Checking Up On Health: June 25, 2013

Health Policy News and Views
Compiled by Benita M. Dodd

ABenitaDodd2013 long way from home: With less than 100 days to go before the main provisions of ObamaCare take effect, there are at least 99 things still outstanding, according to Sarah Kliff of The Washington Post. Among them: opening massive call centers big enough to handle 42 million calls by the end of this year. And training those call center agents on the Affordable Care Act. “You can bet there will be lots of calls: As of November, the vast majority of Americans expected to be eligible for benefits had no idea that they would become available,” Kliff points out. Read her list here.

It’s called choice? A few months back, the Obama administration took flak for initial plans to delay part of ObamaCare’s small-business exchange, the Small Business Health Options Program, or SHOP. It proposed that small businesses could still buy coverage for their employees on the new exchanges, but the employee choice component would be delayed: The employer would choose one insurance provider for everyone. When the final regulation was issued last week, Health and Human Services cemented the delay, and federal officials noted worries about getting the choice function ready to launch in less than six months. “We have serious concerns that issuers would not be operationally ready to offer [health plans] through the SHOP if we implemented employee choice for 2014,” they write in the final regulation. Source: Heartland Institute

Creative ideas: The Atlanta Journal-Constitution’s Sunday editorial on June 23, 2013, mentioned the Foundation’s proposed alternative to Medicaid expansion: “This spring, the pro-free market Georgia Public Policy Foundation’s Kelly McCutchen wrote that public hospitals are required to care for anyone who shows up in their emergency rooms, ‘regardless of their ability to pay. So even if Medicaid did not exist, taxpayers and citizens would be paying for health care for the poor and uninsured.’ McCutchen suggests that a more efficient alternative is to grant state credits to low-income people that would go toward costs of private health insurance. If people didn’t use the credits, the allocated money would then go to safety-net health care providers. Ideas like these show that states and think tanks are working creatively to increase access to basic health care.” Read Kelly’s proposal, “Georgia Has Alternatives to Medicaid Expansion.”

Young people needed: The federal health care law allows young adults to stay on their parents’ policies until they are 26. About 425,000 people in California have taken advantage of the new benefit, officials say, leading to savings for them and their families when they go to the emergency room. Still, more than 2 million Californians ages 19 to 34 are uninsured, according to the UCLA Center for Health Policy Research. Beginning in 2014, nearly everyone will be required to have insurance or face a fine – $95 or 1 percent of their household income in the first year. Many young adults who are not covered through work or their parents may be eligible for Medicaid or the new state-based insurance market places known as exchanges. The success of the law “depends on reaching everyone who is uninsured, but particularly young people who may feel like they don’t need insurance,” said Larry Levitt, a senior vice president at the Kaiser Family Foundation. Convincing them to spend money on insurance, he said, will be a “marketing challenge.” Source: Los Angeles Times

Residents needed: With ObamaCare taking full effect in 2014 and with Baby Boomers set to double the portion of the U.S. population over 65 in the next 15 years, the number of people seeing physicians on a regular basis will soon increase dramatically, according to a Wall Street Journal report. Though enrollment at medical schools has increased in the past several years to accommodate the training of more physicians, medical residencies at hospitals have remained almost constant. The majority of medical residencies are funded by Medicare; Medicare-funded residency positions have been frozen since 1997. Fewer resident positions mean that some who graduate from medical school will not find a residency after graduation. Source: Becker’s Hospital Review

Lots of holes in autism study: Researchers seeking the roots of autism have linked the disorder to chemicals in air pollution. Researchers from Harvard University’s School of Public Health report that pregnant women exposed to high levels of diesel particulates or mercury were twice as likely to have an autistic child compared with peers in low-pollution areas. The findings, published  in Environmental Health Perspectives, are from the largest U.S. study to examine the ties between air pollution and autism. About 2 percent of American school children were diagnosed with autism disorders in 2011 and 2012, according to the Centers for Disease Control and Prevention. Using locational data from the Environmental Protection Agency, researchers estimated the women’s exposure to toxins, a method the lead author admitted is imperfect. Many of the compounds travel together in the air, so separating their contributions was difficult. What’s more, the EPA data, taken once every four years, is an imprecise way of estimating exposure, and the only location accounted for was the women’s residence. Source: Bloomberg News

Fast-tracking drugs: In 2007, Pharmacyclics CEO Richard Miller, whose drug had been rejected by the Food and Drug Administration, wrote a series of opinion pieces in The Wall Street Journal accusing the FDA of “stifling, rather than encouraging, investments in innovation through cumbersome and over-restrictive policies.” That’s changing to faster approvals. And the age of fast approvals is now getting a legislative boost: A provision in the FDA Safety and Innovation Act of 2012 requires the FDA to create a “breakthrough” designation for treatments for life-threatening diseases where “preliminary clinical evidence indicates that the drug may demonstrate substantial improvement over existing therapies.” Dr. Richard Pazdur, director of the FDA Office of Oncology and Hematology Products, says the review process helped speed up many approvals, but it doesn’t mean that the agency’s standards have fallen, Matthew Herper writes in Forbes magazine. “We don’t have a lot of questions on drugs because they’re slam dunks,” Pazdur said. “It’s not if we’re going to approve them. It’s how fast we’re going to approve them.”

In Brief

Big earners: The University of Pittsburgh Medical Center Presbyterian tops the list of 100 top-grossing U.S. hospitals, coming in at $11.87 billion. See the other 99 here.

What’s up, doc? The number of actively licensed physicians in the United States grew 3 percent overall from 2010 to 2012, but decreased in four regions across the country, according to data from the Federation of State Medical Boards published in the Journal of Medical Regulation. Source: Becker’s ASCReview

Need a second opinion? Thirty-five percent of Americans have a great deal or quite a lot of confidence in the U.S. medical system, down from 41 percent last year, and the lowest since 2008, according to a Gallup Poll.

If at first you don’t succeed: The National Institutes of Health awarded $12.7 million to nine academic groups to test potential medicines for diseases including Alzheimer’s disease, Duchenne muscular dystrophy and schizophrenia that drug companies had abandoned because they were viewed as too risky or not lucrative enough. Source:

Did you know? More than 95 percent of medicines that begin human testing do not reach the market. The reason might be because they are ineffective, because they are unsafe, or because a drug company stopped developing them for business reasons. Source:

Early notice: The Food and Drug Administration is proposing to require drug manufacturers to report discontinuances or interruptions in the manufacturing of life-supporting and certain other important drugs. They would report expected production issues six months prior to discontinuation or interruption, or ASAP if six months is not practical. Early notification of issues that could lead to shortages helped FDA prevent more than 100 shortages during 2012, according to the agency.

Nonprofits: Maryland had the highest percentage of nonprofit hospitals in the country in 2010, with 95.7 percent of its hospitals being nonprofit organizations and 4.3 percent being for-profit organizations, according to State Health Facts, a project of the Henry J. Kaiser Family Foundation. Find out the 10 states with the highest percentage of for-profit hospitals here:

Regulatory flexibility: Drugmakers can boost the effectiveness of clinical research by working with health care providers and regulators to redevelop how treatments are purchased and reviewed, according to a report from PharmaFutures. Regulators should be more flexible, the think tank said. Source: Reuters

Play or pay: The Congressional Budget Office (CBO) estimates that by 2016, approximately 6 million people (2 percent of the U.S. population) will be subject to health tax penalties related to the Affordable Care Act individual mandate.

Quotes of Note

“Minor surgery is surgery someone else is having.” – J. Carl Cook

“Keep a watch also upon the faults of the patients, which also make them lie about the taking of things prescribed.” – Hippocrates


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