Health Policy News
Analysis Examines Industry-Wide Implications of the Stupak/Pitts Amendment Banning Funding of Abortion Under Health Reform Bill
WASHINGTON - The Stupak/Pitts Amendment was added to the Affordable Health Care for America Act (H.R. 3962), which passed the House on November 7th. The amendment bans federal funding for abortions and bars payment of federal subsidies to health insurance products sold in exchanges that cover most medically indicated abortions.
An analysis conducted by the GW School of Public Health and Health Services’ Department of Health Policy, concludes that the Amendment would produce industry-wide effects, leading to the elimination of health plan coverage for nearly all medically indicated abortions. Although the Amendment appears to address only plans that receive federal exchange subsidies, even health plans sold to private, large employers that purchase outside the exchange ultimately are likely to be affected, the analysis concludes. These findings are based on an assessment of the extent to which the health benefits services industry adjusts its products over time to conform to the regulatory environment in which it operates.
"Under national health reform, millions of women, including women who are covered by small employers (as employees or spouses or dependents of employees) as well as those who are currently uninsured, will receive their coverage through health insurance exchanges. By barring the sale of subsidized products that cover medically indicated abortions as part of a broader package of benefits, the Amendment can be expected to cause the industry to re-design its offerings in order to avoid violating the legal restrictions on abortion applicable to exchange products that receive subsidies," said Professor Sara Rosenbaum, JD, lead author and Chair of the Department of Health Policy. "The Amendment also can be expected to chill efforts to develop supplemental coverage for medically indicated abortions, because it appears to prohibit the joint administration of both a basic and supplemental product," Rosenbaum noted.
The analysis also concludes that, based on past experiences with claim administration decisions involving treatment exclusions, insurers can be expected to interpret the exclusion broadly, excluding coverage of not only most medically indicated abortion procedures but also treatments for serious illnesses, injuries, and medical conditions that include an abortion undertaken for health reasons.
The analysis is available at http://www.gwumc.edu/sphhs/departments/healthpolicy/dhp_publications/pub_uploads/dhpPublication_FED314C4-5056-9D20-3DBE77EF6ABF0FED.pdf
About The George Washington University Medical Center The George Washington University Medical Center is an internationally recognized interdisciplinary academic health center that has consistently provided high-quality medical care in the Washington, DC metropolitan area, since 1824. The Medical Center comprises the School of Medicine and Health Sciences, the 11th oldest medical school in the country; the School of Public Health and Health Services, the only such school in the nation’s capital; GW Hospital, jointly owned and operated by a partnership between The George Washington University and a subsidiary of Universal Health Services, Inc.; and the GW Medical Faculty Associates, an independent faculty practice plan. For more information on GWUMC, visit www.gwumc.edu.
Media Contacts: Anne Banner, GW,202-994-2261 Sara Rosenbaum, GW, 202-994-4230
The George Washington University Medical Center Office of Communications 202-994-2261
Professor Sara Rosenbaum Named Among Founding Directors of FAIR Health
Professor Sara Rosenbaum Named Among Founding Directors of FAIR Health - Goal of Transparency and Fairness in Health Insurance and Physician Payment Pricing
WASHINGTON - Sara Rosenbaum, J.D., Hirsh Professor of Health Law and Policy and chair of the Department of Health Policy at The George Washington University School of Public Health and Health Services, was named as one of three Founding Directors of FAIR Health, Inc. by New York Attorney General Andrew Cuomo. The not-for-profit corporation, established by Attorney General Andrew Cuomo as part of a legal settlement with the health insurance industry, has a stated mission of bringing “transparency, accountability, and fairness” to the setting of prices for physician services by health insurers.
FAIR Health is financed by a nearly $100 million financial settlement as part of a wide-ranging investigation by Cuomo’s office into how the health insurance industry reimburses consumers for out-of-network health care charges. The corporation will oversee the development of a consumer website and a research database through a special arrangement with the Syracuse University, Cornell University, the University of Rochester, SUNY Upstate Medical University and the University at Buffalo. The initiative will permit consumers, for the first time, to compare health care costs before choosing a provider. It will also result in a comprehensive physician fee data base that will be made available to universities nationwide for research and scholarship.
DHP in the News!
Publications
Requiring health care workers to be vaccinated against influenza is one strategy for reducing its spread in health care settings. SPHHS has released a report that reviews the arguments for and against such mandates, given the risks of influenza in health care settings, the availability of safe and effective vaccines to reduce that risk, and the inadequate health care worker compliance with immunization recommendations (fewer than 50% comply). The report is available at http://www.gwumc.edu/sphhs/about/rapidresponse/index.cfm
Christine Ferguson, J.D., research professor, and Anna Muldoon, M.P.H. candidate, research assistant, published "Not All are Created Equal: Differences in Obesity Attitudes Between Men and Women" in the Sept./Oct. 2009 issue of the journal Women’s Health Issues. The invited commentary, written on behalf of the STOP Obesity Alliance, explores sources and effects of stigma in several environments and attitudinal differences between men and women when it comes to obesity interventions and perceptions. The commentary is available at http://www.whijournal.com/article/S1049-3867(09)00069-3/fulltext
A new article titled "A four-system comparison of patients with chronic illness: the Military Health System, Veterans Health Administration, Medicaid, and commercial plans" has been published by a team of researchers from Thomson Reuters, the Veteran's Administration, Massachusetts General Hospital, and our own Julia Hidalgo, Ph.D., in Military Medicine 174(9).
Sara Rosenbaum, J.D., Hirsh Professor of Health Law & Policy and DHP chair, was a co-author of "Evidence Of An Emerging Digital Divide Among Hospitals That Care For The Poor" which appears as a Health Affairs on-line exclusive. The article explores the growing digital divide in the U.S., noting that hospitals that provide care to large numbers of poor patients also had minimal use of EHRs. It is available at http://content.healthaffairs.org/cgi/content/full/hlthaff.28.6.w1160/DC1
Professor Rosenbaum also wrote a blog for the O'Neill Institutes Legal Solutions in Health Reform blog. "It's the sick, stupid" looks at the importance of protections of protecting the sick from discrimination by insurers in health reform legislation, and is available at http://oneillhealthreform.wordpress.com/
Alexandra Stewart, J.D., published invited commentary regarding the introduction of the HPV vaccine in the U.S. in the British Journal of Healthcare Management (Vol 15 No 11, 2009). Please contact Ms. Stewart if you would like a copy of the article.
Awards & Acknowledgments
The WSJ referenced the recent DHP report "Using Primary Care to Bend the Curve: Estimating the Impact of a Health Center Expansion on Health Care Costs," in an article on federally funded health centers and their financial struggles in time of patient load growth. The story can is available at online.wsj.com/article/SB125409659506345101.html The report also received prominent mention in the House reform bills' Trust Fund to grow CHCs. Department of Health Policy Senior Fellow Margaret Dunkle has been appointed Co-Chair of the Committee on Early Identification and Treatment of the North Los Angeles County Autism Regional Task Force.
On October 22nd, Leighton Ku, Ph.D., spoke about Latino children's health at the National Council of La Raza's symposium titled "Investing in Our Future: The State of Latino Children and Youth." Other speakers included HHS Secretary Kathleen Sebelius, Senator Bob Menendez, and Marian Wright Edelman of the Children's Defense Fund.
The NY Times reviewed "Technological Medicine," a collection of essays on medical technology by Stanley Joel Reiser, M.D., M.P.A., Ph.D., clinical professor. The review is available at http://www.nytimes.com/2009/10/27/health/27books.html?_r=1&ref=health and it is quite good! David Stevens, M.D., F.A.A.F.M., research professor and Director of Quality, NACHC, addressed the October 20th Cabot Primary Care Lecture Series on "Community Health Centers: America's Health Care Home."
Health Care Fraud Challenges Both Public and Private Sectors
PRESS RELEASE:
WASHINGTON - A new analysis published by The George Washington University School of Public Health and Health Services, Department of Health Policy, in collaboration with the National Academy for State Health Policy, finds that health care fraud poses a major challenge in both the private and public insurance sectors and recommends policies aimed at assuring uniform and transparent measurement and reporting of fraud across all forms of coverage. "A critical problem under current policy is the absence of ongoing and reliable fraud estimates similar to those available in the case of public health insurers," said lead author Sara Rosenbaum, Harold and Jane Hirsh Professor of Health Law and Policy and Chair of the Department. "As a result, it is difficult to fashion consistent policies to address fraud, a critical component of health reform."
The report, Health Care Fraud, also finds that fraud information related to public programs is frequently confused with payment error data. "While payment errors represent a major area for program improvement," Rosenbaum notes, "it is essential to separate such errors from actual instances of fraud, since the two problems call for distinct corrective strategies."
This report is issued as Congress considers steps to strengthen the tools and resources available to law enforcement to investigate and prosecute fraud, and as states focus increased attention on this problem.
In reviewing extensive data on health care fraud, the analysis points to evidence that fraud can emanate from the insurance industry itself. This finding is underscored by recent court decisions as well as by New York State's recent prosecution of multiple insurers for fraud in connection with provider claims payments as part of their administration of private insurance products and employee health benefit plans.
“Health Care Fraud” is available online.
A separate brief, Health Insurance Fraud: An Overview, is also available online.
Contacts
Maria Ibañez, NASHP
202.507.7584
Anne Banner, GW
202.994.2261
About The George Washington University Medical Center
The George Washington University Medical Center is an internationally recognized interdisciplinary academic health center that has consistently provided high-quality medical care in the Washington, DC metropolitan area, since 1824. The Medical Center comprises the School of Medicine and Health Sciences, the 11th oldest medical school in the country; the School of Public Health and Health Services, the only such school in the nation’s capital; GW Hospital, jointly owned and operated by a partnership between The George Washington University and a subsidiary of Universal Health Services, Inc.; and the GW Medical Faculty Associates, an independent faculty practice plan. For more information on GWUMC, visit www.gwumc.edu.
About the National Academy for State Health Policy
The National Academy for State Health Policy (NASHP) is an independent academy of state health policy makers working together to identify emerging issues, develop policy solutions, and improve state health policy and practice. As a non-profit, non-partisan organization dedicated to helping states achieve excellence in health policy and practice, NASHP provides a forum on critical health issues across branches and agencies of state government. For more information about NASHP, please visit www.nashp.org.
New Analyses of Senate HELP and Finance Committee Health Reform Proposals Addresses Significant Legal Changes
WASHINGTON – New analyses of the Senate HELP and Finance Committees’ Health Reform proposals examine significant legal changes to the financing and delivery of health care included in these measures. The analyses are part of an ongoing project of The George Washington University Hirsh Health Law and Policy Program, within the School of Public Health and Health Services (SPHHS), to advance public understanding of the legal dimensions of national health reform.
Building on the comparative analyses of previous health reform proposals, the analysis of the Senate HELP Committee’s Affordable Health Choices Act (S. 1679) focuses on legal changes to the structure of the individual and group insurance markets and related coverage provisions. For the Chairman’s Mark of the America’s Healthy Future Act of 2009 (S. 1796), the analysis includes a comprehensive examination of the key legal changes that impact not only coverage, but the ways in which health care is organized and delivered.
“This analysis reflects the enormous progress toward health reform that has been made over the past weeks. With the merger of these two bills, the House and Senate are poised to launch a historic national policy debate,” said Sara Rosenbaum, Hirsh Professor of Health Law and Policy and Chair of the Department of Health Policy. Professor Jane Hyatt Thorpe, who directs the comparative analysis project for the Hirsh Program, added, “These analyses examine the critical legal issues that will largely define the debate, and are designed to help policy makers, health professionals, and consumers understand their scope and meaning.”
The comparative analyses use a special health reform legal taxonomy developed by GW Hirsh Program faculty and staff. The taxonomy is an analytic tool that provides a uniform and consistent mechanism for understanding in detail the key elements of health reform, including access, coverage, affordability, quality, health, financing, and the organization of health care markets, across the various proposals. The taxonomy is used to generate an analytic and comparative analysis of the various proposals that can be viewed independently or comparatively (side by side) in a user-friendly format to provide a consistent and comparative understanding of each legislative proposal.
In addition to the Senate HELP Committee’s Affordable Health Choices Act and the Senate Finance Chairman’s Mark of the America’s Healthy Future Act of 2009, the taxonomy has been used to analyze the House Tri-Committee Bill, The America’s Affordable Health Choices Act (H.R. 3200); the Healthy Americans Act (S. 391); the Patient’s Choice Act (S. 1099); and the American Health Security Act of 2009 (S. 703). Future additions will include legislative proposals as they emerge from the Senate and Congress. The comparative analysis and interactive tool is available on the Department of Health Policy’s Web site at www.gwumc.edu/sphhs/
About Hirsh Health Law and Policy Program
The Hirsh Health Law and Policy Program, one of the largest law and health policy educational endeavors in the nation, was established in 1997 and endowed by Dr. and Mrs. Harold and Jane Hirsh. Located in The George Washington University School of Public Health and Health Services Department of Health Policy, the program offers unique educational opportunities designed to provide a solid grounding in health law and policy to candidates for law degrees, practicing lawyers who seek to specialize in health law and policy, and health policy students. Through an interdisciplinary approach, the program advances understanding of how the law influences all phases of health care, health policy and public health, and how the changing health care system affects traditional areas of the law. The program also prepares participants for a broad range of health law-related careers.
For more information on the Hirsh Program, visit www.gwumc.edu/sphhs/
About The George Washington University Medical Center
The George Washington University Medical Center is an internationally recognized interdisciplinary academic health center that has consistently provided high-quality medical care in the Washington, D.C. metropolitan area since 1824. The Medical Center comprises the School of Medicine and Health Sciences, the 11th oldest medical school in the country; the School of Public Health and Health Services, the only such school in the nation’s capital; GW Hospital, jointly owned and operated by a partnership between The George Washington University and a subsidiary of Universal Health Services, Inc.; and the GW Medical Faculty Associates, an independent faculty practice plan. For more information on GWUMC, visit www.gwumc.edu
