robert Pear reports that approval of the proposal could destroy a deal between the White House and the pharmaceutical industry to lower drug costs:

The industry, represented by the Pharmaceutical Research and Manufacturers of America, or PhRMA, adamantly opposes legalizing additional imports and says the government could not guarantee the safety of imported medicines.

As members of Congress before last year’s election, President Obama and his chief of staff, Rahm Emanuel, supported efforts to allow drug imports. But now the Obama administration, like pharmaceutical companies and the Bush administration, is raising safety concerns.

The chief sponsor of the proposal, Senator Byron L. Dorgan, Democrat of North Dakota, said: “People are walking on eggshells. If we pass legislation allowing people freedom to import drugs, the pharmaceutical industry might not support the health care bill.”

***

In a letter to the Senate, Dr. Margaret A. Hamburg, the commissioner of food and drugs, expressed concern that imported drugs might be contaminated or counterfeit because the Food and Drug Administration “does not have clear authority over foreign supply chains.”
The Congressional Budget Office estimated that Mr. Dorgan’s amendment would save the federal government $19.4 billion over the next decade, because federal programs would spend less on medications.

'U.S. consumers are charged the highest prices in the world for drugs that sell for a fraction of the price in most other countries,' Mr. Dorgan said. “My amendment includes strong safeguards to prohibit drug counterfeiting and other practices that would put the consumer at risk. It applies only to F.D.A.-approved prescription drugs produced in F.D.A.-approved plants from countries with comparable safety standards.”

Controlling Individual Food Choices Of Those Who Are Dependant On Food Stamps

Dependence on government food stamps in the United States is soaring, according to a recent New York Times article. As more are relying on food stamps, the article reports, the stigma associated with food stamp use is fading.

The reality is that reliance on food stamps opens the door to judgments about individual food choices. In the running series Room for Debate, the Editors of the New York Times have collected a series of opinions from several different points of view in an article entitled Food Stamps: The Economics of Eating Well.  

If people buy fresh vegetables or other relatively expensive though nutritious foods, they are considered to be living high on the hog at the taxpayers’ expense. But if they buy cheap foods like hot dogs they are criticized for poor health habits.

Despite these common complaints, does the system work? Are the current rules fair in regulating what people can buy and not buy? Or should the requirements be changed? Should un-nutritious products like soda be banned? Is there a better way to distribute free food and promote nutrition in this country?

• Tom Laskawy, food policy blogger
• Caryn Sweeney, “A Mile in Another’s Shoes” blog
• Adam Drewnowski , obesity researcher, University of Washington
• Julie Guthman, University of California Santa Cruz
• Marion Nestle, author of “Food Politics”
• Christopher Greenslate, author of “On a Dollar a Day”

Medicare Expansion An Alternative To Public Option?

Under a proposal being considered by Senate Democrats, people 55 to 64 will be allowed to buy insurance at subsidized rates under an expansion of the Medicare and Medicaid program. This proposal is part of an alternative to a government-run insurance plan. See The Wall Street Journal, Bloomberg, The New York Times, Yahoo!/The Associated Press, CNN, USA TODAY, The Politico (Washington).

'Cadillac Tax' Could Result in Employers Cutting Health Insurance Benefits

A new survey by the Mercer Group suggests that the 'Cadillac tax' proposed in the Senate Democrats’ health care bill could trigger many employers to cut health care benefits. According to Kaiser Health News, "[t]wo-thirds of employers would raise deductibles, change insurers or scale back coverage to avoid the so-called Cadillac tax on high-cost benefits ...."

The excise tax —which is placed on insurers, but is expected to be passed along to employers — could hit up to 19 percent of medical packages offered by employers in 2013, the first year it goes into effect, according to a separate Mercer analysis of data from 3,000 firms. Whether an employer’s benefits are subject to the tax depends on the combined cost of all medical benefits, including health, dental, vision and other benefits, such as worker and employer contributions to flexible spending or health savings accounts. Workers and employers can put pre-tax money into health savings accounts, helping cover deductibles, for example. If the combined total of all benefits exceeds annual thresholds of $8,500 for individuals or $23,000 for families, the difference would be subject to a 40 percent excise tax.

The Mercer survey (.pdf) of 465 employers – a nonscientific sample – also found that of the 63 percent who would make changes to avoid the tax:

-- 75 percent would raise deductibles or copayments to bring down premium costs.
-- 40 percent would add a lower cost health plan as an alternative.
-- 19 percent would terminate employer contributions to health or flexible savings accounts.

While employers aren’t yet changing benefits in response to the proposal, analysts say, the excise tax is one of their main concerns.

[KVT]