Kaiser Health News offers a handy overview of the legal challenges to the Affordable Care Act, which the Supreme Court will hear over a three-day span later this month. All told, the justices have scheduled six hours of arguments – the most time given to any case since 1966.
At the core of the case is the constitutionality of the individual mandate – the provision of health care reform that would require most Americans to purchase health coverage or pay penalties. The Obama administration will defend the law, while 26 states (along with a business group and four individuals) will challenge it.
The proceedings will begin on March 26, when the justices will hear arguments as to whether the penalty provision of the individual mandate is a “tax", and thus subject to the Anti-Injunction Act. If so, the case could potentially be deferred until 2015, as tax laws can’t be ruled before payments are due.
On March 27, the parties will argue whether or not Congress has the authority to require that people buy insurance under its interstate commerce powers. Defenders say that the individual mandate will end “discriminatory insurance practices that have excluded millions of people from coverage based on medical history,” while critics counter that “the power to compel individuals to engage in commerce in order more effectively to regulate commerce” doesn’t exist.
Finally, March 28 will tackle “severability” – namely, if the individual mandate is struck down, what happens to the rest of the health reform law? Should that happen, the government argues that the ACA could stand, save for “guaranteed-issue” and “community-rating” provisions. The 26 states counter that the mandate was deemed by Congress to be “necessary to make the other provisions work as intended,” and that the court should strike down the whole law.
Studies that confirm the potential hazards of red meat and sugary drinks hardly qualify as front page news nowadays – but the occasional reminder about their risks doesn’t hurt, either. So with that in mind:
Even a small amount of red meat in your diet can significantly increase the chances of premature death, according to a long-range Harvard study. The Los Angeles Times reports that research conducted over 20 years found that that a single daily 3-ounce serving of unprocessed red meat – say, a steak the size of a deck of cards – was associated with a 13% greater chance of dying. And a daily serving of unprocessed red meat, such as a hot dog, increased the risk to 20%.
On the other hand, substituting a serving of nuts for beef or pork was linked to a 19% reduction in the reisk of dearth during the study. Choosing poultry or whole grains also proved beneficial, lowering mortality risk by 14%, while low-fat dairy or legumes decreased risk by 10%, and fish by 7%.
According to Harvard research published by the American Heart Association, men who drank a 12-ounce sugar-sweetened beverage a day had a 20% higher risk of heart disease compared to men who didn’t drink any sugar-sweetened drinks.
Medical News Today reports that the study of over 42,000 men determined that the increase persisted even after controlling for other risk factors, including smoking, physical inactivity, alcohol use and family history of heart disease. However, less frequent consumption – twice weekly and twice monthly – didn’t increase risk.
Beginning in 2013, the Affordable Care Act will change the maximum amount an employee may contribute to a Health FSA plan on a calendar year basis. But if your Health FSA plan happens to run on a plan year basis, it’s critical to be aware of this change and take appropriate measures this year, not next.
Effective January 1, 2013, Health FSA plans may not permit employee salary contributions to exceed $2,500 in a calendar year. For “plan year” groups, this affects your FSA elections in 2012, as the payroll deductions that occur in January 2013 can affect the 2013 Health FSA payroll deductions. Because the maximum deduction for calendar year 2013 cannot exceed $2,500, if a participant elects a greater amount in the 2012-2013 plan year, the amount withdrawn from their 2013 pay could potentially be greater than $2,500.
Example: ABC Company’s plan year runs July to June. Their Health FSA has a maximum contribution of $4,000.
John elects $4,000 in his Health FSA for the July 2012 to June 2013 plan year. He has 24 pay cycles per year (2 per month) and has a total of $333.32 per month deducted from his salary. In July 2013 he elects $2,500 in his Health FSA plan for the July 2013 to June 2014 plan year and has $208.33 per month deducted.
From January 2013 to June 2013, $1,999.92 was deducted on a pre-tax basis ($333.32 x 6 months), and from July 2013 to Dec 2013, $1,249.98 was deducted on a pre-tax basis ($208.33 x 6 months). The total of the two plan year deductions equals $3,249.90, which is greater than the $2,500 permitted by the IRS for the calendar year 2013. This could cause tax consequences for the participants as well the plan for permitted the deductions.
MedBen strongly recommends that groups change their 2012 Health FSA maximum to $2,500 to avoid potential tax issues for plan participants in 2013. Our Health FSA clients with questions regarding this change are welcome to call Sharon A. Mills, Director of Administrative Services, at (800) 423-3151, Ext. 438.
More evidence that newer metal-on-metal (MOM) hip replacements may not be as effective as traditional implants: A British study found that all-metal implants require maintenance at a much higher rate than other types, the Associated Press reports.
Experts analyzed data for more than 400,000 hip replacements – 31,000 of them MOM devices – from the National Joint Registry of England and Wales between 2003 and 2011. After five years, MOMs failed in about 6% of the people studied, requiring repair or replacement. In contrast. the failure rate for people who had ceramic or plastic joints ranged from 1.7% to 2.3%.
Ashley Blom, head of orthopedic research at the University of Bristol and one of the study authors, noted that while over 9 out of 10 MOM implants work fine, the fact that safer alternatives are available means that people need not take the risk. “If I were a patient, I would not choose a metal-on-metal hip,” he said.
Last November, the Food and Drug Administration sponsored a report that uncovered similar failure problems with all-metal hip replacements, and requested that makers conduct safety studies on them.
According to AP, doctors usually expect hip joints to last at least a decade.
March is National Colorectal Cancer Awareness Month – and as such, a perfect time to remind adults between the ages of 50 and 75 about the benefits of getting a colonoscopy.
According to HealthDay, about 1 in 3 U.S. adults who should get screened for colorectal cancer have not yet done so.
“Colorectal cancer is one of the most preventable cancers because the majority of colorectal cancers arise from precancerous growths in the colon called polyps, which can be found during a colonoscopy screening exam and removed before they turn into cancer,” Dr. Gregory Ginsberg, president of the American Society for Gastrointestinal Endoscopy (ASGE), said in a society news release.
Ginsberg also stressed the importance of following pre-colonoscopy instructions carefully to ensure the colon is thoroughly cleaned so no polyps or cancers are missed during the procedure.
MedBen encourages its clients to follow standard guidelines for colonoscopies, mammograms, PSAs and other screenings, as well as an annual wellness exam. MedBen Worksite Wellness members can check their compliance with critical wellness examinations by visiting the MedBen Access website and clicking on the Wellness Plan link under “My Plan”.
A program designed to help people who can’t afford prescription medications has recently come under government scrutiny, Pharmalot reports.
Created in 1992, the 340B Drug Pricing Program offers discounts to public and non-profit health care facilities that provide outpatient drugs. Through the program, participating hospitals and clinics can realize savings of 20-50% off the cost of drugs – and potentially generate additional revenue if government reimbusements exceed prices paid.
But a 2011 report by the US Government Accountability Office found that oversight of the program is inadequate to ensure that participating facilities administer the discounted drugs only to eligible patients, and that drugs are sold to those facilities at or below agreed upon prices. And last week, four Republican members of Congress wrote to several pharmaceutical organizations, including Pharmaceutical Research and Manufacturers of America (PhRMA) and the Biotechnology Organization (BIO), to request detailed information about 340B pricing and audits, and address possible incidents of hoarding.
“With the reliance on self-policing among participating manufacturers and covered entities and the increase in the number of new settings in which the program is offered, the risk of improper purchases or diversion of 340B drugs has significantly increased,” wrote US Senators Orrin Hatch, Chuck Grassley and Mike Enzi, as well as Congressman Joe Pitts.
The Department of Health and Human Services has released a final rule for the implement of state health insurance exchanges, a cornerstone of the Affordable Care Act. The 644-page document outlines details of the insurance marketplaces that will enable uninsured individuals and small businesses to purchase coverage beginning in 2014.
“The final rule outlined the minimum standards states must meet in establishing and operating their exchanges, such as individual and employer eligibility for enrollment. The rule also outlines minimum standards that health insurers must meet to participate in an exchange and the standards employers must meet to participate in the exchange.
“The regulation aims to offer states ’substantial discretion’ in both the design and operation of their exchanges, according to the rule.”
The rule will become effective 60 days after publication in the Federal Register. However, HHS will accept comment on some sections of the regulation, such as “provisions related to the ability of a state to allow agents and brokers to assist qualified individuals in applying for advance payments of the premium tax credit and cost-sharing reductions for qualified health plans, Medicaid and CHIP regulations, options for conducting eligibility determinations and verification for applicants,” as Modern Healthcare notes.
No doubt you’re aware there’s been a lot of talk about birth control lately. Under the Affordable Care Act, contraceptive coverage must be provided to women at no cost beginning August 1. But while the religious and moral implications of this rule have grabbed the headlines, of equal importance is just how far-reaching coverage is expected to go.
There are still a number of unanswered questions about what types of birth control must be covered and how insurers should structure their policies. So Kaiser Health News recently dove headfirst into the regulatory morass and attempted to clear things up a bit. You can read the complete answers at their website, but we’ll provide a preview here:
Are male-based contraceptive methods, such as vasectomies or condoms, covered by the rule? According to a Health and Human Services official, the preventive services guidelines apply to women only.
Are over-the-counter products like female condoms, spermicides, sponges covered by the rules and, if so, will they require a prescription and how will insurers reimburse policyholders for purchases at retail stores? Products that must be covered without cost-sharing include over-the- counter contraceptives when they are prescribed by doctors, the HHS official said. But what specific OTC products are to be included is unclear.
If a hospital stay is required for surgical procedures, such as when a women gets her tubes tied, would the procedure be covered without cost sharing? HHS has not weighed in on this question, but is expected to issue additional guidance in the coming months.
Will insurers be required to cover all products in a class, such as all IUDs, or all birth control pills? Can insurers require a co-pay for a brand-name drug if a generic is available? Insurers say HHS guidance allows them to use “reasonable medical management” to help control costs, which would include allowing them to charge patients for brand name drugs. The HHS official concurred, but stressed the plan must “accommodate any individuals for whom it would be medically inappropriate by having a mechanism for waiving the otherwise applicable cost-sharing for the branded version.”
Who will be covered for contraceptives without co-payments? The package of women’s preventive care benefits must be offered in all new insurance policies sold to individuals and employers starting Aug. 1, as well as in most policies that renew afterwards on the date that they renew. There is an exception for insurance provided by certain nonprofit religious employers who object to birth control.
The Food and Drug Administration may allow popular prescription drugs for high cholesterol, diabetes and other chronic conditions to be sold over the counter. Reuters reports that the agency has sought public comment this week on a plan to make these medications more readily accessible, and will hold a meeting about the proposal later this month.
Previously, the FDA had denied requests to sell cholesterol-lowering drugs without a prescription because of concerns that patients wouldn’t know how to take the drug safely. Proper use requires a knowledge of fat elevations in the blood, known as lipids, which consumers cannot easily determine.
Even considering such a change marks a major turnaround for the agency. Typically, over-the-counter drugs treat such short-term conditions as headache or runny nose, and require only a factbox or pamphlet to take safely. But as Reuters notes, such new technologies as self-serve kiosks, touchscreen pads or interactive videos may help to educate pharmacy customers about drug risks.
By increasing availability, the FDA is hoping that people with chronic conditions would be more vigilant about taking their medications.
A new study demonstrates that stick-to-it-tiveness pays big dividends when it comes to employee health. According to Medical Xpress, researchers found that employees who participated in a wellness program spent less on health care, while employers realized a return on investment (ROI) of almost $3 to $1 over three years.
To determine ROI, the study’s authors tracked the wellness program of a large financial services corporation. Analyzing participation and medical claims data for close to 50,000 employees, and factoring in the program’s implementation costs, they revealed a loss in year one with net savings in years two and three – a 2.45:1 overall ROI.
At MedBen, our clients have realized similar positive outcomes through our worksite wellness program. Our original idea was simple – detect and treat health risks and potentially chronic conditions as early as possible. And provide clear reports that show employers how the program is working.
We chose to offer a wellness program that involves your physicians and uses claims data to track progress. And employers who have put this program in place several years ago have seen measureable results – in a healthier workplace and a healthier bottom line.
To learn more about how wellness can benefit your business, we invite you to call MedBen Vice President of Sales and Marketing Brian Fargus at (888) 627-8683.
A consumer watchdog group’s claim that some popular soft drinks contains a cancerous chemical has brought a rebuttal from the Food and Drug Administation, Reuters reports.
The Center for Science in the Public Interest (CSPI) said Coca-Cola, Pepsi-Cola and Dr. Pepper contain unsafe levels of 4-methylimidazole (4-MI) in their caramel coloring agents. “Coke and Pepsi, with the acquiescence of the FDA, are needlessly exposing millions of Americans to a chemical that causes cancer,” said CSPI executive director Michael Jacobson.
In response, the FDA said it would consider the group’s petition but consider the drinks safe. “A consumer would have to consume well over a thousand cans of soda a day to reach the doses administered in the studies that have shown links to cancer in rodents,” noted Doug Karas, an FDA spokesman, in a statement.
The FDA’s limit for 4-MI in caramel coloring is 250 parts per million (ppm) prior to its dilution in soda. The highest levels of 4-MI found by CSPI were about 0.4 ppm, according to Reuters calculations.
The American Beverage Association also issued a statement: “This is nothing more than CSPI scare tactics. In fact, findings of regulatory agencies worldwide… consider caramel coloring safe for use in foods and beverages.”
Electronic patient records have been the subject of multiple studies, which have borne out the theory that the health information technology (HIT) reduces costs. But new research that focuses on how such information is used paints a very different picture.
According to The Wall Street Journal Health Blog, a study of medical test availability found that doctors who had computerized access to imaging tests and lab results were actually more likely to order more tests (in 18% of visits) than those who used paper records (12.9%). When more advanced imaging tests were considered, the difference spiked to 71% for doctors with electronic access.
So what’s going on here? The research isn’t clear on this point, but study co-author Danny McCormick of the Cambridge Health Alliance says he and his fellow authors speculate that because test results often fall in a grey area, “subtle factors such as the convenience of retrieving results” may spur a doctor to order an additional test.
“If [doctors know] that the image result will show up on the screen with no questions and no problems, it may subtly influence them to order” the test, says McCormick. Further, as the study observes, doctors who typically order tests may also be more likely to have HIT in place – making all the easier to view those tests.
An interesting opinion piece in the New York Times yesterday. Samuel D. Waksal, founder and chief executive of the biotechnology company Kadmon, believes that patients and insurance companies shouldn’t have to pay for prescription drugs unless they produce positive and provable results.
“Here’s how this ‘pay-for-response model’ would work: Say a drug company receives approval for a breast cancer drug. Potential patients would be screened to determine whether their cancer was likely to respond to the drug, depending on whether it had, for example, a particular genetic marker. Most of the cancers that do should respond to the drug, but the presence of the genetic marker is still no guarantee. The Food and Drug Administration could help to come up with criteria with which to determine whether a patient is responding to a drug. If the patient’s oncologist and radiologist determine that the patient is benefiting based on those criteria, then the drug company should be paid. For a cancer drug, these criteria could include anything from tumor shrinkage to survival…
“Not only would this save money, but it would also push drug companies to figure out why certain patients don’t respond to treatment and what to do about it, and researchers to aggressively study genetic variation in disease before beginning larger studies. It would also encourage testing with multiple drugs, approved and experimental, to target just the right pathways of disease in each and every population. Biotechnology companies like mine could stand to profit from this change, but the overall gains to the health care system would be far larger.”
The complete editorial is available on the Times website. (The paper does note that, prior to his work at Kadmon, Waksal spent five years in prison for insider trading.)
If you’ve checked your calendar lately, you may be aware that we’re fast approaching one of the most dreaded days of the year. Sunday, March 11 heralds the return of daylight savings time – which means one less hour of precious slumber.
Nor are the irritations of “springing forward” limited to losing sleep and resetting the clocks. According to Aparajitha Verma, M.D., medical director of the Sleep Disorders Center at the Methodist Neurological Institute in Houston, the average person needs about three or four days to adjust to the time change.
However, there are a few simple strategies minimize the impact to your internal clock. Verma suggests getting up an hour earlier and going to sleep an hour earlier. Take a nap in the afternoon on Sunday if needed, but not within a few hours of bedtime. Napping too close to bedtime can disrupt nighttime sleep.
An even better approach is to practice good “sleep hygiene” year-round, by following these tips (via Medical Xpress):
The Wall Street Journal Health Blog reports that only 10% of coronary stent recipients are given information on alternative treatment options, based on a survey of nearly 500 Medicare patients.
The study – which, it should be noted, was based solely on the patient’s recollection of events – also found that only 19% of coronary stent recipients recalled discussing the drawbacks of the procedure, and only 16% recalled being asked their preferences for treatment type.
A coronary stent is a tube placed in the heart arteries to keep the vessels open. According to Reuters Health, stenting procedures cost the United States about $12 billion every year and up to half of the procedures are unnecessary.
At MedBen, we promote informed heart treatment through Comprehensive Cardiovascular Care Management. Provided through inVentiv Care Management, this clinically accountable solution focuses on cost-effective, safe, and integrated care management for patients affected by cardiovascular disease.
Care management does not and will not overrule the decisions of a patient’s physician. It merely works with the doctor to ensure that the patient is receiving the proper level of treatment, and that his or her care is eligible for coverage under your company’s health care plan.
For additional information about Comprehensive Cardiovascular Care Management and other Accountable Care Solutions available through MedBen, contact Vice President of Sales and Marketing Brian Fargus at (888) 627-8683.
New presidential budget numbers that spike the estimated cost of government insurance subsidies has Republicans on Capitol Hill demanding an explanation, the Associated Press reports.
House Ways and Means Committee Chairman Dave Camp (R-Mi.) wants to know why revised budget numbers put the cost of helping individuals buy health coverage from state exchanges at $478 billion for the years 2014-2021 – about a 30% jump from last year’s budget estimate of $367 billion.
“This staggering increase … cannot be explained by legislative changes or new economic assumptions, and therefore must reflect substantial changes in underlying assumptions regarding … costs,” Camp wrote in a March 2 letter to Treasury Secretary Tim Geithner.
Administration officials claim the increase is due primarily to the effects of newly signed legislation that will raise the cost for one part of the Affordable Care Act, but still save money overall. “The estimates do not assume changes in what exchanges look like, the cost of insurance, or the number of Americans who will get their insurance in this new marketplace,” Treasury spokeswoman Sabrina Siddiqui said in a statement.
If you’re really determined to lose weight, it may aid your cause to hook up with some like-minded people. A recent study suggests that a dedicated team effort helps participants shed at least 5% of their initial body weight, according to WebMD.
“People around us affect our health behaviors,” says researcher Tricia Leahey, PhD. “It could be quite beneficial if a bunch of friends that choose to lose weight make healthy food choices together, and hold each other accountable to those choices.”
Researchers followed a 12-week online weight loss competition in 2009, composed of teams with between 5 and 11 members. They found that people who lost who lost a significant amount of body weight tended to be on the same teams, motivating each other. “If someone is doing really well, it could influence the whole group,” Leahey says.
Noteworthy in the study was the “virtual” nature of the teams, with members getting together via the web. “Social support helps people to do better, and there are a variety of ways to accomplish it,” says Louis Aronne, MD, founder and director of the Comprehensive Weight Control Program.
Does the thought of a dental exam make your teeth chatter? Chances are, your anticipation will far exceed the actual event. But if that knowledge does nothing to calm your fears, WebMD offers a few suggestions, which we summarize here (you can read detailed tips at their website):
By the way, if you’re covered under a MedBen Dental plan, here’s something else to keep in mind: Members have complete freedom of provider choice, so there are no limitations as to which dentist you can use. If one doesn’t “cater to cowards” as advertised, you’re welcome to take your teeth elsewhere.
Employers who would like to know more about MedBen Dental can contact Vice President of Sales and Marketing Brian Fargus at (888) 627-8683.
Unpleasant written warnings about the hazards of smoking will not be accompanied by even more unpleasant visual warnings. According to The Wall Street Journal Health Blog, U.S. District Judge Richard Leon ruled that the federal requirement to place graphic images on cigarette packs is unconstitutional.
The Food and Drug Administration announced the requirement in 2010, with the hopes that by displaying diseased lungs, tracheotomy holes and other disturbing imagery on packages, smokers would think twice before reaching for a cigarette. R.J. Reynolds and other tobacco companies filed a lawsuit against the agency last August, claiming that the rule violated their First Amendment protections against government-compelled speech.
In his ruling, Leon said that the Obama administration failed “to convey any factual information supported by evidence about the actual health consequences of smoking through its use of these graphic images.” He added that the government could have used alternative means to promote an anti-smoking message, such as changing the images to provide actual information rather than simply evoke an emotional response.
In November, Leon had halted the FDA requirement from moving forward pending the outcome of the lawsuit. At the time, he noted that cigarette makers would likely succeed in their effort.
Sometimes, its seems like the more we learn about better health, the less we know. New research can modify or even negate the wellness information that we’ve taken as gospel for years.
Leslie Goldman at Oprah.com recently examined four extablished health rules that no longer hold water – one, literally – and new rules to consider in their place. We’ve summarized them below.
Old Rule: Drink eight glasses of water a day. New Rule: Eat your water.
Much of your daily requirement of water is contained in foods, such as fruits, vegetables, beans, and cooked whole grains like oatmeal. And they offer the added bonus of nutrients.
Old Rule: Eat nine servings of fruits and vegetables. New Rule: Fill half your plate with produce.
Put away the measuring tools, and just make half of every meal produce. And quality counts: Even two or three daily servings of deeply hued fruits and veggies (like blueberries or red peppers) may help reduce your risk of cancer and heart disease.
Old Rule: Avoid red meat. New Rule: Beef in moderation can be healthy.
A recent study found that the cardiovascular risk of red meat comes from processed varieties, such as sausage, hot dogs, and cold cuts – not from steak and hamburgers. Three 4- to 5-ounce servings per week is a good source of iron and immunity-boosting zinc.
Old Rule: Keep your BMI between 18.5 and 24.9. New Rule: Eat healthy, exercise, and let your weight settle naturally.
Cirtics say body mass index ignores a person’s muscle mass and hip circumference. Instead of BMI, focus on eating a nutritious diet and logging 150 minutes of exercise per week.