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STEM CELLS: House To Consider Research Legislation
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The House later this week plans to vote on a measure (HR 3, S 5) -- called the Stem Cell Research Enhancement Act of 2007 -- that would expand federal funding for human embryonic stem cell research, CQ HealthBeat reports (Reichard/Wayne, CQ HealthBeat, 1/8). Federal funding for embryonic stem cell research is allowed only for research using embryonic stem cell lines created on or before Aug. 9, 2001, under a policy announced by President Bush on that date. Bush in July 2006 vetoed the Stem Cell Research Enhancement Act of 2005 (HR 810), which would have expanded stem cell lines that are eligible for federal funding and allowed funding for research using stem cells derived from embryos originally created for fertility treatments and willingly donated by patients (American Health Line, 11/10/06). The House and Senate versions of the Stem Cell Research Enhancement Act of 2007 are the same as the bill Bush vetoed, Reuters reports (Fox, Reuters, 1/8). The Senate is expected to consider the legislation in a few weeks. According to the AP/ABC News, Bush is "all but certain" to veto the measure again if it is passed by Congress. "I think we may be close to or at an ability to override the veto in the Senate," Rep. Diana DeGette (D-Colo.), sponsor of the legislation, said.
Effect of Amniotic Stem Cell Study
According to the AP/ABC News, opponents of embryonic stem cell research have been "bolstered" by a study published in the Jan. 7 online edition of the journal Nature Biotechnology that found that stem cells derived from human amniotic fluid appear to offer many of the same benefits of embryonic stem cells -- including the ability to grow into brain, muscle, bone and other tissues (Kellman, AP/ABC News, 1/9). "This discovery provides great promise for both the future of medical research and the protection of unborn human embryos and may provide the basis for a consensus approach on the challenging issue of stem cell research," House Minority Leader John Boehner (R-Ohio), said in a statement Monday, adding, "In light of this breakthrough, I urge the Democratic leadership of the House to reconsider its decision to force stem cell legislation to a vote this week without hearings or committee debate" (CQ HealthBeat, 1/8). Sen. Tom Harkin (D-Iowa), sponsor of the Senate version of the Cell Research Enhancement Act, said the new study "offers no evidence that amniotic stem cells have as much potential as embryonic stem cells to differentiate into all other cells in the human body" (AP/ABC News, 1/9). The measure's House co-sponsors, Reps. DeGette and Michael Castle (R-Del.), on Monday distributed a letter to colleagues that said, "While this research is very exciting, it is critical to remember every type of stem cell is different" (CQ HealthBeat, 1/8). DeGette said, "People who were already opposed to the bill will simply use this as an excuse," adding, "I don't think we'll lose any votes because of this." White House spokesperson Tony Snow on Monday said, "The vast majority of breakthroughs right now, virtually all, have involved those other than embryonic stem cells. And the president certainly supports continued research along those lines" (Reuters, 1/8).
Broadcast Coverage
PBS' "NewsHour With Jim Lehrer" on Monday interviewed Anthony Atala, senior author of the Nature Biotechnology study and director of Institute for Regenerative Medicine at Wake Forest University (Ifill, "NewsHour With Jim Lehrer," PBS, 1/8). The complete segment is available online in RealPlayer. The complete transcript is available online.
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MEDICARE: Provisions Will Increase Payments to Rural, Urban Hospitals
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Rural and urban hospitals are expected to receive millions of dollars in additional funding in fiscal year 2006 under provisions of the 2003 Medicare law involving prospective payment system reimbursements for inpatient care, according to a Medicare Payment Advisory Committee report, CQ HealthBeat reports. Under the system, hospitals receive a flat payment per Medicare inpatient admission. The report, which analyzes provisions of the Medicare law, found that in FY 2006, payments to rural hospitals are expected to increase by 2.3%, or $377 million, and payments to urban hospitals are expected to increase by 0.7%, or $774 million. MedPAC also found that Medicare will spend about $571 million per year to bring the standardized amount paid to rural and small urban hospitals in line with the amount paid to large urban hospitals. According to the report, other expected Medicare spending increases resulting from the law include the following:
- $314 million per year to lower the labor share from 69.7% to 62% for hospitals with a wage index of less than 1.0;
- $233 million per year to increase disproportionate share payments for rural hospitals and urban hospitals that have fewer than 100 beds. Caps on disproportionate payments will increase from 5.25% to 12% for such hospitals under the law; and
- About $50 million to extend the outpatient "hold harmless" provision for small rural and sole community hospitals for two years.
The report found that based on past experiences, the increases in hospital revenue could be followed by increases in hospital spending, but it is "too soon to determine the magnitude of any change." The report also found that the "magnitude of any change in costs is likely to be small for most hospitals" (Carey, CQ HealthBeat, 1/8). The report is available online. Note: You must have Adobe Acrobat Reader to view the document.
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CDC: Unable To Distribute Educational Brochures, Pamphlets
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Millions of educational brochures and pamphlets that CDC distributes nationally to health departments and the public remain "locked away and in limbo" after a warehouse contractor ended operations over financial problems, the Atlanta Journal-Constitution reports. MCRB Service Bureau on Dec. 29, 2006, closed a warehouse in Elkridge, Md., a move that left CDC unable to distribute brochures and pamphlets on 800 health issues. In November 2006, the warehouse handled 9,150 orders for 490,000 individual brochures and pamphlets, according to MCRB. CDC has told individuals who seek to order brochures through the agency Web site or by telephone that they cannot place orders for at least two weeks. Officials for MCRB informed CDC on Dec. 26, 2006, that the company would end operations on Dec. 29. CDC had hoped that by Wednesday MCRB would reach an agreement to sell the warehouse, but the agency late Monday learned of a possible delay in the sale. Judith Aguilar, acting director of division of health information dissemination at CDC, said that the agency will implement an emergency plan to have a different contractor temporarily distribute the brochures and pamphlets. The delay in distribution of the brochures and pamphlets likely will last a few weeks, CDC officials said. CDC spokesman Tom Skinner said, "We're taking this seriously and want to move as quickly as we can to remedy this situation" (Young, Atlanta Journal-Constitution, 1/9).
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FDA: Approves MedImmune's Refrigerated Version of FluMist
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FDA has approved MedImmune's new refrigerated formulation of FluMist, a nasal spray flu vaccine for healthy children and adults between ages five and 49, Dow Jones reports. The version will be available for the 2007-2008 flu season (Park, Dow Jones, 1/8). The new formulation should allow for greater use in locations such as schools, pharmacies and grocery stores, where storage limitations made the original version of FluMist, which had to be frozen, difficult to stock (AP/Miami Herald, 1/8). Frank Malinoski, senior vice president of medical and scientific affairs at MedImmune, said, "We recognize that the frozen storage presented difficulties, ... and we are confident that this improvement will enhance access to this important vaccine" (CQ HealthBeat, 1/8). MedImmune also is seeking FDA approval for the vaccine to be administered to children between the ages one and five without a history of wheezing or asthma, which would further expand its market (Bishop, Baltimore Sun, 1/9). In an effort to gain approval for younger children, MedImmune last year released to federal regulators the results of a study indicating that FluMist is 55% better than the standard flu shot at preventing infections among children younger than five. In addition, the company contends that the nasal spray is a better alternative to the flu shot for young children who can be averse to needles (Rosenwald, Washington Post, 1/9). MedImmune also is hoping to eventually distribute the vaccine to adults age 50 and older but has not gathered significant evidence to support the effectiveness of the vaccine among this age group. Such obstacles have kept FluMist sales low in comparison to its injectable counterpart (Baltimore Sun, 1/9). Biotechnology analyst Phil Nadeau of Cowen said, "In order for this to be a meaningful product for the company, they need to expand the label and get it out of the freezer. This is a step in the right direction" (Washington Post, 1/9).
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HEALTH CARE SPENDING: Growth Slows for Third Consecutive Year
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U.S. health care spending increased 6.9% in 2005, marking the third consecutive year that the growth rate declined, according to an annual government report published in the January/February issue of Health Affairs, the New York Times reports. The growth rate was the lowest reported since 1999 (Pear, New York Times, 1/9). The health spending growth rate in 2004 was 7.2% (Alonso-Zaldivar, Los Angeles Times, 1/9). The report, prepared by the CMS Office of the Actuary, states, "This might be an encouraging sign for the individuals, businesses and governments that finance health care; however, it is unclear whether this ... is temporary or indicative of a long-term trend" (Appleby, USA Today, 1/9). According to the report, the U.S. spent $1.988 trillion, or $6,697 per person, on health care in 2005. State and federal governments paid about 40% of health care costs, totaling $736.3 billion (Zhang, Wall Street Journal, 1/9). Though the rate of growth in health spending slowed, it continued to rise more quickly than the economy as a whole, wages, and general inflation (Los Angeles Times, 1/9). Health spending accounted for 16% of the gross domestic product in 2005, up from 15.9% the previous year. Public-sector spending on health care increased 7.8% in 2005, compared with a 7% growth rate for businesses and a 6.2% increase for households, according to the report (Zhang, Wall Street Journal, 1/9).
Prescription Drug Costs
A slowdown in prescription drug spending growth was the largest reason for the lower overall growth rate during 2005, according to the report (Krasner, Boston Globe, 1/9). Spending on prescription drugs increased 5.8% in 2005, marking the first time since 1993 that drug spending grew more slowly than overall health care costs. The drug spending growth rate has declined each year since 1999, when it peaked at 18.2%. Drug spending totaled $200.7 billion in 2005, representing 10 cents of every dollar spent on health care (New York Times, 1/9). Health insurers have slowed the growth of drug spending with tiered plans that have patients pay larger copayments for brand-name drugs than generic drugs, the Globe reports. Separate insurance efforts have encouraged the use of less expensive drugs, with more expensive drugs being used only when cheaper products are ineffective (Boston Globe, 1/9). Medicaid spending on prescription drugs increased 2.8% in 2005, coming after an average annual increase of 15.4% from 1994 through 2004, according to HHS economist Aaron Catlin, the principal author of the report. Catlin said that 42 states had slower Medicaid drug spending increases in 2005 than in 2004 by taking such actions as pooling their buying power, negotiating discounts with manufacturers and increasing the use of generic drugs (New York Times, 1/9). Other contributing factors to the drug spending slowdown were pharmaceutical companies' decelerated introduction of new drugs, as well as the immediate aftermath of the withdrawal of Vioxx from the market because of safety concerns, the report found. The report does not include data on the Medicare prescription drug benefit, which was implemented in 2006 (Wall Street Journal, 1/9).
Additional Results
The report also contains the following findings:
- Home health care was the fastest-growing spending category in 2005, increasing 11% in 2005 -- the third consecutive year of double-digit growth. Spending on home health care totaled $47.5 billion.
- Spending on hospital care increased 7.9% in 2005, while spending on physicians increased 7% (New York Times, 1/9).
- Health insurance premium rates increased 6.6% in 2005, "continuing a moderating trend seen in the past couple of years," USA Today reports.
- Out-of-pocket expenses for workers increased 5.8% in 2005, up from 5% in 2004 (USA Today, 1/9).
Reaction
Cathy Cowan, an economist who co-wrote the report, said, "To have a slowdown for three straight years is pretty significant." Cowan said a "convergence" of the GDP growth rate and the health care spending growth rate "means that health care costs are not consuming more of the economy" (Boston Globe, 1/9). Joseph Minarik, an economist and senior vice president of the Committee for Economic Development, said, "I suspect that what we're seeing is something like we observed in the early 1990s, that as costs go up some resistance is being thrown in their path. But the resistance is not a fundamental change, and the fundamentals in the system will continue to push costs higher" (Los Angeles Times, 1/9). Paul Ginsburg, president of the Center for Studying Health System Change, said the growing economy might lead to larger health spending increases in several years. Ginsburg said, "We have a strong growth in jobs and sharp pay increases. These are conditions that will lead to a cyclically higher rate of spending, say in '08 or '09" (USA Today, 1/9). Henry Simmons, president of the National Coalition on Health Care, said, "It would be a disaster if people thought these (spending) numbers mean the crisis is over. Even if costs are only going up at 6.9%, that is still two or three times the rate of growth in take-home pay. It is still unsustainable" (Los Angeles Times, 1/9). An abstract of the study is available online.
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CARDIAC CARE: Insurers Could Save if They Covered Drugs, Study Finds
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Health insurers could prevent 4,736 deaths per year from heart-related problems and save $2.5 billion annually in related costs if they fully covered heart medications for patients who have had a heart attack, according to a study published in Health Affairs, the AP/Los Angeles Times reports. Heart medications and cholesterol-lowering drugs can reduce the risk of death from heart disease by an estimated 80%, although they often are underused. In the study, researchers from Harvard Medical School found that providing full coverage for the medications would cost insurers an average of $550 per patient but would lead to fewer heart attacks, strokes and deaths, saving $1,731 per heart-related event. The researchers also found that patients would be more compliant with their medication regimens if insurers fully covered the medications rather than requiring the patient to assume a share of the cost. Researchers conservatively estimated that full coverage of cardiac drugs would increase compliance rates from 50% to 63% (Freking, AP/Los Angeles Times, 1/8). An abstract of the study is available online.
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MODELS: Fashion Council Recommends Health Measures
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The Council of Fashion Designers of America on Friday introduced guidelines "aimed at promoting healthier behavior" among models, the New York Times reports. The guidelines, which will be sent to designers this week in advance of the fall fashion shows that begin in New York City on Feb. 2, "fall short of modeling restrictions announced in recent months by fashion show organizers" in Madrid, Spain, and Milan, Italy, the Times reports. Madrid this fall began banning models who have a body mass index of less than 18 -- a measure that the World Health Organization deems normal -- while the Milan-based Chamber of Fashion recently began requiring models to hold a license by a committee of city officials and a panel of doctors, nutritionist, psychologists and other experts, among other requirements, before being permitted to model. The U.S. guidelines recommend that fashion-show fittings with younger models be scheduled during daylight hours, rather than late at night, to help models get more sleep. The recommendations also suggest more nutritious backstage catering (Wilson, New York Times, 1/6). The CFDA Health Initiative recommends developing classes to teach designers and agents to identify the warning signs of eating disorders so models can be referred for treatment. In addition, the council advocates the creation of nutrition workshops to educate models about eating properly while maintaining their weight. The council is not expected to set any obligatory requirements on the fashion industry, nor is it expected to impose a penalty on designers who use extremely thin models (Tan, Wall Street Journal, 1/8).
Comments
CFDA President Diane von Furstenberg said, "It is important as a fashion industry to show our interest and see what we can do because we are in a business of image. But I feel like we should promote health as part of beauty rather than setting rules." David Bonnouvrier, CEO of DNA Model Management, said, "It is a serious enough issue that people will pay attention, but we cannot dictate the designers' choices. There will be a conscious effort for a while to address this, but whether that will last is another issue." Patrick O'Connell -- a spokesperson for Anna Wintour, the editor of Vogue who helped create the recommendations -- said, "The feeling is that it is not realistic to dictate or impose rules on a huge fashion industry. However, we do believe raising awareness and consciousness will go the furthest toward increasing people's sensitivities to the problem" (New York Times, 1/6).
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MEDICAL TOURISM: More Patients, Companies Consider Practice
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The Miami Herald on Sunday examined how "growing numbers of Americans with limited or no insurance are outsourcing their medical care" through medical tourism. Patients who participate in medical tourism in some cases travel thousands of miles to receive complex medical procedures in nations where the operations can cost thousands of dollars less than they cost in the U.S. In addition to individual patients, several large U.S. companies have begun to consider whether to include medical tourism as an option for employees with health insurance, according to Arnold Milstein of Mercer Human Resource Consulting. Milstein estimated that medical tourism can result in savings of 60% on the cost of medical procedures. Milicia Bookman, an economist at St. Joseph's University, said, "Medical tourism has the possibility of being the great health care equalizer in this country. You've got highly trained, Western-trained physicians using state-of-the-art technology. What more do you want?" However, the risks of medical tourism "can be significant," and the practice requires patients to find a "hospital with highly trained staff and the equipment and training to handle the wide range of problems that can arise during or after any medical procedure," the Herald reports. Patients can use accreditation by the Joint Commission International, the international division of the Joint Commission on Accreditation of Healthcare Organizations, as an indicator of which hospitals to select, according to Anne Rooney, the vice president of consulting for JCI. JCI, launched in 1998, has accredited about 100 hospitals in 25 nations, she said (Goldstein, Miami Herald, 1/7).
Alaska
The Anchorage Daily News on Sunday also examined the developing medical tourism industry. The Daily News profiled the experiences of several Alaska residents who traveled overseas for medical services (DeVaughn, Anchorage Daily News, 1/7).
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CHINESE MEDICINE: Debate Over Safety, Traditions Examined
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The Los Angeles Times on Monday examined how traditional medicine in China has "become embroiled in the country's struggle to balance tradition and modernity." Traditional Chinese treatments, which typically involve herbs or animal products, are covered under the country's national insurance program. Proponents of Chinese medicine say the treatments cost less than Western medicines and are an important part of Chinese culture. Critics maintain that many Chinese remedies are unsafe and ineffective. The debate intensified in October 2005 when Zhang Gongyao, a professor at a Chinese university, published an online petition calling for an end to national insurance coverage of Chinese medicine, stricter scientific standards for the treatments and Western medical training for practitioners. Fang Zhouzi, a biochemist and founder of a Web site that targets academic fraud, said, "Many herbal medicines considered innocuous are actually very toxic. But practitioners and proponents cover this up using various excuses." Experts in Chinese medicine maintain that adverse reactions from the treatments result from misuse and note that Western treatments also have side effects. Zheng Jinsheng, a professor at the Academy of Chinese Medical Sciences in Beijing, said, "Why don't people talk about Western medicines that cause problems? Why is traditional medicine always blamed?" (Magnier, Los Angeles Times, 1/8).
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EXPRESS SCRIPTS: Takes Action To Restore Caremark Bid
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Hours after its $26 billion stock-and-cash offer to acquire pharmacy benefit manager Caremark Rx was rejected in favor of an offer from CVS, PBM Express Scripts said it would nominate four candidates to the Caremark board at the company's next shareholder meeting in an effort to "salvage" its original bid, the AP/Washington Post reports (AP/Washington Post, 1/9). Further, Express Scripts made antitrust regulatory filings to acquire stock in Caremark and also said it has letters from Citigroup and Credit Suisse to prove that it can fully finance its offer (Reuters/Los Angeles Times, 1/9). CVS in November 2006 made an offer to acquire Caremark for about $21.3 billion. Under the offer, which has received approval from the Federal Trade Commission, Caremark shareholders would receive 1.67 shares of CVS stock for each Caremark share. CVS shareholders would own 54.5% of the combined company -- CVS/Caremark -- and Caremark shareholders would own 45.5%. Express Scripts in December 2006 made a rival offer to acquire Caremark for about $26 billion. Under the offer, Caremark shareholders would receive $29.25 in cash and 0.426 shares of Express Scripts stock for each Caremark share. Caremark shareholders would own about 57% of the combined company, and Express Scripts shareholders would own about 43%. Caremark Rx on Sunday rejected the offer from PBM Express Scripts and said it plans to continue with a rival offer from CVS (American Health Line, 1/8). According to Reuters/Los Angeles Times, Caremark said the Express Scripts proposal "lacked strategic rationale, faced significant antitrust risks and potential delays in closing the deal, and carried the risk of hefty debt load for the combined company" (Reuters/Los Angeles Times, 1/9).
Nominees
Express Scripts nominated to the Caremark board:
Caremark said the vote to approve the board members would have to wait until the company's annual meeting, which generally is held in May but has not yet been scheduled (Freudenheim, New York Times, 1/9). According to the Wall Street Journal, the "task for Express becomes persuading Caremark's shareholders to squelch any CVS offer, which likely would come through a sweetened offer of its own and the disclosure of contract terms that would pass off closing risks and costs to the Express side" (Berman, Wall Street Journal, 1/9). CVS said Express Scripts' announcement is "nothing more than a publicity stunt" and said it plans to close on a merger with Caremark "months before" any board members could be elected (Pack, Tennessean, 1/9).
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VACCINES: AHL Rounds Up Government Contract News
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Newspapers recently reported on the state of government contracts for vaccines of infectious diseases. Summaries appear below.
- Anthrax: HHS is "likely" to release a request for proposal in the coming weeks for a new second-generation anthrax vaccine after ending its $877.5 million contract with VaxGen last month, CQ HealthBeat reports. Avecia Biologicals and Emergent Biosolutions are seen as possible contenders for the government contract. Avecia is in Phase II clinical trials of its recombinant protective antigen, or rPA, vaccine, which has received close to $90 million in funding from NIH since 2002. Avecia applied for HHS' contract in 2004 but lost to VaxGen. An rPA vaccine might be favored because it could potentially have fewer side effects and require fewer doses to provide immunity. It also would be more consistent between production lots, according to government officials. If HHS does not specifically request an rPA vaccine, Emergent is expected to submit an RFP for the contract for BioThax, which is an anthrax vaccine absorbed product. BioThax is approved by FDA and has been a required immunization for military service members. If it submits a proposal, Emergent likely would make a bid to augment BioThax (Berger [1], CQ HealthBeat, 1/5).
- Bird flu: HHS on Thursday announced it has awarded a four-year, $102.6 million contract to BioCryst Pharmaceuticals to develop an antiviral that can treat influenza strains including avian flu, CQ HealthBeat reports (Berger [2], CQ HealthBeat, 1/5). BioCryst, which has never had a commercially successful drug, received the contract because its drug Peramivir has been shown effective in lab studies at combating influenza, the Birmingham News reports. Peramivir blocks the production of an enzyme that BioCryst scientists believe is responsible for spreading the flu virus throughout the body. Peramivir is being tested as an injected dose for those infected with normal flu and as an intravenous drug for those hospitalized (Hubbard, Birmingham News, 1/5). HHS Secretary Mike Leavitt said, "Antivirals are an important element of our pandemic influenza preparedness efforts. Our antiviral strategy includes not only stockpiling existing antiviral drugs but also seeking out new antiviral medications to further broaden our capability to treat and prevent all forms of influenza" (Berger [2], CQ HealthBeat, 1/5).
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WAL-MART: Groups in Urban Areas Seek Improved Health Benefits
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The Los Angeles Alliance for a New Economy and advocacy groups in other cities on Monday in a letter asked Wal-Mart Stores to improve wages and health benefits for employees before the company expands to urban areas, the AP/Boston Herald reports. The letter -- signed by more than 100 political, religious, business and civil rights leaders from 10 cities and addressed to Wal-Mart CEO Lee Scott -- criticized the "poverty-wage jobs" offered by the company. In addition, the letter asked elected officials in urban areas where Wal-Mart seeks to expand to require the company to offer "good jobs that provide quality health insurance and living wages and that allow employees to work free from discrimination and intimidation." In response, Wal-Mart in a statement said, "The public will see through these attacks because they know Wal-Mart offers good jobs and opportunities, helps working families save money and gives back more to our communities than virtually any other company in America." According to Wal-Mart, full-time employees, on average, receive wages of $10.11 per hour, and health plans for workers in some areas cost only $11 per month (AP/Boston Herald, 1/8).
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CALIFORNIA: Schwarzenegger Announces Health Insurance Proposal
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California Gov. Arnold Schwarzenegger (R) on Monday announced a proposal that would require all state residents to obtain health insurance and would share the cost among employers, individuals, health care providers, health insurers and the government, the San Francisco Chronicle reports (Chorneau, San Francisco Chronicle, 1/9). About 6.5 million California residents lack health insurance. According to the Census Bureau, in 2005 19.4% of California residents lacked health insurance, compared with 15.9% nationwide (Carlton, Wall Street Journal, 1/9). Under the proposal, employers with 10 or more employees would have to offer health insurance for workers or pay a fee of 4% of payroll to a state pool that would help workers purchase coverage, with the amount that they pay based on income. Employees could pay for health insurance with pretax income (Steinhauer, New York Times, 1/9). The proposal would provide additional subsidies to help state residents with annual incomes of as much as 250% of the federal poverty level purchase health insurance (Appleby, USA Today, 1/9). The proposal would require health insurers to sell policies to all state residents, regardless of whether they have medical conditions (Benson/Rojas, Sacramento Bee, 1/9). State residents who refuse to obtain health insurance could face reductions in their state income tax refunds or have their wages garnished (Geis/Lee, Washington Post, 1/9). The proposal also would extend coverage under Medi-Cal, the state Medicaid program, to all adults with annual incomes of as much as 100% of the federal poverty level and to children -- regardless of their immigration status -- in households with annual incomes of as much as 300% of the federal poverty level (New York Times, 1/9). In addition, the proposal would increase by $4 billion reimbursements to health care providers under Medi-Cal (USA Today, 1/9). Under the proposal, physicians would have to pay 2% and hospitals would have to pay 4% of their revenue to help cover the cost of the proposal (Ainsworth, San Diego Union-Tribune, 1/9). According to Schwarzenegger aides, the governor would finance the proposal in part with about $5 billion in federal matching funds that the state will receive as a result of restructured health care programs and with state funds currently used to finance charity care (New York Times, 1/9).
Comments
Analysts said that the proposal "is illustrative of the resurgence of interest among politicians at all levels in expanding health coverage to the uninsured and that it provides fresh evidence, with Congress stalled on enacting comprehensive health care reform, the states are beginning to take matters into their own hands," the Post reports (Washington Post, 1/9). Schwarzenegger said, "If you can't afford it, the state will help you buy it, but you must be insured" (Rau, Los Angeles Times, 1/8). According to Schwarzenegger, the cost of health care for state residents without health insurance has contributed to increased premiums for other residents. He said, "We are paying a hidden tax. We are paying higher deductibles. We are paying higher out-of-pocket co-pays, and the list goes on and on (San Diego Union-Tribune, 1/9). States Assembly Speaker Fabian Nunez (D) called the proposal "a good start," adding, "When it's all said and done, employers in California will pay a portion of their payroll deductions toward the cost of insuring their employees" (Los Angeles Times, 1/8). Karen Davis, president of the Commonwealth Fund, said, "This is a very significant proposal. It is not just children he is talking about. It is really dealing with the whole problem of the uninsured, with concrete positions to raise revenues to pay for that coverage and the philosophy of shared responsibility. I think this shows health care is going to be a major issue in the 2008 presidential election" (New York Times, 1/9). Diane Rowland, executive vice president of the Kaiser Family Foundation, said, "Health care for the uninsured is back on the agenda," adding, "The governors are trying to lead the way, but it's also going to take national action to try to address this problem" (Washington Post, 1/9). Bruce Bodaken, chair and president of Blue Shield of California, said, "Taking each part separately, there's something for everyone to hate, but, taken as a whole, there's a lot to like" (Carlton, Wall Street Journal, 1/9).
Criticism
Anmol Singh Mahal, president of the California Medical Association, said, "A tax on physicians is really a tax on those who are sick because it is the sick who go to see their doctors. Deborah Burger, president of the California Nurses Association, criticized the proposal as "a fresh coat of paint on a collapsing house" and a "huge gift to the insurance industry." Burger added, "There are no limits on skyrocketing health premiums, no requirements on what will be included in the required plans" (San Francisco Chronicle, 1/9). State Assembly member Mike Villines (R-Clovis) said that Republicans oppose health insurance proposals with a mandate on employers. He said, "If we put any form of mandate on a business, we are seeing a jobs tax. This isn't a philosophical discussion. This is a jobs discussion. This is the difference between employees having a job and a jobs tax that says no to that" (Los Angeles Times, 1/8). NPR's "All Things Considered" on Tuesday reported on the proposal. The segment includes comments from NPR health policy correspondent Julie Rovner ("All Things Considered," NPR, 1/9). Audio of the segment is available online.
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OBESITY: AHL Highlights Recent Developments
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Several newspapers recently published articles related to obesity. Summaries appear below.- Preteens: Girls ages nine to 12 are more likely to become overweight than girls in their teenage years, according to a study published Monday in the Journal of Pediatrics, the AP/New York Times reports. For the report -- funded by NIH -- lead researcher Douglas Thompson of the Maryland Medical Research Institute and colleagues tracked more than 2,300 black and white girls beginning at age nine until they reached age 18, noting their height, weight, blood pressure and cholesterol yearly. Researchers found that 7.4% of white girls and 17.4% of black girls were overweight by age nine. Each year through age 12, between 2% and 5% of the remaining girls became overweight, and that rate leveled off to between 1% and 2% annually after age 12. Researchers recommended increased oversight of girls' eating habits between ages nine and 12 (AP/New York Times, 1/8).
- Schools: The New York Times on Monday examined some U.S. school districts' "practice of reporting students' body mass scores to parents," one of several tactics being used to address obesity among school-aged children. CDC is expected to release a policy statement on the practice and provide guidelines about the benefits and risks of the obesity report cards. Marlene Schwartz, director of research and school programs at the Rudd Center for Food Policy and Obesity at Yale University, said that obesity report cards have become widespread despite "no solid research" on the physical and psychological impact on students and "no controlled randomized trial" on their effectiveness (Kantor, New York Times, 1/8). In related news, new restrictions in Connecticut on school sales of soda, sports drinks, coffee and tea are "costing some districts money" in lost sales, according to the Times (Spiegel, New York Times, 1/7).
- Trans fats: The Atlanta Journal-Constitution on Saturday examined how as "many of the country's largest restaurant chains scramble to replace trans fats in their best-loved items, some are learning" that "[t]inkering with a favorite food -- or even the mere suggestion of it -- carries risks, ... even when the changes are good for consumer health." Eliminating trans fats from food could prevent an estimated 72,000 heart attacks annually in the U.S., according to Harvard University scientists. However, eliminating trans fats can change the taste of products and informing consumers about a change in menu items "might trigger ... complaints," the Journal-Constitution reports (Lee, Atlanta Journal-Constitution, 1/6).
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WELLNESS SPAS: Offer Traditional, Alternative Medical Services
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The Washington Post on Sunday examined wellness spas, facilities that offer a variety of traditional and alternative medical services in addition to standard services -- such as massages, facials and wraps -- and have become "one of the biggest new trends in travel" and "by far the largest new trend in the spa industry." According to the International Spa Association, 915 wellness spas operated in the U.S. in 2006, compared with 310 in 2004. In addition, revenue for wellness spas in 2006 reached $469 million, a 340% increase over the previous two years. Medical services offered at wellness spas can include acupressure and other massages, exercise and diet programs, laser treatment to increase range of motion and relieve pain related to carpal tunnel syndrome and sports injuries, and treatments for autism or arthritis. Wellness spas often integrate traditional and alternative medical services (Loose, Washington Post, 1/7). Marc Micozzi, director of the Policy Institute for Integrative Medicine, said that wellness spas "provide great environments to deliver a lot more health care services that, despite luxuries, can still be done at a lower cost than in urbanized hospital centers with enormous square-footage costs." He added, "Just about every medical problem can be improved by rest and relaxation. And there is no medical problem that is not made worse by stress. That applies across the board."
Some Concerns
However, Micozzi said that consumers should conduct research on wellness spas and the medical services they offer to avoid "quackery." According Micozzi, consumers can contact the National Center for Complementary and Alternative Medicine at NIH for additional information on wellness spas and the medical services they offer (Washington Post, 1/7). The Post on Sunday also provided several examples of technologically and medically advanced wellness spas in the U.S. (Washington Post, 1/7).
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MEDICARE: Editorial, Opinion Pieces Focus on Democratic Agenda
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Several newspapers recently published an editorial and opinion pieces on Medicare issues included in the Democratic agenda for the 110th Congress. Summaries appear below.
Editorial
- Long Island Newsday: House Democrats plan to "sprint" to address a number of "worthwhile initiatives" -- such as legislation that would require the HHS secretary to negotiate directly with pharmaceutical companies on prices for medications under the Medicare prescription drug benefit and reduce restrictions on federal funding for embryonic stem cell research -- in the first 100 hours of Congress, a Long Island Newsday editorial states. According to the editorial, "by allowing no amendments" to the bills, "Democrats will give Republicans a taste of their own medicine" (Long Island Newsday, 1/7).
Opinion Pieces
- Sarah Berk, Charlotte Observer: House Speaker Nancy Pelosi (D-Calif.) is "trying to fix" the Medicare prescription drug benefit, although "90% of Medicare beneficiaries now have drug coverage and 80% of recipients are satisfied with their coverage," Berk, executive director of Health Care America, writes in an Observer opinion piece. "Premiums are down, as are program costs," she writes, adding, "In fact, program costs dropped by 20% over last year's estimate, which will create a savings of $180 billion over 10 years for taxpayers" (Berk, Charlotte Observer, 1/8).
- Mark Weisbrot, Charlotte Observer: Democrats should seek to expand Medicare through a proposal that would allow all U.S. residents to purchase coverage through the program, Weisbrot, co-director of the Center for Economic and Policy Research, writes. He adds, "It's obvious that we need a universal health care system that can hold down costs, as in the rest of the industrialized world," and an expansion of Medicare could provide a "way to get a foot in the door" (Weisbrot, Charlotte Observer, 1/8).
- Joe Conason, Chicago Sun-Times: Pelosi "deserves congratulations ... for her decision to place promises made by her party to the American people" -- such as efforts to reduce prescription drugs costs -- "above the principle of minority rights within Congress," Conason, a freelance columnist, writes in a Sun-Times opinion piece. After Democrats address such issues, "there will still be plenty of time to show that they can wield the majority gavel with more decency and decorum" than Republicans, Conason adds (Conason, Chicago Sun-Times, 1/7).
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HEALTH CARE IT: Implementation Should Become High Priority
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Implementation of health care information technology "must be one of our nation's top priorities," former House Speaker Newt Gingrich (R-Ga.), founder of the Center for Health Transformation, and Janet Dillione, president of the health care IT division of Siemens Medical Solutions, write in a Philadelphia Inquirer opinion piece. According to the authors, only one-fourth of hospitals and less than 15% of physicians have implemented health care IT. The authors write that the "technological gulf" in health care reduces efficiency, increases costs and might "be involved in ... the persistence of a high error rate in medicine." The authors add, "Health information technology, from electronic prescribing to electronic health records to clinical decision support, is a critical part of the solution" to the issues of health care costs and medical errors. The authors recommend the use of incentives to prompt hospitals and physicians to implement health care IT, the revision of laws that limit implementation of health care IT and the inclusion of health care IT in the curricula of medical schools. "The sad reality is that most physicians put down their laptops and pick up their clipboards when they walk into a patient's room," the authors write, adding, "For the health of our citizens and the future of our country, that's a reality we must change" (Gingrich/Dillione, Philadelphia Inquirer, 1/9).
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Editorial: 202/266-5381 ·
Fax: 202/266-5767 ·
Mailbag:
ahl@advisory.com
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Josh Kotzman, Cheryl Skrzat, Editors
Amanda Wolfe, Editor in Chief
Allison Czapp, Amy Dietterich, Daniel Esquibel, Jennifer Haliski, Kimberley Lufkin, Contributing Editors
Bryn Lansdowne, Tessa Moran, Justyn Ware, Sherkiya Wedgeworth, Cameron Williams, Staff Writers
Sarah Mann, Chris Sowerwine, Copy Editors
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Under Consideration
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