Many are fixated on Florida as a federal judge gets ready to decide whether a multi-state challenge can move forward.

HHS fights back on child-only coverage: The Obama administration is doing all it can to show it's being reasonable and flexible in implementing the healthcare reform law ahead of the midterm elections — and that insurers who still drop coverage are the ones to blame. The Department of Health and Human Services on Wednesday announced new guidance on how states and insurers can work together to ensure child-only health plans can make a profit now that the law bans discrimination against children with pre-existing conditions. http://bit.ly/at5wVa

The announcement was immediately praised by the administration's allies and healthcare reform proponents. Health Care for America Now's Ethan Rome said "there is no legitimate reason for insurers to withdraw from these markets." Ron Pollack at Families USA added there is "no excuse" for insurers to pull out now that HHS has articulated a "reasonable position that gives health insurers the needed flexibility to protect against adverse risk selection." And the American Academy of Pediatrics calls on insurers to "do the right thing by returning to the market and offering quality child-only plans."

Today's the day for healthcare reform lawsuit: Federal Judge Roger Vinson has until the end of the day to meet his deadline for deciding whether the multi-state lawsuit against healthcare reform should go forward. http://bit.ly/ckKGZX

Hearing expected on Ohio abortion ads: The Ohio Election Commission is expected to hold a hearing today on whether to halt billboards that attack Rep. Steve Driehaus's vote for healthcare reform. The billboard ads, sponsored by the Susan B. Anthony List, accuse Driehaus of supporting taxpayer-funded abortion, which Democrats say is a distortion of what the law does. http://bit.ly/b0X9sb

Next door in Pennsylvania, Democrat Rep. Kathy Dahlkemper is also trying to stop another pro-life group from airing radio ads against her, The Associated Press reports, and SBA List has launched its own TV ad campaign criticizing her vote. http://bit.ly/aCoYT7

Administration to propose new rules on black lung: The Obama administration is scheduled to propose new rules today designed to eliminate black lung, a scourge affecting the nation's miners. The disease, more technically known as coal worker's pneumoconiosis ("dusty lung") is caused by inhaling coal dust over long periods of time. 

The big question about Thursday's announcement: Will the agency propose to reduce workers' permissible exposure limit to coal dust? Or will it simply take steps to limit miners' exposure to the dust? http://bit.ly/9e3BuG

Medicare Advantage fight continues: The debate over just how much the healthcare reform law will affect Medicare Advantage — and the millions of seniors who rely on the program — is flaring up again with the release of a new report from Medicare's chief actuary. The key finding: The law's impact on out-of-pocket costs for enrollees will steadily increase until 2017, to a high of $923 in 2017, before falling to $873 in 2019.

Federal Medicaid assistance to states falls short: So says a new report that looked at 24 states that count on recently approved federal funds to fill their Medicaid budgets. Those federal funds — known as the Federal Medical Assistance Percentages, or FMAP — fell $1.74 billion short of what those states hoped for, leaving gaping holes in state budgets, according to new research by The Council of State Governments. http://bit.ly/caYpE4

IOM recommends better nutrition labeling: Nutrition rating systems and symbols on the fronts of food packaging would be most useful to shoppers if they highlighted four nutrients of greatest concern — calories, saturated fat, trans fat and sodium — says a new report from the Institute of Medicine. These food components, the IOM says, are routinely overconsumed and associated most strongly with diet-related health problems affecting many Americans, including obesity, heart disease, high blood pressure, Type 2 diabetes and certain types of cancer. http://bit.ly/cxPbI5

Pesticides ban demanded: Some 13,000 individuals and organizations from across the U.S. sent a letter to the Environmental Protection Agency on Wednesday calling for a ban on the pesticide chlorpyrifos and a phase-out of other organophosphate pesticides. The signees include consumers, families, health advocates and farm workers raising concerns with the widely used pesticides' link to attention and learning problems.

Concurrently, the Endocrine Disruption Exchange announced the addition of chlorpyrifos to their publicly-accessible online database, Critical Windows of Development, spotlighting animal research that links prenatal, low-dose chlorpyrifos exposure to altered health outcomes in the brain and other organs. http://bit.ly/10gZJ

Third workshop set on orphan drugs: The Food and Drug Administration has scheduled the third in a series of workshops on orphan drug designation for academics, biotechnology companies and those unfamiliar with the process for Nov. 4-5, 2010, in Lansdowne, Va. http://bit.ly/b22QAe

Fifty House Democrats are encouraging the EPA to continue its efforts to rein in mountaintop removal coal mining.

Some insurers had asked for dual-tack enrollment authority as they decide whether to continue offering new child-only policies.

More and more minority students are entering the nation's medical schools, the Association of American Medical Colleges (AAMC) reported Wednesday.

The increase was most pronounced among Hispanics, who saw first-year enrollment jump to 1,539 in 2010 — 9 percent above 2009 levels, AAMC found. For black students, the increase was 2.9 percent (to 1,350), while Asians saw enrollment rise 2.4 percent, to 4,214. 

 The number of first-year white students, meanwhile, was 12,094 in 2010 — up 0.4 percent from 2009, the group said.

AAMC President and CEO Darrell G. Kirch said the numbers — which reflect a national trend toward increased diversity — are good news for patients.

"You don't improve the health of communities without having a workforce that reflects the diversity of those communities," Kirch told reporters on a phone call Wednesday.

AAMC is also warning of a looming physician shortage — something that will likely get worse, Kirch said, as the new health reform law extends coverage to about 32 million Americans who lack insurance. 

"An insurance card can't take care of you," Kirch said. "You need a physician to do that." 

The group pegs the shortage at 60,000 doctors by 2015, and 90,000 doctors by 2019.

The Government Accountability Office in a new report calls the Obama administration's restrictions on Medicare Advantage communications "unusual."

During debate over healthcare reform in August and September 2009, health insurance company Humana sent letters to 930,000 beneficiaries enrolled in its Medicare Advantage plans warning that the Democrats' law could hurt seniors' benefits. The Centers for Medicare and Medicaid Services directed Humana to stop the mailings Sept. 18 and extended the order to all other Medicare Advantage groups three days later.

The agency is tasked with reviewing marketing material, such as information on benefits and coverage, that MA plans send to beneficiaries. But in this case, its actions raised accusations of political interference.

"Although CMS's actions generally conformed to its policies and procedures," the report says, "the ... memorandum requesting instructing all MA organizations to discontinue communications on pending legislation while CMS conducted its investigation was unusual."

The report was requested by House Republicans Joe Barton (Texas), Michael Burgess (Texas) and Greg Walden (Ore.).

"This report," Barton said in a statement, "is more evidence that in their efforts to pass health care legislation by any means necessary, the majority was willing to pressure CMS into taking the unprecedented step of halting all communications between Medicare Advantage providers and their beneficiaries." 

The CMS agency, which is part of the Department of Health and Human Services, told GAO the action was "appropriate under the circumstances" given "the degree of potential harm to beneficiaries." HHS also takes issue with the use of the word "unusual," which it says suggests "inappropriate" activity.

GAO stands by its wording.

"Our characterization of CMS's action as unusual is based on discussions with MA organizations and CMS staff," the report states. "They told us that they could not recall a previous example where CMS told all plans to stop an activity after a potential violation was discovered and prior to the completion of an agency investigation."

The Obama administration on Thursday will propose new rules designed to eliminate black lung, a scourge affecting the nation's miners.

The disease, more technically known as coal worker's pneumoconiosis ("dusty lung"), is caused by inhaling coal dust over long periods of time. 

The big question about Thursday's announcement: Will the agency propose to reduce workers' permissible exposure limit (PEL) to coal dust? Or will it simply take steps to limit miners' exposure to the dust?

The difference is nuanced but significant. 

The mining industry has argued the current PEL — which, since 1972, has been set at 2 milligrams of dust per cubic meter of air over an eight-hour shift — is appropriate, but just not very well enforced. In their version of the tale, any occurrence of black lung is the result of companies simply not complying with the current limits.

More than 10,000 miners have died from the disease in the past 10 years.

Many health and mine-safety experts, however, tell a different story. They say the current PEL is too high and doesn't go far enough to protect the nation's miners. If the Labor Department simply takes steps to enforce the PEL without lowering it, they warn, black lung will remain an enormous problem.

"Even if every single company were complying with the standard, you would still have the disease," Celeste Monforton, a former mine-safety official in the Labor Department who's now a public health professor at George Washington University, said Wednesday. "The science tells us that 2 [mg/m3] is not protective."

Bolstering that argument, the National Institute for Occupational Safety and Health (NIOSH) issued a report 15 years ago that found occurrences of black lung in miners exposed to lesser levels of coal dust.

NIOSH recommended the PEL be reduced to 1 mg/m3 over a 10-hour shift. Even at that lower level, the agency warned in a more recent report, some miners would get black lung.

"Even at the 1 mg/m3 coal mine dust exposure limit recommended by the CCD, some occupational effect on ventilatory function is expected," NIOSH said.

Faced with opposition from the coal industry — not to mention the powerful lawmakers of coal country — the proposal was never adopted.

Meanwhile, the cases of black lung in America are on the rise. Last December, NIOSH reported that about 9 percent of miners with at least 25 years experience in the mines tested positive for black lung between 2005 and 2006 — more than double the 4-percent rate of a decade earlier. 

Monforton said it remains unclear why the problem seems to be getting worse. It could be that more miners are being diagnosed simply because more miners are being screened for the disease, she said. Or it might be that more powerful mining equipment is kicking up more coal dust underground; or more miners are working longer shifts; or the coal mines contain more silica — a substance found in quartz that's even more harmful to lungs than coal dust — than previously thought. 

"All the more reason," Monforton said, "to adopt new standards based on science."

We'll know tomorrow if the administration takes that advice.

New data on health insurance denials help make the case for healthcare reform: 

The key findings, according to the panel: 

· From 2007 through 2009, the four largest for-profit health insurance companies — Aetna, Humana, UnitedHealth Group and WellPoint — refused to issue health insurance coverage to more than 651,000 people based on their prior medical history. On average, the four companies denied coverage to one out of every seven applicants based on a pre-existing condition; 

· Over the same period, the number of people denied coverage by the four increased 49 percent (from 172,400 to 257,100) while applications only grew 16 percent;

· The four insurers refused to pay 212,800 claims for medical treatment due to pre-existing conditions during the 2007-2009 time period;

· Each company had business plans that relied on using pre-existing conditions to limit the amount of money paid for medical claims. Internal corporate documents show that insurance company executives were considering practices such as tighter underwriting guidelines, lengthening the look-back period, assessing separate deductibles specifically for identified pre-existing conditions, denying payments for prescription drugs related to pre-existing conditions, linking additional claims to pre-existing conditions exclusions, and narrowing the definition of prior creditable insurance coverage.

The panel also investigated maternity coverage and found that "women who are pregnant, expectant fathers, and families attempting to adopt children are generally unable to obtain health insurance in the individual market."

HHS discusses children's coverage: Jay Angoff, director of HHS’s Office of Consumer Information and Insurance Oversight, holds a press conference call this morning to discuss efforts by HHS and states to improve access to health coverage for children with pre-existing conditions. The call comes as House Republicans are clamoring for more information about some insurers' decision to stop issuing new child-only policies now that the healthcare reform law prohibits them from turning down children with pre-existing conditions. http://bit.ly/bbSPSu

CDC chief talks global health: Thomas Frieden, director of the Centers for Disease Control and Prevention, will talk about the importance of evidence-based global health today at the Stimson Center. http://bit.ly/9q1EY3

Could this explain why seniors aren't embracing healthcare reform? Most seniors enrolled in Medicare's prescription drug benefit don't know that the new healthcare reform law closes Part D's coverage gap, according to poll results released Tuesday. The findings are bad news for Democrats, who are hoping that seniors — among the most reliable voters in midterm elections — will flock to the polls next month in support of the party who backed the new benefits. http://bit.ly/969BlV

Florida docs' group endorses Rick Scott: The Florida Medical Association has endorsed Republican Rick Scott to be the next governor of Florida, arguing that he'll best address the state's tough medical liability environment because he's "not afraid of taking on personal injury lawyers and shaking up the status quo in order to get things done for the people of Florida." Scott, a healthcare entrepreneur, was CEO was forced out by the board of Columbia/HCA 1997 amid a federal investigation that led to the company paying a record $1.7 billion to settle criminal charges. He was never charged with a crime.

Caution urged in revamping medical device approval process: A bipartisan group of 12 Energy and Commerce members wrote Tuesday to Food and Drug Administration Commissioner Margaret Hamburg urging caution as the agency revamps the approval process for medical devices. http://bit.ly/9sctyM

Obama asked to send letters of condolence for military suicides: Pressure is growing for the White House to reverse the military policy that prohibits the president from sending condolence letters to family members of military personnel who have committed suicide. The American Psychiatric Association on Tuesday joined Mental Health America and the American Foundation for Suicide Prevention in asking for a reversal of the policy. These last two are gathering signatures on petitions in an attempt to overturn the policy. http://bit.ly/9BWePE

Wireless innovation challenge launched for veterans' health: The West Wireless Health Institute, in collaboration with the Veterans Affairs Innovation Initiative (VAi2), has issued a $10,000 challenge to innovators to connect patients with their Veterans Health Care provider. http://bit.ly/dqXD6n

Climate change wrecking public health: How are climate change and energy scarcity impacting health care systems in countries around the world? Dramatically, the Post Carbon Institute says in a new report. http://bit.ly/bqFxwJ

Patient safety data made available: Comparative data on patient safety and hospital quality are available online for the first time thanks to the The Commonwealth Fund’s WhyNotTheBest.org. The new measures, developed by HHS' Agency for Healthcare Research and Quality, are available from data submitted by hospitals in nine states: Arizona, Florida, New York, Illinois, New Jersey, Rhode Island, Texas, Vermont and Washington. http://bit.ly/5GyjXm

A bipartisan group of 12 Energy and Commerce members wrote Tuesday to Food and Drug Administration Commissioner Margaret Hamburg urging caution as the agency revamps the approval process for medical devices.

The FDA has launched an assessment of its pre-market review process for low- and moderate-risk devices, known as 510(k). Some consumer advocates argue the process is too lax and allows unsafe devices to get to market; the industry says the process has an outstanding safety record, and some of the 60-plus changes being considered could disrupt it. 

The lawmakers say at least five proposals "should be considered controversial" and "have the potential to disrupt the device review process." They're asking for the FDA to seek additional input from stakeholders and the panel before pressing forward with them.

"Depending on how FDA implements these recommendations," the lawmakers write, "they could prevent companies from using important evidence in product applications, delay the introduction of innovative new therapies, increase the cost and time associated with new product development, and potentially upset the delicate balance that exists between providing information to the public and protecting intellectual property."

The five proposals involve: 

• rescission authority;

• split and multiple predicates;

• clarifying intended use and indications for use;

• mandatory pre-market inspections and mandatory clinical information for a subset of Class II devices; and

• proprietary information.

The lawmakers said they're "not necessarily opposed" to the five recommendations but want "more transparency."

They also request that FDA provide: a more detailed work schedule for implementing the recommendations; a breakdown of how changes to the process would be addressed (through guidance, rulemaking or statutory changes); more details on the proposals; and an analysis of the recommendations' economic impact on the domestic medical device industry.