"The Economics of Health Care"
Oberlin Alumni Magazine
Winter 2007

"Key to Saving Historic Pipe Organs May Lie under the Microscope"
Oberlin Alumni Magazine
Winter 2007

"Beowulf Cluster Takes Computing to New Heights"
Oberlin Alumni Magazine
Winter 2005-2006

"Election Days"
Oberlin Alumni Magazine
Fall 2004

"Mock Convention 2004"
Oberlin Alumni Magazine
Summer 2004

"Experience, Exposure, & Enlightenment: Student interns have a capital good time with D.C. alums"
Oberlin Alumni Magazine
Spring 2001

LINK

"The Clinton Trap"
The Atlantic Online
January 25, 2005

"The Great Debates"
The Atlantic Online
October 20, 2004

"John Kerry, Circa 1996"
The Atlantic Online
October 11, 2004

LINK

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THE BUREAU OF NATIONAL AFFAIRS: HEALTH CARE POLICY REPORT - JULY 22, 2002

House Panel Members Aim to Clarify Hospitals Covered by Conscience Clause

Top Republicans at the House Energy and Commerce Subcommittee on Health advocated July 11 giving hospitals greater power to refuse to provide abortions, and also nullifying requirements for federal programs that prohibit parental notification when prescription drugs are dispensed to a minor.

The committee met to discuss issues surrounding two bills introduced in May, the Abortion Non-Discrimination Act of 2002 (H.R. 4691), and the State's and Parental Rights Improvement Act of 2002 (H.R. 4783).

The Non-Discrimination Act, sponsored by subcommittee Chairman Michael Bilirakis (R-Fla.), would revise provisions of the Public Health Service Act known as the Coats Amendment. The amendment, sponsored by then-Sen. Dan Coats (R-Ind.) and passed in 1996, prohibits the federal government from discriminating against any "health care entity" due to that entity's refusal to provide, or train for, abortions. The amendment, part of an omnibus appropriations bill, was in response to a decision by the Accrediting Council on Graduate Medical Education not to accredit programs which forbid abortion training.

The current bill would add "hospital" to the list of definitions, would add average coverage and payment of abortions to the list of acts protected against discrimination, and would provide other protections to practicing physicians, which sponsors contend was the original intent of the rule.

"In 1998, a number of senators attempted to clarify the record by stating that a 'health care entity' was defined to include physicians and others, which does not mean that it excludes hospitals," Bilirakis said. "However, this clarification has not been sufficient and it has come to my attention that we need to amend the current statute to ensure that hospitals are covered by the conscience clause."

Bill Called 'Sweeping Expansion.' Rep. Sherrod Brown (D-Ohio), the ranking minority member of the subcommittee, called the bill a "sweeping expansion" of the current rule, contending it would affect not only hospitals but also insurance companies and health maintenance organizations. Brown also contended that the bill would negate federal requirements of health care facilities to provide abortions in case of rape, incest, or when the life of the mother is in danger. Brown stated that the bill puts "a political agenda ahead of access critical to health care."

In April, pro-life groups attempted to add a similar provision to a bill, also sponsored by Bilirakis, that would reauthorize for five years the National Health Service Corps and the Consolidated Health Centers program. The controversial issue prevented the bill from passing the committee. The Senate passed a companion bill which did not include such a provision.

Testifying at the July 11 hearing was Karen Vosburgh, the director of the association board of Valley Hospital located in Palmer, Alaska, a hospital which in 1997 was required to provide abortions by the Alaska Supreme Court, on the grounds that it received public funds.

"For those of us who believe that abortion is a form of violence, not a form of health care, being required to provide and support it is a grave injustice," Vosburgh said.

Also appearing as a witness, Catherine Weiss, director of the Reproductive Freedom Project of the American Civil Liberties Union, stated that the bill "amounts to a broad non-compliance permit for religiously affiliated entities that serve the general public and receive public funds, but nevertheless want exemptions from the general laws that govern other health care entities."

Lynn Wardle, a professor from J. Reuben Clark Law School, Brigham Young University, Provo, Utah, also testified.

State Parent Notification Bill. The second bill being considered is a bill sponsored by Rep. Kevin P. Brady (R-Texas), which would allow state governments to require notification of parents when minors receive prescription drugs or devices from federal programs. Specifically, the authors of the legislation state that the bill is intended to change the current regulation on such contraceptive-providing programs as Title X funding from the Office of Family Planning, which currently prohibits any provider from notifying a minor's parents.

"I find it particularly odd that a parent may not know whether their child is on prescription drugs, yet at the same time, may have to provide consent to a school nurse to administer aspirin to their child," said Rep. W.J. (Billy) Tauzin (R-La.), chairman of the House Energy and Commerce Committee. "Parents have a right to know about the health of their children."

But some Democrats on the panel spoke against this measure, saying it would discourage minors from receiving care.

"I can tell you from my personal experience, parental consent requirements for Title X services will result in higher rates of teenage pregnancy," said Rep. Lois Capps (D-Calif.). "Like most of my colleagues, I think it is, if at all possible, the best option, for teens considering sexual activity, to consult with his or her parents...But not all people have that option, for a variety of reasons. And requiring parental consent will cause many teenagers to avoid seeking help."

Rennee Jenkins, speaking on behalf of the American Academy of Family Pediatrics, stated that requiring notification not only could cause fewer minors to seek treatment, but also would adversely affect families. "Making service contingent on mandatory parental involvement...may drastically affect adolescent decision-making. Mandatory parental consent or notification reduces the likelihood that young people will seek timely treatment for sensitive health issues," Jenkins said.

Testifying in favor of the measure was registered nurse Addia Wuchner, chair of the Sexual Education Committee for Northern Kentucky Independent District Health Department, a clinic which considered rejecting Title X funding due to the regulations.

"Lack of parental notification in the Title X program are affronts to parents' rightful role as the primary educators to their children," Wuchner said. She also stated that 75 percent of the female minors who received treatment at her clinic did so without parental notification.

BY ALEX PARKER

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THE BUREAU OF NATIONAL AFFAIRS: MEDICARE REPORT - JULY 19, 2002

Oberstar Proposes Medicare Coverage Buy-In for Caregivers of Family Members

Rep. James L. Oberstar (D-Minn.) July 16 introduced legislation (H.R. 5139) that would create a buy-in Medicare program for caregivers, between the ages of 55 and 65, of chronically ill family members.

"Many of the shortcomings in the health care system related to care at the end of life arise from inherent shortcomings in federal policy," Oberstar said. He added that the bill "will meet the challenges faced by a growing number of people who must live with serious chronic illness for some time before death."

Oberstar said the purpose of the bill was to "guarantee that those caregivers approaching Medicare age would not have to go without health insurance themselves when they are forced to leave work to care for a family member."

The bill, Living Well with Fatal Chronic Illness Act of 2002, also would provide a $3,000 per year tax credit for caregivers of low-income individuals with long-term needs.

"The United States is the only developed nation that does not support family caregivers," Oberstar said. "While this tax credit is not enough to pay for the financial sacrifices incurred by many caregivers who provide long-term care, it will demonstrate support for the significant commitment and contributions made by those who help loved ones live well despite serious illness."

The bill also would require the departments of Health and Human Services and Veterans Affairs to implement programs to improve the quality of end-of-life care.

HHS would have to increase chronic illness and end-of-life services for Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, and the National Institutes of Health, as well as other programs.

Oberstar's office estimates that the buy-in program would cost $120 million per year, the tax credit would cost $14 billion over 10 years, and the programs for HHS and VA would cost $820 million over five years.

The bill has been assigned to the subcommittees on health for the House Energy and Commerce Committee, House Ways and Means Committee, and House Veteran Affairs Committee.

It would call for the creation of a Medicare pilot program to "demonstrate innovative, effective means of delivering care to Medicare beneficiaries with fatal chronic illnesses under the Medicare program."

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THE BUREAU OF NATIONAL AFFAIRS: MEDICARE REPORT - JULY 19, 2002

Urban Hospitals Relying on Medicaid Operating Budget Deficits, Study Says

A report released July 18 by the National Association for Urban Hospitals said its members operate on tighter margins than rural hospitals, especially facilities that provide at least 15 percent of their patient care for Medicaid beneficiaries.

The report, The Financial Condition of Urban Hospitals, shows that hospitals in urban areas where at least 15 percent of their care is given to Medicaid patients have an average operating margin of minus 7.84 percent, while rural hospitals with 15 percent Medicaid care have an average operating budget of 0.57 percent.

"[Urban hospitals] are spending their endowments and relying on investment income," NAUH Executive Director Ellen Kugler said. "Clearly, that cannot continue if the country would like to maintain a core group of urban health care providers."

NAUH called for a halt in scheduled reductions of Medicare and Medicaid reimbursements for hospitals treating a high percentage of Medicaid patients, restoration of Medicare bad debt payments, and implementation of severity-based diagnosis-related group system. It also advocated more examination of hospital service and Medicare/Medicaid formulas for low-income areas.

The report comes days after a report issued July 15 by the National Association of Public Hospitals and Health Systems stating that, for the first time in five years, the average hospital margin for NAPH member hospitals in negative, even after supplemental Medicaid and Medicare payments are factored in (see related item in this section).

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THE BUREAU OF NATIONAL AFFAIRS: MEDICAL RESEARCH LAW & POLICY REVIEW - JULY 17, 2002

Friends Research Institute to Award Scholars For Contributions to Ethics, 'Moral Courage'

The Friends Research Institute Inc. announced July 2 an annual $10,000 award to recognize scholars of research ethics.

The nonprofit organization established the award to "acknowledge the contributions of a leader scholar with moral courage in the area of research ethics," and to "promote the ethical conduct of research and to focus attention on the need to maintain high standards of ethics in research," according to a statement posted on FRI's Web site.

FRI stated that the award would be given to an individual who has made a "significant original contribution to the knowledge of research ethics" and has demonstrated personal moral courage in that field.

The nominating committee is chaired by Harold T. Shapiro, professor emeritus at Princeton University and former chairman of the National Bioethics Advisory Commission.

Recipients must be nominated by Dec. 1. Nominations can be sent by e-mail to mhipsley@friendsresearch.org.

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THE BUREAU OF NATIONAL AFFAIRS: HEALTH CARE POLICY REPORT - JULY 15, 2002

Industry Says Support for Imports, Reimports Erodes Due to Safety Concerns

A drug industry lobbying group released July 8 poll findings that back up its opposition to bringing American-made drugs that have been exported back into this country, and highlighted safety concerns about such drugs.

The Pharmaceutical Research and Manufacturers of America said voters in a poll dramatically changed their opinions on prescription drug importation and reimportation when presented with possible concerns over the safety of imported drugs. Reimportation has been cited by advocates as a possible, if partial, solution to sky-rocketing prescription drug prices in the United States.

PhRMA said the poll shows that after voters are asked whether they find "reasonable concern" over safety issues, support for both the reimportation of American-made drugs and importation of foreign-made drugs drops. These issues include the quality of import storage, possible counterfeit or expired drugs, the possibility of terrorist-poisoned imports, and the capability of the Food and Drug Administration to monitor imports.

The poll shows that 60 percent of voters initially support reimportation, against 23 percent who oppose reimportation and 17 percent who expressed no opinion. After listening to the interviewer's questions, the support for reimportation fell to 41 percent, against 53 percent who oppose it and 6 percent who expressed no opinion. According to the poll, 45 percent of voters initially support the importation of foreign-made drugs, against 42 percent who oppose and 12 percent who expressed no opinion, but when asked a second time, the numbers changed to 33 percent in support, 62 percent in opposition, and 5 percent expressing no opinion.

From Canada. The poll also included questions about importing only from Canada. Although 40 percent said they were more likely to support importation if it was only from Canada, 70 percent expressed concern about "third-world" drugs shipped through Canada, and over 50 percent expressed concern over whether the Canadian regulatory system would be able to handle the volume of importation allowed.

"In this area, opinions are not particularly stable," said Whit Ayres, of Ayres, McHenry & Associates Inc., the polling company which conducted the survey. "Once voters are exposed to a fuller debate, the support collapses."

This issue has been brought up recently as both parties have attempted to draft legislation dealing with Medicare prescription drug benefit plans. Sen. Byron L. Dorgan (D-N.D.) announced in April a Canada-only reimportation bill, and Senate Majority Leader Thomas A. Daschle (D-S.D.) stated in June that he expects a similar amendment to be added to the Senate's Medicare prescription drug plan.

A broader importation bill was passed by Congress in 2000, but the Department of Health and Human Services, under both the Clinton and Bush administrations, chose not to implement it, citing cost and safety concerns.

PhRMA has long been opposed to increased importation or reimportation of prescription drugs.

The late June survey consisted of 1,000 registered voters, with a margin of error of plus or minus 3.16 percent.

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THE BUREAU OF NATIONAL AFFAIRS: MEDICAL RESEARCH LAW & POLICY REVIEW - JULY 15, 2002

URAC Publishes E-Health Rule Guide

The American Accreditation HealthCare Commission, commonly known as URAC, announced June 25 the publication of a book that aims to help health care professionals comply with electronic transaction standards under the Health Insurance Portability and Accountability Act of 1996. The HIPAA Handbook: What Your Organization Should Know about the Electronic Transaction Standards, provides an explanation of "significant challenges faced by most health care organizations as compliance plans are implemented," according to a statement by URAC President and Chief Executive Officer Gary Carneal.

The book can be ordered through URAC's Web site, http://www.urac.org, or by calling the organization at (202) 216-9010.

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THE BUREAU OF NATIONAL AFFAIRS: MEDICARE REPORT - JULY 12, 2002

D.C. Hospital's Program Status Threatened After Government Studies Find Deficiencies

The Centers for Medicare & Medicaid Services has notified a Washington, D.C., hospital that recent surveys found deficiencies in its services, which could lead CMS to remove the hospital from the Medicare program.

In a June 24 letter to Greater Southeast Community Hospital, CMS said a health survey conducted on March 22 and fire safety survey conducted on April 24 found "serious" deficiencies that "require immediate attention."

As a result of the surveys, Greater Southeast has lost its "deemed" status, CMS's recognition that it has fulfilled all the requirements for Medicare services, although it will receive Medicare reimbursement.

In the letter, CMS stated that it would initiate "action to terminate [Greater Southeast's] facility from the Medicare program" if Greater Southeast did not comply with "an acceptable plan of correction."

A spokeswoman for Greater Southeast told BNA July 9 that the hospital submitted a letter of correction. The hospital will not regain its deemed status until CMS is able to conduct another study of the hospital's facilities.

CMS investigator Jamie C. Clark told BNA July 10 that she had received the hospital's plan of correction.

CMS's letter came shortly after a June 20 announcement from the Joint Commission on Accreditation of Healthcare Organizations, Greater Southeast's accreditor, that the hospital was downgraded from full accreditation to "conditional accreditation." The private accreditation body cited problems with initial assessment procedures, medication use, safety issues, and staff credentials.

Hospital: Problems Solved. The staff and management of Greater Southeast say the problems cited in the report have been addressed, and that most of the problems were inherited from previous management. Doctors Community Health Care purchased Southeast in 1999, when the struggling hospital was threatened with bankruptcy.

"It was addressed and corrected in March," Sharon Kirsch, vice president of corporate communications at Doctor's Community Health Care, told BNA. "The vast majority of issues were not patient-oriented."

CMS would not release any information about the specifics of the deficiencies. According to Greater Southeast and Doctor's Community Health Care, problems included miscalibrated machines, procedures for documenting patients' vital signs, policies regarding informed consent clauses, safety policies and procedures, and issues relating to doctors' credentials.

Although the JCAHO and CMS reports are independent, Greater Southeast indicated that many of the issues contained in the two reports were identical.

"They were outstanding learning experiences," Dr. Christopher J. Ackerman, chief medical officer at Greater Southeast, told BNA. "We were very forthright with our problems. We needed to know what issues were out there."

A spokeswoman for CMS said that hospitals do not often lose deemed status. She estimated that in 2001, approximately 10 hospitals in CMS's Region 3, which includes Washington, D.C., encountered similar actions.

BY ALEX PARKER

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THE BUREAU OF NATIONAL AFFAIRS: DAILY REPORT FOR EXECUTIVES - JULY 11, 2002
HEALTH CARE POLICY REPORT - JULY 15, 2002

Imported, Reimported Drug Dangers Cited by FDA Official at Senate Hearing

Allowing pharmaceutical imports, as well as reimports of U.S.-made drugs, would pose a threat that counterfeit, and possibly dangerous, medications would end up in the hands of American consumers, a senior official of the Food and Drug Administration said in July 9 Senate testimony.

FDA's William K. Hubbard outlined current problems that the FDA and U.S. Customs Service have with monitoring all imports, and said that these problems would be exacerbated by proposals to allow imported drugs into the country. Hubbard, the senior associate commissioner for policy, planning and legislation for the FDA, testified before the Senate Special Committee on Aging.

Sen. John Breaux (D-La.), chairman of the committee, said that, based on the testimony, he would not support reimportation/importation. "I'm against the reimportation of drugs into this country until such time as it could be assured that they are as safe as American-made drugs. As it was stated here today, that is not possible."

In a prepared statement, Hubbard said allowing importation or reimportation would create "a wide inlet for counterfeit drugs and other dangerous products that can be injurious to the public health and a threat to the security of our nation's drug supply."

Drug importation has become an important issue, as some claim that the increased competition could drive down prices of prescription drugs in the United States. In 2000, Congress passed an appropriations bill allowing for reimportation of U.S.-made drugs, but then-Health and Human Services Secretary Donna Shalala decided not to implement it, citing cost and safety concerns. Current HHS Secretary Tommy G. Thompson also chose not to implement the law.

Canada Exemption Debated. Sen. Byron L. Dorgan (D-N.D.), a long-time advocate for importation and reimportation, proposed in April a bill to allow for reimportation through Canada (S. 2244), and Senate Majority Leader Thomas Daschle (D-S.D.) said June 19 that it might be added as an amendment to a Senate Medicare prescription drug bill.

Hubbard also dismissed the idea that allowing imports only from Canada would eliminate the dangers, noting that it would "encourage unscrupulous individuals to devise schemes using Canada as a transshipment point for dangerous products from all points around the globe."

Barry E. Piatt, a spokesman for Dorgan, disputed the assertion that allowing reimportation from Canada would be dangerous. "The reimported drugs would have been made under FDA supervision and subject to the same identical chain of custody requirements," said Piatt. "It's a diversionary argument."

Also testifying at the hearing were Elizabeth G. Durant, executive director of trade programs at the U.S. Customs Service; Rick Roberts, an AIDS patient; and John Theriault, vice president of corporate security for Pfizer Inc.

BY ALEX PARKER

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THE BUREAU OF NATIONAL AFFAIRS: MEDICARE REPORT - JULY 5, 2002

Renal Disease Network Criteria Change Will Encourage Accountability, CMS Says

New criteria that the Centers for Medicare & Medicaid Services developed for evaluated end-stage renal disease networks were published in the June 28 Federal Register (67 Fed. Reg. 43613).

The criteria are used to evaluate the performance of the ESRD network organizations under the Medicare program to ensure effective administration of program benefits. The notice said this is the first time CMS has changed the criteria since 1987.

CMS's notice said its goals included "transitioning to a more patient-centered focus" and "shifting from a procedural approach to a more outcome-oriented approach."

The current standards call for review of individual cases for error, according to the notice. Instead, the new procedures will emphasize accountability of the entire network to CMS and internal review within the network of individual errors.

Nonprofit Networks. ESRD networks are nonprofit, nongovernmental organizations that were established in 1978 by amendments to the Social Security Act to administer dialysis or kidney transplantation for patients suffering from the chronic illness.

The transformation of the system began with the implementation of the Health Care Quality Improvement Program in 1994, which sought to bring "typical care into line with the best practices rather than by inspecting individual cases to identify erroneous treatment," according to the CMS notice.

In June 2000, the Department of Health and Human Services Office of Inspector General issued a report stating that the monitoring of the nation's key dialysis facilities has "major shortcomings," and recommended that greater accountability was needed to ensure higher quality care (11 MCR 695, 7/7/00). An inspection report by the IG in February 2002 restated that conclusion (13 MCR 177, 2/15/02).

In the notice, CMS said the changes will not have a major economic effect. As a result, the criteria changes are not classified as a "major rule."

The 60-day comment period ends Aug. 27. Comments should be sent to CMS, Department of Health and Human Services, Attention: CMS-3082-NC, P.O. Box 3016, Baltimore, Md. 21244-3016.

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THE BUREAU OF NATIONAL AFFAIRS: HEALTH PLAN & PROVIDER REPORT - JULY 3, 2002

Accreditation Group, House Panel Chair Promote Disease Management for Industry

An accreditation group and a key House Republican June 26 promoted diease management as a way of helping patients handle chronic conditions such as diabetes and asthma.

Rep. Nancy Johnson (R-Conn.), who chairs the House Ways and Means Subcommittee on Health, praised a new disease management initiative of the National Committee for Quality Assurance. She has also introduced legislation in 2001 (H.R. 3584) that would promote disease management in the Medicare+Choice program.

"Recognizing effective disease management programs through accreditation will help ensure that chronically ill individuals get the best care possible," said Johnson. "I applaud NCQA in their efforts."

NCQA President Margaret O'Kane said, "If the health care system did everything right in terms of treating chronic illnesses, most chronically ill people could live long and productive lives." O'Kane added that promoting disease management is "about making the best practice the standard practice."

On June 10, Washington-based NCQA announced that American Healthways would be its first recipient of disease management accreditation. The primarily Web-based accreditation program tests how health care providers prepare for and respond to chronic illness. Other programs which are currently being evaluated by NCQA include AdvancePCS, Blue Care Network of Michigan, and GlaxoSmithKline HealthCare Management (8HPPR 723, 6/19/02).

In its June 26 statement, NCQA said accreditation for disease management has benefits for health plans. For example, plans with NCQA-accredited DM programs receive automatic credit on related managed care organization accreditation requirements.

Medicare+Choice, the Medicare managed care program, has suffered from helath plan withdrawals in recent year. Johnson described the type of proactive care needed in disease management. She added, "You can't do it with the old fee-for-service system."

Johnson legislation, introduced in late 2001, also would boost payments to health plans in M+C.

"Disease management is cost-effective," said Warren Todd, executive director of the Disease Management Association of America, and industry group that specializes in disease management.

In addition to NCQA, two other accreditation bodies, the American Accreditation HealthCare Commission (known as URAC) and the Joint Commission on Accreditation of HealthCare Organizations (JCAHO) have new disease management programs.

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THE BUREAU OF NATIONAL AFFAIRS: DAILY REPORT FOR EXECUTIVES - JULY 1, 2002
HEALTH CARE POLICY REPORT

HHS Reports 64 Hospitals Closed in 2000, Cites Financial Stress Caused by Competition

Sixty-four hospitals in the United States closed in 2000, primarily because of financial stress, the Department of Health and Human Services Office of Inspector General said in a report released June 28.

The IG attributed the financial stress to competition and low occupancy. However, 19 of the closures resulted from mergers or hospital organizations. Two hospitals cited reductions in Medicare or Medicaid payments, but neither said that was the sole cause.

The report, Hospital Closure 2000 (OEI-04-02-00010), found that while the same number of hospitals closed in 2000 as in 1999, seven more hospitals opened or reopened in 2000 (29) than in 2999 (22). Twenty-two of the hospital closures in 2000 were in rural areas and 42 in urban areas.

The report, prepared by the IG's Office of Evaluation and Inspections, also said hospital closings did not have a large impact on patients because other hospitals were available for inpatient care and emergency services. In half of the affected communities, an alternate hospital was located within three miles--in only one case was the next closest hospital more than 30 miles away.

"The hospital field continues to decrease in size," a spokeswoman for the American Hospital Association said. She said statistics used to gauge the impact on patients might not be sufficient because "the impact is unique in every community."

In the rural hospitals that closed, Medicaid utilization--defined as the percent of Medicaid patient days compared to total days--was higher than the national average, but Medicare utilization was lower, according to the report's statistics.

Conversely, in the closed urban hospitals, Medicaid utilization was lower than the national average while Medicare utilization was higher.

The report also found that in 20 cases after the hospital closed, the building continued to be used for health-related services, such as a health clinic, outpatient facility, or rehabilitation center.

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THE BUREAU OF NATIONAL AFFAIRS: HEALTH CARE POLICY REPORT - JULY 1, 2002

Consumer Group Faults Steep Rise In Drug Prices, Supports Hill Democrats

The prices for the prescription drugs used most heavily by senior citizens rose by an average of nearly three times the inflation rate in 2001, the consumer group Families USA said in a study issued June 24.

The group said that without increased benefits within the Medicare program and a moderation in drug prices, many Americans will continue to be unable to afford the drugs they are prescribed.

The group's study found that the 50 most prescribed drugs for seniors had an average price increase of 7.8 percent between January 2001 and January 2002, almost three times the 2.7 percent rate of inflation for that period. The study also included four-year averages, which showed that drugs used heavily by seniors rose twice as fast in price as the inflation rate between 1997 and 2001. The study was conducted using statistics from the Pennsylvania Pharmaceutical Assistance Contract for the Elderly program, according to the report.

Drugs which increased the most in 2001, according to the study, include metoprolol (a beta blocker), Demadex (a diuretic), Premarin (estrogen replacement), Plavix (anti-platelet agent), and Zestril (ACE inhibitor). For these five, the report claims all rose at least five times the rate of inflation.

Of the 50 drugs examined, 40 were brand-name drugs. These 40 increased in price by an average of 8.1 percent in 2001, and only three of those did not increase in price. Ten of the 50 were generic drugs, and nine of those did not rise in price at all in 2001, creating an average increase of 1.8 percent for the 10 generics, according to the report.

Support for Democrats. Ron Pollack, executive director of Families USA, stated the group's support of congressional Democrats' drug benefit proposals, and said that these proposals are the most reasonable way to deal with the rising costs shown in the report. "There is no reasonable basis for the alarming price increases, which continue to make prescription drugs unaffordable for too many seniors," said Pollack. He also expressed disbelief over the industry claim that the rising costs are due to research and development.

Appearing at the press conference with Pollack were Sen. Debbie Stabenow (D-Mich.) and Rep. Frank Pallone Jr. (D-N.J.), who both criticized the congressional Republicans' Medicare drug benefit plan, which would include a drug benefit costing $310 billion over 10 years. Stabenow and Pallone claimed the bill, which was approved by two house committees on June 19 and June 21 and is headed for the House floor soon, would do little to curb prescription drug costs and would place more of the burden of costs on seniors.

Democrats on the House Ways and Means Committee offered and alternative which would cost as much as $800 billion over the next 10 years, but the amendment was defeated.

"The biggest concern I have is that the Republican bill in the House does nothing in regard to price," said Pallone. Stabenow, who heads the Democratic Prescription Drug Task Force in the Senate, outlined the Democrats' alternative, calling for increased Medicare coverage, giving the secretary of health and human services the ability to negotiate the price of prescription drugs using Medicare's bargaining power, limiting the tax credits given to drug companies for advertising, and eliminating what Stabenow called loopholes in the patent laws, claiming that they allow drug companies to extend patents beyond the 20-year expiration date.

Industry Response. The Pharmaceutical Research and Manufacturers of America, a trade group for the prescription drug industry, released a statement June 24 in response to the report. PhRMA emphasized its commitment to "a meaningful Medicare drug benefit," and also emphasized that patients unable to afford medicines should apply for drug companies' patient assistance programs.

Alan Holmer, president of PhRMA, said prescription drugs can help many people avoid costly surgery. He also said drugs can vary in price, and that seniors "may want to shop around to find the best value" for their medications.

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THE BUREAU OF NATIONAL AFFAIRS: HEALTH CARE FRAUD REPORT - JUNE 26, 2002

Massachusetts Program to Receive Funds From Settlement of Overcharging Allegations

Massachusetts Attorney General Tom Reilly (D) June 6 announced that the state Medicaid program will receive about $92,000 as part of a settlement involving alleged overcharges for services to developmentally disabled people.

The settlement involves Tenet MetroWest Healthcare Limited Partnership in Ashland, Mass. Reilly's office said an investigation that started in 1998 found that the MetroWest Daily Habilitation Program exaggerated conditions of disabled patients to secure higher Medicaid funding.

Reilly's office charged that as a result of MetroWest's activity, the daily rate paid by Medicaid rose from $57.20 to $77.64.

Assistant Attorney General Peter Clark, who directs the AG's Medicaid Fraud Control Unit, handled the settlement with assistance from Assistant U.S. Attorney Roberta Brown from the Office of the U.S. Attorney for the District of Massachusetts. Investigations were conducted by Catherine Fielding and John Curley of Reilly's office.

A spokesman for Tenet's parent company, Tenet Healthcare Corp., said the company has discharged the program's director and terminated the program, a center for mentally handicapped adults, since learning of the investigation.

"As soon as we were alerted, we cooperated," the spokesman for Tenet, based in Santa Barbara, Calif., said. "We did what we could to make sure that this was fully investigated."

Tenet Healthcare acquired MetroWest Medical Center in 1999, after Reilly's office began its investigation into the Medical Center's habilitation program's practices. The AG's office said it did not find any wrongdoing on the part of Tenet Healthcare.

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THE BUREAU OF NATIONAL AFFAIRS: HEALTH PLAN & PROVIDER REPORT - JUNE 26, 2002

Maryland Denies CareFirst Rate Increase

Maryland regulators denied June 18 two small business rate increase requests from CareFirst BlueCross BlueShield that would have taken effect July 1, invoking a state law requiring insurance plans offered to small businesses to spend at least 75 cents of every premium dollar on medical claims.

A spokeswoman for the Maryland Insurance Administration said rather than attaining a 75-percent "loss ratio," CareFirst had a ratio of 73 percent in 2001. A representative from CareFirst told BNA that although there are no immediate plans to resubmit rates, the company is "moving diligently" towards the 75 percent ratio. The health plan had said the rate increases were justified by increased costs.

According to a statement issued by Maryland Insurance Commissioner Steven B. Larsen's office, CareFirst sought a 16.5 percent increase for its Washington, D.C.-based BlueChoice HMO plan, and a 12.4 percent increase for the Preferred Provider Organization plan issued by Group Hospital and Medical Services Inc. Larsen's office had approved prior rate increases for the two plans last year, which took effect on Jan. 1, 2002, and will not be affected by this denial. CareFirst also proposed smaller increases for the District of Columbia market that were approved by the D.C. Department of Insurance and Securities Regulations and take effect in July, a spokesperson for the D.C. agency told BNA.

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THE BUREAU OF NATIONAL AFFAIRS: HEALTH CARE POLICY REPORT - JUNE 24, 2002
HEALTH PLAN & PROVIDER REPORT - JUNE 26, 2002

Report Says Lack of Health Insurance Key to Racial Disparities in Coverage

Lack of health insurance is the most critical reason for continuing disparities between white and minority health care coverage, the Center for Studying Health System Change said June 19.

A study by the center found that the difference between coverage for uninsured whites and minorities is nearly double that of insured whites and minorities.

Based on the findings of the study, the center called for increased coverage as a way to decrease the gap. "Reducing disparities in minority health care will be difficult without narrowing the health insurance gap," J. Lee Hargraves, a senior health researcher who wrote the study's final report, told a press briefing.

According to the report, the gap in coverage remained constant between 1997 and 2001, despite findings by the Centers for Disease Control and Prevention that overall health has improved. The report claimed that insurance, or lack of insurance, was the most important factor in the difference in coverage, followed by income levels. The report was based on three telephone surveys, conducted in 1997, 1999, and 2001, or more than 60,000 people.

The center found a 15.4 percent difference between the percentage of uninsured whites with a regular health provider and uninsured blacks with a provider, and a 20.3 percent difference between whites and Latinos. The difference between insured whites and blacks is 7.3 percent. The report also said that 10.9 percent of whites, 18.7 percent of African Americans, and 32 percent of Latinos currently do not have health insurance.

The study also found that minorities were relying more upon emergency rooms for health care access.

Dr. Elena V. Rios, president of the National Hispanic Medical Association, told the briefing that insurance information needed to be available in both English and Spanish.

Dr. Lucille C. Perez, president of the National Medical Association, praised a bill recently proposed by Sen. Edward Kennedy (D-Mass.) that would require firms who employ more than 100 people to provide health insurance, and also commended the Bush administration for its plans to address the issue later this summer.

Perez and Rios said that increasing the number of minorities in the health care field would be a vital part of ensuring equitable access and treatment.

This report comes on the heels of another issued by the Institute of Medicine in March, which said that minorities receive lower-quality health care, even when income and socio-economic conditions are the same (10 HCPR 455, 3/25/02).

"This study shows that insurance matters," said a representative for the American Association of Health Plans. "We hope this will cause people to seriously look at the problem of the uninsured and seriously look at the cost crisis that's part of it."

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THE BUREAU OF NATIONAL AFFAIRS: HEALTH CARE POLICY REPORT - JUNE 24, 2002

Sen. Dodd Seeks Funds for HHS Panel On National Newborn Screening Standards

Sen. Christopher J. Dodd (D-Conn.) said June 14 that he intends to secure funding to establish more consistent standards nationwide for newborn screening of preventable or treatable genetic illnesses.

At a hearing of a Senate subcommittee, Dodd decried the lack of consistency in state tests for such illnesses as medium-chain acyl-coa dehydrogenase deficiency and other genetically inherited disorders which he cited as being preventable if detected at an early age.

Such screening programs of newborns are run by state health agencies.

Dodd said he and Sen. Mike DeWine (R-Ohio) would attempt to obtain $25 million in appropriations to support provisions of the Children's Health Act of 2000 to create an advisory committee on newborn screening within the Department of Health and Human Services.

Noting that only Connecticut and Massachusetts currently test newborn infants for 30 known diseases, Dodd stated that, for a child born with an inherited disorder, "being born in Connecticut may mean a normal life, while birth in...other states and the District of Columbia could amount to a death sentence." Dodd also stated that, due to the discrepancies, 1,000 children die from preventable disorders every year.

He spoke at a hearing of the Senate Health, Education, Labor, and Pensions Subcommittee on Children and Families, which he chairs.

Planning Legislation. Dodd also said he intends to sponsor legislation that would attempt increase the knowledge of available testing to parents and doctors. This legislation would provide states with the resources for follow-up care for children diagnosed with a disorder detected through newborn screening, he said.

He said screening newborns for disorders could "open a Pandora's box of potential misuse" of the information, and said he is working on legislation to prohibit discrimination based on an individual's genetic information.

Witnesses from HHS and other organizations discussed issues including the price of testing, how such tests would be administered, and what would be required to ensure that children diagnosed with illnesses would be adequately treated.

Peter van Dyck of HHS said he believes states should test newborns for 10 to 14 inherited illnesses and provide parents with information about further voluntary testing. He said he expects this to be the recommendation of an upcoming study of the American College of Medical Genetics. Van Dyck is associate administrator for maternal and child health at HHS's Health Resources and Services Administration.

Jill Wood, the mother of a child who died from an undiagnosed metabolic birth defect not tested for in her home state of Virginia, testified on behalf of the March of Dimes. The March of Dimes presented a list of 10 core disorders that are either preventable or treatable at an early stage, and which it says are most in need of testing. The disorders include sickle-cell anemia, congenital hypothyroidism, and congenital adrenal hyperplasia.

Jeffrey Botkin of the University of Utah School of Medicine testified on behalf of the American Academy of Pediatrics. He said that without minimum standards or guidelines to help states assess what tests are "effective and relevant to their population, children are being subjected to a different panel of tests depending on the state in which they are born." The academy supports establishment of national standards and strengthening the infrastructure between states for newborn screening and treatment. Botkin is adjunct professor of human genetics at the University of Utah School of Medicine.

Also testifying were Scott Rivkees, a pediatrician from the Yale University School of Medicine and a member of the Connecticut Genetics Advisory Committee; and Brad Therrell, director of the National Newborn Screening and Genetics Resource Center.

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THE BUREAU OF NATIONAL AFFAIRS: HEALTH CARE POLICY REPORT - JUNE 17, 2002

Nashville-Based Firm Gets First Approval In NCQA Disease Management Program

The National Committee for Quality Assurance has awarded its first general disease management accreditation to American Healthways, the accreditation body announced June 10.

NCQA said it tested the Nashville, Tenn.-based disease management firm for programs in diabetes, congestive heart failure, coronary artery disease, and chronic obstructive pulmonary disease. American Healthways is the first company to complete inspection, and about 20 others currently are being review by NCQA for potential accreditation, NCQA said. American Healthways said it provides disease and care management services to more than 500,000 patients nationwide.

On its Web site, NCQA said its disease management review process is unique in that it is primary an "off-site review" of electronically submitted materials, both self-assessed scores and supporting documentation. NCQA then confirms the review with a site visit.

Other companies whose reviews NCQA will complete shortly include AdvancePCS, GlaxoSmithKline Healthcare Management, and McKesson Health Solutions LLC.

Other Groups Active. Two other accreditation bodies, the American Accreditation HealthCare Commission (known as URAC) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) have disease management programs. URAC announced its final standards on April 15.

JCAHO launched in February a disease-specific care certification program. Later that month, JCAHO awarded the first certification to the Los Angeles County Department of Health Services. In March, it handed out a disease-specific care certification to Marietta, Ga.-based WellStar Health System.

In another development in disease management, an associations of pharmacists said June 11 that more of its members are charging for disease management services. According to the National Community Pharmacists Association, the number of independent pharmacies charging a separate fee for DM services is "slowly increasing," but the association did not give specific numbers.

The federal government also is getting involved in disease management. Late in February, the Centers for Medicare & Medicaid Services announced that it would take applications for a three-year disease management demonstration project for chronically ill Medicare beneficiaries that includes coverage for prescription drugs.

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THE SACRAMENTO BEE - JANUARY 21, 2001

Protesters vent their unhappiness

By Kevin Diaz and Alex Parker
Bee Washington Bureau

WASHINGTON - It had been more than a quarter-century since Pennsylvania Avenue had been as jammed with demonstrators for a presidential inauguration as it was Saturday.

D.C. police gave no crowd estimate, as has become their custom, but along many parts of the parade route, demonstrators seemed to outnumber other spectators. At Freedom Plaza, a block from the White House, protesters chanting "Hail to the thief" took over a bleacher intended for parade watchers and drowned out the official public address system.

Protesters clashed briefly with police clad in riot gear at a few flash points while President Bush remained inside his armored stretch car for most of the parade.

A couple of protesters threw bottles and tomatoes before the presidential limousine arrived, and one hurled an egg that landed near the motorcade, the Secret Service said.

But the protesters managed little else to interrupt the festivities in the face of a massive show of 7,000 police officers.

"We're offended, because they didn't count the votes," said Mike Soukup, a San Jose accountant, one of scores of self-described "ordinary people" protesting Saturday's inauguration.

Demonstrators carried protest signs, some of them obscene, some of them merely insulting, such as "Smirk the Jerk."

Police reported eight arrests. One of the people arrested was charged with assault with a deadly weapon after slashing tires and trying to assault an officer, one official said. Several other arrests came after a few scuffles involving riot police police and black-clad anarchists who, in one instance, burned a flag on a street corner a few blocks away from the parade route.

But the vast majority of the protesters were peaceful. Judith Lewis, an editor at the L.A. Weekly, said that in contrast to the radical demonstrators at the Democratic National Convention in Los Angeles last summer, many of the inaugural protesters seemed to have been newly galvanized by the election.

"This is a much more mainstream crowd," said Lewis. "I think a lot of people now are going to be motivated to become more active in the next four years."

Indeed, it appeared that the inauguration brought out thousands of occasional and first-time demonstrators from California and elsewhere, most of them galvanized by the contested vote in Florida.

"I don't like how (Bush) supposedly won the election," said David Farmer, a college student from Sacramento who was attending his first protest. "I think it's a little shady that he won in his brother's state."

Nathaniel Khaliq, president of the St. Paul, Minn., NAACP, brought a busload of pickets with him and likened it to a freedom ride, recalling African Americans' historic struggle for voting rights.

"A lot of people lost their lives for the right to vote," he said. "We owed it to them and to our children to make sure (injustice) doesn't go unchallenged."

Traci Yokoyama, a college student from Irvine, expressed similar sentiments.

"I'm protesting because it's terrible the way this election was run," she said. "People shouldn't have to worry about whether their votes are counted or not."

Protests were reported at various other sites around the country. In Sacramento, a nonpartisan group of 500 people gathered at the State Capitol over what they called a "stolen election."

Protesters demanded a fair electoral process and an end to racial discrimination at the polls. Paul and Brenda Hammond of Sacramento objected to how African Americans were disenfranchised in Florida.

"Black people were denied their right to vote," Paul Hammond said, adding that he didn't think Democratic presidential candidate Al Gore fought hard enough for justice for African American voters.

Jen Ferr, a member of the Sacramento County Green Party, waved a sign with the words "A dark day for democracy."

Ferr dressed in all black and wore a crown reminiscent of the Statue of Liberty.

Mike Irwin of Sacramento carried a sign in the shape of a tombstone noting the death of democracy: "Born July 4, 1776, died Dec. 11, 2000, killed by the Supreme Court of the United States."

"I am outraged by the Supreme Court's decision," Irwin said. "I feel that it sets a dangerous precedent for the state of our democracy."

At the inauguration in Washington, Berkeley native Susan Deutscher helped demonstrate the broad cross-section of people protesting the election. She carried a poster saying "Privileged, White, Straight People Against Bush."

Deutscher, marching with friends from an East Coast literary magazine, said she was motivated by a deep dislike for Bush.

"But I want to show the world that he doesn't have a mandate," she said. "Opposition to him is broad-based."

Not all the chants came from the anti-Bush crowd. A small, all-male group of counterdemonstrators taunted the much larger protest group with the chant, "We're rich, we're here, get used to it!"

Others just came to watch or to be watched. Among them was Robert Burck, a Cincinnati guitar player who serenaded the crowd wearing a pair of briefs, a cowboy hat and an American flag.

"I go to all the big events," he said. "Whether they are political or not."

Bee staff writer Gwendolyn Crump and the Associated Press contributed to this report.

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THE MODESTO BEE - JANUARY 20, 2001

Sabatino, nation's mayors talk cities' needs

By ALEX PARKER
BEE WASHINGTON BUREAU

January 20, 2001

WASHINGTON, D.C. -- Even from the opposite side of the country, Mayor Carmen Sabatino could not escape Modesto's blackouts.

In Washington for the 69th Winter Meeting of the U.S. Conference of Mayors, Sabatino spent part of Thursday afternoon in the lobby of the Capital Hilton, talking by cell phone with his secretary about power being restored to portions of north Modesto. Fortunately, Sabatino said, he can rely on the city's professionals to take care of things.

The event, which drew more than 300 mayors, focuses on improving the relationship between cities and the federal government.

Thursday, the mayors endorsed a new set of priorities for improving city life. Sabatino considers some of the priorities, such as better transportation, important for Modesto.

"Unless we have transportation, we're not going to have jobs," Sabatino said. "And unless we have jobs, (it's) going to make it difficult to have housing."

Electricity did not make the list of national mayoral priorities. But as he juggled meetings with cell phone updates, Sabatino saw a lesson in California's electrical woes.

"Deregulation, I think, is the spark that ignited all of this," Sabatino said. "I believe in the free market (but) there are certain things that people need, and government should be involved with things that people need."

Sabatino said that once the state's power problems are resolved, he is optimistic the future will be better for Central Valley cities.

He said he hopes Modesto can secure more federal money for transportation and housing development under President Bush, who has talked of shifting more authority to local officials.

"One of my goals that I have as mayor ... is to make sure that cities get their fair share of tax dollars, whether they be county, state, or federal," Sabatino said. "And, quite frankly, in the last couple of decades, the Central Valley cities have been shortchanged."

Sabatino further expressed his faith that as an organized group, the nation's mayors can garner political attention for local matters.

"If the Conference of Mayors and the League of California Cities continue to direct them toward what our needs are, I don't think those needs will be ignored."

The mayors' conference began Tuesday with the awarding of the Distinguished Public Service Award to President Clinton, the first time in the award's history that it has gone to a president.

In presenting the award, Conference of Mayors President H. Brent Coles cited Clinton's efforts to make the federal government more receptive to local needs.

"I think there's been an increase in the sensitivity to the problems of cities, especially to the area of affordable housing," Sabatino agreed.

When asked what he thought the Bush administration would mean in terms of federal mandates, Sabatino replied only: "I hope that all mandates are funded."

"State and federal people talk and talk and talk," he said, "but the city and local people have to do it."

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SACRAMENTO BEE ONLINE - JANUARY 11, 2001

Disabled cheer wheelchair statue at FDR Memorial

By Alex Parker, Scripps-McClatchy Western Service

WASHINGTON (January 11, 2001) - For Los Angeles native and disability rights activist Taylor Hines, Wednesday's unveiling of a statue depicting Franklin Delano Roosevelt in a wheelchair revealed more than mere illness.

"The unveiling shows that people with disabilities really can do anything they aspire to," said Hines, a staff member with the National Organization on Disability. "As a person with a disability, it's a tremendous inspiration to me."

The statue dedication by President Clinton concluded a five-year struggle by disability rights groups to explicitly depict the polio-stricken Roosevelt in his wheelchair. The private groups formed the Rendezvous with Destiny committee, which raised the $1.65 million needed to complete the memorial.

The late-morning dedication drew disabled lawmakers, Hollywood celebrities and, in one of his final presidential appearances, Bill Clinton. Democratic Sen. Max Cleland of Georgia, who lost both legs in Vietnam, attended along with the likes of actresses Lauren Bacall and Angelica Huston.

"This is a statue of freedom, of the power of every man and woman to transcend their circumstances, to laugh in the face of fate, to make the most of what God has given them," Clinton said.

The original five-acre FDR Memorial opened in 1997, without calling attention to Roosevelt's disability. Roosevelt himself, who lost his ability to walk early in his political career due to polio, famously tried to conceal his illness by discretely using braces, a loyal entourage and an amenable press corps.

Some felt a memorial should likewise not emphasize his disability. Following protests at the original dedication, Clinton and the Congress agreed that the memorial should be enriched with an additional statue - so long as it was funded privately.

"It would be a travesty not to include a depiction of FDR's disability, which he had throughout his 12 years in the White House," said Alan Reich, president of the National Organization on Disability. "We get letters every day from people who say to their disabled children, 'Look, President Roosevelt was in a wheelchair, and he became president, you can become a success in your life."

In stark contrast to the towering memorial figures of Jefferson and Lincoln, the Roosevelt statue is life-sized. It depicts him in the wheelchair that he constructed, sitting up and wearing his glasses. Sculptor Robert Graham - Huston's husband - stated the statue's intimacy was the most important feature in its design.

"I think it's appropriate that the statue is not larger than life, but life-sized," Clinton said. "It is a reminder to all that see it, to all that touch it, that we are free."

Behind the statue is a quote from Eleanor Roosevelt, etched in granite and supplemented in Braille, stating that Roosevelt's illness gave him qualities that he did not have before. That was a central theme of the presentation, that Roosevelt was a highly effective president not in spite of his disability, but because of it.

"FDR was a better president because of his disability," Reich said. "His main leadership qualities - compassion, courage, determination, patience - all came out of his disability experience," Reich said.

Roosevelt's grandson Jim said he loved the monument because "it shows where he would be today. Not where his head was in 1945, but where we as a people are today."

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