Checking Up On Health

Advances in science; spin on the health care law and fraud in government health programs.


Benita Dodd, Vice President, Georgia Public Policy Foundation

Health Policy Briefs
Compiled by Benita M. Dodd

Bed tax,’ again: Andy Miller of Georgia Health News offers a preview of the battle that the Georgia Legislature can expect during discussion of the hospital tax, which goes toward funding the Medicaid entitlement program in the state. Children’s Healthcare of Atlanta, Grady Health System in Atlanta, Memorial University Medical Center in Savannah and HomeTown Health, an association of rural hospitals, already have delivered a letter to leading Georgia officials saying that not renewing the tax, which expires in July 2013, could double Medicaid’s already sizable financial shortfall (at $700 million for 2013-2014). And Grover Norquist of Americans for Tax reform declared, “Fiscal conservatives should not be looking to Washington for more federal aid, especially when the national debt climbed above $16 trillion for the first time last week.”

The hospital tax is based on hospital net patient revenue, making for winners and losers; individual hospitals receive funds based on the Medicaid patients they treat. Grady got more than $9 million in FY 2011; Piedmont lost $6.4 million. The tax generates more than $200 million a year in state revenues, according to the hospital coalition. When matched with federal funds, Georgia receives about $400 million in added funds to support the budget.

Beyond the stem cell: The debate over stem cell ethics may one day be a vague memory, if the advances in research are anything to go by. This week, for example, the Nobel Prize in physiology or medicine was awarded to John Gurdon of the University of Cambridge and Shinya Yamanaka of the University of Kyoto for the discovery that mature cells can be reprogrammed to become like stem cells. Induced pluripotent stem cells have applications in treatments and pharmaceutical research. Source: Bio Smartbriefs

So much for sound science: A French study connecting Monsanto’s genetically modified maize and herbicide Roundup to cancer and early death (in rats) is “of insufficient scientific quality to be considered as valid for risk assessment,” according to the European Food Safety Authority. It found inadequacies in the study’s design, reporting and analysis, which make the study’s conclusions scientifically unsound, the agency said. The German Federal Institute for Risk Assessment, too, cited flaws in the design and data presentation of the study. The study didn’t meet internationally recognized standards for carcinogenicity research and used too few animals, the institute said. “This means that the conclusions drawn by the authors are not supported by the available data,” said Reiner Wittkowski, the institute’s vice president.

We’ll get better when we get bigger … not! Medicare and Medicaid are designatedhigh-risk programs partly because their size and complexity make them vulnerable to fraud,” according to a Government Accountability Office report released today. Along with the CHIP programs, they account for $849.2 billion in federal expenditures. 

In fiscal year 2011, the federal government devoted at least $608 million to conduct to investigate fraud in the programs. (The states also investigate health care fraud in their state’s Medicaid and CHIP programs.)  Among the 10,187 subjects – individuals and entities – investigated in 2010 were different types of providers and suppliers, such as physicians, hospitals, durable medical equipment suppliers, home health agencies and pharmacies.

Many of the 7,848 criminal subjects in 2010 were medical facilities or durable medical equipment suppliers, representing about 40 percent of subjects of criminal cases. That’s not much changed from 2005, when it was at 41 percent. Prosecution was recommended in 15 percent of those cases. Civil fraud cases in 2010, meanwhile, increased about 35 percent over 2005 numbers. About one-third of the 2,339 subjects of civil cases in 2010 were hospitals and medical facilities; nearly half of the cases were pursued and more than half of those (55 percent) resulted in judgments or settlements.

Of the 2,200 individuals and entities were excluded from program participation for health care fraud convictions and other reason, about 60 percent were in the nursing profession. Read the 57-page report here:

The big picture: The Urban Institute predicts that the federal health care law (Obamacare) will increase employer-sponsored insurance coverage and reduce the cost small businesses pay for employee health coverage, once it’s fully implemented. The study released today found the number of Americans covered by employer-sponsored insurance would increase by 2.7 percent and costs-per-person for small businesses (fewer than 50 workers) would decrease by 7.3 percent. Overall for small businesses, those with fewer than 100 employees, total health insurance spending would be reduced by 1.4 percent. But Kevin Kuhlman, manager of legislative affairs for the National Federation of Independent Business, says the report “may overestimate the benefits of the law and underestimate the cost impacts of benefits on businesses.” He points out that federal regulations implementing the law’s essential health benefits package have not yet been released, and overly generous benefits will hike the cost of insurance. Plus, the report does not assess the impact of the health law’s new taxes and fees, many of which start in 2014, on the cost of health insurance. Source: Kaiser Health News

Older parents, younger adults: Many families are waiting until they are much older before they have children. A government report released in June shows pregnancy rates among older women have increased dramatically: Rates for women ages 40 to 44 went up nearly 65 percent. There were just 11.4 pregnancies per 1,000 women in that age group in 1990, compared with 18.8 in 2008. And then, of course, there are the second families. This will have an effect on some young adults, who are able to remain on their parents’ insurance up to age 26 under Obamacare. You can’t stay on Mommy and Daddy’s plan once they move to Medicare, Kaiser Health News reminds you.

Quote of Note: “What some call health, if purchased by perpetual anxiety about diet, isn’t much better than tedious disease.” – Alexander Pope

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