Sen. Tom Harkin (D-Iowa) this week called for quick installation of new rules designed to rein the exploding career college industry, which feeds a large portion of the nation's growing need for healthcare professionals.

"There is evidence that too many of these institutions are driven more by the profit motive than their commitment to educating students," Harkin said in a Washington Post op-ed published Friday. "We must guard against for-profit schools that load up students with tens of thousands of dollars of debt in exchange for largely worthless degrees."

Stricter rules, added Harkin, who chairs the Senate Health, Education, Labor and Pensions Committee, "are urgently needed to take advantage of the strengths of for-profit institutions while avoiding their pitfalls."

The exploding growth of career colleges has raised eyebrows in Washington, not least because those schools got roughly $24 billion in federal tuition subsidies last year — a figure representing 23 percent of the $105 billion in Title IV education funding allocated in the 2008-2009 school year. 

Those subsidies have helped to fuel the enormous growth of career colleges, which have seen enrollment soar roughly 500 percent — from 365,000 students to 1.8 million students — in just the past few years, according to the Government Accountability Office (GAO).

Harkin said that, at certain schools, those subsidies represent as much as 90 percent of all revenues. "In some cases," he adds, "close to 30 percent of that federal investment is being spent on marketing and advertising to persuade students to enroll."

Such concerns have been agitated by recent reports revealing that shady marketing and recruitment practices — even fraud — are not uncommon in the industry. Some recruiters, the GAO found recently, were overpromising the salaries available after graduation, raising concerns that those students would be at risk of defaulting on federal loans at the taxpayers' expense.

In response, the Obama administration has proposed a series of rules designed to ensure that the schools are pumping out graduates employable enough to pay off the debts they incur. 

The industry has pushed back hard, arguing that a number of those proposals would hobble their recruitment and retention of students, leading to glut of workers in the fields being fed by for-profits.

Harkin, though, is backing those proposed rules. 

"New steps can ensure that these students get accurate information about the costs and likely outcomes of educational programs, while weeding out the programs that would leave them with debts they are unlikely to be able to repay," he wrote Friday. "The government should not be in the business of subsidizing for-profit institutions that leave students saddled with onerous debts they cannot repay and degrees or credentials that are of little value."

The issue is of particular importance to the growing health services sector, because career colleges train more than 40 percent of students receiving health degrees and certificates requiring two years of schooling or less, according to the latest survey from the National Center for Education Statistics.

Donald Berwick, head of the Centers for Medicare and Medicaid Services (CMS), is fighting back this week against Republican attacks on the new healthcare law.

Responding to recent GOP claims that the Democrats' reforms are a threat to Medicare, Berwick said Friday that, on the contrary, the healthcare law has made the program "stronger than it has been in years."

"It's no illusion to the seniors and people with disabilities who will pay less for prescription drugs, to the millions of Medicare beneficiaries who will have preventive care and check-ups covered without paying co-pays, or to the people who will be protected from fraud and abuse," Berwick writes in a Washington Post op-ed. "Under the act, Medicare is stronger than it has been in years, and seniors will get new benefits. That's no illusion; that's progress."

The comments are a direct response to another opinion piece penned last week by Michael Leavitt, head of the Health and Human Services Department (HHS) under former President George W. Bush. Also writing in the Post, Leavitt charged that the new healthcare reform law "has weakened" Medicare. 

"Worse," Leavitt wrote, "its changes create the perception of progress, making it more difficult to pursue the reforms that would put Medicare on sound financial footing so future generations of seniors will benefit."

The "perception of progress" was a reference to a recent projection from Medicare's trustees that healthcare reform will extend Medicare's solvency through 2029 — 12 years longer than predicted last year before the law was passed. 

Critics, including many Republicans, say that the math is illegitimate because it "double-counts" the savings generated under the bill, applying those funds both to extending the program and to extending coverage to the uninsured.

Berwick this week says that charge is "inaccurate and oversimplifies what is really going on." 

Rather, he argues, new savings and revenues under the law will go toward extending Medicare's trust fund, and any funds not needed immediately will be invested in Treasury bonds.

"These dollars are used to help cover other investments, such as expanding health coverage to 34 million uninsured people," he writes. "Later, when the trust fund needs to cash in its Treasury bonds, they are repaid, with interest."

Those are rules, he noted, "that Republican and Democratic administrations have used for decades."

Berwick also takes on the critics who claim that cuts to the Medicare Advantage (MA) program — under which the government pays private insurers to cover Medicare patients — threaten patient care.

The CMS chief notes that the Medicare Payment Advisory Commission has for years found that Medicare spends much more on MA patients than those in the traditional program — "without yielding measurably better health outcomes."

A part of those subsidies go to cover the marketing, salaries and other administrative costs at the for-profit companies, leading critics to wonder why the MA program exists at all.

"The new law eliminates these unwarranted subsidies," Berwick writes, "and, for the first time, financially rewards Medicare Advantage health plans that do a better job of providing quality care."

Berwick ends with a final jab at his GOP critics.

"I share Michael Leavitt's belief in the seriousness of the challenges before us," he says, "but I do not share his pessimism."

Worker health issues back on the radar: Advocates are pushing for shorter shifts for medical residents and mandatory flu shots for healthcare workers. Meanwhile, the U.S. Chamber of Commerce rings the alarm bell over mine safety legislation pending in Congress.

Sleep deprivation linked to medical errors: The Occupational Safety and Health Administration (OSHA) issued a statement late Thursday linking medical residents' long hours to a range of safety issues.

"We are very concerned about medical residents working extremely long hours, and we know of evidence linking sleep deprivation with an increased risk of needle sticks, puncture wounds, lacerations, medical errors and motor vehicle accidents," said David Michaels, the Labor Department's OSHA assistant secretary. http://bit.ly/cNSSUf

The statement comes in response to a petition by Public Citizen, SEIU and others requesting that OSHA assume jurisdiction over the work hours of physician residents — and to put strict limits on what those hours can be. http://bit.ly/9OCmVi

Two executives for the mine company running the doomed Upper Big Branch (UBB) project roamed the mine unsupervised for four hours in the immediate aftermath of April's deadly explosion, NPR reported Thursday.

The executives for the Performance Coal Company, a subsidiary of Massey Energy, got as far as the longwall section of the UBB, NPR says, leaving some regulators to wonder if the men tampered with any evidence related to the blast.  

“There’s an issue, whether it occurred or not, there's a question that's gonna come up of whether there was any tampering that took place,” Kevin Stricklin, chief mine official at the Mine Safety and Health Administration, told NPR.

Massey issued a statement denying that any tampering occurred, NPR reported. Rather, the executives were simply searching for survivors, the company said. 

"Card-check" might be dead, but mine safety legislation remains pending among "organized labor’s top priorities in this Congress," the U.S. Chamber of Commerce warned its members Thursday. 

The proposal, sponsored by Rep. George Miller (D-Calif.), "purports" to fix "perceived problems" that led to April's deadly explosion at the Upper Big Branch (UBB) coal mine in West Virginia — although "no official report on the cause of the accident has been released," the Chamber wrote in its annual Labor Day assessment of the country's business climate.

Miller’s proposal, which passed through the House Education and Labor Committee in July, focuses largely on protecting the nation's miners underground. But it also includes language that would greatly expand the powers of the Occupational Safety and Health Administration (OSHA) to police other job sites as well.

The Miller bill, for instance, would hike fines on companies that violate OSHA safety rules; expand whistleblower protections for workers who report safety concerns; and require employers to correct health and safety hazards even when they plan to appeal those citations — a stipulation that currently governs mines, but not other workplaces.

"Workers should have basic workplace protections no matter if they work in a mine extracting coal or at an oil refinery handling explosive chemicals," Miller said during the July markup of his proposal.

The Chamber has a different take, saying the "troubling" reforms represent "the most sweeping changes to [OSHA's powers] since its inception in 1970" — changes that will hobble businesses trying to emerge from the recession.

The expansion of whistleblower protections, for instance, "will lead to an increase in the number of lawsuits against employers," the Chamber said; the mandatory hazard abatement rule "restricts an employer’s due process rights," forcing employers "to immediately begin correcting problems;" and making executives more liable for safety hazards targets folks "who may not have been aware of any of the alleged violations." 

Of note, Don Blankenship, the CEO of the coal giant that owns UBB, was a board member of the U.S. Chamber until June, when the last of his three two-year terms expired. 

Medical residents working long hours risk harm to both themselves and the patients they treat, a group of consumer and labor advocates charged Thursday.

The coalition is urging the Occupational Safety and Health Administration (OSHA) to assume jurisdiction over the work hours of physician residents — and to put strict limits on what those hours can be.

"Working these extreme hours for years at a time, predictably, has ill effects on personal health and safety," the groups wrote in a petition to David Michaels, head of OSHA.

"For OSHA not to regulate resident physician work hours is to abdicate its responsibility to protect the health of those who care for the nation’s sick and dying."

The groups — which include Public Citizen, SEIU and the American Medical Student Association — say the rules established by the Accreditation Council for Graduate Medical Education (ACGME), which currently monitors the residents' work hours, don't go far enough to ensure the safety of residents and the patients they see.

Newly proposed ACGME standards, for instance, would still allow interns to work 20 consecutive 16-hour shifts, the critics argue.

The stress surrounding the extensive hours has been shown to increase the risk of depression, pregnancy complications and even car crashes as the residents commute to work. The fatigue can also lead to medical errors, including needle sticks.

"Harm to resident physicians and errors that adversely affect patient safety result from fatigue," the groups wrote, "and working 90 or 100 hours in a single week provides inadequate time for recovery sleep."

Among the reforms, the petitioners want OSHA:

• To cap the workweek at 80 hours — "without averaging." (ACGME limits the workweek to 80 hours — averaged over four weeks.)

• To establish a limit on single shifts of 16 consecutive hours. (ACGME set the maximum shift at 24 hours, while also allowing an additional six hours of educational activities. That, the groups write, "has been universally interpreted as a 30-hour shift.")

• To require at least one full day off per week, without averaging. (ACGME allows one day off per week, averaged over four weeks.)

• To limit the frequency of in-hospital on-call duty to once every three nights, without averaging. (ACGME has the same limit, averaged over four weeks.)

"To be absolutely clear," the petitioners write, "we are only asking OSHA to regulate and enforce resident physician work hours, a responsibility that is clearly within the agency’s jurisdiction. We are not asking the administration to assume oversight of resident physician education and supervision functions."

That responsibility, they say, should remain with the ACGME.

The average worker is now paying roughly $4,000 toward employer-sponsored family healthcare coverage — a jump of $482 over 2009.

A prominent children's welfare advocate is calling on Nebraska education leaders to resist an appeal from Gov. Dave Heineman (R) to help Republicans repeal the new healthcare reform law.

Heineman's request, says Bruce Lesley, head of First Focus, creates tensions between health and education programs that could ultimately damage both.

"Educators should not be asked to make a 'Hobson’s Choice' of voting for improving the education of children by harming their healthcare or vice versa," Lesley wrote Wednesday in a letter to members of Nebraska's State Board of Education. "I urge you to either oppose or table all efforts that would pit the educational and healthcare needs of children against one another." 

Last week, Heineman wrote to Nebraska education leaders warning that the reform law's Medicaid expansion would erode funding for education programs.

"Don't sit on the sidelines," Heineman lobbied. "I strongly urge you to support the repeal of the recently enacted federal healthcare law."

Heineman's office last month issued a report estimating the reform law's Medicaid expansion will cost Nebraska up to $766 million over the next decade — a much higher projection than those crunched by other analysts, including Nebraska's health department. 

Lesley is quick to note that the federal government, under the reform law, will pick up the entire tab of the Medicaid expansion through 2016 — a timeline leading to the question of how the provision could pose an immediate threat to the state budget.

"It is simply unsound for anyone to threaten the budget for education spending in 2011 based on estimated spending on healthcare in 2017 and beyond," Lesley said.

Full repeal of the reform law, the First Focus president added, would also eliminate a long list of children's health benefits that could diminish the students' performance in the classroom. 

"If you vote to repeal healthcare reform in its entirety, then you would be voting to reimpose pre-existing exclusions on children with cancer, diabetes or other illnesses," Lesley wrote, "to reimpose annual and lifetime limits on what insurance will cover for children, cutting funding for healthcare prevention efforts for children, and to increase the number of uninsured children in this country.

"Children need to be both healthy and educated in order for our nation to compete in the world’s global economy."

Business to benefit from health reform? Democrats are touting a couple of new studies highlighting the law's benefits for employers. Meanwhile, the U.S. Chamber of Commerce holds its Labor Day briefing blasting government policies that create "barriers to job creation" — including healthcare reform.

The RAND Corporation has a perspective in the New England Journal of Medicine looking at the law's effect on workers' health insurance coverage. The authors address the question of "whether the employers’ role in providing insurance will diminish or disappear over time."

Their answer: The law will result in a "large net increase in employer-sponsored insurance offers," particularly among small employers: The proportion of employees at firms with 50 or fewer workers who are offered coverage would increase from 60.4 percent to 85.9 percent under RAND's modeling.

RAND offers two reasons: "greater demand for coverage by workers due to individual penalties for being uninsured and the availability of new, often lower-cost insurance options (because of administrative savings, for example) for small businesses that offer coverage on the exchanges." Read the study: http://bit.ly/d0NZM6

Meanwhile, the Commonwealth Fund writes in a new report that 16.6 million small business employees work in firms that will be eligible for tax credits under the new law. The study says 3.4 million might work in firms that will take advantage of the credits by 2013. Not only that, but the value of the tax credits will increase in 2014, from as much as 35 percent of employers' premium contribution to as much as 50 percent.

The Commonwealth Fund goes on to list other provisions that should benefit small businesses and their employees, including administrative cost limits and annual review of premium increases.

“The Affordable Care Act is a big step forward for small businesses and their employees,” Commonwealth Fund President Karen Davis said in a statement. “Not only will business owners see immediate benefits from the tax credits, but owners and employees alike will be protected from steep premium increases and high out-of-pocket costs, ensuring they will have access to the stable, secure health insurance they deserve.”

Read the Commonwealth Fund press release: http://bit.ly/auXEvB

Read the study: http://bit.ly/cIzlBy

The Chamber of Commerce isn't toning down its criticism of the new law. Among the issues expected to come up at its briefing on obstacles to job creation is the 1099 tax reporting requirement, which businesses are trying to have pared down or eliminated.

The Chamber doesn't think the law can be repealed but it fighting hard to have it amended, according to a memo obtained by ABC News in March: http://bit.ly/b1q05b

Businesses of two minds on health reform? Speaking of the Chamber, 20 or so of the members of its board of directors are participating in the federal Early Retiree Reinsurance Program, according to an analysis by The Hill. The $5 billion program was created by the health reform law and helps pay for retirees medical bills before they're eligible for Medicare.

"We’re pleased the Affordable Care Act is delivering much-needed relief to businesses that provide coverage for their retirees," said an administration official. Read more: http://bit.ly/dg5q6Y

Wyden moves ahead with health-reform waiver: Sen. Ron Wyden (D-Ore.) wants to let Oregon ignore certain provisions of the new law, including its individual mandate, the Huffington Post reports.

"The Oregon Democrat is seeking to take advantage of a provision he helped write into the legislation that allows states to set up their own health care systems as long as they meet minimal requirements established by the Department of Health and Human Services," writes Sam Stein. "In a letter to the state's Health Authority office, Wyden announced that he will introduce legislation to accelerate the start date for state waivers from 2017 to 2014, if not earlier for Oregon specifically." Read more: http://huff.to/asWdhZ

Health Information Technology announcement planned: Health and Human Services Secretary Kathleen Sebelius travels to Cincinnati to highlight the administration's continued investments in HIT. While there, she's scheduled to make "an announcement regarding the use of electronic medical records," according to HHS.


Lawmakers rebuffed on durable medical equipment request: The Obama administration this week rejected a request from House lawmakers that Medicare announce the first-round winners of the agency's competitive bidding program for durable medical equipment (DME).

"We do not believe it would be appropriate or in the public interest to release any bidders' names before the contracting process is complete, as there are a number of risks associated with doing so," Donald Berwick, head of the Centers for Medicare and Medicaid Services (CMS), wrote in an Aug. 30 letter to Rep. Jason Altmire (D-Pa.). Read more: http://bit.ly/c4xCOb

Hospital profits raise eyebrows: Forbes magazine this week released its first-ever survey of America's most profitable hospitals, revealing 24 hospitals with more than 200 beds make 25 cents or more for every dollar of patient revenue they take in. The report is being widely disseminated by the health-insurance industry, which is pushing back against claims that health insurance profits — rather than rising medical costs — are to blame for rising premiums. Read more: http://bit.ly/dDuW2d