The healthcare insurance industry on Tuesday criticized state regulators for adopting a narrow category for what healthcare plans can count as medical care and quality improvements when calculating their medical loss ratios.

Barring healthcare plans from counting fraud prevention and other investments, insurers say, hamstrings their ability to keep costs down.

The National Association of Insurance Commissioners "is conducting a transparent and thorough process as it develops the MLR definition, but the current proposal could have the unintended consequence of turning-back-the-clock on efforts to improve patient safety, enhance the quality of care, and fight fraud," America's Health Insurance Plans President and CEO Karen Ignagni said in a statement. "Preserving patients’ access to high-quality health care services is essential if the key goals of health care reform are to be achieved."

Federal regulators received a slew of requests for changes to their proposed "grandfathering" rules before the comment period ended at midnight on Monday.

The provision is important because it exempts healthcare plans from certain costly requirements of the healthcare reform law, including cost-sharing restrictions and new minimum benefit standards. While healthcare providers in general have been pressing for tight restrictions — they stand to benefit from the more generous coverage provided under the new law — insurers and business groups argue that flexibility will prevent people from losing their coverage.

In comments filed Monday, America's Health Insurance Plans (AHIP) suggests that regulators align allowable cost-sharing changes with rising medical costs and allow changes to prescription drug formularies and provider networks, among other changes.

AHIP has asked its members to lobby lawmakers on the issue throughout the August recess, The Hill reported last week.

Others want tougher standards.

Massey Energy failed to report more than 20 accidents at the Upper Big Branch (UBB) mine over several years prior to April's deadly explosion there, the Associated Press reported Tuesday, citing documents from the Mine Safety and Health Administration (MSHA).

MSHA, which has cited Massey over the accidents, discovered the omissions while investigating April's blast, the AP reported.

The episodes span from January 2008 right up to the UBB explosion, the AP said. "Among other things, they involve unreported roof collapses, assorted injuries and two instances of miners exercising their right to move out of dusty areas of the mine because they've contracted black lung disease," the news wire wrote. "All were supposed to be reported."

The news comes as a number of Massey miners — both former and current — have come forward with claims that the company manipulates its safety record by discouraging injured miners from filing accident reports.

Former Massey miner Chuck Nelson, for instance, said injured miners were often offered simple tasks in the mine office following accidents. The idea was to keep those workers on the payroll and preclude the need for workman's compensation payments, Nelson said. 

"I’ve hauled people out of the mines on a stretcher — at Massey mines," Nelson said in April. "And the very next day you’ll see 'em walking up the hill, coming back to the mine office on crutches and [in] neck braces — just to keep from having a lost-time accident, to keep 'em from filling out an accident report."

More recently, Jeff Harris, another former Massey miner, made similar allegations about the company's policy on "lost-time accidents."

"Reports about Massey’s lost time accidents are also misleading," Harris told lawmakers in late April. "If you got hurt, you were told not to fill out the lost time accident paperwork. The company would just pay guys to sit in the bathhouse or to stay home if they got hurt — anything but fill out the paperwork."

Massey says it's still taking a look at MSHA's newly alleged violations, the AP reported. 

The Centers for Medicare and Medicaid Services (CMS) on Tuesday sent state Medicaid directors a 19-page letter telling them what they need to do to get federal funds for investments in health information technology.

Under last year's recovery act, the federal government agreed to pay 90 percent of states' administrative expenses incurred while trying to persuade Medicaid providers to adopt electronic health records. The letter provides detailed guidance to the states in addition to final regulations issued late last month.

"At a minimum," the letter says, states must "demonstrate to the satisfaction of the Secretary compliance with three requirements:

• Administration of Medicaid incentive payments to Medicaid (eligible professionals) and eligible hospitals;
• Oversight of the Medicaid EHR (electronic health records) Incentive Program, including routine tracking of meaningful use attestations and reporting mechanisms; and 
• Pursuit of initiatives that encourage the adoption of certified EHR technology for the promotion of health care quality and the electronic exchange of health information."

An odd coalition of religious groups, human-rights advocates and prison reformers is pushing the Obama administration to hurry new standards designed to eliminate rape in the nation’s prisons — standards that are already two months overdue.

"At this moment, standards to eradicate sexual assault in prisons await your approval," the groups wrote in an Aug. 2 letter to Attorney General Eric Holder. "We urge you to make a priority of completing your review and adopt the standards as swiftly as possible."

Signatories included representatives of organizations as diverse as Focus on the Family, Human Rights Watch, the National Association of Evangelicals and the American Civil Liberties Union. 

Delay comes with serious consequences. The Bureau of Justice Statistics (BJS) has estimated that 60,000 prisoners — 5 percent of the adult prison population — are sexually assaulted each year. And the statistics are worse in juvenile facilities, where 12 percent of detained youths reported being victims of sexual assault in the past year, BJS reported recently.

A 2003 law, the bipartisan Prison Rape Elimination Act, was designed to eradicate the problem. But although an expert panel proposed new prison-rape standards 14 months ago after an exhaustive four-year review — and though the Department of Justice (DOJ) was supposed to have finalized the rules in June — the agency has delayed the process indefinitely over concerns that it will cost prisons too much to implement the changes.

"The failure of the administration to act is sending a very strong message," Gene Guerrero, criminal justice analyst at the Open Society Policy Center, told reporters at a press conference in Washington on Tuesday.  

Among the proposed changes, the expert panel suggested that prisons isolate vulnerable inmates from more violent offenders; separate genders during inspections and searches; and allow independent inspectors to audit their facilities every few years.

"Even the most rigorous internal monitoring," panel members wrote in their 2009 report, "is no substitute for opening up correctional facilities to outside review."

But Holder told lawmakers in March that pushback from prison officials has left the agency reluctant to institute the reforms. 

“When I speak to wardens, when I speak to people who run local jails, when I speak to people who run state facilities, they look at me and they say, ‘Eric, how are we supposed to do this?’ ” Holder told members of a House Appropriations subcommittee. “ ‘If we are going to segregate people, build new facilities, do training, how are we supposed to do this?’ ”

Prison reformers argue that the cost concerns are overblown. 

"While many corrections leaders strongly support the standards, some officials have exaggerated the cost of implementing these basic measures," the groups wrote to Holder this month. 

The cost projections, for instance, tend to ignore the savings the prisons would see if rapes were reduced, the groups note. Healthcare and litigation costs, for example, would be cut if the new standards were installed, the advocates argue.

Additionally, reformers contend, the cost concerns shouldn't outweigh efforts to rein in prison assaults. “Prison officials claim that it will be too expensive to implement [the standards] — too expensive to prevent staff from raping detainees,” Lovisa Stannow, executive director of Just Detention International, a prisoner-rights group, noted in the Huffington Post earlier this year.

DOJ spokeswoman Hannah August said Tuesday that officials "are working diligently" to install the guidelines "as soon as possible." The agency is expecting to issue proposed standards in the fall, she said.

For proponents of reform, it can't happen soon enough.

"This is a basic humanitarian issue," said Barrett Duke, a leader of the Southern Baptist Ethics & Religious Liberty Commission. 

Prisoners are rightfully being punished for crimes, he added, "but sexual abuse is not supposed to be a part of that."

The conservative Heritage Foundation on Tuesday unveiled a 58-page compilation of policy proposals addressing 23 issues.

The "Solutions for America" chapter on healthcare recommends several strategies to get runaway healthcare costs under control, starting with repealing Democrats' new healthcare reform law.

These include:

• Promoting personal control through tax equity: Heritage wants to eliminate (or at least cap) the tax break for employer-sponsored health insurance and replace it with a system of universal tax credits for taxpayers. Sens. Ron Wyden (D-Ore.) and Robert Bennett (R-Utah) during the healthcare reform debate endorsed a similar approach but it went nowhere because it would upend a system that's been in place since World War II.

Heritage also recommends "redirecting" the Medicaid and CHIP programs "to help low-income individuals and families purchase private health insurance."

• Fixing current government health programs: Heritage wants to transform Medicare into a defined-contribution system "in which the government provides a contribution for benefits and seniors are able to apply their contribution to the health plan that suits them best."
• Promoting federal–state partnerships: States should take the lead in healthcare reform, Heritage argues, by "identifying the key health care challenges facing their citizens, structuring a consumer-based marketplace for health insurance, and expanding affordable health care options for their citizens, including setting up pooling arrangements to protect persons with pre-existing conditions while not unduly burdening taxpayers." And the federal government "should promote interstate commerce in health insurance, extend certain protections for those who maintain continuous coverage and provide states with technical assistance and relief from federal rules that inhibit innovation."
• Providing portability: Americans should own their health plan and be able to carry it with them from job to job. Portability was a central goal of healthcare reform early in the debate but disappeared as Democrats proposed a system of state exchanges where health plans will have to cover everyone starting in 2014.

The National Association of Insurance Commissioners (NAIC) on Tuesday overwhelmingly approved the forms that health plans will submit to regulators to report the proportion of premiums they spend on healthcare.

Under the new healthcare reform law, health plans must spend at least 80 percent of premiums in the individual and small-group markets on healthcare (85 percent for large group plans). If they fall short, the plans must offer rebates to their customers.

The NAIC's executive committee approved the forms — called "blanks" — at its annual national meeting in Seattle.

"The form's approval represents the culmination of months of work ... through meetings, conference calls and public comment periods," the NAIC said in a statement. "The Blanks form is just one of many efforts being executed by the NAIC to meet the requirements of the health care law. State regulators and NAIC staff continue to work diligently to execute these efforts in a thorough and transparent manner."

The pro-abortion rights group EMILY's List launched an Internet campaign on Tuesday aimed at creating support for the 32 female candidates it is endorsing for state and federal office this year. The campaign, called "Sarah Doesn't Speak for Me," aims to counter former Alaska Gov. Sarah Palin's (R) high-profile endorsements of "Mama Grizzly" candidates who want to restrict abortion rights. 

At a press conference Tuesday, EMILY's List President Stephanie Schriock called the Mama Grizzlies "backwards-looking." The charge immediately drew reaction from the competing Susan B. Anthony List, which supports abortion opponents for office. 

"EMILY’s List is running scared — and it shows," Susan B. Anthony List President Marjorie Dannenfelser said in a statement. "Clearly, in this ‘Year of the Pro-Life Woman,’ which Sarah Palin helped make possible, women have found their political voices. Pro-life ‘Mama Grizzlies’ represent the majority of women across the country." 

Schriock called her group's new campaign a "get out the vote hub" and drew particular attention to three key races where its candidates are running against Sarah Palin's endorsees: the California Senate race pitting Sen. Barbara Boxer (D) against Republican Carly Fiorina; the Minnesota House race where Tarryl Clark hopes to unseat Rep. Michele Bachmann (R); and the New Mexico governor's race pitting Democrat Diane Denish against Republican Susana Martinez. 

The EMILY's List campaign features an Internet video of women in bear costumes mocking the "Mama Grizzlies" slogan. The women caution Palin that "there are plenty of Mama Grizzlies out there who would disagree with you." 

EMILY's List says it raised $43 million during the 2007-2008 election cycle and has helped elect 80 pro-abortion-rights women to the U.S. House and 15 to the Senate since 1985. During her press conference, Schriock twice declined to say how much the group was spending on its new campaign. 

The Susan B. Anthony List, for its part, recently launched a bus tour through Indiana, Ohio and Pennsylvania to build momentum for its endorsed candidates. The group says it has elected 75 pro-life women to the U.S. House of Representatives and seven to the U.S. Senate since 1992.

The Obama administration this week said it will step up its enforcement of safety violations related to ventilation systems in the nation's coal mines.

"These standards are not voluntary," Joseph A. Main, who heads the Mine Safety and Health Administration (MSHA), said in a statement, "and every mine operator in the country is on notice that MSHA will not tolerate violations of ventilation standards."

The move comes in direct response to recent testimony surrounding April's Upper Big Branch (UBB) disaster in southern West Virginia, which killed 29 miners and all but killed a 30th. The mine owner — Virginia-based Massey Energy — has been under fire over allegations that the company systematically put coal production above worker safety.

Among the most damning charges, a number of Massey miners — both current and former — have said that company managers habitually encouraged workers to tear down line curtains, sheets of plastic designed to direct fresh air from vents into underground work chambers.

“The ventilation system they had didn’t work,” Stanley “Goose” Stewart, a 15-year veteran of the UBB mine, said during a May field hearing of the House Education and Labor Committee in Beckley, W.Va. “With no air moving, it gave me the feeling that area was a ticking time bomb.”

Stewart, who was 300 feet underground when the blast occurred, was one of the few to get out alive.

Jeff Harris, a former Massey miner, told lawmakers a similar tale in April.

"When we got to a section to mine coal, they’d tear down the ventilation curtain," he said. "The air was so thick you could hardly see in front of you. When an MSHA inspector came to the section, we’d hang the curtain, but as soon as the inspector left, the curtain came down again."

MSHA on Monday also issued a reminder to mine operators that they can't alter their vent plans without the agency's approval.

"Any intentional change to the ventilation system that alters the main air current or any split of the main air current in a manner that could materially affect the safety and health of miners must be approved by MSHA before it is implemented," the agency said.

"This announcement serves to remind all mine operators of their obligation to comply with all federal regulations to ensure the health and safety of their employees," Main said.

"Mine inspectors," he added, "are being instructed to beef up enforcement of ventilation standards."

Massey, which has denied all charges that it fostered a culture that prioritized coal production above worker safety, is under a federal investigation surrounding the UBB blast.