Spurred by last week’s postponed enforcement of the Affordable Care Act’s employer mandate by the White House, House Speaker John Boehner (R-Oh.) has announced that the House will vote next week to similarly delay the individual mandate until 2015, ABC News reports.
in his announcement, Boehner said it’s “indefensible” that financially burdened individuals would have to struggle to meet the mandate, which would require them to buy coverage beginning in 2014 or pay a fine. “Is it fair for the president to give American businesses an exemption from the health law’s mandates without giving the same break to individuals and families across the country? Hell, no, it isn’t!”
House Minority Leader Nancy Pelosi refuted Boehner’s comments, explaining that while a “certain reporting” requirement by businesses was indeed delayed for a year, the Obama administration still hoped that employers would still maintain or enact coverage during the 2014 transition period.
Consumers apparently agree that the individual mandate should go on the back burner, at least for the time being (see chart). A survey by HealthPocket found that 41% of respondents believe the mandate waiver should apply equally to individuals and businesses, compared to 12% who said the mandate should remain and 47% who weren’t sure.
Just because the Food and Drug Administration approves a medication doesn’t mean that the manufacturer is free to relax and reap the rewards – often the agency will require more research be done even after the product hits the market. But not every drugmaker is quick to act on such requests, NPR reports.
Post-approval research used to be conducted more or less at the discretion of the manufacturer before the FDA was given the power to enforce the request in 2007. Curious to see if the mandate had improved compliance, Kevin Fain and some colleagues took a look at the five-year period ending in 2011.
Fain’s team found that prior to the FDA’s new powers, over half of the of the 2,000+ studies the agency expected to be performed hadn’t been started by drugmakers. That number fell to 775 studies, or about 44%, in 2011. Progress. But that’s “still a fairly large number,” said Fain, a research fellow at Johns Hopkins Bloomberg School of Public Health.
The proportion of tardy starts to studies ordered by FDA since the agency got mandatory powers has increased steadily and stood at 271, or about 15%, in 2011. More of the old studies got finished, though none of the newly mandatory ones had been.
The NPR article notes that failure to comply with agreed deadlines can land the drugmaker in hot water, though so far the FDA’s enforcement has been limited to warning letters.
An increase in the amount of time Americans spend exercising hasn’t slowed the rise in obesity, the Los Angeles Times reports.
Data published in the online journal Population Health Metrics revealed that while individuals in two-thirds of the nation’s counties have stepped up their physical activity in the past decade, national obesity rates have also climbed. On the positive side, some recent evidence suggests the rates may be leveling off.
“There has been a lot of progress on physical activity,” said Christopher Murray, lead author of the research. “But we probably also need to do more. There are still more calories coming in … than calories going out in physical activity.”
Indeed, bad diet choices are the single leading cause of America’s poor health compared to other countries, said Robert Lustig, a neuroendocrinologist and clinical professor at UCSF School of Medicine. While physical activity is a critical component of well-being, “[t]here is not one study anywhere in the world that shows that exercise [alone] causes weight loss.”
Lustig noted that poor diet also reduces the will to exercise, and advised that people reduce their insulin levels by drinking less alcohol and eating less sugar, trans fats and corn-fed beef and chicken.
Despite last year’s recommendation by the U.S. Preventive Services Task Force that older men shouldn’t get a prostate cancer screening, most still plan to do so, HealthDay News reports.
A survey of over 1,000 men aged 40 to 74 with no history of prostate cancer found that only 13% of respondents plan to follow the USPSTF recommendation and not get tested, compared to 54% who said they’d ignore it and 33% who were undecided. Blacks, wealthier men, those who’d had a recent PSA test, and those who were at least somewhat worried about prostate cancer were more likely to plan to get a test.
Overall, the survey shows that “we need to do a better job of presenting both the benefits and harms of screening to all patients,” said Linda Squiers, lead author of a report on the survey. “We also should explain the science behind the recommendation in plain language so everyone can understand it.”
The USPSTF website states that “current methods of PSA screening and treatment of screen-detected cancer are not the answer", and critics of the test believe it can lead to unnecessary and harmful treatment. Nevertheless, many physicians say the test serves a useful purpose.
MedBen follows American Cancer Society screening guidelines, which recommend that men at age 50 who are at average risk of the disease and are expected to live at least 10 more years consult with their primary care physician about getting tested.
And the saga continues…
According to The Hill, House Rep. Scott Garrett (R-N.J.) has introduced a resolution charging that President Obama violated the Constitution by delaying enforcement of the employer mandate provision of the Affordable Care Act.
“President Obama is in violation of Section 3 of Article II of the Constitution by refusing to enforce the employer mandate provisions of ObamaCare,” Garrett said. “The executive branch, which has no constitutional authority to write or rewrite law at whim, has usurped the exclusive legislative power of Congress.”
The resolution reads, in part: “[T]he executive branch’s unilateral decision to delay the implementation of a law sets a dangerous precedent under which legislation that is enacted through the passage of that legislation by the democratically elected Members of Congress and the signing of that legislation into law by the President will no longer have the force of law and will instead be relegated to having the status of a mere recommendation, which the President may choose to ignore.”
The Obama administration announced last week that it would delay enforcement of the mandate, which requires employers with more than 50 full-time workers to provide health insurance or pay a penalty, until 2015. In defending the move, the White House said it was necessary to allow businesses time to comply with the new law and that other provisions will be implemented as scheduled.
While MedBen recommends that health plan members see their family doctor regularly, it’s also a good idea to rely on your pharmacist for guidance, as a new study of hypertension treatment demonstrates.
According to HealthDay News, researchers found that 72% of individuals who self-monitored their blood pressure with home kits for six months and partnered with a pharmacist for medication guidance kept their high blood pressure under control, compared to 45% whose care was limited to scheduled physician checkups. And six months following the study, 72% of the home monitoring group still controlled their high blood pressure compared to 57% of the usual care group.
“The reason that only about half of people with [high] blood pressure have it under control is that usual care isn’t working. We combined two interventions that we thought would be very powerful together – home monitoring and pharmacist managements – and this is one system that we’ve shown works very well for blood pressure control,” said senior investigator Dr. Karen Margolis, from the HealthPartners Institute for Education and Research in Minneapolis.
This is not to suggest, however, that the family doctor doesn’t play an important role in helping to control high blood pressure, in addition to managing a patient’s care in general. But it does show how taking on greater responsibility for one’s health, and taking advantage of every available resource, can make a positive difference.
An extensive new study of U.S. health trends from 1990 to 2010 revealed some positive developments, according to the Health Hub:
Still, not all the news was good. The study, conducted by the Cleveland Clinic, found that while the U.S. is spending more, our health is only gradually improving compared to other countries. Additionally, the gap between life expectancy and the expected number of healthy years that an American loses to disability increased from 9.4 to 10.1 years.
The study also determined that disease and long-term disability account for nearly half of the U.S. health burden. The researchers suggested that by stressing education and preventive medicine to limit chronic conditions, our country could reduce that number.
MedBen Worksite Wellness adheres to that philosophy. By promoting prevention of chronic diseases through physician office testing that uses the plan member’s primary care provider, we eliminate the logistical headaches and potential redundancy of on-site screenings. And our program uses customized education and counseling to help high-risk plan members reduce their odds of developing diseases in the first place.
For additional information about worksite wellness, contact MedBen Vice President of Sales and Marketing Brian Fargus at email@example.com.
The employer mandate may be off the table for a year, but other provisions of the Affordable Care Act will arrive on schedule, whether businesses understand them or not. And one particular industry is pressing the federal government for greater clarity, Modern Healthcare reports.
The American Hospital Association and Catholic Health Association, in letters filed with the Internal Revenue Service, called for regulators to define and offer examples of “egregious” violations that could threaten tax exemption for about not-for-profit hospitals. The facilities, which make up about 60% of U.S. hospitals, have been under increased scrutiny to prove whether they provide sufficient community benefit in order to retain their tax-exempt status.
The health care reform law restricts the use of aggressive bill collection practices; requires not-for-profit hospitals to promote financial aid; and mandates an assessment of community need every three years. While hospitals that fix small mistakes won’t lose their tax breaks, those that commit “willful or egregious” violations will face potential loss of tax exemption, the IRS says.
The Catholic Health Association commented that such violations should be limited to those “of the utmost seriousness,” and asked for examples to what constitutes a major violation. The AHA called on the IRS to define or clarify “egregious” as well as “willful” violations that will trigger loss of tax exemption.
So many studies have lauded the benefits of aspirin, it’s easy to conclude that a daily dose doesn’t hurt and may even help. But such thinking is unwise, the Cleveland Clinic’s Health Hub reports.
While it’s true many doctors prescribe aspirin therapy for patients with heart disease, self-prescribing to stay heart healthy carries serious risks, says Steven Nissen, MD, Chairman of the Department of Cardiovascular Medicine at Cleveland Clinic – and some, such as gastrointestinal bleeding or hemorrhagic stroke, can be potentially fatal.
“Only those individuals who are at high risk for a heart attack benefit from taking aspirin as a preventive measure,” says Dr. Nissen. “Before taking a daily dose, you need to have a dialog with your physician about the benefits and risks of aspirin therapy.”
Dr. Nissen acknowledges that for patients who have had a heart attack, bypass surgery or a history of coronary artery disease, the benefits of daily aspirin outweigh the risks. But for others, only people with a cluster of risk factors – say, having diabetes, being a smoker, having high cholesterol and high blood pressure – should consider a daily aspirin, and even then only under a doctor’s counsel.
Not every scientific endeavor aims for the fences. Sometimes, as NPR reports, researchers have more modest goals in mind – such as a simple explanation as to why more people don’t favor lower-cost generic pills:
“Matthew Gentzkow, an economist at the University of Chicago’s Booth school, recently tried to answer this question. Along with a few colleagues, Gentzkow set out to test a hypothesis: Maybe people buy the brand-name pills because they just don’t know that the generic version is basically the same thing.”
Gentzkow and his colleagues discovered that people who know that generics contain the same active ingredient as brand-name pills do indeed tend to go for the cheaper alternative. Pharmacists, for example, bought generics 90% of the time, compared with about 70% of the time for the overall population.
Care to learn more about the saving potential of generics? MedBen plan members who get pharmacy benefits management services through Pharmacy Data Management (PDMI) can find information about generic alternatives and compare prices through MedBen Access. By clicking on your name under “My Rx Claims” in the sidebar menu, you will be taken directly to our medication database.
To access the site, simply go to the MedBen.com home page and select “MedBen Access".
Last week’s announcement that the Obama administration that would delay until 2015 the Affordable Care Act provision requiring businesses with 50 or more employees to provide health insurance or pay a penality has generated a variety of reactions:
Delay For Insurance Mandate Pleases Businesses (NPR): “It is welcome relief that the Administration took this step, particularly in light of the numerous questions that remained in terms of how companies were supposed to comply with the employer mandate provisions that were originally set to take effect next year,” said Gretchen Young of the ERISA Industry Committee. “We do appreciate the sensitivity of the Administration to our concerns and hope that it will carry forward into other difficult issues as well.”
Hospitals to Obama: Spare us, too (Healthwatch): “The goal of the [Affordable Care Act] was to extend coverage to the uninsured, which required a shared responsibility from all stakeholders,” [American Hospital Association President Rich] Umbdenstock said in a statement.
“We are concerned that the delay further erodes the coverage that was envisioned as part of the ACA.”
House Republican leaders slam ObamaCare business mandate delay (Healthwatch): In a joint statement Wednesday, Speaker John Boehner (R-Ohio), House Majority Leader Eric Cantor (R-Va.) and their deputies suggested that if employers deserve relief from a requirement to offer health insurance, individuals should not be made to carry coverage.
“The president owes the American people an answer: why does he think businesses deserve a one year delay from the mandates in ObamaCare, but middle class families and hardworking Americans don’t?” the leaders said.
Right on the heels of a recent study that found smoking and surgery don’t mix comes a analysis that suggests heavy drinking also hinders recovery.
Reuters Health reports that a review of 55 past studies concluded that people who have more that a couple of alcholic drinks every day tend to have more complications after surgery than teetotalers or light drinkers. Infections and slow wound healing were the most common complications associated with heavy drinking.
Patients who drank heavily leading up to surgery were also more than twice as likely to die in the month after their procedures than abstainers, according to lead author Marie Eliasen of the National Institute of Public Health at the University of Southern Denmark in Copenhagen.
While the analysis confirms that “alcohol and surgery are a bad combination,” it’s not clear what effect stopping drinking before surgery would have on complications, Bolette Pedersen of the Clinical Health Promotion Center of Bispebjerg told Reuters by email. Pedersen was not involved in the review.
A recent New York Times article highlights America’s growing use of narcotic painkillers in the past decade. Once prescribed primarily for short-term discomforts, OxyContin and other popular opiods now provide relief from such chronic conditions as back injuries, headaches and arthritis – though questions have arisen about the long-term effectiveness of such drugs.
The growing reliance on painkillers has led to an increase in usage beyond what is required for treatment. In addition to the risk of addiction, side effects can include psychological dependence, reduced drive, extreme lethargy and sleep apnea.
Deaths from opoid overdoses have also risen in the past decade, especially among females. According to the Centers for Disease Control and Prevention, prescription pain pills were involved in 6,631 overdose deaths, intentional and unintentional, among women in 2010, a 415% increase from the 1,287 such deaths in 1999.
In spite of the known risks, narcotic painkillers are now the most widely prescribed class of medications in the United States. But depending on a patient’s overall health, many ailments for which opoids provide temporary comfort may realize more lasting relief through physical therapy.
(Thanks to John Goodman’s Health Policy Blog for the link.)
While the health care community was still abuzz about the announcement that the federal government would postpone the employer mandate until 2015, the Obama administration quietly communicated on Friday that it would also reduce the onus on state exchanges to verify consumers’ income and health insurance status.
The Washington Post reports that in 2014, the insurance marketplaces could rely more heavily on consumers’ self-reported information, in the hopes that stronger verification systems would be in place the following year.
Under the Affordable Care Act, Americans who earn less than 400% of the proverty line – roughly $45,000 for an individual – can use tax subsidies to offset the cost of buying health insurance, provided they don’t already receive affordable health insurance from their company. The new regulations put prospective exchange customers on the honor system in regard to meeting this criteria.
“The exchange may accept the applicant’s attestation regarding enrollment in eligible employer-sponsored plan… without further verification,” according to the final rule, which also scaled back states’ responsibilities to double-check the income levels that consumers report.
The Food and Drug Administration has proposed a rule that would allow generic drugmakers to add new side effect information to their product labeling without first getting approval from the agency, Pharmalot reports. Currently, such drugmakers can only change their labels when updates have first been made to brand equivalents.
The move would mean that generic drug companies could face the same sort of liability over product labeling as brand-name drugmakers – something the Supreme Court essentially protected them against in a ruling last month. Consumer advocates applauded the proposal.
“Many potential hazards are not discovered until years after drugs have been on the market,” says Public Citizen’s Sidney Wolfe in a statement. “Yet, currently, drug manufacturers can do little to warn doctors and patients about newly discovered information, putting patients at risk. The proposed rule is a classic example of harm reduction. When finalized after public comments, it will provide added protection to the tens of millions of people who regularly use generic drugs.”
The rule “would amend the regulations regarding new drug applications, abbreviated new drug applications and biologics license applications to revise and clarify procedures for changes to the labeling of an approved drug to reflect certain types of newly acquired information in advance of FDA’s review of such change,” according to the US Office of Management and Budget.
Businesses have just received a one-year reprieve from enforcement on the penalties for firms not offering affordable coverage to employees working more than 30 hours per week. Yesterday, the White House announced that it has pushed back until 2015 any penalties for the Affordable Care Act provision that would require businesses with 50 or more employees to provide health insurance.
Sometimes referred to as the “pay or play” rule, the mandate has met with criticism by many businesses, which objected to its requirement that they offer coverage to all “full-time” workers – defined under the health care reform law as those who work at least 30 hours per week – or pay a penalty.
In response to the complaints, the Treasury Department expressed its willingness to give employers more time to implement the requirement. “We recognize that the vast majority of businesses that will need to do this reporting already provide health insurance to their workers, and we want to make sure it is easy for others to do so,” wrote Mark J. Mazur, Assistant Secretary for Tax Policy, in a blog post.
Mazur added that the one-year postponement will allow the Treasury “to consider ways to simplify the new reporting requirements consistent with the law.”
Keep in mind that this delay does not affect other employer-related provisions of the ACA that are now or soon to go into effect, such as the Patient-Centered Outcomes Research Institute (PCORI) and Transitional Reinsurance Fees.
More guidance is expected to come out in the next week, and the MedBen Compliance Team will continue to monitor ACA activity and keep clients informed. In the meantime, clients with questions regarding this news may contact Vice President of Compliance Caroline Fraker at firstname.lastname@example.org.
Additionally, MedBen will update its Twitter stream (@MedBenTPA) with any additional clarifications over the next few days. The Twitter stream can be seen by following @MedBenTPA on Twitter.
Happy Independence Day from the staff at MedBen!
Our home office will be closed on Thursday, July 4 to observe the holiday. However, we will be open during our regular business hours on Friday, July 5.
Remember that even when our office is closed, our online customer service is available 365 days a year! To use our MedBen Access claims and benefits information service, simply go to MedBen.com and select “MedBen Access". For those who use Pharmacy Data Management (PDM) as their pharmacy benefits manager, you can check on prescription claims and find lower cost drug options through MedBen Access by clicking on the “Rx” button located in the “My Claims” section of this website.
If you’re a MedBen Flexible Spending Account (FSA) or Health Reimbursement Arrangement (HRA) participant in addition to having other coverage, you also can use MedBen Access to see your FSA/HRA balances, claims submissions and payments. When you log in to MedBen Access, you’ll find an “FSA/HRA Online Inquiry” option (visible only to groups offering MedBen FSAs/HRAs) under the “My Plan” section located on the left sidebar. By selecting this option, users are automatically taken to the MedBen FSA/HRA Online System.
Plan members who prefer to log in directly to the MedBen FSA/HRA Online System can do so by going to the “Plan Members (Insureds)” area of MedBen.com and selecting “FSA/HRA Account Information” from the “Online Services” drop-down menu. Login requires a separate User ID and PIN.
Sometimes, the words “patient” and “consumer” are used interchangeably. And while it may seem unbecoming to describe a person getting a checkup with the same term used for buyers of Big Macs, there are times the word is entirely appropriate, writes Roys Laux:
“[A]s healthcare coverage changes in America, as patients become more responsible for paying out of pocket upfront, you can bet they’ll be looking at the decisions through a consumer lens.
“It’s time for all of us to change our thinking.
“Consumers need to think about what matters most to them so they can effectively value a provider or treatment when they embark on their next hiring decision. A convenient appointment time and waiting room with amenities may be valuable to one, while another places greater value on the volume of procedures the HCP performs each week and yet another values physician bedside manner and staff responsiveness most. With greater visibility into patient experience before one hires a provider, consumers can determine just what service they’re willing to pay for and how much.
“Caregivers need to be open to and encourage patient feedback. Many physicians don’t like to think of new patient acquisition as a ‘hiring experience.’ But that’s exactly what it is. Consumers are paying for a service – a very personal, very important service. Providers should provide great customer service, great clinical quality and visibility about price every step of the way.”
The Food and Drug Administration has approved Brisdelle, the first nonhormonal drug to treat menopausal women, The New York Times reports. Prior to its introduction, treatment had always consisted of hormone therapy.
“There are a significant number of women who suffer from hot flashes associated with menopause and who cannot or do not want to use hormonal treatments, “Dr. Hylton V. Joffe, director of FDA said.
The clinical trial was conducted during a 12 week period. At the conclusion of the study, patients that were administered the Brisdelle had half as many hot flashes as they did prior to taking the drug.
The action by the FDA was somewhat unexpected, because an advisory committee to the agency voted 10 to 4 in March against approval.
No price has been set on Brisdelle, which is due to come onto the market in November. There is, however, a very strong warning label. The drug may cause suicidal thoughts and behavior, and if taken in accordance with other medication such as Tamoxifen, it may reduce the drugs effectiveness to treat breast cancer.
Talk about your rude awakenings… 43% of uninsured Americans are unaware that they may be required to buy health insurance coverage next year, according to a new Gallup survey.
The Healthwatch Blog reports that awareness of the Affordable Care Act’s individual mandate, which requires most taxpayers to buy insurance or pay a penalty, was lower among uninsured people than the general public.
Conversely, most individuals not directly affected by the mandate already know about it. Of the respondents who have coverage, 86% said they’re familiar with the rule.
The individual mandate becomes effective on January 1, although significant exemptions will be available to those who can’t afford coverage even with help from government subsidies. The penalty in 2014 for failing to comply with the mandate is the greater of $95 or 1% of income.