Category: Health Policy

GOP Bill Halts in Senate

Remember back in May when the GOP health bill passed in the House? The momentum stopped there.
The Senate failed to pass a GOP-proposed Health Law yesterday. Senate Majority Leader Mitch McConnell says they’re going to try again early next week, though it doesn’t seem like this will be a promising attempt either. Analysts attribute this to many deep-rooted factors:  the Republican party as a whole not unified behind an action plan other than repealing the ACA, the taking away of funding and resources without a viable exchange, and a severe lack of public hearings and drafting.
Provisions included in a draft of the bill last week including capping funding for Medicaid, and giving states the power to opt out of insurance regulations substantiated in the Affordable Care Act. This fielded much opposition from more moderate Republicans. They cite problems  such as too “deep cuts” to Medicaid, and an insufficient means to account for the expenses of changing the insurance system. This opposition was especially strong in Republican states like Ohio that had expanded Medicaid under the ACA.
Now, Republican Senators are working on re-drafting a “repeal and delay” bill that would phase out aspects of the ACA over a two year time frame–a version of this bill passed in 2015. Of note, the draft of this bill to be debated does not include an amendment proposed by Senator Ted Cruz. According to a report conducted by the Department of Health and Human Services, this amendment might actually result in broader coverage and lower premiums. The quality and correctness of this report is already under great criticism by healthcare and insurance analysts.
Sources: The New York Times, Kaiser Health News

Public Health Selling Souls to the Devil

By: Shauna Ayres MPH: Health Behavior candidate 2017

Today, approximately 2/3 of adults and 1/3 of children in the United States are overweight or obese (Odgen, 2012; Flegal, 2012). It is estimated that the country spends upwards of $190 billion per year treating obesity-related health conditions (Cawley, 2012). This trend is associated with the increase in marketing expenditures ($3.2 billion for carbonated beverages in 2006) and consequently the rise in consumption (US FTC, 2008). Americans are exposed to hundreds of ads each year; however, beverage companies adamantly deny their products and/or marketing tactics are correlated with the current obesity epidemic (HSPH, 2012).

Unfortunately, a study conducted by Daniel Aaron and Michael Siegal out of Boston University found that public health organizations may be enabling beverage companies to continue these detrimental business strategies. Aaron and Siegal discovered that 96 national health organizations accepted money from Coca-Cola and Pepsi and ironically included diabetes organizations such as the American Diabetes Association and the Juvenile Diabetes Research Foundation. Siegel and Aaron note that beverage companies “primary interest[s] [are] of improving profit, at the expense of public health.” It is demonstrated in the numbers. Between 2011 and 2014, the Coca-Cola Company spent more than $6 million annually, on average, on lobbying, while PepsiCo spent more than $3 million a year against 28 bills that established a soda tax or implemented advertising restrictions. Whereas the American Beverage Association spent a little more than $1 million a year (Aaron & Siegal, 2016). This hardly seems like a fair fight.

Siegel equates beverage companies to alcohol and tobacco companies and points out that “corporate philanthropy” is merely a “marketing tool that can be used to silence health organizations that might otherwise lobby and support public health measures against these industries.” The study recommends that health organizations reject sponsorship offers from soda companies and find alternative sources of funding (Aaron & Siegal, 2016; Chedekel, 2016).

Resources:

Aaron, D.G. & Siegal, M.B (2016). Sponsorship of national health organizations by two major soda companies. Am J Prev Med. http://www.ajpmonline.org/article/S0749-3797(16)30331-2/pdf

Cawley, J. & Meyerhoefer, C. (2012). The medical care costs of obesity: an instrumental variables approach. J Health Econ. 31(1):219- 230.

Chedekel, L. (2016). How health groups unwittingly help coca-cola and pepsico. Futurity. http://www.futurity.org/coca-cola-pepsi-lobbying-1272392-2/

Flegal, K.M., Carroll, M.D., Kit, B.K., & Ogden, C,L. (2012). Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA. 307(5):491-497.

Harvard T.H. Chan School of Public Health (HSPH) (2012). Fact Sheet: Sugary drinks and obesity fact sheet. The Nutrition Source. https://cdn1.sph.harvard.edu/wp-content/uploads/sites/30/2012/10/sugary-drinks-and-obesity-fact-sheet-june-2012-the-nutrition-source.pdf

Ogden, C.L., Carroll, M.D., Kit, B.K., & Flegal, K.M. (2012). Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010. JAMA. 307(5):483-490. US FTC, 2008

Corporate Integrity Agreements

Throughout the summer I’ve dedicated several posts to the ways that medical and pharmaceutical publishing should be ethically conducted, according to established requirements and guidelines.

However, I’m sure it comes as no surprise that pharmaceutical companies have consistently failed to play by these rules. Headlines such as “GlaxoSmithKline to Plead Guilty and Pay $3 Billion to Resolve Fraud Allegations and Failure to Report Safety Data,” and “Bristol-Myers Squibb to Pay More Than $515 million to Resolve Illegal Drug Marketing and Pricing Allegations,” are proof that these companies are not always committed to high ethical standards of practice.

Although industry standards such as the ICMJE and GPP3 guidelines are almost universally accepted, they are not laws and are therefore not usually enforceable.

However, when pharmaceutical and biotech companies fall under Federal investigation, the Office of the Inspector General (OIG) can make them agree to abide by a Corporate Integrity Agreement (CIA) as part of their legal settlement.

These CIAs legally obligate companies to abide by many of the tenets of the previously mentioned guidelines and ensure ethical practice by imposing requirements such as:

  • hiring a compliance officer/appointing a compliance committee
  • developing written standards and policies
  • implementing a comprehensive employee training program
  • retaining an independent review organization (IRO) to conduct annual reviews
  • restricting employment of ineligible persons (people who have been flagged for unethical behavior)
  • providing an implementation report and annual reports to OIG on the status of compliance activities

If a company is non-compliant with their CIA, they risk having their product pulled from the list of products that can be reimbursed through Federal health care programs such as Medicare and Medicaid. This loss would be a crippling financial hit to most companies, making compliance with these agreements a high priority.
In this way, the industry can be kept in check and forced to behave in a more ethical manner.

Considerations for Ethical Research and Medical Publishing: Part II

Last week I touched on the way in which pharmaceutical marketing and research activities are separated to decrease the chance of bias or unethical practices in medical research. Today I want to briefly introduce some other guidelines that exist to regulate and guide medical research and publishing.

The International Committee of Medical Journal Editors (ICMJE) is one of the leaders in establishing guidelines and recommendations for ethical medical research practices, including both the way the research is conducted, as well as the way in which the results are reported and published. Major medical journals, such as JAMA, the New England Journal of Medicine, the British Medical Journal, and more, require that studies published in their journals abide by these ethical guidelines.

Contrary to what had previously occurred throughout the history of medical research and publishing, individuals and organizations that conduct medical research are now obligated to publish all of their results (even if they’re negative). This newer industry norm was implemented in response to critiques of companies who selectively published only the studies or trials that showed their product in a positive light, a practice that is now considered biased, misleading, and incredibly unethical.

Anti-bribery statutes and requirements to disclose payments and other transfers of value from industry to health care providers, as well as the required disclosure by all authors of their potential conflicts of interest, such as being employed by the pharmaceutical industry or being in some other position to gain financially from the success or sale of a drug, are additional safeguards against biased and unethical practices.

 

For more information about the guidelines and recommendations guiding medical research and publishing, check out these resources:

The War on Condoms in the Porn Industry

Last week, a California safety board rejected a proposed regulation that would have required porn actors to wear condoms, after only three members of the board voted in favor of the law (four votes were needed for it to pass).

Prior to the vote, industry officials and actors pleaded to the board to reject the regulation, arguing that passing it would either destroy or drive the industry underground. They also argued that pulling the industry underground would essentially eliminate the industry’s own requirement of actors being tested for STDs, putting actors safety at a greater risk.

However, the issue still remains a timely public health concern, especially because a recent CDC report found a porn actor likely infected another performer with HIV while having condom-less sex on a gay porn set, proving that testing alone is inadequate for preventing the spread of STDs.

Because of this, the panel that voted on the regulation is now considering a new worker-safety measure for the porn industry, but the push back from the industry has helped this be an easy task.

What are your thoughts about the regulation? Do you think the two industries can work together to find a happy medium, or is the required use of condoms the only solution?

What’s NC Doing to Prevent Zika?

As Americans grow increasingly concerned about the threat of the Zika virus, it’s important to know what measures are being taken in North Carolina to prevent its spread locally.

Although there have been travel-associated cases in the U.S., the Centers for Disease Control and Prevention (CDC) has found no reported mosquito-borne cases, and state departments of public health nationwide are doing what they can to ensure the virus is kept at bay.

However, those efforts are being challenged in North Carolina. The first step in controlling the spread of Zika is to control the mosquito population, but since 2010, budget shortfalls in North Carolina have resulted in limited funding allotted to mosquito surveillance. Formerly, money was appropriated to localities to control mosquitos, but that money is no longer available. Funding for local governments through control grants was eliminated in 2014.

And while little attention was placed on such cutbacks in the past, the recent threat of Zika has caused some N.C. lawmakers to emphasize the need to restructure the state’s budget to allow funding for more consistent mosquito control. Although reports have shown the virus can be transmitted through sexual contact, mosquitos are thought to be the primary means of transmission.

The state’s most common mosquito — known as a “backyard breeder,” isn’t thought to be susceptible to wide-area spraying programs, making this form of eradication an unlikely option for successfully ridding the state of mosquitos carrying Zika. Epidemiologists say the best solution is to call in experts well versed in the mosquito life cycle, as they would have the ability to properly identify problematic mosquitos and have the best solution for eradicating them.

Viruses like Zika can be particularly alarming since its symptoms aren’t usually apparent in those who contract it. However, the virus has been liked to several cases of microcephaly, a condition where babies are born with smaller-than-average heads. The virus has also been linked to babies suffering from brain damage. The state’s most recent data shows there are around 140,000 N.C. women who are currently pregnant, implying the need to increase prevention efforts, particularly before the summer months — when mosquitos are most rampant in the state.

While funding for mosquito control remains unclear — the legislature won’t reconvene until April 25 — the state is ramping up its ability to test for the virus and is providing education materials to distribute to women who currently are and are planning to become pregnant.

 

Photo credit: University of Washington

Interactive map of vaccine exemptions in the United States

Vaccine

GUEST BLOGGER: Sophia Bernazzani

You may not think about vaccines when they are booking domestic travel within the United States, but it’s worth considering, because each state has a different set of exemptions to vaccines to be aware of. Nursing@Simmons created an interactive map of vaccination exemptions by state to illustrate how these differences in policies can impact public health.

Although they differ throughout the United States, vaccination exemptions can include those related to medical, religious and philosophical reasons.

  1. Medical exemption: An MD or doctor of osteopathy (DO) is usually required to write a medical exemption, but in some states, other health care workers are able to certify that one is needed.
  2. Religious exemption: This exemption is based on First Amendment rights for religious freedom, but can be withdrawn if the state can provide a compelling reason for doing so.
  3. Philosophical, conscientious or personal exemption: This is a blanket exemption, and must include all vaccines. In some states, collaboration with a health care professional is required—as well as the completion of a vaccine education program.

Only three states restrict exemptions to medical reasons alone: West Virginia, Mississippi and most recently, California.

Why do vaccination exemptions matter?

The differences among state-by-state vaccination requirements potentially increase risk to both individual and public health. The CDC states that there is evidence that increased incidence of vaccine-preventable diseases (VPDs) may be connected to higher rates of nonmedical exemptions. Furthermore, philosophical and personal exemptions often happen in specific pockets of the country, which puts people in those areas at greater risk of contracting VPDs, like pertussis and measles. These VPDs can represent a tremendous health risk for anyone who is not vaccinated, particularly infants, young children, and frail, older adults.

VPDs have been declared eradicated in the United States, but there are occasionally small outbreaks of certain diseases, such as what happened with the measles in Disneyland in 2014. Vaccine awareness when planning domestic travel is just one more reason to gain greater understanding of state-based exemptions and how they may impact both your health and that of your family members.

The Costs and Benefits of Full-Time Employment: ACA Challenges

As the enrollment deadline for health coverage through the Affordable Care Act (ACA) has recently passed, more Americans will be eligible to receive heath care that is affordable and consistent, regardless of their pre-existing conditions. Obviously, this is a plus for many on the consumer side of the spectrum, but what does it mean for struggling employers now having to pay more to offer coverage to more of their workers?

The beginning of 2016 marked an ACA requirement that all employers with 50 or more full-time workers offer health coverage, or otherwise pay a steep penalty. In some cases, this has had unintended consequences, forcing employers to downsize, to both cut health costs and/or avoid the requirement altogether.

Some smaller employers are learning the hard way and are making staffing adjustments just to stay afloat. This is especially the case among the fast food industry, where most employers have decided to avoid the steep ACA penalty by making more of their workers part-time, precluding these employees from the option of employer-based coverage. Obviously, this isn’t doing any favors for the employees, so is cutting corners like this really worth it?

Another aspect of this situation is that when employers decide to make more workers part-time, the more workers they have to hire to do the job. As a result, there are usually scheduling headaches and frequent turnover, and as a result, many managers and business owners complain the quality of their establishments has declined.

And this makes sense. If workers who are already earning minimum wage aren’t going to be rewarded in other ways for their work, what incentive do they have to remain loyal to their employer? With less loyalty come fewer skills. It’s a problem that is unfortunately on the rise as ACA mandates — although intended to support the consumer, actually end up not only being ineffective to the employee, but also hurting the employer as well.

In the end, in many cases, the workers end up paying the most severe penalty. Workers who desire to work more hours — to be full-time — yet can’t because their employer can’t afford it. And, as a result of the workforce being flooded with part-time workers, some areas are seeing an increase in their numbers of Medicaid recipients. For many, there is nowhere else to turn, despite their desire to be independent. And for others, they say they come out better by working part-time and receiving health coverage through the state.

So, what do you think? Do you think Obamacare is fulfilling its promise to make Americans safer and more secure through health coverage, or have the unintended consequences caused more problems?

 

Photo credit: Bloomberg News

Wellness in the Workplace: Opportunity or Obligation?

Less than one semester stands between some students and their entry into the professional workforce. For many of these students, the job hunt has already begun. While most people are researching the usual aspects of a position such as the salary, benefits, and time off when considering different employers and offers, a company’s insurance enrollment requirements and wellness programs may also be worth asking about.

Wellness programs are theoretically a win-win situation- employees have the opportunity to access resources to improve their health and take more control in managing or improving chronic health conditions, and with healthier employees, employers are able to lower their costs for both insurance premiums and money lost due to sick days and other productivity losses due to health reasons.

The problem occurs when wellness programs and health screenings come with penalties for opting out, rather than incentives for participating. These compliance penalties are legal under the Affordable Care Act and have been upheld in court, however, they have not been met with unanimous support, especially considering the health information privacy issues and ethical implications of these coercive strategies for employee compliance.

Employee wellness programs are typically positive opportunities, however, it’s good for both employers and employees to be aware of the potential drawbacks and continue to work toward collaborative solutions to control healthcare costs and to create a positive culture of health in the workplace.

For a more in-depth discussion of the debate surrounding employee wellness programs, check out this week’s article in the New York Times.

Changing Our Thinking: Quality Over Quantity for a Better Health System

For many of us covered by a health insurance plan, the thought of how much we spend on the services we receive — whether it’s a routine procedure, such as a mammogram, or a monthly medication for anxiety — is unlikely to cross our minds. The most we might think about the cost incurred lies with our copay, the reduced amount we pay for the service we utilize under our plan. Copays can vary—from $10 to $45—depending on the type of service used.

But what about the actual cost of those services and medications? What does a mammogram really cost? Surely 30 tabs of a common antidepressant don’t cost just $45. Folks without insurance might be more aware of the realities of this, although they are less likely to obtain these types of services and medications for that very reason alone — cost.

While the average cost of a mammogram is around $100, the cost of other preventative services, such as a colonoscopy, can cost upwards of around $5,000. Medicare recipients usually don’t have to feel the sting of such a bill since they’re likely to also receive a special type of coverage called Medigap, which pays for the services Medicare doesn’t cover.

But does that mean we still shouldn’t be concerned with keeping our healthcare expenditures at a minimum or is the sky the limit? And even if you are concerned, will your doctor know how much things cost before you choose to undergo them? Most physicians say they know very little about medical pricing since they received very little or no formal training at all regarding healthcare spending or cost-effectiveness when it comes to tests and treatments.

Instead, most providers were taught the American rationale of healthcare — to focus on the best treatment they can offer, regardless of the cost. But in a world where many individuals are no longer able to afford insurance coverage due to ever-rising expenditures, should our nation continue with this way of thinking? Or should we become more mindful of costs, even if we aren’t the ones bearing the burden of them?

Fortunately, the Affordable Care Act is bringing attention to the long overdue subject, forcing medical equipment companies and the pharmaceutical industry — known as Big Pharma — to take a hit through higher taxes. Those dollars are now being shifted to help fund many new enrollees to receive the coverage they need to remain healthy.

But as more people enroll, will they, too, become less likely to bear in mind the cost that remains for the services they receive? Unfortunately, for those physicians who are interested in helping their patients make informed decisions, there isn’t much help available; however, smartphones have made obtaining this knowledge easier, through apps that link to health insurers’ price databases.

But the question still remains — “Will knowing the price of a colonoscopy have any affect on those that are considering one?” Of course, I’m by no means suggesting patients and providers forego services if they are truly needed, as in cases where there’s a family history or pre-existing conditions occur. But I would like to see more concern placed on the quality of care providers give and patients receive. Making the patient more a part of his/her health plan is key to garnering an interest in what services cost and whether or not they are truly needed.

Perhaps as the ACA makes it’s way into history books and more folks get insured, we’ll see a shift in priorities, with a stronger emphasis on quality care at reduced cost, for that’s the only way we’ll truly begin to see equality for all in the game of the healthcare sector.