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2006-03-06 Kaiser Daily Health Policy Report - Monday, March 6,
 Mar 07, 2006 03:51 PST 

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Monday, March 6, 2006

1. Fifteen States Ask Supreme Court To Intervene in Legal
Dispute Over Cost of Medicare Drug Benefit

2. New York Hospital Rules Result in Loss of Medicare Payments

3. Bush FY 2007 Budget Proposal Would Raise Federal Deficit by
$35B, CBO Estimates

4. NYT Examines State of Bush's Agenda; Highlights Include Plan
B, Medicaid

5. Sen. Obama Proposal Would Help U.S. Automakers with Health
Care Costs In Exchange For Improved Fuel Efficiency

6. '60 Minutes' Examines Hospital Billing Practices for
Uninsured Patients

7. TennCare Eliminates Plan To Enact 'Hard Limits' on Doctor,
Hospital Visits

8. Massachusetts Leaders Agree to Health Care Reform Package
That Would Assess Fees to Companies That Do Not Provide Coverage

9. Carey Addresses Proposals To Change the Medicare Drug
Benefit, Spending Cuts Under Bush's FY 2007 Budget Proposal,
Association Health Plans

10. Developed Nations Face 'Common Challenge' on Health Care
Spending, Opinion Piece Says

11. Tauzin Denies Allegations About Discussions With PhRMA
During Negotiations Over 2003 Medicare Law

12. Patients, MDs Should Have 'Autonomy' in Treatment Decisions,
Editorial Says

13. Opinion Piece Criticizes 'Uproar' Among State Lawmakers Over
Wal-Mart Employees Enrolled in Medicaid



1. Fifteen States Ask Supreme Court To Intervene in Legal
Dispute Over Cost of Medicare Drug Benefit

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Five states on Friday requested permission to file a lawsuit
against HHS in the U.S. Supreme Court, alleging they are being
forced by the federal government to fund the Medicare
prescription drug benefit in violation of the Constitution, the
AP/Seattle Post-Intelligencer reports (Holland, AP/Seattle
Post-Intelligencer, 3/4). The suit challenges the so-called
"clawback" provision of the drug benefit. Under the provision,
Medicare will assume the prescription drug costs for dual
eligibles, but states will have to pay the federal government as
much as 90% of the estimated amount they would have spent on
Medicaid coverage for medications for residents dually eligible
for Medicare and Medicaid. The rate will decrease to 75% over
time. The lawsuit over the provision previously included
California, but the state withdrew after California Attorney
General Bill Lockyer (D) said the federal government had told
state officials that California would not have to make payments
to the federal government under the clawback provision (Kaiser
Daily Health Policy Report, 2/27). The request for permission to
file the suit with the Supreme Court -- state lawsuits against
the federal government can be filed with a lower court or the
Supreme Court, which can refuse to hear the case -- was filed by
the attorneys general of Texas, Kentucky, Maine, Missouri and
New Jersey. Attorneys general from Alaska, Arizona, Connecticut,
Kansas, Mississippi, New Hampshire, Ohio, Oklahoma, South
Carolina and Vermont submitted a supporting brief.


Texas Attorney General Greg Abbott (R), the lead attorney in the
case, said in a statement, "The federal government has placed
what amounts to a direct tax upon Texas and other states in
violation of the U.S. Constitution." Attorneys general for
states filing the brief in support of the lawsuit wrote that the
drug benefit "establishes a dangerous precedent that threatens"
states' independence. CMS spokesperson Gary Karr said states
eventually will save money under the Medicare drug benefit,
adding, "That's why very few states decided to join this
lawsuit, despite requests for them to do so" (AP/Seattle
Post-Intelligencer, 3/4).


At least 1.8 million Medicare beneficiaries have enrolled in
AARP's Medicare prescription drug plan, making the 2003 Medicare
law "more than just a legislative victory" for the group and
"reviv[ing] charges of a conflict of interest between AARP's
roles as a public policy advocate and a private business
enterprise," the Los Angeles Times reports. AARP, the "largest,
most influential body in Washington representing seniors,"
endorsed the 2003 Medicare law during congressional negotiations
over the creation of a Medicare drug benefit, the Times reports.
AARP last year announced that it would provide prescription drug
coverage to Medicare beneficiaries through United Health Group's
MedicareRx plan. Now, with enrollment in MedicareRx accounting
for more than half of total enrollment in Medicare-related plans
offered by UnitedHealth, AARP could collect "tens of millions of
dollars" from its sponsorship of the plan, according to the
Times. AARP, which also offers other types of insurance,
typically charges insurers annual fees of about 4% of premiums
collected, the Times reports. Larry Noble, executive director of
the Center for Responsive Politics, said, "Usually, interest
groups are lobbying for legislation that will financially assist
their members. Here, you have a situation where a group is
lobbying for legislation that they argue benefits their members,
and as it turns out, it's also going to benefit then." Rep. Pete
Stark (D-Calif.), said AARP "can't have it both ways," adding,
"You can't claim to be a disinterested advocate if you're
peddling insurance to make a profit and pay your overhead." AARP
spokesperson Steve Hahn said, "Any money AARP makes will get
plowed back into the services our members want"
(Alonso-Zaldivar, Los Angeles Times, 3/4).

Double-Enrollment Problems

In related news, Karr on Friday "downplay[ed]" reports that many
Medicare beneficiaries who have changed drug plans "are now
actively enrolled in two plans simultaneously," CQ HealthBeat
reports (Reichard, CQ HealthBeat, 3/3). On Wednesday, the New
York Times reported that "tens of thousands" of beneficiaries
are actively enrolled in two plans, a problem that appears
primarily to affect beneficiaries who qualify for a low-income
subsidy. In a recent memo to insurers, the Bush administration
said that government "processing systems have not always sent
the enrollment and disenrollment information to the appropriate
plans" when beneficiaries switch plans. As a result, "many
(possibly all) of the beneficiaries who switched plans are
active on enrollment files at multiple plans," the memo said. In
addition, some "[p]lans have paid claims for beneficiaries who
are no longer enrolled in their plan," the memo said. The issue
has raised concern that beneficiaries who are eligible for the
subsidy mistakenly will be charged premiums or high copays
(Kaiser Daily Health Policy Report, 3/1). According to Karr, it
is unclear how many beneficiaries are simultaneously enrolled in
two plans, but the "vast majority" of beneficiaries who have
switched plans will not experience problems by being enrolled in
two plans. He added that beneficiaries are less likely to become
inadvertently enrolled in two plans at the same time if they
change plans early in the month (CQ HealthBeat, 3/3).

2. New York Hospital Rules Result in Loss of Medicare Payments

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The New York Times on Saturday looked at how "New York is one
of a few states that have not allowed hospitals to establish ...
transitional care units." According to the Times, the nursing
home industry opposes the units, which function like nursing
homes but exist within hospitals and are intended to treat
"subacute" patients, who do not need acute care in hospitals
wards but are sicker than most nursing home patients. Medicare
pays a certain amount for a patient's diagnosis, regardless of
the length of stay in a hospital, but it will pay for several
weeks in a nursing home or transitional care unit. As a result,
some experts say that New York hospitals might have lost
hundreds of millions of dollars per year in Medicare payments
without the units. The Times notes that the average stay for
Medicare patients in acute-care beds in New York in 2003 was 7.5
days, compared with 5.8 nationally, and "[i]n most cases, a
longer patient stay does not mean more money for the hospital."
Patients also are exposed to infection and other health risks in
acute-care units, driving up costs. For many years, New York
hospitals had no incentive to adopt transitional care units
because the state system guaranteed that they would be
compensated for their costs, but the structure was abolished in
1997. Raymond Sweeney, executive vice president of the
Healthcare Association of New York State, said that on the
average day, at least 1,500 Medicare patients in standard
hospital wards do not need acute care and should be in
transitional units. In addition, New York hospital officials say
they often keep patients because nursing homes are full and
unequipped to provide care for certain patients. However,
nursing home officials maintain that their facilities can care
for the transitional patients. Neil Heyman, president of the
Southern New York Association, a nursing home industry group,
said, "It's not true that hospitals have no appropriate place to
send those patients. Nursing homes would take all those
patients, gladly. They take subacute patients all the time"
(Perez-Pena, New York Times, 3/4).


3. Bush FY 2007 Budget Proposal Would Raise Federal Deficit by
$35B, CBO Estimates

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The fiscal year 2007 budget that President Bush has proposed
would increase the federal deficit by $35 billion this year,
with proposed spending reductions for Medicare, Medicaid and
other programs expected to offset about one-third of the cost of
his other proposals, according to a Congressional Budget Office
report released on Friday, the New York Times reports (Andrews,
New York Times, 3/4). According to CBO, the budget proposal over
five years would reduce spending for Medicare by $37 billion and
for all entitlement programs by $56 billion. Over 10 years, the
budget proposal would reduce spending for Medicare by $138
billion and for all entitlement programs by $184 billion,
according to CBO (Cohn, CongressDaily, 3/6). The CBO report also
estimates that the budget proposal would increase the federal
deficit by $1.2 trillion over the next 10 years. The report does
not include military costs for Afghanistan and Iraq after 2006
and "assumes that Congress freezes or cuts the vast majority of
discretionary government programs outside of military and
domestic security ones," the Times reports (New York Times,

Congressional Prospects

Senate Budget Committee Chair Judd Gregg (R-N.H.) and House
Budget Committee Chair Jim Nussle (R-Iowa) have said that they
support additional spending reductions for entitlement programs,
and the committees are expected to mark up the budget proposal
on Thursday. However, spending reductions for Medicare "are
particularly difficult in the Senate" because Sens. Gordon Smith
(R-Ore.) and Olympia Snowe (R-Maine), both moderates, "hold
sway" on the Senate Finance Committee, CQ Today reports (Dennis,
CQ Today, 3/3). Some Senate Republicans also are "balking" at
spending reductions for Medicare, in part because of concerns
about their "prospects in this fall's midterm elections," the
Times reports (New York Times, 3/4). As a result of expected
opposition in the Senate, the House might "opt for a
slimmed-down version to preserve negotiating room in conference
with the Senate" (CongressDaily, 3/6).

Medical Imaging Services Reimbursements

In related news, 31 groups that represent medical imaging
service providers, patients and manufacturers maintain
provisions of the FY 2006 budget reconciliation law enacted last
month will limit access to care and discourage the development
of new technologies, CQ HealthBeat reports. The law caps the
technical component reimbursement for medical imaging services
provided in physician offices to the lesser of the Hospital
Outpatient Prospective Payment System and the Medicare physician
fee schedule, according to the American College of Radiology. In
a letter to congressional leaders, the groups write, "This
provision singles out imaging services to absorb over one-third
of all the Medicare reductions" in the law. CBO estimates that
the law will reduce Medicare reimbursements for medical imaging
services by $2.8 billion over five years, but ACR estimates that
the law will reduce reimbursements by $6 billion over the same
period. ACR officials said that the law "will stifle research
and development of new technologies that are increasingly
replacing more invasive, and often more costly, procedures." In
addition, ACR officials said that the law might increase
out-of-pocket costs for Medicare beneficiaries. Congress should
revise the law before the legislation takes effect in January
2007, ACR officials said (Carey, CQ HealthBeat, 3/3).


4. NYT Examines State of Bush's Agenda; Highlights Include Plan
B, Medicaid

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The New York Times on Sunday examined the question of whether
President Bush can "recover the political clout to continue to
advance his conservative domestic goals." According to the
Times, "major parts of the president's agenda," such as efforts
on the issues of the emergency contraceptive Plan B and
Medicaid, "are rolling on" (Kirkpatrick, New York Times, 3/5).
Summaries appear below.

*Plan B: Because of "abortion politics," FDA has delayed a
decision on an application for over-the-counter sales of the
emergency contraceptive Plan B, despite recommendations from an
independent advisory committee and agency staff that "the
benefits of easy access to the pill outweighed any possible
risks," the Times reports. Susan Wood, director of the FDA
office of women's health, resigned in August 2005 because of
alleged politicization of the Plan B decision. Acting FDA
Commissioner Andrew Von Eschenbach last month suggested to a
House subcommittee that the agency would not make decision on
Plan B in the near future (Harris, New York Times, 3/5).

*Medicaid: "Conservatives say the Bush administration has not
done much to cut the growth" of entitlement programs, but Bush
"won a big victory on Medicaid last month" with the enactment of
the fiscal year 2006 budget reconciliation law, the Times
reports. Under the law, states can reduce benefits and end
coverage for Medicaid beneficiaries who fail to pay premiums. In
addition, the law allows pharmacists to refuse to fill
prescriptions and providers to refuse to provide services to
Medicaid beneficiaries who fail to make copayments. The
Congressional Budget Office estimates that the law will increase
health care costs for millions of Medicaid beneficiaries (Pear,
New York Times, 3/5).


5. Sen. Obama Proposal Would Help U.S. Automakers with Health
Care Costs In Exchange For Improved Fuel Efficiency

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Sen. Barack Obama (D-Ill.) proposed at a speech last week to a
panel at the National Governors Association conference that the
federal government pay some of the Big Three U.S. automakers'
health care costs in exchange for their agreeing to manufacture
cars that get higher gasoline mileage, the Miami Herald reports.
According to the Herald, the proposal "features a traditional
liberal's approach of government help for a troubled blue-collar
industry and environmental conservation, but it adds a
requirement that the industry meet a performance standard in
exchange," and it might "signal a shift toward the political
center." Obama called the proposal "win-win ... for the
industry." Linda Stuntz, a former deputy energy secretary under
former President George H.W. Bush, said the proposal "brings
together some important elements." She said, "I think the auto
industry is ready and would like some help on these sort of
things. ... We're not just going to make it a handout; we've got
to get something in return." Ford Motor spokesperson Mike Moran
said, "We look forward to working with the senator in finding
solutions" (Borenstein, Miami Herald, 3/5).

GM Seeks Court Approval on Retiree Benefit Cuts

General Motors on Monday will present a case in U.S. District
Court that a federal judge should accept a plan to shift some
health care costs to hourly retirees in an effort to reduce the
company's costs by $1 billion per year, the Detroit News
reports. GM last year reached a deal with United Auto Workers to
reduce health care spending, but UAW cannot bargain on behalf of
hourly retirees, so GM and the union are "seeking rare court
approval to prevent any legal challenges," according to the
News. Under the agreement, retired hourly workers would start
paying monthly contributions, deductibles and co-payments for
medical services up to a maximum of $370 per year for
individuals and $752 for families. Because retirees are expected
to oppose the deal, GM "has laid out the gravity of the growing
health care crisis in sworn statements by senior executives,"
the News reports. The company said in a recent court filing,
"Without significant reductions in this growing (health care)
liability, GM's future -- and its continued ability to fund even
reduced health care benefits -- is at serious risk." GM
spokesperson Sharon Baldwin on Friday said the deal should be
approved by the court. She added, "It is fair and reasonable to
all members of the class, and it will allow GM to continue to
provide comprehensive health care benefits to its hourly
retirees at a more competitive cost" (Shepardson, Detroit News,


6. '60 Minutes' Examines Hospital Billing Practices for
Uninsured Patients

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CBS' "60 Minutes" on Sunday examined hospital billing practices
for uninsured patients, who often do not receive discounts on
medical services provided to those with public or private health
insurance. According to Gerard Anderson, a health policy
professor at Johns Hopkins Bloomberg School of Public Health,
"virtually all hospitals" charge uninsured patients more than
those with health insurance. In addition, because hospital price
lists are not available to the public, patients "can't do any
comparative shopping," and hospitals have "no reason to control
prices," Anderson said. Carmela Coyle, senior vice president for
policy at the American Hospital Association, said that although
some hospitals could improve billing practices for uninsured
patients, billing practices at many facilities have "changed
dramatically, literally in the last year." She added that the
U.S. must "find a way to provide health insurance coverage for
everybody." Senate Finance Committee Chair Chuck Grassley
(R-Iowa), who has begun an investigation into the billing
practices and charitable activities of not-for-profit hospitals,
said that billing practices for uninsured patients are "an
institutional bias against uninsured people" and "something to
be outraged about." Grassley said that without voluntary
revisions to hospital billing practices for uninsured patients
"very soon, we'll probably be doing some legislating in that
area." The "60 Minutes" segment also included comments from K.B.
Forbes, executive director of Consejo de Latinos Unidos, and
uninsured U.S. residents and their families (Rather, "60
Minutes," CBS, 3/5). The complete transcript of the segment is
available online. A video excerpt of the segment is available
online in RealPlayer.


7. TennCare Eliminates Plan To Enact 'Hard Limits' on Doctor,
Hospital Visits

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Tennessee is rescinding a plan to place "hard limits" on the
number of doctor and hospital visits TennCare beneficiaries can
make each year after the HHS Departmental Appeals Board on
Tuesday ruled in favor of Tennessee in its dispute with CMS over
$550 million in health care funds, the AP/Knoxville
News-Sentinel reports. Tennessee from 1991 to 2002 levied a bed
tax on nursing homes and used the revenue to receive federal
Medicaid matching funds. CMS sought reimbursement for the
matching funds, and the state had set aside $50 million in
reserve in case HHS ruled against Tennessee in the appeals
process. To offset the reserve fund, Gov. Phil Bredesen (D) in
his budget proposal last month announced plans to save $55
million by limiting TennCare beneficiaries to 12 doctors' visits
per year and 20 days of hospitalization. The limits were
scheduled to begin July 1. However, Bredesen on Wednesday
announced that the appeals board had ruled in the state's favor
and that Tennessee will use the $50 million reserve to eliminate
the planned hard limits on care. He said the state instead will
enact non-pharmaceutical "soft limits" on some beneficiaries
that will require them to receive approval before exceeding the
designated number of visits to health care providers. Bredesen
said, "That's a major win, and I can't tell you how pleased I am
about it. I think it really softens and mitigates a lot of the
legitimate criticism that was out there about the package that
we had" (Schelzig, AP/Knoxville News-Sentinel, 3/2).


8. Massachusetts Leaders Agree to Health Care Reform Package
That Would Assess Fees to Companies That Do Not Provide Coverage

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Massachusetts House and Senate leaders on Friday decided to
charge assessments on businesses that do not provide health
insurance to their employees, leading the way for the state
Legislature to pass a "sweeping" health care bill and qualify
the state for $385 million in federal Medicaid matching funds,
the Boston Globe reports. After several months of negotiations,
State House Speaker Salvatore DiMasi (D) and state Senate
President Robert Travaglini (D) agreed to charge companies with
10 or more employees that do not provide health coverage $295
per year for each worker. The assessment is intended to help
fund the state's free care pool. Michael Widmer -- president of
the Massachusetts Taxpayers Foundation, which helped the two
sides reach an agreement -- said the amount of the assessment
would decrease as more individuals gain coverage and stop
relying on the free care pool. The plan also would require that
all individuals purchase health insurance and that private
insurers offer lower-cost, basic health care coverage. State
residents who cannot afford the coverage would be eligible for
state subsidies. In addition, the compromise would expand
Medicaid coverage to more low-income state residents and
increase Medicaid reimbursements for hospitals, community health
centers and physicians. The increased reimbursement rates would
give the providers $270 million within three years. Additional
details about the compromise were not released, but a senior
legislative aide estimated that the plan could cover half to
two-thirds of the state's 500,000 to 600,000 uninsured when it
is phased in over several years. Travaglini said, "Significant
progress has been made. The logjam is no longer existing. ... I
am confident we will have a comprehensive health care package
before both branches in a very short period of time." Gov. Mitt
Romney (R) said he was "pleased the impasse had been broken" and
would "look forward to reviewing the bill as it moves along"
(Phillips, Boston Globe, 3/4).


9. Carey Addresses Proposals To Change the Medicare Drug
Benefit, Spending Cuts Under Bush's FY 2007 Budget Proposal,
Association Health Plans

Access this story and related links online:

Mary Agnes Carey, associate editor of CQ HealthBeat, discusses
the continued debate over implementation of the Medicare drug
benefit, President Bush's fiscal year 2007 spending plan and
legislation addressing association health plans in this week's
"Health on the Hill from kaisernetwork.org and CQ." Carey notes
that many Democrats said last week that they plan to attach
proposed changes to the drug benefit to other "must-pass"
legislation, while several moderate Republicans said they hope
to change the law to reduce the so-called "doughnut hole" in
coverage or extend the May 15 deadline for enrollment. Democrats
likely will press for more hearings on the issue, but the
prospects for legislation changing the 2003 Medicare law depend
on how fast difficulties in the implementation are addressed,
Carey says. She also discusses how some moderate Republicans
have said they will not support a FY 2007 budget resolution
without changes in Bush's proposed cuts in domestic
discretionary and entitlement programs. According to Carey, the
lawmakers' objections could mean there is not enough support to
pass Bush's plan to reduce entitlement spending by $65 billion
over five years. Carey also discusses a bill (S 1955) that would
allow small businesses to form association health plans to pool
their purchasing power and buy coverage for workers. She says
Senate Health, Education, Labor and Pensions Committee Chair
Mike Enzi (R-Wyo.) has been meeting with senators and
representatives of small businesses to discuss the legislation,
which would require AHPs to cover any mandated benefits already
required by at least 45 states. Carey says the coverage mandate
and growing concern over the number of uninsured U.S. residents
could help the bill gain passage in the Senate (Carey, "Health
on the Hill from kaisernetwork.org and CQ," 3/6). The complete
audio version of "Health on the Hill," transcript and resources
for further research are available online.


10. Developed Nations Face 'Common Challenge' on Health Care
Spending, Opinion Piece Says

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The "rising cost of health care is becoming an American
obsession," and a recent report by the Organization for Economic
Cooperation and Development -- a France-based think tank funded
by 30 developed nations -- is "waving a red flag" about public
health care spending, which will reach an average of 10% of
gross domestic product in the 30 developed countries by 2050,
Wall Street Journal reporter Rafael Gerena-Morales writes in an
opinion piece. Aging populations, increased medical technology
costs and "the effect of rising incomes" are "[a]mong the
biggest drivers of health spending" in developed nations,
Gerena-Morales writes. Gerena-Morales concludes, "Though their
circumstances differ, industrialized countries face a common
challenge: An inexorable rise in the share of government budgets
devoted to health care, a widespread conviction that present
trends are unsustainable and little political consensus on what
to do about it" (Gerena-Morales, Wall Street Journal, 3/6).

11. Tauzin Denies Allegations About Discussions With PhRMA
During Negotiations Over 2003 Medicare Law

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Some congressional Democrats have alleged that Pharmaceutical
Research and Manufacturers of America President Billy Tauzin
began negotiations for the position at the same time he, as
chair of the House Energy and Commerce Committee, helped pass
the 2003 Medicare law, but Tauzin "definitely seems innocent of
the charge" based on information in a letter sent to all members
of Congress on Monday, Roll Call Executive Editor Morton
Kondracke writes in a opinion piece. According to Kondracke,
House Minority Leader Nancy Pelosi (D-Calif.) in December 2005
in a privileged resolution said that Tauzin was "actively
engaged in a job search with the pharmaceutical industry at the
same time he was negotiating on major provisions of the bill."
Sens. Barack Obama (D-Ill.) and Debbie Stabenow (D-Mich.) in the
past month have made similar allegations against Tauzin, and
Sens. Dick Durbin (D-Ill.) and John Kerry (D-Mass.) have implied
that his position at PhRMA was a "payoff" for his help in the
passage of the Medicare law, Kondracke writes. However,
according to Kondracke, attorney Charles Work, who represents
Tauzin, first received a telephone call about the PhRMA position
in late December 2003 -- weeks after President Bush had signed
the Medicare law -- and time sheets indicate that negotiations
between Tauzin and PhRMA began on Jan. 15, 2004. Kondracke
writes that, although congressional Democrats "can attack Tauzin
... for taking" the position at PhRMA, "it's dirty pool to
charge that he was dickering with PhRMA when he wrote" the
Medicare law (Kondracke, Roll Call, 3/6).

12. Patients, MDs Should Have 'Autonomy' in Treatment Decisions,
Editorial Says

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An "excess of caution -- whether due to regulation, litigation
or fear -- can itself be harmful to public health," and patients
and physicians "dealing with fatal or degenerative diseases
ought to have maximum possible autonomy in treatment decisions,"
a Wall Street Journal editorial states. According to the
editorial, "We now know that the FDA could have extended a lot
of lives had it followed that principle with" the cancer
medication Erbitux "from the start." The editorial states that
"Erbitux is a perfect example of why it's important to get
active drugs with reasonable safety profiles out before all the
efficacy data is refined to the 10th decimal place, as the FDA
always tries to insist." Meanwhile, three studies published last
week indicate that the multiple sclerosis medication Tysabri,
which was withdrawn from the market last year after three
patients "developed a rare neurological infection," has "small"
risks and potentially "big" benefits, according to the
editorial. The editorial concludes that FDA "has an opportunity
to extend and improve many more" lives "if it decides to help
facilitate Tysabri's return to the market" (Wall Street Journal,

13. Opinion Piece Criticizes 'Uproar' Among State Lawmakers Over
Wal-Mart Employees Enrolled in Medicaid

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The current "uproar" among state lawmakers over the "discovery"
that some full-time employees, such as many Wal-Mart workers,
are enrolled in Medicaid places "the goals and achievements of
the '90s welfare reform ... down the memory hole," Philadelphia
Inquirer columnist Andrew Cassel writes in an opinion piece.
According to Cassel, welfare reform in the 1990s was based on
the theory that "it was better for government not to abruptly
cut off benefits such as Medicaid and food stamps when people
took jobs, but rather offer them as supplements to entry-level
wages." Although Wal-Mart has annual profits "in the billions,"
they amount to about $6,000 per employee -- "less than many
families pay for a year's worth of health insurance" -- and, in
the event that Wal-Mart expanded health benefits for employees,
the company would have to increase prices or lay off workers to
offset the cost, Cassel writes. He adds that the "sudden
outrage" among state lawmakers over "workers on Medicaid" is
because the "unions that represent workers at Wal-Mart's
competitors are annoyed" by the labor practices of the company,
which "resists attempts to organize its workers." He concludes,
"Their annoyance is understandable. What I don't understand is
why the rest of us ... should care" (Cassel, Philadelphia
Inquirer, 3/5).


The Kaiser Daily Health Policy Report is published for
kaisernetwork.org, a website of The Henry J. Kaiser Family
Foundation. (c) 2006 Advisory Board Company and Kaiser Family
Foundation. All rights reserved.

Jill Braden Balderas, managing editor, kaisernetwork.org
Beth Liu, web writer, kaisernetwork.org
Simone Vozzolo, web producer, HealthCast
Francis Ying, web producer, HealthCast
Amanda Wolfe, senior editor, Kaiser Daily Health Policy Report
Evonne Carroll Young, senior web writer, kaisernetwork.org
Shari Lewis, online communications associate, Kaiser Family
Sahar Neyazi, online communications assistant, Kaiser Family
Robin Sidel, communications officer, online activities, Kaiser
Family Foundation
Larry Levitt, editor-in-chief, kaisernetwork.org; vice
president, Kaiser Family Foundation
DAILY REPORTS PHONE: 202-266-6312; FAX: 202-266-5700; E-MAIL:
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kaisernetwork.org is a website of the Kaiser Family Foundation.
For access to the Foundation's policy research, analyses,
reports and fact sheets, and media partnerships, visit the
Foundation's main website at http://www.kff.org.
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