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Criminal model jury instructions update

Massachsuetts Trial Court Law Library - Sun, 07/20/2014 - 7:30am
  On May 30, 2014 the District Court release six new jury instructions and revised eight others. The new instructions are:  (1) Failure to have ignition interlock device; (2) Disabling an ignition interlock device; (3) Willful interference with a fire fighting operation; (4) Cruelty to animals; (5) Furnishing alcohol to a minor; (6) Improper storage of a firearm. One can see all the instructions online here, or one can borrow the MCLE book, Criminal model jury Instructions in the District Court from any Trial Court Law Library.
Categories: Research & Litigation

To Prevent Surprise Bills, New Health Law Rules Could Widen Insurer Networks

Medicare -- New York Times - Sun, 07/20/2014 - 12:00am
State insurance regulators and the Obama administration plan to revise standards so consumers will encounter fewer unexpected out-of-network bills.
Categories: Elder, Medicare

Summer Food Service Program Provides Free Food for Low Income Children

Massachsuetts Trial Court Law Library - Sat, 07/19/2014 - 9:00am
Thanks to the Federally Funded Food Service Program, over 900 Massachusetts organizations around the state have joined the cause to distribute free food to eligible children ages 18 and under. There are camps, libraries, housing complexes, etc. that provide up to two nutritious meals a day. To find distribution locations and times click on the following link: http://meals4kids.org/downloadable-site-lists   For more information, take a look at the Massachusetts Department of Education page: http://www.doe.mass.edu/cnp/nprograms/sfsp/

  
Categories: Research & Litigation

Mourning The AIDS Researchers Killed In Ukraine Plane Crash

CommonHealth (WBUR) - Fri, 07/18/2014 - 4:33pm

A pro-Russian fighter inspects the site of a crashed Malaysia Airlines passenger plane near the village of Hrabove, Ukraine, eastern Ukraine Friday, July 18, 2014. (AP Photo/Dmitry Lovetsky)

With an estimated 100 HIV/AIDS researchers believed to have been on the Malaysian Airlines flight that went down in Ukraine, the official mourning has begun and will surely grow as names and details emerge. This just in from James Friedman, executive director of the American Academy of HIV Medicine:

It is with heavy heart we learn many of those that perished in the crash of Malaysia Airlines Flight 17 were leading HIV/AIDS researchers traveling to the International AIDS Conference scheduled to begin on Sunday in Australia. While all names have not yet been released, the passing of Dr. Joep Lange, a leading HIV/AIDS researcher, has been confirmed.

It is due to their continued dedication to HIV/AIDS patients worldwide that they were making this journey. Not only did this tragedy take the lives of these researchers, but also robbed the world of their future discoveries and contributions to the HIV/AIDS patients they served.

The HIV/AIDS community mourns the loss of these talented and compassionate researchers and HIV care providers. Our condolences to the families of all those affected by the Malaysia Airlines Flight 17 tragedy.

The New York Times profiles Dr. Lange here, and the Australian Broadcasting Corporation reports that Canadian HIV researcher Trevor Stratton said the crash was a huge loss to the AIDS research world.

“What if the cure for AIDS was on that plane? Really? We don’t know,” he said.

“There were some really prominent researchers that have been doing this for a very long time and we’re getting close to vaccines and people are talking about cures and the end of AIDS.

Categories: Health Care

Sarita Kenedy East Law Library, St. Mary’s University – Pic of the Week

In Custodia Legis - Fri, 07/18/2014 - 12:25pm

Earlier this week, during the American Association of Law Libraries annual conference in San Antonio, Texas, I visited the Sarita Kenedy East Law Library at St. Mary’s University School of Law.  Below are just a few of the pictures that I took while we were treated to a tour of the law library by librarian and associate professor Mike Martinez, Jr.  It is a very spacious library (everything’s bigger in Texas, right?) named for Sarita Kenedy East, a South Texas rancher and philanthropist whose foundation provided funding for the construction of the building in the early 1980s.

In addition to looking around the processing areas, stacks, and study rooms, we were able to enter the lovely Rare Book Room, where valuable books on Texas law, Mexican law, and other works from different parts of the world are stored and displayed (along with a “stately green granite top table”).  In this room we had a chance to see the first law books of Texas following its becoming a state in late 1845, among other items.

The Sarita Kenedy East Law Library is a member of the Federal Depository Library Program (we’ve written about a couple other FDLP libraries previously).

Categories: Research & Litigation

Please Discuss: ‘Gene Drives,’ Sci-Fi Scary Or Cool Leap Forward?

CommonHealth (WBUR) - Fri, 07/18/2014 - 11:35am

Scientists say new “gene drive” technology could help fight malaria by affecting the mosquitoes that carry it. (Wikimedia Commons)

Perhaps you’ve followed that teeny tiny controversy around genetically modified foods, the “GMO” debate. Or you watched the fierce back-and-forth over whether it was a good idea to modify a strain of avian flu in the lab to make it spread more easily, in order to study it.

If this is your kind of spectator sport, it’s time to learn about gene drives, a powerful new genetic technology that basically flips Charles Darwin on his head, allowing a sort of artificial selection to help chosen genes come to dominate in a population.

A paper just out in the journal eLife outlines a way to use gene drives to spread just about any altered gene through wild populations that use sex to reproduce. And a related paper just out in the journal Science calls for greater oversight and a public discourse about the potential risks and benefits of gene drive technology — now, while it’s still in early stages and confined to labs.

I can already imagine the “pro” side of the debate: “This could eradicate malaria. Reduce the use of pesticides. Bolster agriculture for a crowded planet.” And the “con” side: “But what if it goes wrong out in the wild? Have you read no science fiction?”

I spoke with two of the paper’s co-authors: Kevin Esvelt, a technology development fellow at the Wyss Institute for Biologically Inspired Engineering and Harvard Medical School, who is also the lead author of the eLife paper; and Kenneth Oye, Professor in Engineering Systems and Political Science at MIT and director of policy and practices of the National Science Foundation’s Synthetic Biology Engineering Research Center. Our conversation, edited:

CG: So what exactly is a gene drive and why are we talking about it now?

Kevin Esvelt: A gene drive is a potential new technology that may let us alter the traits of wild populations but only over many generations. We think that gene drives have the potential to fix a lot of the problems that we’re currently facing, and that natural ecosystems are facing, because it allows us to alter wild populations in a way that we could never do before.

We would really like to start a public conversation about how we can develop it and use it responsibly, because we all depend on healthy ecosystems and share a responsibility to pass them on to future generations.

So how do they work? The reason we haven’t been able to alter wild populations to date is natural selection. When you say natural selection, you think, ‘How many organisms survive and reproduce?’ And that’s pretty much how it works. The more likely you are to survive and reproduce, then the more copies of your genes there are going to be. So genes that help an organism reproduce more often are going to be favored.

The problem is, when we want to alter a species, the way we want to alter it usually doesn’t help it survive and reproduce in nature. But that’s not the only way that a gene can reproduce. We have two copies of each gene, and when organisms have children, each of the offspring has a 50% chance of getting either copy. But you can imagine that a gene could gain an advantage if it could stack the deck — if it could ensure that it, rather than the alternate version, was inherited 70%, 80%, 90%, or 99% of the time.

How gene drives affect which genes are passed down (Courtesy Kevin Esvelt)

There are a lot of genes in nature that do exactly this; they’ve figured out an incredible variety of ways of doing that. Almost every species in nature has what we would call an ‘inheritance-biasing gene drive’ somewhere in its genome, or at the very least the broken remnants of one. They’re actually all over the place in nature.

The idea that we could harness these to spread our alterations through populations has actually been around for a long time. It was most clearly articulated more than a decade ago in amazing work by Austin Burt of Imperial College London. His idea was very simple. He said, “How about if you take a piece of DNA that cuts its competitor?’

When a gene cuts its competitor, the cell needs to fix the damage. And the best way from the cell’s perspective to fix the damage is use a template to repair it to make sure it’s correct, and that’s one of the advantages of having two copies of everything. But in this case, the gene drive is the alternate copy to use as the template. So when the cell fixes the damage, it copies the gene drive onto the damaged chromosome.

Of the two chromosomes, one of them starts out with the gene drive and one of them starts out without it. The gene drive causes a break in the strand of the chromosome that doesn’t have it, and then the cell copies the gene drive over to fix the break. So you’re guaranteed to get it. You go from an organism that starts out with one copy and it goes to having two copies, and thus, when it has offspring, it’s guaranteed to contribute the gene drive to all of the offspring.

So it sounds like you’re not introducing whole new genes that are then guaranteed to be passed along. It’s that you’re changing the odds of a given gene from 50% to 100%?

The engineering side of this — and this is our contribution — is we’ve outlined a technically feasible way to do this for almost any stretch of DNA using [the gene-editing tool] CRISPR, because the way that we edit genomes with CRISPR is nearly identical to this gene drive strategy already.

What we do to edit a genome is we introduce the CRISPR system into the cell, we have it cut the gene we want to edit, and we supply an altered copy for the cell to use for repair. The only real difference here is that now we’re putting the CRISPR into the genome next to the gene we want to edit.

It still specifies that it will cut the natural version of the gene — the wild-type version. When it does that, typically just after fertilization or maybe just before the organism makes sperm or eggs, then the cell needs to fix the damage to the wild type copy so it looks for homology and it finds the altered gene and the CRISPR system, and it will just copy both of them.

So in fact you can insert a different gene if you want to?

Exactly. In theory it should let us ‘drive’ most of the traits that we know how to alter in organisms using CRISPR.

So it’s called a gene drive because it can drive the dominance of a gene?

We think of it as a drive because it uses this inheritance-biasing trick as the propulsion to launch itself through a population. We think of it as driving through a population, and it’s replicating, but the reason we use the term “drive” is because it’s the inheritance biasing that’s the propulsion — that’s the fitness advantage that ensures that it’s getting passed down to all the offspring and therefore is going to spread through the whole population.

So this has become feasible in the last, would you say, several years, couple years, or months?

Everything we’ve done with CRISPR has been done in the last two years. That entire technology has been developed from scratch in the span of two years. I want to be clear. We haven’t actually done this yet, what we’ve done is outline very clearly why we think it’s going to work because of the concept I just laid out — the mechanisms are the same.

Colleagues of Austin Burt’s have built gene drives using earlier gene-editing technologies by co-opting some of the natural genes. The problem with those is they actually don’t work and can’t work in wild organisms or for just any gene you want. But they’ve done it in artificial systems in the laboratory in multiple species.

We know the cutting and copying strategy works in the laboratory and engineered systems using cutting enzymes. We just haven’t done it specifically with CRISPR yet, and that’s partly just because we have a bad tendency to get really excited about a technology and go through and develop it without really thinking about the implications. So it gets presented to the public as a ‘Hey we can do this, isn’t this great?!’ And sometimes the public goes ‘Whoa, we have concerns about this,’ and the scientists go, ‘Huh?’

And the scientists say, ‘But it’s so cool!’

It’s amazing. It could address so many problems that we’re facing, and it has a tremendous number of potential benefits, but only if we make sure that it is used responsibly and really get the public involved in the decision making.

So let’s talk about potential benefits — what would the malaria scenario be?

Malaria is a really terrible disease. It kills over 650,000 people each year; most of those are children under 5. It affects over 200 million more and sickens them. When you think of a horrific public health burden, malaria is it.

With the gene drive, there are a couple different ways that we might be able to address the malaria problem that are much safer for the people and possibly for the environment as well. Malaria is spread by mosquitoes. There are a lot of different types in Africa and South Asia, which are the main areas where malaria is a problem, but only a handful of them spread malaria effectively. None of us like mosquitoes, but if they didn’t carry diseases, they wouldn’t be nearly so bad.

So why can’t we just alter the mosquito populations so they can’t carry disease? Austin Burt, who first proposed this particular form of gene drive technology, is in the mosquito field. People in that field are aware of the possibility of using a gene drive.  It’ acknowledged to be something of the Holy Grail application for everyone in the mosquito field.

Thats why a lot of laboratories have been working on ways to alter the mosquito so that it can’t transmit malaria anymore. They’ve succeeded. We now have several ways of doing that, from altering the mosquito’s immune system to changing the way it responds to the parasite, because the parasite doesn’t do anything for the mosquito either. It’s just hitching a ride. The reason the mosquito still does it is because the cost of going along is slightly lower than the cost of trying to resist. We know that making the mosquito resistant to malaria is a little costly to the mosquito, but only a little bit, and we know how to make that change.

The idea with the gene drive is okay, we have several changes that can do that — let’s start spreading them through wild mosquito populations using the gene drive. So the idea, then, is you’d still have mosquitoes, they’d be the same in every way except they would not be able to transit malaria effectively.

There are several promising ways: probably stimulating the mosquito’s innate immune system to attack the parasite more effectively is the most promising. The really nice thing about the CRISPR gene drive is that we can use it to make any of these alterations, and for the ones that require inserting new DNA we can do that anywhere in the mosquito genome. So even if the resistance gene that we insert breaks, we can release a new gene drive that inserts a fresh copy somewhere else or overwrites the previous one. So we have unlimited options for driving these genes. That’s one of the great advantages.

It’s possible this strategy won’t work because the parasite will evolve. There’s another thing the gene drives can do: they can alter some of the genes that are important for reproduction in the target organism. These are ideas that Austin Burt originally outlined. And we could potentially use those ideas to suppress the population of mosquitoes to a low enough level that they wouldn’t be able to effectively transmit malaria in an area. And then once the malaria is eradicated because there aren’t enough mosquitoes in high enough densities to carry it, then we can stop and let the mosquitoes come back.

I can just imagine Charles Darwin turning over in his grave…

I think he would love it. Darwin was amazingly prescient. This whole idea of altering traits in the wild — Darwin said, ‘Man selects only for his own good, nature only for the being which she tends.” Natural selection naturally selects for traits that help the organism survive and reproduce, to make the organism better at its job of living. While we breed bulldogs that require birth by C-section to survive, their heads are that large.

The really nice thing is that gene drives can be applied to any disease that’s carried by an insect vector — so malaria, dengue, yellow fever, Lyme, sleeping sickness, the list goes on. And most of those are mosquitoes — not necessarily the same species of mosquitoes.

A couple other potential benefits: A lot of our agriculture depends on herbicides. There are a lot of advances focused on no-till agriculture, which is a lot easier on the topsoil because you have less erosion and keep more nutrients in the soil. But to do that you do need herbicide, and our best herbicide — glyphosate — generally works great, the problem is that a lot of weeds are evolving resistance.

With current technology we can’t do anything about that. We have to develop another herbicide and use that instead. But with a gene drive, we could roll back that mutation to the ancestral version where the weed is still sensitive. We don’t have to alter the crop, we’re just restoring it back to what it was.

Still, wouldn’t this make the GMO opponents protest vehemently?

It’s not a GMO food issue because it’s not in the crop. Essentially, we’re making our chemicals work better, and this applies to organic foods too, which use natural pesticides. The insects and weeds have been evolving resistance to those, too. So this could help organic farmers, too. We don’t have to develop and introduce new chemicals that the weeds don’t have resistance to yet; we can keep using the ones that are tested and maybe even develop chemicals that are totally inert to everything and then gene-drive vulnerability to those chemicals specifically in species. We could potentially have much, much safer pesticides and herbicides. That would require much more research but it’s a great possibility.

We have to emphasize that the gene drive is just the motor that spreads the alteration through the population. The effects are going to depend on what the alteration is and what species we’re spreading it through. So it really doesn’t make sense at all to say, ‘Should we use gene drives?’ because that could mean anything. Rather, we should ask, ‘Is it a good idea to consider driving this particular change though this particular population?’

We’re going to need to ask that question over and over again for each of the possible applications I described, and then whatever else people come up with. So we’ll have to engage over and over again, and each case is going to be unique because the ecosystem that we might be affecting is unique.

But couldn’t people be so scared of something getting loose into our natural populations and being unstoppable because of the power of the gene drive that they say, ‘We’ll put a blanket moratorium on using this technology?’

You certainly could, and if it was everyone in the world, I would agree with that. But I would say we actually have no business whatsoever telling people in Africa who suffer from malaria whether they should use a gene drive. We’re not going to be affected by any of those consequences. Those mosquitoes don’t exist here and any ecosystem ripple effects won’t affect us. We’re not affected by malaria; they are. We’re not going to be affected by the side effects if something happens, they are. That means it’s their decision, not ours.

Ken Oye, how would you sum up the challenge and what do you propose? 

The first issue is: to what extent can we do a preliminary assessment of the implications for environment and for security? The  article we did does a bit of that – we try to work through how gene drives might affect target species and what environmental side effects might emerge. And we examined potential security issues associated with the development of gene drives — uses against humans, against crops, against livestock.

Our preliminary take is that although everyone always says ‘Oh. My. God. People are going to be using gene drives to target ethnic subgroups or modify humans,’ we don’t think that’s viable. Gene drives work over generations, and humans take a long time to reproduce. And with medical sequencing coming in, gene drives would likely be detectable in human populations. So it just isn’t likely to be a big deal as a direct threat to humans.

Let’s flip to animals and crops. You’re talking about shorter reproductive cycles. Much of American agriculture is done with seed produced on seed farms, and much of our livestock is produced with artificial insemination. The artificiality of the way we do our food production, ironically, provides protection against the potential misuse of gene drives. Seed farms can be monitored. Artificial insemination contains or limits the mating choices of animals.

And at the same time — and we wan to underscore that this is potential — there might be potential for misuse against farmers who do not rely on industrial methods of agricultural and livestock production — subsistence farmers, people growing plants in developing countries, or American farmers who do not use typical methods of relying on commercial agriculture. So we are drawing attention to a possibility we think should be analyzed and better understood.

If you look at environmental consequences — this is where we put a lot of our work in that Science article — the potential environmental effects and side effects are extremely complex. Kevin made the point that if you’re evaluating gene drives you have to look at the specific species and the alteration, but I would also highlight context — the ecosystem within which the gene drive is released.

One of our co-authors on this piece is Jim Collins, an evolutionary ecologist and also former head of the biological division of the National Science Foundation. Jim and other evolutionary ecologists bring to the table an understanding of the complexity of natural systems, and that understanding is essential to the evaluation and management of potential ecological implications and effects.

The recommendations we offered in the article were the product of what can only be described as a complex multidisciplinary process. We had in the room synthetic biologists and evolutionary biotech firms and environmental organizations, government regulators and research funders. People actually agreed on important issues. What they agreed on were areas of potential environmental effects; the areas of uncertainty over those effects; the need for publicly funded research to better understand environmental implications, and even the specification of a research agenda to improve our understanding of effects.

Of course, there were disagreements on longstanding controversies such as application of the precautionary principle. But the good news is there was consensus on key areas of uncertainty, the priority areas of research and the need for public funding. The fact that the NSF was sitting in the room and had funded the meeting to discuss research agendas was also encouraging.

It’s quite unusual for a technologist to step forward with a technology at an early stage and invite public discussion. This is quite a novel technology. To have the discussion before rather than after the release, to have broader engagement by larger communities of scientists and publics is something to be commended. Not all scientists would do it.

Readers, thoughts? For further reading:
The New York Times: A Call To Fight Malaria One Mosquito At A Time
The Boston Globe: Harvard Scientists Want Gene Manipulation Debate

Categories: Health Care

The Immodest Scope of Reform Conservatism

Medicare -- New York Times - Fri, 07/18/2014 - 11:31am
On a small movement’s genuinely big ideas.
Categories: Elder, Medicare

State Highlights: Concerns Continue About Coakley-Partners Antitrust Settlement

Kaiser Health News - Fri, 07/18/2014 - 9:55am

A selection of health policy stories from Massachusetts, Oregon, Wisconsin, Maine, New York and Texas.

The Boston Globe: Judge Grants Coakley’s Request For Delay In Partners Antitrust Settlement
Criticism of Attorney General Martha Coakley’s antitrust pact with the state’s largest health care system mounted Thursday as a watchdog panel warned a judge the proposed deal might not meet its goal of holding down medical expenses. But Coakley, a Democratic candidate for governor, signaled she was prepared to toughen the terms of her settlement with Partners HealthCare System. To allow more time to supplement the agreement with findings by the state Health Policy Commission that Partners’ takeover of Hallmark Health could drive up costs, Coakley sought to have a scheduled Aug. 5 hearing on the deal postponed. Suffolk Superior Court Judge Janet L. Sanders agreed and set it for Sept. 29 (Weisman, 7/18).

WBUR: New Concerns About Coakley-Partners Deal
There are new concerns about an agreement Attorney General Martha Coakley negotiated to try and control the prices and market power of Partners HealthCare. The implication, from a commission created to help reduce health spending, is that the deal does not go far enough. “Without lasting change to the market structures,” the Health Policy Commission (HPC) writes in comments to be filed in court, “price caps may not be effective in keeping costs down.” Price caps? The commission dug in on a portion of the deal Coakley reached with Partners — the part that says network prices could not rise faster than inflation for six and a half years (Bebinger, 7/18).

The Wall Street Journal’s Pharmalot: Will Gilead’s Hepatitis C Drug Bust State Budgets?
A new analysis suggests many states may, in fact, be overwhelmed as they attempt to pay for the Solvaldi medication sold by Gilead Sciences, which costs $84,000 for each patient, and several forthcoming treatments that may be priced at a similar level. More than 750,000 Americans with chronic hepatitis C receive health care coverage through Medicaid or the prison system. And in its analysis, Express Scripts, the nation’s largest pharmacy benefits manager, consequently projects that states will collectively spend more than $55.2 billion to provide Sovaldi to all comers (Silverman, 7/17).

The Oregonian: Suspicions, Money Drive Multnomah County's Near Split With Oregon Health Reforms
Emergency rooms flooded with people mentally ill or on drugs. A mental health program poorly managed. Agencies and health systems dumping people's problems on each other to improve bottom lines. Oregon's health reform law, approved with much fanfare and hope in 2012, was supposed to solve problems like these. Instead, Multnomah County, the state's largest, has come to the verge of divorce with the main reform group set up to care for low-income residents in the region, documents and interviews show (Budnick, 7/17).

The Milwaukee Journal Sentinel: Milwaukee Mental Health Board Meets For First Time, Vows Better Care
The new Milwaukee Mental Health Board met for the first time Thursday, vowing to improve care for the more than 13,000 patients who seek help each year through the county's public psychiatric system. The board also indicated it would move to close the county's embattled Mental Health Complex by 2016. "I've been waiting to sit at this table in this situation for a long time," said Milwaukee County Executive Chris Abele, who pushed to strip the County Board of oversight after the Milwaukee Journal Sentinel's "Chronic Crisis" investigation showed how patients continued to die of abuse and neglect as politicians ignored decades of calls for reform (Kissinger, 7/17).

Bangor Daily News: LePage Announces Extra $13.1 Million For Nursing Homes — No Legislature Required
Gov. Paul LePage announced Thursday his administration will use $4.6 million in Medicaid savings to make additional payments to Maine’s 106 nursing homes — and he’ll do it without involving the Legislature. The extra money will draw down federal matching funds of $8.5 million. Combined with state and federal money allocated by the Legislature this spring, Maine’s nursing homes will see a total of $25.4 million in extra revenue this fiscal year (Moretto, 7/17).

Buffalo News: BlueCross BlueShield Withdraws From Medicaid Managed Care Program
Some 53,000 Medicaid recipients in the region, including nearly 29,000 in Erie County, will have to look for new insurance coverage this fall because BlueCross BlueShield of Western New York is withdrawing from the Medicaid managed care program. The insurer, which plans to publicly announce its withdrawal from the program today, informed government officials of the move Thursday in a memo that was obtained by The Buffalo News (Zremski, 7/17).

Kaiser Health News: Capsules: Half Of Texas Abortion Clinics Close Due To State Law
In just over the past year, the number of abortion clinics in Texas fell from 41 to 20, and watchdogs say that as few as six may be left by September. Many of those closed because of the requirement that doctors at those clinics obtain hospital admitting privileges within a certain radius of the clinic, and many doctors couldn’t comply. That requirement began November 1. This week marks the one-year anniversary of the law that started it all (Feibel, 7/17).

Categories: Health Care

SEC Widens Insider Trading Probe

Kaiser Health News - Fri, 07/18/2014 - 9:51am

The Wall Street Journal: SEC Widens Trading Probe to Investment Firms
Federal investigators are examining nearly four dozen hedge funds, asset managers and other investment firms to determine whether they violated insider-trading rules after receiving a tip from a Washington research firm. In a new court filing, the Securities and Exchange Commission said it is looking at 44 investment funds and other entities, including "some of the largest hedge funds and asset management advisors in the nation," as part of its probe into whether anyone broke the law by buying health-insurance stocks in April 2013 ahead of a government announcement that benefited the firm (Mullins and Ackerman, 7/17).

Categories: Health Care

FedEx Indicted On Charges Of Transporting Drugs For Illegal Pharmacies

Kaiser Health News - Fri, 07/18/2014 - 9:51am

A federal grand jury in San Francisco says the shipping company knew it was delivering drugs for illegal online businesses.

Los Angeles Times: Indictment Accuses FedEx Of Moving Drugs For Illegal Online Pharmacies
FedEx conspired to traffic in controlled substances and misbranded prescription medications by helping distribute drugs for illegal Internet pharmacies, an indictment from a federal grand jury in San Francisco alleges. The shipping company knew as early as 2004 that it was delivering drugs to dealers and addicts, Thursday's indictment says (Raab, 7/17).

USA Today: FedEx Charged With Trafficking Drugs For Web Pharmacies
FedEx is facing drug-trafficking charges after a federal grand jury in San Francisco indicted the overnight shipping company, accusing it of conspiring to deliver prescription drugs for illegal Internet pharmacies. The indictment says FedEx knew for a decade that such pharmacies used their services. FedEx took steps to protect its business by setting up special credit policies for Internet pharmacies so it wouldn't lose money if police shut the sites down, the indictment says (Leinwand Leger, 7/17).

Categories: Health Care

Largest U.S. Insurer To Be Major Obamacare Player In 2015

Kaiser Health News - Fri, 07/18/2014 - 9:51am

Insurance giant UnitedHealthcare said Thursday that it would sell policies through online insurance markets in as many as 24 states next year, up from only four this year.

The Associated Press: Largest US Insurer's Move Signals Industry Shift
The nation's largest health insurer expects to play a much bigger role in the health care overhaul next year, as the federal law shifts from raising giant questions for the sector to offering growth opportunities. UnitedHealth Group said Thursday that it will participate in as many as 24 of the law's individual health insurance exchanges in 2015, up from only four this year (Murphy, 7/17).

Kaiser Health News: Capsules: Biggest Insurer Drops Caution, Embraces Obamacare
UnitedHealthcare, the insurance giant that largely sat out the health law's online marketplaces' first year, said Thursday it may sell policies through the exchanges in nearly half the states next year (Hancock, 7/17).

The Wall Street Journal: UnitedHealth Tops Expectations, Raises Outlook
UnitedHealth said it would expand its presence in the health law's marketplaces to "as many as two dozen" states in 2015, when it expects a "better risk vintage"—likely meaning that enrollees won't be so heavily weighted toward those with high-cost medical conditions. The company is in just four states' individual exchanges. The insurer said that despite a smoothed re-enrollment process for those who already have the marketplace plans, it believes current enrollees will still shop around during this fall's open enrollment period, and it also expects to do well among new sign-ups (Calia and Wilde Mathews, 7/17).

Reuters: United Health Plans To Be Major Obamacare Player In 2015
UnitedHealth Group Inc, after wading cautiously into Obamacare insurance exchanges this year, on Thursday vowed to become a major player, participating in as many as two dozen state exchanges in 2015 and growing from there. Shares of the largest U.S. health insurer, which reported sharply higher-than-expected second-quarter results earlier in the day, were up 2.8 percent at $86.14 in afternoon trading after hitting a 52-week high of $87.22. UnitedHealth participates in about a dozen exchanges under the federal Affordable Care Act, President Barack Obama's signature healthcare legislation. The company offers insurance to both individuals and small groups (Pierson, 7/17).

Categories: Health Care

Experts Urge Senate Panel To Increase Hospital Safety Measures

Kaiser Health News - Fri, 07/18/2014 - 9:50am

Consumer advocates and medical specialists tell the committee that patients are not much safer today than they were 15 years ago when a landmark study on medical errors spurred calls for reform.

The Wall Street Journal: Medical Experts Press Lawmakers On Hospital Safety
Medical-quality experts told Senate committee members on Thursday that government action is needed to lower the rate of hospital medical errors and infections, which are believed responsible for an estimated 1,000 or more deaths a day in the U.S. Lisa McGiffert, director of Consumers Union's Safe Patient Project, called on the federal agency that runs Medicare to require the publication of a wide range of hospital-specific infection rates and of medical outcomes such as surgical deaths and complications (Burton, 7/17).

ProPublica: We're Still Not Tracking Patient Harm
The health care community is not doing enough to track and prevent widespread harm to patients, and preventable deaths and injuries in hospitals and other settings will continue unless Congress takes action, medical experts said today on Capitol Hill. Dr. Ashish Jha, a professor at the Harvard School of Public Health, said patients are no better protected now than they were 15 years ago, when a landmark Institute of Medicine report set off alarms about deaths due to medical errors and prompted calls for reform (Allen, 7/17).

Modern Healthcare: Hospital Patients No Safer Today Than 15 Years Ago, Senate Panel Hears
The problem of patients dying or being harmed because of preventable medical errors in U.S. hospitals remains one of grave consequence that is not getting enough attention, according to the chairman of the Senate Subcommittee on Primary Health and Aging, which met Thursday with a panel of patient safety leaders to spotlight the issue. Speakers at the hearing expressed concern that 15 years after the eye-opening Institute of Medicine report "To Err is Human" drew attention to the issue, improvement has been limited, sporadic and inconsistent (Rice, 7/17).

Politico Pro: Experts: Action Needed To Cut Preventable Medical Errors
A national patient safety board, increased monitoring of adverse hospital events, and financial incentives to encourage providers to focus more on medical errors are among the measures needed to finally make progress on hundreds of thousands of patient deaths annually, public health experts said Thursday. Fifteen years after a landmark report called attention to the problem, the experts told a Senate panel that preventable harms continue to exact a tremendous human and financial toll in the United States. The health care system hasn't "moved the needle in any meaningful demonstrable way," and policymakers need to take concrete steps to make a difference, said Ashish Jha, a professor of health policy and management at the Harvard School of Public Health (Villacorta, 7/17).

Categories: Health Care

New York Officials Take Steps In Response To Supreme Court Contraceptive Coverage Decision

Kaiser Health News - Fri, 07/18/2014 - 9:49am

Officials make a change in the state's Medicaid program and legislation is proposed in the state Senate.

The Associated Press: NY’s Medicaid Covering Post-Birth Contraceptives
Emboldened and incensed by the U.S. Supreme Court’s recent decision limiting certain contraceptive coverage in the private sector, New York health officials moved forward Thursday with a plan to provide contraceptive devices to low-income women who don’t want to get pregnant soon after giving birth (7/17).

Bloomberg: New York Officials Want Birth Control Job Coverage Law
New York officials said they’ll propose legislation to blunt the effect of a U.S. Supreme Court decision limiting a requirement that employers provide insurance that covers birth control. New York Attorney General Eric T. Schneiderman and State Senate Democratic Conference Leader Andrea Stewart-Cousins are seeking to require businesses to tell prospective employees about contraception-coverage benefits. The Reproductive Rights Disclosure Act would require employers to give 90 days’ notice before changing coverage. The court in a 5-4 vote ruled last month that family-run businesses including the craft-store chain Hobby Lobby Stores Inc. can claim a religious exemption from the requirement that they include contraceptives in their health-care plans. Such companies are exempt from the contraception requirements of the Affordable Care Act, the court said (Smythe and Klopott, 7/17).

Capital New York: Medicaid Change Allows Reimbursement For I.U.D.s
The state Medicaid program is now reimbursing doctors who implant IUDs after a woman gives birth, city Health Commissioner Dr. Mary Bassett said Thursday. The policy took effect April 1, but city and state officials were looking for ways to publicize the change, which they say could impact thousands of women (Goldberg, 7/17).

Categories: Health Care

VA Request This Week For $17.6B Stalls Congressional Effort To Reform Agency

Kaiser Health News - Fri, 07/18/2014 - 9:48am

Talks between the House and Senate over revamping care for veterans were already difficult but the big spending request complicates the situation.

Politico: VA Request Complicates Reform Push
An unexpected funding request from the Department of Veterans Affairs is complicating negotiations over a bill to reform the embattled agency, Florida Republican Rep. Jeff Miller said on Thursday. On Wednesday, Acting Secretary Sloan Gibson told the Senate Committee on Veterans’ Affairs the department needs $17.6 billion to hire thousands of doctors and reduce wait times at VA facilities (French, 7/17).

Bloomberg: Veterans Health Deal Stalls As Obama Seeks More Spending
Negotiations in Congress over how to finance medical care for U.S. military veterans are stalled although Republicans and Democrats say completing a deal before next month is a top priority. Talks between the House and Senate, already moving slowly, were further disrupted when President Barack Obama’s acting head of the Veterans Affairs Department told lawmakers July 16 the agency needs another 10,000 workers and an additional $17.6 billion through 2017 (Bender, 7/18).

In other VA news -

The Washington Post: VA Uses Patient Privacy To Go After Whistleblowers, Critics Say
Is the Department of Veterans Affairs hiding behind HIPAA to hit federal whistleblowers? HIPAA is the Health Insurance Portability and Accountability Act. It protects the privacy of patients’ health information. It is not meant to be a weapon against federal employees who expose wrongdoing at VA or anywhere else (Davidson, 7/17).

Categories: Health Care

U.S. Territories, Including Puerto Rico, Exempted From Obamacare

Kaiser Health News - Fri, 07/18/2014 - 9:48am

The administration waives the law's requirements for insurers selling policies in the U.S. territories since it does not require residents there to get coverage or provide subsidies. Other stories look at pressure on the administration to issue guidance on the employer mandate and the need to educate newly insured consumers about their coverage.

The Washington Post's Wonkblog: The Administration Just Took Obamacare Away From The Territories
Looking for a place where Obamacare doesn't exist? Try moving to the U.S. Territories, where the Obama administration just provided a pretty big waiver from the law's major coverage provisions. The Affordable Care Act's design dealt a pretty big problem to the territories. It required insurers there to comply with the law's major market reforms — guaranteed coverage, mandated benefits, limits on profits, etc. — without requiring residents to get coverage or providing subsidies to help them afford coverage. The territories — Puerto Rico, the U.S. Virgin Islands, American Samoa, Guam and the Northern Mariana Islands — have been warning for years that would destroy their insurance markets (Millman, 7/17).

The Hill: Pressure Builds On Obama For Decision On Employer Mandate
With the [employer] mandate set to take effect in January, businesses are awaiting final world from the administration on whether they will be required to track and report how many of their employees are receiving coverage. Federal officials are late in delivering the final forms and technical guidance necessary for firms to comply, raising suspicions that the mandate could once again be delayed (Viebeck and Goad, 7/18).

The Washington Post: New Challenge For Obamacare: Enrollees Who Don't Understand Their Insurance
Nine months after Americans began signing up for health insurance under the Affordable Care Act, a challenging new phase is emerging as confused enrollees clamor for help in understanding their coverage. Nonprofit organizations across the country are being swamped by consumers with questions. Many are low-income, have never had insurance and have little knowledge of the health-care system. The rampant confusion poses a potential hurdle for the success of the health law: If many Americans don't understand how health insurance works, that could hurt their ability to use their benefits — or to keep their coverage altogether (Sun, 7/16).

Modern Healthcare: Insurers, Providers May Need to Work Harder To Educate ACA's Newly Covered
Millions of Americans gained health insurance coverage under the Patient Protection and Affordable Care Act this year, but the influx apparently has not yet translated into patients packing doctors' offices. That may reflect a lack of understanding about how and where to seek care—and a lack of outreach by their new plans and providers.  "If coverage expansion is allowing patients to establish new relationships with physicians, we would expect to see physicians devote a greater share of their calendars and work effort to caring for new patients," wrote the authors of a report released this week by the Robert Wood Johnson Foundation and Athenahealth, a company that sells cloud-based health information and practice management technology. But that is not what they found. Though it may seem counterintuitive, the organizations discovered that during the first five months of 2014, all specialties—with the exception of pediatrics—experienced lower rates of new-patient visits than they had in the year-ago period (Landen, 7/17).

Meanwhile, an analysis looks at the impact on Florida should a legal challenge to the law's insurance subsidies in federal markets prevail -

Health News Florida: $4.8B In Florida Subsidies At Stake
A court case challenging the Affordable Care Act's subsidies for plans sold on the federal marketplace could have an outsize effect on Florida, according to a new analysis. A ruling is expected any day on Halbig v Burwell from a three-judge panel of the U.S. Court of Appeals in Washington, D.C. If the government loses and further legal maneuvers fail, the 34 states that rely on the federal exchange would see a $36-billion loss of subsidies, three Urban Institute researchers project. The effects in Florida would be huge, says the study, sponsored by the Robert Wood Johnson Foundation and released on Thursday.  Here, 931,000 people would lose a total of $4.8 billion in subsidies for health insurance. The researchers say most of those people would find premiums unaffordable without subsidies and would become uninsured. That would lead to a collapse of the federal marketplace (Gentry, 7/17).

And in health law news from Capitol Hill -

Politico: Democrats Seek Cost Estimate Of Barack Obama Suit
Democrats on the House committee tasked with overseeing a Republican lawsuit against President Barack Obama are asking the panel’s chairman to detail how much the suit will cost. The four Democrats on the Rules Committee, led by New York Democrat Louise Slaughter, sent a letter on Thursday to Committee Chairman Pete Sessions (R-Texas) asking for the total expected bill for the lawsuit and how the House plans to pay for the cost (French, 7/17).

Categories: Health Care

Help Wanted: CMS Begins Search For Healthcare.gov Contractor

Kaiser Health News - Fri, 07/18/2014 - 9:48am

The Centers for Medicare & Medicaid Services released an 84-page solicitation this week seeking a company to oversee the operations of the troubled health exchange website.  

Modern Healthcare: HealthCare.Gov IT Contract: Any Takers?
The CMS is officially kicking off its search to determine which company will serve as the technology vendor for HealthCare.gov, while saying the search does not indicate dissatisfaction with Accenture, which currently holds the contract. On Wednesday, the CMS released an 84-page solicitation (PDF) saying it is seeking a contractor "capable of working under aggressive time constraints" to successfully fulfill the requirements of the scope of work. These duties include providing analysis, design, development, testing, implementation, documentation, services, maintenance and support for the federal exchange (Dickson, 7/17).

In addition, here's a collection of recent state health exchange and insurance rate developments -

Seattle Times: Lawmakers Quiz Health Insurance Exchange On Glitches, Budget
Lawmakers grilled officials from Washington’s Health Benefit Exchange Thursday, making it clear they’ve heard plenty from constituents who say they’ve paid their premiums but still don’t have health coverage — in most cases because premiums, which they paid to the exchange, aren’t getting to the insurer. The lawmakers’ tales of patient woe were backed up by brokers, a representative of the state’s doctors and Len Sorrin, representing Premera Blue Cross, whose company received the lion’s share of enrollments on the exchange. Sean Graham of the Washington State Medical Association noted the effect of such problems on doctors and other providers, as well. One doctor checked a patient’s coverage, performed surgery, and then was told the patient didn’t actually have coverage. As a result, the patient received a $13,000 bill, he said (Ostrom, 7/17).

The Associated Press: Health Insurance Commissioner OKs 2015 Premiums
Rhode Island's health insurance commissioner announced premium rates for 2015 that include single-digit increases for most insurers and a decrease for one. Commissioner Kathleen Hittner announced the rates Thursday. Some carriers had sought larger increases. …  Hittner noted there will be increased competition and more plan choice next year in the individual market, in part because of the efforts of the state-run health benefits marketplace, HealthSource RI. The marketplaces are a centerpiece of the Obama administration's health care overhaul (Niedowski, 7/17).

Fox News: Connecticut’s Exchange Director Defends Glitches, Fix to Come Friday
Even Access Health, Connecticut’s state-based health insurance exchange that is touted as one of the best in the country, can’t escape the case of the ‘glitch.’ State officials say software coding issues led to coverage problems and payment confusion among enrollees, and will be updated by Friday. The problem was first noticed in early May (Rogers, 7/17).

The Star Tribune: UnitedHealth Will Ramp Up Offerings To State Exchanges
UnitedHealth Group Inc. will double its participation in state-run insurance exchanges over the next year, executives said Thursday, a step by the nation’s biggest insurer that signifies the staying power of new marketplaces that arrived under the federal health care law. The announcement, which came along with quarterly results that surpassed investor expectations and pushed the firm’s stock to an intraday record, added new details to UnitedHealth’s slow but steady adjustment to the Affordable Care Act. The exchanges that debuted last fall on the federal level and in several states like Minnesota are “going to be an established sector in the health care benefits marketplace,” UnitedHealth Chief Executive Stephen Hemsley said in a conference call with investment analysts (Ramstad, 7/17).

And on the Medicaid expansion front -

The California Health Report: State Agency Running Medi-Cal Didn’t Know How Many Docs Took Its Insurance
The California agency that oversees the state’s low-income health plan vastly overstated the number of doctors who accepted patients through the state program last year, even as the number of people enrolled in the program was set to skyrocket under the federal Affordable Care Act, the California Health Report has found. The state’s Medi-Cal provider list had more physicians than were even licensed to practice in California last year. The list had some duplicated names and may have also included doctors who were deceased or retired, Department of Health Care Services spokesman Anthony Cava conceded Tuesday (Guzik, 7/17).

Categories: Health Care

Viewpoints: Democrats' Hypocrisy On Suing Presidents; What's Slowing Health Care Costs?

Kaiser Health News - Fri, 07/18/2014 - 9:47am

The Wall Street Journal: The Boehner-Bashers' Track Record
In the tiny House Rules Committee room in Congress on Wednesday, New York Democrat Louise Slaughter let roll her grievances against House Republicans' lawsuit against Barack Obama. It took a lot of coffee. The suit, which sues the president for unilaterally changing a core provision of ObamaCare, is a "political stunt," declared Ms. Slaughter. Republicans have "timed" it to "peak . . . right as the midterm elections are happening," said the ranking Rules member. ... it seems to have slipped Ms. Slaughter's mind—and the press's attention—that a mere eight years ago she was a plaintiff in a lawsuit filed by congressional Democrats against George W. Bush. The year was 2006, just as Democrats were, uh, peaking in their campaign to take back the House (Kimberley A. Strassel, 7/17). 

The Washington Post's PostPartisan: On Obamacare Lawsuit, Boehner Should Listen To Justice Scalia
Dana Milbank does his usual masterful job highlighting the ridiculousness of yesterday’s House Rules Committee hearing on Speaker John Boehner’s resolution seeking authorization to sue President Obama for allegedly failing to follow the Constitution in delaying the employer mandate of the health-care law. Milbank called it "an amateur hour — or an amateur five hours." Yet, in that mess of a hearing came expert arguments against Boehner’s folly (Jonathan Capehart, 7/17). 

USA Today: With Healthcare, If We Waste Less, We Pay Less
Study after study tells us that we pay too much for health care in the United States, and we're no healthier than the people in nations that spend much less. A 2012 Institute of Medicine report on health care spending in 2009 estimated that of the $2.7 trillion national [spending] on health care that year, 30% — or $810 billion — was wasted on unnecessary services, inefficient service delivery, fraud and abuse, predatory pricing and excessive administrative costs (Mark T. Bertolini, 7/17). 

Bloomberg: Obamacare Isn't What's Slowing Costs
If health-care cost growth is slowing down because we're working a lot of inefficiency out of the system, then the slowdown is obviously a big win for everyone except health-care providers and their shareholders. This explanation is a big favorite with the Barack Obama administration, which likes to credit the Affordable Care Act and related policies for the slowdown. But health-care cost growth might be slowing down for other reasons. Innovation might be slowing down, in which case we’ve got good news and bad news. The good news is that we’ll be spending less on health care in the future. The bad news is that we won’t be getting so much in the way of new treatments. Or the slowdown in cost growth might reflect broader growth trends in the economy (Megan McArdle, 7/17).

Raleigh News & Observer: Lawmakers Confused About Medicaid Reform Should Hold Off On Changes
Trying to engage in a major overhaul of a huge government program such as Medicaid is, to quote an old song, like changing a flat in a hurricane. Even many of the Republican legislators in the General Assembly who are working on Medicaid reform don’t seem to understand what it is they’re trying to do. ... But North Carolina’s Medicaid cost-per-person has declined at a time when that figure is going up nationally. And the state has a larger percentage of providers willing to serve Medicaid patients than in other states. ... For all the confusion about Medicaid reform, one thing is certain: Trying to change it at a point in the legislative short session when members are weary and ready to go home – and with a legislature dominated by Republicans who have never taken on a task as big as this one – is unwise (7/17).

The New York Times' Fixes: When Poverty Makes You Sick, A Lawyer Can Be The Cure
By early summer 2010, the temperature had already reached 100 degrees in Cincinnati. At Cincinnati Children’s Hospital Medical Center, doctors were urging the families of children with asthma to use air-conditioning. One mother handed a piece of paper to her doctor: The child's room did have a window unit, and she was using it. But then the landlord responded — he apparently didn’t want to pay the electric bills. Use that air-conditioner, the letter said, and you will be evicted. A concerned doctor might have tried to call the landlord to fight the notice. Or, she might have handed the letter over to a social worker. But Cincinnati Children's had something better — it had lawyers. In 2008, the hospital and the Legal Aid Society of Greater Cincinnati set up a medical-legal partnership, the Cincinnati Child Health-Law Partnership or Child HeLP (Tina Rosenberg, 7/17). 

Journal of the American Medical Association: New Opportunities In The Changing Landscape Of Prevention
Low levels of investment in prevention research and development represent a missed opportunity to further scientific knowledge and improve population health. It results in fewer career opportunities for prevention scientists and less research output on the cost-effectiveness of disease prevention compared with new treatments and drug therapies. This lack of evidence about the effectiveness of prevention has led the CBO to question its value, with far-reaching consequences to federal funding decisions. The dominant voices within many sectors of medicine call for better treatments at the expense of greater knowledge and implementation of effective prevention and health promotion strategies (Derek Yach and Chris Calitz, 7/17).

Categories: Health Care

Companies Dropping Birth Control Coverage Must Tell Workers

Kaiser Health News - Fri, 07/18/2014 - 9:46am

Closely held companies that drop insurance coverage of birth control for religious reasons have 60 days to inform their employees, the administration said Thursday. The rule follows the Supreme Court's decision allowing some companies to opt out of the federal health law's mandate.

The Wall Street Journal’s Law Blog: Health Plans Must Disclose Changes To Contraceptive Coverage
The Obama administration said Thursday that employers that stop covering contraceptives in workers’ health plans must disclose the change to beneficiaries in the wake of a Supreme Court ruling. The requirement notice that appeared online follows the Supreme Court’s late-June Hobby Lobby decision, which allows some closely held companies to opt out the federal law’s contraceptive coverage requirements on religious grounds. It appeared on a Department of Labor website of frequently asked questions about the Affordable Care Act, which mandates contraception coverage (Armour, 7/17).

Bloomberg: Companies Dropping Birth Control Have To Alert Workers
Closely held companies that decide to drop insurance coverage of birth control for religious reasons have 60 days to tell their employees after they end the benefits, the Obama administration said today. The Supreme Court ruled last month that the U.S. can’t force non-publicly traded companies to cover contraception under the Patient Protection and Affordable Care Act. A 1993 law protecting religious freedom applies to companies whose owners oppose contraception such as intra-uterine devices or the so-called morning after pill, the court said. New rules posted today by the U.S. departments of Health, Labor and the Treasury are the first regulatory response to the decision from the court. The document orders companies to give employees a summary of any changes to their health benefits (Wayne, 7/17).

Categories: Health Care

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