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.

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.

Service members who commit suicide do receive full military honors.

"The contributions of these men and women to their country are not less for having suffered a mental illness," APA President Carol Bernstein said in a statement. "A reversal of this policy ... will not only help to honor the contributions and lives of the service men and women, but will also send a message that discriminating against those with mental illness is not acceptable."

The issue is gaining prominence as the Department of Defense copes with a growing trend in suicides. This year is on track to surpass last year's record of 162 suicides.

The Army says repeated deployments aren't solely to blame, according to Sunday's New York Times, since only about 80 percent of those who commit suicide have been deployed once or never. One growing problem is that a military stretched thin by years of wars is attracting more people who are prone to risky behaviors and suicide.

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.

Yet just 20 percent of Part D beneficiaries are aware that the law cuts the cost of name-brand drug in half next year through the donut hole, according to the survey, conducted by KRC Research for the Medicare Today coalition, an advocacy group.

In addition, 72 percent said they didn't know that the new reform law incrementally closes the donut hole each year after 2011 until the gap is eliminated, pollsters found. Finally, fewer than half of Part D beneficiaries (46 percent) are aware that seniors caught in the donut hole this year will receive a $250 check.

Mary R. Grealy, co-chair of Medicare Today, said the findings are indication that advocates and policymakers have their work cut out if they hope for seniors to understand what the new law does.

"Seniors on limited incomes need to plan their spending and budget their resources and it’s important they know about these changes," Grealy said in a statement. "Congress and the nation’s pharmaceutical companies have taken significant steps to reduce out-of-pocket spending for these ‘donut hole’ seniors and we need to raise awareness of these changes."

The donut hole has been the most controversial element of Part D since the program was created in 2003. In 2010, it works like this: Part D beneficiaries pay 25 percent of their drug costs until total expenses hit $2,830. At that point, seniors are responsible for the full cost of the next $3,610 worth of drugs. After total annual costs hit $6,440, the government picks 95 percent of the tab for the rest of the year.

Under the new healthcare reform law:

• Seniors caught in the donut hole in 2010 get a $250 check to help cover drug costs.

• In 2011, name-brand drugs will be half-price through the donut hole.

• In 2020, the coverage gap will be closed altogether. 

Roughly 31 percent of seniors said they themselves have hit the coverage gap, according to Tuesday's poll. 

The survey was based on the responses of 1,243 Medicare beneficiaries. 

The Air Force’s top uniformed officer on Tuesday warned that growing healthcare costs could hurt other critical military needs.

The White House is sensitive to misinformation, spread by critics, about its signature healthcare reform law.

And in a blog post Tuesday, Stephanie Cutter, the administration’s head of healthcare reform messaging, shot down one persistent rumor: that information about health benefits added to employees' tax forms will translate into higher income taxes. That, she said, is not true.

Employers have the option of adding the value of the plans to 2011 W-2 forms and will be required to do so in 2012, but the goal is to inform employees about their benefits, not tax them.

But the White House seems to have taken the rebuttal a bit far. Cutter goes on to make a general statement that suggests the new law will never tax healthcare plans, which isn't true either.

"For months," she writes, "opponents of health reform have falsely claimed that the Affordable Care Act would lead to the taxation of health care benefits. The claim wasn't true when the rumor first surfaced, it isn't true today and it won't be true tomorrow."

While the W-2 rumors are demonstrably false, the law does create an excise tax on high-cost healthcare plans. Starting in 2018, so-called "Cadillac plans" will be subject to a 40 percent tax on excess benefits.

The law defines such plans as costing more than $10,200 a year for individuals and $27,500 for families, with higher thresholds for risky professions such as firefighters and miners. The tax was one of the most controversial and complicated parts of healthcare reform, with unions pushing until the last minute for more concessions, while budget hawks — including then-White House Budget Director Peter Orszag — argued that it would help keep healthcare demand and costs under control by making care more expensive for people with insurance.

Asked about the blog post, the White House made clear it only meant to address the W-2 rumor.

"False and misleading rumors regarding W2 forms and the new health care law have persisted," a White House official said, "and we have an obligation to stop the rumor mill."