Health Law

As a follow-up up to its article published two days ago, the AP (3/5) reports that a "House committee has approved legislation that would place cigarettes under government regulation for the first time." Although the measure "would not let the Food and Drug Administration (FDA) outlaw tobacco or nicotine, the agency could reduce or eliminate cancer-causing chemicals in cigarette smoke." The legislation would also require that companies divulge ingredient lists and enlarge the warning labels on all packages. Furthermore, the bill "would prohibit candy-flavored cigars and cigarettes and give the FDA authority to ban menthol."

        It also "restricts tobacco marketing to young people," Bloomberg News (3/4) added. The legislation has "broad support," including industry leader Altria Group Inc. and President Barack Obama, and that "may speed approval this year." The House Committee on Energy and Commerce has already "passed the legislation, the Family Smoking Prevention and Tobacco Control Act, in a 39-13 vote" on Wednesday. "All of the Democrats at the panel's meeting voted in favor of the legislation, and they were joined by six Republicans." The measure might eventually move "to the full House" after other committees weigh in.

        But not everyone views the bill in a favorable light, according to Dow Jones Newswires (3/4, Favole). "Several Republican members of the Energy and Commerce Committee voted against the bill, saying the bill would give people the perception that FDA approves the use of tobacco products." Other opponents maintain that the FDA's "handling of recent drug scandals and food outbreaks involving the bacteria salmonella show the agency doesn't have the resources and can't handle the responsibility of overseeing another area of the public's health."

        In addition, a number of "smaller tobacco makers oppose regulation, in part because they believe new restrictions on the marketing of tobacco would essentially lock in Philip Morris' market share," CQ (3/4, Armstrong, Wayne) pointed out. Moreover, "critics of the industry say...that most Republicans are simply looking out for their friends, since the tobacco industry gave $743,000 more to congressional Republicans in the 2008 election cycle than it did to Democrats."

        In light of these and other criticisms, one lawmaker offered an alternative to HR 1256, brought forth by Henry A. Waxman (D-CA), the Winston-Salem (NC) Journal (3/4, Craver) reported. But the House panel rejected Rep. Steve Buyer's (R-IN) amendment, which "would have created a new tobacco harm reduction center within the Department of Health and Human Services (HHS)." Specifically, the HHS center "would combine smoking cessation programs with industry strategies to reduce the harm from tobacco products." Those that supported the amendment argue that the "potential FDA tobacco regulation bill does not carve out a niche for harm-reduction tobacco products." Instead, the "Waxman bill simply keeps the same playing field," while ensuring that "Philip Morris and Marlboro [remain] dominant." And, according to some analysts, "Philip Morris USA helped write the language in the proposed FDA tobacco-regulation bill."

Roll Call (3/5, Murray) reports, "Attempting to make good on campaign promises to curb wasteful spending, President Barack Obama recently ordered deep cuts to a Medicare program favored by the insurance companies, whose criticism of the proposal may be situating the powerful industry for a prime seat at the table when deliberations begin later this week." As part of his new budget, "the President proposed saving $176.6 billion during the next decade by establishing 'competitive bidding' for Medicare Advantage, a taxpayer-financed healthcare program administered by private insurance carriers that is popular with seniors living in rural areas." America's Health Insurance Plans spokesman Robert Zirkelbach maintains that "this budget would ask seniors and Medicare Advantage to fund a disproportionate share of the costs to reform the healthcare system." But, AARP spokesman Jim Dau says that the cuts "would not only help level the playing field for MA and traditional Medicare -- a goal which AARP supports -- but also save Medicare billions of dollars that could be used to improve Medicare and our entire healthcare system."

Bloomberg News (3/5, Randall) reports, "Americans may soon be able to buy cheap drugs imported from other countries without fear of breaking the law, now that a five-year push in Congress for new rules has gained support in President Barack Obama's budget." On Wednesday, Sen. John McCain (R-AZ) and other lawmakers introduced "a proposal to allow drug imports. ... Obama called for the changes in his budget last week, and views the measure as one way to reduce healthcare costs so that medical coverage for the uninsured can be expanded." Data show that "brand-name drugs in other countries cost as much as 70 percent less than in the U.S." Therefore, "allowing imports would save Americans $50 billion over the next decade, including $10 billion for the U.S. government, the lawmakers said." Notably, the "Pharmaceutical Research and Manufacturers of America...opposes the legislation. The group has argued that allowing imports would open the door to unsafe, counterfeit medicines." Meanwhile, "AARP, the largest advocacy group for older Americans, supported" the measure even when it was first introduced on former President George W. Bush.

        CongressDaily (3/5) notes that the lawmakers "expect this to pass," particularly since "Obama announced in his budget a strong interest in implementing this policy."

MedPage Today (3/4, Walker) reported, "Sen. Max Baucus (D-MT) laid out an 'ambitious' plan to have a bipartisan healthcare reform bill ready to go by June or July, while acknowledging the massive task ahead of him. ... But despite the complexity of healthcare reform and the difficulty of gaining bipartisan support for the movement, Baucus said he's been encouraged by what he characterized as growing Republican support for a major healthcare bill this year." Sen. "Baucus said Republicans are likely to come around and support changing the healthcare landscape." However, "vote tallies on two recent healthcare bills gave no indication the GOP is warming to Democrat-sponsored legislation. In February, just nine Senate Republicans voted to expand the State Children's Health Insurance Program." And, "the economic stimulus bill, which contained $19 billion for healthcare, garnered just three votes from the GOP." Nevertheless, the Montana senator "said that he thought Republicans were opening up to the idea of broader legislation after a fiscal summit at the White House last week."

The AP (3/5, Deslatte) reports, "Louisiana likely will have to reduce how much Medicaid pays for services by doctors, hospitals, and other healthcare providers as it works to balance the budget next year," Alan Levine, "the state's health secretary, said Wednesday." Levine also "told lawmakers that he will look at reducing payment rates rather than eliminating any Medicaid services for the poor, elderly, or disabled as a way to cut costs." Yet, "Levine declined to give specifics to the Senate Finance Committee, saying his proposals would be outlined next week when the Jindal administration delivers its budget recommendations to the joint House and Senate budget committee." The lawmakers expressed concern that "cutting the dollars paid to healthcare providers could mean fewer services to Medicaid patients." The AP notes that "about 1.1 million Louisiana residents -- a quarter of the state's population -- receive care" from Medicaid.

Healthcare IT News (3/4, Enrado) reported that, according to a survey by Health Industry Insights, many "independent hospitals, ambulatory care facilities, and hospitals in a health system are still pursuing their [Computerized Physician Order Entry (CPOE)] and electronic medical record projects," though "IT projects overall have slowed down." The survey included 44 respondents, "equally represented in all regions of the country and ranged in size from 1,500 beds to under 200 beds." Overall, "75 percent of the respondents reported the recession has negatively impacted their capital and/or operating budgets," while "85 percent saw a decrease in their capital budget in the first quarter." Moreover, "64 percent reported the economic crisis has forced them to cancel, suspend, delay, or curtail their major IT initiatives." Also, 55 percent of respondents reported that "operating and capital budget reductions have resulted in IT staff hiring freezes." According to Marc Holland, program director for Health Industry Insights' Health Provider Research, the results are "as good as can be expected. ... Healthcare will ride out this downturn certainly impacted but a little more intact compared to other industries."

Healthcare IT News (3/4, Manos) reported that the recently passed "economic stimulus package has allotted $17.2 billion to reward Medicare and Medicaid providers who can prove they are using certified healthcare IT 'in a meaningful way.'" And while the "incentives are scheduled to take effect starting Oct. 1, 2011, experts say providers should not waste time getting prepared because there is a shortage of change management experts available to help." According to one estimate, "94 percent of hospitals currently don't have enough healthcare IT in place to meet the stipulations required to receive bonuses." To qualify, "providers must have certified electronic health record technology capable of providing clinical decision support to physician order entry and capturing query information relevant to healthcare quality." But experts say it is "not as simple as hiring a software technician to make the transition. There is a need for qualified people who know how to help with workflow adaptation and how to implement software packages so they work for the organization."

In Time (3/5), Scot Haig, MD, writes that those arguing for the implementation of healthcare IT argue that "computerized medical records will save us all: save jobs, save money, reduce errors, and transform healthcare as we know it." But Dr. Haig examines the downsides of electronic medical records (EMR), noting, "we must keep in mind there will be a cost to this -- far beyond the billions to be spent setting it up." But many "in medicine are concerned that the greatest cost will be in the quality of medicine that we practice." Many clinicians, in fact, "have found that [Computerized Physician Order Entry (CPOE)] is...in too many ways is just not as good" than writing orders on paper. Haig notes that the managerial obstacles are daunting, but "really hard is going to be getting this multi-billion dollar juggernaut to actually save us money." Dr. Haig describes ways in which administrators may use EMRs to bill for more expensive diagnoses, and how insurance companies may thwart a clinician's opinion by denying payment for tests that they deem unnecessary. He concludes, "With pen and paper, personal commitment to each patient and judgment born of practical experience. None of which I have found in a machine."

The San Diego Union-Tribune (3/5) reports, "State health officials yesterday fined Scripps Mercy Hospital $25,000 – the maximum allowed – for the preventable death of a patient about a year ago at its Chula Vista campus." The woman, who was terminally ill, "died after hospital staff failed to administer saline solution that had been ordered more than four hours earlier." The incident was first made public last summer when "federal regulators said they were considering withholding Medicare and Medi-Cal payments because of the death."

UPI (3/5) reports, "Some 86.7 million people -- one out of every three U.S. residents under the age of 65 -- had no health insurance at some point in 2007 and 2008," according to "the progressive healthcare reform nonprofit group Families USA." They found that, "of the 86.7 million uninsured individuals, 60.2 percent were uninsured for nine months or more, while nearly 74.5 percent were uninsured for six months or more, the group said. It also found 52 percent of individuals in families with incomes between $21,200 and $42,400 per year went without health insurance at some point in 2007-08."

The Wall Street Journal (3/5, Fuhrmans) reports, "The slumping economy is pulling down fragile networks of support that in better times could keep families with insurance but big bills from falling into a financial hole."  According to an estimate by the Commonwealth Fund, "as of 2007, 25 million Americans had to spend at least 10 percent of their income -- five percent for low-income families -- on out-of-pocket medical costs.  That's a 60 percent increase from 2003."  While "families typically have been able to make due as long as they remained employed and on a company health plan," many "companies have steadily raised employees' premiums, deductibles and co-payments to curb their own soaring healthcare spending," which has "left Americans with costly illnesses exposed to a much broader set of economic strains."

Life Sciences Law

The New York Times (3/5, A16, Yardley) reports, "Assisted suicide becomes legal in Washington on Thursday, but dozens of hospitals are not expected to participate, and even supporters of the law say they do not foresee a rush of requests for lethal drugs." The law "allows terminally ill patients who are 18 or older, and who have been found mentally competent, to self-administer lethal drugs under the prescription of a doctor," although an "opt-out provision for hospitals was included, partly for the sake of healthcare providers affiliated with religious groups like the Roman Catholic Church, though many nonreligious hospitals have also invoked it." Cassie Sauer, a spokeswoman for the Washington State Hospital Association, "speculated that as many as two-thirds of hospitals might opt out completely or partly."

The Wall Street Journal (3/5, Koppel) reports, "In the interest of fair trials, attorneys can dismiss people from jury pools for dressing strangely, for being fat, even for just looking at them funny" but are not allowed to dismiss on the basis of race, ethnicity or gender. In an effort to end "discrimination in the jury room critics have called for a radical solution: Get rid of peremptory strikes, which typically allow lawyers to dismiss a limited number of jurors, no questions asked." However, some experts say that a "more realistic reform...would be to cut back significantly on the number of potential jurors each side can boot without explanation."

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