Citizens' Council on Health Care
CCHC HEALTH eNEWS
Tuesday, April 2, 2002


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Providing news and commentary on health care policy,
health insurance issues, and medical confidentiality.
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* MN HOUSE PASSES HEALTH POWERS ACT

* ACTION ITEM: COMMENT ON PROPOSED CHANGES TO PRIVACY RULE

* UNIVERSAL HEALTH CARE CAMPAIGN LAUNCHED

* NATIONAL HEALTH CARE - COMMUNITY BY COMMUNITY

* GROWING NUMBERS OF DOCTORS REFUSING TO TREAT NEW MEDICARE
PATIENTS

* EXPANDING MEDICAID TO THE MIDDLE CLASS

* BUSH: "FOR THE GOOD OF THE HEALTH OF THE NATION"

* PATIENT SAFETY THROUGH FEDERAL SURVEILLANCE


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CCHC REPORT: MN HOUSE PASSES HEALTH POWERS ACT

On March 22, the Republican-controlled Minnesota House
of Representatives passed their version of the Minnesota
Emergency Health Powers Act (HF 3031). Authored by Rep.
Richard Mulder, M.D. (R-Ivanhoe), and co-authored by Rep.
Tom Huntley (D-Duluth), the controversial bill was
quickly passed with little debate: 120 - 11.

Only two amendments were allowed to be offered. One to
improve the definition of bioterrorism and another to
provide citizens with the right to refuse medical testing,
vaccination, treatment, examination, and specimen collection.
The amendment also allows health officials to place such
non-compliant citizens into quarantine.

An amendment to remove the most controversial portion of
the bill was offered and then withdrawn. The bill provides
health officials with ongoing, year-long authority to place
citizens into quarantine with or without a court order.
The Commissioner of Health need only apply for a court order
within 72 hours of imposing quarantine on an individual
suspected of harboring a communicable disease.

After the detained individuals gets a copy of the order, they
may request in writing a court hearing to contest their
confinement. Within 72 hours of receiving their request, a
judge must hear the case, excluding holidays and weekends.
In other words, a person could be detained for over a week
without a judge hearing their side of the case.

The Senate version of the bill, which provides state control
of all medical supplies, facilities, real estate and private
property during a public health emergency is scheduled to be
heard this week. As a result of CCHC testimony, both bills
require the Health Department to study professional immunity,
health care rationing and constitutional issues. But the law
would take effect before the study was completed.

-Citizens' Council on Health Care
-April 2, 2002



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This email publication is free, but it is not free to
produce. Please consider providing CCHC with a tax-
deductible contribution. Online credit card contributions
are taken at: http://www.cchconline.org/donate.php3

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ACTION ITEM: COMMENT ON PROPOSED CHANGES TO PRIVACY RULE

DEADLINE: Friday, April 26, 2002
COMMENT: http://www.hhs.gov/ocr/hipaa/ Specifically: http://erm.hhs.gov:9567/nprm/comments.cfm

To address the concerns of the health care industry,
medical research community and government agencies, the
Bush Administration proposes to change the so-called
federal medical privacy rule, for the most part not to
the benefit of patients.

At the end of each section below, see the "TELL THEM"
statements for suggested comments:

PATIENT CONSENT: The Bush Administration has proposed to
eliminate the requirement that health care providers and
insurers get patient consent before sharing patient data for
the purposes of payment, treatment and "health care
operations."(Sec 164.506) They propose that patients only
receive notice of privacy practices. CCHC has detailed the
broad definitions of "treatment" and "health care operations"
at: http://www.cchc-mn.org/definitions.php3 TELL THEM:
keeping the patient consent requirement respects the
rights of patients. They should not delete it.

PERMISSIVE AUTHORITY TO DISCLOSE: The proposed changes
will not restrict the rule's permissive authority which
gives doctors, hospitals and health plans the right to
disclose patient data without consent for "national health
care priorities" such as law enforcement, public health,
government databases, research, organ transplant centers,
and public safety. (Section 164.512) CONSIDER adding a
comment about this when you comment on Patient Consent
(Sec. 164.506) and Consent for Research (Sec. 164.512)

DE-IDENTIFICATION OF DATA: The Administration is specifically
seeking public comment on their intent to weaken the strict
requirements for de-identification of patient data (the removal
or encryption of data that could possibly identify an
individual). For research, public health, and "health care
operations," the Administration proposes to allow the
admission, discharge and service dates, date of death, age,
and five-digit zip code of patients to remain visible. In
addition, regulators want public comment on inclusion of
city, precinct, neighborhood or county in disclosed medical
record information(Sec. 164.514). TELL THEM: to keep the
original requirement that 18 data elements be deidentified.

Keep in mind: Merging one partially de-identified database
with one completely identifiable database (driver's license
for instance) can make the data identifiable. The
Administration knows this but want to appease corporate and
public health researchers. Regulators suggest making
researchers sign on the dotted line that they won't abuse
the data, sell the data, or contact the patients once
they identify the data. TELL THEM: not to disclose your
identifiable personal data without your consent, even for
research and even with written data use agreements.

CONSENT FOR RESEARCH: They also propose to delete the rule's
requirement that an Institutional Review Board's (IRB) waiver of
the patient's right to give/refuse consent for use of their data
for research be conditioned on whether the disclosure will
adversely affect the privacy rights and the welfare of the
individual. Officials think the requirement to consider privacy
rights conflicts with the requirement to consider minimal
privacy risk before waiving the patient's right to refuse. So
they are choosing minimal privacy risk over consideration of
patient privacy rights. (Sec. 164.512) TELL THEM: Patients
deserve to have their privacy rights considered. In addition,
it should be patients who determine the risks to their privacy,
therefore IRB's should not be able to waive the patient's
right to refuse or to give consent for use of their data for
research.

And finally, regarding research, regulators propose that
no expiration date need be included on any research-based
access to patient data, for any study, but particularly
regarding the creation of research databases or repositories.
(Sec. 164.512) Access to the database data once created would
require a separate authorization, consent or waiver, but no
expiration date for accessing the date need be included on
the waiver, consent or authorization. TELL THEM: that consents
and authorizations must have end dates. If the research
requires more time, an extension should be sought. And no
patient data should be placed on a database without explicit
written patient consent.

PARENT ACCESS/MARKETING/EMPLOYERS: Regulators also propose
to require specific patient consent before health care
providers can send advertisements to patients or use their
information in marketing campaign. (Sec. 164.508) In addition,
the Administration proposes to give State legislatures the
right to determine parent access to medical records.(Sec.
164.502) and clarifies that employment records held by a
covered entity (clinic, practitioner, health plan, hospital)
in its role as employer are not considered protected health
information (Sec. 164.501) TELL THEM: that you appreciate
requiring consent before marketing, and state (local) control
over medical record access decisions.

READ Proposed Changes: http://www.hhs.gov/ocr/hipaa/propmods.pdf
(Explanation, rationale and proposed modifications make up the
first 36 pages. The actual changes are on the last 5 pages, but
you will need the original rule to make much sense of them)

COMMENT ADDRESSES:
EMAIL comments at the Office for Civil Rights web site (Link to http://www.hhs.gov/ocr/hipaa/ )

SEND written comments, postmarked no later than April 26, 2002, to:
U.S. Department of Health and Human Services
Office for Civil Rights
Attn: Privacy 2
Hubert H. Humphrey Building
Room 425A
200 Independence Avenue, SW
Washington, D.C. 20201

COMMENT REQUIREMENTS
1) Include full name, address, and telephone number of
the sender, or a knowledgeable point of contact.
2) Address only those sections of the rule for which comments
are requested.
3) If duplicate comments are provided on various sections of
the rule, please note that in the comment.
4) Comments sent by fax will be destroyed and not considered.
5) Use 8 1/2 x 11 inch paper to make non-email comments.

-Citizens' Council on Health Care
-April 2, 2002


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UNIVERSAL HEALTH CARE CAMPAIGN LAUNCHED


********* OPENING NIGHT **************

Opening Night formally launches the new Congressional
campaign for Universal Health Care.

An Evening With Rep. John Conyers ...featuring the Junior Mance Trio
Friday April 5, 2002
St. Peter's Lutheran Church
East 54th St.

RSVP 718-694-8290 x44

Reception 6pm Program 7pm

Complementary Admission * Donations Accepted

Rep. John Conyers, Jr. has long been a fighter for health
care justice and civil rights for all Americans. A year ago
he established a non-partisan Congressional Universal Health
Care Task Force. The Task Force developed The Health Care
Access Resolution (HCAR 99). Along with America's Health Together(www.healthtogether.org) and the Universal Health
Care Action Network(www.uhcan.org)

Source: email received by CCHC, 4/1/02


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NATIONAL HEALTH CARE - COMMUNITY BY COMMUNITY

On Wednesday, March 20, HHS Secretary Tommy G. Thompson
addressed the National Association of Community Health
Centers (NACHC) during their 27th annual conference. The
organization honored the Secretary with their 2002
Distinguished Community Health Champion Award in recognition
of his commitment to the work of America's health centers,
his respect for the critical role they play in providing
access to care, and his advocacy for increasing the capacity
of these centers.

"We made great strides in extending access to health care
to Americans during the first year of the Bush administration,"
says Thompson. "We increased funding for community health
centers by $165 million, in order to build on the expertise
and compassion that provide care to so many Americans
nationwide. However, there is much more to be done."

The proposed HHS budget for Fiscal Year 2003 requests an
increase of $114.4 million to create 1,200 new community
health centers by 2006. The President's proposal would support
170 new and expanded health centers and provide services to a
million additional patients.

The Secretary will also speak about the importance of
emergency preparedness in light of the increasing threat of
bioterrorist attacks on the U.S. "In 2003 we're calling for
$4.3 billion," says Thompson, "an increase of 45 percent over
the current fiscal year - to support a variety of critical
activities to prevent, identify and respond to incidents of
bioterrorism. Community health centers will be critical in
helping us to prepare and potentially deal with such incidents."

NACHC is a national trade association serving and representing
the interests of America's community health centers. Their
programs in primary and preventive care serve 11 million people
at 3000 health center delivery sites.

Source: HHS WEEKLY REPORT, March 17-23 2002

-Citizens' Council on Health Care
-April 2, 2002


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GROWING NUMBERS OF DOCTORS REFUSING TO TREAT NEW MEDICARE
PATIENTS

For years, doctors have grumbled about Medicare's complex
regulations and reimbursements. But now many are simply refusing
to take new patients who are on Medicare -- and the trend is
spreading.

o Medicare cut payments to doctors by 5.4 percent this year
-- and doctors say payments no longer cover the costs of
caring for the elderly.

o The government estimates that under current law, the fees
paid for each medical service will be reduced in each of
the next three years -- for a total decrease of 17 percent
from 2002 to 2005.

o The American Academy of Family Physicians says that 17
percent of family doctors are refusing new Medicare
patients.

o Doctors explain that the cuts come at the same time their
expenses are climbing -- and that elderly patients require
a lot of time and attention.

Spending for doctors' services accounted for nearly $41 billion
of last year's total $238 billion Medicare budget.

Health policy experts predict the cuts will make it more
difficult for elderly patients to find doctors -- even as the
population ages. Medicare covers 40 million people and the
number of beneficiaries is expected to double by 2030.

Other health care providers like hospitals, nursing homes and
health maintenance organizations are also demanding more money.

Although Medicare can barely support all the benefits promised
under current law, some Capitol Hill politicians are seriously
considering adding new benefits -- such as coverage of
prescription drug costs for the elderly.

Source: Robert Pear, "Many Doctors Shun Patients With Medicare,"
New York Times, March 17, 2002.

For text
http://www.nytimes.com/2002/03/17/health/policy/17HEAL.html

Source: Taken directly from Daily Policy Digest, National Center
for Policy Analysis, http://www.ncpa.org 3/18/02


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"FOR THE GOOD OF THE HEALTH OF THE NATION"

When President Bush announced the nominees for Surgeon
General and Director of the National Institutes of Health,
he said, "The research is overwhelming that simple
improvements in diet and exercise would result in dramatic
improvements in America's health. Studies show that
overweight Americans who are at risk of developing type II
diabetes or coronary heart disease can delay and possibly
prevent these diseases with just moderate exercise and a
healthy diet. Walking 30 minutes a day will dramatically
improve your life. Playing a game with your children in
your backyard will help. Walking in a park can make a
difference to your health.

"These relatively small actions can dramatically reduce
costs and strain on our health care system. Fitness and
a healthy lifestyle are a priority for me. I really like
to run. It makes me feel better. The doc and I are going
to encourage all our country to either run or walk or swim
or bicycle for the good of their families, for the good of
their own health, and for the good of the health of the
nation."

The U.S. Department of Health and Human Services is
following the Bush lead. Secretary Thompson issued a
challenge to HHS employees to eat right and exercise.
Secretary Thompson asked all employees to weigh themselves
the day after Easter, and encouraged anyone who is overweight
to lose 10 pounds, and said that he himself plans to lose
15 pounds.

Source: " President Bush emphasizes prevention" and "HHS
weight loss challenge," HHS WEEKLY REPORT, March 31 - April 6
2002

-Citizens' Council on Health Care
-April 2, 2002


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EXPANDING MEDICAID TO THE MIDDLE CLASS

The Children's Health Insurance Program for children and
their parents provided health coverage to 4.6 million children
at some point during fiscal year 2001. This was a 38 percent
increase from the 3.3 million enrolled at some point during
2000, according to an HHS press release. In addition, more
than 230,000 adults were enrolled in fiscal year 2001.

Created in 1997 with bipartisan support in Congress, SCHIP is
in essence, a state and federal Medicaid expansion program.
According to the press release, HHS made it simpler for states to
coordinate SCHIP and Medicaid plans in August 2001. Under the
new Title XXI of the Social Security Act, states were allowed
to set up a separate child health program, expand their existing
Medicaid programs, or a combination of both.

Coverage is now available for children whose family income is
200 percent of the federal poverty level (FPL) or higher in
38 states and the District of Columbia. The FPL is $17,650
for a family of four, therefore a family of four with an
income of $35,300 qualifies.

To expand SCHIP, President Bush's fiscal year 2003 budget
would make available to states an estimated $3.2 billion
in unused SCHIP funds that otherwise would return to the
federal treasury.

CMS' report on SCHIP enrollment is available at
http://www.hcfa.gov/init/children.htm.

Source: "SCHIP COVERS 4.6 MILLION CHILDREN IN 2001," HHS Press
Release, February 6, 2002. http://www.hhs.gov/news

-Citizens' Council on Health Care
-April 2, 2002


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PATIENT SAFETY THROUGH FEDERAL SURVEILLANCE

President Bush is proposing $10 million in new funding to
support patient safety initiatives and to reduce medical
errors. The funding would bring the total HHS budget for
improving patient safety to $84 million in fiscal year
2003, according to an HHS press release.

"Quality health care is a priority for Americans and for this
administration," Secretary Thompson said.

Under the initiative, HHS' Agency for Healthcare Research
and Quality (AHRQ) will receive $60 million, an increase of
$5 million, for patient safety expertise and adoption of
proven but underused technologies. The Food and Drug
Administration (FDA) will also receive $5 million in new
funding for patient safety, bringing their total funding for
this issue to $22 million. The FDA will assess and follow-up
on reports of adverse events with an emphasis on medication
errors.

The President's proposed fiscal year 2003 budget will also
again request $2 million for the Centers for Disease Control
and Prevention (CDC) for developing a Web-based system for
providers to report data on infections that patients acquire
in hospitals.

The HHS Patient Safety Task Force has been working to
determine data that should be collected to improve patient
safety. The group is working to coordinate federal patient
safety data collection, monitoring, analysis and feedback
efforts in an effort to enhance the usability of data collected
on patient safety and medical errors while reducing the
reporting burdens for health care providers.

Source: "HHS TO PROPOSE NEW FUNDING AND FOCUS ON PATIENT
SAFETY," HHS Press Release, February 1, 2002,
http://www.hhs.gov/news.

-Citizens' Council on Health Care
-April 2, 2002


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NOTE: These news items have been taken directly
from email received by CCHC or from Internet
newspaper publications. Titles in ALL CAPS are
CCHC creations except for those heading articles
from the National Center for Policy Analysis,
the Health Law Pulse, PrivacySecurityNetwork,
and LIST.HEALTHPLAN. Credit to the sending
organization or news service is listed at the
end of each article.
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