human-services

More People Sign Up For Pre-Existing Condition Insurance Plan, But Enrollment Still Low

by on May 17, 2011

Huffington Post…

WASHINGTON — Enrollment in the Affordable Care Act’s fledgling program for people with pre-existing conditions inched up to 18,313 in March, the Obama administration recently announced . The Pre-Existing Condition Insurance Plan, a $5 billion component of the president’s health care reform bill, offers low-cost coverage to people who’ve spent six months or longer excluded from the individual insurance market because of conditions like diabetes, heart disease or cancer. The federal government runs the PCIP in 23 states, while the rest of the states handle it themselves. Enrollment jumped by nearly 6,000 from the previous update in February — the biggest increase yet. The Department of Health and Human Services (HHS), which administers the program, lowered premiums earlier this year in an effort to boost enrollment. For those covered by the PCIP , it can be a godsend. The program was so appealing to one Arizona couple, in fact, that they canceled their insurance policies in January and are spending six months without insurance to qualify for the program come July. Yet the PCIP’s enrollment numbers have been a disappointment for the administration. Though there are millions eligible, officials said it would reach a few hundred thousand at most. But enrollment has fallen far short of even those meager estimates. During the legislative endgame of health care reform, Democrats touted the new program as one of the greatest “immediate deliverables” of the pending law. (High-risk pools like the PCIP also happen to be the centerpiece of Republicans’ alternative vision for health care reform). The PCIP will be phased out in 2014, when it will be illegal for insurance companies to discriminate against the sick. HHS buried the new numbers on its website May 6 and did not put out a press release like it did for the previous update in February. A spokeswoman did not respond to inquiries about why HHS chose not to publicize this quarter’s enrollment figures. HuffPost readers: Applying for the PCIP? Tell us about it — email arthur@huffingtonpost.com . Please include your phone number if you’re willing to do an interview.

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More People Sign Up For Pre-Existing Condition Insurance Plan, But Enrollment Still Low

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GOP Cries Of ‘MediScare’ Prompt Democratic Shout of ‘Hypocrisy’

by on May 11, 2011

Huffington Post…

WASHINGTON — In a bold political about-face, a group of freshman Republicans who won office campaigning against cuts to Medicare last year called on Democrats Wednesday not to do the same in 2012. Complaining that Democrats were using “Mediscare” tactics, they touted a letter signed by 42 members of the 2010 GOP class to President Obama, asking him and his party to stop using Medicare to score political points. “We ask that you stand above partisanship, condemn these disingenuous attacks and work with Congress to reform spending on entitlement programs,” reads the letter, orchestrated by Rep. Adam Kinzinger (R-Ill.) Democrats pounced on the Medicare issue after the House passed a budget proposal authored by Rep. Paul Ryan (R-Wis.) in April. His plan would shift Medicare from a public program to a voucher-like private system, with the already expected rise in costs to seniors under the current system jumping by an extra $6,000 in 10 years. The plan could cut some $1 trillion from the program, by some estimates . Yet in the run-up to the 2010 elections, many Republicans campaigned aggressively against the Democratic health insurance reform law, in part because it cuts $500 billion from the privately run portion of Medicare, the more expensive Medicare Advantage. The Huffington Post identified at least a dozen signers of the letter to President Obama who made a political issue out of the Medicare Advantage cuts last year. Among those running against the $500 billion cut was Scott Tipton, who upended Democratic Rep. John Salazar in Colorado. “Unlike John Salazar, I’ll never put our seniors’ future at risk, he charged in one ad . “Our seniors deserve better.” Current Rep. Cory Gardner (R-Colo.), who defeated Democratic Rep. Betsy Markey, slammed her for the $500 billion cut and a “government takeover” of health care. The charges were typical and widespread. Others who campaigned against Medicare cuts during the 2010 campaign are Reps. Martha Roby (R-Ala.), Todd Young (R-Ind.), Andy Harris (R-Md.), Bob Gibbs (R-Ohio), Todd Young (R-Ind.), Renee Ellmers (R-N.C.), Kristi Noem (R-S.D.), Randy Hultgren (R-Ill.), Sean Duffy (R-Wis.), and Paul Gosar (R-Ariz.). But this year, they are on the defensive, and point to remarks made by Democrats like Health and Human Services Secretary Kathleen Sebelius, who charged recently that under Ryan’s plan, seniors would be reluctant to use medical services that were more expensive and would “die sooner.” The freshman legislators said such remarks were out of bounds, although phrases such as medical “rationing” and “death panels” were watchwords of the 2010 contests. Asked if the freshmen may have committed the sin they were accusing Democrats of — and why it was not hypocritical of them to now gripe about the Democrats’ stance — Kinzinger admitted that mistakes were made during Republicans’ campaigns. “To say that one side is blameless in trying to use issues to win votes is just dishonest,” he told reporters. But he didn’t blush at trying to “reset” the tone now that his party controls the House, and Democrats have the Medicare argument at their disposal. “I’m not going to defend anything done in the past,” he added. “Let’s get past the past. Let’s move forward to the future, and say OK, today is today. We have a real problem. Let’s get past the entrenched politics and move forward together.” Rep. James Lankford (R-Okla.) suggested Democrats were knocking the GOP Medicare plan because they know Republicans are serious about carrying it through. “Typically when you don’t think a proposal is serious, you ignore it. When you think it’s serious and a threat, you yell at it and attack it as hard as you can,” Lankford said. “We feel the attack, we understand what’s going on. But we’re saying let’s get past all the attacks, let’s get on to the serious business that we’ve got to get onto.” Democrats showed no sign of letting up on their strategy of highlighting the GOP’s Medicare proposals, and accused their rivals of taking something of a Hypocritic Oath. “House Republican freshmen used false and misleading scare tactics against seniors last year but are now afraid of the truth: their constituents are outraged that they voted to end Medicare while protecting Big Oil,” said Democratic Congressional Campaign Committee spokesman Jesse Ferguson, referring to Republican objections to ending federal subsidies for the top five petroleum producers. “Voters are smarter than the freshmen give them credit for. They can see through House Republicans’ hypocritical stunt to try silence their constituents’ outrage,” Ferguson said, pointing to recent town halls sessions in members’ districts where voters raised concerns about the Ryan budget.

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Cytori Appoints Tommy G. Thompson to its Board; Names Lloyd Dean Chairman

May 3, 2011

SAN DIEGO, CA–(Marketwire – May 3, 2011) – On April 28, 2011, Cytori Therapeutics ( NASDAQ : CYTX ) elected the Honorable Tommy G. Thompson, former Secretary of the US Department of Health & Human Services and Governor of Wisconsin, as an independent member of Cytori’s Board of Directors. In addition, the Company’s Board of Directors has elected Mr. Lloyd H. Dean to serve as Chairman of the Board. Past Chairman Ronald D. Henriksen will continue to serve as an independent member of the Company’s Board of Directors.

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Obama Health Care Idea Could Mean Better Treatment, Savings

March 31, 2011

WASHINGTON — The Obama administration on Thursday outlined a new approach to medical care that it said could mean higher quality and less risk for patients, while also saving millions of dollars for taxpayers. The plan involves accountable care organizations, which are networks of hospitals, doctors, rehabilitation centers and other providers. They would work together to cut out duplicative tests and procedures, prevent medical errors, and focus on keeping patients healthier and out of the emergency room. “We need to bring the days of fragmented care to an end,” Health and Human Services Secretary Kathleen Sebelius said as she announced a proposal regulation that defines how the networks would operate within Medicare. If things work out, medical providers would share in the savings. If the experiment fails, they’re likely to get stuck with part of any additional costs. Sebelius said early estimates are that Medicare could save as much as $960 million over three years. That’s not a whole lot for a $550-billion-a-year program, but officials say it’s a start. The estimate was prepared by Medicare’s office of the actuary, known for its independence. Eagerly awaited by the health care industry, the new approach was called for in President Barack Obama’s health care overhaul. If it succeeds in Medicare, it is expected spread quickly to employer-provided health insurance. Already in some parts of the country, such as the Minneapolis area, insurers, hospitals and doctors have set up similar networks for privately insured patients. But there are risks. The networks could end up costing more money because of the intensive work involved in coordinating among different providers. Medicare recipients now may see four or five different doctors, who never talk to each other or compare notes. There’s another potential problem. What if a network of hospitals and doctors acquires monopoly power in its community and starts raising prices? Assistant Attorney General Christine Varney said the administration won’t allow that to happen. “We believe there is no area of the economy that can benefit more from collaboration than health care,” said Varney. “Those who collaborate to fix prices inappropriately will be prosecuted.” Unlike some managed care plans, such as health maintenance organizations, patients will not be locked into the new networks. “The beneficiary has not lost any choice at all,” said Medicare administration Donald Berwick. Instead, it will be doctors, hospitals and other service providers who join the networks. They will have to make a three-year commitment to care for a group of at least 5,000 patients. Medicare administrators will monitor performance on costs and quality. If the network succeeds in saving money over what its patients’ care would have otherwise cost, Medicare will share a portion of the gains. If it loses money, providers could get stuck with a bill. Providers are required to let their patients know that they are part of an accountable care organization and to get permission to share personal health information within the network. The experiment is focused on traditional fee-for-service Medicare. “We are committed to getting the details right,” said Sebelius. “The rules we are proposing today are just the first step in a long process.” ___ Online: Department of Health and Human Services: http://www.hhs.gov

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Arizona Budget Cuts Target Potentially Life-Saving Care For Transplant Patients

March 6, 2011

PEORIA, Arizona (Reuters) – A pacemaker and defibrillator fitted to carpenter Douglas Gravagna’s failing heart makes even rising from the couch of his Phoenix-valley home a battle. But it is not congestive heart failure that is killing him, he says. It is a decision by Arizona Governor Jan Brewer to stop funding for some organ transplants as the state struggles to reduce a yawning budget deficit. “She’s signing death warrants — that’s what she’s doing. This is death for me,” says Gravagna, 44, a heavy-set man who takes 14 medications to stay alive. Gravagna is among 98 people denied state Medicaid funding for potentially life-saving transplants and at the forefront of a harrowing battle over the state’s public finances. The measure enacted last October by Brewer trimmed spending on Medicaid, the federal-state health insurance program, to help close a projected 2012 budget deficit of $1.15 billion. It eliminated coverage for transplants including lung, heart, liver and bone marrow after weighing the success and survival rates for certain transplant procedures. Two patients on the Medicaid waiting list have since died, although it is unclear if transplants would have saved them. In a statewide speech, the Republican governor singled out the Arizona Health Care Cost Containment System, as the Medicaid program is called in the desert state, as the greatest drain on state coffers. “At the deficit’s core is the explosive growth in Medicaid spending which, over the last four years, has soared by almost 65 percent and now consumes 29 percent of our state budget,” she said. “If we are to regain control of state spending, we must reform Medicaid and free Arizona from the fiscal manipulation of the federal government,” Brewer said. CUTTING RATES TO PROVIDERS Medicaid, which covers about 60 million Americans — poor adults and children, people who are elderly or have disabilities — is one of the top expenses for states. It makes up about 16 percent of state budgets, said Judith Solomon at the Center on Budget and Policy Priorities. It pays for more than 40 percent of all births in the United States and is the primary bill-payer for nearly two-thirds of the country’s nursing home residents, according to the Kaiser Family Foundation. In Texas the proposed budget would cut rates to Medicaid providers, including doctors, dentists, hospitals and nursing homes, by 10 percent, making it more difficult for patients to find healthcare providers who accept Medicaid. Other states, among them Nevada, Illinois, Mississippi, Nebraska, Colorado and South Dakota, have also proposed provider rate cuts. Proposed cuts range from limiting prescription and doctor visits in California to eliminating adult vision and dental services in Georgia, the center says. Brewer has proposed dropping about 250,000 Arizonans — mostly childless adults — from the program. Most states are not proposing to trim Medicaid rolls because the new federal health reform law requires that they maintain current Medicaid coverage. But the U.S. Health and Human Services Department has said Arizona can drop coverage because the state is providing it through a temporary waiver, and the new law does not require extending that. ‘OTHER PLACES TO MAKE CUTS’ Taking an ax to transplant funding is backed by many Republicans in Arizona, some of who sympathize with Brewer. “It’s a very difficult unenviable position to be in for her,” said Kathy Boatman, a conservative Tea Party activist in the Phoenix valley. “It’s not fun, it’s unpleasant, but when expenses have outpaced income, that’s what you have to do.” But opponents, including state Democrats, the families of desperately sick patients like Gravagna and some doctors say savings can be made without putting lives on the line. “There are other places to make cuts. We’ve cut taxes on the very rich, we have corporate tax loopholes,” said Bruce Madison, a doctor who spoke at a rally to restore transplant funding in Phoenix on Saturday. Madison received a life-saving heart transplant six years ago. State Representative Anna Tovar, a Democrat and former kindergarten teacher, received two transplants to combat a rare form of leukemia. She says Arizona stands to lose more than $3 million a year in federal matching funds for Medicaid to save $1.4 million a year by restricting transplants. “When you look at the big scheme of things, saving $1.4 million for 96 lives is not money well spent,” said Tovar, who has introduced four bills seeking to restore Medicaid funding for transplants. As he grows sicker after being denied a liver transplant last year, Francisco Felix, 32, says any savings from denying him the operation are in some measure a false economy. “If I got a transplant, I could get back to work … pay my taxes, and help Arizona to get back on its feet,” he said at the rally. (Additional reporting by Corrie MacLaggan; Editing by Xavier Briand) Copyright 2010 Thomson Reuters. Click for Restrictions .

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Steve King Dismisses Concerns Over Preexisting Conditions: ‘Minor Thing’

January 19, 2011

Rep. Steve King (R-Iowa) claimed Wednesday that he wasn’t worried about eliminating the popular preexisting conditions provision of the health care bill through the current GOP effort to repeal the law. “I actually don’t think it would be met with tremendous backlash. There are Republicans that support those ideas and we start tomorrow the process of replacement of Obamacare,” King said on MSNBC, when asked how people would react to the potential rescinding of a measure in the health care bill that prevents insurance companies from denying care to patients based on prior medical issues. “It will not work for us to say there’s a certain component of Obamacare that has some merit and so therefore we want to leave that in place and repeal the rest. This is too many pages, it’s too cluttered, it’s too big an argument to allow it to turn on one or two minor things.” King then claimed that the preexisting conditions element of the health care bill, like the rest of the “good” parts of the overhaul package, could also better be handled on a state-by-state basis through Republican solutions. A Department of Health and Human Services study released this week found that up to 50 percent of Americans under age 65 may have preexisting health conditions that would, without the current language of the health insurance reform law, allow insurers to reject them. According to the Affordable Care Act’s benchmark, set for full implementation in 2014, a predicted total of 129 million people with preexisting conditions will all be able to receive insurance despite their medical history. WATCH (via Political Correction ) :

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Robert Gibbs: Larry Summers Replacement Could Come Mid-January

December 26, 2010

WASHINGTON — Don’t look for any big changes in President Barack Obama’s Cabinet as the new year gets under way. The president’s press secretary, Robert Gibbs, tells CNN’s “State of the Union” that he doesn’t expect any major shuffling to take place in the Cabinet. Gibbs says that there’s much work yet to be done at the Treasury Department to implement financial reform and at the Health and Human Services Department to implement health care reform. He calls the president’s team “very talented.” Obama’s top economic adviser, Lawrence Summers, had been expected to depart the administration last fall. Gibbs says he thinks Obama will name Summers’ replacement a week or two after the new Congress convenes. CNN’s interview with Gibbs aired Sunday.

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Peter H. Gleick: Marketing Bottled Water to Kids Under the Guise of a Health Program

September 20, 2010

A new brand of bottled water, aimed specifically at children, is being aggressively marketed in schools from Alaska to New York, through an advertising campaign masquerading as a “health” program. Health is always a great marketing tool. The brand (“Wat-ahh!”), with colorful bottles, kid-focused advertisements, and a pseudo health message (“Healthy Hydration in the Nation”) is being pushed by a company that, ironically, also markets energy drinks with a sex message (“Playboy Energy” drinks). Sex, of course, is another great marketing tool. The company, Full Motion Beverage, claims that their goal is to get kids off of sugary drinks (though, of course, the company sells plenty of those as well) as part of “the fight against childhood obesity.” That’s a great goal. But of course, drinking far, far cheaper (and equally clean) tap water would serve the same purpose, albeit without generating huge profits for the company. And national statistics show that we’re NOT drinking less soda and sugar — we’re drinking less tap water and MORE bottled water and soda. When you visit the company’s “healthy hydration” website, you get a kid-focused “quiz” about the importance of drinking water, the problems with drinking sugary sodas, and the dangers of dehydration, with a conclusion that schools should start a “healthy hydration program” designed by this bottled water company, with the company’s URL and images of their bottled water. “Getting into schools is a huge achievement for our brand,” says Rose Cameron the company’s founder and CEO. “We are therefore excited to be invited into these schools to conduct our Healthy Hydration education program and look forward to meeting the kids!” No doubt, and selling the company’s products. Moreover, the company makes several “versions” of their bottled water, with additives. One of these in particular, Wat-aah “Energy,” contains “oxygen for increased metabolic function and energy.” As I’ve described in detail in my book ” Bottled and Sold: The Story Behind Our Obsession with Bottled Water ,” water products with added “oxygen” are scams. Scientific studies have shown that extra oxygen added to bottled water doesn’t stay there; it comes out of solution when you open the bottle and it provides no demonstrable benefit. But more importantly, we don’t absorb oxygen through our stomachs. We get it through our lungs. Drinking bottled water with extra oxygen will, at best, produce an expensive burp. This kind of corporate advertising to children and schools under the guise of a health program should not be permitted. If companies want to promote health in schools, they should support education programs that do not include pushing particular products. If schools want to adopt an “Anti-Obesity” campaign, they would do better to look to Michelle Obama’s ” Let’s Move ” effort. If schools want to show advertisements about obesity and how to reduce it, they should look to the Ad Council’s Childhood Obesity Prevention effort sponsored by the US Department of Health and Human Services and other organizations that aren’t trying to sell children commercial products. Peter Gleick Pacific Institute

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Chief Medicare Actuary: White House Health Savings Estimates ‘Not Meaningful,’ Give Inaccurate Picture

September 13, 2010

WASHINGTON — When a government report found that President Barack Obama’s health overhaul would modestly raise the nation’s total health care tab, the White House responded with a statistic suggesting costs would go down. It turns out that may be fuzzy math. Health reform director Nancy-Ann DeParle wrote on the White House blog last week that the same government report indicates spending per insured person will be more than $1,000 lower in 2019 because of the law – some 9 percent below previous projections. ___ EDITOR’S NOTE – An occasional look at assertions by public officials and how well they adhere to the facts ___ “The act will make health care more affordable for Americans,” DeParle said. But the head of the nonpartisan economic unit at Medicare that produced the original cost report says the White House number “does not provide a meaningful or accurate indication” of the effect of the health care law. “The amounts quoted in the White House blog are not meaningful and cannot be used to calculate the change in health expenditures per insured person,” Richard Foster, Medicare’s chief actuary, told The Associated Press. The Obama administration stands by its statistic. It’s a dispute about numbers and how they’re bandied about by powerful people in Washington. But you don’t need an economics degree to follow this one. All you have to do is remember your fractions. The health care law expands coverage, reducing the number of uninsured by more than 32 million, although about 24 million will remain without coverage. Still, the share of the population with insurance will go up by nearly 10 percentage points, to about 93 percent. And that makes a difference in the numbers. If you divide total national health care spending by a bigger number of insured people, you get a smaller per-person result. It’s an interesting statistic, but it doesn’t mean the problem of rising costs is solved. “It’s not that it’s false, it’s just that it will be a little misleading,” John Allen Paulos, a mathematics professor at Temple University in Philadelphia, said of the White House number, calling it an “apples-to-oranges miscomparison.” Consider an imaginary country with just three citizens, Peter, Paul and Mary. Peter has health coverage but Paul and Mary are uninsured. Peter spends $1,000 on health care, but Paul and Mary can only afford $500 apiece because they lack coverage. Total national spending: $2,000. National spending per insured person: $2,000. Now suppose a law gets passed to expand coverage. Paul gets insurance, but Mary remains uninsured. Now Peter and Paul are spending $1,000 apiece. Paul spends more than when he was uninsured, so total national health spending goes up to $2,500. But because more people are covered, spending per insured person goes down to $1,250. It’s a simplistic comparison, but would you call that a savings? Paulos said it would make more sense to first figure out the share of total national health care spending by people with health insurance, and then divide that result by the number of insured people – before and after the health care law. The government hasn’t run that calculation. Richard Kronick, a senior Health and Human Services official, said the Obama administration disagrees that its number is misleading. “There are a number of ways to evaluate health care spending and the new law,” said Kronick. “Examining spending on each individual with health insurance is one useful data point.” National health care spending is a kitchen-sink statistic that includes personal health costs of the insured as well as the uninsured, and such categories as research and development and medical infrastructure. In 2019, when the overhaul is fully phased in, the tab will be $4.6 trillion. Foster says it’s acceptable to divide the number by the total U.S. population. In that case, per capita spending would $13,652 as a result of the law, and $13,387 without it. The difference: just $265 per person more. Paulos, the mathematician, said that sounds like a bargain to him. “It’s a relatively small cost given that 30 million more people will be covered,” he said. “You don’t really need this kind of apples to oranges miscomparison.”

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Chief Medicare Actuary: White House Health Savings Estimates ‘Not Meaningful,’ Give Inaccurate Picture

September 13, 2010

WASHINGTON — When a government report found that President Barack Obama’s health overhaul would modestly raise the nation’s total health care tab, the White House responded with a statistic suggesting costs would go down. It turns out that may be fuzzy math. Health reform director Nancy-Ann DeParle wrote on the White House blog last week that the same government report indicates spending per insured person will be more than $1,000 lower in 2019 because of the law – some 9 percent below previous projections. ___ EDITOR’S NOTE – An occasional look at assertions by public officials and how well they adhere to the facts ___ “The act will make health care more affordable for Americans,” DeParle said. But the head of the nonpartisan economic unit at Medicare that produced the original cost report says the White House number “does not provide a meaningful or accurate indication” of the effect of the health care law. “The amounts quoted in the White House blog are not meaningful and cannot be used to calculate the change in health expenditures per insured person,” Richard Foster, Medicare’s chief actuary, told The Associated Press. The Obama administration stands by its statistic. It’s a dispute about numbers and how they’re bandied about by powerful people in Washington. But you don’t need an economics degree to follow this one. All you have to do is remember your fractions. The health care law expands coverage, reducing the number of uninsured by more than 32 million, although about 24 million will remain without coverage. Still, the share of the population with insurance will go up by nearly 10 percentage points, to about 93 percent. And that makes a difference in the numbers. If you divide total national health care spending by a bigger number of insured people, you get a smaller per-person result. It’s an interesting statistic, but it doesn’t mean the problem of rising costs is solved. “It’s not that it’s false, it’s just that it will be a little misleading,” John Allen Paulos, a mathematics professor at Temple University in Philadelphia, said of the White House number, calling it an “apples-to-oranges miscomparison.” Consider an imaginary country with just three citizens, Peter, Paul and Mary. Peter has health coverage but Paul and Mary are uninsured. Peter spends $1,000 on health care, but Paul and Mary can only afford $500 apiece because they lack coverage. Total national spending: $2,000. National spending per insured person: $2,000. Now suppose a law gets passed to expand coverage. Paul gets insurance, but Mary remains uninsured. Now Peter and Paul are spending $1,000 apiece. Paul spends more than when he was uninsured, so total national health spending goes up to $2,500. But because more people are covered, spending per insured person goes down to $1,250. It’s a simplistic comparison, but would you call that a savings? Paulos said it would make more sense to first figure out the share of total national health care spending by people with health insurance, and then divide that result by the number of insured people – before and after the health care law. The government hasn’t run that calculation. Richard Kronick, a senior Health and Human Services official, said the Obama administration disagrees that its number is misleading. “There are a number of ways to evaluate health care spending and the new law,” said Kronick. “Examining spending on each individual with health insurance is one useful data point.” National health care spending is a kitchen-sink statistic that includes personal health costs of the insured as well as the uninsured, and such categories as research and development and medical infrastructure. In 2019, when the overhaul is fully phased in, the tab will be $4.6 trillion. Foster says it’s acceptable to divide the number by the total U.S. population. In that case, per capita spending would $13,652 as a result of the law, and $13,387 without it. The difference: just $265 per person more. Paulos, the mathematician, said that sounds like a bargain to him. “It’s a relatively small cost given that 30 million more people will be covered,” he said. “You don’t really need this kind of apples to oranges miscomparison.”

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Sebelius To Health Insurers: Stop Lying About Your Rate Increases

September 9, 2010

WASHINGTON — President Barack Obama’s top health official on Thursday warned the insurance industry that the administration won’t tolerate blaming premium hikes on the new health overhaul law. “There will be zero tolerance for this type of misinformation and unjustified rate increases,” Health and Human Services Secretary Kathleen Sebelius said in a letter to the insurance lobby. “Simply stated, we will not stand idly by as insurers blame their premium hikes and increased profits on the requirement that they provide consumers with basic protections,” Sebelius said. She warned that bad actors may be excluded from new health insurance markets that will open in 2014 under the law. They’d lose out on a big pool of customers, as many as 30 million people nationwide. The letter to America’s Health Insurance Plans was the latest volley in a war of words over who gets the blame for rising premiums. Polls show that many people expect their costs to go up as a result of the law, but there’s also widespread mistrust of the insurance industry. An HHS official said the letter is a pre-emptive move, after the department learned that several smaller carriers around the country are blaming the new law for rate increases this year. The industry’s top lobbyist responded that the health care law is a factor behind higher rates, but not the only one. “Health insurance premiums are increasing because of soaring prices for medical services, the impact of younger and healthier people dropping their insurance during the weak economy, and additional benefits required under the new law,” said Karen Ignagni, president of the insurers’ trade group. “It’s a basic law of economics that additional benefits incur additional costs.” Sebelius asked Ignagni to help stop “misinformation and scare tactics.” Although the law’s big expansion of coverage under the law won’t take place until 2014, several new benefits go into effect starting later this month. Lifetime dollar caps on coverage are abolished, and plans must allow parents to keep their children on the policy up to age 26. Many plans will also have to guarantee coverage for children regardless of a medical condition, and provide preventive care with no cost-sharing for the patient. The administration estimates that those new benefits will raise premiums by no more than 1 to 2 percent. Major benefit consulting companies say the impact will be in the single digits, although it may vary considerably from plan to plan. “Health plans will continue to do everything they can to incorporate all of these new benefits while keeping health care coverage as affordable as possible for families and employers,” Ignagni said. Unpredictable premium hikes are a constant worry for small businesses and people who buy coverage directly. Employees of large companies are generally shielded from big rate swings from year to year, although their costs also creep up. Obama used premium hikes to his advantage earlier this year in the final push to get health care overhaul legislation through Congress. After Anthem Blue Cross sought an increase of as much as 39 percent for some of its California customers who purchase coverage directly, the president made the company into a poster child for insurance problems. California regulators recently approved an increase averaging 14 percent for Anthem customers. Analysts say the industry is generally in good financial condition this year, and that may help to keep premiums in check.

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Clayton M. Christensen: Health Insurance Rate Wars – Are We Focused on the Right Fight?

July 16, 2010

By Darius Tahir and Clayton Christensen On opposite ends of the country, differing results in battles with health insurers lead us to the same conclusion: we need to attack rising costs of health care delivery which will not be fixed, as many had hoped, by the recent health care legislation or by periodic regulatory tweaks. Recently, Aetna became the second major California insurer to withdraw intended rate hikes after intense examination by state regulators. Anthem Blue Cross had earlier elicited national attention and reproach from the White House when it attempted to raise rates by as much as 39 percent for individual policies. When the company backed down, Secretary of Health and Human Services Kathleen Sebelius hailed the rate increase defeat by saying, “Finally, the power is shifting back to consumers.” Meanwhile, in Massachusetts, the story has turned out to have a different ending. In April, Massachusetts governor Deval Patrick and his insurance division rejected over 200 requested rate increases, ranging from 8 percent to 32 percent, which were proposed by the four largest insurance providers. But last week, the attorneys of the state’s Division of Insurance overturned the cap and pronounced the rate increases reasonable based on what the insurer pays hospitals and physicians. Rate increases are the last symptom of the disease afflicting the health care system. Whether the rate changes are allowed to go through or not, most Americans still won’t have the ability to choose their insurer or to comparison shop for treatments and tests such as MRIs, for which prices vary wildly in large part due to the opacity of health care’s pricing model. Capping insurance rates does little to address the underlying fact that health care needs a fundamentally new business model. In the current system, the patient’s insurer pays most doctors through a fee-for-service scheme wherein each activity and procedure is itemized and reimbursed. This method creates perverse incentives: doctors are encouraged to give too much care and may favor more expensive services, even when a less expensive–and often less invasive–service might be equally or more effective. That means that the fee-for-service model promotes more expensive health care and ultimately, less effective health care practices. Another problem with health care’s business model is that its services are generally housed together in a centralized setting. A hospital performs many services: it treats complicated and urgent cases, but it also has to handle simple treatments that are easy to diagnose and straightforward to cure. This is a critical distinction if health care costs are ever to come down: the former function indeed requires a lot of expertise and technology to manage, but the latter can be delivered elsewhere, in a lower-cost venue by lower-cost personnel. But all too often, the use of new business models and technologies in health care is incentivized along fee-for-service lines, so that prices don’t fall as they have in most other industries. In Massachusetts, for example, digital mammography is 45 percent more expensive than non-digital mammography, even though it ought to be cheaper on a per-unit basis: it’s faster, and it neither requires film nor physical storage. But there is little incentive for hospitals and physicians to disrupt existing business models by undercutting their own prices. Arguing over rate changes is only dealing with the end of a long chain of errors and problems. All that will likely be accomplished is more insurance vs. provider bickering over pricing, or worse yet, a reduction in services that leads to longer queues and less access to care–in essence, an intensification of the status quo. Instead, achieving cost savings and better care by changing the delivery model should be the goal, because those benefits will travel up the chain of care. The Patient Protection and Affordable Care Act makes some efforts, albeit incomplete, to consider this problem. It allocated money to promote electronic medical records, which, if properly deployed, can greatly increase continuity and efficacy of care. It created a group to evaluate comparative effectiveness–determining which treatments and drugs are most effective. It tasked pilot programs to experiment with alternative payment schemes like Accountable Care Organizations. But what happens when the pilot programs’ time is up and the results are in? These initiatives are worthy experiments, but they are each only a piece of re-building a new delivery model that could deliver more for less. Ensuring that we continue to progress down that road will require more attention, more effort, and more political passion. And it starts by redirecting our focus away from the old health care business model and the endless battles it produces. Darius Tahir is a health care researcher with Innosight Institute . Clayton Christensen is a professor at the Harvard Business School and co-founder of Innosight Institute.

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Sen. Dianne Feinstein: Urgent Action Necessary to Stop Health Insurance Corporation Greed

July 1, 2010

Once again, a major health insurance company has been forced to rescind plans for double-digit rate hikes on California consumers after an independent investigation discovered “errors” in the formulas used to calculate the figures. Aetna has scrapped plans for rate hikes of nearly 20 percent, just two months after Anthem Blue Cross — a subsidiary of WellPoint, Inc. — was forced to cancel controversial plans for rate hikes of nearly 40 percent. (Yesterday, Anthem submitted a new proposal for rate increases of up to 20 percent .) Aetna and Anthem are passing these discrepancies off as honest mistakes, but I think the fact that two of California’s four major health insurance companies were caught using flawed formulas to calculate rate is something that raises serious questions. How could two separate multi-billion dollar companies make the same kind of mistakes — miscalculations that nearly resulted in major increases in the cost of health insurance premiums? How many more errors will be found, in California and across the nation, if independent investigations were conducted on a wider sample of health insurance companies? At a time of great hardship for many Americans, it is unconscionable that these mega-corporations can simply misplace a few decimal points and quickly rack up millions in unjust profits. Given the recent instances of corporate malfeasance that have shaken Wall Street to its core and created a disaster of historical proportions in the Gulf of Mexico, these actions beg for more scrutiny. I believe it is time to shine a bright spotlight on how health insurance companies calculate the need for rate hikes. Two bills — one pending in the United States Senate, and another awaiting action by the California state legislature — would allow for greater scrutiny and oversight of the health insurance industry. In March, I introduced legislation that would create a Health Insurance Rate Authority to empower the U.S. Secretary of Health and Human Services to review rate hike proposals and reject any that are not justified. States where the Insurance Commissioner already has authority to review and block rates would not be affected by this law. In states where insurance companies do not need approval to impose rate increases, this law would prevent unjustified rate hikes between now and 2014, when new health insurance exchanges go into effect. Unless we take action, we can expect for-profit health insurance corporations to inflate premium rates as much as possible during this interim period. President Obama supported my proposal and sought to have it included in the health insurance reform that passed into law, but Senate procedural rules resulted in its exclusion from the final package. I am continuing to work across party lines in Washington to build support for a version of the bill, but this is a painstaking process in a Senate chamber that is more divided than I have ever seen it. California’s state leaders, however, can take immediate action to protect the state’s consumers from unfair rate hikes by supporting Assembly Bill 2578, which was passed by the Senate Health Committee last week. AB 2578, authored by Assemblymen Dave Jones and Mike Feuer, would require health insurance companies to receive state approval before increasing premium rates. If the bill is signed into law, California would become one of those states – like New York and some 25 others — where Insurance Commissioners have the power to protect consumers from greedy rate hikes. The decision by Anthem and Aetna to withdraw their flawed rate hike proposals provides a temporary reprieve for hundreds of thousands of Californians, but they only halted the hikes after their bad math was revealed. This problem is not going away — and it may be more widespread than we imagine. There’s only one way to find out. We must grant the Secretary of Health and Human Services — or the state insurance commissioner — the power to review and reject unfair rate hikes. Without independent actuarial reviews of Anthem and Aetna, Californians would have overpaid their health insurance premiums by tens of millions of dollars. We must plug the Rate Hike Loophole. I will continue to work on a national solution to the problem in Washington, but state leaders must act with urgency to protect Californians from health insurance corporation greed. Too many Californians are struggling to pay their bills and make ends meet, and they shouldn’t have to worry about losing their health insurance because they can’t afford it. They need, and deserve, urgent action to protect them from unjust rate hikes.

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New York Avoids Government Shutdown as Lawmakers Pass Weekly Stopgap Bills

June 14, 2010

By Michael Quint June 14 (Bloomberg) — The New York Senate passed emergency spending bills for the 11th consecutive week, avoiding a state government shutdown as lawmakers debate how to close an $8.5 billion budget deficit for the year that began April 1. Agency heads and their 150,000 workers had been making contingency plans if the measures failed and left the state without authority to pay all its bills. Employees were warned that buildings might close and some of them wouldn’t be working tomorrow if the appropriation bills didn’t pass by midnight, according to agency memos. State Senator Pedro Espada , the Bronx Democrat whose threats to oppose the bills ignited warnings of “chaos in the streets” from Governor David Paterson , said June 10 that the government of the third most-populous U.S. state would stay open and he would support the measure today. Paterson won $775 million in annualized reductions, mostly from the Medicaid program, and savings in last week’s bill. That narrowed a projected $9.2 billion deficit in Paterson’s $135.2 billion fiscal 2011 budget proposal, presented in February, to about $8.5 billion. On June 11, Paterson recommended an annual spending plan for human services, such as welfare; and mental health services, such as residences for the disabled, that reduced outlays by $327 million, said Robert Megna , the state budget director. The bills submitted today cut spending by the same amount, said Morgan Hook , a spokesman for Paterson. Welfare Payments The measures approved would extend a 10 percent increase in welfare payments to the poor that took effect June 1. In January, Paterson proposed delaying half the boost. Revenue from bonds and other sources, such as allowing wine sales in grocery stores or higher cigarette taxes, are needed to avoid “pain and the destruction of human services in this state that would be unprecedented,” Espada said. The shutdown threat eased further today when Republican Senator Tom Libous , the chamber’s second-ranking Republican, said lawmakers would pass the bill. Democrats hold a 32 to 30 majority in the Senate, the minimum number needed to pass bills if all Republicans vote no as they have the past three weeks. To contact the reporter on this story: Michael Quint in Albany, New York, at mquint@bloomberg.net .

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Vermont Backs Off Attempt To Take Seniors’ Federal Drug Rebates

June 14, 2010

MONTPELIER, Vt. — Top Vermont officials relented Monday, saying they would not try to collect $250 federal rebates going to some Medicare beneficiaries for prescription drug costs, falling into line with the Obama administration and its own U.S. senators. As recently as Monday morning, a top aide to Gov. Jim Douglas was saying the state would go ahead with plans to ask recipients of checks designed to address the so-called Medicare prescription drug “doughnut hole” to turn the money over to the state. But by the end of the day, Heidi Tringe, Douglas’ deputy chief of staff, said administration officials had given up the idea of collecting the money, in part because of the logistical problems connected with try to get people receiving $250 checks in the mail to turn them over to the state. As he gave in, Douglas on Monday afternoon sent an angry letter to U.S. Health and Human Services Secretary Kathleen Sebelius. “I certainly hope this is not indicative of what lies ahead for collaboration between HHS and states that have taken the lead on health care reform,” he wrote. In a letter to Douglas on Friday, Sebelius, a former Kansas governor, said she understood the states’ financial problems. She wrote that “there is no doubt states face significant financial pressures this year, ” but added, “The rebate checks are intended to provide fiscal relief to seniors, not states.” Sen. Patrick Leahy, D-Vt., and Sen. Bernie Sanders, I-Vt., issued a joint statement on Friday criticizing Vermont’s efforts to collect the rebates. “At a time when Vermont seniors are hurting, the state should reconsider its plans to ask many low-income seniors to return this much-needed help,” the senators’ statement said. “The state’s rebate recall also would add confusion and new layers of complexity for seniors and for the state.” On Monday, Leahy praised the state for changing course. “This is a fair and practical outcome, and I commend Governor Douglas and our legislative leaders for reconsidering the rebate issue,” he said in a statement. The Republican governor argued that with its VPharm program, Vermont had taken steps many other states hadn’t: paying premiums allowing low-income seniors to take advantage of federal Medicare Part D prescription drug coverage, as well as help in covering the gap – the “doughnut hole” – between when an individual’s drug costs exceed the Medicare coverage and when catastrophic coverage takes over. The $250 rebates offered under the federal health care legislation are designed to help fill the same gap. Douglas argued in his letter to Sebelius that “without (the state) capturing the rebates, beneficiaries would essentially be receiving the same benefit twice.” Lawmakers had counted on recouping the money when they crafted a very tight budget this year. Dropping the effort to recoup the funds will cost the state about $590,000, said Rep. Martha Heath, D-Westford, chairwoman of the House Appropriations Committee. “It’s disappointing that the implementation of this law wasn’t set up to recognize the states that were already giving seniors this benefit,” she said.

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Sebelius Warns Employers Not To Jack Up Health Care Costs

June 14, 2010

WASHINGTON — The Obama administration had a message Monday for employers who want to keep federal bureaucrats from rewriting the rules for their company medical plans: Don’t jack up costs for workers, and you won’t have to worry about interference from the new health care law. “What we don’t want is a massive shift of costs to employees,” said Health and Human Services Secretary Kathleen Sebelius. She announced a new regulation that spells out how health plans that predate the health overhaul law can avoid its full impact. Meant to deliver on President Barack Obama’s promise that people who like their current health coverage can keep it, the rule sets limits likely to become increasingly important as medical costs keep rising. Plan changes that would cause a health plan to lose its “grandfathered” status and trigger new federal requirements include: _ Dropping coverage for a particular health problem, for example, diabetes. _ Increasing the proportion of insurance paid by workers, for example from 20 percent of the hospital bill to 25 percent. _ Cutting back the share of premiums that the company pays by more than 5 percent. _ Significantly increasing annual deductibles or co-payments paid by workers. For example, if an employer raises a $1,000 deductible by $500 over the next two years. Workplace coverage is the mainstay of the nation’s health insurance system, and will remain so under the new law. Consumer advocates said the regulation gives employers the flexibility to make needed changes, while protecting workers. “If a plan changes in some significant way, or if it increases cost-sharing amounts, then that results in a very different plan – and it should not be grandfathered in,” said Ron Pollack, executive director of Families USA, an advocacy group that supports the overhaul law. Employers are wary. “It’s a big unknown,” said Steve Wojcik, vice president of the National Business Group on Health, which represents human resources managers at major companies. “It definitely sets boundaries where plans have been used to considering all kinds of changes to both improve quality and control costs.” For example, Wojcik said it’s unclear whether a plan would lose its protected status by making a change such as requiring counseling and dieting before approval of weight-loss surgery. And converting from traditional health insurance to a policy with a health savings account might lead to problems because the latter have significantly higher deductibles. The administration’s own analysis suggests it may not be easy for current plans to keep their special protected status. By 2013, two-thirds of small employer plans will have to relinquish their “grandfathered” status, along with 45 percent of large company plans, according to regulators’ projections. Those plans will have to comply with a range of federal requirements on benefits. The rule, effective immediately, is “a key part of a balanced approach” that will “provide Americans who like their plans with stability,” Sebelius said. It won’t be a free ride for workers, said Wojcik. “Part of the bargain is that employers will be facing higher costs,” he said. “The percentage share of the premiums will remain the same, but costs are going to go up for both sides in terms of dollars.”

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Sebelius Warns Employers Not To Jack Up Health Care Costs

June 14, 2010

WASHINGTON — The Obama administration had a message Monday for employers who want to keep federal bureaucrats from rewriting the rules for their company medical plans: Don’t jack up costs for workers, and you won’t have to worry about interference from the new health care law. “What we don’t want is a massive shift of costs to employees,” said Health and Human Services Secretary Kathleen Sebelius. She announced a new regulation that spells out how health plans that predate the health overhaul law can avoid its full impact. Meant to deliver on President Barack Obama’s promise that people who like their current health coverage can keep it, the rule sets limits likely to become increasingly important as medical costs keep rising. Plan changes that would cause a health plan to lose its “grandfathered” status and trigger new federal requirements include: _ Dropping coverage for a particular health problem, for example, diabetes. _ Increasing the proportion of insurance paid by workers, for example from 20 percent of the hospital bill to 25 percent. _ Cutting back the share of premiums that the company pays by more than 5 percent. _ Significantly increasing annual deductibles or co-payments paid by workers. For example, if an employer raises a $1,000 deductible by $500 over the next two years. Workplace coverage is the mainstay of the nation’s health insurance system, and will remain so under the new law. Consumer advocates said the regulation gives employers the flexibility to make needed changes, while protecting workers. “If a plan changes in some significant way, or if it increases cost-sharing amounts, then that results in a very different plan – and it should not be grandfathered in,” said Ron Pollack, executive director of Families USA, an advocacy group that supports the overhaul law. Employers are wary. “It’s a big unknown,” said Steve Wojcik, vice president of the National Business Group on Health, which represents human resources managers at major companies. “It definitely sets boundaries where plans have been used to considering all kinds of changes to both improve quality and control costs.” For example, Wojcik said it’s unclear whether a plan would lose its protected status by making a change such as requiring counseling and dieting before approval of weight-loss surgery. And converting from traditional health insurance to a policy with a health savings account might lead to problems because the latter have significantly higher deductibles. The administration’s own analysis suggests it may not be easy for current plans to keep their special protected status. By 2013, two-thirds of small employer plans will have to relinquish their “grandfathered” status, along with 45 percent of large company plans, according to regulators’ projections. Those plans will have to comply with a range of federal requirements on benefits. The rule, effective immediately, is “a key part of a balanced approach” that will “provide Americans who like their plans with stability,” Sebelius said. It won’t be a free ride for workers, said Wojcik. “Part of the bargain is that employers will be facing higher costs,” he said. “The percentage share of the premiums will remain the same, but costs are going to go up for both sides in terms of dollars.”

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Obama Said to Name Health Scholar Berwick as Head of Medicare, Medicaid

March 27, 2010

By Hans Nichols and Viola Gienger March 27 (Bloomberg) — President Barack Obama plans to nominate Donald Berwick , a Harvard University health-policy professor, to oversee the Medicare and Medicaid programs, an administration official said. As head of the Centers for- Medicare and Medicaid Services, Berwick would run nation’s health insurance programs for the elderly and the poor. The agency, part of the Department of Health and Human Services, will play a large role in implementing the president’s health care overhaul. The position requires Senate confirmation. Obama announced plans today to install 15 nominees to other administration positions by recess appointments, which bypass the need for Senate confirmation. Berwick wasn’t on that list because he hasn’t yet been nominated by the president, said the official, who spoke on the condition of anonymity. Berwick is a pediatrician and health policy expert who runs the nonprofit Institute for Healthcare Improvement in Cambridge, Massachusetts. To contact the reporter on this story: Hans Nichols in Washington at hnichols2@bloomberg.net

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Health-Care Changes to Start Taking Effect This Year (Correct)

March 24, 2010

By Shannon Pettypiece and Alex Nussbaum (Corrects effective date in first paragraph. Story first moved March 23.) March 23 (Bloomberg) — Indoor tanning salons will charge customers a 10 percent tax beginning in July in one of the changes Americans will see as a result of the U.S. health-care overhaul signed into law by President Barack Obama . Insurers will be required by September to begin providing health coverage to kids with pre-existing illnesses and allow parents to keep children younger than 26 on their plans as the clock has begun ticking on many of the law’s provisions. Medicare recipients will receive a $250 rebate for prescription drugs when they reach a coverage gap called the donut hole if the Senate passes and the president signs companion legislation approved March 21 by the U.S. House. The $940 billion overhaul subsidizes coverage for uninsured Americans, financed by Medicare cuts to hospitals and fees or taxes on insurers, drugmakers, medical-device companies and Americans earning more than $200,000 a year. Many of the changes in the bill of more than 2,400 pages, such as requiring most people to have health insurance and employers to provide coverage, will take at least two years to go into effect. “Most of the major public policy changes embodied in the health care reform legislation will become effective only after the next presidential election in 2012,” said Maury Harris , an economist with UBS AG , said in a research report. High-Risk Pools Within 90 days, the law will provide immediate access to high-risk insurance plans for people who can’t get insurance because of a pre-existing medical problem, Harris said. These high-risk pools will be funded by $5 billion in federal grants. Companies led by Minnetonka, Minnesota-based UnitedHealth Group Inc. , the largest health insurer, will be banned within six months from dropping a person’s coverage because of severe illness and from limiting lifetime or annual benefits. Participants in Medicare, the U.S. government’s health coverage for those 65 and older, are expected get a $250 rebate toward prescription drugs once their benefits run out — a coverage gap know as the “doughnut hole.” The benefit is part of the package of amendments to the legislation now pending in the Senate. Drugmakers led by New York-based Pfizer Inc. will have to offer discounted drugs to Medicare recipients next year, according to an analysis of the legislation by the Kaiser Family Foundation, a nonprofit group based in Menlo Park, California In 2013, individuals whose annual income is more than $200,000 and couples making more than $250,000 will see an increase in Medicare payroll taxes. Those taxes will also be expanded to cover dividend, interest and other unearned income. Employer Coverage In 2014, employers with more than 50 employees will be required to provide health coverage and most people will be required to have health insurance, Harris said in his report. A tax on high-cost “Cadillac” policies won’t go into effect until 2018. The insurance industry also faces about $60 billion in additional fees under the health bill through 2018, and more beyond, though it was able to postpone the levy until 2014. By 2019, the bill is expected to have expanded health insurance coverage to 32 million people, according to UBS’s Harris. The U.S. Health and Human Services Department will have two years to set penalties on hospitals with high readmission rates and longer to test new payment systems for Franklin, Tennessee- based Community Health Systems Inc. , the largest U.S. chain, and its rivals. Financial Disclosure Insurers also will have to reveal how much of members’ premiums they spend on medical care, as opposed to executive salaries or other administrative costs. Next year, they’ll owe a rebate to customers if the insurers spend less than 80 percent on benefits for people in individual or small-group plans. Starting in 2014, states have their say. The legislation leaves it to them to set up and run the online marketplaces, known as exchanges, where customers will comparison-shop for coverage. Among other powers, the exchanges will be able to banish plans for premium increases deemed to be unjustified. The legislation also creates an Independent Payment Advisory Board to suggest cuts in spending by Medicare, the government health program for the elderly and disabled, that could threaten payments for drug and device-makers. Starting in 2014, the panel’s recommendations would take effect unless federal lawmakers substitute their own reductions. To contact the reporter on this story: Alex Nussbaum in New York anussbaum1@bloomberg.net ; Shannon Pettypiece in New York spettypiece@bloomberg.net

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Health-Care Changes to Start Taking Effect This Year (Correct)

March 24, 2010

By Shannon Pettypiece and Alex Nussbaum (Corrects effective date in first paragraph. Story first moved March 23.) March 23 (Bloomberg) — Indoor tanning salons will charge customers a 10 percent tax beginning in July in one of the changes Americans will see as a result of the U.S. health-care overhaul signed into law by President Barack Obama . Insurers will be required by September to begin providing health coverage to kids with pre-existing illnesses and allow parents to keep children younger than 26 on their plans as the clock has begun ticking on many of the law’s provisions. Medicare recipients will receive a $250 rebate for prescription drugs when they reach a coverage gap called the donut hole if the Senate passes and the president signs companion legislation approved March 21 by the U.S. House. The $940 billion overhaul subsidizes coverage for uninsured Americans, financed by Medicare cuts to hospitals and fees or taxes on insurers, drugmakers, medical-device companies and Americans earning more than $200,000 a year. Many of the changes in the bill of more than 2,400 pages, such as requiring most people to have health insurance and employers to provide coverage, will take at least two years to go into effect. “Most of the major public policy changes embodied in the health care reform legislation will become effective only after the next presidential election in 2012,” said Maury Harris , an economist with UBS AG , said in a research report. High-Risk Pools Within 90 days, the law will provide immediate access to high-risk insurance plans for people who can’t get insurance because of a pre-existing medical problem, Harris said. These high-risk pools will be funded by $5 billion in federal grants. Companies led by Minnetonka, Minnesota-based UnitedHealth Group Inc. , the largest health insurer, will be banned within six months from dropping a person’s coverage because of severe illness and from limiting lifetime or annual benefits. Participants in Medicare, the U.S. government’s health coverage for those 65 and older, are expected get a $250 rebate toward prescription drugs once their benefits run out — a coverage gap know as the “doughnut hole.” The benefit is part of the package of amendments to the legislation now pending in the Senate. Drugmakers led by New York-based Pfizer Inc. will have to offer discounted drugs to Medicare recipients next year, according to an analysis of the legislation by the Kaiser Family Foundation, a nonprofit group based in Menlo Park, California In 2013, individuals whose annual income is more than $200,000 and couples making more than $250,000 will see an increase in Medicare payroll taxes. Those taxes will also be expanded to cover dividend, interest and other unearned income. Employer Coverage In 2014, employers with more than 50 employees will be required to provide health coverage and most people will be required to have health insurance, Harris said in his report. A tax on high-cost “Cadillac” policies won’t go into effect until 2018. The insurance industry also faces about $60 billion in additional fees under the health bill through 2018, and more beyond, though it was able to postpone the levy until 2014. By 2019, the bill is expected to have expanded health insurance coverage to 32 million people, according to UBS’s Harris. The U.S. Health and Human Services Department will have two years to set penalties on hospitals with high readmission rates and longer to test new payment systems for Franklin, Tennessee- based Community Health Systems Inc. , the largest U.S. chain, and its rivals. Financial Disclosure Insurers also will have to reveal how much of members’ premiums they spend on medical care, as opposed to executive salaries or other administrative costs. Next year, they’ll owe a rebate to customers if the insurers spend less than 80 percent on benefits for people in individual or small-group plans. Starting in 2014, states have their say. The legislation leaves it to them to set up and run the online marketplaces, known as exchanges, where customers will comparison-shop for coverage. Among other powers, the exchanges will be able to banish plans for premium increases deemed to be unjustified. The legislation also creates an Independent Payment Advisory Board to suggest cuts in spending by Medicare, the government health program for the elderly and disabled, that could threaten payments for drug and device-makers. Starting in 2014, the panel’s recommendations would take effect unless federal lawmakers substitute their own reductions. To contact the reporter on this story: Alex Nussbaum in New York anussbaum1@bloomberg.net ; Shannon Pettypiece in New York spettypiece@bloomberg.net

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Health-Care Overhaul Changes to Start Taking Effect This Year

March 23, 2010

By Shannon Pettypiece and Alex Nussbaum March 23 (Bloomberg) — Indoor tanning salons will charge customers a 10 percent tax beginning today in just one of the changes Americans will see as a result of the U.S. health-care overhaul signed into law by President Barack Obama . Insurers will be required by September to begin providing health coverage to kids with pre-existing illnesses and allow parents to keep children younger than 26 on their plans as the clock has begun ticking on many of the law’s provisions. Medicare recipients will receive a $250 rebate for prescription drugs when they reach a coverage gap called the donut hole if the Senate passes and the president signs companion legislation approved March 21 by the U.S. House. The $940 billion overhaul subsidizes coverage for uninsured Americans, financed by Medicare cuts to hospitals and fees or taxes on insurers, drugmakers, medical-device companies and Americans earning more than $200,000 a year. Many of the changes in the bill of more than 2,400 pages, such as requiring most people to have health insurance and employers to provide coverage, will take at least two years to go into effect. “Most of the major public policy changes embodied in the health care reform legislation will become effective only after the next presidential election in 2012,” said Maury Harris , an economist with UBS AG , said in a research report. High-Risk Pools Within 90 days, the law will provide immediate access to high-risk insurance plans for people who can’t get insurance because of a pre-existing medical problem, Harris said. These high-risk pools will be funded by $5 billion in federal grants. Companies led by Minnetonka, Minnesota-based UnitedHealth Group Inc. , the largest health insurer, will be banned within six months from dropping a person’s coverage because of severe illness and from limiting lifetime or annual benefits. Participants in Medicare, the U.S. government’s health coverage for those 65 and older, are expected get a $250 rebate toward prescription drugs once their benefits run out — a coverage gap know as the “doughnut hole.” The benefit is part of the package of amendments to the legislation now pending in the Senate. Drugmakers led by New York-based Pfizer Inc. will have to offer discounted drugs to Medicare recipients next year, according to an analysis of the legislation by the Kaiser Family Foundation, a nonprofit group based in Menlo Park, California In 2013, individuals whose annual income is more than $200,000 and couples making more than $250,000 will see an increase in Medicare payroll taxes. Those taxes will also be expanded to cover dividend, interest and other unearned income. Employer Coverage In 2014, employers with more than 50 employees will be required to provide health coverage and most people will be required to have health insurance, Harris said in his report. A tax on high-cost “Cadillac” policies won’t go into effect until 2018. The insurance industry also faces about $60 billion in additional fees under the health bill through 2018, and more beyond, though it was able to postpone the levy until 2014. By 2019, the bill is expected to have expanded health insurance coverage to 32 million people, according to UBS’s Harris. The U.S. Health and Human Services Department will have two years to set penalties on hospitals with high readmission rates and longer to test new payment systems for Franklin, Tennessee- based Community Health Systems Inc. , the largest U.S. chain, and its rivals. Financial Disclosure Insurers also will have to reveal how much of members’ premiums they spend on medical care, as opposed to executive salaries or other administrative costs. Next year, they’ll owe a rebate to customers if the insurers spend less than 80 percent on benefits for people in individual or small-group plans. Starting in 2014, states have their say. The legislation leaves it to them to set up and run the online marketplaces, known as exchanges, where customers will comparison-shop for coverage. Among other powers, the exchanges will be able to banish plans for premium increases deemed to be unjustified. The legislation also creates an Independent Payment Advisory Board to suggest cuts in spending by Medicare, the government health program for the elderly and disabled, that could threaten payments for drug and device-makers. Starting in 2014, the panel’s recommendations would take effect unless federal lawmakers substitute their own reductions. To contact the reporter on this story: Alex Nussbaum in New York anussbaum1@bloomberg.net ; Shannon Pettypiece in New York spettypiece@bloomberg.net

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Health-Care Overhaul Bill Signed by Obama to Start Taking Effect This Year

March 23, 2010

By Shannon Pettypiece and Alex Nussbaum March 23 (Bloomberg) — Indoor tanning salons will charge customers a 10 percent tax beginning today in just one of the changes Americans will see as a result of the U.S. health-care overhaul signed into law by President Barack Obama . Insurers will be required by September to begin providing health coverage to kids with pre-existing illnesses and allow parents to keep children younger than 26 on their plans as the clock has begun ticking on many of the law’s provisions. Medicare recipients will receive a $250 rebate for prescription drugs when they reach a coverage gap called the donut hole if the Senate passes and the president signs companion legislation approved March 21 by the U.S. House. The $940 billion overhaul subsidizes coverage for uninsured Americans, financed by Medicare cuts to hospitals and fees or taxes on insurers, drugmakers, medical-device companies and Americans earning more than $200,000 a year. Many of the changes in the bill of more than 2,400 pages, such as requiring most people to have health insurance and employers to provide coverage, will take at least two years to go into effect. “Most of the major public policy changed embodied in the health care reform legislation will become effective only after the next presidential election in 2012,” said Maury Harris , an economist with UBS AG , said in a research report. High-Risk Pools Within 90 days, the law will provide immediate access to high-risk insurance plans for people who can’t get insurance because of a pre-existing medical problem, Harris said. These high-risk pools will be funded by $5 billion in federal grants. Companies led by Minnetonka, Minnesota-based UnitedHealth Group Inc. , the largest health insurer, will be banned within six months from dropping a person’s coverage because of severe illness and from limiting lifetime or annual benefits. Participants in Medicare, the U.S. government’s health coverage for those 65 and older, are expected get a $250 rebate toward prescription drugs once their benefits run out — a coverage gap know as the “doughnut hole.” The benefit is part of the package of amendments to the legislation now pending in the Senate. Drugmakers led by New York-based Pfizer Inc. will have to offer discounted drugs to Medicare recipients next year, according to an analysis of the legislation by the Kaiser Family Foundation, a nonprofit group based in Menlo Park, California In 2013, individuals whose annual income is more than $200,000 and couples making more than $250,000 will see an increase in Medicare payroll taxes. Those taxes will also be expanded to cover dividend, interest and other unearned income. Employer Coverage In 2014, employers with more than 50 employees will be required to provide health coverage and most people will be required to have health insurance, Harris said in his report. A tax on high-cost “Cadillac” policies won’t go into effect until 2018. The insurance industry also faces about $60 billion in additional fees under the health bill through 2018, and more beyond, though it was able to postpone the levy until 2014. By 2019, the bill is expected to have expanded health insurance coverage to 32 million people, according to UBS’s Harris. The U.S. Health and Human Services Department will have two years to set penalties on hospitals with high readmission rates and longer to test new payment systems for Franklin, Tennessee- based Community Health Systems Inc. , the largest U.S. chain, and its rivals. Financial Disclosure Insurers also will have to reveal how much of members’ premiums they spend on medical care, as opposed to executive salaries or other administrative costs. Next year, they’ll owe a rebate to customers if the insurers spend less than 80 percent on benefits for people in individual or small-group plans. Starting in 2014, states have their say. The legislation leaves it to them to set up and run the online marketplaces, known as exchanges, where customers will comparison-shop for coverage. Among other powers, the exchanges will be able to banish plans for premium increases deemed to be unjustified. The legislation also creates an Independent Payment Advisory Board to suggest cuts in spending by Medicare, the government health program for the elderly and disabled, that could threaten payments for drug and device-makers. Starting in 2014, the panel’s recommendations would take effect unless federal lawmakers substitute their own reductions. To contact the reporter on this story: Alex Nussbaum in New York anussbaum1@bloomberg.net ; Shannon Pettypiece in New York spettypiece@bloomberg.net

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Health-Care Overhaul Bill Signed by Obama to Start Taking Effect This Year

March 23, 2010

By Shannon Pettypiece and Alex Nussbaum March 23 (Bloomberg) — Indoor tanning salons will charge customers a 10 percent tax beginning today in just one of the changes Americans will see as a result of the U.S. health-care overhaul signed into law by President Barack Obama . Insurers will be required by September to begin providing health coverage to kids with pre-existing illnesses and allow parents to keep children younger than 26 on their plans as the clock has begun ticking on many of the law’s provisions. Medicare recipients will receive a $250 rebate for prescription drugs when they reach a coverage gap called the donut hole if the Senate passes and the president signs companion legislation approved March 21 by the U.S. House. The $940 billion overhaul subsidizes coverage for uninsured Americans, financed by Medicare cuts to hospitals and fees or taxes on insurers, drugmakers, medical-device companies and Americans earning more than $200,000 a year. Many of the changes in the bill of more than 2,400 pages, such as requiring most people to have health insurance and employers to provide coverage, will take at least two years to go into effect. “Most of the major public policy changed embodied in the health care reform legislation will become effective only after the next presidential election in 2012,” said Maury Harris , an economist with UBS AG , said in a research report. High-Risk Pools Within 90 days, the law will provide immediate access to high-risk insurance plans for people who can’t get insurance because of a pre-existing medical problem, Harris said. These high-risk pools will be funded by $5 billion in federal grants. Companies led by Minnetonka, Minnesota-based UnitedHealth Group Inc. , the largest health insurer, will be banned within six months from dropping a person’s coverage because of severe illness and from limiting lifetime or annual benefits. Participants in Medicare, the U.S. government’s health coverage for those 65 and older, are expected get a $250 rebate toward prescription drugs once their benefits run out — a coverage gap know as the “doughnut hole.” The benefit is part of the package of amendments to the legislation now pending in the Senate. Drugmakers led by New York-based Pfizer Inc. will have to offer discounted drugs to Medicare recipients next year, according to an analysis of the legislation by the Kaiser Family Foundation, a nonprofit group based in Menlo Park, California In 2013, individuals whose annual income is more than $200,000 and couples making more than $250,000 will see an increase in Medicare payroll taxes. Those taxes will also be expanded to cover dividend, interest and other unearned income. Employer Coverage In 2014, employers with more than 50 employees will be required to provide health coverage and most people will be required to have health insurance, Harris said in his report. A tax on high-cost “Cadillac” policies won’t go into effect until 2018. The insurance industry also faces about $60 billion in additional fees under the health bill through 2018, and more beyond, though it was able to postpone the levy until 2014. By 2019, the bill is expected to have expanded health insurance coverage to 32 million people, according to UBS’s Harris. The U.S. Health and Human Services Department will have two years to set penalties on hospitals with high readmission rates and longer to test new payment systems for Franklin, Tennessee- based Community Health Systems Inc. , the largest U.S. chain, and its rivals. Financial Disclosure Insurers also will have to reveal how much of members’ premiums they spend on medical care, as opposed to executive salaries or other administrative costs. Next year, they’ll owe a rebate to customers if the insurers spend less than 80 percent on benefits for people in individual or small-group plans. Starting in 2014, states have their say. The legislation leaves it to them to set up and run the online marketplaces, known as exchanges, where customers will comparison-shop for coverage. Among other powers, the exchanges will be able to banish plans for premium increases deemed to be unjustified. The legislation also creates an Independent Payment Advisory Board to suggest cuts in spending by Medicare, the government health program for the elderly and disabled, that could threaten payments for drug and device-makers. Starting in 2014, the panel’s recommendations would take effect unless federal lawmakers substitute their own reductions. To contact the reporter on this story: Alex Nussbaum in New York anussbaum1@bloomberg.net ; Shannon Pettypiece in New York spettypiece@bloomberg.net

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Health-Care Fight Shifts to U.S. Regulators, Statehouses After House Vote

March 22, 2010

By Alex Nussbaum March 22 (Bloomberg) — Health legislation passed yesterday by the U.S. House changes some rules immediately on insurance coverage while leaving much of the fight over how to remake the medical system to federal regulators, states and courts. Insurers led by UnitedHealth Group Inc. and WellPoint Inc. must cover children with pre-existing health problems at once under the legislation, headed for a Senate vote, and let parents keep children on their insurance plans through age 26. The insurers will also be banned from revoking coverage because of severe illness and from limiting lifetime or annual benefits. Beyond those changes, it will be up to U.S. regulators and state lawmakers to structure the marketplaces where health plans will compete, write the rules governing their profit and decide which medical benefits must be covered. While insurers may gain as many as 32 million customers, the potential for pumped-up profits remains unclear, said Sheryl Skolnick , a health-industry analyst at CRT Capital Group LLC. “There’s going to be a whole other round of uncertainty associated with the implementation of this,” she said in a telephone interview March 19. “There’ll be much, much more to fight on and much, much more to write on.” The U.S. Health and Human Services Department will have two years to set penalties on hospitals with high readmission rates and longer to test new payment systems for Franklin, Tennessee- based Community Health Systems Inc. , the largest U.S. chain, and its rivals. Officials in Idaho and Virginia have promised lawsuits over the bills’ mandate that all Americans get insured. Senate, Obama Democrats must shepherd the package of changes through the U.S. Senate before President Barack Obama can sign their $940 billion health-care overhaul, one of his top domestic priorities, into law. The measures subsidize coverage for uninsured Americans, financed by Medicare cuts to hospitals and fees or taxes on insurers, drugmakers, medical-device companies and Americans earning more than $200,000 a year. The tax on those earners begins in 2013. The subsidies and the expansion of Medicaid, the joint federal-state program for the poor, won’t kick in until 2014. Other changes will take effect with Obama’s pen stroke. While the measure immediately bans insurers from barring coverage for children with pre-existing conditions, adults won’t be protected until 2014. Until then, they’ll be eligible to join high-risk pools funded by $5 billion in federal grants. The drug industry, led by New York-based Pfizer Inc. , will begin offering discounted drugs to elderly Medicare patients next year, part of $80 billion in concessions agreed to by pharmaceutical companies. Generic copies of biotechnology drugs will be allowed for the first time, though the Food and Drug Administration must draft rules governing the process. Revealing Costs Insurers also will have to reveal how much of members’ premiums they spend on medical care, as opposed to executive salaries or other administrative costs. Next year, they’ll owe a rebate to customers if the insurers spend less than 80 percent on benefits for people in individual or small-group plans. How heavy a burden that imposes on industry will depend on the health and human services department, said Carl McDonald , an Oppenheimer & Co. analyst in New York, in a March 17 note to clients. The cap will be easier to meet if it’s applied companywide rather than to individual lines of business, he said. The agency also will set formulas for Medicare payments, define the “essential benefits” that insurers must provide and draft rules on how carriers verify claims and pay doctors. Health and Human Services Secretary Kathleen Sebelius , who has spent weeks criticizing insurers’ “jaw-dropping” rate increases, will have the final verdict, McDonald said. Out From Spotlight “Over the next couple of years, HHS will be consistently churning out regulations and documents explaining exactly how health reform will be implemented,” he said. “Given the stance of this administration toward health insurers over the past year, it’s hard to see how much of this will be favorable.” Insurers may benefit by exiting the spotlight of the current political debate, said Len Nichols , a health economist at George Mason University in Fairfax, Virginia. Their arguments that premiums are rising because medical costs are outpacing inflation may hold more sway with government actuaries, he said in a telephone interview. “It’ll get out of the blatantly political and into the hands of folks who are more used to dealing with these issues,” he said. “It will move the conversation from the headlines to the arena of the actuarial gladiators, which is probably where it should be.” Health Shares Health insurance company shares have gained 71 percent in the past 12 months, as measured by the six-member Standard & Poor’s 500 Managed-Care Index , led by the 124 percent increase for Coventry Health Care Inc. of Bethesda, Maryland. WellPoint, based in Indianapolis, is the biggest U.S. health plan by enrollment, and its shares have gained 80 percent. UnitedHealth , of Minnetonka, Minnesota, is second. Its shares have gained 61 percent over 12 months. Starting in 2014, states have their say. The legislation leaves it to them to set up and run the online marketplaces, known as exchanges, where customers will comparison-shop for coverage. Among other powers, the exchanges will be able to banish plans for premium increases deemed to be unjustified. Lawmakers may merge exchanges with neighboring states, exposing carriers to more competition. They could set up government-run insurance plans for low-income buyers ineligible for Medicaid to pool their bargaining power or apply for federal waivers to impose stricter rules on insurers. The legislation also creates an Independent Payment Advisory Board to suggest cuts in spending by Medicare, the government health program for the elderly and disabled, that could threaten payments for drug and device-makers. Starting in 2014, the panel’s recommendations would take effect unless federal lawmakers substitute their own reductions. A tax on high-cost “Cadillac” policies offered by health plans kicks in in 2018. The industry also faces about $60 billion in additional fees under the health bill through 2018, and more beyond, though it was able to postpone the levy until 2014. “We suspect that over time, the industry lobby may find ways to chip away at those payments,” said Dave Shove , a BMO Capital Markets analyst, in a March 19 note. “For now, we consider this a successful exercise in kicking the can further down the road.” To contact the reporter on this story: Alex Nussbaum in New York anussbaum1@bloomberg.net .

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HHS Leases 114,500 SF in Quincy

March 9, 2010

The Executive Office of Health and Human Services for Massachusetts signed a lease for 114,451 square feet of office space at HarborSouth Tower in Quincy. MassHealth and other related divisions will occupy floors four through eight at 100 Hancock St….

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Aetna’s Chief Cites Costs to Answer White House on Health-Insurance Rates

March 4, 2010

By Nicole Gaouette and Alexandra Thomas March 4 (Bloomberg) — Aetna Inc. ’s chief executive officer answered criticism from President Barack Obama ’s top health official over surging rates by saying unnecessary medicine is helping drive up costs. The CEO, Ronald A. Williams , told Health and Human Services Secretary Kathleen Sebelius at the White House today that “we do things that don’t need to be done in terms of paying for procedures and not paying for results.” Sebelius called the meeting with executives of the top health insurers after WellPoint Inc. , the largest health insurance company by membership, proposed a 39 percent rate increase for some policy holders in California. Obama described the proposal from the Indianapolis-based company as “just a preview” of what would happen if Congress fails to pass health- care legislation. The increases are marketwide and Americans are worried “they’re next,” Sebelius said today. At the same time, she said the CEOS and state insurance commissioners were meeting “to see what kind of ideas we can share.” Williams, whose company is based in Hartford, Connecticut, said there are “issues” in the market for health-care policies for people who must buy insurance on their own and said expanded access would help. All parts of the industry must work to hold down costs, he said, citing unnecessary medical tests as a reason health-care costs are increasing. Obama has pushed Congress to stop debating health-care and yesterday urged lawmakers move to “a final vote” on the biggest changes in the nation’s medical system in 45 years. To do so, Democrats are likely to use a parliamentary maneuver called reconciliation that requires a simple majority in the Senate. Republicans have enough votes to stop a measure under the body’s typical rules. While it has often been used to pass health legislation in the past, reconciliation faces unanimous opposition from Republicans and some Democrats say they are wary as well. Williams and Sebelius spoke before the meeting was closed to reporters. To contact the reporters on this story: Nicole Gaouette in Washington at ngaouette@bloomberg.net ; Alexandra Thomas in Washington at athomas48@bloomberg.net .

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Sanofi Speeds Swine Flu Vaccine Expirations to Mid-February After Recall

February 5, 2010

By Tom Randall Feb. 5 (Bloomberg) — Sanofi-Aventis SA shortened the expiration of its 12 million pre-filled swine flu shots by as much as 16 months to ensure the potency of the vaccine doesn’t decline. The shots should be administered by Feb. 15, according to a Web site run by the U.S. Department of Health and Human Services. The vaccines previously had expiration dates that varied from March to June 2011. Paris-based Sanofi in December recalled 800,000 doses of the shot for H1N1 influenza, known as swine flu, and AstraZeneca Plc withdrew 4.7 million spray vaccines, after tests showed the potency was too low. Flu rates in the U.S. have declined since peaking in late October, and the H1N1 virus is no longer widespread in any state, the U.S. Centers for Disease Control and Prevention reported today. More than 70 million people have received a swine flu vaccine, the Atlanta-based CDC said. The December recalls were made after routine tests showed declining potency in some batches. “The FDA and the manufacturers are really looking into this,” Anne Schuchat , head of the National Center for Immunization and Respiratory Diseases at the CDC, said today during a conference call. The declining potency of pre-filled syringes is “a special focus of attention to understand mechanically what may have been going on and to learn from that.” U.S. Vaccines The shortened expiration date only affects shots in the U.S., said Len Lavenda , a spokesman for Sanofi in Swiftwater, Pennsylvania, in a telephone interview. The shots don’t affect vaccine the company is donating to the Geneva-based World Health Organization because the donated shots are in multidose vials, not pre-filled syringes, he said. Most of the shots were shipped early in the season, and the number of unused doses that are affected by the shortened shelf life is low, said Richard Quartarone, a spokesman for the CDC, in an e-mail. All pre-filled syringes “should now be administered by Feb. 15, 2010, regardless of the expiration imprinted on the package,” according to the U.S. Web site. Sanofi’s decreased vaccine potency may have been due to the key ingredient, antigen, clinging to the wall of the syringe over time, Schuchat said after the December recall. Different Doses Multidose vials, the most common form of the vaccine, aren’t affected by the expiration change. The single-dose syringes are sometimes used for convenience and because they don’t require thimerosal, a preservative that has been shown to be safe in studies though remains controversial. Sanofi shares declined 1.74 Euros, or 3.3 percent, to close at 51.68 in Paris trading . Swine flu continues to circulate in the U.S., though at rates below average for seasonal flu in previous years, the CDC’s Schuchat said. Pneumonia and flu deaths remain at an epidemic level, above average for the season, she said. “We aren’t seeing signs of a major increase in H1N1, but we are seeing persistent transmission,” Schuchat said today. “It’s really easy to be vaccinated now, and we hope that people will take advantage of that.” The U.S. government ordered 229 million doses of antigen. About 155 million doses have been made available in the U.S., and 124 million doses have shipped throughout the country, Schuchat said. To contact the reporters on this story: Tom Randall in New York at trandall6@bloomberg.net

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Jodie Levin-Epstein: Peaceful Revolution: Paid Leave Makes Horse Sense

January 4, 2010

Vacations are good for your health. And, you don’t need to get away to any fancy Caribbean retreat to get the benefit of time-off from work. But it helps if you are a horse. In New York City, that is. The City’s Health Department has proposed new rules for those horses hitched to carriages that carry tourists around parts of town. If implemented, the horses would get 5 weeks of job-protected vacation . During their time off, the horses would continue to enjoy their standard payment — room and board, along with grooming. It is a reasonable business decision to invest in these workers since the vacation time will likely prolong their work-life and enhance their productivity. Added to the economics are the ethics of humane treatment of animals. The Health Department apparently considers the 5 weeks to be akin to a minimum labor standard. An advisory committee had urged that the horses get 8 weeks based upon ‘best practices’; in defending a shorter vacation, Daniel Kass, a department official noted, “Operators are invited to give them more.” It’s time for Congress and the U.S. Department of Health and Human Services to pony-up to the value of vacation for two-legged workers. Workers outside the federal government, that is. Federal workers are entitled to 13 vacation days starting in year one. No wonder the federal government is often viewed as a desirable employer-of-choice. For the rest of the nation’s workforce, however, no federal law provides any paid time off — and that includes vacation, holidays, and sick time. As the Department of Labor explains it, “These benefits are a matter of agreement between an employer and an employee.” One result of that ‘agreement’ is that among working parent households, fully 41 percent of those with incomes below twice the federal poverty level have no paid time off of any kind. While higher income workers tend to have paid leave, they, too, can miss out; for example 17 percent of white collar private workers have no paid vacation . And, even before the recession, what employers gave, they sometimes took away. Access to paid vacation, sick days, and holidays was less likely in 2006 compared to prior peak years. Legislation has been introduced that would begin to give the U.S. human workforce parity with the standards proposed for the Big Apple’s equine workers. A bill that would provide for paid vacations was introduced in Congress in 2009 (while all carriage horses in New York are expected to get 5 weeks, the bill in the U.S. House of Representatives for human employees would enable them to access one or two weeks, depending on the size of their employers). Other pending legislation would provide paid sick days and allow most workers to take up to 7 days in a year to treat or prevent illness, or to take care of a loved one. Numerous national organizations including MomsRising, Take Back Your Time, The National Partnership for Women and Families, and the Center for Law and Social Policy are trying to move these and related paid leave bills. Other nations provide paid time off . Nearly 160 have accepted a UN covenant which declares that all countries should “recognize the right of everyone to the enjoyment of just and favorable conditions of work which ensure, in particular, reasonable limitation of working hours and periodic holidays with pay, as well as remuneration for public holidays.” Indeed, among the world’s 15 most competitive countries , 14 provide paid sick leave, 14 provide paid annual leave, 13 guarantee a weekly day of rest, 13 provide paid leave for new mothers and 12 for new fathers according to Raising the Global Floor . Giving U.S. workers some paid time off just makes horse sense. If horses can get it, why can’t their bosses? A Peaceful Revolution is a blog about innovative ideas to strengthen America’s families through public policies, business practices, and cultural change. Done in collaboration with MomsRising.org , read a new post here each week.

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Demand for Swine Flu Vaccine Rises, Adding to U.S. Shortage, CDC Says

October 27, 2009

By Meg Tirrell Oct. 27 (Bloomberg) — The swine flu vaccine shortage is boosting demand from Americans concerned they won’t get the product in time to hold off the disease, said Thomas Frieden , director of the Centers for Disease Control and Prevention . The amount available to doctors and clinics starting this week will have risen to 22.4 million doses from about 14 million on Oct. 21, Frieden said today. The supply is still smaller than needed, he said. A U.S. health official has blamed the shortage on production delays at two drugmakers, and one manufacturer’s failure to gain regulatory approval for its product. President Barack Obama declared swine flu a national emergency Oct. 24. The disease, also known as H1N1 influenza, is widespread across the country and accounts for 411 confirmed deaths and more than 8,200 hospitalizations since Aug. 30, according to the Atlanta-based CDC. Frieden didn’t update the numbers of infected during today’s call. “We are currently in a situation where we have too little vaccine in the community,” Frieden said during a conference call with reporters. “It’s quite likely that too little vaccine is one of the things that’s making people more interested in getting vaccinated.” Health officials said last week the U.S. won’t get the 195 million doses it had planned for by the end of the year. Americans may get 42 million doses by mid-November, 8 million less than earlier U.S. estimates, said Nicole Lurie , Health and Human Services assistant secretary for preparedness and response, in an Oct. 23 telephone interview. Lurie linked the shortage to production delays. Greater Demand “When we have shortages we see an increase in demand,” Frieden said today. “In the next week or so, there will be a significant increase in the perceived and real availability of vaccine.” Frieden said medical authorities still recommend the vaccine be given first to people most at risk of severe infection from swine flu. Children and young adults ages 6 months to 24 years, pregnant women, those with underlying medical conditions and health-care workers are most at risk according to the CDC. ‘Many millions’ of H1N1 cases have occurred in the U.S. since the outbreak began in April, he said Oct. 23. “We wish we had better technology that could produce vaccine in weeks or months, rather than the six to nine months it takes with current, tried-and-true technology,” Frieden said. “It’s challenging with a limited amount of vaccine for a lot of people who want to get vaccinated.” Similar Symptoms While H1N1 produces similar symptoms and outcomes as seasonal flu in most cases, it targets a younger population and can lead to severe illness and death. The seasonal flu kills about 36,000 people a year in the U.S., though the majority of those deaths are in people over the age of 80. Ninety-five children have died from confirmed swine flu since April 2009, more than the pediatric toll for a typical year of influenza, the CDC said on its Web site, which tracks deaths from 28 states that provide data. To contact the reporter on this story: Meg Tirrell in New York at mtirrell@bloomberg.net .

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David Gray: Flu Season Shows the Need for Workplace Flexibility

October 12, 2009

The month of October is National Work Family Month . Families and workers are trying to succeed and survive in this challenging economy. Going into the Fall, the country is focused on health care. Everywhere we go we hear about it. The primary policy debates in Washington focus around health care reform. Throughout the country health care dominates town hall meetings. Layered on top of this health care debate are the national preparations this month for a possible swine flu pandemic. Schools are setting up quarantine rooms. The government is preparing for the largest inoculation campaign in a generation. Public health officials are engaging in a public education campaign designed to minimize the potential impact of swine flu. The U.S. Department of Health and Human Services has been issuing advice for how we all can reduce the likelihood of contracting swine flu. However, the Centers for Disease Control estimate that up to 40% of the U.S. workforce could be directly affected. The swine flu outbreak has potential to create great disruptions for businesses, school, government offices and employers all throughout the nation. There are many people who are used to going to work when they are a bit under the weather. However, swine flu is changing that equation. Even those who have traditionally prided themselves on going to work while a bit sick are having to rethink their plans and will be staying home now because there is a social price to be paid for going to work “sick” that wasn’t there before. More people will notice and react negatively. So many more workers will be staying home. Millions of businesses are developing contingency plans and continuity of operation plans to keep their businesses and operations going if and when critical employees are out. In just a few weeks, a significant number of American businesses could have their operations negatively affected by swine flu. The swine flu draws attention for the critical need for more workplace flexibility for American businesses. Workplace flexibility is a concept that gives workers flexibility in the how, where and the quantity of hours they work. Now is the time for a national conversation and effort to increase that flexibility. Flexible work arrangements such as telework can allow workers to be productive when they are not able to be in the office. During the swine flu epidemic, it is likely that many workers will be sick enough that they will need to stay away from work, if only to keep their coworkers from being impacted, but they will be well enough to complete substantive work. Or many will be healthy themselves, but they will be needed at home to help care for a family member or a child. Schools across the nation will identify potentially sick children and many will have to stay at home for a week or more, so their working parents will be stuck at home. During National Work & Family Month , our nation needs to recognize that putting in place legislation that meets the needs of workers and businesses by enhancing the flexibility of workplaces can make an important contribution during these months where the flu poses a risk to the American economy. The H1N1 virus highlights in dramatic form the need for workplace flexibility in America. Americans need flexibility throughout the year and throughout their lives. Whether meeting the needs of families, caring for children, staying balanced or working longer in life, workplace flexibility is good for America during this flu season and beyond. We should act now to help support the economy during this time.

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