Governments are under increasing pressure to provide access to expensive new drugs. Canadian patients who want access to drugs that are not publicly insured are seeking to pay for these drugs within public hospitals, states an article in CMAJ (Canadian Medical Association Journal) This analysis by Colleen M. Flood, Canada Research Chair in Health Law and Policy, University of Toronto and Lorian Hardcastle, University of Toronto, discusses the debate over whether this policy should change. It looks at the current legislation, policy implications, and a possible Charter challenge. Every Canadian province has legislation limiting the private sector, which may affect a public hospital's ability to sell drugs. Those against allowing private payment for drugs in public hospitals suggest this practice would constitute unequal treatment and that it might negatively impact the public system, either by taking clinicians' time away from public patients or by eroding political support for a high standard of care in the public system.
The Wall Street Journal reports that insurers are bringing their insurance plans in compliance with new rules and laws that make mental health and substance abuse insurance coverage available to millions of Americans. "The law, called the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, ensures that employees receive the same level of mental-health benefits as they do for medical and surgical care. It bans a plan from using deductibles for the treatment of mental-health disorders or substance abuse that are different from ones for medical and surgical care. And there can no longer be limits on treatment if no limits on medical and surgical care are in place as well." Analysts say the additional cost to insurers will likely be 1.5 percent annually, and employers seem to be keeping the benefit though the law doesn't require them to (Mincer, 2/7). This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation.
The Associated Press reports that aides who helped with President Bill Clinton's health care reform effort are pushing to help President Barack Obama pass his health system overhaul this year. The aides "are adamant that the Democrats can't afford another health care disaster. But they're divided on whether scaling down Obama's plan would be an acceptable solution. ... 'If Bill Clinton couldn't get it done, and Barack Obama can't do it, no Democrat will ever try again, ' said economist Len Nichols, health policy director at the New America Foundation. A Clinton White House health budget aide, Nichols has been operating as an unofficial adviser to lawmakers and administration officials wrestling with details of the current legislation. ... The mere mention of settling for less is causing consternation among former Clinton aides. Obama's health care plan - denounced as a government power grab by critics - is already scaled back from the ambition of the Clinton years." Some of the plans scaled back this time by Democrats include the amount any employer - even small ones - are required to contribute to their employees' health insurance.
In his latest Kaiser Health News column, done in partnership with The New Republic, Jonathan Cohn writes: ''[F]or much of the last year, Republicans have been scaring the bejeezus out of seniors by telling them that Democrats were out to destroy Medicare. But the Roadmap makes clear that it's not Democrats who seek massive, disruptive changes to the program. It's the Republicans. If the coming engagement between the Republicans and President Obama help the public to understand that reality, extending the debate might actually be worth it" (2/8). Read entire column. This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.org. © Henry J. Kaiser Family Foundation. All rights reserved.
News outlets report on how the fate of the health care overhaul might affect health industry mergers and biotech firms. BusinessWeek : "With Congress' sweeping overhaul of the health system stalled, industry will seek its own answers to a push by government and the private sector to rein in costs, said Curtis Lane, senior managing director at MTS Health Partners, a New York-based equity fund." An aging population will further increase health spending, and "[o]ne solution will be increased consolidation, with companies led by WellPoint Inc., the biggest U.S. insurer by enrollment, and Community Health Systems Inc., the largest publicly traded hospital chain, scooping up rivals unable to 'spread rising costs across fewer customers, ' said Paul Keckley, of the Deloitte Center for Health Solutions" (Nussbaum and Tirrell, 2/8). Star-Ledger/NJ.com reports that while some biotech firms, including a start-up called Soligenix, are thriving, many others in the industry are struggling.
Karen Ignagni, President and CEO of America's Health Insurance Plans (AHIP), released the following statement today in response to new health spending projections released by CMS which found that health care's share of the economy grew 1.1 percentage points in 2009 - the largest one-year increase in GDP share since the federal government began keeping track in 1960: "Rising health care costs are crushing our economy and adding a burden on working families and employers across the country. The new CMS data confirm that rising health care costs are driven by increases in underlying medical costs, not health plan administrative costs. In fact, the proportion of health insurance premiums that go towards administrative costs is declining as overall health care costs continue to soar. Without a national, long-term strategy to address the rapid growth in underlying medical costs, health care spending will continue to grow far faster than the economy as a whole, crowding out other important domestic priorities, such as education, energy, and deficit reduction.
"With the possible demise of health care legislation, getting back to business as usual may not be the best thing for the nation's drug makers, " The New York Times reports. "After all, in return for the prospect of tens of millions of newly insured customers and a large degree of regulatory certainty, the pharmaceutical industry had agreed to pay a relatively small price: $8 billion a year in discounts and fees. It was a modest compromise for an industry with $246 billion in prescription drug sales last year. But now, with the health care overhaul on a back burner in Washington and possibly dead for this year, drug makers are getting a sinking sense of how a piecemeal public policy future might look for them." For example, President Barack Obama's budget plan proposed "a new tax on profits from some patents and other intangible assets parked in overseas tax havens by American companies." The provision came as a surprise to drug makers and could be a major financial hit. "The industry giant Pfizer, for example, .
President Obama on Thursday at a Democratic National Committee fundraising reception presented his most clear-cut strategy to date for passing health reform, the New York Times ' " Prescriptions " reports. Obama said that after lawmakers work out the differences between the House and Senate reform bills ( HR 3962, HR 3590 ), he wants to meet publicly with Democrats, Republicans and independent experts to consider the measures and clarify particular reform provisions. Obama said lawmakers and the independent experts would then hold a debate on the overhaul proposals before Congress decides whether to pass a reform bill. Obama also said he wants to work through the proposals "in a methodical way, so that the American people can see and compare what makes most sense." He added, "And it may be that if Congress decides ... we're not going to do it, even after all the facts are laid out, all the options are clear, then the American people can make a judgment as to whether this Congress has done the right thing for them or not.
State Policy Developments: Iowa Seeks To Extend Birth Control Coverage; Minn. Eyes More Health Care For Poor; Miss. Drug Settlement
BusinessWeek : "Mississippi will receive $18.5 million from drug maker Eli Lilly and Co. as part of a settlement over claims the company promoted the anti-psychotic Zyprexa for ailments it was not federally approved to treat, Attorney General Jim Hood said Thursday" (Byrd, 2/4). Radio Iowa : "The state currently provides 'family planning services' - like 'the pill' - for low income women between the ages of 13 and 44. (A proposed) bill would allow low income women to remain eligible until they reach the age of 55" (Henderson, 2/4). Minnesota Public Radio : "The Minnesota Legislature returned to work Thursday, with health care and jobs getting the early attention. (Democratic-Farmer-Labor) leaders marked the opening of the 2010 session by unveiling a $1 billion bonding bill that they want to pass quickly. They also advanced a plan to provide health care coverage to the poor. They want legislators to pass a bill that extends General Assistance Medical Care, or GAMC, for another 16 months to an estimated 35, 000 people" (Pugmire, 2/4).
Los Angeles Times : "California's largest for-profit health insurer is moving to dramatically raise rates for customers with individual policies, setting off a furor among policyholders and prompting state insurance regulators to investigate. Anthem Blue Cross is telling many of its approximately 800, 000 customers who buy individual coverage -- people not covered by group rates" that the increase will kick in March 1 "and may be adjusted 'more frequently' than its typical yearly increases." About 2.1 million Californians are covered by individual insurance policies, while 21 million are covered by Health Maintenance Organizations (HMOs). "The size of the individual rate increases prompted state Insurance Commissioner Steve Poizner recently to call for a review of Anthem's charges. ... Anthem is not the only health insurer imposing double-digit rate increases." Blue Shield of California and Aetna also have upped premiums in recent years. But insurance brokers said "the impending Anthem increases are the largest they have seen" (Helfand, 2/4).