Roll Call: Latest News on Capitol Hill, Congress, Politics and Elections
November 1, 2014

Posts by Paul Jenks

173 Posts

October 31, 2014

Economist: Economic Woes of Ebola in West Africa; Drug Manufacturers Expedite Work on Vaccines

The Ebola crisis is ravaging the economies of the Ebola stricken West African countries of Liberia, Sierra Leone and Guinea. The Economist magazine this week reports that the World Bank estimates the cost to the region at $33 billion over the next 18 months. Prices of food and some basic products have doubled but some commodity-based businesses have been able to continue to export products.

The Economist also reports on drug manufacturers redoubling efforts to produce an Ebola vaccine. The World Health Organization has partnered with GlaxoSmithKline and a U.S. firm, NewLink Genetics, to expedite work on a vaccine. The drugs will be ready for testing in Africa by the end of the year. Also, Johnson & Johnson announced announced last week that it will begin human trials in January on a separate vaccine.

 

Weekly Review: State Quarantine Battles Wait Out 21-Day Incubation Periods

The debate over travel restrictions on persons arriving from the Ebola ravaged region in West Africa shifted this week to posturing over the effectiveness and legality of varying state-level quarantine requirements. Last weekend’s imbroglio over initial strict quarantine rules in New York and New Jersey shifted to less stringent home-based quarantines and monitoring protocols in other states. The Centers for Disease Control and Prevention offered new monitoring guidelines, which helped states to minimize quarantine rules

A nurse, returning from assisting with West Africa relief efforts and originally interred in a New Jersey hospital, was released to travel to Maine. However, the dispute over the legality of Maine’s home-based quarantine has escalated into a current battle between the nurse and the state’s governor and health officials.

Anxiety over Ebola cases in the United States now festers as the current influx of returning volunteers wait out a 21-day waiting period for the possible incubation of the Ebola virus. Also, planning for possible new domestic Ebola cases is haunted by an Associated Press report that the U.S. health care system, especially smaller hospitals, are poorly prepared to handle even localized Ebola cases.

Meanwhile, Secretary of Defense Chuck Hagel this week finalized orders for a 21-day post-mission quarantine of returning military personnel currently serving in West Africa. The White House this week parried questions about the difference between an enforced quarantine for U.S. troops but not for returning civilian health care workers.

Congress is busy preparing for next week’s general election and the next congressional hearing on Ebola, originally scheduled for next week, was delayed until Nov. 12. Witnesses scheduled to testify are Health and Human Services Secretary Sylvia Mathews Burwell and Centers for Disease Control and Prevention Director Tom Frieden. However, the newly appointed Ebola response czar, Ron Klain, is not currently slated to appear before the panel. Separately, various bipartisan pairs of lawmakers are plotting a legislative strategy to press for increased Ebola and other medical research funding.

 

 

October 30, 2014

Cleveland Clinic Queries Staff About Medical Advances Expected in 2015

In July, a massive research project by Thomson Reuters scoured all scientific and patent databases and culled a list of 10 possible medical advances possible by 2025. The list included improved detection and prevention of dementia and Alzheimer’s Disease and genomic engineering to prevent Type 1 Diabetes.

This week, the Cleveland Clinic simply asked its experts on medical innovations expected in 2015. The clinic’s scientists suggested ten advances, including a new speedy and cost-effective blood testing process, single dose radiation therapy for breast cancer and a dengue fever vaccine.

 

Report: Out-of-Pocket Spending Increases but Hospital Utilization Drops

Earlier this month, the Congressional Budget Office reported that federal health care spending has increased, largely due to new health insurance subsidies and an expanded Medicaid program.

This week, the Health Care Cost Institute released its annual health cost report for persons covered by private sector employer-offered plans. The report indicates that health care spending per enrolled person increased by $183 in 2013 and out-of-pocket spending increased 4 percent to an average of $800 per person. However, while costs have increased, the utilization of brand-name prescription drugs, hospital inpatient admissions and outpatient services declined.  The report noted an increase in utilization rates for physician specialist office visits and generic prescriptions.

 

October 29, 2014

Bipartisan Duos Identify Ways to Expedite Ebola Research Funding

When Congress returns next month, it really has one primary task – to extend the federal government’s ability to spend money. And lawmakers are already starting to talk about how Ebola might fit into that discussion.

The current short-term federal appropriations measure expires Dec. 11, and an extension will likely address the mechanics of funding for research on Ebola drugs. Bipartisan congressional leaders on Tuesday were calling for funding adjustments to speed Ebola drug development.

In the House, Michigan Republican Mike Rogers and California Democrat Anna G. Eshoo urged appropriators to include additional funding instructions in an HHS bio-defense program to expedite Ebola drug and vaccine research efforts.

In the Senate, the leaders of the Health, Education, Labor and Pensions Committee, Democrat Tom Harkin of Iowa and Republican Lamar Alexander of Tennessee, announced plans to introduce a bill that would allow funding for Ebola drug research through an existing FDA program designed to expedite the development of drugs to combat neglected tropical diseases. The senators note that Ebola is not currently listed as a qualifying drug for the program.

But discretionary spending limits and annual funding priority battles limit the expansion of medical research funding. CQ HealthBeat’s (CQHealthTweet) Kerry Young reports (subscription) that Utah Republican Sen. Orrin G. Hatch and Massachusetts Democratic Sen. Elizabeth Warren are circulating a separate draft bill intended to change that by marking off a permanent allocation of federal funding for biomedical research, separate from the contested pool of discretionary funds.

October 28, 2014

Health Insurance Group Chief Comments on Upcoming Exchange Enrollment

CQ HealthBeat’s (CQHealthTweet) John Reichard and Rebecca Adams sat down last week with Karen Ignagni, the president and CEO of America’s Health Insurance Plans. Their report (subscription) noted that the top lobbyist for health insurers expressed optimism that the next open enrollment period under the health law will better than last year but warned that a lobbying battle looms over networks that could lead to higher premiums.

Here are a few brief excerpts from their wide-ranging interview. Questions have been condensed.

Ignagni, speaking about the enrollment experience that consumers will have this year compared to last year, when the federal Healthcare.gov website did not work initially:

Because of where we started last year, I don’t expect that kind of situation – we had a problem getting people on the website [Healthcare.gov] entirely last year – so we’re really talking about a very different experience. For consumers that are new to the exchange, they will see a considerably shortened application and they’ll be able to go through the process fairly quickly and be able to get enrolled and that’s a very positive thing. So there’s been a lot of effort to improve the front end…. But we’re in uncharted waters because we’ve never gone through a re- enrollment or renewal process. So we are working very hard to make sure that from a health plan standpoint we’re reaching out to consumers, letting them know that they need to update their information so they can get their latest APTC [advanced payment tax credit] information, their subsidies. That’ll be important for them to know their subsidies as they’re evaluating their choices in the exchange.  That is a very important job that health plans are doing a great deal of outreach [on] to make sure people know about that. We were very pleased to see the administration launching an effort to communicate this message very clearly to consumers – that they need to go back to the exchange and update their information.

Question: One thing consumers ask is “Is my doctor covered?” … Are you thinking of doing anything more to ensure provider directories are accurate?

Plans have on their websites their provider directories and are working very hard to make sure that if a particular clinician decides that he or she doesn’t want to be part of network that we’re updating that when the information comes to us, it gets updated. Sometimes the info doesn’t come from a provider for a month or two to the health plan. So we’re making sure when we get that, we get that on the website. Over time the exchanges, both state as well as federal, will be able to have that information on the exchange websites and we’re very supportive of that … We also are releasing a consumer guide to networks – questions consumers should have at their kitchen table and think about posing.

 

By Paul Jenks Posted at 2:06 p.m.
Insurance

States Begin to Follow New CDC Guidance on Quarantines

The Centers for Disease Control and Prevention on Monday issued new guidelines on monitoring for the Ebola virus in travelers arriving from the Ebola infected region in West Africa. The new policy calls for home quarantines at the most restrictive level and ongoing monitoring for a 21-day period. The policy seeks to stem early attempts to enforce stricter state quarantines.

New York and New Jersey this weekend began implementing a hospital-based quarantine policy, which led to the CDC’s new less restrictive guidance on monitoring incoming persons potentially exposed to the virus. On Monday, New Jersey released its first quarantined patient and New York earlier updated its screening plan at JFK airport to include home monitoring. A range of states followed suit on Monday with updated guidelines that focus on home-based quarantines and activity restrictions. A sampling of states issuing updated guidelines include: Illinois, Maryland, Virginia, Georgia (assumes individual compliance), Minnesota and Maine.

October 27, 2014

Equating Ebola and the Flu on Capitol Hill

ebolasignphoto e1414346947759 240x321 Equating Ebola and the Flu on Capitol Hill

Sign at a deli on Capitol Hill, Sunday, October 26, 2014

CQ Roll Call staff today will be offered an annual flu shot. This year’s inoculation is especially pressing due to concerns about the Ebola virus, which have initial symptoms that are identical with the flu. The similarity of symptoms poses some possible confusion and increased anxiety as flu season begins. Reuters reported last week that hospitals fear a deluge of patients with the flu fearing they have Ebola.

This sign on Sunday greeted people walking by a popular Capitol Hill deli/grocery store. It seems the confusion has already begun.

 

 

 

 

This Week: Quarantine Wrangling

The focus this week, outside of preparations for next week’s congressional elections, will be on new state quarantine orders on health care workers returning from service in West Africa. On Friday, the governors of New York, New Jersey and Illinois initiated a mandatory quarantine targeting returning medical workers. This weekend Florida instituted a 21-day active monitoring regime for new arrivals. New York on Sunday adjusted the terms of the quarantine order, allowing persons under observation to be quarantined at home.

Separately today, the Centers for Disease Control and Prevention begins a previously announced revised post-arrival monitoring process for persons arriving from West Africa. A White House meeting on Sunday assembled a large group of federal officials ahead of possible new revisions to policies on monitoring incoming travelers.

Meanwhile this week, the Society for Women’s Health Research hosts a panel discussion on Wednesday at Washington, DC’s Union Station on expectations and experiences on breast cancer screening. Also on Wednesday, the Association of American Medical Colleges holds a teleconference on research on medical school application and enrollment data. On Thursday, the Cato Institute examines recent federal court rulings on the IRS’ interpretation of the 2010 health care overhaul law. The group is keen on garnering the court’s consideration of a challenge to the legality of federal insurance subsidies in states that utilize the federally operated insurance exchange.

The next congressional hearing on Ebola concerns and health care spending takes place on Wednesday, Nov. 6, after next week’s election.

 

 

October 24, 2014

Cell Phone Data Tracking Rules Hinders Ebola Tracking in West Africa

Amid ongoing controversy over privacy concerns and national security requirements over screening of cell phone data in the U.S., the Ebola crisis in Africa offers a different perspective on the issue. Public health researchers have found that cell phone data is useful in quickly tracking diseases and could be used to monitor the spread of Ebola virus.

This week’s edition of the Economist magazine reports that researchers were able to use cell phone call-data records after previous disease outbreaks to track the spread of the disease. However, real-time access to cell phone data is restricted by government privacy rules and paperwork – plus likely beleaguered West African government agencies. For now, the concept of tracking Ebola through cell phones is on hold but a United Nations telecommunications agency has added emergency access to cell phone data to its agenda for an upcoming meeting next month in South Korea.

 

 

Week in Review — Ebola: House Hearing Today; New Case Identified in New York; Airport Screening & Monitoring Revamped

A House committee today examines the coordination of federal agencies in responding to the Ebola crisis. The hearing session includes testimony from federal agency officials but excludes Centers for Disease Control and Prevention Director Thomas Frieden and the newly appointed federal Ebola response czar Ron Klain. The hearing is colored by a newly identified case in New York City. A doctor, who recently returned from an international aid mission in Africa, is now undergoing treatment at a New York hospital.

Testimony at this morning’s hearing will include an update on the U.S. military mission in Liberia and Senegal, where more than 630 U.S. military personnel have been deployed to build medical facilities and help with logistics. Also, the session will likely address Department of Homeland Security enhancements to the airport screening process. The process was adjusted this week to funnel travelers from West Africa to enter the U.S. through the five selected airports offering Ebola screening. An airline trade group noted that the change in itineraries would impact about nine people each day.

Additionally, the CDC is requiring all passengers arriving from Ebola infected countries to submit to post-arrival monitoring for 21 days, the standard period for incubation of the virus. The CDC this week also updated its guidance to hospitals on proper protective procedures for treating an Ebola patient.

Earlier this week, the remaining U.S. Ebola cases and persons under observation as a result of the initial Texas patient were gradually closing. In Africa, the World Health Organization announced the end of Ebola outbreaks in Senegal and Nigeria but a new case emerged this week in Mali. The pandemic continues in Liberia, Sierra Leone and Guinea.

 

 

October 23, 2014

State Medicaid Directors Respond to Critique of Varying State Standards

Last month, Healthopolis noted a Department of Health and Human Services Inspector General report that surveyed the wide diversity of state approaches to regulating Medicaid managed care programs.

The Inspector General’s analysis prompted the National Association of Medicaid Directors to craft a response to the report, suggesting that the lack of consistency in state supervision of Medicaid programs is not necessarily a failure but rather illustrates different approaches to managed care programs, which are colored by the unique circumstances of each state in managing very complicated factors influencing the Medicaid program.

 

 

Health Programs Factor in Upcoming House Committee Leadership Changes

The focus on upcoming November congressional elections understandably centers on possible election results and which party will control the Senate. However, the election of a new Congress, which convenes in January, also starts the process for reconfiguring the leadership of pivotal House committees. Roll Call’s Emma Dumain and Matt Fuller today examine possible GOP leadership changes in 11 different committees.

Health care program funding authority, particularly for the Medicare program, falls under the jurisdiction of the House Ways and Means Committee. The committee’s current chairman, Michigan Republican Rep. Dave Camp is retiring and Wisconsin Republican Rep. Paul D. Ryan has the inside track — but has some competition — to take over the gavel of the powerful tax committee.

Ryan has led a long-running campaign to overhaul the Medicare program as the chief of the House Budget Committee. His annual budget proposals (view the 2015 budget plan) have suggested ideas on overhauling the Medicare program allowing Medicare beneficiaries to choose between competing private coverage programs with the federal government offering premium support payments. In 2011, a liberal advocacy group attacked an earlier Ryan Medicare proposal with a video featuring a Ryan look-alike actor pushing an elderly woman in a wheelchair off a cliff.  At the helm of the Ways and Means Committee, Ryan would have the opportunity to craft a Medicare overhaul measure instead of offering budgetary suggestions.

If Ryan departs from the budget panel, the heir apparent is the committee’s current Vice Chairman, Rep. Tom Price, a conservative physician from Georgia. Price is a staunch opponent of the 2010 health care overhaul law and has authored his own proposal on overhauling health insurance coverage options. Price’s plan relies on offering tax breaks to give people the means to buy health insurance instead of the current health insurance exchange plan subsidies.

October 22, 2014

EPA Waste Discharge Rule Targets Dentists

The Environmental Protection Agency periodically weighs in on health care provider regulatory matters, usually addressing pollution concerns about medical waste. Today, the environmental regulatory agency published proposed rules on discharges of mercury from dental offices.

Dentists use an amalgam for dental filings and the metal — mostly silver — is bonded together with mercury. The EPA notes that dentists are the main source of mercury discharges into water treatment facilities. The agency claims that mercury waste diffused into the environment is a global pollution problem. The proposed regulations require dentists to use amalgam separators, which separate the mercury for alternative disposal instead of rinsing excess amalgam into the local waste water treatment system.

 

 

 

By Paul Jenks Posted at 3 p.m.
Uncategorized

Annual Spending Waste Report Mocks State Medicaid Provider Taxes and Assorted NIH Grants

Oklahoma Republican Sen. Tom Coburn today unveiled an annual report listing examples of possibly dubious spending on various government programs. The report always offers interesting and sometimes humorous reading and illustrates the often-unusual nature of federal program and grant spending. Sen. Coburn usually highlights examples of unusual health program spending.

This year’s report mocks National Institutes of Health research on human interaction with dogs, the impact of meditating through reading Buddhist texts, and funding for a smart-phone application that helps parents manage the eating habits of fussy children. The eccentric nature of  some NIH grants is a regular target for the annual report. Last year’s waste report blasted a study on marital conflict between husbands and wives.

The 2014 report includes a critique of state Medicaid provider taxes, particularly on nursing homes, which inflates federal Medicaid payments to the state. States collect both the additional tax and the additional Medicaid funding.  In July, Healthopolis highlighted a report that indicates states are increasing relying on Medicaid provider taxes to fund the program.

Other items in this year’s report blast the weighting of sleep apnea as grounds for veterans’ disability benefits and the random assignment of Medicare Part D prescription drug plans to beneficiaries who do not indicate a preference. Roll Call’s Niels Lesniewski reports that this year’s report is presumably the last of the senator’s annual compilation of unusual federal spending. Sen. Coburn is retiring from the Senate at the end of the year.

 

 

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