State issues

A key panel of the Arkansas legislature has blocked an attempt to reject the federal healthcare reform law's requirement that everyone carry insurance, The Associated Press reports.

The panel rejected the bill after an assistant attorney general said it would almost guarantee that the state would get sued. Six other states — Virginia, Idaho, Arizona, Georgia, Missouri and Louisiana — have already enacted legislation rejecting the mandate, while Arizona and Oklahoma amended their constitution to declare that their residents don't have to buy insurance.

A federal judge in Florida is expected to rule any day on a multi-state lawsuit challenging the mandate.

A bipartisan group of former congressional and state leaders on Tuesday will launch a new health project focusing on state-based initiatives. The Bipartisan Policy Center, which offered a compromise blueprint for healthcare reform during the reform debate, is scheduled to announce a new project that will "work with the states, through a series of public and private discussions, to ensure that Americans have access to high-quality, affordable health care."

The new project will be announced by former Senate majority leaders Tom Daschle (D-S.D.) and Bill Frist (R-Tenn.) and by former Gov. Ted Strickland (D-Ohio).

Daschle was involved in the center's healthcare reform effort along with former Senate majority leaders Bob Dole (R-Kan.) and Howard Baker (R-Tenn.). The center made news at the time when it sketched a bipartisan way forward on healthcare reform even as the debate had ground to a halt on Capitol Hill due to partisan gridlock. 

In June 2009, the three former Senate leaders unveiled a 68-page plan titled "Crossing our Lines" that offered a compromise that the Democrat and two Republicans could live with. The proposal included a refundable tax credit and an individual mandate requiring people to buy insurance; it also featured an employer mandate, a major sticking point for Republicans, and offered tax credits for small businesses that offered coverage.

Daschle, meanwhile, had to give up the idea of a public option for a compromise that gave the president fast-track authority to set up a public plan if private insurers failed to cut costs. The proposal also taxed healthcare benefits if they exceed the value of benefits offered to members of Congress.

California’s seven largest health insurers face $4.85 million in fines for improper and late claim payments, according to The Associated Press.

On average, the insurers paid about 80 percent of claims correctly, well below the 95 percent required by state law, the California Department of Managed Health Care said Monday.

The following fines were issued:
• Anthem Blue Cross and Blue Shield of California: $900,000
• United/Pacificare: $800,000
• HealthNet: $750,000
• Kaiser Foundation Health Plan: $750,000
• Cigna: $450,000
• Aenta: $300,000

The insurers also have to pay restitution to hospitals and health providers, which may cost tens of millions of dollars, the department said.

The California Association of Health Plans is preparing a response on behalf of insurers, a spokeswoman told the AP.

Maine's incoming Republican governor, Paul LePage, is preparing to fulfill his campaign promise of repealing that state's universal coverage experiment, reports Stateline.org.

Maine's program, called Dirigo ("I lead," the state's Latin motto), was approved in 2003. It predates not only Democrats' healthcare reform law but also the 2006 Massachusetts model after which the federal law is modeled. 

Unlike the Massachusetts and federal laws, which require people to buy their choice of private coverage with subsidies, the Maine program created a subsidized healthcare plan called DirigoChoice offered through Harvard Pilgrim Health Care. LePage, who has the support of the Tea Party, has called the program a "costly failure" that covers only 3,400 people.

Maine is one of two states, along with Wisconsin, where complete Democratic control of the executive and legislative branch flipped to total Republican control in the midterms.

State funding for tobacco prevention and cessation programs has hit its lowest level since 1999, even as states continue to receive hefty annual payments from the tobacco industry for anti-smoking initiatives.

According to a report released by health groups Wednesday, states will spend an average of two percent of their tobacco-related revenue, or $518 million, on anti-tobacco programs in 2011.

That revenue comes from a combination of tobacco taxes and settlement payments — expected to total $246 billion by 2024 — from a 1998 lawsuit against four leading tobacco companies. The payments, officials promised in 1998, would be used largely for anti-smoking programs.

The overall rate of funding for such programs has dipped 28 percent over the last three years, Wednesday's report states. Some recipients of settlement funds — like Missouri, Tennessee, New Jersey and Connecticut — now allocate only one percent of the amount recommended by the Center for Disease Control (CDC), while three others — Nevada, New Hampshire and Ohio — allocate no money at all. 

The federal government continues to supplement states' efforts with CDC grants, as well as with funds from March's healthcare overhaul and the American Recovery and Reinvestment Act. 

The national rate of smoking among adults remains firm at 20.6 percent. 

The report was issued by the Campaign for Tobacco-Free Kids, American Heart Association, American Cancer Society Cancer Action Network, American Lung Association and Robert Wood Johnson Foundation.

Doctors in Massachusetts think the state's healthcare overhaul — the model for Democrats' national reform law — was a poor choice, according to a new poll.

The Massachusetts Medical Society surveyed 1,000 practicing doctors in its annual Physician Workforce Survey and found only 14 percent recommended Massachusetts's 2006 overhaul as a model for the nation. The Massachusetts reform effort, signed into law by then-Gov. Mitt Romney, created a "Health Connector" and required people to buy subsidized, government-regulated insurance — much like the federal law enacted in March.

A plurality of respondents — 34 percent — preferred a single-payer system, while 32 percent favored a public-private mix with a public option. And 17 percent opted for the status quo before reform, when low-premium, high-deductible health plans were allowed.

Single-payer advocates immediately embraced the results.

"Massachusetts physicians realize that the state's health reform has failed to make health care affordable and accessible, and won't work for the nation," said Rachel Nardin, chair of neurology at Cambridge Hospital and president of the Massachusetts chapter of Physicians for a National Health Program. "These findings show the high support for single-payer Medicare for all by physicians on the front lines of reform."

While the National Association of Insurance Commissioners (NAIC) is making headlines Thursday for finalizing its medical-loss ratio rules, the group also — and more quietly — named its new 2011 leaders.

Susan Voss, Iowa Insurance Commissioner, will take over as president, with 
Florida Commissioner Kevin M. McCarty stepping into the president-elect spot. 

Oklahoma Commissioner Kim Holland will be vice president and James J. Donelon, commissioner in Louisiana, will take over as secretary-treasurer.

All but Donelon are currently serving as NAIC officers. Voss is currently president-elect, McCarty is vice president and Holland is secretary-treasurer. 

Although national teen-pregnancy rates are on the decline, the disparities between states are often dramatic, the Centers for Disease Control and Prevention (CDC) reported Wednesday. 

Some women's health advocates say the discrepancies are indication that comprehensive sex-education programs are producing results for states that offer them, while states emphasizing abstinence-only programs aren't faring as well.  

Whatever the reason, the regional disparities are stark. In Connecticut, Massachusetts, New Hampshire and Vermont, for instance, 2008 birth rates were less than 25 per 1,000 teens aged 15 to 19, CDC found. In the same year, Arkansas, Mississippi, New Mexico, Oklahoma and Texas all had rates topping 60 per 1,000 teens.

Mississippi had the country's highest rate (65.7), CDC says, while New Hampshire had the lowest (19.8).

Leslie Kantor, national education director of the Planned Parenthood Federation of America, said the report "makes it crystal clear that the teen birthrate is lower in states that provide students with comprehensive, evidence-based sex education." 

"The report demonstrates that the surest way to reduce teenage pregnancy is to provide young people with comprehensive, medically accurate sex education, and doing so is especially urgent for African-Americans and Latino teens, who are getting pregnant more frequently than other young people," Kantor said in a statement.

A recent report from the Guttmacher Institute, a women's reproductive health group, bolsters those claims. All five states with the highest teen birth rates have adopted policies requiring that abstinence be stressed when taught as part of sex education, HIV education or both, the group found. Only one of the five states (New Mexico) mandates that sex education be a part of students' curriculum. 

Of the four states with the lowest teen birth rates, none requires that abstinence be stressed to students, according to Guttmacher.

The issue is also one of public health. Children born to teenagers are at higher risk of being born prematurely, having low birth weight and dying during infancy, CDC notes.

Last month, the Obama administration announced $155 million in grants for non-profits, local school districts, universities and other groups sponsoring sex-ed programs "that have been shown to be effective through rigorous research."

"Teen pregnancy is a serious national problem, and we need to use the best science of what works to address it," HHS Secretary Kathleen Sebelius said at the time. 

Kantor says the focus on evidence-based reproductive health education marks "a radical change from the Bush administration, which favored and funded abstinence-only sex education."

The new focus, she said, "represents a true turning point in the history of sex education in the United States."

Rep. Eleanor Holmes Norton (D-D.C.) this week put her voice behind the effort to eliminate pediatric HIV/AIDS in a place where it's become epidemic: the nation's capital.  

At a small gathering on Capitol Hill Friday, the 10-term lawmaker urged Congress for more funding and implored young women to get tested to prevent the disease from spreading to their children — "the most tragic victims," she said, of a scourge that's largely preventable.

"It's a tragedy for the mother," Norton said. "It's an even worse tragedy for the infant." 

Norton would know. The District of Columbia has the highest HIV/AIDS rate (3 percent) in the country, according to a report released last year, and the highest rate of new cases — figures health officials say underestimate the real problem.

Black women represent more than a quarter of those cases, the report found, with nearly 60 percent of them infected through heterosexual sex. The Centers for Disease Control and Prevention estimates that roughly a quarter of women suffering from HIV nationwide don't know they have it — a stark threat to the children they might have contraction.

The Pediatrics AIDS/HIV Care — a Washington advocacy group catering to children suffering from the disease or orphaned by it — estimates that 9 percent of all pediatric HIV/AIDS cases in the country are in D.C. 

Khadijah Tribble, executive director of the group, said Friday that children and women are too often forgotten in the fight against the disease. 

"We have to become focused on them," she said. 

The other big barrier for advocates, Tribble added, is the stigma surrounding the disease, which is generally associated with gay men. Eliminating that, she said, would go a long way toward encouraging women to get the screenings that could prevent more pediatric cases. 

"We can no longer disrespect them and treat them like the scum of the earth," Tribble said. 

Norton was also quick to emphasize that the disease is no longer isolated to the gay community.

"Put all of the homophobia out of your mind," Norton said. "Assume pregnancy, if you're a young woman, and get tested."

About 800 registered nurses are striking today in Oakland over a contract dispute that centers on healthcare benefits. 

The nurses at Children's Hospital Oakland say the facility is pushing higher cost-sharing requirements — up to $4,000 annually — on RNs at the same time the hospital is paying out millions of dollars in administrative salaries.

“Generations of nurses worked hard to win the standards we have today, especially here at Children’s Hospital,” RN Anna Smith, one of the nurse negotiators, said in a statement. “My generation is not going to lead the way turning the clock back. Hands off our healthcare.”

The nurses, who plan a three-day strike, have been working without a contract since mid-July.

For its part, Children's Hospital defended the benefit cuts, arguing the tough economy is forcing its hand.  

"We're having an economic downturn all over the country and health costs are escalating all over," Children's spokeswoman Erin Goldsmith told The San Francisco Chronicle. "We feel the union leadership is out of touch with the economic environment."

The average RN salary at the hospital is $136,000, Goldsmith told the Chronicle.

The CNA has another take. The union said the hospital spent $8.9 million in 2008 on salaries and other compensation for the top 26 top administrators — a figure that includes social club memberships.

“Cutting health benefits for nurses, other hospital workers and our families is an unfair and unnecessary way for the hospital to make up for years of bad management,” said Martha Kuhl, a nurse at Children's Hospital and treasurer of the California Nurses Association (CNA), which organized the strike.