School health intervention effective
WASHINGTON, May 13 (UPI) — A U.S. school intervention involving better food, more exercise and health education resulted in lower cholesterol levels and heart rates, researchers say.
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American Heart Association CEO Nancy Brown Says CDC Report On Children’s Food Environment Underscores Need For Strong Public Policies
Our nation’s youth face major roadblocks to good health with easy access to calorie-laden snacks, sugary beverages and other unhealthy foods in their schools and communities. With about 1 out of every 6 children in the U.S. considered obese, we are condemning our kids to a bleak future of premature health problems such as type-2 diabetes, high cholesterol, high blood pressure and other risk factors for heart disease…
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3 In 4 U.S. Prescriptions Are Now For Generic Drugs
United States (KaiserHealth) – The brand-name pharmaceutical industry has a drug problem.
All 10 of the most prescribed medicines in the U.S. last year were generics, led by the defending champion generic equivalents of Vicodin (hydrocodone plus acetaminophen). There were 131 million prescriptions dispensed for the painkiller last year, up 3 million from 2009, according to data released Tuesday by the IMS Institute for Health Informatics.
The persistence of Vicodin-like medicines at the top of the chart is one reason why the White House is pushing new approaches to reducing the abuse and misuse of prescription painkillers.
In 2010, generic medicines accounted for more than three-quarters of the prescriptions dispensed by retail drugstores and long-term care facilities. The exact figure is 78 percent, a historic high that was up four percentage points from 2009. Generic use has climbed steadily from 63 percent of dispensed prescriptions in 2006.
The shift to generics has picked up a lot of steam lately. Some very popular drugs, including Alzheimer’s pill Aricept and prostate medicine Flomax, went generic in 2010.
Take a close look at simvastatin, the cholesterol-fighter known as Zocor when it was a brand-name giant for Merck. It was the second-most dispensed medicine last year, with 94.1 million prescriptions filled.
Late this year, Lipitor, the top-selling brand-name prescription medicine in the U.S., will also go generic, and it’ll become a whopper pretty fast. It’s No. 12 on the 2010 IMS prescription rankings.
Big Pharma’s losses have meant savings for consumers, insurers and employers that pay for health coverage. The average copayment fell 20 cents to $10.73 last year compared with 2009. The biggest factor in the decline was greater use of generics, which typically require the lowest copayment from consumers, according to IMS.
Where’s the most money going. Cancer medicines. For the third year running, oncology drugs topped the spending list. In 2010, the drugs accounted for about $22.3 billion in spending, up nearly $800 million from 2009.
– Provided by Kaiser Health News.
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Medical Device Industry Lobbies IRS and Congress To Dodge Health Law Tax
Washington, DC, United States (KaiserHealth) – Like many other interest groups, the medical device industry met with White House officials in the run-up to the health care battle in Congress. But while insurers, pharmaceutical firms and even the American Medical Association made agreements trading their support for specific concessions, the device makers were not able to close a similar deal.
As a result, the final health care reform bill included a 2.3 percent excise tax on device makers that’s expected to produce $20 billion over a decade to help pay for expanded health coverage.
That’s the law, or so it would seem.
But in Washington, it’s never over until it’s over. And like other medical interests who are scrambling to influence the implementation of health care reform, medical device makers are showering cash on friends in Congress and working the halls, hoping that one of five bills that would overturn the excise tax might actually make it into law.
Veteran Hill watchers say that may be a long shot, so to hedge its bets, the industry is also lobbying the Internal Revenue Service to write rules exempting hundreds of devices from the excise tax — even though the health law says the exemption should be limited to items widely purchased by the public from retailers. The outcome of that under-the-radar battle is far from certain.
The medical device business and its lobbyists have a strong record of winning concessions and at least partially deflecting the costs of health insurance coverage expansion. An early Senate “framework” version of the health bill pushed by Democrat Max Baucus of Montana, for example, would have nailed the industry with a $40 billion excise tax bill over ten years beginning in 2010. Shocked at the price tag, the device manufacturers’ trade group, the Advanced Medical Technology Association (AdvaMed), pushed back, aided by industry giants Medtronic Inc., Johnson & Johnson, 3M Co., and others.
With the help of a bipartisan group of lawmakers, the device makers succeeded in cutting the tax in half in the final health care law, which also delayed the start date for the tax until 2013, three years later than in the Baucus proposal.
Manufacturers, however, maintain that even the smaller tax in the health care law is catastrophic for them. So the industry is targeting Capitol Hill anew and working the regulatory process, searching for concessions.
Five industry-supported bills currently before Congress would completely overturn the excise tax on medical devices, the most widely supported of which are bills introduced by Sen. Orrin Hatch, R-Utah, and Rep. Erik Paulsen, R-Minn. Hatch’s bill has- Republican co-sponsors. Paulsen’s House bill has 119 co-sponsors, including three Democrats.
Hatch, who has been one of the health care law’s fiercest opponents, says the tax on medical devices will increase insurance premiums and the cost of care. Relying on an excise tax “to fund Obamacare will cripple an important engine of opportunity, job growth and innovation,” Hatch said in a January news release.
CAMPAIGN CONTRIBUTIONS FROM INDUSTRY
In 2009 and 2010, both Hatch and Paulsen were major beneficiaries of medical device industry money.
Hatch was not up for re-election that cycle but received more than $90,000 in campaign donations from the medical supply industry, which made him the trade group’s third largest political beneficiary, according to the Center for Responsive Politics. The political action committee of the AdvaMed association alone contributed $10,584 to Hatch’s campaign, and $3,150 to Paulsen’s.
The political action committees of individual companies also chipped in. The PAC of Boston Scientific, a major manufacturer of heart and other medical devices, contributed $7,000 to Paulsen’s campaign and $5,000 to Hatch’s. Medtronic, the world’s largest medical device maker — which is based in Paulsen’s home state — donated $3,000 to Paulsen and $5,000 to Hatch.
Paulsen spokesman Tom Erickson said the bill is a response to job loss fears, not industry campaign donations, and that more than 400 medical device companies are based in Minnesota. A Hatch spokesman said the senator’s bill reflects his political philosophy: “It’s something he has felt strongly about for a long time, that taxes are counterproductive,” spokesman Mark Eddington said.
Hatch and Paulsen are only two of the friends the device industry is counting on for help.
In late March, Democrat Amy Klobuchar of Minnesota and Republican Scott Brown of Massachusetts launched a new Senate medical technology caucus to increase awareness about issues facing the industry. Both represent states with significant medical device manufacturers and have been major beneficiaries of industry money.
Boston Scientific, which in 2010 had $7.8 billion in sales, is based in Brown’s state. In 2010, Brown received more than $30,000 in campaign donations from the medical supply industry, which is dominated by the device makers. Klobuchar received more than $40,000 in contributions.
“These businesses not only spark medical breakthroughs, they save lives,” Klobuchar said in comments released on the day the new caucus was launched. “Every day in every state small medical technology companies are driving the innovation agenda we need to compete in a global economy. I will continue to work to make sure that Minnesota remains a leader in health care innovation by developing innovative products while maintaining patient safety.”
The House medical technology caucus was revamped in February. According to the industry newsletter MedCity, its new website was launched on the same day that Paulsen, who chairs the group together with Anna Eschoo, D-Calif., addressed the Minnesota life sciences trade group LifeScience Alley.
In the halls of Congress, the medical device manufacturers have long pushed the jobs refrain, first to deflect taxes, and second to fend off scrutiny from the U.S. Food and Drug Administration, which regulates devices. Dr. Josh Makower, the founder of Exploramed, a medical device incubator – who frequently testifies before Congress – said the excise tax will particularly hurt small firms, many of which rely solely on investment capital for years before turning a profit.
“The saddest thing is that these small companies are exactly the ones that are delivering new innovations,” Makower told iWatch News in an e-mail response to questions.
REVOLVING DOOR
In pushing its interests, the device industry benefits from the revolving door connecting K Street with Capitol Hill.
In December, former AdvaMed executive Brett Loper, who lobbied against the excise tax, was named House Speaker John Boehner’s chief policy officer. Elizabeth Kegler, the association’s vice president of government affairs, is a former health policy advisor to Sen. Chuck Grassley, R-Iowa.
Advamed spent almost $1.5 million lobbying Congress on behalf of its members in 2010. First quarter lobby disclosure records for 2011 will not be available until late April, but medical device industry activity suggests the industry has likely not slowed its spending.
Despite device industry campaign donations, powerful allies, and support for the Paulsen bill in the House, George Schutzer, a tax lobbyist and attorney at the Washington firm Patton Boggs, said he doubts Congress is ready to overturn the device tax. A win for the medical device industry would “open the flood gates” for challenges to the health reform bill by other parts of the medical industry, Schutzer said, and would most likely result in an Obama veto.
As a result, the medical device industry has taken the fight beyond Congress to the Internal Revenue Service, which will administer the tax.
That part of the struggle appears to be splitting the industry as manufacturers try to protect their market niches. Although the medical device category includes big-ticket items generally sold to hospitals, including artificial hearts, pacemakers, coronary stents and artificial joints, it also includes a wide range of less expensive items ranging from tongue depressors to examination gloves.
The health law exempts from the excise tax eyeglasses, contact lenses, and any device the Treasury Department determines is generally purchased by the general public at retail for individual use. Certain sectors of the device industry, however, contend that devices from wheelchairs and scooters to home oxygen systems fit the exemption criteria.
In written comments to the IRS, which is expected to publish tax guidance for device manufacturers, DJO Global, the largest U.S. supplier of orthopedic devices, asked for an exemption on all items classified by Medicare as durable medical equipment, prosthetics and orthotics, including bone-growth stimulators and electrotherapy devices. The American Association for Home Care, which represents the home medical care industry, wrote that it believes all durable medical equipment, including complex power wheel chairs, should be exempt.
“Durable medical equipment and home medical equipment fit that exemption language to a tee,” said Jay Witter, senior director of government affairs at the American Association for Home Care, in an interview. Witter quoted a 2009 fact sheet released by former Speaker Nancy Pelosi that said wheelchairs would be exempt, and that the excise tax would apply only to sales of medical devices to hospitals and other institutions. The comment period on the exemption ended in late March; the IRS did not respond to questions on when it might decide who gets the exemption and who doesn’t.
Witter said it is unclear whether wheelchairs and other durable medical equipment were included in revenue calculations that projected $20 billion in revenue from the tax over a decade’s time. But since the majority of home health customers are covered by Medicare, which pays set rates, Witter said the cost of the excise tax cannot be passed on to consumers.
Diana Zuckerman, president of the National Research Center for Women & Families, a think tank that focuses on health issues, said the idea that all durable medical equipment should be exempt from the excise tax is absurd and could impair funding for the health care law.
“If they get what they want, the whole health care bill collapses,” said Zuckerman. “There is too much money involved to get rid of the excise tax or to substantially lower it.”
TAX DEDUCTION WINDFALL?
As device manufactures plead for exemptions, hospitals and group purchasing organizations worry that those who remain on the hook for the tax may simply pass it on in higher prices to hospitals and other purchasers. Curtis Rooney, president of the Health Industry Group Purchasing Association, said the excise tax could even wind up being a windfall for medical device manufacturers.
In a letter to the IRS, Rooney’s organization, along with the American Hospital Association, the Federation of American Hospitals and the Catholic Health Association of the United States, wrote that device manufacturers should be prohibited from passing on the excise tax to consumers, especially if they are allowed to deduct the excise tax when calculating their federal income tax.
Allowing device manufacturers to write off the tax and pass along the cost, the letter says, would “permit a financial ‘double-dip’ that could leave device companies in a better financial position than before the [health law] was enacted.”
Asked if device manufacturers planned to increase the prices charged to hospitals and other consumers to make up for excise tax, an AdvaMed spokeswoman declined to answer. She instead referred to a comment by David Nexon, the association’s senior executive vice president: “Each AdvaMed member company will have to individually decide how to best deal with the damaging effects of the tax. For some, that might mean cutting R&D, reducing staff or other measures. Those are tough business decisions that will have to be made if this tax goes forward and go to the heart of why we opposed the tax in the first place.”
iWatch News is the investigative news report of the Center for Public Integrity, a nonprofit group focused on investigative journalism.
– Provided by Kaiser Health News.
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Americans Like Their Health Care, But Think The System Stinks
Washington, D.C., United States (KaiserHealth) – If America has the best health care system in the world, as some people like to say, then the setups in other countries must really be crummy.
How come? Well, check out the disheartening results of a poll just out from the Robert Wood Johnson Foundation and the Harvard School of Public Health. Fifty-five percent of adults surveyed gave the U.S. health care system a C or D, when asked to assign it a grade. Eleven percent gave it an F.
Can we send the health system to its room until it gets those grades up?
Familiarity trumps data when it comes to picking a hospital, the poll finds. Most people – 57 percent – would chose a hospital they or someone they know has had experience with over a hospital that does well on quality measures – 38 percent.
Indeed, when it comes to health care, people’s views are a little more charitable when the questions focus on their personal experience instead of the abstract. When asked about the quality of care they’ve actually received, nearly a third – 31 percent – of people give it an A. Thirty-four percent say it’s a B. Only 13 percent grade it D or F.
When it comes to some things, such as picking a surgeon, data seem to count for a little bit more. People were pretty much evenly divided on whether the experience of family or friends would be decisive (48 percent were in that camp) and about an equal proportion (47 percent) leaned toward quality ratings.
Data-driven decision making for surgery, at least, seems to be gaining steam. In 2000, the same question got 50 percent in the family-and-friends column and 38 percent in the quality-ratings column.
The results were presented at a meeting of the American Hospital Association. In a statement, Robert Blendon, professor of Health Policy and Political Analysis at the Harvard School of Public Health, said:
The pace of change in having consumers use independent expert ratings when they choose a hospital has been slower than anticipated. More can be done to encourage this.
Blendon’s group conducted the poll, which included responses from 1,034 people and has a margin of error of +/- 3.7 percentage points.
– Provided by Kaiser Health News.
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Medicaid To Offer Rewards For Healthy Behavior
Washington, D.C., United States (KaiserHealth) – A federal grant program authorized in the health overhaul law is offering states $100 million to reward Medicaid recipients who make an effort to quit smoking or keep their weight, blood pressure or cholesterol levels in check.
The grant program is meant to encourage states, many of which are under pressure to cut Medicaid costs, to experiment with an uncertain approach to wellness: offering incentives for healthy behavior.
“Medicaid is almost the sweet spot for financial rewards,” said George Loewenstein, a behavioral economist at Carnegie Mellon University who has studied the effect of financial incentives on behavior. Medicaid recipients, he explains, are economically disadvantaged and have more to gain from incentives.
Loewenstein, however, is dubious about whether incentives, especially those tied to weight loss, could really work. He’s not alone.
Behavioral incentive programs have shown some promise in specific settings, but they are largely untested in the Medicaid population.
The federal dollars for Medicaid incentives reflect a sharpening emphasis on the role of preventive health in targeting the underlying causes of chronic disease, a central pillar of the Obama administration’s health care agenda. States have until May 2 to submit their final proposals to the Centers for Medicare & Medicaid Services for funding, and a number have indicated an interest.
And while states have some flexibility about how they design their incentives, federal guidelines provide a basic profile. Medicaid enrollees who demonstrate a commitment to improving their health will be eligible to receive financial rewards such as coupons or gift certificates. For those who are overweight or trying to quit smoking, that commitment might take the form of weight management classes or tobacco cessation counseling. States are encouraged to provide rewards “on a tiered basis” for attempts at participation, “actual behavior change,” and “achievement of health goals.”
Chronic conditions such as diabetes, bad cholesterol and high blood pressure account for more than 75 percent of the $2.5 trillion the U.S. spends annually on health care, according to data from the Department of Health and Human Services. Cigarette smoking, 10 percent more prevalent among Medicaid enrollees than the population at large, cost Medicaid programs an average of $607 million in 2004, according to the National Center for Health Statistics, and is also the leading preventable cause of death in the U.S.
States Have Mixed Results
To date, a few states have tried transplanting the corporate wellness model to Medicaid, with mixed results. State health officials seem to agree that participation from health care providers and other community organizations, often a challenge, was critical in making their programs work.
West Virginia’s approach, which provides an enhanced coverage plan with added benefits to Medicaid enrollees who agree to adhere to healthy behaviors, has been widely criticized by health advocates.
Idaho, which launched an incentive program in 2007, offers $200 in vouchers to Medicaid enrollees who consult with a doctor about losing weight or quitting smoking. Recipients can use the vouchers for gym memberships, weight management programs, nutrition counseling and tobacco cessation products. Tobacco counseling courses are offered free of charge through public health districts in the state. Idaho is now enrolling about 1,500 new Medicaid participants each year.
According to Tom Kearns, who manages Idaho’s Preventive Health Assistance initiative, participants have written in with positive feedback – but the state doesn’t have data to show whether the incentives are cost-effective or have a large-scale impact on participants’ behavior.
“There’s a lot of challenges in tracking the outcomes of this long-term,” Kearns said. “Ultimately we’d like to have a large enough population to track.”
The state has worked hard to find partners who are willing to accept its vouchers and so far has more luck with community groups, such as the YMCA, than private companies.
Florida has also tried using incentives in its Medicaid managed care pilot program.
The program allows Medicaid enrollees living in five counties to earn up to $125 worth of credits each fiscal year in exchange for their compliance with certain “healthy behaviors,” like getting a flu shot or adhering to a prescribed drug regimen. Participants can redeem the credits at participating pharmacies for over-the-counter products such as bandages and diapers.
But logistical setbacks have dampened the impact of the incentives. At first, few were aware that the program even existed, and some pharmacies refused to accept the Medicaid credits. Several hundred people have received credits for participating in a diabetes or hypertension disease management program since 2006, but as of February, only two individuals were on the record for having attended a smoking cessation course, and six individuals have been credited for entering a weight management or exercise program.
“There’s a question about whether this is really incentivizing anything … that link is very dubious,” said Greg Mellowe, policy director at the consumer advocacy group Florida CHAIN. Most of the credits distributed through Florida’s rewards program in the past five years, Mellowe contends, were awarded for routine visits and immunizations that Medicaid recipients would have sought anyway – and not for significant behavioral changes.
Research On Incentives Is Inconclusive
Research is scant on the effects of incentive programs on mitigating chronic diseases. A smattering of studies have shown that complex behavioral programs with built-in incentives can sometimes produce short-term results-if the incentives are large enough. A 2009 study published in the New England Journal of Medicine found that a program offering people $750 to quit smoking: 15 percent of participants eligible for a reward managed to quit, compared with 5 percent of participants who enrolled in a traditional tobacco cessation program.
A similar study about incentive-based weight loss programs, published by some of the same researchers in the Journal of the American Medical Association, was less optimistic. That study found that financial rewards did help participants lose more weight temporarily, but the losses weren’t fully sustained in the end.
Few behavioral studies have attempted to determine whether people who receive the incentives are able to maintain their short-term success long term – the ultimate goal of incentive-based prevention program. Fewer attempts have been made to address how the design of an incentive program should be adjusted according to the demographics of the target population, such as insuring that low-income participants have transportation to get to appointments and classes.
“In and of itself, without health education and other forms of engagement, it seems to fall short,” said Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities. “The incentives are never going to be enormous because it’s never going to be affordable.”
– Provided by Kaiser Health News.
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Give Yourself The Gift of Goji
Certified organic Goji juice is the most effective because Goji is absorbed better by your body when taken in liquid form. It is free of chemicals, preservatives and is not mixed with another juice for enhanced flavor. I first learned of this little miracle juice when I took home a CD from the local health food store that explained its benefits and history. Fun ways to stay updated on health topics and learn about hidden gems like Goji are by gathering information online from reliable sources, watching interesting and informative shows on TV networks like Discovery Health and taking advantage of free reading materials and CD’s from your local health food store.
Goji grows in South Eastern Europe and in Asia and wasn’t shipped to the U.S. until recently, even though its history dates back to ancient times. Ningxia Goji is the most pure and potent type of Goji juice. The first person to ship it here to the U.S. was Doctor Gary Young when he learned of its benefits. An Olympic swimmer from China came along next and admitted her secret to outperforming all of her competitors was drinking Goji juice.
She had to let the cat out of the bag in order to protect herself from being accused of taking drugs! The word was out, and companies in the United States wanted in. Goji eventually graced the shelves of health food stores across America and in a few select grocery stores. It is easier to buy it today as it is more abundant, but you must understand that Goji juice is expensive to distribute and to buy. Some companies find that it is a greater benefit to sell less expensive, diluted versions of this juice, as it is more affordable and more likely to sell. Uninformed consumers can assume that these versions of Goji juice are just as beneficial as the real thing when in fact they’re not. You can find the closest form of Goji to the real thing at various health food stores if you know what you’re doing. The “good stuff” is only found in China.
There are numerous reasons why you should at least consume one ounce of Goji juice every day (more if you’re feeling under the weather). I have gained many benefits from doing just that. As soon as I drank my first drop of this amazing super juice, the first thing I noticed is that my eyes became clearer. I was amazed at the clarity because I didn’t even notice that my eyes were cloudy until everything became bright and clear. The next thing that I observed is a general sense of contentment. I was relaxed, de-stressed and in a great mood. Goji improved my sleep-wake cycle. I sleep deeper and wake up more rested than ever before. I can also recall the dreams I had when I was sleeping which rarely happens. Blemishes on my skin disappeared one week after religiously taking my morning Goji shot. My skin started to glow and my fingernails were so shiny that it looked like I was wearing clear nail polish. Ladies, if you want to look beautiful, eat organic and take your daily dose of Goji!
Goji helps your body rid of waste naturally and if taken along with eating organic (and perhaps a teaspoon of apple cider vinegar with mother) it will help you shed some extra pounds. I didn’t need to lose weight when I started drinking Goji, but I did have some unnecessary, unwanted meat on my hips that slowly began to disappear. Goji gets rid of that pocket fat that collects in certain areas of your body. My hips became narrower and if I gain weight, it will now be evenly dispersed rather than clumping into those trouble areas! These are just a few of the ways Goji has helped me. This juice works inside and out, optimizing the functions of your mind and body. Here is a partial list of the many amazing benefits of Organic Goji juice:
* Balances skin tone and helps to reduce dry skin * Antioxidants help prevent aging * Reduces risk of cancer * Increases energy * Helps to maintain a stable mood * Improves metabolism * Regulates blood pressure * Cleanses your blood * Improves memory * Improves heart function * Fights Hepatitis B * Boosts your immune system * Lowers cholesterol * Helps regulate blood sugar level I’m assuming you’re ready to buy it, so your probably questioning what you should be looking for in an effective Goji juice. Here are some pointers of what to look for before you buy your “happy berry” juice:
* #1 100% Certified Organic Goji berry juice
* Get pure concentrated Goji juice that is not mixed with another juice so you’ll get the full effect. If you’re spending good money on your Goji, you don’t want it diluted with other juices you can buy for just a few dollars at the grocery store.
* Do not fall for cheaper “natural” versions of Goji juice, as it will at the very least contain a preservative like Sodium Benzoate. This preservative is a carcinogen so it defeats the purpose of taking Goji in the first place.
* You may choose Goji that is sold in a glass container vs. plastic because it stays fresher longer.
Celebrities that swear by Goji juice:
* Mischa Barton * Madonna * Liz Hurley * Mario Lopez * Paula Abdul * Lisa Edelstein
On Health Law’s Anniversary: Predictions For Next Year
Washington, DC, United States (KaiserHealth) – The health care law has been on a roller coaster ride since its passage one year ago, moving forward with implementation plans even as opponents throw up legal and legislative challenges to stop it in its tracks.
At Kaiser Health News, we wondered where these moving parts might be in March 2012, at the measure’s two-year mark. So we asked players and experts from across the nation what they thought the landscape would be like – and, in their view, should be like.
They discussed issues ranging from the new insurance marketplaces called exchanges to the future of accountable care organizations: combinations of hospitals, doctors and sometimes insurers. Here are their edited responses:
Bill Hazel
– Secretary of Health and Human Resources in Virginia, one of the states challenging the constitutionality of the law.
We will be extraordinarily busy. We will probably have designed the new marketplaces – the exchanges – as best we can, but we will still have to go back to the General Assembly for implementation. We’ll have a whole lot to do in a very short period of time. Unless something changes with the law, we will have the whole issue of getting the benefit exchange up and running. Getting it implemented will be a technical challenge.
Currently, everything is in a state of flux. We suspect that aspects of the bill will change with this Congress and we also have the lawsuits, which likely will not be resolved by this time next year.
In Virginia, we’ve authorized the Bureau of Insurance to enforce the law as it stands today. We’ve been told by the General Assembly to plan an exchange and bring it back for approval next year. And we have money budgeted to build an infrastructure that will allow us to determine eligibility for both the formerly eligible and the people newly eligible for Medicaid. We’re trying to streamline and automate the process and are well into that.
Lloyd H. Dean
– President and CEO of Catholic Healthcare West
Over the next year you’ll see more ACOs and more sharing of data and integrating ourselves with other providers.
We’ll begin to see the cost curve bending in the organization. Last year we were one of the first organizations in the country to launch a major accountable care organization – I like to call it a triumvirate, with CHW, Blue Shield of California and Hill Physicians. That’s been a success: We’ve reduced hospital admissions by 22 percent; we’ve reduced the length of stay and hospital days by almost 13 percent. A year from now we’ll be relatively far along in the path of implementing our new electronic health record.
What’s important here is that we’re not sitting on the sidelines waiting for something to happen in Washington, D.C., before we all get in the game. When you look at us a year from now, we’ll be more efficient, with better medical outcomes and better alignment with our physicians and others in the communities we serve.
Tom Goldstein
– Attorney, co-founder of SCOTUSblog
One year from today we should be waiting for a ruling from the Supreme Court. The courts of appeals should have decided the constitutionality and upheld the statute of the reform bill by this fall and the cases should have proceeded quickly to the Supreme Court for expedited consideration.
During the appeals process, I will be watching whether a court invalidates the individual mandate and therefore the entire law. I think that there will have been vigorous dissents on the Commerce Clause so the issue of the fate of the law will still be unsettled by the time it gets to the Supreme Court. But once the cases have been argued, I think the conventional wisdom is that the statute will be upheld because the justices have taken a very broad view of Congress’s power.
Wendy Schiller
– Associate Professor of Political Science and Public Policy, Brown University
The health care message is going to get more complicated for the American voter in 2012. The Republicans clearly ran against the health care bill in 2010, but they’re going to have to come to the table in making cuts to Medicaid and Medicare in the next year. You can’t even get close to cutting the deficit if you don’t cut entitlement spending. It’s going to be much harder for the Republicans to make this a key issue in the 2012 elections.
In Obama’s favor, a lot of the provisions of the health care bill will kick in. And the more people who actually benefit, the more entrenched these programs will be. As we see with Medicare and Medicaid, once a program is entrenched and voters see clear benefits, the [program is] almost impossible to get rid of.
Independents are the only [voting] group you’re really looking at in terms of health care. And the issue will be the battles for the key states — Ohio, Pennsylvania, Illinois, Michigan, Florida and California. It’s really, ironically, going to be a much more localized issue than it is a national issue. From this point forward, it’s the implementation of the health care act that will matter much more for Obama in 2012 than the passage of the act itself.
Ceci Connolly
– Senior Adviser, McKinsey Center for U.S. Health System Reform
What I will be watching are the Republican presidential primaries and the CMS innovation center. I want to be keeping an eye on that, because I feel strongly that the real transformation in health care will come from the private sector. So I am very eager to see if and how quickly seed money from the innovation center can foster truly significant change. Will the innovation center grants help us find a way to deliver the right care at the right time for the right price?
I think what has been striking about health care to date here in the U.S. is this: We have amazing one-off success stories. We can point to them dotting the landscape but the real question is, can and will those be replicated or expanded? That’s why I’m eager about the private sector, but also hopeful that at least this grant money could help nudge it along.
Steven E. Wojcik – Vice President, Public Policy, National Business Group on Health
By March 2012, we hope to convince Congress to adopt medical liability reform that limits how much providers pay in non-economic damages and restricts attorneys’ fees. The administration has signaled that it is open to changes, and there’s a significant gap in the health care law to reduce the unnecessary, added costs we all pay for defensive medicine.
We also will have made sure health care payment reforms pilot projects called for in the health law get implemented quickly and widely throughout the Medicare program because we want to be paying for outcomes and quality not just care. We expect to work through the regulatory process to make sure “consumer directed” or high-deductible health plans are allowed to be offered as rules get drawn up for new insurance exchanges. These plans are the key to getting health costs under control.
Sarah James – Analyst, Wedbush Securities
One of the insurance industry’s main focuses in the next year of health care reform is medical loss ratio [provision, which requires insurers to spend 80 percent of premium revenues on medical care] and how it may change. There’s a push to change the definition of MLR to exclude brokers’ commissions. If it goes through, it would be very positive for the managed care plans. Also, removing broker commissions from premium revenue would make it easier for plans to stay in states like Maine.
Also, there’s the impact of exchanges. Each state’s exchange could be different, creating some favorable markets and some less favorable markets. Another negative aspect is the potential repeal of the individual mandate, which fines people for not having insurance. If you remove that, you’re more likely to have healthy people stay out of plans.
Meanwhile, a lot of insurers are diversifying to areas outside the U.S. with a particular interest in Asia, and also in the technology area. There’s a lot of federal money coming into health information technology.
Katie Mahoney – Director of regulations, U.S. Chamber of Commerce
By March 2012, we hope to persuade Treasury to clarify how the health law bans employers from giving richer health benefits to high paid executives than their employees. We want the regulations to be made clear so employers are not unfairly accused of discriminating against their employees.
The Chamber also hopes to convince regulators to define “essential benefits package” in a less extensive way so it doesn’t make the cost of coverage unaffordable. We don’t want every desirable benefit to be required, because that will drive up costs. The Chamber expects to work through the regulatory process to make sure that employers continue to have important flexibility to design workplace wellness programs. The health law expands the incentive amount that employers’ can offer to workers for participating in wellness programs beginning in 2014. The Chamber also hopes to convince Congress to change the health law’s provision that bars employees from using their flexible spending accounts from buying over-the-counter medications unless they have a doctor’s note.
Howard Bedlin – Vice President for Public Policy and Advocacy, National Council on Aging
Seniors will become more aware of what’s in it for them, because there’s still a lot of confusion and misunderstanding about the implications of health care reform in general. If you’ve been looking at the Kaiser tracking polls, many people don’t even know it’s law.
People will gain a greater understanding of what this means, the fact that some of the Medicare reductions did not cut benefits or impede access to care. They did not cut payments to doctors. They will have access to physicians and may have better access to primary care physicians. Hopefully more will avail themselves of preventive services, annual wellness visits.
I do think an important issue next year, particularly in the fall before the elections, will be what the trends are with regards to Medicare Advantage plans. It will vary a lot by geographic region. What happens next year will have particular implications for folks. We’re talking about a quarter of beneficiaries.
I anticipate that sometime next year, the CLASS program [voluntary long-term care insurance] will be made available for people to sign up. That will affect baby boomers more than seniors, because there will be a work requirement. But seniors who are working will be eligible to sign up. It will provide some meaningful benefits for folks that will be interested in it.
Thomas Johnson – President and CEO, Medicaid Health Plans of America
By March 2012, we want to have regulations on accountable care organizations that ensure managed care plans can play a major role in these new payment and delivery systems. We hope to convince more states to carve drug benefits back into Medicaid managed care. Many states now exclude drug benefit from being managed by their Medicaid managed care plans. We hope to have more guidance on how Medicaid will interact with the insurance exchanges. There should be a recognition that Medicaid health plans have experience in dealing with this population with complex medical histories, and we think our health plans are well suited to be in the exchange. Medicaid health plans should have the option of offering coverage to small business and individuals in the exchanges. We don’t think there should be any barriers that limit their participation.
David Godfrey – Medicaid director, Minnesota
I think we will have made a lot of progress in terms of trying to put the pieces together necessary at the state level to prepare for the creation of the exchanges, although a lot of work will still need to be done on that. But we’ll have a framework, I believe. Also (we’ll be) pursuing different grant opportunities through the ACA, and also begin thinking about policy and program redesign and response to the ACA as well. There’s a lot of interest in administrative simplification. We think this is an opportunity for that. There’s still a lot of work to be done in that area, and we’re still waiting for a lot of the guidance from CMS in terms of just what our programs need to look like by 2014.
The backdrop to all this is we have a significant budget deficit, and there’s going to be incredible pressure in trying to find cost savings in the Medicaid program in response to that and just trying to manage those pressures but still moving forward and putting into place the building blocks we need for 2014.
Rose Ann DeMoro – Executive Director, National Nurses United
(What will you be doing this time next year?) Same thing we’ve been doing: Fighting for a single payer health system, Medicare for all. We’re working with [Sen.] Bernie Sanders in Vermont on his campaign for single payer.
It’s incumbent on us to figure out a way to pay for it and how to get the ideological opposition groups out of the way. We see the Obama thing as essentially a setback in fighting for genuine reform. Obama says he is trying to figure out a way to provide health care for all, and the industry turns around and raises rates to make it unaffordable. We’ve done massive protests in an effort to get insurers to get rate increases rolled back. The problem is that Obama and the Democrats are bipartisan, but the right wing is not.
– Provided by Kaiser Health News.
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Patents for 11 drugs end, pharma firms brace for loss of sales to generics
Washington, DC, United States (AHN) – Patents of 11 drugs sold in the U.S. are about to end this year. Pharmaceutical companies are bracing for loss of sales to generics on the 11 drugs, which have combined yearly sales of almost $50 billion.
By November, Pfizer’s patent for cholesterol drug Lipitor ends, placing at risk the company’s $10 billion yearly sales on the drug. Pfizer filed for a reissue of Lipitor’s calcium salt patent in January 2007, but the Patent Office rejected the application.
To fill in the anticipated sales gaps, some of the large drug firms bought their competitors during the last 24 months. Pfizer purchased Wyeth for $68 billion, Merck bought Schering-Plough for $41 billion, Genentech sold out to Roche for $46 billion and Sanofi-Aventis bought Genzyme for $20 billion.
An industry expert said that it is now panic time for the pharmaceutical industry on realization that drug firms do not have enough products in their pipeline or portfolio or enough revenue to sustain research and development. They also have to deal with research failures, such as the failed clinical trials of the replacement for Lipitor.
As a consequence, the drug firms reduced 53,000 jobs in 2010, on top of the 61,000 jobs they cut in 2009.
Pfizer, with up to 30 percent reduction on R & D in the next two years, will refocus its efforts on smaller niches in cancer, inflammation, neuroscience and branded generics, according to new Pfizer president Ian Read.
The drug firms’ biggest competitors continues to be generic drugs, which now account for 75 percent of all prescriptions in the U.S.
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FDA recalls unapproved cough, cold, allergy drugs
Washington, DC, United States (AHN) – The Food and Drug Administration (FDA) on Wednesday ordered the recall of dozens of unapproved prescription cough, cold and allergy drugs from the market as these pose greater health risks to consumers than approved medicines.
Among the drugs that cannot be legally marketed and distributed in the U.S. are Allerx, Bronkids Liquid, Carbodex DM Drops, Coldamine, Decongest II Tablets, Execof Tablets, J Tan D Tablets Chewable, Liquicough DM Liquid, Mintex, Phenyl T Suspension, Pseudo Cough Syrup, Rhinabid Capsules, Sinutuss DM Tablets, Sitrex Tablets, Viravan DM and Zotex Syrup.
The FDA said the unapproved drugs have not been evaluated by the agency for safety, effectiveness, and quality. It said many health care providers are unaware of the unapproved status of drugs and have continued to unknowingly prescribe them because the drugs’ labels do not disclose that they lack FDA approval.
Deborah Autor, director of the Office of Compliance in the FDA’s Center for Drug Evaluation and Research, said consumers should instead use FDA-approved cough, cold and allergy tablets, syrups and suspension.
Companies that manufacture unapproved drugs must cease manufacturing them within 90 days and stop shipping the products within 180 days, according to the FDA.
The agency also asked consumers and health care professionals to report side effects of the unapproved drugs.
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