News In Healthcare

Pres­i­dent Obama and Con­gress entered marathon nego­ti­a­tions over health reform bills on this day in 2010. Hope­fully those efforts weren’t for noth­ing. More to come on the sta­tus of Health Care Reform as we get closer to the US Supreme Court review­ing the mat­ter in March.

We are about 2 months away to the US Supreme Court hear­ing argu­ments on the con­sti­tu­tion­al­ity of the fed­eral health law. To help keep track of the briefs filed, the news reports and the analy­sis of the argu­ments, Kaiser Health News has put together a site to help us all keep score. If you want to fol­low the case, this site is def­i­nitely worth check­ing out.

In a let­ter to Health and Human Ser­vices Sec­re­tary Kath­leen Sebe­lius, Karen Ignagni head of America’s Health Insur­ance Plans and the nation’s top health insur­ance indus­try offi­cial, said that the indus­try will fully com­ply with new reg­u­la­tions pre­vent­ing cov­er­age denials for chil­dren with pre-existing con­di­tions.  The reg­u­la­tions are expected to be issued within the next few weeks.

It is trou­bling that Ms. Ignagni was in a posi­tion where she had say to the fed­eral gov­ern­ment that the health insur­ance indus­try will fol­low the rules and not cause prob­lems.  How­ever it is believ­able that this was required given the recent actions by health plans to hap­haz­ardly rescind cov­er­age based upon pre-existing conditions.

In a recent blog post, Sen­a­tor Mike Enzi spoke out about Sen­ate Bill 625, oth­er­wise known as the Fam­ily Pre­ven­tion and Tobacco Con­trol Act.  In a nut­shell, he is not a sup­porter of a bill that gives the pub­lic the per­cep­tion that tobacco prod­ucts have been reviewed and approved by the FDA.   Although cer­tain changes have been made to the lan­guage of the leg­is­la­tion, remov­ing the FDA approval process and replac­ing it with merely an approval to be mar­keted, the bill still does not have the goal of get­ting peo­ple to stop smok­ing.  Sen­a­tor Enzi got it right when he said, “Tobacco is one of the biggest con­trib­u­tors to our nation’s grow­ing health care cri­sis.  We need to address this issue head on, not sign a peace treaty with the com­pa­nies who per­pet­u­ate and profit from the cri­sis.”  The bill is cur­rently pend­ing before the Sen­ate Com­mit­tee on Health, Edu­ca­tion, Labor and Pen­sions (HELP).

The fed­eral lit­i­ga­tion attack on not-for-profit hos­pi­tals might have ended in case dis­missals but that didn’t mean that the IRS didn’t pick up on the tax-exempt sta­tus issue.  In a recent news release,  the IRS sum­ma­rized its find­ings from a sur­vey con­ducted in 2006 of almost 500 tax-exempt hos­pi­tals.  In a nut­shell, the IRS found that there is no con­sis­tent def­i­n­i­tion of “uncom­pen­sated care” across all hos­pi­tals and there is no con­sis­tency of how the uncom­pen­sated care is reported.  One rec­om­men­da­tion that came out of the report is that a form 990 spe­cific to hos­pi­tals should be drafted.

 You may remem­ber that last sum­mer Sen­a­tor Chuck Grass­ley released find­ings from his own sur­vey of 10 tax-exempt hos­pi­tal sys­tems and found sim­i­lar results as the IRS.  See the Novem­ber 2006 blog entry which details his posi­tion that hos­pi­tals should adopt the Catholic Health­care Association’s stan­dard of report­ing com­mu­nity ben­e­fit to develop some consistency. 

Do you remem­ber 2 years or so ago hear­ing all about the illicit prac­tices of not-for-profit hos­pi­tals and health sys­tems for charg­ing unin­sured patients full price for their health care?  One attor­ney, Richard Scruggs, led the charge in fed­eral court on behalf of the class of unin­sured vic­tims to get the tax-exempt sta­tus of these not-for-profits revoked.  Well, that really didn’t go any­where but there was one hos­pi­tal sys­tem that fell vic­tim at the hands of a local author­ity who took mat­ters into their own hands.  Four years ago, Provena Covenant Med­ical Cen­ter in Illi­nois had their tax-exempt sta­tus revoked by the Cham­paign County Board of Review.  After years of fight­ing the revo­ca­tion, and pay­ing over $6 mil­lion in taxes, the hos­pi­tal has finally won.  Mod­ern Health­care recently reported that a cir­cuit court judge sided with the hos­pi­tal to rein­state its prop­erty tax exemp­tion.  The county has not yet decided to appeal. 

Yes­ter­day, the Sen­ate over­whelm­ingly approved a bill to enhance the author­ity of the Food and Drug Admin­is­tra­tion.  The Hill reports that while there was a week of del­i­cate nego­ti­at­ing, S.1082 passed the Sen­ate with a vote of 93–1.  The one dis­sent­ing vote came from Sen­a­tor Bernie Sanders (I-Vt.) and is really not sur­pris­ing (see yesterday’s blog entry from Sen­a­tor Sanders).  So, what does this poten­tial leg­is­la­tion actu­ally do?  Well, S.1082 will amend the Fed­eral Food, Drug, and Cos­metic Act and the Pub­lic Health Ser­vice Act and require the Depart­ment of Health and Human Ser­vices to affirm the safety of drugs from abroad, grant the FDA the author­ity to require com­pa­nies to track the side effects of their drugs after they reach the mar­ket, and reau­tho­rize a pro­gram through which drug com­pa­nies and med­ical device com­pa­nies pay user fees to the FDA to get their prod­ucts reviewed for approval. 

On Decem­ber 6, 2006, we reported on the ini­tial effects states were feel­ing as a result of the new doc­u­men­ta­tion require­ments for Med­ic­aid enroll­ment man­dated by the Deficit Reduc­tion Act of 2005 (DRA).  The George Wash­ing­ton Uni­ver­sity Depart­ment of Health Pol­icy recently issued a Pol­icy Brief detail­ing the find­ings of a sur­vey of 300 health cen­ters and the impact the doc­u­men­ta­tion require­ments have had on their facil­i­ties.  In brief, the sur­vey found:

 a.  Almost 90% of all health cen­ters reported enroll­ment dif­fi­cul­ties for patients of all ages, includ­ing new­born children;

b.  For those health cen­ters report­ing a decline in their Med­ic­aid pop­u­la­tion, two-thirds of the respon­dents cited the doc­u­men­ta­tion process as the rea­son for the decline;

c.  One-third of the respon­dents have had to increase staff to han­dle the addi­tional admin­is­tra­tive chal­lenges with the appli­ca­tion and enroll­ment process; and

d.  Ini­tial find­ings esti­mate that the doc­u­men­ta­tion require­ments will elim­i­nate Med­ic­aid cov­er­age for between 105,000 to 320,000 pedi­atric and adult patients.

A dis­cus­sion about this Pol­icy Brief was held and is avail­able for view­ing.

Well, read the Senator’s entry on The Hill’s Con­gress Blog and you will find out.   Yes­ter­day, Sen­a­tor Bernie Sanders of Ver­mont com­mented on all of the recent action regard­ing pre­sprip­tion drugs and the power of the phar­ma­ceu­ti­cal indus­try lobby.   In a nut­shell, Sen­a­tor Sanders’ view is “What this debate on pre­scrip­tion drugs is really about is not safety.  It is about the power of the phar­ma­ceu­ti­cal indus­try, which in this city of enor­mously pow­er­ful spe­cial inter­ests stands alone as the most impor­tant, and in my view the greed­i­est lobby in the entire United States of America.” 

We are not talk­ing about Pres­i­den­tial Pri­maries.   New Hamp­shire was the first state in the nation to enact leg­is­la­tion which blocked phar­ma­ceu­ti­cal com­pa­nies access to data that iden­ti­fies physi­cians and other pre­scribers for use in their sales pitches.  The Man­ches­ter Union-Leader reports, how­ever, that the law was struck down last week by a fed­eral judge on the basis that the law vio­lates the First Amend­ment.  The judge said that while the law “attempts to address impor­tant pub­lic pol­icy con­cerns,” because the state was doing so by “adopt[ing] speech restric­tions as their method, courts must sub­ject their efforts to closer scrutiny.”  The New Hamp­shire Attor­ney Gen­eral is review­ing the deci­sion and decid­ing whether the State will appeal.