Healthcare

Docs won’t benefit from prevention cuts

The just-released House Republicans' payroll tax plan aims to increase doctors’ Medicare reimbursement by dramatically cutting the Prevention and Public Health Fund by more than two-thirds. We must address the rates that Medicare pays doctors, but doing so by raiding the prevention fund is a short-sighted solution that will cost money, not save it. Quality, affordable medical care and community prevention work hand-in-hand. Congress must find another way.

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Proposed federal food advertising guidelines raise legal questions under federal nutrition law

The draft Nutrition Principles to Guide Industry Self-Regulatory Efforts on children-directed food marketing ("Nutrition Principles") has undergone criticism from affected businesses, Members of Congress, and interested members of the public.  In response, the Interagency Working Group ("IWG") that issued the draft last April has pledged to make changes to its original draft.

But the IWG has shown no inclination to make one critical change, which, if unmade, could expose the Nutrition Principles to a legal challenge. Because the Nutrition Principles constitute "dietary guidance" which differs from the official U.S. Dietary Guidelines for Americans ("DGA"), a strong argument can be made that the Secretaries of Agriculture and Health and Human Services must review formally the IWG's draft.

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Secretary must consider most vulnerable when determining essential benefits package

A crucial decision is quietly working its way through the halls of the Department of Health and Human Services that will impact the quality of care available to millions of Americans under the Affordable Care Act (ACA). The issue at hand is the requirements for the essential health benefits package, which will decide which components insurance plans will have to include in order to qualify for the exchanges set up under the ACA. 

Much of the public discussion that has occurred has centered on cost and affordability. The Institute of Medicine (IOM) released a report that set forth a rigid standard for measuring overall essential health benefits – the “typical” employer plan in the small group market – that is focused heavily on cost over the needs of the individual patient. The National Alliance on Mental Illness (NAMI) is concerned for the patient population we represent, as well as other patient populations that have needs that go beyond the bare minimum care. The essential health benefits package must include a wide range of health care products that meet patient needs, especially those with chronic illness or disease, follow the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, and ensure that patients have access to medically appropriate care and not set national standards for whether individual items and services are either included or excluded. 

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Donor governments stop short of crossing the ‘finish line’ in global health

Over the last decade, great progress has been made in developing new global health technologies that show potential to transform the deadliest diseases on earth. This progress has been delivered largely by Product Development Partnerships (PDPs), with critical support from the public, private and philanthropic sectors, which have filled the gap by developing new technologies to prevent, diagnose and treat diseases affecting the world’s most underserved populations. 

Despite the urgent need for new tools, the recently released G-FINDER report reveals that overall global investment in the research and development (R&D) of such products has declined for the first time since 2007, when the tracking of such funding began. This decline is especially troubling given that there are more than 100 products in PDPs’ pipelines. In the case of tuberculosis, novel vaccines are undergoing testing in clinical trials and new treatments are in late-stage development, giving promise to the availability of new solutions in the near term.

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America needs a health care ruling

Unless you practice tax law you probably have never heard of the 1867 Anti-Injunction Act.   

This obscure tax provision enacted into law by Congress in 1867, however, could delay a final ruling on the constitutionality of health care reform until 2015.

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Resolution of legal battle provides opportunity to get reform right

With the recent announcement that the U.S. Supreme Court will consider the challenges to the constitutionality of the Affordable Care Act (ACA), many issues that arose during the original reform debate are again being thrust into the spotlight.  As this high court legal showdown emerges, it also presents an opportunity for the Administration and Congress to work together to ensure that, should health care reform move forward, its provisions are implemented properly and fairly, and in a manner that best protects the very people the law was created to assist.

In the case of the health insurance exchanges, there lies great promise for these marketplaces created under the ACA to help individuals purchase quality, affordable coverage that could otherwise be unattainable. However, due to the reform law’s legislative process and lack of a conference report, many provisions related to the exchanges were unintentionally left unclear, including provisions related to Medicare’s End Stage Renal Disease (ESRD) population and Medicare Secondary Payer (MSP) law.

Each year in the United States, more than 100,000 Americans are diagnosed with ESRD, an irreversible condition that is fatal without regular lifesaving dialysis treatments or a kidney transplant.  Currently, MSP enables ESRD patients with private insurance to keep their preferred coverage for a 30-month window before transitioning to Medicare, giving them time to learn more about their condition, take advantage of plan offerings for care management, and explore how Medicare will handle their coverage moving forward. 

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PBMs save us billions of dollars

The goal of antitrust policy is to protect competition and consumers, not to protect the interests of any particular group of competitors. This fundamental principle is critical when reviewing recent commentary on the proposed merger of Express Scripts and Medco, two Pharmacy Benefit Managers (PBMs). 

A recent opinion piece by David Balto (Step up to the plate: FTC needs to stop the Express Scripts-Medco merger- November 2,2011)
 rehashes the positions of retail pharmacy groups that repeatedly have been disproven by the Federal Trade Commission (FTC), the Congressional Budget Office (CBO) and the Government Accountability Office (GAO). 

Mr. Balto and the lobby for retail pharmacies have waged a long-running battle in state capitals and in Washington to restrict PBMs because they are unhappy that PBMs negotiate lower prescription drug prices for employees, union members, and others than retail pharmacies would charge if left to their own devices.

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Standing up for servicewomen: Rape survivors deserve access to abortion care

Recently, Senator Jeanne Shaheen (D-NH) introduced an amendment to the National Defense Authorization Act to lift the current ban on military insurance covering abortion care in cases where a woman is pregnant after rape or incest. Unfortunately, rape is a very real threat for American servicewomen, and they must be able to access the abortion care they need after experiencing sexual violence.
 
Servicewomen rely on the military for their health care, but under current policy they are left to fend for themselves if they become pregnant after rape or incest. Through our website and toll-free hotline, we hear from military women about their difficulties obtaining abortion care after they experience sexual violence:
 
I am in the military and got raped and became pregnant. I would like to just move on without military intervention. I am stationed in South Korea and abortion is illegal here, even for rape. I cannot go home on leave at this time. I don’t know what to do. What can I do?
Anonymous; South Korea (as reported to NAF)

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Restrictions on birth control hurt everyone

Restricting women’s access to birth control hurts everyone.  It hurts women by limiting their ability to get an education or become self-sufficient, and risks their health when they can’t plan or space their pregnancies.  It hurts children born into families not ready or able to care for them. And it hurts families by robbing them of the ability to decide whether and when to have a child.

That is why independent physicians, nurses, and other health professionals agree that providing access to contraception is good medical and economic policy.  And yet – surprisingly – birth control is under attack.  Anti-women groups, and some members of Congress, are pressuring the Administration to roll back some of provisions of the Affordable Care Act (ACA).  The ACA guarantees access to important preventive health services without expensive co-pays.  This includes contraception for women.  But if anti-women forces get their way, thousands of employers will be allowed to refuse to cover contraceptives in their employer-sponsored health plans.  These forces are attempting to directly interfere with the individual health needs of millions of women by limiting the type of care they can get.

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Supercommittee: Don't force cancer clinics to close

This past summer, Congress appointed a super committee to come up with a plan for cutting the nation’s escalating debt.  To this end, this bipartisan group of lawmakers may be considering cuts to Medicare Part B, the federal program that reimburses physicians for medicines they administer as treatment to America's seniors. 
 
Unlike pills that patients can take themselves at home, Part B drugs must be injected or infused under the direction of a healthcare provider in a professional medical setting, like medicines for cancer patients.  Part B must be kept off the table.  

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