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After-Hours Clinic a partnership of health-care David and Goliath

Kaiser Health News - Tue, 04/22/2014 - 2:40pm
At Swedish Medical Center’s Cherry Hill hospital, the “EMERGENCY” sign glows bright in the dusk above the emergency-room entrance. Some 18,000 people sought help here last year.

Right next to the sign, there’s another one on the building: “After-Hours Clinic.” Operated by Country Doctor Community Health Centers, this clinic — like Swedish’s ER — is open evenings and weekends.

This isn’t competition, but a partnership few would have predicted before the Affordable Care Act, also known as Obamacare. Swedish, a huge, specialty-oriented medical center, has plunked down startup money and a cheap lease to help tiny Country Doctor, whose two clinics were started by idealistic community activists in the late 1960s and early ’70s.

So what has brought these two very different organizations together? In a nutshell: the Affordable Care Act (ACA), with the rumbling disruptions in business-as-usual it has energized. It has changed incentives, brought insurance to people who never had it, and focused attention on unnecessary costs — for example, emergency-room visits for sore throats and ankle sprains.

Both sides see themselves benefiting from this partnership in ways that are part financial, part philosophical. Swedish gains a nonemergency after-hours alternative for patients; County Doctor creates another avenue for those who have had trouble accessing daytime care.

The ACA, by bringing insurance to more, makes the deal affordable for Country Doctor. And by signaling that doctors’ and hospitals’ future livelihood will be linked to value, not volume, the ACA has led Swedish to seek such a partner.

“Before the ACA, hospitals were kind of silos and the alternative providers were silos,” says Howard Springer, Swedish’s administrative director for accountable-care services. Now, for the first time, he says, the two have mutual incentives to cooperate.

The average person may not have read the ACA’s fine print or interpreted the writing on the wall as employers and governments increasingly refuse to play by the old fee-for-each-service rules. But many hospital and clinic leaders understand their world is heading in a new direction.

To make it financially, they’ll have to come together, one way or another, to provide a sort of health-care soup-to-nuts menu, each organization serving not just individual patients but the health of larger communities. This, both of these partners say, is new ground.

“We are not all things to all people,” Swedish’s Springer says. “We are illness-care providers, with a heavy emphasis on specialty care and inpatient care.”

Country Doctors’ clinics, by contrast, focus on primary care and low-income patients, says Dr. Rich Kovar, medical director for County Doctors’ clinics.

It just makes sense for Country Doctor and Swedish to each focus on what it does best, Kovar says. “This is not the solution to all our problems, but it’s the right direction.”

Care for communities

On one recent evening, Brian Stevens, a former sheet-metal fabricator, waits to be seen in the Country Doctor After-Hours Clinic, a bag of clothing and personal effects at his side.

Now homeless, Stevens, 44, does odd jobs for people, such as cleaning gutters and wrestling with climbing rosebushes. A few weeks before, he fell from a scaffold. At a hospital emergency room, he got an X-ray and was told he had no broken bones, and should see his primary-care doctor for follow-up care.

Even though he is newly insured by Medicaid, he couldn’t get in to see a doctor for the next two weeks, and he was hurting.

Another problem: He left his medications on the bus earlier that day.

Patients like Stevens are what Country Doctor does, says Dr. Rich Kovar, medical director for Country Doctor’s clinics.

These days, the clinics pay staff members and use electronic records. But their mission, Kovar says, hasn’t changed from their counterculture origins. Country Doctor began in an abandoned fire station with an all-volunteer staff, and what became Carolyn Downs Family Medical Center grew out of a community effort by the Seattle Black Panthers.

“Our specialty is people without insurance and on Medicaid. That’s what we do,” Kovar says.

Swedish, on the other hand, has been on a different track, building up its specialty centers and services, transforming its southern campus at Cherry Hill into a center for neurosurgery and cardiac care, beefing up its transplant program and building a showcase Orthopedic Institute at its First Hill campus.

Federal regulations have long required hospital emergency rooms to treat all, regardless of ability to pay. Many patients, unable to access care elsewhere because they lacked insurance or were at work during doctors’ hours, sought care in ERs for conditions such as coughs and bladder infections that could have been treated in a doctor’s office.

But as report after report has noted, the ER, with its high costs and lack of continuity for patients, is the wrong place for patients like Stevens, who may need social-services help as much as medical care.

The ACA, by fostering the notion that clinics, hospitals and doctors must think in terms of caring for communities, fueled concerns already afoot. Employers, looking for value, were complaining that uncompensated costs of inappropriate ER visits ballooned their insurance premiums, and the state’s Medicaid program was threatening to restrict payments if hospitals didn’t find ways to better connect patients with primary-care doctors and other services.

At Swedish’s Cherry Hill emergency room, nearly 19 percent of patients seen last year — more than 3,000 — were treated for nonemergency conditions.

“Vulnerable, homeless people — those patients are a huge expense to Swedish,” Kovar notes.

Country Doctor’s clinics, unlike hospital ERs, don’t have high overhead. Half of their patients have had no insurance — above even the 35 percent statewide average for community clinics.

Linda McVeigh, executive director of Country Doctor Community Health Centers, said her organization has long wanted to open such a night-and-weekend-hours clinic.

At about 62,000 patient visits last year, Country Doctor’s daytime clinics were nearing full capacity, and clinic providers often scrambled to find after-hours care for patients.

But after-hours care for people without insurance, cash or credit cards, McVeigh noted, has been virtually nonexistent. “Our poor triage nurses were hugely frustrated that they had nowhere to send people,” she said.

But before the ACA expanded Medicaid eligibility this year, she said, an after-hours clinic was not financially possible. The clinics, as Federally Qualified Health Centers, are focused on underserved patients and bound to take all, regardless of ability to pay. “My concern was that we would get all uninsured patients,” McVeigh said.

The Medicaid expansion makes that less likely. Unlike large medical centers, which often say they lose money on Medicaid reimbursements, Country Doctor’s leaders say they can operate very well on that amount.

Now, McVeigh is eager to bring more patients to the clinic, which opened quietly in December.

Because of federal regulations, Swedish ER staff members can’t simply say to patients with nonemergency conditions: “Hey, why don’t you go next door to Country Doctor?”

But Springer notes there is a “teachable moment” after a visit, when ER staff can explain to a patient that the next time they need a prescription refilled or their rash checked, they might go next door. And, he says, Swedish plans to promote the clinic in the neighborhood.

“My concern at this point is keeping us afloat for the next few months until we can get to a break-even point.” McVeigh says.

Kovar is enthusiastic about the partnership, but even so, he adds: “It’s a gamble. We’re betting the bank.”

“Every reason for us to be partners”

Up to now, major medical centers and community clinics haven’t formed partnerships in this town — or much of anywhere, actually, with very few exceptions.

“Before the Affordable Care Act, hospitals didn’t really partner or even know who the alternative-delivery providers were in their communities,” Springer said.

He recalls a question he put to chief financial officers of regional hospitals at a meeting in 2011: How many knew the name of the heads of their local community-clinic organizations? Not a single hand went up.

Since then, the ACA has changed the willingness and ability of both partners to form such a strange-bedfellows partnership, he said.

Both organizations are contributing. Country Doctor is providing staff, and Swedish, through its foundation, has given $200,000 to sustain the clinic through the startup, leased the building for $1 a year, and pledged to help advertise the clinic.

Kovar and Springer credit Dr. Ralph Pascualy, who heads the Swedish Medical Group representing Swedish medical providers, for seeing early on that Swedish was going to have to make a change.

“The business model had been working pretty well on fee-for-service,” Springer said. “That is not the model that is going to survive in the future.”

Pascualy and others realized that ACA aims to change incentives in health care, moving away from making money by simply doing more and more services — the fee-for-service model that Springer and others call a “volume-based” approach.

The new model, Springer said, will be more focused on value and accountability — meaning offering to provide efficient, cost-effective care to a whole group of people for a price that works for those who pay health-care bills, such as insurers or employers.

But to do that, Swedish calculated that it would have to “embrace and partner with other providers in the community,” Springer says, even though relationships may have been nonexistent or strained in the past.

“We’re trying to change it with this — this was intentional,” says Springer, who sees the model potentially rolling out more broadly.

“This is a kind of trust walk,” Springer says. “There is no reason for us to be competitors. There is every reason for us to be partners.”

Categories: Health Care

CBO Finds Health Reform's Medicaid Expansion Is an Even Better Deal for States

Center on Budget and Policy Priorities - Tue, 04/22/2014 - 12:18pm
Congressional Budget Office (CBO) estimates released last week show that health reform’s Medicaid expansion, which many opponents wrongly claim will cripple state budgets, is an even better deal for states than previously thought.[1] CBO has sharply lowered its estimates of the costs to states of adopting the Medicaid expansion. CBO now estimates that the federal government will, on average, pick up more than 95 percentof the total costof the Medicaid …
Categories: Benefits, Poverty

Is Bigger Better? Idaho Hospital Battle A Microcosm Of Debate Over Industry Consolidation

Kaiser Health News - Tue, 04/22/2014 - 12:14pm

NAMPA, Idaho - When Idaho's largest hospital system bought the state's largest doctor practice in 2012, the groups expressed hope that the deal would spark a revolution in delivering better-quality care.

Instead, it ignited a costly legal battle with state and federal regulators and rival hospital systems.

Officials at Boise-based St. Luke's Health System thought they had the Obama administration on their side because the federal health law encourages hospitals to collaborate with doctors to improve quality and lower costs.

David Pate is president and CEO of St. Luke’s Health System. St. Luke’s is one of dozens of hospitals nationwide to form Medicare accountable care organizations, agreeing to coordinate care with the prospect of qualifying for government bonuses if they hit cost and quality targets (Photo by Phil Galewitz/KHN).

But the Federal Trade Commission filed suit, arguing that St. Luke's purchase of the 43-physician Saltzer Medical Group in Nampa was anticompetitive and would lead to higher prices for Idaho patients.

A federal judge agreed in January, and his order to dissolve the merger has put this picturesque Boise suburb at the center of a national debate over the consolidation of American medicine. The decision pushed back against the merger mania gripping the health care industry, raising questions about whether larger health systems really do rein in spending and improve care, or whether they fuel higher prices in the long run.

Despite St. Luke's good intentions, the judge worried the merged entity would be so dominant that it could raise prices at will. He suggested hospitals could work with doctors to deliver more-efficient care without buying them out.

Similar arguments are being raised in other markets, including Boston, Pittsburgh and Northern California, where hospital systems have gained strength through acquisitions of doctors' practices and other hospitals at a time of rapid consolidation.

In the near term, the federal judge's decision —which St. Luke's plans to appeal — could slow hospitals' acquisitions of physician groups. While hospitals may not hesitate to buy solo or small group doctors' practices, they may be reluctant about
swallowing large groups like Saltzer Medical, which handled most of the primary care services in Nampa, Idaho's second largest city.

"There will be higher caution in hospitals buying doctors' groups when it looks like they have cornered the market," said Robert Lawton Burns, chairman of the health-care management department at University of Pennsylvania.

A 'Schizophrenic Attitude'?

While consolidation in the industry has been underway for decades, the pace has accelerated dramatically since the 2010 passage of the federal health care law. Hospitals and doctors' groups have joined hands in part out of fear of funding cuts and in part, to position themselves for government bonuses. The bonuses are available to providers who agree to form "accountable care organizations," which are rewarded for keeping Medicare patients healthy, rather than for the number of tests or procedures they do.

"The Affordable Care Act is pushing consolidation and working together, but the Federal Trade Commission and the Justice Department seem to be saying, 'Wait a second, there are antitrust laws here," said Robert Field, a law and health policy professor at Drexel University in Philadelphia. "The federal government has a schizophrenic attitude toward provider consolidation."

FTC officials, however, deny there is any broad conflict between the Affordable Care Act and antitrust laws.

"The issues are in those small number of cases where collaboration occurs in a way that gives participants excessive marketplace power," said Deborah Feinstein, director of the bureau of competition for the FTC.

She declined to say whether the FTC is stepping up antitrust enforcement, but noted that the agency is scrutinizing a number of consolidations.

"We have seen over the last couple of years, hospital-doctor combinations that are troubling to us," Feinstein said, referring to hospitals that own doctors’ practices buying more doctors. "And we are looking at it."

Despite the ruling, some experts say they expect the trend toward larger hospital-doctor systems to continue as providers respond to the health law and seek greater clout with insurers.

Burns said the health law is still driving providers together, as is uncertainty about a fast-changing health care marketplace and the belief that there's "strength in numbers."

In the fourth quarter of last year there were 20 such deals nationwide, according to research firm Irving Levin and Associates. Jackson Healthcare reported the proportion of physicians who said they were employed by hospitals increased to 26 percent last year, up from 20 percent in 2012.

Proceeding With Caution

But the Nampa case will make hospitals more cautious, said Steve Messinger, managing partner of ECG Management Consultants in Arlington.

"The boundaries for antitrust enforcement have always been a bit vague," he said. "This confuses the industry because for the longest time it thought integrating physicians was fundamentally a sound business strategy."

Joe Lupica, a consultant with Newpoint Healthcare Advisors in Phoenix, said the Nampa ruling showed a hospital's good intentions do not outweigh antitrust laws. He predicted that while hospitals will continue buying physician practices, they will also look for other ways to collaborate "before rolling the tanks in and using the blunt instrument of acquisition."

FTC officials say they have sought to spell out guidance to health systems to avoid antitrust problems, but it's not a simple matter.

"Antitrust enforcement is not a bright line, nor a number I can give you," Feinstein said. "There are always deals on the margin."

St. Luke's went over the line not just because the court found the merger gave it control over 80 percent of the primary care physicians in the market but because the FTC investigation uncovered internal documents indicating the hospital system might use the acquisition to charge higher rates to insurers. Idaho's largest insurer, Blue Cross of Idaho, also testified it feared St. Luke's would force it to pay more for care.

'I Want To Transform Health Care'

St. Luke's officials denied they had plans to raise prices after the merger. Instead, they said they wanted to pursue a strategy in which the health system — not insurers —took the financial risk of coordinating patients' care and was rewarded for keeping them healthy and out of the hospital. They said that having salaried doctors would make it easier to share electronic health records, stream patient referrals and adopt treatment protocols.

St. Luke's had already become one of dozens of hospitals nationwide that have formed Medicare accountable care organizations under the health law, agreeing to coordinate care with the prospect of qualifying for government bonuses if they hit cost and quality targets.

"I want to transform health care, and we have taken concrete steps to do it. But we can't do this alone," said St. Luke's CEO David Pate, a physician, who has sought to delay the dissolution until after the hospital's appeal is heard.

He said the community has benefited from the merger because Saltzer doctors now treat more Medicare and Medicaid patients as part of a larger hospital system.

Dr. Tom Patterson, a physician at Saltzer Medical Group in Idaho, believes that selling to St. Luke’s was the right move (Photo by Phil Galewitz/KHN)

Some Saltzer patients with uncontrolled diabetes have also gained from a new program paid for by St. Luke's which allows them to meet weekly with a diabetes educator. When Saltzer was independent, doctors said they had no financial incentive —or money — to offer such a program.

Dr. Tom Patterson, a Saltzer pediatrician, said that despite anxiety about his practice's future as a result of the legal battle, he still believes that selling to St. Luke's was the right move. He said he always envisioned working more closely with St. Luke's because it runs the region's only children's hospital. And he thought the merger would help his patients get easier referrals to specialists and better care at area hospitals because they would share the same electronic record system.

"We were just trying to do what we saw as the trend in the nation, to more integrated care," he said. "Higher insurance premiums were not the intention of the merger - our intention was decreasing costs."

But executives at rival Saint Alphonsus — a subsidiary of Trinity Health, an 86-hospital Catholic health system —were not convinced. Saint Alphonsus, which put in a bid to buy Saltzer after it was asked by the medical group, sued to overturn the Saltzer-St. Luke’s merger.

CEO Sally Jeffcoat said Saltzer is “our lifeblood” because referrals from its doctors had accounted for nearly half of the admissions to its Nampa hospital.

Zelda Geyer-Sylvia, president and chief executive of Blue Cross of Idaho, ­does not buy the argument that a larger St. Luke’s would be better able to control costs (Photo by Phil Galewitz/KHN)

“We had to preserve competition,” Jeffcoat said, explaining why her hospital sued to stop the merger. “It would have devastated this hospital.”

Jeffcoat notes that referrals from Saltzer doctors have fallen by 25 percent in the past year even though its Nampa hospital is 50 feet from Saltzer's door.

Besides Saint Alphonsus, no one stood to lose more from the merger than Blue Cross of Idaho, the state's largest insurer. CEO Zelda Geyer-Sylvia doesn't buy Pate's argument that a larger St. Luke's would be better able to control costs.

"Consolidation has not been an effective way of reducing costs or providing more effective care," she said. “People here have all the best intentions, but once you eliminate competition it’s gone.”

Categories: Health Care

U.S. Supreme Court Upholds Michigan's Affirmative Action Ban

Massachsuetts Trial Court Law Library - Tue, 04/22/2014 - 12:04pm

The Supreme Court on Tuesday upheld Michigan's ban on using race as a factor in college admissions.  In Schuette v. Coalition to Defend Affirmative Action the justices said in a 6-2 ruling that Michigan voters had the right to change their state constitution in 2006 to prohibit public colleges and universities from taking account of race in admissions decisions. The justices said that a lower federal court was wrong to set aside the change as discriminatory.
Facts and details of the issues  presented to the court can be found at Cornell University Law School.
Visit our website for more on Massachusetts Law About Discrimination.

Categories: Research & Litigation

Was a 9-Month-old Boy Really Charged with Attempted Murder in Pakistan?

In Custodia Legis - Tue, 04/22/2014 - 10:04am

The following is a guest post by Shameema Rahman, senior legal research specialist in our Public Services Division.

Getting them into line for 1884, Courtesy of the Prints and Photographs Division, Library of Congress.

You may have heard about an incredible article with the headline, “9-month-old boy on the run after attempted murder charge in Pakistan” that appeared in the Washington Times on April 8th. Several news outlets, including CNN News,  have subsequently clarified the initial report by reference to the Pakistan Code.

It turns out the charge was issued in error by the Karala Police Department.  The Penal Code of Pakistan, Act. No. XLV of 1860, Chapter IV, Section 82, clearly states, “Nothing is an offense which is done by a child under seven years of age.” According to USA TODAYthe police officer has been suspended and an investigation has been ordered by the Chief Minister of Punjab.

Categories: Research & Litigation

Polls Offer Competing Visions Of Electorate's Views On Health Law

Kaiser Health News - Tue, 04/22/2014 - 9:25am

A Fox poll finds more than half of voters are inclined to support candidates that oppose the health overhaul, but Democrats say that other polls show a band of independent voters who may not like the law but don't want it repealed.

Fox News: Fox News Poll: Independents More Likely To Back Anti-ObamaCare Candidates
Most voters say ObamaCare will play an important role in their vote in this year's elections, and over half are more inclined to back the candidate who opposes the health care law. That's according to a Fox News poll released Monday. The new poll asks voters what they would do if the only difference between two congressional candidates is that one promises to fight for the health care law and the other promises to fight against it (Blanton, 4/21).

The Wall Street Journal’s Washington Wire: Can Democrats Use Obamacare To Persuade Voters?
Are there any voters left who haven't made up their minds about the Affordable Care Act? Not many, but Democrats are counting on a few at the margins to come their way. Tracking polls by the Kaiser Family Foundation suggest that support for and opposition to the law have remained about the same over the last six months, even as the law’s impact began to be felt in people’s lives, for better and worse. But there remains a narrow band of voters whose attitude toward the law and whose political allegiance may still be up for grabs: Voters who don’t like the law but don’t want it repealed (Hook, 4/21).

In other news about the politics of the law -

Politico: Who Is Dr. Ben Carson? 
In October, Carson made headlines again when he said that the Affordable Care Act’s framework of mandates, insurance exchanges and federal subsidies amounted to "the worst thing that has happened in this nation since slavery." He meant the comparison literally. "It is slavery in a way," Carson, who is African American, went on, "because it is making all of us subservient to the government, and it was never about health care. It was about control." That sense of loss of control over the practice of medicine is what has brought many doctors recently to become vocal in discussions of policy. Several dozen are even running for Congress this year, most as Republicans. But it's Carson who has become one of those curious media stars that often shoots through American politics nowadays—so suddenly popular among conservatives that he bested such 2016 hopefuls as Chris Christie, Scott Walker and Marco Rubio at the CPAC straw poll (Hamblin, 4/21).

Politico: Schwartz Ad Touts Obamacare In Pennsylvania
Most Democratic candidates in competitive races this year are avoiding talking about the Affordable Care Act, but a new ad from Rep. Allyson Schwartz — one of the four Democrats vying to take on Pennsylvania GOP Gov. Tom Corbett — embraces both President Barack Obama and his signature health care law. "I worked with President Obama on the Affordable Care Act and getting health coverage to all Americans," Schwartz says in the ad, shared first with POLITICO. "It was my legislation that said insurance companies can no longer deny coverage for kids with pre-existing conditions. It's something I’m proud of because it also closed the gap in prescription drug coverage for seniors" (Schultheis, 4/21).

Categories: Health Care

New Painkiller, With Fewer Side-Effects, Up For FDA Approval

Kaiser Health News - Tue, 04/22/2014 - 9:24am

The drug, Moxduo, allows patients to take lower doses of other painkillers. Elsewhere, a Food and Drug Administration official talks about another painkiller, Zohydro.

NPR: Powerful Narcotic Painkiller Up For FDA Approval
The Food and Drug Administration is trying to decide whether to approve a powerful new prescription painkiller that's designed to relieve severe pain quickly, and with fewer side effects than other opioids. While some pain experts say the medicine could provide a valuable alternative for some patients in intense pain, the drug (called Moxduo) is also prompting concern that it could exacerbate the epidemic of abuse of prescription painkillers and overdoses. An FDA advisory committee is holding a daylong hearing Tuesday to decide whether to recommend that the agency approve the drug (Stein, 4/22).

CQ Healthbeat: FDA Official Urges Reassessment Of Painkiller Use
While defending the approval of the controversial painkiller Zohydro, the top U.S. drug regulator is calling for a reversal of the trends that have triggered excess use of narcotics in the United States and unleashed an epidemic of prescription drug abuse (Young, 4/22).

Categories: Health Care

McAuliffe Renews His Push To Expand Virginia's Medicaid Program

Kaiser Health News - Tue, 04/22/2014 - 9:23am
Medicaid expansion news from Virginia and Kansas as well as a report about how some CHIP advocates are now concerned about how the expansion could impact the insurance program for children.

The Associated Press: Va. Gov. McAuliffe Touts First 100 Days In Office
Gov. Terry McAuliffe celebrated his first 100 days in office Monday by highlighting his work to improve the state’s economy and by renewing his call to expand Medicaid eligibility to low-income residents (4/21).

The Washington Post: Medicaid Expansion In Kansas On Hold Until At Least 2015
If Kansas opts to expand Medicaid, it won’t happen until at least next year. A new measure, signed into law late last week by Gov. Sam Brownback (R), requires that any expansion of Medicaid be explicitly approved by the state legislature, which has finished its regular session for the year (Chokshi, 4/21).

CQ Healthbeat: CHIP Advocates Cast Wary Eye on the Calendar
Champions of the Children’s Health Insurance Program are starting to worry about its future with federal funding set to expire in 18 months and new coverage alternatives available under the health law. A central question is whether advocates can convince Congress the program covering 8.5 million children is worth keeping even though states now have the option of expanding their Medicaid programs to help cover that population. Lawmakers also authorized hundreds of billions of dollars in subsidies to buy coverage on insurance exchanges (Reichard, 4/21).

Categories: Health Care

Supreme Court Weighs Truth-In-Labeling Issue In Case Involving Juice Product

Kaiser Health News - Tue, 04/22/2014 - 9:22am

The makers of a pomegranate juice called Pom Wonderful ask the court to rule that Coca-Cola is falsely labeling its Pomegranate Blueberry juice that is 99.4 percent apple and grape juice.

Los Angeles Times: Supreme Court Seems Inclined To Bolster Truth-In-Labeling Laws
In a case that could strengthen truth-in-labeling laws, Supreme Court justices on Monday voiced deep skepticism about Coca-Cola's Pomegranate Blueberry juice that is 99.4% apple and grape juice, saying the name would probably fool most consumers, including themselves. The high court is hearing an appeal from Stewart and Lynda Resnick of Los Angeles, makers of a rival pomegranate juice called Pom Wonderful, who complained that the name of the Coca-Cola product, sold under the Minute Maid brand, is false and misleading. … At issue is whether federal law permits selling a product with a name or a label that is almost sure to mislead consumers, and how much latitude manufacturers have in marketing (Savage, 4/21).

The Wall Street Journal: Justices Skeptical Of Coke's Pomegranate Juice Label
Los Angeles-based Pom, which sells juices and juice blends with high content of costly pomegranate juice, claims that Coke is misleading consumers with a Minute Maid product it calls Pomegranate Blueberry Blend of Five Juices. The product, which contains about 0.5% of pomegranate and blueberry juices, highlights the words Pomegranate Blueberry, features a pomegranate and blueberry on its label, and is colored a bluish-purple, altering the natural hue of the less pricey apple and grape juices that make up more than 99% of the beverage (Bravin, 4/21).

The high court will also consider a case Tuesday involving abortion and free speech -

Politico: Abortion At Heart Of Ohio Speech Case
The Supreme Court will consider Tuesday whether an anti-abortion group can challenge an Ohio law that could have restricted it from publicly accusing a political candidate of voting for taxpayer-funded abortions in Obamacare. The justices aren’t likely to decide whether the law chills free speech—although Susan B. Anthony List and even the Ohio attorney general say that it does. They’re instead being asked to decide whether SBA List has standing to challenge the law since the group was never prosecuted under it (Winfield Cunningham, 4/22).

Categories: Health Care

Novartis To Buy GlaxoSmithKline's Oncology Unit

Kaiser Health News - Tue, 04/22/2014 - 9:22am

The deal, worth $14.5 billion, will also see Novartis sell its vaccines unit to Glaxo for up to than $7 billion and partner with Glaxo on their consumer divisions. Novartis also said it will sell its animal health division to Eli Lily for over $5 billion.

The Wall Street Journal: Novartis Buys GlaxoSmithKline's Oncology Unit For $14.5 Billion
Basel-based Novartis said it is acquiring the oncology unit of Britain's GlaxoSmithKline for around $14.5 billion. The Swiss pharmaceutical giant is also selling its vaccines unit to Glaxo for $5.25 billion. Both deals include provisions for milestone payments that could raise the total values. Novartis and Glaxo are also planning to combine their consumer divisions, which sell medicines that don't require a prescription (Falconi and Plumridge, 4/22).

Bloomberg/Los Angeles Times: Novarits To Buy GlaxoSmithKline Cancer Unit For Up To $16 Billion
Novartis AG agreed to buy GlaxoSmithKline Plc’s cancer-drug business for as much as $16 billion, form a consumer-health venture with Glaxo and sell its animal-health operation to Eli Lilly & Co. for $5.4 billion in an overhaul of the Swiss drugmaker. Novartis also will sell its vaccines business, excluding the flu operations, to Glaxo for $7.1 billion, the Basel, Switzerland-based company said in a statement today. That includes royalties and as much as $1.8 billion payments based on the achievement of certain business goals (4/21).

USA Today: Glaxo, Novartis, Eli Lilly In ‘Major 3-Part’ Deal
British drug giant GlaxoSmithKline announced Tuesday that it will sell its cancer-products business to pharmaceutical giant Novartis, in a deal that will see the firm's Swiss rival pay $14.5 billion for its oncology unit. Basel-headquartered Novartis said separately that it will sell its animal health division to U.S. firm Eli Lilly for $5.4 billion (Hjelmgaard, 4/22).

The Wall Street Journal: Novartis, GlaxoSmithKline Consumer-Health Business Unites Big Brands
The new over-the-counter drug and food-supplement business, with sales of around $11 billion, will be called GSK Consumer Healthcare. As the name suggests, Glaxo will control the business, with a 63.5 percent stake and seven of 11 board directors. Glaxo Chief Executive Andrew Witty will chair its board (Plumridge, 4/22).

Categories: Health Care

Detailing The Winners: Which Insurers Scored The Most Health Exchanges Sign-Ups

Kaiser Health News - Tue, 04/22/2014 - 9:22am

In California, it was Anthem Blue Cross, while Kaiser Permanente, Rocky Mountain Health Plans and the Colorado HealthOP appeared to fare well through that state's online insurance marketplace. Meanwhile, reports also track how the small business exchanges did in Rhode Island and Connecticut. 

Los Angeles Times: Anthem Blue Cross Signs Up The Most Californians Under Health Law
With open enrollment for Obamacare wrapped up, insurance giant Anthem Blue Cross stayed ahead of the pack in California sign-ups and widened its lead over rival Blue Shield of California. Anthem signed up 425,058 people through April 15, or 30.5% of Covered California's exchange market under the Affordable Care Act, new data show. Anthem is a unit of Indianapolis-based WellPoint Inc., the nation's second-largest health insurer (Terhune, 4/21). 

The Miami Herald:  Florida Blue Says ACA Enrollments Exceeded Expectations But Premiums May Rise In 2015
Most of the consumers who bought a private health plan from Florida Blue through the Affordable Care Act’s insurance exchanges between October and April were previously uninsured — one of many factors potentially leading to higher premium rates in 2015, according to a senior executive (Chang and Borns, 4/21).

Health News Colorado: Kaiser, Other Nonprofits Score Majority Of Exchange Sign-Ups
Nearly three out of four people who bought private health insurance through Colorado’s exchange selected nonprofit carriers: Kaiser Permanente, Rocky Mountain Health Plans and the Colorado HealthOP. Nearly half picked Kaiser. Kaiser enrolled 58,344 of 127,233 people — or about 46 percent — of those who bought insurance through Connect for Health Colorado between Oct. 1 and the end of open enrollment on March 31 (McCrimmon, 4/21).

Politico Pro: Rhode Island Shines In The SHOP Spotlight
The smallest state in the nation may be able to boast the greatest progress in an Obamacare initiative aimed at, yes, small businesses. Many states pushed their small-business health options programs to the side amid the myriad problems that arose while they were gearing up for the law’s first enrollment season. But Rhode Island put SHOP front and center, and half a year later, its program has signed up a bigger percentage of the population than that of any other state (Villacorta, 4/21).

The CT Mirror: CT Obamacare Exchange Lags In Attracting Small Businesses
Access Health CT, the state’s health insurance exchange, drew national praise for its performance in enrolling more than 208,000 individuals in health care coverage as part of the law commonly known as Obamacare. But the small business side of the state’s exchange -- known as SHOP, for the Small Business Health Options Program -- hasn’t done so well. As of April 8, it had sold plans to 78 businesses, covering a total of 330 people (Becker, 4/21).

Categories: Health Care

The Trials And Tribulations Of The Health Law's Expanded Health Insurance Coverage

Kaiser Health News - Tue, 04/22/2014 - 9:21am

News outlets report how, as the overhaul "chips away" at the nation's number of people without insurance, the law's solutions to the problem often come with challenges of their own.  

The New York Times: Looking At Costs And Risks, Many Skip Health Insurance
Steve Huber, an affable salesman who is still paying off an unexpected medical bill, was not among the millions of Americans who signed up for health insurance under the Affordable Care Act during the enrollment period that ended March 31. After seeing television ads for Kentucky’s new online insurance marketplace, Mr. Huber, 57, made several attempts to explore the website but found it too complicated. Moreover, his income has dropped in recent years, he said, and he felt certain that he could not afford coverage. So he never priced plans or researched whether he qualified for financial assistance (Goodnough, 4/21).

The Associated Press: Affordable Care Act Only Chips Away At A Core Goal
Swan Lockett had high hopes that President Barack Obama’s health overhaul would lead her family to an affordable insurance plan, but that hasn’t happened. Instead, because lawmakers in her state refused to expand Medicaid, the 46-year-old mother of four from Texas uses home remedies or pays $75 to see a doctor when she has an asthma attack (4/21).

Kaiser Health News: Waiting For Medicaid To Kick In
For most of Teresa Martinez’s life, buying health insurance has been out of the question. She works at a Koreatown hair salon, earning about $10 per cut – not nearly enough to afford private coverage. With a long list of ailments including dizziness, blurry vision and leg pain, she eagerly applied last year for a county program that would cover her for free until Obamacare set in (Gorman, 4/21).

The Washington Post’s The Fact Checker: Spinning Obamacare Success: The President Highlights A Less Relevant Number
The Fact Checker was on break last week, but did manage to pass a TV set that aired images of the President’s announcement on April 17 that 8 million people had signed up for health insurance on the Affordable Care Act exchanges. We were struck by a headline in the TV ticker that amplified the president’s message that 35 percent of the enrollees were younger than 35. Why is that important? The “young invincibles” are considered a key to the health law’s success, since they are healthier and won’t requires as much health coverage as older Americans. If the proportion of young and old enrollees was out of whack, insurance companies might feel compelled to boost premiums, which some feared would lead to a cycle of even fewer younger adults and higher premiums (Kessler, 4/22).

Fox News: Congressional Budget Office Projections On Obamacare Raise Questions About Future Enrollment
President Obama and other officials like to point to projections by the Congressional Budget Office to show that ObamaCare "is working," as the president put it. He said 8 million have enrolled in the federal exchanges, but the CBO said in a recent report only 6 million are newly insured and some say even fewer than that did not have prior insurance…That is why the CBO showed that at the end of this year, there will still be 42 million uninsured and 31 million without insurance ten years from now (Angle, 4/22).

Categories: Health Care

State Highlights: Tenn. May Send Addicted Moms To Jail; Hawaii Autism Coverage; Florida Medical Marijuana

Kaiser Health News - Tue, 04/22/2014 - 9:21am

A selection of health policy stories from Tennessee, Hawaii, Florida, Minnesota, Wisconsin and Kansas.

NPR: Tennessee Bill Could Send Addicted Moms To Jail
Pregnant women addicted to illegal narcotics or prescription pain pills could soon be jailed in Tennessee under a bill awaiting the governor's signature. The strict proposal enjoys bipartisan support — despite objections from doctors (Farmer, 4/21). 

The Associated Press: Hawaii Considers Mandated Autism Care Coverage 
Hawaii lawmakers continue to work out the details of Senate Bill 2054, which would require insurance companies to cover applied behavioral analysis and other treatment options. Applied behavioral analysis is widely viewed as the most effective treatment for autism spectrum disorders. But the Hawaii Medical Services Association, one of the state's largest insurance companies, opposed the bill, saying it would be too expensive to provide the services (Bussewitz, 4/21).

The Miami Herald: Florida Gov. Rick Scott’s Medical Czar Opposes Marijuana Bill 
Efforts to legalize a specific strain of marijuana to help children with intractable epilepsy faced a new hurdle Monday as the governor’s chief medical advisor said he opposed the bill because it will allow untested drugs into the market, raising the specter that the governor may veto the bill (Klas, 4/21).

Modern Healthcare: Healthways To Pay $9.4 Million To Minn. Blues Over Telehealth Fraud
Tennessee-based health services firm Healthways has agreed to pay $9.4 million to Blue Cross and Blue Shield of Minnesota to resolve a contract dispute, the company announced last week. Under the settlement, Healthways agrees to pay BCBSMN a total of $4 million by the end of this month and a second payment of $5.5 million in January 2015. The settlement amount will be incurred as a charge within Healthways' first quarter 2014 results, the company said in a statement (Johnson, 4/21).

The Milwaukee Journal Sentinel: Wisconsin Nursing Homes Are Becoming More Home Than Nursing
Gerri Bussey loves to sleep in, and she does so nearly every day. She loves a big breakfast. Once a week she takes a bubble bath in style with a glass of wine. The vivacious 79-year-old isn't on holiday. She's been living at an Oconomowoc nursing home, Shorehaven, rehabilitating from a fall that happened a few months ago. Far from the traditional nursing home with sterile hallways and fluorescent lights, Shorehaven is one of a new breed popping up in the state, and a sign that life for Wisconsin's most vulnerable residents is transforming (Mulvany, 4/21).

The Pioneer Press: Dane County (Wis.) Dementia Program Could Expand Statewide
When Arkady Grinblat would try to go outside of his assisted-living facility, an alarm would go off. Staff told him he couldn't walk into other people's rooms. ... Like other people with behavior problems related to dementia, he risked being sent to Mendota Mental Health Institute. But Dane County's Dementia Support Team arranged for Grinblat to move to a smaller assisted-living facility instead, paying to hire an extra caregiver and put up a fence so Grinblat could get fresh air. The Dementia Support Team, formed in 2009 after a dementia patient from the county lingered at Mendota for more than two years, could expand through a state effort to reform dementia services (Wahlberg, 4/21).

The Associated Press:  Gov. Walker Announces Plan To Expand Family Care Program
Wisconsin health officials are ready to begin expanding the Family Care program that provides in-home care to seven additional counties, but it could take as long as three years to get things ramped up. Gov. Scott Walker said Monday his administration is ready to start work on extending Family Care to Brown, Door, Kewaunee, Marinette, Menominee, Oconto and Shawano counties. The expansion would include 2,434 people who use similar county-based care programs, 977 people on waiting lists for county services and anyone else who resides in the counties and meets the eligibility requirements (Richmond, 4/21).

Kansas Health Institute: Waitlist Problems Delay Services For About 400 Disabled Kansans
State officials say they are prepared to move almost 400 physically disabled Kansans off the waitlist for Medicaid-funded, in-home services but cannot, chiefly because they’re having problems contacting the right people. And they say they have concluded the number of people awaiting services actually might be significantly less than they previously thought (Ranney, 4/21).

Categories: Health Care

Viewpoints: The Case Against Jenny McCarthy's Vaccine Stand; Apathy On HIV; Defeating Alzheimer's

Kaiser Health News - Tue, 04/22/2014 - 9:20am

The New York Times: Autism And The Agitator
What do you call someone who sows misinformation, stokes fear, abets behavior that endangers people's health, extracts enormous visibility from doing so and then says the equivalent of "Who? Me?" I'm not aware of any common noun for a bad actor of this sort. But there’s a proper noun: Jenny McCarthy (Frank Bruni, 4/21).

Los Angeles Times: AIDS At 30: Apathy Plus HIV Kills
In the 30 years since we discovered HIV, the stigma surrounding it has lessened, but it has never completely dissipated. And new threats loom: apathy and ignorance. AIDS advocacy groups are suffering from "prevention fatigue." The waning interest in prevention has propelled rising HIV infections in adolescents and young adults in comparison with other age groups. Of the estimated 1.1 million Americans living with HIV, the Centers for Disease Control and Prevention suggests that 16 percent do not know their HIV status. ... And in December, the White House announced a $100-million initiative toward finding a cure for HIV. This investment has the potential to make an enormous difference. But research is only one piece of the puzzle. Our ability to treat and cure HIV in the future is threatened by the continued stigma, apathy and ignorance surrounding the virus (Nathalia Holt, 4/21). 

The Wall Street Journal: How Congress Can Fight The Alzheimer's Epidemic
Not many people know it, but one of the best ways to curb future health-care spending is with a drug that slows the progression of Alzheimer's disease. Alzheimer's affects more than five million seniors today and last year cost Medicare and Medicaid almost $150 billion. ... If we are to have any chance of mitigating this epidemic, we must find ways to encourage the development of drugs that slow the progression or delay the onset of the inevitable brain failure that characterizes Alzheimer's. Specifically, we need to find incentives for the development of drugs that alter the course of the disease (Kenneth Davis, 4/21). 

The Washington Post’s The Plum Line: The Next Anti-Obamacare Talking Point You Can Safely Ignore
In the past few days, health care wonks have noted with some concern that after a period of years when total health care spending in America was slowing, it looks like it has begun to accelerate again. Republicans will probably begin to argue that this uptick is evidence that the Affordable Care Act has failed in one of its key goals, bringing down overall costs. But is this actually something to worry about? With some important caveats I’ll explain in a moment, the answer is no. In fact, in some ways it's a reason to celebrate (Paul Waldman, 4/21). 

Bloomberg: Are Obamacare's Latest Numbers Good News Or Bad?
The good news is that pretty soon, we'll find out what the insurers are thinking; they'll start filing some of their preliminary rate increases in a couple of weeks. My guess would be that those increases will be modest in places such as New York, which had a lot of signups -- and had also nearly destroyed its private insurance market, so that almost any reform would have been an improvement. My guess would be that in other places, where the signups are too old or too few, premiums will jump sharply. I’d also guess that the backdoor bailouts the administration has been arranging through the risk corridors will be enough to keep existing insurers in the market, though maybe not enough to lure many new ones (Megan McArdle, 4/21).

Bloomberg: Why Voters Won't Turn Out For Obamacare
Successful programs guarantee their own success, regardless of subsequent elections. That's very likely to be the case with health-care reform, no matter how people feel about "Obamacare." It’s hard for politicians to take away benefits people like. What successful programs almost never do -- especially those that are targeted widely and don't put pressure on specific groups to realign -- is win elections. And Obamacare, with its largely invisible and abstract benefits, is particularly poorly designed to achieve that particular goal (Jonathan Bernstein, 4/21).

St. Louis Post-Dispatch:  Medicaid Expansion Argument Is Winning In Missouri
In Missouri, that economic impact of expansion could be profound, creating more than 24,000 jobs and actually adding money to Missouri’s general revenue budget. That’s according to studies that the opponents have failed to counter in any meaningful way (4/21).

The Journal of the American Medical Association: CMS -- Engaging Multiple Payers In Payment Reform
The Affordable Care Act created the Center for Medicare and Medicaid Innovation (Innovation Center) to test innovative payment and service delivery models to reduce program expenditures under Medicare, Medicaid, and the Children's Health Insurance Program (CHIP) ... All of these models share a common pathway for success: they hinge on getting clinicians and health care organizations to manage the health of populations and to act as good stewards of health care resources. ... However, for these models to succeed in the long term, "value-based payment and patient incentives to reward clinicians and health care organizations that offer more real value to patients must spread rapidly to other payers" (Rahul Rajkumar, Patrick H. Conway and Marilyn Tavenner, 4/21). 

Categories: Health Care

First Edition: April 22, 2014

Kaiser Health News - Tue, 04/22/2014 - 7:28am

Today's early morning highlights from the major news organizations, including marketplace news about the Novartis purchase of GlaxoSmithKline's oncology unit for $14.5 billion.

Kaiser Health News: Waiting For Medicaid To Kick In
Kaiser Health News staff writer Anna Gorman, working in collaboration with The Orange County Register, reports: “For most of Teresa Martinez’s life, buying health insurance has been out of the question. She works at a Koreatown hair salon, earning about $10 per cut – not nearly enough to afford private coverage. With a long list of ailments including dizziness, blurry vision and leg pain, she eagerly applied last year for a county program that would cover her for free until Obamacare set in” (Gorman, 4/21). Read the story and watch the related video by Heidi de Marco.

Kaiser Health News: Insuring Your Health: Readers Ask: Who Is Responsible For An Adult Child's Coverage? Must Insurers Notify Smokers Of Ways To Lower Premiums?
Kaiser Health News consumer columnist Michelle Andrews looks into issues raised by the health law (4/22). Read the column.

Kaiser Health News: Capsules: How Are Insurers Responding To New Health Law Enrollees?
Kaiser Health News staff writer Jay Hancock was on C-SPAN’s Washington Journal Monday morning to talk about how insurers are responding to the health law. Hancock said the 8 million new customers have insurers pondering who they, how sick they are and how the new enrollees may affect insurance rates in 2015 (8/21). Watch the video or check out what else is on the blog.

The New York Times: Looking At Costs And Risks, Many Skip Health Insurance
Steve Huber, an affable salesman who is still paying off an unexpected medical bill, was not among the millions of Americans who signed up for health insurance under the Affordable Care Act during the enrollment period that ended March 31. After seeing television ads for Kentucky’s new online insurance marketplace, Mr. Huber, 57, made several attempts to explore the website but found it too complicated. Moreover, his income has dropped in recent years, he said, and he felt certain that he could not afford coverage. So he never priced plans or researched whether he qualified for financial assistance (Goodnough, 4/21).

The Associated Press: Affordable Care Act Only Chips Away At A Core Goal
Swan Lockett had high hopes that President Barack Obama’s health overhaul would lead her family to an affordable insurance plan, but that hasn’t happened. Instead, because lawmakers in her state refused to expand Medicaid, the 46-year-old mother of four from Texas uses home remedies or pays $75 to see a doctor when she has an asthma attack (4/21).

The Wall Street Journal’s Washington Wire: Can Democrats Use Obamacare To Persuade Voters?
Are there any voters left who haven’t made up their minds about the Affordable Care Act? Not many, but Democrats are counting on a few at the margins to come their way. Tracking polls by the Kaiser Family Foundation suggest that support for and opposition to the law have remained about the same over the last six months, even as the law’s impact began to be felt in people’s lives, for better and worse (Hook, 4/21).

The Washington Post’s The Fact Checker: Spinning Obamacare Success: The President Highlights A Less Relevant Number
The Fact Checker was on break last week, but did manage to pass a TV set that aired images of the President’s announcement on April 17 that 8 million people had signed up for health insurance on the Affordable Care Act exchanges. We were struck by a headline in the TV ticker that amplified the president’s message that 35 percent of the enrollees were younger than 35. Why is that important? The “young invincibles” are considered a key to the health law’s success, since they are healthier and won’t requires as much health coverage as older Americans. If the proportion of young and old enrollees was out of whack, insurance companies might feel compelled to boost premiums, which some feared would lead to a cycle of even fewer younger adults and higher premiums (Kessler, 4/22).

Politico: Who Is Dr. Ben Carson? 
That sense of loss of control over the practice of medicine is what has brought many doctors recently to become vocal in discussions of policy. Several dozen are even running for Congress this year, most as Republicans. But it’s Carson who has become one of those curious media stars that often shoots through American politics nowadays—so suddenly popular among conservatives that he bested such 2016 hopefuls as Chris Christie, Scott Walker and Marco Rubio at the CPAC straw poll. Though he does not identify with a political party—he says parties should be dissolved—Carson has spent months speaking to largely GOP audiences, elucidating a deeply Christian, libertarian vision of what the Founding Fathers had in mind (Hamblin, 4/21).

Los Angeles Times: Anthem Blue Cross Signs Up The Most Californians Under Health Law
With open enrollment for Obamacare wrapped up, insurance giant Anthem Blue Cross stayed ahead of the pack in California sign-ups and widened its lead over rival Blue Shield of California. Anthem signed up 425,058 people through April 15, or 30.5% of Covered California's exchange market under the Affordable Care Act, new data show. Anthem is a unit of Indianapolis-based WellPoint Inc., the nation's second-largest health insurer (Terhune, 4/21). 


The Washington Post: Medicaid Expansion In Kansas On Hold Until At Least 2015
If Kansas opts to expand Medicaid, it won’t happen until at least next year. A new measure, signed into law late last week by Gov. Sam Brownback (R), requires that any expansion of Medicaid be explicitly approved by the state legislature, which has finished its regular session for the year (Chokshi, 4/21).

The Associated Press: Va. Gov. McAuliffe Touts First 100 Days In Office
Gov. Terry McAuliffe celebrated his first 100 days in office Monday by highlighting his work to improve the state’s economy and by renewing his call to expand Medicaid eligibility to low-income residents (4/21).

Politico: Abortion At Heart Of Ohio Speech Case
The Supreme Court will consider Tuesday whether an anti-abortion group can challenge an Ohio law that could have restricted it from publicly accusing a political candidate of voting for taxpayer-funded abortions in Obamacare. The justices aren’t likely to decide whether the law chills free speech—although Susan B. Anthony List and even the Ohio attorney general say that it does. They’re instead being asked to decide whether SBA List has standing to challenge the law since the group was never prosecuted under it (Winfield Cunningham, 4/22).

Los Angeles Times: Supreme Court Seems Inclined To Bolster Truth-In-Labeling Laws
In a case that could strengthen truth-in-labeling laws, Supreme Court justices on Monday voiced deep skepticism about Coca-Cola's Pomegranate Blueberry juice that is 99.4% apple and grape juice, saying the name would probably fool most consumers, including themselves. The high court is hearing an appeal from Stewart and Lynda Resnick of Los Angeles, makers of a rival pomegranate juice called Pom Wonderful, who complained that the name of the Coca-Cola product, sold under the Minute Maid brand, is false and misleading. … At issue is whether federal law permits selling a product with a name or a label that is almost sure to mislead consumers, and how much latitude manufacturers have in marketing (Savage, 4/21).

The Wall Street Journal: Justices Skeptical Of Coke's Pomegranate Juice Label
Los Angeles-based Pom, which sells juices and juice blends with high content of costly pomegranate juice, claims that Coke is misleading consumers with a Minute Maid product it calls Pomegranate Blueberry Blend of Five Juices. The product, which contains about 0.5% of pomegranate and blueberry juices, highlights the words Pomegranate Blueberry, features a pomegranate and blueberry on its label, and is colored a bluish-purple, altering the natural hue of the less pricey apple and grape juices that make up more than 99% of the beverage (Bravin, 4/21).

NPR: Powerful Narcotic Painkiller Up For FDA Approval
The Food and Drug Administration is trying to decide whether to approve a powerful new prescription painkiller that's designed to relieve severe pain quickly, and with fewer side effects than other opioids (Stein, 4/22).

The Wall Street Journal: Novartis Buys GlaxoSmithKline's Oncology Unit For $14.5 Billion
Basel-based Novartis said it is acquiring the oncology unit of Britain's GlaxoSmithKline for around $14.5 billion. The Swiss pharmaceutical giant is also selling its vaccines unit to Glaxo for $5.25 billion. Both deals include provisions for milestone payments that could raise the total values. Novartis and Glaxo are also planning to combine their consumer divisions, which sell medicines that don't require a prescription (Falconi and Plumridge, 4/22).

Bloomberg/Los Angeles Times: Novarits To Buy GlaxoSmithKline Cancer Unit For Up To $16 Billion
Novartis AG agreed to buy GlaxoSmithKline Plc’s cancer-drug business for as much as $16 billion, form a consumer-health venture with Glaxo and sell its animal-health operation to Eli Lilly & Co. for $5.4 billion in an overhaul of the Swiss drugmaker. Novartis also will sell its vaccines business, excluding the flu operations, to Glaxo for $7.1 billion, the Basel, Switzerland-based company said in a statement today. That includes royalties and as much as $1.8 billion payments based on the achievement of certain business goals (4/21).

USA Today: Glaxo, Novartis, Eli Lilly In ‘Major 3-Part’ Deal
British drug giant GlaxoSmithKline announced Tuesday that it will sell its cancer-products business to pharmaceutical giant Novartis, in a deal that will see the firm's Swiss rival pay $14.5 billion for its oncology unit. Basel-headquartered Novartis said separately that it will sell its animal health division to U.S. firm Eli Lilly for $5.4 billion (Hjelmgaard, 4/22).

The Wall Street Journal: Novartis, GlaxoSmithKline Consumer-Health Business Unites Big Brands
The new over-the-counter drug and food-supplement business, with sales of around $11 billion, will be called GSK Consumer Healthcare. As the name suggests, Glaxo will control the business, with a 63.5% stake and seven of 11 board directors. Glaxo Chief Executive Andrew Witty will chair its board. The creation of the joint venture is part of a series of transactions announced Tuesday that will reshape both companies (Blumridge, 4/22).

The Wall Street Journal: Walk-In Urgent-Care Companies Are Providing Relief to Retail Landlords
People with relatively minor health problems—say, the flu or a deep cut—aren't the only ones getting relief from growing walk-in "urgent care" companies such as CityMD and PM Pediatrics. These companies also are providing a little tonic to retail landlords. In the last four years, more than 20 of these centers have opened in the New York region, offering a no-appointment alternative to the emergency room or doctor's office (Li, 4/21).

NPR: Tennessee Bill Could Send Addicted Moms To Jail
Pregnant women addicted to illegal narcotics or prescription pain pills could soon be jailed in Tennessee under a bill awaiting the governor's signature. The strict proposal enjoys bipartisan support — despite objections from doctor (Farmer, 4/21). 

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Categories: Health Care

Readers Ask: Who Is Responsible For An Adult Child's Coverage? Must Insurers Notify Smokers Of Ways To Lower Premiums?

Kaiser Health News - Tue, 04/22/2014 - 5:09am

The open enrollment season has ended, but readers continue to have questions about coverage under the health law.

Q. Do we have to carry our 24-year-old daughter on our health insurance policy? She is employed and has two degrees. We informed her that we would be dropping her at the end of the year because it's costing us a fortune, and she told us today that we are required by law to cover her. We do not claim her on our taxes.

A. It’s your decision whether to keep your daughter on your plan. Under the health law, insurers are required to make coverage available to dependent children until age 26, “but it’s up to the policyholder if they want to cover her,” says Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities. Since you no longer claim your daughter on your taxes, you won’t be responsible for paying the penalty if she doesn’t have coverage.

Q. My wife and I are both over 65 and on Medicare. We have custody of a 6-year-old child who is on Medicaid. We live in Indiana and claim him on our federal and state taxes. The state is reviewing our grandchild’s Medicaid status, and we would like to know whether our income is included in the Medicaid eligibility decision.

A. Since you claim your grandson on your taxes, the state will probably consider your income in determining whether he’s eligible for Medicaid or the Children’s Health Insurance Program (CHIP). In Indiana, the income limits vary depending on which program you are in but at the top end of the scale if your modified adjusted gross income is more than 255 percent of the federal poverty level, or $50,465 for a family of three, he may not qualify, says Brian Haile, senior vice president for health policy at Jackson Hewitt Tax Service.

If he’s no longer eligible, you could enroll your grandson in a child-only plan on the health insurance marketplace.

“A Medicaid denial creates a special enrollment opportunity, and the child could be newly eligible for premium tax credits on the marketplace,” says Haile.

Q. Do employers and insurers that charge employees extra for tobacco use in small group health plans have any responsibility to inform employees directly that they can avoid the premium surcharge by enrolling in a smoking cessation program?

More From This Series Insuring Your Health

A. Yes, under the health law both insurers and employers are required to tell workers in small group health plans what they can do to avoid paying a higher premium for smoking, such as participating in a smoking cessation program, says Kirsten Sloan, senior policy director at the American Cancer Society’s Cancer Action Network.

Further, the rules prohibit insurers in the small group market from imposing a tobacco surcharge unless they also offer a wellness program that eliminates the surcharge if workers participate in stop-smoking programs.

Under the health law, insurers that sell plans in the individual and small group markets can no longer turn people down or charge them more because they have pre-existing medical conditions. However, the law allows insurers to vary premiums based on four factors: whether people smoke, their age, family size and where they live.

Smokers can be charged 50 percent more than non-smokers under the law. But a number of states have prohibited insurers from imposing higher premiums on smokers, arguing that by making coverage less affordable it reduces the chance that smokers will participate in programs to quit smoking.

In addition, the health law requires that methods approved by the Food and Drug Administration to quit smoking be covered without any out-of-pocket costs to individuals in non-grandfathered plans. But a study commissioned by the Campaign for Tobacco-Free Kids found that coverage varies widely by plan.

“We have urged HHS to provide further clarification to insurers about the scope of tobacco cessation services they must provide,” says Brian Hickey, the group’s director of federal government relations.

Please send comments or ideas for future topics for the Insuring Your Health column to questions@kaiserhealthnews.org.
Categories: Health Care

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