Roll Call: Latest News on Capitol Hill, Congress, Politics and Elections
October 21, 2014

October 20, 2014

UN Ebola Response Trust Fund Struggles to Turn Pledges into Cash

The United Nations has set up a special trust fund to assist efforts to combat the spread of the Ebola virus in West Africa. However, the response from UN member nations has not overwhelmed the trust fund’s accountants. The UN announced the nearly $1 billion effort in September and Reuters reports that $365 million has been pledged to the fund. However, countries have not been quick to redeem pledges with immediate cash contributions. Colombia led the way with a $100,000 check. On Friday Australia deposited $8.7 million. Even if outstanding current pledges from Venezuela, Chile, Estonia, Finland, India, Kazakhstan, New Zealand, Norway and Romania are received before the end of the month, the fund will still substantially miss its initial $100 million October target.




This Week: Another Committee Hearing on Ebola; Groups Examine Improvements to the Delivery of Health Care

Congressional committees are quickly mobilizing to examine the response effort to combat the spread of the Ebola virus. This week, the House Oversight and Government Reform Committee on Friday takes its turn in quizzing federal health officials. A House panel started the push for hearings in a session last week. Meanwhile, the Aspen Institute today examines leadership of the effort to combat the Ebola virus in West Africa. On Tuesday, a foreign policy group conference call mulls the international implications of the pandemic in Africa. On Wednesday, the retiring House Democratic dean of health care topics, California Rep. Henry A. Waxman discusses national and global health care challenges in a Georgetown University lecture

Overhauling the Delivery of Care

A forum today examines current training and certification standards, best practices and challenges for community health workers. A video of the session will be posted after the discussion. Also, the Brookings Institution will broadcast a half-day forum examining the latest results of accountable care organizations (ACO) efforts to overhaul the delivery of health care. The ACO’s are empowered by the Affordable Care Act to change the method of care delivery with an eye toward reducing health care costs. Also this week, a Capitol Hill conference features prominent health group leaders addressing how hospitals and health systems can foster improvements in delivering health care services. Meanwhile, IBM hosts a conference this week in Arlington, Virginia exhibiting new approaches to delivering health and social programs and the U.S. Chamber of Commerce weighs in with a conference on Wednesday on how the private sector can drive improvements to the health care delivery system


October 17, 2014

Advocates and Chefs Judge Congress on Food Policy

Celebrity chefs might be more accustomed to judging food dishes, but on Thursday they teamed up with farm advocates and policy makers to offer their ratings on something people haven’t always found palatable – Congress.

“Top Chef” head judge Tom Colicchio and Environmental Working Group President Ken Cook – who spearhead the nonprofit organization Food Policy Action – released their third annual National Food Policy Scorecard, which grades lawmakers based on key food and farm bill votes determined by an advisory board. The event took place at Graffiato restaurant in Washington, D.C., where guests could nosh on pizza and other Italian-inspired bites from fellow “Top Chef” alum Mike Isabella.

“Most people don’t connect the dots between what you put on the table and what goes on in Washington,” Colicchio said.

tom 240x320 Advocates and Chefs Judge Congress on Food Policy

Members were judged on their support for a variety of bills and amendments, ranging from sustainable farming and food subsidizes to labeling requirements and safety regulations.

A total of 71 lawmakers from both the House and Senate received perfect scores. All of them were Democrats, with the exception of Independent Sen. Angus King of Maine and Republican Sen. Lisa Murkowski of Alaska. One of the lowest rated Democrats was Collin C. Peterson of Minnesota, who is ranking member of the House Agriculture Committee and got a grade of 39 percent. Seven other Democrats received scores under 50 percent.

Meanwhile, 35 lawmakers – all Republicans – received scores of zero, which the group labels as “food policy failures.”  But not all from the GOP missed the mark. In addition to Murkowski’s perfect score, Sen. Susan Collins of Maine got a 75 percent rating, followed by Republican Rep. Christopher H. Smith of New Jersey with 61 percent.

fork 240x264 Advocates and Chefs Judge Congress on Food Policy

Colicchio noted that they had already received a range of positive and negative calls from lawmaker’s offices since releasing the scorecard on Capitol Hill that morning. “People are starting to take notice,” Colicchio said, adding “We’re not going away.”

CDC Tallies Vaccination Rates for Children in Kindergarten

The Centers for Disease Control and Prevention today issued its annual assessment of vaccination rates for children in kindergarten programs. The agency reviewed state data and reported that median vaccination coverage for the 2013-2014 school year was 94.7 percent for the measles, mumps, and rubella vaccine and 95.0 percent for the diphtheria, tetanus toxoid, and acellular pertussis vaccine. The overall rates are inline with the 95% national vaccination objective. However, many states allow varying levels of exemptions from vaccination due to religious or personal objections. The report records the median national vaccination exemption rate at 1.8 percent. The CDC noted that a high exemption level and failure to maintain vaccination targets could leave children vulnerable to vaccine-preventable diseases.


This Week: Congress Focuses on a Travel Ban and Ebola Response Funding

Lawmakers this week escalated calls for a travel ban for people coming from Ebola-ravaged West African countries. The pleas for travel restrictions culminated at a special recess House subcommittee hearing on Thursday (view C-SPAN video), where lawmakers grilled federal health and border control officials about their recent actions and missteps in managing the response to the first U.S. Ebola case. Republican members are leading the charge for a travel ban – or imposing restrictions on visas –but some Democrats have also endorsed the idea.

However, Centers for Disease Control and Prevention Director Thomas Frieden continued to insist this week that restrictions would only encourage people to avoid regular travel channels and limit governments’ ability to track those who have been exposed to the virus. The Economist, in an opinion that coincided with its cover article on Ebola published today, echoed the same reasoning for avoiding travel restrictions. President Obama told reporters at the White House on Thursday that he does not have a “philosophical objection” to a travel ban but is relying on advice from infectious disease experts, who say the current screening process is the best approach to managing potentially infected travelers.

Meanwhile, a separate congressional battle is brewing over added Ebola response funding for the CDC and the National Institutes of Health. Roll Call’s David Eldridge reported that Democrats are pressing for a separate hearing on Ebola response funding prior to the end of the recess break and claim the CDC cannot do its job adequately without more congressional appropriations. Roll Call’s Emma Dumain wrote that Republicans countered by noting that the CDC has not yet asked for additional funding. Also, CQ HealthBeat’s John Reichard reported (subscription) that hospital executives are scrambling for grant funding for technical assistance in managing Ebola cases, and CQ Roll Call’s Melanie Zanona noted (subscription) that health provider groups have ramped up calls for a boost in funding for a federal hospital preparedness program.

Other related Healthopolis reports on Ebola this week:

October 16, 2014

Cocoa Companies Stir Up Plan to Fight Ebola

Everyone from chocolate companies to social media sites have lined up to help stop the deadly Ebola virus from spreading in West Africa and beyond.

On Wednesday, the World Cocoa Foundation announced at its annual meeting that it will donate $600,000 to support Ebola prevention and care efforts led by the International Federation of Red Cross and Red Crescent Societies and Caritas. The organization said the donations were collected from a variety of its members, including Nestle, Ghirardelli Chocolate and The Hershey Company.

“The spread of Ebola is a serious concern to WCF and our member companies, given our deep and longstanding support for the well-being of West African cocoa-growing communities,” said World Cocoa Foundation President Bill Guyton in a press release. “This member-led contribution reflects an ongoing strong commitment by our industry to health and humanitarian relief efforts during international crises.”

Although Ghana and Ivory Coast – two of the largest cocoa growers – have not yet experienced an Ebola outbreak, the press release notes that 70 percent of the world’s cocoa supply originates in West Africa, which means it could be severely impacted if the virus continues to spread.

Meanwhile, Facebook founder Mark Zuckerberg announced yesterday that he and his wife would donate $25 million to the Centers for Disease Control Foundation, calling the Ebola epidemic a “critical turning point” in a Facebook post. Zuckerberg added that “grants like this directly help the frontline responders in their heroic work. We are hopeful this will help save lives and get this outbreak under control.”

Before the first case of Ebola was even diagnosed in the U.S., the Bill & Melinda Gates Foundation pledged a whopping $50 million last month to combat the epidemic in West Africa, stepping up the pressure on other tech companies.

Study: Ebola Incubation Period May Exceed 21 Days

Doctors are watching those who had contact with the first domestically confirmed Ebola cases in Dallas using a standard 21-day waiting period to see whether a person exposed to the virus will develop an infection. The medical community came up with the standard for observation after past experiences with Ebola, but a study published on Tuesday in the journal PLOS Currents indicates that the virus’ incubation period could exceed 21 days for up to 12 percent of patients. The new research, authored by Dr. Charles N. Haas of Drexel University in Philadelphia, is based on analysis of past Ebola cases, along with data on the first nine months of the current outbreak.

The study noted in its conclusion:

 While the 21-day quarantine value currently used may have arose from reasonable interpretation of early outbreak data, this work suggests a reconsideration is in order and that 21 days may not be sufficiently protective to public health. Further, outbreaks such as the current West Africa EBOV are presenting an opportunity for careful collection of data sufficient to revise and update (perhaps in an adaptive fashion) such recommendations. It may be that incubation time itself is a function of intensity and nature of contact, which may also need to be considered. The estimate of appropriate incubation time would need to explicitly consider the costs and benefits involved in various alternatives, which would incorporate explicit computations from transmission modeling.

By Paul Jenks Posted at 8:28 a.m.
Disease Control

October 15, 2014

Telemedicine Has an Easier Pathway Outside the U.S.

Healthopolis last month highlighted a new report on varying state regulatory agency acceptance of the use of telemedicine, or remote access to health care services through telecommunications devices. The Economist magazine this week examines the varying range of acceptance of telemedicine around the world.

The report notes that the telemedicine concept, which was touted as far back as 1924, is still not completely accepted worldwide despite new electronic devices. The U.S. lags behind in acceptance due to varying state and federal restrictions, but European regulations are simpler and telemedicine increased in Israel after health authorities relaxed guidelines. However, evidence is limited on the cost-effectiveness of remotely offered health services and some physicians are reluctant to adopt the concept.





Ebola: Reviewing Legal Options to Restrict Travel

A consistent lawmaker concern regarding the U.S. response to the Ebola crisis has focused on the airport screening process and possible restrictions on travel from West Africa.  However, there are no direct commercial flights to the U.S. from Guinea, Sierra Leone and Liberia and suggested travel restrictions largely hinge on halting the issuing of visas.

Florida Republican Rep. Tom Rooney on Tuesday penned the most recent request to federal agencies for action on visa restrictions. The Department of State issues visas, the Department of Homeland Security’s Customs and Border Protection agency inspects all people who enter the country and the Centers for Disease Control and Prevention is tasked with preventing the introduction of communicable diseases.

The Congressional Research Service has prepared a brief summary for lawmakers on the legal authority of federal agencies to restrict travel. Federal travel restriction authority ranges from visa limits, “Do Not Board” listings of people with contagious diseases, plus Department of Transportation regulations on passengers with infectious diseases and pilot requirements to report illness they encounter during a flight. Federal and state agencies also can impose isolation and quarantine measures. The CDC’s quarantine authority is authorized for Ebola by a recently revised White House executive order.



By Paul Jenks Posted at 9:23 a.m.
Disease Control

October 14, 2014

European Report Questions Impact of Airport Ebola Screening

A House Energy and Commerce Committee panel on Thursday is set question Centers for Disease Control and Prevention Director Thomas Frieden on his stance against halting all commercial travel from West Africa. The administration last week announced new entry screening procedures at five U.S. airports, which compliments current exit screening at airports in West Africa.

However, this weekend the European Centers for Disease Control and Prevention issued a technical report on the effectiveness of airport screening procedures. The report says the value of exit screening at departing airports is low and the impact of entry screening at arriving airports is also minimal.

Among the report’s findings:

Overall, screening for EVD (Ebola Virus Disease) among travelers may detect a few contagious EVD cases over time. Given that exit screening is in place in the affected countries and the poor intrinsic performance of the methods available, entry screening for EVD is likely to have an exceedingly low yield and represents a high investment, which may only contribute to a limited extent, to the prevention of importation of the disease.

Today and the Week Ahead: Medicaid Spending Report, Experimental Treatment Access and an Ebola Hearing

The quickly developing Ebola crisis is some lawmakers unwilling to wait for their official return from a recess break. A House subcommittee on Thursday will hold a rare recess period hearing in Washington, DC to question CDC Director Thomas Frieden and National Institute of Allergy and Infectious Disease Director Anthony Fauci regarding federal efforts to stem the spread of the virus. Meanwhile, this morning international affairs experts in webcast conference will examine the impact of the Ebola crisis on international security.

Other health topics will try to compete with Ebola this week. This morning, the Kaiser Family Foundation and the National Association of Medicaid Directors will unveil a survey report on state Medicaid spending. Separately, the Aspen Institute holds a private briefing with National Institutes of Health Director Francis Collins on the current state of cancer research.

Also, this week the Biotechnology Industry Organization hosts a summit of health organizations and biotechnology industry leaders to discuss patient and health advocacy and biotechnology issues. Later this week, the Leukemia and Lymphoma Society on Thursday hosts a Capitol Hill briefing on efforts to expand access to experimental therapies that are currently within FDA-sponsored clinical trials.

October 10, 2014

HHS Yields to the States on Health Insurance Network Adequacy

Many health insurance exchange plans have managed to adjust to the requirements of the Affordable Care Act by limiting the network of health care providers available to insured consumers. The law requires networks to be adequate and include a sufficient number of providers but is not specific about details on an adequate network. Some consumers have complained that their plans have left off their networks the largest or most important hospitals or physician groups in their communities.

CQ HealthBeat’s (@CQHealthTweet) Rebecca Adams reported (subscription) Thursday that Department of Health and Human Services Secretary Sylvia Mathews Burwell, speaking at a Washington, D.C. press briefing (view C-SPAN video), said that she is waiting on state insurance officials to weigh in on network adequacy concerns before determining if any action is required by federal officials.



Global Ebola Worries: Congress Mulls Funding and the Pentagon Fears Ebola in the Western Hemisphere

The West African Ebola crisis escalated further this week into a global concern. At a World Bank conference on Thursday, CDC Director Thomas Friedenjoined by a panel of representatives from other Ebola impacted countries — stressed at the need to quickly invest in public health services.

Meanwhile, the recess-bound Congress is preparing for to return for a ‘lame-duck’ session next month, which will likely focus primarily on the Ebola crisis. Several lawmakers this week urged the addition of Ebola response funding for the Centers for Disease Control and Prevention and National Institutes of Health in a possible omnibus spending bill, which is due by Dec. 11. Lawmakers will also gauge the effectiveness of new procedures introduced this week to screen arriving airline passengers.

Additionally CQ HealthBeat’s (@CQHealthTweet) Rebecca Adams, at a Thursday media breakfast with HHS Secretary Sylvia Mathews Burwell, recorded Burwell as saying: “we had one case and I think there may be other cases, and I think we have to recognize that as a nation.” Separately, Roll Call’s Hannah Hess reported that Congress’ in-house physician has readied an Ebola preparedness plan.

Meanwhile, House appropriators this week approved additional Defense Department funding transfers for the Pentagon’s Ebola relief mission in Africa. However, CQ Roll Call’s John Donnelly and Megan Scully reported (subscription) that Senate approval hinges on additional details on force protection plans.

Earlier this week, the Pentagon’s commander of the African relief effort discussed how the military units would interact with local health officials and Ebola patients. On Thursday, the commander for Western Hemisphere military operations noted that his “nightmare scenario” is an Ebola outbreak in Central America and Haiti.

Remark excerpt from U.S. Southern Command Chief, General John Kelly at a conference on Thursday:

The one thing you can bet, the five services of the U.S. military — Army, Navy, Air Force, Marines and Coast Guard — will get it done and will be a large solution to this problem. Specifically in my part of the world, when the Ebola crisis first started maybe three weeks ago, a month ago, I told my staff, let’s pretend that it’s hit our AO, our area of responsibility. The two nightmare scenarios would be Central America and Haiti. And now we’re just watching what AFRICOM does, since they’re doing it, and their plan will be our plan.

But, again, it goes back to this interagency. You’d be surprised how little the U.S. military is actually tasked to do until the problem grows so big, no one else can do it, and then we get called in to do it. The interagency is certainly aware of the possibility of — and likelihood, frankly, of Ebola coming to the Western Hemisphere. But I think the best way to deal with it will be the way it’s being dealt with in Africa. And God forbid — and unfortunately, I think it will happen — when it does come to the hemisphere, we’ll just replicate that.

But there’s only so much bandwidth, if you will, of preventive medicine people and the like that — to go around, and they are totally involved in trying to deal with the problem in West Africa. If it broke into the Western Hemisphere, the countries we’re talking about have almost no ability to deal with it, particularly Haiti and the Central American republics, almost no ability to deal with it.



By Paul Jenks Posted at 8:30 a.m.

October 9, 2014

HHS Auditor: Rural Hospital Patients Pay Higher Coinsurance Rates

Federal Medicare payments are higher for more than 1,300 facilities that meet the criteria as a critical access hospital (CAH). However, federal auditors in a report issued on Wednesday concluded that differences in payment levels for the select group of hospitals serving rural areas compared to other Medicare hospital payment rates means that Medicare beneficiaries at CAH hospitals pay a higher percentage of the costs in coinsurance for outpatient services.

The coinsurance charge for some outpatient services is 20 percent of the hospital charge submitted to Medicare but Medicare allows a higher rate for CAH hospitals, meaning the coinsurance amount is also higher. The Department of Health and Human Services Inspector General recommends congressional action to reduce the percentage of costs that Medicare beneficiaries pay in coinsurance or modify how coinsurance is calculated.

By Paul Jenks Posted at 11:23 a.m.

CBO: Annual Deficit is Lower But Health Program Spending Is Up

The federal government ended the 2014 fiscal year with an estimated $486 billion annual deficit, which is the lowest deficit level since 2008. The Congressional Budget Office monthly budget report pegs the lower deficit estimate largely on increased receipts from taxpayers.

However, overall federal spending — measured as outlays — increased and Medicaid and health insurance subsidy payments increased by 19 percent over 2013 levels. The CBO identifies the 2014 start of subsidized insurance plans and expanded state Medicaid coverage as a main reason for overall spending increase. Federal outlays on Medicaid and insurance premium subsidies increased in 2014 by $49 billion.

In September, the final month of the fiscal year, defense spending and reduced unemployment benefit outlays were down by $2 billion but spending for Medicaid increased 10 percent and Medicare increased 5 percent.





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