Citizens’ Council on Health Care
CCHC HEALTH eNEWS
Wednesday, January 9, 2002


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Providing news and commentary on health care policy,
health insurance issues, and medical confidentiality.
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* ACTION ALERT: COMMENT NOW ON NEW CENTRALIZED MEDICARE DATABASE
Tuesday, January 15, 2002

* PHARMACY GATEKEEPERS FAIL TO CONTROL DRUG COSTS

* OREGON MEDICAID COVERS “THOUSANDS” OF INELIGIBLE

* FLORIDA FIRST TO OFFER NEWBORN SCREENING FOR DIABETES

* MEDICAL MONITORING OF OVERSEAS MILITARY ADVANCES

* “MODEL” STATE HEALTH-CRISIS LAW RAISES CONSTITUTIONAL CONCERNS

* CONGRESSMAN BREAUX CALLS FOR UNIVERSAL HEALTH CARE

* PREVENTIVE SERVICES MAY NOT BE WORTH THE COST


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CCHC Commentary included
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ACTION ALERT: COMMENT NOW ON NEW CENTRALIZED
MEDICARE PATIENT DATABASE - Deadline Jan. 15.

While the nation has been awash in terrorism threats,
and the aftermath of September 11^th, the Centers for Medicare
and Medicaid Services (CMS) has created the nation’s largest
centralized health care database on Americans. Then while
citizens were enjoying the holidays the agency invited the
public to comment on the plan. No one noticed.

CCHC only found out about the December 6^th notice this week,
The agency was willing to wait 40 days before beginning
to disclose personal patient data—unless they were convinced
otherwise by comments from the public. The public’s comments
can include comments on the short time for comments, the new
database, those with whom the data are shared, etc. According
to CMS, the deadline is January 15^th. (see email address/
mailing address information below)

The Database
Medicare and Medicare-eligible individuals, and those soon
to be eligible whether or not they choose to enroll, are
being placed on what the CMS calls a “database of pertinent
and comprehensive personal data.” The Medicare Beneficiary
Database will contain “a complete ‘beneficiary insurance
profile’” Disclosure of data would be allowed without patient
consent for 11 broad purposes, including policy and medical
research and monitoring of physicians and hospitals in search
of health care waste, abuse and fraud.

After the death of a Medicare recipient, patient data will be
kept in the agency’s “active files” for 15 years, after which it
will be archived at the U.S. Department of Health and Human
Services Health Care Data Center—available to researchers and
others in perpetuity.

Who Can Access Data Without Patient Consent?
* Agency Contractors of CMS to maintain MBD.

* Other state and federal agencies, including the IRS, for
various reasons including to determine cost, effectiveness
and quality of care

* Providers and Suppliers of Medicare Services to verify
entitlement status of recipients.

* Third Party Contacts for those who can’t read or write,
don’t understand English, or are incompetent

* Peer Review Organizations to assist in State monitoring/
enforcement

* Employers, Insurers, HMOs, health plans, third-party
administrators (enrollment data only)

* Individuals or organizations doing research, evaluation,
disease prevention projects, health care payment, or health
restoration or maintenance projects

* Member of Congress with a letter of request from constituent

* Department of Justice or HHS, if involved or have interest
in any health care litigation

* CMS contractor to “prevent, deter, discover, detect,
investigate, examine, prosecute, sue with respect to, defend
against, correct, remedy, or otherwise combat fraud or abuse
in such programs.”

* Other federal or state agencies to “prevent, deter, discover,
detect, investigate, examine, prosecute, sue with respect to,
defend against, correct, remedy, or otherwise combat fraud
or abuse in such programs.”

CCHC Requests Comment Extension
CCHC today faxed a letter to the offices of HHS Secretary Tommy
Thompson and Rep. Dan Burton, chairman of the House Committee on
Government Reform and Oversight requesting a 90-day extension to
the time allowed for public comment before the Department begins
to share data.The agency states in their notice that they
may “defer implementation of this system of records or one
or more of the routine use statements...if we receive
comments that persuade us to defer implementation.”

Federal Register Document
http://www.access.gpo.gov/su_docs/fedreg/frcont01.html
(To link to actual Federal Register document, click on
CCHC link above. Then click on December 6, 2001, scroll
down to Centers for Medicare and Medicaid Services, and
click on TEXT or PDF file. PDF file is 9 pages long)


DEADLINE: Tuesday, January 15, 2002

Email Address for Public Comments

nburford@cms.hhs.gov

RE: FR Doc.01-30005, Privacy Act of 1974, System of Records,
The Medicare Beneficiary Database


Mailing Address for Comments

Director, Division of Data Liaison and Distribution
Centers for Medicare and Medicaid Services
Room N2-04-27
7500 Security Boulevard
Baltimore, MD 21244-1850

RE: FR Doc.01-30005, Privacy Act of 1974, System of Records,
The Medicare Beneficiary Database


To Make Individual Phone Request for Extension

Call HHS Secretary Tommy Thompson’s office
and ask to talk to Michelle Shortt
in the Baltimore office of the Centers of
Medicare and Medicaid Services:

Toll Free: 877-696-6775 (HHS)
Direct: 410-786-4658 (CMS)


-Citizens’ Council on Health Care
-January 8, 2002


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PHARMACY GATEKEEPERS FAIL TO CONTROL DRUG COSTS

Large employers and government agencies say that pharmacy
benefit management firms have actually increased the cost
of medications. Pharmacy benefit managers (PBMs) operate
drug plans for about 200 million Americans, negotiating
discounts with pharmaceutical companies in exchange for
including a compnay’s drug on a list of preferred medicines.
These deals encourage use of more expensive medications,
offer patients low copayments for using preferred drugs
and shift the cost to employers.

Lawsuits have been filed against Merck-Medco Managed Care,
the largest pharmacy benfit manager, and AdvancePCS and
Express Scripts, two other large PBMs. The charge: inflation
of prescription costs and failing to act in the best
interests of customers, a requirement of the federal Employee
Retirement Income Security Act.(ERISA). The PBMs counter by
saying that they are independent of employer drug plans
covered under ERISA, and “We are not a public utility” said
David Machlowitz, Merck-Medco’s general counsel (The New
York Times)

Companies have begun to demand better accounting of the
agreements between PBMs and pharmaceutical companies, and
state officials are looking for ways to avoid using PBMs
altogether for their Medicaid programs. Some states have
banded together to get direct discounts from pharmaceutical
companies. Verizon Communications is telling their PBM to
use the right drug for patients rather than making deals
with pharmaceutical firms. Pharmacies are lobbying state
governments to advance regulation and licensing of PBMs.

Source: “Employers and Government Officials Say Pharmacy
Benefit Managers Have Failed to Control Drug Costs,” KAISER
DAILY HEALTH POLICY REPORT Monday, January 7, 2002 (News from
The New York Times, Freudenheim,1/5/02)

-Citizens’ Counsel on Health Care
-January 8, 2002


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OREGON MEDICAID COVERS “THOUSANDS” OF INELIGIBLE

A state audit of the Oregon Health Plan, the state’s Medicaid
expansion program for low-income residents, has concluded that
”thousands” of people have received benefits for which they were
not eligible, costing the state $4.3 million per year, the Portland
Oregonian reports.

A review of benefits awarded in 2000 and 2001 by the Oregon
Secretary of State showed that “in some instances,”
caseworkers either signed up people they knew did not meet
eligibility requirements, did not verify wage information,
failed to ask for a Social Security number or did not ask for
proof of citizenship. In one in four cases in 2000 the auditors
sampled, enrollees in the health plan earned at least 25% more
than the maximum income limit; their participation in the health
plan cost the state an estimated $2.1 million.

Between Jan. 1, 2000, and April 30, 2001, workers for the health
plan failed to ask for a Social Security number in approximately
15,000 cases, costing the state an estimated $1.6 million. While
Social Security numbers are not required when applying for family
coverage, requesting the information would have helped health
officials check on the applicants’ wages.

In addition, the report concluded that the state lost $1.7 million
a year by awarding benefits to undocumented immigrants. According
to the report, because health officials rely on applicants to mail
in a form stating their citizenship, there is a “risk that applicants
would lie about their citizenship status.” Finally, the audit said
caseworkers improperly waived monthly premiums for about 1,260
enrollees who claimed not to be earning any money but who were in
fact working full time. The health plan is open to Oregon residents
who earn up to 100% of the federal poverty level, or $17,650 for a
family of four. Beneficiaries pay a premium of between $6 and $23
per month and must re-apply every six months.

Source: Taken directly from “State Audit Finds Oregon Health Plan
Spent Millions on Ineligible Members,” KAISER DAILY HEALTH POLICY
REPORT, Monday, January 7, 2002.


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FLORIDA FIRST TO OFFER NEWBORN SCREENING FOR DIABETES

Florida will become the first state to offer juvenile
diabetes screening to all newborns under a program
announced on Jan. 3, the Orlando Sentinel reports. The
program will be overseen by the University of Florida
College of Medicine and funded in part by a $10 million
grant from the American Diabetes Association (Suriano,
Orlando Sentinel, ¼).

The Florida Times-Union reports that officials from the
university plan to establish an endowment and “parlay” the
ADA grant into matching funds from the state and “other
sources” (Filaroski, Florida Times-Union, ¼). The
University of Florida will begin testing infants by taking
a blood sample and analyzing its DNA for genes associated
with juvenile, or Type 1, diabetes. This form of the disease
affects about 800,000 Americans, most of whom are under age 40.

Researchers hope to test screen about 4,000 to 5,000 infants
per year initially and “gradually” increase that number as more
funding becomes available. The voluntary program will offer
”lifetime monitoring” to high-risk infants, who may have to
return to the hospital for blood tests every three to six
months.

Dr. Ken Burns, the University of Florida’s vice president for
health affairs, said, “Early detection for this debilitating
disease is becoming more and more critical,” as Type 1 diabetes
can lead to blindness, kidney failure, heart disease, stroke and
amputations.

Eventually, ADA officials hope to offer testing to all 200,000
babies born in the state each year as they look to “discover
what causes the genetic possibility for diabetes to become a
lifelong reality for some people.” They also believe that the
program could motivate other states to consider diabetes screening
for infants. Davida Kruger, chair of the ADA Research Foundation,
said, “Once it gets started here and we see how it goes, we can
make a case for other places as well” (Orlando Sentinel, ¼).

Source: Taken directly from “Florida to Become First State to
Screen All Newborns for Diabetes,” KAISER DAILY HEALTH POLICY
REPORT, Monday, January 7, 2002


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MEDICAL MONITORING OF OVERSEAS MILITARY ADVANCES

In an effort to monitor health problems of troops sent
overseas, the U.S. Department of Defense is requiring
members of the military to complete medical screening
before they leave and upon return to the U.S. In addition,
medical records are being converting into electronic
form on a department database.

The response is geared to address issues of battle-related
ailments, such as were experienced by veterans from the
Persian Gulf, who the government says are now twice as
likely to develop Lou Gehrig’s desease as other military
personnel.

The Pentagon has been forced to be more open about how
it protects its people because consumers are on the
Internet and more aware of health issues. Federal officials
will collect and track data on its personnel to monitor
for combat-related and environmental illness.

Source: “U.S. to Improve Medical Monitoring of Its Troops
Overseas,”John Files, The New York Times, January 8, 2002.

-Citizens’ Council on Health Care
-January 8, 2001


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”MODEL” STATE HEALTH-CRISIS LAW RAISES CONCERNS

As many as a dozen state legislatures are likely this year to
debate bills based on a model law developed for the National
Centers for Disease Control and Prevention. The model would
confer powers on a state’s governor to deal with a serious
bioterrorism attack by ordering quarantines, restricting
residents’ movement and rationing medical supplies.

But civil libertarians and privacy advocates are uneasy with the
scope of the law and fear it could result in unwarranted
government coercion of people to undergo medical treatment,
inappropriate confinement of innocent persons and unnecessary
disclosure of personal medical records.

o Legislative leaders from Massachusetts to Minnesota and
California to South Carolina have introduced—or are
about to introduce—emergency health powers legislation
based on the CDC model.

o Critic Jonathan Turley, a law professor at George
Washington University, warns that the model law “puts the
lives of an entire state in the hands of one person who
may or may not rise to the occasion.”

o Also critical of the effort is the American Legislative
Exchange Council—a group of about 2,400 legislators
dedicated to free markets and individual freedom.

o Georgetown University’s Paul Gostin, the lead writer of
the model act, contends that there must be “hard trade-
offs between civil liberties and property rights of
individuals against the collective rights of society.”

Turley is especially concerned about a provision that, he says,
would give governors “unchecked power” in the first 60 days of a
crisis. State laws already give governors the power to deal with
crises, he maintains.

Source: Sarah Lueck, “States Seek to Strengthen Emergency
Powers,” Wall Street Journal, January 7, 2002.

For text (WSJ subscribers)
http://interactive.wsj.com/articles/SB1010352979589116360.htm

Source: Taken directly from Daily Policy Digest, National Center
for Policy Analysis, http://www.ncpa.org/, 1/7/02.


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CONGRESSMAN BREAUX CALLS FOR UNIVERSAL HEALTH CARE

Sen. John Breaux (D-La.) said on Jan. 2 he would support a
system of universal health care funded in part by the federal
government, the Baton Rouge Advocate reports. During a visit to the
Louisiana State University Earl K. Long Medical Center, Breaux said
he and a number of national research groups have investigated a
proposal to provide universal health coverage in the United States.
”You ought to have health care as a basic right. Everybody in
America should have health insurance and we should help people get
it,” Breaux said. He said that the federal government should help
subsidize the cost of health insurance for those who cannot afford
coverage and dismissed the current employer-based health care system
as an “archaic concept.” Breaux said, “You should be able to pick
your health insurance.” He added that a system of universal health
coverage would reduce health care costs “because there will be more
healthy individuals and the costs will be spread around.” Breaux
will likely announce Jan. 3 whether he plans to run for governor of
Louisiana next year (Shuler, Baton Rouge Advocate, 1/3).

Source: Taken directly from “Sen. John Breaux Calls for Federal
Government to Support Universal Health Insurance,” KAISER DAILY
HEALTH POLICY REPORT, Monday, January 3, 2002


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ARE ROUTINE CANCER TESTS WORTH IT?

Medical researchers are beginning to question one of the most
widely held beliefs in preventive medicine: that screening
healthy people for cancer and catching it early saves lives.
According to Barnett Kramer of the National Institutes of Health,
the evidence shows that some screening tests are much more useful
than others.

Some tests, like Pap tests for cervical cancer and tests for
colon cancer, show clear benefits. But evidence for others, like
mammography and a blood test for early signs of prostate cancer,
is less clear, say researchers.

Tests that detect cancer cannot always discern whether the cancer
is dangerous or is an indolent tumor that might never produce
noticeable symptoms.

Unforeseen consequences can arise when seemingly healthy people
sign up for a screening test. For example:

o Very aggressive prostate cancers may be unstoppable
whenever they are discovered, while others grow slowly and
may not be dangerous.

o Yet once a tumor is found, doctors and patients feel
obliged to treat it, leaving many men incontinent and
impotent.

o Danish scientists found mammograms did not lower the
overall death rate from breast cancer, but the women
tested ended up with more surgery, including mastectomies,
more radiation and chemotherapy than women who were not
screened.

In addition to the risks of such procedures, widespread screening
may needlessly add to the overall cost of medical care if
millions of people are involved. One researcher found that scans
of more than 90 percent of tobacco smokers and former smokers
showed something suspicious. However, many suffered needless
operations and other medical procedures for something that may
have been innocuous.

The testing included chest surgery, which carries a 4 percent
risk of death. And it is not even clear yet whether the early
diagnosis of lung cancers helped.

Source: Gina Kolata, “Questions Grow Over Usefulness of Some
Routine Cancer Tests,” New York Times, December 30, 2001.

For text (requires free registration)
http://www.nytimes.com/2001/12/30/health/30CANC.html

Source: Taken directly from Daily Policy Digest, National Center
for Policy Analysis, http://www.ncpa.org/, 1/3/02.



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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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CITIZENS’ COUNCIL ON HEALTH CARE
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